Common Infections UK Medical PG Flashcards - Medical Study Cards
Master Common Infections with OnCourse flashcards. These spaced repetition flashcards are designed for medical students preparing for NEET PG, USMLE Step 1, USMLE Step 2, MBBS exams, and other medical licensing examinations.
Common Infections Flashcard Deck - 190 Cards
Flashcard 1: What is the management of wet gangrene?
_____
Answer: IV antibiotics, emergency surgical debridement, ± amputation
Flashcard 2: Dry gangrene is _____ progressive
Wet gangrene is rapidly (hours to days) progressive
Answer: slowly (days to weeks)
Flashcard 3: "_____" gangrene is caused by chronic ischaemia and is the most common
Answer: Dry
Flashcard 4: Hospital-acquired infection is also called _____ infection
Answer: nosocomial
Flashcard 5: _____ is the necrosis of tissue due to ischaemia (coagulative necrosis) ± superimposed infection (liquefactive necrosis)
Answer: Gangrene
Flashcard 6: Can COVID-19 be asymptomatic?
_____
Answer: Yes - very commonly and these individuals are contagious
Flashcard 7: _____-associated UTIs are a common causes of hospital-acquired infections
Answer: Catheter
Flashcard 8: Asymptomatic/mild COVID-19 can be managed _____
Answer: at home
Flashcard 9: _____ is an antiphospholipid antibody that may result in false-positive VDRL and RPR tests
Answer: Anticardiolipin
Flashcard 10: Overestimation of oxygen saturations using a pulse oximeter has been documented in _____
Answer: individuals with darker skin
Flashcard 11: Hospital-acquired infections can involve _____-resistant organisms
Answer: multidrug
Flashcard 12: Hospital-acquired infections are prevented with _____ policies
Answer: infection control
Flashcard 13: Fever caused by COVID-19 can be managed with _____ and anti-pyretics
Answer: adequate fluid intake
Flashcard 14: _____ are infections occuring ≥ 48 hours after admission, not present or incubating at the time of hospital entry
Answer: Hospital-acquired infections
Flashcard 15: A false +ve RPR or VDRL can be caused by _____, pregnancy, or autoimmune diseases (e.g. SLE, APS)
Answer: infections
Flashcard 16: "_____" gangrene is caused by bacterial superinfection
Answer: Wet
Flashcard 17: What is the likely diagnosis in a older patient with peripheral arterial disease with dry, shriveled, black toe that is well-demarcated with no systemic symptoms?
_____
Answer: Dry gangrene
Flashcard 18: COVID-19 typically presents with symptoms of an _____ in addition to characteristically causing loss of smell/taste
Answer: URTI
Flashcard 19: What are the most commonly used diagnostic investigations for COVID-19?
_____ & Antigen testing (lateral flow)
Answer: Antigen RT-PCR
Flashcard 20: _____ gangrene resembles mummified tissue
Answer: Dry
Flashcard 21: _____ infections are the most common hospital-acquired infections
Answer: Respiratory
Flashcard 22: A -ve EIA or TPPA indicates _____ or very early infection (false -ve)
Answer: absent current or past infection
Flashcard 23: +ve NTT and -ve TP indicates _____
Answer: false +ve NTT
Flashcard 24: What is the management of dry gangrene?
_____
Answer: Restore vascularisation; angioplasty ± amputation
Flashcard 25: What are the findings upon CXR of COVID-19?
_____ and Uni/bilateral opacities
Answer: Pulmonary consolidation
Flashcard 26: Which strain(s) of Plasmodium is primaquine used to treat?
_____
Answer: Plasmodium vivax/ovale
Flashcard 27: X-rays show no findings in osteomyelitis < _____ days
Answer: 10
Flashcard 28: Malaria causes intravascular haemolysis, which can show _____ Hb, ↑ LDH, & ↑ reticulocytes
Answer: ↓
Flashcard 29: If the initial ELISA test for Lyme disease is negative but there is still a strong suspicion of Lyme disease → _____
Answer: Repeat ELISA 4-6 weeks later
Flashcard 30: What is the investigation of choice for osteomyelitis after x-ray?
_____
Answer: MRI
Flashcard 31: Osteomyelitis is split into sub-groups based on route of infection; _____ & haematogenous (~20%)
Answer: exogenous (~80%)
Flashcard 32: What is the investigations are done in osteomyelitis to identify underlying organisms?
