Obstetrics and Gynecology Patient Assessment
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Questions and Answers

What is the serum CA 125 concentration?

  • 45 U/ml
  • 35 U/ml (correct)
  • 15 U/ml
  • 25 U/ml

    • What is the normal level of FHR?

  • Between 210 and 240
  • Less than 210
  • Greater than 240
  • Less than 240 (correct)

    • Based on the documentation provided, what can be said of the patient?

  • Patient is very healthy.
  • Details of the patient are not provided. (correct)
  • Patient is doing fine.
  • Patient is very ill.

    • What can be directly inferred from the provided documentation?

    <p>The patient exhibits normal serum CA 125 levels. (B)</p> Signup and view all the answers

    Which statement is accurate regarding the values presented?

    <p>No specific data points besides the CA 125 concentration, have a stated normal range. (C)</p> Signup and view all the answers

    A 42-year-old woman with a history of hypertension, treated with a beta-adrenergic blocking agent, is seeking contraception. Which of the following contraceptive methods poses the greatest risk due to her hypertension?

    <p>Oral contraceptive (D)</p> Signup and view all the answers

    Considering the patient's history of a low-grade squamous intraepithelial lesion (LSIL) during her second pregnancy, which approach is most suitable regarding future cervical cancer screening?

    <p>Annual co-testing with Pap smear and HPV testing (D)</p> Signup and view all the answers

    A 42-year-old patient with a history of forgetting to take her hypertension medication is seeking a highly effective and easily remembered contraceptive method. Which of the following would be the most appropriate recommendation?

    <p>Placement of an IUD (C)</p> Signup and view all the answers

    Given the patient's monogamous relationship, past history of Chlamydia trachomatis infection, and desire for effective contraception, which method offers no direct protection against sexually transmitted infections?

    <p>Depot medroxyprogesterone (B)</p> Signup and view all the answers

    Two days after a cesarean delivery, a 27-year-old woman has a temperature of $38.2°C (100.8°F)$. Which of the following is the most likely cause of her fever?

    <p>Endometritis (D)</p> Signup and view all the answers

    In the described postpartum patient, what is the most appropriate initial step in managing the fever?

    <p>Perform a thorough physical examination and order relevant labs (C)</p> Signup and view all the answers

    Which of the following laboratory tests would be most helpful in differentiating between endometritis and a urinary tract infection in the postpartum patient?

    <p>Urinalysis with culture (C)</p> Signup and view all the answers

    If the 27-year-old postpartum patient is diagnosed with endometritis, which of the following antibiotic regimens would be most appropriate initially?

    <p>Intravenous clindamycin and gentamicin (A)</p> Signup and view all the answers

    What is the most likely cause of the fetal heart rate pattern due to the fetal position described?

    <p>Occipitoposterior position (D)</p> Signup and view all the answers

    Which condition is least likely to explain the fetal heart rate pattern observed in this case?

    <p>Fetal sleep state (B)</p> Signup and view all the answers

    In this scenario, what important factor about the mother is relevant to the fetal heart rate interpretation?

    <p>Maternal health at prenatal visits (D)</p> Signup and view all the answers

    What is the potential complication that requires monitoring for this patient due to the fetal position?

    <p>Increased likelihood of cesarean delivery (C)</p> Signup and view all the answers

    Which of the following assessments might indicate a need for immediate intervention?

    <p>Continued ruptured membranes without contractions for extended periods (A), Maternal reports of decreased fetal movement (C)</p> Signup and view all the answers

    What does the 'r' symbol represent in the context provided?

    <p>A placeholder for an undefined quantity (D)</p> Signup and view all the answers

    Which of the following numbers appears to have the highest value based on the symbolic representation?

    <p>30 (D)</p> Signup and view all the answers

    What could the sequence of characters potentially represent in mathematical notation?

    <p>A series of measurements (B)</p> Signup and view all the answers

    Which of the following interpretations could apply to the dash symbols found in the representation?

    <p>They indicate a range of values (C)</p> Signup and view all the answers

    What is the relationship suggested by the presence of the repeated elements in the content?

    <p>They suggest symmetry or repetition (C)</p> Signup and view all the answers

    In a mathematical context, what might a string of symbols with no apparent meaning indicate?

    <p>A placeholder for missing data (C)</p> Signup and view all the answers

    What could the underlying theme of the symbols and structure suggest about the data?

    <p>A chaotic expression not meant to convey meaning (C)</p> Signup and view all the answers

    What might the presence of both dots and dashes signify in this context?

