Funtabulously Frivolous Friday Five 083

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 083

Question 1

Why shouldn’t a Queenslander eat a chinaman?

Reveal the funtabulous answer

Because he/she could get ciguatera poisoning.

A chinaman is a species of piscivorous reef fish. It is notorious for being contaminated by ciguatera toxin.

The toxin is produced by microalgae, ingested by smaller fish, passed up the foodchain, and concentrated in the heads and viscera of larger fish like the chinaman. Ingestion of contaminated fish by humans produces vomiting, paraesthesia, and the bizarre phenomenon of cold allodynia.

Ciguatera is much less common in the waters off WA.

Question 2

Where would you find anchovy sauce pus?

Reveal the funtabulous answer

In an amoebic abscess.

Amoebiasis is caused by Amoeba histolytica. The microbe produces some really wicked proteases and can literally digest human organs (histolytica means “destroys tissue”. In systemic disease, abscesses characteristically form in the liver. The pus is tainted by altered blood and is said to resemble anchovy sauce.

Left: amoebic pus. Right: anchovy sauce. Note the pathognomic absence of basil.

Question 3

Why is shellfish allergy relevant to radiographers?

Reveal the funtabulous answer

It isn’t – or rather it shouldn’t be.

The existence of immunological cross-reactivity between shellfish, tincture of iodine, and iodinated contrast media is a medical myth. The most common precipitant of shellfish allergy is molluscan tropomyosin. Povidone-iodine (Betadine) and iodinated contrast media are unrelated compounds.

While some caution should be exercised in giving contrast media to people with a history of anaphylaxis, those with seafood allergies are at no greater risk than those with allergies to fruit or nuts.

  • Schabelman E, Witting M. The relationship of radiocontrast, iodine, and seafood allergies: a medical myth exposed. J Emerg Med. 2010 Nov;39(5):701-7. Epub 2010 Jan 4. Review. PMID: 20045605

Question 4

Which useful medicines are made from salmon sperm?

Reveal the funtabulous answer

Protamine sulphate and NPH insulin.

Protamine is a poly-cation that helps pack DNA into the heads of sperm. It also forms electrostatic bonds with insulin, delaying its systemic release; and heparin, reversing therapeutic anticoagulation.

There is a worldwide shortage of protamine, after recent legislation removed anonymity for donor salmon.

Question 5

How would you treat fish odour syndrome?

Reveal the funtabulous answer

By excluding marine fish from the diet.

Trimethylaminuria is a rare autosomal recessive condition caused by a hepatic enzyme deficiency. This leads to a build-up of trimethylamine (TMA) in sweat, urine and breath, producing a strong fishy body odour. Sadly the condition manifests in adolescence and there is no cure. Sufferers are advised to avoid eating fish, eggs and soybeans, as they contain precursors to TMA.

Shakespeare’s Caliban, a savage and deformed island dweller, may have had fish odour syndrome:

What have we here? A man or a fish? Dead or alive? A fish: he smells like a fish; a very ancient and fish-like smell

Trinculo the Jester, The Tempest II. ii. 26-29

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Funtabulously Frivolous Friday Five

Jo is an emergency medicine specialist based on the Sunshine Coast. He has qualifications in high fidelity simulation, aeromedical retrieval and point of care ultrasound, and a special interest in educational videography | @FlippEM |

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