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Revalida 2 > 1st Sem Midterms > Flashcards

1st Sem Midterms Flashcards

1
Q

Cell death by necrosis due to mitochondrial dysfunction will be preceded by which event?
a. Increased sirtuins
b. Release of cytochrome C
c. Formation of mitochondrial permeability transition pores
d. Imbalance of BCL2 proteins causing outer membrane leakiness

A

c. Formation of mitochondrial permeability transition pores

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2
Q

Overdose with acetaminophen can be treated by:
a. N-acetylcysteine
b. Thiamine
c. Naloxone
d. Activated charcoal

A

a. N-acetylcysteine

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3
Q

A 19 y/o female develops a sore throat and fever during the past day. Physical Exam shows pharyngeal erythema and congestion. She is given naproxen. Which of the following features of the acute inflammatory response is most affected by the drug
a. Vasodilation
b. Emigration
c. Leukocytosis
d. Phagocytosis

A

a. Vasodilation

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4
Q

True about EXUDATE
a. Low protein and little to no cellular debris
b. It is essentially an ultraHltrate of the blood
c. This is an implication that there is increased permeability triggered by some sort of tissue injury
d. This is an implication of osmotic or hydrostatic imbalances in the vessels, without an increase in the permeability of the vascular walls.

A

c. This is an implication that there is increased permeability triggered by some sort of tissue injury

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5
Q

Member of the immunoglobulin superfamily, is an adhesion molecule present in the intercellular junction
a. CD34
b. CD31
c. ICAM
d. VCAM

A

b. CD31

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6
Q

The increase in heart size in chronic hemodynamic overload due to hypertension is largely due to
a. Fatty change
b. Myocyte intracellular accumulation
c. Muscle hyperplasia
d. Myocyte hypertrophy

A

d. Myocyte hypertrophy

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7
Q

Alcohol metabolism by the enzyme catalase is seen in which part of the hepatocyte?
a. Peroxisome
b. Mitochondria
c. Microsomes
d. Cytosol

A

a. Peroxisome

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8
Q

This complement protein acts as an opsonin when fixed to the microbial cell wall.
a. C1q
b. C5a
c. C3b
d. C3a

A

c. C3b

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9
Q

Formed by homotypic extracellular interactions between transmembrane glycoproteins that mechanically attach cells and their cytoskeletons to other cells.
a. Occluding junctions
b. Anchoring junctions
c. Gap junctions
d. Communicating junctions

A

b. Anchoring junctions

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10
Q

A Trinucleotide repeat mutations are amplifications of a sequence of three nucleotides, they also are associated with an anticipation-type of inheritance, An example is the second most common cause of Mental retardation with a prominent PE finding of macro-orchidism. What nucleotide repeat will be seen in this patient?
a. CAG
b. GAA
c. CGA
d. GCA
e. None of the above

A

e. None of the above
The case is Fragile X syndrome which is CGG.

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11
Q

This is produced by COX-1 which is expressed constitutively by “healthy” endothelium under normal flow conditions.
a. PGE2
b. PGF2
c. PGI2
d. PGD2

A

c. PGI2

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12
Q

Indicate type of hypersensitivity reaction: Poststreptococcal glomerulonephritis
a. Type I
b. Type II
c. Type III
d. Type IV

A

c. Type III

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13
Q

Which of the following does not belong to adaptive immunity?
a. Antibodies
b. Dendritic cell
c. Epithelial barriers
d. T-Lymphocyte

A

c. Epithelial barriers

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14
Q

The most potent hallucinogen.
a. MDMA
b. LSD
c. PCP
d. Cocaine

A

b. LSD

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15
Q

Ubiquitous mold that microscopically have septate filaments branching at acute angles
a. Aspergillus
b. Mucor spp
c. Blastomyces dermatitidis
d. Coccidiodes immitis

A

a. Aspergillus

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16
Q

B cells develop in the bone marrow, now as a step in their maturation, B cells that recognize self antigen will undergo what process after?
a. Apoptosis
b. MHC restriction
c. Receptor editing
d. Somatic recombination

A

c. Receptor editing

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17
Q

The following causes vascular permeability except:
a. Prostaglandin D2
b. Prostaglandin E2
c. Leukotriene D4
d. None of the above

A

d. None of the above

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18
Q

Which cellular change may be reversed when injurious stimuli is removed?
a. Pyknosis
b. Swelling of endoplasmic reticulum
c. Both
d. Neither

A

b. Swelling of endoplasmic reticulum

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19
Q

A 6 y/o child has a legs appearing “bowed” and a chest xray is notable for excess cartilage at the costochondral junction of the ribs. She is most likely suffering from
a. Ricketts
b. Achondroplasia
c. Osteoid osteoma
d. Osteoporosis

A

a. Ricketts

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20
Q

Release of this molecule happens as a protective response to deal with hypoxic stress; this molecule promotes new blood vessel formation, stimulates cell survival pathways, and enhances glycolysis.
a. VEGF-A
b. Angiostatin
c. VEGF-D
d. HIF-1

A

d. HIF-1

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21
Q

The following categories of pathophysiology of edema and the clinical condition are correct, except:
a. Nephrotic syndrome-decreased oncotic pressure
b. Sodium retention-increased hydrostatic pressure
c. Kwashoirkor-decreased oncotic pressure
d. Filariasis-lymphatic obstruction
e. None of the above

A

e. None of the above

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22
Q

Rocker bottom feet is frequently observed in patients with
a. Trisonomy 13
b. Trisonomy 21
c. Trisonomy 18
d. None of the above

A

a. Trisonomy 13

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23
Q

DNA structural variations in the genome that involve the deletion, duplication, or rearrangement of large DNA segments.
a. Single nucleotide polymorphisms
b. Copy number variation
c. Tandem repeats
d. Chromosal aberrations
e. None of the above

A

b. Copy number variation

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24
Q

Autoimmune haemolytic anemia is an example of this hypersensitivity
a. Type I
b. Type II
c. Type III
d. Type IV

A

b. Type II

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25
Q

The most common sexually transmitted bacterial disease is
a. N. gonorrhea
b. C. trachomatis
c. Both
d. None of the above

A

b. C. trachomatis

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26
Q

Deposition of immune complex is seen in which hypersensitivity reaction
a. Type I
b. Type II
c. Type III
d. Type IV

A

c. Type III

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27
Q

Cell change characterized by fading basophilia, presumably due to enzymatic degradation by endonucleases.
a. Karyorrhexis
b. Karyolysis
c. Karyoptosis
d. Pyknosis

A

b. Karyolysis

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28
Q

Pathology of myasthenia gravis is due to:
a. Phagocytosis
b. Vasoactive release of amines
c. Antibody mediated cellular dysfuction
d. Immune complex deposition

A

d. Immune complex deposition

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29
Q

Receptor protein responsible for the binding of platelets to vwf on ECM?
a. GpIa
b. GpIb
c. GpIIb
d. GpIIb/IIIa

A

b. GpIb

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30
Q

A clinicopathologic entity with a triad of dry eyes, dry mouth and arthritis.
a. Scleroderma
b. Sjogren syndrome
c. SLE
d. Dermatomyositis

A

b. Sjogren syndrome

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31
Q

Minamata disease is a disease seen in ___ toxicity.
a. Cadmium
b. Mercury
c. Lead
d. Arsenic

A

b. Mercury

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32
Q

An alteration within cells or in extracellular space which gives a homogenous glassy pink appearance in routine H&E histologic sections is called:
a. Coagulation necrosis
b. Steatosis
c. Hyaline change
d. Fibrinoid necrosis

A

c. Hyaline change

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33
Q

The following are autosomal dominant disorders except:
a. Huntington disease
b. Myotonic dystrophy
c. Duchenne muscular dystrophy
d. Hereditary spherocytosis

A

c. Duchenne muscular dystrophy
X-linked recessive

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34
Q

Aflatoxin has been associated with the development of this malignancy.
a. Lung cancer
b. Acute Myeloid Leukemia
c. Angiosarcoma
d. Liver cancer

A

d. Liver cancer

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35
Q

Which of the following is a stable cell
a. Epidermis
b. Cardiac Myocytes
c. Neuron
d. Hepatocyte

A

d. Hepatocyte

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36
Q

What do both the skin and gut epithelial cells produce to protect against infectious disease?
a. IgA antibodies
b. IgG antibodies
c. IgM antibodies
d. IgE antibodies

A

a. IgA antibodies

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37
Q

A nematode that causes patchy interstitial myocarditis characterized by many eosinophil and scattered giant cells.
a. Trichinella spiralis
b. T. cruzi
c. S. mansoni
d. N. gonorrhea

