The episode begins with House and his team being questioned individually by Dr. Cofield, a doctor from another hospital, as part of a disciplinary hearing.

It all started with a patient named Bill, who is a thirty-two year-old high school chemistry professor who collapsed while jogging and is now in a coma and “paralyzed in all four extremities.” There was no history of trauma, and CT scans of the brain show no evidence of stroke or structural lesions. Reviewing the case, House initially suggests transverse myelitis, but admits it doesn’t really fit the situation. He then presents the patient to his team, who suggest the diagnoses of hepatic encephalopathy or normal pressure hydrocephalus. Chase points out that Bill is hypokalemic (low in potassium), which House takes as a sign that he has thyrotoxic paralysis (a temporary paralysis associated with an overactive thyroid). House starts bill on a regimen of steroids, PTU (an anti-thyroid medication), and beta-blockers (a class of drugs, that among other things, blocks the effects of too much thyroid hormones).

Bill improves and wakes up from his coma. His wife and some of his students visit, and they make a comment about a lab explosion he was in earlier that day. After this key fact is mentioned, Bill starts coughing up some blood. The team learns that during the explosion, conveniently uploaded to the internet, Bill was caught in a burst of hydrofluoric acid and hit his head fairly hard against the wall. The team now suspects that Bill is coughing up blood because of the inhaled chemical, and the rest of his symptoms can be explained by the trauma of hitting his head. House wants to treat Bill with aerosolized (inhaled) Heparin (a blood thinner), a treatment not yet approved, or apparently even tested, in humans.

Everything seems to be going well and Bill is getting ready for discharge. He is being given a bath to remove the remaining chemical on his skin when Adams notices a rash. While she is trying to get a good look at it, the patient freaks out. Adams thinks the rash is invasive Strep, while Park thinks the rash is nothing special but thinks the patient’s freak out was because of the steroids they had put him on. Taub feels the rash, together with the other symptoms like the lung problems, is a sign of Wegener’s granulomatosis. House decides to put Bill on steroids again. If he has Wegener’s, the steroids will cure the condition. In the other two cases, it will worsen the condition enough so the right diagnosis can be made.

Chase agrees with Adams and decides a biopsy of Bill’s rash is the best way to get a diagnosis. Unfortunately, Adams was wrong and Park was right — the patient is having steroid-induced psychosis. Thus, when Bill sees the needle Chase plans on using, he has a psychotic break which requires an injection of Haldol to bring to an end. In the scuffle, Chase was stabbed in the heart with a scalpel. He is rushed off to surgery. The hole in his heart is patched, but Chase later discovers that he can’t feel his legs. The concern is whether Chase has a post-traumatic syringomyelia (a cyst in the spinal canal), or a clot of a radicular artery (vessels which supply the spinal nerves with blood). It ends up being the clot, which is good news because its removal should allow Chase to regain some use of his legs. While all this is going on, House keeps popping in updating the team on Bill, even though they are no longer on the case. First, he suggests that is autonomic dysregulation, then he reports kidney failure which rules out his last diagnosis. Finally, after having w Eureka! moment with a pranked bottle of Vicodin, House diagnoses Bill with tumor lysis syndrome, caused when he he struck the wall after the explosion and ripped open the tumor he didn’t even know he had, spilling its contents into the bloodstream.

The news of Bill’s survival reaches the team just as the results of the disciplinary hearing are to be announced. Learning the patient survived, Cofield lets House of the hook (yet again), a decision that even House is upset with.

As usual, major complaints are in red (red caduceus), modest complaints are in blue (blue Vicodin), and nit-picking ones in green (green pencils):

The first step in treating thyrotoxic paralysis is supplementing to low potassium, which House failed to do.
Steroids are not indicated for the treatment of thyrotoxic paralysis.

The primary sign of tumor lysis syndromeis is hyperkalemia (high potassium) — the exact opposite of what the patient had.
Bill wasn’t showing any of the myriad other symptoms of tumor lysis syndrome.

