ASIGNATURA : INGLES TECNICO II

CICLO : VI
SEMESTRE ACADEMICO : 2020-2
 UNIVERSIDAD PRIVADA SAN JUAN BAUTISTA
FACULTAD DE CIENCIAS DE LA SALUD
ESCUELA PROFESIONAL DE MEDICINA HUMANA
“Dr. Wilfredo Erwin Gardini Tuesta”

ACREDITADA POR SINEACE

RE ACREDITADA INTERNACIONALMENTE POR RIEV

Lesson 2
Neurologic Unit

DOCENTES RESPONSABLES DE LA ASIGNATURA

SEDE LIMA : CONDORI ATAUCURI CARMEN
CHIRINOS MENDOZA ANTUANET
FILIAL ICA : FERNANDEZ DE LA CRUZ MIGUEL ANGEL
FILIAL CHINCHA : FELIX SEBASTIAN LUIS MANUEL
 Neurologic Unit

Learning Goals:
Learning about the signs and symptoms
of a neurologic disease
Reading a cerebrovascular accident
admission note
Writing a progress note
ESP grammar
Did you know?
1. hemiparesis
2. hemiplegia (hemiparalysis)
3. paraplegia
4. quadriplegia
The Brain / The Cranial Nerves
Anatomy
 Warm-Up
I. Anatomy Practice
Complete the following chart.

Combining Form Meaning

neur/o
cranium
spondyl/o
rachi/o
spinal cord / bone marrow
gangli/o ganglion
thalamus
encephal/o brain
cephal/o head
 Warm-Up
II. What do the following terms mean?
Write the meanings of the following terms using the clues provided.
 Warm-Up

III. What do the following abbreviations mean?

1. CVA A. cerebrovascular accident
2. ICH B. transient ischemic attack
3. TIA C. visual field
4. GCS D. intracranial hemorrhage
5. VF E. Glasgow Coma Scale
I. Think before you read.
1. Which motor system and reflex assessments would you include in a neurologic
screening examination?
________________________________________________________________

2. What techniques do you use to elicit deep tendon reflexes?

________________________________________________________________

3. Which cranial nerve and sensory system assessments would you include in a
neurologic screening examination?
________________________________________________________________

4. What is another way of saying a “cerebrovascular accident”?

________________________________________________________________

5. What are the two major categories of cerebrovascular accidents?

________________________________________________________________
 II. Medical Vocabulary from the Main Reading
Do you know which group each of the following terms belongs to? Write them
in the correct boxes below.

1. left hemiplegia
10. Foley catheter
2. diabetes mellitus
11. NG tube
3. hypertension
12. dopamine line
4. recurrent pneumonia
13. intubation
5. dyspnea
14. CBC/DC
6. consciousness
15. sputum smear
unclear
16. ABG
7. neutropenia
8. shock status
9. hypoxic respiratory
failure
 Reading
Admission Note—Case 1 Chief Complaint SOB x 2 days

Present Illness
This 82-year-old woman has a medical history of old CVA with left hemiplegia, DM,
and hypertension. She has been under medical control for years. Due to dyspnea,
she was brought to our ER for help. This time, she has had SOB for about two days.
She also complained of increased sputum amount. Her consciousness was
unclear and was in bedridden status with Foley catheter and NG tube.
According to record, she has recurrent admission due to pneumonia.
Family said the patient did not have a fever at home.

However, at ER, she had a fever of 39+. CBC/DC showed neutropenia with
immature cells. Sputum smear revealed GNCB 3+ and neutrophil 3+. Shock
status was then noted, and dopamine IV line was used. ABG showed hypoxic
respiratory failure, so intubation was done. Now she is admitted to MICU for further
treatment.
 Reading
Reading Comprehension
Answer the questions. There can be more than one correct answer.

1. Which of the following is not true about the patient?

A. She has old CVA with left hemiplegia. B. She had diabetes mellitus.
C. Her hypertension has been under medical control. D. She has had alcohol dependence for years.

2. Which of the following is true?

A. The patient’s consciousness was not clear. B. She was intubated.
C. Her left side was weaker than her right. D. all of the above

3. Which is a likely clinical impression for the above case?

A. hypoxic respiratory failure with hypertension and diabetes mellitus
B. new CVA with end-stage renal failure
C. brain tumor D. heart failure
4. What is in the patient’s medical history?
A. left cerebral infarction B. left hemiplegia
C. pulmonary disease D. all of the above

5. Which of the following is not true about the patient?

A. He was admitted for promotion evaluation. B. He has no earache or tinnitus.
C. He has intracranial hemorrhage. D. The wick was inserted into the right ear.
 Reading
Word Bank
 Reading Strategy
Skimming for the Main Idea of Each Paragraph
(Tip: To identify the main idea, read the title and any subheadings, look at any
photos and diagrams, read the first two and the last sentences of each paragraph,
read quickly, and don’t read every word.)

After you read the passage, put the main ideas below into the correct order.

□ SOB was noted again for about two days, and increased sputum amount was also noted.

□ CBC/DC showed neutropenia with immature cell.

□ Shock status was then noted, and dopamine line was used.

□ The patient had a fever while she was at the ER.

□ This 82-year-old woman has a medical history of old CVA with left hemiplegia, diabetes mellitus, and
hypertension.
 Recognizing Common Abbreviations

What do the following abbreviations mean? Please write them out in the blanks provided.

1. CVA ________________________________________________________________

2. ER ________________________________________________________________

3. SOB ________________________________________________________________

4. NG ________________________________________________________________

5. ABG _______________________________________________________________

6. GNCB ______________________________________________________________

7. MICU _______________________________________________________________

8. CBC/DC _____________________________________________________________

9. DM ________________________________________________________________

10. IV ________________________________________________________________
 Sentence Combining
1. with (prep.): means “having”
She is bedridden. NG tube and Foley catheter are inserted.
She is bedridden with NG tube and Foley catheter.

2. so (conj.): used to show the result

ABG showed hypoxic respiratory failure. Intubation was done.
ABG showed hypoxic respiratory failure, so intubation was done.

3. due to (prep. phr.): used to indicate the reason

She had difficulty in spitting out sputum. Ipratropium was added to her
inhalation therapy.
Due to her difficulty in spitting out sputum, ipratropium was added to her
inhalation therapy.
(Ipratropium was added to her inhalation therapy due to her difficulty in spitting
out sputum.)

4. in a ~ status: means the state or condition that someone is in

The patient is bedridden.
The patient is in a bedridden status.
 Sentence Combining
Your Turn:

1. Her consciousness was unclear. (in a ~ status)

______________________________________________________________

2. Because of dyspnea, she was brought to our ER for help. (due to)
______________________________________________________________

3. She had difficulty in spitting out sputum.

Ipratropium was added to her inhalation therapy. (so)
______________________________________________________________

4. The patient has recurrent admission to the hospital.

The patient has pneumonia. (due to)
______________________________________________________________

5. CBC/DC showed neutropenia.

CBC/DC showed immature cells. (with)
______________________________________________________________
 ESP Focus
You may delete the genitive word which means “the patient’s.”
1. The family asked about the patient’s operation consent form.
2. The patient’s breathing sound is normal.
3. His weight stayed the same over the past two weeks.

Your Turn:
Rewrite the above sentences according to the rule provided.

1. Family_________________________________________________________.

2. ______________________________________________________________.

3. ______________________________________________________________.
 Cloze Test
(1) the referring sheet, the patient is a case of dementia and old CVA. He also
(2) aspiration pneumonia and UGI bleeding. He (3) MM hospital for treatment.
At ER, he kept snoring (4) his consciousness was clear. He (5) more stable
after augmentin injection. His (6) were paralyzed. High WBC was also noted.
CXR (7) increased infiltration over LLL. Under the impression of (8) ,
admission for further evaluation and management was arranged.

______ 1. A. Except for B. Because of C. Due to D. According to

______ 2. A. went to B. got ill C. suffered from D. spread to
______ 3. A. was referred to B. was told C. went to D. arrived at
______ 4. A. also B. although C. but D. and
______ 5. A. looks B. became C. began D. felt
______ 6. A. head B. eyes C. four limbs D. chest
______ 7. A. brought B. changed C. cleared D. showed
______ 8. A. old CVA B. asthma C. recent CVA D. heart failure
 Paragraph Writing
Write your own admission note with the provided facts.

