Funtabulously Frivolous Friday Five 067

It’s the finale of a frenetic few days in the fast lane… and time for a feast of Funtabulously Frivolous Friday Five!

As always, the FFFF is best washed down with a cup of brown joy…


Q1. If a polar explorer has musculoskeletal pains and raised intracranial pressure, what should you suspect they’ve been eating?

  • Polar bear livers (or livers from other polar animals such as seals, walrus, or even their own huskies…)
  • A number of polar explorers are believed to have fallen victim to hypervitaminosis A from consuming the livers of polar animals. A famous example is believed to be the Mawson led Far Eastern Party of the 1911–14 Australasian Antarctic Expedition. The late great Sir Edmund Hillary described Mawson’s month-long journey as “probably the greatest story of lone survival in Polar exploration” .
  • Vitamin A is fat soluble and accumulates in tissues when taken in excess. Features of hypervitaminosis A include gastrointestinal symptoms (e.g. anorexia, vomiting, diarrhoea, and abdominal pain), neurological symptoms (e.g. altered mental state, vision changes, headache and other features of raised intracranial pressure), and musculoskeletal pains.

The last photograph taken of the Far Eastern Party, by Archibald Lang McLean of the Eastern Coastal Party, after the parties separated on 17 November 1912 (from Wikipedia)

Q2. What did Hermann Ebbinghaus describe in 1885?

  • The forgetting curve.
  • In 1885, Ebbinghaus published his classic work Über das Gedächtnis (“On Memory”, later translated to English as Memory. A Contribution to Experimental Psychology). In  it he described experiments demonstrating the exponential decay of recall of memorised facts, as shown in the Ebbinghaus Forgetting Curve. The way to overcome this is to use spaced repetition (or have you already forgotten this LITFL post from earlier in the week…)
  • He also described the  learning curve — you learn the most following the first attempt, with diminishing returns for subsequent repetitions.

The Forgetting Curve; from Stahl et al CNS Spectr. 2010;15(8):491-504 --- click image for source

Q3. Where is the thinnest skin on the body?

Q4. What is the Hawthorn effect?

  • The Hawthorn effect is a form of observer bias that plagues clinical research.
  • It refers to the phenomenon by which subjects taking part in an experiment, independent of any planned experimental intervention, modify their behaviour as a result of being observed.
  • For instance, the Hawthorn effect might partially explain why studies have not been able to convincingly show that MET teams lead to improved outcomes — the control groups might ‘lift their games’ if they know they are being studied!

Q5. What is Twiddler’s syndrome?

  • Twiddler’s syndrome has been described as follows:
“First described in 1968, pacemaker twiddler’s syndrome refers to permanent malfunction of a pacemaker due to the patient’s manipulation of the pulse generator. The sequence of symptoms begins with the patient’s deliberate or subconscious spinning of the pacemaker’s pulse generator in a capacious pocket. The leads are dislodged, and ventricular pacing ceases. Subsequently, with continual reeling of the leads around the generator, the ipsilateral phrenic nerve is stimulated, resulting in diaphragmatic pacing and the sensation of abdominal pulsations. As the leads are further wrapped around the generator, rhythmic arm twitching occurs when the brachial plexus is paced.”
— from Nicholson, et al NEJM 2003

Radiographic evidence of Twiddler's syndrome - from (click image for source)

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  1. Michael Quirke says

    Had a patient the other day who read up on hypervitaminosis A online and tried to OD by drinking 2 litres of carrot juice and taking 15 Vit A tabs. Needless to say he was fine…a shade yellow ( and a little “blue”). The vignette about polar bear livers stuck in my head and lo and behold FFF read my mind! Good stuff.