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Unit 5-6 Chapter 21-29 > Chapter 22: The Lymphatic System and Immunity > Flashcards

Chapter 22: The Lymphatic System and Immunity Flashcards

1
Q

1) Which of the following is NOT a function of the lymphatic and immune system?
a) Draining excess interstitial fluid
b) Maintaining water homeostasis in the body c) Transporting dietary lipids
d) Carrying out immune responses

A

B

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2
Q

2) What is the major difference between lymph and interstitial fluid?
a) Composition of electrolytes
b) White blood cells are present in lymph
c) Location
d) Types of proteins present
e) Red blood cells are present in interstitial fluid

A

C

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3
Q

3) Lack of resistance is also known as:
a) Pathogenic
b) Innate
c) Specific
d) Susceptibility
e) Lymphatic

A

D

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4
Q

5) What causes lymph from the small intestines to appear white?
a) Proteins
b) WBC
c) RBC
d) Lipids
e) Carbohydrates

A

D

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5
Q

6) Which of the following is not considered an organ of the immune system?
a) Spleen
b) Lymph node
c) Red bone marrow
d) Thymus
e) Pancreas

A

E

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6
Q

7) The left subclavian vein receives lymph from the
a) Left axillary vein
b) Lumbar trunk
c) Jugular trunk
d) Thoracic duct
e) Right lymphatic duct

A

D

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7
Q

8) The skeletal muscle and respiratory pumps are used in the
a) Lymphatic system
b) Cardiovascular system
c) Immune system
d) Lymphatic and Immune systems only
e) Lymphatic, Immune and Cardiovascular systems

A

E

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8
Q

9) Which organ produces a hormone that promotes the maturation of T cells?
a) Spleen
b) Lymph node
c) Red bone marrow
d) Thymus
e) Pancreas

A

D

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9
Q

10) In which part of the thymus are T cells thought to die?
a) Capsule
b) Trabeculae
c) Epithelial cells
d) Thymic (Hassall’s) corpuscles
e) T cells do not die in the thymus

A

D

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10
Q

11) Which of the following is a function of the lymphatic system?
a) Drain excessive interstitial fluid
b) Transport dietary lipids
c) Carry out immune responses
d) All of these are functions of the lymphatic system
e) None of these are functions of the lymphatic system

A

D

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11
Q

12) Which of the following is a function of the spleen?
a) Removes worn out blood cells
b) Circulates lymph
c) Cleanses interstitial fluid
d) Cleanses lymph
e) Traps microbes with mucus

A

A

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12
Q

13) Which of these does NOT provide a physical or chemical barrier?
a) Macrophages
b) Saliva
c) Urine
d) Mucus
e) Stratified squamous epithelium

A

A

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13
Q

15) Which of these provides a non-specific cellular disease resistance mechanism?
a) Macrophages
b) T lymphocytes
c) B lymphocytes
d) Memory B cells
e) Stratified squamous epithelium

A

A

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14
Q

16) Which anti-microbial substances reduce viral replication (in uninfected cells)?
a) Transferrins
b) Perforins
c) Complement proteins
d) Defensins
e) Interferons

A

E

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15
Q

17) Which anti-microbial substances promote cytolysis, phagocytosis and inflammation?
a) Transferrins
b) Perforins
c) Complement proteins
d) Defensins
e) Interferons

A

C

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16
Q

18) Which of the following is NOT a sign of inflammation?
a) Redness
b) Pain
c) Heat
d) Mucus production
e) Swelling

A

D

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17
Q

19) Which of the following intensifies the effect of interferons and promotes the rate of repair?
a) Complement proteins
b) Perforin
c) Fever
d) Macrophages
e) Natural killer cells

A

C

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18
Q

20) Which chemical(s) do NOT induce vasodilation and permeability (increased fluid flow) to an infection site?
a) Histamines
b) Kinins
c) Perforin
d) Leukotrienes
e) Complement

A

C

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19
Q

21) When B and T cells are fully developed and mature, they are described as being
a) Immunocompetent
b) Pluripotent stem cells
c) Primary lymphatic cells
d) Specifically promoted
e) Germ cells

A

A

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20
Q

22) Which of the following induces the production of a specific antibody?
a) Phagocytosis
b) Antigen
c) Antibody
d) Defensin
e) Immunoglobulin

