Chapter 9 Seidel Lymphatic System

When you find an enlarged lymph node on examination, the most appropriate question for the examiner to ask a patient is: "Are you aware of any lumps?" "Have you had a change in appetite?" "Do your lymph nodes hurt?" "Where are your largest lymph nodes?"

"Are you aware of any lumps?"

Head node palpation sequence:

1. occipital nodes at base of skull. 2. posauricular nodes superficially over mastoid process 3. preauricular nodes just in front of ear. 4. paroid and retropharyngeal (tonsillar) nodes at angle of mandible 5. submandibular nodes halfway between angle and tip of madible. 6. submental nodes in midline behind tip of mandible.

Neck node palpation sequence:

1. superficial cervical nodes at sternocleidomastoid muscle. 2. posterior cervical nodes along anterior border of trapezius muscle. 3. cervical nodes deep to sternocleidomastoid. 4. supraclavicular areas, probing deeply in angle formed by clavicle and sternocleidomastoid muscle (virchow nodes).

life span of T cells

100-200 days

Palpable nodes in neonate:

2-3mm discrete, palpable, mobile nodes is not unusual. before 2 years of age, inguinal, occipital, and postauricular are common. after 2 years, they are indicative of a problem. Cervical and submandibular are uncommon during first year and more common in older children. Supraclavicular nodes are usually not found.

immune system and lymphoid system begin developing at ____ weeks gestation.

20

life span of B cells

3-4 days

A palpable left supraclavicular lymph node is suggestive of which condition? Middle ear infection Mandibular abscess Abdominal malignancy Epstein-Barr mononucleosis

Abdominal malignancy

The lymphatic system plays an integral role in which of the following body processes? Maintenance of fluid balance Infection control Absorption of fat All of the above

All of the above

Situation: Mario is a 16-year-old male complaining of fatigue and weakness. Listed below are data collected by the health care provider during an interview and examination. Interview Data: Mario indicates that he keeps a busy schedule with school, basketball, and work. He has always been a good student, but he seems to be having a harder time keeping up with everything. He feels he is beginning to let his family and friends down because fatigue and weakness are interfering with his performance at school and on the basketball court. Mario does not want to quit his job because he is saving for college. When asked about other symptoms, he denies changes in appetite or abdominal problems but reports that he thinks he sometimes has a fever. Examination Data: General survey: Alert, thin male. Height 5 ft 7 in; weight 140 pounds. Skin: Skin color is pink. No evidence of bruising. No skin discoloration. Thorax: Respirations are even and unlabored, clear to auscultation. Heart rate and rhythm are regular. Abdomen: Bowel sounds auscultated. Abdomen soft, nontender, and nondistended. Musculoskeletal: Moves all extremities; symmetrical. Moves joints without tenderness. Head and neck: Enlarged and firm cervical lymph nodes in the posterior triangle. Data that deviate from normal findings and suggest the need for further investigation include: Fatigue. Weakness. Enlarged lymph nodes. All of the above.

All of the above.

Situation: Mario is a 16-year-old male complaining of fatigue and weakness. Listed below are data collected by the health care provider during an interview and examination. Interview Data: Mario indicates that he keeps a busy schedule with school, basketball, and work. He has always been a good student, but he seems to be having a harder time keeping up with everything. He feels he is beginning to let his family and friends down because fatigue and weakness are interfering with his performance at school and on the basketball court. Mario does not want to quit his job because he is saving for college. When asked about other symptoms, he denies changes in appetite or abdominal problems but reports that he thinks he sometimes has a fever. Examination Data: General survey: Alert, thin male. Height 5 ft 7 in; weight 140 pounds. Skin: Skin color is pink. No evidence of bruising. No skin discoloration. Thorax: Respirations are even and unlabored, clear to auscultation. Heart rate and rhythm are regular. Abdomen: Bowel sounds auscultated. Abdomen soft, nontender, and nondistended. Musculoskeletal: Moves all extremities; symmetrical. Moves joints without tenderness. Head and neck: Enlarged and firm cervical lymph nodes in the posterior triangle. You consider the possibility of Hodgkin disease. Which of the following questions is it most important to ask Have you had Hepatitis B? Do you have any trouble turning your head? Have you had your tonsils out? Are the enlarged lymph nodes tender?

