April 03, 2007

I heart House

There's only two TV shows that I'll drop all of my studying to sit back and enjoy. The first one is Lost on Wednesday nights. The second one is House on Tuesday nights. I've missed a lot of House, but I always keep myself up to speed on the best website ever!!!

Scott is a family doctor that runs Polite Dissent, home to House MD reviews. He posts a summary of the case with links to all the diseases mentioned and then he provides his own analysis of the results. "House" is rarely up to par with real medicine.

When I was watching tonight's episode, I was all happy because I thought I cracked the case halfway through. I commented on his blog. Here's a longer version of my analysis:

Hey, a first-year med student here. I thought I'd try my hand at a diagnosis tonight. When they mentioned strep infections, I thought about post-strep glomerulonephritis as the cause of the bleeding. It bothered me that it wasn't even mentioned. Do the writers even bother looking up the common differential diagnoses anymore? Rheumatic heart disease-induced clots come from atrial fibrillation (which would be easily seen on an EKG,) but I guess an RF vegetation could have embolized. :-\ The balloon catheterization struck me as bad medicine.

Before they came up with Mirror syndrome, I was rooting for Budd-Chiari syndrome.

My differential diagnosis went something like this:
Since this is a TV show, they'll pick something totally random and rare. It needs to have a cool name and involve as many different organs as possible. Hyperestrogenism is a hypercoagulable state. This could cause clots to form and cause strokes and a blockage of the hepatic vein. The hepatic vein blockage could be asymptomatic at first. Blood would back up in the portal venous system and jaundice would result. Weird splanchnic vasoconstriction would have fetal abnormalities and possible kidney involvement with the hepatorenal syndrome. Acute tubular necrosis could cause protein and blood to show up in the urine. It's all a stretch, but "House" always is.

My fun diagnosis was shattered when the transjugular procedure was clean. Drat! Besides, my diagnosis neglected to consider the ethical and curable issues... a "House" diagnosis needs to be controversial and it needs to have a miraculous recovery at the very last second.

I don't know how corticosteroids leads to pulmonary edema. I don't know how it speeds up the development of the fetal lungs also. If the fetus had a lower urinary tract blockage that restricted the development of the lungs, wouldn't there be oligohydramnios? Wouldn't that lead to POTTER sequence? Less amniotic fluid (which is just baby pee) would mean less room for the baby to grow, which could cause problems with limb development.

I didn't know enough about fetal development, so I just went along for the ride after that.

I liked all the drama in this episode. I thought that there were a bunch of very interesting role reversals... House/Cutty, Chase/Cameron, Cutty/Wilson. The way House stared at his hand at the end of the episode makes me think that there's potential for him to want a baby with Cutty! Haha! That would eat away at Cameron and in turn, break poor Chase's heart.

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