Nguyen Thi Thanh Hong (Ed)

Tran Thi Quynh Anh, Vu Thi Hao, Nguyen Thi Thuong Huyen,
Nguyen Thi Khanh Ly, Trieu Thanh Nam, Nguyen Thi Hong Nhung,
Dao Thi Hong Phuong, Nguyen Quynh Trang

ENGLISH IN MEDICINE 3

BACH KHOA PUBLISHING HOUSE

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 Editor:

Nguyen Thi Thanh Hong, Ph.D

With authors:

Tran Thi Quynh Anh, M.A

Vu Thi Hao, M.A
Nguyen Thi Khanh Ly, M.A
Trieu Thanh Nam, M.A
Nguyen Thi Hong Nhung, Ph.D
Dao Thi Hong Phuong, M.A
Nguyen Quynh Trang, Ph.D
Nguyen Thi Thuong Huyen, M.A

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 PREFACE
This textbook is carried out to meet the needs of renovating general doctor training.
The purpose of this book is not to teach medicine but its aim is to enhance the medical
students‟ linguistic ability to effectively handle a textbook, a journal or a reference book,
an oral presentation or a classroom lecture, an interactive academic session, an online
resources, a medical topic.
The textbook is designed with the four integrated skills (listening, speaking, reading
and writing) combined with emphasizing other important language areas of grammar,
vocabulary or medical terminology and divided into eight units focusing on some medical
systems such as the endocrine system, the reproductive system and the nervous system;
and some topics relating to taking a history; examinations and investigations; diagnosis and
treatment and administering medication which are structured and sequenced.
Various tasks are employed in each unit to help students familiarize with different
learning situations and promote their interest and motivation, including filling in the
blanks, matching words with their meanings, multiple-choice questions, extracting specific
items of information, matching ideas with paragraphs, true/false, correcting false
statements, completing diagrams, labeling pictures, ordering sentences, joining
ideas/sentences, circling correct information, writing sentences by using clues, rewriting
sentences without changing the meaning, writing doctor‟s notes and emails, splitting
medical terms in their word parts, conducting dialogues, responding to the prompts, oral
presentations etc. Therefore, students will be supplied with the learning strategies and
skills to effectively deal with different tasks and exercises in the course book.
The word list with new words and meanings extracted from each unit is provided at
the end of the book which can help students study easier.
The last thing to be mentioned here is that this is the first edition of this course book,
which means mistakes are unavoidable; therefore, any comments are highly appreciated in
order to have better editions in the future.

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 TABLE OF CONTENT
Goals Skills
1 THE ENDOCRINE Vocabulary Listening
Pages SYSTEM Important medical The endocrine system
1-26 Read and understand words about the How do your hormones
short and simple texts endocrine system work?
referring to the Main roots Reading
endocrine system referring to the The endocrine system
Listen for main ideas and endocrine system
Functions of the endocrine
understand words and system
phrases referring to the Language focus Writing
endocrine system Simple Future Building sentences
Discuss the functions of
Invitation letter
the endocrine system
Speaking
Write an invitation letter
to a medical conference The functions of the
endocrine system
2 THE FEMALE Vocabulary Listening
Pages REPRODUCTIVE Medical words Conversation between a
27-57 SYSTEM and main pregnant woman and a nurse
Listen and understand roots/suffixes/pref What happens if an egg is
simple words and ixes referring to fertilized
phrases referring to female Reading
female reproductive reproductive The female reproductive
system system system
Read and understand Sexually transmitted diseases
short and simple texts Language focus Writing
referring to female The Near Future An email of doctor
reproductive system tense
appointment
Write an email of doctor
Speaking
appointment
The female reproductive
Talk and describe the
system
female reproductive
system

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3 THE MALE Vocabulary Listening
Pages REPRODUCTIVE Vocabulary as Sperm release pathway
58-83 SYSTEM well as main roots Why do my testicles ache?
Read for main ideas and referring to the Reading
details about parts of the male reproductive The male reproductive
male reproductive system system system
Listen for specific Language focus What to know about prostate
information relating to Gerunds and cancer?
the male reproductive Infinitives
What to know about prostate
system
cancer?
Describe the structure
Writing
and functions of the male
reproductive system An appointment reminder
email
Write an email to remind
an appointment with a Speaking
patient The structure of the male
reproductive system
Functions of the male
reproductive system
4 THE NERVOUS Vocabulary Listening
Pages SYSTEM Medical words Basic function of the nervous
84-102 Read for general and and main system
specific information roots/suffixes Conversation between a
relating to the nervous referring to the professor and a medical
system nervous system student
Listen for main ideas and Language focus Reading
details relating to the The past perfect The nervous system
nervous system tense Neurology
Talk about the function Patient chart
of the nervous system
Patient assessment
and other relating organs
Writing
write an apology note or
An apology note or email to
email to the doctor
the doctor
Speaking
The function of the nervous
system and other relating
organs

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5 TAKING A HISTORY Language focus Listening
Pages Read for main ideas and The past perfect Taking a history
103-132 detail information passive Reading
relating to taking a Guide to take a history
history History-taking: Relative
Listen to interviews for importance, obstacles, and
details on taking a techniques
history
Writing
Interview for medical A case history
history
Speaking
Write a case history
Interview

6 EXAMINATONS & Language focus Listening

Pages INVESTIGATIONS Verbs to give Giving instructions
133-158 Read and understand polite request Blood Test: Immunoglobulin
physical examination and phrasal A (IgA)
some investigations instructions to Explaining gastroscopy
Give instructions to patients Reading
patients as well as Physical examinations
explain and reassure
Taking blood
patients about the
Investigations – Common
investigation
blood tests
Listen for instructions,
Some useful information
blood tests and
about gastroscopy
gastroscopy
Writing
Describe the results of
the biochemistry and A desription of the results of
haematology lab report the biochemistry and
in basic sentences haematology lab report
Speaking
Giving instructions
Explaining and reassuring
about the investigation

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7 DIAGNOSIS & Language focus Listening
Pages TREATMENT Expressions used Explaining a diagnosis
159-184 Read and understand between doctors Medical treatment
medical terms relating to in discussing a Physiotherapy
diagnosis and treatment diagnosis Reading
Listen and take notes Giving advice Diagnostic medicine
about treatment about treatment Diagnostic process
Explain a diagnosis; Surgical treatment
discuss and give advice Writing
about the treatment An email to inform about an
Write an email to inform appointment for treatment
about an appointment for
Speaking
treatment
Explaining diagnosis
Advising about treatment
8 ADMINISTERING Language focus Listening
Pages MEDICATION Phrasal verbs in A conversation between a
185-214 Understand srud charts medical context doctor and a nurse
and abbreviations Verbs to instruct a Patient medication
Explain benefits and side patient on how to A drug chart
effects use medication Benefits and side effects
Talk about medications Verbs to explain Reading
Complete a clinical how often to take Medical history
incident report medication A doctor‟s report
Using pharmacology
references
Speaking
Information about patients‟
medication
Writing
Clinical incident reporting
Abbreviation writing
exercises
Pages
TAPESCRIPTS
215-236
Pages NEW WORDS
237-248
Page APPENDIX
249-257
Page
REFERENCES
258

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 Unit 1
THE ENDOCRINE SYSTEM

Objectives: After the lesson, students will be able to:

1. List important medical words about the endocrine system and have a thorough
grasp of main roots referring to the endocrine system andapply Simple Future tense
flexibly into four basic skills in medical contexts;
2. Listen for main ideas and understand words and phrases referring to the
endocrine system;
3. Read and understand short and simple texts referring to the endocrine system;
4. Discuss the functions of the endocrine system;
5. Write an invitation letter to a medical conference.

GETTING STARTED
1. Work in pairs. Match the words with their pronunciation, and then practise
pronouncing these words.
0. organ A. /ˈhɔ:məun/

1. endocrine B. /həʊmiəʊˈsteɪsɪs/

2. hormone c. /pærəˈθaɪrɔɪd/

3. homeostasis d. /pɪˈtʃuːɪtəri/

4. pituitary e. /ˈendəʊkrɪn/

5. parathyroid f. /ˈɔ:gən/

2. Close your book. Work in groups of four and write down any words you can
remember from Task 1. What do these words refer to?

READING

Reading 1: The endocrine system

The endocrine system is made up of glands that produce and secrete hormones.
These hormones regulate homeostasis, reproduction, growth and development and

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metabolism. The hormones are released directly into the bloodstream and travel elsewhere
in the body to target organs, upon which they act.
Hormones are chemical messengers created by the body. They transfer information
from one set of cells to another to coordinate the functions of different parts of the body.
Each hormone‟s shape is specific and can be recognised by the corresponding target cells.
The binding sites on the cells of target organs are called hormone receptors. Many
hormones come in antagonistic pairs that have opposite effects on the target organs. For
example, insulin andglucagon have opposite effects on the liver‟s control of blood sugar
level. Insulin lowers the blood sugar level by instructing the liver to take glucose out of
circulation and store it, while glucagon instructs the liver to release some of its stored
supply to raise the blood sugar level.
The endocrine system is regulated by feedback loops to maintain balance and
homeostasis. For the hormones that are regulated by the pituitary gland, a signal is sent
from the hypothalamus to the pituitary gland in the form of a “releasing hormone”, which
stimulates the pituitary gland to secrete a
Pineal body
“stimulating hormone” into the bloodstream. The Pituitary Hypothalamus
stimulating hormone then signals the target gland
Parathyroids Thyroid gland
to secrete its hormone. As the level of this
hormone rises in the bloodstream, the Thymus
Adrenal gland
hypothalamus and the pituitary gland shut down glands

secretion of the releasing hormone and the Pancreas

stimulating hormone, which in turn, slows the Ovaries

secretion by the target gland. This feedback

system results in stable blood concentrations of the
hormones that are regulated by the pituitary gland.
Testicles
The major glands of the endocrine system include
the hypothalamus, pituitary, thyroid, parathyroids,
adrenals and gonads (ovaries and testes). The Figure 1.1. The endocrine system.
pancreas is also part of this system as it has a role
in hormone production.

1. Answer the questions below. Then compare your answers with those of a partner.
0. What is the endocrine system comprised of?
The endocrine system is comprised of glands that produce and secrete hormones.
1. Where are the hormones released to?

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 ___________________________________________________________________
2. The hormones travel to target organs, don‟t they?
___________________________________________________________________
3. What are hormones?
___________________________________________________________________
4. How can hormone‟s shape be recognised?
___________________________________________________________________
5. What is meant by the term “antagonistic pairs” of hormones?
___________________________________________________________________
6. Why is the endocrine system regulated by feedback loops?
___________________________________________________________________
7. The major glands of the endocrine system include adrenals and gonads, don‟t they?
___________________________________________________________________
2. Work in pairs and decided the following sentences are “True” or “False”.
0. _True__. The endocrine system is composed of glands that produce and secrete
hormones.
1. ___ Hormones transfer information from one set of organs to another to coordinate
the functions of different parts of the body.
2. ___ Hormone receptors are the binding sites on the cells of target organs.
3. ___ Insulin and glucagon have similar effects on the liver‟s control of blood sugar
level.
4. ___ Releasing hormone stimulates the pituitary gland to secrete a “stimulating
hormone” into the bloodstream.
5. ___ The major glands of the endocrine system include the hypothalamus,
pituitary, thyroid, parathyroids, adrenals and gonads.
3. Work in pairs. Use the given words to label the diagram.
thyroid gland testicles pineal gland pancreas
hypothalamus ovaries parathyroids thymus gland
adrenal glands pituitary gland

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 10
1
9

8 2

7 3

4
5

Figure 1.2. The endocrine system.

Reading 2: Functions of the Endocrine system

The primary function of the endocrine
system is to produce specialized chemicals
Pineal
called hormones that directly enter the Pituitary body
bloodstream and travel to specific tissues or
Thyroid gland
organs of the body called targets. Some
hormonal actions cause short-term changes, Parathyroid glands

such as a faster heartbeat or sweaty palms

Adrenal
during a panic situation. Others control (Suprarenal)
gland
long-term changes, such as bone and
muscle development. Still other hormones Pancreatic
islets
help maintain continuous body functions,
such as a balance of body fluids, and a
normal metabolism. The endocrine system
also maintains an internal state of
Ovary
equilibrium in the body (homeostasis) so all (Female
) Gonads
body systems function effectively. The Testis
(male)
ductless glands of the endocrine system
include the pituitary body, thyroid gland,
parathyroid glands, adrenal gland, Figure 1.3. Locations of major
endocrine glands.
pancreatic islets, pineal, and thymus glands
as well as the ovary andtestis.
Although hormones travel throughout the body in blood and lymph, they affect only
the target tissues or organs that have specific receptors for the hormone. Once bound to the
receptor, the hormone initiates a specific biological effect. For example, thyroid-stimulating

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hormone (TSH) binds to receptors on cells of the thyroid gland causing it to secrete
thyroxine, but it does not bind to cells of the ovaries because ovarian cells do not have
TSH receptors. Some hormones, such as insulin and thyroxine, have many target organs.
Other hormones, such as calcitonin and some pituitary gland hormones, have only one or a
few target organs. In general, hormones regulate growth,
metabolism, reproduction, energy level, and sexual
characteristics.

Pituitary gland
The pituitary gland, orhypophysis, is a pea-sized
organ located at the base of the brain. It is known as the
master gland because it regulates many body activities
and stimulates other glands to secrete their own specific Pituitary

hormones. The pituitary gland consists of two distinct

portions, an anterior lobe (adenohypophysis) and a
posterior lobe (neurohypophysis). The anterior lobe,
triggered by the action of the hypothalamus, produces at Figure 1.4. Pituitary gland.
least six hormones. The posterior lobe stores and secretes
two hormones produced by the hypothalamus: antidiuretic hormone (ADH) and oxytocin.
These hormones are released into the bloodstream as needed.

Thyroid gland
The thyroid gland, an H-shaped organ, is the
largest gland of the endocrine system located in the
neck just below the larynx, this gland is composed of
two large lobes that are separated by a strip of tissue
called an isthmus. Thyroid hormone (TH) is the body‟s
major metabolic hormone. TH increases the rate of
oxygen consumption and, thus, the rate at which
carbohydrates, proteins, and fats are metabolized. TH is
Normal
actually two active iodine-containing hormones: thyroid

thyroxine (T4) and triiodothyronine (T3). T4 is the

Figure 1.5. Thyroid gland.
major hormone secreted by the thyroid; most T3 is
formed at the target tissues by conversion of T4 to T3. Except for the adult brain, spleen,
testes, uterus, and the thyroid gland itself, thyroid hormone affects virtually every cell in
the body.TH also influences growth hormone and plays an important role in maintaining
blood pressure.

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 Parathyroid glands
The parathyroid glands consist of at least four
separate glands located on the posterior surface of the
lobes of the thyroid gland. The only hormone known
to be secreted by the parathyroid glands is
parathyroid hormone (PTH) which helps to regulate Parathyroid
glands
calcium balance by stimulating three target organs: Thyroid
bones, kidneys, and intestines. Because of PTH gland

stimulation, calcium and phosphates are released

Figure 1.6. Parathyroid glands.
from bones, increasing concentration of these
substances in blood.
Thus, calcium that is necessary for the proper functioning of body tissues is available
in the bloodstream. At the same time, PTH enhances the absorption of calcium and
phosphates from foods in the intestine, causing a rise in blood levels of calcium and
phosphates. PTH causes the kidneys to conserve blood calcium and increase the excretion
of phosphates in urine.

Adrenal glands

Adrenal gland The adrenal glands are paired organs covering the
superior surface of the kidneys. Because of their location,
the adrenal glands are also known as suprarenal glands.
Each adrenal gland is divided into two sections, each having
its own structure and function. The outer adrenal cortex
makes up the bulk of the gland and the adrenal medulla
makes up the inner portion. Although these regions are not
Kidney sharply divided, they represent distinct glands that secrete
different hormones.
Figure 1.7. Adrenal glands.

Pancreas
The pancreaslies inferior to the stomach in a bend of the
duodenum. It functions as an exocrine and endocrine gland. In
its exocrine role, it carries digestive secretions from the
pancreas to the small intestine through a large pancreatic duct.
The digestive secretions assist in the breakdown of proteins,
starches, and fats in the small intestine. In its endocrine role, the
pancreas secretes two other hormones through the islets of
Langerhans: glucagon, which is produced by the alpha cells, Figure 1.8. Pancreas.

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and insulin, which is produced by the beta cells. Both hormones play important roles in
regulating blood glucose (sugar) levels.

Pineal gland

The pineal gland, which is shaped like a pine

cone, is attached to the posterior part of the
third ventricle of the brain. Although the exact functions
of this gland have not been established, there is
evidence that it secretes the hormone melatonin. It is
believed that melatonin may inhibit the activities of the
Figure 1.9. Pineal gland. ovaries. When melatonin production is high, ovulation
is blocked, and there may be a delay in puberty.
1. Work in groups of four. Read the text again and complete the map below.

The endocrine
system

2. Work in pairs and answer the following questions

1. What is the primary function of the endocrine system?
A. to make up the bulk of the gland. B. to carry digestive secretions.
C. to produce specialized chemicals. D. to make up the inner portion.
2. What can some hormonal actions cause?
A. short-term changes B. long-term changes
C. pancreas cancer D. blocked ovulation
3. What are not included in the ductless glands of the endocrine system?
A. Prostate B. Testes

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 C. Thymus glands D. Pancreatic glands
4. What can hormones affect?
A. the target tissues or organs B. ovulation
C. puberty D. melatonin
5. Which gland is located at the base of the brain?
A. pituitary gland B. thyroid gland
C. thymus gland D. pineal gland
6. How many hormones does the anterior lobe produce?
A. at least six B. six
C. not more than six D. at least four
7. Which is the biggest gland of the endocrine system?
A. pituitary gland B. thyroid gland
C. pineal gland D. adrenal gland
8. What is the function of pancreas?
A. to produce specialized chemicals. B. to secrete the hormone melatonin.
C. to carry digestive secretions. D. to make up the bulk of the gland.
9. What is the function of pineal gland?
A. to increase the excretion of phosphates in urine.
B. to regulate calcium balance.
C. to represent distinct glands.
D. to produce specialized chemicals.
10. What would happen when melatonin production is high?
A. to balance the body fluids.
B. to produce specialized chemicals.
C. to maintain continuous body functions.
D. to maintain an internal state of equilibrium in the body.

3. Work in pairs and complete the sentences using the words in the box.
blood calcium parathyroid calcium balance
absorption posterior surface blood
(1)___________ are small endocrine glands in the (2)___________ of humans with
at least four parathyroid glands, located on the back of the thyroid gland in variable

15
locations. The parathyroid gland produces and secretes parathyroid hormone (PTH) in
response to a low (3)___________, which plays a key role in regulating the amount of
calcium in the blood, within the bones and increasing concentration of these substances in
(4)_________. Thus, calcium that is necessary for the proper functioning of body tissues is
available in the bloodstream. At the same time, the (5)_________of calcium and
phosphates is enhanced by PTH from foods in the intestine, causing a rise in blood levels
of calcium and phosphates. PTH causes the kidneys to conserve (6)_________and increase
the excretion of phosphates in urine.

4. Work in pairs and write down the words you could remember from the text
basing on the suggested letters.
1. P___________________ glands 5. T___________________ gland
2. P___________________ gland 6. T___________________ glands
3. A___________________ glands 7. P_____________________
4. P___________________ gland 8. T_____________________

WORD PARTS AND TERMS

Read the table of roots pertaining to the endocrine system and complete the
following exercises.

Table 1.1. Word roots related to the Endocrine system

Root Meaning Example Definition of example

Endocrin/o endocrine glands endocrinopathy any disease of the endocrine

or glands
system

Pituitar pituitary gland, pituitarism condition caused by any

hypophysis disorder of pituitary function

Hypophys pituitary gland, hypophyseal pertaining to the pituitary gland

hypophysis

Thyr/o thyroid gland thyrotropic acting on the thyroid gland

Thyroid/o

Parathyr/o parathyroid gland parathyroidectomy excision of a parathyroid gland

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Parathyroid/o

Adren/o adrenal gland, adrenergic activated (erg-) by or related to

epinephrine epinephrine (adrenaline)
Adrenal/o

Adrenocortic/o adrenal cortex adrenocortical pertaining to the adrenal cortex

Insul/o pancreatic islets insulinoma tumor of islet cells

Thym/o thymus gland thymoma tumor of the thymus gland

Crin/o secrete endocrinology study of endocrine glands (and

their functions)

1. Write a word for each of following definition.

1. excision of a parathyroid gland. ______________
2. inflammation of the thyroid gland. ______________
3. surgical removal of parathyroid gland. ______________
4. enlargement of the adrenal gland. ______________
5. any disease of the thyroid gland. ______________
6. condition of over activity of the thyroid gland. ______________
7. condition of underactivity of the parathyroid gland ______________
8. condition of underactivity of the adrenal gland ______________
9. condition of underactivity of the adrenal cortex ______________
10. condition of overactivity of the pituitary gland (use pituitar) ______________
11. physician who specializes in study of the endocrine system. ______________
12. incision into the thyroid gland. ______________
13. any disease of the adrenal gland. ______________
14. inflammation of the adrenal gland. ______________
15. pertaining to (-ar) the pancreatic islets. ______________

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 16. removal of the adrenal gland ______________
17. enlargement of the thyroid ______________

2. Define each of the following words.

1. endocrinology _____________________________________

2. hypophysectomy _____________________________________

3. thyrolytic _____________________________________

4. hyperadrenalism _____________________________________

5. insulitis _____________________________________

* Note: Words for conditions resulting from endocrine

dysfunctions are formed by adding the suffix -ismto the
name of the gland or its root and adding the prefix hyper-or hypo- for
overactivity or underactivity of thegland.

3. Use the elements listed below to build medical words. Some elements can be
used more than once.
Roots Suffixes Prefixes
acr/o -crine a-
adrenal/o -dipsia endo-
calc/o -ectomy exo-
glyc/o -emia hyper-
kal/i -graphy hypo-
thym/o -itis lith/o
-lysis pancreat/o-
-megaly thyr/o
-oma
poly-
1. tumor of the thymus _______________________

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 2. destruction of glucose (by enzymes) _______________________
3. much thirst _______________________
4. removal of a stone from the pancreas _______________________
5. (glands that) secrete within (the blood) _______________________
6. without thirst _______________________
7. (glands that) secrete outward (through ducts) _______________________
8. blood condition of excessive sugar _______________________
9. destruction of the thymus _______________________
10. enlargement of the thyroid gland _______________________
11. inflammation of the adrenal glands _______________________
12. blood condition of below (normal) calcium _______________________
13. blood condition of excessive potassium _______________________
(an electrolyte)
14. enlargement of the extremities _______________________
15. process of recording (x-ray) the pancreas _______________________

LANGUAGE FOCUS
Language focus: Simple Future tense
• We use Simple Future tense when we decide to do something at the time of speaking
(remember that in this situation, you cannot use the simple present):
e.g. Doctor Lee: Have you called the radiologist?
Ms. Linda (a nurse): No, I haven’t had time to do it.
Doctor Lee: OK. Don’t worry. I will do it.
• We use Simple Future tense when offering, agreeing, refusing and promising to
USAGES

do something, or when asking someone to do something:

e.g. - Offering: That patient seems difficult to deal with. I will help you.
- Agreeing: Dr. Lee: Can I have my book of Hormones and the Endocrine
system written by Bernhard Kleine back?
Dr. Jo: Of course. I will bring it to you tomorrow morning.
- Asking: Will you help me to transport this patient to the Surgery?
- Refusing: Don’t ask to use this microscope. I won‟t allow you to use it.
- Promising: I promise I will send you a copy of the latest article on AIDS

19
 as soon as I get it.
* Note:
• We do not use will to say what someone has already decided to do or arranged
to do (Be going to or Present continuous tense are used instead).
e.g. I am having an appointment with Dr. Lee this Friday.
• We use Simple Future tense with expressions such as: probably, I am sure,
I bet, I think, I suppose, I guess.
e.g. I will probably attend the Conference of Hormones and the Endocrine
system in California.
You should listen to Dr. Higgins giving a conference. I am sure you will love it.
I bet the patient will recover soon.
I guess I will see you in the next annual meeting.
• Positive: Subject + will + verb (infinitive without to)
e.g. I think my parent will visit my uncle in the hospital tomorrow morning.
• Negative: Subject + will not (won‟t) + verb (infinitive without to)
FORM

e.g. You should give up smoking or your health won‟t be better.

• Interrogative: Will + subject + verb (infinitive without to)?
e.g. Will you design some kinds of exercises for this patient?
* Note: Shall is often used in questions to make offers and suggestions.
e.g. Shall we go to the meeting next week?
1. Work in groups of four and categorize the following sentences into different
uses of Simple Future tense.
0. I think I will do a simple blood test to check your thyroid’s
hormone levels.  Simple Future tense with “I think”
1. I am sure drinking coffee will badly affect your health. _____________
2. I think when an insulinoma forms in your pancreas, it will _____________
continue to produce insulin.
3. A: I don‟t know the meaning of “adrenergic”. _____________
B: Don‟t worry. I will help you to check the meaning in
my dictionary.

20
 4. Dr. Lee will probably take part in the local rescue team. _____________
5. Will you deliver these files to the Cardiology Department? _____________

2. Listen to Mia talking about things she will do, and complete the sentences.
0. I will move to Europe.
1. I will ______an exchange student.
2. I will ______in France first.
3. I will ______to Spain.
4. I will ______language.
5. I will likely______trouble.
6. I will______my best!

3. Listen to Mia again and tick  on the correct answer. Then compare your
answers with a partner.
0. What will happen soon?
A. She will work in Europe. B. She will quit her job.
C. She will make friends. D. She will change her job.
1. How long will she live in France?
A. For two months B. For one year
C. For six months D. For two years
2. How many languages will she study?
A. One B. Two C. Three D. Four
3. Who will come out and visit her around New Year?
A. Her best friend B. Her boyfriend
C. Her family D. Her classmates
4. Where will she probably take a trip to?
A. France B. Spain C. Greece D. Italy
5. What will she have problems doing?
A. Buying food B. Making friends C. Finding the ways D. Studying
6. Who will not have time to visit Mia?
A. Her family B. Her boyfriend C. Her classmates D. Her best friends

21
 4. Match the beginnings and ends of these sentences
Example: 1f
1. Will Mrs Andrew a. and will look at you as soon as he
can.

2. What will you do if b. if you diet and take exercise

3. This will only lower your blood c. I‟m sure everything will
pressure be OK.

/.4. Don‟t worry… d. the treatment doesn‟t work?

5. Mr Washid has cancelled his e. when she‟s discharged.
appointment, so
6. Mrs Fontana will need f. go to room three please?
7. Dz Zappa is on his rounds g. a new dressing every two days.
8. I‟ll collect Mum in the car h. He won‟t be seeing you this
afternoon.
5 Use these verbs with will, won’t, or shall to complete the sentences.
need know take speak see die
make give
will make full recovery.
1. We feel sure your father ______________a
mmakemak
2. I‟m afraid I don‟t think your father _____________your name.
3. I think he _____________ae new pair of spectacles soon.
4. I_____________you back to the wards now.
5. _____________Dr Thompson_____________Mrs Detoit this afternoon?
6. I_____________you any more of these tablets.
7. _____________I_____________to the doctor for you?
8. No, Mrs Fitzpatrick, you‟re fine – you _____________tonight.
6. Work in pairs. Use Simple Future tense and suggested words to complete the
following sentences about the Future of Medicine.

22
 0. Data science will change the way doctors do their jobs.
1. Personalised medicine / become / useful /
treating every disease.
_____________________________________
_____________________________________
2. Personalised medicine / spawn / new drugs /
which / capable of / hit / multiple health problems at
once.
______________________________________________________________
3. Personalised medicine / reduce medical side effects, / or help / get rid / them
completely._________________________________________________________
4. Blood samples / stronger alternatives to biopsies in the prediction / response rate to
immunotherapy.
______________________________________________________________
5. Robots / play / roles of Healthcare Practitioners.
_______________________________________________________________

7. Work in pairs and answer the following questions.

+ Which above sentences do you like most?
+ Which two sentences above can you remember?
+ What will the medicine be like in the future?

LISTENING

Listening 1: The endocrine system

1. Listen and number the words you hear.

0. body

____ internal state ___internal temperature ___ ability

___ homeostasis __ endocrine system ___ shivers

2. Listen to the first part of the talk and fill in the gaps in the text below.

23
 Our body is always in flux: when we are __0. cold__, our body shivers, when we
are hot, our body sweats. Our body engages in these activities to keep our internal
(1)______ constant. This is an example of homeostasis which is defined as the (2)_____of
the body to maintain a constant internal state. One major way the body maintains
homeostasis is through the (3)______. The endocrine system is the system of glands that
produce hormones to (4)____ and control body activities. The endocrine system controls
a number of important (5)_______ throughout the body including growth and
development, (6)_______, and homeostasis. There are many different hormones in the
body, and each is responsible for different functions. Estrodiol, testosterone, (7)_______,
growth hormone, and (8)_______ are just a few examples of hormones. Although they are
involved in different functions of the endocrine system, hormones work in in a similar
manner.

1. _______________ 2. _______________ 3. _______________

4. _______________ 5. _______________ 6. _______________
7. _______________ 8. _______________

3. Listen to the last part of the talk and circle on the best answer.
1. Which detects a change in the body’s internal environment?
A. hormones B. kidney C. a gland D. insulin
2. How can hormones activate the target cells?
A. sends a signal. B. amplifies the volume.
C. binds to specific receptors. D. produces signals.
3. What is negative feedback?
A. the temperature in the house.
B. a message to the furnace.
C. the food is digested.
D. allows a system to self regulate a response or output.
4. What can the pancreas sense and release?
A. increased blood glucose/ insulin into blood

24
 B. insulin into blood/ increased blood glucose
C. blood glucose
D. insulin
5. What are hormones?
A. glands B. receptor specific C. feedback D. amplifiers

4. Work in groups of four and complete the chart below. How much do you
remember from the information in 3? Listen and check.

The glands of the A gland (2)______ a

endocrine system change in the body, and
START!
(1)____ to the body in (3)_______ a hormone.
a similar manner

A hormone‟s signal is Hormones through the

(6)________. blood. Hormones are
(5)____ specific

hormones are
(7)________ by
FINISH!
negative feedback.

5. Work in pairs and discuss the five questions in 3. Then, prepare a short talk
to your class.
Example: Hello everyone, I would like to share with you some information related
to_____________

Listening 2: How do your hormones work?

1. Look at the diagram below and fill in the boxes with suggested letter.
Example: 0. O__________: Organ

25
 E__________cell R____________

H__________

B______s______

T__________cell

2. Listen and say the following sentences are True or False. Put a letter T or F
next to the number of each sentence.
1. ____ Our bodies undergo a series of extraordinary metamorphoses: we grow,
experience puberty, and many of us reproduce.
2. ____ The endocrine system regulates everything from sleeping to the rhythm of
the beating heart.
3. ____ The endocrine system relies on interactions of glands, metabolism, and cell
receptors.
4. ____ Hormone-producing glands include seven in the brain, and three in the rest
of the body.
5. ____ The glands extract ingredients to manufacture dozens of hormones from a
network of blood vessels.
6. ____ Each hormone needs to locate a set of target cells in order to bring about a
specific change.
7. ____ The receptors recognize specific hormones after they waft by, and bind to them.
8. ____ Hormone-receptor combination triggers a range of effects that either increase
or decrease specific processes outside the cell.
9. ____ By exposing millions of cells at a time to hormones in carefully-regulated
quantities, the endocrine system drives large-scale changes in the brain.
10. ____ The thyroid, triiodothyronine and thyroxin travel to most of the body‟s
cells.

26
SPEAKING
1. Think about some parts of the endocrine system and write down at least 6
related words. Then share your words with a partner.
Example: parathyroid glands
1._____________ 2._____________ 3._____________
4._____________ 5._____________ 6._____________
7._____________ 8._____________ 9._____________
2. Work in groups of four and discuss the functions of the endocrine system.
Example:
The endocrine systemis made up of glands that produce and secrete hormones.
Hormones ___________________________________________
The pituitary gland_____________________________________
The thyroid gland______________________________________
The parathyroid glands__________________________________
The adrenal glands_____________________________________
The pancreas_________________________________________
The pineal gland______________________________________
3. Work in groups of four. Prepare a short talk of about 2 minutes basing on task 2.
Good morning / afternoon everyone, on behalf of my group, I would like to
_________________________________

WRITING
Writing an invitation letter:
1. Work in pairs and put a tick  on the box of the formality and informality of
the following features.
Formal Informal

0. use of contractions, e.g. I’m 

1. no contractions, e.g. I am__

2. passive constructions

3. phrasal verbs

4. longer words instead of shorter, more common ones,

27
 e.g. information (not facts).

5. direct questions, e.g. can you___?

6. missing out words, e.g. subject pronouns

7. use of imperatives

2. Read the following samples and underline the formal / informal features.
Sample 1

Dear Mr. McLennan, Phrasal verb

REF: INVITATION FOR A CONFERENCE
Greetings to you. We cordially invite you to our national conference that will take
place at the Sunshine Hotel conference room 25th of October at 9 a.m.
The conference will include, but not limited to: Introduction to
new opportunities in the Northern provinces of our country. This will
help you scale into the untapped potential into populous provinces like
Thai Nguyen. You’ll be shown how to raise people’s awareness of the
health of the endocrine system on social media platforms – this would
attract more people into your social health programs. You’ll also be
given the chance to learn how to properly venture into real estate.
By attending this conference, you’ll have the chance to grow both knowledge of your
major and also communication skills. Your presence at our conference will be much
appreciated. Would you like to come?
Our best regards,
Signature
Conference’s representative

Sample 2

Dear Olga,
Two weeks from today, the Diabetes Conference takes place and I don’t want you to miss
it!
The event is all day and free to hundreds people in our area.
This year, all presentations tie together the target in how to prevent and control
diabetes. Doctor Matthias Schlensak, one of the best endocrinologists in the world has
been invited to be the main speaker of this special event.
Meet our supporters and register by 5th May. And of course, let me know if you have any
questions!

28
 Look forward to seeing you at the event!
Conference’s representative

3. Read the sample letters again and underline the phrases used to begin and
end an email. Would you want to change them?
Beginning: __________________________________________________________
Ending: ____________________________________________________________
4. Read the sample letters again and work in groups of four to find out any
useful expressions for writing an invitation email to a conference.
e.g. By attending this conference, you‟ll have the chance to_________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
5. You are going to run a conference about the endocrine system and diabetes.
Work with a partner and study the information below. Try to remember as much
information as you can.

3rd Local Conference on Diabetes and

Endocrinology
Theme:
Innovation methods to prevent Diabetes and
Endocrinology Disorders
Main speakers: Doctor Warren Lee

Time: 8 a.m, August 25th – 27th, 2020 Avenue: The second floor of the town hall

6. Write an invitation email to your colleagues using the given information. You
should write in about 80 – 100 words.

29
FURTHER READING

The pancreas
The pancreas is a tapered gland that lies across the back of the abdomen, behind the
stomach. The broadest part (head) is on the right-hand side, the main part (body) tapers
from the head and extends horizontally and the narrowest part (tail) is on the left-hand side
near the spleen.
The pancreas has both a digestive and a hormonal function. It mostly consists of
exocrine tissue, which secretes digestive enzymes into the duodenum via the pancreatic
duct. Also secreted is sodium bicarbonate, which neutralizes stomach acid entering the
duodenum. The pancreas also contains groups of endocrine cells called the islets of
Langerhans, which secrete the hormones insulin and glucagon. These hormones regulate
the levels of glucose in the blood.
Glucagon tells the liver to take carbohydrate out of storage to raise a low blood sugar
level, while insulin sends signals to the liver prompting it to take excess glucose out of
circulation to lower a blood sugar level that is too high. If a person‟s body does not make
enough insulin and/or there is a reduced response in the target cells of the liver, then the
level of blood sugar rises. When this is out of control, it results in diabetes mellitus.
If diabetes mellitus remains untreated, a person will have chronically high levels of
blood glucose in their body. This is called hyperglycaemia and is characterised by
polydypsia (excessive thirst), polyuria (excessive urination), fatigue, slow healing of
wounds and impaired vision. In extreme cases it can lead to coma and death.
It is important to monitor and administer appropriate doses of insulin when treating
diabetes mellitus. This is because a sharp fall in the level of blood glucose, known as
hypoglycaemia caused by excessive insulin administration, starves the brain of its main
metabolic fuel and can also lead to coma and death. Usual symptoms of hypoglycaemia
include increased appetite, headaches, muscle weakness, loss of concentration and blurred
vision.
Diabetes mellitus, which affects about 7% of Americans and has a strong hereditary
component, is caused either by insufficient secretion of insulin or resistance of body cells
to the effects of insulin. As a result, glucose cannot enter most cells, so blood sugar
remains high and glucose appears in an abundant urine. Because glucose is unavailable as
fuel, the body‟s cells metabolize fats, whose acidic breakdown products, ketones,
accumulate in the blood. Left untreated, the increased urination depletes the body of water
and electrolytes, and the ketone acidosis depresses almost all physiological functions and
leads to coma.

30
 Of the two types of diabetes mellitus, the more serious is type 1 diabetes (formerly
called insulin-dependent diabetes), which develops suddenly, usually before age 15.
Because an autoimmune response destroys the insulin-secreting beta cells in the pancreas,
insulin must be administered to type 1 diabetics several times daily to control blood
glucose levels. After 20-30 years with the disease, most type 1 diabetics develop health
threatening complications: The high level of lipids in their blood predisposes them to
atherosclerosis (hardening of the arteries), and the excessive sugar in their body fluids
disrupts capillary functions. Research on type 1 diabetes has demonstrated that regular
exercise and careful management of diet and blood sugar level can delay the onset of
complications.
Type 2 (non-insulin-dependent) diabetes develops more slowly (usually appearing
after age 40), and accounts for over 90% of all cases of diabetes. Most type 2 diabetics
produce some insulin, but their cells have a reduced sensitivity to the effects of insulin.
More easily managed than type 1, type 2 diabetes can usually be controlled by dietary
modification (such as losing weight and avoiding high-calorie, sugar-rich foods) and
regular exercise. If such measures fail, the condition is treated with insulin injections or
oral medications that raise blood insulin levels or lower blood glucose levels.
Type 2 diabetes is increasing at an alarming rate in the United States. The increased
incidence of this disease is associated with decreased activity levels and increased rates of
obesity. Regular exercise has been found not only to help control type 2 diabetes but also
to decrease the likelihood of its development. One component of this link between exercise
and blood sugar regulation is a hormone produced by osteoblasts, the bone- producing
cells. Osteoblast activity increases in response to weight-bearing exercise. Osteocalcin,
a hormone secreted by osteoblasts, stimulates pancreatic secretion of insulin and stimulates
fat cells to secrete a hormone that increases the insulin sensitivity of cells. Thus, increased
activity of osteoblasts also functions to control blood sugar levels.
1. Answer the questions below. Then compare your answers with those of a
partner.
1. What shape are the adrenal glands?
_______________________________________________________________
2. What are the two parts of each adrenal gland called?
_______________________________________________________________
3. What covers the adrenal glands?
_______________________________________________________________
4. What does the adrenal cortex produce to stabilize blood pressure?
_______________________________________________________________

31
 5. What are the two functions of hydrocortisone?
_______________________________________________________________
6. Where does ACTH originate from?
_______________________________________________________________
7. Which hormones does the adrenal medulla secrete?
_______________________________________________________________
8. What does the adrenal medulla respond to?
_______________________________________________________________
2. Match one of the definitions (1-10) with one of the words in bold in the text on
the pancreas.
1. The organ in the body that removes dead red cells from the blood and produces
white ones. ______________
2. narrower at one end. ______________
3. The first part of the small intestine. ______________
4. Proteins that regulate the rate of a chemical ______________
reaction in the body.
5. To give someone a drug or medical treatment. ______________
6. Seriously. ______________
7. Reaction. ______________
8. Relating to the breaking down of food in the body. ______________
9. Not fully functioning. ______________
10. A substance found in foods such as sugar, bread, ______________
cereals and potatoes.
3. Determine the meaning of the following vocabulary as used in the information
on the pancreas.
islets of Langerhans ______________________________________________
glucose ________________________________________________________
insulin _________________________________________________________
glucagon _______________________________________________________
diabetes mellitus ________________________________________________
hyperglycaemia __________________________________________________
hypoglycaemia ___________________________________________________
metabolic fuel ___________________________________________________

32
 4. Don’t look back the text of Pancreas. Work in pairs and complete the
following paragraph.
The pancreas has both a 0. digestive and a hormonal function. It includes exocrine
tissue, which secretes digestive enzymes into the duodenum via the (1)_______ duct. The
pancreas also contains groups of (2)_______ cells called the islets of Langerhans, which
secrete the hormones insulin and glucagon. These hormones regulate the levels of
(3)_______in the blood. Glucagon tells the (4)_______ to take carbohydrate out of storage,
while insulin sends (5)_______ to the liver prompting it to take excess glucose out of
circulation to lower a blood sugar level. If a person‟s body does not make enough insulin,
then the level of blood sugar rises. So, (6)________will happens. Type 1 diabetes develops
suddenly, usually before age (7)________. Because an autoimmune response destroys the
insulin-secreting beta cells in the (8)________, insulin must be administered to type 1
diabetics several times daily to control blood (9)________ levels. Type 2 diabetes usually
develops after age (10)_______, and accounts for over 90% of all cases of diabetes.

33
 Unit 2
THE FEMALE REPRODUCTIVE SYSTEM

Objectives: After the lesson, students will be able to:

1. Apply the near future, medical words and main roots/suffixes/prefixes referring to
female reproductive system in listening, speaking, reading and writing;
2. Listen and understand simple words and phrases referring to female reproductive
system;
3. Read and understand short and simple texts referring to female reproductive
system;
4. Write an email of doctor appointment;
5. Talk and describe the female reproductive system.

GETTING STARTED
1. What parts of the female reproductive system do you know?
2. Fill in the blanks with the words given in the table below.

Fallopian Tube
(1)
Cervix
(2)
Fimbriae
(3)
Uterus

Fundus

Ovary
(4)
Uterine Tube
(5)
Vagina

Figure 2.1. The Female Reproductive System Diagram.

34
READING

Reading 1: The female reproductive system

What is reproduction?
Reproduction is the process by which organisms make more organisms like
themselves. In the human reproductive process, two kinds of sex cells, or gametes, are
involved. The male gamete, or sperm, and the female gamete, the egg or ovum, meet in the
female's reproductive system. When sperm fertilizes (meets) an egg, this fertilized egg is
called a zygote. The zygote goes through a process of becoming an embryo and developing
into a fetus. The male reproductive system and the female reproductive system both are
needed for reproduction.

What is the female reproductive system?

Figure 2.2. The female reproductive system.

The Female Reproductive System consists of the external and internal organs. The
external parts of the female reproductive organs are vulva, labia minor, labia major and
clitoris.
Vulva: It means covering and is located between the legs. The vulva covers the
opening to the vagina and other reproductive organs inside the body. The fleshy area
located just above the top of the vaginal opening is called the mons pubis.
Labia: The two pairs of skin flaps called the labia (which means lips) (labia majora,
labia minora) surround the vaginal opening.
Clitoris: It is a small sensory organ, located toward the front of the vulva where the
folds of the labia join.

35
 A female's internal reproductive organs are the vagina, uterus, fallopian tubes, and
ovaries.
Vagina: It is a muscular, hollow tube that extends from the vaginal opening to the
uterus. It has muscular walls so the vagina can expand and contract. The vagina serves
three purposes. It's where the penis is inserted during sexual intercourse. It's the pathway
(the birth canal) through which a baby leaves a woman's body during childbirth. It's the
route through which menstrual blood leaves the body during periods.
Uterus (womb): The uterus is the organ that
nourishes the developing offspring. It is shaped like an
upside-down pear, with an upper rounded fundus, a
triangular cavity, and a lower narrow cervix that
projects into the vagina. The innermost layer of the
uterine wall, the endometrium, has a rich blood
supply. It receives the fertilized ovum and becomes
part of the placenta during pregnancy. The
endometrium is shed during the menstrual period if no
fertilization occurs. It takes 2 to 7 days to shed the
lining. Five days is the average. This is called
menstruation or having a period. The muscle layer of
the uterine wall is the myometrium. When a woman Figure 2.3. The menstrual
isn't pregnant, the uterus is only about 3 inches (7.5 cycle.

centimeters) long and 2 inches (5 centimeters) wide.

Cervix (neck): The cervix has strong, thick walls. The opening of the cervix is very
small (no wider than a straw), which is why a tampon can never get lost inside a girl's
body. During childbirth, the cervix can expand to allow a baby to pass.
Fallopian tubes (uterine tube or oviduct): They are at the upper corners of the
uterus, each fallopian tube is attached to a side of the uterus. Within each tube is a tiny
passageway no wider than a sewing needle. At the other end of each fallopian tube is a
fringed area that looks like a funnel. This fringed area wraps around the ovary but doesn't
completely attach to it. When an egg pops out of an ovary, it enters the fallopian tube.
Once the egg is in the fallopian tube, tiny hairs in the tube's lining help push it down the
narrow passageway toward the uterus. The fallopian tubes are the places in which
fertilization occurs.
Ovaries: The two oval-shaped organs that are held by ligaments in the pelvic cavity
on either side of the uterus are ovaries. Each ovary is about the size of an almond. It is
within the ovaries that the female gametes, the eggs or ova (singular, ovum), develop.
Every month several ova ripen, each within a cluster of cells called a graafian follicle. At

36
the time of ovulation, usually only one ovum is released from the ovary and the remainder
of the ripeningova degenerate. The follicle remains behind and continues to function for
about 2 weeks if there is no fertilization of the ovum and for about 2 months if the ovum is
fertilized. The ovaries are also part of the endocrine system because they produce female
sex hormones such as estrogen and progesterone.
How does the female reproductive system work?
The female reproductive system enables a woman to:
produce eggs (ova);
have sexual intercourse;
protect and nourish a fertilized egg until it is fully developed;
give birth.
Sexual reproduction couldn't happen without the sexual organs called the gonads.
Most people think of the gonads as the male testicles. But both sexes have gonads: In
females the gonads are the ovaries, which make female gametes (eggs). The male gonads
make male gametes (sperm). Unless the egg is fertilized by a sperm while in the fallopian
tube, the egg leaves the body about 2 weeks later through the uterus ‒ this is menstruation.
Blood and tissues from the inner lining of the uterus combine to form the menstrual flow,
which in most girls lasts from 3 to 5 days. A girl's first period is called menarche.
1. Read the passage and circle the correct answer.
1. What do the internal parts of the female reproductive system include?
A. the vulva, clitoris and anus
B. the uterus, ovaries, vagina and fallopian tubes
C. the bladder, urethra and uterus
D. the vulva, vagina and ovaries
2. What do the external parts of the female reproductive system include?
A. urethra, vagina, and clitoris
B. fallopian tubes, labia major and labia minor
C. labia minora, labia majora and clitoris
D. uterus, urethra and vagina
3. What is the name of the place where a baby grows?
A. stomach C. ovaries B. vagina D. uterus
4. Where are the eggs (ova) produced and stored?
A. uterus C. ovaries B. fallopian D. cervix

37
 5. How often will an ovary release?
A. one egg each month B. one egg each year
C. one egg each time the person has sex D. seven eggs each month
6. What is menstruation?
A. the release of an egg from the ovary
B. the shedding of the uterine lining each month
C. only necessary if there is a fertilized egg in the uterus
D. a normal and healthy part of growing up
7. Where does an egg travel from?
A. ovary through the uterus into the fallopian tubes
B. ovary through the fallopian tubes into the uterus
C. testes through the vas deferens into the urethra
D. ovary through the vagina into the cervix
8. How long is an average menstrual cycle?
A. one year B. one week C. 28 days D. 7 days
9. What does the menstrual cycle include?
A. ovulation, thickening and shedding of the uterine lining
B. ejaculation, fertilization, implantation
C. ovulation, fertilization, implantation
D. fertilization, thickening and shedding the uterine lining
10. What are the gonads?
A. sexual organs B. eggs C. gametes D. testicles
2. Match each definition with the correct term.

