Medical Diagnoses in The Good Doctor: A Comprehensive Review of Medical Conditions in Season 4
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Season 4 of The Good Doctor marks a significant shift in the medical landscape of St. Bonaventure Hospital. The season opens by confronting the global COVID-19 pandemic head-on, showcasing the evolution of treatment protocols and the virus's multi-systemic impact. As the season progresses, the focus returns to complex surgical anomalies, highlighting everything from rare genetic syndromes to high-stakes field medicine.
Below is a comprehensive review of the specific medical diagnoses and treatments featured throughout Season 4.
Content ⁉️
Episode 1
COVID-19 (SARS-CoV-2) and Multi-Systemic Complications
Mildred initially presented with flu-like symptoms—sore throat, body aches, and cough—and was discharged with a diagnosis of the "flu." She returned rapidly deteriorating with critically low oxygen levels. Diagnosis: Chest X-rays revealed ground glass opacities, a hallmark of COVID-19. Treatment: Her condition progressed to cardiogenic shock, requiring ECMO (extracorporeal membrane oxygenation) to support her heart and lungs, alongside dexamethasone and steroids.
Martin presented with high fever and oxygen saturation of 74%. Diagnosis: His COVID-19 was complicated by bacterial pneumonia and a bacterial abscess on his mitral heart valve. Treatment: Treatment involved lung suctioning, proning, and a primary repair of the heart valve.
Ambar, a pregnant patient whose acidosis worsened, maxing out ventilator pressure. Treatment: To save both mother and child, the team utilized the CHILL study protocol, paralyzing her muscles and lowering her body temperature to reduce oxygen demand.
Walter presented with abdominal pain and diarrhea, mimicking diverticulitis. Diagnosis: An abdominal CT revealed lung damage, confirming COVID-19 despite the lack of respiratory symptoms.
Other Medical Diagnoses and Conditions Discussed
Influenza (Flu): Viral infection often presenting with fever and aches.
Breast Mass: Condition requiring elective lumpectomy, postponed due to the pandemic.
Asthma: Pre-existing respiratory condition increasing COVID-19 risk.
Heart Murmur: Clinical sign signaling valve issues or abscesses.
Pulseless Ventricular Tachycardia (V-tach): Life-threatening rapid heart rate.
Cytokine Storm: Severe immune system overreaction.
Episode 2
COVID-19 Complicated by Posterior Tibial Artery Thrombosis
Martin. Following exposure to the virus, Martin required a ventilator. Dr. Andrews attempted a suspended animation approach, cooling the body to 34 degrees Celsius to aid lung healing. Progression and Diagnosis: A drop in end-tidal CO2 suggested a blood clot in the lung, leading to a heparin drip. However, Martin developed Heparin-Induced Thrombocytopenia (HIT). The final diagnosis was a posterior tibial artery thrombosis causing ischemia in his lower extremity. Treatment: To prevent fatal internal bleeding or stroke while stopping tissue death, the team performed an amputation of the foot and ankle.
Other Medical Diagnoses and Conditions Discussed
Heparin-Induced Thrombocytopenia (HIT): Immune complication causing low platelets and clotting risk.
Stroke: Risk factor associated with suspending anticoagulation therapy.
Sepsis: Systemic response to infection leading to organ failure.
Ischemia: Restriction of blood supply leading to tissue death.
Episode 3
Cardiac Tumor requiring Autotransplantation
A firefighter presented with dizziness initially attributed to caffeine. Imaging revealed a large tumor on the posterior heart wall, inaccessible via thoracotomy. Treatment: The team performed a cardiac autotransplantation, removing the heart completely to excise the tumor. They reconstructed the atrial walls using porcine bladder tissue before reimplantation.
Tuberous Breast Deformity and Artery of Percheron Infarction
A 17-year-old underwent correction for tuberous breast deformity using implants. Progression: Post-operatively, she lapsed into a coma. A scan revealed an Artery of Percheron infarction—a rare clot affecting the brain's consciousness center. Treatment: An emergency stent retrieval removed the clot, leading to a full recovery.
Other Medical Diagnoses and Conditions Discussed
Obesity and Diabetes: Chronic conditions managed in internal medicine.
Anterior Cruciate Ligament (ACL) Injury: Tear of the knee ligament.
