1, the most easily misdiagnosed disease by doctors.
Frequent urination and dysuria
Routine diagnosis: urinary tract infection.
Possible diseases: interstitial cystitis.
Dr. Brian Noroz, a urologist at St. Joseph's Hospital in California, said that if the typical symptoms of urinary tract infection still do not subside after a course of antibiotic treatment, you should ask a doctor for urine culture (different from urine analysis). If the urine culture is negative, the possibility of interstitial cystitis should be suspected, and its other feature is that it will not cause fever.
Chen Zhuo, director of urology, said that the manifestations of interstitial cystitis are often similar to urinary tract infections. In the early stage of the disease, there are usually infectious factors, which are easy to be misdiagnosed.
I can't breathe when I exercise.
Routine diagnosis: bronchitis.
Possible diseases: Exercise-induced asthma.
Dr Joanna Biro, a chest specialist in California, said that exercise can induce asthma. Asthma patients feel normal when they don't exercise, and once they exercise, they may have chest tightness, asthma, severe cough and/or shortness of breath. The symptoms of bronchitis are similar, but they usually occur after upper respiratory tract infection.
Jiang Guang, deputy chief physician of respiratory medicine, said that patients with exercise asthma generally have a characteristic, which often appears within 5~ 15 minutes after strenuous exercise stops. Symptoms mainly include cough, chest tightness, shortness of breath and wheezing. Pulmonary function related parameters can be found to decrease during examination, but they can be relieved by themselves within 30~60 minutes. Therefore, when patients see a doctor, they must explain their causes to the doctor in detail, which will help the doctor to distinguish them from respiratory diseases such as bronchitis.
Dizziness during exercise
Routine diagnosis: dehydration.
Possible disease: hypoglycemia.
Dr Steven masri, an American cardiologist, said that dizziness is a sign of severe dehydration. Relatively speaking, hypoglycemia is rare, but it may occur after taking hypoglycemic drugs or after a single exercise for more than 65,438+0 hours. Dr. masri suggested that if you exercise for a long time and suspect hypoglycemia, you'd better eat less light food containing healthy fats, carbohydrates and protein 30 minutes before exercise.
Chen Yan, head nurse of diabetes nursing clinic, said that hypoglycemia patients usually have dizziness, headache, palpitation, shaking hands, hunger, sweating, pallor and other symptoms, and even coma in severe cases. Some people will have the above symptoms of hypoglycemia after exercise, so prevention is very important.
Emotional changes and weight gain
Conventional diagnosis: depression.
Possible diseases: hypothyroidism (hypothyroidism).
Dr Allen christiansen, an expert on thyroid diseases, said that many diseases can lead to mood swings and weight gain. He suggested that while considering the possibility of depression, we should also consider the possibility of thyroid disease.
Zhang Yongwen, director of endocrinology department, said that hypothyroidism patients had almost no special symptoms in the early stage. However, listlessness, lethargy, memory loss, unexplained edema or weight gain may occur. Many patients will blame these problems on sub-health and delay treatment at the early stage of onset. If left untreated for a long time, the harm of hypothyroidism will further increase, such as depression, decreased heart rate, dyslipidemia, constipation, etc., and women of childbearing age may even be at risk of infertility. If you feel easily emotional, depressed and gain weight for unknown reasons, you should go to the endocrinology department in time.
Chronic headache
Conventional diagnosis: stress muscle tension.
Possible diseases: periodontitis.
Dr. Don Atkins, a dental expert in California, said that grinding teeth and dental diseases may also lead to migraine; Problems such as grinding teeth may be caused by obstructive sleep apnea. He suggested that patients can wear braces and other devices when sleeping to reduce the chances of grinding teeth and headaches. In addition, it can be judged by taking a dental film.
Zhou Junbo, director of the Department of Stomatology, said that the early symptoms of periodontitis are not obvious, and patients often only have secondary gingival bleeding or bad breath. If not treated in time, bacteria in the oral cavity are likely to harm the ear, nose, eyes and other adjacent organs through blood vessels or lymphatic vessels, causing headaches and other diseases. It is suggested that patients with unhealthy teeth and headaches pay attention to oral health.
odontia
Routine diagnosis: periodontitis.