Syringomyelias can occur post-traumatically — when there is trauma to the spinal region. A scalpel to the heart is not going to cause a cyst formation in the spinal cord.

Hydroflouric acid is a very nasty chemical. They should have decontaminated the patient much earlier and I’m surprised he didn’t have any acid burns or other damage. Was he even wearing goggles when performing the experiment? (I also find it hard to believe that he’s use HF for a classroom demonstration with a risk of explosion).

Why biopsy a lesion you suspect is bacterially infected? I can understand performing a biopsy on an unknown lesion, but Chase specifically said that he agreed with Adams, and a biopsy is not how you prove a Strep infection.

I’m a bit confused how a clot in a single radicular artery (caused by what exactly?) could cause paralysis in both legs.

Swelling in the brainstem, like Park suggested, would have shown up on the initial head CT.

What was the rash from?

House carefully scrubs into surgery and gets gowned and gloved – and then grabs an unsterile surgical mask and holds it against his face. Masks are put on before scrubbing.

A disciplinary hearing before the patient’s disposition is even known? No bureaucracy moves that fast.

I found the medical mystery to be moderately interesting this week. It earns a B-. The final solution directly contradicted some of the earlier patient history and left several symptoms unexplained. It earns a C-. The medicine was sloppy and perfunctory this week. When the anatomy is wrong, why would we expect better from the medicine? I give it another C-. The soap opera had some good drama, but the ending was rather anticlimactic — and virtually a deus ex machina (or in this case, patient’s wife ex machina). It earns a B.

The review of the previous episode of House
A list of all prior House reviews

The Plot: A man recently diagnosed with melanoma, but given a good chance of survival, is found dead, with mysterious bleeding from his eyes. The Fringe Team is called in to investigate. During the autopsy, Walter discovers that the victim was killed with a strange mixture of chemicals that shouldn’t act as a poison, yet they do. He concludes, with logic bizarre even for Walter, that it was impossible for someone to discover this toxin on their own — that they must have learned it from someone else, someone with godlike powers.

A second victim is found. Then a third victim manages to escape the killer. The Fringe Team talks to him at the hospital, but learns little other than the killer seems to have some knowledge of the future, and claims to be killing people now to put them out of their future misery. The Fringe Team can’t find any connection between the victims, but Mentat Astrid, visiting from the other universe, is able to find a connection — they all passed through Logan Airport and had the same TSA screener. The Team looks into the screener and learns he was a former MIT professor and mathematical prodigy who felt that the correct mathematical equation could “flatten out” the universe and let someone see the past, present, and future. This professor claimed that he discovered this equation, then disappeared from the university. Interestingly enough, he was working on the equations at his lake house — at Reiden Lake.

The Fringe Team tracks the killer down, but rather than be taken alive, he commits “suicide by cop” and is shot and killed by Olivia. Later, the Observers look through the killer’s belongings and find what he was using to read the future, a gadget belonging to the Observer September, that he lost years before. The head Observer also learns that September did not wipe Peter from existence.

(The B-plot deals with Mentat Astrid crossing over to our universe to talk with our Astrid because Mentat is having difficulty dealing with the death of her father. Bolivia also crosses over, ostensibly to bring Mentat back, and while here has a reconciliation of sorts with Walter. On second thought, this may be the A-plot, which would explain why the Tears of Ra plot felt so thin.

1. Glowing In The Dark Is Not Necessary
Stage I Melanoma is 90-95% curable. Radiation therapy is not used in its treatment at this state, however.

2. Works Great, Unless the Chase Lasts More Than 73 Miles
More blatant Leaf-vertising.

3. Fear Is The Mind-Killer
This is third variation of alternate Astrid we’ve seen. First, was Mentat Astrid, not seen since the merging of the universes. A few episodes ago we had Sheldon Astrid — more nerdy than savant (and Sheldon Astrid had more social skills – well, slightly). This episode, we’re back to the savant, though with more clearly autistic symptomatology. I dub this variation Rain Man Astrid.

