Sanders Exam Prep (Liver)

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Sanders Exam Prep (Liver) - Quiz

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Questions and Answers
  • 1. 

    The liver is an intraperitoneal organ surrounded byperitoneum. Which portion, if any, is NOT coveredby peritoneum?

    • A.

      Right lobe

    • B.

      Bare area

    • C.

      It is all covered

    Correct Answer
    B. Bare area
    Explanation
    The correct answer is "Bare area". The liver is an intraperitoneal organ, meaning it is surrounded by peritoneum. However, the bare area of the liver is not covered by peritoneum. The bare area is a small portion on the posterior surface of the liver where it is in direct contact with the diaphragm, without any peritoneal covering.

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  • 2. 

    A remnant of the fetal ductus venosus that dividesthe caudate lobe of the liver from the left lobe of theliver is the?

    • A.

      Falciform ligament

    • B.

      Ligamentum teres

    • C.

      Ligamentum venosum

    Correct Answer
    C. Ligamentum venosum
    Explanation
    In the fetus, the right branch of the umbilical
    vein becomes the ductus venosus, which goes
    into the inferior vena cava. After birth, the ductus
    venosus becomes a fibrous cord called the ligamentum
    venosum.

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  • 3. 

    The vessel that is responsible for supplying the liverwith the most nutrients is the?

    • A.

      Main portal vein

    • B.

      Hepatic artery

    • C.

      Hepatic vein

    Correct Answer
    A. Main portal vein
    Explanation
    The main portal vein and the hepatic artery
    are responsible for supplying the liver with oxygen
    and nutrients; however, the main portal vein is the
    larger contributor.

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  • 4. 

    Serum glutamic pyruvic transaminase (SGPT) isalso referred to as?

    • A.

      Alkaline phosphatase

    • B.

      A-fetoprotein (AFP)

    • C.

      Alanine aminotransferase (ALT)

    • D.

      Bilirubin

    Correct Answer
    C. Alanine aminotransferase (ALT)
    Explanation
    Alanine aminotransferase (ALT) is also
    known as serum glutamic pyruvic transaminase
    (SGPT). It is the most specific laboratory test for
    liver function. ALT is an enzyme produced in the
    hepatocytes, and there are high concentrations of
    ALT in the liver.

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  • 5. 

    Which of the following vessels is associated withwaveforms that do NOT vary with respiration in anormal patient?

    • A.

      Inferior vena cava

    • B.

      Femoral vein

    • C.

      Portal vein

    • D.

      Jugular vein

    • E.

      Hepatic vein

    Correct Answer
    C. Portal vein
    Explanation
    The waveforms of the hepatic vein, jugular
    vein, femoral vein, and inferior vena cava all vary
    with respiration. Only the portal vein waveform
    does not vary with respiration.

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  • 6. 

    All of the following increase in hepatocellular diseaseEXCEPT??

    • A.

      Bilirubin

    • B.

      Acid phosphatase

    • C.

      Prothrombin time (PT)

    • D.

      Aspartate aminotransferase (AST)

    Correct Answer
    B. Acid phosphatase
    Explanation
    Hepatocellular disease refers to liver cell damage or dysfunction. Bilirubin, prothrombin time (PT), and aspartate aminotransferase (AST) are all markers of liver function and can increase in hepatocellular disease. However, acid phosphatase is not specific to liver function and is not typically elevated in hepatocellular disease. Therefore, acid phosphatase is the exception among the given options.

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  • 7. 

    Fatty infiltration of the liver is associated with all ofthe following EXCEPT?

    • A.

      Ethanol abuse (ETOH)

    • B.

      Oral contraceptives

    • C.

      Intravenous antibiotics

    Correct Answer
    C. Intravenous antibiotics
    Explanation
    Of the choices listed, only intravenous
    antibiotics are not a cause of fatty infiltration of the
    liver. Isolated fatty infiltration of the liver is a benign,
    reversible disorder that affects the hepatocytes
    and may interfere with liver function.

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  • 8. 

    Which of the following decreases in Hepatocellulardisease?

    • A.

      Aspartate aminotransferase (AST)

    • B.

      Alkaline phosphatase

    • C.

      Vitamin K

    Correct Answer
    C. Vitamin K
    Explanation
    VitaminKlevels decrease inhepatocellular
    disease, resulting in a prolonged prothrombin time
    (PT). Prolonged PT carries a poor prognosis, but can
    revert to normal if the liver damage is reversed.

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  • 9. 

