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English in
Use
Medicin
e
Eric H. CAMBRID GE
. U NTVE RSITY l'll ESS
Glendinning Ron
Howard
Conten ts
INTRODUCTION 8 O Allied health professionals 24
A (:on1mun1n h'Jhh
B Ttchnic1Jn\
BASICS C PtolithfflSt'.111d 01·rhorirs
O Health and illness 10 O ()pu.;1.in'
m Medical education 1
8 Tu
e Tu pe"•• 30
D Functions of the 16 A 1\ ledic.a l c.-. ducat1on 111 rhe UK
8 Fxtracr fro1n Jn undcrg:raduarc:
A Eacing prospe.-i "
8 1ñe fi\t" \(11-.t'\ e .\ srudnn ). ,.te...,
e Othcr luoo"""
O Less comnW»t funnions m Medical education 2 32
A ·rhc Found.nion Proranure
MEDICAL ANO PARAMEDICAL 8 People 111rued1.1I edocJtion
C ledH.. I qu.ah.;u1on..
PERSONNEL ANO PLACES
11Medícal practitioners 1 18
m The overseas doctor 34
A Types of rt"g1\tl'Jtton
A 8 Pl.A B
Prac11r1oncr)
8 Special11e.. e PLAB S(JtlOn!I> .111J ad\'i<:c
e Choos'" J •J'C.'<:Oalry
O Medical practitioners 2 20 SYSTEMS, DISEASES ANO
A H05p11al >1.111 SYMPTOMS
6 Medu .1l 1e.un'
C Shift. m Symptoms and signs 36
A
8 L>rscnbmg
l3t1on prublcm'
U Nurses 22
A 1'urs1n1t, p.r.1 C 1";tlk1ng bou1 Olptoms
B Support \\'Orkcr'
C Specinli1..u1on l.'m Blood 38
O The nuro,e\ role A Full blood counr
8 .\naemu
e Pmltl... Jn.ae1n1l
4
11!) Bones 40 fD Mental illness 58
A llo<i<> A Psychiarric di>orders
8 fr.u.1ur 8 Subsranc< abuse
e Írt llK'llt of Ír 14..IUI e Affective disordcrs
o N('uroóc and srrcss--rtlated JJSOrden
m Childhood 42 E Oth« l:}p<S oí íunrnonal d1sordcr
A 1\hln1"""'
B (:ornrnon 1nÍC\". t.OU\ J1..r'\ f1B The nervous system 1 60
e Cur:l1Jc.: J1)C;l'J(' A Sensory loss
8 ;\lcxor loss
IE) The endocrine system 44 e Loss of consctousness
A E-'.<'>> ••d Jdi.,..,._)
8 1\rg;Jll\"C fttdb.11..:k \, -.ttn1't
fD The nervous system 2 62
e Goutt A Thc 1uoror systern
o A lcttc:t oí r<Íc:tr•I 8 Tendon rcAcxcs
e Coma
lllJ The eye 46
f1l) Oncology 64
A P.arc oí che C)'C'
e E\:.tr11u1.auo11 of 1he e)'l' A Neoplas1ns
e RctnlOl'>;\ I hy 8 Syn1pro1ns and signs of n13f ignancy
e Treun1ern of tumours
fl!> The gastrointestinal system 48
A Ean1ln.11io11 of thc .1hdo1ncn m Pregnancy and childbirth 66
8 Thc í.t<'l".C< A Childbirrh
8 Labour
m Gynaecology 50 e Presenr:irion and liC'
A The: Íc1n.1Je rerrodtK'.fl\C 't)\fCl1\
8 1cttilru.111011
iiiJ The respiratory system 68
e A yn.1c'.\:olt1.1I..:on.,ult1t1nn A Cough
o Contr.11:cpt1on 8 Auscuh.atioo
5
INVESTIGATIONS aJ Therapies 92
@D Basic 76 A Rad>0<h<rJp)' and d>emoihenp)
8 A day "' the liíe oí n physio1hcr.1pisr
investigations
e Cogn111"·e Behavioutal Ther.apy
A Ophthalmoscopy
8 81ood pmsur<
C Takmg blood
m Laboratory tests
A A .\licrob1oloj!) t<'it r<qu<st
78
PREVENTION
CD Screening and 94
fonn
B A Bioche1n1tl'!' and llaeina1ology
immunization
lab repon A Scrccnui.¡t
e ícrms u!<d to dc,cnbc lab ""''" 8 Comn'W.>f'I scrttruntt tb
e l1n1nun11;i11on for 1ravllers
mA Endoscopy
Functoons of
80
<ndosrop)
B Emeroscopy EPIOEMIOLOGY
C Repon oí n dingno\lic endoscopy
eJ Epidemiology 96
m X-ray and 82 A Rates
CT
8 lncidcne and prcvaleno:
A Radio¡;rnphy and rnd1ology
C As.sóc1JUOn and CJUSl.tion
B X·ray ('\.Jnunauon
C Compuo<d Tomogr•pbl'
ETHICS
lllJ MRI and ultrasound 84
A Magoct1<. Resonancc lmaging (MRI)
ID Medical ethics 98
B Ulcrasound A GMC guidclines
e Prcpanng for ottdocJI unag¡ng 8 Btocth1<JI issll<1
o Dtscnhong m<dal un•ging e AsS111«l di·mg
m ECG 86
RESEARCH
A Uses of •n t:CC
e ECC pr0<tdure
C A normal FCC
Cii9 Research studies 100
A C.ast--1.;ontrol srud
e Cohon <tud1es
TREATMENT C Trials
O VJriablo
CiiJ Medical treatment 88
A Prescr1¡">tions and druJ:t)
8 The llnt1>h i':abonJI formulal') TAKING A
m Surgical treatment
A The op<ranng
90
CD Taking a history 1
A A ful! ca« h1Stof\
102
8 Pcnorl.11 Jer.¡ib
thwrc
8 lnStTUl1lCl\tS
C Talkina ahout pa1n
e Thc opcra11on
o An opcr.u1on repon
Cii) Taking a history 2 104
A Dn1g hl\to
8 Fanlil}' hitory
C Social Jnd pmonJI h1>tOI'
E) Taking a history 3 106 mlJ Data presentation 2 120
A Re-1t"1n¡¡rhc S)Sttnt; A Line graphs
8 Ask1n ahou1 thr 1".CftCt.ll ncn·ou yMcm 8 Pie chans and bar chans
e PJ.11ttu 1dtas.<'OllCtms and t'\f>t'". tJ.uons e Dcscnbing tr<nds
o
m Research articles
pt,....,1,.,1» on h1>1>1)·t>kon
A TI.. suuaurc of a rcscarch anod< 122
EXAMINATION B Ob,<ct"es
C Main lindings
€!) Physical examination 108
A l \;un1n1ng a p;lltent lmJ Abstracts 124
8 G1'1ntt 1n'Sfrurnon)
A Srrucrurcd absrraru
m Mental state examination 110 8 n..BMJ absmm
lndex 168
11 Health a nd illness
lfJ Asking about health
Hcahh is thc state <>Í the boJ). \Vhen doctors wJnr IO know about a p.ment"s usual
hcahh, ther ask qu.-.suons such as:
\Vhat ")OUr general Ho"\ )·nur healch,
health l1ke? gencrally?
lf you ore in good hcahh. you ore well and havc 110 illncss (disca\c). l f )Oll are hcalthy
you ;trC norrnally wcll.10d can resist illness.lf )OU are lit,vou a re \\Cll .rnd srrong.
""'"' """
lit and not 111
wcll
well not wcll poorly in poor heahh
in good
heahh
very well not vcry wcll
[\) Sickness
Sickncss has a simibr nlt'aning ro illness.lt is also uscd in thc "ª"'"' of a fe" specific
d1scases, for cxampe sleeping sickness and t11l\ cl <ickncss. Paciems also talk atout
s1e.:kncs.s \vhen they mean nausea and vomitinµ.
Poss1hl t•
1nt•an1nqs
1 "as <ick this morning. 1 was ill thb mornmg.
1 fclt unwdl 1h1s morning.
1 vomited th1s mommg.
1 feel sick. 1 feel 111.
1 fccl unwcll.
1 an1 naueou,.
1 feel thc nccd ro vomit.
6 Recovery
Whcn p.1nents rerun 10 normal healrh after 1lln<>. ;;, rhcy have ree<l\ercd .We can also say:
goo
l11c paricnt madc a d rccovcry.
full
complete
lf a p;inenr's health is 111thc process of retummg ro nomial. the p;illl'llt 1s improving. Thc
opposire rs dctcriorating. We can also sai·that the panmt"s rondmon impro•cd or deicrioratcd .
In spc«h, wc often use thc •crb gct to ralk abour change:
l lc gor nver the
1ll11css very quickly.
1
1
l f a paticnr i rclapcd. Anorher word for
bcrrer, hut improveme111, especialli in rteurring
rhenllnc«)
gcts conditions uch as cancer. 1s
ovcr (an = to rccover rcmi4¡;4¡;ioa.
\\rorsc
gct benerag.11n, t he = co in1provc
= co deteriorJtt -
-
Two years IJrt'f she remains
pattl"nt has
\VOíSC
in complete rcmission.
10
1.1 Complete rhe tJ hlc l\lth words from A and B oppos11c.Thc firSt one has bren done for you.
fitness
healrh
illness
sickness
1.2 2 Make word combmauons ustn!l a word from e.Kh box. Look at B and C oppos11e to help¡·ou.
complete sickncss health rcmission sick
feel gct poor travel ovcr
1.4 Choose the correct word w complete each senrcncc.1.ook ar B and C oppositc w l1clp you.
1 Her condition ... ... .......(deteriorare<Vimpr ovcd) and shc dicd.
2 He....... (reLipsed/reco"ered) and was allowed to go home from
ho,piul. 3 The cause oí slcepm¡; ..................... (illnessl icknt<>') was discovertd
in 1901.
4 The patimt made a full (rem1<s1on/rcco1ery ).
5 1ha1e bren in (poor/goodl heahh íor months and íeel \Cí)' fü.
6 Ir was a momh bcfore 1 (got O\'er I got bcttrr)
thc 11ness. 7 He seems to be rather ------·--...(unhcalthy/unwcll)
-his ditt is b. d and he ne>er
exerciscs.
Parts of the body 1
Pa rts of the body
i\losr °'"tem.il partS oí rhc bod) havc ordinal) En¡:Ji>h names.1 \\ell as ana1t•n11cal
names. l)ocrors nonnall) use thc b1glish na mes, t"\ en when 1alkmg 10 cach other.There
are a fcw C\ctption\ 'vhere Jocro111 U\e rhe anuo1nical na1ne;1hese are sho,vn in
bracklt!. bel<)\v.
1 jaw (mandible)
2 ncck
1 ----U. 3 shoulder
4 armpir (axilla)
2 --.!-'-,
5 uppcr arm
6 clbow
4 --+-..i.. -#- 7 back
s--1- --13 8 burtock
-"l ---14 9 'vrisr
6
10 thigh
_.¡._ ---15 11 calf
-+.>..-4---16 12 kg
9 l--\--:0 -11 13 chesr (thorn •)
/-4--i. ---18 7 --i-- 14 breas•
8-'--+
15 stomach.
10--_JI-- tummy
(ahdomen)
16 "ª''el (umb1hcus)
17 hip
\ , '4----19 18 groi n
(inguinal rq;ionl
11 ---' 19 lmcc
12 ;parella =
'-----20 kncccap) 20 ihin
---
l.imb means arm (uppcr limb) or leg (lowcr limb). The trunk is thc body cxdudin¡;rhc
hcad and limbs.
1or a more dctailed diagran1showing p>rt> of rhe body.see Appcndi• 1 on pa'C 00,
thcchcst?
Do )ou get an) pain inyourc;ro1nach?
l'hc doaor oftcn needs to ask about a part back?
of 1hc body:
2.2 Complere rhe senrences using ordina ry Engl ish words. look at A and C opposite to help you.
a A male parienr describi11g angi na pecroris:
lt srarrs ( 1) .... .... ......... ..... thc loin and goes into the
.....
(2) ·-··- · ··········· and (3) ····- -······
····-·imo the resricle.
2.4 Complete the table with words from thc box. The firsr one has been done for you.
abdomen clbow loin \vrist thigh
knee chest arm lcg finger
· Ove-r .f-o
t h.11 ynu
11ou
l'vlakt· a l ist uf t ht· worrls frorn A npp·IJlih· t h;1 t you find i t hard lo
rl·rnt·n1lu:r nr
necd tnost often. Try to lcarn at lcast nlll' nf thl'lll l'Vt:ry day.
gall bladder
lt 'cr---
splecn
When doctors talk about the m•m pan> o( the d1gesrhe system, thcr 11>e rhe words bo" el
or inu:stin<: the small intesrine or thc small bowd, 1he large inresrine or thc large bowel.
When speaking to paoenrs, docto<'l mai rcfcr ro rhe anus and rectum as th< back pasogc.
The chest
The chcst (rhorax ) conrains the orgam of respiranon and rhe hear1. The mam pa ru; of rhc
respi rarory system are thc airways and 1he lungs. The lefr lung is dividcd into rwo
lob. and rhe right inro rhree. Thc a irways consist of 1hc larynx, rhe rrachea (or
windpip<:), 1hc righr and lcfr bronchus, and thc bronchiolc;. Thc che" is separarcd
from rhc abdomen by thc diophragm.
The pelvis
A doctor is explaining the function of thc bladdcr ro a parienr.
Thc bladder is sirua:ed in thc pelvi a )ou lno\\, and ir 1s connccred to cach kidncy bi a long rubc caUed thc we
1 .....
.................
.....
2 ............................... 6 ............................
3 ......................... .....
4 ................................
3.2 Match che conditions ( 1-S) wirh rhc organs affecred (a-h), using your medica( knowlcdgc.
1 hcpariris a hladder
2 pneumonia b gall bladder
3 ncphriris e hearr
4 gasrric ulcer d k idney
5 cysriris e liver
6 angina pecroris f lung
7 cholocysriris g sromach
8 ulcerarive col itis h large bowel
3.3 Complere rhe rexrbook extraer. Look ar A and C opposirc ro help you.
Ove. .f- /
rpantrl·as.tients10lA
Many pao do not know the l ota tion or f unct ion of thl' spleen or t hl'
How l'JOu ld you t'xpla in thl'm to a palil'nl. i n
English?
Other functions
f unrtio Vt·r N'
n h un
speak Sptecb
- >pcak ing
\\ a(king walk gait
breathmg inhale I brca 1hc in / takc a brta ih
rt>Sp1ration brea th in exhale / brcarhe out
unn:irion urina tc urine
n1icruririon nlicrur01tc
pass urinc I pass'vatcr
dcfr\"ation deíe.:atc fooces
pass faeo:s I pass srools srools
n1wstruanon nienstruate (menstrual) pcriod
ha'e a 1icriod (momhl)') pcriod
4.2 º'
Patiems are descrih111g S)Tl1proms thc condirions sho\\ n in brackct>. cimplere
the sentcnces.U>ok at ( and D OpJ'O'U• to hdp you.
1 l"ve ¡:ot pain ami --·-···-·111 both feet. (peripheral neuropathy )
............ . .... solid food.(ocsophage:il srricturc)
2 l"m having difficu lty_.....
3 1 havc a lot of problcms · -···· · ..... ...... ........ .....
........... .(prostatic hypcrt rophy)
4 l"\'C bcen _ _ . more rhan u;ual, c,•en whcn 11"> nor hor. (hypcrthrroidisrr)
--···.
5 l\ c noticed that nt) hands whcn l"m not u;mg rhem. (Parkinsonism )
6 l havc rrouble ·-. when 1 d1mb rhc sta1r..(left heart failure)
3
1 have "º-- _ _ (tasrc/appetitc )
and l\·c lost fi,e k1IO\ m the last fr" \\
ttks.
s The-----------------
garden full oí flowc,,., hur
i> 111) ---- (srnsc/scnsanon)
o( smcU ha> d1sapprared and 1 can·r cn1or th< perfume.
6
(...._i_:a_k_e_a_d_ccr_-_.·_--_-_·-_·_····_<h__r•_•_r1_1c_11__c•__rh_l_i'_'_ _,'y
Spec1alties
peciali<t docrors, for examplc paodiarricians.gcnerally work in hospnals.Howevcr,
thosc who work ourside thc NH, priwiding privare hcahh cnrc, may havc consulting
rooms
ourside a hospital - for cxa mple in the famous Ha dcy Strect in London.
The rwo mai n branchcs oí medicine are surgcry an<l in tcmal medicine.Jnd rhc
doaors who prJctisc rhese branches are callcd surgeons and physicians,
resp<."<:thel)·.Tn Brmin, male surgeons •re addnssed as Ir and fcmales as llls - so
Dr Smirh 1s a ph)s1cian. and
Is Smuh "a surgeon.
Choosi ng a special ty
Jill Marhcws has jusr graduatcd frorn medica! school .111d is rnlking ahout her Íu turr.
'I havcn"t decidcd what 10 s¡x:ciali1c in yer. 1necd
more exper1encc before 1decide, bur rm quite
attracted to rhc idea oí paediarrics b<cau>e 1 hke
working with ch1ldrcn. l"d ccnainly prcfrr to work
with children than, S. ), eldcrly parienrs -<o 1 don"t
fancy geriatr1<'.l>.
1 \vas ncvcr very interesttd in dcrailed anaron1rt u
rhc •u rgical spccialtics lik c ncu ro<urgcry clon·r
really appe.11. You have to be good wi th your
hands, which 1 don"t rhink is a problem for me -
l°•e assisted ar opcrat1onsse'eral times, and l">e
cvcn done sorne minor op; by mrself - but
surgeon> have ro be ablc to do thc same thing agam
and agam without gettm¡; borcd, hkc t)•mg off cut
anerie' and so on. 1 do1ú rhink 1ha1 would be a
prohlcrn for me. but thcy nc".<'d ro 1nake
dcci'li ons fasr and 1 '111 nor too good at ch.u.
1 like ro have rime ro rhink, wluch means surgery\
probJ bl) not righr for mt."
Note: The cofloonion good with IS followcd by a noun -
He's good w1th chifdten.Th collocation good at IS
followcd by thc -1ng form (gerund) of a vtrb. or by a noun
- She's good ot eploining procrdLrrs. Shr's good ot
explonotio11s.
18 Proftnlonol Engfi<h in Ust Medo<"1t
5.1 \Vrire scnrences ro dcscmc rhe work of rhc spedal1sr m cach branch of med1cmc. l<>0k ar 8
opposirc ro hclp you.
1 dcrmatoloAy A oermatologl& epeclsliu& in dii;ea,;e5 of we &kln.
2 rhcumatology
3 traumarology
4 paediarrics
5 obstctrics
5.2 Complete rhc ral>lc "1rh words from A, 8and ( opposue and relared forms.l'ut a suess
mark m fronr of rhc srresscd >)llable in cach word. The first onc has bttn done for )OU.
5.3 Find preposirions 111 C oppo>1te that rnn be used ro make word combinarion> wuh
1hc words in rhc box. 111c11 use rhc correcr form< of rhc words ro complete rhc
<cmcnccs.
5.4 Makc word cornb1nation; using a word from c:tch bo•. Two words can be used
rwice. Look at A, B and C oppositc to help you.
consulting general group health intemal surgical
Pro(essionol En¡lnh In 19
u.."1tdki'1t
Over +o '1ºª
Re- read what Or J1 ll Mathews says ahoul \urql'Ol1\ 111 St..'rl inn C. Makt· <-J ll\I of l hr qualit il'S
she thinks an· nt·t•ch.-d to be a good surqcon . lhl·n 1nakc a sim ilar list of quaht1l·''or another sp·l t:1alty.
lf you arl·a o,tudl·nt , "h1rh hranch of m·l d1cuu·dn you t h1nk you havc t ht:" qua ll tit·o, for? lf you havt· alrt·;1dy t·o
Medica! practitioners 2
Hospi tal staff
Thc pcople who work ul ani l)pe oí workplace.1ndud1ng hospitals.are <all<d 1he staff.
Thé medica! sraff in a Bnnsh ho<ip1tal belong ro one of four mam grOUJ":
• A pre-registration house officer (PRHO).or house officer, is " newly graduared doctor m
the firsr year of posrgrad uatc training.Af1er J ycar,he or she hccornc' a re¡;istercd
med1cal pr;lcririoner. In thc currenr sysre1n of traininH, che Foundarion Pr<>8r
1111n1c, thc nante for
t hcse junior d0<.10"' is Foundario n Year 1 doctor (FY I). (See Unit 1 2)
• A senior house officcr (SHO) "in rhe saond )Car of posrgraduJtc training The titlc
1s now Foundarion Ycar 2 doctor (FY2J. but rhe old 1erms semor housc offiar and
SHO are srill used.
• A specialist rcgi•trar ( pR) is a doctor who ha> complered rhe l oundanon Programn\C',
and itraining in onc oí 1he n1edical specialnc,, There are also Mnnc non-craining rcgitrars
-docrors who havc complcted thcir train ing hut do nor wish ro spccialize yet.