A

a. Trichinella spiralis

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38
Q

Which of these cytokine has a role in allergies?
a. Th1
b. Th2
c. Th4
d. Th17
e. None of the above

A

b. Th2

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39
Q

Glycogen storage diseases arises with lack of the following enzyme, except
a. Acid maltase
b. Muscle phosphorylase
c. Glucose 6 phospatase
d. All of the above
e. None of the above

A

e. None of the above

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40
Q

Features of acute inflammation except;
a. Mild local and systemic signs
b. Fast: minutes to hours
c. Mild tissue injury
d. Cellular infiltrates are mainly neutrophil

A

a. Mild local and systemic signs

41
Q

Plasma membrane transport proteins where transport is relatively slow, solute binds and undergo a series of conformational changes to transport the ligand across the membrane
a. Carrier protein
b. Channel protein
c. Facilitated Diffusion proteins
d. None of the above

A

a. Carrier protein

42
Q

A lysosomal storage disease with a mutation in the gene that encodes glucosylceraminidase presents with an accumulation of glucosylceramide in mononuclear phagocytic cells in the liver, spleen and marrow. The pathognomonic cells shows:
a. Zebra bodies
b. Wrinkled tissue paper celled cytoplasm
c. 8 to 20 multinucleated cells
d. Hydrophic cells with peri-nuclear halo

A

b. Wrinkled tissue paper celled cytoplasm

43
Q

Along with SLE, antiphospholipid antibody syndrome (APAS) has this target antibody which is present in endothelial cell walls, platelets, macrophages, and the mitochondria.
a. Lipooligosaccharide
b. Lipopolysaccharide
c. Cardiolipin
d. M protein

A

c. Cardiolipin

44
Q

A part of histone organization which leads to transcriptional silencing
a. Histone methylation
b. Histone phosphorylation
c. Histone acetylation
d. DNA methylation

A

d. DNA methylation

45
Q

Perforins and granzymes are used by what cell types?
a. CD8+ T cells, NK cells
b. NK cells, Macrophages
c. CD8+ T cells, CD4+ T cells
d. CD4+ T cells, NK cells

A

a. CD8+ T cells, NK cells

46
Q

Which of the following is an example of intracellular hyaline?
a. Pink deposits in walls of arterioles in patients with chronic hypertension
b. Deposition in the basement membrane of the kidney of a patient with CKD
c. Presence of Russell bodies
d. All of the above

A

c. Presence of Russell bodies

47
Q

Which of the following changes best describes the pathophysiology of pulmonary edema in patients with congestive heart failure?
a. Widespread endothelial damage
b. Acute lymphatic obstruction
c. Decreased plasma oncotic pressure
d. Increased hydrostatic pressure

A

d. Increased hydrostatic pressure

48
Q

65-year-old patient came for consult and presented with fever, weight loss, and cough. Due to gross negligence, the patient expired and autopsy was done revealing, neutrophilic infiltrates with central liquefaction and surrounding granulation and fibrosis in the absence of granuloma. Microorganism was revealed to have distinctive branched chains and thin aerial filaments resembling hyphae. Which microorganism should be considered?
a. Aspergillus fumigatus
b. Nocardia spp.
c. Mycobacterium tuberculosis
d. Rhizopus spp.

A

b. Nocardia spp.

49
Q

A 14 year-old female suddenly notices enlargement of her breast followed by cramping in the hypogastric area and episodic fatigue. What could be the cause of the changes in her breast?
a. Physiologic hypertrophy
b. Pathologic hypertrophy
c. Physiologic hyperplasia
d. Metaplasia

A

c. Physiologic hyperplasia

50
Q

Opportunistic pathogen that causes progressive multifocal leukoencephalopathy
a. B. burgdorferi
b. JC Virus
c. C. difcile
d. M. furfur

A

b. JC Virus

51
Q

Patient presents with mental retardation, long face with large mandible, large everted ears and large testicles. The most likely diagnosis is:
a. Hunter syndrome
b. Hurler syndrome
c. Patau syndrome
d. Fragile X syndrome

A

d. Fragile X syndrome

52
Q

Good pasture syndrome is what type of hypersensitivity reaction?
a. Type I
b. Type II
c. Type III
d. Type IV

