"Doctor Xiaoji, do you have an answer?" Zhai Yuhan asked.

The patient's diagnosis was not clear, and the whole hospital was consulted at that time, and everyone tossed together for nearly 2 days to find the problem.

Fortunately, there was no delay, if it was changed to another hospital with a slightly worse level, maybe the grass on the patient's grave would have been one person tall now.

Can Ji Xiang give the correct answer?

Zhai Yuhan felt that it was impossible.

She thinks that she is not deliberately embarrassing Ji Xiang, but just wants to give Ji Xiang a "lesson" so that he can face the myriad diseases in clinical practice more humbly.

Zhai Yuhan even pretended to forget that he did not talk about the most critical step in the physical examination, which was enough to mislead.

"Teacher Zhai, did you not say anything about the key items in the physical examination?" Ji Xiang suddenly asked.

Zhai Yuhan was stunned, and her heart involuntarily thumped, as if she was going to trick Ji Xiang but was discovered by him.

But if you think about it carefully, it shouldn't be possible, the trap you set up has no flaws, and Ji Xiang won't see through it.

"Oh?" Zhai Yuhan deliberately made a calm appearance, "What are you talking about?" The physical examination I just talked about is indeed rather coarse, what do you want to ask? ”

"Which arm is the patient's blood pressure measured after admission?" Ji Xiang asked.

"Isn't it all the same?" Zhao Mengmeng looked at Ji Xiang suspiciously.

She felt that Ji Xiang had said a nonsense.

But the expression on Zhai Yuhan's face suddenly froze, she never expected Ji Xiang to find the problem so quickly.

However, Zhai Yuhan smiled slightly after being surprised, and Ji Xiang walked into the trap by himself like a prey.

"It's different." Ji Xiang said, "The blood pressure in both arms is different, which means that the aortic dissection. Mr. Zhai heard me just say that the rib fracture combined with aortic dissection came to mind. ”

Zhai Yuhan was a little speechless, Ji Xiang was indeed very smart.

Zhao Mengmeng looked at Zhai Yuhan with doubts, and seeing that her expression was stagnant, she guessed that Ji Xiang was right.

But she recalled the patient's medical history again, but still did not answer.

"The patient's blood pressure in his left arm was 152/86 mmHg and his blood pressure in his right arm was 144/89 mmHg." Zhai Yuhan said.

"That's pretty much it." Zhao Mengmeng glanced at Ji Xiang.

Zhai Yuhan threw out a pit he had dug and looked at Ji Xiang with interest.

"Mr. Zhai, I still think it's aortic dissection, and the CTA image display should be." Ji Xiang said slowly.

"Why?" Zhai Yuhan didn't answer Ji Xiang's question, but asked.

"The symptoms of the patient's bilateral lower limb paralysis cannot be explained by bilateral parieto-occipital cerebral infarction, and after ruling out periodic paralysis and other diseases, I am concerned about the presence of spinal cord lesions, and I am inclined to the possibility of spinal cord supply disorders?"

"Combined with the physical examination, the patient can hear signs of a murmur in the right subclavian and carotid artery area, and although the amaurosis can be considered a carotid artery lesion, I still suspect the possibility of aortic disease."

"If I'm not mistaken, the patient's CTA should show aortic dissection with changes in the vertebral arteries."

"......" Zhai Yuhan looked at Ji Xiang silently.

At this moment, she had nothing to say.

Ji Xiang didn't see the patient's information, and made a correct judgment just by digging his own medical history of digging two pits.

You must know that when I met this patient at that time, the First Affiliated Hospital went through 5 rounds of hospital-wide consultation + auxiliary examination, and it took a long time to find the cause of the disease.

However, Ji Xiang showed a diagnostic level that surpassed the experts and professors of the First Affiliated Hospital.

"Doctor Xiaoji, tell me what you think." Zhai Yuhan did not admit that Ji Xiang's diagnosis was correct at the first time, and continued to probe.

She thinks that Ji Xiang is blind, and she can't give reasonable logic at all, and it doesn't seem that she can be regarded as losing without a logical closed loop.

"Paralysis of both lower limbs is a common clinical symptom and can be divided into three categories according to the anatomical location of the lesion.

First, upper motor neuron paralysis is also called central.

Second, lower motor neuron paralysis, also known as peripheral.

Third, myopathic paralysis?"

Ji Xiang began to fold his hands and index one, two, three.

"Thoracoabdominal aortic CTA metaparalysis is characterized by: paralysis of the whole limb is the main monoplegia? Hemiplegia? Paraplegia, increased muscle tone and tendon reflexes, pathological reflexes, no muscle atrophy?"

“……”

Ji Xiang talked eloquently, and Zhai Yuhan was speechless.

Where is this just a logical closed loop, Ji Xiang even took into account the subtleties of each branch's guess, starting from the patient's most serious clinical symptom - paralysis, and analyzed it bit by bit.

"Lower motor neuron paralysis is characterized by muscle groups or individual muscles, decreased muscle tone and tendon reflexes, no pathological signs, and muscle atrophy? Myopathic paralysis is characterized by muscle atrophy in the proximal extremities, symmetrically distributed, and no sensory deficits.

"In the case, the patient developed double lower limb paralysis, no hemiplegia symptoms, no muscle atrophy ......"

Ji Xiang crossed his fingers and said for nearly 5 minutes, and finally gave a conclusion.

"I think CTA imaging is likely to show aortic dissection, Stanforda type with vertebral artery changes."

“！！！”

Zhai Yuhan had already heard an exclamation point.

Until Ji Xiang said at the end, she looked at the young doctor who was faintly emitting a milky white light, and her heart was infinitely confused.

This level of diagnosis is already terrifying, at least in the First Affiliated Hospital or Zhai Yuhan's medical career.

And Ji Xiang's strict logic proves one thing - he is not casually talking nonsense about Meng's diagnosis, but is reasonable and well-founded, and the analysis is meticulous.

But Ji Xiang didn't finish yet.

He didn't seem to notice Zhai Yuhan's expression, and continued, "The aortic dissection of this patient is painless and easy to misdiagnose?

Painless aortic dissection is less common than painful aortic dissection in clinical practice, often combined with neurological symptoms such as limb paralysis, and is easily misdiagnosed as acute ischemic cerebrovascular disease.

"But the treatment is not difficult, with metoprolol? Nifedipine? Urapidil controls heart rate and blood pressure, and can be operated on by vascular surgery when the condition is stable. ”

"Teacher Zhai, the patient has finally recovered and been discharged from the hospital, is he recovering well from walking?"

"Yes." Zhai Yuhan squeezed out a word from between his teeth.

Zhao Mengmeng listened to the dew.

Although she couldn't understand the entire logical judgment of Ji Xiang at all, the word "yes" that Zhai Yuhan said at the end told Zhao Mengmeng a fact - Ji Xiang's judgment was accurate.

That's too strong, isn't it?

Zhao Mengmeng was not as unwilling as Zhai Yuhan, but looked at Ji Xiang with a hint of Mu Qiang's eyes.

It would be great if he could answer the questions as neatly as Ji Xiang.

It's a pity that Zhao Mengmeng always feels that she is missing a breath and has never been able to connect the knowledge and reality in the books.