Travel during pregnancy US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Travel during pregnancy. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Travel during pregnancy US Medical PG Question 1: A 35-year-old G3P2 woman currently 39 weeks pregnant presents to the emergency department with painful vaginal bleeding shortly after a motor vehicle accident in which she was a passenger. She had her seat belt on and reports that the airbag deployed immediately upon her car's impact against a tree. She admits that she actively smokes cigarettes. Her prenatal workup is unremarkable. Her previous pregnancies were remarkable for one episode of chorioamnionitis that resolved with antibiotics. Her temperature is 98.6°F (37°C), blood pressure is 90/60 mmHg, pulse is 130/min, and respirations are 20/min. The fetal pulse is 110/min. Her uterus is tender and firm. The remainder of her physical exam is unremarkable. What is the most likely diagnosis?
- A. Placental abruption (Correct Answer)
- B. Eclampsia
- C. Vasa previa
- D. Preterm labor
- E. Preeclampsia
Travel during pregnancy Explanation: ***Placental abruption***
- The patient's presentation with **painful vaginal bleeding** after blunt abdominal trauma (motor vehicle accident), a **tender and firm uterus**, maternal **hypotension** and **tachycardia**, and fetal **bradycardia** is highly characteristic of placental abruption.
- Risk factors like **smoking** and trauma further increase the likelihood of placental abruption.
*Eclampsia*
- Eclampsia is characterized by **new-onset grand mal seizures** in a pregnant woman with preeclampsia, which is not present in this scenario.
- While the patient's low blood pressure and tachycardia are concerning, they do not point to eclampsia.
*Vasa previa*
- Vasa previa involves **fetal blood vessels** running within the fetal membranes over the internal cervical os, risking rupture during labor or membrane rupture, leading to **painless vaginal bleeding** and **fetal distress**.
- The bleeding in this case is described as painful, and the uterine tenderness and firmness are not typical of vasa previa.
*Preterm labor*
- Preterm labor is defined by **regular uterine contractions** causing cervical changes before 37 weeks of gestation, which is not aligned with the patient being 39 weeks pregnant or her symptoms.
- While trauma can initiate labor, the severity of the bleeding and maternal/fetal distress point away from isolated preterm labor.
*Preeclampsia*
- Preeclampsia is characterized by **new-onset hypertension** (blood pressure ≥140/90 mmHg) and **proteinuria** after 20 weeks of gestation.
- This patient presents with hypotension and no mention of hypertension or proteinuria, making preeclampsia unlikely.
Travel during pregnancy US Medical PG Question 2: A 30-year-old woman, gravida 2, para 1, at 12 weeks' gestation comes to the physician for a prenatal visit. She feels well. Pregnancy and vaginal delivery of her first child were uncomplicated. Five years ago, she was diagnosed with hypertension but reports that she has been noncompliant with her hypertension regimen. The patient does not smoke or drink alcohol. She does not use illicit drugs. Medications include methyldopa, folic acid, and a multivitamin. Her temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 145/90 mm Hg. Physical examination shows no abnormalities. Laboratory studies, including serum glucose level, and thyroid-stimulating hormone concentration, are within normal limits. The patient is at increased risk of developing which of the following complications?
- A. Placenta previa
- B. Abruptio placentae (Correct Answer)
- C. Spontaneous abortion
- D. Polyhydramnios
- E. Uterine rupture
Travel during pregnancy Explanation: ***Abruptio placentae***
- The patient's history of **chronic hypertension** (145/90 mmHg) and her noncompliance with antihypertensive medication significantly increase her risk for **abruptio placentae**. Hypertension is a major risk factor for this condition.
- Abruptio placentae involves the **premature separation of the placenta** from the uterine wall, which can lead to severe maternal hemorrhage, fetal distress, and preterm birth.
*Placenta previa*
- **Placenta previa** is characterized by the placenta covering the cervical os and is primarily associated with risk factors like **previous C-section**, multiple gestations, or advanced maternal age.
- While a serious complication, it is **not directly linked to chronic hypertension** in the same manner as abruptio placentae.
*Spontaneous abortion*
- **Spontaneous abortion** typically occurs in the **first trimester** and is often due to chromosomal abnormalities, endocrine disorders, or uterine anomalies.
