"Okay!" the patient replied.

The old middle-aged man immediately got out of the way.

Lu Cheng recalled the physical examination at the orthopedics department. He looked at the amount of touch, inspected the external skin, and asked the patient to lift his pants. He did not see any obvious signs of muscle atrophy or pigmentation of the sinus tract or skin. If the sinus tract could be seen,

, is very helpful for diagnosing infection, but the patient’s symptoms are more serious.

Fortunately, there is none.

Next is palpation. Palpation can detect tenderness in front of the right hip joint!

Movement: limited flexion of the right hip joint, figure 4 sign (-), Thomas sign (+), straight leg raising test (-), hip impact test (-).

Quantity: No obvious signs of atrophy were found in both lower limbs.

Positive physical signs don’t give much information, but they are enough.

The patient's husband watched helplessly as Lu Cheng felt tenderness and pain in his wife several times. He waited until Lu Cheng had finished work before he dared to ask: "Doctor Lu, how are you doing?"

"Currently, I still consider the possibility of hip joint inflammation, but the inflammation must be divided into specific types. And if you look at this film, you can see signs of bone destruction."

"So, we need further examination to confirm the diagnosis. Although there is no way to determine the specific disease, the only thing that can be determined at present is that Auntie's situation is a bit troublesome, and you may need to be transferred to another department for further treatment." Although Lu Cheng was in the game system at the moment

The panel has obtained relatively accurate information, but it is still relatively conservative.

As a doctor, you have to stick to the bottom line when you should be conservative, and you can't hesitate when it's time to take action!

The information displayed on the game panel is: Hip joint bone destruction: Infectious arthritis (cold abscess): (Characteristics: Germs latent. Attack dodge) lv:???.

It seems that before a laboratory test confirms the infection, even the game system has no way to determine which type of cold bacteria infection it is.

However, Lu Cheng still considered that the possibility of tuberculosis was higher.

When the patient and his family members heard that they were going to be transferred to another department for treatment, their faces showed a slightly ugly look, but they still said very politely: "Thank you, Dr. Lu, for making arrangements. We will know what examinations and treatments should be done next."

Actively cooperate.”

"Okay, thank you for your trust. The next steps are hip puncture and culture and MRI of the hip joint! In addition, we also need to perform IGRA for further auxiliary diagnosis. I will prepare something first." Lu Cheng said

After saying a few words, he turned around and walked out with Huang Shan.

Huang Shan held the medical record to his chest at this moment, with a particularly confused look on his face, and asked: "Brother, do you think she has tuberculous hip arthritis? But the patient does not have the characteristic symptoms of night sweats and low fever?"

Low-grade fever and night sweats are the characteristic manifestations of tuberculosis and are the symptoms written in the textbooks of all tuberculosis infections.

Lu Cheng replied: "Tuberculous arthritis has no systemic manifestations before the tuberculin enters the blood. Maybe the patient has had it before, but didn't pay attention, and then the tuberculin wrapped inside the joints.

!”

"So we can't see these classic manifestations, but we can still see signs of infection from the film. There are only a few special bacteria for cold infection, so we can only guess in this direction and do a hip puncture

Then, just take the synovial fluid and culture it.”

"The current patient has a large amount of fluid accumulation inside the hip joint. I felt special pain when I just pressed it. This is because a large amount of fluid accumulated in the joint cavity and the joint capsule has not been broken open."

"Once the joint is broken, the patient's pain will suddenly be relieved. After this happens, the patient may feel better. However, in fact, symptoms such as night sweats will slowly appear after the joint is broken."

"So it is possible that tuberculous arthritis is still in a relatively early and controllable stage. If it can be diagnosed and treated early, it can be cured without surgical intervention."

"However, this treatment is not suitable for this patient, because she has already suffered bone destruction. If she does not undergo thorough surgical debridement and joint replacement, even if the tuberculosis is cured, she will still have walking pain, which is very severe.

Affects quality of life.”

"This is why I asked her to go to our orthopedics department for continued treatment."

Huang Shan opened his mouth so wide that he could stuff at least two eggs into it.

How did Lu Cheng see this? After all, the endocrinology department also deals with many orthopedic diseases, which is called orthopedics. Why didn't he seem to have many abnormal things, but Lu Cheng could see so much?

And you still talk about it in the same way?

Didn’t you say it was a classmate?

"Oh, then what we need to do now is to prescribe hip MRI, IGRA and hip puncture to collect synovial fluid culture for the patient?" Huang Shan said, but his beautiful eyebrows wrinkled slightly.

