Surgical Management Of Vaginal Vault Prolapse! Trivia Questions Quiz

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Surgical Management Of Vaginal Vault Prolapse! Trivia Questions Quiz - Quiz

Welcome to the trivia questions quiz on the Surgical Management of Vaginal Vault Prolapse! This condition is when the upper portion of the vagina sags or drops into the vaginal canal or outside. Doctors may opt to have a hysterectomy or give vaginal vault suspension to give their patients a chance at a normal life. Take the quiz, and see what you know about these two options for a patient.


Questions and Answers
  • 1. 

    A 44-year-old woman (gravida 5, para 5) comes in complaining that she has noticed a bulge protruding from her vagina. Her other medical problems include hypertension, diabetes mel-litus, and alcoholism. She stands at work as a grocery clerk. She has a family history of genital prolapse. On examination, you notice a uterine prolapse, cystocele, and rectocele. Which of the following is a major risk factor for her pelvic support disorder?

    • A.

      Childbirth

    • B.

      Hypertension

    • C.

      Diabetes mellitus

    • D.

      Positive family history

    • E.

      Environmental factors—job

    Correct Answer
    A. Childbirth
    Explanation
    Childbirth is a major risk factor for pelvic support disorders such as uterine prolapse, cystocele, and rectocele. The woman in the case has had five pregnancies and deliveries (gravida 5, para 5), which increases her risk for developing these conditions. Additionally, her family history of genital prolapse further supports the association between childbirth and pelvic support disorders. The other factors mentioned, such as hypertension, diabetes mellitus, and her job as a grocery clerk, may contribute to pelvic floor weakness but are not as significant as childbirth in this case.

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  • 2. 

    A 49-year-old parous woman comes in complaining that over the last several years, it feels as though “her organs are progressively falling out her vagina.” She also complains of losing urine with coughing, occasional urgency, and sometimes a feeling of incomplete emptying of her bladder with voiding. On further examination,whichoftheabove-mentioned options will you likely find?

    • A.

      Cystocele

    • B.

      Rectocele

    • C.

      Enterocele

    • D.

      Hemorrhoid

    Correct Answer
    A. Cystocele
    Explanation
    In this case, the likely finding on further examination would be a cystocele. A cystocele is a herniation of the bladder into the anterior vaginal wall, which can cause symptoms such as a sensation of organs falling out of the vagina, urinary incontinence with coughing, urgency, and incomplete bladder emptying. A rectocele is a herniation of the rectum into the posterior vaginal wall, an enterocele is a herniation of the small intestine into the vaginal vault, and a hemorrhoid is a swollen vein in the rectum or anus. None of these options align with the patient's symptoms.

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  • 3. 

    A 56-year-old woman complains that she is “sitting on a ball.” She says constipation is a significant problem and that sometimes she needs to push the stool out of her rectum by inserting a finger in the vagina and pressing on a bulge. On further examination, which of the above-mentioned options will you most likely find?

    • A.

      Rectocele 

    • B.

      Cystocele

    • C.

      Enterocele 

    • D.

      Hemorrhoid

    Correct Answer
    A. Rectocele 
    Explanation
    On further examination, the most likely finding would be a rectocele. A rectocele is a bulge or herniation of the front wall of the rectum into the back wall of the vagina. This can occur due to weakened pelvic floor muscles and connective tissues, often as a result of childbirth or aging. The symptoms described by the woman, including the sensation of sitting on a ball, constipation, and the need to manually push stool out of the rectum, are consistent with a rectocele. A cystocele is a similar condition involving the bladder, an enterocele is a herniation of the small intestine, and a hemorrhoid is a swollen blood vessel in the rectum or anus.

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  • 4. 

