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Dental Hygiene > Oral Patholgy > Flashcards

Oral Patholgy Flashcards

1
Q

What is a physiologic loss of tooth structure from tooth to tooth contact?

A

attrition

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2
Q

What is a pathologic form of attrition?

A

Bruxism

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3
Q

What is a habitual grinding of the teeth?

A

Bruxism

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4
Q

What is a pathologic loss of tooth structure due to a chemical process?

A

Erosion

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5
Q

What is erosion from gastric secretions?

A

perimolysis

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6
Q

What can cause erosion?

A

chronic vomiting, bulimia, acidic foods, ect

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7
Q

What is a pathologic loss of tooth structure from a mechanical process?

A

Abrasion

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8
Q

What is a pathologic loss of tooth structure from tooth flexure during mastication?

A

Abfraction

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9
Q

What is an abnormal bend or curve in a tooth root?

A

dilaceration

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10
Q

What is a single enlarged tooth in which the tooth count is normal ake: twinning?

A

Gemination

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11
Q

What is an enlarged tooth in which the tooth count reveals a missing tooth; a tooth attached to another tooth (2 teeth)?

A

Fusion

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12
Q

What is the difference between gemination and fusion?

A

gemination has a normal count of teeth in the oral cavity while during fusion the count will reveal a missing tooth

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13
Q

What is the union of teeth by cementum?

A

concrescence

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14
Q

What is another name for dens invaginatus?

A

dens in dente

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15
Q

What is a deep surface invagination of the crown or root that is lined by enamel?

A

Dens invaginatus

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16
Q

What is the most common tooth to have dens invaginatus?

A

maxillary lateral incisor also common to have a lingual pit

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17
Q

What is another name for Taurodontism?

A

Bull’s teeth

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18
Q

What is a large pulp chamber with furcations close to the apex, and elongated crown?

A

Taurodontism

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19
Q

What disorder is taurodontism most common in?

A

Down Syndrome

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20
Q

What is another name for enamel pearl?

A

Ectopic enamel

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21
Q

What is enamel on the root surface?

A

enamel pearl

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22
Q

What does an enamel pearl look like on a x-ray?

A

rounded, radiopaque

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23
Q

What is a microdont and a macrodont?

A

micro- abnormally small teeth macro= abnormally large teeth (rare)

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24
Q

What is anadontia

A

no teeth

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25
Q

What is hypodontia?

A

fewer than normal teeth

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26
Q

What is oligodontia?

A

missing 6 teeth or more

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27
Q

What is partial anadontia?

A

fewer than normal teeth

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28
Q

What is a syndrome where complete anodontia may be seen?

A

ectodermal dysplasia

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29
Q

What is often seen in people due to high frenum attachment and muscle pull?

A

diastema

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30
Q

What is a name for increased number of teeth?

A

hyperdontia

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31
Q

what is another name for an extra tooth?

A

supernumerary

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32
Q

What is the most common supernumerary tooth?

A

mesiodens (occurs between maxillary and central incisors)

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33
Q

The dorsal surface of the tongue is NOT a likely location for intraoral cancer True or False?

A

TRUE

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34
Q

What is another name for Geographic tongue?

A

Benign migratory glossitis

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35
Q

What areas are involved with geographic tongue?

A

dorsal and lateral borders of the tongue

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36
Q

What type of papillae is lost during geographic tongue?

A

filliform papilla

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37
Q

What area is involved with hairy tongue?

A

dorsal surface of the tongue

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38
Q

Hairy tongue may be associated with?

A

tocacco use, chemical rinses, alcohol, smoking, antibiotic therapy, and poor oral hygiene

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39
Q

What is the only way that environmental hypoplasia can occur?

A

only during tooth formation; can occur with primary and permanent teeth

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40
Q

What is hypocalcemia?

A

low calcium levels in blood

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41
Q

What are some systemic causes of environmental hypoplasia?

A

Birth related trauma, malnutrition (hypocalcemia), chemicals (fluorosis; >.7ppm in drinking water), systemic infection, and idiopathic (unknown)

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42
Q

What are some local factors that cause environmental hypoplasia?

A

local infection or trauma, Turner’s hypoplasia or tooth, electrical burn, irradiation etc…

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43
Q

What may be some systemic infections?

A

congenital syphilis: hutchinson’s incisors and mulberry molars

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44
Q

What is a hereditary defect of enamel formation?

