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DPT 516 > Quiz #10 > Flashcards

Quiz #10 Flashcards

1
Q

what is the role of the ankle joint?

A

rigid lever and mobile adaptor

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2
Q

when the ankle is becoming a mobile adaptor, do the axes of the talonavicular jt become more parallel or cross?

A

the axes become more parallel

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3
Q

when the ankle is becoming a rigid lever, do the axes of the talonavicular jt become more parallel or cross?

A

the axes cross

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4
Q

what are the triplanar motions that make up pronation?

A

DF

eversion

abduction

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5
Q

what are the triplanar motions that make up supination?

A

PF

inversion

adduction

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6
Q

the pronation/supination contribution from the MTJ is ___ that of STJ

A

2x

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7
Q

what happens at the STJ in the CKC?

A

the talus moves on fixed WB calcaneous

WB IR/ER causes pro/sup

allows accomodation on uneven ground

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8
Q

does pronation or supination accompany tibial IR?

A

pronation

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9
Q

does pronation or supination accompany tibial ER?

A

supination

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10
Q

t/f: in the normal foot on the ground, calcaneal condyle on the ground and heads of the metatarsals on the ground are lying in the same plane, the rear foot is slightly inverted

A

true

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11
Q

what actions occur at the longitudinal axis of the MTJ?

A

inversion/eversion

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12
Q

what actions occur at the oblique axis of the MTJ?

A

DF/PF

abd/add

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13
Q

motion around the oblique axis of the MTJ is enhanced by putting the foot in what position?

A

abduction

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14
Q

t/f: pts may outtoeing w/ambulation to allow more pronation from unlocking the midtarsal jt’s oblique axis

A

true

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15
Q

what kind of jt is the tarsometatarsal jt?

A

plantar synovial jt

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16
Q

what are the jt surfaces of the tarsometatarsal jts?

A

bw the tarsal and respective metatarsal jts

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17
Q

what makes up the 1st ray of the foot?

A

1st cuneiform and 1st metatarsal

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18
Q

what is the most mobile ray of the foot?

A

the 1st ray

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19
Q

what makes up the 2nd ray of the foot?

A

2nd cuneiform and 2nd metatarsal

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20
Q

what is the most restricted ray of the foot?

A

the 2nd ray

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21
Q

what makes up the 3rd ray of the foot?

A

3rd cuneiform and 3rd metatarsal

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22
Q

what makes up the 4th and 5 rays of the foot?

A

cuboid and 4th and 5th metatarsals

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23
Q

how much 1st MTP ext is needed for normal gait? for running?

A

65 deg, 85 deg

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24
Q

t/f: when there is a reduction in ROM of the 1st MTP, it acts like decreased DF

A

true

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25
Q

what are some compensations for decreased 1st MTP/DF?

A

steppage gait

circumduction gait

out-toeing

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26
Q

what is hallux limitus?

A

not as much motion as it should have

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27
Q

what is hallux rigidus?

A

very stiff

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28
Q

what is the Windlass mechanism?

A

when the big toe is on the ground as you DF and it tightens up

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29
Q

what is the most injured lig in the body?

A

ant TF

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30
Q

what provides stability of the talocrural jt medially?

A

interosseous membrane

med collateral lig-deltoid lig

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31
Q

what provides stability of the talocrural jt laterally?

A

interosseous membrane

ant TF lig

calcaneofibular lig

post TF lig

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32
Q

lateral ankle sprains make up what % of ankle sprains?

A

85

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33
Q

how does a lat ankle sprain usually occur?

A

PF and inversion

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34
Q

the ATF lig is involved in what % of all ankle sprains?

A

60-70%

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35
Q

what % of ankle sprains involve the ATF and CF ligs?

A

20%

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36
Q

are more lig tears at the lat ankle mid-substance or avulsion injuries?

A

mid-substance

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37
Q

are mid-substance or avulsion injuries easier to treat? why?

A

avulsion injuries are easier to treat bc it’s easier to heal bone on bone than bone to lig

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38
Q

what causes a tib fib syndesmosis sprain (high ankle sprain)?

A

forced DF

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39
Q

what causes an ant capsule ankle sprain?

A

forced PF

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40
Q

what is a grade 1 lateral ankle sprain?

A

min edema, localized tenderness over ATF (12 days b4 return)

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41
Q

what is a grade 2 lateral ankle sprain?

A

localized edema, diffuse tenderness (2-6 weeks b4 return)

may use crutches for a few days

may have ecchymosis

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42
Q

what is a grade 3 lateral ankle sprain?

A

edema, ecchymosis (more than 6 wks b4 return)

only 25-60% symptoms free 1-4 yrs post injury

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43
Q

what are the s/s of lat ankle sprain?

A

edema and hematoma suggests rupture

TTP over ATF

(+) ant drawer

(+) talar tilt test

(+) squeeze test

(+) ER test

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44
Q

what is a (+) ant drawer test?

A

holding the tibia back and calcaneous forward creates p!

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45
Q

what is the talar tilt test?

A

mildly invert the foot (can also PF)

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46
Q

what is the squeeze test-?

A

squeeze the tibia and fibula together (high ankle sprain test)

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47
Q

mechanical instabilities and fxnal instabilities at the ankle can lead to what?

A

recurrent ankle sprains

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48
Q

when the rear foot is inverted is the there more or less pronation?

A

less pronation

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49
Q

is the foot a good or bad mobile adaptor inless pronation?

A

bad mobile adaptor

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50
Q

does a supination or pronated foot lead to lat ankle sprain?

A

supinated foot

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51
Q

what exercises can improve proprioceptive kinesthesia of the ankle?

A

ankle pumps with therabands (although not the best) and CKC strengthening for fxnal exercise

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52
Q

what are the interventions for for lat ankle sprains?

A

control edema

early, supported WB (taping, bracing)

proprioceptive training

OKC to CKC using non-dominent to dominant planes

multiplane fxnal training

plyometrics

sport-specific training

work towards offending plane of motion

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53
Q

why are med ankle sprains less likely than lat ankle sprains?

A

bc the med ankle has more robust support

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54
Q

t/f: there is a greater risk of an avulsion fx of the med mal with a med ankle fx

A

true

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55
Q

t/f: the approaches to treat lat vs med ankle sprains are different

A

false, they are similar

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56
Q

t/f: plantar fascitis is sometimes self limiting

A

true

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57
Q

what % of women with plantar fascitis are obese?

A

90%

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58
Q

what % of men with plantar fascitis are obese?

A

40%

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59
Q

what age does plantar fascitis usually occur at?

A

40-60 yo

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60
Q

what occupational factor leads to plantar fascitis?

A

prolonged standing/walking

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61
Q

what causes acute plantar fascitis?

A

something hits the arch of the foot hard

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62
Q

what factors affect anatomical plantar fascitis?

A

thickness and compressibility of heel pad

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63
Q

what are the biomechanical causes of plantar fascitis?

A

pes cavus, pes planus, overpronation, weak foot intrinsics, hallux rigidus/limitus

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64
Q

t/f: weak glut med/max can contribute to plantar fascitis

A

true

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65
Q

t/f: bad DF of the hallux can contribute to stress on the plantar fascia

A

true

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66
Q

t/f: plantar fascitis usually has an insidious onset

A

true

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67
Q

what are the s/s of plantar fascitis?

A

morning pain

15-30% BL

gastrocs tightness in 78% (trying to DF during gait but the gastrocs won’t let it)

TTp med calcaneal tubercle

p1 w/great toe ext

(+) Windlass test (p! with great toe ext)

presence of heel spurs

hallux abductor valgus (HAV): bunion from excessive pronation

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68
Q

what are the interventions for plantar fasciitis from most to least helpful?

A

low dye taping to support the arch

foot intrinsic PREs

stretching (gastrocs/plantar fascia)

TFM (transverse friction massage)

orthotics

high splints

great toe mobility

NSAIDS

US/phonophoresis

laser

extracorporeal shock wave therapy (adds mechanical influence)

injections

surgery

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69
Q

how many newtons of force can the Achilles tendon handle?

A

9000N

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70
Q

what is the strongest tendon in the body?

A

the Achilles tendon

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71
Q

what are the actions of Achilles tendon?

A

PF and inversion

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72
Q

what tendon controls DF, eversion, and pronation?

A

Achilles tendon

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73
Q

does the paratenon of the achilles tendon have a synovial sheath?

A

no, this affects it stealing process

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74
Q

where is the blood supply for the Achilles tendon?

A

paratenon and muscles vessels

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75
Q

what is nerve supply of the achilles tendon?

A

sural nerve

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76
Q

what is the most common overuse syndrome of the LE?

A

Achilles tendinopathy

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77
Q

what is the prevalence of Achilles tendinopathy?

A

57% in runners (2.9-4% of non-athletes)

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78
Q

what is the incidence of Achilles tendinopathy?

A

7/100,000 in general population

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79
Q

t/f: there is increased incidence of Achilles tendinopathy with increased age

A

true

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80
Q

what is the mean age in which Achilles tendinopathy occurs?

A

30-50 yo

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81
Q

what is usually the MOI in Achilles tendinopathy?

A

eccentric loading and overpronation

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82
Q

what actions can cause rupture of the Achilles tendon?

A

push off, sudden DF in WB, forceful DF

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83
Q

what is the difference bw insertional and noninsertional

A

insertional is closer to the enthesis

noninsertional is more in the midsubstance

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84
Q

is insertional or non insertional injuries easier to treat?

A

non insertional (mid-substance)

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85
Q

is midsubstance or calcaneal insertional injuries of the Achilles tendon more common?

A

mid-substance

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86
Q

are mid-substance injuries of the Achilles tendon more so the med or lat aspect of the midsubstance?

A

med aspect of the midsubstance

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87
Q

what are the morphological and biomechanical changes with aging that can lead to Achilles tendinopathy?

A

decreased collagen diameter/density

decreased GAGs and H2O

decreased tensile strength, linear stiffness, and ultimate load

88
Q

t/f: Achilles tendinopathy is a degenerative process

A

true

89
Q

t/f: there is a decreased collagen synthesis capacity with Achilles tendinopathy

A

true

90
Q

what process may be responsible for the chronic pain associated with Achilles tendinopathy?

A

abnormal neovascularization accompanied by in-grwoth of nerve fasciles

91
Q

Achilles tendinopathy may be associated with what deformity and disease?

A

Haglund’s deformity and Sever’s disease

92
Q

what is the typical presentation for a pt with Achilles tendinopathy?

A

TTP Achilles 2-6 cm proximal to the insertion

tendon thickening

decreased PF strength

decreased PF endurance

p! and stiffness after inactivity that lessens with activity and returns post activity

p! with eccentric DF

Haglund’s deformity

(+) Thompson test

93
Q

what is Haglund’s deformity?

A

a bump on the back of the heel from the stress of the achilles

bone spur

94
Q

what is the Thompson test?

A

squeeze the calf to see if it elicits PF (no PF=positive test for Achilles rupture)

95
Q

what imaging may be used to dx Achilles tendinopathy?

A

x-rays

96
Q

what may be seen on imaging for Achilles tendinopathy?

A

Haglund’s deformity

os trigonum

calcaneal fx

retro calcaneal bursitis

post talar fx

97
Q

what is os trigonum?

A

accessory bone sites on the back of the ankle near the heel

98
Q

what is the treatment for midsubstance tendinopathy?

A

conservative care

correct biomechanical contributions

RICE in acute phase

TFM, stretching, eccentrics training in subacute phase

shoe w/o heel (zero drop shoes) may be used

addition of low energy extra-corporeal shockwave therapy

laser therapy (moderate evidence)

topical glyceryl trinitrate to reduce p! in acute/chronic cases (more evidence needed)

heel lifts early on and gradually reduced

manual therapy (TFM/STM)

taping

into (moderate evidence for low voltage driving in meds)

orthotics

high splints

US

99
Q

t/f: eccentric training may decrease paratenon blood flow and preserve O2 saturation (cuts off excess blood flow to help with pain)

A

true

100
Q

what are eccentrics for Achilles tendinopathy?

A

slow heel lowering (5-6”) that should cause p! but no more than 5/10

101
Q

what are the interventions for insertional tendinopathy?

A

attempt eccentrics

extracorporeal shock wave therapy

no therapy is as effective with insertional tendinopathy as it is for midsubstance

102
Q

about what % of Achilles ruptures are operated on?

A

70

103
Q

are short term costs higher for operative or non-operative groups in Achilles tendinopathy?

A

operative group

104
Q

are long term costs higher for operative or non-operative groups in Achilles tendinopathy?

A

similar in both

105
Q

is long term satisfaction better in operative or non-operative groups in Achilles tendinopathy?

A

similar in both

106
Q

are Achilles re-tear rates higher in operative or non-operative groups?

