COH: Europe In Ruins

Teasers:
A boy of 13 years, Rai Fei, from Taiwan enters the examine room with his mother. His worried mother tells you that her son is staying up increasingly late at night by his computer. When she checked RaiFei's computer to see if he had completed his studying for the weekly chinese exam she found pictures of... To be continued.

Nurse Anna, with a devious grin on her face, taps your shoulder to call your attention to a patient: Simon, 22 year-old student, currently back-packing from Norway has a very bizzare symptom... To be continued.

Will start when enough docs and so on

The thread needs a name - suggestions?

Velocity78 aspires to be a doctor and is studying for that purpose, so I assume he's interested.

I want to be a doc too!

Dr. Gregory Lai's Cave of Lies.

I'm doctor Dix, from Scrubs!  8)

Thats 24*

Can one of my symptoms be hostile behavior towards misdirected attempts of humor

Also I'm having problems with the forums lately,

it seems that posts made by users that have the moderator function "hidden" activated

are unable to be viewed in my browser

the remaining function I have is rapidly disappearing

dont cry for me argentina

OO! I want to be a dentist, does that count? Both have to go to medical school at least  ;D

Dentists are no real doctors!


Also did nobody get my pun with Dr. Dix? God you guys suck. I diagnose lack of humour in this forum!
You should all get a 50mm dose of adrenalin!

How about Lai M.D?

Lai M.D sounds good :p

wtf

I'd rather go with a diff name tbh :)
smt funny, with a zing to it

I'm a biomedical scientist, i have my final exams this month and will start work in histpathology at the end of the month (yay i actually got a job after five years of university). If your going to be a Dr. thats fine, just dont become a GP. Sure they earn more money and work less hours but pathology is where the real fun is to be had, long hours in the office, long hours on the weekend writing reports in your free time. But on the plus side of things you get to chop people up for a living (if you can stomach the smell and some of the cirucumstances in which death has occured, i've attended many autopsies and always likened the smell too a weird kind of raw chicken. Didnt eat for two days after my first time). And if you can help it try to stay away from the wards and the people in the beds, their dirty, smelly and dieing most of the time, hospitals are generally not nice places so try to avoid the patience, we wouldnt want you to contract necrotizing fasciitis or something would we.

My suggestion for a name........something with 'consultant' in it, and thats my professional opinion, anyone concur ?

Most of the autopsying in Sweden aren't done by the pathologist, at least when there's no suspicion of crime. I'm a student teacher in dissection so the smell isn't a problem. Not too keen on doing a lot of microscopy work, however. Forensic medicine, now that is intriguing, but a bit too morbid for my taste.

Forensics hmmmm, glamourised by the television way too much, imo sadly there isnt many jobs in forensics in the uk (only seven forensic pathologist for the country), and the other forensic work can land you stairing at hairs down a scope all day ::). I completely understand your position on microscopy though, cut up is much more interesting even if it only prostates etc

hmm, what about The Infirmary

Hmm, not bad. Makes me think of The Armory. Let's go with it for now.

Case 1: Rai Fei

A boy of 13 years, Rai Fei, from Taiwan enters the examine room with his mother. His worried mother tells you that her son is staying up increasingly late at night by his computer. When she checked RaiFei's computer to see if he had completed his studying for the weekly chinese exam she found pictures of naked women, and to her astonishment he had not fully prepared for his weekly chinese exam! Rai Fei is adamant about the pictures being related to the sex-ed class.

Throughout the mother's history presenting Rai Fei gives you poor eye contact, seems disinterested and you can notice tension between mother and son. No apparent psychotic signs. Pregnancy, delivery and neonatal period normal. Birth weight 3216g. Previously healthy apart from a couple of episodes of otitis. Takes no meds as far as his mother knows. No allergies. His mother believes his son has gotten into drugs.

What condition is Rai Fei suffering from?

What is the first symptom of this condition?

Prognosis?

Condition : being a teenager.
Symptoms : growing interest in the opposite sex, felt need to rebel against society(in the form of not preparing for the test), disobedience towards parents, growing tendency to lie in order to preserve social recognition of those around him.
Prognosis : 3-5 years of being a twat. Medicine or other treatment would just make the illness worse.

Condition:Contagious Womanizologistics
Symptoms: no full preparation for chinese weekly test, tension between mother and son, phallus longatus
Prognosis: soon to become asian sterotype, upskirt fotoshopper, schoolgirl fanatic

Case: serious, sidenote: Tumor in his head.

Shunning eye contact? Obviously the kid smokes marijuana.

i have a case for you Dr. Lai if you would please

Background

Mr. Jones, a 39 year old man who worked in a factory manufacturing wood preservatives, noticed he was bleeding from his gums when cleaning his teeth and had been troubled by mouth ulcers for a couple of months. He was due to have a routine dental check up so he mentioned the problems to the dentist in the course of the consultation. The dentist confirmed the bleeding problem and mouth ulcers and suggested that Mr. Jones visit his GP as there was no underlying dental cause for the symptoms. Mr. Jones made an appointment to see his GP the following week but in the meantime he noticed he was becoming breathless, had developed a cough and was feeling generally “below par”.

On examination, the GP noted that Mr. Jones was pale, confirmed the oral symptoms and noted that Mr. Jones had lower left hand side chest signs. Abdominal palpation revealed a fullness on the left hand side below the rib margin. She finally observed that he had purpura below the knees.

The GP ordered a chest X ray and took a sample of blood for a full blood count (FBC), clotting screen and biochemical analysis.

Within 24 hours of receipt of the blood sample, a local Consultant Haematologist contacted the GP and asked her to refer Mr. Jones to the Haematology outpatient clinic the next day.

The consultant admitted Mr. Jones and requested further blood tests, performed a bone marrow aspirate and trephine biopsy and ordered an abdominal ultrasound. The results of the blood tests were as follows:


Haematology

Haemaglobin           70 g/L
White cell count           6x109/L
Neutrophils              0.5x109/L
Neutrophils appear hyposegmented and hypogranular on examination
Platelets              10x109/L
MCV                 108fL
B12 and folic acid           normal
Ferritin              400ug/L
NAP score             negative
Clotting Screen          normal





Biochemistry

Renal and hepatic functions    normal
Bilirubin             25mM/L

Bone Marrow Report
 
The bone marrow appeared hypercellular with evidence of increased apoptosis but with no megakaryocytic precursors present. Slight erythroid hyperplasia (1:1 ratio with white cells) was noted with 18% sideroblasts. Myeloblasts comprised 25% with many containing Auer rods and neutrophils were reduced but were hyposegmented and hypogranular as in the blood film.

Chest X Ray Report

Left sided pneumonia

Abdominal ultrasound report

Marginally enlarged spleen

Will i live, ahem he live ?
diagnosis and prognosis ?
justify your chosen methods to treat this patient aswell please.


Oh and my diagnosis of rai fei.

condition: dirty little teenage perv, needs a girlfreind.
symtoms: poor eyesight, lack of eye contact, peeling skin on the palm of his favourite hand, suspect stains on clothes/bedroom material/walls in conjunction with the strange dissapearance of everday cylindrical household objects.
treatment options: beat him, beat him some more, lock him up, force religion upon him, send him to an all boys school and forget about him until he's 30 and happily married.

Mr. Jones clearly has radiation poisoning.

Mr. Jones is suffering the "this thread is fun only and only on a very low level of understanding so stick to Lai's examples" disease. Cure: gtfo

 ;D 8)

Thanks for the case, transcription!

Mr Jones

Blood tests says macrocytic anemia, thrombocytopenia, high ferritin and neutropenia. Platelets <20 explains the gum bleeding. Neutropenia explains the pneumonia. The hard part is deciphering the bone marrow report. If you take away the Auer rods and high blast myeloblast count then Myelodysplastic Syndrome would fit, but since those are present - Acute Myeloic Leukemia. As to what subtype, I don't really know, but the age (pretty stupid argument actually) and your question "justify your chosen methods to treat this patient aswell please" makes me think Acute Promyelocytic Leukemia (APL).

If it's APL - ~70% cure rate. I wouldn't tell patients percentages, besides it's the hematologists job who also have more methods of risk stratifying the patient.

Treatment - thrombocyte transfusion, intravenous antibiotics. For the APL (again hematologists line of work) All-trans retinoic acid, an acid form of vitamin A, allows differentiation of malignant promyelocytes to mature neutrophils, and chemotherapy.

See, Leukemia is a cancer, and RP causes cancer. Therefore I win.

This was too easy to answer tbh.

Case 1: Rai Fei

I think he maybe suffering from depression. His first symptom was the loss of interest in school. He is also ashamed of what he was/is doing which is why he doesn't give much eye contact and the tension between him and his mother.
 

I do apologise if noboddy found my little case study fun, i always enjoyed doing them myself whilst i was studying haematology. I wont post anymore, my apologise.

I don't mind. You owe me the answer to your case at least :)

If my memory serves me right it was M3 APL with sideroblastic anaemia and pneumonia. The age of the patient and the presence of the pneumonia would have affected the treatment options, with pneumonia obviously needing to be resolved prior to therapy; bearing in mind certain therapies would be ruled out with increasing age as they are considered too aggressive and are likely to kill the patient. The auer rods are important as they are pathognomic of AML, but you have the APL bang on as you know leukaemias are classified by the cell line in which they arise.

Fluorescent in situ hybridization (FISH) could be utilised to help confirm the classification as M3 leukaemias show a high frequency of t(15;17) translocations of the PML gene which codes for a transcription factor (forget which one), but basically the PML gene becomes fused with the RAR-a gene (which codes for a retinoic acid steroid hormone receptor) and forms a fusion protein which has the function of abnormal transcription causing proliferation which also blocks differentiation.

Ara-C, daunorubicin and thioguanine are commonly used in remission and consolidation therapy, with allogenic or autologous BM transplant required for curative therapy (remmission and currative therapy are not the same thing). Curative therapy is viable as the patient is under 55 meaning a reduced risk of graft versus host disease so.........Allogenic transplantation in combination with high dose ablative chemotherapy preferably.

but im by no means any kind of authority on this stuff, i only got a 2:1 on the case study when i did it myself. But tbh Lai ya did good.  :)

Cool. You've studied more hematology than we have. My role as a junior physician here is more to recognize if things are really fucked up and refer to specialist clinics. In this case it would be to see the alarming blood work and admit the patient to a haematology ward for more work-up. Maybe start him on antibiotics after consulting with a specialist in infectious disease and platelet transfusion with permission from hematology.

I added you to the list if you're interested :D

So when do we see who's diagnosis was correct?

I try to space each segment with 24h in between. Too much work for me otherwise.

ah ok

Case 1: Rai Fei

A boy of 13 years, Rai Fei, from Taiwan enters the examine room with his mother. His worried mother tells you that her son is staying up increasingly late at night by his computer. When she checked RaiFei's computer to see if he had completed his studying for the weekly chinese exam she found pictures of naked women, and to her astonishment he had not fully prepared for his weekly chinese exam! Rai Fei is adamant about the pictures being related to the sex-ed class.

Throughout the mother's history presenting Rai Fei gives you poor eye contact, seems disinterested and you can notice tension between mother and son. No apparent psychotic signs. Pregnancy, delivery and neonatal period normal. Birth weight 3216g. Previously healthy apart from a couple of episodes of otitis. Takes no meds as far as his mother knows. No allergies. His mother believes his son has gotten into drugs.

Your preliminary diagnosis is that Rai Fei has entered puberty. Depression is an important differential diagnosis. Change of sleeping patterns, decreasing interest in things he's previously found enjoyable (in this case school work) and poor emotional contact (eg. eye contact) are signs of depression. However, the above can all be attributed to normal behaviour for his age. http://www.psych.org/Share/Parents-Med-Guide/HTML-Physician-Depression.aspx#6 (http://www.psych.org/Share/Parents-Med-Guide/HTML-Physician-Depression.aspx#6). His poor eye contact is probably because he's ashamed of his behaviour. After all, he wasn't prepared for his weekly chinese exam! Rai Fei, like any teenager, probably also thinks being dragged to the doctor by mom is silly, thus showing disinterest in the ordeal.

From your vast personal experience in malpractice suits cancer is always good to have in mind. Brain tumor can explain a couple of the symptoms but there are no complaints of headache, nausea, somnolence nor any focal neurological symptoms. You write it off as a very unlikely possibility.

As you start to examine from top to toe, an odd finding stops you and make you think: his right breast is larger than his left breast. When you ask his mother about it, she says that this is new.

What primary condition do you suspect now?

How can you confirm your current suspicion in the physical exam (the first somatic sign)?

Annnd the plot thickens....

I still just think Ray Jay or wtf his name is, is just Horny with an urgent case of Procastabation.


But this enlarged breast intrigues me. Couldnt this still be a symptom of puberty? Maybe he has elevated estrogen levels for some reason.

I added you to the enlisted docs, Dr Groundy!

Btw, what does "Procastabation" mean?

Procasterbation:

The act of masterbating instead of doing something important. (ie. homework)

Example:
Two: Instead of doing that project, I was procasterbating.

http://www.urbandictionary.com/define.php?term=procasterbating

I would also propose doing an estrogen and other hormone test. Perhaps it's another hormone at fault?

Also, order a scan/test on the larger brest, make sure there isn't a swelling or tumour underneath.

I concur Doctor.

If the mother does infact suspect the son is taking drugs, then its suitable to suspect that Ray Ray could possibly be administering himself estrogen supplements because he has sexual identification issues.

He's looking at pictures of naked women, not men, so I wouldn't call that a sexual identification issue - if anything, that seems normal.

I somehow believe we'll be seeing elevated testosterone levels, if anything.

Gay women have naked women on their computers too.

Having pictures of naked women on his computer does not indicate what sex the boy identifies with. This is different then being labeled heterosexual/homosexual. There are a slew of terms to describe specific trans-gender identification.

Rai Fei could be a female homosexual trapped in a male body for all we know. It's all psychological.

Edit- but im over-analyzing.. Lets just wait for the tests to come back. This is a very specific and rare diagnosis and I dont feel as if we have all the information yet.

Diagnosis: Scoliosis!

You haven't answered:

Well his back is shaped in one direction, not? That makes the breast look bigger on one side and smaller on the other side!

He may have Hyperandrogenism. Androgen Is A hormone which is secreted by the Adrenal Glands, this hormone is responsible for the production of the hormone estrogen in males. So an over production of Estrogen  can lead to breast enlargement in males. You should do a ct scan to check for masses on the adrenal glands.

LOL WTF IS GOING ON IN THIS THREAD?

It's like reading an episode of House without Hugh Laurie being a sarcastic cunt.

Actions speak louder than words? Within the confines of the series: You can hate House for doing guesswork, taking the hard or difficult decisions but if you were in horrible pain you'd grumble over have to go over basics or things that were obvious to you too. House is one of those characters people love to hate.

Oh, don't get me wrong.  I love House, that entire character is why.  I don't even see why people hate him so much, he's pretty much a BAMF.

Good good I was just protecting my uncle House

I diagnose a disturbed relationship between you two and your fathers in your early childhood. Prognosis: Death by hanging yourself on your wieners.
Cure: Suicide.

I diagnose Baine with being german.

Symptoms: No sense of humour, acts in vile working class packs

Cure: There is no cure for being german.

Don't start a flame war in here

Diagnosis: No sense of humour without being german.

Patient: Velocity78
Symptom: Velocity78
Treatment: Not cost effective, patient discharged. Insurance price increased.

