Term
WHO criteria for metabolic syndrome - 5 |
|
Definition
BP >140/90 or on anti-HTN TG >150 or HDL <39 BMI 30+ or W:H >0.85 insulin resistance or DM2 microalbuminia 20+ mcg/m or A:Cr 30+
need insulin resistance and 2 criteria OR no resistance and 3 criteria |
|
|
Term
combined metabolic syndrome criteria - 9 |
|
Definition
BP >130-140/85-90 or on anit-HTN waist >/= 35in W:H >0.85 BMI 30+ BG >/= 110 or insulin resistance TG >150 HDL <45-50 microalbumin >20 A:Cr >30 |
|
|
Term
management metabolic syndrome - 4 |
|
Definition
diet, exercise, weight loss, metformin |
|
|
Term
non-pregnant DM screening ACOG |
|
Definition
FHX, hx GDM, obesity -> fasting BG q3-5y |
|
|
Term
non-pregnancy DM screening ADA |
|
Definition
>45yo and obese OR BMI 25+ with risk factor do fasting or A1C |
|
|
Term
|
Definition
|
|
Term
lipid risk factors for DM2 |
|
Definition
|
|
Term
|
Definition
polyuria, polydypsia, weight loss + random glucose 200+ OR 2 of these - Fasting 126+, 2h 200+, A1C 6.5+ |
|
|
Term
diagnosis of pre-diabetes |
|
Definition
fasting 100-125 2h 140-199 A1c 5.7-6.4 |
|
|
Term
yearly prevention for DM - 7 |
|
Definition
optho, nutrition, foot exam, lipids, microalbumin (5y after onset DM1), EKG, flu |
|
|
Term
weight loss goal diabetes |
|
Definition
|
|
Term
when to start and add meds in DM2 |
|
Definition
3mo A1C 7+ start med 6mo still 7+ add another |
|
|
Term
A1C goal in DM, how often to monitor |
|
Definition
|
|
Term
MOA metformin / glucophage |
|
Definition
decreased hepatic glucose production, increased intestinal absorption, increased insulin action |
|
|
Term
glucophage - effect on weight gain, hypoglycemia, and CV events/mortality |
|
Definition
no weight changes or hypoglycemia decreased CV |
|
|
Term
thiazolidinediones - effect on weight gain, hypoglycemia, and CV events/mortality |
|
Definition
weight gain possible, no hypoglycemia increases HDL and decreased TG, can cause CHF |
|
|
Term
GLPL1 receptor agonist - effect on weight gain, hypoglycemia, and CV events/mortality |
|
Definition
weight loss, ?glycemia, no comment on cardio |
|
|
Term
DPP4 inhibitors - - effect on weight gain, hypoglycemia, and CV events/mortality |
|
Definition
no hypoglycemia, weight neutral no comment on cardio |
|
|
Term
|
Definition
tolbutamine, chlorpropramide, glyburide, glipizide, glimiperide |
|
|
Term
|
Definition
|
|
Term
GlP1 receptor agonists - 2 |
|
Definition
exenatide/buderon, liraglutide/victoza |
|
|
Term
|
Definition
stigliptin, vildagliptin, saxagliptin, linagliptin |
|
|
Term
|
Definition
invokana/canagglifolzin, faxiga/dapagliflozin, jardance/empagliflozin |
|
|
Term
|
Definition
increases insulin secretion |
|
|
Term
|
Definition
increased peripherial insulin sensitivity |
|
|
Term
GLP1 receptor agonists MOA |
|
Definition
glucagon like peptide 1, insulin secretion increased, glucagon secretion decreased, slows gastric emptying |
|
|
Term
|
Definition
inncreases incretin in gut, increases on demand insulin, decreases glucagon |
|
|
Term
|
Definition
|
|
Term
|
Definition
diarrhea, lactic acidosis, B12 deficiency |
|
|
Term
contraindications metformin - 1 |
|
Definition
|
|
Term
|
Definition
hypoglycemia, weight gain |
|
|
Term
thiazolidinediones SE - 4 |
|
Definition
weight gain, edema, CHF, bone fractures |
|
|
Term
GLP1 receptor agonist SE - 3 |
|
Definition
weight loss, GI sx, acute pancreatitis, medullary thyroid tumors |
|
|
Term
|
Definition
uticaria, angioedema, pancreatitis |
|
|
Term
|
Definition
yeast infection, fornuiers gangrene |
