EB English8 B8Professional BEEnslish English for Health Sciences Martin Milner MATER MATERIA: MATERIAL Fi: Medical Review Board Miguel Casas Arellano, MD Faculty of Medicine, BUAP Luis Guillermo Vazquez de Lara Cisneros, MD, PhD Faculty of Medicine, BUAP 2%) HEINLE "oS CENGAGE learning ‘Rasa Balan Kress. Sapo Spain Unk nga Urea Statese ‘a ¥4 HEINLE oF CENGAGE Leerning: English for Health Sciences ‘Martin Milner Publisher, Global ELT: Chrlstopher Wenger Director of Product Development: Anita Radu Editorial Manager: Berta de Llano Director of Product Marketing: Amy Mabley International Marketing Manager: Ian Martin Development Editor Kylie Mackin Assistant Development Editor: Josephine OBrien Editorial Assistant: Bridget MeLaughln Production Project Manager: Chrystie Hopkins ‘Associate Production Editor: Erika Hokanson Photo Researcher Alejandra Camarillo. llustrator Ignacio (Rak) Ochoa ibaa Interior Design/Composition: Miriam Gémez Alvarado, Miguel Angel Contreras Pérez Cover Design: Miriam Géme2 Alvarado, Miguel ‘Angel Contreras Pésez Cover images: © Comstock images /Alamy Photo Credits: 7, p18, 29, p31, p53, p58, p65, 267, p70: Photos.com/RF: AA: © BananaStock /Alamy All other photos: © Comstock images /Alemy Printed In the United States of America 78910 15141312 (©2006 Heinle, Cengage Learning ALL RIGHTS RESERVED. 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Locate you local afc 3; international.cengoge.com/region ‘Cengage Learning products are represented in Canada by Nelson Education Visit Heinle online a et-heinle.com Visit our corporate website at cengage.comContents Te the Teacher Unit 1 Making a diagnosis Lesson 1 So, what can | do for you Lesson 2 When did the problem begin Lesson 3 1d like to examine you Lesson 4 What's the diagnosis Lesson 5 Let me explain your diet Lesson & To put it’ more simply ‘Team Project 1 Unit 2 Working under pressure > Lesson 1 f you are not sure, ask S Lesson 2 He'll be fine, Mr Slenkovich | Lesson 3. Has he ever feinted before 16 Le { Lesson 5 We need to take a sample ‘a Lesson 8 Can | explain the procedure 4 I'd lke to ask you a few questions Team Project 2 Unit 3 Breaking bad news 3 Lesson 1 Can you describe the pain x Lesson 2 e's how you say it S Lesson 3 It’s getting you down, isn’t it Lesson 4 We need a psychiatric evaluation > Lesson 5 It might be multiple sclerasis * Lesson G I'm afraid to say that... ‘Team Project 3 15 16 18 20 22. 24 26 28 28 30 32 34 38 38 40 42.Unit 4 Calling in the Stroke Team © Lesson 1 She can harely speck Lesson 2 How many fingers can you see Lesson 3 We need to run a few more tests + Lesson 4 What mecication would you prescribe +, Lesson 5 Let's decide your rehabilitation plan Lesson 6 I'm going to teach you some exercises / Team Project 4 Unit 5 Referring a patient Lesson 1 I can’t put up with the pain ( Lesson 2 Thank you for referring the patient ,,Lesson 3 Let's examine your mouth «g Lesson 4 Follow the postoperative advice © Lesson 5 Your test results are back \\,Lesson & You are very lucky ‘Team Project 5 Unit Reviews Grammar Resource Ricture Dictionary Glossary Audio Script Seeereé 82 54 56 37 58 60 62 64 86 68 70 72 7 86 2 a7To the Teacher English for Health Sciences is especially designed for students at the intermediate level who want to use their English for international ‘communication in the fields of Health Science. Objective ‘The purpose of this book is to empower students with the language and life skills they need to reech their career goals. Students are exposed to reel life situations thet enable them to use the language in meaningful ways. The integrated skills approach develops the student's self-confidence to succeed in professional and social encounters within an English-speaking global community. Content English for Health Sciences hes been designed with a core of 30 lessons lus edttional resource sections to provide teachers end course designers with the necessary fexibiity to plan a wide variety of courses. The four sls of isening, speaking, writing, end reacng are developed throughout each unt in professional contexts. Students and practicing professionals will immediately be motivated by the opportunity to practice their Engish language stils in the following job-related situations: Diagnosing Putting a patient at ease with small talk, taking @ medical history, esking open-ended questions, presenting a cese, nd explaining metical examinations and procedures to 8 patient Treating a patient Giving advice, explaining ¢ case ta & reletive, explaining causes end treatments, giving discharge instructions, and calming people down Dealing with difficult cases Describing and identifying causes of pein, being supportive, presenting a cose inlay a8 well as medical terms, and breaking bad news Planning rehabilitation and long-term care Examining @ non-verbal patient, communicating with the next of Kin, cexpleining test results to patent end relatives, explaining the characteristics of fang-term care, and giving instructions for physical therapy Referring a patient Caling in a specialist, referring a patient to anather doctor for tests end / or treatment, and giving postoperative advice To the TeacherUsing the book ‘The five content-based units in English for Health Sciences are divided into Six two-page lessons. Each lesson is designed to present, develop, and practice & particular job-related skil, (See Content) Vocabulary The content vocabulary thet might be unfamiliar to an intermediate-level student is merked with an asterisk. The definitions of these words appear in alphabetical order, by unit, in the glossary at the back of the book. Common technical vocabulary (e.g. surface anatomy, instruments, simple Procedures) is illustrated in the picture dictionary at the back of the book. ‘These words are also recorded on the audia CD far pronunciation practice. Grammar There is no direct grammer instruction in the core lessons, However, completa grammar resource has been provided at the end of the book. The grammar ‘resource can be utized in various ways aoaording to the spaciic needs of ezch less group. It can serve as a reinforcement of the student’s grammar sls ‘and thus be used for selt-study or independent prectice, Alternatively, the ‘teacher may choose to use this material in class to present’ end practice language skils required in the productive exercises throughout the book. The language elements are ordered as they would appear in a tratitional ‘grammar syllabus, but they may be referred tain any order: Each of these topics is composed of @ grammar tox or explanation followed by contextualized examples and practice exercises. listening Many of the workplace situations described are presented and / or established through the istening contexts. Complete audio scripts and an audio CD have been provided for the student to allow for independent listening practice. Student access to audio scripts and CDs also provides mmuti-level instruction opportunities in the classreom. On-going assessment The team projects in each ofthe five units as well as the one-page unit reviews ‘at the end of the book provide ample opportunity for on-going assessment, Unit tests are provided in the Teacher's Resource Book. BEY To the TeacherUnit 1 » Lesson 1 ed So, what can!idofor you @@ EW do you agree or disagree with the following statements. Compare your answers with those of a classmate and discuss the reasons for your choice. When taking a medical history, you should.. 1 try to ask as many open-ended questions as possible. 2. ask questions ike, “And | assume you also have headaches, don't you?" == 4. take notes as you are interviewing the patient a @@ [Put these steps for taking @ patient's history into the correct order Compare your answers with those of a partner: Chief Complaint Famiy History History of Present Condition Introductory “small tlk” Meticaton Past Medical History Physical Examination Social History obooos8o0o0o @@ [i wWork in groups. Discuss the following questions. ‘1, What is the purpose of making “smal talk” at the beginning of a consultation? 2. What topics might be suitable for making “small tlk"? @@ EN Decide if the following ways of making “small talk” are good or bad. Compare your answers with those of a partner You're nat looking very wel, Mrs. Gray. a How's the new house, Mr: Roper? a ‘Are you still playing basketball, Mark? i oo How's work going, Mrs. Gomez? Are you still with the insurance company? a Have you stopped smoking yet, Mrs. Elingson? a a Qo o Oo owrite five more “small talk” questions Walk around the class and make "small talk” with the other students. [EI Gircie the best option, a or b to ask about the chief complaint. Compare your answers with those of @ partner 1. a) So, what brings you here today? 1) So, what brings you here today, Mrs. Wright? 2. 8) OK then, so, what's the problem? b) What's the problem? 3. a) OK, tell me what the problem is. ) OK, tell me everything you can about the problem, 4. al Right, shoot! ) Right, let's begin, 5. a) Well, what can we do for you? 1b) Well, what can | do for you? © Wluisten to Dn Murray and Robert, the medical intern, doing a consultation, Evaluate the first part of the consultation. Cink Studies have chown that doctors interrupt thelr patients, on average, after only 18 seconds of the 4, Smal talk intervigw. Give patients a chance to say what hey ha 2. Opening aestin iy Tia lle te br 3. Allowing patient to speak ‘your questions aten © Hiliisten to the rest of the conversation and complete Robert’s nates. Which steps $3 in taking a medical history are not covered in the consultation? PPP PP Pe Patient Mark Thurston Age: 13 (Chief complaint: (1) __ Excessive thirst a History of present condition —— ‘onset and timing: @) __ Two or three weeks ago, after meals/eatingLesson 2 When did the problem begin pool [EB Match the questions with ‘the steps for taking a Patient's history. Questions a. _3e__ Have you had similar problems before? 4, Introductory “small talk” b. ___ When did the probiem begin? 2. Chief Complaint ©. Are you having any other pain or problems? 3, History of present: condition d. Are you taking any medication? al onset and timing & ___ Are you a smoker? 5) other symptoms f. __ So, hove cen we help you today? ©) previous occurrence 9. _ Has snyone in your family had a similar problem? h, ____ Are you allergic to any medication? 4, Past Metical History i. ___ Have you ever had any other medical problems? 5. Family History i. ____ Do you have job that involves a ot of exercise? 6. Medication k, ___ How's the rest of the femily? 7. Social History Rewrite the following leading questions so they are more open-ended, 1. |megine the pain stops you from working, doesnt it? =n Does the pain interfere with your daily life? ‘As : a —— wold leading: quastins 2, And suppose you get terible back pains as well ome — Tan mana an ger nes De ee 3. | da’t suppose you get indigestion after you eat bread, do you? che riagts eleraaieedy eee wants to bear. Always try to 4. Tepect you don’t know much about oalee disease do you? ask opm-ended questions £0 ‘that the patient expresses the 5. [presume you have @ healthy belenced dit rob in thelr own wards Avaid words lke: assume, 8. So, assume you get stebbing® pains in your chest after exercise, dant you? bebe ea ed Cghseeie 7. Fim sure you've been losing weight as well. Unit 1Write the doctor's questions in the dialogue. Then practice the interview with a partner Doctor: (1) _ So. how cam I help Patient: | have 2 really bad earache. Doctor: (2) Patient: No, itis only in my left ear ah It started about tivo weeks ago. @ No, some days it's not so bad. 6 Yes, sometimes | get headaches as well @ Case1 Name: Charmine Plantz Occupation: Sales manager Age: 31 | Medication: None Chief Complaint: Painless lump* on the front of the neck for one month Other symptoms: Losing weight, always hungry, rapid heartbeat, hot flushes," diarrhea XG Case 3 Name: Bob Smithson Occupation: Construction worker Age: 50 Chief Complaint: Attacks of dizziness* with nausea and vomiting. During attack, high pulse rate and rapid breathing. No pattern to attacks Other symptoms: Hissing* in ears (en both sides), loss of hearing J No, | have never hed an earache like this before, Role-play taking medical histories of the following cases. Case 2 Name: Selina Burton Occupation: Typist Age: 37 Chief Complaint: Tingling* of first | | three fingers and thumb that gets worse at night Other symptoms: Weakness of fingers (has difficulty buttoning clothes), sometimes pain in wn) Case 4 Name: Chuck Talavera Occupation: Farmer Age: 38 Chief Complaint: Cough with bad tasting phlegm” Other symptoms: Low fever, night sweats,” weight loss Social History: Long-term smoker Lesson 2 oHI'd like to examine you EE] Add more words or expressions to the charts. Lam just going 10 take sour temperature. Could you stand up, please? Would you | stand up, stand here, lie down, sit up, | please? | | lam Gust) going to your temperature, Could you | breathe i, breathe out, take off your ''d Gust) ike to | weigh you. 'Fyou could | shirt, relax, roll up your shirt sleve, take some blood for {goto the bathroom and fil this ar, testing, Listen to the conversation and fill in Robert's notes & fs or er Se ep pp e@ddddd dad ad aa aa aa gaudeda talDr Murray is talking to Robert about Mark's case. Fill in the blanks in their dialogue using words from the box. right be a family (3) lend, | would make an initial (5) Dr, Murray: So, Robert, let's run through the case. Can you summarize it for me? Robert: OK. We have a thirteen-year-old male (1) polyuria *, especially after meals, He also (2) of excessive thinst with thet he feels lethargic. There of diabetes melitus. The patient has @ Body Mass Index of 17.5, which indicates that he is underweight. On examination, pulse, temperature, blood pressure, and respiration rate were normal. There was an (4) of the thyroid iabetes Mellitus. of Type 1 Dr. Murray: Very good. | would agree with you. Sa what lab tests would you run? Robert: | think we need ¢ urine glucose test and fasting* (6) In addition, | thnk we ought to do a (7) ajucose test. function test, end a urine ketone test. We could also do an oral glucose tolerance test. @o@ EH Work in groups. Present summaries of the following cases using medical language. Case1 Name: Charmine Plantz Age: 31 | ‘Occupation: Sales Manager ‘Chief Complaint: Lump* on front of neck for one month | Other symptoms: Palpitations. Heat intolerance. Nervousness. Insomnia. Breathlessness.” Increased bowel movements. Light menstrual periods. | Physical examination: Enlarged thyroid, | Tachycardia." Slight hypertension. Warm, | moist, smooth skin, Exophthalmus.* | ‘Tremor. Weight loss. Muscle weakness. Case 2 Name: Selina Burton Age:37 | Occupation: Typist Chief Complaint: Tingling of first three fingers and thumb that gets worse at night Other symptoms: Weakness of fingers (has aifficulty buttoning clothes). Sometimes pain in forearm. 1 Physical examination: Muscle wasting” at base of thumb. Unable to distinguish hot from cold. Hair loss. Case 3 Case 4 Name: Bob Smithson Age: 50 Name: Chuck Talavera Age: 38 Occupation: Construction worker ‘Occupation: Farmer Chief Complaint: Attacks of dizziness with Chief Complaint: Low subjective fever, nausea and vomiting. During attack, high pulse rate and rapid breathing. No pattern to attacks. Other symptoms: Hissing or ringing’ in ears (on both sides), loss of hearing Physical examination: Vital signs* normal. Nystagmus." Positive Romberg test.” cough with bad tasting phlegm, night sweats,” and weight loss getting worse cover the last four months Social History: Long-term smoker Physical examination: Temperature of 38°C, gingival disease, dullness” to percussion and absent breath sounds in lower right lobe" of lung. Clubbing’ of fingers. Lesson 3a Qo QO o a a o What’s the diagnosis = Fasting Blood Glucose Level: 142 mg/dl (Normal range 70-110 mgd!) Glucose Tolerance Test (75gm) 210 mgidl after 2 hours (Normal range less than 140 mg/d) Glucosuriat Postive Thyroid Function ‘Serum Thytoxin of 12 mgldl_ (Normal Range 7-12 mgidl) ll in the blanks in the sentences below using words from the box. Then number the sentences to make @ conversation. Rokert: It loots likes we were correct with our preliminary (1) of diabetes. Robert: That sounds good to me. Naw, where do we begin with the (2) of the diabetes? Dr, Murray: That's right, But what do you think about the thyroid result? Dr. Murray: Well, | think the first (3) is to get the diabetes under control and then we can monitor the thyroid Dr Murray: Hi, Robert. Have you seen Mark Thurston's lab test (4) ? What do you think? De. Murray: Wel, the first step isto dravy up 2 (5) treatment plan. Robert: Well it's just within the (6) ___-but think we ought to do a more comprehensive thyroid review. Below are the elements of Mark's treatment plan. Classify them as either immediate actions (1), ongoing actions (0), or both (B). 1. Train patient to monitor blood suger levels Heve annual eye check . Monitor thyroid function Visit nutritionist Visit podiatrist* ‘Train petient to give insulin injections Instruct patient, satient's family, and school staff to recognize and treat hypoglyoemia® ‘Arrange psychclagical counseling (if necessary) Heve annual dental cheok 410. Run hemoglobin A1G test®Before you listen to Dr. Murray explaining the diagnosis of diabetes, think of three questions that Mrs. Thurston and Mark might ask the doctor. How do you think Dr. Murray will answer? ons from Mrs. 1 and Mark ‘Mark: Wil stl be able to pley basketbel? Pepe Yes, of course. | 30) 15 opens @@ B Role-play the following situations. 