fe Neat 215 Medical practitioners 2 ED Hospital staff The people who work in any type of workplace, including hospitals, ate called “The medical staf in a British hospital belong to one of fear wtae cone the staff, @ A pre-egistration house officer (PRHO}, or house officer, is a newly prac the ist year of postgraduate raining. After ayes he or she becomes «es in practitioner. In the current system of training, the Foundation Programme. the name otcal these junior doctors is Foundation Year 1 doctor (FY). (See Unit 12)” "* "2% for @ A senior house officer (SHO) is in the second year of postgraduate trai now Foundation Year 2 doctor (FY2), but the old terms senior house are stil used. © A specialist registrar (SpR) is a doctor who has completed the Foundation and is training in one of the medical specialties. There are also some non-t ~ doctors who have completed their training but do not wish to specialize ining. The title jg officer and SHO Programme, raining registrars yet, © A consultant is a fully qualified specialist, There may also be some associate specialists = senior doctors who do not wish to become consultants, In addition, there i at leas : medical (or clinical) director, who is responsible for all of the medical staff. | aa Medical teams | Consultant physicians and surgeons are responsible for a specific number of patients in the hospital. Each consultant has a team of junior doctors to help care for those patients, In many hospitals, there are multidisciplinary teams which consist not only of doctors but also of physiotherapists and other allied health professionals (see Unit 8). ‘When patients enter — or are admitted to ~ hospital, they are usually seen first by one of the junior doctors on the ward where they will receive treatment and care. The junior doctor clerks them ~ takes their medical history (see Units 47-49) — and examines them. Some time later, the registrar also sees the patients, and may order investigations or tests, for example X-rays or an ECG, make a provisional diagnosis, and begin treatment. The consultant usually sees the new admissions ~ people who have recently been admitted to the ward for the first time on one of the regular ward rounds, when the management of the patients is discussed with the registrar. Consultants also decide when a patient is ready to be discharged (sent home). On the ward round, the consultant is accompanied by the team and a nurse, and they visit all the patients in the consultant’ care. Shifts Junior doctors now normally work in shifts, which means they normally work for eight hours every day, for example 7 am to 3 pm, and are then free until 7 am the next day. After a week they change to a different shift, for example 3 pm to 11 pm or 11 pm to 7 am. The alternative system is to work from 9 am to S pm every day and to take turns to be on call - available to return to the hospital if necessary from 5 pm to 9 am the next day. Days on call are set out in a rota, or list of names and times. Doctors on call | carry a radio pager, or bleeper, a device which makes a noise when someone is trying to contact them. 20 Professional English in Use Medicine6.1 6.2 6.3 6.4 Make word combinations using a word from each box. Look at A, B and C opposite to help you. associate call house diagnosis, on officer provisional pager radio round ward specialist Match the descriptions (1-5) with the job titles (a-e). Look at A and B opposite to help you. 1 Dr Graham has been a paediatrician for eight years and is responsible for treating the children admitted to Ward 60, 2 Dr Stewart has just started the second year of her Foundation Programme. 3 Dr Singh has started his training as a surgeon. 4 Dr Phillips has just graduated and is working in a large hospital in Birmingham, 5 Dr Millar is in charge of the medical staff in the Birmingham hospital. a specialist registrar b medical director ¢ consultant d SHO e PRHO or house officer Are the following statements true or false? Find reasons for your answers in A, B and C opposite. 1 A medical graduate becomes registered two years after graduation. 2 The system of training doctors in Britain is called the Foundation Programme. 3 The name senior house officer is no longer used in Britain. 4 The consultant is usually the first doctor to see new patients. 5 When working in shifts, all doctors take turns to be on call. Complete the text of a PRHO describing her job. Look at A, B and C opposite to help you. When I get to the ward, the first thing I do is talk to the house officer who was on duty during the last (1) 4 fo find our if there have been any new 2). «Then I generally sce the charge nurse. He tells me if there is anything that needs to be done urgently, such as intravenous lines to put up or take down. Later in the morning, I (3) ss.00s:m:mm any new patients, which basically involves taking a history. On Tuesday and Friday morning the consultant does her ward (4) onsnsssmmnnnons and Ihave to make sure I’m completely up to date on her patients. After that, there are usually lots of things to do, like writing up request forms for blood (5) svn , and so on. In the afternoon, I have to prepare for any patients who are t0 be (6) s0vsn-rennnnn the next day. They're usually happy to be going home! ‘And then of course there are the lectures and tutorials in the (7) programme on Monday and Wednesday. (oa coe] st How does the hospital training of doctors in your country differ from the British system? Taro Rte eT Ce eu er en oe eae tha Professional Engish in Use Medicine 2Nursing grades Nurses working in a hospital have the following grades: ‘i Nurses ae student nurse a nurse who is still in training staff nurse a nurse who has completed the training course ~~ a more experienced nurse who is in charge of, or responsible fox, a ward or department | charge nurse nurse manager ‘a nurse who is in charge of several wards | Note: The old term sister is still sometimes used for a female charge nurse. A female nurse manager may be called matron. Dr James is talking to Sister Watkin: HELD Support workers The clinical support worker, who has done a short course and obtained basic qualifications, and the nursing auxiliary, who is usually unqualified, both assist nursing | staff, There may also be ward clerks, whose duties include making sure patients’ notes and information are up to date, and answering the telephone. [EEE Speciatization Like doctors, nurses can specialize: @ A midwife has specialized from the beginning by doing a course in midwifery, the management of pregnancy and childbirth. @ District nurses visit patients in their homes. @ Health visitors also work in the community, giving advice on the promotion of health and the prevention of illness. HEED) The nurse's role ‘The nurse's role has changed considerably in recent years. In addition to general patient care, checking temperatures, pulse rates and blood pressures, changing dressings, giving injections and removing sutures, nurses now do some of the things previously reserved for doctors, such as preseribing drugs, and ordering laboratory tests. More responsibility for | nurses is planned, as the following article demonstrates. | Nurses carry out surgery in effort to cut patient waiting lists Nurses in Scotiand trained to perform minor surgery have entered the operating theatre for the first time in an ‘effort to cut patient waiting times. Five nurses who have passed a new course at Glasgow Caledonian University are now quslified to carry out such procedures as the removal of small lesions, benign moles and cysts. The Scotsman The verbs perform and carry out are used with all types of procedures. They are often used in the passive form. an examination ee a eee an operation e procedure was | Personnel perform a procedure carry out —_| an experiment a test a biopsy by a nurse, 22 Professional English in Use Medicine71 7.2 7.3 74 Complete the sentences. Look at A, B and C opposite to help you. 1 Someone who specializes in delivering babies is a 2 Someone who is qualified to assist nurses is a sf 3 Someone who is not qualified but is able to assist nurses is a ates 4 A nurse who has qualified i8 @ ...s0.mswnm MUESE. 5 A nurse who specializes in health promotion is a . 6 A nurse who looks after a ward is a 7 A nurse who works in the community is a 8 Someone who answers the ward telephone is a . nurse. nurse. ‘Make word combinations using a word or phrase from each box. Look at D opposite to help you. carry out sutures: change a procedure check an injection give a dressing remove the temperature ‘Complete the sentences with the correct grammatical form of perform. 1 An isotope brain scan is painless and easy 2 Biopsy of the pancreas .....00 . “ast March, 3 If the patient’s condition deteriorates, a laparotomy should 4 Ifa diagnosis of meningitis is suspected a lumbar puncture must... 3 5 Last year we = a randomized, double blind group study. Complete the sentences with the correct grammatical form of carry out. 1 Inow intend a larger study. 2 Unfortunately few properly controlled trials... sv 80 Fat 3. A number of studies recently to look at this question. 4 A right hemicolectomy 0.0. = and the patient made a full recovery. 5 This procedure cM von.om cvwvnnene in the emergency department. (See coe olrt TE een RTS lcn en eta mea nd of tasks do nurses carry out in your country? Are nurses! responsibilities Professional English in Use Medicine 23PB oa) 24 Allied health professionals Community health : a “The health of the community depends on a large number of people other than medical practioness ‘and nurses. These can be grouped under the heading of allied health professionals. They include the following: tw Physiotherapists (physios) help people to move by getting them to do exercises or by treating their body with heat or massage — treatment by manipulating muscles and joints with the hands. (See Unit 42) @ Occupational therapists (OTs) help people with a disability to perform tasks at home and at work. A disability is a physical or mental condition that makes it difficult to liye normally, for example blindness or deafness. Social workers help people to solve their social problems ~ for example poor housing or ‘unemployment - or family problems. @ Chiropodists, also know as podiatrists, treat conditions affecting the feet. Technicians “There are numerous technicians ~ people who work with scientific equipment ~ such as radiographers, who are known as X-ray technicians. Ambulance technicians work in the emergency medicine service. An ambulance technician with more advanced qualifications is called a paramedic. Prosthetists and orthotists Prosthetists and orthotists provide care for anyone who needs an artificial limb, (a prosthesis), or a device to support or control part of the body (an orthosis). They also advise on rehabilitation — helping patients return to normal life and work after treatment. Prosthetists provide artificial replacements for patients who have had an amputation or were born without a limb. Orthotists provide a range of splints and other devices to aid movement, correct deformity from an abnormal development of part of the body, for example club foot (talipes), and relieve pain. A prosthesis Splints Opticians Opticians test eyesight and prescribe glasses - also know as spectacles ~ and contact lenses, when necessary. The examination includes measuring intraocular pressure ~ the pressure of fluid inside the eye — and examining the retina. If the optician suspects an eye disease, such as glaucoma, they refer the patient to their GP for treatment. The GP may then refer the patient to an ophthalmologist, a doctor who specializes in diseases of the eye. Professional Englsh in Use Medicine8.1 Make word combinations using a word from each box. Look at A, B, C and D opposite to help you. ambulance foot artificial lens club tim contact worker health pressure intraocular technician ‘occupational professional social therapist 8.2 Which allied health professionals could best help the following people? Look at A, B, C and D opposite to help you. 1 a young unmarried woman who has just had a baby 2 a woman who is having difficulty using her right arm following a fracture 3 someone who needs glasses 4 an elderly woman who has had a below knee amputation 5 a man whose wife has Alzheimer’s disease 6 a man with a fungal infection of his feet 8.3 Complete the texts. Look at A and C opposite to help you. A prosthetist works with patients of all ages as a member of a clinical team, based at a large hospital. The patients may need a prosthesis as the result of an accident, or (a) --m following a disease such as diabetes. Alternatively they may have been born Without @ (2) num: nsmsn Ofthotists work alongside doctors, nurses, physiotherapists and occupational (3)... vim 0 give the people under their care the best possible (4) ........ cic "Their main aim is to enable the patient to lead a normal life at work and leisure. An orthotist often works in a clinic as part of an outpatient service and also visits other centres to provide a service for people with special needs. They deal with people of all ages. For instance, children who have cerebral palsy may require (5) to help them walk and many older people need special shoes to correct (6)... If damaged, any part of the human skeleton may require some form of orthosis. The orthosis may be needed to reposition the body OF £0 (7) vs: nm-mme PAIN Over to you ‘ Britain is introducing a new member to the healthcare team, called a medical CP), similar to the physician assistant in the United States and other countries. The MCP will be able to carry out some of the functions of a medical practitioner, such as history-taking and examination, and diagnosis and treatment of certain ilinesses, Ts cn es] .. What are the advantages and disadvantages of this in rte Ee Professional English in Use Medicine 25=a 26 Hospitals Introduction to a hospital ' _ ‘ordi Pons is a fourth-year medical student from Barcelona. He has come to Britain on an eae attachment to the Royal Infirmary, Edinburgh. Dr Barron is introducing him to the hospital. Dr Barron: The Royal Infirmary is the name of the university hospital for Edinburgh University It is a general hospital, dealing with all types of patients and illnesses, except paediatrics. We have a specialist hospital for that in another part of Edinburgh, the Fospital for Sick Children. You can see some of the departments in our hospital on the sign. Of course, there are many others, for example the Intensive Co ee Care Unit (ICU), and the Surgical High Dependency Unit (HDU). Rel meal e} ete cmcae Car Parks C&D (visitors & staff) —» Dr Barron: Outpatients are the A Licmss un) ea O nd a people who come to hospital to Felmcncesad Mn ra) attend a clinic or to have tests or treatment and then return home Pony 4 Mra} on the same day Inpatients stay in eer ey the hospital for one or more days. mee The rooms where they stay are eth cit cts Outpatient Departments + requires only one day, such as a simple operation, they can be Lima admitted to the day surgery unit. Der se are) aN + X-ray Department Dem mcr Outpatients Dr Barron: The Accident and Emergency Department (A&E), also called Casualty, is where patients who are acutely ill - with a sudden, serious condition — come for assessment and treatment. Outpatients who have an appointment to see a specialist go to a clinic in one of the Outpatient Departments (OPDs). They have usually been referred to the hospital by their GP, who writes a referral letter to the consultant explaining the patient's problem. Inpatients Dr Barron: The inpatients in a hospital are admitted in one of three main ways. They may be seen in one of the outpatient clinics and admitted from there or, if there is a lot of demand for the treatment they need, as in the case of a hip replacement, they are put on a waiting list for admission. Alternatively, their GP may arrange the admission by telephone because they are acutely ill, for example with suspected myocardial infarction. Or they are seen in the A&E Department, where the doctor on duty - working at that time ~ arranges the admission. This would happen in the case of a patient with a fractured neck of femur, for example. Larger hospitals may have an assessment unit where patients can be admitted temporarily while their condition is assessed. Jordi: Assessed? Dr Barron: Yes ~ decisions are made about their condition, and what needs to be done to help them. After treatment is completed, the patient is discharged back to the GP's care. Professional English in Use Medicine9.1 9.2 9.3 9.4 Complete the table with words from A, B and C opposite. Put a stress mark in front of the stressed syllable in each word. The first one has been done for you. ad'mit assess discharge operate refer treat Make word combinations using a word from each box. Look at C opposite to help you. acutely unit assessment letter on list referral duty waiting ill ‘Which hospital departments would be most appropriate for the following patients? Look at A, Band C opposite to help you. 1 a woman in diabetic coma 2 a patient who has just had a radical prostatectomy 3 a patient who is to have a skin lesion removed 4a man with a foreign body in his eye 5 a woman with a threatened abortion Complete the extract from an information leaflet for patients. Look at A, Band C opposite to help you. ll the receptionist who will ing area. The length of your Over +o you ~ How do hospitals in your country organize admissions? How would you explain the procedure to a colleague from another country? Professional English in Use Medicine 2ail TN 28 Primary care The National Health Service The National Health Service (NHS) is responsible for health cate for everyone inthe UK although a small number choose to pay for private care. Treatment is fre but there isa prescription charge for drugs and appliances, such as a cervical collar, with exemption, for some patients, such as children and the elderly. Primary care is provided by general practitioners, or GPs, (sometimes known as family doctors), nurses, dentists, pharmacists and opticians. GPs work in practices of 1 to 20. Practices are based in a surgery and look afte the health of from 1,000 to 15,000 people in their local community. They also provide health education in areas such as smoking and diet, run clinis, give vaccinations, for example for influenza, and may perform minor surgery such as removal of warts and moles. Ifa patient needs specialist care, the GP wil make a referral - refer the patient to a consultant in secondary care. Patients are normally seen on an appointment basis. Home visits are made when patients are housebound — unable to leave their homes ~ or too ill to attend surgery. Out-of-hourg (OOH) treatment, from 6 pm to 8 am, is provided by the local Primary Care Trust, which organizes shifts of GPs and locum GPs to cover if someone is absent. Note: The noun surgery has three meanings: @ the building where GPs work = The practice has moved to a new surgery on the High Street @ a time when GPs see patients - Morning surgery is from 8.30 to 12.30. @ the work of surgeons ~ The patient needs urgent surgery on a burst appendix. The practice team A typical GP practice employs receptionists. They are responsible for initial patient contact, making appointments, taking requests for repeat prescriptions, taking messages from patients and other health care providers, and for filing and scanning documents into patient records. The practice manager has responsibility for finance and sometimes for IT, supervises reception staff, hires locums, and helps prepare the practice development plan. Practice nurses run asthma, diabetes, and cardiovascular disease clinics as well as one-to- one clinics for those who wish to give up smoking. In addition to practice staff, GPs work with a number of health professionals (see Unit 8): © District nurses visit temporarily housebound patients, such as recently discharged hospital patients, to change dressings, such as ulcer dressings. © Health visitors vist families to carry out check-ups on young children ~ particularly uunder-ives — to make sure they're healthy. Special attention is paid to families in need, such as those living in poverty. They also do baby immunizations. ® Midwives run clinics for antenatal patients, & Physiotherapists provide hands-on treatment but also teach patients exercises they can do to improve their condition after an accident or operation. ‘ 00 am anv atthe sage Are day shee He OOH ond pinta Dr Stuart works in a practice in hace for urgent ancl non-urgent messages a small market town with three ¢=0.am cheeks emails fone the health boar aval partners other family doctors. The surgery prepare for suroeny isin the centre of the town and $20 10.500n morning surgery (ten-ruinute appointments) is shared by three practices. This © pre-booked lst vee. is a typical working morning 2 booked 42 hows ahead wben the sno the daty doco, | an Ss responsible for emergencies and 10.80" 1055 ani ae sea igi responsible for emergencies an gn respon dea wi eat esr gent problems. 11.00- 11.20 am enfee Wien the conference ona with cleus 14.20-11.80.0m check hone visit requests aud divide up visits with calle Professional Englsh in Use Medlcne 43> am im wome vets10.1 10.2 10.3 10.4 Complete the sentences, Look at A opposite to help you. 1 Children, over-60s, and people with some chronic diseases do not have to pay win the UK. 2 Patients with mobility problems may be unable to go out. They ate 3 The average GP is ten minutes long. 4 Aw someone who takes the place of a staff member who is on leave. 5 Care outside working hours is known as... ee treatment. Make word combinations using a word or phrase from each box. One word can be used twice. Look at A and B opposite to help you. messages staff appointments home visits dressings adinic a patient minor surgery Which member of a practice team would be responsible for each of the following? Look at B opposite to help you. 1 Running a clinic for pregnant women 2 Teaching a patient how to strengthen his broken leg 3 Letting the GP know that a patient can’t come to her appointment 4 Running a clinic for people who want to lose weight 5 Visiting a patient who has just returned home after a hernia operation 6 Carrying out check-ups on children in a poor neighbourhood 7 Organizing cover for an absent doctor Complete the diary for Dr Stuart’ afternoon. Look at A and C opposite to help you. abies ei eb ate ear al bod Over +o you We Describe a typical day for a GP in your country or in the country where you work, Professional Engish in Use Medicine 29Medical education in the UK Medical education in the UK covers: @ undergraduate education - four or five years at medical school, the section of a nives responsible for medical education ty @ a two-year Foundation Programme which provides training for new doctors after graduation through a series of placements in different specialties (see Unit 12) @ postgraduate training which doctors take to become GPs or consultants ~ senior specialists ~ often delivered through colleges for different specialties, for example the Royal College of Physicians & continuing professional development in the form of courses and seminars, which doctors undertake throughout their working lives to keep up to date. Ea Extract from an undergraduate prospectus | The MBChB (Bachelor of Medicine, Bachelor of Surgery) is a five-year | Pee eM ec ee Cee Coa a ae oo ee | Rn et CMe cua See a Medical education 1 ear \ Core (Years 1-3) Vocational Studies and Clinical Skills ‘An integrated programme of clinical and scientific topics This component prepares you for the clinical skils | ‘mainly presented through problem-based learning required for contact with patients from Year 1 of your (PBL), where you work with others on a series of case course through periods of practical training where you problems. are attached to a hospital department or general practice. Student Selected Modules Student selected modules SSM) allow you to choose Clinical Attachments (Years 4 and 5) from a menu of subjects such as Sports Medicine or A series of four-week clinical attachments in Medicine, even study a language as preparation for an overseas Surgery, Psychological Medicine, Child Health, Obstetrics ‘elective, a hospital attachment of your own choice, _& Gynaecology and General Practice. j between Years 4 and 5. | i A student's view Ellen, a medical student, describes her course. ‘Tm just finishing my first year of Medicine. What I like about this course is that you're involved with patients from the very beginning, Even in our first year, we spend time in hospital. Much of the course is PBL. We have two 2-hour sessions a week where we work in groups of eight to ten solving clinical problems. We decide together how to tackle the problem, look up books and online sources, make notes and discuss the ease together. Isa \| sgreat way of learning and getting ro know the other students, In the past, medical students had lectures with the whole class taking notes from lecturers from 9.00 to 5.00, but now it’s | mainly group work, although we do have some lectures and seminars, where we work in | small groups with a tutor. I like all of it, even the dissection. We get to cut up cadavers from | the second month of the course: 30 Professional English in Use Medicine11.2 11.3 Match these activities to the stages of medical education in the UK given in A opposite. 1 dissecting cadavers 2 keeping a log of surgical procedures observed and performed 3 working for four months in accident and emergency to experience this specialty 4 taking a four-week attachment in Obstetrics and Gynaecology 5 taking an online course on recent developments in cardiovascular disease Complete the sentences. Look at B and C opposite to help you. 1 Just before their final year, students have the chance to take an .. in a hospital of their choice anywhere in the world. 2 aera contrasts with an approach where each subject is taught separately. 3 These days ~ are often interactive, with regular opportunities for the students to ask questions. 4 IM soooonnnnsnnin nnmmnnsnne Students learn how to treat and manage patients. 5 see can be a topic from outside medicine, such as a foreign language, 6 Dissection of... ~is an important part of the anatomy component. 7 a _ at the University of Edinburgh is one of the oldest in the 8 She's & wnnnnnnnnnsat the Royals one of the leading paediatric heart specialists in the country, 9 The Royal of Surgeons in Edinburgh dates from 1505. 10 We have a ~each week where we discuss topics in a small group with our lecturer. Match each of these activities to one of the components of the undergraduate course described in B and C opposite, 1 Julie spends six weeks working in a small hospital in the Himalayas. 2A group of students discuss together the possible reasons for abdominal pain after meals in an obese 44-year-old male, 3 A small group of students trace the pulmonary artery in a cadaver 4 Otto spends a month working in the paediatric ward of the local hospital. 5 Anne learns how to take blood from an elderly patient. 