Palliative Care Module 1

Which of the following is not considered a general indicator of decline and increasing needs in patients requiring palliative care?

An increase in the serum albumin level above 25g/L.

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A significant decrease in activity and functional performance status.

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The presence of multiple comorbidities as a predictive indicator of mortality.

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Progressive weight loss of more than 10% in the past six months.

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Choosing not to pursue further active treatment.

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Which group of decedents is most likely to be ADL dependent in their final year before death?

Individuals with sudden death

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Individuals dying from cancer

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Individuals with chronic organ failure

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Individuals who are frail

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All groups show similar levels of ADL dependency

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Which of the following opioid is NOT safe for use in patients with renal impairment?

Morphine

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Oxynorm

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Buprenorphine

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Methadone

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Oxycontin

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The parents of a child in the Intensive Care unit with a terminal illness make a choice not to pursue further treatment for their child’s condition. Medical advice has been that there is little hope that any intervention would prolong the child’s life. In this situation, which of the following should not be withheld?

Adequate sedation and analgesia

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Antibiotics

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Artificial hydration and nutrition

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Inotrophic medications

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Red Cell transfusion

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A patient has severe pain from locally advanced pancreatic cancer. The pain is eventually well controlled by 80 mg per 24 hours of subcutaneous morphine infusion in hospital. It is intended to discharge the patient on oral sustained-release morphine.

Which one of the following is likely to be the most appropriate dose?

120 mg bd.

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40 mg bd.

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80 mg bd.

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160 mg bd

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200 mg bd.

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Which of the following opiod has increased risk of QT prolongation?

Methadone

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Oxynorm

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Oxycontin

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Hydromorphone

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Buprenorphine

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Which of the following opioid increases the risk of convulsions?

Pethidine

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Oxycodone

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Hydromorphone

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Buprenorphine

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Methadone

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Which of the following is least consistent with a drug seeking behaviour?

Seeks oral opioids rather than injectables.

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Seeks repeated supply of opiods

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Insists on specific medications and refuses alternatives

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Vague history with lack of accompanying signs.

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History of doctor shopping

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With regards to the management of opioid induced constipation in a patient with advanced metastatic disease currently in hospice care, which of the following is least likely to be useful?

methylcellulose

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methylnatrexone

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rectal examination in patients with faeces of fluid consistency

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lactulose

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senna

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A 78-year-old woman with metastatic breast cancer who has received palliative doses of morphine for 2 months is hospitalized with a 2-week history of abdominal pain and distention. Passage of a bowel movement alleviates her pain, although she reports that the stools are quite hard. Abdominal examination reveals distention and slight tenderness. Rectal examination reveals hard stool in the rectal vault.

Which of the following treatment will most likely relieve this patient’s abdominal symptoms and constipation?

Methylnaltrexone

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Polyethylene glycol

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Docusate

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Replace morphine with tramadol

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Fiber supplementation

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You are reviewing a 66-year-old man with metastatic prostate cancer in the ward. He is known to have spinal metastases but until now has not had any significant problems with pain control. Unfortunately he is now getting regular back pain despite taking regular paracetamol 1g QID and Ibuprofen 400mg TDS. Neurological examination is unremarkable.

What is the most appropriate next step?

Add diclofenac

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Refer for radiotherapy

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Add oral biphosphonates

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Add dexamethasone

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Add fentanyl

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A 70-year-old man with chronic kidney disease stage 4 and metastatic prostate cancer presents to hospital as his pain is not controlled with ParaCode (paracetamol and codeine phosphate).

Which one of the following opioid is the most appropriate to use given his impaired renal function?

Buprenorphine

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Morphine

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Hydromorphone

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Diamorphone

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Tramadol

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A 57-year-old man with lung cancer is currently taking Sevredol 10mg Q4hrly for pain relief.

What dose of oral morphine solution should he be prescribed for breakthrough pain?

10mg

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20mg

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5mg

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30mg

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40mg

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If a patient takes 60mg of oral codeine phosphate every 6 hours, what is the equivalent dose to oral morphine in 24 hours?

24mg

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6mg

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10mg

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2.4mg

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120mg

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A 65 year old man with a diagnosis of metastatic lung cancer is opiate naive and has been prescribed short acting morphine (elixir) at a dose of 5mg every four hours. He required an additional 10mg as breakthrough over the last 24 hours. His pain appears to be well controlled with this medication. So after 3 days, you decide to switch him over to a long acting preparation.

Which of the following dose would be the most appropriate long acting preparation?

M-Eslon 20mg twice daily plus 8mg of immediate release morphine for breakthrough pain

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M-Eslon 40mg twice daily plus 10mg of immediate release morphine for breakthrough pain

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M-Eslon 10mg twice daily plus 5mg of immediate release morphine for breakthrough pain

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M-Eslon 20mg twice daily without any breakthrough medication

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M-Eslon 30mg twice daily plus 10mg of immediate release morphine for breakthrough pain

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Which of the following is the most common side effect of opioid?

Constipation

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Nausea and vomiting

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Drowsiness

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Hallucinations

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Confusion

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Which of the following is the correct single dose equivalent?

60mg oral codeine = 6mg oral morphine

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100mg oral tramadol = 1mg oral morphine

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5mg oral oxycodone = 5mg oral morphine

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5mg subcut oxycodone = 10mg subcut morphine

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6mg oral hydromorphone = 6mg oral morphine

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Which of the following best describes the primary purpose of the Supportive and Palliative Care Indicators Tool (SPICT™)?