A

non-operative group

107
Q

what are the risk factors for tibialis posterior tendinopathy?

A

female

> 40 years old

pes planus

HTN

diabetes

steroid injections

obesity

108
Q

what are the symptoms of tibialis posterior tendinopathy?

A

navicular, prox to med mal, med shin

p! w/single leg heel raises

aches after long walk

p! w/PF and inversion

TTP

swelling post med ankle

109
Q

what are the causes for tib post tendinopathy?

A

overpronation, change in direction, tight gastroc-soleus complex, weak tib ant

110
Q

what do we treat in post tib tendinopathy?

A

inflammation, biomechanical contributions, and impairments

111
Q

what is tarsal tunnel syndrome?

A

peripheral neuropathy of the tibial nerve bw the flexor retinaculum and med mal

involved the tibial nerve including the terminal branches, med/lat plantar nerves

112
Q

there are increased symptoms of tarsal tunnel syndrome with what action?

A

prolonged walking

113
Q

t/f: there can be toe numbness with tarsal tunnel syndrome

A

true

114
Q

what is the test for tarsal tunnel syndrome?

A

tinel test

115
Q

does overpronation or supination contribute to tarsal tunnel syndrome?

A

overpronation

116
Q

what is the intervention for tarsal tunnel syndrome?

A

orthotic w/rearfoot control

proper footwear

PREs for inverters

injection

surgical release

117
Q

are more males of females affected by morton’s neuroma?

A

females

118
Q

what is morton’s neuroma?

A

compression of the interdigital nerve (usually bw metatarsals 3 and 4)

perineural fibrosis, demylenation, and endoneurial fibrosis leading to tenderness and decreased motion

119
Q

what are the s/s of morton’s neuroma?

A

tender bw metatarsal heads on plantar foot

p! w/compression of the forefoot

(+) tinel test

(+) EMG/NCV

120
Q

what are the interventions for morton’s neuroma?

A

wider shoes

orthotics w/metatarsal pad to help spread the metatarsals and reduce stress in the intermetatarsal space

NSAIDS

interspace injection

surgery (last resort)

121
Q

what is hallux abductus valgus?

A

bunion results from valgus stresses of the 1st MTP and overpronation

1st metatarsal migrates med

1st prox phalynx migrates lat

toes crossed

usually biomechanical cause

122
Q

what are the interventions for hallux abductus valgus?

A

conservative care (not often seen)

post–op (p! control, modalities for p!, ROM, manual therapy

123
Q

what causes gaut

A

hyperuricemia

124
Q

what is hyperuricemia?

A

elevated serum uric acid

causes deposition of urate crystals in jts, soft tissue, and kidneys

most common crystal-induced arthritis in the US

125
Q

what is primary uricemia?

A

inherited

126
Q

what is secondary uricemia?

A

acquired due to other metabolic problems

127
Q

what is idiopathic uricemia?

A

other causes not classified under primary or secondary

128
Q

t/f: gout is classified as arthritis

A

true

129
Q

what is the most common inflammatory condition in middle aged men into the 5th decade?

A

gout

130
Q

is gout more common in men or women?

A

men

131
Q

when does gout typically become present?

A

after 20-30 years of hyperuricemia

132
Q

is there an increased risk of gout with a family hx?

A

yes

133
Q

t/f: fever and malaise may be present in gout

A

true

134
Q

gout will have a similar clinical presentation to what other disease?

A

infectious arthritis

135
Q

what are the associated factors of gout?

A

age

duration of hyperuricemia (longer time=increased risk)

genetics

heavy alcohol abuse

obesity

thiazide drugs

lead toxicity

shellfish (purine rich foods)

136
Q

what is the presentation of a pt with gout?

A

acute, monoarticular arthritis

exquisite jt p! (comes on fast)

occurs suddenly at night

big toe involvement is common

erythema

warmth

hypersensitivity

presence of tophi (uric acid crystals that develop on the skin)

137
Q

what are the interventions for gout?

A

meds (allopurinol)

NSAIDS

experimental uricase therapy

rest

reduced WB initially

education

monitored exercise program

138
Q

what is Sever’s disease?

A

also called calcaneal apophysitis

irritation on the apophysitis of the calcaneous

overuse syndrome

139
Q

what age group is commonly affected by Sever’s disease?

A

the skeletally immature (5-13 yo)

often young boys

140
Q

what can cause Sever’s disease?

