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Committee Exam 4 > CE 3 > Flashcards

CE 3 Flashcards

1
Q

You are conducting a histopathological study on wound healing, which is the subject of burn treatment. You have control and experimental groups in your study. When you in samples in your control group under the light microscope, you observed normal histological structures. You detected both bleeding and infiltration areas in the subcutaneous connective tissue in the burn group. In the group treated with burns, you observed that collagen IVs were transformed into collagen I in subcutaneous tissue. In your opinion, which of the following could be the wound healing phase in the burn treatment group?
a) Hemostasis
b) Inflammation
¢) Proliferative Phase
d) Destructive phase
e) Maturation Phase

A

e) maturation phase

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2
Q

A portion of the upper esophagus, collected at autopsy, is fixed with formalin, embedded in paraffin, sectioned at 6 µm, stained with H&E, and examined by light microscopy. Identify the type of epithelium.
a) Keratinized stratified squamous
b) Nonkeratinized stratified squamous
¢) Pseudostratified columnar
d) Stratified cuboidal
e) Transitional

A

B) NON KERATINIZED SQUAMOUS EPITHELIUM

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3
Q

Which of the following fibers is MATCHED with its specifications?
a) Procollagen / is formed to fibrils in fibroblast deep folding.
b) Tropocollagen / required vitamin C for hydroxylation of collagen
c) Collagen fiber / appear white and are termed “white” fibers
d) Elastic fiber / revealed with special silver-staining procedures
e) Reticular fiber / mostly of type I collagen

A

c

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4
Q

Which of the following is composed of smooth muscle?
a) Tunica muscularis externa of stomach
b) Myocardium of heart
c) Tunica muscularis of tongue
d) Musculus biceps brachii
e) Tunica media of medium size artery

A

a plus e

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5
Q

A section of intestinal biopsy is stained with periodic acid-Schiff (PAS) staining and examined at high
magnification. Which of the following terms best describes the PAS- positive goblet cells?
a) Multicellular endocrine glands
b) Multicellular exocrine mucous glands
c) Multicellular exocrine serous glands
d) Unicellular enteroendocrine glands
e) unicellular mucus exocrine glands

A

e

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6
Q

Which of the following is TRUE location/s for Sarcomere?
a) Skeletal muscles only
b) Cardiac muscles only
c) Smooth muscles only
d) Both skeletal and cardiac muscles
e) Skeletal, cardiac, and smooth muscles

A

d

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7
Q

A section of trachea obtained at autopsy is stained with H&E and examined at high magnification. Identify the type of lining epithelium.
a) Ciliated pseudostratified columnar with goblet cells
b) Glandular epithelium
c) Keratinized stratified squamous
d) Non keratinized stratified squamous
e) Simple columnar with goblet cells

A

a

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8
Q

You are an assistant in histology lab and have just received a slide labelled “Under Autonomic Innervation”. You have been tasked with relabeling the slide as cardiac muscle. However, you can be sure of the correctness of the preparation by looking at which of the following?
a) Nuclei located on the periphery of the cell
b) Non-striated fibers, which are autonomic in nature
c) Striations in muscle with communicating junctions called intercalated disks
d) Dark staining Purkinji cells found in nervous tissue
e) Pale staining peripheric nucleus found in epithelial tissue

A

c

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9
Q

This is the impermanent type of tissue that appears in the normal development. It consists of specialized, almost gelatin-like extracellular matrix whose ground substance is frequently referred to as Wharton’s Jelly. Component cells are large, stellate fibroblasts. Their processes often appear to fuse with those of neighboring cells. If is not find in adult tissue. What is the name of this connective tissue type?
A) Reticular Tissue
B) Mucous Connective Tissue
C) Adipose Tissue
D) White Adipose Tissue
E) Brown Adipose Tissue

A

b

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10
Q

Which of the following cell adhesion proteins mediates the trans endothelial migration of leukocytes in the wound?
a) Cadherin
b) Fibronectins
c) Integrins
d) Laminins
e) Selectins

A

c

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11
Q

_________ provide strength to the epithelium by linking the actin cytoskeletons of adjacent cells and form a continuous contractile band around the cell.
a) Zonula occludens
b) Gap junctions
c) Desmosomes
d) Zonula adherens
e) Hemidesmosomes

