Funtabulously Frivolous Friday Five 144
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 144
Question 1
What do Inuits avoid eating that early Europeans didn’t ?
Reveal the funtabulous answer
Polar bear liver,
…but also any liver from the top predators in the arctic region as they can store high levels of vitamin A.
In 1957 Gerrit de Veer was taking refuge in Nova Zemlya recorded the effects he and his men had after eating polar bear livers. Antarctic explorers Douglas Mawson and Xavier Mertz were both poisoned after eating the livers of their sled dogs, contributing to Mertz’s death. Other animal livers to avoid include the Arctic fox, bearded seal and the glaucous gull.
Symptoms of acute hypervitaminosis A include nausea, vomiting, headaches, altered mental status and seizures. [Reference]
Question 2
What did Dr Ludwig die of?
Reveal the funtabulous answer
Ludwigs angina
…well maybe. He did die of an unspecified neck inflammation and it makes a better story to say it was Ludwig angina.
Classically Ludwig angina is a cellulitis of the sublingual and submandibular areas caused by a polymicrobial infection. Those with poor dental hygiene are particularly susceptible. Patients will present septic with submandibular pain and swelling, difficulty opening their mouth, swallowing and talking. The tongue can be pushed superiorly and posteriorly, the sublingual and submandibular swelling is classically described as having a ‘woody’ feel.
- Wilhelm Frederick von Ludwig (1790 – 1865)
- Eponymictionary. Ludwig angina
- CCC. Ludwig angina
- Clinical Case – The True Angina.
- Von Ludwig WF. Über eine in neuerer Zeit wiederholt hier vorgekommene Form von Halsentzündung. Medicinisches Correspondenzblatt des Württembergischen ärztlichen Vereins, Stuttgart, 1836;6:21–25
Question 3
An elderly patient awoke in the middle of the night and noted brisk bleeding from a varicose vein on his shin. Why should you carefully examine the patients feet?
Reveal the funtabulous answer
Look for long toenails on the contralateral foot.
A fatal case of varicose vein injury resulting from an excessively long toenail was described in the Lancet in 2003 titled ‘Nail in the coffin’.
- Fraser R. Nail in the coffin. Lancet. 2003 Jan 4;361(9351):90.
Question 4
How accurate are people at judging a baby’s sex based on a newborn’s facial appearance?
Reveal the funtabulous answer
55% of the time
People are correct at identifying a newborn’s sex 55% of the time, which is statistically significantly better than chance.
It turns out that pediatric nurses (59%) are better than pediatricians and non-healthcare workers. [Reference]
The baby in the picture is my niece who is female.
- Round JE, Deheragoda M. Sex–can you get it right? BMJ. 2002 Dec 21;325(7378):1446-7.
Question 5
And in response to some very keen readers (bestevergilly and Joel Stoia) from an FFFF a few weeks ago, we missed another Hutchinson sign as part of his triad. What is Hutchinson’s triad and what diagnosis does it suggest?
Reveal the funtabulous answer
The triad is named for Sir John Hutchinson (1828-1913) and consists of the combination of
- Hutchinson teeth (notched central incisors and peg-like lateral incisors),
- Interstitial keratosis,
- Deafness due to lesions of the 8th cranial nerve.
The triad is found in congenital syphilis.
See FFFF 139 for the other Hutchinson signs.
FFFF
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.