A

b. Type II

53
Q

These are intracellular proteins expressed from the bile duct epithelia.
a. Uric acid
b. Troponin
c. Alkaline phosphatase
d. Transaminase

A

c. Alkaline phosphatase

54
Q

A 24-year-old male student came for consult due to occasional dysuria. Further PE revealed a red swollen, tender “mass” in the left inguinal area and scanty, clear-to- white penile discharge. He admits to being sexually active with multiple partners. As a medical practitioner, your initial suspect would be infection caused by?
a. Neisseria gonorrheae
b. Treponema pallidum
c. Chlamydia trachomatis
d. Haemophilus ducreyi

A

c. Chlamydia trachomatis

55
Q

64 years old male was celebrating his birthday with his family when he suddenly clutched his left chest. He was suddenly rushed to the emergency room within minutes. Laboratory shows an elevated Troponin I, and ECG changes were also noted. As he is still within the time of the golden period what is the best emergent therapy than can be administered?
a. Aspirin
b. Vitamin K
c. Tissue plasminogen activator
d. Heparin

A

c. Tissue plasminogen activator

56
Q

Phenomenon of unresponsiveness to an antigen as a result of lymphocytes to that antigen, describes
a. Anerygy
b. Autoimmunity
c. Self tolerance
d. Immunologic tolerance

A

d. Immunologic tolerance

57
Q

An example of point mutation wherein a purine base is replaced by another purine base or a pyrimidine base is replaced by another pyrimidine base.
a. Genomic imprinting
b. Transition
c. Silent mutation
d. Gonadal mosaicism

A

b. Transition

58
Q

These are selectins found in lymphocytes and monocytes.
a. L-selectin
b. P-selectin
c. E-selectin
d. CD-31

A

a. L-selectin

59
Q

This occurs when a venous embolus passes through an interatrial or intraventricular defect and gains access to the systemic arterial circulation.
a. Air embolism
b. Caisson’s disease
c. Paradoxical embolism
d. Fat embolism

A

c. Paradoxical embolism

60
Q

Which among the following is a feature of irreversible cell injury?
a. Presence of small clear vacuoles within cytoplasm
b. Dilation of endoplastic reticulum
c. Changes in cellular membrane, specifically blebbing
d. None of the above

A

b. Dilation of endoplastic reticulum

61
Q

Itai-itai disease is a disease seen in ____ toxicity.
a. Cadmium
b. Mercury
c. Lead
d. Arsenic

A

a. Cadmium

62
Q

A 1-year-old child with failure to thrive now exhibits frequent episodes of seizure. Physical examination shows hepatomegaly and ecchymoses of the skin. His blood glucose is abnormally low. Biopsy of his liver was done revealing vacuolated cells positively staining for glycogen. The disease most likely to cause this is?
a. Tay-Sachs disease
b. McArdle Disease
c. von Gierke Disease
d. Pompe Disease

A

c. von Gierke Disease

63
Q

Surface protein is S. pyogenes responsible for antibodies and T cells cross-reacting with cardiac proteins.
a. LPS
b. M protein
c. C protein
d. S protein

A

b. M protein

64
Q

A patient with prolonged PTT and normal PT likely has a deficiency in which of the following coagulation factors?
a. Factor VIII
b. Factor VII
c. Factor V
d. Thrombin

A

a. Factor VIII

65
Q

The following are primary granules except:
a. Elastase
b. Collagenase
c. Acid hydrolase
d. Myeloperoxidase

A

b. Collagenase

66
Q

Which of the following is NOT TRUE of the effects of alcoholism on cellular processes?
a. Depletion of NAD impairs fatty acid oxidation leading to steatosis
b. Depletion of NAD impairs conversion of lactate to pyruvate leading to acidosis.
c. Reactive oxygen species derived from alcohol metabolism causes lipid peroxidation of hepatocyte membranes
d. Acetaldehyde triggers enterotoxin release from gram-positive bacteria

A

d. Acetaldehyde triggers enterotoxin release from gram-positive bacteria

67
Q

Which of the following T cell subset is involved in immediate hypersensitivity reaction?
a. T-helper 1
b. T-helper 2
c. T-helper 3
d. T-helper 4

A

b. T-helper 2

68
Q

Which of the following viruses can enter latency?
a. HSV
b. HPV
c. CMV
d. JC virus

