fictionpage Chapter 34: Unraveling the Mystery!
Chapter 34: Unraveling the Mystery!
Professor Qu Lin quickly moved closer, her voice strained: "Professor Dong, don't tell me that your student set that question?"
Dong Anhua nodded slowly: "That's indeed the case!"
"When I had someone collect the question bank, Chen Zhuoan was also there, and he gave me a question as well."
"I was too embarrassed to admit that I couldn't figure out the answer, so I submitted it to the question-setting team, and I didn't expect it to be selected."
"This isn't just my problem."
This question appeared in the undergraduate clinical reasoning competition, and everyone involved has a responsibility—everyone present.
No one will escape!
What was the cause of the patient's death?
"Where did you learn that from?" Professor Qu Lin asked Chen Zhuoan.
Despite being stared at by many eyes, Chen Zhuoan remained calm.
These kinds of scenes are nothing compared to when he gave reports abroad in his previous life, where the people watching him were all national giants.
These professors can only be considered as regional giants under the national masters.
He shook his head: "Teacher, there were no original questions; I organized them myself."
Professor Deng immediately coughed: "You still dare to organize the question stem yourself?"
"What were you thinking? How dare you do that?"
Chen Zhuoan then shifted the blame to Dong Anhua: "I didn't think my teacher would put it in the exam paper."
Dong Anhua reiterated, "I provided several sets of questions as options!"
"It's not that important now."
"The scores have all been given, and the results have been finalized."
"We could break this problem down, okay? If we adapt it a bit, could we make it into the national competition?"
Dong Anhua said this rather cunningly.
Qu Lin raised an eyebrow instantly: "Isn't that cheating?"
The teaching and research units of Xiangya Hospital are qualified to set a question in the national competition.
However, they may not necessarily choose Xiangya Medical College as the exam setter.
Dong Anhua: "So it needs to be adapted according to the question."
"Furthermore, this case is really interesting. Let's hear what Xiao Chen has to say."
"If we really want to turn this into a question, we need to thoroughly understand the basic principles of this case."
As for whether or not there was cheating?
This is a difficult matter to judge.
During the competition, the questions will definitely not be the same as before; they will be new questions.
However, the question types are all similar, and there are definitely patterns to follow in terms of answering strategies and competition answer templates.
The questions were set by the teaching and research departments of Peking Union Medical College Hospital and Fudan University School of Medicine, or they may have been adapted from other original questions from our school.
Whether the organizing committee will accept your topic for the national competition depends on its quality, its interestingness, and whether it comprehensively and appropriately assesses the students' abilities.
Chen Zhuoan finally explained to everyone: "Actually, it was the magnetic field effect of the MRI that caused the patient's death."
"This has been reported in several related reports both domestically and internationally."
"In the MRI room, there have been many cases of patients being killed by oxygen tanks being suddenly sucked in and crushed, as well as suspicious deaths caused by accidental gunshot wounds."
Dong Anhua: "Everyone can guess the cause of the patient's death."
"But your question clearly states that the patient had no obvious external injury symptoms after losing vital signs."
"The patient has no history of trauma, surgery, or pre-existing medical conditions..."
"There are only a few conditions that can lead to a patient's death during an MRI scan."
"First, claustrophobia."
Second, there are metals inside and outside the body.
"If there are metals inside and outside the body, how could it not cause external trauma?"
"The patient showed no obvious signs of injury when they lost vital signs..."
Chen Zhuoan: "Master, external injuries refer to external damage to the body caused by external objects or forces, or by chemical substances..."
"There are no external injuries or surface wounds, but there could be internal injuries."
Dong Anhua is Chen Zhuoan's teacher, so he had to be the first to argue with Chen Zhuoan: "There are no metal objects in the patient's body!"
Chen Zhuoan emphasized: "The absence of metal implants in the patient's body does not mean that he does not have any metal objects."
Dong Anhua: "What do you mean?"
Chen Zhuoan: "The patient reported chronic pain in the right chest. Gastroscopy revealed a superficial ulcer with a regular, elongated opening..."