A

amelogenesis imperfecta

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45
Q

What are some characteristics of amelogenesis imperfecta?

A

enamel hypoplasia, pits and grooves in teeth, and teeth are often discolored

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46
Q

What is another name for Dentiongenesis imperfecta?

A

Hereditary opalescent dentin

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47
Q

What is a hereditary defect of dentin?

A

dentinogenesis imperfecta

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48
Q

What is another name for osteogenesis imperfecta?

A

brittle bone disease

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49
Q

dentinogenesis may also be associated with?

A

osteogenesis imperfecta

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50
Q

What are some characteristics of dentinogenesis imperfecta?

A

obliterated pulp chambers and crowns

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51
Q

What causes tetracycline staining?

A

ingestion of tetracycline during tooth development

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52
Q

Is tetracycline stain intrinsic or extrinsic?

A

intrinsic

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53
Q

What color does tetracycline turn teeth?

A

black, brown, grey

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54
Q

What is another name for internal resorption?

A

pink tooth of mummery

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55
Q

What can cause internal resorption?

A

tooth trauma or pulpitis

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56
Q

Why is internal resorption also called pink tooth of mummery?

A

because if in pulp chamber, tooth may look “pink”

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57
Q

What is physiologic pigmentation?

A

racial pigmentation or normal pigmentation; variable of healthy pigmentation

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58
Q

What are some characteristics of a melanotic macule?

A

flat, brown lesion

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59
Q

What are some melanotic macules?

A

oral freckle, and oral ephelis

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60
Q

What are amalgam particles in soft tissue?

A

amalgam tattoo

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61
Q

Can you see an amalgam tattoo on a radio-graph?

A

yes, looks like opaque particles

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62
Q

What is an intraoral sebaceous gland (oil) that are small yellow nodules of buccal mucosa and vermilion border after puberty?

A

fordyce’s granules

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63
Q

Are fordyce’s granules usually bilateral?

A

Yes

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64
Q

What is a dilated superficial vein?

A

varicosities

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65
Q

Where are varicosities prominent?

A

on the ventral of the tongue

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66
Q

What is another name for addison’s disease?

A

hypoadrenocorticism

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67
Q

What is a clinical characteristic of addison’s disease?

A

diffuse pigmentation, bronzing of the skin and mucosa

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68
Q

What is the cause of addison’s disease?

A

adrenal cortical insufficiency, and too little steroid production

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69
Q

What is another name for cushing’s syndrome?

A

hypercortisolism

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70
Q

What causes cushing’s syndrome?

A

excess pituitary gland ACTH production; usually from a prescribed corticosteroid therapy

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71
Q

What are some clinical characteristics of cushing’s syndrome?

A

weight gain, buffalo hump (fat accumulation in upper back), moon facies (fat accumulation in the face), and poor healing

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72
Q

What is another name for smoker’s palate?

A

Nicotine Stomatitis

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73
Q

What causes a wrinkled appearance and scattered red dots of the palate?

A

Nicotine Stomatitis

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74
Q

What causes the red dots during Nicotine Somatitis?

A

inflamed minor salivary glands

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75
Q

Is Nicotine Somatitis precancerous?

A

NO

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76
Q

What is a milky white lesion of the buccal mucosa that disappears when stretched?

A

Leukoedema

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77
Q

Is Leukoedema more prominent in dark skinned individuals?

A

YES

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78
Q

What is a hyperkeratotic white line of the buccal mucosa along plane of occlusion?

A

linea alba

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79
Q

What is considered the most common fungal infection of the oral cavity?

A

Candida albicans

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80
Q

What are some local factors that cause candida albicans?

A

xerostomia, complete dentures, steroid inhalers etc..

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81
Q

What are some systemic factors that cause candida albicans

A

antibiotic therapy, HIV+, uncontrolled diabetes etc..

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82
Q

What is another name for pseudomembranous candidiasis and what does it look like?

A

Thrush; white plaques that wipe off; occurs in infants

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83
Q

What is another name for Central papillary atrophy?

A

Median rhomboid glossitis

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84
Q

What does atrophy mean?

A

The wasting away of a tissue or organ, usually due to the degeneration of cells

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85
Q

What is a red, atrophic area in the midline and dorsal of tongue?

A

Central Papillary Atrophy

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86
Q

Is Central Papillary Atrophy usually found in immunocompetent individuals?

