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INTEG FINAL EXAM COMPREHENSIVE STUDY
GUIDE 2026
โ Lymphatic pre-collectors. Answer: Vertically oriented lymphatic vessels that contain valves to direct fluid toward larger vessels โ Lymphatic collectors. Answer: 3-layered vessels (connective, muscle, endothelial tissue); functional unit = lymphangion with intrinsic contractility โ Lymphangion. Answer: The functional unit of lymphatic collectors; has intrinsic contractility โ Lymphatic trunks. Answer: Transport filtered lymph to the 2 main lymphatic ducts โ Thoracic duct. Answer: Largest lymphatic duct; drains ยพ of body including bilateral lower extremities, abdomen, left UE, left head and neck
โ Right lymphatic duct. Answer: Drains ยผ of body including right UE, right chest, right head and neck โ Starling's Law of Equilibrium. Answer: The principle governing fluid balance between ultrafiltration and reabsorption at capillary level โ Ultrafiltration. Answer: When blood capillary pressure (BCP) > colloid osmotic pressure (COP) โ fluid pushed out into tissues โ Reabsorption. Answer: When BCP < COP โ fluid drawn back into vessels โ Lymphatic load. Answer: The only mechanism capable of removing large proteins and macromolecules from the interstitial space โ Mechanical insufficiency. Answer: Reduced lymphatic transport capacity โ lymphedema โ Dynamic insufficiency.
Answer: Chronic accumulation of protein-rich fluid leading to chronic inflammation and hardening of tissues โ Lymphedema Stage 0 (Latency). Answer: No visible or palpable edema, but subjective complaints present โ Lymphedema Stage 1. Answer: Pitting edema reduced with elevation; no fibrosis โ Lymphedema Stage 2. Answer: Non-pitting edema; beginning of fibrosis; not resolved with elevation โ Lymphedema Stage 3. Answer: Non-pitting edema; severe fibrosis; significant skin changes โ Complete Decongestive Therapy (CDT). Answer: Management for lymphedema consisting of: manual lymphatic drainage, specialized exercises, skin/nail care, compression garments or bandages โ Primary lymphedema.
Answer: Less common type; caused by imperfect development of lymph vascular system (unknown or genetic causes); F > M โ Milroy's disease. Answer: Autosomal dominant genetic disorder causing primary lymphedema; M > F; involves one or both legs, maybe face or arms โ Miege's disease (Hereditary lymphedema type II). Answer: Primary lymphedema manifesting in puberty in females; affects LEs, associated with yellow nails, cleft palate, hearing loss โ Secondary lymphedema. Answer: Most common type; acquired due to damage to healthy lymphatic system from external causes โ Leading cause of secondary lymphedema. Answer: Cancer treatment (directly related to number of lymph nodes excised and total radiation received) โ Second leading cause of secondary lymphedema. Answer: Chronic venous insufficiency โ fluid overload damages lymphatic vessels causing combined insufficiency
โ Lab value: BNP. Answer: Marker for heart failure โ Lab value: hematocrit. Answer: % of RBCs; <33% = associated with edema โ Lab value: hemoglobin. Answer: O2 transport protein; <12 (F) or <14 (M) = impaired O delivery โ Lab value: INR. Answer: Normal = 2-3; used to monitor anticoagulation โ Lipedema. Answer: Differential diagnosis for lymphedema; F > M; symmetrical; never involves dorsum of feet โ Venous edema. Answer: Differential diagnosis for lymphedema; characterized by hemosiderin staining and gaiter-area distribution โ Cardiac edema.
Answer: Differential diagnosis for lymphedema; bilateral, pitting, resolves with elevation โ Epidermis. Answer: Outermost skin layer; avascular; made of keratin; contains Langerhans cells and melanocytes โ Stratum Basale. Answer: Deepest epidermal layer; site of rapid cell division; contains keratinocytes and melanocytes โ Stratum Spinosum. Answer: Epidermal layer with desmosomes and Langerhans cells โ Stratum Granulosum. Answer: Granular epidermal layer; lamellar bodies release lipids (ceramides, cholesterol, free fatty acids) โ Stratum Lucidum. Answer: Thin, clear layer of dead cells; found in thicker skin only โ Stratum Corneum.
โ Meissner corpuscles. Answer: Mechanoreceptors for light touch โ Ruffini endings. Answer: Mechanoreceptors for touch and pressure โ Pacinian corpuscles. Answer: Mechanoreceptors for deep touch and pressure โ Free nerve endings. Answer: Sensory receptors for pain, touch, and temperature โ Signs of local wound infection (NERDS). Answer: Non-healing, Exudative, Red/bleeding granulation tissue, Debris, Smell โ local infection โ Signs of systemic wound infection (STONES). Answer: Size increase, Temperature increase, Osteum (bone) exposed, New breakdown, Exudative/Erythema/Edema, Smell โ systemic infection โ Infectious vs. inflammatory wound culture threshold.