1. Student A: Robert Student B: Mark Task: Robert has to explain to Mark how to recognize and treat mild hypoglycemia in simple, non-medical language. Signs and symptoms of mild hypoglycemia Anxiety, tremors, hyperhidrosis* polyphagia’, nausea, tachycardia, ‘mental contusion or difficulty concentrating, vertigo", headache. ‘Treatment As soon as the symptoms have been recognized, it is essential to raise blood sugar level. This can be done by ingesting 15 to 20 grams of ‘carbohydrate. This is equivalent to 6 ‘ounces of cola, or 4 glucose tablets, It will take about 10 to 15 minutes for the blood sugar level to rise to normal. \ El Listen and write down five points that Or Murray told Mark and his mother 2. ‘Student A: Mrs. Thurston ‘Student B: Robert Task: Robert has to explain to Mrs. Thurston how to recognize and treat severe hypoglycemia in simple, non- medical language. Signs and symptoms of severe hypoglycemia Dysarthria’, disorientation, confusion and | irrational behavior, loss of consciousness, | seizures.” Treatment Severe hypoglycemia is potentially life-threatening and treatment should be immediate. Treatment for the unconscious patient is an intramuscular injection of glucagon. Patients whose blood glucose is not well controlled are advised to carry an injection kit that contains glucagon. If there is no response to treatment, then | emergency personnel should be alerted. Lesson 4Let me explain your diet [Ey Read the text and answer the questions below. AD vinic 3 2 = o 6 Refined Sugar in the Diabetic Diet Before insulin was discovered in the 1930s, it was possible to treat Diabetes Mellitus Type 1 by strict ‘controlling carbohydrates inthe diet. Refined* sugar ‘was prohibited because it was thought that it raised blood glucose level to dangerous levels. However, in 1994, a committee for the American Diabetes Association, or ADA, published a paper that {indicated that there was litle experimental evidence ‘to support this position. They pointed out that sugars «form of carbohydrate and all carbohydrates contain approximately the same amount of energy. So, if a patient eats 100 grams of sugar or 100 grams of 1. Before the 1830s, how was diabetes treated? ‘unrefined carbohydrates like tice or potatoes, the amount of glucose entering the blood will be almost the same. ‘Therefore the amount of carbohydrate inthe diet is important, not necessarily the ype of carbohyirate. However, it should be bome in mind that unrefined carbohydrates also contain proteins, etc., which are important in a balanced diet, ‘The important points to remember are that the patient's diet should contain the right number of calories for his or her individual needs and that the dict should be well balanced. 2. On what grounds did the ADA change its policy on refined sugar? 3. Ife patient asked you if it wes allright to substitute 100 grams of candy for 100 grams of potstoes, what would you say? 4, Should unrefined carbohydrates in the form of sugar be prohibited from a diabetic diet? + Est three regular meals per day. = Make sure you eat enough proteins in the form of meat, cheese, eggs, etc. = Don't eat a whole pecket of cookies at one time Put these pieces of advice in the correct columns. = Don't miss a meal, = Try to avai fast food * Eat lots of non-starchy vegetables inciple 2: Eat ahalanced diet Eat three regular meals per day. im Qa Qo o a a A nutritionist is explaining to Mark and his mother how to calculate the calories in his diet. Put these steps in the correct order Then listen and check your answers. __Check that he is getting balanced det. __Weigh his mams servings ___ Add up the number of calories he eats per day. Adjust his diet so that he is getting about 2250 calories. Calculate how many calories there are in one of his mam’s servings. —— Check how many calories there are in a regular serving from the chart.Do some of Mark's calculations. Serving Size of regelar | Calories per | Size of Mark’s | | Calories in one af serving. | regular serving | mom's servings | Mark's moms servings 1. Cornfikes 359 180 cals 709 70/35 x 130 = 26065 2, Spaghetti 3005 300 cals 4509 3. Rice 3000 420 cals 4005 @. Boiled potatoes | 3009 210 cals S009 5. Oatmeal 3505 175 cals 400g @e@ FF Look at these two ways of regulating (ER RERTET Ter a diet, Explain them to your partner in your own words. Make sure your partner has understood. ‘As we have already soon, patimis do not remember everything they are told One wey to help them remember isto repest and summarize what you say at ‘he end ofthe consuilain. Another way is to have the patients themselves do tis repetition and summary. 1. Student A explains to Student B It can be time consuming and complicated to calculate the calories in method. potato, you can use the information in the chart below and substitute 1 small potato for 1/3 cup of boiled rice. You have @ math free way to vary your diet! every meal. Here is a much quicker ; Ifyou know how many calories there are in, say, a serving of meat with 1 small | 2. Student B explains to Student A There is no such thing as a special diabetic diet. Diabetic patients can eat the same type of food as the rest of their family. They just have to control how much they eat and when they eat. The essential |. principle is that they follow a balanced diet | and to do this they can refer to the food pyramid. Another useful way to balance the diet is the “plate method.” This method is described here. The Plate Method. 215 of plate to be filed ‘with starchy foods lke rice, pasta, potatoes, etc. 2/5 of plate to be filled «with fruits and vegetables 1/5 of plate to be filled ‘with meat, fish and chicken, etc.ue 41. euthyroidism 2. hypothyroidism 3. dyslipidemia below to work aut: their meaning. normal thyroid function Diabetes and The presence of thyroid dysfunction may affect diabetes control. Hyperthyroidism Is typically associated with worsening glycemic control and increased insulin requirements. There is underlying increased hepatic glucogenesis, rapid _gastrointestinal glucose absorption, and probably increased insulin resistance. Indeed, thyroid dysfunction may unmask latent diabetes. In diabetic patients with hyperthyroidism, ED The following words all sppear in the article below. Use the article and the chart 4, glycemic 5. alucogenesis, treatment accordingly Restoration of euthyroidism will lover blood glucose level. Hypothyroidism is accompanied by a variety of abnormalities in plasma lipid metabolism, including clevated trigheeride and low-density [ipoprotein (LDL) cholesterol concentrations. Even sub-clinical hypothyroidism can exacerbate the coexisting dyslipidemia commonly found in type 2 diabetes and further Increase the risk of physicians need to anticipate possible cardiovascular diseases. Adequate thyroxine deterioration in glycemic control and adjust replacement will reverse the lipid abnormalities. Prefix Root ‘Suffix | fyper- | too high he ‘sugar ism noun Iypo- | too low -em- blood “ic adjective cu normal pid fat “a poun as abnormal our urine genesis | production To put it more simply Use the chart: to work out the meaning of these words. 3, hyperglycasurie 4, dysuria 1. euglycemia 2. hypertpidemia © B Listen to Doctor Murray explaining the main points of the article "Diabetes and @ Hyperthyroidism” to Mark. Write examples of the techniques he uses to simplify and explain. Uses analogies. 1 Encourages Mark to ask questions. 2. Checks if Mark is understanding 3. 4 5. The car analogy. Accelerator, cas, brake. Asks Mark to repeat what he has learned. Ts positive. Unit 4[El Read the following article. Highlight the parts that are relevant to Mark's case. Then write some notes in non-technical English that could be used to explain the Hemoglobin A1C test to him. Hemoglobin HA1C Tes Background AIC, alo known as glycated hemoglobin or lyeosylated hemoglobin, indicates a pavenc’s blood sizer control over the lst 2-3 months. AIC is formed rose in the blood hinds irreversibly. c© hemoglobin to form a. stable sfyeated hemoglobin ‘complex. Since the normal fife span of red blood cells 90-120 days the AIC will only be eliminated when the ved cals are placed; AIG values are direety proportional to the concentration of ghieose in the blood over the fll fe span of the red blood ees. AIG values are not sujet to the fluctuations that are seen with daily blood giueose monitoring “The AIG vale is an index of mean blood glucose ‘over the past 2-3 nuts but weihted* to the most recent luce vals, Vals show’ che past 30 days as ~5iP ofthe AIC. the preceding 60 days ving ~25% of the value and te preven 00 days giving ~25% ofthe ‘alu. This bis is due tothe body's natural descton and replacement of el hhod cell. Because ells are constany Dving dscoyed and replaced it doesnot take 120 days to det a lncally meaningful change in AIC follssng a sificant changin roca blood gus wad dd dl Pd Clinical Uiity The American Diabetes Association (ADA) recommends AIC as the best tet t0 find out if a pation’ blood sugar is under conto over tne. The test should be pesformel every 3 months for ins ‘ucated pation, during treatment changes, or when Lod glucose i elevated. For stable patients on oral agents te recommended frequency is atleast twice per year The Diabetes Control and Complication Trial and tte United Kingdom Prospective Diabetes. Study studies showed that the lower the AIG number, the neater the chances to slow or prevent the development cof serious eve, Kidney anv nerve disease, The studies ako showed thet any improvement in AIC levels can potentially reduce complications ‘The ADA recommends that action be taken wher AIC resis are over BY and considers the diabetes to Joe under contol when the AIC rest is 7% oles, Searels eta cum Sei hemoglain-m Role-play an explanation about Hemoglobin A1C to Mark. Use your notes from exercise d. Think of another highly technical subject that you are familiar with. First, explain it in simple, non-technical language to your group and then give a technical explanation. Lesson 6 1Team Project 1 Children and adolescents are particularly susceptible to a large number of medical disorders. Their immune system is not as developed as that of adults, and indeed it is normal for young children to have six to eight upper respiratory tract infections and two or three gastrointestinal infections each year. In addition, congenital disorders often begin to show up in carly life. Moreover, the active nature of children and adolescents means that they are more likely to be involved in accidents. oe ‘A Research Phase ‘Work in groups and research first aid for ONE of the following childhood or adolescent illnesses: * Infectious diseases: (measles, mums, chicken Dos, yeatat Roy Wordle pertussis, rubella, diphtheria, etc.) = Nocturnal enuresis child disease = Infectious mononucleosis children disorders * Osgood-Sohlatter disease infant condition = Scoliosis juvenile pediatrics = Exema illness 'B) Presentation Phase * Present your findings to the class, ™ Use pictures or charts / posters to make your presentations more interesting Ae Team Project 1% Ea s 0 0 o a 2S [Bl Listen to the conversation between Robert and Jenny. Write the advice Jenny co w Unit 2 Robert is about to start work in the Emergency Department with Dr Jenny Tan. Write some advice you wuld give him for working in these stressful conditions, Gives Robert. Then compare her advice with yours. MEDICAL SCREENING EXAM Patient... Navas, Slenkovich oe Age: 34, CHIEF COMPLAINT: ..Ageeult. Struck on the head, Unable to close mouth. Vital signs: BE,329/80, Respiration rate: 20... Pulse rate: 20... ‘Temperature: 27° Mental status: .... Conse4eue..om. arrive}, .Wiknesses,.xeport, him being. unconaciaue. ~f0E, about 30 minutes, after the attack, Genera appearance: SLightly, confused... Responda. te. questions. Ability to walk: .. Ambulant. ‘TRIAGE Status. Cabegory, ZIT© [read the telephone conversation between Robert and Dr: Plantz, the dental intern. So Number the lines in the correct orden Then listen and check your answers. [21 Robert: Helo, is that Doctor Pantz? coco br. Plante: Morning, Robert. What can | do for you? tig} tien teeta ey Bere Robert: We have a patient here with hed inure and» possible | language s nat sary. Here are some tips: mandiuir®frecture, Cold yeu cme dow and havea ook? a latgieat iiasiandl ant eee (1 Rabert: Good morning, doctor: This is Robert Mitahel from ask. A misunderstanding could rst i, Emergency. * Ifthe persan is speaking foo quickly, (Robert: About fifteen minutes. Sure. Bye Immediately ack him/her fo slow down (be Plantz: Sure, but Im just fishing @ ward round Is the * As the parson is speaking, repeat what patient stabilized? ‘ being said. The person will soon realize understanding. 1 Planta: Speaking Pca cae ea Make th (Be Plante: No, stabilized! | mean can you wat about @ queter oe ela HayShe wil usually speak slower as wall. (Robert: Sory, | mised tht. What dd you say? Strized? Role-play the following telephone calls, @ Stuient A: Doota: Check evi in Observation Ward, ee Stutent B: Chic Nurse on Obs a - servation Ward, Notimmediteh. none hour (© Student A: Senior Nurse. You are short-stffed* Phone personnel department to request substitute nurse. ‘Stuslent B: Personnel Assistant ‘None available unt efternoon shift. Student A: Nurse. Order unmatched * blood © seudent a: 000 {rom blood bark. i Doctor. Phone pharmacy to check ne B: Blood bank order.” Whore? sae tf th. oer temas dg, 40 Student B: Perret. Give doctor dose ara ‘Svogest abertiveSte He’ll be fine, Mr Slenkovich EE] Read the conversation between a nurse and Wayne's fathen Complete the ‘sentences with verbs in the correct tense. Then listen and check your answers. Nurse: It’s Mr. Slenkovich, Wayne's father, isn't it? Mr. Slenkovich: That's right. What happened to Wayne? Is he all ight? Nurse: He'll be fine, Mr. Slenkovioh, But first things first. It seems thet Wayne (1) (finish) ‘work at 8 o'clock in the evening and (23 (ust leave) the store when two men a (attacld him. lenkovich: (4) (olready go} to the benk with the money from the store? I'm really not sure. Anyway, some people (5) (ee) the assault and called an ambulance. The paramedis checked Wayne over, put on @ neck brace, and brought him in Mr. Slenkovich: Did they get the guys wo attacked him? Nurse: | don't know but the police (6) (already speald ta Weyne. Dr. Tan examined him when he arrived and sent him to have a soen. He (7) (have) @ dislocated jaw, which we put back in place, but there don't seem to be eny broken bones. Anyway, we (8) (decide) to keep him in for the night. Mr. Slenkovich: Why? If he's OK, why can't he come home? Nurse: Well he (3) (knack cut for about ten minutes after the attack and the doctor thinks it best to keep an eye on him. Mr. Slenkovich: Gan | see him? Nurse: Just for a minute, He (10) need) to rest: Find these lay terms in the conversation above. Then match them with the medical terms. 1 keep an eye on him | a. fractures 2, Koocked out [ B.raposition 3. broken bones 6. unconscious 4, neck collar €.cervicl brace 5._____ dislocated jaw dislocated mandible &.____put backin place __| f. place him under observation Role-play the following situations. Use lay terms to explain the cases. Case 1 Case2 Student A: Nurse. Explain case to mother. Student A: Wife Student B: Mother. ‘Student B: Nurse. Explain case to wife. swing at school. Teacher drove him to Brought to ER by colleague. Febrile, ECG hospital. One tooth knocked out and shows generalized ST segment elevation | retrieved", one broken. and there is some pericardial fluid around | } | | James Fox, 6 years old, hit in face by | ‘Art Halamka, 45, chest pain at work. | Missing tooth replaced and splinted*. | the heart as shown by echo. The ‘Temporary crown* put on broken tooth. cardiologist diagnosed pericarditis" and No other injuries besides teeth. _is going to drain the fluid, }© [Ey Read the discharge instruction guidelines below. Then listen to the nurse giving {9 discharge instructions to Wayne and Mr Slenkovich. Check v~ the points she covers, Discharge Instruction Guidelines Make sure patient (or ceregiver) knows: Cl the name of the doctor who treated hinvher. Cl the diagnosis. Gi dose and possible side effects of mecication or treatment, Gi precautions to be taken, eg., no driving, complete rest for two weeks. Cl_what to do ifthe condition fails to improve or worsens, Gi dete and time of folon-up Gf eny) @ [El Read the jumbled conversation and number the lines in the correct orden Then practice the conversation with a partnen Patient: 23! Gee! When do they come out? Nurse: OX, that's everything fished, You can go home nov Nurse: Erm, let me see... 28. Patient: No. | think that’s all dear. "Nurse: Come beckin e week end we'll take ther aut, it’s abit red now eraund the out but that should go away in a day or two. ti: doesnt, or ifthe cut starts to hurt or bleed, then come back right away. OX? Patient: Thanks, nurse. How many stitches* dd they put in? Nurse: Yes. You don’t naed an appointment but it’s quster in the marning. OK, end one more thing, Doctor Byrne wants you to take these pil, Toke three a day for six days. They may make yau feel abit drowsy, so you're not allowed to drive. C1 Patient: Sure. Should ! came back here? C1 Patient: No chance ofthat! My car wil be in the body shop for few weeks, I'm sure C1 Nurse: OK. Any more questions? oO ooo8a0 @ [i] Role-play giving discharge instructions to the relatives in the cases from exercise c. Case 1 Case 2 | Student A: Nurse. ‘Student A: Wife | Student B: Mother ‘Student B: Nurse Discharge instructions Discharge instructions | Antibiotics, three times a day for Colchicine. One pil, twice a day. Report immediately to | a week. Soft food only. Return doctor if there is diarrhea, nausea, vomiting, or stomach to dental department in one pain. Warn that 15 - 30% of patients have recurrences week. Speak to school about of pericarditis. It can take up to three months for a full \ safety of swings. \ recovery. Cheok-up in cardiology in two weeks. sy Lesson 2 KE| » Lesson 3 1 @@ LF Potert is attending a patient, Mr. Legrange. Read the notes and then write the questions you think Robert asked the patient's wife. Has he ever fainted before Medicall “wt Patient: ...chuck Regrange, Age: 54 (CHIEF COMPLAINT, ..coldapeed. af. home... Seni-conscious. on. arsival....contused. Vital signs: .BP...80/50 Respiration rate: .20..... Pulse: ...90,. Temperature: 37.42 ‘TRIAGE STATUS: ...akegory... i sAnoNO. Previous. .beiatory..of..AyREORe?, 2. Jiypakensive. medication, An. Had. just, eaten seafood, An. NO. Jeno, allergies. 