RPAGF Chapter 1520 - 614: Starting from Disease Progression, Drop by More Often
Chapter 1520 - 614: Starting from Disease Progression, Drop by More Often
Director Yin sighed.If this disease were that easy to diagnose, there would be no need to ask Zhou Can for help.
"This case is indeed quite puzzling. It might just be a disease with symptoms similar to cryptococcal meningitis. The second disease I suspect is Tuberculous Meningitis. This disease has an insidious onset, a long course, and symptoms that vary in severity. The patient might have a history of other areas infected by the tubercle bacillus, with prodromal symptoms like low-grade fever, night sweats, loss of appetite, mild headache, lethargy, and fatigue."
"As the disease progresses, the headache worsens with vomiting, neck stiffness, and both Kernig’s sign and Brudzinski’s sign are positive. There’s also the possibility of eyelid drooping, unequal pupil sizes, paralysis of the extraocular muscles, double vision, and facial paralysis due to meningeal adhesions. Normally, in this disease, tendon reflexes may be heightened, and pathological reflexes are positive, but if there’s spinal nerve damage, it may lead to loss of tendon reflexes."
"If this disease is not treated in a timely and correct manner, the condition will continue to deteriorate, eventually reaching the late stage and directly threatening life."
Zhou Can identified the second suspected disease.
"This female patient somewhat resembles having progressed to the second stage of this disease. However, there are also points that do not support this disease, such as some of the patient’s symptoms not matching, and the patient’s chest X-ray showing no abnormalities. In the cerebrospinal fluid test, protein elevated, sugar decreased slightly, but chlorides showed no significant changes."
First, suspect this disease, and then point out some arguments against it.
Diagnosis is sometimes self-contradictory like this.
It’s necessary to see through the layers through repeated reasoning.
"We’ve basically ruled out Tuberculous Meningitis after internal consultations. However, your mention of positive Kernig’s and Brudzinski’s signs is indeed a new discovery."
Director Yin was slightly thoughtful after hearing this.
"How should I put it? Although this disease seems least suspicious to many, I think quite the opposite; I believe it’s very likely this disease. The symptoms of this female patient are quite classic and could fit multiple diseases. Therefore, I believe we should start with symptoms, but not rely solely on them. We should also consider disease progression and whether the patient has a history of illness comprehensively."
Zhou Can never diagnoses from appearances; he prefers to peel away the layers and target the root of the disease.
Perhaps this is a diagnostic talent.
Enabling him to identify the most deeply hidden or most overlooked points among many doubts, pursue them deeply, eliminate interference, and finally uncover the cause.
"Interesting."
Director Yin Hua’s eyes sparkled slightly after hearing this.
"Combining disease progression into the diagnosis is something none of us, including other doctors, have thought of."
"Actually, I also thought of some other suspicious diseases earlier, but ultimately dismissed them. Such as purulent meningitis, Viral Meningitis, and so on."
Zhou Can’s words were straightforward, meaning he highly suspects the patient has Tuberculous Meningitis.
In clinical practice, the diseases doctors most dislike dealing with are those related to tuberculosis.
Tuberculosis is easily transmitted; it is especially stubborn, has a very long course, and the cure period is also very long.
Many patients and their families do not understand medicine; after taking medication and injections for a while and seeing no improvement, they begin to doubt the doctor’s diagnosis and treatment plan. They are unwilling to cooperate with the treatment anymore.
This could lead to wasted efforts.
In the end, doctors can only watch helplessly as the patient falls into the abyss. After it’s over, the family and patient may collectively scold the doctor as incompetent, unable to even treat a disease.
"Tell me the basis on which you concluded that the patient has Tuberculous Meningitis."
There was a cunning glint deep in Director Yin Hua’s eyes, as if he wanted to use this opportunity to delve deeper into Zhou Can’s diagnostic capability.
