SIEDEL CHAPTER 10

Question 1

Which of the following organs does not have lymphatic vessels? a. Brain b. Kidneys c. Liver d. Lungs

Answer 1

A Lymphatic tissues are found abundantly throughout the body except in two places, the placenta and the brain (central nervous system).

Question 2

The predominant formed elements of normal lymph fluid are a. red blood cells. b. white blood cells. c. platelets. d. antigens. e. antibodies.

Answer 2

B Lymph fluid is mostly composed of a variety of lymphocytes, minimal red blood cells, no platelets, and some antigens and antibodies according to its immune function.

Question 3

Cells that line the lymph node sinuses perform the specific function of a. fat absorption. b. fetal immunization. c. hematopoiesis. d. platelet production. e. phagocytosis.

Answer 3

E Lymph nodes defend against the invasion of microorganisms by phagocytosis.

Question 4

Lymph ducts merge into the venous system at the a. portal vein. b. pulmonic vein. c. subclavian veins. d. vena cava. e. jugular veins.

Answer 4

C The large ducts of the lymphatics merge into the venous system at the left and right subclavian veins.

Question 5

Lymph flows faster in response to a. massage. b. decreased blood volume. c. decreased metabolic rate. d. decreased permeability of the capillary walls. e. decreased capillary pressure.

Answer 5

A Lymph flow increases with mounting capillary pressure, greater permeability of the capillary walls, increased metabolic rate, and massage.

Question 6

An increased number of lymphocytes in the blood represents a systemic response to ____ infections. a. most bacterial b. most viral c. all parasitic d. HIV e. all fungal

Answer 6

B An increased number of lymphocytes in the blood represents a systemic response to most viral infections and to some bacterial infections.

Question 7

An organ that is essential to the development of protective immune function in infants but has little or no demonstrated function in adults is the a. spleen. b. appendix. c. thymus. d. pancreas. e. liver.

Answer 7

C In adults, the thymus atrophies, and in older adults, it is replaced by fat and connective tissue.

Question 8

The examination of the upper left quadrant of the abdominal cavity is essential to the evaluation of the immune system because of the location of which organ? a. Spleen b. Liver c. Thymus d. Pancreas e. Stomach

Answer 8

A The spleen is the largest of the lymphatic organs. It is located in the upper left portion of the abdomen.

Question 9

Enlarged tonsils and adenoids may obstruct the a. thoracic duct. b. esophagus. c. nasopharyngeal passageway. d. external auditory meatus. e. oral cavity.

Answer 9

C The palatine tonsils are located on either side of the pharynx, and the adenoids (pharyngeal tonsils) are found on the posterior wall of the pharynx, superior to the soft palate. If these structures become enlarged, they block the passage between the pharynx and the nasal cavity.

Question 10

When enlarged, which lymph nodes are most likely to be a sign of malignancy? a. Occipital b. Anterior cervical c. Posterior cervical d. Femoral e. Supraclavicular

Answer 10

E Supraclavicular nodal enlargement is of special concern because it suggests a malignancy even in children; it may be the sentinel node of Hodgkin lymphoma.

Question 11

Which lymphatic tissue is normally visible during the physical examination? a. Adenoids b. Peyer patches c. Palatine tonsils d. Thymus e. Submandibular

Answer 11

C The palatine tonsils are located at the back of the mouth on either side of the tongue and can be seen more readily than the adenoids. Submandibular nodes may be palpable but are not visible. Peyer patches are located in the small intestines, and the thymus is in the chest.

Question 12

Lymphoid tissue normally regresses to adult size by a. 2 years of age. b. 5 years of age. c. 10 years of age. d. puberty. e. the early 20s.

Answer 12

D The extent of lymphoid tissue is abundant in infants, increases in childhood, and regresses to adult size at puberty.

Question 13

A congenital defect in the immune system of a 2-week-old infant may be suspected if a. there are small, palpable inguinal nodes. b. the umbilical cord has not yet dropped off. c. the tonsils are visible. d. the thymus is visible on a chest radiograph. e. the small postauricular nodes are palpable.

Answer 13

B In some infants, delayed separation of the umbilical cord has been associated with abnormal granulocyte function.

