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Rembe - Chapter 4 (MS) Flashcards

Orthopedics

1
Q

The correct emergency treatment for an injured limb is to:

a. Secure the injured limb to the uninjured one
b. Straighten the injured limb to a normal position
c. Support the injured limb without straightening it
d. Not touch the injured limb

A

c. Support the injured limb without straightening it

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2
Q

An involucrum is

a. Sheath of new bone
b. Pyogenic lesion of a joint
c. Condition caused by premature closure of an epiphysis
d. Tumor metastasis to bone

A

a. Sheath of new bone

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3
Q

The clinical picture of progressive muscular atrophy (aran-Duchenne type) includes

a. Initial weakness and atrophy of the lower extremities
b. Gross sensory losses over weakened or atrophied muscles
c. Hyperactive deep reflexes are first evidence of the disorder
d. Usually the first evidence of the disorder is an atrophy of the intrinsic muscles of the hand

A

d. Usually the first evidence of the disorder is an atrophy of the intrinsic muscles of the hand

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4
Q

In case of delayed union of a fracture of the tibia or femur

a. The patient should drink more milk
b. Immobilization will be shortened
c. Full weight-bearing in a walking cast
d. Protect the fracture line against undue strain

A

d. Protect the fracture line against undue strain

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5
Q

In the repair of fractures

a. A spiral fracture heals more rapidly than a transverse fracture
b. The humerus and forearm bones require about the same duration to heal as the femur and tibia do
c. Beyond puberty, age has more influence on the rate of fracture healing
d. Healing time is indirectly proportional to total volume of damaged bone and the breadth of fracture defect

A

a. A spiral fracture heals more rapidly than a transverse fracture

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6
Q

Causes for nonunion of a fracture include

Inadequate fixation
Adequate fixation
Oversupply of calcium in diet
Not enough calcium in the diet

A

Inadequate fixation

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7
Q

In Guillain-Barre syndrome

a. There is an apparent hypertrophy of the muscles of the calf
b. There is polyneuritis, characterized by a slowly progressive, ascending motor weakness
c. The symptoms are easily confused with those of neuropathy
d. Distal muscle groups tend to be involved more commonly than proximal

A

b. There is polyneuritis, characterized by a slowly progressive, ascending motor weakness

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8
Q

In pseudohypertrophic muscular dystrophy there is

a. Symmetric, ascending motor weakness, sometimes easily confused with poliomyelitis
b. Apparent hypertrophy of muscles of the legs and forearms
c. Normal muscles about the shoulder girdle
d. Hypertrophy of the extensor muscles of the legs and trunk

A

b. Apparent hypertrophy of muscles of the legs and forearms

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9
Q

Klumpke’s paralysis

a. Results from injury to cervical roots 5 and 6 during the birth process
b. Results from injury to cervical 8 and first dorsal root at birth
c. Involves the lower arm and leg
d. Movements of the wrist and fingers are not affected

A

b. Results from injury to cervical 8 and first dorsal root at birth

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10
Q

In Erb-Duchenne or upper arm paralysis the

a. Brachial plexus is involved
b. Cervical plexus is involved (cervical roots 5-6)
c. Radial nerve is involved
d. Median nerve is involved

A

b. Cervical plexus is involved (cervical roots 5-6)

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11
Q

Spina bifida myelocele

a. Is the least severe form of spina bifida
b. Is the most common form of spina bifida
c. Has a low infant mortality rate
d. Infection may easily take place

A

d. Infection may easily take place

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12
Q

A patient is diagnosed as having a coxa vara deformity. This means

a. There is an abnormality of the upper end of the tibia
b. There is a decrease in the angle of inclination between the neck of the femur and its shaft
c. There is a lengthening of the extremity on its affected side
d. It can be either a congenital or an acquired deformity

A

d. It can be either a congenital or an acquired deformity

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13
Q

In spina bifida myelomeningocele

a. The hernia sac contains only cerebrospinal fluid
b. The hernia sac contains cerebrospinal fluid and spinal cord or nerve roots or both
c. There is less likely to be a neurological deficit in the lower extremities
d. The central canal of the spinal cord is greatly dilated and contains a large amount of cerebrospinal fluid

A

b. The hernia sac contains cerebrospinal fluid and spinal cord or nerve roots or both

