In clinical practice, it will be difficult to receive patients, which is an uncontrollable factor.

However, in the process of skill assessment, there is also a difficulty outline, which is a bit excessive, which can obviously be avoided by carefully searching the question bank in advance.

If you really only have a level 2 MRI reading technique, it is too much to take this set of questions, instead of praying for them.

But it's quite interesting, Fang Xian plans to jump to do the question-

After a diagnosis of this injury.

When Fang Xian looked at the structure of other aspects.

No anomalies were found.

The ligaments are in good condition, there are no avulsion fractures, no bone edema, no problems with nerves, blood vessels, as well as muscles, tendons or even at the skin level.

No lesional changes or organic changes were observed.

What about this?

This means that the diagnosis of ankle ligament injury is absolutely correct.

So!

What you want to add, is it really just to make up for obturator lesions and lumbar disc herniation?

It's as simple as writing and supplementing, and then copying it?

Fang Xian didn't know if this was the easiest type of question he had encountered......

It's just a level 5 MRI reading technique, which makes Fang Xian instinctively feel that this case is absolutely impossible to be so simple.

If you only need to identify the positioning, the assessment content of level 1 MRI reading is about the same, how can it be the content of level 5 MRI reading?

So what did you ignore?

Detail!

Detail!

Let's start with the details.

As we all know, on top of the patient's MRI, basically every window, there will be basic information such as the patient's name, gender, and MRI shooting site.

There is also age, which is also the main content of basic information.

Fang Xian enlarged the MRI print and saw vague words.

Patient: "males, 45years (years)." ”

At present, Huaguo's MRI medical equipment is not enough to support clinical needs, so all words are still replaced by words.

Looking at the overall name of the MRI, that is, the MRI imaging of the left ankle joint, there is no mistake in the application of the position.

“male，45years，left。”

When Fang Xian looked at it like this, he suddenly found a very important problem.

The name doesn't mean much, but the male and 45-year-old give a very important message.

Indeed, this patient's MRI did not have any problems structurally, anatomically, or hierarchically.

However, there is a problem with his size!

This patient's ankle joint is quite slender, and the diameter of the ligament is also wrong, unlike the imaging performance of an adult man, and the muscles are also quite delicate.

In the average adult man, the muscles of the lower limbs, especially the muscles of the calves, as long as they are normal, will not be so thin.

Unless he has an underlying medical condition, such as muscle wasting.

Amyotrophic atrophy also has a cause to be inquired about, in addition to nutritional atrophy, apraxia atrophy, and neurotrophic atrophy.

Or rather, neurogenic atrophy!

In this patient, the ligament injury was not accompanied by other signs of edema, which means that it was not a violent injury, but a simple sign of ligament edema.

Wait a minute!

Fang Xian carefully searched for the patient's neural structure and vascular structure!

The diameter of the blood vessel is fine, and there is no thrombus, venous sinus, arterial sinus, etc., which means that the blood circulation is normal!

This suggests that it cannot be a nutritional atrophy.

Is that apraxia?

It depends on the diameter of the nerve --

The diameter of the patient's nerve is particularly slender, almost undetectable in size, and there is no break in continuity.

In general, paralysis is absent.

It wasn't paralyzed, but there was a problem with the size of the nerves, and it was accompanied by ......

This must be a lesion of the upstream nerve fibers, and the biggest possibility is compression.

Space-occupying lesions of the nerves of the lower extremities, usually lumbar disc herniation, or entrapment of the obturator foramen.

If there is an organic lesion in the thigh that compresses the nerve, this situation rarely occurs, and the second is that it will not be compressed to such an extent that it will not be detected.

It's likely that there's no way to fix it.

The written diagnosis of this patient was lateral ligament injury of the left ankle joint, suspected obturator lesion, and lumbar disc herniation.

There is no specific point, which is correct.

It is not stated whether it is an obturator or a herniated lumbar disc, but it is only a speculation. Just suspicious.

Therefore, the important point of this question and the solution to the problem are suspicious.

