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150 ECG - 150 ĐTĐ - HAMPTON - 4th ED.


Tuesday, March 5, 2019


Image result for Medicine 1

UNIT 1:      1.1,        1.2,      1.3,     1.4,     1.5

UNIT 2:      2.1         2.2       2.3.     2.4      2.5      2.6

UNIT 3:      3.1         3.2       3.3.     3.4      3.5      3.6

UNIT 4:      4.1         4.2       4.3.     4.4      4.5      4.6

UNIT 5:      5.1         5.2       5.3.     5.4      5.5      5.6

UNIT 6:      6.1         6.2       6.3.     6.4      6.5      6.6

Page 4: 
Check up: 1  a2  b3  c1  d4

Listening 1: Personal details
1. 1. Karlson    2. correct    3. 2p.m.     4. 19733045    5. 7953    6. correc   7. correct    8.  Dr Jones

Page 5:
Language spot: Asking short and gentle questions
1.  Possible answers 
Can you tell me:
- your family name /what your family name is? your first name(s) / what your first name is? 
- your address /what your address is?
- when you were admitted? the date you were admitted? 
- your hospital number/what your hospital number is? 
- your date of birth / what your date of birth is? 
- your telephone number / what your telephone number is? 
- whetheryou are married or single?
- your job/ what your job is/what you do for a living? 
- the nameofyourGP/ who your GP is?

a. Wheredoyougetthepain?
b. Does the pain spread anywhere else?
c. Does it wake you up at night?
d. Can you tell me what the pain is like?
e. Can you describe the pain for me?
f. How long have you had the pain?
g. Is there anything which makes it worse / better?
h. When did it start?
i. Is there anything which brings it on? Is the pain constant?
k. Have you had the pain before?

3. 1.f    2h    3c(d/e)   4i    5b    6. d/e   7g   8a   9.k  10.j

Listening 2: Presenting complaints
1.f   2.a   3.d    4.e    5.g   6.b    7.c    8.h

1 What’s brought you here?
2. Can you tell me what seems to be bothering you?
3. What can we do for you?

4. Possible answers

What seems to be troubling you? What’s troubling you? What brings you here? What’s the problem? What’s the matter? What can I do for you?

Page 6:
1.e   2. j   3.g   4.k   5.d

a collarbone  b gullet   c breast bone  d tummy, belly  e navel, belly-button  f gut, bowels  g wrist (bone)  h kneecap  i shinbone   j heelbone   k ankle (bone)

Medical terms: word stress
1 sternum, talus, carpus
2 clavicle, abdomen, tibia
3 patella, intestines
4 umbilicus, calcaneus, oesophagus

Describing pain
1c 2f 3e 4g 5h 6d 71 8a 9b lOj 

Page 7:
3 1M 2V 3V 45 5V
The possible conditions described could be:
1 tension headache
2 sub-arachnoid haemorrhage
3 acute pancreatitis
4 appendicitis (or burst appendix)
5 degenerative arthritis

4 Example answer
You can ask the patient to compare it to the worst pain he/she has ever had.

It’s my job
1 Thehighlytrainedteam...
2 Their work (the triage nurses, receptionists, etc.) is vital to the
3 ... next of kin for contact (is taken) in case of emergency.
5 ... the potential for confusion is great unless the data that are taken are accurate...
6 ... information is checked to make sure it is correct and that the patients can confirm their identity.

Listening 3: A presenting complaint p8
100/mm  = 100 beats per minute 
BP = BP blood pressure
BP mm/Hg =  millimetres of mercury
JVP =  jugular venous pressure
CVS = cardiovascular system
NAD = no abnormality detected
O/E = on examination
CNS =     central nervous system

Speaking p8
Possible answers
2 angina 4 administration of aspirin and oxygen; pain relief
3 Angina or myocardial infarction

Language spot p8
Tenses in the presenting complaint
1 al b4 ci d4 el f4 g2 h2 i3
2 1 has been having
2 Do you normally go
3 has eased
4 have been lying
5 is getting / has been getting worse Look at the diagrams. 
The Present Continuous emphasizes that the action is still happening around the time of the presenting complaint. The Present Perfect Continuous emphasizes that it has been happening before and around the presenting complaint.
6 am not taking
7 Has / Does the pain spread The Present Perfect relates to the time up to now and covers the recent history. The Present Simple covers the recent history and asks about each time the pain happens.

Speaking p9
1 a Possible diagnosis: acute pancreatitis, gastritis, duodenitis, peptic ulcer
1 b Possible diagnosis: (acute) appendicitis, cholecystitis, gallstones, ureteric colic

Culture project p10
3 1 Every area of life where people communicate with each other, for example business, diplomatic service, teaching, counselling, shops, buying and selling, etc.