"There are indeed some other bases. For instance, the patient has low-grade fever, vomiting, double vision, and convulsions, all of which are similar to the second-stage symptoms of Tuberculous Meningitis. Moreover, the patient has papilledema, right extraocular muscle paralysis, signs of meningeal irritation, positive pathological signs. ESH increased, neutrophil white blood cells were elevated. These bases are enough to highly suspect Tuberculous Meningitis."
Zhou Can mainly suspected this disease, not just because the progression was similar.
There were also many matching symptoms.
"Hmm, the way you say it, even I think it’s this disease. However, medicine is a rigorous science, and there must be some solid tests as evidence before confirming the diagnosis and medication."
Director Yin was impressed by Zhou Can’s capability.
He noticed that Zhou Can improved particularly quickly, and every once in a while, his abilities in various aspects would enhance significantly.
"If you want testing evidence, isn’t it simple? Take a sample and do a PPD test! You can also have the patient do a head CT or MRI! The most common targets for tuberculosis are thoracic and abdominal organs, but that doesn’t mean if a chest X-ray shows no issues, there’s no infection in the head, right?"
Zhou Can said with a smile.
"Makes sense, I’ll draft an application for the test now, to conduct a purified protein derivative test for tuberculosis on the patient. We can wait for the head CT and other biological test results before proceeding."
Director Yin gladly accepted Zhou Can’s suggestion.
Older doctors often like to say the full name of a test or a short name in Chinese, while younger doctors prefer to take shortcuts and use some English abbreviations wherever possible.
The PPD test for Tuberculous Meningitis is considered a gold standard.
Director Yin initially didn’t order a head CT for the patient, considering the patient’s financial situation. Ethical doctors think carefully about each test they order for a patient, deeming it necessary before ordering.
There are only doctors without ethics, focused solely on making money and completing departmental tasks, who would deliberately order unnecessary tests for patients.
They would want to check everything that might be remotely relevant.
On one hand, they can earn performance bonuses, and on the other hand, conducting more tests provides more diagnostic bases, reducing the probability of misdiagnosis or missed diagnosis. The benefits are all received by the doctors, while the patient suffers more and has to pay many unnecessary testing fees.
One can only say these doctors lack the most basic human empathy, being too selfish and self-serving.
The patient is already very unfortunate to be sick.
But to be treated as a money-making tool by doctors and extorted heavily at the hospital is cruel.
As the medical regulatory system becomes more robust, a medical ethics evaluation system should be established in the future. Those whose scores are failing or with a bad history should be banned from the profession for life.
After Director Yin eagerly finished drafting the application for the test.
Zhou Can took a sip of water and looked at him, "Director Yin, since I’ve helped you tackle a difficult case in your department, shouldn’t you help me by providing some reference opinions on that case of high paraplegia?"
It was only because Zhou Can was familiar with Director Yin and had a good relationship that he dared to speak like this.
When speaking with elders and seniors, he was usually very respectful.
There’s a saying that goes, the closer the relationship, the more casual the interaction.
"Haha, you’re one to never miss an opportunity. I just checked on that little boy in the ward; there isn’t any major discovery. However, based on my many years of clinical experience in neurology, I think the cause of the child’s illness might likely be in the head. Or it might be a composite cause."
With Zhou Can’s help, there was a significant breakthrough in diagnosing the cause of this female patient’s illness that had troubled them for many days, making Director Yin very pleased.
He laughed heartily and discussed the causes of the high paraplegic little boy.
"High paraplegia having a composite cause? That’s new knowledge to me today."
Zhou Can had only heard of mixed hemorrhoids, but never of paralysis having a composite cause.
Internal hemorrhoids and external hemorrhoids occurring simultaneously are clinically referred to as mixed hemorrhoids.
Could high paraplegia mean multiple issues in the nervous system?
"Never heard of it, right? There are plenty of things you haven’t heard of, whether you’re busy or not, you should come by more often, understood?"
Director Yin laughed as he invited.
He liked talented individuals like Zhou Can and encouraged frequent visits to his office for a chat.
Discussing over tea or wine is what many heroic figures enjoy.
"Alright, alright, I will definitely come by more often to learn from you in the future."
Zhou Can promised earnestly.