Pediatric Neck Masses Flashcards Preview

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Flashcards in Pediatric Neck Masses Deck (98):
1

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

begin away from mass and work towards mass

2

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

branchial cleft remnant

3

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

Lyphangioma/cystic hygroma

4

What is the most common congenital neck mass?

Thyroglossal duct cyst

5

where is thyroglossal duct cyst located

midline
- infrahyoid most common

6

when does thyroglassal duct cyst present

during childhood, usually before 10 years of age

7

embryology: what does the thyroglassal duct connect

developing thyroid gland and foramen cecum

8

what happens 5th week gestsation

thyroglossal loses its lumen and fragments

9

What does the mesoderm form?

hyoid bone

10

what does hyoid bone divide

duct into suprahyoid and infrahyoids

11

when does the attenuated duct atrophy

8th week gestation

12

Thyroglassal duct cyst is what type of cyst

epithelial lined cyst

13

Thyroglassal duct cyst is a result from what failure

failure of normal obliteration of thyroglassal duct during development

14

clinical presentation for thyroglassal duct cyst

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

15

what is used to diagnose thyroglossal duct cyst

ultrasound

16

what causes Dermoid

outer layers of skin do not properly grow together

17

What is in a dermoid

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

18

on physical exam what is special about dermoid

move independently with skin

19

what is the second most common site for Dermoid

neck

20

how is dermoid treated

excision

21

how is thyroglossal duct cyst treated

surgical resection

22

when does branchial cleft cyst present

at birth, may present later

23

define branchial cleft cyst

epithelial lined cyst on lateral neck

24

what causes branchial cleft cyst

failure of obliteration of one of the branchial clefts

25

cyst

no external or internal opening

26

sinus

internal or external opening

27

fistula

both internal and external opening

28

what is the most common first branchial cleft cyst

type 2

29

what is type 2 first branchial cleft cyst

ectoderm and mesoderm

30

location of type 2 first branchial cleft cyst

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

31

what is the most common type of branchial cleft cyst

second branchial cleft cyst

32

location of second branchial cleft cyst

- inferior to angle of mandible and anterior to the SCM

33

treatment for second branchial cleft cyst

surgical excision

34

location of third branchial cleft cyst

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

35

what is the difference between 3 and 2 branchial cleft cyst

3rd will end in pharynx at thyrohyoid membrane

36

how does third branchial cleft cyst present

recurrent lower neck infection-polymicrobial

37

what is cystic hygroma

lymphatic malformation
- failure of lymphatic system to connect to venous system
- multi-loculated lymphatic lesion

38

where are cystic hygroma usually found

- left posterior triangle of neck

39

when can cystic hygroma be diagnosed

prenatal, seen in ultrasound

40

when does cystic hygroma present

half at birth
most get it by 2 yrs

41

is cystic hygroma benign or malignant

benign

42

how does cystic hygroma present

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

43

what must the physician worry about with cystic hygroma

airway compression

44

how is cystic hygroma treated

surgical excision

45

when does Hemangiomas present

not typically at birth

46

what is Hemangiomas

bright red macule or papule rash with clear boundaries

47

what happens when there are 5 or more cutaneous hemangiomas

recommend abdominal MRI ( liver)

48

What are the 2 stages of hemangiomas

proliferative
involuational

49

what happens in the proliferative stage of hemangiomas

-begins shortly after birth
-grows
- may ulcerate

50

what happens in the involutional stage of hemangiomas

- superficial lesions change from bright red to dull red, then gray
- flatten and soften
- may complete by 10 yrs

51

what is the most common location for hemangioma

subglottic region

52

what is clinical findings for subglottic hemangioma

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

53

Large beard distribution hemangiom plus stridor equals

prompt hospital admission

54

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

MRI
salt and pepper pattern

55

what is the treatment for heamingiomas

- small isolated or multiple skin lesions on face should be treated after birth to prevent proliferative phase
- close observation

56

when do you intervene with heamingiomas

- accelerated growth
- hemmorrhage
- infection
- ulceration
- funcional porblems
- High output congestive heart failure
- involves eyelids, nose, lips, auricle

57

what is that pharmacologic treatment for haemingiomas

propanolol

58

what are surgical treatment options for haemingiomas

tracheostomy
cyrotherapy
laster therapy
excision

59

what is torticollis

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

Torticollis presents when

first 6-8 weeks of life

61

Torticollis is associated with what

hip dysplasia

62

what is the main treatment for torticollis

exercise to stretch the SCM
- surgery if that does not work

63

Name 2 acquired pediatric neck masses

lymphadenitis
neoplastic

64

cervical lymphadenpathy is secondary to what

infection

65

is cervical lymphadenopathy benign or malignant

benign

66

when does lymphadenopthy get worrisome

- firm
- matted
- nontender
- greater than 2 cm

67

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

broad spectrum antibiotics

68

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

CBC
PPD
CXR
EBV
Bartonella

69

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

biopsy

70

what is gold standard for lyphadenopathy

excisional biopsy

71

what imaging can you get with lymphadenopathy

ultrasound
CT with contrast
MRI for vascular and lymphatic involvement

72

what are common viral lymphadenopathy

HIV
non-specific

73

what are common bacterial lymphadenopathy

acute otitis media, sinusitis, pharyngitis, mycobacterium

74

atypical mycobacterium lymphadenopathy occurs mostly where

submandibular

75

characterize mycobacterium lymphadenopathy

- firm, painless mass
- has not responded to antibiotics
- violet color
- may enlarge and become fluctuant
- positive PPD

76

what drugs do you use to treat atypical mycobactrium lymphadenopathy

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

77

what surgery is performed for mycobactrium lymphadenopathy

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

78

how do you diagnose Bartonella lymphadenopthy

serology

79

what is the treatment for cat scratch lymphadenopathy

doxycycline, erythromycin or azithromycin
- self-limited

80

name a non-infectious lymphadenopathy

Kawasaki's disease

81

what are clinical findings for Kawasaki

- fever greater than 5 days
- cervical lymphadenopathy
- erytherma palms and soles
- conjunctivitis
- strawberry tongue

82

what is the most common neoplastic lymphadenopathy

lymphoma

83

what is the second most common neoplastic lymphadenopathy in children

rhabdomyosarcoma

84

what is the second most common neoplastic lymphadenopathy in adolescent girls

thyroid carcinoma

85

what is lymphoma? where is it most common

painless neck mass,
- head and neck presentation

86

Hodgkins lymphoma commonely presents in who

adolescents

87

non-hodgkins lymphoma commonly presents in who

2- 12 years age old

88

what gender is lymphoma more commonly seen in

males

89

what are 3 increased concern for lymphoma

- greater than 3 cm and firm
- involving multiple organs
- supraclavicular or posterior triangle location

90

Hidgkin is associated with what virus

EBV

91

what is diagnostic tools for lymphoma? treatment?

tissue biopsy
bone marrow biopsy
PET scan

Chemotherapy

92

What is rhabdomyoscarcoma

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

93

Rhabdomyosarcoma develops from cells that come from

skeletal muscles

94

what is the most common type of soft tissue sarcoma

rhabdomyoscaroma

95

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

1. embryonal ( most common)
2. alveolar
3. anaplastic

96

where does embryonal rhabdomyosarcoma usually occur

head
neck
genital
urinary

97

where does alveolar rhabdomyosarcoma usually occur

arms, legs, chest, abdomen, genital, anal

98

how does rhabdomyosarcoma present

lump or swelling that keeps getting bigger