Definitions Terms

1. ___The bottom of the uterus that opens into the vagina. A. Ovulation

2. ___ Female sex organ that becomes larger and firmer B. Ovaries
during sexual arousal.
3. ___ Tubes connecting the ovaries to the uterus. The C. Menstruation
egg travels through here after ovulation. (Period)

38
 4. ___ A membrane that surrounds or partially covers the D. Hymen
opening to the vagina.
5. ___ Monthly shedding of the lining of the uterus. E. Vagina

6. ___ Female glands that produce and release an egg F. Uterus

each month.
7. ___ Process of releasing an egg from the ovary. G. Vulva

8. ___ The female reproductive cell produced in theovaries. H. Cervix

9. ___ A passage leading from the uterus to the outside of I. Egg

the body.
10. ___ The external female sex organ, includes the labia J. Fallopian Tubes
and clitoris.
11. ___ Where a developing baby grows. K. Clitoris

3. Fill in the blanks with given words below to make the explanation of the
female reproductive system correct. Each word will be used only one.
cervix estrogen menstruation ovulation
clitoris hypen Fallopian tubes ovum
egg cells labia progesterone uterus
sperm cell puberty ovaries vagina
First, (1) ________________areproduced in two almond-shaped organs known as
the (2) ________________. During the process of (3) ________________, a mature egg
(4) ________________ is released and enters one of two (5) ________________. For a
few days the egg cell travels towards the pear-shaped (6) ________________. The lining
of this organ thickens in preparation for a fertilized egg. If the egg is not fertilized by the
male (7) ________________, it will leave the body together with the lining of the uterus
and a small amount of blood. This is call (8) ________________.
The lower portion of the uterus if called the (9) ________________ and is a common
site of cancer in women. The female organ of intercourse is the (10) ________________.
A circular fold of skin is usually present at the entrance to this organ and is called the (11)
________________. Outside of this organ are folds of skin covered with pubic hair known

39
as the (12) ________________. Between these skin folds is a small, round, sensitive area
of skin called the (13) ________________.
The development of the reproductive system is triggered by the hormones (14)
________________ and (15) ________________, which cause many physical changes in a
girl. This period of change is call (16) ________________.

Reading 2: Sexually Transmitted Diseases (STDs)

1. Answer these questions.
1. What do you know about STDs?
2. Can you make a list of some of the STDs you know?
Sexually transmitted diseases (STDs), also called sexually transmitted infections
(STIs) or venereal diseases are infections caused by organisms that can be transmitted from
one person to another through sexual activity and intimate contact. The U.S. Centers for
Disease Control and Prevention (CDC) estimates that there are almost 20 million new STD
cases each year in the U.S. Half of cases occur in young people between the ages of 15 and
24 years.
Since many STDs have few or no symptoms, it is possible for a person to have an
infection and to infect others without either of them knowing it. For this reason, screening
for these infections is important to ensure early detection and prompt treatment. Tests for
STDs are recommended as part of routine health screens for sexually active teens and
young adults as well as older adults who may be at risk.
Untreated STDs have significant long-term consequences. They can lead to sterility
in both sexes.
The most common STDs are listed below:
Chlamydia: Chlamydia is the most frequently reported bacterial STD in the U.S.
Infection is caused by a bacterium (Chlamydia trachomatis) and is often called “the silent
epidemic” because infections are common yet many people do not realize that they are
infected. It is easily cured with antibiotics but if left untreated, chlamydia can cause
seriouslong-term effects including infertility and arthritis. Other effects in females include
pelvic inflammatory disease (PID) and a higher risk of having a tubal pregnancy. Other
effects in males include pain / swelling in the testicles (epididymo-orchitis) and urinary
tract problem. These effects can be prevented if you get early STI testing and treatment.
Chlamydia is passed between people through unprotected sexual contact (oral,
vaginal or anal sex without a condom). You can infect others right after you come in
contact with chlamydia. You can spread it to others without knowing it.

40
 Early-stage Chlamydia trachomatis infections often cause few or no signs and
symptoms. Even when signs and symptoms occur, they're often mild, making them easy to
overlook.
Signs and symptoms of Chlamydia for women can include: painful urination; vaginal
discharge in women; painful sexual intercourse; bleeding between periods and after sex.
Signs and symptoms of Chlamydia for men can include: discharge from the penis;
testicular pain.
Chlamydia trachomatis can also infect the rectum, either with no signs or symptoms
or with rectal pain, discharge or bleeding.
Gonorrhea: Neisseria gonorrhoeae causes the bacterial STD gonorrhea. It may not
cause symptoms, especially in women, but can lead to PID, infertility, and other
complications if not treated with antibiotics.
Gonorrhea is passed between people through unprotected sexual contact (oral,
vaginal, or anal sex without a condom). You can infect others right after you come in
contact with gonorrhea. You can spread it to others without knowing it. Babies of infected
mothers can be infected during childbirth. In babies, gonorrhea most commonly affects the
eyes.
In many cases, gonorrhea infection causes no symptoms. Symptoms, however, can
affect many sites in your body, but commonly appear in the genital tract.
Signs and symptoms of gonorrhea infection in women include: increased vaginal
discharge; painful urination; vaginal bleeding between periods, such as after vaginal
intercourse; abdominal or pelvic pain.
Signs and symptoms of gonorrhea infection in men include: painful urination;
pus-like discharge from the tip of the penis; pain or swelling in one testicle.
Syphilis: Syphilis is another bacterial infection that can be easily missed. The first
symptom is a painless chancre (an ulceration of the skin) at the site of exposure that will
disappear on its own, giving the impression that the infection has resolved when, in fact,
the infection persists for a period of time without symptoms. Syphilis can be treated with
antibiotics. However, if left untreated, the disease can spread throughout the body over the
course of many years and cause blindness, paralysis, deafness, brain and heart disease and
mental health problems. Syphilis can also be passed from mothers to unborn children.
The most common route of transmission is through contact with an infected person's
sore during sexual activity. The bacteria enter your body through minor cuts or abrasions
in your skin or mucous membranes. You can spread it to others without knowing it.
Pregnant females can pass the infection on to their unborn children.

41
 Syphilis develops in stages, and symptoms vary with each stage. But the stages may
overlap, and symptoms don't always occur in the same order. You may be infected with
syphilis and not notice any symptoms for years.
Trichomonas: Trichomonasvaginalis is a microscopic parasite that causes
trichomoniasis, a common STD, especially among sexually active young women. The
infection is the most common in females in the vagina and in males in the tube that carries
urine and semen (urethra). It can be treated with a single dose of antibiotic medication. It‟s
important to follow the directions you get with your medicine (e.g. don‟t drink alcohol
while you take the medicine).
Trichomonas is passed between people through unprotected sex (sexual contact
without a condom).
Many women and most men with trichomoniasis have no symptoms, at least not at
first. Trichomoniasis signs and symptoms for women include: an often foul-smelling
vaginal discharge ‒ which might be white, gray, yellow or green, genital redness, burning
and itching, pain with urination or sexual intercourse.
Trichomoniasis rarely causes symptoms in men. When men do have signs and
symptoms, however, they might include: irritation inside the penis, burning with urination
or after ejaculation, discharge from the penis.
Human papillomavirus (HPV): HPV infection is a viral infection that commonly
causes skin or mucous membrane growths (warts). There are more than 100 varieties of
human papillomavirus. Some types of HPV infection cause warts, and some can cause
different types of cancer. Most HPV infections don't lead to cancer. But some types of
genital HPV can cause cancer of the lower part of the uterus that connects to the vagina
(cervix). Other types of cancers, including cancers of the anus, penis, vagina, vulva and
back of the throat (oropharyngeal), have been linked to HPV infection.
These infections are often transmitted sexually or through other skin-to-skin contact.
Vaccines can help protect against the strains of HPV most likely to cause genital warts or
cervical cancer.
In most cases, your body's immune system defeats an HPV infection before it creates
warts. When warts do appear, they vary in appearance depending on which kind of HPV is
involved.
Genital herpes: Genital herpes is a common sexually transmitted infection caused
by the herpes simplex virus (HSV). HSV is spread through intimate skin-to-skin contact
and oral, vaginal, or anal sex. It can be spread people who have oral or genital herpes but
don‟t have sores at the time of contact. After the initial infection, the virus lies dormant in
your body and can reactivate several times a year.

42
 Genital herpes can cause pain, itching and sores in your genital area. But you may
have no signs or symptoms of genital herpes. If infected, you can be contagious even if you
have no visible sores.
There's no cure for genital herpes, but medications can ease symptoms and reduce
the risk of infecting others. Condoms also can help prevent the spread of a genital herpes
infection.
Most people infected with HSV don't know they have it because they don't have any
signs or symptoms or because their signs and symptoms are so mild.
Hepatitis B and Hepatitis C: These are viral infections that can cause liver
inflammation. They can be transmitted through sexual contact although hepatitis C is
spread more often through sharing of contaminated needles or other equipment used to
inject drugs. Both viruses can cause acute forms of the disease that usually result in a few
mild symptoms or no symptoms, but they can also progress to a chronic form that causes
severe and/or lasting liver damage. Treatment of chronic hepatitis with antiviral
medications is available.
Signs and symptoms may include: bleeding easily, bruising easily fatigue, poor
appetite, yellow discoloration of the skin and eyes (jaundice), dark-colored urine, itchy
skin, fluid buildup in your abdomen (ascites) swelling in your legs, weight loss, confusion,
drowsiness and slurred speech (hepatic encephalopathy), spiderlike blood vessels on your
skin (spider angiomas).
Human Immunodeficiency Virus (HIV):
Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-
threatening condition caused by the human immunodeficiency virus (HIV). By damaging
your immune system, HIV interferes with your body's ability to fight infection and disease.
HIV is a sexually transmitted infection (STI). It can also be spread by contact with
infected blood or from mother to child during pregnancy, childbirth or breast-feeding.
Without medication, it may take years before HIV weakens your immune system to the
point that you have AIDS.
There's no cure for HIV/AIDS, but medications can dramatically slow the
progression of the disease. These drugs have reduced AIDS deaths in many developed
nations.
The symptoms of HIV and AIDS vary, depending on the phase of infection.
Primary infection (Acute HIV)
Some people infected by HIV develop a flu-like illness within two to four weeks
after the virus enters the body. This illness, known as primary (acute) HIV infection, may
last for a few weeks. Possible signs and symptoms include: fever, headache, muscle aches

43
and joint pain, rash, sore throat and painful mouth sores, swollen lymph glands, mainly on
the neck, diarrhea, weight loss, cough and night sweats.
These symptoms can be so mild that you might not even notice them.
Clinical latent infection (Chronic HIV)
In this stage of infection, HIV is still present in the body and in white blood cells.
However, many people may not have any symptoms or infections during this time.
This stage can last for many years if you're not receiving antiretroviral therapy
(ART). Some people develop more severe disease much sooner.
2. Circle the correct answer.
1. What age group has the highest rates of STDs infection?
A. 15-24 B. 25-35 C. 36-50 D. 51-60
2. When should you see your doctor?
A. before you decide to become sexually active
B. at the first sign of any STD symptom
C. every year for testing if you become sexually active
D. all of the above
3. Which is true about STDs?
A. Many STDs are extremely painful
B. Many STDs have no symptoms at all
C. Many STDs cause high fevers
D. Many STDs cause the flu
4. What is the most frequently STDs reported in the U.S?
A. Chlamydia B. Gonorrhea C. Syphilis D. Trichomonas
5. Which STD cannotbe treated with antibiotics?
A. Gonorrhea B. Syphilis C. HIV D. D. Trichomonas
3. Using the information provided in the Reading 2, fill in the chart below.
Bacteria or
Infection Transmission Symptoms
Virus?
1. _________ ________ ___________________________ _______________
__________ ________ ___________________________ _______________
__________ _________ ___________________________ _______________
___________________________ _______________

44
 Bacteria or
Infection Transmission Symptoms
Virus?
2. _________ ________ ___________________________ _______________
__________ ________ ___________________________ _______________
__________ _________ ___________________________ _______________
___________________________ _______________

3. _________ ________ ___________________________ _______________

__________ ________ ___________________________ _______________
__________ _________ ___________________________ _______________
___________________________ _______________

4. _________ ________ __________________________ _______________

__________ ________ ___________________________ _______________
__________ _________ ___________________________ _______________
___________________________ _______________
5. _________ ________ ___________________________ _______________
__________ ________ ___________________________ _______________
__________ _________ ___________________________ _______________
_________ ___________________________ _______________
___________________________ _______________
6. _________ ________ ___________________________ _______________
__________ ________ ___________________________ _______________
__________ _________ ___________________________ _______________
_________ ___________________________ _______________
___________________________ _______________
7. _________ ________ ___________________________ _______________
__________ ________ ___________________________ _______________
__________ _________ ___________________________ _______________
_________ ___________________________ _______________
___________________________ _______________
8. _________ ________ ___________________________ _______________
__________ ________ ___________________________ _______________
__________ _________ ___________________________ _______________
_________ ___________________________ _______________
___________________________ _______________

45
 4. Read the following statements and write true (T) or false (F).
1. ____ Many people with STDs don‟t even know they have them.
2. ____ People who start having sex at a younger age are more likely to get an STD.
3. ____ Using a condom can only help prevent pregnancy, not any STDs.
4. ____ A person who only had unprotected sex once doesn‟t have to worry about an
STD.
5.____ The only way to know for sure if you have an STD is to get tested by a
medical professional.
6. ____ If you ignore an STD, it will probably go away.
7. ____ The pill can protect a girl from an STD.
8. ____You can‟t have more than one STD at one time.
9. ____Having sex with many different partners can increase your risk of getting an
STD.
10. ____ As long a person with an STD isn‟t sexually active while he or she is
having symptoms, their partner can‟t catch the disease.
5. Work in pairs and discuss about the ways you protect yourself against STDs?

WORD PARTS AND TERMS

1. Roots for female reproduction and the ovaries.

Table 2.1. Roots for female reproduction and the ovaries

Root Meaning Example Definition of example

gyn/o, woman gynecology study of diseases of women

gynec/o

men/o, mens month, menstruation premenstrual before a menstrual period

oo ovum, egg cell oocyte cell that gives rise to an ovum

ov/o ovum, egg cell ovulation release of an ovum from the

ovary

ovari/o ovary ovarian pertaining to an ovary

oophor/o ovary oophorotomy incision of an ovary

46
 2. Roots for the oviducts, uterus and vagina.

Table 2.2. Roots for the oviducts, uterus, and vagina

Root Meaning Example Definition of example

salping/o oviduct, fallopian salpingectomy excision of an oviduct

tube, uterine tube

uter/o uterus uterine pertaining to uterus

metr/o, uterus metrorrhagia abnormal uterine bleeding

metr/i

hyster/o uterus hysteroscopy endoscopic examination of the

uterus

cervic/o cervix, neck endocervical pertaining to the lining of the

cervix

vagin/o vagina vaginoplasty plastic repair of the vagina

colp/o vagina colpocele harnia of the vagina

3. Roots for female accessory structure

Table 2.3. Roots for the female accessory structure

Root Meaning Example Definition of example

vulv/o vulva vulva pertaining to the vulva

episi/o vulva episiotomy incision of the vulva

perine/o perineum perineal pertaining to perineum

clitor/o. clitoris clitorectomy excision of the clitoris

clitorid/o

mamm/o breast, mammary gland mammoplasty plastic surgery of the breast

mast/o breast, mammary gland amastia absence of the breasts

4. Roots pertaining to pregnancy and birth

47
 Table 2.4. Roots pertaining to pregnancy and birth

Root Meaning Example Definition of example

amnio amnion, amniotic sac diamniotic developing in separate amniotic
sac
embry/o embryo embryonic pertaining to the embryo
fet/o fetus fetoscope endoscope for examining the
fetus
Toc labor eutocia normal labor
nat/i birth neonate newborn
lact/o milk lactation secretion of milk
galact/o milk galactogogue agent that promotes (-agogue)
the flow of milk
gravida pregnant woman multigravida woman who has been pregnant
two or more times
Para woman who has nullipara woman who has never (nulli-)
given birth given birth

5. Define each of the following terms.

1. gynecopathy ____________________________________________________

2. intermenstrual ____________________________________________________

3. oogenesis ____________________________________________________

4. ovulatory ____________________________________________________

5. ovariorrhexis ____________________________________________________

6. oophoritis ____________________________________________________

7. salpingoplasty ____________________________________________________

8. hysterectomy ____________________________________________________

9. metrostenosis ____________________________________________________

48
10. uterovesical ____________________________________________________

11. vaginometer ____________________________________________________

12. colpodynia ____________________________________________________

6. Write a medical term for each of the following definitions.

1. a physician who specializes in the study of diseases of _____________________

women

2. pertaining to an absence of ovulation _____________________

3. profuse bleeding (-rhagia) at the time of menstruation _____________________

4. surgical fixation of an oviduct _____________________

5. radiographic study of the oviduct _____________________

6. presence of pus in an oviduct _____________________

7. surgical removal of an oviduct and ovary _____________________

8. within the uterus _____________________

9. softening of the uterus _____________________

10. operation to remake an opening between the uterine _____________________

tube and the uterus

11. within the cervix _____________________

12. inflammation of the vagina _____________________

13. narrowing of the vagina _____________________

14. any disease of the vulva _____________________

15. suture of the vulva _____________________

16. pertaining to the vagina and perineum _____________________

17. radiograph of the breast _____________________

18. excision of the breast _____________________

49
19. inflammation of the breast _____________________

20. rupture of the amniotic sac _____________________

21. incision of the amnion (to induce labor) _____________________

22. hernia of the uterus _____________________

23. instrument for examination of the embryo _____________________

24. endoscopic examination of the fetus _____________________

25. study of the newborn _____________________

7. Complete the terms based on the meaning given.

1. inflammation of the cervix ______________itis

2. suture of the vagina colp______________

3. surgical puncture to remove fluid from the cul-de-sac _____________centesis

4. surgical repair of the breast mammo_____________

5. removal of both fallopian bi___________ectomy

6. pertaining to newborn neo______________

7. difficult labor dys______________

8. first menstrual period men______________

9. rapid labor ______________tocia

10. production of milk lacto______________

11. no menstrual flow ___________menorrhea

12. painful menstrual flow dys______________

13. white discharge _____________rrhea

(from the vagina and associated with cervicitis)

14. abnormal discharge of milk from the breast galacto______________

15. prolonged menstrual bleeding occurring at regular _____________rrhagia

intervals

50
LANGUAGE FOCUS

The near future: Be going to

We can use “be going to”

To make a prediction about the future, The scan is very clear – you’re going to
based on signs we can see now have twins.

I’m just going to take your temperature.

To talk about your next action

To talk about something you have decided They’ve decided that they are going to
to do carry out a kidney transplant next
Monday.

Notes: Be going to vs Will

Be going to is used Will is used

to express things already decided in the to express on-the-spot decisions.

near future.
- I am going to meet the consultant The patient is in a serious condition. We‟ll
tomorrow. take him to the ICU.

to express intentions and plans. to express hopes, threats, predictions, etc.

- She loves working with children. She is - Neurology won‟t be the same in the next
going to be a paediatrician. two decades.
- We're going to remove the cysts just to - You will have to wear a sling because of
be on the safe side. your dislocated shoulder.

when there is evidence that something to express a prediction or a future event

will definitely happen. that is or is not certain to happen.
- The patient looks as if he is going to die. - He will probably attend the European
Congress of Endocinology.

51
 1. Complete the following sentences using be going to or will and the verbs in
brackets.
1. I ________________ (attend) the 20th International Congress of Cardiology.
2. The patient is looking terrible. I think he ________________ (die) soon.
3. That case looks difficult for you. I ________________ (help) you.
4. There is a CT course in Boston next fall. ________________ (you, attend) it?
5. Can I have the book I lent you last week back? Of course. I ________________
(give) it back to you tomorrow.
6. Don‟t ask to use his stethoscope. He ________________(not lend) it to you.
7. I promise I ________________ (send) you a copy of the latest article on AIDS as
soon as I get it.
8. ________________ (you, help) me with this patient, please?
9. Medicine ________________(be) very different in a hundred years‟ time.
10. I ________________ probably (attend) the European Congress.
11. The nurse ________________ (demonstrate) how to bathe an infant.
2. Rewrite the second sentence so that it has a similar meaning to the first one.
1. My intention is to sign up for an Radiology course.
→ I ______________________________________________________________
2. Mr. William intends to work for a big hospital in the capital city.
→ Mr. William ____________________________________________________
3. My sister‟s plan is to study abroad this September.
→My sister _______________________________________________________
4. Dr. Mike intends to treat the patient by using physiotherapy exercises.
→ Dr. Mike _______________________________________________________
5. Ms. Anna‟s intention is to have a baby this year.
→ Ms. Anna ______________________________________________________
3. Work in pairs. Ask each other about your future as the example below.

A: What do you do after the B: I‟m going to attend a meeting at the

shift? Pathology department.

52
LISTENING

Listening 1

1. Listen to a conversation between a pregnant woman and a nurse. Choose

the correct answer.
1. What are the speakers mainly talking about?
A. different types of STDs
B. how to use contraceptives
C. the results of a pregnancy test
D. the importance of contraceptives
2. What is true of the woman?
A. She is not sexually active.
B. She always uses contraceptives.
C. She recently contracted an STD.
D. She does not take birth control pills.

2. Listen again and complete the conversation.

Doctor: Let‟s see. First, are you (1) ___________ ___________?

Patient: Yes, I am.
Doctor: And do you (2) ___________ ___________?
Patient: Um, well (3) _________________________________.
Doctor: Try to?
Patient: Well, I use them (4) ________________________________________.
Doctor: Ms. Ryan, it‟s very important for you to use a contraceptive every
time. If you don‟t, you could end up with an (5)
______________________. And you‟re putting yourself at risk for
STDs.
Patient: I know. I guess sometimes (6) ________________________________.
Doctor: I see. So you forget your birth control pills or you forget to use a
condom?
Patient: Condoms. I _____________ (7) birth control pills.
Doctor: Well, you should use one every time you have intercourse. But I‟m
going to recommend another form of ______________ (8), too.

53
 3. Work in pairs. Play the roles as a doctor and a patient to practice the conversation
above.

Listening 2: What happens if an egg is fertilized

1. Match the words (1-5) with the definitions (A-G).
1. fertilization A. An organism in the early stages of growth and differentiation

2. blastocyst B. the attachment of the fertilized egg to the uterine lining

3. endometrium C. A thin-walled hollow structure in early embryonic development

4. implantation D. process of joining male and female sexual cells to produce young

5. embryo E. The cord that connects the developing fetus with the placenta while
the fetusis in the uterus.

6. fetus F. An unborn offspring, from the embryo stage until birth.

7. umbilical cord G. innermost lining layer of the uterus

2. Listen to a talk about Fertilization. Read the statements below and write
T (true) or F (false), correct the false ones.
1. ____ After the sperm fertilizes the egg, the fertilized egg has become a
multicelledzygote.
2. ____ In the embryonic stage, the inner cells form a flattened circular shape called
the embryonic disk.
3. ____ The fetus floats in amniotic fluid along the amniotic sac.
4. ____ When the baby is ready for birth, its head presses on the vagina.
5.____ After several hours of the cervix‟s widening, the cervix is opened enough for
the baby to come through.

3. Listen to a talk about fertilization again and fill in the blank with one
word.

54
 If a female and male have sex within
several days of the female's ovulation, (1)
____________ can happen. When the male
ejaculates (when semen leaves the penis), a small
amount of semen is deposited into the vagina.
Millions of sperm are inthis small amount of
semen and they “swim” up from the vagina
through the (2) ______________ and uterus to
meet the egg in the fallopian tube. It takes only
one sperm to fertilize the egg. About 5 to (3) ______________ days after the sperm
fertilizes the egg, the fertilized egg (zygote) has become a multicelled blastocyst.
A blastocyst is about the size of a (4) ______________, and it's a hollow ball of cells with
fluid inside. The blastocyst burrows itself into the lining of the (5) ______________, called
the endometrium. The hormone estrogen causes the endometrium to become thick and rich
with blood. (6) ______________, another hormone released by the ovaries, keeps the
endometrium thick with blood so that the blastocyst can attach to the uterus and absorb (7)
______________ from it. This process is called implantation.
As cells from the blastocyst take in nourishment, another stage of development
begins. In the embryonic stage, the inner cells form a flattened circular shape called the
embryonic disk, which will (8) ______________ into a baby. The outer cells become thin
membranes that form around the baby. The cells multiply (9) ______________ of times
and move to new positions to eventually become the embryo.
After about 8 weeks, the embryo is about the size of a raspberry, but almost all of its
parts ‒ the brain and nerves, the heart and blood, the stomach and (10) ______________,
and the muscles and skin ‒ have formed.
During the fetal stage, which lasts from 9 weeks after (11) ______________ to birth,
development continues as cells multiply, move, and change. The fetus floats in amniotic
fluid inside the amniotic sac. It gets (12) ______________ and nourishment from the
mother's blood via the placenta. This disk-like structure sticks to the inner lining of the uterus
and connects to the fetus via the umbilical cord. The amniotic fluid and membrane cushion
the fetus against bumps and jolts to the mother's body.
Pregnancy lasts an average of (13) ______________ days ‒ about 9 months. When
the baby is ready for birth, its head presses on the cervix, which begins to relax and widen
to get ready for the baby to pass into and through the vagina. Mucus has formed a plug in
the cervix, which is now loosen. It and amniotic fluid come out through the vagina when
the mother's water breaks.

55
 When the contractions of (14) ______________ begin, the walls of the uterus
contract as they are stimulated by the pituitary hormone oxytocin. The contractions cause
the cervix to (15) ______________ and begin to open. After several hours of this
widening, the cervix is dilated (opened) enough for the baby to come through. The baby is
pushed out of the uterus, through the cervix, and along the birth canal. The baby's head
usually comes first. The umbilical cord comes out with the baby. It's clamped and cut close
to the navel after the baby is delivered.
The last stage of the birth process involves the delivery of the placenta, which at that
point is called the afterbirth. After it has separated from the inner lining of the uterus,
contractions of the uterus push it out, along with its membranes and fluids.
4. Work in pairs, look at the two diagrams below and tell your partners what
happen from the ovulation to the baby’s birth based on the things you can remember
from the Listening 2 as example.

Figure 2.4. The Implantation.

Figure 2.5. The human development.

0. Fertilization 1. __________ 2. __________

56
 5. __________ 4. __________ 3. __________

0. The female and male have sex within the female‟s ovulation days, fertilization
occurs.
1. _________________________________________________________________
_________________________________________________________________
2. _________________________________________________________________
__________________________________________________________________
3. _________________________________________________________________
__________________________________________________________________
4. _________________________________________________________________
__________________________________________________________________
5. _________________________________________________________________
_________________________________________________________________

SPEAKING
1. Write the names of the parts of the female reproductive system on the space given
below.

1. ________________

2. ________________

3. ________________

4. ________________

5. ________________

6. ________________

7. ________________

8. ________________

Figure 2.6. The female reproductive system.

57
 2. Watch a video describing the different parts, locations and functions of the
Female Reproductive System and take notes as guided below.
Organs Locations, Shapes Functions
pelvic cavity, producing female gamates
0. Ovary
oval shaped (oocytes) and female sex hormones

____________________ ___________________________
____________________ ___________________________
1. _______________ ____________________ ___________________________
____________________ ___________________________

____________________ ___________________________
____________________ ___________________________
2. _______________ ____________________ ___________________________
____________________ ___________________________

____________________ ___________________________
3. _______________ ____________________ ___________________________
____________________ ___________________________
____________________ ___________________________

____________________ ___________________________
____________________ ___________________________
4. _______________ ____________________ ___________________________
____________________ ___________________________

____________________ ___________________________
____________________ ___________________________
5. _______________ ____________________ ___________________________
____________________ ___________________________

____________________ ___________________________

58
 ____________________ ___________________________
6. _______________ ____________________ ___________________________
____________________ ___________________________

____________________ ___________________________
____________________ ___________________________
7. _______________ ____________________ ___________________________
____________________ ___________________________

____________________ ___________________________
____________________ ___________________________
8. _______________ ____________________ ___________________________
____________________ ___________________________

3. Work in groups of four. Choose 4 – 5 parts of the Female Reproductive System

you are familiar with most, find more information and prepare a short presentation
about:
‒ its position
‒ its function
‒ What it looks like

WRITING
Doctor Appointment Email
Tips When Writing a Doctor’s Appointment Email
Do Don’t
Include all time, date and location Use complex formatting and fonts that
information in a way that is easy to read obscure the details you are trying to
and comprehend. convey.
Include information regarding what to Treat the appointment email like a sales
bring on the day to make the pitch, your tone should be professional and
appointment go smoothly. straight to the point.
Include details regarding how the Forget to provide contact information and

59
appointment was made if it was not clinic details in case there is an issue.
made by the patient directly

1. Study the email and make questions for underlined words.

Dear Mr. Johnson,

I am writing this email to request an appointment with you on (1) 20th
August 2020 at (2) 2:00 p.m.
I am having (3) a severe backache for (4) a month and have visited the
regular physician, (5) Mr. Steven Smith, (6) Daycare Hospital. After a
treatment of (7) two weeks, he suggested me to visit a specialist as my
condition did not improve.
It would be highly appreciated if you book me this slot as I am in severe
pain and you are my hope. I will be bringing along (8) the test results
and the prescription of my previous treatment with the physician. If you
need any further documents, kindly, inform me on my cell 469 2184 5649
Regards,
Joe Galler

1. __________________________________________________________________
2. __________________________________________________________________
3. __________________________________________________________________
4. __________________________________________________________________
5. __________________________________________________________________
6. __________________________________________________________________
7. __________________________________________________________________
8. __________________________________________________________________
2. Write a similar email and replace the underlined words in the email above
with your own words.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

60
 ____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3. Write an email to make an appointment with your doctor. In the email, you
should write:
- the time you intend to meet the doctor
- the reason why you want to meet him/her
- the best way to contact you

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

FURTHER READING
Cervical cancer
From Wikipedia, the free encyclopedia
Cervical cancer is a malignant neoplasm arising from cells originating in the cervix.
One of the most common symptoms of cervical cancer is abnormal vaginal bleeding, but in
some cases there may be no obvious symptoms until the cancer has progressed to an
advanced stage.
Human papillomavirus (HPV) infection appears to be involved in the development of
more than 90% of cases. HPV vaccines are effective against two to four of the high risk
strains of this family of viruses. Since the vaccines only cover some types of HPV,
guidelines still recommend that women have regular Pap smear screening, even after
vaccination. Most cervical cancers aresquamous cell carcinomas, arising in the squamous
(flattened) epithelial cells that line the cervix. Adenocarcinoma, arising in glandular
epithelial cells is the second most common type. Very rarely, cancer can arise in other
types of cells.

61
 Cancer screening using the Pap smear can identify precancerous changes in cervical cells.
Treatment of high-grade changes can prevent the development of cancer in many cases. In
developed countries, the widespread use of cervical screening programs has dramatically
reduced the incidence of invasive cervical cancer. Treatment usually consists of surgery
(including localexcision) in early stages, and chemotherapy and/or radio the rapy in more
advanced stages of the disease.Worldwide, cervical cancer is second most commonand the
fifth deadliest cancer in women. Worldwide, in 2008, it was estimated that there were
473,000 cases of cervical cancer, and in 2010 225,000 deaths. Approximately 80% of
cervical cancers occur in developing countries.
In most cases, cells infected with the HPV virus heal on their own. In some cases,
however, the virus continues to spread and becomes an invasive cancer.
Cervix in relation to upper part of vagina and posterior portion of uterus, showing
difference in covering epithelium of inner structures.
The early stages of cervical cancer may be completely asymptomatic. Vaginal
bleeding, contact bleeding, or (rarely) a vaginal mass may indicate the presence of
malignancy. Also, moderate pain during sexual intercourse and vaginal discharge are
symptoms of cervical cancer. In advanced disease, metastases may be present in
the abdomen, lungs or elsewhere.
Symptoms of advanced cervical cancer may include: loss of appetite, weight loss,
fatigue, pelvic pain, back pain, leg pain, swollen legs, heavy bleeding from the vagina,
bone fractures, and/or (rarely) leakage of urine or faeces from the vagina.
Causes
Infection with some types of human papilloma virus (HPV) is the greatest risk factor
for cervical cancer, followed by smoking. Other risk factors include human immunodeficiency
virus. Not all of the causes of cervical cancer are known, however, and several other
contributing factors have been implicated.
Genital warts, which are a form of benign tumor of epithelial cells, are also caused
by various strains of HPV. However, these serotypes are usually not related to cervical
cancer. It is common to have multiple strains at the same time, including those that can
cause cervical cancer along with those that cause warts. The medically accepted paradigm,
officially endorsed by the American Cancer Society and other organizations, is that a
patient must have been infected with HPV to develop cervical cancer, and is hence viewed
as a sexually transmitted disease (although many dispute that, technically, it is the
causative agent, not the cancer, that is a sexually transmitted disease), but most women
infected with high risk HPV will not develop cervical cancer. Using condoms can reduces,
but does not always prevent transmission. Likewise, HPV can be transmitted by skin-to-
skin-contact with infected areas. In males, there is no commercially available test for HPV,
although HPV is thought to grow preferentially in the epithelium of the glans penis,
and cleaning of this area may be preventative.
1. Answer the following questions.

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 1. What is one of the most common symptoms of cervical cancer?
____________________________________________________________________
2. Where are the squamous cell carcinomas and adenocarcinoma arising?
____________________________________________________________________
3. Why is the cervical cancer so frightening?
____________________________________________________________________
4. How many people died of cervical cancer in 2010 all over the world?
____________________________________________________________________
5. What are the causes of cervical cancer?
____________________________________________________________________
6. Which is a form of benign tumor of epithelial cells?
____________________________________________________________________
2. Read the passage and these statements. Write (T) for true statements and (F)
for false and correct the false ones.
1. ______ The least common symptoms of cervical cancer is vaginal bleeding.

2. ______ HPV vaccines are effective against three to four of the high risk strains of
this family of viruses.

3. ______ Women should have regular Pap smear screening, even after vaccination.
4. ______ Cancer screening using the Pap smear can identify precancerous changes
in cervical cells.
5. ______ Cervical cancer is third most common and the fifth deadliest cancer in
women in the world.

6. ______ Infection with some types of human papilloma virus (HPV) is the greatest
risk factor for cervical cancer, followed by smoking.

7. ______ Genital warts, which are a form of benign tumor of epithelial cells, are also
caused by various strains of HPV.

8. ______ HPV cannot be transmitted by skin-to-skin-contact with infected areas.

The Journey of an Egg

1. Read the following story and fill in the blanks using the words provided.

cervix fallopian tubes Egg vagina

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 ovary menstruation Uterus

Once upon a time, there was a female reproductive system. Each month, due to
changes in hormones, the (1) _________________ invited a thick, soft lining made up of
tissue and blood to grow along its walls. The lining contained nutrients that would be
needed to nourish a growing baby if a pregnancy was to occur. Once the lining had grown,
it waited for the ovaries to do their job. The ovaries contained special reproductive cells,
each cell called an (2)_______________. Each month, one of these cells would reach
maturity and be released from the (3)_______________. This month, it was the right ovary
that got to release an egg. The left one would have to waituntil the next month. The
(4)_________________ ________, which wait for the ovaries torelease an egg, waved
their numerous arms. The waving arms grabbed the egg that was justreleased and gently
guided it into one of the tubes. After about a day of travel, the egg began to dissolve. When
it had disappeared, the brain sent a message to the lining of the uterus telling it that a
fertilized egg wasn‟t going to arrive, so it could leave the uterus. Slowly, the lining passed
through the (5) _________________, into the (6)_________________, and out of the
body. As soon as the lining was gone, the uterus invited a new lining to start to grow. This
time around, it would be the ovary and fallopian tube on the left that would do all the work.
Then, the process would start all over again. This process is called (7) _______________.

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 Unit 3
THE MALE REPRODUCTIVE SYSTEM

Objectives: After study of this unit, students will be able to:

1. Apply gerunds and infinitives, and vocabulary as well as main roots referring to the
male reproductive system in listening, speaking, reading and writing practice;
2. Read for main ideas and details about parts of the male reproductive system;
3. Listen for specific information relating to the male reproductive system;
4. Describe the structure and functions of the male reproductive system;
5. Write an email to remind an appointment with a patient.

GETTING STARTED
The male reproductive system consists of a number of sex organs that play a role in
the process of human reproduction. These organs are located on the outside of the body
and within the pelvis.
FILL IN THE BLANKS WITH THE WORDS FROM THE TABLE

PROSTATE GLAND
Ureter TESTES
(1)__
__
Urinary
Ejaculatory bladder EPIDIDYMIS
duct
(2)__
__ (7)__ SCROTUM
__
Rectum

(6)___ SEMINAL VESICLES

Bulbourethral
gland _

(3)____ VAS DEFERENS

Anus Penis
____
(4)____
____ Foreskin URETHRA
(5)____

Figure 3.1. The diagram of the male reproductive system.

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READING

Reading 1: The male reproductive system

1. Before you read, put the following words into correct place. You can use your
dictionary to help you.
vagina prostate gland ovary bladder penis

urethra semen uterus fimbriae scrotum

vagina

Male Female

Both

What is the male reproductive system?

The male has reproductive organs, or genitals, that are both inside and outside the pelvis.
The male genitals include:
‒ the testicles;
‒ the duct system, which is made up of the epididymis and the vas deferens;
‒ the accessory glands, which include the seminal vesicles and prostate gland;
‒ the penis.
The Testicles (testes, testis): Two testicles dangle down beneath the penis bag of skin
called the scrotum. Each testicle is made up of tightly coiled seminiferous tubules which
manufactures more than 250 million sperm cells each day. The sperm cells are stored in the
testis itself. In addition to producing sperm, the interstitial cells, which are scattered in the
seminiferous tubules, produce testosterone, a steroid hormone accountable for male sexual
urges.
The Epididymis: (epididymides-plural), a pair of tightly coiled, tubelike structures, lie
long the posterior borders of each testis. The functions of each epididymis are to serve as a

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passageway for sperm from the testis to the body surface, store sperm before ejaculation, and
secrete a part of the semen.
The Vas Deferens: The vas deferens are a pair of tubes, a continuation of the
epididymis. The vas extends from the epididymis up through spermatic cord, into the
abdominal cavity and down the posterior of the bladder where it connects with the seminal
vesicle duct and forms the ejaculatory duct. The function of the vas deferens is to act as a
duct for the testis and connect the epididymis with the ejaculatory duct.
The Ejaculatory Ducts: are two short tubes formed by the joining of the vas deferens
with the ducts of the seminal vesicles. They pass through the prostate gland and extend to
the urethra.
The Seminal Vesicles: are two twisted pouches lying along the lower posterior
surface of the bladder, in front of the rectum. They secrete the mucid, liquid part of the
semen, and prostaglandins.
The Prostate Gland: is doughnut shapes, and surrounds the urethra. The prostate
secretes a viscous, alkaline substance that makes up most of the seminal fluid (semen). The
alkalinity protects the sperm from acid present in the urethra of the male and the vagina of
the female and increases its motility.
The Bulbourethral Glands: Located under the prostate gland are a pair of small
glands that are connected to the urethra. They do secrete a fluid before ejaculation.
The Scrotum: is a saclike, skin-covered structure that hangs from the perineal area. It
is separated into two sacs internally, each containing one testis, one epididymis, and the
inferior part of a spermatic cord.
The Penis: The male external sex organ consisting of spongy tissue like mass is
called the penis. The shaft of the penis is covered by a thick layer of skin whereas the head
has only a thin layer, making it more sensitive. The penis contains the urethra, which
carries both reproductive tract secretions and urine, and is the organ by means of which
sperm are introduced into the vagina.
The Spermatic Cords: are formed of white fibrous tissue, encasing the vas deferens,
blood and lymph vessels, and nerves. They are located in the inguinal (groin) canals,
between the scrotum and abdominal cavity.
Semen: A thick white opaque fluid that is secreted by seminal vesicles, glands that
open into the urethra is called semen. The function of semen is to protect the sperm cells in
the vagina, provide energy for weakened sperm cells, and help contract the uterine muscle
to move the sperm cells into the uterus faster. Millions of sperm cells join with this fluid
and are spewed out of the urethra by undulating contractions. The contractions and
discharging of semen is called ejaculation.

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 Sperm (spermatozoa): Sperm are male gametes, or reproductive cells. Sperm form
when certain cells in the male reproductive system divide by meiosis to form haploid cells.
Sperm cells are produced in the seminiferous tubules of the testes and contain genetic
material.

Figure 3.2. Male reproductive anatomy.

How does the male reproductive system work?

The male reproductive system:
‒ makes semen;
‒ releases semen into the reproductive system of the female during sexual intercourse;
‒ produces sex hormones, which help a boy develop into a sexually mature man
during puberty
When a baby boy is born, he has all the parts of his reproductive system in place, but
it isn't until puberty that he is able to reproduce. When puberty begins, usually between the
ages of 9 and 15, the pituitary gland - located near the brain - secretes hormones that
stimulate the testicles to produce testosterone. The production of testosterone brings about
many physical changes.
Although the timing of these changes is different for every guy, the stages of puberty
generally follow a set sequence:
During the first stage of male puberty, the scrotum and testes grow larger.
Next, the penis becomes longer and the seminal vesicles and prostate gland grow.
Hair begins to grow in the pubic area and later on the face and underarms. During
this time, a boy's voice also deepens.

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 Boys also have a growth spurt during puberty as they reach their adult height and
weight.

What do sperm do?

A male who has reached puberty will produce millions of sperm cells every day.
Each sperm is extremely small: only 1/600 of an inch (0.05 millimeters long). Sperm
develop in the testicles within a system of tiny tubes called the seminiferous tubules. At
birth, these tubules contain simple round cells. During puberty, testosterone and other
hormones cause these cells to transform into sperm cells. The cells divide and change until
they have a head and short tail, like tadpoles. The head contains genetic material (genes).
The sperm move into the epididymis, where they complete their development.
The sperm then move to the vas deferens, or sperm duct. The seminal vesicles and
prostate gland make a whitish fluid called seminal fluid, which mixes with sperm to form
semen when a male is sexually stimulated. The penis, which usually hangs limp, becomes
hard when a male is sexually excited. Tissues in the penis fill with blood and it becomes
stiff and erect (an erection). The rigidity of the erect penis makes it easier to insert into the
female's vagina during sex. When the erect penis is stimulated, muscles around the
reproductive organs contract and force the semen through the duct system and urethra.
Semen is pushed out of the male's body through his urethra - this process is
called ejaculation. Each time a guy ejaculates, it can contain up to 500 million sperm.
2. Match each definition on the left with the correct term on the right.
Definitions Terms

1. _B_ narrow tube that carries sperm from the testicles A. penis
to the urethra.

2. ___ male reproductive cell produced in the testicles. B. vas deferens

3. ___ thick fluid that contains sperm. C. prostate gland

4. ___ male organ of copulation. D. sperm

5. ___ sac in which the testes are enclosed. E. epididymis

6. ___ glands where sperm and testosterone are produced. F. semen

7. ___ where semen is produced and stored. G. seminal vesicles

8. ___ where sperm cells are stored for maturation. H. testes

9. ___ structure that produces fluid to help sperm move. I. scrotum

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 3. Read the passage and circle the best answer.
1. What is the testicle made up of?
A. sperm cells B. penis
C. coiled seminiferous tubules D. testosterone
2. Where is the epididymis located?
A. beside the posterior borders of testes B. near the testis
C. on each testis D. at the back of the testes
3. What do the vas deferens do?
A. connect with the seminal vesicle duct
B. connect with the seminal vesicle duct and form the ejaculatory duct
C. connect the epididymis with the ejaculatory duct
D. act as a duct for the testis and connect the epididymis with the ejaculatory duct
4. What is the function of the seminal vesicles?
A. release the mucid B. make up the seminal fluid
C. secrete a fluid before ejaculation D. store sperm
5. What is the shape of the prostate gland?
A. round B. doughnut C. coil D. duct
6. Which part is connected to the urethra?
A. the prostate gland B. the bulbourethral gland
C. the permatic cord D. the ejaculatory duct
7. What does the scrotum contain?
A. testes and epididymis B. sperm
C. prostate gland D. semen and testosterone
8. What is called penis?
A. spongy tissue B. male external sex organ
C. reproductive tract secretion D. vagina
9. Which of the following statements about semen is false?
A. Semen is secreted by seminal vesicles.
B. Semen protects the sperm cells.
C. Semen is produced in the testes.
D. Semen provides energy for weakened sperm cells.

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 10. Where do the sperm move to complete their development?
A. the vas deferens B. the prostate gland
C. the ejaculatory duct D. the epididymis
4. Fill in the blanks in the following sentences with a suitable word.
1. The two __testicles___ are organs that produce sperm and secrete testosterone.
2. The ___________ connect epididymis with the ejaculatory.
3. The position of ___________ is in the inguinal canals.
4. The functions of ___________ are storing sperm and secreting semen.
5. A fluid that protects the sperm cells is ___________.
6. The doughnut-shaped in the male reproductive system is the ________________.
7. ______________are formed by the vas deferens and the seminal vesicles.
8. The _____________ is separated into two sacs internally.
9. The _____________contains the urethra.
10. ___________contain genetic material.
5. Read the following story and fill in the blanks using the words provided.
The Journey of a Sperm
Word bank

ejaculation
penis
scrotum
semen
seminal vesicle
sperm
testicles
urethra
vas deferens
Once upon a time, there was a pair of (1)_______________. They were held in a
special sac called the (2)_______________. This sac could hold the testicles close to the
body to keep them warm, or let them hang away from the body to keep them cool. The
testicles made special reproductive cells called (3)_______________. Once these cells

71
were made, they would wait to be released from the testicles. Sometimes, they would wait
so long that they dissolved. Other times, they would be released from the testicles, make a
journey through the male reproductive system and leave the male‟s body.
On the day in question, it just so happened that the sperm got to be released from the
body. First, he (4)_______________ became larger, longer and firmer until it stuck out
from the body. When the penis gets this way it is called an erection. The sperm travelled
up the (5)_______________. Along the way, it mixed with fluid from the prostate gland,
and with seminal fluid, which was made in the (6)_______________. Once these fluids
mixed, they decided to call themselves (7)_______________. Together they travelled from
the vas deferens into a tube called the (8)_______________.
By this time, the semen was almost at the end of the journey. After travelling through
the vas deferens and the urethra, the semen was released from the penis in a process called
(9)_______________. The erection went away and the penis became smaller and softer.

Reading 2: What to know about prostate cancer

1. Before you read, discuss these questions:
1. What is the most common cancer among men?
2. What do you know about this kind of cancer?
2. Read the passage and answer the following questions.
Prostate cancer is a common type of cancer in males, but it is highly treatable in the
early stages. It begins in the prostate gland, which sits between the penis and the bladder.
Prostate cancer is the most common cancer to affect males in the United States. In
fact, in 2019, the American Cancer Society predict that there will be around 174,650 new
diagnoses of prostate cancer around 31,620 deaths from this type of cancer.
Around 1 in 9 males will receive a diagnosis of prostate cancer at some point in their
life. However, only 1 in 41 of these will die as a result of it. This is because treatment is
effective, especially in the early stages. Routine screening enables doctors to detect many
cases of prostate cancer before they spread.
Symptoms
There are often no symptoms during the early stages of prostate cancer, but screening
can detect changes that can indicate cancer.
Screening involves a test that measures levels of Prostate-specific Antigen (PSA) in
the blood. High levels suggest that cancer may be present.
Males who do experience symptoms may notice:
‒ difficulty starting and maintaining urination,

72
 ‒ a frequent urge to urinate, especially at night,
‒ blood in the urine or semen,
‒ painful urination,
‒ in some cases, pain on ejaculation,
‒ difficulty getting or maintaining an
erection,
‒ pain or discomfort when sitting, if the
prostate is enlarged.
Advanced symptoms
Advanced prostate cancer can involve the
following symptoms:
‒ bone fracture or bone pain, especially,
‒ in the hips, thighs, or shoulders, Figure 3.3. Prostate cancer.

‒ edema, or swelling in the legs or feet,

‒ weight loss,
‒ tiredness,
‒ changes in bowel habits,
‒ back pain.
Treatment
Treatment will depend on the stage of the cancer, among other factors.
Early stage prostate cancer: Share on Pinterest A prostatectomy is one possible
treatment for early stage prostate cancer. If the cancer is small and localized, a doctor may
recommend.
Watchful waiting or monitoring: The doctor may check PSA blood levels regularly
but take no immediate action. Prostate cancer grows slowly, and the risk of side effects
may outweigh the need for immediate treatment.
Surgery: A surgeon may carry out a prostatectomy. They can remove the prostate
gland using either laparoscopic or open surgery.
Radiation therapy: Options include brachytherapy and conformal radiation therapy.
Treatment will depend on various factors. A doctor will discuss the best option for the
individual.
Cause
Prostate cancer develops when specific changes occur, usually in glandular cells.
Nearly 50% of all males over the age of 50 years have prostate cancer. At first, the changes
will be slow, and the cells will not be cancerous. However, they can become cancerous

73
with time. Cancer cells can be high or low grade. High grade cells are more likely to grow
and spread, while low grade cells are not likely to grow and are not a cause for concern.
Diagnosis
If a male has symptoms that may indicate prostate cancer, the doctor will likely:
‒ ask about symptoms,
‒ ask about personal and medical history,
‒ conduct a blood test to access PSA levels,
‒ carry out a urine test to look for other biomarkers,
‒ carry out a physical examination, which may include a digital rectal exam.
The best way to detect prostate cancer in the early stages is to attend regular
screening. Anyone who has not yet attended screening should ask their doctor about the
options.
1. Where does the prostate cancer start?
____________________________________________________________________
__________________________________________________________________
2. When should prostate cancer be treated?
____________________________________________________________________
__________________________________________________________________
3. What do people who have prostate cancer notice in urine?
____________________________________________________________________
__________________________________________________________________
4. What does the treatment of prostate cancer depend on?
____________________________________________________________________
__________________________________________________________________
5. What is the best way to detect prostate cancer in the early stage?
____________________________________________________________________
________________________________________________________________
3. Read the passage again, then mark the following statements are true (T) or
false (F).
1. _F__ A lot of males who are diagnosed of prostate cancer will die as a result of it.
2. ___ Screening can detect prostate cancer in the early stages.
3. ___ One of the prostate cancer symptoms is dysuria.
4. ___ Prostate cancer patients may feel painful and discomfort able when they are
sitting.
5. ___ The symptom of advanced prostate cancer can include general swelling.

