Pathology Exam 2

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gecrouch88
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Pathology Exam 2
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2012-10-09 20:18:16
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Pathology cardiac system
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Cardiac and Pulmonary System
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  1. Describe the blood flow of the heart
    • blood flows from superior vena cava and inferior vena cava to the right atrium
    • then to the tricuspid valve into the right ventricle
    • right ventricle ejects blood through pulmonic valve into pulmonary artery during ventricular systole
    • blood enters pulmonary capillary system
    • exchanges CO2 for O2
    • oxygenated blood leave lungs via pulmonary veins and returns to left atrium
    • from left atrium, blood flows through mitral valve into the left ventricle
    • left ventricle pumps blood into systemic circulation through aorta
    • supplies tissues of body with O2
    • blood then returns to heart through superior vena cava and inferior vena cava to begin cycle again
  2. What is the total body volume, intracellular fluid, extracellular, and blood?
    • Total - 40-50L
    • intracellular fluid - 25-35L
    • extracellular fluid - 10-14L
    • --interstitial
    • --blood plasma
    • Blood - 4-5L
  3. Signs and Symptoms of CVD
    • chest pain
    • palpitations
    • dyspnea
    • cardiac syncope
    • vasovasal syncope
    • fatigue
    • cough
    • cyanosis
    • peripheral edema
    • claudications
  4. What is Angina?
    • symptom of coronary artery disease
    • described as pressure, squeezing and tightness in chest
    • palpitations
    • dyspnea
    • cardiac syncope
  5. What is Coronary Artery Disease?
    • most common and seious effect of aging
    • fatty deposits build up in vessel walls and narrow passageways for movement of blood (artheriosclerosis)
  6. Risk factors for Coronary Heart Disease
    • HTN
    • cigarette smoking (#1 cause of preventable death)
    • family history
    • age
    • inactivity
    • diabetes
    • obesity
  7. Medical Management for Coronary Heart Disease
    • PREVENTION
    • early diagnosis: check cholesterol ~5 years, angiograms
    • modifications of risk factors: quit smoking, manage diabetes and fat
    • exercise: moderate ~30 minutes > 4x/week
    • medication: reduce clotting, treat HTN, decrease cholesterol levels
    • medical surgical intervention: CABG, vessel acclusion
  8. What are the different types of Hypertension?
    • Primary: idiopathic, most common (90-95%)
    • Secondary: 5-10% of all cases
    • Labile: HTN boarderline goes up and down
    • Malignant: elevated BP with diastolic >125, hemmorages
  9. What are the different BP values
    • Normal: s < 120, d <80
    • Prehypertensive: s ~ 120-139, d ~ 80-89
    • Stage 1 Hypertension: s ~ 140-159, d ~ 90-99
    • Stage 2 Hypertension: s >160, d >100
  10. What are the consequences of malignant HTN
    • transient ischemic attack, stroke
    • retinopathy
    • peripheral artery disease
    • chronic kidney disease
    • LVH, CHP, CHF
  11. Symptoms of HTN
    • frequently assymptomatic
    • headaches
    • vertigo
    • flushed face
    • blurred vision
    • nocturnal urinary frequency
    • spontaneous epistaxis (nose bleeds)
  12. Cardiovascular sypmtons of progressive HTN
    • dyspnea
    • orthopenea
    • chest pain
    • leg edema
  13. Cerebral symptoms of progressive HTN
    • nausea
    • vomitting
    • fleeting numbness/tingling in limbs
    • drowsiness
    • confusion
  14. Medical Management of HTN
    • early monitoring
    • aggressive early treatment (esp w/ DM)
