English For Careers Medicine 2 Student's Book 1i5s

Flat, non -palpable change in skin-colour >O.Scm

m

A rash caused by blood in the skin- often multiple ... petechiae

A 'bruise'. Technically a form of purpura

Listening 1 Dermal oedema

Fluid below the epidermis

1 £0) Listen to the extract of a conversation between Dr Jackson and John Dodds. Write as many details as possible. You may have to listen twice.

D

A small thin piece of horny epithelium resembling that of a fish

crust purpura w heal

ecchimosis pustule scale

Listening for details

Dried exudate is a crust of blood I plasma

macule ulcer

pat ch vesicle

2 In groups, discuss how you distinguish between lesions, for example, between a wheal and a plaque? Give an example of a condition in which you would see each of these lesions.

3 Which lesions would you associate with these verbs: itch, ooze, discharge, spread, scab, harden?

2 Work in pairs. One student reads their notes to their partner and they check any differences.

3 ~ Listen again and check for detail.

4 Can you improve on the doctor's questions? 5 Map the doctor's questions: open, closed, leading, etc.

6 What other reassuring statements could the doctor have used?

7 Which diagram in Vocabulary matches the conversation?

68 Unit 7

Patient care

! In which sentences in 1 is the patient very upset?

1 Work in pairs. Match the two parts of the patients' statements. 1 I found the whole experience so distressing

a but I don't really care. b but I'm worried about them.

2 I couldn't leave it

alone. I just kept playing with it 3 It scabbed over and I

picked at it and made it bleed. I know 4 I know it's covered up

5 I keep telling him to

leave it alone 6 I suppose a lot of

people would be bothered by it, 7 I'm almost beside

myself with it; 8 My husband says it's only a few white patches, 9 I've come out in these

c and there are a lot more unsightly things than this, but I am always aware of it. d I shouldn't have but I couldn't help it. e here on both my wrists and elbows. They're really itchy and irritating. f I don't know if I have ever been so distressed in my life. g I'm just worried that it will leave scars on my face. h and I couldn't stop myself from scratching. i and stop rubbing it, but he's just very worked up by it.

little red spots

2 Find words and expressions in 1 that mean the same as these. 1 forma crust 2 play about with 3 ugly 4 conscious 5 agitated

6 7 8 9

terrified blemish macule cicatrix

4 When the patient says something that indicates how they feel, it is important to be able to acknowledge the cues given by the patient. These cues may be verbal, visual, intuitive, or aural. You need to acknowledge them to show that you are listening and then follow them up with reassurance. Choose two or more statements in 1 and decide how you would reassure the patient. USEFUL EXPRESSIONS

It sounds I looks I seems as if ...

You sound I look I seem ... (if I am right?) The treatment can make it look worse than it is. With children, it's difficult to stop them scratching. You must have (been itching a lot with this).

5 Work in pairs. Take turns reassuring each other.

6 Still in pairs use one or more of the other statements in 1 to do a role-play without any preparation.

Derm a: o

5:

69

rash (n) eruption of the skin in spots or patches flare up (v) erupt

• Language spot Commenting on the past 1 Work in pairs. Correct the sentences where necessary. I must've knocked my arm on something and then these lumps have come up. 2 I should've come sooner and then the rash would be so bad. 3 I should've put anything on as that's what's made it flare up. 4 When I was stung, I could go into shock. I wish I'd known. 5 He didn't need to pay for his treatment. 6 Surely, I can't have pick up scabies. 7 I would come earlier, but I had to take the children to school. 8 I should've pay closer attention and kept the box the tablets were in. 9 Yes, you're right. It should've cleared up by now. 10 Shouldn't it have go by now? 11 I needn't have paid for the prescription.

Z Which of the statements in 1 describe things that did not take place?

3 What would be the effect on the patient if the doctor said: You should've paid attention to what you were doing and ...;you shouldn't have used that cream ...

4 Think of three things that you have done recently or you haven't done recently. Describe them to a partner. USEFUL EXPRESSIONS

What I should{n 't) have done was ... What I could have done wa s ... I needn't have I I didn't need to ... , but ... !would've ... but I couldn't ...

» Go to Grammar reference p 123

Speaking 1 Identify the two skin conditions and give reasons for your diagnosis.

El

q o8qddw1 -e

"EdJ"ESOl dUJ£

Z Work in groups. Prepare a role-play. A patient is going to present with a skin complaint. Make a list of the questions you would ask the patient under these headings: The presenting complaint Past medical history Allergies Drug history Family history Social history Psychosocial impact

3 Compare your list with another group or the rest of the class.

4 Work in pairs. Student A, go to page 114. Student B, go to page 116. In the role-play, the patient answers the doctor's questions according to the diagnosis of the skin condition on the picture. The patient shows the picture to the 'doctor' at the appropriate moment. Make sure the doctor does not see the picture with the diagnosis .

5 When you finish, check how many questions in exercise 2 you asked.

6 Give on your own and your partner's performance.

70 Unit 7

Cross- secti on of the skin

Reading

3 Look at these answers. Read the text and decide what

1 Before you read the text, work in pairs. Answer these questions . 1 What functions does the skin perform? 2 What are the layers of the skin? 3 What functions do glands perform?

2 Find w ords in the text which are made from these: 1 society 2 thesis

3 sight 4 out

5 lie 6 append

7 mix 8 number

questions you would ask for each one. 1 the integumentary system 2 prevention of water loss, antigen presentation, and sensation 3 unsightly blemishes 4 about three months 5 the superficial fascia 6 puberty

Applied anatomy and physiology The skin, nails, hair, glands, and associated nerve endings make up the 'integumentary system: Skin The skin acts as a physical, biochemical, and immunological barrier between the outside world and the body. It also has a role in temperature regulation, synthesis of vitamin D, prevention of water loss, antigen presentation, and sensation. It is important to that the skin also has an important psychosocial function. When we look at another person, we are in fact looking at their skin. As our skin represents our outward appearance to the world, unsightly blemishes, despite their small size, can have a significant impact on a person's self esteem. The skin is made up of three layers - epidermis, dermis, and hypodermis. Epidermis This is the outermost layer and is formed of a modified stratified squamous epithelium.

Almost 90% of epithelial cells are keratinocytes. These cells are produced in the basal layer and then rise to the surface as more are produced below and the outer cells are shed. The time taken from forming in the basal layer to shedding is usually about three months. Melanocytes reside in the basal layer and secrete melanin into surrounding keratinocytes via long projections. This, along with the underlying fat and blood, gives the skin its colour. In this way, skin tone is determined by the size and number of melanin granules and not by the number of melanocytes. Dermis Below the epidermis lies a layer of connective tissue consisting of collagen, elastic fibres, and ground substance. It is here where the 'skin appendages', muscles, nerves, and blood vessels lie. Hypodermis Also known as the subcutaneous

4 Work in groups. Describe a case where you dealt with a patient with a dermatological complaint and where you feel that you could've I should've I couldn't have done things differently.

layer or the superficial fascia, this consists of adipose tissue and serves both as a lipid store and provides insulation. It also contributes to the body contours and shape. Glands After infancy, sebaceous glands become active again at puberty and secrete sebum, a mixture of fatty acids and salts, directly onto the skin or into the necks of hair follicles. This waterproofs and lubricates the skin and hair. They are particularly numerous in the upper chest, back, face, and scalp. Sweat glands secrete a mixture of water, electrolytes, urea, urate, ammonia, and mild acids. Eccrine sweat glands are found all over the body surface, besides the mucosa. Apocrine sweat glands are found in the axillae and pubic regions, secrete a more viscous sweat, and are under clear autonomic control. These do not function until puberty.

Dermatology 71

Blackheads . ·

Whiteheads

Listening 2 Dea ling w ith teenagers 1 Work in groups. Look at this scenario. What would have been the management and what advice do you think should have been given? Make a list. A sixteen-year -old male patient, Brian Collins, presented with spots on his face, neck, back, and chest. Examination reveals blackheads (comedones) and whiteheads, red papules, pustules, and cysts.

2 i(,) Listen to an extract from the consultation after the doctor, Dr Aimee Preston, has examined the patient. Check which items on your list were mentioned and add those which were not.

3 (;) Listen again. Answer the questions and say how the doctor does it in each case. 1 Is the doctor sympathetic? 2 Is the doctor reassuring? 3 Is the language simple? 4 Does the doctor seek cooperation? 5 Does the doctor seek to ensure compliance? 6 Does the doctor warn the patient about the duration of the treatment? 7 Does the doctor seek to involve the patient in the management? 8 Does the doctor use 'safety netting'? 9 Does the doctor arrange a follow-up?

4 COl ~om pare notes with partner and if necessary listen again.

5 Work in pairs. Take turns talking to the patient in the scenario in 1 above.

• Language spot Verbs with

to and -ing

1 Look at this extract from Listening 2 and underline the verbs in the -ing form. Can you use the infinitive with to instead?

... tutd I cUm 't £ikej~ (JUt M pet;p{e Urofc at it tutd I t1tinJc it's dirty. Arr.d it

fceetx3e1:tinj won-e. I've tried ~ (JUt

certak fro% but~ workx, tutd

udrt.j diffore11i: CYea-vM tutd stuff 2 Complete the sentences using the -ing form or the toinfinitive of the verbs in brackets. There may be more than one possible answer for some items. I have to it to

(not use) the

ointment you gave me. 2 I stopped

(apply) the cream because it

made my skin very angry looking. 3 I forgot

(make) an appointment to see

the nurse. 4 Yes. I

(get) the medicine.

5 I always avoid

(sit) in the sun.

6 I regret not

(come) in sooner.

7 I didn't finish

8 I meant

meant

(take) the medication. (apply) it every morning, but it (get up) earlier and it made me

late for work. 9 Following the treatment requires _ _ _ __ (plan) and a lot of effort.

3 Work in pairs. Take turns being the doctor and a patient with acne. The patient should choose at least three of the statements above. The doctor should give a response and develop the conversation. USEFUL EXPRESSIONS

Yes. It's not easy... It takes time ... Do you think you could ... ? Is there any way round this ... ? Was there any particular reason ... ?


72 Unit 7

Pronunciation Main stress in a sentence 1 (,) Listen to the patient speaking. Write the exact words that the patient says.

2 Compare your answers with a partner.

3

~ Listen again and mark the main stress in the

sentence. If you need to, listen for a third time.

4 Practise saying the statements to each other. Did your partner say all the syllables?

5 Follow t he same procedure as in Language spot 3. This time concentrate on the pronunciation.

It's my job 1 Before you read, discuss this question in pairs. What do you think is the value of t he practice nurse in helping patient s stick to their treatment ?

2 Read the text and answer the questions. How did Zahra become interested in dermatology? 2 Why do you think skin problems might be particularly upsetting for children and teenagers? 3 What two things can help patients with skin problems? 4 What is the difference between compliance and concordance? 5 How does Zahra encourage a patient to follow a regime?

Zahra EI-Ashry My nam e is Zah ra EI-Ashry. I'm a practice nurse working in a GP surgery, a nd I've got a postgraduate diploma in derm atology. I beca me interested in thi s particular area when I saw how distre ssed people were when they ca me to the surgery where I work with variou s sk in problems. It's bad enough for adults, but fo r children a nd teen age rs it's particularly upsetting. Sometimes, just a few words help to make things better. But the main thing is help with the treatment itse lf as it is sometimes complex. It is ea sy to get annoyed at the patient's poo r compliance until you reframe this as a lack of concordance; then we as health professionals may get annoyed with ourselves which is just as bad . In order to encourage the patient to comply with any regimen that the doctor agrees w ith the patient, we have found that conco rdance works if the patient sees me after the doctor to help in planning treatment through dialogue and unde rstanding lifestyle constraints. We have found from tal king to other practices that nurses are inva luable in demonst rating topical therapies and in optimizing concordance.

3 Work in groups. Describe cases where you know that you have been successful in encouraging patients to keep to a treatment regime. Say why you were successful.

4 What are the main fact ors affecting compliance in your country or where you are working?

Project Work in groups. Each group chooses one of t he items below. Check the suggest ed sources and use your own experience t o collect information on the management of the condition. You may check info rmation wit h student s in other groups. Look at these websit es: 1 2 3 4 5

psoriasis : www.psoriasis-association-org.uk eczema: www. eczema.org.uk solar keratosis: www.SkinCancer.org Also check www.patient.co.uk Electronic Dermatology Atlas www.Dermis.net for photosensitivity I sunlight and t he skin

Dermatology 73

Checklist Assess your progress in this unit. Tick (.I} the statements which are true. I can comment on the past I can use verbs with to or -ing I can talk about dermatology I can understand patient language

Speaking

I can understand patients at natural speed

1 Work in groups. Collate the information from Project that you collected about your chosen topic. Create a scenario with which you are going to test fellow students in another group. In the scenarios you may choose to take a history and discuss the management, or discuss only the management with a patient. Give the patient: a name, an age, an attitude, a level of anxiety. Discuss how the patient will think and react to the diagnosis and management. Write down the scenario on a piece of paper.

2 As a group, go though the information for the scenario once quickly.

3 Work with a partner from another group with a different scenario. Choose who should go first. Give your partner the paper with your scenario on it. Take turns taking the history and discussing the management or discussing the management only. Use the checklist on page 117 and choose at least two criteria for your partner to use to assess your performance, e.g. reassurance, sympathy, empathy, being patient centred.

Keywords Adjective

psychosocia I Nouns

acne (vulgaris} blemish compliance concordance crust cue dermatology purpura scab vesicle wheal Verbs

to be reassuring, sympathetic, and empathetic. USEFUL EXPRESSIONS

You must have been ... We need to be patient ... It takes time to work ... It looks I seems I sounds ...

Writing Reflection on professional experience 1 Work in groups. Talk about the decisions you have made in your career so far. In your consideration, talk about whether you should have chosen or would choose dermatology as a specialty.

2 Within your group, describe cases where you treated a patient with a dermatological problem. Explain what happened and say how you would improve on what you did. Give examples of what you should have and shouldn't have done and say what you learnt from it. to maintain patient confidentiality.

3 When you apply for jobs, you may be asked to give examples of your own experience and what you have learnt from it. Using your own ideas only, write between 150 and 200 words describing the case in 2 and to say what you learnt from it.

avoid itch keep mean pick at play with stop

Useful reference Oxford Handbook of Clinical Examination and Practical Skills, Thomas and Monaghan (eds}, ISBN 978-019-856838-4

74 Unit 8

Check up 1 Work in groups. Describe the pictures.

Vocabulary Medical terminology for surgery 1 Match the prefixes with their meanings. 1 laparoa nose 2 nephrob breast 3 pyeloc large bowel 4 cystod chest 5 cholee uterus 6 col(on)f bile I the biliary system 7 hysterog kidney 8 thoracoh abdomen renal pelvis 9 rhino10 masto- I mammabladder

2 Complete the sentences by combining one of the prefixes above with one of the suffixes below. You may use some of the suffixes more than once. -ectomy -r(h)aphy,

Day Surgery Reception

-lithotomy -ostomy

-pexy -otomy

-plasty

We're going to do something called a _ _ _ _ __ to have a look inside your tummy. 2 I'm afraid we're going to have to do an operation called a

to remove your right kidney.

3 The only option left to us is a

, where

we remove part of your large bowel and then make an opening in your tummy wall. 4 So how do you feel about having your womb removed by laparoscopic _ _ _ _ __ 5 We're going to do a procedure which will involve a _ _ _ _ _ ,where we remove several ribs.

2 What is involved in scrubbing up prior to an operation? How do you gown and glove?

3 Have you ever practised doing sutures on manikins? What manikins have you used?

4 What minor I major operations have you performed or been present at?

5 What are the benefits of day -case surgery to the patient, the surgeon, and the hospital? Is day-case surgery common in your country?

6 We can do bilateral ______, where we lift both breasts. 7 We can do a _ _ _ _ _ , where we stitch the bladder. 8 We're going to have to remove the gall bladder. The technical name for this operation is _ _ _ __ 9 What we're going to do is destroy some stones in the kidney in a procedure called------ · 10 We're going to do a procedure called a _ _ _ __ to fix the large part of your gut.

Surgery 75

In this unit

• understanding medical in surgery • using relative pronouns where and when in explanations • explaining operat ions and informed consent • talking abo ut pain management

Pronunciation Secondary stress Words that are polysyllabic usually have a nucleus and a secondary stress.

1 Look at the words in Vocabulary 2, and in pairs decide where the nucleus and secondary stress occur. 2

£Ol

Listen. Circle the nucleus and underline the secondary stress of each word where appropriate.

1 2 3 4 5

~· • • •••• •••• ••••• •••••

6 7 8 9 10

•••• •••• •••••• ••••••• ••••

3 Work in pairs. Using the sentences in Vocabulary 2, take turns informing each other what operation is going to be done.

Listening 1 Patient response 1

£Ol

Listen to the conversation between Dr Irina Petrov and Mr Blackstone. Decide whether the patient is apprehensive or relaxed about the operation.

2 (;l Listen again. Answer the questions below and note down evidence. 1 Which adjectives describe the doctor's manner I tGne during the conversation?

2 3 4 5 6 7 8 9

brusque caring friendly honest patronizing reassuring Is the doctor patient centred? Does she involve the patient in the decision making? Does the doctor give the patient a chance to ask questions? Is the information presented in a way that the patient can understand? How? Does the doctor ask about consent for the operation? Does the doctor explain the operation clearly? Does the doctor check that the patient understands? Is the doctor reassuring about the pain? Is the doctor aware throughout of the patient's feelings?

3 Work in groups. Study this scenario. What are the similarities between this scenario and the scenario in 1 from the communication point of view? What is the

father likely to feel? A 35-year-old father presents with a seven-year-old child, Arthur, who has perforated appendix. Explain to the father that the child has to have an emergency operation. Explain what you think it is and explain that an operation is necessary. USEFUL EXPRESSIONS

Arthur's got what is .. . We can do an operation called a ... , where we ... What we do is ... How do you feel about Arthur having the operation? We'll need you to sign a consent form ifyou're happy with everything. Is there anything you'd like to ask me?

4 Choose two people in your group to role-play the scenario while the others watch. Use the questions in 2 as a checklist to give .

76 Unit 8

• Language spot Relative pronouns in explanations Work in pairs. Connect the sentences using one or more of the words in brackets and I or'zero relative'. You will need to add and remove some words. EXAMPLE

Herniorrhaphy's an operation. It's done under local or general anaesthetic. The muscle in the tummy wall is strengthened using a special mesh. {where !when) Herniorrhaphy's an operation, done under local or general anaesthetic, where the muscle in the tummy wall is strengthened using a special mesh. We're going to do something. It is called a mastectomy. A breast is removed. (when I where) 2 It's a type of stitch. It is done under the skin so that there is only a faint scar left at the end. The wound heals. (which I when) 3 A colostomy is a procedure. The back age is closed and the end of the gut is attached to an opening in the wall of the tummy. A bag is attached to the opening. (to which I where) 4 It's a type of shock. It happens when the volume of blood in the body decreases. (which I who) 5 Oliguria is a condition. An abnormally small amount of urine is produced. (where I that) 6 It's an operation. The appendix is removed. There is colicky pain in the centre of the tummy followed by vomiting and then a shift of the pain to the right iliac fossa. (where I when)


Patient care 1 Putting yourself in the patient's shoes, what would you ask in response to the explanations in Language spot?

2 Match these responses to the explanations 1-6 in Language spot. a b c d e f

Willit? Are there complications if it is removed? Will that get rid of the cancer, then? But will it be permanent? Does that mean it will be difficult to see? Can you get it back to normal?

3 Take turns explaining the in Language spot and responding using the phrases in 2, then developing the conversation in your own way.

Project 1 Work in groups. Using your own knowledge, describe how pain is managed after an operation.

2 Find out about the organizations and sites below and what they do. Do they give any advice about pain management after operations? • • • • •

colostomy- colostomyassociation.org.uk kidney I kidney stones- kidney.org, medlineplus.gov hysterectomy- hysterectomy-association.org.uk mastectomy- medlineplus.gov tonsillectomy- patient.co.uk hernia- hernia.org

3 In groups, discuss different reactions to pain. How do people measure pain?

4 Check your answers about pain in the Oxford Textbook of Palliative Medicine, 3rd edition, (Doyle et al, 2005, OUP). Also look at pages 172-181 of the Oxford Handbook of Palliative Care (Watson et al, 2005, OUP).

5 Work in pairs. Choose a procedure. Take turns being the doctor talking to the patient about post -operative pain. USEFUL EXPRESSIONS

sore hurt discomfort

Surgery 77

Speaking 1 Work in groups. Decide how you would explain to a patient that he is going to need a permanent colostomy after removal of the part of the bowel. Discuss what information a patient would want to know in order to give consent for the operation, especially about the future, e.g. pain management. Use the questions in 2 in Listening 1 as a guide.

2 Work with a partner from another group. Decide on a name, age, and sex for the patient. Take turns role-playing explaining the operation to the patient and obtaining consent. If you are not happy with the explanation, decline to give consent.

5 You have five minutes to think about the scenario by yourself, focusing on both the doctor's and the patient's roles. Note in exam situations you will usually have only one minute to walk between stations, read, and prepare to role-play the scenario.

3 When you have finished, as a whole class discuss any

6 Two volunteers role-play the scenario in front of the

medical problems or queries that arose during the roleplay. 4 In exam situations, you are faced with role-plays which you need to do without any preparation. Look at this role-play scenario by yourself. Mr Cordobes, a 30-year-old man, has a ten-year-old son who has been involved in a car accident. The child's spleen has been damaged and his femur has been fractured . His spleen is so badly damaged that it needs to be removed. You have to tell the patient's father and explain the procedure to him. What would you say? USEFUL EXPRESSIONS

emergency operation no choice We can boost his immune system starting now until he's an adult. It is possible to live without the spleen.

class. Students sit around so that they can see both the doctor and the patient. The doctors who are watching use the speaking checklist on page 117 to choose a criterion each to assess the performance. Agree all the criteria beforehand. Some students should also observe the doctor to see if their performance is sympathetic I empathetic. Students take turns role-playing and giving . The should be constructive.

78 Unit 8

Reading 1 Skim this summary text. What do you think it is describing? The majority of cysts in the ovaries are harmless and - - - - -- ·but some trigger changes in the ______ as well as in the nature of the periods. Cysts can also become so big that they cause urine problems or make people 3 . Despite being generally harmless, some can turn to 4 _ _ _ __

_ _ _ _ _ is frequently down to luck, so if you have any symptoms that 6

that you

have an ovarian cyst, an internal examination may be performed by your doctor. Treatment is 7 _ _ _ _ __ on various factors like age and the cyst size.

2 Read the text below. Complete the summary in 1 using the correct form of a word from the text.

What are the symptoms, problems, and possible complications? Most ovarian cysts are smal l, benign (noncancerous), and cause no symptoms. Some ovarian cysts cause problems which may include oneor more of the following: • Pain or discomfort in the lower abdomen. The pain may be constant or intermittent. Pain may only occur when you have sex. • Periods sometimes become irregular, or may become heavier or lighter than usual. • Sometimes a cyst may bleed into itself or burst. This can cause a sudden severe pain in the lower abdomen. • Occasionally, a cyst which is growing on a stalk from an ovary may twist the stalk on itself (a'torsion'). This stops the blood flowing through the stalk to the cyst and causes the cyst to lose its blood supply. This can cause sudden severe pain in the lower abdomen. • Large cysts can cause your abdomen to swell or press on nearby structures. For example, they may press on the bladder or rectum which may cause urinary symptoms or constipation.

• Although most cysts are benign, some types ~ave a risk of becoming cancerous. • Rarely, some ovarian cysts make abnormal amounts of female (or male) hormones which can cause unusual symptoms. How is an ovarian cyst diagnosed? As most ovarian cysts cause no symptoms, many cysts are diagnosed by chance. For example, during a routine examination, or if you have an ultrasound scan for another reason.lfyou have symptoms suggestive of an ovarian cyst, your doctor may examine your abdomen and perform a vaginal (internal) examination. He or she may be able to feel an abnormal swelling which may be a cyst. An ultrasound scan can confirm an ovarian cyst. An ultrasound scan is a safe and painless test which uses sound waves to create images of organs and structures inside your body. The probe of the scanner may be placed on yo ur abdomen to scan the ovaries. Asmall probe is also often placed inside the vagina to scan the ovaries to obtain more detailed images. Your doctor may also take a sample of blood. What is the treatment for ovarian cysts? Your specialist will advise on the best course of action. This depends on factors

such as your age, whether you are past the menopause, the appearance and size of the cyst from the ultrasound scan, and whether you have symptoms. Observation Many small ovarian cysts will resolve and disappear over a few months. You may be advised to have a repeat ultrasound scan in a month or so. If the cyst goes away, then no further action isneeded. Operation Removal of an ovarian cyst may be advised, especial ly if you have symptoms or if the cyst is large. Sometimes the specialist may want to remove it to determine exactly which type of cyst it is and make sure there are no cancer cells in it. Most smaller cysts can be removed by laparoscopic ('keyhole') surgery. Some cysts require a more traditional style of operation. The type of the operation depends on factors such as the type of cyst, your age, and whether cancer is suspected or ruled out. In some cases, just the cyst is removed and the ovary tissue preserved. In some cases, the ovary isalso removed, and sometimes other nearby structures such as the uterus and the other ovary. Your specialist will advise on the options for your individual situation.