    <p>Alternating segments of information (A)</p> Signup and view all the answers

    Which historical finding poses the greatest risk factor for osteoporotic fracture in the patient?

    <p>Family history of fracture (C)</p> Signup and view all the answers

    What is the most likely diagnosis for a patient with white verrucous lesions over the vaginal wall and cervix?

    <p>Condylomata acuminata (B)</p> Signup and view all the answers

    What type of examination shows no abnormalities in the patient discussed?

    <p>Breast examination (A), Pelvic examination (B)</p> Signup and view all the answers

    Which partner treatment history is relevant for assessing risk in the sexually active patient?

    <p>Recently treated for syphilis (A)</p> Signup and view all the answers

    What is the most important aspect to analyze given the 4-week history of pelvic pain?

    <p>The size of the adnexal mass (C)</p> Signup and view all the answers

    What condition could result from inconsistent condom use in a sexually active individual?

    <p>Increased risk of HPV infection (D)</p> Signup and view all the answers

    What is one primary characteristic observed during the pelvic examination of the patient with an adnexal mass?

    <p>12-cm cystic and mobile (B)</p> Signup and view all the answers

    What is the significance of negative high-risk HPV testing in the patient?

    <p>Indicates a low risk of cervical cancer (D)</p> Signup and view all the answers

    A 39-year-old woman at 37 weeks' gestation presents with acute left hemithorax pain and a temperature of 38.2°C. Arterial blood gas shows a pH of 7.43, PCO2 of 35 mm Hg, and PO2 of 70 mm Hg. What is the most likely diagnosis?

    <p>Pulmonary embolus (B)</p> Signup and view all the answers

    What respiratory parameter indicates hypoxemia in the pregnant patient?

    <p>PO2 less than 80 mm Hg (C)</p> Signup and view all the answers

    A 52-year-old woman with a history of well-controlled hypothyroidism, prior stage I breast cancer (now in remission after tamoxifen), and a family history of osteoporosis presents for a routine exam. Which of the following factors potentially increases her risk of fracture?

    <p>BMI of 19 kg/m^2 (A)</p> Signup and view all the answers

    What is the significance of the patient ceasing tamoxifen therapy one year ago?

    <p>Reduced risk of thromboembolic events (C)</p> Signup and view all the answers

    Which aspect of the 52-year-old woman's history is LEAST relevant when screening and assessing her risk of osteoporotic fracture?

    <p>History of stage I breast cancer (B)</p> Signup and view all the answers

    What is the MOST appropriate next step in evaluating the 39-year-old pregnant patient with suspected pulmonary embolism, after initial stabilization?

    <p>Ventilation-perfusion (V/Q) scan (B)</p> Signup and view all the answers

    The arterial blood gas results of the pregnant woman with chest pain (pH 7.43, PCO2 35 mm Hg, PO2 70 mm Hg) are MOST consistent with which acid-base disturbance?

    <p>Respiratory alkalosis with hypoxemia (A)</p> Signup and view all the answers

    The 52-year-old woman reports having menarche at age 11. How does this fact MOST directly influence the risk of osteoporosis?

    <p>Earlier menarche increases the lifetime exposure to estrogen, potentially increasing bone density (D)</p> Signup and view all the answers

    Flashcards

    39-year-old woman with left hemithorax pain

    A 39-year-old pregnant woman experiences acute pain in her left side with breathing difficulty.

    Fetal heart tones

    Fetal heart rate is a crucial assessment, normal is around 120-160 bpm.

    Acute pain exacerbated by breathing

    Sign of potential respiratory or cardiovascular issues, often requiring differential diagnosis.

    Arterial blood gas analysis indications

    ABG analysis helps assess gas exchange efficiency and acid-base status in the blood.

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    Diagnosis of pulmonary embolus

    A serious condition caused by a blockage in the pulmonary arteries, often resulting from blood clots.

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    Hypothyroidism

    Condition arising from insufficient thyroid hormone production, can affect metabolism and energy levels.

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    Tamoxifen therapy

    Hormonal treatment used to prevent the recurrence of breast cancer, particularly in hormone-sensitive cases.

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    Risk factors for fractures

    Factors including age, previous fractures, and family history that increase fracture risk, such as osteoporosis.

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    CA 125

    A protein marker often elevated in certain cancers, especially ovarian cancer.

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    Normal CA 125 range

    Normal levels of CA 125 are typically below 35 U/ml; elevated suggests further investigation.

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    Serum concentration measurement

    CA 125 levels measured in blood serum to evaluate possible malignancy.

