{"id":923,"date":"2023-05-10T03:10:00","date_gmt":"2023-05-10T03:10:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=923"},"modified":"2026-02-19T17:29:26","modified_gmt":"2026-02-20T01:29:26","slug":"usmle-step-1-question-of-the-day-compression-of-the-esophagus","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-compression-of-the-esophagus","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Compression of the esophagus"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-compression-of-the-esophagus\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-compression-of-the-esophagus\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-compression-of-the-esophagus\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-compression-of-the-esophagus\/#Major_Takeaway\" >Major Takeaway<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-compression-of-the-esophagus\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-compression-of-the-esophagus\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em>We&#8217;re sharing another <strong>USMLE\u00ae Step 1<\/strong>-style practice question to test your knowledge.\u00a0Today&#8217;s case focuses on a <strong>56-year-old man<\/strong> with <strong>difficulty swallowing, history of hypertension, hyperlipidemia, diabetes, <\/strong>and <strong>esophageal reflux, <\/strong>and <strong>intermittent jitteriness,<\/strong> presents to his physician. Can you figure it out? Let&#8217;s find out!<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A <strong>56-year-old man<\/strong> presents to his primary care physician for evaluation of <strong>difficulty swallowing.<\/strong> Over the past several weeks, the patient has had the sensation of \u201c<strong>food getting stuck<\/strong>\u201d as he swallows. He also has a new history of intermittent \u201c<strong>jitteriness<\/strong>.\u201d Medical history is notable for long-standing <strong>hypertension, hyperlipidemia, diabetes, <\/strong>and <strong>esophageal reflux<\/strong>. The patient\u2019s medications include <strong>metoprolol, metformin, atorvastatin, <\/strong>and <strong>omeprazole<\/strong>. He has a history of medication non-compliance. <strong>Temperature 37.0\u00b0C (98.6\u00b0F), pulse is 89\/min, respirations are 16\/min, and blood pressure is 177\/92 mmHg. <\/strong>The patient\u2019s physical examination is <strong>unremarkable<\/strong>. A portion of the patient\u2019s telemetry strip is demonstrated below.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Which of the following <strong>best describes<\/strong> the <strong>affected anatomic site<\/strong> that most likely resulted in this patient\u2019s clinical symptoms?<\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"544\" height=\"574\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_8d3362.png\" alt=\"The patient\u2019s telemetry strip.\" class=\"wp-image-925\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_8d3362.png 544w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_8d3362.png?resize=284,300 284w\" sizes=\"auto, (max-width: 544px) 100vw, 544px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. &nbsp;Level of the left atrium<br><br>B. Level of the cricopharyngeal muscle<br><br>C. Level of the aortic arch<br><br>D. Level of the left main bronchus<br><br>E. Level of the diaphragm<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down to find the answer!&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. &nbsp;Level of the left atrium<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Level of the cricopharyngeal muscle<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>\u00a0<strong>Food impaction <\/strong>and <strong>stricture formation<\/strong> may result at the esophageal level of the <strong>cricopharyngeus muscle<\/strong>. However, this patient&#8217;s clinical presentation and ECG is more consistent with impaction at the level of the <strong>left atrium secondary to atrial dilation<\/strong> and associated <strong>compression of the esophagus<\/strong>.\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Level of the aortic arch&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>\u00a0<strong>Aortic arch dilation<\/strong> from <strong>aortic dissection or aortic aneurysm<\/strong> may impede the esophagus at this level. However, this patient&#8217;s clinical presentation and ECG is more <strong>consistent with impaction <\/strong>at the level of the <strong>left atrium secondary to atrial dilation<\/strong> and associated <strong>compression of the esophagus.<\/strong>\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Level of the left main bronchus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>\u00a0Impingement at the level of the <strong>left main bronchus <\/strong>may occur from mass effect due to <strong>associated trauma or tumor burden.<\/strong> However, this patient&#8217;s clinical presentation and ECG is more <strong>consistent with impaction<\/strong> at the level of the left atrium secondary to atrial dilation and associated compression of the esophagus.\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Level of the diaphragm<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>\u00a0Esophageal constriction may occur at the diaphragm level due to <strong>long-standing esophageal reflux disease<\/strong> and <strong>associated stricture formation<\/strong>. Typically, affected individuals will have evidence of untreated disease, including <strong>epigastric pain, a metallic taste in the mouth, or a history of gastritis or peptic ulcer disease.<\/strong> This patient&#8217;s clinical presentation and ECG is more consistent with impaction at the level of the left atrium secondary to atrial dilation and associated compression of the esophagus.\u00a0<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents for <strong>dysphagia evaluation<\/strong> and is found to have <strong>new-onset atrial fibrillation<\/strong>. Although rare, <strong>atrial fibrillation<\/strong> and associated left atrial dilation can result in compression of the esophagus and subsequent food impaction.\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The esophagus has multiple compression sites as it courses from the <strong>oropharynx <\/strong>to the <strong>stomach<\/strong>. Superiorly, the <strong>esophagus <\/strong>may constrict as it enters the <strong>mediastinum<\/strong>, where the <strong>cricopharyngeus muscle<\/strong> may cause constriction. <strong>Thoracic constrictions<\/strong> occur where the arch of the aorta crosses the esophagus or at the levels of the left main bronchus and the left atrium. Lastly, the esophagus may constrict crossing the diaphragm.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pathologic insults at any anatomic site can ultimately slow the passage of solid foods and liquids. Over time, these insults can lead to <strong>esophageal stricture formation<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The esophagus has <strong>multiple compression sites<\/strong> as it courses from the <strong>oropharynx <\/strong>to the <strong>stomach<\/strong>. These include the <strong>cricopharyngeus muscle, aortic arch, left main bronchus, left atria, <\/strong>and <strong>esophageal hiatus.\u00a0<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch the Osmosis video: <a href=\"https:\/\/www.osmosis.org\/learn\/Anatomy_of_the_pharynx_and_esophagus\">Anatomy of the pharynx and esophagus<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Cheng, H.T., Cheng, C.L., Lin, C.H., et al. (2008) Caustic ingestion in adults: The role of endoscopic classification in predicting outcome. BMC Gastroenterology. 8, 31. Doi: 10.1186\/1471-230X-8-31.Smith, C.D. (2015) Esophageal strictures and diverticula. The Surgical Clinics of North America. 95(3), 669-681. Doi: 10.1016\/j.suc.2015.02.017.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/10\/Blog_Display_Ads_MOBILE3_2023.png?w=700\" alt=\"\" class=\"wp-image-4729\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/10\/Blog_Display_Ads_MOBILE3_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/10\/Blog_Display_Ads_MOBILE3_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><figcaption class=\"wp-element-caption\"><em><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.&nbsp;<\/sub><\/em><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 1 practice questions? Start your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><br><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Explore today\u2019s USMLE\u00ae Step 1 question focusing on a clinical case of dysphagia, and identify the anatomical site likely causing the patient\u2019s symptoms.<\/p>\n","protected":false},"author":202,"featured_media":924,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1369,44],"tags":[346,303,825,838,215,839,148,279,840,185],"class_list":["post-923","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-step-1-questions","category-step-1","tag-anatomy","tag-atrial-fibrillation","tag-clinical-education","tag-dysphagia","tag-healthcare-education","tag-left-atrium","tag-medical-training","tag-patient-assessment","tag-swallowing-difficulties","tag-usmle"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Compression of the esophagus - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-compression-of-the-esophagus\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Compression of the esophagus - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Explore today\u2019s USMLE\u00ae Step 1 question focusing on a clinical case of dysphagia, and identify the anatomical site likely causing the patient\u2019s symptoms.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-compression-of-the-esophagus\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2023-05-10T03:10:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-02-20T01:29:26+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/45.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1081\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Marina Horiates Kerekes, MD &amp; Team\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-compression-of-the-esophagus#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-compression-of-the-esophagus\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; Team\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/c7e60a94ecf3ec6e6cfe4855957afafc\"},\"headline\":\"USMLE\u00ae Step 1 Question of the Day: Compression of the esophagus\",\"datePublished\":\"2023-05-10T03:10:00+00:00\",\"dateModified\":\"2026-02-20T01:29:26+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-compression-of-the-esophagus\"},\"wordCount\":809,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#organization\"},\"image\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-compression-of-the-esophagus#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/45.webp\",\"keywords\":[\"anatomy\",\"atrial fibrillation\",\"clinical education\",\"dysphagia\",\"healthcare education\",\"left atrium\",\"medical training\",\"patient assessment\",\"swallowing difficulties\",\"USMLE\"],\"articleSection\":[\"Allopathic Medicine (MD)\",\"Exam Prep\",\"Osteopathic Medicine (DO)\",\"USMLE Step 1\",\"USMLE\u00ae Step 1\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-compression-of-the-esophagus#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-compression-of-the-esophagus\",\"url\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-compression-of-the-esophagus\",\"name\":\"USMLE\u00ae Step 1 Question of the Day: Compression of the esophagus - 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A 57-year-old woman presents to her primary care\u2026","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"A study tip titled USMLE Step 1 Question of the Day Histologic Analysis","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/10\/histologic-analysis-10-24.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/10\/histologic-analysis-10-24.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/10\/histologic-analysis-10-24.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/10\/histologic-analysis-10-24.png 2x"},"classes":[]},{"id":1977,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-adrenal-insufficiency","url_meta":{"origin":923,"position":5},"title":"USMLE\u00ae Step 1 Question of the Day: Adrenal Insufficiency","author":"Marina Horiates Kerekes, MD &amp; Team","date":"August 17, 2022","format":false,"excerpt":"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.\u00a0Today's case focuses on a 56-year-old man who has recently immigrated from Vietnam. He experiences worsening fatigue and decreasing exercise tolerance.\u00a0Can you figure it out? 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