Exam

Name___________________________________

SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

Figure 20.1

Using Figure 20.1, match the following:

1) Axillary node(s). 1)

2) Cisterna chyli. 2)

3) Entrance of thoracic duct into subclavian vein. 3)

4) Thoracic duct. 4)

5) Collecting lymphatic vessels. 5)

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Figure 20.2

Using Figure 20.2, match the following:

6) Efferent vessels. 6)

7) Cortex. 7)

8) Medullary cord. 8)

9) Trabecula. 9)

10) Medulla. 10)

MATCHING. Choose the item in column 2 that best matches each item in column 1.

Match the following:

11) Protein-containing fluid within A) Lymph

11)
lymphatic vessels.
B) Thoracic duct
12) Stores blood platelets.
12)
C) Spleen
13) Receives lymph from most of the
13)
body.

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 14) Small organs intimately associated A) Peyer's patches
14)
with lymphatic vessels.
B) Lymph nodes
15) Largest lymphatic organ.
15)
C) Spleen
16) Isolated clusters of lymph follicles
16)
found in the wall of the small
intestine.

TRUE/FALSE. Write 'T' if the statement is true and 'F' if the statement is false.

17) Peyer's patches are clusters of lymphoid tissue found primarily in the large intestine. 17)

18) The lymphatic capillaries function to absorb the excess protein-containing interstitial fluid and 18)
return it to the bloodstream.

19) Lymph capillary permeability is due to minivalves and protein filaments. 19)

20) Lymphatic capillaries are permeable to proteins. 20)

21) Digested fats are absorbed from the intestine by the lymph capillaries. 21)

22) Chyle is delivered to the blood via the lymphatic system. 22)

23) There are more efferent lymphatic vessels leaving a lymph node than there are afferent vessels 23)
entering a lymph node.

24) About 3 liters of fluid are lost to the tissue spaces every 24 hours and are returned to the 24)
bloodstream as lymph.

25) Because lymph vessels are very low-pressure conduits, movements of adjacent tissues are 25)
important in propelling lymph through the lymphatics.

26) Lymphoid tissue is mainly reticular connective tissue. 26)

27) Lymphocytes reside temporarily in lymphoid tissue, then move to other parts of the body. 27)

28) The thymus is the only lymphoid organ that does not DIRECTLY fight antigens. 28)

29) Like blood, lymph flows both to and from the heart. 29)

30) When tissues are inflamed, lymphatic capillaries permit uptake of large particles such as cell 30)
debris, pathogens, and cancer cells.

31) The cisterna chyli collects lymph from the lumbar trunks draining the upper limbs and from the 31)
intestinal trunk draining the digestive organs.

32) If even a small part of the spleen is left in a ten -year-old child, it will most likely regenerate itself. 32)

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 33) In the spleen, red pulp is involved in the immune functions and white pulp is involved in 33)
disposing of worn-out RBCs.

34) The most important role of the spleen is to provide a site for lymphocyte proliferation and immune 34)
surveillance and response.

35) The most important of the secondary lymphoid organs in the body are the lymph nodes. 35)

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

36) Small secondary lymphoid organs, which cluster along lymphatic vessels, are termed ________. 36)
A) lymphatics B) lymph follicles C) lymph nodes D) lacteals

37) Which of the following would NOT be classified as a lymphoid organ? 37)
A) spleen B) tonsils
C) pancreas D) Peyer's patches of the intestine

38) Which of the following statements regarding the thymus is FALSE? 38)
A) Its stroma consists of epithelial tissue.
B) It functions strictly in T lymphocyte maturation.
C) It has follicles similar to those in the spleen.
D) It does not directly fight antigens.

