11/6/13 Flashcards
Every system supplied by blood vessels also has lymphatic drainage. What are 2 exceptions to this rule?
The placenta & the brain.
The immune response to bloodborne antigens begins in what lymphatic organ?
The spleen.
What are the 2 tonsils that are removed? What are they commonly called?
Palatine Tonsils–called tonsils
Nasopharyngeal tonsils–called adenoids
The umbilical cord will fall off when? If not, what does that indicate?
1 to 2 weeks after birth.
If not, could be a congenital defect of the immune system.
Is this normal or abnormal? Finding small 2-3 mm discrete, palpable, mobile nodes in a neonate.
Normal
Finding inguinal, occipital, & postauricular nodes are common before what age? Uncommon after what age?
2 years of age.
Which nodes are common in older children, but uncommon in infants?
Cervical & submandibular nodes
Finding which nodes is always a bad sign?
Supraclavicular nodes…sign of malignancy.
What count goes up during pregnancy? What hormones cause this?
Leukocyte count increases. 7200-8500
Progesterone, Estrogen & Cortisol.
What is the shift of the immunity type when a woman becomes pregnant?
Cell-mediated–>Humoral
*here, the pregnant mom is more suspectible for infections.
What is one upside to being pregnant & your immune system?
This can lead to remission of autoimmune diseases.
What are 2 things that you might see with an HPI that relates to the lymphatic system?
Enlarged nodes
swelling of the extremity
What are some conditions that you want to ask about in the family history section when you are dealing with the lymphatic system?
Malignancy Anemia Recent infectious diseases Tuberculosis Immune Disorders Hemophilia
What are 3 physical signs of problems with the lymph system?
Lymphadenopathy: enlarged lymph nodes
Lymphangitis: red streaks in the skin
Lymphedema: swelling
What are 4 weird body regions that are a part of the lymphatic system?
stomach
appendix
bone marrow
lungs
What are 2 weird functions of the lymphatic system?
Back up hematopoiesis
Absorption of fat soluble substances in the GI tract
What is one sad thing about the lymphatic system?
It is a way to spread malignancy.
Where does the lymphatic system ultimately drain to?
The subclavian veins
T/F massage decreases lymphatic flow
False. It increases lymphatic flow... Other things that increase flow: increased fluid volume increased capillary pressure increased permeability of the capillary walls increased metabolic activity
T/F The lymphatic system is easily obstructed.
True. B/c of the low pressure of the system.
What is the approximate size of lymph nodes?
Smaller than .5–1 cm
Where are superficial nodes located? Deep nodes?
Superficial Nodes–>in the subcutaneous tissue
Deep Nodes–>In body cavities & under fascia & muscle
Viral infections do what to the lymphocyte count?
Increase it!
What is the approximate size of lymphocytes?
7mm–35mm
Humoral immunity includes what lymphocyte?
Cellular immunity?
Humoral–B lymphocyte
Cellular–T lymphocyte (thymus for maturity)
Where is the spleen located?
left upper quadrant
What are the 2 main areas of the spleen?
White Pulp–>lymphatic nodules
Red Pulp–>venous sinusoids
What is a function of the spleen early on in life?
for a while it can form blood cells
Where are Peyer’s Patches located?
in the mucosa of the SI
How are the palatine tonsils activated?
thru inhaled & intranasal antigens
When does the lymphatic system begin to develop?
20 weeks of gestation
What is the state of the lymphatic system at birth?
it is still immature
You shouldn’t be able to feel lymph nodes after what age?
2
Feeling_______ nodes is always a reason for suspicion of malignancy.
Supraclavicular
What happens to your lymph nodes when you get old?
Lymph nodes are lost. They become fatty & fibrotic
This leads to a decreased ability to fight infection.
What are some associated symptoms that you want to ask about w/ the lymphatic system?
malaise fever weight loss night sweats abdominal pain fullness itching "pruritis"
What are 3 predisposing factors for lymphatic system issues?
Infection Surgery Trauma Venous Insufficiency Cardiac or Renal Disorder
What are 2 types of meds that you want to ask about w/ lymphatic system issues?
