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CHAPTER 7: Neurocognitive Disorders
MULTIPLE CHOICE
1. Which term did the term neurocognitive disorder replace in the DSM-5?
a. delirium
b. dementia
c. Alzheimer’s disease
d. amnesia
ANS: B
RAT: The term dementia was replaced with neurocognitive disorder in the DSM-5.
REF: p. 212 Defining Dementia in the DSM-5
BLM: Bloom’s Taxonomy: Remember
2. How many areas of cognitive functioning must be impaired for a diagnosis of neurocognitive
disorder in the DSM-5?
a. one
b. two
c. three
d. four
ANS: A
RAT: Only one area of cognitive functioning needs to be impaired for a diagnosis of
neurocognitive disorder.
REF: p. 212 Defining Dementia in the DSM-5
BLM: Bloom’s Taxonomy: Remember
3. Frank is a 71-year-old widower who lives on his own without the aid of home care. By all
accounts, Frank is independent. Frank didn’t realize that he had problem with his memory until
he was given a simple memory test by his physician, who found a decline compared to how
Frank scored two years earlier. Frank’s symptoms are MOST consistent with which DSM-5
disorder?
a. mild dementia
b. mild neurocognitive disorder
c. early-onset Alzheimer’s disease
d. cognitive impairment
ANS: B
RAT: A diagnosis of mild neurocognitive disorder is appropriate when an individual has a
decline in cognitive functioning that does not interfere with a person’s ability to care for
themselves.
REF: p. 212 Defining Dementia in the DSM-5
BLM: Bloom’s Taxonomy: Apply
4. Donna is 80 years old, and recent tests have showed declines in memory and executive
functioning. In addition, Donna’s children recently convinced her to move from her apartment to
an assisted living facility because they didn’t feel Donna could care for herself anymore.
Donna’s symptoms are MOST consistent with which DSM-5 disorder?
a. major dementia
b. Huntington’s chorea
c. major neurocognitive disorder
d. early-onset Alzheimer’s disease
ANS: C
RAT: A diagnosis of major neurocognitive disorder is given when there is a decline in cognitive
functioning along with the inability to care for oneself.
REF: p. 212 Defining Dementia in the DSM-5
BLM: Bloom’s Taxonomy: Apply
5. Which of the following was required for a diagnosis of dementia in earlier versions of the
DSM, but is NOT a requirement for a diagnosis of neurocognitive disorder in the DSM-5?
a. disinhibition
b. language difficulties
c. attentional difficulties
d. memory problems
ANS: D
RAT: In order to receive a diagnosis of dementia in earlier versions of the DSM a person had to
have significant memory impairment; this impairment is not required by the DSM-5.
REF: p. 212 Defining Dementia in the DSM-5
BLM: Bloom’s Taxonomy: Understand
ANS: C
RAT: Alzheimer’s disease accounts for 60 to 80 percent of all cases of dementia.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Remember
7. Which of the following symptoms is MOST often reported in the early stages of Alzheimer’s
disease?
a. inappropriate social behaviour
b. getting lost while driving
c. difficulty getting dressed
d. difficulty eating
ANS: B
RAT: Individuals in the early stages of Alzheimer’s disease often find themselves lost while
driving.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Understand
8. Which of the following appear on the outside of neurons when a person has Alzheimer’s
disease?
a. amyloid plaques
b. neurofibrillary tangles
c. white matter lesions
d. acetylcholinesterase inhibitors
ANS: A
RAT: One of the key features of Alzheimer’s disease is the formation of amyloid plaques on the
outside of neurons.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Understand
9. In a healthy brain, beta-amyloids are prevented from forming on the outside of neurons by
which of the following?
