_____________________________
| |
| TRAUMA TEAM |
| Diagnosis Guide |
| By Halcyone |
| Version 1.0 |
|_____________________________|
[] TABLE OF CONTENTS []
[] Guide Notes.........................{GN} []
[] General Tips........................{GT} []
[] Diagnosis 1: Overcast................{1} []
[] Diagnosis 2: Signs of Anguish........{2} []
[] Diagnosis 3: Blazing Darkness........{3} []
[] |_Phase 2................{3-2} []
[] Diagnosis 4: Moving Heart............{4} []
[] |_Phase 2................{4-2} []
[] |_Phase 3................{4-3} []
[] Diagnosis 5: The Simplest Truth......{5} []
[] |_Phase 2................{5-2} []
[] |_Phase 3................{5-3} []
[] Diagnosis 6: Going Away..............{6} []
[] Patient Zero 3: Proud One..........{PZ3} []
[] |_Phase 2...........{PZ3-2} []
[] |_Phase 3...........{PZ3-2} []
[] Contact............................{CON} []
[] Updates.............................{UP} []
________________
|{GN} Guide Notes|
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|- Before each part where you must match symptoms to a diagnosis candidate, a |
| "Symptom Round Up" will list all the symptoms you should have at that point. |
|- Under each heading that lists what you should be doing or looking at, |
| actions will be posted in a "thing-to-examine:symptom/result" format. |
|- You don't have to do everything in the exact order I do them. As a result, |
| symptoms may be out of order in the Symptom Round Ups. |
|- When referring to right or left, assume it is the patient's right or left, |
| unless looking at scans. |
|- The first Diagnosis "mission" is actually Diagnosis 2, because Diagnosis 1 |
| is an event. Keep this in mind when looking for the correct mission. |
|- Use the characterss in {} in the Table of Contents to skip to a mission |
| using CTRL+F. |
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_________________
|{GT} General Tips|
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|- Listen to what Gabe and RONI say. That will tell you what you're supposed |
| to do next, and whether or not you're done with what you're currently doing. |
|- When looking at scans and such, remember that you're looking for not only |
| changes in shape, but also coloration. |
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{1} (Diagnosis 1: Overcast is an event)
_________________________________
|{2} Diagnosis 2: Signs of Anguish|
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| Patient | Nicole Summers |
| Age | 14 |
| Gender | Female |
| Summary | Student from a private school. Admitted for breathing problems |
| | that occurred during choir school practice. |
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QUESTION
- 4th statement: Dyspnea
- 6th statement: need for auscultation
- 11th statement: Decrease in Weight
STETHOSCOPE
- Either lung: Tachynpea
- Heart: Tachycardia
VISUAL EXAM
- Hands: Trembling Fingertips
- Neck: Swollen Neck
CT SCANS
- 2nd scan; right light colored triangle at top: Swollen Thyroid Gland
====SYMPTOM ROUND UP====
|| Swollen Thyroid Gland ||
|| Swollen Neck ||
|| Trembling Fingertips ||
|| Tachycardia ||
|| Tachypnea ||
|| Decrease in Weight ||
|| Dyspnea ||
========================
DIAGNOSIS
- Match all symptoms to Painless Thyroiditis, Graves' Disease, and Plummer's
Disease
SCINTIGRAPHY
- Either two blue ovals: Abnormal Thyroid Uptake
DIAGNOSTIC
- FT3: High FT3 Level
- FT4: High FT4 Level
- TSH: Low TSH Level
=====SYMPTOM ROUND UP=====
|| Low TSH Level ||
|| High FT4 Level ||
|| High FT3 Level ||
|| Abnormal Thyroid Uptake ||
|| Swollen Thyroid Gland ||