74
 6. ___ Surgeons can only use laparoscopic surgery in performing a prostatectomy.
7. ___ Doctors may investigate urine when prostate cancer is suspected.

WORD PARTS AND TERMS

1. Roots pertaining to the male reproductive system.

Table 3.1. Roots for male reproduction

Root Meaning Example Definition of example

andr/o male androblastoma tumor cells secrete a male sex hormone

balan/o glans penis balanitis inflammation of glans penis

epididym/o epididymis epididymitis inflammation of the epididymis

orch/o, orchi/o testis, testicle orchioplasty surgical repair of a testicle

orchid/o testis, testicle orchidectomy removal of a testicle

osche/o scrotum oscheoma tumor of the scrotum

prostat/o prostate prostatectomy excision of the prostate gland

semin semen inseminate to introduce semen into a woman

sperm/o,
sperm (seed) aspermia inability to secrete sperm
spermat/o

test/o testis, testicle testicular pertaining to testicle

vas deferens,
vas/o vasorrhaphy suture of the vas deferens
vessel

seminal radiographic study of the seminal

vesicul/o vesiculography
vesicle vesicles

2. Match each of the following terms and write the appropriate letter to the left
of each number.
_H_ 1. balanorrhea A. excision of seminal vesicle

___ 2. orchitis B. radiograph of a seminal vesicle

___ 3. prostatitis C. any diseases pertaining to male sex

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 ___ 4. balanoplasty D. inflammation of the prostate gland

___ 5. spermatolysis E. inflammation of the testis or testicle

___ 6. vesiculography F. destruction of sperm

___ 7. andropathy G. surgical repair of the glans penis

___ 8. vesiculectomy H. excessive discharge from the glans penis

3. Write a word for each of the following definitions.

1. excessive discharge from the prostate gland ____prostatorrhea____
2. excision of an epididymis ____________________
3. disease of the testis ____________________
4. excision of the testis ____________________
5. inflammation of a seminal vesicle ____________________
6. excision of the vas deferens ____________________
7. excision of the seminal vesicles ____________________
8. producing or forming sperm ____________________
9. condition of scanty sperm ____________________
10. condition in which there is sperm in the urine ____________________
11. fixation of a testicle ____________________
12. enlargement of the prostate gland ____________________
4. Write the root, suffix and the meaning. Bases on the meaning, writte a brief
definition for each term.
1. prostatitis
Root: prostat/o = prostate gland
Suffix: -itis = inflammation
Definition: inflammation of the prostate gland
2. spermatolysis
Root: ______________________________________________
Suffix: ______________________________________________
Definition: ___________________________________________
3. orchialgia
Root: _______________________________________________
Suffix: _____________________________________________

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 Definition: ___________________________________________
4. oscheoplasty
Root: _______________________________________________
Suffix: ______________________________________________
Definition: ___________________________________________
5. epididymitis
Root: _______________________________________________
Suffix: _______________________________________________
Definition: ___________________________________________
6. epididyectomy
Root: _______________________________________________
Suffix: ______________________________________________
Definition: ___________________________________________
7. spermatocele
Root: _______________________________________________
Suffix: ______________________________________________
Definition: ___________________________________________
8. balanitis
Root: _______________________________________________
Suffix: ______________________________________________
Definition: ___________________________________________
9. vasectomy
Root: _______________________________________________
Suffix: ______________________________________________
Definition: ___________________________________________
10. prostatorrhea
Root: _______________________________________________
Suffix: ______________________________________________
Definition: ___________________________________________

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LANGUAGE FOCUS

Gerunds and to + infinitives

Gerunds (-ing form)
A gerund is a noun made by adding “-ing” to a verb.
The -ing form is used:
after certain verbs Finish: I‟ve finished filling in consent form.
(avoid, consider, finish, enjoy, Enjoy: I enjoy talking to patients while I‟m in
fancy, suggest, stand….)
the ward.
POSITIONS

after some phrasal verbs (give up, Give up: Are you gonna give up smoking?
keep on, go on)
Go on: Go on taking these tablets, you will
feel better.
after a preposition What are the advantages of developing new
surgical techniques?
Are you interested in working for our
hospital?
with “before” and “after” Discharge Mr. Brown before operating on the
aneurysm.
What physical exercise did you do after
finishing your prescription?
We can use -ing form of a verb as a noun. –Ing nouns can be used as:
a subject Giving injections for children is not easy.
an object We finished taking this patient‟s history.
USAGES

a complement Are you interested in taking part in 2nd

International Congress of Diabetes and
Endocrinology?
We can also use –ing form of a The surgeons have had a very tiring day.
verb as an adjective
The commonest –ing adjectives amusing, boring, interesting, shocking, tiring,
are: worrying

78
 To infinitives
An infinitive is the “to” form of the verb.
The to-infinitive is used:

after certain verbs Promise: The patient promised to give up

(advise, agree, appear, decide, smoking.
promise, expect) Decide: Dr. Parker‟s patients decided to leave
the emergency room.

with structures after some V + to inf: I asked to see Dr. Knight, the
verbs: want, ask, expect, help, surgeon who operated on my patient.
would like, would prefer V + Object + to inf: I asked Dr. Knight to
POSITIONS

inform me about my patient.

with structure after the V + O + Inf: Remind me to report those

following verbs: tell, order, radiographs tomorrow before 10 a.m.
remind, warn, force, persuade,
invite, teach.

after certain adjectives It‟s so difficult to treat diseases caused by

(angry, happy, difficult) viruses.

after question words (where, The student asked me how to take this patient‟s
how, what…) temperature.
To-infinitive can be used as:
a subject To become a doctor is his dream.
an object
USAGES

She agreed to have an operation.

a subject complement What is essential is to maintain a healthy diet?

Using to infinitive to show They decided to perform an operation

purpose immediately to save the patient‟s life.
The doctor needs some gauze to cover the
patient‟s wound.

Gerunds or To-infinitives
Some verbs can be followed by either -ing or to-infinitive: begin, start, continue.
The patient began to improve after intubation.

79
 The patient began improving after intubation.
With some verbs, the use of -ing and to-infinitive after them have different meanings.
Gerunds (V-ing) To-infinitives
try do something to try and solve a make an effort to do something
problem
If your headache persists, try taking The patient tried to keep her eyes
an aspirin. open.

stop stop an action interrupt an action to do something

else
If you want to loose weight, you I saw Dr. Vida on my way to the
should stop eating unhealthy and ward and I stopped to give him my
fatty food. report.

forget not be able to remember a past even not do something you are/were
planning to do
He‟s forgotten finishing the
prescription, so he looked for I forgot to take this medicine before
medicine to take. meal.
remember talk about action in the past that we talk about things that we need to do
remembered
I remembered using gloves when I remember to take the patient‟s blood
doing the procedure. pressure.

1. Circle the correct word or phrase in the following passage

LAUGHTER IS THE BEST MEDICINE!

The next time you‟re feeling ill, try (1) watching / to watch a comedy instead of
just doing nothing. At least, that‟s what some doctors suggest (2) doing / to do. If you
want (3) getting / to get better, there‟s nothing like laughter. First of all, an activity you
enjoy (4) doing / to do takes your mind off your illness. Time seems (5) passing / to pass
more quickly and you stop (6) worrying / to worry about how you feel.

2. Complete the sentences using the correct form of the verbs below. Add any
other words you need.

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have call get jerk improve educate

wear take bend down talk make

1. The patient was too weak ______________ up!

2. Did you remember________________ your gloves before giving injections?
3. There‟s no answer at her family. Let‟s try ________________ambulance.
4. I would like you ________________ as far as you can.
5. You should avoid________________ your body when doing these exercises.
6. The patient‟s family refused ________________ an operation.
7. It‟s very difficult _________________to depressed patients.
8. ________________a diagnosis is very important before treatment.
9. If you promise ________________these medicine on time, you‟ll be better.
10. Doctors should be responsible for _________ their patients on how ________
their health.
3. Rephrase the following sentences using suggested words.
1. Could you pass me the sterile gauze?
Would you mind =>Would you mind passing me the sterile gauze?
2. It‟s important to take these capsules before meals.
Taking___________________________________________________________
3. They spent two hours performing the surgical transplant.
It ________________________________________________________________
4. Gillian took the patient‟s t.p.r then she filled in the report.
Before____________________________________________________________
5. Jenny doesn‟t want to go on duty at the weekend.
Jenny doesn’t like__________________________________________________
6. Sarah checked and recorded the patient's temperature.
I remembered Sarah________________________________________________
7. The doctor advised me to stay in bed for a few days.
The doctor suggested_______________________________________________

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LISTENING

Listening 1: Sperm release pathway

1. Listen and number the words you hear.

Sperm Vas deferens Urethra
1 1 1
Seminal vesicle Penis Epididymis

Testicle Prostate gland Semen

2. Listen again and mark the following statements are true (T) or false (F).
1. ___ The sperm are produced in the testes.
2.___ The urethra runs from the penis to the bladder.
3. ___ The release process starts when the penis fills with sperm.
4.___ Sperm travel to the vas deferens from the epididymis.
5. ___ The penis ejaculates semen through the urethra.

3. Listen again and fill in the missing words.

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 Sperm are produced and released by the male reproductive (1)____________.
The testes are where sperm are produced. The testes are linked to the rest of the male
reproductive organs by the vas deferens which extends over the base of the pelvic bone
or ilium, and wraps around to the ampulla, seminal vesicle, and (2)______________.
The urethra then runs from the bladder through the penis. Sperm production in the
(3)_______________ takes place in coiled structure called seminiferous tubules.
Along the top of each testicle is the epididymis. This is a cordlike structure where the
sperm (4)_____________ and are stored.
The release process starts when the penis fills with (5)______________ and
becomes erect. Continuing to stimulate the penis will cause (6)_______________.
Mature sperm begin their journey by travelling from the epididymis to the vas deferens
which propels sperm forward with smooth (7)_______________ contractions. The
sperm arrive first at the ampulla just above the prostate gland. Here, secretions from the
seminal vesicle located next to the ampulla are added. Next, the seminal fluid is
propelled forward through the ejaculatory ducts toward urethra. As it passes the
prostate gland, a milky fluid is added to make (8)_______________. Finally, the semen
is ejaculated from the penis through the urethra.

Listening 2: Why do my testicles ache?

1. Listen to Luke talking about his problems and take notes.

Luke’s report

Age

Problem

Frequency

Symptoms

2. Listen to the consultant’s advice. What should Luke do?

3. Listen again and fill in the missing words. Then check your answer in 2.

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 Consultant: It‟s good that you asked this question! Guys should always take
testicular pain seriously, even if there‟s no obvious (1)______________. Some of the
things that cause testicular pain can lead to permanent (2)______________ if they go on
for too long. Because your pain keeps coming back and there might be some
(3)______________, you should tell a parent and call your doctor‟s office right away. It‟s
possible that you are having “growing pain”, but only a doctor can tell for sure. Your
doctor may send you to a urologist, a (4)______________ in conditions that affect a guy‟s
reproductive system. Masturbation will not cause the kind of pain that you
(5)______________. Neither will use a laptop though it‟s best to sit at a desk or table when
using one. If you can‟t do that, put a (6)______________ between your body and your
laptop.

SPEAKING
1. Work in pairs. Write the name of each part on the diagram.
Prostate gland Epididymis Testis
Penis Bulbourethral gland Seminal vesicle
Urethra Vas deferens

(4)
(1)
(5)

(2) (6)

(7)
(3)
(8)

Figure 3.4. The male reproductive structure.

2. Fill in each blank with a suitable word from 1. Sometimes you need to use
plural form.

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 1. ____________are glands where sperm and testosterone are produced. They are
held in the scrotum.
2. The ____________is a tube that transports sperm from the epididymis to the
ejaculatory ducts and the urethra.
3. The ____________ produces a thin fluid that helps sperm move. This fluid is
secreted into the vas deferens and mixed with sperm.
4. Sperm cells are stored in the ____________ for maturation.
5. ____________ - 2 smalls glands located beneath the prostate. These glands secrete
a fluid that helps sperm survive the acidic environment of the vagina.
6. _______ are a pair of glands located underneath the bladder – they produce a thick
fluid made up of fructose which provides energy that the sperm need to survive.
7. The ____________ is used to discharge urine and semen from the body.
8. The ____________ is the male sex organ, reaching its full size during puberty. It
also acts as a conduit for urine to leave the body.

3. Work in pairs, ask and answer using the suggested structures.

Asking Answering

Where is the penis? The penis is located in………….

What’s it like? It is…………

What is the function of……….? It helps / transports…………

4. Look at the diagram again and talk about the male reproductive system.
5. Label diagram of the male and female reproductive system and talk about the
functions of each part.

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 8. _______

WRITING

An Appointment Reminder Email

1. Read the email and answer the questions below.

Hi Luke,
This is reminder that your appointment is scheduled in my
office on Thursday at 8.30 a.m for your testicle check.
Please have a list of all your current medication. You are
going to have some investigations, so you shouldn’t eat or drink
anything before you come.
If you cannot make this appointment, please callme at least
24 hours prior to this appointment to rearrange for another
time.
Dr. Scott

1. Why does Dr. Scott write this email?

__________________________________________________________________

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 2. What does Luke need to bring?
__________________________________________________________________
3. What shouldn‟t he do before the appointment?
__________________________________________________________________
2. Cover the email. Can you complete the sentences with these expressions?
Then look at the email to check.
scheduled Appointment list

medication Reminder investigations

1. This is __________that your appointment is ___________on Thursday.

2. Please have with you a __________of all your current___________.
3. You are going to have some ___________.
4. If you cannot make this__________, please call me.
3. Write an email to your patient. Think about:
- Reasons of appointment (reexamining, investigating……).
- Time and place to meet.
- What the patient should do and bring.
Write at least 50 words.

Dear
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Dr.

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FURTHER READING

Further Reading 1: The male reproductive system

Using the fifteen words provided, fill in the blanks to make this explanation of the
male reproductive system correct. Each will be used only once.
Cowper’s glands Epididymis prostate testes

seminal vesicle Erection scrotum urine

vas deferens Orgasm semen urethra

nocturnal emissions Penis sperm

First, (1)_______________ are produced in the small seminiferous tubules of the

(2)_______________. These oval-shaped glands are protected by a sac called the
(3)_______________. After the sperm cells are produced, they are stored in a large coiled
tube on the outer surface of each testicle called the (4)_______________. From this tube,
the sperm go into a larger tube called the (5)_______________, which eventually carries
them to the external male reproductive organ, the (6)_______________. Along the way
sperm is nourished by a sugary fluid from the (7)_______________, a chemical fluid from
the (8)_______________which is the most common site of cancer in men, and fluid from
the (9)_______________ which are two small glands located near the bladder. These fluids
plus the sperm cells combine to form (10)_______________, the fluid ejaculated from the
penis during (11)_______________. Before a male can ejaculate the spongy tissue
surrounding the penis becomes engorged with blood causing the penis to become stiff and
hard. This is known as an (12)_______________. The tube that carries the semen from the
body is the (13)_______________. This tube also carries (14)_______________ from the
bladder. Males can also have uncontrolled ejaculation during sleep, which are called
(15)_______________.
Further Reading 2: Premature ejaculation
Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse
than he or his partner would like. Premature ejaculation is a common sexual complaint.
Estimates vary, but as many as 1 out of 3 men say they experience this problem at some
time.
As long as it happens infrequently, it‟s not cause for concern. However, you might be
diagnosed with premature ejaculation if you:
‒ Always or nearly always ejaculate within one minute of penetration;
‒ Are unable to delay ejaculation during intercourse all or nearly all of the time;
‒ Feel distressed and frustrated, and tend to avoid sexual intimacy as a result.

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 Both psychological and biological factors can play a role in premature ejaculation.
Although many men feel embarrassed talking about it, premature ejaculation is a common
and treatable condition. Medications, counseling and sexual techniques that delay
ejaculation – or a combination of these – can help improved sex for you and your partner.
Symptoms
The main symptoms premature ejaculation is the inability to delay ejaculation for
more than one minute after penetration. However, the problem might occur in all sexual
situations, even during masturbation.
Many men feel that they have symptoms of premature ejaculation, but the symptoms
don‟t meet the diagnostic criteria for premature ejaculation. Instead these men might have
natural variable premature ejaculation, which includes periods of rapid ejaculation as well
as periods of normal ejaculation.
Causes
The exact cause of premature ejaculation isn‟t known. While it was once thought to
be only psychological, doctors now know premature ejaculation involves a complex
interaction of psychological and biological factors.
Psychological factors that might play a role include:
‒ Early sexual experiences;
‒ Sexual abuse;
‒ Poor body image;
‒ Depression;
‒ Worrying about premature ejaculation;
‒ Guilty feelings that increase your tendency to rush through sexual encounters.
A number of biological factors might contribute to premature ejaculation, including:
‒ Abnormal hormone levels;
‒ Abnormal levels of brain chemicals called neurotransmitters;
‒ Inflammation and infection of the prostate or urethra;
‒ Inherited traits.
Diagnosis
In addition to asking about your sex life, your doctor will ask about your health
history and might do a physical exam. If you have both premature ejaculation and trouble
getting or maintaining an erection, your doctor might order blood tests to check your male
hormone (testosterone) levels or other tests.
In some cases, your doctor might suggest that you go to a urologist or a mental health
professional who specializes in sexual dysfunction.

89
 Treatment
Common treatment options for premature ejaculation include behavioral techniques,
topical anesthetics, medication and counseling. Keep in mind that it might take time to find
the treatment or combination of treatments that will work for you. Behavioral treatment
plus drug therapy might be the most effective course.
Summarize the main ideas of the passage by filling in the information.
1. Definition ____________________________________________________

____________________________________________________

2. Symptoms ____________________________________________________

3. Causes Psychological factors:

____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
Biological factors:

____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________

4. Diagnosis Doctor asks:

____________________________________________________
____________________________________________________
Doctor orders:__________________________________
Doctor suggests: ________________________________

5. Treatment ____________________________________________________
____________________________________________________

____________________________________________________

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 Unit 4
THE NERVOUS SYSTEM

Objectives: After the lesson, students will be able to:

1. Apply the past perfect tense, medical words and main roots/suffixes referring to
the nervous system in language skills;
2. Read for general and specific information relating to the nervous system;
3. Talk about the function of the nervous system and other relating organs;
4. Listen for main ideas and details relating to the nervous system;
5. Write an apology note or email to the doctor.

GETTING STARTED
Talk about these questions:
1. What are the main parts of nervous
system?
2. Why is the nervous system so
important to bodily function?

READING

Reading 1: The Nervous System

The nervous system is an organ
system containing a network of specialized
cells called neurons that coordinate the
actions of an animal and transmit signals
between different parts of its body. In most
animals the nervous system consists of two Figure 4.1. The Central Nervous System.
parts, central and peripheral. The central
nervous system (CNS) of vertebrates (such as humans) contains the brain, spinal cord, and
retina. The peripheral nervous system (PNS) consists of sensory neurons, clusters of

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neurons called ganglia, and nerves connecting them to each other and to the central
nervous system.
These regions are all interconnected by means of complex neural pathways.

The neuron
The neuron is the basic functional unit of the
nervous system (Figure 4.2). Each neuron has two
types of fibers extending from the cell body: the
dendrite, which carries impulses toward the cell
body, and the axon, which carries impulses away
from the cell body.
Each neuron is part of a relay system that
carries information through the nervous system. A Figure 4.2. The Neuron.
neuron that transmits impulses toward the CNS is a
sensory neuron; a neuron that transmits impulses away from the CNS is a motor neuron.
There are also connecting neurons within the CNS. The point of contact between two nerve
cells is the synapse. At the synapse, energy is passed from one cell to another by means of
a chemical neurotransmitter.
Nerves
Individual neuron fibers are held together in
bundles like wires in a cable. If this bundle is part of
the PNS, it is called a nerve. A collection of cell
bodies along the pathway of a nerve is a ganglion. A
few nerves (sensory nerves) contain only sensory
neurons, and a few (motor nerves) contain only motor Figure 4.3. The Nerves.
neurons, but most contain both types of fibers and are
described as mixed nerves.
The brain
The brain is the nervous tissue contained
within the cranium; consists of the cerebrum,
diencephalon, brainstem, and cerebellum (root
encephal/o).
The cerebrum is the largest part of the brain. It
is composed largely of white matter with a thin
outer layer of gray matter, the cerebral cortex. It is

Figure 4.4. The brain.

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within the cortex that the higher brain functions of memory, reasoning, and abstract
thought occur. The cerebrum is divided into two hemispheres by a deep groove, the
longitudinal fissure. Each hemisphere is further divided into lobes with specialized
functions.

1. Match the letter of each function next to its matching part.

1. cerebrum ________ 4. spinal cord _________
2. cerebellum ________ 5. spinal nerves _________
3. medulla ________
A. It controls balance and muscular
coordination.
B. It controls thought, voluntary movement,
memory and learning, and also processes information
from the senses
C. They carry impulses between the spinal cord
and body parts.
D. It controls breathing, heartbeat,and other vital
body processes.
E. It relays impuses between the brain and
otherparts of the body.
2. Underline the correct word (s) to complete
each sentence. Take turns reading the correct
sentences aloud with a partner.
Figure 4.5. The nervous
1. The central nervous system comprises the system.
brain and nerves / spinal cord.
2. The part of the nervous system that consists of sensory neurons is the CNS/PNS.
3. Dendrite / Axon carries impulses toward the cell body.
4. Nerves are parts of the PNS / CNS.
5. The cerebrum / diencephalon is the largest part of the brain.
3. Choose the best answer to complete each sentence.
1. Each neuron has _______________ types of fibers extending from the cell body.
A. two B. three C. four D. five
2. The axon carries impulses __________________ from the cell body.
A. toward B. away C. to D. on
3. The point of contact between two nerve cells is the _________________.
A. synapse B. sensory

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 C. hemisphere D. longitudinal fissure
4. A collection of cell bodies along the pathway of a nerve is a _________________.
A. cell body B. deep groove C. ganglion D. organ
5. Each hemisphere is further divided into ___________ with specialized functions.
A. hemisphere B. synapses C. axons D. lobes
4. Summarize the main points of the Reading text using these suggested questions.
1. What is the nervous system?
___________________________________________________________________
2. How many parts are there in the nervous system?
___________________________________________________________________
3. What are sensory neurons and motor neurons?
____________________________________________________________________
4. What are mixed nerves?
___________________________________________________________________
5. What is the biggest part of the brain?
_________________________________________________________________
5. Write the correct term from the list below in the space next to its definition.
brain Hypothalamus reflex
brain stem Interneurons sensory neuron
central nervous system motor neuron spinal cord
cerebellum peripheral nervous system thalamus
cerebrum peripheral Nervous System

__________________ 1. carries motor responses from the central nervous

system to muscles, glands and other organs
__________________ 2. site of capacity for learning, memory, perception and
intellectual function
__________________ 3. consists of the brain and spinal cord
__________________ 4. relays sensory information
__________________ 5. dense cable of nervous tissue that runs through the
vertebral column
__________________ 6. contains neurons that branch throughout the body

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 __________________ 7. carries information from sense organs to the central
nervous system
__________________ 8. the body‟s main processing center
__________________ 9. regulates breathing, heart rate and endocrine
functions
__________________ 10. link neurons to each other
__________________ 11. collection of structures leading down to the spinal
cord
__________________ 12. regulates balance, posture and movement
__________________ 13. a sudden, rapid and involuntary self-protective motor
response
__________________ 14. consists of all the nervous tissue that lies outside the
central nervous system

6. The diagram below is of a nerve cell or neuron. Add the following labels to
the diagram.
Node of Ranvier Myelin Cell body Dendrites
Schawann cell Axon terminal Nucleus

1
7
5
2

6
3 4

Figure 4.6. The Neurons.

Reading 2: Neurology
Discuss these questions:
1. What is involved in the field of neurology?
2. What are some different nervous system
disorders?

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 Neurology
Some of the scariest diseases can be those that take away our ability to move and
think clearly. Neurology has developed as a field that specializes in treating disorders of
the nervous system – everything from the brain to the nerves in the fingertips. Neurologists
are trained to investigate and treat these diseases.
While we often think of neurology as focusing on the brain and spinal cord – the
central nervous system – it actually concentrates on nerves the entire body. This peripheral
nervous system consists of nerves that extend throughout the body‟s limbs and organs. Part
of this is the autonomic nervous system, which controls bodily functions at the
subconscious level, such as heart rate.
Disorders can strike at any of these systems. Some ailments, such as feelings of
vertigo and numbness, can be treated with medication, but
they may also be symptoms of a more serious condition.
Patients with recurring seizures may also be placed on
regular medicine. Several trauma to the brain or spinal
cord can result paralysis or a coma. A neurosurgeon may
operate to address the problem, but the effects may be
lifelong. Unfortunately, many disorders have no cure or
treatment. For example, Alzheimer‟s disease, which
slowly takes away the ability to think clearly, cannot yet
be stopped by modern medicine.

1. Match the words (1-6) on the left with the definitions (A-F) on the right.
1.____vertigo A. a long state of unconsciousness during which a
person does not wake or respond to stimuli.
2.____Alzheimer‟s disease B. the loss of function in one or more muscles.
3. ____coma C. a kind of dizziness in which a person feels like he is
moving when stationary.
4. ____numbness D. a symptom of exessive brain activity, resulting in
temporary thrashing movements or a loss of awareness.
5. ____paralysis E. a brain illness that causes a person to lose memory
and the ability to think clearly.
6. ____seizure F. the inability of a part of the body to feel stimulation.

2. Mark the following statements as true (T) or false (F).

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 1. ____ Neurology concentrates on the central nervous system.
2. ____ Vertigo and Numbness can‟t be treated with medication.
3. ____ Regular medicine can be placed for patients with recurring seizures .
4. ____ Seizures can result in paralysis.
5. ____ Any disorders also have cure or treatment.
3. Fill in the blanks with the correct words and phrases.
The peripheral nervous system Neurologists Neurology
The autonomic nervous system Paralysis
1. Diseases relating to the nervous system are treated by _______________.
2. A field specializing in treating neurological disorders is called _______________.
3. _______________ controls the heart rate.
4. _______________ contains nerves extending the body‟s limbs and organs.
5. _______________ can be resulted from several trauma to the brain or spinal cord.

WORD PARTS AND TERMS

1. Roots for the Nervous System and spinal cord.

Table 4.1. Roots for the nervous system and spinal cord

Root Meaning Example Definition of example

neur/o, neur/i nervous system, Neurologist one who studies or specializes
nervous tissue, nerve in nerve or nervous system

gli/o neuroglia Glioma a neuroglial tumor

gangli/o, ganglion ganglionectomy surgical removal of a ganglion
ganglion/o
mening/o, meninges Meningocele hernia of the meninges through
meninge/o the skull or spinal column
myel/o spinal cord (also bone myelodysplasia abnormal development of the
marrow) spinal cord
radicul/o root of a spinal nerve radiculopathy any disease of a spinal nerve
root

97
 2. Roots for the brain.

Table 4.2. Roots for the brain

Root Meaning Example Definition of example

encephal/o brain encephalocele hernia of the brain

cerebr/o cerebrum (loosely, cerebritis inflammation of the brain

cerebr/o brain)
cortic/o cerebral cortex, corticospinal pertaining to the cerebral
outerportion cortex and spinal cord
cerebell/o cerebellum intracerebellar within the cerebellum
thalam/o thalamus thalamotomy incision of the thalamus
ventricul/o cavity, ventricle supraventricular above a ventricle
medull/o medulla oblongata medullary pertaining to the medulla
(also spinal cord)
psych/o mind Psychopathy any disease of the mind
somn/o, somn/i sleep Insomnia the inability to sleep
(sleeplessness)

3. Suffixes for diseases relating to the nervous system.

Table 4.3. Suffixes for diseases relating tothe nervous system

Suffixes Meaning Example Definition of example

-asthenia weakness, debility analgesia absence of (a normal sense of) pain
-esthesia feeling hyperesthesia increased feeling

-phasia speech heterophasia uttering words that are different from

those intended

-lalia speech, babble coprolalia compulsive use of obscene

words (copro means “feces”)

-lexia reading dyslexia difficulty in reading

-plegia paralysis tetraplegia paralysis of all four limbs

-paresis partial paralysis hemiparesis partial paralysis of one side of the body

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-lepsy seizure narcolepsy condition marked by sudden episodes of
sleep

-phobia persistent, agoraphobia fear of being in a public place (from

irrational fear greek agora, meaning “market place”)

-mania excited state, megalomania exaggerated self – important;

obsession “delusion”

-kinesia movement hyperkinesia excessive movement; also called

hyperactivity

4. Write a word for each of the following definitions.

1. pain in a nerve ____________________________________
2. any disease of the nervous system ____________________________________
3. inflammation of the spinal cord ___________ _________________________
4. the study of nerve or nervous system ____________________________________
5. radiographic study of the spinal cord ____________________________________
6. inflammation of the meninges ____________________________________
7. slowness in speech ____________________________________
8. paralysis of the heart ____________________________________

5. Match the following terms with their definitions and write the appropriate
letter to the left of each number.
_____1. psychotherapy A. inflammation of the meninges
_____2. neurology B. any disease of the nervous system

_____3. neuropathy C. inflammation of the spinal

cord and meninges
_____4. myelomeningitis D. study of the nervous system

_____ 5. gangliectomy E. excessive sleepiness

_____ 6. meningitis F. treatment of disorders of the mind

_____ 7. hypersomnia G. excision of a ganglion

6. Define each of the following words.

1. encephalitis ____________________________________________________

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 2. extramedullary____________________________________________________
3. psychology ____________________________________________________
4. cerebrospinal ____________________________________________________
5. ventriculitis ____________________________________________________
6. insommia ____________________________________________________
7. aphasia ____________________________________________________
8. bradylexia ____________________________________________________
9. pyromania ____________________________________________________
10. gynephobia ____________________________________________________

7. Write an adjective for each of the following definitions. Note the endings.
1. pertaining to (-al) the cerebrum _______________________________
2. pertaining to (al) the cerebral cortex _______________________________
3. pertaining to (ia) the speech, babble _______________________________
4. pertaining to (-ar) the cerellum _______________________________
5. pertaining to (-ar) a ventricle _______________________________

LANGUAGE FOCUS
The Past Perfect Tense
Form: Timeline
Positive: S + had + past participle

The doctor had left by the time we arrived.

Negative: S + had not (hadn‟t) + past participle

Therefore! The past perfect is
the past of the past!!
The doctor hadn’t left by the time we arrived.

Questions: Had + S + past participle?

Had the doctor left by the time we arrived? Yes, he had.

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Usage:
A finished action before a second point in the past.
They had sent the CT film before the operation started.
Something that started in the past and continued up to another action or time in the
past.
When he graduated, he had been in London for six years.
1. Complete the sentences by using the appropriate form of the verb in brackets.
1. They (not feel) _______________ nauseous before they were allowed to come
back home.
2. ____You (finish) ___________ the medical project by the time you came back?
3. The patient ___________ (die) before the doctor arrived
4. Before she (become) ____________ a professional, she (work) ____________in
an international hospital for many years.
5. Mrs. Lee (take) _______________ the medication as prescribed to alleviate her
headache before she (go) _______________ to party last night.
6. She felt better after she (take) _______________ some medicine.
7. Nobody knew what medicine she (take) _______________.
8. The patient (spend) _______________ several years in Africa before he was
treated here.
9. She (have) _______________ a mental illness for 2 years before she knew.
10. Before the man was taken to the hospital, he (become) _______________
unconsious because of a serious damage in the brain.
2. Make sentences in the past perfect tense using suggested words and phrases.
1. He / say / he / never / take / medication / before.
__________________________________________________________________
2. Patient / have / stomach / pain / five / year / before / he / take / medication.
__________________________________________________________________
3. Peter / have / excessive / sleepiness / 2 days / before / he / phone / doctor.
__________________________________________________________________
4. Patient / have / rash / face / 3 days / before / he / go / hospital.
__________________________________________________________________
5. Nurse / check / the patient‟s pressure / by the time / doctor / come.
__________________________________________________________________

101
 6. He / suffer / insomnia / many / year / by the time / he / get / right / treatment / last
year.
__________________________________________________________________
3. Complete sentences using the past perfect tense by using the given.
1. She felt better because ______________________________________________
2. The patient apologised because _______________________________________
3. They felt better after _______________________________________________
4. The patient was discharged from hospital because ________________________
5. The reason why he was happy was ____________________________________

LISTENING

Listening 1: Basic function of the nervous system

Discussion
What can you see in Figure 4.7? Can you describe each one of them?

102
 Figure 4.7. The nervous system.

2. Listen and tick () the words you hear.

brain signals system  drink 

eat  see  sensation  function 

3. Listen and choose the correct answer for each question about the nervous
system function.
1. What is the central nervous system made of?
A. The brain and spinal cord C. The brain and nerves
B. Nerves extending to all parts of the body D. The spinal cord
2. What does the nervous system transit?
A. The brain B. The body C. The organs D. The signals
3. How many ways is the nervous system divided functionally?
A. One B. Two C. Three D. Four
4. What is the region of the peripheral nervous system called?
A. The central nervous system B. The somatic nervous system
C. The autonomic nervous system D. The enteric nervous system
5. Which functions may overlap as well?
A. Somatic responses
B. Autonomic functions
C. The sensations
D. Somatic and autonomic integrative functions

4. Listen again. Fill in the missing information in the numbered space with the
words you hear.
THE FUNCTION OF THE NERVOUS SYSTEM
The nervous system has two main parts: the central and (1)_______________
nervous systems. The central nervous system (CNS) is made up of the brain and spinal
cord and the peripheral nervous system (PNS) is made up of nerves that branch off from
the spinal cord and (2)_______________ to all parts of the body.

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 The nervous system transmits signals between the brain and the rest of the body,
including internal organs. In this way, the nervous system‟s activity controls the
(3)_______________ to move, breathe, see, think, and more.
The nervous system can be divided on the basis of its functions. There are two ways
to consider how the nervous system is divided (4)_______________ . First, the basic
functions of the nervous system are sensation, (5)_______________ and response.
Secondly, control of the body can be somatic or autonomic (6)_______________ that are
largely defined by the structures that are involved in the response. There is also a region of
the peripheral nervous system that is called the enteric nervous system that is responsible
for a (7)_______________ set of functions.
The nervous system can also be divided on the basis of how it controls the body. The
somatic nervous system (SNS) is responsible for functions that result in moving skeletal
muscles. Any (8)_______________ or integrative functions that result in the movement of
skeletal muscle would be considered somatic. The autonomic nervous system (ANS) is
responsible for functions that affect cardiac or smooth muscle tissue, or that cause glands
to produce their secretions. (9)_______________ functions are distributed between central
and peripheral regions of the nervous system. The (10)_______________ that lead to
autonomic functions can be the same sensations that are part of initiating somatic
responses. Somatic and autonomic integrative functions may overlap as well.
5. Work in group. Make a diagram about the nervous system with its structure and
function based on the information in Task 4. Compare with other groups.

Listening 2: Conversation between a professor and a medical student

1. Discussion
What do you know about synapses?
What is its function you know?

2. Listen to a conversation between a professor

and a medical student. Choose the correct
answers.
1. What is the conversation mainly about?
A. The types and functions of synapse
B. Common nervous system aliments
C. Ways to test neuron performance
D. How the nervous system grows
2. What does the woman fail to answer correctly?

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 A. How synapse transfer information
B. The number of synapses in the average brain
C. What the connections between neurons are called
D. The different kinds of synapses

3. Listen again and complete the conversation with the words you hear.

Professor: Very good. And what

(1)_______________ of (2)_______________ do
synapses send?
Student: They send chemical or
(3)_______________ signals to another cell.
Professor: Right again. So tell me, about how
many synapses are there in the (4)______
_______?
Figure 4.8. Synapses in the
Student: Hmm… That‟s a (5)_______________ nervous system.
one. I would guess about 100 billion.
Professor: Not quite. It‟s actually many times that-
100 to (6)_______________ trillion.
Student: Wow, that‟s a lot of
(7)_______________
Professor: Indeed. All that (8)_______ _______ is
what makes the brain so powerful.

Figure 4.9. Synapses:

How your brain
communicates.

4. Work with a partner, act out the roles as a professor and a student to practise the
conversation.

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SPEAKING
1. Make the questions using the suggested words.
1. How many parts / nervous system / have?
_________________________________________________________________
2. What / central nervous system / make of?
_________________________________________________________________
3. What / peripheral nervous system / make of?
_________________________________________________________________
4. What / nervous system / transmit?
_________________________________________________________________
5. What / nervous system / control?
_________________________________________________________________
6. How / nervous system / divide?
_________________________________________________________________
7. What / basic / function / nervous system?
_________________________________________________________________
8. What / enteric nervous system / responsible?
_________________________________________________________________
9. What / somatic nervous system / responsible?
__________________________________________________________________
10. Where / autonomic function / distribute?
__________________________________________________________________
2. Make two or more questions to add in the list above.
3. Talk to your partner. Use the questions above to ask and answer about the
nervous system. Students can use the information in Listening 1, Task 4 for a help if
necessary.

How many parts does It has two main parts, the

the nervous system central and peripheral
have? nervous systems.

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 4. Work in pairs, use your diagrams you have made in Listening 1, Task 5 to
talk about parts of the nervous system. You should talk about:
- its structure
- its function

WRITING

Apology note or email to someone

Steps to write an apology note or an email.

The Greeting
The first step is to address the person.
Dear Sir,
Hi,…

The Apology
Next, write what you are apologizing for.
I’m (really) sorry for (not) …
I’m writing to say sorry for...
I apologize for (not) …

The reason What and Why

Say why you want to apologize, describe how you felt when you didn’t accept the
invitation, arrive at the party or come on the meeting …
This section can be one or two sentences, for example:
I couldn’t come to the date because…
It was my pity for not coming to …. because …
Closing
The option that you choose will depend on your relationship with the person.
With love,
Yours truly,
Many thanks,

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Signature
Sign your name here.

1. Read the email below and find out the 5 mistakes.

Dear Dr. William,

I had a appointment to have a health check up with you on Saturday.

But I‟m so sorry to not coming because I will be out of the city on this
weekend for business. I will be free Saturday next. Can we meet you at
your office?

Hope to see you soon

Kind regards,

Mark
2. Study the requirement for the following email and discuss these questions.

You made an appointment with your doctor this Friday to have re-
examination after heart treatment. However, you can‟t go because of some
reasons.
Write an email to your doctor, Mr Robert. In the email, you should:
 Apologize to him (her);
 Explain why you can‟t go;
 Suggest another day when you could meet.
Write about 50 words.

1. What‟s the purpose of the email?

_______________________________________________________________
2.What contents does the email need to address?
_______________________________________________________________
3. How many words does the email include?
_______________________________________________________________

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Dear…………,
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
………………..

FURTHER READING
DEMENTIA
Dementia is a medical term for mental deterioration (worsening), especially in
thought and memory processes. Such worsening of mental condition can be caused by
infection, injury, toxins from alcoholism and tumors, and cerebral arteriosclerosis
(clogging of small arteries in the brain).
The prehensile dementias (Alzheimer‟s
disease) represent a group of degenerative
diseases of the brain in which the mental
deterioration becomes obvious in the middle age
(around 45). Commonly, the first symptom is the
patient becomes unusually unreasonable in his
actions and judgments. He can no longer fully
understand a situation at hand; and therefore,
reacts inappropriately. Memory gradually fades
and recent events are no longer remembered.
However, events that occurred early in life can
Figure 4.10. Dementia.
easily be recalled. The patient may move around
aimlessly and get lost in his own house. There is a progressive deterioration of personal
care and cleanliness. Eventually, the patient loses his command over language and is
unable to express himself clearly. This process, unfortunately, continues weakening the
patient‟s muscular system to the extent that he is finally confined to bed, completely
helpless and dependent on others until he dies.
The mental deterioration in aged patients (above 60) is known as senile dementia.
Whether it is caused by the degenerative processes of the brain or cerebral arteriosclerosis

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is not clear yet. However, it does appear that senile dementia is probably secondary to a
degenerative process similar to that of Alzheimer‟s disease but occurring late in life.
Whether or not dementia can be halted depends very much on its cause. If, for
example, the dementia is the result of some brain infection or exposure to toxins from
alcohol or any other drug, killing the infectious agent or removing the toxins may be very
useful in arresting it. There is no specific cure for any of the degenerative diseases of the
brain.
1. Circle the letter of the best answer.
1. The word “it” refers to _______.
A. prehensile dementia B. brain
C. senile dementia D. the mental deterioration
2. Prehensile dementia can be caused by _______.
A. mental deterioration B. old age C. memory loss D. cerebral tumors
3. The topic of the last paragraph is _______.
A. Causes of Dementia B. Treatment of Dementia
C. Prehensile Dementia D. Senile Dementia
4. Senile dementia is similar to Alzheimer‟s disease in that it _______.
A. is secondary to brain infection
B. occurs late in life
C. is secondary to cerebral arteriosclerosis
D. may be secondary to a degenerative process
5. One of the latest symptoms of dementia is _______.
A. the patient‟s inability to understand a given situation
B. the patient reacts unreasonably to a situation
C. the patient forgets recent events
D. the patient‟s inability to talk properly
6. Both prehensile and senile dementias are alike in that they _______.
A. lead to cerebral arteriosclerosis B. cause mental deterioration
C. occur late in life D. result in brain injury
2. Match the following causes to their effects. Put the letter in the blanks.
CAUSE EFFECT

____ removal of toxins from the A. confinement to bed and complete

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patient helplessness

____ memory loss B. deterioration of thought and memory

process

____ physical weakness C. making wrong judgments

____ inability to think clearly D. inability to remember recent events

____ infection, injury, toxins, tumors E. arrest of dementia due to poisoning

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 Unit 5
TAKING A HISTORY

Objectives: By the end of the unit, students will be able to:

1. Read for main ideas and detail information relating to taking a history;
2. Listen to interviews for details on taking a history;
3. Apply use of the past perfect passive in speaking and writing;
4. Interview for medical history;
5. Write a case history.

GETTING STARTED
Talk about these questions:
1. What kinds of information do doctors try to get in taking a history?
2. Why do doctors need to take a history?
READING
Reading 1: Guide to take a history
1. Read the passage “Guide to take a history”. Then, complete the table using
information from the passage.
Type of history Information included

Past medical history

Social history

Family medical history

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 Guide to take a History
As a medical professional, you should be prepared to take thorough medical
histories. The data you collect reveals important details about a patient.
Doctors use these details to uncover likely causes of medical conditions and
establish diagnoses.
First, get as many details as possible about a patient's complaint. Find out if
the patient has a history of the condition. Ask when the patient experienced the
onset of symptoms. Check what makes it worse and what makes it better.
Then find out about the patient's past medical history. Record any previous
medical problems, especially those that could relate to the current condition.
Other details can also contribute to a useful medical history. A good social
history includes information about the patient's personal habits and lifestyle. A
family medical history reveals conditions that are more likely to occur in a
particular family.
Before any medical procedure, make sure you have an updated record of
the patient's allergies. This way, you avoid exposing patients to medications or
substances that might harm them.

2. Match the words (1-6) with the definitions (A-F).

1 _______ data A the first instance of something
2 _______ complaint B e record of a patient's family's conditions
3 _______ onset C a collection of information
4 _______ family medical history D a condition that causes a reaction or illness
5 _______ procedure E a medical treatment
6 _______ allergy F a pain or illness reported by a patient

3. Read the following sentence pairs. Choose where the words best fit the
blanks.
history of / current
A Paul's family has a __________________ cancer.
B The patient's ___________________ condition was caused by a recent injury.
social history / past medical history
A The patient's ____________________ included her previous surgeries.

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 B The patient's ______________________ included her occupation.

Reading 2

History - taking: Relative importance, obstacles, and techniques

1. In pairs, answer the following questions:
Which patient history information have you practiced to take?
_____________________________ _____________________________
_____________________________ _____________________________
What obstacles have you faced as taking patient medical history?
______________________________ _____________________________
_____________________________ _____________________________
2. Read the text and answer the questions.

History - taking: Relative importance, obstacles, and techniques

Eliciting a full patient history through open-ended questioning and active listening
will ultimately save time while offering critical clues to the diagnosis. In one classic study,
researchers evaluated the relative importance of the medical history, the physical exam,
and diagnostic studies. Physicians were asked to predict their diagnosis after taking just the
history, and then again after performing the history with the physical exam. In 66 of the 80
patients studied, an accurate diagnosis was predicted based solely on the medical history. It
is now estimated that between 70% to 90% of medical diagnoses can be determined by the
history alone; in addition to being one of the oldest diagnostic tools, a comprehensive
history is one of the most reliable.
Despite the importance of the patient history, clinicians frequently interrupt their
patients before they can fully describe their symptoms. A study by Beckman and Frankel
showed that 75% of the time, physicians interrupted their patients after they expressed only
one concern within 18 seconds. Once interrupted, less than 2% of the patients went back to
completing their initial statements. The end result is not only incomplete information but
often a disagreement between patients' and providers' views of the illness and the purpose
of the visit.
When providers interrupt patients, they not only lose key information about the
diagnosis but also risk having the encounter end with an "oh by the way" concern, also
known as "the hidden agenda." While these last-minute issues may not surface until the
end of the visit, the root of this problem often stems from rushing through the history
during the beginning of the visit when unmet concerns are not addressed.

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 Furthermore, some experts note that contrary to common opinion, most patients do
not communicate their primary concern first, and therefore, their most worrisome
symptoms are often left until the end of the appointment or not addressed at all. This
reinforces the need to obtain a patient's entire agenda of concerns at the beginning of the
office visit, which will not only facilitate an accurate diagnosis and treatment, but also
improve time management.
One approach to eliciting patients' concerns is to ask an open-ended question, such as
"Is there something else you want to address in the visit today?"
In a study utilizing this specific question, researchers noted that this intervention
eliminated 78% of unmet concerns and reduced last-minute "oh by the way" complaints.
Interestingly, researchers also found that asking this question did not increase the length of
the visit. Experts recommend using open-ended questions to elicit the patient's full list of
concerns at the beginning of the encounter and then using this list to construct an
appointment agenda. Clinicians can discuss appointment length in addition to their own
concerns regarding the patient's health issues and then together, the patient and provider
can prioritize the concerns and agree on a plan. This approach should ultimately improve
both patient and provider satisfaction as well as diagnostic accuracy.
3. Choose the best answer for each question.
1. Which impact does taking full patient history have?
A. Eliciting patients‟ concerns C. Offering important clues
B. Deciding diagnosis D. Saving time and offering critical clues
2. In classical study, how many patients were accurately predicted based only on
medical history?
A. 70/90 C. 50/70 B. 66/80 D. less than 2%
3. Apart from incomplete information, which end result was caused by doctors’
interruption?
A. Disagreement between patients' and providers' views
B. Disagreement between patients' and nurses
C. Disagreement between patients' and doctors
D. Disagreement between doctors and nurses
4. According to the text, what is the approach to elicit patients’ concerns?
A. Asking as many questions as possible
B. Asking an open – ended question
C. Asking open – ended questions quickly
D. Asking open – ended questions loudly and quickly

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 5. When are open – ended question recommended to use by the experts?
A. As soon as the encounter begins
B. After setting the date for appointment
C. On the phone before the encounter
D. On the second visit
4. Decide each statement as True (T) or False (F).
Based on a classical study, it was estimated that between 70% to
1._______
90% of medical diagnoses could be determined by the history alone.
A patient‟s comprehensive history is one of the most reliable tool of
2. _______
diagnosis.
Clinicians seldom interrupt their patients before they can fully
3. _______
describe their symptoms.
Physicians interrupted patients after they expressed only one
4. _______
concern within 18 seconds.
Actually, more than 2% of the patients went back to completing
5. _______
their initial statements after being interrupted.
Some experts note that, some patients do not communicate their
6. _______
primary concern first.
It is noted that the most worrisome symptoms are often left until the
7. _______
end of the appointment.
Utilizing the specific question intervention could eliminate 78% of
8. _______
unmet concerns and reduced last-minute complaints.
Researchers found that asking an open – ended question increased
9. _______
the length of the visit.
Experts also recommend to use open – ended questions for
10. ______
constructing an appointment agenda.