|
|
Term
how to divvy up insulin in a new DM2 needing meds |
|
Definition
0.6 U/kg/d, 1/2 at bedtime, 1/2 at meals |
|
|
Term
when to increase insulin in DM2 |
|
Definition
increase 2-4U if fasting >130 |
|
|
Term
|
Definition
aspart/novorapid glylizine/apidra lispro/humalog |
|
|
Term
short acting insulin types - 3 |
|
Definition
regular = humilinR, novilinR, grTronto |
|
|
Term
intermdiate insulin types - 2 |
|
Definition
NPH - humulinN, novolin NPH |
|
|
Term
long acting insulin types - 2 |
|
Definition
detemir/levemir glargine/lantus |
|
|
Term
rapid insulin - onset, peak, duration |
|
Definition
|
|
Term
short insulin - onset, peak, duration |
|
Definition
|
|
Term
intermediate insulin - - onset, peak, duration |
|
Definition
|
|
Term
long acting insulin - onset, peak, duration |
|
Definition
|
|
Term
what complications of DM might a type 2 be unable to control just with glucose control |
|
Definition
|
|
Term
most common complication of pregnancy |
|
Definition
|
|
Term
|
Definition
HPL and insulinase both made by placenta |
|
|
Term
criteria for early GDM screening |
|
Definition
BMI 25+ with one (FHX DM, inactivity, AA, latino, native A, asian , PI, prior >4000g, prior GDM, HTN, HDL <35, TG >250, PCOS, acanthosis, CVD)
BMI >40
A1C >5.7 |
|
|
Term
1h GTT is at how many weeks and how much glucose |
|
Definition
|
|
Term
|
Definition
increases diagnosis to 18% from 7% without improvement in outcomes and increased cost |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
pre-eclampsia/HTN, operative delivery, DM2, weight gain >40 lbs |
|
|
Term
|
Definition
1/3 remain DM postpartum, 50% lifetime risk |
|
|
Term
#1 and 2 most common fetal risks of GDM and % |
|
Definition
hypoglycemia 50% macrosomia 30-40% |
|
|
Term
congenital anomalies associated with GDM and % - 4 |
|
Definition
cardiac 2-5x ONTD 2-5x femoral hypoplasia unusual facies (20% of the syndrome patients were DM babies) caudal regression |
|
|
Term
fetal organ and metabolic changes associated with GDM - 7 |
|
Definition
polyhydraminos, HSM, cardiomeagly, RDS, hyperbilirubinemia, hypocalcemia, stillbirth |
|
|
Term
what increases the already increased risk of stillbirth in GDM - 2 |
|
Definition
poor glucose control, A1C >7 |
|
|
Term
fetal risk specific to maternal ketosis |
|
Definition
|
|
Term
incidence of polyhydraminos |
|
Definition
|
|
Term
definition polyhydraminos |
|
Definition
AFI >24, MVP >8, severe AFI 35+ |
|
|
Term
causes of polyhydraminos - 2 categories and % |
|
Definition
congenital 79%, idiopathic 50% |
|
|
Term
causes of polyhydraminos - 13 |
|
Definition
T18, GI abnormalities, chorioangina, CCAM, muscular dystrophy, ONTD, anancephaly, hydrancephaly, holoprosencephaly, DM, HTN, macrosomia, hydrops |
|
|
Term
GI anomalies associated with polyhydraminos - 6 |
|
Definition
esophageal atresia, TE fistula, SBO, hypoplastic jaw, swallowing disorders, abdominal wall defects |
|
|
Term
# of CD needed to prevent 1 brachial plexus injury |
|
Definition
|
|
Term
% of infants you thought were >4500g and really went |
|
Definition
|
|
Term
when you can offer CD for macrosomia in GDM |
|
Definition
|
|
Term
when to avoid operative delivery in macrosomia suspected patient |
|
Definition
>4000g, prolonged second stage |
|
|
Term
complications of fetal macrosomia - 3 |
|
Definition
shoulder, clavicle fracture, brachial plexus injury |
|
|
Term
causes of femoral hypoplasia unusual facies syndrome and % - 3 |
|
Definition
|
|
Term
sings of femoral hypoplasia unusual facies syndrome - 19 |
|
Definition
upslanting eyes, short nose long tip, elongated pithilrym, thin upper lip, macrognathia, clefts, low ears, hypoplastic femurs and UE, club foot, polydactyly, sindactyly, restricted elbow/shoulder ROM, inguinal hernias, pelvic/spinal abnormalities, PCKD/dysplasia, hypoplastic penis/labia, VSD, pulmonary stenosis, truncus arteriosis |
|
|
Term
prognosis femoral hyopoplasia unusual facies syndrome |
|
Definition
|
|
Term
caudal regression signs - 5 |
|
Definition
sacral agenesis, sineromelia, renal agenesis, anal agensis, single umnbilical artery |
|
|
Term
recommended kcal/d in GDM ideal, overweight morbid, underweight |
|
Definition
under - 40 ideal - 30 over - 25 morbid - 15 |
|
|
Term
how meals are divided up in GDM |
|
Definition
10% breakfast 20% lunch 30% dinner 30% snacks |
|
|
Term
how macros are broken down GDM |
|
Definition
40% carbs (complex high fiber) 20% protein 40% fats (<7% saturated) |
|
|
Term
how many carbs per meal in GDM |
|
Definition
|
|
Term
why do we use 1h PP in GDM - 4 |
|
Definition
decreased A1c, better control, less macrosomia, lower CD |
|
|
Term
goal fasting, 1h, 2h glucose GDM |
|
Definition
fast - 95 1h - 140 2h - 120 |
|
|
Term
when to start or increase insulin GDM |
|
Definition
|
|
Term
how much insulin to use per Kg in 1-3T |
|
Definition
1T 0.7 2T 0.8 3T 0.9 term 1.0 resistant... 1-2 |
|
|
Term
how to break down insulin to start meds in GDM |
|
Definition
calculate daily - 2/3AM, 1/3PM AM - 2/3 NPH, 1/3 rapid PM- 1/2 NPH, 1/2 rapid |
|
|
Term
how to use carb ratio instead of rapid insulin |
|
Definition
total units rapid needed a day / 500 = #
carb ration is 1:# |
|
|
Term
why is metofmrin not first line |
|
Definition
26-46% will need insulin evuntally |
|
|
Term
|
Definition
2.5mg HS for elevated fasting 2.5mg breakfast for elevated PP max 10mg/d |
|
|
Term
why isnt glyburide used anymore - 6 |
|
Definition
infant and maternal hypoglycemia and macrosomia, 4-16% will require insulin anyways, increased birth injury |
|
|
Term
in GDM what does exercise help reduce |
|
Definition
|
|
Term
|
Definition
check q2h, if >120 start drip at 1.25 U/h, stop if <70 and give 100-150 D5 |
|
|
Term
|
Definition
impaired: fasting 100-125, 2h 140-199 diabetes: fasting >126, 2h >200 |
|
|
Term
how much glucose in 2h GTT |
|
Definition
|
|
Term
when is a PP glucose test done |
|
Definition
|
|
Term
if mom doesnt get PP diabetes, when is the next time she needs screenign |
|
Definition
|
|
Term
3 methods for diagnosis of HTN |
|
Definition
12-14 home values, continuous ambulatory values, 2 office values 2wk apart |
|
|
Term
4 requirements when taking a BP |
|
Definition
seated for 5min, arm at level of heart, no caffeine or smoking within 30min |
|
|
Term
values for each stage of HTN |
|
Definition
normal <120/80 elevated <130/80 stage 1 <140/90 stage 2 >140/90 |
|
|
Term
when do you start meds for HTN |
|
Definition
130-140/90 if risk factors, >140/90 start meds |
|
|
Term
when do you add a second HTN medication |
|
Definition
|
|
Term
what are the target BP goals for HTN |
|
Definition
<130/80 for most, <140/90 if labile BP, orthostatic hypotension, medication SE, >70yo, frail |
|
|
Term
what is the follow up schedule for HTN medication starts |
|
Definition
routine in 4-6wk, urgency q1wk |
|
|
Term
|
Definition
EKG to rule out LVH, Cr to rule out renal, P:Cr if Cr is high, K+ to rule out aldosterone, renin:ald if K+ is high |
|
|
Term
lifestyle modifications for HTH in order from most mmHg reduction to least - 5 |