Chemotherapy
Antibiotics
What are some things that you should ask about for PMH w/ a person w/ lymphatic issues?
Tuberculosis! Blood transfusion! Organ Transplant! HIV infection! Malignancy!
What are some important social history factors for lymphatic issues?
HIV–sexual history & recreational drugs
Travel
Alcohol use
T/F you have to worry about taxoplasmosis w/ older adults.
True.
What are tender nodes indicative of?
Inflammation
What characteristics do cancerous nodes have?
large, but non-tender
What is lymphangioma?
congenital malformation of dilated lymphatics
What are shotty nodes?
Nodes that feel like there are pellets underneath.
What are fluctuant nodes?
Nodes that exhibit a wavelike motion when they are palpated.
What are matted nodes?
A group of nodes that feel connected & seem to move as a unit.
What are 2 additional disorders you want to ask about in family hx w/ head & neck exam?
Thyroid Disorders
Headaches
Moon facies w/ erythemetous skin is what disorder?
Cushing Syndrome
Dull, puffy, yellowed skin Coarse sparse hair temporal loss of eyebrows periorbital edema prominent tongue What disorder?
Myxedema
Fine, moist skin Fine Hair Prominent Eyes Lid retraction Staring/startled expression What disorder?
Hyperthyroid
Butterfly Rash
What disorder?
SLE/Lupus
Facial asymmetry not able to close one eye drooping of lower eyelid & mouth Loss of naso labial fold What disorder? Which cranial nerve?
Bell’s Palsy
Cranial Nerve 7
Coarsening of Facial Features
Broad Nose
Prominent Zygomatic Arch
Which disorder?
Acromegaly
Depressed nasal bridge Epicanthal folds Low set ears Large tongues Which disorder?
Down’s Syndrome
Smooth philtrum Wide Set Eyes Mild ptosis Thin upper lip Which disorder?
FAS Fetal Alcohol Syndrome
What are the general things that you palpate for on a head & neck exam?
fusion of suture for 6 mo old babies. Texture of hair, temporal artery, salivary glands
When do you percuss on a head & neck exam?
For hypocalcemia. Trousseau’s Sign.
How is auscultation involved in the head & neck exam?
you can hear w/ the bell a bruit sometimes over the eyeball, temple, & occiput
What are some things that you look for upon inspection of the neck?
Jugular vein distention, carotid artery prominence, webbing, edema, thyroid enlargement
What do you palpate in a neck exam?
midline trachea, hyoid bone, thyroid & cricoid cartilage, tracheal rings.
What are the 2 signs for aortic aneurysm that can sometimes be elicited during the neck exam?
Cardarelli’s Sign
Oliver’s Sign
Molding from a vaginal delivery can be resolved usu in what time frame?
within one week.
When do fontanels usu close by on a baby?
24 months. should be 4-5 cm.
What might a bulging fontanel indicate?
hydrocephalus, intracranial mass, meningitis
Where do you palpate for craniotabes?
Firmly the scalp above & behind the ears
What can transillumination usu distinguish b/w?
Increased Fluid vs. Decreased Brain mass
What special head & neck things usu happen in the pregnant woman?
Hyperpigmentation of the skin—mask of pregnancy
Thyroid gland hypertrophies & may have an associated bruit
What is acute suppurative lymphadenitis?
inflammation & infection of a lymph node
What is lymphedema?
swelling from accumulation of lymph fluid.
What is lymphangioma aka cystic hygroma?
congenital malformation of dilated lymphatics
What is lymphatic filariasis? aka elephantiasis
lymphedema throughout the entire body
What is non-Hodgkin lymphoma?
malignant neoplasm of the lymphatic system.
What is Hodgkin disease?
Malignant Lymphoma
What is epstein barr virus mononucleosis?
Infectious mono
What is taxoplasmosis?
caused by a parasite
What is roseola infantum?
Infection by human herpes virus 6
What is herpes simplex?
Infection by human herpes virus 1 or 2
What is Cat Scratch Disease?
subacute or chronic lymphadenitis in children
