Posted May 17, 200915 yr 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?
May 17, 200915 yr Author GRIDS Would present as low CD4 cells and macrophages rather than low neutrophils.
May 17, 200915 yr Author She's a vampire obviously... Actual red blood cells in the urine, not just porphyrin compounds. It's not porphyria.
May 17, 200915 yr Author Where the hell do you get these things from? I come up with them myself, based on literature on past medical cases involving certain diseases.
May 18, 200915 yr Author FAK3R;620821']My balls itch... please assist If you're like ataraxia, lay off the black hookers and get meds for STDs.
May 18, 200915 yr If you're like ataraxia, lay off the black hookers and get meds for STDs. he could have crabs, shave off all your bodily hair and wash everything
May 18, 200915 yr Author Cadaver;620824']i need a diagnosis get on irc STAT No can do, just send me an PM on the forum and I'll get back to you.
May 18, 200915 yr sideways;620823']he could have crabs, shave off all your bodily hair and wash everything Shaving the hair doesn't help to get rid of crabs, they move around easier then.
May 18, 200915 yr 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? Dr. House. You have admitted to Mayfield Psychiatric Hospital. You are not in the right condition to be posting on these forums. NOW, HERE IS AN INTERESTING THOUGHT I HAVE ON THE TELEVISION SERIES KNOWN AS HOUSE MD. We all know in the season finale that House was admitted to Mayfield Psychiatric Hospital. This hospital is really called Greystone Park Psychiatric Hospital. Yes yes, YOU HAVE HEARD THIS NAME BEFORE! This is the same hospital Woody Guthrie died in. From what? HD! Huntingtons! Doctor 13 Also has huntingtons disease. The connection between Bob Dylan, woody guthrie and House will show up in season 6 Want me to ruin season 6 for you? House cures 13. Edited May 18, 200915 yr by Seth Bullock
May 19, 200915 yr Author *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.
May 19, 200915 yr *sigh* No effort. That's because these threads are no longer interesting. Everytime I see one of these threads I just wonder why the hell you haven't got the hint yet. If you want medical brilliance or any form of brilliance whatsoever, I wouldn't recommend myg0t forums.
May 20, 200915 yr *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. You are a disgrace to Dr. House. You COULD have been funny but first of all, you dont act like house at all. Where is the funny? Where is the rock status House has achieved? do you even watch the show? gtfo cause you remind me of my doctor, a normal old fat piece of shit, gtfo
May 20, 200915 yr You are a disgrace to Dr. House. You COULD have been funny but first of all, you dont act like house at all. Where is the funny? Where is the rock status House has achieved? do you even watch the show? gtfo cause you remind me of my doctor, a normal old fat piece of shit, gtfo my doctor usually has blood shot eyes...I think he smokes up before seeing me.
May 20, 200915 yr Dr. House owns you all, stfu or participate. Edited May 20, 200915 yr by Myriad lol typos
May 20, 200915 yr Author You are a disgrace to Dr. House. You COULD have been funny but first of all, you dont act like house at all. Where is the funny? Where is the rock status House has achieved? do you even watch the show? gtfo cause you remind me of my doctor, a normal old fat piece of shit, gtfo LOL!
May 20, 200915 yr she did too many SCAT videos. that's what happens when you eat somebody else's shit.
May 20, 200915 yr BUTT_PLUG;621128']she did too many SCAT videos. that's what happens when you eat somebody else's shit. That's why one should only eat their own shit.
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