39) Which of the following correctly describes the pathway of lymph? 39)
A) lymphatic ducts to lymphatic capillaries to lymphatic vessels to lymphatic trunks
B) lymphatic capillaries to lymphatic vessels to lymphatic trunks to lymphatic ducts
C) lymphatic ducts to lymphatic trunks to lymphatic vessels to lymphatic capillaries
D) lymphatic vessels to lymphatic trunks to lymphatic ducts to lymphatic capillaries

40) The thymus is most active during ________. 40)

A) childhood B) middle age
C) fetal development D) old age

41) Lymph traveling from the left arm would enter the venous circulation via the _______. 41)
A) thoracic duct B) axillary nodes
C) right lymphatic duct D) cisterna chili

42) Which of the following is NOT a part of the lymphatic system? 42)
A) lymphatic vessels B) lymph
C) erythrocytes D) lymph nodes

43) The lymphatic capillaries are ________. 43)

A) less permeable than blood capillaries B) as permeable as blood capillaries
C) completely impermeable D) more permeable than blood capillaries

44) Antibodies that act against a particular foreign substance are released by ________. 44)
A) T lymphocytes B) plasma cells
C) medullary cords D) lymph nodes

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45) Lymph leaves a lymph node via ________. 45)
A) efferent lymphatic vessels B) the subcapsular sinus
C) the cortical sinus D) afferent lymphatic vessels

46) Lymph vessels do NOT transport ________. 46)

A) leaked plasma proteins
B) lymphocytes
C) dietary fats
D) excess tissue fluid
E) erythrocytes

47) Functions of the spleen include all of those below EXCEPT ________. 47)
A) forming crypts that trap bacteria
B) removal of old or defective blood cells from the blood
C) storage of iron
D) storage of blood platelets

48) When the lymphatic structures of a limb are blocked due to tumors, the result is ________. 48)
A) abnormally high lymph drainage from the distal region
B) severe localized edema distal to the blockage of that limb
C) increased pressure in the lymphatics proximal in the limb to the blockage
D) shrinkage of tissues distal in the limb to the blockage due to inadequate delivery of lymph

49) Select the correct statement about lymph transport. 49)

A) Lymph transport depends on the movement of adjacent tissues, such as skeletal muscles.
B) Under normal conditions, lymph vessels are very high-pressure conduits.
C) Lymph transport is faster than that occurring in veins.
D) Lymph transport is only necessary when illness causes tissue swelling.

50) Select the correct statement about lymphocytes. 50)

A) The two main types are T cells and macrophages.
B) B cells produce plasma cells, which secrete antibodies into the blood.
C) T cells are the only form of lymphocyte found in lymphoid tissue.
D) T cells are the precursors of B cells.

51) Select the correct statement about lymphoid tissue. 51)

A) Lymphoid tissue is predominantly reticular connective tissue.
B) Once a lymphocyte enters the lymphoid tissue, it resides there permanently.
C) Lymphoid macrophages secrete antibodies into the blood.
D) T lymphocytes act by ingesting foreign substances.

52) Lymphoid tissue that appears as a swelling of the mucosa in the oral cavity is called a(n) ________. 52)
A) tonsil B) Peyer's patch C) thymus D) appendix

53) Which of the following structures is NOT considered mucosa-associated lymphoid tissue 53)
(MALT)?
A) Peyer's patches B) appendix C) thymus D) tonsils

54) Peyer's patches are found in the distal portion of the ________. 54)
A) small intestine B) esophagus C) large intestine D) stomach

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55) Lymphatic capillaries are present in ________. 55)
A) CNS B) bone marrow
C) bones and teeth D) digestive organs

56) What is a bubo? 56)

A) a wall in a lymph node B) an infected lymph node
C) a lobe of the spleen D) an infected Peyer's patch

57) The thymus is the only lymphoid organ that does NOT ________. 57)
A) directly fight antigens B) have lymphocytes
C) have a cortex and medulla D) produce hormones

58) Large clusters of lymph nodes are NOT found in the ________ region. 58)
A) inguinal B) axillary C) cervical D) popliteal

59) Mucosa-associated lymphoid tissues include all of the following EXCEPT ________. 59)
A) palatine tonsils B) Peyer's patches
C) islets of Langerhans D) lingual tonsils