- While hypertension could theoretically contribute to some pregnancy complications, it is **not a primary risk factor** for spontaneous abortion at 12 weeks gestation.
*Polyhydramnios*
- **Polyhydramnios** is an excessive accumulation of amniotic fluid, often associated with **maternal diabetes**, fetal anomalies (e.g., GI obstruction, anencephaly), or multiple gestations.
- Maternal hypertension is **not a direct risk factor** for polyhydramnios.
*Uterine rupture*
- **Uterine rupture** is a rare but catastrophic event, most commonly associated with a **previous uterine scar** (e.g., from a prior C-section or myomectomy).
- The patient's history of a prior vaginal delivery and absence of uterine surgery means she is **not at increased risk** for uterine rupture at this stage.
Travel during pregnancy US Medical PG Question 3: A 20-year-old primigravid woman comes to the physician in October for her first prenatal visit. She has delayed the visit because she wanted a “natural birth” but was recently convinced to get a checkup after feeling more tired than usual. She feels well. Menarche was at the age of 12 years and menses used to occur at regular 28-day intervals and last 3–7 days. The patient emigrated from Mexico 2 years ago. Her immunization records are unavailable. Pelvic examination shows a uterus consistent in size with a 28-week gestation. Laboratory studies show:
Hemoglobin 12.4 g/dL
Leukocyte count 8,000/mm3
Blood group B negative
Serum
Glucose 88 mg/dL
Creatinine 1.1 mg/dL
TSH 3.8 μU/mL
Rapid plasma reagin negative
HIV antibody negative
Hepatitis B surface antigen negative
Urinalysis shows no abnormalities. Urine culture is negative. Chlamydia and gonorrhea testing are negative. A Pap smear is normal. Administration of which of the following vaccines is most appropriate at this time?
- A. Varicella and influenza
- B. Varicella and Tdap
- C. Influenza only
- D. Tdap and influenza (Correct Answer)
- E. Hepatitis B and MMR
Travel during pregnancy Explanation: ***Tdap and influenza***
- The **Tdap vaccine** is recommended for pregnant women during each pregnancy, preferably between **27 and 36 weeks gestation**, to provide passive immunity to the newborn against pertussis. The patient is at 28 weeks gestation.
- The **influenza vaccine** is recommended for all pregnant women, regardless of trimester, during flu season (October in this case) to protect both the mother and the newborn.
*Varicella and influenza*
- The **varicella vaccine is contraindicated in pregnancy** because it is a live attenuated vaccine.
- While influenza vaccine is appropriate, administering varicella vaccine is not.
*Varicella and Tdap*
- As mentioned, the **varicella vaccine is contraindicated in pregnancy** due to its live attenuated nature.
- Although Tdap is appropriate, varicella is not.
*Influenza only*
- While the **influenza vaccine is appropriate**, the **Tdap vaccine** is also indicated for this patient given her gestational age and the benefits for the newborn.
- Administering only influenza would miss an opportunity to provide crucial pertussis protection.
*Hepatitis B and MMR*
- The **Hepatitis B vaccine** is safe in pregnancy if indicated, but the patient tested **Hepatitis B surface antigen negative**, suggesting no current infection and no immediate need for vaccination based on the provided information.
- The **MMR vaccine is contraindicated in pregnancy** because it is a live attenuated vaccine.
Travel during pregnancy US Medical PG Question 4: A 28-year-old woman, gravida 2, para 1, at 30 weeks' gestation comes to the physician because of headache for the past 5 days. Her pregnancy has been uncomplicated to date. Pregnancy and vaginal delivery of her first child were uncomplicated. The patient does not smoke or drink alcohol. She does not use illicit drugs. Medications include folic acid and a multivitamin. Her temperature is 37°C (98.6°F), pulse is 82/min, and blood pressure is 150/92 mm Hg. Physical examination reveals 2+ pitting edema in the lower extremities. Laboratory studies show:
Hemoglobin 11.8 g/dL
Platelet count 290,000/mm3
Urine
pH 6.3
Protein 2+
WBC negative
Bacteria occasional
Nitrites negative
The patient is at increased risk of developing which of the following complications?
