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…introducing Funtabulously Frivolous Friday Five 110
Question 1
A young fit male is out surfing, as he moves through the white water at waist depth another surfer hits in his chest and he goes into cardiac arrest. The life guards successfully defibrillate the surfer after one shock and he comes to your department sat up on the bed talking. What condition has he suffered from?
- Commotio Cordis
- Effectively ventricular fibrillation triggered by a blunt, non penetrating, and often innocent appearing unintentional blow to the chest without damage to the ribs, sternum or heart.
- The latin translation is “agitation of the heart“.
- A blow of approximately 30-50mph lands on the T wave creating an ‘R’ on ‘T’ phenomenon and VF. See our LITFL post on Commotio Cordis
Question 2
What causes a Sardonic Smile?
- Derived from the Hemlock induced wry smiles peri-euthanasia…
- Among the pre-Roman people of Sardinia they would euthanize their elderly. While doing so they would laugh loudly which is the origin of the sardonic laughter
- However, the Sardoni believed that laughter during this killing would transform death into a new birth, and nullifies the murder.
- Scientists in Italy theorised that the Sardoni used hemlock water dropwort that causes a sardonic grin before dropping the elders from a high rock or beating them to death.
- Hemlock water dropwort contains Oenanthotoxin a toxin that acts as a noncompetitive gamma-aminobutyruc acid agonist.
- However, if you are not killing your elders then you may see a Risus sardonicus – the apparent smile on a face of someone who either has tetanus or Strychnine poisoning – see tox conundrum 007.
- Reference G. Appendino, F. Pollastro, L. Verotta, M. Ballero, A. Romano, P. Wyrembek, K. Szczuraszek, J. W. Mozrzymas, and O. Taglialatela-Scafati (2009). “Polyacetylenes from Sardinian Oenanthe fistulosa: A Molecular Clue to risus sardonicus”. Journal of Natural Products 72 (5): 962–965
Question 3
Why did van Gogh paint in yellow? What disease might this represent?
- Xanthopsia…
- Arnold WN and Loftus LS reviewed the works of Van Gogh and his correspondence to answer this question…opinions vary, but possibilities to be excluded include
- Digoxin toxicity is known to cause cataracts by blocking the sodium pump on the lens and thus causing a yellow hue.
- Bilirubin deposition in the lens associated with jaundice
- Congenital cataracts
- Absinthe hallucinations.
- However, there is no evidence that van Gogh was either jaundice or digoxin toxic. It is also unlikely that van Gogh had cataracts due to his youth. Hallucinations from absinthe may be an explanation for certain canvases but not for the majority.
- So despite popular interesting theories about his health and drug abuse, his correspondence would indicate that he had a preference for the exaggerated yellow colours. [Reference PMID: 1794418]
Question 4
Where were cephalosporins discovered?
- In the sewers of Sardinia.
- It not all white lab coats, fancy conical glasses and staring at petri dishes. A large number of antibiotics have been discovered in rather gruesome circumstances.
- Giuseppe Brotzu of Sardinia wondered why typhoid fever was less virulent in his city than elsewhere. He had many theories until one day while passing through the bay of “Su Siccu” he saw some young people swimming in the waters near a sewage outlet and wondered why they had not contracted this disease from contaminated faeces.
- With haste he scooped up some sewer water, boiled up some placenta for medium and discovered a cure for this gram negative bacteria. [Reference]
I can taste a new antibiotic in here somewhere!!
Question 5
What is a Sister Mary Joseph Nodule?
- It is a metastatic lesion involving the umbilicus.
- Reportedly present in 1-3% of all intra-abdominal and/or pelvic malignancies (adenocarcinoma being the most common primary).
- This lesion is likely to be reported on a CT scan but the ever observant Sister Mary Joseph (born Julia Dempsey 1856-1939) was surgical assistant to William Mayo of Mayo Clinics, and pointed out the frequent finding of a nodule in the umbilicus of patients with advanced cancer.
- Other differentials of umbilical lesions include a paraumbilical hernia, surgical scar, endometriosis, granuloma, primary umbilical tumour and umbilical lint (aka belly button fluff). [Reference]
…and in other news
//www.youtube.com/watch?v=aS3xaXsh6vo
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