60) Which of the following is NOT a method that maintains lymph flow? 60)
A) capillary smooth muscle contraction B) valves in lymph vessel walls
C) skeletal muscle contraction D) breathing

61) The tonsils located at the base of the tongue are the ________. 61)
A) palatine tonsils B) pharyngeal tonsils
C) Peyer's tonsils D) lingual tonsils

62) Which lymphoid organs and tissues are characterized by a cortex and medulla? 62)
A) spleen and thymus only
B) lymph nodes, spleen, and mucosa-associated lymphoid tissues (MALT) only
C) lymph nodes, thymus and spleen only
D) lymph nodes and thymus only

63) Which lymphoid organ atrophies as we age? 63)

A) thymus B) appendix C) tonsils D) spleen

64) Which of the following is considered a primary lymphoid organ? 64)

A) tonsils B) thymus C) spleen D) appendix

65) Which of the following is NOT a function of the lymphatic system? 65)
A) transporting respiratory gases B) carrying out immune responses
C) transporting dietary fats D) draining excess interstitial fluid

66) Which of the following is NOT a function of the spleen? 66)

A) produce new erythrocytes in adults
B) store iron from hemoglobin
C) house B and T lymphocytes
D) remove and recycle old erythrocytes and platelets

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67) The blood testis barrier is to newly formed sperm cells as the blood thymus barrier is to ________. 67)
A) plasma cells B) mast cells
C) T lymphocyte precursors D) white pulp

68) Which of the following statements is FALSE? 68)

A) Antibodies mark antigens for destruction.
B) T lymphocytes originate from the red bone marrow.
C) Only lymph nodes filter lymph.
D) The thymus consists mainly of lymphoid tissue.

69) Which of the following statements is FALSE regarding the spleen? 69)
A) The splenic artery and vein enter and exit the spleen at the hilum.
B) Red pulp is where immune functions take place.
C) Clusters of white pulp look like islands in a sea of red pulp.
D) The spleen is the largest lymphoid organ.

70) Flow of lymph through a lymph node is slowed due to ________. 70)
A) the presence of lymphocytes and macrophages
B) the viscous nature of lymph
C) fewer efferent vessels draining it compared to many afferent vessels feeding it
D) mini-valves

71) Tonsils have blind-ended structures called ________ that trap bacteria and particulate matter. 71)
A) tonsillar corpuscles B) germinal centers
C) lymphoid follicles D) tonsillar crypts

72) From the right leg, lymph moves in which order? 72)
A) right lumbar trunk, thoracic duct, left subclavian vein
B) right lumbar trunk, right lymphatic duct, left subclavian vein
C) right lumbar trunk, right lymphatic duct, right subclavian vein
D) right lumbar trunk, thoracic duct, right subclavian vein

73) Although B and T lymphocytes originate in the bone marrow, T cells mature in the ________. 73)
A) appendix B) spleen C) tonsils D) thymus

74) Lymphatic ________ are formed from the union of the largest collecting lymphatic vessels. 74)
A) capillaries B) trunks C) ducts D) nodes

75) Fats absorbed from the small intestine are transported to the bloodstream via ________. 75)
A) lymph nodes B) Peyer's patches C) lacteals D) tonsils

76) Which lymphoid organ or tissue lacks a reticular fiber stroma? 76)
A) spleen
B) thymus
C) mucosa-associated lymphoid tissue (MALT)
D) lymph nodes

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SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

77) Describe the structural and functional relationship between a capillary bed of the blood 77)
vascular system and lymphatic capillaries.

78) Describe the mechanisms by which lymphatic fluid is moved through the lymphatics. 78)

79) What is the consequence of obstruction of the lymphatics? 79)

80) Where are the lymph node aggregations most dense? 80)

81) What is the special role of the thymus gland? 81)

82) Name the tonsils and state their body locations. 82)

83) List the functions of the spleen. 83)

84) Characterize lymph transport in terms of rate, volume, and ability to change. 84)

85) How do the lymphatic capillaries differ from blood capillaries? 85)

86) How does the lymphatic system both help and hinder the spread of cancer through the 86)
body?