A

B

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21
Q

23) Which of the following stimulates an immune response ONLY when it is attached to a large carrier molecule?
a) Epitope
b) Antigen
c) Hapten
d) MHC antigen
e) CD8

A

C

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22
Q

24) Genetic recombination generates diversity in what part (s) of the immune system?
a) Antigen receptors
b) MHC antigen
c) Hapten
d) MHC antigen and antigen receptors
e) Epitopes

A

D

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23
Q

25) Which class of cells includes macrophages, B cells and dendritic cells?
a) Antigen presenting cells
b) Primary lymphocytes
c) T cells
d) RBC
e) Epitope cells

A

A

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24
Q

26) To become activated, which of the following requires being bound to a foreign antigen AND simultaneous costimulation?
a) B Cell
b) T Cell
c) Interferon
d) MHC antigen
e) Antigen-presenting cell

A

B

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25
Q

27) Which cells display CD4 proteins and interact with MHC Class II antigens?
a) Cytotoxic T cells
b) Helper T Cells
c) Memory T Cells
d) MHC antigens
e) B cells

A

B

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26
Q

28) Which T cell toxin fragments DNA?
a) Perforin
b) Tumor antigen
c) Interferons
d) Lymphotoxin
e) Toxin T

A

D

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27
Q

30) Which class of antibodies is mainly found in sweat, tears, breast milk and GI secretions?
a) IgG
b) IgA
c) IgM
d) IgD
e) IgE

A

B

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28
Q

31) Which of the following leads to inflammation, enhancement of phagocytosis and lysis of microbes?
a) Classical complement system
b) Alternative complement system
c) Apoptosis
d) Classical and Alternative complement systems
e) Hapten activation

A

D

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29
Q

32) Which action makes microbes more susceptible to phagocytosis?
a) Opsonization
b) Cytolysis
c) Inflammation
d) Complement
e) Hybridoma

A

A

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30
Q

33) Which of the following is an inactive, self-responsive cell?
a) Deleted cell
b) Hybridoma cell
c) Epitopic cell
d) Anergy cell
e) Natural killer cell

A

D

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31
Q

41) The inability of the immune system to protect the body from a pathogen causes
a) immunodeficiency diseases
b) allergy
c) autoimmune disease
d) transplantations
e) graft

A

A

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32
Q

42) An acute allergic response can lead to:
a) transplantation
b) retroviruses
c) anaphylactic shock
d) passive immunity
e) active immunity

A

C

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33
Q

43) Natural exposure to an infectious agent leads to:
a) Passive immunity
b) Active immunity
c) Both of these choices
d) None of these choices

A

B

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34
Q

44) Which class of antibodies indicates a recent invasion?
a) IgA
b) IgE
c) IgM
d) IgD
e) IgG

A

C

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35
Q

45) Which of the following cells is part of the body’s second line of defense?
a) Mucous cells
b) Germ cells
c) B and T Lymphocytes
d) Natural killer cells
e) None of these choices

A

D

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36
Q

46) Which of the following cells is the most variable cell in the immune system?
a) Natural killer cell
b) Monocyte
c) RBC
d) Lymphocyte
e) Macrophage

A

D

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37
Q

47) The primary response will peak how many days after exposure?
a) 1 day or less
b) 2–7
c) 10–17
d) 20–30
e) Over a month

A

C

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38
Q

48) Which type of immunity defends against any type of invader?
a) Nonspecific
b) Specific
c) Cell mediated
d) Antibody mediated immunity
e) None of these choices

A

A

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39
Q

49) The ability of an antigen to react specifically with the antibodies or cells it has provoked is called
a) Specificity
b) Immunogenicity
c) Reactivity
d) Epitopes
e) Immune Response

A

C

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40
Q

50) Which of the following is a small hormone that can stimulate or inhibit many normal cell functions?
a) Enzyme
b) Kinins
c) Cytokine
d) MHC
e) Leukocyte

A

C

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41
Q

62) Which type of adaptive immunity will result from intravenous injection of immunoglobulins?
a) naturally acquired active immunity
b) naturally acquired passive immunity
c) artificially acquired active immunity
d) artificially acquired passive immunity
e) None of these choices

A

D

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42
Q

63) Which type of adaptive immunity will result from mother-to-baby IgA transfer via breast feeding?
a) naturally acquired active immunity
b) naturally acquired passive immunity
c) artificially acquired active immunity
d) artificially acquired passive immunity
e) None of these choices

