【My medical skills can add experience points】【】
"Okay, I'll come right over."
Zhou Can answered very simply. He waited until Director Zhang hung up the phone before he moved the phone away from his ear.
It is the most basic courtesy to wait for the other party to hang up first when talking on the phone with elders, teachers, or leaders.
Some newcomers in the workplace are used to being careless. When talking to their leaders, they are 'informal', rushing to hang up the phone, or rushing to talk to the leaders. These are taboos.
If you don't pay attention to these details, it's easy to see that other colleagues who joined the company are obviously not as capable as yourself, but they are getting better every two years.
But he was still standing still.
Human accidents are equally important as work ability and business level.
Dr. Pang, who was standing next to him, watched Zhou Can hang up the phone and secretly breathed a sigh of relief. She could hear clearly just now that director Zhang Bihua relied heavily on Zhou Can, and he treated Zhou Can as an equal when talking.
She was particularly afraid of Zhou Can suing her.
Fortunately, Zhou Can has the generosity of a man, and acts aboveboard.
And did not clean her up.
"Doctor Pang, I would like to trouble you and the two nurses to take care of her for a while. I will go to the outpatient hall and I should be back soon. In case of any emergencies, please call me as soon as possible."
Zhou Can left quickly after instructing the three of them.
Dr. Pang watched Zhou Can leave and felt a chill down his back.
It was only then that she discovered that Director Zhang had spoken to Zhou Can just now, which scared her into a cold sweat.
When Zhou Can rushed to the outpatient hall, he found that yesterday's female patient with polydipsia, diabetes insipidus, and impaired consciousness was sitting at Director Zhang Bihua's desk for diagnosis. She looks much better than yesterday.
Yesterday he looked demented, with a bent body and sickly.
After a day of hospital treatment, she now looks like a completely different person. My mind is much clearer, and my eyes have a gleam of light.
"Doctor Zhou, I'm just waiting for you to come over and help with the consultation!"
A deputy chief physician of the obstetrics and gynecology department greeted Zhou Can with a smile for the first time.
"Ah... me? I'm just a little Pearson, you're flattering me too much! Director Luo's words are not putting gold on my face, but putting a bucket of gold on my head."
Naturally, Zhou Can would not foolishly acquiesce in other people's flattery.
This director Luo had never even looked at him before, but now he suddenly became so enthusiastic, just two words 'snobbish'.
"Doctor Zhou has working experience in rotations in multiple departments, so maybe he can give some constructive diagnostic advice on this case!" Zhang Bihua took over the conversation.
"After the patient was treated with measures such as fluid replacement and intravenous infusion of insulin, her blood sugar and blood sodium have dropped a lot, and her mind has become much clearer. However, she still has poor appetite, poor mental state, and poor sleep. At the same time, she drinks a lot. Urine and other symptoms still exist.”
When Zhang Bihua said this, Zhou Can understood what it meant.
Although the patient's condition improved greatly after treatment, it was just a temporary solution.
At present, only the patient's diabetes is in remission.
Zhou Can looked at the patient.
"Are you having normal bowel movements now?"
"once a day."
Patients have been able to communicate directly with Zhou Can.
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【My medical skills can add experience points】【】
This made Zhou Can very happy.
"Have you checked the patient's menstrual and marriage history?" Zhou Can turned to ask Director Zhang.
"Just now, I asked her when she was sober. She had menarche at the age of 14, and each menstrual cycle is about 50 days. It looks like five days of menstruation, and the amount of menstrual blood is heavy. She got married at the age of 21 and gave birth to a child."
Director Zhang briefly introduced the patient's situation.
A normal woman's menstrual cycle is between 28 and 35 days, but this patient's menstrual cycle is as long as 50 days, which is obviously abnormal.
But from another perspective, a 50-day menstrual cycle may not be a bad thing.
Because women ovulate about 400-500 times in their lifetime. In fact, most women only ovulate around 400 times in total.
[In other words, currently the best app for reading and listening to books, Yeguo Reading, install the latest version of .yeguoyuedu. 】
A 28-day menstrual cycle means that the eggs in the body will be discharged in a shorter period of time.
At this time, women will stop menstruating and menopause will come.
