It seems like the FFFF+F that was served up last week was a little too easy for some…
Well, this week we’ve cranked up the FFFF to a freakish fifty-five funtabs on the frivolometer.
Can you handle it?
Q1. What did King George II of Great Britain die of, and what was he doing at the time?
- King George II died while on the commode on October 25, 1760. His death was one of the first well documented cases of thoracic aortic dissection (see Die like a King).
- According to Horace Walpole‘s memoirs, King George “rose as usual at six, and drank his chocolate; for all his actions were invariably methodic. A quarter after seven he went into a little closet. His German valet de chambre in waiting heard a noise, and running in, found the King dead on the floor.”
- The King’s post mortem report in the “Transactions of the Royal Society” of 1761 read:
“The lungs were in a natural state, free from every appearance of inflammation or tubercle, but upon examining the heart, its pericardium was found distended with a quantity of blood nearly sufficient to fill a pint cup, and upon removing this blood a round orifice appeared in the middle of the upper side of the right ventricle of the heart, large enough to admit the extremity of the little finger. Through this orifice, all the blood brought to the right ventricle had been discharged into the cavity of the pericardium. The auricles and ventricles were found absolutely void of blood, either in a fluid or congealed state. The two great arteries of the right ventricle were stretched beyond their natural state and in the trunk of the aorta, we found a transverse fissure about an inch and a half long, through which some blood had recently passed under its external coat and formed an elevated ecchymosis. This appearance showed the true state of an incipient aneurysm of the aorta.”
- Aneursyms were often the end result of syphilis in those days….
Q2. What is the Windkessel effect?
- During systole the elastic fibers of the aorta allow the aorta to stretch and expand, during diastole retraction of the elastic fibers of the aorta help propel blood forward. The effect of this elasticity is the Windkessel effect, which results in a smoothing of the pulsatile flow through the aorta and a decrease in pulse pressure.
- Windkessel in German literally means ‘air chamber’.
Q3. A man with a past history of CABG for coronary artery disease has been taking his dog for a walk every day for years. The day after his dog dies he notices severe calf pain while walking down the street, that goes away with rest. What has he got and why is there a temporal relationship to the death of beloved pet?
- He has claudication from peripheral vascular disease as a manifestation of atherosclerosis.
- When he walked his dog he had to stop at every lamp-post so the dog could urinate. Without the dog he no longer rested before attaining his ‘claudication distance’.
- This was a favorite exercise in clinico-pathological correlation of Prof Koelmeyer of The Breakfast Club fame.
Q4. Usually women seeking medical assistance after condom has burst want emergency contraception or STD advice. But how might a burst condom explain why a woman presents with a profound metabolic acidosis with vasoconstriction and dilated pupils?
- She might be a cocaine smuggling mule!
- A condom packed with cocaine swallowed by a body packer may have these clinical manifestations if it bursts.
Q5. What diagnosis, named for a Frenchman, should be suspected in a patient with intermittent buttock pain and impotence?
- Leriche syndrome
- This is caused by aortic occlusive disease, occurring just proximal to the aortic bifurcation. The patient may also have cool, atrophied legs and absent femoral pulses.
- In yet another example of Stigler’s law, Leriche’s syndrome was actually first described by Glasgow’s Robert Graham in 1814, not Rene Leriche.
Remember kids… The lyrics to ‘I can sing a rainbow‘ must have been written by a bloke…