Posted: March 9th, 2021
Lymphedema is a condition that affects humans due to lymphatic
drainage obstruction or disturbance in the distal segment due to infections and malignancies. Lymphedema is a chronic complication that can lead to psychological and physical distress. This condition is one of the critical reasons gynecologic malignancy patients have a low quality of life after multimodal therapy (Rebegea, 2020).
What is elephantiasis?
Brugia malayi an Elephantiasis Filarial Human Nematode that is part and parcel of a wider variety of diseases, including lymphatic filariasis and blindness. Virtually all filarius nematodes infecting human beings live in mutualism with endosymbionts. These endobionts Wolbachia are found in somatic hypodermal tissues and even in female germs that vertically pass them to a nematode progeny (Chevignon, 2021).
Provide the differential diagnosis of mumps versus cervical adenitis.
Differential diagnosis of patients with parotitis or swelling of the
salivary gland should take mumps into account regardless of the background history of vaccination. Mumps virus is one of the neuroinvasive viruses that reduced since MMR vaccination incorporates immunization programs for children and adolescents in many countries. Other conditions causing mumps include immunologic diseases, allergies, drug reactions, or tumors (Gonçalves, 2020). On the other hand, cervical adenitis involves swelling around the neck. The lymphatic nodes may increase in size as they tackle infection in the mouth, throat, sinuses, or other skin, face, or neck areas. The treatment of the bacterial infection in most cases requires antibiotics.
Thorax and Lungs
Define and provide an example of a disease/situation where this sign/symptom might be present:
Several forms of breathing are natural and abnormal. Every pattern is essential clinically and helpful in the patient evaluation and testing. A stroke patient may show several respiratory symptoms (Barrios-López, 2020). A stroke affecting a brain stem can also cause respiratory issues with the body’s vital function, such as breathing, pulse, and body temperature. This kind of stroke will lead to coma or death, more likely.
Support your answer with a previous experience you have encountered in your career.
A patient with severe chest pains had a probability of an underlying
injury or metabolic abnormalities indicate irregular breathing habits. Mechanical ventilation and sedation may hinder breathing patterns associated with a head injury (Vaporidi, 2020). After a few tests, there was an observation that the patient had abnormal deep and sighing breath rates. Later the patient was diagnosed with Kussmaul breathing, and by profound reflection, the patient had diabetes.
Name and write the location of the five traditionally designated auscultatory areas
The auscultation areas are based around the heart valves. Four out of five production points are the aortic, pulmonary, tricuspid, and mitral valves. The fifth point is Erb’s point, which lies on the third intercostal space’s sternum’s left side (Zhao, 2020). In the second intercostal field, the aortic point is situated right on the everlasting boundary. In another intercostal space, the pulmonary point lies to the left of the sternal border. The second sound of the normal heartbeats is the sound that emits from the aortic and pulmonary ends.
Possible suggestion to help this patient’s problem and explanation of rationale
In my opinion, Rutosides tend to mitigate signs of late pregnancy venous insufficiency. Whether the medication is safe in pregnancy is nevertheless not understood. According to Halabchi (2020), external pneumatic compression seems to alleviate swelling of the ankles. Diureses and a decrease in blood pressure were observed by immersion in water for 50 minutes. It is not clear for how long or if these improvements are sustained.
Barrios-López, J. M., Rego-García, I., Martínez, C. M., Romero-Fábrega, J. C., Rodríguez, M. R., Giménez, J. R., … & Pérez, M. F. (2020). Ischaemic stroke and SARS-CoV-2 infection: a causal or incidental association? Neurology (English Edition), 35(5), 295-302. Approach. World Journal of Orthopedics, 11(12), 534.
Chevignon, G., Foray, V., Pérez-Jiménez, M. M., Libro, S., Chung, M., Foster, J. M., & Landmann, F. (2021). Dual RNAseq analyses at soma and germline levels reveal evolutionary innovations in the elephantiasis-agent Brugia malayi, and adaptation of its Wolbachia endosymbionts. PLOS Neglected Tropical Diseases, 15(1), e0008935.
Gonçalves, R., Gomes, J., Martins, A., Duque, V., Lemos, J. M., & Trindade, L. (2020). Acute disseminated encephalomyelitis after mumps infection in a vaccinated patient. IDCases, 23, e01017.
Halabchi, F., & Hassabi, M. (2020). Acute ankle sprain in athletes: Clinical aspects and algorithmic
Rebegea, L. F., Stoleriu, G., Manolache, N., Serban, C., Craescu, M., Lupu, M. N., & Ciobotaru, O. R. (2020). Associated risk factors of lower limb lymphedema after treatment of cervical and endometrial cancer. Experimental and therapeutic medicine, 20(6), 1-1.
Vaporidi, K., Akoumianaki, E., Telias, I., Goligher, E. C., Brochard, L., & Georgopoulos, D. (2020). Respiratory drive in critically ill patients. Pathophysiology and clinical implications. American journal of respiratory and critical care medicine, 201(1), 20-32.