Surgery 79

J Match the two parts of the sentences below. 1 Many small cysts simply 2 Size and symptoms sometimes 3 Cyst removal may be done to 4 Sometimes it is possible to

a leave the ovary tissue. b ascertain cyst type. c dictate the surgical removal of ovarian cysts. d go away in a matter of months

4 Work in groups. Talk about the first time you were involved in an operation and your reaction(s).

Vocabulary Technical vocabulary 1 Work in pairs. Describe the condition shown in the diagram. Can it occur at any age?

2 Work in groups. Complete the sentences. If necessary look at the words in the upside-down box below. 1 The small bowel

as if it were

swallowing itself by invagination.

Listening Z Getting into conversations 1

2

£Ol

Listen to the five short conversations and decide what each one is about. Time how long it takes you to work out what is happening and put your hand up when you have worked it out, but do not interrupt the playing of the recording.

£Ol

Listen again and match the five conversations with these descriptions. a ___ Anaesthetic assessment b ___ Worried about recurrence of a problem c ___ Postponement d ___ Awake in day surgery e ___ Refusing consent

J

~ Listen again. Work in pairs. One partner

concentrates on the patient and the other on the doctor. Write down how the patient puts pressure on the doctor and how the doctor resists pressure from the patient. Compare your answers with another pair.

4 Work in pairs. Create a scenario around one of the conversations, giving the patient a name, age, and so on. Take turns role-playing the situations and then developing them in your own way. For example, for extract 5, you could take a pre-operative assessment, asking about the drug and family history.

2 The patient presents with episodic intermittent ______ crying and drawing his legs up. 3 The child may blood per

(like

redcurrant jam or merely flecks -late stage). 4 A sausage-shaped

may be felt.

5 The child may be and moribund. 6 The least _ __ _ __ approach is ultrasound with reduction by air enema (preferred to barium). 7 Pneumatic _ _ __ __ , where a balloon catheter is ed PR under radiographic control, is another option that is effective in up to 80% of cases. 8 There may be right lower quadrant ______ ±perforation on plain abdominal film. 9 If reduction by enema fails , reduction at laparoscopy or ______ is needed. 10 Any necrotic bowel should be _ _ _ __ SCldOJS

pel)]:J 04S

p

uonJnp

wnpell

A:j.1JBdO

SSBW

AWO:j.01BdBI

3 Check with other groups for help with sentences you cannot complete. 4 Work in pairs. Choose a sentence from 2 for your partner to explain to you what it means in lay . Use your own experience if possible. USEFUL EXPRESSIONS

get rid of doesn't work fold inside itself what we're going to need to do remove

80 Unit 8

Speaking

Project

1 Work in groups. Look at the scenario below. Decide what the patient is likely to be concerned about, for example, the recurrence of the cysts, whether they are cancerous, what caused them, why it happened to her, the length of time off work. What is she likely to say and what would be your reply? Miss Tanaka, who is 22 years old, has been itted to hospital after being diagnosed as having a right ovarian cyst. A laparotomy is going to be performed and she has to stay in hospital for four days and subsequently stay at home for six weeks. Explain the situation to her. Note that a sub-cuticle suture is going to be used for skin repair.

2 Decide how you are going to explain what a cyst is, where it is, what is going to be removed, and what is going to be done with the removed cyst. Then decide how to describe the sub-cuticle suture, and finally when to ask the patient to sign the consent form.

3 Take turns role-playing the scenario in the' goldfish bowl' setting described in Unit 5. This time, however, the doctor or the patient may interrupt the role-play to ask questions or clarify specific details. Limit each interruption to a maximum of two minutes. 4 Give to the doctor and the patient using the speaking checklist on page 117.

5 When two or three pairs have done the role-play, work on your own. In two minutes, prepare what you would say to the patient for the scenario below and repeat steps J and 4 above. Mrs Brodie's eight-month-old baby has been crying I screaming for the past eight hours, i.e. all night. The findings show the baby is suffering from intussusception. Explain to the mother what it is and how it will be treated.

1 Use these references to find out what you can about OSCE exams, especially for the PLAB, USMLE, and fellowship exams for the Royal Colleges in the UK: www.gmc.org • For DOPS (directly observed procedural skills} see the Royal College- www.rlondon.ac. uk • USMLE-www.usmle.org

2 How many stations are there in an OSCE and how long does a station last?

3 Which of the following stations are normally found in anOSCE?

D Taking blood pressure D Doing R D Giving a presentation D Explaining procedures to a patient D Taking a case history

0

Reciting medical detail

D Dealing with difficult situations D Suturing 0 Using manikins for clinical examinations

Checklist Assess your progress in t his unit. Tick (.t) the statements wh ich are true.

I can understand some medica l r. surgery I can use relative pronouns in exp lanat·ors

Writing

I can explain operations and gain informed consent I can ta lk about pain management

Describing a complicated operation 1 Work in pairs. Describe a complicated operation which you have been involved in, focusing on pre-operative visit, assessment by the anaesthetist, the day of the operation, and post-operative care, including pain management. Mention anything that went particularly well, anything that could have gone better, and what you would have done differently.

2 Work on your own. Write a description of no more than 200 words, using the phrases in italics in 1 as a step-by-step guide. USEFUL EXPRESSIONS

... an operation where ... Moreover, ... I Furthermore, ... The benefit of. .. was ... The main thing I learnt from this was ... ... worked well I ... went smoothly I What could have gone better was ...

3 Work in pairs. Check for mistakes. not to copy each other's writing and to maintain anonymity and confidentiality.

4 Give your description to another partner to read. Ask each other questions about the description: Why did you ... ? What factors made ... ? Could you have ... ?

Keywords Adjective

inconsolab le Nouns

consent day-case surgery herniorrh aphy intussuscepti on laparotomy perforated appendix reduction Verbs

glove gown resect scrub up t elescope Prefixes

col(on)cystohysterolapa romasto- I mammonephro-

Useful reference Oxford Handbook of Clinical Surgery 3rd edition, Mclatchie et al (eds), ISBN 978-019-856825-4

82 Unit 9

Check up 1 Work in pairs. Describe the pictures.

Listening 1 A heart condition 1 (;) Listen to Mr Lawson's wife talking to the doctor in A&E. What do you think the patient's condition is? Why?

2 Describe the doctor's manner and the mood of the patient's wife. Give reasons.

J (;) Listen again and write down notes on what is said about

2 Match these captions to the ECGs in 1. Acute anterior myocardial infarction • Complete heart block

J Look at these statistics for the UK taken from the Oxford Handbook of General Practice. Is the incidence

of heart disease higher or lower in your country? Why?

1 2 3 4

the GTN spray the time when the pain started thrombolysis prognosis.

4 (;) Work in groups. Compare your notes and listen again. Discuss the possible differential diagnosis of the patient's condition.

5 Choose one member to report back t o the whole class. Coronary heart disease (CHD) is the most common cause of death in the UK (1:4 deaths). Mortality is falling, but morbidity is rising.

6 Work in pairs. Take turns role-playing the conversation between a patient's spouse and a doctor with the same presentation as in 1.

Cardiology 83

In this unit • using technical and non-technical • talking about the future and reassuring patients about the prognosis • talking about heart disease • talking about signs and symptoms • understanding people speaking at natural speed

Vocabulary Avoidance of technical 1 In these sentences, the speaker is trying to avoid using one of the technical words or phrases in the list below. Match each word to a sentence. a hypokalaemia f line b titrate to effect g secure venous access c diuretic h reperfuse d contraindication i thrombolysis e arrhythmia tolerate 1 If we can, we give him a drug to dissolve any clots, then we increase his chances of getting better. 2 My heart is not beating in a normal rhythm. 3 There are several reasons why this drug should not be used. 4 You have no side effects with this drug. 5 We're going to give you something to help reduce the swelling in your ankles. 6 As soon as the patient is brought in, we need to get into a vein. 7 We'll increase the painkiller by the same amount each time until it kicks in. 8 This drug will get the blood flowing back again through the heart. 9 If this doesn't work, we'll move onto the next stage of treatment. 10 You've got very low levels of potassium.

2 Work in groups. Choose a drug that is recommended for use tn thrombolysis or treating myocardial infarction or hypertension (e.g. ace inhibitor, a diuretic, (simva) statin, aspirin.) Discuss your own experience of prescribing the drug.

• Language spot The f uture 1 Work in pairs. What tenses are used in these sentences? 1 The ward round starts at 10, so we have half an hour. 2 She normally stops at 12, but today, I think she'll have finished her rounds well before 11.30. 3 The ward round is finishing at 12 noon. 4 So we'll definitely be sitting in the canteen at 1.10. 5 We'll have been working for 12 hours by 1.00 this afternoon.

:Z Work in pairs. Read all the sentences 1-6 below, then match them with the relevant points or periods on the diagram. A

8

c

0

E

F

G

H

-

1 We'll have had eight hours on duty by the end of the day. 2 We're having an hour for lunch. 3 We'll have just finished lunch by the time the consultant arrives for her ward rounds . 4 The weekly presentation, which will last two hours, will end just before lunch. 5 Dr Ian Garfield will be starting the presentation as soon as he arrives. 6 The shift today starts at 10.00 with a presentation. ) Work in pairs. Put the verbs in brackets into the correct future form in the active or ive. 1 If his progress so far is anything to go by, (be) up and about in a few days. he 2 He _ _ __ _ (send) home this Saturday. 3 She

(soon move) out of intensive care.

4 That means in ten minutes, it

(be)

roughly 60 minutes since the pain first came on. 5 He

(walk) around without any

problem in a matter of days. 6

(he be able) to go into a rehabilitation

unit before he comes out? 7 What _ _ _ _ _ (hehave)toeatbythetimei get there today? 8 The consultant _ _ _ __ (come) round at about 1.00 p.m., so we

(see) him then.

4 Work in pairs. Prepare three or four questions about what you will have done, are planning to do, will be doing, and will do today. Give your questions to your partner and then ask each other the questions.


84 Unit 9

Pronunciation

Patient care

Speaking at natural speed

1 Work in pairs. How would you respond to the statements below, made by the spouse of a patient who has just been brought into A&E suffering from a heart attack? 1 He's been in the theatre for ages now. 2 Things are looking bad, aren't they? 3 Will he be OK? 4 He looks rather well. 5 I'm a bit anxious about what'll happen with the procedure you described. 6 How long's he going to be in here? 7 He thinks he's going to die, doctor.

When people speak at natural speed, it is possible to catch the gist of what they say, but sometimes the exact words can be difficult to work out.

Z Compare your statements with other students. Then

1 (i) Listen and complete the sentences. Note that contractions are used. 1 __________________________ theatre for over three hours in a few minutes' time. 2 Dr Nur -------------------------his clinic till2.00 p.m. 3 -------------------------- in no time. 4 All being well, _ _ _ _ _ _ _ _ _ _ __

home by the weekend. 5 The operation __________________________ for 5.00 this afternoon. _________________________ theveinsonthe 6 right leg stripped this afternoon, am I right? 7 The doctor said------------------------- a general anaesthetic. 8 -------------------------to the clinic off

and on for the past three years.

Z Work in pairs. Compare your answers.

3
5 Work in pairs. Take turns saying only the stressed words in each sentence. Then say the whole sentence using the stressed words to give you the rhythm.

discuss them with the class.

3 Work in pairs. What type of word is missing in the blank spaces (noun, verb, etc.)? Complete the responses below with one word. a Oh. It's only a of days now. In fact, he'll be seeing the consultant tomorrow morning and if he's happy, you can ... goes according to b Yes, he does. And if plan, this time next week I expect he'll be sitting at home with you. c It's not to feel this, but you got him here quickly, which'll help him. d It's actually not as bad as it seems. The machines and tubes, I'm , don't make things look good, but they're there to help him. He'll be like this for a little and then ... e Yes. We expect he'll be ready to leave in a couple of days. It's the anaesthetic and the painkillers; they're making him a bit confused, but that'll soon ______ off. f It always seems longer when you're sitting waiting. shortly; in fact, here's I'm sure he'll be the nurse now. g It's only to feel worried; everybody would be, but I can assure you it'll help him.

4 Match each response a-g to a statement in 1. 5 Work in pairs. Take turns saying the statements in 1 to each other and responding in your own way.

Cardiology 85

the mnemonic SOCRATES for questions related to pain.

Dialogue can transform a symptom from airy nothingness to a fact Dialogue-transformed symptoms explain one of the junior doctor's main vexations: when patients retell symptoms to a consultant in the light of day they bear no resemblance to what you originally heard. But do not be vexed: your dialogue may have helped the patient more than any ward round.

-Oxford Handbook of Clinical Medicine

Project

Signs and symptoms Competition 1 Work in groups. Using your own experience, decide what conditions the following signs and symptoms represent. Compete to see which group finishes with all the correct answers first. Symptoms: dyspnoea, cough productive of frothy pink sputum, palpitations (often associated with atrial fibrillation and resultant emboli) Signs: palmar erythema, malar flush, tapping apex beat, left parasternal heave, loud Sl, mid-diastolic murmur± opening snap. 2 Symptoms: shortness of breath and breathing worse on lying flat Signs: collapsing pulse, sustained apex beat displaced to the left, left parasternal heave, soft Sl, loud 52 (pulmonary component), pansystolic murmur heard at the apex and radiating to the left axilla± mid-systolic click, 3rd heart sound. 3 Symptoms: calf pain, swelling and loss of use Signs: warm, tense, swollen limb, erythema, dilated superficial veins, cyanosis. There may be palpable thrombus in the deep veins. Often pain on palpating the calf. 4 Symptoms: constant retrosternal 'soreness', worse on inspiration (pleuritic), relieved slightly by sitting forwards, not related to movement or exertion Signs: If chronic, constrictive, may cause Kussmaul's sign, impalpable apex beat, 53, hepatomegaly, splenomegaly, ascites (pseudo-cirrhosis). srgpreJUdd f7 (li\G) SJSOquron:n. UTdi\. dddp t uoq.-e:nl3ml3d1 IEllJW SJSOUdlS IE1+JW l

z

2 Work in groups. Choose one of the conditions in 1. Present the details to the rest of the class. You may do this as a formal Power Point presentation with a question and answer session at the end, or informally on behalf of your groups with questions at the end.

1 Work in groups. Make a list of cardiac risk factors. Search for information at www.americanheart.org.

Speaking 1 Work in groups of four. Make a list of questions you would ask the patient in the scenario below. Think about how the patient would feel, what his I her anxieties might be, and how you differentiate the pain from angina pectoris. Mr Gregory, a 57-year-old patient, presents with a severe retrosternal burning pain which the patient is convinced is connected with the heart. The pain comes after eating and drinking alcohol and there is a history of dyspepsia. The pain is relieved by GTN spray, but only after about twenty minutes. Take the history and reassure the patient that the pain is not connected with his heart, but is oesophageal spasm.

2 Take turns role-playing taking the history and reassuring the patient. During each role-play, the two other students use the checklist on page 117 to monitor the performance of the patient and the doctor, who choose at least two criteria to be assessed on: asking questions, empathy I sympathy, reassurance, prognosis, and clarity ofpronunciation.

3 One of the monitoring doctors times the role-play: a maximum of five minutes.

4 The doctor and the patient each give about themselves and each other. The monitors also give . Then the roles are rotated to allow each group member a chance to role-play the doctor.

5 One pair of students (or more) volunteers to role-play the scenario while the rest of the class watches and gives .

6 Student A, go to page 114. Student B, go to page 115. Student B, take the history from student A and reassure the patient and vice versa. At the relevant point the patient gives the doctor the ECG.

86 Unit 9

Reading 1 Work in pairs. Discuss these questions. 1 What do you know about hypertension? 2 What are the causes? What is the usual presentation? 3 Have you treated a patient with hypertension? Was it drug or non-drug treatment?

2 Find these items in the text. 1 2 3 4 5

a definition an effect of treatment prevalence of high BP precipitating factors I aetiology of the high BP a connection with other illnesses

High Blood Pressure - Hypertension Hypertension (HT) is commonly called

omega-3 fatty acids is protective against

to continue them for life. These tablets are

high blood pressure, nowadays (2005 on)

high blood pressure and heart disease.

very successful at preventing heart attacks

defined as above 140/85 mm Hg; or if

and strokes and have very few side effects.

of UK adults have hypertension. Advice

Hypertension -why worry if you feel OK?

and treatment includes exercise, lifestyle

High blood pressure does not necessarily

changes, and I or diet changes, as well as

make someone feel unwell; however, if

one is diabetic, over 135/80. About 38%

drugs. Possibly as many as 16 million UK people

Five self-help measures are suggested:

untreated it tends to cause damage to blood

•

Avoid being overweight.

vessels and the heart. The link between

have high blood pressure, and the proportion

hypertension and coronary heart disease

of the population is slowly increasing

and stroke is very well established.

over the years. About 5% have an obvious

Correct treatment of hypertension

underlying cause such as kidney disease.

reduces the risk of a heart attack by

Most of the rest have no single obvious

about 20% and reduces the risk of stroke

cause. Some have a genetic component,

by about 40%. Here risk is based on the

with hypertension tending to run in families.

observed reduced occurrences in treated

In addition there are environmental and

past patients. The purpose of treating

Reduce salt intake. Keep alcohol down.

•

Exercise can reduce your blood pressure and help to keep your weight down . Start slowly and build up. Walking is excellent. Aim for 20 to 30 minutes' activity at least three times a week. Or even better, walk for half

lifestyle factors. The most important causes

hypertension is to prevent this damage to

are being obese, smoking, too much alcohol,

blood vessels and the heart from occurring

too much salt, stress, lack of exercise, poor

and so help to prevent these illnesses. Most

diet, too little potassium, and family history

people with hypertension need tablets to

of relatives with hypertension. Oily fish with

lower their blood pressure. Usually, they need

J Complete these notes using a word or a number from the text.

•

an hour five times per week, which is better than more intense exercise for a shorter time. •

Don't smoke.

4 Discuss in groups:

· HT for dia/Je1:ic patients 1._ _ __

How common is hypertension in your country or where you work?

• Mo~to 2 -pUu~dief Mtd~r~ For 3_ _ _ _ _ peop£e ndjud one catAU

What measures are being taken to reduce it?

4 - - - fatty add, heip P.jaMtd hijk !M-od tymu.re MUi !teart dU.eM.e ~with COY011AYf !teart dU.eM.e MUi

woke s_ _ _ __

Are they effective? Give reasons and examples.

"You've got the blood pressure of a teenager who lives on junk food , TV and the computer."

www.CartoonStock.com

Listening 2

Have you thought about taking this tablet once a day after meals?

Advice about lifestyle changes 1
The suggestion here doesn't work because you want to direct the patient. It would be better to say: You take I Take this tablet ... or You 'll need to take this tablet once a day after meals.

1 Work in groups. Look at these statements. Where and when can you say them without annoying a patient? Which are appropriate for making suggestions to patients about changing their lifestyle to reduce the risk of future heart attack? Give reasons.

Z Before you listen again, can you answer any of the questions below from the information you have? 1 What evidence can you find of the doctor's good bedside manner? 2 What evidence can you find of the patient's cooperative manner? 3 How does the doctor seek to involve the patient in lifestyle changes? 4 How does the doctor make a suggestion about lifestyle changes? 5 How does the doctor reassure the patient of the effect of the lifestyle change suggested?

3 l(J) Listen again. Answer the questions. 4 What other lifestyle changes could the doctor encourage this patient to make? How else could the doctor phrase his suggestions?

Patient care When patients are hypertensive, they may have no symptoms. It is therefore not always easy for them to accept or follow any therapy or even to keep to it. You, therefore, need to be able to give patients advice and information in a way that fits the situation and doesn't put them off. Look at the following examples:

Stop smoking. The imperative here is inappropriate for giving patients advice about lifestyle changes.

.,

1 2 3 4 5 6 7 8 9 10 11

You'll need to stop smoking from now on. You could stop driving for a while, say six weeks. Have you ever tried to do any kind of sport? Don't take any alcohol. I'd strongly advise you to take the medication. It's better for you if you avoid salt. You need to make sure you take this regularly. You might want to take this medication from now on. You shouldn't eat fatty food like sweets and cakes. Try and give up smoking if you can. You take this one once a day, preferably in the evening. 12 You need to come back and see me after one month.

Z Work in pairs. Write at least three sentences giving advice about these topics. 1 2 3 4 5

caffeine and caffeine-rich products relaxation I stress management dynamic exercise- walking, swimming, cycling salt intake fruit and fibre

3 Work in pairs. Using the notes you made in Listening 2, take turns role-playing the conversation between Mary and her GP. Continue giving advice to Mary about changes to lifestyle. Emphasize the benefits the changes will bring. USEFUL EXPRESSIONS

Ifyou ... It 'll make you ... You 'll soon notice the difference. It'll reduce ... All being well, you 'll have ...

88 Unit 9

Cardiovascular disease is estimated to cost the EU economy€192 billion a year. 57% is due to direct health care costs, 21% to productivity losses and 22% to the informal care of people with CVD. Costs vary hugely between EU member states- per capita annually, Bulgaria costs under€60 but and the UK cost over€600.

-European Heart Network

Speaking

Project 1 Work in groups. Search for information on the web or in books or pool your own experience. Each group should research a different subject from: 1 drug treatment for hypertension

2 prescribing statins for hypercholesterolaemia, especially any contraindications and side effects 3 non-drug therapy for cholesterol

1 Type in the words statin, hypertension, cholesterol on the internet or check these sources. • www.bhsoc.org • www.nice.org.uk • www.patient.co.uk • www.yourtotalhealth.ivillage.com • www.bhf.org.uk

'

Also check the Oxford Handbook of General Practice, 2nd edition pages 324-5

l1 1 Work in pairs. Take turns talking to a 65-year-old, Vincent Fournier, who presents with hypertension, about the medication he needs to take. Check for any contraindications. Explain: • how to take the medication • when to take it • the benefits of taking it • any side effects. Arrange for follow-up in one month's time.

1 Two students volunteer to role-play the part of the doctor and the patient in the scenario below in front of the class. Use the Checklist on page 117 to give using the following two criteria: ability to encourage the patient and spontaneity. A 55-year-old patient, Mr(s) Slater, has high cholesterol. Give advice about non-drug therapy for high cholesterol with written instructions and I or drug therapy with benefits and side effects.

3 Give . to be constructive.

3 Select which information to talk about and share the information with the class.

C ecklist As sessyou r progress in th is un it. Tick (.I) the statements wh ich are true. I can understand and use technical and non-technical I can talk about the future and reassure

patients about the prognosis I can talk about heart disease

Writing

I can talk about signs and symptoms

Difficulties in persuasion

I can understand people speaking at

1 Work in pairs. Make a list of the difficulties doctors face trying to persuade patients of the need to take medication. Explain the difficulties, giving examples from your own experience. to maintain confidentiality.

2 Compare your list with other students in the class and add to

3 Work on your own. Write between 200 and 250 words explaining the difficulties you listed in 1. Use the useful expressions and suggested plan to guide you as you write your answer. USEFUL EXPRESSIONS

Introduction: an overview or example of the topic The main barrier ... Another difficulty ... ... can also effect patient's compliance.

Keywords Adjectives

frothy

your own list.

main obstacles problems faced by doctors First of all I second(ly) l third(Iy) In addition, I furthermore I similarly In conclusion, I as we have seen,

natural speed

Nouns

arrhythmia atria l fibri llat ion cholesterol contraindication diuretic DVT

..

dynamic exerc ise hypertension lifestyle line mitral stenosis morbidity mortality perica rd it is SOCRATES

stat in thrombo lysis Verb

tolerate Conclusion or summary

Useful reference Oxford Handbook of Clinical Medicine 7th edition, Longmore et al, ISBN 978-0-19-856837-7

90 Unit 10

Check up 1 Work in groups. Describe the photos. What is the link between the photos? Give an example relating to each photo.

Vocabulary Coughs 1 Choose the adjective that best fits the diagnosis in italics in each case. 1 Laryngitis: I've got this really bad cough and my voice is high -pitched I hoarse I smooth . 2 Tracheitis: I've got a dry cough and it's slightly painful ! painless I really painful.

