Arterial Exam Interpretation Quiz
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Questions and Answers

What does a drop in ankle pressure greater than 50% during an arterial exam indicate?

  • Multiple level disease (correct)
  • Single level disease
  • Aortic disease
  • Normal arterial function

    • Which pressure change indicates significant disease between two adjacent segments?

  • A drop of 15 mmHg
  • A drop of 50 mmHg
  • A drop of 20 mmHg
  • A drop of 30 mmHg (correct)

    • If a patient shows a triphasic waveform in the proximal femoral artery but a monophasic waveform in the mid-segment of the femoral artery, what is suspected?

  • Normal arterial flow
  • Aneurysm in the femoral artery
  • Mid Superficial Femoral Artery stenosis or occlusion (correct)
  • Peripheral artery disease in the lower leg

    • What is indicated by an ankle pressure drop of less than 35% that returns to baseline within one minute?

    <p>Normal arterial function</p> Signup and view all the answers

    Considering the pressure readings of upper thigh 175 mmHg and distal thigh 120 mmHg, what can be inferred if there is a significant drop in pressures?

    <p>Possible occlusion in the distal vessel</p> Signup and view all the answers

    What is the ABI value for the right leg?

    <p>0.98</p> Signup and view all the answers

    Why is it essential to calculate ABI values?

    <p>To assess the severity of peripheral artery disease.</p> Signup and view all the answers

    What is the left leg's ankle pressure measured by DPA?

    <p>122 mmHg</p> Signup and view all the answers

    Based on the provided pressures, what could be a consequence of an improperly conducted resting arterial exam?

    <p>Underestimation of disease severity.</p> Signup and view all the answers

    Which formula is used to calculate ABI?

    <p>Ankle Pressure/Brachial Pressure</p> Signup and view all the answers

    What could cause the overestimation of disease severity identified in the resting exam?

    <p>Incorrect measurement of blood flow.</p> Signup and view all the answers

    What does a lower ABI value indicate regarding peripheral artery disease?

    <p>Worsened blood flow.</p> Signup and view all the answers

    What is a characteristic finding of coarctation of the aorta?

    <p>Weak or absent femoral pulses</p> Signup and view all the answers

    In a patient with coarctation of the aorta, which of the following is likely to be observed?

    <p>Pressure gradient between arms and legs</p> Signup and view all the answers

    Why is atherosclerotic vascular disease unlikely in a 9-year-old?

    <p>Atherosclerosis typically affects older adults</p> Signup and view all the answers

    What would indicate severe arterial insufficiency in the case presented?

    <p>Both ABIs well below the normal range</p> Signup and view all the answers

    What should be the initial step for an exam if a patient appears slightly short of breath?

    <p>Have him rest for 20-30 minutes</p> Signup and view all the answers

    Which condition involves blood flow reversal in the vertebral artery?

    <p>Subclavian steal syndrome</p> Signup and view all the answers

    Which clinical clue is essential when diagnosing coarctation of the aorta in a child?

    <p>Chronic fatigue</p> Signup and view all the answers

    What happens to blood pressure in the arms and legs in coarctation of the aorta?

    <p>Blood pressure is high in arms and low in legs</p> Signup and view all the answers

    What is indicated by a pressure drop of more than 30 mmHg between the low thigh and calf with an absent dicrotic notch on the PVR waveform?

    <p>Mild femoral popliteal disease</p> Signup and view all the answers

    Which of the following options is consistent with right mild femoral popliteal and mild tibial artery occlusive disease?

    <p>Left moderate iliac occlusive disease</p> Signup and view all the answers

    Why is option A (Aorta and bilateral severe iliac occlusive disease) deemed not consistent with the provided data?

    <p>No evidence of severe iliac disease is noted</p> Signup and view all the answers

    What does a pressure drop and absent dicrotic notch suggest regarding vascular health?

    <p>Mild arterial disease</p> Signup and view all the answers

    Which condition is not implied by a pressure drop of more than 30 mmHg between the low thigh and calf?

    <p>Moderate femoral occlusive disease</p> Signup and view all the answers

    Which vascular condition accounts for a severe pressure drop consistent with the given statement?

    <p>Bilateral severe iliac occlusive disease</p> Signup and view all the answers

    What is likely if a patient shows no evidence of severe iliac disease based on a pressure waveform analysis?