|
Definition
weight loss, diet change, exercise, Na reduction, smoking (no data on mmHg) |
|
|
Term
how much does exercise decrease HTN |
|
Definition
|
|
Term
how much does diet decrease HTN |
|
Definition
|
|
Term
how much does weight loss decrease HTN |
|
Definition
|
|
Term
how much does Na reduction decrease HTN |
|
Definition
|
|
Term
5 risk factors for essential HTN |
|
Definition
Na, alcohol >2/d, obesity, AA, FHX |
|
|
Term
causes of secondary HTN - 10 |
|
Definition
renal, OSA, obesity, drugs, hyperthyroid, hyperparathyroid, aortic coarctation, cushings, pheochromocytoma, parimary hyper Ald / conns |
|
|
Term
signs of renal disease causing HTN - 9 |
|
Definition
bruit, hematuria, edema, severe HTN >55yo, increased Cr after ACEI, UL small or big/palpable kidney, increased Cr, proteinuria |
|
|
Term
3 drugs that can cause HTN |
|
Definition
|
|
Term
signs of hyperparathyroidism - 8 |
|
Definition
bone pain, kidney stones, psych disorders, polyuria, weight loss, weakness, apathy, Ca abnormalities |
|
|
Term
signs of aortic coarctation - 10 |
|
Definition
usually asymptomatic, HA, leg fatigue, epistaxis, pulse in neck, delayed peripherial pulses, bruit over back, BP different in each arm, CXR notching / 3 sign, abnormal ECHO |
|
|
Term
signs of cushings disease - 9 |
|
Definition
emotionally labile, muscle weakness, bruising, moon facies, central obesity, striae, osteoporosis, DM, hirsturism |
|
|
Term
test for cushings disease |
|
Definition
|
|
Term
signs of pheochromocytoma - 9 |
|
Definition
palpitations, pallor, sweating, CP, HA, abd pain, tremor, weight loss, anxiety |
|
|
Term
diagnosis of pehochromocytoma |
|
Definition
urine and serum metanepherines |
|
|
Term
lab changes in primary hypoaldosteronism - 2 |
|
Definition
|
|
Term
4 requirements if on OCPs with HTN |
|
Definition
well controlled, non-smoker, no vascular disease, <35yo |
|
|
Term
|
Definition
<180/120 without end organ damage |
|
|
Term
|
Definition
medication non-compliance |
|
|
Term
management of HTN urgency |
|
Definition
goal <160/100 in hours to days, outpatient, q1wk check in |
|
|
Term
define HTN emergency - 6 parts |
|
Definition
>180/120 with end organ dysfunction - brain, visual changes, renal, cardiac, pulmonary, hemoglobin |
|
|
Term
management of BP in HTN urgency |
|
Definition
drop MAP by 10-20% in 1h then 5-15% in 23h, slowly reintroduce PO meds and wean off drip |
|
|
Term
what does rapid HTN reversal cause |
|
Definition
|
|
Term
meds used in drip for HTN emergency - 4 |
|
Definition
nitroprusside (not ideal), nicardipine, labetalol, enlaprilat |
|
|
Term
complications of nitroprusside drip |
|
Definition
tachyphylaxis - diminishing response to successive doses of the drug |
|
|
Term
what HTN meds are used in someone without comorbidities - 4 |
|
Definition
|
|
Term
what HTN medications are used in CHF - 5 |
|
Definition
ACEI, ARB, BB, HCTZ, aldosterone antagonists |
|
|
Term
what medications are used in HTN with recent MI - 4 |
|
Definition
ACEI, ARB, BB, aldosterone antagonist |
|
|
Term
what medications are usedin HTN with CKD - 2 |
|
Definition
|
|
Term
what HTN medications are used in CAD - 2 |
|
Definition
|
|
Term
what HTN medications are used in AFib/flutter for rate control - 2 |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
500-3000mg/d in 2-3 doses |
|
|
Term
|
Definition
|
|
Term
fetal SE of labetalol - 3 |
|
Definition
IUGR, bradycardia, hypoglycemia |
|
|
Term
maternal SE of labetalol - 8 |
|
Definition