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 5. Which part or information from the
text above is useful for you? How can you
apply this information in your professional
practice? Discuss with your friends.

LANGUAGE FOCUS

Language focus 1: Past perfect passive

1. Decide if the underlined verbs in the following sentences are in active voice or
passive voice. Fill them in the appropriate column.
1. They had sent the CT films before the operation started.
2. The CT films had been sent before the operation started.
3. The dentist had given this man novocaine before he started working on a cavity
that needed a filling.
4. This man had been given novocaine by the dentist before he started working on a
cavity that needed a filling.

Active voice Passive voice

2. Fill active voice or passive voice to the statements below.

1. When the verb is in the ________________, the subject performs the action.
2. When the verb is in the ________________, the subject receives the action.
3. The _____________ focuses on the person who does the action.
4. The _____________ focuses on the receiver or the result of the action.
3. Forming of Past perfect passive.
Affirmative form Object + had been + verb (past participle) + by Subject

Negative Form Object + had not been + verb (past participle) + by Subject
(had not = hadn’t)

Question form Had + object + been + verb (past participle) + by Subject?

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 Note:
 Sometimes we use the passive voice because we don't know or do not want to
express who performed the action.
 The passive voice is often used in formal texts. Switching to the active voice will
make your writing clearer and easier to read.

Examples:

Active Passive

They had sent the CT films before the The CT films had been sent before the
operation started. operation started.

They hadn’t sent the CT films before the The CT films hadn’t been sent before
operation started. the operation started.

Had they sent the CT films before the Had the CT films been sent before the
operation started? operation started?

4. Complete these sentences by putting the verbs in the past perfect passives.
1. Mr. Wildgoose (note) to have increased thirst and nocturia for the previous 2 weeks.
2. In 1960, a year after diazepam (firstly synthesize), Roche along with Merk and
Lundbeck introduced amitriptyline to the market.
3. The internship (not complete) by the time he left his home country.
4. Measurements of the extent of the corneal displacement (perform) 5 times.
5. A diagnosis of left oculomotor nerve palsy (make) before the patient was sent to
the specialty department for treatment.
6. The tumors (collect) and the weight (measure) after three months post-injection.
7. The patient (admit) to hospital before their family knew.
8. He (diagnose) as having Parkinson‟s disease by the time he was 60.
9. The patient (operate) three days after he was admitted to Department of
Traumatology.
10. The old man (hospitalize) with hypotension one month before he visited his
family doctor for counseling.

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5. Change the following sentences from active to passive voice. Use the past perfect
tense.
1. When we arrived at the hospital, the surgeon had already begun the operation.
_________________________________________________________________
2. Dr. James had given the patient first-aid before the ambulance came.
_________________________________________________________________
3. Dr. Macpherson had prescribed him with frusemide, 20 mg, with good effect in
relieving his breathlessness.
_________________________________________________________________
4. Doctor had advised him to drink plenty of water and continue with his antibiotic.
_________________________________________________________________
5. Physicians had already required her to stay in the isolation area before asking her
to take the test.
_________________________________________________________________
6. It was said that the family doctor had advised her to retire by the time she was 55.
_________________________________________________________________

6. Use the given ideas. Complete the sentences with the past perfect passives.
1. Everybody got better after they had been ________________________________
2. Nobody knew the reason why the epidemics had been ______________________
3. By the time the disease appeared, all of the students had been ________________
4. Many people said before the researchers came, they had been ________________
5. She had been ______________________________________________________

Language focus 2: Asking basic questions in taking a history

1. Study this short dialogue and find how the doctor starts the interview.
Doctor: Well, Mrs. Black. What‟s brought you along today?
Patient: I‟ve got a bad dose of flu.
Doctor: How long has it been bothering you?
Patient: Two or three days.

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 NOTE 1
How the doctor starts the interview:
 What‟s brought you along today?

Other ways of starting an interview are:

 What can I do for you?
 What seems to be the problem?

How the doctor asks how long the problem has lasted.
 How long have they been bothering you?

Another way of asking about this is:

 How long have you had them?

2. Work in pair. Practice this short dialogue. Use the ways of starting an interview,
replying from the list (1), (2) and (3).
Doctor: Well, Mrs. Black. What‟s brought you along today?(1)
Patient: I‟ve got a bad dose of flu. (2)
Doctor: How long has it been bothering you?
Patient: Two or three days. (3)
(1) (2) (3)

What can I do for you? terrible constipation since Tuesday

What seem to be the problem? swollen ankles a fortnight

What problem has brought you

a pain in my stomach for almost a month
here today?

3. Read the dialogue below and practice in pairs. Use the other ways of asking and in
the NOTE 2 below in the list (1) to help you.
Doctor: Which part of your head is affected?
Patient: Just here.
Doctor: Can you describe the pain?
Patient: It‟s a dull sort of ache. (1)

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 a dull of sort ache
NOTE 2
a feeling of pressure
How the doctor asks where the problem is:
very sore, like a knife,
a burning pain  Which part of your head is affected?
Other ways of finding this out are:
4. Read the dialogue below
and underline the question asking  Where does it hurt?
if anything relieves the pain. Do  Where is it sore?
you know other ways to ask How the doctor asks about the type of pain:
similarly?  Can you describe the pain?
Doctor: Where does it hurt?
Other ways of asking this are:
Patient: Right across here.
 What’s the pain like?
Doctor: Can you describe the
 What kind of pain is it?
pain?
Patient: It‟s like a heavy
weight pressing on my chest.
Doctor: Does anything make it better?
Patient: If I stop for a bit, it goes away.

NOTE 3
How the doctor asks if anything relieves the pain of headaches:
 Is there anything that make them better?
Similarly he can ask:
 Does anything make them worse?
Doctors often ask if anything else affects the problem. For example.
 What effect does food have?
 Does lying down help the pain?

5. Work with a partner. Complete the dialogues below. Use all the ways of
questioning you have studied in Languages focus 2.
1. Doctor: ______________________________________________?
Patient: Here, just under my ribs.
Doctor: ______________________________________________?
Patient: It gets worse and worse. Then it goes away.
Doctor: ______________________________________________?
Patient: Food makes it worse.

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 2. Doctor: ______________________________________________?
Patient: It‟s right here.
Doctor: ______________________________________________?
Patient: It‟s a gnawing kind of pain.
Doctor: ______________________________________________?
Patient: Yes, if I eat, it gets better.
3. Doctor: ______________________________________________?
Patient: Down here.
Doctor: ______________________________________________?
Patient: It‟s sharp, stabbing pain. It‟s like a knife.
Doctor: ______________________________________________?
Patient: If I take a deep breath, or cough, it‟s really sore.
4. Doctor: ______________________________________________?
Patient: Down here.
Doctor: ______________________________________________?
Patient: It‟s sharp, stabbing pain. It‟s like a knife.
Doctor: ______________________________________________?
Patient: If I take a deep breath, or cough, it‟s really sore.
Language focus 3: Asking about systems and symptoms
1. Listen to an extract from an interview between a doctor and her patient, a
50-year-old office worker who has complained of feeling tired, lacking energy and not
being herself.
As you listen, indicate whether the patient has a significant complaint or not by
marking the appropriate column with a tick () for each system.
System Complaint No complaint
ENT
RS
CVS
GIS
GUS
CNS
Psychiatric

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 Language focus3:
How the doctor asks about the systems:
 Have you had any trouble with your stomach or bowels?
 What’s your appetite like?
 Any problem with your waterworks?
 What about coughs or wheezing or shortness of breath?
 Have you noticed any weakness or tingling in your limbs?

2. Listen to a physician interviewing a patient admitted to hospital with FUO

(fever of unknown origin). Tick () each point below covered in the interview.
FEVER ACHES & PAINS CVS URINARY
duration head dyspnoea dysuria
frequency teeth palpitations frequency
time eyes ht irregularity strangury
chills abdomen GIS discolouration
sweats chest diarrhoea
night sweat neck melaena NEUROLOGICAL
GENERAL SYMPTOMS loin RESPIRATORY vision
malaise back cough photophobia
weakness pubic coryza blackouts
myalgia muscle sore throat diplopia
weight loss joints dyspnoea
drowsiness bone pleuritic pain
delirium bleeding? SKIN sputum
anorexia nose rash haemoptysis
vomiting skin pruritis
photophobia urine bruising

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 Language focus 3 (cont’): Asking about the symptoms
Listen again and note that the doctor uses rising intonation for these questions:
 Any pain in your muscles?
 Have you lost any weight?
 Have you had cough at all?
 Is there any blood in it?
 Have you had any pains in your chest?
When we ask Yes/No questions like these, we normally use rising intonation. Note that
the voice changes on the important word.
For example: Any pain in your muscles?

3. Match each of the suspected problems in the first column with a suitable
questions from the second column. For example: 1c.
Suspected problem Question

1 depression A Have you had any pain in your chest?

2 cardiac failure B Do you ever get wheezy?

3 asthma C What sort of mood have you been in recently?

4 prostate D Any problem with your waterworks?

5 coronary thrombosis E Have you ever coughed up blood?

6 cancer of the lung F Have you had any shortness of breath?

4. Work in pairs. Student A should start.

A: Play the part of the doctor. Ask questions about systems and specific problems for
each of these cases.
1. The patient is a man in late middle age. He has coughed up blood several times in
the last few weeks.
2. The patient is an elderly man. He has been getting more and more constipated over
the past few months.
3. The patients is a middle aged woman. She gets pain in her stomach after meals.

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 B: Play the part of the patients. Use the information given below for each case above.
1. You are a 60-year-old electrician (male). You have coughed up blood several
times over the last few weeks. You have noticed that you‟re losing weight. Your clothes
don‟t fit you properly. You smoke 30 cigarettes a day.
2. You are 68. You are a retired schoolteacher (male). You have been getting more
and more constipated over the past few months. You‟ve noticed blood in your stools. You
have been losing weight.
3. You are 45. You are a housewife. You have three children. You get a pain in your
stomach after meals. Sometimes you feel squeamish. Fried and oily foods seem to be
worst.

LISTENING
A CASE HISTORY
1. Work in pairs. What do you think each patient in pictures a – h might be
complaining of?

a c
b

d e f

h
g

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 2. Listen and match each picture in 1 with a conversation.
1. ____________ 2. ____________ 3.____________ 4. ____________
5. ____________ 6. ____________ 7.____________ 8. ____________

3. Listen to the conversation between Mr. Bloomfield, a 28 year-old civil

servant, and a local general practitioner, Dr. Dickson and complete the notes below.

Present complaints
C/O breathlessness, 3/52
(1)_______________, (2) ______________, productive (3) _______________
with white (4)_________________
History of present complaints
Attacks worse: (5) _______________ and (6) _________________
Cough wakes patient about (7) ________________ times/week
Other symptoms: chest (8)___________________
Contributory causes: no (9) _______________________ precipitants; history
suggests (10) __________________.
Past medical history
No history of (11) _________________ attacks
Family History
Mother/sister: (12) _________________________

4. Work in pairs. Take turns role-playing the conversation between Dr. Dickson
and Mr. Bloomfield. Use the notes from the exercise to guide you.
5. With a partner, discuss why the past medical history, family history, personal
and social history, and drugs and allergy history are important?

SPEAKING

TAKING A HISTORY
1. Tick () the things a doctor needs to do before taking a patient history.
Greeting patients and introduce yourself
Ask for patients‟ personal details

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 What is your name?
How old are you?
“Hello, I‟m Dr. Suzuki.
What is your job? Please sit down. It is
Where do you live? Mary Jones, isn‟t it?”

Greeting patients will create welcoming

and comfortable environment, and
respect and interest in patients.

2. Match the parts in taking a history (1-8) to the information (a-h).

1 Present a At this stage, patients should be encouraged to
complaints/illnesses describe general state of health, spontaneous
symptoms to check any additional problems.

2 History of present b It is to give patients the chance to express their own

complaints/illnesses ideas and concern about their problem and to know
their expectations.

3 Past medical history c It is essential to obtain full details of drugs,

medications taken by a patient (including the type of
drug, the dose used, the frequency and the patient‟s
compliance) and drug allergies.

4 Medication history d This section records the patient‟s symptoms.

5 Family history e This collects the patient‟s health in general and in the past.

6 Social history f It provides further information of the

problem/complaint, such as the onset, character of the
onset, duration, frequency, the course, location,
quality, quantity, and alleviating factors.

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 7 Review of system g It includes relevant information about occupation,
housing, personal habits (recreation, physical exercise,
alcohol and tobacco), work environment, etc.
8 Asking for a patient‟s h By asking this, a doctor will have more information
ideas, concerns & of a patient‟s family health.
expectations

3. Work in pairs.
3.1. Place the information (1-8) to each group of questions below.
1. Asking about the chief complaints 7. Asking about duration
2. Asking about location 8. Asking about type of pain and severity of
3. Asking about relieving problem
and aggravatingproblem 9. Asking about other symptoms
4. Asking about past medical 10. Asking about medication history
history 11. Asking about social history
5. Asking about family history 12. Asking about patient‟s ideas, concerns &
6. Asking about systems expectations

A Asking about the chief complaints B

What problems have brought you here today? When did the pain start/begin?
What‟s been troubling you? How long have you been having this pain?
What seems to be the problem? How long has the pain lasted?
How can I help you? How often do you have the pain?
What can I do for you?

C D

Where does it hurt What‟s the pain like?

Where is it sore? What kind of pain it is?
Show me where the problem is? Can you describe the pain?
Which part of your head is affected Is it bad enough to wake you up?
Does it stay in one place or does it go Does it affect your work?
anywhere else? Is it continue or does it come and go?
How long does it last?

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 E F
Is there anything that makes it better/worse? Have you noticed anything else?
Does anything make it better/worse Apart from your headache, are there any
other problems

G H

Have you had anything like this before? Have you taken anything for it?
How have you been keeping up to now? What do you take?
Have you ever been admitted to the hospital? Did the tablets help?
Has there been any change in your health since Do you know if you have any drug
your last visit? allergies?

I J
Are your parents alive and well? Do you have any children?
How old was he when he died? Who do you live with?
What did he die of? Is there any stress at home?
Do you know the cause of death? Do you have any troubles at work?
Does anyone in your family suffer from this Do you smoke?
problem? How many do you smoke a day?
Do you drink?
How much do you usually drink a week?

K L

Have you been feeling in general? How do you think you got this problem?
What is your appetite like? Do you have any ideas about this?
Have you had any loss or gain weight? Do you have any concerns?
How many kilos did you lose? What are your worries about this?
Have you noticed any headaches? What do you think will happen?
Do you have any problems with sleeping? What you expect from me?
Have you had any coughing? What were you hoping we could do for
you?
3.2. Please indicate the questions above as Open (O) or Close (C).

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 4. Fill Open question or Closed question to the appropriate statements (a-c) below.
_________ can usually be answered with one or two words.
_________ are used to elicit specific pieces of information. Sometimes the answer is
vague.
_________ usually can‟t be answered with just one or two words, but encourages a
patient to explain more.
5. Indicate the question used in the conversation (1-3) as Open or Close.
1 _____________ 2 ____________ 3 _____________

2 Doctor: Can you tell me more about

your the pain?
1 Doctor: Are you sleeping well?
Patient: I keep getting this terrible
Patient: Yes, I am.
pain down my left arm.

3 Doctor: Are you sleeping well?

Patient: Yes, I am.

6. Study this extract from a case history.

The patient was a 59-year-old man, head of a small engineering firm (1), who
complained of a central chest pain (2) which occurred on exertions (3) and was
sometimes accompanied by sweating (4). He smoked 40 cigarettes a day (5). The pain
had first appeared three moths previously (6) and was becoming increasingly frequent
(7). He had noticed some weight gain recently (4 kg) (8) and also complained that his
hair had become very dull and lifeless. He felt the cold much more than he used to. He
denied any palpitations (9) or ankle oedema (10).

What questions might a doctor ask a patient to obtain the underlined content in the
case history? Use the questions studied in 1 and 6.2. You may ask more than one question
for each piece of information.

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 For example:

1 What is your job?

2 What‟s brought you along today? Which part of your chest is affected?

10

7. Read the case information and fill in the doctor’s note below.

Patient Information:
Name: Mr. Peter Wilson
Sex: M Marital status: M
Occupation: Steelrope worker Age: 48
You had an attack of chest pain last night. The pain was behind your
breastbone. You also had an aching pain in your neck and right arm. The pain lasted
15 minutes. You were very restless and couldn‟t sleep. You‟ve also been coughing
up rusty colored spit.

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 For the past year you‟ve suffered from breathlessness when you walk uphill
or climb stairs. You‟ve had a cough for some years. You often bring phlegm. In
the past three weeks on three occasions you‟ve felt a tight pain in the middle of
your chest. The pain has spread to your right arm. There pains happened when you
were working in the garden. They lasted a few minutes. Your ankles feel puffy.
You find that your shoes feel tight by the evening although this swelling goes
away after you‟ve had a night‟s rest. You‟ve had cramp pain in your right calf for
the last month whenever you walk any distance. If you rest, the pains go away.
You‟ve been in good health in the past although you had whooping cough
and wheezy bronchitis as a child. You smoke 20 to 30 cigarettes a day. Your
mother is still alive, aged 80. Your father died of a heart attack when he was 56.
You have one sister. She had TB when she was younger.

Doctor’s notes:
Surname Wilson First name Peter
Age 48 Sex M Marital status M
Occupation
Present complaint

History of present complaint

Past medical history

Social history Family history

8. Work in pairs. Student B should start.

A: Play the part of a patient. Use the information provided in the patient information
and the doctor‟s notes to help you.

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 B: Play the part of the doctor. Try to find out what the patient‟s problems are.
Remember to start the consultation by greeting the patient and asking personal details
Eg: Good morning. Take a sit. I am Dr. Suzuki. ……………

WRITING
A CASE HISTORY
1. Answer the following questions.
1. What information is included in a case history?
________________________________________
2. Have you ever written a case history?
________________________________________
3. Where can you find the information to write up a case history?
________________________________________

2. Study the structure of a case history below

It establishes the focus to the case and provides orientation to
1. Introduction readers. It should consist of a few clear and concise opening
statements, which typically include information on name, age,
marital status, occupation, referral details, central problem.
This should be a detailed account of the patient's central
2. History of
problem that you have already identified in your opening
presenting
statement. The details about the problem and related symptoms
complaint
are organized in a chronological order.
In this section of the report, you need to show the relationship
3. Past medical
between current medical conditions and symptoms, with those in
history
the past and the complexity of medical problems.
5. Medication This past presents medications taken by the patient that may
history influence the patient's symptom.
It includes details of family members, and family history of the
6. Family history
symptoms.
Some information may include early development, childhood,
7. Social history school, adolescence, occupation, sexual history, marital history,
children, social network, habits, leisure, etc.

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 3. Study the case history and find the information about the patient
1. previous occupation _______________________________
2. central problem _______________________________
3. condition immediately _______________________________
prior to admission _______________________________
4. reasons for emergency _______________________________
Admission _______________________________
5. duration of increased thirst _______________________________
and nocturia _______________________________
6. father‟s cause of death _______________________________
7. alcohol consumption _______________________________

CASE HISTORY
Mr. Wildgoose, a retired bus driver, was unwell and in bed with a cough and
general malaise when he called in his general practitioner. A lower respiratory tract
infection was diagnosed and erythromycin prescribed.
Two days later, at a second home visit, he was found to be a little breathless and
complaining that he felt worse. He was advised to drink plenty of water and to continue
with his antibiotic. Another two days passed and the general practitioner returned to
find the patient breathless at rest. Emergency admission to hospital was hospital was
arranged on the grounds of “severe chest infection”.
On arrival in the ward, he was unable to give any history but it was ascertained
from his wife that he had been confused and unable to get up for the previous 24 hours.
He had been incontinent of urine on a few occasions during this time. He had been
noted to have increased thirst and nocturia for the previous 2 weeks.
His past history included appendicectomy at age 11 years, cervical spondylosis
10 years ago, and hypertention for which he had been taking a thiazide diuretic for
3 years. His father had died at 62 years of myocardial infarction and his mother had had
rheumatoid arthritis. His wife kept generally well but had also had a throat infection the
previous week. Mr. Wildgoose drank little alcohol and had stopped smoking 2 years
previously.

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 5. Study the case history again and underline the following parts.
Introduction
History of presenting complaint
Past medical history
Family history
Social history
6. Study the case history again and answer the questions.
1. Were the details about the problem and related symptoms organized in a
chronological order? What is it?
______________________________________________________
2. What is the role of these time expressions in the case history?
Two days later, ….
Another two days ….
…..for the previous 24 hours.
7. Make up the introduction below, using the given words.
Lucy / 34 year-old / single mother / live with her fiance and 5 year-old son.
______________________________________________________
______________________________________________________
Lucy / refer / Monash Medical Centre / by / general practice / with / 4-week history
of headache.
______________________________________________________
______________________________________________________
8. Complete the extract from the case report written by Dr. Martin after the
consultation with Mr. Wood. Insert the verbs in the correct form into the appropriate
blank space.
present have be (x2) smoke work radiate
A 49 year-old man (1) presented in A & E with chest pain. He had had the pain for 3
hours prior to arrival. The pain (2) ___________ in the centre of his chest and (3)
_________ to his left shoulder.
He (4) _________ a history of chest pain on exercise, which has been present for
previous six months.

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 He (5) __________ approximately 20 cigarettes a day and (6) __________ teetotal.
He has been prescribed aspirin, B-blockers for the previous two years, and a GTN spray to
use as required, which is two to three times per week. His father dies of myocardial
infarction aged 65. He (7) __________ as a gallery attendant.

9. Use the notes below to write out a case history. Then, compare your writing
with your partner.

- 35 year-old woman Mrs Bentley telephoned A&E/3am c/o severe

vomiting/five hours duration/very loose motions several times/same
period/some cramping pains/central/lower abdomen/started about six
hours prior/call.
- no smoke and alcohol/previous evening egg mayonnaise
sandwiches - way home from work.
- no dysuria/periods regular/last menstrual period two weeks ago/
appendicectomy 15 years before - nullipara.

____________________________________________________________________
____________________________________________________________________

____________________________________________________________________
____________________________________________________________________

____________________________________________________________________
____________________________________________________________________

____________________________________________________________________

FURTHER PRACTICE

READING
Routine Checkups
0 D - Website excerpt

The main aim of the website is to offer advice on the required or recommended
check-ups that everyone should have annually. You will learn why you should treat check-
ups as a mandatory activity and depending on whether you are a woman or man which

136
diseases you can screen for. Moreover, you will obtain information on how to prepare to a
check-up so that it is effective and reliable.
1
Is there anything more important than your health and the health of your relatives?
Of course there isn‟t, so it‟s time you took charge of your health and scheduled
an appointment with your doctor to discuss the tests and screenings you need. This will
help identify health problems before they start or at their early stage, when you have better
chances for a successful treatment. This is the best thing you can do to stay healthy!
2

First of all you need to review your family health history. It is one of the most
important risk factors for serious health problems such as heart disease, stroke,
diabetes and cancer. When you present your family health history to your specialist,
they will assess the risk of a disease and recommend measures you can take to
prevent it, such as doing exercise, changing your diet and so on.
3

Regardless of your gender, the one thing you should get is an annual blood test. It is
the most important step an adult person can take to prevent life-threatening diseases, as its
results can help you notice any critical changes in your body before they manifest as a
serious health issue.
There are many blood tests you can get, but the most important ones are the complete
blood count, the chemistry panel and the fibrinogen. Let‟s now explain what each
procedure involves. The complete blood count offers information on the number,
percentage and concentration of platelets, red blood cells, and white blood cells.
Therefore, it is useful in the detection of such health disorders as an infection and anemia.
The chemistry panel gives information on such parameters as total cholesterol,
high-density and low-density lipo-protein (HDL and LDL) or blood glucose. This can help
detect problems such as diabetes and coronary artery disease.
The fibrinogen level test‟s importance cannot be underestimated as well. The level of
fibrinogen increases when tissue inflammation occurs, and since atherosclerosis and heart
disease are inflammatory processes, this test can help assess the risk of heart disease and
stroke.
With the blood test done, you should also screen for various types of cancer, some of
which may affect both men and women, e.g. colorectal cancer. There are a few screening

137
methods to detect it, of which colonoscopy is most accurate. You should have the test done
if you are over 50, or younger if there were cases of colorectal cancer in your family.
One other thing everyone should monitor regardless of their gender is their Body
Mass Index - BMI. With obesity being a serious social issue in developed countries, it‟s
good to be aware whether you are overweight and should think about your diet more
carefully.
4

If you are a female, then apart from the aforementioned tests and screenings, you
should have a BRCA genetic test done. This is the test of two genes, BRCA 1 and BRCA 2,
which are responsible for the production of tumor suppressor protein. When these genes
are mutated or altered in any way, cells are more likely to develop genetic abnormalities
leading to cancer, in particular breast cancer. Another type of cancer that women should
screen for is cervical cancer. The test which facilitates its detection is called a Pap smear
and it should be done every three years.
5

If you are an over 50 man, you should definitely get screened for abdominal aortic
aneurysm, especially if you have ever been a smoker. Abdominal aortic aneurysm, or
AAA for short, is a bulging in the body‟s largest artery - the abdominal aorta. AAA may
burst which can result in severe bleeding or even death. To verify whether you are at risk
of AAA occurrence, you can have ultrasound examination done, which is absolutely
painless.
A type of cancer that is male-specific is called prostate cancer. The test commonly
used to screen for it is called DRE, which stands for digital rectal exam. It involves a
manual examination of the rectum to estimate the size of the prostate and feel for any
lumps or abnormalities.
1. Read the reading above. Match the headings (A-F) to an appropriate
paragraph.
I am a woman, what should I check?
How should I prepare?
Why check-ups matter
Website excerpt
What are the fundamental things to check?
I am a man, what should I check?
2. Scan the reading and summarize the contentsmentioned in each paragraph.

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 1

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
3. Read the text again and write a short explanation for the following
words/word phrases. Use dictionary to help you.
mandatory __________________________________________________
measures __________________________________________________
chemistry panel __________________________________________________
fibrinogen __________________________________________________
platelets __________________________________________________

139
 detection __________________________________________________
parameters __________________________________________________
atherosclerosis __________________________________________________
stroke __________________________________________________
monitor __________________________________________________
colorectal cancer __________________________________________________
colonoscopy __________________________________________________
aneurysm __________________________________________________
prostate cancer __________________________________________________
lumps __________________________________________________

LISTENING

1. Listen to an interview between a doctor and a patient. Circle the correct

answer for each question.
1. What‘s brought the patient to the doctor?
A. He has headache.
B. He has flu.
C. He has gained weight.
D. He is worried about his weight.
2. When did the patient’s wife pass away?
A. recently B. 4 months ago
C. 14 months ago D. 5 months ago
3. Which part of the patient’s head is affected?
A. on the top B. on the right side
C. on the left side D. at the centre
4. How does the patient feel?
A. worried B. feeling down
C. something heavy pressing down D. tired
5. What’s the patient’s appetite like
A. hasn‟t been like eating B. hasn‟t feel differently
C. doesn‟t like meat D. finds everything delicous

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 2. Listen again and complete the present complaints of the case notes below.
SURNAME Hudson FIRST NAMES William Henry

Age 65 Marital status

OCCUPATION Retired postmaster

Present complaint

History of present complaint

Review of other system

Social history

3. Listen again and fill in the blanks with one or two words.
Doctor: Good afternoon, Mr. Hudson. Just have a seat. I haven‟t seen you for a good
long time. What‟s brought you along here today?
Patient: Well, doctor. I‟ve been having these (1) ______ and I seem to be have lost
some weight and …
Doctor: I see, and how long have these (2)__________ been bothering you?
Patient: Well, I don‟t know. For quite a while now. The wife passed away you
know, about (3) _________ ________ ago. And I‟ve been feeling down since then.
Doctor: And which part of your head is affected?
Patient: Just here. Just here on the (4) ___________. It feels as if there were
something heavy, a heavy (5) _____________ pressing down on me.
Doctor: I see, and have they affected your vision at all?
Patient: No, no I wouldn‟t say so.
Doctor: Not even seeing lights or black spots?
Patient: No, nothing like that.
Doctor: And they haven‟t made you feel sick at all?
Patient: No.

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 Doctor: Now, you told me that you‟ve lost some weight. What‟s your appetite been
like?
Patient: Well, actually I haven‟t really been feeling (6) _________ eating. I‟ve
really been off my food for the moment and …
Doctor: And what about your bowels, any problems?
Patient: No, no they‟re. I‟m quite all right, no (7) ____________.
Doctor: And what about your waterworks?
Patient: Well, I‟ve been having trouble getting started and I have to, I seem to have
to get up during the (8)____________, two or three times at night.
Doctor: And has this come on recently?
Patient: Well, no, not exactly. I think I‟ve noticed it (9) __________ over the past,
the past few months.
Doctor: And do you get any pain when you‟re passing (10) ______________?
Patient: No, no.
Doctor: And have you noticed any blood, any traces of blood?
Patient: No, no, I can‟t say that I have.

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 Unit 6
EXAMINATION AND INVESTIGATIONS

Objectives: After the lesson, students will be able to:

1. Apply polite request and some phrasal verbs to give instructions to patients;
2. Read and understand physical examination and some investigations.;
3. Give instructions to patients as well as explain and reassure patients about the
investigations;
4. Listen for instructions, blood tests and gastroscopy;
5. Describe the results of the biochemistry and haematology lab report in basic
sentences.

GETTING STARTED
Look at the pictures and answer the questions:
1. What are the doctors in the following pictures doing?
2. Do these actions belong to an examination or an investigation?

1. __________________________ 2. _________________________

3. __________________________ 4. _________________________

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READING

Reading 1: Physical examinations

1. Before you read the passage, discuss these questions:
1. What do doctors look for during a physical examination?
2. What is involved in giving a physical examination?
3. What does checking a patient‟s vital signs mean?
4. What physical conditions are hard to find during a physical examination?

2. Read the two passages below. Then, choose the correct answers.
A physical examination
History taking is generally followed by physical examination or clinical examination
- the process by which a doctor investigates the body of a patient for signs of disease.
Generally, there are four parts of physical examination:
Inspection: looking for signs
Palpation: feeling for signs
Percussion: tapping for signs, used when doing a lung and / or gut examination.
Auscultation: listening using the stethoscope, or in olden times, purely listening with
direct ear

144
 Whatever part of the patient is examined, whatever disease is suspected, the four
motions must be done.
In that order, you look first then feel; when you have felt, you may tap, but not
before; and last of all comes the stethoscope.
The examination will cover most of the basic system of the body, including the heart
system, lung system, gastrointestinal system and nerve system examination.

Giving a physical examination for providers of medical care

A physical examination is one of the most basic of medical care procedures.
Follow these simple steps to be sure that your exams are thorough
and effective every time.
Make sure the patient is comfortable and that the examination environment is
optional.
Check vital signs. With the patient sitting, take his/her temperature using an oral
thermometer. Then measure the patient‟s pulse. Use a stethoscope to conduct auscultation
of the patient‟s breathing.
Have the patient lie down. Use percussion techniques to check the condition of
organs beneath the abdomen.
Conduct a general inspection of physical body parts. Check the arms, legs, back, and
neck with palpation. Evaluate the patient‟s posture. Make observations of the patient‟s
body language. It can reveal symptoms that affect the diagnosis.

1. What does the first passage instruct doctors to do?

A. collect demographic data B. perform a physical exam
C. assess body build and affect D. perform auscultation
2. What should doctors do while performing palpation of the skin?
A. check for abnormal spots B. look for patient discomfort
C. listen for irregular sounds D. assess body build and affect
3. What does listening to in physical examination refer to?
A. palpation C. percussion
B. inspection D. auscultation
4.What is the purpose of the instructions in the second passage?
A. to explain how to give a physical examination
B. to demonstrate how body language affects vital signs
C. to compare percussion and auscultation techniques

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 D. to describe the importance of physical examinations
5. Which of the following is NOT an aspect of checking vital signs?
A. checking pulse C. taking temperature
B. doing auscultation D. evaluating posture
6. What is a thermometer used to?
A. to listen to a patient‟s heart and lungs
B. to take a patient‟s temperature
C. to check a patient‟s pulse
D. to make sure the examination environment is optimal
7. What is one purpose of percussion techniques?
A. to measure a patient‟s pulse
B. to determine the quality of a patient‟s breathing
C. to check the condition of internal organs
D. to evaluate a patient‟s mood
8. Which of the following refers to checking neck, back, arms, and legs?
A. auscultation C. percussion
B. inspection D. palpation
3. Write a word that has the similar meaning to the underlined part.
1. The doctor performs the process of examining the body by
p________
touch. He is checking for tender areas.

2. The doctor performed an investigation of the patient‟s ear. i_________

3. Through watching carefully the doctor noticed that the patient

o__________
was limping.

4. The doctor examined the patient‟s body by tapping various parts

p_________
such as abdomen and chest.

5. The doctor performs the process of examining the patient‟s

body by listening to the heart and lungs. He is checking for any a _ _ _ _ _ _ _ _ _ _
irregular sounds.

Reading 2: Taking blood

1. Work in pairs. Match 1-7 in the illustrations to words a-g.

146
tourniquet sterile field crook of the elbow clenched fist pillow

3 4
1

5 6

a. antiseptic wipe ___________

b. cotton ball ___________
c. needle ___________
d. plaster ___________
e. spicemen tube ___________
f. syringe ___________
g. tourniquet ___________
2. Read the instructions a doctor giving to a patient having a blood test. Then,
answer the questions:
Doctor: I need to take some blood for a blood test, OK?

Patient: Yes, that‟s fine.

Doctor: Could you hold out your arm for me, please? Now, put your arm on
the pillow for support. That‟s right. I‟ll get you to tilt your arm down
to help the blood fill your veins. I‟ll wrap the tourniquet around your
upper arm so your veins will stand out better. I‟d like you to make a
fist to help as well. That‟s it. Please don‟t pump your hand or it will

147
 give a false reading. I‟m going to look for a vein in the crook of your
elbow now.

Patient: OK.

Doctor: OK. Now I‟m just going to slide the needle into your vein.

Patient: All right.

Doctor: You‟ll feel a little sting but I need you to hold your arm still.

Patient: Ooh, yes. I felt that.

Doctor: That‟s it. Now, I‟ll take the needle out.

Patient: Thanks.

Doctor: I‟ll put on a plaster and get you to apply some pressure for a few
minutes.

Patient: Will do. Thanks.

1. What‟s the first thing the patient has to do in taking blood?

_________________________________________________________________
2. Why does the doctor use a tourniquet before taking the blood?
_________________________________________________________________
3. Does the doctor want the patient to pump their hand a few times?
_________________________________________________________________
4. Did the patient feel any discomfort when the doctor inserts the needle?
_________________________________________________________________
5. What does the patient need to do when the doctor finishes taking the blood sample?
_________________________________________________________________
3. Match the instructions 1-8 with the reasons for the instructions A-H.
1._____ Could you hold out your arm for me, A. to help the blood fill your
please? veins

2._____ Now, put your arm on the pillow B. or it will give a false reading

3._____ I‟ll get you tilt your arm down C. to take the blood

4._____ I‟ll wrap the tourniquet around your upper D. for support
arm

148
 5._____Please don‟t pump your hand E. to prevent bruising

6._____ I‟m going to look for a vein in the crook F. so I can do a blood test
of your elbow

7._____ Now I‟m just going to slide the needle into G. because it‟s usually easier
your vein there

8._____ I‟ll get you to apply some pressure for a H. so your veins will stand out
few minutes better

Reading 3: Investigations – Common blood tests

1. Read the following text and answer the questions below:
After physical examination the physician makes an initial diagnosis which must be
confirmed by laboratory findings and imaging technologies before the treatment is decided
upon. The most common laboratory findings are biopsy, blood and urinary testing.
Imaging studies include radiography (X-ray), ultrasound investigation, computed
tomography (CT), electrocardiography (ECG), electroencephalography (EEG),
magnetic resonance imaging (MRI).
Full blood counts are performed to assess the overall health of a patient. It checks for
blood abnormalities such as anaemia by checking the haemoglobin level (Hb). It can also
test the white cell count or WCC. Increased white cell counts may be found when patients
have an infection. Increases in platelets can also be tested in the full blood count and may
indicate a bleeding disorder.
Fasting blood glucose levels are blood tests which are used to screen for diabetes.
Sometimes an oral glucose tolerance test is used at the same time. The oral glucose
tolerance test or OGTT is performed by giving the patient a very sweet drink and then
checking the effect on the body by taking a blood sample. Several blood samples are taken
at regular intervals.
Patients on anticoagulant medication need regular blood tests to check clotting times
and monitor the efficiency of the medication. Blood is taken for an INR test and the dose
of the patient‟s anti-clotting medication is regulated so that the patient is not under-dosed
and runs the risk of forming blood clots or over-dosed and runs the risk of heavy bleeding.

1. What are some ways tests can be performed?

_________________________________________________________________

149
 2. How can doctors reduce anxiety in patients who are nervous about having blood
taken?
_________________________________________________________________
3. What are some of the reasons that blood tests are performed?
_________________________________________________________________
4. What kinds of test are used to check glucose levels?
_________________________________________________________________
5. What is one of the reasons that an INR test is done?
_________________________________________________________________
2. Match the questions 1-5 with the correct answers A-E.
1. What is the blood test for? A. It‟s to check for protein.

2. Why are you taking a swab from my B. It‟s to check your capillary blood sugar
nose? level.

3. Why are you testing my urine? C. It‟s to check for infection.

4. Why are you taking blood from my D. It‟s to check your white cell count.
finger?

5. Why are you taking a swab of the E. It‟s to check for MRSA.
wound?

Reading 4: Some useful information about gastroscopy

1. Work in pairs. Read the given headings of the leaflet about gastroscopy and
decide what information each part of the text contains.
_____________________________________
What preparation do I
need to do? _____________________________________
_____________________________________

_____________________________________
What can I expect
_____________________________________
after a gastroscopy?
_____________________________________

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 _____________________________________
Is gastroscopy _____________________________________
reliable?
_____________________________________

_____________________________________
Are there any side effects
_____________________________________
or complications from
having a gastroscopy? _____________________________________
_____________________________________

2. Find words or phrases in the text with the same meaning as the followings:
1. avoid food _____________________________________
2. calm _____________________________________
3. use anything mechanical _____________________________________
4. a friend to take you home _____________________________________
5. not 100% reliable _____________________________________
6. a painful pharynx _____________________________________

Are there any side effects or complications

from having a gastroscopy?

? Most gastroscopies are done without any

problem. Some people have a mild sore
throat for a day or so afterwards. You may
feel tired or sleepy for several hours if you
have a sedative. There is a slightly
increased risk of developing a chest
What preparation do I need to do? infection or pneumonia following a
The hospital department will usually give gastroscopy.
you instructions before your test. These Occasionally, the endoscope causes some
commonly include: damage to the gut. This may cause
* Don‟t eat for 4-6 hours before the tests. bleeding, infection, and rarely, perforation.
The stomach needs to be empty. (Small sips If any of the following occur within 48
of water may be allowed up to two hours hours after a gastroscopy, consult a doctor
before the test.) immediately:

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* If you have a sedative, have somebody * Abdominal pain;
accompany you home. * Fever;
* If you are taking any other medication, tell * Difficulty breathing;
your doctor. It may need to be stopped
before the test. * Vomiting blood.
A small number of people have a heart
What can I expect after a gastroscopy?
attack or stroke during, or soon after, a
Most people are ready to go home after gastroscopy. These serious complications
resting for half an hour or so. are rare in most people who are otherwise
If you have had a sedative, you may take a reasonably healthy.
bit longer to be ready to go home. The
sedative will normally make you feel quite
pleasant and relaxed. However, you should
not drive, operate machinery or drink
alcohol for 24 hours after having the
sedative. You will need somebody to
accompany you home and to stay with you
for 24 hours until the effects have fully
worn off. Most people are able to resume
normal activities after 24 hours.

Is gastroscopy reliable?
Gastroscopy is a good test for seeing
abnormalities in the upper gut. However, it
is not foolproof. For example, gastroscopy
may not detect a small number of cases of
early ulcers or early cancer.

3. Work in pairs. Use the given words and the text to help you make the
questions. Then answer them.
1. What / need 4-6 hours before?
___________________________________________________________________
2. How / sedative / feel?
___________________________________________________________________
3. What / not / do?
___________________________________________________________________
4. What / need / after the operation?

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 ___________________________________________________________________
5. How successful / test?
___________________________________________________________________
6. What / some people have afterwards?
___________________________________________________________________

LANGUAGE FOCUS

Language focus 1: Giving instructions

Giving instructions
Examples
to a patient

- Take off your coat, please.

1. Imperative - Stand up.
(To soften imperatives, - Bend your head forward for me, please.
add for me, please) - Keep your knees and feet steady.
- Go back to the centre.

2. Can / Could (Could Could / Can you (just) + infinitive without TO + (please)?
is slightly gentler than - Could / Can you (just) bend down as far as you can, please.
Can). - Could / Can you (just) bend your head forward for me, please.
3. Would you +
infinitive without TO + - Would you slip off your top things?
(please)?
- Now I just want to see you standing.
- Now I’d like to see you lean backward.
4. I would like you to / I
- I would like you to slide your right and down the right side of
want you to + verb.
your thigh.
- Now would you like to lie onto the couch?

5. Useful expressions Now OK That‟s it

for softening Just That‟s fine Fine

1. Work in pairs. Decide which of these instructions are inappropriate to use

with a patient.
1. Could you just lie on your left side for me?

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 2. If you could just pop off your clothes and then…
3. On the left side, please.
4. Just bring your legs up to your chest. Yes, like that and relax. I‟m just going to…
5. Can you just bend your knees towards your chin and curl your neck?
6. I‟d like you to stand up for me, if you can.
2. You want to examine a patient. Match the examinations in the first column
with the instructions in the second column.
Examinations Instructions

1. ___D___The throat Remove your sock and shoe.

2. _______The ears Remove your top clothing.
3. _______The chest Turn your head this way.
4. _______The back Open your mouth.
5. _______The foot Tilt your head back.
6. _______The nasal passage Stand up.

3. Practise with a partner what you would say to a patient when carrying out
these examinations using the information in the above exercise. For examples:
- I’d just like to examine your throat. Could you please open your mouth as wide as
you can?

Language focus 2: Phrasal verbs connected with the body

= relax muscles / We always do exercises to loosen

loosen up /
warm up parts of the body up / warm up before playing
tennis.

= turn quickly I swung round when I heard my

swing around / name and saw Jude running towards
round
me.

tense up = stress “Relax! Don‟t tense up and you‟ll

float!” said the swimming
instructor.

= get warm “Ooh! It was freezing outside! Turn

thaw out
the heater on! I need to thaw out”.

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 = get thinner and Poor old Mrs Jones is just wasting
waste away
weaker away. She‟s been ill, poor woman.

pick yourself up = stand up again (Parent to child who has just fallen).
“Come on, pick yourself up! Don‟t
cry! You‟re OK.”

= bend / fold When she told me, it was so funny I

double up / over (because of pain just doubled up laughing.
or laughter)

(to somebody who is trying on a

turn around / = change position / skirt). “Turn around, let me see it
round (sb/th) from behind.”
direction
- He turned the car around and
drove back home.

1. Answer these questions using one of the phrasal verbs on the table above..
1. What do you normally need to do before starting on an exercise routine?
_______________________________________________________________
2. If you have been outside for a long time on a very cold day, what may it take you
some time to do when you go indoors again?
_______________________________________________________________
3. What do you have to do if you fall over?
_______________________________________________________________
4. What do you do if you hear a sudden noise behind you?
_______________________________________________________________
5. What happens to your muscles if you are feeling very anxious?
_______________________________________________________________
6. What happens if someone doesn‟t eat enough over a long period of time?
_______________________________________________________________
2. Rewrite each sentence using the verb in brackets in an appropriate form.

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 1. You must be freezing – do come inside and get warm. (thaw)
_______________________________________________________________
2. Look at me – now face in the opposite direction. (turn)
_______________________________________________________________
3. The taxi driver stood up again after he tripped over the suitcase. (pick)
_______________________________________________________________
4. If you don‟t eat more, you‟ll get far too skinny. (waste)
_______________________________________________________________
5. The stand-up comic was so good that we spent the evening in fits of laughter.
(double)
_______________________________________________________________

LISTENING

Listening 1: Giving instructions

1. Listen to the instructions from a neurologist and put these drawings in the
correct order.

A. B. C.

D. E. F.

2. Listen to the instructions again and fill in the blanks. Then practise
speaking by role play.

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Doctor: Would you slip off your top things, please? Now I just want to see you
standing. Hands by your side. You‟re sticking that hip out a little bit, aren‟t
you?

Patient: Yes, well, I can‟t straighten up easily.

Doctor: Could you (1)______ (2)_____ as far as you can with your knees straight
and stop when you‟ve had enough.

Patient: Oh, that‟s the limit.

Doctor: Not very far, is it? Stand up again. Now I would like you to (3)________
(4)_________. That‟s not much either. Now stand up straight again. Now
first of all, I would like you to (5)________ your right and down the right
side of your thigh. See how far you can go. That‟s fine. Now (6)_______
the same thing on the (7) __________ side. Fine. Now just come back to
stand straight. Now keep feet together just as they are. Keep your knees
firm. Now try and (8)_________ both shoulders round to the right. Look
right round. Keep your knees and feet steady.

Patient: Oh, that‟s sore.

Doctor: Go back to the centre again. Now try the same things and go round to the
left side. Fine. Now back to the centre. That‟s fine. Now would you like
to (9)________ onto the couch and (10)________ on your face? I‟m just
going to try and find out where the sore spot is.

3. Complete the sentences with these words

make tilt pop keep stand up cough turn

1. Can you just _____________ behind screen and undress for me, please?
2. I need to examine your lower back, so if you could _________________ on your
tummy for me, please. Thank you.
3. Just _______________ for me. And again. That‟s fine.
4. I‟d like you to _________________ for me. Do you need any help getting up?
5. Could you just_________________ your head to the left? Yes. That‟s it.
6. Can you ________________ a tight fist for me? Fine.

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 7. I would like you to _________________ nice and still for me if you can. OK.
Listening 2: Blood Test: Immunoglobulin A (IgA)

1. Listen to the man talk about immunoglobulin A and fill in the gaps below:
What It Is
An IgA test measures the blood level of immunoglobulin A, one of the most common
antibodies in the body. Antibodies are (1)_____________ made by the immune system to
fight bacteria, viruses, and toxins.
IgA is found in high concentrations in the body's mucous membranes, particularly
the (2)__________ passages and gastrointestinal tract, as well as in saliva and tears.
IgA also plays a role in allergic reactions. IgA levels also may be high in
autoimmune conditions, disorders in which the body mistakenly makes antibodies against
healthy tissues.
Why It's Done
An IgA test can (3)_______________ doctors diagnose problems with the immune
system, intestines, and kidneys. It may be done in kids who have recurrent infections. It's
also used to evaluate autoimmune conditions, such as rheumatoid (4)___________, lupus,
and celiac disease. Kids born with low levels of IgA - or none at all - are at increased risk
of developing an autoimmune condition, infections, asthma, and allergies.
Preparation
Your doctor will tell you if any special preparations are (5)_____________ before
this test. On the day of the test, having your child wear a T-shirt or short-sleeved shirt can
make things easier for your child and the technician who will be drawing the blood.
The Procedure
A health professional will usually draw the blood from a vein. For an infant, the
blood may be obtained by puncturing the heel with a small needle (lancet). If the blood is
being drawn from a (6)______________, the skin surface is cleaned with antiseptic, and an
elastic band (tourniquet) is placed around the upper arm to apply pressure and cause the
veins to swell with blood. A needle is inserted into a vein (usually in the arm inside of the
elbow or on the back of the hand) and blood is withdrawn and collected in a vial or
syringe.

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 After the (7)_______________, the elastic band is removed. Once the blood has been
collected, the needle is removed and the area is covered with cotton or a bandage to stop
the bleeding. Collecting blood for this test will only (8)_________ a few minutes.
What to Expect
Either method (heel or vein
withdrawal) of collecting a sample of
blood is only temporarily (9)
_________________ and can feel like a
quick pinprick. Afterward, there may be
some mild bruising, which should go
away in a few days.

