Lymphatics

Question 1

Why do lymphatic collecting vessels have lots of valves? [1]

Answer 1

V. low pressure environment: stops back flow

Question 2

Describe lymph. circulation from lympathic capillary to the lymphatic duct

Answer 2

Lymphatic capillary –> l. collecting vessels –> lymph nodes –> lymph trunk –> lymphatic duct

Question 3

Lymph travels into the lymph node via [] lymphatic vessels

Lymph leaves via the [] lymphatic vessel

Answer 3

Lymph travels into the lymph node via tha afferent lymphatic vessels

Lymph leaves via the efferent lymphatic vessel

Question 4

Which two vessels connect at the venous angle? [2]

Answer 4

IJV joins subclavian vein

Question 5

What is chylothorax? [1]

Why may it occur? [1]

Answer 5

Chylothorax: leakage of lymph into the pleural cavities

Can cccur due thoracic duct damage

Question 6

Name 3 main superficial lymph nodes xx

Answer 6

Cervical
Axillary
Inguinal

Question 7

What are the paths for the deep and superficial cervical lymph nodes?

Answer 7

Superficial cervical lymph nodes run down external jugular vein.

Drain to the deep cervical lymph nodes: run down internal jugual vein

Question 8

What is the cisterna chyli? [1]

Answer 8

The cisterna chyli is the abdominal origin of the thoracic duct, and it receives the bilateral lumbar lymphatic trunks. It is located in the retrocrural space, to the right side and behind of the abdominal aorta.

Question 9

Label A-F of the lymph node

Answer 9

A: afferent lymphatic vessels
B: trabeculae
C: capsule
D: cortex
E: medulla
F; efferent lympahtic vessels

Question 10

Which of the following is where the lymphocytes are located in the lymph node?

A
B
C
D
E
F

Answer 10

Which of the following is where the lymphocytes are located in the lymph node?

A
B
C
D : cortex
E
F

Question 11

Lymph from which parts of the body drains into the right lymphatic duct and the thoracic duct? [2]

Answer 11

The right lymphatic duct drains lymph from the right upper limb, right side of thorax and right halves of head and neck

The thoracic duct drains lymph into the circulatory system at the left brachiocephalic vein between the left subclavian and left internal jugular veins from the rest of the body

Question 12

Label A & B xx

Answer 12

A: Thoracic duct
B: Left venous angle

Question 13

Where is the primary site of cancer for elevated virchows node? [1]

Answer 13

GI cancer

Question 14

Which lymph vessels run over the SCM? [1]

Answer 14

Vessels enter superficial cervical lymph nodes along the course of the EJV (over SCM). Efferent vessels→ deep chain

Question 15

Name the superficial cervical nodes [6]

Answer 15

Parotid
Buccal
Submental
Submandibular
Retroauricular
Occipital

Question 16

Label A-F

Answer 16

A: Parotid
B: Buccal
C: Submental
D: Submandibular
E; Retroauricular
F: Occipital

Question 17

What is the difference in lymph node feel when malignant compared to when fighting infection? [2]

Answer 17

Infection: firm, tender, enlarged and warm.

Malignancies: Firm, non-tender, matted (i.e. stuck to each other), fixed (i.e. not freely mobile but rather stuck down to underlying tissue), and increase in size over time

Question 18

Which are more likely to develop cancer:

Anterior cervical nodes
Deep cervical nodes

Answer 18

Which are more likely to develop cancer:

Anterior cervical nodes
Deep cervical nodes

Question 19

Which are more likely to develop cancer:

Anterior cervical nodes
Deep cervical nodes

Answer 19

Which are more likely to develop cancer:

Anterior cervical nodes
Deep cervical nodes

Question 20

What is a radical masectomy vs a modified radiacl masetcomy?

Answer 20

A radical mastectomy involves the removal of all breast tissue, along with the nipple, axillary lymph nodes and a portion of pectoralis major. This is rarely performed today.

A modified radical mastectomy involves **removal of the breast, nipple and most axillary lymph nodes. **

Question 21

What is a radical masectomy vs a modified radiacl masetcomy?

Answer 21

A radical mastectomy involves the removal of all breast tissue, along with the nipple, axillary lymph nodes and a portion of pectoralis major. This is rarely performed today.

A modified radical mastectomy involves **removal of the breast, nipple and most axillary lymph nodes. **

Question 22

What is a method for identifying which lymph node a tumour drains into?

Answer 22

Sentinel Lymph node identification:
Insert radioactive dye into the tumour: drains w/ the lymph into lymph node – shows first node

Question 23

Exactly where are the inguinal lymph nodes located? [1]

Answer 23

of the femoral triangle [1]

Question 24

What are the two groups of inguinal lymph nodes and where are they located? [2]

Where do they recieve drainage from? [2]

Answer 24

• Vertical – lie along termination great saphenous vein: Majority of superficial lymphatics from leg
• Horizontal – (run superficial to inguinal ligament)
  Superficial lymphatics from anterior abdominal wall, the perineum, and the external genitalia (excl. testes)

Question 25

What are the two groups of inguinal lymph nodes and where are they located? [2] Where do they recieve drainage from? [2]

Answer 25

- **Vertical** – lie along termination great saphenous vein: **Majority of superficial lymphatics from leg** - **Horizontal** – (run superficial to inguinal ligament) **Superficial lymphatics from anterior abdominal wall, the perineum, and the external genitalia** (excl. testes)

Question 26

Efferents from superficial lymph nodes drain to the **[]** inguinal nodes

Answer 26

Efferents from superficial lymph nodes drain to the **deep** inguinal nodes

Question 27

What is the path of the testes lymphatic drainage? What is the path of the scrotum lymphatic drainage? What is the path of the ovaries lympahtic drainage?

