Term
| Every tissue supplied by blood vessels has lymphatic vessels except which two organs? |
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Definition
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Term
| roles of the lymphatic system |
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Definition
1. movement of lymph
2. production of lymphocytes
3. production of antibodies
4. phagocytosis
5. manufacture of blood when the primary sources are pathophysiologically compmromised |
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Term
| lymphatic drainage point for the right upper body |
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Definition
| lymphatic trunk that empties into the right subclavian vein |
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Term
| lymphatic drainage point for the rest of the body (except right upper body) |
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Definition
| thoracic duct into the left subclavian vein |
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Term
| lymph drainage of the lower extremity |
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Definition
| small saphenous lymph vessels --> popliteal nodes --> great saphenous lymphatic vessels --> inferior superficial inguinal nodes --> deep sublinguinal node --> superior superficial inguinal nodes |
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Term
| lymphatic drainage of female genital tract |
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Definition
| deep inguinal nodes --> superficial inguinal nodes --> obturator nodes --> external and internal iliac nodes --> common iliac nodes --> preaortic nodes |
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Term
| lymphatic drainage of the trunk |
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Definition
| preaortic nodes --> mesentery nodes (cisterna chiyli) --> mediastinal nodes --> bronchial nodes --> trachial nodes --> thoracic duct and lymphatic trunk |
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Term
| lymphatic drainage of upper limb and shoulder |
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Definition
radial lymphatic vessels --> epitrochlear nodes --> brachial (axillary) nodes --> central nodes --> subclavian nodes --> supraclavicular
**brachial --> subscapular --> external mammary (anterior pectoral) --> central nodes
**medial pec = internal mammary --> mammary (Rotter) nodes --> central |
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Term
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Definition
| preauricular, posterior auricular (mastoid), parotid, sternomastoid, retropharyngeal (tonsilar), interanl jugular chain |
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Term
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Definition
| submandibular, submental, sublingual, suprahyoid, thyrolinguofacial, anterior deep and superficial cervical, posterior cervical spinal nerve chain, posterior superficial cervical chain, internal jugular chain, supraclavicular |
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Term
| normal size of lymph nodes |
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Definition
| usually tiny but some as large as 0.5-1 cm |
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Term
| from where do lymphocytes arise? |
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Definition
| primarily produced in the bone marrow; also lymph nodes, tonsils, adenoids, and spleen |
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Term
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Definition
formed in bone marrow
produce antibodies and are characterized by various arrangements of immunoglobulins on their surface
responsible for humoral immune response
have relatively short life span = 3-4 days |
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Term
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Definition
made in bone marrow, and then flow to thymus for further differentiation
found in profusion in the centers of lymph nodes
responsible for controlling immune response brought on by B-lymphocytes (cellular response)
more numerous than B cells and live 100-200 days |
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Term
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Definition
| made up of lymphatic nodules and diffuse lymphatic tissue |
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Term
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Definition
| made up of venous sinusoids (contains blood-filtered macrophages) |
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Term
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Definition
"the tonsils", set between the palatine arches on either side of the pharynx
composed mainly of lymphoid tissue and organized in follicles and crypts (both covered by mucous membranes) |
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Term
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Definition
"adenoids"
located at the nasopharyngeal border |
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Term
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Definition
| located near the base of the tongue |
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Term
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Definition
raised areas of lymph tissue in the mucosa of the small intestine (ilium)
consist of clustered lymphoid nodules |
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Term
| when does the immune system and the lymphoid system begin to develop? |
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Definition
| about 20 weeks of gestation |
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Term
| when is the thymus the largest relative to the rest of the body? |
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Definition
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Term
| when is the thymus at its greatest absolute weight? |
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Definition
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Term
| which lymphoid tissue (tonsil) is much larger during early childhood than after puberty? |
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Definition
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Term
| which nodes are commonly palpable before 2 years of age, but would be abnormal/significant if palpable after 2 years of age? |
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Definition
| inguinal, occipital and postauricular nodes |
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Term
| which nodes are almost always abnormal if palpable at any age? |
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Definition
supraclavicular nodes
high association with malignancy |
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Term
| which nodes are uncommonly palpable during the first year, but much more common in older children? |
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Definition
| cervical and submandibular nodes |
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Term
| effect of pregnancy on the immune system |
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Definition
1. leukocyte count increases (increased segmented neutrophils or granulocytes due to increased estrogen and cortisol levels)
2. increased susceptibility to certain infectious diseases
3. can lead to remission in the mother of autoimmune/inflammatory disease |
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Term
| effect of old age on lymph system |
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Definition
1. number of lymph nodes my diminish and size may decrease