87) How does the structure of a lymph node allow lymphocytes and macrophages to perform 87)
their protective function?

88) Define the term MALT. What is its function? 88)

89) How are lymphatic capillaries affected by tissue inflammation? 89)

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

90) A mother takes her son to the doctor and describes the following symptoms that she has observed. The child is
running a fever, has flu-like symptoms, and his lymph glands are very swollen and sore to the touch. Of what
significance are the swollen and sore lymph glands?

91) A woman had a mastectomy that included the removal of axillary lymph nodes on her left side. What does she
risk regarding her left arm and why?

92) A man involved in a traffic accident is rushed to the emergency room of a hospital with severe internal
bleeding. Examination reveals a ruptured spleen. What is the treatment of choice and what is the likely
long-term outcome (prognosis)?

93) While passing through a village on safari you notice a man with one enormous leg and one normal -sized leg.
What could have caused the increased size of the swollen leg?

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94) Lymphedema may occur as a complication after a radical mastectomy, in which lymph nodes have been
removed. Explain why it might occur.

95) A nurse palpated enlarged lymph nodes. Describe signs and symptoms that help to distinguish cancerous
lymph nodes from infected lymph nodes.

96) Describe why the prognosis of cancer is best when there is no detectable spread from the region of the primary
tumor to the lymph nodes.

97) As the human immunodeficiency virus (HIV) progresses, some individuals develop persistent generalized
lymphadenopathy (any disease of the lymph nodes). Explain why this may occur.

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Answer Key
Testname: UNTITLED20

1) B
2) D
3) A
4) C
5) E
6) E
7) C
8) D
9) A
10) D
11) A
12) C
13) B
14) B
15) C
16) A
17) FALSE
18) TRUE
19) TRUE
20) TRUE
21) TRUE
22) TRUE
23) FALSE
24) TRUE
25) TRUE
26) TRUE
27) TRUE
28) TRUE
29) FALSE
30) TRUE
31) FALSE
32) TRUE
33) FALSE
34) FALSE
35) TRUE
36) C
37) C
38) C
39) B
40) A
41) A
42) C
43) D
44) B
45) A
46) E
47) A
48) B
49) A
50) B
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Answer Key
Testname: UNTITLED20

51) A
52) A
53) C
54) A
55) D
56) B
57) A
58) D
59) C
60) A
61) D
62) D
63) A
64) B
65) A
66) A
67) C
68) D
69) B
70) C
71) D
72) A
73) D
74) B
75) C
76) B
77) Blind-ended lymphatic capillaries weave between the tissue cells and blood capillaries in the loose connective tissues
of the body. Although similar to blood capillaries, lymphatic capillaries are even more permeable due to minivalves
that act as one-way swinging doors. Leaked fluid from blood capillaries is taken up by the lymphatic capillaries as
well as proteins in the interstitial space that are unable to enter blood capillaries.
78) Lymphatic fluid is moved through the lymphatics by the milking action of active skeletal muscles, pressure changes
within the thorax during breathing, valves to prevent backflow, and pulsation of adjacent arteries.
79) Obstruction of the lymphatics results in edema distal in the body to the obstruction.
80) Lymph node aggregations are most dense near the body surface in the inguinal, axillary, and cervical regions of the
body.
81) By secreting hormones, the thymus gland causes T lymphocytes to become immunocompetent (able to defend against
specific pathogens in the immune response).
82) Palatine tonsils are located on either side at the posterior end of the oral cavity. The lingual tonsil lies at the base of the
tongue. The pharyngeal tonsil is in the posterior wall of the nasopharynx. The tiny tubal tonsils surround the openings
of the auditory tubes into the pharynx.
83) The spleen's main functions are to remove aged or defective blood cells and platelets from the blood and to store or
release some of the breakdown products of RBCs to the blood for processing by the liver. Other functions include
acting as a blood filter and reservoir, serving as a site for erythrocyte production in developing embryos, storing blood
platelets, and providing a site for lymphocyte proliferation and immune surveillance and response.
84) Lymph transport is sporadic and much slower than that occurring in veins. About 3 liters of lymph enters the
bloodstream in a 24-hour period. An increase in physical activity will cause lymph flow to increase, balancing the
greater rate of fluid outflow from the vascular system.