5,..No. history. of, frauma. ee PuysicaL ... Patient. 4s.4n.respixatory.. diatress.,..e. 4s. droays.andpale,..2uk, awakens..when, vou. talk, to. hin. tie. has, generalised urtieartat..He has.ne, sonjunctival* edenat. His. lips.end, tongue. are.not. swollen? Bis..voise, scunda.normal....Heart. tachysardic. without. mumuxa®.His. lung. examination, shows. mild. wheesing* and faix aerationt. with mininal retzactionst.. Ris, ebdomen.A#..20ft..ond nen-kender...°.RASe. te moderately. Pade. Has Mr. Legrange had fainting attacks like this before? 1 2 a 4 5 @ [By Listen to the conversation between Robert and Mrs. Legrange and check your @ answers, we Match the columns. 1 \ had just fished dinner 2. that the nurse noticed that she had gen him the wrong dose. 2 Te was only ater the patent became B. when | got this pain in my stomach ungonsious, 3 The post mortem indicated 6. Kim hed spent smost two years hospital By the time she wes only four years old, |” d. until the petient had already been discharged. + — The foreign object in the traches was not €. that the patient had died from gunshot wounds noticedRobert suspects Mr Legrange has had 2 severe allergic reaction to the seafood or the seafood was poisonous. Read the following articles and answer the questions. Anaphylactic shock naphylactic shock is a severe allergie response by ‘the body to a foreign substance (allergen) On first contact with the allergen, there is no allergic reaction but the body produces antigen ‘specific immunoglobulin E (gE). On subsequent contact, the allergen binds* with the IgE and produces a caseade* of mediators” which include histamine, leukotriene C4, prostaglandin D2, and ‘ryptase. These mediators produce the symptoms of anaphylactie shock. ‘The most common allergens are drugs (penieilin), intravenous radiocontrast media, stings and certain types of food (hellish, peanuts), ‘Symptoms and Signs Skin: Urticaria,* redness, swelling* of the face, eyelids, lips, tongue, throat, hands and fee. Respiratory: Difficulty in breathing caused by swelling or spasm of the airway. Cardiovascular: Hypotension, tachycardia leading to syncope Scombroid Toxicity_____ Scombroid toxicity is caused by eating fish which not fresh, Members of the Scombroidea family which typically have dark meat, eg,, tuna and ‘mackerel, are usually responsible, ‘acteria in the muscles of the fish convert the artino acid histidine into histamine, Histamine normally present in fish at levels of around Inig/ 100g, However levels of 20 - 50 mg/ 1003 are found in fsh and cause scomibroid toxicity. fs important fo note that histamine does not break clown when heated. ‘Symptoms and Signs ‘Skin: Flushing’, urticarial rash’, swelling of face or tongue, sweating. Gastrointestinal: Difficulty swallowing, nausea, vomiting diarrhea, abdominal cramping.* General: Weakness, confusion. ‘Treatment ‘The first priority is ABC: Airway, Breathing and Cardiae. Intubation* may be difficult due to edema* in which cease oxygen should be given through bap/valve/masi ventilation. If this does not work then a standard cvicothyrotomy* is an option. Tt may be necessary in patients with hypotension to start lmge volume intravenous fluid resuscitation to help restore circulation, Epinephrine is the drug of choice for severe allengie reactions. It works in two ways! by constricting* the blood vessels, which increases blood pressure, and by widening the airway" to help breathing. Antihistamines are also used as an adjunct, Itis advisable to keep pationts under observation for 12 hours, Cardiovascular: Tachyeandia, hypotension or hypertension. Gastrointestinal: Nausea, vomiting, diarrhea, Respiratory: Respiratory distress, General: Headache, dizziness Treatment ‘The cause of the problem is histamine and so antihistamines suck as diphenhydramine are used. Epinephrine is effective but is not wsvally necessary Tecause there is no full cascade of mediators. It Prognosis ‘Scombroid toxicity isnot life-threatening and patients ‘usually make a full recovery within a few hours 1. Is it possible to get enephylactic shock on first contact: with an allergen? Give reasons, 2. Would cooking the fish prevent scambroid toxicity? Give reasons, 3. Why are the symptoms of anaphylactic shock and scombroid toxicity very similar? 4. From the information you have, which do you think is the most likely diagnosis for Mr, Legrange. Give reasons. Lesson 3 EatI'd like to ask you a few questions denny: So Robert, how's it going? Robert: Things move quickly around here, don’t they? What have we next? Jenny: A two-year-old child who is wheezing and having problems breathing, Here's the Medical Screening Exam. Id like you to take @ loak first. MEDICAL SCREENING EXAM Patient: 20¥iee. Tolan, Respiration Rate: ‘Temperature: .38.. ‘TRIAGE STATUS: .Catesery,.3F, El IF you were Robert, what questions would you ask this patient's parents? Use the summaries of the illnesses opposite to help you, © By Listen and write the questions Robert actually does ask. Compare his questions B, with your own, [By At this stage, what diagnosis would you make? Use the following expressions. IMPOSSIBLE CERTAIN Itcan'tbe tis unlikely to be It could / might / may be I's likely tobe ‘It must be Your teacher will tell you what Robert found when he examined the patient and also give you some lab results. What diagnosis would you make now? fa 1.Wheezing, cough, br 12ezing, cough, breathles: during rest, infants are not interested in feeding, sit upright, Older children talk in words _, (elsentoncs),agtatod 1 Asst usual lke ace tight perminuto. ahs ¥ Heart rate: 1 7 Retecinre pau Per minute, 3. Broncbiolitis* © Wheezing, fever, poor appetite, debydration. © Flared* nostrils. © irritability, with difficulty sleeping and signs of fatigue. © Granosts. © Rapid, shallow breathing 60 10.80 times a minute). © Rapid heartbeat. 5. Croup Cystic fibrosis cough often followed by vomiting. y of recurring infections Family history, Tips and fingerneis tur blue (cyanosis) Respiratory distress with retractions. Increased anterio-posterior diameter of chest, Clubbing* of fingers. ge ‘ * 4. Aspiration of foreign body Episodic cough, dificu apa her proximately 50% of children Jespitorysidor® or eae heczing, with prolongati ne Nt prolongation ofthe reathing with Inercosal,subcomait and suprasternal* retractions ifferences in *b Seas in pteusson* owen each Fever and cyanosis are less common. ty in breathing «History of mild upper respiratory infection with nasal © __ cmrgeston, sore throat, and loud cough. > a Fever (38 - 39°C) Respiratory stridor usually develops at night. Inspiratory stridor with nesal flaring, Suprasternal and intercostal retractions. Lethargy or agitation may be a result of hypoxemia.* Rapid heart rate, fast breathing. Children may be unable to maintain adequate oral intake resulting in dehydration. Cyanosis isa late ominous sign. Lesson 4 EWe need to take a sample © Ey Listen and take notes about the signs and symptoms the patient presents. oD “4 Occupation: Bank... Patient Number: ... 26428522... | Name: Susan. TRORDS....n. Address: 17, Oakview. Terrace. Home phone: 27489291... Age: 24. Lerk. Date: 1/22/96. clot. Sever... headache... P..264..R.AB., Read the conversation and undeniine the most appropriate ward or expression. Compare your answers with those of a partner He mentioned a lumber something, No, don’t worry. We take the sample Susan: Will it hurt? Good afternoon, Susan. Has the doctor explined what he is going to do? OK. Let me explain. We need to get e samale of (1) 8, CSF b. cerebrospinal fuid™ c. fluid fram your spine to check if you have (2) a. a brain infection b. meningitis c, anything wrong. Whet! He's gong to put: a needle in my brain? from your back. Nurse: No, we wil (3 e. give you 8 local anesthetic b. inject some lignocaine® o, numb your back frst. What happens then? The doctor then (4) a. sucks out b. takes out c, aspretes some fluid and we send it to the lb. Easy! hope so.Circle the word or expression most appropriate to use with Patients. Compare your answers with those of a partnen 1 2 3 4 a excise the growth al put you to sleen | a analgesic al ja 8) cut the grawth out ‘|b anesthetize you |b) pain kiler 8) injection remove the growth | c} put you out ¢) pain reliever 0} shot 5. 6 1 a. al investigate a} swaling al cachexio* a) intestinal hemorrhage 8) take a look at ) lump b! underweight 8) bleeding in your abdomen o) assess tumor ©) skinny <3 boot oss fram your intestines 3. 10. u. 2. al hypertensive medication | a) insert-@ catheter | a) to praduce a stool | a) to go to the bathroom 6) some pls to lower your |) put ina tube 1) to defecate 8) to urate blood pressure cl introduce @ catheter | c) to mave your bowels | c) to take @ pee €) little yellow pls ‘We'll have to perform surgery to cut out the tumor, ____You'l need a small operation to remove the swelling. ‘We need to investigate the possibility thet you have cancer, Rewrite the following sentences so that they sound less threatening far a patient. . am going to put a catheter in your urethra to collect your urine. The only way I can get this tooth out is to cut away a piece af bone and lever® it out. We will have to dril a hole in your head ta teke out the fui, {Tam going ta administer a subcutaneous injection inta the deltoid muscle Think of a situation in your own field that requires careful use of words. Explain it to the class. lesson 5 EILesson 6 the procedure [By Put the sentences below in the correct order to describe the lumbar puncture procedure. Advance the needle 2 cm until you hear a 'pop' sound. This is when the needle passes through the dura.** Then advance the needle 2-3mm, and check for CSF. Continue until CSF is returned. Ifyou hit bone or biood returns, withdraw to the skin and redirect the needle, Attach the menometer* and measure the pressure. Remove the manometer and collect three samples (about 1-2 cc each) af the CSF for testing, Steriize the puncture site, ‘Then locate the puncture site, Ths is between the 4th and Sth lumbar vertebrae. The 4th lumber vertebra is level with the superior iliac crest. Using @ 25-gauge needle, inject 1% lidocaine to anesthetize the skin at the puncture site. The needle shouid be in the midine® and pointing towerds the patient's umbilicus.” When CSF begins to flow, discard the frst few drops. Have the patiens ie on the edge of the bed, facing away from the operator: The knees shoud be lifted upto the chest and the neck flexed, The head should be resting ona plow and the whole ofthe sgine parallel to tha ground. This isto ensure an accurate pressure reading 8O oOo 0000 ‘Susan's lab tests are back. Read the following data and the results of Susan's tests and make a diagnosis. se a ae Niral meningitis CSF Pressure ~30mm 120 Nard Color Clear Sometimes tubid® | Clear | Cell count <5x106L [increased iS Increased Differential Lymphocytes (60-70%) | High neutrophil count | High lymphocyte count Monocytes (30-5094) | | aba Neutrophils (None) Protein 015-045 gf. Increased | Normal or slight increas. CSF / serum glucose ratio® | = 60% Reduced ‘Normal or slight increase, Gram’s stain = Sometimes positive | Negative | Protein: 12 g/l. CSF Glucose: 2.0 mM Serum glucose: 6.0 mM Cell count: 200 red blood cells, 200 white blood cells xg 90% neutrophils Gram’s stain: Negative[By Read the article and answer the questions. Causes and Treatment of Bacterial Meningitis Streptococcus pneumonia (pneumococcus) ‘This is a very common cause of meningitis in the United States. It mainly affects young children and older people but it ean infect anyone. In recent years, some types of Streptococcus pneumonia have become resistant to penicillin but fortunately the organism is still susceptible to the third generation cephalosporins. ‘This organism is highly contagious and is often responsible for mass outbreak in college dormitories and military bases. It often begins with an upper respiratory tract infection and then spreads to the brain. Penicillin is the drug of choice but resistant strains* have been reported and these are best treated with ceftriaxone. Haemophilus influenzae (naemophilus) ‘This bacterium used to be the most common cause of meningitis but since the introduction of vaccinations, it has become lees common. When it is met, third generation cephalosporins are the treatment of choice. ‘These three bacteria account for over 80% of meningitis cases. Less common causative agents include Escherichia coli, which mainly affects neonates, and Listeria monocytogenes, which tends to affect the elderly. The use of steroids Recent studies have indicated that when steroids* are used alongside antibiotics, there is a lowering of mortality and other unfavorable outcomes. tis thought that steroids help by reducing the body's inflammatory reaction to the breakdown products that are produced when the antibiotics kill the bacteria. It is therefore crucial that the steroids are given before or with the first dose of antibioties so that they are present in the tissues when the initial inflammatory burst® occurs, 1. According to the article, how many differant types of bacteria are responsible for meningitis? 2. Of thase bacteria, which do you think are most likely to be responsible for Susan’s meningitis? 4. Identifying the specific bacteria tekes at least 24 hours and Susan needs treatment urgently, Which antibiotics ‘would you give? 44, Explain why itis important that steroids are given early in the treatment of meningitis, Lesson 6Team Project ‘All health care professionals, and indeed all adults, need to know some basic first aid procedures. (® Research Phase Werk in groups and research first aid for ONE of the following: Useful Key Words first aid = Drug overdose = Broken bones emergency treatment ® Electric shocks * Nosebleeds herrea = Choking = Sports injuries = Fainting =~ Unconsciousness: Or you cen choose another topic that is relevant to your field. You should find information on: 1 How to recognize / diagnose the condition = What to do. = What not to do. = What preventative measures, if any, could be taken. (B) Presentation Phase Present your findings to the cass. = Use pictures or posters / charts to make your presentations more interesting. e Siaeeen toate ieMatch the columns. Features af pain Main questions Follow-up questions tae? fF 8 ‘a. How long does \.[s it near the surface of Location the pain last? your body or deep inside? 2 -Does anything bring the pain on? Il Does 8 hot-water bottle con ige pack help? |__ Triggering? factors 3 ©. Can you describe tthe pain? Ti Do you feel better standing, sting, or lying down, for example? | _Duration 4 Intensity & character 4, Does anything make the pain worse? IV, Does it hurt all the time? 5. Have you had a pain V Have you had to stop doing certain Onset like this before? activities lke walking or climbing stains because of the pain? 6. When do you get the pain? | VI Does it start in one plece and spread? Timing 7. g. Where is the pain? Vil. Does the pain make i difficult Alleviating® factors for you to concentrate? a 1. When did the pain stare? | Vil. is it in one pert of your Body Aagraveting® factors or in more than one place? 3. i Does anything make 1K Does it come on slowiy or quick? Previous occurrence the pain better?[Bi write the words in the box in the correct columns. Intensity of pain Character of pain Severe Mild Unscramble and camplete the following sentences, using the word order 1) Intensity, 2) Character, 8) Location, 4) Duration. 41 aching / in his back / for three weeks / dull / pain The patient has a dull, aching pain in his back that has lasted for three weeks. 2. in his chest / since yesterday / stabbing / intense / pain 8. excruciating / for two days / headache / throbbing 4. in her fingers / mild / for 2 months / cramp 5. earache / unbeareble / throbbing / for 3 days El Work with a partner and practice cislogues using the sentences from exercise d. Use the main questions and follow-up questions from exercise b to continue the dialogues. Example: A: Can you tell me about the pain? | have hed a dull, aching pain in my back that has lasted for 3 weeks, Does it hurt all the time? B: No, it comes on later in the day. Does anything make it better? Yes, lying dovn or taking a hot bath,2 s a r It’s how you say it ED You will hear the following sentences said twice; once with an “accusing” tone of voice and once with @ “supporting” tone of voice. Write which tone is used first (1) and which tone is used second (2). Accusing tone Supporting | Xccntuccece) tone 1. You should have called me. 2. Why didn’t you come sooner? 3. Sorry, what did you say? 4, Did you understend whet | seid? 5. How many times have you been here? 6. Why didn’t you finish the treatment? ‘The old saying, “It's mot what ‘you sey, t's ow you say it” is especially true in the medical fie A smell change in a eth care provider's intonation can campletely change a patient's atttude and cooperation. Read these sentences to each other check your intonation. © [By Listen to the recording again and repeat the sentences with the supporting tone. using @ supporting tone. Then listen to ‘Student A reads to Student B Student B reads to Student A 1, Why didn’t you let me know sooner? 2, Are you teling me everything? 3. Sorry, can you say thet again? | don’t think | need to see you aaein. 5, What do you mean by that? And don’t forget to bring the urine sample 7.1 don’t think there's anything wrong with you, . Why didn’t you call me? Listen to the patient interview and decide who has a more supporting tone, Dr. Murray or Robert. Ciee ‘Anew syndrome, known as the “door knob syndrome" has been described in the hterature, This takes place after a doctor-patient interview whan the patient reaches the office door and says to the dactr, “Oh doctor, thare is something else.” ‘The remady is simple. The doctor stmmply has to ‘say "Is that everything?’ atthe ond of the interview to allow the patient to ring up anything else that is ‘worrying him o her.‘Name: John Bloom Age: 36 Chief Complaint: “bad back” 1. Onset: 2. Location: 4. Duration: _ 5. Timing: bad in the morning 6. Triggering factors: 7, Alleviating factors: takin 8. Aggravating factors: 9. Previous occurrences: 10. Family history: none known. IL Social History: ng a nap 3. Intensity and character: like a cramp, seems like the muscles are all stiff Card 1 You have had an intense sherp* pain inthe right side of your chest for ten days. It hurts @ lot when you breathe, The pain starts on the tp of your right shoulder end spreads down to your ri. The pain is much worse i you move around and you have to lie stl all the time, When you try to sit up, itis very painful. Card 3 You are getting intense pain on your right cheek. It is excruciatingly painful e starts if you touch any part of your face. Brushing your taeth can also start it of It lests just a few seconds but you get attacks many times per day. Nothing seams to make it better Role-play taking a history of pain of the following cases. Student A is the doctor and Student B, the patient. Reverse roles after each card. Card 2 You have a severe, shooting* pain that travels down the back of your left leg vo your ankle. I sometimes starts when you are sitting doing nothing, but at other times if you sneeze or cough, the pein begins. You also have a tingling, burning feeling most of the time in your leg. The pein gets better if you lft your knees up to your chest. I started @ month ago and has been getting worse Card 4 You have been having severe headaches for the last 3 weeks. lt sterts with e dul ache on the left side of your neck end builds up to @ severe, throbbing headeche on the left side of your head. Before the pain starts, you start seeing "spots" in front of your eyes and during the headache you cannot tolerate light. It usuelly lasts for about three hours. Lesson 2 EELesson 3 i as a It’s getting you down, isn’t it @@ By Fead the following conversation between Mr. Bloom and @ nurse in Radiography. Replace the phrasal verbs in italics with expressions from the box. Then practice the dialogue. Unit 3 Nurse: Morning, Mr. Bloom. Here for your tests? Mr. Bloom: Thet's right. ‘arse: And hove are you feeling? Mr. Bloom: Oh, my back’s really getting me down, a Nurse: If you can just stick it out (2) 8 bit longer 'm sure they'll find out (3) \what’s wrong. Mr. Bloom: | hope so. | don’t think | can put up with @ any longer, ‘Nurse: OK, well you can talk this over (6) with the doctor Mr. Bloom: Yes, when he shows up. (6) Nurse: He's very busy, but he should be here in a short while. Once Phrasal verbs, e.g. to put up with, are used in ‘informal, nontechnical speech, Their equivalents, eg. tolerate end tobe more formal. When specking ‘with patiant, tis better to use phrase verbs. Write @ conversation involving a patient. Use the phrasal verbs in exercise a and those below. Then practice your conversation with e partner, Phrasal verh | Definition Example get over to recover It's not a serious fness. You'll get over i ie couple of weeks, ve uplin to abandon hope, to You fought so hard, don’t give up 7in now, surrender ‘come dawn with | to start an finess ‘She got fu fist and then the whole fanily came dawn with it go through with | to proceed in spite of fears | 1 have decided to-go through with the aperetion, Told cub not to surrender Iehurts, but think I can hold out far another few days, Teep on to continue Tnaw those pls taste terrible but you have to Feap on taking them. stick with to persist, to continue Tow this is taking a Tong time, But you wil just have to stick with it.(Gi Dave, the radiographer, is having problems with his equipment. Read the ‘telephone conversation and fill in the blanks with question tags. Dave: Hi, Chuck. t's Dave. We are having a problem with the XL45 again. The fms are coming out clea. Chuck: Oh no, and I'm really busy at the moment. Can we just run over a few things on the phone? Sure thing. Shoot. First, it’s plugged in, (1) _ ist it 2 Give me a break, Of course itis. Chuck: You didn’t leave the collimator shutters closed, (2) 2 No, | don’t think so. Chuck: You haven't been playing with the gain control, (3) ? Never touched it. Chuck: What about the footswitch? You are keeping your foot on it all the time, (4) i Dave: Sure, Chuck: OK, well it looks lke I'l have to come over. You'll still be there this afternoon, (5) 2 Dave: | finish at 10:00 today. So if you can come és soon as possible, | would appreciate it. Chuck: ll do my best. See you later. You will hear the following question tags said twice, once as a confirmation and once as a question. Write which is seid first (1) and which is said secand (2), Confirmation | Question 2 8 isn't he? 2. You've got Mr. Bloom's notes, haven't you? 3. You're here for @ chest X-ray, aren't you? 4, This isn't going to hurt, is it? 5. can leave naw, can’t 1? © Ey Listen to the recording again and repeat the sentences. o bey Write five sentences using question tags. Read your sentences to @ partner using either @ confirmation or a question tone. Your partner must identify which tone you are using.We need a psychiatric evaluation @@ Eq work in pairs. Try to recall the details of Mr Bloom's case from memory. © [DD Read and listen to the conversation between Dr. Murray and Robert. #2, Underline the verb forms in the passive voice. Then practice the conversation Dr, Murray: So, Robert, let's go aver Mr. Bloom's case. Can you review it for me? Robert: Sure, The patient presented on February 4 this yeer complaining of lawer back pain. There wes no history of traume, Analgesics were preserved end the patent was advised to avoid strenuous work and heavy lifting. Dr, Murray: Go on. Robert The patent was seen again on Agi 8 complnin that he ws stil pain end that te contin was werse, He also ccamplained of denression, The patient was referred for radiography. Dr, Murray: OK. Let's have a look atthe redagraph, What do you think? Robert: Let me see. Well, it looks fine to me. : Murray: To me, too. So whet do you suggest? ert: Wel, | ink he shouldbe referred for a psychological evlustion at this pont. Maybe the back pain is psychosomatic. After all he seems ta be réther depressed i Dr. Murray: ll rght. Thar might be valuable but | also think he ought to be referred to neurologist Write the verbs in the passive voice. Case 1 Case 2 The patient (moh) (1)_was involved _ina “The patient (1) (see) _by Dr road traffic aocident and (2) take) Helingbaum and a mucocele * (2) (find) to Emergency where he (8) (examine) Con the loner lip. The eyst by Dr. Singh. Radiographs (4) (request) | (@) (excise) under local anesthetic and a compound fracture of the | and the patient (4) (instruct) four (tnd) He (6) act) to return the folowing week when the sutures ‘and (7) (take) aa © (remove) to the operating room where the facture (@ (etabitzo) by Dr. Massoud. cases ‘The patient, 2 72-year-old male, (1) admit) ‘on Sunday evening in acute respiratory distress. On exarnination, the patient (2) (fing) _ to be cyanotic" and with blood pressure of 80/85, On chest auscultation,” crackles (3) (hee!) The pationt (4) (sedate) ©) (place) na veniator Hes responding weltotreaiment,@@ [i Pole-play explaining the cases in exercise e to a relative or colleague using the active vaice and less formal language. Example: Caset \ ‘Your son was in car accident so they brought | him here. Dr. Singh checked him and found a very bad fracture of his thigh bone. So, they took him to the operating room and Dr. Massoud set the fracture ‘Ths passive voice 1s mare formel than the active voice and is often used when professionals ‘are speaking ar writing to other professionals. It is ‘more appropriate to use the active voice with patients, patients relatives and close colleagues. %\ Ey in your notebook, write another case history in the passive voice and then practice explaining it in less formal language to your group. [DD Read the referral letter and underline the passives, Ashville Medical Center rv al Primary Care Unit Aly Kt, %, FS ‘To: Dr Ruth Fendwvck, Department of Peyciatry * Dear Ruth I would be grateful if you would do a psychiatric evaluation of the following patient: James Bloom, a 34-year-old engineer, presented 3 months ago complaining of a stif, painful back and depression. A thorough physical examination seas performed, but no eause of the symptoms was found, Radiographs were taken but no abnormalities were reported. Thave been unable to detect any physical eause of the problem but diazepam was prescribed and the patient reported an improvement, | would therefore like to investigate the possibility of the symptoms being of psychiatric origin, ‘Your sincerely Bruce Murray MD & [El] Write another referral letter to a psychiatrist for the following case. ‘Selena Hislop, Travel Agent, 56 yrs. Presenting complaint: halitosis* Physical Examination: At time of exam, no halitosis detected. No apparent medical or dental cause. Lesson 4 EY9 Lesson 5 It might be multiple sclerosis S By Usten and fill in the table as Robert reports the results of his literature review. [liness Main symptoms | Mental status Chronic generalized Lockjaw* (75% of cases) (2) tetanus Stiffness of (1) - Stiff Person = Painful musculer spasms* in back and (4) in ‘Syndrome (3) ____ limbs. most patients. 1 Spasms occur with strong emotional stimulus, e.g., surprise, anger, Spasms (5) during sleep. Isaac's Syndrome | = Progressive stifiness and spasms. Normal "= Rippiing® movement of muscles. = Spesms (6) during sleep. Multiple Sclerosis | = Peinful muscle spesms. Depression in = Parasthesia or (7) (8) = Fatigue patients. |n groups, discuss which is the most likely diagnosis for Mr. Bloom. Use the following expressions: ARPOSSIBLE| $a? cerry It can't be It is unlikely to be It could / might / may be It's likely to be It must be Read the neurologist's report on Mr. Bloom. Number the paragraphs in the correct orden Ashville Medical Center Department of Neurology Re: James Bloom (Thank you for referring the above patient. (My diagnosis, therefore, is that the patient is suffering from Stiff Person Syndrome. (The patient complains of painful spasms in the back and shoulders, which relapse ‘when sleeping. Associated depression was also reported. The patient denies any sensory neuropathy.” C11 would be happy to arrange treatment and follow-up in the department. (On examination, I noted that the patient had an exaggerated upright and stiff pposture* and there was a marked startle response.* [arranged a GAD antibody test* and the results were positive, (Dear Bruce Yours sigeerely argeVv Dr. Gurdey@ El Discuss the differential diagnosis of the following patient. What follow-up questions would you like to ask? What tests would be useful? Main symptoms Pericarditis| [ Myocardial infarction ‘Sharp retrosternal® chest pain, which is often improved by sitting forward. Worse with inspirtion and associated shortness of breath, palpitations, shoulder discomfort, and cough. Change of posture and breathing influence the pin. Continuous, pressing, retrosternal chest pain. Lasts about 20 ‘minutes. Possibly radiating to the arms (usually to the left arm), back, neok, or the lower jaw. Intensity does not alter. Breathing or changing posture does not influence the severity of the pain. Episodes of pain ere related to activity; reli with rest, | Pleuritis Nausea and vomiting are sometimes the main Symptoms. Sametimes hypotension, presenting as czziness or fainting. ‘localized stabbing pain when bresthing. Associated with recent or present respiratory illness. Fever, malaise. Aggravated by coughing and deep breathing, Gastroesophageal refiux (hiatal hernia) Burning or pressing pain in the middle of the chest. Associated with eating. May be triggered by exercise, Neusee. Worse lying down, Pulmonary embolism Central stabbing ohest pain; also may be burning, aching or dul, heavy sensation. Rapid breathing, Tachycardia, Pain is often not severe although onset is sudden. May be worsened by breathing deeply, coughing, eating, or bending,, Lesson G I'm afraid to say that .. . [ED Read the article on Stiff Person Syndrome and write the verbs in parentheses in the passive voice. Then answer the questions in your notebook. ‘STIFF PERSON SYNDROME Stiff Person Syndrome (SPS) (fist describe) (1) __was first described ___ in 1956 by Moersch and ‘Woltmann. (think) (2)__ tobe an auto immune disease and it (associate) @ ___ with other auto immune diseases like diabetes and hyperthyroidism, Hligh levels of an antibody to the enzyme GAD (find) (4). in many patients. GAD Gavotve) (6) _ in the production of GABA, a neurotransmitter. The functions of GABA (not clearly understand) (6) _ = butt appears to be involved inthe suppression* (of voluntary muscle stimulation. If GAD levels dower) (7)___________ significantly, then the availabilty of GABA (decrease) (8) ____ and muscles become continuously stimulated. by the motor neurons. GABA (also involve)(9)_in the suppression of ansiety. SPS (characterize) (10)___by muscle spasms in the back and shoulders. The spasms (preciptate*) (11)__by emotional distress and they (often relieve) (12) with sleep. Depression and anxiety (often report) (13) by patients. If the patient presents at an carly stage, few objective findings may be found initially. Unfortunately, because Of the lack of clear symptoms and apparent strong psychological components, these patients (often label) (14)__as psychogenic and effective treatment (often delay) (15) _ SPS (usually teat) (16) by benzodiazepines but recent researc has indicated that ‘ntavenous immunoglobalin is effecsive in some cases. Physiotherapy (need) (17) = by nearly all patients. ‘The prognosis of the disease is variable. Some patients respond wel to treatment and only have episodes of slifuess. Other patients become severely physically and mentally handicapped. 11. According to the artiole, do all patients with SPS heve diabetes? Explain your answer, 2. How do high levels of antibodies to GAD cause muscle spasms? 3. What makes the muscle spasms worse and what makes them better? 4, Which pars ofthe article would you not tall to patient? Why? 5, Stiff Person Syndrome was orginally called Stif Man Syndrome. Why do you think the neme was changed?Decide whether the following ways of breaking bad news are direct or indirect Then compere your answers with those of another student. Direct | Indirect 4, listen, I've got some bad news for you. '. I'm afraid to say thet your tests are not very encouraging, ©. OK, your tests are back and it seems as though we may have more serious problem than we first thought. 4. I'm going to be frank with you. it seems as though you have a terminal ilhess. ©. Well, your scans are back and it appears you have a rather suspicious growth. £. 1am about 20% certain that: when we do the biopsy, we are going to find cancer. oo0 ooO0 oo00 ooo @@ BF] Aote-play the following situation ‘Student A: Doctor Task: First, break the news that Mr. Bloom has. ‘SPS. Think carefully about how you will do this. Then describe the: ‘condition to the patient and answer his questions. ‘Student B: Mr. Bloom oe would like to ask the doctor about the diagnosis, its causes, coerce =) Fiole-play explaining the following situations to patients or superiors. Change roles after each situation. 1. Dentist: When extracting a lower 2. Nurse: You gave bedi premolar, you cut the mental nerve the wrong dose of fascinates aes (the nerve that supplies the lower medication to a patient ae meee lip). Sometimes the loss of Break the news to the cand etree, sensation is permanent, sometimes docior. Hovrever in the United States, i ‘there isa feeling of parasthesia (ins and needles’), and ‘sometimes there is a full recovery. {indicates concern and interest on the part of both speaker and Iistener. 3. Radiographer: A patient was referred with a suspected fracture 4. General Practitioner: You referred a 78-year-old of the cranium for an emergency patient to a cancer specialist, and the results indicate that X-ray and you forgot to put the the patient has a large, aggressive, malignant tumor in slide in the X-ray machine. the lung and also has bone metastases.” Surgery is Explain to the radiologist. impossible and chemotherapy is unlikely to work. @e@ BF Work with a partner, Each of you should think of 8 situation where you, as health care professionals, have had to break bad news, either to a patient or a superior Role-play the situations. Lesson 6 EDTeam Project 3 In the United States, a rare disease is defined as a disease that affeets less than 200,000 people. However, there are some diseases that affect just a handful of people. Drug companies are very reluctant to spend money researching new drugs for rare diseases because sales would be so low they would never get their investment back again. ‘A. Research Phase Work in groups and research ONE of the following rare diseases: Jumping Frenchmen of Meine Sudden Infant Death Syndrome Jamaican Vomiting Sickness Q fever or Another rare disease relevant to your field You will need to find information on: [Useful Key Words] = cause rare diseases = symptoms orphan diseases physical signs typical patient (age. gender, occupation, relevant social background) ® investigations = treatment = prognosis Presentation Phase = Present your findings to the class. = Use pictures or posters/charts, ZEA Team Project 3nit 4 alling in the Stroke TeamUnit 4 ~ Lesson 1 She can hardly speak Robert is now working with Dr. Oliveira. Dr: Oliveira is interviewing @ patient and her husband. Write her questions. Br. Oliveira: Now, what is the problem, Mrs. Mershall? Mr. Marshall: Sorry, doctor, but she seems to be having problems talking. | can't hardly understand her, iueira: (1) About two hours beck, / guess. Around nine o'clock. ‘Mr. Marshall: We were working out beck and she said that her chest was starting to pain her again. Dr. Ol ‘Me. Marshall: You bet she's hed chest pains before. She wes in hospital two weeks ago, over in California when we were seeing our son Dr. (4) Mr. Marshall: Well, she sat down and took a little rest. She said she was feeling better Dr. Dliveira: (5) Mr. Marshall: Wel, then | noticed that, she was speaking kind of funny. And she couldn't walk real good. Her hand end arm were funny as well Dr. Oliveira: (6) ‘Mr. Marshall Or. Oliveira: (7) ‘Mr. Marshall: Yes, she is taking some little white pills for her high blood pressure. Dr, Oliveira: (8) _ Mr. Marshall: Yes, | brought them with me. Here they are. liveira: Yes, you're right. They're metoprobonol, it’s @ B blocker. OK, it's time to have e lock at your wife. het would be her right side. Mr. Marshall uses some colloquial American expressions. Write their formal equivalents in the right-hand column. Eolloquial American English Formal English 1. oan't hardly ean hardly 2. two hours back 3. | guess 4. out back 5. to pain 8. you bet 7. real good2 ¥ Fill in a8 many gaps as possible using the information from the consultation on the previous page jem os pt ps por add od obs Last name: (1) Marshall __| First name: (2) Occupation: (4) Marital status: (5) Chief complaint: Chest pain starting (6) ‘go. Shortly after she developed numbnass® and weakness on 7) side, Mid dysarthria. Blood pressure: Heart rate: Respiratory rate: Temperature: @ @ a0 m1 Past medical history: Potient trested for "(121 * 2782 ago. Hypertension, Social history: No alcohol. Quit smoking sixteen years ego. Medication: (13) the information in the Patient's Medical Record above. FED Write fve questions that you would ask the following patient's relatives. Case 1: 80-year-old woman, ving lone, found uncenscious by visting daughter ee 5. Role-play teking a history of the two cases in Exercise d. Or Oliveira is calling the head of the Stroke Team. Listen to the call and fill in the rest of Lesson 1 EE= Lesson 2 How many fingers can you see EE] Below are the guidelines for same of the NIH (National Institute of Health) ‘Stroke Scale categories. If you were the doctor testing these categories, what instructions and/or explanations would you give Mrs. Marshall? Remember that Mrs. Marshall seems to understand but can’t speak. 