It can be challenging enough to diagnose a patient’s problem in the real world — just imagine how much more difficult it would be in a comic book world where magic, mutant abilities, aliens, advanced technology, and psychic powers all exist. Here are a handful of actual comic book medical cases -- are your diagnostic skills up to the task?

Case Study #1

The patient is 13 year old girl who is very bright and generally does extremely well academically. For the past week she has been sent home repeatedly from school with bad headaches. There is no prior history of headaches. There are no associated symptoms. The headaches resolve with rest in a dark room; over-the-counter medication offers little relief. Of note, there is increased stress at home with her parents frequently discussing divorce.

This patient has:
  1. Migraine headaches
  2. Tension headaches
  3. Chronic Daily Headaches
  4. Somatization related to stress avoidance
  5. The emergence of a mutant power
Case Study #2

The patient is a fifty year-old man who complains of several minutes of "blacking out." He does not recall fainting or falling, but there are several minutes that he cannot remember. He denies any recent head trauma. He had a high stress job and smokes at least 2 packs of cigarettes per day. He has a known history of cardiovascular disease including a severe heart attack within the past few years.

The most likely cause of this patient’s complaint is:
  1. Transient Ischemic Attack (a "mini-stroke")
  2. Heart arrhythmia
  3. Vasovagal response (a "fainting spell")
  4. Brief amnesia related to psychological stress
  5. Possession by a ghost
Case Study #3

The patient is a 16 year-old male, previously healthy, who complains of sudden onset of severe hair loss. Examination of the scalp reveals smooth skin. No hairs, including broken hairs or exclamation point hairs, are seen. There is no scar tissue. He denies any tingling, numbness, or pain of the scalp. A KOH skin scraping is negative. The patient denies any family history of similar conditions.

The most likely cause of this patient’s condition is:
  1. Alopecia areata
  2. Trichotillomania
  3. Exposure to chemical fumes
  4. Tinea capitis (scalp ringworm)
  5. Gamma radiation exposure
Case Study #4

The patient is a ninety year-old male in surprisingly good health. He is a highly functioning member of society most of the time. However, he has been experiencing intermittent fits of rage characterized by aggressive behavior, violent acting out, and paranoid thinking. The physical exam is unremarkable except for an abnormally shaped pinna and bilateral malleolar protuberances. A psychological exam is normal, though it reveals a definite streak of narcissism. The MMSE is normal.

This patient has:
  1. Alzheimer’s disease with sundowning
  2. Alien possession
  3. Antisocial Personality Disorder
  4. Bipolar Disorder
  5. Blood oxygen imbalance
Case Study #5

The Patient is a twenty-five year-old athletic male in generally good condition. He complains of a headache that feels like his brain is “being twisted inside and out.” He describes the pain as burning; There is no radiation of the pain, though he also describes bilateral eye pain. He denies any aura or premonitions before the headache. There is no seizure-like activity. Cranial nerves II – XII are normal on exam. He reports that he had a similar problem roughly five years previous, but that it resolved spontaneously.

This patient’s diagnosis is:
  1. Migraine headache
  2. Psychic attack
  3. Reemergence of a suppressed mutant ability
  4. Ruptured aneurysm
  5. Atypical Seizure
Case Study #6

The patient is a six year-old girl with no significant past medical history. She is up to date on all her immunizations and previously had been an active and playful girl. Her parents found her unresponsive and she has not shown any sign of coming out of her coma since. Initial tests show a normal white cell count and no signs of infection or toxins. Of note, her parents are divorced and have a contentious relationship.

The most likely cause of this patient’s condition is:
  1. Diabetic ketoacidosis with coma
  2. Head trauma (due to child abuse)
  3. Soul stolen by demon
  4. Psychic attack
  5. Inborn error of metabolism
Case Study #7

The patient is a healthy male in his mid-30s who complains of the sudden onset of severe dizziness. He also reports that the dizziness is associated with visual disturbances: a swirling pattern of pastel colors. He denies any previous similar episodes. There is no history of cardiovascular or neurological problems. He exercises regularly, if not excessively, and reports that he has a very high stress job.

This patient has suffered:
  1. A partial seizure
  2. A psychic attack
  3. Acute labyrinthitis
  4. Ocular migraine
  5. Teleportation to a distant planet
Case Study #8

A 21 year-old female complains of a one-month history of increasing anxiety including episodes of poor memory recall. She complains of a severe generalized headache, pounding in nature, and increasing in intensity. She also complains of the sudden onset of hot flashes. She is unable to provide any family medical history as her mother died when she was an infant and she was raised by her stepfather.

This patient has:
  1. Hyperthyroidism
  2. Anxiety disorder with panic attacks
  3. Exposure to mutagenic chemicals
  4. Early onset menopause
  5. Caught in the tail of a comet
Case Study #9

The patient is a teenage female who complains of several days of fever, chills, fatigue, and congestion. She is generally very active and her past medical history is significant for migraine headaches which started a few months ago, but have since apparently resolved. She reports no recent travel.

This patient’s diagnosis is:
  1. Severe allergies
  2. Viral upper respiratory infection (i.e. a “cold”)
  3. Spiritual possesion
  4. Pneumonia
  5. Exposure to alien spores
Case Study #10

The patient is a male in his late thirties. Though generally healthy, he leads a sedentary lifestyle and has a high stress job. His face had a ruddy complexion and he admits to being a “social drinker.”

