"Wang Huan, is this really what Teacher Zhou told you?" In a demonstration classroom, Peng Lingli looked at the shared learning materials that Wang Huan brought out. She couldn't move her eyes away immediately, and her tone was slightly sour.
"It's true, what the teacher just said today, I wrote it down."
"I asked my teacher that these things can be passed on to others. So I took it and shared it with Senior Brother Peng. In addition, thank you Senior Brother Peng for teaching me so many learning methods." Wang Huan nodded, reciprocating the favor.
.
She had asked Peng Lingli many questions before, but she had never had the opportunity to share anything with Peng Lingli.
"Thank you, Wang Huan, these are really good things. I'm afraid not many people can figure out how to learn them."
"When learning to read MRI films, first read the report, then the lesions, and then the anatomy. Then look at the layers and theories, and then look at the shortcomings of the current MRI."
"Teacher Zhou, this is not easy. Since this thing can be distributed, can I send it to Guo Lin for a look?" Peng Lingli suggested.
Guo Lin was an intern with them, but it was a seven-year internship, and now he is in another department.
But no matter which major you study, the general knowledge you learn can be used, so you can also form a temporary study group.
Now it is mainly Peng Lingli who leads Wang Huan.
"Okay, no problem."
"Oh, by the way, Senior Brother Peng, I have two examples here that the teacher gave me." Wang Huan took the initiative to share, mainly because he felt that he was too good at it, and Peng Lingli took her to study most of the time.
From Wang Huan's point of view, Senior Brother Peng Lingli had no secrets. Naturally, now that it was the other way around, she couldn't hide any secrets and told everything.
"Example question? What example question?" Peng Lingli was curious.
Zhou Cheng is such an awesome teacher that he even prepared sample questions for Wang Huan on film reading.
Peng Lingli knew that Zhou Cheng had taken Wang Huan to look at the joints and anatomy today, and she wanted to know what kind of thing Zhou Cheng would give Wang Huan to consolidate.
Wang Huan opened a compressed package from WeChat on his mobile phone. The compressed package contained a set of pictures and several word documents.
Respectively titled: 1. Learning rules, 2. Standard diagnosis, 3. Diagnostic analysis, 4. MRI original films.
"This thing is interesting, open it and take a look!" Peng Lingli came slightly closer, but kept a certain distance and did not mean to take advantage.
"Learn the rules!"
"The diagnostic content given by the standard diagnosis is absolutely correct! If the corresponding diagnostic content cannot be deduced from the original MRI film, it proves that your thinking is wrong. Please try to figure it out carefully or check the diagnostic analysis."
"You can have ten minutes for MRI reading and three minutes to sort out the diagnostic and inference process." This is very much like a rule of the game.
After Wang Huan read it, she found that senior brother Peng Lingli was waiting for her. He was obviously reading faster, and then said: "Brother, then I have opened the diagnostic criteria."
"Wait a minute, cast the screen!"
"The projector in this demonstration classroom can project a screen..." Peng Lingli became interested and planned to zoom in and take a closer look.
Almost five minutes later, the projection results came out. Wang Huan opened them one by one——
"This diagnosis is an absolute diagnostic criterion!!!"
Peng Lingli and Wang Huan didn't pay attention at first, and then turned on the MRI. But Peng Lingli discovered the problem immediately: "That's wrong, why is this only an MRI of the ankle joint?"
"If you look at the other photos, there is no MRI of the hip joint or pelvis?" Peng Lingli was dumbfounded at the time.
Wang Huan turned around, and at the nuclear magnetic level given in the first example, the content displayed was indeed only at the level of the ankle joint!
Nothing else.
Peng Lingli swiped the various MRI levels left and right, and finally determined one point.
"Ah this?" Peng Lingli hesitated.
"How did this suspicious diagnosis come about?" Peng Lingli was confused on the spot.
Wang Huan shook his head: "My teacher sent me this, and I don't know."
According to the truth, as long as it is not a bad move, it will not be in the wrong position!
Would Teacher Zhou make such an obvious mistake? Did he want to re-make up two nuclear magnetic planes himself?
Is this guess correct?
Then the diagnosis must be wrong.
But before, Zhou Cheng also marked it with words. The diagnosis is an absolute standard and cannot be wrong. If you can't answer it, please see the diagnosis analysis.
Of course Peng Lingli would not read the diagnostic analysis so easily.
So, this movie is too strange.
After reading the X-ray carefully, it appears that there is no problem with lateral ankle ligament damage.
