Chapter 2229: 2152 If You're Wrong, Be Sure to Tell Me

Li Lao, what's wrong?

No, the rounds are about to start, right? Li Lao looked at the words on the A4 paper and asked softly.

Hmm, there's still one minute.

The Department of Internal Medicine's rounds have strict rules; they must start on time, with no allowance for lateness.

When the time comes, the door is locked and no one can enter. If you really miss it, just wait to go back and be scolded by the director for four hours.

Soon, the rounds began, and the doctor from the Endocrinology Department, Doctor Wang, started presenting the case.

Li Lao listened to the case summary while looking at the text on the A4 paper. The person who wrote it likely understood the patient's condition and was very thorough.

The listed abnormal test items on the lab report were almost identical to the pre‑hospital history reported by Doctor Wang.

This is interesting; Li Lao thought the patient's family was very conscientious. The consulting doctor was probably an experienced senior physician, omitting what should be omitted and detailing what should be detailed—I couldn't find any mistake.

Just a pre‑hospital condition analysis made Li Lao feel a sense of regret for wasting talent.

This is talent; if it were spent half a lifetime in a small hospital and reduced to mediocrity, that would be a real shame.

First, let's see; if his final diagnosis is close, I might as well ask this doctor what he thinks.

If he's indeed a promising young talent, I could give him an opportunity.

Li Lao thought, then turned to the second page.

【Pre‑admission CT showed a solid lesion in both adrenal glands; I think the standard at Medical University Affiliated Hospital shouldn't be so low as to really admit the patient to Urology and prepare for surgery.】

This kid.

Li Lao adjusted his glasses, and upon seeing this sentence, he wasn't angry but showed a knowing smile.

She looked at the CT, and it indeed resembled a solid lesion. If it were a small hospital's doctor, they might suspect a malignant tumor, but after reviewing it she considered it a hematoma. The subsequent enhanced 64‑slice CT also confirmed this.

This kid does have talent; reading the images isn't that simple. It's just that his tone is a bit sharp, still needing polishing.

【I estimate the enhancement has already been done, judging no blood supply, diagnosis is hematoma. If a clear diagnosis has already been made, this paragraph can be ignored.】

To use his talent, first smooth his edge. Li Lao leisurely thought, this kid still doesn't know how many experts there are in the world, thinking his little ability is extraordinary.

If he were my student, I might have to sternly reprimand him for a while to grind off that arrogance first.

Thinking of this, Li Lao gave an awkward smile. I'm not that kind of person; putting on a stern front is hard to intimidate anyone.

However, there are many ways to temper one's temper; it's not necessary to scold someone.

【Combining skin pigmentation, low cortisol, high ACTH, low aldosterone, high renin, low androgen, the diagnosis of primary adrenal insufficiency is clear.】

Hmm, this statement is correct.

【Haven't you already completed the differential diagnosis? If not, don't bother; it's an immune system disease—now is still time to consult me, the Rheumatology and Immunology Department, for a joint consultation.】

Oh, so it's a doctor from the Rheumatology and Immunology Department; Li Lao thought.

Doctors with high competence in the Rheumatology and Immunology Department usually handle various difficult cases; it's inevitable they feel a sense of superiority, thinking others can't diagnose.

Rheumatology and Immunology diseases? I also considered that; let's first see what he has to say.

However, Li Lao wasn't in a hurry; instead, he focused his gaze here and listened carefully to the opinions of the other departments' consultations.

Differential diagnoses such as adrenal tuberculosis, fungal infection, solid tumors, etc., were examined one by one in an orderly manner; Li Lao was still quite satisfied with the doctors he had trained.

Well‑founded and logical, it was like solving a difficult math problem.

Finally, Doctor Wang gave his opinion, suggesting a consultation with the Rheumatology and Immunology Department.

"Thrombophilia is a class of diseases that are prone to thrombosis and embolism due to hereditary deficiencies in anticoagulant or fibrinolytic proteins, or due to acquired thrombotic risk factors." The director of the Rheumatology and Immunology Department sat in his seat, flipping through the medical record and began to speak.

"Acquired thrombophilia is also called acquired hypercoagulable state; its causes include antiphospholipid syndrome, pregnancy or oral contraceptives, perioperative period and traumatic obesity, neoplastic diseases, diabetes, paroxysmal nocturnal hemoglobinuria, and renal syndrome, with antiphospholipid syndrome being the most common."

"Combining the patient's history, clinically we first consider antiphospholipid syndrome."

Hmm, just as I thought, Li Lao turned the A4 paper in his hand to the next page, preparing to see whether the doctor from the external hospital's Rheumatology and Immunology Department had also made the correct diagnosis.

【As for APS, I estimate the technical capability of Medical University Affiliated Hospital wouldn't miss this. Although the patient has a history of oral contraceptive use and multiple miscarriages, this is merely a triggering factor that exacerbates APS.】

This little guy is quite interesting; Li Lao's interest grew stronger.

Next, the A4 paper listed some lab tests; some he knew, some had not yet been released when he wrote this material.

For the test results that hadn't come out, he made relevant analyses based on whether they were problematic or not.

【Now, are you sure it's primary APS or secondary APS?】

Li Lao read this passage with great interest, while the director of the Rheumatology and Immunology Department, after analyzing the test report, also began to discuss this point.

【It's secondary; don't waste effort overthinking it.】

Too arrogant; although the analysis was sound, Li Lao still passed judgment on the person who wrote this material.

【According to the 2006 Sydney APS classification criteria, making the judgment takes a long time; the patient can't last that long.】

Li Lao looked at the words on the paper while listening to the Rheumatology and Immunology Department director's words.

"The patient has thrombocytopenia, thrombosis of the splenic vein, renal vein, and bilateral adrenal veins, a positive lupus anticoagulant test, and anticardiolipin antibody at 120 RU/ml."

Most of the guesses on the paper were correct; the lupus anticoagulant test result wasn't back when he got the data, yet just guessing got it right? Li Lao was a bit doubtful, but he felt this kid was a little unstable.

【Aren't you curious how I guessed correctly?】

Whether reasoning forward or backward, one always needs objective basis. The text on one page ran out, so Li Lao casually turned to the next page.

It actually breaks off here—truly intolerable!

【Actually, I'm not so sure either, but the boss said that based on the imaging data we could indicate secondary APS. For this we argued for five minutes; I couldn't convince him. If your final test results can prove the boss's claim wrong, you must tell me—I'll smash the test results in his face.】

Um……

Li Lao was stunned for a moment.