2 Work in groups. Describe interesting presentations involving respiratory medicine that you dealt with successfully. Describe how you might improve your performance if you were to see the same case again.

3 What is the definition of asthma? What symptoms would you expect to see?

4 Asthma affects 5-8% of the population in the UK. What is the percentage in your country? Is it increasing or decreasing? What are the causes in your country?

3 Pleurisy: my chest really hurts when I cough. I get this stabbing I dull ! sharp pain right here in the chest when I cough. 4 Post-nasal drip: I've not got any pain or anything; just a dry, barking I tickly I painful cough. I'm always trying to clear my throat at night. 5 Asthma: I've been getting this wheezy I tickly I painful cough after doing exercise and sometimes in the morning. 6 Oesophageal reflux: first thing in the morning I get this dry I tickly I hollow cough and it often makes me feel sick. 7 Epiglottis: she's really poorly with this terrible tickly I barking I dry cough. 8 Laryngeal nerve palsy: the cough sounds really barking I hoarse I hollow.

9 Bronchitis: he's had this productive I mild I hollow cough for days now with some fever but no breathlessness.

2 <;!) Listen and identify the coughs which you hear 1-5 as wheezy, hoarse, productive, barking, dry. Check your answers with a partner.

Respiratory medicine 91

In this unit

e language for coug h and sputum e explaining investigations e using a I an, the, and zero article • checking the patient understands devices e describing data

Vocabulary

3 Work in pairs. Take turns asking a patient to describe one of the coughs in 2 and then develop the conversation using your own knowledge.

Nature of the sputum 1 Cover the causes a-h in the right hand column with your hand and use your own knowledge to diagnose the cause of the sputum 1-8. Nature of sputum Causes 1 white I grey a bronchiectasis I 2 green I yellow abscesses 3 green and offensive b congestive cardiac 4 sticky, rusty failure c asthma I smoking 5 frothy, pink 6 separates to three d severe bronchiectasis layers e bronchitis I 7 very sticky, often green bronchiectasis 8 sticky, with plugs f asthma g allergic aspergillosis h lobar pneumonia

Listening 1 Signs and symptoms 1 Work in pairs. Decide what the most likely diagnosis is of a patient who presents with recurrent episodes of bronchitis several years prior to presentation with these signs and symptoms: Signs 1 coarse inspiratory and expiratory crackles on auscultation 2 airflow obstruction with wheeze Symptoms 1 cough 2 chronic sputum production (typically tenacious, purulent, and daily) 3 intermittent haemoptyses 4 breathlessness 5 intermittent pleuritic pain (usually in association with infections) 6 lethargy I malaise

...

2 ~ Work in pairs. Listen to the conversation between Dr Zoltan and Mrs Fitzgerald, who is not asthmatic and is a non- smoker. Student A, listen to the questions the doctor asks and write them down in note form. Student B, write down what the patient says.

3 Using the doctor's questions as a guide, explain what the patient says and decide on a possible diagnosis. Is it the same as in 1 above? If not, why not?

2 Match the nature of the sputum to the causes in 1. 3 Apart from the nature of the sputum, what investigations I tests would you do tp establish the causes in a-h?

4 Work in pairs. Choose one of the conditions in 1. Then take turns taking the history from each other.

5 Work in pairs. Choose several of the conditions a -h. Explain to the patient what you think the diagnosis might be and what tests you are going to do.

92 Unit 10

afferent (a dj) carrying or directin g som ething towa rd s a body part

cessation (n) stopping lodged (a dj) stu ck OSA Ob str ucti ve Slee p Apnoea COPD Chroni c Obstru cti ve Pulmon ary Disease

• Language spot The definite and indefinite article 1 Work in pairs. Complete the sentences using the, a, an, or zero article (0). 1 _ _ _ _ _ _ breathlessness refers to

_ _ _ _ _ _ abnormal and uncomfortable awareness of breathing. Its physiological mechanisms are poorly understood; _ _ _ _ _ _ possible afferent sources for _ _ _ _ _ _ sensation include _ _ _ _ __ receptors in _ _ _ _ _ _ respiratory muscles. All patients need

full history and

examination. 2 _ _ _ __ _ smoking is ______..._

main cause of _ _ _ _ _ _ chronic obstructive pulmonary disease and lung cancer. _ _ _ _ _ _ NHS spends £1.7 billion per year caring for people with _ _ _ _ _ _ smokingrelated conditions. Government targets have been set to reduce number of smokers in _ _ _ _ _ _ UK, and health authorities have been allocated funding for _ _ _ __ _ smoking cessation services.

2 In the sentences below, find the four extra definite articles. 1 The mortality for patients with the pneumonia who are managed in the community is less than 1%, but one in four patients with pneumonia is itted to hospital and mortality for those itted is around 9%. 2 TB is spread by the airborne droplets containing mycobacterium tuberculosis (MTB). Droplets can remain airborne for hours after the expectoration because of their small size. Infectious droplets are inhaled and become lodged in the distal airways. 3 Pulmonary embolism is a clinically significant obstruction of part or all of the pulmonary vascular tree, usually caused by the thrombus from a different site.

J In the sentences below, put the words in italics in the correct order to complete the texts. Pay particular attention to the articles. 1 The I majority I chest I patients I of I with I pain I referred I to I have I acute I either I pleuritic I the I respiratory I team ! well-localized /.pain I pain I or I persistent.

2 Not all patients need treatment. evidence I significant I treatment I the I for I on I benefits I symptoms I rests, I which I drive I treatment, rather than the degree of OSA on a sleep study. decisions I require I a I dialogue ! treatment I close I between I patient I physician I and. 3 In addition to ive care, antiviral treatment of pneumonia with amantidine or rimantidine may shorten the I an I of I illness I if I started I duration I of I symptom I within I hours I 48 I onset.

» Go to Grammar reference p 125 Listening 2 Mistake recognition 1 ~ Listen to the recording of five pairs of statements. Decide in which statement (a orb) the use of the articles is correct.

2 (;) Check your answers with a partner and listen again. J (;) Work in pairs. Listen to sentences 1-7 in turn and decide together whether the articles in each sentence are correct. Check your answers w ith another pair.

4 (;) Listen again and check your answers.

Speaking Work in pairs. Rank these causes of breathlessness in order of speed of onset: Instantaneous, Acute (minuteshours), Subacute (days), Chronic (months-years). Check your answers with another pair. pleural effusion fibrotic lung disease COPD asbestosis

pneumothorax exacerbations of asthma pulmonary embolism

Respiratory med icine 93

TB tuberculosis esolve (v) disappear

Signs and symptoms Lung conditions

Speaking 1 Work in pairs. Write down a scenario for a patient presenting with the symptoms and signs in Signs and symptoms and decide on a cause.

2 Work with a pair who have prepared a different scenario. Swap scenarios and prepare your role as a patient for your new scenario.

3 Take turns taking the history from the patient and explaining the tests in Signs and symptoms 2. Then explain the results and treatment.

4 Work in groups of four. While two doctors do the roleplay, one doctor uses a copy of the speaking checklist on page 117 to monitor the doctor and give at the end on agreed criteria. The fourth doctor listens for correct examples of the use of the articles and incorrect use.

1 Work in pairs. Choose one of these clinical conditions and symptoms 1-6. What questions would you ask to reach a possible diagnosis? 1 Pneumonia

fever, rigors malaise, anorexia, dyspnoea, cough, purulent sputum, haemoptysis, and pleuritic pain 2 TB

productive cough, haemoptysis, breathlessness, weight loss, night sweats, malaise, chest pain 3 COPD

cough, sputum, dyspnoea, wheeze 4 Lung tumour

cough, haemoptysis, dyspnoea, chest pain, recurrent or slow resolving pneumonia, anorexia, weight loss 5 Pulmonary embolism

acute breathlessness, pleuritic chest pain, haemoptysis, dizziness, syncope 6 Mesothelioma

chest pain (dull ache, 'boring', diffuse, occasionally pleuritic), dyspnoea, weight loss, profuse sweating, asymptomatic

2 What tests I investigations would you want to do for the condition you have chosen?

3 What treatment would be suitable in each case?

5 Two doctors volunteer to do a role-play in front of the class. The class chooses a scenario where a patient thinks he I she has one of the conditions 1-6 in Signs and symptoms but the diagnosis is bronchitis or a bad viral flu . The doctor reassures the patient that it is not the condition he I she fears. The role-play may include all or part of the following: the history, the investigations, the diagnosis, or the treatment. USEFUL EXPRESSIONS

From what you have told me, ... It looks as ifyou have ... Ifyou had ... ,you'd ... Patients with ... usually have ... It doesn 't sound pleasant, but ... Because yourfriend had ... If it doesn't go away, come back and see me.

94 Unit 10

3 Work in pairs. Find these phrases in the text. Are they

Reading 1 Work in groups. Before you look at the text, describe Figure 1, which shows the flow-volume loop.

2 Use these words to complete 1-7 in the text. peak expiratory flow rate inspiration closing volume dynamic compression fixed upper airway narrowing expiration peak flow

causes or effects? 1 and hence the airways are at their most open 2 the highest flow rates are possible at the beginning of the blow 3 and are less able to resist dynamic compression 4 Also, increasingly with age, the small airways may actually close off 5 the inspiratory muscles are approaching the end of their 'travel'

Flow-volume loop

tissue, are pulling the hardest and ing the airways against 2_ __

A good starting point to the understanding of lung function tests is the flow-volume loop. This plots inspiratory and expiratory flow against lung volume during a maximal expiratory and maximal inspiratory manoeuvre. At the beginning of the 1_ _ _ from a full breath in, the expiratory muscles

during the exhalation manoeuvre. This means that the highest flow rates are possible at the beginning of the blow, hence the sudden rise to a 3_ _ _ in

are at their strongest, the lungs at their biggest, and hence the airways are at their most open. (A). Because the lungs are at their largest, the radial attachments to the airways, effectively the alveolar I capillary membranes and their connective

the 100 ms or so of the forced breath out. (B). This is the 4_ _ _ and is essentially what a peak flow meter measures. As the lung empties, and the lung volume drops, the dilatory pull on the airways from the radial attachments of the surrounding lung tissue reduces. (C). Hence the airways narrow and become less ed, and are less able to resist dynamic compression. This means that the

RV

Inspiratory

flow

Fig.1

maximal airflow obtainable, regardless of effort, falls too. Eventually, the expiratory muscles come to the end of their 'travel' and cannot squeeze the chest any more. Also, increasingly with age, the small airways may actually close off, preventing any more emptying. (D). The volume at which this begins is called the s___ . As maximal 6_ _ _ starts, although the inspiratory muscles are at their strongest, the airways are at their smallest. Thus, flow rates start low and increase as the airways open up. However, as the airways open up, the inspiratory muscles are approaching the end of their 'travel' and are weakening. This means the flow rates fall again; hence, the different rounded appearance of the inspiratory limb of the flow-volume curve. Thus, normally the inspiratory and expiratory flow rates depend on lung volume and are termed 'volumedependent'. If there is 7_ _ _ , such as from a fibrous tumour in the trachea, then the size of the airway at this point may become so narrow that it now limits maximal flows.

Respiratory med'c1n e 95

It is now estimated that as many as 300 million people suffer from asthma. British children are three times more likely to suffer asthma than those from , , or Italy. The highest prevalence rates for asthma in the world are found in the UK, New Zealand, Australia, Ireland, and Canada. Nepal, Romania, Albania, Indonesia, and Macau have the lowest prevalence rates of asthma.

-GINA {Global Initiativefor Asthma)

Speaking

PEAK FLOW READINGS CHART -""

~

~

~m~_~

1 Work in pairs. Describe the device below.

~

~~~

~~·::;~~-reo·~

Date and time 8: $. Mon, 01 Aug 200512:00 PM 503 87%

~

Sun,31Jui200512:00PM

480 83% X

Sat,30Jul200512:00 PM

541

0

'-'

--·;:::;

~~~~ "'""

>=

-.

::;;

Notes

XX X

X

X

94%

Fri, 29 Jul2005 12:00 PM

516 89%

X

Thu, 28Jul200512:00 PM

483 84%

X

Wed, 27 Jul200512:00 PM

565 98%

Tue,26Jui200512:00PM

497 86%

Mon, 25Jui200512:00PM

273 47% XXX X

Sun,24Jui200512:00PM

501

87% X

X

X

X X

X

X

XX

X

X

XXX XX

Sat, 23Jui200512:00PM

540 93% X

X

X

Fri, 22 Jul200512:00 PM

537 93% X

X

X

Thu, 21Jui200512:00PM

471

Wed,20 Jui200512:00PM

547 95%

Tue, 19Jui200512:00PM

544 94% X

X

XXX

X

XXX

X

X

81 % X X

Mon, 18 Jul200512:00 PM 470 81 %

2 Make a list of the steps involved in explaining to a patient how to use a peak flow meter. Take turns explaining to each other using the picture in 1 and these expressions.

Sun, 17 Jul200512:00 PM

500 86%

X

XX

Sat, 16Jul200512:00 PM

480 83% X

X X

X X X X

Fri, 15 Jul200512:00 PM

475 82%

Thu, 14Jul200512:00 PM

520 90%

Wed, 13 Jul200512:00 PM

370 64% X

X

X

Tue, 12Jul200512:00 PM

496 86% X

X

X

Mon, 11 Jul200512:00 PM

562 97%

X XX

X= Mild or occasional symptoms XX= Medium or frequent symptoms

XXX= Severe or continuous symptoms

USEFUL EXPRESSIONS

You need to ... Can you stand or sit upright? Ensure the meter is set at ... Take a deep breath. Sealyour lips around it. Blow out as hard and as fast possible. Record the best of three efforts. Repeat.

3 Explain to the patient how to record the readings appropriately using the chart.

Project 1 Work in pairs. Find information on the internet on explaining the use of inhalers to patients. Or choose one of the sites below. www.patient.co.uk Asthma UK: www.asthma.org.uk American Society of Chest Physicians: www.chestnet.org • British Thoracic Society: www.brit-thoracic.org.uk European Respiratory Society: www.ersnet.org Society of Thoracic Surgeons: www.sts.org BTS training site: www.chestnet.net • For simple thoracic anatomy and other anatomy see: anatomy.uams.edu Also check the Oxford Handbook of Clinical Examination and Practical Skills.

2 Share and compare the information with other students and choose the best resource.

96 Unit 10

Listening 3

Speaking

Explaining a device

Work in pairs. Take turns explaining to the patient how to use the breath-activated inhaler and then ask the patient to explain it to you. The patient should make some mistakes. Correct the patient politely.

1 ~ Listen to a nurse explaining to a patient how to use a breath-activated pressurized MDI (Metered Dose Inhaler). Write down the verbs the nurse uses to explain how to use the device after she says: First of all, you remove the cap ...

2 Work in pairs. Compare lists and check with other students to complete your list.

3 ~ The nurse asks the patient to explain the procedure to her. The following illustrations show what the patient explained to the nurse. Listen again to the nurse's explanation. Which three steps are not illustrated?

4 Work in pairs. Compare answers.

USEFUL EXPRESSIONS

OK, that's fine, but try to do it like this. Do you want to show me again? Fine, just try doing it like this. OK, just see if you can do it like this. That's nearly it. Can you try it again for me?

Writing Describing data 1 Work by yourself. Look at the chart opposite which shows trends in annual rates of primary care consultations, hospital issions, and mortality for asthma among children under five. Which line or lines on the chart do these words and phrases relate to? 1 2 3 4 5 6 7 8 9 10

trends overall experience a steady decline almost to zero increase substantially during halve more than halve reach a high, throughout the period hospital ission rate rise sharply upward trend downward trend overall with the exception of

Res piratory medi cine 97

Checklist Assess you r progress in this unit. Tick {.f) the statements which a re true. I can understand language for cough and sputum I can explain investigations I can use a I an, the, and zero article I can check the patient understands devices

Asthma and allergies: decrease in hospital issions in 1990s

I can describe data

180

160

140

120

100

l...--'"

J

I

If

.............

80

~

~

"\

-

'"

60

40

20

0

-

1990

1991

1992

1993

""' -" "' , \

::---.......

""""'-!!~~

~

Keywords

1994

.............

,/'

1995

1996

.............

....... ....

1997

1998

1999

2000

Annual hospita l issions per 10,000 (Eng land & Wa les) Annual deaths per million (UK) Patients treated for asthma annually per 1,000 (England & Wales) Weekly GP episodes per 100,000 (England & Wales)

Trends in annual rates of primary care consultations, hospital issions, and mortal ity for asthma among children aged under five r yea rs

2 Work in groups. Check your answers. Together prepare orally a description of the data of between 150 and 200 words, using the phrases below. At this stage do not write, but you may make notes. USEFUL EXPRESSIONS

The graph I chart shows I illustrates I provides information about I provides a breakdown of. .. Generally speaking, the trends ..., with the exception of..., For example, I For instance,... / Take ...,for example. Similarly, I Likewise, I Furthermore ,.. . As regards I Regarding I With regard to I As can be seen I Turning to ... By contrast I Compared to I In comparison with I By comparison Respectively As against I As opposed to

3 On your own, write a description of the data using the simple past. Quote the data to your description. You do not need to describe every change in the chart.

Adjectives barking breath-activated expiratory hoarse hollow inspiratory offensive productive purulent tenacious tick ly Nouns bronchitis crackles expectoration high malaise MDI sputum trend

Useful reference Oxford Handbook of Respiratory Medicine 2nd edition, Chapman et al, ISB N 978-019-954516-2

98 Unit 11

Check up 1 Describe these pictures. What relevance do they have for the spread of infectious diseases?

Project 1 Work in groups. Use your own knowledge and the internet to find out more information about these milestones in public health practice nationally and internationally. 1600s- Variolation (the induction of mild smallpox to reduce mortality, an ancient practice in Asia) spreads to Africa, Europe, the Ottoman Empire, and the Americas. 2 1796- Edward Jenner immunizes James Phipps with cowpox virus. 3 1854- John Snow shows that cholera spreads through contaminated drinking water. 4 1873- Henrik Arnhauer Hansen identifies the bacillus causing leprosy under microscope. 5 1882- Koch discovers the bacillus causing tuberculosis.

2 Work in groups. In the UK certain diseases are notifiable. What types of diseases do you think have to be notified to the authorities and why do they have to be notified? Do you have the same system in your country?

3 What epidemics I pandemics do you know in the world since the beginning of the twentieth century?

6 1887- Ronald Ross in India describes the malariamosquito life cycle. 7 1928- Fleming discovers the antibacterial effect of penicillin. 8 1953- Polio vaccine introduced.

2 Share the information you have found with the class.

Tropical di seases 99

In this unit

• • • •

ta lking about tropical diseases using vocabulary related to travel lers' diarrhoea using linking words like next, then, when in descriptions talking about sickle-cell anaemia and rehabilitation after stroke • showing respect in discussions

Speaking

4 <(,) Listen again and complete the notes made by a student during the presentation. In each space write no more than three words from the talk.

1 Work in pairs. Choose the three most important developments in Project 1. Rank them in order of importance.

'N (;(-f.,_ -tr"!velhs cu-~

t"'ck- {ru-M f.w[idttys U'r'fu-rt"f.tl;(- tv -t/tirJ_ "!trMt '- - - - - - -

2 Compare your rankings with other pairs. Are their rankings similar to yours?

rrvl0tvry, Med tv "!Jk- "!trM-t

3 Choose the most important development from the list.

. -tf,_e !)1/rlftTYN

USEFUL EXPRESSIONS

If it were not for... If ...hadn 't ... ,

· "!re"!J -tr"!velkd tv ( ()/t£:.~ 6-ncf JtvjJu-verJ )

... is the single most ... Byfar, the most ...

· -tf,_e dv<.r"!-ticrrv rrf ff..e. tr"!ve[

Listening 1

. nvt~riA rru-rf:11.erxw

Treating returning travellers

· k"'-l-t;.,_ rrf mewen

rrf -tf,_e , _ _ _ _ __

· suvurl cu-11;(-"f.c-tJ vvkls-t "!tru-"!d .,

· medic"![ -tre"!-tmetl;(- received "!tro"f.d. Fvt.l[ U"!frl.i~-turrv sf.wvt.ld 6-ec!/werv. rrvves-ti:J"~-tUrN, ~ "!trM-t FB'C, -thick- "!M ~ + for nvt~r/A, LFD, vir"!l serolu-._JJ, 6-lovd cvt.ltw"e, s-tuvl cvt.ltw"e (eNw-e &-t &s fresf.,_), MIV .

M"!~r/A

-tf,_e v k.. E"'-!)1 tv WI.UJ dtAc!fMJW Gre"!-t ' M"!rjy "!~ !)tW'ftvYN 1-

1 ~ Listen to the talk on treating illness among returning travellers. Look at the notes and the picture above and decide what the illness is.

2 Work in pairs. Look at the notes made by a student. What is the part of speech (noun, verb, etc.) of each of the missing words?

3 What do the abbreviations stand for? Use a dictionary or ask a partner.

- C"!i'L- rresetl;(- VViJ"t"'

rrf f,_e"'-d"f.cf,_e,

~"'-yiA, "!M "!MrUIA, follu-vved fevers, ri:Jm, "!M R for R-•2 f.ww-s "1.-t "'- -ti-me

nvr~we,

fJ recw-r0;t ,

vvkcf.,_ ~-t

5 What questions would you ask in taking the history of a businessman who had been to South America and presented with fever?

6 Work in pairs and take turns taking the history from each other.

100 Unit 11

The Health Protection Agency has a useful A-Z of topics at www.hpa .org.uk

Vocabulary Travellers' diarrhoea 1 Complete the text using these adjectives. chlorinated hyper -osmolar self-limiting unpeeled

contaminated preferable sw eet ened

frequent reputable unhygienic

Management • Most episodes are 1_ _ _ _ __ • Increase fluid intake. Eating e.g. broth with noodles or salty crackers with 2 drinks will provide a balance of carbohydrate and salt. • Oral rehydration solution (ORS} is 3_ _ _ __ if the diarrhoea is frequent or severe or if there are signs of dehydration, weakness, or muscle cramps. • Drinks designed for rehydration during sports activities do not contain the correct balance of salts for diarrhoea treatment. Sodas and fruit juices are often 4 or have high sugar content and can make diarrhoea worse. • Prompt antibiotic treatment reduces symptom duration. • Loperamide shortens the episode in older children and adults with s small volume stools. (Do not use loperamide ifthere is blood in the stools, fever, tenesmus, or other signs of dysentery.) Prevention Avoid 6 fruit, uncooked vegetables, sauces which are not freshly prepared and handled in ______ conditions e.g. by street vendors. Where there is no reliable source of s_ _ _ _ __ water, sterilize water by boiling or with chlorine tablets or drink bottled water from a 9_ _ _ __ source. Avoid bottled water where the bottles are immersed in water or ice to keep them cool. Beware ice or ice cream, which may be made using IO ______ water. When trekking or in isolated places, it is advisable to carry packets of ORS and a course of treatment. Hand sanitizers are useful when hand-washing is impossible.

2 Work in pairs. Take turns explaining to another doctor the management or prevention of travellers' diarrhoea. Then explain the management or prevention to a patient.

1 Work in groups. Describe an interesting case presentation of a patient who had a disease that is not prevalent in Western Europe or one that is not prevalent in your country. Say what you learnt from the case and what you would do differently if you had to do it again.

2 Choose one student from each group to describe their case to the rest of the class. If possible, use PowerPoint or the electronic smart board.

3 Work on your own. Write a description of no more than 150-200 words ofthe case you described. Describe the sequence of events and add what you learnt from it and how you would improve your performance if you did it again.

Tropical diseases 101

always to maintain patient confidentiality.

• Language spot Linking words

Red blood cell

0

Male Gametocyte

HUMAN MOSQUITO

Female Gamete Zygote \

0 0 1 Work in pairs. Look at the diagram of the life cycle of the malarial parasite. Describe steps 1-5 in your own words.

2 Read this description of the same steps. Underline the words that are suitable in each case. In some cases more than one is suitable. The sexual part of the life cycle of the malarial mosquito takes place in the invertebrate host {the Anopheles mosquito) and the asexual cycle occurs in the vertebrate host (the human). At the vertebrate stage,lwhen I where I then the mosquito needs blood for her eggs, she bites the human host and at the same time injects motile sporozoites into the blood stream. 2After that I Next I Then these invade hepatocytes, 3where I when I then they develop into liver schizonts. 4 When I As soon as I Next each schizont ruptures, thousands of merozoites are released. 5After that I Once I After this happens, the merozoites invade red blood cells. This 6 after that I next I then triggers the part of the cycle which is responsible for all the clinical manifestations of the disease.