A

c. CMV

69
Q

What receptor is expressed on the plasma membrane of dendritic cells that detect fungal glycans and elicit inflammatory reaction against fungi.
a. Toll like receptor
b. C-type Lectin Receptors (CLRs)
c. Rig-Like Receptors (RLR)
d. G-Protein Coupled Receptors

A

b. C-type Lectin Receptors (CLRs)

70
Q

Abundant in liver and gonads where it is used for steroid hormone and lipoprotein synthesis, and modification of hydrophobic compounds into water-soluble molecules
a. Smooth endoplasmic reticulum
b. Rough endoplasmic reticulum
c. Lysosomes
d. Proteasome

A

a. Smooth endoplasmic reticulum

71
Q

Initial receptor for viral infection of measles virus expressed on activated lymphocytes, dendritic cells and monocytes.
a. CD46
b. Nectin 4
c. SLAMF-1
d. CD155

A

c. SLAMF-1

72
Q

Reprogramming of stem cell pathway is the underlying mechanism of which cellular adaptation?
a. Atrophy
b. Metaplasia
c. Hyperplasia
d. Hypertrophy

A

b. Metaplasia

73
Q

Leukocytes inability to migrate to the site of infection and inflammation due to a mutation in fucosyl transferase
a. Leukocyte adhesion defect 1
b. Leukocyte adhesion defect 2
c. Myeloperoxidase deficiency
d. Chronic granulomatous disease

A

b. Leukocyte adhesion defect 2

74
Q

There is progressive fibrosis interstitial and perivascular fibrosis in the skin and multiple organs
a. Mixed connective tissue disease
b. SLE
c. Sjogren
d. Scleroderma

A

d. Scleroderma

75
Q

What is the second most common cause of mental retardation after trisomy 21?
a. Turner syndrome
b. Fragile X syndrome
c. Marfan syndrome
d. Klinefelter syndrome

A

b. Fragile X Syndrome

76
Q

The following agents may cause lung cancer except
a. Berrylium
b. Asbestos
c. Radon
d. Chromium

A

d. Chromium

77
Q

Type of mutation occur when the insertion or deletion of one or two base pairs alters the reading frame of the DNA strand
a. Silent mutation
b. Frame shift mutation
c. Missense mutation
d. Non-sense mutation

A

b. Frame shift mutation

78
Q

This vitamin A derivative is used in the treatment of acute promyelocytic leukemia.
a. 13-cis-retinoic acid
b. Beta-carotene
c. Isotretinoin
d. All-trans-retinoic acid

A

d. All-trans-retinoic acid

79
Q

37 years old patient came to you with imaging findings stating that the liver has central vein and sinusoidal distension as well as centrilobular necrosis. You remember during discussion of the acinar model of blood flow that the centrilobular hepatocytes is at what zone?
a. Zone 1
b. Zone 2
c. Zone 3
d. Zone 4

A

c. Zone 3

80
Q

Which of the following is responsible for neutralization of microbe, phagocytosis and complement activation?
a. Regulatory T-Lymphocyte
b. Cytotoxic T-Lymphocyte
c. Helper T-lymphocyte
d. B-lymphocyte

A

d. B-lymphocyte

81
Q

In which of the following organs is the pathologic finding of a focal, hemorrhagic lesion most likely to be seen?
a. Lung with pulmonary thromboembolism
b. Kidney with renal artery thrombus
c. Heart with complete coronary artery occlusion
d. Brain with middle cerebral artery thrombus

A

a. Lung with pulmonary thromboembolism

82
Q

Numerous factors are considered in platelet adhesion defects including loss of factors and glycoprotein deficiencies. One such deficiency is Glanzmann thrombasthenia which primarily involves which of the following complexes?
a. gpIIb-IIa complex
b. gpIIa-IIb complex
c. gpIIb-IIIa complex
d. gpIIa-IIIb complex

A

c. gpIIb-IIIa complex

83
Q

A 26-year- old man has a sudden loss of vision in the right eye. On physical examination, there is a subluxation of the right crystalline lens. On auscultation of the chest, a mid-systolic click is audible. Echocardiogram was requested showing a floppy mitral valve and dilated aortic arch. On interview, patient says his brothers also have similar symptoms. This is caused by a defect in?
a. Collagen
b. NF-2
c. NF-1
d. Fibrillin-1