3 2 It is an approach which means that the doctor needs to deal with the patient as a person, rather than just the illness, giving them the opportunity to speak and make decisions about their treatment. The doctor needs to be able to interpret the patient’s body language and mood, not just their illness.

3 3 The Calgary Cambridge method is a patient-centred approach to communicating. It teaches tools such as asking open questions, dealing with patients’ concerns and expectations, and nonverbal communication such as body language.

Writing p11
A case report
1 1 presented 2 was 3 radiated 4 had 5 smoked  6 was 7 worked

2 On examination, he was sweaty, but no abnormalities were found in the cardiovascular or respiratory systems. His blood pressure was 138 / 82 and his pulse rate was 110 / mm regular. He was given analgesia and streptokinase intravenously and his beta blockers were continued. His pain settled and after two days he began to mobilize.

Vocabulary p13
1 1f  2a 3g 4d 5e  6b 7c
2 1 practice manager 2 Health visitors 3 Receptionists 4 general practitioner  5 practice nurse
6 midwife 7 District nurses

Listening 1 p13
1T 2F 3F 4T 5F

Language spot p14
Present Perfect and Past Simple
1 The coughing started five days ago and it has been so bad it has woken me up every night.
2 When did the attacks first come on?
3 Has anything made it worse since it started?
4 He has never taken any medication in his life.
5 What happened when you were near animals as a child?
6 My father died over 20 years ago.
7 Did you get these problems every day when you lived in Africa?
8 Have you ever had coughing attacks like this before?
9 Has anyone in your family ever had an illness like this as far as you are aware?

Speaking p15
1 1911
2 1948
3 free comprehensive care
4 42,000
5 10,500
6 quarter
Student B:
1 250 million
2 15
3 7,000
4 14
5 78
6 40

Listening 2 p15
A case history
1 breathlessness 2 wheezing 3 cough 4 phlegm 5 at night. 6 in the morning. 7 three 8 tightness 9 known  10 asthma  11 previous  12 eczema
1 intrinsic and extrinsic asthma, COPD, pulmonary oedema.
2 PEFR, sputum culture, FBC, U&E, CRP, ABG analysis.
3 Teach the patient to use a peak flow meterto monitor PEFR twice a day. Use a step-by-step approach: Step 1 l-2 agonist as required for symptom relief.

4 Example questions:
Do you have any brothers and sisters/children? Are they in good health /alive and well? Are your parents/close relatives alive and well / in good health? Have they had any major illnesses in the past? Has anyone in your family had anything like this?

Vocabulary p15
Signs and symptoms
Condition a:
1 Symptom
2 Sign/Symptom
3 Sign/Symptom
4 Symptom
5 Symptom

Condition b:
1 Symptom
2 Sign
3 Symptom
4 Symptom
5 Sign
6 Sign/Symptom

Condition C:
1 Sign
2 Symptom
3 Sign
4 Sign
5 Symptom

a sinusitis
b asthma
c gastroenteritis.

a) Diverticular disease;
Symptoms: abdominal pain cramps (usually left-sided, improves with bowel opening) irregular bowel habit, flatus, bloating. PR bleeding.
Signs: increased temperature, increased pulse, ± decreased BP, LIF tenderness, ± peritonitis, distension.

b) Pneumonia:
Symptoms: cough, increased sputum (green), pleuritic chest pain, breathless, haemoptysis. fever, unwell, confusion.
Signs: Increased temperature, increased RR, increased pulse, decreased sats, unequal air entry, bronchial breathing, dull percussion, reduced expansion.

Speaking p15
2 Possible questions:
a Can you describe the pain for me? Have you had any fever? Is there anything that makes the pain better/worse?
b What seems to be bothering you? Can you describe the tightness a bit more for me? Is there anything else associated with the tightness? When is the coughing worse?
c Are your bowels OK? Any diarrhoea/vomiting? What is the pain like?

3 Main investigations:
a CT scan, but rarely necessary
b PEFR, sputum culture, FBC, U&E, CRP, blood cultures, ABG analysis
c ^WCC, ^CRP, stool cultures, and possibly an abdominal X-ray

Vocabulary p16
Non-technical language
1 1 start  2 precipitate

1 do
2 has got
3 avoid
4 prone
5 comes and goes
6 there all the time
7 stick to
8 admitted
9 booked

Listening 3 p16
Short questions in the general history
1 Is your appetite ok?
2 Bowels OK?
3 Waterworks OK?
4 Sleeping OK?

