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Q1
A 30-year-old woman complains of episodic epigastric pain that improves with food and recurs 2-3 hours after meals. The most likely diagnosis is:
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Q2
A 40-year-old smoker has chronic cough with sputum production. Spirometry reveals a normal FEV1/FVC ratio but a markedly reduced diffusing capacity for carbon monoxide (DLCO). Which subtype of COPD is most consistent with these findings?
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Q3
An HIV-positive woman is in her first trimester of pregnancy. Which antiretroviral drug is contraindicated during this period?
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Q4
A 45-year-old man presents with fatigue, pallor and spoon-shaped nails. Laboratory studies show Hb 9 g/dL, MCV 70 fL, serum ferritin low, and TIBC elevated. Which is the most appropriate initial management?
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Q5
A 50-year-old man with type 2 diabetes on metformin 1 g BD and glimepiride 4 mg has fasting glucose 156 mg/dL, HbA1c 8.1%, BMI 27, and no hypoglycemia symptoms. What is the most appropriate next step?
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Q6
A 62-year-old man with hypertension presents with progressive dyspnea on exertion and bilateral ankle edema. Echocardiography shows left ventricular ejection fraction of 35%. Which of the following is the first-line pharmacologic therapy to reduce mortality in this patient with heart failure with reduced ejection fraction (HFrEF)?
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Q7
A 28-year-old man presents with a 2-day history of sore throat, fever, and tender cervical lymphadenopathy. Which finding would most strongly suggest bacterial pharyngitis requiring antibiotics?
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Q8
What is the first-line screening test for diabetes mellitus in a patient with risk factors in primary care?
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Q9
Which age group is recommended for colorectal cancer screening with colonoscopy every 10 years in Nepalese primary care settings?
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Q10
A 50-year-old man presents with a 2-cm suspicious pigmented lesion on his back that has irregular borders. What is the next step?
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Q11
Which of the following tools is most appropriate for assessing a patient's readiness to stop smoking in primary care?
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Q12
According to the National Referral Guidelines, which document must accompany a patient when being referred from a Primary Health Care Center to a District Hospital?
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Q13
Which parameter is part of the SOFA score for cardiovascular assessment?
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Q14
What is the most common cause of preventable death in trauma patients?
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Q15
A 28-year-old pregnant woman at 36 weeks gestation presents with sudden severe abdominal pain, vaginal bleeding, and a tender, firm uterus on examination. What is the most likely diagnosis?
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Q16
According to Nepal Ministry of Health guidelines, pregnant women should receive iron supplementation starting from which period?
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Q17
Which statement about vitamin A supplementation in Nepal is correct?
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Q18
A 70-year-old woman presents with a history of two falls in the past month. She lives alone, takes amitriptyline for neuropathic pain, and reports feeling dizzy when standing. Which medication is most likely contributing to her fall risk?
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Q19
Which antihypertensive drug has the lowest risk of causing orthostatic hypotension in elderly patients?
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Q20
Which of the following is an example of a 'confounding variable' in a study examining the association between coffee consumption and lung cancer?
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Q21
Which of the following statements accurately reflects the role of Accredited Social Health Activist (ASHA) in environmental health promotion?
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Q22
A 25-year-old male is brought to the emergency department by his family. For the last 3 weeks, he has been claiming that the Nepal government has implanted a chip in his brain to monitor his thoughts and has stopped bathing. He has no history of substance abuse. What is the most likely diagnosis?
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Q23
Which of the following community-level interventions has the strongest evidence for reducing adolescent alcohol consumption in Nepal?
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Q24
What is the initial fluid resuscitation goal in diabetic ketoacidosis?
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Q25
A 68-year-old patient with known COPD presents with increased exertional dyspnea, productive cough, and a decrease in DLCO. Which COPD subtype is most consistent with these findings?
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Q26
Which cardiac rhythm is most likely to respond to defibrillation during out-of-hospital cardiac arrest?
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Q27
A 22-year-old woman complains of itching and a thick, white discharge from the vagina. What is the most likely diagnosis?
