The genius doctor starts from the game

Chapter 166 Teaching rounds and hiding!
The next day, Lu Cheng came to the department early, but Professor Huang Yu and the others hadn't arrived yet.But several interns have arrived.

Lu Chengcheng asked: "How is it? How did you read yesterday?"

Several people nodded and glanced at each other, not daring to speak.Lu Cheng pointed out the way of thinking for him, reading the book, not to mention how enjoyable it is.

Then hurry up early today to get acquainted with the patient.

After a while, Professor Huang Yu came. Seeing Lu Cheng mingling with several interns, he couldn't help asking curiously, "Students, what are your names?"

Qin An and Zhou Xiaosheng hurriedly introduced themselves, and then stood in front of Huang Yu in a dignified manner.

This is one of the few times Huang Yu saw the interns being so active, so he looked at Lu Cheng and said, "Xiao Lu, there are not many surgery arrangements for our surgery day tomorrow, right? If there are not many, we will conduct another teaching survey today." house?"

Lu Cheng's eyes lit up when he heard this, and he said with a smile: "Professor Huang's arrangement, these students are really blessed."

The teaching rounds that were conducted just two days ago came again today. Even the internal medicine department did not dare to be so diligent.

Huang Yu said: "Then it's settled, let's make it official today."

Lu Cheng was stunned, the formal teaching rounds, that is, after the bed doctor expresses his opinion, then the interns, the trainees, and then the attending physician, associate professor and professor, correct them one by one. Students see clearly the differences in thinking of doctors at each level.

It took a lot of time, but seeing that Huang Yu really wanted to do it, Lu Cheng could only smile and say yes.He is the director, so of course he has to follow his arrangements.

……

The class was over quickly, Huang Yu didn't delay, and Professor Xu immediately started his own rounds and went to surgery.

So Professor Huang just told everyone that there will be teaching rounds, Professor Huang Yu took the lead, then Associate Professor Zhou Ren and Qin Qiguo followed closely, Lu Cheng and Zheng Liu followed,

Then there are the three graduate students of orthopedics, Xu Diqing, Lin Ruiqi, and Xia Qing. Xu Diqing is Lin Ruiqi's senior brother, also from the second department of orthopedics, but Xia Qing is not the same advisor.

The bed doctors include Huang Yawei, who came over from the general surgery department, and Chen Nuo, who came from the spine department.

There is also a trainee doctor, Jiangzhou, who comes from Hengshi in Hunan Province.

Coupled with a few interns, it can be described as a huge scale.

A group of people walked to bed 1, and everyone lined up in a U shape. Huang Yu, Zhou Ren, and Qin Qiguo stood on the left side of the patient, and Xia Qing should stand on the right side.

Before Professor Huang and the others even started to speak, Xia Qing took the initiative to stand opposite Professor Huang and the others.

He said proactively: "Professor Huang, this is a patient who has suffered from left knee joint pain for 6 years and aggravated it with walking impairment for 6 months."

"A middle-aged woman took Erecoxib for analgesia before being admitted to the hospital. At first, it had a certain effect, but in the past 6 months, the symptoms have gradually worsened. Especially when going up and down stairs, the pain will be more obvious. It has been completed so far. The X-ray of the left knee joint was taken in the standing position and the lateral position."

"In terms of physical examination, there is no tenderness in the left knee joint, the range of motion is acceptable, and there is no obvious limitation."

"Diagnostic considerations on admission were patellar elevation and knee osteoarthritis."

"The film is here."

These medical histories and physical examinations were all prepared by Xia Qing in advance, and he did it by himself. The time was mainly too late. He returned to the dormitory after the operation yesterday.

However, because there were too many things to remember, he only remembered the general idea, and the most important thing was to remember the main complaint and diagnosis.

Sure enough, Xia Qing's homework still made Professor Huang's eyes light up slightly.

"It seems that Xia Qing did his homework in advance. If that's the case, you can read the film for us first." Professor Huang first praised, and then directly gave the X film to Xia Qing's hands .

Xia Qing froze on the spot, what's going on?

Although I heard that Professor Huang likes to ask questions, but there is no need to do it, right?
In fact, this was Xia Qing's misunderstanding, and it was also Professor Huang's misunderstanding. Professor Huang thought that Xia Qing had done a lot of homework before, so he directly called him to review the films.

But Professor Huang didn't know that Xia Qing was actually familiar with the medical records in advance.

Xia Qing's tutor specializes in bone tumors, and his first rotating department is bone tumors. If you ask him to look at the location and shape of bone tumors, Xia Qing thinks he still has some skills.

But look at the high patella in joint surgery?

But I have already pretended, and I have to finish it with tears in my eyes.

Xia Qing took the film and said: "Professor Huang, we can see from the lateral view of this film that the patient's joint space is narrow and there are a lot of uneven bones, which is consistent with the symptoms of knee osteoarthritis. diagnosis."

