After asking about his medical history, Zhang Tianyang's A4 paper was already full of handwriting.

Senior Sister Chen stretched out her head to take a look, and her mouth was slurking.

"Young male, megaspleen chain, this is an incurable disease. ”

Zhang Tianyang stared at the notes he had made and pondered, "Indeed, there are too many possible reasons. Senior sister, what do you think about it?"

"Don't ask me. Chen Shishi instantly changed to a computer farther away to show the distance.

"I'm not qualified to express my opinion on this kind of incurable disease, you can call Senior Brother He or Professor Zhu after you prescribe a regular medical order!"

"Okay. ”

Zhang Tianyang shrugged his shoulders, this kind of thing of judging the condition is indeed a bit out of line.

"What kind of patient?"

Senior Brother She was a little curious, and silently floated over to see Zhang Tianyang write medical records.

looked at it, and floated back silently.

Incurable diseases, farewell!

......

In addition to the regular admission package, the 79-bed lad focuses on differential diagnosis.

Zhang Tianyang thought for a while, and then prescribed him a few additional checks.

Reticulocytes, schistosomiasis antibody testing, ceruloplasmin, urine copper quantification, and ophthalmologic consultation.

Reticulocytes are used to screen for blood diseases, in fact, Zhang Tianyang still wants to do a bone piercing for him, but he still has to wait for the results of the blood routine to come out first.

The schistosomiasis antibody test is to see if the liver and spleen are major due to schistosomiasis, and a more definitive diagnosis is to do an abdominal CT with contrast, but such an expensive test as enhanced CT is not something that he can prescribe.

Ceruloplasmin, urine ketone quantification, and ophthalmologic consultation are used to screen for hereditary Wilson's disease, and patients with this disease will have an accumulation of "copper" in their bodies, and ceruloplasmin and urine copper will be high, and the characteristic K-F ring can also be seen in the eyes.

"That's all I can do. ”

Zhang Tianyang sighed, and just wanted to call Senior Brother He, but Chen Shishi's mobile phone rang first.

"Hey, Senior Brother He, are you done with it?"

It's Senior Brother He's phone.

"Ah, Xiao Chen, Professor Zhu told me that you have a new 27-year-old with a large spleen, how about now. ”

The 79 bed lad does have a hard background.

Professor Zhu gave him a special instruction in the morning, and asked Senior Brother He to take a special look at him in the afternoon, which was not an ordinary concern for him.

"The patient is here, it was taken by the junior brother, senior brother, you tell him?"

Chen Shishi gave the phone to Zhang Tianyang, and Zhang Tianyang quickly introduced the young man's condition to Senior Brother He.

"It's hard to say so young. ”

The background voice opposite Senior Brother He was still noisy, "Xiao Zhang, did you ask where he is from?"

"I asked, Yixing, Jiangsu Province, is an epidemic area of schistosomiasis, and I also had a history of contact with infected water when I was a child, and I have been prescribed schistosomiasis antibodies.

By the way, do you want to do an enhanced CT of the upper abdomen? If you can see the map-like changes, you can be sure that it is a schistosome. ”

After Zhang Tianyang finished speaking, the other side was silent for a while.

Senior Brother He was going to instruct Zhang Tianyang to ask for a specific medical history and teach him how to diagnose schistosomiasis.

As soon as he said that he was asked where he was from, the other side immediately reacted that he wanted to ask the question of schistosomiasis, and then crackled and finished everything.

The thinking is clear, not to mention, but also very accurate.

It's really different from my previous interns.

"Do it, make an appointment with him. ”

Senior Brother He paused for a long time, but still didn't hold back, "Are you really Xiao Zhang?"

"yes, it's me, what's wrong?"

"It's fine. Senior Brother He snorted and reversed his inherent impression.

"By the way, Xiao Zhang, did you ask about his family history?"

When asked, he himself said that no one in his family had such a situation. I have prescribed ceruloplasmin to him, and I have also prescribed urine ketone ration, and the ophthalmology consultation list has just been typed out, and I haven't given it to him yet. ”

Yes, I just said a family history and guessed what I wanted to ask!

Senior Brother He was shocked for a moment, and suddenly a strong sense of satisfaction surged from the bottom of his heart.

It would be great if all the junior doctors under him were like Xiao Zhang!

As soon as you frown, he knows how to tap. As soon as you snort, he knows how hard to use. As soon as you look up, he knows to kiss you......

Sorry for the wrong screen.

If all the junior doctors are like Xiao Zhang, they have an accurate judgment of the condition, and you don't need to say that everything has been arranged, and he can quickly understand your meaning and report accurately and in detail if you say a word......

It's not like the interns I took before, saying what I said and doing, and if I didn't say it, I would never do it.

will only shout about whether it's big or not, whether it's cool or not, and call Dad.

What's the difference with a tool man?

"Alas, it's hard to find. ”

Senior Brother He suddenly sighed, leaving Zhang Tianyang stunned.

Fortunately, a new question quickly came out on the other side, "Xiao Zhang, what else are you considering?"

"Considering the blood system disease, I have already checked the blood routine and reticulocytes, and I want to wait for the blood routine to come out before prescribing it to him. ”

It's all taken into account......

Senior Brother He sighed, and suddenly felt that he was just an ornament.

Although his guesses had already been told by the other side, he suddenly became curious about whether this Xiao Zhang would have any ideas that he hadn't expected.

So he asked tentatively, "What else?"

"And another, I'm not sure about, is it possible that it is idiopathic splenomegaly?"

Zhang Tianyang thought about the literature he had studied in the system.

"Some patients with an enlarged spleen will be classified as idiopathic splenomegaly because they can't find the cause, but it seems that someone has studied that most of these patients with enlarged spleen have had umbilical cord infections in their childhood.

I also asked the patient, but he didn't know much about it himself, and said that he would call his parents to ask. ”

"Idiopathic splenomegaly. ”

Senior Brother He muttered silently, thinking that there was indeed such a possibility.

On the other side, Zhang Tianyang has already begun to explain, "Idiopathic splenomegaly is only considered when the cause cannot be found, I think it is better to let the patient do all the tests to see the results first." ”

"Yes, you're right. ”

Even if he couldn't see the scene on the other side on the phone, Senior Brother He was nodding vigorously.

"Okay, you can look at this patient, if there is any examination you think you need to do, make an appointment first, and I will communicate with the patient when he rounds the ward tomorrow."

You judge, I don't worry!"

After hanging up the phone, Zhang Tianyang continued to examine the patient on the computer.

I was worried that I didn't have the authority to open it, but now I'm going to open it all.

"Do all these things?"

Senior Brother She didn't know when he quietly floated behind Zhang Tianyang again, with a shocked face.

"Senior brother, have you asked the senior doctor?"

"I asked, and said I looked open. ”

Zhang Tianyang didn't care, and continued to prescribe the doctor's order, leaving Senior Brother She behind him with a solemn face.

Can this kind of examination, which can cost hundreds of dollars, be prescribed without the approval of the senior doctor one by one?

If you open too much, isn't it a pit patient?

Senior Brother She frowned, and secretly made up his mind in his heart.

No, I must report to Professor Zhu truthfully when she rounds the ward tomorrow!