A

B

43
Q

64) Natural passive immunity is associated with which of the following?
a) Vaccination
b) Exposure to a microbe resulting in antibody formation
c) Receiving booster shots
d) Transfer of IgG from mother to fetus
e) Intravenous injection of antibodies

A

D

44
Q

65) Which cells increase the permeability of blood vessels by releasing histamine?
a) neutrophils
b) eosinophils
c) lymphocytes
d) mast cells
e) macrophages

A

D

45
Q

66) Which cytokine released by macrophages acts on the hypothalamus to raise the body temperature during fever?
a) Interleukin-1
b) Interleukin-2
c) Interleukin-4
d) Gamma interferon
e) Perforin

A

A

46
Q

67) Antigens that induce an allergic reaction are called
a) lymphotoxin
b) perforin
c) granulysin
d) interleukin-1
e) allergen

A

E

47
Q

68) Which cell is considered to be the most important cell in the immune system?
a) Cytotoxic T Cells
b) B lymphocytes
c) T Helper cells
d) Eosinophils
e) macrophages

A

C

48
Q

69) Which of the following is NOT an effect of aging on the immune system?
a) Increased susceptibility to infections
b) Increased susceptibility to malignancies
c) Decreased response to vaccines
d) Increased response of T cells to antigens
e) Decreased production of antibodies

A

D

49
Q

70) Which of the following is an effect of stress on the immune system?
a) Increased activity of T lymphocytes
b) Increased activity of B lymphocytes
c) Activation of the immune system
d) Inhibition of the immune system
e) Increased production of antibodies

A

D

50
Q

71) Which cells of the immune system are the primary targets the HIV virus?
a) B cells
b) helper T cells
c) cytotoxic T cells
d) antigen-presenting cells
e) all of these cells are affected by HIV

A

B

51
Q

72) Which type of allergic reaction is the most common type?
a) Type I (anaphylactic) reaction
b) Type II (cytotoxic ) reaction
c) Type III (immune-complex) reactions
d) Type IV (cell-mediated) reactions
e) All of these types are common allergic reactions.

A

A

52
Q

73) Which of the following organ systems is NOT aided by the MALT (mucosa-associated lymphatic tissue)?
a) Respiratory system
b) Digestive system
c) Muscular system
d) Urinary system
e) Reproductive system

A

C

53
Q

74) Which of the following is an incorrect matching of immune system cells and their functions?
a) Macrophage – process and presentation of foreign antigens to T cells
b) Dendritic cell – processes and presents antigen to T and B cells
c) B cells – process and presents antigen to helper T cells
d) Plasma cell – produces and secretes antibodies
e) All of these are correct matching of the cells and their functions

A

E

54
Q

1) The lymphatic system functions include
A) reabsorbing fluid lost from the capillaries and transporting it to the blood.
B) absorbing fats from the digestive system.
C) defending the body against infectious disease.
D) A and B are correct.
E) A, B and C are correct.

A

E

55
Q

2) Which of the following is NOT considered part of the lymphatic system?
A) lymph
B) lymphatic vessels
C) yellow bone marrow
D) lymph nodes
E) spleen

A

C

56
Q

3) Lymphatic vessels
A) include capillaries that are open at both ends.
B) resemble thin-walled veins with extra valves in structure.
C) follow the routes of arteries in the skin.
D) follow the routes of veins in the abdomen and thorax.
E) drain lymph into urine at the kidney.

A

B

57
Q

4) Place the following in the order that lymph would travel through them from the right thigh to the blood supply:
1. cysterna chyli
2. thoracic (left lymphatic) duct
3. right lymphatic duct
4. right lumbar trunk
A) 4, 1, 2, but never 3
B) 4, 1, 3, but never 2
C) 3, 1, 2, but never 4
D) 3, 1, 4, but never 2
E) 1, 3, 2, but never 4

A

A

58
Q

5) Lymph
A) is nearly identical to interstitial fluid in most parts of the body.
B) formation helps return fluid and plasma proteins that leaked from capillaries to the blood.
C) flow is dependent on pressure arising from contraction of the left ventricle of the heart.
D) A and B are correct.
E) A, B and C are correct.

