"Uncle, I don't want to be a teacher. Just call me Xiao Lu or Doctor Lu." Lu Cheng introduced himself.

The main reason is that I am a graduate student and have not yet entered school, so I have to prepare my name badge. Although it has been handed over to the medical department to make, it is only my own name badge, so it will take some time to complete it.

Or if the medical department does not want to do it alone, it is possible to wait until all professional graduate students have registered and then do it together.

The middle-aged man and his wife are both on the thin side. The man's hair is half white and short, and he looks very capable. His clothes are neatly dressed, and he obviously pays attention to them all the time. There are not too many wrinkles.

The middle-aged woman looked a little weak. After she heard her husband talking to Lu Cheng while lying on the bed, she quickly turned around and said, "Is the orthopedic doctor here? Lao Xiang, help me shake the bed."

She was touching her right thigh and talking, and her energy was a little sluggish.

The middle-aged man quickly shook the bed, and then explained: "Doctor Lu, my daughter is also a doctor. Just follow her call when she calls you teacher. She just entered a professional graduate school this year. Only then did I realize that doctors are hardworking, but

We have no choice but to trouble you."

"My wife has been suffering from intermittent pain in her legs for four or five years. I could bear it before. Later, I took a picture and it was said that she had postmenopausal osteoporosis, so I have been taking calcium supplements. This time I came to the hospital because Professor Du from the outpatient department considered it.

Maybe the osteoporosis is a bit severe."

"Then yesterday, the old problem of leg pain suddenly happened again, but this time it was more severe. It didn't get better after a while like before. It started to hurt a little bit last night, and it continues to hurt now. It's getting worse and worse.

, I took several painkiller injections during the day before I felt a little better.”

"But after the effect of the medicine wore off, the pain became unbearable again."

The old man was shaking the bed and talking at the same time. He spoke clearly and clearly. He must be a literate person.

After Lu Cheng nodded, Huang Shan added: "Last night the patient complained that he was in a bit of pain, so he added some non-steroidal drugs, but the effect didn't seem to be obvious. I just had a pelvic X-ray this morning. I was on duty during the day.

My senior sister gave me tramadol once."

“As soon as the plain film came out, I asked for a consultation.”

"Old man, where did you put the film? Take it out and show it to Dr. Lu." Huang Shan asked immediately after finishing speaking.

The patient pointed to the bottom of the mattress and said slowly: "The film taken this morning is under here. Dr. Lu, could you please take a look at it."

As he spoke, he touched his thigh and crotch, which seemed to be in severe pain.

Her husband wanted to stand up and help, but Lu Cheng was faster than his hands. He took out the pelvic radiograph from the brown bag with the name of the Second Xiangya Hospital and looked at the bright light outside the window carefully.

After seeing the details of the film clearly,

Lu Cheng's brows furrowed at that time.

"Huang Shan, go and get me the patient's medical record. I want to see her laboratory test information." Lu Cheng said after reading.

Huang Shan was stunned for a moment, then said immediately: "Oh, okay, I'll get it right away."

The patient's pelvic plain film does not show symptoms of avascular necrosis of the femoral head or osteoarthritis, but the imaging of the right hip joint is obviously messier than that of the left hip joint, and there are some high-density imaging that look very similar to

It's the clouds and mist floating there.

Moreover, the bone in the patient's femoral head was also slightly destroyed, although it was not a characteristic symptom like a bone tumor.

But it is definitely not an ordinary collapse after necrosis of the femoral head, because the entire shape of the femoral head is intact.

Much like that kind of infectious arthritis!

The reason why Lu Cheng was able to see so much was mainly based on his experience in treating post-fracture infection. After all, ordinary doctors and even some professional orthopedic doctors would drill holes for post-fracture infection, but there are still traces to follow.

That is, after bacteria erode soft tissue and fracture ends, they will leave some clues.

The diagnosis of infectious arthritis cannot be confirmed by reading films. It requires systematic diagnosis. The most important factors are fever, pain, laboratory test results showing elevated inflammation indicators, and then imaging examinations.

manifestations of infection.

That's why Lu Chengcai asked Huang Shan to get the medical records!

The evidence-based medical evidence of laboratory test results is higher than that of imaging tests, and the patient's own symptoms, such as fever, pain, etc., are higher than laboratory test results.

These things are not taught in textbooks, and they mainly rely on the documents sent by Fang Nixin that Lu Cheng had read before.

They are all related to infection after fracture. The statistics in the literature are slightly higher than the theory, but the theoretical part has not yet been implemented, so we must be ahead of the textbook!

Every bit of these is accumulation.

This made Lu Cheng feel very fulfilled, and he also felt that it was a good thing to have such a top-notch senior sister.

Lu Cheng then asked: "Old man, have you had any other diseases before? In addition to osteoporosis, have you ever had tuberculosis or more fevers?"

Infectious arthritis is divided into idiopathic infections and non-idiopathic infections. Non-idiopathic infections are common bacterial infections, while idiopathic infections are caused by special bacteria, such as tuberculosis, typhoid and other special bacteria.