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Answer Key
Testname: UNTITLED20

85) Although similar to blood capillaries, lymphatic capillaries differ structurally in the following ways: (1) The
endothelial cells forming the walls of lymphatic capillaries are not tightly joined. Their edges loosely overlap one
another, forming flaplike minivalves. (2) Bundles of fine filaments anchor the endothelial cells to surrounding
structures so that any increase in interstitial fluid volume separates the cell flaps, exposing gaps in the wall rather than
causing the lymphatic capillary to collapse.
86) Lymph nodes help rid the body of cancer cells by immune mechanisms. Lymph vessels may also be used to spread
cancer cells throughout the body if immunity is not effective against the cancer cells because a cancer cell that escapes
lymphatic filtration will reach the bloodstream and be carried anywhere in the body.
87) Macrophages and lymphocytes are located in lymph nodes. Macrophages ingest microorganisms and cellular debris.
Lymphocytes monitor the lymphatic stream for the presence of antigens and mount an immune response. Because
there are fewer efferent vessels draining the node than afferent vessels that feed it, the flow of lymph through the
node stagnates somewhat, allowing time for the lymphocytes and macrophages to work.
88) MALT is an acronym for mucosa-associated lymphoid tissues. It includes Peyer's patches, the appendix, and the
tonsils in the digestive tract, lymphoid follicles in the walls of the bronchi, and genitourinary tract. Collectively,
MALT protects passages open to the exterior from foreign matter invading the walls.
89) When tissues become inflamed, lymphatic capillaries develop openings that permit uptake of larger particles such as
cell debris, pathogens (disease-causing microorganisms such as bacteria and viruses), and cancer cells. In the lymph
nodes, cells of the immune system "examine" the lymph and cleanse it of debris.
90) When tissues are inflamed, such as due to a bacterial infection, lymphatic capillaries develop openings that permit the
uptake of the pathogens. The inflammation and pain indicate lymph nodes infected by microorganisms.
91) Total removal of the axillary lymph nodes results in severe localized edema because the lymphatic vessels are also
lost. This results in chronic edema along the arm, although some lymphatic drainage is eventually reestablished by
regrowth of the vessels.
92) Supportive care or splenic repair is the treatment of choice, depending on severity. Splenectomy is not as necessary as
once believed, and is now performed less frequently. If the spleen does need to be removed, the prognosis is very
good, as the functions of the spleen are largely taken over by the liver and bone marrow.
93) The man has Filariasis commonly known as elephantiasis, which is caused by parasitic worms that get in the lymph
system and reproduce to proportions that block the vessels. The swelling is due to edema.
94) Anything that prevents the normal return of lymph to the blood, such as blockage of the lymphatics by tumors or
removal of lymphatics during surgery, results in severe localized edema (lymphedema).
95) Tender nodes are usually due to inflammation, whereas hard, fixed, nontender nodes are suggestive of malignancy.
96) Cancer cells that break free from the primary tumor can metastasize via the lymph system. Even if a lymph node is
99% effective in trapping malignant cells, given the ability of a tumor to continuously shed cells into lymphatic
capillaries, that still means that 100 out of every 10,000 cells get through. So the presence of any trapped cells in a
lymph node is a warning that a few others may have escaped entrapment.
97) This may occur because lymph nodes are overwhelmed by a large number of virus particles trapped in the nodes,
which stimulate an ineffective immune reaction but cannot be quickly eliminated due to the weakened immune state.
The weak immune reaction persists, causing swelling of the nodes.

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