    <p>Mild femoral disease is present</p> Signup and view all the answers

    What characterization does NOT match the pressure drop over 30 mmHg between the low thigh and calf?

    <p>Presence of mild iliac disease</p> Signup and view all the answers

    What principle does photoplethysmography utilize to detect changes in venous volume in the leg?

    <p>Infrared light released into tissues</p> Signup and view all the answers

    How does hemoglobin affect the measurement in photoplethysmography?

    <p>It absorbs light, correlating with blood volume changes.</p> Signup and view all the answers

    What indicates severe disease in the waveform of photoplethysmography?

    <p>Damped wave with low amplitude and minimal difference between systolic and diastolic volumes</p> Signup and view all the answers

    Why can photoplethysmography safely be used on diabetic patients?

    <p>It is not affected by calcified blood vessels.</p> Signup and view all the answers

    What should be ensured when preparing to perform a photoplethysmography exam?

    <p>A towel can be used to reduce surrounding light effects.</p> Signup and view all the answers

    Which of the following conditions may limit the accuracy of PPG measurements?

    <p>Tight strap around the digit</p> Signup and view all the answers

    What change in blood flow would you expect in a patient with mild arterial disease during a PPG examination?

    <p>Sharp peak is preserved but reflection is reduced</p> Signup and view all the answers

    When is it advised to obtain digital PPG tracings if the ABI findings do not correspond?

    <p>When the ABI is normal and Doppler evaluation is inconclusive</p> Signup and view all the answers

    Which statement about the waveforms resulting from photoplethysmography is true?

    <p>They reflect changes in blood volume through light assessments.</p> Signup and view all the answers

    What is a notable effect of medial calcification on the ABI reading?

    <p>It can lead to a normal or elevated ABI despite underlying issues.</p> Signup and view all the answers

    What condition is indicated by a slight decrease in high thigh pressure on the right side?

    <p>Mild iliac disease</p> Signup and view all the answers

    Which description fits the right moderate disease identified in the analysis?

    <p>Pressure drop between low thigh and calf</p> Signup and view all the answers

    What symptom is associated with the left mild disease according to the data?

    <p>Absent dicrotic notch on PVR waveform</p> Signup and view all the answers

    What is the overall finding regarding the segmental pressures and pulse volume recordings?

    <p>They are consistent with various degrees of occlusive disease.</p> Signup and view all the answers

    What dysfunction is suggested by the absence of the dicrotic notch?

    <p>Mild occlusive disease</p> Signup and view all the answers

    How do the findings on the right side compare to the left mild disease?

    <p>They indicate more severe disease.</p> Signup and view all the answers

    Which of the following conditions has a specific drop in pressure between low thigh and calf?

    <p>Right moderate femoral popliteal disease</p> Signup and view all the answers

    What does a reduction in pulse volume recordings suggest regarding vascular health?

    <p>Possible significant occlusion</p> Signup and view all the answers

    What condition is indicated by a normal ABI calculation despite the presence of monophasic flow in the popliteal and calf arteries?

    <p>Medial calcification</p> Signup and view all the answers

    What does a decrease in ABI during exercise testing typically indicate?

    <p>Peripheral artery disease is likely present</p> Signup and view all the answers

    Which testing method can provide better evaluation of lower extremity pressures in cases of suspected arterial disease, especially when ABI values are over 1.0?

    <p>Digit plethysmography</p> Signup and view all the answers

    What does a consistently high ABI value above 1.0 suggest about the vascular condition of a patient with diabetes?

    <p>Possible medial calcification affecting readings</p> Signup and view all the answers

    In the context of ABI tests, what finding would most likely lead to an erroneous classification of a patient's vascular health?

    <p>Monophasic flow coupled with medial calcification</p> Signup and view all the answers

    What condition is the most common cause of pseudoclaudication?

    <p>Lumbar spinal stenosis</p> Signup and view all the answers

    How should arterial pressures in the toes be evaluated to eliminate the effects of hydrostatic pressure?

    <p>With the patient supine</p> Signup and view all the answers

    What should be done before repeating a blood pressure measurement?

    <p>Wait at least 1 minute</p> Signup and view all the answers

    Which of the following symptoms is NOT typically caused by neurogenic thoracic outlet syndrome?

