The 36-bed eldest sister is a true temperament, and if she says goodbye, she really worships.

Seeing her hands raised high and slowly down, Zhang Tianyang was a little panicked.

"Eh, don't bye, I'm kidding!

There is no kind of fortune telling, it's all science, science!"

Seeing that the mouth cannon was playing big, he hurriedly grabbed the arm of the eldest sister who bowed down.

However, the eldest sister of the 35th bed is also from the Northeast, tall and strong, he almost failed to prevent it, and he stuck himself on the ground.

The male family member next to him hurriedly pulled it and smiled apologetically at Zhang Tianyang.

"I'm sorry, doctor, our mother-in-law is a bit of a tiger. ”

"It's okay, huh?"

Zhang Tianyang rubbed his arm that was a little painful by the eldest sister of the 36th bed, and when he heard this, he turned his head and glanced at the man who spoke, a little stunned.

Wait.

Just now he said that the eldest sister of the 36th bed is his mother-in-law, right?

Mother-in-law, it's a wife, right?

He looked at the half-white hair, the bitter folds on his face, and the man who looked like he was forty or fifty years old.

I couldn't help but turn my head to look at the 35-bed sister who was sturdy, ruddy, and well-maintained, and looked like she was just thirty years old......

Are they husband and wife?

Not father and daughter?

Well???

Zhang Tianyang was in a daze, and the 36-bed eldest sister over there suddenly gave up asking Zhang Tianyang about her illness, squinted her eyes and grabbed the man's neckline.

"Who do you mean?"

The man's eyes widened instantly, and he whispered a small defense.

"I didn't, you heard it wrong, you ......"

"Who are you talking about?"

"I'm a tiger, I said I'm a tiger......"

The man's voice became more and more small and aggrieved, Zhang Tianyang couldn't stand it anymore, and quickly diverted his attention.

"Well, I'll ask something more. ”

"Oh, okay!"

The 36-bed eldest sister instantly staged a face-changing trick, smiling at Zhang Tianyang.

"Master, what else do you want to ask?

Zhang Tianyang's face instantly darkened.

"I'm really not a fortune teller, I'm just a doctor, don't call it that, and besides, I'm going to ask for medical history......"

The eldest sister of the 36th bed waved her hand, "Okay, master!"

Zhang Tianyang: "......"

Well, this stalk can't get by!

Zhang Tianyang silently re-managed his expression, and then conducted detailed consultations according to his preset plan.

The situation of 36 beds is actually much simpler than 35 beds.

The unlucky intern had already asked about the process of blood pressure fluctuations and the effects of medication and effects, and Zhang Tianyang added that he asked about the state at the beginning of the illness.

It was easy to ask, not only high blood pressure, headache, but also feeling weak, the local hospital checked "low potassium", and prescribed potassium tablets.

It's just that the 36-bed eldest sister and her family members felt that it was a trivial matter, so they didn't say it without asking.

It wasn't until Zhang Tianyang pointed it out that he was shocked.

Listening to Zhang Tianyang easily ask a bunch of details that he didn't know at all, the unlucky intern became more and more silent.

He felt the gap between himself and Zhang Tianyang.

Listening to Zhang Tianyang's consultation, he felt that he had learned a lot of things, but thinking about it, it seemed that he would not be able to reproduce it for a while.

A little depressed, but at the same time very motivated.

He picked up his pace and wrote hard.

The eldest sister of the 36th bed didn't think about it so much, she had a more cheerful personality and couldn't hold back her words.

"Master, ah, doctor. ”

She smiled, squinting, a little curious and inquisitive, "Well, how did you figure it out...... Ahem, how do you know about my symptoms?"

Zhang Tianyang put away his blue and black pen and blinked innocently.

"Isn't it normal to extrapolate the disease from the symptoms and then deduce the symptoms from the disease?"

The 36-bed eldest sister quietly glanced at the unlucky intern next to her.

The unlucky intern who was struggling to write a book was stunned, slowly lowered his head, and apologized in a low voice.

"I'm sorry ......"

It's because I'm too good to push it out......

Moreover, in fact, he is still a little confused.

Zhang Tianyang is indeed very powerful, but some steps are too jumpy, and he can't keep up with his thinking.

Zhang Tianyang glanced back at the unlucky intern who had buried his head in his chest, sighed softly, and then looked at the 36-bed eldest sister again.

"Forget it, I'll explain it to you. ”

"The disease of hypertension is divided into primary and secondary, and primary means that you have high blood pressure directly, and there is no other introduction.

Secondary means that you have a problem somewhere else that affects your blood pressure. ”

"Essential hypertension is generally more common in the elderly, and it is unlikely that it is primary at such a young age as this eldest sister, so let's consider secondary first. ”

"There are many common causes of secondary hypertension, endocrine, renal, ......"

