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SURG 7500 > High Yield PPT: Emma Holliday Ramahi > Flashcards

High Yield PPT: Emma Holliday Ramahi Flashcards

1
Q

Absolute contraindication to surgery?

A

Diabetic Coma, DKA

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2
Q

What to do to try to maximize someones nutrition?

A

Enteral feedings

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3
Q

Other reasons surgeons will delay surgery?

A

Liver failure

Poor nutrition

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4
Q

When should a smoker stop smoking prior to surgery?

A

8 weeks!

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5
Q

Smoker patient: what to think of as coming out of anesthesia?

A

Don’t keep O2 sat at 100 % because likely chronic CO2 retainer. Hypoxia is their strongest drive for respiration.

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6
Q

What is Goldman’s Index?

A

Tells you who is at greatest risk for surgery

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7
Q

Most important factor in Goldman’s index (biggest predictor of peri-operative mortality)?

A

CHF

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8
Q

What should you check in patient with CHF?

A

Ejection fraction

(if less than 35 %, no surgery).

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9
Q

2nd most important indicator when predicting mortality from surgery?

A

MI within 6 months

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10
Q

Patient who comes in for pre-op evaluation and has a late systolic ejection murmur, crescendo-decrescendo?

A

Aortic stenosis

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11
Q

Meds to stop before surgery?

A 
Aspirin
NSAIDs
Metformin
Vit. E
Warfarin
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12
Q

Why stop metformin?

A

Risk of lactic acidosis

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13
Q

Want INR less than?

A

1.5

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14
Q

Take what dose of insulin?

A

1/2 morning dose

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15
Q

When do you dialyze before surgery?

A

24 hours pre-op

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16
Q

Why worry if BUN > 100?

A

Increased risk of post-op bleeding. Uremia –> uremic toxins interact with platelets!!

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17
Q

Coag pannel of patient with uremic platelet dysfunction?

A

normal platelet count

Increased bleeding time

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18
Q

Good for weaning patient off of ventilator?

A

Pressure support

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19
Q

Assist-control vent setting

A

Set Tidal Volume and Rate…if patient takes a breath, predetermined volume still delivered

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20
Q

Pressure suppor vent

A

Patient rules rate! Boost of pressure is given if they are not able to take in entire TV on their own!

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21
Q

CPAP

A

Patient breathes on own! But + pressure given all the time in order to make sure alveoli stay open

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22
Q

PEEP

A

Keeps alveoli open in patients with ARDS or CHF…alveoli are collapsing and that’s what is causing the difficulty in facilitating gas exchange. Positive pressure only given at the END of cycle

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23
Q

Patient on vent…how do we want to evaluate management?

A

ABG

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24
Q

low pO2 in patient on vent

A

not getting enough oxygen…increase FiO2!

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25
Q

What does too much oxygen do?

A

Free radical damage…too high concentrations can worsen ARDS etc.

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26
Q

Patient has low PaCO2 and high pH…how can you fix it?

A

Decrease TV (better option because decreasing more of the air in the functional space)

or decrease rate–blow out less CO2

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27
Q

Anion gap equation

A

Na+ - (Cl- + HCO3-)

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28
Q

Normal anion gap

A

8-12

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29
Q

Causes of non-gap acidosis

A

Diarrhea**main one
Diuretic
RTAs

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30
Q

Why is diarrhea most common cause of non-gap acidosis?

A

GI tract has a lot of bicarb…if pooping a lot…getting rid of a lot of bicarb–metabolic acidosis

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31
Q

How to differentiate cause of metabolic alkalosis?

A

Check Urine Chloride

Vomiting–urine chloride will be low

High–could be genetic problem

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32
Q

Causes of hypervolemic hypernatremia?

A

CHF
Nephrotic
Cirrhotic

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33
Q

Next test after finding a patient with Normal volume but decreased sodium…SIADH

A

CXR. Paraneoplastic syndrome associated with lung cancer

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34
Q

Treatment of hyponatremia if patient is hypovolemic?

A

Normal saline

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35
Q

When do we use hypertonic 3 % saline?

A

Severly symptomatic hyponatremia (seizures, Altered mental status, or if sodium is super lowwww like less than 110)

Why don’t we use this hypertonic saline more often?
Central pontine myelinolysis

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36
Q

Appropriate rate of sodium correction

A

Between 12-24 meq/day

or 0.5-1 mEq/hour

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37
Q

Treatment of Hypernatremia

A

Replace with D5W or hypotonic fluid

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38
Q

Low calcium can do what to EKG

A

Prolonged QT interval

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39
Q

Symptoms of Hypokalemia

A

Paralysis
Ileus
ST depression
U waves

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40
Q

Tx of hypokalemia

A

Give potassium! Monitor renal function.