bronchospasm, increased uterine tone, CHF, headache, fatigue, elevated TG/VDRL, lowers HDL |
|
|
Term
contraindications to labetalol - 3 |
|
Definition
asthma, acute systolic CHF, conduction abnormalities |
|
|
Term
|
Definition
vasodilation and decreased CO by inhibiting catecholamines at B adrenergic receptor |
|
|
Term
|
Definition
vasodilation by blocking Ca uptake |
|
|
Term
|
Definition
HA, tachycardia, orthostatic hypotension, edema, MI in CAD |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
sedation, elevated LFT / hepatitis, hemolysis, fever, depression |
|
|
Term
|
Definition
|
|
Term
|
Definition
dizziness, headache, dry mouth |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
decrease plasma volume, venous return, CO, PVR by blocking Na reabsorption in distal convoluted tubule |
|
|
Term
|
Definition
|
|
Term
|
Definition
volume depletion, electrolyte abnormalities, increased UA, low PLT, hypokalemia, arrhythmia |
|
|
Term
what med should you be careful with on HCTZ and why |
|
Definition
muscle relaxants, low K can potentiate their action |
|
|
Term
monitoring required if on HCTZ |
|
Definition
Cr and K 2wk post initiation |
|
|
Term
|
Definition
|
|
Term
|
Definition
flushing, headache, SLE like reaction, tachycardia, hypotension |
|
|
Term
|
Definition
|
|
Term
SE nitroprusside fetal - 1 |
|
Definition
|
|
Term
|
Definition
cyanide toxicity, headache, nausea, vomiting |
|
|
Term
|
Definition
HA, tachycardia, methemoglobinemia |
|
|
Term
contraindication nitroglycerine - 1 |
|
Definition
|
|
Term
why don't we use atenolol in pregnancy |
|
Definition
|
|
Term
|
Definition
renal dysplasia, anuria/oligo, arterial hypotension, IUGR, RDS, pulmonary hypoplasia, limb defects, death |
|
|
Term
why do you DC ACEI pre-op |
|
Definition
prolonged hypotension during surgery |
|
|
Term
|
Definition
cough 5-35% that improves in 1-4wk post DC, hyperkalemia, angioedema |
|
|
Term
monitoring if on ACEI - 3 |
|
Definition
Cr and K in 1-2wk after starting, if takes NSAIDS monitor Cr |
|
|
Term
|
Definition
blocks angiotensin II Causing arterial and venous dilation and natiuresis |
|
|
Term
|
Definition
blocks NE vasoconstriction in vascular smooth muscle |
|
|
Term
|
Definition
syncope after 1st dose, stress incontinence, weakness, dizziness, decreased cholesterol and LDL, increased HDL |
|
|
Term
|
Definition
direct relaxation of arterial wall smooth muscle |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
#1 cause of death in women |
|
Definition
cardiovascular disease 44% |
|
|
Term
risk reduction for cardiovascular disease - 8 |
|
Definition
stop smoking, DASH, exercise, weight loss, control BP, control glucose, control lipids, ASA 81mg/d |
|
|
Term
who gets ASA for cardiovascular disease prrevention |
|
Definition
|
|
Term
describe cardiac chest pain - 8 |
|
Definition
exertional, <20min, squeezing, heaviness, radiation, nausea, diaphoresis, agitation |
|
|
Term
what are the 2 cardiac enzymes and their onset, peak, duration |
|
Definition
CPK - O 3-12h, P 18-24h, D 36-48h TROP - O 3-13h, P 18-24h, D 10d |
|
|
Term
|
Definition
MONA BAAA - morphine, O2 if low, nitro SL x3, ASA 325mg chewed, BB/metoprolol 25mg PO, atorvastatin 80mg PO, anti-PLT/tricagrelor, anti-coag |
|
|
Term
how do you choose an anticoagulant in an MI |
|
Definition
if going to PCI to heparin, if doing fibrinolytic do lovenox |
|
|
Term
how do you management a suspected CVA - acronym |
|
Definition
ACT GET CT - airway, circulation, temp, glucose, EKG, tox screen, CT |