a. alpha-secretase
b. beta-secretase
c. gamma-secretase
d. delta-secretase
ANS: A
RAT: In a normal brain alpha-secretase cuts off amyloid precursor protein, preventing the
production of amyloid plaques.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Understand
10. Which of the following interacts with amyloid precursor protein to produce amyloid plaques?
a. alpha-secretase
b. beta-secretase
c. gamma-secretase
d. delta-secretase
ANS: B
RAT: Beta-secretase cuts of APP in the wrong place, allowing amyloid plaques to grow on the
outside of neurons.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Understand
11. Which of the following occur inside of neurons when a person has Alzheimer’s disease?
a. amyloid plaques
b. acetylcholinesterase inhibitors
c. beta-secretase
d. neurofibrillary tangles
ANS: D
RAT: Neurofibrillary tangles occur inside the neuron and block nutrients from entering, leading
to neuronal death.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Understand
ANS: C
RAT: Tau protein is responsible for keeping microtubules within a neuron straight. In
Alzheimer’s disease tau instead forms into tangles.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Understand
13. Gareth donated his brain to science. After Gareth died, an examination of his brain revealed
amyloid plaques and neurofibrillary tangles. What can scientists conclude from these
observations of Gareth’s brain?
a. Gareth definitely had sporadic Alzheimer’s disease
b. Gareth definitely had early-onset familial Alzheimer’s disease
c. Gareth definitely did NOT have any form of Alzheimer’s disease
d. Gareth may or may not have had Alzheimer’s disease
ANS: D
RAT: Amyloid plaques and neurofibrillary tangles sometimes form in the brains of individuals
who do not show symptoms of Alzheimer’s disease.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Apply
14. Which of the following is a biomarker for Alzheimer’s disease described in the text?
a. hippocampal atrophy
b. prefrontal lobe atrophy
c. cerebellar atrophy
d. parietal atrophy
ANS: A
RAT: Atrophy in the hippocampus is a biomarker of Alzheimer’s disease.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Remember
15. George had a spinal tap to test for biomarkers of Alzheimer’s disease. What substances were
George’s doctors MOST likely looking for in George’s cerebrospinal fluid?
a. acetylcholinesterase inhibitors and tau
b. tau and amyloid protein
c. amyloid protein and beta-secretase
d. beta-secretase and acetylcholinesterase inhibitors
ANS: B
RAT: The presence of tau and amyloid protein in cerebrospinal fluid is considered a biomarker
of Alzheimer’s disease.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Apply
16. What does current research suggest is the BEST predictor of Alzheimer’s disease
progression?
a. the amount of beta-secretase in the brain
b. the amount of tau in the brain
c. the amount of atrophy in the hippocampus
d. the amount of atrophy in the frontal lobes
ANS: B
RAT: Tau protein is linked to neurofibrillary tangles, which are believed to cause Alzheimer’s
disease progression as they kill neurons.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Understand
17. What number of genes are associated with early-onset familial Alzheimer’s disease, by
which a person with a mutation in any one of them will almost certainly develop Alzheimer’s
disease?
a. two
b. three
c. four
d. five
ANS: B
RAT: A mutation in the presenilin, PS2, or amyloid precursor protein gene leads to the
development of early-onset familial Alzheimer’s disease.
REF: p. 215 Alzheimer’s Disease |
BLM: Bloom’s Taxonomy: Remember
18. A person must develop Alzheimer’s disease after what age to be diagnosed with sporadic
Alzheimer’s disease?
a. 55
b. 60
c. 65
d. 70
ANS: C
RAT: When Alzheimer’s disease develops after age 65 it is referred to as sporadic or late-onset
Alzheimer’s disease.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Understand
19. Dr. Khan studies the genetics of sporadic Alzheimer’s disease. Which of the following is she
MOST interested in?
a. the presenilin PS1 gene
b. the presenilin PS2 gene
c. the amyloid precursor protein gene
d. the apolipoprotein gene
ANS: D
RAT: Different variations of the apolipoprotein gene increase and decrease the risk of
developing Alzheimer’s disease.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Understand
20. Sandra has one copy of the ApoE2 gene and one copy of the ApoE3 gene. What does this
means for Sandra?
a. she has a reduced risk of developing Alzheimer’s disease
b. she will definitely develop Alzheimer’s disease
c. she has an increased risk for developing Alzheimer’s disease
d. she will definitely NOT develop Alzheimer’s disease
ANS: A
RAT: The ApoE2 gene reduces a person’s risk of developing Alzheimer’s disease.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Apply
21. Marcelle has been told he is at increased risk for developing sporadic Alzheimer’s disease
compared to most people, although it is also possible that he won’t develop the disease at all.
