Lymphatic drainage pathways Practice Questions

Question 1

A 49-year-old woman presents to her physician with complaints of breast swelling and redness of the skin over her right breast for the past 1 month. She also mentions that the skin above her right breast appears to have thickened. She denies any pain or nipple discharge. The past medical history is significant for a total abdominal hysterectomy at 45 years of age. Her last mammogram 1 year ago was negative for any pathologic changes. On examination, the right breast was diffusely erythematous with gross edema and tenderness and appeared larger than the left breast. The right nipple was retracted and the right breast was warmer than the left breast. No localized mass was palpated. Which of the following statements best describes the patient’s most likely condition?

Accepted Answer

The inflammation is due to obstruction of dermal lymphatic vessels.

Answer

It shows predominant lymphatic spread.

Answer

The lesion expresses receptors for estrogen and progesterone.

Answer

The lesion is due to Streptococcal infection.

Answer

It is a benign lesion.

Question 2

A 43-year-old man comes to the physician because of weight loss and swelling on the left side of his neck. Physical examination shows a firm, enlarged left upper cervical lymph node that is immobile. Immunohistochemical testing performed on a biopsy specimen from the lymph node stains positive for cytokeratin. Which of the following is the most likely site of the primary neoplasm in this patient?

Accepted Answer

Nasopharynx

Answer

Nerve sheath

Answer

Bone

Answer

Muscle

Answer

Skin

Question 3

A 32-year-old man comes to the physician because of a 3-week history of cough, weight loss, and night sweats. He migrated from Sri Lanka 6 months ago. He appears emaciated. His temperature is 38.1°C (100.5°F). Physical examination shows enlargement of the right supraclavicular lymph node. Chest and abdominal examination show no abnormalities. An interferon-gamma assay is positive. A biopsy specimen of the cervical lymph node is most likely to show the causal organism in which of the following locations?

Accepted Answer

Paracortex

Answer

Mantle zone

Answer

Medullary sinus

Answer

Germinal center

Answer

Subcapsular sinus

Question 4

A 39-year-old man presents with painless swelling of the right testis and a sensation of heaviness. The physical examination revealed an intra-testicular solid mass that could not be felt separately from the testis. After a thorough evaluation, he was diagnosed with testicular seminoma. Which of the following group of lymph nodes are most likely involved?

Accepted Answer

Para-aortic lymph nodes

Answer

Superficial inguinal lymph nodes (lateral group)

Answer

Deep inguinal lymph nodes

Answer

Superficial inguinal lymph nodes (medial group)

Answer

Para-rectal lymph nodes

Question 5

A 59-year-old woman presents to her primary care provider with a 6-month history of progressive left-arm swelling. Two years ago she had a partial mastectomy and axillary lymph node dissection for left breast cancer. She was also treated with radiotherapy at the time. Upon further questioning, she denies fever, pain, or skin changes, but reports difficulty with daily tasks because her hand feels heavy and weak. She is bothered by the appearance of her enlarged extremity and has stopped playing tennis. On physical examination, nonpitting edema of the left arm is noted with hyperkeratosis, papillomatosis, and induration of the skin. Limb elevation, exercise, and static compression bandaging are started. If the patient has no improvement, which of the following will be the best next step?

Accepted Answer

Vascularized lymph node transfer

Answer

Diethylcarbamazine

Answer

Low molecular weight heparin

Answer

Endovascular stenting

Answer

Antibiotics

Question 6

A 35-year-old woman volunteers for a study on respiratory physiology. Pressure probes A and B are placed as follows:
Probe A: between the parietal and visceral pleura
Probe B: within the cavity of an alveolus
The probes provide a pressure reading relative to atmospheric pressure. To obtain a baseline reading, she is asked to sit comfortably and breathe normally. Which of the following sets of values will most likely be seen at the end of inspiration?

Accepted Answer

Probe A: -6 mm Hg; Probe B: 0 mm Hg

Answer

Probe A: 0 mm Hg; Probe B: -1 mm Hg

Answer

Probe A: -4 mm Hg; Probe B: 0 mm Hg

Answer

Probe A: -4 mm Hg; Probe B: -1 mm Hg

Answer

Probe A: -6 mm Hg; Probe B: -1 mm Hg

Question 7

An otherwise healthy 39-year-old woman presents to her primary care provider because of right-leg swelling, which started 4 months ago following travel to Kenya. The swelling has been slowly progressive and interferes with daily tasks. She denies smoking or alcohol use. Family history is irrelevant. Vital signs include: temperature 38.1°C (100.5°F), blood pressure 115/72 mm Hg, and pulse 99/min. Physical examination reveals non-pitting edema of the entire right leg. The overlying skin is rough, thick and indurated. The left leg is normal in size and shape. Which of the following is the most likely cause of this patient condition?

Accepted Answer

Obstruction of lymphatic channels

Answer

Hypoalbuminemia

Answer

Lymphatic hypoplasia

Answer

Venous thromboembolism

Answer

Persistent elevation of venous pressures

Question 8

A pathologist receives a patient sample for analysis. Cells in the sample are first labeled with fluorescent antibodies and then passed across a laser beam in a single file of particles. The light scatter and fluorescent intensity of the particles are plotted on a graph; this information is used to characterize the sample. This laboratory method would be most useful to establish the diagnosis of a patient with which of the following?

Accepted Answer

Pancytopenia and deep vein thrombosis with intermittent hemoglobinuria

Answer

Ventricular septal defect and facial dysmorphism with low T-lymphocyte count

Answer

Painless generalized lymphadenopathy with monomorphic cells and interspersed benign histiocytes on histology

Answer

Multiple opportunistic infections with decreased CD4 counts

Answer

Vesicular lesions with dermatomal distribution and dendritic corneal ulcers

Question 9

A 23-year-old woman presents to her primary care physician with 3 days of fatigue and back pain after she started a drug for malaria prophylaxis. She says that her urine has also been darker over the same time period. Her past medical history is significant for allergies as well as a broken elbow that was treated in a cast 10 years ago. She does not take any medications, does not smoke, and drinks socially. Peripheral blood smear reveals both red blood cells with dark intracellular inclusions as well as abnormally shaped red blood cells. The immune cells responsible for the shape of these red blood cells are located in which of the following places?

Accepted Answer

Red pulp of the spleen

Answer

Lymph nodes

Answer

Bone marrow

Answer

White pulp of the spleen

Answer

Blood vessels

Question 10

Arrange in sequence the structures involved in the direct pathway (1=Striatum, 2=GPi, 3=Thalamus, 4=Cortex output, 5=Cortex input):-

Accepted Answer

5,1,2,3,4

Answer

1,3,4,2,5

Answer

1,2,3,4,5

Answer

5,4,2,3,1

Answer

5,1,3,2,4

Lymphatic drainage pathways

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Principles of lymphatic circulation

Head and neck lymphatics

Upper limb lymphatic drainage

Breast lymphatic drainage

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Abdominal lymphatic drainage

Pelvic lymphatic drainage

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Thoracic duct and right lymphatic duct

Lymph node groups and clinical significance

Lymphedema pathophysiology

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