Come on, Dr. Wu

Chapter 363 Second Stage Assessment
It was already eleven o'clock in the evening when the operation was over.

"Okay, I'll take you guys out for a midnight snack."

After a busy day, I asked You Zhiyi to bring lunch back from the cafeteria. I just ate a quick bite and didn't eat dinner. I had planned to eat after the outpatient clinic was over, but who would have thought that there was an emergency surgery.

It was already eleven o'clock in the evening, and the five of them were all hungry.

It’s called a midnight snack, but it doesn’t act like a midnight snack at all.

Midnight snacks are usually light and easily digestible foods that can slightly replenish the energy lost during the day.

But the midnight snack that Wu Xiaofu took Cheng Shi and the others to have seemed like their last supper.

In the small restaurant, there were five people and eight dishes, six of which were meat dishes.

Seeing Wu Xiaofu eating with relish, the two girls who originally wanted to lose weight couldn't help swallowing their saliva and started eating.

"For other professions, they need to be careful about eating midnight snacks, but we don't. We are busy every day and it is good enough to have enough food. There is no need to be so particular.

It’s best to always be full because no one knows when the next meal will be.”

After hearing what Wu Xiaofu said, they no longer felt any psychological burden and just ate to their heart's content.

Yes, who knows if there will be anything to do at night? If you don’t eat enough, how can you have the energy to work?

"How about it?"

Jiang Bei sat next to Cheng Shi, touched Cheng Shi with her arm and asked. Cheng Shi knew what Jiang Bei was asking, it was nothing more than the feeling of holding the mirror for Wu Xiaofu.

Cheng Shi thought about it for a while and said, "Okay."

But this answer made Jiang Bei very angry, "I don't know what's good, I'm asking you what's good about it."

“I didn’t dare to relax at all when I was holding the mirror for the boss. At that time, my memory and reaction ability seemed to be much better.

I dared not even have any hesitation about the next move. Often when the mirror paused, I would start thinking about how to move next.

Moreover, the boss also guided me, which made me learn very quickly. After this operation, I made great progress. I even felt that I could try this type of patient next time."

After these words were spoken, not only Jiang Bei, but also Liu Lin and You Zhiyi were envious, they also wanted it.

"Cheng Shi has a very good and solid foundation. You should learn from him. This kind of character and foundation will make others feel at ease. You should have experienced this in your usual cooperation."

That's right, no matter who is with Cheng Shi, they feel at ease. This guy may not be the best, but he is definitely the most stable.

However, after hearing Wu Xiaofu say this, they became even more envious.

After half an hour of eating, everyone went home.

On the way home, Jiang Bei hesitated and asked.

"Boss, what is the content of our assessment tomorrow? Can you give us a little hint?"

Facing Jiang Bei and Cheng Shi's expectant gazes, Wu Xiaofu smiled and said, "This is what you will mainly learn this week, the outpatient clinic and admitting patients."

Outpatient clinic! Accepting patients!

The two of them were cheered up. If that was the case, they would have a good chance of success. They had worked hard this week and reaped great rewards.

"Thank you, boss."

The two were a little excited. The boss really took care of them.

But after they went back, they realized that they had thought too much. Not only Wu Xiaofu had revealed the questions, but Lin Dongping and the others had also revealed the questions. After communicating in the group, they found out that they already knew what would be tested tomorrow.

Well, they suspected that if they didn’t ask, Wu Xiaofu would not tell them. The boss was really bad.

However, they still couldn't feel at ease even though they knew what they would be tested on.

Jiang Bei had clearly been up all day and should be very sleepy by now, but she just couldn't fall asleep.

I prepared for the exam for a while, then lay down and tossed and turned, not knowing when I finally fell asleep.

There was no need for Wu Xiaofu to notify them when the assessment would begin. Before eight o'clock, all eight of them had already arrived at the hospital.

Wu Xiaofu and the others arrived and smiled when they saw the eight people in the conference room.

"See, my assessment last week was effective."

Lin Dongping and the others also laughed when they heard this.

Eight consultation rooms have been arranged.

Although there were still quite a few patients seeing patients at the First Affiliated Hospital on Saturday, some consulting rooms were still empty, which was just right for their assessment.

Wu Xiaofu felt that there was no point in conducting an assessment using standardized patients, and it would not be a good idea to make things difficult for the eight of them. It would be better to do it with real guns and real bullets.

Therefore, Wu Xiaofu and Lin Dongping specially selected some patients.

Yes, these patients were also selected, five patients each, and all of them agreed and were willing to come for treatment on Saturday.

After Jiang Bei and the others were each assigned to the clinic, they were also a little nervous.

Wu Xiaofu has already said that one person has five patients and one hour is enough to see five patients.