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41
Q

EKG changes of hyperkalemia?

A

Peaked T waves
Prolonged PR and QRS
Sine waves

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42
Q

Treatment of hyperkalemia

*IMPORTANT

A

Give:

  1. Calcium-gluconate-stabilize cardiac membranes
  2. Insulin + glucose–shift K+ into cells
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43
Q

What can be used besides Insulin to get K+ into cells?

A

B-agonist like Albuterol

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44
Q

Makes you poop out potassium

A

kayexalate

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45
Q

maintenance iVF of choice

A

D51/2NS

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46
Q

erythematous, not peeling

A

1st deg. burn

epidermis

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47
Q

super painful, loss of integrity of epidermis

A

2nd degree burn

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48
Q

Dark or pale, no sensation because damage goes all the way through dermis and starts to affect nerves

A

3rd degree burn

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49
Q

Patient comes in confused, headache, cherry red skin

A

carbon monoxide poisoning

Check carboxyhemoglobin!

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50
Q

Cause of clotting in old people

A

Cancer

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51
Q

New clots, edematous, high BP, foamy pee

A

Nephrotic syndrome

(because losing protein in urine…some of first to go-antithrombin III)–hypercoaguabule state!

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52
Q

Most common inherited hypercoaguablitity?

A

Factor V leiden

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53
Q

What can’t you give someone with ATIII def?

A

Heparin

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54
Q

Young woman with multiple Spontaneous abortions?

A

lupus anticoagulant

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55
Q

Post op patient with thrombocytopenia but increased clotting?

A

Maybe they received heparain! HIT

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56
Q

Treat HIT with?

A

Leparudin or Agatroban

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57
Q

isolated decrease in platelets?

A

ITP

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58
Q

Normal platelets, increased bleeding time and PTT?

A

vWF disease

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59
Q

Low platelets
coags high
schistocytes
etc…

A

DIC

due to gram-sepsis (LPS), carcinomatosis, OB stuff

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60
Q

Parkland formula

A

for burn patient fluid resuscitation

Adults:
Kg x %BSA x 3-4

Kids:
Kg x %BSA x 2-4

Give half in first 8 hours, the rest over the next 16 hours

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61
Q

Route of giving antibiotics to burn patients

A

TOPICAL

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62
Q

Can cause leukopenia

Does not penetrate eschar

A

Silver sulfadiazene

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63
Q

Penetrates eschar

hurts like hell

A

Mafenide

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64
Q

Can cause hypokalemia and hyponatremia

doesn’t penetrate eschar

A

Silver nitrate

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65
Q

Electrical burn…get what test?

A

EKG

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66
Q

Pee red but no RBC in it…

A

Rhabdomyolysis causing myoglobinuria

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67
Q

Find myoglobinuria, check?

A

K+ level! Can cause fatal arrhythmias

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68
Q

Airway if patient is unconscious?

A

INTUBATE

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69
Q

Feel subcutaneous emphysema in neck after patient stabbed

A

Fiberoptic bronchoscope

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70
Q

What do you do after you intubate patient?

A

listen for breath sounds

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71
Q

indications to take someone with hemothorax to OR

A

High output greater than 1.5 L during initial chest tube insertion or greater than 200 cc/hour for first 4 hours

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72
Q

“White out lung”

A

Pulmonary contusion

Tx. Control pain, wait

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73
Q

Flail chest

A

> 3 consecutive rib fractures

Moves in upon inspiration

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74
Q

Tx for flail chest

A

Nerve block (for pain control)