• A oonsultant is o íully qual ificd specia list. Thcrc may also be somc associat< specialis1s
-senior doctors who do not wish ro lx-comc consultanrs.ln .1dd111on. rhere is ar least
one rnedical (or diniral) director. who is rC$pons1Me for all of 1he medi<JI s1aff.
Shifts
J u111or docrors now norm:i lly work in shifts, which mc•ns they norma lly work for
eighr hour> cvery day, for examplc 7 .1111 ro 3 pm, ancl are rhen free unril 7:11n 1hc
ncxr day. Afrcr a wcek rhey changc ro a d1fferenr shift, for example 3 pm ro l l pm or
1 1 pm to
-.m1. The altcmarive system 1s 10 work from 9 am to 5 pm every day and to 1akc
rums 10 he on eall -a•·ailablc ro recum 10 1he hospual if nect"SS. 1)' - from 5 pm
ro 9 am ch., n"r da¡. Days on call are ser out in a rota, or hst of names and times_
Doctors on call
.:. rry J radio pager, or blecper, a device which makcs a noise when sorncone 1s rrrns ro
cont;lcl rhe111.
6.2 .\!J1<h 1hc descriptions (1-5) wirh r he j ob rirles (a-e). Look ar A and B opposire ro help you.
1 Dr Graham has bccn a paediatrician for cight years and is responsible for 1reating 1he children
aJmitted ro Ward 60.
2 Dr Sre\\lart has jusr S[arted thc sccond year oí her Foundarion Progra1nme.
3 Dr Singh has srarred his rra ining as a surgeon .
4 Dr Phillips has jusr grnduaied :md is work ing in a large hospiral in Birmingha m.
5 Dr .\lillar is in charge of 1he medica! staff in the Birmingham hospital.
a >pt.:1alist regimar
b med1cal dirt'Ctor
e consuhanr
d SHO
e PRHO or house office1
6.3 Art> rhf' follo\viog r:'ltf'l1ltnr rrue or fulse? Find reaS< OS for your anS\V('íS in A. B and e opposire.
1 A medica!graduare bccomes registered rwo years after graduarion.
2 The sysrem of rraining doctors in Brita in is called 1he foundation Programme.
3 The name senior housc officcr is no longcr used in Brirain.
4 The <onsultant is usuaU y the first docror ro see new
pariems. 5 \"l;"hen working in shifts, ali doctors take turns
to be on call.
6.4 Comrlete 1he rext of a PRHO describing her job . Look ar A, B a nd C opposite to help you.
\\nen 1 ge110 1he ward , the fim thing 1 do is talk ro thc house officer who was
on duty dunng the last ( 1) .........-............................ , ro find our if rherc havc
been any new
2 . ............................... . Then 1 gcncrnlly sce rhc charge nurse. He rells me if there is
Jll' rhing rhar needs ro be done urgemly, such as inrrnven<>us lincs to pur up or take
do,,-n. Later i n thc n1orning, 1 (3) ..................................-....any ne'v parienrs, \\lhich basical l y
rn'oh·es raking a hisrory.On Tuesday and Frida y morning the consulrnnt <loes her ward
4 ...................................., and 1 have to rna kc sure J'm cornplerely up ro dare on
her patien!S. Aiter tha1, rhere are usually lo!Sof things 10 do, likc writing up
request forrns for blood
5 .................... ..... .... ,and so on. In the aften1oon, l have ro prepare for any parienrs \vho
Jre ro be (6) ........................................ rhe nex1day.They'rc usually happy to be going home!
And thcn of course there are rhe lccrures and rurorials in rhe (7)
........................................ prmrammc on Monday and \'(lednesday.
Spccializa tion
Like doctors. nurses can specialitc:
• A midwife has specialize<I fro111 thc beginning hy doing • course in midwifcrr,
rhe managernent of p-egnancy ;111d childbirrh .
• Ditrict nurses visir parienrs 111 thc1r ho1ne.
• Healch visitors al!O work in thc corn111uno1y, givmg advice on 1he promotoon of
health and 1he prevenrion of illness.
TSco1smon
fhe verbs perform and carry out are u5Cd with all l) pe> of proccdurcs. Thei are
oftcn used in the passive forrn.
.in CX.lfllÚldltQJl
an opcrahon
perforrncd
a procedurc an cxriment a res1
perforrn a biop;y
lne proccdurc was camed out
by a nurse.
carry out
j/
22
7.1 Complete the senrences. Look ar A, B and C opposite to help you.
1 Somcone who specialiies 111 delivenng bab1es 1s a ... ................ .....
........
2 Someone who is qualified to assisr nurses is a ............. . . .. ........
............... .................................................. . 3 Someonc who is nor
qualified bu t is able 10 assist nurscs is a ........... ........ .................................... ...... .
4 A nurse who has qua lificd is a .............................. .nu rse.
5 A nurse who specializes in hea lth promoiion is a ..................... .................. ...................... .
6 A nurse who looks after a ward is a ........ .......................nurse.
7 A nurse \\ h<> \VO rks i n rhe co1lln1unity is a .............. .....
1 .._........ nurse.
8 Someone who a nswer.. rhc ward tclephone is a ...... ....
..................... ............ ................... .
7.2 Make word combinarions using a word or phrase from each box. Look ar D oppos1te
to hclp you.
carry out change check give remove sutures
a procedure an injection a dressing
the temperaturc
7.3 Complete rhe sentences wirh rhc corrccr grammatical form of /Jerfor m.
1 An isotope brain sean is pa in less and easy ...............................................................
2 Biopsy of the pancrcas ............................................................... lasr March.
3 If rhc pa tient's condition deteriorares, a la¡>a rot0my should ............................... .... ........................ .
4 _lf a di gnosis of n1í'ningi ti i(; (;111\pN'rrci :a hunhnr puncturc n1ust ................. ....... ....
..........................
5 Last year we .......................................
.......................a randomized, double blind group srudy.
7.4 Complete the sentences wirh the correct grammarical form of carry 0111.
23
Over .+-o 11ou '1
What kind of tasks do nurses carry out in your country? Are:nurst•s' rl'Sponsibilities
increasing? What are the implications of this?
24
[;] Allied health professiona ls
r.i.1 Community health
The health of the cornmuniry depends on a large nu mber oí peoplc othcr than medica !
prnctitioncrs and nurses. Thesc can be gr<>upcd undcr thc hcading of allicd hcalth
proíessionals. They indud:the following:
• Pbysiorherapisrs (physios) help people to move by gening rhem to do cxcrciscs or by
trcating their body with hcat or massage -treaanent by manipulating musclcs and joi nrs
with the hands.(Sec Unit 42)
• Occupational rberapis<s (0Ts) help people with a disabiliry to perform tasks at home
and at work. A disability is a physical or mental condition that makcs it diíficulr ro live
normally, for example blindness or deafness.
• Social workers help people to solve rheir social problems - for example poor
housing or uncmploymcnr -or family problcms.
• Chiropodists, also know as podiarrim, rrear conditions affecring rhe feet.
[;] Technicians
Thtrc are numerous tcchnicians - pcoplc \vho \Vork \virh scienrific equipn1enr -
such as radiographers, who are known as X-ray rechnicians.Ambulance technicians work
in thc en1ergency medicine service. An an1bulance rechnician \virh more advanced
qualificarions is c-alled a paramedic.
A prosthcsis Splints
lll Opticians
Opticians test cycsight and prescri be glasses -also know as spectacles -and contact
lcnses, \vhen necessary. 11"1e exan1ination includes n1c-. asuring intraocu lar prc'.:Ssure -
the pressure of fluid inside the eye -and exa mini11g rhe retina. 1f rhe oprician suspecrs
an
eye disease, such as glaucoma, rhey refer rhe parient ro their GP for trearmcnt. The GP
may then reíer the parient ro an ophthalmologist, a doctor who special izes in diseases
of rhe eye.
8.1 Make word combinauon; us111g a word from each box. Look a1A, B,C and O opp:>site
to help you.
a1nbulancc artificial club rontact health intraocular foot lens limb wOt'ker
oc:cupational social pressu technician professional therapist
B.2 Which allied hea lrh probsionals cou ld bes1 hclp 1hc following people? l.ook ar A, 8, C and O
opposire to hcl p you.
1a young unma rried wman who has just had a h:ihy
2 a woman who is havii ,g d ifficuhy using her nght arm following a fracmrc
3 someone who needs ¡tbsses
4 an dderl) woman "ho has had a bdow kntt amputanon
5 a man whose w1fc has Alzheimer's d1sease
6 a man "irh a fungal onfcrt1on of bis feet
- Neonatology
The rooms where they sray are
callcd wards. lf a paticnt's (Em
Departments +
treatmcnt requires only one day, gency) Outpatient
such as
a simple operation, they can be All Wards -
admined 10 rhe day surgery unit.
Day Surgery Unit & Endoscopy +
+- X -ray Department
+-Combined Assessment
fil Outpatients
Dr Barron: The Accidcnt and Emcrgcncy Depanmcor (A&E), also called Casualty,
is 'vhere pari enrs 'vho are acurely ill - 'virh a suddcn, scrious condirion - come (or
assessn1cnr and trcatmcnr. Outpatients \\lhO have an appoinonenr to see a specialisr
go ro a clinic in one of rhc Outpatient Oepartmcnts (OPDs). Thcy havc usually been
referred
to thc hospital by rhcir GP, who wrires a referra l lcner 10 the consulianr cxplaining the
paticnr's problcm.
[i lnpatients
Dr Barron : The inpatienrs Ln a hospital are ad_n1irted in one of rhree 1nai11 \Vays. Thcy
may be seen in one of thcourparicnt clinics and admitred from chere or, if there is a lot of
dcmand for rhe crearmem rhey need, as in rhc case of a hip rcplaccmcnt, thcy are pul on a
waitin¡; list for admission. Alrernativcly, their GP may arrange rhe admission by relephone
bccause they are acutely ill,for cxample with suspected rnyocardia l infarcrion. Or they
are secn in thc A&E Department, where the doctor on dury -working ar thar time -
arranges rhe admission. This would happcn in the case of a patient with a fracrured neck
of femur, for examplc. Larger hospirals may have an assessmcnt unit where parients can
be admined remporari ly while rhei r condition is asscsscd.
.)ordi: Assessed?
Dr Barron:Yes - decisions are made about their condirion, and whar needs ro be done
ro help them. After treatmem is complercd, the paticm is discharged back ro the GP's
care.
9.1 Complete rhc table wirh words from A, B and C opposire.Pur a stress mark on front of
the stressed'yl bhl' in r:ich word . The rr onc has bccn done for you.
V«r Nuu
'
h n
ad 'n1it
assess
discharge
operare
rrfrr
treat
9.2 Make word comhinarioni using a word from c:ich oox. Look ar C opposire ro help rou.
acutely assessment on unit lettcr list
referral waiting duty
11
9.3 Which hospital departmt11ts would be mosr appropriate for che following pancms?
Look ar A, B and C opposirc ro help you.
1 2 \YOm:inin cli'1hC't ic ('onl:-1
2 a patienr who ha> ju>1 had a radical pro"artx:romy
3 a paticnr who is ro ha'"a skin Jcsion
removed 4 a man wirh a forc1gn body in his
eye
S a woman with a thrca"'ned abonion
9.4 Complete rhe cxrrntt from an mformation kalkt for pa11enrs. Look ar A, B
and C opposire ro hclp you.
81\11im.ma111.11&1DiMilfill!lllCMP!Filhd!!"Hllli!
M*llll
iDJ Primary ca re
E The National Health Service
The National Heal1h Service (NHS) is responsible for healrh care for everyone in the
UK, although a small numbtr choosc to pay for privare care. Treatmcnt is fr<'<! bur
therc is a prc.scription chargc for drugs and applianccs, such as a cervical collar, \Vith
exen1prions for some parienrs, such a; children and che elderl)'·
Primary care is provided by general pracritioners, or GPs, (somctimes known as family
docrors), nurscs, dcnrisrs, pharn1acisrs and opticians. GPs '''ork in practices of J ro
20. Pracrices a re based in a surgery a nd look afrer rhe health of from 1,000 ro 15,000
people in thci r local community.Thcy also providc hcalth education in arcas such as
sm<>khg
and dier, run clinics, give vaccinations, for exan1ple for influenza, and 111ay perforn1
n1i_nor surgery such as removal of warrs and moles. lf a patient needs specialisr care, the
GP will makc a rcferral - refer rhc paticnt to a consulranr in seconda ry care.
Parlenrs are nonnally seen on an appointn1ent basis. Hon1e visits are n1ade \Vhen
patients are housebound - unable to leave their homes - or too ill to attend
surgery.Out-of-bours (00H) rreatmenc, from 6 pm to 8 am, is provided by the local
Primary Care Trusr, wh ich orga niies shifrs of GPs and locum GPs ro cover if someone
is absenr.
Note: The noun surgery has three meanings:
• the building where GPs work - Theproctice hos moved to o new surgery on the High Street.
• a time when GPs see patients - Morning surgery is from 8.30 to 12.30.
• the work of surgeons - The potient needs urgent surgcry on o burst oppendix.
10.2 Make word combinarions using a word or phrase from each box. One word can be
used rwice. Look at A and B oopositc to help you.
niessages staff appointments ho1ne visits dressings
change make perform refer run a clinic
supervise take a patient n1inor su rgery
10.3 Which member of a practice team would be responsi ble for each of the
following? Look a< B opposire 10 help you .
1 Running a clinic for pregnant women
2 Tcaching a patient how ro srrengrhen his broken leg
3 Lerring rhe GP kno\v chat a paricnr can'r come ro her appoinnncnt
4 Running a clinic for people who wanr to lose weight
5 Visiring tl parient \vho has just returned home afrer a hernia opcrarion
6 Carrying out check·ups on children in a poor neighbourhood
7 Organizing cover (or an absent doctor
10.4 Comple1e rhe diary for O·Srua rt's afrernoon . Look at A and C opposite ro help you.
. ;n;o11;;u11,;;a11;u11,;e;"",oª'"§191111141111
29
ill Medica l education 1
r.J Med ica! education i n the UK
Medica! education i n rhe UK covers:
• undergraduatc cducation - four or five years ar medica! school, rhe secrion ol a
universiry responsible for 111edical educarion
•a l'\\fO year Foundarion Prograrn mc \vhich providcs training for nC\V docrors a hcr
graduarion through a series of placemenrs in differenr specialries (see Unir 121
• postgraduat e trair.ing which docrors rnke to become GPs or consuhants - serior
specialiscs - often delivered rhrough collcges for different specialties, for example
the Royal College of Physicians
• continuing professional devclopment in rhe form of courses and seminars, which
docrors undertake rhrouglu>ur rhcir working livcs to keep up to date.
to a
hospital
traíning
depanmert «
case general
problems. practice.
•rm jusr finish ing my first year of Medicine. Whar 1 like abour chis course is char you're
involved \.V irh parienrs fro1n rhe very bcgi nning. Evcn in our firsr year, \ve spend ri1ne i n
hospita l. Much of the course is PBL. We have rwo 2·hour sessions a week whcre wc work
in groups of eighr to ren solving dinical problems. We decide rogerher how ro tackle che
problem, look up books and online sources, make notes and discuss the case togcther. lt's
a great way of lea rning and getting to know the other srudents. In che past,medica(
students had lecturcs with the whole class taking notes from lectur<rs from 9.00 to 5.00,
but now it's mainly group \Vork, alchough \VC do have sorne lecrures and scn1inars,
\Vhere \ve \\ 0rk in smnlJ groups \virh a ruror. 1 like ali of ir, cvcn rhc <lis)ci.:don .\'e gel 10 c.:ut
1
uµ \.:l:uh1vcr f10111
rhe second monrh of 1he course.'
11.1 Match th<"S<' activiries to the scages oí med1cal cJucauon m the UJ( gfren in A opposttc.
1 J1»e<:ting Cdd.n-.:1"$
2 kttpmg a log of surgic2I pures obsc.-.cd and performed
3 workmg for four months in amdent and cmcr¡:cncy 10 cxperience this specialry
4 t.1king a four-week attachmenc in Obstcrri< and Gynaecology
5 caking an online coursc on recent dcvclopmcnts in cardiovascular disease
11.3 Match cach of rhese activiri<' ro one of thc componcnrs of thc undergraduate
course describcd in B and C opposite.
1 julte spends six weeks workmg in a mall hospotal m thc Himalaras.
2 A group of srudents dilCUss togerhcr rhc possoblc reasons for abdominal p>1n afrcr mcals 111 an
obcse 44-rear-old malc.
3 A small group oísrudems rraee rhc pulmon•t) anct) in a cada, cr.
4 Otto >pends a month working m thc p.1ed1atric ward of rhc local
hospital. 5 Anne le-arns how ro rake blood from an cldcrl) paucm.
6 Juma chooses ro srud y Travel Medic111e m h1s founh year.
31
Medica! education 2
The Foundation Programme
The Foundalion Progra ntrne is a f\\roayear training progra111n1c \vhich forn1s rhe bri e
lX't\vten
univcrsiry-level study at medieal school, and spocialisr or general pracrice rra ining. l t
consists of a series of placements , each lasring four 1nonrhs,'vhich allo'v rhe junior
doctor, kno,vn as a trainee, to sample differenr specialries, for exarnple paediarrics. A
year one traince (FYl ) corresponds to prc-registration house officer (PRHO) posrs a nd a
ye1. r two tra inee ( FY2) to senior house officer (SHO) posr.;.Each rrainee has an
educarional supervisor who ensures that n1orc senior doctors deliver tra ining i n different
\vays, including clinical and cducariona l supervision.To progrcss, trainccs have ro
demonsrrare a range of clinical co1npetcncies \Vhich are assessed through observarion in
their workplacc.
{BMJ Cartt:f'S 2005;Amt'1'1ded wirh ptrm on from the 8ti.1J Publishing
Group)
Medica! qualifications
BMSc Bachelor of Medica) Scicnccs. A dcgrec often taken after rhree years of
BMed Sci medica) srudies by srudenrs who may wish to follow a ca recr in
medica) research.
MBChB, Bachdor of Medicine, Bachelor of Surgery. Bachelor degrees
MBBS are undergra duare degrees. This is the firsr degree for UK
BMBCh,
MD, DM docrors.
Doctor of Medicine
DRCOG Diploma of rhe Royal College of Obstetrics and Gynaecology
MRCP Mernber of rhe Royal Collcgc of Physicians or Member of rhe
MRCS Royal Collegc clf Surgeons. Doctors become 1'lember.; by
succcssfully
corn lering rhe asscssmcnt ptocedures in rheir college.
FRCS Fellow of the Royal College oí Surgeons of England. Orher collcges a
FRCS(Ed) re indicared by the letters which follow.for example Edinburgh,
FRCS(Glas) Gl1sgow or lreland.
FRCSI J Jow doctors become a Fellow depencls on their college.Fot the
FRCS, further exa rninarions rnust be passed . For orher colleges ir is by
no111ination or \\IOrk assess1nent.
12.1 Complete the phrascs with verbs from rhe box. Two phrases can be complered in rwo
differenr w•ys. Look >r A ond B opposite to help you
12.2 Match the two parrs of rhe senrences. Look at A, B and C opposite co help
you. An FY 1 is a doctor
2 A den1onstrator is an anaromy rcacher
3 A clinical rrainer is a consulranr
4 A supervisor is a consulrant
5 A medica! school is
6 A placement is
7 A college is
8 A Fellow is a specialist
a a body of specialisrs responsible for delivering and assessing training in their
specialry. b responsi ble for the train ing programmc oí a trainee.
e a period spenr as a rra inee in a hospital or in General Practicc.
d in the first year o( the Foundation Program me.
e \vho h,1s rc lchccl rhc hishest lcvcl i n thcir spccialry.
f \vho providcs training during periods of d irect clinical
carc. g parr of a universiry responsiblc for medica!
education.
h \vho rcachcs disscction.
12.3 Write in full thc qualifications of thc doctors and surgeons.Look at C opposite 10 help you.
1 Mr A. H. Younghusband, M BChB, FRCS, FRCSI
PLAB
Before rhey can obrain full registration , some carc¡¡ories of overseas doctors are
required ro rakc the Professional and Linguistic Asscssmcnts Board (PLAB) test. PLAB
is designcd ro ensu1e rhose who pass can pracrise saíely ar the leve!of an SHO in a
first appoinm1enr in a UK hospiral.
Part 1 consisrs of a wrirren test of knowledge, skills and attit11des. Part 2 is an
Objeaive Strucru.red Clinical Exa111inarion (OSCE). lt consi srs of l 6 five- n1Lnute
clinic:ll scenario!:, known as stations, to asscss professional skills.
Note: For a full description of PlAB. S<'.( http://www.gmc-uk.org/doctors/plab/
Read the insrructions ourside each Don'r forger rhe ABC (airways, brea thing,
srarion carefully. You have one 1ninure circulation} protocolin cvery cn1crgcnty
for rhis. srarion.
Keep in mind safcty Check rhe patient undersra nds whar is happen ing;
precautions like rhrowing rhe rhen ask thcm about any conccrns thcy may havc.
sharps in rhe sharps bin. Don't just give a lecture. l.isren carefullr ro ,vhar rhe
actor says.
Note: Sharps are needles and blades which must be disposed of safely in a special container
called a sharps bin.
doctor
3 A doctor who has successfully complcred the fim Foundation Year ( FYI )
4 An SHO who has succcssfully complered the Foundarion Programme and gained a
Certificare of Complerion of Tra in ing after severa !specialisr registrar posrs
13.2 Writc the abbrev iations in words. Look ar A, B and C opposite ro help you.
1 Any doctor who wants to work in rhe UK musr regisrer with the
GMC. 2 Some overseas docrors musr pass die PLAB resr before rhey
5 Before you can obtain specialist registration, you must have a CCT.
Presen ta tion
Parients say they wcnt to (see) the doetor; doctors say the parienr prescmed. The symptom
\vhich causes a patienr tC> visi r a doctor - or ro prescnt - is ca lled the presenring syrnpto nl,
presenting con1plainr or prcsenfation.
( He presented 10 his GP wirh chest pain. ) ( The usual presentation is rhcst pain. )
Nuu Acljl'rl
n 1w
ex'hausrion
fatigue
lcthargy
ti redncss
14.2 Make word combinationsusing a word from each box. Look at A, B and C opposire ro help you.
compla in with of out on
off- out of present put oolour
worn sorts
14.3 Complete rhe senrences wirh rhe correct form of thc vcrb prese nt.
1 A 67-year-old man ............................ with a 9-momh history of incrcasing
shortness oi breath. 2 The most common ·················· ····-···is loss of
consciousness.
3 Cranial arrcriris n1ay ...-.......................... as fever'virhout any obvious causes.
4 The patie1lt usu:llly ........ .. ·········-···with :l cvcrc sore throa.r.
5 The····-····-············
··-··symptoms in this pariem could perhaps be due to renal
foilure. 6 Orher conditions wirh a simila r ....................... ...... include acure
cholecysriris.
7 R educed growrh is an important ....-..........................complaim of codiac
disease. 8 Two momhs following·················· ····-··, rhe patiem was able
ro walk.
14.4 Read rhe parienr's descri ption of her symptoms thcn complete rhe case reporr. Look
at C opposire ro help you .
Anaemia
Anaemia is one of rhe commonest diseases of rhe blood.Ir may be due ro:
• blccding - loss of bloo<l
• exccssive desrrucrion of red cclls
• lo\v producrion, for exa111ple because rhc dicr is lacking, or deficient in, iron (Fe).
A medica! srudenr has examined an elderly pacienr wirh a very low leve!of haemog.obin
and is djscussing rhe case \Vith her profts.. r:
Professor: Whar's che mosr likely diagnosis in rhis case'
Srt1denr: Mosr probably c:arcinom:t of t.he bo"vel wich chronic blood Joss:.
Professor: Whac's agaiHst rhar as a diagnosis?
Srudcnr: Well, he hasn't had any change in his bowel habic, or losr weighc.
Professor: Whar else "ould you include in rhe diffcrcntial diagnosis of sevcrc anacmia in a
man of rhis age?
Studenr: He rni ghr have leukaen1ia of son1e SQn, or aplasric anacmia, bur thar's
rare - i t would be vcry unusual. Anocher cause is iron deficiency, bu e he
seems 10 have an adequate dier.
Profem>r: OK. No,v, rhere's anorher cause of anaen1ia ,,,hich 1 rhi nk is 1nore l ikely.
Srudenr: Chronic bleeding ulcer ?
Profossor: Yes, thar·s righc. But \Vhac about pernicious anaen1ia? Can you cxcludc rhar?
Srudenr: Well, he's gor none of the typical ncurological symproms, like paraesrhesiae.
Pernicious anaemia
Jordi Pons, rhe medica!srudent from Barcelona, has made sorne languagc notos in his
tcxtbook.
Pernicious anaemia (PA) is a condition in which there ataxia. The spleen may
is atrophy of the gastric mucosa with consequent be palpable .
failure of intrinsk lacta< prnduction and vitamin 812
malabsorption. The onset is insidious,with
progressively increasing symptoms of anaemia.
Patients are sometimes said to ha a lemon-yellow
colour o.ving to a combination of pallor and mild
jaundice ca•sed by excessive brea kdown of
haemoglobin because of ileffeaive red cell proouction in
the bone marrow.A red sore tongue (glossitis) is
sometimes piesent. Patients present with symmetrical
paraesthesiae in the fingers and toes, earty loss of
vibration sen.se,and progressive weakness and
Pro(essionol E.ngtish in Use Mtd1one 39
Ott = be9t1o1. W..the eovít!:I of OCl'\tS
t....tolí.o«.< = slo·N\1:1 tlevelop 'ti""iM.ttL = ••eh se tllt s•w.t
,,aLlor = tac of eolo«r víbrotí.o"' st"-St = obiüt!:I te feel
,...l.tl = slí.0ht vibrotio
joi..wjí.Ge = btLtrubtv.ne"'ia proeressive = eo....ttiM< tidevelo¡>
brtaR.<low"' = olivisio"" t....to S"'4•Utrp•tts be ,..,•..,.""' = 5* tlss«t p•Lp11bu = eav.. be fett wi.th the h••
38 Professional Engflsh in
Uv.Medidn<!
15.1 Fmd words tn <he box ";,¡, opposite rneanongs. l .ook at B and C opposite 10 hdp you.
15.2 Make word combinations using a word from each hox. Look ar B and C opposirc 10 hclp you.
diagnosis sense onsel marrow
bone diffcrcntial insidious iron pemicious inereasing deficiency anacmia
progressively vibralion
lnqll\h An;1torn1t·al .
nanu· n 1n1t·
skull cran1un1
jaw bone mandible
spine vertebral column
brcasrbonc srernun1
rib cosra
collarbonc davide
shoulder blade seapula
rhigh bonc femur
kneecap parella
shinbon c tibia
Fractures
A fracrure is a break in a bone. Some of rhe differenr rypes of fracture:
"\
greenstick displaced impacred open (compound )
con1n1inuted
..,>.
:e .•
9 ,.
J
' "
10 r
16.2 Match the I)' oí fra<tLtt (l-5) wirh rhe dcscripuons (a-;,). Look ar 8 OPP'"'" 10help you.
1 Oprn
2 comminured
3 displaced
4 greensrick
5 impacred
a There is a break in 1hc sk in.
b Thc bone is benr. I r C>C<ur> mainly in
children. e The bone is brokcn in10 several
pieces.
d The broken pieces are scparated.
e The broken pi are pushed rogcther.
(1) ·----·---..·--·.. ·a fracture involves trying to return the bones to as near to thelr
original position as posslble. lf a fractureis allowed to heal in a displaced
positlon the fracture
Coeliac disease
A med1c1. I srudcnt ha m:dc somc languagc notes whole reading her 1e:1-. tbook.
1a1111ng gluten. The dinical features onclude d1arrtcea. malabsorption and failure vittl
to thrive
to Thele -' ol malnutrition and thete ..
may• be signs
z'2'' ''°'9
rtaetici'\. to
= •.,. , t¡,t c:t Í"''"
MÍ CW\.o to soli.d focas
L = te s¡j'4"-SQ..,;i
S4<_!i<.S <f O >.UDSl
.....,U.bsorptíc" = J>l'C' Qllsc<;.t.c..
......i......tñtio... = PI"" di(t (l'\Wt.o':U'....)
tldJtefat = ha(
thrivt = erow str...gt1:1
dLste:: s." "tiliK'9
dtU.!jed = !tlter · t"ª"
"'l'teted
faU..rt = wkt" "'""" t•at '5
tiq>tcted d Mt ht!pf'"
stot1<rt = siu, tspteialLtJ •eht
Verl> Nu Ad¡t·r11w
un(,) hl
dda¡
devrlop
di<rend distended
foil
nourish
1 Babi \\ 1th 1he feral akohol S) ndrome may prrsem wnh 10 1hme.
2 Abdominal _ rn•> br due 10 an enlargcJ ll\ cr.
3 Small amounis of alcohol m prq¡nancy can aff'f fetal ·-
·--- 4 Mona hry from measles can be reduced by bener
5 ......... ...........in onc or more of thc milcstones may be thc first sign of di<e.1>c.
Goitre
An enlarged rhyroid gland is called a goirrc. The enla rgemenr may be di ffusc -
involving mosr of the gla nd, or localizcd - limited ro a particular arca, as in a
solitary (single)
nodule. The incrcased blood ílow in diffuse enlargemcnr, for example in Graves' disease,
may give rise ro a palpable thrill - vibra rion felr with rhe hand, and an audible bruir
-noise heard rhrough a srethoscope, over rhe gland .
A letter of referral
Mrs Oavis's docror has rderred her ro an endocrinologisr.
Oear Doctor,
ovemcrivc:more
1 woud be grateful n you would see thls 50-year-
acrive rhan is
woman who has lost 20 kilos In weight old in spite of eating usual
more than usual. She describes herself as overactive and at first she thought the weight losswas due to this. But
moro recently she has developed palpitntions, diarrhoea. palpirarions:
and heat intolerance. She has noticed that her hands have a tendency to shake. a\varcncss of
Her syrnptoms suggested hyperthyroidlsm and lhis was rapid or irregular
confirmed by my hcat intolcrance:which revealed an enlarged thyroid , red sweaty palms and a heanbeat
examination fine tremar of the hands.
inabil ity to
cope with high fine tremor: very
temperarurcs slight involunrary
mo\'emcnts
44 Pro(essional English in Use Medidne
18.1 Complere rhe rabie wirh words from A, B and C opposire and relared forms.Pur a
srress mark in fronr of the messed syllable in cach word . The first one has bccn done
for you.
vrl Noun
l
in'hibit
produce
release
replace
secrerion
stinlulacion
18.4 Match Mrs Davisºs symptoms ( 1-7) wirh the quesrions her doctor asked (a-g). Look at
D opposire to help you .
1 diarrhoca a Do you prefer hor wearher or cold?
2 earing n1ore b Is your weight steady?
3 hear inrolemnce e What is your appetire like?
4 overacriviry d Are your bowels normal?
5 palpirarions A re you able ro sít and relax?
e Do your hands shake?
6 wcight loss f Have you ever felt your hearr bearing ra pid ly or irregula rly?
7 rremor g
eyelid
cyelashcs
pupil
l<>Oi< lor squint (sirabismus).4rooping ol !lleuppe< lid (ptosis) or oscillation of lhe eyos !he...,.,...
us).In lid lag,
eyelld movos írregularty instea:f olsmoo<lily when lhe patient is asked to lool< clown.
Next. examine the pupils and note vmettier:
they are equal in $ize
they are regular in oudine (eventv citculat)
lhey ar•abnoonally dilato<I (ia.'go) or constricted (sma
lhey react normolly to light and accommoda tíon (fools on ,_objoos).
To test the reaction to accommodation, ast tllé patien1 to look lnto the dis1ance. Hold your finger in front of their n»e, and
tlle pationt to lool< at n.The e)OS should como togethe<. or converge. and tlle pupilsshould con<trict as !he patietit lool<s at tlle fin
Chl!Ck also for cataract (opaciy ol tlle leos).
E 1
Reti nopa thy
Hypenensive changes in the reri11a can be classified from grades l to 4:
• grade 1- sil ver wiring (incrcase in the light reílex) of rhc ancries only
• grade 2 -grade l plus artcriovcnous nipping (indenrarion of veins where they are
crossed by a rrcrics)
• grade 3 -grade 2 plus flamc-shapcd haemorrhagcs and cottonwool exudares
• grade 4 -grade 3 plus papilloedema.
cottonwool exudate
19. 1 Complete rhe rabie with words from B opposire and relared forms.
Vn Nou AcljtTl l
h n Vl'
accommodare
cons:trlcrion
convergence
dilat(>n,
dilamrion
droop
oscillate
reaet
19.2 Match rhe picrures (1-<i) wirh che condirions (a-f). Look ar B opposire ro hclp you.
1 a drooping of lids
4 b dilared pupils
e irregular pupil
d cararact
e squint
f consr:ricred pupils
19.3 Complete rhe extraer from a rextbook. Look ar C opposite to help you.
Retinoscopy
Examine the retina with an ophthalmoscope,if possible with the (1) .......... ............._....
dilated to obtain the maximum view. Look for papílloedema,and for (2) ............ ..... . ...........-
..................................haemoohages and (3) ..... ............. ..................exudates. Assess the state of
the (4) ............. ..................and note the presence of any narrowíng, as wellas
(5)......................... .........at arte<iovenous crossings.
-
Pro(essionol EngfM in Use Meéidne 47
The gastroi ntesti na l system
Examination of the abdomen
Here is an extract from :t textbook dl'SCription of ho\v to examine the abdon1en.
The faeces
There are severa! words for rhe faeces.
Doctors sOnleti1nes say: Patienrs son1erin1es say:
There was blood in the srools. M¡• motioos have been very loose larely.
Have your bowcls moved today? Have you had a bowel movemenr roday?
Have you noriced any changc of bowc,I habir? How ofren do you open your bowds?
Cha nge in bowel habit could be constipation - hard, infrequenr srools, or diatrhoea -
frequent soft or liquid srools.
TI'e colour can vary fr(Hn bl:ick, due to alrered blood <lS in n1el::iena , to ycllO\v, grey or cven
whitc.Melaena stools are ofren described as rarry - like mr, rhe black sricky substance rhat is
used in road making. Thc srools may be red when fresh blood is prcsent. Blood that can only be
dctccted wirh special resrs is called faccal occult blood (FOB). When rhere is a high fat content,
the siools are palc, and re somerimes described as day colourcd. Stools that are large in
volume are described as bulky. A bad smell is described as foul or offcnsivc.
4
9
20.1 Complete rhe case reporr. Look ar A oppos1re ro hclp you.
Physical examina tion rel'ea led a thin girl with slighl pallor. She was not obviously
dehydrated. The lemperatu re was 38ºC, pulse 100/min, blood pressure 110/80
mmHg. Examination of the resl of the cardiovascular and respiralory systems was normal.
The abdomen was not (1) · --·There was generalized (2)
, which was most marked in the right lower (3) and was
associated with
(4) but not (5) There was no rebound (6) _ --and
no (7) were felt. (8) sounds were reduced.
20.2 March rhe dcscripuon; of rhc srools ( 1-6) wirh rhe condirions mosr likcly ro cause
rhem (a-f), using your me<l ical <nowlcdge.Look ar ll opposite to help you .
Type of stools Condilion
1 loose, bloody a ga<rr1c ukcr
2 loose, p;ilc, bulky b irrirahlc bowel syndromc
3 clay-<:olourro e ulccrame coliris
4 black, ralT)' d cholcra
5 small, hard e coelOJc d1sease
6 cica warery wuh mucus f ob'imicuvc¡aundice
20.3 Match rhc fcarurt-;, ( 1-7) ro rhe docror's qucsr1on; {a-g). Look ar B opposire ro
hclp rou. 1 blood a How ofren do you open your bowcls?
2 lx>\vel habit b Are you going 10 1he roiler 1nore ofren rhan 11un111I?
3 change in bowel hahu e Are the morions ha rd or loosc?
4 bulk d Do rhc morions ha\·c an un usual smell?
5 colour e \Vhar abou1 rhc appcarancc of the srools?
6 consisrrnq f Ha»e you pa;;cd black srools?
7 offensiveness g Isthe siie or rhe amount of the srool normal?
right left
upr
quadrant
right i(ft
lowtr lowtf
quadrant cuadran!
The abdom<n can be: dMd<d
1nto tour quadrants.
Ove.r +o
1101.4
L nnk hack <11 70.7
ahnvr
. In \\lhat ot her rondil1eu1' t h;it you t•nrotu1trr rt· 1ul,;11 lv "
lht·
1ppearanrt· of lht· ...tool; lyp1t·al? How would you dt•,rnht·tht·1 r 1
appt·aranrt·
Gyna ecology
The female reproductive system
Fallopian 1ube
(salpinx)
ovary
neck of womb
(ccrvix)
Menstruation
A period is rhe com mon r1111e íor a menstrual (monthly) period. The onsct of
mcnstruation is known as mcnarche. The lasr menstrual period is commonly
abbreviared in docrors' nores: LMP 2/52 ago rneans rhc lasr menstrual pcriod was two
wceks ago.
Thc menstrual cyclc,or length and frequency of periods, is usually writren in rhe form
4/28. which rneans lasring 4 days and occurring cvcry 28 days. lf a period lasrs more
rhan four or fivc days ir can be described as prolonged. The rerrn heavy periods mean s
excessive blood loss - menorrhagia, ofren wirh rhc passagc of dots-coagulared blood .
·rhc rcrm pcriod pains rncans dyS1nenorrhoea, or pa inful rnenstruarion.
The rime when a woman ;rops menstruating, normally ar a bour the age oí 50, is ca lled
rhe menopa use or climacreric.In everyday English ir is known as the change of life, cr
simply rhe change.Symproms of rhe menopause includc ho1flushes -sudden sensation
of heat -and night swca1s.
A gynaecological consultation
A gynaecologist is talking ro a 30-year-old woman.
Gynaecologist Patient
Contraception
For women, methods ro prcvcm pregnancy include che oral conrraccptivc pill (known
Professional Entl sh ti'> Use SI
N
as 1hc Pill), rhc diaphragm, and che intrau rerine devicc (fUD) or coppcr coil.
Condoms are available for borh nlcn and \vo1ncn.
21.2 Read the convcrsation bctween rhe gynaeco logisr and rhe pariem in C opposire, and complere
rhe notes abour rhe parient.
menarche:
111enstrual cyclc:
LMP:
menorrhagia?
dysn1enorrhoea?
discharge?
21.3 Now wrire rhe quesrions thar rhe doctor asked . Look at C opposirc to help you.
rnenarche:
menstrual cydc:
LMP:
n1enorrhagia?
dysrnenorrhoe.a?
discharge?
21.4 Complete thc case rcporr.Onc word is needed t\Vice. Look ar B and C opposire ro help you.
A 45-year-old woman had been having (1) ... .... ..... .....periods lasting for 8 days.with the passage of (2) ..
any hot (5) ..... ....... .. ... .or night sweats,and her general health had always been good. She had taken th
condonl5
IUD
Hea rt rhyth m
The nonnal resting heart ra<e as 65-75 beats per minu<e. In arhleres u may be as low as
40 beats r nunurc. I n extreme athletic Jet" 1t), rhe hcan ra<e can go as h1gh as
200/min. Thc hean rhy1hm may he regular or irregular.In an irregula r rhychm
(arrhyth1111a). rhcre may be carly bea<s which imerrup< the regular rhyrhm (prcmarure
bcats); or 1he rhythm may vary \Yith rc,piration; or ir may be co1nplctcly irregular, as in
fibrillarion . \Xlh<'.fl pariems are awa re oí i riegula riry, they dc!>Cribe rhc symprom as
palpitations .
A 22-year-old student was admitted to hospital with a long history of heart problems.
She had been increasingly tired, with shortness of breath on exertion, orthopnoea, and palpitations.A mltr.1 v•lve repla
Heart failure
Heari failure occurs whtn rhe heari is unablc to mainrain sufliciem cardiac outpu < - the
amount oí blood pump<d by the hearr cach manutc - íor the body's nttds.1< may
1nvolve the left side oí the hcan, the riglu side, or both. In leh heart fuilure the main
S) mpDm is breathlcssncss.The '> mptoms oí right hcart failure 111dude periphcral
ocdema ts"e!ling), hq¡inning in the íeci and anklts.This is known as pi11ing ocdema
ií, when J lingcr is pushed into the fücilm!l. 11 causes a small depress1on or pat.
<roruspod vaM
septum
22.2 Makc word combinations using a word from cach box. Two words can be used !\vice. Look
ar B and C opposire ro help you.
22.3 Wrire che words a paricm would use ro describe che symptoms below. Look ar A, B and
e(lpposite ro help you.
1 Jy!lpnoca
2 arrhythmia
3 orrhopnoea
4 ocdema
22.4 Complete rhe case reporr. Look ar A, B and C opposire ro help you.
2
'
e i Jkj
Areas of auscultation.The letters indicate the approximate position of the heart valves:
P Puln1onary valvc; A Aortic valve;M Mitral valve: T Triscupid valve. The circles indic:ate lht position for auscultation for c
valvular heart discase. The ribs are nul'nbered.
Vn Nou
n
•auscu1rarc
h
examine
inspect
palpare
percuss
23.2 rur rhe srcps for exa1nining rhe heart and circularion in order, according ro rhc four-
srage sysrcm . Look at A oppositr ro hclp you.
a Ñleasure rhe hearr
size. b Aie rhere any
nlurn1urs? e Fcel rhe
radial pulse.
d Look for dubbing.
e Locare rhe apex bear.
f Norc any thrills.