J Work in pairs and describe steps 6-10. » Go to Grammar reference p 126

Writing Describing a life cycle 1 Work in pairs. Write about 150 words describing steps 6-10 in the life cycle ofthe malarial parasite in the diagram in Language spot.

2 Compare your answer with another pair of students. Check each other's writing for mistakes. USEFUL WORDS AND EXPRESSIONS

At the next step I stage I phase ... Following that ... Afterwards ... Before ...

102 Unit 11

deoxygenated (adj) having oxygen removed infarct (n) an area of cell death I necrosis which is caused by an obstruction of the local blood supply. Another word for

dactylitis (n) inflammation of the fingers and toes

infarction.

Reading

Sickle-cell anaemia \

··....J····.....·

\\ ····.\·...........

l

1 Work in groups. Before you look at the text, look at the titles and pool your knowledge on sickle-cell anaemia. Predict what you expect to see in the reading age.

2 Find words in the age which mean: 1 2 3 4 5 6 7 8 9

to break down or disintegrate combine with another compound to form a polymer characteristic interchange blocking accompanying or occurring with broughton develops later change.

The sickle-cell gene is common in equatorial Africa (frequency 25%), Saudi Arabia, and south Asia but less common in the Mediterranean and the mixed populations of the Americas (frequency 5%). It is due to a single point mutation in the Hb ~-globin gene chain. When deoxygenated , HbS molecules polymerize into elongated structures causing erythrocytes to deform and haemolyze. Sickled red cells are rigid and block the micro-circulation in various organs, causing infarcts. The inheritance of the disease is autosomal co-dominant (i.e. sickle-cell disease is due to heterozygous inheritance HbAS). The trait is generally asymptomatic. Sickle-cell disease occurs with homozygous inheritance of the gene (HbSS) or co-inheritance of another ~-globin chain disorder such as HbC (see below). Sickle-cell disease and glucose-phosphate dehydrogenase (G6PD) deficiency may occur together because of the high prevalence of both conditions in some regions. They provide protection against malaria.

Clinical features of sickle-cell anaemia Severe haemolytic anaemia is punctuated by severe pain crises. Young patients alternate periods of good health with acute crises. Later chronic ill health supervenes due to organ damage. Symptoms begin after six months of age as the HbF level declines. The first signs are often of acute dactylitis due to occlusive necrosis of the small bones of the hands and feet, resulting in digits of varying length. The long bones are affected in older children and adults. Anaemia (Hb 6-8 g/dl; reticulocytes 10-20%) is well tolerated because of cardiac compensation and a lower affinity of HbS for oxygen.

Tropi cal diseases 103

CNS ce ntra l nervo us system CXR chest X-ray

3 Work in pairs. Are the statements true or fal se? The severity of comp lications depends on a number of factors including the propor tion of non-sickle Hb molecules (e.g. HbF) and the ratio a to~ chains, which may be modified by concom itant a thalassaemia trait or conditions affecting ~-globin chain production (Bantu haplotype is associated with severe disease, whi lst Senegalese and Asian haplotypes are less severe).

2 3 4

Types of crises •

• •

•

•

Painful vascular-occlusive: frequent and precipi tated by infections, aci dosis, dehydration, or hypoxia. Infarcts often occu r in the axial skeleton, lungs, and spleen. Repeated splenic infa rction leads to hyposplenism in adu lthood. Crises can involve the CNS (in 7% of the patients) and spinal cord. Visceral sequestration: due to sickling within organs and pooling of blood. Chest: pulmonary infiltrates on CXR, fever, chest pain, tac hypnoea, cough, wheeze. There is often concom itant infection, microvascu lar occlusion, and bronchoconstriction. Chest crises can arise duri ng a painful crisis; patients should be monitored ca reful ly for this comp lication , which can be fatal. Haemolytic: raised rate of haemolysis with a fall in Hb. Usually accompanying a painful cris is. Concomitant G6PD deficiency may wo rsen haemolysis. Aplastic: Arrest of red cel l production due to infection wi th parvovi rus and I or folate deficiency. It is characterized by a sudden fal l in Hb and reticu locytes, emergency blood transfusion can be life-saving.

5 6 7

The sickle-cell gene is as widespread in the Americas as it is in Africa. Infarcts can be caused when sickled red cells obstruct circulation in certain organs. Sickle-cell disease and G6PD combined protect sufferers against malaria. The first signs of severe haemolytic anaemia are always seen in the bones and hands of the feet. The severity of the complications is linked to the proportion of non -sickle Hb molecules. Patients can die when a chest crisis occurs during a painful crisis. During an aplastic crisis, a blood transfusion always saves lives.

4 Work in groups. How common is sickle-cell anaemia in your country? Have you treated cases of this condition? Give examples.

Listening 2 Maintaining good health 1 <('~} Listen to the conversation between Dr Lindt and Mrs Boyce. What is the subject of the conversation?

2 <('~} Listen again. Write down as many details as you can.

3 (;) Work in pairs. Compare your answers with a colleague and if necessary listen again.

4 Work in groups. Describe the best ways for patients with sickle-cell disease to maintain good h ealth. Make notes and share your information with the class.

5 Work in pairs. You are a GP and you are going to t alk to a patient, Mr(s) Dillon, about the best ways to maintain good health for himself I herself. Using the notes from 1 and 4 above, take turns role-playing the conversation. US E FUL E XPRESSIONS

It's important ... You need to ... Where possible try to ... Ifyou {do this) ... , then .. . Ifyou get (sick, especially high fever) ... , .. . immediately.Don'twait.

104 Unit 11

Physiotherapy should never be painful. The expression 'No pain, no gain' has no place in physiotherapy.

-Oxford Handbook ofTropical Medicine

Patient care

Stroke

One of the complications of sickle-cell anaemia is stroke. Rehabilitation and physiotherapy after stroke is essential24 hours a day and as the physiotherapy can be undone by bad posture during the night and at other times, it is a good idea to teach the relatives the basics of physiotherapy.

Speaking

1 Work in pairs. Look at the diagrams, which show positioning and movements for hemiplegic patients lying down. Decide what instructions you would give to someone to explain how to position a hemiplegic relative.

Hemiplegic side= blue

2 Match these sentences to the pictures in 1. 1 Help Andrew to get up to sit on the bed. 2 Position Andrew on the stroke {hemiplegic) side like this with a cushion under the head and leg like this. 3 Roll Andrew onto his normal side while ing his weak shoulder. 4 Lay Andrew on the normal side like this with cushions under the stroke {hemiplegic) arm and leg. 5 Position and cushion Andrew in the supine position.

3 Work in pairs. Take turns explaining to a relative how to position and a patient who has suffered a stroke. Use the diagrams above to help you.

1 Work in groups. Look at statements 1-10 and match them with a-g. 1 Do you want to add anything to that? 2 Ahmed, what about you? 3 I agree with what you said but, what about ... ? 4 Can I just say that ... ? 5 I think you're right, but we also need to think about ... 6 I think that's it exactly. 7 I'm not so sure if that's going to work. 8 Any more suggestions or ideas from anyone? 9 No, I'm sorry. It's OK. You go first. 10 Shall we appoint someone to take notes? a b c d e f g

agreeing disagreeing agreeing and disagreeing inviting someone to speak adding information apologizing for speaking over someone taking the lead in the discussion

2 Can you add any more expressions of your own to the list above?

Tropical disea ses 105

Checklist Assess your progress in this unit. Tick (.f) the statements which are true.

I can talk about tropical diseases I can understand and use vocabulary related to travellers' diarrhoea I can use linking words like next, then, when in descriptions

3 Look at the task below, which is an awareness exercise for GPs working in areas with patients from a wide range of backgrounds. Spend several minutes thinking about the task. Make mental notes about the measures, but don't write anything down. You are working in a general practice in the UK which covers an area where there are many patients who have come from or whose families have come from South America, Africa, and south-east Asia. You do not feel that the GP practice is catering well for these patients. What are the three best measures to improve the situation?

4 Work in groups ofthree or four. Each group should pair with another group, one as group A and the other as group B. Group A discusses the task in J and decides on the three best solutions. Each student in Group B monitors the performance of a student in group A. After fifteen minutes of discussion, the students each give in pairs on the performance using the following criteria: ability at turn taking, respect for colleagues, contribution

to the discussion, teamwork.

1

li

- 0

<---Task

--->0 .._

\_,~~ i

5 Change roles and this time the students in group B discuss while those in A monitor.

6 Choose the best measure to improve the situation.

I can talk about sickle-cell anaemia and reha bi Iitation after stroke I can show respect in discussions

Keywords Adjectives

notifiable sweetened unhygienic unpeeled Nouns

epidemic gametocyte haemolyze host life cycle malaria merozoite milestone pandemic rigor schizont sickle-cell anaemia sporozoite stopover travellers' diarrhoea va riolation

Useful reference Oxford Handbook of Tropical Medicine, 3rd edition, Eddleston, ISBN 978-019-920409-0

106 Unit 12

Check up 1 Describe these pictures.

2 Work in groups. What are the main advantages and disadvantages of technology?

J Some people think that deskilling and losing sight of the patient are the main downsides of the use of technology in medicine. Do you agree?

4 Why do people often resist the introduction of new technology? Give examples from your own experience. What are the reactions to innovations in science and medicine in particular in your country?

Technology 107

In this unit using vocabulary about change evaluating change and development asking and dealing with negative quest ions writing about arguments

e e e e

Vocabulary

Listening 1

Change

Technological advances

1 Work in pairs. Which two adjectives in italics can you use together t o complete each sentence? Are the two adjectives you chose in the correct order? 1 Technology like computers has brought about structural I big !far-reaching change in the provision of health care internationally. 2 The first face transplant represented a diplomatic I medical I real breakthrough. 3 In recent years, some very dramatic I enormous I technological advances have been made in medicine. 4 Throughout history, many important I recent I medical developments have been curtailed out of fear and ignorance. 5 Keyhole surgery was a(n) ingenious I modern I latest invention. 6 Society at large, not just the medical field, is undergoing a computing I complete I technological revolution. 7 A radical I whole I sudden transformation occurred in the way patients were treated. 8 Stifling constant I scientific I important innovations in medicine through lack of funding is indefensible. 9 I'd like to find something tracing the constant I biological I technological evolution of medical sci-ence. 10 The government sponsored a pioneering I latest I t initiative between the medical schools.

2 Work in pairs. What are the verb forms of the nouns in bold in 1?

1 (,) Work in groups. Listen to two doctors, a male and female , discussing technological advances in medicine. Two students (Students A) concentrate on what the female doctor says and two students (Students B) concentrate on the male doctor. Make notes as you listen.

2 Students A, check your notes with each other. Students B, do the same. Then combine your information.

J (,) Then listen again and check you have understood everything.

4 Make a list of developments you would like to see in medicine. Describe and evaluate your predictions for the future . Give reasons for your comments.

108 Unit 12

xeno-transplant (n) animal to human transplant

Vocabulary

Speaking

Evaluating change

1 Work in groups of four. Discuss which of these issues you think are controversial or sensitive matters for you and for the general public.

1 Work in groups. Look at the adjectives on page 107 in Vocabulary 1. Which adjectives evaluate the nouns? Which describe?

2 Work out which adjectives are being described below. The words are jumbled upside down below. 1 a synonym of the word dangerous

• Animal experiments I vivisection • Xeno-transplants • Face transplants • Genetic manipulation • Growing spare body parts

z_ _ __

2 to do with being advantageous

-

3 a synonym for convincing

p

n e

4 to do with causing harm

f

5 to do with having great worth

v

e

6 to do with being easy to use at

anytime

2 Choose a topic from 1 and divide into two sides, for c

7 a synonym for frightening

t

a

and against. Prepare at least three arguments for each side. Then debate the issue. Discuss also whether the procedure is acceptable in your own country.

m

8 to do with not being able to something 9 a synonym for damaging

10 to do with distasteful

;JiqEUOI:p;J[qo snopiEZEl.{ :j.U;JIU;JAUOJ

diqEnreAu! ITIJWlEl.{ IE!J!J;lU;Jq

USEFUL EXPRESSIONS

i- -e d 0 _j

e

;JJqSEnSI;Jd ;JN!SU;Jj:;Jpll! IEfU;lWTJ:j.;lp 8U!WlE1E

J Which ofthese words are synonyms of the words in 2? One word may be used twice. compelling offensive shocking

helpful practical unjustifiable

incalculable risky unsafe

arouse emotion I controversy I debate controversial I sensitive I debatable issue outweigh I offset I be more important than any I compensate for

J Choose a member from one group to summarize both sides of the argument for the rest of the class. other group should lend .

Listening :Z Trying to persuade the doctor 1 {(;) Listen to the five short conversations between a doctor and a patient. Write down the patient's first question in each conversation.

2 Work in pairs. Compare your answers.

J Work in pairs. Discuss why you think the patients asked the questions that they did. Then check your answers in the Grammar reference on page 126.

4 {(;) Listen again. Write down the doctor's reply. 5 Take turns asking each other questions and replying.

Technology 109

Why innovate? Within three years of introduction of the first anti retrovira I treatments, AIDS deaths d rapped by 70%. Improvements in treatment have helped cut cancer death rates in half. Vaccines have saved countles s children from diseases such as polio, rubella, measles, and tetanus.

-Council for American Medica/Innovation

• Language spot Negative questions 1 Look at the faces. What feelings do you think they are showing?

3 Work in pairs. Match the meanings a-k to the statements 1-11 in 2. a b c d e f g h

You should have. He's late. I don't like this new one. I can't afford to pay for it. It's missing. Iwantone. I feel angry because it's been cancelled. I think you've left me off the waiting list. You've kept us waiting too long. j I don't want to stop. k I think you've forgotten.

4 l(i} All of the statements in 2 are made by a patient. Work in pairs. Listen and decide which you would put into the categories below. Some may fit into more than one category. a b c d e f

a strong criticism a mild criticism areminder avoiding criticism showing shock I surprise persuasion I a demand

5 Decide how you would reply to each statement in 2. USEFUL EXPRESSIONS

2 Work in pairs. Look at these statements made by patients. What feelings or thoughts could lie behind the questions? 1 Couldn't I just keep using the same device? 2 Isn't this available on the NHS? 3 Wouldn't it be better for me just to continue with medication? 4 Doesn't this device come with a cap on it? 5 Shouldn't my daughter be next? 6 Won't I be having the operation today either? 7 Can't I have an MRI scan? 8 Hasn't the doctor arrived yet? 9 Haven't you done that referral letter yet? 10 Didn't you say I could go home today? 11 Aren't I next on the waiting list?

You could I can, but ... I'm afraid not, because ... Oh, yes, sorry ... Oh,yes,you're right. I'm very sorry, but ... Yes, we have. I did, but ...

6 Work in pairs. Take turns asking and replying to the questions. Develop the answers in your own way.

7 Can you think of acceptable and unacceptable examples of situations where you can use negative questions like those in 2 with colleagues? Give reasons. Look at the audio script for Listening 2 on page 137.

» Go to Grammar reference p 12 6

110 Unit 12

Speaking 1 Work in pairs. Look at the photos. You have two patients. One patient is insisting on having each of the procedures or items in the photos and the other is reluctant to have them. Decide what the patient might say in each case.

Z Work in pairs. Take turns role-playing the conversation between the doctor and the patient. The patient can be difficult and insistent.

Reading 1 Work in pairs. Look at the three extract s on page 111. What do you think is the source of each text?

Z Match these sources to the extracts 1-3. A newspaper A website for patients A specialist website on stem cell research

J Replace the highlighted words in these sent ences with a word from the extracts. Scientists learnt how to grow stem cells in the laboratory after years of experimentation. 2 Stem cell treatment involves hazards as well as being harsh. 3 Professor Dhillon's reaction is unambiguous when asked if the research at Edinburgh met any resistance. 4 As it is connected with the use of foetuses, the term stem cell is quite sensitive to many people. 5 Patients are given information as to when the advantages are greater than the dangers in a stem cell transplant.

Technology 111

harvest (v) (of tissue or organs) collect unspecialized (adj} of cells, not differentiated

Do not go where the path may lead , go instead where there is no path and leave a trail. -Ralph Waldo Emerson, 1803-1882

Stem Cell Transplant A stem cell transplant is used to increase the chance of a cure or remission for a number of cancers and blood disorders. It usually involves intense chemotherapy followed by an infusion of stem cells. The treatment requires close nursing and medical care for a number of weeks. It can be a gruelling treatment and there are risks. Your specialist can advise when the likely benefits of this procedure can outweigh the risks.

What is a stem cell transplant? A stem cell transplant may be used so that you can have intensive high dose chemotherapy (and sometimes radiotherapy) to kill cancerous cells. The chemotherapy is higher than conventional chemotherapy and also kills the stem cells in the bone marrow that would normally make blood cells. Therefore, following the chemotherapy, you are given back (transplanted) stem cells which can then make normal blood cells again. A stem cell transplant is sometimes called a bone marrow transplant. However, stem cells can be obtained from blood as well as from the bone marrow. So, the term stem cell transplant is now used.

Stem cell research is a subject almost guaranteed to prompt mixed reactions. As if to illustrate that fact, two high-profile Scottish stem cell trials were announced this week, to very different responses. While one was branded 'immoral and unethical' by critics, the other was warmly welcomed as offering a potential cure for some types of blindness. The difference is that the former- a trial in Glasgow to insert stem cells into the brains of stroke victimsrelies on stem cells harvested from human embryos, which must be destroyed to enable the beginning of a cell line. Edinburgh uses stem cells from voluntary adult donors, harvested after their death, to treat corneal blindness. It is the use of voluntary adult donors that makes all the difference to those with moral and ethical objections to stem cell therapy. Asked if he had encountered any opposition, Prof Dhillon is unequivocal. 'No. Because we're using tissue that's been generously donated by adult donors after death, those issues don't arise with this type of research. 'I think the term stem cell has become rather emotive in that it's linked with a number of images and issues, both ethical and moral, associated with the use of foetuses, and this trial is not using foetal stem cells. But I think it's important for clinicians, scientists, and the public to have an open debate.'

4 Answer these questions. 1 Why is it important for scientists to understand the signals in a mature organism that cause a stem cell population to proliferate and remain unspecialized until the cells are needed for repair of a specific tissue? 2 Why has the Edinburgh trial not had a negative response to its work?

The specific factors and conditions that allow stem cells to remain unspecialized are of great interest to scientists. It has taken scientists many years of trial and error to learn to grow stern cells in the laboratory without them spontaneously differentiating into specific cell types. For example, it took twenty years to learn how to grow human embryonic stern cells in the laboratory following the development of conditions for growing mouse stern cells. Therefore an important area of research is understanding the signals in a mature organism that cause a stern cell population to proliferate and remain unspecialized until the cells are needed for repair of a specific tissue. Such information is critical for scientists to be able to grow large numbers of unspecialized stern cells in the laboratory for further experimentation.

3 What difference is mentioned between normal chemotherapy and that used in stem cell transplants? 5 Work in groups. Are you interested in genetics? Give reasons and examples.

112 Unit 12

demystify (v) take away the mystery about something; to make something clear Pandora's box (n) a process that, if started, will cause many problems that cannot be solved

Frankenstein (n) a fictional doctor who assembled a human from the parts of dead people, resulting in a creature often called 'Frankentein's Monster'

Speaking 1 Work in pairs. Look at the picture and describe what is happening.

The novel Frankenstein, published in 1818, was written by Mary Shelley.

4 Discuss the main arguments for and against stem cell research I therapy from the ethical and scientific view. Look at the words and ideas below.

~eorle·s mi ll~t at e(Jse

rvt

t ke

awa~

the rn~~~er~ 2 Work in pairs. Is each statement for or against stem cell therapies? 1 Stem cell research is the breakthrough that sufferers of illnesses and paralysis have been waiting for. 2 The best way to approach the issue is to clarify how the procedure works to make people feel at ease with stem cell research. Once it has been de mystified, people are more likely to accept it. 3 Stem cell research and therapies are indefensible because they interfere with nature. 4 Many people are apprehensive about harvesting stem cells from embryos to use in any kind of treatment.

OP.etL a.. I c.ut

of wormS

Creo..Ce ()... rnonsfer r10

id.tQ...f

.,/:he outuwY~f

vnnaivra.. L

alarm endanjer

·eorard•ze

rut a1

risk

reckless

5 I can understand the faith people have in stem cell therapy, but I think it is a step too far both ethically and scientifically. 6 Provided there are sufficient safeguards in place, stem cell research is surely a welcome development 7 A development like stem cell research is scientifically complex and has such dangerous consequences that it's impossible to allay people's fears. 8 Stem cell research and therapy give hope to thousands of sufferers.

3 Decide which category of statements you agree with. Then compare your answers with another pair of students.

5 Make a master list of ideas in 4 for the whole class.

Technology 113

Discovery consists of seeing what everybody else has seen and thinking what nobody else has thought. -Albert von Szent-Gydrgyi 7893-7986, Hungarian biochemist

Writing

Checklist

Stem cell therapy

Assess your progress in this unit. Tick (.I'} the statements which are true.

1 Work in pairs. Look at the text on stem cell therapy. Complete the text by inserting these phrases. a b c d e

these innovations not just objectionable, but dangerous a major breakthrough in medical science the knock-on effect and other important medical advances Stem cell therapy is 1_ _ _ which offers new hope for stroke victims as well as for sufferers of many other conditions. However, the benefits are not just limited to the patient, but extend to the carer, often a family member, and the health care system. From the family's point of view the patient would be given their lives back and would possibly even be able to lead an active life and work again. For the carer, there is the release from the burden of care and the possibility of finding work. The cost of medical care will be brought down with a reduction in community , the supply of medications and equipment like hoists, and home modifications. The time spent in hospital will also be reduced. So in a short time the research will soon pay for itself. Then there is 2_ _ _ of being able to use the money saved to pay for other areas of treatment. It must be emphasized that the health care system will only gain from 3_ _ _ if any changes are well managed and the benefits spread around.

I can understand and use vocabulary about change I can evaluate change and development I can ask and deal with negative questions I can write about arguments

Keywords Adjectives

alarming beneficial compelling emotive far-reaching hazardous ingenious objectionable persuasive radical reckless sensitive uneasy unequivocal u njustitia ble Nouns

breakthrough criticism development revolution

Some people, however, have reservations about this 4_ __ that have taken place in recent years, primarily from the ethical point of view. They feel that stem cell research . 5 15 - - - ·

2 Work on your own and continue the third paragraph. Compare your answer with a partner.

Useful reference Oxford Handbook of Clinical Mt!dicine, 7th edition, Longmore et al, ISBN 978-0-19-856837-7

114 Speaking activities

Speaking activities Student A

Unit 7 p.69

Unit 1 p.7 •

Choose one of the pictures and show it to the doctor at the appropriate moment.

You are the brother I sister of a 22-year-old male I female whom you witnessed ing out in a shop. This is the first time it happened. Your brother I sister had no prodrome; a cry followed by tonic I clonic movements; post-ictal drowsiness, confusion, cyanosis, frothing from the mouth, incontinence, aching limbs; slow recovery lasting about twenty minutes. Add any further information from your own medical knowledge. Possible diagnosis: epilepsy, but need to rule out other possibilities.

Unit 3 p.23 Your notes

3 07ears oj P.je 111Aie I

Unit 9 p.85

fomaie, paU1- U1

...

fk eflMw, fejt-/uuuJ.ed, !JCTM to fk !Jf"K, p{-ti.f/ I s1uadt a.nd wm,e W&ijkts, kM RSI '11.Jhen at work, ~ U1 tke wrUlj d.ire-sK't uu ~"0 t~ 1W'f!Jo to tke !}ym, pl-ay U1 tke park, fore up joids Unit 5 p.42 You are Mrs Buxton. You gave birth to a baby ten days ago. You present to the GP's surgery with a little bit of tearfulness which has gone on longer than the first few days after giving birth, but is nothing serious. You are getting a lot of from your friends and family. You • laugh at things as per normal • look forward to things • know things not your fault even if get on top of you • are sometimes anxious I worried but normal • are sometimes panicky, but no more than normal • are coping quite well • have no problem sleeping • are not sad a lot • cried a little first few days, then perked up, then started again; not a lot, but it's there • have never thought of harming yourself.

You are a 45-year-old patient who has pericarditis. You are anxious and have the following: Sharp chest pain, central retrosternal, worse on deep inspiration, change in position, exercise and swallowing, pericardial effusion may cause dysphagia by pressing the oesophagus. At the appropriate point show the doctor the ECG.

Listening template 115

Listening template Unitl

page4

Names

IPatient Doct or:

Sequence of events

Place: Description ofthe event:

Reaction to the event:

Before the event:

After the event:

Past events:

116 Speaking activities

Student B

Unit 7 p.69

Unit 1 p.7

Choose one of the pictures and show it to the doctor at the appropriate moment.