A

d

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12
Q

You are engaged in basic research to identify novel markers for the isolation and log-term culture of hemopoietic stem cells. In addition to cord blood, hemopoietic stem cells have been isolated from which of the following fetal organs?
a) Brain
b) Gonads
c) Liver
d) Lungs
e) Pancreas

A

The fetal liver is the major hematopoietic organ during development

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13
Q

You attend a lecture about lactation and breast-feeding. Under the influence of pregnancy-associated hormones, epithelial cells of the mammary gland secrete lipids, carbohydrates, and proteins. The lipid component of breast milk is released from apical surface of the glandular epithelial cells as lipid droplets within an envelope of the plasma membrane. Which of the following terms best describes the mechanism of secretion?
a) Merocrine
b) Holocrine
c) Apocrine
d) Eccrine
e) Endocrine

A

Apocrine glands in the breast secrete fat droplets into breast milk

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14
Q

Which of the following CAN be stated about loose connective tissue?
a) It is a cellular connective tissue with abundant ground substance
b) There is less amorphous ground substance
c) The fibers are arranged in parallel array and densely packed to provide maximum strength.
d) Fibrous capsules of organs and of joints and dermis of the skin are found.
e) It allows recoil of tissue following stretching

A

a

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15
Q

A 35-year-old construction worker sustains a laceration on the palmar surface of her left hand. The wound is cleaned, sutured, and wrapped with sterile gauze. Which of the following formed elements of the blood initiates thrombosis and hemostasis in this patient’s wound?
a) Erythrocytes
b) Granulocytes
c) Lymphocytes
d) Monocytes
e) Platelets

A

e

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16
Q

The connective tissue that surrounds both individual muscle fibers and bundles of muscle fibers is essential for force transduction. At the end of the muscle, the connective tissue continues as a tendon or some other arrangement or collagen fibers that attaches the muscle usually, to bone. A rich supply of blood vessels and nerves in the connective tissue. Which of the following surrounds individual muscle fibers?
a) Sarcolemma
b) Perimysium
c) Endomysium
d) Epimysium
e) Sarcoplasmic Reticulum

A

c

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17
Q

Which of the following can be classified as “specialized connective tissue”?
a) Loose connective tissue
b) Elastic connective tissue
c) Adipose tissue
d) Dense regular connective tissue
e) Dense irregular connective tissue

A

c

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18
Q

The internal structure of microvilli contains a core of __________ that are cross linked by several actin bundling proteins.
a) Fibrin
b) Myosin I
c) Actin filaments
d) Villin
e) Espin

A

c

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19
Q

What type of epithelium lines the urinary bladder and is capable of distention?
a) Stratified columnar epithelium
b) Stratified squamous epithelium
c) Stratified cuboidal epithelium
d) Transitional epithelium
e) Pseudostratified columnar epithelium

A

d

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20
Q

In the excitation-contraction of smooth muscle, calcium binds to ___________ just after influx into the cytoplasm.
a) Tropomyosin
b) Myosin light chain
c) Troponin
d) Calmodulin
e) Protein kinase A

A

d

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21
Q

What is the released one from the terminal cisternae that combine with troponin and removes the blocking action tropomyosin, resulting in formation of cross-bridges?
a) Myosin
b) Calmodulin
c) Ca+2
d) Troponin
e) Acetylcholine

A

c

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22
Q

Which of the following does NOT effect on resting membrane potential?
a) K ions
b) Na ions
c) K-Na leaking channels
d) Proteins
e) Na-K ATPase

A

d

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23
Q

Which of the following ion flux is responsible for depolarization the skeletal muscle cell membrane?
a) sodium
b) chloride
c) potassium
d) phosphate
e) calcium

A

a

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24
Q

The term that means a continued mild or partial contraction of a muscle that keeps it healthy and ready to respond is muscle
a) tone
b) summation
c) tetanus
d) stimulation
e) twitch

A

a

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25
Q

In skeletal muscles, which of the following is a Ca+2 sensor?
a) Actin
b) Myosin
c) Troponin
d) Tropomyosin
e) Titin

