"Mr. Li, what's wrong?"
"No, the rounds are about to start." Mr. Li looked at the words on the A4 paper and asked in a low voice.
"Well, one more minute."
The rules for internal medicine rounds are very strict. You must start at the right time. There is no such thing as being late.
It closes at a certain time and no one can enter. If you really miss it, just wait until you go back and be pointed at and scolded by the director for 4 hours.
Soon, the rounds began, and Dr. Wang from the Department of Endocrinology began to introduce the condition.
Mr. Li listened to the brief introduction of the condition and read the text on the A4 paper. The person writing should have an understanding of the patient's condition and be very detailed.
The laboratory items listed on the problematic laboratory order were almost identical to the pre-hospital medical history reported by Dr. Wang.
It’s a bit interesting. Mr. Li feels that the patient’s family is very considerate. The doctor I went to consult was probably an experienced doctor. He omitted everything that should be omitted and detailed what should be detailed, but he couldn't make any mistakes.
Just a pre-hospital condition analysis made Mr. Li feel a pity for talents in his heart.
This is talent. It would be a pity if he spent half his life in a small hospital and reduced his talent to mediocrity.
Let's take a look at it first. If his final diagnosis is close, you might as well ask the doctor what he thinks.
If he really is a good young talent, I can give him a chance myself.
Mr. Li thought to himself and turned to the second page.
The CT scan before admission showed that there were solid spaces occupying the bilateral adrenal glands. I thought the level of the Affiliated Hospital of Medical University should not be so low, and the patient was actually sent to the Department of Urology to prepare for surgery.
This kid.
Mr. Li held up his flower mirror. After seeing this sentence, he was not angry, but showed a knowing smile.
She looked at the CT scan, and it looked like it was actually a placeholder. If you are a doctor from a small hospital, you may consider it to be a malignant tumor. But after reading it, she thought it was a hematoma. The subsequent enhanced 64-slice CT scan also confirmed this.
This kid still has some talent, but watching movies, it’s not that simple. It's just that the tone is a bit sharp and less polished.
I estimate that the enhancement has been completed. I judge that there is no blood supply and the diagnosis is hematoma. If you have already made a clear judgment, you can ignore this paragraph.
If you want to take advantage of it, first rub its edge. Mr. Li thought leisurely in his heart that this kid still doesn't know how many experts there are in the world, and thinks that his little ability is great.
If he were his own student, he might have to scold him sternly for a period of time to wear off the arrogance in his body.
Thinking of this, Mr. Li smiled awkwardly. I'm not that kind of person. I pretend to sound serious, but it's hard to scare people.
However, there are many ways to get rid of one's temper, and it doesn't necessarily have to be training.
Combined with skin pigmentation, decreased cortisol, increased ACTH, decreased aldosterone, increased renin levels, and decreased androgen levels, the diagnosis of primary adrenocortical insufficiency is clear.
Well, this sentence is correct.
Have you completed the differential diagnosis? If you haven't done it, don't do it. It's an immune system disease. It's not too late to consult me for rheumatism and immunology now.
Oh, it turns out to be a doctor from the Department of Rheumatology and Immunology, Mr. Li thought to himself.
Generally, doctors with high level of rheumatology and immunology are responsible for dealing with various difficult and complicated diseases. They inevitably have a sense of arrogance in their hearts, thinking that others will not treat them.
Is it a rheumatic immune disease? I thought about it myself too, let's see what he said first.
However, Mr. Li was not in a hurry. Instead, he stopped here and listened carefully to the consultation opinions of other departments.
Adrenal tuberculosis, fungal infection, solid tumors and other differential diagnoses were identified one by one, and he was very satisfied with the doctors he trained.
Well-founded and organized, just like solving a math problem.
Finally, Dr. Wang expressed his opinion and suggested consultation with the rheumatology and immunology department.
"Thrombophilia is a type of disease that is prone to thromboembolism due to hereditary defects such as anticoagulant proteins and fibrinolytic proteins or the presence of acquired risk factors for thrombosis." The director of the Department of Rheumatology and Immunology sat in his seat and turned his hands. He started speaking while looking at his medical records.
"Acquired thrombophilia, also known as acquired hypercoagulability, is caused by antiphospholipid syndrome, pregnancy or oral contraceptives, perioperative and traumatic obesity, neoplastic disease, diabetes, paroxysmal nocturnal hemoglobinuria, and nephropathy syndromes, etc., with antiphospholipid syndrome being the most common.”
"Based on the patient's medical history, antiphospholipid syndrome is the first clinical consideration."
Well, just as he thought, Mr. Li turned the A4 paper in his hand to the next page, ready to see if the rheumatology immunologist from another hospital also made a correct diagnosis.
As for APS, I guess the technical strength of the Affiliated Hospital of Medical University will not miss this place. Although the patient had a history of oral contraceptives and multiple miscarriages, this was only one factor that aggravated APS.
The little guy is quite interesting, and Mr. Li is getting more and more interested.
Next, some laboratory tests were displayed on the A4 paper, some of which he knew, and some of which had not been released when he wrote this information.
The inspection results that have not come out are all analyzed according to whether there are problems or no problems.
Now, are you sure it is primary APS or secondary APS
Mr. Li looked at this passage with interest, and the director of the Department of Rheumatology and Immunology also began to talk about this after analyzing the inspection report.
It's secondary, don't bother thinking about it.
Too arrogant. Although the analysis was well-founded, Mr. Li still made a judgment on the person who wrote this information.
Judging according to the 2006 Sydney APS classification standards, the time is very long, and the patient cannot survive that long.
Mr. 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, and bilateral adrenal vein thrombosis, a positive lupus anticoagulant factor test, and anticardiolipin antibodies >120 RU/ml."
The guesses on the paper were basically correct. When he obtained the information on the lupus anticoagulant factor test, he had not yet reported back. Is it right to just rely on guesses? Mr. Li was a little confused, but he felt that this child was a little unstable.
Are you confused about how I guessed it right
Whether it is forward reasoning or reverse reasoning, there must always be an objective basis. The words on the page were gone, and Mr. Li turned to the next page.
It's really unbearable that it's cut off here!
In fact, I am not sure, but my boss said that based on the imaging data, it can be shown that it is secondary APS. We argued for 5 minutes about this, but I couldn't convince him. If your final inspection results prove that the boss's statement is wrong, you must tell me and I will throw the inspection results in his face.
Well…
Mr. Li was startled for a moment.