Are the enlarged lymph nodes tender?

Mrs. Tucker is a 34-year-old patient who presents to your office with a complaint of a sore throat. On examination, you find an enlarged thyrolinguofacial lymph node. Which of the following would you assess? Area proximal to the enlarged node Posterior superficial cervical chain Occipital nodes Preauricular nodes

Area proximal to the enlarged node

Which guideline will typically guide assessment of the lymph system? Assess the entire lymph system at once, exploring all accessible nodes. Assess both superficial and deep nodes, using palpation and a Doppler. Assess the lymph system region by region as each body system is assessed. Assess the lymph nodes when the patient's history suggests a need to do so.

Assess the lymph system region by region as each body system is assessed.

Vaccines that cause temporary axillary node enlargement:

BCG, small pox. HPV in head/neck region.

PMH:

CXR-reasons and results TB and other skin tests blood transfusion, use of blood products chronic illness-cardiac, renal, malignancy, HIV surgery-trauma to regional lymph nodes, organ transplant recurrent infections autoimmune disorder allergies

Antibodies induced by attack invaders create which of the following type of immunity? Humoral immunity Cellular immunity Immunocompetent immunity Effector immunity

Cellular immunity

A patient with tuberculosis with apparent enlarged palpable nodes is most likely to have which finding? Warm, tender nodes with evidence of inflammation Incorrect Pulsating lymph nodes Cold, nontender lymph nodes Cysts masquerading as nodes

Cold, nontender lymph nodes

Where on the body would you palpate the epitrochlear lymph nodes? Groove between the triceps and the biceps at the elbow Deep in the medial aspect of the groin Just in front of the tragus At the angle of the mandible

Groove between the triceps and the biceps at the elbow

Mrs. Cousins is a 35-year-old patient who presents to your clinic. Your diagnosis is acute cervical lymphadenitis. Which of the following is the most likely etiology? Group A beta-hemolytic strep Pneumocystis carinii infection Milroy disease Infectious mononucleosis

Group A beta-hemolytic strep

Antibodies produced by B cells create which of the following type of immunity? Humoral immunity Cellular immunity Immunocompetent immunity Effector immunity

Humoral immunity

Where are the superficial lymph nodes located? In the subcutaneous connective tissue. In the fascia. In the muscle. Within body cavities.

In the subcutaneous connective tissue.

Inguinal and Popliteal nodes

Lie supine with knee slightly flexed. Superior superifical inguinal nodes are close to surface. Inferior are deeper in groin. Drainage of testes is in abdomen. Enlargement suggests infection or metastatic carcinoma in anatomic area. Popliteal nodes-relax posterior popliteal fossa by flexing knee. Wrap hand around the knee and palpate fossa with fingers.

Situation: Mario is a 16-year-old male complaining of fatigue and weakness. Listed below are data collected by the health care provider during an interview and examination. Interview Data: Mario indicates that he keeps a busy schedule with school, basketball, and work. He has always been a good student, but he seems to be having a harder time keeping up with everything. He feels he is beginning to let his family and friends down because fatigue and weakness are interfering with his performance at school and on the basketball court. Mario does not want to quit his job because he is saving for college. When asked about other symptoms, he denies changes in appetite or abdominal problems but reports that he thinks he sometimes has a fever. Examination Data: General survey: Alert, thin male. Height 5 ft 7 in; weight 140 pounds. Skin: Skin color is pink. No evidence of bruising. No skin discoloration. Thorax: Respirations are even and unlabored, clear to auscultation. Heart rate and rhythm are regular. Abdomen: Bowel sounds auscultated. Abdomen soft, nontender, and nondistended. Musculoskeletal: Moves all extremities; symmetrical. Moves joints without tenderness. Head and neck: Enlarged and firm cervical lymph nodes in the posterior triangle. You consider the possibility of Hodgkin disease. Which other characteristic of the cervical lymph nodes would be most consistent with this diagnosis? Gritty and warm to touch Symmetrically enlarged on the right and left neck Painful on movement or palpation Matted and rubbery in consistency

Matted and rubbery in consistency

Spleen

May report pain or heavy sensation in left upper quadrant. May cause early satiety or discomfort after eating.