However, the result of solving the problem is, no changes are made!

Thus, the thirty-sixth and thirty-seventh MRI plain films, consecutively, appeared to correspond correctly.

The correspondence of two consecutive MRIs is correct, such a sassy routine, but anyone who has a slightly less solid foundation may doubt their own judgment, and then generously write a diagnosis that please make up for something.

And then it was routined.

Fortunately, Fang Xian's basic skills are solid enough, and it is easy to grasp some detailed problems.

It's just that when he did this, Fang Xian finally discovered that something was wrong with this assessment.

turned his head and looked at Zhou Cheng and Professor Yang Yifeng-

He asked, "Professor Zhou, Professor Yang, is this really the assessment content of Level 2 MRI reading?" ”

Although Fang Xian gave the answer, he questioned the existence of this set of questions.

This cannot be what should appear in the level 2 MRI assessment, even if it is a level 4 assessment. Level 5 can barely do it.

Yang Yifeng waved his hand: "You continue to take the next test, and then you will talk about it after the test." ”

Fang Xian could only click on the page icon and move the reading film to the next one......

After doing three or four more MRI readings, Fang Xian could basically determine that the thirty-sixth MRI imaging was one of the most difficult questions in this exam.

And in the subsequent verification process, it was also proved that this is indeed the case.

Except for the forty-ninth, which is the penultimate one, which also has a big pit, the other difficulties are very small.

And the pit of forty-nine MRI images is only comparable to this.

It's just that the mindset is different.

The forty-ninth MRI image took half an hour, and after many arguments and deductions, it was possible to understand the MRI and finally write down the correct answer.

In this way, after Fang Xian finished reading all the flat films in the second stage, two and a half hours had already passed.

It's already past lunchtime.

At the end of the assessment, Fang Xian's final score was 91 points, and the assessment had passed!

But! ~

When Fang Xian saw this achievement, he was still skeptical.

looked at Professor Zhou and Professor Yang.

"Let's go, go to eat, people are iron, rice is steel, and the performance is quite good. If it weren't for the fact that two of the MRI machines were too brainless, you would probably have scored more than 93 points. Yang Yifeng said this a little old-fashionedly.

The three of them just casually found a fly restaurant and had lunch.

Taste ok.

And during the time of cooking, Professor Zhou and Professor Yang didn't say a word, so Fang Xian didn't want to continue to ask, but he was secretly drumming in his heart.

Isn't it, I really have a problem with my current MRI reading technique, and it shows level 5 on the panel, but it can't pass the level 5 skill level certification assessment of the medical association?

Then it's a bit of fun.

After the meal, the three of them came to the skills training room again.

Fang Xian was a little unstable in front of the first MRI plain film of the 'Level 3 MRI Reading Technique', and almost broke the big defense......

The medical society defines the skill level of MRI reading as such that level 1 can see the location of the lesion and determine the anatomical direction. Level 2 depends on the nature of the lesion, and at the same time, it can distinguish what type of lesion it belongs to.

Such as trauma, chronic injury, infection, etc.

Level 3 looks at the anatomy, such an anatomy is a pure anatomy, not the general position of the anatomy seen in the level 1, but an absolute anatomy, which is to find the blood vessels, nerves, arterial veins, etc. of the human body in the MRI.

But even so.

Fang Xian, who has a level 5 MRI reading technique, doesn't feel that he can't do it.

But at the moment!

Fang Xian stood in front of the assessment table, carefully looking at the MRI images on the screen, and his mood could not be calmed down for a long time.

The first image made Fang Xian almost lose his senses, and I really wanted to say, what kind of thing is this.

First, the MRI image shows that the image is located in the upper abdomen.

That's right, because the ribs can be faintly seen.

However, what is shown on this MRI is -

If Fang Xian's cursory glance is correct-

It is believed that the abdominal wall is ruptured, the vertebral body is bursting and fragmented, and in the upper abdomen, the phalanges of the toes, teeth, and the uterus and its appendages appear......

