Tiếng anh trong y khoa

tài liệu bao gồm các thuật ngữ thường được dùng trong y khoa cũng như những câu giao tiếp giữa nhân viên y tế với bệnh nhân, người nhà bệnh nhân là người nước ngoài. bênh cạnh những phần giao tiếp trong quá trình làm việc tài liệu cũng cung cấp hệ thống từ vựng liên quan đến cơ thể người giúp chúng ta có thể tra cứu mọi lúc mọi nơi trong quá trình công tác. các từ vựng trong tài liệu được chia thành các mục theo kiểu cây tiến hóa giúp các bạn dể nhớ và có thể liên tưởng được những từ khác khi tình cờ bắt gặp trên báo, tạp chí hay tập san y tế của các báo chuyên nghành.

CAMBRIDGE

Taking a history 2

Examining a patient

3 Reading skills: Using a pharmacology reference , ~~ _ _ 3'

Special examinations

1 Instructing, explaining and rea~,~":,,:"~g ~ ~ ~~~~ ~ ~~~~~~~~~~~ 38

Investigations

1 Explaining and discussing 1~.~e~,~,,~g~' ~ "O ~ " ~ ' ~~~~~~~~~~~~~~~~ 50

Making a diagnosis

3 Reading skills: Reading articles 3 ~ _ ~ ~_ _ 71

Appendix 4 A broad equivalence of positions in Ult;: NHS aflll US lIusf}ilal sysh:lIIs _ 143

v

To +he student This book aims to help you communicate in English with patients and their

relatives, with medical colleagues, and with paramedical staff [t is also designed to

help you cope with medical reading 01 all kinds from case notes to journal articles

Those of you who are medical stude ts will lind this book useful in the clinical phase of your studies The authors have cooperated closely with members of the medical profession in preparing this book to ensure authenticity They have long experience in helping overseas medical personnel with their cOlllmunicative needs The book is divided into seven units The units are sequenced to match your

own dealings with a palien! You start with the English needed for consultations and continue with examinations - both general and specialist Next you study the language required to discuss investigations, diagnoses and treatment both with

the patient and with English-speaking colleagues Finally you examine the English

of treatment - medical surgical and physiotherapy

The first six units have lour sections The first section introduces new language

and provides practice activities in a medical context The second practises further language items on the same general themes and includes listening and writing practice involving medical documents The third deals with reading skills and aims

to develop the skills needed 10 understand a range of medical texts including

hospital documents textbooks reference materials and articles The final section consolidates the material covered in the first two sections in the context of a

continuing case history which provides a link from unit to unit Unit 7 has three sections on different forms of treatment and a final reading section focusing on using an online database

The lan uage activities in this book are coded according to the main skill

developed

Listening /asks 1 '-' 10

The listening passages include simulated doctor-patient interviews, a discussion among doctors a phone call from a hospital laboratory and a physiotherapist

giving instructions to a patient

The tasks are varied but all have at leasl two of lhese stages: before-listcnillg, while-iiSlenillg and after - listening 111 the before·listening stage you may be asked for

example, to predict the questions a doctor will use in an interview, or the order in whiCh the doctor will ask about systems or simply to fill in the gaps In a dialogue

While-listelling activities often involve comparing your predictions with the actual words used on the recording or taking notes from a consultation Frequently you

will be asked to complete an authentic document using information from the rf!(:ording Sometimes you are asked to concentrate on the form of the answer the

exact words used or the intonation pattern of the speaker

Aft e r-listening activities focus on using the information you have obtained from the

recording For example you may be asked to decide which department a patient should be referred to or to complete a referral letter

If you are working alone you can try this approach:

Try to do as much of Ihe activity as you can without the recording Guess the

answers when you cannot be sure This will help you to focus your listening on

any problems which remain In addition it will narrow down the possible

meanings wh n you listen

2 Listf'n 10 Ihf' ff'('orrling In rhec:k your answers and to fill in any gaps Listen 10

sections you cannot understand as often as you like

:J Turn to the Tapescrlpt and listen to the recording again with its heli->

Speakmg tasks U

The speaking tasks focus on speaking Engli h In all aspects of patient care Most 01

these tasks ask you to work with a partn r and some ask you to explain to your

teacher or group the words you would use in particular situations

The sll aklng tasks for pairs include: guided-practice activities with word or

picture cues, information-gap activities which require the eXChange of data to

complete a form or to solve a problem, opinion-gap activities where you must

Justify your ch ice of investigation or the diagnosis you make to your partner, and

role-plays: doctor-patient, doctor-relative and doctor-doctor

The guided-practice activities afe relatively Simple as most of the words you

require are provided Make slife that you and your partner have the chance to

play both l>artS If you finish the activity ahead of time try to add other examples

o your own

The gap activities re<luire as a first step careful reading or listening to acquire

Information and to understand the situation Then you are asked to exchange your

findings with your l>artner Make sure you exchange your data and Ideas orally

There Is no point in simply exchanging written answers so that your partner can

copy them down Once you have completed the exchange read the text or study

the diagram your partner has use<1 That way you can check that you have

understood your partner correctly and that your partner has given you accurate

information

For the rolc-plays your teacher may ask you first to prepare your role with

another student This gives you the chance to work out together the language to

use illld to anticipate wh t the other role-player will say so that you can respond

appropriately You wlilthen be aske<1 to play the role with a new partner If time

allows exchange roles and repeat the task so that both you and your partner have

the chance to play both parts Some of Ihe role-plays have been recorded so tha

you con compore your performance with those of native speakers The recording

is a guide and does not provide the only correct way to perform the roles

In all these activttles there will be times when you do not understand your

partller or your partner d es nol understand you Making yourself understood in

such situatio s is an important part of acquiring a language Ask your partner to

clarify or rCI)cal pOints you do not understand Repeat and rephrase if your

partner cannot understand you

If you are working alone obviously it is difficult to have meaningful s]lCaklng

practice This does 1I0t mean that you should omit these activities SllCak aloud

the parts, playing both roles where required Then compare your perlorm3nce

with the recording Stop the recording aftf'r f'aC"h phrasP,;,nn try to repeat it using

the same pronunciation and intonation as the speaker Refer to the Tapescript for

help

I

3

Reading actlvities cover: locaUug specifiC information in a case history

transferring information from a lext to a ta!)le or a medical document s ch as a form or a letter, completing the gaps In a text, Identifying relevant sections of medical articles and using an o nline database