You are the husband I wife of a 50-year-old male I female whom you witnessed collapsing at the entrance to a cinema. The onset was sudden; there was pallor and sweating, rapid recovery, flushing, no nausea, arrhythmia, no incontinence; several similar episodes previously. Add any further information from your own medical knowledge. Possible diagnosis: cardiac syncopal event, but need to rule out other possibilities.

Unit 3 p.23 Your notes

of

4SJeaYf P.je -male I fouw.le~ hue I ~ Uj~ rtMUte1} ~ Mtide luu-d

roa.d? uuc_'t >-tot /uu to r-tMt1 Lowe-r back M wdt I tr~ :for uw.,r~

audibie;-of

Unit 9 p.85 You are a 40-year-old patient who presents with atrial fibrillation. You are anxious and have a slight chest pain w ith palpitations and dyspnoea. You fainted before you came to the hospital. At the appropriate point show the doctor the ECG. r-r-

Unit 5 p.42 You are Mrs Chaplin. You gave birth to a baby ten days ago. You present to the GP's surgery with a little bit of tearfulness which has gone on longer than the first few days after giving birth. You are getting no from your friends and family and you are feeling panicky. You • don't laugh at things as per normal • look forward to things, but definitely less than before • know things not your fault even if get on top of you but sometimes reproach yourself • are often anxious I worried • are sometimes panicky, but more than normal • are not coping well • have problems sleeping • are miserable a lot of the time • cried a little first few days then it got worse • are unhappy and crying a lot • have never thought of harming self or the baby.

-"

I I I

Speaking checklist 117

Speaking checklist Unit3 UnitS UnitS UnitS UnitS Unitg UnitlO

page 26 page 39 page42 page77 page 80 page 85 and 88 page 93

Date:

Candidate:

Criteria

Grade*

1

2

3

4

5

*Grades A Good B Satisfactory C Needs improvement

This Page Photocopiable ©Oxford University Press

Comments

118 Grammar reference

Grammar reference Unit1

We can use time markers such as when or after to link actions. Be very careful about the tense you use.

Rapid tense change

I was cleaning the windows when I slipped and broke my leg. or When I was cleaning the windows, I slipped and broke my leg.

When describing a series of actions, it is very important to convey accurately the sequence of events. It is helpful to that the Past Continuous and Past Perfect Continuous provide a background to other actions. Past Continuous: I wa s lifting a box ... =Subject+ Past Simple of be+ -ing form Past Perfect Continuous:My mother had been f eeling dizzy for a few days. =Subject+ Past Simple of have+ been+ -ing form We often u se the Past Simple for events that interrupt other actions or which are connected to a context that has been provided.

NOT

J clefl1'!eci the 'Ni1'!6le>vs whe1'1 I slipped fl1'!ci13roke

~

After I had rested, I felt better. He doesn 't anything after the am-bulance arrived.

Note the use of the comma when after or when come at the beginning of the sentence.

Comparative and superlative adjectives and adverbs Comparative and superlative adjectives

Past Simple: I was lifting a box when I fell over. My mother fa inted this morning. She had been feeling dizzy for a few days.

Short adjective

It is common to use the Past Simple to describe a series of consecutive events. We often use words such as suddenly and then to provide continuity.

Adjective ending in -e

I got on the bus and then I sat down. Suddenly, I felt sick.

We use the Past Perfect to refer back to an earlier action that is finished. Past Perfect: My father had fallen earlier that day. = Subject+ Past Simple of have+ past participle We use the Present Perfect to talk about something that happened at anytime in the past up to t he present moment. Present Perfect: She hasn 't eaten anything today. =Subject+ Present Simple of have+ past participle

Adjective

Comparative Superlative

+ -er I -est

short

shorter

the shortest

+ -r I -st

large

large r

the largest

double the wet Short adjective consonant+ ending in -er I -est vowel+ consonant, except -w

wetter

the wettest

Adjective of two or more syllables

more modern

the most modern

more l most modern +adjective

expensive more expensive

the most expensive

Adjective change -y to lively ending in -i + -er I -est consonant +-y

liveli er

the liveliest

Irregu lar adjective

good

better

bad far

worse farther I further

best worst farthest I furthest

We use the Present Perfect Continuous to talk about something that has happened continuously or repetitively from a point in the past right up to the present. Sometimes, we can use either a Present Perfect or a Present Perfect Continuous form. The important thing to is that the latter emphasizes the continuous aspect of the action.

Comparative adjectives

Present Perfect Continuous: She's been having dizzy spells for some time now. =Subject+ Present Simple of have+ been+ -ing form

We use than after the adjective when directly comparing two things. In the UK, this treatment is m ore expensive than in the USA.

Grammar reference 119

We can also use less+ adjective to mean the opposite of more. The injury is less serious than we thought. NOT

TA.e il'ljliry is less serioblser ...

We use more and less before nouns. Note that it is more correct to use fewer rather than less before countable nouns. There is more information available now, and more people expect a full explanation. In the past, there was less information available, and fewer people expected a full explanation. We use (not) as ... as to describe two things or situations that are (not) the same as each other. The outcome is as good as it possibly can be. The medication isn't as strong as the one you were taking before. Superlative adjectives

We don't use than after a superlative adjective. Rest is the best treatment we can offer him. The superlative forms of more and less are the most and the least. This is the most serious case I've seen. That hospital has the least up-to-date facilities in the region.

Present Perfect

We use the Present Perfect to talk about something that has happened recently. We sometimes use just to emphasize a very recent event. The patient has {just) discharged himself You haven't broken your arm. =have I has(+ not)+ past participle

We also use the Present Perfect to refer to a time span from any time in the past up to the present. He's broken his arm several times. =

during his life

She's fallen over twice this month.

Present Continuous

We use the Present Continuous to describe an action or situation t hat is happening now. We don't generally use the Present Continuous with verbs of perception such as think, know, sound or look+ adjective. My head's throbbing. I'm getting pains in my shoulder. His arm isn't aching as much as it was before.

=am I is I are I(+ not)+ -ing fo rm

Comparative adverbs Present Simple

We can use more, less and (not) as ... as in the same way for adverbs as for adjectives. She is shaking more violently now. He is bleeding less profusely than before. Mr Janssen's heart isn't beating as fast as it was thirty minutes ago. We generally don't use adverbs in the superlative form.

Unit2 Talking about the present There are several ways to talk about actions in the present or recent past.

We use the Present Simple to describe a state. We can use the verb be or a verb of perception, or verbs such as need or have got. The wound is ve ry sore. It looks serio us. That doesn't sound good. He needs stronger painkillers. We can also use the Present Simple to talk about a habit or repeated action. This is sometimes combined with an adverb of frequency such as-often or regularly. She falls over very easily. He doesn't take his medication every day. Do you get pains in your back? With some verbs, we can use either the Present Continuous or Present Simple with no real change in meaning, e.g. hurt, show, or work.


It hurts j ust here.

.

=It's hurting just here. The X-ray shows a hairline fracture. =

The X-ray's showing a hairline fracture.

The tablets don 't work. =The tablets aren 't working.

Saying what's necessary politely but firmly To give a polite instruction, we often use You need to+ infinitive. This is less direct, and therefore more polite, than u sing the imperative on its own.

You need to take a course of tablets. NOT

Take 6l COlHSe ojtCl/9/ets.

We can use the negative form of need to say that something isn't necessary.

You do n't need to make the appointment yourself However, we do use the affirmative and negative imperative as part of an instruction, for example combined with an if-clause.

Ask your GP if you 're concerned. or If you're concerned, ask your GP Don't wait for the pain to get worse before ing your doctor again. The expression Don't hesitate to+ infinitive without to is a fixed phrase and indicates a desire to be helpful.

Unit3 Types of questions We use different types of questions according to the kind of information we want.

Yes I no questions These are closed questions. They don't begin with a question word, and generally require a 'yec;,' or 'no' answer. With yes/no questions, we invert the subject and verb.

Have you got the medication with you? Is y ou r knee painful? Do you take your medication every day? Can you bend your arm? Wh- questions When we need to have more information, we ask open questions, often beginning with a question word such as where, what, when, how, why. The word order is the same as for yes/no questions.

What's the problem? Wh ere does it hurt? How long has your leg been infected? However, we can modify these questions to make them even more open. We can invite someone to talk about or describe something by using Can you tell me ...? or What do you think ...?

Can you tell m e how it happened? What do you thin k the problem is?

Don 't hesitate to call me. Other structures we use with an if-clause or other context are You have to I You must+ infinitive without to. On their own, they are much too direct.

If thepaingetsworse,you must I have to let us know immediately. Alternative ways of making a direct instruction sound more polite, or of making unwelcome information sound more acceptable, are You're going to have to I You 'll have to I You 'll need to+ infinitive without to.

You 're going to have to be itted, I'm afraid. He'll have to wait some time for a bed.

Note that in the sentences above, the question form is indirect. NOT

Cti.Ryou tell me WRClt is thepFOI9lem?

We can use a word such as else in yes/no or whquestions to elicit a longer reply from a patient. Note the position of else.

Does it hu rt anywhere else? Where else does it hurt? Is there anything else you 'd like to talk about?


Unit4

ought to to try to persuade someone to do something.

Giving advice and talking about expectation

You should eat more fruit and vegetables. You ought to attend all the antenatal appointments if you can.

There are several ways of talking about the best thing to do in a situation. We generally use modal verbs, which are followed by infinitive without to. Possibility We use can and may to talk about possibility. Eating certain types of cheese in pregnancy can/may be dangerous.

In the question form, we tend to only use can, as may is used more commonly when requesting permission.

You shouldn't try to do too much housework.

We can also use the negative question form Can't as a persuasive device. Can't I have an appointment sooner? Can't you refer me to a different clinic?

Note that we often use negative question forms when we are (or want to sound) less certain about something. Should n't I be taking any other supplements?

Can drinking raw milk affect the baby?

Can't exercise be harmful to the baby?

Permission

Expectation

We also use both can and may to request permission.

We also use should!shouldn 't and ought to to talk about expectation.

You can/may continue to play most sports.

In the question form, we use may to ask about a specific request, such as opening a window. We use can when we are asking about a general situation.

You should/ ought to be careful about drinking too much caffeine. You shouldn 't have more than three cups of coffee per day.

Ca n I drink any alcohol during pregnancy? but May I have a glass of water, please?

Conclusion

Necessity

We use must or can 't to come to a conclusion or make a deduction.

We usually t alk about necessity by using the verb need+ infinitive.

An epidural must be quite painful, surely?

You'llfind you need to rest more frequently. Do I need to start taking folic acid now? Oblig~tion

Obligation is a stronger form of necessity. We generally use mustlmustn 't and have to to talk about obligation.

I can't be more than six weeks pregnant.

UnitS Phrasal verbs- separable and inseparable

You mustn't do anything that risks raising your blood pressure further.

Phrasal verbs are verbs used with different particles which change the meaning of the verb, e.g. get in and get over. The meaning of these two phrasal verbs is easy to understand. Some phrasal verbs are more idiomatic, so the combination of verb.+ particle gives a special meaning, e.g. get over also means 'recover'.

Note that the question form of must is Must+ subject, but it is more common to use Do+ subject+ have to.

Some phrasal verbs have an object. Often, the verb and the particle are separable.

Do I have to have a special diet?

The surgeon pu t on his gloves. The surgeon put his gloves on.

Pregnant women must/ have to take every opportunity to put their feet up.

NOT

/',1Nst I have a special fiiet?

Persuasion

However, a pronoun always goes before the particle.

As a form of advice, we use should/shouldn't and

He took them off again.


NOT

He took offt11:em fl§flil'!.

With some ghrasal verbs, the verb and particle can't be separated. This depends entirely on the meaning of the phrasal verb. For example: get someone down =

depress someone

NOT

§et ffOVll'! someol'!e

get down the stairs

= walk down the stairs NOT

§et tl1:e ste.irs flowl'!

The negative form is didn't use to. There didn 't use to be a direct bu sfrom here to the hospital. get used to

We use get used to+ noun or -ing form to talk about becoming accustomed to a person, thing, or situation. We can use get used to in any tense, and form the negative accordingly. He 's getting used to the new rota at work. They've got used to working together. I won't get used to living in a city very easily. She can 't get used to these new uniforms.

but be used to get some food down

= eat some food These phrasal verbs have to be learnt individually.

Unit6 would, used to, get used to, be used to would

We use would+ infinitive without to to talk about a habitual or regular action in the past. When !worked at the hospital, ! would often take the train because the parking was so bad. He would get through a packet of cigarettes a day. We can use the negative form wouldn 't. When she was alive, she wouldn 't answerthe phone unless she was expecting a call. used to

We use used to+ infinitive to talk about habitual or regular actions in the past. When I was doing an early shift, I used to have breakfast at the hospital. She used to eat two chocolate bars every day. We can also use used to+ infinitive to talk about a state or continuous action in the past. He used to be a heavy smoker. NOT

He ·.vo'lllfiee e. 11:ee.vysmoker.

They used to work in my department. Tl1:ey ·.vo'lllfi work il'l my flepe.rtmel'!t.

NOT

We use be used to+ noun or -ing form to mean that we are accustomed to a person, thing, or situation. We also use be used to in different tenses. We're used to a more dynamic environment. She won 't be used to running such a large department.

Purpose and reason We use to and in order to before a clause that explains a purpose or gives a reason. In order to is often regarded as being more formal than to and can carry more emphasis when the opening clause is long. However, in many cases, they can be used interchangeably. You need to take regular exercise to I in order to improve your genera/fitness. I'll give you a prescription for some tablets to I in order to help ease the pain. Note that to I in order to must be followed by the infinitive without to. We can't introduce a pronoun. NOT You need to take regular exercise to/ il'l order to it will improve ... NOT

You need to take regular exercise to/ il'l order to

yo'll ·.viii §et better.


Unit7 Commenting on the past We often use the conditional perfect form would have+ past participle to talk about situations in the past happening differently. In informal language, we sometimes use the contracted form of have. ! would've gone to see the doctor sooner, but !was on holiday. It wouldn 't have made much difference. We can use other verbs in this structure: must have

• to talk about deduction She never picked up her prescription. She must've got better. can't have

• to talk about a negative deduction There are still patients waiting. Doctor Jarvin can't have left already. could/couldn't have

• to talk about possibility in the past or a lack of opportunity in the past It's just as well the notes mention her allergy. She could have been taken seriously ill. I couldn 't have gone to the hospital that day even if I'd wanted to. shouldlshouldn 't have

• to talk about past obligation or to advise on a course of action in the past Yo~ should have asked for clarification ifyou had any doubts about your treatment. They were quite hostile. They shouldn't have spoken to you like that. needn't have (didn't need to+ infinitive without to)

• to talk about a course of action in the past that wasn't necessary We needn't have asked the doctor to explain the condition, as there was a very helpful leaflet. Instead of needn't have, we can use didn't need to+ infinitive without to. We didn 't need to ask the doctor to explain the condition, as there was a very helpful leaflet. However, the difference is that in the first sentence, needn't have suggests that the people did ask the

doctor to explain, but it was unnecessary because they later found a leaflet. In the second sentence, didn't need to suggests that the people didn't ask for an explanation because they'd already found the leaflet.

Verbs with to and -ing Some verbs are followed by the infinitive, and others are followed by the -ing form. Verbs followed by the infinitive: These include: agree, arrange, ask, choose, decide, expect.jorget, hope, manage, offer, plan, prepare, promise, threaten, want, wish

We offered to give the man a lift to the hospital. He didn't want to see a female doctor.

Verbs followed by the -ing form These include: it (to}, avoid, carry on, consider, deny. dislike, enjoy. finish , give up, imagine, involve, keep (on}, mention, p ractise, regret, , risk, suggest He denied wasting the surgery's time. Pay attention to the position of the negative form. This depends on whether the main verb or subordinate verb is the negative element. I reg ret not telling my family sooner. N.B. this is the opposite of I don 't regret telling my family sooner. Verbs followed by the infinitive or -ing form There are some verbs that can be followed by either the infinitive or the -ing form, with no change in meaning. These include: continue, intend, like, love, mean, prefer, start, try I'll continue working Ito work here for as long as I can. They tried talking Ito talk reasonably to the man, who was being very aggressive.

124

Grammar reference

UnitS

Unit9

Relative p(onouns in explanations

The future

We often use relative pronouns to connect a series of sentences describing an activity or situation.

There are several different ways of talking about the future.

These pronouns are who, which, where, and when. The pronouns who and which can be replaced by that.

will

Who

• used for people, and can be combined with a preposition The patient, to who(m) the consent form will be given, must be sufficiently alert to sign it. Which

• refers to things, procedures, or situations. Which can also be combined with a preposition. The tube is then connected, which enables the patient to breathe normally. The patient is connected to a monitoring device, to which other tubes are attached. This is a procedure in which we remove part of the bowel. Where • ='in which'. We use where to talk about what is involved in a procedure or situation. This is an operation where we remove part of the bowel. When

•

='after which time' or ' at which point'. When describes a point in a sequence of events at which something is expected to occur. The anaesthetic is reduced and the patient taken to the recovery room, when he or she will start to come round.

Sometimes, we can omit the relative pronoun and have a participle as a connector. This is common when we are connecting more than two clauses, to avoid having a sentence that is too long and clumsy. This is a complex procedure. It is performed under general anaesthetic. This is a complex procedure, performed under general anaesthetic. (='which is performed') We're going to do a procedure which will involve major surgery. We 're going to do a procedure involving major surgery. (= 'which will involve')

We use will to talk about the future in general. Th e presentation will finish at about 4 o'clock: There won't be much time for questions afterwards. We can also use will in the main clause of a first conditional sentence. If the presentation finishes earlier, there'll be more time for questions. Present Simple

We use the Present Simple to talk about the future in the if-clause of a first conditional sentence. We also use the Present Simple to talk about future timetabled events. Dr Carlin 's train leaves London at 1.30 and gets into Oxford at 2.10. We also use the Present Simple with time expressions such as before, after, as soon as, and when. We need to make sure that everything is ready before Dr Carlin arrives. N OT

... 19cfore Dr C6lrlil'l vlill6lrrive.

When he gets here, could you let me know? N OT

Whel'l R.e will~et R.ere ...

Present Continuous

We use the Present Continuous to t alk about something that has been planned or arranged. When this includes timetabled events, it is possible to use either the Present Simple or the Present Continuous. The ceremony is taking place in November. or The ceremony takes place in November. However: We're sending out invitations over the next couple of weeks. NOT

We semi out il'lvit6ltio1'ls ...

Future Continuous

We use the Future Continuous to talk about an action that will be happening at a given point in the future . This can be part of a schedule or can be a


continuous action. However, this tense must always be used with a time reference. Will the doctor be starting her rounds before 10.30? This time next week, you'll be flying back to the USA.

We use the when there is only one of the thing we're talking about. The government is cutting spending on health.

(=the government of a particular country)

= Subject+ will+ be+ -ing form The sun is a major source of vitamin D.

Future Perfect

We use the Future Perfect to talk about an action that will have finished at a given point in the future. Dr Singh will have finished his rounds by lunchtime.

=Subject+ will+ have+ past participle Will he have left intensive care by then?

Future Perfect Continuous

We use the Future Perfect Continuous to talk about an action that leads up to a given point in the future. The action isn't necessarily finished at that future point. This is a long presentation. Byfive o'clock, Dr Schwartz will have been talking for an hour and a half

(=it's possible that Dr Schwartz will continue beyond five o'clock) =Subject+ will+ have+ been+ -ing form

a, an

We use the indefinite articles a and an before singular countable nouns when it isn't necessary to make clear which particular thing we are talking about. We need to make a decision about the future of this unit.

(= any decision) Compare with: The decision was not very popular.

(=the decision that was eventually made) A number ofpeople have presented with the same

symptoms.

(=several)

Unit 10

Binge drinking is the major cause of liver disease. (= it is a significantly greater factor than other possible causes)

The definite and indefinite article

zero article

The rules for using the, a, an, or zero article are as follows:

We use no article (zero article) before plural or uncountable nouns when we are talking about something in general.

the

We use the definite article the before singular or plural countable nouns when we want to make it clear which person or thing we're referring to. The disease is spreading very quickly.

(=a specific disease, which we have talked about in a previous sentence) The number ofpeople being itted to hospital with 'flu has increased dramatically.

(=a specific quantity) Binge drinking is a major cause of liver disease.

(=there are other factors , but we don't know how significant they are)

Disease is a majorfactor in early mortality in many developing countries.

(=disease in general) People need to be informed about safe levels of consumption.

(=people everywhere) Compare with: The people who drink and smoke to excess are the ones who cost the government most.

(=a specific group of people) Governments are looking to reduce health costs.

(=the governments of several or all countries)


Unit 11 Linking words There are several ways of linking ideas within sentences and between one sentence and the next.

The patient is taken into recovery. After this, he or she is returned to the ward. next

Next is similar to after that. However, we tend to use next at the beginning of the sentence.

when

Next, the patient is returned to the ward.

When refers to a particular time or stage in a process.

once

When a person is bitten by the tsetse fly, he or she may experience symptoms such as fever and headaches.

At a later stage, sleeping sickness enters a neurological phase, when the parasite es through the bloodbrain barrier. where

Where expands on a process or procedure. In a biopsy, where a sample of tissue is removed for further testing, the patient is often given only a local anaesthetic. Where can also describe a location. The camera is inserted into the stomach, where it is able to take images of the lining. then

Then introduces the next stage in a process or

procedure. Look at how the punctuation is used. Then, the parasite enters the blood and lymph systems. The lymph nodes then swell up. If left untreated, other symptoms such as anaemia will appear, and t hen the disease enters a neurological phase.

Once as a time reference must be followed by a clause. It means that the next stage of the process can't begin until the previous stage is completed. The second stage follows on immediately. Once the patient recovers, he or she is taken back to the ward. NOT

Orwe, ti'tept~tiel'lt stt~rts te recever

The Present Simple and Present Perfect can be used after once with no real difference in meaning. Once the patient has recovered, he or she is taken back to the ward. as soon as

A s soon as is similar to once in meaning and use. However, as soon as+ Present Simple suggests that

two stages are happening almost at the same time. As soon as the patient comes round, let me know.

As soon as + Present Perfect suggests that the first

action is completed before t he second one begins. As soon as the doctor has consulted with his colleague, he will speak to you.

after tha t

Unit 12

After that is a general term, signalling the next stage

Negative questions

in a process or procedure. There is no indication of how much time has ed between the two stages. Its meaning and use is similar to then . We can say after that happens to refer more specifically to an action that has just been described. The disease had practically disappeared between 1969 and 1965. After that, screening and surveillance were relaxed and the disease has now returned. after this

After this is slightly more specific than after that, and

means more immediately after the last point or stage made. We can also say after this happens.

We often use negative questions to avoid being overly direct when making a demand or criticism, or when reminding or persuading someone to do something. The choice of a negative question can suggest that the speaker has expectations and wants to avoid a direct 'yes' or 'no' response. A less direct question can also show that the speaker is trying to avoid criticism. For example, beginning a question Isn 't the consultant going to be talking to my daughter? is much less assertive than Is the consultant going to talk to my daughter?


• The most straightforward type of negative question is one that appears to be requesting information. Aren't these tablets very expensive? The speaker knows that they're expensive and is checking that this is understood. Compare with the more open affirmative question:Are these tablets very expensive? When we expect something to have happened, we can use the negative form Haven't I Hasn't. The addition of yet makes this a stronger criticism. Haven't they found my records yet? • A question beginning with Can't or Couldn 't is an attempt to persuade a person in a decision-making role to agree to their demand or request. The choice of an affirmative question would risk inviting a 'no' response. Can't I Couldn't I (just) call in and get the results myself? An alternative is Wouldn't it be better ... ? Wouldn't it be better if I phoned the hospital myself? • We often convey shock or surprise as well as criticism by beginning a question with Shouldn't. Shouldn't you have told us about this sooner? It would not make sense to begin this question with Should . The speaker is implying that the other person is acting irresponsibly. We could also use Couldn 't here, to indicate that it was within another person's capacity to do something. • To remind someone about something, we can use Didn't you say ... ? This is followed by an indirect speech clause, but ends in a question mark. Didn'tyou say that I would be near the top of the waiting list?

128 Listening scripts

Listening scripts Unit 1 Listening 1 D = Doctor, P = Patient D Hi, Mr Stone, I'm Dr Tariq, one of the

doctors in A&E. How are you? P I'm OK, but I'm a bit worried about my

wife. D Your wife's OK.

