Ch 9 and Ch 10 (Lymphatic, Head, Neck) Flashcards Preview

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Flashcards in Ch 9 and Ch 10 (Lymphatic, Head, Neck) Deck (111)
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1

What are the 7 parts of the lymphatic system?

fluid, collecting ducts, lymph nodes, spleen, thymus, tonsils, adenoids, and peyer patches.

2

Can you find parts of the lymphatic system in the stomach, appendix, bone marrow and lungs?

yes

3

if (blank) is failing the patient may suffer from allergies, immune deficiency, or autoimmune diseases

lympathic system

4

The only tissues in the body that do not have lymphatic vessels are the (blank) and (blank)

brain and placenta

5

Fluid balance, production of lymphocytes, production of antibodies, phagocytosis of other cells/foreign bodies, backup of normal hematopoietic cells and (blank)

absorption of fat soluble substances from the GI tract

6

What color is lymph?

clear to yellow

7

What has cellular components mostly made of WBC’s “lymphocytes” with possible RBC’?.

lymph fluid

8

The microscopic ducts eventually coalesce and drain into the venous system at the (blank)

subclavian veins.

9

The lympathic system relies on the (blank) for flow

cardiovascular system

10

What are these:
Encapsulated structures that usually occur in groups. Superficial nodes are in the subcutaneous tissue. Deeper nodes exist in body cavities and under fascia and muscles. Most are smaller than 0.5 to 1cm.

lymph nodes

11

(blank) are a hint at the lymphatic system’s function via inspection/palpation for changes from baseline. Changes are mostly seen due to infection or malignancy.

superficial lymph nodes

12

(blank) cause an increase in lymphocyte counts.

Viral infections

13

Where is the spleen located?

left upper quadrant

14

The (blank) are activated by inhaled and intranasal antigens.

palatine tonsils

15

lymphatic system begins at (blank) gestation but is still immature at birth.

20 weeks

16

(blank) should always start a possible suspicion for malignancy.

Supraclavicular nodes

17

Palpable lymph nodes (inguinal, occipital, and postauricular nodes) after (blank) of age are more likely to be abnormal and indicate infection in children

2 years

18

Hep A, Hep B, Rubella, rubeola, and varicella, often present with obvious (blank)

Posterior cervical nodes

19

What makes for a suspicious node?

fast growing, immovable, painful, and large (2 cm) , should keep an eye out of bigger than .5cm

20

Is it a problem to have children with enlarged palantine tonsils?

no

21

Diphenylydantoin, aspirin, barbiturates, penicillin, tetracyclin, iodide, cephalosporin, sulfonamide, mesanoin can cause what>

nodal enlargement

22

What are the signs of mumps (epedmic parotiditis)?

painful swelling of parotid gland, and swelling of salivary glands on the mandible

23

How can you tell the difference between mumps and cervical adenitis?

cervical adenitis doesnt obscure the angle of the jaw and you can separate the node from the angle so you can feel the jaw.

24

(blank) is lymph tissue in the mucosa of the small intestine.

peyers patches

25

The umbilical cord should drop off by (blank) weeks after birth. If it hangs on longer->immune system defect

1-2

26

If cervical and submandibular nodes are present in the first year of life is this abnormal?

yes!

27

(blank) nodes should always start a possible susupicion for malignancy.

supraclavicular

28

Changes in pregnant women are due to (blank X 3)

progesterone, estrogen, and cortisol levels

29

In pregnant women what increases cells increase?

their leukocytes form 7200 to 8500 with largest increase in neutrophils and granulocytes

30

What type of immunity is increased in pregnant women?

humoral immunity (possibel decrease in autoimmune/inflammatory disease)

31

Who does this happen to?
Number and elements of lymph nodes are lost; the nodes may become fatty and fibrotic, leading to decreased ability to fight infection.