"Moreover, we can see that there is a large gap between the tibial plateau and the patella in front of the knee joint, which is different from the X-ray of the knee joint of normal people."

"If the gap is narrow, it is a low patella. If it is widened, it is a diagnosis of a high patella."

Medicine is the least pretentious department. Sometimes it is clear and revealed in a sentence or two.

Even the very unprofessional word "Gap" came out, and Professor Huang probably had an understanding of Xia Qing's level in his heart.

I am still an undergraduate student, similar to Fan Cheng and the others. Common diseases such as osteoarthritis are not bad, but it is still a lot worse when it comes to very professional and in-depth aspects.

However, we can't expect everyone to be an experienced person like Xia Yuan, and we can't ask everyone to be an evildoer like Lu Cheng.

Professor Huang still nodded, and praised Xia Qing: "Xia Qing's ability to do homework in advance is worth learning from."

"Several interns, after listening to what your brother Xia Qing said, do you have any opinions of your own?"

"Zhou Xiaosheng, let me tell you."

Professor Huang gave the opportunity directly to Zhou Xiaosheng who was closest to him.

Zhou Xiaosheng's expression flustered a little, as if he was not used to Professor Huang's directness. After all, the departments he practiced before rarely took the initiative to lead them to teach rounds.

Huang Yu's straightforwardness made him a little surprised, but Zhou Xiaosheng still took the film and watched it carefully for more than 20 seconds.

He said: "Professor Huang, from the front view of this film, we can see that both the inner and outer spaces of the joint are narrow, and the inner space is more narrow, so there may be a diagnosis of varus knee."

"In addition, Brother Xia just said that the diagnosis of osteoarthritis, according to the X-ray standard, should belong to the third stage of arthritis."

"Then we look at the lateral view, because of the intercondylar eminence of the tibia, it's not easy for us to see the narrowing of the joint space here."

"So let's look at the patella again. According to the Insall-Salvati measurement method, that is, if the length of the patellar tendon is greater than the length of the longest diagonal of the patella, it should be at least greater than 1.2, so it is more in line with the diagnosis of a high patella."

"In addition, we consider the patient's pain symptoms, which are more obvious. If we look at the lower edge of the patella, we can actually see the surface of the patella, which is not very flat, so there is damage to the patella cartilage. This cannot be seen on the X-ray. For evaluation, it can only be evaluated intraoperatively or on MRI."

As soon as Zhou Xiaosheng finished speaking, Xia Qing's eyes widened.

You fucking snakeskin.

Are you really an intern and not a PhD student in orthopedics?Was Professor Huang specially invited to mess with me?
Before he knew it, Xia Qing took a few steps back, trying to hide himself.

Whether there is skill or not, one word can still be heard, Professor Huang's face immediately smiled, just this week Xiaosheng, his professional skills are stronger than ordinary graduate students, which makes people's eyes shine.

But you can't favor one over another, Professor Huang asked Luo Weihua again, "Luo Weihua, do you have any special views on this case?"

Having said that, Luo Weihua took a special look at Zhou Xiaosheng, quite admiring and regretful, if Professor Huang called him first, he would be able to answer it, but it is obviously a bit difficult for him to go deeper.

Then he looked at Qin An, and found that Luo Weihua's eyes were not focused on Zhou Xiaosheng who was showing off.

Luo Weihua was interested in Qin An, but Qin An didn't seem to see Zhou Xiaosheng's eyes.

Professor Huang saw it in his eyes, but he didn't say anything clearly. He turned to look at Luo Weihua.

Luo Weihua then said again: "Professor Huang, Zhou Xiaosheng has already finished talking. I can't see anything else on this film. However, high patellas usually have patella tenderness and fear signs (+), I think this If the patient has a physical examination, he should have it."

Professor Huang said directly: "Since you said so, then you can do it for us."

Professor Huang is taking the school exam. Sometimes, being able to say it and being able to do it are not the same thing.

I saw Luo Weihua walked to the patient's bed, first pulled up the curtains, and then said: "Hello, Auntie, I'm going to give you a physical examination now, can I trouble you to lie down?"

"Oh, okay." The middle-aged aunt lay down suspiciously, thinking in her heart, this doctor is so young, he looks like an intern, can he do it?
However, these behaviors are details in the eyes of Professor Huang and others, and Luo Weihua is very good at protecting the privacy of patients.

"Auntie, don't use too much force on your legs. My arm can't twist your thigh. I may have a little pain during the inspection. If it hurts, just tell me, and I won't do it." , is it okay?" Luo Weihua explained while preparing his hands.

"Okay, okay. I'll tell you when I feel pain." The middle-aged aunt said quickly, fearing that the intern would hurt herself.

