"Oh? Myasthenia gravis? The patient has typical symptoms of light morning and heavy evening?" Wu Mian asked lazily, lying on a bamboo chair.


    "..." Taoist Lin stopped talking.


    How can I forget that the typical characteristic of myasthenia gravis is light in the morning and heavy in the evening! It''s over now. I was caught by little martial uncle.


    Seeing that Taoist Lin didn''t speak, Wu Mian guessed something, waved and said, "is there a case? Let me have a look."


    "Little martial uncle, the medical record is here. It''s an outpatient medical record. It''s very simple." Taoist Lin handed the medical record to Wu Mian and explained, "the patient''s family said that they had difficulty swallowing, drooling and progressive aggravation one week ago."


    Wu Mian flipped through the medical record, glanced at it and handed it to Chu Zhixi.


    "That''s great, Lao Lin!" Wu Mian said with a smile. "Just a person with dysphagia and drooling, you can diagnose myasthenia gravis."


    "Little martial uncle..." Taoist Lin smiled.


    I knew it would be said by the little martial uncle, but there''s no good way. Who can''t recite diagnostics.


    "Tell me about the diagnostic criteria of myasthenia gravis." Wu Mian asked.


    Taoist Lin feels so embarrassed. It''s really troublesome to talk to little martial uncle. Always ask yourself the diagnostic criteria. How do you know.


    I haven''t finished that diagnostics yet, have I. And... I guess I can''t finish it all my life.


    "First, patients will have eyelid ptosis, blurred vision, diplopia, strabismus and inflexible eye rotation."


    "Second, the patient''s expression is indifferent, with a wry smile, a big tongue, difficulty in articulation, and often accompanied by nasal sound."


    "Third..."


    Lying on the bamboo chair, Wu Mian told Taoist Lin about myasthenia gravis. Don''t say, according to Wu Mian, Liu Yiyi can''t be diagnosed with myasthenia gravis at all.


    There is no similarity except dysphagia, drooling and weakness of limbs. But recalling Liu Yiyi''s general weakness, Taoist Lin always felt that it must be caused by myasthenia gravis.


    Is it a mistake in the diagnosis? Taoist Lin was startled by such an idea in his mind.


    "Brother, the patient''s eyelids drooped on both sides, and the eye movement was not affected; the bilateral nasolabial sulcus became shallow, the active mouth opening range was limited by about 1cm, and the facial pain and warmth existed symmetrically on both sides; the shoulder, neck, back and limb muscles were weak, so they could not turn their neck and shrug, keep sitting, lift their hands, and stand; no obvious abnormalities were found in the other specialized examinations of nervous system."


    "It looks like myasthenia gravis. Taoist Lin didn''t make a clear diagnosis, and there is reason," Chu Zhixi said.


    "Ha ha." Wu Mian smiled and looked up at Taoist Lin.


    Taoist Lin was grateful, but little Shiniang was kind enough to help him speak.


    "Neostigmine test is positive, and the diagnosis of local hospital is myasthenia gravis." Chu Zhixi said, "but I don''t think so, but how did it come?"


    "Little Shiniang, why not?" Taoist Lin dared not talk to Wu Mian, licked his face and asked Chu Zhixi.


    "Patients with myasthenia gravis have a positive neostigmine test, but a positive neostigmine test does not necessarily mean myasthenia gravis." Chu Zhixi frowned and said, "according to a neostigmine test, it is a little hasty. More examinations need to be done, but it is only an outpatient medical record. I think it should be caused by the lack of cooperation of patients and their families."


    "But the patient''s general weakness and the positive neostigmine test are the evidence," said Taoist Lin.


    "The patient had an acute onset and quickly progressed to the whole body within one week, which is not in line with the subacute or chronic onset of myasthenia gravis, an autoimmune disease," Chu Zhixi said.


    "..." Taoist Lin looked confused.


    As an undergraduate medical student, Taoist Lin still has a certain medical foundation after clinical internship and practice.


    But that was nearly 20 years ago. It''s good to remember the diagnosis of myasthenia gravis. Taoist Lin didn''t think of all the details Chu Zhixi said.


    "Secondly, patients with pharyngeal and laryngeal muscle weakness as the first symptom, and most myasthenia gravis are first affected by extraocular muscles."


    "The most important thing is what my brother said about light morning and heavy evening." Chu Zhixi continued. "The symptoms of myasthenia gravis have no significant improvement after rest, while myasthenia gravis has the characteristics of fluctuation and light morning and heavy evening."


    "None of these, only the positive diagnosis of neostigmine test, I don''t think it''s rigorous."


    "Little martial aunt, what are you thinking about?" Taoist Lin felt a little empty. If he had myasthenia gravis, it would be better to say, but little martial uncle and little martial aunt said one, two, three, four, five. This is the possibility of Guman boy''s trouble.


    With that, he couldn''t help raising his head, glanced at the stone tablet of the back mountain, and felt a little calm in his heart.


    "Lao Lin, did you hesitate to ask about the medical history but didn''t say something?" Wu Mian asked when he saw the change in Taoist Lin''s expression.


    "Er... Little martial uncle, the patient''s family members said that they had invited Guman Tong for a trip to Thailand a few months ago." Taoist Lin whispered, trying not to scare Chu Zhixi.


    "Don''t be ridiculous. They can invite Guman children? They don''t raise Guman children casually. There are many rules." Wu Mian said, "does the patient''s family think it''s all Guman children''s revenge?"


    "Well, little martial uncle, see clearly." Taoist Lin saw that Wu Mian didn''t care. Chu Zhixi also looked flat after hearing this, which gradually relieved him.


    "Little martial uncle, what''s the problem? It''s too strange. Is it getting cold?" Taoist Lin asked.


    However, as soon as this sentence was asked, Taoist Lin regretted it.


    Little martial uncle, will you ask yourself the diagnostic criteria of freezing people next? Don''t mention the diagnostic criteria. The gradually frozen person is just a common name. Taoist Lin can''t tell what the scientific name is.


    A disease such as atrophy.


    Forget it, you''d better talk less.


    But Taoist Lin guessed wrong. Wu Mian did not ask about the diagnostic criteria of gradually frozen people. He stood up and said, "Lao Lin, Taoist robe."


    "Little martial uncle, are you going to see the patient?"


    "Go and have a look." Wu Mian smiled. "Girl, you''re in the back mountain. Don''t follow."


    "I want to see it, too."


    "It''s related to Guman Tong. Stay away. It doesn''t matter if I go to have a look. If Yang is booming, don''t go." Wu Mian smiled and touched Chu Zhixi''s head.


    "Well," said Chu Zhixi helplessly, "come back and tell me how to diagnose."


    Taoist Lin didn''t want to eat dog food. He hurriedly went into the house and took his Taoist robe and helped little martial uncle put it on.


    Except that the little crew cut is a little dazzling, little martial uncle is much more handsome than himself, which Taoist Lin admires.


    This is a world of beauty fighting. Even wearing Taoist robes, you have to fight for beauty. There is no reason to talk about it.