The Staghorn Challenge

You may remember that Professor Staghorn was recently inaugurated as the newest member of the UCEM Council Executive. Hidden in his profile were about 30 veiled references to kidney stones, particularly those of the staghorn variety. The following challenge was put out to the entire webosphere: can anyone identify at least 20 of these references?

“After much struggle and sacrifice” – his own words – one man crossed the line first to become the esteemed winner of the ‘Staghorn Challenge’…

Leon Gussow of The Poison Review fame

[WARNING: Spoiler alert – if you want to try the challenge for yourself, you need to read Professor Staghorn profile first….]

Here are Leon’s answers; with my clarifications in italics:

  1. iliacusone of the 3 most common sites for kidney stone obstruction is the pelvic brim where the ureters arch over the iliac vessels.
  2. anaconda (The website for the Maryland Kidney Stone Center is copyrighted by Anaconda Partners LLC (okay, I was desperate) – admirable desperation!
  3. Struviterefers to kidney stones that contain calcium magnesium phosphate, and that may form staghorn calculi.
  4. Staghornstruvite-containing kidney stones that are named for their appearance, and are associated with infection.
  5. calyxiathe calyces (plural of calyx) are tubes that collect urine into the renal pelvis from which the ureters arise.
  6. ureticathe ureters are the tubes that transmit urine from the kidneys to the bladder, and become obstructed by larger kidney stones.
  7. colica‘renal or ureteric colic’ is the severe pain associated with restlessness and nausea/vomiting caused by kidney stones.
  8. calculusthe branch of mathematics that shares its name with the medical term for stone.
  9. candiruthe fish notorious for lodging itself in the urethra of unwitting victims who choose to urinate in rivers.
  10. hematuria – blood in the urine, may be caused by kidney stones.
  11. crystalcrystals may be seen in the urine of patients with kidney stones – ‘coffin-lid’ crystals may be present in those with struvite-containing kidney stones.
  12. (Rolling) Stonesif only they did…
  13. ejaculateda term used to describe an event considered important by most urologists.
  14. p*ssheada hint: * means ‘i’
  15. grown men crya common end result of kidney stones.
  16. (slow) passagethe slower the passage, the longer the pain lasts…
  17. shadowy (stones may shadow on ultrasound) – stones cast a shadow on ultrasound because they do not transmit ultrasound waves. Uric acid stones and blood clots tend to be radiolucent and may be invisible or appear as ‘shadows’ on plain X-rays.
  18. causticstruvite stones are associated with alkaline urine (pH >7.5).
  19. CTnon-contrast enhanced helical computed tomography is now the standard imaging modality for identifying kidney stones and renal tract obstruction.
  20. gripping (his opponent’s groin) – colic-type pain is sometimes described as gripping, and the pain of kidney stones is classically referred from ‘loin to groin’.

For completeness, here are the other hidden references:

  1. Professor Inglebert Struvite Staghorn – the initials form a urologically relevant acronym. The astute reader always looks for the acronyms in any UCEM-related announcement…
  2. Ear-splittinga somewhat cryptic reference to the fact that struvite stones are associated with infections by urea-splitting organisms like Proteus spp.
  3. Portuguese União Júnior – PUJ refers to the pelvi-ureteric juction, another of the three common sites for kidney stones to become lodged.
  4. Urologista type of medically-qualified plumber with an interest in unblocking the pipes that pass urine.
  5. ProteanStruvite stones are associated with infections caused by Proteus spp.
  6. Providential… and infections caused by Providentia spp. (Klebsiella is another important cause, but was not included in Staghorn’s profile).
  7. (blow to the) lointhe pain of kidney stones is classically referred from ‘loin to groin’.
  8. Universidade de Virgens e Jogadores – UVJ or VUJ refers to the vesico-ureteric junction, the third of the common sites for kidney stones to become lodged.
  9. UCEM’s Inquisitorial Disciplinary Committee – IDC refers to indwelling catheter.
  10. Utopian Border Patrolcould this be a cryptic reference to stones preventing the passage of urine? @justrobyn thought so, who are we to argue?

As UCEM have generously agreed to confer an honorary Fellowship of the winner of the Staghorn Challenge, Leon can now add F.UCEM to his list of credentials.

Utopian College of Emergency for Medicine

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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