Funtabulously Frivolous Friday Five 266

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 266

Question 1

Who gets brick dust urine?

Reveal the funtabulous answer


Babies when first born produce/excrete a multitude of colours into the nappy; black meconium, turning to green or yellow stools. White vaginal discharge and also orange or red, brick-dust coloured stained nappy in the first couple of days after birth.

Often mistaken for blood, this stain is from urate crystals; a sign of over concentrated urine which is normal and resolves once milk intake increase.

Question 2

A man with a past history of CABG for coronary artery disease has been taking his dog for a walk every day for years. The day after his dog dies he notices severe calf pain on walking that goes away with rest. What has he got and why is there a temporal relationship to the death of beloved pet?

Reveal the funtabulous answer

He has claudication from peripheral vascular disease.

When he walked his dog he had to stop at every lampost so the dog could urinate. [Story credit: Dr Tim Koelmeyer] 

Question 3

What is coprolalia?

Reveal the funtabulous answer

Involuntary swearing or the involuntary utterance of obscene words or socially inappropriate and derogatory remarks.

The term comes from the Greek κόπρος (kopros) meaning “feces” and λαλιά (lalia) from lalein, “to talk”.

Coprolalia is a form of tic. Tics are usually simple, non-verbal sounds or can be emotionally charged words occurring in a seemingly inappropriate context. Tics can sometimes arise from a variety of underlying brain disorders such as stroke, encephalitis, seizure disorders, Sydenham Chorea, Huntington chorea, cerebral tumours and dementia.

Tics are most commonly seen in Gilles de la Tourette syndrome which usually occurs in childhood, overlaps with obsessive-compulsive disorder, and is often familial.

While obscenities have culturally determined meaning, they are also usually short, explosive words consisting of high-frequency phonemes, and this is true in most languages. A computer program which randomly generates high-frequency phonemes can also swear at you. Interestingly, there are reports deaf patients with Tourette syndrome who involuntarily swear using sign language (classic 2 fingers up – with no recall of events) thus providing the possibility that tics are determined by phenological features, brief explosive actions rather than semantic content.

Question 4

In 1932, Von bergmann demonstrated an unusual effect by distending the lower oesophagus of the dog. What was it?

Reveal the funtabulous answer

Coronary artery constriction.

Following from this a group in Papworth hospital, UK studied 35 patients with Syndrome X (cardiac microvascular dysfunction causing angina in patients with normal epicardial coronary arteries on angiography) and 24 heart transplant patients and instilled hydrochloric acid into the distal oesophagus while monitoring the coronary blood flow.

It was noted the patients with Syndrome X had a significant reduction in coronary blood flow with the introduction of acid whereas the denervated hearts in the transplant group were unaffected. The group hypothesised a cardio-oesophageal neural reflex is responsible and maybe a trap for young players when sending patients home with reflux sounding chest pain who infect have underlying cardiac disease. Other studies have shown oesophageal acid can produce bradycardia and apnoea in neonates and atrioventricular block has occurred in patients with oesophageal spasm.

Question 5

Jonathan Swift wrote: Travels into Several Remote Nations of the world. In Four Parts. By Lemuel Gulliver, First a Surgeon, and than a Captain of Several Ships.

What medical condition could he have been suffering from when he created the Lilliputians of Lilliput? 

Reveal the funtabulous answer

A number of conditions, not just alcohol withdrawal or anticholingeric delirium.

Lilliputian hallucinations have been associated with dementia, schizophrenia, toxoplasmosis, basilar migraine, mesencephalic lesions, visual loss (Charles Bonnet syndrome) and narcolepsy.  

Fortunately Jonathan Swift did not appear to be suffering from any of the above but wanted the irony of representing the tiniest race visited by Gulliver to be the most vainglorious and smug, symbolising humankind’s wildly excessive pride in its own puny existence (well thats one theory anyway).

His novel however resulted in the adoption of hallucinations of tiny people or animals being coined ‘lilliputian’ in the medical literature from 1909.

…and finally

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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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