Tumor Angiogenesis: Process of a tumor creating its own blood supply.
Rheumatic Fever: Inflammatory disease potentially damaging the heart.
Cerebral Embolism: Clots traveling to the brain causing neurological damage.
Episode 4
Rh-Incompatibility and Delayed Interval Delivery
Pregnant with twins, Kenzie was misdiagnosed with preeclampsia. The true diagnosis was Rh-incompatibility, where her body attacked the Rh-positive fetus. Treatment: After the amniotic sac of the stronger twin ruptured, the team performed a delayed interval delivery. They delivered the first twin but used medication to stop contractions, keeping the weaker twin in utero for lung maturation.
Amelanotic Melanoma
Billy. A biopsy of a suspected ingrown hair revealed amelanotic melanoma, which had metastasized to the liver. Treatment: Treatment was complicated by anaphylactic shock from dye and a bile duct leak, leading to severe infection.
Other Medical Diagnoses and Conditions Discussed
Cutaneous Pili Migrans: Rare condition of a migrating hair shaft.
Creeping Eruption: Parasitic disease causing skin lesions.
Persistent Left-Sided Superior Vena Cava: Congenital heart anomaly.
Cardiac Tamponade: Fluid buildup preventing effective heart pumping.
Peritonitis: Dangerous infection of the abdominal lining.
Episode 5
Dermoid Cyst with Associated Retrograde Memory Loss
Ellie presented with symptoms mimicking migraines. Neurological exams revealed a dermoid cyst near the hippocampus containing fat, hair, and teeth. Treatment: The cyst leaked, causing seizures. Surgeons performed a craniotomy for removal. The procedure was successful but resulted in retrograde memory loss.
Ruptured Suprarenal Aortic Aneurysm
Carl presented with back pain, initially suspected as a fracture. He suffered a ruptured suprarenal aortic aneurysm. Treatment: During emergency repair, a secondary aneurysm formed, causing liver failure. A complex Y-shaped vein graft was attempted, but the patient developed Disseminated Intravascular Coagulation (DIC) and passed away.
Other Medical Diagnoses and Conditions Discussed
Positive Babinski Sign: Indicator of CNS involvement.
Osteomyelitis: Bone infection.
L2 Compression Fracture: Vertebral wedging causing neural impingement.
Asystole: Cessation of electrical heart activity.
Episode 6
Prinzmetal's Angina
Rose Babcock, claiming to be an "empath," presented with hypertension and tachycardia. Diagnosis: After suffering a cardiac arrest, she was diagnosed with Prinzmetal's Angina, a condition involving heart vasospasms triggered by stress—in her case, the emotional distress of others.
Complex Regional Pain Syndrome (CRPS)
Ben Harris, a veteran with shrapnel injuries and PTSD developed Complex Regional Pain Syndrome (CRPS), causing debilitating arm pain. Treatment: Surgeons performed an amygdala ablation using a thermal laser to dampen his fear response and alleviate pain.
Other Medical Diagnoses and Conditions Discussed
Flail Chest: Rib cage segment breaking under stress.
Hemoperitoneum: Blood accumulation in the abdomen.
Grade-Three Liver Laceration: Significant tear in liver tissue.
Congenital IgA Deficiency: Immune disorder increasing infection risk.
Episode 7
CRISPR-Induced Amyloidosis Mimicry
Wyatt presented with frostbite and a perforated bowel. He admitted to self-administering CRISPR cocktails to stop aging. Diagnosis: The genetic tampering caused a condition mimicking amyloidosis, where deposits attacked his nerves and spleen. Treatment: An experimental procedure using CRISPR via a modified herpes virus was proposed to reverse the modification.
Li-Fraumeni Syndrome (LFS)
Hannah Palmer presented with a hematoma and a deviated trachea caused by a tumor. Diagnosis: Due to a history of recurring cancers and toxin exposure, she was diagnosed with Li-Fraumeni Syndrome (LFS), a genetic predisposition to tumors. Treatment: Thyroidectomy followed by radioactive iodine therapy.
Other Medical Diagnoses and Conditions Discussed
Melanoma: Skin cancer requiring surveillance.
Autoimmune Polyneuropathy: Immune system attacking nerves.
Carcinomatous Autonomic Neuropathy: Nerve damage affecting involuntary functions.