A

D

59
Q

6) The thymus
A) is a bilobed organ found between the heart and the thoracic vertebrae.
B) grows in size and function throughout adulthood.
C) contains many immature T cells in its cortex.
D) contains many mature B cells in its medulla.
E) contains thymic macrophages that release thymosin and other hormones.

A

C

60
Q

7) Lymph nodes
A) occur in superficial and deep groups along the lymphatic vessels.
B) receive lymph via efferent vessels.
C) contain mostly T cells in their outer cortexes.
D) contain mostly B cells in their inner cortexes.
E) contain only T cells in their medullae.

A

A

61
Q

8) The spleen
A) contains white pulp, which consists mostly of lymphocytes and macrophages.
B) contains red pulp, which performs functions related to blood cells.
C) is located on the inferior surface of the liver in the right hypochondriac region.
D) A and B are correct.
E) A, B and C are correct.

A

D

62
Q

9) Lymphatic nodules
A) include the tonsils and Peyer’s patches.
B) are surrounded by a capsule.
C) are scattered among the serous membranes of the viscera.
D) A and B are correct.
E) A, B and C are correct.

A

A

63
Q

10) Which of the following is NOT true of the development of lymphatic tissues?
A) Lymphatic vessels develop from lymph sacs, which arise from mesoderm.
B) Lymph sacs develop in conjunction with veins, but most ultimately lose connection with them.
C) The spleen develops from ectoderm.
D) The thymus develops from the 3rd pharyngeal pouch.
E) Development of the lymphatic system begins by the 5th week after conception.

A

C

64
Q

11) What do all nonspecific defenses have in common?
A) They are present at birth.
B) They work against all potential invaders.
C) They provide immediate protection.
D) They are considered innate defenses.
E) All of these are correct.

A

E

65
Q

12) The first line of defense against pathogens includes
A) inflammation and phagocytosis.
B) the skin and mucous membranes.
C) interferon and complement.
D) fever and lysozyme.
E) skin and phagocytosis.

A

B

66
Q

13) All of the following mechanisms actually expel pathogens from the body EXCEPT:
A) vaginal secretion
B) emesis (vomiting)
C) phagocytosis
D) urination
E) defecation

A

C

67
Q

14) Which of the following is an antimicrobial protein found in the blood and interstitial fluid?
A) interferon
B) complement
C) transferrin
D) A and B are correct.
E) A, B and C are correct.

A

E

68
Q

15) Which substance prevents viral replication?
A) interferon
B) complement
C) transferrin
D) lysozyme
E) sebum

A

A

69
Q

16) Natural killer (NK) cells
A) are large, specialized monocytes.
B) ingest microbes.
C) secrete perforin and granzymes to destroy target cells.
D) constitute 50-70% of all lymphocytes in the blood.
E) cannot attack body cells.

A

C

70
Q

17) Which of the following is NOT a phagocyte?
A) histiocyte
B) lymphocyte
C) monocyte
D) microglia
E) Kupffer cell

A

B

71
Q

18) Place the stages of phagocytosis in the order in which they occur:
1. adherence
2. chemotaxis
3. killing
4. ingestion
5. digestion
A) 1, 2, 4, 5, 3
B) 2, 1, 5, 4, 3
C) 2, 4, 1, 5, 3
D) 2, 1, 4, 5, 3
E) 2, 1, 4, 3, 5

A

D

72
Q

19) Inflammation
A) is a tissue response to injury.
B) is characterized by redness, swelling, heat and pain.
C) is the body’s first and foremost defense against infection.
D) A and B are correct.
E) A, B and C are correct.

A

D

73
Q

20) The first stage of the inflammation response is
A) vasodilation
B) vasoconstriction
C) chemotaxis
D) phagocytosis
E) tissue repair

A

A

74
Q

21) How does immunity differ from nonspecific defenses?
A) Immunity provides protection against specific foreign antigens.
B) Immunity displays memory.
C) Immunity requires distinction between self and nonself antigens.
D) A and B are correct.
E) A, B and C are correct.

A

E

75
Q

22) Which of the following is NOT correct?
A) Immunocompetent cells are able to conduct immune responses when properly stimulated.
B) Immunocompetent cells include B cells and NK cells.
C) Immunocompetent cells have distinct plasma membrane proteins.
D) Immunocompetent cells that will become plasma cells complete development in bone marrow.
E) Immunocompetent cells that will be CD4 or CD8 cells complete development in the thymus.

