Name that Mass
This was not meant to be part of our vacation..
Twists and Turns
No pain, no gain
Kitchen Sink
100
The cyst with all three germ layers
What is Mature Teratoma/Dermoid Cyst?
100
A 16 yo F presents with hx of traveling to Bolivia this summer. She has had watery, smelly diarrhea for the last week with multiple episodes of daily flatulence. Her mother says that he has been burping a lot and it smells horrible, "like sulfur".
Giardiasis
100
A pediatric patient with acute-onset severe pelvic pain, nausea, and vomiting should be evaluated for this complication.
What is ovarian torsion?
100
A family presents after staying in a rural cabin in Hawaii; it was the summer and the had their windows open to enjoy the fresh, cool night air. When they wake up in the morning they find a dead bat in the bedroom where they were sleeping with no evidence of a bite or scratch. What should happen next?
Do nothing. Hawaii is rabies-free
If it was any other state or country you would give RIG and vaccine to anyone who was sleeping in the room, even if there was no evidence of a bite or scratch.
100
After multiple patients present with diarrhea, it appears that a community-wide outbreak is occurring. It is thought that the drinking water may be contaminated with an acid-fast organism.
What is the likely organism?
Cryptosporidium--prolonged diarrhea that is self limited in immunocompetent individuals
Sources: contaminated city water, water parks and swimming pools.
200
This condition is usually associated with this cyst.
Endometrioma (Chocolate cyst)
What is Endometriosis?
200
A traveler presents your clinic with vomiting. He fell ill 1 hour after eating fried rice from the street cart that had the food containers sitting at room temperature. You think this is likely due to B. cereus emetic type of gastroenteritis. What toxin is associated with this type?
Heat-stable toxin, short incubation period of 1-6 hours
200
This is the recommended management for an asymptomatic 4 cm simple ovarian cyst in a pediatric patient.
What is observation with follow-up serial ultrasounds?
200
A 2 year old African child from rural Chad presents with fever and paralysis that began in the proximal muscles of the thigh and has progressively involved more distal muscle groups. He was diagnosed wit Polio. How many Polio vaccine doses does one typically get during routine vaccination schedule?
Extra Credit: name the ages at which each dose is given for +100 points
4 doses:
2 months old--> 1st dose
4 months old--> 2nd dose
6–18 months old-->3rd dose
4–6 years old-->4th dose
200
The use of this imaging modality can help differentiate benign hemorrhagic cysts from malignant neoplastic cysts when ultrasound is inconclusive.
What is MRI with contrast?
300
An 18 yo F presents with intermittent LLQ pain, and a simple, anechoic cyst seen on the L ovary. Her serum tumor markers are normal. This is the most common type of cyst in pediatric patients.
What is a functional cyst (ie. follicular or corpus luteum cyst)?
300
A 17 yo M presents with pneumonia, diarrhea, headache, delirium and confusion. He just arrived from a cruise trip where there was a water park with Jacuzzis. What is the most likely etiology?
Legionella pneumophilia
300
This rare but serious complication can occur with a ruptured ovarian cyst.
What is peritonitis?
300
Two children 9 months and 3 years of game present for evaluation 24 hours after an outbreak of measles. The 9 month -old has not received the MMR vaccine and the 3 year old has received 1 dose.
Who qualifies for post-exposure prophylaxis with MMR indicated?
During an outbreak, measles vaccine given to susceptible individuals within 72 hours.
Susceptible individuals include all exposed individuals who are eligible to received the vaccine (>12 months of age) and who have not been vaccinated or only received 1 dose.
300
A 14 year old form Hawaii present with the following:
fever, jaundice, conjunctival redness without exudates, myalgias and headaches
Labs: Cr 1.9, Bilirubin is disproportionately high compared to AST/ALT that is mildly elevated.
What is the diagnosis?
Leptospirosis-biphasic illness that is separated by 3-4 days of no fever
Rats, dogs, livestock are vectors.
400
This common endocrine disorder, associated with insulin resistance and infertility, has a strong genetic component, is characterized by hyperandrogenism and is associated with this type of cyst.
What is PCOS and Follicular cysts?
400
What increases your risk of acquiring neuroinvasive illness from West Nile Virus?
Increases with Age, and is highest among adults >60 yrs of age.
400
A hemorrhagic ovarian cyst can sometimes be mistaken for this life-threatening condition due to free fluid in the pelvis and acute pain.
What is an ectopic pregnancy?
400
A 7 year old girl comes into the office to get her flue vaccine. She is allergic to eggs. Can you give her a flu vaccine or do you have to refer her to an allergist?
No, egg based vaccine products can be safely given to people with an egg allergy
400
While ovarian cystectomy is the preferred fertility-sparing surgery, this additional procedure may be considered in recurrent torsion cases.
What is oophoropexy?
500
A complex ovarian cyst with solid components and elevated AFP or β-hCG should raise concern for this type of tumor.
What is a germ cell tumor?
500
A 13 year old girl who recently vacationing in a hostel in Australia where they had lorikeet feeding events for guests. She has a fever of 105 F , myalgias, rigors, pneumonia and splenomegaly. What is the most likely etiology?
Chlamydia psittaci--commonly found in parrots and parakeets.
500
When managing an asymptomatic ovarian cyst, this factor other than size is a key determinant in deciding whether to intervene surgically.
What is complexity on imaging (solid components, septations, abnormal Doppler flow)?
500
A 6 y old child presents to your office for WCC and routine vaccinations. Mother states that they are planning on traveling to an area that is know to be high risk for yellow fever, and would like for him to be immunized. Can you give it during this visit? (Yes or No)
No, live attenuated vaccines need to be given 28 months apart.
500
AFP is to __
B-hCG is to __
LDH is to __
Inhibin is to __
AFP is to Yolk Sac Tumor
B-hCG is to Choriocarcinoma
LDH is to Dysgerminoma
Inhibin is to Granulosa Cell Tumor