PDLP Chapter 24 Fan Banban!
Chapter 24 Fan Banban!
6 month 26 day.
When Chen Zhuoan returned to his graduate student dormitory after get off work in the afternoon, he heard a loud noise.
"Senior Brother Chen, you can have opinions about me, but you can't have opinions about the questions I did?!"
"There's no way I only got 70 points!"
"Even if it's not a perfect score, it's at least in the nineties."
Chen Chunyu: "What? Only in the nineties?"
"Please think about your answer carefully. This is a clinical reasoning competition, not your final exam."
"The reference answers for grading have all been discussed and approved by a panel of experts and professors!"
Fan Fan: "I don't believe it. I read the book, and my answer is the most accurate!"
"Moreover, the questions you set this time are beyond the scope of the undergraduate textbook syllabus."
"You should be giving multiple-choice questions, not full case analyses!"
Chen Chunyu: "Let me emphasize this again, this is a clinical reasoning skills competition, not your final exam."
"The Clinical Reasoning Skills Competition has no short answer questions; it consists entirely of clinical case questions."
"You're not convinced, are you?"
"Come on, let's take a look at the original question together..."
[The patient, a 63-year-old male, was admitted to the hospital with a sudden onset of severe upper abdominal pain for 4 hours. Physical examination on admission revealed: temperature 39.6℃, blood pressure 80/50 mmHg, heart rate 120 bpm. Further examination revealed scleral icterus, generalized abdominal pain, rebound tenderness, and muscle guarding, with the upper abdomen being the most affected. He had a history of cholelithiasis. Laboratory tests showed: serum amylase 566.3 U/L (Somogyi method), white blood cell count 20.4 × 10⁹/L…]
What is the most likely diagnosis? Please list the diagnostic criteria and differential diagnoses.
What is the preferred auxiliary examination?
[Briefly describe the treatment principles.]
Chen Chunyu: "What is the diagnosis?"
Fan Fan: "Acute obstructive suppurative cholangitis (AOSC), septic shock; biliary pancreatitis."
Chen Chunyu: "Do you have biliary pancreatitis? Who told you to make this up out of thin air?"
"Cholecholangitis, intestinal obstruction, and gastrointestinal perforation can all lead to a mild to moderate increase in serum amylase levels."
"The patient's serum amylase level is far below the 'more than three times the upper limit of normal' requirement for diagnosing acute pancreatitis. Why did you write 'pancreatitis'?"
"You got the differential diagnosis and the preferred auxiliary examinations right."
"What about treatment?"
"What was your answer?" Chen Chunyu asked back, his hands behind his back.
It's common for graduate and doctoral students to be responsible for grading undergraduate competitions.
Fan Fan has a pretty good memory: "Treatment principle: While fighting shock, perform emergency biliary decompression and drainage. Specific plan: If vital signs permit, the first choice is emergency laparotomy, choledochotomy for decompression and T-tube drainage."
"What's wrong with it?"
Chen Chunyu: "How did you diagnose AOSC?"
Fan Fan: "Reynolds' Five-in-One Campaign!"
"Recite it from memory!"
Fan Fan: "Charcot's triad (abdominal pain, chills and high fever, jaundice) complicated by shock and altered mental status!"
Chen Chunyu: "Okay, then let me ask you, did the AOSC patient die from an obstruction, or how did they die?"
Fan Fan: "Septic shock, biliary liver abscess, septicemia, and multiple organ failure."
Chen Chunyu asked, "Then why didn't you write it down? You didn't write down the most crucial information?"
"Actively treat shock... You know about bile duct incision for decompression and infection control, but you didn't write that down?"
"Organ support, correction of electrolyte imbalance and acidosis, prevention of multiple organ failure, you didn't even write that."
"The summary is for you to write about these fundamental principles, not for you to write about details like in a senior professional exam. You still have to write it, right?"
"Strictly speaking, you could lose 15 points on this question, yet you still got over 90, or even a perfect score?"
Fan Fan continued to argue, "The surgery is the most crucial part; the textbook doesn't mention anti-infection treatment..."
"Did the textbook describe the patient's primary cause of death?"
"In clinical practice, should patients present with symptoms according to the textbook? If they don't, will you refuse to treat them?"
(The author specifically consulted the 7th edition of Surgery from 2008, as well as the later 8th, 9th, and 10th editions.)
Fan Fan continued to argue: "This answer key does not meet the textbook standards."
Chen Chunyu: "But it can save lives!"
Fan Fan: "The questions this time were far beyond the syllabus."
Chen Chunyu: "But it can save lives."
"Also, I didn't create the questions, and I didn't provide the answer key. I'm just responsible for grading you according to the marking criteria!"
