CLINICAL CARE OF THE LYMPHATIC SYSTEM

Question 1

Definition: Enlarged lymph node(s)
Has many possible etiologies.
Can present a diagnostic problem if no cause is identified after history and physical.

Answer 1

PERIPHERAL LYMPHADENOPATHY

Question 2

What does generalized mean

Answer 2

More than one region

Question 3

What does localized mean?

Answer 3

Only one region involved

Question 4

________ may be a feature of a number of systemic diseases that can be recognized by
other clinical findings

Answer 4

Generalized lymphadopathy

Question 4

________ may be a feature of a number of systemic diseases that can be recognized by
other clinical findings

Answer 4

Generalized lymphadenopathy

Question 5

True/False
These issues will  cause localized lymphadenopathy
(a) HIV
(b) TB
(c) Lupus
(d) Infectious Mono
   1) Malignancy

Answer 5

False

Causes generalized lymphadenopathy

Question 6

___________________ is a thorough history and physical will commonly lead to an appropriate differential diagnosis which will then guide work up and further evaluation. (imaging, biopsy, labs)

Answer 6

Evaluation

Question 7

What do you look for in the Exam portion?

Answer 7

(a) Location
(b) Size
(c) Consistency:
(d) Fixation vs mobile
(e) Tenderness

Question 8

Consistency:

1) Hard nodes are found in _____
2) Firm, rubbery nodes are found in ____

Answer 8

1) cancers

2) lymphomas

Question 9

Fixation vs mobile

1) Normal lymph nodes are _____________ in the subcutaneous space
2) Abnormal nodes can _____________ by invading cancer

Answer 9

1) freely movable

2) become fixed to adjacent tissues

Question 10

___________ suggests recent, rapid enlargement that has put pain receptors in the capsule under tension. This typically occurs with inflammatory
processes such as infection.

Answer 10

Tenderness

Question 11

Patients with localized lymphadenopathy can be observed for _______ if there is nothing else in the history, physical examination, and laboratory screening to suggest malignancy.

Biopsy is appropriate if an abnormal node has not resolved after _______.

Answer 11

1) three to four weeks

2) four weeks

Question 12

The evaluation of patients with generalized lymphadenopathy without suspected diagnosis based on history and physical examination should start with:

Answer 12

1) complete blood count (CBC)
2) chest radiograph
3) human immunodeficiency virus (HIV) testing.

Question 13

These suggest what issue
(1) Painless persistent edema of one or both lower extremities, primarily in young women.
(2) Pitting edema without ulceration, varicosities, or stasis pigmentation.
(3) There may be episodes of lymphangitis and cellulitis.
Symptoms and physical findings
(1) Aching discomfort with sensation of heaviness or fullness.
(2) Hypertrophy of the limb with markedly thickened and fibrotic skin and subcutaneous
tissue in very advanced cases.
(3) Pitting Edema

Answer 13

Lymphedema

Question 14

Primary or secondary Lymphedema

______ is due to congenital developmental abnormalities (lymphatic hypoplasia) impairing lymph flow from the extremity.

Answer 14

Primary

Question 15

Primary or secondary Lymphedema
__________ form of lymphedema involves inflammatory or mechanical lymphatic obstruction from trauma, regional lymph node resection, irradiation, or extensive involvement of regional nodes by malignant disease or filariasis.

Answer 15

Secondary

Question 16

Tx for Lymphedema

Answer 16

(1) Referral
(2) Elevation, especially during sleeping hours
(3) Compression stockings
(4) Diuretic therapy

Question 17

Complications for lymphedema

Answer 17

(1) Secondary cellulitis in the extremity should be avoided by means of good hygiene and
treatment of any trichophytosis of the toes.
(2) Amputation if complications
(3) Deep Vein Thrombosis

Question 18

True/False
No effective cure for lymphedema, the treatment strategies are designed to control the problem and allow normal activity and function

Answer 18

True

Question 19

With aggressive treatment, ____________, good relief of symptoms can be achieved.

Answer 19

including pneumatic compression devices

Question 20

The long-term outlook is dictated by the associated conditions and avoidance of _______.

Answer 20

recurrent cellulitis