Healing Doctor

Chapter 343 Reviewing the Exam Paper (Part 1)

Soon, one renowned expert after another appeared.

Zhou Tianbo didn't leave. He shamelessly followed behind She Yong, greeting each member of the expert group, but in his heart he kept thinking about Ji Xiang, who could make the system issue an alarm.

The problem likely lies with the electronic review system, Zhou Tianbo leans towards that conclusion.

"Professor Zhou, you're not really here to check on that resident trainee Ji Xiang's grades, are you?" She Yong asked when no one was around.

"Young Master, I did come to see his grades," Zhou Tianbo admitted. "I knew he could score at least 480 points, but I didn't expect him to get a perfect score."

"There must be a problem with the system. Take the current medical licensing exam, for example. There are a lot of multiple-choice questions at the end, and the answers are all ambiguous. Let alone resident physicians, even if you were to take the exam again, it's hard to say whether you could get 550," She Yong said.

Zhou Tianbo took a deep breath.

Soon, twelve experts sat down in the small conference room of the National Health Commission.

"Dear teachers, the system has triggered an alarm, so I have no choice but to ask you all to review this. I'm really sorry," She Yongxian said politely.

"How many points?" one person asked.

"Full marks."

"!!!"

"!!!"

The room full of veteran experts stared wide-eyed at She Yong.

"So, I'd like to trouble you all," She Yong said. "I've checked it against the standard answer, and it's definitely correct. Please take a look."

The senior experts were not upset; their lives were ordinary, and such a major event as today was rare.

They began reviewing the questions and finalizing the correct answers.

In Zhou Tianbo's view, the initial single-choice questions were not difficult, but the later multiple-choice questions were likely ambiguous.

but!

The expert panel began discussing question thirty-eight.

"Who set question 38?" an old expert said with dissatisfaction.

Zhou Tianbo quickly found question thirty-eight on the young master's computer.

The question stem is a medical history: A 38-year-old female patient sought medical attention locally seven days ago due to sudden upper abdominal pain. Upon admission, her serum amylase and urine amylase were significantly elevated. After being transferred to our hospital, she experienced oliguria for two days. Currently, her serum amylase is basically normal, while her urine amylase is slightly elevated.

Proteinuria (+), significantly elevated urine glucose, no pyuria. (Clinical requirements called for fasting and fluid restriction; due to the patient's special circumstances, no contrast agent was administered.) Additional information: Kidney volume approximately 12x7x5 cm³.

Next is the CT scan of the upper abdomen.

The answer choices include cerebral infarction, sudden cardiac death, and acute pancreatitis.

"Isn't this a freebie?" Zhou Tianbo thought to himself as he saw the answer and considered the patient's medical history.

Elevated blood and urine amylase levels indicate what else could it be but acute pancreatitis?

He wasn't a gastroenterologist or a hepatobiliary or pancreatic surgeon, so he couldn't understand the upper abdominal CT scan and didn't examine it.

If it were him answering the question, he would definitely choose acute pancreatitis directly.

"Let me share my thoughts," an elderly man with white hair and beard said, tapping the table.

The others looked up at him.

Zhou Tianbo recognized him; he was the retired former director of the Hepatobiliary and Pancreatic Surgery Department at the Imperial Cancer Hospital, and his remarks should be representative.

"Given the patient's abdominal pain symptoms and elevated amylase levels, pancreatitis is highly probable."

The abdominal CT scan should note that the pancreatic tail is swollen, the interspace between the pancreatic head and the pancreas is unclear, and the kidneys adjacent to the pancreas are enlarged.

It should be noted that both kidneys are enlarged on CT scan, which is the cause of oliguria; the patient's gallbladder is full, and the presence of stones cannot be ruled out; pancreatitis may be the cause; there appears to be mucosal thickening on the posterior abdominal wall near the pylorus, which cannot be ruled out as chronic antral gastritis.

Based on the patient's medical history, chronic bile reflux is suspected. Furthermore, acute pancreatitis leading to renal failure is often related to systemic inflammatory response syndrome; in this case, pancreatic lesions are likely affecting the kidneys. The patient's inferior vena cava is thickened; is concurrent heart failure also present?

"So," the old man paused, emphasizing his words, "if it were up to me, I would choose sudden cardiac death."

A commotion erupted in the small classroom.

Zhou Tianbo was somewhat confused.

If it were me, pancreatitis would be the first option, renal insufficiency the second, and I would never choose sudden cardiac death.

However, the old expert's analysis was so logical that Zhou Tianbo couldn't utter a single word of dissent.

"Mr. Sun, the standard answer is sudden cardiac death. Do you also think it's correct?" another person asked.

"Hmm, I've seen similar patients before." The old man was somewhat displeased. He said in a deep voice, "They didn't even give me the complete medical records, just an X-ray and a brief medical history. Is this an exam? This is making things difficult for me!"

"When I show these kinds of questions to my doctoral students, they are more than 80% likely to get them wrong."

"!!!"

"Never mind." The old man shook his head. "The answers on the reviewed exam paper are correct. What I'm saying is that this question is problematic. It's too difficult, the difficulty level is beyond the syllabus, clinical... Hey, if you don't believe me, let the directors of all the major tertiary hospitals in the capital take a look. I bet not many of them could answer it correctly."

Indeed, what he said was very apt.

"This candidate must have guessed correctly," someone chuckled. "Since the answer is correct, let's continue."

Zhou Tianbo's heart was pounding. He had a vague feeling that things were not as he had imagined.

He knew that Ji Xiang was definitely not guessing correctly.

That young man... how come he has so much clinical experience!

The expert group's attitude clearly became more rigorous and serious.

If it weren't for Professor Sun's detailed explanation of that question, everyone present would probably have been misled.

Whoever set the questions is incredibly boring.

Because the expert panel consists of top experts, when they get serious, they can quickly find the correct answers to even the tricky questions.

The answers were not much different from the standard answers on the exam paper, and Ji Xiang's exam paper review was gradually approved.

No matter how difficult the questions are in the question bank, or how many traps are hidden in the question stem, Ji Xiang can always find the correct answer.

Soon, we came to the more challenging questions.

Soon, the argument broke out again.

This is an essay question. A patient suspected of having a stroke was admitted to the hospital, but the patient's family refused thrombolysis, thus missing the best opportunity for treatment.

The patient's left upper limb muscle strength was grade 0, and left lower limb muscle strength was grade I.

At that time, the patient was treated with aspirin, atorvastatin, low molecular weight heparin, edaravone and other drugs. After two days of treatment, the patient’s limb muscle strength improved, and the muscle strength of the left upper and lower limbs reached grade IV.

After the condition relapsed, low molecular weight heparin was discontinued and clopidogrel was added as a dual antiplatelet agent.

A cervical and cranial CTA examination revealed occlusion of the right carotid artery and right vertebral artery, occlusion of the origin of the left internal carotid artery, and severe stenosis of the origin of the left vertebral artery.

However, during the carotid artery stenting procedure, the patient suddenly experienced a severe allergic reaction.

The patient experienced respiratory and cardiac arrest, but was successfully resuscitated.

The question arises—what medication or procedure caused the patient's allergic reaction?

(End of this chapter)