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ACOLS WRITTEN TEST > Day One - Anatomy > Flashcards

Day One - Anatomy Flashcards

1
Q

What is the most common cause of Ly in the US?

A

breast cancer surgery

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2
Q

What does lymphatic load consist of?

A

Water
Proteins
Cells
Fat (long chain fatty acids)

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3
Q

What are characteristics of proteins?

A

macromolecues
hydrophilic - attract water
too large to be reabsorbed by blood capillaries

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4
Q

What are characteristics of long chain fatty acids?

A

> 16 carbon atoms
re-synthesized by body into chylomicrons
cannot be absorbed by the blood vessels (too large)

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5
Q

Where are chylomicrons absorbed?

A

in the digestive system

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6
Q

What are characteristics of short chain fatty acids?

A

< 16 carbon atoms

reabsorbed by venous blood capillaries of the small intestine

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7
Q

All cells that become free in the interstitial space will become…

A

lymphatic load

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8
Q

What percentage of lymphatic load is water?

A

96%

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9
Q

True or false: Most lymphedema cases involve the deep LS

A

False - most involve the superficial LS

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10
Q

What is the start of the lymphatic system?

A

initial lymph capillaries

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11
Q

Initial lymph capillaries cover the entire body surface to form the…

A

initial lymph vessel plexus

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12
Q

What are some characteristics of lymphatic collectors?

A
  • have well developed muscular walls
  • located in the superficial fatty tissue
  • are suprafascial
  • can regenerate/repair
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13
Q

What is the purpose of lymphatic collectors?

A

transport lymph to regional lymph nodes and lymphatic trunks

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14
Q

Which part of the nervous system innervates the smooth muscles?

A

sympathetic portion of the ANS

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15
Q

The inherent contraction of a lymphangion is _________ per minute. With MLD, the contraction can increase to ________ per minute.

A

10-12

60

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16
Q

What are the 3 groups of regional lymph nodes?

A
  • axillary
  • inguinal
  • cervical
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17
Q

Inguinal lymph nodes are located in the…

A

medial femoral triangle

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18
Q

What form the borders of the medial femoral triangle?

A
  • inguinal ligament (superior)
  • gracilis (medial)
  • sartorius (lateral)
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19
Q

What are the skin drainage areas of the inguinal lymph nodes?

A
  • legs
  • lower body quadrants
  • external genitalia
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20
Q

What is the inguinal lymph node pathway?

A

perforate fascia below inguinal ligament –> pelvic lymph nodes –>
lumbar lymph nodes –> lumbar trunks –> cysterna chyli –> thoracic duct –> left venous angle

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21
Q

Where are the bulk of the axillary lymph nodes located?

A

between the pectoralis and latissimus dorsi muscles

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22
Q

The efferent vessels from the axillary lymph nodes converge to form the…

A

subclavian trunk

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23
Q

What skin areas do the axillary lymph nodes drain?

A
  • upper quadrants

- upper extremities

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24
Q

Describe the pathway of lymph fluid to the left venous angle.

A

LEs to inguinal lnn — under inguinal ligament to the pelvic lnn — lumbar lnn — (R) and (L) lumbar trunks — gastrointestinal trunk — cisterna chyli —thoracic duct — left venous angle

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25
Q

What do the lumbar trunks drain?

A
  • lower extremities
  • lower body quadrants
  • external genitalia
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26
Q

What forms the cysterna chyli?

A
  • both lumbar trunks (R and L)

- gastrointestinal trunk

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27
Q

What are characteristics of the thoracic duct?

A
  • originates together with the cysterna chyli
  • represents the largest lymph trunk in the body
  • perforates the diaphragm with aorta
  • empties into the (L) venous angle
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28
Q

What is the left venous angle composed of?

A
  • left internal jugular vein

- left subclavian vein

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29
Q

The thoracic duct empties approximately ___ of the total body lymph fluid into the left venous angle.

A

3/4

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30
Q

The right lymphatic duct is formed by the confluence of which trunks?

A
  • right jugular
  • supraclavicular
  • subclavian
  • parasternal
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31
Q

The jugular trunk is formed by the…

A

efferent vessels from the internal jugular nodes

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32
Q

The internal jugular nodes empty the…

A

Ipsilateral head and neck

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33
Q

The supraclavicular trunk is formed by…

A

efferent lymph vessels of supraclavicular lymph nodes

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34
Q

The supraclavicular lymph nodes drain the

A
  • head and neck
  • shoulder region
  • parts of the mammary gland
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35
Q

The subclavian trunk drains the…

A

lymph originating from the axillary lymph nodes

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36
Q

The axillary lymph nodes are responsible for draining…

A
  • upper extremities
  • upper quadrants (ant and post)
  • majority of the mammary gland
  • shoulder region
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37
Q

The parasternal trunk drains…

A
  • part of the mammary gland
  • parts of the pleura
  • diaphragm
  • liver
  • pericardium
  • striated musculature in chest and abdominal areas
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38
Q

Where are the axillary lymph nodes located?