    <p>Claudication</p> Signup and view all the answers

    What should be the position of the patient when conducting arterial pressure assessments?

    <p>Supine</p> Signup and view all the answers

    Which anatomical structure is commonly compressed in neurogenic thoracic outlet syndrome?

    <p>Brachial plexus</p> Signup and view all the answers

    What occurs when the spaces between the vertebrae in the lower back narrow?

    <p>Lumbar spinal stenosis</p> Signup and view all the answers

    What type of pressure reading may be inaccurate if the system is not allowed to normalize after the first measurement?

    <p>Arterial pressure</p> Signup and view all the answers

    What should be done if a normal ABI does not correlate with the Doppler evaluation results?

    <p>Perform digital tracings and obtain pressures</p> Signup and view all the answers

    What result can medial calcification lead to regarding ABI readings?

    <p>Produces a falsely normal ABI with monophasic flow</p> Signup and view all the answers

    What is the primary purpose of digital plethysmography?

    <p>To evaluate flow and pressure measurements in the toes</p> Signup and view all the answers

    Which statement is true about the impact of medial calcification on digital arteries?

    <p>Digital arteries are typically unaffected by medial calcification</p> Signup and view all the answers

    Under which circumstance is it advisable to use digital plethysmography?

    <p>If ABI is normal but Doppler evaluation does not correspond</p> Signup and view all the answers

    What could be a reason for a diabetic patient to undergo digital pressures and PPG evaluation?

    <p>To evaluate healing in a non-healing toe injury</p> Signup and view all the answers

    What can the presence of monophasic flow in calf arteries indicate despite a normal ABI?

    <p>Severe arterial obstruction in lower leg arteries</p> Signup and view all the answers

    What does it indicate if a patient presents with a normal ABI but has a discrepancy in Doppler evaluation?

    <p>There might be underlying vascular issues requiring clarification</p> Signup and view all the answers

    What level of disease is identified on the patient's right side?

    <p>Moderate femoral popliteal occlusive disease</p> Signup and view all the answers

    Which indicator aligns with the presence of right mild iliac disease?

    <p>Slight decrease in high thigh pressure</p> Signup and view all the answers

    What does the presence of an absent dicrotic notch suggest?

    <p>Severe arterial insufficiency</p> Signup and view all the answers

    How does the pressure behave between low thigh and calf in cases of right moderate femoral popliteal occlusive disease?

    <p>Significant drop in pressure</p> Signup and view all the answers

    What other condition may be inferred if dicrotic notch is absent on the PVR waveform?

    <p>Severe iliac occlusive disease</p> Signup and view all the answers

    In the context of the findings, which statement about right side conditions is accurate?

    <p>Right side displays moderate occlusive disease</p> Signup and view all the answers

    What does a slight pressure drop in high thigh pressure on the right side imply?

    <p>Mild vascular issues</p> Signup and view all the answers

    Which aspect is NOT consistent with the findings of mild femoral popliteal occlusive disease?

    <p>Presence of dicrotic notch</p> Signup and view all the answers

    What does the reduced pressure in the left 3rd digit compared to the right 3rd digit indicate?

    <p>Localized disease in the left hand</p> Signup and view all the answers

    Why are the brachial, radial, and ulnar pressures considered normal bilaterally?

    <p>They do not show localized disease</p> Signup and view all the answers

    What should be the next step in evaluation after finding an abnormal pressure in the left 3rd digit?

    <p>Evaluate additional digits on the left hand</p> Signup and view all the answers

    What might the abnormal pressure in the left 3rd digit indicate?

    <p>Localized disease in the palmar arch or digital artery</p> Signup and view all the answers

    What waveform finding is expected in the proximal femoral artery for normal flow?

    <p>Triphasic</p> Signup and view all the answers

    How does the normal bilateral measurements of brachial, radial, and ulnar pressures affect the interpretation of localized disease?

    <p>Supports that the issue is localized rather than systemic</p> Signup and view all the answers

    What does a drop in pressure greater than 30 mmHg between two adjacent segments of the artery indicate?

    <p>Significant disease in the artery</p> Signup and view all the answers

    What is the significance of the pressure measurement of 110 mmHg in the left 3rd digit?

