Author: Kristopher Maday PA-C

Ep-PAINE-nym

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Epstein-Barr Virus

Other Known Aliases – Human gammaherpesvirus 4

Definition – double-stranded DNA herpes virus that infects B lymphocytes and epithelial cells and has both active replication and latency periods that can cause disease

Clinical Significance – known to the be the causative pathogen for infectious mononucleosis, it is also associated Burkitt’s lymphoma, Hodgkin’s lymphoma, and other various other diseases and cancers. It is transmitted through oral transfer of saliva and genital secretions

History – Named after Sir Michael Anthony Epstein (1921-), a British pathologist who received his medical doctorate from Cambridge University, and Yvonne Barr (1932-2016), an Irish pathologist who received her PhD from the University of London in 1966. Upon hearing a lecture by Denis Burkitt in 1961 on a new endemic cancer in Africa, the former decided to change his career path to search for the cause of this cancer. After working for two years on tumor cells from this cancer, he, with the help of the later as a PhD student, finally isolated the virus cell lines and published their preliminary findings, with colleague Bert Achong, in the Lancet in 1964.

References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. EPSTEIN MA, ACHONG BG, BARR YM. VIRUS PARTICLES IN CULTURED LYMPHOBLASTS FROM BURKITT’S LYMPHOMA. Lancet. 1964; 1(7335):702-3. [pubmed]

PAINE #PANCE Pearl – Pulmonology

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Question

A 68yo man, with a history of COPD and 57-pack-year history of smoking, presents to the office with worsening shortness of breath on exertion, dizziness, and leg swelling over the past 6-months. He states that his inhalers don’t seem to be helping as much and he is finding it more and more difficult to walk without getting breathless. He denies orthopnea, paroxysmal nocturnal dyspnea, or increased cough. Vital signs show BP-157/98 mmHg, HR-88 bpm, RR-23 bpm, O2-90% on room air, and temp-98.9o. Physical examination reveals (+) JVD, widened split S2, 1+ pitting edema of the legs to the knee, and hepatomegaly. EKG is below.

  1. What does the EKG show?
  2. What is the diagnosis?
  3. What is the next step in evaluation?
  4. What is the definitive diagnostic study for this condition?

Answer

  1. The EKG shows numerous findings of chronic pulmonary disease including:
    • Right axis deviation
    • Peaked P-waves (>2.5mm) in inferior leads (II, III, aVF)
    • Clockwise rotation of the heart with delayed R/S transition point
    • Absent R-waves in right precordial leads (V1-V3)
    • Low voltage left sided leads
  2. Given the absence of left sided heart failure and the patients extensive pulmonary history, the presentation is highly suggestive of pulmonary hypertension with cor pulmonale.
    • Cor pulmonale is a complication of pulmonary hypertension and is defined as structural alterations or impaired function of the right ventricle
  3. The next step in evaluation of this patient is getting an echocardiogram to evaluate global heart function and degree of pulmonary hypertension present
  4. The definitive diagnostic study of pulmonary hypertension and cor pulmonale is a right heart catheterization.

References

  1. https://litfl.com/ecg-in-chronic-obstructive-pulmonary-disease/

Ep-PAINE-nym

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Schamroth Test

Other Known Aliases – none

Definition – test used for diagnosing nail clubbing by examining the window seen between the nails of opposite fingers

Clinical Significance – there should be a diamond size window in “normal” nails when performing this test. In patients with nail clubbing, this window is obliterated

History – Named after Leo Schamroth (1924-1988), a Belgium-born, South African cardiologist who received his medical doctorate from the University of Witwatersrand in 1948. He completed his residency at Johannesburg General Hospital and joined the staff at Baragwanath Hospital in 1956, where he would stay his entire career culminating in chief physician in 1972. He would publish over 300 papers and eight textbooks in the realm of cardiology, and his Introduction to Electrocardiography is still one of the most stolen medical textbooks in the world. He published his eponymous finding in an article entitled “Personal Experience” in 1972 in the South African Medical Journal.

References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. Schamroth L. Personal experience. S Afr Med J. 1976; 50(9):297-300. [pubmed]

PAINE #PANCE Pearl – Pulmonology

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Question

A 68yo man, with a history of COPD and 57-pack-year history of smoking, presents to the office with worsening shortness of breath on exertion, dizziness, and leg swelling over the past 6-months. He states that his inhalers don’t seem to be helping as much and he is finding it more and more difficult to walk without getting breathless. He denies orthopnea, paroxysmal nocturnal dyspnea, or increased cough. Vital signs show BP-157/98 mmHg, HR-88 bpm, RR-23 bpm, O2-90% on room air, and temp-98.9o. Physical examination reveals (+) JVD, widened split S2, 1+ pitting edema of the legs to the knee, and hepatomegaly. EKG is below.

  1. What does the EKG show?
  2. What is the diagnosis?
  3. What is the next step in evaluation?
  4. What is the definitive diagnostic study for this condition?

