Masses and Lymphadenopathy

Question 1

What is lymphadenopathy (LAD)?

Answer 1

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

Question 2

What is the most important part of the work-up for a child with lymphadenopathy?

Answer 2

History and physical

Question 3

What LN location should you be wary of if there is enlargement?

Answer 3

Supraclavicular

Question 4

What LN qualities are reassuring?

Answer 4

1) Soft
2) Mobile
3) Non tender
4) Not warm/red

Question 5

What LN qualites are more concerning?

Answer 5

1) Very large
2) Fixed location
3) Tender
4) Erythematous and warm

Question 6

Enlargement of what organs may be indicative of a malignancy or systemic infection?

Answer 6

Liver/spleen

Question 7

Cervical lymphadenopathy is one of the diagnostic criteria of what disease?

Answer 7

Kawasaki disease

Question 8

What viral infection causes mononucleosis (severe pharyngitis, cervical LAD, spleen enlargement)?

Answer 8

Epstein-Barr virus

Question 9

What viral infection in a child will cause wasting and has diffuse lymphadenopathy?

Answer 9

HIV

Question 10

Bartonella henselae (Cat-scratch disease) causes what type of LAD?

What is seen on exam of the retina?

Answer 10

1) Axillary LAD

2) Macular star

Question 11

What bacterial infection is associated with skinning rabbits?

Answer 11

Tularemia

Question 12

What is a super common cause of bacterial lymphadenitis, and with these conditions you want to look for lesion on skin in region of body that drains into the enlarged node?

Answer 12

Staph/strep

Question 13

What should be performed with any child presenting with lymphadenopathy and shortness-of-breath?

What is suspected?

Answer 13

1) Chest x-ray

2) Lymphoma at mediastinum

Question 14

If watchful waiting of a LN is the plan what should always be done?

Answer 14

Schedule a follow-up with patient and tell them to return right away if things get worse

Question 15

If a biopsy must be done on a suspicious LN what type of biopsy is best?

Answer 15

Excisional biopsy

Question 16

What is the most common tumor-like lesions of infancy that can involve cavernous, capillary or port wine stain “birthmarks”?

Answer 16

Hemangioma

Question 17

What is Sturge Weber syndrome?

What is the hallmark?

Answer 17

1) Leptomeningeal angiomas

2) Facial port wine stain

Question 18

In regards to hemangiomas any growth or deep dimple over what area of a baby should raise concern?

What should be done?

Answer 18

1) Lumbar/sacral area

2) MRI or US to check for spinal cord or vertebral abnormality

Question 19

What are fibrosarcomas?

Answer 19

A malignant neoplasm where fibroblasts divide excessively without cellular control

Question 20

What is a tumor of sympathetic ganglia and adrenal medulla?

Where is it derived from?

Answer 20

1) Neuroblastoma

2) Primordial NCC

Question 21

What do 90% of neuroblastomas produce?

What levels are elevated in neuroblastoma?

If it is cutaneous what descriptive symptom do they have?

Answer 21

1) Catecholamines
2) Urine VMA and HVA (catecholamine breakdown products)
2) Blueberry muffin baby

Question 22

What is the most common primary renal tumor of childhood with peak incidence between 2-5 years of age?

About 5 to 10% of theses tumors invovle?

Answer 22

1) Wilms tumor

2) Both kidneys

Question 23

Risk of Wilms Tumor is increased with what congenital malformation?

Answer 23

Beckwith-Wiedemann syndrome

Question 24

What are symptoms of Beckwith-Wiedemann syndrome?

Answer 24

1) Macroglossia
2) Organ enlargement
3) Omphalocele
4) Hemihypertrophy

Question 25

What is the most common malignancy in kids < 10 years old?

Answer 25

Leukemia

Question 26

What is the most common malignancy in adolescents 15-19 yo?

Answer 26

Hodgkin lymphoma

Question 27

What do Wilms tumors usually present with?

Answer 27

1) Large abdominal mass (especially in younger patients)
2) Hematuria
3) HTN
4) Pulmonary metastases