6 Juma chooses to study Travel Medicine in his fourth year. Over +o you ot Deere Rc ee a erie ere ec Professional English in Use Medicine 31_ 32 Medical education 2 The Foundation Programme “The Foundation Programme is a two-year training programme which forms the bridge between university-level study at medical school, and specialist or general practice training. It consists of a series of placements, each lasting four months, which allow the junior doctor, known as a trainee, to sample different specialties, for example paediatrics. A year one trainee (FY1) corresponds to pre-registration house officer (PRHO) posts and a year two trainee (FY2) to Senior house officer (SHO) posts. Each trainee has an educational supervisor who ensures that more senior doctors deliver training in different ways, including clinical and educational supervision. To progress, trainees have to demonstrate a range of clinical competencies which are assessed through observation in their workplace. (BN Corer 2005; Amended with persion from the BMU Publishing Guy Eee People in medical education ‘An academic, or in some cases a postgraduate student, who leads tutorials. Tn anatomy teaching, someone who demonstrates how to dissect, Demonstrators are often postgraduate students paying their way through medical school. lecturer / senior lecturer | An academic with teaching and research responsibilities who contributes to the teaching of a particular discipline. ‘A senior academic with teaching and research responsibilities for tutor demonstrator professor 1 particular discipline, Usually a leading figure in their discipline, college tutor ‘A consultant responsible for delivering a college training programme. clinical trainer ‘A consultant assigned to a trainee who provides training during | periods of direct clinical care. educational supervisor _| A consultant who supervises a trainee’s period of training. Medical qualifications BMSc Bachelor of Medical Sciences. A degree often taken after three years of BMed Sci medical studies by students who may wish to follow a career in medical research. MBChB, MBBS | Bachelor of Medicine, Bachelor of Surgery. Bachelor degrees are BMBCh, BMBS | undergraduate degrees. This isthe first degree for UK doctors. ‘MD, DM Doctor of Medicine DRCOG Diploma of the Royal College of Obstetrics and Gynaecology | MRCP Member of the Royal College of Physicians or Member of the Royal ‘MRCS | College of Surgeons. Doctors become Members by successfully completing the assessment procedures in their college. FRCS Fellow of the Royal College of Surgeons of England. Other colleges are FRCS(Ed) indicated by the letters which follow, for example Edinburgh, Glasgow ot FRCS(Glas) Ireland. FRCSL How doctors become a Fellow depends on their college. For the FRCS, further examinations must be passed. For other colleges it is by nomination or work assessment. Professional English in Use Medicine12.1 12.2 12.3 Complete the phrases with verbs from the box. Two phrases can be completed in two different ways. Look at A and B opposite to help you. assess deliver demonstrate provide supervise take ~~ competence or how to do something, a trainee by ensuring she successfully completes her training course ot a training programme (as a teacher) --€ course of a training programme (as a student) progress or competence ‘Match the two parts of the sentences. Look at A, B and C opposite to help you. 1 An FY1 is a doctor 2 A demonstrator is an anatomy teacher 3 A clinical trainer is a consultant 4 A supervisor is a consultant 5 A medical school is 6 A placement is 7 Accollege is 8 A Fellow is a specialist 2 a body of specialists responsible for delivering and assessing training in their specialty. b responsible for the training programme of a trainee. € a period spent as a trainee in a hospital or in General Practice. d in the first year of the Foundation Programme. € who has reached the highest level in their specialty. £ who provides training during periods of direct clinical care. 9 part of a university responsible for medical education. h who teaches dissection. ‘Write in full the qualifications of the doctors and surgeons. Look at C opposite to help you. 1 Mr A. H. Younghusband, MBChB, FRCS, FRCSI 2 Dr C Doyle, BMed Sci, DM, MRCP 3 Ms E Inglis, MBBS, FRCS 4 Dr E Merryweather, BM, MD, FRCP Over +o you a How do you become a specialist in your country? List the stages. Professional English in Use Medicine 33Types of registration To manage and treat patients in the UK, all doctors must register with the General Medical Council (GMC). There are several types of registration: @ Provisional registration is for doctors who have just qualified from medical schoo| UK or from certain European Economic Area (EEA) member states. @ Full registration is for doctors who have completed their year’s clinical training, @ Limited registration is for international medical graduates who have not completed the equivalent of a year’s clinical training in the UK. @ ‘Specialise registration is for doctors who have completed specialist medical training ang have a Certificate of Completion of Training (CCT). The GP Register is a register of all those eligible to work in general practice in the NHS, Note: For full details of the General Medical Council see wwwgme-uk.org MED us Before they can obtain full registration, some categories of overseas doctors are required to take the Professional and Linguistic Assessments Board (PLAB) test. PLAB is designed to ensure those who pass can practise safely at the level of an SHO in a first appointment ina UK hospital. Part 1 consists of a written test of knowledge, skills and attitudes. Part 2 is an Objective Structured Clinical Examination (OSCE). It consists of 16 five-minute clinical scenarios, known as stations, to assess professional skills. Note: For a full description of PLAB, see http://mwwgme-ukorg/doctors/plab/ HERES °8 stations and advice OSCEs assess these skills: © Clinical examination: Your ability to carry out a physical examination of a simulated patient, an actor trained to play this role, will be assessed. Uncomfortable or intimate examinations will be cazried out using a manikin, an anatomical model. WEES the overseas doctor Lin the @ Practical skills: You will be assessed on practical skills such as suturing and giving, intravenous injections. | @ Communication skills: Your ability to interact with a simulated patient, or in some cases the examiner, will be assessed. Skills tested may include breaking bad news and giving advice on lifestyle. @ History taking: Your ability to take an accurate history and make a reasoned diagnosis will be assessed. Advice on the stations from a successful candidate: Read the instructions outside each station Don't forget the ABC (airways, breathing, carefully. You have one minute for this, circulation) protocol in every emergency station. : ) Keepin mind safety precauions (~ Check the patient understands what is happenings then sharps bin. i) |. give a lecture. Listen carefully to what the actor says. Note: Sharps are needles and blades which must be disposed of safely in a special container yf like throwing the sharps in the | ask them about any concerns they may have. Don't just ( | called a sharps bin. 34 Professional English in Use Medicine Fa Ss13.1 13.2 13.3 ‘What kind of registration might these doctors obtain? Look at A opposite to help you. 1 A newly qualified Spanish doctor 2 Anewly qualified Nigerian doctor 3A doctor who has successfully completed the first Foundation Year (FY1) 4 An SHO who has successfully completed the Foundation Programme and gained a Certificate of Completion of Training after several specialist registrar posts Write the abbreviations in words. Look at A, B and C opposite to help you. 1 Any doctor who wants to work in the UK must register with the GMC. 2 Some overseas doctors must pass the PLAB test before they can register. 3 Part 2 of the test consists of an OSCE. 4 In any emergency, remember the ABC protocol. 5 Before you can obtain specialist registration, you must have a CCT. Complete the text. Look at A, B and C opposite to help you. My name's Musa and I come from Yemen, I came to the UK about two years ago, after graduating, Because Yemen is ouside the BEA, I could only obsain (1). with the (2) wo at first. It was very difficult for x me to ‘obtain a place on a Foundation Programme. Although I speak good English, I had to take the (3) om test to show that I could work safely in the UK. If I had to give some | advice to other candidates, it would be that at counselling (4) a » you shouldn’t simply memorize a set of phrases. I's better to realy think about what you're saying to the actor and get the intonation right. After completing my year’s clinical training, I was able to obtain (5) . « But I found ie difficult to get an SHO post in my chosen specialty, paediatrics, as hospitals now have to demonstrate there isn't a suitable candidate from the EEA. Once I've completed my second Foundation Year, I should obtain a (6). which will allow me to proceed to (7) ee wi the GMC, an important step on the road to becoming a paediatric consultant. (Ze voor ot Explain how a foreign doctor can register to wo register to work in another ¢ k in your country. Find out how you can Tsim ume ues Professional English in Use Medicine 35Symptoms and signs Describing problems ‘The problems which a patient reports to the doctor are called symptoms, for example pain or nausea. Signs are what the doctor finds, also known as findings, on examining the patient, for example high blood pressure or a rapid pulse rate. Symptoms are also known as complaints. To report a patient's symptoms or complaints, doctors say: rad) ay In case notes, the abbreviation c/o is used: Mr Farnsworth was admitted 6 complaining of chest pain. o/o chest palw HEED Presentation | Patients say they went to (see) the doctor; doctors say the patient presented. The symptom which causes a patient to visit a doctor - or to present — is called the presenting symptom, presenting complaint or presentation. Hiis | Presenting symptom | was chest pain. presenting complaint ( He presented to his GP with chest pain. ) (The usual presentation is chest pain, \\ Talking about symptoms iredness Joss of energy | feel tired all the time. | lethargy I feel completely worn out. \ fatigue Lately I've been feeling completely lassitude exhausted at the end of the day. ‘malaise general feeling of being | Ifeel unwell. unwell I don’t feel well. Tve been feeling off-colour for two days. Thaven’t been feeling myself for a week. P've been out of sorts all day. anorexia loss of appetite ‘My appetite is very poor. ve been off my food for days. weight gain | increase in weight ve put on eight kilos in the last year. Pve gained five kilos. weight loss decrease in weight T'm not eating any less than usual but 've lost a lot of weight recently. constipation hard, infrequent faeces ‘My motions are very hard. T’ve been quite constipated lately. Pm not very regular. Note: The verb feel is also used with other adjectives, such as hot, cold, nervous, anxious, dizzy, weak ~ She said she felt dizzy. 36 Professional English in Use Medicine14,1 14.2 14.3 144 ‘Complete the table with words from C opposite. Put a stress mark in front of the stressed syllable in each word. The first one has been done for you. ex'haustion fatigue | lethargy | tiredness i Make word combinations using a word from each box. Look at A, B and C opposite to help you, ‘complain with off- of out of out present on put colour worn sorts Complete the sentences with the correct form of the verb present. 1 A 67-year-old man with a 9-month history of increasing shortness of breath. 2 The most common is loss of consciousness. 3 Cranial arteritis may s fever without any obvious causes. 4 The patient usually . with a severe sore throat. The nvn--eeen Symptoms in this patient could perhaps be due to renal failure. 6 Other conditions with a similar... include acute cholecystitis. 7 Reduced growth is an important .... complaint of coeliac disease. 