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D&T 3 test 2 > Pediatric Neck Masses > Flashcards

Pediatric Neck Masses Flashcards

1
Q

When you do a head and neck exam where should you start

A

begin away from mass and work towards mass

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2
Q

what might be a possible cause of a mass anterior to the sternocleidomastoid muscle

A

branchial cleft remnant

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3
Q

what might be a possible cause of a mass posterior to the sternocleidomastoid muscle

A

Lyphangioma/cystic hygroma

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4
Q

What is the most common congenital neck mass?

A

Thyroglossal duct cyst

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5
Q

where is thyroglossal duct cyst located

A

midline

- infrahyoid most common

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6
Q

when does thyroglassal duct cyst present

A

during childhood, usually before 10 years of age

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7
Q

embryology: what does the thyroglassal duct connect

A

developing thyroid gland and foramen cecum

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8
Q

what happens 5th week gestsation

A

thyroglossal loses its lumen and fragments

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9
Q

What does the mesoderm form?

A

hyoid bone

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10
Q

what does hyoid bone divide

A

duct into suprahyoid and infrahyoids

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11
Q

when does the attenuated duct atrophy

A

8th week gestation

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12
Q

Thyroglassal duct cyst is what type of cyst

A

epithelial lined cyst

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13
Q

Thyroglassal duct cyst is a result from what failure

A

failure of normal obliteration of thyroglassal duct during development

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14
Q

clinical presentation for thyroglassal duct cyst

A

painless
if infected- red warm painful lump
- MOVES SUPERIORLY WITH SWALLOWING OR PROTRUSION OF TONGUE
- associated with ectopic thyroid

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15
Q

what is used to diagnose thyroglossal duct cyst

A

ultrasound

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16
Q

what causes Dermoid

A

outer layers of skin do not properly grow together

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17
Q

What is in a dermoid

A

epithelium lined

- tissues, hair follicles, sebaceous, sweat glands ( secrete their stuff which makes dermoid grow)

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18
Q

on physical exam what is special about dermoid

A

move independently with skin

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19
Q

what is the second most common site for Dermoid

A

neck

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20
Q

how is dermoid treated

A

excision

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21
Q

how is thyroglossal duct cyst treated

A

surgical resection

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22
Q

when does branchial cleft cyst present

A

at birth, may present later

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23
Q

define branchial cleft cyst

A

epithelial lined cyst on lateral neck

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24
Q

what causes branchial cleft cyst

A

failure of obliteration of one of the branchial clefts

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25
Q

cyst

A

no external or internal opening

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26
Q

sinus

A

internal or external opening

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27
Q

fistula

A

both internal and external opening

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28
Q

what is the most common first branchial cleft cyst

A

type 2

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29
Q

what is type 2 first branchial cleft cyst

A

ectoderm and mesoderm

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30
Q

location of type 2 first branchial cleft cyst

A
  • below angle of mandible

- inferior to external auditory canal or at the bony cartilaginous junction of external auditory canal

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31
Q

what is the most common type of branchial cleft cyst

A

second branchial cleft cyst

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32
Q

location of second branchial cleft cyst

A
  • inferior to angle of mandible and anterior to the SCM
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33
Q

treatment for second branchial cleft cyst

A

surgical excision

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34
Q

location of third branchial cleft cyst

A

anterior to SCM
typically lower in neck than 2nd
- more common on left side

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35
Q

what is the difference between 3 and 2 branchial cleft cyst

A

3rd will end in pharynx at thyrohyoid membrane

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36
Q

how does third branchial cleft cyst present

A

recurrent lower neck infection-polymicrobial

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37
Q

what is cystic hygroma

A

lymphatic malformation

  • failure of lymphatic system to connect to venous system
  • multi-loculated lymphatic lesion
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38
Q

where are cystic hygroma usually found

A
  • left posterior triangle of neck
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39
Q

when can cystic hygroma be diagnosed

A

prenatal, seen in ultrasound

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40
Q

when does cystic hygroma present

A

half at birth

most get it by 2 yrs

41
Q

is cystic hygroma benign or malignant

A

benign

42
Q

how does cystic hygroma present

A

soft, painless, compressible (doughy) mass that may transilluminate

43
Q

what must the physician worry about with cystic hygroma

A

airway compression

44
Q

how is cystic hygroma treated

A

surgical excision

45
Q

when does Hemangiomas present

A

not typically at birth

46
Q

what is Hemangiomas

A

bright red macule or papule rash with clear boundaries

47
Q

what happens when there are 5 or more cutaneous hemangiomas

A

recommend abdominal MRI ( liver)

48
Q

What are the 2 stages of hemangiomas

A

proliferative

involuational

49
Q

what happens in the proliferative stage of hemangiomas

A
  • begins shortly after birth
  • grows
  • may ulcerate
50
Q

what happens in the involutional stage of hemangiomas

A
  • superficial lesions change from bright red to dull red, then gray
  • flatten and soften
  • may complete by 10 yrs
51
Q

what is the most common location for hemangioma

A

subglottic region

52
Q

what is clinical findings for subglottic hemangioma

A 
biphasic stridor 
exacerbated with agitation, crying 
- initially diagnosed as croup
feeding difficulties 
sleep disturbances
53
Q

Large beard distribution hemangiom plus stridor equals

A

prompt hospital admission

54
Q

what is the best imaging for hemangiomas? what type of pattern is seen?

