Season 4
Episode 1 - Alone
Brief Plot Summary
Megan is one of the few survivors after her building collapsed. She has a persistent fever and can only blink her eye. At her home House finds her diary and realizes she's on antidepressants. She has tachycardia and is shocked back into sinus rhythm. They believe she is an alcoholic and she develops pancreatitis; however, they find no abnormalities. When she has massive internal bleeding, they begin surgery where House notices her enlarged uterus, indicating an abortion. House puts her on tamoxifen to block estrogen receptors. When House finds multiple granulomas, he realizes she has an allergy to cephalosporin even though she took it for strep throat recently. Finally House realizes that the patient can't be Megan and when he read Liz's (another crash victim of the collapse) file, the symptoms match perfectly.
Megan is one of the few survivors after her building collapsed. She has a persistent fever and can only blink her eye. At her home House finds her diary and realizes she's on antidepressants. She has tachycardia and is shocked back into sinus rhythm. They believe she is an alcoholic and she develops pancreatitis; however, they find no abnormalities. When she has massive internal bleeding, they begin surgery where House notices her enlarged uterus, indicating an abortion. House puts her on tamoxifen to block estrogen receptors. When House finds multiple granulomas, he realizes she has an allergy to cephalosporin even though she took it for strep throat recently. Finally House realizes that the patient can't be Megan and when he read Liz's (another crash victim of the collapse) file, the symptoms match perfectly.
Diagnosed Disease: Variety of Symptoms - Liz's condition was mainly exacerbated by her misidentification and was the cause of an allergy that went out of control due to incorrect patient history from her misidentification.
Episode 2 - The Right Stuff
Brief Plot Summary
Captain Greta Cooper came in wanted to be diagnosed off the books because she works for the air force. She is "hearing with her eyes"; she has synesthesia. House puts Cooper in a hyperbaric oxygen chamber where she has a heart attack and is immediately defibrillated into sinus rhythm. The new intern applicants look for infectious diseases in the cafeteria and conduct thyroid function tests. As her temperature begins to spike, she has a psychotic attack. House wants to stress her liver to see if the problem is there. One of the interns suggests getting her drunk. When she has trouble breathing, he believes it could be lung cancer and wants a biopsy. When they find cysts in the lungs, Dr. Chase suggests Von Hippel-Lindau disease, which would explain her symptoms.
Captain Greta Cooper came in wanted to be diagnosed off the books because she works for the air force. She is "hearing with her eyes"; she has synesthesia. House puts Cooper in a hyperbaric oxygen chamber where she has a heart attack and is immediately defibrillated into sinus rhythm. The new intern applicants look for infectious diseases in the cafeteria and conduct thyroid function tests. As her temperature begins to spike, she has a psychotic attack. House wants to stress her liver to see if the problem is there. One of the interns suggests getting her drunk. When she has trouble breathing, he believes it could be lung cancer and wants a biopsy. When they find cysts in the lungs, Dr. Chase suggests Von Hippel-Lindau disease, which would explain her symptoms.
Diagnosed Disease: Von Hippel-Lindau Disease - Rare genetic disorder predisposing patients to benign and malignant tumor growths throughout the body, usually in the nervous system.
SymptomsNeurological problems, organ malfunctions, tumor growths or cysts
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CausesGenetic disease that is passed on from the parent. One dysfunctional VHL gene and one functional VHL gene lead to tumor development in cells that use the wrong gene.
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TestsPatient history and at least 2 identified tumors need to be detected for a diagnosis.
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Treatment/CureNo way to treat the underlying cause, but early detection can significantly increase quality of life. Yearly screening for retinal angiomas and hemangioblastomas are conducted in susceptible patients who carry the dysfunctional gene.
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Episode 3 - 97 Seconds
Brief Plot Summary
Thomas Stark, a man suffering from spinal muscular atrophy and confined to a wheelchair, is brought in when he suddenly becomes unconscious and is almost hit by a car in the middle of the road. Thirteen think it could be a parasite called strongyloides that he picked up in Thailand. Taub and the men's team don't know what's wrong and are attempting to test the feces of bugs that they will allow to bite him. During the procedure, Stark begins to choke meaning his throat is closing up. The women's team decide to run a tilt table test to see if the fainting has gone away and the choking was just part of the patient's SMA. Meanwhile, the men's team believe it could be a tumor in the esophagus near the carotid artery hitting the vagus nerve leading to the fainting. A CT shows weakening of the walls, but the tilt table test was positive and seemed to confirm Thirteen's diagnosis. However, when Amber draws blood, it's green, meaning kidney failure. Antibiotics aren't helping his pneumonia and the skin biopsy is negative for scleroderma. With small areas of necrotic tissue seen in his lymph node, House thinks its cancer; however, clear pneumonia fluid means it's not cancer. When the dog dies, House realizes the the patient never actually took the ivermectin, the dog did and it was fatal for the dog.