When assessing the lymph nodes of the head, which nodes do you palpate first? Occipital Preauricular Postauricular Retropharyngeal

Occipital

How should the supraclavicular lymph nodes be assessed? Place the patient in a supine position, and ask the patient to hold his or her breath. Place the patient in the Trendelenburg position and illuminate the lymph nodes with a bright light. Palpate deeply behind the clavicles as the patient flexes his head forward. Palpate lightly below the clavicles with the patient in a sitting position.

Palpate deeply behind the clavicles as the patient flexes his head forward.

Mrs. Doh presents to your office with her 7-year-old son. Because of his religion, he has not had routine immunizations. You are concerned that he has mumps. Which of the following would help differentiate mumps from cervical adenitis? Palpating the angle of the jaw Palpating enlarged lymph nodes Noting painful lymph nodes Noting swelling of the face

Palpating the angle of the jaw

During pregnancy, which of the following occurs to create increased susceptibility to infection? Shift from immunocompetent to effector-mediated immunity Shift from effector immunity to cell-mediated immunity Shift for antibody production to cell-mediated immunity Shift from cell-mediated to antibody production

Shift from cell-mediated to antibody production

Infection in which anatomic area can cause inquinal lymph node enlargement? Testes Surface of the penis Prostatic capsule Lower uterine segment

Surface of the penis

Which of the following is a type of blood cell that has a life span of 100 to 200 days? B-cells T-cells Stem cells Marrow-derived cells

T-cells

2-month-old infant is brought to the clinic for immunizations. The examiner palpates enlarged inguinal nodes. What additional finding might explain the enlarged nodes? The mother reports that the infant suffers from colic. The infant's length and weight are above the 85th percentile. The infant has a severe diaper rash. A port wine stain is present on the infant's left thigh.

The infant has a severe diaper rash.

A 19-year-old male has a severe infection involving the fifth digit of the right hand. Where should the examiner expect to palpate enlarged and tender lymph nodes? The radial aspect of the wrist The palmar aspect of the hand The medial epicondyle of the humerus The left lower neck

The medial epicondyle of the humerus

Marrow-derived cells are further differentiated to T-lymphocytes in which part of the lymph system? Thymus Spleen Tonsils Peyer patches

Thymus

Mr. Booker is a 44-year-old patient who presents for routine examination. On examination, you suspect an enlarged lymph node but are unsure. Which examination method is used to differentiate an enlarged lymph node from a cyst? Palpation Auscultation for a bruit Biopsy Transillumination

Transillumination

What is the red pulp of the spleen? Venous sinusoids Recycled hemoglobin Clustered lymphoid nodules Activated antigen tissue

Venous sinusoids

Situation: Mario is a 16-year-old male complaining of fatigue and weakness. Listed below are data collected by the health care provider during an interview and examination. Interview Data: Mario indicates that he keeps a busy schedule with school, basketball, and work. He has always been a good student, but he seems to be having a harder time keeping up with everything. He feels he is beginning to let his family and friends down because fatigue and weakness are interfering with his performance at school and on the basketball court. Mario does not want to quit his job because he is saving for college. When asked about other symptoms, he denies changes in appetite or abdominal problems but reports that he thinks he sometimes has a fever. Examination Data: General survey: Alert, thin male. Height 5 ft 7 in; weight 140 pounds. Skin: Skin color is pink. No evidence of bruising. No skin discoloration. Thorax: Respirations are even and unlabored, clear to auscultation. Heart rate and rhythm are regular. Abdomen: Bowel sounds auscultated. Abdomen soft, nontender, and nondistended. Musculoskeletal: Moves all extremities; symmetrical. Moves joints without tenderness. Head and neck: Enlarged and firm cervical lymph nodes in the posterior triangle. Problem(s) the patient may have include: chronic infection. lymphoma. other malignancy. all of the above.

all of the above.

