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Specialty Medicine > Pediatric Airway II > Flashcards

Pediatric Airway II Flashcards

1
Q

True or false: as opposed to adults, most pediatric neck masses are benign

A

True

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2
Q

True or false: an adult neck mass is malignant until proven otherwise

A

True

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3
Q

The majority of pediatric neck masses have what underlying etiology?

A

Inflammatory

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4
Q

What is the first step in characterizing neck masses?

A

Identify location (relative to SCM and clavicle)

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5
Q

How do you take a h/o a neck mass?

A
  • Congenital (at birth)?

- Changing?

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6
Q

What are the two major congenital causes of lateral neck masses?

A
  • Branchial anomalies

- Fibromatosis coli

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7
Q

What is fibromatosis coli?

A

a benign proliferation of fibrous tissue infiltrating the lower third of the, (SCM) and is the most common cause of neonatal torticollis.

The mass, also known as a hematoma of the sternocleidomastoid, is firm and hard on palpation, but is neither tender nor inflamed.

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8
Q

What are laryngoceles?

A

A congenital anomalous air sac communicating with the cavity of the larynx, which may bulge outward on the neck.

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9
Q

What are thymic cysts?

A

Cysts in the thymus that ascend into the neck, causing a cystic mass

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10
Q

What type of branchial anomalies are the most common?

A

Type 2

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11
Q

What is a type II branchial cleft cyst? Where does it end up?

A

Remnant of the division between the 2nd and 3rd branchial arch, ending up in the mouth

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12
Q

What is a type I brachial cleft cyst? Where does it end up?

A

Remnant of the division between the 1st and 2d arch, ending up in the ear canal

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13
Q

What is the location for a type II branchial cleft cyst?

A

at the level of the cricoid, and anterior to the SCM

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14
Q

What is the nerve that is affected with type I brachial cleft cyst?

A

CN VII

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15
Q

What is a type III branchial cleft cyst? Where does it end up?

A

Remnant of the division of the 3rd and 4th branchial arch

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16
Q

What is a pyriform sinus fistula?

A

Type III branchial cyst

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17
Q

What is the anatomical location of type III branchial cleft cysts?

A

Neck to the ipsilateral piriform sinus to the the ipsilateral thyroid

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18
Q

What is the anatomical location of type I branchial cleft cysts? Where do they usually end up?

A

Between the bifurcation of the carotid, just posterior to the angle of the mandible

End up in the ear, with the facial nerve

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19
Q

What is the most common cause for acute onset of a lateral neck mass?

A

Acute viral lymphadenitis

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20
Q

What is the bacteria that causes cat scratch fever?

A

Bartonella henselae

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21
Q

Dog bite cellulitis - what bacteria?

A

Pasteurella multocida

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22
Q

What are the top 3 viruses that cause acute viral lymphadenitis?

A
  1. Rhinovirus
  2. Parainfluenza
  3. flu
  4. EBV
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23
Q

What is the most common bacterial cause of acute bacterial lymphadenitis?

A
  1. Staph Aureus

2. GAS

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24
Q

What are the uncommon bacterial causes of acute bacterial lymphadenitis?

A

Anaerobic bacteria

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25
Q

What are the cutaneous changes associated with mycobacterial lymphadenitis?

A

Purplish discoloration with palpable fluctuance

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26
Q

What is the usual h/o mycobacterial lymphadenitis?

A

Slow growing neck mass that does not respond to usual abx, and is NOT associated with illness or discomfort

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27
Q

True or false: PDD testing is usually positive with mycobacterial lymphadenitis?

A

True

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28
Q

What is the usual cause of mycobacterial lymphadenitis?

A
  • MAC

- Scrufflum

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29
Q

What is the treatment for mycobacterial lymphadenitis?

A
  • Surgical excision

- Ethambutol and azithromycin

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30
Q

What is the treatment for MAC infections, in general?

A

Macrolide and ethambutol

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31
Q

What is the MA and classic side effect of ethambutol?

A
  • It disrupts arabinogalactan synthesis by inhibiting the enzyme arabinosyl transferase
  • Optic neuritis
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32
Q

What is the general presentation of Cat scratch disease?

A
  • Body aches
  • Malaise
  • Low grade fever
  • Swelling at the inoculation site
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33
Q

How do you diagnose cat scratch disease?

A

Serological testing

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34
Q

What is the prognosis for cat scratch disease?

A

Self limited

35
Q

What is the first time that a congenital neck mass usually presents itself?

A

When it becomes infected, following a URI

36
Q

Most congenital neck masses are lined with what sort of epithelium? What is the significance of this?

A

Respiratory–URIs are often the cause of infections of the cysts

37
Q

What are the three major infections of the deep neck that can present as bacterial lymphadenitis? Which are the most common?

A
  • Peritonsillar infection
  • Retropharyngeal
  • Prevertebral
38
Q

What are the major non-infectious etiologies of inflammatory lateral neck masses? (3)

A
  • Sarcoidosis
  • Kawasaki disease
  • Castleman disease
39
Q

What is the usual presentation of thyroglossal duct cysts?

