A small experience of a doctor, accumulated over a long period of time and summarized in dribs and drabs, I hope it will be helpful to you. 1. Nasal congestion and nasopharyngeal carcinoma Patient, 50 years old, visited the clinic with nasal congestion and low fever. After checking the blood picture and chest X-ray, he was given “gentamicin and virazole” as a sedative for “upper respiratory tract infection”. 2 days later, the patient complained of deafness, which was suspected to be caused by gentamicin, so he was changed to “ampicillin” as a sedative, which did not improve. The patient went to a higher level hospital about a week later and was diagnosed with “nasopharyngeal carcinoma”. 2. Trigeminal neuralgia and intracranial hemorrhage A 24-year-old patient complained of unbearable headache and tapping on the table. “Patients with cerebrovascular accident use less sugar water for rehydration.” The brain of cerebrovascular accident patients is in a state of oxygen deprivation, and after sugar water is replenished in, brain cells will increase glycolysis in a state of oxygen deprivation, causing lactic acid to accumulate …… 3. diarrhea, abdominal pain and liver cancer A young woman was seen for 2 days for abdominal pain and diarrhea, and was given rehydration and levofloxacin to fight infection. During the infusion of levofloxacin, the patient suddenly developed stiffness of the limbs and laughter, and after sedation was given, the patient would still laugh from time to time. After admission to the hospital, the patient’s family refused to pay, so he was given rehydration fluids and oral flavopiridol anti-infection every day. However, the patient still had a small amount of diarrhea from time to time and could not control his bowel movements, and had occasional episodes of laughter, abdominal pain, and rigidity of the limbs. The patient had a history of divorce, and hysteria was considered to be induced and treated until the abdominal pain and diarrhea were relieved. Later, ultrasound was performed with a small amount of peritoneal fluid and liver ultrasound was multiple substantial masses in the liver with portal vein emboli formation and AFP > 1000 ng/mL. final diagnosis was primary liver cancer, which explained all her symptoms. 4. Persistent postoperative coma 40-year-old male with giant mediastinal tumor and occasional ventricular premature preoperative ECG. Under general anesthesia, the patient was stable during the operation and the operation went smoothly, and the chest was closed in about 2 hours, waiting for the anesthesia to wake up. After 30 minutes, the patient was still unconscious, with oxygen saturation of 95% to 100%, normal blood pressure, heart rate of 120 beats/min, occasional ventricular premature, mechanical ventilation, tidal volume of 400 mL, and lid conjunctival edema. The patient was still unconscious after 1 hour, and a medical consultation was requested. “What is the blood gas? The patient was immediately ventilated with pure oxygen and was awake 15 minutes later. We should not ignore carbon dioxide retention because of mechanical ventilation and oxygen inhalation. 5. Childhood coma and nutrition A 13-year-old boy was admitted to the hospital because he had not passed stool for 3 days. After drinking 2 bottles of iced tea, he became unconscious, had petechiae all over his body, had 2 fingers of neck resistance, had routine blood WBC of about 12, had severe acid replacement blood gas, and had PH 7.29. At that time, he was considered to have rheumatism. Later, the child’s condition worsened and was transferred to the ICU for lumbar puncture, and once the blood glucose was checked, it was 38. 6. Heart disease and cancer The patient, 70 years old, had a history of rheumatic heart disease for decades and was admitted to the hospital with palpitations, shortness of breath and nausea for 2 hours. His blood pressure was measured at 120/80 mmhg, heart rate was 145 beats/min, and his body was clammy and cold, with no obvious signs and symptoms of heart failure. “The heart was the only consideration. The heart rate was 145 beats per minute. The ascites sign was positive, and non-coagulated blood was extracted by laparotomy, and blood pressure started to drop. 7. Gastroenteritis and gastric hemorrhage The patient was a female who presented to the clinic with abdominal pain and diarrhea for 3 hours. She complained that she bought a bowl of spicy cold noodles on the street at noon, which might not be very hygienic, and had abdominal pain and diarrhea twice. The patient was asked to check the blood count, but just before the entrance of the clinic, he suddenly said, “I want to vomit” and went to the bathroom. The diagnosis of “acute upper gastrointestinal hemorrhage” was made. Clinically, one should not believe too much in the causative factors told by the patient, which can easily mislead the diagnosis; observation of the patient’s secretions and excretions can help the diagnosis.