    • physical activity and exercise
    • nutrition
    • lifestyle modifications
    • --weight control, smoking cessastion
    • medication
    • --antihypertensives
  15. What degree of change in BP can reduce risk of CVD and by how much?
    • 2 mmHg change can reduce CVD by 10%
    • 7% decrease of ischemic heart disease mortality
    • 10% decrease of stroke mortatlity
  16. What is the most common site of an MI?
    left coronary artery
  17. What is an Myocardial Infarction?
    • occlusion of coronary arter, L or R
    • majority involves L ventricle
    • 80-90% due to coronary artery thrombosis
    • smokers 2x MI, 2-4x more sudden death
    • area of injury becomes necrotic
    • size and location determine damage
  18. What are the symptoms of an MI?
    • sudden sensation of pressure
    • prolonged "crushing chest pain"
    • occassionally radiates to arms, throat, neck and back
    • constant pain 30min - hours
    • observable pallor, SOB, diaphoresis
    • atypical signs from women
  19. What are the Post-MI symptoms?
    • arrythmias
    • CHF
    • thromboembolism
    • cardiac shock
    • pericarditis
  20. What are the diagnostic test for an MI?
    • ECG - infarcted tissue is electrically silent
    • cardiac troponin - markers of myocardial injury
    • TEE - ultrasound image of heart
    • pulmonary artery pressure measure
  21. What is the treatment for an MI
    • rest
    • O2 therapy
    • morphine
    • drugs (pain relief, anticoagulation to prevent thrombosis formation, limit infarction size, reduce vasoconstriction
    • cardiac rehab
    • prognosis depends on size/site of infarct
  22. How could cardio disease affect PT treatment?
    • during evaluation, assess cardiac signs and symptoms
    • check degree of impairment
    • level of disabilitylevel of functional limitations
    • pt needs to communicate symptoms to MD
    • PTs need to help pt characterize symptoms
    • when beyond scope of practice > REFER
  23. What are the implications for PT for CAD?
    • cardiac rehab: education and exercise, promotes development and maintenance
    • post-op considerations: sternal precautions
    • sutured? closed?
    • no pulling up in bed
    • no push, pull, lift >10lbs for 6 weeks
    • no driving
    • shoulder, neck, torso ROM may/not be limited
    • avoid shoulder horizontal abduction
  24. What are the implications for PT for HTN
    • know patients medications
    • avoiding heaving lifting and isometrics
    • close monitoring of vitals
  25. What are the implications for PT for an MI?
    • progressive physical activity begins w/in 24 hours
    • gentle exercises as prophylactic (prevent immobility)
    • avoid intra-abdominal pressure (no valsalva)
    • avoid excessive hot water submersion
    • close monitoring of vitals
    • return to sex requires MD guidance
  26. What is Congestive Heart Failure?
    • heart unable to pump sufficient blood to meet metabolic needs
    • pulmonary congestion and HTN due to:
    • --back up of blood in pulmonary veins
    • --increased pressure in pulmonary capillaries
    • acute or chronic
  27. What are the four types of CHF?
    • systolic heart failure
    • diastolic heart failure
    • left sided heart failure = CHF
    • right sided heart failure = Cor Pulmonale
  28. What is the incidence of CHF
    • older adults
    • existing CVD - especially in pre-existing HTN
  29. What are the risk factors for CHF?
    • emotional stress
    • physical inactivity
    • obesity
    • diabetes
    • nutritional deficiency
    • fever
    • infection
    • anemia
    • throid disorder
    • pulmonary disease
    • medications
  30. What are the etiologic factors of CHF?
    • HTN
    • CAD
    • MI
    • valvular heart disease
    • congenital heart disease
    • endocarditis
    • pericarditis
    • myocarditis
    • cardiomyopathy
    • chronic alcoholism
    • chronic anemia
  31. What is the pathophysiology of CHF?
    • 1st Compensation Phase:
    • chambers enlarge to hold increase of blood
    • right ventricles pump increased blood to the lungs
    • accumulation of blood leads to pulmonary edema
    • fluid seeps from distended blood vessels
    • leads to SOB and flooding of air spaces
    • 2nd Compensation Phase:
    • as myocardial cells lose contractibility
    • --HR increases
    • --muscle mass increases
    • --strengthens contraction
    • results in ventricular hypertrophy and need more O2
    • angina due to ischemia when coronary arteries unable to meet O2 demands
    • 3rd Compensation Phase:
    • decrease blood coming from the heart, decreased blood through kidneys
    • kidneys respond by retaining water and sodium to increase blood flow
    • exacerbates tissue edema
    • expanded blood volume increases load on the system
  32. What is compensated CHF?
    if system is still able to maintain normal levels
  33. What is decompensated CHF?
    • after compensation fails and unable to maintain levels, disease progresses to final stage
    • massive heart overload
  34. Results of Left-Sided Heart Failure
    • decrease level ventricle output deosn't meets body's metabolic needs
    • causes pulmonary edema/disturbance in respiratory control
    • dyspnea
    • fatigue and muscular weakness
    • renal changes
    • --decrease urine formation, decrease blood flow, decrease cardiac output
    • --renine secretions, stim angiotension, vasoconstriction
    • (increased preipheral vascular resistance, increased BP, increased cardiac work, worse heart failure)
  35. What are symptoms of Left sided heart failure?
    • pulmonary edema
    • cerebral hypoxia
  36. Results of Right-Sided Heart Failure
    • failure of R ventricle to pump blood to lungs
    • dependent edema - fluid retained because body senses decrease blood volume in kidneys
    • jugular vein distension
    • cyanosis - lack of O2 (turns blue)
  37. Medical Management for CHF
    • diagnosis
    • diet and exercise!!!
    • medications to decrease workload, increase strength and contraction
    • surgeries - CABG
    • pronosis
  38. What is pulmonary edema/congestion?
    • excessive fluid in alveoli and/or interstitial spaces
    • barrier to gas exchange
    • primarily associated with left sided CHF
    • --acute HTN
    • --mitral valve disease
    • --kidney and liver disorders
    • --IV narcotics
    • --inhalation of smoke
    • --shock, ect
    • normally lung is "dry" through lymphatic drainage and a balance of capillary hydrostatic pressure, pulm oncotic, and capillary permeability
  39. Pulmonary Edema is cause by?
    • fluid overload:
    • fluid pushed from capillaries into interstitial tissue
    • peripheral pressure "backs up" system causing limited "forward flow"
    • decreased serum and albumin:
    • decreased production of plasma protein -> decrease capillary oncotic pressure -> decreased reabsorption at venous end -> edema
    • lymphatic ovstruction:
    • lymph obst decreases absorption of interstitial fluid -> decreased transport of capillary filtered protein -> increased tissue oncotic pressure which pulls fluid in -> edema
    • disruption of capillary permeability:
    • increased capillary permeability
    • movement of protein plasma into tissues
    • icreased tissue oncotic pressure
    • edema
  40. What are the symptoms of Pulmonary Edema?
    • initially assymptomatic
    • occur in stages
    • restlessness, anxiety, feeling of cathing a cold
    • persistant cough, slight dyspnea, diaphoresis
    • hypoxia
  41. What is the medical management for Pulmonary Edema?
    • prevention - lower salt intake or meds if at risk
    • diagnosis ASAP
    • treatment - supplemental O2, diuretics, diet
    • prognosis
  42. What is an Aneurysm?
    • abnormal stretching in wall of an artery, vein, or the heart with diameter increases more that 50% of normal
    • >5cm is likely to rupture
  43. What are the symptoms of an Aneurysm?
    • may be assymptomatic
    • depends on size, position, and rate of growth
    • AAA (untreated) - intermittent/constant pain in mid-ab or low back
    • AA disection - sharp pain in base of neck/scapular area, MI reversible ischemia, stroke, paraplegia, renal failure, ichemia of arms/legs due to pressure
  44. What is the medical management of an Aneurysm?
    • diagnosis - detection of mass by x-ray
    • prevention - smoking cessation, BP control and cholesterol
    • treatment - surgery is >5cm
    • surgery - replaces diseased aorta or stent graft
  45. What are the diagnostic tests for Cardiovascular function?
    • ECG/EKG
    • ausculation (heart sounds)
    • exercise stress tests
    • chest x-ray
    • cardiac catheterization
    • angiography
    • doppler studies (assess blood flow)
    • blood tests
    • arterial blood gas determination
  46. What are the general treatments for Cardiac disorders?
    • diatary modifications
    • regular exercise program
    • quit smoking
    • drug therapy
    • surgical intervention
  47. What type of drug therapy is used for cardiac disorders?
    • vasodilaters
    • beta-blockers
    • anticoagulants
    • cholesterol/lipid reducing drugs
    • calcium ion channel blockers
    • digitalis compounds (digoxins)
    • antihypertenstive drugs
  48. What are the surgical interventions for cardiac disorders?
    • angioplasty: squishes clot against wall to try and keep open
    • stenting: like angioplasty, balloon is permanent
    • rotational atherectom: drills out clot
    • CABG: healthy blood vessels removed from leg, creates new blood flow around occulsion
    • coarctation of aorta
  49. What are the PT implications for CHF?
    • montior vitals!!
