Funtabulously Frivolous Friday Five 250

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 Funtabulously Frivolous Friday Five 250

Question 1

What is luftsichel sign?
Reveal the funtabulous answer

Seen on CXR in some cases of left upper lobe collapse.  It refers to the hyperinflation of the superior segment of the lower lobe interposing itself between the mediastinum and the collapsed left upper lobe.

It is derived from the German words “luft” meaning air, and “sichel” meaning sickle, and literally describes an ‘air crescent’ which may be seen between the aortic arch and the medial border of the collapsed lung. [Reference]

Luftsichel sign

Question 2

What is rhinitis medicamentosa?
Reveal the funtabulous answer

Rebound nasal congestion after extended use of topical decongestants (e.g. oxymetazoline, phenylephrine, xylometazoline and naphazoline nasal sprays).

Various theories exist but in essence there is dysregulation of sympathetic tone between beta adrenergic stimulation (causing vasodilatation) and alpha adrenergic stimulation (which provided vasoconstriction). [Reference]

Question 3

While observing a junior doing a procedural sedation you note that they ask the patient about any egg allergy in reference to the use of propofol. Is it necessary to ask about egg or soy allergy?
Reveal the funtabulous answer


Five major allergens, Gal d 1–5 , have been characterized in hen’s eggs. Ovomucoid (Gal d 1 ) and ovalbumin (Gal d 2 ) originate primarily from the egg white and constitute 10% and 50% of white proteins, respectively. Chicken serum albumin (Gal d 5 ) is the major allergen in egg yolk.

Propofol is an alkylphenol derivative (2,6-di-isopropylphenol) marketed as an oil water emulsion using soybean oil (10%), and egg lecithin (1.2%) as the emulsifying agent. Lecithin (from the Greek lekithos, meaning egg yolk) is a highly purified phosphatide found in egg yolk, which is not the allergenic determinant. 

The few documented IgE-mediated anaphylactic reactions to propofol have been shown to be elicited by the iso-propyl or
phenol groups rather than the lipid vehicle. [Reference]

The same is true for patients with soy allergy:  Refined soy oil, such as that present in propofol, is safe for people with soy allergy because the allergenic proteins are removed during the refining process. Thus, it is unlikely that the soy oil present in propofol may induce allergy, as the dose of protein contained in refined soy oil is too small to provoke a reaction.

Question 4

What is the cause of Hatter’s shakes?
Mad Hatter
Reveal the funtabulous answer


Mad hatters existed before Lewis Carroll put one into Alice in Wonderland, but no one is truly sure how this 19th century expression originated.

The popular theory is linked to the hat-making industry and mercury poisoning. In the 18th and 19th centuries, industrial workers used a toxic substance, mercury nitrate, as part of the process of turning the fur of small animals, such as rabbits, into felt for hats. Prolonged exposure to mercury caused employees to develop a variety of physical and mental ailments, including tremors (dubbed “hatter’s shakes”), speech problems, emotional instability and hallucinations. [Reference]

“Researchers have suggested that Boston Corbett, a hat industry worker who killed John Wilkes Booth, President Abraham Lincoln’s assassin, might’ve suffered from poor mental health due to mercury poisoning. Corbett, who’d been employed as a hat maker since he was a young man, became a religious zealot and in 1858 castrated himself with a pair of scissors as a way to curb his libido. He went on to serve in the Union Army during the Civil War, and after Lincoln was shot by Booth on April 14, 1865, at Ford’s Theatre in Washington, D.C., Corbett and his regiment, the 16th New York Cavalry, were sent to track down the gunman, who was on the lam. On April 26, the soldiers surrounded Booth in a Virginia barn; however, Corbett disobeyed orders to capture the fugitive alive and instead shot and killed him. Corbett was cleared of blame by the military and lauded by many in the public as a hero for his role in avenging the president’s death. Eventually, he resumed working in the hat industry. In 1887, he landed in a mental asylum after threatening a group of people at the Kansas Statehouse with a gun. The following year, this possible “mad hatter,” who was then in his 50s, escaped the facility and soon disappeared for good.”

Question 5

Acetaminophen, tylenol and paracetamol are different names for the same drug. How are these names derived?
Reveal the funtabulous answer

They are all derived from the chemical name N-acetyl-para-aminophenol (as is the commonly used abbreviation APAP):

  • para-ACETylAMINOPHENol
  • para-aceTYLaminophENOL
  • PARA-aCETylAMinophenOL

…and finally

Renaissance mansplaining

Mansplaining  Renaissance style


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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