A

yes

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87
Q

Mary comes in with fissured areas at the corners of her mouth, what do you suspect and what would be her treatment?

A

Angular Cheilitis; the treatment would be antifungal cream, a topical like nystatin and clotrimazole and a systemic antibiotic like ketoconazole, and fluconazole (diflucan)

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88
Q

What has a similar appearance like angular cheilitis?

A

severe riboflavin (vit B12) deficiency

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89
Q

What 2 tongue lesions have to do with the filiform on the tongue?

A

Geographic tongue and hairy tongue

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90
Q

What is the cause of geographic tongue?

A

idiopathic, unknown cause

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91
Q

Why my you see Candidiasis in a patient taking antibiotic therapy?

A

It would be a side effect of the antibiotic

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92
Q

Desquamative gingivitis may be seen in?

A

cicatricial pemphigoid, pemphigus vulgaris, and lichen planus

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93
Q

Enamel hypercalcification has an appearance of?

A

chalky white spots

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94
Q

Hairy tongue causes the filiform papilla to?

A

elongate

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95
Q

Fissured tongue is also known as?

A

Scrotal or furrowed tongue

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96
Q

Trisomy 21 is another name for what syndrome?

A

Down Syndrome

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97
Q

Does Down syndrome patients have an increased risk of periodontal disease?

A

YES

98
Q

Does Down Syndrome have increased risk of dental caries?

A

NO, just periodontal disease

99
Q

What are some oral characteristics of individuals with down syndrome?

A

fissured tongue, macroglossia, mouth breathers, hypodontia, and taurodontism

100
Q

What is considered the most common “tumor” of the oral cavity?

A

irritation fibroma

101
Q

What are some clinical characteristics of a fibroma (irritation or traumatic fibroma)?

A

smooth, pink, firm, elevated lesion- nodule

102
Q

What are some clinical characteristics a of a papilloma- oral or squamous)?

A

pedunculated (on a stalk), wart-like, soft lesion

103
Q

Papilloma, skin warts (veruca vulgarism), and genital warts (conyloma acuminatum) are all caused by what virus?

A

HPV- Human Papilloma Virus

104
Q

What weeks of gestation does a cleft lip occur?

A

4th to 7th week

105
Q

What weeks of gestation does a cleft palate occur?

A

8th and 12th week

106
Q

When in utero is the cleft lip apparent?

A

by end of the 2nd month in utero

107
Q

When in utero is the cleft palate apparent?

A

by end of the 3rd month in utero

108
Q

What can cause gingival enlargement?

A

anticonvulants, calcium channel blockers, cyclosporine, genetic factors, and hormonal changes

109
Q

What are some anticonvulsant drugs that contribute to gingival enlargement?

A

dilantin,phenytoin, and sodium valproate

110
Q

What are some calcium channel blockers?

A

nifedipine and diltiazem

111
Q

What is another name for epulis fissuratum?

A

Inflammatory fibrous hyperplasia

112
Q

What causes epulis fissuratum (Inflammatory fibrous hyperplasia)?

A

ill-fitting dentures, and “Fibroma” around denture flange

113
Q

What is the most common location to find papillary hyperplasia?

A

the palate

114
Q

What is another name for papillary hyperplasia?

A

Pseudopapillomatosis

115
Q

What causes papillary hyperplasia?

A

a maxillary denture that is never removed

116
Q

What is pyogenic granuloma composed of?

A

granulation tissue

117
Q

What is granulation tissue?

A

young connective tissue, blood vessels, and inflammation

118
Q

What is another name for pyogenic granuloma?

A

pregnancy tumor because this is often seen during pregnancy

119
Q

What is the most common location where a pyogenic granuloma is found?

A

gingiva

120
Q

What is another name for chronic hyperplastic pulpits?

A

pulp poylp, and pulp granuloma

121
Q

What does hyperplasia mean?

A

increase in the NUMBER of cells

122
Q

What does hypertrophy mean?

A

increase in the SIZE of the cells

123
Q

What is a exophytic lesion inside of carious teeth in children composed of granulation tissue and usually does not display any pain?

A

hyperplastic pulpitis (pulp polyp)

124
Q

What inflammatory soft tissue lesion looks clinically simular to a pyogenic granuloma?