|| Swollen Neck ||
|| Trembling Fingertips ||
|| Tachycardia ||
|| Tachypnea ||
|| Decrease in Weight ||
|| Dyspnea ||
===========================
DIAGNOSIS
- Match remaining symptoms to Plummer's Disease
_________________________________
|{3} Diagnosis 3: Blazing Darkness|
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|Patient | Jacob Tillman |
|Age | 55 |
|Gender | Male |
|Summary | Assistant Secretary of the HHS. Patient had collapsed at home and |
| | was brought to Resurgam, unaware of any symptoms. |
------------------------------------------------------------------------------
QUESTION
- 3rd statement: Gets Tired Easily
- 11th statement: Lack of Appetite
- 12th statement: Bloated Abdomen
- 14th statement: Nausea
DIAGNOSTIC
- Platelet Count: Low Platelet Count
- Total Bilirubin: High Total Bilirubin Level
- AST: High AST Level
- ALT: High ALT Level
- Cholesterol: Low Total Cholesterol
VISUAL EXAM:
- Right Leg: Shaking Legs
- Stomache: patient angered
- Eyes: Jaundice
=======SYMPTOM ROUND UP========
|| Jaundice ||
|| Shaking Legs ||
|| Low Total Cholesterol Level ||
|| High ALT Level ||
|| High AST Level ||
|| High Total Bilirubin Level ||
|| Low Platelet Count ||
|| Nausea ||
|| Bloated Abdomen ||
|| Lack of Appetite ||
|| Gets Tired Easily ||
===============================
DIAGNOSIS
- Match all symptoms to Congestive Liver Failure: move back to exam room to get
CT scans
CT SCANS
- 2nd scan; dark blue shadow on left side: Ascites Accumulation
- 3rd scan: liver is larger in bottom right corner: Swollen Liver
=======SYMPTOM ROUND UP========
|| Swollen Liver ||
|| Ascites Accumulation ||
|| Jaundice ||
|| Shaking Legs ||
|| Low Total Cholesterol Level ||
|| High ALT Level ||
|| High AST Level ||
|| High Total Bilirubin Level ||
|| Low Platelet Count ||
|| Nausea ||
|| Bloated Abdomen ||
|| Lack of Appetite ||
|| Gets Tired Easily ||
===============================
DIAGNOSIS
- Match remaining symptoms to Congestive Liver Failure
_____________________________________________
|{3-2} Diagnosis 3: Blazing Darkness - Phase 2|
------------------------------------------------------------------------------
| Patient | Jacob Tillman |
| Age | 55 |
| Gender | Male |
| Summary | Patient suffers from congestive liver failure. Possible link to |
| | primary affliction. Continuing diagnosis. |
------------------------------------------------------------------------------
QUESTION
- 3rd statement: Dyspnea
- 6th statement: Chest Pain
STETHOSCOPE
- Either lung: Discontinuous Sounds
- Heart: S3 and S4
DIAGNOSTIC
- Blood Pressure: Low Blood Pressure
- BNP: High BNP Level
EKG
- Top row, downward spike: Abnormal Q Waves
- Bottom row, occasional valley after up and down spikes: Negative T Waves
X-RAY
- Enormously swollen heart in lower abdomen: Enlarged Heart
Return to exam room
====SYMPTOM ROUND UP====
|| Enlarged Heart ||
|| Negative T Waves ||
|| Abnormal Q Waves ||
|| High BNP Level ||
|| Low Blood Pressure ||
|| S3 and S4 ||
|| Discontinuous Sounds ||
|| Chest Pain ||
|| Dyspnea ||
========================
DIAGNOSIS
- Match all symptoms to Dilated Cardiomyopathy
Return to exam room
ULTRA SOUND
- 3rd scan; black hole in center: Enlarged Left Ventricle
=====SYMPTOM ROUND UP======
|| Enlarged Left Ventricle ||
|| Enlarged Heart ||
|| Negative T Waves ||
|| Abnormal Q Waves ||
|| High BNP Level ||
|| Low Blood Pressure ||
|| S3 and S4 ||
|| Discontinuous Sounds ||
|| Chest Pain ||
|| Dyspnea ||
===========================
DIAGNOSIS
- Match remaining symptom to Dilated Cardiomyopathy
_____________________________
|{4} Diagnosis 4: Moving Heart|
