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consists of lymph fluid, collecting ducts and various tissues including the lymph nodes, spleen, thymus, tonsils, adenoids, and Peyer patches
lymphatic system
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protects the body from antigenic substances of invading organisms, removes damaged cells from circulation and provides partial, but often ineffecient barrier to maturation of malignant cells w/in body
immune system
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Every tissue supplied by blood vessels has lymphatic vessels except
brain and placenta
-
is a clear, sometimes opalescent or yellow-tingued fluid that contains a variety of WBCs (mostly lymphocytes) and on occasion, RBCs
lymph
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the drainage point for the right upper body is a lymphatic trunk that empties into the
right subclavian vein
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drains lymph from the rest of the ody into the left subclavian vein
thoracic duct
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are discrete structures surrounded by capsule composed of connective tissue and few elastic fibers and usually occur in groups
lymph nodes
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located in subcu connective tissues
superficial nodes
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lie beneath the fascia of muscles and w/in various body cavities
deeper nodes
-
defend against invasion of microorganisms and other particles w/ filtration and phagocytosis and aid in the maturation of lymphocytes and monocytes
lymph nodes
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central to the body's response to antigenic substances; not identical in size or fcn; small - 5 times that; arise from number of sits in body; primarily produced in bone marrow
lymphocytes
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sense the difference in cells of the body that have been invaded by any foreign substance or even a malignant change; have important role in controlling immune responses brought about by B-lymphoctyes
T-lymphocytes
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type of immunity involving the antibodies produced by B cells
humoral
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type of immunity involving attacks on "invaders" by the cells themselves
cellular
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located in superior mediastinum, extending upward into lower neck; essential for development of protective immune fcn; site for production of T-cells
thymus
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situated in left upper quadrant of ab cavity btwn stomach and diaphragm; blood forming organ early in life, site for storage of red corpuscles and part of body's defense system with blood-filtering macrophages
spleen
-
made up of lymphatic noduls and diffuse lymphatic tissue of the spleen
white pulp
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made up of venous sinusoids of the spleen
red pulp
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set btwn palatine arches on either side of pharynx just beyond base of tongue; organized as follicles and crypts; covered by mucous membrane
palatine tonsils
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located at nasopharyngeal border
pharyngeal tonsils or adenoids
-
located near the base of the tongue
lingual tonsils
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small, raised areas of lymph tissue on the mucosa of the small intestine and consist of many clustered lymphoid noduls and serve the intestinal tract
Peyer's patches
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the immune system and lymphoid system begin developing at what week of gestation
20
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at its largest relative to rest of body shortly after birth, reaches its greates absolute weight at puberty; then involutes replacing much of its tissue w/ fat and becoming rudimentary organ in adult
thymus
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inguinal, occipital and postauricular nodes are common before ? age
2 years
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cervical and submandibular nodes are uncommon during the ? year but more common in older children
1st
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_____nodes are not usually found in infants and their presence assoicated w/ high incidence of malignancy, is always a cause for concern
supraclavicular
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_____ is a state of altered immune fcn
pregnancy
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an increased number of lymphocytes in the blood represents a systemic response to _____ and some ______
viral infections and bacterial infections
-
the nodes of older adults are more likely to be _____ and ____, a contributing factor in impaired ability to resist infection
fibrotic and fatty
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to gently palpate for superficial lymph nodes, use what?
pads of second, third, and fourth fingers
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____ is almost always indictaive of inflammation
tenderness
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small, multiple nodes that feel like BBs under the skin; movable, discrete and move under your fingers
"shotty" nodes
-
a node that is ______ is cause for concern
fixed
-
enlarged lymph node(s)
lymphadenopathy
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inflamed and enlarged lymph node(s)
lymphadenitis
-
inflammation of lymphatics that drain an area of infection; tender erythematous streaks extend proximally from infected area; regional nodes may also be tender
lymphangitis
-
edematous swelling due to excess accumulation of lymph fluid in tissues caused by inadequate lymph drainage
lymphedema
-
congenital malformation of dilated lymphatics
lymphangioma
-
wavelike motion that is felt when node is palpated
fluctuant
-
group of nodes that feel connected and seem to move as a unit
matted
-
____ nodes are not usually tender
cancerous
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nodes may become warm or tender to the touch, matted, and much less discrete with
bacterial infections
-
involvement of lymph nodes to which a ______ has spread is often asymmetric; contralateral nodes in similar location may not be palpable
malignancy
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is the dividing line for the anterior and posterior traingles of the neck and is useful landmark for describing location