    A 68-year-old woman complains of something falling out of her vagina, and she thinks it causes a constant backache. The backache is least symptomatic when she gets up in the morning and worsens as the day goes on. She says she cannot understand why she has this because 4 years ago she had an abdominal hysterectomy and urethral suspension (Burch procedure) to correct the “falling out” and some problem with urine loss. Her ability to hold her urine is excellent since the first surgery. Given her history, on the examination which of the above-mentioned do you expect to find?

    • A.

      Enterocele

    • B.

      Cystocele

    • C.

      Rectocele

    • D.

      Hemorrhoid

    Correct Answer
    A. Enterocele
    Explanation
    Based on the patient's symptoms and history of previous surgeries, the expected finding on examination would be an enterocele. An enterocele is a type of pelvic organ prolapse where the small intestine protrudes into the vagina. This can cause a sensation of something falling out of the vagina and can also contribute to backache, which worsens throughout the day due to gravity and increased intra-abdominal pressure. The previous surgeries she had may have addressed the urinary incontinence issue but did not prevent the development of an enterocele.

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  • 5. 

    A 90-year-old woman comes to your office complaining that she feels as though she is “sitting on a ball.” On examination, you find that the vagina is essentially turned inside out, and the entire uterus lies outside the vaginal introitus. This condition is known as which of the following?

    • A.

      Fourth-degree prolapse or procidentia

    • B.

      Vaginal evisceration

    • C.

      Third-degree prolapse

    • D.

      Second-degree prolapse

    • E.

      First-degree prolapse

    Correct Answer
    A. Fourth-degree prolapse or procidentia
    Explanation
    The condition described in the question, where the entire uterus lies outside the vaginal introitus, is known as fourth-degree prolapse or procidentia. This is the most severe form of uterine prolapse, where the uterus completely protrudes outside the vagina. Vaginal evisceration refers to the protrusion of abdominal contents through a vaginal defect. Third-degree prolapse refers to the descent of the cervix to the level of the vaginal introitus. Second-degree prolapse refers to the descent of the cervix but not reaching the vaginal introitus. First-degree prolapse refers to the descent of the uterus but still remaining within the vagina.

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  • 6. 

    A 54-year-old postmenopausal woman G4P4 presents with a complaint of vaginal fullness and pressure. Figure 19–1 depicts a visual drawing of your examination findings on pelvic examination, including split speculum examination. The letter A represents which of the following? (grafico)

    • A.

      Enterocele

    • B.

      Sigmoidocele 

    • C.

      Rectocele

    • D.

      Cystocele

    Correct Answer
    A. Enterocele
    Explanation
    Based on the description provided, the visual drawing on pelvic examination, and the letter A representing the finding, the correct answer is enterocele. An enterocele is a type of pelvic organ prolapse where the small intestine protrudes into the vaginal canal. This can cause symptoms of vaginal fullness and pressure, which aligns with the patient's complaint.

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  • 7. 

    An 18-year-old nulliparous woman comes into your office, complaining of a 24-hour history of urinary frequency, urgency, and suprapubic pain. She had intercourse for the first time earlier this week. She is using a diaphragm for birth control. Which of the following statements reflects current knowledge about uncomplicated urinary tract infections?

    • A.

      In women who have frequent UTIs related to coitus, infection can be prevented with low-dose postcoital antibiotics.

    • B.

      A teenager is more likely to have asymptomatic bacteriuria than is a postmenopausal woman.

    • C.

      Use of a diaphragm helps prevent the development of UTIs.

    • D.

      In a freshly voided, clean-catch urine specimen, leukocyte esterase and nitrites, in combination have a poor test performance in diagnosing UTI.

    • E.

      Cystitis occurs two times more commonly in men than in women.

    Correct Answer
    A. In women who have frequent UTIs related to coitus, infection can be prevented with low-dose postcoital antibiotics.
    Explanation
    The correct answer states that in women who have frequent UTIs related to coitus, infection can be prevented with low-dose postcoital antibiotics. This means that taking a low dose of antibiotics after sexual intercourse can help prevent UTIs in women who frequently experience them after having sex. This is a current knowledge about uncomplicated urinary tract infections and a recommended preventive measure for this specific group of women.

