Funtabulously Frivolous Friday Five 258

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 258

Question 1

We are commonly taught in medical school to search for tactile fremitus during the chest exam. Students are taught to instruct the patient to say the number 99 to elicit these vibrations. However the true enunciation may have been lost in translation.

What should we get the patient to say and why?

Reveal the funtabulous answer

Boy, boy, or boogy, woogy – or originally neun und neunzig.

When our medical ancestors studied in Austria or Germany, they observed that physicians asked patients to say neun und neunzig to evoke fremitus over the thorax. When they came home they taught their patients to say ninety-nine, thus translating literally, but not phonetically, what they had heard.

This was a serious error, since their teachers would have asked patients to say: nein, nein, if that was the sound they had wanted. Neun und neunzig is pronounced noyn unt noynzig and the oy is what it takes to evoke palpable, low-pitched vibrations, most effectively transmitted from the larynx to the rib-cage. “Nein, nein” and ninety-nine are high-pitched sounds, useless for evoking fremitus. We continue to translate the one phrase we should have left in German.

William Dock, MD (1973)

Dock W. Examination of the chest: advantages of conducting and reporting it in English. Bull NY Acad Med 1973;49: 575-582 [PMC1807045]

Question 2

What is Hoffa’s Syndrome?

Reveal the funtabulous answer

Infrapatellar fat pad impingement.

Damage to the infra patellar tendon can results in damage and swelling to the infra patellar fat pad resulting in entrapment between the femur and the patella every time the leg is extended. It was described for the first time in 1904 by Dr Albert Hoffa.

See video for the clinical examination:

Larbi A et al. Hoffa’s disease: A report on 5 cases. Diagnostics and Interventional Imaging. 2014:95(11);1068-1073

Question 3

A 22 year-old woman complained about blurred vision after an episode of recovered cardiorespiratory arrest. She had bilateral low visual acuity (count fingers) and no ophthalmological or visual pathways changes. She also had an apparent lack of awareness of the deficit. 

What disease does she have?

Reveal the funtabulous answer

Anton-Babinski syndrome

A rare presentation of a stroke/ischaemic injury/trauma which occurs in the occipital lobe resulting in cortical blindness but patients are still adamant they can see despite evidence to the contrary.

Martin JA et al. Anton-Babinski syndrome, case report. Arch Soc Esp Oftalmol. 2018.doi: 10.1016/j.oftal.2018.04.004

Question 4

Peruvian pig farmers are at an increased risk of what neurological condition?

Reveal the funtabulous answer


Cysticercosis is a parasitic infection that results from ingestion of eggs from the adult tapeworm, Taenia solium (T. solium).

Eggs of the tapeworm are shed in stool and contaminate food through poor hygiene. When these eggs are ingested and exposed to gastric acid in the human stomach, they lose their protective capsule and turn into larval cysts, called oncospheres. Oncospheres cross the gastrointestinal tract and migrate via the vascular system to the brain, muscle, eyes, and other structures. Once in the brain, the larval cysts (cysticerci) initially generate a minimal immune response and may remain in the brain as viable cysts for years.

Neurocysticercosis is the most common parasitic infection of the brain and a leading cause of epilepsy in the developing world, especially Latin America, India, Africa, and China.

See FFFF 249 for a brief history of their discovery in human as a disease by a doctor who fed spoiled pork to prisoners. 

DeGiorgio CM et al. Neurocyticercosis. Epilepsy Curr. 2004 4(3):107-111

Question 5

A resident presented a patient with a past history of abdomino-perineal resection to his consultant. Among his examination findings he stated ‘PR NAD‘. The consultant was mystified…

What did the resident mean by NAD?

Reveal the funtabulous answer

No anus detected!

More commonly NAD means “no abnormality detected” or in the case of those skipping their examinations it could be “not actually done”. 

…and finally

Medical inquest


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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