    <p>It indicates abnormal perfusion</p> Signup and view all the answers

    If a patient presents with leg pain and the segmental pressures are significantly lower at the upper thigh compared to the distal thigh, what condition may be suspected?

    <p>Mid superficial femoral artery stenosis</p> Signup and view all the answers

    Which of the following best describes the intended follow-up after discovering the reduced pressure in the left 3rd digit?

    <p>Comprehensive assessment of all left hand digits</p> Signup and view all the answers

    Calculate the ABI for the right leg using the provided arm and ankle pressures. What is the correct ABI value?

    <p>0.84</p> Signup and view all the answers

    Based on the observed left 3rd digit pressure, what implication does it have regarding disease distribution?

    <p>Potential for more widespread disease in the left palmar arch</p> Signup and view all the answers

    What condition can explain a duplex examination showing medium velocity triphasic flow with minimal atherosclerosis in the bilateral arteries?

    <p>Mild arterial disease</p> Signup and view all the answers

    Which segmental exam pressure is most consistent with a significant drop that indicates a possible mid-SFA stenosis?

    <p>Upper Thigh 175 mmHg</p> Signup and view all the answers

    In a segmental pressure exam, what does the presence of a monophasic waveform in the mid-segment of the femoral artery indicate?

    <p>Possible arterial obstruction</p> Signup and view all the answers

    What is the significance of measuring pressures at different levels during a four-cuff segmental exam?

    <p>To identify specific areas of arterial disease</p> Signup and view all the answers

    What does a pressure gradient greater than 30 mmHg between the thigh and calf suggest?

    <p>Presence of femoral popliteal disease</p> Signup and view all the answers

    What is the first component lost in a PVR waveform when arterial disease is present?

    <p>Dicrotic limb</p> Signup and view all the answers

    What is likely indicated by a pressure reading of 155 mmHg in the thigh compared to 90 mmHg in the calf?

    <p>Significant pressure drop</p> Signup and view all the answers

    What is a potential consequence of significant pressure gradients observed in patients with intermittent claudication?

    <p>Worsening ischemic conditions</p> Signup and view all the answers

    What does the absence of a dicrotic notch in a PVR waveform typically indicate?

    <p>Severe arterial insufficiency</p> Signup and view all the answers

    In the context of the examination data provided, what does bilateral intermittent claudication suggest?

    <p>Common iliac occlusive disease</p> Signup and view all the answers

    Which statement accurately describes one possible implication of a significant drop in pressures between the low thigh and calf?

    <p>Potential femoral popliteal occlusive disease</p> Signup and view all the answers

    What can be inferred if a patient exhibits a drop in calf pressure during a physical examination?

    <p>Potential arterial occlusion</p> Signup and view all the answers

    What condition is suggested by a significant pressure drop from the thigh to the calf on the right side?

    <p>Right femoral popliteal disease</p> Signup and view all the answers

    What does the pressure reading of 95 mmHg at the thigh level on the left side indicate?

    <p>Obstruction in the iliac artery</p> Signup and view all the answers

    In photoplethysmography, what is the primary function of the infrared light?

    <p>It reflects off blood cells to create waveforms.</p> Signup and view all the answers

    Which of the following pressure readings indicates a likely vascular obstruction on the left side?

    <p>Thigh pressure of 95 mmHg</p> Signup and view all the answers

    How is the pressure index assessed between the thigh and the calf on the right side?

    <p>A low index implies arterial obstruction.</p> Signup and view all the answers

    Which of the following statements corresponds to the interpretation of the right side's biopsy findings?

    <p>There is significant femoral artery disease.</p> Signup and view all the answers

    If there is a significant drop in systolic pressure from the thigh to calf on the right side, what is the differential diagnosis most likely?

    <p>Right femoral popliteal disease</p> Signup and view all the answers

    What does an index of 0.80 at the ankle (DPA) indicate in terms of vascular health?

    <p>Severity of arterial disease</p> Signup and view all the answers

    What does the segmental pressure reading of 210 mmHg on the left side represent?

    <p>Low Thigh Pressure</p> Signup and view all the answers

    Which finding suggests mild iliac disease on the right side?

    <p>166 mmHg High Thigh Pressure</p> Signup and view all the answers

    What does an ankle pressure reading of 85 mmHg indicate?

