Gou in the operating room to add some upgrades

Chapter 182: Unfair Assessment (Please subscribe)

In clinical practice, it may be difficult to treat patients, which is an uncontrollable factor.

However, during the skill assessment process, the difficulty level was exceeded, which was a bit excessive. This could obviously have been avoided by carefully searching the question bank in advance.

If you really only have level 2 MRI reading skills, taking this set of questions would be too much, instead of praying for them.

But it's quite interesting. Fang Xian plans to take a leap to solve the problem——

After diagnosing the injury.

Fang Xian looked at other aspects of the structure.

No abnormalities were found.

The continuity of the ligament is intact, there is no avulsion fracture, no bone edema, no nerve, blood vessel, muscle tendon or even skin level problems.

No changes in lesions or organic changes were seen.

Then this?

This means that the diagnosis of ankle ligament injury is absolutely correct.

and so!
What I want to supplement, is it really just to supplement the obturator lesions and lumbar disc herniation?

Is it as simple as writing the supplement and then copying it?

Fang Xian didn't know if this was the simplest type of question he had encountered...

It was just the Level 5 MRI reading technique that made Fang Xian instinctively feel that this case could never be that simple.

If you only need to identify the position, the assessment content of level 1 MRI reading is almost the same. How could it be the content of level 5 MRI reading?

Then what content did you ignore?
detail!

detail!

Let’s start with the details.

As we all know, on the patient's MRI, basic information such as the patient's name, gender, and the location where the MRI was taken will appear in basically every window.

There is also age, which is also the main content of basic information.

Fang Xian enlarged the nuclear magnetic print and saw the blurry words.

Patient: "males, 45 years old."

At present, China's MRI medical equipment is not enough to support clinical needs. Therefore, all texts are still replaced by words.

Looking at the overall name of the MRI, that is, the MRI of the left ankle joint, there is no wrong site application.

"male, 45 years, left."

When Fang Xian looked at it like this, he suddenly discovered a very important problem.

The name means nothing, but being male and 45 years old gives very important information.

Indeed, this patient's MRI showed no structural, anatomical, or hierarchical problems.

However, there is a problem with his size!
This patient's ankle joint is quite slender, and the diameter of the ligaments is also wrong. It does not look like the imaging appearance of an adult man, and the muscles are also quite delicate.

For an ordinary adult man, the muscles of the lower limbs, especially the muscles of the calf, as long as they are normal, will not be so thin.

Unless he has an underlying disease, for example, muscle atrophy.

As for muscle atrophy, there are also etiologies that can be consulted, except for nutritional atrophy, disuse atrophy, and neurotrophic atrophy.

Or rather, neurogenic atrophy!
In this patient, the ligament injury was not accompanied by other signs of edema, which meant that it was not a violent injury, but a simple sign of ligament edema.

Wait!
Fang Xian carefully searched for the patient's neural structure and vascular structure!
The diameter of the blood vessel is fine, and no thrombus, venous sinus, arterial sinus, etc. are seen, which means that the blood supply is normal!
This shows that it is impossible to be atrophy of nutrition.

Isn't that apracticable?
It depends on the diameter of the nerve——

The diameter of the patient's nerve is extremely thin, almost undetectable, and the continuity is not broken.

In general, there are no symptoms of paralysis.

Not paralyzed, but there is a problem with the size of the nerves, and it's accompanied by...

This must be due to pathological changes in the upstream nerve fibers. The biggest possibility is compression.

Space-occupying lesions of lower extremity nerves are usually lumbar disc herniation, or entrapment at the obturator foramen.

If the organic lesion in the thigh compresses the nerve, this kind of situation rarely occurs, and the second is that it will not be compressed to such a degree that it will not be discovered.

It's very possible that there is no way to solve it.

The written diagnosis of this patient was that the lateral ligament of the left ankle was injured, suspicious obturator lesions, and herniated lumbar intervertebral disc.

There is no specific point, which is correct.

It is not stated whether it is an obturator or a herniated lumbar intervertebral disc, it is just a speculation.Just suspicious.

