week 4 module 13 lymph system

Question 1

infants

Answer 1

lymph system begins development at 20wks gestation
immature at birth
inc. in childhood especially 6-9y/o

Question 2

preg.

Answer 2

temporary remission of autoimmune/inflammatory disorders

Question 3

older adults

Answer 3

nodes dec. size and number with age

Question 4

HPI enlarged nodes

Answer 4

character: onset, location, duration, number
local s/s: pain, redness, warmth, red streaks
systemic s/s: malaise, fever, wt. loss, night seat, abd. pain
predisposing factors: infection, surgery, trauma
meds: chemo, antibiotics

Question 5

HPI swelling of extremity

Answer 5

uni/bilateral
intermittent or constant
predisposing factors: CV or renal disorder, surgery, infection, trauma, venous insufficiency.
assoc. s/s: warmth, redness/discoloration, ulceration

Question 6

PMH

Answer 6

chest imaging
TB
blood transfusions, use of blood products
Chronic illness: cardiac, renal, malignancy, HIV
surgery: trauma, organ transplant, lymph node biopsy
recurrent infections
autoimmune disorders
allergies

Question 7

FH

Answer 7

malignancy
anemia
recent infectious disease
TB
immune disorders
hemophilia

Question 8

personal and social hx

Answer 8

travel: asia, africa, wester pacific, india, philippines
recreational drugs
sexual hx

Question 9

infants and childrens hx

Answer 9

recurrent infections

- tonsillitis, adenoiditis, bacterial infections, oral candidiasis, chronic diarrhea, chronic severe ecamea

Question 10

preg patients

Answer 10

weeks of gestation
exposure to infections
pets in household: cat feces
immunization status

Question 11

older adults

Answer 11

autoimmune disease
recent infection or traume to nodes
delayed healing
immunization status

Question 12

lymphadenopathy

Answer 12

enlarged lymph nodes

Question 13

lymphadenitis

Answer 13

inflamed and enlarged lymph nodes

Question 14

lymphangitis

Answer 14

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

Question 15

lymphedema

Answer 15

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

Question 16

lymphangioma

Answer 16

congenital malformation of dilated lymphatics

Question 17

shotty nodes

Answer 17

small non-tender nodes that feel like BB’s or buckshot under the skin

Question 18

fluctuant nodes

Answer 18

wavelike motion that is felt when the node is palpated

Question 19

matted nodes

Answer 19

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

Question 20

hard, fixed, painless node

Answer 20

suggests malignant process

- usually rapid enlargement

Question 21

tender node

Answer 21

more likely an inflammatory process

Question 22

virchow node

Answer 22

palpable supraclavicular node on left

- clue to thoracic or abdominal malignancy

Question 23

slow nodal enlargement suggests

Answer 23

benign process

Question 24

acute lymphangitis patho

Answer 24

inflammation of one or more lymphatic vessels

Question 25

acute lymphangitis subjective

Answer 25

``` enlarged lymphnode pain malaise possible fever minor trauma to skin distal to the area of infection ```

Question 26

acute lymphangitis objective

Answer 26

red streaks after the course of the lymphatic collecting duct tracing of fine lines streaking up the extremity indurated and palpable to gentle touch sometimes look distal for sites of infection, esp. between digits

Question 27

acute suppurative lymphadenitis patho

Answer 27

infection and inflammation of a lymph node, single or group

Question 28

acute suppurative lymphadenitis subjective

Answer 28

enlarged nodes | pain

Question 29

acute suppurative lymphadenitis objective

Answer 29

involved node usually firm and tender overlying tissue edematous, erythematous, within 72hr abscess formation extensive; nodes fluctuant

Question 30

mycobacterial adenitis characterized by

Answer 30

inflammation without warmth that may or may not be tender

Question 31

lymphedema patho

Answer 31

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

Question 32

lymphedema subjective

Answer 32

``` painless swelling of limb; uni/bilateral onset usually gradual hx of trauma, surgery, or radiation to area travel where filariasis is common family hx leg swelling ```

Question 33

lymphedema objective

Answer 33

swelling and often distortion of extremities may or may not pit overlying skin thickens and feels tougher than usual

Question 34

primary lymphedema

Answer 34

apparent at birth and most often involves the legs degree varies with the severity and distribution of the abnormality may not appear till young adulthood