4. Strike That, This Plot Is The Mind-Killer
This had to be one of the stupidest plots I’ve seen in Fringe this season, if not ever. Neil can see the future and wants to put people out of their misery. Fine, that makes sense, more or less. But to do it, he chooses to use an unknown yet highly distinctive poison that draws attention to his crimes? Thus allowing him only to “save” two people?
And that entire “no one would ever think to combine these chemicals to make this unexpected poison” concept is ludicrous as well. Why could Walter tell so fast that these chemicals, that apparently cannot be combined, were combined, and were what was killing the victims. Why did the person using them have to have learned from God or someone godlike. Walter was able to learn the creation of this toxin just be performing the autopsy, and there’s nothing godlike involved in that at all.
As stupid as the plot was, the Astrids and Olivias did pull off some excellent acting.

The Astrid and Olivia storyline was well done, but the “main” story was (almost) entirely unsatisfying (I’ll give a little credit to the Obervers for trying to make it interesting). Despite Anna Torv’s and Jasika Nicole’s best effort, the ludicrous Tears of Ra plot causes the Fringe Doomsday Clock to advance a minute toward midnight.

This week’s Fringe cipher was: EMPATH.
A list of all previous Fringe reviews is available here.
As always, Karl has more to say over at his blog.

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I’ve got nothing negative or snarky to say today, I think the Special Olympics are a great organization and I’ve had a great time every time I’ve helped them (and apparently I helped Superman as well).

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Tags: comics psa superman special olympics

A teenager presents to the Princeton-Plainsboro Hospital clinic complaining of some difficulty breathing. All she wants is an inhaler for her “asthma” but House correctly recognizes that she is homeless and the man with her isn’t really her father. What really piques his interest is when she starts bleeding from her ear. He mentions that this is a sign of a skull fracture, but can find no fracture — or any other cause of the bleeding — so he admits her to his service. The team’s initial diagnoses focus on her homelessness and consist of drug use, malnutrition, or HIV. Chase goes further and suggests she may have a squamous cell cancer of the middle ear with paraneoplastic syndrome, while Taub, backed by Adams, suggests a possible cerebral (brain) infection, probably pneumococcus. House agrees with Taub and Adams and starts “Jane Doe” on ceftriaxone (a potent antibiotic).

Adams and Park check out Doe’s school — where she is doing quite well — and also check out her address on record with the school, which is a foreclosed home she has fixed up. Looking around the house, Adams finds a few beers and some mold. She now suspects Doe has a fungal infection and starts her on fluconazole (an antifungal medication). Upset that the team went behind her back digging into her history, Doe tries to leave, but collapses as soon as she gets out of bed, complaining that she “can’t feel her legs” (her symptoms are later identified as paralysis, which is different from the paresthesia she was complaining of).

Looking over her symptoms of ear bleeding, problems breathing, and lower extremity paralysis, the team’s new differential diagnosis is transverse myelitis, endocarditis with septic emboli, or the fairly vague “vasculitis” (inflammation of the blood vessels). House goes with the vague and starts the patient on steroids to treat the presumed vasculitis. Initially, she is doing better on the steroids, but then things quickly go to hell. Her estranged mother shows up, identifying the patient as Callie, and in the middle of the confrontation, Callie begins coughing up blood. Different diagnoses are considered based on where the blood may be coming from (respiratory or gastrointestinal source). Chase suggests she has a sinusitis and a bleeding disorder, and Adams suggests Zollinger-Ellison syndrome (a condition where the patient has a tumor which secretes gastrin, which causes the stomach to pump out too much acid). House thinks Adams has the better idea and orders an EGD (upper endoscopy), which reveals bleeding ulcers in the esophagus; unfortunately, this doesn’t fit any of the diagnoses discussed. The team now considers the diagnoses of HPV (human papilloma virus), alcohol-induced esophagitis, or a berry aneurysm of the brain. House thinks it is the aneurysm and wants a quick cerebral angiogram followed by surgery before the aneurysm has a chance to rupture, which would rapidly kill her. Adams favors the alcohol theory — Callie does admit drinking an occasional beer — and Callie’s mother agrees with Adams and decides to forgo the angiogram and surgery. Callie seems to be doing well and is actually talking with her mother when she suddenly falls unconscious. Coudl she have had a berry aneurysm which burst? Was House right? She is rushed to the OR suite for the cerebral angiogram, but no aneurysm is detected. Her blood pressure begins to plummet and the team buys time with some pressors (medications that increase blood pressure), but still don’t know what is wrong her. Brainstorming, Adams first suggests cancer, then recalls hearing about a trip Callie took to Florida two years before and wonders is she may have contracted dengue or cholera. House (rightfully) scoffs at those, then after learning Callie went swimming in a freshwater canal while in Florida, correctly diagnoses her with ascariasis (a parasitic worm infection). After Callie is treated, she sneaks out of the hospital to be on her own again, still unwilling to trust her mother. (I’m assuming she snuck off to the Disney Channel, where she was able to find a much happier family).