- A. Abruptio placentae (Correct Answer)
- B. Polyhydramnios
- C. Uterine rupture
- D. Spontaneous abortion
- E. Placenta previa
Travel during pregnancy Explanation: ***Abruptio placentae***
- The patient presents with **preeclampsia** (new-onset hypertension after 20 weeks gestation, proteinuria, and edema), which is a significant risk factor for **placental abruption**.
- Preeclampsia can lead to **vasoconstriction** and **decidual hemorrhage**, causing premature separation of the placenta from the uterine wall.
*Polyhydramnios*
- **Polyhydramnios** is an excess of amniotic fluid, typically associated with **fetal anomalies** (e.g., esophageal atresia, anencephaly) or **maternal diabetes**, none of which are indicated here.
- While it can complicate pregnancy, it is not directly linked to preeclampsia as a primary complication.
*Uterine rupture*
- **Uterine rupture** is a rare but catastrophic event, most commonly associated with a **prior Cesarean section**, extensive uterine surgery, or **traumatic injury**.
- This patient had an uncomplicated vaginal delivery previously, and there are no signs suggesting a heightened risk for uterine rupture.
*Spontaneous abortion*
- **Spontaneous abortion** occurs before 20 weeks of gestation. This patient is at **30 weeks' gestation**, making spontaneous abortion highly unlikely.
- The term for pregnancy loss after 20 weeks is stillbirth, which is also not the most immediate or direct complication linked to preeclampsia for the mother.
*Placenta previa*
- **Placenta previa** occurs when the placenta covers the cervical os, a condition diagnosed by **ultrasound** and presenting with **painless vaginal bleeding**.
- Preeclampsia does not directly cause placenta previa; these are distinct obstetric complications with different etiologies.
Travel during pregnancy US Medical PG Question 5: A 21-year-old woman comes to the physician because she had a positive pregnancy test at home. For the past 3 weeks, she has had nausea and increased urinary frequency. She also had three episodes of non-bloody vomiting. She attends college and is on the varsity soccer team. She runs 45 minutes daily and lifts weights for strength training for 1 hour three times per week. She also reports that she wants to renew her ski pass for the upcoming winter season. Her vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following is the most appropriate recommendation?
- A. Stop playing soccer, stop strength training, and do not buy a ski pass
- B. Continue playing soccer, stop strength training, and do not buy a ski pass
- C. Stop playing soccer, continue strength training, and buy a ski pass
- D. Stop playing soccer, continue strength training, and do not buy a ski pass (Correct Answer)
- E. Continue playing soccer, continue strength training, and do not buy a ski pass
Travel during pregnancy Explanation: ***Stop playing soccer, continue strength training, and do not buy a ski pass***
- This recommendation balances a **healthy lifestyle** with the **safety concerns** associated with pregnancy, reducing exposure to high-impact activities while encouraging beneficial exercises.
- **Soccer** and **skiing** pose risks of falls and abdominal trauma, which are best avoided during pregnancy, while **strength training** can be safely modified.
*Stop playing soccer, stop strength training, and do not buy a ski pass*
- While stopping soccer and skiing is appropriate, completely stopping **strength training** may be overly restrictive, as moderate exercise is generally encouraged in pregnancy.
- Maintaining some level of physical activity, such as **modified strength training**, can help manage weight, improve mood, and prepare the body for labor.
*Continue playing soccer, stop strength training, and do not buy a ski pass*
- **Continuing soccer** is not recommended due to the **high risk of falls** and **abdominal trauma**, which could harm the fetus.
- While stopping skiing is appropriate, discouraging all forms of strength training might remove **beneficial exercise** from her routine.
*Stop playing soccer, continue strength training, and buy a ski pass*
- **Buying a ski pass** and potentially skiing is **contraindicated** due to the high risk of falls and injury, which could endanger the pregnancy.
- Although stopping soccer and continuing strength training are appropriate, the inclusion of skiing makes this an **unsafe recommendation**.
*Continue playing soccer, continue strength training, and do not buy a ski pass*
- **Continuing soccer** is unsafe during pregnancy due to the significant risk of falls, collisions, and **abdominal injury**.
- While strength training can be safely continued with modifications, the inclusion of soccer makes this recommendation **inappropriate**.