Ep-PAINE-nym

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Hippocratic Fingers

Other Known Aliases – clubbing of the fingers

Definition – soft tissue swelling of the terminal phalynx

Clinical Significance – this is a nonspecific clinical finding that can be caused by numerous diseases, but is classically associated with any disease that can cause physiologic hypoxia. The exact mechanism for development is unknown, but is theorized to be caused by vasodilation, secretion of growth factors, overproduction of prostaglandin E2, and increased entry of megakaryocytes.

History – Named after Hippocrates (460-370 BC), who was a Greek physician and is considered to be the “Father of Medicine”, due to his approach in observation of clinical diseases. Though I cant find an original source for this eponym, it is one of those historical “facts” that nobody really challenges.

References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com

Ep-PAINE-nym

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Foramen of Winslow

Other Known Aliases – omental foramen, epiploic foramen

Definition – anatomic passage between the greater sac and the lesser sac of the abdomen

Clinical Significance – there are four anatomic borders of this communication:

  • Anterior – hepatoduodenal ligament
  • Posterior – peritoneum covering the IVC
  • Superior – peritoneum covering the caudate lobe of the liver
  • Inferior – peritoneum covering the commencement of the duodenum and hepatic artery

History – Named after Jacob Winslow (1669-1760), a Danish-born French anatomist who received his degree from Ole Borch’s College in 1693, while training under barber-surgeon Johannes de Buchwalde. He would concentrate on anatomy, instead of surgery, as the site of blood “alarmed him”. He would go on to train with many of the most revered surgeons and anatomists of his time while traveling Europe and was widely regarded as the greatest European anatomist of his day. His career would culminate in achieving professor anatomicus and full professor of anatomy at Jardin du Roi in 1743. His most famous work entitled “Exposition anatomique de la structure du corps humain” was published in 1732 and was the quintessential anatomical text of the mid-1700’s

References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. WInslow JB. Exposition Anatomique de La Structure Du Corps Humain. 1732 [link]

PAINE #PANCE Pearl – Surgery

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Question

A 37yo man is presenting to your practice to establish primary care. He reports a history of controlled inflammatory bowel disease and sees a gastroenterologist every 6 months. Before you begin your physical examination:

  1. What are some of the identifiable extraintestinal manifestations of inflammatory bowel disease

Answer

A simple mnemonic for the extraintestinal manifestations of inflammatory bowel disease is A PIE SACK:

  • Apthous ulcers
  • Pyoderma gangrenosum
  • Iritis
  • Erythema nodosum
  • Sclerosing cholangitis
  • Arthritis or Ankylosing Spondylitis
  • Clubbing of the fingers
  • Kidney (amyloid deposits, nephrotic syndrome)

Ep-PAINE-nym

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Pringle Maneuver

Other Known Aliases – none

Definition – surgical technique whereby the hepatoduodenal ligament is clamped to limit blood flow through the hepatic artery and portal vein to the liver

Clinical Significance – the specific technique is to insert an index finger through the foramen of Winslow behind the porta hepatis and pinch between the finger and the thumb. You can also slide a non-crushing clamp along the finger, or wrap a vessel loop around to occlude. This technique controls the majority of the blood flow to the liver and is used to control bleeding during liver surgery or after liver trauma.

History – Named after James Hogarth Pringle (1863-1941), who was an Australian/Scottish surgeon and received his medical doctorate from the University of Edinburgh Medical School in 1885. He would have a prestigious career pioneering management and treatments for long bone fractures, head injuries, malignant melanomas, and reconstructive arterial surgery using vein grafts. He would describe his eponymous maneuver in 1908 in an article in the Annals of Surgery entitled “Notes on the Arrest of Hepatic Hemorrhage Due to Trauma”. It should also be noted that he was a fervent advocate for women in medicine, allowing them in his clinic well before any of his colleagues, and becoming Lecturer in Surgery and Demonstrator of Anatomy at Queen Margaret College, which was one of the first medical schools for women in Scotland.

References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. Pringle JH. V. Notes on the Arrest of Hepatic Hemorrhage Due to Trauma. Ann Surg. 1908; 48(4):541-9. [PDF]

PAINE #PANCE Pearl – Surgery

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Question

A 37yo man is presenting to your practice to establish primary care. He reports a history of controlled inflammatory bowel disease and sees a gastroenterologist every 6 months. Before you begin your physical examination:

  1. What are some of the identifiable extraintestinal manifestations of inflammatory bowel disease

Ep-PAINE-nym

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Triangle of Calot

Other Known Aliases – none

Definition – anatomic space bordered by the cystic duct (inferiorly), common hepatic duct (medially) and cystic artery (superiorly)

Clinical Significance – this anatomic space is where you can see lymphadenopathy in patients with cholecystitis. This is often confused with the cystohepatic triangle (read more here).

History – Named after Jean-François Calot (1861-1944), who was a French surgeon and received his medical doctorate from Saine-Pe de Bigorre in 1880. He would go on to have a modest career in the field of orthopaedic surgery, and is known for describing the treatment of spinal deformities in Pott’s Disease. He would describe his eponymonic area in his doctoral thesis defense in 1891.

References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. Calor JF, De la cholécystectomie. Doctoral thesis, Paris, 1891.