January 21, 200916 yr Okay, now it's starting to sound like an alien abduction. What are his EKG readings and anal probe results?
January 21, 200916 yr Author He's been exposed to something. Plain and simple. Examine his place of employment. Workplace is a typical office building, built around 10 years ago when the dot com boom took place. No signs of asbestos or lead paint in the walls. Building has passed its annual inspections every year. Noone else in the workplace reports having been sick with anything remotely related to what the patient has. Tox screens are negative for heavy metal poisoning.
January 21, 200916 yr Author Okay, now it's starting to sound like an alien abduction. What are his EKG readings and anal probe results? His pulse is over 100, tachycardic as shown by the rapid EKG. P-R Interval 0.16sec, QRS complex 0.12 sec, no signs of bundle block or atrial fibrilation. However, EKG shows that it's sinus rhythm tachycardia, which is consistent with pheochromocytoma, which we already proved. Edited January 21, 200916 yr by Dr. House
January 21, 200916 yr Stop googling so you can sound smart CJ. Guy clearly has an std/AIDS from having sex with niggers. It is ataraxia.
January 21, 200916 yr Opter;606137']Stop googling so you can sound smart CJ. Guy clearly has an std/AIDS from having sex with niggers. It is ataraxia. case closed
January 21, 200916 yr Opter;606137']Stop googling so you can sound smart CJ. Guy clearly has an std/AIDS from having sex with niggers. It is ataraxia. i didnt i used my senergy to add adequate depth to my neural traces Edited January 21, 200916 yr by [myg0t]B34V3RS
January 21, 200916 yr CJ;606143']i didnt i used my senergy to add adequate depth to my neural traces lol faggot mod keeps changing my WORDS
January 21, 200916 yr Author Jedi Pimp;606122']hemorrhagic pheochromocytoma with severe hypertension and bad burrito from del taco. Hemorrhaging would account for the low RBC and hemoglobin levels, but not the low erythropoietin. Renal cell carcinoma causing the kidneys to fail causes low levels of erythropoietin, which in effect lowers synthesis of hemoglobin and RBC. Pheochromocytoma would indeed cause the severe hyptertension. Thing is, what would cause a patient to have two different types of cancers developing simultaneously? Cancer is normally a disease associated with old age. This patient is 34 years old, chances of him developing one type of cancer is already rare, much less two, possiblly three types of abnormal growths if you could the one in the capillaries of the back of his eyes.
January 21, 200916 yr Author I think this final diagnosis will be very hard to do, cause it's extremely rare. Good job on getting this far and singling out pheochromocytoma and renal cell carcinoma as the two causes of high blood pressure despite a significant drop in hemoglobiin and RBC levels. The reasoning behind this is that you have neoplasia in two separate organs that could be seen by CT scan. Logically you'd think it was metasis from one organ to another, but pathology of the biopsy actually showed that the histology were of two different types of tissue. It would make sense because renal cell carcinoma would cause the kidneys to shut down, causing dark urine due to problems filtering out the blood, elevated BUN and creatinine due to the kidney's inability to function in filtering out toxins from the body. In addition, one very important function of the kidneys is to secrete erythropoietin. Erythropoietin is the compound responsible for synthesis of heme rings component of hemoglobin. Lower than normal levels, naturally would result in deficient heme synthesis resulting in the low hemoglobin and RBC levels. Pheochromocytoma is a cancer of the adrenal medulla, one that causes overactivity of the cells. Thus, since the primary function of the adrenal medulla is secretion of catecholamines such as epinephrine, pheochromocytoma would result in large levels of catecholamines being released. The effects of this increase in catecholamines would increase arteriole constriction, cardiac contractility, and rate of SA node depolarization yielding tachycardia and elevated blood pressure. The final thing to add is that when we check for metastasis, we always look at nearby lymph nodes to determine whether there is metastasis. This turned out to be negative which means that the growth in the capillary bed of the patient's eyes are actually a third growth. He denies having any symptoms which means that it may not be a neoplasia. So, the patient essentially has three abnormal growths going on at the same time. A patient 34 years old who, normally would not have to worry about cancer for another 10 years, has multiple types of cancers simultaneously growing. What would cause a patient to have these symptoms and this family history?
January 21, 200916 yr mass in the eye could be a retinoblastoma which could be related to the phaeochromocytoma.. what is the patient's past medical history?
January 21, 200916 yr mass in the eye could be a retinoblastoma which could be related to the phaeochromocytoma.. what is the patient's past medical history? He's got eye problems from staring at your's and r0k's signatures too long.