Older adults

32

What is pruritis?

itchy sensation

33

What is this for?
Character: onset, location, duration, number, tenderness
Associated local symptoms: pain, redness, warmth, red streaks
Associated systemic symptoms: malaise, fever, weight loss, night sweats, abdominal pain or fullness itching “pruritis”
Predisposing factors: infection, surgery, trauma
Medications: chemotherapy, antibiotics
Swelling of Extremity
Unilateral or bilateral, intermittent or constant
Predisposing factors: cardiac or renal disorder, surgery, infection, trauma, venous insufficiency
Associated symptoms: warmth, redness or discoloration, ulceration
Efforts at treatment and their effect: support stockings, elevation

HPI of enlarged lymph nods

34

What is this for?
Chest radiographs; reason and results
Tuberculosis and other skin testing
Blood transfusions, use of blood products
Chronic illness: cardiac, renal, malignancy, HIV infection
Surgery: trauma to regional lymph nodes; organ transplant
Recurrent infections
Autoimmune disorder
Allergies

PMH for enlarged lymph nodes

35

What is this important for?
Malignancy, anemia, recent infectious diseases tuberculosis, immune disorders, hemophilia

FH for enlarged lymph nodes

36

What is this important for?
Travel (Asia, Africa, Western Pacific, India, Philippines), Recreational drugs (Especially injected), ETOH use, Sexual History (HIV risk factors.)

Personal/social history

37

What are these important for?
Recurrent infections: tonsillitis, adenoiditis, bacterial infections, oral candidiasis, and chronic diarrhea. Recent infections or trauma distal to nodes, poor growth/Failure to thrive, Loss of interest in playing/eating, immunization history, maternal HIV infection, hemophilia

For infants

38

What are these important for?
weeks of gestation, exposure to rubella or other infections, Pets in household (cat feces etc.)

Pregnant women

39

What is this important for?
Autoimmune disease, recent infection/trauma distal to affected L nodes, delayed healing.
Diseases involving the lymphatic system: Toxoplasmosis, Roseaola infantum (HHV-6), HSV 1 or 2, cat scratch disease, HIV/AIDS, Serum sickness, Latex allergy type IV dermatitis, Latex allergy type I reaction

Older Adults

40

What is tenderness indicative of?

inflammation

41

Are cancerous nodes large and tender?

just large, not tender

42

How and what should you palpate and inspect for when looking at lymph nodes?

Use the pads of your fingers to lightly palpate note the consistency, mobility, tenderness, size and warmth.

43

What is lymphadenopathy (adenopathy)?

enlarged lymph nodes

44

What is lymphadenitis?

inflamed and enlarged lymph nodes

45

What is lymphangitis?

inflammation of the lymphatics that drain an area of infection; tender erythematous streaks extend proximally from the infected area; regional nodes may also be tender

46

What is lymphedema?

edematous swelling due to excess accumulation of lymph fluid in tissues caused by inadequate lymph drainage

47

What is lymphangioma?

Congenital malformation of dilated lymphatics

48

What are small nodes that feel like BBs or buckshot under the skin called?

shotty

49

What are wavelike motion that is felt when the node is palpated?

fluctuant

50

What are a group of nodes that feel connected and seem to move as a unit?

matted

51

Where are these nodes located:
Occipital, Postauricualr, Preauricular, parotid, retropharyngeal, submandibular, Submental, Anterior/Posterior Cervical Nodes, Supraclavicular (Virchow’s Node)

Head and neck

52

Axilla, Inguinal and Popliteal Fossa, Spleen are found where?

not the head and neck

53

(blank) are common sites of metastatic disease.

Supraclavicular nodes

54

The harder the node and the more discrete, the more likely it is a (blank)

malignancy

55

The more tender the node the more likely it is an (blank)

inflammation

56

Do nodes pulsate?

NOOOO!!! arteries do

57

A palpable (blank) node on the left is a significant clue to thoracic or abdominal malignancy

supraclavicular node

58

Slow growth means benign while fast growth without inflammation suggests (blank)

malignancy

59

If an enlarged lymph node is found examine (blank)

PALS
P=primary site A=all associated nodes
L= liver S=spleen

60

How is the order of the 6 step node check in the head done?

alphabetical order
Occipital, postauricular, presauricular, partorid and retropharyngeal, submandibular, submental

61

immunizations can cause what?