Obviously, the phalanges, generally in the lower limbs, are the bony support of the toes, which come from the lowest part of the body, and the teeth come from the mouth.

The uterus is the organ in the lower abdomen.

And the positioning of this piece is an MRI of the upper abdomen.

However, there is no visible liver, pancreas, spleen and other organs that should belong to the upper abdomen, only the remains.

This is a sheet that has no clinical medical significance, no biological significance!

MRI with diagnostic significance only!

Fang Xian has had surgery to destroy the injury, but the damage in the clinic is much more refreshing than this thing.

There is absolutely no possibility of survival for a patient's organs to be displaced to such an extent, and it is estimated that the teaching hospital took such a random photo before the corpse was collected and used as material for teaching and examinations.

And the diagnosis of this MRI, although it is meaningless, is a bit too much.

This time, the form of assessment is to fill in the diagnosis by yourself according to the content of the MRI image, and the content of the MRI image is the absolute standard.

Even if there is a mismatch between the anatomical position and the unknown cognition, the performance on the MRI image is still the benchmark.

What else can I do?

There are many diagnoses, so I need to do it.

Otherwise, the teachers in the trauma center can not carefully analyze the diagnosis of damage one by one?

Fang Xian read the film carefully and began to type: "Open injury of the upper abdomen: fracture of the abdominal wall, multiple organ damage, multiple organ displacement, multiple abdominal internal organ damage: liver rupture, spleen rupture, ......"

"Ectopic bony tissue, toe fracture ......"

"Multiple vertebral burst fractures, thoracolumbar spinal cord burst injuries, pedicle tears, multiple splanchnic nerve injuries, ......"

"Uterine and adnexal tear lines fall off, bladder rupture, ......"

In this film, the final diagnosis is more than 600 words.

Moreover, the diagnosis is not as simple as typing words, and it took more than 20 minutes for Fang Xian to correct the diagnosis.

It is not difficult to read the film, but it is very time-consuming to type out so many words, if it is a follow-up diagnosis, it is arranged like this, Fang Xian estimates that the skill assessment of this level 3 MRI reading technique will have a total of more than 100 questions.

I'm afraid it will take dozens of hours to complete this assessment.

It is no wonder that the skill level assessment of the medical association is very difficult, and some people say that it is the standard of a dead mother.

Fang Xian finished correcting the text, checked it for another three minutes, and then took a half step back, and bowed very reverently to the general teacher to whom this flat film belonged.

The appearance of this set of NMR, for teachers, has no meaning of life, and its appearance only has teaching significance.

Respect is also in the heart.

After Fang Xian finished writing, he clicked on the next MRI image.

The red light reappeared, which seemed to represent that Fang Xian's previous diagnosis was still wrong or missing.

But it can't be helped!

Fang Xian has made a total of more than eighty diagnoses, and this has not been able to complete all the diagnoses, it is really too many diagnoses!

Some inconsequential diagnoses, meaningless diagnoses at all. Fang Xian didn't fill it in, because the answer to the exam questions of this skill trainer was too harsh.

Fang Xian's mood collapsed slightly.

After all, it is not good to be a teacher.

And he looked at the MRI sleeve in the second assessment table, and after looking at it, his brows furrowed again.

Something was wrong.

This is an MRI of the right shoulder joint.

The text indicates that there is no obvious abnormality.

But at this stage, the text has no reference meaning, and the NMR performance is the most correct answer.

At first glance, there was no obvious abnormality, and, because of his previous experience, Fang Xian also carefully looked at the diameter of the muscles and nerve fibers, and he also saw no obvious abnormality.

However, after Fang Xian changed the level many times before and after, he finally discovered the problem.

I almost got an eye-catcher-

This patient did not have fractures, ligaments, muscles, or rotator cuff injuries that are common on MRI of the shoulder joint!

However, it is a post-operative MRI sleeve.

And this surgery, which happens to be related to orthopedics, is called phrenic nerve transfer.