However, all eight of them had been to outpatient clinics before, so it was good that they knew there were examinations. If they did not bring their own examination sheets, it would be really difficult to get a clear diagnosis and provide treatment in ten minutes per person.

However, if there is no difficulty at all, it would not be called an assessment.

Let’s first look at Fu Yuanhang. The first patient has entered the neurosurgery department, where Fu Yuanhang is an intern doctor.

Fu Yuanhang heard someone knocking on the door and said, "Come in."

A middle-aged female patient was pushed into the consulting room by a young woman.

They should be a mother and daughter. Fu Yuanhang looked at the middle-aged woman in the wheelchair. Her eyes were dull and she might have vision problems. She must be the patient.

Thinking about the disease that might cause blindness and mobility problems, he stood up, moved the stool next to him away, and asked the patient's family to push the patient over.

"Hello, this is the patient, right? Why are you here?"

As for medical consultation skills, Fu Yuanhang and his colleagues have received training since college, and master's and doctoral students have also had experience in following medical consultations. In fact, there are not too many problems to be found in the medical consultation process.

Especially since Fu Yuanhang was so rigorous, Wu Xiaofu and the others nodded when they saw Fu Yuanhang's performance.

In one minute, the patient's basic information will be available.

A 56-year-old female patient had decreased vision in both eyes for more than two months.

The patient had undergone cranial magnetic resonance imaging locally and was brought here this time, which made Xun Qi feel relieved.

The patient had always been very healthy, with basically no medical history and had never been hospitalized before. Two months ago, while he was working, he suddenly had blurred vision.

I originally thought that I just didn’t get enough rest and that it would get better after a while, but my eyesight has been bad for the next two months and is still getting worse.

Seeing that the condition was not working, the patient notified his family and went to the local hospital for a check-up. The local authorities suggested that he come to Donghai for a check-up.

So the patient comes here.

The MRI film was placed on the light-transmitting board. Fu Yuanhang was also refreshed when he looked at the film.

This is of utmost importance and foundation in the study of neurosurgery. Unless you are distracted in class, you should master it.

Of course, it is difficult for those who lack experience in viewing films to tell it at a glance.

Now that there is the Snowman Expedition, the scope is suddenly narrowed.

Cystic transformation of pituitary tumor, Rathke cyst.

Both of them have the snowman sign, the difference lies in whether the cyst wall is strengthened.

Looking more closely, the patient's cyst wall is enhanced and the optic chiasm is lifted, so we should consider cystic transformation of the pituitary tumor.

Fu Yuanhang already had a tendency in his mind, but pituitary tumors are generally chronic and multiple, and are more common in young and middle-aged people. Considering the patient group, it is a bit inappropriate.

We also have to consider Rathke cyst. In the patient's imaging, there is a mass in the pituitary area, low signal at T1, high signal at T2, enhanced enhancement of the cyst wall, but no enhancement inside the cyst. Since there is no enhancement inside the cyst, we should also consider Rathke cyst.

It should also be differentiated from craniopharyngioma.

However, no matter which one it is, hospitalization is required. Outpatient treatment is only the first step, and Fu Yuanhang does not need to solve the patient's problem in the outpatient clinic.

Fu Yuanhang was still more inclined to believe that it was pituitary tumor cystic change, so the initial diagnosis directly wrote pituitary tumor cystic change?

The question mark is used for the sake of rigor. In the differential diagnosis section, Riske's cyst and craniopharyngioma are also written down.

However, there were problems when explaining it to the patients. When they heard that it was a pituitary tumor, they panicked, even though they didn't know what a pituitary tumor was.

But if it's associated with a tumor, is there anything good about it?
Fortunately, Fu Yuanhang was well prepared and told the patient and his family that this was a benign tumor, the patient's current condition was not serious, there were still many treatment options, and the prognosis was good.

Only then did the patients and their families feel relieved.

The patient was admitted to the hospital for further diagnosis and treatment, and surgical treatment was performed if necessary. Attention was paid to changes in pituitary-related hormones. This was the end of the first patient.

Lin Dongping looked at the performance of his disciples and nodded.

Although Fu Yuanhang's performance was not as good as people expected after he started his internship, his personality often revealed some instinctive arrogance, which made it difficult for patients to empathize with him, and his performance was not up to par,

But after two weeks, Fu Yuanhang had obviously recognized his problems and made changes.

Among the eight people, Fu Yuanhang is undoubtedly one of the best in terms of basic level and excellence, perhaps only slightly worse than Xun Qi.

As long as you perform normally, others may not be able to compare with you.

Now that Fu Yuanhang has found his form, his true strength is immediately revealed, and he treated the first patient very well.

