Chapter 614: Starting from the course of the disease, come and sit with me more often when you have time.

Author: Jiangbian Yuweng

Chapter 614: Starting from the course of the disease, come and sit with me more often when you have time.

Sometimes he always likes to bring a bit of black humor and tell some cold jokes.

And he is very sincere in his treatment of others.

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

All older doctors have experienced being bitten by a poisonous snake because of their kindness at work.

"If you're not running away, then what did you do? Go to the inpatient ward to molest the nurse?"

Director Yin asked after hearing this.

"Hey, don't say this nonsense. If my girlfriend hears it, I will be forced 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 had gone to the ward to check on the patient, Director Yin's face suddenly showed a smile.

"Hoho! I underestimated you. Is there any diagnostic breakthrough?"

He is most concerned about the diagnosis and treatment of patients.

I immediately asked if there was any breakthrough in diagnosis.

His eyes were full of expectation, because Zhou Can was able to make a breakthrough every time he made a move, and he almost never let him down.

"There are some small findings. Let me consider it carefully based on the patient's test results, and then provide some reference opinions."

After saying that, Zhou Can actually picked up the patient's information and began to study it carefully.

This is already the second time of research.

Sometimes doctors diagnose diseases like this. They need to repeatedly review the patient's examination report, cause of disease, and medical history, and only after confirming that they are correct can they draw a conclusion.

Walking on thin ice and being cautious is the norm for doctors when diagnosing diseases.

Director Yin did not bother him, smiled and silently gave him a cup of tea, and then studied the case of high paraplegia.

They are both really interesting.

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

Clinically, this can be called consultation.

Brainstorming is a common method used by doctors to deal with difficult cases. After all, a person's wisdom and strength are limited. Each doctor's diagnostic ideas are different and the findings will be different.

Just like a blind man feeling an elephant, different diagnostic thinking will lead to different ways of discovering the cause of the disease.

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

After nearly twenty minutes, Zhou Can seemed to have come to a conclusion.

He raised his head and looked at Director Yin.

"You say it, I'll listen!"

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

"Although the course of this female patient's disease is very long, after I inquired about it, I thought that she had an acute onset of illness. It was because of an accidental cold, and then she started to have a headache, which has lasted to this day. The characteristics of this disease are that it has an acute onset and a long course.

, the condition progressed relatively slowly. I just entered the ward to examine her and found that her optic disc was edematous, she had head pulling pain when turning her right eye, and she had an obvious gag reflex when swallowing..."

"Her white blood cell count was high, ESR was fast, and the number of cerebrospinal fluid cells was elevated, with mainly mononuclear cells. The cerebrospinal fluid protein was also significantly elevated, and the sugar was reduced, but the chloride was normal. No acid-fast bacilli were detected in the cerebrospinal fluid.

Cryptococcus neoformans, etc. The X-ray 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 fever when she was admitted, my diagnostic conclusion is that acute infection is more likely.

"

After Zhou Can described the patient's comprehensive situation, he made a summary.

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

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

"Let me first talk about several suspected diseases, and then we will discuss them one by one. The first one is cryptococcal meningitis. This disease mostly occurs in young adults. The patient is in his thirties this year and is in young adulthood. This disease There are two types of onset, subacute and chronic, which are very consistent with the patient's acute onset. The disease is accompanied by moderate or mild fever, which is also consistent with the patient's condition. This disease also causes headache, vomiting, blurred vision, and complex symptoms. Nuchal rigidity and meningeal irritation are highly consistent with the patient’s symptoms.”

"Furthermore, as the disease progresses, consciousness disorders will occur, and a few 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 first started with the patient's symptoms and found a disease that was highly consistent with his symptoms.

"However, although the sugar content of the patient's cerebrospinal fluid was significantly reduced, the chloride did not change, and the ink stain did not find Cryptococcus or Cryptococcus neoformans, so the disease cannot be diagnosed. The cerebrospinal fluid can be taken multiple times and sent to the laboratory to repeatedly search for cryptococci. "

Every disease has a gold standard for diagnosis.

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

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

Therefore, doctors are extremely cautious when diagnosing the cause of the disease. Unless they find a gold standard, they will not make a conclusion easily.

"I have also suspected this disease. I have taken cerebrospinal fluid for examination for many days in a row, and the results have not found cryptococcus."

Director Yin sighed.

If this disease was so easy to diagnose, there would be no need to ask Zhou Can for help.

