medical simulator

The cases Professor Song brought were of course joint surgery cases, and all of them were hip joints.

Hip tuberculosis, hip osteoarthritis, hip dysplasia with avascular necrosis of the femoral head, hip infection!

These are four classic cases of differential diagnosis of the hip joint. To complete the diagnosis, many auxiliary examination methods are needed to confirm the diagnosis.

But that is for ordinary doctors, and for top joint surgeons, there are different signs among hip tuberculosis, osteoarthritis, dysplasia and infection, even displayed in the information volume Among the fewest flat sheets.

It is time to be able to diagnose through this.

It's just that, to see synovitis from ordinary plain films, Zhou Cheng's thinking this week is also amazing.

Zhou Cheng pursed his lips and said, "Ms. Luo, you specifically pointed out this kind of hip synovitis when we were in the outpatient clinic together, and we checked the information together later."

It happened on the weekend last week. At that time, Luo Yun hadn't been to the outpatient clinic for a long time, and it was Zhou Cheng's first visit to the clinic at that time, so Luo Yun explained the cases that Zhou Cheng didn't know about.

However, another situation is that Luo Yun was licked to death by Zhou Cheng in the simulated world! ~

He also passively gave out the academic gift package, the knowledge points contained in it include the plain film reading of synovitis, but maybe Luo Yun didn't call it out in time, and Zhou Cheng now has a perfect level of skills, as high as 50+!

It can be said that the knowledge reserve is extremely rich, so there is no problem in completing the mobilization of these knowledge structures, and then I can see something different.

"That's an MRI. The signs of synovitis on the MRI are completely different from the signs on ordinary X-ray films." Luo Yun is very satisfied with Zhou Cheng's talent, but ah, Zhou Cheng's Modesty and stability are what he has never liked.

Obviously I can see it, but I have to find a reason to prevaricate, although this is a consensus among all disciplines at present, everyone has to live with face...

But you must know that in the daily communication, I have given more face, and in the process of flattering each other, I feel that I am very good, so I don't study, and I don't go in-depth.

"Has no one raised their hands yet?"

Professor Song looked around and saw that no one raised their hands anymore, and he was quite satisfied with the effect of this set of flat films he brought.

Of course, Professor Song didn't know if Mr. Xu and Mr. Kong saw it, but they probably did, so they wouldn't tell the truth.

Luo Yun touched Zhou Cheng: "You raised your hand to answer the question?"

Zhou Cheng quickly shrank his body, trembling slightly: "Mr. Luo, me? Now?"

Then Zhou Cheng shuddered violently, shaking his head like a rattle.

Just kidding, on weekdays in the department, when facing Yan Haihan, he felt a feeling of looking at the mountains and was trembling. Although Yan Haihan has stepped down from the position of director now, Zhou Cheng is still a little nervous when he sees Yan Haihan. fear.

And if the director of Yan Haihan is a landowner in the No. [-] Hospital, then when he faces Ding Changle, how should he confess?Ding Changle is currently the head of trauma surgery in Hunan Province.

Ding Changle is just the director and professor of trauma surgery in one of the three affiliated hospitals of Shonan University. Compared with the resume of a great director like Lei Zhong, who is also the dean, he is a little less interesting.

This Professor Song, according to Luo Yun's introduction, is currently the deputy director of the Second Affiliated Hospital of Shonan University and Professor Li's mentor!

Professor Li and Professor Lei Zhong are figures of a generation!

Even Professor Liu Yiping will be respectful to Professor Song, so he will answer this question?

Forget it, the level of difference is too much.

"Ms. Luo, you can answer." Zhou Cheng waved his hands repeatedly and lowered his head.

Luo Yun sighed, and said, "What are you afraid of? Tell me what you know. If you make a mistake, the old professor will naturally correct it for you. You can remember it for a lifetime."

But Zhou Cheng still didn't dare to show off the limelight, mainly because he wasn't used to it yet, he hadn't even attended a class in the department, and he had been in the limelight before, now Zhou Cheng really didn't want to ask him to show off.

Through the mock copy, Zhou Cheng knew more and more how difficult it is to promote the development of a subject.

Although the skills that Zhou Cheng has acquired so far may be the perfect point in this era, but after a few decades, the ceiling of these skills may be redefined.

I had a mock copy, so I was able to take a shortcut, while the others had earned their fame through their hard work and talent.

Zhou Cheng can stand up to answer questions, and maybe attract the attention of everyone, but showing off with skills is not Zhou Cheng's original intention.

Zhou Cheng rubbed his hair and didn't say much.

……

After Professor Song saw that no one raised his hand, he stopped wasting any more time, and took the initiative to end his confusion:

"This plain film is superficially similar to the first plain film I listed. But it is only similar, not the same plain film of a patient."

"It can be seen that these four plain films have a wide range of enhancements, which can also be called whitening phenomenon!"

"This wide-ranging whitening phenomenon basically takes into account the infection of the joint cavity! It is not enough to simply see the infection step."

"At this time, we can use some other special factors to make detailed distinctions one by one."

Professor Song said, and flipped through the plain film to the first plain film: "The last case just now, the medical history only lasted for one year!"

"And there is no tenderness around the hip joint! This shows that the articular surface in our joint cavity has not been eroded particularly severely, and may not even have invaded the pain layer."

"But in the first film, we can also see extensive enhancement, but its medical history has lasted for more than [-] years!"

Professor Song said, holding up two fingers.

"It has not been discovered for 20 years, which means that the patient just does not have the symptoms of high fever and chills that accompany common hip joint infections, otherwise the infection focus may have been discovered."

"If it's not a heat infection, then it can only be a cold infection focus."

Heat infection means that there will be traditional infectious symptoms after infection, but cold infection focus is not necessarily the case. Often patients do not have too many symptoms and are ignored.

"And no matter how the cold infection can last for more than ten years before the onset worsens, we have to consider whether this patient has tuberculosis."

"Tuberculosis in the joint cavity may not be detected by ordinary blood tests for tuberculosis and tuberculosis antibody antigens."

"There won't even be corresponding typical symptoms, and the diagnosis can only be made by biopsy and culture."

"Then, how can we make a diagnosis through this film?"

"It can only be identified by medical history."

Professor Song turned to the fourth picture while talking, and apologized to the person who answered the diagnosis:

"When our doctors read the film, we should not only look at the plain film, but also consider the length of the patient's medical history and age."

"If she had hip osteoarthritis, she'd been in pain for more than 20 years!"

"Will she still have joint space? But when we look at this film, the space is only a little narrow, but we can see some small insect-like cavities, so we have to think in the direction of infection, right?"

"So the first plain film, we can also preliminarily consider hip joint tuberculosis and septic hip arthritis."

In this regard, Professor Song made a point and clarified the distinction between tuberculosis and common joint infections.Professor Song didn't stay any longer, but continued to read the second and third flat films.

"Next, let's look at the second film. This film is the best one in today's group of films. It is congenital hip dysplasia and femoral head necrosis. This should be our joint surgeon. Essential skills."

"We can first see that the CE angle of the hip joint is outside the range of normal people. At the same time, we can also see that the bone quality on the femoral head is uneven, with localized regular reduction, necrosis and collapse. more likely."

"Let's not worry about this film. If you don't know how to watch it, you should go home and study it hard. Don't let us spend our whole life in joint surgery and forget the door to enter joint surgery. That would be ridiculous!"

"The third film! This is a very interesting flat film."

"We should take into account patients with intermittent claudication."

"In addition to neurogenic and vascular diseases, we also need to consider our orthopedic diseases."

"Hip Synovitis."

"The tenderness in front of the hip joint lasted for 8 years and became worse for two years. We could not see the narrowing of the joint space and the formation of osteophytes. On the contrary, we could see that the local imaging density in the joint space increased."

"In this way, the sciatic nerve inflammation caused by hip joint compression on the sciatic nerve can be temporarily ruled out. Although synovitis is relatively rare, if we also consider..."

Professor Song's in-depth analysis directly won a lot of applause...

When Luo Yun heard Professor Song give the final answer, he couldn't help but give Zhou Cheng another look: "Look, you dare not raise your hand to answer the question. What are you afraid of? What you said is right. .”

"Do you think you will never stand there for the rest of your life? If you don't even have the most basic courage and the courage to admit mistakes, how can you study well?"

When Luo Yun was scolding Zhou Cheng.

Professor Song's lecture on the stage is over.

He is not young at all, so he doesn't need to prepare too much content.

As the beginning of the second half of today's meeting, Professor Song has already laid down the leader, and it is a leader that many people rarely see. Such a case!

At the same time, it can be presented, and it can be explained in detail. It may only be an older generation like Professor Song who has a lifetime of experience as a reserve.

It is possible to unscrew each disease individually and explain the simple theorem of this particularly complicated case in a simple way.

If it is a young professor, he may know the diagnosis himself, but he cannot analyze the differential diagnosis, but relies on various laboratory tests, then the impact of this sharing will not be so strong.

"Mr. Luo, isn't it great to just take a class like this?" Zhou Cheng also felt that Luo Yun's thinking was very strange.

If this is an operating table, Zhou Cheng can go up to complete an operation without hesitation, and this will not hinder him.

But this is Zhou Cheng's first time participating in such an academic conference. He didn't even go through the principles and procedures, so if he asked questions and answered them casually, it would offend people, because Zhou Cheng was afraid that the questions he asked would At that time, no one could answer, and of course the venue was shut down.

How bad is that.

Moreover, the speakers above are all Zhou Cheng's targets, so how could he offend them?It would be great to hear more about their private goods, and it would be great to throw out some seemingly outrageous conjectures.

"Me?" Luo Yun suddenly had an expression of hatred for iron.

Back then, it was his teacher who asked him to give a lecture on the stage, and he rushed up, but he didn't hesitate.

At that time, he couldn't keep up with Zhou Cheng?

Just to force yourself!

It can be said that if Mr. Zeng did not force Luo Yun to give lectures in various venues and force him to prepare too many things as background, he would not be able to learn so quickly!

On Zhou Cheng's side, he is obviously capable and strong, but he just seems dumb.

How timid as a mouse!It doesn't have the same demeanor as he did back then, and it's also a wonderful flower.

Zhou Cheng pursed his lips and continued to listen.

Luo Yun also sighed, and gave up the inner struggle.I didn't think that Zhou Cheng was hopeless, but that Zhou Cheng's edges and corners were almost smoothed out. At his age, he would think about too many things.

At this moment, Zhou Cheng knew very well what to say and what not to say.

Although before, it was common for different professors to fight each other.

But who are those people?

Who are you?Ordinary training, no teacher and no foundation.

He's going to cause trouble, and if someone just stands up here, Cai Dongfan will be crushed. Does he dare to say anything more?

dare not.

Luo Yun is different, his teacher can make him have a kind of unbridled irascibility.

……

Next, Professor Chen from West China called a group of speakers from prefecture-level hospitals in Hunan Province to share the cases they talked about.The first quarter of the second half of the annual meeting is finally over!

After a tea break, Professor Zhuang, the director of the Joint Surgery Department of the Second Affiliated Hospital of Shonan University, finally came to the rostrum!became the chairman of the meeting.

The second half of the meeting is considered to be the beginning.

Professor Zhuang emphasized in an extremely loud voice:

"Welcome all colleagues, experts, professors, and teachers to come to our joint surgery venue again."

"The next thing I want to share with us is the professor of orthopedics at Hunan Provincial People's Hospital and a member of the Hunan Provincial Orthopedics Committee. Dong He, Professor Dong. He is also a top expert in our orthopedics family in Hunan Province. Welcome!"

Zhou Cheng listened to Professor Zhuang's words, carefully read the above resume, and found that Dong He was actually just an associate professor, and the writing was so correct, but what Professor Zhuang read out was still a professor.

I don't know if it's Professor Zhuang's slip of the tongue, or if it's something else.

At this moment, Luo Yun began to knock on the table again to make a point!

"Listen carefully, there is definitely a big melon in this scene!"

"What big melon?" Zhou Cheng was curious.

"You just have to watch." Luo Yun turned out to be tricked!

Zhou Cheng squinted his eyes first. Dong He was only the deputy director of Xiang Provincial People's Hospital, but he was praised so much by Professor Zhuang. Luo Yun also said that there are big melons. It seems that there is something wrong with the doorway here.

Is there any grievance between Professor Zhuang and Professor Dong He?

No time to think about it.

Dong He quickly walked to the stage, bowed to the applause of the crowd, and said:

"Thank you everyone, thank you teachers for your applause."

"But it's a pity." Dong He was extremely talkative, with clear words and a frustrating tone.

"Today, all the experts brought us successful cases, and they came to teach us lessons."

"But I came here today to trouble the teachers. The main reason is that I brought a failure case we encountered today. I really have nothing to do, so I came here to ask you for advice."