The diagnosis is benchmarked.
In fact, Peng Lingli feels that it is somewhat difficult to detect ligament damage from this MRI level.
Because generally speaking, ligament injuries are caused by rupture. However, at this MRI level, there is no continuous rupture. The anatomical structure is normal, but there is a relatively severe edema signal.
If you look more carefully!
According to the anatomy pointed out by Zhou Chengti, if you look at the layers, you can see that the fibrous structure with ligaments is broken!
That's right!
The diagnosis of damage can definitely be made. At this time, it only means minor damage, not the broad range, including fractures, etc.
But, after this diagnosis.
Peng Lingli looked at other aspects of the structure.
No more abnormalities were found.
The continuity of the ligaments is intact, there is no avulsion fracture, no bone edema, and no problems with nerves, blood vessels, muscles, tendons, or even skin.
No changes in lesions or organic changes were seen...
What about this?
This means that the diagnosis of ankle ligament injury is absolutely correct!
This is also in line with the sample questions provided by Zhou Cheng.
but?
In this case, what I need to supplement is just to supplement the obturator lesions and lumbar disc herniation?
But how to make up for it?
Wang Huan frowned.
More than twenty minutes have passed.
It was far beyond the suggested time given by Zhou Cheng, and the two of them still had no idea.
Peng Lingli asked simply: "Did you see it?"
Wang Huan shook his head: "Senior brother, why don't we look at the diagnostic analysis?"
"Okay!" Peng Lingli actually didn't want to read it, but maybe she wasn't used to Zhou Cheng's way of setting questions, so.
The two of them opened the film reading and analysis.
First, these few words appeared.
detail!
detail!
Two short words, plus a shocking exclamation mark.
As we all know, on the patient's MRI, basically every window of the MRI!
Basic information such as the patient's name, gender, MRI imaging site, etc. will be displayed.
Age is the main content of basic information!
When she saw this, Peng Lingli said: "Will you take out the MRI film again?"
"I'll send it to you, senior brother." Wang Huan suggested.
The two zoomed in on the MRI image and saw blurry words.
Patient: "Zhang XX, male, 45 years old."
At present, China's MRI medical equipment is not enough to support clinical needs. Therefore, all text is still replaced by words or letters.
Looking at the overall name of the MRI, which is the MRI of the left ankle joint, there is no site error.
"Zhang XX, male, 45 years, left."
Peng Lingli frowned. These things shouldn't be enough to support a suspicious diagnosis, right?
When looking at the analysis again, Zhou Cheng placed the next section of analysis on the second page.
The name means nothing!
However, being male and 45 years old gives very important information!
The current MRI of the patient shows no structural, anatomical, or hierarchical problems.
However, there was a problem with the diameter of the patient's structure!
When Peng Lingli heard this, her eyes lit up, and when she looked at the scale again, she suddenly realized something!
Then he smiled bitterly——
In this patient, the ankle joint appears quite slender, and the diameter of the ligaments is also relatively small.
So although there is no problem with the structure, it does not resemble the imaging appearance of an adult man. The diameter and transverse diameter of the muscles should not be so delicate.
For an average adult man, the muscles of the lower limbs, especially the muscles of the calf, are not so thin as long as they are normal.
Unless he has a basic disease, such as muscle atrophy.
As for muscular atrophy, there are also causes that can be inquired about. In addition to nutritional atrophy, disuse atrophy, and neurotrophic atrophy.
In other words, neurogenic atrophy!
In this patient, the ligament injury did not come with other signs of edema, which means it was not a violent injury, but a simple sign of ligament edema.
However, even so, it seems that there is still no way to find a corresponding diagnosis?
Can't there be exceptions? Peng Lingli thought this way.
Zhou Cheng wrote in the prompt given on the third page.
"Nerves, blood vessels, and lower limbs, muscle-tendon ratios are positively correlated under normal circumstances!" Peng Lingli read it and immediately went to the MRI level to look for it.
Then carefully search for the patient's neural structure and vascular structure!
The diameter of the blood vessels is normal, and no thrombi, venous sinuses, arterial sinuses, etc. are seen, which means the blood supply is normal!
This indicates that it cannot be nutritional atrophy.
Is that apraxia?
This depends on the diameter of the nerve.
The diameter of the patient's nerves is extremely slender, almost insignificant, and the continuity is not broken.
It means that under normal circumstances, there are no symptoms of paralysis.
Not paralyzed, but there is a problem with the size of the nerves...