A

B

76
Q

23) Cell-mediated immunity
A) includes conversion of CD8 cells to cytotoxic (killer) T cells.
B) includes differentiation of CD4 cells into helper T cells.
C) always involves cells attacking cells.
D) works best against intracellular pathogens, cancer cells, and transplanted cells.
E) All of these are correct.

A

E

77
Q

24) Which of the following is NOT true of antigens?
A) They have immunogenicity; they can provoke immune responses.
B) They have reactivity; they can react with the antibodies or cells they provoked.
C) They have small parts called haptens that stimulate an immune response.
D) They are often large protein molecules.
E) They may be natural or man-made molecules.

A

C

78
Q

25) Why can the body recognize so many different antigens?
A) The body has billions of genes for antigen receptors.
B) A given antigen receptor can bind many very different antigens.
C) Most antigens differ only slightly; one receptor can recognize closely related antigens.
D) The genes for antigen receptors can be recombined to form many different receptor proteins.
E) All of these are correct.

A

D

79
Q

26) MHC antigens
A) are self-antigens.
B) include type I antigens, which are found on virtually all nucleated cells in the body.
C) include type II antigens, which are found only on activated antigen-presenting cells.
D) A and B are correct.
E) A, B and C are correct.

A

E

80
Q

27) Which of the following is correct?
A) T cells only recognize antigenic fragments that are processed and presented in specific ways.
B) Exogenous antigens trigger production of abnormal MHC I complexes.
C) Endogenous antigens cause production of MHC II complexes by antigen presenting cells.
D) A and B are correct.
E) A, B and C are correct.

A

A

81
Q

28) Which of the following is correct?
A) At any given time, most T cells are actively attacking antigens.
B) Antigen-MHC complex binding to TCRs is required but not sufficient to activate T cells.
C) CD4 and CD8 proteins are alternate forms of MHC proteins that can activate T cells.
D) Costimulated T cells enter a state of anergy.
E) Activated T cells shrink and lose mitotic ability.

A

B

82
Q

29) Helper T cells
A) bear CD4 proteins in their plasma membranes.
B) secrete interleukins.
C) interact with APCs.
D) A and B are correct.
E) A, B and C are correct.

A

E

83
Q

30) Cytotoxic T cells
A) arise from CD4 cells.
B) are most effective against extracellular pathogens.
C) need exposure to antigen associated with both MHC-I and MHC-II molecules for full activity.
D) do not need stimulation by interleukins to become activated.
E) All of these are correct.

A

C

84
Q

31) Cytotoxic cells may destroy pathogens and abnormal body cells via all of the following mechanisms EXCEPT:
A) releasing of granzymes, causing apoptosis of the target cell.
B) phagocytosis of the target cell.
C) creating channels in the target plasma membrane using perforin, thereby causing cytolysis.
D) using granulysin to create holes in the pathogen’s plasma membrane.
E) secreting lymphotoxin, which activates enzymes in the pathogen and destroys its DNA.

A

B

85
Q

32) B cells do each of the following EXCEPT
A) bear BCRs in their plasma membranes that are similar to the antibodies they will secrete.
B) can recognize unprocessed antigens.
C) react more strongly to unprocessed antigens than processed ones.
D) proliferate and differentiate in response to helper T cell secretions.
E) become plasma cells.

A

C

86
Q

33) Which is NOT true of antibodies?
A) They are protein molecules that bind to specific antigens.
B) They are produced by T cells.
C) They consist of 2 heavy and 2 light chains.
D) They contain fixed and variable regions.
E) They are also called immunoglobulins.

A

B

87
Q

34) How do antibodies disable antigens?
A) agglutinating and precipitating antigens
B) immobilizing bacteria and enhancing phagocytosis
C) activating complement
D) A and B are correct.
E) A, B and C are correct.

A

E

88
Q

35) The antibody that can cross the placenta and is the most abundant antibody produced is
A) IgG
B) IgD
C) IgA
D) IgM
E) IgE

A

A

89
Q

36) Complement
A) is a series of proteins that assist in fighting infections.
B) is associated with phagocytosis, cytolysis, and inflammation.
C) is made by the spleen.
D) A and B are correct.
E) A, B and C are correct.

