Lymphedema is a chronic condition caused by lymphatic drainage obstruction that can lead to psychological and physical distress. It is a common complication after treatment for gynecologic cancers. Elephantiasis involves gross swelling of body areas like limbs caused by obstruction of the lymphatic system allowing lymph fluid accumulation. Differential diagnosis for neck swelling includes mumps, caused by the mumps virus, and cervical adenitis, caused by bacterial infection in the head, neck, or throat areas treated with antibiotics. Abnormal breathing patterns can occur after stroke or head injury. Kussmaul breathing seen in a patient with chest pain and irregular breathing was diagnosed as diabetic ketoacidosis. [END SUMMARY]

1. REPLY 1
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

2. 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.
Cardiovascular System

3. 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.
References
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.

4. 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.,

5. 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.
REPLY 2
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).
Lymphatic:
“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

6. 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
hypercapnea
is a disproportionate rise in minute ventilation relative to an
increase in metabolic level. These conditions may not always be

7. 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.
Cardiovascular:
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

8. 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.
Resources:
Centers for Disease Control Prevention (CDC). (2019).
Mumps.
https://www.cdc.gov/mumps/ (Links to an external site.)
index.html
Fairview Health (2019). Fairview Health.
Cervical Adenitis
. Fairview/Home/Patient-Education/
Articles/English/c/e/r/v/iCervical_Adenitis_Antibiotic_Treatme
nt_Child_511842en
Jarvis, C. & Eckhardt, A. (2019). Physical Examination and
Health Assessment 8th Edition.

9. National Organization for Rare Disorders (NORD), (2009).
Elephantiasis.
https://
rarediseases.org/rare- diseases/elephantiasis/#causes
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.)
books/NBK213/
200 WORDS EACH
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