As with listening the reading activities have at least two of these stages: before-,

while-and afrer-reading In t hebefore-reading stage you may be asked to list the main features of two similar medical problems In the wh i le -readin g stage you read two l}aSsages from textbooks to sec whether your answers are correcLln the after - reading stage you comrmre your list to deCide which are the key features for differentiating between the problems

If you are working alone, you can try this approach:

Using whatever clues are provided, the text title for example, try to anticipate what the text will contain Read a sample of the text to help you

2 Read the text to check your answers and to fill in any gaps Note how long it takes you to find all the answers or to complete the task

3 Check your answers with the Key (p 105) Where your answers differ from the Key, reread the appropriate sections of the text

Writing ta sks ~ Many of the activities whose main locus is on other skills also involve writing When you listen to the recor<Hng or re'l.d a ]>assage, yOIl may be asked to write notes Writing is an authenllc response to the listening or r("ading text

Activities which focus mainly on writing include letters of referral and a discharge summary There arc no special problems or special approach needed for those of you who are working on your own Attempt the Iask and check your answers with the Key in the normal way

Language focus

Throughout the book there are brief comments on key language items introduced

by the tasks, starting with basic questions The focus is on the language used in medical communication Grammar ])Dints without medical relevance are not included

1 Taking a history 1

CI

-,

Section 1 Asking basic questions

You will hea r an ex tr ac t fro m an intervi ew between a doctor and h is

patient As you listen, complete the Present Complaint section of the case

notes b e l ow

AGE 3.2 SEX (\'\ MARITAL STATUS (V\

OCCUPATION

PRESENT COMPLAINT

Now compare your notes with those made by the doctor These Me given

in the Key on p ID5 Explain these sections in the notes

-,

,

•

o -"

5

Note how th e doctor starts the int e rv ie w:

Other ways of starting an interview are:

- \.VI'at can I do for you?

- VVlwt seems to be the problem?

Note how th e doctor asks how long the problem has l asted

- How long have they been boll/ering you?

Another wa y of asking about this is:

- How 10l/g have you had them?

S tudy th is s h ort dialogue

D DOCTOR: Well , Mrs Black Whaf s brougltl you along loday?

PATIEN T : I've got a bad dose of flu (1) DOCTOR: How long has i t been bolllering you?

PAnENT; Two or thre e days ( 2 )

/

Practise thi s dialo gue Your partner should play th e part of t he p atient H e

or she ca n select replies from li sts ( 1 ) and (2) below Use all the ways of starting an interview and asking how l ong th e problem has lasted

(/ J

a bad dose 01 lIu terrible constipation swollen ankles

a pa in in my stomac h

(2) two or three days since Tuesday

a fort night for almost a month

Note how the doctor asks where the problem is:

- Whi ch part of yollr head is affe cted ?

Other ways of finding t h is out are ;

- Where does it hurl r

Note how the doctor asks about the type of pain:

Othe r ways o f asking this are:

- Whor s the pain like?

- What kind of pain is if?

• Hurt is a verb We use it I ike this: My fool hurK Sore is an adJeCtive We can say: My fool is sore or 11,(me () sore fool

•

u

u

Pra ctise finding out information li ke this Work in the same way as in

Task 2 Use all the methods give n in Language focus 2 in your q ues tionin g

DOCTOR: Whi c h p a rI of your I lead ( cilest , back , etc.) is aff ec t e d ?

PATIENT: .Just here

DOCTOR: Can YOll describe Ille pain ?

PATIENT: It's a dull so rt o f ac h e (I)

Note h ow th e doctor a s ks if anything relieve s th e pain of headaches:

- I s Iher e a nything llial makes them bel/er r

Simila rl y h e c an ask:

- Does all Y llling make them worse ?

Doc t ors o ften ask if anyt hing else affec ts the problem For examp l e:

- What effect does food have?

* Belter means fmpf'Ot.lCd or relieved It does not mean CUfI?ll

Work with a p a rtn e r In eac'1 of these cases , ask you r partne r wh ere the

pa in is Then as k tw o o th er appropriate q u est ion s t o help you reach a

dia gnosis Th e r e i s a diagram in th e Ke y show in g you r partn e r where to

indi ca t e i n each c ase Use all th e ways of qu esti onin g we ' have studied in

thi s sectio n For e xampl e:

DOCTOR: Where does it hurt?

PAT I EN T Righ t ac r oss here (indica ting the central c h est area )

DOCTOR: Can you describe the pain?

PAT I E N T It's lik e a hea vy weig ht pressin g on my c he st

DO CTO R : Does anything make it better?

PAT I E NT : If I stop for a bil , it goes aw ay

In this e xampl e , th e patient's sym pt oms

~

o ,

7

PATIENT: It gets worse and worse Then it g oes away

PATIENT: When I cough , it hurts most

Wo r k in pairs S tudent A should sta rt

o A: P l ay th e part of the doctor Repeal Task 4 but add two or t hr ee more

que s tions in each case to help you decide on a diag n osis For insta n ce,

i n th e examp l e whe r e the patient's sym ptoms suggest angina, yo u

co uld ask:

B,

- Does anything make it worse?

- How IOllg does the paill last?

- I s the re allytllillg else you f ee l at the same time?

Play th e part of the patients Use the r ep li es in Task 4 and the ex tra information in the Key t o help you

Section 2 Taking notes

These notes show the doctor's findings when he examine<1 Mr Hall Not e

th e exp lanations given for the abbr e vi ations used What do the ot her

ringed abbreviat ions stand for ?