lymph node enlargement

62

Grading of lymphedema
Stage 0
Stage 1
Stage 2
Stage 3

0= latent or subclinical
1= pitting may occur, there is early accumulation of fluid relatively high in protein content and subsides with elevation
2=tissue fibrosis present. Limb elevation alone rarely reduces tissue swelling. Pitting may be present. Late stage 2, the limb may or may not pit as tissue fibrosis supervenes.
3= pitting is absent. Trophic skin changes are present (acanthosis, fat deposits, warty overgrowths)

63

Red pulp consists of (blank)
White pulp consists of (blank)

venous sinusoids
Lymphatic nodules

64

(blank) exist in body cavities and under fascia and muscles

Deeper nodes

65

The lymph nodes that are most accessible to inspection and palpation include
The necklace of nodes which are what?

axillary
epitrochlear
supperficial superior inguinal
Superficial inferior inguinal
popliteal

66

When does lymphadenopathy require further investigation?

older patients w/ localized and persistent lymphadenopathy, young adults and children w/ localized supraclavicular lymphadenopathy, posterior cervical lymphadenopathy adds a risk for malignancy, more than lymphadenopathy that occurs in the anterior cervical chain, any lump that grows rapidly and insistently at any age

67

Is lymphangioma or hemangioma transilluminate?

Lymphangioma is transilluminate

68

From the hyoid bone to the trachea name everything in between?

hyoid bone, cricothyroid ligament, thyroid cartilage, cricoid cartilage, thyroid gland, pyramidal lobe, right lobe, isthmus, left lobe, trachea

69

What is this important for?
A. OLDCARTS (as it relates to complaint) – onset, location, duration, character, alleviating/aggravating factors, radiation, timing, severity
B. Focus –Head injury, headache, stiff neck, thyroid disorders

HPI head and neck

70

What is this important for:
Immunizations…CHF/Cancers, Hypertension, Asthma, Diabetes, Stroke)
B. Focus: Trauma, subdural hematoma, recent lumbar puncture, radiation treatment of head/neck, Headaches (vascular/migraine), previous surgeries, seizure disorder, thyroid disorders

PMI for head and neck

71

What is this important for?
Headaches: type, character
Thyroid disorders

FH for head and neck

72

What is this important for?
Employment/exposures, stress, Potential risk of injury, Nutrition/skipping meals, EtOh use, Drug use
Infants-intrauterine exposures of etoh/drugs, birth history, unusual head shape, ability to control head, any acute symptoms of illness, congenital anomalies, neonatal screening
Pregnant women-Weeks Gestation, pre-existing disease, Thyroid function, Pregnancy induced HTN, Drug Use
Older adults- dizziness or vertigo, weakness, fall risk, drug use

Social history for head and neck

73

What do you inspect for with the head and face?

Position, facial features, facies, symmetry, tics, size, shape

74

Coarse, dry and brittle hair may be associated with what?

hypothyroidism

75

(blank) has moon facies with thin erythemetous skin;

cushing syndrome

76

(blank) has Dull, puffy, yellowed skin, coarse sparse hair, temporal loss of eyebrows periorbital edema, and prominent tongue;

myxedema

77

(blank) has fine moist skin with fine hair, prominent eyes and lid retraction and staring/startled expression,

hyperthyroid

78

(blank) has butterfly rash

SLE/Lupus

79

(blank) has (CN VII) Facial asymmetry not able to close one eye, drooping of lower eyelid and mouth, loss of naso labial fold;

Bell's palsy

80

(blank) has (CN VII) Facial asymmetry not able to close one eye, drooping of lower eyelid and mouth, loss of naso labial fold;

Acromegaly

81

(blank) has depressed nasal bridge, epicanthal folds, low set ears, large tongue; Fetal alcohol syndrome-smooth philtrum, wide set eyes, mild ptosis, thin upper lip.

Down syndrome

82

Upon palpation of head and neck what should you feel for?

Feel for shape, fusion of sutures (after 6 months), note texture of hair, temporal artery, salivary glands

83

When do you percuss?
What is a sign for hypocalcaemia?

only for hypocalcaemia (percussion on the masseter muscle may produce a hyperactive masseteric reflex denoting a chvostek sign)
-Trousseau's sign

84

Occasionally auscultation can be used when necessary, a bruit can be heard over the eyeball, temple, and occiput; by using the (blank) of the stethoscope

bell

85

What is this important for?
Symmetry, anterior/posterior triangles, Jugular venous distention, carotid artery prominence, webbing, edema, thyroid enlargement

Inspection of the neck

86

What is this important for?
(may be difficult due to body habitus): midline trachea, hyoid bone, thyroid and cricoid cartilage, tracheal rings, May also elicit Cardarelli’s sign and Oliver’s sign for aortic aneurysm.

palpation of neck

87

What signs are important for aortic aneurysm?

