Since 1981 Health School

  Chapter 433 Distinctive diagnosis

  Everyone discussed for a long time, and then all looked at Chen Qi, wanting to hear the opinions of the dean.

  Bianmeng has a more jumpy temper and is Chen Qi's confidant, so he was the first to ask:

   "Tou Chen, what do you think is the patient's condition?"

  Chen Qi stood in front of several X-rays lined up in a row and pondered for a while, then said something that surprised everyone:

   "I think it's an inflammation."

"what???"

  Everyone in the office was surprised. If Chen Qi hadn't been the dean, many people would have booed him.

   What are you kidding? Inflammation, is there inflammation that lasts for 3 years?

how is this possible?

  The surgical director couldn't bear it any longer, and asked:

   "If it is inflammation, repeated anti-infection treatment for 2 weeks, and used the best antibacterial drug in the provincial capital, how could it not be absorbed at all?"

   "That's right, if it's inflammation, why hasn't the patient's lung shadow changed much in the past three years?"

   "Yes, look at this film, the boundary of this shadow is not very clear, if it is inflammation, the edge should be very clear."

  With Director Bian at the beginning, everyone began to refute in a hurry. Anyway, it was you, Chen Qi, who said it. Don’t be afraid to say the wrong thing during the discussion.

   Only Yan Shifan continued to look back at the film thoughtfully.

   Seeing that everyone didn't believe it, Chen Qi patiently explained:

"Then let's take stock. First of all, everyone thinks that the lung mass and lung abscess can be ruled out. The diagnosis of tuberculosis is generally recognized as the most suitable, but anti-tuberculosis treatment is ineffective, so only inflammation is the most likely, right? "

  Just as everyone was about to say something, Director Bian made a silent movement.

"However, inflammation is the most unlikely diagnosis that everyone thinks, because the time is wrong, it has been 3 years. And because anti-infection treatment has already been taken, the effect is also not great, so everyone dare not even think about this possibility, but everyone Thinking about it in reverse, if you don’t look at the time, just look at the film and the clinical symptoms, does it look like inflammation?”

   Zhang Xingshun interjected at this time: "But looking at this film and clinical symptoms, it is also similar to tuberculosis."

  shh~~~~

  Everyone in the office laughed wildly, booing Chen Qi one after another.

  Chen Qi didn't care too much, and was sincerely happy that everyone had such a relaxed atmosphere that didn't worship authority.

   "I said it was inflammation. The first thing everyone thinks of is lung infection, or pneumonia, right?"

  Everyone is nodding, what is the meaning of the lung infection focus?

"Okay, let's review the X-rays of pneumonia first. The first and most common one is Streptococcus pneumoniae pneumonia. Patients may show thickened lung markings in the early stage. As the disease progresses, realistic shadows may appear. Bar?

  Attention everyone, the airway sign of the bronchi can be seen in the shadow of this consolidation. Some patients may have a small amount of pleural effusion due to the inflammation spreading to the pleura, causing a small amount of pleural effusion. Have you seen this patient? "

  Everyone shook their heads in unison again.

  Chen Qi talked about internal medicine knowledge, which was relatively unfamiliar to surgeons, so everyone listened very carefully.

"Then let's look at another very common staphylococcal pneumonia in clinical practice, which is acute suppurative lung inflammation caused by the invasion of staphylococcus. X-ray examination can show consolidation of lung segments and lobes, or Lobular infiltrates with single or multiple fluid-air sacs.

  Pay attention, everyone has seen the film of fluid-air cystic cavity, and this characteristic manifestation is not seen in patients, so staphylococcal pneumonia can also be ruled out, no problem, right?

   There are other types of pneumonia, such as mycoplasma pneumonia, which can be manifested as infiltrates of various forms, which are segmentally distributed, mostly in the lower lobe of the lung, and sometimes extend outward from the hilum.

  If the pneumonia is caused by a virus infection, the lungs may show ground-glass shadows, which may manifest as both lungs. In addition, patients with novel coronavirus pneumonia may also have patchy shadows, which are mainly distributed outside the lungs, and it is very easy to develop into white lungs..."

  Director Bian suddenly raised his hand to interrupt:

   "Wait, I know other types of pneumonia, what is the new type of coronavirus pneumonia? Why haven't I heard of this disease?"

  Chen Qi was startled, thinking badly, how could he have leaked about a kind of COVID-19 that was popular all over the world in his previous life.

   "Uh, don't pay attention to these details. This is a type of pneumonia developed by Medicaid. It has not been officially applied clinically. It's normal for you surgeons to not know. Cough cough, where did I go?"