Possible diseases: sinusitis.
Dr Atkins said that the sinuses are very close to the root tips of teeth. If it is caused by sinusitis, it will be helpful to relieve nasal congestion with nasal spray. He suggested that patients might as well breathe through one nose first, and then breathe through the other nose to determine whether the toothache is caused by sinusitis. Doctors can take X-rays and make further examinations to make a definite diagnosis.
Yang Ming, director of the Department of Otolaryngology, said that nasal cavity and oral cavity are neighbors, and the health of nasal cavity will also affect the health of oral cavity. Patients with rhinitis should pay attention to whether it is caused by nasal diseases if periodontitis is difficult to cure repeatedly.
feel numb in the hand
Conventional diagnosis: carpal tunnel syndrome.
Possible diseases: thoracic outlet syndrome.
Dr. Michael Shepard, an expert in plastic surgery at Hogg Orthopaedics Institute in California, said that thoracic outlet syndrome refers to the symptoms similar to carpal tunnel syndrome caused by the compression of subclavian artery and brachial plexus, and patients will feel numb and tingling.
Zhou Jianbin, director of the Pain Department, said that in fact, scapulohumeral periarthritis is most easily confused with thoracic outlet syndrome. At least 30% patients with shoulder pain in outpatient department will mistake themselves for scapulohumeral periarthritis, and even some inexperienced doctors will misdiagnose them. The main symptom of this kind of patients is the compression of brachial plexus. Although the pain of the affected shoulder and upper limb is aggravated when the shoulder joint is abduction and pronation, some of them are like scapulohumeral periarthritis, but the severity of the disease is more serious than scapulohumeral periarthritis. The main clinical symptoms of thoracic outlet syndrome are cold arms, easy fatigue or dull pain in shoulders, arms or hands, which are generally difficult to distinguish. Patients are advised to see a doctor in time.
Asthma and dyspnea
Conventional diagnosis: asthma.
Possible diseases: chronic obstructive pulmonary disease.
When the patient exerts force, he will have shortness of breath, dyspnea, and gradually aggravate, accompanied by chronic cough. Often misdiagnosed as asthma. The similarity between asthma and chronic obstructive pulmonary disease is dyspnea, but asthma is characterized by today and tomorrow. It is necessary to measure vital capacity.
Li Fang, director of respiratory medicine, said that many patients with early COPD have no obvious symptoms, and often miss the best opportunity for diagnosis and treatment, or even misdiagnose them. Once there are symptoms such as repeated cough and dyspnea, the condition has developed to the middle and late stage. At present, the "gold standard" of diagnosis recognized in the industry is lung function examination. But this is often not in the routine physical examination. It is suggested that housewives who have been dealing with kitchen fumes for a long time and "heavy smokers" who often smoke should have their lung function tested once a year from the age of 40, even if they have no symptoms.
Stiff shoulders and slow movements
Routine diagnosis: scapulohumeral periarthritis.
Possible diseases: Parkinson's disease.
Parkinson's disease is characterized by stiff shoulders and slow movements. 70% patients are accompanied by trembling, abnormal posture (excessive forward leaning) and slow pace. Often misdiagnosed as scapulohumeral periarthritis and primary tremor.
Zhang Lin, an attending physician in neurology, said that besides trembling hands and feet, there are some atypical manifestations that are easily overlooked and deserve our attention. Long-term low back pain is one of the early symptoms of Parkinson's disease, but it is generally easily ignored by patients. For example, some elderly patients with Parkinson's disease may suddenly suffer from physical pain. In addition to shoulder pain, there may be symptoms such as back pain, low back pain and leg pain. Therefore, patients and their families often think of other low back and leg pain diseases such as scapulohumeral periarthritis first. Therefore, if these pains are not obviously improved after treatment, it is necessary to attract the attention of the neurology clinic and further clarify the cause.
menoxenia
Conventional diagnosis: dysmenorrhea.
