Thursday, October 6, 2011

I wish we had more public service announcements featuring Big Bird

For the past several weeks, we have been presented different cases of fake patients. This is more for the purpose of exposing us to things we don’t know and teaching us how to research and reason to find out information. The diagnosis isn’t even important.

Well, for most groups. For our group, the diagnosis is important. And boy do we get excited about it. Other groups meeting in rooms around us said we were the loudest group they’d heard. And it’s true. We were yelling and cheering the first time we met about the diagnosis. Basically, our group is awesome.

When I went to shadow the transplant surgeons this week, they were excited about the diagnosis for our latest patient. I have been ordered to deliver a full report next week.

To give you a taste of our excitement, I will give you a sample case, so you can play along at home.

I give you PATIENT #5.
“28 year old woman comes into the ER with weakness, fever and weight loss. Her boyfriend was sick several weeks ago. Patient admits to use heroin regularly; it’s unclear how much. She is also a sex worker.
Yeah, this really doesn't have anything to do with the case
Pulse = 100/min
BP = normal
Temp = normal 
The physical exam only yielded a few irregularities. The woman is extremely emaciated. Her sclerae are slightly yellow. The liver is palpable. The woman seems nervous and keeps tapping her foot. She has obvious needle marks on both arms.
She has an elevated WBC, Bilirubin, AST and ALT. She is positive for Hep B and Hep C antibodies, but not for Hep A. Her hemoglobin is normal. 
Her rapid HIV test is positive. "

Your diagnosis?

PS. And no mocking me because I don't know anything. You can only play along if you play nice.


  1. So yeah, the obvious choice is Hepatitis C, right? But then, what rules out an opportunistic infection of the liver from HIV? Do you typically not see something like that? Since she has positive Hep C antibodies, we can assume she has it. Or maybe she doesn't have HIV at all and she got a false positive.

    This is all the information we get before we are supposed to choose a definitive diagnosis.

  2. hepatoma! courtesy of hep c.