Chapter 10: Lymphatic System

Question 1

Which organ does not have lymphatic vessels?
a. Brain
b. Kidneys
c. Liver
d. Lungs

Answer 1

ANS: A
Lymphatic tissues are found abundantly throughout the body except in two places, the
placenta and the brain (central nervous system). Lymphatic tissues are found abundantly in
the kidneys, liver, and lungs.

Question 2

Cells that line the lymph node sinuses perform the specific function of
a. fat absorption.
b. fetal immunization.
c. hematopoiesis.
d. phagocytosis.

Answer 2

ANS: D
Lymph nodes defend against the invasion of microorganisms by phagocytosis.

Question 3

Lymph flows faster in response to
a. increased metabolic activity.
b. decreased blood volume.
c. decreased metabolic rate.
d. decreased permeability of the capillary walls.

Answer 3

ANS: A
Lymph flow increases with mounting capillary pressure, greater permeability of the capillary
walls, or increased metabolic rate.

Question 4

An organ that is essential to the development of protective immune function in the infant but
has little or no demonstrated function in the adult is the
a. spleen.
b. liver.
c. thymus.
d. pancreas.

Answer 4

ANS: C
In the adult, the thymus atrophies and, in the older adult, is replaced by fat and connective
tissue.

Question 5

Mr. Shea is a 45-year-old patient who presents to the office for multiple complaints. The
examination of the upper left quadrant of the abdominal cavity is essential to the evaluation of
the immune system because of the location of which organ?
a. Spleen
b. Liver
c. Stomach
d. Pancreas

Answer 5

ANS: A
The spleen is the largest of the lymphatic organs. It is located in the upper left portion of the
abdomen.

Question 6

Mrs. Farrel brings in her 6-year-old son with complaints of a sore throat and fever. As the
healthcare provider, you are concerned about his tonsils and adenoids. Enlarged tonsils and
adenoids may obstruct the
a. thoracic duct.
b. esophagus.
c. nasopharyngeal passageway.
d. external auditory meatus.

Answer 6

ANS: C

The palatine tonsils are located on either side of the pharynx; the adenoids (pharyngeal
tonsils) are found on the posterior wall of the pharynx and superior to the soft palate. If these
structures become enlarged, they block the passage between the pharynx and nasal cavity.

Question 7

Mrs. Sing is a 44-year-old patient who presents to the office with a complaint of enlarged
lymph nodes. When enlarged, which lymph nodes are most likely to be a sign of pathology
(e.g., malignancy)?
a. Occipital
b. Anterior cervical
c. Supraclavicular
d. Femoral

Answer 7

ANS: C
Supraclavicular nodal enlargement is of special concern because it suggests a malignancy,
even in children; an enlarged supraclavicular lymph node may be the sentinel node of
Hodgkin disease.

Question 8

As adults age, their ability to resist infection is reduced because of the lymphatic nodes
becoming more
a. fibrotic.
b. mucoid.
c. porous.
d. profuse.

Answer 8

ANS: A
Older adults’ lymph nodes diminish in both number and size and are replaced with more
fibrotic and fatty tissues.

Question 9

Equipment for examining the lymphatic system includes a
a. caliper.
b. centimeter ruler.
c. goniometer.
d. syringe and needle.

Answer 9

ANS: B
The centimeter ruler and marking pencil are the only equipment needed for examination of the
lymphatic system. They are used to measure and outline the borders of the nodes.

Question 10

Which nodes are most often associated with inflammation?
a. Shotty
b. Movable
c. Fixed
d. Tender

Answer 10

ANS: D
Tenderness is almost always indicative of inflammation. Shotty nodes (feel like the tip of an eraser) that are fixed are of greater concern. Shotty, movable, or fixed nodes are not usually
associated with inflammation.

Question 11

Which nodes are also called Virchow nodes?
a. Internal mammary
b. Anterior axillary
c. Deep cervical
d. Supraclavicular

Answer 11

ANS: D
The supraclavicular nodes are also referred to as Virchow nodes.

