"One of the most obvious manifestations is that the patient has blood in the sputum, subcutaneous bleeding, and nosebleed. You can take a look at the latest blood routine test, white blood cells are not high. However, red blood cells are low and hemoglobin is low. ”

"With this hemoglobin criterion, a diagnosis of mild to moderate anemia can be made. As we all know, chronic anemia can affect the function of the heart. ”

"Therefore, I agree with Dr. Ding's opinion that this patient, applying the diagnostic methodology of our neurology department, her diagnosis is that the damage to multiple organ function is not light."

"I also agree with Dr. Ding's analysis that 'monism' should be used to explain all the current symptoms and signs of the patient."

"Of course, everyone can say 'monism' and likes to say it, but it is not easy to really use 'monism' to explain this patient's condition."

"I looked at the patient's last hospitalization record, combined with the patient's current clinical manifestations, and I am still confident in using 'monism' to explain this patient."

"First, this patient had a chest X-ray taken during his last hospitalization, and the results of the chest X-ray showed that a suspicious nodular lesion could be seen in the right upper lung, and regular re-examination was recommended. Unfortunately, there is no one in the respiratory medicine department to follow up with the patient and conduct regular follow-ups. ”

"This time the patient was hospitalized, and the 'inflammatory' lesions found in the patient's chest x-ray happened to be on the nodular lesions taken in the chest x-ray of the previous hospitalization. In my opinion, this is definitely not a coincidence. ”

"Second, so far, the main damage of the patient is mainly to the blood system, especially the coagulation problem. Bleeding in multiple parts of the body leads to hemorrhagic anemia. ”

So, what causes patients to have such a situation? That's what I'm talking about about qualitative diagnosis. Speaking of the key point, Lin Lin deliberately paused.

In the doctor's office, there was silence, and all eyes were staring at Lin Lin.

"I think the culprit of all the patient's current symptoms is a lesion in the upper right lung, and this lesion, the most likely disease, is lung cancer, and oat cell carcinoma is more likely."

"Because, lung cancer of this nature, it is easy to have a situation, that is, 'distance reaction'."

"The so-called 'distance reaction' is that lung cancer produces some active substances that circulate through the blood and affect places far away from lung cancer. It is also called 'paraneoplastic syndrome'. ”

"Generally speaking, the nervous system, digestive system and blood system are the most susceptible systems."

"Mechanistically, this is an immune response, which can be an antigen, an antigen-antibody complex, or a combination of the above."

"Judging from the speed of this patient's progression, there shouldn't be much time left, so I suggest ......" Speaking of this, Lin Lin paused again.

Perhaps, some of you have heard of paraneoplastic syndrome, but it is the first time in the neurology department to hear Lin Lin analyze it so clearly.

After being reborn, Lin Lin knew very well that with every discussion, he was imparting to his colleagues the wealth of knowledge and experience he had accumulated over the decades. And he doesn't mind teaching this to his colleagues.

In the office, there was silence, and pins could be heard. Everyone wants to hear what Lin Lin suggests.

"I suggest contacting the CT room immediately to do an urgent chest CT for the patient. I am very unoptimistic about the prognosis of this patient, who is likely to die from a massive hemorrhage. ”

"However, I hope that before she leaves, the diagnosis can be clarified, so that she can walk clearly and clearly. Of course, let's also learn from it. ”

In her previous life, Lin Lin personally witnessed the patient's death after a violent gastrointestinal hemorrhage in the afternoon after a chest CT scan.

After Lin Lin finished speaking, the office fell silent again. There were no objections, and no one spoke again.

Ling Xiaoyun was conquered by Lin Lin's unbridled imagination. She also believes that Lin Lin's analysis is very reasonable, and it can also explain the evolution of this patient's entire condition.

What annoyed Ling Xiaoyun the most was that she had never thought in this direction. Again, knowledge, limits the breadth and breadth of her thoughts.

"Dr. Lin's analysis is very wonderful and pertinent, and it is completely in line with the evolution of this patient's condition. Of course, is the end result like what Dr. Lin analyzed? ”

"I'm sure there's a lot of urgency to get to the bottom of this mystery. Therefore, Dr. Ding should contact the CT room immediately and do a chest CT scan for the patient as quickly as possible. ”

Ling Xiaoyun's words ended today's discussion and agreed with Lin Lin's analysis.

Ding Feng immediately took action, and when the doctor in the CT room heard about it, he was also very interested and immediately asked Ding Feng to send the patient to the CT room.

Ding Feng wrote the CT application form, issued a doctor's order, and then together with Lin Lin, sent the patient to the CT room with a lathe.

Lin Lin also wanted to see if his analysis was consistent with the facts for the first time.

Lin Lin and Ding Feng stayed in the CT operation room, watching the technician operate the CT machine, scanning the patient's chest layer by layer.

"Stop, stop, zoom in on that." Dr. Tian in the CT room shouted, and the technician immediately magnified the level of what Dr. Tian said.

"I can't run, lung cancer. You see, this nodule in the upper right lung, with unclear edges, is like a 'ground glass', a typical lung cancer image. Okay, look further down and pay attention to the nearby lymph nodes. "Dr Tian is very experienced.

The technician retrieved the images that had been scanned and found that the lymph nodes around the nodules had metastases very obviously, and the hilum also had lymph node metastases and was abnormally enlarged.

"Doctor Ding, you're still amazing!" Dr. Tian said to Ding Feng.

"It's not that I'm good, it's Dr. Lin who is good, and he proposed this." Ding Feng is frank.

"It's Dr. Lin again. Hey, listen up, all the checklists prescribed by Dr. Lin in the future, you must wake up your spirits. The positive rate of the orders he prescribed was at least 85 percent or more. ”

For Lin Lin, Dr. Tian knows. Now I heard Ding Feng say that this patient is Dr. Lin's "masterpiece" again, and quickly reminded the doctors and technicians in the department.

In this era, there are not many ways to measure the level of a doctor, and one of the important indicators is how high the positive rate of the doctor's examination list is.

The high positive rate of the examination list prescribed by Lin Lin made Dr. Tian stunned, and he was particularly impressed by Lin Lin because of this.