_____________________________ | | | 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| ------------------------------------------------------------------------------ |- 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. | ------------------------------------------------------------------------------ _________________ |{GT} General Tips| ------------------------------------------------------------------------------ |- 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. | ------------------------------------------------------------------------------ {1} (Diagnosis 1: Overcast is an event) _________________________________ |{2} Diagnosis 2: Signs of Anguish| ------------------------------------------------------------------------------ | Patient | Nicole Summers | | Age | 14 | | Gender | Female | | Summary | Student from a private school. Admitted for breathing problems | | | that occurred during choir school practice. | ------------------------------------------------------------------------------ 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| ------------------------------------------------------------------------------ |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. | ------------------------------------------------------------------------------ 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| ------------------------------------------------------------------------------ | 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. | ------------------------------------------------------------------------------ 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| ------------------------------------------------------------------------------ | 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. | ------------------------------------------------------------------------------ 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| ------------------------------------------------------------------------------ | 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| ------------------------------------------------------------------------------ | 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 | ------------------------------------------------------------------------------ | For questions, comments, and corrections, you can reach me at | | halcyone@gmail.com | ------------------------------------------------------------------------------ _____________ |{UP} UPDATES | ------------------------------------------------------------------------------ | 5/26/10 - v1.0: Guide complete. | ------------------------------------------------------------------------------