------------------------------------------------------------------------------
| Patient | Shelly Brooks |
| Age | 28 |
| Gender | Female |
| Summary | Patient is a stock broker previously treated for chronic renal |
| | failure. She was admitted for an unusually long cold. |
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QUESTION
- 4th statement: Fever
- 5th statement: Weight Loss
- 6th statement: Night Sweats
- 12th statement: need for auscultation
VISUAL EXAM
- Four red dots: Pigment Spots
SCINTIGRAPHY
- Dark spot below left lung on left image: Abnormal Uptake Into Pigment Spots
===========SYMPTOM ROUND UP===========
|| Abnormal Uptake Into Pigment spots ||
|| Pigment Spots ||
|| Night Sweats ||
|| Weight Loss ||
|| Fever ||
======================================
DIAGNOSIS
- Match all symptoms to Kaposi's Sarcoma
QUESTION
- 13th statement, exit questions after: Positive Antibody Reaction
===========SYMPTOM ROUND UP===========
|| Positive Antibody Reaction ||
|| Abnormal Uptake Into Pigment spots ||
|| Pigment Spots ||
|| Night Sweats ||
|| Weight Loss ||
|| Fever ||
======================================
DIAGNOSIS
- Match remaining symptom to Kaposi's Sarcoma
_________________________________________
|{4-2} Diagnosis 4: Moving Heart - Phase 2|
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| Patient | Shelly Brooks |
| Age | 28 |
| Gender | Female |
| Summary | Patient was diagnosed with Kaposi's Sarcoma, but the onset occured |
| | very quickly. Readmitted for abdominal pain. |
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QUESTION
- 1st statement: Stomachache
- 2nd statement: Nausea
- 6th statement: Bloated Abdomen
- 11th statement: Constipation
STETHOSCOPE
- Stomache: Aggravated Bowel Sounds
X-RAY
- Sideways "["-shaped shadow on upper right: Air-Fluid Level Formation
CT SCANS
- 4th scan; small circle in top right: Tumor Shadows on Small Intestine
==========SYMPTOM ROUND UP==========
|| Tumor Shadows on Small Intestine ||
|| Air-Fluid Level Formation ||
|| Aggravated Bowel Sounds ||
|| Constipation ||
|| Bloated Abdomen ||
|| Nausea ||
|| Stomachache ||
====================================
DIAGNOSIS
- Match all symptoms to Occlusive Ileus
_________________________________________
|{4-3} Diagnosis 4: Moving Heart - Phase 3|
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| Patient | Shelly Brooks |
| Age | 28 |
| Gender | Female |
| Summary | Tumors identified as an ileus. Metastasis of the tumors is |
| | expected. Continuing diagnosis. |
------------------------------------------------------------------------------
QUESTION
- 1st statement: Chest Pains
- 2nd statement: Coughing
Use the stethoscope and EKG
QUESTION
- 1st statement: Bloody Sputum
- 4th statement: Dyspnea
STETHOSCOPE
- Left lung: Attenuation of Respiratory Sounds
X-RAY
- Shadow in lower left corner: Pleural Effusion
===========SYMPTOM ROUND UP==========
|| Pleural Effusion ||
|| Attenuation of Respiratory Sounds ||
|| Dyspnea ||
|| Bloody Sputum ||
|| Coughing ||
|| Chest Pain ||
=====================================
DIAGNOSIS
- Match all symptoms to Carcinomatous Pleuritis
X-RAY
- 2nd scan; strange shadowing on right near ribs
CT SCAN
- 4th scan; small white shadow in upper right corner: Tumor Shadows on Lung
===========SYMPTOM ROUND UP==========
|| Tumor Shadows on Lung ||
|| Pleural Effusion ||
|| Attenuation of Respiratory Sounds ||
|| Dyspnea ||
|| Bloody Sputum ||
|| Coughing ||
|| Chest Pain ||
=====================================
DIAGNOSIS
- Match remaining symptom to Carcinomatous Pleuritis