Therefore, the important point and solution idea of ​​this question are two words suspicious.

However, the result of solving the problem is that no changes are made!

Therefore, No. 30 six and No. 30 seven MRI plain films continuously appeared in correct correspondence.

The correspondence between two consecutive MRIs is correct. This kind of cunning routine may make anyone with a weak foundation doubt their own judgment, and then generously write "please make up for the diagnosis".

Then I was tricked.

Fortunately, Fang Xian's basic skills are solid enough, and he can easily grasp some detailed issues.

However, when he reached this point, Fang Xian finally discovered something was wrong with this assessment.

Turning back, he looked at Professor Zhou Cheng and Professor Yang Yifeng——

He asked: "Professor Zhou, Professor Yang, is this really the assessment content of level 2 MRI reading?"

Although Fang Xian gave the answer, he still had doubts about the existence of this set of questions.

This cannot be something that should appear in the level 2 MRI reading skills assessment process. It is impossible to appear even in the level 4 assessment. At level 5, I can barely do it.

Yang Yifeng waved his hand: "You continue to take the test, and we will talk about it after the test."

Conveniently, I can only click on the page icon and move to the next picture...

After reading three or four more MRI scans, Fang Xian was basically certain that the No. 30 six-scan MRI scan was one of the most difficult questions in this exam.

And in the subsequent verification process, it was also proved that this was indeed the case.

Except for the nine cards No. 40, which is the penultimate card, and also sets up a big pit, the other difficulties are very small.

The pits of the 49 nuclear magnetic images are only comparable to this.

Just the mindset is different.

As for the nine MRI images No. 40, it took Fang Xian half an hour. After many arguments and deductions, he could understand the MRI clearly and finally write down the correct answer.

In this way, a full two and a half hours had passed when Fang Xian finished reading all the flat films in the second stage.

The time has already passed the lunch time.

At the end of the assessment, Fang Xian's final score was 91 points, and he had passed the assessment!

but! ~
When Fang Xian saw this result, he was still confused.

Look at Professor Zhou and Professor Yang.

"Let's go and have a meal. People are like iron and rice is like steel. Your performance is quite good. If the machine evaluation of two of the two MRIs hadn't been too rigid, you might still have gotten 93 points or more." Yang Yifeng said slightly. Said this in an old-fashioned way.

The three of them just found a fly restaurant for lunch.

The taste is ok.

And during the meal time, Professor Zhou and Professor Yang were silent, so Fang Xian couldn't continue to ask questions, but he was beating the drum secretly in his heart.

Could it be that there is something really wrong with my current MRI reading skills? It shows level 5 on the panel, but I failed the Level 5 skill level certification test of the Medical Association?

Then this fun is a bit too much.

After the meal, the three of them came to the skills training room again.

Fang Xian's mentality became a little unstable in front of the first MRI plain film of the 'Level 3 MRI Reading Technique', and he almost broke his defense...

The Medical Association’s definition of the skill level of MRI reading is that level 1 can see the location of the lesion and determine the anatomical direction. Level 2 looks at the nature of the lesion and can identify the type of the lesion while locating it.

Such as trauma, chronic injury, infection, etc.

Level 3 looks at anatomy. This kind of anatomy is pure anatomy. It is not the general anatomy position seen at level 1, but an absolute anatomy. It is to find the blood vessels, nerves, arteries and veins of the human body in the MRI. .

But even so.

Fang Xian, who has level 5 MRI reading skills, doesn't feel like he can't do it.

But now!
Fang Xian stood in front of the examination table and carefully looked at the MRI images on the screen, feeling unable to calm down for a long time.

The first image almost made Fang Xian lose his sense of proportion. He really wanted to say, what the hell is this?First, this MRI image shows that the location of the picture is the upper abdomen.

This is true as the ribs can be faintly seen.

However, the content of this NMR display is -

If Fang Xian's rough reading was correct——

It should be that the abdominal wall was ruptured, the vertebral body burst into fragments, and in the upper abdomen, the phalanges of the toes, teeth, and the uterus and its appendages appeared...

Obviously, the phalanges, usually in the lower limbs, are the bony supports of the toes and come from the lowest end of the body, while the teeth come from the mouth.

The uterus is an organ in the lower abdomen.

The positioning of this film is an MRI of the upper abdomen.

However, the liver, pancreas, spleen and other organs that should belong to the upper abdomen could not be seen, only the remains.

This is a picture with no clinical significance or biological significance!
MRI with diagnostic significance only!

Fang Xian had undergone surgery to destroy injuries, but clinical injuries were much more refreshing than this.

There is absolutely no possibility of survival for a patient whose organs have been displaced to such an extent. It is estimated that the teaching hospital took such a random photo before collecting the body and used it as teaching and examination material.

Although the diagnosis of this MRI is meaningless, it is a bit too much.

The assessment format this time is to fill in the diagnosis yourself based on the content of the MRI image. The content of the MRI image is the absolute standard.

Even if there is a mismatch between the anatomical location and unknown cognition, the performance on the MRI images will still be used as the benchmark.

What else can I do?
There are many diagnoses, but we still need to do them.

Otherwise, wouldn’t the teachers at the trauma center carefully analyze the diagnosis of damage one by one?
Fang Xian read the film carefully and started typing: "Open injuries in the upper abdomen: abdominal wall rupture trauma, multiple organ injuries, multiple organ displacements, multiple abdominal internal organ destruction injuries: liver rupture, spleen rupture..."

"Bony tissue abnormality, toe fracture..."

"Multiple vertebral burst fractures, thoracolumbar spinal cord burst injuries, pedicle tears, multiple visceral nerve injuries..."

"The tear lines of the uterus and appendages fell off, and the bladder ruptured..."

Just from this one picture, the final diagnosis was over 600 words long.

Moreover, making a diagnosis is no more than just typing words. It took Fang Xian more than 20 minutes to give this opinion on correcting the diagnosis.

Reading the images is not difficult, but typing out so much text is very time-consuming. If subsequent diagnoses are arranged in this way, Fang Xian estimates that the skills assessment for this level 3 MRI reading technique will total more than 100 questions. .

I'm afraid it will take dozens of hours to complete this assessment.

No wonder the skill level assessment of the Medical Association is very difficult. Some people say it is a dead-end standard.

Fang Xian finished correcting the text and checked it for another three minutes before taking a slight step back and bowing very reverently to the general teacher to whom this flat photo belonged.

The appearance of this set of nuclear magnetism has no life significance for teachers. Its appearance has only teaching significance.

Respect is in the heart and traces.

After Fang Xian finished writing, he clicked on the next MRI image.

The reappearance of red light seemed to indicate that there were still errors or omissions in Fang Xian's previous diagnosis.

But there is no way!

Fang Xian has made more than 80 diagnoses in total. This has not been able to complete all the diagnoses. It really has too many diagnoses!
Some irrelevant diagnoses, diagnoses that have no meaning at all.Fang Xian did not fill it in because the test question and answer settings of this skill training device were too harsh.

Fang Xian's mood dropped a little.

After all, it was a bad start.

And he looked at the MRI cover in the second examination table. After taking a look at it, he frowned tightly again.

Found something wrong.

This is an MRI of the right shoulder joint.

The text prompts that there is no obvious abnormality.

But at this stage, the text has no reference meaning, and the NMR performance is the most correct answer.

At first glance, there was no obvious abnormality. Moreover, because of his previous experience, Fang Xian also carefully looked at the diameter of the muscles and nerve fibers, and found no obvious abnormalities.

However, it was only after Fang Xian changed the level several times that he finally discovered the problem.

It almost hit my eye——

This patient had no fractures, no ligament or muscle injuries, and no rotator cuff injuries that are common in shoulder joint MRI!
However, it is a post-operative MRI sleeve.

This surgery is related to orthopedics and is called phrenic nerve transposition.

This requires very deep film reading skills to discover, and it also requires a certain reserve of professional knowledge.