Ear Nou, Throat

OCCUPATION

-l ' O/ E ) Ge.,eral Condition ohea., 1.65fV\ raJl, KS "<'l

ENT ) wo; ;-;- baf1, silks

Study this l etter from a GP to a consultan t W r ite dow n t h e quest i ons

which a doctor might ask to obtain the information ringed in the letter

ror example:

4 How long did it last?

8 What was the cause of death?

This 42-year-old ~S~O;>had a severe attack of

~ral c6est ~ €IDoithS ~WhiCh~ - t - d ;4rl - O - rru - ~ and waS~lieVed5bY resYThis has recurred several

c:Q:oronary KthrombOSi§) p hySical examination was

in view o f his age

Diagnosis: angina Thank you for seeing him

Yours sincerely,

If transpor1 reQUired please state: ~ ~

Stretcher/ Sluing case Silting case - two man lift

Sig nature

The hosp i tal co n sultant made t h ese notes o f h e r interview with

Mr Green Complete as many of the gaps as yo u can with the h elp of the

lette r on p to

T hen li sten to t he r ecording and complete the remaining gaps Use the

abbreviations yo u have s t udied In this unit

SURNAME (' ) F IRST NAMES PeI'<r

AGE (2) SEX (\'\ M A RITAL STATUS (\'\

OCCUPATION (3)

(4) <host po.io mtJ;~ to L orM Storr", wlih

S£JQ/'t o.fto.c.L< "0 ~SpAota t>o.iA letS (5) ,,)iMJ

~ rtSf, t\etS OUAJrW SiAU, 01'\ ~OA

(D '"

II

Study t hese c a se notes What questions might th e doctor have asked to

~ obtain the info rmati o n th ey co ntain ?

)

PRESENT COMPLAINT

'I Pm,.1 h~ 41< l"IIow'iAj ",It!,

Worst io ',M, "Mti ~"beAtii~o,

A lso ' I , h<j~ off ",1 - Mti ' $I"

I

I, A""' j"iC.S L _ roJi'-f,

,

b )

lloj>1.ssW L PO"' , iO~~ L~

Work in pai r s and try to r ec r e ate the c on su ltati on S i udent A sho uld s tart

U A: P l ay th e part of th e p a t ie nt s Use th e case no t es as prompts

B: Play the part of t h e doctor rind ou l what the pallent i s co mplainin g of

Do not l ook at th e case notes

Sectio n 3 R d

ea tng skills: Scanning a case history

Read th e fOllow in g c a se hi s t ory and find

about the patient as qUi"kl " and underlme this information

y as you '-.:<111

1 prevIous occup tion

2 Initial symptoms

;) initial diagnosis

<1 condition Immediately pnor to admission

5 reason for emergency admission

6 duration of increased thirst and nocturia

7 father's cause of death

8 alcohol consumption

Mr Wild goose , a r e tir e d bus driver, was unw ell and In

b ed with a co u g h a nd gene ral malaise when he cal l ed

in his general practitioner A lower respiratory Iract

in f ec ti o n was diagnosed and e r ythromycin

prescribed Two d ays lat e r , al a second home visit ,

he was found t o b e a little breat hl ess an d

co m pl ainin g thaI h e felt worse H e was advised to

drink p l enty and to contl n ue with his antibiotlc

An oth er 2 days passed ilnd th e genera l pracUtioner

r eturned t o find the patient b a r e l y r ousable and

breathless a t rest Emergency admission to hospital

was a rran ged on th e gro und s of ' seve r e ches t

inf ec tion ' O n a rrivaf in th e ward, he was u n able to

give any history but It was asce rt ained from hi s w if e

that he had b ee n co nfu se d and u na bl e t o ge t up for

th e previous 24h H e ha d b ee n in con tin e nt of urine

on a few occasions durin g th is time H e ha d been

noted t o h ave inc rea sed thi r s t and n oc tur ia for th e

previous 2 weeks

Hi s past hi s t ory inclu ded appendicectomy at age

II yea r s , ce rvi cal s pond y l osis 1 0 yea rs ago , and

hypertension for which h e had been takin g a thiazide

d iur etiC f o r 3 yea r s Hi s f ather had died a t 62 yea r s of

myoca rdial infar c t ion and his mother had had

rheumat oid a rthr itis H is wi f e k e p t ge n e rall y well but

had also had a throat i n fection the pr e viou s week Mr

WiJdgoose drank littl e alcohol and had stopped

s m ok i ng 2 yea r s pr eviolls ly

13

LI

Section 4 Case history: William Hudson

I n thi s section in each unit we will follow th e m edica l history of William Hud son In this ex tract he is visiting hi s n ew doctor for the first time As you listen , complete th e personal d etails and Present Complain t sectio n of the case notes below

SURNAME H.xIson FIRST NAMES will""", H~

OCCUPATION

PRESENT COMPLAINT

Work in pairs and try to recr eate the co n su lt ation Stude nt A sho uld s tart

U A: Play th e part of William Hud so n Use Ihe case notes to help you

B : Play the part of th e do c t or Find out what th e pat i e nt i s co mplainin g o f

Do not look at the case notes

The case of William Hud son cont inu es in U n l t 2

2 Taking a history 2

You will hear an extra ct from an Inte r view between a d oc tor and her patien t The patient is a 50-ye ar-old office work er who has complained of

feelin g tir e d , la c kin g ene rgy and not b ei ng hers e lf As you listen , indicate

appropriate column with a tick (.I) for each system

System

E N T

RS CVS

G I S GUS CNS

Psychiatric

1

1 5

o

~

c:

Note how the doctor as ks about th e sys te m s:

- Have you any lroubl e wi lli your s t omach or b o w e ls?

- Whal s yo ur appetite Me?

- Any prob l e m s with your wa t erworks?

- What abou l coughs o r wheezing or s h or t ness of breath ?

- Have you nO l iced any weakn ess o r tingling i n yo ur l mbs ?

Match e c h of th e s u spected problem s in the first c olumn with a s uitabl e

~ ques t ion from the second co lumn For example: I e

Sus pect e d probl e m

c) What sort of mood have you been in recently?

d ) Any p roblem with your waterworks?

e) Have you ever coughed up blood?

o H ave you had any shortness of breath?