"This is a classic sharps injury, not simply a chronic gastric ulcer caused by digestive juices or the autoimmune system!"
"There are no irregularly shaped, elongated types of stomach ulcers."
Dong Anhua: "You mean, the patient swallowed something they shouldn't have?"
"But your question didn't provide a description?"
Chen Zhuoan: "What if the patient themselves are unaware of this?"
"The patient has no dementia or history of mental illness, so he certainly wouldn't intentionally swallow metal objects."
"But it's possible that they swallowed it unknowingly and without their knowledge."
"The regular ulcer openings in the stomach are clear evidence!"
Dong Anhua: "Then why didn't we see any metal?"
"It slid down the digestive tract into the intestines."
"The contents of the stomach are relatively regular. If the metal is not embedded in the stomach wall, it will not remain and will be moved into the intestines by the peristalsis of the stomach."
Chen Zhuoan continued, "In the last sentence of the article, the autopsy results showed a large amount of blood accumulation in the lower abdomen, a regular rupture in the abdominal aorta, and no signs of aortic aneurysm or dissection."
"It was because the metal fragment, under the influence of the magnetic field, flew towards the spine and severed the aorta. The metal fragment was then trapped by the vertebrae!"
Dong Anhua: "If you put it that way, who would have thought of that?"
"Some of them are deliberately trying to create trouble."
Chen Zhuoan frowned, but his voice was clear: "The patient, medical staff, and family members may not be able to detect this kind of accident, but the patient may die as a result."
"Isn't that how clinical practice is? There aren't any rigid, classic rules."
"When typical cases emerge, they will become classic materials in the eyes of teachers."
"There are many deaths with more suspicious causes than this."
"This question has quite a few traps!"
"First, there is a rupture in the abdominal aorta. The differential diagnosis is aortic dissection and aortic aneurysm."
"Second, widespread peritonitis caused by perforated gastric ulcer."
"Third, this question also tests the standard classification of gastric ulcers and the types of trauma."
Chen Zhuoan answered calmly and slowly.
In fact, there are quite a few cases of intestinal perforation caused by accidentally ingesting foreign objects.
Too many children have suffered perforations or even died from swallowing foreign objects.
The reason why Chen Zhuoan did not choose a child as a typical case, but only chose an "unintentional" case, which is to simulate the "ignorance" of a child!
They didn't even know that doing so was dangerous.
In fact, this was a case that Chen Zhuoan himself had personally experienced, but that was in his previous life.
Chen Zhuoan made some adjustments and placed it in the current version.
This patient underwent a gastroscopy, which revealed a well-defined ulcer opening. This should have suggested that the injury was likely caused by a metal or hard object.
The reason this question is difficult to answer is that the patient's direct cause of death was a ruptured abdominal aorta.
However, there was no obvious history of trauma, no underlying medical history such as aortic dissection or aneurysm, making it difficult to consider the fundamental mechanism of arterial rupture...
Professor Deng scratched his temple: "Treating patients is like solving a crime...each step is interconnected..."
"Each of a patient's physical signs may have its own specific underlying principles; it just depends on whether we doctors can match them one by one."
"That is indeed a good question."
"However, the question you provided is still too short. It would be appropriate to use it in a competition for senior-level professors or an exhibition match."
"Using it to test undergraduate students? That's still too difficult."
Chen Zhuoan glanced at Professor Deng and explained, "Teacher... I was just hanging out with my teacher for fun."
Everyone fell silent.
He looked at Dong Anhua.
Dong Anhua laughed indifferently: "This question is still of good quality. The other ones I recommended weren't selected either."
"Well, the points have already been given out..."
Professor Deng gestured, "Alright, alright, let's do a final check on everyone's scores, and then prepare to release the announcement..."
Dong Anhua then said, "Director Deng, may Zhuo An and I leave now?"
"Okay, you guys go ahead, we'll check the scores of the other people again."
"The point difference is too big; let's see if we can improve it by one or two points."