Funtabulously Frivolous Friday Five 061

Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF, introducing the Funtabulously Frivolous Friday Five 061

Question 1

What is dressing apraxia? Where is the lesion?

Reveal the funtabulous answer

Apraxia is the loss of the ability to execute learned purposeful movements.

Patients with a lesion of the non-dominant parietal lobe may exhibit dressing apraxia.

This can be tested by giving a patient a cardigan, coat or jacket that is folded inside out and asking him or her to put it on…


Question 2

How can you check for plantar reflexes without causing a withdrawal response?

Reveal the funtabulous answer

The plantar reflex involves the L5, S1 and S2 nerve roots and (according to Talley & O’Connor) is elicited by using the ‘key to an expensive motor car’  to stroke distally along the lateral aspect of the sole of the foot then curving inwards towards the middle metatarsophalangeal joint  before reaching the toes.

Upgoing plantars are abnormal in people older than 1 year of age, and are characterised by extension of the hallux (big toe) at the first metatarsophalangeal joint  in conjunction with with fanning of the other toes. This abnormal extensor response is also known as the Babinski response and suggests an upper motor neuron lesion.

Assessing the plantars can be confounded by a withdrawal response to the noxious stimulus of the car key. This can be avoided by using the technique shown in this video:


Question 3

What is Carnett’s test?

Reveal the funtabulous answer

A test for abdominal wall pain attributed to American surgeon John Carnett.

  • First, identify the localised area of tenderness by palpation with the patient supine.
  • Ask the patient to cross his or her arms and sit halfway up, then palpate again.

If the tenderness disappears the pain is likely to be from within the abdominal cavity. The contracted abdominal muscles protects the abdominal contents from compression by the palpating hand.

If the tenderness persists or is greater, the pain probably orginates from the abdominal wall (e.g. muscle strain, myositis).

  • False positives may arise from inflammation of the parietal peritoneum underlying the abdominal wall (e.g. appendicitis).

Question 4

What does ‘milkmaid’s grip’ suggest?

Reveal the funtabulous answer

Chorea

Chorea refers to non-repetitive abrupt involuntary jerky movements (more distal than proximal) classically resulting from lesions in the corpus striatum. Choreiform movements may be disguised by the patient by completing the involuntary movement with a voluntary one.

Chorea may be detected on shaking the patient’s hand if they are unable to maintain a sustained grip. This known as the ‘milkmaid grip‘.

Causes of chorea include:

  • Huntington’s disease
  • Sydenham’s chorea
  • Senility
  • Wilson’s disease
  • Drugs — e.g phenothiazines, oral contraceptive pill, phenytoin, L-dopa
  • Vasculitis or connective tissue diseases, e.g. systemic lupus erythematosus
  • Thyrotoxicosis
  • Polycythemia or other causes of hyperviscosity
  • Viral encephalitis

Question 5

How is Weiss’ sign elicited and what condition does it suggest?

Reveal the funtabulous answer

Weiss sign is better known as Chvostek sign and is seen in hypocalcemia, as well as some other hyperexcitable states such as anxiety and even in some ‘normal’ individuals.

The sign is elicited by tapping over the facial nerve anterior to the tragus of the ear. The sign is present if there is a brisk muscular twitch on the same side of the face (often involving the lips).


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Funtabulously Frivolous Friday Five

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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