P That's good. D Amir, one of the paramedics, says you

P

D

P

D

P

D

P D P

D P

were walking along the street when your wife collapsed. Can you tell me a bit more about what you actually saw? Mmm. Yes, sure. We were shopping in Cambridge Street in town, when suddenly Barbara, my wife, just fainted . Mmm, we tried to get her upright and she started twitching quite violently. It was quite scary. Yes, it certainly can be, but it can happen when people faint like this. Did anything else happen? No. Nothing at all. She came round very rapidly. But we dialled 999 and a paramedic appeared almost instantly and then the ambulance almost immediately afterwards. Do you think she had a seizure or something like epilepsy? We don't think so. But can I ask you a few more questions? Did she complain of anything before that? Mmm. She had been complaining of feeling a bit unwell, and had almost fainted and she felt a bit woozy? She ... yes, er... she was a bit dizzy and she was yawning repeatedly and then all of a sudden, there she was, lying on the ground. Anything else? Was she ill or anything before she fell? No. Just tired. What about her eyesight? Nothing, but she said her hearing was a bit funny- she wasn't hearing clearly. Any vomiting? No.

D When she fell, how did she fall?

P She just crumpled to the ground slowly. In fact, it all happened so abruptly and silently I didn't realize it had happened. D So she didn't cry out or anything? P No, there was no warning sign at all. D Just a few more questions. P OK. D Has she ever had anything like this before? P When I come to think of it, she ed out once before about a month ago. She hasn't been feeling well off and on over the summer. We thought it was the heat. D At the moment it looks like ...

it most probably made the difference between life and death. Dave emphasized the importance of quick intervention when someone suffers a cardiac arrest and took the opportunity to remind of the public that they can learn cardiopulmonary resuscitation- or R -at free 'Heartstart' classes given across the capital by the London Ambulance Service and ed by the British Heart Foundation. Effective R buys time for a patient and doubles a person's chances of survival.

Unit 2

Listening 2

Listening 1

Gary Edwards, a British Airways customer service arrivals agent, had been sitting with his work colleagues in a rest room at Heathrow Airport's Terminal One when he suffered severe pain in his chest and arms. Within seconds, he lost consciousness and stopped breathing. His British Airways colleagues immediately dialled 999 for an ambulance and began attempts to resuscitate him.

D = Doctor, P =Patient

All he can is that he had got up from the sofa and said to his colleagues that his chest and arm hurt. After that, everything went blank. Within seconds of the 999 call being made, cycle paramedic Dave Parks reached Mr Edwards. Dave was able to continue resuscitation and re-start Mr Edwards's heart after three attempts using the portable defibrillator that is carried on ambulance bicycles. Paramedics, dispatched in an ambulance at the same time as the bicycle ambulance, arrived a few minutes later to continue treatment and took Mr Edwards to hospital. This resuscitation shows how well-suited bikes are to reaching patients quickly inside the airport. As they are based at the airport and were able to get to him so quickly,

D You look as if you are in quite a lot of

pain. P Yes, I think I've hurt my hip badly. It's

giving me a lot of pain. D I think we need to get you some

P

D P

D

painkillers. So ... can you tell me a bit more? Oh, I slipped on the kitchen floor. I must have spilled some water and I was coming into the living room with a cup of tea and I just went down on my bottom and twisted my leg. Oh, dear. That sounds bad. It was. I couldn't move. Fortunately, I had my mobile in my apron pocket and I phoned my neighbour who had the key to come in. She called an ambulance. Falls like this happen so easily. You may just have pulled a t out of place rather than breaking anything.

2

D What's brought you here today?

P My wrist is really hurting. I think I've

broken it. D OK. How did it happen?

P Well, I was coming out of a shop and

I was trying to avoid someone and I didn't notice the paving stone was

Listening scripts 129

raised and I just tripped and of course I put out my hands to protect myself and break my fall. My wrist took the full force of my fall. D It certainly looks quite bad, yes. I think we need to do an X-ray. 3

D =Doctor, F =Patient's father D What's happened here? F She fell down from a tree at school and they called me and I came here from work as the ambulance was bringing her here. D Oh, I see. F She's crying a lot and I think she's fractured something in her leg. D She may not have broken anything, but let's have a look at her. Language spot

1 So you've taken some painkillers, but they don't work, and your arm's still hurting you just here. 2 My toe is throbbing with pain. I don't know what I've done. It looks as if it's broken. 3 He's had several falls recently and he has several fractures, but he's not crying a lot. Listening 2

As health professionals, we give advice about healthy lifestyles, which should include accident prevention. When we use tf'te word accident, it seems to imply that accidents are unavoidable. It is true that we do not live a life free of risk, but the danger of accidents can be minimized by simple precautions ... and thinking ahead. We can, for example, make patients aware of the potential for risk. All risk situations including those in the home or garden, in the workplace, on the road, or during leisure activities such as hillwalking or mountain climbing should be treated with due respect. People need to be reminded to think of others, especially children and the elderly. Once an accident has happened

it is too late to go back and take precautions. There are many simple pieces of advice that can be given to prevent accidents in the home like fitting stairs with banisters or rails and making sure that halls and stairways are well lit. Encouraging people to climb up only on something firm and strong can help reduce the risk of falls. Another thing to avoid is loose rugs and flooring in order to reduce the risk of slipping or tripping especially when old people or children are around. And if small children are about, ponds and swimming pools in the garden need to be covered. DIY at home or home improvements is another area with potential for accidents. When using power tools, people need to be encouraged to use adequate protection including sturdy shoes, gloves, and goggles.

Unit 3 Listening 1

D =Doctor, P =Patient Conversation A

D So what has happened to you, Mrs Skinner? P Well, I've hurt my hand. D Right. When did it happen? P I've had it since the week before last. D Hm, where do you get the pain? P Here on the heel of my hand. D Is that both hands? P No, just this one. D And have you taken anything for it? p I've tried painkillers and that, but they haven't worked. When the tablets wear off, it's still there. I don't have a touch of arthritis, do you think? D At this stage it's difficult to say. It's something we have to try and rule out. But can I just ask you what you think caused it? P I don't really know. D Anything at work?

P I don't know. It may be the work. I type a lot. D OK. So you sit at a desk all day. P Yes. D Mm. Now the pain, does it ... ? Conversation B

D So what has happened to you, Mrs Skinner? P Well, I've hurt my hand. D Tell me a bit more about it. p I've had it since the week before last here on the heel of my hand, and I'm finding it difficult to work and also to go to the gym. I've tried painkillers and that, but they haven't worked. When the tablets wear off, it's still there. I don't have a touch of arthritis, do you think? D At this stage it's difficult to say. It's something we have to try and rule out. But can I just ask you what you think caused it? P I don't really know. It may be the work. D Can you tell me when it is worst? P Mmm. When I'm at the gym, when I'm typing, and when the boss is around! D Yes, I can imagine the boss making it worse. You mentioned the gym. P Yes. D Do you go a lot? P Yes, I do. D I'd just like you to put your arm ... Listening 2

D = Doctor, P = Patient D Alexander, you've had quite a bang on your head. P Yeah, and I'm surprised I feel OK. I thought it might give me a really bad headache or something, but I really feel fine. I'm just a bit shaken, really. D Yes. These things can knock you quite a bit. You still need to be careful over the next twenty-four hours, even though you feel fine . P What? You mean I have to stay in the hospital?


D Oh, no, you don't need to stay in

P

D

P D

P D P D

P

hospital, but we need you to look after yourself and rest for the next twentyfourhours . Rest? But I can't. I have to go to my best friend's party this evening. I just can't miss it. He's getting married tomorrow. But I'm afraid you do need to be careful. And you need to have someone to go home with you and stay with you for the next twentyfour hours as well. But I feel OK. I mean, why all the fuss? Yes, you may feel well, but some things may develop afterwards. Like what? You may get a headache. Well, I can take a paracetamol. Yes, but other things could happen like blurred vision or vomiting. OK, but I can come back if anything goes wrong.

Pronunciation

2

3

4

5

6 7

Can you tell me a little bit more about how it all happened? But if your child's mood changes in any way, make sure you us immediately. But I can't. I have to go to my best friend's party this evening. But I'm afraid you do need to be careful. I'm not sure but I think I've torn a ligament in my foot. It's swollen and I can't get my shoe on. I've had it since the week before last, here on the heel of my hand. And you need to have someone to go home with you and stay with you for the next twenty-four hours as well.

Unit 4 Listening

D = Doctor, P = Patient

Exercise 4 D Good morning, Mrs Canterbury. How

P D

P D

P D

P D

P D

P D P D

are you enjoying this fine weather we're having? I love it. It's been the best we've had for a long time. Yes, it's been remarkable. Let's hope it continues. Well, I think it may. Yes. It looks like it. So, what can we do for you? Mmm, well, doctor, it's not really trouble, I think ... I think I'm expecting. Ah, I see, and are you happy about that? Oh, yes, we've been trying for ages. OK. Well, let's take some details. Can you when your last period was? Mmm, not exactly, but probably about six weeks ago. So you think you've missed one? Yes. I'm as regular as clockwork. Any other changes you've noticed? Er, I do feel a bit sick most mornings, and my breasts feel a bit tender. Right, if I give you a little bowl, can you just pop to the toilet and bring back a sample for me?

Exercise 5 D Well, congratulations, Mrs Canterbury,

P D P D

P

you were right, you are expecting, and if your dates are correct you're probably about four weeks gone. Oh, so the baby'll probably be born in October. Around then, yes. We'll be able to be more precise after you've had a scan. When will that be? It's usually done at about twelve weeks. By that time we can usually get a clear picture of the baby. Now, I take it you'll have your baby in hospital? I haven't really thought about it.

D Well since it's your first, it's probably

best. We'll check your details later and sort out the hospital. P So you'll let me know which hospital it'll be? D Yes, that's right. Now I just want to ask you a few questions about your lifestyle. Do you eat sensibly? P Generally yes, though I do skip meals sometimes when I'm rushect. D Well, it's very important now that you make sure you eat nutritious food regularly. P I realize that. Urn, does it matter what I eat? D Yes, there are certain things you need to steer clear of, like shellfish and soft cheese. You don't want to risk any kind of food poisoning. Now what about alcohol? P A couple of glasses now and then, but I haven't been on a binge for ages. D Good, well keep it that way. Alcohol should really be avoided in pregnancy, but the occasional drink will do no harm. Do you smoke? P Occasionally, but it's not a real habit. D Well, try to cut down, if not give up altogether. With a growing baby inside you, you need to be very careful what you are putting into your body. Are there any questions you'd like to ask? P No. D And congratulations, Mrs Canterbury. P Thank you very much. Pronunciation

At vaginal hysterectomy, the uterus is brought down through the vagina. 2 What happens is the womb is brought down through the vagina. 3 Pre-eclampsia is pregnancy-induced hypertension with proteinuria with or without oedema. 4 It's a condition where the blood pressure is raised with protein in the urine and possibly swelling. Normal labour is often heralded by a show.

6 When an induction is being planned, the state of the cervix will be assessed. 7 Ankle swelling is very common when you're pregnant. 8 It tends to worsen at night? Well, if you use a firm mattress and wear flat shoes, it will help.

Unit 5 Listening 1

He's Caucasian, around about fifty years of age. His clothes are very extravagant with lots of clashing bright colours. But he is not very clean in himself, and he doesn't look as if he's eating properly. It's the first time that I've seen the patient, but he looks just a little thin. He's not very aggressive, just elated and is talking rather fast. There is copious rapid speech, which is hard to interrupt. He talks at a much faster rate than normal, which may reflect the acceleration of speed of thought in affective illnesses. The patient stutters slightly and speaks rather loudly. His speech has a rhythmic pattern and he uses a range of intonation patterns appropriately. The speech is appropriate to the situation, though it is fast. It is at times pointless with digressions. There are no word-finding difficulties nor any neologisms. Pronunciation

1 I can laugh at the problems I have. 2 It's difficult to distinguish one day from another at the moment. 3 Of course I care for the child. 4 I'm not trying to hint at anything. 5 She insisted on going home. 6 I sometimes blame myself for the day-to-day problems. 7 The child depends on me for everything.

way and down she goes. I don't know how she hasn't hurt herself at all.

Listening 2

D = Doctor, P = Patient D Now, I want to ask you about some experiences which sometimes people have but find it difficult to talk about. These are questions I ask everyone. Is that OK? P Yeah. D Have you ever had the sensation that you were unreal or that the world had become unreal? P It's like ... I don't know how to explain it. It's ... I suppose it's like being in a play somehow. That maybe sounds as if I'm going mad. D Have you ever had the experience of hearing noises or voices when there was no one there to explain it? P Yes, sometimes. D Is it OK to talk about this further? P Yeah, if you want. D When did it happen? P The last time was a couple of days ago. D Were you fully awake? P Yeah, it was during the day. D How often has it happened? P Recently only once or twice. D And where did the sound appear to come from? P I don't know. From someone in the room.

Unit 6 Listening 1

M = Man, D = Doctor M She used to be able to get around quite easily. In fact, she would often go out all over the place in the bus. And I think she finds it difficult getting used to the changes in her life. But now she says that she gets a bit muzzy in the head when she's standing at times and then when she manages to sit down it all es. D Has she fallen at all? M Mmm, yes. Sometimes she doesn't make it to a chair and her legs give

2

M = Man, W = Woman M It was really exciting, the whole experience. But I'm not sure I'd want to go through it that often. W How many people were there? M Five or six others, I think. They were very high calibre. A couple of them had years of experience working in care of the elderly. One used to run a geriatric hospital in his own country. I don't think I stood a chance. 3 W =Woman, M = Man W There are a couple of things that could be done to help this patient. We could get in occupational health to get things like a perching stool installed and grab rails. M Yes, and also flooring and lighting. And I don't think all the clutter helps. As the place is full of rubbish, small changes like that will help a lot. 4 D = Doctor, C = Consultant D And apart from the expression there are other tell-tale signs like difficulty in swallowing, a decrease in the blink rate, and lead-pipe rigidity. C Did you pick up anything else with this patient? D Mmm ... the handwriting. C What about it? D It was really small. His wife said in the past he would write very long elegant letters and now ...

Listening 2

D = Doctor, P = Patient D Can you tell me how it affects you, Mrs Day? P I don't know where to start. I feel tired a lot of the time because the pain keeps me awake at night. And at work I can't sit for long. I have to get up and walk around. At work, people don't know how bad it is and it upsets me when they make comments.


D Unfortunately, unless people have

things like this themselves, they don't realize how bad"it is. P No, I'm afraid not. D Is there anything else? P Mmm ... it stops me doing certain things ... like I can't catch the bus, because I'm afraid offalling if the bus suddenly jolts, and I can't really go out and enjoy myself. D What about the tablets your GP prescribed? Have you been taking them? P Not really. Sometimes. D Sometimes. P Yeah. D Can you tell me why that is? P I don't like taking them in case I get hooked or anything like that or in case they affect my stomach. D But when you do take them, do they help? P Yes, for a while. When the pain is so bad I can't bear it, I take them. D So you take them when the pain's intolerable. P Yeah. D Have you been doing any physiotherapy? P No, not really. D What about exercise? P When I start to do anything it hurts a lot. So it puts me off. D Well, you know, to help improve your strength and build up your muscles, exercise like swimming really helps.

Unit 7 Listening 1 D = Doctor, P = Patient D Good morning, John. How are you

today? P Fine, doctor, except for the weather! D Yes, it's a bit uncomfortable at the

moment. We're not used to the heat. We want it, but when we get it, we can't cope. P Yes, you're right there. We're never happy.

D So what can we do for you? P Well, I've got this rash with big

wheals all over. And it's quite itchy and getting worse. D Oh, yes. It does look quite dramatic. Can you tell me some more about it? P Well, I just suddenly came out in it last night. It started on my back and then it just spread. I put some lotion on it, and it helped for a while ... and then I thought they are getting so bad, I'm itching all over. And with the heat it's unbearable. D So you have them everywhere? OK, we'll have a look in a moment. But can you just tell me ... you said you used a lotion? P Calamine lotion. It was all I had, and then this morning I came straight here. D You said itching. Is there any pain with it? P No, just itching. D OK, just itching. Have you had it before? P Yes, once I had it, and I came here and they gave me some antihistamine, and it went away, but it wasn't as bad as this. I should've kept the name of the tablets or kept some as they helped before. They just seem to be spreading all over. D Were the tablets Piriton? P Yes, I think they were. D OK. Is there anything you think that might have triggered this? P Not that I'm aware of. D Pets? P I don't have a pet, and I haven't been near any. D What about drugs? P No, I'm not on anything. D Are you aware of being allergic to anything? P No, I don't think so. Listening 2 D = Doctor, P = Patient D

OK, thank you. You can put your shirt back on again.

P OK. D From what I can see it's acne. P Can you do anything for it? D Oh,yes. P That's a relief. D Has this been upsetting you? P Yes, a little. D Can you tell me how? P I get teased at college about it, and I

don't like going out as people look at it ... and I think it's dirty. And it keeps getting worse. I've tried cutting out certain foods , but nothing works, and using different creams and stuff. D Well, I can assure, it's nothing to do with being dirty. And it's more common than you think. You are nearly seventeen now? P Yeah. D Well, the peak age is about eighteen. And diet doesn't affect acne either. P Ah,OK. D But the creams you've been using might just make it worse. P Mmm, yeah, I shouldn't have used them. I should've come here. D Yes, but you're here now- that's the main thing. P Yeah. D So what we need to do first is to reduce the number of spots. P OK. D Acne's nothing to do with poor hygiene, but if you wash twice a day and then put on a moisturizer like aqueous cream, that will help. P Aque ... D Aqueous cream. It's this. It comes in tubs like this. And cream here. I'm going to give you some creambenzoyl peroxide- to put on twice a day and this antibiotic cream. I take it you are not taking antibiotic tablets or capsules. P No,I'mnot. D Now, I must point out that these can take weeks to work, so you need to be patient. P But they will go away?


D We will certainly do our best to

P D

P D

P D

P D

make sure they do. Do you think you'll be able to keep going with the treatment? !think SO. Would you like to see the nurse who can go through it with you? Yeah. And I'm going to give you this print out from an acne group. It's got their website on it. You can check it out. OK, thanks. So you think you'll be OK with this? Yeah, I feel better. OK. You can take this prescription and make an appointment to see the nurse and come back and see me in a couple of months, but if you need to come back sooner, by all means do.

Pronunciation 1 I should've kept on using the cream

2 3 4 5

6

7

you gave me. I should've taken it all more seriously. I have to say I regret not applying the cream now. I shouldn't have put anything on it as that's what's made it worse. I meant to get up and do it first thing in the morning but I didn't. I must've picked it and made it bleed. I stopped using it because it made my skin itchy.

UnitS

Listening 1 D = Doctor, P = Patient D Good afternoon, Mr Blackstone. My

name is Dr Petrov. How are you today? P Fine, thank you, doctor. D You're coping with all this rain we're

having? P Yeah. It's a bit much at the moment. D Yes, it's slowing down everything.

Right. I see from your GP's letter that you've got a hernia. Am I right? P Mmm. Yes. I've got this swelling in my groin. D OK. Can you tell me about it? P It's just down here in my groin on the right side. It's been there for about three or four months now. It's a bit uncomfortable when it is sticking out; I'm aware of it. I try to sort of put it back in, but it only happens when I'm lying down. I'm a ... I'm a driver so I sometimes have to do a lot of lifting and that. D You said the hernia pops back in again when you're lying down? P Yes. D Has there ever been any time when it's stayed out? P No, though sometimes it takes its time going back in again. D Hm, right. OK. Shall we have a look? P OK. D OK, as your GP says, you've got what

P D

Pronunciation

laparotomy 2 nephrectomy 3 colostomy 4 hysterectomy thoracoplasty 6 mastopexy 7 cystorrhaphy 8 cholecystectomy 9 pyelolithotomy 10 colopexy

P

P D

P D

is called an inguinal hernia. Mm-hm. Do you know what a hernia is exactly? Not really. You can get a hernia like you have where there is a weakness in the membrane or the lining that holds in all the gut. Part of the gut then sticks out at the weak point and forms a bulge, which is what has happened here. Let me just draw it for you. OK. I ... I see. Can you fix it? Yes. We can do an operation called a herniorrhaphy, where we repair the weak part of the gut using a special

D

P D

P D

P D

mesh. What we do is make one or two small holes in your tummy, one around the belly button and the other on the left side. It's a day-case surgery, so you'll be in and out quite quickly. How do you feel about having the operation ? Oh, yeah, no problem. Will I be put to sleep? Well, we can do this under a local anaesthetic or general. I don't fancy being awake and hearing and seeing everything. Yes, I can understand why you wouldn't want that. It can be a bit off-putting to some people, but we'll see what the anaesthetist has to say when he does the assessment. Er, we'll need you to sign a consent form if you're happy with everything when you come for a pre-operation assessment. Yeah. I'm OK with that. Is there anything you'd like to ask me? Mmm, er, what about the pain? We can talk about the pain at the assessment.

Listening 2 D = Doctor, P = Patient D Would you like me to go over

anything again? P No, I don't think so. D Do you feel OK about g the

form? P I'm not sure. I'm a bit worried about

what might happen afterwards. It's a big step and a bit drastic. I'm ... I'm not sure I want to go through with it. D Would you like some time to think about it and perhaps talk to other women who've had their womb removed? 2

P Can't you squeeze me in at all today?

This is the second time this has happened. D I'm afraid we can't. There's an emergency, and there're no beds available.


P But the same thing happened the last time. D Unfortunately, yes, it did, but the situation's unavoidable. P OK. Can you gu arantee this won't happen the next time? 3 P Will they come back? D I'm afraid we can't guarant ee they won't. P Is it common? 4

D I can see you're a bit apprehensive about this. P I am, yes. D What are you worried about in particular? P Well, a number of things. Feeling pain, seeing what's going on, hearing everything, and the smell. If I'm awake, will I feel any pain? D No. You won't feel any pain, but you'll feel your insides being touched. P And what about seeing what's happening? 5 A =Anaesthetist, P =Patient A Have you had a general anaesthetic before? P Yes. A Recently? P No, not for a couple of years. A Did you have any problems with the anaesthetic? P No, nothing. But I don't like having general anaesthetics.

Unit 9 Listening 1

W = Patient's wife, D = Doctor WHe's not very well at all, is he doctor? D He's actually OK. He's a bit more stable. WThat's a relief. D I just need to ask you a few quick questions . Can you tell me what happened? WWe were sitting at home and he started getting this pain in the centre

of his chest. He'd had it several times before and he used the spray thing he's got. D The GTN spray? WYeah ... yeah that's it. And so he gave himself a few puffs but the pain wouldn't go and I could see that he was getting breathless and agitated and he said he felt sick. He started vomiting a little ... and he was beginning to sweat. And he said he thought he was going to die. D OK. So can you tell me what time that was? WWell, I called for an ambulance at sevenish and it came like a shot, ... so it was less than an hour ago in total. D So has he had any other pain? WHe said the pain was in both arms.

time. For the moment he just needs a bit of rest. Pronunciation

2 3 4

5

6

7 8

D Your husband is doing very well. It's good you got him straight into hospital, but I need to ask you a few quick questions. WOK. D Has your husband had any injuries or any other major illness? WNo. D Any bleeding? WNo. D Any major surgery? WNo, nothing like that. D Anything else you can think of? WNo. Nothing. D OK. What we're going to need to do, with your consent, is to give your husband something to help get rid of any blood clots. There is a risk of stroke with the procedure, and ... ... but the benefit can be dramatic if we get it down quickly. It can have a considerable effect. There doesn't seem to be any reason why he shouldn't have the medication, but we need to give it as soon as possible and we need your consent. WOK. Can I just ask ... D By the looks of it, it's all gone very well and he'll be up and about in no

He'll have been in the theatre for over three hours in a few minutes' time. Dr Nur isn't starting his clinic till two p.m. He'll be in and out in no time. All being well, he'll be able to go home by the weekend. The operation's scheduled for five this afternoon. You're having the veins on the right leg stripped this afternoon, am I right? The doctor said I'll be having a general anaesthetic. He'll have been coming to the clinic off and on for the past three years.

Listening 2

D =Doctor, P =Patient D OK, Mary. Your blood pressure is quite high, one-forty over eight-five. I think the last time it was fairly normal. P Yes, it was. That was about a year ago. D Mmm, it was a year ago last July. P At least I've been healthy all this time, apart from these headaches. D Yes. Well, everything else seems to be OK, so there may be no other cause. I'll run a few tests just to make sure that your kidneys, etc. are OK and we can refer you for an ECG at the hospital. P OK. D Is there anything you think might be the cause of the high blood pressure? P Well, since I took early retirement I've been less active and I've put on quite a bit of weight. I used t o be quite active, but I've let things slip a little. D So when did you retire? P About a year and a half ago. D Do you know how much you weigh now? P Mmm, I weighed myself about two weeks ago and I was a hundred and twelve kilos which for my height I think is quite heavy, I know.