___________________________________
|{5} Diagnosis 5: The Simplest Truth|
------------------------------------------------------------------------------
| Patient | Joshua Cunningham |
| Age | 10 |
| Gender | Male |
| Summary | Patient underwent endoscopic surgery. Currently being diagnosed |
| | for addiional health problems. |
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Do QUESITON, STEHTOSCOPE, EKG, and VISUAL EXAM
STETHOSCOPE
- Either lung: Tachypnea
- Heart: Tachycardia
VISUAL EXAM
- Abdomen: gets him to use his hands
- Blood on shirt: Hematemesis
X-RAY
- 2nd scan; small white shadow near center: Caved-In Gastric Wall
QUESTION
- 2nd statement: Stomachache
- 3rd statement: Lack of Appetite
====SYMPTOM ROUND UP=====
|| Lack of Appetite ||
|| Stomachache ||
|| Caved-In Gastric Wall ||
|| Hematemesis ||
|| Tachycardia ||
|| Tachypnea ||
=========================
DIAGNOSIS
- Match all symptoms to Gastric Ulcer
_______________________________________________
|{5-2} Diagnosis 5: The Simplest Truth - Phase 2|
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| Patient | Joshua Cunningham |
| Age | 10 |
| Gender | Male |
| Summary | Sudden relapse of gastric ulcers has been confirmed. Continuing |
| | diagnosis to determine the cause of the relapse. |
------------------------------------------------------------------------------
DIAGNOSTIC
- Serum Amylase: High Serum Amylase Level
- Serum Lipase: High Serum Lipase Level
- Elastase: High Elastase Level
X-RAY
- Shadows in top right: Abnormal Bowel Gas in Intestine
CT SCAN
- 3rd scan; enlarged white shadow in top center: Swollen Pancreas
QUESTION
- 2nd statement: Back Pain
- 4th statement: Nausea
VISUAL EXAM
- Red marks around navel: Blood Spots Near Navel
- Red marks on left side: Blood Spots on Left Abdomen
=========SYMPTOM ROUND UP==========
|| Blood Spots on Left Abdomen ||
|| Blood spots Near Navel ||
|| Nausea ||
|| Back Pain ||
|| Swollen Pancreas ||
|| Abnormal Bowel Gas in Intestine ||
|| High Elastase Level ||
|| High Serum Lipase Level ||
|| High Serum Amylase Level ||
===================================
DIAGNOSIS
- Match all symptoms to Acute Pancreatitis
_______________________________________________
|{5-3} Diagnosis 5: The Simplest Truth - Phase 3|
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| Patient | Joshua Cunningham |
| Age | 10 |
| Gender | Male |
| Summary | Confirmed onset of pancreatitis, unrelated to the gastric ulcers. |
| | Diagnosis will continue. |
------------------------------------------------------------------------------
QUESTION
- 4th statement: Polydipsia and Polyuria
DIAGNOSTIC
- Serum Calcium: High Blood Calcium Level
- Ser. Phosphorus: Low Serum Phosphorus Level
- Serum PRL: High Serum PRL Level
- Serum Gastrin: High Serum Gastrin Level
- Intact-PTH: High Intact-PTH Level
======SYMPTOM ROUND UP========
|| High Intact-PTH Level ||
|| High Serum Gastrin Level ||
|| High Serum PRL Level ||
|| Low Serum Phosphorus Level ||
|| High Blood Calcium Level ||
|| Polydipsia and Polyuria ||
==============================
DIAGNOSIS
- Match all symtpoms except "High Serum Gastrin Level" and "High Serum PRL
Level" to Hyperparathyroidism
X-RAY
- Bone on pointer finger after first knuckle slightly faded: Subperiosteal
Bone Resorption
SCINTIGRAPHY
- Blue dot at base of neck: Parathyroid Adenoma
========SYMPTOM ROUND UP=========
|| Parathyroid Adenoma ||
|| Subperiosteal Bone Resorption ||
|| High Intact-PTH Level ||
|| High Serum Gastrin Level ||
|| High Serum PRL Level ||
|| Low Serum Phosphorus Level ||
|| High Blood Calcium Level ||
|| Polydipsia and Polyuria ||
