Shout it out
Know Your Drugs
Odd names
Symptomatology
Dr. House level
Picture Hints
Final Jeopardy
100
Electrolyte abnormaltiy?
Hyperkalemia
100
What drug was previously known as “The Devil’s Lettuce”
Cannabis
Harry Anslinger from the Federal Bureau of Narcotics began demonizing cannabis from the 1930s. One piece of anti-cannabis propaganda was a 52-minute film titled “Devil’s Harvest”, this is in stark contrast to it being in the US Pharmacopeia in the 1850s as a herbal remedy. Anslinger also referred to it as “marihuana” to play a xenophobic sentiment to Mexican immigrants (so try not to use the term marijuana).
In a little sense of irony, Anslinger, from being head of the Federal Bureau of Narcotics, required regular doses of opiates to control his angina towards the end of life.
100
12 young females present to your emergency department all within the space of 2 weeks complaining of tingling and burning on the lateral aspect of their thighs. One girl wonders if this is the start of MS after a google doc consult as it appears to come and go lasting hours at a time.
You correctly diagnose them with Bernhardt–Roth syndrome, what is the other name/cause of these symptoms?
Meralgia paresthetica
Meralgia paresthetica is a painful mononeuropathy of the lateral femoral cutaneous nerve (LFCN) that manifests clinically as numbness, burning, itching, or pain over the anterior and lateral aspects of the thigh
100
What is ‘Bendopnea‘?
Shortness of breath when leaning forward.
100
Which drug can treat pericarditis, Behçet disease and Familial Mediterranean fever and is also used to produce seedless watermelons?
Colchicine
100
One for the cardiologists..
Wolf | Parking son | White (flag)
Wolff-Parksinson-White syndrome (WPW)
200
What is this condition?
Dupuytren contracture
200
What does ‘chasing the dragon’ refer to?
Smoking heroin
The practice of ‘chasing the dragon’ was first recognized in Hong Kong in the 1950s. Heroin is placed on a piece of aluminium foil, heated with a flame from below, and the resulting vapour is “chased” and inhaled with a straw or other tube. The rippling effect of the drug fumes in the air is often likened to a dragon’s tail.
200
How many Ramsay Hunt Syndromes do you know? Just want the number
3
Ramsey Hunt syndrome 1 is also called Ramsay Hunt cerebellar syndrome, a rare condition secondary to cerebellar degeneration with causes myoclonic epilepsy, progressive ataxia and tremor.
Ramsay Hunt syndrome type 2 is the herpes zoster infection of the geniculate ganglion. A triad of ipsilateral facial paralysis, ear pain and vesicles on the face or around the ear is classic
Ramsay Hunt syndrome type 3 is an occupational induced neuropathy. It is caused by damage to the deep palmar branch of the ulnar nerve (in Guyon’s canal) causing weakness and wasting of the small muscles in the hand.
200
What is ‘sphenopalatine ganglioneuralgia‘ more commonly know as?
‘Brain freeze’ or ‘ice cream headache.’
200
A young male presents with an all-over body rash and burning sensation. He took a whole kitchen full of supplements for a pre-workout mix. He’s never been allergic to anything before and the rash has just given him widespread redness. No urticaria, no wheeze or throat symptoms.
Caffeine tabs are not in the mix. As you sift through the 25 different tabs he’s taken his rash resolves and he feels better more than 2 hours after he took the supplements.
What common supplement caused this flushing phenomenon?
Niacin (nicotinic acid vitamin), or vitamin B3
200
One for the GI peeps..
Boar – Halve
Boerhaave syndrome
Boerhaave syndrome: spontaneous oesophageal rupture resulting from sudden increased intra-oesophageal pressure. Most commonly associated with emesis with incomplete cricopharyngeal relaxation.
Anyone know the classic triad of esophageal rupture?
300
What is shown in the electron microscope image below?
kidney stone
300
Which drug is named after the Ancient Greek god of dreams?
Morphine - named for Morpheus – the Greek god of dreams
1803 Freidrich Sertürner a 21-year-old pharmacist’s assistant isolated an organic alkaloid from the opium poppy plant. Through some self-experimentation, he found it was a significant pain reliever and also made subjects sleepy and the name for this new compound was morphine.
