A patient has no other symptoms except for the progressive aggravation of stubborn hiccups. The first thing he suspects is the reflex reaction of the gastrointestinal tract.

Because the digestive tract is close to the bottom of the diaphragm, they sometimes appear very duller than the heart and lungs that are sensitive to the reaction. Generally, in this case, doctors will routinely use acid inhibitors for diagnostic anti-gastric acid treatment.

When the acid inhibitor treatment is ineffective, it will continue to consider that it is mentally derived. This is how the First People's Hospital judged it at the beginning. Finally, it gave lorazepam and chlorpromazine, but the effect was very little. Judging from his current chat status, he did not find any perception disorder, no mental breakdown or emotional changes.

There are neither the symptoms of organic diseases nor the symptoms of psychiatrics, but the stubborn hiccups are constantly aggravating. From the beginning, the speed is increased every half minute to less than ten seconds. Qi Jing has reason to believe that the old man is hiding his condition.

Of course, this kind of concealment may be either active or passive. He is not interested in which type it is. Qi Jing only cares about the symptom that is hidden deep.

Nowadays, no problem was found in ordinary X-ray and CT examinations, and they refused MRI. If they wanted to find the cause, they could only rely on consultation. If the consultations were not resulted, Qi Jing could only give him another set of physical examinations.

To find loopholes, you have to start with the most ordinary chat and intersperse problems in the chat.

Qi Jing suddenly mentioned something, which made Hu Dongsheng feel a little strange. However, the old man had long been used to this kind of chat these days and said with a smile: "I usually raise flowers and plants at home and let out birds."

Hu Dongsheng had already adjusted his thinking to the most keenest state, and just one sentence made him exude many doubtful branch details.

If you have flowers and plants, you need to use fertilizer repellent. Usually, you will encounter some insects. Fertilizer repellent can cause poisoning, and insects will carry many microorganisms. It is better to understand if you walk the birds. After staying by Qi Jing for so long, there is a very important one among the difficult and complicated diseases you come into contact with, zoonotic diseases.

The poisoning was really unaware of it, so his first reaction was infection.

But just as he chose the right path of thinking and was about to move forward, he suddenly stopped his legs and stepped back. He looked at his choice again and found that he was really not considering it. The old man didn't have a fever from beginning to end, and the blood report was normal, and there were no other symptoms. It didn't look like an infection no matter how he looked.

Qi Jing seemed to have thought of this a long time ago, and he didn't stop talking here, and immediately talked to the next topic: "You must have many friends, old man."

"Yes, have breakfast early in the morning, go...uh, go to the garden for a walk, play chess and chat." The old man smiled very happily, "This feeling, uh, this feeling is just comfortable."

Hu Dongsheng stood aside, repeatedly pondered the purpose of this sentence, and finally found that this was just the lubricant among the two questions.

Because Qi Jing then returned to the attitude he asked just now: "Don't you usually have colds, headaches, fever, etc."

"How is that possible? There will definitely be a cold." The old man said with a smile. "Sometimes, if you don't pay attention to keeping warm, you will not be able to do it the next day if you blow cold wind in the morning. However, the cold is not serious, so you will be fine after two days of rest."

Qi Jing seemed to have obtained a lot of information, and looked at him and nodded repeatedly, but Hu Dongsheng next to him felt lonely.

What is the relationship between a cold and hiccups? If you really care about his usual physical condition, you have to ask the gastrointestinal tract to better fit this symptom, right? Even if you really want to ask about a cold, why don’t you ask deeper, you don’t mention any of the symptoms. Just a casual word about a cold ended, and then you went to a chat mode.

Hu Dongsheng couldn't ask now, so he could only stand aside and stare blankly.

Qi Jing smiled and said, "You have so many friends around you. I think your body should be the best. If you don't have three heights, your legs and feet are flexible enough. You can take two bird cages to ride a bicycle for several kilometers to the park every day."

"Hahaha, yes, yes...uh~" The old man raised his neck and laughed.

Maybe it was because he laughed a little louder, or maybe he was opening his mouth wider, and a hiccup that was far louder than before jumped out of his throat. The old man hurriedly covered his mouth and looked around embarrassedly: "Haha, sorry."

The sudden loud noise brought a burst of laughter, followed by various jokes from people around him:

"Old Zhang is really well on everything. The hiccup is too exaggerated. Sometimes when he falls asleep, he can't help but slap it."

"I really envy Lao Zhang's body. It's not like me. I have to take a lot of medicine every day."

"Just take medicine on time, it's not as painful as you said."

"Doctor, why is Lao Zhang hiccupping constantly? Has the cause been found? Seeing him like this every day, I'm almost taken over and beaten with him."

“Hahaha~”

Qi Jing saw the patients and family members around him, and smiled and explained: "Everyone is really familiar with Lao Zhang. We are still checking, so we are almost looking up."

"Doctor, you don't have to worry so much." Lao Zhang seemed to like this feeling of being surrounded and admired. He patted his chest with his hand and said, "I don't think I'm sick, uh, I'll prescribe the medicine I used before and let me discharge it."

"The medicine is not prescribed randomly. Your situation still needs to be used by the doctor." Qi Jing smiled and refused his request.

"That's it..." This is the third time that Lao Zhang heard this answer today. He felt a little unhappy and gritted his teeth and said, "Then I will just be discharged from the hospital. I've been used to hiccups these days. Anyway, you can't find out the problem."

The more he said this, the more suspicious Qi Jing felt, the more he refused to give up easily. He continued to pinch the question in his mouth and asked:

"Oh, when ordinary people get older, they start to have problems with their parts everywhere. Some problems are not too serious, they are just a little uncomfortable. Old man, this is not the case on you?"

Lao Zhang shook his head: "No."

"Isn't there really?" Qi Jing sighed, "It's so tiring to let me guess one by one. Can you think about it carefully? Everyone will be relaxed."

"Think about it? What's there to think about?" Lao Zhang frowned, "Doctor, don't think about it, there is nothing."

Qi Jing worked all night shifts and carried several overweight elderly people in the middle of the night. He was really tired. Now he went around with an elderly patient and was really troublesome. But he couldn't give it to Hu Dongsheng for full responsibility. With the old man's current appearance, ordinary consultations are definitely useless, so he still has to do it himself.

Fortunately, I have collected a lot of information before, so it will be easier for the future.

In the past, Qi Jing would encounter patients who refused to admit their symptoms from time to time. The reasons were different, but for doctors, they were actually the same. It was just two words, so it was troublesome.

So later he learned some countermeasures, which were of some effect on such patients.

Since Lao Zhang refused to admit it himself, he changed his previous questioning model and replaced the simplest and most direct statements, forcing him to admit it.

While talking about those words, he also used his fingers to specify the area on his body to deepen the other person's impression:

"From anatomy, there are many parts of the human body, but there are only a few scattered symptoms. The most common ones are chest, lungs, stomach, lower abdomen, ribs, shoulders, neck, head, waist, back, arms, knees..."

The sudden change of rhythm made Hu Dongsheng shudder.

He had never seen such a consultation. Strictly speaking, this could not be considered a consultation at all. To put it bluntly, it was just to repeat the main parts of a person's body. This was not how the diagnosis was taught during undergraduate studies. He was still thinking about where he would go next, but he didn't expect that Qi Jing suddenly stopped the sound and immediately locked the first part: "Is it the arm?"

Lao Zhang was startled by the sudden pause and question, and sat straight there and didn't know how to answer.

Seeing this, Qi Jing nodded: "It seems to be the arm, the left hand? The right hand? The right hand. Where is the problem with the arm? Forearm? Upper arm? Elbow joint? Wrist? Fingers? Palm..."

His eyes only looked at Lao Zhang's face, and his left finger kept wandering back and forth on his entire right arm, and finally stopped at the farthest end: "Oh, is it the finger?"

Qi Jing was getting closer and closer to the target, and Lao Zhang became more and more nervous. He didn't know how the doctor saw the problem. The patients and family members around him also noticed something was wrong and kept silent, just pretending to be a show.

"Doctor, I, uh, I'm not sick, don't guess, it's as scary as if I were to examine a prisoner."

The old man couldn't help but burp again, but his tone was much weaker than before: "Just prescribe some medicine for me to go back, it's definitely okay."

He was discharged from the hospital twice in a row. With Qi Jing's temper, he would have lost patience. If he had changed to another time, he might have signed the letter to Lao Zhang. But now he was so encouraging by that symptom. Whether it was for the patient or for himself, he could not let go easily. He had to ask clearly.

All he was thinking about now was to go home and take a shower and sleep. He ignored the old man's wishes and further accelerated his speed:

"The five fingers on a hand are the thumb, index finger, middle finger, ring finger, little finger...the thumb and index finger. The symptoms on the finger are just the few, pain, swelling, numbness, stiffness, convulsions, joint acid...they are convulsions, muscle twitching."

Lao Zhang felt that his body was transparent and he was seen through.

The little secret in my heart is like a mind growing out, and I keep running out, and I can no longer hide it.

Qi Jing was already a hungry wolf with blood smell, and would never miss this short opportunity: "When did the convulsion appear? A month ago? Half a month? A week? A week!"

"How often does it happen? Once by chance? Once every three days? Once a day? Three times a day? It seems that the frequency is not low, and it has something to do with the aggravation of hiccups."

He finally picked up the last layer of window paper and breathed a sigh of relief.

"Tell Director Wang that the patient had muscle twitching with his right index finger a week ago, and the frequency increased with the aggravation of hiccups. It can be suspected that there is a positive correlation." Qi Jing looked at Hu Dongsheng and pinched his forehead, "I am tired, go back to sleep first, and you guys will come next."

......

Five minutes later, Hu Dongsheng returned to the clinic.

Ji Qing was about to get off work. Xia Wei was sitting aside and talking to Wang Ting about the situation of several seriously ill patients. After seeing him entering the door, he quickly asked with a smile: "Why, you gave up so quickly?"

Hu Dongsheng smiled bitterly: "Uh, I'm about to give up."

"I'll just say that the patient has no symptoms, and it's useless to ask." Xia Wei's expression was a little subtle, as if she had noticed Lao Zhang's indescribable hidden danger for a long time. "I guess it's just for money. Just his son, who dares to be hospitalized...what's wrong with you?"

“I’ll get the checklist.”

Hu Dongsheng did not sit down, but ran to the table, took out an x-ray from a stack of documents, and said, "Brother Qi asked us to do a cervical lateral film and look for orthopedic consultation at the same time."

"Isn't it asymptomatic?"

"Yes, there are symptoms. A week ago, the patient had muscles twitching on his right thumb and index finger." Hu Dongsheng moved his finger and said, "Now the chance of twitching is getting more and more frequent, and Brother Qi feels it is related to his hiccups."

Generally, there are not many causes of muscle twitching, which are roughly classified as calcium deficiency and excessive fatigue and cervical spine.

Lao Zhang has normal blood calcium, and fatigue is even more untold. The only thing left is the cervical spine. The stubborn hiccup reflex arc needs to pass through the spinal cord of c3c5, and finger twitching can basically be locked in the high cervical cord of c3c4.

I had a chest radiograph when I was admitted to the hospital before, but because of the mediastinum, the spine was not clearly photographed. In fact, I didn’t see any big problems after the CT.

Wang Ting took out the patient's chest CT and inserted it into the film reader. At the same time, he took out the examination report from the patient's medical record and looked at it carefully: "The CT cannot be seen, the patient's economic strength is limited, so he really has to do a lateral x-ray to eliminate it."

"Well, Brother Qi said that if you can't find the problem after taking X-rays, you can only go to MRI."

"Um."

Wang Ting also agreed with this approach, but Xia Wei, who was standing by, seemed to be stuck in the consultation and could not get through.

"etc!"

Seeing that Hu Dongsheng had already written the x-ray examination sheet and even clearly marked the range of the examination neck, Xia Wei felt a little incredible: "As soon as I was admitted to the hospital, I had a consultation on the entire hiccup reflex arc, and I specifically asked if there was any numbness and convulsions in my fingers. But the old man said he had never had it before, why did he have it now?"

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