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  • 8. 

    A woman complains of postvoid dribbling of urine when she stands, painful intercourse, and dysuria. She has no other symptoms. Which of the following is she most likely to have?

    • A.

      A urethral diverticulum

    • B.

      Genuine urinary stress incontinence

    • C.

      Detrusor instability

    • D.

      A urinary fistula

    • E.

      UTI

    Correct Answer
    A. A urethral diverticulum
    Explanation
    The woman's symptoms of postvoid dribbling of urine, painful intercourse, and dysuria are suggestive of a urethral diverticulum. A urethral diverticulum is a pocket or pouch that forms in the urethra, which can cause urine to collect and lead to postvoid dribbling. Painful intercourse and dysuria can occur if the diverticulum becomes infected or inflamed. Genuine urinary stress incontinence is unlikely as it typically presents with leakage of urine during activities that increase intra-abdominal pressure, such as coughing or sneezing. Detrusor instability refers to involuntary contractions of the bladder, which would present with urgency and frequency of urination. A urinary fistula would typically present with continuous leakage of urine. UTI is a possibility, but the specific symptoms described are more consistent with a urethral diverticulum.

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  • 9. 

    A 38-year-old multigravid woman complains of the painless loss of urine, beginning immediately with coughing, laughing, lifting, or straining. Immediate cessation of the activity stops the urine loss after only a few drops. Which of the following is this history most suggestive of?

    • A.

      Stress incontinence

    • B.

      Urge incontinence

    • C.

      Fistula

    • D.

      Urethral diverticulum

    • E.

      UTI

    Correct Answer
    A. Stress incontinence
    Explanation
    This history is most suggestive of stress incontinence. Stress incontinence is characterized by the loss of urine during activities that increase intra-abdominal pressure, such as coughing, laughing, lifting, or straining. The urine loss is painless and stops immediately when the activity is ceased. This is different from urge incontinence, which is characterized by a sudden and strong need to urinate, and the inability to hold urine long enough to reach the toilet. Fistula and urethral diverticulum can also cause urinary leakage, but they are typically associated with other symptoms such as pain or discomfort. UTI may cause symptoms such as frequent urination or burning sensation, but it is not typically associated with painless urine loss during specific activities.

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  • 10. 

    Kegel exercises were designed to do which of the following?

    • A.

      Improve the tone of the muscles surrounding the bladder base and proximal bladder neck

    • B.

      Prevent denervation of pelvic muscles after childbirth

    • C.

      Decrease the muscle atrophy associated with aging

    • D.

      Increase the blood flow to the perineum to speed the healing of an episiotomy

    • E.

      Strengthen the abdominal muscles after childbirth

    Correct Answer
    A. Improve the tone of the muscles surrounding the bladder base and proximal bladder neck
    Explanation
    Kegel exercises were specifically designed to improve the tone of the muscles surrounding the bladder base and proximal bladder neck. These exercises involve contracting and relaxing the pelvic floor muscles, which helps to strengthen and tone them. By doing so, Kegel exercises can help to improve bladder control, reduce urinary incontinence, and enhance sexual satisfaction.

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  • 11. 

    A 10-year-old patient’s mother gives a history of the child constantly wetting herself, requiring the continuous use of diapers since birth. The child is otherwise very healthy and happy and does well in school. Which of the following diagnoses would most closely fit this clinical history?

    • A.

      Ectopic ureter with fistula to the vagina

    • B.

      Maternal anxiety

    • C.

      Stress incontinence

    • D.

      Urethral diverticula

    • E.

