Thank FFFF It’s Christmas

Draw near, and gather round the FFFFire for this very Christmas edition of Funtabulous medical trivia.

This year we celebrate the 12 days of Christmas in Emergency with an eclectic collection of 12 festive related questions to amuse and bemuse….

…but first – a word from our sponsor

Question 1

  • Which of the following are known to have engaged in parthenogenesis?
  1. The New Mexico Whiptail lizard
  2. The domesticated honey bee
  3. The water flea Daphnia pulex
  4. The blessed virgin Mary
  5. All of the above

  • All of the Above
  • Parthenogenesis is a form of asexual reproduction in which growth and development of embryos occur without fertilization

Question 2

  • A 2 year old boy presents with acute airway obstruction in March, following a 15 month history of ‘noisy breathing and hoarseness’. A lateral neck X-Ray is performed…What is the most likely aetiology?

christmas foreign body

  • Stridorosi ornamenti chronicus
  • An urgent laryngotracheal bronchoscopy was performed following inhalational induction of anesthesia
  • Using a fiberoptic bronchoscope,visualization of the larynx through a laryngeal mask airway revealed a flat plastic Christmas tree embedded within granulomatous cords causing almost complete obstruction and requiring tracheostomy prior to extraction

xmas foreign body

Question 3

  • Why does Rudolph have a red nose?

  • Rudolph uses his nose as a thermoregulatory organ
  • In the arctic, reindeer have evolved to keep warm – but like all animals, sometimes they need to cool down. Unlike humans, they cannot sweat, so have to use their nose as a heat exchanger.
  • Medical researchers from Rotterdam and zoophisiologists from Tromsø have recently collaborated to review the blood vessel structures within the nose which allow the reindeer to do that.
  • The nasal microcirculation of reindeer is richly vascularised, with a vascular density 25% higher than that in humans. These results highlight the intrinsic physiological properties of Rudolph’s legendary luminous red nose, which help to protect it from freezing during sleigh rides and to regulate the temperature of the reindeer’s brain, factors essential for flying reindeer pulling Santa Claus’s sleigh under extreme temperatures. [Why Rudolph’s nose is red: observational study BMJ 2012]

Question 4

  • The ingestion of which alcohol may result in “snow storm” vision?

  • Methanol
  • Methanol poisoning is associated with toxic optic neuropathy, blurred vision (snowfield or snow storm vision), dilated pupils, optic disc congestion and can result in permanent blindness
  • Blurred or snowfield vision in methanol poisoning usually resolves. However, long term outcomes for patients presenting with complete blindness cannot be predicted [Reference]

Question 5

  • What were Frosty the Snowman’s last words?
  2. “I’ll be back again some day”
  3. “I suppose it had to come to this. Such is life.”
  4. “All those moments will be lost in time, like [coughs] tears in rain”
  5. “I swear I never forced them to touch my snowballs”

  • “I’ll be back again some day”
frostyBut he waved goodbye
Saying, “Don’t you cry
I’ll be back again some day”

Question 6

  • How many Joules of energy will the lead pair of reindeer absorb (theoretically) as they traverse the globe?

  • 14.3 QUINTILLION joules of energy
  • Explanation courtesy of “I F@#$ing Love Science
  • No known species of reindeer can fly. However, there are hundreds of thousands, even millions of species of living organisms yet to be classified. While most of these are insects and germs, this does not COMPLETELY rule out flying reindeer which only Santa has ever seen.
  • There are 2 billion children (persons under 18) in the world. Since Santa doesn’t (appear) to handle the Muslim, Hindu, Jewish & Buddhist children, that reduces the workload to 15% of the total – 378 million according to Population Reference Bureau. At an average (census) rate of 3.5 children per household, that’s 91.8 million homes. One presumes there’s at least one good child in each.
  • Santa has 31 hours of Christmas to work with. This is due to the different time zones and the rotation of the earth, assuming he travels east to west (which seems logical). This works out to 822.6 visits/second.
  • This is to say that for each Christian household with good children, Santa has .001 seconds to park, hop out of the sleigh, jump down the chimney, fill the stockings, distribute the remaining presents under the tree, eat whatever snacks have been left, get back up the chimney, get back into the sleigh and move on to the next house.
  • Assuming that each of these 91.8 million stops are evenly distributed around the earth (which of course, we know to be false but for the purposes of our calculations we will accept), we are now talking about 0.78 miles/household, a total trip of 75.5 million miles; not counting stops to do what most of us must do at least once ever 31 hours, plus feeding etc.
  • So Santa’s sleigh must be moving at 650 miles/second, 3,000 times the speed of sound. For purposes of comparison, the fastest man-made vehicle on the earth, the Ulysses space probe, moves at a poky 27.4 miles per second. A conventional reindeer can run, TOPS, 15 miles/hour.
  • The payload on the sleigh adds another interesting element. Assuming that each child gets nothing more than a medium-size Lego set (2 lb.); the sleigh is carrying 321,300 tons, not counting Santa, who is invariably described as overweight. On land, conventional reindeer can pull no more than 300 lbs. Even granting that “flying reindeer” (see above) could pull 10 TIMES the normal amount, we cannot do the job with 8, or even 9 reindeer. We need 214,200. This increases the payload – not counting the weight of the sleigh to 353,430 tons. This is four times the weight of the ocean-liner Queen Elizabeth!!!
  • 353,00 tons traveling at 650 miles/second creates enormous air resistance. This will heat the reindeer up in the same fashion as a spacecraft reentering the earth’s atmosphere. The lead pair of reindeer will absorb 14.3 QUINTILLION joules of energy…per second…each!!! In short, they will burst into flame almost instantaneously, exposing the reindeer behind them, and creating deafening sonic booms in their wake. The entire reindeer team will be vaporized within 0.00426th of a second. Meanwhile, Santa will be subjected to centrifugal forces 17,500.06 times greater than gravity, A 250 lb Santa (seems ludicrously slim) would be pinned to the back of this sleigh by 4,315,015 lbs. of force.
  • Therefore, if Santa ever DID deliver presents on Christmas Eve … he’s dead now.

