5. Lymph Nodes Of The Head And Neck

Question 1

What 3 things make up the lymphatic system?

Answer 1

Lymph nodes.
Lymphatics.
Lymph.

Question 2

Where is the lymph system not found?

Answer 2

Eyeball, inner ear, cartilage.

Question 3

Why doesn’t all the fluid that enters the interstitial space from the arterioles get reabsorbed at the venule side, as the pressures change from high hydrostatic pressure to higher oncotic pressure?

Answer 3

Some small proteins, cell debris and bacteria leak out of capillaries into interstitial space, increasing oncotic pressure here slightly, meaning so fluid is retained.

Question 4

When does tissue fluid become lymph?

Answer 4

When it moves from the interstitium into a lymphatic capillary.

Question 5

How much lymph does the body produce a day?

Answer 5

3-4L.

Question 6

What structures does lymph pass through in it’s uni-directional flow from tissue fluid to the venous system?

Answer 6

Tissue fluid.
Lymphatic capillary.
Lymphatic vessel.
Lymph node.
Larger lymphatic vessel.
Lymph node.
Larger lymphatic vessel.
Lymphatic trunks (right and left).
Lymphatic ducts (right and left).
Venous system.

Question 7

How does the lymph system ensure unidirectional slow despite the fact it is a low pressure system with no central pump?

Answer 7

Valves.
Passive contraction - due to external compression from pulsation of arteries and muscle contraction.
Intrinsic constriction - constrict in response to stretch.

Question 8

What veins do the right lymphatic duct and thoracic duct of the lymphatic system drain into?

Answer 8

Right lymphatic duct - into right subclavian vein.

Thoracic duct - into left subclavian vein.

Question 9

What is lymphoedema?

Answer 9

Abnormal collection of protein-rich fluid causing tissue swelling due to compromised lymphatic system.

Question 10

Name 3 things that can cause chronic lymphoedema

Answer 10

Removal or enlargement of lymph nodes.
Infections.
Damage to lymphatic system eg cancer treatments.
Lack of limb movement.
Congenital conditions eg Milroy’s syndrome.

Question 11

Name 3 lymph organs

Answer 11

Spleen.
Tonsils
Thymus.

Question 12

What types of immune cells do lymph nodes contain?

Answer 12

B and T lymphocytes.

Macrophages.

Question 13

What type of connective tissue is the outer capsule and inside of a lymph node formed from?

Answer 13

Tough fibrous outer capsule.

Reticular connective tissue inside.

Question 14

How do lymph nodes act as defect even against infection?

Answer 14

Physical filter.
Phagocytic filter.
Lymphocytes activate and proliferate in response to antigens.

Question 15

How does an enlarged lymph node due to an infection tend to feel when palpated?

Answer 15

Tender and mobile.

Question 16

How does an enlarged lymph node due to a malignancy tend to feel when palpated?

Answer 16

Hard, matted, non-tender.

Question 17

What should you do as a doctor is a lymph node is found to be enlarged in a patient?

Answer 17

Take a comprehensive history.
Examine the area of tissue it drains.
If systemic disease/malignancy suspected examine other lymph nodes and body systems.

Question 18

What are regional lymph nodes?

Answer 18

Superficial nodes that drain specific areas.

Question 19

What are terminal lymph nodes?

Answer 19

Deep nodes that receive drainage from a number of regional nodes.

Question 20

What is a lymphadenopathy?

Answer 20

Enlarged lymph node.

Question 21

What is the most common cause of swelling in the neck?

Answer 21

Enlarged cervical lymph nodes.

Question 22

In what layer of fascia are the regional lymph nodes of the neck found?

Answer 22

Superficial cervical fascia.

Question 23

In what layer of fascia are the terminal lymph nodes of the neck found? What structures are they closely associated with?

Answer 23

Investing layer of deep cervical fascia.

Associated with internal jugular vein, deep to the sternocleidomastoid, within the carotid sheath.

Question 24

What are the 5 locations of the regional lymph nodes in the head?

Answer 24

Submental.
Submandibular.
Preauricular.
Postauricular.
Occipital.

Question 25

What are the 3 locations of regional cervical lymph nodes?

Answer 25

Superficial (associated with EJV).
Posterior (associated with EJV).
Anterior (associated with AJV).

Question 26

What is waldeyer’s ring?

Answer 26

An annular collection of lymphatic tissue surrounding the entrance to the aerodigestive tracts.

Question 27

What structures make up waldeyer’s ring?

Answer 27

Pharyngeal tonsil.
Tubal tonsils.
Palatine tonsils.
Lingual tonsils.

Question 28

Where do lymphatics from the tonsils drain into?

Answer 28

Drain into the upper pharynx and then can drain into the retropharyngeal space.

Question 29

What are the 3 locations of the terminal cervical lymph nodes?

Answer 29

Jugulo-digastric.
Jugulo-omohyoid.
Supraclavicular lymph nodes.

Question 30

What region of the body does the left supraclavicular lymph node (Virchow’s node) drain lymph from?

Answer 30

Abdomen and thorax.

Question 31

What region of the body does the right supraclavicular lymph node drain lymph from?

Answer 31

Mid section chest, oesophagus and lungs.

Question 32

What lymph nodes may be enlarged by a mouth ulcer?

Answer 32

Submental lymph nodes.

Question 33

What lymph nodes may be enlarged by conjunctivitis?

Answer 33

Preauricular lymph nodes.

Question 34

What lymph nodes may be enlarged in tonsilitis?

Answer 34

Jugular diagastric lymph nodes.

Question 35

Where does lymph fluid passing through the deep cervical lymph nodes drain into?

Answer 35

Into the subclavian vein via the thoracic duct or right lymphatic duct.