Neck Masses, Congenital/Developmental Deformities Flashcards
Consistency of lymphoma
Rubbery
What 2 other symptoms are typical of a lymphoma?
Night sweats
HSmegaly
How to tell if a neck lump is a thyroid swelling
Moves upwards on swallowing
Age group - thyroglossal cyst
<20 y/o
Consistency - thyroglossal cyst
Soft and mobile
Where would you find a thyroglossal cyst
Midline - between hyoid and thyroid bones
Which is the most common midline lump?
Thyroglossal cyst
How to check if a midline lump is a thyroglossal cyst?
Moves up on tongue protrusion
Mx thyroglossal cyst
Excise - sistrunk procedure
Defining feature pharyngeal pouch
Gurgles on palpation
Features cystic hygroma
L sided
@ birth
Posterior triangle
Transilluminates
When do people get branchial cysts?
Typically after URTI
In early adulthood
Where are branchial cysts
Between SCM and pharynx
Features branchial cyst
Oval
Mobile
Soft
Non-pulsatile
Diagnosis branchial cyst
USS
Mx branchial cyst
Excise
What can a cervical rib lead to?
Thoracic outlet syndrome
Features of a typically reactive LN (6)
<1cm Fluctuate Worse on URTI Clear source of infection Jugulogastric area Child otherwise well
When would you biopsy a LN? (4)
> 2cm
Hx malig
Supraclavicular
Increasing in size
What xray do you need for a suspected foreign body
AP
Lateral
If a chest XR is positive in a foreign body inhalation, what is your next investigation
Rigid bronchoscopy
Why must you always take the foreign body out ?
Risk of infection
How to differentiate an inhaled 2p coin and button battery
Button battery has halo around it
Methods removal foreign body (6)
Parental kiss Wax hook Croc forceps Suction Oil/alcohol - kill insects GA if uncooperative
Why are children with OSA skinny?
Because growth hormone is secreted at night when children are asleep
Bad signs - paeds airway (5)
Quiet child No crying Marked recessions Mottled Incr tachyC
Congenital causes of supraglottic obstruction (insp stridor) (3)
Laryngomalacia
Bifid epiglottis
Cysts
Acquired causes of supraglottic obstruction (insp stridor) (3)
Traumatic
RRP
Cysts
Congeintal causes of glottic obstruction (insp stridor) (3)
Atresia
Webs
VCMI
Acquired causes of glottic obstruction (insp stridor) (3)
Traumatic/web
RRP
VCMI
Congenital causes of subglottic obstruction (biphasic stridor) (2)
Congenital SGS
Haemangioma
Acquired causes of subglottic obstruction (biphasic stridor) (2)
Traumatic SGS
Croup
Congenital causes tracheal obstruction (washing machine stridor) (3)
Tracheomalacia
Stenosis/complete ring
Extrinsic/vascular
Acquired causes tracheal obstruction (washing machine stridor) (3)
Tracheomalacia
Traumatic/iatrogenic
Extrinsic
Commonest cause stridor in newborn
VC motion impairment
Commonest cause stridor - weeks old baby
Laryngomalacia
Commonest cause stridor - months old baby
Recurrent respiratory papillomatosis
Commonest cause stridor - intubated baby in NICU/PICU
Subglottic stenosis
Commonest cause stridor - years old child (3)
Croup
Epiglottitis
FB
Which 2 neck pathologies in children cause a TOXIC fever
Epiglottitis
Tracheitis
What is a lipoma?
Overgrowth of adipose tissue
Features of a lipoma
Mobile
Non-tender
Soft
Doesn’t transilluminate
What is an epidermoid cyst?
Keratin filled cyst
Features of an epidermoid cyst
Central punctum
Mobile
Non tender
Doesn’t translilluminate
Another name for carotid body tumour
Paraganglioma
What age group gets paragangliomas
30-50y/o
Which conditions are more associated with paragangliomas
MEN2
VHL
NF1
Features of carotid body tumour
Soft
Pulsatile
Slow growing
What is Laryngomalacia
Immature cartilage of upper larynx collapses inward during inhalation
PS Laryngomalacia
Inspiratory stridor
Poor feeding
Ix laryngomalacia
Flexiscope - shortened epiglottis + aryepiglottic folds
Mx laryngomalacia
Self resolving :)
Can Tx w/ supraglottoplasty
Age epiglottis
2-7
Mx epiglottitis
Med emergency Dont examine paeds ENT/anaesthetics IMMEDIATELY IV ceftriaxone Steroids
What is unilateral VC palsy due to
Iatrogenic
Weak/breathy cry
What is bilateral VC palsy due to
Idiopathic
RDS
What % of kids w/ bilateral VC palsy will recover>?
50%
Diagnosis VC malsy
Microlayngoscopy
Cause of recurrent respiratory papillomatosis (RRP)
HPV 6+11b
RF RRP
1st child
Vaginal delivery
Young mother
PS RRP
Husky voice
Airway obstruction
Mx RRP
Repeated debulking
Gardasil (prevent in future)
What is acquired subglottic stenosis
Narrowing of subglottic airway
PS acquired sublgottic stenosis
Biphasic stridor
What is congential SGS due to
In utero malformation /cricoid cartilage
What is acquired SGS due to
mechanical trauma/infection
