The Case of The Missing Eponym
A Clinical Case: by Eve Purdy
An otherwise healthy 44 y/o male presents with R ankle pain and inability to weight-bear after falling off a horse. The exact mechanism of injury (external/internal rotation or pronation/supination) is unclear. R ankle is diffusely swollen with tenderness over the tip of the medial malleolus. Neurovascular intact. He has no other injuries.
The important historical fact that this man was thrown off a horse and positive screening with the Ottawa ankle rules which make me think that he needs an x-ray. I present to the attending with this plan.
After discussing our fear of horses, she agrees and we order the ankle series. This is more or less what we get back.
A perfectly normal looking ankle…on x-ray at least →
There is no way- I don’t believe it. I express my surprise at the negative x-ray given the patient’s presentation to the attending and she asks, “well did he have any proximal fibula tenderness?”. I had checked, and he did.
← So we order an AP proximal fibula. This is what we get next.
A spiral fracture of the proximal fibula. So now we are working with: medial malleolar tenderness, bruising and swelling and a fibula fracture.
With the new knowledge in mind we review the original ankle films and are able to convince ourselves (maybe with a little confirmation bias) that the joint space might be a tiny bit wide.
Nothing like some more impressive Maisonneuve’s that look like this →
We consult ortho and sure enough they agree. He is scheduled for follow up, and likely surgery (necessary for most Maisonneuve fractures) the next day.
A discussion of the treatment is beyond the scope of this article but a nice review of evidence-based management of this injury can be found here.
So what about the Eponym?
This whole clinical encounter would have been much smoother if I had just known the eponym.
At the time I didn’t know what a Maisonneuve fracture was. I knew enough to look for proximal fibula tenderness in my initial physical exam because I had remembered learning something about energy transfer through the interosseous membrane in ankle injuries, but I couldn’t put it all together. I didn’t know the words to describe what I was worried about. The word Maisonneuve would have really helped me express what I was thinking.
In the online Clinical Problem Solving course through Coursera you can learn about the importance of problem processing. The importance of taking a patient’s complaint and turning it into medical language that triggers our memory about the condition and that allows us to communicate efficiently.
I know they are a hot subject but like it or not in this case and for many other conditions eponyms are an important part of problem processing.
Instead of sending the patient back and forth to x-ray and taking up time and space in a busy ED if I had said the first time, “I am worried about a Maisonneuve fracture” he could have had both x-rays at once.
What is an Eponym?
If you are, or ever have been a PA student and you are not familiar with eponyms then you just may be living under a rock.
"Eponyms" is best known as an app that gives a short description of more than 1,700 common and obscure medical eponyms.
Medical eponyms are terms used in medicine which are named after people (and occasionally places or things). New discoveries are often attached to the people who made the discovery because of the nature of the history of medicine. This has produced a large number of medical eponyms:Wikipedia
Why are Eponyms Important?
The case above gives a beautiful demonstrations of why knowing medical eponymous can save dollars, unnecessary testing and even lives.
The Daily Eponym on your iPhone
Eponyms come up all the time, they are hot topics during preceptor pimping sessions on your PA school rotations and they make excellent post rotational and PANCE or PANRE exam questions.
In the old days when I was toting around my beloved palm zire 71 eponyms was one of the most talked about and downloaded (or "beamed" - shout out to my fellow gen X'ers out there) of every medical students arsenal. Well that, and the infamous Palma Sutra 🙂
The problem with eponyms is that there really are only a handful of those 1,700 medical terms that are important to know and seem to come up all the time.
So, in the spirit of the daily PANCE and PANRE I wanted to do something for all you hard working, nose to the grindstone PA students out there (and maybe even help save a life along the way). And with this intention I am delighted to bring to you The Daily Eponym.
This is an email series designed to do exactly what it sounds like, send you an eponym a day to your inbox for the rest of your life. (ok not really, but until I run out of good ones to send you)
Who knows, you might wake up one day to the answer that will save you from your next surgical rotation pimp session (read the section about "ego dementor's" and doctor Dick) or make that inspirational diagnosis that you can tell at dinner parties.
Better yet, it is FREE!
You can sign up to start the series using the form at the top of this post.
When you know everything, or you are just sick of it, cancel your subscription, I won't be hurt although don't blame me if you miss that surprise question about The Apley Scratch Test.
View all posts in this series
You may also like -
- Free PANCE and PANRE Board Review – Email Series
I am super excited to announce my Free Daily PANCE and PANRE board review email review series.
It's 60 days of PANCE and PANRE Board Review Questions and Answers delivered directly to your inbox.
It is an easy and fun way to […]
- The Physician Assistant Job or PA School Interview – Email EtiquetteThe following is an excerpt from the book Cut the Crap, Get a Job! a New Job Search Process for a New Era. In preparation of your next job or PA school interview I will be running a series of excerpts from this book over the next few […]
- The Audio PANCE and PANRE Board Review Podcast Episode 9
Welcome to episode 9 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.
The Audio PANCE and PANRE is an audio board review series that includes 10 Multiple Choice PANCE and PANRE Board Review Questions in […]