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112 Cards in this Set
- Front
- Back
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True or False: Thyroid nodules in children that are palpable do not have a high rate of malignancy, but should be watched.
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FALSE: they do tend to have a high rate of malignancy
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What are some pertinent medical history findings that would increase a child's risk for thyroid cancer?
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-Prematurity
-heart defects -exposure to xray |
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What is a goiter?
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Enlarged thyroid.
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True or false: Goiters are indicative of hyperthyroidism because the thyroid is overactive thus, overgrowing,
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FALSE: goiters can occur without hyper or hypothyroidism. They may be euthryoid goiters: meaning Normal TSH and T4 levels
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The normal texture of the thyroid is ____ and without ____.
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Soft; nodules
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What is the best indication for the proper size of the lateral lobes of the patient's thyroid?
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The size of the third phalanx of a child's thumb
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Females have (>/<) thyroid disease than males.
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>
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What tanner stage(s) are involved in a growth of the thyroid?
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2-3
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Where must a child be referred to when nodules are felt upon exam?
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Endocrine for biopsy
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What are the most common head and neck lesions?
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-Cystic hygromas
-Hemangiomas -Branchial cleft cysts -Preauricular pits, sinuses and cysts -Ranula |
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What are cystic hygromas?
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Multiloculated cystic lymphatic formation. Collection of lymphatic sacs that contain clear, colorless lymph
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What is the possible cause of cystic hygroma?
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Congenital and probably represents a cluster of lymph channels that failed to connect into the normal lymphatic pathway
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Why is a cystic hygroma dangerous?
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As it grows, it may cause tracheal compression and stridor
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What is the rate of cystic hygromas?
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1: 12000 births
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Cystic hygromas are usually found in the __ year of life?
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Second
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Cystic hygromas occur 2:1 on the (right/left) side of the neck?
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left
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Describe how cystic hygromas feel upon assessment?
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Discrete, soft, mobile, nontender, cystic mass
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Where do cystic hygromas occur in the neck?
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in the posterior triangle of the neck
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True or false: hemangiomas are common.
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True
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What is the growth pattern of hemangiomas?
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They increase in the first year and then start to regress
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Where do hemangiomas often occur?
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lips, eyes, nose and ears
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What are the common treatment options for hemangiomas?
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-Beta blockers
-ablated using laser -surgical removal |
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Why are hemangiomas on the head and neck worrisome?
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they can obstruct the airway
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If a patient has ___ or must hemangiomas, their liver must be watched because they can ____.
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5; hemorrhage
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What are the complications of hemangiomas?
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-Hemorrhage
-Ulceraction -Infection, necrosis -DIC -Airway obstruction -CHF |
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The most common congenital neck mass is a ___.
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Second branchial cleft cyst. Occurs in 2-3% of the population
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Describe the assessment of a second branchial cleft cyst.
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-smooth
-nontender -fluctulant masses -occur along the lower 3rd of the anteriomedial border of the sternocleidomastoid between the muscle and overlying skin |
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Where do branchial cysts often occur?
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-occur along the lower 3rd of the anteriomedial border of the sternocleidomastoid between the muscle and overlying skin
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A branchial cleft cyst presents as a?
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Solitary, painless mass in the neck of a child or young adult
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What is the typical presentation of a branchial cyst?
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Small cartilaginous horn in the lower anterior border of the neck. Small pencil tips
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Which type of neck lesion is usually found below the level of the hyoid bone in the midline or off center?
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Thyroglossal duct cyst
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A thyroglossal duct cyst is seen best when the neck is ____.
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Hyperextended
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Why must thyroglossal duct cysts be removed when found?
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Have a high rate of thyroid carcinoma
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What direction should the HCP provider give to a patient to assess for hypoglossal duct cyst and why?
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Stick out their tongue or swallow.
-The lesion is usually connected to the base of the tongue |
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True or false: thyroglossal ducts cysts can occur anywhere from the base of the tongue to the diaphragm?
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TRUE
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Which lesion is described as a prominent glistening mass in the floor of the mouth near the frenula?
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Ranula
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Why do ranula occur?
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Due to partial obstruction of sublingual salivary duct
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How many lymph nodes do we have in our body?
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600
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What are the 2 ways lymph nodes can enlarge?