Answer 27

What is the path of the testes lymphatic drainage? **Testes --> preaortic aorta** What is the path of the scrotum lymphatic drainage? **Scrotum --> superficical inguinal nodes** What is the path of the ovaries lympahtic drainage? **Ovaries --> preaortic aorta**

Question 28

What is the path of the testes lymphatic drainage? What is the path of the scrotum lymphatic drainage? What is the path of the ovaries lympahtic drainage?

Answer 28

What is the path of the testes lymphatic drainage? **Testes --> preaortic aorta** What is the path of the scrotum lymphatic drainage? **Scrotum --> superficical inguinal nodes** What is the path of the ovaries lympahtic drainage? **Ovaries --> preaortic aorta**

Question 29

FYI

Answer 29

Deep lymphatics accompany arteries and receive drainage from internal organs.

Question 30

Lymph from the internal and external iliac nodes drains into the [] nodes and then the [] nodes. Lymph from the GI tract drains into the [] lymph nodes ([], [] and [] nodes) Intestinal + right and left lumbar trunks drain to []

Answer 30

Lymph from the internal and external iliac nodes drains into the **common iliac nodes** and then the **lumbar nodes.** Lymph from the GI tract drains into the **pre-aortic lymph nodes** (**celiac, superior mesenteric and inferior mesenteric nodes**) Intestinal + right and left lumbar trunks drain to **cisterna chyli** (beginning of thoracic duct)

Question 31

Label A-C

Answer 31

A: Cisterna chyli B: Pre-aortic C: Iliac

Question 32

deep drainage of the thorax xx

Question 33

The spleen is a site of: [] proliferation [] filtration, destruction and storage.

Answer 33

The spleen is a site of: **lymphocyte** proliferation **RBC** filtration, destruction and storage.

Question 34

Label A-D

Answer 34

A: Palatine B: Lingual C: Pharyngeal D: Tubal tonsils

Question 35

What is waldeyers ring? [4]

Answer 35

Waldeyer's ring consists of four tonsillar structures: - **pharyngeal** - **tubal** - **palatine** - **lingual** As well as small collections of lymphatic tissue disbursed throughout the mucosal lining of the pharynx (mucosa-associated lymphoid tissue, MALT).

Question 36

Where do you find each of the following tonsils? Palatine [1] Lingual [1] Pharyngeal [1] Tubal [1]

Answer 36

Palatine: between **palatoglossal & palatopharyngeal** Lingual: **back of tongue** Pharyngeal adenoids if enlarged: **top of nasopharynx** Tubal tonsils: **opening of eustachian tube**

Question 37

What is lymphatic filariasis?

Answer 37

Roundworm infection of lymph nodes blocking the lymphatic drainage so interstitial fluid builds up in the tissues.

Question 38

From the breast: - 75% drains into [] nodes - 25% goes to [] nodes

Answer 38

Clinically important because of relationship to breast 75% of lymph drains into **axillary** node from breast 25% goes to **parasternal** nodes

Question 39

What are the axillary lymph nodes? [4] Where do they drain lymph from? [4] Ddescribe their path to to L / R venous angle [2]

Answer 39

**Humeral** lymph nodes drain from **upper limb** **Pectoral** lymph nodes drain from **anterior chest wall** (majority drains into here) **Subscapular** lymph nodes drain from** posterior chest wall** (rotator cuffs etc) Together: go to **central** --> **apical** --> **supraclavicular** --> **left / right venous angle**

Question 40

Describe the path of deep drainage of the thorax lymphatics

Answer 40

Sub pleural plexus --> interlobal lymph vessels --> interpulmnarry lobes --> inferior trachea bronchiol nodes --> superior trachea bronchiole lobes --> bronchomediastinal trunks --> L / R venous angle

Question 41

Which of the following recieves lymphatric drainage from the heart? Interpulmonary nodes Superior tracheobronchial nodes Inferior tracheobronchial nodes Bronchomediastinal trunks Interlobar lymph vessels

Answer 41

Which of the following recieves lymphatric drainage from the heart? Interpulmonary nodes Superior tracheobronchial nodes **Inferior tracheobronchial nodes** Bronchomediastinal trunks Interlobar lymph vessels

Question 42

Which of the following is located around the hilum of the lung? Interpulmonary nodes Superior tracheobronchial nodes Inferior tracheobronchial nodes Bronchomediastinal trunks Interlobar lymph vessels

Answer 42

Which of the following is located around the hilum of the lung? Interpulmonary nodes **Superior tracheobronchial nodes** Inferior tracheobronchial nodes Bronchomediastinal trunks Interlobar lymph vessels

Question 43

The thoracic duct enters the thorax through the [] and travels in the [] mediastinum between the [] and the [] vein.

Answer 43

The thoracic duct enters the thorax through the **aortic hiatus** and travels in the **posterior mediastinum** between the **aorta** and the **azygos vein**.

Question 44

Where do you find each of the following is called the adenoids if enlarged? Palatine Lingual Pharyngeal Tubal

Answer 44

Where do you find each of the following is called the adenoids if enlarged? Palatine Lingual **Pharyngeal** Tubal