Answer: >100,000 organisms/g of tissue = infection โ Necrotizing fasciitis. Answer: Life-threatening, rapidly spreading flesh-eating infection of skin and fascia; intense pain, high fever, chills โ Pyoderma gangrenosum. Answer: Rare autoimmune disorder causing painful ulcers; treated with corticosteroids or immunosuppressants โ Radiation dermatitis. Answer: Inflammatory response to radiation; erythema, edema, pruritus; peaks 2 weeks after exposure โ Herpes zoster (shingles). Answer: Painful rash on one side of body; triggered by stress or immune deficiency โ Molluscum contagiosum. Answer: Caused by pox virus; asymptomatic dome-shaped papules โ Serous drainage.
Answer: Gaiter area (ankle to knee); large, irregular shape, indistinct edges; granular or slough-covered base; copious exudate; significant edema; hemosiderin staining โ ABI: normal. Answer: 1. โ ABI: mild insufficiency. Answer: 0. โ ABI: moderate insufficiency / mixed arterial-venous disease. Answer: 0.5-0. โ ABI: severe insufficiency. Answer: <0. โ Neuropathic/diabetic foot ulcer location. Answer: Plantar surface of foot or toes, surrounded by a callus โ Semmes-Weinstein monofilament test. Answer: 5.07 monofilament applying 10g force; detects loss of protective sensation
โ Total contact cast (TCC). Answer: Gold standard management for diabetic/neuropathic ulcers; redistributes weight and protects wound bed โ Kennedy's ulcer. Answer: Develops during the active dying process; on sacrum with sudden onset; shaped like a pear, butterfly, or horseshoe โ Arterial ulcer pain. Answer: Severe pain โ Venous ulcer pain. Answer: Moderate pain โ Neuropathic ulcer pain. Answer: No pain โ Sickle cell ulcer. Answer: Very painful; scant to no drainage โ Inflammatory phase of wound healing.
โ Wound size: greatest method. Answer: Greatest length ร greatest width; reliable but inflates actual wound size โ Wound size: clock method. Answer: 12-6 = length; 9-3 = width; more anatomically standardized โ Granulation tissue appearance. Answer: Light pink to beefy red, shiny, granular โ Epithelialization tissue appearance. Answer: Whitish, pale pink, translucent โ Eschar. Answer: Hard, adherent, brown/black non-viable tissue โ Slough. Answer: White/gray/yellow/tan, mucinous or stringy non-viable tissue โ Maceration.
Answer: White, soft tissue caused by excess moisture; decreases tensile strength โ Braden scale. Answer: Gold standard pressure injury risk tool for hospitals and long-term care; domains: sensory perception, moisture, activity, mobility, nutrition, friction/shear; score 6-23 (lower = higher risk) โ Norton scale. Answer: Pressure injury risk tool for acute and skilled nursing; domains: physical condition, mental condition, activity, mobility, incontinence; <10 = very high risk โ Cubbin-Jackson scale. Answer: Pressure injury risk tool for ICU patients; better than Braden for critically ill; accounts for hemodynamics, respiratory status, oxygenation โ BWAT (Bates-Jensen Wound Assessment Tool). Answer: 15-item wound status tool; higher score = more severe wound โ PUSH tool.
Answer: Multilayer pads; highly absorptive; combines properties of foams, alginates, and hydrogels โ Foams. Answer: Soft open-cell polyurethane; highly absorptive and breathable; provides thermal insulation; for minimal to moderate exudate โ Gauze. Answer: Highly absorbent but permeable to bacteria; can adhere to wound bed causing re-injury โ Impregnated gauze. Answer: Coated with petroleum jelly or zinc oxide; semi-occlusive; non-adherent contact layer for fragile wounds โ Contact layers. Answer: Thin, porous, non-adherent sheets that protect fragile granulating wound bed from trauma of dressing changes โ Unna boots. Answer: Compression bandaging for venous stasis ulcers; contraindicated for arterial insufficiency
โ Dressing for infected wounds. Answer: Antimicrobial (silver or iodine impregnated) dressings, alginates, medical-grade honey; NOT hydrocolloids โ Dressing for dry/desiccated wounds. Answer: Hydrogels and transparent films โ Dressing for heavy/copious drainage. Answer: Alginates, hydrofibers, foams โ Dressing for odor management. Answer: Charcoal dressings, medical-grade honey (MEDI-honey) โ Sharp debridement. Answer: Selective; removes non-viable tissue using scissors, forceps, scalpels, dermal curettes; NOT delegated to PTAs โ Mechanical debridement. Answer: Non-selective; may remove healthy and necrotic tissue; includes hydromechanical, pulsed lavage with suction, and surgical debridement โ Autolytic debridement.