"This matter is indeed very strange. It may be a disease with symptoms similar to cryptococcal meningitis. The second disease I suspect is tuberculous meningitis. The onset of this disease is insidious, the course is long, and the symptoms It can range from mild to severe. The condition may have a history of tuberculosis infection in other parts of the body. In the prodromal stage, there are symptoms such as low-grade fever, night sweats, loss of appetite, mild headache, malaise, and fatigue."

"As the disease progresses, headaches worsen with vomiting, neck stiffness, Kernig's sign, and Brudzinski's sign are all positive. There may also be eyelid ptosis, pupil anomalies, and extraocular muscle paralysis due to meningeal adhesion. Diplopia, facial paralysis and other symptoms. Under normal circumstances, after suffering from this disease, the tendon reflexes can be hyperactive and the pathological reflexes are positive. However, if the spinal nerve is damaged, the tendon reflexes may disappear."

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

Zhou Can revealed the suspected second disease.

"This female patient seems to have progressed to the second stage of the disease. However, there are also 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 X-ray chest X-ray found no abnormalities. .The cerebrospinal fluid test showed an increase in protein and a decrease in sugar, but there was no significant change in chloride."

First he suspected the disease, and then he gave some arguments that did not support the disease.

Diagnoses are sometimes so contradictory.

It is necessary to clear the clouds and see the light through repeated inferences.

"Tuberculous meningitis has been basically ruled out after consultation within our department. However, you just mentioned Kernig's sign and Brudzinski's sign is positive. These are some new findings."

Director Yin had some thoughts after listening.

"How should I put it? Although this disease is the least suspicious, I think on the contrary, I think it is very likely to be this disease. The symptoms of this female patient are relatively classic, and there are many diseases that can match it. Therefore, I think it is necessary to

We should start from the symptoms, but we cannot rely entirely on the symptoms. At the same time, we should also consider the progression of the disease and whether the patient has a medical history to make a comprehensive diagnosis."

Zhou Can never looks at the symptoms when diagnosing a disease. He prefers to peel off the cocoons and point directly to the disease itself.

Maybe it's a diagnostic gift.

When diagnosing various difficult cases, he can identify one of the many doubtful points that is the most hidden or least likely to be taken seriously by other doctors, and then pursue it in depth, eliminate interference, and finally identify the cause of the disease.

"interesting."

After hearing this, Director Yin Hua's eyes shone slightly.

"Diagnosis based on the progression of the disease is something I and other doctors really didn't think of."

"Actually, I just thought of some other suspicious diseases, but they were all ruled out in the end. For example, purulent meningitis, viral meningitis, etc."

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

Clinically, what doctors dislike most are tuberculosis-related diseases.

Tuberculosis is easily contagious, is extremely stubborn, has an extremely long course, and takes a very long time to cure.

Many patients and their family members do not understand medicine. After taking medicine and injections for a period of time, they find that their condition does not seem to improve, and they begin to doubt the doctor's diagnosis and treatment plan. They are unwilling to cooperate with the treatment.

This will result in wasted effort.

In the end, the doctor could only watch the patient fall into the abyss. After it was over, the family members and patients would collectively accuse the doctor of being a quack who couldn't even cure a disease.

"Tell me the basis for your conclusion that the patient has tuberculous meningitis."

There was a hint of cunning deep in Director Yin Hua's 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, which are similar to the symptoms of the second stage of tuberculous meningitis. In addition, the patient's optic disc was edematous and his right extraocular muscles were paralyzed.

, meningeal irritation sign +, pathological signs are positive, ESH increases rapidly, and neutrophils are high. These evidences are sufficient to highly suspect tuberculous meningitis."

Zhou Can mainly suspected that the patient had this disease, and it was not just determined based on the progression of the disease being similar to this disease.

There are many other symptoms that are also consistent.

"Well, after you said that, I thought it was this disease. However, medicine is a rigorous subject, and some solid examination evidence is needed to confirm the diagnosis and medication."

Director Yin was amazed at Zhou Can's strength.

He found that Zhou Can's progress was extremely fast, and every once in a while, his strength in all aspects would be greatly improved.

"Isn't it easy to find the basis for the examination? Take the specimen and do the PPD test! Then you can also ask the patient to do a head CT or MRI! The most common target of tuberculosis is the organs in the chest and abdominal cavity, but it does not mean that

If no problem is found on the chest X-ray, we can assume that there is no infection in the head, right?"

Zhou Can said with a smile.

"That makes sense. I will apply for a test now and give the patient a tuberculin pure protein derivative test. It won't be too late after the results of biological tests such as head CT come out."
To be continued...