A

d. Fibrillin-1

84
Q

This is a basic form of nuclear chromatin which is cytochemically dense and transcriptionally inactive
a. Telomere
b. Centromere
c. Heterochromatin
d. Euchromatin

A

c. Heterochromatin

85
Q

All of the following are true regarding ethanol consumption, except;
a. Acetaldehyde is the major metabolite of alcohol and is responsible for many of the toxic effects
b. Acute alcohol intoxication results in primarily CNS depressant effects
c. Aldehyde dehydrogenase is the major enzyme responsible for metabolizing alcohol
d. All of the choices are true

A

c. Aldehyde dehydrogenase is the major enzyme responsible for metabolizing alcohol

86
Q

Coagulation factors are inhibited by protein C and S?
a. Factors VIII and VWF
b. Va and VIIIa
c. II and IX
d. IX and XIII

A

b. Va and VIIIa

87
Q

Abnormal fusion of primary granules which results in a malfunctioning WBC with a diminished phagocytic capability;
a. Chediak-Higashi syndrome
b. Leukocyte adhesion defect
c. Chronic granulomatous disease
d. Myeloperoxidase deHciency

A

a. Chediak-Higashi syndrome

88
Q

Tay-Sachs disease is caused by?
a. Glycogen accumulation within the cells
b. Glucocerebrosidase deHciency causing accumulation of glucocerebroside
c. Point mutations or deletions in LDL receptors causing abnormal transport
d. Deficiency in hexosaminidase A

A

d. Deficiency in hexosaminidase A

89
Q

What is it called when viral agents have a predilection for certain types of cell to infect?
a. Tropism
b. Antigenic variation
c. Transmission
d. Virulence

A

a. Tropism

90
Q

FLIP is a protein produced by poxvirus and herpes virus which inhibits apoptotic process by blocking what specific molecule?
a. BCL-XL
b. Fas Ligand
c. FADD
d. TNF-1

A

c. FADD

91
Q

A 68 year old female with multiple myeloma dies of acute renal failure. At autopsy, her kidneys and liver were pale gray, with waxy cut sections, while her spleen showed tapioca-like granules. On histology, these organs show deposits that;
a. Have empty vacuoles that uptake Sudan black
b. Are infitrated by neutrophils and histiocytes
c. Will fluoresce an apple green color when stained with Congo red
d. Are bluish, with concentric laminations

A

c. Will fluoresce an apple green color when stained with Congo red

92
Q

In tuberculosis, naive T-cells are differentiated into Th1 through;
a. Granuloma formation
b. PD-1 blockade
c. IL-12 stimulation
d. Caseous necrosis and formation of epithelioid cells.

A

c. IL-12 stimulation

93
Q

A patient takes aspirin for arthritis. Although her joint pain is reduced with this therapy, the inflammatory process continues. Aspirin therapy alleviates pain via reduction in the synthesis of
a. Complement C1q
b. Histamine
c. Leukotriene E4
d. Prostaglandins

A

d. Prostaglandins

94
Q

HIV viral surface proteins essential for viral entry into cells.
a. gp41
b. p17
c. gp120
d. p24

A

c. gp120

95
Q

Increased number of hemosiderin-laden macrophages is a tell-tale sign of _____.
a. Old hemorrhage
b. Melanoma
c. Sunburn or radiation injury
d. Formation of myelin figures
d. All of the above

A

a. Old hemorrhage

96
Q

What is the most common etiologic factor in acute myeloid leukemia?
a. Benzene
b. Radiation Exposure
c. Mercury
d. Lead

A

a. Benzene

97
Q

Phenomenon of unresponsiveness to an antigen as a result of lymphocytes to that antigen, describes
a. Anergy
b. Self tolerance
c. Autoimmunity
d. Immunologic tolerance

A

d. Immunologic tolerance

98
Q

Which of the following are not involved in the measurement of extrinsic pathway of coagulation cascade?
a. Factor XII
b. Factor X
c. Factor VII
d. Factor V

A

a. Factor XII

99
Q

It is the basic subunit of chromatin which consists of 147 base pairs of DNA wrapped in approximately two turns around an octameric protein core containing two copies each of histones
a. Histone
b. Nucleosome
c. Chromatin
d. Centromere

A

b. Nucleosome

Revalida 2 (6 decks)

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