A
  • axilla (apex)
  • pectoralis minor (anterior border)
  • subscapularis (posterior border)
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39
Q

What are the five groups of axillary nerves?

A
  • anterior (pectoral) group
  • posterior (subscapular) group
  • central group
  • lateral (infraclavicular) group
  • apical group
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40
Q

The efferent vessels from the axillary lymph nodes converge to form the…

A

subclavian trunk

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41
Q

Axillary lymph nodes drain the…

A
  • upper quadrants

- upper extremities

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42
Q

Watersheds represent linear areas that separate _________.

A

territories

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43
Q

Name the watersheds.

A
  • upper horizontal
  • sagittal/median
  • low horizontal/transverse
  • gluteal
44
Q

True or false: Lymph collectors usually cross watersheds.

A

False

45
Q

What are characteristics of lymphatic territories?

A
  • made up of several collectors that run adjacent to each other
  • are responsible for draining the same body area
  • run towards the same group of regional lymph nodes
46
Q

Territories of the trunk are called…

A

quadrants

47
Q

Upper quadrants (territories of the trunk) drain into the…

A

axillary lymph nodes

48
Q

Lower quadrants (territories of the trunk) drain into the…

A

inguinal lymph nodes

49
Q

Lymph above the upper horizontal watershed drains into the…

A

cervical lymph nodes

50
Q

On the extremities, lymphatic territories are called…

A

bundles

51
Q

Define intra-territorial anastomoses.

A

Collectors within the same territory that anastomise/communicate.

52
Q

Define inter-territorial anastomoses.

A

Connections between collectors of two adjacent territories. Occur where collector’s origins directly align with each other at the watersheds.

53
Q

What are the main inter-territorial anastomoses?

A
  • AAA - anterior axillo-axillary anastomosis
  • AII - anterior inter-inguinal anastomosis
  • AI (or IA) - axillo-inguinal (or inguinal-axillary)
  • PAA - posterior axillo-axillary anastomosis
  • PII - posterior inter-inguinal anastomosis
54
Q

Describe the pathway of lymph fluid to the left venous angle.

A

from LEs to inguinal lnn –> from inguinal lnn, dive under the inguinal lig to pelvic lnn (now part of deep LS) –> lumbar lnn –> lumbar trunks (GI trunk may join here - side road) –> cisterna chyli –> thoracic duct –> left venous angle

55
Q

Where is the cisterna chyli located?

A

anterior to T11-L2

56
Q

What is the “end of the track” (or terminus) of the lymphatic system?

A

(R) or (L) venous angles

57
Q

The venous angles occur at the junction of what veins?

A
  • internal jugular

- subclavian

58
Q

The lumbar trunks are responsible for draining…

A
  • LEs
  • lower body quadrants
  • external genitalia
59
Q

The lumbar trunks and GI trunk converge to form the…

A

cisterna chyli

60
Q

What form the borders of the parasternal trunk?

A
  • anterior border of intercostal spaces

- parallel to mammary artery

61
Q

Efferent vessels pass via the parasternal trunk to the…

A

venous angle

62
Q

Skin areas that drain into the left venous angle include…

A
  • LEs
  • both lower quadrants
  • external genitalia
  • (L) upper quadrant (ant and post)
  • LUE
  • (L) side of head/face/shoulder
63
Q

The (L) venous angle drains ~ ______ in a 24 hour period.

A

2-4 L

64
Q

Skin areas that drain into the (R) venous angle include…

A
  • (R) upper quadrant (ant and post)
  • RUE
  • (R) head/face/shoulder
65
Q

The (R) venous angle drains ______ in a 24 hour period.

A

300 mL (soda can)

66
Q

Where are the deep cervical lymph nodes located?

A

lateral cervical triangle

67
Q

What are the borders of the lateral cervical triangle?

A
  • SCM (anterior)
  • upper trapezius (posterior)
  • clavicle (inferior)
68
Q

The jugular chain of deep cervical lnn are located near the…

A

SCM muscle

69
Q

The accessory chain of the deep cervical lnn is located near the…

A

upper trapezius muscles

70
Q

The supraclavicular chain of deep cervical lymph nodes is located near the…

A

clavicle

71
Q

What composes the peri-cervical lymphatic circle?

A
  • occipital lnn
  • retro-auricular lnn
  • pre-auricular (parotid) lnn
  • submandibular lnn
  • submental lnn
72
Q

Where are the occipital lnn located?