Parkinson’s Disease: Progressive nervous system disorder.
Episode 8
Boerhaave Syndrome
Coach (Darya's Father). The patient collapsed after chronic heartburn. Percussion revealed fluid in the chest. Diagnosis: Boerhaave syndrome, a spontaneous rupture of the esophagus. Treatment: An abscess made the tissue too friable for repair, necessitating an esophageal diversion and permanent tube feeding.
Kyphoscoliosis and Torsade de Pointes
Darya, a gymnast presented with an intestinal fiber blockage. Diagnosis: She had the bone density of an 80-year-old (kyphoscoliosis) due to malnutrition. Supplements triggered Torsade de Pointes (cardiac arrhythmia). Treatment: Endoscopic clearance of blockage, heart stabilization, and spinal fusion.
Other Medical Diagnoses and Conditions Discussed
Intestinal Fiber Blockage: Obstruction from indigestible material.
Nutritional Deficiencies: Low calcium from restricted diets.
Esophageal Abscess: Infected fluid collection following rupture.
Episode 9
Hormone-Producing Prolactinoma and Pregnancy
Rio Gutierrez, a transgender man, presented with a pituitary mass. Missing testosterone shots led to pregnancy, which fueled the tumor's growth. Diagnosis: Prolactinoma impinging on optic fibers. Treatment: An open pterional craniotomy was performed to resect the tumor while preserving the pregnancy.
Hypertrophic Obstructive Cardiomyopathy (HOCM)
Zara Norton presented in hypertensive crisis. Mismanagement led to cardiogenic shock. Diagnosis: Hypertrophic Obstructive Cardiomyopathy (HOCM), where the heart septum is abnormally thick. Treatment: An open myectomy was performed. Complications led to a third-degree heart block, requiring a dual-chamber pacemaker.
Other Medical Diagnoses and Conditions Discussed
Cardiogenic Shock: Critical decline in cardiac output.
Myocardial Edema: Fluid accumulation in heart muscle.
Gender Dysphoria: Distress regarding gender identity.
Air Embolism: Air bubbles blocking blood flow.
Episode 10
End-Stage Liver Disease
Jamie, a patient with Down Syndrome, had autoimmune hepatitis progressing to end-stage liver disease. Treatment: A multi-organ donor chain was organized to facilitate a life-saving transplant.
Pulmonary Fungal Infection (Fungal Lobar Bleed)
Cort Graham, an athlete presented with lung fluid, initially suspected to be recurrent sarcoma. Diagnosis: A fungal infection causing a lobar bleed. He admitted to faking a history of chemotherapy (Bleomycin). Treatment: Since his lungs were not scarred by chemo, a lobectomy was successfully performed.
Other Medical Diagnoses and Conditions Discussed
Sarcoma: Malignant tumor.
Nonalcoholic Fatty Liver Disease: Fat accumulation in the liver.
Kidney Failure: Condition affecting donors in the organ chain.
Episode 11
Ankylosing Spondylitis and Chest Cavity Restriction
Jeffrey Williams suffered from ankylosing spondylitis, fusing his spine. Treatment: Dr. Glassman performed a reconstruction. However, straightening the spine caused the chest to compress the vena cava. The team broke the sternum and used metal bars to prop the chest open, similar to pectus excavatum treatment.
Ruptured Brain Aneurysm and Paraganglioma
Dannie had been in a vegetative state for 10 years. A paraganglioma was found releasing dopamine. Progression: During removal, the tumor ruptured, flooding her brain with dopamine and causing a temporary awakening. Outcome: The tumor was malignant, and the awakening was temporary. Dannie signed a DNR and passed away.
Other Medical Diagnoses and Conditions Discussed
CSF Leak: Spinal fluid escape requiring graft.
Spinal Shock: Temporary loss of cord function.
Chest-Cavity Restriction: Limitation in thoracic space compressing the heart.
Episode 12
Trigeminal Neuralgia
Oscar presented with debilitating facial pain. Diagnosis: Trigeminal neuralgia caused by an aberrant cerebellar artery compressing the nerve. Treatment: After a microvascular decompression failed, he underwent DREZ lesioning, severing nerve signals to the brain.
