CLT Lymphedema Pathophysiology & Staging 1 — Questions and Answers
Question 1: Lymphedema is defined as swelling caused by:
- Excess sodium retention in kidneys
- Accumulation of protein-rich fluid due to lymphatic insufficiency (Correct answer)
- Heart failure and venous hypertension
- Allergic reaction causing histamine release
Correct answer: Accumulation of protein-rich fluid due to lymphatic insufficiency
Lymphedema results from the accumulation of protein-rich interstitial fluid when lymphatic transport capacity is insufficient to handle the lymphatic load.
Question 2: What is the difference between primary and secondary lymphedema?
- Primary is always unilateral; secondary is always bilateral
- Primary results from developmental lymphatic abnormalities; secondary results from damage to an intact system (Correct answer)
- Primary is more severe than secondary
- Primary occurs in adults; secondary occurs in children
Correct answer: Primary results from developmental lymphatic abnormalities; secondary results from damage to an intact system
Primary lymphedema results from congenital or developmental abnormalities of lymphatic vessels, while secondary lymphedema occurs when an otherwise normal system is damaged.
Question 3: According to the International Society of Lymphology (ISL), Stage 0 lymphedema is characterized by:
- Visible pitting edema
- Latent or subclinical condition with no visible swelling despite impaired transport (Correct answer)
- Irreversible fibrotic tissue changes
- Spontaneously reversible swelling
Correct answer: Latent or subclinical condition with no visible swelling despite impaired transport
ISL Stage 0 (latent stage) describes lymphatic dysfunction without visible edema, where transport capacity is reduced but not yet overwhelmed.
Question 4: Pitting edema in lymphedema is most characteristic of which ISL stage?
- Stage 0
- Stage I (Correct answer)
- Stage II with fibrosis
- Stage III
Correct answer: Stage I
ISL Stage I lymphedema presents with pitting edema that reduces with limb elevation, indicating primarily fluid accumulation without significant fibrosis.
Question 5: The Stemmer sign is used to assess lymphedema by:
- Measuring circumferential limb differences
- Attempting to pinch a fold of skin at the base of the second toe or finger (Correct answer)
- Checking pitting with fingertip pressure
- Assessing skin color changes in the extremity
Correct answer: Attempting to pinch a fold of skin at the base of the second toe or finger
A positive Stemmer sign occurs when you cannot pinch and lift a fold of skin at the base of the second toe or finger due to fibrotic skin thickening.
Question 6: Fibrosis in chronic lymphedema is primarily caused by:
- Bacterial infection of lymph nodes
- Chronic protein accumulation stimulating inflammatory fibroblast activity (Correct answer)
- Venous insufficiency complicating lymphatic flow
- Repeated MLD treatments over time
Correct answer: Chronic protein accumulation stimulating inflammatory fibroblast activity
Chronic protein-rich fluid accumulation triggers chronic inflammation and stimulates fibroblasts to deposit collagen, leading to progressive tissue fibrosis.
CLT Lymphedema Pathophysiology & Staging 1
Lymphedema is defined as swelling caused by: