Day 1

Question 1

Global swelling indicates

Answer 1

Kidney, heart, and liver problems

Question 2

What is the main purpose of the lymphatic system?

Answer 2

Drain substances that cannot be drained/reabsorbed by the blood system.

Question 3

What are commonalities between circulatory and lymphatic systems?

Answer 3

• Protect the body from infection and disease
• Superficial & deep organ systems
• Leukocytes
• Blood plasma
• Serum proteins
• Common pathway to heart

Question 4

Circulatory and lymphatic system differences

Answer 4

• No central pump (lymphatic system is innervated by sympathetic part of ANS)
• Lymph transport is interrupted by lymph nodes

Question 5

What is edema?

Answer 5

• Accumulation of water in tissues
• Symptom
• Caused by dynamic insuffancy of lymphatic system

Question 6

What is lymphedema?

Answer 6

• Amnormal accumulation of water and protein
• Disease process
• Mechanical insuffancy of lymphatic system

Question 7

What are lymphatic loads made of?

Answer 7

Water
Protein
Cells
Long-chain fatty acids (Fat)

Question 8

How many liters are returned to venous system via the thoracic duct in 24 hours

Answer 8

2-4 Liters

Question 9

It is the responsibility of the lymphatic system to remove what from the tissue spaces?

Answer 9

Proteins

Question 10

What can not be absorbed by the blood vessels of the small intestines?

Answer 10

Long-chain fatty acids

Question 11

Lymphatic loads/cell fragments include

Answer 11

• All cells that become free in the interstitial space
• Hematoma contents, RBC, WBC, CA cells, bacteria, viruses, and tattoo ink (90-95%)
• Inhaled spores
• Cell fragments too large to be reabsorbed by venous capillaries

Question 12

If mechanical insuffancy is not treated what happens?

Answer 12

Lymphedema continues to progress

Question 13

Initial lymph capillaries are where

Answer 13

Plexus

Question 14

Lymph collectors are located where?

Answer 14

Suprafascial fatty tissue

Question 15

Each lymph capillary endothelial cells is connected to surrounding interstitial tissue via what

Answer 15

Anchoring filaments

Question 16

Locations of perforating precollectors

Answer 16

Parasternal
Paravertebral
Intercostal

Question 17

Purpose of lymphatic collectors

Answer 17

Transport lymph to regional lymphatic nodes and lymphatic trunks

Question 18

Which part of the nervous system innervated the smooth muscles?

Answer 18

Sympathetic portion of the autonomic nervous system (ANS)

Question 19

3 main regional lymph nodes

Answer 19

Axillary, inguinal, and cervical

Question 20

What makes up the femoral lymph node borders (femoral triangle)?

Answer 20

Inguinal ligament, sartorius muscle, and gracilis muscle

Question 21

How many inguinal lymph nodes are there?

Answer 21

6-12

Question 22

What skin areas drain to inguinal lymph nodes?

Answer 22

Legs
Lower body quadrants
External genitalia of men and women (penis and scrotum or external labia)

Question 23

Where are axillary lymph nodes located

Answer 23

Between pectoralis and latissimus dorsi

Question 24

How many axillary lymph nodes are there?

Answer 24

12(10)-24

Question 25

Where is the upper horizontal watershed?

Answer 25

Sternal notch - clavicle - acromion - spine of scapula - between c7/t2

Question 26

Where is the lower horizontal watershed?

Answer 26

Umbilicus - lower boarder of ribs - to t12

Question 27

Where is the sagittal watershed?

Answer 27

Midline dividing body from L to R - vertex to the perineum

Question 28

What are intra-territorial anastomosis

Answer 28

Connections between collectors within the same territory

Question 29

What are inter-territorial anastomoses

Answer 29

Anastomoses where the collector's origins directly align with each other at the watersheds

Question 30

How many collectors for every anastomoses?

Answer 30

7-10

Question 31

What are the 6 anastomoses?

Answer 31

``` AAA: Anterior Axillo-axillary AII: anterior inter inguinal AI or IA: right or left axillo-inguinal or inguinal-axillary (only on front side) PAA: posterior Axillo-axillary PII: posterior inter inguinal ```

Question 32

Where is the cisterna chyli

Answer 32

Anterior to vertebrae T11-L2

Question 33

What makes up the venous angle (R or L)?

Answer 33

Internal jugular and subclavian veins

Question 34

The lymph from lumbar trunks feeds into what?

Answer 34

Cisterna chyli

Question 35

How much lymph goes through the R lymphatic duct in 24 hours

Answer 35

300ml (soda can)

Question 36

What drains into L venous angle?

Answer 36

Lower extremities, bil lower quadrants, external genitalia, L upper quadrant, LUE, L side face/head/neck

Question 37

What drains into the R venous angle?

Answer 37

R upper quadrant, RUE, R face/head/neck

Question 38

What are the boarders of deep cervical lymph nodes/lateral cervical triangle

Answer 38

Anterior boarder: SCM Posterior boarder: upper trapezius Inferior boarder: clavicle

Question 39

Where does the upper extremity have a bottle neck?

Answer 39

Antecubital fossa

Question 40

What lymph nodes do the upper extremity drain into?

Answer 40

Axillary and supraclavicular lymph nodes

Question 41

Ventro-medial bundle is where?

Answer 41

15 collectors; Drains plantar surface of feet, 1/2 medial sole, dorsum of foot, lower leg, bottlenecks behind medial femoral condyle, and increases to run to inguinal lymph nodes

Question 42

Dorsi-lateral bundle is where?

Answer 42

1/2 sole of foot, heel, and narrow strip following Achilles to popliteal fossa

Question 43

What options do you have to re-route lymph?

Answer 43

Utilize lymph collectors in affected area, plexus, lymphatic vasa-vasorum, anastomoses, deep lymph vessels

Question 44

What are the general effects of MLD?

Answer 44

``` Increase lymph production Increase lymphangiomotorocity Increase in venous return Reverse of lymph flow Soothing Analgesic ```

Question 45

What are neck contraindications (absolute)?

Answer 45

``` Carotid endoarterectomy Hyperthyroidism/thyroid problems Carotid-sinus syndrome History of CVA Cardiac arrhythmia ```