Mr. Charles is a 38-year-old patient who presents to your office with a complaint of fatigue and a family history of hypothyroidism. As the examiner palpates an enlarged lymph node, the patient complains of pain. This is an indication of: an inflammatory process. Hodgkin disease. immature lymph node development. malignancy.

an inflammatory process.

humoral immunity:

antibodies produced by B cells

easily palpable lymph nodes generally ____(are/are not) found in healthy adults

are not

cellular immunity:

attacks on invaders by the cells themselves.

older adults history:

autoimmune disease present or recent infection, trauma to distal nodes delayed healing immunization status: Flu, PN, TDaP, shingles

Function of lymphatic system:

conserving fluid and plasma that leak from capillaries defending body against disease absorbing lipids from intestinal tract

Mr. Harold is a 47-year-old patient who presents to your office with a complaint of fatigue. The examiner is palpating the superior superficial inguinal lymph nodes on Mr. Harold. Where is the examiner palpating? at the lateral aspect of the groin. just above the groin along the base of the pelvic bone. between the femoral artery and femoral vein. deeper in the groin.

deeper in the groin.

spleen fuctions:

destroying old red blood cells producing antibodies storing red blood cells filtering micoorganisms from blood

HPI:

enlarged nodes: character:onset, location, duration, number, tenderness associated local sx: pain, redness, warmth, red streaks associated systemic sx: malaise, fever, weight loss, night sweats, abd pain or fullness, itching predisposing factors: infection, surgery, trauma swelling of extremity: uni or bi, intermittent or constant, duration predisposing factors: cardiac or renal disorder, surgery, infection, trauma, venous insufficiency associated symptoms: warmth, redness or discoloration, ulceration efforts at treatment and effect: support stockings, elevation

nodes in older adults:

fibrotic and fatty

wavelike motion that is felt when the node is palpated

fluctuant nodes

Immunity shift in pregnancy

from cell-mediated to antibody production/humoral immunity

he lymph fluid flows more readily with: increased collecting ducts. greater perfusion of microscopic tubules. decreased superficial nodes. greater permeability of capillary walls.

greater permeability of capillary walls.

Reminders about node:

hard, fixed, painless node suggest malignant process. more tender it is, more likely it is inflammatory process. Nodes do not pulsate, arteries do. Virchow node-palpable supraclavicular node on left is clue to thoracic or abdominal malignancy. slow nodal enlargement over weeks and months suggests benign; rapid enlargement w/o signs of inflammation suggest malignancy.

T lymphocytes:

have important role in controlling immune responses brought about by B-lymphocytes.

In addition to the head, neck, axilla, and inguinal areas, the examiner may also assess lymph nodes: on the palmar aspect of the hands. in the popliteal region. in the patellar region. on the dorsum of the foot.

in the popliteal region.

location of spleen:

left upper quadrant of abdominal cavity between stomach and diaphragm.

The tonsils located near the base of the tongue are the: laryngeal tonsils. pharyngeal tonsils. palatine tonsils. lingual tonsils.

lingual tonsils.

Lymphatic system includes:

lymph fluid collecting ducts lymph nodes spleen thymus tonsils adenoids Peyer patches in small intestines

inflamed and enlarged lymph nodes:

lymphadenitis

enlarged lymph nodes:

lymphadenopathy (adenopathy)

congenital malformation of dilated lymphatics

lymphangioma

inflammation of lymphatics that drain an area of infection; tender erythematous streaks extend proximally from infected area; reigional nodes may also be tender.

lymphangitis

white pulp:

lymphatic nodules and diffuse lymphatic tissue

drainage point for right upper body:

lymphatic trunk that empties into right subclavian vein.

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

lymphedema

Family history

malignancy anemia recurrent infectious disease TB immune disorders hemophilia

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

matted nodes

The examiner notes enlarged tonsils in a young child. The examiner should recognize that this: is an indication of a retropharyngeal abscess. may be an early indication of Epstein-Barr virus. is an indication that the child has lymphoma. may be a normal finding.

may be a normal finding.

Risk factors:

multiple sexual contacts IV drug use hepatitis, TB, or STI blood or clotting factor transfusion mother with HIV infection sexual abuse

Mumps versus cervical adenitis

mumps-painful swelling of paroid glands uni or bilaterally and by swelling and tenderness of other salivary glands along mandible. Can obscure angle of jaw and may appear as cervical adenitis. Distinguishable on palpation-cervical adenitis does not obscure angle of jaw. Fingers can separate node form angle to feel hard sharpeness of bone usually not found with parotid swelling.

Mr. Wilson is a 65-year-old patient who presents to your office for routine examination. Lymph nodes in healthy adults are usually: large and soft. nonpalpable or minimally palpable. hard and irregular. large and hard.

nonpalpable or minimally palpable.

nodes in TB:

often felt in cervical chains; usually body temp, soft, matted, and non tender or painful.

one undesirable role of lymphatic system:

one pathway for the spread of malignancy

Head and neck:

palpate entire neck. anterior border of sternoclediomastoid muscle is dividing line for anterior and posterior triangles of neck.

Cat scratch disease: cause of subacute or chronic lymphadenitis in children

patho: caused by Bartonella henselae and Bartonella clarridgeiae usually follows bite or scratch from kitten or cat. subjective: bite, scratch, or wound from cat or kitten. papule or pustule lasts 3-5 days then becomes vesicular and crusts in 2-3 days. painful enlarged lymph nodes objective: inoculation lesion: may be healing lymphadenopathy in 1-2 weeks in region that drains primary lesion. single lymph most often. common head, neck, axillae. can be large. often red and tender suppurate. diagnosis-nodal enlargement >3 weeks with inoculation lesion and cat interaction. lymphadenopathy can last 2-4 months or longer.

Roseola Infantum (HHV-6): infection by human herpes virus 6

patho: common in infancy with peak age 2 years. present in saliva of most adults and secreted by oral secretions. latency in fully developed immune system with lifelong infection of host. periodic reactivation of latent virus and production of recurrent infection; allows spread to new hosts subjective: fever-usually high grade 3-4 days sometimes mild resp illness and lymphadenopathy objective: adenopathy, discrete and not tender, involves occipital and postauricular chains, may last a while. when fever diminishes, morbilliform fine maculopapular rash occurs from trunk to extremities.

HIV/AIDS

patho: dysfunction of cell-mediated immunity HIV antibodies to HIV but sequelae of recurrent infections and neoplastic disease not occured. AIDS is recurrent, often severe, opportunistic infections. Common diseases with AIDS-kaposis sarcoma, pneuomocystis jiroveci PN, pulmonary TB, recurrent PN, invasive cervical CA, partoid enlargement simulating mumps, anemia and thrombocytopenia, chronic diarrhea, recurrent infections. subjective: enlarged lymph nodes initial sx-severe fatigue, malaise, weakness, weight loss, arthralgias, persistent diarrhea. objective: generalized lymphadenopathy children-may be prolonged clinical latent period but initial signs can be neruodevelopmental problems with developmental milestone loss. Decreased CD4 T-lymphocyte count and increasing viral load level.

Lymphangioma/cystic hygroma: congenital malformation of dilated lymphatics

patho: failure of complete development and subsequent obstruction of lymphatic system; commonly in neck. subjective: painless cystic masses usually manifests during first year of life and often enlarged after respiratory infection asymptomatic when in posterior triangle of neck but can cause airway/swallowing problems if anterior. objective: soft, nontender easily compressible spongy fluid-containing mass without discrete margins. most present at birth and apparent early in life, usually in neck or axilla may be large enough to distort face and neck diagnosis-physical exam and imagining which show thin-walled, multiloculated cystic mass.

Toxoplasmosis: Zoonosis, caused by parasite Topxoplasma gondii

patho: ingestion or inhalation of oocysts in soil/fomites, undercooked meat, raw eggs, cat feces persist for life w/o signs of disease In immunosuppression, quiescent parasites multiply resulting in neurologic disease or organ manifestations. serious congenital infection in pregnancy especially in first trimester. subjective: no significant symptoms history of eating raw or rare meats, uncooked eggs history of direct contact w/cat feces objective data: single node, chronically enlarged and nontender usually posterior cervical chain

Epstein-Barr Virus Mononucleosis: infectious mononucleosis

patho: initially infects oral epithelial cells; spreads to contiguous structures such as salivary glands with eventual viremia and infection of entire lymphoreticular system including liver and spleen. incubuation period is 30-50 days. subjective: malaise, fatigue, acute or prolonged (>1 week), fever, HA, sore throat, nausea, abdominal pain, and myalgia prodromal period 1-2 weeks. objective: generalized lymphadenopathy in anterior and posterior cervical nodes and submandibular lymph nodes. epitrochlear lymphadenopathy is suggestive. hepatomegaly; elevated liver enzymes splenomegaly 2-3cm below costal margin is typical. moderate to severe pharyngitis with tonsillar enlargement, some exudates petechia at junction of hard/soft palate seen mono spot test

Latex allergy Type IV Dermatitis (Delayed hypersensitivity)

patho: involves immune system and caused by chemicals in latex. subjective: latex exposure allergy to cross-sensitizing foods (banana, avocado, potato, tomato, kiwi) objective: skin reaction 24-48hrs after contact. vesicular lesions, erythema may progress to oozing skin blisters.

Acute Suppurative Lymphadenitis: infection and inflammation of lymph node; may affect single or localized group of nodes:

patho: most common group A beta-hemolytic streptococci and coagulase-positive staphylococcal infection. may include actinomyocotic adenitis from dental disease; enlarged because of cellular infiltration and edema. tender because of capsule distention. most often in cervical region due to microbial drainage from infections of teeth or tonsils and axillary or inguinal regions due to infections in extremities. systemic viral infections and bacteremia can produce generalized lymphadenopathy. subjective: enlarged lymph node pain from enlarged lymph nodes objective data: involved node usually firm and tender overlying tissue edematous; skin appears erythematous usually within 72 hours when abscess formation is extensive, nodes fluctuant. mycobacterial adenitis-inflammation without warmth that may/may not be tender.

Non-Hodgkin Lymphoma: Malignant neoplasm of lymphatic system and reticuloendothelial tissue

patho: most often in lymph nodes in chest, neck, abdomen, tonsils, and skin. most arise in B cells; rest occur in T cells. Subjective: painless enlarged lymph node fever, weight loss, night sweats, abd pain or fullness family history objective: nodes may be localized in posterior cervical triangle or may become matted, crossing into anterior triangle. well-defined and solid. cannot distinguish from Hodgkin through exam alone.

Acute lymphangitis: inflammation of one or more lymphatic vessels

patho: pathogenic organisms enter lymphatic vessels through wound or complication of infection and produce local inflammatory response. Extends proximally toward regional lymph nodes. subjective: enlarged lymph node pain, malaise, possibly fever minor trauma to skin distal to area of infection Objective: red streaks in skin follow course of lymphatic draining duct. appears as tracing of rather fine lines streaking up extremity sometimes indurated and palpable to gentle touch. look distal to inflammation for sites of infection, particularly between digits.

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

patho: result of protein-rich interstitial volume overload, secondary to lymph drainage failure. four mechanisms: increased blood capillary hydrostatic pressure, decreased plasma protein concentration, increased blood permeability, blockage of lymph return. primary-hypoplasia and maldevelopment of lymphatic system, more common in females than males, manifest in infants or later; "praecox" in adolescence and "tarda" in patients 40 years and older. Secondary-acquired damage to regional lymph nodes-pressure from tumors, scar tissue after radiation, or surgical removal. subjective: painless swelling of limb, uni or bilateral onset gradual history of trauma, surgery, or radiation to regional area travel to areas with filariasis is common family history of leg swelling objective: swelling and often grotesque distortion of extremities may or may not pit overlying skin thickens and feels tougher primary often apparent at birth and usually with legs and dorsum of foot;

Serum Sickness (Type III Hypersensitivity reaction) serum sickness is an immune complex disease

patho: systemic type III hypersensitivity response to antigens. mediate by tissue deposition of circulating immune complexes, activation of complement, and ensuing inflammatory response. can react similarly to repeated exposure; subsequent reactions can be fatal. subjective: enlarged lymph nodes pain, pruritis, erythematous swelling at injection site urticaria, other rashes, lymphadenopathy, joint pain, fever, facial edema medications-beta-lactam antibx (espec. cefaclor), sulfonamide, minocycline organ transplant objective: apparent in 7-10 days after administration urticaria, maculopapular or purpuric lesions lymphadenopathy in area draining injection site facial/neck edema symptoms subside, recurring at times over several weeks.