3 Visual fields ‘Visual fields of both eyes are examined. In most cases, the physician asks the patient to count fingers in all four ‘uadrants.* Each eye is independently tested. if a patient is unable to resgond verbally, the physician should have the patient hold up the number of fingers seen. OK, Mrs. Marshall, I’m going to check how much you can see. I’m going to hold up some fingers in different places and I want you to hold up the same number of fingers. OK? 4 Facial movement The patient is examined by looking at the patient's face and noting eny spontaneous fecial mavements. The facial movements in response to commands are also tested. Such commands may inclide asking the patient to ‘grimace or smile, to puff out* hisyher cheeks, to pucker*, and to close his/her eyes forcefully. 7 Limb ataxia® The patient is examined for evidence of a uniterel cerebellar Iesin.° Limb movement abnormalities related to sensory or motor dysfunction are also detected. Limb ataxia fs checked by the fnger-to-nose and heel-to-shin* tests. The “normal” sie should be checked frst, The movements shoud be well performed, smooth, accurate, and non-clumsy:* ‘8 Sensory The patient is examined with pin in the praximal* portions ofall four limbs and esked how the stimulus feels. The patint’s eyes donot need to be closed. The patient s ased i the stimulus is sharp o dul an if there is any asymmetry* between the right and lft sides.@ Fill in the gaps with words from the box. normal therapy onset diagnosis administered effective ‘A computed tomography, or CT, scan is essential when @ stroke is suspected for the folowing reason The mein (1) for strokes is the use of thrombalytic agents. These would be dengerous if @ to patients with hemorrhagic strokes and so it is important to have a clear @_ of an ischemic® stroke before thrombolyties are edministered However, the frst signs of intre-cranil ischemia eppear on CT scans about five to six hours after the alae of symptoms and thrombolytics are only (5) if administered in the first three hours of the crisis. Therefore, 2 6) CT scan af the brain is required for the administration of thrombolytics. @e@ [Fj ead the following text about CT scans. Then role-play explaining the purpose and procedure of a CT scan to Mr and Mrs. Marshall. The CT scanner ACT scanner is basicaly an X-ray machine that revolves around the patent. Instead of sing photographic plates to capture the X-rays, it uses electronic sensrs. These sensors convert the X-rays into digital data, which are then sent to 8 computer. This computer processes the information and produces images of “slces" ofthe body. ‘The GT scan has a major advantage aver normel rediogrephs in that allows the doctor to see soft tissue lesions * Hence, CT scans are indispensable inthe evaluation of cerebro-vascular accidents, or strokes, es all the damage is in the soft tissues. The following precautions have to be taken: © itis important thet the patient remave all metal or plestc objets (earrings, dentures, lasses, et.) before the scan, © Ibis nenessery for al rciology staff and relates to leave the room. If the patient is enous bout this, then reassure them that they can see the control room and thet there is two-wey communication between the petient end the steff o relatives. In pecatric cases, a parent may te alowed to stay with the patent but vill have to wear a lead apron * The procedure is quick and painless. Some patients complsin of CCaustrophobia when they ae in the tunnel ofthe scanner, but as scanners g2% quicker and quicker: this has became less of problem. @@ [J Prepare a short description or explanation of a piece of equipment or procedure that you are familiar with. Present it to the class without mentioning its name. Your classmates have to guess what it is. Lesson 2 GAZA3 1) rs. Marshall is going to have an ECG. Read the text below and fil in the gaps with words from the box. ‘The ECG, or electrocartiagram, or EKG, is @ non-intrusive test used to measure the electrical activity of the heer. The heart (1) ‘electrical signals that travel through its muscles. However; these signels “leak” out of the heart and pass through the (2) chest wal, This is fortunate because it, means thet the signals, can be easily (3) extemally without discomfort to the patient or (4) provetiures, To perform an ECS, sensors are (5) to the arms, legs and chest well in very specific places and the EOG machine then automaticaly produces @ numer of graphs that the doctor can use to 6) @ heart disorder, Patients are often under the impression thet they are going to be electrocuted when they are connacted up to the ECG. tt may be necessary to (7) ____ them and explsn the procedure more clearly. Its important that the patient remain ( during the test as any small movements, even trembling or shivering, can affect the results. Robert is calling the hospital in California where Mrs. Marshall received treatment ten days ago. Listen and fill in the gaps in his notes. St dd PPP a dd . (o) pessaceeecapseee chest pain. On admission: ECG: ‘ST segment and T wave (2) Diagnosis: Acute MI Re: Morphine 2 mg IV G) sie Nitroglycerin Heparin After 6/24: ECG: Reduced ST segment and T wave abnormality. Elevated levels of CK-MB myocardial (4) After 24/24: (6) subsided. ECG normal. Elevated CK-MB. Patient discharged herself after 36/24. 4 aWork with a partner Write the full forms of these abbreviations from Exercise B. 4. PMH 2. OE 3. ECG 4. Ml 5. Px BW 7. [24 Mrs. Marshall needs a drip line.* Put the steps for setting up a drip line in the correct order, Collect all the equipment: you vill need Open the roller clamp to allow the correct flow of fluid. ‘Attach tubing to IV bag, open roller clamp, and fill tubing with fuid, close clamp, ‘Set up the IV stand. Secure the catheter to the skin with adhesive tape. ‘Apply a tourniquet® around the patient's arm, 10 om above the elbow. Select @ vein, cleanse with alcohol, insert the needle rapidly and smoothly through the skin into the vein, Fill in the patient's details an the label, attach it to the \V solution bag and hang the bag on the IV stand. \Wesh your hends and put on gloves. OO OF O08 OOO ooO8 When blood appears, attach the catheter to the tubing, 1. roller clamp 3. stand 2. IV solution bag 4, catheter @@ FF work in pairs. Role-play the following situations. 4. Student A explains the purpose end procedure of en ECG to student B. 2. Student B explains the purpose and procedure of putting up a drip line to student A.@@ Ey Find a partner and role-play the following situation. J Harbinger ofthe Stroke Team | Situation: Dr. Harbinger has arrived and asks | Robert to give him a summary of Mrs. Marshal's ‘case so far, including past medical history, present | complaint, history of present complaint, | medications, etc. Dr. Harbinger asks follow-up | ‘questions to clarify doubts and obtain further details about the case, Listen to the actual conversation between Robert and Or. Harbinger of the {B—_ Stroke Team, Check that: you included all the points in your role play. © Bh Listen to the second part of the conversation and fill in the gaps in Mrs. Ps Marshall's notes. re PHYSICAL SIGNS Cardio-vascular: No murmurs, rubs*, or gallops* Neuro - Mental status: Alert Cranial nerves: Mild facial droop" on (1)______ Visual fields: Profound right VF deficit” Motor: Drift* of right arm and leg Sensory: Decreased (2) on right Spe Moderate expressive aphasia” Cerebellar: NAD* LAB RESULTS Glucose: @) | INR:* @) Platelets: (Gh oeeeoreece | CT SCAN No acute hemorrhagic infarct or subarachnoid” blood. No evidence of (6) ____neoplasm,” arteriovenous malformation,” or aneurysm.* ECG ‘Absence of R waves in the anterior precordial leads consistent with previous ” infarctRead the following text. What further questions would you want to ask before prescribing thrombolytics far Mrs. Marshall? What additional tests would you order? Contraindications to the use of thrombolyties {thas been shown that medications that dissolve blood clots, or thrombolstie, if administered correctly, can improve recovery from a stroke. Thrombolyties are most effective when administered within three hours of the cerebro-vascular accident, However, these medications are not without risks and the physlelan must ensure that the patient does not have any ofthe following contraindications: 1. Rapidly improving or minor symptoms | 10. History of gastrointestinal or usimay tract 2, Bvidenoe of intracranial hemorrhage on hemorrhage within 21 days pre-treatment exam 14, Recent lanbar puneture History of intrarantal hemorrhage 12, Tnracranal neoplasm," arteriovenous ‘malformation, or aneurysm” 18, Known bleeding diathesis including, but not limited to: «© current use of oral anticoagulants? (c.g, warfarin sodium) or recent se, with Suspieion of subarachnoid” hemorrhage Recent intracranial surgery serious head trauma or recent previous stroke (<8 months) 6. Major sungery or serious trauma exeluding head trauma in the previous 14 days International normalized ratio (INR) >1.2 7 On repeated measurements, systolic blood © administration of Heparin within 48 hours pressure >185 mmiig or diastolic blood pressure preceding the onset ofthe stroke or an >110 mig at the time treatment is to begin, elevated activated Purtal Thromboplastin Patients require agaressive treatment to reduce ‘Time (aPTT)* at presentation ‘blood pressure to within these Iimts. © platelet? count <100,000 mms. 14, Abnormal blood glucose (250 or > 400mg.) 9, Active internal bleeding 15, Post myocardial infarction pericarditis Seigure* at onset of stroke (Seasons gine gosmnanisummanase?astStdce, M-SA2hrt- 20) @ © Robert needs to explain the risks and benefits of thrombolytic agents to Mr. Marshall. Role-play the situation using the information in the following text to help you. Thrombolytic Agents in the Treatment of Ischemic Strokes: Benefits and Risks ‘There are two types of stroke: ischemic and The principal risk from thrombolytic agents is symptomatic hhemorthagie. Ischemic stokes are caused when one of intracranial hemorbage. 64% of patients who took thrombolytics the major arteries to the brain is occluded® by 2 had an inta-cerebral hemorchage as opposed 10 0.6% wha were thrombus.* given the placebo, 75% of patients who suffer symptomatic intracranial bemorshage die within three months. Studies fave shown that selected patients with ischemic stokes who are given thrombolytic agents Although shrombolytis are potentially highly beneficial fo the Within three hours of the cerebro-vascular accident patient, they are not without their risks. It is therefore highly are 33% more likely fo hve a near normal NIH advisable to have an open disewssion withthe patent and relatives, stroke index afer three months than patients who outlining the benefits and risks, before a decision is taken to receive no treatment, administer trombolstes. (Saves rs atin ge or an Soe Ba Bay Ga Te poms air ae oN Bl Wa REST) Lesson 4ET} ; Lesson & Let’s decide your rehabilitation plan 1D Some 24 hours have passed and Mrs. Marshall is making @ good recovery. Some decisions now have to be made about her rehabilitation plan. Write the sentences below in the correct boxes in the flow chart. (Source: hap:iwww ogp med.va goslepe!STRIst_ 20 years OVE: Oral hygiene excellent, Full dentition, no dental restorations. No gingivitis, periodontal disease or caries. Nicotine staining of teeth. Soft tissues healthy. Strong, halitosis but appears not caused by oral pathology. 7 pathology of respiratory tract, 7? liver disease. |B) Read your classmate's letter and write a reply. Use the information below.Grammar Resource Guestion forms (review! Reported speech Past simple vs. past continuous tense Past perfect tense Modis for deduction Tag questions Passive vaice Phrasal verbs a 8Review: Question forms Yes, | do. No, | don't. Yes, my son does. No, thay don't, Yes, | can. a you feel any pain? Does anyone in your family have the seme problem? Gan you turn your head to the left? No, | can't Why are you here today? What seems to be the trouble? When did you first notioe the ringing in your ears? Where does it hurt? How would you describe the pain? 1'm having trouble welkng, 1 think Pve hurt: my fot, Two days ago. In the middle of my back. It comes and goes. = Wh- questions start with who, what, where, when, why or how. "Whe questions always require a longer answer. PRACTICE Read the patient's answers below. Write the doctor's questions. 1.0 7 A Yes, Ido. | smoke a peck of cigarettes e day. 2a sami ‘A: | have this lump on the back of my neck. 3.0: ‘A; It hurts when you touch it right there. 40: A: Yes, do, Pm allergic to periilin, 5.0: é ‘A: Yes, Ido. | run five miles a day. EETTTET Think about your most recent doctor's appointment. Write down at least three questions the doctor asked you. M42] Grammar ResourceReported speech “You don’t get enough exercise,” ‘The doctor said (that) I didn’t get enough exercise, “Your test results are inconclusive.” | The doctor told me (thet) my test results were inconclusive “Please sit down,” The nurse asked me to sit dawn, * Reported speech reports what someone has seid. * The use of that's optionel. = Some reporting verbs €.9. tell must be followed by an indirect object or pronaun, * Change the present tense in direct speech ta the past tense in reported speech. * Change the pronouns to reflect the correct person, sey agree complein explain tell ask assure advise reply state. answer convince promise remind teach PRACTICE Imagine you are reporting what a doctor told you during e consultation, Change the direct speech to reported speech. 41. “Do you have any family history of diabetes?” The doctor asked me if | hud any family history of diabetes. 2. "Your temperature is a litle high.” 3. “Can you roll up your sleeve.” 4, “Please stand aver here," 5. “You can exercise normally during the treatment.” EESTI Think about a recent conversation you have had. Retell it in reported speech, Grammar Resource EAI© Past continuous vs. simple past ‘Afirmative statement 1 was just finishing the night shift when an emergency case came in. Subject + was / were + present participle Negetive statement He wasn’t complaining cbout the pain until we got here Subject + was / were + not + present participle Yes/no questions Were you leaving the hospital when the patient arrived? Wes / were + subject: + present participle Wh- questions What was she doing when she fainted? Wh- word + was/were + subject + present participle "Use the past continuous to tak ebout ection thet were already in progress ata given time inthe pest The past continucus is nat used on its own very often Iti frequently used together with the simple past to show that one ection hegan and wes in progress when another action happened In these situetions, the adverbs when and whl are often used Wile | was finishing @ ward round, a new patient came into Emergency. Doctor Platz was just keving the hospital when the ambulance arrived. PRACTICE 1 Complete this text about a medical intern’s first night shift using the verb in parentheses in the correct form When | (arrive) at the Emergency Department for my first night shift, several patients and their relatives, (weit) to be attended. A nurse (look for) the relatives of 2 patient who had just been admitted. A doctor (ask for) some test results. A child (ory) while a nurse, (try) to take a blood sample. Some nurses (leave) the hospital efter finishing work end the night staff (start) their shifts. PRACTICE 2 Write sentences about two events using the simple past and the past continuous. Use when or while. 