A

c

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26
Q

A 56-year-old man sees a neurologist because of weakness in his legs that improves over the course of the day or with exercise. Extracellular electrical recordings from a single skeletal muscle fiber reveal normal miniature end-plate potentials. Low-frequency electrical stimulations of motor neurons, however, elicits an abnormally small depolarization. The amplitude of the depolarization is increased after exercise. A preliminary diagnosis is confirmed by the presence of which of the following?
a) Acetylcholine receptor problem
b) The voltage sensitive Ca++ channel problem
c) Mutation in the gene that codes for the ne receptor
d) Relatively few vesicles in the presynaptic terminal
e) Residual acetylcholine in the neuromuscular junction

A

b

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27
Q

Which of the following statements about acetylcholinesterase is correct?
a) Produces acetylcholine
b) Is the acetylcholine receptor in muscle tissue
c) Is responsible for smooth but not skeletal muscle contraction
d) Degrades the neurotransmitter which is found in the neuromuscular junction
e) Exist in nucleus

A

d

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28
Q

Smooth muscle contraction is terminated by which of the following?
a) Dephosphorylation of myosin kinase
b) Dephosphorylation of myosin light chain
c) Efflux of Ca++ ions across the plasma membrane
d) Inhibition of myosin phosphatase
e) Uptake of Ca++ ions into the sarcoplasmic reticulum

A

b

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29
Q

Excitation—contraction coupling in skeletal muscle involves all of the following events, EXCEPT one (find the correct answer)
a) ATP hydrolysis
b) Increased Na+ conductance of sarcolemma
c) Conformational change in dihydropyridine receptor
d) Binding of Ca++ to calmodulin
e) Depolarization of the transverse tubule (T tubule) membrane

A

d

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30
Q

Which of the following is NOT one of the sliding theory elements?
a) Actin
b) Tropomyosin
c) ATP
d) Calcium
e) Nucleus

A

e

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31
Q

The functional unit of striated muscle fiber is called?
a) Myofilament
b) Triad
c) Calcium-calmodulin complex
d) Sarcomere
e) Sarcoplasmic reticulum

A

d

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32
Q

The nervous system may activate more motor units to make muscle contraction more powerful. This process is called?
a) Summation
b) Tetanus
c) Recruitment
d) Twitch
e) Fatigue

A

c

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33
Q

A basketball player admits to the hospital with pain during left shoulder movements. An X-ray reveals dislocation of the head of the humerus from the glenoid cavity. The surgeon explains to the patient that he has to repair a ring-shaped structure which is increasing the depth of the joint cavity and adding stability to the Joint. This patient has a tear in _______________?
a) Trapezoid ligament
b) Glenoid labrum
c) Biceps brachii tendon
d) Joint capsule
e) Coracohumeral ligament

A

Labrum. The glenoid labrum is a ring composed of mostly dense fibrous tissue. The average depth of the glenoid cavity is 2.5 mm, but the labrum serves to increase this depth

34
Q

A 70-year-old female patient complains about pain in her nape. After the physical examination, you order a magnetic resonance imaging (MRI) scan of the neck. MRI sections reveal a lesion on the ligament that is between the laminae of the C4 and C5 vertebrae. Which ligament is affected in this patient?
a) Interspinous ligament
b) Tectorial membrane
c) Posterior longitudinal ligament
d) Ligamentum nuchae
e) Ligamentum flavum

A

e

35
Q

During a yoga class, a student finds his left thigh extension is minimal. His instructor shows yoga poses to stretch the structures that are limiting the range of extension movement. Which of the following structures does not limit the extension movement of the hip joint?
a) Ischiofemoral ligament
b) Iliofemoral ligament
c) Sacro tuberous ligament
d) Joint capsule
e) Pubofemoral ligament

A

a

36
Q

Which statement is not true about the synovial joints?
a) A thin layer of hyaline cartilage covers the articular surfaces
b) Articular discs provide extra strength and support to the joint
c) Synovial joints do not have the ability to move
d) Synovial fluid forms an important thin lubricating film that covers the surface of a joint
e) Synovial joint capsule consists of two layers: fibrous capsule and synovial membrane

A

c

37
Q

When fully opening the mouth, what are the main movements of the upper and lower parts of the
temporomandibular joint, respectively?
a) Protrusion — Depression
b) Retraction — Extension
c) Protrusion — Rotation
d) Lateral excursion — Depression
e) Protrusion — Elevation

A

d

38
Q

If two bones are connected only with short ligament, which is the type of this joint?
a) Suture
b) Synchondrosis
c) Symphysis
d) Syndesmosis
e) Synostosis