3.3 A doctor is presenti ng rhe case of a 43-year-old woman ar a meeting in thc Cardiology
Departmenr. Complete rhe rexr of her presentarion. Look ar B opposire ro help you.
On cxan1ination shc \Vas pyrcxial \Vith a rcn1pcrarurc of 38.5. Shc \vas shorr of brcath.
Her pulse was variable berween 100 and 180 and was irregular in rime and
( 1) ................
Her blood prcssure was l30/80 and her JVP was up 5 cenrimetres showing norma l
movemcnr wirh respirarion. Her periphcral (2) ................................werc all prcsent and
rhcre was no (3) ...........................or (4) ................................cyanosis. Her apex (5)
................................was
displaced ro rhe anterior axillary line but still in thc fifrh intercostal (6)
................................ . Her heart sounds were'ery inrcrcsting. When she was initia lly
examined ir was nored that she had pan-systolic and mid-diastolic (7)
................................ , heard besr at the apex.
When she'vas exan1ine<l so1ne hours larer, rhere 'vas a harsh perica rdial fricrion
(8) ................................ all ovcr rhc prccordium. Our diagnosis at that time was of
mitral stenosis and incompeiene with a recenr onset of pericarditis and arrial
fibrillation.
Microorganisms
lnfecrions differ from orher diseascs in a numbcr of aspecrs:
• Mosr in1porrantly, rhey are caused by living 1nicroorganisn1s - such as viruses or bacteria
- rhar can usually be idenrificd, thus esrablishing the actiology early in thc illncss.Many
of rhse nrg:t 11is1l1 . i11cluding all hacreria, are sensirive ro anribiorics and 1n<>sr
infecrions are potentially curable, unlike many non-iu fectious degenerative and chronic
diseases.
• Con1n1unicability is anorhcr factor \vhich di fferentiates infections from non-infcctious
diseases. Transmission of pachogenic organisms ro ocher people, directly or indirecrly,
may lead to an outbreak or epidernic.
• Finally, ma ny infeccions are prevenrable by hygienic measurcs, by vaccincs,
(csp<'.Cially live arrenuatcd vaccincs such as rubella vaccine) or by drug prophylaxis
(for example, chloroquine ro prevent malaria ).
Micro(>rganisms include bacreria, viruses, fungi, prorozoa (such as rhe
parasi1e rhar causes malaria). Another general word for rhese
parhogens is n1icrobcs. f>atienrs often refer ro microbcs as gcnns or
bugs.
Norice rhe con1111on ex1>ressions for acquiring an infcctious discasc:
1 rhink !'ve
caught caughr thc ílu
Could he have sorne diseasc from thc
picked vug that's going
up dog? round .
Source and spread of infection j
Here is an exrract from a medica!
rexrbook.
lnfection may originate from the patient (endogenous), usually from skln, nasopharynx or bowe, or from
outside sources(exogenous), often another person who may be either suffering from an infecticn or
carrying
a pa.thogenie mieroor110.ni3m. Carrier& are usuolly heolthy and m.oy h.:1rbour thc org.:1ni::;.m in thcthroa.t (for
example. diphtlleria), bcw.<el (salmooella), or bloocf (hepatitis 8or HIV). Non.humansources of lr1fection
include water (e.g.choler'l). milk (e.g. tuberculosis), food (e.g. botutism), animals(e.g. rabies), birds
56 Professionol EJigfl•h on Use
Med•cm<:
(e.g. ps.ittacosis) and also the soil (e.g. legionella - Legionnaires' disease).
The incubation period isthe period between the invasion of the tissues by pathogens and thie appearance of
clinical features of infection. The period of infectivity is the time that the patient isínfectious to others.
24.2 Complete 1he case reporr on 1he parienr in A opposi1c. Look ar A, B and C oppo<ire ro
help you.
On examination, he looked unwell.His pulse rate was 100/minute.He had a palpab'e spleen.The combination of (1)and (2)in a
(4) ................................regularly. The diagnosis was confirmed by the presence of (5) ................................in his blood film
Substance abuse
Abuse of a subsra nce means using ir in a '"ªY 1hat is har1nful. The co111monest fonns of
subsrance abuse are alcoholism and drug abuse.
Noun AdJl' t 1w
r
offeahc
anxious
behaviourul
dcmcntcd
d isturbcd
su icida!
25.2 Makc word tombinations using a word from c 1th box. Two words can be used rwic<. Lool at
8,C and E opposire ro
behavioural cating major mental personality
psythomotor slccp substancc
25. Cv111plc1c 1111: 11tc1n.:es. Lvok ar J\,C. 1) ¡111d I! oppoire to help you.
3 1 The way a person beha•es is his or her . ... ........ .
2 A persi rcnr emorional s:are is a
3 A suddcn orrack of anxiet)' is a ......
4 The form of dcmenria associoted wuh Jgcmg i;called
S A d1wrder which is nor assoaared with parholog1cal chonges is ------
6 An idea "hich forces a panent ro repear unn.,.,"tSSJry aroons is a ----
"'h1ch S) mproms of depression was th1s pallen! suffenng from? Look ar C opposuc 10
25. help you.
4
A 56·year-old woman presented to her GP complaining of increasing tiredness over the past
few months.She had lost interest in most things. She was sleeping poorly and tended to wake up early, but
more often. She was eating normally and her weight was steady.
'- -
Motor loss
Motor loss symproms and signs include:
• weakness - loss ol power
• paralysis -complete loss of power
• tremor - involunrary rhychmic movemenc, especially of 1he hands
• abnonnal gait - unu.sudl ntanncr of \Vdlking.
Specch may also be affecced, for cxample wirh boarseness -a rough, deep voice as u1
voca l cord paralysis.Slurred spccch mcans po<>r a rticulati(m, as in ccrcbcllar disease.
r
Loss of consciousness
Pa1icnrs may describe sudden loss clf consciousness in a number of ways:
r fir.
passed OUI. '
1 had aseizure.
had a blackout.
convulsion.
fainred.
Fit, seiz:ure and convulsion ace all used ro refer to violenr involuntary n1oven1ents, as
in epilcpsy.
Doctors may say:
When did you lose consciousness?
The principal differential diagnosis isbetween an epileptic lit and a syncopal attack, or
fainting. Syncope isa sudden Iof consciousness due to temporary failure of the cerebra l
circulatio1.Syncope isdistinguished from a ieizure principally by the circumstances in which the
event occurs.Fer example, syncope usua lly occurs whilst standing, under situations of severe
stress, or in association with an
arrhythrnia.Sometimes a convulsionand urinary incontinence - los uf control or tite blddder -occur
even in a syncopal attack..Thus. neither of these isspecific for an epilepticattack.The key is to
establish the presente or absence of prodromal symptoms, or symptoms that occur
immed iately before the attadc.Syncopal episod?s are usually preceded by symptoms of
dizziness and light·headedness. I n epilepsy, people may gel a warning, known as an aura, that
an attack is going to happen .
Note: The noun convulsion is often used in plu ral form - He had convulsions as
a child.
60 Professional English in Use Medicine
26.1 Comple1e rhc rahle w11h wrds from A, B and C oppo,11c.
Ad¡cctiv Nou
c n
blind
conscious
deaf
ditty
numb
liglu-headcd
unste.1dy
26.2 Make word combinarion < u<ing " word from each bo<. l.ook ar A, B and C opposire to
help you.
double epileplic prodromal syneopal urinary visual aruity
atladt íncontinentt synptom vision
fit
26.3 A doctor is trying 10 determine rhe cause (>Í los' oí cono;ciousness in a 52-yca r-<ild man.
Complete che doctor'> qucsoons. Look ar C oppo;11c and nr 1he ra bie in 26. l abovc ro help
you.
-
The nervous system 2
The motor system
Exarni nacion of lhe n101or sysre1n should include assess1nent o( thc follo\\ ing:
1
• muscle bullc (amounr of muscle tissue). Look for signs of wasting (muscle atrophy)
• muscle tone (amount of tension i n a muscle whcn it is rclaxcd). Tone can be
increased (spasticity ), or decreased (flaccidiry)
• muscle power (srrength)
• coordination (rhe abiliry ro use severa!musclcs at thc same time to perform
complex actions)
• gait (the manncr oí wa lking)
• reflexes (see B bdow)
• in"oluntary 111ove1nents, for cxan1ple a tic or a trcmor.
Herc is an cxrract fron1a case report abour a parienr \virh a rremor.
On examination, her lace showed little or no expression.. There was a tremor affecting mainly her right hand.
Tendon reflexes
Exan1inar1on of rhe ncr.rous sysre1n normally
includes testing the tcndon rcflexcs, for example
the knee jerks, wich a t<ndon hamm er (also
known as a rcílcx hammcr). Thc reílexes
rnay be absent (0), diminished (-), normal
(+) or brisk (+++). The plantar reflexcs are
also checked. The norma l plantar response
is a downgoing (+) movemenr (plantar
ílexion) of the big toe. An upgoing (t) toe
(extensor or Babinski response) is abnormal.
Coma
Testing the kncc jrrk with a ttndon hammer
Con1 1 is unconsc-iousness 'virh a reduced response 'º exrernal sti1nuli.
Doctors sa y: ( The pan.enr -1s ·1_n a \f¿o- The pau·enr ·1s con1arose.
coma.
Noun Adjl"CllVl'
a bsence
diminution
flaccid
spastic
wasred
-
27.2 A doetor is g1vin¡¡inrrucóons to a patienr du ring cxamination of rhe motor system. ldennfy
what the doctor is assc>Si 11g in each case.Look ai A opposirc ro help you.
1 J 'd like you to rcbx. J ºrn ju" going to movc your a r111 up and down.
2 C111 1 sec your lrnnds?
3 Now, l'm going to >traighrcn your arm out. Try to stop me.
4 Can you touch rny finger wirh yours and rhen touch rour nosc? Good. Now do 11 again wirh
)'OUt C)'es cJosed.
27.3 Compl<tc the scntcnces.1)()k ar A, Band C opposuc and ar thc rabie in 27.1 ahove to
hdp you.
1 A ·-----------··- hand droops limply ro forrn a righr angle with the wrist.
2 · ···-··-···- ........reílcx('S are rcflexes that are strongcr than norn1a l.
3 Muscle .....................-........ ..... means rhe mu>clc is rcduccd in bulk.
4 A tic is a fortn of ... .........····-··-··n1ovc111c1n.
5 A key is oftcn used to rcsr rhc ......·--·---·--.............. response.
6 His ---·---·---..·- W•S poor: he could not pcrforrn rapid alrcmaring movcmtnt>.
7 A is used to test rcflcxes.
8 When somcrhm¡:1s , 11 is less rhan normal.
27.4 A patient is brought to A&F in coma. \Vhcn her namc is spoken, she opcns her c)es hur
she does nor answrr qucsnons, or obe)• insrructions. Whar IS her scorc? ces
63
-
Oncology
Neoplasms
A ncoplasm is an abnormal new growrh of tissue. Malignan< ncoplasms -cancers
-are likely ro spread and cause scrious i ll ncss or dearh. Benign neoplasms do nor
spread and are lcss harmful.
\'Uhen speaking ro parienrs, docrors generally say growrh or rwnou r.
growrh
You have a small in thc bowel.
tu1nour
Malignane nJnlO\lrs are characterizcd by rapid gro\vth and invasiveness. The ru111our may
invade local rissues or may spread ro disranr parts of the body {mctasrasis). Neoplasms
which are rhe resulr of nerasrasis are called sccondaries, as opposed ro rhe original
run1our'vhich is the prin1ary.
We have rhe resulrs ot rhc sean back nO\V and l'rn afra1d rhey .sho\v rhar you have a small growrh in rhe pr
Note: To invade (verb) is to enter and spread throughou t a part of the bo<ly,and thisprocess is
invasion {noun). l f a tumour is described as invasivc, it has the ability to spread.
A 33-year-old man presented to his GP complain ing of a painless lump on the right side of
his neck, which had been present for about two months and was enlarging, He had been leeling generally un
sweats.He had no significan!past medica ) histoiy.
Treatment of tumours
A run1our can so111eti1nes be con1plecely removed or excised by surgery. lf rh1s is
not possible, for example if ir has alrcady merasrasized to orher parts of rhc body, ir
may be possible ro destroy ir by radiorherapy or by chemothcrapy (see Unir 42).
When a cure is not possible, palliative trcarrncnr is givcn, which is only imended ro
relieve symproms.
28.2 The notes below are abour che parienr described in B opposire. Use rhem to pur the senrences
e
(1-9) in the correct order, to make thc ncxt paragraph of thc case rcport. Use Appcndix 11 on
page XX if you need help with the abbreviarions.
OE f 37.8ºC
5rt'looth. flrm 3)( 4 cm ma% in R 6upract.Mcular f056a.
nodte 1-2 cm Ú1 dia.mettr. palpal>le: fn both a:&lae a.nd ingujnaJ arta§
OropM,,.,.NAD
P 100/min "°'Jlor 6f' 112166
CVS NAO R& AO
Al><l m•Ot> palP"l>fe Z, cm l>elow L coetal margin
CN& NAD
Labour
Thc process by which rhc forus and placenta are pushcd out of thc menos is callcd
labour. 11 is divided inro four mges.Sorne words which are combinecl wi1h labour are:
Vl'rh Nou
n
abort
deliver
inducrion
miscarry
pr<sen1
rermination
129.3 Dr Bennctt, an SI 10, is pre<cnti ng a parienr ar a wcek ly meeting in thc obsrerric unir oi a
hospit.al. Coanpl etc thé pr<:'lenrarion ...vith rhc corrcct forni of vcrb.s fron1 29.2 ul.>oYc.
This is Clara Davis. 5he carne to 1he antenatJ I clmic ar nine weeks.In her past
obstcrric history,she had a prcgnancy "hen shc was 18. wh1<h \V3< (1) and
anorher onc a ycar later. which sponraneously (2) .Sincc thm <he ha<
had three prtgnancics. In 1he fim, che baby was (3) nonnally a1 40 we<ks.
ln che second, she had an (4) of labour al 39 weeks bccausc of fetal
distress. The chird baby (51--------·---·as a br=h and was (6) ·---·---- ..
...by caesare.an scct1on.
ProfessKJnol E.n1tish rn Use M td<1nt 67
-
The respiratory system
Cough
Cough is a common symprom of up¡>cr respiratory rract infection (URTI) and
lung disease.A cough may productive, where the patiem coughs up sputum, or
non-producti vc, \vhcrc therc is no spurun1. A producrivc cough is ofren described zs
loose and a non·productive cough as dry.Spurum (or phlegm) may be clear or white
(mucoid ), yellow d ue ro the presence of pus (purulent), or blood-staincd (as in
hacmoptysis).
A doctor iscxamining • patient who iscomplaining of a cough.
Doctor: How long have you had thc cough ?
Mr Ha111i Oh, for years.
lron: Do you smoke?
DoclOr: 1used ro smokc hcavily, bm 1 gave up a year ago.
Mr Hamilton: Do you cough up an)' phlegm?
Doctor: Yes.
Mr Hamilton: What colour is ir?
Doctor: Usually yellow.
Mr Hamilton: Have you ever noticcd any blood in ir'
Doctor: No.
Mr Hamilton: Any problems with your breathing'
Doctor: Yes, 1ger very short of brearh. 1 have ro stop halfway up rhe stairs ro gcr
Mr Hamilton: my br<ath back.
The doctor writes i n rhe patiem's case notes: clo dy pnota & cough c. purulent
6putum for ye;a r6. No hae;mopti6.
Note: The noun phlcgm ¡¡pronounccd /flcm/.
Auscu ltation
The docror is exan1i ning Mr f--lan1ilron's chesr.
Listening to the chest with a stethoscope may revea! rhe presence of sounds, apart from
the normal breath sounds.There are two main kinds of addcd sounds:
• crackles, which sound likc hairs being rubbed tc gcther and suggest the presmce of /luid
in rhe lungs
• wheezes, which are more musical sounds, like whistling, and indicare narrowing of
thc airways.TI1c sound of an asthma patient's brearhing is also called whceze .
TI1e sound heard when the pleural surfaces are in/lamed, as in pleurisy, is called a pleural rub.
TI1e doctor asks Mr Hami lton to say 'njnety-n ine' to check vocal resonance, which
may be increased (as in pneumonia), or dccreased (as in pncumothorax ).
Aft-er exan1ining Mr Ha1nilton, rhe docror adds ro his notes:
30.2 Rewrice thc qucs11ons, usirg words rhar are bener kno'"'10 paticnrs. look ac A opirc ro
hclp rou.
1 Is your cough producm·e?
2 What eolou r is rite spurum?
3 Is ic evcr pu rulcnt?
4 Have you cver had haemoprysis?
5 Do you suffer from dy<pnoca?
30.3 Are che following siaremenh true or false? Gi'e rrJ;on; íor your answers.usrng your medica!
knowledge and A and B opposore ro hclp i·ou.
1 A patiem who has a loose cough productS phlegJll.
2 Crackles arr heard when the airwars arr narrowed.
3 A patient who ha; a non·producrive cough produces sput urn.
4 Wheezes are rypical o( p eurisy.
5 A pleural rub is a sign oí asthma.
36',¡r old ó
clo sudden R cheet palnwftll M.o.while watchlng 1Y.
pain t l>y deep t>reathe and coughing
5-0.l>.pereleted CNe<' 4 houre from ite oneet to heamvalIn A&E
51. non·pro.:luc:Uve cough
f'H & FH nJ relevant
3152 holWy in M t<a:\a 3152
OE T 37.4'C RR 24/min JVP t : 6P ll0/64 P12a/mn
3 cm
RS chost oxpanelon + b<cause of pain
pleural rut> R lowor zono posriorly
Otherwi,;e NAD
-
Pto(tssional Engl1sh 1n Ust M td l"Jnt 69
The skin 1
Sorne types of skin lesion
Mccloca l Common word Featu
term
macule spot res
1101 raised above rhe surface of rhe skin
Note: The liquid (often yel ow) formed as a resull of infection is pus. l f a lesion is pustular.
it is filled with pus.
Rashes
A single skin lesion can be regular or irregular in shape. When there are many
(mulriple) lesions, especially macules or papules, the resulr is a rash, (or spots in
common language); for examplc rhc rash of an infcctiousdisease such as rubella. A
rash is said ro erupt,or break our.
in spors
M y Little boy has broken out ali over his body.
in a rash
31.2 Read the descriprion of thr rash of rubella a nd complete the notes.Look at A and B opposite
to help you.
The spots are scattered pink macules which appear firsr behind the ea rs and on the
forehead. The rash spread rapidly, first to rhe trunk and then ro the lirnbs.
locarion and distribution:
grouping:
rype of lesion:
colour:
grouping:
rype of lesion:
colou r:
grouping:
rype ol lesion:
colour:
Case report
Read the case reporr and compare it wirh rhe illusrrar on.
A 9-year-old boy presented to the Accident and Emergency department alter he stumbled and fell while running in a
to the head from a rock and had been scratched by bushes. On examination,a vertical laceration 1 cm long was not
Sores
The word sorcis a pc¡pular term for many differenr iypes of skin lcsion,csp<'Cially
ink'Ctcdlesions. A pressure sore is a skin ulcer causcd by pressure,for example rhe
pressure oflyingin bed'orlong pcriods (also known as a bedsore.or docubitus
ula:r). A cold soreis alesion caused by /Jerpes simplex.
Note: The adjective sore rreans painful,for example a sore throat.
graze
scrarch
stab wound
rcar
32.4 Complete the scnrences. l<.'Ok at A, B and C opposirc r<> hclp you.
Frequent changes of position are necessary in che i111111obile parienr ro prevcnr rhc dc·vclopn1cnr
of a pressure ........................................
2 He had severa) .......................................wounds in thc a bdomen from the knifc.
3 He was knocked u nconscious by a heavy ........... ........................... ro the head.
4 The \\/Ounds 'vere only .. ..........-........................ lnd rcqui red no rrearn1enr.
Ovr .f-o
tjot1
The pollee have asked you to exanline a rnan who has been involved
restaurant. What type of injuries \vould you expect to find, and how· 1n a fight 111 a m1ght they have
hl'l·n
l'ausl·d?
Doctor:
Are you
having
any
trouble
wirh
your
warerwo
rks?
Mr
Jones:
Well, 1
do seem
ro have
ro go to
thc
toilct
more
ofren
cha n l
used to.
Doccor:
How
often is
rhat?
Nlr
Jones:
Ir
depcnd
s, bur
so1neri
n1es it's
cvery
hour or
even
1nore
ofren.
Docror:
Whac
abou1
ar
nighr?
Do you have to get up ar nighr? Mr jones:
Yes.Ncarly always rwo or rhree times.
Oocror: Do you ger any burning or pain \vhen you pass \Vater?
Mr jones: No, not usua lly.
