醫(yī)學英語視聽說.doc

Medical English Watching Listening and Speaking醫(yī)學英語視聽說考試資料Test Introduction：Part 1：名詞解釋Part 2：簡答Part 3：病例分析Part 4：體檢Questions For Diagnosis &Treatment-Chest Pain 1Possible Disease M.I.(myocardial infarction)心肌梗塞Angina 心絞痛Pericarditis心包炎Pulmonary embolism 肺栓塞Pneumothorax 氣胸Cholecystitis膽囊炎Severe indigestion嚴重消化不良Pneumonia 肺炎Pancreatitis胰腺炎Musculoskelrtal 骨骼系統(tǒng)性疼痛2Descriptions of PainAches疼痛 ,throbbing悸痛,pulsing疼痛，stings 刺痛like a stabbing pain, Sharp pain,comes in waves ,sudden pain,My chest feels tightIt feels like a tight band around my chestPressure ,壓迫感3. Useful Sentences For Chest Pain How Long What does the pain feel like? Show me where the pain is? Is the pain just in that area or does it spead anywhere else? Do u have any pain in ur shoulder or down ur left arm? Is the pain constant there all the time? Does the pain get worse when u -breathe in or out? -walk around or do heavy work? What painkillers did u have?Aspirin（阿司匹林,paracetamol(撲熱息痛)Here are the Forms（化驗單），U Need to have some blood test, X-ray,and ECG right away！Ur results show that u have -,I am afraid u will have to be admitted into hospital for treatment (住院治療) U need to have intravenous antibiotics (靜脈輸液)，and oral medication (口服藥)。 Question for Diagnosis &Treatment -Diarrhea(腹瀉)1.Possible DiseaseFood poisoning 食物中毒Dysentery痢疾Intestinal Obstruction腸梗阻Dehydration脫水Intussusception 腸套疊Enteritis 腸炎(小腸炎)Crohns Disease 節(jié)段性回腸炎Irritable bowel syndrome 過敏性結(jié)腸炎Bowel Tumour腸瘤Constipation 便秘2.Descriptive Words for Faeces糞便 and Diarrhea Liquid液體 watery 水樣Lumpy 粒狀Semi-soft 半軟Mucous 粘液Bloody bloody and like jelly帶血膠狀Dark brown 咖啡色Cream color 乳白色Beige 淺褐色Dry 干燥Black and sticky黑色呈柏油Smelly 發(fā)臭的Pus 膿 Milk deposits 牛奶沉淀Un-digested未消化的Pale 白色Green 青色 3.Question for Diarrhea （順序為橫）How long How many times Bloody? Stool（大便） look like?Do they smell? Pain when u have diarrhea?Vomit? Eat something wrong?Able to eat ?How about fluids ? Any fever or headache?Do u feel dehydrated (脫水)?Specimen（樣品）of stools ;blood test; x-ray; ultrasound(超聲)-U must take fluids ,and just have a light diet until feel betterPossible bowel cancer（腸癌）（順序為橫）3 times a week 2 or 3times a dayA bit soft ,dark brown Not smellpain going with Abdominal pain or discomfortFeel bloated 腹脹 Press on stomach and palpate Do test of specimen of ur stools ,blood test Might need endoscopic內(nèi)窺鏡的,內(nèi)窺鏡檢查的 or sigmoidoscopy乙狀結(jié)腸鏡檢查術Questions For Diagnosis & Treatment-Abdominal Pain1.Possible DiseaseAbdominal Obstruction 腹脹bd mnlAppendicitis 闌尾炎pendsats Food Poisoning 食物中毒Hepatitis 肝炎heptatsCholecystitis(gallstones) 膽囊炎，（膽結(jié)石）klisistaitisGynecological Problems 婦科疾病ainikldiklStomach Ulcer 胃潰瘍lsPancreatitis 胰腺炎pkritaitisUrological Problems 泌尿系統(tǒng)問題Respiratory problems 呼吸系統(tǒng)問題resprt:riCardiovascular problems 心血管問題k:di:vskjl2.Useful Sentences How long?where? how painful is it?Did the pain strat there or somewhere else?Does it hurt more after certain exercises or actions?Do u feel that u have had fever at anytime?Are u passing urine ok?(你排尿正常嗎？)What does ur urine look like?Are u having your bowels open regularly?