FINAL PHSY DI 1 exam 2

What should your first question be when the patient reports a mass/lump/bump?

How long has it been there?

What is acute lymphangitis?

inflammation of one or more lymphatic vessel

What is acute suppurative lymphandentis?

infection and inflammation of a lymph node

may affect a single or localized group of nodes

What is lymphedema?

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

Lymphedema staging is due to __

amount of fluid

What is the MC cause of lymphedema?

congestive heart failure

What can cause a unilateral lymphedema?

lymph node damage in patients with conditions like mastectomy

What is lymphangioma/cystic hygroma?

congenital malformation of dilated lymphatics

What is lymphatic filariasis?

massive accumulation of lymphedema throughout the body

MC cause of secondary lymphedema worldwide

What is Non-Hodgkin lymphoma?

malignant neoplasm of the lymphatic system

What is Hodgkin lymphoma?

Reed sternberg cells

malignant lymphoma

What disease is associated with Epstein barr virus mononucleosis?

infectious mononucleosis

What is toxoplasmosis?

Zoonosis→ caused by the parasite toxoplasma gondii

What is roseola infantum?

HHV-6

What is herpes simplex?

HSV

can be 1 or 2

Cat scratch disease classically demonstrates __

axillary lymphadenopathy

Cat scratch disease is MC causes of __ in childern

subacute or chronic lymphadenitis

Serum sickness is what type of hypersensitivity reaction?

type 3

What is immune complex disease/latex allergy type IV dermatitis?

allergic contact dermatitis that involves the immune system and is caused by chemicals used in latex products

What is latex allergy type 1 reaction?

true allergic reaction caused by protein antibodies

Lymphatic system consists of__

1. Lymph fluid/collecting ducts

2. Lymph nodes

3. spleen

4. thymus

5. tonsils and adenoids

6. Peyer patches

Where is lymph tissue?

mucosa of the stomach, appendix, bone marrow, and lungs

What are the exceptions to where lymph tissue is located?

placenta and central nervous system

What is lymphatic systems role in immunologic and metabolic processes?

1. maintains fluid balance

2. filtration of fluid before it is returned to blood stream

3. Phagocytosis

4. Production of antibodies

5. Absorption of fat and fat-soluble substances

6. Pathway for spread of malignancy

What is composition of lymph?

1. Clear fluid

2. Mostly white blood cells

3. Occasional red blood cells

4. proteins

T/F the drainage of lymph is a leaky system

true

Lymph is circulated via the __ system

cardiovascular

Lymph is collected by __

tubules/ducts

What is a good way to describe the lymph drainage?

closed but porous (leaky) circulation

The right lymph duct drains__

liver

The rest of the body is drained by the __

thoracic duct

B-lymphocytes produce __

antibodies

T-lymphocytes do what?

control the immune responses brought about by B-lymphocytes

The thymus is located where?

superior mediastinum

When is the thymus primarily functioning?

infancy and childhood

What can cause enlargement of the spleen?

1. infection

2. injury

3. revert back to creating blood

Palatine tonsils are commonly referred to as __

tonsils

Pharyngeal tonsils are commonly referred to as __

adenoids

What are peyer patches?

small, raised areas of lymph tissue on the mucosa of the small intestine

Thymus is at its largest relative to the rest of the body when?

shortly after birth

Pregnancy is a state of __

altered immune function

What count increases with pregnancy?

leukocyte (WBC)

When you are an older adults, # and size of lymph nodes __

decreases

What are lymph nodes?

discrete structures surrounded by a capsule composed of connective tissue and a few elastic fibrils

What are you inspecting the regions of nodes for? (EYES only)

1. Edema

2. Erythema

3. Red streaks→ lymphangitis

4. Enlargement→ lymphadenopathy

What are you palpating superficial lymph nodes and compare side to side for?

1. Size

2. Consistency

3. Mobility

4. Discrete borders or matting

5. Tenderness

6. Warmth

What is the head sequence for palpating lymph nodes?

1. Occipital nodes

2. postauricular nodes

3. preauricular nodes

4. parotid nodes and glands

5. submandibular nodes and glands

6. submental nodes and glands

What is the neck sequence for palpating lymph nodes?