    A complex cystic area is seen in the liver. Which ofthe following patients, whose occupations arelisted, is MOST at risk to contract this condition?

    • A.

      Shepherd

    • B.

      Asbestos worker

    • C.

      Carpenter

    • D.

      Coal miner

    Correct Answer
    A. Shepherd
    Explanation
    Shepherds are at risk for hydatid disease.
    The eggs of this parasite are excreted in the feces
    of infected animals, predominantly sheep, resulting
    in humans becoming hosts. The liver is the
    most common site for cyst development.

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  • 10. 

    Which of the following is a rare malignant tumor,most commonly found in infants and children, thatcauses abdominal distention and hepatomegaly?

    • A.

      Focal nodular hyperplasia

    • B.

      Hepatoblastoma

    • C.

      Hepatocellular carcinoma

    Correct Answer
    B. Hepatoblastoma
    Explanation
    Hepatoblastoma causes liver enlargement
    and occurs in small children. Rhabdomyosarcoma
    affects the same age-group, but most often
    develops around the bladder. Hepatocellular carcinoma
    is typically seen in an older population. Focal
    nodular hyperplasia is a benign mass. A hematoma
    is a benign, blood-filled mass secondary to trauma.

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  • 11. 

    The vessel(s) in the liver that is(are) important indenning lobar anatomy for hepatic resection is(are)the?

    • A.

      Inferior vena cava

    • B.

      Hepatic arteries

    • C.

      Hepatic veins

    Correct Answer
    C. Hepatic veins
    Explanation
    The hepatic veins define the separation
    between the lobes and segments of the liver. The
    umbilical vein is no longer patent after birth. There
    is no portal artery. The portal vein and hepatic arteries
    supply the liver with oxygen and nutrients but
    do not separate the lobes. The inferior vena cava
    does not separate the lobes of the liver.

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  • 12. 

    Choppy, triphasic flow patterns are seen in the

    • A.

      Hepatic veins

    • B.

      Hepatic arteries

    • C.

      Portal veins

    Correct Answer
    A. Hepatic veins
    Explanation
    Because of their close proximity to the
    right atrium, hepatic veins exhibit a pulsatile,
    choppy flow. Normal portal veins have a nonpulsatile,
    even flow. The hepatic arteries have a low-resistance
    arterial pattern. In normal patients, the superior
    mesenteric artery Doppler signal changes
    from a high- to low-resistance arterial pattern when
    the patient goes from a fasting to postprandial
    state. The iliac veins do not normally pulsate, although
    the veins vary with respiration.

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  • 13. 

    A health care worker contracted hepatitis B from anaccidental needle stick. Which of the following isNOT likely to be seen on her abdominal sonogram?

    • A.

      A hypoechoic liver

    • B.

      A thickened gallbladder wall

    • C.

      A lobular outline to the liver

    Correct Answer
    C. A lobular outline to the liver
    Explanation
    This one is tricky I added it, but you will not be graded on this question. :)

    A lobular outline to the liver is a feature
    of cirrhosis, not hepatitis. Prominent portal vessels,
    a thickened gallbladder wall, splenomegaly, and a
    hypoechoic liver are all seen in hepatitis. Prominent
    portal vessels, giving rise to the "starry night" appearance,are caused by edema of the liver.

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  • 14. 

    Which of the following is a liver function test relatedto a blood clotting mechanism?

    • A.

      Bilirubin level

    • B.

      Aspartate aminotransferase (AST)

    • C.

      Alanine aminotransferase (ALT)

    • D.

      Prothrombin time

    • E.

      Lactic acid dehydrogenase (LH)

    Correct Answer
    D. Prothrombin time
    Explanation
    Prothrombin time is a measurement of
    one of the factors involved in blood clotting; it is affected
    by the amount of vitamin K. A prolonged
    prothrombin time is often an indicator of poor liver
    function

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  • 15. 

    Cirrhosis of the liver can be caused by all of the followingEXCEPT?

    • A.

      Obstruction by cholelithiasis

    • B.

      Diabetes mellitus

    • C.

      Hepatitis B

    Correct Answer
    B. Diabetes mellitus
    Explanation
    Cirrhosis of the liver is a chronic, progressive
    disease caused by multiple factors that destroy the liver. Diabetes mellitus is caused by faulty insulin
    production in the pancreas. If uncomplicated,
    diabetes mellitus does not affect the liver.

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  • 16. 