Before the aunt could finish speaking, Luo Weihua's left hand had already pressed to the front of her patella, and the other hand grabbed his tibia.

After a little effort, my aunt cried out: "It hurts, it hurts a little."

"Okay." Luo Weihua immediately relaxed.

Luo Weihua then began to push the patella laterally.

I saw that before I started to push it far, I saw the aunt immediately said: "Ouch, ouch."

Then she got up straight up, making gestures with both hands to grab Luo Weihua's hand, but before she caught it, Luo Weihua let go of her hand and said, "Auntie, does it hurt? I've already done it."

"No, it's not painful, but I'm scared." Auntie looked like she had seen a ghost.

It's not that I'm afraid of pain, it's just that there is a feeling that my patella may be pushed away from myself.

Only then did Luo Weihua reply: "Professor Huang, the patient's patellar tenderness and fear signs are both positive. Therefore, it is in line with the diagnosis of high patella."

Professor Huang nodded appreciatively. This dark-skinned Luo Weihua had a fairly standard physical examination. It can be seen that he really knows how to do it.

Professor Huang praised: "Student Luo Weihua did a good physical examination, he must have practiced before."

Luo Weihua was a little embarrassed, but just nodded.

So Huang Yu looked at the last girl, Qin An, who he thought was least interested in orthopedics and surgery.

Qin An seemed to know that he couldn't escape, so he said: "Professor Huang, the patient's Q angle is greater than 15°, and the knee joint must be unstable, so if only the soft tissue reconstruction of the high patella is done, the treatment may not be achieved. Purpose."

"For a patient like this, what would our orthopedic department usually do?"

Asking this question directly surprised everyone present.

Qin An looked thin and weak, but he spoke and asked questions in such a calm manner that directly made Professor Huang's eyes shine.

Instead of answering, he asked, "Student Qin An, what ideas and suggestions do you have?"

"First of all, the patient's diagnosis is in line with stage 3 changes of knee arthritis, with obvious symptoms and indications for joint replacement. I think it is possible to perform a patella surface replacement and soft tissue reconstruction during the joint replacement, such as Judet surgery. .”

Qin An really answered.

This surprised Professor Huang,

Judet surgery, the full name is Judet quadriceps plastic surgery, this is a very professional term, not to mention postgraduates, even orthopedic surgeons who do not engage in joint surgery, not many know this professional term.

Now, Professor Huang turned his head directly to Zhou Ren. This patient was admitted by Zhou Ren.

"Professor Zhou, what did you think about Qin An's proposal just now? You are the chief surgeon of the patient."

Zhou Ren glanced at Qin An, he never thought that Qin An would give out all the treatment opinions other than the diagnosis.

And it is similar to Professor Huang's suggestion,
However, as the chief surgeon, he already had his own thoughts in mind, and said, "Professor Huang, I still reserve my own opinion. I prefer to shorten the patellar tendon and reconstruct it with arthroscopic cleaning. It would be more appropriate."

Zhou Ren didn't give his own explanation directly, because he had already explained to Professor Huang that Professor Huang is the central point of the current teaching rounds, and everything should follow his arrangement.

But obviously, even if Professor Huang is on Qin An's side, he will still reserve his opinion.Unless Professor Huang wants to take over the patient himself.

There were differences in the treatment plan.

In fact, Professor Huang really wanted to stand by Qin An's side, so he said: "In comparison, I agree with Qin An's suggestion, but Professor Zhou has his own ideas, and we can focus on discussing them in the afternoon. "

"Qin Qiguo, what do you think?"

Qin Qiguo didn't speak, it was because Professor Huang and Professor Zhou had different treatment opinions, each had their own reasons, they were colleagues, not students, so of course they didn't intervene.

Only graduate students like Xia Qing, Chen Nuo, and the others could say a few more words.

Seeing Professor Huang looking at him again, Xia Qing hurriedly said, "Professor Huang, I don't know, I don't even know what the Judet technique is."

Wasn't the embarrassment he lost before not big enough?
The opinion on film reading and physical examination that I said, are those all opinions on film reading and physical examination?
That's just bullshit, no,
Fart is not.

This shit is really an intern?
If it weren't for looking at their badges, Xia Qing would have felt the urge to explode on the spot, because in this way, his previous efforts seemed a little in vain.

In this way, Professor Huang was the only one left to ask questions.

Zhang Yawei is not a graduate student in orthopedics, so asking them seems to be using them as a foreshadowing.

And Chen Nuoben was taciturn. When he looked at him, there was a little panic on his face, and he probably couldn't speak.
"Xiao Lu, do you have your own opinion?"

Lu Cheng narrowed his eyes, and then said: "Professor Huang, I may agree with Associate Professor Zhou Ren's opinion more."

Professor Huang's eyes flickered slightly,
The voice didn't change much and continued to chase: "Tell me your opinion?"

(End of this chapter)