(排便正常嗎)Are u menstruating ?is it normal ?Bleeding?is it normal ?Having a period?is it normal?(females ,月經(jīng)來了嗎？)Are u vomiting?What do u vomit? Is there a pattern?(一般什么情況下嘔吐)Are u able to eat or drink?Do u get pain after eating and drinking?Please lay down ,I need to examine u I will need to do some investigations :blood tests ,x-ray and ultrasound ,urine tests and stool testsCholecystitisD:Hello ,my name is Dr pan ,how can I help u?P:I have had abdominal pain for a few days and its getting worse.D;how long have u had abdominal pain?P;about three days.D;where is it?can u show me ?P:yes ,just here .D;how painful is it?P:at first it was just on and off ,but now it seems to be there all the time.D: on a scale of 1 to 10;if no pains is 1 and very painful 10,what number would u give your pain?P; Id give it a 7D;did the pain start there or somewhere else?P;its always been there .D;does it hurt more after exercise or actions?P；if iam waling around a lot ,it will hurt a bit more.D; do u feel that u have had a fever at any time?P;no,I dont think so ,I have felt hot but I havent taken my temperature.D；I need to take ur temperature ,pulse ,and B/PAre u passing urine ok?P;yesD;what does ur urine look like?P;normal D;are u having ur bowels open regulatly?P;usually I do ,but I havent had my bowels open for a couple of days.D;have u vomited?P;no,I thought I was going to today but the feeling passed.D;are u able to eat and drink anything?P;Im drinking but I havent really felt like eating.D:what have u been drinking?P：I have had a couple of glasses of water and a couple of cups of coffee.D:does the pain get worse after eating or drinking、P;no ,not that I ve noticed.D;I need to examine you.please lay down,and loosen ur clothing for me.P;ok.D;show me where it hurts.P:it hurts just there.D;ok take a nice big breth, breathe in and out ,now try and relax.P:ouch,that hurts.D；OK thanks ,u can get dressed now.P:I will need to do some investigations : :blood tests ,x-ray and ultrasound ,urine tests and stool testsD;hello ,your results show that u might have cholecystitis,u need to be admitted to hospital for observation and treatment ,and we may need to do more tests before we have a correct diagnosis.P;do I really need to be admitted into hospital, isnt there anything u can give me for the pain and to help the problem?D; sorry , no ,it is best that u are admitted for further test ,we can check that u havent got gallstones or something seriously with ur liver.P;all right ,PPT of Abdomial Pain“All who have had much experience of the group of cases known generally as the acute abdomen will probably agree that in that condition early diagnosis is exceptional.”Types of abdominal pain Colicky（絞痛 0pain - caused by distention（膨脹）of a hollow viscus（空臟器）, such as bowel. Somatic （軀干身體）pain - caused by inflammation（炎癥）of the parietal peritoneum（壁層腹膜）; Visceral（內(nèi)臟的）pain - caused by inflammation of the visceral peritoneum and capsule of solid organs.Quadrant（象限）View of the AbdomenRight UpperCholecystitis（膽囊炎） Inflammation of the gall bladder 膽囊, caused by duct obstruction （管道堵塞）with a gall stone. Pain is usually steady