Funtabulously Frivolous Friday Five 251

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 251

Question 1

What are you suffering from if you experience sphenopalatine ganglioneuralgia?

Reveal the funtabulous answer

Ice Cream Headache or “Brain Freeze” or ICE-H (Ice Cream Evoked Headache).

Certainly experience dictates that rapidly eaten ice cream is more likely to evoke an episode of sphenopalatine ganglioneuralgia, as was confirmed in a non-controlled study published in BMJ 2002.

Relief can be obtained from stopping the PO ingestion and raising one’s tongue to the roof of their mouth.

Question 2

Which country, in only 2016, was declared Malaria free

Reveal the funtabulous answer

Sri Lanka.

In the mid 1900s Sri Lanka was one of the most malaria ridden countries in the world. In the 1970s and 1980s it experienced further surges in numbers of malaria cases. A well orchestrated program that targeted mosquitoes as well as the parasite pool in the human host was highly effective.

This is testament to the courage and vision of its leaders, and signifies the great leaps that can be made when targeted action is taken. It also demonstrates the importance of grass-roots community engagement and a whole-of-society approach when it comes to making dramatic public health gains,” – WHO certifies Sri Lanka malaria-free Regional Director, Dr Poonam Khetrapal Singh.

Question 3

Why is your teenage patient more likely to hear the bells toll when they present with acute testicular torsion.

Reveal the funtabulous answer

He has a bell clapper testis.

Testicular torsion (more accurately spermatic cord torsion) is a true urological emergency. 

The bell clapper deformity refers to an anatomical variation whereby the parietal layer of the tunica vaginalis encircles the entirety of the testicle, epididymis and distal spermatic cord, rather than fixing at the base of the epididymis.  This lets the anatomy swing free in the scrotum, like the clapper in a bell and predisposes toward torsion.

Martin AD, Rushton HG. The prevalence of bell clapper anomaly in the solitary testis in cases of prior perinatal torsion. J Urol. 2014 May;191(5 Suppl):1573-7. [PMID 24679875]

Question 4

A child eating pies is generally very happy, a child with FPIES after eating is miserable.  What is FPIES?

Reveal the funtabulous answer

FPIES – Food Protein Induced Enterocolitis Syndrome

A non-IgE mediated gastrointestinal food allergy primarily in infants.

Initially described in the 1970s, it has since become increasingly diagnosed and recognised in acute and gastrointestinal medicine.

In acute FPIES reactions, repetitive vomiting typically develops 1 to 4 hours after ingestion of the food allergen and is often accompanied by lethargy, pallor, and/or limpness. Diarrhea may occur within 5 to 10 hours in a subset of patients. Symptoms can lead to dehydration and if severe, hypotension and hypovolemic shock requiring emergency care. Hypothermia, methemoglobinemia, and acidemia have also been reported, and patients may appear to have sepsis. 

In contrast to IgE mediated reactions, rice is one of the most common precipitants resulting in up to half of all reactions requiring hospitalization.  Other common food triggers are cow’s milk, soy, grains, meat (both white and red), legumes, potato and fruit.  80% react to more than one food.

Children respond well to IV fluid boluses (usually only one), recover spontaneously within 2 days, and are well in between episodes of FPIES, and are otherwise normal.  The cornerstone of ongoing management is avoidance of the trigger.  The overall prognosis is good.  The majority of children are able to tolerate the trigger 1 to 3 years after diagnosis.

Leonard SA, Pecora V, Fiocchi AG, Anna Nowak-Wegrzyn A. Food protein-induced enterocolitis syndrome: a review of the new guidelines. World Allergy Organization Journal 2018;11:4

Baker M. Do you want FPIES with that? LITFL 2018

Question 5

According to the Institute of Medicine estimates, how long does is take on average for the recommendations from randomised controlled trials to be implemented in clinical practice?

Reveal the funtabulous answer

17 years

No recent updates have been given since 2001 to know if the world of FOAM has changed this estimate but given the acquisition of knowledge is only one step in the complex process, it is unlikely the time frame (in general) has reduced significantly. [Reference]

…and finally, be safe

It’s time to stop harming our healers. ZDoggMD


Funtabulously Frivolous Friday Five

Dr Mark Corden BSc, MBBS, FRACP. Paediatric Emergency Physician working in Northern Hospital, Melbourne. Loves medical history and trivia...and assumes everyone around him feels the same...| LinkedIn |

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