This Doctor is Great

28 beds,

Wu Xi, male, 42 years old.

Zhou Mo stood beside the bed: "Wu Xi, right, can you tell me about your condition?"

"Okay, okay, my situation is like this... When I was exercising at home today, I suddenly felt chest pain, and then I quickly called 120 and came to the hospital..."

"The emergency department gave me the diagnosis of "hypertension complicated with chronic nephritis"..."

"??????"

Zhou Mo was stunned for a moment.

"Wait, nephritis? Are you sure?"

"Yes, sure, the doctor in the emergency department drew me blood, and then did some tests, and then determined that I had chronic nephritis..."

Zhou Mo: "..."

Zhou Mo opened the system with an ipad and found the patient's medical records.

Sure enough, there was a kidney function test, and many kidney function indicators had risen.

There is also blood routine, the most obvious one is white blood cells, which has increased significantly.

And blood pressure, admission measurement is 170/110mmhg...

"Is high blood pressure primary?"

"What's the meaning?"

"Meaning, does high blood pressure cause nephritis? Or does nephritis cause high blood pressure..."

There is still a difference between the two.

Hypertension can cause renal damage for a long time, and chronic nephritis can cause secondary hypertension.

Of course, it is not difficult to judge,

If it is malignant hypertension, renal function can progress rapidly.

Blood pressure increased more than 5 years before renal damage; renal function damage was mild and progressed slowly: anemia was later and milder; urine protein was rarely 2+ or more.

"Hey, do you have a fever?"

"Yes, I had a fever three days ago. I originally just took medicine at home, but I suddenly had chest pains, so I came to the hospital..."

"The emergency department has determined that you have a fever caused by nephritis?"

"yes."

It took an hour of consultation and physical examination to finally figure out the general condition of this patient.

Ten years ago, the patient Wu Bin had high blood pressure, and then two years ago, he had a fever every few months, and he didn't take it seriously.

Since the beginning of this year, Wu Bin found that when he urinated, there were a lot of bubbles in his pee.

I didn't care at first, but after a week or two, there were more and more pee bubbles.

At that time, he wondered why there were so many bubbles in his pee.

So I went to the hospital for an examination, only to find out that it was a kidney problem.

The bubbles are caused by the high protein content in the urine (the specific indicator is the urine protein +++ in the urine routine (the more +, the more serious it is)).

In addition to the two diseases of hypertension and nephritis, patient Wu Xi also has coronary heart disease (coronary atherosclerosis).

Long-term high blood pressure, Wu Xi did not take regular medication, resulting in high blood pressure, resulting in high pressure on the arterial wall, resulting in endothelial cell damage, low-density lipoprotein cholesterol entering the arterial wall, and stimulating smooth muscle cell proliferation. Coronary heart disease.

Then, this time, it was coronary heart disease that caused angina pectoris.

"Okay, I'm done checking..."

"Thank you doctor..."

Zhou Mo nodded and left the ward.

……

In kidney disease,

Zhou Mo is not very familiar with it, he has read relatively few materials, and what he knows is only the knowledge in school, so he needs to take the time to get familiar with this one.

In this case, I may have to round up the wards with the Nephrology Department tomorrow. When I ask three questions, I will be embarrassed by the Cardiology Department.

Back to the duty room,

Write the course of the first diagnosis...

Then, regarding the doctor's order, Zhou Mo felt stable first and searched for relevant guidelines.

'Hypertension complicated with chronic nephritis, if the patient can tolerate it, blood pressure can be reduced to 130/80mmhg, and if necessary, it can be combined with 2-3 antihypertensive drugs, including a RAAS blocking drug (acei or ARB) ...'

'If renal function is significantly impaired, or there is a large amount of urinary protein, dihydropyridine calcium antagonists should be used first...'

'Precautions for medication:...'

……

"Huh~~~"

Wang Lilong was at the table next to Zhou Mo and made a surprised voice.

"Zhou Mo, are you seeing a nephrologist?"

"Yes, I just received a patient with high blood pressure and chronic nephritis, so I need to supplement the information..."

"You haven't read the information on nephrology before?"

"No, it's blank..."

"Then you have to learn it, but it's not enough to be fooled. Nephrology is a separate department with thousands of diseases, and nephritis alone has a lot of attention. Now I'm afraid it's too late..."

"It's okay, I have my study method..." Zhou Mo said.

When Wang Lilong heard this, his eyes suddenly lit up!

Zhou Mo's study method?

Isn't this what you've always wanted to explore?

I want to learn too!

Wang Lilong immediately pretended to be curious and asked for advice: "Do you have a quick way? Can you teach me?"

Zhou Mo is generous: "Yes, my method is to read a lot of relevant textbook knowledge and literature... Just read a lot..."

"..." Wang Lilong said, "Are you teasing me on a horse? ' expression.

Isn't this rote memorization?

I will too!

Why can't I study faster than you?

Zhou Mo: "Okay, let's not talk about it, I'll read the book first..."

Then,

Started to read a lot of books.

"Ding...you read the textbook "Internal Medicine·Urinary System Diseases", you understood 100% of the essence, and remembered it forever..."

"Ding...you read the paper "Precautions for Medication in Chronic Nephritis",..."

"Ding...you read..."

The system kept ringing in my ears.

A lot of knowledge about kidney, nephritis, and chronic nephritis poured in.

Eating and reading books.

half an hour...

One hour……

two hours...

Wang Lilong was sitting next to him. On the surface, he was working **** the computer. In fact, he was doing two things with one mind. Most of his attention was paid to what Zhou Mo was doing.

Half an hour: "He was actually reading the textbook..."

One hour: "He read the paper..."

Two hours: "What's the matter? Didn't he lie to me? He has always been excellent~www.readwn.com~ The learning method is just rote memorization? It's unreasonable, I don't believe it..."

Three hours: "He's still watching! Watching so much, so fast, doesn't his head explode? Can you understand? Can you remember?"

Four hours later,

Wang Lilong doubted his life.

Zhou Mo is really reading books, documents, guides...

"Could it be that his learning method is really 'rote memorization'?"

Wang Lilong felt that this afternoon, he had observed a loneliness!

"No, maybe he's just confusing me!"

"Don't want me to know his real learning method!"

……

Zhou Mo didn't know that Wang Zhenglong had so many inner dramas, and he extracted it from the sea of ​​knowledge in the "kidney".

at this time,

He has basically mastered most of the renal knowledge, and he is somewhat confident about the medication.

16:10,

He needs to go to the room.

Went to a ward round, checked both beds 28 and 29, and then came back to write medical records and doctor's orders.

17:00…

Zhou Mo wrote detailed medical records for 28 patients, including detailed diagnosis and judgment of chronic nephritis, and then issued a doctor's order, including hypertension control and medication for chronic nephritis.

soon,

As the attending teacher Huang Li, he received a doctor's order written by Zhou Mo.

"Hey, chronic nephritis? You need to ask a nephrologist for consultation..."

"Zhou Mo's diagnosis seems to be quite familiar with the kidneys?"

"Hey, Zhou Mo actually prescribed medicine for nephritis? He also understands the medicine?"

Teacher Huang Li was surprised.

Then forwarded it to the doctor on duty in the kidney...

.