As usual, major complaints are in red (red caduceus), modest complaints are in blue (blue Vicodin), and nit-picking ones in green (green pencils):

House dismisses Adams suggestions of dengue and cholera by pointing out the two year gap between exposure and symptoms, but then diagnoses ascariasis, which has precisely the same problem. The worms would not have sat quiescent for two years, not when they had their preferred environment, no matter what the fancy graphics at the end showed.
I’ll grant that ascariasis can cause pulmonary symptoms and gastrointestinal symptoms (because the worms travel intestines to liver to liver blood flow to lungs, then up the trachea, and swallowed back down to the intestines). Ears (and even if they could get to the ears, how were they causing bleeding? Drilling a hole?)? Brain (and yet not be visible on CT scan)?

Ears should not bleed. House looked in Callie’s ear and said it was normal. I would expect him to see a bleeding source (such as a scratch, cyst, infection, etc) in the canal, or a hole in the tympanic membrane which would let blood from deeper in the ear out into the canal. He mentioned neither of these – so how could there be blood?
Other than Chase’s mention of squamous cell cancer of the ear, none of the diagnoses mentioned are going to cause ear bleeding, particularly ear bleeding that looks normal on exam. For example, Zollinger-Ellison? How is a gastrin-secreting tumor going to cause ear bleeding? Callie only has four symptoms, and Adams still skips one in her diagnosis

Taub’s phrasing “cerebral infection” was a odd. He seems to be suggesting meningitis — for which pneumoccocus is a common cause and ceftriaxone a good choice of medication — but that doesn’t fit with Adams comment about lack of fever. You would expect a fever — and meningeal signs — with meningitis. They could possibly be referring to a brain abscess, but that would have shown up on the CT, and pneumococcus (and thus the choice of ceftriaxone) much less common.

No vaccine is 100% protective, and Callie could still get pneumococcus even after being immunized. Plus, the vaccine only covers a handful of different pneumococcus serotypes (admittedly the most common), and she could have been infected with one of the serotypes not covered by the vaccine.
Why would Adams, who doesn’t believe much of what Callie says, believe a shot record to be true? Callie likely forged or lied on her school shot records. It’s not like her parents really signed it.

When Callie stands up and collapses to the floor, she complains she can’t feel her legs (paresthesia). That’s different that an inability to move her legs (paralysis). It’s possible she has both and can’t move or feel her legs, but then the most common complaint would be that she couldn’t move her legs, not that she couldn’t feel them.

PPH is in for some tough times. In the past two weeks, they’ve let two patients escape– two they should have been watching closely. Last week, a patient with Alzheimer’s (known to be elopement risks), and this week, a minor left AMA, a minor with a history of running away.

I found the medical mystery to be more interesting than usual this week, because the symptoms were quite disparate. I give it B. The final solution was a let down, because it couldn’t really explain half the symptoms (and the most interesting half at that); it deserves no more than a D. The medicine was very sloppy this week, with many of the diagnoses not explaining all the symptoms — and there were only three or four symptoms to work with. I give it a C-. The soap opera was adequate and average. There were a couple of nice scenes, and Wilson got a few good lines, but it really wasn’t anything above average: C.

The review of the previous episode of House
A list of all prior House reviews

This week, Roxana wins with 9 points. Harvey, Little apple, rileyjo, Rouge Rogue, Silvina and TheJester were second with 8 points.

Overall, James H retains the lead with 46 points. Dr. R moves back up to second with 44 points. Nextsundayad and Roxana are tied for third with 42 points. wkmaier is fifth with 40 points. If you have 35 or more points, then you are in the top 10%.

Click here to see the full scoreboard.

The Plot: Emily is a teenager who occasionally catches glimpses of someone’s pending death. She quickly sketches the scene she sees in her sketchbook, rips out the page, and then hands it to the victim. She’s essentially Cassandra, and her warnings of imminent death do no good to the victim. They do bring her to the attention of the Fringe Team, especially Olivia, who is still coming to terms with the Observer who told her that she had to die.

Emily gives the Fringe Team a sketch she made showing numerous victims amid piles of rubble. The image is centered on one particular man. The team is able to figure out who he is via his bus pass. Walter hypnotizes Emily (using the standard red and green lights) to gain more information and learns that the disaster will take place at a courthouse. Olivia and Lincoln learn that the man in question recently lost custody of his children in a divorce proceedings. They track him down to a local courthouse and the FBI finds a large bomb in the bed of his pickup truck. They are able to block the radio detonator, but he threatens them with a small bomb he is wearing. Olivia is able to talk him into surrendering and no one is killed. For once, Emily’s prediction does not come true.

When Olivia calls Emily to thank for her help, she learns that she is missing. Olivia tracks her down to a pond-side bench at a park she was fond of. Emily has foreseen her own death and has come to her favorite spot to die, which she does, quietly, in the arms of her father.

Later in the evening, Nina Sharp comes over to Olivia’s apartment to check on her. Olivia complains about the migraines she’s been having (the ones caused by Nina’s secret injections), so Nina promises to send over some “new medicine” the next day.

1. Math Must Be Different in Spain
The math Olivia and Broyles use on the Spanish Flu doesn’t add up. If the last case was 1919, then 91 years later is 2010, not 2012 (or even 2011, when the episode was undoubtedly filmed). Unless they are suggesting that 1 and 2 year-old do not make antibodies, which would contradict years of immunization and vaccine research.

2. Billy Squier
An “overload of electrical energy in her brain was just too much” is not the definition of stroke; it’s the definition of a seizure. A stroke is what I like to call a “plumbing problem” – the required blood cannot get to the brain either due to a blockage (embolic stroke) or bleeding out (hemorrhagic stroke). A problem with the brain’s electrical system would be a stroke, at least in the sense Olivia is describing.
Neither of these would account for the bloody nose, so I’m going to count that as a psychic nosebleed.

3. Scan Acquired
I’m amazed Walter could get such an accurate reading from the occipital lobe when he had no sensors anywhere near it.
Theta-1 waves are said to occur during voluntary motion and REM sleep, though the exact definition of a theta-1 wave varies.
Theta-1 waves originate in the hippocampus, a part of the brain which is nowhere near the occipital lobe.
Since blood carries oxygen, it would be hard to get increased oxygen without increased blood. And since when does an EEG measure either?

4. Radio Free Albemuth
Now I’m no radio-specialist or electrician, but is it really that easy to jam a specific frequency? How did they know they weren’t going to set off the bomb by accident?
Was it wise to send Peter and Lincoln, not trained in demolitions, it to help the bomb squad? Particularly in regards to Peter, he’s one of a kind and is it really worth risking him?

5. Must Be Those Ceramic Wires and Electrodes
So the bomb Albert was wearing had not detectable metal in it? Really?

6. Oh By The Way
When are the Fringe Team finally going learn that they need to sit down and have a long debriefing session with Peter. How many times has he recognized something they didn’t or knew more than they did? Just off the top of my head: shapeshifter’s memory banks, David Robert Jones, and the Observers. I’m sure I’m missing a few others.