=================================
DIAGNOSIS
- Match "Parathyroid Adenoma" and "Subperiosteal Bone Resorption" to
Hyperparathyroidism
QUESTION
- 3rd statement: Visual Field Loss
- 4th statement: Headache
MRI
- 5th scan; enlarged white shadow near center: Tumor Shadow on Pituitary Gland
=========SYMPTOM ROUND UP==========
|| Tumor Shadow on Pituitary Gland ||
|| Headache ||
|| Visual Field Loss ||
|| Parathyroid Adenoma ||
|| Subperiosteal Bone Resorption ||
|| High Intact-PTH Level ||
|| High Serum Gastrin Level ||
|| High Serum PRL Level ||
|| Low Serum Phosphorus Level ||
|| High Blood Calcium Level ||
|| Polydipsia and Polyuria ||
===================================
DIAGNOSIS
- Match "High Serum PRL Level," "Visual Field Loss," "Headache," and "Tumor
Shadow on Pituitary Gland" to Pituitary Adenoma
- Match all symptoms to Wermer's Syndrome
CT SCAN
- 4th scan; small blue shadow on pancreas: Tumor Shadows on Pancreas
=========SYMPTOM ROUND UP==========
|| Tumor Shadows on Pancreas ||
|| Tumor Shadow on Pituitary Gland ||
|| Headache ||
|| Visual Field Loss ||
|| Parathyroid Adenoma ||
|| Subperiosteal Bone Resorption ||
|| High Intact-PTH Level ||
|| High Serum Gastrin Level ||
|| High Serum PRL Level ||
|| Low Serum Phosphorus Level ||
|| High Blood Calcium Level ||
|| Polydipsia and Polyuria ||
===================================
DIAGNOSIS
- Match remaining symptom to Wermer's Syndrome
{6} (Diagnosis 6: Going Away is an event)
_______________________________
|{PZ3} Patient Zero 3: Proud One|
------------------------------------------------------------------------------
| Patient | Samuel Trumbull |
| Age | 27 |
| Gender | Male |
| Summary | Researcher at USAMRIID who becam ill while investigating a |
| | skeleton found in Backcove. Currently in quarantine. |
------------------------------------------------------------------------------
VISUAL EXAM
- Left eye: Blepharoptosis
- Left arm: Swollen Arm
- Fingers: Swollen Fingertips
QUESTION
- 2nd statement: Chest Pains
- 3rd statement: Bloody Sputum
- 4th statement: Numb Left Arm
X-RAY
- White shadow in top right on collar bone: Tumor Shadow on the Lung
======SYMPTOM ROUND UP======
|| Tumor Shadow on the Lung ||
|| Numb Left Arm ||
|| Bloody Sputum ||
|| Chest Pains ||
|| Swollen Fingertips ||
|| Swollen Arm ||
|| Blepharoptosis ||
============================
DIAGNOSIS
- Match all symptoms to Pancoast Tumor
X-RAY
- Strange Shadowing on right side (exit afterwards): Positive for Malignant
Tumor Cells
===========SYMPTOM ROUND UP===========
|| Positive for Malignant Tumor Cells ||
|| Tumor Shadow on the Lung ||
|| Numb Left Arm ||
|| Bloody Sputum ||
|| Chest Pains ||
|| Swollen Fingertips ||
|| Swollen Arm ||
|| Blepharoptosis ||
======================================
DIAGNOSIS
- Match remaining symptom to Pancoast Tumor
___________________________________________
|{PZ3-2} Patient Zero 3: Proud One - Phase 2|
------------------------------------------------------------------------------
| Patient | Samuel Trumbull |
| Age | 27 |
| Gender | Male |
| Summary | Patient diagnosed with Pancoast Tumor. Continuing diagnosis to |
| | monitor status and investigate unknown lung shadow. |
------------------------------------------------------------------------------
QUESTION
- 2nd statement: Stomachache
VISUAL EXAM
- Eyes: Jaundice
DIAGNOSTIC
- Total Bilirubin: High Total Bilirubin Level
- AST: High AST Level
- ALT: High ALT Level
- y-GTP: High y-GTP Level
- LAP: High LAP Level
- PIVKA-II: High PIVKA-II Level
- AFP: High AFP Level
=======SYMPTOM ROUND UP=======
|| High AFP Level ||