      Vesicovaginal fistula

    Correct Answer
    A. Ectopic ureter with fistula to the vagina
    Explanation
    The given clinical history of a 10-year-old patient constantly wetting herself and requiring the continuous use of diapers since birth suggests a congenital abnormality. Ectopic ureter with fistula to the vagina is a condition where the ureter, which normally carries urine from the kidney to the bladder, does not connect properly to the bladder and instead connects to the vagina. This abnormal connection can lead to continuous urinary leakage and the need for diapers. The fact that the child is otherwise healthy and does well in school supports the diagnosis of ectopic ureter with fistula to the vagina.

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  • 12. 

    A 52-year-old postmenopausal woman complains of urinary frequency, urgency, and urge incontinence. She is otherwise healthy. Which of the following should be included in the behavioral treatment you recommend?

    • A.

      Bladder retraining

    • B.

      Relaxation techniques

    • C.

      Anticholinergic medication

    • D.

      Voiding every hour during the daytime

    Correct Answer
    A. Bladder retraining
    Explanation
    Bladder retraining should be included in the behavioral treatment for this postmenopausal woman with urinary frequency, urgency, and urge incontinence. Bladder retraining involves gradually increasing the time between voiding to help the bladder regain control and reduce urgency and frequency. This technique can be effective in improving bladder function and reducing symptoms. Relaxation techniques may also be beneficial in managing stress and reducing urgency, but they are not specifically mentioned in the question. Anticholinergic medication may be considered as a pharmacological treatment option, but the question specifically asks for a behavioral treatment. Voiding every hour during the daytime is not a recommended approach as it may reinforce the urge and frequency symptoms.

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  • 13. 

    A 35-year-old woman (gravida 4, para 4) complains that she loses urine intermittently and without warning. At other times, she cannot get to the bathroom in time when she first feels the urge to void and also loses urine. She denies dysuria or loss of urine with exercise. Pelvic examination is normal, except for a first-degree cystocele. Postvoid residual is 150 mL. Of the following options, which is the best plan?

    • A.

      Perform urodynamic testing looking for a neurogenic bladder

    • B.

      Give her a trial of anticholinergic medication

    • C.

      Do an intravenous pyelogram (IVP) looking for a urinary fistula

    • D.

      Teach clean intermittent self-catheterization

    • E.

      Instruct in Kegel exercises

    Correct Answer
    A. Perform urodynamic testing looking for a neurogenic bladder
    Explanation
    The patient's symptoms of urinary incontinence and urgency suggest a possible neurogenic bladder, which is a dysfunction of the nerves that control bladder function. Urodynamic testing is the best plan to evaluate the bladder function and determine the cause of the symptoms. This test measures various parameters such as bladder pressure, urine flow rate, and bladder capacity to assess the coordination and function of the bladder muscles and nerves. This will help in making an accurate diagnosis and guiding appropriate management. The other options such as anticholinergic medication, IVP, self-catheterization, and Kegel exercises may be considered as treatment options depending on the underlying cause identified through urodynamic testing.

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  • 14. 

    Which of the following is the most common cause of rectovaginal fistula?

    • A.

      Obstetrical delivery

    • B.

      Irradiation to the pelvis

    • C.

      Carcinoma

    • D.

      Hemorrhoidectomy

    • E.

      Crohn’s disease

    Correct Answer
    A. Obstetrical delivery
    Explanation
    Rectovaginal fistula is an abnormal connection between the rectum and vagina. It is most commonly caused by obstetrical delivery, particularly difficult or prolonged deliveries that result in trauma to the tissues between the rectum and vagina. This can lead to a tear or hole in the tissue, creating the fistula. Other causes such as irradiation to the pelvis, carcinoma, hemorrhoidectomy, and Crohn's disease can also lead to rectovaginal fistula, but they are less common compared to obstetrical delivery.

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  • 15. 

    If a rectovaginal fistula is identified, which of the following should initial treatment include?

    • A.

      Vaginal repair of the fistula

    • B.

      Systemic steroids and antibiotics

    • C.

      Rectal pull-through operation

    • D.

      Bowel resection

    Correct Answer
    A. Vaginal repair of the fistula
    Explanation
    The initial treatment for a rectovaginal fistula should include vaginal repair of the fistula. This is because a rectovaginal fistula is an abnormal connection between the rectum and the vagina, which can result in the passage of stool through the vagina. Vaginal repair of the fistula aims to close the abnormal connection and restore normal anatomy and function. Systemic steroids and antibiotics may be used as adjunctive treatments to reduce inflammation and prevent infection, but they are not the primary treatment for the fistula. Rectal pull-through operation and bowel resection are not appropriate initial treatments for a rectovaginal fistula.

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  • 16. 

    Fecal incontinence is most likely related to which of the following?

    • A.

      Innervation of the pelvic floor and the anal sphincters

    • B.

      Interplay between the pubococcygeus muscle and rectum

    • C.

      Normal colonic transit time

    • D.

      Urinary retention

    • E.

      Nulliparity

    Correct Answer
    A. Innervation of the pelvic floor and the anal sphincters
    Explanation
    Fecal incontinence refers to the inability to control bowel movements, resulting in involuntary leakage of stool. The correct answer, "innervation of the pelvic floor and the anal sphincters," provides a plausible explanation for this condition. The pelvic floor muscles and anal sphincters play a crucial role in maintaining continence by contracting and relaxing to control the passage of stool. Any disruption or dysfunction in the innervation of these muscles can lead to fecal incontinence. This can be caused by various factors such as nerve damage, trauma, or certain medical conditions affecting the nervous system.

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  • 17. 

    When performing a vaginal hysterectomy for any indication, prevention of future enterocele or vaginal vault prolapse is aided by which of the following?

    • A.

      Reattachment of the cardinal and uterosacral ligaments to the vaginal cuff

    • B.

      Complete a purse string suture closure of the cul-de-sac peritoneum

    • C.

      Placing a vaginal pack for 24 hours postoperatively

    • D.

      Closing the vaginal mucosa

    • E.

      Reattachment of the round ligaments to the vaginal cuff

    Correct Answer
    A. Reattachment of the cardinal and uterosacral ligaments to the vaginal cuff
    Explanation
    When performing a vaginal hysterectomy, the cardinal and uterosacral ligaments are detached from the uterus. By reattaching these ligaments to the vaginal cuff, it helps to provide support to the vaginal vault and prevent future enterocele or vaginal vault prolapse. This reattachment helps to maintain the integrity and support of the pelvic floor.

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  • 18. 

    A 30-year-old woman complains of 36 hours of urinary frequency, dysuria, and pelvic pain. She has never had a UTI and has no medical problems. Which of the following is the most likely pathogen?

    • A.

      Escherichia coli

    • B.

      Staphylococcus saprophyticus

    • C.

      Klebsiella pneumonia

    • D.

      Proteus mirabilis

    • E.

      Enterococci

    Correct Answer
    A. Escherichia coli
    Explanation
    The most likely pathogen in this case is Escherichia coli. This is because E. coli is the most common cause of urinary tract infections (UTIs), accounting for approximately 80-90% of cases. The patient's symptoms of urinary frequency, dysuria, and pelvic pain are consistent with a UTI, and since she has never had a UTI before, it is likely that she has been exposed to E. coli for the first time. Other pathogens listed, such as Staphylococcus saprophyticus, Klebsiella pneumonia, Proteus mirabilis, and enterococci, can also cause UTIs, but they are less common than E. coli.

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  • 19. 

    Which of the following is the recommended treatment regimen?

    • A.

      3-day course of trimethoprim-sulfamethoxazole (TMP-SMZ)

    • B.

      7-day course of tetracycline

    • C.

      7-day course of ciprofloxacin

    • D.

      3-day course of amoxicillin

    • E.