.

If you have these medical histories, it will make the relevant diagnosis more accurate.

Ordinary bacterial infections are generally called hot infections, but tuberculosis and typhoid infections may not necessarily cause high fever, but can also be called cold infections!

If a patient has a fever while in the hospital, it is impossible for the endocrinology department, as a department of internal medicine, to not notice it.

Therefore, even before starting the physical examination, Lu Cheng already had his own diagnostic ideas.

When seeing a doctor, when you are a doctor, diagnosis is the key and first priority!

Knowledge systematization is also a relatively strong cornerstone, and clinical thinking systematization is a very important skeleton for knowledge systematization. It is also a good choice to lay the skeleton first and then fill it in.

This was what Lin Hui told Lu Cheng, and it was also something that no one had ever told Lu Cheng before when he was at Changshi First People's Hospital.

It's the right time to come here.

"No, my wife has always been in good health. He rarely suffers from headaches and fever. He just had osteoporosis a few years ago and rarely catches a cold."

"Could this leg pain be related to the fever?" The old man's reaction was quite sensitive, and he immediately found the key to the problem!

"I'm just asking first. It's hard to say yet. But when I look at this film, you can see bone destruction here and here. This doesn't look like a simple imaging manifestation of osteoporosis."

"If you look at this film again, it looks a bit like a cloud-like whiteness, which is also a bit like a symptom of infection. But we are not film doctors, so we still have to ask clearly and consider it comprehensively after seeing all the examinations." Lu

Cheng replied carefully.

"Yes, yes, you have to think about it all! It's better to think about it comprehensively. My daughter also said the same. She is a cardiologist. Although my wife has osteoporosis, we usually ask her to prescribe some medicine for us. She

They said she was not a professional and would not prescribe medicine to us. She had to come to the hospital to receive professional and systematic treatment and examination."

The old man smiled happily. Then he said: "Doctor Lu, what kind of infection does my wife have, tuberculosis? Can these be cured now? Tuberculosis was a terminal disease in our time. But recently, it has been

Over the years, it has appeared less and less.”

When Lu Cheng heard this, he became a little cautious and said: "Tuberculosis can be cured after systematic treatment. Don't worry, there are less and less tuberculosis now because the treatment is effective."

"But it must be done in a timely manner, and the diagnosis of tuberculosis is not that simple and requires systematic examination. Moreover, there are some occult tuberculosis that cannot be detected at all."

"Don't be impatient, let's take our time and look more carefully."

Although the patient and his wife seem to be educated people, and their daughter is also a doctor, logically speaking, they can understand the difficulty of being a doctor, but once such people don't understand, it will be a big trouble!

As a doctor, you don't need to be very good, but when you want to find trouble, you have to find the right one.

At this time, it is better not to say anything than to say the wrong thing. Every word must be carefully considered and considered comprehensively.

Soon, Huang Shan brought over the medical records.

Lu Cheng opened it immediately after taking it.

In the medical record, the first thing that bears the brunt is the results of laboratory examinations, which are cut very neatly row by row, in order of date, and are clear at a glance.

Well, in this area, Lu Cheng instantly felt that the internal medicine doctors did an excellent job, making people feel very comfortable at first glance.

The date is on the left, the inspection items are in the middle, and the negative and positive signs are on the right.

If it is surgery, there are a bunch of examination sheets put together. You can find what you want. Maybe the first one is an imaging examination sheet, and the next one is a record of the disease process...

Lu Cheng quickly saw the relevant positive result indicators: blood routine (+), combined antibody (+), combined antigen (-).

PPD tuberculin test (-)!

Erythrocyte sedimentation rate (+), C-reactive protein (+), IL-6 (-).

When I looked at the detailed information on the blood routine paper, I did not see an increase in white blood cells and neutrophils, but the lymphocytes were slightly higher, but the increase was not significant.

On the next page of the lab exam is a temperature chart and blood pressure chart.

The patient's body temperature has always been within the normal range, and his blood pressure has also been within the normal range.

As expected, this laboratory test did not provide any basis for supporting the diagnosis.

So next, Lu Cheng still has to rely on physical examination to assist in the diagnosis.

Huang Shan had been paying attention to Lu Cheng's expression. She was very nervous, even more nervous than Lu Cheng, because she knew that Lu Cheng was not a real chief resident, but a fake. She was afraid that Lu Cheng would not look good, and she was also afraid that Lu Cheng would say

Otherwise, the secret will be exposed.

But I also hope that Lu Cheng can bring about miracles. After all, he is a graduate student of his own class, so he can come for a private consultation.

Moreover, we were so predestined that we took the same train when we came to Shashi, and then we met with an accident, and then we found out that we were studying together.

The key is that Lu Cheng is a bit handsome...

Huang Shan's thoughts were a little wandering, but he was quickly interrupted by Lu Cheng's voice.

Lu Cheng put down the medical record book and said, "Auntie, I'm going to do a physical examination for you. Just lie down and cooperate with me. If any movement hurts, just tell me directly, okay?

good?"
To be continued...