Doctor Tries To Make The Diagnosis | Doctordle

Start playing and then just go where your mind takes you.

>> Ah, it's a dangerous place.

A once viral game called Wordle has now become medically transitioned into Doctorul.

Terrible name.

Let's see how much medicine I actually know.

Let's get started.

Be woo. 42-year-old woman presents for premenstrual breast pain.

This is like it's asking me to be Gary Brecka right now.

It's asking me to make a diagnosis of just that.

Okay, so we're going to say physiologic.

>> I think this is where you might run into trouble.

This like predetermined >> Ah, so this is interesting.

The problem is all of these are pathologic and they're all pretty serious.

I mean, it's not that it's not serious,

it's that I need to know more before I start making a diagnosis of

something serious.

>> That's not how Doctorul works.

>> But that's not how medicine should work.

There should be like a updated version of this.

Oh my god, like malingering.

Yeah, she's faking.

>> Okay, let's go.

>> Okay, so most likely diagnosis in a 12-year-old boy with rough,

raised lesions.

I would say wart, verruca vulgaris.

Oh.

>> Nailed it.

>> Okay.

>> We're a real doctor over here.

>> Warts caused by viruses.

We usually freeze them off in our office.

There are some over-the-counter treatments.

Usually not as good.

Need multiple treatments a lot of times in order to get them fully out.

But otherwise pretty benign.

A 42-year-old woman presents to her primary care physician with complaints of poor sleep

and difficulty concentrating at work.

Okay, guess where I'm going.

Damn.

She attributes her symptoms to just stress and avoids discussing specific triggers.

Poor sleep usually doesn't happen as a result of just stress.

So let's say generalized anxiety disorder.

No.

On further questioning, she admits to frequent nightmares and feeling on edge.

Well, this is getting interesting.

This is where my investigative mind goes.

So like, "Ooh, she's having frequent nightmares cuz she's taking Benadryl."

And because she's taking Benadryl so often,

she's having decreased concentration at work cuz she's feeling sleepier from the Benadryl.

Is it just depression?

No.

She recently declined a promotion

that would have required air travel citing discomfort with airports

and crowds.

Agoraphobia?

No.

She becomes visibly tense

when asked about a car accident she survived 3 years ago

and mentions that avoiding

that part of town is a post-traumatic stress disorder.

Yeah!

I mean, that's not how I would have presented it, but man,

you got to go.

That's interesting.

A newborn is assessed in the hospital for cyanosis and tachypnea.

Ah, how new is this newborn?

God, there's Like, I I would think they would reach for something crazy like

tetralogy tetralogy of Fallot.

Nope.

Supplemental oxygen does not improve symptoms.

Transposition of the great vessels.

LOOK AT THAT, BABY!

LOOK AT THAT!

>> >> AND THEY ASK ME WHY I'M KEYNOTING THE American Academy of Pediatrics

conference at the end of this year.

>> Let them know.

>> Come on, that that's a hard one.

>> That was impressive.

>> Okay, the first one is true though.

A newborn cyanosis tachypnea is tetralogy of Fallot or transposition of the great vessels.

A 40-year-old man presents with white patches on the side of his tongue.

They're probably going to want me to say thrush,

but I don't think it's thrush.

I think that they're going to say that it's not scrapeable,

which means it's leukoplakia.

>> ORAL LEUKOPLAKIA?

>> ORAL CANDIDIASIS.

>> WOW.

What about the other leukoplakia that I had?

>> DO IT!

JUST DO IT!

>> I DON'T think it's leukoplakia cuz it's a >> Do it!

>> What's the other one?

Oh, are you kidding me?

Is it chronic mucocutaneous candidiasis?

I don't know.

Physical exam shows feathery white plaques, lateral borders of the tongue.

The plaques cannot be removed.

God, is it hairy?

It might be that hairy one.

Hairy leukoplakia.

My first guess was right.

Yo, how crazy is that?

It wasn't oral leukoplakia, it was hairy leukoplakia.

That's why with no shame I would use up-to-date in a scenario like this

or my dermatological textbook.

A 30-year-old woman presents with vaginal discharge and itching.

Okay, that would be yeast infection until proven otherwise.

