A. Lymph returns blood to the venous system. The venous systems has a stronger osmotic pressure whil the arterial system has a greater hydrostatic pressure. The hydrostatic pressure in the arterial systems forces transudate into the interstitial and cellular space. This raises the hydrostatic pressure in these areas which cause for ENDOTHELIAL END SACS to open and for fluid to flow into the lymph vessels.
The driving force behind the movement of fluid in the lymphatic system is
C. Plasma hydrostatic is the strongest moving pressure in the system.
As the left ventricle pumps blood into the aorta, this will first raise
A. This will raise the plasma hydrostatic pressure. Which is created by stretching the tissue. As
blood is forced into the aorta, the hydrostatic pressure rises because of the arteries resistance to stretch as they fill. Thus we see that the arteries have a higher hysdrostatic pressure and the veins have a higher osmotic pressure (tendency to “suck” blood in)
T/F albumin helps to regulate osmotic pressure?
T/FThe deeper vessels of the lymphatci system have their own valves and smooth muscles which keep the fluid moving in the right direction.
Of the fluid that leaks out of the blood, what percentage returns directly back to the venous systems?
Why does blood leak out one side and get taken back in the other.
T/F Injury to a blood vessel means injury to the lymphatic system in the area.
John has lymphadenitis which has disrupted the flow of lymph. What is true of the circumstance?
B. Sincelymph is no longer flowing through the nodes at a normal pace there will be an increase in hydrostatic pressure within the afferent lymph vessels. There will by many lymphocytes and macrophages in the nodes.
Endothelial end sacs
C. The endothelial end sacs are pushed open directly by an increase in the tissue hydrostatic pressure. The hydrostatic plasma pressure is what causes fluid to be pushed from the blood into the tissue causing that rise in tissue hydrostatic pressure. The end sacs are then opened up and fluid is pushed into the lymph vessels.
Pt. presents with swollen and palpable lymph nodes, the best thing to do is
B. Any inflammation of the lymphs nodes that is palpable is an indication for a referral to a physician.
Pt.presents with severe swelling in their left leg. The tissue is soft and pits. You send her home to elevate the leg and successfully reduce the swelling this would be
the the patient has a type of lymphedema, it would be stage I according to the International Society of Lymphology (ISL) scale.
Stage I: soft and pitting with reversibility with elevation.
Stage II: nonpitting and not see reversal with elevation, clinical fibrosis, and skin changes.
Stage III: know as lymphostatic elephantitis and has severe nonpitting and fibrotic edema. There are also atrophic changes in the skin leaving it thick and leathery, keratotic skin, skin folds with tissue flaps, warty protrusions, papillomas (mole like) and leaking lymph fistulae or wounds.
Of the know causes of lymphedema, the ration of incidence or females to males is
E. The notes don't talk about the ration for secondary lymphodema. But in primary lymphodeman (idiopathic), the ratio is 4:1 for women to men
Juan lives in deep in the Congo, he has a fat swollen leg that looks rubbers and has sores leaking fluid all over it. The most probably cause of his stage III lymphedema is
A. Most cases of lymphodema in tropical regions is caused by the filarial worm. Filiariasis
is a major cause in tropical climates. The worm can reach up to 20 cm and 2 cm in diameter and the male has a whipping tail that can damage the endothelium of the lymphatic vessels and when they die the can cause even greater inflammation.
Which of the following would not be a known cause of lympedema?
i. severe lacerations
j. Crush injuries
D. scraps and bruises
Which would not be a pathogenesis of lyphodema
A. In theory increased venous osmotic pressure would assist in the movement of blood.
T/F Anything that causes a lack of variation in total tissue pressure may cause lymphodema.
Which is not a step in treating lymphedema?
B. use if diuretics does not help lymphedema. If you have cancer, you must treat for cancer with out worrying about developing lymphedema. The notes say an increased level of proteolysis helps to reduce the interstitial protein and soften tissue and increase healing, but I am not sure how you do that.
Lymphangitis is not
Any individual with an impaired lymphatic system should not
A. heat will cause vasodilation. The problem is there is too much fluid in
the area and inadequate lymph transportation. Heat would amplify the
What do we call a thickened cutaneous fold of skin over the second toe?
T/F Formation of platelets, erythrocytes, leukocytes, and plasma occurs in the bone marrow and is controlled by hormones.
F. Plasma is not formed in the bone marrow.
Which of the following is not part of the lymphatic part of the hematologic system?
B. Peyer's patches are small patches of lymphatic tissue in the small intestine.
The following are common ways of blood doping.
T/F Patient will have asignificantly different blood composition today than he/she did 20 years ago.
T/F General antihistamines are often accompanied with blood transfusions.
In a bloodless medical program there are often low
C. Hg levels need to watch closed in bloodless Medicine. Hemoglobin less than 10 is contraindication for exercise.
T/F Hemochromatosis is autosomal dominant heredity disorder found most often in men although there is equal prevelance. Why?
T. Hemochromatosis is a autosomal recessive hereditary disorder where the individual absorbs too much Fe. It is of equal prevelance between males and femals, however males experience symptoms more often. It is usually asymptomatic until around 50-60 yrs of age.
A female pt. present with disease causing a a lower capacity to carry oxygen, the disease is most likely
B. Sickle Cell Disease. Anemia is associated with a decreased ability to carry oxygen, but it is a symptom not a disease.
Which is not a common type of anemia?
E. Those are made up.
Which of the following is not generally associated with anemia.