Travel during pregnancy US Medical PG Question 6: A 27-year-old G0P0 female presents to her OB/GYN for a preconception visit to seek advice before becoming pregnant. A detailed history reveals no prior medical or surgical history, and she appears to be in good health currently. Her vaccination history is up-to-date. She denies tobacco or recreational drug use and admits to drinking 2 glasses of wine per week. She states that she is looking to start trying to become pregnant within the next month, hopefully by the end of January. Which of the following is NOT recommended as a next step for this patient's preconception care?
- A. Begin 400 mcg folic acid supplementation
- B. Administer measles, mumps, rubella (MMR) vaccination (Correct Answer)
- C. Obtain rubella titer
- D. Obtain varicella zoster titer
- E. Recommend inactivated influenza vaccination
Travel during pregnancy Explanation: ***Administer measles, mumps, rubella (MMR) vaccination***
- Live-attenuated vaccines like **MMR** are contraindicated during pregnancy and should ideally be given **at least one month prior to conception**.
- If her vaccination history is up-to-date and she plans to conceive within the month, administering MMR is not recommended at this time without confirming immunity first.
*Begin 400 mcg folic acid supplementation*
- **Folic acid supplementation** at 400 mcg daily is recommended for all women of childbearing age to prevent **neural tube defects**, ideally starting at least one month before conception and continuing through the first trimester.
- This is a crucial step in preconception care to ensure adequate levels when the neural tube is forming.
*Obtain rubella titer*
- Checking a **rubella titer** is standard preconception care to determine immunity, as rubella infection during pregnancy can lead to serious congenital anomalies.
- If she is not immune, the MMR vaccine can be offered, but with a **one-month contraception period** before attempting conception.
*Obtain varicella zoster titer*
- Determining **varicella immunity** is important because congenital varicella syndrome can occur if a non-immune mother contracts chickenpox during pregnancy.
- If she is not immune, the **varicella vaccine** can be administered, followed by a **one-month waiting period** before conception.
*Recommend inactivated influenza vaccination*
- **Inactivated influenza vaccination** is safe and recommended during any stage of pregnancy, including the preconception period, to protect both the mother and newborn from severe influenza outcomes.
- It can be given even if she plans to conceive within the month, as it is not a live vaccine.
Travel during pregnancy US Medical PG Question 7: A 26-year-old woman presents to the women’s health clinic with a 9-week delay in menses. The patient has a history of grand mal seizures, and was recently diagnosed with acute sinusitis. She is prescribed lamotrigine and amoxicillin. The patient smokes one-half pack of cigarettes every day for 10 years, and drinks socially a few weekends every month. Her mother died of breast cancer when she was 61 years old. The vital signs are stable during the current office visit. Physical examination is grossly normal. The physician orders a urine beta-hCG that comes back positive. Abdominal ultrasound shows an embryo consistent in dates with the first day of last menstrual period. Given the history of the patient, which of the following would most likely decrease congenital malformations in the newborn?
- A. Decrease alcohol consumption
- B. Switching to cephalexin
- C. Folic acid supplementation (Correct Answer)
- D. Smoking cessation
- E. Switching to another antiepileptic medication
Travel during pregnancy Explanation: ***Folic acid supplementation***
- **Folic acid** (vitamin B9) is crucial in early pregnancy for **neural tube development** and significantly reduces the risk of **neural tube defects** and other congenital malformations.
- Given the patient’s history of **lamotrigine** use, which can increase the risk of neural tube defects, folic acid supplementation is even more critical.
*Decrease alcohol consumption*
- While **alcohol cessation** is important to prevent **fetal alcohol syndrome** and other alcohol-related developmental issues, it primarily affects neurological development and facial dysmorphology rather than primarily preventing
- The effects of alcohol are typically more pronounced with **chronic heavy consumption**, and while any reduction is beneficial, it is not the most likely intervention to decrease general congenital malformations.
*Switching to cephalexin*
- **Amoxicillin** is considered **safe in pregnancy** and is a penicillin-class antibiotic, while **cephalexin** is a cephalosporin.
- Switching antibiotics from one safe drug to another without a clear medical indication (e.g., allergy, resistance) would **not decrease the risk of congenital malformations**.
*Smoking cessation*
- **Smoking cessation** is vital during pregnancy as it reduces the risk of **low birth weight**, **preterm birth**, and other complications like placental abruption.