Question 14

During pregnancy, the leukocyte count normally increases because of more a. reticulocytes. b. lymphocytes. c. atypical lymphocytes. d. polymorphonuclear leukocytes. e. monocytes.

Answer 14

D The type of leukocyte that increases during pregnancy is the polymorphonuclear leukocytes (neutrophils, eosinophils, and basophils), not the lymphocytes (including monocytes), reticulocytes, or atypical lymphocytes.

Question 15

As adults age, their ability to resist infection decreases because of lymphatic nodes becoming more a. hematopoietic. b. mucoid. c. porous. d. profuse. e. fibrotic.

Answer 15

E Older adults’ lymph nodes diminish in both number and size and are replaced with more fibrotic and fatty tissues.

Question 16

Which part of the hand is used to assess lymph node size? a. Pads of the fingers b. Tips of the fingers c. Palm d. Ulnar surface e. Dorsal surface

Answer 16

A The pads of the fingers are more sensitive and better for palpation than the fingertips and the palm; the ulnar surfaces of the hand and fingers are more sensitive for distinguishing vibration. The dorsal surface is more sensitive for distinguishing temperature.

Question 17

Which risk factor is least likely to result in contracting HIV? a. Prostitution b. Hemophilia c. Intravenous drug use d. Working with AIDS patients e. Sexual contact with intravenous drug users

Answer 17

D As a work-related risk for HIV infection, providing health care is considered rare. Multiple and indiscriminate sexual contacts, hemophilia, and intravenous drug use carry higher rates of transmission of HIV.

Question 18

Equipment for examining the lymphatic system includes a a. caliper. b. centimeter ruler. c. goniometer. d. syringe and needle. e. stethoscope.

Answer 18

B The centimeter ruler and the marking pencil are the only equipment needed for this system examination. They are used to measure and outline the borders of the nodes.

Question 19

Which nodes are most often associated with inflammation? a. Shotty b. Movable c. Fixed d. Tender e. Matted

Answer 19

D Tenderness is almost always indicative of inflammation.

Question 20

Nodes located nearest the palatine tonsils are the a. supraclavicular. b. retropharyngeal. c. submental. d. submandibular. e. posterior cervical.

Answer 20

B The retropharyngeal (tonsillar) nodes and the parotid nodes lie at the angle of the mandible. The submental and submandibular nodes lie more distal to the mandible. The posterior cervical nodes lie posterior to the sternocleidomastoid muscles The supraclavicular nodes lie superior to the clavicles.

Question 21

Nodes that are palpable just inferior to the chin are the a. infraclavicular. b. Virchow. c. submandibular. d. parotid. e. submental.

Answer 21

E Nodes most inferior to the chin and distal from the mandible are the submental nodes.

Question 22

Nodes located nearest the elbow are the a. supraclavicular. b. axillary. c. epitrochlear. d. popliteal. e. femoral.

Answer 22

C Nodes nearest the elbow are the epitrochlear, nearest the clavicle are the supraclavicular, nearest the knee are the popliteal, nearest the inguinal region are the femoral, and nearest the armpit are the axillary.

Question 23

Which landmark is the dividing line between the anterior and posterior cervical triangles? a. Clavicle b. Cervical spine c. Sternocleidomastoid d. Sternum e. Hyoid bone

Answer 23

C The landmark dividing the anterior and posterior cervical triangles is the sternocleidomastoid muscle.

Question 24

Which nodes are also called Virchow nodes? a. Internal mammary b. Anterior axillary c. Deep cervical d. Supraclavicular e. Preauricular

Answer 24

D The supraclavicular nodes are also referred to as Virchow nodes.

Question 25

The harder and more discrete a node, the more likely a(n) a. innocent cause. b. infection. c. malignancy. d. metabolic disease. e. drug reaction.

Answer 25

C Tender nodes almost always indicate the presence of an infection, but a hard, discrete, and nontender node is more likely to represent a malignancy.

Question 26

Normal supraclavicular lymph nodes are a. clustered in a capsule. b. firm and discrete. c. less than 3 cm in diameter. d. not palpable. e. matted.

Answer 26

D Supraclavicular nodes, when palpated, are a concern; normally, they are not palpable.