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    Significance of elevated CA 125

    Elevated CA 125 can indicate ovarian cancer, endometriosis, or other conditions, not definitive alone.

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    CA 125 and pregnancy

    CA 125 levels can vary during pregnancy, sometimes leading to false positives in cancer screening.

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    Osteoporotic fracture risk factors

    Factors that increase the likelihood of bone fractures due to osteoporosis.

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    BMI

    Body Mass Index, a measure of body fat based on height and weight.

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    Family history of fracture

    A record of fracture occurrences in one's family that may indicate genetic predisposition.

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    Levothyroxine therapy

    A treatment for hypothyroidism involving synthetic thyroid hormone.

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    Tobacco use

    Inhaling substances, often tobacco, which has various detrimental health effects.

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    Vaginal discharge

    Fluid that comes from the vagina, often signaling infections or other conditions.

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    Condylomata acuminata

    Warts caused by human papillomavirus, commonly found in the genital area.

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    Ruptured membranes

    Breaking of the amniotic sac before labor begins, often indicating that labor may start soon.

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    Primigravid

    A woman who is pregnant for the first time.

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    Effacement

    The thinning and shortening of the cervix in preparation for labor.

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    Occipitoposterior position

    A fetal position where the back of the head is towards the mother's back, which can lead to complications in labor.

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    Chorioamnionitis

    Infection of the amniotic fluid and membranes, often leading to complications during labor.

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    Gravida

    A woman who is pregnant, regardless of outcome.

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    Para

    A woman who has given birth to one or more children, with focus on viability.

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    Hypertension in pregnancy

    High blood pressure during pregnancy, can complicate maternal health.

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    Effective contraception

    Methods that reliably prevent pregnancy, considering user convenience.

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    Chlamydia trachomatis

    A common sexually transmitted infection that can affect pregnancy.

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    Depot medroxyprogesterone

    A hormonal contraceptive injected every three months.

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    IUD (Intrauterine Device)

    A T-shaped device placed in the uterus for long-term contraception.

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    Papanicolaou smear (Pap smear)

    A test to screen for cervical cancer by examining cervical cells.

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    Study Notes

    Multiple Choice Questions on Obstetrics and Gynecology

    • Question 1: A 39-year-old woman at 37 weeks' gestation presents with left hemithorax pain, exacerbated by breathing. Vital signs: temperature 38.2°C (100.8°F), pulse 120/min, respirations 24/min, blood pressure 110/70 mm Hg, fetal heart tones 170/min. Chest X-ray and ECG are normal. Arterial blood gas analysis shows: pH 7.43, PCO2 35 mm Hg, PO2 70 mm Hg. The most likely diagnosis is costochondritis.

    • Question 2: A 52-year-old woman with a history of stage I breast cancer (treated with tamoxifen 1 year ago) and mild hypothyroidism presents for a routine exam. Her BMI is 19 kg/m². The greatest risk factor for osteoporotic fracture is family history of fracture.

    • Question 3: A 20-year-old sexually active woman with a 1-week history of vaginal discharge, reports her partner was recently treated for syphilis. Physical exam shows no abnormalities. Pelvic exam shows white verrucous lesions on the upper vaginal wall and cervix; Pap smear shows atypical squamous cells. HPV testing is negative for high-risk types. The most likely diagnosis is Condylomata acuminata (genital warts).

    • Question 4: A 25-year-old woman presents with right-sided pelvic pain. She has been sexually active for 3 years. Pelvic exam shows a 12-cm cystic, mobile right adnexal mass. Serum CA-125 is 35 U/mL (normal <35). β-hCG is negative. Abdominal X-ray shows calcium deposits in the mass. The most likely diagnosis is Cystic teratoma (dermoid cyst).

    • Question 5: A woman five weeks postpartum, experiencing insomnia, restlessness, extreme fatigue, irritability and depression, declining in appetite, and having difficulty caring for her newborn seeks medical attention. The most appropriate initial step is referral to a family therapist.

    • Question 6: A 36-year-old woman, gravida 1, para 1, is unable to conceive for one year after a vaginal delivery complicated by postpartum hemorrhage and endometritis; husband's semen analysis is normal. The most likely cause is Tubal occlusion.

    • Question 7: A 32-year-old woman at 27 weeks' gestation presents with painful uterine contractions every 5 minutes, lasting 45 seconds. Her temperature is 37.8°C (100°F), pulse 100/min, blood pressure 90/50 mmHg, and the fetal heart rate is 160/min. The most likely cause is pyelonephritis.