|
|
Term
when do you intubate in CVA - 2 |
|
Definition
hypoventilation, vomiting |
|
|
Term
|
Definition
<185/100, <200/100 if not getting thrombolytic, decrease 15% in 24h |
|
|
Term
when does fever occurring during a CVA |
|
Definition
|
|
Term
why is fever concerning during a CVA |
|
Definition
|
|
Term
why do you get glucose in a suspected CVA |
|
Definition
hypoglycemia can present like CVA |
|
|
Term
when should CT be done in CVA |
|
Definition
|
|
Term
other labs not in the acrynm you should get in a CVA - 6 |
|
Definition
hCG, CBC, CMP, INR, PTT, cardiac enzymes, don't forget to oxygenate |
|
|
Term
inclusion criteria for thrombolytic for CVA |
|
Definition
|
|
Term
exclusion criteria for thrombolytic for CVA - 9 |
|
Definition
trauma/CVA within last 3mo, concern for SAH, BP >180/110, active bleeding, warfarin with increased INR, heparin with increased PTT, low PLT, abnormal glucose, bleeding suggested on CT |
|
|
Term
|
Definition
freidwald equation = LDL = total -HDL -(TG/5) |
|
|
Term
what should you always correct before treating LDL |
|
Definition
|
|
Term
|
Definition
total <170, LDL <100, HDL >45 |
|
|
Term
|
Definition
total <200, LDL <100, HDL >50 |
|
|
Term
management of hyperlipidemia 0-19yo |
|
Definition
lifestyle modifications, assess for familial hyperlipidemia syndrome and treat if has that |
|
|
Term
management of hyperlipidemia 29-30yo |
|
Definition
lifestyle modifications, assess if early FHX hyperlpipidemia or assess if DL >160 |
|
|
Term
management of HLD 40-75yo is guided by |
|
Definition
|
|
Term
management of HLD based on ASCVD risk |
|
Definition
- <5% - lifestyle - 5-7.5% - LS, Rx if risks - 7.5-20% - LS, moderate statin (high dose if risks) - >20% - LS, high dose statin |
|
|
Term
what are 3 things where you would just jump to a high dose statin regardless of ASCVD |
|
Definition
DM with risk factors, vascular disease, LDL >190 |
|
|
Term
at what age do you consider not starting hyperlipidemia medications |
|
Definition
|
|
Term
contraindications to statins - 3 |
|
Definition
pregnancy, myopathy, liver disease |
|
|
Term
|
Definition
elevated LFT, liver failure, muscle pain, rhabdo |
|
|
Term
|
Definition
|
|
Term
|
Definition
atorvastatin 40/80mg, rotuvostatin 20/40mg |
|
|
Term
moderate dose statins - 4 |
|
Definition
atorvastatin 10/20mg, rotuvostatin 5/10, simvastatin 20/40, pravastatin 40/80 |
|
|
Term
3 things other than statins used to treat HLD |
|
Definition
PC5K inhibitors (repatha, proluvent), O3 FA (vascepa, lovaza), emtricitibine |
|
|
Term
|
Definition
|
|
Term
how much LDL is needed to really protect cardiovascular |
|
Definition
|
|
Term
2 things that increase LDL and which is best |
|
Definition
niacin (increases it but no CV benefit), exercises (increases it and CV benefit) |
|
|
Term
after starting statin when do you follow up and what is the goal |
|
Definition
6-12wk, LDL decreased by 50% (high dose) or 25% (mod dose), LDL <100 (or <70 if risk factors) |
|
|
Term
what do you do if someone does not meet their LDL goals at follow up after statin |
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Definition
educate on lifestyle and medication adherence, follow up again 6wk, if still not meeting goal increase dose or add an agent |
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Term
if someone has HLD what labs should you get - 4 |
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Definition
glucose, TSH, hCG, urine protein |
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