The Staghorn Challenge

You may remember that Professor Staghorn was recently inaugurated as the newest member of the UCEM Council Executive. Hidden in Prof Staghorn’s 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’. He is:

Leon Gussow

of The Poison Review fame

[WARNING: Spoiler alert - if you want to try the challenge for yourself, you need to read this first.]

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

  1. iliacus
    - one 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. Struvite
    - refers to kidney stones that contain calcium magnesium phosphate, and that may form staghorn calculi.
  4. Staghorn
    - struvite-containing kidney stones that are named for their appearance, and are associated with infection.
  5. calyxia
    - the calyces (plural of calyx) are tubes that collect urine into the renal pelvis from which the ureters arise.
  6. uretica
    - the 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. calculus
    - the branch of mathematics that shares its name with the medical term for stone.
  9. candiru
    - the 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. crystal
    - crystals 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) Stones
    - if only they did…
  13. ejaculated
    - a term used to describe an event considered important by most urologists.
  14. p*sshead
    - a hint: * means ‘i’.
  15. grown men cry
    - a common end result of kidney stones.
  16. (slow) passage
    - the 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. caustic
    - struvite stones are associated with alkaline urine (pH >7.5).
  19. CT
    - non-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-splitting
    - a 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. Urologist
    - a type of medically-qualified plumber with an interest in unblocking the pipes that pass urine.
  5. Protean
    - Struvite 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) loin
    - the 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 Patrol
    - could 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 FUCEM to his list of credentials.

But wait, there’s more…

UCEM have also decided to reward the exceptionally lateral thinking of

Robyn Flach

who came a close second to Leon in ‘The Staghorn Challenge’. Robyn will be able to bask in the eternal glory of being the first Fellow of UCEM to have no medical qualifications whatsoever!

Congratulations Leon and Robyn!… and relax – Prof Stickler has exempted you from the viva voce exam. You will be forwarded your diploma and fellowship paraphernalia at UCEM’s bureaucratic leisure.

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