Some women stop menstruating in their forties, and menopause comes later, which is not a good thing.
Because according to scientific research, the later a woman's menopause age, the slower her aging process, and the body's immunity can always be maintained at a high level.
This patient had a menstruation every 50 days, almost twice as long as the average woman.
It also means that she stops menstruating later than the average woman and menopause comes later.
"What about her current physical condition?"
"Body temperature is 37.7 degrees, heart rate is 83/min, respiration is 24/min, blood pressure is 116/75mmhg." Yang Chan replied next to her.
She is responsible for every physical examination of patients.
It is equivalent to laying hands on Director Zhang.
Body temperature is low-grade fever, blood pressure and heart rate are basically normal.
Zhou Can walked around to the patient to check her neck.
"It has been checked, and the pharynx is slightly red and swollen, the tonsils are obviously enlarged, and the thyroid gland is normal. There is no obvious edema in the lower limbs. The breathing is normal and there is no noise."
Yang Chan's work is quite meticulous.
Zhou Can smiled and gave her a thumbs up.
"It's worthy of being a famous teacher who produces a talented student. The monitor's physical examination work is really good!" In one sentence, both Director Zhang and Yang Chan were praised.
Both of them had a smile on their faces.
There are very few women who don't like being praised.
"Have you tested the patient's urine?"
"Here, this is the latest urine test report." Yang Chan took the initiative to hand over the results of the urine routine test to Zhou Can.
After taking it, Zhou Can took it and looked at it, and then checked the patient's other biochemical examination data.
"The urine ketone body is positive, and the blood gas indicates metabolic acidosis, so she must be ketoacidosis!"
Zhou Can made a conclusion after reading it.
"The diagnosis result was given by Director Zhang and other experts just now."
Yang Chan replied.
"What we need to consider now is why the patient will experience disturbance of consciousness or even coma after stopping the drug and switching to traditional Chinese medicine?" Director Zhang pointed out the problem to be solved to Zhou Can.
The experts have just discussed, and there should be some conclusions.
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【My medical skills can add experience points】【】
It's just that there may be some differences of opinion.
"From the analysis of the patient's symptoms and examination data, I think her disease should be treated separately. The cause of disturbance of consciousness and even coma is not necessarily related to taking traditional Chinese medicine. She should be in hyperosmotic coma."
Zhou Can found that during the diagnosis process, his mind was exceptionally clear and his thinking was clear.
"Hyperosmolar coma often occurs in elderly patients, but she is only in her thirties, still very young. Personally, I think the possibility of hyperosmolarity is unlikely."
Director Luo, who was somewhat snobby, disagreed with Zhou Can's diagnosis.
"There are no absolutes in the world, and this patient's situation is quite special. My diagnosis is as follows. The patient had been taking Mining before, and only when she stopped taking the medicine did the diabetes insipidus worsen and her body became dehydrated. Then she also The hypoglycemic drugs were also stopped, and Chinese medicine was used instead. This will lead to an increase in blood sugar levels, and dehydration will inevitably increase, eventually leading to hyperosmolar coma. Ketoacidosis is also caused by the discontinuation of hypoglycemic drugs."
Zhou Can made a detailed analysis of the patient's pathological mechanism and its pharmacological mechanism.
【Pathological diagnosis experience value +1, pharmacological syndrome differentiation experience value +1. If you successfully diagnose a difficult case, the experience points of pathology and pharmacology will each be rewarded with 100 meridians. 】
The experience points have already been credited, which shows that Zhou Can's diagnosis is completely correct.
The diagnosis of this disease in five days is not difficult at all.
The main reason is that there are multiple and complex diseases, like a bundle of hemp. If you want to diagnose the pathology correctly, you must straighten them out one by one.
Zhou Can diagnoses and treats amenorrhea, polydipsia, disturbance of consciousness and other diseases separately, which greatly reduces the difficulty of diagnosis.
And can not be interfered by other pathological mechanisms.
"Well said! I think the diagnosis opinion of the patient in hyperosmolar coma is completely correct." Director Zhang firmly supported his diagnosis conclusion after listening to Zhou Can's analysis.
"Well, even if the patient's disturbance of consciousness is a hyperosmolar coma, what about her polyuria?"