    Common conditions in which the gallbladder wallis thickened include all of the following EXCEPT***Think ***** This is a tough one!!!!Will not count if you get it wrong

    • A.

      Fatty infiltration of the liver

    • B.

      Hypoalbuminemia

    • C.

      Acute cholecystitis

    Correct Answer
    A. Fatty infiltration of the liver
    Explanation
    Isolated fatty infiltration of the liver is not
    associated with gallbladder wall thickening. Acute
    cholecystitis, AIDS, ascites, and hypoalbuminemia
    all cause gallbladder wall thickening.

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  • 17. 

    All of the following are typical of long-standing cirrhosisEXCEPT?

    • A.

      Hepatofugal flow of the portal veins

    • B.

      A small liver

    • C.

      An enlarged liver

    Correct Answer
    C. An enlarged liver
    Explanation
    Cirrhosis is a fibrotic process that causes
    the liver to shrink. An enlarged liver occurs in the
    early stages of alcohol-related liver disease when
    there is fatty infiltration or hepatitis. A nodular outline,
    increased echogenicity, and hepatofugalflow of
    the portal veins are all features of severe cirrhosis.

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  • 18. 

    A highly vascular, benign tumor in the liver is referredto as a?

    • A.

      Hemangioma

    • B.

      Hepatoma

    • C.

      Hepatic adenoma

    Correct Answer
    A. Hemangioma
    Explanation
    Hemangiomas are benign, vascular tumors

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  • 19. 

    All of the following are possible causes of hyper-bilirubin-emiaEXCEPT??

    • A.

      Severe cirrhosis

    • B.

      Common duct stone

    • C.

      Presbyductia

    Correct Answer
    C. Presbyductia
    Explanation
    Presbyductia is a term used to describe
    the normal enlargement of the common bile duct
    with age. Although hyperbilirubinemia is usually
    associated with liver disease or biliary obstruction,
    it can occur in the presence of destruction of red
    blood cells, as in hemolytic anemia.

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  • 20. 

    On which of the following views are all three hepaticveins BEST seen?

    • A.

      Transverse, midliver

    • B.

      Longitudinal, midline

    • C.

      Longitudinal, adjacent to the aorta

    • D.

      Transverse, close to the diaphragm

    Correct Answer
    D. Transverse, close to the diaphragm
    Explanation
    A high transverse view close to the diaphragm
    best shows the three hepatic veins. The
    veins join the inferior vena cava just below the diaphragm.
    Longtudinal views only show a single
    vein.

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  • 21. 

    The porta hepatis contains all of the following EXCEPT??

    • A.

      Glisson's capsule

    • B.

      The sphincter of Oddi

    • C.

      The portal vein

    • D.

      The hepatic artery

    • E.

      The common bile duct

    Correct Answer
    B. The sphincter of Oddi
    Explanation
    The sphincter of Oddi is at the entrance
    of the common bile duct and pancreatic duct into
    the duodenum; it does not lie in the porta hepatis.
    Glisson's capsule refers to the fibrous tissue surrounding
    the portal veins, bile ducts, and hepatic
    arteries as they travel together in the liver. Glisson's
    capsule also surrounds the liver. The common
    hepatic duct becomes the common bile duct
    at the point where it is joined by the cystic duct,
    which is in the porta hepatis.

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  • 22. 

    All of the following are characteristics of the hepaticveins EXCEPT?

    • A.

      They branch away from the diaphragm

    • B.

      They have echogenic walls

    • C.

      They can be traced into the inferior vena cava

    • D.

      All three are best seen on a transverse scan

    Correct Answer
    B. They have echogenic walls
    Explanation
    Hepatic veins do not have echogenic walls.

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  • 23. 

    The vessel that typically runs between the portalvein and the common bile duct is the??

    • A.

      Hepatic artery

    • B.

      Inferior vena cava

    • C.

      Gastroduodenal artery

    Correct Answer
    A. Hepatic artery
    Explanation
    The hepatic artery normally runs between
    the common bile duct and the portal vein.
    It may have a tortuous course and usually bifurcates
    proximal to the bifurcation of the common
    hepatic duct.

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  • 24. 

    Hepatofugal flow may be indicative of all of thefollowing EXCEPT?

    • A.

      A cirrhotic liver

    • B.

      Portal hypertension

    • C.

      Common bile duct obstruction

    Correct Answer
    C. Common bile duct obstruction
    Explanation
    Common bile duct obstruction is not associated
    with hepatofugal flow. Hepatofugal flow
    occurs when the pressure in the portal system of
    the liver is increased and blood cannot flow
    through the portal vein. A reversal of the normal
    direction of flow is detected with Doppler imaging;
    however, a poor Doppler angle may create
    false direction of flow.