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14
Q

An osteotomy is

Removal of a sequestrum
Fusion of a joint
Debridement of osteomyelitis
Operative sectioning of a bone

A

Operative sectioning of a bone

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15
Q

Cancellous or spongy bone

a. Is non lamellar
b. Is the structural feature of the diaphysis
c. Is found in the epiphyseal areas of long bones
d. Has the Haversian system as its conspicuous structural feature

A

c. Is found in the epiphyseal areas of long bones

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16
Q

Hyaline cartilage is nourished through the

Nutrient arteries of the diaphysis
Vessels from the periosteum
Joint fluid
Haversian canals

A

Joint fluid

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17
Q

The four basic concepts which should be considered for fractures are

a. Reduction, refraction, retention, and rehabilitation
b. Recluse, reduction, retention, and rehabilitation
c. Recognition, reduction, retention and rehabilitation
d. Refracture, reduction, retention and rehabilitation

A

c. Recognition, reduction, retention and rehabilitation

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18
Q

All of the following are signs and symptoms of a shoulder dislocation, EXCEPT

a. Injured shoulder is held in a flexed position
b. Head of humerus can be palpated
c. Localized pain in the area of injury
d. Definite sensation of crepitus

A

d. Definite sensation of crepitus

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19
Q

Which of the following is frequently injured as a complication of shoulder dislocation?

Radial nerve
Radial artery
Axillary nerve
Axillary artery

A

Axillary nerve

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20
Q

A clinical picture in which there is a deformity of (1) foot inversion, (2) forefoot adduction, and (3) plantar flexion would most likely be

a. Talipes equinovarus
b. Talipes calcaneovalgus
c. Talipes valgus
d. Talipes calcaneus

A

a. Talipes equinovarus

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21
Q

The etiology of congenital dysplasia of the hip is

a. Trauma at birth
b. The virus of German measles during the first trimester
c. Inadequate nutritional status of the mother
d. Unknown

A

d. Unknown

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22
Q

Which of the following statements does NOT apply to osteogenesis imperfecta?

a. A rare congenital skeletal disease
b. Bones are extremely fragile and multiple fractures are common
c. The etiology is unknown
d. Bone fragility and the tendency for fractures is more severe following injury

A

d. Bone fragility and the tendency for fractures is more severe following injury

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23
Q

Osteosclerosis is characterized by

a. Fibrous dysplasia of bone
b. Regions of increased bone density noted on roentgenograms
c. Decreased bone density giving a moth-eaten appearance
d. Demineralization of bone tissue

A

b. Regions of increased bone density noted on roentgenograms

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24
Q

Myositis ossificans is characterized by

a. Pathologic fractures
b. Osteosclerosis of bone tissue
c. A fibrous dysplasia of bone
d. Transformation of soft tissue structures into bony consistency

A

d. Transformation of soft tissue structures into bony consistency

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25
Q

A patient who has fallen downstairs complains of pain in his left groin and gluteal area; the right hip is flexed, adducted, and internally rotated. The most likely diagnosis is

Fractured acetabulum
Dislocated hip
Fractured femoral head
Dislocated tibia

A

Dislocated hip

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26
Q

Balanced skeletal traction is frequently used for the treatment of fractures of the

Patella
Tibia
Femur
Humerus

A

Femur

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27
Q

Which of the following is a positive sign of a fracture?

Crepitus
Abrasions
Shock
Pain

A

Crepitus

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28
Q

Which of the following is the first stage of bony callus formation following a fracture?

Metaplasia
Provisional callus
Periosteum
Blood clot

A

Blood clot

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29
Q

The Denis-Browne splint is used for the correction of

Talipes equinovarus
Talipes calcaneovalgus
Talipes valgus
All of the above

A

All of the above

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30
Q

Osteoclasis refers to

a. A condition in which there is an abnormal number of osteoclasts in bone tissue
b. A decrease in the number of osteoclasts
c. The surgical removal of a sequestrum
d. The nonsurgical fracturing of a bone to correct a deformity

A

d. The nonsurgical fracturing of a bone to correct a deformity

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31
Q

The term phocomelia refers to

a. A defect in which a finger of either hand is missing
b. A congenital absence of the sacrum
c. Underdevelopment of the femur
d. A complete absence of a middle or intercalary segment of a limb

A

d. A complete absence of a middle or intercalary segment of a limb

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32
Q

A congenital deformity in which there are supernumerary digits of the hand or foot is called

