My medical skills add experience

Chapter 614 Start with the course of the disease, come to my place when you have time

Sometimes he always likes to have a bit of black humor, tell some bad jokes and so on.

And treat people very sincerely.

Of course, it's not that kind of bottomless sincerity.You can be extremely honest with friends and trusted people, but when it comes to patients and family members, it depends on the situation.

Any doctor who is a little older has once tasted the taste of being bitten by a "poisonous snake" because of his kindness at work.

"It's not running away, so what did you do? You went to the inpatient department to moles the nurse girl?"

Director Yin asked after hearing the words.

"Hey, you can't talk nonsense. If my girlfriend hears it, I must be punished to sleep on the sofa. I just went to the ward to check on this female patient, and did some examinations and inquiries on her."

Hearing that Zhou Can went to check on the patient in the ward, Director Yin suddenly smiled.

"Hoho! I underestimated you. Any diagnostic breakthrough?"

He cares most about the patient's diagnosis and treatment.

Immediately asked whether there was a breakthrough in diagnosis.

His eyes were full of anticipation, because Zhou Can made a breakthrough every time he made a shot, and almost never let him down.

"There are some small discoveries. Allow me to carefully consider the test results of the patient and then provide some reference opinions."

After speaking, Zhou Can really picked up the patient's information and began to study it carefully.

This is already the second study.

Sometimes a doctor's diagnosis is like this. It is necessary to repeatedly scrutinize the patient's examination report, etiology, and medical history, and then draw a conclusion after confirming that it is correct.

It is the normal state of doctors to diagnose diseases as if walking on thin ice and being cautious.

Director Yin didn't bother him, and quietly refilled him a cup of tea with a smile, and then studied the case of the high paraplegia by himself.

The two of them are really interesting.

When encountering difficult cases, diagnose each other's cases.

Clinically, this can be called consultation.

Brainstorming is a common method used by doctors to deal with difficult cases.A person's wisdom and strength are limited after all, and each doctor's diagnosis ideas are different, and the findings will also be different.

Just like a blind man feeling an elephant, different ways of diagnosing and finding the cause will also be different.

For example, when diagnosing a patient with a cold, some people start with the patient's fever, some start with the patient's lack of appetite, and some start with the patient's headache or general fatigue.The diagnostic ideas are different, but the final correct answer is basically the same.

After nearly 10 minutes or so, Zhou Can seemed to have come to a conclusion.

He raised his head and looked at Director Yin.

"You say, I listen!"

Director Yin had already diagnosed the little boy with high paraplegia, and he was drinking tea leisurely.Seeing Zhou Can looking up, he immediately understood that Zhou Can's diagnosis had also come to an end.

"Although the course of the female patient's disease was very long, after I asked, I thought she had a sudden onset. It was because of an accidental cold, and then she started to have a headache, which finally lasted until now. The characteristics of this disease are sudden onset and long course. , the progress of the disease is relatively slow. I went into the ward to check her just now, and found that her optic disc was edematous, her head had pain when turning her right eye, and she had obvious gag reflex when swallowing..."

"Her white blood cell count was high, ESR increased rapidly, and the number of cells in the cerebrospinal fluid increased, mainly mononuclear. The protein in the cerebrospinal fluid also increased significantly, the sugar decreased, but the chloride was normal. No acid-fast bacilli, Cryptococcus neoformans, etc. The chest X-ray is normal, indicating that there are no obvious lesions in the chest and lungs. In addition, her blood count is also a bit high. Combined with the fact that the patient had a fever when she was admitted to the hospital, my diagnosis is more likely to be acute infection. "

After Zhou Can narrated the comprehensive situation of the patient, he made a summary.

"I agree with this point, the patient does have the possibility of acute infection."

Director Yin nodded in agreement with Zhou Can's point of view.

"Let me talk about several suspected diseases first, and then we will discuss them one by one. The first one is cryptococcal meningitis neoformans. This disease mostly occurs in young adults. The patient is in his 30s this year, and he is a young adult. This disease has There are two kinds of subacute and chronic onset, which are very consistent with the acute onset of the patient. The disease is accompanied by moderate or mild fever, which is also consistent with the patient's condition. The disease also presents with headache, vomiting, blurred vision, and diplopia Neck stiffness and meningeal irritation are highly consistent with the patient's symptoms."

"Moreover, as the disease progresses, disturbance of consciousness will occur, and a small number of patients will experience convulsions all over the body, which is also consistent with the patient. The suspicion of this disease is extremely high."

Zhou Can started with the patient's symptoms and found a disease that was highly consistent with his symptoms.