- However, the primary link of smoking is not directly with **congenital malformations** like neural tube defects, but rather with growth restriction and adverse perinatal outcomes.
*Switching to another antiepileptic medication*
- This patient is on **lamotrigine**, which is considered one of the **safer antiepileptic drugs (AEDs)** in pregnancy, especially compared to others like **valproic acid**.
- Switching to an alternative AED might even carry a **higher risk for congenital malformations** and is generally not recommended unless lamotrigine is ineffective or contraindicated.
Travel during pregnancy US Medical PG Question 8: A 25-year-old G1P0 woman at 22 weeks’ gestation presents to the emergency department with persistent vomiting over the past 8 weeks which has resulted in 5.5 kg (12.1 lb) of unintentional weight loss. She has not received any routine prenatal care to this point. She reports having tried diet modification and over-the-counter remedies with no improvement. The patient's blood pressure is 103/75 mm Hg, pulse is 93/min, respiratory rate is 15/min, and temperature is 36.7°C (98.1°F). Physical examination reveals an anxious and fatigued-appearing young woman, but whose findings are otherwise within normal limits. What is the next and most important step in her management?
- A. Begin treatment with vitamin B6
- B. Begin treatment with metoclopramide
- C. Obtain a basic electrolyte panel
- D. Obtain a beta hCG and pelvic ultrasound
- E. Admit and begin intravenous rehydration (Correct Answer)
Travel during pregnancy Explanation: ***Admit and begin intravenous rehydration***
- The patient exhibits signs of **hyperemesis gravidarum**, including persistent vomiting, **significant weight loss** (5.5 kg), and inability to maintain hydration orally.
- **Intravenous rehydration** is crucial to correct dehydration and electrolyte imbalances, which can lead to serious complications if left untreated.
*Begin treatment with vitamin B6*
- While **pyridoxine (vitamin B6)** is a first-line treatment for **mild to moderate nausea and vomiting of pregnancy**, it is insufficient for severe cases involving significant weight loss and dehydration.
- This patient's symptoms are beyond what can be effectively addressed with vitamin B6 alone and require more aggressive management.
*Begin treatment with metoclopramide*
- **Metoclopramide** is an antiemetic that can be used for nausea and vomiting in pregnancy, but it is typically reserved for cases where first-line therapies (like vitamin B6) are ineffective.
- Before starting medication, especially in a severely dehydrated patient, addressing the immediate fluid and electrolyte deficits is paramount.
*Obtain a basic electrolyte panel*
- While obtaining an **electrolyte panel** is an important diagnostic step to assess the degree of electrolyte disturbance, it is not the *most important first step* in management.
- The patient's clinical presentation of persistent vomiting and weight loss clearly indicates the need for immediate intravenous rehydration regardless of initial electrolyte results.
*Obtain a beta hCG and pelvic ultrasound*
- A **beta hCG level** and **pelvic ultrasound** might be indicated later to rule out other causes of hyperemesis, such as **multiple gestation** or **molar pregnancy**.
- However, given the patient's acute symptoms of dehydration and weight loss, immediate stabilization with intravenous fluids takes precedence over diagnostic imaging.
Travel during pregnancy US Medical PG Question 9: A 27-year-old woman, gravida 2, para 1, at 36 weeks' gestation comes to the physician for a prenatal visit. She feels well. Fetal movements are adequate. This is her 7th prenatal visit. She had an ultrasound scan performed 1 month ago that showed a live intrauterine pregnancy consistent with a 32-week gestation with no anomalies. She had a Pap smear performed 1 year ago, which was normal. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 36-week gestation. Her blood group and type is A negative. Which of the following is the most appropriate next step in management?
- A. Transabdominal doppler ultrasonography
- B. Rh antibody testing
- C. Swab for GBS culture (Correct Answer)
- D. Serum PAPP-A and HCG levels
- E. Complete blood count
Travel during pregnancy Explanation: ***Swab for GBS culture***
- All pregnant women should be screened for **Group B Streptococcus (GBS)** between **36 weeks 0 days and 37 weeks 6 days** of gestation.
- A positive GBS culture requires **intrapartum antibiotic prophylaxis** to prevent early-onset neonatal GBS disease.
