"What's wrong, Old Li?"
"No, the rounds are about to start, right?" Old Li looked at the words on the A4 paper and asked in a low voice.
"Yes, there's still one minute left."
The rules of the internal medicine department were very strict. They had to start when the time was up. There was no such thing as being late.
When the time was up, the door was closed, and no one was allowed to enter. If they really missed it, they would be scolded by the director for four hours.
Soon, the rounds began. Doctor Wang from the endocrinology department began to introduce the patient's condition.
Old Li listened to the introduction of the patient's condition while looking at the words on the A4 paper. The person who wrote should have some understanding of the patient's condition, and it was very detailed.
The test items on the problematic test list were almost identical to the pre-hospital medical history reported by Doctor Wang.
Interesting. Old Li felt that the patient's family was quite meticulous. The doctor who went to consult was probably an experienced doctor. He omitted what should be omitted and detailed what should be detailed. He could not find any mistakes.
It was just a pre-hospital analysis of the patient's condition, but Old Li felt a sense of cherishing talent.
This was a talent. It would be a pity if he spent half his life in a small hospital and attributed his talent to mediocrity.
He would wait and see first. If his final diagnosis was close, he might as well ask the doctor what he thought.
If he was really a good young talent, he could give him a chance.
Old Li thought to himself and turned to the second page.
[The pre-admission CT showed that there was a solid space occupying the bilateral adrenal glands. I think the level of the First Affiliated Hospital of Provincial Capital Medical University should not be so low. Really send the patient to the Department of Genitourinary Surgery and prepare for surgery.]
This child.
Old Li adjusted his reading glasses. After seeing this sentence, he did not get angry. Instead, he revealed a knowing smile.
She looked at the CT. It did look like a solid space occupying. If it was a doctor from a small hospital, he might have considered it a malignant tumor. However, after she finished looking at it, she considered a hematoma. The 64-slice CT enhancement that came back later also confirmed this point.
This child was still talented. Looking at the radiographic films, it was not that simple. It was just that his tone was a little sharp, and he was still not polished enough.
[I think the enhancement has been completed. There is no blood supply. The diagnosis is a hematoma. If you already have a clear judgment, you can ignore this paragraph.]
If you want to use the sharp, you must first rub the sharp. Old Li thought in his heart. This child still did not know how many experts there were in the world. He still thought that he was very capable.
If it was his own student, he might have to sternly reprimand him for a period of time to wear down his arrogance.
Thinking of this, Old Li smiled awkwardly. I'm not that kind of person. It's hard to scare people by pretending to be fierce.
However, there were many ways to get rid of one's temper. You didn't have to scold someone.
[Combined with skin pigmentation, cortisol, ACTH, aldosterone, renin, androgen, the diagnosis of primary adrenal insufficiency is clear.]
Yes, this sentence is correct.
[Are you done with the differential diagnosis? If you haven't done it yet, then don't do it. It's an immune system disease. It's still not too late to seek my Rheumatology Immunology for a consultation.]
"Oh, he's a doctor from the Department of Rheumatology and Immunology," Dr. Li thought.
Usually, doctors with high standards in the Department of Rheumatology and Immunology were in charge of handling all kinds of difficult and miscellaneous diseases. It was inevitable that they would be arrogant and think that other people did not know how to treat patients.
Is it a rheumatic disease? I'm thinking the same thing. Let's see what he says first.
However, Old Li was not in a hurry. Instead, he fixed his gaze here and listened carefully to the consultation opinions of the other departments.
The differential diagnoses of adrenal tuberculosis, fungal infection, solid tumors, and so on were identified one by one. Old Li was very satisfied with the doctors he had trained.
It was well-grounded and well-organized, just like solving a difficult math problem.
Finally, Doctor Wang gave his opinion and suggested that the Department of Rheumatology and Immunology consult.
"Thromboembolism is a type of disease that is prone to thromboembolism due to genetic defects such as anticoagulant proteins and fibrin, or due to the presence of risk factors for acquired thrombosis." The director of the Department of Rheumatology and Immunology sat in his seat and began to speak while flipping through the medical records in his hands.
"Acquired thromboembolism is also known as acquired hypercoagulable state. The causes include antiphospholipid syndrome, pregnancy or oral contraceptives, perioperative and traumatic obesity, tumor disease, diabetes, paroxysmal hemoglobinuria, and nephrotic syndrome. Antiphospholipid syndrome is the most common."
"Based on the patient's medical history, the first clinical consideration is antiphospholipid syndrome."
Yes, it was the same as what he had thought. Old Li turned the A4 paper in his hand to the next page, ready to see if the rheumatology and immunology doctor from the outer hospital had also made the correct diagnosis.
[APS, I reckon that the technical strength of the First Affiliated Hospital of Provincial Capital Medical University would not have thought of this. Although the patient has a history of oral contraceptives and has a history of multiple miscarriages, this is only a trigger to aggravate APS.]
The little guy was quite interesting. Old Li's interest became stronger and stronger.
Next, some tests were displayed on the A4 paper. Some of them were known to him, and some were not available when he wrote this information.
The test results that did not come out were all analyzed according to whether there were problems or no problems.
[Now, are you sure that it is a primary APS or a secondary APS?]
Old Li looked at this paragraph with interest. After the director of the Department of Rheumatology and Immunology analyzed the examination report, he also began to talk about this point.
[It's secondary. Don't waste your energy thinking about it.]
It was too arrogant. Although the analysis was reasonable, Old Li still made a judgment for the person who wrote this information.
[According to the 2006 Sydney APS classification standards, it will take a long time. The patient will not be able to survive that long.]
Old Li looked at the words written on the paper and listened to the words of the director of the Department of Rheumatology and Immunology.
"This patient has thrombocytopenia, splenic vein, renal vein, bilateral adrenal vein thrombosis, lupus anticoagulation factor test positive, anti-cardiolipin antibody > 120.
RU/ml。”
The guesses on the paper were basically correct. When he obtained the information about the lupus anticoagulation factor test, he had not reported it yet. Should it be possible just based on guesses? Old Li was a little puzzled, but in his heart, he felt that this child was a little unsteady.
[Are you wondering how I guessed correctly?]
Whether it was forward or backward, there was always an objective basis. The words on the page were gone, and Old Li flipped to the next page.
It actually ended here. It was really intolerable!
[Actually, I'm not sure, but the boss said that judging from the image data, it can show that it is a secondary APS. We argued for five minutes about this, and I couldn't convince him. If your final examination results can prove that the boss's statement is wrong, you must tell me. I will throw the examination results in his face.]
Uh …
Old Li was stunned for a moment.
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