Work in pairs S tudent A sho uld s tart

probl ems f o r each of the~e cases The patient has enou g h info rm at i on to

an swer at least two key qu es tions

B : Play the part of the patients You r information is given in the Key

The palient is a man i n I ,,-Ie middle age He has coughed up b lood several times in the last few weeks

2 The patient is an e l derly man He has been getting more and more cons t ipa t ed over the past few months

3 The patient is a middle-aged woman She gets pain in h er s tomach after meals

4 The patient i s a young woman She has pain when she is passing urine

5 The patient is a young man He has a frontal headache

Se l ec t from the list the fiv e dia g nose s which mat ch these cases

FEVER

f duration

In this extract you will hear a physician interviewing a patient who has

The physician suspects TB She has already asked about family history,

etc The following f orm i s part of a FUO c h ec klist First listen a n d tick ( I)

each point covered in the in t erv i ew

ACHES AND PAINS CVS URINARY

:::::::::J hllfregularity

-, sweats chest GIS

_ weakness C ioiots ' ' coryza sore throat

-, dyspnoea

:::=:J WI loss

~

bleeding? SKIN ' -' sputum

~ delirium

~

photophobia L -.J urine bruising

,

Listen again to the FUO extract from Task 5 Note that the doctor

- Hu~ yuu Just u/ly weighl?

- Ha ve you had a cough 01 all?

-Is Illere any blood in it ?

- /-lave you had any pains in yOllr ches t ?

'

Underline the important word in each of the questions above Then

listen again to see if you can hear the change on these words Check

your answers with the Key

,

" :to

Study this extract from a case history

The patient was a 59-year-old man, head of Q small e ngineering firm (I ),

who co mplained of central dIes! pain (2) which occurred on exertion (3)

and was sometimes accompanied by sweating (4) H e smoked 40 cigarettes

a day (5) The pain had first appeared three months previ ollsly (6) and was

becomin.f? jncreasin!{ly frequent (7), He had noticed some weight go;"

recently (4 kg) (8) a d also complained that his hair had become very dull

a n d lifeless He felt the cold mu c h more than he used to He denied any

palpitations ( 9 ) or ankle oedema (10)

What questions might a doctor ask a patient to obtain the information in itali cs in th e c ase his t o r y? Use th e question types s t udied in U nit 1 and this unit You may ask more than one question for each piece of

information For exa mple:

1 Vv'hat's your job?

2 What's brough t you a l ong today? Vv'hich part of your chest is affected?

When you have finIsh e d, put your qu estions in the most natural order for

a consultation

Work in pairs S tud e nt A s hould start

H A: Play the part of th e patient Base your repli es on the in formati on given

in the extract above

B: Play the part of the doc t o r Find out what th e patient is complaining of

H e r e are s o me other questions which a doctor mi ght ask a patient

comp laining of FUO Which pr o b l ems in the checklist in Task 5 do th ey refer to'! I ndicate on the f orm by writing the appropriate letter in t h e

correc t box

Example: a) Have you any pain in passing water?

URINARY Lo.l dysuria

b ) Do you su ffer from doub l e v i s i on?

c) Any shortness of breath?

d ) Does l i ght bo t her you?

e) Are your stools black?

f) Do you have a cold?

Match each of the medical term s for common sy mptoms in the firs t

col umn with a term which a patient wou ld easily understand or might u s e ,

fr o m the s eco nd column For example: lk

M e dical t e rm / Non - medi c al term

I paraesthesia a ) swelling, p u ffiness

2 productive cough b ) indigestion

3 anaesthesia c ) coughing up phlegm o r s p it

4 retros t ernal ches t pa i n d) trouble holding you r water

5 orthopn e a e) cr a m p in th e l e g m u scles w h i c h comes and goes

6 stress incon t inence f) numbness

7 dysmenorrhoea g) sleeplessness

8 dyspepsia h ) out of breath, out o f p uff, b r eathlessness

10 intermittent cla u i cat i on j) pain behind the breas t bone

II insomnia k ) pins and needles

12 dyspno e a 1 ) shortness o f b re a t h wh en you lie down

Work in pair s Student B should start

o A : Play th e part of a patient U se the information in the Key to h e lp you

B : Play the part of t h e doctor Tr y to lind out what the patient's problems

are R e m embe r your patien t w ill n ot unde r sta nd m e dical t e rm s

Remember also t o use r i s in g into n ation for Yes / No que s tions Record you r findings in the Present Coml > iaint section of the f or m below

Whe n y ou have finished , S tu den t A should c he c k the do c t or ' s notes

S tud ent B should compare his or her notes with the Key

SURNAME Wil"", FIRST NAMES Pu-v

OCCUPATION Sf'uJ"'f"- vJorlW

PRESENT COMPLAINT

•

Thi s is part of a letter of r e f e rra l from a d oc t or t o a consulla nt co n ce rnin g the s am e pati e nt Using t he notes in the K ey, co mple te this sectio n of th e lette r Use th e appropriate m ed i cal t erms

Letter o f r efe rr al (part')

Deal' Dr MacPherson, I'd be pleased t.o have your advice on the future ma.nagement of this

48 - year-old steelrope worker who gives a hiStory of ( 1)

on exertion of one yea.r's duration and a (2) cough which he has had for some years

During the las t three week s he has had t hree attacks of chest tightness and pain radia.tlng into the upper right arm The a.ttacks have come on after exertion and have lasted several minutes He has noticed a.nkle (3) increasing during the da,y and

relieved by overnight rest He also gives a month's histo ry of

( 4) of t h e right leg relieved by rest Last night he had

an attack of acute (5) chest pain lasting 15 minutes, associated with extreme restlessness and a (6) spit

He gives a hiStory of good health but had childhcod whooping cough and a wheezy bronchit.1s He smokes an average of 20 to 30 cigarettes

a day His Sister has a history of possible pulmor a.ry tuberculosis and his fathe r died of a heart attack at the age of 56