8 Two months following... » the patient was able to walk. Read the patient's description of her symptoms then complete the case report. Look at C ‘opposite to help you. Twas well until a few months ago. In ee the beginning, I just felt off-colour and ‘A'50-year-old housewife, who had been well a bit tired. But lately P've been feeling | | until four months previously, completely worn out at the end of the day. | | (1)... _.... of tiredness and Pm not eating any more than usual but @ «She had (3) ve put on nine kilos in the last year. My | | 9 kg in weight in the year before she motions are hard and my hair has started | | (4)... to her GP although she to fall out. denied eating more than usual. She was ©) and she noticed that her hair had started to fll out (oly Tae coe oy OL Write a short case report about this 60-year-old man Thaven’t been myself for several months now. I feel completely worn out after doing anything. I've been off my food and I've lost ten kilos in weight. Write in the past tense and use medical terms for the underlined expressic ise writing similar case reports for your own patients. Professional English in Use Medicine 3715) A) 38 Blood Full blood count In the investigation of blood diseases, the simplest test is a full blood count (FBC). A ful] blood count measures the following in a sample of blood: {the amount of haemoglobin @ the number of the different cells — red blood cells (erythrocytes), white blood cells (leucocytes) and platelets (thrombocytes) @ the volume of the cells © the erythrocyte sedimentation rate (ESR) ~ a measurement of how quickly red blood cay, fall to the bottom of a sample of blood. Anaemia Anaemia is one of the commonest diseases of the blood. It may be due to: @ bleeding — loss of blood © excessive destruction of red cells @ low production, for example because the diet is lacking, or deficient in, iron (Fe). A medical student has examined an elderly patient with a very low level of haemoglobin and is discussing the case with her professor: Professor: What's the most likely diagnosis in this case? Student: Most probably carcinoma of the bowel with chronic blood loss. Professor: What's against that as a diagnosis? Student: Well, he hasn't had any change in his bowel habit, or lost weight. Professor: What else would you include in the differential diagnosis of severe anaemia in a ‘man of this age? Student: He might have leukaemia of some sort, or aplastic anaemia, but that’s rare ~ it would be very unusual. Another cause is iron deficiency, but he seems to have an adequate diet. Professor: OK. Now, there’s another cause of anaemia which I think is more likely. Student: Chronic bleeding ulcer? Professor: Yes, that’s right. But what about pernicious anaemia? Can you exclude that? Student: Well, he's got none of the typical neurological symptoms, like paraesthesiae, Pernicious anaemia Jordi Pons, the medical student from Barcelona, has made some language notes in his textbook, Pernicious anaemia (PA) isa condition in which there is atrophy of the gastric mucosa with consequent fallure of intrinsic factor production and vitamin B;2 malabsorption. The onset is insidious, with progressively increasing symptoms of anaemia, Patients are sometimes said to have 2 lemon-yellow colour owing to a combination of pallor and mild jaundice caused by excessive breakdown of haemoglobin because of ineffective red cell production in the bone marrow. A red sore tongue (loss) is sometimes present, Patients present with symmetrical paraesthesiae in the fingers and toes, early loss of vibration sense, and Progressive weakness and atavla. The spleen may be palpable. Professional Englsh in Use Medicine onset = beginning insidious = slontyy developing pallor = Lacie o wild = slight Jaundice = bitircbinagneia bbrenledown. = division into smaller parts bone marrow = soft tissue int! of bones vibrations progressive = continuing to develop palpable = can be felt with the hana ity15.1 15.2 15.3 15.4 Find words in the box with opposite meanings. Look at B and C opposite to help you. adequate unlikely mild common, insidious for against severe rare sudden inadequate likely Make word combinations using a word from each box. Look at B and C opposite to help you. bone diagnosis differential sense insidious: onset iron marrow pernicious increasing progressively deficiency vibration anaemia Complete the sentences, Look at A, B and C opposite to help you. 1 A39-year-old man presented with a history Of 0...» abdominal distension over a period of six months. 2 Blindness may be caused by vitamin A : 3 The bleeding and purpura are caused by abnormal eon function. 4 The white cell count is normal $0 We CAM. acute leukaemia. 5 The yellow colour of her skin and conjunetivae is probably due £0...» 6 There was a ---»Mass in the right upper quadrant of the abdomen. 7 Treatment is aimed at restoring fluid balance with _. intravenous fluids. 8 The anaemia may be due to increased red cell... ‘Complete the conversation. Look at C opposite to help you. Professor: What is against the diagnosis of pernicious anaemia on physical examination? Student: The problem started quite suddenly. So it didn’t have the typical (1) 0. cmon» He doesn’t have any skin (2) n-ne. and he doesn’t have (3) sw paraesthesiae, of absent (4) svoonnnmmnmm Sense, and I couldn't feel his spleen. Professor: What about his tongue? Student: His tongue was normal and not inflamed or (5) onl T ae gene to List the causes of anaemia mentioned in the conversation in B opposite. Then choose remen R MOR SDy English. Use the index to help you. Pea me ere) Professional English in Use Medicine 39Bones Some common English names for bones: skull cranium 16 ee Soap jaw bone mandible spine vertebral column breastbone sternum ib costa | collarbone clavicle | shoulder blade scapula thigh bone femur kneecap patella | shinbone tibia HED Fractures | AA fracture is a break in a bone. Some of the different types of fracture: | S eK * | | : N 5 greenstick displaced comminuted impacted open (compound) \ A pathological fracture is fracture in a diseased bone. A fatigue or stress fracture is due to | repeated minor trauma, for example long-distance marching or running, HES) Treatment of fractures ‘When the fragments of a broken bone heal and join together, they unite. Union may be promoted, nl 9 or helped, by reducing the fracture ~ replacing the fragments in theit anatomical position if they are displaced. After reduction, excessive movement of the broken bone is prevented by fixation — either external, for example a splint or plaster of Paris cast, or internal, for example a pin or a plate and screws. A displaced fracture which is not reduced may result piaster cast apin a plate and screws in malunion ~ incomplete or incorrect union, Note: The verb reduce has several meanings in medicine: @ to make smaller ~ | think we'd better reduce the dose of your tablets. in surgery) to return to anatomical position - A hernia can normally be reduced by manipulation. & (in chemistry) to remove oxygen or add hydrogen ~ Nitric acid is a reducing agent. 40 Professional English in Use Medicine16.1 16.2 16.3 Label the diagram using words from the box. Look at A opposite to help you. breastbone collarbone jaw bone kneecap rib shinbone shoulder blade skull spine thigh bone ‘Match the types of fracture (1-5) with the descriptions (a-e). Look at B opposite to help you. 1 open 2 comminuted 3 displaced 4 greenstick 5 impacted a There is a break in the skin. b The bone is bent. It occurs mainly in children. ¢ The bone is broken into several pieces. d The broken pieces are separated. € The broken pieces are pushed together. Complete the textbook extract. Look at C opposite to help you. (1) position as possible. If a fracture is allowed to heal in a displaced position the fracture will (2) . .». but it may go on to (3) _. fracture involves trying to return the bones to as near to their original onan ge (17 a You have diagnosed a stress fracture of the tibia in a young female dancer. How would you Peon eR ee or ne enn Om Oar sons Professional English in Use Medicine 4= ‘ er 42 Childhood Milestones ith puberty ~ the Childhood is the period during which a person is a child. It ends with pul one of sexual maturity, Infant is another word for a young child; infancy isthe period from birth until about five years of age. ‘The milestones in a child’s development and the ages at which they usually occur are: sitting — by 9 months crawling - by 12 months first words - by 18 months walking - by 18 months talking (two-word sentences) Common infectious diseases morbilli/rubeola measles = by 3 years, rubella German measles varicella chickenpox infectious parotitis ‘mumps pertussis whooping cough acute laryngotracheitis ‘croup scarlatina scarlet fever theumatic fever theumatic fever tetanus Tockjaw poliomyelitis polio Coeliac disease A medical student has made some language notes while reading her textbook. Coeliac disease isa disease ofthe smal intestine caused by sensitivity to gluten It can present at any age but in infancy it appears after weaning (on to cereals containing gluten. The clinical features include diarrhoes, malabsorption and failure to thrive, There may be signs of malnutrition and there may be some abdominal distension. Thete is delayed growth and delayed puberty, leading to short stature in adulthood. eens ean = Professional Englsh in Use Medicine | sensitivity to = having a negative ny, dlinbeal features = the syruptones and signs of a disease malabsorption malnutrition = poor dist (mutrition) thrive = grow strongly distension = swelling delayed = Later than expectea| failure = when something tat is | expected does wot happen stature = size, especially height17.1 17.2 17.3 Complete the table with words from A and C opposite. Then complete the sentences with words from the table. a emo) i delay develop distend distended fail nourish 1 Babies with the fetal alcohol syndrome may present with 2. Abdominal nmnmnm may be due to an enlarged liver. 3 Small amounts of alcohol in pregnancy can affect feta . 4 Mortality from measles can be reduced by bettet u.n0= 5 nemo i ONE OF More of the milestones may be the fist sign of disease. wm to thrive. ‘Complete the sentences, Look at A and C opposite to help you. 1 After sitting, babies learn £0 w.smsmsnee- and then to walk. 2 A child who has started eating solid food has been . 3 Someone who is not very tall is said to be of short 4 The stages in a child’s development are known as the 5 A child who is beginning to develop sexually has reached ‘Write the common English name for each disease, using your medical knowledge. 1 enlarged parotid glands 2 difficulty opening the mouth 3 rash and enlarged posterior occipital nodes 4 paroxysmal cough with vomiting 5 papules and vesicles, first on trunk 6 cough and cold followed by rash 7 sore throat and rash 8 swollen joints and a heart murmur 9 fever followed by muscle weakness 10 cough with stridor oJ ae coer} ot What are the main childhood illnesses in your country? What are the clinical features of Tan essed Professional English in Use Medicine 43a The endocrine system Excess and deficiency [An excess ~ too much, or a deficiency ~ too little, of circulating hormones causes a wide range of medical conditions, for example hyperthyroidism and hypothyroidism. Where there is an excess of hormone, one form of treatment consists of giving the patient something which inhibits the production of that hormone, as in the use of carbimazole to treat hyperthyroidism. When a hormone is deficient, treatment may be by replacement therapy, for example injections of insulin in the treatment of Type 1 diabetes. Doctors say: (“Sutferers of type 1 diabetes are deficient Negative feedback systems 41 TRH [thyrotrophin-releasing hormone) is secreted in the hypothalamus and triggers the i | production of TSH (thyroid-stimulating hormone) pituitary in the pituitary, 2. TSH stimulates the TSH receptor in the thyroid to increase synthesis of bath T (thyroxine) and eros negative ‘Tg (triiodothyronine) and also to release stored hormone, producing increased plasma levels of Ta and Ts. 3 Ts feeds back on the pitutery and perhaps the Sontion hypothalamus to inhibit TRH and TSH secretion. peripheralmtssue tissues actions Goitre ‘An enlarged thyroid gland is called a goitre. The enlargement may be diffuse ~ involving most of the gland, or localized ~ limited to a particular area, as in a solitary (single) nodule. The increased blood flow in diffuse enlargement, for example in Graves’ disease, may give rise to a palpable thrill~ vibration felt with the hand, and an audible bruit = noise heard through a stethoscope, over the gland. A letter of referral ‘Mrs Davis's doctor has referred her to an endocrinologist. Dear Doctor, ; | would be grateful if you would see this 50-year-old peerite a woman who has lost 20 kilos in weight in spite of eating | Neal more than usual, She describes herself as overactive and at first she thought the weight loss was due to this. But___ palpitations: more recently she has developed palpitations, diarrhoea, | awareness of heat intolerance:—2%4 hgat intolerance. She has noticed that her hands rapid or irregular inability t0 have a tendency to shake. heartbeat cope with high Her symptoms suggested hyperthyroidism and this was temperatures confirmed by my examination which revealed an enlarged _ [fine tremor: very slight involuntary thyroid, red sweaty palms and a fine tremor of the hands. movements Professional Englsh in Use Medicine18.1 18.2 18.3 18.4 ‘Complete the table with words from A, B and C opposite and related forms. Put a stress mark in front of the stressed syllable in each word. The first one has been done for you. inhibit produce release replace secretion stimulation Complete the passage from a textbook, using the illustration and your own knowledge. Look at B opposite to help you. hypothalamus. secondary sexual Pulses of GnRH (gonadotrophin-releasing hormone) are Sencemss, released from the hypothalamus and (1) LH and FSH (2) ... . from the pituitary. @) testosterone (4) ... from Leydig cells of the testis. Testosterone (5) ern hypothalamus/pituitary to (6) @ . FSH (8) cells in the seminiferous tubules to (9) ... mature sperm and the inhibins A and B. Inhibin causes feedback on the pituitary to decrease FSH (10) back on the GnRH the Sertoli Complete the sentences. Look at A and C opposite to help you. 1A change affects many parts of an organ or gland. 2a _ change affects only one part. 3 His diet is... vw in iron: he doesn’t get enough iron. 4 Ty and Ty increase the basal metabolic rate. ‘Match Mrs Davis's symptoms (1-7) with the questions her doctor asked (a-g). Look at D ‘opposite to help you. 1 diarrhoea a Do you prefer hot weather or cold? 2 eating more b Is your weight steady? 3 heat intolerance ¢ What is your appetite like? 4 overactivity d. Are your bowels normal? 5 palpitations € Are you able to sit and relax? 6 weight loss f Do your hands shake? 