Syndactyly
Macrodactyly
Microdactyly
Polydactyly

A

Polydactyly

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33
Q

The most common and serious deformities as far as congenital dislocations are concerned affect the

Spine
Shoulder
Hip
Knee

A

Hip

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34
Q

Buck’s traction is used in the treatment of femoral fractures for a child aged

5 years - 40 pounds
3 years - 30 pounds
3 years - 40 pounds
6 years - 60 pounds

A

3 years - 30 pounds

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35
Q

Heberden’s nodes are associated with

Osteoarthritis
Rheumatoid arthritis
Atrophic arthritis
Gout

A

Osteoarthritis

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36
Q

Tophi are associated with

Osteoarthritis
Rheumatoid arthritis
Gout
Avascular necrosis of the femoral head

A

Gout

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37
Q

Tuberculosis of the spine is also known as

Legg-calve-perthes disease
Little’s disease
Still’s disease
Pott’s disease

A

Pott’s disease

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38
Q

Skeletal traction is more frequently used in treating fractures of the

Tibia
Femoral shunt
Neck of the femur
Knee

A

Femoral shunt

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39
Q

The Pearson attachment when used in conjunction with a Thomas splint, allows

Immobilization of the hip
Hip flexion
Knee flexion
Ankle flexion

A

Knee flexion

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40
Q

In differentiating osteoarthritis from rheumatoid arthritis, the latter

a. Is a systemic disease; the patient is sick
b. Is associated with chronic inflammatory signs and cutaneous changes
c. Involves the distal interphalangeal joints producing the fusiform finger
d. More often involves weight-bearing joints

A

a. Is a systemic disease; the patient is sick

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41
Q

In a fractured bone

a. Callus may be minimal and predominantly bone if the fracture is an undisplaced linear fracture
b. There may be limited callus in fractures of the shafts of young bones
c. Callus is minimal in fractures where movement takes place while it is healing
d. The hematoma prevents callus formation

A

a. Callus may be minimal and predominantly bone if the fracture is an undisplaced linear fracture

42
Q

When a bone is fractured, blood extravasates into the area and forms a hematoma, which begins to organize within 24 hours. This organization of the hematoma means that

a. The blood clot dissipates and is absorbed
b. A blood clot has formed
c. The blood clot is invaded by granulation tissue
d. The healing process has not begun

A

c. The blood clot is invaded by granulation tissue

43
Q

The clinical picture of Charcot’s joint includes

a. The joint range of motion is decreased
b. There is swelling of the joint
c. Pain is severe
d. There is stability of the joint

A

b. There is swelling of the joint

44
Q

The clinical picture of scoliosis includes

a. Inequality of arm length
b. Asymmetric weakness of abdominal muscles
c. An A-P curvature of the spine that is exaggerated
d. Senile Osteoporosis

A

c. An A-P curvature of the spine that is exaggerated

45
Q

The silver fork deformity results from an unreduced or inadequately reduced

Fracture of the lower ulna
Colles fracture
Fracture of the first metacarpal
Fracture of one or more carpals

A

Colles fracture

46
Q

Volkmann’s ischemic contracture

a. Is a congenital deformity
b. Is a complication of fractures or injuries to the lower end of the radius
c. Results in osteoporosis following fractures because Volkmann’s canals are obliterated
d. Results in a severe claw hand deformity

A

b. Is a complication of fractures or injuries to the lower end of the radius

47
Q

In differentiating osteoarthritis from rheumatoid arthritis, the former

a. Is a systemic disease
b. Is more commonly associated with acute inflammatory signs and cutaneous changes
c. Involves the distal interphalangeal joints rather than the proximal joint
d. Results in bony ankylosis and osteoporosis

A

d. Results in bony ankylosis and osteoporosis

48
Q

A spinal fracture is defined as one which

Results from torsion of the limb
Is at an angle across the bone
Occurs mainly in children
Results from metastatic tumor

A

Results from torsion of the limb

49
Q

Of the three degrees of congenital dysplasia of the hip, which of the following is found or observed in acetabular dysplasia?

a. There is subluxation of the hip
b. There is dislocation of the hip
c. The acetabulum is shallow but the head of the femur remains seated
d. The head of the femur rides upward and outward from the acetabulum

A

c. The acetabulum is shallow but the head of the femur remains seated

50
Q

Characteristic pathological changes in congenital dislocation of the hip include

a. The acetabulum is usually shallow
b. Anterior dislocation is more common than posterior dislocation of the femoral head
c. The femoral head is larger on the affected side
d. The abductor muscles become shortened and contracted

A

a. The acetabulum is usually shallow

51
Q

An oblique fracture is described as one which

a. Occurs frequently in children
b. Proceeds at an angle across bone
c. Is typical of ski injuries
d. Results from torsion

A

b. Proceeds at an angle across bone

52
Q

A greenstick fracture is best described as one which

a. Occurs in people with recent activity
b. Results from metastatic tumor
c. Occurs frequently in children and heals rapidly
d. Results from twisting the limb

A

c. Occurs frequently in children and heals rapidly

53
Q

A fatigue fracture occurs as a result of

a. People increasing level of activity
b. Children playing and falling very hard
c. Metastatic tumors from the breast
d. Recent ski injury

A

a. People increasing level of activity

54
Q

The Denis-Browne splint

a. Is used in the treatment of a silver fork fracture
b. May be used to reverse the deformities of Pott’s disease
c. Can be used in stabilizing the cervical area in treating whiplash injuries
d. Is frequently used in correcting the deformities of a congenital clubfoot

A

d. Is frequently used in correcting the deformities of a congenital clubfoot

55
Q

A disease in which there is deficiency in mineralization of bone matrix is

Scurvy
Osteitis deformans
Osteoporosis
Osteomalacia

A

Osteoporosis

56
Q

A shepherd’s crook deformity

a. Involves the humerus
b. May be associated with fibrous dysplasia of the femur
c. Would most likely be present in children
d. Is roentgenographic evidence of osteogenesis imperfecta

A

b. May be associated with fibrous dysplasia of the femur

57
Q

The increase in the length of long bones

a. Is appositional growth
b. Take place at the epiphyseal plates
c. Progresses at a rapid rate under the endosteum
d. Results in a lengthening of Sharpey’s fibers

A

b. Take place at the epiphyseal plates

58
Q

Osteoblasts are located in

Haversian canals
Volkmann’s canals
Lacunae
None of the above

A

None of the above

59
Q

The Volkmann’s canals

a. Run parallel with the length of long bone
b. Contain the processes of osteocytes
c. Are located only in cancellous or spongy bone
d. None of the above

A

None of the above

60
Q

Bone cells called osteoblasts are

Multinucleated cells
Associated with the necrotic
Associated with bone resorption
Precursors of the osteocytes

A

Precursors of the osteocytes

61
Q

An osteon is

A juvenile bone cell
A mature bone cell
A Haversian system
The stem cell for an osteoclast

A

The stem cell for an osteoclast

62
Q

A pathologic fracture is best defined as one which

a. Occurs mainly in children after an illness
b. Occurs as a result from torsion of a limb
c. Is first recognized from a ski injury
d. Is most frequently caused by a primary tumor

A

d. Is most frequently caused by a primary tumor

63
Q

Ewing’s sarcoma

a. Is a malignant tumor of medullary origin
b. Simulates a low-grade osteomyelitis
c. Has an onset characterized by pain, tenderness, fever, and leukocytosis
d. All of the above

A

d. All of the above

64
Q

Which of the following muscles are usually involved in Erb-Duchenne paralysis?

a. Deltoideus and internal rotators of the shoulder
b. Biceps, brachialis, supinator, and brachioradialis
c. Wrist flexors and finger flexors
d. Wrist extensors

A

b. Biceps, brachialis, supinator, and brachioradialis

65
Q

Which of the following conditions is found to be more common in children than adults?