T hen co mpl ete the second part of th e l e tt e r of r eferral

SURNAME wilsOA FIRST NAMES Por"

PRESENT COMPLAINT

R.i'rost,mol eNsf' f"'iA l.sf' A!j hf' mJiOhAj f'o """- MJ R """

fu"t\OA 15 ~iA s Ac.c,o""f""'iW ~ ""H<sSAOSS Di{f sIUf"j' Coy:t , N5~ spif' 1 y 8)80£, ~'" ""ff S"""'-J""', post' "' 1 :1 ~rfle.ss ifl eMsr 1'3, paiI\ n;tJio.tv.j to R ()f(Y\J

~ Ofl e.<.trf'i0l\ ) l o.stw (YIiflS,

A lso ~/o ~ MWt5 ifl ft t tJltl\i~, ifl~ tftItI\t cJ~{Q.f'i()l\ R ",If

H

DIE

General Condition &<Yf, bamJ-WsW, ~Sf""'" MtJ

p<lipWnl ~OSiS, "'"J F~ clob.blAj '

P 84 ~' 8? ""I" SI!t1'j' ~ ~ t" ""US,

MANAGEMENT

R, fu-,<k 2.0 Mj Iv

M"'J'hI A< toti'ro.tiI ~dIZIM toti'ro.t< 15 "':j 1M

Letter of ref er r al (part 2)

~

On eXa.Ir.lnatlon, he is of (7) build with a barrel-sha.ped

chest He Is (8) with some peripheral

(11) in time a.nd force BP 140/92 sitting He has pitting

( 1 2) at the a.nkles to the level of the knee There is

(14) pressure

interspace (16) sounds were closed but faint He also

Impalpable below the popllteal arteries He was given

brea.thle ssness Morphine tartra.te/:::ycllzlne tartrate, 15 mg was given

(20),

Yours sincerely,

Work in pairs Stude nt A should s t a rt

A: Play th e part of a trai n ee doc t or As k about t h e finding s on examination

and treatment to dat e of Mr Wi l so n B: Play the part of t he doctor who has examined Mr Wilson Supply any

information on M r Wilson 's exa m ina ti on a nd tr ea t me nt using th e notes given in Tas k 13

V>

,

0"

<> ,

You will h ea r a discussion betw ee n a genera l p ra ct itioner and a

consu l ta nt Com plete the case notes below

OCCUPATION

PRESENT COMPLAINT

IMMEDIATE PAST HISTORY

c

iffl'l~ This is a transcript o f the co nversation betw een t h e two doctors Try to

complete the consu l tant 's questions Then c h eck yo ur answe r s by

listenin g to the recordin g

GP: H e llo , Jim I wond er i f you could see a pati e nt for me?

CONSULTANT: Ce rtainly, John ( 1 ) the story ?

an infrequent attend e r in the past but he came to see m e this

morning comp la ining of paiTl ill hi , right leg and i n hi s ba c k (a)

CONSU LT ANT: And (2) ( 3) this star t ?

GP : Well , it came on about six weeks ag o ( b ) a nd it's becom e

g raduall y more seve re ove r th e p as t co upl e of weeks

CONSULJANT: • (4) th e pain loc alised ?

OP: No, poorly At first he thought he'd just pulled a muscle But it's

got so bad that h e h asn't b een able to do his work properly It's

also been a€' ttin g to thp ~trlgP where the pain is wak in g him up

at night (c) , irs been so se v e r e, and he' s also n o ticed s o me

t ingling in hi s rigllt foot (d) H e's hav in g d iff i c ult y in c arrying on

w it h his wo rk (e ) He's als o los t thre e kilos ( f) and bas b ecome quite d e pr esse d

CONSULTANT: ••• • (5) h e (6) a nythin g similar

( 7 ) t h e p as t ?

Gf>: No , not exactl y, but he has suffe red from intermillent pain in his

back (g) Para ce tamol gave so me reli ef(J.1) but didn't s olve the

problem comp l etely

Look at th e information in itali cs in the tr a sc ript above What questi ons

might a doctor ask to obtain this kind of i nformati on from a pat i en t ? For example:

it came on about six w ee ks ago (b ) Question: When did you first not ice t he pain ?

Now try th e other e xa mp l es ( a ) to (h) in the same way In whi c h

d epartm e nt do you think the cons ultant works?

r

23

Section 3 Reading skills: Noting information from a textbook

T ry to comp l ete t he t ab le b e l ow which shows some of th e key f eatures of two medica l prob l ems Th e n s tu dy the t ex t boo k ext r ac t s op p osi t e t o

c h eck you r answe r s a nd t o com pl e t e t h e t able Thi s will h elp you make a

