Doctor: It's reasonable to perform surgery on yourself.

Jiang Dong'er was about to fall to the ground in pain.

Xu Qiu saw this and hurried to help her.

Shi Lian also came to help, and the two of them half-carried and half-carried Jiang Dong'er to the examination bed.

Jiang Dong'er said word by word: "I can't tell where it hurts, but I feel uncomfortable all over, my legs are weak when I walk, and I can't breathe..."

After hearing this description, Xu Qiu had several diagnoses in his mind.

He reminded: "I want to do a stethoscope."

Jiang Dong'er closed her eyes: "Well, come on!"

She just wanted to lift up her shirt, but Xu Qiu held her hand.

She opened her eyes with some surprise and saw Xu Qiu pressing the stethoscope directly on her chest.

Although the friction sound through the clothes would affect the diagnosis and delay the condition, it was not a big problem for Xu Qiu.

"There is nothing wrong with the heart..."

"The lung breath sounds are also normal, with no specific manifestations..."

The presence of wet rales or wheezing in the lungs can indicate the presence of sputum, infection, etc., but Jiang Dong'er does not even have these basic abnormal manifestations, and still sounds normal.

"Although tuberculosis cannot be diagnosed by auscultation. However, more serious tuberculosis infection can generally cause lung inflammation and bronchial stenosis, which can cause two different breath sounds, but I didn't hear them in Jiang Dong'er..." Xu Qiu shook his head slightly, the probability of tuberculosis should not be high.

Of course, this was not confirmed by auscultation.

In fact, the auscultation of tuberculosis does not have many characteristics, and the same pathological breath sounds can also exist in many other lung diseases.

What made Xu Qiu make a judgment was Jiang Dong'er's performance and the pain all over his body.

This is a situation that tuberculosis will never occur.

"Lift up some clothes, not too much, just below the chest." Xu Qiu said.

Jiang Dong'er grimaced in pain, and with the help of Shi Lian, she rolled up the clothes and was lifting them below the chest.

Xu Qiu ignored the close-fitting lace edge and observed the patient's abdominal skin, blood vessels and movements, while pressing alternately.

There was no local tenderness or rebound pain...

After that, the nervous system was examined again, and no signs of meningeal irritation were found.

Hematuria and various abnormal symptoms of the urogenital system were also ruled out during the questioning.

"From this point of view, it is basically impossible to be pulmonary tuberculosis." Xu Qiu shook his head.

Many patients with extrapulmonary tuberculosis have symptoms of involvement, such as headaches and meningeal irritation of the nervous system; alternating diarrhea and local tenderness of the digestive system; local hematuria and urinary tract infection symptoms of the urogenital system, etc....

But Jiang Dong'er had none of them.

It is too unlikely to find the presence of Mycobacterium tuberculosis in a single pulmonary tuberculosis.

"Pain all over the body, pain in unknown parts and unknown causes?" Xu Qiu pondered.

He also focused on the waist, lower limbs, etc.

But there was no obvious tenderness and percussion pain in the waist, the straight leg raising test of both lower limbs was negative, and the 4-character test of the left lower limb was weakly positive.

The straight leg raising test checks for lumbar disc herniation and sciatic nerve lesions. The procedure is very simple. Let the patient lie on his back, fully straighten both lower limbs and put them together. The doctor holds the patient's ankle with one hand, holds the knee with the other hand and keeps the lower limbs fully straight, while gradually raising the affected limb...

Normal people can raise their limbs to 70 to 90 degrees. As long as it is less than this range, it means that the patient has lesions in the intervertebral disc or sciatic nerve.

But, it is obvious that Jiang Dong'er has no problem.

As for the 4-character test, it is a 4-shaped test method with two legs overlapped to observe the lesions of the sacroiliac joint.

The patient has mild sacroiliac joint pain, but weak positive results cannot mean much.

In addition, Jiang Dong'er's hip flexion and knee flexion tests are negative, and the patellar friction test and drawer test are negative...

It seems that the problem is not in the lower limbs?

After trying the upper limbs and other parts, Xu Qiu finally put his attention back to the lower limbs.

From the results of the physical examination, the patient has pain everywhere, but it does not belong to any pathological manifestation.

If you have pain everywhere, it doesn't mean you have a disease everywhere.

For example, the straight leg raising test is positive only when the pain increases with raising.

But Jiang Dong'er's condition is always painful, which cannot be counted as a straight leg raising test...

Similarly, other tests are the same, and it is impossible to draw a meaningful positive sign from Jiang Dong'er.

Finally, Xu Qiu's eyes returned to the lower limbs.

According to the patient's description, her lower limb pain is more obvious, and she can hardly walk.

At the same time, the only seemingly abnormal 4-word test on the left lower limb gave a weak positive indicator.

In this case... overwork?

Many people who have no history of trauma but are overworked in a short period of time will also experience this kind of pain. The solution is very clear, just do a femoral nerve block, or do an injection in the lateral dural space or the interpsoas major groove, which should be able to relieve it.

Or is it an obturator nerve block?

If this is the case, massage the adductor femoris, gluteus medius, gluteus minimus, etc., and then use physical therapy drugs in a targeted manner.

It could also be vascular diseases such as vasculitis.

In this case, from lung disease to pain, and then to blood vessels, the disease and symptoms span three systems, I am afraid the result will not be very good.

Judging from Xu Qiu's experience, compared with diseases of other systems such as vasculitis, Jiang Dong'er's symptoms are more like bone pain!

After thinking about it, he made a further decision:

"Take me for a pelvic radiograph and lumbar spine CT, focusing on the L4-5 intervertebral disc."

"Also, do a bronchoscopy and take a biopsy."

The former is to check the patient's sudden pain.

The latter is aimed at the mass shadow in the upper lobe of the right lung to further confirm whether it is tuberculosis or other diseases.

Ordinary sampling may not find tuberculosis lesions in the lungs, but if a bronchoscopy is performed, there is almost no error and Mycobacterium tuberculosis will definitely be detected.

If not, it can be excluded directly.

Of course, the bronchoscope will perform a supporting biopsy, and the components of the mass will not be revealed under the biopsy.

"Bronchoscopy……"

On the examination bed, Jiang Donger's face suddenly turned pale when he heard this examination.

Xu Qiu noticed something was wrong and asked, "What's wrong? Have you done this before?"

Traditional bronchoscopy involves inserting a bronchoscope through the mouth or nasal cavity, which can easily cause irritating coughing, nausea, vomiting, pain and other discomforts. Patients who have had it done once will almost always leave a psychological shadow.

But now major hospitals have popularized painless examinations. Tracheal cannulation can be done through endoscopic technology, which can even be performed under anesthesia, and the pain is almost negligible.

But Jiang Donger shook his head desperately.

She trembled and said: "I heard that people will die during bronchoscopy. There is a hospital in Hunan Province where two people who did bronchoscopy died in three months..."

——

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