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ENT Advanced > Lymph Nodes > Flashcards

Lymph Nodes Flashcards

1
Q

What drives movement of tissue fluid?

A

Breathing and muscle contraction

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2
Q

Functional importance of lymphatic system?

A

Assists capillaries in return if plasma proteins that leak into extracellular space
Transport of cellular debris that doesn’t use the circulatory system
Absorbs/transports fats from the digestive system
Fluid balance of the body
Regulation of cell volume

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3
Q

Clinical importance of the lymphatic system?

A

Conduit for spread of infections and malignancies
Plasma protein return - major constituent of immune system
Site for primary tumours
Blockage leads to lymphoedema

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4
Q

Properties of lymph?

A 
Transudative fluid 
Transparent and yellowish
Alkaline
Water makes up 96%
Has solute such as proteins, lipids, glucose, electrolytes, cells
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5
Q

How much lymph is produced a day?

A

3-4L of lymph produced a day at rest

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6
Q

Name the lymph organs

A 
Bone marrow
Spleen
Thymus gland
Lymph nodes
Tonsils
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7
Q

What are the main cells in lymph nodes?

A

Phagocytes and macrophages

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8
Q

Describe the course of lymph fluid

A

Blind ended lymph channels (microscopic)
Become vessels
Large lymph vessels
Lymphatic trunks
Unite to form either right lymph duct or thoracic lymph duct
Ducts into the venous system at subclavian vein

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9
Q

Which lymphatic duct takes the most lymph?

A

Thoracic duct - 100ml

Right lymphatic duct only takes 20ml

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10
Q

Which parts of the body does the right lymphatic duct drain?

A

Right upper part including

  • right head
  • right neck
  • right thorax
  • right upper limb
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11
Q

Where does lymph from the right lymphatic duct enter the venous system at?

A

Right venous angle - at the union of the right internal jugular vein and right subclavian vein

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12
Q

Where is the lymphatic system absent?

A 
CNS
Eyeball
Inner ear
Cartilage 
Bone
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13
Q

What are the superficial and deep lymph nodes separated by in the head and neck?

A

Depp fascia of the neck

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14
Q

How are the lymph nodes of the head and neck arranged clinically?

A

Regional which drain specific anatomical regions
Terminal where the regional ones merge
Regional nodes -> terminal nodes -> trunks -> right/thoracic ducts

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15
Q

Where are the vertical lymph nodes found?

A

Vertical lane that closely follows course of the internal jugular vein
-difficult to palpate because they are deep in the tissues of the neck

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16
Q

How are the superficial lymph nodes arranged?

A

Outer circle - collar around the lower margins of the neck. Called peri-cervicular collar nodes from the chin to occipital

Inner circle - lie within outer circle. Surround upper airway passages and openings of alimentary passages. Aka innermost circle

17
Q

Which lymph nodes are found in the carotid sheath?

A

Deep/terminal lymph nodes
They surround the whole length of the internal jugular
Start from base of skull to the clavicle
Ultimately drain all lymph from head and neck
Most lymph reaching them has been drained by the inner and outer circles

18
Q

Where does lymph from the thoracic duct enter the venous system?

A

Left venous angle - at the union of the internal jugular vein and subclavian vein

19
Q

How are the lymph nodes of the head and neck grouped?

A

12 regional groups

1 terminal group aka deep cervical nodes

20
Q

Name the regional lymph nodes

A 
Occipital
Retroauricular aka mastoid
Parotid
Buccal aka facial
Submandibular
Submental
Anterior
Cervical
Superficial cervical
Retropharyngeal
Laryngeal
Tracheal
21
Q

Where are the superficial cervical lymph nodes found?

A

Along the course of the external jugular vein

22
Q

Name the lymph nodes in the terminal group

A

Jugulo-digastric - receives from tonsil and tongue

Jugulo-omohyoid - receives from tongue, oral cavity, trachea, oesophagus and thyroid

23
Q

What structure do the deep cervical nodes in the posterior triangle of the neck lie close to?

A

Accessory nerve - may have to be removed in the case of malignancy

24
Q

Where does lymph from the regional lymph nodes drain to?

A

Deep cervical lymph nodes - jugular lymph trunks

  • > left side joins the thoracic duct -> left brachiocephalic vein
  • > right side joins right lymphatic duct -> venous system at junction between the subclavian and internal jugular veins
25
Q

Where does the thoracic duct begin?

A

Cisterna chyli at L3

26
Q

What is lymphadenopathy?

A

Enlargement of the lymph nodes

27
Q

What can cause lymphadenopathy?

A

Malignancy

Infection

28
Q

On palpation, how can you tell if it’s a malignancy or an infection?

A

Malignancy
-craggy and not tender

Infection
-tender and smooth

29
Q

What is glandular fever caused by?

A

Epstein-Barr virus

-produces atypical lymphocytes

30
Q

Symptoms of glandular fever?

A

Swollen, tender lymph nodes
Fever
Fatigue
Sore throat

31
Q

What is lymphoma?

A

Solid tumour of lymphoid cells
-B or T cell
Originates in the lymph node

32
Q

What type of cancer is seen in the majority of head and neck cancers?

A

Squamous cell carcinoma

33
Q

What are head and neck cancers associated with?

A

Smoking
Alcohol
HPV

34
Q

How does head and neck cancer present?

A 
Lymphadenopathy
Mass in the neck
Sore throat
Dysphagia
Hoarseness
35
Q

Function of lymph nodes?

A

Phagocytic cells filter out particulate matter and micro-organisms
Antigens are presented to the immune system

36
Q

What happens in the cortex of lymph nodes?

A

B cells enter. If activated, they proliferate and become follicle-centres cells.
Take up the antigen, process it and present it to T cells. T cells cause development of B cells by release of cytokines (IL-4) and B cells become centrocytes or centroblasts.
Centroblasts leave the follicle and pass to the paracortex.
Become immunoblasts

37
Q

What is in the paracortex of the lymph nodes?

A

Lymphocytes - primary site for T cells. Also accessory cells and supporting cells.

38
Q

What is in the medulla of the lymph nodes?

A

Many macrophages
Blood vessels
Medullary cords which are rich in plasma cells
Medullary sinuses

ENT Advanced (24 decks)

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