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  • 25. 

    With hepatopetal flow, the blood in the portal veinand the blood in the hepatic artery?

    • A.

      Flows in the same direction

    • B.

      Flows away from the liver

    • C.

      Cannot be detected with Doppler

    Correct Answer
    A. Flows in the same direction
    Explanation
    Blood in the normal portal vein and the
    hepatic artery is detectable with Doppler. In both
    vessels, the blood flows hi the same direction—hepatopetal
    flow (i.e., toward the liver). Turbulence is
    not a characteristic of the flow in either vessel.

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  • 26. 

    The normal Doppler waveform of the portal veinis

    • A.

      Biphasic

    • B.

      Triphasic

    • C.

      Monophasic

    Correct Answer
    C. Monophasic
    Explanation
    The normal portal vein flows continuously
    into the liver, which makes it a monophasic
    waveform. Triphasic describes a waveform seen
    particularly in the leg arteries and hepatic veins.

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  • 27. 

    All of the following are features of portal hypertensionEXCEPT

    • A.

      Hepatic artery thrombosis

    • B.

      Splenomegaly

    • C.

      Recanalization of the paraumbilical veins

    Correct Answer
    A. Hepatic artery thrombosis
    Explanation
    Portal hypertension refers to an increase
    in pressure in the portal venous system, usually
    caused by liver disease or possibly portal vein
    thrombosis. Hepatic artery thrombosis is not a
    typical result of portal hypertension; however, the
    portal vein often becomes thrombosed in portal
    hypertension. Collaterals and splenomegaly result
    from the pressure being reversed or forced to create
    new paths.

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  • 28. 

    Which of the following statements concerningmetastatic lesions to the liver is TRUE?*Hard Question will not count in grading*

    • A.

      Metastases in the gallbladder are from melanoma

    • B.

      Metastases from the colon invariably appear as "bull's eye" lesions

    • C.

      Color flow Doppler demonstrates if a tumor or metastatic lesion is vascular

    • D.

      Lymphoma causes hypoechoic lesions in the liver

    • E.

      One can never make a tissue-specific diagnosis from the sonographic appearance of a lesion

    Correct Answer
    E. One can never make a tissue-specific diagnosis from the sonographic appearance of a lesion
    Explanation
    The first four answers are absolute statements:
    melanomas frequently metastasize to the
    gallbladder; colon metastases are sometimes "bull's
    eye" lesions; color flow Dopplermay show vascular
    flow; and lymphomatous lesions in the liver are
    usually hypoechoic, but not always. Actually, this
    was a trick question to ask after the cautionary tip
    about "never" being in the answer. However, in
    this case "never" means "not always," so it is stopping
    you from making an absolute statement.

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  • 29. 

    A 23-year-old college student is referred by the universityhealth clinic because of diffuse abdominaland right upper quadrant pain. There is some freefluid in her abdomen and an encapsulated mass inher liver that is solid but contains complex cysticcomponents. The sonologist, quite correctly, makeshepatic adenoma the first differential diagnosis forall of the following reasons EXCEPT one. Which is it?**Will not be graded*** Hard question to get you thinking :)

    • A.

      While ultrasound features are variable, hepatic adenomas often appear encapsulated

    • B.

      Metastatic lesions in her liver would have a "bull's eye" appearance

    • C.

      The cystic areas are compatible with bleeding inside the mass, as hepatic adenomas are prone to do

    • D.

      Upon questioning, the patient reported having been on oral contraceptives since her freshman year

    Correct Answer
    B. Metastatic lesions in her liver would have a "bull's eye" appearance
    Explanation
    If a mass and ascites are discovered, it is
    necessary to search carefully for metastases and
    enlarged lymph nodes, treating the lesion as a
    possible malignancy. However, in their absence,
    this woman's history—especially the oral contraceptive
    use—is appropriate for hepatic adenoma.
    Hepatic adenomas are benign, so metastatic lesions
    ("bull's eye" or otherwise) would not be
    present. The free fluid in her abdomen is from the
    bleeding going on in her mass, which has ruptured
    through the capsule into the peritoneum, irritating
    it and causing her diffuse pain.

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  • 30. 

    In a patient with a highly echogenic liver, all of thefollowing laboratory values can help distinguishbetween cirrhosis and a normal liver EXCEPT?