D OK, let's just check your weight and

height. D For your height, which is five foot

P D

P

D

P D P

D

P D

P D

P D

eleven inches, or about one point eight metres, your weight which is now a hundred and fifteen kilos is quite high, if you look on this chartit should be somewhere here. Oh. That is quite a lot over. I do need to get it down. Yes. I see from your family history, your father had heart problems and there's a family history of heart disease. Yes, on my father's side, all his brothers and sisters had problems with angina. If nothing shows up in the tests, you seem to be generally quite healthy, but the problem is hypertension, which can lead to other problems. Mmm, I'm aware of that. Do you think you can get your weight down easily? I can try. Well I just have to ... somehow. Did you do any sport before? Well, I used to swim and walk a lot. Have you thought of starting up again? Yeah, I suppose I could. You'll feel the benefit of it quite quickly and if you're careful with what you eat, you'll be back to what you were before. I hope so. Would you like to ...

Unit 10 Vocabulary

Coughs: 1 dry, 2 hoarse, 3 barking, 4 productive, 5 wheezy Listening 1 D = Doctor, P = Patient P I've got this really bad cough, doctor,

and I can't shake it off.

D OK. So the cough's been getting worse.

Tell me a little bit more about it. P Well, I've had this cough for a week or so, and it's been getting worse. I didn't think anything of it as I tend to get something at this time of year. But it's there all the time and the phlegm I bring up- it's a greenish-yellow colour and it's streaked with blood. And I have a touch of fever. D You said the phlegm was streaky? P Yes, but only a little. D And how much phlegm do you produce? P Not that much. It would be less than a teaspoon each time. D So not much. P No. And it comes up quite easily. I try to get it up to try and keep my chest clear. D And is there any smell? P No. Not that I've noticed. It's just the look of it that's not nice; it's rubbery or sticky like mucus from the nose. It's horrible. D Any pain? P No, not really. D It sounds as if you've got a touch of ... Listening 2

Exercise 1 1 a It normally occurs early in the morning and sometimes late at the night or after I do any exercise, but at moment it's bad with the cold air. b It normally occurs early in the morning and sometimes late at night or after I do any exercise, but at the moment it's bad with the cold air. 2 a Does the breathlessness you've got have any effect on your daily activities? Your lifestyle? Your work? b Does breathlessness you've got have any effect on your daily activities? Your lifestyle? Your work? 3 a How many flights of stairs can you manage generally?

b How many flights of the stairs can you manage generally? 4 a Have you had chest disease in past? b Have you had chest disease in the past? 5 a Is it triggered by situation or particular activity? b Is it triggered by a situation or particular activity? Exercise 3 Yes. My father had problem with his lungs . 2 The shortness of breath came on practically immediately. 3 I can walk for quite a distance maybe a hundred yards or so - and then I get short of breath. 4 The cold air at moment makes the breathlessness worse, so I stay at home when it's very cold. 5 I've used nebulizer. 6 I've had it for week now. 7 Does the way you lie make it worse? Or is it worse when you do the particular exercises? Listening 3 N = Nurse, P = Patient N There are different inhaler devices

to suit different people and the one I'm going to show you how to use is this breath-activated Pressurized MDI, which stands for Metered Dose Inhaler. Are you familiar with this? P No, not really. I've seen them, but not used one. N Well, it's an autoinhaler, which releases a dose of the drug when a breath is taken. This means that you don't worry about breathing and hand coordination, and it means that you know that a dose has been successfully delivered. First of all, you remove the cap and shake the inhaler several times like this. You then prime the device by pushing this lever here right up, keeping the canister upright at the same time like this. If you find it difficult to push

136 Listening scr ipts

P N

P N

P N

the lever up by hand, you can use the edge of the table to push it against. Is this OK so far? • Yeah. It's clear. OK. So you sit upright with your head up and breathe out. Then you seal your lips around the mouthpiece here. You inhale slowly and deeply. Breathe in steadily rather than quickly. When the inhaler clicks, don't stop- just continue taking a really deep breath. You won't feel the spray hitting the back of your throat although the taste in your mouth might change. Is this all OK so far? Yeah, fine . Then you remove the inhaler and hold your breath for as long as possible, mm, up to ten seconds. You then push the lever down and replace the cap. Wait a bit and then when you have recovered, take the next dose. But to prime it before each dose. Do you have any questions? No, none. It all seems very clear. OK, can you explain to me how to do it?

Unit 11

A full examination should be given, checking particularly for fever, jaundice, abdominal tenderness, chest signs, rashes, and lymphadenopathy. Exact investigations depend on symptoms and examination findings, but consider FBC, thick and thin bloodfilms for malaria, LFTs, viral serology, blood culture, stool culture ensure it is fresh- and MSU. And on this slide we have information on malaria, which incidentally comes from a sixteenth-century Italian term -mal' aria- meaning 'foul or bad air'. There are about two thousand cases notified each year in the UK. Malaria is of course very easy to miss, one reason being that it's a great mimic, and so it can present with virtually any symptoms. It usually consists of a prodrome of headache, malaise, myalgia, and anorexia, followed by recurring fevers, rigors, and drenching sweats, which last for eight to twelve hours at a time. The examination may be normal, but one needs to look for anaemia, and jaundice with or without hepatosplenomegaly.

D

P D

P

D P

Unit 12 Listening 1

A, B = Doctors A

If we had a case of a patient, say a Listening 1

In addition to the usual differential diagnosis, in all returned travellers who present unwell, it's crucial to consider imported disease. And as tropical medicine is a specialized field, when you're unsure, seek expert advice by telephone or it the patient. OK, now if we tum to the next slide here, it shows what we need to ask about the history. As well as the symptoms, it's essential to find out about the area or areas travelled to, including brief stopovers, the duration of travel, immunizations received prior to travel, malaria prophylaxis, health of of the travel party, sexual s whilst abroad, and medical treatment received abroad.

businessman, who had been to South America and presented with ... Listening 2

D = Doctor, P = Patient D You haven't had any problems for

quite a while, have you? P No, nothing serious. I've been quite

lucky, really. I keep myself nice and warm, especially at this time of year, and I make sure I eat properly and drink well. I've never been a big coffee drinker, but I like a cup of tea, and I drink plenty of water as well. And even though I've had a flu jab, I keep away from people. And I always take vitamins every day without fail, so it keeps my folic acid up. My friend had leg ulcers, so I'm very careful- I'm trying to avoid that, but my hip is bad

at times. so I have to use a walking stick. You seem to be doing very well. You've been doing all the right things we talked about when you first became a patient here. Well, yes, I've done my best. Looking through your notes you've only had one blood transfusion, am I right? Yes. That was a while back. The only thing really is my hip and now this pain. OK, first we're going to give you painkillers. OK ...

B

A

B A

There are many advantages to new technology. Recent medical breakthroughs like keyhole surgery are transforming the lives of patients, especially as regards the improvement in the speed of delivery of services and the speed of recovery on the part of the patient. But there's also the increased convenience for the patient in all this. Let's say we have a patient with long established diabetes, and we are able to offer a simple solution like a spray instead of injecting, then there is going to be little resistance. Well, the spray may not benefit every patient. Maybe not, but it's a step in the right direction. Can't you ever see the beneficial side of anything rather than always dwelling on the downside? Wouldn't you even feel better in yourself if you were a bit more positive? I'm not always negative. I'm just playing devil's advocate. And surely anything that makes taking medication easier is going to increase the likelihood of patients


B

A

B

A

B

A

B

A

ing to take medication and sticking to it in the long term, if needed. But no matter what, you have to it that there are downsides to new technology. It's not all rosy. Like what, for instance? Well, I can think of at least two things, one being that with increased life expectancy also comes increased morbidity and not everyone wants to live with a poor quality of life. I know I wouldn't. You say that now, but maybe not later on, and as medical science progresses, so will quality of life for those who are living longer. I would say that by the time we reach our sixth decade, the quality of life from the medical point of view will be what it is for the average forty-year-old now. Maybe, and I hope you're right, but I think that there is always the danger with technology of losing sight of the patient. The information that people have is being lost as we switch on machines and the machine does the work for us. A simple example is taking blood pressure. The old sphygonometer is being replaced by digital machines and I'm not sure everyone could even read the BP correctly. Well, you have a point there. Deskilling is a problem, but this is all about managing change. I know it arouses debate and at times some aspects are sensitive, but I don't resist it and by and large I think the dramatic technological advances in recent years have been invaluable. And I wouldn't want to stifle change. Me neither. I think we agree generally but just can't agree on some of the finer detail. Yes, I suppose we ...

Listening 2

D = Doctor, P = Patient

1 P Can't I just have the antibiotics I had the last time? D Well, what you've got is different from the last time. This is a virus. P But won't they work against viruses ? 2 P Won't an MRI scan show if there's anything there or not? D An MRI scan's not suitable here. It's clear from what you've said that there's nothing sinister here. P But my friend had the same and he died of a brain tumour. 3 P Won't these steroids make me put on weight if I take them? D They can make people add weight, but it's only a short course. P OK. 4 P Isn't that new stem cell treatment available for people with strokes? D It's still at the trial stage, I'm afraid. P Can't my husband be part of the t rial? 5 P Wouldn't it be better if I just stayed on this treatment for my diabetes? D You can, but you might find this is more convenient for you. Do you want to think about it fo r a while? P Yeah, OK. I'm just worried about upsetting everything, that's all. Language spot

2 3 4

6 7 8 9 10

11

Couldn't I just keep using the same device? Isn't this available on the NHS? Wouldn't it be better for me just to continue with the medication? Doesn't this device come with a cap on it? Shouldn't my daughter be next? Won't I be having the operation today either? Can't I have an MRI scan? Hasn 't the doctor arrived yet? Haven't you done that referral letter yet? Didn't you say I could go home today? Aren't I next on the waiting list?

138 Glossary

Glossary Vowels J:

breech

u

surgery disabil ity e

book

aJ

line

u:

mood

au

gown

Ll

imm unize

Jl

avoid

bump

IJ

period

sensitive

a~

paramedic

:J:

curl

e:J

fl are

o:

alarming

J

perception

U:l

reass ure

D

stop

Cl

ageing

J:

w arning

;)0

co pe

Consonants p

hyperten sion

r

affect

h

hollow

b

bronc hitis

v

stopover

111

im pairment

t elescope

0

afterbirth

11

ma nia

d

ra dical

0

wi th

IJ

alarmi ng

k

con sent

di slocate

I

ma laria

9

glove

z

tJ

dispat ch

s

revo lut ion

d3

bin ge

3

conclu sion

abnormal perception 'xb ,nJ:ml p 'sepJn n a way of seeing or experiencing events that is not normal, especially when it is harmful or not wanted abruptly ,;, 'bnptli. adv suddenly and unexpectedly, especially in an unpleasant way acne (vulgaris) ,xkni ' \ I '9o:m, n a skin condition in which your face, neck, etc. is covered in pimples (=spots) . Acne is common among young people. affect ''<efekt n emotions or feelings, especia lly when considering how this influences behaviour afterbirth 'o:lbb3:8 n the placenta and other material that comes out of a woman 's body after a baby is born ageing e1d3II) adj becoming older alarming :J 'lo:mnJ adj caus ing worry and fear analyse '<en;J]aJz/ vto study or examine something, especially by separating it into its parts, in order to understand or explain it

analyze

anosognosia a~. nnsog 'n;Josi;J, n a mental condition in which a patient is unable to recogn ise that they have lost a physica I sense or abi Iity antenatal ,<enti 'ncill adj relating to the medical care given to pregnant women anxiety '<etJ 'zaiJti/ n the state of feeling nervous or worried that som ething bad is going to happen apathy l'<ep:JOi/ n the feeling of not being interested in or enthusia stic about anything appraisal ':l 'preJZI. n a meeting in which a doctor discusses with a more senior doctor how we ll he or she has been doing their job; the system of ho lding such meetings arrhythmia :J 'nomi;J. n a condition in which the heart does not beat normally atrial fibrillation ,eJtri;J[ 'faibrrleiJnl n a condition in which the atria(= the two upper spaces in the heart) do not beat normally, causing the patient to develop a rapid pul se that is not regular, a common type of arrhythmia

rapid response yourself \A

w orry

avoid J'VJtd vto try not to do someth ing because it is harmful or unpleasant avulsion ;J 'vAIJn n the act or process of tea ring a piece from a bone by a tendon or a ligament: an avulsion fracture baby blues 'be1bi blu:z. n a depressed feeling that some women get after the birth of a baby ball b:d n (of the foot) the part underneath the bi g toe bang ' b
Glossary 139

n a mark on the skin that spoils its appearance blister 'bllst:J(r) n a swelling on the surface of the skin that is filled with liquid and is caused by rubbing or burning bradykinesia , bnedii~I 111:71:1 n a condition in which a person makes unusual ly slow movements, often associated wit h Parkinson's disease breakthrough / 'brcikOru:. nan important new discovery or achievement breath-activated breO a:kti\CJlld adj (of an inhaler) releasing spray automatically when a person takes a breath breech hn:tJ n used to describe the position of a baby within the mother in which when it is born, the baby's feet or bottom come out first bronchitis hroiJ 'kaJlls n an inflammation of the bronchial tubes, resulting in coughing and difficulty in breathing bump lump v to hit something, especially a part of your body, against or on something bystander bmstxnd:J( r) n a person who sees an event, such as a crime or an acc ident, but who is not directly involved in it cholesterol b'lcst:Jrol n a substance simi lar to fat that is found in blood and most tissues of the body. High levels of cholesterol in the blood are associated with heart disease. col- knl- prefix relating to the colon compelling bm pciJJ) adj (of an idea, an argument, etc.) able to convince you that something is true compliance bm 'plaJJns n the act of follow ing the instructions given to you by a doctor or nurse concerning your treatment, such as by taking your medicine conclusion bn klu:;;n n a judgement or a decision, made after considering all the information connected with the situation blemish 'blem1J

n agreement by a patient to follow a particular course of treatment after discussing the choices available to them with a doctor or nurse consent bn 'u t n official agreement, given by a patient to a doctor, to have a particular medical treatment such as an operation concordance k0n k0:d:11b

Continui ng Professi on al Development

bn li11JU : n p

1

l cf • nl dJ\cbpm:Jnt

n a system for staff who are already qualified in which they receive regular training about new medical procedures connected with their job contra indication f • J'1lli kc1Jn n a possib le reason for not giving a patient a particular drug or treatment cope w ith b l' ,1 vto deal successfully with something difficult crackles h.J ,tk l nsmall,sharpsounds that are heard when listening to the sounds within someone's body(= auscultation), often associated with emphysema (= air in the tissues) criticism , n the act of expressing disapproval of somebody or someth ing; a statement showing disapproval crust ~ r n a hard layer that covers a soft substance or liquid; a scab cue k_it.: n something that you say or do in order to show some body what you are thinking or feeling so that they may respond , give advice, etc. curl k. : v to form or make something form a curved shape, for example your toes cyst o- ~ "t ~ . prefix relating to the bladde r day-case surgery dLJ kc1s s;{:d:=;:1ri n operations that are performed in a single day, without the need for the patient to spend the night in hospital afterwards depen d on d1 pend nn vto rely on somebody for help or in order to do something dermatology d:1:1110 tniJd:=;i n the area of medicine concerned with the study and treatment of skin diseases

n 1 the process of creating something new or more advanced; a new method, product, etc. 2 a new stage in a changing situation 3 the gradual growth of something so that it becomes more advanced, stronger, etc. disability d1':1 bil•ll nan inability to do something such as walk, speak, or learn normally, due to an impairment disinhibition dJ,JI1hJ h fn n the state or act of expressing your thoughts and feelings openly without concern about the opinion of other people dislocate dJsl;~keJl vto put a bone out of its norma l position in a t dispatch d1 spa:tJ vto send a person or thing somewhere in order to do something diuretic ,da 1ju rcllk n a substance that causes an increase in the flow of urine DVT di: \ i: 'ti: n (deep vein thrombosis) a serious condition caused by a blood clot(= a thick mass of blood) forming in a vein dynamic exercise da1 na:m1k eks;,sall n physical activity in which the muscles are continuously moving, for example swimming or walking elation i 'lcJ.fn n a feeling of great happiness and excitement embarrassingly 1m ba:rJsJJ]Ii adv used to say that something makes you feel shy or ashamed emotive i 11100lJ\ adj causing people to feel strong emotions epidemic ,1 dcm1k n a large number of cases of a particular disease happening at the same time in a particular community et al ct 'a:] abbreviation (used after the names of the main writers of a report, research paper, etc.) and other people not mentioned. eta/ comes from the Latin phrase et alii/alia= and others evaluation 1 \
140 Glossary

exasperated 19 z
extremely annoyed, especially if you cannot do anything to improve the situation expectation /, ckspek 'tci.fn n 1 a belief that something will happen because it seems likely 2 a strong belief about the way something should happen or how somebody should behave be expecting bi: Ik 'spcktiiJ vto be pregnant expectoration 1k spekt;:. rciJn n the act of coughing up material from your lungs and then spitting it out expiratory cks pa1r~ tri adj relating to the act of breathing out air from the lungs fai nt fcmt vto suddenly become unconscious because not enough blood is going to your brain fan out l

n a painfu l condition in which the shoulder t becomes stiff and difficult to move gait gcn nawayofwa lking gametocyte g:J'mi:t:Jsait n a cell that is in the process of becoming a gamete gamete 'y<emi:t. n a male or fema le sex cel l get at / ~Jet · ~t v 1 to keep criticizing somebody 2 to learn or discover something get down get daon v 1 to make somebody feel sad or depressed 2 to swallow or eat something, usual ly with difficu lty get on get ' on v 1 to have a friendly relationship with somebody 2 (get on somebody's nerves) to irritate or annoy somebody

v 1 to return to your usual state of health after an illness 2 to deal with or gain control of a problem or difficult situation get through to .get Oru: t:J, v 1 to make with somebody by telephone, etc 2 to make somebody understand or accept what you say, especially when you are trying to help them giddy q1di adjfeelingdizzy(=that everything is moving around and that you are going to fall) glove 4l n v to put on surgical gloves before an operation gone gon adj having been pregnant for the length oftime mentioned gown ·gaon vto put on a gown(= a piece of clothing that is worn over other clothes during an operation) groggy 'grogi. adjfeeling weak and unable to think clearly because you are ill or very tired haemolyze hi:m;-~lai7 v to destroy red blood cells by causing them to break open and release their haemoglobin ; to be destroyed in this way hairline 'hcJlain n a very thin crack or line in the surface of a bone : a hairline fracture handicap ha!Illlik<ep. n in inability to do certain things such as do a particular job, get an education, etc., because of a disability hazardous 'h
nan animal or a plant on which another living thing(= a parasite) lives and feeds hypertension ,ha1p0 'tcnJn n blood pressure that is higher than is normal hystero- '111St:Jr:l0 prefix relating to the uterus impacted Im 'pa!ktid adj used to describe a type of fracture in which the two broken ends of the bone are pushed into each other impa irment Im 'peJmJnt n a condition in which you are not able to use a part of your body or brain normally impromptu un 'promptju: adj, adv done w ithout preparation or planning inconsolable ,mbn s:lOIJbl adj extremely sad and unable to accept help or comfort ingenious 111 'd3i:niJs adj (of a device, a plan, a method, etc.) very suitable for a particular purpose and using clever new ideas inspiratory ,ms pairJtri adj relating to the act of breathing in air to the lungs intussusception , mt~s~ ' s.fn n a painful condition, most common among young children, in which a section of the intestine becomes folded within itself with the result that it becomes blocked itch 1tj' vto have an uncomfortable feeling on your skin that makes you want to scratch it; to make your skin feel like this job specification ,d3ob ,spesifi 'keiJn n a description of the skills, knowledge, and experience that are required to do a particular job keep ,ki:p v to continue doing something land l
Glossary 141

lcuf S
(=the opening that connects the left atrium and the left ventricle of the heart) becomes more narrow than is normal mood mu:d n the way you are feeling at a particular time morbidity mJ: 'bid;Jti n the number of people who have a particular illness morning sickness mJ:n11_1 stknJs n the need to vomit that some women feel when they are pregnant, often only in the morning mortality mJ: 't<elJti/ n the number of people who die from a particular illness negotiate nt ' g;:~oJic t l vto agree something by formal discussion nephro- 'nefr;Jo prefix relating to the kidney(s) notifiable 'nJo ttfatJbl adj (of a disease) so serious that it must be reported to the authorities objectionable Jb ' d :ic kJ;:~ n;>b] adj

unpleasant or offensive adj extremely unpleasant on edge nn cd; adj to be nervous, excited, or bad-tempered offensive ;. I~IN\

on top of the world nn t np

;>\

(\;.

'' ·dd adj very happy or proud pandemic JXCn dcm1k n a serious disease that spreads over a whole region or a large part of the world paramed ic pa.:rJ ncdtk n a person whose job involves giving emergency medical treatment to sick or injured people in their home, at the scene of an accident, etc., before they are taken to hospita l patch pa.: ti n a small area of something that is different from the area around it perforated appendix p :d;:~retltd

;. pcnd tk -. n a serious condition in which the appendix bursts after becoming infected and then swollen pericarditis ,penka: datlis n a serious inflammation of the pericardium (=the thin layer of tissue surrounding the heart) period ptJriJd n the flow of blood each month from the body of a woman who is not pregnant

persuasion p;:~ swe13n n the act

of convincing somebody to do something persuasive p;:~ S\\Ctsl\ adj able to persuade somebody to do or believe something pick at p1k ;Jl vto touch something several times with your nails or fingers, especially by repeatedly removing small pieces of it p1k ' P v 1 to take hold of something and lift it up 2 to start again; continue playwith 'plci \\tO vtokee ptouching or moving something POP ,pi: JO 'pi: n (plaster of paris) a white powder that becomes hard when it is mixed with water and left to dry. POP is used to make plaster casts(= a so lid case that is put on a person's body in order to cover and protect a broken bone); a cast made of this material pre-eclampsia , pri: t'kl a:mpsiJ n a condition in which a pregnant woman has high blood pressure, which can become serious if it is not treated productive prd'd\kll\ adj(ofacough) producing sputum or mucus(= a thick liquid that is produced in parts of the body, such as the nose) prone to sth 'pr;1on tJ adj likely to suffer from something, such as a particular illness psychosocial satbo '> ;Juj"l adj concerning the mental and social aspects of something and how they influence each other purpura /p3: 'pjop nan area of red or purple spots on the skin , caused by bleeding underneath the surface of the skin purulent 'pj o Jr;JIJnt adj containing or producing pus(= a thick yellowish liquid that is produced in an infected wound) radical 'r<ed tk l adj new and very different from what is usually done rapid response ,ra;> ptd n 'spons n the act or process of dea li ng with a medical emergency quickly pick up

142 Glossary

n a friendly relationship in which people understand each other very well reckless rek!;Js adj showing a lack of care about the danger or the con sequences of your action s reduction n dAkJn n the act or process of returning a part of the body to its normal position, for example after a hernia, by performing an operation or other medical procedure rehabilitation ,ri:;J biii 'tciJn n the process in which a person learn s to have a normal life aga in after they have been very ill or had a serious injury resect n sd. t v to cut out part of an organ or a piece of tissue from the body revolution rcv;l 'lu:Jn n a major change in methods, ideas, etc. that affects many people rig idity n d3Hbti n the state of being stiff and difficult to move or bend rigo r 'ng:J(r) n a sudden attack of shivering(= shaking of the body}, accompanied by a feeling of coldness and a rapid rise in body temperature, usually indicating the start of a feve r rupture nptJ;J(r) vto burst or break apart something inside the body; to be broken or to burst apart safety net 'se1fti net, n used to describe any arrangement that is intended to protect a patient and prevent problems from developing after they finish consulting a doctor or having treatment scab sk<eb. n a hard layer of dried blood that forms over a cut as it heals scab over " ska::b ciOv;J(r) v to form a rapport ne p::l:(r)

scab schizont 'sk

also 'Jarzont n a stage in the life cycle of the parasite that causes malaria, during which it reproduces itself many times by dividing to form new cells(= merozoites)

sknb 'P v (of a doctor, nurse, etc.) to wash your hands and arms before performing an operation seizure 'si:3;1(r) n a sudden attack of an illness, such as epilepsy, in which

scrub up

a person becomes unconscious and their body shakes violently; = a fit sensitive sens;"ltl\ ad} 1 (of a subject) needing to be t reated carefully because it may offend or upset peop le 2 (of people} easily offended or upset shuffling 'J\0!1] ad} (of the way somebody walks} slowly without lifting your feet completely off the ground; SEE marche apetit pas sickle-cell anaemia srkl sci ;1 'ni:mi;J, n a serious form of anaemi a, mostly affecting people of African origin, in which the red blood cell s lose their normal shape when oxyge n level s are low simple srmpl ad} (of a fract ure) involving a break of the bone but with little damage to the surrounding skin and muscle slip (over) 'slip ,;"!OV;J(r)/ vto slide a short distance by accident so that you fall or nearly fall small oft he back , ,smJ:! ;J\ o;:~ ba:~k n the lower part of the back where it curves in small talk 'sm:>:l t::1:k n polite conversation about ordinary or unimportant subjects, for example in order to make a patient feel rela xed smash sm<eJ vto break something vio lently into many pieces ; to be broken in this way SOCRATES ''sokr;Jl!:z n used as a way of ing how to j udge the nature of a patient's pain . Each letter of SOCRATES refers to a word which relates to a question , the words are: Site, Onset, Character, Radiation,

