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4.13 No More Mister Nice Guy

This review is a partial one only, and will be completed when/if a transcript becomes available.

Initial Symptoms: Man with nystagmus + syncope + dysgeusia
Diagnosis: Chagas disease (Kutner)

Contributions by Team
House (1): Realizes patient's niceness is a neurological symptom
Cameron (0): None
Chase (0): None
Foreman (0): None
Kutner (2): Runs VDRL test, diagnosis for Chagas disease
Taub (0): None
Thirteen (1): Idea to perform bubble test to test for heart defect

Notes: Given that Cameron was working the ER without nurses, she can be forgiven for classifying a fainting patient as "low priority".
I'm assuming that all of the patient's symptoms were caused by Chagas disease, because chronic infection can cause heart and intestinal problems as well as the encephalitis that caused the neurological problems. Thirteen therefore gets credit for thinking of heart problems and proposing the bubble test, which when performed appears to have triggered Kutner's epiphany about Chagas disease. Kutner is awarded a point for running the VDRL test for neurosyphilis because Chagas disease also yields a false positive with this test; so do many other conditions, but that wasn't mentioned on the show.



Blogger Lacy said...

The problem with this episode is that Kutner ran a VDRL for neurosyphilis on a blood sample. You must run it on cerebral spinal fluid if you are looking for neurosyphilis. And no doctor thought to do a confirmatory test, such as an microhemagglutination assay or FTA-ABS assay, to confirm syphilis. The VDRL is very prone to false negatives.

November 6, 2008 1:01 PM  

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