While out to dinner alone one night, he experiences the sudden onset of a severe weakness of the left arm. None of his other limbs are affected. There is no history of prior injury, and he denies any numbness, tingling, or pain in the involved extremity.

The correct diagnosis for this patient is:
  1. A stroke
  2. Caught up in a science experiment gone wrong
  3. Multiple Sclerosis
  4. Victim of a magic spell
  5. Tetrodotoxin poisoning (i.e fugu, or puffer fish)
Case Study #11

The patient is a male of indeterminate age who complains of brief episodes of intense central abdominal pain. He rates the pain an 8 (on a scale of 1-10) and each episode lasts fifteen to thirty seconds. He has had the symptoms for the past 1-2 weeks and the pain in getting worse every day. He denies any nausea or vomiting; no fever or diarrhea. He is a heavy drinker and a heavy smoker.

The correct diagnosis for this patient is:
  1. Strychnine poisoning
  2. Peptic ulcer
  3. Alien embryo
  4. Appendicitis
  5. Ruptured spleen
Case Study #12

This patient is a thirty year-old female who recently started a new high-stress job after being let go by her previous employer. She complains of several weeks of severe headaches. The pain comes on suddenly and is described as completely debilitating. She denies nausea or photophobia, but notes a feeling of intense weakness. She denies any premonitory aura. She reports that her headaches are so intense that the pain will render her completely unconscious for several hours. She remains tired for several hours after awakening.

The correct diagnosis for this patient is:
  1. Migraine Headache
  2. Emergence of an alternate personality
  3. Tension (stress) headache
  4. Repeated psychic attacks
  5. Complex partial seizure
Case Study #13

An elderly woman comes in your office complaining of increasing weakness over the past several months. It has become difficult for her to complete her normal activities around the house due to this weakness as she has started dropping dishes and at times has difficulty standing up. Her past medical history is significant for heart disease and a recent anemia which required a transfusion to correct. She is a non-smoker. She eats a healthy diet, but gets little exercise.

The correct diagnosis for this patient is:
  1. Parkinson's Disease
  2. Anemia
  3. Heart failure
  4. Radiation poisoning
  5. Soul used in a black magic rite
Case Study #14

This patient is a male college student. Something of an anti-establishment type, he has been known to dabble in recreational drugs. He complains of the sudden onset of convulsions and severe burning central abdominal pain, 10/10 on the pain scale. There is no radiation of the pain and no alleviating or aggravating factors. After several hours, the pain resolved and there has not been a second episode. He denies any fever, nausea, vomiting, or diarrhea. He denies any recent dietary changes or any recent increase in stress. There is no history of a seizure disorder.

The correct diagnosis for this patient is:
  1. Gastric Ulcer
  2. Reaction to impurities in street drugs
  3. Sympathetic pain from a twin
  4. Alien parasite
  5. Hepatitis A infection
Case Study #15

The patient is generally healthy young female in her mid-twenties who has experienced several episodes of sudden uncontrollable rage which have led to a good amount of property damage. She feels dizzy for a few seconds before one of the episodes begins, and experiences a severe pounding headache, but denies any other aura or premonition. Afterwards, she feels confused and sleepy and has no memory of what happened. People who have witnessed the episodes state that she acts “possessed” but displays no other physical changes. Patient has no significant medical history, but does come from a broken home where she was abandoned by her father at a young age and her mother died early.

The correct diagnosis for this patient is:
  1. Withdrawal from illegal drugs
  2. Anabolic-steroid rage episode (i.e. “Roid rage”)
  3. Atypical partial seizure
  4. Gamma radiation exposure
  5. Psychological fugue state
Case Study #16

For the past several days, the patient -- a healthy male in his early thirties -- complains of episodes of lightheadedness. After several minutes of symptoms, the patient develops tunnel vision and then quickly passes out. The episodes always seem to occur around the same time of the evening. When he awakes in the morning, he has no memory of the previous night. There experiences no incontinence. He denies any history of similar episodes. The patient is adopted, so family history is unavailable.

The correct diagnosis for this patient is:
  1. Partial Complex Seizures
  2. Attempted possession by an alien entity
  3. Alcohol related blackouts
  4. Lycanthropy
  5. Affected by radiation from a passing satellite
Case Study #17

The patient is a previously healthy male in his early 50s. While talking with his son, he suffered the acute onset of severe generalized abdominal pain. A short time later, he collapses, unconscious. There was no nausea, vomiting, diarrhea, or fever. There has been no recent travel or unusual means. His son remains symptom free.

The correct diagnosis for this patient is:
  1. Deliberate poisoning
  2. Appendicitis
  3. Mesenteric ischemia
  4. Victim of a voodoo ritual
  5. Food poisoning

A tremendous thanks to all of Dr. Scott's intrepid teaching assitants including J. Aparo, J. Byrne, J. Carey, C. Claremont, D. Cockrum, K. Giffen, F. Guardineer, B. Haney, F. Herron, J. Kirby, L. Manco, M. Pasko, A. Plastino, J. Siegel, and D. Sprang.

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