He sometimes likes to bring a bit of black humor and tell some cold jokes and so on.

And he treats people very sincerely.

Of course, it's not that kind of sincerity without a bottom line. You can be very honest with friends and people you trust, but when it comes to patients and family members, it's a matter of situation.

But any doctor who is a little older has tasted the taste of being bitten by a 'poisonous snake' because of his kindness in his work.

"It's not a slip, so what are you doing? Ran to the inpatient department to molest the nurse's little sister? ”

Director Yin asked when he heard this.

"Hey, you can't talk nonsense, if my girlfriend hears it, she has to punish me for sleeping on the sofa. I just went to the ward to check on this female patient and did some examinations and questioning of her. ”

Hearing that Zhou Can had gone to the ward to check on the patient, Director Yin's face suddenly showed a smile.

"Ho! I'm underestimating you. Are there any diagnostic breakthroughs? ”

He cares most about the care of his patients.

I immediately asked if there was a breakthrough in the diagnosis.

His eyes were full of anticipation, because Zhou Can was able to make a breakthrough every time he made a shot, and he almost never disappointed him.

"There are some small discoveries. Let me take a closer look at the patient's test results and then provide some references. ”

After speaking, Zhou Can really picked up the patient's information and began to study it carefully.

This is the second time that the study has been studied.

Sometimes the doctor needs to repeatedly review the patient's examination report, the cause and medical history, and confirm that it is correct before making a conclusion.

Walking on thin ice and being cautious is the norm for doctors to diagnose diseases.

Director Yin didn't bother him, smiled and silently added him a cup of tea, and then studied the case of high paraplegia.

The two of them are really interesting.

When encountering difficult cases, diagnose each other's cases.

Clinically, this can be called a consultation.

Brainstorming is a common tool for doctors to deal with difficult cases. After all, a person's wisdom and strength are limited, and each doctor's diagnosis ideas are different, and their findings will be different.

Just like a blind man touching an elephant, the way of discovering the cause will be different depending on the diagnostic thinking.

For example, when diagnosing a patient with a cold, some people start with the patient's fever, some people start with the patient's lack of appetite, and some people start with the patient's headache or malaise. The idea of diagnosis is different, but the final correct answer is basically the same.

After nearly twenty minutes or so, Zhou Can seemed to have come to a conclusion.

Raised his head and looked at Director Yin.

"You say, I'll listen!"

Director Yin had already finished diagnosing the little boy who was a high paraplegic and was leisurely drinking tea. Seeing Zhou Can looking up, he immediately understood that Zhou Can's diagnosis had come to an end.

"Although the course of this female patient's illness was very long, after I inquired, I thought that she had a very acute onset. It was because of an accidental cold, and then the headache began, which eventually continues to this day. The disease is characterized by a rapid onset, a long course of the disease, and a relatively slow progression. I just went into the ward to examine her, and found that her optic nerve disc was edema, her head was pulling and painful when her right eye was turning, and there was a pronounced gag reflex ...... when swallowing."

"She has a high white blood cell count, an elevated ESR, an elevated cerebrospinal fluid cell count, and a predominantly monocyte count. CSF protein is also markedly elevated, sugar is low, but chloride is normal. No acid-fast bacilli or Cryptococcus neoformans were detected in cerebrospinal fluid. Chest x-ray is normal, indicating no significant lesions in the chest and lungs. In addition, her blood level is also a bit high. Combined with the presence of fever at the time of admission, my diagnosis is more likely to be acutely infected. ”

After Zhou Can described the comprehensive situation of the patient, he made a summary.

"I agree with this, there is a real possibility of acute infection in the patient."

Director Yin nodded in agreement with Zhou Can's point of view.

"I'll talk about a few of the suspected diseases first, and then we'll talk about them one by one. The first is cryptococcal meningitis neoformans. The disease mostly occurs in young adults, and patients are in their Chinese New Year's Eve this year. There are two types of disease: subacute and chronic, which are very consistent with the acute onset of the patient. It is accompanied by moderate or mild fever and is also consistent with the patient's condition. Headache, vomiting, blurred vision, diplopia, nuchal rigidity, and meningeal irritation are also present, and are highly consistent with the patient's symptoms. ”

"And as the disease progresses, consciousness will be impaired, and a small number of patients will have convulsions, which is also consistent with the patient. The suspicion is extremely high. ”

Zhou Can first started with the patient's symptoms and found out a disease that was highly consistent with his symptoms.

However, although the sugar content of the patient's cerebrospinal fluid was significantly reduced, the chloride did not change, and the ink stain did not find cryptococcus or Cryptococcus neoformans, so the disease could not be diagnosed. Cerebrospinal fluid can be drawn several times and sent to the laboratory to search for cryptococcus repeatedly. ”

There is a gold standard for diagnosing every disease.

