Funtabulously Frivolous Friday Five 284

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 284

Question 1

How soon after being hit by a TASER could you have enough capacity to consent?

Reveal the funtabulous answer

10 minutes.

In this observational study 115 officers were either shot in the back by a TASER for 5-seconds, given a 90-second high-intensity interval training exercise, low level alcohol intoxication (blood alcohol 0.12 or lower), high level alcohol intoxication (blood alcohol above 0.12), and a control condition. Results on the Automated Neuropsychological Assessment Metrics battery (subtests for procedural reaction time, matching to sample, and logical relations) were compared among groups at baseline and at 10, 35, 60, and 85  minutes after exposure.

There was no difference in cognitive ability from baseline 10 minutes post being tased.

Worryingly 7 of these officers were excluded as they failed the pre-cognitive test!

Bonus FFFF: Many people might be surprised to learn that the word taser is an acronym. The (debatable) non-lethal weapon that causes temporary paralysis was invented in the 1970s by a man named Jack Cover. Cover aimed to create a non-lethal weapon that could be used in situations in which firing a real gun would prove fatal, like in an airplane hijacking. The inspirations behind the invention were eclectic. First, he witnessed a hiker survive a run-in with an electric fence. And second, he recalled a fictional electric rifle used in his favorite science-fiction novel growing up. It’s this 1911 novel, Tom Swift and His Electric Rifle, that inspired the name TASER.

Reference: Dawes Et al. The neurocognitive effects of a conducted electrical weapon compared to high intensity interval training and alcohol intoxication – implications for Miranda and consent. Journal of Forensic and Legal Medicine. 2018;53:51-57

Question 2

So I think we can all agree that watching ER would get you through emergency fellowship training but what about the modern equivalents? When it comes to medications which show is more accurate, Grey’s Anatomy, House, Nurse Jackie, Doc Martin and Royal Pains?

Reveal the funtabulous answer

Doc Martin

Approximately 100 randomly selected hours of five medical television dramas (House, Grey’s Anatomy, Nurse Jackie, Doc Martin and Royal Pains) were assessed for the appropriateness of advice given based on the medication indicated, number of safety checks performed, and the level of adherence to standard clinical guidelines.

Although the medication advice given was often for the correct indication and the advice somewhat followed clinical guidelines, it frequently omitted adequate safety checks. Doc Martin had the highest mean appropriateness score, whereas House and Grey’s Anatomy had the lowest.

For a deeper dive see our reference: Cowley et al. Does the “script” need a rewrite? Is medication advice in television medical dramas appropriate? J Clinger’s Pharm Ther. 2017;42(6):765-773

Question 3

Which eponymous condition is associated with Die Glotzaugen-cachexie [Goggle-eyed cachexia], first described in 1840.

Reveal the funtabulous answer

Basedow disease (1840) – [aka Graves disease, Parry disease]. Autoimmune disease that affects the thyroid. A form of hyperthyroidism manifesting the triad of goitre, exophthalmos and pretibial myxoedema.

Karl Adolph von Basedow (1799-1854), in March 1840 described an association of exophthalmos, tachycardia, and goitre in four cases (Madame F, G, C and Herr M) monitored over periods of 2, 5, 10 and 11 years. Described locally as the ‘Merseburger Triad‘ and in 1858 as Basedow disease [Hirsch 1858;2:224-225]

There appeared an eminent protrusion of the eye balls, which by the way were absolutely healthy and had a completely full sight. In spite of this the sick woman was sleeping with open eyes and had a frightening appearance.’ 

Basedow;1840 (Madame G)

Question 4

What is ‘gone with the wind syndrome’?

Reveal the funtabulous answer

Many video rental shops reported in 1988 that 80% of revenue came from 20% of videotapes. A video-chain executive discussed the “Gone with the Wind syndrome”, however, in which every store had to offer classics like Gone with the WindCasablanca, or The African Queen to appear to have a large inventory, even if customers very rarely rented them

This 80:20 split on video tapes is also know as the Pareto Principle. It is an illustration of a power law relationship that basically states that 80% of the effects relate to 20% of the causes.

For instance, 80% of the crime in the US is thought to be due to 20% of the criminals. Similarly 80% of health care costs are due to 20% of the population. Vilfredo Pareto was an Italian economist who noted in 1906 that 80% of Italian property was owned by 20% of the people – and that 80% of the peas in his garden came from 20% of the pods. The principle has been challenged by many, including Paul Krugman, yet the power law phenomenon seems to hold some truth, even if the the split may vary considerably from 80/20.

Question 5

The cause of President Abraham Lincoln’s unusual physical features have long been debated. What two disease process are most likely?

Reveal the funtabulous answer

Marfan syndrome and multiple endocrine neoplasia type 2B.

Marfan’s has long been proposed due to his skeletal features and reported ‘loose-jointedness’ however, there has never been any cardiac nor ocular features of the disease in Lincoln’s historical record.

Currently marfanoid habitus spans about 12 distinct genetic disorders, MEN2B being one of them. MEN2B is characterised extra-skeletally by overgrowth of neural derived cells, medullary thyroid cancer, pheochromocytoma and early death.

Due to limited records researchers have now looked at Abraham Lincoln’s mother and established that she too had hypotonic skeletal muscles resulting in myopathic facies and ‘pseudodepression’ and died of a wasting disease at 34 supporting the MEN2B hypothesis.

She was quite tall. No tape line measurement as to statue could be given, but it appears certain that she was above the average in statue and there is good reason for supposing her to have been five feet ten inches. She was bony, angular, lean and with the common expression heard ‘thin’. She had long arms, large head, with the forehead exceedingly broad and not at all a retreating forehead. Her [sic] eyes were small, deep sunken and gray-blue in coloraturas. Her ears were very large and stood out from the head; her mouth was large and nose quite prominent. Her cheek bones were very high, chin prominent and a long ‘stingy’ neck with the chest ‘sunken’.

Murr JE on Nancy Lincoln 1918.


…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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