Cardarellis and Oliver's

88

What is this?
may involve inspection, palpation and auscultation. Have the patient slightly extend their neck, from the lateral view evaluate gland size while swallowing. Palpation can be done from in front of or behind the patient. Using one hand to deviate the trachea and the pads of the first three fingers on the other hand to evaluate for enlargement, masses, and texture. If the thyroid appears enlarged, auscultation is indicated to evaluate for increased vascularity/bruit.

Thyroid Exam

89

What is this important for:
measure head circumference, check for symmetry of shape, skin lesions, bulging or dented areas of the scalp/skull (caput vs. cephalohematoma)

Inspection of infant head

90

What is this important for:
Face: symmetry, features, paralysis, color, texture

Neck: Symmetry, size, shape, edema, neck veins, masses (Thyroglossal duct cyst vs. brachial cleft cyst, webbing and excessive nuchal skin, or fractured clavicle vs. cystic hygroma

Inspection of infant face and neck

91

What is this important for?
Identify suture lines, fontanels (Check for mastoid fontanel) tender areas of the scalp, molding from vaginal delivery usually resolves by 1 week of age.
Fontanels close by 24 months of age and should not measure greater than 4-5cm.
A bulging fontanel may be an indicator of hydrocephalus, intracranial mass, meningitis etc.
While palpating the scalp palpate firmly above and behind the ears for craniotabes.

Transillumination is performed in a dark room and can indicated increased fluid vs. decreased brain mass.

Palpation of the infant head

92

What is this important for?
palpate the sternocleidomastoid muscle for masses, palpate the trachea, and attempt to palpate the thyroid.

Palpation of the infant neck

93

Fontanels close by (blank) of age and should not measure greater than 4-5cm.

24 months

94

A bulging (blank) may be an indicator of hydrocephalus, intracranial mass, meningitis etc.

fontanel

95

(blank) is a thinning and softening of the infantile skull

craniotabes

96

Hyperpigmentation of the face “mask of Pregnancy is (blank)

cholasma

97

Who does this happen in?
Hyperpigmentation of the face "Cholasma". The thyroid gland hypertrophies and may have an associated bruit.

pregnant women

98

Whos is this important in?
may vary with nutritional intake. Use caution when evaluating range of motion. Note any pain, crepitus, dizziness, jerkiness, or limitations on movement. The thyroid will likely feel more fibrotic, nodular, and irregular.

old people

99

What are these?
Salivary gland tumor, thyroglossal duct cyst, brachial cleft cyst, torticollis (wry neck), Hypo/Hyperthyroid, Myxedema, Grave’s disease, Hashimoto disease

Infants; Encephalocele, Microcephaly, craniosynostosis.

Important disease states for the head and neck

100

If you have high serum TSH what will you get?
If you have low serum TSH what will you get?

hypothyrdoism
Hyperthyroidism

101

(blank) is caused by iodine deficiency

goiter

102

In the normal gland, the right lobe is often (blank) than the left

larger

103

What kind of headache only happens at night?
only at morning?

cluster
hypertensive

104

Are cranial bruits common in children up to 5 yrs of age or who have anemia?

yes

105

Is it normal for pregnant women to have hypertrophy of thyroid gland?

yes

106

Does the thyroid gland move with swallowing?

yes (subcutaneous fat doesnt)

107

(blank) often feels firm and well defined upon palpation while (blank) feels soft with poorly deefined margins

Cephalohematoma
caput

108

Caput succedaneum is bleeding between the (blank) and the periosteum, while cephalohematoma is bleeding between the periosteum and the (blank).

skin of the scalp
bone of the skull

109

Ossification of sutures begins after completion of brain growth at age (blank) and finished by adulthood

6

110

The skull is composed of how many bones?

7

111

What are the palpebral fissures and the nasolabial folds?

major landmarks of the face