Doctor of Healing

Chapter 483
"Doctor Xiaoji, do you have an answer?" Zhai Yuhan asked.

The diagnosis of this patient was not clear. At that time, the whole hospital consulted, and it took nearly two days for everyone to find the problem.

Fortunately, there was no delay. If it was changed to another hospital with a slightly lower level, the grass on the grave of the patient might already be as tall as a person.

Can Ji Xiang give the correct answer?
Zhai Yuhan thought it was impossible.

She thought that she did not intentionally make things difficult for Ji Xiang, but just wanted to teach Ji Xiang a "lesson" so that he could face clinically strange diseases more humbly.

Zhai Yuhan even pretended to forget that he did not explain the most critical step in the physical examination, which was misleading enough.

"Mr. Zhai, is there any key item in the physical examination that you didn't mention?" Ji Xiang asked suddenly.

Zhai Yuhan was startled, her heart beat involuntarily, as if she was trying to trick Ji Xiang but he found out.

But if you think about it carefully, it should be impossible. Ji Xiang will not see through the trap he set up without flaws.

"Oh?" Zhai Yuhan pretended to be calm on purpose, "What are you talking about. The physical examination I just mentioned is indeed rough. Do you have any questions?"

"Which arm was the patient's blood pressure measured after admission?" Ji Xiang asked.

"Which one is not the same?" Zhao Mengmeng looked at Ji Xiang suspiciously.

She felt that Ji Xiang had said something nonsense.

But Zhai Yuhan's expression froze immediately, she never expected that Ji Xiang would find the problem so quickly and sharply.

But Zhai Yuhan smiled slightly after being surprised, and Ji Xiang walked into the trap by himself like a prey.

"It's not the same." Ji Xiang said, "The blood pressure in both arms is different, which means aortic dissection. Mr. Zhai thought of this case after hearing what I just said about rib fracture combined with aortic dissection."

Zhai Yuhan was a little speechless, but Ji Xiang was indeed very smart.

Zhao Mengmeng looked at Zhai Yuhan full of doubts. Seeing her expression was frozen, she guessed that Ji Xiang was right.

But she recalled the patient's medical history again, but still had no answer.

"The blood pressure of the patient's left arm is 152/86mmHg, and the blood pressure of the right arm is 144/89mmHg." Zhai Yuhan said.

"That's about the same." Zhao Mengmeng glanced at Ji Xiang.

Di Yuhan threw out a hole he dug, and looked at Ji Xiang with great interest.

"Ms. Zhai, I still think it's aortic dissection. The CTA image shows it should be." Ji Xiang said slowly.

"Why?" Zhai Yuhan did not answer Ji Xiang's question, but asked.

"The symptoms of paralysis of the patient's lower limbs cannot be explained by bilateral parietal and occipital cerebral infarction. After excluding periodic paralysis and other diseases, I suspect that there is a spinal cord lesion, and the possibility of spinal cord blood supply disorder is inclined."

"Combined with the physical examination, the patient's right subclavian and carotid artery area can be heard and signs of murmurs. Although the amaurosis can be considered to be carotid artery disease, I still suspect the possibility of aortic disease."

"If you guessed right, the patient's CTA should show aortic dissection and changes in the vertebral artery."

"..." Zhai Yuhan silently looked at Ji Xiang.

At this moment, she has nothing to say.

Jixiang did not see the patient's information, and made a correct judgment based on the medical history of the two holes he dug.

We must know that when we met this patient, the First Affiliated Hospital went through 5 rounds of hospital-wide consultation + auxiliary examination, and it took a long time until the cause was finally found.

However, Jixiang showed a diagnostic level that surpassed the experts and professors of the First Affiliated Hospital.

"Doctor Xiaoji, tell me what you think about it." Zhai Yuhan didn't immediately admit that Jixiang's diagnosis was correct, and continued to probe.

She thinks that Jixiang is delusional, and he can't give a reasonable logic at all. If there is no logical closed loop, it doesn't seem to be regarded as her own loss.

"Paralysis of the lower extremities is a common clinical symptom, which can be divided into three categories according to the anatomical location of the lesion.

First, upper motor neuron paralysis is also called central.

Second, lower motor neuron paralysis, also known as peripheral.

Third, myopathic paralysis"

Ji Xiang began to count one, two, three with his fingers.

"The characteristics of thoracoabdominal aortic CTA paralysis are: monoplegia, hemiplegia, paraplegia with the main paralysis of the whole limbs, increased muscle tone and tendon reflexes, pathological reflexes, and no muscle atrophy"

"..."

Ji Xiang talked eloquently, but Zhai Yuhan was speechless.

This is not just a logical closed loop. Ji Xiang even considered the details of every branch of guessing, starting from the most serious clinical symptom of the patient - paralysis, and analyzed it bit by bit.

"Lower motor neuron paralysis is characterized by muscle group or single muscle, decreased muscle tone and tendon reflexes, no pathological signs, muscle atrophy Myopathic paralysis is characterized by muscle atrophy in the proximal extremity, symmetrical distribution, no sensation obstacle"

"In the case, the patient suffered paralysis of both lower limbs, no symptoms of hemiplegia, no muscle atrophy..."

Ji Xiang talked with his fingers for nearly 5 minutes, and finally gave a conclusion.

"I think the CTA images will most likely show aortic dissection, Stanford type A with changes in the vertebral artery."

"!!!"

Zhai Yuhan had already heard the exclamation mark at the end.

Until the end of Jixiang's speech, she stared blankly at the young doctor who was faintly exuding milky white light, feeling infinitely confused.

This level of diagnosis is already terrifying, at least not encountered in the First Affiliated Hospital or Zhai Yuhan's medical career.

Moreover, Ji Xiang's rigorous logic proved one thing - he did not just talk nonsense about Meng's diagnosis, but was well-founded and meticulously analyzed.

But Ji Xiang is not finished yet.

He didn't seem to notice Zhai Yuhan's expression, and continued, "The aortic dissection in this patient is painless, and it is easy to misdiagnose.

Painless aortic dissection is less common than painful aortic dissection in clinical practice. It is often accompanied by neurological symptoms such as limb paralysis, and is easily misdiagnosed as acute ischemic cerebrovascular disease. lead to catastrophic consequences”

"But the treatment is not difficult. Use metoprolol, nifedipine, urapidil to control heart rate and blood pressure, and wait for the condition to stabilize and then perform surgery by vascular surgery."

"Mr. Zhai, the patient finally recovered and was discharged from the hospital. Has the patient recovered well?"

"Yes." Di Yuhan squeezed out a word from between his teeth.

Zhao Mengmeng's head was dewy.

Although she couldn't understand Ji Xiang's entire logical judgment at all, the word "yes" that Zhai Yuhan said at the end told Zhao Mengmeng a fact - Ji Xiang's judgment was accurate.

This is too strong!

Zhao Mengmeng was not as unwilling as Zhai Yuhan, but looked at Jixiang with a hint of admiration.

It would be great if I could answer questions as cleanly as Jixiang.

It's a pity that Zhao Mengmeng always feels that he is short of breath, and he still can't connect the knowledge in the book with reality.

(End of this chapter)