A

between the splenius capitis and skull

73
Q

What do the occipital lymph nodes drain?

A
  • posterior scalp
  • muscles and ligaments
  • skin of upper neck
  • facets of C1-3
74
Q

Where are the retro-auricular lymph nodes located?

A

on the mastoid process

75
Q

The retro-auricular lymph nodes drain…

A
  • parietal scalp

- skin of posterior ear

76
Q

Where are the pre-auricular (parotid) lymph nodes located?

A

embedded in parotid gland

77
Q

The pre-auricular (parotid) lymph nodes drain…

A
  • forehead
  • upper lid
  • lateral part of lower lid
  • skin of anterior ear
78
Q

Where are the submandibular lymph nodes located?

A
  • embedded in salivary glands

- posterior to mandible

79
Q

The submandibular lymph nodes drain the…

A
  • medial portion of lower eye lid
  • cheek
  • nose
  • upper and lower lip
  • sinuses
  • gums
80
Q

What do the submental lymph nodes drain?

A
  • middle of lower lip

- chin

81
Q

Name the territories (bundles) of the hand.

A
  • radial
  • ulnar
  • mesothenar
  • descending
82
Q

Name the territories (bundles) of the forearm.

A
  • radial
  • median
  • ulnar
83
Q

All lymph collectors of the forearm converge and decrease in number at the…

A

antecubital fossa “bottleneck”

84
Q

The medial upper arm territory is a continuation of the ________ that run directly to the _______.

A

bottleneck collectors

axillary lymph nodes

85
Q

The medial upper arm territory is located between the _______ and _______ muscles.

A

biceps

triceps

86
Q

The lateral upper arm territory drains into the _______ and ______ lymph nodes.

A

axillary (infraclavicular)

supraclavicular

87
Q

The Mascagni-Sappy (MS) Pathway - cephalic bundle is important because…

A

explains why some people do not develop lymphedema

88
Q

The MS pathway of the arm is present in _____ percentage of the population?

A

16%

89
Q

The MS pathway is the direct connection of what bundles of the UE?

A
  • radial forearm bundle

- lateral upper arm bundle

90
Q

The MS pathway terminates at the…

A

supra or infra clavicular lymph nodes

91
Q

Name the lower extremity bundles.

A
  • ventro-medial bundle

- dorso-lateral bundle

92
Q

What is the primary LE bundle for transport of lymph fluid out of the LE?

A

ventro-medial bundle

93
Q

What does the ventro-medial bundle drain?

A
  • plantar surface of the feet (met heads to distal toes)
  • 1/2 medial sole of foot
  • dorsum of foot
  • lower leg
  • lower leg to bottleneck at medial femoral condyle to inguinal lnn
94
Q

What does the dorso-lateral bundle of the LE drain?

A
  • lateral malleolus
  • 1/2 sole of foot (plantar surface - lateral)
  • heel area
  • narrow strip following achilles tendon, along calf to popliteal fossa
95
Q

Where do the mammary glands drain?

A
  • 3/4 into axillary nodes

- 1/4 into parasternal nodes (are not removed in breast CA sx)

96
Q

What drains the intercostal spaces?

A
  • para-sternal lnn - drain anterior intercostal spaces

- para-vertebral lnn - drain posterior intercostal spaces

97
Q

Where do external genitalia of men and women drain?

A
  • inguinal lnn
98
Q

Where do pelvic organs drain?

A
  • pelvic lnn
99
Q

Which lymph vaso-vasorum do we use, clinically?

A
  • femoral vein

- cephalic vein

100
Q

Where is the femoral lymph vaso-vasorum located?

A
  • medial to the sartorius
101
Q

Where is the cephalic lymph vaso-vasorum located?

A
  • in delto-pectoral groove
102
Q

What can be activated to re-route lymph?

A
  • utilize existing lymph collectors in affected area
  • plexus
  • lymph vaso-vasorum
  • anastomoses
  • deep lymph vessels (create suction effect from superficial to deep)
  • exercise - stretches lymph vessels/increases lymphangiomotoricity
103
Q

What are the general effects of MLD?

A
  • increase in lymph production by opening lymph capillaries
  • increase lymphangiomotoricity by stimulating smooth mm
  • reverse of lymph flow through anastomoses towards healthy side
  • increase in venous return
  • soothing
  • analgesic effect
104
Q

What are the absolute contraindications for neck MLD?

A
  • carotid endoarterectomy
  • medicated thyroid dysfunction
  • carotid-sinus syndrome
  • history of CVA or multiple TIA
  • cardiac arrhythmia
105
Q

True or False. Age > 60 is an absolute contraindication to neck MLD.

A

False. It is a relative contra-indication.

ACOLS WRITTEN TEST (6 decks)

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