Lymphatic System — MCQs
Which of the following group of lymph nodes does NOT receive direct lymphatic drainage from the perineum?
The aortic hiatus is formed by the right and left crura of the diaphragm. Which of the following structures does NOT pass through the aortic hiatus?
Absence of lymph nodes is characteristic of -
All of the following are features of Lymph node histology except:
T cells in lymph node are present in:
Identify the condition given in the image below?
Lymphatic drainage of cervix is to
What is the most common site of lymphangiosarcoma?
Which of the following area is marked in the histology of lymph node? (AIIMS May 2017)
Characteristic of protective epithelium is:
Lymphatic System Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following group of lymph nodes does NOT receive direct lymphatic drainage from the perineum?
- A. Superficial inguinal
- B. Internal iliac
- C. External iliac (Correct Answer)
- D. Deep inguinal
Explanation: ***External iliac*** - The external iliac lymph nodes do **NOT receive direct lymphatic drainage** from the perineum. - They primarily receive lymph from the **deep inguinal nodes**, pelvic organs (bladder, upper vagina), and lower anterior abdominal wall [1]. - Perineal lymphatics drain to superficial inguinal, deep inguinal, or internal iliac nodes first, making external iliac a **secondary or tertiary drainage station** rather than a direct recipient. *Superficial inguinal* - These are the **primary drainage site** for lymph from the superficial perineum. - They receive direct lymphatic vessels from the **vulva, distal vagina, labia majora**, scrotum, and skin of the perineum. - This is the main first-line drainage pathway for superficial perineal structures. *Internal iliac* - Internal iliac lymph nodes receive **direct lymphatic drainage** from the deep perineum, including the **male urethra, prostate**, and deep structures [2], [3]. - They serve as primary drainage for pelvic visceral structures and deep perineal tissues [3]. *Deep inguinal* - Deep inguinal lymph nodes receive lymph from the **superficial inguinal nodes** and from deep structures of the lower limb. - They are part of the drainage pathway from the perineum via the superficial inguinal nodes.
Question 2: The aortic hiatus is formed by the right and left crura of the diaphragm. Which of the following structures does NOT pass through the aortic hiatus?
- A. Thoracic duct
- B. Left vagus nerve
- C. Left gastric vein (Correct Answer)
- D. Azygos vein
Explanation: ***Left gastric vein*** - The **left gastric vein** is part of the **portal venous system** and drains into the portal vein. - It **does NOT pass through the diaphragm** via the aortic hiatus or any other diaphragmatic opening. - It has **no anatomical relationship** with the aortic hiatus, making it the best answer to this question. *Thoracic duct* - The **thoracic duct** is the largest lymphatic vessel in the body and **passes through the aortic hiatus** along with the aorta. - It ascends through the aortic hiatus at the **T12 vertebral level** to eventually drain into the left subclavian vein. - It lies posterior to the aorta as it traverses the hiatus. *Left vagus nerve* - The **left vagus nerve** does NOT pass through the aortic hiatus, but it **does pass through the esophageal hiatus** at the T10 level. - It contributes to the **anterior vagal trunk** as it enters the abdomen with the esophagus. - While this structure doesn't pass through the aortic hiatus, it does traverse the diaphragm through a different opening, making it a less definitive answer than the left gastric vein. *Azygos vein* - The **azygos vein** typically **passes through the aortic hiatus** alongside the aorta and thoracic duct. - It may occasionally pass through a separate opening in the right crus of the diaphragm. - It collects deoxygenated blood from the posterior walls of the thorax and abdomen before draining into the superior vena cava.
Question 3: Absence of lymph nodes is characteristic of -
- A. Placenta
- B. Brain (Correct Answer)
- C. Lung
- D. Liver
Explanation: ***Brain*** - The **central nervous system (CNS)**, including the brain, is the **classic textbook answer** for organs lacking lymph nodes due to its status as an immunologically privileged site [1]. - The **blood-brain barrier** prevents conventional lymphatic drainage, and there are **no organized lymph nodes** within the brain parenchyma [1]. - Recent evidence suggests lymphatic-like drainage pathways (glymphatic system and meningeal lymphatics) that clear waste, but these do **not contain lymph nodes**. - Brain is the **most definitive answer** among organs completely devoid of lymph nodes. *Placenta* - The placenta is also an immunologically privileged organ that **lacks organized lymph nodes**. - However, it is a **temporary organ** (present only during pregnancy), whereas the brain is a permanent organ, making brain the more classical answer in exam contexts. - Its immune regulation occurs through specialized cellular mechanisms rather than lymph node-mediated immunity. *Lung* - The lungs are rich in **lymphatic vessels** and contain numerous **lymph nodes**, particularly in the hilar and mediastinal regions [2], [3]. - These lymph nodes play a crucial role in immune surveillance and drainage of lymphatic fluid from the pulmonary tissues. - **Clearly has lymph nodes** - incorrect option. *Liver* - The liver has an extensive **lymphatic system** and contains regional lymph nodes, primarily located in the **porta hepatis**. - These lymph nodes contribute to immune responses against pathogens entering via the portal circulation. - **Clearly has lymph nodes** - incorrect option.