There is no problem with the blood vessels, but there is a problem with the nerves. This means that they are neither nutritional nor apraxia. The apraxia will be reduced in equal proportions, and the diameter of the blood vessels may be small, which is most obvious because there is no need for so much blood supply.
.
However, the diameter of the patient's blood vessels is normal, which means that he has exercised a lot and has such a large blood supply. Is this right?
so!
This must be a disease of the upstream nerve fibers. The most likely possibility is compression.
Space-occupying lesions of the nerves in the lower limbs are usually lumbar disc herniation or obturator compression.
If there is an organic disease in the thigh that compresses the nerves, this rarely happens. Secondly, the compression will not go unnoticed to such an extent.
Ankle ligament damage is not discovered until it is injured.
Then it is very likely that there is no way to solve it, or it has not been discovered.
The written diagnosis of this patient was: lateral ligament injury of the left ankle joint, suspected obturator lesion, and lumbar disc herniation.
There is no specific direction, this is the correct correspondence.
There is no explanation as to whether it is an obturator or a lumbar disc herniation. It is just a speculation. It is just suspicious.
Therefore, the important point and solution idea of this question are two words suspicious!
When Peng Lingli scrolled down, Wang Huan stopped: "Brother, wait a moment, I don't understand."
Peng Lingli said: "Okay, don't worry, you first read the tips given by Teacher Zhou."
"This kind of question tests our basic skills and overall understanding of medical knowledge, not just the content of our orthopedics. This question is great!"
Peng Lingli discovered that since she entered clinical medicine, most of the time she just memorized and memorized the information, and then looked for key words to answer questions. There was no critical thinking like science at all.
Why? The current examination-oriented education in clinical medicine is basically a dead formula.
For example, an examination result corresponds to a diagnosis, without any twists and turns.
For example, if a physical examination result appears, it corresponds to the corresponding diagnosis, and we will not play tricks on you.
Too easy and not challenging.
But Zhou Cheng’s question was different.
After a while, Peng Lingli realized that Wang Huan might not have any ideas yet, so she started to say: "The rules set by Teacher Zhou are very interesting!"
"The answer is absolutely correct. No changes can be made. The answer must be correct."
"Without this rule, there is no way to diagnose the disease."
"This is a routine, but it is also a particularly novel teaching method..."
"Look, Wang Huan..." Peng Lingli said, carefully comparing it to Wang Huan, and then explaining the internal logical level and structure.
There is a feeling that I have finally encountered a challenging and interesting example problem.
While saying this, the door to the teaching classroom was pushed open, and it was Guo Lin who walked in again.
"Senior Brother Peng, Junior Sister Wang." Guo Lin's expression flashed at this moment.
"Just in time, Guo Lin, have you seen the compressed package that Junior Sister Wang sent you? It's very interesting. I'm currently dismantling the questions given by Teacher Zhou with Wang Huan."
"I feel like I haven't thought about it like this for a long time."
"And let me tell you, Guo Lin, in order to see such a diagnosis, it must be combined with the overall framework given by Teacher Zhou."
Hearing this, Guo Lin scratched his head in confusion and said, "Can this diagnosis really be seen?"
"Yeah, okay?" Peng Lingli felt calm now.
"Report, lesion location, anatomical structure, layers, theory, limitations. This is the outline that Teacher Zhou gave Wang Huan when teaching MRI reading. Think about it, almost everything is involved in it." Peng Lingli said, while
Thumbs up.
Guo Lin murmured, and after hearing this, he immediately turned around and walked out.
"Why are you going? There is another example, why don't you do it?" Peng Lingli asked.
"I'm going to ask if it's too late for me to transfer to another department!" Guo Lin's voice came from outside the teaching classroom.
Wang Huan's mouth opened slightly, his face full of astonishment.
Peng Lingli was not surprised. He and Guo Lin had lamented before that learning medicine actually relies on rote memorization, and rote memorization can rarely be applied clinically, and there is basically no dexterity.
But now, something different came out, and Guo Lin was naturally shocked.
So does he!
"Senior Brother Peng, is this okay?" Wang Huan asked.
"What's wrong, if it weren't for the fact that my teacher is the director, I would also like to follow Teacher Zhou."
"I finally understand why Senior Brother Yang likes to play with Teacher Zhou." Peng Lingli's heartbeat accelerated slightly, and she felt like a confidant was hard to find.
Because medicine, whether it’s writing articles or anything else, has too many routines and is too simple. In fact, it’s just mechanical repetition. For him, whether it’s writing papers or doing experiments, he loses interest.