Funtabulously Frivolous Friday Five 291

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 291

Question 1

Who (most probably) said:

Listen, listen to the patient’s story! He is telling you the diagnosis.

Reveal the funtabulous answer

John Benjamin Murphy (1857 – 1916)

Murphy, of Murphy’s sign renown, was an American physician and abdominal surgeon.

The quote is more commonly recorded as “listen to your patient, he is telling you the diagnosis“, and attributed to Sir William Osler (1849 – 1919), but there is no official recording of the quote in any of his publications. The first attribution to Osler is in 1964 and then in 1968 as an inscription on a medal to honour Professor Masakazu Abe, President of Jikei University School of Medicine.

The earliest direct attribution we can find is in a 1939 JAMA publication by Dr NC Gilbert, expounded upon by JB Herrick in his 1949 memoirs

“No, sir, you are wrong, and I’ll tell you why.” Dr. N. C. Gilbert tells how Dr. Murphy used to shake his finger in the students’ faces and say in his shrill voice, “Listen, listen to the patient’s story! He is telling you the diagnosis.” Lessons taught m this dramatic way never failed to make an impression.

JB Herrick. Memories Of Eighty Years. 1949: 183

Question 2

What is Rytand’s Law?

Reveal the funtabulous answer

The prognosis for a patient with myocardial infarction is worse when anticoagulants are given to someone else…

Rytand DA, 1951

David Abramson Rytand (1909 – 1991) was an American physician and cardiologist. He is more commonly associated with the Rytand murmur (1946) a mid-late blowing diastolic murmur heard occasionally in patients with complete atrioventricular heart block.

Question 3

You are knee deep in 80 year old abdominal pain ?cause, hoping for something a bit more simple. Your heart sinks, intractable migraine is the next chart and they are allergic to all non-opioids. Never fear, you have one last trick… the Raskin Protocol. What is the Raskin Protocol?

Reveal the funtabulous answer

The treatment of retractable migraines with dihydroergotamine (DHE) popularised by Neurologist Dr Neil Raskin.

In the original study 89% of patients were headache free within 48 hours. The regimen consisted of 0.5mg – 1mg of DHE IV with 10mg of metoclopramide IV (DHE causes nausea), and repeated every 8 hours for 2 days.

In the emergency department a slightly modified regimen can be used whereby a test dose of 0.5mg is given and repeated 1 hour later if no improvement (along with the 10mg of metoclopramide).

DHE should not be used within 24 hours of triptans or ergot-like agents. It is also contraindicated in patients with hypertension, ischaemic heart disease, pregnancy and breast feeding.

Other common drug tricks include prochlorperazine 10mg IV, chlorpromazine 12.5mg IV and Ketorolac 30mg IV/IM.

Question 4

Who gets the ‘Texidor Twinge’?

Reveal the funtabulous answer

Young healthy adults.

The Texidor Twinge or precordial catch syndrome (PCS) is a non-serious condition in which there are sharp stabbing pains in the chest. These typically get worse with breathing in and occur within a small area. Spells of pain usually last less than a few minutes. Typically it begins at rest and other symptoms are absent.

The syndrome was first described and named in 1893 by Henri Huchard (1844 – 1910), a French cardiologist, who called it “précordialgie” (from the latin “praecordia” meaning “before the heart”), or “Syndrôme de Huchard” (“Huchard syndrome”).

En général, à de rares exceptions près, chaque fois qu’un malade vient se plaindre au médecin, d’une douleur dans la région cardiaque, il n’a pas d’affection organique du cœur

Huchard 1893

In 1955, the Huchard syndrome was studied in greater depth by Albert J. Miller (1922-2020) and Teodoro A. Texidor (1913-1998), cardiologists at the Cardiovascular Department and the Department of Medicine at the Michael Reese Hospital in Chicago Miller himself also suffered from the syndrome:

The pain is sudden in onset, is severe, and is localised above the cardiac apex. It has always occurred at rest or during mild activity and invariably has been associated with a “slouched” posture”. The immediate reaction to the pain is a suspension of breathing in mid-respiration or in expiration… breathing is then confined to shallow chest excursions.

Miller, Texidor 1955


Question 5

In an attempt to better my fast track technical skills I’ve been assisting in theatre with plastics, while telling a colleague about this deliberate practise they laughed… “you should just play video games like me and stop wasting your time”. Who will end up being the “better surgeon”, me or my game playing colleague?

Reveal the funtabulous answer

Unfortunately my game playing colleague (to a certain extent) according to a 2007 study done in New York.

Past video game play in excess of 3 h/wk correlated with 37% fewer errors (P<.02) and 27% faster completion (P<.03).

Overall Top Gun score (time and errors) was 33% better (P<.005) for video game players and 42% better (P<.01) if they played more than 3 h/wk. Current video game players made 32% fewer errors (P=.04), performed 24% faster (P<.04), and scored 26% better overall (time and errors) (P<.005) than their nonplaying colleagues. Regression analysis also indicated that video game skill and past video game experience are significant predictors of demonstrated laparoscopic skills.

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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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