medical simulator

"The diagnostic content given by the standard diagnosis is absolutely correct! If the corresponding diagnostic content cannot be deduced from the original NMR film, it proves that your deliberation is wrong. Please try to figure it out carefully or check the diagnostic analysis."

"You can have 10 minutes to read the MRI and 3 minutes to sort out the diagnosis and inference process." This is very much like a game rule.

After Wang Huan finished reading, he found that senior brother Peng Lingli was waiting for her, obviously because he could read faster, and then said, "Brother, then I have activated 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.

After about 5 minutes, the screencasting results came out.The rings were opened one by one——

"Left lateral ligament injury, suspicious obturator lesion, lumbar disc herniation."

This is a literal diagnostic criterion.

"This diagnosis is an absolute diagnostic standard!!!"

Peng Lingli and Wang Huan didn't care at first, and then turned on the NMR.It's just that Peng Lingli discovered the problem immediately: "No, why is there only an MRI of the ankle joint?"

"Look at the other photos again. There is no MRI of the hip joint or pelvis?" Peng Lingli was dumbfounded at the time.

Wang Huan turned around, and on the NMR level given in the first example, the displayed content was indeed only at the level of the ankle joint!

nothing else.

Peng Lingli swiped left and right for each NMR layer, and finally settled on one point.

"Ah this?" Peng Lingli hesitated.

"How did you get this suspicious diagnosis?" Peng Lingli was stunned on the spot.

Wang Huan shook his head: "This thing was sent to me by my teacher, I don't know."

According to the principle, as long as it is not a bad brush, it will not make a mistake in the part!

Would Teacher Zhou make such an obvious mistake?Could it be that he wants to re-fabricate two nuclear magnetic planes by himself?

Is this guess right?

It must have been a wrong diagnosis.

But before, Zhou Cheng also marked it in words. The diagnosis is an absolute standard, and it is impossible to be wrong. If you can’t answer it, please read the diagnosis analysis.

Of course, Peng Lingli would not go through the diagnosis and analysis so easily.

Then, this film is too strange.

Read the film carefully again, the lateral ankle ligament is injured, this is no problem.

Diagnosis is benchmarked.

In fact, Peng Lingli felt that it was somewhat difficult to read the film from the MRI level to find the ligament injury.

Because in general, ligament injuries are ruptured.On the MRI level, there is no continuity break, the anatomical structure is normal, but there are relatively severe edema signals.

If you look carefully!

According to the dissection mentioned by Zhou Cheng, after looking at the layers, you can see the fibrous structure with ligaments broken!

That's right!

The diagnosis of injury can definitely be made. At this time, it only means a slight injury, not a wide range, including fractures and so on.

Just, after this diagnosis.

When Peng Lingli looked at other aspects of the structure.

No abnormalities were found.

The continuity of the ligament is intact, there is no avulsion fracture, no bone edema, no nerve, blood vessel, muscle tendon or even skin level problems.

No changes in lesions or organic changes were seen...

Then this?

It means that the diagnosis of ankle ligament injury is absolutely correct!

This is also in line with Zhou Cheng's example regulations.

but?

In this way, what I want to supplement is just to supplement obturator lesions and lumbar disc herniation?

But how to make up for it?

Wang Huan frowned tightly.

More than 20 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 simply asked, "Did you see it?"

Wang Huan shook his head: "Brother, why don't we just look at the diagnostic analysis?"

"Okay!" Peng Lingli actually didn't want to read it, but it might be because she wasn't used to Zhou Cheng's way of writing questions, so that's why.

The two opened the reading analysis.

In the first place, there are only a few words.

detail!

detail!

Two short words, plus a shocking exclamation point.

As we all know, above the patient's MRI, basically every window of MRI!

Basic information such as the patient's name, gender, and MRI site will be displayed.

Age is the main content of basic information!

Seeing this, Peng Lingli said, "Can you take out the MRI again?"

"Let me send it to you, brother." Wang Huan suggested.

The two zoomed in on the MRI image and saw vague words.

Patient: "Zhang XX, male (male), 45years (years old)."

At present, Huaguo's MRI medical equipment is not enough to support clinical needs. Therefore, all words are still replaced by words or letters.

Looking at the overall name of the MRI, that is, the MRI of the left ankle joint, there is no wrong site application.

"Zhang XX, male, 45 years, left."

Peng Lingli frowned. These things should not be enough to support a suspicious diagnosis, right?