Present Illness

1. Age: 67
2. Gender: male
3. Past history: underlying diseases of diabetes mellitus, hypertension, ischemic
heart disease ten years ago, and stroke without sequelae 20 years ago
4. Medication: aspirin, antihypertensive drugs, antidiabetic drugs, and lipid-
lowering drugs
5. Time, place, and what happened: afternoon, year/month/date, home, left-sided
weakness
6. Treatment at our ER: mannitol
7. ER doctors’ diagnosis: right cerebral infarct
8. Doctor’s order: admission to hospital
 Paragraph Writing

This is a 67-year-old _______________________________________________

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
 Listening for Fun

I. Listen to the conversation and answer the following questions.

1. What is the patient’s blood pressure?
________________________________________________________________

2. What is the nurse checking for the patient?

________________________________________________________________
3. What is the patient complaining about?
________________________________________________________________
4. Who is helping the patient with the rehabilitation exercise?
________________________________________________________________

II. Listen to the conversation again and write down your own muscle
power checking procedures.
________________________________________________________________
________________________________________________________________
 Listening for Fun
III. Listen again and fill in the missing words.
Patient: I exercise every morning and afternoon, but I am not (1) _________
(2) _________ (3) _________.
Nurse: You’ll have to be patient. Rehabilitation (4) _________ (5) _________.
Patient: I know. I follow all the instructions of my physical therapist.
Nurse: You will get better as long as you are willing to (6) _________
(7) _________ (8) _________.
Patient: Thank you for the encouragement.
Nurse: You’re welcome. Now, it’s time to (9) _________ your (10) _________
again.
 Crossword Puzzle
Solve the crossword puzzle with the clues provided. Include spaces if necessary.

ACROSS
2. a breathing symptom
4. not functioning
6. a memory problem
8. a chemical found in celery
9. a condition necessary for discharge
11. medicine for infection
12. repeated

DOWN
1. a kind of scan
3. a CVA symptom
5. forced to stay in bed because of illness
7. not fully developed or grown
8. relating to the lungs
10. not solid
Crossword Puzzle
 Reading and Writing
Fill in the blanks of the Case 2 Admission Note with the following choices (A-F). Then answer
the questions. There can be more than one correct answer.

A. right-sided weakness since the night of 7/16 D. had severe vomiting and elevated BP up to 200 mmHg
B. when a fall incident occurred E. where brain CT revealed recent infarction in the left
C. Under the impression of stroke hemisphere
F. had one episode of syncope
Case 2 Admission Note
Chief Complaint
Acute onset of right-sided weakness since 7/16 night
Present Illness
The 69 y/o man living in the nursing home was a patient of DM under control with OHA. He complained
of (1) _________. He could walk and hold things in his right hand until the next day (7/17) (2)_________.
He was brought to our Orthopedic OPD right after the fall. No obvious fracture was noted then.
However, the patient (3) _________. So he was sent to our ER, (4) _________.
He denied having dizziness or double vision. Tracing back the patient’s history, he (5) _________
3 weeks ago. Elevated sugar level (sugar: 320 mg/dl) and BP (260 mmHg) were noted at that time. No
sequela was found after that episode. (6) _________, he was admitted to our ward for further evaluation
and treatment.
 Reading and Writing

______ 1. What signs and symptoms did the patient have that indicate infarction
of the hemisphere?
A. severe vomiting
B. low BP
C. double vision
D. dizziness

______ 2. Was there a fracture after the fall?

A. There was no fracture.
B. There was a fracture in his right femur.
C. There was a fracture in the left radius.
D. He hurt both knees.

______ 3. What was the episode that occurred 3 weeks ago?

A. vertigo
B. high blood sugar
C. poor appetite
D. syncope
 Reading and Writing
Fill in the blanks of the Case 3 Progress Note with the following choices (A-F).
A. Worried about memory D. Left hemisphere ischemic stroke
impairment. (infarction)
B. Anticoagulant therapy with E. Muscle power
warfarin 1# QD F. Closely monitor neurologic
C. occasional choking condition

Case 3 Progress Note

S:
Right-sided weakness was much improved after rehabilitation programs.
(1) _________ Had occasional choking the past few days.