Then Fang Xian took a closer look and realized that it was a transposition of the phrenic nerve and ulnar nerve.

It may be that there is some structural abnormality on the proximal side of the ulnar nerve. Therefore, such a transposition surgery was performed to replace the damage to the proximal end of the ulnar nerve, thereby allowing functional reconstruction.

However, such surgery will have certain sequelae!
That is, when you burp normally, or when there is abnormal activity of the diaphragm, your little finger and ring finger may bend involuntarily.

But it is also an alternative treatment.

To diagnose this, comprehensive theoretical knowledge of trauma surgery and hand surgery is required.

Fang Xian was thinking, could a doctor in the imaging department really make such a diagnosis?Are they so knowledgeable?

Therefore, Fang Xian wrote the diagnosis generously: "After phrenic nerve-ulnar nerve transposition."

You only need to write down the diagnosis, not the specific performance, so Fang Xian will not elaborate on it.

Then clicked on the third set of MRI sets!

This time there was no redness, which meant that Fang Xian's diagnosis was initially correct.

This MRI is relatively simple. It just shows multiple space-occupying lesions in the brain and only needs to correspond to different brain gyri.

No blood vessels were compressed, and no other infections were seen. Fang Xian quickly wrote down multiple intracranial space-occupying lesions: space-occupying lesions in the frontal gyrus and temporal gyrus, the nature of which is yet to be investigated...

Although Fang Xian was sure that it was glioma, at this time, Fang Xian felt that it was better not to turn into a wise man.

However, when Fang Xian was about to click on the next picture, Fang Xian discovered that there was a big hole in this question. He quickly retracted his little paw that was about to hold the mouse and corrected his previous diagnosis.

"Consider normal brain images."

He also muttered in a low voice: "What kind of lunatic would wear a hat to get an MRI of his head..."

Yes, this patient is not sick at all. The previous placeholder was actually the projection of the hat.

"Uh-huh!~" When Fang Xian finished muttering, Zhou Cheng coughed.

"Do the questions well and don't complain."

Fang Xian immediately turned his head and saw that Professor Yang Yifeng's expression was not right at the moment, so he quickly shut his mouth obediently.

Oh, it’s Professor Yang, that’s okay! !

It wasn't until the No. 16 plain film that Fang Xian encountered the more troublesome MRI image again.And it’s a very interesting set of impact pictures.

If nothing else, it is very easy for beginners or people who do not understand pediatric orthopedics to misread the MRI of the wrist joint.

Because the bones of the wrist joint are not fully developed, and the ulnar and radius bones are separated from the epiphysis, and the metacarpal bones develop abnormally.

Then, on the MRI, there were still signs of multiple bone loss and free nerves.

There are a lot of corresponding text prompts given. It is estimated that at least several imaging professors, after carefully reading the films, gave the most tempting diagnostic report, and then asked you to delete or delete some.

But the final result is to eliminate all diagnoses and modify them to: normal wrist joint signs in a 6-year-old child.

Yes, in childhood, it is generally possible to tell a child’s age through a plain radiograph of the wrist joint.

The reason why Fang Xian was able to determine that he was six years old was because the articular surface of the small polygonal bone at the proximal end of the second metacarpal bone began to become concave, and the epiphyseal ossification center of the ulna began to appear.

Moreover, the adjacent surfaces of the skull and hamate have overlapped.

The skull here does not refer to the peripheral bones of the skull, but there is a sesamoid bone called the skull inside the wrist joint, which is adjacent to the hamate bone.

This nuclear magnetism is extremely tempting and deflective.

It needs to be carefully screened, and it is not particularly difficult. It can only be difficult for people with average skills.

It can only be regarded as a small episode.

However, just when Fang Xian was about to go on like this.

I discovered that, damn, this nuclear magnetic field still had a big pitfall, and I almost didn't avoid it.

This is not a plain radiograph of a child's pediatric orthopedic wrist joint. This is not a plain radiograph of a human wrist joint. It is probably from a monkey...

(End of this chapter)