House Wiki

Editing

Daryl

1
  • The edit can be undone. Please check the comparison below to verify that this is what you want to do, and then save the changes below to finish undoing the edit. If you are undoing an edit that is …
Latest revision Your text
Line 59: Line 59:
   
 
== Reaching the diagnosis ==
 
== Reaching the diagnosis ==
As House initially thinks, a football player suffering from a blackout points directly to [[concussion]]. However, he is usually savvy enough to realize that the "stupid doctors" have already looked into that, and his team confirms that the [[emergency room]] did a [[CT Scan]] to rule it out, as well as ruling out [[stroke]] and [[cortical degeneration]], which are the next likely candidates. Taub also points out he's had a [[psych consult]], so the next most likely candidate, [[mental illness]], is off the table. House jumps to [[steroid abuse]], which also fits the patient's symptoms and medical history. Despite the negative test, House believes that it is more likely given the patient's routine use of [[lidocaine]] to treat pain. However, the team correctly points out the negative test result makes it unlikely and that excess [[GNRH]] from a malfunctioning [[pituitary]] hasn't been ruled out. House orders [[venous sampling]] to test the GNRH levels to see if they are abnormal, and an [[MRI]] of the pituitary to see if it's been damaged, which would explain elevated GNRH. However, he notes if the pituitary is normal, steroid abuse is back on the table.
 
 
House is smug when the GNRH levels are elevated and the pituitary is normal. Both point back to steroid abuse despite Daryl's denials.
 
 
However, the immediate [[tachycardia]] points away from steroid abuse. Foreman orders an [[EKG]] and [[sestamibi scan]] to look for the cause. When those are clear, they discuss something that wouldn't show up, like [[patent foramen ovale]] which could cause [[clotting]]. However, Marcus's suggestion of [[hypertrophic cardiomyopathy]] fits better and can't be detected by a standard EKG. Despite the danger, House orders a [[stress test]], which would result in a [[cardiac arrest]].
 
 
When Daryl breezes through the stress test (failing even to raise his heart rate to 150 after exercising for nearly an hour) House decides to try [[vasodilator|vasodilators]] instead. However, he notes Daryl's palms are unusually pale, pointing to [[Raynaud's phenomenon]] and circulatory problems. However, it can be caused by several unrelated illnesses. House decides to do a diagnostic trial by giving him intravenous [[alcohol]] which will cause [[itch|itching]] if it's [[lymphoma]] and loss of the radial pulse if it's [[Takayasu's arteritis]].
 
 
Daryl starts getting itchy, pointing to the lymphoma. Immediate treatment is removal of the [[spleen]], which would allow him to play football for scouts, followed by [[radiation therapy]] during the off-season.
 
 
However, during surgery, they note the spleen is fine, but the [[liver]] is inflamed. Since it caused the itching, lymphoma can be ruled out. In addition, the [[blood tests]] they ran to try to confirm it have ruled it out. The liver [[biopsy]] was inconclusive. Taub's idea was that an injection needle was used and he was infected with [[hepatitis]], which fits all the other symptoms as well. However, when they go to test the blood, they discover [[cryoglobulinemia]], most likely from working out in the cold. That also explains all the symptoms and the treatment is simple - [[warfarin]].
 
 
When it turns out that Daryl has actually gained a tiny amount of weight in the hospital, pointing to [[paraneoplastic syndrome]] and [[cancer]]. Several cancers can result in [[human growth hormone]] and there is no reason to prefer any of them. When they find blood in his [[urine]], it confirms [[kidney]] failure and that cancer is the most likely. As they've done a full body scan looking for its source, House believes that it may be a [[skin cancer]] that has gone unnoticed, most likely [[melanoma]], which would not show up well against dark skin and might be mistaken for a [[bruise]]. He examines the palms of Daryl's hands and the soles of his feet and finds a possibility between two toes.
 
   
 
== Explaining the medicine ==
 
== Explaining the medicine ==
  Loading editor
Below are some commonly used wiki markup codes. Simply click on what you want to use and it will appear in the edit box above.

View this template