O:
T: 36°C P: 80/min
R: 18/min BP: 110/74 mmHg Pupil: 3/3 Light reflex: +/+
NEUROLOGIC EXAMINATION<NE> : Right central facial palsy
Consciousness: clear Speech: slurred speech
GCS: E4V5M6 Swallowing: (2) _________
Tongue protrusion: deviation to right side
 Reading and Writing
A. Worried about memory D. Left hemisphere ischemic stroke
impairment. (infarction)
B. Anticoagulant therapy with E. Muscle power
warfarin 1# QD F. Closely monitor neurologic
C. occasional choking condition

(3) _________ Babinski sign:

R upper proximal: 4+ L upper proximal: 5 plantar flexion/plantar flexion
R upper distal: 4+ L upper distal: 5
------------------------------------------------------ Functional status:
R lower proximal: 4+ L lower proximal: 5 rolling: good to left side
R lower distal: 4+ L lower distal: 5 sitting: good
standing: fair
Deep tendon reflex walking: fair with quadricane
R elbow: ++ L elbow: ++ (walker)
R wrist: ++ L wrist: ++
------------------------------------------------------ ANS: Urine/stool: continence/continence
R knee: ++ L knee: ++ ADL: Partial dependent
R ankle: ++ L ankle: ++ (near independent)
 Reading and Writing
A. Worried about memory impairment.
B. Anticoagulant therapy with warfarin 1# QD
C. occasional choking
D. Left hemisphere ischemic stroke (infarction)
E. Muscle power
F. Closely monitor neurologic condition

A: (4) _________.

P:
1. (5) _________
2. F/U PT (prothrombin) QD
3. (6) _________
4. Arrange neurorehabilitation programs
5. IVF hydration (N/S at 60 ml/hr)
6. Watch for deterioration
 Supplementary Reading
Subdural Hemorrhage (SDH) Chief Complaint
Left ear canal bleeding and vomiting after falling down at nursing
home today
Present Illness
This 68-year-old male has a history of right cerebral infarction with left hemiplegia and
dysphagia since January 1, 2013. He comes to our rehabilitation department regularly
for rehab. Today, he suffered from left ear canal bleeding and vomiting after falling down
at the nursing home, where he lives. He also complained about bilateral hearing
impairment. He was brought to our ER for evaluation and treatment. Brain CT revealed
left temporal lobe subdural hemorrhage (SDH) & intracranial hemorrhage (ICH). A wick
was inserted into his left ear in the ER. No earache, tinnitus, blurred vision, or double
vision was noted. After the initial management, close observation was suggested. With
an initial diagnosis of left temporal SDH & ICH with bilateral hearing impairment, he was
admitted for further evaluation and management.
 Supplementary Reading
I. ESP Vocabulary Building
Check the appropriate columns.

Synonym Antonym Family

bleeding / blood

vomit / throw up

bilateral / lateral

blurred / blurry

impairment / injury

close / thorough
 Supplementary Reading
II. Reading Comprehension : Answer the questions. There can be more than one correct
answer.

1. What could be the cause of the patient’s vomiting?

A. hemiplegia B. dysphagia
C. falling down D. dizziness

2. What was inserted into the patient’s ear in the ER?

A. a tube B. a wick
C. a knife D. a catheterization

3. What was the patient complaining about?

A. dyspnea
C. fever
4. What is in the patient’s medical history?
A. left cerebral infarction
C. pulmonary disease
B. cerebral infarction
D. bilateral hearing impairment
B. left hemiplegia
D. all of the above

5. Which of the following is not true about the patient?

A. He was admitted for promotion evaluation. B. He has no earache or tinnitus.
C. He has intracranial hemorrhage. D. The wick was inserted into the right ear.
 Supplementary Reading

III. Cloze Test

Fill in the blanks with the choices provided.

1. He comes to our rehabilitation department ______________ for rehab.

(regularly / independently / scarcely)

2. Today, he suffered from left ear canal bleeding and vomiting after falling down
at the nursing home, ______________ he lives. (whom / where / which)

3. Brain CT ______________ left temporal lobe subdural hemorrhage (SDH) &

intracranial hemorrhage (ICH). (concealed / reconnected / revealed)

4. After the initial management, close observation was ______________.

(suggested / cleared / detected)
 Bibliografía Básica

Terms And Strategies For Medical Records Reading And Writing Student´s book; Judith Perry, Doug
Nienhuis, 2016, Live ABC Publisher
 Lesson 2

Neurologic Unit
-The End-