PEDIATRICS Section 3: Head and Neck Flashcards

1
Q

Embryology wise, the thyroid starts where?

A

at the back of the tongue and descends downward to a location that would be considered normal.

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2
Q

What represents the persistence of the inferior portion of the thyroglossal duct?

A

“Pyramidal lobe”

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3
Q

What happens when normal descent of the tongue gets fucked up?

A

The thyroid either:

Stays at the back of the tongue (lingual thyroid)

or

Ends up halfway down the neck or even in the chest (Ectopic thyroid)

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4
Q

How do you diagnose ectopic tissue?

A

Nukes (I-23 or Tc-MIBI) –> superior

next is CT

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5
Q

What is the most common locationof ectopic thyroid tissue?

A

Lingular thyroid (back of the tongue)

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6
Q

What is the embryological thyroid interstate highway to the neck?

Failure to involute fully results in?

A

Thyroglossal duct

Cyst (Thyroglossal duct) - hence the name

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7
Q

Classic location of Thyroglossal duct cyst

A
  1. Base of the tongue
  2. Midline anterior to the hyoid
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8
Q

Diagnosis?

A

Thyroglossal Duct Cyst

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9
Q

“MIDLINE” cyst in the neck of a Kid

A

Thyroglossal Duct Cyst

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10
Q

Next step after you looke for Midline cyst in the neck of a kid?

A

Confirm Normal thyroid location and/or look for ectopic tissue (USD +/- Tc-MIBI or I-123)

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11
Q

If you see a nodule within a suspected cyst in the midline cyst in the neck of a kid - consider?

A

CANCER (usually papillary

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12
Q

Sign of infection in Thyroglossal duct cyst

A

Rim enhancement + Fatty stranding

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13
Q

Management for Thyroglossal Duct Cyst

A

Sistrunk Procedure - Remove cyst, tract + hyoid = decreases recurrence

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14
Q

Where do dermoid cyst usually occur? but when they happen in the neck, what will be the classic look?

A

It is true that dermoids almost always occur below the clavicles, but when they do happen in the neck they have a pretty classic look; midline sublingual / submandibular space with a “sac of marbles” appearance.

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15
Q

Diagnosis? Describe

A

Dermoid cys- marbles of lobules of fat within the fluid

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16
Q

What is the most common branchial cleft cyst?

A

2nd Branchial clef cyst (95%)

17
Q

Classic location of branchial cleft cyst.

A

Angle of the mandible

18
Q

Diagnosis? what is the sign?

A

Branchial cleft cyst

Extension of the cyst between ICA and ECA just above the carotid bifurcation - “Notch Sign”

19
Q

Where is the 2nd branchial cleft cyst specifically located?

A

Posterior and lateral to the submandibular gland or lateral to the carotid space, or anterior to the sternocleidomastoid

REMEMBER - Lateral to everything

20
Q

2nd branchial cleft cyst buzzword

A

“LATERAL”

21
Q

BCC (branchial cleft cyst) mimics

A

Necrotic level 2 lymph node
Thyroid CA (History of radiation exposure)
NPC (History of HPV) - Early adulthood

22
Q

If you have a new Branchial cleft cyst in an 18 year old, what do you consider?

A

A necrotic node.

23
Q

I say LATERAL cyst in the neck you say?

A

Branchial Cleft Cyst (BCC)

24
Q

I say MIDLIN cyst in the neck, you say?

A

Thyroglossal duct cyst (TGDC)

25
Q

What are the two jugular vein issues that occur in kids that are worth mentioning?

A

Septic Thrombophlebitis and Phlebectasia

26
Q

a.k.a clotted jugular vein

A

Septic Thrombophlebitis

27
Q

In what setting do you usually see Septic Thrombophlebitis?

A

recent pharyngeal infection (or recent ENT surgery)

28
Q

is a rare complication of bacterial pharyngitis/tonsillitis and involves an extension of the infection into the lateral pharyngeal spaces of the neck with subsequent septic thrombophlebitis of the internal jugular vein(s)

A

Lemierre syndrome (LS)

29
Q

After identifying Septic Thrombophlebitis, what should you do next?

A

Look for septic emboli in the lungs

30
Q

What bacteria causes septic emboli?

A

Fusobacterium necrophorum

31
Q

Diagnosis?

A

Lemierre Syndrome

32
Q

Idiopathic dilated Jugular vein

A

Phlebectasia

33
Q

A six-year-old child with no particular past medical history presented with a two-year history of progressively enlarging mass on the right side of the neck.

Diagnosis?

A

Phlebectasia