2. nodes are more likely to fibrotic and fatty = impaired ability to resist infection |
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Term
| lymphadenopahty (adenopathy) |
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Definition
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Term
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Definition
| inflammation of the lymphatics that drain an area of infection; tender erythematous streaks extend proximally from the infected area; region nodes may also be tender |
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Term
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Definition
| edematous swelling due to excess accumulation of lymph fluid in tissues caused by inadequate lymph drainage |
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Term
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Definition
| more likely to be malignant |
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Term
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Definition
| most likely it is an inflammation |
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Term
| benign vs. malignant node enlargement |
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Definition
benign = slow nodal enlargement over weeks or months
malignant = rapid enlargement without inflammation |
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Term
| True or false: a node fixed to surrounding tissue is an expected finding. |
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Definition
| false, this is a cause for concern |
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Term
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Definition
| inflamed or enlarged lymph node(s) |
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Term
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Definition
| congenital malformation of dilated lymphatics |
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Term
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Definition
| small nodes that feel like BBs or buckshot under the skin |
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Term
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Definition
wavelike motion that is felt when the node is palpated
suggest suppuration from infection |
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Term
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Definition
| group of nodes that feel connected and seem to move as a unit |
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Term
| are cancerous nodes usually tender? |
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Definition
| no; malignant nodes are usually harder than expected and contralateral nodes are asymmetric |
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Term
| infections of the ear usually drain to which nodes? |
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Definition
| preauricular, retropharyngeal and deep cervical nodes |
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Term
| which nodes are usually affected in TB and what do they feel like? |
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Definition
cervical chain nodes
are usually "cold", soft, matted and not tender or painful |
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Term
| where are the supraclavicular nodes felt (during disease states)? |
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Definition
| anterior to the sternocleidomastoid muscle and above the clavical |
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Term
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Definition
firm, palpable supraclavicular nodes (usually on the left); known as a "signal node"
if on the left = may be a sign of either abdominal or thoracic malignancy |
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Term
| which nodes drain the lungs? |
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Definition
| mediastinal collecting ducts |
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Term
| immunizations (BCG and smallpox) can cause temporary enlargement of which nodes? |
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Definition
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Term
| where are epitrochlear nodes found? |
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Definition
| proximal and slighly anterior to the medial epicondyle of the humerus in the groove between between the triceps and biceps muscles |
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Term
| which nodes lie close to the surface over the inguinal canals? |
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Definition
| superior superficial inguinal (femoral) nodes |
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Term
| to where do the vulva and lower 1/3 of the vagina drain? |
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Definition
the inguinal nodes
**enlargement of these nodes suggest infection or metastatic carcinoma |
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Term
| which nodes may be readily visible in very thin children? |
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Definition
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Term
| what is the usual shape of normal nodes (often seen in children)? |
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Definition
| globular or ovoid, sometimes flatter or more cylindrical |
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Term
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Definition
mumps
painful swelling of the parotid glands unilaterally or bilaterally |
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Term
| mumps vs. cervical adenitis |
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Definition
| cervical adenitis does not ordinarily obscure the angle of the jaw and mumps will |
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Term
| which diseases often present with obvious cervical nodes, usually posterior rather than anterior? |
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Definition
common childhood diseases: rubella, rubeola, and varicella
also Hep A and B and infectious mononucleosis |
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Term
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Definition
inflammation of one or more lymphatic vessels
causes = pathogenic organism
S/O data = enlarge lymph nodes, pain, mailaise, possible fever, minor trauma to the skin distal to the area of infection, red streak in skin following course of lymphatic collecting duct, sometimes indurated and palpable to gentle touch |
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Term
| Acute suppurative lymphadenitis |
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Definition
infection and inflammation of a lymph node; may affect a single or localized group of nodes
causes = group A beta-hemolytic streptococci and coagulase-positive staphylococci (most common), actinomycotic adenitis (from dental disease), mycobacteria (in presence of TB infection), pasteruella multocida infection (from dog or cat bite), systemic viral infections
S/O data = enlarged lymph nodes may be firm, tender and painful, overlying skin appears red within 72 hours |
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Term
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Definition
| characterized by inflammation without warmth that may or may not be slightly tender (from TB infection) |
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Term
| Lymphedema (pathophys, S/O data) |
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Definition
edematous swelling due to excess accumulation of lymph fluid in tissues caused by inadequate lymph drainage