Pyogenic arthritis
Osteitis pubis
Acromegaly
Osteitis deformans

A

Pyogenic arthritis

66
Q

Progressive muscular atrophy (Aran-Duchenne type) is

a. A primary disease of the spinal cord
b. Characterized by a slow degeneration of the anterior horn cells
c. Found most often in adults between ages 25 and 45 years
d. All of the above

A

d. All of the above

67
Q

Congenital talipes equinovarus is

a. The most common congenital deformity of the foot
b. More common in boys
c. A foot position of inversion and plantar flexion
d. All of the above

A

d. All of the above

68
Q

The deformity known as metatarsus varus is quite common and

a. Is easily overlooked during infancy before walking begins
b. Is characterized by forefoot abduction
c. Is one of the causes of eversion
d. In mild cases yields to simple exercises which include stretching the forefoot into abduction

A

d. In mild cases yields to simple exercises which include stretching the forefoot into abduction

69
Q

Syndactyly refers to

a. Webbed fingers or toes
b. A decreased numbers of fingers or toes
c. An increased number of fingers and toes
d. A fibrous or bony union between two bones separated by an interosseous membrane

A

Webbed fingers or toes

70
Q

Postural deviations resulting from untreated congenital hip dislocation include

a. Lumbar spine deviates toward the affected side
b. Forward tilting of the pelvis
c. Increased lumbar lordosis
d. All of the above

A

All of the above

71
Q

A condition characterized by flattening, breaking, cystic changes, and reconstitution of the femoral head is known as

a. Slipped femoral epiphysis
b. Calve-Legg-Perthes disease
c. Osteoarthritis of the femoral head
d. Osteogenic sarcoma

A

b. Calve-Legg-Perthes disease

72
Q

An overweight teenage male has symptoms of moderate groin and knee pain; leg abducts and externally rotates during hip flexion. The most likely diagnosis is

a. Congenital dislocated hip
b. Calve-Legg-Perthes disease
c. Slipped capital femoral epiphysis
d. Fractured femoral head

A

c. Slipped capital femoral epiphysis

73
Q

Von Recklinghausen’s disease of bone is

Rickets
Fibrous dysplasia of bone
Hyperparathyroidism
Hypopituitarism

A

Hyperparathyroidism

74
Q

Which of the following is a lipid storage disorder in which histiocytes laden with a lipid accumulate in bone marrow, spleen, liver, etc.?

Achondroplasia
Gaucher’s disease
Osteomalacia
Osteogenesis imperfecta

A

Gaucher’s disease

75
Q

Idiopathic scoliosis treatment depends primarily upon

a. Surgery after the curvature has increased
b. Brace the spine for 2 years
c. Use a cast prior to surgery
d. Diagnosis with relative skeletal immaturity

A

d. Diagnosis with relative skeletal immaturity

76
Q

A supracondylar fracture of the humerus would most likely cause a peripheral nerve injury involving

Axillary nerve
Radial nerve
Musculocutaneous nerve
Median nerve

A

Median nerve

77
Q

Atrophy of the muscles of the thenar eminence would indicate injury to which nerve?

Musculocutaneous
Radial
UInar
Median

A

Median

78
Q

A patient with a peripheral nerve injury presents a clinical picture involving the right hand. There is inability to fully flex the index finger and the middle finger, thumb opposition is lost, and the sensory deficit includes the lateral one-half of the right finger, the middle and index finger, and the thumb. Which nerve is involved?

Musculocutaneous
Radial
Median
Ulnar

A

Median

79
Q

A peripheral nerve injury which produced a deformity of claw hand would improve which nerve?

Musculocutaneous
Radial
Median
Ulnar

A

Ulnar

80
Q

Thoracic outlet syndromes are

a. Cervical intervertebral disks and related traumatic lesions
b. Various forms of cervical root compression causing radiating pain
c. Associated with the glenoid fossa of the shoulder
d. Various types of injury to synovial membranes

A

b. Various forms of cervical root compression causing radiating pain

81
Q

Consider the following clinical picture of the knee joint: there is marked swelling of the knee joint, the tibia can be displaced forward on the femur, there is pain and marked instability of the knee joint. Which of the following structures are likely involved?

Tibia collateral ligament
Fibular collateral ligament
Anterior cruciate ligament
Posterior cruciate ligament

A

Anterior cruciate ligament

82
Q

Which of the following conditions is subject to frequent intra articular hemorrhage, especially of the knee, which leads to degeneration of the articular cartilage, over growth of the synovium, and proliferation of bone at the articular edges?

Still’s disease
Diastematomyelia
Epiphyseal arrest
Hemophilia

A

Epiphyseal arrest

83
Q

A fracture of the second lumbar vertebrae would involve which segment of the spinal cord?