"However, although the sugar content in the patient's cerebrospinal fluid was significantly reduced, the chloride content did not change, and neither Cryptococcus nor Cryptococcus neoformans were found in the ink dyeing, so the disease cannot be diagnosed. The cerebrospinal fluid can be extracted multiple times and sent to the laboratory to repeatedly search for Cryptococcus."

Every disease has a gold standard for diagnosis.

For example, in cryptococcal meningitis neoformans, even if the patient's symptoms are all consistent with the disease, but no cryptococcus is found in the cerebrospinal fluid test, the disease cannot be diagnosed.

In clinical practice, there are many strange diseases whose symptoms are basically similar to a certain disease, but they are not this disease.

Therefore, doctors are extremely cautious when diagnosing the etiology. Unless a gold standard is found, they will not easily draw a conclusion.

"I also suspected this disease. I have taken cerebrospinal fluid for several consecutive days and sent it for inspection, but no Cryptococcus was found in the results."

Director Yin sighed.

If the disease is so easy to diagnose, there is no need to ask Zhou Can for help.

"This matter is indeed very strange. It may happen to be a disease with similar symptoms to cryptococcal meningitis. The second disease I suspect is tuberculous meningitis. This disease has an insidious onset and a long course of symptoms. It can range from mild to severe. There may be a history of tuberculosis infection in other parts of the condition, and the prodromal period includes low-grade fever, night sweats, loss of appetite, mild headache, malaise, fatigue and other symptoms."

"As the disease progresses, the headache intensifies with vomiting, neck stiffness, Kellnig's sign, and Brudzinski's sign are both positive. There may also be ptosis due to meningeal adhesions, different pupil sizes, and extraocular muscle paralysis. Symptoms such as diplopia and facial paralysis. Under normal circumstances, after suffering from this disease, tendon reflexes can be hyperactive and pathological reflexes are positive, but spinal nerve damage may lead to the disappearance of tendon reflexes."

"If the disease cannot be treated in time and correctly, the condition will continue to deteriorate and eventually enter an advanced stage, directly threatening life."

Zhou Can mentioned the second disease he suspected.

"This female patient is more likely to have progressed to the second stage of the disease. However, there are some arguments that do not support the disease. For example, some of the patient's symptoms are different from the disease, and the patient's chest X-ray showed no abnormalities. .The cerebrospinal fluid test showed that the protein increased and the sugar decreased, but there was no significant change in chloride."

First suspect the disease, and then say some arguments that do not support the disease.

Diagnoses are sometimes contradictory in this way.

It is necessary to see the sun through repeated deduction.

"Tuberculotic meningitis, we have basically ruled it out after consultation in our department. But you just mentioned that the Kellnig's sign and Brudzinski's sign were positive. These are some new findings."

Director Yin thought a little after listening.

"How should I put it! Although this disease is the least suspicious, I think it is very likely to be the disease. The symptoms of this female patient are relatively classic, and many diseases can be matched with it. Therefore, I think both Starting from the symptoms and signs, it cannot be based entirely on the symptoms, but it should also be comprehensively dialectical based on the progress of the disease and whether the patient has a medical history."

Zhou Can never looks at the appearance when he diagnoses a disease. He prefers to peel the cocoons and point directly at the lesion itself.

Maybe it's a diagnostic gift.

When diagnosing various difficult cases, he is able to locate the most hidden doubtful point among many doubtful points, or the doubtful point that is least likely to be valued by other doctors, and then pursue it in depth, eliminate interference, and finally find out the cause.

"interesting."

Director Yin Hua's eyes shone slightly after hearing this.

"Diagnosing it in conjunction with the progression of the disease is something that I and other doctors really didn't think of."

"Actually, I thought of some other suspicious diseases just now, but they were all ruled out in the end. Such as suppurative meningitis, viral meningitis, etc."

The meaning of Zhou Can's words is very straightforward, that is, it is highly suspected that the patient is tuberculous meningitis.

Clinically, the last thing doctors like is the disease related to tuberculosis.

Tuberculosis is easily contagious, it is particularly stubborn, the course of the disease is extremely long, and the cure cycle is also extremely long.

Many patients and their family members do not understand medicine. After taking medicine and injections for a period of time, they found that their condition did not seem to improve, and began to doubt the doctor's diagnosis and treatment plan.Do not want to cooperate with treatment.

This can lead to wasted effort.

In the end, the doctor can only watch the patient fall into the abyss.After it's over, family members and patients will collectively scold the doctor as a quack doctor who can't even cure a disease.

"Tell me the basis on which you concluded that the patient had tuberculous meningitis."

Director Yin Hua had a hint of cunning deep in his eyes, as if he wanted to take the opportunity to dig deeper into Zhou Can's diagnostic ability.