*Don’t give opiates–decrease resp. drive

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75
Q

Petechial rash in chest

A

Fat embolism

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76
Q

hypotensive, tachycardic

77
Q

Pulsus parodoxus

Electrical alternans

A

Pericardial tamponade

78
Q

Confirmatory test for pericardial tamponade

A

FAST exam

*Then do the needle decompression

79
Q

GCS subcategory breakdown of maximum points

A

Eyes 4
Verbal 5
Motor 6

80
Q

Surgical intervention for increased ICP

A

ventriculostomy

81
Q

Zone 3 of neck

A

above angle of mandible

82
Q

Zone 2 of neck

A

angle of mandible to cricoid

83
Q

Zone 1

A

below cricoid

84
Q

W/u for zone 1

A

aortography and triple endoscopy

85
Q

w/u zone 2

A

2D doppler

+/- exploratory surgery

86
Q

Zone 1 w/u

A

Aortography

87
Q

Free air under diaphragm

88
Q

Stable patient with blunt abdominal trauma

89
Q

Lower rib fracture + bleeding into abdomen

A

Spleen or liver lac

90
Q

Positive Kehr sign + viscera in thorax

A

diaphram rupture

(pain in left shoulder, referred pain due to phrenic nerve)–Kehr sign

91
Q

Handlebar sign

A

Pain and bruising over pancreas

92
Q

blood at urethra, high riding prostate

A

pelvic fracture with urethral or bladder injury

93
Q

test for urethral injury

A

Retrograde urethrogram

94
Q

Head fracture that goes to OR

A

Depressed skull fracture

95
Q

Shoulder pain after seizure

A

posterior shoulder dislocation

96
Q

Arm outwardly rotated, numb over deltoid (axillary nerve injury)

A

Ant. dislocation

97
Q

Old lady FOOSH, distal radius displaced

A

Colle’s fracture

98
Q

Hand hurts after punching wall

A

metacarpal neck fracture

99
Q

clavicle break location

A

between middle and distal thirds

100
Q

Fever POD1

A

Atelactasis

101
Q

Dx of atelectasis?

A

Listen
CXR
Bilateral fluff in lower lobes

102
Q

POD1 super high fever to 104

A

Nec fasc

*spread along scarpas fascia…usually due to strep and clostridium

103
Q

Tx of nec fasc

A

OR..debridement!

With IV penicillin!!

104
Q

Cause of malignant hyperthermia

A

Succ or halothane

Prob with ryanodine receptor gene defect

105
Q

Fever POD3-5

106
Q

Tx of pneumonia

A

cover with fluoroquinolone Like Mocifloxacin in mean time in case it is strep pneumo…await culture

107
Q

POD7, edema at incision site, induration, No drainage

A

Cellulitis

Tx. antibiotics

108
Q

POD7, edema, induration, plus drainage

A

open wound
Re-pack it
No abx necessary

109
Q

Salmon colored fluid from incision

A

dehiscence

110
Q

treatment of dehiscence

A

go bak to OR
Problem is violation of the fascia.
Primary closure of fascia
IV abx

111
Q

Post c-section or hysterectomy unexplained fever

A

Pelvic thrombophlebitis

Tx. Antibiotics, heparin

112
Q

Cause of pressure ulcer

113
Q

Marjolin’s ulcer

A

squamous cell carcinoma in chronic ulcer

114
Q

Transudative pleural effision

Low pleural glucose

A

Rheumatoid arthritis

115
Q

Transudative effusion

High lymphoytes

A

tuberculosis

116
Q

Bloody transudative pleural effusion

A

malignant or pulmonary embolus

117
Q

Lights criteria

A

Transudative pleural effusion if
LDH < 200
LDH effusion compared to serum <0.6
Protein eff/serum <0.5

118
Q

VATS

A

video assisted thoracic surgery

119
Q

Type of abscess you don’t want to drain

A

Lung abscess

Tx*Antibiotics
Penicillin or Clindamycin

120
Q

Lung shows a spot with air/fluid level

121
Q

most common benign lung nodule…popcorn calcification

122
Q

concentric calcifications on x-ray

A

old granuloma

123
Q

most common type of lung cancer in non-smokers

A

adenocarcinoma

124
Q

weird spot that adenocarcinomas like to go

A

Adrenal glands

125
Q

Patient with kidney stones, constipation, malaise, low PTH, + central lung mass

A

Squamous cell carcinoma

126
Q

Why low PTH in squamous cell carcinoma

A

Paraneoplastic syndrome

Secretion of PTH-rP

127
Q

Paraneoplastic syndromes associated with small cell carcinoma

A

Pancoast tumor
Lambert eaton syndrome
SIADH

128
Q

Peripheral lung mass, cavitating, distant mets

A

Large Cell carcinoma

129
Q

Which lung cancers get surgery?

A

Non-small cell!!

Small cell is very chemo, radio sensitive.