Which of the following gene combinations does Marcelle MOST likely have?
a. ApoE2; ApoE2
b. ApoE2; ApoE3
c. ApoE3; ApoE3
d. ApoE4; ApoE4
ANS: D
RAT: Having two copies of the ApoE4 gene greatly increases the chances that a person will
develop sporadic Alzheimer’s disease.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Apply
22. Which element has been found at higher levels in people with Alzheimer’s disease than in
people without Alzheimer’s disease?
a. manganese
b. aluminum
c. phosphorus
d. lead
ANS: B
RAT: People with Alzheimer’s disease have been found to have increased levels of aluminum in
their brains compared to people without Alzheimer’s disease.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Remember
ANS: B
RAT: Approximately 2 out of 3 people with Alzheimer’s disease are women.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Understand
24. Mary and John both have had Alzheimer’s disease for the same length of time. Which of the
following MOST likely describes Mary?
a. Mary is likely to be more aggressive than John.
b. Mary is likely to have more comorbid conditions than John.
c. Mary is likely to die sooner than John.
d. Mary is likely to have greater disability than John.
ANS: D
RAT: Women with Alzheimer’s disease have greater disability than men, but also tend to live
longer with the disease than men.
REF: p. 215 Alzheimer’s Disease
BLM: Bloom’s Taxonomy: Apply
ANS: A
RAT: Mild cognitive impairment that can affect memory and other cognitive functions can
sometimes be caused by medications.
REF: p. 223 Mild Cognitive Impairment
BLM: Bloom’s Taxonomy: Understand
26. Fatima has vascular dementia, which was MOST likely caused by which of the following?
a. small vessel disease
b. a cerebral vascular accident
c. amyloid plaques
d. neurofibrillary tangles
ANS: A
RAT: Most vascular dementia is caused by small vessel disease, which involves damage to small
arteries, arterioles, capillaries, and small veins in the brain.
REF: p. 224 Vascular Dementia
BLM: Bloom’s Taxonomy: Apply
ANS: B
RAT: White matter lesions are caused by small vessel disease, which is associated with vascular
dementia.
REF: p. 224 Vascular Dementia
BLM: Bloom’s Taxonomy: Understand
28. Ellie is 78 years old and her behaviour has changed dramatically over the last year. Although
Ellie used to be friendly with other people who lived in her apartment complex, recently she has
begun to shout and swear at people from her balcony. Ellie’s behaviour is MOST consistent with
which of the following?
a. fronto-temporal neurocognitive disorder, behavioural type
b. fronto-temporal neurocognitive disorder, language type
c. alcohol-related dementia
d. neuro-cognitive disorder with Lewy bodies
ANS: A
RAT: The fronto-temporal neurocognitive disorder often involves disinhibited behaviour
including shouting and swearing inappropriately.
REF: p. 226 Fronto-Temporal Neurocognitive Disorder
BLM: Bloom’s Taxonomy: Apply
29. Dino is 77 years old and has begun to have complex hallucinations. Recently Dino was trying
to escape from a hallucination when he fell and injured his hip. While in hospital a
neuropsychologist MOST likely diagnosed Dino with which of the following?
a. Alzheimer’s disease
b. neurocognitive disorder with Lewy bodies
c. fronto-temporal neurocognitive disorder
d. alcohol-related dementia
ANS: B
RAT: Neurocognitive disorder with Lewy bodies often involves complex hallucinations and
delusions and sufferers are at increased risk for falls.
REF: p. 227 Neurocognitive Disorder with Lewy Bodies
BLM: Bloom’s Taxonomy: Apply
30. Dr. Eto performed hip surgery on 100 older adults last year. Approximately how many of Dr.
Eto’s patients will have developed delirium after their surgery?
a. 10
b. 25
c. 50
d. 75
ANS: C
RAT: Delirium develops in up to one-half of patients following hip surgery.
REF: p. 228 Delerium
BLM: Bloom’s Taxonomy: Apply
31. Which of the following has been found to have a positive effect on mild cognitive
impairment?
a. acetylcholinesterase inhibitors
b. vitamin E
c. NSAIDs
d. memory training
ANS: D
RAT: While pharmacological treatments have not been found to help MCI, memory training has
positive effects on both objective and subjective measures of memory.
REF: p. 229 Cognitive Enhancers and Memory Training
BLM: Bloom’s Taxonomy: Remember
32. Which of the following are the MOST common behavioural and psychological symptoms of
dementia (BPSD)?
a. psychosis and disinhibition
b. disinhibition and agitation
c. agitation and aggression
d. aggression and psychosis
ANS: C
RAT: Agitation and aggression are the most common and most distressing BPSD.
REF: p. 229 Behavioural and Psychological Symptoms of Dementia (BPSD)
BLM: Bloom’s Taxonomy: Understand
33. Which of the following has shown promise as an effective way of reducing agitation in
people with dementia?
a. aromatherapy
b. light therapy
c. person-centred care
d. benzodiazepines
ANS: C
RAT: Drug therapies, light therapy, and aromatherapy are not recommended for the treatment of
agitation. Training caregivers in person-centred care has been found to reduce agitation.
REF: p. 229 Behavioural and Psychological Symptoms of Dementia (BPSD)
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BLM: Bloom’s Taxonomy:
34. What are the two most common informal caregiving tasks?
a. meal preparation and managing finances
b. managing finances and coordinating appointments
c. coordinating appointments and transportation
d. transportation and meal preparation
ANS: D
RAT: The most common informal caregiving activities are transportation and household work,
including meal preparation.
REF: p. 230 Informal Caregiving
BLM: Bloom’s Taxonomy: Remember
35. For every 100 older adults that receive informal care, approximately how many live in the
same household as their caregiver?
a. 81
b. 64
c. 42
d. 14
ANS: D
RAT: Only about 14% of older adults who receive informal care live in the same household as
their caregiver.
REF: p. 230 Informal Caregiving
BLM: Bloom’s Taxonomy: Apply
36. Which of the following mental health issues is MORE common among informal caregivers
than among people who do not provide informal care?
a. anxiety and depression
b. mania
c. substance use disorder
d. obsessive compulsive disorder
ANS: A
RAT: Anxiety is common among caregivers and is sometimes labelled dementia anxiety.
REF: p. 253 Challenges of Caregiving
BLM: Bloom’s Taxonomy: Remember
37. Lisa provides care for her mother Jean, who has Alzheimer’s disease and lives with Lisa.
Twice a week a paid caregiver comes to Lisa’s house and cares for Jean. Which of the following
describes what Lisa is receiving?
a. informal care
b. respite care
c. compassionate release
d. reminiscent therapy
ANS: B
RAT: Respite care provides informal caregivers with a break from their responsibilities.
REF: p. 253 Challenges of Caregiving
BLM: Bloom’s Taxonomy: Apply
38. Leonard is 52 years old and has been incarcerated in Canada for 15 years. Leonard’s
physiology is MOST likely to resemble that of a non-incarcerated person who is what age?
a. 53 years old
b. 45 years old
c. 67 years old
d. 72 years old
ANS: C
RAT: Being incarcerated ages a person by 10 to 15 years.
REF: p. 235 Incarcerated Older Adults with Dementia
BLM: Bloom’s Taxonomy: Apply
39. Which of the following ailments is MOST likely to contribute to an older person’s likelihood
of committing a crime and becoming incarcerated?
a. macular degeneration
b. early dementia
c. heart disease
d. anxiety
ANS: B
RAT: Many people with dementia are less inhibited and may be more likely to commit certain
crimes, such as those related to deviant sexual behaviour.
