Dr. House

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*sigh* No effort. I'm disappointed. First part was really easy, I'm surprised sp0rky or blocky didn't get it. High fever was the first indication that it's infection. Low blood pressure + hypoglycemia + Disseminated Intravascular Coagulation (DIC) = classic triad indicating Septic Shock due to the infection. Part II was an inherited immunodeficiency characterized by low neutrophils, history of repeated infections, internal bleeding due to low platelet count. In this case, the patient is experiencing the accelerated phase, which usually occurs later on in childhood. It's characterized by uncontrolled histiocyte division and deposition into random organs, leading to multi-systemic failure. The condition as a whole is known as Chediak-Higashi Syndrome. It hasn't been an episode of House, but a rare condition like this, I wouldn't be surprised if it did show up as the final diagnosis at some point.

They lost a horse to the economic crisis, too hard to maintain. They also lost CJ . Two or three others also recently left, if I remember correctly.

That is correct. Rikioh, for example, is far buffer and has a higher lean body mass than anyone I know here.

Come on, noone wants to give this case a try?

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No can do, just send me an PM on the forum and I'll get back to you.

If you're like ataraxia, lay off the black hookers and get meds for STDs.

I come up with them myself, based on literature on past medical cases involving certain diseases.

Actual red blood cells in the urine, not just porphyrin compounds. It's not porphyria.

Would present as low CD4 cells and macrophages rather than low neutrophils.

This will be a two part case, the first part being easier, and the second part being much harder. Patient, 16 year old girl, admitted to the ER complaining of a severe fever, severe disseminated rash, fainting, and severe back pain. On physical examination, the patient looked extremely pale and her blood pressure had dropped to 64/38. On auscultation, blood flow sounds indicative of renal artery thrombosis. Percussion of the abdomen revealed an enlarged liver and spleen. An angiogram revealed multiple clots forming in the renal arteries. Ultrasound revealed the presence of fluid in the peritoneal cavity, indicative of internal bleeding. Blood Tests revealed the following: Low Neutrophil count Elevated Histiocyte count Low Platelet count Low RBC count Glucose - 41 mg/dl ALT - 87 AST - 69 The ER doctors recognized the acute symptoms and admitted the patient to be treated appropriately. Two days after presentation, the patient's blood pressure returned to normal and fever dropped. Part I - What did the acute symptoms suggest about the patient and how did the doctors treat the patient to get their fever back down and blood pressure back up? During the time that the patient was recovering, a more complete medical history was obtained from the parents. This revealed the following: Past Medical History - Patient has been hospitalized multiple times in the past for severe infection and in the past 12 months alone, has had six cases of Staphylococcus infection. Patient has a history of anemia and has always been extremely pale, almost to the point of albino. Medical records from past hospital visits report that the patient had low neutrophil count, elevated histiocyte count, low RBC count, and low platelets. Parents report the their daughter is eating healthy and takes a daily multivitamin with no history of anorexia or any other sort of eating disorder. They report that she does not smoke, drink, or use any sort of illicit drugs, and a Tox screen confirms this. Two days later, the internal bleeding stopped and fluid was drained from the peritoneal cavity. Just when the patient seemed to be in the clear, however, the patient suddenly appeared jaundiced and became disoriented as to where she was and why she was in the hospital. Her urine revealed large amounts of RBC. Coughing that morning also revealed blood in the sputum. Blood was drawn and revealed the following: Elevated direct and indirect bilirubin, severely elevated ALT and AST levels, elevated BUN, elevated creatinine. Low platelets, low neutrophils, elevated histiocytes. ANA is negative (It's not Lupus) An T2 MRI was ordered of the upper abdomen, revealing regions of hypoxia in the kidney (expected from the previous arterial clotting) but also unknown deposits in the kidneys, liver, and the spleen, which continued to appear severely enlarged. Similar deposits were found when a scan of the patient's lungs was performed. A liver biopsy was ordered, revealing benign histiocytosis that was phagocytosing erythrocytes. Part II - Taking the patient's past medical history into account and the newest set of developments, what is your final diagnosis of the patient?

Also, my DDx for this person, defective Orbitofrontal Cortex.

Post pictures of yourself smearing that shit all over your cock.

Yeah, I'm not going to lie, that was a pretty bad episode. I watch it mostly because you can actually learn stuff from the stuff they talk about, such as ways of testing for certain tumors and clots. Problem is that House is starting to follow suit with the other medical shows and become more involved in the drama aspects of the show. It makes sense why they would do it, because with the exception of people in the medical field like me, most people who watch the show won't really understand 50% of what they're even talking about. A lot of people may have stopped watching because of that, and so like every other doctor show on TV, it's starting to steer towards stuff that more people can relate to or find interesting, like the character's personal problems. In all honesty, I really hope that it gets back to its previous state, cause if I wanted to watch a bunch of doctors talk about their relationship and mental problems, I'd go watch Gray's Anatomy.

I think so. I have no idea who the person is, but to the best of my knowledge, it's not CP.

http://tunteella.xerc.biz/dump/00022018.jpg Happy Birthday

^^ Ulcerative colitis, Crohn's Disease, hemorrhoids, anal fissures, colorectal cancer, or diverticulitis.

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Donkeys everywhere approve your entry into myg0t http://tunteella.xerc.biz/dump/00021787.jpg

http://terribleanalogies.com/blog/wp-content/uploads/2009/01/grinds_my_gears.jpg This swine flu craze that's going on here in the U.S. The swine flu is pretty much a newer unexpected version of the normal seasonal flu virus. Out of hundreds that have been infected in the U.S., only one person has died, and that was a Mexican toddler. All of the people who died in Mexico from this flu were most likely malnourised or immunosuppressed in some way. Yet, thank the News broadcasting companies here in the U.S. for all their "efforts" to help. Thanks to them, medical masks are backordered all over the U.S. and the number of unnecessary perscriptions for neuraminindase inhibitors have shot up exponentially. I don't even want to think about the increase in resistant strains of the flu against drugs like Tamiflu after these few months. People are treating this swine flu like it's ebola.

I am ashamed to say that ataraxia was able to track me down earlier today and forced me to hang out with him. He threatened that he would keep hiring black hookers to come knock on my door unless I hung out with him today and posted pictures of what we did today. Hence, here's a picture of me at my apartment: http://i39.tinypic.com/24dr39u.jpg

Damn. I even did a forum search for screwdriver to make sure and it didn't come up. Feel free to delete if you want.

http://www.efukt.com/2452_1_Guy_1_Screwdriver.html

Good job with the cervical vertebrae. The name of this constellation of syndromes is probably not familiar to everyone. It's called Brown-Sequard Syndrome, which is a spinal cord lesion, either by tumor (unlikely due to it being rapid onset), physical injury, or ischemic stroke (most likely in this case). If you do a CT scan, you'd find a hypodense region on the right side of the spinal cord. T2 MRI would most likely present with a hyperintense region at the same location correlating to cytotoxic edema that usually follows an ischemic stroke. Needle prick is testing the pain and temperature sensory function. The way the spinal cord is organized is that two point distinction, proprioception, and touch sensation travels in the DWC of the ipsilateral spinal cord, while pain and temperature sensation travels contralaterally. That's why the patient could not feel pain on the left side of his body. EDIT: To be exact, it'd have to be at around C4 or above, as C5 and below contribute to sensory and motor function of the upper limb. Also, I told you guys this was a simple case.