A

d

39
Q

Which muscles form the suboccipital triangle that is around the vertebral artery?
a) Rectus capitis posterior major — Obliquus capitis superior — Obliquus capitis inferior
b) Rectus capitis posterior minor — Rectus capitis posterior major — Splenius capitis
c) Rectus capitis posterior minor — Obliquus capitis inferior - Splenius capitis
d) Obliquus capitis superior — Obliquus capitis inferior — Rectus capitis posterior minor
e) Obliquus capitis inferior — Rectus capitis posterior minor — Rectus capitis posterior major

A

a

40
Q

A 50-year-old female patient complains of neck pain and weakness. She states she had this problem since the lymph node biopsy on the left neck region a few days ago. After your physical examination, you realized the weakness
of the left trapezius muscle, this indicates damage to which structure?
a) Vagus nerve (10th cranial nerve)
b) Accessory nerve (11th cranial nerve)
c) Branches of the cervical plexus
d) Facial nerve (7th cranial nerve)
e) Branches of the brachial plexus

A

b

41
Q

Which type of articulation occurs between the tubercle of the rib IV and the transverse process of the corresponding thoracic vertebra (T4)?
a) Symphysis
b) Plane
c) Condyloid
d) Pivot
e) Saddle

A

b

42
Q

A patient fell during a hike. She admits to the hospital with pain and limited movements in the X joint. ER doctor finds a scaphoid fracture and the scaphoid is a major contributor to the X joint. What is the name of X joint?
a) Carpometacarpal — I
b) Distal radioulnar
c) Carpometacarpal — V
d) Radiocarpal
e) Ulno-carpal

A

d

43
Q

Which one is NOT a feature of the sternoclavicular joint?
a) Posterior sternoclavicular ligament
b) Interclavicular ligament
c) Trapezoid ligament
d) Articular disc
e) Costoclavicular ligament

A

c

44
Q

A student notices redness and pain around the left elbow joint. When she puts her elbow onto the table to write elbow pain increases. Which structure overlies the olecranon process reduces the friction and possibly got inflamed in this student?
a) Nerve that innervates the elbow joint capsule
b) Insertion tendon of the biceps brachii muscle
c) Synovial membrane of the elbow joint
d) Subcutaneous olecranon bursa
e) Hyaline cartilage that covers the trochlear notch

A

d

45
Q

You want to study the knee joint in the cadaver. You start dissection to reach the joint capsule. When you start the dissection from the anterior aspect, which of the following extracapular ligament can be seen inferior to the patella most superficially?
a) Lateral collateral ligament
b) Oblique popliteal ligament
c) Transverse ligament of the knee
d) Medial collateral ligament
e) Patellar ligament

A

e

46
Q

A 45-year-old male patient complains about back pain. During the physical examination, you realize that pain is exclusively related to breathing movements. Which one of the following muscles has respiratory function and causes pain in this patient?
a) Serratus posterior inferior
b) Rhomboid major
c) Latissimus dorsi
d) Splenius cervicis
e) Longissimus thoracis

A

c

47
Q

Which muscle forms the lateral column of the erector spinae?
a) Semispinalis
b) Iliocostalis
c) Spinalis
d) Longissimus
e) Splenius

A

b

48
Q

Which joint creates dorsiflexion movement?
a) Subtalar joint
b) Tarsometatarsal joint
c) Talocrural joint
d) Inferior tibiofibular joint
e) Transverse tarsal joint

A

c

49
Q

A 20-year-old hockey player complains about shoulder pain. He says that he fell on an outstretched hand during the match. During the physical examination, you realize that the clavicle is markedly elevated over the top of the shoulder. Which joint is affected in this patient?
a) Acromioclavicular joint
b) Sternoclavicular joint
c) Glenohumeral joint
d) Sternocostal joint
e) Distal radio-ulnar joint

A

a

50
Q

What is the type of joint between the tooth and its alveolar socket in the maxilla or mandible?
a) Saddle
b) Plane
c) Suture
d) Gomphosis
e) Symphysis

A

d

51
Q

When the prime mover is extending a body part, what movement is created by the antagonist muscle?
a) Extending the proximal part
b) Stabilization of the proximal part
c) Flexing same part
d) Synergist muscle relaxes
e) Flexing the distal part

