Chapter 485: Theory Linked to Practice

"Doctor Xiao Ji, do you have an answer?" Zhai Yuhan asked.

The diagnosis for this patient was unclear; at the time, the entire hospital held a consultation, and everyone spent nearly 2 days tossing and turning before finding the source of the problem.

Fortunately, there was no delay; if it had been another hospital with a slightly lower standard, the grass on the patient's grave might already be as tall as a person by now.

Could Ji Xiang give the correct answer?

Zhai Yuhan thought it impossible.

She believed she wasn't intentionally making things difficult for Ji Xiang, but merely wanted to give him a "lesson" to make him face the strange and varied diseases in Clinical practice with more humility.

Zhai Yuhan even pretended to forget that she hadn't mentioned the most critical step in the physical examination, providing plenty of misdirection.

"Teacher Zhai, is there a key item in the physical examination you didn't mention?" Ji Xiang suddenly asked.

Zhai Yuhan was startled; her heart began to thump uncontrollably, as if she were trying to prank Ji Xiang but had been caught by him.

But thinking carefully, it should be impossible; the trap she set was flawless, and Ji Xiang shouldn't be able to see through it.

"Oh?" Zhai Yuhan deliberately put on a composed expression. "What are you talking about? The physical examination I just described was indeed quite rough; what do you want to ask?"

"Which arm was used to measure the blood pressure after the patient was admitted?" Ji Xiang asked.

"Isn't it the same for either one?" Zhao Mengmeng looked at Ji Xiang in confusion.

She felt Ji Xiang had said something pointless.

But the expression on Zhai Yuhan's face suddenly froze; she never expected Ji Xiang to find the crux of the problem so sharply and quickly.

However, after her surprise, Zhai Yuhan smiled slightly; Ji Xiang had walked into the trap just like prey.

"It's not the same," Ji Xiang said. "Different blood pressure in both arms implies Aortic Dissection. Teacher Zhai, you must have thought of this case because you heard me mention Rib Fracture combined with Aortic Dissection just now, right?"

Zhai Yuhan was somewhat speechless; Ji Xiang was indeed very smart.

Zhao Mengmeng looked at Zhai Yuhan, full of doubt, and seeing her frozen expression, guessed that Ji Xiang must be right.

Yet she recalled the patient's medical history again, and still had no answer.

"The patient's left arm blood pressure was 152/86 mmHg, and the right arm was 144/89 mmHg," Zhai Yuhan said.

"That's about the same, isn't it?" Zhao Mengmeng glanced at Ji Xiang.

Zhai Yuhan threw out another pit she had dug, watching Ji Xiang with great interest.

"Teacher Zhai, I still believe it is Aortic Dissection; the CTA imaging should show it," Ji Xiang said slowly.

"Why?" Zhai Yuhan didn't answer Ji Xiang's question, but instead pressed him.

"The patient's symptoms of paralysis in both lower limbs cannot be explained by bilateral parietal-occipital lobe Cerebral Infarction. After excluding diseases like periodic paralysis, I suspect a spinal cord lesion, leaning towards the possibility of spinal cord blood supply impairment."

"Combined with the physical examination, the sign of a murmur audible in the patient's right subclavian and carotid artery area—although adding amaurosis could suggest carotid artery disease—I still suspect the possibility of aortic disease."

"If I'm not mistaken, the patient's CTA should show Aortic Dissection, with changes in the vertebral artery."

"..." Zhai Yuhan watched Ji Xiang silently.

At this moment, she had nothing to say.

Ji Xiang hadn't seen the patient's records and had made the correct judgment based solely on the medical history for which she had dug two pits.

One must know that when they encountered this patient at the time, the Affiliated Hospital went through 5 rounds of hospital-wide consultations plus Auxiliary examinations, struggling for a long time until the very end to find the cause.

Yet Ji Xiang displayed a diagnostic level surpassing the Experts and professors of the Affiliated Hospital.

"Doctor Xiao Ji, tell me how you considered this," Zhai Yuhan didn't admit immediately that Ji Xiang's diagnosis was correct, continuing to probe.

She believed Ji Xiang was guessing and couldn't provide a reasonable logic at all; without a logical closed loop, it didn't seem like she had lost.

"Paralysis of both lower limbs is a common Clinical symptom, which can be divided into 3 categories according to the anatomical site of the lesion."

"First, Upper Motor Neuron Paralysis, also called central."

"Second, Lower Motor Neuron Paralysis, also called peripheral."

"Third, Myopathic Paralysis."

Ji Xiang began to count one, two, three on his fingers.

"The characteristics of Upper Motor Neuron Paralysis are: mainly paralysis of the entire limb, monoplegia, hemiplegia, or paraplegia; increased muscle tone and tendon reflexes; presence of pathological reflexes; no muscle atrophy."

"..."

Ji Xiang spoke eloquently, and Zhai Yuhan was left speechless.

This was far more than just a logical closed loop; Ji Xiang had even considered the subtle details of every branch of speculation, starting from the patient's most severe Clinical symptom—paralysis—and analyzing it thread by thread.

"The characteristics of Lower Motor Neuron Paralysis are muscle groups or single muscles, weakened muscle tone and tendon reflexes, no pathological signs, and muscle atrophy. The characteristics of Myopathic Paralysis are muscle atrophy in the proximal limbs, symmetrical distribution, and no sensory impairment."

"In this case, the patient had paralysis of both lower limbs, no symptoms of hemiplegia, and no muscle atrophy..."

Ji Xiang counted on his fingers for nearly 5 minutes, finally giving his conclusion.

"I believe the CTA imaging will most likely show Aortic Dissection, Stanford type A, accompanied by changes in the vertebral artery."

"!!!"

Zhai Yuhan had long since heard an earful of exclamation marks.

Until Ji Xiang finished speaking, she stared blankly at the young Doctor who seemed to be faintly radiating a milky white light, her heart filled with infinite confusion.

This level of diagnosis could be called terrifying; at least in the Affiliated Hospital or in Zhai Yuhan's medical career, she had never encountered it.

Moreover, Ji Xiang's rigorous logic proved one thing—he wasn't just spouting nonsense or guessing the diagnosis, but had sound reasons and analyzed it with meticulous detail.

But Ji Xiang wasn't finished yet.

He didn't seem to notice Zhai Yuhan's expression and continued, "The Aortic Dissection in this patient manifested as painless, making it easy to misdiagnose."

"Painless Aortic Dissection is rarer in Clinical practice than painful Aortic Dissection; it is often accompanied by neurological symptoms such as limb paralysis and is easily misdiagnosed as acute ischemic cerebrovascular disease. Administering Thrombolysis within the treatment window for Cerebral Infarction would lead to catastrophic consequences."

"But the treatment is not difficult; use Metoprolol, Nifedipine, and Urapidil to control heart rate and blood pressure, and wait for the condition to stabilize before the Vascular Surgery Department performs surgery."

"Teacher Zhai, the patient recovered and was discharged in the end, right? Did their walking recover well?"

"Yes," Zhai Yuhan squeezed the word out through her teeth.

Zhao Mengmeng listened, completely bewildered.

Although she was completely unable to understand the entire logical judgment Ji Xiang had explained, the word "yes" that Zhai Yuhan said at the end told Zhao Mengmeng a fact—Ji Xiang's judgment was accurate and without error.

This is just too impressive!

Zhao Mengmeng did not have as much unwillingness as Zhai Yuhan, but instead looked at Ji Xiang with a hint of admiration for the strong.

If only she could answer questions as cleanly and efficiently as Ji Xiang, how good that would be.

Unfortunately, Zhao Mengmeng always felt she lacked a certain spark, and was never able to connect the knowledge taught in books with reality.

(End of chapter)