for an hour or more after onset and made worse by eating. If there is significant inflammation associated with the cholecystitis, there may be local peritoneal pain (somatic pain)腹膜性疼痛. Pain may be referred to the scapular(肩胛的)area and accompanies nausea惡心, vomiting, and fever without jaundice黃疸. Diagnosed with ultrasound(超聲).Cholangitis膽管炎 Caused by obstruction of the biliary tract(膽道)leading to bacterial overgrowth in the gall bladder. Marked by Charcots Triad（查科三聯(lián)征） RUQ(右上腹)pain, jaundice and fever. Diagnosed by ultrasound. Is an emergency and must be treated with IV antibiotics(靜脈抗生素). May require decompression(解壓)via（憑借）endoscopic(內(nèi)窺鏡的)or surgical means.Hepatitis（肝炎） Caused by inflammation（感染） of the liver by viruses（病毒）, alcohol or certain drugs. Marked by tender, enlarged liver with malaise（不舒服）, fever and jaundice. Diagnosed by history and laboratory evaluation - liver function tests and viral serologies.（病毒血清學的檢查） Treatment depends on etiology （病因，病原）of disease. Pancreatitis（胰腺炎） Most commonly caused by alcoholism (50%) and gall stones (30%) obstructing the common bile .（膽汁）duct（管道）. Constant mid-epigastric（上腹部的） visceral（內(nèi)臟的）pain usually occurring after a heavy meal or alcoholic binge. Pain may radiate to the back (50%) and is accompanied by nausea, vomiting and anorexia （厭食癥）. Diagnosed by amylase （淀粉酶）and lipase脂肪酶. Imaging by CT scan may be desirable in some cases.Left UpperPeptic Ulcer （胃潰瘍） Caused by increased gastric acid production （胃酸容物）or decreased mucosal（粘膜的）protection. Increased gastric acid production may be caused by alcoholism（酒精中毒）or gastrin producing tumor (Zollinger-Ellison Syndrome佐林格-埃利森綜合征). Decreased mucosal protection may be caused by overuse of NSAIDs（非類固醇抗炎藥）or by infection with Helicobacter pylori幽門螺旋桿菌. Pain is visceral and may become somatic （腹膜性疼痛）if perforation（穿孔）occurs. There may be radiation to the back. Diagnosed by H. pylori antigen（抗原）in the serum（血清）, endoscopy內(nèi)鏡檢查 Left Lower（卵巢囊腫不考。）Right LowerAppendicitis Caused by obstruction of the appendiceal（闌尾的）lumen(腔) Pain starts as periumbilical(臍周的)and migrates(遷移)to the RLQ (McBurneys Point) Is accompanied by nausea, vomiting and anorexia(厭食癥). May have fever - especially if ruptured. Diagnosed by ultrasound or CT scan. Treatment is surgical and is an emergency if ruptured.General Abdominal Pain Some causes of abdominal pain are generalized and not restricted to any specific quadrant.Gastritis(胃炎) Caused by inflammation of the gastrointestinal tract by microorganisms(微生物), radiation（放射物）and other irritants（刺激物）. Described as diffuse（擴散）crampy（痙攣）痛 abdominal pain. Often accompanied by diarrhea, nausea, vomiting, dehydration（脫水）and fever. Diagnosis is by history and so on Bowel Obstruction（腸梗阻） Caused by obstruction of the bowel lumen （空腔）by mass, volvulus（腸扭轉(zhuǎn)）, intussusception（腸套疊）around scar（傷疤）adhesions（粘連）. Pain is colicky in nature，accompanied by vomiting May be accompanied by watery diarrhea - Diagnosed by abdominal x-rays looking for distended(膨脹的)loops環(huán)結(jié) of bowel and air-fluid levels（氣液面）.Kidney Stones Caused by obstruction of the upper urinary tract（上泌尿道）by a stone that is induced（導致）by dehydration（脫水）, infection, hypercalcemia （血鈣過多）and other metabolic imbalances.（代謝不平衡） Pain is described as colicky and located anywhere from the flank（側(cè)面）to the groin （腹股溝）. Diagnosed by intravenous pyelogram（靜脈注射腎盂造影圖）, ultrasound or CT scan.Appropriate Exam Vital signs to evaluate for signs of infection, dehydration, shock, instability. Inspect visually for distention, scars,jaundice, signs of hernias疝, or masses. Auscultate - high pitched bowel sounds may indicate early obstruction. No bowel sounds indicate ileus（腸梗阻）. Increased bowel sounds may be associated with gastritis. Palpate and Percuss - for tenderness（疼痛）, masses（包塊）, pulsation（脈動), hernias疝, ,CVA tenderness0（脊肋角疼痛）, liver and spleen size, ascites（腹水）and hyperresonance（過清音）. Pelvic exam in women Rectal exam（直腸檢查） General Introduction StrokeClassification of Stroke Ischemic Stroke缺血性腦卒中. (75% “Brain Infarct”腦梗死 ) Occlusive:閉塞性 Thrombosis 血栓形成 Embolism 栓塞 Anterior Circulation 前循環(huán) Occlusion of carotid artery （頸動脈）involve cerebral hemispheres （大腦兩半球） Posterior Circulation 后循環(huán) Vertebro-basilar artery （椎基底動脈） distribution involve brainstem（腦干）or cerebellum（小腦） Hemorrhagic Stroke出血性卒中 Subarachnoid蛛網(wǎng)膜下的 Aneurysm 動脈瘤(most common) Arteriovenous malformation動靜脈型血管畸形 Intracerebral大腦內(nèi)的 Hypertension 高血壓(most common) Amyloid angiopathy（淀粉樣腦血管病）in elderlyStroke Risk FactorsModifiable Hypertension Tobacco use -TIA( Transient ischemic attack) Heart Disease Diabetes Mellitus Sickle Cell 鐮狀細胞and increased RBCUnmodifiable Age Gender Race Previous CVA（腦血管意外） Heredity（遺傳）Stroke Signs and SymptomsIschemic(缺血性的)- Carotid Circulation(.頸動脈循環(huán)) Unilateral paralysis單側(cè)的癱瘓(opposite side) Numbness麻痹 (opposite side) Language disturbance（障礙） Aphasia失語癥 difficult comprehension, nonsense胡說, difficult reading/writing Dysarthria發(fā)音困難 slurred speech語言不清, abnormal pronunciation. Visual disturbance (opposite side) Monocular blindness（單眼盲）(same side)-Vertebrobasilar Circulation 椎基底動脈循環(huán) Vertigo 眩暈 Visual disturbance 視力障礙(Both eyes simultaneously) Diplopia復視 Paralysis Numbness Dysarthria Ataxia 共濟失調(diào)Diabetes糖尿病Patient: Recently Ive been feeling very thirsty and passing a lot of urine, Is there any wrong with me?最近我總覺得口渴和尿量很多。是有了什么毛病吧？Doctor: How is you appetite? How do you feel otherwise?你的胃口怎么樣？一般健康狀況好嗎？P: Ive lost weight despite my good appetite, and I feel weak all the time.盡管我的食欲很好，我的體重還是減輕了。我整天覺得很疲勞D: Let me examine your urine. You may have diabetes. 我給你檢查一下尿吧。很可能你得了糖尿病。P: What is that? Can it be cured?這是什么意思？糖尿病能夠治愈嗎？D: Diabetes is a chronic disease due to poor functioning of the pancreas. It upsets the metabolism of sugar, fat and protein. Right now, it cant be cured, but it can be controlled so that you can enjoy life and feel well. You should stick to a special diet and avoid sugar and sweets.糖尿病是一種慢性病，由于胰腺功能不良引起。它使糖、脂肪喝蛋白質(zhì)的代謝發(fā)生異常。目前還沒有治愈辦法。但是可以被控制，因此你能生活得很愉快。你應堅持控制飲食，不吃糖和甜食。P: Can I smoke?我能吸煙嗎？D: Smoking is harmful to anyones health. Better give it up.吸煙對任何人都是有害的。我勸你戒煙。P: Can I drink alcohol?我能飲酒嗎？