Актуальная Медицина - General Medicine Ward Round. Taking a History and Doing a Physical Examination. Diagnostics

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Чат

Active Vocabulary: General Symptoms:
Bleeding [`bli:dǐŋ] – кровотеча Weakness [`wi:knǐs] – слабкість
Malaise [mə`leǐz] – нездужання Backache [`bækeǐk] – біль у спині
Sweating [`swetǐŋ] – спітніння Stomach ache [`stǎmək`eǐk] – біль у шлунку
Running nose [`rǎnǐŋ`nəυz] – нежить Vomiting [`vomǐtǐŋ] – блювання
Indigestion [ǐndǐ`dзest∫ən] – нетравлення Inflammation [ǐnflə`meǐ∫n] – запалення
Inflammatory condition – запальний процес
[ǐn`flæmətərǐ kən`dǐ∫n] Vitamin deficiency – авітаміноз
[`v a ǐ t əmǐn dǐ `fǐ∫ənsǐ] 
Heart attack [`hα:t ə`tæk] – серцевий напад Hypertension [`h a ǐpə:`ten∫n] – підвищений тиск
Pain in the joints [`peǐn ǐn ðə `dзoǐnts ]
– біль у суглобах Rash [`ræ∫]– висип
Pain in the neck [`peǐn ǐn ðə`nek]– біль в шиї To go through the ops [`gəυ`θru: ðə`ops]– пройти через операції

У вас є скарги? Do you have any complaints? Чи мали ви ускладнення на серце? Did you have complications on your heart (kidneys)? 
У пацієнта підвищена температура – The patient ran a temperature.
Чи ви відчуваєте біль при ковтанні? - Does it hurt you when you swallow (breathe)?
Ви вже консультувались у лікаря? – Have you consulted a doctor?
Нас оглянув терапевт. – We were examined by the therapeutist.
Ви намагалися збити температуру? – Did you try to keep the temperature down?
Пацієнт роздягся до пояса. – The patient stripped to his waist.
Терапевт прослухав серце та легені. – The therapist sounded patient’s chest and lungs.
Чи вам вимірювали кров’яний тиск? – Was you blood pressure tested (examined)?
Вам потрібно зробити рентген для діагностики. – You should have your chest x-rayed to determine your diagnosis.
Ви вже зробили аналіз крові? – Have you already had your blood examined?
Лікар надав відпустку хворому через хворобу. – The doctor put a patient on a sick-list.
Він приписав ліки від грипу. – He prescribed medicine for flu.
Вас покладуть до лікарні. – You’ll be hospitalized.
Йому негайно необхідно зробити переливання крові. – He should have his blood transfused immediately.
Вам необхідно полоскати горло двічі на день. – You must gargle your throat twice a day.
Хворому наклали гіпс на ногу. – The patient’s leg was put in plaster-of Paris.
Замовте терміново ліки. – Have your prescription made up.
Вам буде необхідна термінова вакцинація. – You’ll need an urgent vaccination.
У нього були ускладнення після хвороби. – He had a complication after an illness.
У екстренному випадку вас покладуть до нашої лікарні на діагностику. – In case of emergency you will be admitted to our hospital for diagnostics.
Ми зареєструємо вас у реєстраційній. – We’ll register you in the receptionist’s.

Dialogue 1: General Medicine Ward Round.

Doctor O: (staff physician) – Did he ever have a skin rash? Butterfly rash on the face?
Doctor F: (resident in Medicine) – No. He never did have. Actually his physician advised him to avoid exposure to the sun.
Dr. Ost. – Did you repeat the L.E. cell prep. this time? And the serology? 
Dr. F. – Both were positive.
Dr. O. – I think that the diagnosis of SLE (systemic lupus erythematosus) is well established, and I won’t give further comments in regard to the diagnosis.
I think that at the present time, he has exacerbation of the disease.
What kind of treatment is he on?
Dr. F. – He is on aristocort 4 mg every 8 hours and chloroquine 250 mg.daily.

Abbreviations: 

SLE – systemic lupus erythematosus [erǐθə mæ`təυzəs]
LE cell prep – lupus erythematosus cell preparation [prǐpə`reǐ∫n]
Ox – diagnosis [`d a ǐə`gnəυsǐs]
UA – urinalysis [јυrǐ`nælǐsǐs]
Histo – histoplasmosis [`hǐstəυplæz`məυzǐs]
AFB – acid fast bacillus [`æsǐd`fα:st bə`tsǐləz]
PPD – purified protein derivative [`pјu:rǐfa ǐd`proteǐn dǐ`rǐvətǐv]
MEq – milliequivalent [mǐlǐə`kwi:vələnt]
Temp. – temperature [`temprǐt∫ə]

Vocabulary:

Medicine rounds [`medǐkl`ra υndz] – медичні обходи
Serology [sǐ`rolədзǐ]– серологія (серологічний тест на сифіліс)
Anorexia [ənəυ`reksǐə] – втрата апетиту
Lung infiltration [lǎŋ ǐnfǐl`treǐ∫n] – просочування легень
To work up a patient – вивчати хворого для правильного діагнозу
Furmur [`fə:mə]– патологічний ритм серця
Rale [`reǐl]– незвичний шум в легенях
Malignancy [mə`li:gnənsǐ] – ракове захворювання

Dialogue 2. In the Emergency room.

