Funtabulously Frivolous Friday Five 064

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 064

Question 1

A patient with a cranial nerve palsy is walking around with his head tilted to the right. Why is he doing this? Which cranial nerve is affected and on which side?

Reveal the funtabulous answer

Left trochlear nerve palsy (cranial nerve IV).

The patient is unable to intort his LEFT eye (i.e. he can’t look down when the eye is adducted, which occurs when he looks to the right).

To maintain binocular vision patients with cranial nerve IV palsies tend to tilt their heads to the opposite side to the lesion, so that they do not have to intort the affected eye.

Question 2

What is synkinesis?

Reveal the funtabulous answer

Synkinesis refers to involuntary muscle movements that accompany voluntary ones because of the ‘mis-wiring’ of nerves.

Synkinesis may be congenital or acquired. Proposed mechanisms include aberrant nerve regeneration, interneuronal ephaptic transmission, and nuclear hyperexcitability.

Below is a video showing synkinesis following a Bell’s palsy. When the patient blinks, the right side of his mouth also moves. The opposite can also occur — involuntary blinking when the patient smiles.

The Marcus Gunn jaw winking phenomenon is a congenital synkinesis associated with ptosis. It is also known as trigemino-oculomotor synkinesis and involves the 5th and 3rd cranial nerves. Cranial nerve V triggers pterygoid muscle contraction which opens the jaw, and is associated with pathological stimulation of the oculomotor nerve branch to levator palpebrae superioris which elevates the eyelid on the same side. As the video below shows, when the jaw opens, the ptosed (droopy) eyelid is raised.

Question 3

If there are turkey vultures circling overhead and you are not dead, what should you suspect?

Reveal the funtabulous answer

A nearby gas leak.

Some carrion-feeding birds have well developed senses of smell. The turkey vulture is attracted to the deathly stink of mercaptans and other chemicals emanating from dead and decaying bodies.

Similar chemicals are emitted from leaking gas pipes. In the 1930s, California gas company repair crews would watch for circling turkey vultures to help detect gas leaks [read more here].

Question 4

When people kiss, which way do they generally tilt their heads?

Reveal the funtabulous answer

To the right.

A 2003 study that observed 124 couples kissing in various locations in various countries found that couples were twice as likely to tilt their heads to the right. This study was published in Nature would you believe (see this Nature News article).

  • Güntürkün, O. Adult persistence of head-turning asymmetry. Nature421, 711, (2003). PMID: 12610611

Question 5

How accurate are the references listed in articles published in major medical journals?

Reveal the funtabulous answer

It depends on the journal, but in 2005 it ranged from 4.1% (New Eng J Med) to a whopping 40.3% (Lancet).

Of course, the study this data is from had to be published in the Lancet, and it was (though I haven’t checked its references yet…):

  • Siebers R, Holt S. Accuracy of references in five leading medical journals. Lancet. 2000 Oct 21;356(9239):1445. PMID: 11052618.

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Funtabulously Frivolous Friday Five

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a 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 three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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