Funtabulously Frivolous Friday Five 259

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 259


Question 1

A 28 year-old Australian doctor presents to the emergency department with cough, shortness of breath, myalgias, headache and fever. He recently moved house and has been doing a lot of gardening and potting plants. What infectious cause should you consider?

Reveal the funtabulous answer

Legionella longbeachae

This species accounts for most cases of Legionellosis in Australia, and may closely mimic the flu.

In a soil survey in Australia published in 1990, 33 (73%) of 45 potting soil samples tested positive for Legionella; 26 (79%) of the 33 contained L. longbeachae.

Although particularly common in Australia, the bug was first isolated in Long Beach, California (hence the name) and is found around the world. It is often not diagnosed as the standard urine antigen only detects Legionella pneumophila serotype 1 and serology should be requested. It is typically contracted by inhalation while working with potting mix, mulch and soil.

Suggested safety measures include:

  • Wetting down the potting mix to reduce the dust.
  • Wearing gloves and a P2 mask when using potting mix.
  • Washing hands after handling potting mix or soil, and before eating, drinking or smoking.

Li JS et al. A review of national legionellosis surveillance in Australia, 1991 to 2000. Commun Dis Intell Q Rep. 2002;26(3):461-8


Question 2

Which sort of blood disorder was successfully treated in 1926 with a diet of liver only?

Reveal the funtabulous answer

Pernicious Anaemia

In 1926, George Richards Minot unwittingly set the stage for millions of dinnertime fights between mothers and children. 

In that year, Minot and his partner William P. Murphy proved conclusively that liver is, in fact, good for you. The discovery that liver could cure pernicious anemia, which at the time killed thousands annually, led to a 1934 Nobel Prize in Physiology or Medicine.

The story behind the defeat of anaemia began in 1918, where George Hoyt Whipple (of Whipple disease… not Whipple procedure) was exploring how different foods affected haemoglobin production in animals. 

Five years later, Whipple and Frieda Robscheit-Robbins, MD, showed that an animal’s bone marrow increased hemoglobin production in response to chronic anemia, but only in the presence of such foods as liver and spinach. 

In 1922, building on Whipple’s experiments, Minot began trying to improve the eating habits of his private patients with pernicious anemia with Murphy’s help. He ordered a diet “rich in iron and purine derivatives, containing 100 grams to 240 grams of liver, 120 grams of muscle meat, leafy vegetables, especially lettuce and spinach, fruit and egg and milk.” 

Patients on Minot’s diet recovered rapidly, with many showing improvement after only a few days. Later examination of patients’ blood showed newly formed reticulocytes, demonstrating the diet’s efficacy. 

In 1927, Minot began working with Harvard chemist Edwin J. Cohn, PhD, to isolate the active ingredient in liver. The pair identified “water-soluble vitamin B,” but it was not until 1948 that researchers in the United States and Great Britain pinpointed vitamin B12 as the crucial compound. That discovery meant that what had been a fatal disease could be treated with monthly injections of 30 mcg to 100 mcg of cyanocobalamin.


BORDLEY, J. Pernicious Anemia and Liver Therapy. AJN, American Journal of Nursing, 1930;30(12), 1481–1488. doi:10.1097/00000446-193012000-00006


Question 3

What diagnosis, named for a Frenchman, should be suspected in a patient with intermittent buttock pain and marital problems

Reveal the funtabulous answer

Leriche syndrome

Named after Dr René Leriche (1879–1955) in 1940 (aortoiliac occlusive disease) – ‘obliteration’ of the abdominal aorta at it’s bifurcation into the common iliac arteries. [1940;48:601-604]

Symptoms include: Impotence, buttock claudication, absent/reduced limb pulses secondary to saddle embolus or atherosclerosis at the aortic bifurcation.

Eponym Library: René Leriche


Question 4

Recalling your horrific weekend on call, your colleague trumps you by stating after a pleasant dinner out at a sushi bar they spent the weekend ventilated in ICU. What had they eaten? 

Reveal the funtabulous answer

Fugu or puffer fish

Tetrodotoxin is a naturally occurring sodium channel blocker. It is found in several species of tetraodon puffer fish (in the liver, testes and ovaries). Tetrodotoxin is also found in various other marine animals like globefish, starfish, sunfish, stars, frogs, crabs, snails and Australian blue-ringed octopus. 

The blockade of the sodium channels causes nerve and muscle paralysis. Symptoms include weakening of voluntary muscles and respiratory failure from paralysis of the diaphragm. Treatment is supportive care until the effects wear off.

Fugu is a delicacy in Japan and requires a special license in which to serve the sashimi due to a number of hospitalisations and deaths in the past. 

Toxicology Library: Blue Ringed Octopus


Question 5

What is a symblepharon?

Reveal the funtabulous answer

Symblepharon

Symblepharon is the adhesion of the palpebral conjunctiva to the bulbar conjunctiva.

It can be caused by some eye diseases (such as trachoma), caustic exposure, conjunctivitis or trauma to the eye.

EyeRounds.org


…and finally

I'll get a green in there...
Jacob van Oost I: UKparamedic humour

FFFF

Funtabulously Frivolous Friday Five

Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Burnaby Hospital in Vancouver Emergency. Loves the misery of alpine climbing and working in austere environments. Supporter of FOAMed, toxicology, tropical medicine, sim and ultrasound

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