Funtabulously Frivolous Friday Five 293
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 293
Question 1
A patient presents with a foreign body sensation in his right eye and you detect a clear ‘saucer’ like defect on the cornea near the limbus. It is not opaque and there is no fluorescein uptake. What is the diagnosis?
Reveal the funtabulous answer
Corneal Dellen
The video below is post-op but Dellen’s can occur by any means that cause a defect in the tear film. Treatment is with copious amounts of lubrication.
Question 2
‘Woman with a Mirror’ was painted by Renaissance painter Titan. You’ll note the dilated pupils. What substance was popularly used in the Renaissance period to dilate the pupils of females to appear more seductive?
Reveal the funtabulous answer
Atropine from the Atropa Belladonna.
The name Atropa belladonna was published by Carl Linnaeus in Species Plantarum in 1753. Atropa is derived from the name of the Greek goddess Atropos (‘she who may not be turned aside’ i.e. ‘the inflexible’ or ‘the implacable’) – one of the three Greek fates or destinies who would determine the course of a man’s life by the weaving of threads that symbolised his birth, the events in his life, and finally his death, with Atropos cutting these threads to mark the last of these. The name “belladonna” comes from the Italian, meaning ‘beautiful lady’; originating from its usage to increase the pupil size in women which was fashionable in the Renaissance period.
Question 3
What is the common term for this foot post AAA repair?
Reveal the funtabulous answer
Trash Foot
Trash foot is secondary to acute lower limb ischaemia following aortic surgery. The exact cause of the ischaemia is unknown, but it has been attributed to athero-emboli from native arteries, thrombo-emboli from any prosthetic graft or thrombosis of small vessels in the distal arterial tree.
Reference:
- Kuhan G, Raptis S. Trash foot following operations involving the abdominal aorta. Aust N Z J Surg. 1997; 67: 21-4
Question 4
Next up in resus you are called to help a 300kg male into one of the bariatric beds, he complains of being dizzy and the paramedics tell you he has a pacemaker, you look at the screen and he has a heart rate of 180 and you recall something about pacemaker mediated tachycardia. You finally locate the magnet but it hasn’t done anything to the pacemaker, now what?
Reveal the funtabulous answer
Find a second
In some obese patients if the device is planted deep, one magnet is not enough as the magnetic filed will not reach, adding another on top is an actual course of action to increase that magnetic field. I don’t know about you but I have trouble finding one magnet let alone another.
Reference:
- Jacob S et al. Clinical applications of magnets on cardiac rhythm management devices. Europace 2011;13:1222-1230
Question 5
A young woman presents with a grossly swollen left leg, no risk factors for DVT but clinically looks like she has an acute venous occlusion. What anatomical syndrome might she have?
Reveal the funtabulous answer
May-Thurner syndrome
May-Thurner syndrome (MTS) is an anatomically and pathologically variable condition leading to venous outflow obstruction as a result of extrinsic venous compression in the iliocaval venous territory. With partial venous obstruction, the condition can be asymptomatic, but progression with symptoms related to chronic venous hypertension or venous occlusion can occur, with or without venous thrombosis.
Reference:
- May R, Thurner J. The cause of the Predominatly Sinistral Occurrence of Thrombosis of the pelvic veins. Angiology. 1957 Oct;8(5):419-27.
- Altawan AS. May-Thurner syndrome: What sonographers should know. ARMDS
And Finally…
FFFF
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.
The painting Woman with a mirror was painted by Tiziano Vecellio (1490-1576). Although he was a giant (Titan) painter he was actually known as “Titian” (with an “i”). Just my 2c to this excellent and very instructive 4F series.
Thank you, as you can tell I am illiterate when it comes to the arts. All updated.