Funtabulously Frivolous Friday Five 117 • LITFL • FFFF

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 117

Question 1

You have a patient with the Thinker’s Sign (or Dahl sign), what condition is your patient likely to have?

Reveal the funtabulous answer

Thigh hyperpigmentation

This sign was first described in 1963 by HJ Rothenberg as the Thinker’s sign; 1970 by Mark V Dahl (Dahl sign); and later by JR Whiteside as the ‘Target sign‘. Hyperpigmentation on the thighs is caused by repeated pressure from sitting in a tripod position (similar to Rodin’s Thinker).

Most patients suffer from COPD.

Rothenberg HJ. The ‘thinker’s sign’. JAMA 1963; 184: 902-3
Dahl MV. Emphysema. Arch Dermatol 1970; 101: 117
Whiteside JR. Target sign for emphysema. Chest 1979; 75: 530.

Question 2

This is a Curschmann spiral – with what condition is it commonly associated?

Reveal the funtabulous answer

Asthma

Spiraled mucous plugs containing shed epithelium. Most often seen in the sputum of asthmatics (but can also be in several lung diseases).

Named after German physician Heinrich Curschmann (1846 – 1910)

Question 3

What was known as the “Vietnamese time bomb“?

Reveal the funtabulous answer

Infection with Burkholderia pseudomallei

Vietnam war veterans often developed this, up to a decade after returning from Vietnam.

It is hypothesised the helicopter blades would spin the bacteria into the air as the soldiers were embarking or disembarking.

B.pseudomallei is a slow growing bacteria and presenting with a broad spectrum of symptoms from dermal rashes to liver abscess. Mortality can be as high as 40%.

Question 4

While at the gym, a patient in her 30’s suffers an episode of visual loss, but is relatively unstressed. What condition may she suffer from and name the phenomenon?

Reveal the funtabulous answer

Uhthoff phenomenon

This episode may be an exacerbation of multiple sclerosis

MS symptoms exacerbated by heat and exercise (e.g. exercise increasing body temp) is known as Uhthoff phenomenon.

Phenomenon is named after Wilhelm Uhthoff, a German ophthalmologist who described it in 1890 as exercise-induced amblyopia in multiple sclerosis patients

Uhthoff W. Untersuchungen über die bei der multiplen Herdsklerose vorkommenden Augenstörungen. Archiv für Psychiatrie und Nervenkrankheiten. 1889; 21: 55-116; 303 – 410.
Pearce JM. Early observations on optic neuritis and Uhthoff’s sign. Eur Neurol. 2010;63(4):243-7.
Opara JA, Brola W, Wylegala AA, Wylegala E. Uhthoff`s phenomenon 125 years later – what do we know today? J Med Life. 2016 Jan-Mar;9(1):101-105
Panginikkod S. Uhthoff Phenomenon. Stat Pearls

Question 5

We have all been involved with the palliative care of a patient at some point, but what are the origins of the word ‘palliative‘ and when did hospices first come into existence?

Reveal the funtabulous answer

The term is derived from the Latin word palliare – which means “to cloak“.

The first hospices (in the current/”medical” sense) were established in 1967, although hospice-like facilities have existed since the fourteenth century. [Reference]