Doctor: Do you have any trouble
gctting srarred ' Mr joncs: No.
Docror: Is che strci.m normal? J mea n is rhere still a
good strong flow? Mr joncs : Pcrhaps nor quite so good as
ic used ro be.
Oocror: Do you ever lose control of your bladdcr ? Any leaking
or dribi>ling? Mr jones: Wcll, perhaps a litrle dri bbLlng
from rime to time.
Docror: H:i ve )'011 rvl'r pa e<l hlooci i n thc ll rine?
Mr J ones: No, never.
Con1n1on urinary syn1pro111s and their dcfinitions:
Urinalysis
Urinalysis is rhc analysis of urine. Simple screeni ng resrs of lhe urh1e are carried
out with reagent
strips, for example Cl in isrix for the detecrion of glucose. More derailed tests a re car-
ied out in
a laborotory on a specimcn of urinc. Typical specimens a re a midstrc. 111 specimcn
(MSU) and a catheter specimcn (CSU). Microscopic cxaminarion rnay revea) rhc
prcscnce of red blood cells, puscells, or casrs. Casrsare solid bodics formed by
prorcin or cells.
Plus signs are uscd in case nores ro i ndicare abnormal findings.A small
amount (+) 1s clescribcd as a trace. For a la rge amounr (+++), che words
gross or markcd ca n be used, for exan1ple gross hae111:auria. \'<lhen
thcrc is nothing. rhe 'vord nil is conunon.
sug 111.íl
ar +
protel ·n1ere was no suga a trace of
++ prorein and gross haem aru ria.
111.
+
bloo
c:I
33.2 Match the patienrs' descriptions of their symproms ( 1-7) wirh the medica! terms (a--gt.
Look ar A opposite to help you.
1 'Ihave to pee every half hour or so.'
2 'I get a scalding pain whcn 1 pass water.'
3 ·1 have ro ger up several rin1es ro pass \varcr at night.'
4 '1 have to rush ro go ro the roilet."
5 'Ihave trouble gctting started .'
6 'Ican't hold my water.'
7 'Ipassed sorne blood in m¡• llf ine.·
a dysuria
b frequency
e hacmaturia
d hesira ncy
e notturia
f urgency
g inconrinence
33.3 Writc thc docwr's qucsrions for each (Jf rhc sympwms in 33.2 above. W(Jk ar J\ opposite
10 hclp you. You will need ro rh ink of your own q uesrion for urgency.
33.4 Describe rhe findings of rh:laboratory repon in words. Look at B opposire ro hclp you.
bloovl +
prote"" +++
casts Vl.iL
Blood pressure
A smhoscopc
,, .
A sphygm o m anomctcr
A srethoscopc is uscd to hcar tht sound oí blood rushing back through thc ancry.
Thc first rhumping sound 1s 1hc 1ys1olic blood prcssure (SBP).Whcn thc 1hump1
;ou nd is no longer heard, that's 1hc d iasiolic hlood pressu rc (DBP).
-Taking blood
l)uring vcnipuncrure, the phlebotomi>t, a 1cchnicia n who rakcs blood. inscns a nccdlc
11110 a vein and wi1hdraws blood imo a spccimen 1ubr, which is sem to 1he
haematolog} laboratory for analysis..U,ually thc phlcbo1omist can find a •ein in thc
inner pan oí'h• doo\\, the antccubiral fossa, that IS e.sil} a=ss1ble.She may apply a
1oumiquct -a ught band - abo-. the si1e.or the p;mem ma} be asked 10 dench rheir
hand 10 make a fui. tn ordtr 10 rnake 1he •«in more promincnt. Aftcrwards, 1he
patient may be asked to pre.s hghtly on a dressing, usuaUy a piccc oí g;iuzc, to hclp
the blood 10 dot and 10 pm·tm S\\elling and a hacmatoma (a black and bluc mark, or a
bruisc) whcrc the vein was punctured.
Note: A bruise is a specific mark. Bruising can be uscd to describe a number of bruiscs or a larger
arca - The paticnt exhibited bruising on thc ríght farf:Drm.
Righr, Mr Gokl, because you've been having rhcse headaches l'm going to have a
look at your eycs, particularly thc back oí your cyc - the retina. l'm going to put (
1) a cwole of drons in your eye, (2) ,yb jch will n1ake j e easjer for n1e ro see r h e
retina. After a fc\v 111inutes you niay find your vision a bir blurry. This \YÍll \Vl-ar
off aftcr about an hour.
(3) 1uced to grr rid oí as much externa! l ight as oossible. This meaos closing the blinds.
Now, l'd like you 10 (4) look srra ight ahead at that dock . This takcs a few minutes and
your eyes might feel a bit tired so you can blink if you nced 10.l don't want you ro
look at me, look at the dock.
OVe-r +o 11ou
Prarlisr talki ng a p<.1l il·nt through an inVl''iot igation t ha t you rarry out
rrgularly.
7 Professionol English ;n Use
8 Medicine
Proftffionol Engti.sh in Use Mtdant 77
Laboratory tests
A Microbiology request form
A M icrobiology reques1 form uses a number of abbreviarions for specimcn types (sec
Append ix U on page 131 for an explanation of thcse abbrcviations).
ckvatcd raiscd
When the results are within the norma l \Vithin norn1al lin1iu.
range, doctors say: Porassitnn isnor1_nal.
unrc.n1arkablc.
U111 t ahhrl'v1a t 1on Fu ll form
g/L UL 109/L grams per litre
fL litres pcr rrc
mmol/L ri111es ten to the po\ver nine per litre
umol/L or!"nol/L fcmtolirrcs n1illi111ols per lirre micromols per lirre unirs per litre
U/L
35.1 Write rhe namc of rhc spa1men for each of rhe >u>pectcd condirions. Look ar A oppo:.ire
ro help you.
Suspt·rkd Spt·t·1nu·
rnnd1t1011 n
anaemia
bacteria! conju ncrivim
genital herpes
meningitis 1
scpócarmia
urinary infccrion
urinary infccrion (carhcrcr in place)
35.2 Complete rhe scntences dcscribing rhe resulrs of thc repon i n B opposirc. Look a r C opposire
ro help you.
1 Haemoglobin 1s • onc hundrcd and forty·thrtt
per lure.
2 Cn:arininc "shghtl) • fih}·e1ghr lirre.
3 Alkaline Phosphata'i<'
·----, one hundred and thirty-one _
11
······--···--·····-·····--···--··---·--···--·---·----·--···----·----····---···---
···--···--·--··- -·····--·
----··---·-------·--------
En teroscopy
Or ja rdine is ralking her parienr dtrough an
enteroscopy.
Now, l 'm jusi lubricarinl( thc rube with a jclly which conrains a local anaesrhcric.
lt'll help ro ensu re a smoorh passage as ir passes down and you shouldn't fcd roo
much.
J 'm going t<> fecd rhe tube through your nose. This is rhe mosr uncomfortable part <lf thc
procedure bur ir's ver¡bricí. You 'll gcr uscd ro thc tube in a few minutes' time.OK.
when ir hits rhe back of your throar, takc a deliberate swallow. 1'11 rell you when.
I
Now !Swallow, swalbw. That's ir. Well done.
\/rb Nou
n
consent
cxcision
incise
insertion
recovcr
swallow
36.3 Rcplacc rhc undcrlincd'vords and phr 1.scs 'virh altcrnari ,c '''tJ1J!) auJ µlua írona Coppositt.
Afrer connccting rhc patienr ro an { 1) jnsrru n1cnr \Vhich 111easures levels of oxygen jn t'Je
blood and pu lse tate and placing him (2) on bis lefr sjde, oxygen was provided
rhrough H (3) tuf>r in his nosc and rne (4) dru" rrearmt·nr prjor ro rhe procedure
adn1i11iscered as stared. Shortly afrerward, the endoscope was (5) inserred inro rhe
oesophagus. Afrer rhe exan1inarion, the paticnt \vas (6) to rhe recovery area.
Nasal cannula
Radiology is thc use of radiarion in thc diagnosis and trearmcnt of discascs such as canccr.
X-ray examination
The chesr X-ray is the commonesr diagnosric X-ray exa minarion. Normally a frontal
(ameroposrerior) view is obrained. Thc paticm stands facing thc photographic plate with
the chest pressed to rhc ?lare, with hands on hips and elbows pushed out in fronr. The
radiographer , thc rechnician who rakcs thc X-ray, asks thc patient not to movc, thcn to
brearhe in deeply and not to breathe out. This makes a blurred. unclear X-ray i mage less
l ikcly and improvcs the qua liry of thc irnagc, as it is casicr to see abnormalitics in air-
filled (inAated ) lungs than in deflated lu ngs.
e Kccp stb Now, t•kc • dccp brearh and hold your brcarh.
For a side, or lateral view, the paticnt is asked to srand sidcways to the photographic plate
wirh arms raiscd. A chest X-ray may be rcpcared at inrervals to track for any changes.
Thesc rcpeatcd cxa111ina1ions are called serial chest X· rays.
Computed Tomography
riere is an extraer írom a hospital's press release.
The Western Genera! has installed a new GE LightSpeed 16 Computed Tomography (CT) Scanner. CT uses anX-ra
The new scanner takes up to 16 simultaneous cross-sectional images (slices) and transmits more data in less time
smallabnormalities.
The scanner will be used for:
diagnosing muscle and bone disorders
locatlngtumours,infections and clots
monitoring the progress of malignan!diseases and the l'9llpoM9 to therapy (treatment)
providingaccurate guidance for nterventional
.ocedl...such
. as biopsies, and dra nage
-rwnovlng fluid trom the site of an injury or
3 7.1 Choose me correa word r phrasc to rnmplctc cach scntence. Look at A and 8 oppositc
10 hclp you.
1 In rad1ogr.1phy, barium is uscd as a contras! ·--(image/mediuml.
2 'lis.ue which absorbs radianon and appcars dark on an X-rar is·---·---
·---..
(radiolucenr/radiopaqur ).
3 An ........................--....(enema/injecrion ) 1s a liqu1d inrroduced into the bowel by way of the anus.
4 X·rays used ro measure rhc progress o( n dise.1sc.1rccallcd
................-.....-....·- (rcpcatcdlserial) X-rays.
5 1( a paticnt moves during an X ray, rhc i ma¡;c may be ................_.............. (blu rrccVahno11n al).
6 lt"s easier to see abnormaliric< when 1hc l ungs are .........-.....-.............(deílatedlin ílaied).
37.2 Complete rhe words.Each lx-.gins with r<1d10. 1.ook at A and B opposite to
help you. 1 Using radiation ro diagnose and trcat d1scasc 1s radio.·----------- .
2 Using radiation 10 make images is radio
3 Us1ng radiar-ion ro pro,ide rreatn-.ent t5 radio. .
4 1( sonlC'lhing is n0t pcnttrablc by rad1anon, 11 1s radio
5 1( som<:thmg is penetrable by rad1anon, 11 1s rad1
----
6 A tcchnician \\•ho admi,1srrr X-r..l)\ ,.. a radia
Ultrasound
Ulrrasound exarni narion uses high-frequcncy sound \vavcs to vie'v organs and
struc1ures i nside rhe body.The wavcs are generated and received hy a hand -held
device called a rransducer. The reílecred waves are processcd by a computer which
produces dera iled
images for d isplay on a monitor.Ulrrasound is safe as ir <loes nor employ ionizing
radiarion li ke X·rays. Ir is a cheap, quick and non-invasive investiga.rion - \virh no
surgical proced urc - for a wide range of referra ls, a lrhough T'lSu lrs can be
unsarisfactory i n obesc (overweight) patienrs.
revcaled reduction of
Describing medical imaging n1erasrnses.
38.2 Match whar rhe radiographcr says during an MRI sean wirh a nu m bered point in C opposire.
a You don•r nced any injoctions.
b 1 want you ro lie down and just relax.
e lr's importanr that you try not to 1nove.
d 1'111 going ro go rhrough your qucsrionnaire \Vith you.
e Ir will be over in th ree-quarrers of an hour.
f lr's very i111porranr thar you put any metal objecrs inro chis tray.
j]8.3 Match what thc radiographcr says during an ultrasound wirh a numbered poinr in C
opposite. a l'm going to pur sorne gel c)n your abdomen. You mighr find ir a bit cold.
b Tiiat's ir. All done. 1'11 jusr dean you up.
e l'd likc yc¡u ro lic flar on your back on thc rabie.
d The gel is to make sure rhere's a good conracr wirh your skin.
<:: 1'11 movc this back and ÍOn\•ard$ ro covcr thc ,vholc arca.
"8.4 Makc word combinations using a word from cach box. You may nc.::d to look at
Unirs 34 ro 37. Then use some of the word combinarions ro complete rhe
sentences.
breathe cxcisc experience forcign hold ínformed íntroduce local rccovcry
Pro(essionol English on 85
u..Mtd10nt
ECG
Uses of an ECG
An dccirocardiogram (ECC) is a iracing, or drawmg. produced by an clecirocardiogmph -a
device which records clectrical acriviry in thc hcar1. An ECC can be used for:
• deciding 1f 1hc hcan is pcrforming normall)' or suffering from abnormali1ics, for
cxample cardiac arrhithn"1 -extra or skip heanbcat>
• indicating damag< to hcan muscle, such as he.in attacks, or ischacm1a of hcan
muscle (angjna)
• derecring conduction abnormalitics: hcan blocks and bund le branch block> (B88)
• scrccning íor ischaen1ic heart diseasc during an cxcrcise 'olerancc 1cs1, oftcn tnrrled out on
an exerci<e bi ke or trcadmi ll
• providing informmion on rhe physical condition of the hea rt, for ex:unplc in pa 1iems
wirh left "emricular hypertrophy (LVH)
• derecting elearoli1e di>turbances, for cxamplc low plasma potassium le,cls.
ECG procedure
1 kre is an e\rract from 1 medica) tcxtbool.
A normal ECG
The picrure show an ECG tracing ORS
oí a normal hcanbea1 sho" ng a P complcx
wave, a QRS comple, and a T R
""'e, Each largc square 1s «Jll\
alenr ro
0.2 seconds. Thc R -R in1er>al
gi•·es
the hcart mte, in th1s CJ>e 75/rnin.In
the case of abnormali1ie•. rhe QRS
complex can be widcncd or tuo tall.
The ST segmcnt can be clcvatcd
or dcpresscd. Thc r W.l"C can P
be waw
the righr way up, or inwrtcd -the
'"''rong '''ªY up.
º
PR inl irrval
1
1wavt"
OJ nt<rval
s
39.1 l'ind words and phrases in A and B opposire wirh rhc following
meanings.
1 the marks produccd by an l:CG styl us
2 a test which determines how well a paticnt copes with physicil
exercise 3 a misscd hearr bear
4 a change in rhc chemid composirion of body íluids
d ...............................
5 rhe ílow of elecrric cumnr in the heart
6 tesring for discase
7 check or adjust an i nstrumenr before
use 8 thc pen which produces the
drawing
This very a
bnormal
ECG¡hows a ( 1)
.............................
... of
approximarcly
33/min; a single
long
pause
of
approxi
martly 4
scconds
berween
venrricu
lar
complex
es wirh
arria!
acriviry:
widened
QRS (2)
..............
..............
... in
keeping
le:id 11
In the UK, parienrs rake presc-riptions ro a chcmist's shop, \\lhich sells a 'vide range of
non prescription medicines and other producrs such as cos1netics, for di.s-pcnsing by
a pharmacist (the person who pre1>ares the medicines). In hospirn ls, prescriptions are
dispensed by che pharmacy (rhe departmem where the drugs are prcpared).
Drngs come in many diffcrcnt forms.See Appendix 111 on page '1 43 for descriptions and
illustrations, and Appendix JI on page J 31 for a list of abbreviarions used in prescriprions.
Note: Latín abbreviations in prescriptions are being replaccd by English,but may still be sn.
SULCONAZOLE NITRATE
lndications: Fungalskininfections
Cautions: Contact with eyes and mucous membranes should be avoided.
Side-effects:Occasional local irritation and hypersensitivity
reactions include mild burning
sensation,erythema,andiching.Also bl stering. Treatment should
be discontinued if these are severe.
Dose:Apply 1-2 times daily,continuing for 2-3 weeks alter lesions
have healed.
Exelderm® (Centrapharm)
Cream, sulconazore nitrate 1%
lnstrum ents
The nlost basic surg.i ca 1 insrrun1enrs are sho,vn in rhe
scalpcl
picn1re. rcrractor
diss('cring forceps
scissors
The operation
Thc opcration begins when the surgeon makes an incisioo or cut. Control of bleeding
is very i1nporranr. A S\Vab is a pad of corroo or orhcr n1arcrial uscd ro soak up
blood frorn the opcration site. A suckcr is a mechanical device which aspiraces
-sucks u p - blood. Bleecling vessels are tied with ligatum; or scalcd by an cle<'.tric
current (diathcrmy).
Drains may be inserred:o carry away fluid wh ich mighr act asa cu lture mediu m for
bacteria. Various mctho1s are uscd to close the wound, for example su1ures (also
known as sti1ches), or staples. final! •, die wound is covered with a dressing.
.
A surgcon is talking 10 a ntdical srudent abour asfüung at operarions.Complete his
¡1.2
advK:e using word< from A, B and C opposire.
An 111 - rrust be able to carry out the following tasks to hclp thc
surgeon. Firsily, he or <he must hclp in (2) --- the paticnt and punmg the
(3)-···-··--····. 111 ploce to providc (4) ·------ condirions. Experr
handling of a (5) -...-........... is l'Ssenrial ro allow rhc
;ur¡;eon to Sl'C what he is doing.
Thc as. istanr musr al<o kt'ép rhc operation sirc free of blood, by careful uo;e of rhc
(6) .......-.....-............ .... .. or (71 .........................-......... .Thc < 11rgco11 al>o needs assisrnnce with
tying and curring (8) ...... .... -. ....,and with r hc insertion of a (9) ' ,.,.'
......
if nocessary.Finally. rhe asMstant may be asked 10 close the wound
wirh
(10) or uhcr cJe,'ices.
91
Therapies
Radiotherapy and chemotherapy
Radiotherapy is rhe use of radiarion in conrrolled doses 10 trear canccrs. Ir works by
damaging rhe DNA of malignanr cells. Radiotherapy may be uscd:
• as curari vc treatnX'nt, for exanlplc to shrink tu1nours
• as adjuvant treatn1ent, alongsidc or follo\ving chen1orhcrapy - rrean11enr 'viril anri-
cancer
drugs
• in lo\ver doses as palliati ve rrearn1enr ro reduce pain and other syn1ptoms of .:ancer or
disease, bur nor as a cure.
A radiologisr derermines the dose and thc exact rarger for the radiarion bea ms.Doslge
is measured in grays (G¡).A daily dose is a fracrion. Radiorherapy can also be
deli,ercd inrerna lly by radioacrive implanrs such as needles, or by liquids such as
srronrium for son1c bone cnncers.
•
,¡ •
•
• A Zimmer fran1e
Work begins a round 8.00 am. 1 check for ncw ( 1 ) ................................... 011 rhe compurer and
prepare for my morning appoinnnenrs. Berween 9.00 and 12.00 1 5"" ncw paticnts around rhe hospiral. 1 carry out a
(2).. ............... ........... is. 1 work wirh broken limbs, joinr (3)........................................ and tigament repairs. 1 deal wi
or specialisrs.
\%at do l likc ab
(4) ......................
pcople back to no
(5) ··········-···-·····
can get on \virh
injury or an oper:.
AS 1''F.fDFD
Boos1cr doses for 11. .anus.diphtht'ria a1ld nleas)es 1and a ooe-rimc dosc of polio f<>r 1duhs.
..13.2 Complete rhe senrences using informarion from B opposire. The firsr one has
been dooe for you.
1 Women aged from 50 ro 70 :;.IJQu.l<il.11.ª'll:..mª.mmQer.<ip.hY.. .tbl.'"-!'.'ii.W. lib."k.f.Qr..m:;,1;,c.ª.n
r..
2 Parienrs wirh hearr disease
...........................................................................................................................................................
3 \\!fornen bctwcen 20 and 60
........................................................................................................................................................ .
4 Patienrs over 40 with hi¡;h risk facrors
................................................................................................................................
5 Parierirs with diaberes
.......................................................................................................................................................................
6 Pregnanr women
................................................................................................................................................................................ .
43.3 Which of the immunizarions listed in C opposire would you recommend íor rhe íollowing
visirors to South Asia?
A tourisr \vho 'vill stay for a fe\v nights in five-star hotels in
1najor ciries 2 A backpacker who will travcl by local rransporr from
one city ro anorher 3 A medica! studenr doing an elective i n a ciry
hospital
4 ¡\ volunreer \\1ho 'viJI live for a year in a rural con1munity
5 A traveller \vho has nor had a reranus vacc ination for ren ycars
Ove.r .f-o 11ou
Wha t in1111u111zat1011s art:' adviS L'd f or v 1 itor l o yo u r roun t ry. or <-1 rnun t ry ynu \vou ld l i k e tu
VISl t ?
JZ-4.2 Complere the tcxt, using thc correcr gronuna rical form o( cach word. Look a r rhe rabie
and ar A, B and C opposire ro help you.
lncldenceorlu.ng c.:ance.r
(Su.r\'eillance and Hisk Assessrne1u Divlsion.CCDP. Health Ca.nada)
negatíve inAuence on 1Make sore that yoor personal beliefs do not prejudice your patients'
Bioethical issues
Euthanasia
Should the medical profession help 1he renni nally i ll to cnd rhcir livt'$ whcn rhcy choosc?
Gcnctic cnginccring
Shou ld we permir an embryo ro be cloned - copied exacdy - to replace a child who has
died? Should parcnts be able ro selecr rhe genetic makeup of their children to produce so-
called designer babies ?
Human fcrtiliry
!VF- in ,;tro fertilizati on -has mad c it possiblc for infertile women 10 have children, bur
should this include womcn long pasr the normal age of childbeari ng'
Embryos can be frozen and implamcd in rhe mother ar a latcr date but shou ld this require rhe
conscnt or pcrmiss ion oi borh parenrs if rhe marriage has broken down?
What are che righrs of a surrogatc morhcr, one who carries a child for a woman who is
unable ro do so, over rhar child?
Transplant surgcry
Who should give consenr for rhe removal of body parrs for transplant surgery?
Assisted dying
A medical srndent has madc some language nores on a journal arride.
A 53-year old woman wtti Incurable muscular "1 off = tM.C'Je&i Í'(W!A. tke Qvl.C '"te'Stlr
d)'s110phy llew to Switzerland to endher lije.Aa9isted .Ql'\d bQ ¡;,'N""- ¡.rO ,.,_ tht
5.2 Match each he-•dlinc ro an opcning linc from a newspaper report.Look ar B and
C opposire to help you .
1 5
66-year-old becom es oldest mother Using body parts without consent
6
2
Frozen embryo case to go to U!full tace transplant search on 1
Europe
3
Surrogate mother sued by coue 7 'Designer baby' rules are relaxed
4 8
Embryo cloning - wherewill it take
us? Doctors back infa nt merey killi ng
a A woma n of 30 who agreed ro bear a child for a childless couple rhcn rcfused to part with the
child has been ...
b A surgeon has been accu sed of rcmoving organs from parients wirhout their knowledge ...
e Three-quarrers oí llelgian doctors are wifüng ro assist in rhc dearh of critically ill babics ro cnd
thcir suffering.
d A woman hoping ro srop rhe desrrucrion of six embryos creared wirh her cggs and her ex
parmer's sperm launched a case at rhc Europca n Court of H uman Righrs ...
e A \\I01nan has given birdl in Ron1ania folJo,ving I VF rrearmenr.
f Consultan!plasric surgeon Dr Pctcr Butlcr has been given the go-ahead by a hospir I erhics
con1rnjrree ro find a parienr \vho 1neers selection crireria for a full facc transplan t.
g lf your fovourite pcr dies, ir is rechnically possible ro produce exacr replicas - but whar abour
hun1ans?
h Ir is now legal ro selecr embryos ro provide blood cell 1ra nsplanrs for sick siblings.
Research studies
Case-con trol studies
Here are sorne exrracts fron1 a medica) texrbook.
ln a C•I 1 11,.llMy, agroup of peoplc sulTering from a disease (the cases) is compared with
•ll'CJUP wbo do 11111 llMI the disease. but are similar in othcr ways (thc conrrols). Thetwo
groups, the¡JllWJ¡• H• inthelllldy. aie compared 10 see if they were cxpo!Sed to a
,_...is
possiblc risk factor or not. A rllk Hldhi1ig which may contribute 10 the cause of
disease.This lype of study is ollilil u.I•a fint 11ep ia idlllllifying the cause of a disease.
Cohort studies
Ina -..111111y . a group (cohort) of people (subjects) who are similar is studicd ovcr a
period of)WS (a la ¿ 1 dh 1study) 10 determine if there is a relationsltip between
exposure to a risk ÍICIDl' lllddeRlupiW of a disease. Al lhe beginning of a prospectfre
study, none oi 1hc subjoc1s haslhedileue.Tbey se wi-cl up for a number of years, and
a1 thc eod of the period, those who lla\'ll clrw' p die dilC1lse me compare<! wilh 1hose who
have not In a retrospecti\'e study. the m ucbela look beck, by SIUdying hospital records for
example, at whal has happencd in the pas1. cou¡wiu¡¡ •ibjetU ñlb8lle developed the
disca.'>C with those who havc not. In a cohon srudy and in a c1n cWlllOI 8lud¡r die subjccls
arc only observed and there is no intcrvention such as drug a• 1m1 ar lllllP'IY- A c:obort
llUdy is a more rcliable method of idcntifying tbe cause of disease dllllac•e SIUdy.8ut
filrproofof cause. a trial is needed.
Trials
In a 11'1111. a group of people who are suffcring from a discase are gjven a panicular
lreatment. To determine lhe elTCCliveness of 1be treaunent,a controUro tria!is
performcd. Two groups are SIUdied: one group (the study group) is given 1he rreatmem and
the other (the conrrol group)
is DOI. 1beconrrols may be given a placebo -something which sccms to be idcntical to the
a- but whicb has no elfect. lf there is an cqual possibility lhat pa1ien1S may be !
elected for the SIUdy IJJOUP or for the controls, lhe rrial is said 10 be randomized. A
randomized contn>lled lrW malra bla- error in a study which inftucnces the resullS -less
li.kely.An additional way of
n:movinc bias is hl!Mllng·patienlS do nol know if lhey are reccMng thc trea1ment or tl1e placebo.
lf, inIAliritm,die rescarcher.; do not know wbo is receiving lhe trea1ment, the ttial is a
double llllBd trllll Reebni...t conttolled ttials are tc'>Cd ro test ireaunents or preventivo
measures.
Variables
lf the subjeclS in a study are all aged 50, thcn age is a constan in the study. lf thcir ages
range from 20 to 70, lhen a is a variable. A confoundíng variable is any variable
wbich is associated with bolh the diseasc and thc risk factor being studied (for example,
smoking in the case of cooks llld lung cancer discussed in Unit 44). lf such variables cxisl
there is no way for thc rcseareher to knaw whether tbc diffm:nc.:c in llti; rik fac.:Lv1 ur Lhc
confou11 di11g var1able is tbc oac dll;\t is truty Cllllingtbe disease.
100 Pro(e.sioool Engsh in Uio Mtdidne
46.1 Complete the table with words from A, B and C opposire.
Noun Ver
b
bias
control
exposure
(person) participare
inrcrvcnc
Study
7 Something that might b<' a part of thc ca use of a disease is a ........................................ facrcr.
8 Son1crhlng rhar nlig.hr cause confusion about rhc enuse of a discasc is a ....... ·····-····-····-······
variable.
.J Study the rescarch questions below, and in cach case decide which of thc rcscarth study
rypes menrioned in A, B and C opposire would answer rhe quesrions best. Use the i n<lex or a
dictionary ro look up any unfa1niliar \vords.
3
To develop a relativefy simple, inexpensivt>., and accurate test lllat measures telomerase activity
in voided uñne to apply to large-scale screening programs for bladcler cancer detection.
(JAMA 2005;294: 20521
4
To evaluate the relativa nsk of being responsible for a
fatal crash while driving under theinfluence of cannabis.
(8MJ 2005;331 : 1371 Rtproduffl with ptormission from l.he BMJ Publishing Groop)
Personal details
Normally, patienrs·pcrwnal derails have lx-cn emered in rhei r record< by a n urse or
:.tdn1inistrnrivc srJÍÍ bcforc a docror secs rhen1. llo,vcvcr, on larer consultation a dt'ICtor
may wish to check dcrnils;uch as address, da te oí hirrh, occupation or marit.11
status. To find our or to check a patiem·s occupation, doctors ask:
Do you
work?
What do )'OU do for a li,ing?
Parienrs
may
respond: No, rm o, l'm rctired.
º
1
Note:A spouse can br a wofe or husband.A widow IS a wornan whose husband IS no long¡:r living;
a widower is a man whose wofe is no longer living To :woid 53'1'"9 sorneone is dead, patoen1S may
say that person has passed away.
o\ ' !Al'• f""(r-,tPíl l'."!'Yl. l>t'"11t ' 11 Cl1°"VOt!::j W. 1-o11:l:.M! ::-.-s,Nt> Jl"tti.f.1,t'1' N> "' •t •f
"'""' .... ,.
2 RcaJ 1hcconcinuacion of 1hc case no1es for 1hc paum1 in C opposi1c.Wri1c che
docto1-. questtons. l.ook a1Appcn<ix IV on pagc 144 10 hclp you.
J
Doc1or: C1. n you tell me what 1he problcm is?
Pa1icnr: l'vc go1a 1errible headache.
Doc1or: ( 1) ········-···-····-····-··.....
P,uicnr: J ust here.
l)octor : (2) ···· ··········· ···-············ ..... .......................
........... ....... .......... .... ......... ..........
....... -.......... ...... ........ . ?
P,uicnt: Well, it's really b:td. And it 1hroh.
Doctor: Have you had an thing like 1hi> hcforc?
J>,1ucnr: Yes, about every chree monrhs.l'vc had thcm for 1he Jase cen years or •o.
Doetor: (3) - . ·-··--·---·----·---·-· - -·--··--·----·---·-·... ,
PJucnt Usually one or two days. Th1 one siancd yestcrday moming.
Ooctor: (4) >
Paucnt Thcy usuall)' sran jusc bcforc 111 · rcriod. eumes if 1 eat chocolace. l'm noc surc.
Do.tor: (5) '
PJttcnt: lf l l1e down in a aark room 11 hclps. l 1h1 makes 1hem worse.
Doc1or (6) -------- ----------- ------
PJttcnr: lf l move my head, it gets more pamíul.
[)ocwr: Apan from the he1dache, (7) . ·····-·--···-···---···--····· ?
P,uicm: Yes, my eye feels srrange.Someumc-; 1 CJ n't sec clcarly, things get blurred. 1 ícel
;,ick Jnd
01nctin1cs 1 an1 sick.
lt is essential to obtain full details of ali the drugs and medications taken by the patient. Not infrequently pa
lt is necessary to determine the precise identity of the drug, the dose used, the frequency of administration
lt is importa ni to ask about known drug allergies or suspected drug readions and to record the information
Family history
Note thc agc, health or cause of death of parenrs, siblings (brothcrs and sisters).spouse
(husband or wife), and child ren. To find out about fomily history, doctors ask:
• Do you have any brorhers and • How old was he whcn he died?
sisters? • Do you know the cause of dcath? /
• Do you havc any childrcn ? Whar did he die of?
• Are all your closc relarives alivc? • Does anyone in your fomily have
• Are your parenrsalivc and well? a serious illness?
• Is anyone raking regular medication?
Social and personal history
Record the releva nr informaricm abour occupatioo, housing and personal habits induding
recrcarion, physical exercise. alcohol and robacco and, in the case oíchildren, about school
and fomily relarionships. Typical qucstions in raking a social and personal hisrory are:
• \Vhat kind of house do you live in? • Do you smoke?
• Do you live alone? • day?
HO\Y 111any a
-• \Vho
• sharcs your bome with you ? • Havc
or S("hool ? •
How old are your children?
Are any of thenl :tt nurs('ry
Whar
-you rried giving up?
about alcohol?
\Vi rle, heer or spirits?
• Do you have any financia!problcms? • Whar's rhc m<>sr you would drink i n a
• Do you have any hobbies or week?
inrcrcsts?
• Are you a\!•'are of any diffcrcncc in your
• What abour exercise? alcohol consumprion ovcr rhc past fivc years?
104 Pro(essionol English in Use M edicine
1
48.1 Complete rhc scnrcnces. Lool ar A, B and C oppo<irc ro help you.
1 rharmacies sell a wide va ricry oí ................... ..-
....................-.
ª'
remedi e; well as dispens111g prescriprions from phi;icians.
2 Thc "t quannry oí rhe medocanon to 1"' rakcn ar an) onc rime.
3 A drug 1s h•P'rsens1ri•iry ro a pant<ular drug.
4A "a medica non prcpattd from plant>. csp<e••lly a
tr.1d1t1011 1I ren1Cd).
5 Your hrorhcrs and your'i"ers a re your .............
6 , ..... ···· is 'vhar you do for physical or 111c11ta l ti111ulu s outsidc '''ork.
7 ...can t.tke ni;u1y for111s:aparrmenrs, ingle roon1s, hou\C'l, hostels.
8 Thc pa11ent"s ----- . to drug rrcamienr, h" w1llingness or abil it)' to takc rhc
right d°"' at t nghr time rnd írcq°"11C\·.is essennal.
8.3 Srud) t hc w..-ial his1ory of M r Block. Wnre rhe que<>11on' rhc doctor asked to
ohtain rhe numhered mfom1arion. Lool at C opposire ro help )OU.
Social hist0<y:Mr G.Bladt
Home - l.1H-s in a derached hou;c '"th a large gardcn 1 .
Fam1ly - Four children: rwo gi rl1:tgl-d 3 and 4,two hO)> aged 6 and S. AH are
bcin raught ar home by his w fc111.
Occupation - Manager oía DIY wa rehouse. Srres<ful job irwolving dealing with
frequcnr sraft prohlem' and mccmg monthly .ales rargers. l.trge mongage ' 11.
al 1ntertSts - Has li:tle 11111e for excrcise or mt<tt<tS ours1dt' work •.
Habits - l'rl-sentl) smoking 20 pcr day '.Has m<-d 111co1111e parches without "icces»•1.
Aver.tgc Jlcohol inrakc J un11'pcr d.1y ar weekend>' "'. No problem wirh alcohol
\\1irhdra\val1M1•
49.2 Read thc cx<rJct from a con<uhation. In the numbered quc;tions (1-4), i 1hc d0ctor
cncouragon¡;thc patienr ro ralk ahout her ideas (1), her conccrns (C) ar her
expcctati<>ns
{E)? 1 ook at C opposirr to heJp )OU.
Pancnt: J"m a bi1 conccrned ahout tll) colic. 1 had 3 fnend worh somethong s1m1lar
and it tu rncd out to be more serious. Ir"s gor me womcd.
Ooc1or: ( 1) What do you me.111 by colic?
Patient: A pain in rhe s1cmach.
Doc1or: (2) What do you think mi¡;ht have brough1 1hi< on?
l'aricm: Ir just secmed 10come on. 1 do1ú know whot 11 is.
DOctor: You said you wtre a t>11 worried because your fr1cnd had a similar problem. (3) \Vhat
are )'OUr '''orrteS about th1s?
Parienr: Yes, 1had a friend. Shc rurned out to ha•·c s1onl.ich canccr. She anuall) died in rhc
e11d. DOctor: (4) What were ynu hop111g 1 could do for you 1oday?
P.uicnt: 1 ¡ust want 10 krow 1h.11 1 don·r have a11y1h111g too serious.
49.3 Complete the'cnrenccs with phra<al vcrbs. Look a r 1) opp<»ite ro hdp luu.
1 Thc hcadaches ---·-- -·- 1n the n1orning.
2 Howe.rr much 1 car, 1don·, secm to -----an) weigu.
3 l"vc med 10 ----smoking se•eral
times. 4 J"m so deprcss«l 1 don't fed 1 can ---
5 Whcn 1 cough, 1 ···-····· _ ·······-····-· phlegm.
6 l le rhou¡:ht he had sromach achc but it ········-····· .... to be C\lncer.
Ahd11n11no.1I pa1n
Wt·1qht In''
Chotnqt· 111 hcn- hah1t
ifcl (t'. palt". hlack. frt'sh blood)
Cnlour of mot1on g . d<irk,
Giving instructions
\Xlhen exan1i ning a parienr, politc íom1s are oftcn used for rhe initial insrrucrion:
Could you bend forward as fa r as you can?
Jf you could cross your arms in fronr of your chesr.
Whar l'd likc 10 do is examine you standing up.
Aftcr rhar dircct insrrucric:»ls n1a)' be used:
Stand with your feer rogerher.
Lie pcríecdy srill.
To soften an instruction:
Can you jusr rurn ro rhe side again?
Could you jusr lie on the couch?
For a lisr oí verbs commonly uscd in instrucrions during exami nations and
invesrigarions, sce Appcndix V on page 145.
50.1 Complcrc rhc i11;trut ions u<i ng ;mrable verbs. Look a r Appendix V 011 page 145 10 help you.
1 .... ....···--··srraighr nhe1d and . .......... _ . . )'HUf nosc '\'irh your r1ghc-:orefinger¡
rhen w1th your lcft fordingcr.
2 -on 1iw, rdgc of rhe couch and your ltgs h3ng loosely.
J ----rour erchds ughtl).
4 _ all your clothes do"n to )'Our undcrwcar.
5 . ....--..·--·you r chcst w1th your
chin.
6 ...... ....-.................. slo"ly ami lnok over your left <hou ldcr.
7 ......................... ............011 your side.
8 .. -- ............-... looking nt me.
9 -·- . your slecve.
10 the pin, nor thr light.
50.2 9
r
e_
8
"
10
2
13
S1 r\
3 ,J 6 r.::
1
11
50.3 Complete thc instrucrions íor a lumba r puncturc wirh words nnd phrase< from A and
B
oppo<ire.
Mood
When describing a parie nr's mood, ir is berrer for doctors ro use rhe pariem's own words
rarher rhan rheir own subj ecrive dcscriprion of rhe patient's mood. Patienrs may say:
agitatcd
m low
restlt-'SS anxious iserable sad
I
anxiery unhappy
\VOrricd
vound up dcprcssed
dejcc1cd
panícky
1 ger very confused abour time.1 can'r remember whar day ir is.
People makc me angry. Thcy'rc so irrirating.
1ger muddled when f 'm shopping. 1 go our for milk and 1 come back wirh che<'.SC.
51.2 Complcrc thc rabie wirh word• from A opposirc.Then complcre thc senrcnccs bclow.
Noun 1 Ad ·11v
w r
confus1on
dcluded
dcpres1ion depr<."llVC (illn)
(parienr)
di•oric1111-d
obsess1on (srmptoms,thoughrs)
oi><.h>l\ C compulsi»e (disorder)
ps)Ch1atr¡ (fiddl
-
1 Paricnr• in ............
(pracmioner )
51.3 \Vtite thc doetor's questions IO the mental StatC C.X3m103110n. Look 3t C Oppos1tC tO )p )'OU.
Doctor: ( 1) . -···-····-· ·····--···-·· ·--···-··---·· ?
Pa rienr: 1 fccl low.l"m not en1oyin¡¡li fc.
Doctor: (2) ........
.... ·-···
·· .. M . . . .. . . . . . . •• • . ... . ?
Parienr: No, norhing.
Doctor: (3) ?
Panem: 1 frd run down. rm reall} ured.
Doctor: (4)
Panenr: for months now.
Doctor: (51 · ···---······ ·········--···
Paricnr: 1 c.rn'r get ro sleep and whcn 1 do slee(> 1 wake up early.
Doctor: (6) ...................-......... .. .............H. ........ ........ .................. ........... ..
............... ...................... ?
Patienr: l"ve ¡;or no appenre. 1 don'1enjoy food.
Doctor: CI ?
Patienr: l"m lo1mg wcight.
Docror: (8) ---
Parienr: 1can't remember where l"ve pur anythin¡;.
Doctor: (9) ·-··-···-···. . .·-····-
···-···. Pnrienr: Don·r l ike thinki ng aoour ir.
Doctor: ( 1 0) ..········-······ . ...········-········.. ...... ................................................................
Parient: l\ e thou¡;hr about u hut 1 donºt have rhe ......:
couragc.
-- An explanation of angina A
--// /
Having cxamincd you, l'rn confidenr that you'rc suffering from angina.
TI1c heart is a pump. Thc more you do physically, rhc hardcr ir has <O work. Sur
<S we ge1olde 1he blood vesscls which supply oxygen to 1he hear1 begi n to
barden and get furred up, so rhey btx:omc narrowcr.They can't supply all che
oxygen rhe hearr needs. TI1e resul1 is che pain )'OU feel as angi na.
Beca.use you're experiencing pain ar resr as \vell as on exerrion, J'n1 going to have you
ad1nirred ro rhe coronary care unir righr a\vay so rhar your rrcarn1enr can srarr ar once.
You'll be gi ven d rugs 10 case che pain and 1 expccr you 'll have an angiogram. Tiiey
may advise surgery or M1gioplasty - thar's a "'ªl' of opening up the blood vessels to
the hean so chey can provide more oxygcn.
You should try to give up smoking. You won't be able to smoke at a ll in hospital
;o it's a good time ro stop.
J expccr che rreatmenr will improve your pain ar leasr and may ger rid of ir
complc1ely. Wc can nevcr be absolutely ccrtain about rhc futurc but you should
remain oprimistic. Do you have any ques1ions?
