the end.

Question 1

What are the 3 main functions of the lymphatic system?

Answer 1

1. Drainage of the interstitial fluid from tissues
2. Absorbs and transports proteins and long chain fatty acids
3. Immune system response against infection, removes foreign organisms

Question 2

Lymph Fluid carries 4 Major things

Answer 2

1. Protein macromolecules
2. Excess water
3. Long chain fatty acids
4. Cell load-cell fragments

Question 3

This type of lymphatic vessel makes up 40% of the lymph system and absorbs fluid from the interstitium.

Answer 3

Superificial/initial lymphatics

Question 4

This type of lympatic vessel is considered the absorber and transporter and has unidirectional valves to direct lymph flow

Answer 4

Precollectors

Question 5

This type of lymphatic vessel is considered the transporting vessel, have one way valves toward the heart. it’s valves divide the lymph system into functional units called lymphangions

Answer 5

Collectors

Question 6

This type of lymphatic vessel is considered filter sites where lymphoctyes identify and destroy foreign material

Answer 6

Nodes

Question 7

Average axillary nodes are____ and aveage inguinal nodes are ____

Answer 7

10-24, 8-15

Question 8

Largest lymphatic trunk in the body, picks up L subclavian trunk and plugs into L subclavian Vein 75% of lymph drains here

Answer 8

Thoracic duct

Question 9

This lymphatic structure is very short and manages fluid of the right arm and torso above the waist, plugs into the R subclavain

Answer 9

R lymphatic duct

Question 10

This lymphatic structure you can find around L2, L lumbar trunk, R lumbar turnk and intestinal trunk collect here and then proceed to the thoracic duct

Answer 10

Cisterna Chyli

Question 11

Which nodes do most of the fluid of the lower body drain into

Answer 11

inguinal

Question 12

Skin of the abdomen, skin of the buttocks and most organs of the lower body with the exception of portions of the liver drain where?

Answer 12

right terminus

Question 13

Whole arm, skin of chest and skin of back drain in what type of node

Answer 13

axillary

Question 14

Intercostals drain to ____

Answer 14

thoracic duct and cisterna chyi directly

Question 15

Occurs when a fluid is forced through a membrane and as a result of the hydrostatic and osmotic pressure differences

Answer 15

Filtration

Question 16

List the 4 factors that lead to increased filtration

Answer 16

1. Heat
2. Exercise
3. Venous Congestion
4. Other (meds, hormones, ANS_

Question 17

Accumulation of lymphatic fluid that causes swelling in the tissues of an extremity or other body part. Occurs when lymphatic system is damaged causing flow to interrupt

Answer 17

Lymphedema

Question 18

This type of lymphedema is rare and is usually due to congenital malformation or impairment of lymphatics, Le affected most often

Answer 18

Primary lymphedema

Question 19

This type of lymphedma is acquired and more common caused by filiararsis, cancer tx, chronic VIs

Answer 19

Secondary Lymphedema

Question 20

What is the most common reason for lymphedema

Answer 20

Filiariasis

Question 21

This type of lympatic insufficiency occurs when normal lympatic vessels are overwhelmed by lympatic load. Usually due to CHF, Kidney dysfunction, hunger edema, burns, varicose veins.

Answer 21

Dynamic

Question 22

This type of lymphatic insufficiency has a normal lymphatic load but there is some type of impairment to the lymphatic system. Results in low flow, high protein edema.

Answer 22

Lyphostatic edema

Question 23

T/F functional lymphostatic edema is potentially reversivable but organic is not

Answer 23

true

Question 24

T/F organic scondary lymphostatic edema is most common

Answer 24

t

Question 25

____% of patients after breast cancer acquire lymphedema and ____% with prostate

Answer 25

23-45 and 70

Question 26

List the chief complaints in lymphedema

Answer 26

1. Limb heaviness 2. Paresthesia 3. Achiness 4. Skin tightness 5. Altered cosmesis 6. Decreasaed ADls/ROM

Question 27

Name the condition. Bilateral symmetrical increase in adipose tissue deposition in the abdomen, buttocks and LE, note in Feet. effect mostly women, triggered by puberty, preg, menopause

Answer 27

Lipedema

Question 28

Increase compliance of fat allows interstitial fluid to accumulate and leads to

Answer 28

lipolymphedema

Question 29

Stages of Lymphedema 1. Stage 0 2. Stage 1 3. Stage 2 4. Stage 3

Answer 29

Latent: no edema present, commonly due to radiation or surgery Reversible: edema that pits when digital pressure is applied Spontaneously Irreversible: does not pit when digital Lymphostatic elephatiatis: extreme increase in limb volume

Question 30

Unilateral Lyphedema Mild Moderate severe

Answer 30

Mild: <3cm Moderate 3-5 Severe: greater than 5 cm difference (circumf.)

