The 12 clinical questions of Christmas: A not-very-academic Yuletide Quiz

Pulse’s clinical adviser Dr Keith Hopcroft sets a festive Christmas clinical quiz. Unfortunately, it is unlikely to count towards your CPD (unless your appraiser has had one too many sherries)

What is haemophilia B, or Factor IX deficiency, also known as? (One point, and if you get this wrong, give up now)

With your knowledge of Santa, speculate on what cause, or causes, or contributory causes, you might put for death on his MCCD? (Up to six points)

Match the phobia to the definition (seven points):

Why would you advise a patient with narcolepsy not to pull a Christmas cracker? (Up to two points)

What is the connection between these two pictures? (One point)

In the original paper on Holiday Heart Syndrome (atrial fibrillation triggered by alcohol), what percentage occurred between Christmas Eve and New Year’s Day? (One point)

1. 2%
2. 5%
3. 10%
4. 17%
5. 22%

Which of the following titles are genuine published works of research, and which are ChatGPT fakes? (Seven points)

1. Dashing Through the Snow: The Risk of Orthopaedic Injuries During Christmas and New Year Holidays.
2. Christmas: an event driven by our hormones
3. A Comprehensive Analysis of Seasonal Diet Variations and Their Impact on Metabolic Syndrome.
4. The Company Christmas Party and Employee Happiness
5. Ho Ho Ho or Oh No No? The Psychological Impact of Christmas Music in Retail Workers.
6. Penile Fractures: the Price of a Merry Christmas
7. Bah Humbug! Association Between Sending Christmas Cards to Trial Participants and Trial Retention

This child may well have gobbled down his Christmas Pudding. So what can you see in the abdomen? And what would you do? And what joke does this enable you to make? (One point for each, so three points)

True of false? (One point for each you get right, so five points)

1. You are 50% more likely to die in a housefire over Christmas
2. On average, thirty people die each Christmas from (likely turkey related) food poisoning
3. December has the lowest number of suicides of any month
4. 1,000 people in the UK each year suffer Christmas tree related injuries
5. 350 people are hurt by fairy lights each year in the UK

What is this skin rash, and what connection does it have with Yuletide? (Two points)

It’s frosty – and icy – outside. Which are the five bones most likely to be fractured in a fall from standing onto the pavement? (Five guesses only and one point for each correct, total five points)

Cryptic ClinicoChristmas mash ups – each forms a misspelt diagnosis or clinical sign (tricky, so two points for each correct answer)

1. When a sparkling Christmas decoration causes a strep throat
2. A leafy adornment might be a key factor in peptic ulceration
3. Seeing the roast come out of the oven might make your heart race
4. Farm workers and lovers of unpasteurised cheese are at greatest risk of this rare disease caused by the least favourite Christmas vegetable
5. The abdominal sounds you hear thought the stethoscope in someone who’s swallowed a tree decoration

Answers:

1 Christmas disease – one point

2 Obesity, COPD (smoke from chimneys), diabetes, sleep apnoea, alcoholic-related (all that sherry), hypertension (obesity+alcohol) – max possible six points

3
Selaphobia – Fear of flashing lights
Syngenesophobia – Fear of relatives
Meleagrisophobia – Fear of turkeys
Chionophobia – Fear of snow
Pogonophobia – Fear of beards
Tarandophobia – Fear of reindeer
Interrogophobia – Fear of quizzes
(seven points)

4 Because cataplexy – a total loss of muscular control, which can lead to collapse, is a possible feature of narcolepsy. And this is typically triggered by excitement (anticipation of cracker), noise (the bang of the cracker), laughter (the joke in the cracker) and anger (the annoyance and getting the duff end of the cracker). A point if you mentioned cataplexy and a further point if you came up with any of the cracker-linked triggers.

5 Kissing – glandular fever is known as the ‘kissing disease’ – one point.

6 22% – one point
(Ref: Ettinger PO, Wu CF, De La Cruz C Jr., Weisse AB, Ahmed SS, Regan TJ. Arrhythmias and the “Holiday Heart”: alcohol-associated cardiac rhythm disorders. Am Heart J1978;95:555-62. doi:10.1016/0002-8703(78)90296-X pmid:636996)

7 a,c,e,: false (generated by ChatGPT)
b,d,f,g: true
One point for each correct
And a nod to BMJ for the original idea:
Ghost in the machine or monkey with a typewriter—generating titles for Christmas research articles in The BMJ using artificial intelligence: observational study
Robin Marlow, Dora Wood
BMJ 2021; 375: e067732 (Published 15 Dec 2021)

8 Coin swallowed within Christmas pudding (old tradition) – one point.
Observation would be reasonable, with the usual warnings – one point. (If foreign bodies are going to impact then they usually do so at the upper or lower oesophageal sphincter – and this has clearly passed beyond those points. So there is a good chance that it will be passed safely – one review suggested spontaneous passing of foreign bodies in 60.3% of cases).
Joke you can make:  ‘Let me know if there’s any change.’ (funnier when people used to use actual money) – one point, though deserves more.

9 All true – one point for each one you got right. Mind you, the source was the Daily Mail, so maybe all false. Give yourself the points anyway.

10 This is pityriasis rosea – one point
Christmas tree-distribution – one point; and a bonus point if you said the (Hark the) herald (angels sing) patch.

11 Distal radius, scaphoid, hip, ankle, clavicle – five points.

12
A. Tinsellitis
B. Hollycobacter pylori
C. Turkeychardia
D. Brusselosis
E. Baublerygmi
(Two points for each)

Total scores and rating:
0-10:  Ho-ho-hopeless
10-20: you’re a bit of a Christmas turkey
20-30: mid Christmas dinner table anonymity
30-40: an elfey score
40-50: go to the top of the Xmas tree

We originally listed Dr Keith Hopcroft as clinical director. We have updated this to reflect he is Pulse’s clinical adviser. Looks like we had one too many sherries ourselves…