Funtabulously Frivolous Friday Five 139

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 139

Question 1

Who is likely to have given one of the first blood transfusion in the United States

Reveal the funtabulous answer

William Stewart Halsted (1852 – 1922)

His sister had delivered her first baby and severe haemorrhage followed.

His sister had uncontrolled haemorrhage and others thought she would not survive. Dr. Halsted then took over, stopped the haemorrhage and gave a direct blood transfusion from his arm to his sister with success.

He also successfully operated on his mother by lamplight at 2 am who had ascending cholangitis.


Question 2

Which biological toxin, on a pound-for-pound basis, is has the potential to kill more humans than any other?

Reveal the funtabulous answer

Botulinum A toxin

There are actually 6 different types (A to F) produced by the spore-forming gram positive bacillus Clostridium botulinum.

Botulinum toxin acts presynaptically to prevent the release of acetylcholine. Consequently the effects include autonomic dysfunction and a progressive flaccid paralysis with early bulbar involvement, usually within 2-72 hours.

It has an LD50 of 1ng/kg, making it 100,000 more toxic than sarin. [Reference]

Question 3

A patient presents with neurosyphilis. After appropriate treatment is started they develop fevers, rigors, hypotension and tachycardia. What is the most likely pathophysiology of this reaction?

Reveal the funtabulous answer

Jarisch-Herxheimer reaction

Treatment with penicillin can cause a reaction as above secondary to the rapid release of endotoxin.

The Jarisch–Herxheimer reaction is classically associated with penicillin treatment of syphilis and normally only a few hours.

The reaction is also seen in other diseases caused by spirochetes, such as borreliosis (Lyme disease and tick-borne relapsing fever), leptospirosis, Q fever, bartonellosis (including cat scratch disease), brucellosis, typhoid fever, trichinosis, and cerebral trypanosomiasis. [Reference]

Question 4

There are two Hutchinson signs, one is important if you are a dermatologist and the other if you are an ophthalmologist. What are they?

Reveal the funtabulous answer

Hutchinson sign (ophthalmology) relates to involvement of the tip of the nose from facial herpes zoster. It implies involvement of the nasal branch of the nasociliary nerve (branch of the ophthalmic division of the trigeminal nerve) and thus raises the specter of involvement of the eye.

Hutchinson sign (dermatology) refers to pigmentation in the paronychial area suggesting subungual melanoma. [Reference]


Question 5

What is topagnosis?

Reveal the funtabulous answer

The inability to identify which part of the body has been touched.

It is a symptom of disease in the parietal lobe of the brain. [Reference]

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Funtabulously Frivolous Friday Five

Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Kelowna hospital, British Columbia. Loves the misery of alpine climbing and working in austere environments (namely tertiary trauma centres). Supporter of FOAMed, lifelong education and trying to find that elusive peak performance.

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