Question 4: All of the following are features of Lymph node histology except:
- A. Both Efferent and Afferent are present
- B. Subcapsular sinus present
- C. Cortex and Medulla are present
- D. Red pulp and White pulp are present (Correct Answer)
Explanation: ***Red pulp and White pulp are present*** - **Red pulp** and **white pulp** are characteristic histological features of the **spleen**, not lymph nodes [1]. - The white pulp contains lymphoid follicles (PALS - periarteriolar lymphoid sheaths), while the red pulp is involved in filtering blood and destroying old red blood cells [1]. - This is the feature that does NOT belong to lymph node histology. *Both Efferent and Afferent are present* - Lymph nodes have multiple **afferent lymphatic vessels** that bring lymph into the node and usually one or two **efferent lymphatic vessels** that carry lymph away [2]. - This arrangement allows for efficient filtering of lymph and immune surveillance [2]. - This IS a feature of lymph nodes. *Subcapsular sinus present* - The **subcapsular sinus** is a space located directly beneath the capsule of the lymph node, which receives lymph from the afferent lymphatic vessels. - It contains a network of reticular fibers and macrophages, acting as the initial filtering area. - This IS a feature of lymph nodes. *Cortex and Medulla are present* - Lymph nodes are histologically divided into an outer **cortex** and an inner **medulla**. - The cortex contains lymphoid follicles (B-cell areas) and paracortical areas (T-cell areas), while the medulla consists of medullary cords and sinuses. - This IS a feature of lymph nodes.
Question 5: T cells in lymph node are present in:
- A. Paracortical area (Correct Answer)
- B. Mantle layer
- C. Medullary cords
- D. Cortical follicles
Explanation: ***Paracortical area*** - The **paracortical area** contains a high concentration of **T cells**, particularly activated T cells in response to antigenic stimulation [1]. - It plays a crucial role in **immune responses**, bridging the cortex and medulla of the lymph node [1]. *Mantle layer* - The **mantle layer** surrounds the follicles and primarily consists of **B cells**, not T cells. - It is involved in the initial immune response but does not contain a significant number of T lymphocytes. *Medullary cords* - **Medullary cords** mainly contain **plasma cells** and macrophages, with very few T cells present. - Their primary function is the secretion of antibodies rather than T cell activation or response. *Cortical follicles* - **Cortical follicles** are primarily sites for **B cell activation and proliferation**. - While they may have some T cells at their periphery, the majority of T cells are located in the paracortical area.
Question 6: Identify the condition given in the image below?
- A. Chronic lymphedema (Correct Answer)
- B. Cushing syndrome
- C. Osteoporosis
- D. None of the options
Explanation: ***Chronic lymphedema*** - The image shows a **swollen foot** with **thickened, dry, and hyperkeratotic skin**, and **deep skin folds**, particularly between the toes. This is characteristic of **chronic lymphedema** due to impaired lymphatic drainage. - The presence of the **Stemmer's sign** (inability to pinch and lift the skin at the base of the second toe) is a common finding in lymphedema, which can be inferred from the overall appearance of the toes. *Cushing syndrome* - Cushing syndrome is characterized by **central obesity**, **moon facies**, **buffalo hump**, and **thin, fragile skin** with **striae**, not typically severe localized edema and skin changes as seen in the image. - While fluid retention can occur, it does not manifest as the characteristic cutaneous changes of chronic lymphedema. *Osteoporosis* - Osteoporosis is a condition of **decreased bone density**, making bones fragile and prone to fractures. - It does not present with visible skin changes or edema as depicted in the image. *None of the options* - The image clearly shows severe manifestations identifiable as **chronic lymphedema**, therefore one of the provided options is correct.