"There are some other evidences. For example, the patient had low-grade fever, vomiting, double vision, and convulsions, all of which were similar to the symptoms of the second stage of tuberculous meningitis. In addition, the patient's optic disc edema and right extraocular muscle paralysis , Meningeal irritation sign +, positive pathological sign. ESH increased rapidly, neutrophils were high. These evidences are enough to highly suspect tuberculous meningitis."

Zhou Can mainly suspects that the patient has this disease, but not just based on the similarity of the course of the disease to this disease.

There are many other symptoms as well.

"Well, from what you said, I think it's the disease. But medicine is a rigorous discipline, and there must be some solid inspection evidence to diagnose the drug."

Director Yin was amazed at Zhou Can's strength.

He found that Zhou Can's progress was very fast, and every once in a while, his strength in all aspects would improve significantly.

"Isn't it easy to check the basis? Take a specimen for a PPD test! Then you can ask the patient to have a head CT or MRI! The most common target of tuberculosis is the viscera in the chest and abdomen, but it doesn't mean If there is no problem found in the X-ray chest film, it can be considered that there is no infection in the head, right?"

Zhou Can said with a smile.

"It makes sense. I will apply for an examination now, and give the patient a tuberculin pure protein derivative test. It won't be too late after the results of head CT and other biological tests come out."

Director Yin readily accepted Zhou Can's suggestion.

Older doctors usually like to say the full name or shortened Chinese name of a certain examination, while young doctors are lazy if they can, and like to say some English abbreviations.

The PPD test is the gold standard for detecting tuberculous meningitis.

Director Yin did not start the head CT for the patient because of the economical consideration of the patient.A doctor with medical ethics will prescribe every examination for a patient after careful consideration, and only prescribe it when he feels it is necessary.

Only some doctors who have no medical ethics and only want to make money and complete the tasks of the department will deliberately prescribe more examinations for patients.

As long as they can withstand the inspection from above, they can't wait to check all the patients.

On the one hand, you can earn performance commissions. On the other hand, doing more checks can provide more diagnostic basis and reduce the probability of misdiagnosis and missed diagnosis.The benefits are all obtained by the doctor, and the patient suffers more and pays a lot of unnecessary examination fees.

It can only be said that such a doctor lacks the most basic human sympathy and is too selfish.

It is already very unfortunate for patients to be ill.

When they arrive at the hospital, they will be used as a tool to make money by the doctors, and they will be slaughtered several times.

As the medical supervision system becomes more and more sound, a medical ethics scoring system should be established in the future.For those doctors who fail the grades or have a black history, they will be banned for life.

Wait until Director Yin finished the inspection application excitedly.

Zhou Can took a sip of water, looked at the other party and said, "Director Yin, I helped you overcome the difficult case in your department. Should you also help me and provide some reference for the case of high paraplegia?"

Zhou Can dare to say that only if he is very familiar with Director Yin and has a good relationship.

He usually respects his elders and seniors when he speaks.

There is a saying that the closer the relationship is, the more casual you get along with it.

"Haha, you don't suffer at all, boy. I went to the ward to check the condition of the little boy just now, and if there is any major discovery, I think that the cause of the sick child is very serious based on years of clinical neurology experience. It could be in the head. Or it could be a combination."

With the help of Zhou Can, Director Yin made a major breakthrough in the diagnosis of the etiology of this female patient who had been troubled for many days, and she was in a good mood.

He laughed and talked about the cause of the little boy with high paraplegia.

"Does this kind of high paraplegia have a compound etiology? Today is an increase in knowledge."

Zhou Can only heard of mixed hemorrhoids, never heard of paralysis and compound etiology.

Internal hemorrhoids and external hemorrhoids occur simultaneously, which is called mixed hemorrhoids clinically.

High paraplegia, could it be that there are problems in multiple parts of the nervous system?

"Have you never heard of it? There are still many things you haven't heard of. In the future, no matter if you are free or not, come to my place more often, you know?"

Director Yin invited with a smile.

He just likes a good seed like Zhou Can, and he often comes to his office to chat.

Cooking wine to discuss swords, brewing tea to discuss morality, this is something that many heroes like.

"All right, all right, I will come over more often to ask you for advice in the future."

Zhou Can readily agreed.

　The old book strives to be completed next month, and it will not be unfinished, otherwise I will be sorry for the support of tens of thousands of paying readers.Readers who like medical literature, you can take a look at Brother Jiang's new book, it will be great if it suits your appetite, and I can get your continued support.It doesn't matter if it doesn't suit your taste, we look forward to the next fate, at least you have been with us and met you.Thank you, thank you readers for your silent support all the time, and I bow deeply.

　　
　
(End of this chapter)