This requires a very deep reading skill to discover, and it also requires a certain amount of professional knowledge.

Then after Fang Xian looked at it carefully, he realized that it was a transposition of the phrenic nerve and the ulnar nerve.

It may be that there is some structural abnormality proximal to the ulnar nerve, so this transposition is performed to replace the destruction of the proximal ulnar nerve and thus reconstruct the function.

It's just that such an operation will have certain sequelae!

That is, when you have a normal hiccup, or when there is abnormal activity of the diaphragm, the little finger and ring finger may bend involuntarily.

But it's also an alternative treatment.

To diagnose this, theoretical knowledge of trauma surgery and hand surgery is required.

Fang Xian was thinking, such a diagnosis, the doctor in the imaging department would really be? Are they so knowledgeable?

Therefore, Fang Xian generously wrote the diagnosis: "After phrenic nerve-ulnar nerve transposition." ”

Only need to write the diagnosis, not the specific performance, and Fang Xian will not repeat it.

Then click on the third set of NMR sets!

This time it did not appear red, which means that Fang Xian's diagnosis is preliminarily correct.

This MRI is relatively simple, it is just a multiple space-occupying lesion in the skull, and it only needs to correspond to different gyrus.

There was no compression of the blood vessels, and no other infections were seen, so Fang Xian quickly wrote multiple intracranial masses: frontal gyrus and temporal gyrus mass lesions, the nature of which is to be investigated......

Although Fang Xian could be sure that it was a glioma, at this time, Fang Xian felt that it was better not to be a big smarter.

It's just that when Fang Xian was about to click to the next one, Fang Xian found a big hole in this question, and quickly withdrew the little paw that was about to hold the mouse, and corrected the previous diagnosis.

"Consider normal cranial images."

He also muttered in a low voice: "What kind of neuropathy wears a hat to do an MRI of the skull......"

Yes, this patient is not sick at all, and the previous occupancy is actually a projection of a hat.

"Uh-huh! ~" When Fang Xian finished muttering and scolding, Zhou Cheng coughed.

"Do the questions well, don't complain."

Fang Xian immediately turned his head and saw that Professor Yang Yifeng's expression was not quite right at the moment, so he quickly closed his mouth obediently.

Oh, it's Professor Yang, that's okay!!

It wasn't until the sixteenth plain film that Fang Xian encountered the more troublesome MRI image again. And it's a very interesting set of influence diagrams.

If nothing else, if you are a beginner or someone who does not understand pediatric orthopedics, it is very easy to misinterpret the MRI of the wrist joint.

Because the bones of the wrist joint are not fully developed, and the ulnar radius is separated from the epiphysis, and the metacarpal bone is abnormally developed.

Then, on top of the MRI, there were still signs of multiple bone loss and nerve dissociation.

The corresponding text prompts given, that are a lot, it is estimated that at least several imaging professors, after carefully reading the film, gave the most tempting diagnostic report, and then asked you to delete and reduce some.

However, the final result is to remove all the diagnoses and revise them to: normal wrist signs in 6-year-old children.

Yes, in childhood, the age of the child can probably be seen through the plain film of the wrist joint.

The reason why Fang Xian was able to determine that he was six years old was because the articular surface of the small polygonal bone at the proximal end of the second metacarpal bone began to concave, and the ossification center of the epiphysis of the ulna began to appear.

In addition, the adjacent faces of the skull and hook bone have overlapped.

The skull here does not refer to the peripheral bones of the skull, but to have a sesamoid bone called the skull in the wrist joint, which is adjacent to the hook bone.

This NMR is very tempting and partial.

It needs to be carefully screened, and it is not particularly difficult, and it can only be difficult for people with average level.

It can only be regarded as a small episode.

However, just when Fang Xian was about to go down like this.

I found that TM's, this MRI, still has a big hole, and I almost didn't avoid it.

This is not a plain wrist joint of pediatric orthopedics for children, this TM is not a plain film of the wrist joint of a person, it is estimated to be a monkey's ......

(End of chapter)