Question 7

  • What is the name of this seasonal ophthalmological condition?

Festive Eye Condition

  • Christmas Eye
  • The infection creates a superficial ulcer over the conjunctiva and the cornea resulting in a painful stinging sensation and a temporary loss of vision.
  • It is a severe chemical reaction to plant and dust matter.
  • The infection usually only occurs in late November through to January
  • Also known as Alpine Eye

Question 8

  • Which syndrome characterised by the association of polycystic ovaries and incomplete emptying of the bladder associated with abnormal electromyographic activity?

  • Fowler-Christmas-Chapple syndrome [Reference]

Question 9

  • What is the most likely medical condition that afflicted “Tiny Tim” in Dickens’ 1843 novella “A Christmas Carol”?

  • Renal tubular acidosis (type I)
  • Unfortunately Dickens did not reveal what Tiny Tim’s illness was….and his multifaceted and implicitly reversible illness remains a mystery and open to debate and speculation.
  • However, it is possible to construct a differential diagnosis based on Tim’s short stature, asymmetric crippling disorder, and curious intermittent weakness that would (if untreated) lead to his death, within a period of 1 year.
  • Dr. Donald Lewis reviewed the pediatric texts from 1830 to 1850 to discover that the most common treatment plans of the time included
    • (1) General measures such as country air and exercise, and fish oils such as cod and halibut (vitamin D)
    • (2) Specific treatments of tonics (containing combinations of belladonna, opium, sodium bicarbonate, sodium citrate, and potassium chloride) emphasizing alkalis, and splinting and bracing the limbs.
  • Dr Lewis concluded that “treatments emphasising vitamin D and alkalinization with sodium bicarbonate and sodium citrate suggest the plausible speculation that Tiny Tim had renal tubular acidosis (type I)
  • RTA type 1 is a disorder characterized by growth failure and, if left untreated, complicated by osteomalacia with pathologic fractures, hypokalemic muscle weakness and periodic paralysis, nephrocalcinosis leading to renal failure, and death
  • Alternate conspiracists dictate that the most likely diagnosis is Rickets.
  • Either illness was treatable during Dickens’ lifetime, thus following in line with the comment of the Ghost of Christmas Present that Tiny Tim would die “only if the present remains unchanged.”

Question 10

  • Which year did “Santa Never Make it to Darwin” and why?

  • 1974
  • Cyclone Tracy

On Christmas Eve of seventy-four
The warning sounded out
For all the broadcast stations
A great storm was near aboutThe girls and boys asleep in bed
Tomorrow was the day
Their mums and dads all prayed
The mighty storm would turn awaySanta never made it into Darwin
Disaster struck at dawn on Christmas Day
Santa never made it into Darwin
A big wind came and blew the town away

SANTA NEVER MADE IT INTO DARWIN – (Bill Cate) Bill & Boyd – 1975

Question 11

  • By which name is Type IIIb jejunal atresia with agenesis of the dorsal mesentery, more commonly known?

Question 12

  • What is the eponymous name for Factor IX deficiency? Who was the eponymee?

  • Christmas disease or Haemophilia Type B
  • Named after Stephen Christmas (12 February 1947 – 20 December 1993) – the first patient described Haemophilia B in 1952 by a group of British doctors [Reference]

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