Funtabulously Frivolous Friday Five 071

Wow… FFFF turns 71 today!

That means we’ve now gone through 20 prime numbers in our never-ending quest for ever more funtabulous frivolity.

What does today’s edition have in store?

Read on to find out…

Question 1

What condition may sound appealing to a dairy farmer, but makes afflicted patients cough up blood and pass ‘coca cola’ urine?

  • Goodpasture’s disease, an autoimmune disease characterized by hemorrhage of the lungs and glomerulonepheritis.
  • Named after Dr. Ernest Goodpasture, this disease is caused by a type II hypersensitivity reaction to the Goodpasture antigen on the basement membrane of the glomerulus of the kidneys and the pulmonary alveolus.
  • First signs of the disease are vague such as nausea and fatigue or pallor. Most patients seek medical attention with the development of hemoptysis or hematuria.
  • Treatment includes plasmapheresis to remove the antibody, corticosteroids to suppress the immune system, and ACE inhibitors to slow kidney damage from hypertension.

Credit for this question goes to LITFL reader AWild — thanks for contributing some funtabulosity!

Question 2

One of Brazil’s most famous medical doctors died recently, he was aged of 57 years and shared his name with an ancient philosopher. Who was he and what was he famous for?

“Beauty comes first. Victory is secondary. What matters is joy.” — Socrates
  • Socrates was the slender 6ft 4in midfield maestro who, in the 1982 World Cup, conducted an orchestra of football geniuses that included the great Zico. Though they failed to win the cup, the team was immortalised by their brilliant football. They even over-shadowed the New Zealand All Whites in their first World Cup adventure…
  • Socrates achieved the rare feat of studying medicine and becoming a doctor while being a professional footballer. But he wasn’t ‘just’ a footballer, he was the Da Vinci of Brazilian football.
  • Socrates died on December 4th 2011 aged only 57 years. He succumbed to septic shock following a gastrointestinal infection. His obituary in the Economist is well worth reading (hat tip to Joe LEx).

Question 3

On June 29, 2011, the Wyoming Department of Health was notified of two laboratory-confirmed cases of Campylobacter jejuni enteritis among persons working at a local sheep ranch. What activity led to these people becoming infected?

  • They used their teeth as ‘castration aids’.

Click image for source

  • C. jejuni is frequently transmitted by fecal-oral contact or consuming contaminated food or water. Infections are commonly associated with eating poultry or unpasteurized dairy products. In this case, the two ‘victims’ were among a dozen people working at a at a Wyoming sheep ranch, castrating and docking the tails of 1,600 lambs. They were the only two who got sick, they were the only two who ‘used their teeth’.
  • According to the report in MMWR:
    “Ranch owners and employees were advised to use standardized, age-specific techniques for lamb castration (e.g., Burdizzo, rubber rings, or surgery) and to wash their hands thoroughly after contact with animals.”
    They were not advised to use their teeth.

Question 4

What is ‘son et lumiere’ sign?

  • A rare combination of ‘sound and light’ (in other words, a flaming burp) that may be caused by conditions such as pyloric stenosis.
  • Daniel’s described a case in the BMJ in 1973:

“The patient concerned had had a vagotomy and pyloroplasty a year previously and complained of increasing vomiting. On examination there was obvious splashing in the stomach, suggesting a diagnosis if pyloric stenosis. He was asked if he experienced foul eructations and replied that he certainly did. Then, rather diffidently, he said, “On one occasion I was lighting a cigarette when I belched and the explosion burnt my nose and hair.”

  • Other names proposed for this sign include: eluctation (eructation-to belch; lux-light), belch flambe, bangina oris, alight wind, pyloropyrotechnics, and the eructant dragon syndrome.
  • Daniels HA. Letter: Son et lumière? Br Med J. 1973 Dec 1;4(5891):554. PMID: 4758508;  PMCID: PMC1587500.
  • Danzl DF. Flatology. J Emerg Med. 1992 Jan-Feb;10(1):79-88. Review. PMID: 1629596.

Question 5

What is ‘Sutton’s slip’?

  • ‘Sutton’s slip’ is a bias, or ‘cognitive predisposition to respond’, that occurs when possibilities other than the obvious are not given sufficient consideration.
  • It is also known as going for the obvious, going where the money is, Occam’s razor mistake, and KISS error.
  • It takes it name from the apocryphal story of the Brooklyn bank robber Willie Sutton who, when asked by the Judge why he robbed banks, is alleged to have replied, “Because that’s where the money is!”. The diagnostic strategy of going for the obvious is referred to as Sutton’s Law… Most of the time it works! But I suggest you follow the maxim “if you hear hoof beats, think horses…. but don’t forget about zebras completely (especially if you’re lost in the savanna)”.
  • Croskerry P, Cosby KS, Schenkel SM, Wears RL. Patient Safety in Emergency Medicine. Lippincott Williams & Wilkins, 2008

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