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Q28
At what age is the second dose of measles-rubella (MR) vaccine scheduled in Nepal's routine immunization program?
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Q29
The national plan that includes the construction of health information systems across all health facilities is called?
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Q30
A 28-year-old man has recurrent abdominal pain associated with bowel movements, alternating diarrhea and constipation, and bloating; he meets Rome IV criteria for IBS. What is the first-line treatment?
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Q31
Which laboratory finding is most specific for vitamin B12 deficiency in a patient with macrocytic anemia?
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Q32
Which lifestyle modification is most effective in reducing the risk of developing type 2 diabetes in adults?
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Q33
Which of the following best defines the principle of "continuity of care" in family medicine?
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Q34
According to Nepal's newborn screening program, when should the thyroid-stimulating hormone (TSH) test be performed on dried blood spot samples?
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Q35
A family physician maintains a list of all hypertensive patients and flags those whose blood pressure has been uncontrolled for >3 months. This activity exemplifies which Chronic Care Model element?
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Q36
Following airway securing with cervical spine protection in the primary survey of a trauma patient, which assessment is performed next?
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Q37
For neuropathic pain in an older adult, which medication is considered first-line due to efficacy and safety profile?
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Q38
A prospective cohort study of 1,000 adults evaluates the association between a new dietary supplement and the incidence of hypertension over 5 years. Which measure of association is most appropriate to quantify the strength of this relationship?
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Q39
A pregnant woman with opioid dependence requires maintenance therapy. Which medication is considered safe and recommended by WHO and Nepal's guidelines?
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Q40
A 62-year-old man presents with a 6-month history of resting tremor in the right hand, bradykinesia, and postural instability. He has a stooped posture and decreased facial expression. Which of the following is the most appropriate initial pharmacotherapy?
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Q41
According to Nepal's policy, what information must accompany a referral slip for a patient being sent from a district hospital to a provincial referral hospital?
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Q42
A 22-year-old female is brought to the ED in a state of extreme agitation and aggression following a psychotic break. She is resisting verbal redirection and posing a danger to staff. Which combination of medications is generally recommended for rapid chemical restraint in such psychiatric emergencies?
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Q43
A COPD patient has a body-mass index of 28 kg/mΒ². According to GOLD nutritional categories, how is his weight status classified?
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Q44
Which of the following vaccines is recommended to be administered as a two-dose series at ages 12-15 years for protection against meningococcal disease in Nepal?
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Q45
In acute decompensated heart failure with pulmonary edema and systolic BP 180/110 mmHg, which intravenous vasodilator is preferred as first-line afterload reduction?
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Q46
A 45-year-old male with known HIV infection presents with a CD4 count of 80 cells/Β΅L. He develops a progressive headache, low-grade fever, and confusion. An MRI shows ring-enhancing lesions in the basal ganglia. What is the most likely opportunistic infection?
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Q47
Which governmental authority in Nepal is responsible for granting licenses for the procurement and distribution of oral morphine for palliative care?
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Q48
A 5-year-old child presents with colicky abdominal pain, vomiting, and a palpable 'sausage-shaped' mass in the right lower quadrant. Which diagnosis is most likely?
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Q49
A 26-year-old woman has a 2-mm mucosal mucocele on the lower lip and wishes it removed. Which minor procedure is appropriate in primary care?
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Q50
In the context of child growth monitoring in primary care, 'failure to thrive' is most accurately defined as:
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Q51
A 45-year-old woman presents with pleuritic chest pain relieved by leaning forward and a friction rub on auscultation. Which is the most likely diagnosis?
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Q52
According to Nepal Ministry of Health, which immunization is NOT recommended for newborns at birth?
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Q53
In the context of occupational health surveillance in Nepal, which of the following is considered a 'biological monitor' for exposure to organophosphate pesticides in agricultural workers?