Getting the Results

The blood sample will be processed by a machine. The results are commonly
available within a day or two. If results suggest (10)___________________, the doctor
may perform further tests.
Risks
This test is considered a safe procedure. However, as with many medical tests, some
problems can occur with having blood drawn, like:
• fainting or feeling lightheaded;
• hematoma (11)____________ accumulating under the skin causing a lump or
bruise;
• pain associated with multiple punctures to locate a vein.
Helping Your Child
Having a blood test is relatively (12)______________. Still, many children are afraid
of needles. Explaining the test in terms your child might understand can help ease some of
the fear.
Allow your child to ask the technician any (13)______________ he or she might
have. Tell your child to try to relax during the procedure, as tense muscles can make it
(14)_______________ and more painful to draw blood. It also may help for your child to
look away when the needle is being inserted into the skin.
If You Have Questions
If you have questions about the IgA (15)_____________, speak with your doctor.
Listening 3: Explaining gastroscopy
1. Work in pairs. Use the words from A to E to label the diagram of a
gastroscopy.

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 1. ____

a flexible tube 2. _____

side channels for introducing other
instruments
a grabbing instrument
a light and camera 3. _____
endoscope

5. ____

4. ____

2. Listen to Dr. John explaining the endoscopy to a patient, Mr. James.

Complete the statements to make them softer for the
patient
We‟re doing an endoscopy. OK?
We want to look at your gullet and your stomach.
We‟ll make you relaxed.
We‟ll pass a bendy tube into your stomach.
Your stomach will be looked at.
We‟ll take a sample of the stomach lining.
Air is blown into your stomach.

3. Listen again. Compare your answers, and then practise by role play

SPEAKING

Speaking 1: Giving instructions

1. Work in pairs. Give instructions to a patient to carry out the lumbar
puncture basing on the given pictures and these clues. Then practise speaking.

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 Now I want / you / move / right / the edge / the bed.
______________________________________
Lie / left side.
______________________________________
Now can / bend / both / knees / up / far / they‟ll go?
______________________________________
Put / head / right down / meet / knees. Curl up.
______________________________________
1.
Now I / going / wipe / back / antiseptic.
________________________________________
Now I / going / give / local anaesthetic.
________________________________________
You will feel just a slight jab, OK?
Right now, lie still, that‟s very important.

2.

Now I / going / take / fluid / off /back / find out

what‟s giving you these headaches.
________________________________________
________________________________________
________________________________________

3.

2. The case notes record the doctor’s findings on examination. Work in pairs to
complete the conversation below using the given words. Then play a role.
uncomfortable take off breaths blood pressure lungs

heart slip pulse lie down passage

Doctor: I‟ll just check a few things to see if we can get to the bottom of these problems.
First of all I‟ll check your (1)_____________ and then I‟ll do your (2)-
__________________. I‟d like you to (3)___________________ your jacket

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 and roll up your sleeve.

Patient: How is it doctor?

Doctor: It‟s just a little above normal, but that doesn‟t mean too much. If you‟d like to
roll up your shirt, I‟m going to check your (4)___________ and
(5)______________. Now just breathe normally. Good. Now I‟d like you to take
deep (6)________________ in and out through your mouth. That‟s fine. Now if
you‟d like to (7)______________ on the couch, I‟ll examine your stomach.

Patient: Right.

Doctor: Take a deep breath in and out. And again. Aha. Now I‟ll just see if there‟s any
sign of a hernia. Could you (8)_______________ your trousers down? That‟s
fine. Give a cough, please. Again, please. Now because you‟ve been having
trouble with your waterworks, I‟d like to examine your back
(9)________________. If you‟d roll over onto your left side and bend your
knees up. You might find this a bit (10)___________________, but it won‟t take
long. That‟s it. All finished. You can get your clothes on now.

Speaking 2: Explaining and reassuring about the investigation

1. Some useful expressions for explaining and reassuring patients about the
investigation

Expressions Examples

- We’re going to do something called a gastroscopy.

Explain what the doctor - Well, what we are going to do is (to) have a look at your
is going to do and why: gullet and your stomach to see what’s going on there.

- Now I’m going to take some fluid off your back to find out
what’s giving you these headaches.

Reassure the patient - It’s a routine procedure.

about the investigation: - The tube will have a tiny camera on the end.

- It won’t take very long.

- Now I’m going to give you a local anaesthetic so it won’t be

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 sore.

2. Here is part of a doctor’s explanation during a sternal marrow investigation.

The explanation has been put in the wrong order. Rearrange it.
a. Now I‟m going to give you an injection of local anaesthetic. First into the skin and
then into the bone.
b. Then we‟ll put a dressing over the area.
c. Now the next thing I‟m going to do is to put a towel, a clean towel, over the area.
d. First of all, I‟m just going to wash the area with a bit of antiseptic.
e. Just going to remove the needle from your chest.
f. Now we‟re ready to do the actual test.
g. Now I‟m going to remove the actual cells from your bone.

3. Work in pairs. Practise preparing a patient for the following investigations.

Explain, instruct, reassure using the clues.

- lie down on the table. Ultrasound scan / woman, 26 / baby

small for dates at 32 weeks
- gel help / get a contact / the picture / clear.

- rub in the gel / put on the equipment

- keep as still as you can

- turn / head to the right / see the scan / as/ I

/ take / it.

- black part / the baby‟s head / and / this /

body.

- as you can see, it / move around / very

well.

- These dots / measure the baby / so / we /

work out when the baby is due .

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 Myelogram / man, 53 / carpenter / - we / put / needle / back.
prolapsed intervertebral disc - we / inject / fluid in, put / onto/ table / and / take /
X-ray pictures.

- roll onto / left side. I / want / roll up into / a little

ball, to bring / knees up and / tuck / head down.

- I / going / swab / back. You‟ll feel it / cold. You /

feel/ me/ pressing in. I / injecting / the stuff in.

- OK. I / take/ needle / out. Now straighten out/

gently / and / lie on / front. We/ take / pictures /
now.

WRITING

Describe a lab report

1. Kevin Hall’s GP phones the hospital to arrange for his admission. Fill in the
gaps using the information from the haematology lab, the clinical chemistry results
below.

TELEPHONE REPORT FROM DEPARTMENT OF CLINICAL

HAEMATOLOGY LABORATORY BIOCHEMISTRY SOUTHERN GENERAL
HOSPITAL, NHS TRUST
PATIENT‟S NAME UNIT NO
GP 5487 HALL, KEVIN 30/04/62 M
HALL Kevin
DR WATSON HEALTH CENTRE,
NEWTOWN
Date Collected 25/05/94
Time Collected 00.00
BLOOD FILM Date received 25/05/94
WBC x 109/L 7.2 NEUTRO 60% Time received 13.15
Hb g/dl 12.0 LYMPH 30% Spec 74627
Hct 0.39 MONO 5% S/Pl SODIUM (135-145) mmol/l 158
MCV fl 81 EOSINO 4% S/Pl POTASSIUM (3.5-5) mmol/l 6.2
Platelets x109/L 264 BASO 1% S/Pl CHLORIDE (95-105) mmol/l 96
ESR mm 43

164
 OTHER INFORMATION S/Pl CO2 (21-26 ) mmol/l 16
RBC 3.32 Serum/ Pl UREA (3.3-6.6) mm0l/l 50.1
Burr cells ++ TOTAL PROTEIN (60-80) s/l 71
…………………………………………………… S/Pl CREATININE (.07-0.11) mmol/l 0.09
PROTHROMBIN RATIO………………………:1 S/Pl GLUCOSE (3.9-5.0) 5.1
TIME MESSAGE RECEIVED…………..AM/PM COMMENTS
MESSAGE RECEIVED BY …………………… Report printed on 26-May-94 8:38:30
DATE RECEIVED ………………………………

I‟m phoning about a 32-year-old man. I saw him a year ago when he complained of
headaches which had been troubling him for three months. On examination he was found
to have a blood (1)_____________ of 180 over 120. Urinalysis was normal, ECG and
chest X-rays were also (2)_______________. He was commenced on a beta blocker and
diuretic but his blood pressure remained slightly (3)_________________.
On a recent visit he (4)____________ of nausea, vomiting and headaches. His
blood pressure was 160 over 120, urinalysis showed (5)_____________ plus plus and a
trace of glucose. I‟ve just received his lab results. His haemoglobin is (6)__________,
ESR (7)____________. Blood film showed poikilocytosis plus and (8)___________ cells
plus plus. Blood urea was (9)____________ raised, (10)___________, sodium 158,
potassium 6.2, bicarbonate (11)______________.
I‟d like to arrange is urgent admission for investigation and treatment of chronic
renal (12)_____________.

2. Terms used to describe lab results.

Doctors sometimes need to explain abnormal results to the patients. They can use
these terms:

When the results are within the normal range, doctors say:
within normal limits.

165
 Potassium is normal.
unremarkable.

In order to explain abnormal results without worrying the patients, doctors can use
the expressions such as:
- It‟s a little bit too high.
- It‟s slightly high.
- It‟s a bit higher than it should be.

Unit abbreviation Full form

g/L grams per liter

L/L liters per liter

109/L times ten to the power nine per liter

fL femtoliters

mmol/L millimols per liter

umol/L or µmol/L micromols per liter

U/L units per liter

3. Complete the sentences describing the results of the biochemistry and

haematology lab report. Use the terms above.
Value Range Unit Value Range Unit

Full blood count Urea & electrolytes

(FBC (U&E)

Haemoglobin (Hb) 143 115-165 g/L Urea 4.5 2.5-6.6 mmol/L

Haematocrit 0.224 0.37-0.47 L/L Creatinine 58 60-120 umol/L

(HCT)

Mean cell volume 72.5 78.0-98.0 fL Sodium (Na) 138 135-145 mmol/L
(MCV)

White cell count 7.4 4.0-11.0 109/L Potassium (K) 4.5 3.6-5 mmol/L
(WCC)

Liver function test

166
 (LFT)

Bilirubin 7 3-16 µmol/L

ALT 9 10-50 U/L

Alkaline 131 40-125 U/L

Phosphatase
(Alk.Phos)

1. Haemoglobin is ________ _________ _________, one hundred and forty-three

_________ per liter.
2. Creatinine is slightly _________, fifty-eight _________ _________ liter.
3. Alkaline Phosphatase is _________, one hundred and thirty –one ________
_________ _________.
4. ALT is slightly____________, nine ________ _________ _________.
5. Bilirubin is ___________, seven ________ _________ _________.
4. Write full descriptions of the following results from a case history. Look at
part 2 and 3 above to help.
A. Na: 138 B. K: 4.5 C. WCC: 12.2 D. HCT: 0.224

E. MCV: 72.5 F. Alk.Phos: 72 G. ALT: 9

A. Sodium is normal, one hundred and thirty-eight millimols per liter.

B. _______________________________________________________________
C. _______________________________________________________________
D. _______________________________________________________________
E. _______________________________________________________________
f. _______________________________________________________________
g. _______________________________________________________________

FURTHER READING
1. It was 200 years ago that a French doctor when examining a female patient rolled
up sheets of paper and placed them to her heart instead of pitting his ear to her chest. This

167
single act gave birth to that universal marker of medical practice, the stethoscope. Over
two centuries this device has travelled widely, and is now seen in S&M shops, toy stores,
medical exam rooms. Unfortunately on its two hundredth birthday, instead of celebration,
there's the talk of dispatching the stethoscope to the morgue. Last week, Jagat Narula, a
cardiologist provocatively claimed: “The stethoscope is dead.”
2. In 2014, Indian born 15-year-old Suman Mulumudi invented the Steth 10 in
Seattle. He is one among several who have come up with alternatives to the regular
stethoscope. His invention is essentially heart and lung sound and converts them into a
spectrogram which can be annotated an iPhone case that amplifies and stored for future
reference. The device is on the market. Besides this, there are other choices on the market.
Others have cited a portable ultrasound machine as a possible successor. An FDA
approved digital stethoscope that records the sounds of a patient's heart and transmits it
into an app is also around. The clip stored in the cloud can be transferred for a second
opinion anywhere in the world. Some stethoscope apps play doctor and deliver snap
diagnosis by applying algorithms to match the patient's recordings with a re-programmed
index of common sounds detected for listening to internal sounds of the body.
3. The gains, experts say, are greater diagnostic accuracy, real-time results and
streamlined treatment that saves the patient time and money by eliminating superfluous
tests and medication. But not all Indian doctors are convinced about it. Dr Vinita Arora
maintains that technology is what you tell technology. Good history taking and listening to
a patient can never be substituted. If the machine misses even one sign the diagnosis could
be incorrect. According to another doctor, Dr CT Deshmukh, ninety per cent of doctors
can't do without a stetho, but some others point out stethos stand-ins will not penetrate the
Indian market until the new digital devices are introduced to students right at medical
school. According to Dr Neelesh Bhandari, when you go to techno conferences you realize
that stethoscopes are going out because apps and mobile devices are more accurate and tell
you more. For manufacturers of steel stethoscopes their devices are a bargain at „500 to‟
2000. Even though electronic stethoscopes have been available for several years you will
seldom come across them in use.
4. The economics of operating the next-gen stethoscope may prove a hurdle in India.
Logistically the steep imbalance between doctor-patient ratio ‒ 6 doctors to every 10,000
people could suppose that quicker, more efficient tools with telemedicine capabilities
would have sped up diagnosis. But then again 80% of the population is treated in rural
India where steady electricity is a luxury.
5. This is why other doctors feel that it is not yet time for the stethoscope to exit
although they believe that will undoubtedly come. For the present, the convention is
suggestive of the doctor's authority because when a patient sees an individual with a

168
stethoscope they feel reassured that they are in capable hands and feel on the way to
recovery. Moreover, if you take away the symbol you take away the placebo effect of the
doctor.
6. Finally, it is worthwhile to remember that a conventional stetho may not relay
messages but it has always had a processor-between the ear tips.

1. On the basis of your understanding of the passage choose the best answer for
the following questions.
1. The French doctor examining a woman patient __________.
A. rolled up his sleeve B. rolled up sheets of paper
C. placed a paper to his ear D. invented the stethoscope
2. The stethoscope can now be seen in__________.
A. medical operating rooms, toy shops
B. toy shops and sports
C. medical examination rooms and toy shops are
D. bookstores and hospitals
3. The stethoscope has been in use for __________.
A. a century B. 200 years
C. since 2014 D. before the computer age
4. The digital stethoscope records__________.
A. the patient's heartbeat and stores it in its memory
B. the heartbeat and transmits it to the iPhone
C. the heartbeat and warns the doctor
D. the patient's heartbeat and stores it in an app
2. Answer the following questions briefly.
1. Who is Suman Mulumudi?
________________________________________________________________
2. What is special about Mulumudi's invention?
________________________________________________________________
3. What does the FDI digital stethoscope do?
________________________________________________________________
4. Why will the digital stethoscope prove a hurdle in India?
________________________________________________________________
5. What is Dr Vinita Arora's take on technology?

169
 ________________________________________________________________
6. What is a patient's reaction to the conventional stethoscope?
________________________________________________________________
3. Find words from the passage which mean the opposite of the following:
1. local (paragraph 1) _______________________________
2. immovable (paragraph 2) _______________________________

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 Unit 7
DIAGNOSIS & TREATMENT

Objectives: After the lesson, students will be able to:

1. Apply expressions usedbetween doctors and patients in discussing a diagnosis and
giving advice about treatment;
2. Read and understand medical terms relating to diagnosis and treatment;
3. Listen and take notes about treatment;
4. Explain a diagnosis and discuss and give advice about the treatment for patients;
5. Write an email to inform about an appointment for treatment.

GETTING STARTED
1. What do you think each patient in pictures A-H might have? Discuss with
your partners in groups.

A D

B E

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C F

2. What should they do with their problems? Discuss with your partner.

READING

Reading 1: Diagnostic medicine

1. Ask and answer the following questions.
1. Do you like watching films about doctors?
_________________________________________________________________
2. What films about doctors have you ever seen?
_________________________________________________________________
3. Have you heard of or watched House?
_________________________________________________________________
2. Underline the following words in the text and then put them into the correct
column.

diagnose examine vomiting ascertain

rash nausea fatigued
constipation
prescribe lesion bruise
carry out
tingling serious diagnostic
insomnia
cure

Verbs Nouns/symptoms Adjectives

diagnose, _____________________ _____________________

_____________________ _____________________ _____________________

_____________________ _____________________ _____________________

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_____________________ _____________________ _____________________

_____________________ _____________________ _____________________

_____________________ _____________________ _____________________

_____________________ _____________________ _____________________

For many years medicine has been seen as a profession

far removed from glamour and popular culture, but in recent
years the TV show Dr House has popularized the world of
diagnostic medicine.
Week after week, he unfailingly manages to diagnose
even the most unusual of diseases and even has time for
some fun and games. However, life in the real world is
slightly different.
Diagnostic medicine is predominantly the realm
of general practitioners, or family doctors who are usually
the first contact between the patient and the medical
professionals who are there to cure them. The priority for a
GP is to diagnose the patient as quickly and accurately as possible, and to do this they will
need to examine the patient and study the symptoms which the patient has. If a patient is
presenting with a rash, then there is a good chance the doctor is looking at nothing more
serious than an allergic reaction.
Correctly diagnosing a patient is no easy matter, and takes a great deal of hard work -
something which Dr House fails to show. There are thousands of possible medical
conditions, many of which show some of the same common symptoms such as vomiting
or nausea, so in diagnosing a patient a doctor must look at the big picture of all symptoms
together rather than individually.
In doing this most diagnostic examinations will
take the symptoms you have, the symptoms you had as
well as your physical and mental state into account. So
the fact that the patient has worked a 60-hour working
week and is feeling fatigued can be just as important
to ascertaining the problem as the fact he has a poor
diet and has had constipation for the last three days.

173
 It takes years of study and many more years of practice to be able to work effectively
in diagnostic medicine as to the untrained, and even trained eye two very different
symptoms can present in a surprisingly similar way. If we take the example of a bruise and
a lesion, the causes and meanings of which can be completely different but may appear to
be almost identical, and it is only through practice and knowing what you are looking for
that you can see the difference.
Most of the time, the diagnosis will show a common illness for which the doctor
will prescribe something to help like: painkillers to stop an ache or barbiturates to relieve
insomnia but some visits may result in nothing more that some good advice like: go to bed
and rest if the patient is suffering from the common cold.
Of course with so many viruses, bacteria, conditions and disorders it is impossible
for one doctor to be able to diagnose everyone so if your GP is in doubt he will refer you to
a specialist who will be able to carry out tests to find the cause of that tingling sensation in
your foot.
Unfortunately, more and more people are turning
to the internet to help with their diagnosis rather than
visiting their family doctor. Admittedly, it may save time
and money - but a computer is unable to analyze
the symptoms and compare them to your medical
history, so by simply stating that you are running a
fever - you could be told there is nothing wrong, or you
could be told you are dying.
So even though the real doctors may be less
entertaining than Dr House, if you feel that something is wrong, you are much better off
going to your local clinic than jumping online.
2. Read the text above and answer the questions below.
1. What is the role of family doctors in diagnostic medicine?
___________________________________________________________________
2. Why does correctly diagnosing a patient take a great deal of hard work?
___________________________________________________________________
3. What do most diagnostic examinations take into account?
___________________________________________________________________
4. When does the doctor prescribe painkillers?
___________________________________________________________________
5. Why is a doctor impossible to be able to diagnose everyone?
___________________________________________________________________

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 6. How can turning to the internet help people?
___________________________________________________________________
7. According to the text, what can not a computer do?
___________________________________________________________________
8. What does the author advise to someone if they feel something wrong?
___________________________________________________________________
3. Discuss the following questions in groups.
1. Why do you think medical TV shows like Dr House are so popular?
_________________________________________________________________
2. What difficulties do you think general practitioners face in diagnosing patients?
_________________________________________________________________
3. Have you ever received a diagnosis you didn't agree with? What happened?
_________________________________________________________________

Reading 2: Diagnostic process

1. The following suffixes for diagnosis pertain to procedures or investigations.
Match each of the suffixes with its meaning.
1._________–graphy A. process of visual examination

2._________ –metry B. act of recording data

3._________ –scopy C. measurement of

2. The following terms are investigations. Match them with parts of the body to
be done on.
bronchoscopy A. blood vessels

audiometry B. stomach
gastroscopy C. heart
angiography D. ears
pelvimetry E. pelvis
cardiography F. bronchus / bronchi

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 3. Read the article about diagnostic process as quickly as possible. Underline all
thetechniques that doctors do to make a diagnosis
Making a correct diagnosis is a very responsible task any time a patient consults a
physician, regardless of the supposed seriousness of the symptoms. Forming the right one
will allow the patient to recover quickly or might even save his or her life, whereas making
a mistake might lead to dramatic consequences.
Centuries ago, when physicians had very primitive tools at their disposal or had none
at all, taking a patient's medical history was sometimes the only way to identify diseases
patients were suffering from. These days, however, there are many modern diagnostic
techniques that utilize cutting-edge devices and tools, which help in diagnosis and keeping
people healthy. Let's take a closer look at some of them.
The choice of a diagnostic technique
depends on the symptoms a patient
experiences. For example, if a female patient
comes to consult a GP, concerned about a
lump on her breast she discovered when she
was performing self-examination, the GP will
suggest doing a mammogram, which will
allow a specialist to determine what the lump
is exactly and if any further tests need to be done. If the mammogram indicates the
presence of a tumor, then a biopsy is needed to determine whether the tumor is malignant
or not.
Biopsy is not the only technique
employed in case of a suspicion of cancer.
The use of a particular method or device is
determined by the patient's symptoms,
results of the tests and the location of the
tumor. For instance, if there is a suspicion
of a colon cancer, an endoscopy is
performed, which involves inserting a tool
directly into the organ (in this case the
colon). In the case of women, a
common screening method used in order to detect cancerous or pre-cancerous changes in
the female reproductive system is called a Pap test, named after a Greek Doctor Georgios
Papanikolaou, who invented it.

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 Some techniques are less invasive
and do not require putting anything into
the body or removing anything from it.
For example, if doctors suspect a brain
tumor, they will recommend tomography,
performance of which will result in a
detailed scan of the brain. Tomography
belongs to a group of non-invasive
techniques which use X-rays to produce
images, called radiography, which also
includes taking an X-ray in the case of a bone fracture. Although images produced through
radiography are commonly referred to as “X-rays”, some professionals argue that they
should be called “radiographs”, as “x-rays” are just photons of energy and cannot be seen
by the naked eye.
There are more non-invasive techniques used in case of various medical conditions.
The electrocardiogram (ECG) is one of them. It is a test, which records the electrical
activity of the heart, used to detect and study such heart problems as a heart attack or
arrhythmia. Another one is a blood culture, performed to test for and find an infection in
the blood caused by bacteria or fungi. Such tests are invaluable tools , as they make it
possible to verify and confirm the doctor's diagnosis and thus assure the patient that the
treatment is appropriate before the patient gives their consent for further treatment.
The vast majority of the aforementioned diagnostic methods are adopted in case of a
suspicion of a disease or disorder. Nevertheless, there are methods employed in less
depressing, more optimistic circumstances, such as the use of ultrasound during pregnancy,
to produce images of an unborn baby still in its mother's womb.
Besides self-examination, all of the methods described in the article require a visit to
a specialist clinic or a hospital unit and are sometimes an unpleasant or painful experience.
Therefore, we should not forget to go for regular check-ups at local surgeries so as not to
lead to a situation when they will be necessary.
4. Read the text again. Decide if the following statement true (T) or false (F) and tick
(√) in the right box.
True False Statements

1 Hundreds of years ago, doctors did not have many tools to identify
the patients‟ diseases.

2 Mammogram is indicated when a female patient found a lump in her

breast.

3 Only biopsy is used to confirm a case of cancer.

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4 A Pap test is a screening method which is used for women.

5 Tomography using X-rays to produce images is a non-invasive

technique.

6 Blood culture can detect bacteria in the blood.

7 All diagnostic techniques are employed only in case of a suspicion

of a disease.

8 Almost all the techniques require a visit to a specialist clinic or

hospital unit.

5. Discuss the following questions with your partners.

1. Which diagnostic methods are you familiar with?
_________________________________________________________________
2. Which ones would you like to learn more about?
_________________________________________________________________
3. Have you heard of any other modern techniques not described in the article?
_________________________________________________________________

Reading 3: Surgical treatment

1. Before you read, match the picture with its right name.
retractor scalpel artery forceps dissecting forceps scissors

1. 2. 3.

4. 5.

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 2. Which of the above instruments is needed for each of the following
procedures?
1. making an incision ____________________

2. keeping the sides of the wound open ____________________

3. cutting sutures ____________________

4. holding the cut ends of blood vessels before ____________________

they are tied

3. Read about the surgical treatment and answer the below questions:
The operating theatre
Surgery is carried out in an operating theatre. Great care is taken to make sure that
operations take place in sterile conditions – free from microorganisms. The surgeon and his
or her assistant wash or scrub up, and put on surgical gowns, masks, and gloves. The
patient‟s skin is prepared by disinfecting it with an antiseptic solution. This known as
prepping (preparing) the patient. They are then covered with sterile drapes, so that only the
area of the operation is exposed.
The operation
The operation begins when the surgeon makes an incision or cut. Control of bleeding
is very important. A swab is a pad of cotton or other materials used to soak up blood from
the operation site. A sucker is a mechanical device which aspirates – sucks up – blood.
Bleeding vessels are tied with ligatures or sealed by an electric current (diathermy).
Drains may be inserted to carry away fluid which might act as a culture medium for
bacteria. Various methods are used to close the wound, for example sutures (also known as
stiches), or staples. Finally, the wound is covered with a dressing.
1. Where do you know the surgeons and their assistants carry out the operations?
_________________________________________________________________
2. Which basic surgical instruments are used in operations?
_________________________________________________________________
3. What is one of the most important things to a successful operation?
_________________________________________________________________
4. What factor do the surgeons and the assistants pay special attention to during
operations?
_________________________________________________________________

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 5. Which tool is used to suck up blood from the operation site?
_________________________________________________________________
6. Which ways do the surgeons use to close the wound?
_________________________________________________________________
4. A surgeon is taking to a medical student about assisting at operations.
Complete the advice using the suggested words.
drapes drain assistant suckers preparing (prepping)

ligatures swabs sterile retractor sutures (stiches/ staples)

An (1)_______________must be able to carry out the following tasks to help the

surgeon. Firstly, he or she must help in (2)_______________ the patient and putting the
(3)________________in place to provide (4)________________conditions. Expert
handling of a (5)________________is essential to allow the surgeon to see what he is
doing.
The assistant must also keep the operation site free of blood, by careful use of the
(6)________________ or (7)_________________. The surgeon also needs assistance with
tying and cutting (8)__________________, and with the insertion of a
(9)_________________, if necessary. Finally, the assistant may be asked to close the
wound with (10)____________________ or other devices.

LISTENING
Listening 1: Explaining a diagnosis
When explaining a diagnosis, a patient would
expect you to answer the following points:
- What is the cause of my problem? (cause)
- How serious is it? (severity)
- What are you going to do about it? (future
management)
- What are the chances of a full recovery?
1. Discuss the following questions:
1. How do you think you should explain to the patient?
_________________________________________________________________
2. What kind of language should you use? Should we use medical terms or non
medical terms? Do we need to explain medical terms if we have to use?
_________________________________________________________________

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 2. You will hear the doctor explaining the diagnosis to the patient. As you listen,
note the points and the order in which they are dealt with.
Explaining points Notes Order

What is the cause of the patient‟s _________________________________

problem? _________________________________
CAUSE
How serious is it? _________________________________
SEVERITY _________________________________
What is the doctor going to do _________________________________
about it? _________________________________
FUTURE MANAGEMENT
What are the chances of a full _________________________________
recovery? _________________________________
CHANCE OF RECOVERY

3. When explaining a diagnosis, you can make sure your explanations are easily
by avoiding medical where possible and defining the terms you use in a simple way.
Work in pairs / groups of four to give simple explanations for patients of these terms:
1. the pancreas: is an organ located near the stomach; it produces insulin –
a substance helps to control the sugar level in blood.

2. the thyroid: _____________________________________________

_____________________________________________

3. fibroids: _____________________________________________
_____________________________________________

4. emphysema: _____________________________________________
_____________________________________________

5. arrhythmia: _____________________________________________
_____________________________________________

6. bone marrow: _____________________________________________

_____________________________________________

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7. the prostate gland: _____________________________________________
_____________________________________________

8. gastro-esophageal reflux: _____________________________________________

_____________________________________________

4. Practice explaining the terms in exercise 3 in pairs.

Listening 2: Medical treatment

1. Mr. Jameson was diagnosed with prolapsed
intervertebral disc. Discuss your treatment for the
patient with your partner. Think about the following
questions:
- What painkillers can he use to ease the pain?
- How often does he take them?
- What should he do?
- What should he avoid doing?

2. Listen to the conversation between the doctor and Mr. Jameson and
complete the management section. Compare with your ideas.
MANAGEMENT
Dihydrocodeine 2 q.d.sp.c,
……………………………………………………………….

3. Listen to the final part of the conversation and complete the doctor’s
instructions to Mr. Jameson by putting one word in each gap.
Doctor: Now, Mr. Jameson, here is a prescription for some (1)_____________which
you are to take (2)_____________ of every (3)_____________hours. Try to take them
(4)_________________(5)________________ if possible in case they cause you
indigestion. You (6)_______________take them during the night as well if you are awake
with the (7)_______________.

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 Listening 3: Physiotherapy

1. Look at the diagrams below. Listen carefully to the instructions that the
physiotherapist gave Mr. Jameson for his spinal extension exercises. Put these
diagrams in the correct order using the instructions. Number them 1 to 5.
1.____ 2.____ 3.____ 4.____ 5.____

A B

C D

2. Complete these instructions to Mr. Jameson using appropriate language.

1. _______________on a hard surface.
2. _______________careful while getting out of bed______________roll over and
then get up from your side.
3. _______________ bending forward, for example, if you are picking up something
off the floor.
4. _______________to bend your knees and keep your back straight.
5. _______________lifting heavy weights.
3. Try to remember all the movements. Practice giving the instructions for the
exercises in pairs.

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LANGUAGE FOCUS

Language focus 1: Expressions used between doctors in discussing a diagnosis.

Certain Fairly certain Uncertain

is seems might
Yes must probably could
likely may

can‟t unlikely possibly

definitely not a possibility
No
exclude
rule out

When making a diagnosis and not having enough

information, we are uncertain about our diagnosis. We can
say:
- The patient might have cervical spondylosis.
- Cervical spondylosis is a possibility.
The findings on examination provide more evidence.
Some diagnoses become more likely while others become
less likely. We can say:
- He seems to have temporal arteritis.
- There is no neck stiffness. It’s unlikely that he’s got
cervical spondylosis.
When we have the results of the investigations, we have stronger evidence for our
final diagnosis. We can say:
- A raised ESR makes temporal arteritis very likely.
- Normal MRI scan excludes a space-occupying lesion.
- He can’t have a space-occupying lesion.
Finally, when we have done the right investigation, such as a biopsy, and we are
certain about our diagnosis, we can say:
- He must have temporal arteritis.
1. Here is some initial information about a 59-year-old man. Work in groups of
four and write down several possible diagnoses for this patient.

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 SURNAME Nicol FIRST NAME Harvey

AGE 59 SEX M MARITAL STATUS M

OCCUPATION officer worker

PRESENT COMPLAINT
Complaint of headaches, Left side for 3 weeks, unrelieved by aspirin.
Initial flu-like symptoms. Unable to sleep.
Slightly weight loss. Feels “weak and tired”.
__________________________________ __________________________________
__________________________________ __________________________________
__________________________________ __________________________________

2. Here are the doctor’s findings on examination.

ON EXAMINATION

General condition:
Good Temperature: 37.4o
Ear-Nose-Throat (ENT):
Respiratory System (RS):
Cardiovascular System (CVS):
Pulse (P): 80/min. regular Blood pressure (BP) 160/95
Heart sound (HS): normal left temporal artery palpable
Gastrointestinal System (GIS):
Genito-urinary System (GUS):
Central Nervous System (CNS):
No neck stiffness. Fundi normal
Neck movements full with no pain
Basing on the evidence on examination, you discuss the possible diagnoses in the above
task 5 and decide which diagnosis is the most likely, which one is the least likely. Exclude
any which now seem very unlikely.

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 _________________________________ __________________________________
_________________________________ __________________________________
_________________________________ __________________________________
3. Here are the results of some investigations for this patient. Discuss and make
the final diagnosis.

INVESTIGATIONS
ESR (Erythrocyte sedimentation rate): 80 mm in the first hour
Neutropils: 85%
MRI scan (Magnetic Resonance Imaging): normal
Biopsy showed the changes of giant cell arteritis

Language focus 2: Giving advice about treatment

1. Note how the doctor advises the patient about the following points:
1. The duration of the treatment:
- You’ll need a few days off work…
2. How the patient must conduct himself
during the treatment:
- You should rest for a day or two…
- It’s really not good to rest for longer than that.
- If you rest for a long time, your muscles will
get weaker and the pain will feel worse.
- Don’t wait until the pain is out of control
2. Note how the physiotherapist marks the sequence of instructions:
- First of all, you lie down…
- Now place your hands on your back…
3. Note how the physiotherapist advises the patient:
- You should do these exercise three times a day, preferably on an empty stomach.
- You should try to do them as slowly and smoothly as possible.
4. Note how the physiotherapist cautions the patient:
- You should try to avoid jerking your body.

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 5. Complete the advice using the given words or phrases.
avoid settle carry on gave up

cut down end up start off

1. If you __________ ___________smoking, you increase the risk of lung cancer

and heart disease.
2. Your health would improve if you ____________ ______________ alcohol
completely.
3. You could ________________ _______________ with a serious drug problem.
4. I‟m going to _____________you _____________with some tablet. If they don‟t
help, we‟ll need to think about surgery.
5. ______________ ______________ on the amount of salt you take with your
food.
6. I expect things will _______________ in a few days and you‟ll be able to get up.
7. Try to ________________situations where you feel stressed.
6. Match the two parts of the sentences from the two below columns.
1.__C__ If you still have pain, A. try to avoid caffeine later in the day.

2.______ If you find it difficult to give up B. if you find your breathlessness has
smoking, increased,

3.______ Your symptoms will return, C. keep taking paracetamol.

4.______ If you can‟t get to sleep, D. I can refer you to a consultant.

5.______ Come back and see me again E. if you start smoking again.

6.______ If you‟re still concerned, F. I can arrange for nicotine replacement

therapy.

SPEAKING

Speaking 1: Explaining diagnosis

1. Work in pairs. Read an explanation of angina and find out some expressions
you think used to give explanation.

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 Having examined you, I‟m confident that you‟re suffering from angina.
The heart is a pump. The more you do physically, the harder it has to work. But as
we get older, the blood vessels which supply oxygen to the heart begin to harden and get
furred up, so they become narrower. They can‟t supply all the oxygen the heart needs. The
result is the pain you feel as angina.
Because you‟re experiencing pain at rest as well as on exertion, I‟m going to have
you admitted to the coronary care unit right away so that your treatment can start at once.
You‟ll be given drugs to ease the pain and I expect you‟ll have an angiogram. They may
advise surgery or angioplasty – that‟s a way of opening up the blood vessels to the heart
so they can provide more oxygen.
You should try to give up smoking. You won‟t be able to smoke at all in hospital so
it‟s a good time to stop.
I expect the treatment will improve your pain at least and may get rid of it
completely. We can never be absolutely certain about the future but you should remain
optimistic. Do you have any questions?

2. Some useful expressions for explaining diagnosis.

The explanation should cover:
- You’re suffering from…
- You’ve developed…
The diagnosis - You have…
- This is why…
- This is mainly because…

- I’ll make you an appointment…

- I’m going to have you admitted to…
- I’ll arrange for you to…
The management plan
- You’ll be given…
- I expect you’ll have…
- They may advise…

- The nurse will give you advice on…

Advice about changing lifestyle
- You should try to give up…

188
 - I want you to …
- It’s important that you …

- I expect the treatment will …

- Hopefully we can …
The prognosis
- We can never be absolutely certain about …
- You should remain optimistic.

- Do you have any questions?

Questions time
- Is there anything you’d like to ask?

3. Work in pairs to complete the explanation of diabetes. Use the useful

expressions above.
You‟ve (1)_____________Type 2 diabetes. This is (2)__________________ very
overweight. Your body isn‟t producing enough insulin. (3)________________ you feel so
thirsty and why you pass urine so frequently. It‟s also the reason you have this very itchy
rash and you have a problem with your eyes.
The nurse will (4)_______________________________ your diet and I‟ll
(5)________________________a dietician. I‟m (6)_____________________ tablest to
control your high blood sugar. You don‟t need insulin right now but it is possible you
might need it in the future.
You (7)___________________lose weight and I (8)____________________ see a
podiatrist. It‟s important with diabetes that you take good care of your feet. You should
also see your optician every six months for eye checks.
Diabetes is a serious condition and can affect your heart, blood pressure, circulation,
kidneys and vision but we can limit these problems by controlling your blood sugar.
No case of diabetes can be described as mild. I‟ll (9)_________________ to attend
the diabetic clinic every two months so we can check your progress.
(10)____________________ reduce this to six month visits once your condition is
under control. Is there (11)__________________?

189
 4. Work in pairs to give your explanations for the diagnoses.
1. A 33-year-old salesman suffering from
duodenal ulcer.
______________________________
______________________________
______________________________
______________________________
______________________________

2. A 6-year-old boy with Perthes‟ disease,

accompanied by his parents.
______________________________
______________________________
______________________________
______________________________
______________________________

3. A 21-year-old professional footballer

with a torn meniscus of the right knee.
______________________________
______________________________
______________________________
______________________________
______________________________

4. A 43-year-old teacher with fibroids.

______________________________
______________________________
______________________________
______________________________
______________________________

190
5. An 82-year-old retired nurse suffering
from dementia, accompanied by her son
and daughter.
______________________________
______________________________
______________________________
______________________________
______________________________

6. A 2-week-old baby with tetralogy of

Fallot, accompanied by her parents
______________________________
______________________________
______________________________
______________________________
______________________________

7. A 35-year-old receptionist suffering

from hypothyroidism.
______________________________
______________________________
______________________________
______________________________
______________________________

5. Listen to the doctors giving explanations to the above patients. Compare

with your own explanations.

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Speaking 2: Advising about treatment
1. Some useful expressions.
- Carry on drinking lots of fluids.
Advising a
- If you still have some pain, you can keep taking paracetamol.
course of
action - Some time off work might help. If you felt that it would be helpful, you
could take a week off and see how you felt after that.
- Cut out fatty food.
Advising
- You should try to avoid tight clothing, sitting in deep armchairs and
patients to
bending, especially after meals.
avoid
something - There are few things about your lifestyle we could address. Perhaps cut
down on the amount you’re drinking. Giving up smoking would help.
- If you aren’t feeling better in 7 to 14 days, you really must come back
and see me again.
- If you keep damaging it, you’re going to end up with a long-term
problem.
Warnings
- If you feel that things aren’t settling, aren’t getting back to normal, it’s
important that you see me again.
- It’s very important you don’t stop taking the tablets suddenly or your
symptoms will return.

2. Advise a patient with high blood pressure about physical activity. Look at the
information in the table.
Advice for people with heart disease or high blood pressure

DO AVOID

Moderate, rhythmic (aerobic) exercise Intense exercise such as weight-lifting,

such as brisk walking, cycling or pressups, heavy digging and isometric
swimming. exercise.

Any regular physical activity that you are Any sport or activity that brings on angina.
used to.

Eat a low cholesterol diet. Moving from floor to standing exercise too
quickly.

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 For example: - You should avoid heavy digging.
- You shouldn‟t do any heavy digging.
- You could try brisk walking.
3. Work in pairs. Practice saying what you would advise Mrs. White using the
information below.
OVER TO YOU
A patient of yours, Mrs. White, aged 44, has been complaining of very heavy periods.
An ultrasound scan of her pelvis shows she has a small fibroid in her uterus. She asks
about treatment. These options are possible:
Do nothing. The fibroid will shrink when she becomes menopausal.
See a gynaecologist who may advise removal of the fibroid or a hysterectomy.

WRITING
1. Read the following sample letter from the doctor to the patient to inform on
the operation she is going to have.

Dear Mrs. Osman,

Your operation is on Monday 14th January. Please go to B Ward at
12.30 p.m. Your consultant is Mr. Hamilton.
You can have light breakfast at 7.30 a.m and have water up to 10.15
a.m. Please do not wear jewellery or make-up. You will need to bring
slippers and a dressing gown.
Please contact the number (098765321123) to confirm your bed for
this date as soon as possible.
Your sincerely,
J Manning

Discuss the following questions with your partner:

- What is the date of Mrs. Osman‟s operation?
- Where and what time does she need to present?

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 - Can she have breakfast and drink water in the morning?
- What things does she need to remember to do?
2. Complete the following sentences without looking at the email.
1. Your operation is ______________Monday 14th January.
2. Please______________to______________B ______________12.30 p.m.
3. Your______________is Mr. Hamilton.
4. You ______________breakfast at 7.30 a.m.
5. Please, do not ______________and make-up.
6. You will ______________bring______________.
Some suggested words or phrases for writing

Your operation is at / on / in….

We are having the operation on you at / on / in….

Please go / come to (where? ward / room)….meet (who? doctor / consultant)….

You can go / come to (where? ward / room)….meet (who? doctor / consultant)….

You can / can’t / must / musn’t…

Do not…
You will need to…
You will bring/ take….

Please phone/ contact….

3. Mr. Jameson has been suffering from leg and back pain. An MRI scan of the
lumbar spine confirmed that the patient had a prolapsed intervertebral disc. Recently
Mr. Jameson‟s condition has worsened and his doctor decided to refer him to a
neurosurgeon for an operation to be arranged. Write a letter to Mr. Jameson to inform him
about the operation.
Dear Mr. Jameson,
__________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

194
 _______________________________________________________________________
Your sincerely,
________________

FURTHER READING
Reading 1:
1. Put these steps in the correct sequence to show how the operation was
completed. Step 1 is (a) and step 7 is (g). The other steps are out of sequence.
a) Release aortic cross clamp and vent air from the left heart and ascending aorta.
b) Administer protamine sulphate and adjust blood volume.
c) Defibrillate the heart and wean heart off bypass.
d) Remove cannulae and repair cannulation and vent sites.
e) Complete proximal vein anastomoses to the ascending aorta.
f) Ascertain haemostasis.
g) Insert drains.
2. Read part of the Discharge Summary and answer the questions below.
History: 58-year-old salesman who has been hypertensive for 15 years. Had an
inferior myocardial infarction in 1998. For the past 3 months he has had increasing
angina pectoris which has been present at rest. Recently admitted to hospital with
prolonged chest pain, found to have positive thallium scan despite negative acute ECG
or enzyme changes. Other past history of hypothyroidism diagnosed 3 years ago.
Stopped smoking 20 cigarettes a day 5 years ago.
Medications: Aspirin 300 mg daily, heparin sodium 5000 units t.d.s., diamorphine
5 mg 4 hourly p.r.n, cyclizine 50 mg 4 hourly p.r.n, paracetamol 1 g q.d.s.
Temazepam 20 mg nocte, GTN pump spray 400-800 µg p.r.n, atenolol mg daily,
isosorbidemononitrate m/r 60 mg in the morning, thyroxine 0.1 mg daily,
bendrofluazide 2.5 mg tablet daily, amlodipine 5 mg in the morning.
Examination: Obese. Pulse 60 regular, BP 130/80, no signs of failure, heart
sounds normal. Soft midsystolic murmur at apex and aortic areas.
Investigations: Routine haematology and biochemistry normal. Chest X-ray: normal.
ECG showed evidence of previous infarct, Q waves in T3 + AVF, inverted T5 in V1-V5.

Answer the questions:

- What is the reason for the patient‟s admission to the hospital?

195
 - What did he have a heart attack?
- What kinds of medications was the patient given?
- What did the doctor find on examination?
3. Read the procedure section of the Discharge Summary. Complete the gaps in
the procedure using these verbs. The verbs are not in the correct order.
administered grafted anastomosed opened
continued prepared cross-clamped rewarmed
Procedure: Vein was ______________ (1) for use as grafts. Systemic heparin was
______________ (2) and bypass established, the left ventricle was vented, the aorta was
______________(3) and cold cardioplegic arrest of the heart obtained. Topical cooling
was ______________ (4) for the duration of the aortic cross clamp.
Attention was first turned to the first and second obtuse marginal branches of the
circumplex coronary artery. The first obtuse marginal was intramuscular with proximal
artheroma. It admitted a 1.5 mm occlude and was ______________ (5) with saphenous
sequential grafts, side to side using continuous 6/0 special prolene which was used for
all subsequent distal anastomoses. The end of the saphenous graft was recurved and
______________ (6) to the second obtuse marginal around a 1.75 mm occlude. The left
anterior descending was ______________ (7) in its distal hald and accepted a 1.5 mm
occlude around which it was grafted with a single length of long saphenous vein.
Lastly, the right coronary artery was opened at the crux and again grafted with a
single length of saphenous vein around a 1.5 mm occlude whilst the circulation
was______________(8).

Reading 2: Talking to a patient before an anaesthetic

Read the following dialogue between an anaesthetist and a patient.
Anaesthetist: Good morning, Mrs. Smith. My name is Dr. Greenway. I‟ll be your
anaesthetist tomorrow. I need to ask some questions before your anaesthetic.
Patient: Yes, certainly.
Doctor: Have you ever had an
anaesthetic ?
Patient: No, I haven‟t.
Doctor: OK. What is your general
health like?
Patient: It‟s quite good.
Doctor: Do you smoke?
Patient: Yes. Why?
Doctor: If you smoke, you have more
risk of breathing problems than people who don‟t smoke.

196
 Patient: I see.
Doctor: Do have any loose teeth, crowns or bridges?
Patient: I have two crowns in my front teeth.
Doctor: All right, I‟ll make a note of that. I‟ll have to take more care during
intubation. Are you taking any medication at the moment?
Patient: Not at the moment. I was taking aspirin daily. I was told to stop taking them
a week ago.
Doctor: That‟s good. Aspirin increases the risk of bleeding so it‟s important to stop
taking it before an operation.
1. Answer the following questions:
1. What is the first thing the anaesthetist asks the patient?
___________________________________________________________________
2. How is the patient‟s general health?
___________________________________________________________________
3. What does the doctor tell the patient about the risk of smoking?
___________________________________________________________________
4. Why does the doctor have to take care when he intubates the patient?
___________________________________________________________________
5. Why did the patient stop taking aspirin?
_________________________________________________________________
2. Complete the following advice to patients before an operation. Use the words
in the box below.
Before you start, review the following:
If you are + adjective, you’ll have a greater risk of…
If you don’t +verb, you’ll have a greater risk of…
If you don’t + verb, there’ll be a greater risk of…
cardiac problems wound heavy bleeding breathing problems
1. If you don‟t cut down on smoking, you‟ll have a greater risk of____________
after the operation.
2. If you don‟t lose weight before the operation, you‟ll have a greater risk of ______.
3. If you don‟t control your glucose levels, there‟ll be more risk that your
________________will take longer to heal.
4. If you don‟t stop taking aspirin a week before the operation, there‟ll be more
chance of ________________after the operation.

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 Unit 8
ADMINISTERING MEDICATION

Objectives: After the lesson, students will be able to:

1. Apply expressions in medical contexts, verbs to instruct a patient on how to use
medication and explain how often to take medication;
2. Understand drug charts and abbreviations;
3. Explain benefits and side effects;
4. Talk about medications;
5. Complete a clinical incident report.

GETTING STARTED
1. Work in pairs and answer the following questions:
1. What are the different kinds of medication you are familiar with?
2. What precautions do you need to take before prescribing medication?
2. Match the pictures with these names:
1. suppository _________ 6. adhesive patch _________
2. inhaler _________ 7. table spoon _________
3. ointment _________ 8. dropper _________
4. capsule _________ 9. syrups _________
5. IV drip _________ 10. tablets _________

A B C D

198
 E F G

H
I K

READING

Reading 1: Medical history

Patient: Cathrine Gates

Medical History
Medications:
05/12
Ms. Gates came in complaining of a rash. She received a topical ointment to
administer to the affected area.
05/17
Ms. Gates was admitted to the hospital with serious dehydration and breathing
trouble. She was given fluids through an I.V. She was also given a 200 mg dosage of
steroids. The route of administration was an intramuscular injection (IM).
05/19
Ms. Gate's persistent illness has been caused by an infection. Serious complications
have arisen. Antibiotics are being given through subcutaneous injections and P.R.
05/26
Ms. Gates was discharged today. Her physician prescribed antibiotic pills to be
taken for two weeks. These should be taken P.O. and can be swallowed or absorbed
sublingually.

199
 1. Read the patient chart. Then, mark the following statements as true (T) or
false (F).
1. _________ Ms. Gates was given fluids through an intramuscular injection.
2. _________ Ms. Gates received antibiotics P.O. while in the hospital.
3. _________ Ms. Gates' antibiotic pills can be taken sublingually.
2. Match the words (1-6) with the definitions.
1. _______ topical A. injected into the fatty layer under the skin with a
syringe
2. _______ sublingual B. taken orally, or through the mouth
3. _______ subcutaneous C. injection into a vein using a syringe, often over a
long period of time
4. _______ P.R D. applied to a certain part of the surface of the body
5. _______ I.V E. given beneath the tongue
6. _______ P.O F. taken through the rectum

3. Listen and read the patient chart again. How did Ms. Gates receive medicine?
Reading 2: A doctor’s report
1. Read the the following report.

