House S07EP19 “Last Temptation”

Masters pondering a differential

Well, we are winding down the semester, and the current season of House. I hope that after the semester is finished, you’ll continue to keep YCPMicro in your newsfeed by hitting the “Sign me up!” button down in the lower right hand corner. This week’s episode gives us the following cryptic summary via Fox.com:

Masters faces a career crossroads on her last day as a medical student and struggles with the choice to continue on the path to become a surgeon or to accept the rare opportunity to join House’s team officially. Meanwhile, the team treats a 16-year-old girl who inexplicably collapsed days before embarking on an ambitious sailing tour around the globe.

Not much to go from that. Check back Monday at 8:00 PM for an update!

Here’s a recap: this is likely the last episode guest starring Amber Tamblyn as Martha Masters, so this was a Martha-centric episode. She is finishing up her third year of medical school, and is trying to decide where to do her internship: Surgery or Diagnostics. Everyone advises her to go for Surgery.

The medical mystery involves a sailing prodigy, who  shows neurological symptoms of unknown etiology. Masters immediately bonds with the patient, which as it turns out is not such a great idea. The team runs through a gamut of possible causes, including: adrenal insufficiency due to trauma, cerebral vascular pathology, pineal gland calcification, Wegener’s Syndrome, Salmonella enterica infection of the bone, and finally lymphoid sarcoma. It’s the final one that is correct, resulting in the recommended treatment of chemotherapy and amputation to prevent metastasis. Amputation, of course, would prevent the prodigy from accomplishing her dream of being the youngest person to solo sail around the world, and consequently she refuses to do the treatment. Master’s compromises her ethics by switching meds and inducing cardiac arrest. During the resultant emergency to put in a pacemaker, the team finds that the cancer has metastasized to the lymph nodes of the neck. This complication almost certainly meant that Kendall would have died by delaying treatment. Her parent authorize the amputation, and Master’s realizes that she cannot work for House.

So our diagnosis was sarcoma, or a cancer arising from the connective tissues (bone, cartilage, fat) of the body. They can arise from a number of different sources, and their aggressiveness and responsiveness to treatment varies according to their source.  Lower grade tumors generally respond well to chemotherapy and radiation therapy, but higher grade tumors may have a strong tendency to metastasize, or move to another location in the body. This behavior can make surgical treatment very difficult, as it becomes difficult to find where the tumor has moved to. These types of cancers are relatively rare, and represent only about one percent of cancer diagnoses in the United States.

Because sarcomas can arise from a large number of tissue sources, and metastasis can lead to a even larger number of affected body systems, it is difficult to use the signs and symptoms of the patient in tonight’s episode as a clear indicator of a specific type of cancer. Masters was tipped off to the final clue by connecting the chickens from the episode with Salmonella, which can move from the gastrointestinal tract where it is self-limiting, to the bone tissue where it can be extremely serious.  This prompted the careful physical exam to find the cancer. Ultimately, it required MRI and biopsy to confirm the diagnosis. Let’s rate this mystery as “plausible,” but I think again we should fault the diagnosticians for not performing a careful physical exam to start out with, particularly since they suspected a possible trauma in the first place!

Advertisements

About ycpmicro

My name is David Singleton, and I am an Associate Professor of Microbiology at York College of Pennsylvania. My main course is BIO230, a course taken by allied-health students at YCP. Views on this site are my own.

Posted on April 17, 2011, in House Party! and tagged . Bookmark the permalink. 2 Comments.

  1. I cannot believe I missed last night’s House episode. I love House, and I think Masters does not belong on House. Yes, she is intelligent, but she is too good and has good morals to be part of House’s team. Last, episode she could not do anything without lying to the patient, and House’s motto is “EVERYONE LIES!” Being part of his team would break her down and lessen her as a moral character–proof being that she switched the medicine this episode. That is not who she is. I suppose House could make her a better doctor (more like him) by corrupting her, but I think she would be better off as a person without him.

  2. I particularly liked the story House related about how his leg got hurt, and how he didn’t want the procedure done even though it would save his life; Masters ended up doing the same thing.

    We’ve also been having some significant discussion over the past two weeks of really important medical ethics issues, with euthanasia last week, then with irrational patient choices this week. All care givers, irregardless of where they are in health care will come into contact with these issues, and we need to decide what our responses will be!

%d bloggers like this: