Lymphatics OSCE Flashcards
(42 cards)
1
Q
if the shape of a lymph node is irregular, what should you think?
A
- regular is round
- think cancer
2
Q
color of skin observations
A
- should be unchanged from baseline
- red: infection
- pale: other
3
Q
tenderness of lymph nodes
A
- regular: none
- large and tender: infection (fast process)
- large and non tender: lymphoma (slower process)
4
Q
what is the regular consistency of lymph nodes?
A
- regular: spongy
- hard is not normal
5
Q
Virchow’s Node
A
- on left side, supraclavicular
- enlarged due to metastasis
- could mean intra-abdominal cancer because abdomen drains to deep visceral–>cisterns chyli–>thoracic duct–>Virchow
6
Q
where is the superior and inferior inguinal LN?
A
- find ASIS and move medial and inferior
- –inferior to femoral triangle
7
Q
what is the significance in the epitrochlear inguinal LN?
A
- superior and posterior to medial humeral epicondyle
- if it is enlarged, could mean secondary syphilis
8
Q
5 treatment zones of lymphatic OMT treatment
A
- thoracic inlet down to thoracoabdominal diaphragm
- abdominal diaphragm down to pelvic diaphragm
- upper extremities
- lower extremities
- head and neck
9
Q
goal of lymphatic OMT treatment
A
move lymph centrally
10
Q
what to start with and end with in lymphatic OMT treatment?
A
- open thoracic inlet
- treat thoracic inlet again at end
11
Q
thoracic inlet myofascial release
A
- purpose move lymph centrally
- position: drive the bus, pt supine with doc at head of table
- technique: index fingers on SC joint, angle rib 1, thumb on T1 transverse process
- –press toward pt’s feet and twist hands to feel ROM
- –if restrict to one side, perform direct technique until feel tissue creep
12
Q
pectoral traction treatment
A
- purpose: increasing negative pressure on thorax
- position: pt supine with doc at head of table
- technique: grasp inferior border of pec at anterior axilla
- –arms extended, apply cephalic traction bilaterally
- –pull when pt inhales and resist on exhale
13
Q
doming diaphragm
A
- purpose: relax diaphragm so it can produce greater pressure gradients to promote lymph drainage back to venous circulation–improves diaphragm excursion/frees up diaphragmatic motion and thus improves ability to move lymph back centrally
- position: pt supine with doc at side of table facing cephalad
- technique: doc’s hand on infracostal region, below thoracic cage (xiphoid process) with fingertips/thumbs pointing cephalad
- –have pt take deep breath and press down on exhalation and resist on inhalation
- –repeat 3-4 times on last time move thumbs cephalad under xiphoid
14
Q
rib raise seated
A
- purpose: stimulates sympathetic chain ganglia, improved lymph flow
- position: pt seated with doc standing facing pt
- technique: pt cross arms and lean towards doc
- –grasp posterior inferior rib angle lateral to transverse process
- –apply anterolateral traction and pull cephalad toward doc
- –continue up ribs
15
Q
rib raise supine
A
- purpose: stimulates sympathetic chain ganglia, improved lymph flow
- position: pt supine with doc standing on side to treat
- technique: contact rib angles–start bottom to top
- –flex fingers and apply traction by rocking backward
16
Q
tapotement treatment
A
- purpose: loosen up lateral in lungs and get expulsion of it
- position: pt supine with doc at side of table
- technique:
- –hacking–karate chop its ulnar side of hands
- –cupping–cup hands
- –slapping–palmar surface
17
Q
thoracic pump
A
- purpose: affect pressure gradients, indicated for clearing thoracic dict region especially for COPD, URI, LRI, swollen upper extremities, enhance immune fcn
- repetitive
- position: pt supine with doc at head of table
- technique: place thenar eminence of each hand over respective pectoral muscle just inferior to clavicle on ribs 2-4
- –apply rhythmic pumping at a rate of 110-120 times/min
18
Q
vacuum version of thoracic pump
A
- purpose: affect pressure gradients, indicated for clearing thoracic dict region especially for COPD, URI, LRI, swollen upper extremities, enhance immune fcn
- position: pt supine with doc at head of table
- technique: place thenar eminence of each hand over respective pectoral muscle just inferior to clavicle on ribs 2-4
- –as pt exhales, apply a compressive force downward and maintain end point in inhalation
- –continue for 4-5 breaths
- –at beginning of last inhalation, briskly remove hands to allow for rapid deep inhalation
19
Q
abdominal pump treatment
A
- purpose: indirectly affects pressure gradients, indirectly massage thoracic duct at its origin in cisterna chyli
- position: pt supine with doc next to pt
- technique: palms on abdomen with fingers towards the pt’s head and thumbs side by side
- –pump in a rhythmic manner at 20-30 times per minute
20
Q
sacral rocking
A
- purpose: relax muscles at lumbosacral joint
- position: pt prone with doc at side