D: In moderation. As you know alcohol contains calories and must be counted in your meal plan.可適當喝一點。你知道酒精能增加熱卡，因此必須計算在你的食譜之內(nèi)。P:How can I keep to a good diet?我怎樣才能保持一個良好的飲食方案呢？D: You should learn as much as you can about diabetes, have your urine tested regularly, stick to your diet, take your medicine and have some regular exercise. Then you can live a full, useful and meaningful life.你應當盡量學習一些有過糖尿病的知識，定期檢查你的小便。堅持食譜中的規(guī)定，按時服藥。要有定量的運動。于是你能生活得美滿、有益和有意義。Symptoms of Diabetes(糖尿病) Few glucose can reach muscle cell>weak and fatigue Breakdown protein to release energy>feels hungry,loss weight Kidney extract excess glucose >thirsty,frequent urinaion,kidney damage消化系統(tǒng)疾病*Peptic Ulcer 消化性潰瘍Patient: I have a pain in my stomach我胃疼。Doctor: How long have you had it?疼了多久？P: I have had it off and on ( intermittently) for the past three years. It has been really bad these past two weeks.斷斷續(xù)續(xù)已經(jīng)疼了三年，近兩周來疼的很厲害。D: Do you feel it only when your stomach is empty?是在肚子空的時候才覺得疼痛嗎？P: Yes. After I eat, it goes away for a while.是的，吃了東西以后疼痛緩解一會兒。D: When do you get it?什么時候才疼呢？P: Usually when I get very nervous. Sometimes it wakes me up in the middle of the night.通常是在我興奮激動時，有時半夜把我疼醒了。D: What kind of pain do you have?是怎樣一種疼痛？P: It gives me a burning sensation.象燒灼一樣地疼。D: Usually how do you get relief?平常您是怎樣止疼的呢？P: After I take some sodium bicarbonate, the pain goes away temporarily.在服小蘇打后，疼痛可暫時緩解。D: Have you had any nausea or vomiting?你惡心嘔吐過嗎？P: Yes, occasionally.是的，有時候有。D: Are your bowels regular? Have you observed your stools?你大便正常嗎？你注意過你的糞便嗎？P: I usually have to go once every other day. I was very worried because last night I went twice and the color was black(tarry).平常我隔日大便一次。昨晚我大便了兩次，顏色還是黑（象柏油似）的，我很擔心。D: Let me examine your abdomen. Lie down on your back and bend your knees up please.讓我檢查一下您的肚子，請仰躺，把腿卷起來。It sounds like a duodenal ulcer, but we have to do some tests, and take an x-ray first, before we can be certain.看起來象十二指腸潰瘍，但需做一些化驗和拍張X線片才能確診。You should have a complete rest and give your stomach as little work as possible. Take only fluids. There is nothing better than boiled tepid milk taken regularly in small quantities. In addition, I will give you some medicine. If the black stools persist or your condition gets worse, come back to the hospital at once.您應當徹底休息并盡量減輕胃的工作，應當吃流食。按時少量吃些煮過的溫牛奶是最好不過了。此外，我還要給您一些藥。如果持續(xù)有黑便或病情有惡化，就馬上來看。P: Thank you. Ill follow your advice.謝謝您，我將遵囑。Peptic-duodenal Ulcer（胃十二指腸潰瘍）Patient: My stools have been black for the past two days and I feel weak.這兩天我大便發(fā)黑而且感到虛弱。Doctor: Have they ever been black before?以前你的大便發(fā)黑過嗎？P: No. This is the first time.沒有。這是第一次。D: Have you had any pain?你感到有什么地方疼痛嗎？P: Yes, in my stomach.是的，我胃痛。D: How long have you had it?你痛了多久？P: Ive had it on and off for the past two years, but it was never as bad as this before.我好好壞壞疼了兩年，但從來沒有象這次那樣疼過。D: When do you feel the pain?什么時間疼？P: Just after meals my stomach aches. Sometimen vomited.剛吃完飯就疼，有時還吐。Now I have it almost every day. It often awakens me 2 to 3 hours after I go to sleep.我?guī)缀趺刻於继?，常常在夜間入睡兩、三小時就把我疼醒了。D: What kind of a pain is it?是什么性質(zhì)的疼呢？P: like heartburn.燒心樣疼。D: Does spicy food affect if?辛辣食物會加重疼痛嗎？