Practicing Medical Skills in a Small Clinic-Chapter 295 - 165: Overturning Everything—It’s Beneficial to Learn More Branches of Medicine (Part 2)

Chapter 295: Chapter 165: Overturning Everything—It’s Beneficial to Learn More Branches of Medicine (Part 2)

Li Jingsheng proactively shifted the topic back to the patient.

Have to think of a way to help Director Mu tackle this highly difficult case.

"Currently Cheng Qian is in a state of unconsciousness, has become incontinent, is convulsing, and has urine the color of soy sauce. The subcutaneous hemorrhage has worsened, with a very noticeable purpura phenomenon now appearing."

Director Mu roughly described the patient’s condition.

Looking at this situation, if the cause of the illness cannot be quickly identified, it’s feared they won’t hold out much longer.

"Is it okay to go to the ward to see the patient?"

"No problem, I’ll take you there."

Director Mu personally led him to the ward to check.

Li Jingsheng went to the ward to check on the female patient, who while currently not in the ICU, had a highlighted note on her bed card.

She is a patient of focus for nurses and on-duty doctors.

Typically, medical staff will check the ward every fifteen to thirty minutes for such cases.

Although there are family members accompanying by the bedside, they don’t understand medicine, thus can’t promptly identify some potential risks.

The patient is basically in a semi-unconscious state.

Seeing Li Jingsheng standing by the bedside, her eyes showed slight changes, and her body convulsed uncontrollably.

The middle-aged woman, under fifty, accompanying by the bedside had eyes red and swollen like peaches.

Seeing her daughter, who was perfectly fine, suddenly fall ill like this, of course, parents can’t help but be anxious.

The patient still has a persistent high fever.

"Let me take a look at her joints!"

Li Jingsheng said to the family member.

The family member just stood on one side, dumbfounded, without speaking.

Li Jingsheng lifted the quilt and felt the patient’s ulna, radius, elbow joint, etc. Then he checked her leg bones.

Because the patient has a persistent high fever and the cause couldn’t be identified, he thought about trying the Bone Touching Skill.

During the bone examination, he didn’t sense anything abnormal.

But strangely, he felt the patient’s bone temperature seemed significantly higher.

Given the patient was in a feverish state, the body’s internal bone temperature rising along isn’t unusual.

However, the bone temperature Li Jingsheng felt didn’t seem to solely follow superficial increases.

Rather, it appeared the patient’s bone temperature was slightly higher than body temperature.

What illness would affect the patient’s bones?

Additionally, he noticed slight water blisters appearing on parts of the skin on the back of the patient’s calf.

They were unevenly distributed.

This seemed not to be caused by fever.

"Director Mu, I’ve completed the examination."

After the examination, Li Jingsheng habitually used disinfectant to clean his hands.

Meanwhile, his mind was still contemplating the patient’s illness.

"Let’s go discuss this in the office."

Director Mu guided Li Jingsheng back to the office.

"Tell me, why are both sepsis and neurological system infections ruled out?"

Director Mu had evidently regained composure from the earlier shock.

"The cerebrospinal fluid test results were normal, intracranial pressure was reasonably normal, cranial CT didn’t find any occupying lesions or internal hemorrhage, nor cerebral infarction, so I consider neurological damage unlikely. As for sepsis, based on previous encounters, the patient’s symptoms don’t match, and the history and characteristics are inconsistent. Solely relying on neutrophils is rather tenuous, so it can be ruled out. Now I suspect she likely has an immune system disease."

Li Jingsheng had already harbored such suspicions after initially reviewing the patient’s records.

After the ward observation, these suspicions not only persisted but intensified.

"Director Luo from neurology mentioned the possibility of tuberculosis meningitis, what do you think?"

Upon hearing Li Jingsheng suspect immune system disease, Director Mu didn’t entirely agree.

"But wasn’t the cerebrospinal fluid test normal? That disease can be ruled out immediately."

Li Jingsheng couldn’t understand why Director Mu asked this.

"I think so too. This case is truly complex. Suppose it were pulmonary or respiratory tract disease, at least I’m more experienced in those areas. Given the headache, fever, and likeness to upper respiratory infection, although upon examination, it’s evidently not a respiratory disease!"

Director Mu lamented like a child.

Faced with this case, he too was out of luck.

Symptoms similar to respiratory diseases in actuality belong to other fields.

Directly confounding him, an esteemed expert in the respiratory domain.

"Why do you think it’s an immune system disease? Explain your thoughts."

Director Mu decided to first listen to the young man’s opinion.

"My thinking is quite straightforward: common diseases can’t explain all of the patient’s symptoms, hence it’s surely a rare disease. Based on the hemolytic manifestations, I thought of a terrifying skin disease caused precisely by immune system disorders."

Li Jingsheng’s medical knowledge is solid but not encyclopedic.

At least he personally doesn’t consider himself extensively knowledgeable.

Book-loving he truly is.

Learning broadly he also genuinely does.

During rotations and departmental transfers in large hospitals, enforcing increased focus on domain-specific medical knowledge upon each transfer.

When running his clinic later, even more so.

Though most encounters are minor ailments, a wide variety, anything can be encountered.

This similarly demands extensive medical knowledge.

Director Mu was momentarily speechless.

Is this method of diagnosing permissible?

Initially, he thought Li Jingsheng would deliver grand lectures on medical dialectics.

Unexpectedly, it was just one sentence: if common diseases can’t explain it, consider rare diseases.

The words may be blunt, but the logic holds.

Diagnosis doesn’t necessarily require a formulaic, textbook analysis.

Flexible clinical reasoning sometimes employing unconventional approaches might precisely target the focus.

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