So im mocked for saying not to start a flame war? just following forum rules...

Disease has advanced. Patient now reports being mocked.

Treatment: Suggested systematic desensitization therapy by means of overexposure to symptom.

bite me

There was just no way this thread was going to succeed with the group of dumb asses we have around here.

This guy's a real doctor.


Nurse Rached? Is that you?

So aside from Smokaz being himself, any other differentials on the left breast enlargement?

cause: Enlarged breast due to increased muscle mass from excessive masturbation.
examination: Tell him to preform a jerking motion while touching his breast (gay doctor here I come) to determine if the cause is correct.
treatment: Send him to left hand jerking course

Case 1: Rai Fei

A boy of 13 years, Rai Fei, from Taiwan enters the examine room with his mother. His worried mother tells you that her son is staying up increasingly late at night by his computer. When she checked RaiFei's computer to see if he had completed his studying for the weekly chinese exam she found pictures of naked women, and to her astonishment he had not fully prepared for his weekly chinese exam! Rai Fei is adamant about the pictures being related to the sex-ed class.

Throughout the mother's history presenting Rai Fei gives you poor eye contact, seems disinterested and you can notice tension between mother and son. No apparent psychotic signs. Pregnancy, delivery and neonatal period normal. Birth weight 3216g. Previously healthy apart from a couple of episodes of otitis. Takes no meds as far as his mother knows. No allergies. His mother believes his son has gotten into drugs.

Your preliminary diagnosis is that Rai Fei has entered puberty. Depression is an important differential diagnosis. Change of sleeping patterns, decreasing interest in things he's previously found enjoyable (in this case school work) and poor emotional contact (eg. eye contact) are signs of depression. However, the above can all be attributed to normal behaviour for his age. http://www.psych.org/Share/Parents-Med-Guide/HTML-Physician-Depression.aspx#6. His poor eye contact is probably because he's ashamed of his behaviour. After all, he wasn't prepared for his weekly chinese exam! Rai Fei, like any teenager, probably also thinks being dragged to the doctor by mom is silly, thus showing disinterest in the ordeal.

From your vast personal experience in malpractice suits cancer is always good to have in mind. Brain tumor can explain a couple of the symptoms but there are no complaints of headache, nausea, somnolence nor any focal neurological symptoms. You write it off as a very unlikely possibility.

As you start to examine from top to toe, an odd finding stops you and make you think: his right breast is larger than his left breast. When you ask his mother about it, she says that this is new.

Your finding does not make you change your mind regarding onset of puberty as being the cause. The breast enlargement is called gynecomastia and is in fact a common symptom among pubertal boys. The enlargement will resolve in 90% of cases within months to years. Palpating the breast and lymph nodes did not evoke any suspicion of a tumorous mass. No other findings in the physical exam, but you want to do one last thing to confirm your diagnosis by checking for the first somatic sign of puberty. You ask the mother to step out and then put on your surgical gloves with a slapping sound to your wrist (for extra drama).

1. Rai Fei gulps and speaks for the first time - "what are you doing?"

2. This exam can be hard to interpret the result from. Is there any tool that can help you more precisely evaluate the finding? What is this tool called?

3. Post a picture of this tool

Case 1: Rai Fei


1. Rai Fei gulps and speaks for the first time - what are you doing?
(http://t3.gstatic.com/images?q=tbn:R0ubJ4QARnUfGM:http://fc02.deviantart.com/fs24/f/2007/335/4/c/TF2_Tag___Medic_by_schroe.png)


2. This exam can be hard to interpret the result from. Is there any tool that can help you more precisely evaluate the finding? What is this tool called?

It's an analomatorizor!


3. Post a picture of this tool


(http://t0.gstatic.com/images?q=tbn:s0-Mb543W7v7rM:http://www.ubercharged.net/wp-content/uploads/2009/03/tf2_medic.jpg)

1. I'm going to check if your little factory downstairs is making the white stuff(not milk).

2. Well, it'd be easier to check for puberty hairs, but if we're going to be making the kid cum, then... The Suprapubic Cystoscope(Googled prostatoscope and this sounded like fun) should be of use.

3. No.

I was going to reply with gynomastia, but Hyperandrogenism sounded cooler. ugh gotta go back to class now -.-

I'm extending your tinking time. Everyone is welcome with their theories.

You could expose the boy to pornographic material during an EEG to establish whether or not puberty has struck.  :P

Case 1: Rai Fei

A boy of 13 years, Rai Fei, from Taiwan enters the examine room with his mother. His worried mother tells you that her son is staying up increasingly late at night by his computer. When she checked RaiFei's computer to see if he had completed his studying for the weekly chinese exam she found pictures of naked women, and to her astonishment he had not fully prepared for his weekly chinese exam! Rai Fei is adamant about the pictures being related to the sex-ed class.

Throughout the mother's history presenting Rai Fei gives you poor eye contact, seems disinterested and you can notice tension between mother and son. No apparent psychotic signs. Pregnancy, delivery and neonatal period normal. Birth weight 3216g. Previously healthy apart from a couple of episodes of otitis. Takes no meds as far as his mother knows. No allergies. His mother believes his son has gotten into drugs.

Your preliminary diagnosis is that Rai Fei has entered puberty. Depression is an important differential diagnosis. Change of sleeping patterns, decreasing interest in things he's previously found enjoyable (in this case school work) and poor emotional contact (eg. eye contact) are signs of depression. However, the above can all be attributed to normal behaviour for his age. http://www.psych.org/Share/Parents-Med-Guide/HTML-Physician-Depression.aspx#6. His poor eye contact is probably because he's ashamed of his behaviour. After all, he wasn't prepared for his weekly chinese exam! Rai Fei, like any teenager, probably also thinks being dragged to the doctor by mom is silly, thus showing disinterest in the ordeal.

From your vast personal experience in malpractice suits cancer is always good to have in mind. Brain tumor can explain a couple of the symptoms but there are no complaints of headache, nausea, somnolence nor any focal neurological symptoms. You write it off as a very unlikely possibility.

As you start to examine from top to toe, an odd finding stops you and make you think: his right breast is larger than his left breast. When you ask his mother about it, she says that this is new.

Your finding does not make you change your mind regarding onset of puberty as being the cause. The breast enlargement is called gynecomastia and is in fact a common symptom among pubertal boys. The enlargement will resolve in 90% of cases within months to years. Palpating the breast and lymph nodes did not evoke any suspicion of a tumorous mass. No other findings in the physical exam, but you want to do one last thing to confirm your diagnosis by checking for the first somatic sign of puberty. You ask the mother to step out and then put on your surgical gloves with a slapping sound to your wrist (for extra drama).

You palpate Rai Fei's scrotum for testicular growth. You're uncertain if either of the testicles are large enough to signal the onset of puberty. This exam can be hard to interpret the result from. You know a tool/gadget that can help you more precisely evaluate the findings. You ask nurse Vanessa to fetch it for you, but can't remember the name. Did it end on -meter (or did it in fact end with -y). Nurse Vanessa taps her foot impatiently.

1. What is this tool/gadget called?

You manage to come up with the name after some tinking, but nurse Vanessa isn't completely sure what you're meaning. Fortunately, just as you recall the name a mental image of it appears in your head.

2. Post a picture of this tool/gadget

Case 1: Rai Fei

A boy of 13 years, Rai Fei, from Taiwan enters the examine room with his mother. His worried mother tells you that her son is staying up increasingly late at night by his computer. When she checked RaiFei's computer to see if he had completed his studying for the weekly chinese exam she found pictures of naked women, and to her astonishment he had not fully prepared for his weekly chinese exam! Rai Fei is adamant about the pictures being related to the sex-ed class.

Throughout the mother's history presenting Rai Fei gives you poor eye contact, seems disinterested and you can notice tension between mother and son. No apparent psychotic signs. Pregnancy, delivery and neonatal period normal. Birth weight 3216g. Previously healthy apart from a couple of episodes of otitis. Takes no meds as far as his mother knows. No allergies. His mother believes his son has gotten into drugs.

Your preliminary diagnosis is that Rai Fei has entered puberty. Depression is an important differential diagnosis. Change of sleeping patterns, decreasing interest in things he's previously found enjoyable (in this case school work) and poor emotional contact (eg. eye contact) are signs of depression. However, the above can all be attributed to normal behaviour for his age. http://www.psych.org/Share/Parents-Med-Guide/HTML-Physician-Depression.aspx#6. His poor eye contact is probably because he's ashamed of his behaviour. After all, he wasn't prepared for his weekly chinese exam! Rai Fei, like any teenager, probably also thinks being dragged to the doctor by mom is silly, thus showing disinterest in the ordeal.

From your vast personal experience in malpractice suits cancer is always good to have in mind. Brain tumor can explain a couple of the symptoms but there are no complaints of headache, nausea, somnolence nor any focal neurological symptoms. You write it off as a very unlikely possibility.

As you start to examine from top to toe, an odd finding stops you and make you think: his right breast is larger than his left breast. When you ask his mother about it, she says that this is new.

Your finding does not make you change your mind regarding onset of puberty as being the cause. The breast enlargement is called gynecomastia and is in fact a common symptom among pubertal boys. The enlargement will resolve in 90% of cases within months to years. Palpating the breast and lymph nodes did not evoke any suspicion of a tumorous mass. No other findings in the physical exam, but you want to do one last thing to confirm your diagnosis by checking for the first somatic sign of puberty. You ask the mother to step out and then put on your surgical gloves with a slapping sound to your wrist (for extra drama).

You palpate Rai Fei's scrotum for testicular growth. You're uncertain if either of the testicles are large enough to signal the onset of puberty. This exam can be hard to interpret the result from. You know a tool/gadget that can help you more precisely evaluate the findings. You ask nurse Vanessa to fetch it for you, but can't remember the name. Did it end on -meter (or did it in fact end with -y). Nurse Vanessa taps her foot impatiently.

1. What is this tool/gadget called?
An orchidometer

You manage to come up with the name after some tinking, but nurse Vanessa isn't completely sure what you're meaning. Fortunately, just as you recall the name a mental image of it appears in your head.

2. Post a picture of this tool/gadget

(http://2.bp.blogspot.com/_fyRykSB60oA/RvZGzsm7TmI/AAAAAAAABG8/qmKRyP1ZGxc/s400/prchidometer2.jpg)

4 ml or larger indicates start of puberty has occured. Adult size 12-25 ml.

You use the orchidometer to evaluate your findings. Left testicle 4 ml. Right testicle 5 ml. Reassured of your diagnosis, you discharge Rai Fei with the advice to seek a general practioner if the gynecomastia doesn't subside within 18 moths. You hurry off, past a disgruntled waiting room, to the 9 AM coffee break.

*CASE CLOSED*

Feedback will be appreciated

what is this topic about?
whats the point of it?

I was sure the answer was going to be ball-o-meter :(

If you read my opening post, you should find the answers to your questions.

You were right then. Orchis basically means ball in greek, just sounds more scientific.

Wow i was shocked for a moment, i thought you wanted to put that thing in his ass.

sick man....

google says infirmary is somewhere they take care of sick peoples or hospital i guess

So those doctors can have sex with them or what?

I thought it was disclaimer. Google said that.

Could you post us a picture or video of what this act looks like?

Find a pornagraphy, watch it and add some imagination by yourself I think.

Nono, I'd really rather you posted a picture of it.

Everytime I upload a picture,
It doesn't work.
But I really prepared one.

That's it.

Is he an iron man?

This thread has gone into afib, we need a crash cart in here!


Charging 60......Clear!

Charging 90......Clear!

The Thread has been stabilized you may now post again