While there was nothing specifically wrong with this episode (other than the questionable science and math), it just didn’t gel particular well, with the attempt at pathos at the end being a more than a little over-the-top. The Fringe Doomsday Clock heads back towards midnight.

This week’s Fringe cipher was: MARCH.
A list of all previous Fringe reviews is available here.
Karl should soon have more to say over at his blog, providing he’s not partying too hard on his vacation.

Tags: television fringe precognition bomb hypnosis

Nope. The mayor has the measles, yet still wants to attend the City Council meeting. Truly a problem requiring all the abilities of the Man of Steel (sorry, orphans, try to enjoy the searing pain from the toxic waste).

This is Superman, so he must have a brillaint plan to “beat those measly measles,” right? Wrong again. No shrinking down and battling the evil virus and its zombified cells. No jumping forward a few years in time, grabbing a measles vaccine, then jumping back in time to before the mayor was infected. None of that. Instead, Superman visits a glass factory and makes a giant glass globe.

Then he plunks the mayor in the sphere, along with his desk, some papers, and what looks like a very limited supply of air, and flies him off to the City Council meeting.

Mission accomplished.
This was truly a job for Superman.
Join us tomorrow when he helps City Councilman Adams take an old couch to the curb for trash pickup.

The doctor is working hard to “pull them thru” by…doing what, exactly? Putting a warm washcloth over their eyes? Tucking them in?

Now, I’m no expect on knockout gases, but I think I could do better than that.

I like the way there’s a list of rules on the back wall. I can only imagine what they say: “No roughhousing,” “No running with scissors,” “Wash your hands before returning to work”

Andres is a man with early onset Alzheimer’s disease. He is being evaluated for possible inclusion in a drug study when he develops bloody vomiting. He is admitted to Princeton-Plainsboro Hospital and assigned to House’s service. The team’s initial thought is that the patient has a gastrointestinal bleed which is causing the bloody emesis. An EGD (upper endoscopy) is performed and it shows a Mallory-Weiss tear (a rip in the esophagus of those who vomit frequently or forcefully), but that is a consequence of vomiting, not a cause. Andres is also noted to have elevated liver enzymes, and the diagnoses of gallbladder disease and steatohepatitis (fatty liver) are mentioned. House favors the latter and decides to start the patient on statins (a class of cholesterol drug as high cholesterol is almost always seen with steatohepatitis) and double check the liver (initially a biopsy, but overruled by Foreman to an ultrasound examination), but before they can perform the testing, Andres becomes more violent that ever, punching his wife, and requires sedation. At this time, the team also notices bloody urine. The differential diagnosis now consists of rhabdomyolysis (severe sudden muscle damage) and TTP (thrombotic thrombocytopenic purpura). House thinks TTP fits best, and orders Andres started on plasmapheresis.

Overnight, Andres elopes (the medical term for a patient, especially a demented one, who leaves the hospital). In the middle of a snowstorm, the team tracks him down to an old soccer field, but by the time they find him, he is hypothermic and pulseless. CPR is started, because, as Chase reminds Adams, they’re not dead until they’re warm and dead (sudden hypothermia can sometimes be protective of a patient, though this is more common in children than in adults, so it’s medical tradition not to declare someone dead until they’re back to normal temperature). Andres is brought back to the hospital, sent to the ICU, and started on extracorporeal warming of his blood. As he warms up, his brain function returns, then his heart. He’s initially in ventricular fibrillation, but he returns to a normal rhythm after some amiodarone (a medication used to suppress heart arrhythmias) and defibrillation. Unfortunately, he seems to have lost his ability to speak English and now only murmurs in Portuguese, his native language. He also develops a fever, but is this a symptom of his original admitting disease, or a consequence of being hypothermic? Looking over Andres’ symptoms, House sticks with the diagnosis of TTP and wants to resume plasmapherises. Foreman, instead, favors a viral infection that has spread to the brain to cause encephalitis. House relents, and has the patient started on interferon.

