Masses and Lymph (Peds) - Newman

Question 1

lymph nodes that are abnormal in size, number, or consistency

Answer 1

lymphadenopathy

Question 2

what size is considered enlarged for a node?

Answer 2

2cm

Question 3

what is considered “good” quality of LN’s?

Answer 3

nodes where you expect them

• soft
• mobile
• not warm
• not tender
• pt feeling overall ok

Question 4

what is “concerning” to feel on a LN?

Answer 4

multiple locations of nodes

• very large nodes
• matted and “stuck down”
• fluctuant
• tender
• associated with liver/spleen

Question 5

when do you biopsy an enlarged or unusual lymph node in a systemically well patient?

Answer 5

you can watch, try abx, if nodes get bigger/more developed, or don’t go away after 4-6 weeks, bx may be considered

Question 6

when do you biopsy an enlarged or unusual lymph node if pt is systematically ill, having respiratory symptoms, poor B-signs?

Answer 6

if lab/imaging is performed in a patient you are concerned about, look for results
- if anything is suspicious, bx is likely needed

NOTE: excision bx is best

Question 7

what are the two most common viral causes of lymphadenopathy in children?

Answer 7

• EBV: causes mono (severe pharyngitis, cervical LAD, splenomegaly_
• HIV: will see wasting and diffuse lymphadenopathy

Question 8

what are the three most common bacterial causes of lymphadenopathy in children?

Answer 8

• cat scratch disease: bartonella henslea infection, axillary LAD
• tularemia: from skinning rabbits
• staph/strep: super common cause, look for lesion on skin in region of body that drains into the enlarged node

Question 9

what is the benign tumor of infancy and childhood that Newman wants us to know for this exam?

Answer 9

• *hemangioma**
• MC tumor of infancy
• is cavernous (big, dilated, deformed vessels
• common in skin of new babies (usually raised, usually gets bigger before regressing)

Question 10

what should you check for if you see a growth or dimple over a babies lumbo/sacral area?

Answer 10

do MRI to check for spinal cord or vertebral abnormality!!!

Question 11

tumor of sympathetic ganglia and adrenal medulla

• elevated urine VMA and HVA (both breakdown products of catecholamines)
• if cutaneous -> blueberry muffin baby

Answer 11

neuroblastoma

Question 12

MC primary renal tumor of childhood

• peak incidence between 2-5 years of age
• Beckwith-Wiedmann syndrome

Answer 12

Wilms tumor

Question 13

what is Beckwith-Wiedmann syndrome and what is there an increased risk of with this condition?

Answer 13

macroglossia, organ enlargement, hemi-hypertrophy, omphalocele
- risk of Wilms tumor is increased!

Question 14

what is the most common malignancy in kids <10 years of age?

Answer 14

leukemia

Question 15

what is the most common malignancy in adolescents 15-19 y/o?

Answer 15

Hodgkin lymphoma