Herpes Simplex (HSV): infection by HSV1 or HSV2

patho: transmitted by oral secretions, genital secretions, or close contact. lytic infection of fibroblasts and epithelial cells. establishes latent infection in neurons. HSV1-oral HSV2-genital subjective: burning, itching lesions may have enlarged lymph nodes objective: labial and gingival vesicles or ulcers may have enlargement of anterior cervical and submandibular nodes. Firm, quiet, discrete, movable, and tender nodes.

Latex Allergy Type I Reaction

patho: true reaction caused by IgE protein antibodies antigen-antibody reaction causes release of histamine, leukotrines, prostaglandins, kinins. subjective: latex exposure allergy to cross-sensitizing foods (banana, avocado, potato, tomato, kiwi) objective: local urticaria (skin wheals), generalized urticaria with angioedema, asthma, eye/nose itching, GI symptoms, anaphylaxis

Hodgkin Lymphoma: malignant lymphoma

patho: unknown eitology starts in single node or chain and spreads neoplastic giant cells release factors that induce accumulation of reactive lymphocytes, macrophages, and granulocytes. all races, usually late adolescence and young adulthood; males twice as likely. starts in B cell located in neck area. subjective: painless enlarged lymph nodes may have abdominal pain, sometimes fever may have hx of infectious mono objective: variable clinical presentation most common-painless enlargement of cervical lymph nodes often in posterior triangle, generally asymmetric and progressive. sometimes matted and firm, almost rubbery usually asymmetric nodal size may fluctuate

Lymphatic Filariasis (Elephantiasis) massive accumulation of lymphedema throughout the body; most common cause of secondary lymphedema worldwide

patho: widespread inflammation and obstruction by filarial worms Wuchereria bancrofti or Brugia malayi; transmitted by mosquitos. adequate drainage prevented. more susceptible to infection, cellulitis, and fibrosis. Subjective: swelling of limb or body area travel to infected areas may develop fever with lymphangitis and lymphadenitis, chronic pulmonary infection, and progressive lymphedema. Objective: lymphedema of entire arm or leg; genital regions diagnosis by microfilariae microscopically in blood.

The tonsils that are located near the nasopharyngeal border are the: laryngeal tonsils. pharyngeal tonsils. palatine tonsils. lingual tonsils.

pharyngeal tonsils.

Thymus reaches greatest absolute weight during:

puberty.

WBC count in pregnancy

raises from 8,000 during first trimester and plateau in the second and third trimester at 8500. Increase is due to circulating segmented neutrophils or granulocytes. Leukocyte level return to normal 1-2 weeks after delivery.

Infants/children personal history:

recurrent infections (tonsillitis, adenoiditis, otitis media, abscesses, chronic severe eczema) present or recent infections, trauma to distal nodes poor growth, failure to thrive loss of interest in playing or eating immunization history maternal HIV infection hemophilia

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

shotty nodes

Peyer patches:

small raised areas of lymph tissue on mucosa of small intestine and have many clustered lymphoid nodules.

Epitrochlear nodes:

support arm in one hand and explore elbow with other.Grasp the right wrist, palm facing up, and with left hand. Relaxed position at 90 degrees. Place right hand under right elbow and cup fingers around elbow to find proximal and slightly anterior to medical epicondyle of humerus. Palpate groove between biceps and triceps muscle.

Axillae node:

support forearm with contralateral arm and bring palm of your examining hand flat into axilla; rotate fingertips and palm. if palpable, attempt to glide fingers beneath the nodes.

palpable lymph node suspected with malignancy:

supraclavicular node

drainage point for rest of body:

thoracic duct drains into left subclavian vein.

personal/social history:

travel especially to Asia, Africa, Western Pacific, India, Phillipines illicit drugs, especially IV sexual history

red pulp:

venous sinusoids

Pregnant women history:

weeks of gestation exposure to infections presence of pets immunization status: Flu, PN, meningococcal, TdaP.