REF: p. 235 Incarcerated Older Adults with Dementia
BLM: Bloom’s Taxonomy: Remember
40. Which of the following do some researchers claim is an early symptom of Alzheimer’s
disease?
a. depression
b. anxiety
c. schizophrenia
d. mania
ANS: A
RAT: Depression and dementia are closely linked and many people with depression early in life
develop Alzheimer’s disease later in life.
REF: p. 239 Depression in Dementia
BLM: Bloom’s Taxonomy: Remember
ESSAY QUESTIONS
2. Describe three biomarkers of Alzheimer’s disease and explain why using biomarkers to
diagnose is controversial.
3. Compare and contrast the causes of early-onset and sporadic Alzheimer’s disease
4. Describe delirium and explain why it is important for clinicians to differentiate between
delirium and dementia.
5. Define informal care and describe features of a typical caregiver and a typical care recipient
and the types of informal care tasks that are most often provided. Describe at least two major
problems frequently experienced by informal caregivers and identify one way to reduce the
impact of these problems.
"Ja palkkamme?"
"Sitä ei makseta."
Mutta suurin joukko oli vielä jälellä. Nämä olivat sellaisia, jotka
asuivat kauimpana metsissä, ja he neuvottelivat, eikö heidän ollut
alistuttava rangaistukseen saadakseen jatkaa työtä…
"Varokoon itseään!"
"Mistä he ovat?"
Muuan Erik herran periaatteista oli, että piti aina ensin lakaista
oman ovensa edusta, ennenkuin meni muiden kynnyksille, öin ja
päivin mietti hän keinoja, miten lieventää hätää Suomessa, ja
ottaisiko hän nyt työhön vierasta väkeä oman väen edellä? Jos pieni
osa siitä olikin osoittautunut kelvottomiksi, ei siltä ollut mitään syytä
epäillä kaikkia.
Mutta nyt ei tullut ketään. Vahinko oli tosin pieni, sillä linnan omat
metsämiehet voivat yllin kyllin tyydyttää tarpeen, mutta se herätti
kummastusta. Ja samoin herätti ihmettelyä se, että niin aniharvat
tulivat pyytämään apua.
*****
Oli kulunut noin kaksi kuukautta siitä, kun kaivostyö pysähtyi. Oli
elonaika käsissä, ja ritari arveli, että nyt jos koskaan olisi kansalla
työtä elatuksekseen. Sitä paitsi oli hänen aikansa hyvin täpärällä.
Asema Ruotsissa ei ollut ilahuttava. Hän oli tarmonsa takaa
varoittanut liitosta hansakaupunkien kanssa ja ennustanut, ettei
näihin ollut luottamista. Kun liitto siitä huolimatta, etupäässä
Hemming Gaddin kehoituksesta, tehtiin, piti hän tarkoin silmällä
Suomen rannikoita ollakseen valmis vastustamaan tanskalaisten
mahdollisia hyökkäyksiä. Kun sitten tuli tieto, että Hannu kuningas
oli tehnyt Lyypekin kanssa sopimuksen molemminpuolisesta avusta,
silloin hän näki, kuinka uhkaavat pilvet kasaantuivat yhä
sankemmiksi, mutta pelottomana päätti hän ei ainoastaan tehdä
kaikkensa Suomen suojelemiseksi, vaan myös varustaa laivoja
Ruotsiakin puolustamaan.
"Ei, se on hyvä!"
"Jos lapsi on isälle hyvin rakas, täytyy hänen uhrata se. Täten
sovittaa hän kaikki ne, joita vastaan on rikkonut. Kun he näkevät,
että hän on katunut ja sovittanut syntinsä, rakastavat ja uskovat he
häntä yhtä suuresti kuin ennenkin."
"Vapaaehtoisesti, niin!"
"Liian myöhä?"
Näin sanoen kumarsi hän syvään ja riensi pois. Ritari oli vähällä
huutaa hänet takaisin. Hän katui katkerasti lausumiaan ankaria
sanoja. Sakko ei ollut tehnyt mitään pahaa, ja hän oli tosiaankin
antanut pojalle luvan mennä ja tulla milloin itse tahtoi.