A

Central, slow growing, segmental mass, that is not identifiable at birth.

40
Q

What are thyroglossal duct cysts?

A

Embryological remnant of the migratory path of the thyroid from the foramen cecum to its home in the neck

41
Q

How do you prevent recurrences of thyroglossal duct cysts?

A

Excise the portion within the hyoid bone

42
Q

What is the treatment for thyroglossal duct cysts?

A

excise, and place on thyroid replacement

43
Q

What must be done with excision of a thyroglossal duct cyst?

A

Must follow back to the hyoid bone

44
Q

What is the base for the tongue muscles?

A

Hyoid bone

45
Q

What are dermoid cysts? Where in the neck are they usually found?

A

a teratoma of a cystic nature that contains an array of developmentally mature, solid tissues

Usually a midline structure

46
Q

How common are dermoid cysts?

A

Very common

47
Q

What is the prognosis for untreated dermoid cysts?

A

Will continue to grow unless resected

48
Q

True or false: dermoid cysts often become infected

A

False–rarely infected

49
Q

What is a plunging ranula?

A

Prolapse of the salivary secretions through the mylohyoid into the neck, causing a bullfrog swelling in the submental triangle

50
Q

What is the source of the secretions that cause a plunging ranula?

A

Sublingual glands

51
Q

What is the usual presentation of a plunging ranula?

A

Frog like neck

52
Q

What is the usual source (anatomic location) of bacterial lymphadenitis in the neck?

A

Oral cavity

53
Q

What is the most common pediatric neoplasm of the head and neck?

A

Hemangiomas

54
Q

What are the major issues with vascular malformations of the neck?

A
  • Suffocation if involves the airway

- Substantial functional defects

55
Q

What is the pharmacological treatment for vascular hemangiomas?

A

Propranolol

56
Q

What is the most common neoplasm in the pediatric airway? What about the vocal fold?

A

Hemangiomas are most common in general

Vocal fold = Papillomas

57
Q

What are the adult derivatives of the 1st aortic arch?

A

Maxillary artery

58
Q

What are the adult derivatives of the 2nd aortic arch?

A

Stapedial artery

59
Q

What are the adult derivatives of the 3rd aortic arch?

A

Common carotid

“C is the third letter of the alphabet”

60
Q

What are the adult derivatives of the 4th aortic arch?

A

Left - aortic arch
right - right subclavian

“4th arch = 4 limbs”

61
Q

What are the adult derivatives of the 5th aortic arch?

A

Degenerates

62
Q

What are the adult derivatives of the 6th aortic arch?

A

Pulmonary artery and the ductus arteriosus

63
Q

What are the bony derivatives of the 1st branchial arch? (3)

A
  • Mandible
  • Malleus
  • Spheno-Mandibular ligament
64
Q

What are the CNs of the first arch?

A

V2 and V3

65
Q

What is treacher collins syndrome?

A

1st arch neural crest cells fail to migrate, leading to mandibular hypoplasia, and facial abnormalities

66
Q

What are the bony derivatives of the 2nd branchial arch?

A
  • Stapes
  • Styloid
  • Stylohyoid ligament
67
Q

What are the muscular derivatives of the 2nd branchial arch?

A

Stapedius
Stylohyoid
PlatySma

68
Q

What is the CN that innervate the 2nd branchial arch?

A

CN VII (Smile nerve)

69
Q

What is the congenital abnormality caused by failure of the 2nd branchial arch to obliterate?

A

Fistula between the tonsillar area and lateral neck

70
Q

What cartilaginous structure that comes from the 3rd branchial arch?

A

Greater horn of the hyoid

71
Q

What are the muscles derived from the 3rd branchial arch? Which nerve?

A
  • StyloPharyngeus

- GlossoPharyngeal nerve from CN IX

72
Q

What are the muscular derivatives of the 4th arch? (3)

A
  • Pharyngeal constrictors
  • cricothyroid
  • Levator veli palatini
73
Q

What CN goes with the 4th branchial arch?

A

CN X

74
Q

What are the muscular derivatives of the 6th arch?

A

all intrinsic muscle of the larynx, except the cricothyroid

75
Q

What is the CN that goes with the 6th branchial arch?

A

CN X

76
Q

What is the classic presentation of a type II branchial cleft cysts?

A

Young female that has recurrent cysts at the level of the piriform sinus on the left side

77
Q

True or false: teratomas are often present in utero

A

true

78
Q

What is the most common type of malignancy in the head and neck area?

A

Lymphoma

79
Q

Most lymphomas of the head and neck appear after what age?

A

5 years

80
Q

What is the most common neck malignancy under six years of age?

A

Neuroblastoma

81
Q

What is the most common type of sarcomas?

A

Rhabdomyosarcoma

82
Q

A lymph node greater than how many cm in an infant within one year is considered abnormal? What about greater than 1 year?

A

Greater than 1 cm within one year

Greater than 3 cm older than 1 year

83
Q

What is the most common soft tissue malignancy in childhood?

A

Rhabdomyosarcoma

Specialty Medicine (36 decks)

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