  Wang Yuelei reminded: "Tou Chen, you talked about different imaging manifestations of pneumonia."

   "Oh yes, you see, we have eliminated one by one, is there no pneumonia that matches Jin Wenyao's film? So we can also rule out the diagnosis of pneumonia."

   Now everyone is confused and confused. I thought you said it was a lung infection and inflammation, and then said it was not pneumonia. What kind of trouble is this?

  You are the dean, you have the final say?

  Chen Qi became annoyed when he saw everyone's confused, questioning, and surprised eyes:

   "It's really good to say that you are rough surgeons. Pneumonia is the only type of lung inflammation? Don't you consider the surrounding infection caused by a foreign body entering the lungs?"

  Zhang Xingshun dissatisfied:

"Tou Chen, you said it was a foreign body in the bronchi, which is common in clinical practice, but you want to talk about a foreign body in the lung, and it is still in the patient's right middle lung. How could there be a foreign body in this place? How did the foreign body fall into the right lung lobe? of?"

   "That's right!"

   There was another burst of doubts from the crowd.

  Why do you question? It was precisely because they were doctors that they directly doubted Chen Qi's statement.

   Foreign bodies may be inhaled into the lungs through the mouth and trachea, especially some relatively small foreign bodies.

  For example, some rice grains, small plastic grains, small screws, or some small beans such as mung beans may pass through the trachea and enter the lungs.

   Then there may be infection and inflammation in the lungs, or long-term irritating cough, fever, chest pain, and sometimes an asthma attack.

  In acute cases, dyspnea, cyanosis, etc. may occur, and in severe cases, it may lead to hypoxia and respiratory failure.

  From this point of view, Jin Wenyao's symptoms are indeed very similar, and the symptoms can be explained.

  However, the premise of this being inhaled into the lungs is a small foreign body, at most the size of a mung bean.

  Some relatively large foreign bodies, such as coins and relatively large toys, usually cannot enter the lungs through the bronchi, and in most cases enter the gastrointestinal tract through the throat and esophagus.

   Let’s take a look at the shadow of Jin Wenyao’s right lung. It is an oval-shaped high-density shadow with the longest diameter reaching 10cm. Even if there is a foreign object in the shadow, it must be at least 6 or 7cm in size.

   This is obviously illogical.

  In this way, in the case discussion meeting, everyone can tell you your opinion, and I say my observation, and no one can convince anyone.

  The problem is back to the original point. If you can’t make a clear diagnosis, how can you treat it symptomatically?

  Modern medical treatment is based on evidence. You can put forward various hypotheses, but you must have auxiliary examinations to prove the correctness of your views.

   Just like the police catching a thief, you know that the thief broke the law, and the police can’t just convict you based on suspicion, it’s easy to catch and misjudgment by mistake, leading to bad consequences (in medical terms, it’s a misdiagnosis)

  So you have to find evidence to prove that the thief stole something, so that the thief can be convicted and the community can be restored to peace.

  Thinking of this, Chen Qi was also helpless.

  Jin Wenyao's illness is imminent, and they are not allowed to guess like this.

  According to Chen Qi's previous practice in Huangtan, that is, no matter what happens, he will be anesthetized first, and then he will have an incision, and see what's inside?

  But now it’s no longer possible. One is that he is the dean, and the dean will take the lead in standardizing diagnosis and treatment, and he can’t do whatever he wants like before.

  The second family, the Jin family, is in bad shape, so keep an eye on it. If you are dissatisfied, you may have to go through the gate of the county government again, so the advancement of the Fourth Hospital this year will not be mentioned.

  What to do?

  Chen Qi knocked on the table and thought of an idea. Anyway, the Jin family needed money for medical treatment, and it wasn't Chen Qi's money, so why save it for them?

  So he looked at several subordinates in the office and had an idea in his mind:

   "Yang Tihao, Zhang Xingshun, I entrust you two with a task. Send this Jin Wenyao to the First Affiliated Hospital of the Province. They have advanced equipment. Let them do a few tests for us. When the results come out, you will come back with the patient."

  Chen Qi is now as close as a family to the First Provincial Affiliated Hospital, making the Fourth Affiliated Hospital like a branch of the Provincial First Affiliated Court, doing a few inspections, and it’s not that they don’t pay inspection fees.

   "Okay Mr. Chen, what kind of inspections should we do?"

   "Complete set of CT, lung function, tumor indicators, biochemistry..."

  Chen Qi counted with his fingers one by one. To say the same thing means that the Jin family's wallet will start to bleed again.

   Although these inspections are very common in later generations, and the price is not expensive, but in the 1980s, these were all new gadgets, and the inspection fee was naturally not the whole family.