A

growth spurts

tight gastroc-soleus complex

repetitive jumping/landing (gymnasts/dancers)

Achilles pulls on growth plate of post heel

141
Q

what % of Sever’s disease cases are BL?

A

60

142
Q

what are the s/s of Sever’s disease?

A

CC: heel p! increased w/running or jumping

p! in post heel

143
Q

how is Sever’s disease dxed?

A

radiographs (sclerosis or fragmentation of the apophysis is possible)

144
Q

what is the treatment for Sever’s disease?

A

activity modification (dec duration, intensity, and frequency of activity)

calf/heel cord stretch if tight

heel cups/soft orthotics (softens blow of the heel)

NSAIDS

ice

short leg cast if symptoms aren’t getting better (recalcitrant symptoms)

145
Q

how long does it typically take for Sever’s disease to resolve?

A

2-3 months, but can be longer or recurrent

146
Q

t/f: Sever’s disease is often self-limiting

A

true

147
Q

what may you have to teach a pt with Sever’s disease?

A

proper running techniques

148
Q

what are some types of fxs at the ankle?

A

single malleolar

bimalleolar

trimalleolar

Pott’s fx

149
Q

what is a trimalleolar fx?

A

lat and med mal and back of the tibia fxed

150
Q

how are ankle fxs managed?

A

ROM, strengthening, and fxn based on impairment

151
Q

what is a Jones fx?

A

avulsion of the base of the 5th metatarsal

sometimes overuse injury

152
Q

how is a Jones fx managed?

A

surgical

conservative (boot)

PT (impairment based, control WB forces)

153
Q

what is a Lisfranc fx?

A

midfoot injury

hyperDF of midfoot

fxs or torn ligs

single to multiple jts of midfoot affected

possible instability of the arch

154
Q

how are Lisfranc fxs managed?

A

surgical (ORIF)

fusion (too much lig damage so jts have to be fused)

PT (impairment based)

155
Q

what % of ppl will have LBP?

A

80

156
Q

what is the single most common disability under 45 yo?

A

LBP

157
Q

are females or males more affected by neck pain?

A

females

158
Q

t/f: there is an increased incidence of neck pain in the populations over 50 yo

A

true

159
Q

does LBP or neck pain experience smaller fxnal improvements?

A

neck pain

160
Q

what are the characteristics of the cervical vertebrae

A

more transverse facet orientation

bifid spinous process

up/down glide

161
Q

what is the up/down glide of the cervical spine with L rotation?

A

L downglide
R upglide

162
Q

what are the characteristics of the thoracic vertebrae?

A

more frontal facet orientation

facets and demifacets with the ribs

163
Q

what are the characteristics of the lumbar vertebrae?

A

more sagittal facet orientation

bigger vertebral bodies

164
Q

what is the frontal jt of the spine?

A

synovial jt w/CLC and possibly menisci that directs and determines the quantity of motion in each plane

absorbs WB forces

has triple innervation

165
Q

what is the triple innervation of the frontal jt of the spine?

A

ant. middle, and post pillar

166
Q

what closes the cervical facets?

A

ext, rot, and SB toward

167
Q

what opens the cervical facets?

A

flex, rot, and SB away

168
Q

what closes the lumbar facets?

A

ext and SB toward, and rot away

169
Q

what opens the lumbar facets?

A

flex and SB away, and rot toward

170
Q

are sprains/strains in the spine opening or closing dysfxn?

A

can be either

171
Q

if a pt has ext dysfxn, does the segment move worse in flex or ext?

A

ext

172
Q

if a pt has an ext bias, do they prefer flex or ext?

A

ext

173
Q

t/f: if one spinal segment tightens, adjacent segments may become hypermobile to compensate

A

true

174
Q

what may lead to suspicions of a spinal sprain/strain?

A

h/o trauma

physical exam reveals transient neuro s/s, ROM deficits (potentially in capsular pattern), tissue texture, tension, tone changes

175
Q

what would be the capsular pattern in spinal sprain/strain?

A

limits in SB w/rot equally limited ext throughout spine

176
Q

what are the interventions for spinal sprain/strains?

A

address the cause

NSAIDS/relaxants

protection to gradual mobilization

jt and soft tissue mobilization

177
Q

what is the prognosis for spinal sprains/strains?