Question 27

Which of the following findings indicates that the examiner is assessing a blood vessel rather than a lymph node? a. A bruit b. Size less than 1 cm c. Tenderness d. Redness e. Warmth

Answer 27

A Pulsations and auscultation of bruits indicate a blood vessel and not a lymph node.

Question 28

Transillumination is done during an examination of the lymphatic system to a. detect lymphatic pulsation. b. distinguish nodes from cysts. c. evaluate nodal contours. d. observe erythematous lesions. e. distinguish blood vessels from nodes.

Answer 28

B Larger nodal masses should be transilluminated to determine whether the mass is a cyst, rather than a node.

Question 29

Nodes located at the base of the skull are the _____ nodes. a. preauricular b. postauricular c. occipital d. epitrochlear e. parotid

Answer 29

C The occipital nodes are at the base of the skull.

Question 30

Nodes located over the mastoid process are the _____ nodes. a. preauricular b. postauricular c. occipital d. epitrochlear e. posterior cervical

Answer 30

B Nodes located superficially over the mastoid process are the postauricular nodes.

Question 31

When examining lymph nodes near a joint in the arm or leg, which of the following maneuvers is likely to facilitate the examination? a. Extension of the extremity b. Circumduction of the extremity c. Abduction of the extremity d. Rotation of the extremity e. Flexion of the extremity

Answer 31

E Bending joint areas will ease taut tissues and allow for better accessibility to palpation.

Question 32

When examining the epitrochlear nodes, which joint should be supported? a. Elbow b. Knee c. Shoulder d. Wrist e. First metacarpophalangeal

Answer 32

A To palpate the epitrochlear nodes, you should support the elbow with one hand while you explore with the other hand.

Question 33

Palpation of the scalene triangle for supraclavicular nodes should be done with a. fingers hooked over the clavicle next to the sternocleidomastoid muscle. b. fingers along the depression above the medial humeral condyle. c. the pads of three fingers in a superficial circular motion. d. tissue rolled gently against the chest wall, moving sideways. e. the pads of the fingertips along the anterior surface of the trapezius muscle.

Answer 33

A Palpation of the supraclavicular lymph nodes is performed with the examiner’s hand gently flexing the patient’s head forward while the fingers of the opposite hand are hooked over the clavicle, lateral to the sternocleidomastoid muscle.

Question 34

To palpate the inguinal nodes, you should have the patient a. bend over a table and cough. b. lie supine, with the knees slightly flexed. c. lie supine, with the legs extended. d. stand with the back extended. e. lie prone, with the knees slightly flexed.

Answer 34

B To palpate the inguinal nodes, you should have the patient lying supine, with the knees slightly flexed.

Question 35

It is not unusual to find postauricular and occipital nodes in a. children younger than 2 years of age. b. school-age children. c. adolescents. d. adults. e. older adults.

Answer 35

A Children younger than 2 years of age often have enlarged postauricular and occipital nodes.

Question 36

Large palatine tonsils are common in a. females. b. children. c. adolescents. d. young adults. e. older adults.

Answer 36

B The palatine tonsils are larger in early childhood and are not necessarily an indication of infection.

Question 37

Obstruction of the nasopharynx, pulmonary hypertension, and risk of sleep apnea may be associated with excessively enlarged a. branchial cleft cysts. b. cystic hygromas. c. palatine tonsils. d. thyroglossal duct cysts. e. lymphangiomas.

Answer 37

C Palatine tonsil enlargement, grade 3+ to 4+, may obstruct the nasopharynx, which increases the risk of sleep apnea and, rarely, pulmonary hypertension. The other choices are congenital embryonic structures in the neck.

Question 38

The most important clue to the diagnosis of a child with an immunodeficiency disease is a. family history. b. illness in siblings. c. previous hospitalizations. d. serious recurring infections. e. cervical adenitis.

Answer 38

D Although family history, illness in siblings, and previous hospitalizations are helpful clues to discover an immunodeficiency in a child, it is most important to review the occurrence of serious, uncommon infections such as Pneumocystis jirovecii and other fungal infections that do not respond as expected to therapy.

