Healing Doctor

Chapter 484 Connecting Theory with Practice

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

The patient's diagnosis was unclear, and it took the entire hospital nearly two days of consultation to find the problem.

Fortunately, there was no delay. If it had been another hospital with slightly lower standards, the patient might be buried with grass as tall as a person by now.

Can Ji Xiang provide the correct answer?

Zhai Yuhan thought it was impossible.

She believes she did not intentionally make things difficult for Ji Xiang, but only wanted to teach him a "lesson" so that he would be more humble in the face of the strange and wonderful diseases in clinical practice.

Zhai Yuhan even pretended to forget that she hadn't explained the most crucial step in the physical examination, thus misleading everyone.

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

Zhai Yuhan was startled, her heart pounding involuntarily, as if she had been caught trying to prank Ji Xiang.

However, upon closer reflection, it seems unlikely. The trap I set was flawless, and Ji Xiang wouldn't have seen through it.

"Oh?" Zhai Yuhan deliberately feigned composure. "What are you talking about? The physical examination I just described was indeed rather rough. Is there anything you want to ask?"

"Which arm was the patient's blood pressure measured after admission?" Ji Xiang asked.

"Aren't they all the same?" Zhao Mengmeng looked at Ji Xiang with a puzzled expression.

She felt that Ji Xiang had said something pointless.

Zhai Yuhan's expression froze instantly; she never expected that Ji Xiang would so quickly and astutely pinpoint the problem.

However, after her initial surprise, Zhai Yuhan smiled slightly, realizing that Ji Xiang had walked right into the trap like prey.

"It's different," Ji Xiang said. "Different blood pressure in both arms means aortic dissection. Professor Zhai must have thought of this case after I mentioned rib fracture complicated by aortic dissection."

Zhai Yuhan was speechless; Ji Xiang was indeed very clever.

Zhao Mengmeng looked at Zhai Yuhan with a puzzled expression. Seeing her frozen expression, she guessed that Ji Xiang was right.

But after reviewing the patient's medical history again, she still had no answer.

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

"That's about right." Zhao Mengmeng glanced at Ji Xiang.

Zhai Yuhan threw out the hole she had dug and looked at Ji Xiang with great interest.

"Professor Zhai, I still think it's aortic dissection. The CTA imaging should show that, right?" Ji Xiang said slowly.

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

"The patient's symptoms of paralysis in both lower limbs cannot be explained by bilateral parietal-occipital lobe cerebral infarction. After ruling out diseases such as periodic paralysis, I suspect there may be a spinal cord lesion, and I tend to think that there may be a spinal cord blood supply disorder."

"Based on the physical examination, a murmur could be heard in the right subclavian and carotid artery areas. Although the blurred vision 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 and changes in the vertebral artery."

"..." Zhai Yuhan looked at Ji Xiang silently.

At that moment, she was speechless.

Ji Xiang made the correct judgment without seeing the patient's information, based solely on the medical history he had dug himself into two holes.

It's worth noting that when the First Affiliated Hospital encountered this patient, it took five rounds of hospital-wide consultations and auxiliary examinations, a long and arduous process, before they finally found the cause of the illness.

Ji Xiang, however, demonstrated a diagnostic level that surpassed that of the experts and professors at the First Affiliated Hospital.

"Dr. Ji, tell me what your reasoning is." Zhai Yuhan did not immediately admit that Ji Xiang's diagnosis was correct, and continued to probe.

She believes that Ji Xiang was just guessing and couldn't provide any reasonable logic. Without a logical loop, it seems that he can't be considered to have lost.

"Bilateral lower limb paralysis is a common clinical symptom, which can be divided into three categories according to the anatomical location of the lesion."

First, upper motor neuron paralysis is also called central paralysis.

Second, lower motor neuron paralysis, also known as peripheral paralysis.

Third, myopathic paralysis.

Ji Xiang started counting on his fingers: one, two, three.

"The characteristics of paralysis in the thoracic and abdominal aortic CTA are: predominantly paralysis of the entire limb, monoplegia, hemiplegia, paraplegia, increased muscle tone and tendon reflexes, the appearance of pathological reflexes, and no muscle atrophy."

"..."

Ji Xiang spoke eloquently, leaving Zhai Yuhan speechless.

This is not merely a logical closed loop; Ji Xiang has considered even the smallest details of every branch of speculation, starting with the patient's most severe clinical symptom—paralysis—and analyzing it thread by thread.

"Lower motor neuron paralysis is characterized by decreased muscle tone and tendon reflexes in muscle groups or individual muscles, without pathological signs, and muscle atrophy. Myopathic paralysis is characterized by muscle atrophy in the proximal limbs, symmetrically distributed, without sensory disturbances."

"In this case, the patient presented with paralysis of both lower limbs, but no hemiplegia or muscle atrophy..."

Ji Xiang talked for almost five minutes, counting on his fingers, before finally giving his conclusion.

"I think the CTA images will most likely show aortic dissection, Stanford type A, accompanied by changes in the vertebral artery."

"!!!"

Zhai Yuhan had already noticed the exclamation marks all over the place.

As Ji Xiang finished speaking, she stared blankly at the young doctor who was faintly radiating a milky white light, feeling utterly confused.

This level of diagnostic ability is terrifying; it's something that has never been encountered before, at least not in the First Affiliated Hospital or in Zhai Yuhan's medical career.

Moreover, Ji Xiang's rigorous logic proves one thing—his diagnosis was not a random guess, but rather based on sound reasoning and meticulous analysis.

But Ji Xiang hadn't finished speaking.

He seemed oblivious to Zhai Yuhan's expression and continued, "In this case, the aortic dissection was painless, making it easy to misdiagnose."

Painless aortic dissection is less common clinically than painful aortic dissection. It is often accompanied by neurological symptoms such as limb paralysis, making it easy to misdiagnose as acute ischemic cerebrovascular disease. Administering thrombolytic therapy within the treatment window for cerebral infarction can lead to catastrophic consequences.

"But the treatment is not difficult. Metoprolol, nifedipine, and urapidil can be used to control heart rate and blood pressure. Once the condition is stable, surgery can be performed by a vascular surgeon."

"Teacher Zhai, the patient has finally recovered and been discharged from the hospital, right? Has his walking ability recovered very well?"

"Yes," Zhai Yuhan squeezed out a single word through gritted teeth.

Zhao Mengmeng was completely bewildered.

Although she couldn't understand Ji Xiang's entire logical reasoning at all, Zhai Yuhan's final "yes" told Zhao Mengmeng one fact—Ji Xiang's judgment was accurate.

That's incredible!

Zhao Mengmeng didn't feel as resentful as Zhai Yuhan; instead, she looked at Ji Xiang with a hint of admiration.

How wonderful it would be if I could answer questions as cleanly and concisely as Ji Xiang.

Unfortunately, Zhao Mengmeng always felt that something was missing, and she was never able to connect the knowledge taught in books with reality.

(End of this chapter)