Season 2
Episode 1 - Acceptance
Brief Plot Summary
Clarence has been given the death penalty. However, he collapses while playing basketball. Initial symptoms are Tachycardia, pulmonary edema, hypoxia (low oxygen). House orders an arterial blood gas test which comes back with a pH of 7.28 and decreased HCO3 which indicates a new symptom: Anion Gap Acidosis. He then gets bradycardia and is given atropine to raise his heart rate. When House finds out that he's drank an ink cartridge to commit suicide (the anion gap and bradycardia) which has methanol and to counter it, House gives him alcohol. However, House thinks its a problem in his brain and lists depression as another symptom. Now Clarence's colon is necrotic and they remove a foot of it from surgery. Pheochromocytoma is a fit since it would release extra adrenaline and explain the symptoms and random bursts of strength.
Clarence has been given the death penalty. However, he collapses while playing basketball. Initial symptoms are Tachycardia, pulmonary edema, hypoxia (low oxygen). House orders an arterial blood gas test which comes back with a pH of 7.28 and decreased HCO3 which indicates a new symptom: Anion Gap Acidosis. He then gets bradycardia and is given atropine to raise his heart rate. When House finds out that he's drank an ink cartridge to commit suicide (the anion gap and bradycardia) which has methanol and to counter it, House gives him alcohol. However, House thinks its a problem in his brain and lists depression as another symptom. Now Clarence's colon is necrotic and they remove a foot of it from surgery. Pheochromocytoma is a fit since it would release extra adrenaline and explain the symptoms and random bursts of strength.
Diagnosed Disease: Pheochromocytoma - A small tumor on the adrenal gland that secretes extra adrenaline.
SymptomsHypertension, tachycardia, headaches, sudden bursts of rage combined with extreme strength, sweating
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CausesTumor that induces the production of or actually produces extra adrenaline.
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TestsCT Scans and MRIs can be used to locate the tumor
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Treatment/CureTreatment is simply removal of the tumor through surgery. Sometimes however, the tumor can return and cause the symptoms to re-occur.
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Source Links: NIH Page
Episode 2 - Autopsy
Brief Plot Summary
A 9 year old girl with terminal cancer (alveolar rhabdomyosarcoma) comes in with hallucinations but MRI's reveal no cancer. They try to test for infection but it comes negative. She has low oxygen levels and they hear an extra flap in the mitral valve echo indicating a cancer that affects the heart and the brain. However the tumor is benign, but she starts bleeding in her eye. Now House thinks her bravery might be a symptom and he wants to induce a hypothermic cardiac arrest that will allow an MRI to spot the clot in amygdala of the brain, which is the "fear center". However, the clot was in the hypocampus meaning she was actually brave.
A 9 year old girl with terminal cancer (alveolar rhabdomyosarcoma) comes in with hallucinations but MRI's reveal no cancer. They try to test for infection but it comes negative. She has low oxygen levels and they hear an extra flap in the mitral valve echo indicating a cancer that affects the heart and the brain. However the tumor is benign, but she starts bleeding in her eye. Now House thinks her bravery might be a symptom and he wants to induce a hypothermic cardiac arrest that will allow an MRI to spot the clot in amygdala of the brain, which is the "fear center". However, the clot was in the hypocampus meaning she was actually brave.
Diagnosed Disease: Blood Clot in the Brain - Blood clots, also called thrombi, are extremely dangerous since they can dislodge and travel through the bloodstream and suddenly get stuck and cause tissue death in organs.
SymptomsHallucinations and hypoxia were the only symptoms seen, but blood clots cause symptoms based on where they get stuck.
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CausesBlood clots can be caused due to a number of different conditions but in this case, her cancer caused the clot to form and be released into the brain.
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Tests |
Treatment/CureSurgery is required to pull the clot out so that it doesn't cause permanent damage.
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Source Links: NIH page
Episode 3 - Humpty Dumpty
Brief Plot Summary
Alfredo is a construction worker who falls from the roof and his fingers turn blue and he suffers from pneummonia. His kidneys are begining to shut down and his second hand is become blue as well after the first one was amputated.
Alfredo is a construction worker who falls from the roof and his fingers turn blue and he suffers from pneummonia. His kidneys are begining to shut down and his second hand is become blue as well after the first one was amputated.
Diagnosed Disease: Psittacosis - Infection of the heart (endocarditis) caused by a bacterium called Chlamidophila psittaci. It causes small clumps of the bacteria to dislodge sometimes and block circulation. Interestingly, this disease usually affects birds and he got it from working at cock fights and his asthama made him more susceptible.
SymptomsPresents first with severe pneumonia and then systemic illness, clots formed by clumps of bacteria that can cut off circulation to parts of the body, inflammation of the heart, breathing problems, other organ failure due to blood blockage
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CausesIt is caused by infection from the Chlamidophila psittaci bacteria that usually affects birds.
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TestsBlood tests can indicate whether a person is infected or not. Also, it will cause pneomonia and the infection won't test positive for endocarditis.
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Treatment/CureDoxycycline is the standard drug used to treat; however, other antibiotics can be used as well.
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Source Links: NIH Page
Episode 4 - TB or not TB
Brief Plot Summary
A humanitarian who is out to save people in Africa from Tuberculosis falls during a speech. He has a wide variety of symptoms that match TB such as low glucose levels in the spinal fluid, but also don't such as an abnormal PR interval of his heart rate. After taking the TB medication, he continues to have low glucose levels in his spinal fluid which indicates that he has a tumor in his pancreas that is producing excess insulin.
A humanitarian who is out to save people in Africa from Tuberculosis falls during a speech. He has a wide variety of symptoms that match TB such as low glucose levels in the spinal fluid, but also don't such as an abnormal PR interval of his heart rate. After taking the TB medication, he continues to have low glucose levels in his spinal fluid which indicates that he has a tumor in his pancreas that is producing excess insulin.
Diagnosed Disease: Nesidioblastoma - Also known as islet cell carcinoma, this rare cancer is what caused the symptoms that presented much like TB. In this case, the tumor cells in the pancreas were producing insulin which caused the low glucose levels. However, these cancers are very small as well.
SymptomsInsulin secretion, low glucose in the cerebral spinal fluid, intermittent periods of low blood glucose that cause neurological symptoms such as blurry vision and headaches
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CausesIslet cancer cells that can produce extra insulin, sometimes they can produce other hormones as well which would lead to different symptoms.
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TestsSometimes they can be spotted on CT scans or MRIs; the tumor can be stimulated by injecting calcium into the artery and measuring the hormone secretion and blood glucose level, if it drops very fast, it means there is a tumor producing extra insulin.
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Treatment/CureThe tumor is usually removed through surgery; chances of survival are good as long as it hasn't metastisized.
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Composition of the Pancreas
On the left is a great picture showing what the pancreas is composed of. Looking at figure c, the acinar cells produce digestive enzymes and make up the bulk of the pancreas. Figure d show the endocrine cells of the pancreas, namely, alpha and beta cells that regulate glucose usage, delta cells that modulate the other cells and PP cells that produce pancreatic polypeptide. Together, these cells are known as the islet of langerhans. |
Source Links: NIH Full Article, Nature Magazine Article