d iffe r e ntia l dia g usis between th e t wo p r o bl e m s

ANGINA PECTORIS

Angina pectoris Is the term Uli! '(! to dcscribe discomfort due to

transient myocardial Ischaemia and constitutes a clinical

syndrome rather than a disease; It may occur whcnever there is

an imbalance betw! 'efl myocardial oxygen sUJlply and demand

FACTORS INFLUENCING MYOCARDIAL OXYGEN SUPPLY AND

• Coronary vasomotor lone

Oxygenation

• Haemoglobin

• Oxygen saluration 'N.B coronary blood /low Is confined to diastole

Coronary atheronl1lls by far the mOSI common cause but

angina Is also 11 fellture of aortic valve rlll.easc hYJlCrtrophlc

cardiomyopathy and some othe.r forms of heart disease

Clinical fealures

The history Is by far the most lmportonl faClor in making the

diagllosis Stable angina is ch:lracterlsed by lelt-slded or ccntrill

chesl pain Ihat Is precipitated by exertion and promptly

relieved by rest

Most l)allents describe a srnse of oppression or tightness in

the chcst - ·like a Iland round the chest"; 'pain· may be denied

When describing angina the victim often clos! 'S a hand around

Ihe throat, puts u hand or clenched [1st on the sternum or

pLaceJ both hamis "("TOSS the lower chesl The term ·angill,f is

derived from the Greek word for l'itrangulatlun and many

patients report a 'choklng' srnsation Breathlessness is

sometimes a promincntleature

The pain may radiate to the n! 'Ck or Jaw and is oftcn

accompanied by discomfort in the arms, parlicularly the lefl

the wrists and sollletimes Ihe hands; the patient may also

describe a feeling of heaviness or uselcssness in the arms

Occasionally the pain Is epigastric or lnlerSCllpular Angina may

occur at any of these places of reference without che.~ 1

discomfort but a history of precipitation by effort and relief by

rest or sublingual Ililrale, ~hou l d still allow the condition to be

recognised

Symptom, tend to hI' worse after u meal in Ihe cold and

when walking uphill or Into a strong whld Some patlellt!> find

that the pain comes when they start walking ami that later II

does nol reI urn despite greater effort ('start-up angina") Some

exverience the Ilaln when lying flat (decubitus angina) and

some arc awakened by II (nocturnaillnglna)

AUillna may also occur capriciously as a resull of coronary

arterial spasm; occasionally this Is accomp<,nled by transient

ST elevation on the EeG (Prinzmetat"5 or variant angina)

CLINICAL SITUATIONS PRECIPITATING ANGINA

• Physical exertion

• Cold expOSllre

• tleavy meals

• Inten se emotion

• Lyingllat (decubitus angina)

• Vivid dreams (nocturnal angina)

II is useful 10 CJ.:IS~Ify lhe Iy f

; l in~~~IJ)' and ~tiolo~ically s:e ~h~=~~~ I~~ If U"" most comrllon p!ltilot. ·

the ~_ ·~61C proc o'>.'l inl·oh·lng

penC ulum Pllln or a pencanhl ~ electrocard I"lIph • nctlOfl !\lb

~iOl1 lI;ith ,~ IC changes and pcneanJillJ effu_

ul;jC tamp!)f\~ and parado

Cardinal m~mf~~tallOn~ of many fonns 0~1f; pulse ate

cardius and ""II be COf1)'(\cn:d lI!Cutc

p.'n-of the most c o m , prIOr 10 a dl.)cUSJIOII

mon OTlJb of the dl.~()(der

Ch~~, I'm>! IS an Important bu

~}"mpIOI1l m 'ariou~ form I not In'mable usually JlfCl>em in Ihe ac~t o~ ~u!e PCTlcardnis: H IS

mM of !he ~ e In « hous I}"~ and In

y otnlS pre~umed [0 be relmed 10 II' r

sen~HII'Hy or autounmunu)· P f }~

-sl I de lun IS 0 len aOl>em '" a ow}" leloping tuhen:uJou~ PINirrnd.at"

~la ~l ic Of" u~"'ic pericardili~ The I ~Ii~ olf on'.,n_:()-

tl~ 1\ Oftcn e J p·,.".!rUI_ • \~re I I~ d~":M,: ICr h!icuuy I"CITO ! I and J~rt prccOn.i!aJ rcfclred 10 Ihe b~~, '"m,'

quem .,U, ~ 11 ge ften the )Jam I~ plcurille come

° aecolnp,lnyin, pi I n

s arp and agsr~l'ated by ins

ehan~es in bod Pll"ll.tlOl1 COtIghlng and

Y pasiliOIl bul wmellmes H i~ a

~Ieady cOl1striclhc pain which rad arm or both !.ltes IIUO either

· ~ amls and rc<;o:mbJe~ Ihal of myocardial I'<C·",mm· Iht>rerure f ·

· f ' con USIon "'"h In)"OI.·lIllllaJ

III arcnun I ~ CQrnmon Ch lhe pericardial arnc'tti~ncaJJ}" ho"'-eler

J ' paID llIay be ~hel'cd hy ~mlllg up and e.3nlDg ror.oard Thc differential.un of

myn.-Mduu mf2rCtion ~ro acule

UIUln owehT !bc'<C CIll)'1I1e cle\","on ~ if the ""'"

· ~~ur arc qUlle IrxxlcSI

&IH'n thoc CXlcn~"c cleetrocanl· cllwatlon in pmcardi!i ~ IOgrnphic ST-<.egllX'nt TIle ,""mtdillllriC/if." rllb is lhe

phy~ical sign: II may h~le up ;0 th~no;:,~:'Jl'Ort3nt pcrcan llac cycle lind i~ hlgb'pilched ,p!)f\o:nls '

rat" !>CrJIC" lUg and Ing: "CIUl somelnne:~ be eliciled nol I "0

~ - n p cum nCllon rub nmy he audible dunn IIISjllrnllon wllh the: pallent Jean· , ' left I 1"_ Ing ono'ard or In Ihe

31erd ""cuhllu~ jlQSUlon The b stant and uu to IS ortcn Incon·

nSIIOI"y and a loud to·and_fro Icalhe sound lIIay disappear Wilhll, a fe'" hours ~s bl ry n'appear the follOWing d.Jy I )' 10

MOlkr;lle cJe\,at.ons oflhe MB f f

, ,., masc may OCCur and non

-25

Section 4 Case history: William Hudsor

You will hear an ex tract from a consultation with Mr Hudson The doctor has not seen him for seven years H e has just retired from the Post Office

As you listen, complete the Present Com plaint sect ion of the case notes

be l ow

SURNAME H.,.Js"" FIAST NAMES WiUiatv< H~

OCCUPATION fWI'id postM<>.Sr.r

PRESENT COMPLAINT

Here is an edi t ed version of th e consultation Com pl e te the doctor's questions Then check your answers with the r ecording and the Tapescript

for a l ong time , _ , " {l) brought you here t o da y ?

PATIENT: Well, doctor , I've been having th ese headaches and I 've lost a bit of

weight

DOCTOR: And how long _ (2) the headaches

bothering you?

PATIENT: Well , for quite a while now The wife pas sed away four months ago

I' ve been f eeli n g down since then

DOCTOR: _ ( 4 ) part of your head i s affected'!