"Yeah." Lu Cheng nodded, seeming to have seen Huang Shan's difficulty, and said: "Hip puncture must be done, but the operation of hip puncture is more professional. You go and prepare a puncture bag first, and I will help

If you get a puncture, you can submit it for examination again."

"Remember to prescribe bacterial culture of synovial fluid and general endoscopy. This is very important."

Huang Shan indeed felt that joint puncture was difficult. Ordinary medical students were not required to perform a more specialized operation such as joint puncture. However, she felt that even Lu Cheng might not know what she had never learned before!

Unexpectedly, Lu Cheng took over this difficult job right away.

After hearing this, Huang Shan frowned and said with a smile, "Thank you, senior brother. I'll go check it out right away."

…

Twenty minutes later.

Lu Cheng pushed the dressing cart out of the ward, then asked Huang Shan to hand two tubes of light yellow joint fluid to the nurse station, and asked the nurse to call and send it to the laboratory immediately.

"Brother, you are simply amazing."

"It was punctured so quickly. I just searched on Lilac Garden. It is very difficult to puncture the hip joint. Some people have punctured deeply and almost hit the femoral artery." Huang Shan chirped, his face full of laughter.

Shocked.

After all, Dingxiangyuan is a relatively professional forum, and most of the people on it are doctors. So many people are talking about difficult things, and Lu Cheng can solve them in less than five minutes.

This is not as simple as being awesome.

Lu Cheng didn't think anything of it. He could get in a hip arthroscope, let alone a puncture. If an excellent sports medicine doctor changed his career to become a nurse and specialized in performing joint punctures in outpatient clinics, he would simply be able to get as many punctures as he wanted!

"It's nothing serious. Many people in the orthopedics department can do it. You should call the nurse first to send these two tubes of joint fluid. I suggest you ask for a consultation from the infectious disease department."

"Okay, thank you, senior brother!" Huang Shan said immediately, and then walked directly to the treatment room.

After Lu Cheng finished handling all the dirty things on the dressing cart, he saw Huang Shan surrounded by a group of senior sisters asking questions.

When Lu Cheng was passing by, he occasionally heard a senior sister ask him why you didn't ask him for WeChat.

Lu Cheng passed by directly and walked out of the department door. Huang Shan was just dealing with his senior sisters, so when Lu Cheng left, he didn't even have time to say thank you.

"Junior sister, do you know this handsome guy? He is many years older than you. You just came here, isn't he your senior from the previous school? And then you met him by chance after you went back?" The senior sister immediately started to have wild ideas.

stand up.

"Junior sister, how do you know this senior brother? Do you want VX?"

Huang Shan was 'forced' to keep retreating and said, "Senior sister, he is a teacher of orthopedics."

"What's wrong, teacher? The chief resident is not much older than us. Junior sister, you can't be so selfish. Junior sister, please hand over VX quickly? I'll treat you to two cups of milk tea!"

"I'll treat you to hot pot."

"I'll buy you a lipstick, junior sister. Isn't this a good deal?"

"Junior sister, you are still young, and there are still a lot of junior brothers and sisters waiting for you, but the senior sisters are not good enough. My family has been urging me to find a boyfriend for many years."

Huang Shan had embarrassment written all over her face. When her senior sisters asked her if she had VX, she didn't know whether it was out of shyness or some other mentality, but she said no.

But at this moment, the senior sisters didn't seem to admit this lie, and she was at a loss.

Just when Huang Shan was tired of dealing with the verbal bombardment from several senior sisters, suddenly, a person walked out from the office. She joked and said, "I'll answer it for you. His name is Lu Cheng.

He's from our emergency department. I have his VX here, do you want it?"

"As long as someone invites me to drink a cup of milk tea, it will be fine."

Hearing this, Huang Shan looked over and saw a girl with delicate features and a height of about 1.75 meters. She was standing there in a white coat with a very delicate face.

It makes her a little jealous, who has always been confident about her appearance.

When the other senior sisters who were acting like wolves and tigers just now heard this, they turned around to look at the speaker, and their expressions changed.

Then they quickly found excuses and said, "Senior Sister Fang, no, no, no, I still have medical records to finish. I have to go and write the medical records. We are busy!"

"I'll post the checklist!"

"I'm going to see a new patient."

Fang Nixin pouted and muttered to herself in a low voice: "You are so brave, you still want VX like others."
Chapter completed!