A

peripheral giant cell granuloma

125
Q

What is the only difference between pyogenic granuloma and peripheral giant cell granuloma?

A

peripheral giant cell granuloma contains a multi-nucleated giant cell

126
Q

Where is central giant cell granuloma located?

A

inside the bone

127
Q

Mary comes in complaining of a painful ulcer on her lip what usually occurred?

A

traumatic ulcer, most often from biting

128
Q

A patient comes in complaining of a recurring painful ulcer on her tongue, and claims she has been under a lot of stress lately, you take a look and it and it has an erythematous halo around the ulcer, what type of ulcer may this be?

A

aphthous ulceration

129
Q

What type of tissue does an aphthous ulcer occur on?

A

only moveable mucosa; never on palate or attached gingiva

130
Q

What type of herpes is Herpes Simplex Virus 1 (HSV-1)?

A

oral herpes

131
Q

What type of herpes is Herpes Simplex Virus 2 (HSV-2)?

A

genital herpes

132
Q

What type of virus is the Varicella-Zoster Virus (VZV)?

A

chickenpox and shingles

133
Q

What type of virus is Epstein-Bar Virus (EBV)?

A

mono, OHL, Burkitt’s lymphoma

134
Q

What type of herpes is Human Herpes Virus-8 (HHV-8)?

A

Kaposi’s sarcoma herpes virus- sexually transmitted

135
Q

can you cure a herpes virus?

A

NO, it will always remain in the body, but may become dormant

136
Q

What is another name for Herpes Simplex type 1?

A

Primary Herpes Simplex

137
Q

What age do primary herpes simplex virus typically occur?

A

age 1-5 years

138
Q

What type of herpes usually have a vesicle stage?

A

primary herpes simplex and herpes labialis

139
Q

Where is primary herpes simplex usually located?

A

any area of the oral cavity including the gingiva

140
Q

What starts to show up before the ulcer in primary herpes simplex virus?

A

Vesicles

141
Q

In recurrent intraoral HSV are vesicles seen?

A

Vesicles are rarely seen

142
Q

What is another name for herpes labialis?

A

cold sores or fever blisters

143
Q

What herpes virus has a prodromal stage?

A

Herpes Labialis

144
Q

What is prodromal symptoms?

A

burning, tingling before a lesion

145
Q

What is herpes labialis?

A

recurrent HSV on the lips

146
Q

How long does recurrent intraoral HSV usually take to heal?

A

7-10 days

147
Q

What is the location of recurrent intraoral HSV?

A

occurs only on “bound down” keratinized mucosa (hard palate and attached gingiva)

148
Q

What is herpetic whitlow?

A

recurrent HSV on the finger

149
Q

What are some characteristics of chickenpox?

A

occurs in crops- erythema, vesicles, pustules, and crusted lesions

150
Q

Are Varicella-Zoster and Epstein-Bar viruses a herpes virus?

A

YES

151
Q

What 2 viral lesions have the etiology of the Epstein-Bar Virus?

A

Infectious mononucleosis and oral hairy leukoplakia

152
Q

What may be the first manifestation of the HIV infection?

A

Oral hairy leukoplakia

153
Q

What viral infection can cause bleeding of the palate?

A

Infectious mononucleosis

154
Q

A patient comes in and complains of white, furrowed lines on the lateral surface of the tongue, what might be the reason?

A

oral hairy leukoplakia

155
Q

What viral lesion is most often associated with HIV?

A

Kaposi’s Sarcoma

156
Q

What has the clinical appearance of multiple bluish purple macules and plaques, and have vascular neoplasm?

A

Kaposi’s Sarcoma

157
Q

What 2 viral lesions are caused by the coxsackie virus?

A

Herpangina and hand-foot-&mouth disease

158
Q

What viral lesion has vesicles or ulcers of the posterior oral cavity?

A

Herpangina

159
Q

What viral lesion has vesicles or ulcers of mouth, hands, and feet?

A

hand-foot-&mouth disease

160
Q

A pt comes in and has big blisters on her lips. You go over her health history and she explains she has an autoimmune disorder that causes these blisters. What type of disease does she have and what is the treatment?

A

Vesiculobullous disease, steroids

161
Q

What is an acute ulcerative condition of skin and mucous membranes that is an immunologic response to foods, chemicals, drugs, or microbial infection?

A

Erythema multiforme

162
Q

50% of people with Erythema multiforme create lesions that look like?