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Q54
A 22-year-old woman presents with pruritic skin lesions, right upper quadrant discomfort, and serum alkaline phosphatase of 480 U/L (normal <120). Anti-mitochondrial antibody is positive. Which diagnosis is most consistent?
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Q55
A 60-year-old man arrives with sudden severe headache described as 'the worst headache of my life', associated with nausea and neck stiffness, without trauma. What is the most likely diagnosis?
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Q56
A 45-year-old smoker wishes to quit. What is the most appropriate first-contact management strategy?
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Q57
A 58-year-old man with newly diagnosed hypertension has an LDL-cholesterol of 140 mg/dL and a 10-year ASCVD risk of 15 %. According to current lipid guidelines, which statin intensity should be started?
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Q58
Which of the following best captures the principle of 'continuity of care' in home visits for chronic disease management?
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Q59
In the context of the 'Social Ecological Model' of behavior change, which of the following represents an 'Environmental' or 'Community' level intervention for increasing physical activity in a Nepali village?
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Q60
A 28-year-old woman is found unconscious after an overdose of 10 g of paracetamol. 6 hours after ingestion, her serum acetaminophen level is 150 Β΅g/mL. According to the RumackβMatthew nomogram, what is the appropriate next step?
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Q61
Which of the following is NOT considered a typical prodromal symptom of schizophrenia?
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Q62
A 28-year-old woman with systemic lupus erythematosus has a flare with renal involvement. Which antibody is most specific for lupus nephritis?
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Q63
Which of the following is the most effective intervention to reduce road traffic injuries in Nepal?
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Q64
A 59-year-old man with hypertension and diabetes has a BP of 145/92 mmHg despite taking amlodipine 10 mg. He has albuminuria (UACR 350 mg/g). Which agent is the most appropriate first-choice addition to optimize renal protection?
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Q65
Which of the following is the primary indicator that DKA is resolving and the patient can transition to subcutaneous insulin?
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Q66
Which biomarker is most useful for guiding diuretic therapy and prognostication in chronic heart failure?
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Q67
A 58-year-old man with severe COPD presents with increased dyspnea and sputum volume. He has a history of chronic heart failure. Which of the following medications is most likely to cause a significant increase in the risk of pneumonia in this patient?
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Q68
Among elderly people (β₯65 years) in Nepal, which nutrient deficiency is most commonly associated with increased risk of falls?
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Q69
For a patient with end-stage renal disease on concurrent morphine therapy for pain, which dose modification is most appropriate to maintain analgesia while minimizing accumulation risk?
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Q70
A 48-year-old man with chronic hepatitis B infection presents with fatigue, jaundice, AFP 150 ng/mL, and a 4 cm hepatic lesion on ultrasound. What is the most likely diagnosis?
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Q71
A 60-year-old woman with known osteoporosis falls and now has severe back pain, a kyphotic deformity, and bilateral leg sensory loss. Which injury is most likely and what is the most urgent management?
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Q72
A 22-year-old pregnant woman at 14 weeks gestation notes a rapidly growing, bleeding, 4-mm lesion on her gingiva that is tender to touch. Clinical diagnosis is pyogenic granuloma (pregnancy tumor). Which minor procedure can be safely performed in primary care?
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Q73
For a 6-year-old child in cardiac arrest, what is the recommended chest compression depth?
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Q74
At what gestational age is the second antenatal care visit typically scheduled according to the focused ANC model in Nepal?
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Q75
A 40-year-old male working in a battery recycling plant presents with abdominal colic, wrist drop, and a bluish line on the gums. Peripheral blood smear is most likely to show:
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Q76
According to the Nepalese clinical practice guideline for obesity, which waist circumference defines abdominal obesity in South Asian men?
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Q77
Which of the following is the most appropriate timing for the first dose of hepatitis B vaccine in newborns according to Nepal's immunization schedule?
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Q78
When evaluating the effectiveness of a health education program on hand-washing practices, which study design provides the strongest evidence for causality?
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Q79
HbA1c reflects glucose control for:
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Q80
A 50-year-old man has LDL cholesterol 160 mg/dL, HDL 35 mg/dL, and triglycerides 250 mg/dL. Which lipid-lowering agent is most appropriate as first-line therapy?
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Q81
According to Nepal-adapted hypertension guidelines, what is the recommended target blood pressure for a patient with type 2 diabetes and chronic kidney disease stage 3 (eGFR β 45 mL/min/1.73 mΒ²)?
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Q82
Which of the following is a critical ethical consideration when documenting findings from a home visit in the patient's electronic medical record?
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Q83
The recommended daily salt intake for adults in Nepal is:
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Q84
A 12-year-old boy inquires about condom use. Which statement about confidentiality in adolescent sexual-health services is correct under Nepal law?
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Q85
What is the primary objective of palliative care for a patient with terminal dementia?
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Q86
A 55-year-old man presents with melena, mild hypotension, hemoglobin 9 g/dL, normal platelet count and coagulation profile. What is the most appropriate initial pharmacologic intervention?
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Q87
A 31-year-old man with severe major depressive disorder develops mutism, waxy flexibility, and staring for the past 24 hours. After supportive care fails, which medication is used both diagnostically and therapeutically as the first-line challenge in catatonia?
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Q88
In a patient with hypertrophic obstructive cardiomyopathy, which medication class is contraindicated due to risk of worsening outflow-tract obstruction?
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Q89
A 76-year-old patient with chronic obstructive pulmonary disease (COPD) and severe disability requires long-term oxygen therapy. What is the primary goal of this therapy in a palliative/long-term care setting?
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Q90
In a primary care setting, which of the following is the most appropriate way to manage a patient with multiple chronic comorbidities (Diabetes, Hypertension, COPD) to ensure comprehensive care?
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Q91
What is the recommended daily fibre intake for adults aged 65 years and older in Nepal?
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Q92
In palliative sedation, which of the following is an essential prerequisite before initiating continuous deep sedation?
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Q93
Which of the following is the most appropriate follow-up interval after a brief motivational interview for reducing sedentary behavior in a middle-aged office worker?
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Q94
Which surgical procedure is considered the gold-standard for maximal weight loss and metabolic improvement in a patient with BMI 42 kg/mΒ² and severe obstructive sleep apnoea?
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Q95
A 16-year-old girl presents with recurrent episodes of binge eating followed by self-induced vomiting. Her BMI is 19 kg/mΒ². Which of the following is the most appropriate initial management step in primary care?
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Q96
A 55-year-old man with high-speed collision presents with thoracic spine fracture. Which imaging is best to assess for spinal cord injury?
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Q97
A chronic alcoholic presents with confusion, nystagmus and gait ataxia. Which vitamin deficiency is most likely responsible for these neurological features?
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Q98
When should a postpartum check-up be arranged for a mother after a normal delivery in Nepal?
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Q99
A 55-year-old woman with type 2 diabetes has an LDL-C of 130 mg/dL, no clinical atherosclerotic cardiovascular disease, and an estimated 10-year ASCVD risk of 9 %. According to ACC/AHA 2019 primary-prevention guidance, which statin regimen should be initiated?
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Q100
In ACLS for a patient with pulseless ventricular tachycardia who has just received a synchronized shock, which antiarrhythmic drug is recommended as the first adjunctive therapy according to Nepal's algorithms?
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Q101
Which of the following is the gold standard for diagnosing the severity of metabolic acidosis in a patient with suspected methanol poisoning?
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Q102
A 5-year-old boy with known type-1 diabetes presents with polyuria, vomiting, abdominal pain, and a blood glucose of 450 mg/dL. His breath smells fruity and his serum bicarbonate is 12 mmol/L. What is the most appropriate initial therapy?
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Q103
Which of the following is the correct sequence of the 'Stabilization Phase' management in a child with SAM and medical complications?
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Q104
The National Vector Borne Disease Control Programme (NVBDCP) prioritises several diseases for control. Which of the following is a priority disease under this programme?