130
Q

ARDS causes

A

Gram - sepsis
Pancreatitis
Gastric aspiration

131
Q

Criteria for ARDS criteria

A

Bilateral fluffy infiltrates

PaO2/FiO2 ratio <200

PCWP is < 18 (means not cardiac)

132
Q

Treatment of ARDS

A

Vent setting on PEEP

133
Q

diastolic murmur

widened pulse pressure

A

aortic regurgitation

134
Q

Late systolic murmur with click

A

mitral valve prolapse

135
Q

holosystolic murmur with late diastolic rumble

136
Q

Tx of Zenker’s

137
Q

Bird beak on barium swallow

138
Q

Surgery done on achalasia if medical management fails

A

Heller myotomy

139
Q

Dysphagia worse with hot/cold liquids

A

Diffuse esophogeal spasm

140
Q

Medical treatment of esophageal spasm and achalasia

A

Calcium channel blocker

Nitrates

141
Q

Gastric lymphoma associated with what disease

142
Q

MALT lymphoma tx

A

Eradicate H. Pylori

143
Q

Mentriers disease

A

protein losing enteropathy

enlarged rugae

144
Q

Mid epigastric pain better with eating

A

Duodenal ulcer

145
Q

Triple therapy

A

PPI
Clarithromycin
Amoxicillin

146
Q

Refractory ulcers after Triple therapy?

A

ZE syndrome

147
Q

SMA syndrome

A

Happens after rapid weight loss…duodenal compressed between abdominal aorta and SMA

148
Q

How does one get gastric varices from pancreatitis?

A

Pancreatitis can cause splenic vein thrombosis…which leads to gastric varices.

149
Q

Courvoisier’s sign

A

large nontender GB
Itching and jaundice
*Adenocarcinoma of pancreas

150
Q

Trousseau’s sign

A

Migratory thrombophlebitis

151
Q

Pancreatic cancer dx

A

Endoscopic US and FNA biopsy

152
Q

When is pancreatic tumor deemed resectable

A

No mets outside abdomen

no extension into SMA, portal vein, liver, etc.

153
Q

Whipple’s triad (insulinoma)

A

Sxs (sweat, tremors, hunger, seizures)
Blood glucose <45
Sx resolve when glucose administered

154
Q

Glucagonoma sx

A

hyperglycemia
diarrhea
weight loss

155
Q

characteristic rash of glucagonoma

A

necrolytic migratory erythema

156
Q

VIPoma sx

A 
watery diarrhea
flushing
hypokalemia
dehydration
flushing
157
Q 
Pentad: RUQ pain
Fever
Jaundice
Decrease BP
Altered mental status
A

Ascending cholangitis

158
Q

liver bacterial abscess bugs

A

E. Coli
Bacteroides
Enterococcus

159
Q

Treatment for entamoeba histolytica

A

Metronidazole

160
Q

RUQ pain with large liver cysts

A

enchinococcus (from dog feces)

161
Q

Skin test for enchinococcus

A

+Casoni test

162
Q

Tx for echinococcus

A

SURGERY + Albendazole

Remove entire cyst, rupture = anaphylaxis

163
Q

what happens to carcinoid tumor to get syndrome?

A

Mets!

If was just in GI tract, serotonin would be denatured before it got out

164
Q

1 spot for carcinoid tumor

165
Q

vitamin ppl with carcinoid syndrome def. in?

A

Niacin!

Serotonin and niacin both made from tryptophan! All is being used to make serotonin
diarrhea, dementia, dermatitis

166
Q

Transmural inflammation

167
Q

Granulomas

168
Q

Smokers have low risk

169
Q

Smokers have high risk

170
Q

Higher risk for colon cancer: Crohns or UC?

171
Q

Associated with p-ANCA

A

UC! and PSC!

172
Q

1 cause of death post AAA repair

173
Q

Post AAA repair 1-2 years later have GI bleeding

A

Aortoenteric fistula

174
Q

W/u for mesenteric ischemia

A

angiography

175
Q

Best test for PAD

176
Q

Blood thinner regimen for DVT

A

Treat with heparin
Overlap heparin for 5 days with Warfarin
Continue warfarin 3-6 months

177
Q

Hashimoto’s predisposes to….

A

Thyroid lymphoma

178
Q

Breast cancer that is more often bilateral

179
Q

Orange peel skin on breast

A

Inflammatory BC

180
Q

Eczema of nipple

A

Paget’s Disease of breast

181
Q

Precursor to squamous cell carcinoma of skin

A

actinic keratosis

182
Q

number one prognostic indicator of melanoma

183
Q

Dx of sarcoma

A

BIOPSY

not FNA

184
Q

Where does sarcoma like to spread to first? How?

A

LUNGS

Hematogenously

185
Q

Osteosarcoma

A

Proximal femur, distal tibia

Codman’s triangle and sunray appearance on x-ray

186
Q

Cause of hyperacute rejection

A

preformed antibodies

187
Q

cause of acute rejection

A

T cell reaction

188
Q

Treatment of acute rejection

A

Steroid bolus

+ Antilymphocyte agent (OKT3)

189
Q

What do you do for chronic rejection

A

re-transplantation

SURG 7500 (8 decks)

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