Director Luo compromised.
"Don't worry, let's treat them one by one. The patient's polyuria and polydipsia, based on the analysis of the test data and her actual condition, can basically be diagnosed as diabetes insipidus. And it belongs to central diabetes insipidus."
Zhou Can's split-and-attack style of play has also refreshed many doctors.
Because many doctors are accustomed to a fixed thinking, thinking that although patients have many symptoms, there is usually only one cause. Find the cause of the disease and treat it symptomatically, and the disease will be cured.
In fact, it does.
But there is also the possibility of multiple diseases or multiple diseases.
The most common clinical situation is that a patient suffers from multiple underlying diseases at the same time, for example, a patient suffers from hypertension, diabetes, and nephritis at the same time, which is extremely common in clinical practice.
But this common underlying condition is very easy to diagnose.
High blood pressure, blood pressure was checked out.
If you have diabetes, check your blood sugar and urine routine. Even for more complicated diabetes, a supplementary liver and kidney function test, blood lipid, and islet function test can also confirm the diagnosis.
The above-mentioned diseases basically have gold standards for diagnosis, so they are easy to detect.
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【My medical skills can add experience points】【】
The cause of this patient is complicated and confusing. Type 2 diabetes is only one cause on the surface, but because the patient listened to his relatives and stopped taking western medicine and taking traditional Chinese medicine, which made the disease worse, it is obvious that there is more than one cause.
Under such circumstances, if the diagnosis and treatment of diabetes are still carried out, it will definitely be like the doctors in the previous hospitals, unable to cure the disease at all.
"Judging from the results of the patient's water deprivation-vasopressin test, the diagnosis of central diabetes insipidus is tenable." Director Jiang of the Neurology Department supported Zhou Can's diagnostic point of view.
So many experts at the scene jointly diagnosed the woman, attracting many family members and patients to watch.
In addition to being surprised, they also wanted to take the opportunity to see which of these experts was more powerful.
At the same time, you can also see how the experts diagnose the disease?
The water deprivation-vasopressin test of this audio-visual teacher showed that desmopressin was stopped twice. After eight hours of water deprivation, the blood osmotic pressure was 330mosm\\/l, and the urine osmotic pressure was 103mosm\\ /l, after the injection of vasopressin, the urine osmotic pressure rose to 590mosm\\/l.
The MRI detection of the sellar area revealed that the pituitary stalk was thickened, and the high signal in the posterior lobe of the pituitary disappeared.
Zhou Can determined that the patient had central diabetes insipidus based on the key data of these examinations.
"Then what causes central diabetes insipidus? Is it caused by type 2 diabetes?" Yang Chan really didn't understand and asked, since Zhou Can was her classmate anyway.
"I think it should be caused by pituitary stalk disease."
Zhou Can was very confident about the diagnosis.
Yang Chan didn't need to actively ask, he went on to explain, "Pituitary stalk lesions, germ cell tumors can easily cause this disease in the clinical process. And it usually occurs in children. This patient is in his thirties, basically The possibility of germ cell tumor can be ruled out. From the analysis of her examination data and symptoms, lymphocytic hypophysitis may be more likely."
After Yang Chan finished listening, she pondered for more than ten seconds, then nodded half understanding.
"Now I just suspect that the probability of lymphocytic hypophysitis is high, but there is no way to diagnose it!"
She was able to put forward this opinion, which shows that she really thought about it, and she has a certain understanding of Zhou Can's diagnostic thinking and the pathological analysis in it.
Zhang Bihua couldn't help showing a satisfied smile when he saw the obvious progress of his lover.
First he looked at Yang Chan, and then at Zhou Can. There seemed to be a trace of expectation in his eyes, and he hoped that the two young people could communicate and cooperate more.
More precisely, she hoped that Yang Chan could learn from Zhou Canduo.
"The best way to diagnose this disease is to take tissue samples for biopsy, but the surgery is very difficult."
Zhou Can's current surgical ability is not bad.
It has even been comparable to many chief physicians in surgery.
Even he said that the operation is difficult, which means that sampling for pathological biopsy is basically impossible.
No doctor would dare to take such a risk.