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Q105
A 52-year-old woman reports fluctuating diplopia and ptosis that worsen toward the end of the day and improve with rest. Which test is most useful to confirm the suspected diagnosis?
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Q106
During a home visit, a physician uses the "HOME" mnemonic for planning. What does the "M" represent?
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Q107
A 38-year-old man with newly diagnosed sputum-smear positive pulmonary tuberculosis is started on the standard Category I regimen. After how many months should the continuation phase (HR) be completed according to the Nepal National Tuberculosis Programme?
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Q108
A 45-year-old woman with chronic atopic dermatitis has pruritic, erythematous plaques on her elbows and knees. Which topical therapy is most appropriate first-line?
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Q109
During a first-contact visit, a 58-year-old man reports difficulty swallowing solids for the past 2 weeks. Physical examination reveals a smooth, non-tender epigastric mass. Which of the following is the most appropriate next step in comprehensive care?
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Q110
What is the target coverage percentage for the third dose of pentavalent vaccine (DTP-HepB-Hib) in infants by the end of the first year of life as per Nepal's Immunization Goal 2025?
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Q111
A 26-year-old female is brought to the emergency department after a suicide attempt by cutting her wrists. She is currently hemodynamically stable but expresses a strong desire to kill herself again. Which of the following is the most appropriate immediate management strategy?
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Q112
A 45-year-old woman with chronic asthma is well controlled on low-dose inhaled corticosteroid. She is planning a pregnancy. What is the recommended step-down strategy?
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Q113
A 62-year-old man underwent PCI for anterior STEMI and is being discharged. According to current lipid guidelines, which statin regimen is recommended for secondary prevention?
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Q114
During a brief intervention for hazardous alcohol use, the "Assess" step of the WHO 5 A's includes which action?
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Q115
Which of the following nutrients is essential to supplement in infants who are exclusively breastfed and living in areas with limited sunlight exposure to prevent rickets?
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Q116
In deciding to discontinue artificial nutrition in a patient with advanced cancer, which ethical principle most directly guides the clinician?
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Q117
A 60-year-old man with T2DM presents with a glucose level of 650 mg/dL, serum osmolality of 330 mOsm/kg, and a pH of 7.35. He is severely dehydrated and confused. No ketones are found in the urine. What is the most critical initial step in management?
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Q118
Which therapeutic food is employed by Nepal's National Community-Based Management of Acute Malnutrition (CMAM) programme for treating severe acute malnutrition?
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Q119
What is the recommended initial dose of tranexamic acid (TXA) for an adult trauma patient with or at risk of significant hemorrhage, according to current ATLS guidelines?
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Q120
A 48-year-old man with a BMI of 36 kg/m2, hypertension, and impaired fasting glucose has attempted lifestyle modification for six months without weight loss. According to Nepal obesity guidelines, which pharmacologic agent is recommended as first-line therapy for weight reduction in this patient?
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Q121
A 27-year-old woman has an asymptomatic cystic ovarian mass measuring 6 cm on ultrasound. Which management option carries the highest risk of torsion?
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Q122
Which intervention has the strongest evidence for reducing indoor air pollution-related acute lower respiratory infections in children under five in rural Nepal?
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Q123
A 73-year-old woman reports feeling 'the floor moving' when she turns in bed and has difficulty maintaining balance while standing. Which geriatric syndrome does this description most closely represent?
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Q124
Which of the following describes 'management continuity' in the context of a patient with multiple comorbidities?
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Q125
Which of the following is considered a 'systemic' failure in the referral process between a health post and a district hospital in Nepal?
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Q126
During the primary survey of a trauma patient, the 'C' (Circulation) assessment reveals an absent radial pulse and a blood pressure of 70/40 mmHg. Which of the following is the priority action?
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Q127
A 2-year-old child presents with fever, tachycardia (HR 170/min), hypotension (BP 70/40 mmHg), delayed capillary refill (>3 s) and cold extremities. What is the recommended initial fluid bolus for septic shock in this child?
