I'm really an intern

Chapter 386 The end of science is metaphysics

The eldest sister in bed 36 is a real person, and she really says goodbye when she says goodbye.

Seeing her raising her hands up and down slowly, Zhang Tianyang panicked a little.

"Hey, please, please, I'm just kidding!

There is no such thing as fortune-telling, it is all science, science! "

Seeing that he was playing too much, he quickly grabbed the elder sister's bowing arm.

However, the 35-bed eldest sister is also from the Northeast, tall and strong. He almost stopped the failure and threw himself into the ground.

The male family members next to him hurriedly gave Zhang Tianyang an apologetic smile.

"I'm sorry, doctor, our mother-in-law is a bit of a tiger."

"It's all right, eh?"

Zhang Tianyang rubbed his aching arm from being held by the 36-bed elder sister, and turned his head to look at the man who spoke, feeling a little dazed.

Wait a minute.

He just said that the eldest sister in bed 36 is his wife, right?

The mother-in-law is the wife, right?

He looked at the half-white hair and the furrows on his face, he looked like a man in his 50s or [-]s.

Then I couldn't help turning my head to look at the 30-bed eldest sister who is physically strong, has a ruddy complexion, and is well-maintained. She looks like she is just 35 years old.

They are husband and wife?

Not father and daughter?

Ok? ? ?

Zhang Tianyang was in a daze, the 36-bed lady over there suddenly gave up asking Zhang Tianyang about her illness, squinted her eyes and grabbed the man by the neckline.

"Who are you talking about? Who is the tiger? What do you mean?"

The man's eyes widened in an instant, and he defended in a low voice.

"I didn't, you heard me wrong, you"

"What me! Who are you talking about!"

"I am a tiger, I say I am a tiger"

The man's voice became softer and more aggrieved, Zhang Tianyang couldn't stand it anymore, so he quickly shifted his attention.

"Then what, let me ask something more."

"Hey, good!"

The 36-bed eldest sister performed a face-changing skill in an instant, smiling at Zhang Tianyang.

"Master, what else do you want to ask? Birthday horoscope?"

Zhang Tianyang's face darkened instantly.

"I'm really not a fortune teller, I'm just a doctor, don't call it that, and I want to ask about medical history"

The eldest sister in bed 36 waved her hand, "Okay, master!"

Zhang Tianyang: ""

Well, this stalk can't pass!

Zhang Tianyang silently re-managed his expressions, and then conducted detailed consultations according to his preset plan.

The situation of 36 beds is actually much simpler than that of 35 beds.

The unlucky intern had already asked about the process of the patient's blood pressure fluctuations, the medication and its effects, and Zhang Tianyang asked about the initial state of the disease.

It was easy to ask. At that time, not only had high blood pressure, headache, but also felt weak all over. The local hospital checked for "low potassium" and prescribed potassium tablets.

It's just that the 36-bed elder sister and her family members thought it was a trivial matter, so they didn't mention it until they asked.

It wasn't until Zhang Tianyang pointed it out that he was shocked.

Listening to Zhang Tianyang casually asking a bunch of details that he didn't know, the unlucky intern became more and more silent.

He felt the gap between himself and Zhang Tianyang.

Listening to Zhang Tianyang's consultation, he felt that he had learned a lot, but thinking about it, it seemed that he would not be able to repeat it for a while.

A little depressing, but very motivating at the same time.

He speeded up and wrote vigorously.

The eldest sister in bed 36 didn't think so much. She has a more cheerful personality and can't hold back her words.

"Master, ah, doctor."

She smiled, squinted her eyes, with a little curiosity and inquiry, "Well, how did you figure out the cough, how did you know my symptoms?"

Zhang Tianyang put away his blue and black pen and blinked innocently.

"Isn't it normal to deduce the disease from the symptoms, and then infer the symptoms from the disease?"

The 36-bed eldest sister quietly glanced at the unlucky intern next to her.

The unlucky intern who was writing quickly paused, lowered his head slowly, and apologized softly.

"sorry"

It's because I'm too picky, I didn't push it out

Moreover, in fact, he is still a little confused now.

Zhang Tianyang is indeed very powerful, but he jumped too many steps, and he couldn't keep up with his train of thought.

Zhang Tianyang looked back at the unlucky intern who had already buried his head in his chest, sighed softly, and then looked back at the eldest sister in bed 36.

"Forget it, let me explain to you."

"The disease of high blood pressure is divided into primary and secondary. Primary means that you have high blood pressure directly, and there is no other reason.

Secondary means that you have a problem in other places, which then affects your blood pressure. "

"Essential hypertension is generally more common among the elderly. For those as young as this elder sister, it is unlikely to be primary. Let's consider secondary first."

"There are many common causes of secondary hypertension, endocrine and renal"

Zhang Tianyang turned to look at the unlucky intern.

