LYMPHATICS

Question 1

What organs are associated with the lymphatic system?

Answer 1

spleen
tonsils
thymus
bone marrow

Question 2

Is lymphedema associated with chronic ARTERIAL or chronic VENOUS insufficiency?

Answer 2

venous insufficiency

Question 3

What is a good test to differentially diagnose lymphedema from lipidemia?

Answer 3

stemmer’s sign: positive in lymphedema, negative in lipidemia

Question 4

Is involvement typically unilateral or bilateral for lipidemia?

Answer 4

bilateral

Question 5

What is lymphadenopathy?

Answer 5

enlargement of lymph nodes usually d/t infection

Question 6

T/F: chemotherapy can result in lymphedema.

Answer 6

false, it’s radiation

Question 7

T/F: Trauma can damage lymph flow.

Answer 7

true; burns/scars/wounds can damage or impede lymph flow

Question 8

What is filariasis?

Answer 8

international cause for secondary lymphedema via mosquito-borne disease

Question 9

In volumetric measurement, how much % difference from one side to the other is considered lymphedema?

Answer 9

10%

Question 10

What is the blood pressure assessment restriction for those with lymphedema?

Answer 10

it SHOULD NOT be taken on the affected side

Question 11

You’re assessing your patient and you find hard, immobile lymph nodes. What are your next steps?

Answer 11

refer to physician, as this is likely cancerous issuez

Question 12

You’re assessing your patient and find soft, tender lymph nodes that move easily. Pt has no known infection. What are your next steps?

Answer 12

refer to doc if no known corresponding illness

Question 13

Your patient comes into your outpatient clinic with edema in her R leg only. What do you need to rule out first before you think it might be lymphedema?

Answer 13

DVT in RLE
post thrombotic syndrome
arthritis
bakers cyst

Question 14

What diagnostic test is able to diagnose lymphedema?

Answer 14

lymphoscintigraphy

Question 15

What is CDT?

Answer 15

complete decongestive therapy: manual lymph drainage, short stretch compression bandages, exercises, functional training, skin care, and lymphedema education

Question 16

What would be a contraindication to begin CDT?

Answer 16

poorly controlled CP disease (won’t tolerate excess fluid on heart)
- or kidney disease

Question 17

With Debbie’s lymphedema (just BLEs), where would you have began MLD?

Answer 17

at thoracic duct (clear here first for LUE, BLEs, and torso)

• clear at R lymphatic duct for RUE

Question 18

What activities are contraindicated for exercise in patients with lymphedema?

Answer 18

strenuous activities, jogging, ballistic movements, rotational movements
- all exacerbate lymphedema

Question 19

Your patient with RUE lymphedema begins to have aching pain in her armpit with the UE exercise you’re giving her. . What could this indicate, and what should you do?

Answer 19

could indicate lymph overload: discomfort, aching, pain, change in skin color in proximal lymph areas
- stop activity if any of the above are present

Question 20

What kind of exercise should you give your patients with lymphedema?

Answer 20

walking/cycling/water aerobics

Question 21

T/F: Nail care and observation is very important with lymphedema

Answer 21

yes, randomly; need regular inspection and cleansing, as well as protection with appropriate footwear

Question 22

What modalities can you not use on your patient with lymphedema?

Answer 22

anything that causes vasodilation, increasing lymph load

• heat (paraffin, sauna)
• ice
• contrast bath
• hydrotherapy

Question 23

If using pressure pumps, do you want high pressure or low pressure for phase II management of lymphedema?

Answer 23

low pressure (>45mmHg CONTRAINDIC)
- high pressure can damage lymph nodes, may move water instead of proteins, and increase genital lymphedema (if on LEs)