The diagnosis of pituitary tumor cystic change was correct. Although the process was flawed, the merits outweigh the flaws and it is understandable.

Wu Xiaofu and his colleagues almost unanimously gave high scores to the performance of this first patient during the consultation.

The most important thing in outpatient clinics is to give a preliminary diagnosis. If the preliminary diagnosis is correct, subsequent diagnosis and treatment will be more effective. However, if the preliminary diagnosis is wrong or the direction is wrong, then the follow-up will be troublesome.

Because both nurses and residents will prejudge this preliminary diagnosis and conduct the following series of examinations.

As for the patient's family members, they can't tell others later that the outpatient clinic made a mistake and that it should actually be this disease.

So, if the initial diagnosis is correct, you can get more than half of the points.

What's more, Fu Yuanhang cleverly left room when explaining the patient's condition and mentioned other possibilities, but he was more inclined to this one.

Pituitary tumors are a relatively common disease in neurosurgery and are not difficult to treat. The snowman sign is the key point. If you can find it, you are halfway to success.

According to Wu Xiaofu and his colleagues, the first patient was of medium to high difficulty. After this one, the only one left would be more difficult than this one.

All eyes are focused on Xun Qi, his patients are not simple either.

The patient who came to Xun Qi's clinic was a 13-year-old female patient. The little girl had just entered junior high school and started suffering from asthma before she entered school. Because she had a history of pollen allergy, her parents did not take it seriously and just kept her away from allergens as usual, thinking that she would get better soon.

However, the condition became more and more serious.

Xun Qi's medical consultation was even more rigorous than Fu Yuanhang's.

While asking, the medical record was written. A few months ago, the patient had repeated shortness of breath without obvious cause, which worsened after activity and was relieved after rest. He had no fever, cough, sputum, palpitation, chest pain, hemoptysis and other discomforts, and was not treated.

He has a history of hypothyroidism and pollen allergy.

Physical examination: low breath sounds in both lower lungs, nothing else special.

Auxiliary examination: Tumor markers: Cytokeratin 19 fragment 2.71ng/ml: CA12575.2U/ml; SCC 4.7ng/ml.

Ultrasound examination of the cervical, supraclavicular and bilateral axillary lymph nodes showed: 1. Multiple enlarged lymph nodes in both cervical regions; 2. Multiple enlarged lymph nodes in the left supraclavicular region; 3. Multiple lymph nodes in both axillary regions were detected.

Chest CT showed a huge mass in the mediastinum.

This!
Xun Qi watched the film, then looked at the little girl who was only thirteen years old, and there was inevitably some distress in his eyes.

In fact, he felt something was not good when he saw the abnormal tumor markers.

Although this is not the gold standard for diagnosing tumors, once an abnormality occurs, especially an obvious abnormality of this kind, it will basically not get better.

However, it may also be caused by inflammation. It is possible that asthma for several months may cause some inflammation.

But after seeing the chest CT, I finally gave up.

The mediastinal mass has a large shadow area, which can actually be equated with a tumor. Although there are occasional accidents, they are rare.

What's more, it occupies such a huge space.

The patient also has problems with his cervical lymph nodes, which makes the situation even more pessimistic. This is a sign of lymph node metastasis.

After writing down the diagnosis of mediastinal tumor, Xun Qi asked the patient's mother to take the child out of the clinic and began to explain the situation to the patient's father.

Combining many examinations and physical examinations, the possibility that the patient's tumor is benign is basically small.

After hearing these words, the patient's father's face changed, "How is this possible?"

Although he had a bad premonition, the patient's father still found it hard to accept what Xun Qi told him.

"She's only thirteen."

Yes, she was only thirteen years old, and Xun Qi felt a little uncomfortable. Even though he was a doctor and was used to seeing life and death, he couldn't help but feel emotional when encountering such a situation.

After hearing that the patient may have lymph node metastasis, further examination is needed, including a puncture biopsy to determine the nature of the pathology, and then a full body check to see if there is any distant metastasis.

The patient's father regretted it even more.

"It's my fault. It's my fault that I didn't bring her to the hospital earlier. It's my fault."

Anyone who sees this situation will feel uncomfortable. Xun Qi wanted to comfort the patient, but he knew that no comfort would be as effective as examining the patient as soon as possible, determining the condition, and providing treatment as soon as possible.

While persuading the patient's family to agree to hospitalization, Xun Qi was making a treatment plan, which also included considering that the patient had thymoma.

Various tumors in the chest have different properties, symptoms, and imaging manifestations, but they can still be distinguished from the subtle details.

However, pathology is the gold standard, but if there is a direction, subsequent diagnosis can be faster.

(End of this chapter)