For example, in cryptococcal meningitis neoformans, even if the patient's symptoms are all consistent with the disease, but no cryptococcus is found in the cerebrospinal fluid, the diagnosis cannot be made.

In clinical practice, there are many bizarre diseases that are similar in symptoms to a certain disease, but are not the disease.

Therefore, doctors are extremely cautious in diagnosing the cause and will not easily draw conclusions unless they find a gold standard.

"I also suspected this disease, and I have been sampling cerebrospinal fluid for several days for testing, and no cryptococci have been found."

Director Yin sighed.

If this disease was so easy to diagnose, there would be no need to ask Zhou Can for help.

"It's really strange, and it could be a disease with symptoms similar to that of cryptococcal neoformanitis. The second disease I suspected, tuberculous meningitis. The onset of the disease is insidious, the course of the disease is very long, and the symptoms range from mild to severe. There may be a history of tuberculosis infection in other parts of the disease, and symptoms such as low-grade fever, night sweats, loss of appetite, mild headache, malaise, and fatigue may occur in the prodromal stage. ”

"As the disease progresses, the headache worsens with vomiting, the neck is rigid, and both Kernig's sign and Brudzinski's sign are positive. There may also be symptoms such as drooping eyelids, different pupil sizes, paralysis of extraocular muscles, diplopia, and facial paralysis due to meningeal adhesions. Normally, after this disease, tendon reflexes may be hyperactive and pathologic reflexes may be positive, but spinal nerve damage may lead to loss of tendon reflexes. ”

"If the disease is not treated correctly in time, the condition will continue to deteriorate, and eventually enter an advanced stage, which is directly life-threatening."

Zhou Can said the second disease of suspicion.

"This female patient is more like she has progressed to the second stage of the disease. However, there are some arguments that do not support the disease, such as the fact that some of the patient's symptoms are different from the disease, and the patient's chest x-ray does not reveal any abnormalities. Cerebrospinal fluid (CSF) showed an increase in protein and a decrease in sugar, but no significant change in chloride. ”

First he was suspicious of the disease, and then he made some arguments that did not support it.

Diagnoses are sometimes so contradictory.

It is necessary to make inferences back and forth.

"Tuberculous meningitis, after consultation within our department, has basically ruled it out. But you mentioned that the Kerniggs sign and Brudzinski's sign are positive, which is something new. ”

After listening to this, Director Yin thought for a while.

"How to say it! Although this disease is the least suspected, I think it is very likely. This female patient's symptoms are classic, and she can be matched with a variety of diseases. Therefore, I believe that we should not only start from the symptoms, but also should not be based on the symptoms, but should also be combined with the progress of the disease and whether the patient has a medical history. ”

Zhou Can never looks at the appearance of his diagnosis, he prefers to peel off the cocoon and point directly at the lesion itself.

Maybe it's a diagnostic gift.

When he diagnoses various difficult cases, he can lock down the most hidden suspicions or the doubts that are least likely to be paid attention to by other doctors, and then pursue them deeply, eliminate interference, and finally find out the cause.

"It's kind of interesting."

After Director Yin Hua listened, his eyes lit up slightly.

"Diagnosis based on the progression of the disease is something that I and other doctors really didn't think about."

"Actually, I thought of some other suspicious illnesses just now, but they were all ruled out. For example, purulent meningitis, viral meningitis, and so on. ”

The meaning of Zhou Can's words is already very straightforward, that is, there is a high suspicion that the patient is tuberculous meningitis.

Clinically, the last thing doctors like is tuberculosis-related diseases.

Tuberculosis is easily contagious, it is particularly stubborn, the course of the disease is extremely long, and the cure period is also extremely long.

Many patients and their family members do not understand medicine, and after taking medicine and injections for a period of time, they find that their condition does not seem to be improving, and they begin to doubt the doctor's diagnosis and treatment plan. Unwilling to cooperate with treatment.

This can lead to the loss of previous efforts.

In the end, the doctor could only watch the patient fall into the abyss. After it is over, the family members and patients will collectively scold the doctor for being a quack doctor who will not be able to cure even a single disease.

"Tell me about the basis for your determination that the patient has tuberculous meningitis."

There was a hint of cunning in the depths of Director Yin Hua's eyes, as if he wanted to take the opportunity to dig deeper into Zhou Can's diagnostic strength.