Zhao, J., Jiang, W., & Zeng, R. (2020). Physical Examination of Chest. In Handbook of Clinical Diagnostics (pp. 169-203). Springer, Singapore.
Lymphedema is an accumulation of protein-rich fluid in the interstitial spaces of the arm following breast surgery or treatment as a result of lymph node damage or removal (Jarvis, 523, 2020).
“Elephantiasis is a condition characterized by gross enlargement of an area of the body, especially the limbs. Other areas commonly affected include the external genitals. Elephantiasis is caused by obstruction of the lymphatic system, which results in the accumulation of a fluid called lymph in the affected areas.” (NORD, 2009). Some of the causes for elephantiasis are bacterial sexually transmitted diseases, specifically lymphogranuloma venereum (LGV) and donovanosis, a parasitic disease known as lymphatic filariasis, a protozoan disease called leishmaniasis, tuberculosis, leprosy, and a repeated streptococcal infection. (NORD, 2009)
“Mumps is a contagious disease that is caused by a virus. It typically starts with a few days of fever, headache, muscle aches, tiredness, and loss of appetite. Then most people will have swelling of their salivary glands. This is what causes the puffy cheeks and a tender, swollen jaw.” (CDC, 2019).
“Cervical adenitis is inflammation of a lymph node in the neck. . An infection in the mouth, throat, sinuses, or other areas of the head, face, or neck may cause the lymph nodes in the neck to increase in size as they fight infection. If the enlargement is from a bacterial infection, the condition is called bacterial cervical adenitis.” (Fairview, 2020).
Thorax and Lungs:
Dyspnea is difficult or labored breathing; shortness of breath.
Orthopnea is the sensation of breathlessness in the recumbent position, relieved by sitting or standing. (NIH, 1990)
Paroxysmal nocturnal dyspnea (PND) is a sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position. (NIH, 1990)
Apnea temporary cessation of breathing, especially during sleep.
Tachypnea is an increase in the respiratory rate above normal; hyperventilation is increased minute ventilation relative to metabolic need, and hypercapneais a disproportionate rise in minute ventilation relative to an increase in metabolic level. These conditions may not always be associated with dyspnea. (NIH, 1990). Metabolic Acidosis can cause this.
Bradypnea is an abnormally slow breathing rate. This can be caused by toxins, thyroid disorder, head injury, or opiods.
Hyperpena is breathing more deeply. Usually when someone is exercising.
Kussmaul breathing slow, deep respirations. Can be caused by Diabetic Ketoacidosis. Metabolic Acidosis.
Cheyne-Stokes alternating periods of hyperventilation and apnea. Cerebral hypoperfusion from any cause can cause Cheyne-Stokes. It is usually related to heart failure or stroke. It may also be caused by: brain tumors. traumatic brain injuries or End of Life.
A pneumonic I was taught in school that I still remember is ape to man or all people enjoy time magazine.
1. Aortic-Second Right intercostal space.
2. Pulmonic-Second left intercostal space.
3. Erb’s Point- Third intercostal space. (S1 S2)
4. Tricuspid-Left lower sternal boarder.
5. Mitral-Fifth interspace at around left mid-clavicular line.
By listening to each area you can identify if there is an abnormality in a specific part of the heart. This allows you to hear murmurs, congenital abnormalities such as patent ductus arteriosus, valve defects, abnormal heart sounds that would indicate heart failure such as ventricular gallop S3, and atrial gallops which occurs with CAD (Jarvis, 2020).
A pregnant patient (32 weeks’ gestation) is having difficulty with dependent edema and painful varicosities. What can you suggest to help this patient’s problem and explain rationale. I would suggest lying on the left side with a pillow between her legs. I would also recommend elevating her legs when possible to above the heart level. This will help with the return of unoxygenated blood flow to the heart. Baby puts pressure on the Inferior Vena Cava and the Aorta by turning to the left side with will increase blood flow by way of repositioning baby. Also exercise assists with vascular drainage by way of contracting the muscles.
Centers for Disease Control Prevention (CDC). (2019). Mumps. https://www.cdc.gov/mumps/ (Links to an external site.)
Fairview Health (2019). Fairview Health. Cervical Adenitis. Fairview/Home/Patient-Education/
Jarvis, C. & Eckhardt, A. (2019). Physical Examination and Health Assessment 8th Edition.
National Organization for Rare Disorders (NORD), (2009). Elephantiasis. https://
National Institute of Health (NIH). Mukerji V. (1990). Dyspnea, Orthopnea, and Paroxysmal
Nocturnal Dyspnea. Clinical Methods: The History, Physical, and Laboratory
Examinations. 3rd edition. Chapter 11. Available from: https://www.ncbi.nlm.nih.gov/ (Links to an external site.)
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