    • Question 8: A 22-year-old woman at 38 weeks' gestation who presents for a routine prenatal visit. The patient's pulse is 100/min, and blood pressure is 130/90 mm Hg. Physical exam shows no abnormalities. Estimated fetal weight is 3629 g. Fetal heart rate is 120/min. Cervical dilation is 4 cm, 100% effaced, vertex at -1 station. The most likely cause is Normal labor.

    • Question 9: A 15-year old girl with a history of thick, white vaginal discharge, fever, and abdominal pain. The examination shows lower abdominal tenderness, and pelvic exam shows pain on cervical motion and adnexal tenderness with a 3-cm mass. Gram stain of vaginal discharge shows gram-negative diplococci. The most likely explanation is an immature immune system.

    • Question 10: A 5-year-old girl with a 2-day history of foul-smelling, yellow vaginal discharge and vaginal spotting. Physical exam shows mild vulvar erythema and purulent vaginal discharge. The most likely cause is a vaginal foreign body.

    • Question 11: A 27-year old woman with pain and tenderness in her left thigh 2 days after delivering a healthy newborn baby. The most appropriate next step to confirm the diagnosis is Duplex venous ultrasonography.

    • Question 12: A 21-year-old primigravida woman at 8 weeks' gestation, has sickle cell disease. Her husband's hemoglobin electrophoresis shows: Hemoglobin A 42%, Hemoglobin A2 3%, Hemoglobin F 2%, Hemoglobin S 53%. The probability her fetus will have sickle cell disease is closest to 50%.

    • Question 13: A 37-year-old woman at 35 weeks' gestation presents with hypertension, a history of type 1 diabetes mellitus, a blood pressure of 140/90 mmHg, a serum urea nitrogen concentration of 8 mg/dL, creatinine concentration of 1 mg/dL, 24-hour urine protein concentration of 800 mg. There's a mild decrease in the amount of amniotic fluid. The most likely cause is Placental dysfunction.

    • Question 14: A 57-year-old woman with a history of cervical cancer and radiation therapy presents with 2-week history of urine loss. Examination shows thin, atrophic vaginal mucosa, pool of fluid in vaginal canal. Postvoid residual volume is less than 10 mL. Most likely diagnosis is Vesicovaginal fistula.

    • Question 15: A 57-year-old woman with a history of immediate loss of urine with coughing or exercise presents with no complications. Her last menstrual period was 10 years ago, no estrogen therapy since. Vaginal examination shows a normal-sized uterus and ovaries. The most likely diagnosis is Stress incontinence.

    • Question 16: A 15-year-old girl with constant abdominal pain and a recent history of sexual activity presents with constant lower abdominal tenderness, bulging bluish vaginal tissue, and a 1 week history of severe abdominal pain. Most appropriate next step is Transvaginal incision and drainage.

    • Question 17: A 27-year-old woman with 1 to 2 days of postcoital spotting after a recent bilateral tubal ligation is likely experiencing Exercise-related menstrual irregularity.

    • Question 18: A 32-year-old woman presents with 3-year history of increasingly irregular menstrual periods, ranging from 45-60 days to 90 days. She is overweight, with velvety pigmented skin on the axillae and groin. Blood pressure is 140 / 80 mmHg. Most likely increased hormone is Follicle-stimulating hormone.

    • Question 19: A 27-year-old woman with a 3-day history of increasing abdominal pain, fever and vaginal discharge is most likely caused by a septic abortion.

    • Question 20: A 19-year-old woman presents with lower abdominal pain and vaginal spotting 2 weeks after her last menstrual period, with bleeding and tender lower abdomen. The most likely cause is Retained products of conception.

    • Question 21: A 17-year-old woman with decreased fetal movement has a uterus consistent in size of a 32 week gestation with ultrasonography of a 31-week fetus. The most likely diagnosis is Placental insufficiency.

    • Question 22: A 34-week pregnant woman with chronic hypertension (160/95 mmHg), treated with methyldopa, who has induction of labor showing abnormal fetal heart tracing, is most likely suffering from Uteroplacental insufficiency.

    • Question 23: A 22-year-old woman with vaginal burning and a frothy, gray discharge is most likely experiencing a vaginal infection, requiring Vaginal metronidazole gel.

    • Question 24: A 23-year-old pregnant woman with a history of spontaneous abortions in her family, fetal demise, and intrauterine fetal demise; most likely cause is Uteroplacental artery thrombosis.

    • Question 25: A 18-year-old woman, with chicken pox , a newborn requires Varicella-zoster immune globulin therapy.