    <p>Mild dysfunction</p> Signup and view all the answers

    What does a segmental/brachial index value of 1.79 on the left side imply?

    <p>Mild obstruction</p> Signup and view all the answers

    What condition is indicated by a pressure drop greater than 30 mmHg between the low thigh and calf?

    <p>Moderate femoral disease</p> Signup and view all the answers

    What does the notation of 'slight rounding and decrease in amplitude' in pulse volume recordings suggest?

    <p>Mild arterial disease</p> Signup and view all the answers

    Which finding supports the conclusion of left mild femoral popliteal occlusive disease?

    <p>210 mmHg Low Thigh Pressure</p> Signup and view all the answers

    What does an absent dicrotic notch on the PVR waveform indicate?

    <p>Significant arterial stenosis</p> Signup and view all the answers

    What does the right side show in terms of occlusive disease?

    <p>Mild iliac and moderate femoral popliteal occlusive disease</p> Signup and view all the answers

    Which option describes a consistent characterization of left mild femoral popliteal occlusive disease?

    <p>Mild occlusive disease present</p> Signup and view all the answers

    Which of the following is NOT a finding associated with the analysis of mild iliac disease?

    <p>Severe iliac artery stenosis</p> Signup and view all the answers

    How would one best characterize right mild iliac and moderate femoral disease?

    <p>Stable and manageable with conservative treatment</p> Signup and view all the answers

    What could be a potential misinterpretation regarding the findings of femoral popliteal occlusive disease?

    <p>Assuming all occlusive disease is severe</p> Signup and view all the answers

    What is suggested by the presence of mild disease on the right side compared to the left?

    <p>The left side has higher occlusion levels</p> Signup and view all the answers

    Which of the following findings would likely indicate the need for further examination?

    <p>Notable variations in segmental pressures</p> Signup and view all the answers

    Which characterization is least likely to match the analysis of right mild femoral popliteal disease?

    <p>Severe unilateral occlusion</p> Signup and view all the answers

    Which condition is likely if mild iliac disease is present on the right side?

    <p>Stable condition warranting regular monitoring</p> Signup and view all the answers

    What does a relatively close pressure reading between the upper forearm and brachial pressure suggest?

    <p>Obstruction in the distal brachial artery</p> Signup and view all the answers

    What do abnormal digit tracings alongside normal ankle-brachial indices indicate?

    <p>Discrepancy in blood flow between smaller and larger arteries</p> Signup and view all the answers

    What is the recommended sample size for PW Doppler evaluation of an artery?

    <p>1.0-1.5 mm</p> Signup and view all the answers

    What does significant drop in pressure between the upper forearm and wrist-radial measurements suggest?

    <p>Obstruction of the brachial artery</p> Signup and view all the answers

    Why might the pressure measurements at the upper forearm and wrist be significant in diagnosis?

    <p>They suggest localized vascular issues.</p> Signup and view all the answers

    What could be the interpretation of close pressure readings at the upper forearm and brachial pressure?

    <p>Indication of significant brachial obstruction</p> Signup and view all the answers

    In the evaluation of peripheral arterial disease, what does a discrepancy between digit and ankle-brachial indices imply?

    <p>Potential ischemia in distal structures</p> Signup and view all the answers

    What does it indicate if the pressure at the upper forearm is similar to the brachial pressure?

    <p>Potential distal brachial artery obstruction</p> Signup and view all the answers

    What does the pressure drop between the upper forearm and wrist-radial measurement indicate?

    <p>Compromised blood flow through the radial artery.</p> Signup and view all the answers

    Why could a pressure drop at the radial measurement site imply an obstruction?

    <p>The brachial artery branches into the radial artery.</p> Signup and view all the answers

    Which factor suggests a localized issue affecting blood flow through the radial artery?

    <p>A drop in pressure specifically at the radial measurement site.</p> Signup and view all the answers

    What anatomical consideration supports the interpretation of a pressure drop at the radial site?

    <p>The radial artery originates from the brachial artery.</p> Signup and view all the answers

    What implication does a pressure drop of 10 mmHg from the upper forearm to the wrist-radial reading suggest?

    <p>Possible arterial obstruction.</p> Signup and view all the answers

    How could the observed pressures help inform clinical decisions?

