Lymph

Question 1

What are the 3 functions of the lymphatic system?

Answer 1

1) Vascular function one-way drainage of interstitial fluid from tissues to venous circulation. 2) digestive function by absorbing fats and fat-soluble vitamins from the digestive system to venous circulation. 3) immune function by defending against invading microorganisms and disease

Question 2

What basic thing does lymph flow follow?

Answer 2

pressure

Question 3

What basic components are in lymph?

Answer 3

proteins, minerals, nutrients, damaged cells, cancer cells, pathogens

Question 4

Where do both lymphatic ducts enter into?

Answer 4

subclavian veins

Question 5

What are the 6 key lymph organs?

Answer 5

tonsils/adenoids, thymus, spleen, peyer’s patches, appendix, bone marrow

Question 6

Where is waldeyer’s ring of MALT?

Answer 6

mucosal tissue of the posterior oropharynx

Question 7

What is a common cause of lymphangitis?

Answer 7

a distal bacterial infection, commonly Group A beta-hemolytic streptococci

Question 8

What thing causes cat scratch fever/disease?

Answer 8

bartonella henselae

Question 9

Features of cat-scratch disease/fever?

Answer 9

onset days-2weeks, non-painful bump at the site, fatigue, painful lymphadenopathy, headache, fever, often is self-limited

Question 10

What do enlarged/hardened mediastinal/hilar nodes show up as on a CXR or CT?

Answer 10

mediastinal mass

Question 11

What are the 2 regions of lymph nodes in the abdomen?

Answer 11

intra-obdominal and retroperitoneal (drains testes)

Question 12

What are the 2 division of superficial inguinal lymph nodes?

Answer 12

horiztonal (below inguinal ligament: drains superficial lower back, butt, external genitalis, perianal region) and vertical groups (near saphenous vein, drains most of the leg except the heel and outer aspect of foot)

Question 13

Where does the heel and outer foot drain to?

Answer 13

deep to the popliteal space, so no visible lymphadenopathy

Question 14

What are the 4 broad categories of causes of lymphadenopathy?

Answer 14

infection, inflammatory, malignancy, medication

Question 15

What are the 4 basic infectious disease causes of lymphadenopathy?

Answer 15

viral, bacterial, fungal/mycobacterial, spirochetal (syphilis or lyme disease)

Question 16

What is mononucleosis? What causes it? What are the classic triad of symptoms?

Answer 16

~80% caused by Epstein Barr Virus, triad of fever, tonsillar pharyngitis, lymphadenopathy

Question 17

What are the symptoms of HIV/AIDS in early/acute infection? in latent/chronic? in late-stage progression to AIDS?

Answer 17

early - fever, chills, fatigue, malaise, sore throat.
latent/chronic - usually none
late stage progression to aids - night sweats, fever, unintentional weight loss, fatigue, mouth sores,
generalized lymphadenopathy with all?

Question 18

Describe lymphoma and it’s presenting sxs?

Answer 18

it is a malignancy of the lymphocytes. most common presentation is painless enlargement of the lymph nodes. B-symptoms include fatigue, fevers, night sweats, unintentional weight loss

Question 19

What is leukemia?

Answer 19

it is a malignancy of a single white blood cell line, with out of control growth to the bone marrow and/or lymph system.

Question 20

What are the common sxs of leukemia?

Answer 20

fatigue, SOB, abnormal bleeding, bruising, petechiae

Question 21

What is the difference between acute and chronic leukemia?

Answer 21

acute is a rapid increase in immature WBC cell line, ill-appearing. chronic is a mature WBC cell line that develops over years and is found incidentally in lab work

Question 22

What is needed to make a metastatic solid tumor diagnosis?

Answer 22

biopsy

Question 23

What is the name of the node dubbed “the seat of the devil? Where is it located?

Answer 23

Virchow’s node is in the left-sided supraclavicular region, junction of thoracic duct and left subclavian vein.

Question 24

What sign is associated with an enlarged Virchow’s node? What does it signal?

Answer 24

Trosier’s sign, metastatic gastric of abdominal cancer

Question 25

What medications can cause lymphadenopathy?

Answer 25

anti-epileptics, antibiotic, anti-hypertensives, anti-gout

Question 26

What inflammatory or immunologic diseases can cause lymphadenopathy?

Answer 26

systemic lupus erythematous, rheumatoid arthritis

Question 27

What is lymphedema?

Answer 27

lymph load is greater than the transport capacity, causing an abnormal accumulation of interstitial lymph fluid

Question 28

What are the primary (1) and secondary (4) causes of lymphedema?

Answer 28

congenital abnormality; fluid volume overload, obesity, pregnancy, cancer, inflammatory disorders

Question 29

What are the primary descriptor words for the 4 stages of lymphedema?

Answer 29

1 - asymptomatic with abnormal flow but no fluid, 2 - swelling and pitting, 3- permanent swelling non-pitting, 4- lymphostatic elephantiasis very deformed

Question 30

What are the 4 grades of edema?

Answer 30

1: 2mm barely detectable
2: 4mm deep pit with few seconds to rebound
3: 6mm deep pit 10-12 seconds to rebound
4: 8mm very deep pit >20 seconds to rebound

Question 31

What 4 steps are there to lymph inspection?

Answer 31

neck symmetry, visible enlargement of nodes, unilateral/bilateral extremity swelling, sacral and peripheral areas

Question 32

What are the 4 best practices of palpation of lymph areas?

Answer 32

no creepy finger (use finger pads), small circular motions, remove skin tension, move skin over underlying tissues

Question 33

What are the 5 areas to palpate for the lymph assessment?

Answer 33

cervical, epitrochlear, axillary, inguinal, pre-tibial pressure