Differential Diagnosis for...Whatever You Want
One person gets the pager. They present a patient, usually by a dialogue between House and them, and get to basically choose the end result disease. Then, people can guess what the disease is, by ordering tests and asking questions about the patient. When presenting a case, one must include: –Symptoms –Onset of Symptoms –Patient Gender/Age –*NEW* CBC/Chem-7 results –*NEW* Vitals –*NEW* Patient History The person with the pager may show progression of symptoms and results of tests in dialogue as well. After someone figures it out, then the case is over, and the person who figures it out gets the pager.After someone wins or gets the pager somehow, they have 24 hours from the time that they get it to present a patient. If the person is inactive for 36 hours after presenting a patient/checking up on the patient/performing tests, then the case is considered dead. A new case may be presented by anybody. After the next case is completed, then the old case may be picked up if the presenter returns. I'm not starting, because I have the medical knowledge of a 13-year-old. :wink:

House: *playing GameBoy* Leave me alone. Arizona: That's not what I heard to do. Wilson: Ignore him. He's sore because I beat him at poker last night and Cuddy called us in. House: Exactly. Which means leave me alone! Arizona: So, why exactly are we here? It's Saturday. Cuddy: Yes, but poor health doesn't stop for the weekends. 4 year old female had a heart attack. House: *looks up* Cuddy: Anyway, she came in to the ER last night after collapsing. She was assessed and transferred to cardiology right away. House: Why is she ours now? Cuddy: Cardiology can't figure out why a 4 year old would have a blocked aorta and aortic stenosis. CBC and Chem-7 normal. Vitals indicative of recent heart attack, but thankfully stable. She spent the night in surgery. No significant health problems before this. Family history of heart disease, hypertension, and problems with cholesterol. Arizona: Wow. House: See it all the time. Cuddy: House! Just to make her more human, here's a picture. Arizona: Cute kid! Cute freckles. House: Would you bet your medical license on those freckles?

Well, when you say rash, I say Kawasaki, but it doesn't really fit with patient history. Any history of fever, abdo pain or lethargy? Joint pain? What about her tongue, pharynx, lips, hands and feet?

Hi Silja!!! Arizona: Well, yeah, those look like freckles. House: Do either of the parents have them? Arizona: The mother does. House: When was your last eye exam? Arizona: *cleans glasses, looks closer at pic* Okay, so not all of them are freckles. Silja: Well, when you say rash, I say Kawasaki, but it doesn't really fit with patient history. House: We can test, We as in Arizona, but you're right in that it doesn't fit the patient history. And, those legions look more tuberous than just freckles. Arizona: *zips* Silja: Any history of fever, abdo pain or lethargy? Joint pain? Wilson: *looking through chart* Not really. Silja: What about her tongue, pharynx, lips, hands and feet? Wilson: Aside from the blocked aorta and aortic stenosis, she's been in pretty good health up until now. Arizona: *zips back* House: *looking over Wilson's shoulder* You missed a line. She has those legions all over her body. And idiot-girl running the tests thinks they're freckles. Arizona: I'm not an idiot, and negative for anemia or high platelets. No coronary artery aneurisms either and the radiogram for congestive heart failure showed that other arteries had partial blockages as well. House: You did more work that you were supposed to. Arizona: There's no definitive test for Kawasaki's, but it did help us find out more. Wilson, are you sure she doesn't have any joint pain? Wilson: Maybe a little in her right ankle.

Lipid panel please.

SILJA: Lipid panel please! HOUSE: Why didn't the cardiologists order that? WILSON: You know why. ARIZONA: I'll go do that. *zips out, then back in* Total cholesterol severely elevated at 943 mg/dL. LDLs also severly elevated, HDLs normal. HOUSE: Looks like someone won't be eating French fries anytime soon.

True, but it does look like someone will be doing an LDL receptor analysis

SILJA: True, but it does look like someone will be doing an LDL receptor analysis. ARIZONA: And let me guess, that someone will be me? HOUSE: Smart girl, now you're catching on. ARIZONA: *zips out, in* Without coming out and saying exactly what it is, the analysis shows two homozygous recessive alleles. HOUSE: Well Silja, looks like you're about to get the pager in a post or two. SILJA: *smirks*

If I were an evil person, and there are people who will swear to that, I'd ask for liver, kidney and thyroid panels, fasting plasma glucose and a glucose tolerance test. Who am I kidding? I am an evil person, but I'll answer anyway: Familial hypercholesterolemia.

HOUSE: You're smirking. ARIZONA: She knows the answer. SILJA: If I were an evil person... ARIZONA: Yes you are. But remember, House and I can mock you for answering correctly and get away with it. HOUSE: *grins an evil grin* SILJA: Who am I kidding - it's Familial hypercholesterolemia. ARIZONA: Of the homozygous variety. Pager's yours. *smirks* SILJA: *gives Arizona the look of death* ARIZONA: We're probably the only two playing right now anyway, so mock me!

Hmmm, must find new case. Should I perhaps wait until there are a few more people around? Perhaps we should PM a few people.

You're probably right Silja - we can see who will be playing more frequently. Also, we can take this time to organize this thread a bit more - posting the acceptable values for vitals and basics of how to research this game will help as well. Standard Range of Vitals for Adults in US Temperature: 97.6 F- 99.6 F (oral) Respirations: 12-20 per minute Pulse: 60-100 beats per minute (some places 60-90) Blood Pressure: between 90/60 and 120/80 Ranges of Blood Pressure in US Hypotension (low) - under 90/60 Normal - between 90/60 and 120/80 Pre-Hypertension - between 120/80 and 130/90 Stage 1 Hypertension (high) - between 130/90 and 160/100 Stage 2 Hypertension - above 160/100 Accelerated Hypertension - above 240/120 without end-stage organ failure blood pressure values based on recommendations by American Heart Association

Thank you for those vitals, arizonamyrie. Since I have been practicing for Liver Rounds, I'm going to post the normals for liver tests: Alanine transaminase (ALT) Normal up to 40 Aspartate transaminase (AST) Normal up to 40 Alkaline phosphatase (AlkPhos) Normal up to 120-150 Total Bilirubin Normal from 0.3-1.9 Direct Bilirubin Normal from 0 to 0.3 Albumin (ALB) Normal from 3.4-5.4 If someone gives results fairly close to these (eg. 2 for total bilirubin rather than 1.9) it could just be laboratory variation. Cameron always tends to get sliiiiightly higher results for serum albumin than Chase. I don't think he centrifuges very well, personally. If you message me very nicely, I may even tell you what to look for in test elevations. I've been doing this constantly for the past week, so I remember these pretty well. If I have to do one more ALT to AlkPhos ratio, I'll go insane. In a good way, of course... :twisted:

Thanks for the Liver Panel - it's murder to find it in the book I have as is without breaking it down to its smaller tests. If you all don't mind, it would be cool to post more of the standard tests we end up running - CBC, Basic Met Panel (Chem 7), UA. Complete Blood Count (adult) Red Blood Cell Count: male 4.7-6.1, female 4.2-5.4 Hemoglobin: m 14-18g/dl or 8.7-11.2 mmol/L, f 12-16 g/dl or 7.4-9.9 mmol/L Hematocrit: m 42-52%, f 37-47% Red Blood Cell Indices: --Mean Corpuscular Volume: 80-95 um --Mean Corpuscular Hemoglobin: 27-31 pg --Mean Corpuscular Hemoglobin Concentration: 32-36% --Red Blood Cell Distribution Width: 11-14.5% White Blood Cell Count: 5000-10,000/mm^3 --Neutrophils: 55-70% or 2500-8000/mm^3 --Lymphocytes: 20-40% or 1000-4000/mm^3 --Monocytes: 2-8% or 100-700/mm^3 --Eosinophils: 1-4% or 50-500/mm^3 --Basophils: 0.5-1% or 25-100/mm^3 Blood Smear: normal (quantity/size/shape/color) Platelet Count: 150,000-400,000/mm^3 Mean Platelet Volume: 7.4-10.4 fL Basic Metabolic Panel (adult) AKA: Chem-7; results for fasting Blood Urea Nitrogen (BUN): 10-20 mg/dl Calcium: 9.0-10.5 mg/dl Carbon Dioxide: 23-30 mEq/L Chloride: 98-106 mEq/L Creatinine: m 0.6-1.2 mg/dl, f 0.5-1.1 mg/dl Glucose: 70-110 mg/dl Potassium: 3.5-5.0 mEq/L Sodium: 136-145 mEq/L All values from "Mosby's Diagnostic and Laboratory Test Reference," Eight Edition (2007) I'll leave the rest for now as I have other things I need to attend to at the moment (laundry, dinner, dog).

Alright, let's see if we can get some of these new tests to work! Chai: House, I have a case. House: *reading a medical journal in Korean* 나는 관심이 끌리지 않는다 Chai: 당신은 무엇을 말했는가? House: I said, 나는 관심이 끌리지 않는다. Are you deaf? Chai: (Sucks air in through teeth, attempting not to get annoyed. Failing) Anyway, there's this kid... House: You're interested in a kid? Better go ask Chase about that... Chase: It was one kiss for a dying girl! House: We know that's what you say to yourself at night, sweetie... Chai: Anyway, last week a 12 year-old kid was admitted to the clinic for pain in his left loin. He was diagnosed with a urinary tract infection and sent home with some amoxicillin. After taking it, he went into anaphylactic shock-- House: Ooh, I love that part! It's always just so fun to watch them grab at their throats when they can't breath-- Chai: (authoritatively) House? Shut it. Anyway, we treated him with some other antibiotics. Now he has a rash. House: On his left loin? Chai: On his...(checks chart. Appears stupified by what she reads) ankles. House: Sufficiently weird. I'll take it. Chai: Oh, and House? House: Yeah? Chai: You may want to read a translated version of that article. Your Korean sucks.