Jiang Dong'er was so painful that she was about to fall to the ground.

Seeing this, Xu Qiu hurriedly went to support him.

Shi Lian also came to help, and the two of them moved Jiang Dong'er to the examination bed half-held and half-carried.

Jiang Donger said word by word: "I can't say where it hurts, but I feel uncomfortable, my legs are weak when I walk, and I can't breathe..."

After hearing this description, several diagnoses emerged in Xu Qiu's mind.

He reminded: "I want to do an auscultation."

Jiang Dong'er closed her eyes: "Yeah, come on!"

Just as she was about to lift her top, Xu Qiu held her hand down.

Opened in surprise, she saw Xu Qiu pressing the stethoscope directly on her chest.

Although the diagnosis may be affected by frictional sounds through the clothes and delayed the condition, it is not a big problem for Xu Qiu.

"There is no problem with the heart..."

"The lung breathing sounds, etc. are also normal, and there is no specific manifestation..."

The presence of damp rales or wheezing in the lungs can indicate sputum, infection, etc., but Jiang Donger does not even have these basic abnormalities, which sounds normal.

"Although tuberculosis cannot be judged by auscultation, the more serious infection of Mycobacterium tuberculosis can generally cause lung inflammation and bronchial stenosis, which will trigger two different breathing sounds, but it is not heard in Jiang Donger...

…” Xu Qiu shook his head slightly, the chance of tuberculosis should not be high.

Of course, this was not confirmed by his auscultation.

In fact, the auscultation of tuberculosis does not have many characteristics, and the same pathological respiratory sounds can also exist in many other lung diseases.

What made Xu Qiu make a judgment was Jiang Donger's performance and his current general pain.

This is a condition that tuberculosis will never occur.

"Pick up some clothes, don't need to be too much, just be below your chest." Xu Qiu said.

Jiang Dong'er grinned in pain. With Shi Lian's help, she rolled up her clothes and was pulling her under her chest.

Xu Qiu ignored the lace edges close to her body, observed the patient's abdomen's skin, blood vessels and movements, and pressed alternately.

There is no tenderness or rebound pain in the area...

Afterwards, another nervous system examination was found, and meningeal irritation was not found.

The question also ruled out abnormal symptoms of hematuria and various urogenital system.

"It seems that it is basically impossible to have tuberculosis." Xu Qiu shook his head.

Many people with extrapulmonary tuberculosis have symptoms of involvement, such as headaches in the nervous system, meningeal irritation; alternating diarrhea in the digestive system, local tenderness; local hematuria in the urogenital system, urinary tract infection manifestations, etc.

But Jiang Dong'er didn't have any.

The possibility of mycobacterium tuberculosis in a single lung is too small.

"The whole body hurts, unknown parts and unknown causes?" Xu Qiu thought.

He also focused on checking his waist, lower limbs, etc.

However, there was no obvious tenderness or poking pain in the waist. The straight leg elevation test of both lower limbs was negative, while the experiment of left lower limb 4 showed weak positive.

The straight leg elevation experiment examines lumbar disc herniation and sciatic nerve lesions. The method is very simple. The patient is kept on his back, and his lower limbs are completely straightened and then closed together. The doctor holds the patient's ankle with one hand and holds the knee with the other hand.

Keep the lower limbs completely straight and gradually raise the affected limbs...

Normal people can raise their limbs to 70 to 90 degrees. As long as they are less than this range, it means that the patient has lesions of the intervertebral disc or sciatic nerve.

But, obviously, Jiang Dong'er has no problem.

As for the 4-character experiment, it is a 4-character examination method that overlaps the legs to form a 4-character shape, and the lesions of the sacroiliac joint are observed.

The patient has mild sacroiliac joint pain, but weak positive does not mean too much.

In addition, Jiang Donger's hip flexion and knee flexion experiment was negative, the patella friction test and drawer test were negative...

It seems that the problem is not in the lower limbs?

He tried to do other parts of the upper limbs, and in the end Xu Qiu turned his attention back to his lower limbs.

Judging from the results of the physical examination, the patient has pain everywhere, but it does not constitute any pathological manifestations.

It hurts everywhere, but it doesn’t mean there are illnesses everywhere.

For example, in the straight leg elevation experiment, it is considered positive only when the pain of elevation is exacerbated.

But Jiang Donger's condition is always painful and cannot be regarded as a straight leg lift experiment...

Similarly, other experiments are the same, and it is impossible to induce a meaningful positive sign from Jiang Dong'er.

Finally, Xu Qiu's eyes returned to his lower limbs.

According to the patient's description, her lower limb pain was even more obvious and she could hardly walk.

At the same time, the only 4-word experiment that seems to be abnormal is also the left lower limb, gave a weak positive indicator.

This situation...overworked?

Many people who have no history of trauma but are overworked in the short term will also experience this kind of pain. The solution is very clear. Just do individual femoral nerve block, or do lateral dural space injection or interposterior lumbar groove injection, which should be able to do.

ease.

Or is obstructive nerve block?

If this is the case, massage and relieve the adductor femoral muscle, gluteus medius, gluteus minimus, etc., and then targeted physical therapy drugs.

It may also be vascular lesions such as vasculitis.

In this case, the disease and symptoms that range from lung disease to pain, and then jump to blood vessels, and span three systems may not have a good result.

Judging from Xu Qiu's experience, Jiang Donger's behavior is more like bone pain than other system diseases such as vasculitis!

After thinking about it, he made a further decision:

"Take a flat pelvic film and lumbar spine CT, and focus on the L4-5 intervertebral disc."

"In addition, do a bronchoscope and take a biopsy."

The former is to check for sudden pain in the patient.

The latter targets the clump shadows in the upper lobe of the right lung to further confirm whether it is tuberculosis or other diseases.

Ordinary sampling may not find tuberculosis lesions in the lungs, but if you do a bronchoscopy, you will almost never make any mistakes. Mycobacterium tuberculosis can be detected.

If not, it can be directly excluded.

Of course, bronchoscopes will perform a matching biopsy, and what is the component of the clump shadow at that time? There is no way to hide under the biopsy.

"Bronchioscopy..."

On the examination bed, Jiang Dong'er's face suddenly turned pale when she heard this examination.

Xu Qiu noticed something was wrong and asked, "What's wrong? Have you done it before?"

Traditional bronchoscopy is inserted into the bronchoscopy through the mouth or nasal cavity, which can easily cause irritating choking, nausea, vomiting, pain and other discomforts. Patients who have done it once will almost leave a psychological shadow.

However, major hospitals now have popularized painless examinations, and tracheal catheters are used to make endoscopic techniques, and even under anesthesia. The pain level is almost negligible.

But Jiang Dong'er shook her head desperately.

She trembled and said, "I heard that having a bronchoscopy will kill people. There is a hospital in Hunan Province who died in three months and had a bronchoscopy..."

——
Chapter completed!