52.1 Match rhe srages of a consulrarion {1-4) wirh rhe seorences used {a-f). Look ar A and C
opposite to help you.
diagnosis
2 1nanagement
3 general advice
4 prognosis
a l'm going ro have you adm irred ro rhe coronary care unir.
b 1 expecr the trearmenr w1ll improvc you r pain ar leasr and may ger rid of it
complcrdy. e Having examincd you, l'm conJidenr rhar you're suffering from angi
na.
d You should rry ro give up smoking.
e \V/e can nevcr be abs.<>1urely cerrain about the furure bur you should rc111ain opri1nistic.
f You'll he given drugs ro ease the pa in and 1 exp<"Cr you ºll have a n angiogra m.
52.2 Replace the underlined words and phrascs wi th appropriare lay rerms.Look at Appendix
Vl on page 146 ro help you.
1 Mr Harris, I'n1 afraid your \vife's suffered ao acure cerebroyagular evcnr.
2 Thc runs rhrough rhe middle of thc prosrare .
3 The reason for your nocmria is rhat your prosrare is enlarged.
4 Do you suffer from dyspnoea when you cxert yourself?
5 1'1n going to give you an analgesic and an anrj-jnOa1nn 1arorv for your spraincd anklr.
6 l'm putting you on anri· depressaors loe a short time to help you ger back ro norma l life.
52.3 Complete rhe expla nation of diabetes. L..ook at A opposite to help you.
Youºvc ( 1) .. ...... .. ............. ....................Ty¡x 2 Ji"U<t<>. Th i> ;, (2) ...........................................
..........................................
very overweight. Your body isn'r producing enough insulin. (3) ................................................
you feel so rhirsry and why you pass urine so frequenrly. lt's also the reason you have this
vcry irchy rash and you ha vc a problenl \\'ith your eyes.
The nurse will (4) ................................................your dier and 1'11 (5) ......................................................
..........................
a dierician. l'm (6) ................................................ra blets ro control your high blood sugar. You
don'r need i nsulin right now but ir is possible you might need ir in rhe future.
You (7) ............................................... lose weighr a nd 1 (8)
...............................................................................................see
a podiattist. lt's importanr with diabetes that you takc good care of your feet. You should also
see you r opticlan every six 1nonths for eye checks.
Diabetes is a scrious condirion and can affect your hcart, blood pressure, circulation, kidneys
and vision bur we can limit thcsc problems by conrrolling your blood sugar.
o case of diabetes can be described as mild. 1'11 (9) ................................................ to attend
rhe diaberic clinic evcry nvo n1onrhs so -.ve can check your progress.
{ 10) ...................... ....... ...................reduce this to six monthly visits once your cond irion is under control.
Is thcre ( 1 1 )................................. .......... ?
1ions we can use. The fimop1ion 1;10 11')' rablers likc Prozac chat lift )ou up a bit. Thc olher oprion 1s counll111g.
1t can be caused by d1e1or st rtss.
There t\t'C sorne quite simple 1cs1s
''ecan do. lf )Ou'rc súll conccmed, "e
""" rcfcr
)ou ro a hosp11al.
Somc rime off work m\¡ht help. lf you Carry on drink ing lor>
of íluid..
feh that would be hclpful, you could take a week off and ltt how you fdt after cluit.
Other rhing< miglu hclp, like raising rhe hcad of your bed. 'That's onc of rhc ;i mpl rhings we
could s1art you off with . You said you haven'r rricd indi¡;esrion remedies. TI1nr'> SM1cthing you co
You should rry ro ª'oid right dorhing, sirring 111 dcep armchairs and bendm¡:. t>pcc1ally after meals.
Warnings
Whcn a doctor''""" ro wJrn a pacienr rhat thc con.equence of ignoring thc advicc
wuld be serious, he or he may ;ay:
lí you aren't íecl in¡; hcucr in 7 to 14 days, l f you keep damaging ir, you 'rc
you really mus1 come hack and see me going ro cnd up with a lon¡;·term
again. p•oblem.
lf you feel tha1 1h111gs rcti'I serrling, lt';"') imponant )'OU don) s1op
aren·, gctting back 10norm.1 1t"> taking tite cablers suddenl• or )OUr
1mporomt that you see me agam. >ymp1oms will recurn.
53.1 Complete the adv1cc.l ook at A, B, C and D opp<»11c to help you.
1 lf you ................... ... ..... ..••.....•...•.....•...•••..smokmg, you increasc rhe risk
of lung ca11ccr a nd hearr disease.
2 Your hea lth would i mprove if you ... ....... ..... .... .............................alcohol
complcrel)'. 3 You could ••........ . .•.••.•.........•..... with a
erious drug problem.
4 l'm going <0 ---·you.... .. wirh sorne rablers. lf they don'r help,
we'll need to thmk abour ""l<I).
5 _ on rhe amounr of salt rou rake wirh your
food. 6 1 expea things w11l --in a fcw days and you'll be able to get up.
7 Try to <1ruarions where rou feel srrtssed.
53.2 Match the rwo pam of 1he senrences. Look at A, ll. <.. .111d O oppositc ro
hclp you. 1 lf you still havc pa in,
2 lf you find it difficulr ro give up smoking,
3 Your syn1prom.) \vill rerurn
4 lf you can"t ger to lecp,
5 Come back and see me a;;.
in 6 lf you're still concemed.
a cry co a•o1d caff<mc larer m rhe da).
b 1f you find your brcarhle<.>ncss has increased.
e keep caking paracc1amol.
d 1 can rcfer you to a
consulram. e if you start smoki
ni: agai n.
f 1 C!ln rrange íor nicotinc rcpl'-1oenlent thcropy.
53.3 Advise a patiem with h1gh blood pressure about phy 1cal acriviiy.Look at the
i nformarion in the table, and ar eop)lO'iÍte to help you.
Eat a low cholesterol d1et. Movmg from íloor to scanding cxcr.:i.es too q111ckl).
..bm:tA.ea ---
v.111.1 .t ¡y oo ne,._ _
YC. 1l.Lk!.MY.m:K.Wll 1<1r.
4, ·· ···---- ··-
2 Choose an appropriate setting and have a friend or relativc of thc patient presem.
3 Take time.
4 Use appropriate languagc.
5 Emphasi1,e the positivc.
One can never be certain about thcsc 1hings but l 'd say
it's a n1attcr of n1onth; rather chan years.
l'd like ro record this consultation so you can listen again if anything is1i't clear.
Mr HaI'!'y Scott
Diagnosis: Prevlous pancreatlc cancer
I reviewed Mr Scott Inthe Onco ogy Cllnic toda.y. He ha.s been less well and ha.s
Jost 12 kg Inthe past few months. Unfortunately, hls CT sca.n shows an a.rea of i!
J.<letlned low attenuatlon In the tail of the pancrea.s.Although thls Is conslstent
Wlth focaJ pancreatitis, the general fee!lng at the Multidlscipllna.ry Te8.m meeting
wa.s that thls repretents recurrent d.isease.Thls Is especlally Ukely in view of hls
cllnica.l deterioration and rtstng CA19.9. I d.l.scu.ued thls with Mr Scott arid hls
wife. He wa.s obvlously dlaappointed with the sca.n results but still tries to
remal.n poaltive. We dlscussed the fa.et that ery wun't an option and
aymptom control was lmportwt. We alSo d.iscussed the role of palllatlve
Gemcitablne. •me potentlal benetlts are small but lt Is usually well tolerated and he
wa.s 1™1n to prooeed w!th thls. I W1ll therefore book him lnto Ward 8 to
atantreatmanl in the next few weeks and have re-ehecked hls bloods toda.y. In the
meantlme, I would be V&J'Y grateful 1f you would reter him to your d!etlclan. He
hlmself is keeD. ror thls to happen. We wi1l see hlro back In Cllnic once bis
treatment has started.
54.1 Complete tbc ntract from rbc oncolo¡i1<1\ <On>ulm1on "nh Mr Scon. Look at A and B
oppouc- ro hclp you.
54.2 Complete rhe srnrences wi:h words from thc box. Look at A and B opposire ro help )
1wofold
There was a incrcasc in che number of X berwccn 1990 nnd 2000.
th rccfold
rwofold
lne number of X 1ncrta'ied
thrcefold
littween 1990 and 2000.
doubled
Tu number oí X
trcbled
Approximating
When refemng m che d.u,1 presenred on slide-;, 11u111hcrs are often roundcd, for c<w1ple 41 .
3
!J<,comes 4 1 or cvcn 40. When rhis is dt1nc, ir is common 10 use e><pres>ion' of
approx:i nrncion:
aboue
around
Sid.xffecrs wcre reponed by approximaicly ÍOrt) pariems. /
roughly
sorne
Numbers are frequcndy prcsenred as frac11on1 or pcm:ncages, even when che C\Jct
rllUl'lber is gi ven.
When rou wam co emphas1zc a numbe for exa mp 11.8°0, rou can sa :
almosc 10º• nearly 10º• more than 9°o
over 9°0 jusi under 1Oºo
Table 1 (1) ........................... ........trends in 1he frequency of hospital admission for peóorated peptic
uker
in the Uni1ed Kingdom (2) ..........................-...........with changesin the
annualprescription rates for non· steroidal antHnflammatOI}' drugs.
For women O\'er 65 the annual number of prescriptions increased (3).. lrom t
967 to 1982.during which rates ot perfuration of duodenal ulce<s (4) for !hose agtd
65 to 74 and mon? than (5) for !hose aged 75 and O\'er.For men O\'er
65.prescnptJons showEd a simikY increase.Al1hough perfuration rates were actually for !hose
aged 65 to 74in 1982.there was a (6)............-.......increase in those aged 75 and ab<M!.
(BMJ 1986;292:614 Amcn<kd w1th ptrmission from tht 8MJ Puthh1n9 Group)
55.2 The data in rhc rnblc i i,. :ld.1ptt".CI from :io "rticle ent iclc'.<'I •Alcohol drinking in nlidd lc ._1!!.e'
Choosc the corrt word> ro complete rhe de;criprron below. Look ar e oppo,itc 10 hel p )'OU.
Son1e peoph.·
OVe..r .f-o
1 ' ... 1
"
':fOll
Jroxin1ating ft•t•I lh.i l
b unrit•nl1 f ap
i t·. What do
you th ink?
Pro
Us•
1
Data presentation 2
Line graphs
Norice rhe verbs used to describe changes ovcr a period of rime.
/
rise fati
I
reach a peak remain thc samc
increase drop
go up dccrease
go dO\\'n
Norice rhe difference:
I
rise sbarply
stecply
rise srcadily
gradually
rapidly
A line graph
Pie charts
Pie charrs are an effecrive way of showing thc relarionshi p of
parrs ro a wholc: the complere circle or pie represems rhc
whole, while the parrs are represenred by scgmcnrs or slices.
In 1his pie charr, which shows a health aurhoriry's costs, rhe
orange slice rcpresems cosrs of hospiral services. So, hospital
services accoum for 60% of rhe cosrs.
Hospital scrvicc-.s
Describing trends
Thc bar chart below shows rbe prevalence of 1 rrv in di ffcrenr counrries.
HIV rares have fallen in somc countries as a rcsult of safer sex, bu1 rhe ovcrall trend is an increasc in HTV infccrions. Th
56.1 Complrie 1he 1ahlc "11h words from A oppo;ue.Puc a ;trt mark in from of 1he messed
syllabk of rwo >yllnhlc words. The firs< onc has bcen done for you.
Vrrh Nou
n
'decreasc
drop
fa])
locreasc
risc
-
56.2 Choose rhe corree< words io co111ple1e 1he dcscropuon of 1he har charr. Look .11 A
aoKI C opposite to hclp yc>u .
Figure 6 shows that 1he over;11l 11umber of c:i<e' uf HIV ( 1) ·--·········· . .... (dropped I
remained che same) )CJrly untol 1988, 1hen (2) ·-··-·(rosc/dropped)
(3) ------·- (;harply/¡¡r:idually ). Cases 111 hecerosexual men and wornen
(4) _ _ (ln.a>N/fell) (5) _ (steeply/steadily), especoallr
for people exposed abro.id. The number of infocted pt'Oplc 1111trong drugs
(6) (fclho'-C) after (7) _ (rc-aching a peak I droppon) on
1987.This ma) be beca use of che development of nttdle e>.change scheltlC".
Mother 10-infon1 cran;mo;sion (8)··--··--···-··· (rcpresemed/accounted ) for a sorull
number of case<. C1reÍUI management of la bou r grcatly reduced 1he number in
che
lace 1990s.
3000
Ochcrs
••
Mothtr to 1nfant
2500
•• •• Thc,.p<uh<
l) 2000
• •'"""'"9
Htttrwxual
'¡;
1500 •Homos<J<ual
"E'
z 1000
500
.. .,,
"'
....... g¡
"""' " ' ::;:
a>
;
"s:' "
s:'
o !!? !!? !!? !!? !!? !!? fogu 6
2 C
""'' "'
C>
Pr
Use
1
Resea rch articles
The structure of a resea rch article
Research artides are rypkally divided inro four
nin.in secrions:
lntroduction
Methods
Resuhs
Discussio n
11iis is somerimes called 1he IMRaO srructure of
arrides.
lñc lntroduction conrains background informarion;
in other \vords, ir re1ninds rhe reader \vhat is
already known about thc subjcct. lt includes
inforn1arion abour previous studies, and expla i ns \vhat has nor bctn invcstigatcd
previously.Finally, thcrc ·s usually a statemenr of rhe objecrive., or purpose of rhe
research (why rhey did it).
In rhe case of c11ical research, rhe Med1ods section gives derai ls of rhe p<". Ople who werc
srudied
- rhe participanrs i n the research. The mcthod section also conrains informarion about any
intcrvcntion carried out, for exan1ple 1nedication, advice, operacions. Ir gives derails of che
steps caken in che srudy, ho\v the participanrs \vcrc choscn, and includes rhe main things
rnea.sured, such as blood levels. Finall)', there is informa tion about statistical analysis.
"íhe J ci:ults section tells wh3t \V3S found, rhe findi_ngs of rhe srudy.
The l)iscussion secrion conrnins explanarions, and daims for the importancc of the
m1dy. lt may also J ist Jimitations, or par!S of rhe study which were unsa risfacrory, and
sug¡>, esr whar research needs ro lx done in rhe fururc. Thcrc is usually a Condusion,
which is son1edmcs a separare section.
At rhe cnd of mosr arride", rhcrc is a short secrion c•.lled Acknowlcdgeme nts. ln
rhis che a uthors thank people who have helped thcm in their research. Finally, thcrc
is a l isr of
Refercnces -che books and arrides which the authors have used.
Objecti ves
Srarcmenrs about objectives oftcn contain che following verbs:
assess Wc assessed whethcr ...
determine The aiin of our srudy was ro determine wherher
investigare
... We invt'Stigarcd thc ...
evaluare ·1nis srudy evaluared rhe ...
57.J :-low \\Tire a scnrencc abour Lhc main finding m t"Jch oí rhc srud in 57.2
aho•e, assuming a result 3S shown 111 bracktts bdow.1 OOl 31C Opposite 10
hclp }OU.
1 (no)
2 (yes)
3 (yes)
4 (uncenain)
ilrticle. Many jou rna ls rcquirc contributors (a urhors wishing ro publish thcir arricles in rhe
jou rnal) ro provide a structured abstraer -an abstraer which is divided inro specific
secrions.
AGE AT RETIREr>.·t ENT ANO LONG TERJ.4 SURVIVAL OF AN INDUSfRIAL POPULATK)N: PROSPECTIV'E COHORT $TUDY
OOJECTIVE
To asscss nhcthcr early :ctirc1ncnt is assocíaled ''ri1 h be-Her survlval .
DESIOI\
Long 1erm prospec1ive cchon srudy.
SETnNG
Petroleu1n and pelrochen1ical industry. United States.
SllOJECTS
Past cmployccs oí Shcll Oil who rctircd at agcs 55, 60, and 65 bctwccn 1 January
1973 and 31 December 2003.
r-.lAIN OUTCOME MEASURE
Hazard ratio oíde lh adjusted for sex. yer of entry 10 study, and socioeconom ic status.
RESULTS
Subjccts who rctircd carly at 55 and who wcrc s1ill alivc at 65 had a significantly higllcr
monal ity titan 1hose who rc1ired a1 65 (hazard ratio 1 .37, 95% confidence in1erval 1 .09 10 1 .
73). Monaliry was also significant ly highcr for s.ubjccts in thc first 1 O ycars aftcr rcürcmcnt a1
55 co1nparcd \vith th•:>SC \\•ho continued working (1.89, 1.58 10 2.27).After adjus1me111.
monaliry was similar between those who rctircd at 60 and 1hosc who rctircd at 65 ( 1 .06. 0.92
10 1.22). Monality did 1101 diffcr for thc firs1 fivc
years after retircment a1 00 comparcd with cominuing work al 60 (1.04, 0.82 10 1.31).
CONCLliSIONS
Rcriñng carly at 55 or 60 \vaS not assoc iatc".<I \vith bcncr survival than rctiring at 65 in a
cotx>rt of past employ.'.es of the pe1roche111ical industry.Monality was higher in employees who
rctircd at 55 1han in those \vho continued \vorting.
(BMJ 2005;331: 995 Amend<d w;th ¡><fm;ss;on ímm the 8MJ l'ublish;ng Group}
Note :Slighlly ditferent headings are uscd in sorne journal For example. The New
Pro(«•íoool Engsh In Use 1
Medklne lS
Englond Journol of Medicine divides articles into Background, Methods, Results and
Conclusions. You must consult the Guide to Contributors for the precise requirements of the
journal you wish to contribute to.
58.3 Thc secrions of rhc ab>rrn<"t below are in the wrong order.and thc hcadings have
littn removed. D<cide rhe corre". !ordcr,and gi'e each secroon a 11tle froon B
oppos11e.
England, Scotland. and \\•les.
2 l listor¡·oí asthma. whttz¡bronchiris.or whee11ng obtaoncd from interview "uh'ub¡c<"ts·
pa renrs at agc. 7, 1 1, and 1 6 and reponed ar 1111crv1ew hr subj<'CIS ar agcs 23 a nd H
3 To describe rhe oncidcncc J•••J oí wheezing illness fron• b1nh ro age 33 and rhc rda11on of
incidencc ro pcrinaral. medical, social, environmen1.1l, and liíesryle factors.
4 Thc cumulnrivc incidencc "í whcezinJ1, il lness was 18% by agc 7, 24% by age 16, and
43% by age 33. l ncidence during childhood was mongly.111d indepcndenrly a'lsociarcd with
pncumonia, hay fevcr, ond eczema. J...J lncidence from agc J 7 co 33 was a<sociarcd
mongly with active cogarcuc >mok ng and a hisrory oí ha) fe, er. 1- ..)
5 Atopy and acrwe Clga rette smoking are mator míluco..'é!o on the incidence 3nd rocurreice of
wheezing dunng adulthoo.l.
6 18.559 pcople bom on .l-9 March 1958. 5801 (31%) .:onrribured informanon ar.1gts -. 1 1.
16, 23, and 33 > ears.
7 Prospecrive longimdin.11'n1dy.
(8MJ200S; Amcndrd Wlltl pt'fmissiOf'I rrom lht BMJ Pubhhn1CJ Group)
58.4 Some jou rnals use d iffcrcnt he'1di ngs ro thosc in the BMJ. Ma tch rhc headings (
1-5) ro thc corresponding BM} hcadmgs (a-e).
1 Findings
2 Purpose
3 Background
4 lnrerprecarion
5 Panicipanrs
a l nrroduction
b Objecrive
e Subjccts
d Results
e Condusion
Conference presentations
The structure of a presentation
Omference (or congressi presenrations are iypically dividcd into IMRaD secrions (sec
Unir 57).
lf rhe presenration has a differenr form, rhe speaker may sra rr by ourlining irs
srructure. This helps ro orientare rbe audience:
1'11 begin by ...
First of ali, l'll ...
l'll then ...
Secondly, 1'11 ...
finally, l'll ...
Many speakers like ro sta rr a ne\v section \Vi th a signa!:
NO\\', ...
Moving on to X, ...
As far as X is coocerned, ...
An alrernarive- rechnique is ro use a question:
How did wc investigare this probkm? (ro introduce Merhod)
What did we find? (ro introduce Resulrs)
How does rhis compare with pre••ious srudics? (to introduce Discussion)
The introduction
A formal way of bcginning is:
J'd like to present to you the rcsults of our research into ...
Many speakers prefer 10 begin in a less forma l way:
When we first bt,,¡an 10 k>ok into thc qucstion of X, wc thought ...
You may wish ro begin wirh a generalisarion or reference ro shared
knowledge: lt is well known that ...
Man y srudies have shown rhar ...
X has establishcd clearly that ...
Signalling
Orher signals rhat you may wish to give include:
Emphasizing Giving examples
• l 'd like 10 ernphasize ... • For instance ...