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Q128
A study finds that the odds ratio (OR) for the association between smoking and oral cancer is 3.5 with a 95% confidence interval of 2.1 to 5.9. This result is:
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Q129
A 55-year-old man has chronic low back pain, morning stiffness lasting more than three hours, improves with exercise, sacroiliac tenderness and is HLA-B27 positive. What is the most likely diagnosis?
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Q130
Which of the following is the most appropriate target for the anion gap in the resolution of DKA?
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Q131
A 55-year-old patient presents with a symptomatic pleural effusion. During the procedure of thoracentesis, the patient suddenly develops an acute cough and shortness of breath. What is the most immediate priority for the primary care physician?
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Q132
A 46-year-old man presents to a primary-care clinic for a routine health check. Which of the following screening tests is NOT recommended as part of the comprehensive first-contact assessment in the Nepal essential health-care package?
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Q133
A 60-year-old man with type 2 diabetes and hypertension presents with generalized swelling, frothy urine, BP 150/95, serum creatinine 1.8 mg/dL, and urine protein/creatinine ratio 3.5 g/g. Renal biopsy shows diffuse thickening of the glomerular basement membrane with a "spike and dome" appearance on silver stain. What is the most likely diagnosis?
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Q134
A 45-year-old man with known asthma presents to the clinic with worsening shortness of breath, wheezing, and inability to speak full sentences. His peak expiratory flow rate (PEFR) is 30% of predicted. Which of the following is the most appropriate immediate management?
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Q135
During a postpartum visit 48 hours after a vaginal delivery, what should be assessed during the physical examination?
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Q136
Which of the following is the primary method for evaluating pubertal development in a clinical setting?
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Q137
Which screening instrument is validated for detecting postpartum depression in Nepali primary-care settings?
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Q138
A 45-year-old man has a chronic cough for 5 weeks, weight loss, and night sweats. Sputum smear is negative, but the chest radiograph shows upper-lobe infiltrates and bilateral hilar lymphadenopathy. Which is the most appropriate next step in management?
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Q139
A 59-year-old woman with a history of myocardial infarction and diabetes is taking aspirin 81 mg daily. What is the recommended dose of aspirin for secondary prevention of ASCVD?
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Q140
An 83-year-old patient with multiple comorbidities is being reviewed for 'deprescribing'. Which of the following medications is most likely to be considered 'potentially inappropriate' for this patient according to the Beers Criteria?
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Q141
A 45-year-old man with long-standing type 1 diabetes reports burning pain in his feet, loss of vibration sense and absent ankle reflexes. Which test is most appropriate to screen for early diabetic nephropathy?
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Q142
In a hemodynamically unstable patient with severe pelvic hemorrhage, which advanced technique may be employed as a bridge to definitive control?
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Q143
Which bedside sign is most reliable for assessing the severity of an acute asthma exacerbation in a primary-care setting?
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Q144
In an elderly patient with acute decompensated heart failure and preserved renal function, which combination is most effective for rapid diuresis?
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Q145
A 30-year-old woman with a known seizure disorder and recent high-dose quetiapine use becomes agitated and starts having a generalized tonic-clonic seizure. Which medication should be given first to control the seizure and agitation?
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Q146
In a cross-sectional survey of 400 residents, 25% are current smokers. What does this figure represent?
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Q147
A 70-year-old man has greasy, yellowish, scaly plaques on the scalp, eyebrows, and nasolabial folds that worsen with stress. What is the most likely diagnosis?
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Q148
In acute TCA overdose with a QRS duration of 140 ms, which specific treatment should be given immediately?
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Q149
A conscious adult presents with severe facial swelling that threatens the airway. Which airway adjunct is most appropriate for rapid securing of the airway?
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Q150
A 60-year-old male presents with a 4-mm intradermal lesion on the back. Which minor procedure offers definitive diagnosis?
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Q151
When seeing a patient with chronic kidney disease during a home visit, what should the physician prioritize?
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Q152
Which simple visual test is used for adult visual acuity screening in Nepal's primary care?