PATIENT: Ju st her e, on the top It feels like a heavy weight pressing down o n

(5) they affected yo ur eyesight at all?

No , I wouldn't say so

No

Now , you told me yo u've lost some weight

appe t ite (9 ) like?

I' ve been off my food

(10) about your bowels ,

pr oble m s?

No , I'm quite all right

What _ (12) your waterworks?

(7) sic k ?

(8) your

( 11 )

Well , I 've been having problems getting started and I have to ge t

up t wo o r three times at night

DOCTOR: (13) th;s ( 14) on recently?

PATIE N T No, I've noticed it gradu ally over the past few mont hs

DOCTOR: , " - (15) pain when yOll , " , (16) water?

PATIENT: No

DOCTOR: , ( 17 ) you , (18) any blood <!

PATIENT: No

Note h ow the actual cons ultat ion on the recording differs slightly from

this version What differences can yOll note? This consultation continues

in Uni t 3

,

27

3

•

M

drawings which s h ow some of the movements examined Predict the orde r in which the neurologist examined her patient by numbering the drawings Drawing (e) s how s the first movement examined

Now listen to th e ext r ac t from th e n euro log ist's examination and check your predictions

gua f

N ote h ow the doctor instructs th e pa t ient what to do:

- Now I jusl wan/IO see you standing

- Could you bend down as far as you ca n?

- Keep you r knees and feet steady

I nst ru ctions , es p ec i ally to cha nge position or r e m ove clo thin g, ar e oft e n made like th is:

- Would you slip off your top things, p l ease?

- Now I would like you to lean bac k wards

The doctor of t en p r e p ares the pati e nt for th e next part of t h e

exami nati on i n thi s wa y:

- I'm jusl going 10 find out where the sore spot is

Th ese drawings show a do c tor t es tin g a p atient's r efl exes Pred i ct th e

I , 1 0 o rd e r in w h ic h t h e ref l exes were t este d by numb e rin g them

Using th e pictures i n Task :t to h e lp you, w rit e dow n what yo u would say

to a pati ent t o test t h ese r e fl exes W h en y ou have finished , co mp are you r

i nst ru ctions a nd comme nt s wi t h the re c ordin g

In struc t a patient to take up the correc t (>osition prepare him or her lor

,

o

the recording

her instructions on the n ex t page with th e help of the dr;'lwlngs

back, please? Now I'm going to take your l eft leg and see how far we

PATIENT : Yes, ju st a little Just slightly

far Now let's see wh at happens if I (3) your toes back

PATIENT: Oh, that's worse

DOCTOR:: I ' m go ing to " " (4) your knf!f' How rlOf'.<; thill fpp[?

PATlHa: That's sore

DOCTOR: I'm just going to (6) behind you r knee

PATIENT: Oh , that hurts a lot

DOC TOR : Where does it .(7)7

DOCTOR: Right Now would " you (8) over onto your tummy?

Bend your right knee H ow does I ha l (9)?

DOCTOR: Now I'm go ing to (10) your thigh off the couch

Now listen to the recording to check your answers

A doctor has been called as an emergency to see a 55-year-o ld man at home

with a history of high blood pressure who has c ollapsed with a sudden

c rushing ce ntral ches t pain radiating to the back and legs List what you

wou l d exami n e with such a patient

Listen to the extract and note down what the doctor examined

Compare yo ur list with the examinations the doctor carried out

'

.'

G)

31

2 He uses expressions such as OK , Fine, 77w{:S il

3 He uses falling intonation on these expressions

Turn back to Task 5 U sing o n l y t he d i agrams to help y ou , w r i t e down what you would say to t h e p atient when ma k ing t h i s exa m i n ation Then compare your a n swer wi t h the T apescript

Study this c h ecklist for the firs t examina t io n of a patient on attendance at

an antenatal clinic Some of t hese exa m inations are ca rr ied out as rout i ne

on subse quent visits M a rk t hem with a tick ( I) on the checklist

THE FIRST EXAMINATION

2 Weight 0 11 Blood sample tor haemoglobin 0

3 Auscultation 01 heart and lungs C 12 Blood sample for serological lest for

4 Examination of breasts and syphilis 0

nipples 0 13 Blood sample for rubella

Examination of urine D antibodies 0

5

14 Blood sam:lle for HIV antibodies

6 Examination of pelvis D

15 Examinaticn of abdomen to assess

7 Examination of legs "J size of uterus 0

8 Inspection of teeth n 16 Examinaticn of vagina and

9 Estimation of blood pressure n cervix 0

Now study these extra c t s f r o m an obstetrician's e x a mination of a pa t ie n t

attending for h e r 32-week an t enatal appointment Ma t ch each extrac t to the nu m bered examina t ions on t h e checklist Fo r example:

a Have you brought your urine sample? ~

b) Now would you like to sit up and I'll take your blood :xessure?

c) Now I'll take a sample of blood to check your haemoglobin

d) Have you noticed any swelling of your ankles? L t'.:; have a quick look e) Now if you'd like to lie down on the couch, I'll take a look at the baby I'll just

measure to see what height it is

Put the ex t racts o n th e pr ev i o u s page i n th e o r der i n w hich you wou l d

U 1 <- 10 A: P lay t he pa r t o f th e obs t e tr i cian Th e ca rd below s h ows th e fi ndin gs on

exam inat io n of a pa t i ent att e ndin g for her 3 2-w ee k app oin tm e n t Base

un de r s t an d Ask about any thi n g o n the ca rel wh ic h y ou d o n t

N II If lhe", IS My du ng on Ihl' ""rd ,,·hich you do no!