Listing points • ·.. such as ···
• Firsdy, ... Contrasting
• Sccondly, ... • On the other hand
... Rcferr ing to siides • In contrast ...
• This slidc shows ... • However, ···
The conclusion
Ir is in1PQrtanr ro end well, for exan1plc by sun1n1in up rhe main conclusions.
So, \Ve can see ...
In conc1usion, To sun1 up, l'd
Fina Uy,10 say end by ... rhese srudies show ...
like
59.2 \Xliilc d1t: \vvrd vr plan.1 U-!tt::d lJy che speaker in rhc prcscnrarion in .59. 1 above nexr ro irs
fu nction. Look at B, C and D opp<>site to help you .
Emphasizing
Listing
Exemplifying
Conrrasring
Summing up
Changing topic
Referring to a slidc
Announcing rhe topic
• loudness of voice
• speed of delivery
• usl of tmphasis and pausing
•l'Vt' contact wi th the au 1ience 1
Sed1on Example
language
lnrroducrion l'd like ro prc.;cnr M r Simpson,
Parienc's age and occuparion a 34-yca r-old plumber,
Presenring symprom(s) and who prc.;ented wirh a one monrh hisrory of brea:hlessness.
durarion
Associa red S)'mproms He also complained of ank le swelling which he'd had for
f\\IO 'veeks.
Slides
Ln a formaJ presenra rion, rhc 111ain poinrs are usually surn1narized on slides.
SH with 1son
married
25 cigs/day; 50 units alcohol/week '
nilrelevant
PH FH OE ·.
father d.42 MI; mother a&w obese; 2 spider naevion ches! P 11O/min reg.
BP 100/60
enlarged heart and blat. pleural effusions
CXR
60.2 Put rhe scc1ions of a short informal case presentarion in rhc correcr order.Look ar A opposire t0
help you.
1 Mr Collins is a 60-year-old securiry guard.
2 There 'vas no relevant previous n1edical history.
3 He smokes 20 ciga mres pcr day and drinks 15-20 urlits of alcohol each week .
4 On examinarion, rhere was marked renderness around rhe lower legs abovc the anklcs and
knecs.There were crackles ar rhc kft base postcriorly in rhe chcst. 111ere was nor hing else
abnormal ro find on exam inarion excepr for dubbing of rhe fingcrs.
5 He presented wirh a six-week hisrory of pain in the legs.
6 Chest X-ray showed consolidarion in the lefr lower lobe.Bronchoscopy and biopsy showcd
adenocarcinoma of rhe lung and computcd romography {CT) sean showed rhar rhis was
nor resecrable.
7 Trearmenr with chemorhera py has rcsulrcd in rcmporary improvcment in rhe chesr X·ray
bur rhe leg pain has conrinued ro prove d ifficulr ro conrrol.
8 The pain, \vhich \vas l ocared around the ankles, had been increasing i n inrensi ty and \•1as
associared wirh local renderness.
9 On romine qucsrioning, he said that he had had a morning cough wirh small amounrs of
'vhire spuru1n for i-nany years. He produced, once, so1ne srrcaks of blood i n thc spururn.
60.3 Read the prcsenration below and make notes for a slide. Look ar C opposirc ro hclp you.
l'd like ro presenr M r McNa mara who's a 63·year-old taxi driver who prcsenred ro the
Ourpaticnt Clinic with a thrcc-monrh hisrory of increasing shorrness of brearh and ankle
swelling. He had a chronic cough with purulenr spurum and occasional haemoprysis. Of
note in his pasr medical history was rhat he'd had a pari ial gasrrecromy in 1980.
On examinarion, he was pale. 1 lc was apyrexial. He had leg oedema, bur no clubbing
or lymphadenoparhy. And examinarion of h is chest was cnrirely mlrmal. His liver was
palpable 5 centimetrcs below rhe costal margin, and was smoorh a nd non tender, and rhere
\Vas also a scar fron1 his previous operarion.
burrock-+--t
AN Jnrenaral
AP Jntero-posrerior
APH antepanum haemorrha¡:c
ARM Jrtílicíal ruprur< oí membranes
AS alomcntar¡ S)S em
ASO mial <ep1JI dcíect
ASO anrisrreptolysm O
ATS {lnritetanic scrun1; anutcranus serum
AVF augmenrcd volragc foor
Ahbrt'v 1ation Mcaning
symhol
or
co casualry officer
COAD chronic obsrrucrive nir,vays diseasc
COP change oí plasrer
CPN communiry psychiorric nurse
creps crepirarions
CSF cercbrospinal fluid
CSSD Central Sterile Supply Depot
csu c;.nheter spccimen of ur111c
csw cl inical supporr workcr
CT cerebral tumour; coronary th roonbosis; compureri1cd romo¡;raphy
cv cardiovascular
CVA cardio\'ascular accident; cerebrovascular accident
cvs cardio,ascular system: cerebro,ascular S)'Stem
Cx cerv1x
CXR chest X-ray
D divorced; diecVdead
D&C dilatation and curcrrnge
D&V dh1rrhoea and von1iring
ºº dangerous drugs
ODA Dang«<>us Drugs Aa
decub. lrmg clown (L1rin)
DIC drunk in charge
di decilirre
DN Districr Nurse
DNA did nor attend
DNA dcoxyribonucleic acid
DOA dead on arri\lal
008 dare oí birrh
DRCOC Diploma oí rhe Royal Collc¡te oí Obsrerricians and C)naecologists
ORO Dis. blement Re<;etrlcment Oífice
DS disseminared sclcro'1S
Gcncrol Practitioner
genera l p.ira lysis of the in<;. 11c
glu1a1111('. p)·ru,•ic rransan11nasc
inrravenous
inferior vena cava
in virro ferr ilizarion
intravcnous pyclog.ram
inrravenous urogram
invesrigation
insulin zinc suspension
u urea; unir
U&E urea and elecrrolyres
U/L units pcr litre
UGS urogeniral sysrem
UMN upper n1oror neurone
LJRTI upper respirarory traer infection
ulrrasound sean
uss
UVL ulrra-violet light
VD venereal disease
VDRL vcnercal discase research la borarory
VE vaginal examination
VI virgo inracta
VI' vcnous prcssure
VSD ventricular sepral dcfect
vv varicose vein(s)
Vx vertcx
\VÍd0\\1/\vidO\\le'f
w
WBC white blo<><l ccll count; white blood corpusdes
wcc white cell count
WHO World Healrh Organizarion
WNL \virhin norn1al li1nirs
WR Wasscnnann rcacrion
XR X-roy
YOB year of bi rth
.•
tablets inhaler
Oinrmems are greasier than ttt:11ns and ha,c a thicker 1exrure. lbis makes 1hcm adhcre:o
tbe aff= arca longer.Crcam> 1re more acccptable cosmetrcally and tend to be used on
th< face as thcy are lcss visible. Pastes .m stiffcr preparations whrch contain more powdrrcd
solids.Lotions are liquid and uscd in are.is s,rch as rhe scalp whcre an oimmem or cream
would adhcrc to 1he ha ir.
Appcnd
IV Symptoms and pain
1x
Feature Typ1ca l
quL·st1on
Main Sitc Whcrc docs it hurt?
ShO\V n1c \vhcrc it hurtS.
Radiation Does it go anywhere clsc?
Cha racter Can you describe rhe pain?
Procipiraring factors Docs anything bring thcm on ?
Tame of onset When do they start?
Tame of resolution When do they stop?
Frequency How often do you get thcm?
Aggrava ring foctors Docs anyrhing make them worse?
Is thcre anything else that affects rhem ?
Relieving facrors Docs anything make them better?
Associated fearures Do you fed anything else wrong whcn it's there?
Hnvc you riny other problc1ns rclatcd to thc pain?
Duratíon How long do rhey lasr?
Scverity How bad is it?
Description of pain
Pa t1en t"s desm pt ion of Expl an
pa111 allon
aching / an ache a general pnin, ofren in rr1uscles and joinrs
boring like a drill
burnin g with heat
colicky an inter1nittenr pain \vhich varies in inrensiry, co1nes and
goes in \vaves
crampy/cramp an involunrary spas1nodic 111uselc conrractio:i
crushing a feeling of pressure
dull a background pain, opposite of sharp
gna\v1ng biring
grippi11g a feeling of righrness
scalding likc boiling water
sharp acure
srabbing li ke a knife
stingjng sharp, burning, like :an lnsccr sring
throbbing \virh a pulse or beat
curl up sit
sit up
Simple definitions
Mosr parienrs do 1101 have any med ica! knowledge, so ir is imporranr ro use simple words
rhey will undcrsrand whcn ral king about certain parts of rhc body or medica! condirions.
coxa hip
cubirus clbow
mamma brca<r
nates buuock<
p;nella kncecap
3.3 1 organs
2 li..cr
3 gall bladdcr
4 kidM)'
5 k1dncy
Pro(...ionol Engt.sh 111 Ust Mtd""1t
147
Over to you -sample answer
The splt'(·n 1.s s1tu;ucd on rhe upper left 1dc of your abdo111<.>n. undcr )·our r1hi.. Ir :ic" '' ::t
filre-r. helping to destroy old, worn-out blood cells. h al>o produces cells thar hel p prorect your
body fron1 infecrion.
The pancreas is a gland decp inside your "bdomcn, bch ind your liver. Ir normally produces
insulin, which your lxxly needs to help ir More and utiliLe ¡;lucose, and "°
1t "imrortJnt in
conrrolling the a mount of sugar in your blood.
5.2
8.3 1 ampu1.11ion
3 thernpists 5 splines 7 relieve
2 limb 4 rehab1hL111on 6 deformity/deform mcs
dis'chirgc 0d1scharge
.'operatc oper'anon
re'fcr re'ferral
'rreat 'trt3Cllle0f
9.2 acurel)' ill
asscssn1cnr uni l
on duty
referral lerrer
\vairi11g l.isr
11.2 1 elecrive
2 problem-based lea rning 4 dinical arrachments 7 medical 10 senlinar
5 srudenr sclccrcd school
3 lecrures
modules 6 cadavers 8 consulranr
9 Collcge
12.3 Bachelor of Medicii:e, Bachelor of Surgery, Fcllow of the Roy,11 College of Surb>eons of
England, Fcl low of the Royal College of Surgcons of l reland
2 Bachelor of Medica! Sciences, Docror of Medicine, Member of the Roya l Collcge of Physicia
ns 3 Bachelor of Medicire, Bachelor of Surgery, Fellow of the Royal Collcgc of Surgeons
4 Bachelor of Mcdicir.e, Docror of Medicine, Fcllow of rhe Royal College of Physicians
o
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o
f
s
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r
s
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e
s
e
n
r
\
\
'
i
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h
i
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r
c
a
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i
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g
v
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Proftssionol English in Use Med1cne 15 1
16.1 1 skull
2 j 1\v bonc
3 spine
4 breastbonc
5 rib
6 collarbone
7 shouldcr
blade 8 rhigh
bone
9 kneecap
10 shinbone
18.2 Ans\vers given are rhe \\fOrds uscd in rhc origina l rexr; possi ble alternativcs are sho,vn in
brackets.
1 srimulare (trigger) 4 production (seeretion) 7 secrerion {prod 10 secretion {production )
2 release {secretion) 5 feeds uction)
3 stimulares (tnggers) 6 111h1b1t 8 stimulares (triggers)
9 prod uce
21.3 menarche: llow old wcrc )Oll when you srartcd m gc1 rhem / you r
periocl<' menstrual cycle: A re you r pcriods regular? How long do thc
pcriods lasr usually? L\4P: When was )'Our lo>t pcriod?
menorrhag1a? Would )'OU 'ªl' they are l ighr or hcavy? Do you ger dors?
dysmcnorrhoc:n? Oo )<>u et pcnod pains?
dascharge? Is there an) d1;<hargc berwccn thc pcriod;? Whar colour is 1t?
in'spcct in'specrion
pal'pare pal'parion
per'cuss per'cussion
24.1 l j, 2e, Ja, 4h, 5b, Ge, 7f, 8d, 9g, 10i
25.4 i·hc
paticnr
has
three of
the
listed
sympto
ms:
tircdncs
s
(fatigue)
lo oí intercs1
sleeping poorly (insomni•)
n
c
o
p
a
l
a
n
a 7 control 8 involuntary
c
k Ovcr 10 you -sample answer
According to thc article, the smells are mawbcrry,
u >moke, soap, me111hol, clovcs. pinea pplc, nacu
r ral gas. lilac, lemon and learhcr.
1 Nf )Utl 27
Adjt'l'llVt'
n .1
aabsc1vcc ab<enr
r d1m1nuhon d1m111"h<d
} fbcc1dirv flacc1d
spasucil) spa<ric
1
n\\ JSUng wasted
c
o
n 27.2 1 mu;clc rone 3 powcr
t 2 muscle bulk and possibly 4 coordinarion
i involumary movcmencs
n
e
n
c
c
:
v
i
s
u
a
l
a
c
u
1
t
)
26. hcadcd
3
J s
p
cons a
d
ciou .
snes s l
c l
s d
2 4 l
'vars )
ningt 6
r
e h
s g
s h
r
27.4 GCS 5 (eye opening:to spe<'Ch = 3, verbal response: none = 1, motor r<'Sponse: none = 1)
28.2 6, 3, 7, 2, 8,4. 5, 1
30.1 blood-stainecl
brearh sounds
pleural rub
productive cough
vocal resonance
156 Pro(essionol English in Ust Medicine
30.2 1 Do you cough up any phlegm? / Is it a loose
cough? 2 Wh,u colour is rhe ph egrn?
3 Is it ever yellow?
4 Havc you noriccd any blood in ir?
5 Any problcms with your breathing?
30.3 true - A productivc cough is often described as loase ... A cough may be productivc,
where the parienr coughs u p spurum (or phlegm)
2 false -crackles ... sug¡;est the presence of ílu id in the lungs
3 false - A cough may be ... non·producrivc, whcrc thcre is no spuru m
4 false - wheezes ... indicare narrowing of the airways.The sound of an asrhma
paticnt's brearhing is also callcd whcczc
5 false -TI1e sound heard when rhe pleura l surfoces are inílamcd, as in plcurisy, is called a
pleural rub
31.1 1 Shinglcs
3 small 5 small blisrers 7 sca bs
2 spors
blisrers 6 filled with pus 8 scars
4 spotslblisrers
31.2 locarion and distriburion: first behind the ears and on the forchcad then thc tnmk
and limbs
grou ping:sca"ered
typc of lcsion :
macules colour: pink
31.4 locarion and distriburion: below larera l a ngle of rhe lefr eye
gr(>uping:single
rype of lesion: nodule
colour: ,vhire/pink
(basal cell carcinoma)
32.3 There is a laceration/tear 011 rhe lefr shouldcr and an incised wou nd I a cur approxinately 6 cm
in length abovc the lefr nipple.
36. 1 3 5 7 9 local
2 jell) 4 6 8 rigid 1o ger u<;«!
caureri1e c'cise ro
36.3 1 pulse oxin1eter 3 n.t\:tl cannul:.i 5 inrroduced
2 i n thc left lareral posi1ion 4 preonc<lica rion 6 rransferred
40.2 1
3 side-cffoct 5 bl"term¡: 7 Caunoru. 9 pharrmci'r
lrru.mon 4 com:r:undoc;ired 6 dose 8 lndic:irions 10 pharrmC\
2 chtrn15t\
40.3 treptokmasc.one and a half n11ll1on unn b) mrra,·enou> mfusion O\-Cr StXI)' mmut.
A;pirm. rbree hundred milligram,.h) mouth. 11nmed1a1el).
l)1.1111orph1nc, t\vo poinr five ro five n11ll1KrJn1 , u1ttJ\oc11ou);ly.i1nn1ed1<1tel).
Mcroclopramide, ren milligra m;, mrra•enou;ly, 1mmed1ately.
GTN, three hundred miuogram> per livc milli litrc;, hy intravcnous infu1ion. Sr.1rt ar forty
1nicrogrnnls per n1inure.
41.2 1 J>SISt.mt 6
2 prcppingfprcp iring swaIW,ud..cr 7
3 drapcs 't":ker/,,,·.1th
4 >tcrilc 8 logaru res
5 rctractor 9 drain
10 >11rurc.J,11rchc.J,r.1pb
42.l 1 chcmorherapy
3 phy,iorhcrapy 5 physiorherapy
2 radiothcmpy
4 Cognitive Bchav1oural 6 Cogniti, c Behavioura l Therap)'
111erapy
44.3 .1ffCClcd by
as.oc1at1on bef\veen
1nc1dcncc of
lead to
ral't' 1n
1 1nadcncr oí 2 asso.;iation lJr:&'\\l-,:u 3 kJJ 1v 4 .-an: in 5 .iffcx.:rcd b)
48.3 1 What kind of housc do you live in? 5 Do you s1noke? HO\V n1any a day?
2 Ase any of rhem ar nursery or 6 Have you tricd giving up?
school? 3 Do you havc an)' financia ! 7 How much do you drink in a week?
problems? 8 C111 you give up alcohol whcn you want?
4 Do you have an)' hobbies or
inreresrs?
162 Pro(essioool Eng6sh in Ure M edicine
49.1 la, 2c. Je, 4c, Sb, 6d, 7f
49.2 1 1, 2 l. 3 C, 4 E
50.2 1
Touch your shoulders with ynur hands.
2 Put your hands behind your hcad.
3 Put you r hands behind your b.1ck.
4
R"i"' your arms above you r hcad.
5 Bcnd your head forwa rd ... backward.
6 Bcnd your head ro ne right ... ro 1hc
7
lcft. Turn your head ro 1he right ... to
8 1he lcft. Bcnd backwards.
9 Touch rour toes.
10
With¡our hcel on che ground, tum ¡our!001as for as you
11
can. llcnd your knce.
12
llcnd to thc left ... r» 1he ng/11.
13 lknd your toes up and down.
52.1 1 e
2 a, f
3d
4 b,e
52.3 1 devcloped
2 (mainly) because you a re
3 This is why / lr's rhe reason why
4 give you advice on
5 rnake )'OU an appoinrn1enr \Vith I arrange for you to sce
6 going ro srart you on
7 should I should rry ro
8 \\ ant you to
1
53.1 1 carry 011 2 gavc up 3 end up 4 srarr, off 5 Cur down 6 scttle 7 avoid
1hrl'c ros..ib1litics: onc is embol izarion which '' rel.111\'cl)' minor. Ir means closing off thc
:mery that feed; the fihroid. Thc $CCOnd would l>e rcm0\.11 oí thc fibroid alone wirhout
rcmoving your
\\Omb. This needs ahdominal \ur¡:cr , "'d a h)sterectomy whcn your womb os remo•cd.
You don't ha•e to decide toda). 1 can g1"c lou leaflets and recommend web;1tC\ for )·ou to look
a1. The-n come back and Stt n1r- 1n f'\\·o \\ ttk·11n1c.
56.1 Vn Nou
h n
56.2 dropped
dc'crcase 3 gradually 'decrca'>C
5 stcadily 7 reaching a peak
2
droprose
4 incre3sed drop 6 tell 8 accounrcd
fall fati
56.3 l ine
rn'c:re.. scgraph I bar chart 2 ba r chan 3 pie chart
'incrcasc
-
risc rise
57.1 1 Results 4 Mcth0<I (Subjecrs)
2 lnrroduction (Objt'Ctivc of thc rcscarch)
3 Method (Starisrical analysis) 57.2 Possible answers:
Pro(euional Entlish In Use 165
Medone
5 Oiscussion (Main finding) 7 Di scussi on (Li111itarion)
6 lnrroducrion (Background) 8 Results
1 Wc asscssed 'vhether t:alciun1and virarnin D supplen1entar ion reduce rhe risk of
fractures in posnnenopausal \von1en.
2 The ai1n of our srudy 'vas ro dercrrni ne \vherher rhe'vay docrors dress influences patienrs'
confidence and rrusr in rhem.
3 This study eva luared die risk of HH V-8 transmission by hlood rransfusion.
4 We investigarcd thc association bctween never being married and i ncreased risk of dearh.
58.2 Past employees of Shcll Oil who rcti rcd at ages 55, 60, and 65 berween 1 ja nuary J 973 and
3 1 December 2003
2 To assess whcrher carly retirement is associa ted wirh berrer survival
3 Pctroleum and perrochemical indusrry, Un ired Srares
4 Hazard rario of dearh adjustcd for scx, year of enrry ro srudy, and socioeconomic srarus
5 Long tcrm prospecrive cohort srudy 6
No
58.3 The correct order is: 3 (Objecrive), 7 (Dcsign), 1 (Setting), 6 (Subjccts),2 (Main
outcome measure), 4 ( Resulrs), 5 ;Conclusion)
59.1 The corrccr ordcr is: 4 (Topic), 9 ( Pathophysiology ),5 (Sclurces), 6 (Sources), 2 (Diagnosis),
8 (Diagnosis), 3 (Diagnosis), 1 O (Diagnosis), 7 (Trea tmenr), 1 (Treatmenr)