January 21, 200916 yr Author mass in the eye could be a retinoblastoma which could be related to the phaeochromocytoma.. what is the patient's past medical history? Typical presentation of retinoblastoma is childhood onset of a tumor of the retina. Typically it causes blindness and high rate of metastasis. After excision of the primary tumor, patients with hereditary RB can potentially develop tumors elsewhere later on in life, usually osteomas. Our patient, on the other hand, does not have any significant past medical history, no history of childhood illness or surgery such as RB. Patient also does not report any problems with his eyesight despite the capillary masses.
January 21, 200916 yr is the mass in the eye neoplastic?.. only cause of multiple tumors I can think of is MEN (multiple endocrine neoplasia)- which has nothing to do with this case. the findings in his eye could be due to hypertensive retinopathy.. were there any haemorrhages/exudates found during fundoscopy?
January 21, 200916 yr I think this final diagnosis will be very hard to do, cause it's extremely rare. Good job on getting this far and singling out pheochromocytoma and renal cell carcinoma as the two causes of high blood pressure despite a significant drop in hemoglobiin and RBC levels. The reasoning behind this is that you have neoplasia in two separate organs that could be seen by CT scan. Logically you'd think it was metasis from one organ to another, but pathology of the biopsy actually showed that the histology were of two different types of tissue. It would make sense because renal cell carcinoma would cause the kidneys to shut down, causing dark urine due to problems filtering out the blood, elevated BUN and creatinine due to the kidney's inability to function in filtering out toxins from the body. In addition, one very important function of the kidneys is to secrete erythropoietin. Erythropoietin is the compound responsible for synthesis of heme rings component of hemoglobin. Lower than normal levels, naturally would result in deficient heme synthesis resulting in the low hemoglobin and RBC levels. Pheochromocytoma is a cancer of the adrenal medulla, one that causes overactivity of the cells. Thus, since the primary function of the adrenal medulla is secretion of catecholamines such as epinephrine, pheochromocytoma would result in large levels of catecholamines being released. The effects of this increase in catecholamines would increase arteriole constriction, cardiac contractility, and rate of SA node depolarization yielding tachycardia and elevated blood pressure. The final thing to add is that when we check for metastasis, we always look at nearby lymph nodes to determine whether there is metastasis. This turned out to be negative which means that the growth in the capillary bed of the patient's eyes are actually a third growth. He denies having any symptoms which means that it may not be a neoplasia. So, the patient essentially has three abnormal growths going on at the same time. A patient 34 years old who, normally would not have to worry about cancer for another 10 years, has multiple types of cancers simultaneously growing. What would cause a patient to have these symptoms and this family history? When you are a famous doctor who has cured AIDS and cancer, please remember to mention myg0t and specifically me, John_Winthrop, in your lab reports.
January 22, 200916 yr Author is the mass in the eye neoplastic?.. only cause of multiple tumors I can think of is MEN (multiple endocrine neoplasia)- which has nothing to do with this case. the findings in his eye could be due to hypertensive retinopathy.. were there any haemorrhages/exudates found during fundoscopy? No hemorrhaging in the retina. They just look like swelled up knots of the capillaries near the retina.
January 22, 200916 yr Author If noone gets it in ~an hour or so, I'll just post the answer so you can read about it if you're interested.
January 22, 200916 yr Author Yeah, as I expected, this final diagnosis would be very hard to figure out. So the mass in the eyes isn't a neoplastic growth, which is why i said they didn't appear neoplastic and looked more like knots of the capillaries in the retina. These knots represent a growth known as angiomatosis. Angiomatosis, Pheochromocytoma, and Renal Cell Carcinoma combined are common symptoms for an extremely rare genetic condition called Von Hippel-Lindau Syndrome. It's a hereditary genetic defect in the VHL tumor suppressor gene, inherited via a dominant inheritance pattern. This explains why the mother of the patient died of Renal Cancer, implying that she also had Von Hippel-Lindau syndrome. Since it is a dominantly inherited genetic defect, only one copy of it was required to have the disease, which is why the patient has it despite how his father lived a long life and died from cardiac problems. Tumor suppressor genes normally help to maintain fidelity of the genetic code. A mutation such as in the VHL tumor suppressor gene predisposes the patient to additional mutations causing them to exhibit the symptom of multiple tumors developing in different organs. For some unknown reason, many patients with this disease suffer from pheochromocytoma, renal cell carcinoma, and angiomatosis. The unfortunate thing about this disease is that there's no cure for it. Only thing that can be done for these patients is to excise the tumors and have them come back to the hospital for occasional checkups and tests to ensure that the tumors don't return, and that new tumors don't appear. Thus, Final Diagnosis: Von Hippel-Lindau Disease. Overall, I'm impressed that everyone figured out all the individual symptoms. Those are the more common things you see in clinic.