_____
Answer: Bone biopsy & blood cultures
Flashcard 33: _____ is a bone infection caused by bacteria leading to inflammation, necrosis, & bone destruction
Answer: Osteomyelitis
Flashcard 34: Ticks are generally found in _____ areas in the South of England and the Scottish Highlands
Answer: wooded
Flashcard 35: Lyme disease can be diagnosed in patients with an _____ rash at the site of a tick bite
Answer: erythema migrans
Flashcard 36: Osteomeylitis in diabetics presents as a non-healing ulcer with a +ve "_____" test
Answer: probe-to-bone
Flashcard 37: What is the initial management of osteomyelitis in stable patients?
_____
Answer: Blood cultures with 6 weeks of IV antibiotics
Flashcard 38: What drugs are used for chemoprophylaxis against malaria?
_____
Answer: MAD Cunts
Mefloquine
Atovaquone with proguanil
Doxycyline
Chloroquine
Flashcard 39: _____ is caused by Borrelia Burgdoferi
Answer: Lyme disease
Flashcard 40: Most common causes of osteomyelitis:
Overall: _____
Diabetes: Polymicrobial
Penetrative puncture: Pseudomonas aeruginosa
Sickle cell: Salmonella > Staph aureus
Answer: Staphylococcus aureus
Flashcard 41: Osteomyelitis presents with localised _____, warmth, & oedema with systemic fever & malaise
Answer: erythema
Flashcard 42: What is the management of confirmed/strongly suspected Lyme disease?
1st Line: _____
2nd Line: Amoxicillin
3rd Line: Azithromycin
Answer: Doxycycline
Flashcard 43: What is the initial imaging for osteomyelitis?
_____
Answer: X-ray
Flashcard 44: What is the radical management for P. vivax & P. ovale malaria?
ACT or chloroquine WITH _____
Answer: primaquine
Flashcard 45: Spot diagnosis = _____
Answer: osteomyelitis; of 1st MTP
Flashcard 46: What is the management of asymptomatic tick bites?
_____
Answer: Removal of entire tick, NO ANTIBIOTIC PROPHYLAXIS
Flashcard 47: Screening for _____ is required before using primaquine due to risk of haemolysis
Answer: G6PD deficiency
Flashcard 48: _____ osteomyelitis mostly occurs in adults
Hematogenous osteomyelitis mostly occurs in children
Answer: Exogenous
Flashcard 49: What is the management for non-falciparum malaria?
_____ or chloroquine
Answer: ACT; artemether with lumefantrine
Flashcard 50: _____ is a zoonotic bacteria spread by dog & cat bites that causes cellulitis, which can progress into osteomyelitis
Answer: Pasteurella multocida
Flashcard 51: Redness or a local skin reaction to a tick bite after 1 day _____ erythema migrans
Answer: IS NOT
Flashcard 52: Lyme disease can present with _____ symptoms such as fever/sweats, headache, muscle aches, fatigue
Answer: non-specific
Flashcard 53: _____ osteomyelitis in patients with diabetes is typically preceded by a long-standing foot ulcer that spreads contiguously to bone, causing a(n) polymicrobial infection
Answer: Exogenous
Flashcard 54: Malaria presents with _____ fevers
Answer: cyclical
Flashcard 55: Primary infection of HSV-1 typically manifests as _____
Answer: gingivostomatitis
Flashcard 56: Merozoites of Plasmodium invade _____, mature into trophozoites, and cyclically release more merozoites
Answer: erythrocytes
Flashcard 57: What is the management of recurrent episodes of genital herpes?
_____
Answer: - Conservative
- Episodic management with anti-virals
- Suppressive management with anti-virals
Flashcard 58: Malaria is transmitted by the female _____ mosquito
Answer: Anopheles
Flashcard 59: HSV-2 is primarily transmitted through _____
Answer: sexual contact
Flashcard 60: _____ is an immune-mediated hypersensitivity reaction that can appear 1-2 weeks after herpes simplex virus (HSV) infection
Answer: Erythema multiforme
Flashcard 61: Which virus can present with swollen gums and inflamed lesions on the hard palate and lips?
