"Oh, myasthenia gravis, and does the patient have typical symptoms of morning and twilight?" Wu Mian asked lazily while lying on a bamboo chair.

"......" Daoist Lin stopped speaking for a moment.

How did I forget that the typical characteristics of myasthenia gravis are light in the morning and heavy in the evening! Now it's over, and I was grabbed by my little uncle's pigtails.

Seeing that Daoist Lin didn't speak, Wu Mian guessed something, beckoned, and said, "Is there a case, I'll take a look." ”

"Uncle Xiao, the medical record is here, it's an outpatient medical record, and it's very simple to write. Lin Daoshi handed the medical records to Wu Mian and explained, "The patient's family said that he had difficulty swallowing, drooling, and progressively worsened one week ago. ”

Wu Mian flipped through the medical records casually, glanced at them twice, and handed them to Chu Zhixi.

"Awesome Lao Lin!" Wu Mian said with a smile, "Just a difficulty swallowing and drooling can diagnose myasthenia gravis." ”

"Little uncle......" Daoist Lin smiled wryly.

I knew that I would be told by Uncle Xiao, but there was no good way, who couldn't memorize "Diagnostics".

"Tell me what the diagnostic criteria for myasthenia gravis are. Wu Mian asked.

Daoist Lin felt so embarrassed, it was really too troublesome to talk to Uncle Xiao. At every turn, I ask myself about the diagnostic criteria, and I don't know.

I haven't finished reading that book yet, have I've not. And...... I guess I won't be able to finish it in my life.

"First, patients will have droopy eyelids, blurred vision, diplopia, strabismus, and inflexible eye movement. ”

"Second, the patient has an indifferent expression, a wry smile, a large tongue, and dysarthria, often accompanied by a nasal voice. ”

"Third ......"

Wu Mian lay on the bamboo chair and told Daoist Lin about myasthenia gravis in one, two, three, four or five. Not to mention, according to Wu Mian, Liu Yiyi can't be diagnosed with myasthenia gravis at all.

There is little resemblance except for difficulty swallowing, drooling, and weakness in the limbs. But recalling Liu Yiyi's state of weakness all over his body, Lin Daoshi always felt that it must be caused by myasthenia gravis.

Could it be that there was a mistake in the diagnosis book? Daoist Lin had such an idea in his mind, which startled him.

"Brother, the patient has drooping eyelids on both sides, eye movement is not affected, bilateral nasolabial folds are shallow, the active opening amplitude is limited by about 1 cm, and the pain and temperature sensation on both sides of the face are symmetrical; the muscles of the shoulder, neck, back and limbs are weak, and he cannot turn his neck and shrug his shoulders, cannot maintain a sitting position, cannot raise his hands, and cannot stand; and the rest of the neurological examinations have found no obvious abnormalities. ”

"It looks like myasthenia gravis, and Lin Daochang is not clearly diagnosed, which is also understandable. Chu Zhixi said.

"Huh. Wu Mian smiled and raised his eyes to look at Daoist Lin.

Daoist Lin was grateful, but the little master was still considerate and helped him speak.

"The neostigmine test was positive, and the local hospital diagnosis was also myasthenia gravis. Chu Zhixi said, "But I don't think it's like it, but how did it come?"

"Little Master, why don't you look like it?" Daoist Lin didn't dare to talk to Wu Mian, licking his face and asking Chu Zhixi.

"Patients with myasthenia gravis have a positive neostigmine test, but a positive neostigmine test does not necessarily mean myasthenia gravis. Chu Zhixi frowned and said, "It is a bit hasty to diagnose it according to a new si's test. More tests are needed, but they are only outpatient medical records, which I think is caused by the lack of cooperation of the patient and the patient's family. ”

"But the patient's general weakness is evidenced by a positive neostigmine test. Lin Daoist argued.

"The patient has an acute onset and progresses to the whole body relatively quickly within 1 week, which is not in line with myasthenia gravis, which is a subacute or chronic autoimmune disease. Chu Zhixi said.

"......" Daoist Lin looked confused.

As a medical student who graduated from a bachelor's degree, after clinical clerkship and internship, Lin Daoshi still has a certain medical foundation.

But after all, it was nearly twenty years ago, and it was already very good to remember the diagnosis of myasthenia gravis, and all the details that Chu Zhixi said, Daoist Lin couldn't think of it at all.

"Second, weakness in the throat muscles is the first symptom, and most myasthenia gravis is the first symptom of extraocular muscle involvement. ”

"The most important thing is that my brother said that the morning is light and the twilight is heavy. Chu Zhixi continued, "The patient's myasthenia symptoms did not improve significantly after rest, while myasthenia gravis fluctuated, accompanied by the characteristics of mild morning and twilight heaviness. ”

"None of these, only a positive neostigmine test, which I don't think is rigorous. ”

"Little Master, then what are you considering?" Lin Daoist felt a little empty in his heart, if it was myasthenia gravis, it would be good to say, but Uncle Xiao and Little Master Niang said one, two, three, four, five, this is the possibility of Gu Man Tong's trouble.

As he spoke, he involuntarily raised his head, glanced at the stone tablet in the back mountain, and was slightly settled in his heart.

"Lao Lin, did you ask about your medical history, but you didn't say some things?" Wu Mian saw the change in Daoist Lin's expression and knew that there was something wrong, so he asked.

"Uh...... Uncle Xiao, the patient's family said that they traveled to Thailand a few months ago and invited Kuman Thong. Daoist Lin whispered, trying not to frighten Chu Zhixi.

"Don't talk nonsense, they can also invite Gu Man Tong? Raising Gu Man Tong is not just a casual raiser, there are many rules. Wu Mian said, "Do the patient's families think that this is all Kuman Tong's rebellion?"

"Well, Uncle Xiao Ming. Daoist Lin saw that Wu Mian didn't care, and Chu Zhixi also had a flat face after hearing it, so he gradually felt relieved.

"Uncle Junior, what kind of problem do you say? This is too strange, could it be a person with gradual freezing?" asked Daoist Lin.

But as soon as this sentence was asked, Daoist Lin already regretted it.

In the next sentence, will Uncle Xiao ask himself about the diagnostic criteria for ALS? Not to mention the diagnostic criteria, ALS is just a common name, and he can't tell what the scientific name of the diagnosis is.

What atrophy or something like that.

Forget it, let's talk less.

But Daoist Lin guessed wrong, Wu Mian did not ask about the diagnostic criteria for ALS. He stood up and said, "Old Lin, Dao robe." ”

"Uncle Xiao, are you going to see a patient?"

"Take a look. Wu Mian smiled, "Girl, you are in the back mountain, don't follow." ”

"I want to see it too. ”

"It is said that it has something to do with Kuman Tong, so stay away. It's okay if I take a look, the yang energy is strong, so don't go. Wu Mian smiled and touched Chu Zhixi's head.

"Okay. Chu Zhixi was helpless and said, "Come back and tell me how it was diagnosed." ”

Daoist Lin didn't want to eat dog food, so he hurriedly went into the house to get a Taoist robe and helped Uncle Xiao put it on.

In addition to the fact that the little flat head is a little dazzling, Uncle Xiao's outfit is much more handsome than himself, and Daoist Lin is envious.

This is a world of fighting for appearance, and even wearing a robe has to fight for appearance, where is there any reason to talk about.