Zhang Tianyang turned his head to look at the hapless intern.

He was ostensibly explaining to the 36-bed patient, but he was actually explaining to the hapless intern.

"Considering that the patient has been admitted to our department, we can assume that this is a disease that can be operated on, so the direction of consideration can be excluded, such as hyperthyroidism, which can be ruled out temporarily, and some major medical treatment of renal hypertension can also be temporarily disconsidered. ”

"Then the most common ones that require surgery are adrenal gland-related diseases, such as primary hyperaldosteronism, which has a high incidence of high blood pressure and hypokalemia. ”

I see!

The hapless intern suddenly brightened.

He nodded violently as he scribbled the record, and his eyes, which had been covered with a layer of things, gradually lit up.

The eldest sister of the 36th bed has been in a fog since the first few words, and now when she hears it, she has a feeling that she seems to understand something, but she seems to have more things she doesn't understand.

Zhang Tianyang simply ignored her and led the topic to 35 beds.

"Celiura, commonly seen in blocked thoracic ducts or extensive obstruction of abdominal lymphatic vessels, chyle reflux into the urine, making the urine cloudy as **, urine chyle test positive.

When you see white urine, you should think of chyluria, but at the same time, be careful to distinguish it from pyuria.

Persistent celiuria can lead to protein loss, but for some mild cases of celiuria, the doctor will recommend a controlled diet to expect improvement, and resume the diet after the celiura disappears.

But the 35 beds have not improved, so I guess that the diet has not been adjusted, and the long-term intake has decreased, and the absorption has decreased......"

Zhang Tianyang glanced up at the towering cheekbones and sunken cheeks of the 35-bed woman.

The hapless intern also looked up, and then suddenly understood.

The malnutrition of 35 beds is inextricably linked to diet control and persistent chyluria.

No wonder, Zhang Tianyang can reverse the patient's eating habits!

"And that technique. ”

Zhang Tianyang continued to state his reasoning.

"There are only a few ways to deal with chyluria, and considering that the urine returns to normal half a year after surgery, and then recurs, we should think of lymphangioligation around the renal pedicle.

This surgery is effective, but it is prone to recurrence because the lymph tends to establish collateral circulation.

Just enough to match the number. ”

Zhang Tianyang's tone was not hurried or slow, he spoke eloquently, without showing off his skills or with any personal feelings, as if he was talking about an ordinary thing.

"The same is true for asking people around you, because the common cause of chylutura is filariasis, and with the patient's place of origin, it is easy to make associations.

In the epidemic area, she must be not the only one who is infected, and the people around her also have chyluria, which is a very normal reasoning.

In terms of medication, Haiqunsheng is a special drug for Malayan filaria, and the local hospital must have experience. ”

All the ideas finally came together.

While the unlucky intern was struggling to write, the eyes that looked at Zhang Tianyang had turned into extreme admiration.

He was once again deeply aware of the gap between himself and Zhang Tianyang.

Obviously, they are all interns, but they can be so clear-minded, have a solid foundation, and have smooth logic.

You, you, you're so vegetable!

You have to learn from others!

On the side, the two-bed patient and two family members tried hard to understand Zhang Tianyang's explanation.

But soon, they all chose to give up.

With such professional knowledge, if you can understand it, what else do you need a doctor to do?

I don't understand it, but I feel like it's amazing!

Doctor 666!

The patients and their families who had been reduced to four salted fish silently shouted 666 in their hearts, and their eyes on Zhang Tianyang became more and more eager.

I don't understand.

I don't understand, but I can subdue other little doctors, which means that this doctor has goods in his stomach and is a big guy!

Isn't it fragrant to have a big guy take care of himself?

"So, in fact, I didn't tell the fortune just now, but reasoned the results based on the available evidence and the knowledge I have.

It is said that the end of science is metaphysics, but it is not.

It's still science at its core.

It's just that because I've omitted the process, it seems to be very metaphysical. ”

Zhang Tianyang made a final summary.

"So, don't call me Master anymore, it's all a joke. ”

However, the four pairs of eyes were bright and eager to try.

"Yes, Master!"

"Got it, big ...... Doctor!"

"What, doctor, are you our bedside doctor?"

"Master, uh, doctor, can you add your WeChat? I want to communicate with you about your condition further. ”

"Doctor, I also want to add your WeChat ......"

"Doctor, I didn't understand very well just now, can you leave a call......"

The four of them instantly surrounded Zhang Tianyang, who had finished the lecture, in the center, cordial and enthusiastic.

Zhang Tianyang was tired of coping and looked confused.

Wait.

Didn't they all say that it wasn't metaphysics?

How can I be more excited!

Who's that!

That intern who was isolated outside the circle of people!

Don't be in a daze!

Come and save me!

Stealing incense