_____
Answer: HSV-1
Flashcard 62: Herpes virus can be transmitted via saliva, sex, and vertically through the _____
Answer: placenta
Flashcard 63: HSV-1 remains latent in the _____ ganglion
Answer: trigeminal
Flashcard 64: What is the management of reactivation of oral herpes?
_____
Answer: Self-care advice
Flashcard 65: Keratoconjunctivitis is an ophthalmic complication of _____ with "serpiginous" or "dendritic" ulcers on slit-lamp
Answer: HSV-1
Flashcard 66: An estimated ~_____% of people under 50 years have HSV-1 and ~13% have HSV-2
Answer: 64
Flashcard 67: Primary genital herpes has a ↑ high risk of _____
Answer: reactivation
Flashcard 68: Plasmodium species is diagnosed with _____ stained with Giemsa
Answer: thick & thin blood smears
Flashcard 69: What is the gold-standard investigation for malaria?
_____
Answer: Thick & thin blood smears
Flashcard 70: What cells do Plasmodium species infect?
_____
Answer: Hepatocytes (liver stage) & erythrocytes (blood stage)
Flashcard 71: Plasmodium _____ is the most common cause of malaria
Answer: falciparum
Flashcard 72: Dormant/latent HSV reactivates in response to _____, triggering viral replication in sensory ganglia and anterograde axonal transport to epithelial surfaces
Answer: physiological or immunological stressors
Flashcard 73: What is the management of primary infection of oral herpes?
_____
Answer: Consider prescribing oral aciclovir or valaciclovir
Flashcard 74: Oral herpes is transmitted through salivery secretions (e.g. during _____)
Answer: kissing
Flashcard 75: Latent HSV-1 reactivation can be triggered by _____
Answer: sunlight
Flashcard 76: Genital herpes rash initially presents as "_____" appearance and then progress into painful ulcers
Answer: dew drops on a rose petal
Flashcard 77: What is the likely diagnosis of a patient returning from holiday in Nigeria who has cyclical fever & chills, headaches, N&V?
_____
Answer: Malaria
Flashcard 78: _____ is a lifelong, neurotropic virus causing oral (HSV-1) & genital (HSV-2) lesions with recurrent reactivations
Answer: Herpes simplex virus (HSV)
Flashcard 79: _____ is a painful hand vesicle that occurs when the skin comes in contact with HSV-1 or HSV-2 (common in dentists)
Answer: Herpetic whitlow
Flashcard 80: Genital herpes should be diagnosed in a(n) _____, PCR is the investigation of choice
Answer: genitourinary (GUM) clinic
Flashcard 81: What is the prognosis of genital herpes in immunocompetent individuals?
_____
Answer: The reactivations become less frequent overtime
Flashcard 82: What is the management of primary infection of genital herpes?
_____
Answer: Aciclovir or valaciclovir to be taken within 5 days of onset
Flashcard 83: Which genital infection is characterized by dysuria, tender, small ulcers with an erythematous base and mild lymphadenopathy?
_____
Answer: Herpes simplex virus
Flashcard 84: On palpation, patients with malaria can have _____, particularly in chronic or repeated malaria
Answer: splenomegaly
Flashcard 85: _____ is a mosquito-borne infectious disease caused by Plasmodium parasites, leading to cyclical fever, haemolysis, & organ dysfunction
Answer: Malaria
Flashcard 86: Plasmodium _____ is the most common non-falciparum species
Answer: vivax
Flashcard 87: HSV-1 (oral herpes) is a clinical diagnosis, but can be definitively diagnosed with _____
Answer: PCR
Flashcard 88: After primary infection of herpes simplex virus it travels via retrograde axonal transport to a _____ where it establishes lifelong latency
Answer: sensory ganglion
Flashcard 89: Encourage usage of _____ for oral herpes that is triggered by sunlight
Answer: sunscreen
Flashcard 90: Reactivation of HSV-1 typically manifests as _____
Answer: labial herpes (cold sores)
Flashcard 91: The high prevalence of the sickle cell allele in Africans is likely due to its protective role against _____ malaria
Answer: Plasmodium falciparum
Flashcard 92: HSV-1 is most common in _____
Answer: early childhood
Flashcard 93: P. _____ = irregular fever spikes
P. vivax, ovale = tertian (48 hourly) fever spikes
P. malariae = quartan (72 hourly) fever spikes
Answer: falciparum
Flashcard 94: Oral herpes is caused by _____
Genital herpes is caused by HSV-2 (most common); HSV-1
Answer: HSV-1
Flashcard 95: Tender _____ lymphadenopathy is clasically associated with HSV-2
Answer: inguinal
Flashcard 96: Chlamydia is transmitted through _____ or vertical transmission during delivery
Answer: sexual contact (vaginal, anal, oral)
Flashcard 97: What is the investigation for chlamydia in females?
_____
Answer: NAAT*; taken from vulvovaginal swab
Flashcard 98: _____ is a common STI caused by Neisseria gonorrhoeae
Answer: Gonorrhoea
Flashcard 99: _____ are disproportionately affected by gonorrhoea
Answer: Men sho have sex with men (MSM)
Flashcard 100: Gonorrhoeae discharge = _____
Chlamydia discharge = thin "watery" white
Answer: thick purulent white / yellow-green
Flashcard 101: Pertussis most commonly occurs in _____ especially if they are unvaccinated
Answer: infants (<1yr)
Flashcard 102: Chlamydia most often presents _____, but can present with mucopurulent discharge & dysuria
Answer: asymptomatically
Flashcard 103: A pertussis booster is given in pregnancy at _____
Answer: 20 weeks (given from 16 weeks)
Flashcard 104: Oral/vulvovagnitis candidiasis is a clinical diagnosis but _____ can be done to identify pseudohyphae
Answer: wet mount microscopy w/KOH preparation
Flashcard 105: What is the most common cause of pelvic inflammatory disease?
_____
Answer: Chlamydia
Flashcard 106: Chalmydia trachomatis serotypes _____ causes an STI
Answer: D-K
Flashcard 107: Inhaled corticosteroids can cause _____ as the most common side effect
Answer: oropharyngeal candidiasis
Flashcard 108: _____ is a possible complication of untreated chlamydial cervicitis that can cause tubal factor infertility & ↑ risk of ectopic pregnancy
Answer: Pelvic inflammatory disease
Flashcard 109: _____ candidiasis can present with odynophagia
Answer: Oesophageal
Flashcard 110: Subacute pelvic inflammatory disease often goes undiagnosed caused from _____
Answer: Chlamydia trachomatis (D-K)
Flashcard 111: _____ white plaques can be easily scraped off
Answer: Oral candidiasis
Flashcard 112: What is the likely causative organism in a male that presents with dysuria, urinary frequency, and mucopurulent discharge? Gram stain and urine culture are negative
_____
Answer: Chlamydia trachomatis
Flashcard 113: Rapid antigenic variation of pili in gonorrhoea makes patients susceptible to _____
Answer: reinfection
Flashcard 114: What is the investigation for gonorrhoea in males?
_____
Answer: NAAT*; with First-Catch Urine (FCU)
Flashcard 115: What is the management for oropharyngeal candidiasis?
1st-line: _____
2nd-line: oral -azole
Answer: micanzole gel / nystatin
Flashcard 116: What is the management for oesophageal candidiasis?
_____
Answer: Oral -azole
Flashcard 117: Gonorrhoea is transmitted through _____ or vertical transmission during delivery
Answer: sexual contact (vaginal, anal, oral)
Flashcard 118: _____ is the most common STI caused by Chlamydia trachomatis
Answer: Chlamydia
Flashcard 119: Whooping cough can result in posttussive _____ (infants) & syncope (adults)
Answer: vomiting
Flashcard 120: Gonorrhoea presents with _____ discharge & dysuria
Answer: thick purulent white/yellow-green
Flashcard 121: Recurrent vulvovaginal candidiasis should be investigated for _____
Answer: diabetes mellitus
Flashcard 122: The catarrhal stage of pertussis presents with _____
Answer: URTI symptoms
Flashcard 123: Oropharyngeal _____ presents with a creamy white "curd"-like plaques
Answer: candidiasis
Flashcard 124: _____ candidiasis may be seen in the immunocompromised or those using oral steroids
Answer: Oropharyngeal and oesophageal
Flashcard 125: SGLT-2 inhibitors may cause increased risk of vulvovaginal _____
Answer: candidiasis
Flashcard 126: Chalmydia trachomatis serotypes are: _____; D-K; L1, L2, L3
Answer: A, B, C
Flashcard 127: Route of transmission for pertussis is via _____
Answer: respiratory droplets
Flashcard 128: Asymptomatic presentations of gonorrhoea predominantly occur in _____
Answer: females
Flashcard 129: Chlamydia trachomatis is an _____ intracellular bacteria
Answer: obligate
Flashcard 130: Vulvovaginal candidiasis presents with pruritis, dysuria, dyspareunia and "_____" discharge
Answer: cottage-cheese
Flashcard 131: What is the management for vulvovaginal candidiasis?
1st-line: _____
Alternative: topical -azoles (creams & pessaries)
Answer: oral -azole
Flashcard 132: What is the management for chlamydia trachomatis?
1st-line: _____
Alternative: azithromycin (e.g. in pregnancy)
Answer: doxycycline
Flashcard 133: A young female presents with dysuria, on urine culture there are WBC without bacterial growth. What is the likely diagnosis?
_____
Answer: Chlamydia trachomatis or N. gonorrhoeae causing sterile pyuria
Flashcard 134: Neisseria gonorrhoeae is a gram _____ diplococci
Answer: -ve
Flashcard 135: Whooping cough is worse at _____
Answer: night
Flashcard 136: _____ for pertussis is given at 2 months, 3 months, 4 months, & 3 years 4 months
Answer: DTaP
Flashcard 137: Oropharyngeal candidiasis caused by inhaled corticosteroids can be reduced with _____
Answer: rinsing their mouth & spitting
Flashcard 138: Incubation period for gonorrhoea is _____
Answer: 2-8 days
Flashcard 139: What is the investigation for chlamydia in males?
_____
Answer: NAAT*; with First-Catch Urine (FCU)
Flashcard 140: Vulvovaginal candidiasis is a fungal (yeast) infection associated with a vaginal pH _____
Answer: <4.5
Flashcard 141: Incubation period for chlamydia is _____
Answer: 1-3 weeks
Flashcard 142: Candidiasis can present as _____, oropharyngeal candidiasis, oesophageal candidiasis, mammary candidiasis & systemic infection
Answer: vulvovaginal candidiasis
Flashcard 143: On wet mount microscopy, motile trophozoites are seen in _____
Answer: Trichomonas vaginalis
Flashcard 144: Trichomonas vaginalis presents with a _____-smelling discharge
Answer: foul
Flashcard 145: _____ is the most common vaginal infection
Answer: Bacterial vaginosis
Flashcard 146: What is the gold-standard investigation for trichomonas vaginalis?
_____
Answer: NAAT (nucleic acid amplification test)
Flashcard 147: Candida albicans is part of the normal _____
Answer: flora
Flashcard 148: What is the initial investigation for trichomonas vaginalis?
_____
Answer: Swab for wet mount microscopy; motile trophozoites observed
Flashcard 149: What is the management for trichomonas vaginalis?
_____
Answer: Metronidazole (FYI, this is ideally treated in sexual health clinics)
Flashcard 150: _____ & trichomoniasis both cause an ↑ vaginal pH > 4.5
Answer: Bacterial vaginosis
Flashcard 151: Bacterial vaginosis in pregnancy increases the risk of _____
Answer: preterm labour, PROM, chorioamnionitis...
Flashcard 152: What is the management for symptomatic bacterial vaginosis?
_____
Answer: Metronidazole
Flashcard 153: _____ is a protozoal infection associated with a vaginal pH >4.5
Answer: Trichomonas vaginalis
Flashcard 154: _____ vaginalis presents with a(n) frothy yellow-green discharge
Answer: Trichomonas
Flashcard 155: _____ causes cervicitis, presenting as a(n) "strawberry cervix" on speculum exam
Answer: Trichomonas vaginalis
Flashcard 156: _____ is a protozoan parasite that causes a common STI called trichomoniasis
Answer: Trichomonas vaginalis
Flashcard 157: Amsel criteria for bacterial vaginosis:
_____
Answer:
• Thin, homogenous grey-white discharge
• +ve amine whiff test
• Vaginal pH > 4.5
• Clue cells on wet mount microscopy
Flashcard 158: The most common organism associated with bacterial vaginosis is _____
Answer: Gardnerella vaginalis
Flashcard 159: On wet mount microscopy, clue cells are seen in _____
Answer: bacterial vaginosis
Flashcard 160: _____ is the imbalance of vaginal microbiota, resulting in a ↓ of protective lactobacilli & an overgrowth of other bacteria
Answer: Bacterial vaginosis
Flashcard 161: Bacterial vaginosis is diagnosed with a score of 3 out of 4 on the _____ criteria
Answer: Amsel
Flashcard 162: What is the management for asymptomatic bacterial vaginosis?