    • A.

      Liver function tests (LFTs)

    • B.

      Acetylcholinesterase

    • C.

      Alanine aminotransferase (ALT)

    • D.

      Aspartate aminotransferase (AST)

    • E.

      Gamma-glutamyltransferase (GGT)

    Correct Answer
    B. Acetylcholinesterase
    Explanation
    Acetylcholinesterase is not a laboratory value that can help distinguish between cirrhosis and a normal liver. Acetylcholinesterase is an enzyme that breaks down acetylcholine, a neurotransmitter. It is not specific to liver function and therefore would not be useful in differentiating between cirrhosis and a normal liver.

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  • 31. 

    A casual reading of an abdominal sonogram in apatient with a Riedel's lobe could result in which ofthe following misdiagnoses?

    • A.

      Hepatomegaly

    • B.

      A mass in the head of the pancreas

    • C.

      Hepatoma

    Correct Answer
    A. Hepatomegaly
    Explanation
    A Riedel's lobe is a long, thin extension of
    the right lobe of the liver that can put the liver edge
    well below the lower pole of the right kidney. Sonologists
    using this criterion to make a diagnosis of hepatomegaly
    will be guilty of not seeing the forest for
    the trees—the entire liver must be taken into account.
    The left lobe is often small in patients with a
    Riedel's lobe, and patients with a small anteroposterior
    diameter have livers that extend more inferiorly
    to compensate. A Reidels lobe is unlikely to be
    mistaken for any of the other options.

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  • 32. 

    A patient with end-stage cirrhosis exhibits hepatofugalportal flow, making the presence of collateralvessels likely. A close look at which of thefollowing will MOST easily demonstrate collateralflow?

    • A.

      Ligamentum venosum

    • B.

      Ligamentum teres

    • C.

      Gallbladder region

    Correct Answer
    B. Ligamentum teres
    Explanation
    Hepatofugal portal flow occurs in advanced
    portal hypertension, a common sequel to
    chronic cirrhosis. When sinusoidal resistance to
    flow is so great that the direction of flow reverses,
    portosystemic collaterals open up; the easiest to
    detect is the recanalized paraumbilical vein that
    travels in the ligamentum teres. To locate the paraumbilical
    vein, find the ascending portion of the
    left portal vein and follow the umbilical portion of
    it inferiorly between the medial and lateral segments
    of the left lobe of the liver. Color flow
    Doppler will demonstrate flow and that the vein is
    indeed recanalized.

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  • 33. 

    A preoperative ultrasound study reveals a solitaryliver mass displacing two structures in the liver.The surgeon is told he can confine his operation tothe medial segment of the left lobe. Which twostructures are being displaced?

    • A.

      Ligamentum teres and gallbladder

    • B.

      Fissure for the ligamentum venosum and left portal vein

    • C.

      Left hepatic vein and middle hepatic vein

    Correct Answer
    C. Left hepatic vein and middle hepatic vein
    Explanation
    The middle and left hepatic veins border
    the medial segment of the left lobe of the liver. The
    ligamentum teres separates the lateral and medial
    segments of the left lobe at a more inferior level. A
    mass that touches the gallbladder would have to
    be in the right anterior lobe. The main portal vein
    and hepatic duct are down by the porta hepatis.The left portal vein lies exclusively in the lateral segment of the left lobe, not the medial segment.

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  • 34. 

    A 30-year-old man is referred to ultrasound forgeneralized right upper quadrant tenderness andearly signs of jaundice. His gallbladder appearsnormal, but there are bright focal areas withoutshadowing scattered throughout his liver. Onclose inspection, these areas are seen to be thewalls of the portal vein branches. What is first inthe list of differential diagnoses?

    • A.

      Hepatitis

    • B.

      Choledocholithiasis

    • C.

      Pneumobilia

    Correct Answer
    A. Hepatitis
    Explanation
    Jaundice brings to mind obstruction from
    choledocholithiasis, but with an absence of gallstones
    or shadowing throughout the liver a nonobstructive
    cause should be considered. A subtle increase
    in echogenicity of the portal triads is one of
    the few sonographic indications of hepatitis; however,
    this finding is not always present. It is possible
    that the increase in periportal echogenicity is
    caused by the decreased parenchymal echogenicity
    sometimes seen in hepatitis. Pneumobilia would
    cause linear echogenicity with dirty shadowing.
    Choledocholithiasis would be seen as one or more
    echogenic densities with acoustic shadowing.

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