A

c

52
Q

Which one is a saddle-type synovial joint?
a) Distal radioulnar joint between radius and ulna
b) Midcarpal joint between proximal and distal rows of the carpal bones
c) Carpometacarpal joint of the trapezium
d) Distal interphalangeal joint of the 4th finger
e) Metacarpophalangeal joint of the 3rd finger

A

c

53
Q

After a sports injury, the team doctor tests his athlete’s knee by pulling anteriorly on the leg with the flexed knee. If the leg translates (moves) forward significantly, this indicates damage to which structure?
a) Medial collateral ligament
b) Anterior cruciate ligament
c) Fibular collateral ligament
d) Medial meniscus
e) Posterior cruciate ligament

A

b

54
Q

Dissection is delicately cutting and separating the tissues of the cadaver. During a dissection session, which one is the 3rd structure to cut to reach a muscle?
a) Superficial fascia
b) Deep fascia
c) Epimysium
d) Skin
e) Periosteum

A

a

55
Q

A patient fell from the stairs. After falling from the stairs, a patient had pain and swelling around the lateral side of the ankle joint. After the physical examination, you order a magnetic resonance imaging (MRI) scan of the ankle. MRI sections reveal a tear on the ligament that is between the fibula and calcaneus. Which ligament is affected in this patient?
a) Anterior talofibular ligament
b) Plantar calcaneonavicular ligament
c) Talocalcaneal ligament
d) Calcaneofibular ligament
e) Posterior talofibular ligament

A

d

56
Q

Which structure is an insertion site for the Trapezius?
a) External occipital protuberance
b) Ligamentum nuchae
c) Superior nuchal line
d) Spinous processes of the upper thoracic vertebrae
e) Spine of scapula

A

e

57
Q

Where are the 1st and 2nd neurons of the descending pathway located?
a) Cortex and brainstem
b) Cortex and thalamus
c) Cortex and anterior horn of the spinal cord
d) Cortex and cerebellum
e) Cortex and spinal ganglion

A

a

58
Q

After a motorcycle accident injury, a patient cannot walk. When he tries to take a step, his tibia slips posterior over the fixed femur, then he falls. Which ligament is injured in this accident?
a) Transverse ligament of the knee
b) Lateral collateral ligament
c) Anterior cruciate ligament
d) Posterior cruciate ligament
e) Lateral meniscus

A

d

59
Q

A patient tears a ligament while over-adducting the femur during a Pilates workout. An orthopedic surgeon spots a bleeding artery at the center of the torn ligament. Which ligament is torn in this patient?
a) Transverse acetabular ligament
b) Anterior cruciate ligament
c) Pubofemoral ligament
d) Ischiofemoral ligament
e) Ligament of head of femur

A

e

60
Q

Which ligament is an intracapsular ligament of the knee?
a) Transverse ligament
b) Patellar ligament
c) Fibular collateral ligament
d) Oblique popliteal ligament
e) Tibial collateral ligament

A

a

61
Q

Where is the location of Bregma?
a) Between temporal, parietal, and occipital
b) Between frontal and two nasals
c) Between occipital and two parietals
d) Between frontal and two parietals
e) Between frontal, temporal and parietal

A

d

62
Q

Which of the below cells is an innate immune cell?
a) B lymphocyte
b) Cytotoxic B cell
c) Th17 cell
d) Plasma cell
e) Mast cell

A

e

63
Q

Which of the below cells migrate to tissue first in inflammation?
a) T lymphocyte
b) T regulatory cell
c) Macrophage
d) Neutrophil
e) Mast cell

A

d

64
Q

In case of viral infection, which cells will provide long term protection by secretion of immunoglobulin?
a) T helper
b) T cytotoxic
c) Plasma cell
d) T regulatory
e) Mast cell

A

a

65
Q

If you have been vaccinated to a bacteria or virus, what will be the immune response when body meets the same type of intruder a second time?
a) There will be faster and higher amount of immunoglobulin secretion by memory B cells.
b) There will a same type of response occurring after the vaccine was introduced.
c) The number of released immunoglobulins will be less than the first time
d) The immunoglobulins and their secretion will not have any changes
e) The number of neutrophils effected by this infection will stay same

A

a

66
Q

What is the name of recommended immunology book and authors for the year 2023 to Phase I medical students?
a) Cellular and Molecular Immunology by Roitt et al
b) Immunology, Best for Medical Students by Roitt et al
c) Immunology for Medical Students by Lichtmann et al
d) Basic Immunology by Abul K Abbas et al
e) Immune System and Its Disorders by Robert Rich