1.Retropharyngeal/tonsillar nodes

2. Anterior cervical nodes

3. SCM nodes

4. Posterior cervical nodes

5. Supraclavicular nodes

Lymph nodes are most commonly described as __

small, moveable/mobile, “shotty”

Normal nodes are usually not __

1. Larger than 1cm

2. Hard

3. Fixed

4. Tender

5. Fluctuant

Enlarged postauricular/occipital is common in who?

children younger than age 2→ uncommonly palpated beyond age 2

Enlarged cervical/submandibular nodes are more frequent in who?

children older than age 1

T/F Enlarged tonsils are common

true

Palpate lymph nodes with what part of your finger?

finger pads of second and third digits→ NOT TIPS

The harder the node, the more likely the __

malignancy

The more tender the node, the more likely __

the inflammation

Nodes do not pulsate, __ do

arteries

A palpable supraclavicular node on the left is a clue to __

abdominal or thoracic malignancy

What is another name for palpable left supraclavicular node?

Virchow node

What is it called if you have a hard and enlarged left supraclavicular node?

Troisier sign

What are some midline neck masses?

1. thyroid goiter

2. thyroglossal duct cyst

3. dermoid/teratoma

4. fat pad

What are some lateral neck masses?

1. brachial/pharyngeal cleft cyst

2. laryngocele

3. dermoid/teratoma

4. lymph node enlargement

5. salivary gland enlargement

6. torticollis

What are you inspecting during a neck examination?

1. symmetry

2. alignment of trachea

3. fullness

4. masses, webbing, and skinfolds

What are you palpating on the neck?

1. Lymph nodes

2. salivary glands

3. thyroid glands

4. trachea for midline position

5. tracheal tug for rhythm movement of aortic pulsation

6. movement of hyoid bone and cartilages with swallowing

What arteries are we auscultating?

1. temporal

2. carotid

3. subclavian

What are some facial features to take note of?

1. facial features, symmetry, tics or spasms

2. head position and shape

3. skull size and shape

4. hair pattern

What is the difference between stroke and bell’s palsy? (TQ)

stroke spares upper face (forehead)

bell’s palsy affects entire side of face

What is the placement for a trachea palpation?

seated with slight forward lean

What is a tracheal tug?

downward displacement of the cricoid cartilage with each ventricular contraction

What would a downward tug of the trachea reveal?

presence of an aortic arch aneurysm

What is campbell’s sign?

downward displacement of the thyroid cartilage during inspiration

What is Campbell’s sign due to?

COPD

What is transillumination?

putting a light up to the skull of infants

What is transillumination used for?

suspected intracranial lesions or a rapidly increasing head circumference

What is Macewen sign?

percussion of skull with one finger

stronger (deep) sounds indicate abnormalities

What could Macewen sign indicate?

hydrocephalus or a brain abscess

What children are likely to have bruits?

children up to 5

children with anemia

What is chloasma/melasma?

mask of pregnancy

hyperpigmentation of face (grey or brown patches on face)

What may cause older adults to have sunken eyes and eyelids loose and wrinkled?

Vitamin C, K and iron

Evaluate ROM of neck in older patients for __

pain or crepitus

jerkiness or limited movement

As individuals age, thyroid becomes more __

fibrotic

What is second only to the heart in # of errors in examination technique? (TQ)

thyroid gland

What are you palpating the thyroid gland for?

1. size

2. shape

3. configuration

4. consistency/texture

5. tenderness

6. nodules

Where is the thyroid located?

2 cm above clavicles

isthmus of the thyroid is below cricoid cartilage

The thyroid texture can be compared to a __

almond (mildly ridged)

The average thyroid lobe is __ cm wide

2

The average thyroid lobe is __ cm high

5

The isthmus is __cm in width and height

1.25-2

Larger thyroid glands occur where?

iodine deficient areas→ mountainous regions

Do men or women have larger and more easily palpable thyroid glands?

women

Which lobe is often larger?

right

A pyramidal lobe may be present in __%

21-55

5% of people have posterior extracapsular tissue that extends superior from posterior aspect of the tongue, what is this called?

lingual thyroid

What can cause false-positive results?

1. Thin patients

2. long necklines→ pseudo-goiters -→ Modigliani syndrome

3. fat pads→ does not rise with deglutition

What can cause a false negative?

1. inadequate examination

2. short/thick necked patients

3. Atypical or ectopic placement of the thyroid

What is a lingual thyroid?

normal structure that are in abnormal position

should descend to normal position

What are some red flags for thyroid problem?

1. changed temperature preference

2. swelling of neck

3. change in texture of hair, skin, nails

4. change in emotional stability

5. increased prominence of eyes

6. tachycardia

7. change in menstrual flow

8. change in bowel habits

What are some signs of hyperthyroidism?

oily hair

nails longer

hair longer

What are some signs of hypothyroidism?

dry hair

short nails

short hair

What is a goiter?

chronic enlargement of the thyroid