Funtabulously Frivolous Friday Five 281

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 281

Question 1

What is depicted in this portrait of Leonardo da Vinci?

Museum of Galleries Dell’Accademia, Venice

Reveal the funtabulous answer

Ulnar nerve palsy (claw hand).

It had originally been hypothesised until recently that da Vinci suffered a stroke but you’d expect a clenched hand with increased muscular spasticity. Also he had no other reports of any cognitive decline or motor impairment.

Further evidence appeared via an entry from a Cardinal’s assistant who visited the artist’s house:

One cannot indeed expect any more good work from him as a certain paralysis has crippled his right hand… And although Messer Leonardo can no longer paint with the sweetness which was peculiar to him, he can still design and instruct others.

Antonio de Beatis 1517.

References


Question 2

You see and 35 yr old female in your fast track area with a chief complaint of twitching of her eyelids and diagnose blepharoclonus. What is blepharoclonus and what is the differential?

Reveal the funtabulous answer

Myoclonic rhythmic eyelid closure.

The aetiology is largely unknown as it can be an under reported symptom by the patient and also missed on neurological examination. The following conditions have been associated with blepharoclonus and therefore neurological follow up is recommended:

  • Head Trauma – affecting the basal ganglia
  • Hydrocephalus
  • Multiple Sclerosis
  • Hashimotos encephalopathy
  • Movement disorders
  • Leukoencephalopathy
  • Cranial Synkinesis (e.g. post Bell’s Palsy)
  • Familial

Reference


Question 3

Which of these antibiotics have >90% bioavailability when given orally?

  • Azithromycin
  • Clindamycin
  • Doxycycline
  • Metronidazole
  • Moxifloxacin
  • Rifampin
  • TMP/SMX

Reveal the funtabulous answer

All of them except Azithromycin.

A classic post from Jenny Koehl PharmD (aliem.com) tackled the problem of an IV shortage and pointed out that in certain cases IV antibiotics equals PO, especially when the bioavailability is >90%.


Question 4

A 35 year old man presents with a swollen and uncomfortable right arm after some big sessions at the gym. What sign can be seen over his right shoulder and what is the diagnosis?

Ultrasound Case 085 1 Upper limb 2

Reveal the funtabulous answer

Urschel’s sign – prominent superficial veins over the right upper arm and shoulder.

The cause is due to axillary-subclavian vein thrombosis resulting from repetitive, strenuous upper extremity activity also know as effort thrombosis or Paget Schrotter syndrome:

1858 – Sir James Paget described ‘some affections of voluntary muscles as a consequence of excessive exercise’ with reference to four cases of enlargement of the upper limb appearing to be associated with ‘dilated or varicose state of the veins’

1875 – Paget described in greater detail two of these cases in the chapter “gouty phlebitis” in his collection of Clinical lectures and essays. This is generally taken as the first description of effort thrombosis, despite a clear reference to the original publication of the cases from March 1858. 

In strong contrast with cases of widely diffused phlebitis, are those in which a single small portion of a great vein becomes obstructed…

A man about 50 years old, thin, and moderately muscular, and usually healthy, observed, during a September, that his right arm was growing larger, and, as he thought, stronger, and fitter for work…I found the upper arm two inches more in circumference than the left, and the whole limb enlarged in the same proportion.

With the help of the hot douche, warmth, and friction, the swelling of the arm very gradually subsided; and, as it did so, the cord-like feeling of the obliterated axillary vein became more distinct. A year elapsed before the vein regained its completely natural condition.

‘Gouty Phlebitis’ 1875

1884 – Leopold Von Schrötter postulated that the upper limb swelling in otherwise fit and healthy individuals resulted from direct damage to the vein caused by stretching that occurred with muscular strain of exercise.

1948 – English surgeon, ESR Hughes termed the condition Paget-Schroetter syndrome

The association of acute venous stasis and a healthy person constitutes a syndrome which, in the absence of unanimity of opinion as regards the aetiology or pathology, might well be called the ‘Paget-Schrotter syndrome’.

Hughes ESR, 1948

See the full case on Ultrasound 085


Question 5

A shout out to Conor Davis of OSCE video fame who asks: Which town in Australia has an annual emergency attendance of 50,000 with a population of only 24,000?

Reveal the funtabulous answer

Alice Springs

Some other interesting FFFF facts:

  • It’s 1532km to Adelaide and 1499km to Darwin (the nearest tertiary referral centres)
  • It serves an area of approx 1 million square kilometres – that’s more than the entire UK, France and Ireland put together or > double the size of California/all of British Colombia to make it local for our North American colleagues!
  • Roughly 50% of the population is indigenous however they make up 60% of ED presentations 80% of admissions and 90% of ICU admissions (these were told to me verbally) 
  • It’s traditional indigenous name is “Mparntwe”
  • The syphyllis rates are some of the highest in Australia- the pregnancy screening positive test rate has exploded. We see congenial syphyllis here. 
  • 3% of the population will get acute rheumatic fever.
  • It has one of the highest concentrations of End stage renal disease in Australia and the busiest dialysis unit in the country (approx 80 runs per day)
  • It’s an awesome spot – The “River” Todd runs through the centre of the town but only has water in it 5% of the year. The annual Henley-on-Todd Regatta where contestants make their own “boat” to race down a dry river bed has once been cancelled, in 1993 due to flooding. 

…and finally

29,000,000 articles and 250GB of data over 70 years

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Funtabulously Frivolous Friday Five

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

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