On the surface, he was explaining to the 36-bed patient, but in fact he was explaining to the unlucky intern.

"Considering that the patient has already been admitted to our department, we can assume that this is a disease that can be operated on, so we can rule out some of the directions to consider, such as hyperthyroidism, which can be ruled out temporarily, and some renal hypertension that is mainly treated by internal medicine can also be ruled out. You can ignore it for now.”

"The most common ones that require surgery are adrenal-related diseases, such as primary aldosteronism with a high incidence, and the symptoms are typical hypertension and hypokalemia."

That's it!

The unlucky intern suddenly realized.

He nodded violently while scribbling, and his eyes, which seemed to be covered with something, gradually lit up.

The eldest sister in bed 36 has been confused since the first few words. After hearing it now, she seems to understand something, but there seems to be more things she doesn't understand.

Zhang Tianyang simply ignored her and brought the topic back to bed 35.

"Chyluria is common in thoracic duct blockage or extensive blockage of abdominal lymphatic vessels, chyle flows back into the urine, making the urine cloudy like **, and the urine chyle test is positive.

When you see white urine, you must think of chyluria, but at the same time, pay attention to distinguish it from pyuria.

Persistent chyluria will lead to protein loss, but for some mild chyluria, the doctor will suggest diet control, expect to improve, and resume diet after chyluria disappears.

But the 35th bed has not improved, so I guess that the diet has not been adjusted, the long-term intake has decreased, and the absorption has decreased.”

Zhang Tianyang looked up at the woman in bed 35 with high cheekbones and sunken cheeks.

The unlucky intern also looked up, and suddenly understood.

The malnourished appearance of bed 35 is inextricably linked to diet control and persistent chyluria.

No wonder, Zhang Tianyang can reverse the patient's eating habits!

"And that spell."

Zhang Tianyang continued to state his reasoning.

"There are only a few ways to deal with chyluria, and considering that the urine returned to normal half a year after the operation and then relapsed, it is necessary to think of ligation of lymphatic vessels around the renal pedicle.

This operation is effective, but because the lymph is easy to establish collateral circulation, it is easy to relapse.

Just right on the number. "

Zhang Tianyang's tone was neither urgent nor slow, and he spoke eloquently, without showing off skills or bringing any personal emotions, as if he was talking about an ordinary thing.

"The same is true when asking people around, because the common cause of chyluria is filariasis, and with the patient's hometown information, it is easy to associate.

In the case of an epidemic area, she must not be the only one infected, and the people around her also have chyluria, which is a normal reasoning.

In terms of medication, Haiqunsheng is a specific drug against Malayi filariasis, and the local hospital must have experience. "

All the ideas finally came together.

While the unlucky intern was furiously writing, his eyes towards Zhang Tianyang had turned into extreme admiration.

He once again deeply realized the gap between himself and Zhang Tianyang.

Obviously they are all interns, but they can think so clearly, have a solid foundation, and have a smooth logic.

You, you, you are so good!

You have to learn from others!

On the side, the two-bed patient and two family members tried hard to understand Zhang Tianyang's explanation.

But soon, they all chose to give up.

With such professional knowledge, if you can understand it yourself, why do you need a doctor?

I don't understand it, but it sounds great!

Doctor 666!

The patients and their family members who had been reduced to four salted fish silently shouted 666 in their hearts, and looked at Zhang Tianyang with more eager eyes.

I don't understand.

I don't understand, but being able to subdue other little doctors means that this doctor has something in his stomach and is a big boss!

Wouldn't it be nice to have a big boss take care of yourself?

"So, in fact, I didn't calculate those just now, but based on the existing evidence and the knowledge I have, I deduced the results.

It is said that the end of science is metaphysics, but it is not.

Essentially still science.

It's just that because I omitted the process, it seems very metaphysical. "

Zhang Tianyang made the final conclusion.

"So, don't call me master anymore, it's all a joke."

However, the four pairs of eyes were piercing, eager to try.

"Okay, Master!"

"Understood, big doctor!"

"Then what, doctor, are you our bed doctor?"

"Master, uh, doctor, can you add your WeChat? I want to have a further discussion with you about your condition."

"Doctor, I also want to add you on WeChat"

"Doctor, I didn't understand very well just now, can you leave a call?"

The four of them immediately surrounded Zhang Tianyang who had finished his lecture, cordial and enthusiastic.

Zhang Tianyang was tired of coping and looked confused.

Wait a minute.

Didn’t they all say that it’s not metaphysics?

Why are you more excited? Hey!

who!

That intern who was isolated outside the circle of people!

Don't stand there in a daze!

Come and save me!

　The past two days are almost [-] words~ By the way, I will be on duty again tomorrow, ying ying ying

　　

　

(End of this chapter)