    <p>They help identify potential arterial obstructions.</p> Signup and view all the answers

    What might a 5 mmHg pressure drop specifically at the radial artery suggest about blood supply?

    <p>There is an obstruction in the radial artery itself.</p> Signup and view all the answers

    What is the potential interpretation of the pressure gradient observed between different limbs during measurements?

    <p>Indications of possible vascular disease.</p> Signup and view all the answers

    Study Notes

    Thoracic Outlet Syndrome (TOS)

    • TOS is a condition where a muscular band, cervical rib, or fibrous band compresses the brachial plexus.
    • Many patients are asymptomatic.
    • Symptoms include dull aching pain, radiating from the compression point, numbness (paresthesia), pain, and increased symptoms with arm/neck movements or exercise. Swelling can also occur with venous TOS.
    • The location of compression can vary.

    Examination Techniques for TOS

    • PPG exam can be performed with the sensor placed on the 2nd digit of the radial artery.
    • Doppler exam can be performed with the transducer placed on the radial artery.

    Types of TOS

    • Neurogenic TOS (most common type, >90%): Compression of the brachial plexus from cervical ribs, anterior scalene muscles, and ligaments. Symptoms include paresthesia, numbness, and pain.
    • Arterial TOS (least common, ~1%): Compression of the subclavian artery from the head of the humerus. Symptoms may not be identified by ultrasound if only the nervous system is involved.
    • Venous TOS (also called Paget-Schroetter syndrome or effort thrombosis): Compression of the subclavian vein against the first rib and scalenus anticus muscle with abduction of the arm. Symptoms include paresthesia, numbness, pain, increased symptoms with arm/neck movements or exercise, swelling with venous TOS, and intermittent symptoms that vary with patient position.

    Exam Techniques

    • General Procedure: Evaluate the patient first for atherosclerosis; establish normal flow patterns, then evaluate flow changes with position changes. The patient sits with palms up and resting on thighs.
    • PPG & PVR: Perform PPG tracings of the second digit (index finger) at rest and with maneuvers, and PVR tracings with a brachial cuff at rest and with maneuvers. Note any changes in flow or waveforms with position changes.
    • Doppler Evaluation (Arterial): Evaluate the radial artery at the wrist. Obtain Doppler samples, and perform TOS maneuvers. Repeat Doppler samples.
    • Doppler Evaluation (Venous): Evaluate the distal subclavian vein. Establish baseline flow with Doppler, perform TOS maneuvers and repeat Doppler samples. Record any changes in flow velocities with maneuvers.

    TOS Maneuvers

    • Neutral Position: Used for baseline tracing before maneuvers to initiate symptoms. Record positions used to evaluate patient. Note any symptoms or changes in waveforms with this position.
    • 90 Degree Abduction: Raise the arm up with hand at the same height as the shoulder, palm up. Turn the head toward the affected arm and then away, while recording waveforms. Note any symptoms or waveform changes.
    • 180 Degree Abduction: Raise the arm straight up with the palm turned towards the head. Turn the head toward the affected arm and then away, while recording waveforms. Note any symptoms or waveform changes.
    • Adson Maneuver: Patient sits tall with chest forward, takes a deep breath, and turns their head to the affected side, extends the arm, and raises it slightly. Evaluate with head turned to the unaffected side. Note symptoms and waveform changes, and any changes in pressure values.
    • Costoclavicular Maneuver: Patient pushes elbows back, shoulders down, and sticks chest out. Face forward with chin level. Turn head to affected side and away. Record waveforms. Note any symptoms or waveform changes.

    Abnormal Findings

    • PPG/PVR: Significantly reduced amplitude or absent signal with patient maneuvers.
    • Arterial Doppler: Significantly reduced or absent signal with patient maneuvers. Evaluation may not identify symptoms if only nervous system is involved. Note any changes in waveform morphology or flow velocities with each maneuver.
    • Venous Doppler: Venous signal becomes continuous or disappears. Note changes in flow with different maneuvers.

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    Physiological Part II PDF

    Description

    Test your knowledge on interpreting various outcomes from arterial exams, focusing on ankle pressure changes and waveform analysis. This quiz covers indications of significant disease states and pressure fluctuations in different segments of the arteries. Enhance your understanding of vascular assessments and their implications for patient health.

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