P: Yes. Its often worse after I eat spicy food or onions.是的，吃了辛辣的食物或洋蔥都加重疼痛。D: Do you have less pain after eating?吃東西后疼痛就緩和些嗎？P: Yes, a little.是的，稍緩和些。D: Did you vomit sometimes?你吐過嗎？P: Yes, I did.吐過。D: What did you vomit, food or blood?吐出的是什么東西，食物還是血？P: Food with a little blood.食物和一點血。D: What was the color of the blood, red or black?吐出的血是鮮紅的，還是黑的？P: Like coffee.象咖啡似的。D: Ill examine you abdomen. Lie down on your back and loosen you clothes. Please bend your knees. I think wed better take a x-ray film of your gastrointestinal tract. I think youve got a peptic ulcer ( duodenal ulcer). Ill give you some medicine. Have a good rest at home.讓我檢查一下你的腹部。躺下，松開衣服請屈膝。我想我們最好照個胃腸X線片像。我看你得的是胃（十二指腸）潰瘍。我要給你一些藥。好好在家休息。P: Is there anything else I should do?還要注意些什么嗎？D: If possible avoid all alcohol. Whenever you have any bleeding, come immediately to the hospital.如果可能應戒酒，若再有出血馬上到醫(yī)院來。Your problem probably comes from a duodenal ulcer. You are suffering from shock due to bleeding. The medicine we have been using has not been effective and so we feel that it is necessary to perform an operation.你可能是十二指腸潰瘍。你的休克是因失血引起的。我們用過許多藥效果都不好。所以我們認為需要手術治療。P: Do anything you feel is necessary, Doctor!醫(yī)生，你認為需要就做吧！D: I would like to talk about the operation with you. The operation may be the best way to cure you. However, there are centain dangers in operating, such as the hazards of anesthetics, or you may be unable to withstand the stress of the operation. Moreover, after the operation, post-operative complicaions may occur, such as bleeding, infections or even continued intestinal obstruction.我要和你談談手術的問題。手術也許是治療的最好辦法。但是手術也有一定的危險。如麻醉的危害或你的身體經(jīng)受不住手術，同時手術后可能會出現(xiàn)并發(fā)癥，如出血、感染，甚至持續(xù)腸梗阻。Vomiting and Diarrhea（嘔吐和腹瀉）Parent: My child has been vomiting frequently.從什么時候開始的？一天大概幾次？Doctor: When did it start? How frequently?有十天了。一天吐五次左右。P: It started aboout ten days ago. He vomits about five times a day.他通常在什么時候吐？D: When does he usually vomit?他通常在進食以后吐。P: Usually after taking food.每次吐的量多還是少？D: Does he vomit a large or small amount each time?每次吐的不太多。P: Not too much.每次吐的不太多。D: Is his stool normal?大便正常嗎？P: Yes.正常。D: How about his appetite?他的胃口怎樣？P: Its good.他的胃口是好的。D: Is he losing weight?他的體重減輕了嗎？P: No. Everything else seems to be all right.沒有。別的似乎都很正常D: Most likely this is due to improper feeding. After feeding, the baby should be held erect over your shoulder and patted gently on the back, so that any swallowed air can come out. After burping him, put him in his crip on his right side with his head slightly raised. If he should vomit, you should turn him on to his side with his face down, so he cant inhale his vomit.他的嘔吐看來是喂養(yǎng)不當。每次喂完奶，應該把孩子豎起來，靠在您的肩膀上，然后輕輕拍他的后背。這樣吞咽的氣可以排出來。讓他打嗝以后，孩子應向右側(cè)躺，頭稍稍微抬起一點。如果他吐的話，應使他臉朝下，他就不致于把吐的東西吸進去了。D: Has he got diarrhea?他腹瀉嗎？P: Yes for two days.已經(jīng)腹瀉兩天了。D: How many times a day? Is stool watery (very loose, large in amount)? Is there pus, blood or mucus in it?一天大便幾次？是水樣便（很稀，量很多）嗎？里面有沒有膿、血或粘液？P: About five times a day. They are quite loose with milk cured and undigested food in them.一天大約五次，很稀，還有奶瓣和不消化的食物。D: Hes probably got indigestion. Please stop all food exc