"The facts are clear and the evidence is solid, so don't come looking for me."
Fan Fan: "Who set that question?"
Chen Chunyu: "How would I know?"
"Go ahead and report it..."
……
Chen Zhuoan returned to his seat, behaving as usual.
These are all minor incidents.
In his past life, when he was in charge of setting the questions for the senior professional title exam, a group of middle-aged men were throwing a tantrum!
But what's the point?
It's just a small matter.
Although he didn't see the exam paper, Chen Zhuoan overheard Chen Chunyu and Fan Fan's conversation and felt that Fan Banban's nickname was indeed well-deserved.
The first question was actually a free point question; it was the simplest question in the entire exam.
Later, considering that the scores of the test takers were really too bad, the grading process became more relaxed.
but?
If you don't give the crucial points, how can you expect to get points?
When Chen Zhuoan reviewed this real death case, he discovered that the patient's actual cause of death was septic shock!
The obstruction has been actively relieved, but AOSC doesn't joke around. If the infection isn't well controlled, relieving it could lead to sepsis that can kill people!
This death occurred even under the most aggressive and maximal anti-infection measures implemented in clinical practice.
If we don't fight the infection?
100% certain death, guaranteed!
Even if you puncture your gallbladder, it won't help!
Fan Fan suddenly asked again, "What was the diagnosis for the last big question?"
Chen Chunyu paused for a moment: "The last big question was all given full marks, all of them were 20 points."
Chen Zhuoan took out his water glass, sipped a few mouthfuls, and wanted to laugh.
It's probably because some of the old sly guys in the surgical department don't want to admit their lack of knowledge, so they can't come up with a reference answer.
They also refused to ask Dong Anhua, an orthopedic surgeon.
Hmm... this is very much a hierarchical hierarchy among veteran surgeons.
Finally, Fan Fan left the dormitory.
Chen Chunyu wiped the fine sweat from his forehead: "See, Xiao Chen? This is Fan Banban."
"Do you know what he asked when he went for his clinical internship last week?"
Chen Zhuoan finally turned to the side, picked up the water glass, took another sip, and gently shook his head.
"Teacher, I didn't do anything wrong. The guidelines say that the first aid for pneumothorax is puncture!"
"The textbook describes closed thoracic drainage."
"The instructions didn't mention filling the syringe with water; my procedure was the most standard!"
"My teacher was speechless when she heard this."
Chen Zhuoan also sighed: "It proves that they've read the book."
"After all, they're enthusiasts, and still young..."
Chen Chunyu was taken aback: "A fan?"
"You're more sarcastic than I am."
Chen Zhuoan then asked, "Aren't you going to the lab?"
Upon hearing Chen Zhuoan say this, Chen Chunyu's large face immediately broke into a most gratified smile, and he stopped calling him "Little Chen."
"Brother Chen...that?"
"Which orthopedic surgeon would you recommend I schedule an appointment with?"
"I think a professor can supervise a maximum of two eight-year programs, right?"
Chen Zhuoan: "It's okay. Associate Professor Zeng Tianfang is also a doctoral supervisor, although he doesn't have a regular quota for supervising doctoral students."
"We can take you on an eight-year program; you and Liu Chun can choose whichever you prefer... We won't rely on teachers to graduate."
"As long as they don't make things difficult for the process!"
Chen Chunyu's eyelids flickered, and his voice, mimicking Chen Zhuoan's somewhat old-fashioned tone, said, "We're the first cohort of students in the eight-year pilot program? They shouldn't dare to block us, right?"
"Otherwise, the school would probably have challenged them to a debate!"
Playing is playing, and making a fuss is making a fuss.
If a doctoral supervisor causes a few problems due to personal reasons during the eight-year pilot program, the university will let you know where your professorship came from!
Chen Zhuoan thought about it carefully before saying, "Then you should hurry up and go find my teacher, Professor Dong, and recommend yourselves!"
"You'll have plenty of fat to eat."
"It would be best to go now."
Chen Zhuoan didn't personally handle the project on improving tendon techniques, but he didn't mind that his two roommates had a good meal.
Although his fellow colleagues in the department are also like brothers, his roommates in the dormitory are the people Chen Zhuoan is currently most familiar with.
In his previous life, Chen Zhuoan changed mentors, and his connection with them became somewhat weaker.
After saying this, Chen Zhuoan's mind turned serious.
But we need to quickly change our mindset. For the rest of our lives, these fellow disciples will be our true fellow disciples.
The scene of "when the tree falls, the monkeys scatter" can never be repeated!
After Chen Zhuoan finished speaking, he checked the time again. It was still early, only 1 p.m., and there were still more than seven hours until 8:40 p.m.