Question 7: Lymphatic drainage of cervix is to
- A. Iliac lymph nodes (Correct Answer)
- B. Para-aortic lymph nodes
- C. Deep inguinal lymph nodes
- D. Superficial inguinal lymph nodes
Explanation: ***Iliac lymph nodes*** - The primary lymphatic drainage of the cervix is to the **internal**, **external**, and **common iliac lymph nodes**. - This pathway is crucial for understanding the spread of **cervical cancer**. *Para-aortic lymph nodes* - While sometimes involved in advanced cases, the **para-aortic nodes** are typically considered a secondary drainage site, usually after the iliac nodes are affected. - They are the primary drainage for organs like the **ovaries** and **testes**. *Deep inguinal lymph nodes* - These nodes primarily drain structures of the **lower limb** and some external genital areas, but not the cervix directly. - They are located deeper in the groin region, distinct from the internal pelvic drainage. *Superficial inguinal lymph nodes* - These nodes drain the **skin of the lower abdomen**, perineum, and external genitalia, as well as the lower limbs. - They do not receive direct lymphatic drainage from the **cervix**.
Question 8: What is the most common site of lymphangiosarcoma?
- A. Liver
- B. Spleen
- C. Post-mastectomy lymphedema of the arm (Correct Answer)
- D. Retroperitoneum
Explanation: ***Post-mastectomy lymphedema of the arm*** - Lymphangiosarcoma is a rare, aggressive malignancy that most commonly arises in the setting of **chronic lymphedema**, particularly following **radical mastectomy** for breast cancer [1]. - The chronic lymphedema, often in the arm, creates a microenvironment conducive to the development of this vascular malignancy, known as **Stewart-Treves syndrome**. *Liver* - While the liver can be a site of various primary and metastatic cancers, it is not the most common location for **lymphangiosarcoma**. - Primary liver cancers are typically **hepatocellular carcinoma** or **cholangiocarcinoma**. *Spleen* - The spleen is rarely a primary site for any sarcoma and is not typically associated with the development of **lymphangiosarcoma**. - Splenic involvement usually indicates metastatic disease or a primary **lymphoid malignancy**. *Retroperitoneum* - The retroperitoneum can be a site for various soft tissue sarcomas, such as **liposarcoma** or **leiomyosarcoma** [2]. - However, it is not the most common primary site for **lymphangiosarcoma**, which has a strong predilection for areas of chronic lymphedema. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 125-126. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1222.
Question 9: Which of the following area is marked in the histology of lymph node? (AIIMS May 2017)
- A. Mantle zone
- B. Marginal zone
- C. Germinal center (Correct Answer)
- D. Paracortical area
Explanation: ***Germinal center*** - The image illustrates a **germinal center**, characterized by its **lighter staining** and a distinct network of cells (likely follicular dendritic cells) which are responsible for B-cell proliferation and differentiation. - The pointer indicates the surrounding, more basophilic lymphocytes, often seen adjacent to the paler germinal center. *Mantle zone* - The mantle zone surrounds the germinal center and consists of **small, inactive B-lymphocytes** that stain more densely (darker) than the cells within the germinal center. - It would be seen as a darker ring immediately outside the lighter germinal center. *Marginal zone* - The marginal zone is typically found in the **spleen** and is a region of B cells that surrounds the white pulp. - It is not a primary structural component identified within the follicular architecture of a lymph node in the manner depicted. *Paracortical area* - The paracortex is primarily a **T-cell zone**, located between the follicles and the medulla within the lymph node. - It would not exhibit the distinct follicular structure with a light center and surrounding darker cells as shown.
Question 10: Characteristic of protective epithelium is:
- A. Microvilli
- B. Thinness
- C. Pinocytic vesicle
- D. High regenerative capacity (Correct Answer)
Explanation: ***High regenerative capacity*** - **Protective epithelia**, such as in the skin or lining of the gastrointestinal tract, are constantly exposed to environmental stressors and damage. - Their cells have a high rate of division and replacement, ensuring the **integrity of the barrier function** [1]. *Microvilli* - **Microvilli** are characteristic of epithelia involved in **absorption**, such as those in the small intestine. - They increase the surface area for absorption but are not the primary characteristic of protective epithelia. *Thinness* - **Thin epithelia**, like **simple squamous epithelium**, are adapted for efficient gas exchange or filtration (e.g., in the lungs or kidney glomeruli). - Protective epithelia are often **stratified** and thus thicker to withstand abrasion and provide a robust barrier. *Pinocytic vesicle* - **Pinocytic vesicles** are involved in **fluid and solute uptake** by cells (pinocytosis or "cell drinking"). - While all cells perform pinocytosis, it is not a defining characteristic unique to protective epithelia.
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