Funtabulously Frivolous Friday Five 078

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 078

Question 1

A 28 year-old Australian doctor presents to the emergency department with cough, shortness of breath, myalgias, headache and fever. He recently moved house and has been doing a lot of gardening and potting plants. What infectious cause should you consider?

Reveal the funtabulous answer

Legionella longbeachae

This species accounts for most cases of Legionellosis in Australia, and may closely mimic the flu.

In a soil survey in Australia published in 1990, 33 (73%) of 45 potting soil samples tested positive for Legionella; 26 (79%) of the 33 contained L. longbeachae.

Although particularly common in Australia, the bug was first isolated in Long Beach, California and is found around the world. It is typically contracted by inhalation while working with potting mix, mulch and soil.

Suggested safety measures include:
— Wetting down the potting mix to reduce the dust.
— Wearing gloves and a P2 mask when using potting mix.
— Washing hands after handling potting mix or soil, and before eating, drinking or smoking.

  • Li JS, O’Brien ED, Guest C. A review of national legionellosis surveillance in Australia, 1991 to 2000. Commun Dis Intell. 2002;26(3):461-8. PMID: 12416715.
  • Lim I, Sangster N, Reid DP, Lanser JA. Legionella longbeachae pneumonia: report of two cases. Med J Aust. 1989 May 15;150(10):599-601. PMID: 2654579.

Question 2

A patient on a flight from Los Angeles to Sydney is found to have meningococcal disease. Who from the plane should receive chemoprophylaxis?

Reveal the funtabulous answer

Passengers that were seated either side of the affected individual.
(This assumes that no household contacts of the affected individual were also on the plane, and that the stricken person didn’t join the ‘mile high’ club with anyone en route to Sydney…)

This advice applies to flights of 8 or more hours duration. Shorter duration flights generally don’t need chemoprophylaxis. Furthermore, passengers sitting in the row ahead or behind, or more than one seat away to the side, do not need chemoprophylaxis.

  • Centers for Disease Control and Prevention (CDC). Exposure to patients with meningococcal disease on aircrafts–United States, 1999-2001. MMWR Morb Mortal Wkly Rep. 2001 Jun 15;50(23):485-9. PMID: 11428727. [Free fulltext]

Question 3

Who coined the term epilepsy?

Reveal the funtabulous answer

John Hughlings Jackson (1835-1911)

Jackson is known as the ‘Father of British Neurology’ and coined the term epilepsy in 1866. Jackson, a Yorkshireman, is widely credited with the first electrical theory of epilepsy, but was actually preceded by Irish physician Robert Bentley Todd who lectured on the subject in 1849.

  • Reynolds E. Todd, Hughlings Jackson, and the electrical basis of epilepsy. Lancet. 2001 Aug 18;358(9281):575-7. PMID: 11520547.

Question 4

What is pituri?

Reveal the funtabulous answer

Pituri is derived from plants of the Duboisia genus and is chewed by Indigenous Australians for its stimulant, euphoric, antispasmodic and analgesic effects.

Duboisia hopwoodi has one of the highest nicotine contents of any native Australian plant. It also contains the anticholinergic alkaloids scopolamine and hyoscine.

Pituri was, and is, used in traditional rituals in Central Australia. It’s use at the time of European contact has been compared to the role of tobacco in indigenous American societies prior to European discovery. Probable traditional uses include analgesia during ritual circumcision, ameliorating hunger during travel, and as a stimulant before a fight.

Don’t mistake a wad of pituri for a fungating oral tumour! (See this photo from the National Library of Australia)

  • Ratsch A, Steadman KJ, Bogossian F. The pituri story: a review of the historical literature surrounding traditional Australian Aboriginal use of nicotine in Central Australia. J Ethnobiol Ethnomed. 2010 Sep 12;6:26. PubMed PMID: 20831827; PubMed Central PMCID: PMC2944156.

Question 5

A young woman presents with swelling of the lips and eyes, has a hoarse voice and shortness of breath. This came on after passionately kissing her boyfriend. Her past medical history is significant for penicillin allergy. What is the likely diagnosis?

Reveal the funtabulous answer

Her boyfriend may be taking a penicillin-based antibiotic.

Liccardi et al (2002) reported such a case, that was confirmed by challenge tests, which involved giving the partner a placebo or varying doses of antibiotic prior to kissing the patient.

So, you can add this to the list of different forms of Dangerous Love out there…

  • Liccardi G, Gilder J, D’Amato M, D’Amato G. Drug allergy transmitted by passionate kissing. Lancet. 2002 May 11;359(9318):1700. PMID: 12020564. [free fulltext]

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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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