"Director Ding's idea is very worthy of promotion at the hospital level. The promotion work, please go back to Section Chief Ye and think about it, the medical department will come forward, and the directors of each section will be the main body of responsibility, and it must be carried out. ”

"Now, let me tell you what I think of this patient." Lin Lin changed her words and began to analyze the patient.

"This patient is a middle-aged woman with a subacute onset and progressive sexual development. The main symptom is discharge-like, severe pain accompanied by numbness and weakness in the limbs. ”

"After being admitted to the hospital, the patient's condition improved after treatment with dexamethasone. Pain decreases and pain occurs less frequently. ”

"Among the large instrumental examinations that patients have done, the most valuable is the MRI of the head. Although no abnormalities were found, the negative results also have great reference value for us. ”

"The way you see me inducing pain in patients is actually a true reflection of the patient's usual pain. This sign is called 'electric shock with head down'. There is no pain in it, but the pain like an electric shock is very painful. ”

"The signs I noticed today also include weakness in the left limb, which of course is relative to the right side. Sensory deficits in the right limb, positive sign of difficulty in closing eyes, positive pathological sign of left limb, hyperreflexia of tendons in both lower limbs, decreased biceps reflex in both upper limbs, and active triceps reflex. ”

"The difference between these two reflections, I don't know if you see it. This sign is of special significance for the localization diagnosis, especially the longitudinal localization of the spinal cord. ”

"In addition, the patient's joint position and joint kinesthesia in both lower limbs are lost, which is consistent with the difficulty of standing with the eyes closed."

"Combined with the above symptoms and signs, in terms of localization and diagnosis, I consider that the site of the patient's lesion is in the cervical spinal cord. Longitudinally localized, the lesion is centered on the fifth cervical medulla and extends to the upper and lower spinal cords. ”

"Lateral localization, the lesion is left posterior, with predominantly posterior cord lesions, and also affects the pyramidal tract and sensory conduction fibers."

"Everyone must be very concerned about the qualitative diagnosis of this patient, that is, what disease she is suffering from."

"If my judgment is correct, the patient is suffering from a neurological disease that is not very common, called spinal multiple sclerosis. This type is mainly found in Asian populations. ”

"So, the next step that needs to be done is to do an MRI of the cervical spinal cord. At present, there is no specific test for hematology and cerebrospinal fluid examination. ”

"In terms of treatment, intravenous dexamethasone can be changed to oral prednisone, which can start at 60 mg per day and gradually adjust according to the patient's condition. After all, this disease requires long-term medication. ”

"In addition, carbamazepine can be added, starting with 0.1 grams three times a day. During medication, pay attention to the side effects of carbamazepine, such as rash, such as low white blood cells, such as hyponatremia, etc. ”

Finally, the patient can be given diazepam at night before bedtime. First, diazepam can raise the pain threshold, thereby reducing the occurrence of pain. Second, the application of hormones can cause insomnia in patients, and the use of diazepam can relieve the pain of insomnia. ”

"Dean Lin, you just said that a negative MRI of the head is also very important. Is there any special significance in this patient? Ye Xiu listened carefully.

"Yes, it means a lot. As I said earlier, multiple sclerosis in Asians is mainly spinal cord type, but it does not mean that Asians will not have cerebral multiple sclerosis. In some cases, the cerebral hemispheres and spinal cord may be affected at the same time. ”

"So, the brain MRI was negative, so we ruled out brain involvement." In Lin Lin's previous life, she had explored this kind of disease.

"Dean Lin's analysis has opened our minds. It seems that we need to read more books and study. As far as I know, Dean Lin is a regular visitor to the library and reads a large number of foreign medical journals. ”

"I follow Director Ding's train of thought just now, are we carrying out special business learning in the class?" Zhuo Yiming is also a person who loves to learn.

"Mr. Zhuo's advice is very good. Go back, Director Ding will study it. The hospital will soon enter the evaluation work of a tertiary hospital, and everyone should not be too tired. ”

"Isn't it starting with one question a month, everyone has to participate and prepare. A topic, if divergent, can involve many issues. Over the course of a year, everyone will learn a lot of knowledge. Lin Lin gave specific suggestions.

"I agree with Dean Lin's suggestion. One question per month, not much, you can have enough time to prepare, and it will not make you too nervous and tired. Director Ding, count me in. Ling Xiaoyun expressed his position positively.

"Section Chief Ye and I, in the coming time, the work will be very busy. In the afternoon, Section Chief Ye was going to Guangcheng to study in a closed area for a week. After coming back, I have to participate in the formulation of various articles and regulations for the review work, hehe, staying up late, it is estimated that it will become the norm in the next few months. ”

"Therefore, Section Chief Ye and I will not participate in this study plan for the time being. However, if you have a special case and need me to participate in the discussion, you can call me at any time. ”

"Thank you very much for Mr. Zhuo's proposal, thank you Dean Lin for your specific suggestions, and thank Director Ling for your support. I also feel that in order to improve my business skills, I must continue to learn new knowledge. ”

"I still remember when Dean Lin scored 98.5 points in the English test. The efforts made by Dean Lin are beyond our imagination. What everyone sees is Dean Lin's awesomeness. What everyone didn't see was Dean Lin's uninterrupted learning. ”

"I think today's ward rounds of Dean Lin are really worth it. It not only solves the clinical problem, but also points us in the direction of learning. ”

"I will definitely work with Director Ling, Teacher Zhuo and Teacher Li to develop a plan to get all of us moving. Thank you again Dean Lin! Ding Feng made a concluding speech.

Ye Xiu stood up, came to Ding Feng's side, and said, "Director Ding, your summary is too good. Haha, it's worth it, it's so worth it. ”

"yes, we're worth it, you've spent real money."

"That's worth it, these knowledge points can't be bought with money."

"Hehe, Section Chief Ye, hurry up and prepare, don't delay." Lin Lin said to Ye Xiu with a smile.

"Okay, Dean Lin, I'm leaving." Ye Xiu made an OK gesture towards Lin Lin, then turned around and left quickly.

Ling Xiaoyun looked at Ye Xiu's distant back and said to Lin Lin, "Dean Lin, looking at her, I think a little of what you used to be. You, junior sister, are too much like you. ”