Question 12

The harder and more discrete a node, the more likely that there is a(n)
a. innocent cause.
b. infection.
c. malignancy.
d. metabolic disease.

Answer 12

ANS: C
Tender nodes almost always indicate the presence of an infection, whereas a hard, discrete,
and nontender node is more likely to represent a malignancy.

Question 13

Which finding indicates that the examiner is assessing a blood vessel rather than a lymph
node?
a. A bruit
b. Inflammation
c. Tenderness
d. Redness

Answer 13

ANS: A
Pulsations and auscultation of bruits indicate a blood vessel and not a lymph node.

Question 14

When examining lymph nodes near a joint in the arm or leg, which of the following
maneuvers is likely to facilitate the examination?
a. Extension of the extremity
b. Circumduction of the extremity
c. Flexion of the extremity
d. Rotation of the extremity

Answer 14

ANS: C
Bending joint areas will ease taut tissues and allow for better accessibility to palpation

Question 15

To palpate the inguinal nodes, you should have the patient
a. bend over a table and cough.
b. lie supine with knees slightly flexed.
c. lie supine with legs extended.
d. stand and cough vigorously.

Answer 15

ANS: B

To palpate the inguinal nodes, you should have the patient lie supine and slightly flex her or
his knees.

Question 16

The most important clue to the diagnosis of immunodeficiency disease in a child is
a. family history.
b. illness in siblings.
c. previous hospitalizations.
d. serious recurring infections.

Answer 16

ANS: D
Although family history, illness in siblings, and previous hospitalizations are helpful clues to
discover an immunodeficiency in a child, it is most important to review the occurrence of
serious, uncommon infections, such as Pneumocystis jirovecii, or other fungal infections that
do not respond as expected to therapy.

Question 17

A red streak that follows the course of the lymphatic collecting duct is a finding associated
with
a. Hodgkin disease.
b. lymphangitis.
c. lymphedema.
d. lymphoma.

Answer 17

ANS: B

Lymphangitis—inflammation of the lymphatic vessels—is evident by a red streak that follows
the course of the inflamed lymphatic duct. Hodgkin disease and lymphoma refer to
malignancies manifested primarily by nodal enlargements; lymphedema is lymph swelling
that distinguishes itself from interstitial edema because it does not pit.

Question 18

Which disorder is characterized by a single node that is chronically enlarged and nontender in
a patient with no other symptoms?
a. Retropharyngeal abscess
b. Streptococcal pharyngitis
c. Mononucleosis
d. Toxoplasmosis

Answer 18

ANS: D
Toxoplasmosis is characterized by a chronically enlarged, nontender, single node—usually in
the posterior cervical chain.

Question 19

Initial signs and symptoms of Epstein-Barr virus mononucleosis usually include
a. pharyngitis, fever, and malaise.
b. bleeding gums and spontaneous nosebleeds.
c. headache, visual disturbance, and rash.
d. inguinal adenopathy and painful urination.

Answer 19

ANS: A
Presenting signs and symptoms of Epstein-Barr virus mononucleosis are pharyngitis, fever,
fatigue, malaise, often splenomegaly, and occasionally hepatomegaly and/or rash.

Question 20

Tender nodes associated with cat scratch disease are usually found in which area?
a. Epitrochlear area
b. Popliteal area
c. Axilla
d. Inguinal area

Answer 20

ANS: C
Cat scratch disease usually results in enlargement of nodes in the head, neck, and axillae.
Although epitrochlear enlargement occurs most exclusively in cat scratch fever, its occurrence
is less common.

Question 21

Serum sickness is usually characterized first by the appearance of
a. lymph node enlargement.
b. joint pain.
c. urticaria.
d. fever.

Answer 21

ANS: C
Urticaria is the first sign of serum sickness, followed by lymphadenopathy, joint pain, fever,
and facial edema.

Question 22

Which condition stimulates lymph node enlargement? (Select all that apply.)
a. Graves disease
b. Lymphangioma
c. Esophageal reflux
d. Parotid swelling

Answer 22

ANS: A, B, D
Lymph node enlargement is stimulated by Graves disease, lymphangioma, and parotid
swelling.