Possible diseases: endometriosis.
Symptoms of endometriosis include dysmenorrhea, menorrhagia or irregular menstruation. 70% patients will be misdiagnosed as irritable bowel syndrome, dysmenorrhea and even "psychological pain".
Liu Depei, director of the Department of Obstetrics and Gynecology, said that if a middle-aged person or woman has dysmenorrhea after she has no history of dysmenorrhea, it is generally considered as secondary dysmenorrhea, which is mostly caused by gynecological diseases, such as endometriosis, hysteromyoma, pelvic inflammatory disease, adnexitis and endometritis. And the characteristics of dysmenorrhea in different diseases are different. For example, dysmenorrhea induced by endometriosis is characterized by secondary and progressive aggravation. With the aggravation of local lesions, the pain is aggravated year by year.
2. Diagnosis of pelvic inflammatory disease
1. Examination of male partners
This is helpful for the diagnosis of female pelvic inflammatory disease. Men with urethral secretions can directly smear or culture gonococcus. If it is positive, it is strong evidence, especially in asymptomatic or mild patients. Or we can find more white blood cells. If all male partners of PID patients are treated, whether they have urethritis symptoms or not, it is obviously very meaningful to reduce the recurrence.
2. Pathogen culture
Specimens from the same source should be inoculated on Searle-Martin medium immediately or within 30 seconds, cultured in an incubator at 35℃ for 48 hours, and identified by glycolysis. The new relatively rapid chlamydia enzyme method replaces the traditional chlamydia detection method, and chlamydia trachomatis antigen can also be detected by mammalian cell culture, which is an enzyme-linked immunosorbent assay. The average sensitivity was 89.5% and the specificity was 98.4%. Bacteriological culture can also obtain other aerobic and anaerobic strains, which can be used as the basis for selecting antibiotics.
3, secretion smear directly
Samples can be taken from female private parts, cervical canal secretions, urethral secretions or peritoneal fluid (obtained through posterior fornix, abdominal wall or laparoscopy), smeared directly, dried, and stained with methylene blue or Gram. Anyone who sees gram-negative diplococcus in polymorphonuclear leukocytes is infected with gonorrhea. Because the detection rate of cervical gonorrhea is only 67%, the negative smear does not rule out gonorrhea, while the positive smear is very specific. The microscopic examination of Chlamydia trachomatis can use fluorescein monoclonal antibody dye, and any star-shaped flashing fluorescent spot observed under the fluorescence microscope is positive.
4. Ultrasonic examination
B-ultrasound or gray-scale ultrasound scanning is mainly used to take pictures. The accuracy of this technology in identifying lumps or abscesses formed by adhesion of fallopian tubes, ovaries and intestines is 85%. However, it is difficult to show the characteristics of mild to moderate pelvic inflammatory disease in B-ultrasound images.
5. Laparoscopy
If it is not diffuse peritonitis, the patient is generally in good condition. Patients with acute abdomen such as pelvic inflammatory disease or suspected pelvic inflammatory disease can undergo laparoscopic examination. Laparoscopic examination can not only make a definite diagnosis and differential diagnosis, but also make a preliminary judgment on the degree of pelvic inflammatory disease.
6, posterior fornix puncture
Posterior fornix puncture is one of the most commonly used and valuable diagnostic methods for gynecological acute abdomen. Through puncture, the contents of abdominal cavity or uterine rectal fossa, such as normal peritoneal fluid, blood (fresh, old, blood clots, etc. ), purulent secretion or pus, can make the diagnosis more clear, puncture objective examination and culture is more necessary.
Tips: Delayed treatment of pelvic inflammatory disease will directly affect the uterine and fallopian tube function of patients, especially those with chronic pelvic inflammatory disease. In severe cases, the fallopian tube will become stiff or blocked, which will lead to poor sperm circulation and egg transport and induce infertility. Therefore, it is very important to diagnose pelvic inflammatory disease in time.