200
 On 24 Dec 2010, a woman of unknown age, Maria Gallois, fainted after developing a
sudden, severe skin rash and inflammation all over her body.
Ms. Gallois, the well-known opera singer, lost consciousness 30 minutes before she
had planned to go on stage. She was taken to hospital and regained consciousness an hour
later. She reported that she had not had anything to eat except some chocolate four hours
before. In addition to small, red, itching spots all over her body, she also reported a racing
heart, a headache, and insomnia after starting on Mensamint™ three weeks previously. At
the hospital, the patient showed evidence of hyperactivity, accompanied by confusion and
agitation. Subsequently, Mensammt™ was discontinued, but the symptoms persisted until a
strong sedative was administered. After 24 hours, all symptoms except for a mild skin
irritation had subsided and the patient was discharged from hospital. Some symptoms are
suspected side effects of Mensammf™.
Vital signs: temperature 100 °F (38.8 °C) and blood pressure 160/110.
Known allergies: peanuts, penicillin.
Current medications: two 100 mg Mensamint™ lozenges taken once daily for improved
short-term and long-term memory. Mimifem oral contraceptive 0.2 mg daily.
The patient has a history of hypertension, mild heart palpitations, high adrenalin
levels, and often suffers from insomnia.
Frederick M. Wright, MD
Attending Physician

2. Now answer the following questions.

1. What were the patient‟s symptoms before she was admitted to hospital?
___________________________________________________________________
2. How was she treated by her physician?
___________________________________________________________________
3. What was her condition when she was discharged from the hospital?
___________________________________________________________________
3. Match the following symptoms in bold in the doctor’s report with their
definitions.
1. ____ hypertension a. sleeplessness
2. ____ rash b. general discomfort, bad feeling
3. ____ palpitation c. red, warm, and swollen
4. ____ insomnia d. you feel like you want to scratch
5. ____ inflammation e. heart racing
6. ____ itching f. high blood pressure
7. ____ irritation g. a lot of spots on the skin

201
 Reading 3: Using pharmacology references
1. Match the following terms with their pronunciation and definitions
1 indication A. /ˌɪntərˈækʃn/ G. a warning or a piece of advice about
a possible danger or risk of using
medications

2 Contra-indication B. /ˌɪndɪˈkeɪʃn/ H. an amount of a medicine or a drug that

is taken once, or regularly over a period of
time
3 Side-effect C. /dəʊs/ I. A reaction between two or more
medications
4 Interaction D. /ˈkɔːʃn/ K. a symptom that suggests that particular
medical treatment is necessary
5 Dose E. L. a medical reason for not giving
/ˌkɒntrəˌɪndɪˈkeɪʃn/ somebody a particular drug or medical
treatment
6 Caution F. /ˈsaɪd ɪfekt/ M. an extra and usually bad effect that a
drug has on you, as well as curing illness
or pain

2. Using the prescribing information which follows, choose the mostappropriate

antibiotic for these patients.

Number Patients Appropriate antibiotic

1. A 4-year-old boy with meningitis due to ___________________

pneumococcus. He is allergic topenicillin.
___________________

2. A 67-year-old man with a history of chronic ___________________

bronchitis now suffering from pneumonia. The ___________________
causative organism is resistant to tetracycline.

3. A 27-year-old woman with urinary tract infection ___________________

in early pregnancy. ___________________

4. A 4-year-old girl with septic arthritis due to ___________________

haemophilius influenza.

202
 ___________________

5. An 18-year-old man with left leg amputation ___________________

above the knee following a road traffic accident. ___________________

6. A 50-year-old woman with endocarditis caused by ___________________

strep, viridians. ___________________

7. A 13-year-old girl with disfiguring acne. ___________________

8. An 8-year-old boy with tonsillitis due to ___________________

hemolytic streptococcus.
___________________

9. A 43-year-old dairyman with brucellosis. ___________________

10. A 4-year-old unimmunised sibling of a 2-year-old ___________________

boy with whooping cough. ___________________

GENTAMICIN
Indications: septicemia and neonatal sepsis; meningitis and other CNS infections; biliary-tract
infection, acute pyelonephritis or prostatitis; endocarditis caused by strep. Viridians or Strep
fuecalis (with a penicillin); pneumonia in hospital patients, adjunct in listerial meningitis.
Cautions: renal impairment, infant and elderly (adjust dose and monitor renal, auditory and
vestibular functions together with plasma gentamicin concentration); avoid prolonged use.
Contra-indications: pregnancy; myasthenia gravis.
Side-effects: vestibular and auditory damage; nephrotoxcicity; rarely hypomagnesaemia on
prolonged therapy, antibiotic- associated colitis.
Dose: by intramuscular or by slow intravenous injection over at least 3 minutes or by
intravenous infusion, 2 – 5 mg/kg daily (in divided doses every 8 hours); reduce dose and
measure plasma concentration in renal impairment.
CHILD up to 2 weeks, 3 mg/kg every 12 hours, 2weeks-12 years, 2 mg/kg every 8 hours…
By intrathecal injection, 1 mg daily (increases if necessary to 5 mg daily), with 2-4 mg/kg
daily. by intramuscular injection (in divided doses every 8 hours).

203
 TETRACYCLINE
Indications: exacerbations of chronic bronchitis; brucellosis, Chlamydia, mycoplasma, and
rickettsia; pleural effusions due to malignancy or cirrhosis; acne vulgaris.
Cautions: hepatic impairment (avoid intravenous administration); renal impairment; rarely
causes photosensitivity; interactions (tetracycline‟s).
Contra-indications: renal impairment, pregnancy and breast-feeding, children under 12
years old of age, systemic lupus erythematous.
Side-effects: nausea, vomiting, diarrhea; erythematic (discontinue treatment); headache and
visual disturbances may indicate benign intracranial hypertension; hepatoxicity, antibiotic-
associated pancreatitis and colitis reported.
Dose: by mouth, 250 mg every 6 hours, increased severe infections to 500 mg every 6-8
hours.
Primary, secondary or latent syphilis, 500 mg every 6 hours for 15 days.
Non-gonococcal aresthritis, 500 mg every 6 hours for 7-14 days (21 days if failure or
relapse following the first course).
Counseling: Tablets or capsules should be swallowed whole with plenty of fluid while
sitting or standing.
By intravenous infusion, 500 mg every 12 hours; max. 2 g daily.

204
 ERYTHROMYCIN
Indications: alternative to penicillin in hypersensitive patients, campylobacter enteritis,
pneumonia legionaires‟ disease, syphylis, non-gonococcal urethritis, chronic prostatitis,
diphtheria and whooping cough prophylaxis; acne vulgaris and rosacea.
Cautions: hepatic and renal impairment; prolongation of QT interval (ventricular tachycardia
reported); porphyria; pregnancy (not known to be harmful) and breast-feeding (only small
amounts in milk); interactions: erythromycin and other macrolides).
ARRHYTHMIAS: Avoid concomitant administration with pimozide or terfenadine.
Side effects: nausea, vomiting, abdominal discomfort. Diarrhoea (antibiotic- associated colitis
reported); uticaria, rashes and other allergic reactions; reversible hearing loss reported after
large doses; cholestatic jaundice, cardiac effects (including chest pain and arrhythmias),
myasthenia-like syndrome, Steven-Johnson syndrome, and toxic epidermal necrolysis also
reported.
Doses: by mouth, ADULT and CHILD over 8 years, 250-500 mg every 6 hours or 0.5-1 g
every 12 hours, up to 4 g daily in severe infections; CHILD up to 2 years 125 mg every 6 hours,
2-8 years 250 mg every 6 hours, doses doubled for severe infections.
Early syphilis, 500 mg 4 times daily for 14 days.
Uncomplicated genital chlamydia, non-gonococcal urithritis, 500 mg twice daily for 14 days.
By intravenous infusion, ADULT and CHILD severe infections, 50 mg/kg daily by continuous
infusion or in divided doses every 6 hours; mild infections (oral treatment not possible), 25
mg/kg daily.
NEONATE 30-45 mg/kg daily in 3 divided doses.

(Amoxycilin)
Indications: see under Ampicilin; also endocarditis prophylaxis and treatment; anthrax; adjunct
in listerial meningitis; Helicobacter Pylori eradication.
Cautions: see under Ampicilin.
Contra-indications: see under Ampicilin.
Doses: by mouth, 250 mg every 8 hours, doubled in severe infections. CHILD up to 10 years,
125 mg every 8 hours, doubled in severe infections. Pneumonia, 0.5-1 g every 8 hours.
Anthrax, 500 mg every 8 hours. CHILD body-weight under 20 kg, 80 mg/kg daily in 3 divided
doses; body-weight over 20 kg, adult dose.
Short couse oral therapy:
Dental abscess, 3 g repeated after 8 hours. Urinary tract infection, 3 g repeated after 10-12 hours.
Otitis media, CHILD 3-10 years, 750 mg twice daily for two days.
By intramuscular injection, 500 mg every 8 hours. CHILD 50-100 mg/kg daily in divided doses.
By intravenous injection or infusion, 500 mg every 8 hours increased to 1 g every 6 hours in
severe infections; CHILD, 50-100 mg/kg daily in divided doses.

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 BENZYLPENICILLIN
(Penicillin G)
Indications: throat infections, otitis media, streptococcal endocarditis, meningococcal
meningitis, pneumonia , prophylaxis in limb amputations.
Cautions: history of allergy; renal impairment.
Interactions (penicillin).
Contra-indications: penicillin hypersensitivity.
Side effects: hypersensitivity reactions including uticaria, fever, joint pains; rash;
angioedema; anaphylaxis, serum sickness-like reactions, haemolytic anaemia and interstitial
nephritis, neutropenia, transient leucopenia and thrombocytopenia; coagulation disorders or
central nervous system toxicity including convulsions reported (especially with high doses
or in severe renal impairment) diarrhea and antibiotic- associated colitis.
Dose: by intramuscular or by low intravenous injection or by infusion, 1,2 g daily in 4
divided doses, increase if necessary to 2,4 g daily or more. PREMATIVE INFANT and
Neonate,
50 mg/kg daily in 2 divided doses; INFANT 1-4 weeks, 75 mg/kg daily in 3 divided doses;
CHILD 1 month - 12 years, 100 mg/kg daily in 4 divided doses (higher doses may be
required).
Bacterial endocarditis, by slow intravenous injection or by infusion, 72 g daily in 4-6 divided
doses.
Meningococcal meningitis, by slow intravenous injection or by infusion, 2,4 g every 4-6
hours; PREMATIVE INFANT and NEONATE, 100 mg/kg daily in 2 divided doses,
INFANT 1-4 weeks, 150 mg/kg daily in 3 divided doses; CHILD 1 month - 12 years, 180-
300 mg/kg daily in 4-6 divided doses.
Important, if bacterial meningitis and especially if meningococcal disease is suspected
general practitioners are advised to give a single injection of Benzyl penicillin by
intramuscular or by intravenous injection before transporting the patient urgently to
hospital. Suitable doses are; ADULT 1,2 g INFANT 300 mg CHILD 1-9 years 600 mg, 10
years and over as for adult.
In Penicillin allergy
Cefotaxime may be an alternative, chloramphenicol may be used if there is a history of
anaphylaxis to penicillin.
By intrathecal injection, not recommended.
Bezylpenicillin doses in BNF may differ from those in product literature.

206
 PHENOXYMETHYLPENICILLIN
(Penicillin V)
Indications: tonsillitis, otitis media, erysipelas; rheumatic fever and pneumococcal
infection prophylaxis
Cautions: contraindications; side effects: see under Bezylpenicillin; interactions: see
Penicillin.
Doses: 500mg every 6 hours increased to 750 mg every 6 hours in severe infections;
CHILD, every 6 hours, up to 1 year 62.5 mg, 1-5 years 125 mg, 6-12 years 250 mg.
NOTE: Phenoxymethylpenicillin dose in BNF may differ from those in product literature.

207
 CEFUROXIME
Indications: see under Cefaclor; surgical prophylaxis; more active against Haemophilus
influ-enzae and Neisseria gonorrhea; Lyme disease.
Cautions: Contra-indications; Side-effects: see under Cefaclor.
Dose: by mouth (as cefuroxime acetyl), 250 mg twice daily in most infections including mild
to moderate lower respiratory-tract infections (e.g. bronchitis); doubled for more severe lower
respiratory-tract infections or if pneumonia suspected Urinary-tract infection, 125 mg twice
daily, double in pyelonephritis.
Gonorrhea, 1 g as a single dose.
CHILD over 3 months, 125 mg twice daily, if necessary doubled in child over 2 years with otitis
media.
Lyme disease, ADULT and CHILD over 12 years, 500 mg twice daily for 20 days.
By intramuscular injection or intravenous injection or infusion, 750 mg every 6-8 hours; 1.5 g
every 6-8 hours in severe injections; single doses over 750 mg intravenous route only.
CHILD usual dose 60 mg/kg daily (range 30-10 mg/kg daily) in 3-4 divided doses (2-3 divided
doses in neonates).
Gonorrhea, 1.5 g as a single dose by intramuscular injection (divided between 2 sites).
Surgical prophylaxis, 1.5 g by intravenous injection at induction; may be supplemented with
750 mg intramuscularly 8 and 16 hours later (abdominal, pelvic, and orthopedic operations) or
followed by 750 mg intramuscularly every 8 hours for further 24-48 hours (cardiac,
pulmonary, oesophageal and vascular operations).
Meningitis, 3 g intravenously every 8 hours.
CHILD, 200-240 mg/kg daily (in 3-4 divided doses) reduced to 100 mg/kg daily after 3 days
or on clinical improvement; NEONATE, 100 mg/kg daily reduced to 50 mg/kg daily.

208
 CEFOTAXIME
Indications: see under Cefaclor; surgical prophylaxis; Haemophilus epiglottitis and meningitis.
Cautions: Contra-indications: see under Cefaclor.
Side-effects: see under Cefaclor; rarely arrhythmias following rapid injection reported.
Doses: by intramuscular or intravenous injection or intravenous infusion, 1 g every 12 hours
increased in severe infection (e.g mengitis) to 8 g daily in 4 divided doses, higher doses up to
12 g daily in 3-4 divided doses) may be required
NEONATE 50 mg/kg daily in 2-4 divided doses increased to 150-200 mg/kg daily in severe
infections; CHILD 100-150 mg/kg daily in 2-4 divided doses incrceased up to 200 mg/kg daily
in very severe infections.
Gonorrhoea.500 mg is a single dose.
Important If bacterial meningitis and epecially if meningococcal disease suspected the patient
should be transferred urgently to hospital. If Benzylenicillin cannot be given (eg because of an
allergy, a single dose.
of cefotaxime may be given (if available) before urgent transfer to hospital. Suitable dose of
Cefotaxime by intravenous injection (or by intramuscular injection) are ADULT and CHILD
over 12 years CHILD under 12 years 50 mg/kg. Chloramphenicol may be ued if there is a
history of anaphylaxis to penicillins or cephalosporins.

AMPICILLIN
Indications: urinary-tract infections, otitis media, sinusitis, chronic bronchitis, invasive
salmonella‟s gonorrhea.
Cautions: history of allergy; renal impairment; erythematous rashes common in glandular
fever, chronic lymphatic leukemia, and possibly HIV infection; interactions.
Contra-indications: penicillin hypersensitivity.
Side-effects: nausea, diarrhea; rashes (discontinue treatment); rarely, antibiotic-associated
colitis.
Dose: by mouth, 0.25-1 g every 6 hours, at least 30 minutes before food.
Gonorrhea, 2-3.5 g as a single dose with probenecid 1 g.
Urinary-tract infections, 500 mg every 8 hours.
By intramuscular injection or intravenous injection or infusion, 500 mg every 4-6 hours;
higher doses in meningitis.
CHILD under 10 years, any route half adult dose.

3. Work in pairs. Explain your choices for the above patients with your partner.

209
LANGUAGE FOCUS

Language focus 1: Phrasal verbs in medical context

Phrasal verbs are phrases that indicate actions. They are generally used in spoken
English and informal texts. Examples of such verbs include: turn down, come across and
run into.
Phrasal verbs consist of a verb and a preposition or an adverb.
In Listening 3 the doctor says to the patient:
There’s a lot of information to take in at one time.
The verb to take in means here to understand. It is separable phrasal verb because
you can separate the verb take and the particle in:
It is difficult to take in information.
↑ ↑
verb particle
It is difficult to take information in.
↑ ↑
verb particle
The verb to get up is an example of an inseparable phrasal verb because you cannot
separate the verb and the particle:
If you can, take the medication soon after you get up in the morning.
↑ ↑
verb particle
Read the following dialogue

210
 Mrs Smith: How are you these days? Have you managed to throw off (1) that
cold you had when we last met?
Mr Jones: Well, yes, it cleared up afer a couple of days, but I‟d no sooner got
over that than I picked up another one. It‟s horrible. I keep
breaking out in (2) a sweat and my nose is completely bunged-up
(3).
Mrs Smith Well, I hope you don‟t pass it on to me. I‟m feeling bad enough as
it is. My arthritis has flared up (4) again. And you know I fell and
cut my hand a week ago? It‟s only just started to heal up (5) and
the swelling hasn‟t gone down (6) yet.
Mr Jones: I think we should both go to the doctor‟s again, don‟t you?

The words in bold in the dialogue are phrasal verbs used for talking about how you
are. The phrasal verbs numbered 1-6 means as the following:
1. (informal) get rid of a slight illness 4. (of illness) returned
2. (of sweat, spots, rash) suddenly appears 5. become covered by new skin
on the skin
3. (informal) blocked 6. returned to its normal size
Phrasal verbs have their own special uses in the medical workplace. Here are
some common phrasal verbs

pass away = die His mother passed away last year.

Thường

break out = Develop skin The measles caused me to break out

sores or irritation in a rash.
Thường
fight off = Resist an illness I‟m trying to fight off a cold.

Thường
pass out = Faint, lose People everywhere were passing out
consciousness from the heat.
Thường
= Recover from It‟s taken me ages to get over the
get over
something flu.
Thường

211
 come down with = Become sick (not I think I‟m coming down with the
seriously) flu.
Thường
throw up = Be sick, vomit The baby‟s thrown up her dinner.

Thường
= Become Your mother hasn‟t yet come round
come round
conscious from the anaesthetic.
Thường = Stop something
block up from moving
My nose is blocked up.
through something
Thường else

swell up = Become large, The boy‟s arm swelled up where the

inflated, or bulging bee had stung him.
Thường
You should dose up with vitamin C
dose up (UK) = Give medicine to
to fight colds off.
Thường
= Become less A cold continues at its peak for
let up
strong or stop several days, then it gradually let up.
Thường
= Shake something She has failed to shake off her
shake off in order to get stomach injury.
something off of it
Thường
= blocked and air I can‟t breathe – my nose is all
stuff up
can‟t pass through stuffed up thanks to my allergies.
Thường
I‟m overweight; the doctor says I
cut down on = reduce
need to cut down on fried foods.

You‟ll need a prescription-strength

get rid of = eliminate
ointment to get rid of that rash.

212
 1. Rewrite the underlined parts of these sentences using a phrasal verb or phrasal
expression from the opposite page. Make any other necessary changes.

Doctor: So, how can I help you today?

1. Patient: I think I‟ve caught a chest infection. I‟m coughing and
wheezing a lot.

__________________________________________________________________

Doctor: When did you first notice the problem?

2.
Patient: Well, a rash suddenly appeared on my neck about a week ago.

__________________________________________________________________

Doctor: And what‟s troubling you, Mrs. James?

Patient: Well, I had an ear infection about a month ago. It seemed to
3.
disappear when I took the antibiotics you gave me but now it‟s returned
again.

__________________________________________________________________

Doctor: Mr. Kelly, hello, how are things?

4. Patient: Well, OK, but my nose is blocked all the time. Can you give
me something for it?

__________________________________________________________________

Doctor: Miss Peters, what can I do for you?

5. Patient: Well, I sprained my ankle a week ago, but the swelling hasn‟t
diminished and it‟s still painful.

__________________________________________________________________

2. Read the remarks about different people and then answer the questions
below.

Bethany: I just can‟t seem to Teddy: I hope Bethany doesn‟t

throw off this cold. pass on her cold.

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 Grace: I‟m getting over the flu Elliot: I know I look really
now. washed out.

William: My scar is healing over Harry: I feel totally burnt out.

nicely now.

Natasha: This bronchitis is taking a Daniel: I keep nodding off and

lot out of me. missing parts of the TV show.

1. Who is feeling weak because of an illness? ___________________

2. Who is ill but getting better? ___________________
3. Who is feeling sleepy? ___________________
4. Who is finding it difficult to get better? ___________________
5. Who is completely exhausted from overwork? ___________________
6. Who is pale, ill and tired? ___________________
7. Whose skin is looking better? ___________________
8. Who is keen not to catch someone else‟s illness? ___________________
3. Read the following passsage, match the words in bold with their meanings
below.

At the doctor’s
Don‟t worry. There‟s a lot of it going
around (1). I‟ll put you on some tablets tohelp
you sleep. They should knock you out (2). Keep
taking them for at least a fortnight – you
shouldn‟t come off them until I say so. This
particular bug takesa lot out of (3) you, so when
you begin to feel better, make sure you eat lots of
fruitand vegetables to build yourself up (4).

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 ___ A. make yourself stronger ___ C. make you sleep heavily
___ B. a lot of people are complaining of this ___ B. makes you feel very weak

Over to you: Find a magazine article on a health issue and make a note of any phrasal
verbs that are used in it.

Language focus 2: Instructing a patient on how to use medication

Verbs are used to instruct a patient on how to use medication:

- take - swallow - chew - apply
- inhale from - rub in/on - use - put
- massage in - suck - dip - insert
We use imperatives to instruct a patient on how to use medication
Put it under your tongue until I remove it.

Some common prescription abbreviation about how to take medication and their
meaning
Prescription abbreviation Meaning

IM intramuscular

inj injection

INH inhalation

IV intravenous
NPO Nothing by mouth
po By mouth
pr Per rectum
prn As needed/as required
PV Per vagina
SC, SQ subcutaneous
SL Sublingual (beneath the tongue)

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 ss One half
tb tablet
tbsp tablespoon (15ml)
tsp Teaspoon (5ml)
ud As directed

4. How do you use the following items?

(a) capsule (d) cream (g) liniment (j) loze

(b) ointment (e) pill (h) spray (k) tablet

(c) tincture (f) inhaler (i) nebuliser (l) gel

1. take _______________ capsule, lozenge, pill, tablet _______________

2. swallow __________________________________________
3. chew __________________________________________
4. inhale from __________________________________________
5. apply __________________________________________
6. rub in/on __________________________________________
7. use __________________________________________
8. put (on) __________________________________________
9. massage in __________________________________________
10. suck __________________________________________

5. Complete the doctor’s advice using verbs from the list above. When you
have completed the exercise, listen to the recording and repeat the advice.
1. ________________ this tablet half an hour before meals.
2. ________________ this tablet without chewing.
3. ________________a pich of this powder and mix it with some water.
4. ________________ a thin coat of this ointment every evening and then cover with
a wet dressing.
5. Dip a cotton bud in this tincture and ________________ it to your gums.
6. Pour an ampoule of this solution into boiling water and ________________ it for
five minutes.
7. This is a bitter tablet, so ________________ it with some sort of juice.

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 6. Give the patient instructions on how to use each item illustrated. Use the
verbs from the box.
apply crush drop gargle

shake rub place insert

swallow take use

A B C D

E F G H

Listen to the recording, number the pictures in the order you hear them and repeat
in the order you hear them and repeat the instructions.

7. Read the following dialogue.

Doctor: You need to take the tablet before food so it works properly.
Patient: All right. Before I eat anything.
Doctor: That‟s right. And you should swallow the tablet whole too.
Patient: OK. I should swallow it without chewing it.
Doctor: It‟s important that the tablet isn‟t broken up before it gets into your
stomach.
Patient: All right. I understand.
Complete the following sentences. Use the words in the box below.
shouldn’t Don’t need should It’s important

217
 1. You __________ to complete the course of medication.
2. You __________ swallow the capsule with the whole glass of water.
3. ______________ chew the tablet before you swallow it.
4. ______________ that you check the label before taking any medication.
5. You __________ drink alcohol while taking this medication.

Language focus 3: Explaining how often to take medication

Doctors need to explain how to take medication effectively especially after they
prescribe new medication to patients. They explain How often? And What time? So that
the medication has the correct on the patient.
Language useful for explaining how often to take medication
Take this three times a day.
This is a prescription for an antibiotic. Take this twice a day, after meal.
This is the antibiotic the doctor prescribed for you.
These are…………….
These are your antibiotics
supposed to………….
You are supposed to take this three times a day.
He is supposed to take this after meals.

Some common prescription abbreviation about how often to take medication and
their meaning
Prescription Medical Prescription Medical terminology
directions terminology directions
shorthand shorthand

AC before meals qlw Every week

bd/BID twice daily q4h Every 4 hours

D day QAM Every morning

gtt drop QPM Every evening

H hour QD Once daily, every day

hrly hourly QH Every hour

218
hrs hours QHS Every night at bedtime

HS at bedtime QID/qds Four times daily/four

time each day

od once a day QM Every morning

OM every morning qwk Once a week

ON on night SID Once a day

Q every TID/tds Three times daily/three

time each day

qld every day qlw Every week

8. Match these common prescription abbreviations with their meaning

1. ___ PO A once a day/24h

2. ___ Pr B sublingual

3. ___ I.V C taken orally, or through the mouth

4. ___ prn D taken before meals

5. ___ SID E taken through the rectum

6. ___ SL F as required

7. ___ AC G injection into a vein using a syringe

9. Work in pairs. Say the meaning of these abbreviations used in administering

drugs.

The frequency of drugs:

On, bd, tds, tds, 4-6h, 8h, 1-4h
The route of administration:
IV, IM, SC, PR, INH
Measurements:
µg, mg, g, ml

219
 10. Work in pairs. Take turns reading this chart aloud. Say the abbreviations as
complete words.
Drug Dose Freg Route 24hMax

paracetamol 1g qds PO 4g

loperamide 4 mg prn PO 16 mg

ranitidine 150 mg bd PO 300 mg

atorvastatin 10 (10-80 mg) od PO 80 mg

EXAMPLE
Give the patient one gram of paracetamol four times a day by mouth up to a
maximum of 4 grams
Give them between …. and …..
Give up to a maximum of …..

LISTENING

Listening 1: A conversation between a doctor and a nurse

1. Listen to a conversation between a doctor and nurse. Choose the correct

answers.
1. What are the speakers mainly talking about?
A. differences between antibiotics and aspirin
B. how to perform an intramuscular injection
C. a mistake involving routes of administration
D. what medications to give to two patients
2. Why should Mr. Brown be given aspirin sublingually?
A. He can only have 600 mg per day.
B. He does not like to swallow pills.
C. He is afraid of getting injections.
D. He is unable to chew tablets.

2. Listen again and complete the conversation.

220
 Doctor: Cindy, let's review these patients' meds 1 ______ ______ _______ _______.
Nurse: Sure thing, Doctor.
Doctor: Ms. Fulton should receive 150 mg of antibiotics 2 ________ _________.
Nurse: 3 _________ ___________ _____________ administered P.O. or through an
injection?
Doctor: An IM 4 _________ _____________ ____________.
Second, Mr. Brown can have aspirin if he asks for it, but not more than 600
mg per day.
Nurse: Okay. 5 _________ _____________ ____________ take that sublingually,
right?
Doctor: Yes, he can't 6 _____________ ____________.
Nurse: Got it. Thanks,
Doctor: Have a good night.

Listening 2: Patient medication

3. Listen to the nurse give information about patients’ medication. Match

each patient with the problem they have and with a medication type.
Patient problem medication
Mr Gupta allergy antibiotic
Mr Gill constipation painkiller
Mr Sawyer skin infection laxative
Mr Thomas respiratory tract infection antibiotic
Mr Cheong abdominal pain antihistamine

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 4. Listen again and write down the dosage for each patient.
1. Mr Gupta ____________ mg of Morphine every __________ hours.

2. Mr Gill A ______ mg infusion of Clindamycin over a _____ hour period.

3. Mr Sawyer One _______ mg tablespoon of Metamucil, _______ times a day.

4. Mr Thomas ______ mg of Cephalexin every ______ hours.

5. Mr Cheong An injection of __________ mg of Dimotane every _____ hours.

Listening 3: A drug chart

5. Study the chart below and make sure you understand the abbreviations,
headings, and so on.
Patient Dob Hospital No
Mrs T Hawthorne 04.02.63 18345727Z

Drug Date
____________ 1 ____________ 2
Route Dose Start Time
____________ 3 50 mg ____________ 4 ____________ 5
Max frequency Max dose/24hr Dose
____________ 6 600 mg 50mg
Indications for use Route
____________ 7 ____________ 8
Signature Pharmacy Given by
A Smith ____________ 9

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 6. Listen to a doctor checking the chart with a colleague and complete the
missing information in the chart.
Listening 4: Benefits and side effects
7. The sentences below are from an explanation of the benefits and side effects
of aspirin to a patient, Mr. Johnson, who is being discharged after an uncomplicated
MI. Work in pairs. In your own words, complete the blank spaces in the doctor’s
sentences.
1. I‟ve got some good news for you. You‟ve made ______________ and we are
going to ______________.
2. First, I‟d just like to have a brief chat with you ____________.
3. If at any time you want to stop me and ask questions, ___________. There‟s a lot
of information to take in at one time.
4. We‟re going to give you a very small dose of 75 mg. It‟s a much smaller doses
than you‟d normally buy over the counter. You take it ___________.
5. The aspirin will help a lot, as ___________ and so ___________.
6. And I emphasize the word possible, ___________. But I just have to point them
out, so that you are aware of them and can do something about it if anything happens.
7. Sometimes, people get ___________ .
Or aspirin can make ___________.
Or it can cause ___________.

8. Listen and make notes for each blank space in 1. Do not try to write down
every word.

9. Compare your notes with a partner and then write the complete sentences,
then listen again and check your answer.
10. Work in pairs. Take turns explaining the benefits and side effects of aspirin.
11. Work in pairs. Answer the questions below about the doctor in listening task 8.
Does the doctor:
- use simple non-technical language?
- keep the drug regime simple?
- explain the function of medication clearly?
- ask the patient to repeat the information given?

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SPEAKING
1. Unscramble the dialogue below. Use the prompts after the dialogue to help
you.
Patient: Ok. Take the tablet with a full glass of water.
Doctor: That‟s right. And you should drink a whole glass of water, too.
Patient: OK. After I eat something.
Doctor: It‟s important that you take the tablet with a full glass of water so you don‟t
feel sick.
Patient: All right. I understand.
Doctor: You need to take the tablet after food so you don‟t feel queasy
Doctor: You need ___________________________________________________
Patient: OK. After ___________________________________________________
Doctor: That‟s right. _________________________________________________
Patient: OK. Take ___________________________________________________
Doctor: It‟s important that _____________________________________________
Patient: All right. ____________________________________________________
2. Role play. In pairs, role play the dialogue. Use the prompts below to help you.
Student A, you are a doctor. Student B, you are a patient. Swap roles.

Doctor: need / take / antibiotic / half hour before food / works properly
Patient: All right. Before / food.
Doctor: That‟s right. Swallow / tablet whole
Patient: OK. Swallow / without chewing.
Doctor: important / don‟t drink alcohol / interacts/antibiotic / lessens effect.
Patient: all right.

3. Work in pairs. You are going to exchange details about patient’s medication.
Student A look at this page. Student B go to page 308 (Appendix 3)
Student A
Ask Student A questions to complete this information about patients‟ medication.

224
 Mrs Dupont ½ teaspoon TDS, at mealtimes

Mrs Francis painkiller

Miss Wang 500 mg SID x 2 days

Miss Ekobu antihistamines

Mr Strauss SID, AC

Mr Rossi 75 mg capsule Tamiflu

Mr Metcalf laxative

Mr Takahashi Injection 30 mg 1/3 hours

WRITING

Writing 1: Clinical incident reporting

1. Look at the sample clinical incident reporting form below. Try to remember
as much information about the incident as possible.
Name of staff involved Grade and speciality PRHO Agency/locum
Medicine N/A
C.J.Flint

Brief detail of incident:

Patient was prescribed Augmentin 625 mg/8h PO, despite penicillin allergy (this
was stated on drug chart). This was noted by the pharmacist and the patient did not take
any Augmentin. The team PRHO was contacted and an alternative antibiotic was
prescribed.

2. Without looking at the form in 1, expand the notes below into full sentences.

225
 ____________________________
Notes ____________________________
Patient prescibed augmentin 625 mg/8h PO ____________________________
Penicillin allergy state on drug chart, noted ____________________________
Pharmacist patient not take Augmentin ____________________________
Dr Perez team ____________________________
Contact alternative antibiotic prescribe ____________________________
____________________________
____________________________
3. Complete two clinical incident reporting forms from the notes below. In each
____________________________
case it was a “near miss” incident.

____________________________
Notes ____________________________
____________________________
Patient Flumazenil 200 mcg (µg) up to 1
1 ____________________________
mg. drug chart / patient epileptic. Noted
Duncan patient not take flumazenil ____________________________
Dr Zhou team contact alternative drug ____________________________
____________________________
____
____________________________
___________________________
Notes ____
___________________________
____________________________
Precribe tetracyline 250-500/6h drug ___________________________
2 ____
chart patient photosensitive noted ___________________________
pharmacist patient not take drug Dr ___________________________
Harper team contact alternative ___________________________
___________________________
_____
4. In groups, discuss clinical incident reporting. Give examples from your
___________________________
experience. Discuss why the procedure is important for the patient, the hospital, and
_____
for you and/or your colleagues. ___________________________
Is it difficult to admit mistakes like this in all cultures?
_____ Give reasons and examples.

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 Writing 2: Abbreviation writing exercises
5. Read the following sentences written with abbreviations and rewrite them as
complete sentences.
1. A 47 yo WM recently Dx with ED is C/O feeling dizzy, flushed, and LBP. He has
taken one Viagra 50-mg tab po 6 different times about 1 hr before sexual activity.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
2. A 29 yo WF with HO Hep B is C/O a thick Vag D/C that looks like cottage
cheese. Her MedHx includes Hepsera to Tx Hep B and Nasonex for nasal congestion.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
3. A 56 yo BF with HTN x 5 yrs is C/O a rapid heart beat. All include sulfa. She is
currently smoking 1 ppd cig and has been smoking for 36 yrs. Current MedHx includes
Captopril 25-mg po TID x 5 yrs and digoxin 5-mg po SID.
___________________________________________________________________
__________________________________________________________________
___________________________________________________________________
4. The pt. is C/O abd pain and worsening bloody diarrhea. He states he feels like he
has the flu. He was Dx with UC 3 wks ago. He has been taking Asacol po SID (dosage
UNK). All include PCN.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
5. The 43 yo WF is C/O abd pain and a foul vag D/C. Her LMP was 2 mos ago. She is
on BCP and denies she is pregnant. She has MS and is currently taking Betaseron Inj SID.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
6. The 21 yo WF‟s CC is nausea, loss of appetite, dizziness, and HAs. She began taking
Macrodantin cap po SID 5 days to Tx UTI. Pt has NKDA but other All include wasps, bees,
and iodine. She is on BCP and has been taking Aleve 1 tab prn for her HAs.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

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 7. The 30 yo BM is C/O painful and burning urination, and penile discharge for
about 1 wk. Hehas NKDA but is allergic to latex. Pt. had HO TB 5 yrs ago and was
prescribed rifampin. Pt. also has history of STDs-gonorrhea and chlamydia. He was Dx 2
yrs ago and was prescribed doxycycline and azithromycin. Pt does not remember dosage.
Pt. does not always use condoms or practice safe sex.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
8. The Pt. was brought in by her husband. He stated she was experiencing terrible
pain in her sternum and in her back and heartburn. Pt. was A&O. She had Endo 4 days ago
and was Dx with HH, GERD, and an inflamed esophagus. Her PMD prescribed ranitidine
1 tsp AM and 1 tsp PM SID. PSH includes appendectomy and rt. knee surgery. All include
Bactrim and cats.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
9. The 32 yo BM is C/O constipation 2 wks. He is taking Metamucil BID. The Pt.‟s
other current medications include Lipitor 20 mg po QHS to treat cholesterol and 2
glyburide 5 mg tab po BID for DM type II.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
10. The 69 yo BM is C/O of weakness and aching pain in both legs around the calf
area for a long time. He can‟t walk as far as he used to. Pt. has Hx of CAD, angina, and
high cholesterol. His Meds include Atenol 50-mg tab po SID, Mevacor 20-mg tab po daily,
and ASA 325-mgtab po SID.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

FURTHER READING
Completing a SOAP Note Exercise
Read the following patient scenario carefully. After reading it thoroughly, complete
the blank SOAP note form below. Put the information that you have read into the
appropriate sections. Use abbreviations and pay careful attention to spelling. Based on the
patient scenario presented, not every section of the SOAP note will be completed.

228
 Patient Scenario
MC is a 68-year-old white woman who is brought to the clinic by her son, who lives
with her. Her son states that his mother is not feeling well and has been coughing a lot. She
did not sleep well last night because the cough kept waking her up. MC has also been
coughing up phlegm and sputum. Her son also states that his mother is not eating as much.
MC has had chronic bronchitis since she was 22 and has been smoking since she was 15
years old. She developed chronic obstructive pulmonary disease 10 years ago. She has had
an Atrovent inhaler and is supposed to take four to six inhalations four times a day, but she
doesn‟t always do so. MC has had hypertension for 8 years and is taking 20 milligrams of
Lisinopril once a day. MC also takes 10 milligrams of Fosamax daily in the morning for
osteoporosis. She also had a complete hysterectomy when she was 42 as a result of fibroids
and severe menstrual bleeding. MC has also had two benign breast nodules removed. She
had a negative right breast biopsy in 1999 and a negative left breast biopsy in 2005. The
son states there is no history of breast cancer in the family, but that MC‟s sister died from
ovarian cancer at the age of 45 fifteen years ago. There is no history of diabetes or CAD in
her family. MC is allergic to iodine and sulfa. She is also allergic to cats. MC lives with
her son and his wife and two grandchildren ages 6 and 8. She worked until age 64 as a
supermarket cashier. She has been a widow 18 years. Her husband died of colon cancer.
She smokes a pack of cigarettes a week. She has tried to quit and wore the patch but with
no success. She doesn‟t drink alcohol. MC is tired, experiencing labored breathing, but is
cooperative. Her blood pressure is 137/82. Her pulse is 84. She weighs 135 pounds and
measures 66 inches tall. Her temperature is 98 degrees. There is no nasal discharge. Labs
and X-ray have been ordered and results are pending.
Patient: _____________________________________
S:
CC: ____________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
HPI: _____________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
PMH: ___________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
FH: _____________________________________________________________

229
 ________________________________________________________________
________________________________________________________________
________________________________________________________________
SH: _____________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
O:
Meds: _________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Allergies: _______________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
PE: _____________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Labs: ___________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
A: ______________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
P: ______________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

230
 SOAP Notes Comprehension Exercise
Now that you have completed a written SOAP related to the patient scenario, assess
your understanding of the patient‟s information in the SOAP note by doing the exercises
below.
Multiple Choice Questions
Choose the correct answer from A, B, and C.
1. _____ The patient‟s chief complaint is:
A. she has been a widow for 18 years
B. she is not feeling well and coughing a lot
C. she is allergic to sulfa and iodine
D. she coughed up phlegm
2. _____ The patient‟s husband‟s death of colon cancer and the patient‟s sister‟s
death of ovariancancer documents:
A. PMH
B. FH
C. SH
D. PHI
3. _____ The patient‟s allergies are documented in the:
A. assessment section of the SOAP note
B. subjective section of the SOAP note
C. objective section of the SOAP note
D. plan section of the SOAP note
4. _____ The patient:
A. works as a supermarket cashier and lives with her son and his family
B. is retired and lives alone
C. is retired and lives with her son and his family
D. works as a supermarket cashier and lives alone
5. _____ The patient‟s medication information includes:
A. medications to treat DM, CAD, and OA and is documented in the objective
section of the SOAP note
B. medications for HTN, chronic bronchitis, and COP and is documented in the
assessment section of the SOAP note
C. medications for HTN, chronic bronchitis, COPD, and osteoporosis and is
documented in the objective section of the SOAP note
D. medications for HTN, chronic bronchitis, and osteoporosis and is
documented in the objective section of the SOAP note

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 TAPESCRIPTS

UNIT 1
Language focus
Tapescript 2
Soon I will quit my job and move to Europe. I am very excited about it. I will be an
exchange student for one year in France and Spain. I will live in France first for six
months, and then I will move to Spain and I will live there for six months.
In both countries, I will study language at a local university. I do not know French or
Spanish now, so I will likely have trouble when I first move there. Still, I will do my best!
Tapescript 5
Soon I will quit my job and move to Europe. I am very excited about it. I will be an
exchange student for one year in France and Spain. I will live in France first for six
months, and then I will move to Spain and I will live there for six months.
In both countries, I will study language at a local university. I do not know French or
Spanish now, so I will likely have trouble when I first move there. Still, I will do my best!
I will live alone, and I am sure I will miss friends, but I hope I will make new friends
soon. My best friend will come out and visit me around New Year. We will probably take
a trip to Greece. We won‟t know our plans until later.
I am sure I will have some problems when I first move there. I will have a hard time
buying food, and talking but I am sure I will be fine.
I will miss a lot of things about my country, and I will miss my boyfriend. He will
not have time to visit me, so I won‟t see him until I return. I will write him every week
when I am there. I think we will stay together, but I am not sure. I hope we will stay
together!
I am sure my life will be different and I will change, but I hope I will change in a
good way, and I hope I won‟t regret my decision. As we say, only time will tell!
Listening 1
Tapescript 1
Our body is always in flux: when we are cold, our body shivers, when we are hot,
our body sweats. Our body engages in these activities to keep our internal temperature
constant. This is an example of homeostasis which is defined as the ability of the body to
maintain a constant internal state. One major way the body maintains homeostasis is
through the endocrine system.
Tapescript 2
Our body is always in flux: when we are cold, our body shivers, when we are hot,
our body sweats. Our body engages in these activities to keep our internal temperature

232
constant. This is an example of homeostasis which is defined as the ability of the body to
maintain a constant internal state. One major way the body maintains homeostasis is
through the endocrine system. The endocrine system is the system of glands that produce
hormones to regulate and control body activities. The endocrine system controls a number
of important functions throughout the body including growth and development,
metabolism, and homeostasis. There are many different hormones in the body, and each is
responsible for different functions. Estrodiol, testosterone, insulin, growth hormone, and
epinephrine are just a few examples of hormones. Although they are involved in different
functions of the endocrine system, hormones work in a similar manner.
Tapescript 3
First, a gland detects a change in the body‟s internal environment. This gland then
increases the secretion of hormones, which enter the bloodstream. Hormones travel
through the blood and can have potential effects throughout the body. However, hormones
will not act on every cell. Hormones activate target cells by binding to specific receptors
on the outside or inside the target cells. When a hormone binds to a receptor, the receptor
sends a signal throughout the cell. Just like a megaphone amplifies the volume of a
person‟s voice. A hormone‟s message is amplified inside the cell. This signal goes a long
way. Just a few hormones can induce great change. Once hormones have succeeded in
sending their messages to the target cells, and, in this case, homeostasis is achieved, the
gland decreases the secretion of hormones. The mechanism by which the gland stops
secreting hormones is called negative feedback. What exactly is negative feedback?
Negative feedback allows a system to self-regulate a response or output. The following
example may help explain. A house regulates its temperature using negative feedback.
When a thermostat detects a decrease in temperature, it sends a message to the furnace to
produce heat. When the thermostat detects that the room temperature has returned to the
correct level, it stops sending its message to the furnace. A furnace will turn on and off
several times a day to keep the temperature relatively constant.
Now, let‟s look at a specific example of homeostasis using a hormone that many of
you may have already heard of: insulin. Let‟s say a person eats a meal. As the food is
digested and glucose is absorbed into the bloodstream, blood glucose level begins to rise. It
is important for this glucose to be removed from the blood, otherwise it may cause damage
to important organs such as liver, brain, and kidneys. Thus, to maintain glucose blood
level, insulin is released from an endocrine gland: pancreas. The pancreas senses increased
blood glucose and releases insulin into the blood. Insulin travels through the blood and
binds to receptors on muscles, fat tissue, and as shown her, the liver. Upon binding to
receptors, insulin causes an increase in glucose transporters, allowing excess glucose to be
taken from the blood and stored in the liver for future use. This uptake of the glucose by
the liver and other organs for storage, restores blood glucose levels back to a balanced
state. Homeostasis has been achieved! Because blood glucose levels have reached
homeostasis, the pancreas will stop secreting insulin. This is just one type of hormone
involved in the endocrine system. Remember, the glands of the endocrine system send

233
messages to the body in a similar manner. A gland senses a change in the body, and secrets
a hormone. Hormones travel through the blood. Hormones are receptor specific. A
hormone‟s signal is amplified. And finally, hormones are regulated by feedback – many
times, negative feedback.
Tapescript 4
Remember, the glands of the endocrine system send messages to the body in a
similar manner. A gland senses a change in the body, and secrets a hormone. Hormones
travel through the blood. Hormones are receptor specific. A hormone‟s signal is amplified.
And finally, hormones are regulated by feedback – many times, negative feedback.
Listening 2
Tapescript 2
Over our lifetimes, our bodies undergo a series of extraordinary metamorphoses: we
grow, experience puberty, and many of us reproduce. Behind the scenes, the endocrine
system works constantly to orchestrate these changes. Alongside growth and sexual
maturity, this system regulates everything from your sleep to the rhythm of your beating
heart, exerting its influence over each and every one of your cells. The endocrine system
relies on interactions between three features to do its job: glands, hormones, and trillions of
cell receptors.
Firstly, there are several hormone-producing glands: three in your brain, and seven in
the rest of your body. Each is surrounded by a network of blood vessels, from which they
extract ingredients to manufacture dozens of hormones. Those hormones are then pumped
out in tiny amounts, usually in the bloodstream. From there, each hormone needs to locate
a set of target cells in order to bring about a specific change. To find its targets, it‟s helped
along by receptors, which are special proteins inside or on the cell‟s surface. Those
receptors recognize specific hormones as they waft by, and bind to them. When this
happens, that hormone-receptor combination triggers a range of effects that either increase
or decrease specific processes inside the cell to change the ways that cell behaves. By
exposing millions of cells at a time to hormones in carefully-regulated quantities, the
endocrine system drives large-scale changes across the body. Take, for instance, the
thyroid and the two hormones it produces, triiodothyronine and thyroxine. These hormones
travel to most of the body‟s cells where they influence how quickly those cells use energy
and how rapidly they work.

UNIT 2
Listening 1
Doctor: Okay, Ms. Ryan. I have a few questions before we get started with your
physical exam.
Patient: Oh sure. What do you need to know?
Doctor: Let‟s see. First, are you sexually active?