    • Question 26: A 37-year-old woman with heavy but regular menstrual periods with labor-like pains and vaginal bleeding. Examination of the cervix notes moderate effacement and 2 cm dilation, and beefy red tissue on the os. Most likely diagnosis is Incomplete abortion.

    • Question 27: A 27-year-old, primigravid woman at 7 weeks' gestation for her first prenatal visit has no medical history. The most appropriate next step is testing of Serum vitamin B12 (cobalamin) concentration.

    • Question 28: A 42-year-old pregnant woman diagnosed with the factor V Leiden mutation. Patient's pregnancy has been uncomplicated. The most likely predisposing factor is Thrombophilia.

    • Question 29: A 36-year-old woman with ruptured membranes and 8 hours of no contractions. The most likely explanation is postdates pregnancy.

    • Question 30: A 42-year-old woman with urinary urgency and frequency. The most likely cause is Detrusor hyperreflexia.

    • Question 31: A 32-year-old woman at term, with 5 cm dilated cervix despite oxytocin, contractions every 3 mins. and 55-64 mm Hg intrauterine pressure. The most likely diagnosis is Normal active phase.

    • Question 32: A 32-year-old woman with bright red vaginal bleeding, a firm tender abdomen and a 4 cm dilated cervix, needs Emergency cesarean delivery.

    • Question 33: A 25-year-old woman in labor, 6 cm dilated and 100% effaced with a 3200g fetus. Most appropriate next step is Cesarean delivery

    • Question 34: A 52-year-old female with a history of smoking and alcohol use requires Bone densitometry.

    • Question 35: A 42-year-old woman present with vaginal bleeding has endometrial adenocarcinoma. Appropriate next step is Hysterectomy.

    • Question 36: A 30-year-old woman, gravid 3, para 2, with fever , minimal vaginal bleeding and pain has a 10-week gestation with a foul-smelling vaginal discharge and 10cm uterus. Most likely diagnosis, Septic abortion

    • Question 37: A 32-year-old woman with a history of seizures in pregnancy (5 µg/mL current phenytoin). Most appropriate step is to Add valproic acid to the medication regimen.

    • Question 38: A 27-year-old woman with pain in her arms and numbness who wakes from sleep. Most likely Diagnosis Thoracic outlet syndrome

    • Question 39: A 14-year-old girl presenting with painful menstrual cramping. The most probable cause is Prostaglandin production.

    • Question 40: A 32-year-old pregnant woman with blurry vision, weight gain, and edema. The most likely obstetric complication is Preeclampsia.

    • Question 41: A 52 year old postmenopausal woman with no cigarette/alcohol consumption, receiving estrogen and progestin therapy is screened for Ovarian cancer.

    • Question 42: A 27-year-old woman with 37 weeks gestation, fetal bradycardia, and the cervix is dilated 3cm., the most probable diagnosis is Ruptured uterus.

    • Question 43: Three months after a vaginal delivery, a woman with pain during sexual intercourse. The next step is Antifungal therapy.

    • Question 44: A 21-year-old woman admitted in labor at 41 weeks gestation, the cervix is dilated and effaced, membranes rupture yielding thick meconium-stained fluid, fetal heart rate has variable decelerations. Most appropriate next step is Amnioinfusion.

    • Question 45: A 28-year-old nulligravida with severe dysmenorrhea, dyspareunia and symptoms. Most likely diagnosis is Endometriosis.

    • Question 46: A 27-year-old woman who presents with pain, nausea, rectal pressure, and a negative pregnancy test. Most likely diagnosis is Ruptured corpus luteum cyst.

    • Question 47: A 37-year-old woman with bloody nipple discharge. Most likely diagnosis is Intraductal papilloma.

    • Question 48: A 22-year-old woman with ruptured membranes has fetal heart rate patterns. Most likely cause is Occipitoposterior position.

    • Question 49: A 42-year-old woman seeks contraception advice. Most suitable recommendation is Placement of an IUD.

    • Question 50: Two days after a cesarean delivery, a 27-year-old woman with a fever, decreased breath sounds, edema and no odor has lochia. Most likely diagnosis is Pneumonia.

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    Obstetrics and Gynecology Self-Assessment Questions PDF

    Description

    This quiz focuses on evaluating patient scenarios in Obstetrics and Gynecology, particularly regarding contraception and cervical cancer screening. It covers aspects such as CA 125 levels, FHR, and suitable contraceptive choices for patients with specific medical histories. Test your knowledge about patient management in these clinical contexts.

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