Question 39

A red streak that follows the course of the lymphatic collecting duct is a finding associated with a. Hodgkin lymphoma. b. lymphangitis. c. lymphedema. d. non-Hodgkin lymphoma. e. roseola infantum.

Answer 39

B Lymphangitis, inflammation of the lymphatic vessels, is evident by a red streak that follows the course of the inflamed lymphatic duct. Hodgkin lymphoma and non-Hodgkin lymphoma refer to malignancies manifested primarily by nodal enlargements; lymphedema is lymph swelling that distinguishes itself from interstitial edema because it does not pit. Roseola is a common early childhood viral illness that may present with occipital and postauricular adenopathy.

Question 40

To find the infection site associated with acute lymphangitis, the examiner should look _____ to the inflammation. a. proximal b. distal c. contralateral d. anterior e. posterior

Answer 40

B The red streak of inflammation will follow the direction (proximal) of lymphatic flow, away from the periphery, and with the infection site distal to the streak.

Question 41

The most common causes of acute suppurative lymphadenitis are a. HIV and herpes zoster. b. Haemophilus influenzae and adenovirus. c. herpes simplex type 1 and type 2. d. streptococcal and staphylococcal organisms. e. mumps.

Answer 41

D Group A beta-hemolytic streptococci and coagulase-positive staphylococci are the most common organisms responsible for suppurative (pus-forming) lymphadenitis. The other choices do not result in suppurative lymphadenitis.

Question 42

Which disorder is characterized by a single node that is chronically enlarged and nontender in a patient with no other symptoms? a. Retropharyngeal abscess b. Streptococcal pharyngitis c. Mononucleosis d. Toxoplasmosis e. Herpes simplex

Answer 42

D Toxoplasmosis is displayed as a chronically enlarged, nontender, single node usually in the posterior cervical chain.

Question 43

Initial signs and symptoms of Epstein-Barr virus mononucleosis most often include a. pharyngitis, fever, and malaise. b. bleeding gums and spontaneous nosebleeds. c. headache, visual disturbance, and rash. d. inguinal adenopathy and painful urination. e. discrete labial and gingival ulcers and high-grade fever.

Answer 43

A Presenting symptoms of Epstein-Barr virus mononucleosis include pharyngitis, fever, fatigue, malaise, often splenomegaly, and occasionally hepatomegaly or rash.

Question 44

Enlarged inguinal nodes are likely to be associated with a. cat scratch disease. b. pelvic inflammatory disease. c. uterine cancer. d. testicular cancer. e. genital herpes.

Answer 44

E Uterine and testicular cancers are not inflammatory processes and are not likely to cause enlarged inguinal nodes. The female genitalia drain into the pelvis and the testes drain into the abdomen, where they are not accessible to inspection and palpation. Lesions to both the vulva and penile and scrotal areas cause inguinal nodal enlargement. Cat scratch disease usually involves the nodes of the head, neck, and axillae.

Question 45

Tender nodes associated with cat scratch disease are most commonly found in which area? a. Epitrochlear b. Popliteal c. Axilla d. Inguinal e. Supraclavicular

Answer 45

C Cat scratch disease results most commonly in nodal enlargement in the head, neck, and axillae. Although epitrochlear enlargement occurs most exclusively in cat scratch fever, its occurrence is less common.

Question 46

Which disorder is a dysfunction of cell-mediated immunity? a. Acute idiopathic polyneuritis b. Acquired immunodeficiency syndrome (AIDS) c. Epstein-Barr virus (EBV) mononucleosis d. Systemic lupus erythematosus (SLE) e. Toxoplasmosis

Answer 46

B HIV infection is characterized by a dysfunction of cell-mediated immunity (e.g., T lymphocytes). EBV is a viral infection, SLE is an autoimmune disorder, toxoplasmosis is a protozoan infection, and acute idiopathic polyneuritis (Guillain-Barré syndrome) is an immune disorder affecting the myelin sheaths.

Question 47

Serum sickness is usually characterized first by the appearance of: a. diffuse lymph node enlargement. b. joint pain. c. urticaria. d. fever. e. a single enlarged posterior cervical node.

Answer 47

C Urticaria is the first reaction of serum sickness followed by lymphadenopathy, joint pain, fever, and facial edema.