A

D

90
Q

37) Which of the following correctly describes a pathway leading to activation of complement C3 protein?
A) classical: lipid-carbohydrate complexes on microbe surfaces interact with factors B,D, and P
B) alternate: antigen-antibody complexes bind to and activate C1
C) lectin: liver produces lectins in response to chemicals from macrophages digesting pathogens
D) A and B are correct.
E) A, B and C are correct.

A

C

91
Q

389) Immunological memory
A) provides rapid response to subsequent infections by the same pathogen.
B) is due to the presence of long-lasting antibodies and very long-lived lymphocytes.
C) provides the basis for vaccination.
D) can be measured, in part, by an antibody titer.
E) All of these are correct.

A

E

92
Q

39) Which of the following is correct?
A) B and T cells display self-tolerance.
B) T cells must be able to recognize self-antigens.
C) T cells must not display self-recognition.
D) A and B are correct.
E) A, B and C are correct.

A

D

93
Q

40) Negative selection
A) by deletion results in T cells that remain alive but cannot be activated.
B) by anergy results in apoptosis of T cells that would destroy self tissues.
C) leads to development of self-tolerance.
D) A and B are correct.
E) A, B and C are correct.

A

C

94
Q

41) Which of the following lists contains only antigen presenting cells (APCs)?
A) B cells, dendritic cells, macrophages
B) neutrophils, macrophages, eosinophils
C) B cells, T cells, natural killer cells
D) B cells, plasma cells, memory B cells
E) helper T cells, cytotoxic T cells, memory T cells

A

A

95
Q

42) Which of the following lists contains only cells involved in antibody-mediated immunity?
A) B cells, dendritic cells, macrophages
B) neutrophils, macrophages, eosinophils
C) B cells, T cells, natural killer cells
D) B cells, plasma cells, memory B cells
E) helper T cells, cytotoxic T cells, memory T cells

A

D

96
Q

43) How does increased stress impact immunity?
A) by encouraging bad habits (e.g. drinking, smoking)
B) by depressing cortisol levels
C) by causing excessive sleep
D) by encouraging exercise
E) All of these are correct.

A

B

97
Q

44) Which of the following is NOT associated with aging of the immune system?
A) higher susceptibility to malignancies
B) higher susceptibility to infections
C) increased recognition of self vs. nonself
D) decreased effectiveness of cell-mediated immunity
E) slowed antibody-mediated immunity

A

C

98
Q

45) AIDS
A) is caused by the human immunodeficiency virus.
B) is transmitted by exchange of blood or other body fluids.
C) is observed in both heterosexual and homosexual individuals.
D) A and B are correct.
E) A, B and C are correct.

A

E

99
Q

46) Which of the following is NOT correct?
A) Current, widely used diagnostic tests for AIDS detect HIV particles in the blood. B) AIDS is characterized by a helper T cell count less than 200 cells/μL.
C) AIDS is characterized by frequent opportunistic infections.
D) HIV usually triggers a brief, flu-like illness soon after initially infecting someone.
E) AIDS patients usually receive a combination of reverse transcriptase and protease inhibitors.

A

A

100
Q

47) Which of the following is correct?
A) Allergies are immune hyposensitivity disorders.
B) Type I reactions are delayed reactions associated with tuberculosis and poison ivy.
C) Type II reactions are caused by IgG or IgM antibodies reacting to blood cells.
D) Type III reactions are common and occur within minutes of exposure to an allergen.
E) Type IV reactions occur when immune complexes escape phagocytosis.

A

C

101
Q

48) Loss of self-tolerance, or autoimmunity, is associated with which of the following?
A) rheumatoid arthritis
B) systemic lupus erythematosus
C) rheumatic fever
D) type I diabetes mellitus
E) All of these are correct.

A

E

102
Q

49) Infectious mononucleosis
A) is caused by Staphylococcus bacteria.
B) makes B cells look more like monocytes.
C) most commonly affects adults over the age of 25 years.
D) is most commonly transmitted by ingestion of food contaminated with feces.
E) causes severe diarrhea.

A

B

103
Q

50) Lymphomas
A) are cancers of the lymph nodes and other lymphatic organs.
B) includes Hodgkin disease, which has a high cure rate if detected early.
C) includes non-Hodgkin lymphoma, which is less common than Hodgkin disease.
D) A and B are correct.
E) A, B and C are correct.

A

D

Unit 5-6 Chapter 21-29 (9 decks)

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