Several young doctors looked at the medical records for a long time but only understood the general idea. They were not sure and asked Chen Xia to help explain it.
Chen Xia took the medical record and explained each line of text one by one.
"Let's first look at the chief complaint from the Second Hospital: a 20-year-old young male, previously healthy, thin, with limb weakness for two weeks and mental disturbances for four days. What can you tell from this complaint?"
Wu Shaochen: "Two weeks of weakness in the limbs. Does this indicate muscle weakness caused by various myopathies?"
Mo Yongfang: "Mental abnormality, could it be a mental illness caused by a broken heart? Or hysteria cannot be ruled out."
Chen Xia knocked his head. "Idiot! The previous pathological signs were all positive. Add to that the weakness in the limbs and the mental abnormalities. Of course, the first thing to consider is an abnormality in the central nervous system. How can you not identify something so simple?"
Mo Yongfang was rather stubborn. "Mr. Chen, I'm not convinced. Can you explain it in detail and see if you can convince us?"
"Come, let me explain it to you one by one.
The patient is a young male with a subacute onset and progressively worsening symptoms. Symptoms progressed from limb weakness over two weeks to an epileptic seizure four days ago, and then to psychiatric disturbances. His personal history included recent emotional problems. Physical examination revealed impaired consciousness, higher-order functional impairment, horizontal nystagmus, and positive pyramidal tract signs. Is this generally true?
Now let's pick out some words. Two weeks ago, there was no inducement, and then the symptoms of limb weakness gradually worsened. Four days ago, there were convulsions, foaming at the mouth, upturned eyelids, twitching of the limbs, incontinence, positive horizontal nystagmus, bilateral pathological signs (+), and meningeal irritation signs (-).
Do you see what's coming?"
Wu Shaochen suddenly understood: "Oh~~~ I see, the lesion is more likely to be in the brain."
Chen Xia nodded. "Based on the main positive symptoms, we can basically locate the lesion. It has spread from the bilateral cerebral white matter to the cortex, involving the vestibular center. It is a diffuse multifocal disease."
Mo Yongfang wasn't good at treating illnesses, but he was the best at flattering people. He immediately gave a thumbs up and said, "High, it really is high."
"Get lost! Do you think this is Tunnel Warfare? Are you the puppet army commander?"
Hahahaha~~~~~
"Pay attention, be serious. You're seeing a doctor. Be careful of complaints. B-society big brother Gu Weige won't let you go."
Hahahaha~~~~~
Everyone covered their mouths and hid their faces with medical records. They wanted to laugh but didn't dare to, and it was very difficult to hold it in.
Lin Jianjiang and Cao Liping stood by and smiled awkwardly, and began to admire Chen Xia a little in their hearts.
As a qualified "old teacher", although his personality was a bit vacant back then, he had 5 years of undergraduate study, 3 years of graduate school, and many years of rotation in emergency internal medicine and surgery after joining the workforce. His foundation was still there, and it was easy for him to deal with a few young people.
"What a joke! Come on, let me test you. For horizontal nystagmus, where do you think the lesion is located?"
Several young doctors looked confused, and the smarter ones had already taken a step back.
"Stupid, the lesion is in the brainstem. Come, let me test you again. What does a positive bilateral pathological sign indicate? Mo Yongfang, you don't need to retreat anymore. Answer it."
Mo Yongfang looked miserable: "Mr. Chen, your question is too difficult. Can you make it simpler?"
"Hey, that's easy. Okay, then let me ask you, clinically, what are the three types of myasthenia gravis based on the anatomical location of the lesion?"
"I know this. It's divided into upper motor neuron central paralysis, lower motor neuron peripheral paralysis, and myopathic paralysis."
"Then can you tell me about the characteristics of upper motor neuron paralysis?"
"Damn it, Mr. Chen, it's easy to lose friends if you keep doing this. Oh, could you please stop asking so many questions? I, I, I..."
"Fuck you! Get lost! A college student doesn't know as much as a technical secondary school student like me, and you still have the nerve to laugh. I'll punish you by buying me some popsicles."
Everyone just breathed a sigh of relief and looked at Mo Yongfang sympathetically, when suddenly Chen Xia pointed at Wang Jinfa and asked, "You, answer it."
Wang Jinfa hesitated for a long time before saying, "I'll go buy some popsicles."
Now everyone couldn't hold it in any longer and almost laughed out loud, and could only cover their faces with their hands.
Chen Xia stopped talking. He still had to teach what he needed to teach. These little fans might become the backbone of each department or even the director in the future. Then they would become Chen Xia's direct subordinates.
In a hospital, it's unusual to have no gangs or factions. Where there are people, there are rivers and lakes. Now that Chen Xianyu has been reborn, he can't continue to be as lazy as in his previous life, right? Otherwise, this novel won't be good.
"In fact, for this patient, we can use the SHMITT principle for diagnosis and differential diagnosis."
When everyone saw that Section Chief Chen was about to start teaching formally, they all took out paper and pens. The medical knowledge he spoke of was not something that could be learned from books.
For example, they had never heard of the SHMITT principle method and thought it must have been created by Mr. Chen. While they admired him, they also wanted to learn it well.
“S-vessel disease: acute onset, rapid progression, often unilateral lesions, so this patient does not meet the criteria and can be excluded;
H genetic disease, M metabolic disease: slow onset and long course, which may take years or even decades. This patient only had 2 weeks, so it does not meet the criteria;
I Infection and Immunity: The patient has no fever and normal white blood cell count in blood test, which does not meet the requirement;
T tumor and trauma: No headache and no history of trauma at the time of onset, so it does not meet the requirements. Of course, vomiting after being drunk does not count.
T poisoning: The patient had a subacute onset, characterized by eye symptoms, ataxia, and mental impairment. So, guess what? Does this resemble Wernicke's encephalopathy caused by alcohol consumption? The patient had no respiratory or circulatory symptoms, so does this suggest chronic drug poisoning?
Other systemic diseases: such as hysteria, psychosis, etc., are they possible? However, the pyramidal tract signs of these diseases will not be positive, so they do not meet the criteria.
Therefore, through the SHMITT principle, we can actually determine a general situation without the aid of a test report, and it also helps us to be more targeted during the examination, rather than looking for a needle in a haystack or feeling an elephant in the dark, which may lead to missing the best opportunity for rescue and treatment.
After talking for a long time, Chen Xia felt a little thirsty. Nurse Lin Xingchen very considerately handed him a thermos cup and looked at him with admiration.
This caused the glasses of Lin Jianjiang and Cao Liping, who were watching, to shatter.
After all, they graduated from high school, but they are the youngest employees in the company. They usually just do odd jobs for the master chefs and do small tasks. They dare not even make a sound at work.
Look at Chen Xia again. He didn't even finish high school. He probably took over his father's job and went to work in the hospital. Two years later, he has transformed himself and looks like a real master. He even has someone handing him a cup when he drinks water.
Comparing yourself with others is really frustrating.
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