anterior border of the sternocleidomastoid muscle
-
a _____ node in the left supraclavicular region may be result of either ab or htoracic malignancy
Virchow
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To palpate the inguinal and popliteal area, have the pt lie _____ w/ knee slightly flexed
supine
-
facial muscles are innervated by cranial nerves
V trigeminal and VII facial
-
is the major accessible artery of the face
temporal artery
-
glands located anterior to the ear and above the mandible
parotid
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glands located medial to mandible at the angle of the jaw
submandibular
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glands located anteriorly in the floor of the mouth
sublingual
-
is formed by cervical vertebrae, ligaments, and sternocleidomastoid and trapezius muscles which give it support and movement
neck
-
is formed by the medial border of the sternocleidomastoid muscles, mandible, and midline
anterior triangle
-
is formed by the trapezius and sternocleidomastoid muscles and clavicle and contains the posterior cervical lymph nodes
posterior triangle
-
is the largest endocrine gland in the body, producing thyroxine (T4) and triiodothyronine (T3); has two lateral lobes that are butterfuly shaped and joined by isthmus at lower aspect
thyroid gland
-
a ____ lobe extending upward from the isthmus slightly to the left of midline, is present in about 1/3 of the population
pyramidal
-
_____ are the membranous spaces formed where four cranial bones meet and intersect
anterior and posterior fontanels
-
ossification of the sutures begins after completion of brain growth at about ____ and is finished by adulthood
6 years
-
the posterior fontanel ossifies usually blosing by ____ and the anterior fontanel closing by ____
2 months and 24 months
-
pregnancy is a _____ state
euthyroid
-
the rate of ___ production and degradation gradually decreases with aging and the thyroid gland becomes more______
T4; fibrotic
-
a horizontal jerking or bobbing motion may be associated with a
tremor
-
nodding movement may be associated with ____, esp. if nodding is synchronized with the pulse
aortic insufficieny
-
is defined as an expression or appearance of face and features of head and neck that, when considered together, is characteristic of a clinical condition or syndrome
facies
-
suspect _______ when the entire side of the face is affected
facial nerve paralysis
-
suspect ____ when the lower face is affected
facial nerve weakness
-
if only the mouth is involved, suspect a problem with the peripheral _______
trigeminal nerve
-
spasmodic muscular contractions of the face, head, or neck; may be associated w/ pressure on or degenerative changes o the facial nerves, a feature of Tourette syndrome or possibly pyschogenic in origin
tics
-
_____ of the head and neck is not routinely performed with one exception when evaluating for hypercalcemia, where may produce hyperactive masseteric reflex, the Chvostek sign
percussion
-
is not routinely performed but if you suspect a vascular anomaly of the brain, use the bell and listen over temporal region, over eyes, and below occiput
auscultation
-
webbing, excessive posterior cervical skin or an unusually short neck may be associated w/
chromosomal anomalies
-
the transverse portion of the omohyoid muscle in the posterior triangle can sometimes be mistaken for a
mass
-
marked edema of the neck may be associated w/
local infections
-
mass filling the base of the neck or visible thyroid tissue that glides upward when pt swallows may indicate an enlarged
thyroid
-
the thyroid and cricoid cartilages should be smooth and nontender and move under your finger when the pt
swallows
-
a tugging sensation, synchronous with the pulse, is evidence of ________ suggesting the presence of an aortic aneurysm
tracheal ring sign (Cardarelli's sign or Oliver's sign)
-
____ can actually make exam of thyroid more difficult
hyperextension
-
if the thyroid gland is enlarged, auscultation for vascular sounds w/ the ______; in a hypermetabolic state, blood supply is dramatically increased and vascular bruit, a soft rushing sound, may be heard
bell of stethoscope
-
is subcu edema over the present part of the infant's head at birth; most common form of birth trauma of the scap and usually occurs over the occiput and crosses suture lines
caput succedaneum
-
is a subperiosteal collection of blood and is therefore bound by the suture lines; commonly found in the parietal region and may not be immediately obvious at birth; firm and edges are well defined; does not cross suture lines; may liquefy and become fluctuant on palpation as it ages
cephalhematoma
-
preterm infnats often have long, narrow heads (______) because their soft cranial bones become flattened w/ positioning and weight of the head
brachiocephaly
-
can result from premature fusion of one of the sutures (craniosynotosis) or from external deformation
plagiocephaly
-
is common among infants with toritcollis
positional plagiocephaly
-
bulging of the skill of the frontal areas is associated w/ prematurity, thalassemia, and rickets
bossing
-
resistance to flexion of the neck is associated w/ meningeal irriation
nuchal rigidity
-
a third fontenal (mastoid fontanel) located btwn anterior and posterior fontanels, may be an expected variant but is also common in infants w/
Down syndrome
-
in infants younger than 6 months, the anterior fontenal diameter should not exceed_____; should get progressively smaller beyond that age, closing completely by_____
4-5 cm; 18-24 months
-
a ____ fontanel with marked pulsations may indicate increased intracranial pressure from a space-occupying mass or meningitis
bulging
-
a softening of the outer table of the skull
craniotabes
-
a ___ upon palpation of clavicles is indicative of fracture that occured at time fo birth in newborns
crunch
-
a ring of 2 cm or less byond the rim of the trnasilluminator is expected on all regions of the head excep the ____, where ring should be 1 cm or less
occiput
-
direct prercussion of the skull with one finger is useful to detect
Macewen sign
-
___ are common in children up to 5 years or in children with anemia; after 5, presence may suggest vascular anomalies or increased intracranial pressure
cranial bruits
-
"mask of preg"; blotchy, brownish hyperpigmentation of the face, particularly over the malar prominences and forehead; may further darken w/ sun expsoure, generally fades after delivery
chloasma
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