I'm really an intern

Chapter 53

After asking about the medical history, Zhang Tianyang's A4 paper was filled with handwriting.

Senior Sister Chen stretched her head over to have a look, and clicked her tongue.

"Young male, giant spleen Chayin, this is an intractable disease."

Zhang Tianyang stared at the notes he made and pondered, "Indeed, there are too many possible reasons. Sister, how did you think about it?"

"Don't ask me." Chen Shishi instantly changed to a computer farther away to show distance.

"I'm not qualified to comment on this kind of intractable disease. After you prescribe the routine doctor's order, call Senior Brother He or Professor Zhu for instructions!"

"OK."

Zhang Tianyang shrugged, this kind of judgment of the condition is indeed a bit out of line.

"What patient?"

Senior brother She was a little curious, and silently floated over to watch Zhang Tianyang write the medical records.

After watching and watching, he floated back silently.

Intractable diseases, farewell, farewell!

In addition to the regular admission package, the 79-bed lad focuses on differential diagnosis.

Zhang Tianyang thought for a while, and then prescribed a few additional checks for him.

Reticulocytes, schistosome antibody detection, ceruloplasmin, urine copper quantification, and ophthalmology consultation.

The reticulocytes are used to screen for diseases of the blood system. In fact, Zhang Tianyang wants to give him a bone piercing, but he still has to wait for the results of the blood routine test.

The schistosomiasis antibody test is to see if the liver and spleen are caused by schistosomiasis. A more definite diagnosis is to do an enhanced CT of the abdomen, but enhanced CT is such an expensive examination that he can’t just prescribe it.

Quantification of ceruloplasmin, urine ketone, and ophthalmology consultation are to screen for hereditary hepatolenticular degeneration. Patients with this disease will have "copper" accumulation in their bodies, and both ceruloplasmin and urine copper will be high , the characteristic KF ring can also be seen in the eye.

"That's all I can decide."

Zhang Tianyang sighed, and just about to call Senior Brother He, Chen Shishi's cell phone rang first.

"Hello? Brother He? Are you done with it?"

It's Brother He's phone number.

"Ah, Xiao Chen, Professor Zhu told me that you have newly admitted a 27-year-old with an enlarged spleen. How is it now?"

The 79-bed guy does have a solid background.

Professor Zhu gave special instructions in the morning, and asked Brother He to take a special look at it in the afternoon. He was not ordinary concerned about him.

"The patient came and was taken by the younger brother. Brother, you tell him?"

Chen Shishi gave Zhang Tianyang the phone, and Zhang Tianyang quickly introduced the young man's condition to Senior Brother He.

"So young, it's hard to say."

The background sound opposite Senior Brother He was still noisy, "Xiao Zhang, did you ask where he is from?"

"I asked, Yixing in Jiangsu Province is an endemic area for schistosomiasis. I also had a history of exposure to infested water when I was a child, and I have been prescribed schistosomiasis antibodies.

By the way, do you want to do an enhanced CT of his upper abdomen?If you can see the map change, you can be sure that it is a schistosomiasis. "

After Zhang Tianyang finished speaking, the other side was silent for a while.

Brother He originally planned to direct Zhang Tianyang to ask specific medical history and teach him how to diagnose schistosomiasis.

As a result, as soon as I asked him where he was from, the other party immediately realized that he wanted to ask about schistosomiasis, and then he finished talking.

Not to mention clear thinking, but also very accurate.

It is really different from the former intern students.

"Do it, make an appointment with him."

Brother He paused for a while, but still couldn't hold back, "Are you really Xiao Zhang?"

"Yeah, it's me, what's wrong?"

"It's okay." Senior Brother He laughed and reversed his inherent impression.

"By the way, Xiao Zhang, have you asked about his family history?"

"I asked, and he said that no one in his family has this problem. I have already prescribed ceruloplasmin and urine ketone quantification for him. I just typed out the ophthalmology consultation form and haven't given it to him yet."

Well, again, he guessed what he wanted to ask after only mentioning a family history!

Brother He was shocked for a moment, and suddenly a deep sense of satisfaction welled up from the bottom of his heart.

It would be great if all the subordinate doctors under him were like Xiao Zhang!

Sorry for the wrong screen.

If all junior doctors are like Xiao Zhang, who have accurate judgments on the condition, you have already arranged everything without saying anything, and he can quickly understand what you mean when you say a word and report accurately and detailedly

It's not like the intern students I have brought before, who say what to do, and they will never do it if they don't say it.

How is it different from a tool man?

"Oh, it's hard to come by."

Brother He sighed suddenly, which stunned Zhang Tianyang.

Fortunately, the other side quickly asked a new question, "Xiao Zhang, what else are you thinking about?"

"Considering blood system diseases, blood routine and reticulocytes have been checked, and I want to wait for the blood routine to come out before prescribing him."

All considered

Brother He sighed, and suddenly felt that he was just a display.

Although his guesses had already been told by the other party, he suddenly became curious as to whether this little Zhang would have any thoughts that he hadn't thought of.

So he tentatively asked, "What else?"

"There is another one, I'm not sure, could it be idiopathic splenomegaly?"

Zhang Tianyang thought about the literature he had studied in the system.

"Some patients with splenomegaly can't find the cause, and they will be classified as idiopathic splenomegaly, but it seems that some people have studied it, and most of these patients with splenomegaly had umbilical cord infection in childhood.

I also asked the patient, but he didn't know very well, and said he would call his parents to ask. "

"Idiopathic splenomegaly."

Brother He murmured silently, thinking that it was indeed possible.

Zhang Tianyang on the opposite side has already begun to explain, "Idiopathic splenomegaly is only considered when the cause cannot be found. I think it is better to let the patient do all the examinations and see the results first."

"Yes, you are right."

Even if you can't see the scene on the other side when you call, Senior Brother He is still nodding his head vigorously.

"Okay, let's take a look at this patient, and if there is any examination you think you need to do, make an appointment first, and I will communicate with the patient during the rounds tomorrow.

You judge, I rest assured! "

After hanging up the phone, Zhang Tianyang continued to check the patient on the computer.

I was worried that I didn't have the authority to open it before, but now I will open it all.

"Do all these things?"

Brother She didn't know when he floated behind Zhang Tianyang quietly again, with a shocked expression on his face.

"Junior brother, have you asked the superior doctor?"

"I asked, and told me to look at it."

Zhang Tianyang didn't care, and continued to give the doctor's order, leaving Senior Brother She behind with a serious face.

Can this kind of examination, which costs hundreds of dollars, be prescribed without the approval of the superior doctors one by one?

If it is opened too much, isn't it cheating the patient?

Senior Brother She frowned, secretly making up his mind.

No, I must report truthfully to Professor Zhu when she makes her ward rounds tomorrow!

(End of this chapter)