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Flashcards in Pediatric Airway II Deck (83):
1

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

True

2

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

True

3

The majority of pediatric neck masses have what underlying etiology?

Inflammatory

4

What is the first step in characterizing neck masses?

Identify location (relative to SCM and clavicle)

5

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

-Congenital (at birth)?
-Changing?

6

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

-Branchial anomalies
-Fibromatosis coli

7

What is fibromatosis coli?

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.

8

What are laryngoceles?

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

9

What are thymic cysts?

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

10

What type of branchial anomalies are the most common?

Type 2

11

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

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

12

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

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

13

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

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

14

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

CN VII

15

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

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

16

What is a pyriform sinus fistula?

Type III branchial cyst

17

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

Neck to the ipsilateral piriform sinus to the the ipsilateral thyroid

18

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

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

End up in the ear, with the facial nerve

19

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

Acute viral lymphadenitis

20

What is the bacteria that causes cat scratch fever?

Bartonella henselae

21

Dog bite cellulitis - what bacteria?

Pasteurella multocida

22

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

1. Rhinovirus
2. Parainfluenza
3. flu
4. EBV

23

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

1. Staph Aureus
2. GAS

24

What are the uncommon bacterial causes of acute bacterial lymphadenitis?

Anaerobic bacteria

25

What are the cutaneous changes associated with mycobacterial lymphadenitis?

Purplish discoloration with palpable fluctuance

26

What is the usual h/o mycobacterial lymphadenitis?

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

27

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

True

28

What is the usual cause of mycobacterial lymphadenitis?

-MAC
-Scrufflum

29

What is the treatment for mycobacterial lymphadenitis?

-Surgical excision
-Ethambutol and azithromycin

30

What is the treatment for MAC infections, in general?

Macrolide and ethambutol

31

What is the MA and classic side effect of ethambutol?

-It disrupts arabinogalactan synthesis by inhibiting the enzyme arabinosyl transferase
-Optic neuritis

32

What is the general presentation of Cat scratch disease?

-Body aches
-Malaise
-Low grade fever
-Swelling at the inoculation site

33

How do you diagnose cat scratch disease?

Serological testing

34

What is the prognosis for cat scratch disease?

Self limited

35

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

When it becomes infected, following a URI

36

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

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

37

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

-**Peritonsillar infection**
-**Retropharyngeal**
-Prevertebral

38

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

-Sarcoidosis
-Kawasaki disease
-Castleman disease

39

What is the usual presentation of thyroglossal duct cysts?

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

40

What are thyroglossal duct cysts?

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

41

How do you prevent recurrences of thyroglossal duct cysts?

Excise the portion within the hyoid bone

42

What is the treatment for thyroglossal duct cysts?

excise, and place on thyroid replacement

43

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

Must follow back to the hyoid bone

44

What is the base for the tongue muscles?

Hyoid bone

45

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

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

Usually a midline structure

46

How common are dermoid cysts?

Very common

47

What is the prognosis for untreated dermoid cysts?

Will continue to grow unless resected

48

True or false: dermoid cysts often become infected

False--rarely infected

49

What is a plunging ranula?

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

50

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

Sublingual glands

51

What is the usual presentation of a plunging ranula?

Frog like neck

52

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

Oral cavity

53

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

Hemangiomas

54

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

-Suffocation if involves the airway
-Substantial functional defects

55

What is the pharmacological treatment for vascular hemangiomas?

Propranolol

56

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

Hemangiomas are most common in general

Vocal fold = Papillomas

57

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

Maxillary artery

58

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

Stapedial artery

59

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

Common carotid

"C is the third letter of the alphabet"

60

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

Left - aortic arch
right - right subclavian

"4th arch = 4 limbs"

61

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

Degenerates

62

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

Pulmonary artery and the ductus arteriosus

63

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

-Mandible
-Malleus
-Spheno-Mandibular ligament

64

What are the CNs of the first arch?

V2 and V3

65

What is treacher collins syndrome?

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

66

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

-Stapes
-Styloid
-Stylohyoid ligament

67

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

Stapedius
Stylohyoid
PlatySma

68

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

CN VII (Smile nerve)

69

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

Fistula between the tonsillar area and lateral neck

70

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

Greater horn of the hyoid

71

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

-StyloPharyngeus
-GlossoPharyngeal nerve from CN IX

72

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

-Pharyngeal constrictors
-cricothyroid
-Levator veli palatini

73

What CN goes with the 4th branchial arch?

CN X

74

What are the muscular derivatives of the 6th arch?

all intrinsic muscle of the larynx, except the cricothyroid

75

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

CN X

76

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

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

77

True or false: teratomas are often present in utero

true

78

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

Lymphoma

79

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

5 years

80

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

Neuroblastoma

81

What is the most common type of sarcomas?

Rhabdomyosarcoma

82

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

Greater than 1 cm within one year

Greater than 3 cm older than 1 year

83

What is the most common soft tissue malignancy in childhood?

Rhabdomyosarcoma