Funtabulously Frivolous Friday Five 342

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 342

Question 1

What condition are you more likely to get after the clocks change?

Reveal the funtabulous answer

Acute myocardial infarction

We all have an in-built circadian rhythm and it has been discovered if left in the dark our rhythm is on average 20mins over the 24hr schedule. We, therefore, need to see the sun every morning just to make that slight adjustment and keep us in sync with the world.

We all know how it feels to be jet-lagged but a metanalysis in 2019 of over 100,000 patients showed that the stress on our body clocks of daylight saving time (DST) actually increased our risk of having an MI. The risk was observed one week after DST. The spring shift gave the biggest risk with an OR = 1.05; 95% CI: 1.02–1.07; p < 0.001 whereas, the Autumn shift did not show any increased rates. Certainly, a reason to put a stop to daylight savings but also a warning for us shift workers. 

Reference:


Question 2

Your patient in ICU has been there a month with multiple complications post sepsis and is finally feeding again. The nurses are concerned he seems to be acting drunk after every meal so order an alcohol level which comes back positive. All staff are pondering where he got the alcohol from. He has no visitors, he can’t get out of bed and no iatrogenic source has been identified.

You smile as you know it is entirely possible to get this result.

What syndrome do they have?

Reveal the funtabulous answer

Auto-brewery syndrome (ABS).

Also known as gut fermentation syndrome. 

A rare diagnosis in which ingested carbohydrates are converted to alcohol from fungal yeast in the upper small bowel and caecum. The altered gut microbiome occurred from the antibiotics accumulated during the admission in intensive care.

In the actual case from the reference, a 46-year-old male was pulled over by police for acting drunk while driving and had a positive breathalyser. He fiercely denied he had any alcohol. His aunt then got him his own breathalyser and he repeatedly kept getting high results. This led to him being investigated by medics and eventually he was diagnosed with ABS as a result of antibiotic therapy. 

Reference:


Question 3

You are studying for an exam and while taking a break at your local café you marvel at the fact the waiters and waitresses can recall every order and deliver everything to the right person no matter how big the table is and despite multiple interruptions.

You ponder how their memory is so good and wish you could embrace the same learning skills for your revision. You pluck up the courage and ask a passing waitress “what’s your secret”. They reply “It’s the Zeigarnik effect.” Not waiting to look stupid, you smile and say “ah, of course.”

What is the Zeigarnik effect?

Reveal the funtabulous answer

The ability to recall an activity more readily if it’s been interrupted or not completed.

Unfortunately, it’s unlikely to help you with your studies because Bluma Zeigarnik the Soviet psychologist it’s named after, reported that the wait staff had poorer recollection for the completed task i.e. no recollection of prior completed orders.

Using this theory in revision would include stopping studying halfway through and going to study something else. This is most likely to be ineffective. However, it probably accounts for why we keep recalling patients and jobs on shift that have incomplete tasks and once discharged or admitted we are less likely to recall the case. Well, that’s the theory anyway.

References


Question 4

Deflated that the Zeigarnik method isn’t going to help your studies one of your colleagues tells you about the Pomodoro technique.

What is this Pomodoro technique and why is it so named?

Reveal the funtabulous answer

A Time management method developed by Francesco Cirillo in the 1980s

Traditionally you have 25 minutes to complete a task before taking a short break. It is named Pomodoro after the famous tomato kitchen timer.

There are 6 incremental steps as detailed in the short video below. The educational theory has suggested that we remember the beginning and the ending more readily of our social interactions (and revision sessions), therefore the more beginning and endings you make the more you can recall.

So the more Pomodoro’s the more you can recall. It’s equally effective as one of the objectives is about eliminating distraction. See for yourself:


Question 5

A 32-year-old male is seen in your emergency department with a large abdominal mass with signs of peritonism. Fortunately, he’s been worked up prior to his visit and the pathology is back showing he has a malignant fibrous histiocytoma. Your friendly surgeon is on call and as the man now has signs of a perforation agrees to take him for urgent surgery.

During the operation, your colleague cuts himself on the palm of his hand and comes to Emergency for post-exposure advice. You do your local standard procedures and reassure them they will be okay from a viral point of view…but

Could the surgeon catch cancer from this cut?

Reveal the funtabulous answer

Super rare, but yes. 

This case was in NJEM in 1996. The surgeon in question developed a hard mass on his hand 5 months later. It was resected and diagnosed as a malignant fibrous histiocytoma. The pathologist involved was the same one who investigated the patient’s tumour. After numerous investigations, the pathologist could confirm that both tumours were morphologically identical.

Reference:


…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.

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