7 tremor 4g Have you ever felt your heart beating rapidly or irregularly? Over +o you st Write a referral letter to an endocrinologist for a patient who you believe has Non eek eae oe cE Professional English in Use Medicine 45Parts of the eye a) The eye eed eyebrow | in} Examination of the eye i Here is an extract from a textbook description of how to examine the eye. {ook or quit (stabs), drooping ofthe upe id (ts) rosin ofthe ees nystagmss) nid a, the upper | ‘yl moves inegualy instead of smocthly when the patent is asked to look down, Next, examine the pupils and note whether «they are equal in size + they are regular in outline (eveny cele) * they are abnommaly dilated Jarge) or constricted (mal) * they react normally to light and accommodation (focus on near objects) reek reaction accommodation ask te patent ook int th stance Hold younger in Font of hl nose ad ask | Re Ratet to look ati The eyes shold cme tgethr or converge, and he pupils should constrict asthe patent bate the finger, Check also for cataract (pacity ofthe lens) I hard formed semi-formed soft (loose) liquid/watery ‘The colour can vary from black, due to altered blood as in melaena, to yellow, grey or even white, Melaena stools are often described as tarry like tar, the black sticky substance that is used in road making. The stools may be red when fresh blood is present. Blood that can only be detected with special tests is called faecal occult blood (FOB). When there is a high fat content, the stools are pale, and are sometimes described as clay-coloured. Stools that are large in volume are described as bulky. A bad smell is described as foul or offensive. Professional English in Use Medicine20.1 20.2 20.3 Complete the case report. Look at A opposite to help you. Physical examination revealed a thin girl with slight pallor. She was not obviously dehydrated. The temperature was 38°C, pulse 100/min, blood pressure 110/80 mmHg. Examination of the rest of the cardiovascular and respiratory systems was normal. The abdomen was not (1 . There was generalized (2) . which was most marked in the right lower (3) and was associated with but not (5)... « There was no rebound (6)... were felt. (8) sounds were reduced. ‘Match the descriptions of the stools (1-6) with the conditions most likely to cause them (a-f), using your medical knowledge. Look at B opposite to help you. Type of stools Condition 1 loose, bloody a gastric ulcer 2 loose, pale, bulky b irritable bowel syndrome 3 clay-coloured © ulcerative colitis 4 black, tarry d cholera 5 small, hard © coeliac disease f 6 clear, watery with mucus obstructive jaundice Match the features (1-7) to the doctor’s questions (a~g). Look at B opposite to help you. 1 blood a How often do you open your bowels? 2 bowel habit b Are you going to the toilet more often than normal? 3 change in bowel habit © Are the motions hard or loose? 4 bulk Do the motions have an unusual smell? d 5 colour © What about the appearance of the stools? 6 consistency f Have you passed black stools? 7 offensiveness g Is the size or the amount of the stool normal? = | lower quadrant The abdomen can be divided Cl into four quadrants. Look back at 20.2 above. In what other conditions that you encounter regularly is the appearance of the stools typical? How would you describe their appearance? Professional English in Use Medicine 4950 Gynaecology The female reproductive system womb. Fallopian tube (salpinx) ovary neck of womb (cervix) ; vagina Menstruation A period is the common name for a menstrual (monthly) period. The onset of ‘menstruation is known as menarche, The last menstrual period is commonly abbreviated in doctors’ notes: LMP 2/52 ago means the last menstrual period was two weeks ago, ‘The menstrual cycle, or length and frequency of periods, is usually written in the form 4/28, which means lasting 4 days and occurring every 28 days. If a period lasts more than four or five days it can be described as prolonged. The term heavy periods means excessive blood loss ~ menorrhagia, often with the passage of clots - coagulated blood, ‘The term period pains means dysmenorrhoea, or painful menstruation, The time when a woman stops menstruating, normally at about the age of 50, is called the menopause or climacteric. In everyday English it is known as the change of life, or simply the change. Symptoms of the menopause include hot flushes ~ sudden sensation of heat ~ and night sweats. A gynaecological consultation A gynaecologist is talking to a 30-year-old woman. Gynaecologist Patient Yes. Every four weeks. About 12. A week ago. ‘Are your periods regular? How often do you get them? How old were you when you started to get them? ‘When was your last period? How long do the periods last usually? Would you say they are light or heavy? Do you get clots? Do you get period pains? Is there any discharge between the periods? ‘What colour is it? 4 or S days. Light. No. Not really. A little, White. Contraception For women, methods to prevent pregnancy include the oral contraceptive pill (known as the Pill), the diaphragm, and the intrauterine device (IUD) or copper coil. Condoms are available for both men and women. Professional English in Use Medicine21.1 Write a simple English phrase for each of the medical terms below using your medical knowledge. Look at A and B opposite to help you. 1 hysterectomy 2 menorthagia 3 salpingitis 4 cervical biopsy 21.2 Read the conversation between the gynaecologist and the patient in C opposite, and complete the notes about the patient. menarche: menstrual cycle: LMP: menorrhagia? dysmenorthoea? discharge? 21.3 Now write the questions that the doctor asked. Look at C opposite to help you. menarche: menstrual cycle: LMP: menorthagia? dysmenorthoea? discharge? 21.4 Complete the case report. One word is needed twice. Look at B and C opposite to help you. ‘45-year-old woman had been having (1) -nu petiods lasting for 8 days, with the passage of (2) .., for 9 months. There was no bleeding between (3)....... or after intercourse. Her (4) --» were not particularly painful. She had not noticed any hot (5) . or night sweats, and her general health had always been good, She hhad taken the (6) oeronnm COMLACEPLVE (7) nm - until a year previously, when a copper (8) was fitted. She had had a normal pregnancy when she was 25. diaphragm ‘copper coil condoms (olan coe 217 st What is the attitude to contraception in your country? At what age do you think females should be prescribed contraceptives? Professional Engish in Use Medicine 51Shortness of breath ey The heart and circulation 1 es) Shortness of breath, or breathlessness, is dyspnoea. At first this is caused by exertion ~ physical activity such as climbing stairs ~ but in severe cases it may be present even at rest. A patient who is breathless when lying flat (orthopnoea), for example in bed, will tend to sleep raised up on two or more pillows. The abbreviation SOBOE stands for shortness of breath on exercise (or on exertion, or on effort). Patients say: I get terribly short of breath climbing stairs. Doctors can ask: How many pillows do you sleep on? Heart rhythm The normal resting heart rate is 65-75 beats per minute. In athletes it may be as low as 40 beats per minute, In extreme athletic activity, the heart rate can go as high as 200/min, The heart rhythm may be regular or irregular. In an irregular rhythm (arrhythmia), there may be early beats which interrupt the regular rhythm (premature beats); or the rhythm may vary with respiration; or it may be completely irregular, as in fibrillation. When Patients are aware of irregularity, they describe the symptom as palpitations. ‘A 22-year-old student was admitted to hospital with a long history of heart problems. She had been increasingly tited, with shortness of breath on exertion, orthopnoea, and Palpitations. A mitral valve replacement had been carried out 3 years previously and this had stabilized the symptoms of heart failure but was followed by episodes (attacks) of atrial fibrillation, which had been particularly severe for the 6 months before admission, Heart failure Heart failure occurs when the heart is unable to maintain sufficient cardiac output — the amount of blood pumped by the heart each minute - for the body's needs. It may involve the left side of the heart, the right side, or both. In left heart failure the main symprom is breathlessness. The symproms of right heart failure include peripheral oedema (swelling), beginning in the feet and ankles. This is known as pitting oedema if, when a finger is pushed into the swelling, it causes a small depression or pit. aorta pulmonary artery tricuspid valve 52 Professional English in Use Medicine22.1 22.2 22.3 22.4 Complete the conversation based on the case history in B opposite. What seems to be the problem? Te been getting (1)... How long have you had them? For about six months, But I've had heart problems for years, with tiredness and (2) . of (3) «In the end I couldn’t walk more than a hundred metres without having to stop. I had to sleep on three (4) Thad a (5) replacement three years ago, and that improved things for a while. ‘Make word combinations using a word from each box. Two words can be used twice. Look at B and C opposite to help you. at output atrial failure cardiac oedema heart fibrillation on beats pitting effort premature rest Write the words a patient would use to describe the symptoms below. Look at A, B and C opposite to help you. 1 dyspnoea 2 arrhythmia 3 orthopnoea 4 oedema Complete the case report. Look at A, B and C opposite to help you. ‘A 60-year-old woman attended her GP's surgery complaining of breathlessness on (1) - This had been increasing over the previous eight months until it was produc- ing problems at around 500 metres walking on the level. There was no history of chest pain. She had had several (2) of fast (3) - which lasted 20-30 minutes and were associated with some (4) breath. She had noticed some ©) on ..of her ankles by the end of the day. This disappeared overnight. Over +o you Y How would you manage the treatment of the woman in 22.4 above? Professional English in Use Medicine54 The heart and circulation 2 Physical examination Medical examination is normally carried out in four stages: inspection (looking), palpation (feeling with the hands), percussion (tapping with a finger) and auscultation (listening with a stethoscope). Note: The verb is palpate; the noun is palpation (not palpitation ~ see Unit 22). Examining the heart and circulation Here is an extract from a textbook description of how to examine the cardiovascular system. Look at the lips, tongue and nails for the blue discoloration of eyanosis. Cyanosis may be central or peripheral. Inspect the hands for clubbing, Feel the radial pulse at the wrist and note the rate (for example 70/min) and rhythm (regular or irregular), The pulse may be irregular in force as well as time. Check that the other peripheral pulses are present. Measure the blood pressure, and assess the jugular venous pressure (JVP). Palpate the cchest for the apex beat ~ the normal position isthe fifth leftintercostal space, one centimetre medial to the midelavicular line. Feel for any thrills. Heart size may be measured by percussion, Listen for murmurs and other abnormal sounds, for example friction rubs, beginning at the mitral area, Murmurs may be soft or loud. A harsh murmur is loud and rough. Note the time of any murmur in relation to the cardiac cycle. The most common murmurs © mid-systolic (in the middle of systole) © pan-systolic (lasting for the whole of systole) © early diastolic © mid-diastolic © late diastolic (pre-systolic) Continue by listening at the tricuspid, aortic and pulmonary areas. Professional English in Use Medicine a : Areas of auscultation. The letters indicate the approximate position ofthe heart valves: P Pulmonary valve; A Aortic valve; M Mitral valve; ‘T Triscupid valve. The circles indicate the position for auscultation for cardiac murmurs indicating valvular heart disease. The ribs are numbered.23.1 23.2 23.3 Complete the table with words from A opposite. Put a stress mark in front of the stressed syllable in each word. The first one has been done for you. act TD ‘auscultate examine inspect palpate percuss Put the steps for examining the heart and circulation in orders, according to the four-stage system. Look at A opposite to help you. a Measure the heart size. Are there any murmurs? Feel the radial pulse. d Look for clubbing. ¢ Locate the apex beat. F Note any thrills. ‘A doctor is presenting the case of a 43-year-old woman at a meeting in the Cardiology Department. Complete the text of her presentation. Look at B opposite to help you. { On examination she was pyrexial with a temperature of 38.5. She was short of breath. Her pulse was variable between 100 and 180 and was irregular in time and (1) Her blood reais) was 130/80 and her JVP was up 5 centimetres showing normal movement with respraion Her peripheral (2) .nm--n- Were all present and there was no (3) saan OF (4) cyanosis. Her apex (5) was displaced to the anterior axillary line but still in the fifth intercostal (6) 2.0.» Her heart sounds were very interesting. When she was intially examined it was noted that she had pan-systolic and mid-diastolic (7) , heard best at the apex. When she was examined some hours later, there was a harsh pericardial friction = all over the precordium. Our diagnosis at that time was of mitral | stenosis and incompetence with a recent onset of pericarditis and atrial fibrillation. Over to you ot How many signs of heart disease can you find in B opposite? Can you add any signs of to the list? Professional English in Use Medicine 55ead ams 56 Source and spread of infection Infections Fever ‘A medical student has made some language notes on a case report. fever = pyrexia (aloo remember PUO ~ pyrexia of ‘A 24-year-old man presented with a fever unksiowt aie) which he had had for three days. On the | fever also known as temperature ~ ‘Ive got a third day he had had a severe attack of temperature, fever with sweating and rigors. the only | adjectives = feverieh/febrile ard pyrexial past history of relevance was hepatitis opposites = afebrlelapyrexial four years earlier and glandular fever (infection with Epstein-Barr virus) at the | Some eymptoms of fever age of 18 years, He had retumed from oweating Arica three weeks previously. rigors (severe shivering and seneation of coldness, also known as chills) 1 HEED Microorganisms Infections differ from other diseases in a number of aspects: © Most importantly, they are caused by living microorganisms ~ such as viruses or bacteria ~ that can usually be identified, thus establishing the aetiology early in the illness. Many of these organisms, including all bacter potentially curable, unlike many non-infectious degenerative and chronic diseases, @ Communicability is another factor which differentiates infections from non-infectious diseases. Transmission of pathogenic organisms to other people, directly or indirectly, may lead to an outbreak or epidemic. © Finally, many infections are preventable by hygienic measures, by vaccines, (especially live artenuated vaccines such as rubella vaccine) or by drug prophylaxis (for example, chloroquine to prevent malaria), Microorganisms include bacteria, viruses, fungi, protozoa (such as the parasite that causes malaria). Another general word for these pathogens is microbes. Patients often refer to microbes as germs or bugs. Notice the common expressions for acquiring an infectious disease: are sensitive to antibiotics and most infections are T caught 5 a { Ithink I've caught Could he have | ed up | S0me disease from the dog? ik tities going round. Here is an extract from a medical textbook. Infection may originate from the patient (endogenous), usually from skin, nasopharynx or bowel, or from outside sources (exogenous), often another person who may be either suffering from an infection or carrying ‘ pathogenic microorganism. Carriers are usually healthy and may harbour the organism in the throat (for example, diphtheria), bowel (salmonella), or blood (hepatitis B or HIV). Non-human sources of infection include water (eg. cholera), milk (e9, tuberculosis), food (e., botulism), animals (eg. rabies), birds (eg. psittacosis) and also the soil (e.9. legionella ~ Legionnaires’ disease) ‘The incubation period is the period between the invasion of the tissues by pathogens and the appearance of Clinical features of infection. The period of infectivity isthe time that the patient is infectious to others. teeter tte ER eID eS OT ttn Professional English in Use Medicine24.1. Match the two parts of the sentences. Look at A, B and C opposite to help you. 1 1988 saw the UK launch of live attenuated 2 Chickenpox (varicella) is a common infectious 3 Rabies has an incubation 4 The patient remained febrile 5 He was admitted with a four-day history of influenza-type symptoms of fever with 6 Quite a proportion of patients who recover from hepatitis B 7 The central part of Africa is in the midst of an epidemic 8 Measles (rubeola) is most 9 Lyme disease is caused by transmission 10 PUO stands for a petiod ranging from four days to many months. b rigors, myalgia and general malaise. ¢ become carriers of the virus. d infectious during the catarthal stage. € disease of childhood. f of AIDS. g of B. burgdorferi from animal to man by ixodid ticks. h with peaks of temperature of 39.5°C. i pyrexia of unknown origin. j measles, mumps, and rubella (MMR) vaccine. 24.2 Complete the case report on the patient in A opposite. Look at A, B and C opposite to help you. (On examination, he looked unwell. His pulse rate was 100/minute. He had a palpable spleen. The combination of (1) swe 490 (2) in a patient who has recently returned from Africa strongly suggests a diagnosis of malaria. The (3) .. period is usually 10-14 days. In this case, the patient admitted he had not been taking (A) o-nnnennnnene ularly, The diagnosis was confirmed by the presence of (5) cenenenrnnenen itt his blood film. 24.3 Complete the sentences. Look at A, B and C opposite to help you. 1 An infection which can be treated successfully with antibiotics is... 2 Another word for an epidemic is an 3 Bacteria and viruses are examples of.. 4 Someone whose temperature is normal is... 5 The common infection with Epstein-Barr virus is known as Cases of HIV infection reach record high in the UK need Describe the situation with regard to HIV in your country. What measures are being Pree ncOnd Professional English in Use Medicine 87YAs¥ Mental illness az Psychiatric disorders Psychiatric disorders can be divided into organic and functional. Dementia is a mental disorder due to organic brain disease, The commonest form of dementia is that associated with old ages senile dementia. Disorders in which there is no obvious pathology or anatomical change in an organ are termed functional. These are described below. Substance abuse Abuse of a substance means using it in a way that is harmful. The commonest forms of substance abuse are alcoholism and drug abuse. Affective disorders Here is an extract from a medical textbook. Affect and mood are similar in meaning and refer to the emotions (for example, happiness or sadness). Affect tends to be used for temporary emotions, and is expressed through manner of speaking, facial expression, or behaviour. Mood is used to refer to a more permanent emotional state. The most common form of affective disorder is depression, the symptoms of which are: « poor appetite or significant weight loss « sleep disturbanee (for example, insomnia — inability to sleep) ‘« psychomotor agitation (excessive movement and thought) or psychomotor retardation (slowing of movement and thought) « oss of interest in stimulating activities decreased ability to think and concentrate ‘ feeling that one is of no value to others, or that one has done something wrong « recurrent thoughts of death or suicide. Five, or possibly four, of the above symptoms, ‘occurring nearly every day for at least two ‘weeks, constitute a major depression. | ® fatigue (loss cf energy) Neurotic and stress-related disorders ‘An example of neurotic disorder is obsessive compulsive disorder. An obsession is an idea that is so persistent that it interferes with the patient's life. A compulsion is an obsessive idea that forces the patient to act even though they recognize that it is unnecessary. A \ common form of this is compulsive washing of the hands. Stress is a feeling of being | unable to cope. It can lead to anxiety or fear of problems. A sudden attack of anxiety is called a panic attack, Other types of functional disorder | These include: ' 1 behavioural syndromes associated with physiological disturbance (such as eating | disorders) @ disorders of adult personality and behaviour (for example, personality disorder) @ mental retardation — delayed mental development © schizophrenia and other disorders in which there are delusions (false beliefs). 58 Professional English in Use Medicine25.1 25.2 25.3 25.4 Complete the table with words from A, C, D and E opposite. affective anxious behavioural demented disturbed suicidal ‘Make word combinations using a word from each box. Two words can be used twice, Look at B, Cand E opposite to behavioural abuse eating disturbance major retardation mental disorder personality depression psychomotor syndrome sleep substance Complete the sentences. Look at A, C, D and E opposite to help you. 1 The way a person behaves is his or her... 2A persistent emotional state is a . 3 A sudden attack of anxiety is a . 4 The form of dementia associated with ageing is called 5 A disorder which is not associated with pathological changes is 6 An idea which forces a patient to repeat unnecessary actions is a . Which symptoms of depression was this patient suffering from? Look at C opposite to help you. ‘A. 56-year-old woman presented to her GP complaining of increasing tiredness over the past few months. She had lost interest in most things. She was sleeping poorly and tended to wake up early, but denied any suicidal tendencies. She was thirsty and was passing urine more often. She was eating normally and her weight was steady. Over +o you st NUT ae roe PMR ESR e nT RM goss eed Give your reasons. Professional English in Use Medicine 59"aims 60 The nervous system 1 Sensory loss The central nervous system controls the sensory and motor functions of the body. Diseases of this system therefore lead to loss of some of these functions. hearing _| deafness buzzing or ringing in the ear (tinnitus) blindness double vision (diplopia) blurring (loss of visual acuity ~ clarity of vision) numbness (anaesthesia) | tingling or pins and needles (paraesthesiae) sight sensation (feeling) balance unsteadiness (ataxia) _| dizziness (vertigo) Note: There are no common words for loss of, or conditions relating to, taste and smell, Motor loss ‘Motor loss symptoms and signs include: @ weakness — loss of power @ paralysis — complete loss of power @ tremor ~ involuntary rhythmic movement, especially of the hands @ abnormal gait - unusual manner of walking. Speech may also be affected, for example with hoarseness ~ a rough, deep voice as in vocal cord paralysis. Slurred speech means poor articulation, as in cerebellar disease. Loss of consciousness Patients may describe sudden loss of consciousness in a number of ways: passed out. fit. had a blackout. Thad a | seizure. fainted. convulsion. Fit, seizure and convulsion are all used to refer to violent involuntary movements, as in epilepsy. Doctors may $Y! (“Then did you lose consciousness? Here is a passage from a textbook on the causes of loss of consciousness. The principal differential diagnosis is between an epileptic fit and a syncopal attack, or fainting. ‘Syncope is a sudden loss of consciousness due to temporary failure ofthe cerebral circulation, Syncope is distinguished from a seizure principally by the circumstances in which the event occurs. For example, syncope usually occurs whilst standing, under situations of severe stress, or in association with an _arrvythmia. Sometimes a convulsion and urinary incontinence —loss of control ofthe bladder - occur _ even in a syncopal attack. Thus, neither of these is specific for an epileptic attack. The key isto establish the presence or absence of prodromal symptoms, or symptoms that accur immediately before the attack. Syncopal episodes are usually preceded by symptoms of dizziness and light-headedness. In coleps pepe ey get warning ow as an aur, thatan tacks gong bape. Note: The noun convulsion is often used in plural form ~ He had convulsions 05 0 oni. Professional English in Use Medicine26.1 26.2 26.3 Complete the table with words from A, B and C opposite. conscious deaf dizzy numb light-headed unsteady Make word combinations using a word from each box. Look at A, B and C opposite to help you. double acuity epileptic attack prodromal incontinence syncopal symptom urinary vision visual fit A doctor is trying to determine the cause of loss of consciousness in a 52-year-old man. Complete the doctor's questions. Look at C opposite and at the table in 26.1 above to help you. Did you lose (1) Did you get a (2). suddenly or gradually? of the attack? ‘What were you doing before you (3) . out? Were you worried or under any (4) Did you feel (5)... attack? at the time? wee OF (6) san » before the Did you lose (7) .. of your bladder? Did your wife notice any (8) - movements while you were unconscious? Cems ae d ‘According to a newspaper article, research has shown that inability to identify ten particular smells is an early sign of Alzheimer’s disease. What do you think the ten smells are? Professional English in Use Medicine 61mea The nervous system 2 A motor system Examination of the motor system should include assessment ofthe following: @ muscle bulk (amount of muscle tissue). Look for signs of wasting (muscle atrophy) @ muscle tone (amount of tension in a muscle when it is relaxed). Tone can be increased (spasticity), or decreased (flaccidity) | @ muscle power (strength) @ coordination (the ability to use several muscles at the same time to perform complex actions) | @ gait (the manner of walking) | @ reflexes (see B below) \ ® involuntary movements, for example a tic or a tremor. | Here is an extract from a case report about a patient with a tremor, : [On examination her face showed litle or no expression. There was a temor acting | mainly her right hand, She had generally increased muscle tone. Power, reflexes, coordina. tion and sensation were within normal limits, Examination of her gait showed that she was | slow to start walking and had difficulty stopping and turning. HEED Tendon reflexes Examination of the nervous system normally i) includes testing the tendon reflexes, for example II the knee jerks, with a tendon hammer (also known as a reflex hammer). The reflexes may be absent (0), diminished (-), normal (+) or brisk (+++), The plantar reflexes are also checked. The normal plantar response is a downgoing (J) movement (plantar flexion) of the big toe. An upgoing (‘) toe (extensor ot Babinski response) is abnormal. Testing the knee jerk with a tendon hammer Coma Coma is unconsciousness with a reduced response to external stimuli. Doctors sa¥: (The patient is in a coma. ‘The patient is comatose. | ‘The Glasgow Coma Scale (GCS) score is calculated as follows: ete ne Witten mes Bone | Spontaneous 4 | Oriented 5 | Obeys 6 To speech 3 | Confused 4 | Localizes 5 To pain 2 | Inappropriate 3 | Withdraws 4 None 1 | Incomprehensible 2 | Flexion 3 None 1 | Extension 2 None 1 62 Professional English in Use Medicine27.1 Complete the table with words from A and B opposite. absence diminution flaccid spastic wasted 27.2 A doctor is giving instructions to a patient during examination of the motor system. Identify what the doctor is assessing in each case. Look at A opposite to help you. 1 Td like you to relax. P’m just going to move your arm up and down. 2 Can I see your hands? 