Patient: - Doctor, I have a belly ache. I threw up several times, and I have had several loose BM’s since 5 A.M.
Doctor: - Did you eat anything that was spoiled?
P. – Well, Doc, last night my wife and I went out for dinner, and I’m kind of suspicious that the food was no good.
Dr. – I think you’ve got an acute gastroenteritis. This is nothing to be worried about. Just take these pills, one every four hours and you will be all right. Stay on a soft diet today.

HPI (history of present illness) – історія хвороби
RS (respiratory system) – дихальна система
CV (cardiovascular) – серцево-судинна система
GI (gastrointestinal) – гастрокишкова система
GU (genitourinary) – сечостатева система
MS (musculoskeletal) – м язево-скелетна система


Exacerbation of disease [i: gzəsə:`beǐ∫n əv dǐ`zi:z] – загострення хвороби
Physical Examination [`fǐzǐkl ǐgzəmǐ`neǐ∫n] – обстеження
General appearance [`dзenǐrl ə`pǐərəns] – ознаки життя
Mucous membranes [`mјu:kəυǐs mǐm`breǐns] – слизові оболонки
Tympanic membranes [tǐm`pænǐk mǐm`breǐns] – барабанні мембрани
A tongue blade [`tǎŋ`bleǐd] – лопатка для язика
Palpation of the abdomen [pəlpeǐ∫n əv ði: `æbdəmǐn] – пульпація живота
A navel [`neǐvl]– пупок
Reflexes [rǐ`fleksǐz]– рефлекси
The vibratory sensation [va ǐ`breǐtərǐ sǐn`seǐ∫n] – вібруюча чуттєвість
Blood pressure machine cuff [`blǎd `pre∫ə mə`∫i:n kǎf]. – манжета приладу для вимірювання тиску крові
Rectal examination [`rektl ǐgzəmǐ`neǐ∫n] – ректальне обстеження
Eye ground [`a ǐ`gra υnd] – дно ока
Ophthalmoscope [əf`θælməυ`skəυp]– офтальмоскоп



Dialogue: Doing The Physical Examination.

Dr. Andrews came closer to the patient, and he noted the patient’s general appearance, checked carefully the skin and mucous membranes. With an ophthalmoscope, he visualized the eye grounds, and with the otoscope the tympanic membranes. Then he took the tongue blade and a flashlight.
Dr. A. – Please open your mouth wide and stick out your tongue because I want to check your throat. Say Ah! Ah! (Next he checked the patient’s neck and chest)
Dr. A. – Please take a deep breath and hold it. Now blow your air out and hold it. Don’t breathe now. Breathe in and out through your mouth. Say ninety nine, ninety nine……
(Dr Andrews asked Mr. Cook to lie down on the examining table and performed the palpation of the abdomen).
Dr. A. – Did it hurt anywhere that I touched you? Any tender spot?
Patient – It was sore around the navel.
(After checking the patient’s back, genitals and extremities, he performed the rectal examination. Finally, he took the reflex hammer and tuning fork and checked the reflexes and the vibratory sensation.
Dr. A. – Give me your arm, I want to check your blood pressure. Let me put my blood pressure machine cuff around your arm, and please relax, otherwise your blood pressure will go up. It’s 120 over 70…..That is a normal blood pressure.
Patient – What is your opinion, doc?
Dr. A. – Well, you’re going to have some laboratory tests done starting tomorrow, with blood and urine tests, and x-ray of your stomach. 
I’ll let you know your diagnosis as soon as we have the tests finished.
Training Exercises

Ex.1. Make up your sentences:


The patient 
Has

Had
 Complications (on)

Operations (on)
Disorder of
Complaints (of)
Problems (with) Backache, stomachache, malaise
Vomiting, inflammation, indigestion
Inflammatory condition, malignancy
Heart attack, lung infiltration
Lungs, liver, gall-bladder, kidneys
RS, CV, GU, MS, GI (systems)


Ex.2: Make up you requests:






Would
 



You
 Ease the patient’s pain? Admit the patient for active observation?
Keep the temperature down? Be in charge of medical procedures?
Sound patient’s chest and lungs? Give him his medical certificate?
Test patients blood, urine, feces? Register me at the regitration office?
Refer him to a hospital? Register yourself in our dermatovenerologic dispensary?
Discharge him from a hospital? 


Ex. 3: Suppose you are on call. Write the orders you feel that are necessary for the following problems:

1. Gastric ulcer with bleeding
2. Epileptic convulsion
3. Acute pulmonary edema
4. Abdominal distention with vomiting
5. Pneumonia
6. Patients with headache, insomnia, nervousness, nausea and vomiting.


Ex. 4: Make up your own dialogues using active vocabulary.

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