ENT - pediatric neck mass

Question 1

the majority of pediatric neck masses are ____________ (benign / malignant) and __________ (inflammatory / non-inflammatory

Answer 1

• benign

- inflammatory

Question 2

what are the congenital types of lateral neck masses?

Answer 2

• branchial anomalies

- fibromatosis coli (lump of fibrous tissue, scar, and muscle within the SCM)

Question 3

fibromatosis coli is associated with what condition?

Answer 3

torticollis

Question 4

what is the most common congenital lateral neck mass?

Answer 4

type II branchial cleft cyst

Question 5

at what level are type II branchial cleft cysts located?

Answer 5

level of the cricoid and anterior to SCM

Question 6

embryologically type II branchial cleft cysts are remnants of the division between the _____________

Answer 6

2nd and 3rd branchial arch

Question 7

what is the location / origin of type II branchial cleft cysts?

Answer 7

skin and path between bifurcation of carotid

Question 8

embryologically type I branchial cleft cysts are remnants of the division between the _____________

Answer 8

1st and 2nd branchial arch

Question 9

type III branchial cleft cyst is aka:

Answer 9

piriform sinus fistula

Question 10

embryologically type III branchial cleft cysts are remnants of the division between the _____________

Answer 10

3rd and 4th branchial arch

Question 11

what is the location / origin of type III branchial cleft cysts?

Answer 11

ipsilateral piriform sinus

Question 12

what is the location / origin of type I branchial cleft cysts?

Answer 12

auricle and ear canal, and intertwined with facial nerve

Question 13

what is the most common cause for quick onset of lateral neck mass?

Answer 13

acute viral lymphadenitis

Question 14

what are the two most common causative agents for acute bacterial lymphadenitis?

Answer 14

• s. aureus

- group A beta hemolytic strep

Question 15

diagnosis?

• presents with what apepars to be an infected and slowly enlarging neck mass
• no associated illness and no discomfort or tenderness to palpation
• gradual violaceous changes to the overlying skin with palpable fluctuance
• PPD often positive

Answer 15

atypical mycobacterial infection

Question 16

what is the treatment for atypical mycobacterial infection? what is unusual about it?

Answer 16

• surgical
• supplemental abx
• very slow growing, not a lot of turnover for abx to take effect

Question 17

what is the presentation for cat scratch disease? how is it diagnosed?

Answer 17

• skin lesion at site of inoculation
• body aches, malaise, low grade fever
• diagnosed with serology for antibodies

Question 18

most congenital neck masses are lined with _____________ epithelium

Answer 18

respiratory

Question 19

what are the noninfectious etiologies of lateral neck masses?

Answer 19

• sarcoidosis
• kawasaki
• castelman disease

Question 20

what are the midline neck masses?

Answer 20

• thyroglossal duct cyst
• dermoid cyst
• plunging ranula
• thymic cyst
• ectopic thyroid

Question 21

what is important about the path of a thyroglossal duct?

Answer 21

it goes through the body of the hyoid

Question 22

what is the treatment for hemangioma?

Answer 22

propanolol

Question 23

lymphatic malformations are aka:

Answer 23

cystic hygromas

Question 24

what is the most common neck malignancy UNDER 6 years of age?

Answer 24

neuroblastoma

Question 25

what is the most common malignancy overall in children?

Answer 25

lymphoma

Question 26

what are the abnormality cutoffs for size and age regarding malignancy in children?

Answer 26

- lymph node over 1 cm under 1 yo - lymph node over 3 cm over 1 yo - rapidly enlarging nontender long standing mass with overlying changes in skin

Question 27

what is the most common soft tissue malignancy in childhood?

Answer 27

rhabdomyosarcoma