Andres is not doing any better. He falls back into ventricular fibrillation and this time requires three shocks to correct (apparently they neglected the amiodarone this time around). Foreman maintains it is a viral infection of the brain, such as encephalitis or meningitis, while House now favors toxin exposure. This week, it is Foreman who has the Eureka! moment while talking with some hospital donors. Seeing a flower bouquet still looking fresh despite being over a week old, he recalls that aspirin in the water can prolong the life of cut flowers, and this leads him to diagnose the patient with Reye’s syndrome. Some corticosteroids and Andres is back to normal (well, as normal as someone with early onset Alzheimer’s can be.)

Meanwhile, Wilson is treating a patient with a bladder infection (which he apparently diagnoses by palpating her neck). In the course of his discussion with her, he learns that she and her husband are self-proclaimed “asexuals”, completely disinterested in sex. House finds this head to believe and wagers $100 that he’ll find a medical cause for the lack of sex. He runs tests on the patient’s blood, but everything is normal. He eventually lures the husband in for an exam and discovers a pituitary tumor (a “macroprolactinoma“) that is suppressing the normal sexual urges. With some treatment, the high levels prolactin can be treated and the patient’s symptoms (in this case his nonexistent sex drive) corrected.

As usual, major complaints are in red (red caduceus), modest complaints are in blue (blue Vicodin), and nit-picking ones in green (green pencils):

Pet peeve here: Defibrillation does not “shock the heart back into rhythm.” The shock from defibrillation momentarily stops the conduction of the arrhythmia, allowing (hopefully) a normal rhythm to take over. The shock itself does not “jump start” the heart or start the normal rhythm, it just stops the bad rhythm — an important distinction.

TTP (thrombotic thrombocytopenic purpura) -– none of three parts (the T, T, or P) fits. There was no mention of low platelets (though other lab abnormalities were mentioned), no clotting, and no purpura. (In fact, there was no mention of rash at all, and rash is almost always seen in Reye’s).

In regards to his symptoms, Reye’s syndrome is quite a stretch with few of Andres symptoms matching well, but then again, Reye’s in adults is quite a stretch in-and-of-itself.

Symptoms of death in the hypothermic do not resolve that predictably (“Ah, 93 degrees, must be time for the ventricular fibrillation”), and frankly, the patient usually remains dead.

Interferon is not a treatment for encephalitis or meningitis.

Cortciosteroids are used in Reye’s to treat swelling of the brain — something they never bothered to look for, despite the more-than-expected behavioral changes.

Third episode so far this season where there is debate whether societally atypical behaviors are symptoms or not. Charity, paranoia, and now aggression.

Before starting statins in a patient with elevated liver enzymes, I’d want to make sure the cholesterol is indeed high and require treatment, as the statins themselves can elevate liver functions.

While there is debate over the use of “chemical restraints” (sedation in aggressive patients), diazepam is unusual for a first line agent. Haldol seems the more common choice. On the other hand, diazepam can be more easily reversed if something goes wrong.

The medical mystery this week was OK, but not great — but that still makes it better than most episodes this season. The big mystery was why Andres developed Alzheimer’s so young, but answering that was outside the scope of the episode. I give the medical mystery a C+. The final solution kind of more or less fit, if you ignored the usual time course of Reye’s Syndrome. I give it another C+. The medicine was uninspiring this week, with diagnoses thrown around that could be easily tested, but never were. Plus Foreman, a neurologist, was using meningitis and encephalitis interchangeably. I give the overall medicine a C. The soap opera was enjoyable this week from the pathos (Chase), to the humorous (the yellow cards, Park and her “tapping”), to the unethical (House and Wilson). It deserves an A-. (Bonus points for the Spider-Man allusion. And what manga was House reading when first talking to Wilson? Maybe someone should tell him they’re read right-to-left, not left-to-right.)

The review of the previous episode of House
A list of all prior House reviews