Dr. House

Patient, 35 year old male is admitted to the hospital two days ago initially complaining of weakness of his legs. Patient reports that over the past week, walking has become increasingly weak, as he reports that he feels as though he no longer can control his legs as well. On physical examination, physicians use a reflex hammer to test the patellar tendon and found that there was no reflex. Patient was then admitted to the hospital and during the course of the past two days, he lost almost complete motor function in his legs, yielding almost complete paralysis. Today, he began to feel weakness in his arms and reports that this was the same feeling he had in his legs just a week ago. Patient reports that it is becoming increasingly difficult to swallow food. Despite paralysis of his legs, the patient reports deep aching pains radiating throughout the paralyzed limbs. Infection was suspected, but found that the patient had no fever during the entire time he was at the hospital. An LP was done, which found no elevated cell counts but high levels of protein. It is feared that with the rapid course of the disease, it won't be long before his throat and diaphragm muscles may fail. What's your differential diagnosis?

Patient, 64 year old male admitted to the hospital presents with chest pain, shortness of breath, edema of the legs, and diarrhea. Endoscopy was performed and found that the patient also had gastrointestinal bleeding. Heart sounds yielded a heart murmur and cardiac arrhythmia. Blood tests showed elevated IgG light chain proteins. Heart biopsy showed the presence of IgG proteins. Differential diagnosis? Go!

Patient, 27 years old collapses from shortness of breath. Chest X-ray showed spontaneous pneumothorax, for which the surgeons were able to repair. Patient has nearsightedness and his joints are unproportionally long and hyperextended. While doing physical examination of the patient, he was found to have an area of his back pulsating at the same rate as his heart. His arms and legs felt cold to the touch. Differential diagnosis? Go.

Patient admitted with blood pressure of 190/105. Blood workup shows normal levels of sodium but elevated levels of norepinephrine and other catecholamines in the blood. CT scan shows a unilateral dense mass extending downward from above the left kindey. What is the differential diagnosis?