A

Bull’s eye or target lesion

163
Q

What virus is a common trigger for Erythema multiforme?

A

recurrent Herpes Simplex Virus

164
Q

What is another name for Erythema multiforme?

A

Steven-Johnson’s Syndrome

165
Q

What syndrome occurs when 2 mucosal surfaces are involved and is usually triggered by a drug?

A

Steven-Johnson’s Syndrome

166
Q

What disorder has mucosa and skin ulcerations and lesions that look like a butterfly rash?

A

Chronic discoid (cutaneous) lupus erythematosis

167
Q

What disease of the skin has fine, lace-like network of white lines known as wickham’s striae on the oral mucosa?

A

Lichen Planus

168
Q

What are some known vesiculobullous diseases?

A

Erythema multiforme, Lichen Planus, Pemphigus, Pemphigoid

169
Q

What is a disease of autoantibodies to desmosomes?

A

Pemphigus

170
Q

What is a disease of autoantibodies to hemidesmosomes?

A

Pemphigoid

171
Q

What is the most common site of a mucocele?

A

the lower lip

172
Q

What is caused by a traumatic severance of the salivary gland duct?

A

mucocele

173
Q

What is a wharton’s duct?

A

submandibular salivary gland duct

174
Q

What is a obstruction of the wharton’s duct and causes a swelling on the floor of the mouth?

A

Ranula

175
Q

What is a sialolithiasis?

A

Salivary gland stone which is a calcification within the gland or duct

176
Q

What x-ray is used for detecting sialolithiasis?

A

occlussal film

177
Q

What is the most common site for a siolithith?

A

wharton’s duct

178
Q

What is the most common tumor of the salivary gland?

A

Benign mixed tumor (Pleomorphic adenoma)

179
Q

What is the most common location of the Pleomorphic adenoma?

A

Parotid gland

180
Q

What is the most common intraoral location for the pleomorphic adenoma?

A

The hard palate

181
Q

What is another name for mumps?

A

epidemic parotitis

182
Q

What is a virus transmitted through saliva or respiratory secretions and are a bilateral parotid enlargement?

A

Mumps aka Epidemic parotitis

183
Q

What are some known cancers of the skin?

A

Basal Cell Carcinoma, squamous cell carcinoma, and melanoma

184
Q

What is the most common form of oral cancer?

A

squamous cell carcinoma aka epidermoid carcinoma

185
Q

What is 3 major risk factors for receiving a squamous cell carcinoma?

A

Smoking and alcohol consumption, and HPV

186
Q

What is dysplasia aka carcinoma-in-situ?

A

premalignant lesions, not invasive yet

187
Q

What is the most common site of squamous cell carcinoma?

A

lateral of tongue and floor of the mouth

188
Q

What is a snuff dipper’s lesion?

A

smokeless tobacco keratosis

189
Q

what are some clinical signs of smokeless tobacco keratosis?

A

gingival recession, tooth staining, and decay, and wrinkled corrugated white lesions at site of placement

190
Q

What are some causes of xerostomia?

A

drugs, head and neck radiation, and Sjogren syndrome

191
Q

What is Sjogren syndrome?

A

an autoimmune disease with dry eyes and mouth from inflammation

192
Q

What is a epithelial lined pathologic cavity?

A

cyst

193
Q

What kind of cyst is where the lining of the lumen is derived from epithelia produced during tooth development?

A

odontogenic cyst

194
Q

What is the remnants of dental lamina?

A

Epithelial Rests of Serres

195
Q

What is remnants of Hertwig’s root sheath?

A

Epithelial Rests of Malassez

196
Q

What are some other names for a Radicular cyst?

A

periapical cyst, and apical periodontal cyst

197
Q

Where is a radicular cyst located?

A

apex of necrotic tooth

198
Q

What is a residual cyst?

A

a radicular cyst that was left behind after extraction

199
Q

What is another name for dentigerous cyst?

A

Follicular cyst

200
Q

What is a dentigerous cyst and where is it most common located?

A

a cyst around the crown of an impacted tooth; most common around 3rd molars and maxillary canines

201
Q

What is a primordial cyst?

A

this occurs in place of a tooth

202
Q

What are some characteristics of a odontogenic keratocyst?

A

a unilocular or multilocular radiolucency, usually occur in posterior of mandible and has a high recurrence rate

203
Q

What cyst is a unilocular radiolucency between roots of madibular premolars?