Associations, Timing of pain/duration, Exacerbating/ Relieving factors, Severity soil s:>rl v to accidentally release solid waste from your body onto your clothes, bed sheets, etc. spiral ' sparr;:~L ad} (of a fracture) caused by twisting the bone so that it breaks spont aneously spon terni;1s!i adv happening naturally, without the need for medical treatment or assistance sporozoite ,sporci 'Z;loart n a stage in the life cycle of the parasite that causes malaria. Sporozoites form within the body of a mosquito which

then es them to humans where they travel to the liver cells to form a schizont. sputum 'spju:t;,m n thick liquid from

the throat or lungs that is coughed up because of disease, etc. In non medical situations, sputum is often called phlegm lkm. . squash skwnJ vto press or crush something so that it becomes damaged or changes shape statin 'st<etm n a type of drug that helps to lower cholesterol stop stop v to prevent somebody from doing something stopover stop;"!O\:J(r) n a short stay somewhere between two parts of a journey straighten 'strc1tn vto become straight; to make something straight stub ·st \b v to hurt your toe by accidentally hitting it against something hard stumble st.\mbl v to fall or almost fall while you are walking or running sweetened S\\ i:tnd ad} (of food or a drink) made to taste sweeter by adding sugar, etc. telescope telisbop v (of the different parts of something) to slide within each other tenacious [;l 'nciJ;Js. adj sticky and difficult to pull apart the Pill t);J prl n the contraceptive pill (= a pill that some women take to prevent them becoming pregnant) thread Orcd nan idea that connects the different parts of a conversation , argument, etc. thrombolysis ,Ornm bolrsrs n the act or process of dissolving a blood clot(= a thick ma ss of blood) t ickly trkli ad} (of a cough} producing an irritating sensation on your throat that makes you want to cough tingling 'lll]glrrJ nan uncomfortable feeling in a part of your body as if a lot of small sharp points are pushing into it tolerate t o!;JrCil v to be able to be affected by a drug without being harmed

Glossary 143

travellers' diarrhoea ,tr<e\ JIJz dmJ ' nJ;

nan illness in which you solid waste from your body frequently, and in liquid form , and which is developed while travelling in a foreign country tremor trcm;~( r) n a slight shaking movement in a part of your body, often associated with Parkinson's disease trend trend n a general direction in which a situation is changing or developing trip (over/up) I trip (over/on sth) '' trip ;IO\J(r) - \]1 -on vto catch your

foot on something and fall or almost fall try (for a baby) tnu v to attempt to conceive twist l\~ist vto injure part of your body, especially your ankle, wrist, or knee, by bending it in an awkward way twitch twrtJ v (of a person's body) to make a sudden quick movement, especially one that you cannot control uncooperative \nb o' np;~r;"~ll\ adj not willing to be helpful to other people or do what they ask uneasy \n i:n adjfeeling worried or unhappy about a particular situation unequivocal \n r k\\ I\ ;~kl adj expressing your opinion or intention very clearly and firmly unhygienic \nhar'd3i:nrk, adj not clean and therefore likely to cause disease or infection unjusti~able \11 d3.\strfarJbl adj (of an action) impossible to excuse or accept because there is no good reason for it unpeeled \n pi:ld adj (of a fruit or vegetable) with a skin that has not been removed variolation \'CJriJ laiJn n (historical) the practice of deliberate ly giving somebody a small amount of the smallpox(= variola) virus so that they cannot catch this disease in future vesicle vcsrkl n a small blister filled with clear liquid, associated with skin conditions such as eczema warning \\J:nrrJ nan instruction telling somebody what to do or what not to do

wJ:nrrJ -;am n a change in a person's health or behaviour that indicates that they may have a particular illness;= a prodrome wet \\Cl 1 vto urinate by accident 2adj (ofweather) rain wheal also weal \\ r: l n a sore red swelling on the skin, associated with skin conditions such as urticaria woozy \\u:zi . adjfeelingunsteadyand confused worry about \\ Hi ;~ha o t v to keep thinking about unpleasant things th at might happen or about problems that you have wryneck ramek n a condition affecting the neck muscles which causes the neck to turn so that eventually the head is permanently held to one side;= torticollis warning sign

OXFORD UNIVERSITY PRESS

Great Clarendon Street, Oxford ox2 6DP Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dares Salaam Hong Kong Karachi Kual a Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Ausu·ia Brazil Chile Czech Republic Greece Guatemala Hungary Italy Japan Poland Portugal Singa pore South Korea Switzerland Thailand Turkey Ukraine V ietnam

(Mid section view of young manflmageDj), 86 (Pouring salt/Banana Stock). 87 (Measuring blood pressure/Claude Cortier/AGE Photostock), 88 (Doctor with patientfHerve GysselsfPhotononstop). 88 (Woman taking pills/Stockbroker). 90 (Living room/David GeorgefRed Cover), 90 (Woman sneezing/ Martin Leigh/OSF). 90 (Crowded public transponfWhite). 90 (Waiting room/Science Photo Library

RF). 93 (Testing forTB/CDC/Phototake Science), 98 (Spa room/MAISANT Ludovic/Hemis). 98 (Blue Poison Dart Frog/Chris Mattisonfage fotostock). 99 (Mosqu ito bitingfP&R Fotosfage fotostock). 100 (Medical seminarfBanana Stock), 100 (Star fruit/Burke Triolo/Brand X Pictures), 100 (Kebab/Ciaran

Griffin/White). 100 (Cola/foodCollecti on). 103 (Blood transfusion/Yoav Levy/Phototake Science). 106 (Blood Pressure Sphygmomanometer/Ron Chapple StockfPhotolibrary RF), 110 (MRJ Scanner/

Corbis). 110 (Ultrasound Machine/Corbis). 110 (Lumbar Puncmre/IAURENT/B HOP AME/BSIP Medical). 112 (Stem cell illustration/GILLES/BSIP Medical): PunchStock p.7 (Ba tteiy/Photodi sc): Rex Features pp.4 (London Motorcycle Para medic/11V). 4 (Paramedic using a bicycle), 106 (Futuristic ambulance): Science Photo Library pp.16 (Late ral X-Ray of the Elbow/Living Art Enterprises. LLC), 16 (Fractured fibula x·rayfAthenais. ISM). 16 (Fractured pe lvis, x-rayfDu Cane Medical imaging Ltd ). 28 (Obstetric

consulrationnan Hooton). 28 (Newborn baby/Keith/Custom Medical Stock Photo). 40 (Emil Kraepelin/ National Library ofMedicine). 66 {Vitiligo skin disorder/Maria Platt·Evans). 66 (RashfD r p. Marazzi). 66 (ScabiesfDr p. Marazzi). 69 (Impetigo/Or p. Marazzi), 71 (Acne vulgaris/St. Bartholomew's Hospita l), 71 (Acne vulgaris/Or p. Marazzi). 71 (Acne on chinfDr p. Marazzi), 74 (Hospital recovery room/Simon

Fraser). 76 (X-ray of appendix and colon/Lunagrafix). 78 (Dermoid ovarian cyst/ISM). 80 (Removal of an ovarian cystfDr Najeeb Layyous). 82 (X-ray of e nlarged hearr{Dr p. Marazzi), 92 (X·ray of pu lmonary

OXFORD and OXFORD ENGLISH are ed trade marks of Oxford University Press in the UK and in certain other countries

embolism/Zephyr). 93 [fB Skin Test/Manin M. Rotker). 93 ri\Ibcrculosis diagnosis/Andy Crump. IDR. WHO). 93 (resti ng for lung diseases/Arne Massee). 95 (Lung function test/Goneyl jay). 102 (Sickle cell

© Oxford University Press 2010

anae mia SEM), 106 (Artificial handfVolker Steger). 106 (Cell divisionfDr Paul Andrews. Un iversity of Dundee), lOS (Bone bioceranticfKlaus Guldbr.mdsen), 110 (Heart surgeryfVolkar Steger). 1l0 (X-ray machinesfGustoimages), ItO (Medical prescriptionfCristina Pedrazzini). llO (Acupuncture{fek Image).

The moral rig hts of the author have been asserted Database rig ht Oxford University Press (maker) First published 2010 2014 2013 2012 2011 2010

10 9 8 7 6 5 4 3 2 1

No unauthorized photocopying All rig hts reserved. No part of this publication may be reproduced, sto red in a retrieval system, or u ·ansmitted, in any form or by a ny means, without the prior permission in writing of Oxford University Press, or as expressly permitted b y law, or under tern1s agreed with the appropriate reprogTaphics rights organization. Enquiries concerning reproduction outside the sco pe of th e above should be se nt to the ELT Rights Deparunent, Oxford University Press, at the address a bove You must not circulate this book in any other binding or cover and you must impose this same condition on any acquirer Any websites referred to in this publication are in the public dom ain and their addresses are provided by Oxford University Press for information o nly. Oxford Un iversity Press disclaims any responsibility for the content ISBN: 978 019 456956 9 Printed in China ACKNOWLEDGEMENTS filustrations by: julian Baker p p.19, 31. 45. 49. 62. 70, 79. 91. %. 101. 102 (map); www.canoonstock.com

p.87: Mark Duffin pp.l6 (pan fire. knife, tin can. plug). 35: Melvyn Evans pp.42, 71: joy Gosney pp.38. 112 (Pandora's box): Andy Hammond p. 104 (cartoon); Ian Moores pp.21, 56, 104 (patient care): Oxford Handbook ofPsychiaoy p.43 (graph): Oxford Handbook of Geriatric Medicine p.SO; Oxford Handbook of Cli nical Medicine 7 pp.57 (lesions), 82 (ECGs), 6th edition p.95 (peak flow chart): Oxford Handbook

of Renal Medicine p.96 (diagram): Tony Sigley pp.S. 12. 25, 2. 30, 37. 39, 77, 84, 109. Cover image courtesy of. Masterfile 'nw Publisher would like to thank thefo!lowingfor their kind pem1ission to reproduce photographs: age fotostock p.14 {X ray of fractured toefDinodia): Alamy Images pp.13 {Leg in plasrer{Helene Roge rs). Alamy Images p.14 (Abraham Calles); Alamy Images p.16 (Coloured x-ray); 18 (Arm in plaster/Rodger Tamblyn). 20 (Runner with pulled m.uscle{Dennis MacDonald). 20 (Painful hamstring/joh n Fryer), 4

22 (Blistered hand/JHP Adults), 23 (man with bad back/vario images GmbH & Co.KG ). 28 (antenatal classfBubbles Photolibrary). 29 (ante nata l ultrasonic scan/peter has lund karlsson). Alamy Images p.41 (Post-nata l depression/AJ Photo); Alamy Images p.44 (Aerobics exercise class/john Cole); 47 (Rehabilitation wardfllene MacDonald). 57 (Senior citizens fitness class/INSADCO Photography), 61 (Ciose·up ofhandsfHorizon International Images Limited), Ala my Images p.66 (lichen planus/ James Stevenson): Alamy Images p.68 (Itchy ski n/Lea Paterson): 69 (acne rosacea/Hercules Robinson), 72 (NursejGeomphotography), Alamy Im ages p.75 (He rn ia operation/Mark Thomas):

Ala my Images p.80 (Medical training/Sam Ogde n); 90 (Flying pollen/blickwinkel), 90 (Dusty building site/FogStock), Ala my Images p.96 (lnhaler/Gustoimages): Alamy Images p.106 (Nanorobot/Roger Harris): 11 4 (Psoriasis/Hercu les Robinson); Corbis pp.4 (Air ambulance medics/David Spurde ns). 9 (Mobile Emergency Defibrillator{Paul SeheultfEye Ubiquirous). 36 (Ernest HemingwayfBettman n).

36 (Samuel Beckett/Hulton-Deutsch Collection). 36 (Audrey Hepburn/john Springer Collection). 36 (Marilyn MonroejBenmann). 44 (Researc he rs wea ring old age si mulation devices{rwPhoro). Corbis p.46 (Elde rly woman wa lking/joan Co malatf<~ge fotostock): 48 (Swimming exercise class/Ronnie Kaufman), 53 (Deconstruction workfKathrin Brunnhoferfepa/). 58 (Newly opened Roman boxf Reuters). 59 {Endoscopic surgery training/john Madere), 66 (Woman with frecklesjPalrik Giardino). 66 (Ecze ma/Lester V. Bergm a n). 69 (D isca rded medica ti on/Ursu la Klawitter). 72 (Medicine cabinet/

George B. Diebold), Corbis p.74 (Surgeon preparing for surgery/An Becker/Art Becker Photogra phy/ Flirt Coll ection); 98 (Women planting ricejFrans Lanting). 11 2 (Frallke nstei n 's MonsterjBettmann): Getry Images pp.20 (Injured rugby player Shane McDonald), 40 (Sigmund Freud). 66 (Sunburn/Peter

cade). 106 (Pacemakers): OUP pp.32 (woman/Photodisc), 44 (Birthdaycelebrations/image100). 46 Uames Parki nson/C) Sword), 54 (Sk ier/Photodisc), 86 (scales/Digital Vision). 86 (cyclists/Photodisc), 86 (sa ladn mage Source). 86 (as htray/BananaStock). 98 (Crowd/Photodisc). 98 (Ai rcraft landing/ Digital Vision). 100 {tomatoes{Photodisc), 100 {strawberriesfPhotodisc). 100 (grapesfJngram ). 100 (ice cream/Mark Mason). 107 (Couple talking at tablejPhotodisc). 110 (MedicinefPhotodisc): Photolibrary pp.4 (Paramed ics/White). 6 (Using a mobile phone{Giow Im ages). 6 (Doctor with patientflndex Stock

Imagery). 7 (X-ray/Scott Camazine/Phototake Science). 8 (Cyclist/Nicole Hiii/Rubbcrball), 15 (Doctor smiling/Seth joel/Whi te). 20 (De hydrated/BiueMoon lmages/Biuemoon Stock Inc.). 24 (School spons day/GoGo Images), 28 (Woman in doctor's office/Monkey Business Images Ltd/Stockbroker). 33 (Doctor with patient/Asia Images Group), 34 (Cutting umbilical cord/Herve Gysse ls/Photononstop). 44 (E lderly woman in chair/Image Source). 66 (PsoriasisjMed icimage). 67 (Allergy test/Image Source). 74 {Day surgery unit/Image Source). 81 (Group of doctors studyingfjavier L..arreafage fotostock ), 82

111 (Stem cell). 113 (Albert Szent-Gyorgi), 114 (atopic eczema). 115 (Swollen leg/Dr p. Marazzi). 115 (venous leg ulcerfDr p. Marazzi); Universiry of Wisconsin-Madison Archives p.40 (Counesy University of Wisconsin-Madison Archives): Wellcome Trust Medical Phorographic Ubrary pp.34 (Hospital birth room). 74 (Sun1res on a manikin).

The author and publisher are grateful to those who have given pennission to reprodilce the following extracts and adaptations of copyright material: pp.S and 9 Ext ra cts from ·square Mil e cycle·paramedics become the new Ciry-slickers'. 14 August 2006. from www.londonambulance. nhs.uk. Reproduced by pern1iss ion: p.10 Extract from 'Guidelines on Co ntinuing Professional Development' by jacky Hanson and Henry Guly. from www.colleme rgencymed.ac.uk. Reproduced by permission: pp.l6. 17. 18 Extracts from 'Accidents and their Prevention' by Dr M Preston, from www.patient.co.uk. Reproduced by permission: p.24 Extract from Coalter. F (2009) "Physical fitness and health', Val ue of Sport Monitor. Sport Englandjl.JK Sport. Reproduced by permission; p.32 Extract from 'Antenata l Classes' from www.nct.org.uk. Reproduced by permission: p.34 Extract from 'Third Stage of Labour' from www.nct.org.uk. Reproduced by pennission: p.40 From Oxford Handboo k of Psychiatry by Semple, D, Oxford University Press 2006. Reproduced by permission: p.47 From Oxford Handbook of Geriatric Medici ne by Bowler, Let al.. Oxford Universiry Press 2006. Reproduced by permission: p.52 From Oxford Ha ndbook of Emergency Med icine 3rd Edition by Wyatt, j. p. et a l. , Oxford University Press 2006. Reproduced by permission: p.54 Extract from 'The Big Question: Is skiing now so dangerous that speed lin1its shou ld be im posed?' by Jamie Buckley. 15 january 2009. The Independent. Reproduced by permission; p.SS From 'Involvi ng fathers in matern ity care: best practice' by jeremy Davies© The Roya l Co ll ege of Midwives 2009. All Rights Reserved. Re produced by permission; p.56 From 'B rain pattern associ ated with genetic risk of Obsessive Co mpulsive Disorder' by Genevieve Mau l. 26 November 2007. from www.i n.cam.ac.uk. Reprod uced by permiss ion: p.57 From 'More seniors-only fitness centres popping up'. 19 june 2007. Reproduced by permission of The Press Association: p.SS From 'Roman face cream found at London temple site' by Paul Peachey. 29 july 2003, The Independent. Reproduced by permission: p.59 From 'New training method helps surgeons evaluate their own minimally invasive surgery skills', 12january 2009, Delft University ofTechnology www.tudelft.nl. Reproduced by permission; p.60 From 'Heart's Surplus Energy May Help Power Pacemakers. Defibrillators'. Reprinted with permission. http:/f americanheart.mediaroom.comfindex.php?s=43&item=547 0 2009, American Heart Association, Inc.; p.61 From Oxford Handbook of Respiratory Medicine by Chapman. Setal. Oxford University Press 2006. Reproduced by permission; p.62 From Oxford Handbook of Expedition a nd Wilderness Medicine by johnson. C. Oxford University Press 2008. Reproduced by permission: p.63 From 'Smart fabrics make clever (medical) clothing' from ICf Results, hrtp:fjcordis.europa.eufictresu lts: p. 70 From Oxford Handbook of Clin ica l Exa mination and Practical Skills by Thomas,j et a l. Oxford Universiry Press 2008. Reproduced by permission; p. 78 From 'Ovarian Cyst' from www.patient. co.uk. Reproduced by permission: p.79 From Oxford Handbook of Clinical Medicine 7th Ed ition by Longmore. M. Oxford University Press 2007. Reproduced by permission; p.86 From 'High Blood Pressure- Hypertension' by Dr Richard Maddiso n. 2008, from www.ba.co.uk, The British Cardiac Patiems Association. Reproduced by perm iss ion; pp.90. 91 From Oxford Handbook of Clinica l Examination and Practical Ski ll s by Thomas, J et al., Oxford University Press 2008. Reproduced by permission; p.99 From Oxford Handbook of General Practice 2nd Edition by Pencheon. D et a!., Oxford University Press 2006. Reproduced by permission : pp.100, 101,102. 103 From Oxford Handbook ofTropica l Medicine 3rd Edition by Eddlestone. Met at.. Oxford Un iversiry Press 2008. Reproduced by permission; p.111 From 'Stem Cell Transplant' from www.patient.co.uk. Reproduced by penn iss ion; p.lll From 'Sue Gyford: A new vision of hope for the blind' by Sue Gyford, 21 january 2009. from http:/fnews.scotsman.com. Reproduced by permission: p.111 From 'Stem Cell Basics' by Narionallnstitutes of Health, from http:flstemcells.nih.gov.

Sourct'S: pp.S, 6, 12. 15 Oxford Handbook of Emergency Medicine 3rd Edition by Wyatt,]. p. et al.. Oxford Universiry Press 2006; pp.22, 45, 47, 85, 90.93 Oxford Handbook of Clinical Medicine 7th Edition by Longmore. e t a!., Oxford Universiry Press 2007; pp.28. 29 Oxford Handbook of Clinical Specialities 7th Edition by Collier, Longmore and Brinsden, Oxfo rd University Press 2006: pp.39, 41, 42 Oxford Handbook of Psychiatry by Semple, D. Oxford Universiry Press 2006: p.SO 2004 figures from Eurostat; p.66 Oxford Handbook of Cli nical Examination and Practical Skills by Thomas. jet a!.. Oxford Unive rsity Press 2008: p.78 Oxford Handbook of Clinical Surgery 3rd Edition by Mcl.atchie. Get al.. Oxford University Press 2007; pp.82. Oxford Handbook of General Practice 2nd Edition by Pencheon. D et al.. Oxford Unive rsity Press 2006: pp.91, 92, 93,94 Oxford Handbook of Respiratoiy Medicine by Chapman. S. Oxfo rd Universiry Press 2006: p.98 Oxford Handbook of Public Health Practice 2nd Edition by Pencheon, D. eta!., Oxford University Press; p.104 Oxford Handbook ofTropical Medicine 3rd Ed ition by Eddlestone. M et al. , Oxford University Press 2008

Although every effort has been made to trace and copyright holders before publication, this has not been possible in some cases. We apologize for any apparent inftingement of copyright and if notified, the publisher will be pleased to rectify any errors or omissions at the earliest opportunity. The author and publisher would like to thank the following people who assisted in the development of this tille:

Dr Mark Fenton MA (Oxon) PhD MB BS MR(UK). Consultant cardiologist, Kent and canterbu ry Hospital. East Kent Hospitals Trust; Dean Wang. Escola d'ldiomes, University ofVic. Spain. Special thanks are also due to: Eileen Flannigan (au thor: Grammar Reference), Ben Francis (author: Glossary. Website), Anna Gu nn. Diane Winkleby. and Lewis Lansford for his cons iderable editorial and gu idance.

Oxford University Press makes no representation, express or implied, thnt l11e drug dosages in this book are correct. Readers must therefore always check the product infonnation and clinical procedures with the most up to date published product infomiation and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work.

' Invaluable. It teaches us how " to use words more eHectively, and that helps us to become beHer doctors. ' Dr Murray Longmore, BM BCh DRCOG MRCGP. Co-author of the Oxford Handbook of Clinical Medicine

English for Medicine is a

new, up-to-date course for medical

students, doctors, and advanced nurses who need to communicate in English. • Learn the English you need to do the job • Practise language in real work situations • Learn the right vocabulary for speaking to patients and colleagues

In this series:

gives you the language, information, and skills you need to develop your career: • Based on the communication skills required for OSCE (Obiective Structured Clinical Examination). • Examples from the Oxford Handbook series - authentic material from the world's best-selling medical handbooks.

• It's my job- authentic

insights from professionals working in

medicine.

• Patient care sections develop students'

skills in doctor-patient

relations. • Online interactive exercises to revise and recycle language:

www.oup.com/elt/oefc ISBN 978 01 9 4023009

Also available: ..

..

OXFORD HANDBOOK OF

CLINICAl M DCNE

For the teacher, the Teacher's Resource Book provides everything you need to teach English for medicine with confidence: • •

Background information and specialist knowledge of the subiect Photocopiable class activities and grammar tests

•

Further resources are available at:

www.oup.com/ elt/teacher /oefc Available now: Medicine 2 Class CD Medicine

2 Teacher's

Resource Book

ISBN 978 019 4569583 ISBN 978 019 4569576

•

Your career in medicine starts here

... with Oxford English for Careers. ISBN 978 019 9232178

C3 3i ;1

OXFORD ENGLI SH ISBN 978-0-19-456956-9

UNIVERSITY PRESS

www.oup.comjelt

9

780194 5 6 9569

English For Careers Medicine 2 Student's Book 1i5s

Overview 1s532p

More details 6h715l

Related Documents 2w1qw

English For Careers Medicine 2 Student's Book 1i5s

Epdf.tips Oxford English For Careers Tourism 2 Students Book 1y2752

English For Careers Medicine 1 Student's Book.pdf rt5u

Oxford English For Careers - Commerce 1 - Students Book [englishonlineclub.com].pdf 45663w

Internal+medicine+essentials+for+clerkship+students+2 714v5a

English Students Book 3jq6q

More Documents from "St" 2yi5w

Wapsi By Umera Ahmed.pdf 4j5p4u

Jana Tujhe Jab Jana Epi 6 4w272n

Koi Chand Rakh Meri Shaam Par 5b646

Rare Books On Calligraphy And Penmanship.txt 2k1l3a

English For Careers Medicine 2 Student's Book 1i5s

Deborah Tannen 714i1r