When looking at the analysis again, Zhou Cheng put the next paragraph of analysis on the second page.

Names mean nothing!

However, for men and 45 years old, it is giving very important information!

The current MRI of the patient has no problems in terms of structure, anatomy, and level.

However, there is a problem with the structural diameter of the patient!

Peng Lingli's eyes lit up when she heard the words, and when she looked at the scale again, she suddenly realized something!

Then he smiled wryly——

In this patient, the ankle joint is quite slender, and the diameter of the ligament is relatively small.

So while the structure is fine, it doesn't look like the radiographic appearance of an adult male.The diameter and transverse diameter of the muscles should not be so delicate.

For an ordinary adult man, the muscles of the lower limbs, especially the muscles of the calf, as long as they are normal, will not be so thin.

Unless he has an underlying disease, for example, muscle atrophy.

As for muscle atrophy, there are also etiologies that can be consulted, except for nutritional atrophy, disuse atrophy, and neurotrophic atrophy.

Or rather, neurogenic atrophy!

In this patient, the ligament injury was not accompanied by other signs of edema, which meant that 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 the corresponding diagnosis?

Can't there be exceptions?Peng Lingli thought so sensibly.

Zhou Cheng wrote in the reminder given on the third page.

"The ratio of nerves, blood vessels, and lower limbs to muscles and tendons is positively correlated under normal circumstances!" Peng Lingli looked for it on the MRI level after reading it.

Then carefully searched for the patient's neural structure and vascular structure!

The diameter of the blood vessel is fine, and no thrombus, venous sinus, arterial sinus, etc. are seen, which means that the blood supply is normal!

This shows that it is impossible to be atrophy of nutrition.

Isn't that apracticable?

It depends on the diameter of the nerve.

The diameter of the patient's nerve is extremely thin, almost undetectable, and the continuity is not broken.

In general, there are no symptoms of paralysis.

Not paralyzed, but there is a problem with the size of the nerve...

There is no problem with the blood vessels, but there is a problem with the nerves. This means that it is not nutritional or disusable. The disusable ones will be reduced in equal proportions, and the diameter of the blood vessels may be the most obvious because there is no need for so much blood supply. .

But the patient's blood vessel diameter is normal, which means that he has exercised a lot and has so much blood supply, right?

and so!

This must be due to pathological changes in the upstream nerve fibers. The biggest possibility is compression.

Space-occupying lesions of lower extremity nerves are usually lumbar disc herniation, or entrapment at the obturator foramen.

If the organic lesion in the thigh compresses the nerve, this kind of situation rarely occurs, and the second is that it will not be compressed to such a degree that it will not be discovered.

It is not discovered until the ankle ligament injury is discovered.

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 that the lateral ligament of the left ankle was injured, suspicious obturator lesions, and herniated lumbar intervertebral disc.

There is no specific point, which is correct.

It is not stated whether it is an obturator or a herniated lumbar intervertebral disc, it is just a speculation.Just suspicious.

Therefore, the important point of this question and the idea of ​​​​solving the question are suspicious!

When Peng Lingli scrolled down again, Wang Huan stopped: "Brother, wait a moment, I didn't understand."

Peng Lingli said: "Okay, don't worry, you can read the reminder given by Teacher Zhou first."

"Such a question is a test of our basic skills and overall understanding of medical knowledge, not just our orthopedics content. This question is great!"

Peng Lingli found that since she entered clinical medicine, most of the time she just memorized, and then she could find the key words to do the questions. She didn't have the deliberate thinking of science at all.

Why, the exam-oriented education in clinical medicine is basically a dead formula.

For example, a test result corresponds to a diagnosis, without twists and turns.

For example, when a physical examination result appears, it corresponds to the corresponding diagnosis, and I will not play tricks with 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, so she started to say: "The rules set by Mr. Zhou are very interesting!"

"The answer is absolutely correct, no changes can be made, and the correspondence must be correct."

"Without this rule, there is no way to diagnose."

"This is a routine, but it is also a particularly novel teaching method..."

"Look, Wang Huan..." Peng Lingli said while carefully comparing Wang Huan, and then explaining the internal logic level and structure.

There is a feeling that I have finally encountered a challenging and interesting sample problem at the same time.

While saying this, the door of the classroom was pushed open, and it was Guo Lin who walked in again.

"Senior Brother Peng, Junior Sister Wang." Guo Lin's expression flickered at the moment.