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 Patient: Yes, I am.
Doctor: And do you use contraceptives?
Patient: Um, well I try to.
Doctor: Try to?
Patient: Well, I use them most of the time.
Doctor: Ms. Ryan, it‟s very important for you to use a contraceptive every time. If
you don‟t, you could end up with an unwanted pregnancy. And you‟re putting yourself at
risk for STDs.
Patient: I know. I guess sometimes I just forget.
Doctor: I see. So you forget your birth control pills or you forget to use a condom?
Patient: Condoms. I don‟t take birth control pills.
Doctor: Well, you should use one every time you have intercourse. But I‟m going to
recommend another form of birth control, too.
Listening 2
If a female and male have sex within several days of the female's ovulation,
fertilization can happen. When the male ejaculates (when semen leaves the penis), a small
amount of semen is deposited into the vagina. Millions of sperm are in this small amount
of semen, and they "swim" up from the vagina through the cervix and uterus to meet the
egg in the fallopian tube. It takes only one sperm to fertilize the egg.
About 5 to 6 days after the sperm fertilizes the egg, the fertilized egg (zygote) has
become a multicelled blastocyst. A blastocyst is about the size of a pinhead, and it's a
hollow ball of cells with fluid inside. The blastocyst burrows itself into the lining of the
uterus, called the endometrium. The hormone estrogen causes the endometrium to become
thick and rich with blood. Progesterone, another hormone released by the ovaries, keeps
the endometrium thick with blood so that the blastocyst can attach to the uterus and absorb
nutrients from it. This process is called implantation.
As cells from the blastocyst take in nourishment, another stage of development
begins. In the embryonic stage, the inner cells form a flattened circular shape called the
embryonic disk, which will develop into a baby. The outer cells become thin membranes
that form around the baby. The cells multiply thousands of times and move to new
positions to eventually become the embryo.
After about 8 weeks, the embryo is about the size of a raspberry, but almost all of its
parts ‒ the brain and nerves, the heart and blood, the stomach and intestines, and the
muscles and skin ‒ have formed.
During the fetal stage, which lasts from 9 weeks after fertilization to birth,
development continues as cells multiply, move, and change. The fetus floats in amniotic
fluid inside the amniotic sac. It gets oxygen and nourishment from the mother's blood via
the placenta. This disk-like structure sticks to the inner lining of the uterus and connects to

235
the fetus via the umbilical cord. The amniotic fluid and membrane cushion the fetus
against bumps and jolts to the mother's body.
Pregnancy lasts an average of 280 days ‒ about 9 months. When the baby is ready for
birth, its head presses on the cervix, which begins to relax and widen to get ready for the
baby to pass into and through the vagina. Mucus has formed a plug in the cervix, which
now losen. It and amniotic fluid come out through the vagina when the mother's water
breaks.
When the contractions of labor begin, the walls of the uterus contract as they are
stimulated by the pituitary hormone oxytocin. The contractions cause the cervix to widen
and begin to open. After several hours of this widening, the cervix is dilated (opened)
enough for the baby to come through. The baby is pushed out of the uterus, through the
cervix, and along the birth canal. The baby's head usually comes first. The umbilical cord
comes out with the baby. It's clamped and cut close to the navel after the baby is delivered.
The last stage of the birth process involves the delivery of the placenta, which at that
point is called the afterbirth. After it has separated from the inner lining of the uterus,
contractions of the uterus push it out, along with its membranes and fluids.

UNIT 3
Listening 1
Tapescript 1, 2, 3
Sperm are produced and released by the male reproductive organs. The testes are
where sperm are produced. The testes are linked to the rest of the male reproductive organs
by the vas deferens which extends over the base of the pelvic bone or ilium, and wraps
around to the ampulla, seminal vesicle, and prostate.
The urethra then runs from the bladder through the penis. Sperm production in the
testes takes place in coiled structure called seminiferous tubules. Along the top of each
testicle is the epididymis. This is a cordlike structure where the sperm mature and are
stored.
The release process starts when the penis fills with blood and becomes erect.
Continuing to stimulate the penis will cause ejaculation. Mature sperm begin their journey
by travelling from the epididymis to the vas deferens which propels sperm forward with
smooth muscle contractions.
The sperm arrive first at the ampulla just above the prostate gland. Here, secretions
from the seminal vesicle located next to the ampulla are added. Next, the seminal fluid is
propelled forward through the ejaculatory ducts toward urethra. As it passes the prostate
gland, a milky fluid is added to make semen.
Finally, the semen is ejaculated from the penis through the urethra.
Listening 2
Tapescript 1

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 Luke: I‟m 14 years old and I‟ve recently had aching testicles for a few hours a day
maybe twice a month. I thought it might be growing pains, but could it be due to
masturbation or because I keep my laptop on my lap constantly? Is it an infection? There
are no lumps but it seems to be faintly swelled. I have not injured my testicles.
Tapescript 2, 3
Consultant: It‟s good that you asked this question! Guys should always take
testicular pain seriously, even if there‟s no obvious injury. Some of the things that cause
testicular pain can lead to permanent damage if they go on for too long. Because your pain
keeps coming back and there might be some swelling, you should tell a parent and call
your doctor‟s office right away. It‟s possible that you are having “growing pain”, but only
a doctor can tell for sure. Your doctor may send you to a urologist, a specialist in
conditions that affect a guy‟s reproductive system. Masturbation will not cause the kind of
pain that you describe. Neither will use a laptop though it‟s best to sit at a desk or table
when using one. If you can‟t do that, put a pillow between your body and your laptop.

UNIT 4
Listening 1
Tapescript 2
The nervous system has two main parts: the central and peripheral nervous systems.
The central nervous system (CNS) is made up of the brain and spinal cord and
the peripheral nervous system (PNS) is made up of nerves that branch off from the spinal
cord and extend to all parts of the body.
The nervous system transmits signals between the brain and the rest of the body,
including internal organs. In this way, the nervous system‟s activity controls the ability to
move, breathe, see, think, and more.
Tapescript 3, 4
The nervous system has two main parts: the central and peripheral nervous systems.
The central nervous system (CNS) is made up of the brain and spinal cord and
the peripheral nervous system (PNS) is made up of nerves that branch off from the spinal
cord and extend to all parts of the body.
The nervous system transmits signals between the brain and the rest of the body,
including internal organs. In this way, the nervous system‟s activity controls the ability to
move, breathe, see, think, and more.
The nervous system can be divided on the basis of its functions. There are two ways
to consider how the nervous system is divided functionally. First, the basic functions of the
nervous system are sensation, integration, and response. Secondly, control of the body can
be somatic or autonomic divisions that are largely defined by the structures that are
involved in the response. There is also a region of the peripheral nervous system that is
called the enteric nervous system that is responsible for a specific set of functions.

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 The nervous system can also be divided on the basis of how it controls the body. The
somatic nervous system (SNS) is responsible for functions that result in moving skeletal
muscles. Any sensory or integrative functions that result in the movement of skeletal
muscle would be considered somatic. The autonomic nervous system (ANS) is responsible
for functions that affect cardiac or smooth muscle tissue, or that cause glands to produce
their secretions. Autonomic functions are distributed between central and peripheral
regions of the nervous system. The sensations that lead to autonomic functions can be the
same sensations that are part of initiating somatic responses. Somatic and autonomic
integrative functions may overlap as well.
Listening 2
Tapescript 2, 3
Professor: Class. Let‟s see if you have been studying the nervous system. Elizabeth,
would you answer a few questions for me?
Student: Certainly, Professor.
Professor: First, what are the connections between neurons called?
Student: Those synapses? Professor? They enable the transfer of information.
Professor: Very good. And what types of signals do synapses send?
Student: They send chemical or electrical signals to another cell.
Professor: Right again. So tell me about how many synapses are there in average
brain?
Student: Hmm, that‟s a tough one. I would guess about 100 billion.
Professor: Not quite. It‟s actually many times that 100 to 500 trillion.
Student: Wow, that‟s a lot of synapses.
Professor: Indeed. All that information exchange is what makes the brain so
powerful.

UNIT 5
Language focus 3
Tapescript 1 – Interview between a doctor and a patient
Doctor: Now, Mrs Brown, can you tell me, have you had any trouble with your
stomach or bowels?
Patient: Well, I sometimes get a bit of indigestion.
Doctor: I see, and could you tell me more about that?
Patient: Well, it only comes on if I have a hot, something spicy, you know, like a
curry.
Doctor: I see, well that‟s quite normal really. And what‟s your appetite like/
Patient: Not bad.

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 Doctor: And any problem with your waterworks?
Patient: No, they‟re, they‟re all right.
Doctor: And are you still having your periods regularly?
Patient: No, they stopped, must have five years ago.
Doctor: Any pain in the chest, any palpitation, swelling of the ankles?
Patient: Not really, doctor.
Doctor: And what about coughs or wheezing or shortness of breath?
Patient: Only when I‟ve got a cold.
Doctor: Have you noticed any weakness or tingling in your limbs?
Patient: No, no, I can‟t say that I have, really.
Doctor: What sort of mood have you been in recently?
Patient: I‟ve been feeling a bit down. You know, I‟m not sleeping well.
Language focus 3
Tapescript 2 – Interview between a doctor and a patient
Doctor: And how long, how long have you had this temperature?
Patient: Oh, I don‟t know exactly. About two months on and off.
Doctor: And does, is the temperature there all time or does it come on at any
particular time?
Patient: Well, sometimes I‟m all right during day but, I wake up at night and I‟m
drenched in sweat, drenched, and sometimes my whole body shakes and ….
Doctor: And how have you been feeling in general?
Patient: Well, I don‟t know. I‟ve been feeling a bit tired, a bit tired and weak. And I
just don‟t seem to have any energy.
Doctor: And have you noticed any, any pain in your muscles?
Patient: Yes, well, actually I have a bit, yes.
Doctor: And what about your weight? Have you lost any weight?
Patient: Yes, yes, I have, about a stone.
Doctor: I see, and what about your appetite? What‟s your appetite been like?
Patient: Well, I‟ve really been off my food this last while. I just haven‟t felt like
eating.
Doctor: And have you had a cough at all?
Patient: Oh yes, I have. Nearly all the time. I sometimes bring up a lot of phlegm.
Doctor: And is there, have you noticed any blood in it?
Patient: No, not always but yes, sometimes.
Doctor: Have you had any pains in your chest?

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 Patient: Only if I take a deep breath.
Listening: A case history
Tapescript 2 – Presenting complaint
D = doctor, P = patient
1 D What‟s brought you here?
P My wrist is throbbing since I fell in the street.
2 D Can you tell me what seems to be bothering you?
P I‟ve got a really sorethroat.
3 D What‟s brought you here?
P I‟ve been getting a kind of boring pain right here, which goes through to my
back.
4D Can you tell me what seems to be bothering you?
P Well, it feels a bit tender just here on my right side.
5D Can you tell me what seems to be bothering you?
P I‟ve got this gnawing kind of pain right about here in my stomach.
6D What can I do for you?
P Well, I‟ve got this sharp pain up and down my leg.
7D What can we do for you?
P I feel as if there‟s a tight band squeezing all the way round my head.
8D What‟s brought you here?
P I‟ve got crushing pain right here in my chest.
Tapescript 3 – Taking history
D = doctor, P = patient
D Good morning, Mr. Bloomfield. My name‟s Dr. Dickson. I am a locum GP
standing in for Dr. Wright. What can we do for you?
P I‟ve been having some problems with my breathing.
D Mm-hmm. Can you tell me a little bit more about this?
P Well, I keep getting breathlessness and wheezing in my chest. It all started about
three weeks ago, and I‟ve been coughing a lot with it, some white phlegm. I thought it
might be a cold coming on, but then after about another week I started finding it more and
more difficult to catch my breath.
D Right, so you‟ve had the wheezing and breathlessness for roughly three weeks.
P Yes, give or take a day.
D And do you get these bouts of wheezing and shortness of breath every day?
P No, they come and go.

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 D How frequently do you get them?
P The first week there was only one I think, and then they started getting worse,
three, four times a week. It‟s not being able to get my breath that‟s really worrying.
D And so the attacks, have they increased the past two weeks?
P Yes. They‟re much more frequent.
D OK. When do the attacks come on?
P At any time, but they seem to be worse at night. And in the morning.
D Have you noticed any change in the severity of the attacks, especially in the
morning?
P Yeah.
D Do they wake you up at night?
P About three times a week.
D I see. You been off work at all?
P No. But nearly didn‟t go in yesterday.
D Was that the worst so far?
P Yeah.
D And have you had anything else with it?
P No just tightness.
D Are you aware of anything that triggers the attacks?
P Erm, like what?
D Dust, feathers, new carpets?
P No, I can‟t really say I am.
D OK. Have you had any infections recently like flu or sore throat or chest
infection?
P No. Not for a long time, except this.
D And what about medications? Are you taking anything?
P No.
D No aspirin?
P No.
D Are you doing any exercise, jogging for instance?
P No.
D What about pets at home?
P Yeah, things are fine.
D And what about work? I see you‟re a civil servant. Any stress or problems at work
or anything like that?
P Mmm, work‟s been getting me down recently.

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 D In what way?
P Well, there‟s been a lot of changes going on and recently and I suppose I‟m a bit
anxious what with the mortage and that.
D Mm-hmm. And this has been getting to you?
P Yes… more and more.
D I see. And does the wheezing et cetera continue over the weekends?
P Erm, no. When I come to think about it, it doesn‟t.
D OK. Some general questions. Have you ever had anything like this before?
P No, never.
D Do you have other illnesses?
P Erm …
D High blood pressure, diabetes or heart problems?
P No. Nothing like that. This is the first time I‟ve been ill in my life.
D Has anyone in your family had anything similar?
P No. Not as far as I know.
D What about eczema, anyone in your family with that?
P Both my sister and my mother have it.
Further practice
Tapescript 1 & 2 – An interview between a doctor and patient
Doctor: Good afternoon, Mr. Hudson. Just have a seat. I haven‟t seen you for a good
long time. What‟s brought you along here today?
Patient: Well, doctor. I‟ve been having these headaches and I seem to be have lost
some weight and …
Doctor: I see, and how long have these headaches been bothering you?
Patient: Well, I don‟t know. For quite a while now. The wife passed away you know,
about four months ago. And I‟ve been feeling down since then.
Doctor: And which part of your head is affected?
Patient: Just here. Just here on the top. It feels as if there were something heavy,
a heavy weight pressing down on me.
Doctor: I see, and have they affected your vision at all?
Patient: No, no, I wouldn‟t say so.
Doctor: Not even seeing lights or black spots?
Patient: No, nothing like that.
Doctor: And they haven‟t made you feel sick at all?
Patient: No.

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 Doctor: Now, you told me that you‟ve lost some weight. What‟s your appetite been
like?
Patient: Well, actually I haven‟t really been feeling like eating. I‟ve really been off
my food for the moment and …
Doctor: And what about your bowels, any problems?
Patient: No, no they‟re. I‟m quite all right, no problems.
Doctor: And what about your waterworks?
Patient: Well, I‟ve been having trouble getting started and I have to, I seem to have
to get up during the night, two or three times at night.
Doctor: And has this come on recently?
Patient: Well, no, not exactly. I think I‟ve noticed it gradually over the past, the past
few months.
Doctor: And do you get any pain when you‟re passing water?
Patient: No, no.
Doctor: And have you noticed any blood, any traces of blood?
Patient: No, no, I can‟t say that I have.

UNIT 6
Listening 1: Giving instructions
Doctor: Would you slip off your top things, please. Now I just want to see you
standing. Hands by your side. You‟re sticking that hip out a little bit, aren‟t
you?
Patient: Yes, well, I can‟t straighten up easily.
Doctor: Could you bend down as far as you can with your knees straight and stop when
you‟ve had enough.
Patient: Oh, that‟s the limit.
Doctor: Not very far, is it? Stand up again. Now I would like you to lean backwards.
That‟s not much either. Now stand up straight again. Now first of all, I would
like you to slide your right and down the right side of your thigh. See how far
you can go. That‟s fine. Now do the same thing on the left side. Fine. Now just
come back to stand straight. Now keep feet together just as they are. Keep your
knees firm. Now try and turn both shoulders round to the right. Look right
round. Keep your knees and feet steady.

Patient: Oh, that‟s sore.

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Doctor: Go back to the centre again. Now try the same things and go round to the left
side. Fine. Now back to the centre. That‟s fine. Now would you like to get onto
the couch and lieon your face? I‟m just going to try and find out where the sore
spot is.

Listening 2: Blood Test: Immunoglobulin A (IgA)

What It Is
An IgA test measures the blood level of immunoglobulin A, one of the most common
antibodies in the body. Antibodies are proteins made by the immune system to fight
bacteria, viruses, and toxins.
IgA is found in high concentrations in the body's mucous membranes, particularly
the respiratory passages and gastrointestinal tract, as well as in saliva and tears.
IgA also plays a role in allergic reactions. IgA levels also may be high in
autoimmune conditions, disorders in which the body mistakenly makes antibodies against
healthy tissues.
Why It's Done
An IgA test can help doctors diagnose problems with the immune system, intestines,
and kidneys. It may be done in kids who have recurrent infections. It's also used to evaluate
autoimmune conditions, such as rheumatoid arthritis, lupus, and celiac disease. Kids born
with low levels of IgA - or none at all - are at increased risk of developing an autoimmune
condition, infections, asthma, and allergies.
Preparation
Your doctor will tell you if any special preparations are required before this test. On
the day of the test, having your child wear a T-shirt or short-sleeved shirt can make things
easier for your child and the technician who will be drawing the blood.
The Procedure
A health professional will usually draw the blood from a vein. For an infant, the
blood may be obtained by puncturing the heel with a small needle (lancet). If the blood is
being drawn from a vein, the skin surface is cleaned with antiseptic, and an elastic band
(tourniquet) is placed around the upper arm to apply pressure and cause the veins to swell
with blood. A needle is inserted into a vein (usually in the arm inside of the elbow or on
the back of the hand) and blood is withdrawn and collected in a vial or syringe.
After the procedure, the elastic band is removed. Once the blood has been collected,
the needle is removed and the area is covered with cotton or a bandage to stop the
bleeding. Collecting blood for this test will only take a few minutes.
What to Expect
Either method (heel or vein withdrawal) of collecting a sample of blood is only
temporarily uncomfortable and can feel like a quick pinprick. Afterward, there may be
some mild bruising, which should go away in a few days.

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 Getting the Results
The blood sample will be processed by a machine. The results are commonly available
within a day or two. If results suggest an abnormality, the doctor may perform further tests.
Risks
This test is considered a safe procedure. However, as with many medical tests, some
problems can occur with having blood drawn, like:
• fainting or feeling lightheaded;
• hematoma (blood accumulating under the skin causing a lump or bruise);
• pain associated with multiple punctures to locate a vein.
Helping Your Child
Having a blood test is relatively painless. Still, many children are afraid of needles.
Explaining the test in terms your child might understand can help ease some of the fear.
Allow your child to ask the technician any questions he or she might have. Tell your
child to try to relax during the procedure, as tense muscles can make it harder and more
painful to draw blood. It also may help for your child to look away when the needle is
being inserted into the skin.
If You Have Questions
If you have questions about the IgA test, speak with your doctor.
Listening 3: Explaining gastroscopy
D = Doctor, P = Patient
D I need to explain the procedure to you and get you to sign the consent form.
P OK.
D So we‟re going to do something called a gastroscopy. Do you know what that is?
P No, I don‟t. No.
D Well, what we are going to do is have a look at your gullet and your stomach to
see what‟s going on there.
P OK.
D It‟s a routine procedure. What we are going to do first is to give you something to
help you relax, and then we‟re going to numb your throat with a spray. Then, we are going
to pass a bendy tube, which is no thicker than your little finger down through your throat
into your stomach, OK?
P I see.
D The tube will have a tiny camera on the end so that we can look at your stomach.
And if we see anything there what we can do is take a tiny tissue sample.
P Right.
D We‟re also going to blow some air into your stomach to help us see a bit better, so
you will feel a bit full and possibly want to belch.

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 P It sounds a bit scary.
D I agree it can…

UNIT 7
Listening 1: Explaining a diagnosis
Doctor: Well, Mr. Jameson, there‟s a nerve running behind your knee and your hip
and through your spine.
Patient: Uhh.
Doctor: When you lift your leg, that nerve should slide in and out of your spine quite
freely, but with your leg, the nerve won‟t slide very far. When you lift it, the nerve gets
trapped and it‟s very sore. When I bend your knee, that takes the tension off and eases the
pain. If we straighten it, the nerve goes taut and it‟s painful.
Patient: Aye.
Doctor: Now what is trapping the nerve? Well, your MRI scan confirms that you‟ve
got a damaged disc in the lower part of your back.
Patient: Oh, I see.
Doctor: The disc is a little pad of gristle which lies between the bones in your spine.
Now, if you lift heavy loads in the wrong way, you can damage it. And that‟s what‟s
happened to you. You‟ve damaged a disc. It‟s pressing on a nerve in your spine so that it
can‟t slide freely and that‟s the cause of these pains you‟ve been having.
Patient: Uhuh.
Doctor: Now we‟re going to try to solve the problem first of all with bed rest to let
the disc get back to normal and with drugs to take away the pain and help the disc recover.
We‟ll also give you some physio to ease your leg and back. I can‟t promise this will be
entirely successful and we may have to consider an operation at a later date.
Listening 2
Tapescript 2
Patient: Have I got to rest? I was hoping you could give me something to ease the
pain so that I could get back to work.
Doctor: Well, I‟m afraid going back to work is out of the questions just now. I think
it will be some weeks before you can go back to your kind of active work. You‟re going to
have to rest and to begin with at least two weeks of complete bed rest.
Patient: I see.
Doctor: You must rest to allow this swelling to go down and be absorbed to reduce
the pressure on the nerve and lessen the pain. Movement will only increase the pressure. If
you get up, even to sit on a chair, all the body weight above the damaged disc will press
down on the disc below causing more pressure with the risk of pushing out more of the soft
disc centre and making the problem worse. Rest also help relieve the tight muscle spasm.

246
So, for the first week it should be complete bed rest on a firm, hard mattress, a low pillow,
better still, no pillow. You should also try to have your meals lying down. Don‟t sit up to
eat. I‟ll give you drugs to relieve the pain and stiff muscles. When the pain and stiffness
improve, I‟ll get the physiotherapist to instruct you in exercises to strengthen your back
muscles, and to make you more supple and we‟ll then gradually mobilise you, letting you
get up for longer each day, being guided by the pain you‟re experiencing.
Patient: Ok.
Doctor: So this will have to be the programme. It‟s not a condition which you can get
up and work off, I‟m afraid.
Tapescript 3
Doctor: Now, Mr. Jameson, here is a prescription for some tablets which you
are to take two of every six hours. Try to take them after food/meals if possible in
case they cause you indigestion. You can take them during the night as well if you
are awake with the pain.
Listening 3
Physio: First of all, you lie down on your tummy on a hard surface. The floor will do.
Now place your hands on your back and lift one leg up straight without bending your knee.
Then bring it down and lift the other leg up in the same way and then bring it down. Repeat
this exercise five times doing it alternately with each leg.
Keeping the same position, place your hands on your back and lift your chest up off
the floor, and then bring it down slowly. Repeat this exercise five times.
Now keeping your hands at your sides and lying on your tummy, lift alternate leg
and arm simultaneously – for example, your right leg and left arm – and then bring them
down. Next lift your other alternate leg and arm, and then bring them down. Repeat this
exercise five times.
Keep your hands on your back and then lift your chest and legs up simultaneously,
and then lift bring them down slowly. Repeat this exercise also five times. This is a
difficult exercise but with practice you‟ll be able to do it properly.
Now you have to change position. So lie on your back with your hands on your sides
and bend your knees up, keeping your feet on the floor. Now lift up your bottom and then
bring it down slowly. Repeat this exercise five times.
You should do these exercises three times a day, preferably on an empty stomach
before meals. Then depending on your progress, after two weeks or so we‟ll increase the
number of times you do these exercises. You should try to do them as slowly and smoothly
as possible and try to avoid jerking your body.
Speaking 1
1. A 33-year-old salesman suffering from a duodenal ulcer.

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 Doctor: Your stomach has been producing too much acid. This has inflamed an area
in your bowel. It‟s possible that your stressful job has aggravated the situation. This is
quite a common condition and there is an effective treatment. It doesn‟t involve surgery.
2. A 6-year-old boy with Perthes‟ disease, accompanied by his parents.
Doctor: What‟s happened to your son‟s hip is caused by a disturbance of the blood
supply to the growing bone. This causes the bone to soften. When he walks, it puts
pressure on the bone and it changes shape. It‟s painful and he limps. This problem isn‟t
uncommon with young boys and if we treat it now, it won‟t cause any permanent damage.
3. A 21-year-old professional footballer with a torn meniscus of the right knee.
Doctor: The cartilage, which is the cushioning tissue between the bones of your knee,
has torn when your knee was twisting.
Patient: Right.
Doctor: We need to do some further tests – an MRI scan and possibly an
arthroscopy.
Patient: Sorry.
Doctor: That means looking into the joint with a kind of telescope. If there is torn
cartilage, we can remove it then. Footballers often get this kind of problem and with
treatment and physio, you will be able to play again.
4. A 43-year-old teacher with fibroids.
Doctor: Er, well your heavy periods are caused by a condition known as fibroids.
Fibroids are a type of growth in the womb. They‟re not related to cancer and there are quite
common. When you get to the change of life, they may become smaller and cause you no
trouble but at your age and because the bleeding has made you anaemic, the best treatment
is an operation.
5. An 82-year-old retired nurse suffering from dementia accompanied by her son and
daughter.
Doctor: Your mother is in the early stages of dementia which is a condition of the
brain in older people which causes loss of memory, particularly recent memory.
Sometimes people with dementia also have delusions. Her personality may change, for
example she may become rude and aggressive. Her mood may become very up and down.
At this stage she can stay at home with some help and her condition will deteriorate and
she will need to go into care in the long term.
6. A 2-week-old baby with tetralogy of Fallot, accompanied by her parents.
Doctor: Your baby has a heart condition which developed when she was growing in
the womb. Some babies with this condition are born looking blue but it‟s also possible for
the blueness to develop after a few weeks. The blood flow in the heart becomes abnormal
and this causes your baby to grunt and have difficulty in feeding. Fortunately there is an
operation for this condition which is very successful. It‟s extremely likely your baby will
go to lead a normal life.

248
 7. A 35-year-old receptionist suffering from hypothyroidism.
Doctor: The cause of your problem is your thyroid gland which is situated here in
your neck. The hormones from this gland affect all areas of your body. If the gland isn‟t
working properly, many things can go wrong. For example, it can cause weight gain and
hair loss. This is a common condition and the treatment is simple.

UNIT 8
Language focus task 5
1. Take this tablet/pill/ half an hour before meals
2. Swallow this tablet without chewing.
3. Take a pinch of this powder and mix it with some water.
4. Apply a thin coat of this ointment every evening and then cover with a wet
dressing.
5. Dip a cotton bud in this tincture and apply it to your gums.
6. Pour an ampoule of this solution into boiling water and inhale it for five minutes.
7. This is a bitter tablet/pill/, so takeit with some sort of juice.

Language focus task 6

1. a) If you are unable to swallow this tablet/pill/, break it in half or crush it into a
powder.
b) Place this pill under your tongue and allow it to dissolve.
2. Take this capsule with some water.
3. a) Drop some mixture on a sugar cube.
b) Shake the mixture well before taking.
4. Insert one of these suppositories into the vagina before going to bed.
5. Rub a thin layer of this cream on your skin.
6. Use three drops of these eye drops every evening.
7. Apply some talcum powder to your skin.
8. Mix 15 drops in a cup of water and gargle 2-3 times a day.

Listening 1
Tapescript 1, 2
Doctor (M): Cindy, let's review these patients‟ meds before I head out.
Nurse (F): Sure thing, Doctor.

249
 Doctor: Ms. Fulton should receive 150 mg of antibiotics twice daily.
Nurse: Should that be administered P.O. or through an injection?
Doctor: An IM would work better. Second, Mr. Brown can have aspirin if he asks for
it, but not more than 600 mg per day.
Nurse: Okay. He'll want to take that sublingually, right?
Doctor: Yes, he can't chew tablets.
Nurse: Got it. Thanks, Doctor. Have a good night.

Listening 2
Tapescript 3, 4
1. Let‟s start with Mr Gupta. He‟s had pain all night in the lower abdomen. The
doctor says he needs stronger pain relief, so he has prescribed thirty milligrams of
Morphine every four hours.
2. We have moved Mr Gill to an isolation room, as he has an infection in his
respiratory tract. A new antibiotic may work, so we are giving him a 600 milligram
infusion of Clindamycin over a period of four hours.
3. Now, Mr Sawyer. We have to encourage bowel movement, so laxative could be
useful. He has one tablespoon of Metamucil-That‟s 15 milligrams-three times a day.
4. Right. Mr Thomas is on antibiotics for his skin infection. Cephalexin is in tablet
form, to be taken with food. 250 milligrams every six hours.
5. Lastly, Mr Cheong receives an injection of an antihistamine every eight hours 10
milligrams of Dimotane each time. May be this will control his allergies.
Listening 3
Tapescript 6
Let‟s see now, Mrs T Hawthorne, date of birth fourth February 1963, hospital
number 1834572Z. She was prescribed Tramadol today - fifteenth October 2009, given
intramuscularly, fifty milligrams, started on thirteenth October at eleven thirty. All Ok.
Mmm Maximum frequency every four hours, maximum dose six hundred milligrams, Ok.
To be administered as required intramuscularly and given by Senior Nurse Bond.
Listening 4
Tapescript 8, 9
Doctor: Good afternoon, Mr Johnson. My name is Dr Haward. How are you today?
Patient: I‟m fine, doctor.
Doctor: That‟s good. Well, … I‟ve got some good news for you. You‟ve made very
good progress and we‟re going to let you go home.
Patient: Really?

250
 Doctor: Yes. But before you go, there‟s just one or two things to do. I can see you‟re
very pleased about going home.
Patient: Well, I am.
Doctor: Well, we won‟t keep you long then. First, I‟d just like to have a brieft chat
with you about your medication.
Patient: OK.
Doctor: We‟re going to give you lots of tablets to take with you… and make you
rattle a bit.
Patient: Ok. I thought that might happen.
Doctor: Right. Now, if at any time you want to stop me and ask questions, feel free
to do so. There‟s a lot of information to take in at one time.
Patient: Yeah, fine.
Doctor: The first tablet, which I am sure you‟re familiar with, is this little white one,
aspirin.
Patient: Yeah.
Doctor: We‟re going to give you a very small dose of 75 milligrams. It‟s a much
smaller dose than you‟d normally buy over the counter. You take it by mouth once day
after a meal from now on.
Patient: OK. Why do I need to take it?
Doctor: The aspirin will help you a lot, as it thins the blood and so helps to prevent
further attacks.
Patient: That‟s good.
Doctor: Now as with everything we take there are some possible side effects.
Patient: Mm-hmm?
Doctor: And I emphasize the word possible, as you may not get any of them. But I
just have to point them out, so that you‟re aware of them and can do something about it if
anything happens.
Patient: OK.
Doctor: Sometimes, people get an upset stomach. Or aspirin can make the stools of
some people dark and smelly, or it can cause bleeding like nose leeds or shortness of
breath. But remember, I‟m just pointing them out to you so that you‟re aware of them.
Also look at the leaflet that come with the tablets. If you do get anything, just get in touch
with your GP is everything OK so far?
Patient: Yeah.
Doctor: OK. Would you like to go through everything and explain it to me?

251
 NEW WORDS

UNIT 1
adrenal (adjective) /əˈdriːnəl/ thượng thận
adrenal gland (n, singular /əˈdriːnəlɡlænd/ tuyến thượng thận
plural)
antagonistic (adjective) /æntæɡənˈɪstɪk/ đối kháng
anterior lobe (n, singular) /ænˈtɪə.ri.ərləʊb / đại não
conversion (n, singular) /kənˈvɜːʃən/ sự chuyển đổi
/kənˈvɜːʒən/
equilibrium (n, singular) /ˌekwɪˈlɪbriəm/ sự cân bằng
/ˌiːkwɪˈlɪbriəm/
excretion (n, singular) /ɪkˈskriː.ʃən/ sự/chất bài tiết
glucagon (n, singular) /ˈɡluː.kə.ɡɒn/ một hoóc môn được các tế
bào alpha của tụy bài tiết
gonad (n, singular) /ˈɡəʊ.næd/ tuyến sinh dục
homeostasis (n, singular) /ˌhəʊ.mi.əʊˈsteɪ.sɪs/ cân bằng nội môi
hypothalamus (n, singular) /ˌhaɪ.pəʊˈθæl.ə.məs/ vùng dưới đồi
iodine (n, singular) /ˈaɪ.ə.diːn/ iốt
isthmus (n, singular) /ˈɪsθ.məs/ eo
melatonin (n, singular) /mel.əˈtəʊ.nɪn/ một loại hoóc môn được
tạo bởi tuyến tùng
ovaries (n, plural) /ˈəʊ.vər.iz/ buồng trứng
oxytocin (n, singular) /ˌɒk.sɪˈtəʊ.sɪn/ một loại hoóc môn tự nhiên
trong cơ thể
parathyroid (adjective) /ˌpær.əˈθaɪ.rɔɪd/ thuộc về tuyến cận giáp
pancreatic duct (n, singular) /ˌpæŋ.kriˌæt.ik ống tụy
ˈdʌkt/
phosphate (n, singular) /ˈfɒs.feɪt/ một hợp chất vô cơ và
muối của axit phosphoric
pineal (n, singular) /ˈpɪn.i.əl/ tuyến tùng
pituitary gland (n, singular) /pɪˈtʃuː.ɪ.tər.i ˌɡlænd/ tuyến yên
puberty (n, singular) /ˈpjuː.bə.ti/ tuổi dậy thì
receptor (n, singular) /rɪˈsep.tər/ thụ thể
secretion (n, singular) /sɪˈkriː.ʃən/ sự/chất bài tiết
starches (n, plural) /stɑːtʃiz/ các loại tinh bột

252
strip (verb) /strɪp/ mảnh, đoạn (dài, dẹt)
testes (n, plural) /ˈtes.tiːz/ tinh hoàn
thyroid (n, singular) /ˈθaɪ.rɔɪd/ tuyến giáp
thymus gland (n, singular) /ˈθaɪ.məsɡlænd// tuyến ức
thyroxine (n, singular) /θaɪˈrɒk.sɪn/ hoóc môn tuyến giáp
ventricle (n, singular) /ˈven.trɪ.kəl/ não thất

UNIT 2
asymptomatic (adj) /ˌeɪ.sɪmp.təˈmæt.ɪk/ không có triệu chứng bị
bệnh
benign (adj) /bɪˈnaɪn/ u lành tính
blastocyst (n) /‟blæstəυsist/ túi phôi, túi mầm
burrow (n) /ˈbʌr.əʊ/ làm tổ
chemotherapy (n) /ˌkiː.məʊˈθer.ə.pi/ hóa trị liệu
cluster (n) /ˈklʌs.tər/ cụm
(v) tụ lại
ectopic pregnancy (n) /ekˌtɒp.ɪk mang thai ngoài tử cung
ˈpreɡ.nən.si/
embryo (n) /ˈem.bri.əʊ/ phôi thai
embryonic (adj) /ˌem.briˈɒn.ɪk/ còn phôi thai
endometrium (n) /ˌen.dəʊˈmiː.tri.əm/ nội mạc tử cung
epidemic (n, adj) /ˌep.ɪˈdem.ɪk/ bệnh dịch, dịch
fallopian tube (n) /fəˌləʊ.pi.ən ˈtʃuːb/ ống dẫn trứng, vòi trứng
fertilization (n) /ˌfɜː.tɪ.laɪˈzeɪ.ʃən/ sự thụ tinh
fetus (n) /ˈfiː.təs/ thai, thai nhi
fimbriae (n) /‟fimbriə/ tua loa vòi tử cung
gamete (n) /ˈɡæm.iːt/ giao tử
gonad (n) /ˈɡəʊ.næd/ tuyến sinh dục
implantation (n) /ɪm.plɑːnˈteɪ.ʃən/ sự cấy, sự làm tổ của trứng
infertility (n) /ˌɪn.fəˈtɪl.ə.ti/ vô sinh
intimate (n,v, adj) /ˈɪn.tɪ.mət/ thân mật, có quan hệ tình
dục
invasive (adj) /ɪnˈveɪ.sɪv/ xâm lấn
malignancy (n) /məˈlɪɡ.nən.si/ áctính
metastasis (n, singular) /meˈtæs.tə.sɪs/ di căn
metastases (n, plural) /meˈtæs.tə.siːz/ di căn
mucus (n) /ˈmjuː.kəs/ dịch nhầy, niêm dịch
myometrium (n) /‟maiəυ‟mi triəm/ cơ tử cung

253
neoplasm (n) /ˈniː.ə.plæz.əm/ u, khối u, ung thư
nourish (v) /ˈnʌr.ɪʃ/ nuôi, nuôi dưỡng
nourishment (n) /ˈnʌr.ɪʃ.mənt/ sự nuôi dưỡng
offspring (n) /ˈɒf.sprɪŋ/ con, con cái
ova (n, plural) /ˈəʊ.və/ trứng
ovary (n, singular) /ˈəʊ.vər.i/ buồng trứng
ovum (n, singular) /ˈəʊ.vəm/ trứng
persist (v) /pəˈsɪst/ vẫn tồn tại, dai dẳng
placenta (n) /pləˈsen.tə/ thau thai
precancerous (adj) /ˌpriːˈkæn.sər.əs/ tiền ung thư
premenstrual (adj) /ˌpriːˈmen.stru.əl/ trước kỳ kinh nguyệt
sterility (n) /stəˈrɪl.ə.ti/ sự vô sinh
uterus (n) /ˈjuː.tər.əs/ tử cung, dạ con
vagina (n) /vəˈdʒaɪ.nə/ âm đạo

UNIT 3
biomarker (n) /ˈbaɪəʊ mɑːkə/ dấu ấn sinh học
bulbourethral gland (n) /bulˈboure´thral tuyến hành - niệu quản
ɡlænd/
ejaculate (v) /iˈdʒæk.jə.leɪt/ xuất tinh
ejaculation (n) /ɪdʒækjʊˈleɪʃən/ sự xuất tinh
ejaculatory (adj) /ɪˈdʒækjʊlətərɪ/ xuất tinh
epididymis (n) /ɛpɪˈdɪdɪmɪs/ mào tinh hoàn
erect (v) /ɪˈrɛkt/ cương cứng
erection (n) /ɪˈrɛkʃən/ sự cương cứng
laparoscopic (adj) /læp.ə.rəˈskɒp.ɪk/ nội soi ổ bụng
masturbation (n) /mæs tərˈbeɪʃən/ sự thủ dâm
penis (n) /ˈpiːnɪs/ dương vật
prostate (n) /ˈprɒs.teɪt/ tuyến tiền liệt
prostate cancer (n) /ˈprɒs.teɪtˈkæn.sər/ ung thư tuyến tiền liệt
prostatectomy (n) /prɒs.təˈtek.tə.mi/ phẫu thuật cắt bỏ tuyến tiền
liệt
scrotum (n) /ˈskrəʊtəm/ bìu
secrete (v) /sɪˈkriːt/ tiết ra
semen (n) /ˈsiː.mən/ tinh dịch
seminal vesicle (n) /ˈsem.ɪ.nəl ˈves.ɪ.kəl/ túi tinh
sperm (n) /spɜːm/ tinh trùng
spermatic cord (n) /spɜːˈmæt.ɪk kɔːd/ dây tinh hoàn

254
spermatolysis (n) /spərməˈtələsis/ phân hủy tinh trùng
tubelike (n) /tʃuːblaɪk/ ống dẫn
vas deferens (n) /væs ˈdef.ə.renz/ ống dẫn tinh
foreskin (n) /ˈfɔː.skɪn/ bao quy đầu
intercourse (n) /ˈɪn.tə.kɔːs/ sự giao hợp
pubic (adj) /ˈpjuː.bɪk/ (thuộc) mu, xương mu

UNIT 4
axon (n) /'æɜə(r)/ sợi trục (thần kinh)
central nervous (adj) /'sentrəl'nə:vəs'sisti hệ thần kinh trung ương
system m/
cerebrum (n) /seribrəm/ não, óc
cerebellum (n) /,seri'beləm/ tiểu não
cortex (n, singular) /'kɔ:teks/ vỏ não
dementia (n) /diˈmenʃə/ chứng mất trí
dendrite (n) /'dendrait/ hình cây
fissure (n,v) /'fiʃə/ chỗ nứt, nứt
ganglion (n, singular) /'gæɳgliən/ hạch
hemisphere (n) /'hemisfiə/ bán cầu não
layer (n) /'leiə/ lớp
longitudinal (adj) /,lɔndʤi'tju:dinl/ theo chiều dọc
motor neurons (n) /'moutənjuə'rɔn/ thần kinh vận động
nerves (n, plural) / nə:vz/ thần kinh, dây thần kinh
nervous (adj) /'nə:vəs/ (thuộc) thần kinh
nervous system (n) /'nə:vəs'sistim/ hệ thần kinh
neurology (n) /njuə'rɔlədʤi/ khoa thần kinh, thần kinh
học
neurologist (n) /njuə'rɔlədʤist/ bác sĩ chuyên khoa thần
kinh
neurons (n) /njuə'rɔn/ tế bào thần kinh
peripheral (adj) /pə'rifərəl/ (thuộc) ngoại vi
retina (n, singular) /'retinə/ võng mạc
retinas (n, plural) võng mạc
spinal cord (n) /'spainlkɔ:d/ tủy sống
synapse (n) /si'næps/ khớp thần kinh
vertebrate (adj) /'və:tibrit/ có xương sống

255
UNIT 5
accuracy (n) /ˈækjərəsi/ sự chính xác
accurate (adj) /ˈækjərət/ chính xác
anorexia (n) /ˌænəˈreksiə/ chán ăn
approach (n) /əˈprəʊtʃ/ hướng tiếp cận
blackout (n) /ˈblækaʊt/ mất ý thức
breathlessness (n) /ˈbreθləsnəs/ khó thở
cavity (n) /ˈkævəti/ lỗ sâu răng
complaint (n) /kəmˈpleɪnt/ phàn nàn
comprehensive (adj) /ˌkɒmprɪˈhensɪv/ toàn diện
concern (n) /kənˈsɜːn/ mối quan tâm
coryza (n) /kəˈraizə/ cảm cúm
data (n) /ˈdeɪtə/ số liệu
delirium (n) /dɪˈlɪriəm/ mê sảng
diplopia (n) /dɪˈpləʊ.pi.ə/ chứng nhìn đôi
drowsiness (n) /ˈdraʊzinəs/ buồn ngủ
eczema (n) /ˈeksɪmə/ bệnh chàm
elicit (v) /ɪˈlɪsɪt/ gợi mở
estimate (v) /ˈestɪmeɪt/ ước tính, đánh giá
exertion (n) /ɪɡˈzɜːʃn/ nỗ lực, gắng sức
haemoptysis (n) /hi: ˈmɒptəsis/ ho ra máu
hypotension (n) /,haipouˈtenʃn/ bệnh hạ huyết áp
incomplete (adj) /ˌɪnkəmˈpliːt/ thiếu, chưa hoàn chỉnh
initial (adj) /ɪˈnɪʃl/ ban đầu
intervention (n) /ˌɪntəˈvenʃn/ can thiệp
loin (n) /lɔɪn/ thắt lưng
malaise (n) /məˈleɪz/ khó chịu
medication (n) /ˌmedɪˈkeɪʃn/ thuốc chữa bệnh
novocaine (n) /ˈnəʊvəkeɪn/ thuốc tê
nullipara (n/adj) /nʌˈlipərə/ chưa sinh con lần nào
obstacle (n) /ˈɒbstəkl/ khó khăn, trở ngại
thuộc dây thần kinh vận
oculomotor (adj) /,ɔkjulouˈmoutə/
nhãn
oedema (n) /ɪˈdiːmə/ phù nề
onset (n) /ˈɒnset/ khởi phát
palpitations (n) /ˌpælpɪˈteɪʃnz/ đánh trống ngực
phlegm (n) /flem/ đờm dãi
photophobia (n) / fəυtəυˈfəυbiə/ chứng sợ ánh sáng

256
prioritize (v) /praɪˈɒrətaɪz/ ưu tiên
procedure (n) /prəˈsiːdʒə(r)/ quy trình
pruritus (n) /prʊˈraɪtəs/ viêm ngứa
puffy (adj) /ˈpʌfi/ sưng húp
record (n) /ˈrekɔːd/ bệnh án
restless (adj) /ˈrestləs/ bồn chồn
spit (n) /spɪt/ nước bọt, nước dãi
sputum (n) /ˈspjuː.təm/ đờm
strangury (n) / ˈstræŋgjυri/ chứng đái són đau
ultimately (adv) /ˈʌltɪmətli/ cuối cùng
worrisome (adj) /ˈwʌrisəm/ đáng lo lắng

UNIT 6
auscultation (n) /ˌɔːskəlˈteɪʃn/ nghe (dùng ống nghe)
bend down p. verb /benddaʊn/ cúi gập người
biopsy (n) /ˈbaɪ.ɒp.si/ xét nghiệm sinh thiết tế
bào
clenched (v) /klentʃ/ (cầm/nắm) chặt
computed tomography /kəmˈpjuːtd chụp cắt lớp vi tính
təˈmɒɡ.rə.fi/
crook of the elbow (v) /krʊk/ uốn cong, gập
double up/over p. verb /ˈdʌb.əl/ uốn gập
electrocardiography (n) /iˌlek.trəˈkɑːrdi.ə.ɡræf điện tâm đồ
i/
electroencephalography (n) /iˌlek.troʊ.enˈsef.ə.lə.ɡ điện não đồ
ræfi/
fist (n) /fɪst/ nắm tay
inspection (n) /ɪnˈspek.ʃən/ kiểm tra, khám
lightheaded (adj) /ˈlɑɪtˌhed·əd/ hoa mắt, choáng váng
loosen up/warm up /ˈluː.sən ᴧp/ /wɔːm ᴧp/ khởi động/thư giãn
magnetic resonance (n) /mæɡˌnet.ɪk chụp cộng hưởng từ
imaging ˈrez.ən.əns ˌɪm.ɪdʒ.ɪŋ/
mucosa (n) /mjuːˈkoʊ.sə/ niêm mạc
optional adj /ˈɑːp.ʃən.əl/ tùy ý
palpation (n) /pælˈpeɪ.ʃən/ chạm/ sờ
percussion (n) /pɚˈkʌʃ.ən/ gõ nhẹ

257
pinprick (n) /ˈpɪn.prɪk/ châm bằng đinh ghim
poikilocytosis (n) /‟pɔikiləυsai „təυsis/ hồng cầu dị dạng
posture (n) /ˈpɑːs.tʃɚ/ dáng điệu
radiography (n) /ˌreɪ.diˈɑː.ɡrə.fi/ việc chụp x-quang
rheumatoid arthritis (n) /ˌruː.mə.tɔɪd viêm khớp dạng thấp
ɑːˈθraɪ.tɪs/
sedate (v) /sɪˈdeɪt/ cho dùng thuốc an thần
sedative (n) /ˈsed.ə.tɪv/ thuốc an thần
sterile adj /ˈster.aɪl/ /ˈster.əl/ vô trùng, vô sinh
stethoscope (n) /ˈsteθ.ə.skoʊp/ ống nghe
swing around/round p.verb /swʌŋ/ /əˈraʊnd/ quay ngoắt, thay đổi/
chuyển hướng hoàn
toàn
thaw out p.verb /θɔː/ /aʊt/ làm cho ấm lên
tourniquet (n) /ˈtʊə.nɪ.keɪ/ ga-rô
/ˈtɝː.nɪ.kɪt/
turn around/round p.verb /tɜːn//əˈraʊnd/ quay (mặt)
ultrasound scan (n) /ˈʌl.trə.saʊnds kæn/ siêu âm
waste away p. verb /weɪst/ /əˈweɪ/ gầy mòn, ốm yếu đi

UNIT 7
anaesthesia (n) /ˌæn.əsˈθiː.zi.ə/ (việc) gây mê
anaesthetic (adj) /ˌæn.əsˈθet.ɪk/ (thuộc về) gây mê
anaesthetist (n) /əˈniːs.θə.tɪst/ bác sỹ gây mê
ascertain (v) /ˌæs.əˈteɪn/ khẳng định
atopic eczema (n) /eɪˈtɒp.ɪkˈek.sɪ.mə/ viêm da cơ địa
assure (v) /əˈʃɔːr/ quả quyết, đảm bảo
carry out (phr. v) /ˈkær.i/ tiến hành, thực hiện
cure (v) /kjʊər/ chữa lành/khỏi
carcinoma (n) /kɑː.sɪˈnəʊ.mə/ ung thư biểu mô
diagnose (v) /ˈdaɪ.əɡ.nəʊz/ chẩn đoán
diagnostic (adj) /ˌdaɪ.əɡˈnɒs.tɪk/ thuộc về chẩn đoán
emphysema (n) /ˌem.fəˈsiː.mə/ phế khí thũng
fibroid (n) /'faibrɔid/ chứng u xơ (tử cung)
hypothyroidism (n) /ˌhaɪ.pəʊˈθaɪ.rɔɪd.ɪzəm/ bệnh suy giáp, giảm
năng tuyến giáp
insomnia (n) /ɪnˈsɒm.ni.ə/ chứng mất ngủ
insulin-dependent (adj/n) /ˈɪn.sjə.lɪndɪˈpen.dənt/ (đái tháo đường) phụ