A " n : SA T A L N o und<-r:sund do I>Ol he"IaI' 10 a, l your 1>OC i Of 01" MId" if~

LM I' .1l131tll Age '"' J>n:gnaocy TCSI: U lIr~ ,o ll"d Sca n

lJale I(",ull l) "le ReD W e , Surname

ED D , •• ">I~ Parit y 0 t 0 , +IS/OJ , L <hI w u_< Fi!">l Naliles

Wh e n y ou h ave c ompl e t e d yo ur role-p l aY I com p a r e y our v e r s io n with th e

r ecor d e d c ons u ltati on

Section 3 Reading s kill s: URing a pharmacology reference

Using the prescribing information wh i ch f ollows, c hoo se the mos t appropr i ate antibiot i c for these patie n ts

penicillin

pneumonia The causative organism IS reSistant to tetracycline

4 A 4-year-old girl with septic arthritiS due to haemophilus influenzae,

traffic accident

6 A 50-year-old woman with endocarditis caused by ~trep vindans

8 An 8-yp.ar-old boy with tonsillitis due AHOl(ICILLIN

(Amc>.yciLmj

9 A 43-year-old dairyman with brucellosis

lOA 4-year-old unimmunised sibling of

Indication" soc: undoor Ampledhn; abo cndocan:Iitis

prophylu:Jl (Table 2, Sf:'COOfI 5 I); and IrQlmcrll (T_ble I, secbon 5,1); antluu (Kdion 5.1 1 2); adJunct", IlStenal !IIeIIJJliltlS (Table I, ICCtion

5_1): He/icob4C_PJ-{ori~ (KCbOrII J)

a 2-year-old boy with whooping cough

Contra-OndlQd.ons: soc: L.IOder Arnpoc:dbn

Dose: by ""-"'lJo, 250 m, every 8 hows doubled III severe mfecttons, CHtD lip 10 I 0 y~, 125 mg

every- 8 bours, doubled "'lCverc ",rcctiOfll

Pneumonia 0_5 IS r:wry Illoun

Antluu (I:'ealincnl and pI)It-('xposure pmphy

!::.sS-«e alto S«tIon S_U2), 500mg cvery 8

, :, CHlD body.Wtlaht under 20 q, 80 "'8I1ci

dady lD 1 diVIded doses body·we'3ht Ovtf 10kS

Sitotf-cotUse """I tIIenJpy

Denial ~ 3 g Iq)CaII!d after 8 baun

~.1rJoa infectioas, 31 Iq)QIlId after 10 12

OttiU mroia, OtLO 3 -10 )'eVI, 7SOma ~

<:lady for 2 days

By /Jltro"'~ i"jectiQ" 500111J every I hours·

O«D, 50 1 JOll\i"kg dIody In dlvKlod 00- '

n, mlrrlW"OI4 i'!ltctw" ", ;"/I<lk", SOIl mg cvcry 8

hours IlICreakd to II every IS hours in 5eYerc

;;;::;;O/IJ; CHtD, 50-100 mglka daily in d,vided

PHENOXYHETHYLPENICILLIN

U'eIO O;: IIbI'I V)

h>d! e atlon " tonsilln OllUS mocha , ef)'SlpdA~

,hellmatl c fcver nd pncumo«>Ccal mf«lIon

propIIyLuis (Table 2, section 5_1)

I

Caudon" ICC under B enzylpenlcllhn, I"ttr

u-dH l: Append 1 (penicilhn.) C~ncIkM>ons: see under Bcnzylpc:l1IcllI'"

Sid dr.as: sec under lknzyl p emcllhn DONI : 500 rna every I> hooun mcrea5ed up 10 I S

every 6 hours in scv= ",fOCllons; CH I LD, evcry IS houn up to 1 year1S2 _ 5 rna 1 -5 yean 125 ma, 6-

12 yean 250rna NOTE i'bc:noJ;ymclIt)Ipen>c Jl dotoI III ltN! SM' may

BENZYLPENICILLIN

,

c

M

Study these ca s e notes from Mr Hudson ' s consultation, part of whi c h y ou studied in Unit 2 , S ection 4 Try to work out the meanings of the c ir cl ed abbreviati o ns Refer to Appendix 2 for help

SURNAME HvclsoA FIRST NAMES "'liIIio.fv H~

OCCUPATION R.J-irul postMost<r

The c ase notes record the doctor's findings on exa minati on Write down

what you would say to Mr Hudson when carrying out thi s e xamination ,

Then list e n to the recording to compare your answer

You d ec id e to r e f e r Mr Hudson for further treatment The sur g eon is

Mr Fieldin g Writ e a letter to him outlin i ng Mr Hudson ' s probl e m s Use the

f o rm bel o w , When you have finished, compare your ve rs ion with th e K e y

Th e c as e o f Mr Hudson continues in Unit 4

4

-Special examinations

You w ill hear an int e rvi e w between a hospital c onsu lta nt , Mr Davidson ,

and a patient Mr Pri e s tly A s you listen , complet e the case notes and decide which department the patient has been referred to

OCCUPATION

Now listen again to complet e the d o c t or 's questions

I Can you see any l etters at _ (a) ?

2 Well, with the right eye, , (b) you see _ (e) ?

3 N ow does ,( d) make , (e) dif f eren c e?

Think ab ou t the intonation of the completed qu es tions in Task 2 Mark the

1 -> 10 word s wh ere you expect the speake r 's vo i ce to go up or down

o

Now li s t e n to t he recording to check your answers

Note how th e do c t o r s t arts the examination:

- I'd just like to

- Could you just for me?

Note how th e doctor indicates the exami na tion i s finished;

YOll want to examine a patl e nt M a tch th e examina ti ons in the fir s t colum n

with the ins tructi ons in th e secon d COIUIIJlL Til e ll IJra t :tlsl::! wIth a partn e r

and in Unit 3 Fo r exa mp le:

I-d I'd jus t li ke to examin e your t h r oat Could you please open your mou t h as wide as you can?

Examinations I nstruc tions

2 the eals b ) R e mov e your top clothing

3 the chest c ) Turn your head t his way

S the foot e ) Tilt your head back

6 t h e nasal passage f) Stand up

W h at do you think the doctor is examini n g by giving eac h o f th ese

in s t ructions?

2 B reathe in as far as you can Now ou t as far as you can

5 I want you to keep this und er you r tongue until I remove it

6 W ould you roll over on your l eft si de a nd bend your knees up? This may be a