Patient care p16
Pronunciation 2
Questions: rising and falling intonation
1 The doctor’s voice rises.
2 1F 2F 3R 4R SF 6R 7R 8R 9F 10R

Reading p17-18
a homelessness or sleeping rough
b cramped housing,/accommodation
c smoking (in front of children)
d eating too much

1 y  2^  3<  4=>

1 homelessness, sleeping rough, employment and unemployment, divorce and immigration status
2 80 years ago, tobacco was fashionable and more affordable for those in higher paid jobs.
3 Some general reasons are general anxiety about living conditions, lack of security, worry about the future.
4 Some reasons are they probably have little or no money; no access to cooking facilities; lack of a balanced diet with fresh vegetables; no fixed routine.

4 Possible answers:
Poor diet and stress increase the risk of coronary vascular diseases and cancers. Those who are unemployed or under the threat of unemployment may not be able to afford to eat properly or may be suffering high levels of stress due to uncertainty about their future, therefore are more likely to suffer from these diseases. Violence and accidents may occur for various reasons like frustration and anger as a result of work loss. One study showed that after the announcement of a factory closure, GP consultation rates increased by20% and referral rates by 60%.

Writing p18
A referral letter
1 All points in the list are covered except 9, 12, and 13.
1 NHS Number 6784335792
2 Hospital Number 1017786S
3 Re David Hunt 17 May1975 (M)
4 18 Greencross Street, London SE17 2PD
5 ...on and off for more than three months.
6 The rashes have also decreased in frequency and
7 ... to be related to allergy to carpets, nor work or other common factors.
8 The patient spent several years in East Africa working
9 a teacher in his early 20s.

3 has complained— Present Perfect 
has erupted— Present Perfect 
has also complained— Present Perfect 
have also increased— Present Perfect 
does not appear— Present Simple 
has responded— Present Perfect 
has had — Present Perfect 
spent— Past Simple
may have — modal verb ÷ infinitive without to
would appreciate — Second Conditional

Checkup p20
1 They all show a newly qualified /junior doctor at work.
a A newly-qualified /junior doctor is asking a patient to get
undressed. The doctor perhaps took a case history before the scene in the picture and afterwards examined the patient.
b A newly-qualified /junior doctor is writing up case history notes. The doctor perhaps took a case history, and after writing up the notes, saw another patient.
c A slightly older doctor is explaining a procedure to newly qualified /junior doctors. The senior doctor perhaps asked the students what they knew and, after demonstrating, asked for volunteers to show what they learnt.
d A newly-qualified /junior doctor is talking with a consultant and the team during a ward round. The consultant may have asked the junior doctor questions about the patients and then advised on treatment, investigations, etc.
e A newly-qualified /junior doctor is asking a phlebotomist to take some blood from a patient. A senior doctor may have asked for the test The junior doctor may have had difficulty and then called the phlebotomist to take the blood instead.

6 A newly-qualified /junior doctor is handing over at the end of a shift. He may have written a list of particular jobs to be done, handed over and gone home.

Listening 1 p20
Preparing for the first ward round
a familiar with your patients.
b looking for patients.
c refer to them quickly.
d the patients on the ward.
e access information easily.

Patient care p21
1 Consent from the patient is a legal requirement where the procedure is invasive. The consent maybe necessary in writing. 
2 It is important that the patient knows who the doctor is, to put the patient at ease. The doctor may be wearing a name badge, but the patient may not be wearing his/her glasses; the patient may not be able to read, etc.
3 All necessary equipment needs to be present. A missing instrument in the middle of a procedure may cause problems.

2 Possible answers
Explain the procedure to the patient simply and clearly.
Explain why it is necessary.
Explain what the procedure will be like for the patient.
Think about previous successful procedures you have done.
Prepare the procedure by thinking through each step and use this process to check though the equipment.
Decide whether you need an assistant.

Vocabulary p21
Instructions for a procedure
a Withdraw
b Drain
c Mark
d Wash
e Obtain
f Sterilize
g Prepare
h Attach

2 The instructions relate to the first stages of a lumbar puncture. 

Speaking p22
a Wet hands and forearms under running water.
b Take soap from dispenser.
c Soap up, rubbing palm to palm.
d Rub with fingers interlaced.
e Massage between fingers, right palm over back of left hand, left palm over back of right hand.
f Rub with fingers locked, including fingertips.
g Rub rotationally with thumbs interlocked.
h Rinse thoroughly.
i Dry hands thoroughly using a paper towel.
j Dispose of towel into foot-operated pedal bin. Do not re-contaminate hands by touching the bin lid.

