"I don’t know what you’re talking about!"

Li Wei said, "If you’ve got the skills, pass the preliminary round first. Let’s see if you can even finish the exam paper."

With that, he ignored him, adjusted the collar of his polo shirt, and strode into Lecture Hall 2.

"I’m heading in," Jiang He said, waving to Chen Hao. "You don’t have to wait for me."

"Nah," Chen Hao said. "I’ll wait. After the exam, we’ll get Zijian and Old Wang and go for some malatang."

Jiang He agreed and walked into the exam hall.

Inside the tiered lecture hall, hundreds of people were seated.

Jiang He found his assigned seat and sat down.

The surface of the desk was pitted and uneven.

In the top-right corner, someone had scrawled "Love you for 10,000 years..." in correction fluid.

A few moments later, the proctor entered.

It was Professor Wang Xiaoqing from the School of Basic Medical Sciences, famously known for her strictness as "Master Extinction."

She stood at the lectern and announced, "Put all your bags and notes away! Turn off your phones! If I catch anyone cheating, the consequences will be severe. I don’t need to stress that point, do I?"

After her announcement, the exam papers were distributed.

The exam consisted of four pages, A3-sized and printed double-sided.

When Jiang He received his paper, he first scanned the entire exam.

The workload was immense.

There were twenty single-answer multiple-choice questions, twenty multiple-answer questions, five short-answer questions, and two extremely complex case analyses.

For a two-hour exam, it was practically Hell-level difficulty.

No wonder the third-year students were considered cannon fodder.

Just reading through the questions would probably take up more than half the allotted time.

The bell rang. The exam began!

Jiang He uncapped his pen, his gaze landing on the first question.

1. Which of the following is not a cause of hypovolemic shock?

A. Pelvic fracture B. Hepatosplenic rupture C. Severe diarrhea D. Myocardial infarction

Without even half a second of hesitation, Jiang He chose D.

Myocardial infarction causes cardiogenic shock. That was one of the most basic concepts from second-year pathophysiology.

This was a gimme question.

’It’s a classic strategy—start with a few easy questions to calm the students’ nerves...’

2. Regarding the treatment of peptic ulcers, which of the following is not part of the triple therapy for eradicating Helicobacter pylori?

Jiang He’s hand paused for a fraction of a second.

’If this were in the future, the answer would be debatable,’ he thought. ’By then, quadruple therapy would be common, with even more considerations for antibiotic resistance.’

But in 2008, a proton-pump inhibitor plus two antibiotics was the textbook gold standard.

The results of his studying over the past two days were paying off.

He quickly adjusted his mindset, blocking out newer drugs like Vonoprazan from his memory, and precisely selected the correct answer.

Jiang He blazed through the rest of the multiple-choice questions.

For him, these questions were all instant solves, with almost no exceptions.

’Signs of acute appendicitis... McBurney’s point tenderness... B it is.’

’X-ray findings for chronic bronchitis with emphysema... barrel chest... A.’

’Respiratory characteristics of diabetic ketoacidosis... breath smells like rotten apples... C.’

While the other students were still scratching their heads in frustration, Jiang He was already turning to the next page...

Having finished all the multiple-choice questions, he moved on to the major case analysis section.

This was where the scores would really diverge, the very core of the clinical skills competition.

The first case was fairly standard: a typical patient with liver cirrhosis and portal hypertension. The question asked for the diagnostic basis and a treatment plan.

Without a moment’s thought, Jiang He began to write.

He wrote down: Splenectomy and pericardial devascularization.

This was the most mainstream surgical procedure in China back in 2008.

And finally, the last question—the tiebreaker.

The question was long, taking up a full half-page of paper.

Patient: Male, 58 years old. Admitted after 3 hours of sudden, severe upper abdominal pain. History of cholelithiasis. Physical exam: Generalized abdominal tenderness, rebound tenderness, and muscle guarding, most severe in the upper abdomen. BP 80/50 mmHg, pulse 120/min. Labs: Serum amylase 500 U/L (Somogyi), WBC 20x10^9/L...

Questions: 1. What is the most likely diagnosis? 2. What is the preferred ancillary test? 3. Briefly outline the principles of treatment.

This question was a trap.

Most students, upon seeing the history of cholelithiasis, elevated serum amylase, and severe abdominal pain, would immediately jump to a diagnosis of severe acute pancreatitis.

If they wrote that, they would score zero points on this question.

Jiang He’s sharp eyes caught the abnormal blood pressure reading.

80/50 mmHg.

’The patient is in shock.’

Uncomplicated pancreatitis, unless it was a case of fulminant necrosis, would rarely cause such severe shock within three hours of onset.

Then he spotted a hidden detail in the prompt: scleral icterus.

It was a sign of obstruction.

Combined with the high fever, abdominal pain, jaundice (even if subclinical), and hypotension...

This was a classic, if incomplete, presentation of Reynolds’ pentad.

The true diagnosis had to be Acute Obstructive Suppurative Cholangitis (AOSC).

The pancreatitis was merely a secondary issue, a concurrent symptom.

A gallstone was lodged in the ampulla, causing both biliary obstruction and pancreatic fluid reflux.

If the obstruction wasn’t relieved and the patient was only treated for pancreatitis, they would certainly die.

This question was a test of decisiveness in a critical emergency.

Jiang He picked up his pen and wrote:

Diagnosis: Acute Obstructive Suppurative Cholangitis (AOSC) with septic shock; gallstone pancreatitis.

Preferred Ancillary Test: Bedside ultrasound.

Treatment Principles: Simultaneously manage shock while performing emergency biliary decompression and drainage.

Specific Plan: If vital signs permit, the preferred procedure is an emergency laparotomy for choledochotomy and decompression with T-tube drainage.

As he wrote this, Jiang He sighed internally.

’If this were a decade or so in the future, a patient like this would just be sent for an emergency ERCP with EST for stone removal. It would be a minimally invasive procedure, no open surgery required.’

But in 2008, major surgery was still the ultimate life-saving trump card.

’The technology of this era is still too primitive...’

He wrote the final word.

Jiang He glanced at the time.

7:45 PM.

Only forty minutes had passed since the exam started.

He double-checked his name and student ID number.

After confirming everything was correct, he straightened his papers, placed them face down on his desk, and stood up.

Professor Wang Xiaoqing, who was monitoring the exam, frowned and walked over quickly. "Is something wrong, student? Do you need to use the restroom?"

Jiang He shook his head and said calmly, "Professor, I’m turning in my exam."

Li Wei, sitting in the back, could only stare. "?"

He couldn’t help but look up in astonishment, his eyes fixed on Jiang He.

’Turning in his exam?’

’How long has the exam even been going on?!’

’Even the fifth-year seniors, who’ve spent a year on clinical rotations, are still writing. And you, a third-year, are done already?’

’There’s only one explanation—he gave up.’

’Those two big case studies must have been too hard. He probably couldn’t even make up an answer, so he just decided to throw in the towel.’

As Li Wei thought this, the flicker of unease he’d felt from Jiang He’s earlier confidence completely vanished.

Meanwhile, Cheng Xiyao, who was sitting by the window in the third row, also looked up in surprise.

Her eyes were filled with disbelief.

’I just got to the case studies, and Jiang He is already done?’

She didn’t think Jiang He was the type to just give up.

’Could it be... he actually finished it all? How is that possible?’