      7-day course of erythromycin

    Correct Answer
    A. 3-day course of trimethoprim-sulfamethoxazole (TMP-SMZ)
    Explanation
    The recommended treatment regimen is a 3-day course of trimethoprim-sulfamethoxazole (TMP-SMZ) because it is the most effective and appropriate treatment for the condition described in the question. The other options, such as tetracycline, ciprofloxacin, amoxicillin, and erythromycin, may not be as effective or may have more side effects compared to TMP-SMZ. Therefore, the 3-day course of TMP-SMZ is the best choice for treatment.

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  • 20. 

    If the patient is pregnant and in the third trimester, which of the following is the appropriate therapy?

    • A.

      3- to 7-day course of nitrofurantoin

    • B.

      1-day course of nitrofurantoin

    • C.

      3- to 7-day course of amoxicillin/clavulanic acid (Augmentin)

    • D.

      3- to 7-day course of TMP-SMZ

    Correct Answer
    A. 3- to 7-day course of nitrofurantoin
    Explanation
    Nitrofurantoin is the appropriate therapy for a pregnant patient in the third trimester. It is commonly used to treat urinary tract infections (UTIs) during pregnancy due to its safety profile. Nitrofurantoin is effective against most common urinary tract pathogens and has a low risk of adverse effects on the fetus. A 3- to 7-day course is typically recommended to ensure complete eradication of the infection. Other options, such as amoxicillin/clavulanic acid and TMP-SMZ, may have potential risks to the fetus and are generally avoided in pregnancy unless there are no alternative options available.

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  • 21. 

    A 49-year-old woman had a radical hysterectomy and lymph node sampling for stage 1B squamous cell cancer of the cervix. A suprapubic catheter was placed at the time of surgery. She is now 8 weeks postoperative and has not been able to void. She is also leaking urine with activity, coughing, and sneezing. What is the most likely reason for voiding difficulty?

    • A.

      Innervation to the lower urinary tract was transected

    • B.

      Overdistention of the bladder

    • C.

      Postoperative swelling around the bladder

    • D.

      Outflow obstruction

    • E.

      Spasm of the pelvic floor muscles

    Correct Answer
    A. Innervation to the lower urinary tract was transected
    Explanation
    The most likely reason for the patient's voiding difficulty is that the innervation to the lower urinary tract was transected during the radical hysterectomy and lymph node sampling surgery. This means that the nerves responsible for controlling the bladder and initiating the voiding reflex were cut, leading to an inability to void. The patient's symptoms of leaking urine with activity, coughing, and sneezing further support this explanation.

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  • 22. 

    A 49-year-old woman had a radical hysterectomy and lymph node sampling for stage 1B squamous cell cancer of the cervix. A suprapubic catheter was placed at the time of surgery. She is now 8 weeks postoperative and has not been able to void. She is also leaking urine with activity, coughing, and sneezing. The most likely etiology of her incontinence is which of the following?

    • A.

      Stress incontinence

    • B.

      Urge incontinence

    • C.

      Overflow incontinence

    • D.

      Ureterovaginal fistula

    • E.

      Urethral diverticulum

    Correct Answer
    A. Stress incontinence
    Explanation
    The most likely etiology of the patient's incontinence is stress incontinence. Stress incontinence is characterized by leakage of urine with activities such as coughing, sneezing, or physical exertion. In this case, the patient's symptoms of leaking urine with activity suggest stress incontinence as the cause. The fact that she has not been able to void also suggests that there may be some obstruction or dysfunction in the urinary system, which is not consistent with urge or overflow incontinence. Ureterovaginal fistula and urethral diverticulum are less likely causes in this scenario.

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  • 23. 

    Which of the following is a normal urologic consequence of aging?

    • A.

      Elevated postvoid residual from 50 to 100 mL

    • B.

      Incontinence

    • C.

      Increased daytime diuresis

    • D.

      Increased bladder capacity

    • E.

      Delayed sensation of first desire to void

    Correct Answer
    A. Elevated postvoid residual from 50 to 100 mL

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  • Mar 21, 2023
    Quiz Edited by
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    Jenna
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