Lymphedema Quiz 2

Question 1

How is lymphedema characterized?

Answer 1

Chronic disease with no cure
Swelling in affected area (normally an extremity)
Swelling occurs due to impaired flow of lymph fluid

Question 2

What type of tissue does lymphedema primarily affect?

Answer 2

Subcutaneous fatty tissue

Question 3

What’s the epidemiology of lymphedema?

Answer 3

Patients with breast cancer and radiation (10-40% incidence range)

Question 4

Why is lymphedema becoming more prevalent?

Answer 4

Patients with cancer living longer
Obesity Rates are rising
Population is aging

Question 5

What is the purpose of the lymphatic system?

Answer 5

Return fluid and protein from interstitial spaces to the vascular system (has no basement membrane, allows vessels to absorb larger molecules)

Question 6

What are the 2 functions of the lymphatic system?

Answer 6

Maintain pressure and volume of interstitial fluid and blood by returning excess water and dissolved substances
Assist the immune system at the lymph nodes and other lymphatic tissue with lympocytes and macrophages

Question 7

How much fluid is absorbed per day?

Answer 7

2-4L

Question 8

What is lymph fluid consisted of?

Answer 8

Protein
Water
Fatty Acids
Salts
White Blood Cells
Microorganisms
Debris

Question 9

What does the superficial and deep vessels of the lymphatic system drain?

Answer 9

Superficial - drains skin and subcutaneous tissues

Deep - Drains tissues to the fascia and below (located with major blood vessels, especially veins)

Question 10

What is the order of vessels in the lymphatic system from smallest to largest?

Answer 10

Capillaries -> Precollectors -> Collectors -> Nodes -> Trunks -> Ducts

Question 11

Which vessels have valves in the lymphatic system?

Answer 11

Collectors

No valves in precollectors, fluid flows in direction of low pressure

Question 12

What are some characteristics of acute lymphedema?

Answer 12

Lasts less than 6 months (reversible)
Pitting edema with pressure
Lack of brawny skin changes

Question 13

What are the risk factors for acute lymphedema?

Answer 13

Surgical drains with leakage of drainage back into surgical site
Acute injury to a limb
Radiation therapy
Infection
Phlebitis

Question 14

What are some characteristics of chronic lymphedema?

Answer 14

Not reversible

Skin Changes likely

Question 15

What are the the 2 types of chronic lymphedema?

Answer 15

Primary - Idiopathic or Congenital

Secondary - Acquired

Question 16

Where does primary lymphedema generally involve?

Answer 16

Leg or legs

Question 17

What are the 3 classifications of primary lymphedema and how old are patients affected?

Answer 17

Congenital =

Question 18

What is secondary lymphedema most commonly asociated with?

Answer 18

Malignancy and subsequent treatment

Question 19

What are some ways dysfunction generally occurs at the lymph nodes?

Answer 19

Surgery
Radiation
Trauma
Infection
Malignancy
Scar Tissue

Question 20

What happens at stage 0 of lymphedema?

Answer 20

Reversible
Swelling is not evident
Damage to lymphatic function has occurred
May exist for months or years before swelling is detectable

Question 21

What happens in stage 1 of lymphedema?

Answer 21

Reversible
Lymph fluid with high protein content
Fluid dissipates after the involved limb is elevated
Pitting edema begins distally
No palpable fibrosis
Negative or borderline Stemmer sign

Question 22

What are the levels of pitting edema

Answer 22

0+ no pitting edema
1+ Mild pitting edema (2mm depression that dissapears rapidly
2+ Moderate (4mm takes 10-15 seconds to disappear)
3+ Moderately severe (6mm takes more than a minute)
4+ Severe (8mm that lasts for 2 minutes)

Question 23

What is stage 2 of lymphedema?

Answer 23

Irreversible
Pitting edema is present
Non-pitting edema develops
Limb elevation doesn't reduce edema
Tissue fibrosis starts
Positive Stemmer sign
Skin Thickens
Skin has rough cobblestone appearance and texture

Question 24

What is stage 3 of lymphedema?

Answer 24

Irreversible
Also known as Elephantiasis
Pitting edema NOT present
Increased skin changes

Question 25

What is the Stemmer’s Sign/Test?

Answer 25

Inability to pinch a skin fold on dorsal aspect at base of 2nd toe (or base of middle finger)

Question 26

Can you get a false positive with Stemmer’s Sign/Test?

Answer 26

No

Question 27

What is Lipedema?

Answer 27

Fat deposition in irregular patterns/amounts
Predominately found in legs
Can lead to lymphedema due to tissue congestion

Question 28

What causes lipedema?

Answer 28

Unknown
Female hormones suspected
-puberty
-Pregnancy
-Around time of menopause

Question 29

Does lipedema respond to compression therapy?

Answer 29

Not really