Part 5 of 5: If I could be a doctor...
If I could be a doctor (I could, and I am), I would have to periodically update my Continuing Medical Education (CME) and my certification to prove to myself, my patients, and various government agencies that I still know a thing or two about a field that changes all the time.

Being a horrible procrastinator, I always fall very far behind with anything that isn't due in the next eight minutes. So with CME which is due every two years, I've fallen about two years behind, and with recertification, I don't even want to talk about it. So after a kick in the pants helpful encouragement from ball-and-chain and Psychotoddler, I sat down and scheduled specific times in which I would catch up on my educational obligations.

The nice thing is that nowadays I can do all of it on the web. A Giant And Highly Reputed Internal Medicine Organization has a series of open-book tests that we have to take. We're allowed to use any information source, even colleagues. The goal isn't to trick us to get the wrong answer; the goal is to make us learn some medicine while searching for the right answer.

Let's work through a question together, shall we?

Question 5

Two men dined at a restaurant where they each had onion soup, a salad, grilled tuna, steamed vegetables, cheese, and coffee.

What? Hold it right there! This is an important clue. Grown men only go out to dinner and share all of their dishes if (1) they are at a Chinese restaurant (not that there's anything wrong with that), or if (2) they are lovers (not that there's anything wrong with that). Since they are clearly not having Chinese food, we must deduce that they are sharing bodily fluids. Immediately I skip the rest of the question and look at the choices to see if any of the choices are diseases which are more common in men who "go out to dinner" with men.

Which of the following is the most likely cause of their symptoms?

(A) Scombroid fish poisoning
(B) Ciguatera fish poisoning
(C) Clostridial food poisoning
(D) Bacillus cereus food poisoning
(E) Reaction to tyramine

Huh!? Not only, as far as I know, aren't any of these especially prevalent in very well dressed men who accessorize, but I've never even heard of A, B or D. Looks like I'll have to actually read the rest of the question.

Two men dined at a restaurant where they each had onion soup, a salad, grilled tuna, steamed vegetables, cheese, and coffee. They shared a bottle of wine.

Hmmmm... Still sounds romantic to me, and red wine can cause a idiosyncratic tyramine reaction. OK. Keep reading.

As they completed the meal, both men began to have severe headache, intense flushing, urticaria, palpitation, nausea, and abdominal cramping. One man also had bronchospasm and tightness of the throat.

Which of the following is the most likely cause of their symptoms?

Ahhh… It looks like the whole homoeroticism thing was a red herring. The reason we are told that two of them dined together is because they both got sick, so that eliminates idiosyncratic reactions. Cross out E. So they both got sick because they got some kind of food poisoning, but of A through D, I've only heard of C, and this is nothing like it. They're having a histamine reaction. Looks like I need help from the website of Yet Another Giant And Highly Reputed Internal Medicine Organization. Let's see if they can point me to an article. Aha! Look at this:

Infectious Disease Clinics of North America 1987 Sep;1(3):665-76.

Intoxications from the seas: ciguatera, scombroid, and paralytic shellfish poisoning

There's an article you don't read everyday.

Sporadic cases and outbreaks of intoxications borne by fish and shellfish have increased in frequency during recent years. Ciguatera, scombroid, and paralytic shellfish poisoning account for nearly 16 per cent of all reported foodborne outbreaks of disease in the United States.

Blah, blah, blah. Skim...

Scombroid fish intoxication resembles histamine poisoning and may be treated effectively with antihistamines.

Yay! The answer is A!

Only 55 more questions to go.

And that completes the fascinating "If I could be…" challenge that Psychotoddler punished me with. So to which three lucky slobs do I pass the plague challenge? To no one. My conscience is clean. I'm taking this little socially transmitted disease to the grave with me.

- served up by Doctor Bean @ 4:32 PM