1. me /just finish / they / cell ward round / to emergency / Z 1 was just finishing a ward round when they called me to emergency 2. my e-mails / arrive / wait for / patient / check / 8. She / work / the garden / start / feel ill / she 4. he / cough / wheeze / patient / the consulting room / come into 5. have surgery /he /his relatives / outside / weit SEY Grammar Resource© Past perfect tense ‘Afiomative statement The doctor had explained the tests when the nurse arrived Subject + hed + pest perticole Negative statement | had not expected to jzave the hospital so saon after surgery. Subjact + had + not + past participle Yes/no questions Hau! you explained the procedure before? Had + subject + past participle Wh- questions What had you eaten before you sterted feeling il? Wh- word + had + subject + past participle * Use the past perfecto talk about an action that was completed before enother action ar time in the past or to explain why this event heppened. * The past perfect is used forthe earlier action, and the simple past forthe later action * With before and after, the present perfect isn’t necessary because the time relationship has already been established. Before Jui fnished work, she started to fel il. After the operation, they took me back to my room. PRACTICE 1 Read the sentences and circle the correct verb forms. 1. | Gust finished / had just finished) work when | (started / hed started) to feel dizzy. 2. Susana (was / had been) worried about the operstion. She (never had / had never had) surgery before. 3. By the time he (arrived / hed arrived) at the hospital, his wife (had / had had) the baby. 4, The patient (complained / had complained) that he (didn’t eat / hadn't eaten) before coming to the hospital. PRACTICE 2 Complete the text below with the verbs in the correct tense (simple past ar past perfect) 1 (check into) the hospital inthe afternoon, | te) worried because 1 (never have) surgery before and | (ot know) what to expect. But Jake (stay) with me until they (tell tim that he had to leave, By evening, | {already prepare) for the operation. | {wait for them to take me the operating thester, Befare | (inow it, the operation was aver and | (be) back in my room. Someone (leave) some flowers and a card in my room. They. (be) from Jake. Grammar Resource* Modals for deduction ‘The patient has a mild fever and cough. Could, might. and may can be used to say that a situation is {t could / might / may be a viral infection. | possible. In this example, there are other possible diagnoses (besides the viral infection) ‘With these levels of glucose, it must be ‘Must can be used when we have & bigh level of certainty diabetes. bout a particular situation. In this case, the level of glucose indicates that other possbiities have been eliminated, ‘We can be faity certain that the patient has disbates. The tests came back negative The opposite of must for expressing high degree of certainty Ie can't be meningitis about something is can’. n this case, the tests dane to check the dagnosis of meningitis were negative. We can be fery sure the patient doesn’t have the disesse * We can also use it is likely / unlikely to express strong possibilty. There is na knavn family history. It's unlikely to be hereditary. {t's likely that she picked it up at school. A lot of her classmates are ill. PRACTICE 1 Write Do you think questions with the follawing modals. 4, might / have an infection Do vou think my son might have an infection? _ 2. could / teke a pain killer 3, may / have hurt the tendon 4, might / need tests PRACTICE 2 Use modal verbs to make deductions about the following situations. 11, She's wheezing and in obvious respiratory cistress, She might have bronchiolitis. 2. The patient: has dierrhee, nausea and stomach pain 3, Susan has been sneezing all morning 4. There are differences in percussion between each side of the chest. FD Sraimimar Resource* Tag question Simple present You work, don't you? Present continuous | You ere working, aren't you? Simple past They talked, didn’t they? Past continuous They were talking, weren't they? Present perfect: They have talked, haven't they? Past perfect They had talked, hadn't they? Future You wil tal, won't you? Present, past and future tenses Yes, | do. No, | don‘, Yes, lem, No, I'm not. Yes, they dd. No, they didn't Yes, they were, No, they weren't Yes, they have. No, they haven't. Yes, they had. No, they hadn't Yes, we wil. No, we wan't. * Tag questions are used to check if something is true. * Atay question uses an auxiliary verb + a pronoun. * A tog question uses the same tense as the min ver * A teg question can consist of a negative statement, and an affirmative tag question You don't wark, da you? PRACTICE Match the tag questions to the statements 4 2, 3, 4 5, 6 7 8. 9. 0. He was informed of the procedure, Roberto didn't do 8 good job, The hospital wes offering free screening, haven't been late for any appointments, Sarah had worked herd, They arrived a few minutes lave for work, You haven't been exercising lately, Iwas at thet meeting, We had increased the hospital's efficiency, She has taken on more responsibilty, hadn't she? . wasn’t he? wasn’t it? didn’t they? didn't we? have you? hasn't she? hadn't we? wasn't |? have I? did he? EXERT) Add a tag question to each statement. Then answer the questions so they are true for you. 1. You are always on time for class, —_ 2. You do exercise, 3. You try to meintein healthy det, 4, Your grades were great last semester, Grammar Resource EEE| The passive voice ‘Afnmative statement Operations are performed everyday (by surgeons). Subject + be + past participle Negative staternent 1 was not told about the meeting (by the chet resident). Subject + be + not + past participle Yes/no questions Wore raingraphs taken? Be + subject + past participle Wh- questions ‘When was the donor organ delivered? Wh- word + be + subject + past participle = The passive voice can be used with any verb tense. The form of the verb to be is changed to indicate the tense. The hospital was builtin 1965. (pest simple) The fracture is heing set at the moment. (present continuous) She has been moved to another werd. (present, perfect) The doctor will he finished shortly. (will future) ‘= Sentences in the passive voice talk meinly about the resuit of the ection, nat the person who does the action (the agent). ‘= Include the agent in the sentence only if this information is important. The surgery was performed by Dr. Church. PRACTICE 4 Rewrite each sentence in the passive voice. 41. Dr. Rowlngs referred the patient for further tests. 2. We removed the stitches on his last visit. 3. Dr. Marshall examined the patient. 4, We ran some routine tests. 5, Suroke patients usually require extensive postoperative care PRACTICE 2 Fill in the correct form of the verb in the active or passive voice. 1. We (Go) a biopsy after finding ¢ lesion inside her mouth. 2. The doctor. (test) the patient's reflexes. 3. This condition (treat) with antibiotics. 4, Depression (present) in many ofthese cases. 5. De Murrey (examine) the patient 6, The patient, ~eamplan) of a intense stabbing pain in his back WEL Gisiiinar escurce* Phrasal verbs z splinition 23. AE | He wrote down the dose. Two-part phrasal verbs consist of @ verb + preposition | can’t put up with the pein any longer. and / or adverb, Let's callin @ specialist. Some two-part phrasal verbs can be separeted by a noun Let's all a specialist in, or pronoun, Let's call her in If pronoun is used, it must separate the parts of the verb. Don't give up now. You have almost Some two-part: phrasal verbs cannot be separated. finished your treatment We need to come up with an explenation for | Mult-word verbs consist of a verb, an adverb and a the problem, preposition, They can never be separated and always take a direct object, + Some two-part phrasel verbs can be seperated: callin / up, fill out, leave out, put on, set up, turn on, write down, = Some two-part phrasel verbs cannot be separated: look into, show up, keep on, give up / in. PRACTICE 4 Underline the correct sentence. If both are correct, underline bath of them. 1. wrote down the correct dose. / 1 wrote the correct dose dawn 2. He left out the test results. / He left the test results out. 8. Did they ever look into the cause of the fever? / Did they ever look the cause of the fever into? 4. Ifyou can’t put the pain up with, we'll call in ¢ specialist. / If you can’t put up with the pain, we'll call in a specials, PRACTICE 2 Rewrite each sentence using a pronoun instead of the underlined noun. You can turn on the machine. 4. 2. She set up two anoointments, 3. You should put on the robe. 4, We need to callin e specialist. 5. Please fill out the insurance form. Grammar Resource ESPicture Dictionary 4 Surface Anatomy 2 The Human Skeleton 3 General Anatomy 4 Medical Instruments 5 Nursing Procedures 87 88 Ee so st@The Human Skeleton 1 [— Midical term | Lay term 7 orem sal 2. mandi jaw bone 3. david ‘collar bore 4. siemum breast bone humerus arm 6.) radius, 6) uina_| forearm 7. pelvic girdle hip bone femur thigh bone 3, patel free cap 10.2) tbe, 6) fouls | stintone “1 cervcal spine | neck bane 1, scapula shoulder Bade 78. cage ribs 1 spine Back bone@General Anatomy [tren@Medical Instruments Ss [struments 7. sstacone 2. themonetr 3 schyomonnomitr| 4 osone 1 opthlnasope refx hanmer 7. dental probe del mor $.camps 70. salGlossary | Nate: The definitions given in the glossary are specific to the context in which they are met in English for Health Sciences. | For a more general definition, the reader is advised to consult @ dictionary. eee eee eee 1a statistical sampling or testing error caused by systematically favoring some outcomes over others ‘to stick together fa lack or shortage of breath celiac disease n disease caused by an allergic reaction in the intestine to a protein (gluten) found in wheat cephalosporin 0 ‘type of antibiotic used for penicilin-resistant bacteria clubbing 7 thickening, usually et ends of fingers dizziness 0 vertigo, 8 feeling of being unstable, about to fall duliness 0 8 dead sound heard when the chest is tapped dure fone of the membranes around the brain and spinal cord dysarthrie slurred, unclear speech exophthalmus 0 staring eyes flaring 1 dilating, expansion or opening of the nostrils fasting n ‘the act or practice of abstaining from or eating very little glucosuria Presence in the urine of abnormal amounts of sugar hemegiobin AIC test n a test that shows average blood sugar throughout @ two- to three-month period hissing Cin ears} n tinnitus, 8 sound like sir escaping from e tire hot flush ‘a hot sensation hyperhidrosis heavy sweating hypoglycemia low blood sugar ketone » @ product of fat metabolism found in the urine of diabetic patients lobe » rounded projection of a body organ or part lump ‘tumor, swelling mean n average muscle wasting ad loss of the tissue of the muscles night sweats 1 profuse sweating during sleep nystagmus 0 involuntary eye movements ophthalmoscope n an instrument used to examine the eyes oral agents ‘medication taken by mouth etoscope 0 an instrument used to examine the ears phlegm n @ moist excretion that protects mucus membranes, mucus Podiatrist 7 ‘specialist in caring for the fest polyphagia 1 excessive hunger polyuria frequent: urination rash red spots or marks on the skin refined {sugar ad processed (white sugar) ringing 0 a sound like a bell in the ears Romberg test 1 neurological test where the patient is asked ta stand with the eyes closed and the fest close together; tests poor balance seizure a an attack where the patient's body becomes rigid and collapses sphygnamometer n an instrument used for measuring blood pressure stabbing ad describing 8 pain like a knife entering the bady stridor 7 2 sound made when breathing out ‘tachycardia 1 rapidly beating heart. tingling 7, adj 2 fesling of pins and needles, partielly numb, parasthesia ‘remar 1 shaking vertiga 0 dizziness vital signe temperature, blood pressure, pulse and respiration rate weighted adj adjusted to reflect value or proportion wheezing 1 breathing with difficulty, making a hoarse whistling soundUnit 2 ‘seration © airway 7 bronchiolitie = inflammatory burst © sion eachexic a cascade * cerebrospinal fluid 0 comatose 21 conjunctival 2) constricting cramping” orest 0 ericothyretomy 7 CSF n CSF / serum glucose dose n drowsy ad) edema n flared adj flex flushing 0 Grams stain hemateme 7 hypoxemia intercostal adj intubation 1 lethargy 0 lever vo lignocaine 1 mandibular ac) manometer 7 nanstender 6d) numb v Observation Ward 7 orderly 7 percussion 7 pericarditis 0 post mortem 7 retrastions 7 retrieve v shift 0 short-staffed a) splint v supply of arr to the lungs ‘the breathing passage, larynx, trachea and branchi ieflemmacion of che air sacks of the lungs caused by respiratory syncytial virus 2 ropid increase in inflammation of a tissue abbreviation for “complains of underweight, thin cone event leading to another and so on tthe fluid that surrounds the brain and spinal cord in 8 coma, unconscious related to the conjunctiva, ar membrane covering the eye tightening 2 painful sensation felt in the muscles after excessive exercise tthe top or peak of a curve «surgical operation to open the wind pipe at the front of the neck to allow the patient to breath tthe visible part of 2 tooth cerebro spinal fluid ratio n tthe ratio between the glucose level in the cerebro-spinal fluid and the tlucose level in the serum. the recommended amount of 6 drug taken by a patient sleepy swelling caused by excessive lymph fluid in the tissues dilated, open to bend {a reddening of the skin fa stain on a microscope slide used to identify bacteria, 1 blood filed swelling, 2 bruise abnormally low oxygen in the blood between the ribs putting a tube into a hollow organ, e.g. the trachea or esophagus lacking energy to lift out @ tooth a local analgesic referring to the mandible (jaw bone) a meter for measuring pressure a chemical released from cells as @ result of the interaction between an antibody and an antigen ‘an imaginary line drawn down the center of the body @ heart sound like someone speaking very quietly not painful ‘to make part of the body lose its ability to feel @ room in @ hospital where patients are watched carefully 2 hospital worker who cleans end does chores hitting or tapping something inflarsmation around the heart ‘an examination performed after death drawing in of the neck and chest with each breath 9 recover, to find ‘the part of the day in which 2 person works not enaugh workers for the tasks to be performed support or restrict with a rigid appliance (splint) ‘8 group of fat soluble compounds, e.g., progesterone, cholesterol tthe thread closing @ wound or cut a type or species of a bacterium or virus ‘@ rough vibrating sound when breathing in below the ribs under ane of the linings (dura mater) of the brain and spinal cordsuprasternal adj swelling 7 swollen ad) syncope 7 ‘cunbiel od) umbilicus 7 unmatched bleod urticarial rash n ward reund 1 Unit 3 ‘ching cj aggravating ad alleviating adj auscultation 1 blunt ac cavity 7 eyanetic ax ull og) ECG n excruciating od flank n frank adj neuropathy 1 posture n retrosternal ad rippling ad sharp ad hosting adj slight aj spasm 1 stabilize y startle response suppression 7 euture 7 trigger v unbearable adj aneurysm 1 anticoagulants aphasia n aaymmetry 0 ataxia clumsy ac) deficit n above the chest bane ‘an abnormal enlargement, tumor being abnormally enlarged fainting, brief loss of consciousness cloudy, not clear tthe navel, the scar left when the umbilical cord is cut blood which can be given to a patient of any blood group hives. welts, small white bumps on the skin often caused by insect or plant stings. a doctor's tour of his patients dull, lasting (pain) making something worse making something better listening to something, usually with @ stethoscope not sharp hole, often in a tooth blue color of the skin, especially the lips ‘not intense (pain) electrocardiogram, sometimes known as an EKG extremely painful the side of the abdomen ‘open. direct, unafraid to sey the truth 2 test to find if there are antibodies to the enzyme GAD bad-smelling breath involuntary contraction of the jaw muscles (plural metastases), secondary cancer grawths nat severe ‘small harmless bluish-colored swelling on the lips or in the mouth an abnormality in the nervous system ‘the way the body is held to start, to initiate, to set aff 8 feeling like something is pushing a part of the body behind the breastbone like waves on water 8 sensation like a needle 2 sensation that travels quickly from one pert of the body to another not severe involuntary contraction of a muscle to use a pin or plate to stop a fractured bone moving involuntary reaction to @ sudden, unexpected stimulus reduction, lowering, decrease stitch used for sewing @ wound a small piece of cotton used to clean wounds like @ heart beat partially numb, parasthesia, pins and needles to start, to initiate samething 2 pain which the patient cannot tolerate away from the midline 8 pathological swelling in the walls of @ blood vessel medications used to stop the blood clotting loss of ability to understand or produce language when one side of something is different: from the other lack of coordination uncoardinated a lack of something a hereditary predisposition to en illnessdoreal ad) rife 7 drip line 0 droop n extension 7 flexion 9 galt n gallop 9 glenohumeral joint n alice grimace v harnese n hemorrhagic ad) INF n iechemie ad joint lesion 7 malformation 7 mobilization 9 NAD n neglect 1 Reaplasm 1 numbness 7 nursing home 7 peclude v toward the back of the body the falling movernent of a limb when the patient cannot support: it 2 tube which carries fluid or medication into the patient's blood hanging downward straightening an arm or leg bending of a joint so the angle of the bones at the joint decreases walking an abnormal heart sound with three or four separate beats the shoulder joint the smooth movement of a joint to make an ugly face tapes or straps used to support some thing bleeding a test to measure how quickly the blood clots. Prothrombin Time/international Normalized Ratio a lack of blood supply to an organ tthe place where two bones meet 8 diseased or injured piece of tissue 3 part of the body that is not: formed correctly movement: ‘abbreviation for Nothing Abnormal Detected ‘the habit of nat using a part of the body that is damaged ‘an abnormal growth of tissue, a tumor lack of physical sensation or feeling {an institution for people who cannot look after themselves, usually the elderly +0 block Partial Thromboplastin Time Plasticity n platelet 0 probe 0 pronation 1 proximal od pucker v puff out v quadrant 7 carpal joint n end range n rehab 7 rub n set up v shin slurred ad) subarachnoid ad) supination ‘temporal af ‘thrombus n ‘tourniquet UE D (aPTD na test to measure how quickly the biood clots tthe ability to change shape or function @ blood cell which takes part in blood clot formation @ sensor that measures something (often electricity) to turn the hand so the palm faces down or back to shape the lips as if giving a kiss ‘to expand, often used with the cheeks a quarter of a circle wrist joint, tthe limit of movement of a joint abbreviation for rehabilitation fn abnormal heart sound cause by friction between the pericardium and the heert to install tthe front: of the leg below the knee pranounced indistinctly below one of the membranes (arachnoid) that covers the brain to rotate the hand so the palm faces forwards near temples of skull a blood clot ‘a piece of equipment (often a rubber tube) to temporarily stap the flow (of blood in @ lime upper extremity, arm removal and examination of exemple of tissue from a living body for diagnostic purposes a blue coloring of the skin caused by injury invasive malignant. tumor that: tends ta metastasize to ather areas of the body ‘abbreviation for Cardiovascular system unwanted, waste material, e.g. wax in the ear degenerative disease @ disorder in which the patient: slowly gets worse or deterioratesET “Giossary derangement 1 erupted ad) erythematous 2% excision biopsy 7 aan abnormality in the usual arrangement. visible reddening of the skin caused by diistation and congestion af the capilaries the complete removel of a lesion for microscopic examination external auditory meatus 1 exudate n febrile ay floss v gauze pad n gingiva n gingival recession » gingivitio n © pack 7 jew n ligament n lymph node lymphadenopathy 1 mandible 9 mastication 7 meatus 7 NSAIDe n ecelusion otalgia n palpate v papilla n pericoronal axj ericdontal ligament 1 periodontitis pocket 1 putt n radiolucency » Gide effect 7 ginusitie n socket 7 spatula 7 the canal that leads from the external ear to the ear drum fluid, especially lymph or blood, that escapes from & wound ar lesion characterized by fever, feverish to clean between the teeth with 8 thread ‘an absorbent piece of cotton the gums receding or shrinking of the gums inflammation of the gums @ cloth bag contain ice which is placed against a wound used to reduce swelling tthe bone to which the lower teeth ere attached sheet or band of tough, fibrous tissue connecting bones or cartilages at a joint or supporting an organ small gland which is part of the lymphatic system 8 chronic, abnormal enlargement of the lymph nodes, usually associated with diseese lower jaw chewing 2 body opening or passage ‘the lining of the internal surfaces of the bady Non-Steroid Anti-Inflammatory Orugs (ental) the manner in which the upper and lower teeth meet earache to feel tthe piece of gum between the teeth ‘around the crown of a tooth tthe fibers thet connect the teeth to the bone inflammation of the fibers that connect the teeth to the jaws ‘an abnormal recess between the gums and the tooth short, forceful exhelation of breath allowing the passage af x-rays or other radiation ‘the additional, sometimes unwanted effect of an action inflammation of the nasal sinuses ‘the hole left in the jaw after a tooth has been extracted @ fist instrument for holding down the tongue temperomendibular joint 1 tenderness 7 third molar 0 tinnitus 7 TMs 1 wisdom tooth n ‘the jaw joint, the jeint: between the mandible and the cranium sensitivity to pain wisdom teeth, the last molar teeth a hissing or ringing sound in the ear ‘temperomendibular joint lack of uniformity, consistancy tthe last’ molar withdrawal symptoms 7 ‘the unpleasant feeling a person hes when an addictive drug. e.g nicotine is taken aweySo Audio Script ‘Unit 1 Making a diagnosis Lesson 1 D Page 3, Exercise H co Br Murray: Come in, please. tt’s Mrs. Thurston and this is, T2 Mark, isn’t it? ‘Mrs. Thurston: That's right, Dr: Murray. (Dr. Murray: Can | introduce a colleague? This is Robert, Mitchell. He's a medical student. Robert: Nice to mest you. Mrs. Thurston: Nice to meet you, too. (Dr. Murray: Now, how can we help you? ‘Mrs. Thurstan: Yes, well the problem is Mark. | knaw he’s ata difficult age and al teenagers just want to drink ‘soda and eat; junk food, but he drinks lke about three bottles of soda a day. Those big bottles! And then of ‘course, he's always going to the bathroom. You know ‘sometimes I think... ‘Dr, Murray: OK, thank you, Mrs. Thurston. Can | just ask Marka few questions? OK, Mark, so you've been feeling very thirsty S Page 3, Exercise 1 99 De. Murray: When dl this thirstness begin? Maric dl say about two or three weeks ago. Dr, Murray: And are you thirsty ll the time? ‘Marke Yes. But especialy fter | have eaten. [Dr Murray: Ard how often do you have to go tothe bathroom? Mark: Oh, | don't know. About sc times a dy. Maybe more, Dr. Murray: What about at right? Marke Yeah, | have to getup in the night as wel. Dr, Murray: Have you had any problems ie this before, Mark? ‘Mark No, I don't think so Dr, Murray: OK, Mirk You're doing great. Now, are you having any other probiers? Mark Like what? Dr. Murray: Wel, other health problems, school, you know anything? ‘Mrs, Thurstan: Hs teachers say he's lazy, Just won't work Dr. Murray: Mark? Marke Wel, 'm always tired. | used to play a lt of basketball, but now | get tired in no time, Dr, Murray: And when cid this start? Marie Azout @ mont ago, | quess. Dr. Murray: Anything ese? ‘Mark: No, | don’t think so (Or. Murray: Robert, ae there any questions that you would ike to ask Mark? Robert: Thenk you, Doctor. Yes, there are, Mark, have you been losing weight recently? ‘Maric No, | don't think so. Don't relly know. (Mrs. Thurstan: Actualy doctor, it's funny you should say that, but | was saying to his dad the other day that Mark's looking thin. But his dad said thay it was just a stage he was going through and that he would fil out ‘eter. Robert: Thenk you. Just one mare question, Mrs. ‘Thurston. Has enyone else in your fmiy had a sirilar problemi? (Mis. Thurston: No, I dont think so. My mother died of a stroke end my father is stil alve, but he's not wel. You ‘know, he has problems with his heart. And he has problems with his eves es well-nothing tke Mark has, Robert: Thank you very much, Mir Thurston. Lesson 3 & Page 6, Exercise B 60 Dr: Mnrray: Now, Mark, just he vo check ot few things. Could you takeoff your shoes, soos, and shirt, please? OK, thet's fe. And now could you stand onthe scales end we'l measure your height and weight. OK, Robert, so Mark weighs 110 lbs end is 5 feet 6 inches tal, (OK, Merk, now_'m just going to take your temperature. Open wide. Fre. While we're wating for that, take your blood pressure OK, so your temperature is 98.6 degrees and your blood pressure is 120 over 70. No problem there. Let's check your pus. OK, Robert, Heart rate oF 60 and resrirtin rate of 15. Fine, Mark You're ding great. Now, i you could just stand up and Il have a look at your eyes and eas. Open your mouth please. Say each. OK, Robert. Audio Scripts @ 8 EET Audio Script Everything OK there. Now, you could just turn around end ook upto the cing, ke to cheok your neck. Robert, would you make @ note that there isa sight sweling ofthe thyroid land Now, Lesson 4 Page 3, Exercise D Dr. Murray: Good morning. Mrs. Thurston and Mark Good morring, Dr. Murray: So, Mark, How ere yau feeling? Marke Pretty much the same, Doctor. Dr, Murray: OK. Wel, Mark, we have the eb resus end 25 we suspected, it appears that you have diabetes. Mrs. Thurston: Oh, no! Thet’s what my father has. Does this mean thet Mark wl have to Give himself nections? ‘And my dad has al these other problems that they say come from diabetes. Dr, Murray: Don': worry too much, Mes. Thurston, Each case is cferent and we have made alt of progress in the last few years ‘Marke: Does this mean I won't be able to play sports anymore? Dr. Murray: Not ata, Mark, You willbe able to laed @ completely normal fe. You can eet mare or less the same food a8 all your friends. No one will even know you have diabetes. ‘Mis, Thurston: But hel have to give himse injections, won't he? Dr, Murray: Not necessary. There are some nev gadgets that you wear thet do away with rections. Marke Yeah, there's another kid at school who has ane of ‘those, But he hasta tate blood semples Dr. Murray: Yes, that's right, you have ta check the amount of suger in your blood. (Mrs, Thurston: Don't worry, Merk. sure everything is going to be OK. Dr. Murray: That's right. Thankyou, Mrs. Thurston, But please remember, Merk, diabetes isa serous cordltion and it can have long-term consequences if you don't fol a very careful treatment plan, OK? Now, a's go ‘through everything step by step. Lesson 5 Page 10, Exercise C ‘Nutritionist: Hall, it's Mrs. Thurston end Mark, isn't? ‘Mrs, Thurston: That's right. We're here about Mark's dt. ‘Nutritionist: Yes, Dr Murray asked me to speak to you. | expect that he's exined all bout diabetes and haw we treat it. Mrs. Thurstan: Yes, he has, bu 'm stil nat sure exacty whet | have to cook for Mark st going to be a lot of trouble? Nutritionist: Don’t worry. Mark wil be able to eat more or less the seme as the rest ofthe fami, We just have ta rmeke sure he is getting the right amount of food at the right time and he has a belanced diet. Simple! ‘Mrs. Thurston: Wel, | hope sol ‘Nutritior IK, Mark. First we need ta calculate haw many calories you need per day. I've got your age height end weight herein your notes, but | aso need to krow whether you are especialy active. mean, do you play alt of sports? Marke Yes, | would say so. | used to play basketball every cay before | got sick. Nutritionist: OK, so let me see. According ta the computer, ‘are cong to nead about 2250 calories per day. Mrs. Thurston: Whet does thet mean? ‘Nutritionist: OK, Mrs. Thurston, we're coming to that. Mark, do you know wiat carbohydrates are? Marke Sure, that’s where you get your energy fram. Things lke bread ard potatos. Nutritionist: Fight! And wiat about nutrition labels, can you understand them? Marke Sure. They tel you how mary calves you get from one serving and how much protein end vitarins there are, Can | ask you a question though? ‘Nutritionist: Sur, fre awey! ‘Maric | don't realy ge ths thing about serving, 'm used ‘to my mom's servings, and then you goto a restaursr and they give you tiny tle servings. seams all servings are diferent. How can you know how many calories you're getting? ‘Nutritionist: You're exec right, The tricks to look at the nutrition lel careful. always says how many ou for grams there are in 8 regular serving Mark So, #1 weigh one of moms reguer servings, be able to tell how many calories I'm getting Nutritionist: Do you think you can do that? Marke No problem. Nutritionist: OK. Now there are @ few more things you need to know. Fst, some foods dont have nutrition label, ike potatoes, som going to give you a chart vith thet information, Nex, the way you cook the food affects the numberof calories per serving Fried rice much more energy then balled rice fr exemple. Marke OX. So| weigh one of mom's monster servings, |up the calories on the chart and then calculate how many celories there ere in one serving. Easy! ‘Nutritionist: Oh, there's one last thing. You have to make ssure you eat @ balanced dit. Marke That's the food pyramid thing, isn't it? Mutrtionist: You got it! As a rough guide, 50% of your diet should be carbohydrate, 25% fruit and vegetables and 25% protein. ‘Marie So no fatty things and candy? ‘Nutritionist: Keep them to @ minimum, You can eat them, but just don’t eat too many. Lesson 6 S Page 12, Exercise co Dr: Murray: OK, Mark. We need to do a coupe of tests. 7 The first one is your thyroid function test. Marke What's thet? | think you told me lest time bu Ive forgotten. There was so much to understand, ‘Dr. Murray: It tests how well our thyroid s working, We thirkit's workng abt too well and we want to check ‘Clear? Any questions? ‘Marke 'm sorry. What's my thyroid? Dr, Murray: OX. e's start from the begining Your thyroid land, n some weys, i lke the acceeretor ono car: contro, haw fast your system works and lots of ther things es well. The thyroid lend produces # hormone, that's chemical messenger, caled thyrin. i there is ‘oo much in your blood, your system goes to qui, there ist enough it goes too slow, Do you fallow? Marie: Sure, ‘Dr. Murray: So f the thyroid lard is ie the aocelereto, ‘what is thyroxin lke? ‘Marke Erm, Well | suppose it's lke the gs. Too much and you go too fast Dr. Murray: You got “Mark: But what has this got ta do with my diabetes? Dr. Murray: Wel, you remember ast time | tol you that carbohydrate makes your blood sugar go up and insuin and exercise keep your blood suser levels dav ‘Markc Sure, that’s why lhave to reduce my insulin if do a lot of exercise. Dr. Murray: Fight! And you've been having problems belancing the two, haven't you? Mark: és, it's not ess, but 'm trying. Dr. Murray: Wel, this is where the thyroid comes in t's really dificult to keep your boad sugar right if your ‘thyroid gland keeps putting its fot onthe accelerator ‘Maric And 'm sryng to put my fot onthe broke at the same time. Or, Murray: OK! So you soe why we have to keep checking your thyroid function ‘Marke Yes, that's much clearer Dr, Murray: OK, Merk, 'm sure you understood but just to check, can you run through it again for me, Marke OK, my thyroid function tests are high, but only by abit. So we want to... Unit 2 Working under pressure Lesson 1 SD Page 16, Exercise B © Robert: Good moming, Oc Tan. I'm Robert Mitchel be 78 ith you for the next mnt Jenny: Hi, Robert. That's right, Dr: Murray tld me you ‘would be caning. nd by the wey, we dont have time for Dr. Tan in here.This is ifn the fast lene. Just call me Jenny. Robert: OX, Jenny. Looking forward to werking wth you. Robert: Jenry, ve never worked in the Emergency Room before. Is there any acvce you could give me? Jenny: Sure, Number one: Don't parc. Keap cool Robert: OX, easy to say, but dificult to do. Jenny: Fight! Then f you are not sure, ask. This is realy important. ' been dong tis jb for six years and I'm sil learning. Robert: OK. Life in the ER is extausting, You work ong hours, you're on your feet all the time and the pressure can get to you. So, my advice is got plenty of sleep when you can You'l ned it Robert: So, no partying after work. enny: You'll be so tied, you won't even be abe to switch on the TV Robert: Sounds fun! Jenny: And finaly, never use the “G" word. Robert: Excuse me? Jenny: Never say, “Things are real quiet today.” It is queranteed to bring in ten ambulances and three hecopters. Robert: Gotcha! Jenny: DK, s0 t's 9p 've ust had @ look at this patent and I've sent him for a sean. While we're waiting far the results, please get nurse to contact the next of kin and arrange for the dantal intern to examine the patient. [have feeling thet he has a fractured aw, ‘Audio Script EMPage 17, Exercise © Robert: Helo, is that Doctor Panty? Dr, Plantz: Speaking, Robert: Good morning, doctor. This is Robert Michel from R. Dr. Plant: Morning, Robert. Wht: ca | do for you? Robert: We have a patent hee with head injuries and a pmsible mandibular frcture, Could you came dawn and take a lool? Dr, Planta: Sue, but Im justfrishing @ werd round. Is the patient stbited? Robert: Sorry | rissa thet. What did you say? Strized? Dr. Planta: No stabized! | mean, can you wait about @ quarter of en hour? Robert: Abou ftaen minutes. Sure. Bye see Lesson 2 © Page 18, Exercise A co Nurse: t's Mr. Slenkovich, Wayne's father, isn't? M0 Ii, Slenkawich: That's right. What's happened to Wayne? 15 he al ight? ‘Nurse: Hel be fine, Mr. Slenkoich, But irs things frst. I ‘seems that Wayne frished work at 8 o'clck in the ‘evening and was just leaving the store when wwo men attacked him Mr. Siankovich: Had ha ready been to the bank with the ‘money from the store? Nurse: Im realy not sure, Anyway, some peoole saw the sseult and called an ambulance. The paramedies checked Wayne over, put on 3 neck brace, and brought bimin (Mr, Slenkoich: Did they get the guys who ettacked him? urs: | don’t know but the police have already spoken to \Weyne. Dr Tan examined him when he arrived and sent hi to have @ soan, He had @ disooacad jae, hich we put back in place, but there don’ seem ta be any broken bones. Anyway, we decided ta keep him infor the night. ‘Mr. Slenkouich: Why? f he's OK, why can't he come home? Nurse: Well he was knocked out fr ebout ten minutes after the attack and the dactor thinks that its best to keep an eye on hi. Mr. Slenkovich: Can | see hi? Nurse: Just for @ minute, He needs to rest. Page 18, Exercise D Nurse: Good news, Wayne. The doctor says you can go home now. 3 i " ETSY avciio Script Wayne: Grest! Nurse: But before you leave, can | just check on afew things? Wayne: Sure. Nurse: The doctor would lke you to take these pls, You have to take one pill every eight hours until they are all finished. There is enough for @ week. OK? Wayne: OX. So one when | get up, one at lunchtime, and one before Igo ta bed ‘Nurse: Right. Now, Dr. Tan says you have @ mild concussion and so you must nos drive for at least a week. Wayne: No probim.