300
Developing after a thalamic stroke, What is a principle symptoms in Déjerine syndrome?
Pain
Better known as Dejerine-Roussy syndrome or thalamic pain syndrome. It is a condition that develops after a thalamic stroke. As initial stroke symptoms dissipate, an imbalance in sensation develops. Some patients develop persistent cutaneous hyperaesthesia or severe persistent or paroxysmal intolerable pains on one side of their body.
300
What is a ‘cafe coronary’?
Complete and abrupt upper airway obstruction by a bolus of food, often meat, which occludes the esophagus and larynx, so named as the sudden onset of symptoms simulates acute myocardial infarction
300
Your patient in ICU has been there a month with multiple complications post sepsis and is finally feeding again. The nurses are concerned he seems to be acting drunk after every meal so order an alcohol level which comes back positive. All staff are pondering where he got the alcohol from. He has no visitors, he can’t get out of bed and no iatrogenic source has been identified.
What syndrome do they have?
Auto-brewery syndrome (ABS).
Also known as gut fermentation syndrome.
- Malik F, Wickremesinghe P, Saverimuttu J. Case report and literature review of auto-brewery syndrome: probably an underdiagnosed medical condition. BMJ Open Gastroenterol. 2019 Aug 5;6(1):e000325
300
For the psychiatrists...
Catatonia
400
What is this? Hint: Famous med-fluencer
GlauComflecken
small anterior subcapsular grey-white fleck-like opacities secondary to lens epithelial cell necrosis.
Glaukomflecken changes are usually seen after an episode of acute primary angle closure (APAC attack), which refers to an eye with a narrow anterior chamber angle that is acutely closed, resulting in marked increases in intra-ocular pressure.
400
What profoundly useful drug did dentist Horace Wells discover whilst visiting a sideshow in 1844?
Nitrous Oxide
Horace had gone to see the show exhibiting nitrous oxide put on by the American showman (and former medical student) Gardner Quincy Colton. Wells noticed at the time that one of the participants injured their leg whilst jumping about under the effects of the nitrous oxide but exhibited no pain.
The following day Wells invited Colton to his dentistry practice where he himself was given the nitrous, and had a colleague extract one of his teeth. Wells felt no pain during this procedure and thus began his feverish endeavors in both self experimentation, analgesia and procedural sedation.
400
Where would you find Rokitansky-Aschoff sinuses?
Hint: its a "storage tank"
In the gallbladder.
Named after the pathologists that discovered them in the 1800s, Karel Freiherr von Rokitansky (1804-1878) and Karl Albert Ludwig Aschoff (1866-1942). They are diverticula of the gallbladder wall, which can be microscopic or macroscopic. They are not considered to be worrisome per-se but represent chronic inflammation from cholecystitis. They can mimic gallbladder adenocarcinoma.
400
Where is your pain if you experience Texidor’s twinge?
Chest
The Texidor twinge, better known is precordial catch syndrome, is a benign and quite common yet underrecognized cause of chest pain in children and adolescents. The syndrome has a remarkably consistent, characteristic presentation and is therefore easily diagnosed.
400
A 41-year-old woman presents with a right frontotemporal headache and drooping of the right eye. The previous day she rode a roller coaster ride. Examination revealed a right Horner syndrome with ptosis, meiosis, and no anhidrosis. What is the diagnosis?
Roller Coaster Stroke (carotid artery dissection to be precise)
Roller coaster rides can generate force in excess of 4 “Gs,” which in combination with neck movements could potentially rip the carotid intima. Distension of the injured arterial wall compresses the adjacent sympathetic fibers, resulting in a Horner syndrome, which is typically without anhidrosis, in lesions above the bifurcation, where the fibres supplying the face leave to traverse with the external carotid artery.
The phenomenon of roller coaster stroke doesn’t just have to involve the carotid artery it can also involve the vertebrals. These phenomena mainly occur in a younger population without stroke risk factors. It is important to ask about minimal trauma weeks before an incident including minor MVAs (not just roller coaster rides) and for some, they can be unlucky and have spontaneous dissections.
400
Seen in kids
Kawasaki Disease
500
Name this finding
Lung pulse
500
What substance, which has an opioid potency 100 times that of heroin, and can be visibly mistaken for cocaine when in powdered form?