"There are some other grounds. For example, patients with low-grade fever, vomiting, double vision, and convulsions are similar to the symptoms of the second process of tuberculous meningitis. In addition, the patient had edema of the optic nerve disc, paralysis of the right extraocular muscle, meningeal irritation+, and positive pathological signs. ESH is elevated and neutrophils are high. These grounds are sufficient to raise suspicion of tuberculous meningitis. ”

Zhou Can focused on suspecting that the patient had this disease, but it was not only determined that the course of the disease was similar to the disease.

There are many other symptoms that are also compatible.

"Well, when you say that, I think it's the disease. However, medicine is a rigorous discipline, and there must be some strong examination evidence to confirm the diagnosis of medication. ”

Director Yin was amazed by Zhou Can's strength.

He found that Zhou Can's progress was particularly fast, and every once in a while, his strength in all aspects would improve extremely significantly.

"Isn't it easy to check the basis? Take a specimen for PPD test! Then you can also have the patient do a head CT or MRI! The most common target of tuberculosis is the organs in the chest and abdominal cavity, but it does not mean that the chest x-ray does not detect the problem, and it is considered that there is no infection in the head, right? ”

Zhou Can said with a smile.

"It makes sense, I'll open an application for examination right now and give the patient a tuberculin pure protein derivative test. It is not too late to start after the results of biological tests such as head CT are available. ”

Director Yin gladly accepted Zhou Can's suggestion.

Older doctors usually like to say the full name of a test or a shortened Chinese name, while younger doctors are lazy and like to say some English abbreviations.

The PPD test is a gold standard for tuberculous meningitis.

Director Yin did not prescribe head CT to the patient first, which was for the patient's economic considerations. Doctors with medical ethics prescribe every examination they prescribe to their patients after careful consideration and will only prescribe it when they feel it is necessary.

Only some doctors who have no medical ethics and only think about making money and completing the tasks of the department will deliberately prescribe more examinations to patients.

As long as they can be examined from above, they are eager to check the patient.

On the one hand, you can earn performance commissions, and on the other hand, doing more examinations can provide more diagnostic basis and reduce the probability of misdiagnosis and missed diagnosis. The benefits are all reaped by the doctors, and the patients suffer a lot of guilt, and there are a lot of unnecessary examination fees.

It can only be said that such doctors lack the most basic human compassion and are too selfish.

It is already very unfortunate for the patient to get sick.

When he arrived at the hospital, he was used by the doctor as a tool to make money, and he was slaughtered several times.

As the medical regulatory system becomes more and more sophisticated, a medical ethics scoring system should be established in the future. For those doctors who fail the rating, or have a black history, they will be banned for life.

Wait until Director Yin happily finishes the inspection application.

Zhou Can took a sip of water, looked at the other party and said, "Director Yin, I helped you overcome the difficult cases in your department together, should you also help me and provide a little reference for the case of high paraplegia?" ”

Only when he is very familiar with Director Yin and has a good relationship can Zhou Can dare to say so.

He usually speaks to his elders and seniors, and he is very respectful.

There is a saying that the closer the relationship, the more casual it is when you get along.

"Haha, you kid doesn't suffer at all. I went to the ward just now to check on the little boy's condition, and if I want to say that there is no major discovery, it is not. However, with my years of clinical experience in neurology, I believe that the cause of the child is most likely to be in the head. Or it may be a compound. ”

With the help of Zhou Can, Director Yin made a major breakthrough in the diagnosis of the etiology of this female patient who had been plagued for many days, and she was in a good mood.

Laughing heartily, he talked about the cause of the little boy who was a high paraplegic.

"Is there a compound cause of this high paraplegia? Today is a day of insight. ”

Zhou Can has only heard of mixed hemorrhoids, and has never heard of paralysis and compound causes.

Internal hemorrhoids occur at the same time as external hemorrhoids and are clinically called mixed hemorrhoids.

High paraplegia, could it be that there is a problem in multiple parts of the nervous system?

"Haven't heard of it? There are still many things you haven't heard of, no matter whether you are free or not, you will come to me and sit here, you know? ”

Director Yin invited with a smile.

He likes Zhou Can, a good seedling, and comes to his office to chat.

Boiling wine and swords, boiling tea and talking about Taoism, this is something that many heroes like.

"Okay, okay, I'll definitely come over to ask you more in the future."

Zhou Can agreed.

The old book will be finished next month, and it will not be finished, otherwise I am sorry for the support of tens of thousands of paying readers. Readers who like medical literature are great, you can take a look at Brother Jiang's new book, it would be great if it suited your appetite, and you can get your continued support. It doesn't matter if you don't like it, let's look forward to the next fate, at least you have been with you and met you. Thanksgiving, thank you readers for your silent support and deep bowing.

(End of chapter)