3 Now, I’m going to straighten your arm out. Try to stop me. 4 Can you touch my finger with yours and then touch your nose? Good. Now do it again with your eyes closed. 27.3 ried the sentences. Look at A, B and C opposite and at the table in 27.1 above to help you. 1A. hand drops limply to form a right angle with the wrist. oe reflexes are reflexes that are stronger than normal. 3 Muscle : ans the muscle is reduced in bulk. 4 Atic is a form of wwe MOVemMent. 5 Akey is often used t0 test theo m.n _ response. 6 His... ssn: Was poor: he could not perform rapid alternating movements. i : von #8 used t0 test reflexes. 8 When something i8 sonny it 8 less than normal. 27.4 A patient is brought to A&E in coma. When her name is spoken, she opens her eyes but she does not answer questions, or obey instructions. What is her GCS score? The plantar reflex Over to you e ere RES a CMe ceg What is your diagnosis for the patient in A opposite? Professional English in Use Medicineee) , aa 64 Oncology Neoplasms ‘A neoplasm is an abnormal new growth of tissue. Malignant neoplasms ~ cancers ~ are likely to spread and cause serious illness or death, Benign neoplasms do not spread and are less harmful. When speaking to patients, doctors generally say growth or tumour. growth |. | You have a small — into, 7 A lump or swelling is collection of tissue or fluid which is visible or palpable ~ can be palpated or felt with the fingers. A lump may be due to a neoplasm, but there are other causes such as inflammation or fluid accumulation. Patients say: Doctors say: C Thave a lump in my left breast. ) ( ‘There was a firm, palpable mass in the liver ‘Malignant tumours are characterized by rapid growth and invasiveness. The tumour may invade local tissues or may spread to distant parts of the body (metastasis). Neoplasms which are the result of metastasis are called secondaries, as opposed to the original tumour which is the primary. ‘We have the results of the scan back now and I'm afraid they show that you have a small growth in the prostate. Fortunately, it appears to be at an early stage and there is no sign of spread. So if we remove it, there is every chance of a complete cure, Note: To invade (verb) is to enter and spread throughout a part of the body, and this process is invasion (noun). If a tumour is described as invasive, it has the ability to spread. Symptoms and signs of malignancy The symptoms of malignant disease may be related to the size and location of the tumour. For example, a space-occupying lesion in the brain causes raised intracranial pressure and symptoms such as headache, vomiting, or visual disturbance. Tumours of the colon may obstruct (block) the lumen and cause change in bowel habit. Other possible symptoms of malignancy include bleeding, pain, and weight loss. renee ee ere ee ‘A 33-year-old man presented to his GP complaining of a painless lump on the right side of his neck, which had been present for about two months and was enlarging. He had been feeling generally unwell and had lost about 5 kg in weight. He was also complaining of night sweats. He had no significant past medical history. Treatment of tumours A tumour can sometimes be completely removed or excised by surgery. If this is not possible, for example if it has already metastasized to other patts of the body, it may be Possible to destroy it by radiotherapy or by chemotherapy (see Unit 42). When a cure is not possible, palliative treatment is given, which is only intended to relieve symptoms. Professional English in Use Medicine28.1 Complete the table with words from A, B and C opposite and related forms. et dae cure curative ‘excision grow growing invasive obstruction obstructive palliate palliation palpable spread spreading swell swelling, swollen 28.2. The notes below are about the patient described in B opposite. Use them to put the sentences (1-9) in the correct order, to make the next paragraph of the case report. Use Appendix I on page XX if you need help with the abbreviations. OE T S78 ‘emooth, firm 3 x-4 om mass in R supraclavicular fossa. odes 1-2 om in diameter, palpable in both axillae and inguinal areas Oropharyrx NAD F100 Imin regular BP 112/66 CVS NAD RS NAD Abd mass palpable 3 cm below L. costal margin CNS NAD 1 Examination of the central nervous system was normal. 2 His mouth and throat were normal. 3 There was a smooth, firm 3 x 4 cm mass in the right supraclavicular fossa. 4 His cardiovascular and respiratory systems were normal. 5 On abdominal examination, there was a mass palpable 3 cm below the left costal margin. 6 On examination, his temperature was 37.8°C. 7 There were enlarged lymph nodes in both axillae and inguinal areas. 8 His pulse rate was 100/min regular and blood pressure 112/66. 28.3 Complete the sentences. Look at A, B and C opposite to help you. 1 Distant... f rumour cells is known as metastasis. 2 Many symptoms of cancer, such as difficulty swallowing, are due to 3 The opposite of painful is 4 Ko .. neoplasm is called a cancer. 5 Tumours which do not invade or metastasize are. 6. tumours are those which result from the spread of a primary. 7 Ifa cure is not possible, nnn treatment should be given. 8A. sous liver suggests metastasis. Over +o you “a The most likely clinical diagnosis in the patient (described in B opposite and 28.2 above) is lymphoma. How would you explain his condition to him? Professional Englsh in Use Medicine 65— Pregnancy and childbirth Childbirth ‘The expected date of delivery (EDD) is the date on which a woman is expected to give birth to the child she is carrying (pregnant with). It is calculated by adding 280 days or 40 weeks to the first day of the last menstrual period (LMP). Childbirth is also referred to by doctors as parturition. Delivery is the process of helping the child to be born. A spontaneous vaginal delivery (SVD) is a normal delivery. If there are complications, the | baby may be delivered by caesarean section (surgically removed). A full-term pregnancy is 40 weeks, divided into three trimesters. A baby who is born before this is premature, and one born after 40 weeks is postmature. A baby who is born dead, for example because the umbilical cord is around its neck, is stillborn, A pregnancy may end before term spontaneously, with a miscarriage (spontaneous abortion), or be deliberately terminated with an induced abortion (termination of pregnancy). Note: the verb induce means to cause something to happen. Labour The process by which the fetus and placenta are pushed out of the uterus is called labour, Tt is divided into four stages. Some words which are combined with labour are: Premature prolonged spontaneous induced false Presentation and lie Fetal lie is the position of the fetus in the uterus. The normal | lie is longitudinal, and the abnormal lie is transverse. Fetal presentation refers to ‘the part of the fetus which occupies the centre of the pelvic canal and which the examining finger feels on vaginal examination’ (Butterworth). The normal | presentation is with the head ! (vertex presentation). Breech \| presentation means the buttocks are presenting (breech is an old word for buttocks), Abnormal presentations may require Obstetric forceps | delivery with forceps. 66 Professional English in Use Medicine29.1 Complete the sentences. Look at A, B and C opposite to help you. 1A baby that is born a week before the EDD is ~» of pregnancy may be necessary for medical reasons. 3 ‘The fiw thee months of pregnancy are known as the first 4 Fetal distress in the first stage of... is an indication for caesarean 5 It was a breech . and delivery was by forceps. another term for a spontaneous abortion, as wound tightly around the baby’s neck and it was unfortunately 29.2 Complete the table with words from A opposite. on Nin abort deliver induction miscarry present termination 29.3. Dr Bennett, an SHO, is presenting a patient at a weekly meeting in the obstetric unit of a hospital. Complete the presentation with the correct forms of verbs from 29.2 above. ‘This is Clara Davis. She came to the antenatal clinic at nine weeks. In her past obstetric history, she had a pregnancy when she was 18, which was (1) and another one a year later, which spontaneously (2) jince then she has had three pregnancies. In the first, the baby was (3) .. normally at 40 weeks. In the second, she had an (4) .-w distress. The third baby (5) caesarean section. _..of labour at 39 weeks because of fetal sevens 8 4 Breech and WAS (6). by Romanian woman gives birth at 66 | ‘A 66-year-old woman is believed to have become the World’s yesterday, after giving birth toa girl. ea tore es What is the oldest and youngest age for giving birth that you have known? In your opinio should assisted conception be available for anyone who wants it? If not, what do you think Teens Professional English in Use Medicine 67Aifteters PaRIO) 1 The fespiraton system PEED cousn WD ov is a common symptom of upper respiratory tract infection (URTI) and lung disease. A cough may be productive, where the patient coughs up sputum, or non-productive, where there is no sputum. A productive cough is often described as loose and a non-productive cough as dry. Sputum (or phlegm) may be clear or white (mucoid), yellow due to the presence of pus (purulent), or blood-stained (as in haemoptysis). | A doctor is examining a patient who is complaining of a cough. Doctor: How long have you had the cough? Mr Hamilton: Oh, for years. | Doctor: Do you smoke? Mr Hamilton: I used to smoke heavily, but I gave up a year ago. \ Doctor: Do you cough up any phlegm? i Mr Hamilton: Yes. | Doctor: What colour is it? Mr Hamilton: | Usually yellow. i Doctor: Have you ever noticed any blood in it? ‘Mr Hamilton: No. Doctor: Any problems with your breathing? | Mr Hamilton: Yes, get very short of breath. I have to stop halfway up the stairs to get | my breath back. The doctor writes in the patient’s case notes: 0/0 dyspnoea & cough . purulent | sputum for years. No haemoptysis. ttonennnctemnsintieatittnenaatenmnad Note: The noun phlegm is pronounced /flem). } ES) Auscultation The doctor is examining Mr Hamilton's chest. | | Take deep breaths in and out through your mouth. Good. Now say ‘ninety Listening to the chest with a stethoscope may reveal the presence of sounds, apart from the normal breath sounds. There are two main kinds of added sounds: \ @ crackles, which sound like hairs being rubbed together and suggest the presence of fluid in the lungs @ wheezes, which are more musical sounds, like whistling, and indicate narrowing of the airways. The sound of an asthma patient’s breathing is also called wheeze. | The sound heard when the pleural surfaces are inflamed, as in pleurisy, is called a pleural rub. | The doctor asks Mr Hamilton to say ‘ninety-nine’ to check vocal resonance, which may be increased (as in pneumonia), or decreased (as in pneumothorax). After examining Mr Hamilton, the doctor adds to his notes: 'y OE Cheet: early inspiratory crackles ! both lung bases + expiratory wheeze 68 Professional English in Use Medicine30.1 Make word combinations using a word from each box. Look at A and B opposite to help you. 30.2 30.3 blood- cough breath rub pleural stained productive resonance vocal sounds Rewrite the questions, using words that are better known to patients. Look at A opposite to help you. 1 Is your cough productive? 2 What colour is the sputum? 3 Is it ever purulent? 4 Have you ever had haemoptysis? 5 Do you suffer from dyspnoea? Are the following statements true or false? Give reasons for your answers, using your medical knowledge and A and B opposite to help you. 1A patient who has a loose cough produces phlegm. 2 Crackles are heard when the airways are narrowed. 3 A patient who has a non-productive cough produces sputum. 4 Wheezes are typical of pleurisy. 5 A pleural rub is a sign of asthma. Over to you ol Use the notes below to write a case report, and add your provisional diagnosis of the case. ee he RS REM Se RON se nme os Begin: ‘A 36-year-old man complained of sudden right-sided chest pain Bb yroldd clo sudden R chest pain with aob while watching TK pain A by deep breaths and coughing 0b. persisted over the 4 hours from Ite onset to his arrival in AGE sl. non-productive cough PH & FH nil relevant 3/82 holiday in Australia 3/52 previously OE T 374°C RR 24/min JP ABcm BP TIO/G4 P128/min RS chest expansion ¥ because of pain pleural rub R lower zone posteriorly tno other added eounde Otherwise NAD Ease ora Eros Professional English in Use Medicine 69= The skin 1 70 Some types of skin lesion a Medical term TUG macule spot not raised above the surface of the skin papule spot raised above the surface of the skin nodule lump a large papule vesicle small blister filled with fluid bulla blister a large vesicle pustule = filled with pus crust seab dried blood ete. on the surface of the skin scales scales a thin layer of epidermis separated from the skin catrix sear ‘a mark on the skin after healing (plural: cicatrices) naevus birthmark a coloured skin lesion present at birth fleshy naevus mole a raised brown naevus verruca wart a nodule produced by HPV furuncle boil a large pustule, or skin abscess Note: The liquid (often yellow) formed as a result of infection is pus. Ifa lesion is pustular, it is filled with pus. Rashes ‘A single skin lesion can be regular or irregular in shape. When there are many (multiple) lesions, especially macules or papules, the result is a rash, (or spots in common language); for example the rash of an infectious disease such as rubella. A rash is said to erupt, or break out, ‘My little boy has broken out aaa all over his body. . 