Thomas Stark, a man suffering from spinal muscular atrophy and confined to a wheelchair, is brought in when he suddenly becomes unconscious and is almost hit by a car in the middle of the road. Thirteen think it could be a parasite called strongyloides that he picked up in Thailand. Taub and the men's team don't know what's wrong and are attempting to test the feces of bugs that they will allow to bite him. During the procedure, Stark begins to choke meaning his throat is closing up. The women's team decide to run a tilt table test to see if the fainting has gone away and the choking was just part of the patient's SMA. Meanwhile, the men's team believe it could be a tumor in the esophagus near the carotid artery hitting the vagus nerve leading to the fainting. A CT shows weakening of the walls, but the tilt table test was positive and seemed to confirm Thirteen's diagnosis. However, when Amber draws blood, it's green, meaning kidney failure. Antibiotics aren't helping his pneumonia and the skin biopsy is negative for scleroderma. With small areas of necrotic tissue seen in his lymph node, House thinks its cancer; however, clear pneumonia fluid means it's not cancer. When the dog dies, House realizes the the patient never actually took the ivermectin, the dog did and it was fatal for the dog.
Diagnosed Disease: Strongyloidiasis - Disease caused by infection from the parasitic round worm Strongyloides stercoralis.
SymptomsPresents initially with dermatitis and then when in the lungs, causes pneumonia-like symptoms. If the gastric tract is infected, it could lead to pain, ulcers, and appetite loss.
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CausesContact with the worm is made in low sanitary conditions in tropical areas where the parasite infests the soil.
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TestsStool samples with larvae and biopsies are the most direct methods, while any travel history to tropical regions can be an indicator as well.
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Treatment/CureIvermectin is the anti-parasitic drug of choice.
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Source Links: Wiki
Episode 4 - Guardian Angels
Brief Plot Summary
Irene works as a funeral cosmetician and is admitted after hallucinating being raped by a cadaver and having a seizure. The fellows believe it could be the human form of mad-cow disease, Creutzfeldt-Jakob disease. Then they realize that she is hallucinating her mother, who is dead, meaning it's also a delusion. She is also hallucinating their previous patient. After asking the patient a series of questions with her mother there, House gets a accurate description of parkinson's symptoms. However, Irene suddenly develops legions on her arms. They believe it could be vasculitis behind the retina causing the hallucinations. However, she begins vomiting blood. They find that she is bleeding from her liver during surgery to stop the bleeding. Amber believes he could have ergot poisoning from the moldy rye bread she's been eating.
Irene works as a funeral cosmetician and is admitted after hallucinating being raped by a cadaver and having a seizure. The fellows believe it could be the human form of mad-cow disease, Creutzfeldt-Jakob disease. Then they realize that she is hallucinating her mother, who is dead, meaning it's also a delusion. She is also hallucinating their previous patient. After asking the patient a series of questions with her mother there, House gets a accurate description of parkinson's symptoms. However, Irene suddenly develops legions on her arms. They believe it could be vasculitis behind the retina causing the hallucinations. However, she begins vomiting blood. They find that she is bleeding from her liver during surgery to stop the bleeding. Amber believes he could have ergot poisoning from the moldy rye bread she's been eating.
Diagnosed Disease: Ergot Poisoning - Poisoning as a result of ergot fungi causing LSD-like symptoms
SymptomsNausea, vomiting, muscle pain, hallucination, delusions, seizures and convulsions, vision loss, Vasoconstriction leading to skin legions and tissue necrosis from gangrene
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CausesEating bread, usually rye, contaminated with the ergot fungus.
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TestsCan be detected in blood, but usually based from history and symptoms.
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Treatment/CureAntidepressants can help with the LSD-like symptoms, but discontinued exposure to the fungus will usually cure the patient.
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Source Links: WebMD