A

MRI

salt and pepper pattern

55
Q

what is the treatment for heamingiomas

A
  • small isolated or multiple skin lesions on face should be treated after birth to prevent proliferative phase
  • close observation
56
Q

when do you intervene with heamingiomas

A
  • accelerated growth
  • hemmorrhage
  • infection
  • ulceration
  • funcional porblems
  • High output congestive heart failure
  • involves eyelids, nose, lips, auricle
57
Q

what is that pharmacologic treatment for haemingiomas

A

propanolol

58
Q

what are surgical treatment options for haemingiomas

A

tracheostomy
cyrotherapy
laster therapy
excision

59
Q

what is torticollis

A

SCM is tight and short due to muscle injury at birth or in utero
- head tilted laterally toward affects muscle, rotated to opposite side

60
Q

Torticollis presents when

A

first 6-8 weeks of life

61
Q

Torticollis is associated with what

A

hip dysplasia

62
Q

what is the main treatment for torticollis

A

exercise to stretch the SCM

- surgery if that does not work

63
Q

Name 2 acquired pediatric neck masses

A

lymphadenitis

neoplastic

64
Q

cervical lymphadenpathy is secondary to what

A

infection

65
Q

is cervical lymphadenopathy benign or malignant

A

benign

66
Q

when does lymphadenopthy get worrisome

A
  • firm
  • matted
  • nontender
  • greater than 2 cm
67
Q

how does one treat acute lymphadenopathy ( less than 2 weeks)

A

broad spectrum antibiotics

68
Q

how does one treat subacute lymphadenopathy ( 2-6 weeks)

A 
CBC
PPD 
CXR
EBV
Bartonella
69
Q

how does one treat chronic lymphadenopathy ( greater than 6 weeks)

A

biopsy

70
Q

what is gold standard for lyphadenopathy

A

excisional biopsy

71
Q

what imaging can you get with lymphadenopathy

A

ultrasound
CT with contrast
MRI for vascular and lymphatic involvement

72
Q

what are common viral lymphadenopathy

A

HIV

non-specific

73
Q

what are common bacterial lymphadenopathy

A

acute otitis media, sinusitis, pharyngitis, mycobacterium

74
Q

atypical mycobacterium lymphadenopathy occurs mostly where

A

submandibular

75
Q

characterize mycobacterium lymphadenopathy

A
  • firm, painless mass
  • has not responded to antibiotics
  • violet color
  • may enlarge and become fluctuant
  • positive PPD
76
Q

what drugs do you use to treat atypical mycobactrium lymphadenopathy

A
  • macolides- azithro Main choice
  • rifampin, ethambutal, aminoglycosides, fluoroquinolones
  • 3 antimicrobials for at least 12 months
77
Q

what surgery is performed for mycobactrium lymphadenopathy

A

surgical excision

- not incision and drainage due to risk of chronic sinus tract drainage

78
Q

how do you diagnose Bartonella lymphadenopthy

A

serology

79
Q

what is the treatment for cat scratch lymphadenopathy

A

doxycycline, erythromycin or azithromycin

- self-limited

80
Q

name a non-infectious lymphadenopathy

A

Kawasaki’s disease

81
Q

what are clinical findings for Kawasaki

A
  • fever greater than 5 days
  • cervical lymphadenopathy
  • erytherma palms and soles
  • conjunctivitis
  • strawberry tongue
82
Q

what is the most common neoplastic lymphadenopathy

A

lymphoma

83
Q

what is the second most common neoplastic lymphadenopathy in children

A

rhabdomyosarcoma

84
Q

what is the second most common neoplastic lymphadenopathy in adolescent girls

A

thyroid carcinoma

85
Q

what is lymphoma? where is it most common

A

painless neck mass,

- head and neck presentation

86
Q

Hodgkins lymphoma commonely presents in who

A

adolescents

87
Q

non-hodgkins lymphoma commonly presents in who

A

2- 12 years age old

88
Q

what gender is lymphoma more commonly seen in

A

males

89
Q

what are 3 increased concern for lymphoma

A
  • greater than 3 cm and firm
  • involving multiple organs
  • supraclavicular or posterior triangle location
90
Q

Hidgkin is associated with what virus

A

EBV

91
Q

what is diagnostic tools for lymphoma? treatment?

A

tissue biopsy
bone marrow biopsy
PET scan

Chemotherapy

92
Q

What is rhabdomyoscarcoma

A

sarcoma - malignant cells arise from soft tissue, such as muscles, connective tissue or bone

93
Q

Rhabdomyosarcoma develops from cells that come from

A

skeletal muscles

94
Q

what is the most common type of soft tissue sarcoma

A

rhabdomyoscaroma

95
Q

what are 3 maintypes of rhabdomyosarcoma? which one is the most common?

A
  1. embryonal ( most common)
  2. alveolar
  3. anaplastic
96
Q

where does embryonal rhabdomyosarcoma usually occur

A

head
neck
genital
urinary

97
Q

where does alveolar rhabdomyosarcoma usually occur

A

arms, legs, chest, abdomen, genital, anal

98
Q

how does rhabdomyosarcoma present

A

lump or swelling that keeps getting bigger

D&T 3 test 2 (14 decks)

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