_____
Answer: No management necessary
Flashcard 163: Trichomonas vaginalis is commonly _____, particularly in men
Answer: asymptomatic
Flashcard 164: Sexual intercourse, vaginal douching, vaginal soaps & perfumes are risk factors for _____
Answer: bacterial vaginosis
Flashcard 165: Trichomonas vaginalis is primarily transmitted through _____
Answer: sexual contact
Flashcard 166: _____ is a fungal infection caused by the Candida species, primarily Candida albicans ranging from mucocutaneous infections (e.g. oral thrush, vulvovaginal candidiasis) to systemic infections (e.g. candidaemia)
Answer: Candidiasis
Flashcard 167: Vaccination against human papilloma virus (HPV) is given at _____
Answer: 12-13 years old for BOTH genders
Flashcard 168: +ve amine whiff test is when drops of 10% potassium hydroxide (KOH) is added to vaginal discharge on a slide → this releases volatile amines producing the characteristic _____ odour
Answer: fishy
Flashcard 169: Bacterial vaginosis presents asymptomatically or with _____ discharge and a fishy odour
Answer: thin, grey-white
Flashcard 170: The pathophysiology of bacterial vaginosis involves ↓ decreased colonization of the vagina with _____, leading to ↑ increased pH and overgrowth of anaerobic bacteria
Answer: lactobacilli
Flashcard 171: _____ vaginalis can present with itching & burning
Answer: Trichomonas
Flashcard 172:
Do NOT swab pressure sores unless _____
Answer: signs of infection are present
Flashcard 173:
Secretions in palliative patients suspected to be caused by a chest infection may be managed with a _____
Answer: single dose of a broad spectrum antibiotic
Flashcard 174: < 2 month post-valve surgery patient with infective endocarditis is most commonly caused by _____
Answer: Staphylococcus epidermis
Flashcard 175: The most common cause of constrictive pericarditis is _____
Answer: tuberculosis
Flashcard 176: What is the most common cause of myocarditis?
_____
Answer: Viral - Cocksackie virus, parvovirus
Flashcard 177: What is the most common cause of viral myocarditis?
_____
Answer: Cocksackie viruses
Flashcard 178: The second most common organism that causes infective endocarditis is _____
Answer: Streptococcus viridans
Flashcard 179: One symptom associated with bacterial endocarditis is _____, which are round, white spots on the retina surrounded by hemorrhage
Answer: Roth spots
Flashcard 180:
_____ is a condition caused by infection of the endocardium, most commonly the heart valves
Answer: Infective endocarditis
Flashcard 181: _____ procedures increase the risk of infective endocarditis because Streptococcus viridans can be found in the mouth
Answer: Dental
Flashcard 182: Endocarditis secondary to rheumatic fever most commonly affects the _____ valve
Answer: mitral
Flashcard 183: FROM JANE infective endocarditis:
F_____
Roth spots
Osler nodes
Murmer
Janeway lesions
Anaemia
Nail-bed haemorrhage
Eemboli
Answer: ever
Flashcard 184: Infective endocarditis most commonly affects the _____ valve
Answer: mitral
Flashcard 185: IVDU patient with infective endocarditis is most commonly caused by _____
Answer: Staphylococcus aureus
Flashcard 186: The HACEK organisms (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella) are associated with endocarditis with _____ blood cultures
Answer: negative
Flashcard 187: The first most common organism that causes infective endocarditis is _____
Answer: Staphylococcus aureus
Flashcard 188: _____ cause of infective endocarditis = Staphylococcus aureus
Sub-acute cause of infective endocarditis = Streptococcus viridans
Answer: Acute
Flashcard 189:
What is the most common cause of pelvic inflammatory disease?
_____
Answer: Chlamydia trachomatis; responsible for up to 40% of cases
Flashcard 190: Persistent infection with _____ is the leading cause of cervical cancer
Answer: human papillomavirus (HPV)
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