    • exercise - low to moderate exercise with tests, gradual increase intesity and duration, maintain functional levels
  50. What are the PT implications for Pulmonary Edema?
    • monitor vitals
    • watch for jugular distension
    • pitting edema
    • dyspnea
  51. What are the PT implications for an Aneurysm?
    • activites restricted post surgery - only bedside mobility
    • monitor vitals
    • no valsalva maneuvers
  52. What structures are in the upper respiratory system?
    • nasal cavity
    • oral cavity
    • larynx
    • pharynx
  53. What structures are in the lower respiratory system?
    • trachea
    • bronchii
    • lungs
  54. Structures of the lower airway
    • 1st 16 generations are for condution
    • transitional airways lead into final respiratory zones
    • --consists of alveoli where gas exchange happens
  55. What are the funtions of the lungs?
    • ventilation: ability to move air in and out of lungs via pressure gradient
    • respiration: gas exchange that supplies O2 to blood and body tissues. removes CO2
  56. What are the symptoms of pulmonary dysfunction?
    • cough
    • dyspnea
    • abnormal sputum
    • chest pain
    • hypoventilation (most common)
    • hemoptysis
    • cyanosis
    • digital clubbing
    • altered breathing patterns
  57. How does aging affect pulmonary function?
    • physiological function of lungs
    • ability of respiratory system to defend
    • structural changes lead to decrease gas exchange
    • --decrease chest wall compliance
    • --decrease elastic recoil
    • --decrease gas exchange 2o flattened alveolar walls decreased surface area
    • --decreased cilliary action to clean out mucus leads to increased infection
    • --decreased respiratory musculoskeletal strength and endurance leads to dyspnea
    • --pulmonary complications during anesthesia post-op
    • --decreased effective cough leads to increased risk of pneumonia and atelectasis
  58. Describe Pneumonia
    • inflammation of parenchyma of lungs
    • may be secondary to disease
    • often follows influenza
    • may involve B lungs at lobe or bronchioles and alveoli
    • causes:
    • bacterial, viral, fungal, or myoplasmal infection
    • inhalation of toxins, chemicals, smoke, dust, gases
    • apiration of food, fluid, vomitus
  59. What are the different types of pneumonia?
    • aspiration: suck and swollow difficulties, anatomic defense mechanisms are impaired
    • fungal: limited geographic region or compromised immune system
    • viral: usually mild and self-limiting
    • bacterial: may follow influenza virus
  60. What is the source of pneumonia?
    • usually airborn pathogens
    • circulation, sinus or contagious infection
    • aspiration
  61. What are the risk factors of pneumonia?
    • cigarette smoking
    • complications of influenza and sinusitis
    • chronic bronchitis, uremia, dehydration, malnutrition
    • DM- poorly controlled
    • hospitalization, surgery intubatin, incontinance, inactivity
    • impaired cough and/or swallowing
    • pooling of secretions in aireways after being supine too long
    • impaires gas exchange which leads to dyspnea
  62. What are the symptoms of pneumonia?
    • sudden and sharp pleuritic chest pain aggravated by chest movement
    • hacking, productive cough with green/rust colored sputum
    • dyspnea, tachypnea, decreased chest wall excursion on effective side
    • cyanosis, HA, fever, aches, chills, synalgias
  63. What is the medical management for pneumonia?
    • diagnosis: suptum cultures, blood culture, urine test, chest X-ray, physical exam, percussion and aussiltation
    • treatment:
    • bacterial and mycoplasmal¬†- to antibiotics and rest, fluids
    • fungal - antifungal meds
    • viral - symptomatic relief
    • vaccination - for elder, good for 3-5 years
    • airway clearnence PRN
  64. What is chronic obstructive pulmonary disorder (COPD)?
    • chronic airflow that is NOT fully reversible
    • caused by - emphysema and chronic bronchitis
    • 4th leading cause of death - 2nd behind heart disease as cause of disability
  65. What is the medical management of COPD?
    • diagnosis:
    • smoking history, physical exam, chest xray
    • use pirometer - max force of exhalation
    • labs for blood gas and blood pH, sputum culture, precsence of immunoglobulin
    • treatment:
    • can be managed, but not cured
    • different for everyone depending on severityearly diagnosis
    • --slow progression
    • --relieve symptoms
    • --icrease ability to stay active
    • --prevent and treat complications
    • --improve quality of life
    • smoking cessation
    • airway clearance
    • pharmacological management
    • exercise
    • goal = improve oxygenation and decrease CO2 retention
    • medications -
    • --brochodialators
    • --O2 therapy
    • --annual flu vaccine
    • --lung volume reduction surgery
    • --steroids
    • --pneumonia vaccine
    • --lung transplant
    • education:
    • support to stop smoking
    • conservation of energy
    • breathing exerciases
    • chest physiotherapy
    • self-manage medications
  66. What is Emphysema?
    • pathological accumulation of air in tissues (lungs)
    • abnormal distension of air spaces
    • destruction of elastin proteins which normally maintain strength of alveoli walls
    • leads to collapse of bronchioles and air is trapped
    • destruction of walls between alveoli leads to pockets of air
  67. What are the three types of Emphysema?
    • Centrilobar:
    • distruction of bronchioles
    • most common
    • mostly in smokers
    • Panlobar:
    • destroys air spaces of entire acinus
    • involves lower lung
    • mostly in smokers
    • Paraseptal:
    • destroys alveoli in lower lobes
  68. Clinical Manifestations of Emphysema
    • early stages:
    • dyspnea on exertion (DOE)
    • nonproductive cough
    • diaphragm flattens
    • barrel chest
    • hypoxia
    • prolonged expiratory phase
    • late stages:
    • dyspnea at rest
    • hypercapnia (increase CO2 in blood)
    • pursed-lip breathing
    • use of accessory muscles to breathe
    • underweight
    • lung sounds diminished
  69. Who are known as the "pink-puffers"?
    • people with emphysema
    • breathing is difficult and working hard
    • causes face to turn pink
  70. What is Chronic Bronchitis?
    • a productive cough at least 3mo/year > 2 years
    • inflammation and scarring of bronchial lining
    • increased mucous production
    • irritants increase mucous secretion and hypertrophy
  71. Who are known as the "Blue Bloaters"?
    • people with chronic bronchitis
    • cyanotic color fo skin and liops
    • hypoxia and fluid retention
  72. What is the medical management for chronic bronchitis?
    • persistant cough and sputum production - worse in the am and evening
    • SOB, prolonged expiration, persistant coughing
    • later:
    • decreased chest expansion, wheezing, cyanosis
    • hypoxia, sever disability or death
  73. What is Asthma?
    • a reversible obstructive lung disease
    • inflammation and increased smooth muscle reation of airway
    • chronic condition with exacerbations
    • mucosal edema
    • broncospasms
    • increased mucus gland secretions
    • mucus plugs airways (edema)
    • hypoxemia, increased WOB
    • extrinsic (allergic) - 50% of all cases
    • intrisic - no known cause
    • most common chronic diseases in adults and children
    • incidences of asthma/deaths are increasing
  74. What are the risk factors for Asthma?
    • environmental factors
    • low birth weight
    • childhood - more likely < 5 years
    • antibiotic use in infancy
    • before puberty - boys 3x>girls. after boys = girls
    • industrialized regions
    • colder climates
    • low SES
    • overcrowding living with environmental factors
    • obesity
  75. What are the symptoms of Asthma?
    • cough
    • respiratory-related signs
    • chest
  76. What are the different types of Asthma?
    • extrinsic
    • intrinsic
    • adult-onset
    • allergies
    • exercise-induced
    • aspirin-sensitive
    • occupational
    • emotional stress
  77. What are the 3 stages of Asthma?
    • mild:
    • symptoms reverse with stop of activity
    • Sx <2x/wk
    • inhaler PRN
    • moderate:
    • audible wheezing
    • leans forward to catch breath
    • daily symptoms
    • daytime Sx >2x/wk night >4x/wk
    • Severe:
    • blue lips and fingernails
    • tachypnea
    • cyanosis induced seizures
    • skin and rib retraction
    • activity limited
    • frequent day and night symptoms
  78. What is Cystic Fibrosis?
    • congenital disorder in the exocrine system
    • affects hepatic, male reproductive syst and respiratory system
    • predisposed to chronic bacterial airway infections
    • develop obstructive lung disease
    • progressive loss of pulmonary functions
  79. What does Cystic Fibrosis result in?
    • dehydrated and increase viscosity of mucous glands secretions
    • elevation of sweat electrolytes
    • abnormal increase of sodium and choloride concentrations in sweat
  80. What are they symptoms of Cystic Fibrosis?
    • pulmonary:
    • chronic bronchitis
    • dyspnea
    • emphesema
    • clubbing
    • kyphosis
    • cyanosis
    • tachypenia
    • respiratory failure
    • barrel chest
    • pigeon chest
    • gastrointestinal:
    • intestinal obstruction
    • anorexia
    • malnutrition
    • DM
    • hypotention
    • anemia
    • heart:
    • cor pulmonale
    • plycythemia
    • reproductive:
    • 98% infertility in males
    • musculoskeletal:
    • muscle atrophy
    • marked tissue wasting
    • myalgia
    • RA
    • osteopneia
  81. What is the medical management for cystic fibrosis?
    • diagnosis:
    • prenatal genetic testing
    • newborn screening
    • genotype analysis
    • PFTs
    • sweat test
    • chloride levels > 60mmols/L
    • treatment:
    • alleviate symptoms
    • thin secretions
    • airway clearance
    • nutritional management
    • supplemental O2
  82. Implications for PT for Cystic Fibrosis
    • breathing/posture exercises
    • exercise
    • CF centers for life long care
  83. What is Lung Cancer?
    • malignancy of epithelium of respiratory tract
    • leading cuase of cancer deaths in US
    • preventable!!
    • more people die of lung cancer than breast, colon, and prostate together
  84. What are the risk factors of Lung Cancer?
    • environmental exposure
    • 2nd hand smoke (increased risk 1.5x)
    • nutrition
    • genetic
    • age
  85. What are the symptoms of Lung Cancer?
    • depend on location in lung
    • productive coughdyspnea
    • recurrant infections
    • chest pain
    • anorexia
    • fatigue
  86. What are the two types of Lung Cancer?
    • small cell:
    • a result of obstructive air flow
    • non-small cell:
    • few symtoms until localized
    • sharp and sever pleural pain increase with inspiration
    • digital clubbing
  87. What is the medical management for Lung Cancer?
    • PREVENTION
    • diagnosis:
    • chest xray
    • sputum cytology
    • staging tests:
    • CT chest/abdomen
    • bone scan
    • treatment:
    • prognosis is poor
    • caught early ->70% cure rate
    • death within one year without treatment
    • in one year of smoking cessation decreases risk by 1/2
  88. What are the implications for PT for Lung Cancer?
    • teaching gradual exercises, postitioning, prevent loss of funtion
    • energy conservation is key!
  89. What is Cor Pulmonale?
    • enlargement of R ventricle due to pulmonary HTN
    • occurs mostly in females and smokers
    • causes:
    • pulmonary vascular disease
    • repiratory disease (COPD)
  90. What are they symptoms of Cor Pulmonale?
    • attributable to pulmonary HTN
    • typical exertional angina
    • less common Sx- productive cough, hoarseness, hemotysis
    • severe R ventricular failure
    • exercise induced cyanosis, clubbing
  91. What is the medical management for Cor Pulmonale?
    • treatment:
    • reduce workload of R ventricle
    • supplemental O2, salt and fluid retention
    • surgical removal of PE if accessable
  92. What are the PT implications for Cor Pulmonale?
    • monitor vitals
    • purse-lip breathing
  93. What are the PT implications for Pneumonia?
    • standard precautions
    • ventilory support/ supplemental O2 early ambulation
    • proper positioning to preent aspiration
  94. What are the PT implications for COPD?
    • montior vitals
    • gentle progression program
  95. What are the PT implications for Asthma
    • watch vitals
    • watch for cyanosis

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