A

d

67
Q

Which cell have a role in both innate and adaptive immune response?
a) T regulatory
b) T cytotoxic
c) T helper
d) B lymphocyte
e) Natural killer T cells

A

e

68
Q

Which one is true about steady-state condition on cell membrane?
a) Net force on ions is zero (FNa + FK + FCI = 0)
b) Net force on ions is greater than zero (FNa + FK + FCI > 0)
c) There is no ion flow (INa =IK = ICl = 0)
d) Net ion flow is zero (INa + IK + ICl = 0)
e) Net ion flow is greater than zero (INa + IK + ICl > 0)

A

d

69
Q

The contraction velocity of a muscles is 5ms-1. If the load is 180 N, what is the power output of the muscle at that velocity?
a) 36 Watts
b) 72 W
c) 270 Watts
d) 450 Watts
e) 900 Watts

A

e

70
Q

Which of the following statements about NaCl, sucrose and osmotic pressure is true?
a) NaCl has a higher osmotic pressure compared to sucrose at the same concentration
b) NaCl has a lower osmotic pressure compared to sucrose at the same concentration
c) NaCl has the same osmotic pressure as sucrose at the same concentration
d) NaCl has no effect on osmotic pressure
e) Sucrose has no effect on osmotic pressure

A

a

71
Q

What is the Nernst equation used for?
a) To calculate the concentration of an ion inside a cell
b) To calculate the resting membrane potential of a neuron
c) To calculate the action potential of a neuron
d) To calculate the equilibrium potential of an ion
e) To calculate the concentration of an ion outside a cell

A

d

72
Q

What is the optimal length of a muscle fiber for generating the maximum force?
a) Maximum force does not depend on optimal length
b) The optimal length depends on the muscle fiber type
c) The length at which the muscle fiber is fully relaxed
d) The length at which the muscle fiber is fully stretched
e) The length at which the amount of actin and myosin filament overlap is maximal

A

e

73
Q

What is the equilibrium potential of an ion?
a) The voltage across the membrane when the ion is at equilibrium state
b) The concentration of the ion inside the cell when the ion is at equilibrium state
c) The concentration of the ion outside the cell when the ion is at equilibrium state
d) The difference in voltage across the membrane for two different ions
e) The concentration of the ion in the extracellular matrix

A

a

74
Q

What is efficiency in muscle contraction?
a) Work done by muscle/ Chemical energy
b) Work done by muscle/ Resting heat
c) Chemical energy/ Resting heat
d) Chemical energy/ Activation heat
e) Resting heat/ Activation heat

A

b

75
Q

What is the effect of the refractory period on the generation of action potentials?
a) It increases the rate of action potential propagation
b) It decreases the threshold for suprathreshold stimulation
c) It prevents the generation of additional action potentials during the period
d) It increases the amplitude of the action potentials
e) It generates sub-threshold potentials

A

c

76
Q

Which of the parameters is not correct/ used for the model of electrical circuit of neuron?
a) Current
b) Voltage
c) Inductance
d) Capacitance
e) Resistance

A

c

77
Q

Which one of the following is the first ethics code coming from Hippocratic Oath?
a) First do no harm
b) Beneficence
c) Justice
d) Autonomy
e) Compassion

A

a

78
Q

Which one of the following is not a finding of Duchenne Muscular Dystrophy?
a) Abnormal mental status
b) Muscle coordination is low for age
c) Muscles are weak, and grip strength is weak
d) Muscles of the calf appear hypertrophied
e) He gets up to a standing position using Gowers maneuver

A

a

79
Q

What is the rate-limiting step of the cross-bridge cycle in muscle fibers?
a) ATP binding to myosin heads
b) Calcium binding to troponin molecules
c) Actin binding to myosin heads
d) ADP and Pi releasing from actin-myosin complex
e) Myosin heads undergoing conformational changes

A

d

80
Q

Which one of the following is the famous collection of books written by Hippocrates and his pupils?
a) Book of Ayurveda
b) Book of Reflexology
c) Galenic Anatomy
d) Susruta Samhita
e) Corpus Hipocraticum

A

e

Committee Exam 4 (35 decks)

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