7 ‘The following features of a skin lesion are usually noted: ® location @ size @ shape @ colour @ type. For a rash, note also: ® distribution (widespread — on many parts of the body, or localized — on one part only) @ grouping (scattered — more or less evenly spread out, or in clusters ~ small groups). Professional English in Use Medicine311 31.2 31.3 Complete the description of herpes zoster (shingles) by replacing the medical words in brackets with ordinary English words. Look at A and B opposite to help you. (herpes zoster) usually starts with pain and soreness. Then red (macules) appear that develop into groups of (3) mms.m-:m (vesicles) over a particular area on one side of the body. In most patients, new (4) (lesions) continue to appear for 3 to 5 days. The (5)... sna (vesicles) become (6) ... = (pustular) and then form (7) (crusts). In severe cases, there may be (8) vw (cicatrices) afterwards. (BM) 2005; 2 148 Amended with permission from the BMJ Publishing Group} Read the description of the rash of rubella and complete the notes. Look at A and B opposite to help you. The spots are scattered pink macules which appear first behind the ears and on the forehead. The rash spreads rapidly, first ro the trunk and then to the limbs. location and distribution: grouping: type of lesion: colour: Complete the notes for the rash in the photograph, and suggest a diagnosis. Look at A and B opposite to help you. location and distribution: grouping: type of lesion: colour: Complete the notes for the lesion in the photograph, and suggest a diagnosis. Look at A and B opposite to help you. location and distribution: grouping: type of lesion: colour: ola coo) ww What types of rashes are common in your country? Is th ENA unc Na To Bee ommend Professional English in Use Medicine nThe skin 2 Cy Injuries to the skin Here is an extract from a medical website. Mechanical injuries to the skin are + A laceration (also called a tear) isa) : divided into those caused by a blunt wound involving both the dermis and force, such as a punch from a fist, and epidermis. It is usually distinguished those caused by a sharp force, such as from penetrating or incised wounds by | a knife, its irregular edges and relative lack of bleeding. | Injuries from blunt forces * An abrasion (also called a graze or —_‘Injuries from sharp forces a scratch) is a superficial (surface) An incised wound (also called a cut) | i | injury involving only the epidermis, is a break in the skin where the length iI | which has been removed by friction. of the wound on the surface is greater | A scratch is linear, as in fingernail than the depth of the wound - for i scratches, whereas a graze involves example, a wound caused by a razor | a wider area, as in abrasions caused blade. li by dragging part of the body over a + The depth of a penetrating wound | rough surface. is greater than the superficial length | * Acontusion (also called a bruise) of the wound - for example, a stab i | is an injury that occurs when blood wound caused by a knife. i vessels in the skin are damaged. . (amended with permission from the BMJ Publishing Group) WEED se report \ Read the case report and compare it with the illustration. \ A 9-year-old boy presented to the Accident and \ Emergency department after he stumbled and fell while running in a wood. He had received a blow to the head from a rock and had been scratched by bushes. On examination, a vertical laceration 1 cm Jong was noted on the bridge of his nose just right of the midline. There were a number of superficial scratches on the right side of his forehead. His right upper lid was mildly contused. (eM 1998; 316: 1368 ‘Amended with permission from the BN Publishing Group) MES sores The word sore is a popular term for many different types of skin lesion, especially infected lesions. A pressure sore is a skin ulcer caused by pressure, for example the pressure of lying in bed for long periods (also known as a bedsore, or decubitus ulcer). A cold sore is a lesion caused by herpes simplex. Note: The adjective sore means painful, for example a sore throat. 2 Professional English in Use Medicine.1. Write the corresponding medical terms for the ordinary Fi -ds and say what kind of 32 somees involved. Look at A opposite wo help pore nn? nent Wor and ay wha emma ron) aCuee bruise cut graze scratch stab wound tear 32.2 Choose the correct words to complete the description of the injuries shown in the illustration, Look at A and B opposite to help you, There ate (1) nvnmmnan (Sctatches/grazes) above the left eyebrow and on the left side of the neck, a (contusion/laceration) to the left lower lip and (3).... vwonsnmnen (Cutsftears) to the left cheek. VN 32.3. Write a description of the injuries shown in the illustration. Look at A and B opposite and at 32.2 above to help you. 32.4 Complete the sentences. Look at A, B and C opposite to help you. 1 Frequent changes of position are necessary in the immobile patient to prevent the development ofa pressure 2 He had several ... wounds in the abdomen from the knife, 3 He was knocked unconscious by a heavy... vom to the head. 4 The wounds were Only ..0s:nm-n» ANd required no treatment. Over +o you pt asked you to examine a man who has been involved in a fight in a crea restaurant. What type of injuries would you expect to find, and how might they have eeetcsttd Professional English in Use Medicine 7314 The urinary system Urinary symptoms Urine is formed in the kidneys and stored in the bladder until it is passed (or voided), Patients may say: Doctors may say: 7 pass water. Are you having any trouble with your) ( thavesome pin when |B i ( As yout Doctor: Are you having any trouble with your waterworks? Mr Jones: Well, I do seem to have to go to the toilet more often than I used to. Doctor: How often is that? Mr Jones: It depends, but sometimes it’s every hour or even more often. Doctor; What about at night? Do you have to get up at night? Mr Jones: Yes, Nearly always two or three times. Doctor; Do you get any burning or pain when you pass water? ‘Mr Jones: No, not usually. Doctor: Do you have any trouble getting started? Mr Jones: No. Doctor: Is the stream normal? I mean is there still a good strong flow? ‘Mr Jones: Perhaps not quite so good as it used to be. Doctor: Do you ever lose control of your bladder? Any leaking or dribbling? ‘Mr Jones: Well, perhaps a little dribbling from time to time. Doctor: Have you ever passed blood in the urine? Mr Jones: No, never. ‘Common urinary symptoms and their definitions: frequency Frequent passing of urine dysuria burning or scalding pain in the urethra when passing urine nocturia urination at night urgency ‘urgent need to pass urine hesitancy difficulty starting to pass urine urinary incontinence __| involuntary passing of urine haematuria macroscopic blood in the urine Urinalysis Urinalysis is the analysis of urine. Simple screening tests of the urine are carried out with reagent strips, for example Clinistix for the detection of glucose. More detailed tests are carried out in a laboratory on a specimen of urine. Typical specimens are a midstream specimen (MSU) and a catheter specimen (CSU). Microscopic examination may reveal the presence of red blood cells pus cells, or casts. Casts are solid bodies formed by protein or cells. lus signs are used in case notes to indicate abnormal findings. A small amount (+) is described as a trace. For a large amount (+++), the words gross or marked can be used, for example gross haematuria, When there is nothing, the word nil is common. sugar onl ff protein + | [There was no sugar a trace of bleed 4+ | (_ Protein and ross hamatria Professional English in Use Medicine33.1 33.2 33.3 Look at the conversation in A opposite and complete the notes about Mr Jones. Use medical terms where possible. c/o (4) and (2) No (8) or (4) e i Little wealeer No incontinence apart from ocensional. (6) . fort. yr Match the patients’ descriptions of their symptoms (1-7) with the medical terms (a-g). Look at A opposite to help you. 1 ‘Thave to pee every half hour ot so. 2 ‘Igeta scalding pain when I pass water? 3 ‘Thave to get up several times to pass water at night.” 4 ‘Thave to rush to go to the toilet.” 5 ‘Thave trouble getting started.” 6 ‘Ican't hold my water” 7 ‘Ipassed some blood in my urine.’ a dysuria 'b frequency ¢ haematuria d hesitancy e nocturia f urgency g incontinence Write the doctor's questions for each of the symptoms in 33.2 above, Look at A opposite to help you. You will need to think of your own question for urgency. 33.4. Describe the findings of the laboratory report in words. Look at B opposite to help you. blood + protein. +++ casts wil Over to you oe What is your provisional diagnosis for Mr Jones? Professional English in Use Medicine 15Basic investigations : Gy Ophthalmoscopy ‘An ophthalmoscope allows the doctor to examine all parts of the eye: the iris, lens, retina and optic disc. For best results, the examination is done with dimmed, or lowered, lights to allow the pupil to ‘maximally dilate or widen. A topical mydriatic solution may be applied to the eye to aid dilation. The patient is then asked to fixate on a target for the duration | | of the test. Direct ophthalmoscopy | HEED Blood pressure i A sphygmomanometer ae car “2 a A stethoscope bell: diaphragm A stethoscope is used to hear the sound of blood rushing back through the artery. The first thumping sound is the systolic blood pressure (SBP). When the thumping , sound is no longer heard, that’s the diastolic blood pressure (DBP). valve HES) Taking blood During venipuncture, the phlebotomist, a technician who takes blood, inserts a needle | into a vein and withdraws blood into a specimen tube, which is sent to the haematology laboratory for analysis. Usually the phlebotomist can find a vein in the inner part of the elbow, the antecubital fossa, that is easily accessible. She may apply a tourniquet — a tight band ~ above the site, or the patient may be asked to clench their hand to make a fst, in order to make the vein more prominent. Afterwards, the patient may be asked to press lightly on a dressing, usually a piece of gauze, to help the blood to clot and to prevent swelling and a haematoma (a black and blue mark, or a bruise) where the vein was punctured. Note: A bruise is a specific mark. Bruising can be used to describe a number of bruises or a larger area - The patient exhibited bruising on the right forearm. 16 Professional English in Use Medicine34,1 A doctor is talking to a patient during an ophthalmoscopy. Match the underlined expressions she uses (1-4) to expressions with similar meanings from A opposite (a-d).. > ana aaniis {_ Right, Mr Gold, because you've been having these headaches I'm going to have a look at your eyes, particularly the back of your eye ~ the retina. I’m going to put (1) a. couple. ‘of drops in your eye, (2) which will make it easier for me to see the retina. After a few minutes you may find your vision a bit blurry. This will wear off after about an hour. (3) Lnged to get rid of as much external light as possible, This means closing the blinds. Now, I'd like you to (4) look straight ahead at that clock. This takes a few minutes and your eyes might feel a bit tired so you can blink if you need to. I don’t want you to look at ine, look at the clock. a the examination is done with dimmed lights b a topical mydriatic solution ¢ toaid dilation i fixate on a target 34.2 Complete the instructions. Look at B opposite to help you. 1 Wrap the ~~... around the patient’s upper arm. 2 Place the uuu OVer the area of the brachial artery. Raise the patient’s arm so that the brachial artery is at the same height as the heart, 3 Close the valve on the 7 4 Pump up the pressure to at least 150 mmHg, Open the coven a little and slowly deflate the cuff while listening and watching the pressure... a 5 The first sound you hear is the flow of blood through the brachial artery. The value ‘on the gauge at that point is the : se 6 Continue listening while you slowly the cuff. 7 The blood pressure is measured when the sound completely disappears. 34,3. Complete the text. Look at C opposite to help you. (a sonmns afe specially trained in taking blood. They are skilled at (2) vivs0ensne™ puncturing the vein to take a blood sample. The wrist, hand and foot can be used but more often a vein in the inner part of the elbow is used. If it is difficult to locate a suitable vein, the patient may be asked to make a (3) 4 0F @ (4) evninnnmnnnne ay be applied on the upper arm to make the vein more apparent. Afterwards, a (5) is applied and the patient is asked to press gently. This helps to stop the bleeding and prevent (6) .. cars the site. It is important that (7) .. snnvsnmsann afe labelled correctly before they are sent to the haematology (8) . Where a full blood count or other investigations will be carried out. (Zee coors ‘i Practise talking a patient through an investigation that you carry out regularly Professional English in Use Medicine 7