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Q153
Withdrawal of a PEG tube in a patient with advanced dementia is primarily supported by which ethical principle?
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Q154
Which dietary advice is most appropriate to improve iron absorption in a patient with iron deficiency anemia?
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Q155
A 30-year-old man presents with redness, tearing and a purulent discharge from both eyes for 2 days. There is no pre-auricular lymphadenopathy. Which of the following is the most appropriate treatment?
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Q156
Which of the following interventions has the highest impact on reducing heat-related illness among outdoor agricultural workers in the Terai during summer months?
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Q157
According to the Chronic Care Model, which of the following best describes the 'informed, activated patient'?
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Q158
Which characteristic of an acute myocardial infarction is most strongly associated with early (in-hospital) mortality?
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Q159
55-year-old man has a 1.5-cm superficial abscess over the sternum with a fluctuant area. Which minor procedure should be performed first?
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Q160
A 22-year-old pregnant woman at 32 weeks gestation presents with sudden onset of shortness of breath and chest pain. She has a history of prolonged bed rest due to previous preterm labor. Her oxygen saturation is 85% on room air. What is the most likely diagnosis?
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Q161
A 27-year-old male, recently returned from a flood-affected district, describes recurrent nightmares, flashbacks, hypervigilance, and avoidance of reminders of the disaster for the past 3 weeks. Which brief screening tool is recommended by WHO for PTSD detection in disaster-affected Nepali communities?
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Q162
In Nepal's referral guidelines, which of the following conditions is classified as a "red flag" requiring immediate referral from a PHCC to a district hospital?
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Q163
A 30-year-old woman follows a bicycle collision and sustains a right wrist injury with a visible deformity. The radiograph shows a lunate displaced proximally with a piano-key sign. Which ligament is most likely injured?
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Q164
A 40-year-old woman reports dyspareunia, deep pelvic pressure and a sensation of a lump in the vagina that worsens with intercourse. Examination reveals a 3-cm posterior vaginal wall bulge that reduces on Valsalva. Which type of prolapse is this?
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Q165
In a cohort of 10,000 pregnant women, 200 develop preeclampsia over the course of pregnancy. How is the incidence of preeclampsia best expressed?
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Q166
Which of the following is the primary mechanism of action of Acamprosate in the treatment of alcohol dependence?
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Q167
A 58-year-old woman develops painless purpuric lesions on the lower legs, renal insufficiency, low complement C3, and positive anti-C1q antibodies. Which diagnosis is most consistent?
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Q168
Which of the following is the most appropriate strategy for a family physician to manage a 'resistant' family member during a home visit?
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Q169
A 68-year-old man with severe COPD has a resting PaOβ of 55 mmHg (SpOβ 88%) on room air. He meets criteria for long-term oxygen therapy (LTOT). Which of the following blood-gas values also qualifies a patient for LTOT?
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Q170
In a Nepal primary care setting, what is the recommended method for early detection of anemia in school-age children (5-10 years)?
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Q171
A 22-year-old woman presents after a neurotoxic snake bite with ptosis and facial weakness. Which of the following is the correct initial dose of antivenom for a neurotoxic envenomation?
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Q172
A 22-year-old female presents with severe agitation, paranoia, and tachycardia after binge use of MDMA. Which medication is the most appropriate initial pharmacologic intervention?
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Q173
During the resuscitation of a patient in PEA, the team considers the 'H's and 'T's. Which of the following is NOT one of the recognized reversible causes of cardiac arrest?
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Q174
A 55-year-old patient presents with a suspected actinic keratosis on the scalp. The primary care physician decides to use a chemical cauterant. Which of the following agents is most commonly used for the chemical destruction of such precancerous lesions in primary care?
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Q175
In primary care, which screening test is recommended for detecting hepatitis B infection in pregnant women at the first antenatal visit?
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D
Q176
For anxiolysis in a terminal patient with minimal respiratory depression, which medication is most appropriate?