Twelfth thoracic
First lumbar
Second lumbar
None of the above

A

None of the above

84
Q

The clinical picture of progressive muscular atrophy (Aran-Duchenne type)

a. Involved the lower extremities initially and progresses upward
b. Produces gross sensory losses over areas of muscle atrophy
c. Includes initial involvement usually of the hand intrinsic muscles and then progression upward and downward to the lower extremities
d. Includes initial involvement of bowel and bladder reflexes

A

c. Includes initial involvement usually of the hand intrinsic muscles and then progression upward and downward to the lower extremities

85
Q

The pathogenesis of Friedreich’s ataxia is

a. A degeneration of the anterior horn cells of the spinal cord
b. A developmental defect of the cerebral cortex
c. Hypoxia to the central nervous system at birth
d. Degeneration of sclerosis of the nerve fibers of the dorsal and lateral tracts of the spinal cord

A

d. Degeneration of sclerosis of the nerve fibers of the dorsal and lateral tracts of the spinal cord

86
Q

In the case of a fractured femur, delayed union is present if the fracture site is not clinically firm in

10 weeks
20 weeks
6 months
7 months

A

20 weeks

87
Q

In bone fractures in young individuals, new bone formation begins on the inner and outer surfaces of the damaged bone within

48 hours
96 hours
6 days
8 days

A

48 hours

88
Q

Which of the following conditions presents clinical evidence of clubbed fingers and toes and a broadening of the nails?

a. Secondary hypertrophic pulmonary osteoarthropathy
b. Osteitis deformans
c. Infantile cortical hyperostosis
d. Progressive myositis ossificans

A

a. Secondary hypertrophic pulmonary osteoarthropathy

89
Q

Talipes equinovarus is best treated by

Conservative management
Bryant’s traction
Buck’s traction
Surgical procedure

A

Conservative management

90
Q

A disease in which there is an outstanding characteristic of bone destruction with little tendency toward formation of new bone is

Osteomyelitis
Blastomycosis
Tuberculosis
Echinococcus cyst

A

Tuberculosis

91
Q

The epiphysis of a bone is located

a. Directly adjacent to the joint
b. Directly below the metaphysic
c. Directly above the diaphysis
d. Directly adjacent to the periosteum

A

a. Directly adjacent to the joint

92
Q

Which of the following bone tumors is malignant?

Osteogenic sarcoma
Osteoma
Chondroma
Osteochondroma

A

Osteogenic sarcoma

93
Q

In treating a baby, you observe that there is limitation of abduction of the flexed right hip and an asymmetry of the gluteal folds. What deformity would you suspect?

Osgood-Schlatter’s disease
Osteochondritis dissecans
Acetabular dysplasia
Osteogenesis imperfecta

A

Acetabular dysplasia

94
Q

Achondroplasia is a condition in which there is

a. A deficiency in the amount and growth of the articular cartilage
b. An increase or hyperplasia of cartilage cells on the articular surface of bones
c. An abnormal bone growth resulting in retardation of the longitudinal growth of bones
d. An absence of epiphyseal plates in juvenile bone

A

c. An abnormal bone growth resulting in retardation of the longitudinal growth of bones

95
Q

The condition described as Paget’s disease is called

Progressive myositis ossificans
Osteitis fibrosa cystica
Osteitis deformans
Osteosclerosis

A

Osteitis deformans

96
Q

Which of the following organisms is responsible for the highest percentage of cases of pyogenic or suppurative osteomyelitis

Salmonella
Gonococcus
Streptococcus
Staphylococcus

A

Staphylococcus

97
Q

Congenital dysplasia of the hip is

a. More common among girls than boys
b. A rare deformity in this country
c. Frequently observed in black children
d. Of low incidence in northern Italy and Japan

A

a. More common among girls than boys

98
Q

The term hydrarthrosis refers to

a. An operation to remove fluid from a cavity of the body
b. A condition associated with rheumatoid arthritis
c. No joint effusion
d. A form of hydrocephalus

A

b. A condition associated with rheumatoid arthritis

99
Q

A patient has a congenital coxa valga deformity. This means there is

a. An increase in the angle of inclination between the neck of the femur
b. A lengthening of the extremity on the affected side
c. An increase in the angle formed between the neck of the femur and its shaft
d. An abnormality of the upper end of the tibia

A

a. An increase in the angle of inclination between the neck of the femur

100
Q

An angulated fracture of a long bone is also known as

Oblique
Transverse
Spiral
Greenstick

A

Oblique

cheska PTRP 2 (29 decks)

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