Question 35

Stage 0 lymphedema

Answer 35

latent or subclinical | swelling is not evident despite impaired lymph transport

Question 36

Stage 1 lymphedema

Answer 36

pitting may occur early accumulation of fluid relatively high in protein content - subsides with elevation

Question 37

Stage 2 lymphedema

Answer 37

tissue fibrosis is present limb elevation alone rarely reduces swelling pitting may be present, as fibrosis worsens pitting decreases

Question 38

Stage 3 lymphedema

Answer 38

pitting is absent | trophic skin changes are present

Question 39

lymphangioma/cystic hygroma patho

Answer 39

congenital malformation of dilated lymphatics

Question 40

lymphangioma subjective

Answer 40

painless cystic masses usually manifest during 1st year of life - often enlarged after an URI asymptomatic when in posterior triangle of neck - found anteriorly may cause airway/swallowing issues

Question 41

lymphangioma/ cystic hygroma objective

Answer 41

soft, nontender, and easily compressible spongy fluid-containing mass without discrete margins. most present at birth - neck, axilla, less common: chest, extremities

Question 42

lymphatic filariasis (elephantiasis) patho

Answer 42

massive accumulation of lymphedema throughout the body | - widespread inflammation and obstruction of the lymphatics by the filarial worms transmitted by mosquitos

Question 43

lymphatic filariasis (elephantiasis) subjective

Answer 43

swelling of limb or body area travel: asia, africa, western pacific, india, philippines many w/out s/s fever, chronic pulmonary infection

Question 44

non-hodgkin lymphoma patho

Answer 44

malignant neoplasm of the lymphatic system and the reticuloendothelial tissues

Question 45

non-hodgkin's subjective

Answer 45

``` painless enlarged lymph nodes fever wt. loss night sweats abd. pain/fullness family hx ```

Question 46

non-hodgkin's objective

Answer 46

- nodes may be localized in the posterior cervical triangle or may become matted, crossing into the anterior triangle - nodes well defined and solid

Question 47

Hodgkin's lymphoma patho

Answer 47

malignant lymphoma starts in single node and spreads to contiguous lymph nodes, spleen, liver, and bone marrow. neoplastic giant cells release factors that induce accumulation of lymphocytes, macrophages, and granulocytes

Question 48

hodgkin lymphoma subjective

Answer 48

painless enlarged lymph nodes may have abd. pain sometimes fever possible hx of mononucleosis

Question 49

hodgkin lymphoma objective

Answer 49

most common: - painless enlargement of cervical lymph nodes - - generally asymmetric and progressive Nodes sometimes matted and firm, almost rubbery

Question 50

Epstein-Barr virus Mononucleosis patho

Answer 50

infectious mono oral epithelial cells incubation period 30-50 days

Question 51

epstein-barr virus mononucleosis subjective

Answer 51

``` malaise fatigue acute or prolonged fever HA ST nausea abd pain myalgia ```

Question 52

epstein-barr virus mononucleosis objective

Answer 52

- generalized lymphadenopathy, most common in cervical nodes and submandibular - epitrochlear lymphadenopathy - hepatomegaly - splenomegaly - moderate to severe pharyngitis with tonsillar enlargement, occasional exudates - petechiae at the junction of the hard and soft palate

Question 53

toxoplasmosis patho

Answer 53

zoonosis, caused by the parasite toxoplasma gondii - ingestion of oocysts in soil undercooked meat, raw eggs, cat feces or litter - infection persists for life without s/s - immunosuppresion: neurologic disease and organ manifestations - preg: serous congenital infection, particularly in 1st trimester

Question 54

toxoplasmosis subjective

Answer 54

no s/s hx of eating raw or rare meat, undercooked eggs hx contact with cat feces

Question 55

toxoplasmosis objective

Answer 55

single node, chronically enlarged and nontender | - usually in the posterior cervical chain

Question 56

roseola infantum patho

Answer 56

infection by human herpes virus 6 - common in infancy peak age 2 years - present in the saliva of most adults transmitted by oral secretions

Question 57

roseola infantum subjective

Answer 57

fever- high grade and persistant over 3-4 days | may have mild resp. illness and lymphadenopathy

Question 58

roseola infantum objective

Answer 58

- adeopathy, discrete and not tender, involves the occipital and postauricular chains, may last for some time. - when fever diminishes, morbillifrom fine maculopapular rash occurs, spreads from trunk to extremities, then child begins to feel better