D. Niacin is not generally associated with anemia
Your body can only absorb B12 with when parietal cells in the stomach are producing sufficient
D. The stomach parietal cells help to produceintrinsic factor, which helps the absorbtion of B12 which is important in the making of RBC. B12 is also important for the absorbtion of Fe.
Hemachromatosis is best treated by
B. Therapeutic phlebotomy is a good treatment. It works by thinning out the Fe in the blood.
Which is of the following is a true statement?
A. Hg is the number of RBC in blood usually expressed in g/100mL. Hematocrit is the percentage of RBC in blood. (low 14g/mL and 12g/mL and 41% and 37% for males and females respectively)
Pt. has Hg. count of 13g/100mL. The follwing may be true.
E. All cases may be true depending on the sex (<14 is anemia for males and <12 for females.) So depending and the gender they may or may not be classified as anemic, either why the count is really low, and an auto immune disorder may be destroying RBC or the may have a GI lesion. Anemia is often commonly caused by decrease production of RBC
Which is not a group of leukocytes?
B. Neutrocytes don't exist, A neutrophil is a type of granulocyte along with basophils and eosinophils.
The main role of granulocytes is
A. Eosinophils, basophils, and especially neutrophils are all capable of lysing. Moncoytes are called macrophages once they enter the tissue. Lymphocytes produce antibodies and secret cytokines
A. Leukocytosis is a transient increase in leukocytes where the blood count is >10,000/mL. Infection
is indicated at levels over 10,000/mL. A reduction in leukocytes is called leukopenia. Higher numbers of lymphocytes is called lymphocytosis
Pt. has a bacterial infection accompanied with high levels of herapin and histamine. What would be the main cause of this?
D. Basophilserupt and release inflammation factors in response to bacterial and other infections. Just think B for bacteria and basophils.
Pt. eats a food that he is allergic to, this is most likely to cause high levels of
D. eosinophilia is a high number of eosinophils usually the result of an allergic reaction. They
are usually late to arrive in inflammatory responses. They are weaker than neutrophils, but may perform phagocytosis. They also defend against parasitic infections.
This is the most plentiful of granulocytes and is usually used to describe
early stages of infection. They are the first phagocytic cells to reach
an infected area.
D. Neutrophils. Neutrophilia is what we call a high number of neutrophils. Monocytes are not
granulocytes. They are the most plentiful of granulocytes and work together with moncytes. Neutrophilia is low levels of neutrocytes, usually occurring in prolonged infection when the production cannot keep
up with the demand.
Pt. who is healthy but has asthma would most likely have increased chances of
D. Asthma may often be treated by prednisone. Predisone causes decreases in lymphocyte levels. Basophilia is usually present in bacterial infections, neutrophilia is associated with early stages of infection, and monocytosis is seen in chronic infections pt is healthy so none of those would be the best choice.
Where do malignant lymphomas arise from?
B. major lymphoid cells
HD is marked by the presences of
C. Reed-Sternberg cells (double egg looking cells) are the difference between Hodgkin’s disease and Non-Hodgkin’s lymphoma (NHL) is usually caused by exposure of benzene and industrial pollutants and polychlorinated biphenyls (PCB)
What is often the first symptom of NHL?
B. Lymphadenopathy (often pain less) is usually the first sign of NHL. This is why is it important refer a pt. with palpable lymph nodes. SCD-sickle cell disease. Reed-strenberg is with HD. Lymphocytosis would most likely be present with NHL, but isn’t necessarily a first sign.
Pt. has RA and back pain along with enlarged lymph nodes. As a HCW you would suspect
A. NHL. thyroidism would need to be more specific, hypo? hyper? etc.
Multiple Myeloma is
A. It is a primary malignant neoplasm of cells arising most often in bone marrow, is the same thing as plasma cell myeloma, and it is incurable. Often express with bone pain and renal problems.
A very common myeloproliferative disorder would
Hemostasis problems may be caused by.
Apsrin is not recommend for individuals with Thrombocytopenia prombelms because
C. It does thin blood, but that best answer that it inactivates the cyclooxygenase which causes the platelets to have the inability to aggregate and effects vasoconstriciton
D. DIC is NUTZ because it causes both extra coagulation and hemorrhaging. Itis a condition where there is overactivation of both the coagulation and fibrinolysis. You will end up with hemorrhaging and clots all over, a seemingly paradoxical condition.
This disored is autosomal recessive
B. SCD and hemochromatosis (over absorbtion of Fe) are both autosomal recessive
Pt. has a autosomal recessive disorder where bleeding is prolonged although the blood flow is normal. They most likely have
C. Hemophilia A is the most common form 80%
A person with hemophilia experiences hemorrhages with slight trauma and spontaneous bleeding, their condition is rated as
B. Severe may bleed spontaneously or with only slight trauma. Moderate may have major bleeding episodes after mild trauma, but not spontaneous bleeding. Mild have rare spontaneous hemorrhages.
What is the most common form of treatment for pt. with hemophilia?
Therapy for a pt. with hemophilia should not include
Which is not a main neoplastic disease of the blood and lymph?
C. Leukemia is the replacement of blood forming cells by malignant clones of lymphocytic or myelogenous cells. Malignant Lymphomas are cancers arising from the lymphoids (HD and NHL). Multiple Myeloma is an accumulation of monoclonal plasma cells in bone marrow that produce one class of immunoglobulin. Myeloproliferative disoreders are uncontrolled expansion of all bone marrow elements.