Aberrant Vertebral Artery (Musician’s Dystonia)
Dr. Silas Chambers, a surgeon presented with hand tremors only when his wrist was straight (musician’s dystonia). Diagnosis: An aberrant vertebral artery pressing on the spinal cord. Treatment: A radial artery graft bypass relocated the vessel. A clot in a sulcal artery required removal.
Other Medical Diagnoses and Conditions Discussed
Carpal Tunnel Syndrome: Nerve compression in the wrist.
Multiple Sclerosis (MS): CNS disease.
Acoustic Neuroma: Noncancerous tumor on the vestibular nerve.
Carotid Stenosis: Narrowing of neck arteries.
Episode 13
Bernard-Soulier Syndrome
Maya a dancer presented with a retroperitoneal bleed and failed to clot. Diagnosis: Bernard-Soulier syndrome, a genetic disorder causing large platelets and bleeding. Progression: Blood-filled pseudotumors destroyed her femur. Treatment: Due to platelet rejection during reconstruction, the leg was amputated to save her life.
Familial Adenomatous Polyposis (FAP)
Miles Browne presented with stroke-like symptoms due to terminal cancer. Diagnosis: Surgery revealed a significant polyp burden, confirming Familial Adenomatous Polyposis (FAP).
Other Medical Diagnoses and Conditions Discussed
Retroperitoneal Bleed: Hemorrhage behind the abdominal cavity.
Osteoarthritis: Degenerative joint disease.
Platelet Rejection: Immune reaction to transfusion.
Hypokalemia: Low potassium levels.
Episode 14
Aggressive Male Breast Cancer
Bradley "The Body" Vargas, an MMA fighter presented with a chest hematoma. A biopsy revealed aggressive breast cancer, obscured by pectoral implants. Treatment: He underwent a total mastectomy to achieve clean margins.
Parkinson’s Disease
Jean Starzak, a pilot admitted for hip replacement suffered blood pressure crashes. Diagnosis: Her history of constipation and sleep issues, combined with surgical instability, led to a diagnosis of Parkinson’s Disease.
Other Medical Diagnoses and Conditions Discussed
Chest Contusion: Severe bruising.
Sinus Bradycardia: Slow heart rate.
Carotid Sinus Hypersensitivity: Over-responsiveness to pressure.
Addison’s Disease: Adrenal insufficiency.
Episode 15
Multiple Gunshot Wounds and Migrating Intracranial Fragment
Mason, a 9-year-old with gunshot wounds arrived in PEA. Treatment: Surgeons inflated a urinary catheter balloon inside the right ventricle to occlude a hole in the heart.
Ethan suffered a gunshot wound to the head. Diagnosis: A focal seizure revealed a migrating bullet fragment in the brain. Treatment: The fragment was removed endoscopically by following a trail of heme products.
Lea underwent screening for Gestational Diabetes. Outcome: The glucose test was negative.
Other Medical Diagnoses and Conditions Discussed
Right Ventricle Perforation: Hole in the heart requiring occlusion.
Liver Laceration: Traumatic tear in the liver.
Brain Herniation: Displacement of brain tissue due to pressure.
Episode 16
Type 2 Vasa Previa and Umbilical Artery Embolism
Lea Dilallo presented with abdominal pain. Ultrasound revealed Type 2 vasa previa, where fetal vessels run across the cervix. Treatment: Fetoscopic laser ablation was performed. Outcome: A second clot was discovered in the umbilical artery. Combined with non-responsive fetal lungs, the pregnancy became non-viable.
Other Medical Diagnoses and Conditions Discussed
Round Ligament Pain: Pregnancy-related abdominal pain.
Ventricular Fibrillation (V-fib): Life-threatening heart rhythm.
Obstetric Cholestasis: Liver disorder in pregnancy.
Aortic Dissection: Tear in the aortic wall.
Pulmonary Embolism: Clot in the lungs.
Episode 17
Coarctation of the Abdominal Aorta
Artie Hill presented with "cold feet" and valve failure after a bypass. Diagnosis: Coarctation of the abdominal aorta (congenital narrowing) had caused high blood pressure, damaging the heart. Treatment: Open-heart surgery to replace the valve.
Basilar Artery Aneurysm
Senator Marian Clark suffered hemi-facial spasms. Diagnosis: A tortuous basilar artery was compressing the facial nerve. Treatment: During a sling procedure, the artery dilated, requiring a high-risk basilar artery bypass.