A

lateral periodontal cyst

204
Q

What are some non-odontogenic cysts?

A

globulomaxillary, nasopalatine duct cyst, and nasolabial cyst

205
Q

What is another name for nasolabial cyst?

A

nasolacrimal cyst

206
Q

What kind of cyst is a nasolabial cyst?

A

a soft tissue cyst, usual located at the ala of the nose

207
Q

What is another name for a nasopalatine cyst?

A

Incisive canal cyst

208
Q

What cyst is an oval radiolucency of the midline of anterior maxilla and may appear heart shaped due to the anterior nasal spine?

A

nasopalatine duct cyst

209
Q

What is another name for a tumor?

A

neoplasm

210
Q

What is a carcinoma?

A

malignant neoplasm of epithelial tissue

211
Q

What is a sarcoma?

A

malignant neoplasm of mesenchymal tissue (muscle bone, connective tissue)

212
Q

What is adeno?

A

gladular (glands are epithelial)

213
Q

When a tumor has a oma at the end of the word it means it is?

A

benign

214
Q

When a tumor has sarcoma or carcinoma at the end of the word it means?

A

malignant

215
Q

What is a malignancy of plasma cells?

A

multiple myeloma

216
Q

What are some characteristics of multiple myeloma?

A

bone pain and punched out radiolucencies

217
Q

What kind of tumor is most often benign derived from elements of tooth development?

A

Odontogenic tumor

218
Q

What is the most common odontogenic tumor?

A

odontoma

219
Q

What type of tumor is composed of enamel and dentin and can look like little teeth?

A

odontoma

220
Q

What are 3 characteristics of ameloblastoma?

A

usually mutilocular radiolucency a soap bubble or honey combed radiolucency, in posterior of mandible, and high recurrence rate

221
Q

What is a bony protuberance of facial surfaces of the jaws?

A

exostosis

222
Q

What type of bone lesion involves middle age black women and the lower anterior and teeth are considered vital?

A

periapical cemental dysplasia

223
Q

What is another name for periapical cemental dysplasia?

A

periapical cemento osseous dysplasia, false cementoma

224
Q

What is condensing osteitis?

A

a radiopaque lesion at apex of inflamed necrotic tooth

225
Q

What is another name for condensing osteitis?

A

Focal sclerosing osteomyelitis

226
Q

What is another name for paget’s disease?

A

osteitis deformans

227
Q

What is paget’s disease?

A

the thickening and enlargement of the bones (bone metabolism, hat will not fit, dentures will not fit), it also increases alkaline phosphatase in blood

228
Q

What disease has a cotton wool radiopacities?

A

paget’s disease

229
Q

dysplastic lesions of squamous epithelium occur most often on the?

A

floor of the mouth

230
Q

the most common malignancy in the oral cavity is?

A

epidermoid carcinoma

231
Q

recurrent apthous ulcers appear to be associated with?

A

stress, not herpes virus

232
Q

a 26 year old black female was examined clinically and radiographically. On a mandibular periapical radiograph that included the central and lateral incisors, radiolucent lesions were found at the apex of each of these four teeth. Six months later, the radiolucent areas were radiopaque. Each of the four teeth retained it vitality. This patient most likely has?

A

cementomas

233
Q

Non-perforating internal resorption is best managed by?

A

root canal treatment

234
Q

Clinically and microscopically, an epulis fissurtatum is most similar to which of the following lesions?

A

Irritation Fibroma

235
Q

The first clinically observable reaction to radiation overexposure is?

A

erythema of the skin

236
Q

A specific presentation of oral candidiasis, sometimes seen in otherwise healthy patients is?

A

median rhomboid glossitis

237
Q

Bence-Jones proteins in the urine and multiple bone radiolucencies can be found in which of the following diseases?

A

multiple myeloma

238
Q

What 3 conditions is the papillomavirus found?

A

oral papilloma, condyloma acuminatum, and squamous cell carcinoma

239
Q

Carcinoma that does not invade the connective tissue is referred to as?

A

Carcinoma in situ

240
Q

Supernumerary teeth are a common feature of which of the following syndromes?

A

Cleidocranial dysostosis

241
Q

Which is the most common location for Aids-related “oral hairy leukoplakia”?

A

lateral border of the tongue

Dental Hygiene (19 decks)

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