Especially the patient's current physical condition is extremely poor, and the ability to tolerate surgery is enough to make any surgeon daunting.
"Then is there any other way?" Yang Chan asked.
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【My medical skills can add experience points】【】
"There must be a way! For example, direct radiation therapy instead of pathological biopsy." Zhou Can looked at the family members and patients.
When many family members hear about radiotherapy, they can't help but associate it with cancer and strong side effects.
In fact, radiation therapy does cause some harm to the body.
Such as hair loss, sore throat, nausea and vomiting, headache, fatigue and so on.
"We won't do it, we won't do it!"
The family members directly shook their heads and refused.
"Actually, radiation therapy is not as scary as imagined. I suggest you try it once and see the effect of the treatment before deciding whether to continue radiation therapy."
Director Zhang Bihua spoke at this time.
She directly helped Zhou Can with the ideological work of his family members and patients, which showed that she recognized Zhou Can's diagnosis result.
"Thank you, Director Zhang, for your kindness. We don't do this treatment. Because we had a relative who died after radiotherapy, and someone in our village also suffered from radiotherapy, and his health deteriorated day by day, and finally died."
The family members were extremely resistant to radiotherapy and were full of fear.
Doctors only have the right to make suggestions, and if family members and patients disagree, there is no way to implement them.
Seeing that Zhang Bihua couldn't be persuaded, he rolled his eyes and thought of a new idea.
She looked at Zhou Can.
"What does Dr. Zhou think is the cause of the patient's amenorrhea?"
Zhou Can and Director Zhang looked at each other and understood her deep meaning in seconds.
It seems that Director Zhang has already diagnosed the cause of the patient.
Maybe he was not sure, or he wanted to train the juniors, so he was called to help with the consultation.
"I don't think the cause of the patient's secondary amenorrhea was caused by dilatation and curettage, but by pituitary lesions. It is not difficult to diagnose this, just do a functional test of each thalamus-pituitary axis."
Zhou Can determined that the patient's central diabetes insipidus and amenorrhea were all related to pituitary lesions.
"What are the opinions of the experts?"
Zhang Bihua also knew that Zhou Can was young and had little qualifications. His family members and patients might not be convinced by what he said.
This requires other experts to support Zhou Can's argument.
"I think Dr. Zhou's diagnosis should be correct." Director Jiang was the first to support Zhou Can's point of view.
"It's a good idea to do a functional test of the thalamus-pituitary axis. As long as the results come out, it will be clear whether the cause of amenorrhea is caused by pituitary lesions."
Surprisingly, Du Leng stood up to support Zhou Can's inspection plan.
Facing Zhou Can's gaze, Du Leng immediately looked away.
He, a returnee Ph.D., must perform well, right?
You can't just watch Zhou Can make a splash by himself!
Mystery is just what he is good at~www.mtlnovel.com~ He has been listening carefully to Zhou Can's analysis just now. After analyzing it, although he is not convinced on his face, he agrees with Zhou Can's diagnosis ideas and opinions in his heart.
Jumping out to support Zhou Can now can not only show his generosity, but also show his face once.
It is equivalent to Zhou Can planting peach trees, and he picks peaches.
"Would you like to do this test?"
Director Zhang looked at the family members and patients.
The patient belongs to the kind of woman who has no independent opinions, and everything is based on the opinions of her husband. She looked at her husband beside her.
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【My medical skills can add experience points】【】
"As long as we don't do that radiotherapy, we are all willing to do it."
The family members agreed to do this inspection.
Director Zhang issued an inspection application for them and asked them to hurry up and do it.
After the family members and patients left, Zhang Bihua looked at Zhou Can.
"How does Dr. Zhou think this patient's blood sugar should be controlled?"
Finding ways to control the patient's blood sugar should be a top priority.
I have already used the medicine yesterday, and I must continue the treatment today.
Everyone knows that the treatment of diabetes only needs to use insulin.
Director Zhang deliberately tested him, and naturally asked about specific medications.
"I think the regular administration of insulin glargine, followed by intensive therapy with insulin aspart before meals, should bring this patient's blood sugar under control fairly quickly."
Zhou Can gave the answer.
In his mind, he was thinking about how to treat the patient's pituitary lesions.