Sleepless Doctor

"Oh? Myasthenia gravis? The patient has typical symptoms of morning light and evening heavy?" Wu Mian asked lazily, lying on the bamboo chair.

"..." Lin Daoshi said nothing for a while.

How can I forget that the typical characteristic of myasthenia gravis is that the morning is light and the evening is heavy! It was over now, and the little uncle grabbed the pigtail.

Seeing that Taoist Lin did not speak, Wu Mian guessed something, beckoned, and said, "Is there a case? Let me take a look."

"Uncle Master, here is the medical record, which is just an outpatient medical record. It is very simple to write." Lin Daoshi handed the medical record to Wu Mian and explained, "The patient's family said that he had difficulty swallowing, drooling, and worsening a week ago. "

Wu Mian flipped through the medical records and gave the medical records to Chu Zhixi after scanning two eyes.

"Awesome Lao Lin!" Wu Mian said with a smile, "Just a dysphagia and drooling, you can diagnose myasthenia gravis."

"Little Master..." Lin Daoshi smiled wryly.

I knew it would be said by the little uncle, but there is no good way to do it, who can't let myself memorize "Diagnosis".

"Tell me, what are the diagnostic criteria for myasthenia gravis." Wu Mian asked.

Lin Daoshi felt embarrassed, and it was really too troublesome to talk to the little uncle. Always ask yourself the diagnostic criteria, how do you know it?

That "Diagnostics" hasn't been finished yet, isn't it? And...I guess I won't finish it in a lifetime.

"First, patients will have drooping eyelids, blurred vision, diplopia, strabismus, and inflexible eye movement."

"Secondly, the patient has an indifferent expression, a bitter smile, a big tongue, difficulty in articulation, often accompanied by nasal sounds."

"third……"

Wu Mian lay on the bamboo chair, telling Taoist Lin about myasthenia gravis. Let alone, according to Wu Mian, Liu Yiyi cannot be diagnosed with myasthenia gravis at all.

Except for dysphagia, drooling, and weakness, nothing similar. But thinking back to Liu Yiyi's state of general weakness, Lin Daoshi always felt that myasthenia gravis must be caused.

Could it be that the diagnosis is wrong? Lin Daoshi was startled by such a thought in his mind.

“Brother, the patient’s eyelids are drooping, and eye movements are not affected; the nasolabial folds on both sides become shallow, the active mouth opening is limited by about 1cm, and facial pain and temperature sensations are bilaterally symmetrical; the muscles of the shoulder, neck, back and limbs are weak. You cannot turn your neck or shrug your shoulders, stay in a sitting position, raise your hands, or stand; the rest of the neurological specialist examinations found no obvious abnormalities."

"It looks like myasthenia gravis, Lin Daochang has not made a clear diagnosis, and he is justified." Chu Zhixi said.

"Haha." Wu Mian smiled and looked up at Taoist Lin.

Lin Daoshi was grateful, but the little teacher was caring, helping herself to speak.

"The neostigmine test is positive, and the local hospital also diagnosed myasthenia gravis." Chu Zhixi said, "but I don't think it is like it, but how did it come from?"

"Little sister, why don't you look like it?" Lin Daoshi was afraid to talk to Wu Mian, licking his face and asked Chu Zhixi.

"Patients with myasthenia gravis have a positive neostigmine test, but a positive neostigmine test does not necessarily mean myasthenia gravis." Chu Zhixi frowned and said, "diagnosed based on a neostigmine test, a bit sloppy. There are more tests to be done, but it is just an outpatient medical record. I think it should be caused by the patient and the patient’s family not cooperating."

"But the patient is weak, and there is a positive neostigmine test as evidence." Lin Daoshi argued.

"The patient has a rapid onset and progresses to the whole body quickly within 1 week, which is not in line with the subacute or chronic onset of myasthenia gravis, an autoimmune disease." Chu Zhixi said.

"..." Lin Daoshi looked dazed.

As an undergraduate medical student, after clinical internship and internship, Lin Daoshi still has a certain medical foundation.

But after all, it was nearly 20 years ago. It is already very good to remember the diagnosis of myasthenia gravis. Lin Daoshi couldn't think of all the details that Chu Zhixi said.

"Secondly, the patient has muscle weakness in the throat as the first symptom, and most myasthenia gravis is first affected by the extraocular muscles."

"The most important thing is the light in the morning and heavy in the evening as my brother said." Chu Zhixi continued, "The patient's myasthenia symptoms did not improve significantly after rest, while myasthenia gravis has volatility, accompanied by the characteristics of light in the morning and heavy in the evening. "

"None of these, only a positive neostigmine test diagnosis, I don't think it is rigorous."

"Little sister, what are you thinking about?" Lin Daoshi felt a little guilty. If myasthenia gravis is good to say, but Xiao Shishu and Xiao Shiniang said after one, two, three, four and five meals, this is Gu Mantong. The possibility of haunting.

As he said, he involuntarily raised his head, glanced at the stone stele in the back mountain, and felt calm.

"Lao Lin, did you hesitate asking about the medical history, but didn't say something?" Wu Mian asked when he saw the change in Taoist Lin's expression and knew there was a difference.

"Uh...Little Master, the patient's family said that they visited Thailand a few months ago and invited Gumantong." Lin Daoshi whispered, trying not to frighten Chu Zhixi.

"Don't be nonsense, Gumantong and others can also be invited? It is not casual to raise Gumantong, there are many rules." Wu Mian said, "Do the patient's family think this is Gumantong backlash?"

"Well, Xiao Shishu sees it clearly." Lin Taoshi didn't care about Wu Mian, and Chu Zhixi also looked plain when he heard it, and then he gradually felt relieved.

"Little Master, what is the problem? This is too strange, is it because people are gradually freezing?" Lin Daoshi asked.

But as soon as this sentence was asked, Lin Taoshi already regretted it.

In the next sentence, will the little uncle ask himself the diagnostic criteria for gradually freezing people? Not to mention the diagnostic criteria, people who gradually freeze is just a common name, and Lin Daoshi can't tell what the scientific name is for the diagnosis.

What a shrinking disease.

Forget it, I'd better talk less myself.

But Lin Daoshi was wrong, and Wu Mian didn't question the diagnostic criteria of Gye Frozen. He stood up and said, "Old Lin, Dao Robe."

"Little Master~www.wuxiaspot.com~ Are you going to see a patient?"

"Go and take a look." Wu Mian smiled, "Girl, you are in the back mountain, don't follow."

"I also want to see."

"Said it is related to Gumantong, stay away. It doesn't matter if I go and take a look, the yang is strong, so don't go." Wu Mian smiled and touched Chu Zhixi's head.

"Okay." Chu Zhixi said helplessly, "Come back and tell me how it was diagnosed."

Lin Daoshi didn't want to eat dog food, so he hurriedly went into the house and took the Taoist robe and helped the young master to put it on.

In addition to Xiaoping's head is a bit dazzling, Xiao Shishu's outfit is much more handsome than his own, Lin Taoist looks envious.

This is a world where you have to fight for your face, even if you wear a robes, there is no reason to say.

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