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1. proliferation of normal cells
2. infiltration by a foreign body or abnormal cells |
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What is the anterior triangle?
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Bound superiorly by mandibular border and extends along the sternocleidomastoid to the mid line of the neck anteriorly
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What is the posterior triangle?
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Bounded by the sternocleidomastoid muscle, the distal 2/3s of the clavicle and the posterior mid line of the neck
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Palpate the lymph nodes with the ___ of your ___ and ___ fingers for the various groups.
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pads; middle; index
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What regions are drained by the preauricular node?
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- anterior and temporal scalp, anterior ear canal and pinna and conjunctiva
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What is the #1 reason for enlarged postauricular nodes?
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LICE
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What sections are drained by the postauricular nodes?
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Temporal and parietal scalp
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which lymph node(s) drain the posterior scalp?
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The occipital
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the tonsillar and superficial cervical nodes drain the ___.
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Lower larynx, lower ear canal and parotid
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If a child has large submandibular nodes, what should they be assessed for?
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Dental infections
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What is drained through the submandibular nodes?
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Cheek, nose, lips, tongue, submandibular gland, buccal mucosa
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Which lymph nodes drains the lower lip and the floor of the mouth?
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The submental.
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Which lymph node drains the right side, mediastinum and lungs and the left side abdomen>?
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The supraclavicular
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What is drained through the deep cervical chain?
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-tonsils
-adenoids -posterior scalp and neck -tongue -larynx -thryoid -palate -nose -esophagus -paranasal sinus |
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What are shotty nodes?
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nodes that are small, mobile, soft and non-tender
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What does the axillary nodes drain?
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Arm
breast thorax neck |
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What lymph node drains the medial arm below the elbow?
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Epitrochlear
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which lymph node drains the lower leg
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popliteal
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What does the inguinal lymph node drain?
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Genitalia, buttocks, abdominal wall below umbilicus, and the lower extremity
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It is normal for the ___ and ___ lymph nodes to be up to 1cm.
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axillary and cervical
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The inguinal region can be up to ___ cm.
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1.5
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The epitrochlear region usually has nodes that are ___ cm
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0.5
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If a node is greater than 2cm, what is a differential diagnosis?
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underlying malignancy
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True or False: a palpable lymph node that is painful is indicative of malignancy?
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FALSE: malignancies don't hurt
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Tender lymph nodes is most likely caused by ___.
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infection
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What are possible diagnoses for nodes that are fixed and matted to each other?
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Cancers and invasive inflammation like TB or sarcoidosis
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__-% of the nodes in the posterior triangle are malignant.
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50
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Ture or false: lymph nodes are palpable in newborns?
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FALSE
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What are the possible diagnoses with lymph nodes found in newborns?
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HIV, congenital syphilis, congenital CMV
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What are the congenital lesions that are often confused with lymph nodes in newborns?
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-cystic hygroma
-branchial cleft cysts -thyroglossal duct cysts -cervical rib |
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Which disease asssociated with lymphadenopathy is considered more indolent and can have 6-12 months of lymphadenopathy?
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Hodgkin's lymphoma
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What are the associated symptoms of hodgkins?
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Night sweats
fever weight loss pruritus athralgias fatigue=secondary to anemia |
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What is the number 1 cause of lymphadenopathy?
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Infection
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Which disease has a hallmark symptom of enlarged supraclavicular nodes?
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Tuberculosis
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What are the mycobacterium causes of lymphadenopathy?
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TB
Atypical: in Arizona |
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Coccidiomycosis, cryptococcosis and histoplasmosis are all ___ that are associated with lymphadenopathy.
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Fungi
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What are the 2 protozoal infections that can cause lymphadenopathy.
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-Toxoplasmosis
-Leishmaniasis |
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What are 2 spirochete associated diseases that can cause lymphadenopathy?
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-Lyme
-Syphilis |
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What are the 3 malignancies that are considered a differential diagnosis for lymphadenopathy?
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-Leukemia
-Lymphoma -Metastasis from sold tumor |
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LIst the immunological differential diagnoses that are associated with lymphadenopathy.
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-Autoimmune
-lymphoproliferative disease -serum sickness -langerhans cell histiocytosis -dermatomyositis -rheumatoid arthritis -chronic granulomatous disease |
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What are 2 endocrine disorders that can cause lymphadenopathy?
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-Addisons
-Hypothyroidism |
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List the rare miscellaneous disorders that have been known to cause lymphadenopathy.
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-Churg Strauss syndrome
-Kawasaki disease -lipid storage disease -amyloidosis -Sarcodosis |
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What is reactive adenopathy?
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reaction to an infection in the drainage area
ie: pharyngitis, otitis media, conjunctivitis |
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What is the term used to describe infections resulting from the ear, nose and throat and causing large lymph nodes?
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reactive adenopathy
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What is lymphadenitis?
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-inflamed, enlarged, tender lymph node
-acute onset |
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Lymphadenitis is associated with ___, ___, warm lymph nodes with ___.
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tender, erythematous; fever
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What will an ultrasound identify with a patient with lymphadenitis?
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abscess
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What is the treatment for lymphadenitis?
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Anti-strep or anti-staph agent
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How is lymphadenopathy different from lymphadenitis?
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adenopathy is less common than localized adenitis.
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Lymphadenopathy can be a sign of serious underlying ___ ___.
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systemic disease
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What are the major causes of non-infectious lymphadenopathy?
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-medication (serum sickness)
-Malignancy -Autoimmune disease |
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What type of allergic reaction is serum sickness?
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Type 3, from medication
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What are the 3 abnormals of lymphadenopathy?
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-Abnormal size
-abnormal number -abnormal consistency |
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What are the symptoms of serum sickness associated lymphadenopathy?
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-Fever
-Arthralgias -Malaise -Pruritis -Rash which can be urticarial |
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What are the offending medications associated with serum sickness?
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-Tegretol
-Cephalosporins (ceclor) -Penicillins -Phenytoin -sulfaonamides |
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Which drug can cause lymphadenopathy without serum sickness?
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phenytoin
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Describe the characteristics of childhood cancers with lymphadenopathy?
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-Non-tender
-bulky and grow rapidly -may be associated with pallor, bruising, petechiae, hepatosplenomegaly |
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What are the 3 common autoimmune diseases associated with lymphadenopathy
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-SLE, JIA, Dermatomyositis
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True or false: Lymphadenopathy associated with autoimmune disease has nodes that are tender, discrete and range in size from 0.1cm-5cm?
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FALSE: NONTENDER, range from 0.5cm to a few centimeters
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What are the steps to take when a patient has acute localized CERVICAL lymphadenopathy?
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-First step, observation if not sick
-if bacterial infection is suspected treat with a cephalosporin -Consider a PPD |
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True or false: steroid use to treat lymphadenopathy is the gold standard of treatment in children with leukemia?
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FALSE!!!! it can mask the symptoms of leukemia
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What are the diagnostic tests to order for lymphadenopathy?
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-CBC
-ESR, CRP -Lactate dehydrogenase -PPD -specific serolgocial tests for infections -Chest XRAY |
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what lab test should be conducted if malignancy associated lymphadenopathy is detected?
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Lactate dehydrogenase: has a marker for hematologic malignancy
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What may a chest xray show in terms of lymphadenopathy symptoms
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-Mediastinal mass or hilar adenopathy
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What are the conditions in which a biopsy of cervical adenopathy should be done?
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-continued progression
-enlarge supraclavicular node -hard, fixed or nontender -absence of symptoms suggesting infections -fever > 1 week -night sweats -weight loss greater than 1-% -abnormal finding on CBC, ESR, chest Xray |
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What are the signs of Cervical Adenitis???
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-Swelling is tender is warmth
-nuchal rigidity if the node is posterior |
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The medulla of the lymph nodes is made up of ___ attached to ___ fibers.
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macrophages; reticular
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What covers the lymph node?
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thick fibrous capsule
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What are the 2 basic parts of the lymph node?
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-cortex
-medulla |
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What is the cortex of the lymph node populated with?
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lymphocytes
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What is the primary resting place of the B Cell>?
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the cortex of the lymph node
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What do the B cells of the lymph nodes produce?
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immunoglobulins
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Where do the T lymphocytes reside?
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circulate within lymp nodes
blood stream lymphatic ducts |
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What is the name of the inward pointing structure of the lymph node?
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trabaculae
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