*Transabdominal doppler ultrasonography*
- **Doppler ultrasonography** is primarily used to assess **fetal well-being** in cases of **fetal growth restriction**, preeclampsia, or other high-risk conditions.
- This patient has a **normal-sized uterus** and **adequate fetal movements**, indicating no immediate need for fetal Doppler assessment.
*Rh antibody testing*
- **Rh antibody testing** (indirect Coombs test) is performed early in pregnancy for Rh-negative women and typically repeated at **28 weeks' gestation** before anti-D immune globulin administration.
- Repeating this test at 36 weeks is not the most appropriate *next* step as the routine schedule for Rh immune globulin would typically be managed prior to this point.
*Serum PAPP-A and HCG levels*
- **Serum PAPP-A and HCG levels** are components of **first-trimester screening** for chromosomal abnormalities, performed between 11 and 14 weeks of gestation.
- At 36 weeks' gestation, these markers are not relevant for current fetal assessment.
*Complete blood count*
- A **complete blood count (CBC)** is routinely performed in the first trimester and often repeated in the **late second or early third trimester** (around 28 weeks) to check for anemia.
- While a CBC might be done as part of general prenatal care, it is not the most urgent or specifically indicated test at 36 weeks in the absence of symptoms.
Travel during pregnancy US Medical PG Question 10: A 29-year-old G1P0 presents to her obstetrician for her first prenatal care visit at 12 weeks gestation by last menstrual period. She states that her breasts are very tender and swollen, and her exercise endurance has declined. She otherwise feels well. She is concerned about preterm birth, as she heard that certain cervical procedures increase the risk. The patient has a gynecologic history of loop electrosurgical excision procedure (LEEP) for cervical dysplasia several years ago and has had negative Pap smears since then. She also has mild intermittent asthma that is well controlled with occasional use of her albuterol inhaler. At this visit, this patient’s temperature is 98.6°F (37.0°C), pulse is 69/min, blood pressure is 119/61 mmHg, and respirations are 13/min. Cardiopulmonary exam is unremarkable, and the uterine fundus is just palpable at the pelvic brim. Pelvic exam reveals normal female external genitalia, a closed and slightly soft cervix, a 12-week-size uterus, and no adnexal masses. Which of the following is the best method for evaluating for possible cervical incompetence in this patient?
- A. Transabdominal ultrasound in the first trimester
- B. Transvaginal ultrasound in the first trimester
- C. Serial transvaginal ultrasounds starting at 16 weeks gestation
- D. Transabdominal ultrasound at 18 weeks gestation
- E. Transvaginal ultrasound at 18 weeks gestation (Correct Answer)
Travel during pregnancy Explanation: ***Transvaginal ultrasound at 18 weeks gestation***
- A history of **LEEP** is a risk factor for **cervical incompetence** and warrants screening with transvaginal ultrasound.
- The optimal timing for **cervical length** screening in women with a history of cervical procedures is typically between **18 and 24 weeks gestation**, as the risk of cervical shortening usually manifests during this period.
*Transabdominal ultrasound in the first trimester*
- **Transabdominal ultrasound** is generally not ideal for precise **cervical length measurement** due to potential shadowing from the fetus or maternal obesity.
- **First-trimester cervical length measurement** is not typically recommended for routine screening of cervical incompetence, as changes are less pronounced early in pregnancy.
*Transvaginal ultrasound in the first trimester*
- While more accurate than transabdominal, **first-trimester transvaginal ultrasound** for cervical length is not standard for predicting cervical incompetence.
- Significant cervical shortening due to incompetence often occurs later in the second trimester, so early screening may miss the condition.
*Serial transvaginal ultrasounds starting at 16 weeks gestation*
- While **serial transvaginal ultrasounds** starting at 16 weeks can be part of a management plan for high-risk patients, the most critical single assessment typically occurs at **18-24 weeks**.
- Starting serial scans too early may not be necessary if the cervix is long and closed at the initial key screening, unless there are other strong indications.
*Transabdominal ultrasound at 18 weeks gestation*
- Similar to first-trimester transabdominal ultrasound, **transabdominal imaging** at 18 weeks is generally **less accurate** than transvaginal for measuring cervical length.
- **Transvaginal ultrasound** offers a clearer and more precise view of the cervix, which is crucial for assessing potential shortening or funneling.
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