I Can See Health

  Chapter 13 Different Skill Tests (Part 2)

   "There are still two minutes, please pay attention to the test time and avoid overtime!"

   "One more minute!"

   "Thirty seconds left!"

   "The first room, the exam is over!"

  “…”

   When Lu Chen came out of the first room, he was a little confused.

   What kind of diagnosis this patient is, he is still not 100% sure.

   He can only say what he thinks is the most likely diagnosis!

   In this exam question, the two most important inspection reports are missing.

   That is the result of coronary angiography or aortic CTA!

   But if you take out these two inspection reports directly, there is no need to take the exam.

   "It's up to luck now..."

  Lu Chen shook his head slightly. He just noticed that when he said his answer, the female examiner on the side showed no expression.

   He couldn't judge whether he was correct or not from the examiner's micro-expression.

  …

   All four candidates stood at the door.

   Outside the corridor, the middle-aged examiner shouted loudly, "All the candidates will be postponed in turn and go to the next ward."

  Lu Chen walked into the second ward.

   In the second ward, there is a young girl.

   The color on her head is also red!

   "Start consultation and physical examination!"

   After hearing the examiner's order, Lu Chen immediately began to consult.

   "Patient female, twenty-three years old."

   "Chief Complaint: Headache for 3 days admitted to hospital."

  “…physical examination: blood pressure 220/130mmHg…”

   "This second patient's condition seems to be much simpler than the first one." Lu Chen thought.

   In a young woman with elevated blood pressure, secondary hypertension should be considered first.

  Hypertension is divided into two types in terms of etiology.

  Essential hypertension, the cause of which is unknown, cannot be cured, and requires lifelong medication.

   Secondary hypertension, high blood pressure caused by other factors, is the only curable high blood pressure.

   After sorting out his thoughts, Lu Chen said in a deep voice: "The patient's current diagnosis: the cause of secondary hypertension is to be determined. It is recommended to improve the four items of hypertension, cortisol, catecholamines, and adrenal CT."

   These inspection items that need to be improved are all tests to determine the cause of secondary hypertension.

  The examiner nodded, and also took out the relevant test sheets and inspection sheets.

  Lu Chen carefully took the report and read it carefully.

   "The four items of hypertension are normal."

   "Cortisol is normal."

   "Catecholamines are normal."

   "The contrast-enhanced CT of the adrenal glands and renal blood vessels were all normal!"

   "Heart ultrasound is normal!"

  “…”

  All tests and inspection reports are normal!

   "This, is it essential hypertension?"

   A question arose in Lu Chen's heart.

   But the patient is so young and has no family history of hypertension, is it considered essential hypertension?

   Exam time passed minute by minute.

  The examiner continued to remind: "Please complete the diagnosis and treatment methods again."

  Lu Chen couldn't make up his mind again.

   On the face of it, continued hypertension seems to have been ruled out.

   But when Lu Chen looked at the patient on the bed, he always felt something was wrong!

   "The last thirty seconds to answer!"

  “…”

   When he walked out of the second ward, Lu Chen already had deep doubts about himself.

   Who wrote these exam questions?

   is completely out of the scope of undergraduate knowledge, and even if a doctor with rich clinical experience comes, he may not be able to answer correctly.

  …

   Exams are still going on.

  Lu Chen walked into the third room.

   The patient in this room is an old woman.

   And the color on her head is also red!

  From physical examination, consultation to final diagnosis and treatment, Lu Chen did not dare to have any contempt.

   Fortunately, the case this time did not exceed Lu Chen's expectations.

  The old lady is a typical chronic heart failure patient. From diagnosis to treatment, Lu Chen thought he answered perfectly.

   "Call..."

   Walking out of the third room, Lu Chen breathed a sigh of relief.

  This third case gave him a little bit of confidence, and now he has at least a shred of confidence.

   "Please note, candidates, only the last ward is left!"

   Gently pushed open the door of the last ward.

   A young and middle-aged man was sitting on the ward. He looked no different from a normal person.

   His face was full of red light, and his spirit and posture were all normal.

  Lu Chen focused and saw that the color on his head was green!

   The color of the patient's head in the first three wards is all red, only the color of the last patient's head is green!

   Green represents health.

   Could it be that this young man is not sick?

   In addition, Lu Chen was a little surprised that this patient was also connected to an ECG monitor.

   This made Lu Chen not dare to relax at all.

   This skill test has already given him too many "surprises".

   Start consultation and physical examination.

   "Male patient, thirty years old."

   "Main complaint: intermittent heart palpitations for 1 year, with another attack for half an hour."

   "Every time the symptoms of palpitations occur suddenly, and then stop suddenly. The cardiopulmonary and abdominal examinations are all negative!"

   This time, the examiner did not rush to ask Lu Chen to make a diagnosis, but took out an electrocardiogram of the patient during the attack.

   "Interpret this ECG to diagnose and treat the patient."

  Lu Chen picked up the electrocardiogram and began to study carefully.

   "Regular rhythm, fast heart rate, about 160 beats/min."

   "No P waves were seen, and QRS waves were normal. Retrograde P waves were visible."

  Lu Chen took a quick look at the complete ECG.

   This is an electrocardiogram of a typical episode of paroxysmal supraventricular tachycardia!

  Paroxysmal supraventricular tachycardia is a cardiac arrhythmia.

   can be seen in normal people and patients with structural heart disease, and can be completely cured by radiofrequency ablation!

   This is also one of the few curable diseases in cardiovascular medicine.

  Lu Chen also had doubts.

  Why does the system determine that the color of patients with "paroxysmal supraventricular tachycardia" is green?

   When a paroxysmal attack occurs, the heart rate rises to around 160 beats per minute.

  The normal heart rate is 60-100 beats per minute!

  When the heart rate reaches 160 beats/min, it can cause heart failure, myocardial infarction, and even sudden death!

   So even if the color of this young man is not red, it should at least be yellow!

   It will never be green anyway!

   Just as Lu Chen was thinking about it, the ECG monitor beside the bed suddenly sounded an alarm!

"woo woo woo woo…"

The    alarm sound was a bit harsh, and Lu Chen immediately looked at it intently.

   Heart rate reached 164 beats!

The waveform on the    monitor looks the same as this electrocardiogram in his hand.

   This is a paroxysmal supraventricular tachycardia attack!

   But what made him a little strange was that the chief examiner on the side didn't move, and he wasn't nervous at all.

   And the color on this patient's head is still green!

   A glint of light flashed in Lu Chen's eyes, and he had his own judgment in his heart.

   This patient is a fake patient!

   is absolutely impossible to be a real patient!

   The waveform of the supraventricular tachycardia in the ECG monitoring is likely to be recorded before!

   "Doctor, I'm a little flustered..."

   The young man suddenly covered his chest and frowned.

   You are acting too fake, Lu Chen was a little speechless.

   A person with a heart rate of 160 beats per minute does not have such a relaxed expression!

   However, what should cooperate with your performance, you still have to cooperate.

   "Is the symptoms the same as the previous episodes?" Lu Chen asked quickly.

   "Well, it's the same." The young man nodded, "Then what should we do?"

  Lu Chen smiled and said, "Don't worry, you have a paroxysmal supraventricular tachycardia."

   "Next, you do these moves with me."

   "Okay, doctor."

   The first choice for supraventricular tachycardia is not drug treatment, but by stimulating the vagus nerve to stop the onset of supraventricular tachycardia!

   "Exhale forcefully after holding your breath."

   "Irritation of the throat causes nausea."

   "Massage the carotid sinus, first try the right side for 10 seconds, if it doesn't work, try the left side for 10 seconds, don't press on both sides at the same time."

   "Press the eyeball first, right and then left, no more than 10 seconds each time."

  “…”

   After this series of methods to stimulate the vagus nerve, the heart rate on the ECG monitor began to drop slowly!

   From 160 to 140, then to 110, and finally settled at 90!

   If he hadn't known that this was a fake patient, perhaps Lu Chen would still be a little complacent.

  Suppressing the onset of supraventricular tachycardia by stimulating the vagus nerve, the success rate is actually not very high.

  Lu Chen only saw one case during his internship.

   "Thank you doctor, I don't panic anymore." The young man looked "excited".

  Lu Chen smiled slightly.

The    system did not increase the thank you value, nor did the system completion degree increase!

   Your thank you is too fake!

   Whenever the update is late, don't doubt, I'm on the night shift.

   (end of this chapter)