Function of lymph nodes + spleen

Question 1

Function of the lymphatic system

Answer 1

filter lymph + return lymph to the circulation (prevents oedema)

Question 2

primary lymphoid tissues

Answer 2

bone marrow

thymus

Question 3

secondary lymphoid tissues

Answer 3

lymph nodes
spleen
tonsils

Question 4

what in lymph nodes ensures unidirectional lymph flow

Answer 4

valves

Question 5

what cells are seen in lymph nodes

Answer 5

Lymphocytes: B cells, T cells, NK cells
Macrophage
Dendritic cells
Endothelial cells

Question 6

where do B cells mature

Answer 6

bone marrow

Question 7

where do T cells mature

Answer 7

Thymus

Question 8

where in the lymph node is lymph filtered

Answer 8

node parenchyma

Question 9

marker for B cell

Answer 9

CD20

Question 10

marker for T cell

Answer 10

CD3

Question 11

causes of lymphadenopathy

Answer 11

local inflammation
systemic inflammation
malignancy (haematological/metastatic)
other conditions e.g. sarcoidosis

Question 12

what is lymphangitis

Answer 12

superficial infection may see red lines extending up lymph tract from an inflamed lesion

Question 13

what would a lymphadenopathy of predominant B cells mean

Answer 13

autoimmune conditions

infections

Question 14

what would a lymphadenopathy of predominant phagocytic response mean

Answer 14

draining a tumour site

Question 15

what would a lymphadenopathy of predominant T cells mean

Answer 15

viral infections

drugs e.g. phenytoin

Question 16

what is a malignant lymphadenopathy called

Answer 16

lymphoma

Question 17

what does a generalised lymphadenopathy suggest

Answer 17

systemic inflammatory process or widespread malignancy

Question 18

where is the spleen located

is it palpable?

Answer 18

left upper quadrant

not usually palpable unless substantially enlgarged

Question 19

blood supply to the spleen

Answer 19

splenic artery

Question 20

what is the splenic artery a branch of

Answer 20

coeliac axis

Question 21

what vessel drains the spleen

Answer 21

splenic vein

Question 22

what two vessels form the portal vein

Answer 22

splenic vein

superior mesenteric vein

Question 23

what does the parenchyma of the spleen include

Answer 23

red pulp

white pulp

Question 24

contents of the red pulp of the spleen

Answer 24

sinusoids + cords (contain macrophage + some fibroblasts)

Question 25

what does the white pulp in the spleen do

Answer 25

comprises the peri-arteriolar lymphoid sheath (PALS) | Contains CD4+ cells and lymphoid cells

Question 26

how does PALS work

Answer 26

antigen reaches white pulp via the blood antigen presenting cells in the white pulp present antigen to immune reactive cells when stimulated by antigen, T and B cell responses may occur

Question 27

features of splenomegaly

Answer 27

dragging sensation in LUQ discomfort with eating pain if infarction hypersplenism

Question 28

triad of hypersplenism

Answer 28

splenomegaly fall in one or more cellular components of blood correction of cytopenias by splenectomy

Question 29

infective causes of splenomegaly

Answer 29

EBV, malaria, TB, typhoid

Question 30

congestive causes of splenomegaly

Answer 30

hepatic cirrhosis portal/splenic vein thrombosis cardiac failure

Question 31

haematological causes of splenomegaly

Answer 31

lymphoma/leukaemia haemolytic anaemia myeloproliferative disorders

Question 32

inflammatory conditions that can cause splenomegaly

Answer 32

rheumatoid arthritis | SLE

Question 33

causes of hyposplenism

Answer 33

splenectomy coeliac disease sickle cell sarcoidosis

Question 34

feature of hyposplenism

Answer 34

Howell-jolly bodies

Question 35

what do people need to be immunised against after a splenectomy

Answer 35

pneumococcus

Question 36

what is lymphoma

Answer 36

malignant lymphocytes that accumulate in the lymph node

Question 37

subdivisions of lymphoma

Answer 37

Hodgkin lymphoma | Non-Hodgkin lymphoma

Question 38

symptoms of lymphoma

Answer 38

painless, non-tender, rubbery/soft, asymmetrical lump NOT TETHERED fever, night sweats, weight loss, itch, pain, fatigue

Question 39

presentation of a viral lymphadenopathy

Answer 39

tender, hard and smooth lymph node

Question 40

presentation of a bacterial lymphadenopathy

Answer 40

tender, hard and smooth lymph node with skin inflamed

Question 41

how would a metastatic lymphadenopathy present

Answer 41

non-tender, hard lymph node with an irregular surface | TETHERED

Question 42

how is a lymphadenopathy investigated

Answer 42

FNA or core biopsy

Question 43

what investigation can be done to sub classify a confirmed lymphoma

Answer 43

immunohistochemistry

Question 44

4 types of Hodgkin disease

Answer 44

nodular sclerosis lymphocyte rich mixed cellularity lymphocyte depleted

Question 45

what cell type is associated with Hodgkin disease

Answer 45

reed Sternberg cells

Question 46

what immunomarker is +ve in non-hodgkin lymphoma

Answer 46

CD20

Question 47

what immunomarker is +ve in reed Sternberg cells (Hodgkin lymphoma)

Answer 47

CD30 and CD15

Question 48

two types of non-hodgkin lymphoma

Answer 48

T cell | B cell

Question 49

which type of non-hodgkin lymphoma is most common

Answer 49

B cell

Question 50

what is a B cell non-hodgkin lymphoma divided into

Answer 50

low grade B cell | high grade B cell

Question 51

how is a lymphoma staged

Answer 51

1. one group of glands above diaphragm 2. more than one group of glands either above or below diaphragm 3. both above and below the diaphragm 4. extra nodal disease

Question 52

what tissue is the spleen derived from

Answer 52

mesoderm

Question 53

weight of average spleen

Answer 53

150g