So, vulvovaginal vulvovaginal candidiasis.

She's sexually active with two partners and they use condoms inconsistently.

She reports her partners have no symptoms.

Okay, bacterial vaginosis, uh gonorrhea, chlamydia, trick.

Why am I missing trick?

I shouldn't be missing trick.

>> What happened there?

>> Because all of these would be tested for.

So, it's like you don't just say, "Oh, is it this one?

Is it this one?

Is it this one?"

And you keep setting the poor patient back for 10 tests.

A 30-year-old man presents with fever, muscle pains,

and chills for the past 3 days.

I mean, like influenza, right?

Let's just go influenza.

He reports that he experienced similar symptoms lasting a week a few days ago.

That doesn't make sense.

Let's skip again.

He recently returned from humanitarian trip.

He has malaria.

Malaria.

Oh my god, there's three different types of malaria.

Oh my god, babesiosis?

No, oh my god.

He denies tick exposure does not break of lice.

Typhus.

Borrelia recurrentis.

Bro, never heard of you in my life.

Never heard of you in my life.

A 30-year-old man presents with 3 days of fever, abdominal pain,

and diarrhea.

That's really broad.

You could be anything with this.

Let's go with the salmonella gastroenteritis.

He reports that the symptoms started day after attacking barbecue.

Let's call it norovirus for now.

I doubt it's norovirus though.

No.

He reports a diarrhea is initially watery but blood tinged.

I feel like it's it's salmonella.

I'm I'm going to go E. coli.

No.

He recalls eating low temperature smoked chicken recipe in

which the meat near the bone appeared undercooked.

Campylobacter?

Campylobacter, here we go.

Yeah!

The most common bacteria that you get sick from salmonella, campylobacter, E. coli.

That's what went with all of these.

I thought norovirus could be a distractor which it ended up being.

A 40-year-old man presents with rhinitis

and multiple asthma exacerbations requiring systemic corticosteroids

and hospitalizations over the year.

I know what they're going for.

They're going for some like IgA selective IgA deficiency.

No.

He reports no history of asthma exacerbation.

So, he randomly has asthma now.

Let's see if it's a COPD diagnosis.

No.

He reports new onset foot drop

as well as frequent bouts of nausea

and vomiting.

Oh my goodness.

So, he's having some sort of loss of control over his neuro system.

But, why rhinitis?

Oh, wait.

Oh, wait.

Oh, wait.

Oh, wait.

Oh, wait.

Oh, wait.

Cystic fibrosis.

Physical exam reveals rhinitis, nasal polyps, and palpable purpura.

Oh my goodness.

This feels like straight up boards question.

Is it like Buerger's disease?

Eosinophil and positive P-ANCA with normal platelets.

I'm going to go lupus just cuz sometimes you always have to think about

lupus.

It's never lupus.

A lung biopsy shows granulomatous inflammation with eosinophilic infiltration.

The nasal polyps is is definitely some sort of giveaway.

Churg-Strauss syndrome.

Yeah!

>> Yo, we got there.

>> Small to medium vessel necrotizing vasculitis, eosinophilia, asthma, granuloma.

Look at that.

T-cell B-cell activation.

A 22-year-old presents with right hand pain

and swelling that began earlier today.

>> Um.

>> Pain that started earlier today in the hand.

You know what?

This is a good one to skip cuz I don't know.

He reports sudden onset of pain when his hand struck the wall during racquetball.

Ooh, boxer's fracture.

Bro, call me Kobe.

A 63-year-old woman presents with acute chest pain

and shortness of breath

that began shortly after her boyfriend ended the relationship.

Takotsubo.

Yeah.

That's a broken heart syndrome.

Yeah, so patients like this, they start having elevations in their cardiac enzymes.

They end up going into the cath lab

because they think that there's a blockage

and they actually have no blockages

and it was temporary.

Don't break up with your boyfriend or loved one on Valentine's Day.

A 22-year-old woman presents with a several-month history of voice changes.

>> >> That rules out anything infectious because anything infectious wouldn't be several months,

otherwise there'd be an issue.

But let's go based on the age, vocal cord polyp.

>> All right.

Now, you know what?

Now you got it.

>> Yeah.

A 34-year-old woman presents with a 6-week history of crampy lower abdominal pain,

intermittent loose stools, sometimes with visible mucus.

Okay, so this is some kind of fat malabsorption.

Let's go with celiac.

She returned 8 weeks ago from a 3-month volunteer placement in rural Guatemala where

she reports drinking untreated well water on several occasions,

eating street food regularly.

I don't think it's one of these acute ones.

It's some kind of parasite.

Let's say tapeworm.

On closer question, she says bloody diarrhea.

Uh.

Hookworm.

Stool microscopy reveals motile trophozoites containing ingested red blood cells

and colonoscopy shows scattered flask-shaped mucosal ulcerations.

Leptospirosis?

No.

Right upper quadrant ultrasound performed to investigate a dull aching sensation she mentions revealing

a 5-cm hypoechoic lesions in the right hepatic lobe.

It's some kind of freaking protozoan and I can't put my finger on it.

Shigella?

She started metronidazole followed by a luminal agent and her symptoms resolved.

It's some kind of worm.

Trichodosis is my best guess.

Nope.

Entamoeba histolytica.

That's a good one.

It's a pathological protozoan.

I said I It's a protozoa of some sort.

I said it like a hundred times, but we just don't see this here.

Uh A 58-year-old man presents to the emergency department with nausea

and chest pain that began

when eating Thanksgiving dinner.

All right, we're going to have to assume heart attack.

He has a history of hypertension, high risk, hyperlipidemia, high cholesterol,

high risk. 30 pack-year smoking history, very high risk.

Let's say non-ST elevation MI.

Physical exam reveals diaphoresis and mild tachycardia.

So, he has a fast heart rate and he's sweating.

These are not very valuable.

I mean, are they really going for dissecting uh aortic dissection?

Like, that's aggressive.

Nope.

ECG shows diffuse ST depression.

I mean, if it was elevations, I would say like maybe myocarditis.

Pulmonary embolism?

Serial troponins are negative.

So, he's not having a heart attack.

He's not having a pulmonary embolism,

but he's having nausea and he's having chest pain.

Oh my god, is this some kind of like lung cancer presenting tumor?

Small cell carcinoma?

The patient reports that the pain occurs with both exertion

and at rest and has been increasing frequency over the past week.

He said it happened during Thanksgiving dinner.

Oh, unstable angina.

Oh my god.

Oh my god, this is so embarrassing.

Yeah.

I should have gotten that.

My bad.

My bad.

A 45-year-old man presents to the emergency room with fever, chills, headache,

painful groin swelling, and weakness.

Okay, I'm going to say prostatitis.

Wrong.

He recently returned from a camping trip in New Mexico where he slept without

a tent for multiple days.

Jesus.

Oh, they're going to say it's some kind of bug bite.

Blastomycosis.

No, on physical exam there are firm,

non-tender lymph nodes in the inguinal region

that are not showing any warmth

or tenderness.

Yeah, I know.

Something that bit him.

What bites in Mexico?

Coccidioidomycosis?

No.

Leukocytosis.

Okay, his white count He doesn't have a lot of platelets.

Uh shh.

God, what is it?

Over the next 3 days the buboes come out and become suppurative.

Oh my god, they're going to say it's the bubonic plague.

IT'S THE BUBONIC PLAGUE.

>> OH, THAT'S THE BEST.

>> I mean, how was I supposed to I bubonic plague, man. >> in the clinic?

>> Yeah, last week. 40-year-old man presents with pain

and swelling over his right knee. 4-year-old is a bit young for OA.

Let's go rheumatoid arthritis, even though it's not the most likely cause.

He denies instability or limited range of motion.

Okay.

So, pain and swelling over his right knee.

If he doesn't have instability, we know that there's no tears of anything.

There's no limitations in range of motion, which is good.

Prepatellar bursitis.

Look at that.

Two guesses.

A 26-year-old man presents with crampy abdominal pain

and bloody diarrhea for several months.

I'm going ulcerative colitis until proven otherwise.

>> And that's it.

That's it.

>> How about reacting to some of the world's rarest diseases?

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