Other Medical Diagnoses and Conditions Discussed
Gastric Reflux: Digestive backflow.
Multiple Sclerosis (MS): CNS disease.
Turner Syndrome: Chromosomal condition.
Paravalvular Leak: Blood leaking around a prosthetic valve.
Episode 18
Arteriovenous Malformation (AVM)
Ava, a long-standing AVM became critical during puberty. Treatment: The mass infiltrated the lung. Surgeons removed the medial clavicle to access and resect the lung tissue.
Systemic Fungal Lesions
Unnamed Male. A patient injecting homemade psilocybin (mushroom) serum developed fungal lesions in the lungs and liver. Treatment: Aggressive surgical excision was required due to peritoneal scarring.
Torn Posterior Tibial Artery
Dr. Shaun Murphy suffered a dislocated ankle and torn posterior tibial artery while camping. Treatment: Lea performed emergency field surgery using a tent repair kit and a fishhook to suture the artery.
Other Medical Diagnoses and Conditions Discussed
Stroke: Interruption of blood supply to the brain.
Drug-Resistant Depression: Condition treated with alternative therapies.
Peritoneal Scarring: Fibrous tissue preventing laparoscopic tools.
Episode 19
Thoracic Outlet Syndrome and Paradoxical Embolism
Miguel presented with thoracic outlet syndrome. A clot traveled through a hole in his heart to the brain stem. Treatment: Lacking TPA, the team used a snake venom derivative to break up the clot.
Advanced Patent Ductus Arteriosus (PDA)
Aimé Navarro Gomez, a patient in Guatemala presented with a large PDA. Outcome: The condition had caused irreversible pulmonary hypertension. It was deemed inoperable.
Ameloblastoma
Bastion Alonso Ramos, a 12-year-old presented with a massive ameloblastoma tumor thinning the orbital floor. Treatment: A bifrontal trepanation and skull base reconstruction were planned.
Other Medical Diagnoses and Conditions Discussed
Hepatic Adenoma: Non-cancerous liver tumor.
Gallstones: Stones blocking the bile duct.
Rheumatic Heart Disease: Valve damage from infection.
Endocarditis: Infection of the heart lining.
Episode 20
Gallbladder Cancer and Post-Op Bleed
Edna, a routine gallstone surgery revealed gallbladder cancer. Treatment: Dr. Browne performed a resection. A post-operative crash was correctly diagnosed as a stomach bleed rather than a liver bleed.
Incarcerated Ischemic Ventral Hernia
Leon Castillo. Non-compliance with rest led to an incarcerated ventral hernia. Treatment: Dr. Lim performed an emergency repair with a bypass graft to restore blood flow.
Bone-Invading Sinus Tumor
Bastion. The tumor invaded the paranasal sinuses and facial bones. Treatment: The team sourced titanium miniplates from a dental surgeon to reconstruct the skull after removing facial bones.
Other Medical Diagnoses and Conditions Discussed
Ulcer: Condition requiring debridement.
Common Femoral Artery Occlusion: Blockage requiring bypass.
Post-Traumatic Stress Disorder (PTSD): Treated with a pharmaceutical regimen.
🔖 Key Takeaways
🗝️ Pandemic Medicine: The season provided a stark look at the realities of COVID-19, including the use of ECMO, prone positioning, and the management of multi-systemic complications like thromboses.
🗝️ Field Trauma: From repairing a torn artery with a fishing hook to improvised cardiac occlusions, the team demonstrated extreme resourcefulness outside the OR.
🗝️ Genetic Anomalies: Rare conditions such as Li-Fraumeni Syndrome, Bernard-Soulier syndrome, and CRISPR-induced complications highlighted the intersection of genetics and surgery.
🗝️ Surgical Innovation: The season featured high-risk procedures like cardiac autotransplantation, amygdala ablation for pain, and using snake venom for clotting.
🗝️ Pregnancy Complications: The narrative heavily featured high-risk obstetrics, including Rh-incompatibility, vasa previa, and the tragic loss of a pregnancy due to umbilical embolism.
Keywords: Medical Diagnoses The Good Doctor Season 4
Medical Diagnoses The Good Doctor Season 4
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