causes:
primary = hypoplasia and maldevelopment of lympatic system (more common in females)
secondary = acquired damage to regional lymph nodes (tumors, scar tissue, surgical removal of lymph nodes), filariasis (parasite)
S/O data = painless swelling of limb, gradual onset, may or may not pit, skin thickens and feels tougher than normal |
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Term
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Definition
Stage 0 = latent or subclinical
Stage I = pitting may occur; early accumulation of fluid relatively high in protein content, subsides with limb elevation
Stage II = tissue fibrosis present; limb elevation does not relieve it; pitting may be present
Stage III = pitting is absent; trophic skin changes are present (acanthosis, fat deposits and warty overgrowths) |
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Term
| Lymphangioma/cystic hygroma |
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Definition
congenital malformation of dilated lymphatics
cause = failure of complete development of lymphatic system
S/O data = commonly found in neck, painless cystic mass, usually seen in 1st year of life (enlarged after URI), asymptomatic when in the back but can cause decreased respiratory function when in the front; compressible spongy fluid-containing mass without discrete margins |
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Term
| Lymphatic filariasis (elephantiasis) |
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Definition
massive accumulation of lymphedema throughout the body; most common cause of secondary lymphedema worldwide
causes = filarial worms (wucheria bancrofti and grugia malayi = transmitted by mosquitoes)
S/O data = swelling of limb or body area, may be asymptomatic or may see fever, chronic pulmonary infection and progressive lymphedema |
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Term
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Definition
malignant neoplasm of the lymphatic system and reticuloendothelial tissues
occur most commonly in lymph nodes of chest, neck, abdomen, tonsils, and skin
most arise in B-cell; rest occur in T-cells
S/O data = painless enlarged lymph nodes, fever, weight loss, night sweats, abdominal pain or fullness, family hx common, nodes may be matted in posterior cervical triangle, nodes usually well defined and solid
**cannot distinguish these condition from those of Hodgkins disease through PE alone |
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Term
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Definition
Malignant lymphoma
causes = unknown etiology; EBV most likely involved
spreads to other lymph nodes, spleen, liver and bone marrow
occurs often in the yong and in people older than 50 y old (more common in males)
Most often stars in B-cells located in lymph nodes in the neck area
S/O data = painless enlarged cervical lymph nodes in post triangle (matted and firm, almost rubbery), abdominal pain, sometimes fever, hx of mono, usually asymmetric, nodal size may be fluctuate |
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Term
| Epstein-Barr Virus Mononucelosis |
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Definition
infectious mononuecleosis
incubation period = 30-50 days
S/O data = malaise, fatigue, acute or prolonged fever, headache, sore throat, nausea, abdominal pain and myalgia
prodromal period = 1-2 weeks
generalized lymphadenopahty (epitrochlear nodes are especially suggestive of mono), hepatomegaly, splenomegaly (2-3cm below costal margin), pharyngitis with tonsilar enlargement, petechiae at junction of the hard and soft palate |
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Term
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Definition
zoonosis, caused by parasite Toxoplasma gondii
causes = ingestion or inhalation of oocysts in soil/fomites, undercooked meat or raw eggs, cat feces or litter
infection persists for life without signs of disease, can cause neuologic disease in immunocompromised pt and congenital infection in pregnant women
S/O data = no significant symptoms, single node is chronically enlarged and nontender (usually in the post cervical chain) |
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Term
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Definition
infection by human herpes virus 6
common in infancy with peak age of acquisition at 2 years
virus present in saliva and passed to children; can stay dormant and produce recurrent infections
S/O data = fever (usually high grade over 3-4 days), sometimes associated with respiratory illness and lymphadenopathy (with tenderness = involves occipital and postauricular chains), when fever diminishes = morbilliform fine maculopapular rash occurs (spreads from trunk to extremities) |
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Term
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Definition
infection of human herpes virus 1 (HSV-1) or human herpes virus 2 (HSV-2)
HSV-1 = transmitted by oral secretions; predilection for oropharyngeal infection
HSV-2 = transmitted by genital secretions and causes mainly genital infection
HSV causes lytic infection of fibroblasts and epithelial cells, and establishes latent infection in neurons
S/O data = burning, itching lesions, may have enlargement of the anterior cervical and submandibular nodes (movable and tender) |
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Term
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Definition
A common cause of subacute or chronic lymphadenitis in children
caused by Baronella henselae (most common) and B. quintana or Afipia felis; usually following a bite or scratch from a kitten or cat
S/O data = inoculation lesion (papule or pustule lasts 3-5 days then becomes vasicular and crusts in 2-3 days); painful enlarged lymph nodes; nodes large, tender, red and occasionally suppurate (pus forming) |
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Term
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Definition
| S/O data = enlarged lymph nodes (generalized lymphadenopathy), more prolonged clinical latent period in children |
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Term
| Serum Sickness (Type III hypersensitivity reaction) |
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Definition
serum sickness is an immune complex disease
causes = antigen
S/O data = enlarged lymph nodes, pain pruritus and erythematous swelling at the injection site, urticaria, rash, joint pain, fever and facial edema
medication that cause it = Beta-lactam antibiotics, sulfonamide, antibiotics, minocycline
symptoms become apparent 7-10 days following administration of substance, symptoms subside slowly, recurring at times over several weeks |
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Term
| Latex Allergy Type IV dematitis (delayed hypersensitivity) |
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Definition
Allergic contact dermatitis caused by latex products
S/O data = allergy to cross-sensitizing foods (banana, avocado, potato, tomato, kiwi); skin reaction usually begins 24-48 hours after contact, vesicular lesions, erythema, rxn may progress to oozing skin blisters |
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Term
| Latex Allergy Type I Reaction |
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Definition
true allergic reaction to latex
caused by protein antibodies (IgE) to latex
S/O data = allergy to cross-sensitizing foods; local urticaria, generalized urticaria with angioedema, asthma, eye/nose itching and GI symptoms, anaphylaxis |
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