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D
Q177
Which factor is the strongest predictor of hypertension in Nepali adolescents?
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Q178
A 38-year-old woman with a known history of major depressive disorder has a clear plan to jump tonight but is currently calm and cooperative. What is the most important immediate psychiatric action?
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Q179
In the context of waste management in Nepal's healthcare facilities, which of the following waste categories should be treated by autoclaving or incineration before final disposal?
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Q180
A 30-year-old female presents with excessive worry about multiple areas of her life, including her children's grades, her spouse's health, and minor household chores. These symptoms have been present for 7 months and are accompanied by muscle tension and fatigue. What is the most likely diagnosis?
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D
Q181
A 38-year-old male with newly diagnosed smear-positive pulmonary TB begins treatment under the NTP. Which regimen describes the standard intensive phase?
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Q182
Under Nepal's National Family Planning Programme, which long-acting reversible contraceptive was introduced in 2018?
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Q183
Which of the following is a realistic short-term goal for reducing sedentary behavior in an adult patient?
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Q184
Which professional cadre is traditionally responsible for managing the daily operations of a Health Post in Nepal, although the governance is now with the local government?
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Q185
A 58-year-old male smoker presents seeking help to quit. Which evidence-based approach is the most appropriate initial step in comprehensive first-contact care?
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Q186
A 55-year-old man presents with sudden onset left-sided hemiparesis and aphasia 2 hours ago. CT head shows no hemorrhage. What is the most appropriate next step?
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D
Q187
A patient presents with a suspected compartment syndrome of the forearm. Which of the following clinical findings is considered a late and ominous sign indicating irreversible muscle necrosis?
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Q188
A 55-year-old man with chronic alcohol use presents with confusion, ataxia, and ophthalmoplegia. Laboratory tests show serum thiamine level low. Which vitamin should be administered promptly to prevent irreversible neurological damage?
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Q189
Which pharmacologic agent is specifically indicated for relapse prevention in severe alcohol dependence by reducing the rewarding effects of alcohol?
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D
Q190
Which tool is recommended for developmental screening of a 9-month-old child at primary health centres in Nepal?
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Q191
Which postpartum condition is most frequently observed within the first week after delivery among Nepali mothers?
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D
Q192
A 40-year-old man presents with multiple firm, non-tender, flesh-colored papules with central umbilication distributed on his trunk. Which diagnosis fits?
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Q193
An 82-year-old man with hypertension and type 2 diabetes presents with recurrent nocturia and urgency incontinence. On digital rectal examination the prostate is mildly enlarged, non-tender, and smooth. Which investigation best distinguishes overflow incontinence from detrusor overactivity?
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Q194
A 67-year-old male with a history of myocardial infarction presents with new-onset shortness of breath and orthopnea. On examination, he has S3 gallop and bilateral pulmonary rales. Which of the following is the most likely underlying mechanism of his current presentation?
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Q195
What is the primary physiological goal of administering intravenous fluids in the initial management of Diabetic Ketoacidosis (DKA)?
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Q196
A 55-year-old woman presents to the ED with a suicide plan but is cooperative and calm at the moment. What is the most critical immediate step?
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Q197
A 68-year-old woman has a 1-cm skin tag on the axilla that is irritated by clothing. What is the preferred removal technique in primary care?
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Q198
In a patient diagnosed with uncomplicated Plasmodium falciparum malaria in Nepal, which oral regimen is recommended by the national malaria treatment guidelines?
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Q199
A 2-year-old child presents with a history of cough and fast breathing. On examination, the respiratory rate is 42 breaths per minute. According to IMCI, for a child aged 12 months to 5 years, this child is classified as having:
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Q200
A 17-year-old girl presents with a 1-year history of irregular menses and excessive hair growth. She desires pregnancy in the future. Which of the following is the most appropriate counseling regarding fertility in this condition?
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D
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MDGP / Family Medicine Licensure Exam preparation SET 2
200 multiple-choice questions Β· 200 questions Β· 3 hours Β· Masters-level licensing
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