A

90% resolved in 8 wks w/o impairments

178
Q

what is the nucleus pulposus of the IV disc?

A

center of disc composed of hydrophilic proteoglycans

179
Q

what is the inner non-fibrous annulus of the IV disc?

A

transition zone bw nucleus and annulus

180
Q

what is the annulus fibrosis of the IV disc?

A

type 1 and 2 CT arranged in concentric rings (that don’t connect all the way around) from oblique to more vertical fiber direction

181
Q

what is the cartilaginous end plate of the IV disc?

A

semi-permimeable structure allowing the influx and efflux of fluid

182
Q

what is the neurovascular capsule of the IV disc?

A

perimeter of the disc only

183
Q

t/f: only the outer ring of the IV discs are innervated?

A

true

184
Q

t/f: a pt may not notice IV disc damage until the outer portion becomes involved

A

true

185
Q

what are the fxns of the IV disc?

A

allows motion through deformation in all directions

limits motion (primarily rotation)

maintains diameter of the IVF (prevents nerve pinching)

transmits shock to vertebral bodies

186
Q

what are the diurnal changes of the IV disc?

A

normal cycle of disc hydration which depends on segmental motion

187
Q

how does the IV disc receive nutrition/get rid of wastes?

A

motion and redistribution of forces allows fluid to be pushed in and out

188
Q

what age is most commonly affected by HNP (slipped disc)?

A

25-50 yo

189
Q

do most ppl with a HNP have p!?

A

yes

190
Q

what are the most common locations for HNP?

A

C5-6, L4-5, L5-S1

191
Q

what is the most common site for HNP?

A

L5-S1

192
Q

what are the stages of HNP?

A

prediscal

immediate

settled

chronic

193
Q

what is the prediscal stage of HNP?

A

dull ache

194
Q

what is the immediate stage of HNP?

A

sharp, local, no neuro s/s

195
Q

what is the settled stage of HNP?

A

lat shift, neuro s/s, peripheralization w/repeated movement

196
Q

t/f: as we age the IV discs lose hydration

A

true

197
Q

what is peripheralization?

A

p! travels away from the source

198
Q

what is centralization?

A

p! travels toward the source

199
Q

do we want to see peripheralization or centralization?

A

centralization

200
Q

what is lateral shifting?

A

the body is shifted away from the painful side (defined by the direction of the shoulder not the hip)

201
Q

does the center or periphery of the IV disc breakdown first? why?

A

the center bc it has more collagen

202
Q

t/f: some bulging of the disc is normal with compression

A

true

203
Q

in flexion, the __ disc is pinched, fluid is pushed ___, and the nucleus is pushed __

A

ant, post, post

204
Q

in extension, the __ disc is pinched, fluid is pushed ___, and the nucleus is pushed ___

A

post, ant, ant

205
Q

is the following a bulging disc, herniated disc, or extruded disc?

outward pressure, disc is still contained

A

bulging disc

206
Q

is the following a bulging disc, herniated disc, or extruded disc?

fluid is starting to flow out

A

herniated disc

207
Q

is the following a bulging disc, herniated disc, or extruded disc?

more severe, could mean a portion of the disc has torn off and is irritating the nerve

A

extruded disc

208
Q

what are physical exam findings with HNP?

A

neuro s/s, sx referral patterns, poor tolerance for flexion (or ext bias)

209
Q

how is a HNP dxed?

A

MRI, CT, myelograms

210
Q

what is a myelogram?

A

dye injected in subdural area of the spine and flows around w/CSF, take a radiograph to see if the dye flows where it’s supposed to (won’t fill space beyond herniation)

211
Q

why are MRI findings for HNP not always very helpful?

A

many healthy individuals will have (+) MRI findings, so treat imairments not the test results

212
Q

what are the interventions for HNP?

A

conservative care (PT)

NSAIDS, epidural injections

surgical intervention (microdiscectomy, laminectomy, fusion, replacement)

213
Q

what is the prognosis for HNP?

A

80% better w/conservative care (PT)

reoccurance rate of 6%

favorable if the disc is reducible

214
Q

what does a T1 weighted image show?

A

best to appreciate normal anatomy

fat cartilage, and muscles are white

fluid is dark

215
Q

what does a T2 weighted image show?

A

best to appreciate pathology

fluid, acute hemorrhage, physiologic iron appear white

fluid is light

DPT 516 (14 decks)

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