Nitazenes
2-benzyl benzimidazole, nitazene, opioids were first developed in the 1950s as analgesics, but were found to be so potent they were never approved or marketed as medicines. Since 2019, they have re-emerged within illegal drug supplies in the United States, UK and other European countries.
Relatively cheap to produce, nitazenes can range from tens to many hundreds of times more potent than morphine, thus create a profoundly high risk of overdose. Though nitazenes are structurally unrelated to other opioids, they bind with the mu-opioid receptor; thus create the predictable analgesia and euphoria. Nitazenes also suppress the respiratory system, which can result in death, but the effects are seen at much lower doses.
Steps taken by the Taliban to dramatically cut opium production in Afghanistan prompted the appearance of nitazenes on the European heroin market. She adds that nitazenes have also been detected in cocaine and synthetic cannabis, known commonly as ‘spice’, as well as counterfeit medicines, including benzodiazepines and oxycodone.
500
What are Maydl’s, Littre’s, Amyand’s and pantaloons types of?
Hint: other types include Spigelian and obturator
They are all types of hernia
Pantaloon is only really diagnosed during the operation when the surgeon discovers both an indirect and direct inguinal hernia.
Maydl’s hernia. Two small bowel loops within a single hernial sac, that is, there are two efferent and two afferent loops of bowel, forming a “W” shape. Often resulting in strangulation of the middle section, if not all, bowel within the hernial sac. If not acted on promptly has a high rate of complications.
Littre’s hernia is one containing a Meckel’s diverticulum. Named after French physician and anatomist, Alexis Littre (1658-1726). First described in Observations sur une nouvelle espèce de hernie in 1700
Amyand hernia: rare inguinal hernia with the appendix in the hernial sac. Named after French surgeon, Claudius Amyand (c1680–1740)
500
Where is your pain if you are affected by Kounis Syndrome?
The heart (most commonly presenting as a STEMI).
Kounis syndrome, named after a Greek cardiologist Nicholas Kounis who described the phenomenon in 1991 as a histamine-induced coronary artery spasm. Hypersensitivity can be induced by exposure to drugs, food, environmental and other triggers like contrast media or unfortunately coronary stents. The most common manifestation is allergic acute coronary syndrome (referred to as ‘allergic angina’), which is most frequent in middle aged men. Three main variants exist:
- Vasospastic allergic angina.
- Allergic myocardial infarction.
- Stent thrombosis with occluding thrombus that is infiltrated by eosinophils and/or mast cells.
500
63 year old lady who’s been complaining of ‘feeling full’ for the past 3-4 months. On examination you note a roundish abdomen and a nodule in her umbilicus. What is top of the differential?
Cancer
Sign observed in the umbilicus is the ‘Sister Joseph nodule‘ (1928)
Metastatic carcinoma of the umbilicus characteristically associated with adenocarcinoma from the stomach, large bowel, ovary, or pancreas. For many patients the nodule is the first sign of malignancy.
500
One for the surgeons/proceduralists..
Bier block technique provides analgesia, muscle relaxation and a relatively bloodless field. It involves injection of local anaesthetic into the venous system of an extremity which has previously been exsanguinated by gravity or compression. The local anaesthetic diffuses into the surrounding nerves. Local ischaemia, caused by the tourniquet, contributes to the analgesic effect.
500
Samuel Shem wrote this in what book?
"There is no body cavity that cannot be reached with a number fourteen gauge needle and a good strong arm"
House of God
Laws of the House of God:
- GOMERS don’t die.
- GOMERS go to ground.
- At a cardiac arrest, the first procedure is to take your own pulse.
- The patient is the one with the disease.
- Placement comes first.
- There is no body cavity that cannot be reached with a #14G needle and a good strong arm.
- Age + BUN = Lasix dose.
- They can always hurt you more.
- The only good admission is a dead admission.
- If you don’t take a temperature, you can’t find a fever.
- Show me a BMS (Best Medical Student, a student at The Best Medical School) who only triples my work and I will kiss his feet.
- If the radiology resident and the medical student both see a lesion on the chest x-ray, there can be no lesion there.
- The delivery of good medical care is to do as much nothing as possible.