To help identify people whose health is deteriorating and assess them for unmet supportive and palliative care needs, planning their care accordingly.

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To exclusively manage pain in patients with terminal cancer.

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To identify patients who may benefit from a referral to a specialist palliative care service for complex symptom management.

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To serve as a diagnostic tool for determining the type of cancer a patient has.

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To replace detailed clinical assessments and discussions with patients about their care preferences.

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Which of the following tools is NOT used to describe patient function?

ECOG Performance Status

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Karnofsky Performance Status Scale (KPS)

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Barthel Index

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Resource Utilization Groups-Activities of Daily Living (RUG-ADL)

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Mini-Mental State Examination (MMSE)

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When conducting advanced care planning conversations with patients, which of the following is NOT recommended to encourage and support the process?

Initiate the conversation right before the patient loses their capacity to make decisions about their care.

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Communicate openly and honestly with patients about their prognosis and options.

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Offer to include a support person in the conversation or clarify how the patient likes to be supported in making decisions.

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Provide patients with alternative sources of information about their health and care.

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Ask patients what matters to them, including their expectations about their health and care, cultural and spiritual needs, and other personal preferences that may be important to their care experience.

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A 68-year-old male patient with terminal cancer, has expressed his wishes regarding end-of-life care. He has a strong desire for a dignified passing that aligns with his personal beliefs and comfort.

Which of the following aspects of his care plan would NOT directly contribute to fulfilling his wish for a good death?

Offering aggressive treatment aimed at extending his life by a few weeks, despite his poor prognosis.

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Administering analgesics to manage his pain effectively.

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Ensuring his family is prepared to perform his desired spiritual rituals at the time of death.

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Planning for his care to take place in his home, as it is his preferred place to pass.

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Providing emotional support and involving his close friends and family in his care.

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In the context of identifying biomarkers indicative of the final days to weeks of life in cancer patients, which of the following is NOT considered an evidence-based biomarker of dying?

Hypernatremia

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Elevated C-reactive protein (CRP)

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Leukocytosis

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Low albumin

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Elevated urea

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Which of the following medications is NOT commonly used for end-of-life (EOL) care to manage symptoms such as pain, agitation, nausea/vomiting, and respiratory secretions?

Tramadol

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Haloperidol

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Fentanyl citrate

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Hyoscine butylbromide

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Morphine

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A 54-year-old patient with metastatic breast cancer is started on an anti-emetic regimen by the hospice team for severe nausea and vomiting. Three days into treatment, the patient complains of sudden onset of difficulty in speaking and stiffness around her mouth and neck.

Her medical history is notable for hypothyroidism, and she is currently on levothyroxine.

Which anti-emetic medication is most likely responsible for these side effects?

Metoclopramide

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Ondansetron

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Domperidone

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Benzodiazepine

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Cyclizine

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A palliative patient with advanced Parkinson’s disease presents with symptoms of nausea and vomiting.

Which of the following anti-emetic medications is most appropriate for managing this patient’s symptoms?

Domperidone

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Metoclopramide

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Haloperidol

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Cyclizine

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Ondansetron

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A 63 year old male patient with end-stage liver disease (ESLD) presents with significant bleeding manifested as haematemesis and melena. The patient’s history reveals advanced malignancy and known coagulopathies associated with their liver condition. The patient expressed a wish to pursue active treatment.

In managing this acute bleeding episode, which of the following interventions is most appropriate?

Administer fresh frozen plasma and consider factor concentrates

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Administer Tranexamic Acid (TXA) 1g PO TDS

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Immediate surgery to control the source of bleeding

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Start continuous bladder irrigation for haematuria

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Apply dark towels and wait for crisis orders

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A 68-year-old patient with advanced myeloma presents with symptoms of severe hypercalcemia, including confusion, nausea, vomiting, and polyuria.

Laboratory tests confirm an adjusted calcium level of 3.2 mmol/L.

Which of the following interventions is least appropriate in the initial management of hypercalcemia of malignancy in this patient?

Increasing dietary calcium intake

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Administration of intravenous hydration followed by bisphosphonates

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Initiation of Denosumab therapy

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Administration of Calcitonin

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Starting Corticosteroids

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A 72-year-old patient with advanced lung cancer presents to the palliative care clinic with symptoms of major airway obstruction, manifesting as difficulty breathing, wheezing, and frequent coughing. The patient’s goals of care have been discussed, focusing on comfort and quality of life.

Which of the following is the most appropriate palliative management strategy for this patient’s airway obstruction?

Administration of opioids for symptom control

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Immediate bronchoscopy for dilation and stenting

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Administration of high-dose Dexamethasone

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Use of Benzodiazepines for anxiety relief

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Initiation of external beam radiation therapy

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A second year House Officer is assessing a patient and observing signs that may indicate the patient is entering the terminal phase of life.

Which of the following observations is least indicative of the patient entering the last hours of life?

The ability to only drink small sips of fluid.

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Breathing pattern changes, becoming irregular with periods of apnea.

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Fluctuating heart rate.

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Development of upper airway secretions, often referred to as "death rattle."

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Mottled skin

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When managing a dying person, which of the following actions is essential regarding medication management?

Cease non-comfort medications to focus on symptom management and comfort.

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Increase the dosage of life-prolonging medications to maximize the patient's lifespan.

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Continue all prescribed medications regardless of their impact on the patient's comfort.

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Introduce new medications for chronic conditions that have not been previously treated.

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Prophylactic antibiotics to prevent new infections during the terminal phase.

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Palliative Care Module 1

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