  Just a CT examination costs several hundred yuan. A farmer earns only a few hundred yuan a year these days? But there is no way, no matter how expensive it is, you have to do it, and you have to queue up to do it with the back door open.

  Who said there is only one CT for tens of millions of people in the whole province? Why is the clinical value of CT so unique?

   It is estimated that some people will question Chen Qi's medical ethics. Why do you have nothing to ask the Jin family to spend so much money? Are you not a miracle doctor? You know it by touching it twice.

  Chen Qi will definitely pooh his face:

fine? It's okay, why did you come to the hospital? It's okay, you haven't been cured for 3 years? You need to make a clear diagnosis. These tests are mandatory. If you like to do it or not, don’t do it and get out.

  When the Jin family heard that they were going to the provincial capital for a comprehensive inspection, the second daughter-in-law and the younger daughter-in-law twitched in distress, thinking that the family's brick and tile mansions would be lost.

  So he looked at the old father pitifully.

  In order to maintain the dignity of the Jin family in the village and the clan, the three sons did not separate the family, and the property was shared. The head of the family was Jin Kangsheng himself.

  Luo Cuifeng was very happy, anyway, it wasn't her personal money that was spent, but the money in the family's account, which meant that their eldest wife was taking advantage of the second and third bedrooms.

   At this time, let alone go to the provincial capital, even if she goes to the capital, she will not blink her eyes.

  Jin Kangsheng is the head of the family, so he naturally knows his family's financial situation. A precious grandson has been sick for 3 years, and after 3 years, he can only be described as having no money left.

   (Not to mention 1986, even if there is a three-year long-term illness in 2020, unless there is a mine at home, no one can stop it)

  But the old man knew in his heart that this was also his grandson's last chance. After all, Chen Qi had cured almost 100% of the patients he had handled so far.

  Thinking of this, Jin Kangsheng gritted his teeth:

"Boss, you go back to the village now and borrow money. Let's use our house as collateral. First borrow 2,000 yuan, oh no, 3,000 yuan. If you can't borrow that much, you can secretly withdraw it from the family's public account Part of it, don't let the villagers know."

  The boss of the Jin family nodded and ran away.

  The second daughter-in-law of the Jin family couldn't help it: "Father, we can't live without a house in the future?"

  The youngest daughter-in-law's face is full of frost, she doesn't say a word, she has already planned in her heart, this family will be divided sooner or later, the sooner the better, there is a saying that goes well, a dog that bites doesn't bark...

  Jin Kangsheng sighed and comforted the two wives:

"Father, I can't help it. After all, Xiaoyao is the only boy in our family, but father promises that this is the last time. If Chen Qi is willing to take action, Xiaoyao's illness will definitely be cured, and there will be no need to spend such unreasonable money in the future." .”

  The second daughter-in-law stomped her feet and left the ward with a straight face.

   In this way, the Jin family prepared the money, and the doctors from the Fourth Hospital took Jin Wenyao to the provincial hospital for a walk.

  The First Affiliated Hospital of the Province, Outpatient Building.

  Surgery Director Xu Jinxing saw all the patient's information, especially the X-rays, and read it several times, and then suspiciously pulled Yang Tihao and Zhang Xingshun, two young doctors from the Fourth Hospital of Yuezhong, who were accompanying the patient, together.

   "What are you, Dean Chen, doing? Such a simple tuberculosis patient has been sent up for CT?"

  Yang Tihao and Zhang Xingshun looked at me and I looked at you, a little confused, why did the great expert and "teacher" in the provincial capital also diagnose tuberculosis?

  Yang Tihao hurriedly reminded:

   "But Director Xu, we have treated this for tuberculosis before, but it didn't work, so we ruled out tuberculosis when we discussed it in the hospital."

   "You ruled out a diagnosis of tuberculosis?"

   Director Xu was a little unconfident after being told, and went back to the film reader, looked through a few films carefully, and was full of question marks:

"No, whether it's the patient's clinical symptoms or the X-ray findings, do you think this thing looks like a tuberculosis? Well, it's a bit bigger, but it can't be ruled out that it's tuberculosis, right? By the way, you guys What does Dean Chen think?"

  Yang Tihao replied with a little embarrassment: "Let's Chen Tou say that inflammation is more likely."

  Xu Jinxing almost spit out a mouthful of tea, if Chen Qi didn't say it, but if other doctors explained it like this, he would be scolding.

   "Inflammation? Inflammation that lasted for 3 years? Inflammation that is ineffective with anti-inflammatory treatment? Did Chen Qi miss it this time?"

  (end of this chapter)