Can You Make the Diagnosis?

June 25th, 2008

Filed under: Comics, Medicine

How good a diagnostician are you? Using the provided history and physical exam details, will you be able to provide the correct diagnosis for these three patients?

(Case studies #1 and 2, along with a brief explanation, can be found in the previous post “The Art of Differential Diagnosis in a Super-Hero World“)

Case Study #3: The patient is a16 year-old male, previously healthy, who complains of sudden onset of severe hair loss. Examination of the scalp reveals smooth skin. No hair, 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:
A. Alopecia areata
B. Trichotillomania
C. Exposure to chemical fumes
D. Tinea capitis (scalp ringworm)
E. Gamma radiation exposure

Click here for the ANSWER
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:
A. Alzheimer’s disease with sundowning
B. Alien possession
C. Antisocial Personality Disorder
D. Bipolar Disorder
E. Blood oxygen imbalance

Click here for the ANSWER
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:
A. Migraine headache
B. Psychic attack
C. Reemergence of a suppressed mutant ability
D. Ruptured aneurysm
E. Atypical Seizure

Click here for the ANSWER
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11 Responses to “ Can You Make the Diagnosis? ”

  1. Jayunderscorezero
    June 26th, 2008 at 3:14 am

    Ok, I have to say, #4 completely threw me.

    Thanks for doing these again!

  2. Dr Archeville
    June 26th, 2008 at 7:13 am

    #3 could also describe Charles Xavier, I believe (though in that case it’d be “emergence of a mutant power”)

  3. Scott
    June 26th, 2008 at 9:01 am
    Official Comment

    While Xavier had the headache (which seems to be common in mutants developing their powers), he was lacking the eye symptoms that Cyclops experienced.

  4. fluffy
    June 26th, 2008 at 11:52 am

    I totally nailed #5 (and figured it was Cyclops). Then I looked at the thought bubble. Holy crap is that some long-winded, calm, and thorough exposition for someone whose eyes are burning. When I’m having a migraine all I can think is “AAAAAAAAAARRGH makeitstopmakeitstopmakeitstop.”

  5. Harvey
    June 26th, 2008 at 1:44 pm

    The physical exam was unremarkable, except that the patient has little wings on his ankles. Ahem…

  6. Scott
    June 26th, 2008 at 2:01 pm
    Official Comment

    Harvey,

    those would be the “bilateral maleolar protuebrances.”

  7. Dr Archeville
    June 26th, 2008 at 2:19 pm

    >> While Xavier had the headache (which seems to be
    >> common in mutants developing their powers), he was
    >> lacking the eye symptoms that Cyclops experienced.

    That’s no.5. I was referring to no.3 (bald Luthor).

  8. Scott
    June 26th, 2008 at 2:27 pm
    Official Comment

    Ahhh. That makes more sense. Though honestly, I have no idea how Xavier lost his hair. I just assumed it was standard male-pattern baldness. Did he lose his hair all at once as well? And if so, was Superboy around?

  9. Graeme
    June 26th, 2008 at 3:51 pm

    Heh, I only got a few of them, but it was fun playing Super Hero Doctor! I’d love to see more of these!

  10. Dr Archeville
    June 27th, 2008 at 7:10 am

    > Though honestly, I have no idea how Xavier lost his hair. I
    > just assumed it was standard male-pattern baldness. Did
    > he lose his hair all at once as well? And if so, was Superboy
    > around?

    All of the things I’ve read addressing when he went bald say that it happened while in college. And most of the comics dealing with his past say he attended college at an age when most folks were still in high school (one ish of EXCALIBUR says he graduated w/ honors from Harvard at 16).

    Doubt Superboy had a hand (lung?) in it, though Wanda may’ve accelerated it.

  11. Your Obedient Serpent
    June 27th, 2008 at 11:14 am

    I think “glowing and smoldering eyes” should have been included in the symptoms on #5.

    I mean, I got it anyway, but, you know — when I was working in the ER, that’s something even us patient transporters would have noticed.

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