Free Web NovelChapter 572: Chapter 261: Diagnosis of Difficult Hematological Cases
"Doctors who have signed up for the competition on hematological diseases, please pay attention, we will first announce the competition rules. We will provide the patient’s basic information, and then participants will propose examination requests based on their preliminary diagnoses. The scoring rules are as follows: each additional routine examination request will deduct one point, and each additional CT, MRI, and advanced biochemical examination request will deduct two points. Correct diagnostic direction adds 1 to 5 points.
For example, if the preliminary diagnostic direction is correct, 1 point is added; if the second step diagnostic direction is also correct, 2 points are added. If the diagnostic direction is consistently correct, a total of 5 points can be added.
Fully correct diagnostic results score 30 points.
Each missed diagnosis deducts 10 points. Incorrect diagnosis scores zero points.
Correct treatment plan scores 20 points.
If there are errors in the treatment plan, points will be deducted based on the potential consequences of the treatment. For example, if an error in the surgical plan results in patient disability, 10 points are deducted. If it results in patient death, 20 points are deducted.
Aggravation of the patient’s condition due to medication deducts 5 points, turning severe deducts 10 points, resulting in patient death deducts 20 points."
The entire competition rules are set based on clinical practice.
The sole purpose is to identify the cause of the patient’s condition with the lowest cost and to cure it.
It tests a doctor’s comprehensive diagnostic and treatment capabilities in all aspects.
This is just the first event of the competition, and it’s already this strict.
This also heightened Li Jingsheng’s anticipation for this skills competition.
Doctors fear working in isolation the most.
He can take this opportunity to learn how doctors from more than 170 hospitals inside and outside the province diagnose and treat various diseases.
This will be greatly beneficial for his future clinic practice.
"If contestants do not answer correctly, non-contestants present can also answer questions. You can open the tablet on the table, enter your hospital’s name, personal name, ID number, and phone number verification, and you can participate in answering questions. If you get a high score, you can be considered as part of the competition and are eligible to obtain trophies and honor certificates."
For this kind of event, the prize money is not attractive.
The doctors present are all top-tier, even if they win first place, the prize money is only five hundred yuan.
Hardly any doctor would think much of it.
The truly valuable items are the trophies and honor certificates.
These will serve as reference bases for future evaluations, promotions, and professional title evaluations.
Their gold content is very high.
The governing bodies and the Western Medical Association recognize them.
"Actually, even if non-contestants do not participate in the competition, they can enter their personal information to bind the tablet on the table. This will facilitate answering questions in the next event or watching the correct answers at that time."
The examiner’s words echoed again.
The crowd began to operate the tablets on the table one after another.
Qiaobang Hospital really has money to burn.
Even if a single tablet only costs fifteen hundred, so many tablets are still astronomical in number.
Li Jingsheng, with a mindset to give it a try, also bound accordingly following the instructions.
Once binding was completed, a flashing red box automatically appeared.
Current quiz.
Clicking on it immediately displayed the patient’s basic information.
It’s truly very convenient.
High technology has changed people’s lives, bringing great convenience.
Patient information: Mr. Xu, 54 years old, male, noticed purplish spots on his skin while watching TV at home at 9 p.m. That evening, seeing the spots did not dissipate, he grew fearful and went to the hospital for consultation.
The patient is usually healthy. Two days ago, he experienced sore throat, fever, and headache, and took pain relief tablets and spiramycin.
After taking the medication, the condition improved, the headache was relieved, the body temperature returned to normal, but the sore throat did not get better.
The next night after taking the medication, small subcutaneous hemorrhages appeared on the face, limbs, lower back, and chest.
Afterward, they slowly enlarged, becoming purpura.
Before hospital admission, the patient felt soreness in the knees and lower limb muscles.
Upon admission, body temperature was 36.7 degrees, blood pressure was 105/75 mmHg, heart and lung were normal, consciousness was clear, skin could be seen with bleeding spots.
The size of the bleeding patches varied, mostly with diameters from one millimeter to two centimeters.
They were scattered over the entire body, most on the limbs, fewer on the trunk.
Oral mucosa showed bleeding points and ecchymoses.
Abdominal examination revealed tenderness around the navel, without muscle tension.
No redness or swelling of both knee joints.
These are the basic information provided.
After reading through, Li Jingsheng couldn’t help but recall the case of ITP he received a few days ago. That little boy had difficulty stopping bleeding, due to thrombocytopenia.
This patient’s initial symptoms seemed somewhat like a cold. After medication, the fever went down, and the headache ceased.
As for the sore throat, it was still painful, which is normal.
Throat pain generally doesn’t heal that quickly.
The mouth, throat, and nasal cavity are quite special, with humid environments and mucous membranes. When inflammation or abscesses occur, recovery requires a little more time.
Anyway, signing up for the competition is free.
He attempted to click on the request for a blood count.
It immediately showed a deduction of 1 point.
He didn’t expect it to be so intelligent, having set up the scoring rules.
Deducting points for examinations is to prevent doctors from mindlessly requesting examinations.
In some hospitals, the management of examination requests is very lax, and doctors are even encouraged to request more examinations. In such cases, it can spoil doctors’ diagnostic habits.
Because without supervision, regardless of the patient’s condition, doctors would issue a slew of examination requests.
Even wishing that every patient undergo a full suite of tests.
Actually, this is not only a loss of medical ethics but also a severe waste of healthcare resources.
Each additional examination a patient undergoes greatly increases the waiting time.
Drawing blood, waiting in line for half an hour is quite common.
A color Doppler ultrasound takes half an hour or even longer to wait normally.
Imagine patients with an ailing body, queueing here and there, constantly tossed around, without receiving timely and effective treatment.
After a day of tossing around, exams might not be finished yet, and the doctor is already off duty.
Doctors who indiscriminately order tests like this are truly shameful.
They completely disregard the patient.
Frankly speaking, in their eyes, patients have become cash machines: tests are ordered, patients just pay, whether they live or die is no concern to the doctors.
In medical procedures, if a patient encounters an accident or their condition worsens and threatens life during the testing queue, doctors only have a duty to rescue. They are not held liable.
There have been hospitals making headlines due to such a decline in medical ethics.
Patients were already critically ill, yet the doctors were busying themselves taking a group photo, leaving the patients unattended.
Ultimately, the patient died because of untimely rescue.
Angry family members took the hospital to court.
Finally, those negligent doctors and nurses received due punishment, but the life lost could never return.
To the family, it left everlasting grief.
This skill competition deducts points for every test application made by doctors and deducts another 2 points for ordering non-routine tests and examinations.
Li Jingsheng thinks this is excellent.
This is how it should be.
A truly skillful doctor must have their judgment first and then order corresponding tests to verify whether their judgment is correct.
Li Jingsheng filed a blood routine test application, and the results immediately came out.
The first data he wanted to see was hemoglobin, at 176g/L.
White blood cells are 21.9 times ten to the ninth power per liter.
Neutrophil segmented nuclei account for more than 80%.
Platelets are 82 times ten to the ninth power per liter.
The results additionally showed that the patient’s bleeding and clotting time are normal.
This indicates the patient’s clotting should not be an issue.
But the patient fell ill suddenly, so what could be the cause?
Li Jingsheng instinctively looked around the venue, many people were absorbed in manipulating their tablets.
It’s estimated that most doctors think similarly; since they’re here anyway, the competition does not cost money. In a skill competition not requiring real practice, one might as well participate.
Perhaps they’ll encounter something they are skilled at and win.
Being selected by the organizers to use as test material must mean it’s meticulously chosen, with high difficulty.
One can tell from everyone scratching their ears and furrowing their brows thinking hard.
No one speaks up to discuss.
There is still this level of professionalism.
Moreover, there is monitoring on site, any cheating will be captured clearly.
The doctors here are elites among elites, they certainly cherish their reputations.
No one will engage in such foolish cheating.
The organizers probably won’t allow it either.
From the scoring rules, it is apparent the organizers host this event to genuinely enhance doctors’ diagnostic capabilities and boost everyone’s knowledge.
"Bleeding certainly results from blood vessel rupture. So many bleeding points indicate systemic bleeding."
Li Jingsheng pondered silently.
Though blood disorder is not his forte, he possesses certain skills in cardiovascular and immune system areas.
There are various factors causing such bleeding, categorized into congenital and acquired bleeding.
For instance, hemophilia is a genetic disease.
The patient’s bleeding seems more like telangiectasia rather than vessel rupture.
Li Jingsheng thinks the patient’s ability to survive to this age, having never experienced such disease before, suggests congenital disease is highly unlikely.
Thus, it’s acquired.
The most common acquired ones are allergic purpura, drug-induced purpura, and infectious purpura.
Before developing purpura, the patient took two medications for headache, throat soreness, and fever.
The primary suspicion naturally falls on drug-induced purpura.
Furthermore, allergic purpura usually doesn’t accompany thrombocytopenia.
Drug-induced purpura tends to lead to thrombocytopenia.
However, sometimes it doesn’t.
Li Jingsheng realized that a habit of sparingly ordering tests for the patient’s sake is indeed beneficial.
Now, diagnosing this case, he feels his advantage.
Of course, it’s also related to his clinic’s poor conditions, incapable of performing some tests.
When diagnosing, he usually conducts physical examinations and, depending on the necessity, sees whether tests like ultrasound or X-ray are needed.
Even routine blood tests can’t be done.
This patient exhibits significant thrombocytopenia.
Prior to falling ill, it should have been normal, or purpura and subcutaneous bleeding would’ve already appeared.
Thrombocytopenia should be the main cause of the bleeding.
A healthy person’s platelet count can exceed 100, reaching as high as nearly 300.
This patient’s platelet count is merely in the 80s, there’s definitely an issue.
So what could be causing the thrombocytopenia?
Li Jingsheng began a detailed diagnostic process, examining each possibility one by one.
