dkrc Chapter 49 Exam is over, results pending!
Chapter 49 Exam is over, results pending!
The first case was completed by Chen Zhuoan's team in just fifteen minutes, ahead of schedule.
After Chen Zhuoan clearly announced that the examination team could not make things difficult for everyone after the operation was completed, they promptly gave the second case.
The second case is relatively typical and classic.
It is rheumatic valvular heart disease complicated by atrial fibrillation, accompanied by sudden severe abdominal pain, but no specific tenderness or rebound tenderness is found on physical examination.
Chen Zhuoan knew what kind of trick the question setter was using just by looking at the question.
This is a classic case of superior and inferior mesenteric artery embolism in the abdomen!
Of course, this kind of diagnosis is also difficult. If you are not very proficient in chest and abdominal emergency diagnosis, it is easy to misdiagnose.
The case was typical, so the test results were also typical.
CT results and other information are available.
When Chen Zhuoan and the others dealt with it, they simply followed the proper procedures.
After admission, the patient underwent routine medical examinations, a routine CT scan, and was then routinely taken to the operating room.
After completing another exploratory laparotomy, Chen Zhuoan said, "Results observed during the operation."
After the volunteer handed over the intraoperative results, Chen Zhuoan quickly replied: "Implantation of the superior mesenteric artery is visible. Check the basic condition of the intestinal tract immediately."
The volunteer then handed over the basic information about the intestinal tract.
"No transmural necrosis of the intestinal tract occurred; thrombectomy was performed."
"Has the intestinal blood supply been restored after the thrombectomy?"
Arterial embolism always involves a window of tissue necrosis; it's absolutely not something that can be done by simply opening the abdomen and cutting it out!
Cutting it directly is a violent choice made by those who don't know anything about it.
After the volunteers handed over all the results, Chen Zhuoan officially announced: "Close the abdomen and send the patient back to the ward for further observation."
"Post-operative patient recovery status!"
Sure enough, the volunteers handed over the post-operative results, and then they started playing their tricks again.
During the surgery, a filter was installed in conjunction with the vascular surgery team, but it was still ineffective, and the patient suffered another myocardial infarction after the surgery!
This is a typical case of combined medical and surgical complications.
Immediate action was taken to address the underlying cardiac issues. Anticoagulation therapy proved ineffective, and angiography revealed multiple emboli, indicating the need for arterial sheath placement and interventional thrombectomy.
It took the team twenty minutes to finally finish treating this case.
After confirming that nothing was overlooked and the patient recovered and was discharged from the hospital, Chen Zhuoan reported: "Treatment completed."
Those two exam questions are now "gone".
There are fifteen minutes left in the exam.
After the examiners had filled out the forms for everyone's performance, a bald, middle-aged man suddenly launched a sneak attack.
"Why fabricate a case out of thin air when dealing with the first case?"
Chen Zhuoan replied to Ziru: "It's not something created out of nothing, it's something that must exist."
"If treated according to standard hemopneumothorax protocols, this patient...would certainly die!"
"With this kind of treatment, it won't help no matter who comes."
Middle-aged: "Hemopneumothorax can also lead to high pressure in the pleural cavity."
"There is high-pressure release."
Chen Zhuoan: "Hydraulic compression of lung tissue requires a large amount of fluid."
"Air pressure compresses lung tissue, requiring an extremely high pressure state."
"If there were even a little less fluid and a little less air pressure, the patient's respiratory function wouldn't be completely collapsed!"
"The reason why the patient's breathing difficulties do not subside is not due to hemopneumothorax."
"Pulmonary bullae are just a superficial phenomenon!"
Middle-aged man: "You've never even seen a patient."
"This is the pathogenesis of breathing difficulties."
"Respiratory tract, atelectasis of the lung parenchyma, and nerve innervation disorder."
"Pneumothorax is just one manifestation of atelectasis. If the compliance of the lungs decreases, it can still lead to atelectasis."
"If the respiratory muscles are under the control of nerves, it can also lead to relative atelectasis."
"However, respiratory muscle dysfunction is not only caused by intracranial factors, but also by possible damage to the muscles themselves."
Every word Chen Zhuoan uttered addressed the root cause of the disease.
It has nothing to do with textbooks, but only with the pathogenesis of this disease!
He wasn't intimidated by the examiners at all.
Even if you bring up the original medical records, he can argue with the other party for dozens of hours without backing down!
Even if you made a mistake in your judgment, it must be because the other party missed some information.
This is Chen Zhuoan's clinical thinking and diagnostic logic, which points directly to the fundamental principles.
In Chen Zhuoan's view, what is called appearance is just trivial details.
The middle-aged man finally fell silent.
The other examiners said, "Alright, alright, team five has finished the exam. You can go back now."
As a test taker, you should be polite where appropriate.
After bowing to everyone, Chen Zhuoan led his team out of the meeting.
……
As soon as they stepped out of the classroom, Fu Yongbing called out in a strange tone, "Captain, are you suspecting there were problems with the rescue process?"
Chen Zhuoan: "This is not a doubt, it's just a specific analysis."
Chen Zhuoan glanced back at the classroom; the door was closed, but he estimated that the people inside could still hear them talking.
As a seasoned surgeon, Chen Zhuoan added, "Clinical diagnosis and treatment vary from person to person; everyone has their own understanding."
There is no absolute right or wrong!
Fu Yongbing had a loud voice: "But that old man's face turned green... I think you're definitely right, Captain..."
Chen Zhuoan: "..."
In fact, both the examiners and volunteers inside could hear what Fu Yongbing was saying.
The examination room fell silent instantly.
The other three looked both reserved and eager to see what would happen.
See? They just casually bring out death records from the hospital, don't they?
As the saying goes, "It's better to die for your friend than for yourself; it's not like you're losing face."
So it doesn't matter anymore.
Of course, they were all very well-mannered, so they didn't laugh!
……
After saying goodbye to Han Yuanyuan and the others, Chen Zhuoan naturally went to treat himself with his Su Baobao.
Since we're all here at Xiangya Medical College, we definitely have to check out that spicy hot pot place on the back street.
The two of them ordered a total of over fifty yuan.
This is over fifty yuan from 10 years ago, enough for two people to enjoy a hearty meal.
Sitting in her seat, Su Xiheng said with some concern, "An'an, I think our first case might be a bit too much?"
Chen Zhuoan said nonchalantly, "It's fine, as long as the examiners sitting here are proper clinical doctors, not the kind who are just pure theorists."
"Our ratings won't be particularly low!"
"The exam room is video-recorded, and someone will review it later."
"Our hospital also has professors who review the papers; they don't dare to give random scores."
"Let's not talk about first place, but top two is a sure thing!" Chen Zhuoan said confidently.
Just because the person who set the question was wrong doesn't mean Chen Zhuoan was wrong.
If the other party insists on operating according to the question, then Chen Zhuoan has no choice.
His mindset was solely focused on keeping the patient alive, not on solving problems.
This is a clinical reasoning skills competition, not an exam for associate senior, attending physician, or senior professional titles!
Su Xiheng was relieved.
The two held hands and started talking about renting a house.
Renting a place is expensive, which is not really suitable for students.
However, renting a house would be better if it were more convenient to study together.
Su Xiheng said, "We can cook then, which might save us some money."
Chen Zhuoan reassured him, "It's just that the rent is a thousand, which is too expensive."
"It's okay, if we can win a good prize in the national competition, we'll get a bonus."
After finishing their meal, the two walked hand in hand down the street, and then boarded a bus heading back to Xiangya Hospital.
Afterwards, Chen Zhuoan and Su Xiheng got off the car at the Xiangjiang River and continued walking.
At nine o'clock in the evening, Chen Zhuoan suddenly received a call from his teacher, Dong Anhua.
"Chen Zhuoan, what's wrong with you? Why is your group's result pending?"
Chen Zhuoan smiled upon hearing this: "Oh, Master, perhaps the examiners are having trouble giving scores."
Dong Anhua's voice tightened instantly: "What's going on?"