Sakko ymmärsi, ketä hänen oli tästä kiittäminen, ja hän päätti
kostaa. Kun hän sentähden kohtasi tiellä saman liiviläisen, joka
työmiesten puolesta oli matkustanut Turkuun ostamaan leipää,
juolahti heti hänen mieleensä, että tämä saattoi antaa hänelle keinot
siihen.
"Tiedättekö siitä?"
Nyt paljastui petos. Sana sakeni sanasta. Ritari oli maksanut väen
palkat, mutta päällysmies oli pitänyt ne omina hyvinään.
Oli merkillistä nähdä tällöin Sakkoa. Ensin tuijotti hän eteensä, että
saattoi luulla silmien muljahtavan hänen päästään pois, sitten pääsi
metsäläinen valloilleen. Hän heittäytyi maahan pitkäkseen, päästi
raikuvan riemuhuudon, teki korkeita hyppyjä, itki ja nauroi
vuoronperään. Mutta lopulta hän heittäytyi polvilleen ritarin eteen,
suuteli hänen käsiään ja pyysi häntä ottamaan puukon ja pistämään
sen hänen sydämeensä, koska hän oli voinut epäillä sellaista isäntää.
"Luulit siis, että minä tahdoin pettää työmiehiä?" kysyi Erik herra,
melkein hämmästyksissään.
"Mikä hullu olin!" huudahti hän. "Mutta minä kyllä löydän hänet!"
Asia koski kovasti Erik herran mieleen. Nyt oli hän saanut
selityksen rahvaan kummalliseen käytökseen, ja syvemmin kuin hän
tahtoi tunnustaa harmitti häntä se, että heillä oli näennäisesti
päteviä syitä epäluuloon.
Mutta kun Gunilla rouva katsoi taakseen, havaitsi hän, että jälestä
tuli ihmisiä tuhansittain, ja yhtä suurelta näytti joukko hänen
edelläänkin. Hän oli joutunut keskelle juhlakulkuetta, joka hitaasti
asteli tietä myöten.
Gunilla tunsi hänet; hän oli muuan niistä miehistä, jotka olivat
ottaneet osaa kaivostyöhön.
"Mitä puhutkaan!"
Se oli ritari. Hän kantoi jotakin käsivarrellaan, mutta oli niin pimeä,
ettei voinut eroittaa, mitä se oli.
"Tässä se on!"
"Kyllä se on!"
Mutta ilo oli pian ainoa tunne, joka valtasi kaikkien mielet. Kotiväki
puhui siitä pelosta, jota oli tuntenut. Mutta tällöin katselivat he
hämillään toisiinsa, ikäänkuin peläten sanoa enemmän kuin oli lupa.
"Hän on poissa."
"Sitten sanon sen", vastasi Erik herra, "mutta sillä ehdolla, että
ensin katsot oikein varmasti, että tässä makaava lapsi on sinun oma
lapsesi."
"Minäkö?… Erik!…"
"Maksoi!"
"Mistä puhutte?"
"Ja Sakko?"
"Hän antoi henkensä lapsenne puolesta! Aivan sen edellä oli hän
sanonut meille, kuinka asia oli."
"Mitä sanotte?"
"Sanovat!"
"Joko hän ei ole ollut parempi kuin hekään, ja silloin ei hän myös
ole koskaan tehnyt niitä hyviä töitä, joita he sanovat hänen
tekemikseen; tai ovat he kurjia ulkokullattuja, jotka käyttävät hänen
nimeään kilpenään, jonka takana synti on luvallinen."
"Pappikin on ihminen."
"Ja se on?"
"Vaikeinta kaikista."
"Mutta hyvin?"
"Miksi ei?"
"Mitä sanotte?"
"Että siksi ovat papit ja munkit tehneet sen opin, jota saarnaavat.
Jos joku sellainen tulee tölliini, saa hän mennä niine hyvineen; ei
hän tahdo edistää herransa, vaan omaa ja luostarinsa asiaa."
"Mitä tarjoatte?"
"Viisikymmentä henkeä!"
"Sata!"
"Enemmän!"
"Viisi sataa!"
"Vielä enemmän!"
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