258
 thuộc insulin
intubate (v) /ˈɪn.tʃuː.beɪt/ luồn (dây) vào
intubation (n) /ɪn.tʃuːˈbeɪ.ʃən/ sự luồn dây vào
invasive (adj) /ɪnˈveɪ.sɪv/ xâm lấn
indiscretion (n) /ˌɪn.dɪˈskreʃ.ən/ sự bừa bãi, không
kiêng khem
jaundice (n) /ˈdʒɔːn.dɪs/ bệnh vàng da
lesion (n) /ˈliː.ʒən/ thương tổn
maculopapular rash (n) /ræʃ/ ban sần
mammogram (n) /ˈmæm.ə.ɡræm/ X-quang tuyến vú
non-invasive (n) /ˌnɒn.ɪnˈveɪ.sɪv/ không xâm lấn
petechial rash (n) /pə'ti:kiəlræʃ/ ban có đốm xuất huyết
phenomenon (n) /fəˈnɒm.ɪ.nən/ hiện tượng
suspicion (n) /səˈspɪʃ.ən/ sự nghi ngờ
tomography (n) /təˈmɑːɡ.rə.fi/ chụp cắt lớp
UNIT 8
adhesive (adj) /ədˈhiːsɪv/ độ kết dính, dán
administer (v) /ədˈmɪnɪstər/ quản lý, sử dụng
administration (n) /ədˌmɪnɪˈstreɪʃən/
adverse (adj) /ˈædvɜːs/ , /ədˈvɜːs/ bất lợi, có hại
adverse event biến cố bất lợi (biến cố xảy
ra trong quá trình sử dụng
thuốc)
capsule (n) /ˈkæp.sjuːl/ viên nang
caution (n) /ˈkɔːʃən/ thận trọng, chú ý
contra-indication (n) /kɒn.trəɪn.dɪˈkeɪ.ʃən/ chống chỉ định
discharge (v) /dɪsˈtʃɑːdʒ/ xuất viện
dehydration (n) /ˌdiːhaɪˈdreɪʃən/ mất nước
dose (n) /dəʊs/ liều lượng (liều thuốc cần
(dosage) /ˈdəʊ sɪdʒ/ dùng mỗi lần)
hepatic impairment /hepˈæt.ɪk/ /ɪmˈpeə.mənt/ suy gan
hospitalization (n) /hɒspɪtəlaɪˈzeɪʃən/ nhập viện
hypersensitive (adj) /ˌhaɪpəˈsensɪtɪv/ quá mẫn cảm
hypersensitivity (n) /ˌhaɪpəsensəˈtɪvəti/ quá mẫn cảm
impairment (n) /ɪmˈpeə.mənt/ sự suy yếu, hư hại
infusion (n) /ɪnˈfjuːʒən/ truyền dịch
inhaler (n) /ɪnˈheɪlər/ ống xịt thuốc, ống hít,
lọ ngửi
indication (n) /ɪn.dɪˈkeɪ.ʃən/ chỉ định
intraarterial (adj) /ˌɪn.trə ɑːˈtɪə.ri.əl/ trong động mạch

259
intraarterial injection /intrə ɑːˈtɪə.ri.əl/ tiêm động mạch
intraarticular injection /intrə ɑːˈtɪk.jə.lər/ tiêm khớp
intramuscular (adj) /ˌɪn.trəˈmʌs.kjə.lər/ trong cơ, vào bắp
intramuscular injection ˌɪn.trəˈmʌs.kjə.lər tiêm bắp
ɪnˈdʒek.ʃən/
intraperitoneal injection /peritə‟ni: əl ɪnˈdʒek.ʃən/ tiêm phúc mạc
intrathecal (adj) /ˌɪn.trəˈθiːkəl/ nội tủy mạc
intrathecal injection /ˌɪn.trəˈθiːkəl/ tiêm tủy sống
/ɪnˈdʒek.ʃən/
intravenous (adj) /ˌɪntrəˈviːnəs/ vào tĩnh mạch
intravenous injection /ˌɪntrəˈviːnəs/ tiêm tĩnh mạch
/ɪnˈdʒek.ʃən/
neonate (n) /ˈniː.əʊ.neɪt/ trẻ sơ sinh
ointment (n) /ˈɔɪntmənt/ thuốc mỡ
premative infant /ˈprem.ə.tiv ɪn.fənt/ trẻ sinh non, sinh thiếu
tháng
prophylaxix (n) /ˌprɒf.ɪˈlæksɪs/ dự phòng
side effect (n) /ˈsaɪd ɪˌfekt/ tác dụng phụ
subcutanneous (adj) /ˌsʌbkjuˈteɪniəs/ dưới da
sublingual (adj) /ˌsʌbˈlɪŋɡwəl/ dưới lưỡi
suppository (n) /səˈpɒz.ɪtəri/ thuốc đạn (nhét vào hậu
môn, âm đạo, …)
syrup (n) /ˈsɪrəp/ xi rô

260
 APPENDIX 1

Pharmacy Documentation Abbreviations

Patient Information-Personal and Physical
ADR adverse drug reaction
All allergies
A&O alert and oriented
A&O 1 alert and oriented to person
A&O 2 alert and oriented to person and place
A&O 3 alert and oriented to person, place, and time
BF black female
BM black male
BMF black married female
BMM black married male
BP blood pressure
BPM, bpm beats per minute
CC chief complaint
C/O complains of
CV cardiovascular
DD demographic data
DH drug history
DOB date of birth
Dx diagnosis
ETHO alcohol
Ext extremities
F female
FH family history
F/U follow-up
Gen general appearance
Genit/Rectal genital/rectal
HO history of
HPI history of present illness
Hx history
ID identification
Kg kilogram
Labs laboratory tests and results
lb pound

261
LMP last menstrual period
M male
MAR medication administration record
Meds medications
MedHx medication history
MS musculoskeletal
NKA no known allergies
NKDA no known drug allergies
NL normal
OTC over the counter
P pulse, pressure, plan
PE physical examination
PMD private medical doctor
PMH past medical history
PMI past medical illness
PP patient profile
PPD packs per day
PSH past surgical history
Pt. patient
R/O rule out
ROS review of system
RR respiration rate
SH social history
S/P status post
S/S signs/symptoms
SQ subcutaneous
Sx symptom
T, Temp temperature
TPR temperature, pulse, respiration
Tx treatment
UNK unknown
VS vital signs
VSS vital signs stable
WD well developed
WDM white divorced male
WDWN-BF well-developed, well-nourished black female
WDWN-BM well-developed, well-nourished black male
WDWN-WF well-developed, well nourished white female
WDWN-WM well-developed, well-nourished white male
WF white female
WM white male

262
WMF white married female
WMM white married male
WN well-nourished
WNL within normal limits
Wt. weight
yo year old
Body Parts
Abd abdomen
AD right ear
AS left ear
AU each ear
CNS central nervous system
Cx cervix
EENT eyes, ears, nose, throat
HEENT head, eyes, ears, nose, throat
HR heart rate
OD right eye
OS left eye
OU both eyes

Symptoms/Signs/Side Effects
CFNS chills, fever, and night sweats
Cig cigarettes
CP chest pain
DOE dyspnea on exertion
FUO fever of unknown origin
HA headache
LBP lower back pain
NSR normal sinus rhythm
N&V nausea and vomiting
N/V/D nausea/vomiting/diarrhea
PND paroxysmal nocturnal dyspnea
SOB shortness of breath

Diseases/Medical Conditions
AD Alzheimer‟s disease
AIH autoimmune hepatitis

263
ALD alcoholic liver disease
ALL acute lymphocytic leukemia
ALS amyotrophic lateral sclerosis (Lou Gehrig‟s disease)
AMI acute myocardial infarction
ANLL acute non-lymphocytic leukemia
AOM acute otitis media (middle ear infection)
CA cancer
CAD coronary artery disease
CF cystic fibrosis
CHD coronary heart disease
CHF coronary heart failure
COPD chronic obstructive pulmonary disease
CP chest pain, cerebral palsy
CV cardiovascular
CVA cerebrovascular accident
DI diabetes insipidus
DJD degenerative joint disease
DM diabetes mellitus
DVT deep venous thrombosis
ED erectile dysfunction
Fx. fracture
GE gastroesophageal/gastroenterology
GERD gastroesophageal reflux disease
GI gastrointestinal
GU gastric ulcer, genitourinary
HAV hepatitis A virus
HBV hepatitis B virus
HCV hepatitis C virus
HD Hodgkin‟s disease
HH hiatal hernia
HPV human papilloma virus
HSV herpes simplex virus
HTN hypertension
IBD inflammatory bowel disease
IBS irritable bowel syndrome
IDDM insulin-dependent diabetes mellitus
IM infectious mononucleosis

264
MI myocardial infarction
MS multiple sclerosis
NHL non-Hodgkin‟s lymphoma
NIDDM non-insulin-dependent diabetes mellitus
OA osteoarthritis
PE pulmonary embolism
PID pelvic inflammatory disease
PMDD postmenopausal dysphoric disorder
PMS premenstrual syndrome
PUD peptic ulcer disease
PVD peripheral vascular disease
RA rheumatoid arthritis
STD sexually transmitted disease
TB tuberculosis
TIA transient ischemic attack
TSS toxic shock syndrome
UC ulcerative colitis
URI upper respiratory infection
UTI urinary tract infection
Medication
APAP acetaminophen
ASA aspirin
ATB antibiotic
BCP birth control pill
Nitro nitroglycerin
NSAID nonsteroidal anti-inflammatory drug
OC oral contraceptive
PCN penicillin
Tyl Tylenol
Diagnostic Tests
BC blood culture
Bx biopsy
CBC complete blood count
Cx culture
CXR chest x-ray
Endo endoscopy, endotracheal
INR international normalization ratio
UA urinalysis
XR x-ray
Dosage/Dosage Method
aa of each
AC before meals

265
BID twice daily
Cap capsule
Crm cream
D day
Gt drop
H hour
Hrly hourly
Hrs hours
HS at bedtime
IM intramuscular
Inj injection
INH inhalation
IV intravenous
mcg micrograms
mg milligrams
mos month
NPO nothing by mouth
oint ointment
PC after meals
pil pill
po by mouth
pr per rectum
prn as needed
pulv powder
PV per vagina
Q every
q1d every day
q1w every week
q4h every 4 hours
q6h every 6 hours
QAM every morning
QPM every evening
QD once daily, every day
QH every hour
QHS every night at bedtime
QID four times daily
QM every morning
QOD this is no longer an acceptable abbreviation for every other
day; you must spell out “every other day”

266
Qs up to
qwk once a week
Rx prescription
SID once a day
SC, SQ subcutaneous
SL sublingual (beneath the tongue)
Ss one half
tab tablet
tsp teaspoon
TID three times daily
ud as directed
ung ointment
wk week
period of time (e.g., “for five days” 5 days)
yr year
Recommendations
BR bed rest
D/C discontinue; discharge
F/U follow-up

267
 APPENDIX 2
Glossary of Medical Word Elements
Medical word elements
Element Meaning
A
a- without, not
-a noun ending
ab- from, away from
abdomin/o abdomen
abort/o to miscarry
-ac pertaining to
acid/o acid
acous/o hearing
acr/o extremity
acromi/o acromion (projection of the scapula)
-acusia hearing
-acusis hearing
-ad toward
ad- toward
aden/o gland
adenoid/o adenoids
adip/o fat
adren/o adrenal glands
adrenal/o adrenal glands
aer/o air
af- toward
agglutin/o clumping, gluing
agora- marketplace
-al pertaining to
albin/o white
aniso- unequal, dissimilar
ankyl/o stiffness; bent, crooked
ante- before, in front of
anti- against

268
aort/o aorta
append/o appendix
appendic/o appendix
aque/o water
-ar pertaining to
-arche beginning
arteri/o artery
arteriol/o arteriole
arthr/o joint
-ary pertaining to
asbest/o asbestos
-asthenia weakness, debility
astr/o star
-ate having the form of, possessing
atel/o incomplete; imperfect
ather/o fatty plaque
-ation process (of)
atri/o atrium
audi/o hearing
audit/o hearing
aur/o ear
auricul/o ear
auto- self, own
ax/o axis, axon
azot/o nitrogenous compounds
B

bacteri/o bacteria (singular, bacterium)

balan/o glans penis
bas/o base (alkaline, opposite of acid)
bi- two
bacteri/o bacteria (singular, bacterium)
balan/o glans penis
bas/o base (alkaline, opposite of acid)
bi- two

269
bil/i bile, gall
bi/o life
-blast embryonic cell
blast/o embryonic cell
blephar/o eyelid
brachi/o arm
brachy- short
brady- slow
bronch/o bronchus (plural, bronchi)
bronchi/o bronchus (plural, bronchi)
bronchiol/o bronchiole
bucc/o cheek
C

calc/o calcium
calcane/o calcaneum (heel bone)
-capnia carbon dioxide (CO2)
carcin/o cancer
cardi/o heart
-cardia heart condition
carp/o carpus (wrist bones)
cata- down
caud/o tail
cauter/o heat, burn
cec/o cecum
-cele hernia, swelling
-centesis surgical puncture
cephal/o head
-ceps head
-ception conceiving
cerebell/o cerebellum
cerebr/o cerebrum
cervic/o neck; cervix uteri (neck of uterus)
chalic/o limestone
cheil/o lip

270
chem/o chemical; drug
chlor/o green
chol/e bile, gall
cholangi/o bile vessel
cholecyst/o gallbladder
choledoch/o bile duct
chondr/o cartilage
chori/o chorion
choroid/o choroid
chrom/o color
chromat/o color
-cide killing
circum- around
cirrh/o yellow
-cision a cutting
-clasia to break; surgical fracture
-clasis to break; surgical fracture
-clast to break; surgical fracture
clavicul/o clavicle (collar bone)
clon/o clonus (turmoil)
-clysis irrigation, washing
coccyg/o- coccyx (tailbone)
cochle/o cochlea
col/o colon
colon/o colon
colp/o vagina
condyl/o condyle
coni/o dust
conjunctiv/o conjunctiva
-continence to hold back
contra- against, opposite
cor/o pupil
core/o pupil
corne/o cornea

271
coron/o heart
corp/o body
corpor/o body
cortic/o cortex
cost/o ribs
crani/o cranium (skull)
crin/o secrete
-crine secrete
cruci/o cross
cry/o cold
crypt/o hidden
culd/o cul-de-sac
-cusia hearing
-cusis hearing
cutane/o skin
cyan/o blue
cruci/o cross
cycl/o ciliary body of the eye; circular; cycle
-cyesis pregnancy
cyst/o bladder
cyt/o cell
-cyte cell
D

dacry/o tear; lacrimal apparatus (duct, sac or gland)

dacryocyst/o lacrimal sac
dactyl/o fingers; toes
de- cessation
dendr/o tree
dent/o teeth
derm/o skin
-derma skin
dermat/o skin
-desis binding, fixation (of a bone or join)
di- double

272
dia- through, across
dipl- double
dipl/o double
dips/o thirst
-dipsia thirst
dist/o far, farthest
dors/o back (of body)
duct/o to lead; carry
-duction act of leading, bringing, conductin
duoden/o duodenum (first part of the small intestine)
dur/o dura mater; hard
-dynia pain
dys- bad; painful; difficult
E

-eal pertaining to
ec- out, out from
echo- repeated sound
-ectasis dilation, expansion
ecto- outside, outward
-ectomy excision, removal
-edema swelling
ef- away from
electr/o electricity
-ema state of; condition
embol/o embolus (plug)
-emesis vomiting
-emia blood condition
emphys/o to inflate
en- in, within
encephal/o brain
end- in, within
endo- in, within
enter/o intestine (usually small)
eosin/o dawn (rose-colored)

273
epi- above, upon
epididym/o epididymis
epiglott/o epiglottis
episi/o vulva
erythem/o red
erythemat/o red
erythr/o red
eschar/o scab
-esis condition
eso- inward
esophag/o esophagus
esthes/o feeling
-esthesia feeling
eti/o cause
eu- good, normal
ex- out, out from
exo- outside, outward
extra- outside
F

faci/o face
fasci/o band, fascia (fibrous membrane
supporting and separating muscles)
femor/o femur (thigh bone)
-ferent to carry
fibr/o fiber, fibrous tissue
fibul/o fibula (smaller bone of the lower leg)
fluor/o luminous, fluorescence
G

galact/o milk
gangli/o ganglion (knot or knotlike mass)
gastr/o stomach
-gen forming, producing, origin
gen/o forming, producing, origin

274
-genesis forming, producing, origin
genit/o genitalia
gest/o pregnancy
gingiv/o gum(s)
glauc/o gray
gli/o glue; neuroglial tis
-glia glue; neuroglial tis
-globin protein
glomerul/o glomerulus
gloss/o tongue
glott/o glottis
gluc/o sugar, sweetness
glucos/o sugar, sweetness
glyc/o sugar, sweetness
glycos/o sugar, sweetness
gnos/o knowing
-gnosis knowing
gonad/o gonads, sex glands
goni/o angle
gon/o seed (ovum or sperm)
-grade to go
-graft transplantation
-gram record, writing
granul/o granule
-graph instrument for record
-graphy process of recording
-gravida pregnant woman
gyn/o woman, female
gynec/o woman, female
H

hallucin/o hallucination
hedon/o pleasure
hem/o blood
hemangi/o blood vessel

275
hemat/o blood
hemi- one half
hepat/o liver
hetero- different
hidr/o sweat
hist/o tissue
histi/o tissue
home/o same, alike
homeo- same, alike
homo- same
humer/o humerus (upper arm bone)
hydr/o water
hyp- under, below, deficient
hyper- excessive, above normal
hyp/o under, below, deficient
hypn/o sleep
hypo- under, below, deficient
hyster/o uterus (womb)
hallucin/o hallucination
hedon/o pleasure
hem/o blood
hemangi/o blood vessel
hemat/o blood
hemi- one half
hepat/o liver
hetero- different
hidr/o sweat
hist/o tissue
histi/o tissue
home/o same, alike
homeo- same, alike
homo- same
humer/o humerus (upper arm bone)
hydr/o water

276
hyp- under, below, deficient
hyper- excessive, above normal
hyp/o under, below, deficient
hypn/o sleep
hypo- under, below, deficient
hyster/o uterus (womb)
I

-ia condition
-iac pertaining to
-iasis abnormal condition (produced by something specified)
iatr/o physician; medicine; treatment
-iatry medicine; treatment
-ic pertaining to
-ical pertaining to
-ice noun ending
ichthy/o dry, scaly
-ician specialist
-icle small, minute
-icterus jaundice
idi/o unknown, peculiar
-ile pertaining to
ile/o ileum (third part of the small intestine)
ili/o ilium (lateral, flaring portion of the hip bone)
im- not
immun/o immune, immunity, safe
in- in, not
-ine pertaining to
infer/o lower, below
infra- below, under
inguin/o groin
insulin/o insulin
inter- between
intra- in, within
-ion the act of

277
-ior pertaining to
irid/o iris
-is noun ending
isch/o to hold back; block
ischi/o ischium (lower portion of the hip bone)
-ism condition
iso- same, equal
-ist specialist
-isy state of; condition
-itic pertaining to
-itis inflammation
-ive pertaining to
-ization process (of)
J, K

jaund/o yellow
jejun/o jejunum (second part of the sintestine)
kal/i potassium (an electrolyte)
kary/o nucleus
kerat/o horny tissue; hard; cornea
kern/o kernel (nucleus)
ket/o ketone bodies (acids and acetones)
keton/o ketone bodies (acids and acetones)
kinesi/o movement
-kinesia movement
kinet/o movement
klept/o to steal
kyph/o humpback

L
labi/o lip
labyrinth/o labyrinth (inner ear)
lacrim/o tear; lacrimal apparatus (duct, sac, or gland)
lact/o milk
-lalia speech, babble

278
lamin/o lamina (part of the vertebral arch)
lapar/o abdomen
laryng/o larynx (voice box)
later/o side, to one side
lei/o smooth
leiomy/o smooth muscle (visceral)
-lepsy seizure
lept/o thin, slender
leuk/o white
lex/o word, phrase
lingu/o tongue
lip/o fat
lipid/o fat
-listhesis slipping
-lith stone, calculus
lith/o stone, calculus
lob/o lobe
log/o study of
-logist specialist in the study of
-logy study of
lord/o curve, swayback
-lucent to shine; clear
lumb/o loins (lower back)
lymph/o lymph
lymphaden/o lymph gland (node)

M
macro- large
mal- bad
-malacia softening
mamm/o breast
-mania state of mental disorder, frenzy
mast/o breast
mastoid/o mastoid process
maxill/o maxilla (upper jaw bone)

279
meat/o opening, meatus
medi- middle
medi/o middle
mediastin/o mediastinum
medull/o medulla
mega- enlargement
megal/o enlargement
-megaly enlargement
melan/o black
men/o menses, menstruation
mening/o meninges (membranes covering the brain and spinal cord)
meningi/o meninges (membranes covering the brain and spinal cord)
ment/o mind
meso- middle
meta- change, beyond
metacarp/o metacarpus (hand bones)
metatars/o metatarsus (foot bones)
-meter instrument for measuring
metr/o uterus (womb); measure
metri/o uterus (womb)
-metry act of measuring
mi/o smaller, less
micr/o small
micro- small
mono- one
morph/o form, shape, structure
muc/o mucus
multi- many, much
muscul/o muscle
mut/a genetic change
my/o muscle
myc/o fungus (plural, fungi)
mydr/o widen, enlarge
myel/o bone marrow; spinal cord

280
myos/o muscle
myring/o tympanic membrane (eardrum)
myx/o mucus
N
narc/o stupor; numbness; sleep
nas/o nose
nat/o birth
natr/o sodium (an electrolyte)
necr/o death, necrosis
neo- new
nephr/o kidney
narc/o stupor; numbness; sleep
neur/o nerve
neutr/o neutral; neither
nid/o nest
noct/o night
nucle/o nucleus
nulli- none
nyctal/o night

obstetr/o midwife
ocul/o eye
odont/o teeth
-oid resembling
-ole small, minute
olig/o scanty
-oma tumor
omphal/o navel (umbilicu
onc/o tumor
onych/o nail
oophor/o ovary
-opaque obscure
ophthalm/o eye

281
-opia vision
-opsia vision
-opsy view of
opt/o eye, vision
optic/o eye, vision
or/o mouth
orch/o testis (plural, testes)
orchi/o testis (plural, testes)
orchid/o testis (plural, testes)
-orexia appetite
orth/o straight
-ory pertaining to
-ose pertaining to; sugar
-osis abnormal conditio, increase (used primarily with blood cells)
-osmia smell
oste/o bone
ot/o ear
-ous pertaining to
ovari/o ovary
ox/i oxygen
ox/o oxygen
-oxia oxygen
oxy- quick, sharp

pachy- thick
palat/o palate (roof of the mouth)
pan- all
pancreat/o pancreas
-para to bear (offspring)
para- near, beside; beyond
parathyroid/o parathyroid glands
-paresis partial paralysis
patell/o patella (kneecap)
path/o disease

282
-pathy - disease
pector/o chest
ped/i foot; child
ped/o foot; child
pedicul/o lice
pelv/i pelvis
pelv/o pelvis
pen/o penis
-penia decrease, deficiency
-pepsia digestion
per- through
peri- around
perine/o perineum (area between the scrotum [or vulva in the female]
and anus)
peritone/o peritoneum
-pexy fixation (of an organ)
phac/o lens
phag/o swallowing, eating
-phage swallowing, eating
-phagia swallowing, eating
phalang/ phalanges (bones of the fingers and toes)
pharmaceutic/o drug, medicine
pharyng/o pharynx (throat)
-phasia speech
phe/o dusky, dark
-phil attraction for
phil/o attraction for
-philia attraction for
phim/o muzzle
phleb/o vein
-phobia fear
-phonia voice
-phoresis carrying, transmission
-phoria feeling (mental state)
phot/o light phot/o light

283
phren/o diaphragm; mind
-phylaxis protection
-physis growth
pil/o hair
pituitar/o pituitary gland
-plakia plaque
plas/o formation, growth
-plasia formation, growth
-plasm formation, growth
-plasty surgical repair
-plegia paralysis
pleur/o pleura
-plexy stroke
-pnea breathing
pneum/o air; lung
pneumon/o air; lung
pod/o foot
-poiesis formation, production
poikil/o varied, irregular
poli/o gray; gray matter (of the brain or spinal cord)
poly- many, much
polyp/o small growth
-porosis porous
post- after, behind
poster/o back (of body), behind, posterior
-potence power
-prandial meal
pre- before, in front of
presby/o old age
primi- first
pro- before, in front of
proct/o anus, rectum
prostat/o prostate gland
proxim/o near, nearest

284
pseudo- false
psych/o mind
-ptosis prolapse, downward displacement
ptyal/o saliva
-ptysis spitting
pub/o pelvis bone (anterior part of the pelvic bone)
pulmon/o lung
pupill/o pupil
py/o pus
pyel/o renal pelvis
pylor/o pylorus
pyr/o fire
Q, R
quadri- four
rachi/o spine
radi/o radiation, x-ray; radius (lower arm bone on the thumb side)
radicul/o nerve root
rect/o rectum
ren/o kidney
reticul/o net, mesh
retin/o retina
retro- backward, behind
rhabd/o rod-shaped (striated)
rhabdomy/o rod-shaped (striated) muscle
rhin/o nose
rhytid/o wrinkle
roentgen/o x-rays
-rrhage bursting forth (of)
-rrhagia bursting forth (of)
-rrhaphy suture
-rrhea discharge, flow
-rrhexis rupture
-rrhythm/o rhythm
rube/o red

285
S
sacr/o sacrum
salping/o tube (usually the fallopian or eustachian [auditory] tube)
-salpinx tube (usually the fallopian or eustachian [auditory] tube)
sarc/o flesh (connective tissue)
-sarcoma malignant tumor of connective tissue
scapul/o scapula (shoulder blade)
-schisis a splitting
schiz/o split
scler/o hardening; sclera (white of the eye)
scoli/o crooked, bent
-scope instrument for examining
-scopy visual examination
scot/o darkness
seb/o sebum, sebaceous
semi- one half
semin/o semen; seed
semin/i semen; seed
sept/o septum
sequestr/o separation
ser/o serum
sial/o saliva, salivary gland
sider/o iron
sigmoid/o sigmoid colon
silic/o flint
sin/o sinus, cavity
sinus/o sinus, cavity
-sis state of; condition
-social society
somat/o body
somn/o sleep
son/o sound
-spadias slit, fissure
sacr/o sacrum
salping/o tube (usually the fallopian or eustachian [auditory] tube)
-salpinx tube (usually the fallopian or eustachian [auditory] tube)
sarc/o flesh (connective tissue)

286
-sarcoma malignant tumor of connective tissue
scapul/o scapula (shoulder blade)
-schisis a splitting
schiz/o split
scler/o hardening; sclera (white of the eye)
scoli/o crooked, bent
-scope instrument for examining
-scopy visual examination
scot/o darkness
seb/o sebum, sebaceous
semi- one half
semin/o semen; seed
semin/i semen; seed
sept/o septum
sequestr/o separation
ser/o serum
sial/o saliva, salivary gland
sider/o iron
sigmoid/o sigmoid colon
silic/o flint
sin/o sinus, cavity
sinus/o sinus, cavity
-sis state of; condition
-social society
somat/o body
somn/o sleep
son/o sound
-spadias slit, fissure
-spasm involuntary contraction, twitching
sperm/i spermatozoa, sperm cells
sperm/o spermatozoa, sperm cells
spermat/o spermatozoa, sperm cells
sphygm/o pulse
-sphyxia pulse
spin/o spine
spir/o breathe
splen/o spleen

287
spondyl/o vertebrae (backbone)
squam/o scale
staped/o stapes
-stasis standing still
steat/o fat
sten/o narrowing, stricture
-stenosis narrowing, stricture
stern/o sternum (breastbone)
steth/o chest
sthen/o strength
stigmat/o point, mark
stomat/o mouth
-stomy forming an opening (mouth)
sub- under, below
sudor/o sweat
super- upper, above
super/o upper, above
supra- above; excessive; superior
sym- union, together, joined
syn- union, together, joined
synapt/o synapsis, point of contact
synov/o synovial membrane, synovial fluid
T
tachy- rapid
tax/o order, coordination
-taxia order, coordination
ten/o tendon
tend/o tendon
tendin/o tendon
-tension to stretch
test/o testis (plural, testes)
thalam/o thalamus
thalass/o sea
thec/o sheath (usually referring to the meninges)
thel/o nipple
therapeut/o treatment
-therapy treatment

288
therm/o heat
thorac/o chest
-thorax chest
thromb/o blood clot
thym/o thymus gland
-thymia mind; emotion
thyr/o thyroid gland
thyroid/o thyroid gland
tibi/o tibia (larger bone of the lower leg)
-tic pertaining to
ill/o to pull
-tocia childbirth, labor
tom/o to cut
-tome instrument to cut
-tomy incision
ton/o tension
tonsill/o tonsils
tox/o poison
-toxic pertaining to poison
toxic/o poison
trabecul/o trabecula (supporting bundles of fibers)
trache/o trachea (windpipe)
trans- across, through
tri- three
trich/o hair
trigon/o trigone (triangular region at the base of the bladder)
-tripsy crushing
-trophy development, nourishment
-tropia turning
-tropin stimulate
tubercul/o a little swelling
tympan/o tympanic membrane (eardrum)
U
-ula small, minute
-ule small, minute
uln/o ulna (lower arm bone on the opposite side of the thumb)

289
ultra- excess, beyond
-um structure, thing
umbilic/o umbilicus, navel
-ula small, minute
ungu/o nail
uni- one
ur/o urine, urinary tract
ureter/o ureter
urethr/o urethra
-uria urine
urin/o urine, urinary tract
-us condition; structure
uter/o uterus (womb)
uvul/o uvula
V, W
vagin/o vagina
valv/o valve
valvul/o valve
varic/o dilated vein
vas/o vessel; vas deferens; duct
vascul/o vessel (usually blood or lymph)
ven/o vein
ventr/o belly, belly side
ventricul/o ventricle (of the heart or brain)
-version turning
vertebr/o vertebrae (backbone)
vesic/o bladder
vesicul/o seminal vesicle
vest/o clothes
viscer/o internal organs
vitr/o vitreous body (of the eye)
vitre/o glassy
vol/o volume
voyeur/o to see

290
vulv/o vulva
X, Y, Z
xanth/o yellow
xen/o foreign, strange
xer/o dry
xiph/o sword
-y condition; process

English terms
Meaning Element
A
abdomen abdomin/o
abdominal wall lapar/o
abnormal condition (produced by something -iasis
specified)
abnormal condition; increase (used primarily -osis
with blood cells)
above, upon epi
above; excessive; superior supra
acid acid/o
acromion (projection of acromi/o the scapula) acromi/o
across, through trans
act of leading, bringing, conducting -duction
act of measuring act of measuring
adenoids adenoid/o
adrenal glands adren/o, adrenal/o
after, behind post
against t anti
against, opposite contra
against; up; back a ana
air aer/o
air; lung pneum/o, pneumon/o
albumin (protein) albumin/o

291
all pan
alveolus; air sac alveol/o
amnion (amniotic sac) amni/o
aneurysm (widened blood vessel) aneurysm/o
angle goni/o
anterior, front anter/o
anus an/o
anus, rectum proct/o
aorta aort/o
appendix append/o, appendic/o
appetite -orexia
arm brachi/o
around circum, peri
arteriole arteriol/o
artery arteri/o
asbestos asbest/o
atrium atri/o
attraction for -phil, phil/o, -philia
away from ef
axis, axon ax/o
B

back (of body) dors/o

back (of body), behind, posterior poster/o
backward, behind retro
bacteria (singular, bacterium) bacteri/o
bad mal
bad; painful; difficult dys
band, fascia (fibrous membrane supporting fasci/o
and separating muscles)
base (alkaline, opposite of acid) bas/o
to bear (offspring) -para
before, in front of ante, pre, pro
beginning -arche
belly, belly side ventr/o
below, under infra

292
between inter
bile duct choledoch/o
bile vessel cholangi/o
bile, gall bil/i, chol/e
binding, fixation (of a bone or joint) -desis
birth nat/o
black melan/o
bladder cyst/o, vesic/o
blood hem/o, hemat/o
blood clot thromb/o
blood condition -emia
blood vessel hemangi/o
blue cyan/o
body corp/o, corpor/o, somat/o
bone oste/o
bone marrow; spinal cord myel/o
brain encephal/o
to break; surgical fracture -clasia, -clasis, -clast
breast mamm/o, mast/o
breathe spir/o
breathing -pnea
bronchiole bronchiol/o
bronchus (plural, bronchi) bronch/o, bronchi/o
bursting forth (of) -rrhage, -rrhagia
C

calcaneum (heel bone) calcane/o

calcium calc/o
cancer carcin/o
carbon dioxide (CO2) -capnia
carpus (wrist bones) carp/o
to carry -ferent
carrying, transmission -phoresis
cartilage chondr/o
cause eti/o
cecum cec/o

293
cell cyt/o, -cyte
cerebellum cerebell/o
cerebrum cerebr/o
cessation de
change, beyond meta
cheek bucc/o
chemical; drug chem/o
chest pector/o, steth/o, thorac/o, -thorax
childbirth, labor -tocia
choking pain angin/o
chorion chori/o
choroid choroid/o
ciliary body of the eye cycl/o
circular; cycle, clavicle (collar bone) clavicul/o
clonus (turmoil) clon/o
clothes vest/o
clumping, gluing agglutin/o
coal, coal dust anthrac/o
coccyx (tailbone) coccyg/o
cochlea cochle/o
cold cry/o
colon col/o, colon/o
color chrom/o, chromat/o
conceiving -ception
condition -esis, -ia, -ism
condition; process -y
condition; structure -us
condyle condyl/o
conjunctiva conjunctiv/o
cornea corne/o
cortex cortic/o
cranium (skull) crani/o
crooked, bent scoli/o
cross cruci/o
crushing -tripsy
cul-de-sac culd/o

294
curve, swayback lord/o
to cut tom/o
a cutting -cision
D

darkness scot/o
dawn (rose-colored) eosin/o
death, necrosis necr/o
decrease, deficiency -penia
deficient, under, below hypo
development, nourishment -trophy
diaphragm; mind phren/o
different hetero
digestion -pepsia
dilated vein varic/o
dilation, expansion -ectasis
discharge, flow -rrhea
disease path/o, -pathy
double di, dipl, dipl/o
down cata
drug, medicine pharmaceutic/o
dry xer/o
dry, scaly ichthy/o
dull, dim ambly/o
duodenum (first part of the small intestine) duoden/o
dura mater; hard dur/o
dusky, dark phe/o
dust coni/o
E

ear aur/o, auricul/o, ot/o

electricity electr/o
embolus (plug) embol/o
embryonic cell -blast, blast/o
enlargement mega, megal/o, -megaly
epididymis epididym/o

295
epiglottis epiglott/o
esophagus esophag/o
excess, beyond ultra
excessive, above normal hyper
excision, removal -ectomy
extremity acr/o
eye ocul/o, ophthalm/o
eye, vision opt/o, optic/o
eyelid blephar/o
F

face faci/o
false pseudo
far, farthest dist/o
fat adip/o, lip/o, lipid/o, steat/o
fatty plaque ather/o
fear -phobia
feeling esthes/o, -esthesia
feeling (mental state) -phoria
femur (thigh bone) femor/o
fiber, fibrous tissue fibr/o
fibula (smaller bone of the lower leg) fibul/o
fingers; toes dactyl/o
fire pyr/o
first primi
fixation (of an organ) -pexy
flesh (connective tissue) sarc/o
flint silic/o
foot pod/o
foot; child ped/i, ped/o
foreign, strange xen/o
form, shape, structure morph/o
formation, growth plas/o, -plasia, -plasm
formation, production -poiesis
forming an opening (mouth) -stomy
forming, producing, origin -gen, gen/o, -genesis

296
four quadri
from, away from ab
fungus (plural, fungi) myc/o
G

gallbladder cholecyst/o
ganglion (knot or knotlike mass) gangli/o
genetic change mut/a
genitalia genit/o
gland aden/o
glans penis balan/o
glassy vitre/o
glomerulus glomerul/o
glottis glott/o
glue; neuroglial tissue gli/o
-glia
to go -grade
gonads, sex glands gonad/o
good, normal eu
granule granul/o
gray glauc/o
gray; gray matter (of the brain or spinal cord) poli/o
green chlor/o
groin inguin/o
growth -physis
gum(s) gingiv/o
H

hair pil/o, trich/o

hallucination hallucin/o
hardening; sclera (white of the eye) scler/o
having the form of, possessing -ate
head cephal/o
-ceps
hearing acous/o, -acusis, audi/o, audit/o,
-cusia, -cusis
heart cardi/o, coron/o

297
heart condition -cardia
heat therm/o
heat, burn cauter/o
hernia, swelling -cele
hidden crypt/o
to hold back -continence
to hold back; block isch/o
horny tissue; hard; cornea kerat/o
humerus (upper arm bone) humer/o
humpback kyph/o
I

ileum (third part of the small intestine) ile/o

ilium (lateral, flaring portion of the hip bone) ili/o
immune, immunity, safe immun/o
in, not in
in, within en, end, endo, intra
incision -tomy
incomplete; imperfect atel/o
increase (used primarily with blood cells); -osis
abnormal condition
inflammation -itis
to inflate emphys/o
instrument for examining -scope
instrument for measuring -meter
instrument for recording -graph
instrument to cut -tome
insulin insulin/o
internal organs viscer/o
intestine (usually small intestine) enter/o
involuntary contraction, twitching -spasm
inward eso
iris irid/o
iron sider/o
irrigation, washing -clysis
ischium (lower portion of the hip bone) ischi/o

298
J, K

jaundice -icterus
jejunum (second part of the small intestine) jejun/o
joint arthr/o
kernel (nucleus) kern/o
ketone bodies (acids and acetones) ket/o, keton/o
kidney nephr/o, ren/o
killing -cide
knowing gnos/o, -gnosis
L

labyrinth (inner ear) labyrinth/o

lacrimal sac dacryocyst/o
lamina (part of the vertebral arch) lamin/o
large macro
larynx (voice box) laryng/o
to lead; carry duct/o
lens phac/o
lice pedicul/o
life bi/o
light phot/o
limestone chalic/o
lip cheil/o
lip labi/o
liver hepat/o
lobe lob/o
loins (lower back) lumb/o
lower, below infer/o
luminous, fluorescence fluor/o
lung pulmon/o
lymph lymph/o
lymph gland (node) lymphaden/o
lymph vessel lymphangi/o
M

male andr/o

299
malignant tumor of connective tissue -sarcoma
many, much multi
marketplace agora
maxilla (upper jaw bone) maxill/o
meal -prandial
mediastinum mediastin/o
medicine; treatment -iatry
medulla medull/o
meninges (membranes covering the brain and mening/o
spinal cord)
meningi/o
menses, menstruation men/o
metacarpus (hand bones) metacarp/o
metatarsus (foot bones) metatars/o
middle medi, medi/o, meso
midwife obstetr/o
milk galact/o
milk lact/o
mind ment/o, psych/o
mind; emotion -thymia
to miscarry abort/o
mouth or/o, stomat/o
movement kinesi/o, -kinesia, kinet/o
mucus muc/o, myx/o
muscle muscul/o, my/o, myos/o
muzzle phim/o
N

nail onych/o
ungu/o
narrowing, stricture sten/o, -stenosis
navel (umbilicus) omphal/o
near, beside; beyond para
near, nearest proxim/o
neck; cervix uteri (neck of uterus) cervic/o
nerve neur/o

300
nerve root radicul/o
nest nid/o
net, mesh reticul/o
neutral; neither neutr/o
new neo
night noct/o
nyctal/o
nipple thel/o
nitrogenous compounds azot/o
none nulli
nose nas/o
rhin/o
not im
noun ending -a
-ice
-is
nucleus kary/o
nucle/o
O

obscure -opaque
old age presby/o
one mono, uni
one half hemi, semi
opening, meatus meat/o
order, coordination tax/o, -taxia
other, differing from the normal allo
out, out from ec, ex
outside extra
outside, outward ecto, exo
ovary oophor/o, ovari/o
oxygen ox/i, ox/o, -oxia
P

pain -algesia

301
 -algia
-dynia
palate (roof of the mouth) palat/o
pancreas pancreat/o
paralysis -plegia
parathyroid glands parathyroid/o
partial paralysis -paresis
patella (kneecap) patell/o
pelvis pelv/i
pelv/o
pelvis bone (anterior part of pub/o
the pelvic bone) pen/o
penis
perineum (area between the scrotum [or vulva perine/o
in the female] and anus)
peritoneum peritone/o
pertaining to -ac, -al, -ar, -ary, -eal, -iac, -ic, -ical,
-ile, -ine, -ior, -itic, -ive, -ory,-ous
-tic
pertaining to poison -toxic
pertaining to sugar -ose
phalanges (bones of the fingers and toes) phalang/o
pharynx (throat) pharynx (throat), pharyng/o
physician; medicine; treatment iatr/o
pituitary gland pituitar/o
plaque -plakia
pleasure hedon/o
pleura pleur/o
point, mark stigmat/o
poison tox/o
toxic/o toxic/o
-porosis -porosis
potassium (an electrolyte) kal/i
power -potence
pregnancy -cyesis, gest/o
pregnant woman -gravida
process (of) -ation, -ization

302
process of recording -graphy
prolapse, downward, displacement -ptosis
prostate gland prostat/o
protection -phylaxis
protein -globin
to pull ill/o
pulse sphygm/o, -sphyxia
pupil cor/o, core/o, pupill/o
pus py/o
pylorus pylor/o
Q, R

quick, sharp oxy

radiation, x-ray; radius (lower arm bone on the radi/o
thumb side)
rapid tachy
record, writing -gram
rectum rect/o
red erythem/o
erythemat/o
erythr/o
rube/o
renal pelvis pyel/o
repeated sound echo
resembling -oid
retina retin/o
rhythm -rrhythm/o
ribs cost/o
rod-shaped (striated) rhabd/o
rod-shaped (striated) muscle rhabdomy/o
rupture -rrhexis
S

sacrum sacr/o
saliva ptyal/o
saliva, salivary gland sial/o

303
same homo

same, alike home/o

homeo
same, equal iso
scab eschar/o
scale squam/o
scanty olig/o
scapula (shoulder blade) scapul/o
sea thalass/o
sebum, sebaceous seb/o
secrete crin/o, -crine
to see voyeur/o
seed (ovum or spermatozoon) gon/o
seizure -lepsy
self, own auto
semen; seed semin/o
semin/i
seminal vesicle vesicul/o
separation sequestr/o
separation; destruction; loosening -lysis
septum sept/o
serum ser/o
sheath (usually referring thec/o to the theco
meninges)
to shine; clear -lucent
short brachy
side, to one side later/o
sigmoid colon sigmoid/o
sinus, cavity sin/o, sinus/o
skin cutane/o, derm/o, -derma, dermat/o
sleep hypn/o, somn/o
slipping -listhesis
slit, fissure -spadias
slow brady
small micr/o
small growth polyp/o

304
small, minute -icle, -ole, -ula, -ule
smaller, less mi/o
smell -osmia
smooth lei/o
smooth muscle (visceral) leiomy/o
society -social
sodium (an electrolyte) natr/o
softening -malacia
sound son/o
specialist -ician, - ist
specialist in the study of -logist
speech -phasia
speech, babble -lalia
spermatozoa, sperm cells sperm/i, sperm/o, spermat/o
spine rachi/o
spin/o spin/o
spitting -ptysis
spleen splen/o
split schiz/o
a splitting -schisis
standing still -stasis
stapes staped/o
star astr/o
state of mental disorder, frenzy -mania
state of; condition -ema, -isy, -sis
to steal klept/o
sternum (breastbone) stern/o
stiffness; bent, crooked ankyl/o
stimulate -tropin
stomach gastr/o
stone, calculus -lith, lith/o
straight orth/o
strength sthen/o
to stretch -tension
stroke -plexy
structure, thing -um

305
study of log/o, -logy
stupor; numbness; sleep narc/o
sugar, sweetness gluc/o, glucos/o, glyc/o, glycos/o
surgical puncture -centesis
surgical repair -plasty
suture -rrhaphy
swallowing, eating phag/o, -phage, -phagia
sweat hidr/o, sudor/o
swelling -edema
a little swelling tubercul/o
sword xiph/o
synapsis, point of contact synapt/o
synovial membrane, synovial synov/o
fluid
T

tail caud/o
tear; lacrimal apparatus (duct, sac, or gland) dacry/o, caud/o
teeth lacrim/o, dent/o, odont/o
tendon ten/o, tend/o, tendin/o
tension ton/o
testis (plural, testes) orch/o, orchi/o, orchid/o, test/o
thalamus thalam/o
the act of -ion
thick pachy
thin, slender lept/o
thing, structure -um
thirst dips/o, -dipsia
three tri
through per
through, across dia
thymus gland thym/o
thyroid gland thyr/o, thyroid/o
tibia (larger bone of the lower leg) tibi/o
tissue hist/o, histi/o
tongue gloss/o, lingu/o

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tonsils tonsill/o
toward -ad, ad, af
trabecula (supporting bundles of fibers) trabecul/o
trachea (windpipe) trache/o
transplantation -graft
treatment therapeut/o, -therapy
tree dendr/o
trigone (triangular region at the base of the trigon/o
bladder)
tube (usually the fallopian or eustachian salping/o, -salpinx
[auditory] tube)
tumor -oma, onc/o
two bi
tympanic membrane, (eardrum) myring/o, tympan/o
U

ulna (lower arm bone on the opposite side of uln/o

the thumb)
umbilicus, navel umbilic/o
under, below sub
under, below, deficient hyp
hyp/o
hypo
unequal, dissimilar aniso
union, together, joined sym
syn
unknown, peculiar idi/o
upper, above super
super/o
ureter ureter/o
urethra urethr/o
urine -uria
urine, urinary tract ur/o
urin/o
uterus (womb) hyster/o
metri/o
uter/o
uterus (womb); measure metr/o

307
uvula uvul/o
V

vagina colp/o, vagin/o

valve valv/o, valvul/o
varied, irregular poikil/o
vein phleb/o, ven/o
ventricle (of the heart or brain) ventricul/o
vertebrae (backbone) spondyl/o, vertebr/o
vessel (usually blood or lymph) angi/o, vascul/o
vessel; vas deferens; duct vas/o
view of -opsy
vision -opia, -opsia
visual examination -scopy
vitreous body (of the eye) vitr/o
voice -phonia
volume vol/o
vomiting -emesis
vulva episi/o, vulv/o
W, X, Y, Z

water aque/o, hydr/o

weakness, debility -asthenia
white albin/o, leuk/o
widen, enlarge mydr/o
without, not a, an
woman, female gyn/o, gynec/o
word, phrase lex/o
wrinkle rhytid/o
x-rays roentgen/o
yellow cirrh/o, jaund/o, xanth/o

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 APPENDIX 3
Speaking activity page …
Student B
Ask Student A questions to complete this information about patients‟ medication, for
example What dosage should I give Mrs Dupont? Does Mrs Dupont need? What
medication is Mrs Francis on?
Mrs Dupont antibiotic

Mrs Francis infusion 4 mg/minute

Miss Wang Iron supplement

Miss Ekobu 2 capsules antihistamines SID, q4h

(with water)

Mr Strauss 1 capsule Vitamin supplement

Mr Rossi 2/day x 5 days

Mr Metcalf 1 tsp prn

Mr Takahashi painkiller

309
 REFERENCES

[1] Barbara A. Gylys, Mary Ellen Wedding (2013). Medical Terminology Systems:
A body system approach. F. A. Davis Company. Philadelphia.
[2] Barbara Janson Cohen (2007). Medical Terminology: An Illustrated Guide.
Lippincott Williams & Wilkins Publisher.
[3] Eric H. Glendenning Ron Howard (2007). Professional English in use-
Medicine.Cambridge University Press.
[4] Eric H. Glendenning, Beverly A. S. Holmstrom (1998). English in medicine:
A course in communication skills. Cambridge University Press.
[5] Gretchen Bloom (1982). The Language of Medicine in English. Regents
Publishing Company, Inc.
[6] Malcolm Mann, Steve Taylore-Knowles (2008). Destination B1: Grammar and
vocabulary. Macmillan.
[7] R. Ribes & P. R. Ros (2006). Medical English. Springer Press.
[8] Rawdon Wyatt (2006). Check your English vocabulary for medicine. A & C
Black London.
[9] Robert Liesenborghs (1998). English for Nurses and Health Care Students-
Book 1. VSAT M Co., Ltd.
[10] Robin A. Bradley (2008). English for Nurses and Health Care. A course in
general and professional English. McGraw-Hill ELT.
[11] Shirley Soltesz Steiner, R. N., M. S. (2005). Quick Medical terminology. John
Wiley & Sons, Inc.
[12] Virgina Evans, Jenny Dooley & Trang M. Tran (2012). Career Paths: Medical.
Express Publishing.

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 ENGLISH IN MEDICINE 3

Bach Khoa Publishing House, Hanoi

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Responsible for Publication:

Director – Editor-in-Chief: Dr. Bui Duc Hung

Editor: Do Thanh Thuy

Book designer: Nguyen Thi Thu
Cover designer: Duong Hoang Anh

Printed at: Khuyen hoc printing CO., LTD, 9/64 lane 35 Cat Linh, Dong Da, Ha Noi.
Quantity: 3.000 copies. Size: 19 × 27 cm.
Registrated number: 2438 – 2017/CXBIPH/01 – 50/BKHN; ISBN: 978-604-95-0278-1.
Publishing decision number: 137/QĐ – ĐHBK – BKHN, 22/8/2017.
Archived: III – 2017.

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