Question 31

Describe a postive stemmer sign

Answer 31

fold of skin pinched and lifted up at the base of the second toe. Positive when skin fold is THICKER THAN 2 mm

Question 32

What is the gold standard for diagnosing lymphedema

Answer 32

Volumtry

Question 33

What are absolute contras to MLD

Answer 33

1. Acute infection 2. Untreated cancer 3. Thrombo

Question 34

Wound caused by friction to skin surface can be superficial or partial thickness

Answer 34

abrasion

Question 35

With a clean abrasion what type of dressing should be used

Answer 35

Moisture-rententive

Question 36

With a contaminated abrasion what type of dressing should be used

Answer 36

broad-spectrum antimicrobial and gauze dressing

Question 37

Traumatic wounds resulting from shear or friction forces that separate the epidermis from the dermis, partial thickness wound

Answer 37

Skin tears (if there is a skin flap remove it)

Question 38

Payne Martin Classification for Skin Tears ``` IA IB IIA IIB III ```

Answer 38

``` IA: Linear (Epidermis and dermis pulled apart) IB: Flap (epidermal flap covers dermis) IIA: Scant tissue loss IIB: Moderate to Large tissue loss III: Skin tear with complete tissue loss ```

Question 39

Surgical wounds should be kept clean and dry for _____hours

Answer 39

24-48 hours

Question 40

Infection is 4x more likely with ____-

Answer 40

staples

Question 41

Epitheliazation in surgical wounds occur in

Answer 41

7-10 days

Question 42

Factors influencing Dehiscence wounds

Answer 42

1. Malnutrition 2. Diabetes 3. Steriods 4. Smoking

Question 43

80-90% of all bite wounds are caused by

Answer 43

Dogs

Question 44

Most bite wounds are polymicrobial and you should consider

Answer 44

the use of short term antiseptics

Question 45

Only 2 types of spider bites require medical intervention what are they

Answer 45

1. Black widow | 2. Brown Recluse

Question 46

Black widow bite how will patient present

Answer 46

Patient will be ill within 1-3 hours, will be weak, headache, naseous, hyperreflexia, SOB, diaphoresiss, HTN, tachycardia

Question 47

Treatment for Black widow bite

Answer 47

antivenom, NSAID, and muscle relaxer

Question 48

Brown Recluse exist in what parts of the country

Answer 48

SW, SE, MDW

Question 49

Majority of brown recluse bites heal without complication in

Answer 49

3-5 days

Question 50

If bitten by a brown recluse patient will present how?

Answer 50

Within 24 hours, red inflammed, blue thrombosis, white ischemia with possible necrostic center. Fever, nausea malaise and joint pain.

Question 51

How is Brown recluse bite treated

Answer 51

treat with debridement of necrotic tissue, avoid heat, antihistamines, steriods.

Question 52

Damage from radiation depends on what 4 factors

Answer 52

1. Dose 2. Type 3. Location 4. SA

Question 53

What are the patient variables that could contribute to skin damage from radiation

Answer 53

1. Age 2. Co-morbitideis 3. Meds 4. Nurtrition 5. Immune function

Question 54

``` Skin Reaction due to Radiation Treatment Grade 1 Grade 2 Grade 3 Grade 4 ```

Answer 54

1. Faint erythema, dry desquarrriation, decrease sweating response 2. Bright erythema, tenderness, moderate edema, moist des. 3. Moist desqu. with pitting edema 4. Ulceration or necrosis

Question 55

Intervention for radiation damage

Answer 55

silvadine cream, decrease bathing frequency, oatmeal baths

Question 56

What condition is non-infectious progressive necrotizing skin condition, thought to be due to neutrophil dysfunction

Answer 56

Pyoderma Gangrenosum

Question 57

Pyoderma Gangrenosum presentation

Answer 57

small, painful papule, vesicle or postuel on LE/Trunk may have fever mailaise, myalgia.

Question 58

When should a practioner suspect Pyoderma Gangrenosum

Answer 58

1. Positive wound cultures without response to antibiotics | 2. Wound not responding to standard care for presume wound etiology

Question 59

Interventions for Pyoderma Gangrenosum

Answer 59

1. Systemic, topical and locally injjected corticosteriods

Question 60

What is contraindicated when treating pyoderma gangrenosum

Answer 60

extensive debridement

Question 61

T/F wound healing is slow and recurrence is common in Pyoderma gangrenosum and PCP will typically rx meds 6-12 months after wound closure

Answer 61

T