Funtabulously Frivolous Friday Five 126

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 126

Question 1

An anxious but otherwise healthy child receives oral midazolam as an anxiolytic prior to an ED procedure. The child develops agitation and delirium. How do you treat this idiosyncratic postmidazolam paradoxical reaction?

Reveal the funtabulous answer

Flumazenil

Case reports indicate that such reactions can be quickly and effectively terminated with flumazenil


Question 2

Purpura fulminans has a high mortality rate (50%). It is associated with a diffuse rash that affects the whole body, and onset is 12 – 24 hours after initial flu-like symptoms. What are the most common infectious and noninfectious causes of PF?

Reveal the funtabulous answer

  • Also known as Purpura gangrenosa is an acute, often fatal, thrombotic disorder which manifests as blood spots and bruising which rapidly leads to skin necrosis and DIC. It often occurs in neonates but can occur in adults with sepsis.
  • The most common noninfectious aetiology is protein C or S deficiency (acquired or congenital).
  • N meningitidis is the most common infectious cause

Question 3

A Segond fracture is a small avulsion of the lateral tibial plateau. It has been considered pathognomic for what injury? Also what is a reverse Second fracture?

Reveal the funtabulous answer

Segond fracture considered pathognomonic for ACL disruption. However, it should be noted that this fracture pattern is seen with increasing frequency with PCL disruptions – particularly the reverse second fracture (this is an avulsion fracture of the medial proximal tibia, see below).

Paul Ferdinand Segond (1851-1912) was a French surgeon who not only was a knee specialist but also perfected the vaginal hysterectomy.


Question 4

When a diagnosis of anaphylaxis is uncertain, a serum tryptase level might be helpful, but how sensitive is a serum tryptase level for anaphylaxis?

Reveal the funtabulous answer

The sensitivity of serum tryptase in patients who present to the ED with acute allergic reactions is low (21%);

Moreover, serum tryptase level is not elevated in most patients who develop anaphylaxis from foods


Question 5

Name a cause of renal failure and meningitis in white-water canoeists.

Reveal the funtabulous answer

Leptospirosis ( the organism is forced through the cribriform plate during a capsize).

Hence, the public health message not to go putting your head under water when you find those natural hot springs! 


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Funtabulously Frivolous Friday Five

Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Burnaby Hospital in Vancouver. Loves the misery of alpine climbing and working in austere environments. Supporter of FOAMed, toxicology, tropical medicine, sim and ultrasound

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