|| High PIVKA-II Level ||
|| High LAP Level ||
|| High y-GTP Level ||
|| High ALT Level ||
|| High AST Level ||
|| High Total Bilirubin Level ||
|| Jaundice ||
|| Stomachache ||
==============================
DIAGNOSIS
- Match all symptoms to Malignant Liver Tumor
CT SCAN
- 3nd scan; Large blue shadow (liver): Swollen Liver
- 4th scan; faing blue shadow on left side
SCINTIGRAPHY
- Darkest blue shadows: Abnormal Accumulation in Liver
========SYMPTOM ROUND UP==========
|| Abnormal Accumulation in Liver ||
|| Swollen Liver ||
|| High AFP Level ||
|| High PIVKA-II Level ||
|| High LAP Level ||
|| High y-GTP Level ||
|| High ALT Level ||
|| High AST Level ||
|| High Total Bilirubin Level ||
|| Jaundice ||
|| Stomachache ||
==================================
DIAGNOSIS
- Match remaining symptoms to Malignant Liver Tumor
___________________________________________
|{PZ3-3} Patient Zero 3: Proud One - Phase 3|
------------------------------------------------------------------------------
| Patient | Samuel Trumbull |
| Age | 27 |
| Gender | Male |
| Summary | Continuing diagnosis to investigate the abnormal shadowing |
| |discovered in liver along with shadowing in lungs. |
------------------------------------------------------------------------------
QUESTION
- 6th statement: Muscle Pains
- 9th statement: Headache
- 12th statement: Anemia
- 14th statement: Fever
VISUAL EXAM
- Bloodshot Eyes
- Brown splotches on chest: Pigment Spots on Skin
====SYMPTOM ROUND UP=====
|| Pigment Spots on Skin ||
|| Bloodshot Eyes ||
|| Fever ||
|| Anemia ||
|| Headache ||
|| Muscle Pains ||
=========================
DIAGNOSIS
- Match "Fever," "Headache," and "Pigment Spots on Skin" to Typhoid
- Match "Bloodshot Eyes," "Headache," and "Fever" to Acute Hemorrhagic
Conjunctivitis
- Match "Fever," "Headache," and "Muscle Pains" to Acute Severe Respiratory
Syndrome
- Match "Fever," "Bloodshot Eyes," "Headache," "Muscle Pains," and "Anemia"
to Malaria
- Match "Fever" to Bacillary Dysentery
VISUAL EXAM
- Mouth: Hematemesis
- Red splotches on chest: Skin Hemorrhaging
DIAGNOSTIC
- Blood Pressure: Low Blood Pressure
- White Cell Count: Low White Blood Cell Count
- Fibrinogen: Low Fibrinogen Level
- APTT: High APTT Level
- Platelet Count: Low Platelet Count
======SYMPTOM ROUND UP========
|| Low Platelet Count ||
|| High APTT Level ||
|| Low Fibrinogen Level ||
|| Low White Blood Cell Count ||
|| Low Blood Pressure ||
|| Skin Hemorrhaging ||
|| Hematemesis ||
|| Pigment Spots on Skin ||
|| Bloodshot Eyes ||
|| Fever ||
|| Anemia ||
|| Headache ||
|| Muscle Pains ||
==============================
DIAGNOSIS
- Match all symptoms to Viral Hemorrhagic Fever
QUESTION
- 4th statement
- 9th statement (exit after): Positive Antibody Reaction
======SYMPTOM ROUND UP========
|| Positive Antibody Reaction ||
|| Low Platelet Count ||
|| High APTT Level ||
|| Low Fibrinogen Level ||
|| Low White Blood Cell Count ||
|| Low Blood Pressure ||
|| Skin Hemorrhaging ||
|| Hematemesis ||
|| Pigment Spots on Skin ||
|| Bloodshot Eyes ||
|| Fever ||
|| Anemia ||
|| Headache ||
|| Muscle Pains ||
==============================
DIAGNOSIS
- Match remaining symptom to Viral Hemorrhagic Fever
______________
|{CON} CONTACT |
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| For questions, comments, and corrections, you can reach me at |
|
[email protected] |
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_____________
|{UP} UPDATES |
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| 5/26/10 - v1.0: Guide complete. |
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