| don't realy fel ike driving atthe ‘moment. Nurse: OK, now your jaw. You mustn't open your mouth Wit for afew days. ‘Wayne: What i| have to yawn? Nurse: Good point. you support your aw with your hands, ic should help Wayne: OK. Lesson 3 aye 20, Exercise B Robert: OX, it’s Mrs. Legrange, isn’t it? | believe your husband colapsed at home. Can you tll me what happened? (Mrs, Legrange: Yes, Doctor, we had just gotten back to the house, and Chuck was complaining that he wasn't fesing wel, end that he hed hearthum and was sort cf itchy and then he sort of went funy and feted, Robert: Hes he had ary problems ike this before? Fainting or heertbum or anything? Mrs. Legrange: No, | don’t think so. Robert: Is he taking any medication at the moment? ‘Mrs, Legranges He hes lo bood pressure and he's taking ‘some lice yellow pls. Robert: Had he eaten anything before he passed out? ‘Mrs. Legrange: Oh, yes. Wie had just had lurch with our daughter Robert: Wat cdl you have for lunch? Mrs, Legrange: We had oyster. t was her bithday Robert: is IV. Lagrange alryc to seafood? Mrs. Legrange: I'm not sure. We almost never ext sad, | dont ke much Robert: OK. Did Mir Legrange fll or bang his heed he passed out? ‘Mrs. Legrange: No. Like | said, we had just come in andi ‘came over all funnyLesson 4 & Page 22, Exercise B {£P, Mahert: Good evening's Mis. Ton, isn't ° Mrs. Talan:Tht's right. What do you thirk’s wrong vith Louise? Robert: Wel she's in no immediate denger so Idle to ask you afew questions before I check her aver Now, you Say that she shaving problems breething and she's wheezing, Mrs, Tolan: That's ight. Robert: When td this start? ‘Mrs. Tolan: Wel, she has hada bc o col since yesterday, but she got realy bed during the night. Robert: Has she had attacks ike this before? ‘Mis. Tolan: She's had cols, of coursa, but nothing lke this Roltert: Does she have a cough as wel? Mrs, Tolan: Yes. Att. Robert: is it loud cough? ‘Mrs, Tolan: No, not realy. with this reelly bad headache. Ive never had @ headache like this before, Really painful. And then today | started having problems with my eyes. Thet’s why 'm wearing the sunglasses. It seems lke my eyes are really sersitive to the sun. And I don't know why, but Ihave @ stffrneck. | must have slept in a strange postion and hurt my nack. Anyway, | decided this was more than @ cold and came in here. Robert: You did the right thing. t's definitely more than cold. Can I just ask you 8 couple of questions about the headache? You say it began shout 24 hours ago? Susan: That’ right, Robert: Where isthe headache? Front? Back? Susan: At the front, Rohert: One side or both? Susan: Both. Robert: OK, | think we wil have to do 2 few more investigations. 'm going to call the dactor and then | Robert: Hes she vomited at al? think we wil have ta do 6 lumber puncture, The nurse (Mrs. Tolan: No, Actualy she wouldn't eat anything all day. wil sty with you and explain everything She's realy lost her eppetite ‘Robert: Has she been drinking enything? Unit 3 Breaking bad news ‘Mrs, Tolan: She had some mik before she went to bed, but ot much, Lesson 2 Robert: Do you remember f she had choked on anything, aye 32, Exercise A tke a toy, before the wheezing started? ‘Mrs. Tolan: No, | dont thnk o. I just started when she went to bed. Robert: Has Louise hed anyother medical problems? Mrs. Tolan: Wel she hed measls lat year. Robert: Anything ese? [Mrs Tolan: No, just colds end things, Robert: Does aryone else in the family have chest problems? ‘Ms. Totan: No, we're alin good health, Robert: And her grandparents? Mrs. Tolan: No, they're fina 2s well Robert: And when did all this begin? ‘Susan: About two days ago. | woke up feeing tired and | didn't fe! lke eating. Then during the day I was sort of hot and cold and started sweeting. Sa, | thought OK it’s, 3 cold and I'l callin siok. But then last right | sterted Go 1. You shoud have cle me You shouid have called me, 2. Why cd’ you core sooner? ‘Why didn’t you come sooner? 3. Sorry, what dd you say? Somy, what you say? 4. Did you understand what | said? Did you understand whet | said? ‘5. How many times have you been here? How many times have you been here? 6. Why didn't you finish the trestment? ‘Why ih you rsh the treatment? Lesson 5 Se Powe 22, Exercise B © Page 24, Exercise A co 1. You should have called me, £2, Robert: Good afternoon, Susan. OK, | see from your nates "You should have called me. that you havea fever and a headache 2. Why dich you come sooner? Susan: That's right. hy id's you come sooner? Sorry, whet ld you say? Sorry, what oil you say? 4, Did you understand what: | said? Did you understend what I said? i. How many times have you been here? Audio Script |How mary times have you been here? 18. Why didn't you fish the treatment? Why did't you frish the treatment? SD Page 22, Exercise C 1. Why dn’ you et me know sooner? 7 2. Are you teling me everything? 3. Sory, can you say that acai? 4. I don’t think | need to see you sain 43, What do you mean by that? 6. And dont forget to bring the urine sample 1. | dont think there's anything wrong with you 8 Why cit you call me? & Page 22, Exercise D 0. Dr, Murray: Good morning, Mr. Bloom. How's it going? 2 in, Bloom: Not very well, rm aired Dr, Murray: Wel, t's see. Last time you were here, ‘when was it-tv0 months ago-you were having problems with your back. (Me. Bloom: That's right. Andit seems to be geting worse. Dr. Murray: Oh dear: Why cc's you cal me sooner? (Mr Bloom: | was hoping it would gt better Dr. Murray: Wel, it’s go over your symptoms agai, shall ‘we? Bxacly where does i hurt? (Mr. Bloom: Imm, a the bottom of my back but it sometimes goes up to my shoulders as wel. Dr. Murray: Can you desaribe the pain? [Mr Bloom: Wel, t's sort of cramp. It seems ike the muscles are all tense and st. Dr. Murray: How bad is the pain? (Mr. Bloom: Wel, sometimes it's really bed | had to take a couple of days off work last week benause it was sa bad, Br. Murray: And how long do these oremps lst? [Mr Bloom: I: s2ems to vary. Sometimes a coupe of hours, sometimes less. Dr. Murray: Does it hurt at any particular time of day? Mr. Bloom: i's ba inthe mori, 'm realy sti when get up. Dr. Murray: And does anything tigger the pan, you know, anything thet brings it on, makes it stat? [Mr Bloom: | knaw this is going to sound funy, but 'm ‘worried oF nervous about something or # things go vwrong at work it seems to come on. Dr. Murray: Rober, do you have ary question for Mr. Bloor? Robert: Wel, ust 2 couple. Me Bloom, does anything make the pein got better? ‘Mr, Bloom: Wel, Ive noticed that tke a rap, it coes aay. oD re Audio Script Robert: Right! And does anything meke it worse, lke bending or working inthe garden? Mr. Bloom: No, rot realy. Just the stress Robert: Have you had anything ike this before? (Mr. Bloom: No, | don't think so, | hurt my back gardening ‘once, but thet was years ago. Robert: Hes anyone in your family had anything ike this? (Mr. Bloom: No, not 2s fa 9s | know, Robert: | sae from your notes that you are an engineer Does this mean you have ta do lats of physiel work? [Mr Bloom: No, actualy moss of my work is sisting at @ ‘computer. Robert: Wel, thnk that’s al. Thenk you, Mc Bloom. Br. Murray: OX, | thnk we ought ta take some X-rays to see if we can see anything. Ifyou see the recetioris, she wil make én appointment. Thankyou very much, ‘Mr. Bloom. MrBlaom: There's just one more thing. You know, ve bees feeling a bit depressed lately. Dr, Murray: OK. Tel me ebout it. When dd you start to feel depressed. ..? Page 33, Exercise E Dr. Murray: Good raring, Mr. Bloom, How's it going? Mr, Bloom: Not very wel, m aad. Dr. Murray; Wel, let's see. Lest time you were here, when ‘was i-Swo months ago-you were having problems with your back. ‘Mr. Bloom: That's right. And it seems to be getting worse (Dr. Murray: Oh dear. Why didn't you call me sooner? ‘Mr. Bloom: | was hoping it would get better. [e. Murray: Wel, let's go over your symptoms again, shal ‘we? Exactly where does it hurt? ‘Mr. Bloom: Mimm, atthe bottom of my back but it ‘sometimes goes up to my shoulders as well. Dr. Murray: Can you desribe the pain? ‘Mr. Bloom: Wiel, it's sort ofa oremp. t seems ike the mmusales are all tense and sift. Dr. Murray: How bad is the pain? ‘Mr. Bloom: Wel, sometimes it's realy bad. had to take = couple of days off work ast week because i was so bas Br. Murray: And how long do these cramps last? Mr. Bloom: It seems to vary. Sometimes a couple of hours sometimes less Dr. Murray: Does it hurt at ary particular time of dey? Mr. Bloom: i's bad in the moring. Im really st when | get up. Dr. Murray: And does anything trigger the pain, you knovw. anything that brings it on, makes it start?co wm (Mle ise Pie Shs s going to sound furny but i'm wormed or nervous about someting orf things go wrong et work, it seems to come on Dr. Murray: Robert, do you have any questions for ‘Mr. Bloom? Robert: Wel, just a couple, Mr, Bloom, does anything make the pin get etter? Mr, Bloom: Wel, I've noticed theif | take a nap, goes away. Robert: Fight! And does anything mek i worse, ike bending or working inthe garden? Mr. Bloom: No, not realy. Just the stress. Robert: Have you had anything ike this before? ‘Mr, Bloom: No, | don’t think so. | hurt my back gardening once, but that wes years ago Robert: Hes enyone in your family had anything ike this? Mr. Bloom: No, nat as fara | kno. Robert: | see from your notes that you are an engineer Does this mezn you have todo lots of physical work? Mr. Bloom: No, actuly most of my vorkis sting at computer, Robert: Wel, thnk thet's al. Thark you, Mr, Bloom ‘Br. Murray: OX. | think we ought to take some X-rays to see if we can see anything, I you see the receptionist, she wil make an eppointment. Thank you very much, Mr. Blom, Mr. Bloom: There's just one more thing. You know, Ive been fing « bit depressed lat, Dr. Murray: OK. Tel me about i. When sl you stert to feel depressed . ..? Lesson 3 Page 35, Exercise D 4. Me. Bloom's next, isn't he? (Mrz Bloom's next, isn't he? 2. You've got Mr: Bloom's notes, haven’ you? You've got Mr. Bloom's notes, haven't you? You're here fora chest Y-rey, arent you? You're here for a chest X-rey, aren’ you? 4, This isn't going to hurt, ist? This isn't going ta hurt, st? 5. can leave now, can't? | can leave now, can’ 12 Page 35, Exarcise E 4. Mr. Bloom's next, isn't he? Me. Bloom's next, isn’ he? 2. You've got Mi: Bloom's notes, haven't you? You've got Mr: Bloom's notes, haven't you? 3. You're here for a chest Xray, aren't you? You're here fora chest X-ray, arent you? 4, This going to hurt, ist? S__ Mision going to ure ist? op 5. I can leave now, can't |? 722 can leave now, cans IP Lesson 4 Page 36 Exercise B Dr, Murray: So, Robert, kt’s go aver Mr, Bloom's case. Can you revi it for me? Robert: Sure, The patient presented on February 4 this year complaining of ower beck pain, There wes no history of trauma, Anelesios were presarbed and the patient wes edvised to avoid strenuous work end heavy iting, Dr. Murray: Go on. Robert: The patient wes seen sgsin on ApS comelcning thet he wes sil in pn end thet the condition mes ‘worse. He also compleined of depression he paste was refered for racoarepty. Dr, Murray: OK. Let's heve lok st the reiogracs Wh you think? Robert: Let me see, Wl, it acs fe to me De. Murray: To me, too, 0 what do you suggest? Robert: Wel, thnk he shouldbe refered for 2 psychological evehtion at this pint. Maybe the beck pains psychasomati. After al, he seems to be nether depressed. lurray: Alright, That ight be valuable but | also chink he ough to be referred to @ neurologist. Or @ Lesson 5 co Page 38, Exercise A "25 B, Murray: OK, we've gat the neurologist’s report now. But before | show it ta you, | asked you to doa bit of research about Mr. Bloom's case. What did you come up with? Robert: Wel | started of by investgetng al the possible causes of muscle spasms in the back and legs in a mide-eged patient. Dr. Murray: And? Robert: Wel, 2s you canimacine, there are los, but I think | have narrowed it down to four possible condtions. Fst, there is possbiity that it is chronic tetanus. Mr. loom isa keen gardener, and iis possible that he has become infected from the sol He as stifess of the neck, which is typical of tetanus, but he has no spasms of the jaw muscles, and 75% of patents presen with lock. Audio ScriptDr. Murray: OK, but what about the depression? ks depression a common symptom of tetanus? Robert: Notas far as | know. However, there is 8 very re condtian known as Stff Person Syndrome where ‘depression is very commonly associted with stifness and spasms in the backend lower lbs. Dr. Murray: Tel me more Robert: Welt seems thatthe spasms happen when the patient gets some strong emotional stimulus, such as ‘when they ae surprised or enry. Dr. Murray: And how would you contr diagnosis? Robert: There isa blood test, but nota ptients with the clinica signs end symptoms test postive, De. Murray: OK. Anjching ese? Robert: Wl there is anther very rare condition called Isaac's Syndrome, which is cheracterzed by painful ‘muscles spasms. Dr. Murray: And how sé ferent from Stiff Person Syndrome? Robert: Vil, the hig difference is thatthe spasms don't stop when the patient i asleep in Stff Person Syndrome, they do. Dr. Murray: Wel, that shoid be easy to check. And what's <> the last one? 2. Robert: There isthe possi of Muliple Sclerosis. Painful "2S ‘muscles spasms are common and depression is reported in many patents. Dr. Murray: But there woud be other symptoms as wel, wouldn't there? Robert: Yes, patients often complain of paresthesia or “pins and needles” and fatigue is very carson Dr, Murray: OK, Robert. You've done a good job there, Page 45, Exercise D Dr. liver: Good morning, is thatthe stroke uit? ‘Woman: Thats right. What can we do for you? Dr. vera: We have & patient who as just come in end we ‘suspect she has had a stroke. Can | speak to a doctor, please? ‘Woman: Putting you through Male: Good morning, Steve Herbinger speaking Dr. iver: Good morning, Dr: Hrbinger, this is Luciana Clvers from Primery Care, We havea patent aver here that we think might eve he stroke Dr, Harbinger: OK. can you run through the case? Dr. iiveira: Sur. The patient's name is Linda Marshal. She Audio Script is 62-year-old, retired factory worker who Ives with her husband, She has a history of ischemic heart ciscase athouch we are stil tying to get the detail. Her husband reports that she complained about chest ain this moring ard then shortly ater developed right Sed hemiparesis with mid dysarthria Dr. Harbinger: OK, let me get that right, Chest pins and then right-sided weakness with speech dficuly? Dr. liveira: Thet’s right. Vial signs OK. BP 144 over 87, Pulse 89, Respiratory rate 20 and temperature of 985, Dr. Harbinger: When did she have the ettack? Dr, Oliveira: At chout 9.00 this morning Dr, Harbinger: Abou two hours aoo, OK. Sounds ike @ possible cancidste for thrombolyics. Send her fora GT scan, do 12 lead ECG, we need international rormaized ratio (INR) and activated patil thromboplastin tine (@PTT). And find out what you can aout the hear disease. 'm on my wey. Dr Oliveira: Wow! Superdoc or what! Lesson 3 Page 48, Exercise B Robert: His thet Dr. Ki? Dr. Kim: Speaking Robert: Good morning, Dr. Kin, Tiss Robert Mihell speaking from Ashvile Hospital We have e patient here ‘whom you treated about 10 days ago. She has presented with a stroke and we woul lke to check up on the treatment she had with you. Dr. Kim: Sure. What's the patient's name? Robert: Vrs. linda Mershal, aged 62. Dr. Kim: OX, let me check the computer OK, here we are. Retired factory worker: Right? Robert: Right. ‘Dr. Kim: OK, she presented with retrosternel chest pain. The electrocrciogram showed ST segment end T wave sbnormality but there wes no @ wave ebnormelty. A cdagnass of non-transmural Ml was made and the Patient wes admitted. Robert: OK, let me just write that down, Retrasterral chest pain. E08, no @ wave abnormality but ST segiment and T wave ebnormalty, Diagnosis: myocardial infarction, OK. De, Kim: Fight. We gave her the usual acute Ml ‘medications: IV morphine, aspirin, nitroglycerin, and heparin and put her under observation. Robert: OK, so we have intra venous morphine aii, ritroglyerin, and heparin. OKDr. Kim: She responded very wel and after sic hours her T waves were loking much better. We ran 8 OK-MB myocardial enzyme test, which was elevated and confirmed the dagnass Robert: CXMB high Dr. Kim: After 24 hours, ECG was almost normal end, 2s you would expect CK-MB levels were stl igh. The pin hed subsided and then, against cur adice, the patient discharged herseft She said she was on holy end wanted to spend time with her grandohidren, not with «8 bunch of doctors if remember her words correct. Robert: Wow, so she just walked right out of the hosital No medication. Nothing? De. Kim: That's right. She signed her own discharge forms and off she went obert: Thanks for the tip, D: Kim, we ere considering Giving her thrombolytic. Wes there anything in her ‘treatment or history to contrinicatethrombclytes? : Uke | said, she's not on antcnogulants, butt would be good idea to do another EOG and an INR, Robert: Yes, thet’s what we were planning. Thanks again, Dr: Kim. Good to tak to you. o 125 Or. Harbinger: OK, Robert, what have you got for me? Dr Ofveira gave me some of the facts, but i'l be good ‘ractoe for you to review the case Robert: OK, this is Mrs. Marshall, a 62-year-old retired factory worker. She was treated for a myocardial infarct ten days ago in Calfornia where she was admitted and received monphine, asprin, nitroglycerin, heparin. She then cischanged herself after 36 hours. Dr. Harbinger: What! She just walked out? Robert: Scid she wanted to spend her holdeys with her grandchildren, not with a bunch of doctors! Dr. Harbinger: Wel, she hes @ point | suppose. OK, whet new? Robert: She presented here at 10,00 a.m, She had mid isarthria and her husbend reported that she had ‘complained of chest pains at about 9.00 am. and later ‘developed hemiplegia on the right, Her vital signs were as follows: Blood pressure: 144/87. Heart rate Respiratory Rate: 20. Tempereture: 98.6°F On ‘examination, she hed a NH stroke scale of 9. Or. Harbinger: NIH 9.0K, now what else have you got for ime in the way of © Page 50, Exercise ¢ gp Dr. Harkinger: OK, so we frst heve to decide we can use 727 thrombolyties. What do you think, Robert? Robert: OK. et me give you the important physical signs fist. Hor heart seems fine: there are no murmurs, rubs, or gaps. De Harbinger: OK. So there ae no signs of pericarditis, That's good. Robert: She seas to be der but hes mid expressive

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