Pretend you are a teacher preparing a quiz for the text I will provide. 
            Each quiz question should follow the format below. 
            Ensure that you carefully recheck the questions and answers for accuracy. 
            The output should be a ready-to-use list of dictionaries for the Python eval function:

            [

                    "question": "WRITE THE QUESTION HERE",
                    "options": ["A) OPTION_1", "B) OPTION_2", "C) OPTION_3", "D) OPTION_4"],
                    "answer": INDEX_OF_CORRECT_ANSWER_IN_OPTIONS_LIST,
                    "explanation": "EXPLAIN WHY THE ANSWER IS CORRECT"

            ]

            Text:
             of drainage of an affected organ. 
Typically, hard or firm, not tender, fixed and irregular. 
 
 
 
 
195 
Chronic Lymphatic Obstruction (Lymphedema) 
• Definition:  is a hypertrophic condition of the skin and subcutaneous tissues that is caused 
by chronic lymphatic obstruction. 
• Sites:  It affects the extremities, scrotum, external genitalia, and rarely the breasts.  
Lymphedema of the lower limbs is the most common type. Another common example is 
post-mastectomy lymphedema of the upper limb. 
• Etiology: 
1. Primary lymphedema:  
This is due to congenital malformations of the lymphatic vessels. 
 
Lymphedema congenita 
Lymphedema praecox 
Lymphedema 
tarda 
Incidence 
10% 
80% 
10% 
Age 
At or within 1 year of birth 
Usually at adolescence 
After 35 years 
Sex 
M > F 
F > M 
M = F 
Sites 
Commonly bilateral and involves 
the whole leg 
Commonly unilateral- and 
below the knee 
Usually unilateral 
2. Secondary lymphedema 
1. Post-traumatic: 
a.  Injuries as circumferential scars of the limbs. 
b.  Operations as block dissection of regional lymph nodes. 
c.  Burns at the site of lymph nodes. 
d.  Irradiation of the regional lymph nodes. 
2. Post-inflammatory: 
a. Non-specific infection 
i. Recurrent non-specific lymphangitis. 
ii. Recurrent cellulitis due to evident focus of infection as inter-digital infection and chronic 
leg ulcer. 
b. Specific infections 
i. Filarial  
ii. Tuberculous (elephantiasis tuberculosa). 
 
196 
3. Neoplastic 
a- Primary affection of lymph nodes, as lymphomas. 
b- Primary affection of lymphatics as lymphangiosarcoma. 
c- Secondary affection of lymph nodes by metastasis. 
▪ Pathology: 
1. Stagnation of lymph leads to accumulation of large amounts of protein-rich fluids in 
the tissues that are irritant inducing foreign body reaction in the form of plasma cells, 
eosinophils, lymphocytes, monocytes and polymorphnuclear leukocytes. Later on, 
fibrosis appears and collagen fibres are deposited with very little elastic tissue 
formation leading to fibrosis in the subcutaneous tissues.   
2. Recurrent attacks of lymphangitis lead to more lymphatic obstruction.  
▪ Pathological stages: 
1) Stage of soft pitting edema. 
2) Stage of lymphorrhea: due to rupture of lymphatic vessels discharging their lymph. 
3) Stage of fibrosis (non- pitting): extravasated fluid excites fibrosis of skin& subcutaneous 
tissues 
4) Stage of elephantiasis: skin becomes rough, puckered, thickened, non -pitting like 
elephant skin but not liable to ulceration. 
Filarial lymphedema of the lower limbs 
▪ Etiology and incidence 
• 
The most common cause of secondary lymphedema of the lower limbs in Egypt and whole world is filarial 
infection with Wuchereria Bancrofti.  
• 
Humans are the definitive host where adult worms live in lymph nodes and lymph vessels while Culex 
Pipens mosquitos are the intermediate host. 
• 
The disease is endemic in Egypt in areas near the Mediterranean Sea e.g. in Damietta and in some areas 
representing important st

            Quiz: