The road to the rise of great doctors

Chapter 112 Closing
As the saying goes, “If the foundation is not strong, the earth will shake.”

In order to select truly outstanding people, especially in a critical period like the first term, it is not difficult to understand such a wide and detailed assessment scope.The quota limit is also based on this consideration.After all, from the perspective of process and approval, they all speculated that this would take up part of the doctoral enrollment quota.

Liu Dong calmed down and began to glance at the films for the video assessment, and he had an idea in his mind, "It's quite a typical film, so let's do it in order."

He speculated that the experts who set the questions probably did not have high expectations for medical students, even the best among them, to read imaging films.If there are difficult-to-find imaging films, I am afraid that the final score will generally be low. When it is fed back to the school, it may appear that the training level of the affiliated hospital is relatively poor, which will be too ugly.It is still a typical film. With this support, the range of topics can be enriched and improved.

After all, even doctors in departments such as internal medicine, gynecology, and pediatrics who have worked in clinical practice for several years, except for the relatively high-quality images in the undergraduate department, most people will probably forget about other images, even if they are typical. It's over.

Li Xiao's clear cheers echoed in Liu Dong's ears, and his heart was filled with strength. His eyes were steady, and the images and pictures he had learned flashed through his mind as he made the final decision.

First, look at the first imaging examination film - chest X-ray.

Chest X-ray, the full name is posteroanterior chest X-ray, is an X-ray examination.

When observing and analyzing a chest X-ray, the first thing to determine is whether it is a normal or abnormal chest X-ray.

The teacher's instructions during the imaging training class flashed through my mind, and then I followed the order of interpretation of chest X-ray films seriously and began to make judgments one by one.

First, the thorax, trachea, and intercostal spaces were all normal. “The thorax was symmetrical, the trachea was centered, and the ribs and intercostal spaces on both sides were normal.”

Next, we looked at the lung texture. Some were normal and some were abnormal. "The texture of the left lung was clear and no obvious substantial infiltration was seen." The left lung was normal, but the problem was in the right lung, which was different from the normal appearance: "On the right side, the middle Patchy dense shadows can be seen in the upper lungs with unclear edges."

"The hilus on both sides is not large, and the mediastinum has no deviation."——Normal performance.

"The size and shape of the heart are normal, and there is no thickening of the pleura on both sides."——Normal performance.

"The two diaphragmatic surfaces are smooth and the costophrenic angles on both sides are sharp."

Liu Dong was reading and writing, making a comprehensive interpretation, "Well, it's just a movie about pneumonia."

After writing the description, he wrote in the last column the tentative diagnosis he had made: "Lobar pneumonia of the right upper lung."

Lobar pneumonia is diagnosed according to anatomical classification. There are generally three categories: lobar pneumonia, lobular pneumonia, and interstitial pneumonia.

Lobar pneumonia is usually caused by infection by multiple pathogens. The lesions involve the fly tissue of more than one lung segment and are an acute inflammation dominated by diffuse fibrin exudation in the alveoli.Generally speaking, for adults, it is caused by fatigue or some bad living habits.Moreover, this disease generally has a long recovery period, so you must have certain expectations during treatment and do not stop treatment prematurely. You must also pay special attention to avoid re-induction when the resistance is weak during the recovery period after cure.

Liu Dong checked the answer again and found that there were no typos, so he put it aside. At the same time, he raised his hand to indicate to the examiner that he had finished answering the first question and could hand in the paper.

Without pausing, he continued to review the images for the second question.

"What a coincidence, I am familiar with this disease." Yes, he not only read the films many times before, but also actually managed many patients with this disease!The combination of theory and practice makes it still fresh in his memory.

He thought back to his time on a rotation in urology.At that time, he treated two patients with renal angiomyolipoma in succession, and the treatment methods were different.He also studied the films he reviewed later through the computer system.

Although the film used for the exam is not of the same person, it is very typical of the same disease. "Stay steady, don't waver, look again carefully, don't miss anything and get incomplete points!"

Liu Dong quickly looked at it again and found that he had not made a mistake in his judgment. This person did have this disease, and there were no comorbidities elsewhere, such as cysts and other common physical examination abnormalities! "There were no other imaging abnormalities."

Next, answer the question formally.While thinking about the characteristics of the disease, he wrote a description of the imaging shown in the film.

Renal angiomyolipoma is the most common benign tumor of the kidney. In the past, it was considered to be a "tumor-like malformation" composed of malformed blood vessels, smooth muscle, and fat. It is a kind of hamartoma, so it is called renal hamartoma. More.

In recent years, with new research findings, it is believed that renal angiomyolipoma originates from perivascular epithelial cells, smooth muscle is the tumor component, and fat is the metaplastic component, thus changing the understanding of this tumor.At present, this disease has been reclassified into a new type-the perivascular epithelial tumor spectrum.

In other words, the treatment of this disease has not changed, but from a pathological perspective, it is now subdivided into two types.

The first is the classic type, composed of adipose tissue, spindle and epithelioid smooth muscle cells, and thick-walled blood vessels.

The second type is the epithelioid type, which is a variation on the classic type and is characterized by epithelioid cell proliferation.

From a diagnostic perspective, the difference between the two is:

The classic type can generally be diagnosed clearly through the characteristic fat density (plain scans of computed tomography scans are low-density, which can be confirmed by measuring fat density). The imaging diagnosis and pathological diagnosis are particularly consistent.

In the epithelioid type, there is very little fat tissue in the tumor, and plain CT scan shows a soft tissue mass with equal, slightly higher or slightly lower density.Because of this structure, it is not typical in plain examination of computed tomography. It is difficult to distinguish from small renal cell carcinoma through imaging examination. It depends on pathology to achieve the final diagnosis and to formulate a follow-up plan!

Liu Dong wrote the answer seriously. The initial diagnosis was "left renal angiomyolipoma."

Medicine is a subject that requires talent, but it is also a subject where God rewards hard work.Its upper and lower limits are relatively high.At the same time, it is a subject that requires more experience, so in the process of growth, it is particularly important to be able to get opportunities in time.

Those who are promoted to deputy chief physicians in their 30s, or those who are promoted to chief doctors in their 40s, generally have a brighter future.And those who have struggled to realize the opportunity to move from intermediate professional titles to senior professional titles have become the baseline strength of the team.

After handing in the paper, Liu Dong continued to the next step - electrocardiogram recognition.Liu Dong has not yet gone to the cardiology department for internship, and his knowledge of this part is still limited to the level of classroom learning. Fortunately, the test questions are relatively basic questions, and his answers to this part should be at an above-average level.

"When I get to the cardiology department in the future, I must get this done!" He thought silently.

After completing these, when I returned to the waiting room, I found that I was not the first one. "One, two, three" "I am the fourth one to come out."

He was a little strange, he didn't think these people were so powerful.He thought silently in his heart, "Sure enough, people can't be judged by their appearance. I'll look at you with admiration after three days apart!"

After another 10 minutes, other people came out one after another.The examiner also completed the scoring very quickly, but there will be cross-quality control later, so the scores will not be announced today.

As the show ended, Liu Dong and Cai Mingming talked about their doubts about the three people. Cai Mingming burst out laughing and said, "Don't you know, sometimes people give up. I heard that they all I have already given up, but I don’t want to take the initiative to tell the counselor, so I will take advantage of the assessment and plan to automatically fail.”

"No wonder." Liu Dong sighed, everyone has their own ambitions.

(End of this chapter)