- technique: heal of cephalad hand on sacral base with fingers pointing towards the coccyx, caudad hand on top
- –exert a gentle pressure downward
- –alternate direction following respiration
21
Q
effleurage of zone 3
A
- purpose: aid in movement of lymph toward central core
- position: pt supine, doc at side, standing
- –raise pt’s arm up to allow gravity to assist in drainage
- technique: doc’s other hand induces a stroking force directed distal to proximal on affected arm
22
Q
petrissage of zone 3
A
- purpose: aid in movement of lymph toward central core
- position: pt supine, doc at side, standing
- –raise pt’s arm up to allow gravity to assist in drainage
- technique: doc induces a kneading/twisting force directed distal to proximal on affected arm utilizing both hands
23
Q
effleurage of zone 4
A
- purpose: aid in movement of lymph toward central core
- position: pt supine, doc at side, standing
- –raise pt’s leg up to allow gravity to assist in drainage
- technique: doc’s other hand induces a stroking force directed distal to proximal on affected arm
24
Q
petrissage of zone 4
A
- purpose: aid in movement of lymph toward central core
- position: pt supine, doc at side, standing
- –raise pt’s leg up to allow gravity to assist in drainage
- technique: doc induces a kneading/twisting force directed distal to proximal on affected arm utilizing both hands
25
pedal pump
- purpose: motion/fluid wave in body passively moves fluid centrally by creating an oscillatory pump
- position: pt supine with doc at feet
- technique: contact plantar portion of feet, dorsiflex feet
- --apply a cephalad force to induce repetitive force to khyperdorsiflex feet
- --do at 100x/min
26
iliotibial band effleurage
- purpose: reduce lymphatic congestion to aid other treatments to the IT band
- position: pt is lateral recumbent with affected side up and doc facing pt
- technique: doc's cephalad hand contacts the pt's greater trochanter for stabilization
- --make a C shape and contact IT band
- --start 1/2 way down leg and move distal to proximal
- --then, after freeing of some congestion, move just superior to knee and stroke distal to proximal
27
cervical stroking
- purpose: stretch muscle groups surrounding cervical vertebrae
- position: pt supine with doc at head of table
- technique: place hands along paravertebral muscles and slowly stroke in a caudal direction
28
anterior cervical traction
- purpose: stretch muscle groups surrounding cervical vertebrae
- position: pt supine with doc at head of table
- technique: locate anterior and posterior border of inferior portion of SCM muscle
- --place thumb along anterior margin, the second through 5th digits on posterior margin
- --gently lidt anteriorly and laterally until relaxation
- --move superiorly to middle portion then again at most superior
- --repeat up to 3 times
29
pre and post auricular
- purpose: move congested lymph in ear region, temporal scalp, and lateral eyelids
- position: pt seated with doc at front or behind pt
- technique: spread fingers around ear to contact
- --apply a CW and CCW motion to auricular lymph nodes
30
mandibular drainage: galbreath technique
- purpose: direct pressure technique to move lymph for eustachian tube dysfunction, lymphatic congesting in ENT, or submandibular region
- position: pt supine and rotate head to doc, doc opposite side of tx
- technique: place cephalad hand on TMJ with fingertips and thenar eminence on rams
- --apply a slow, repetitive downward traction on mandible from angle out (face raking)
31
submandibular
- purpose: direct pressure technique to move lymph around trachea and esophagus
- position pt supine or seated with doc at head
- technique: walking fingers motion under mandible to chin, massage
32
anterior tracheal/deep cervical
- purpose: direct pressure technique to move lymph around trachea and esophagus
- position: pt supine or seated with doc at head of table
- technique: place fingers lateral to trachea, move from side to side in downward direction
33
supra hyoid and infra hyoid cricoid release
- purpose: direct pressure technique to move lymph from tongue, lips, upper neck jaw
- position: pt supine with doc standing
- technique: place fingers lateral to hyoid bone, gently move from side to side
34
what LN can you use for otitis externa?
-pre and post auricular
35
what does normal LN feel like?
-pea sized, round, spongy, moveable
36
what does abnormal LN feel like?
irregular, larger, tender, red, warm
37
4 parts of axillary triangle
- apex at top
- rib: central/medial
- scapula: posterior axillary
- pectoral: anterior axillary
38
epitrochlear LN
- medial on epicondyle
| - enlarged in secondary syphilis
39
what is the contraindication for bacterial infection?
-do not do if no antibiotics and temp above 102 deg
40
thoracic pump rate
110-120
41
abdominal pump rate
20-30
42
pedal pump
100
