Comments on: House – episode 15

By: ecoli

ecoli — Thu, 20 Oct 2011 21:09:29 +0000

Maggie,
I am certainly no doctor, but from the OMIM text on OTD I can deduct that it isn’t always lethal. Also, “partial” deficiency does not usually refer to heterozygosity (which would be what you referred to), but to genes that still work a bit.(enough to “hide” the disease most of the time but not when you take, say, a nitrogen-rich meal when you have partial OTD)

By: Maggie

Maggie — Sun, 28 Nov 2010 04:58:32 +0000

How come this adult man presented OTD all the sudden? I mean.. OTD in men is very serious.. because they all present full deficiency not like women that can present partial.. this is because the enzyme genes are on the X cromosome… its an X-linked disease.. Plus.. the first symptom in full OTD is an neonatal hyperamonemia and if the deficiency wasnt diagnosed at that time the patient probbably would have died because of the hyperamonemia.. obviously without OT his urea cycle doesnt work.. how could he survived without urea cycle all those years?? please help! i need to know if dr house was right this time..

By: Diseraph

Diseraph — Thu, 14 Oct 2010 03:41:37 +0000

Anyone know how he knew the kitty toy would be magnetic?

By: NZMedStudent

NZMedStudent — Thu, 18 Mar 2010 07:10:57 +0000

Also, dialysis would have worked just as well as a pig!!

By: NZMedStudent

NZMedStudent — Thu, 18 Mar 2010 07:10:05 +0000

Late comment, but we just did a case study at med school with exactly this problem- OTC deficiency (though in a 6-month-old). Our metabolic medicine lecturer loves House! We even watched part of this in our tutorial, though mostly so that we could tell the tutor what we would have done in that situation… ie the right thing. For example, the whole “if you don’t admit your brother is gay, he’ll die” drama at the end is silly- it would have been straightforward to confirm OTC deficiency by measuring his orotic acid levels as well as his ammonia and amino acid levels. Though much less fun to watch!

By: Lalilu

Lalilu — Wed, 20 Jan 2010 15:16:35 +0000

Marc, you are wrong. The single GCS are counted together, and a GCS of 8 or lower is actually exactly that. Have no better source than Wiki, but it is correct:

Individual elements as well as the sum of the score are important. Hence, the score is expressed in the form “GCS 9 = E2 V4 M3 at 07:35″.

Generally, brain injury is classified as:

* Severe, with GCS ≤ 8
* Moderate, GCS 9 – 12
* Minor, GCS ≥ 13.

Ergo if you score a GCS of 3, you are more or less dead, at least with respect to interaction.

By: Marc

Marc — Sat, 25 Jul 2009 18:13:28 +0000

Caught an error. At one point House is telling his team that the patient is in a coma with a GCS of 8. I think it’s Omar who says something like “that’s practically dead”. Not true. GCS of 8 isn’t actually a coma. Now a GCS of 3 – OK, but not 8. Google the GCS and you’ll see.

By: Beth

Beth — Thu, 08 Jan 2009 15:30:38 +0000

I loved the clinic interludes in this one. While the specifics of the medicine in House are often totally bogus, and there is often little or no method to House’s diagnostic madness, the discovery of the toy cat in the child’s nose illustrated a valuable medical meta-principle which is also pointed out in a later episode (the death row guy): Patients do things for reasons. The kid chose the same nostril multiple times, leading House to conclude there was something wrong in that nostril (which was the cat).

I am a pre-med student and I have little knowledge but a lot of interest in the ways this show gets things right and/or wrong. The notion of looking at the patient’s actions from their point of view is something I think this episode got right, even though it was only in the comic relief clinic interludes. The real-life application of this principle is important not only in diagnostics (seen here) but especially in studying patient decision-making and adherence patterns. Bump that medicine grade up to a B+.

By: Quinn

Quinn — Mon, 03 Nov 2008 04:01:26 +0000

whomsoever- They said it was marketed to homosexuals, not that it was particularly effective. :-) Lots of pseudomedication is marketed to specific social groups, usually related to the health myths that happen to be most popular in that social group.

By: Rob

Rob — Wed, 19 Dec 2007 00:15:28 +0000

From the 3rd-year virology course I took, I think HepC is sometimes (but not always) curable by alpha-interferon or one of the new pegylated interferons. However, I find it odd that they didn’t mention that the patient might have contracted HCV from blood transfusions that he may have gotten when he had his previous head injury (the tire iron thing). Contaminated blood transfusions are rare these days, but still possible.

And I also agree that it was odd they didn’t check his blood ammonia levels early on since comas are readily caused by a buildup of ammonia when the liver screws up.