Chapter 2152

"Old Li, what's the matter?"

"No, the tour is about to begin." Li Lao looked at the words on A4 paper and asked in a low voice.

"Well, one more minute."

The rules of the internal medicine tour are very strict. It must start when the time comes. There is no saying that you are late.

Close the door at o'clock. No one can enter. If you miss it, wait until you go back and be scolded by the director for four hours.

Soon, the tour began, and Dr. Wang of the endocrinology department began to introduce his condition.

While listening to the brief introduction of his illness, Li Lao looked at the words on A4 paper. The writer should know something about the patient's condition and be very detailed.

The test items listed in the problematic test sheet are almost the same as the pre hospital medical history reported by Dr. Wang.

It's a little interesting. Mr. Li thinks the patient's family is very interested. The doctor who went to consult is also an experienced old doctor. What should be omitted between the lines should be detailed. He can't make mistakes.

Just a pre hospital condition analysis, Li Lao's heart rose a feeling of cherishing talent.

This is a talent. It would be a pity if you spent half your life in a small hospital and attributed your talent to mediocrity.

Let's look at it first. If his final diagnosis can be close, I might as well ask the doctor what he thinks.

If you are a good young talent, you can give him a chance.

Li Lao thought and turned to the second page.

[the CT before admission showed that there was solid space occupying in both adrenal glands. I think the level of the Affiliated Hospital of medical university should not be so low. We really sent the patient to urology for surgery.]

The child.

Old Li held the flower glasses. When he saw this sentence, he was not angry, but showed a knowing smile.

She looked at the CT. It really looked like a real space occupying lesion. If you are a doctor in a small hospital, you may consider malignant tumors. But after reading it, she thought it was a hematoma. This was also confirmed by the subsequent 64 slice CT enhancement.

The child still has talent. Watching movies is not that simple. It's just that the tone is a little sharp, but it's still polished less.

I think the enhancement has been completed. It is judged that there is no blood supply and the diagnosis is hematoma. If there is a clear judgment, this paragraph can be ignored

If you want to use its advantages, rub its front first. Old Li thought leisurely that the child still didn't know how many experts there were in the world. He thought his ability was great.

If you are one of your students, maybe you should scold him for a period of time and wear off this pride first.

Thinking of this, Li Lao smiled in embarrassment. I'm not that kind of person. I pretend to be fierce, but it's hard to scare people.

However, there are many ways to wear off your temper. You don't have to discipline people.

[combined with skin pigmentation, decreased cortisol, increased ACTH, decreased aldosterone, increased renin level and decreased androgen level, the diagnosis of primary adrenocortical insufficiency is clear.]

Well, that's right.

[have you finished the differential diagnosis? If you haven't done it, don't do it. It's an immune system disease. It's too late to come to me for consultation.]

Oh, it turned out to be a doctor in the rheumatology and Immunology Department. Old Li thought to himself.

Generally, doctors with a high level of rheumatism and immunology are responsible for dealing with all kinds of difficult and miscellaneous diseases. It is inevitable that they have a sense of pride in their hearts and think that no one else will see a doctor.

Rheumatic immune disease? I think so, too. Let's see what he says first.

However, Li Lao was not in a hurry, but stopped here and listened carefully to the consultation opinions of other departments.

The differential diagnosis of adrenal tuberculosis, fungal infection, solid tumor and so on is one by one. Li is very satisfied with the doctors he has trained.

Well grounded and organized, just like solving a mathematical problem.

Finally, Dr. Wang expressed his opinions and suggested that the rheumatology and Immunology Department should consult.

"Thromboembolism is a kind of disease prone to thromboembolism due to genetic defects such as anticoagulant protein and fibrinolytic protein or risk factors of acquired thrombosis." The director of Rheumatology and Immunology Department sat in his position, turned over the medical record in his hand and began to speak.

Acquired thromboembolism is also known as acquired hypercoagulable state. The causes include antiphospholipid syndrome, gestational or oral contraceptives, perioperative and traumatic obesity, neoplastic diseases, diabetes, paroxysmal nocturnal hemoglobinuria and nephrotic syndrome, etc. antiphospholipid syndrome is most common.

"Combined with the patient's medical history, antiphospholipid syndrome should be considered first."

Well, as he thought, Mr. Li turned the A4 paper in his hand to the next page to see if the rheumatism and Immunology doctor in the hospital had also made a correct diagnosis.

[as for APS, it is estimated that the technical force of the Affiliated Hospital of Medical University will not be surprised here. Although the patient has a history of oral contraceptives and multiple abortions, this is only an incentive to aggravate APS.]

The little guy is very interesting. Old Li is more and more interested.

Next, some laboratory tests were displayed on A4 paper, some of which he knew and some of which he had not come out when he wrote this information.

The inspection results that didn't come out were analyzed according to the problems and no problems.

[now, are you sure whether it is primary APS or secondary APS?]

Li laorao looked at this passage with interest, and the director of Rheumatology and Immunology Department began to say this after analyzing the inspection report.

It's secondary. Don't bother to think about it

It's too arrogant. Although the analysis is justified, Mr. Li still made a judgment for the person who wrote this information.

[Judging according to the Sydney APS classification standard in 2006, the time is very long, and the patient can't last that long.]

Li Lao looked at the words written on the paper and listened to the words of the director of rheumatism and Immunology Department.

"This patient has thrombocytopenia, splenic vein, renal vein and bilateral adrenal vein thrombosis, positive lupus anticoagulant factor test and anticardiolipin antibody & amp; amp; gt; 120 Ru / ml."

The guesses on the paper are basically right. He didn't return the data when he obtained the lupus anticoagulant factor test. Can he be right just by guessing? Li Lao was puzzled, but he felt that the child was a little unstable.

Are you wondering how I guessed right

Whether it is forward or backward, there must always be objective basis. When the words on one page were gone, Li laoshun turned to the next page.

It's unbearable to break here!

[in fact, I'm not sure, but the boss said that judging from the image data, it could show that it was secondary APS. We quarreled for 5 minutes, and I couldn't convince him. If your final examination results can prove that the boss's statement is wrong, be sure to tell me, and I'll throw the examination results in his face.]

Uh

Li was stunned.