Reading p22-23
1 provide feedback
2 undertake procedures
3 assess competence
4 identify strengths

Speaking p23
Possible answers
Primary Survey
Protect the cervical spine.
Assess for any signs of obstruction.
Ascertain patency, establish a patent airway
Determine respiratory rate.
Check bilateral chest movement.

Listening 2 p24
Giving instructions

1 a4 b7 c2 d3 e5 f6 g1
4 IV cannulation
5 Possible answers
Can you sit in an upright position for me? That’s fine.
Can you lie down flat for me?
Now I’d like you to roll up your right sleeve above the elbow. OK, thank you.
I’d like you to raise your elbow — that’s it. (to apply the tourniquet) Can you lift your arm for a second for me? (to put a paper towel underneath to collect any blood spills) Thank you.
And just stretch out your arm and relax. Thank you. Just relax and keep nice and still for me, if you can. Can you clench and unclench your fist for me?
Can you wait for a second while I get a senior colleague? (If the cannula can’t be inserted).

Language spot p25
Making polite requests to patients
1 c and g are inappropriate as they are very abrupt.

2 Possible answers
1 Can you just pop behind the screen
2 ... so if you could turn onto your stomach (for me), (please). (Thank you).
3 Just cough for me.
4 I’d like you to stand up for me.
5 Could you (just) tilt your head
6 Can you make a tight fist...
7 I’d like you to keep nice and still

Listening 3 p25
It’s my job
1 a firm
2 two senior doctors
3 specialist registrars (SpR)
4 specialist registrars (SpR)
S the consultant
6 the consultants’ rounds
7 the junior doctor

Writing p27
Case notes
WR Ward Round
RTA / RTC road traffic accident / road traffic collision
Obs Observation(s)
(T) temperature
BP blood pressure
O/E on examination
INR international normalized ratio
LFT liver function test
U+E urea and electrolytes
(H) home
mane tomorrow
(0/P in 6/52) Out-patient in 6 weeks

Check up  p28
1 An endoscopy (or gastroscopy)
Word stress
Pronunciation p28
1c 2d 3a 4b
endoscope (•..) endoscopy (.•..) endoscopic (..•.)
(•..) 2 (.•..) 1,3, 5 (..•.) 4,6,7
3 is true

Listening 1
Patient care
1 The patient is asked to stop anti-acid therapy for two weeks beforehand if possible.
2 The patient is also advised to take nil by mouth for eight hours before the procedure is done, but note that water up to four hours before the operation (pre-op) may be OK.
3 The patient is advised not to drive if sedation is involved.

3 The most common verb form is the Present Simple Passive.

Language spot p29
Explaining investigations / procedures with the Present Passive
1 The needle is inserted (by the dodor).
2 This procedure is often performed by a nurse / nurses.
3 Gentle pressure is then applied to the puncture site (by the doctor).
4 The procedure is explained to the patient (by the sister).
5 The skin is cleaned (by the nurse).
6 This emergency procedure is not performed by doctors without training.
7 The vein is tapped (by the doctor).
8 Generally, this procedure is not performed by nurses.

In sentences 1,3,4,5, and 7 the agent is left out when explaining a procedure because it is not necessary: it is clear from the context who the agent is. In 2,6, and 8 the agent is necessary because naming the agent is the purpose of the sentence.

le 2b 3a 4c 5d
1 consent/obtained
2 anaesthetized
3 sedated
4 endoscope/advanced
5 air/blown
6 patient/given
7 swallow/section
8 mucosa/biopsied

1 Obtain informed consent.
2 Anaesthetize the pharynx using a spray.
3 Sedate the patient to induce drowsiness.
4 Introduce the endoscope and advance it further down
5 Blow air into the stomach via the side channel in the endoscope
6 Give the patient a plastic mouth guard to bite on.
7 Ask the patient to swallow the first section of the endoscope.
8 Biopsy the stomach mucosa using the thin ‘grabbing’ instrument

6 1, 2 / 3,6.7/4,5,8 Note: 2 and 3 occur closely together, as do 7and 4.

Listening 2 p30
Explaining gastroscopy (endoscopy)
Steps l, 3,2,4,8,and 5.
1 gullet
2 numb
3 throat
4 bendy
5 (take)a tiny tissue sample
6 something to help you relax

3 •..: flexible, biopsy, sedative, visualize

1 We’re going to do something called a gastroscopy.
2 What we are going to do is to have a look at your gullet and your stomach to see what’s going on there.
3 First, we’re going to give you something to help you relax.
4 We are going to pass a bendy tube, which is no thicker than your little finger, down through your throat into your stomach.
5 The tube will have a tiny camera on the end so that we can look at your stomach.
6 We’re also going to blow some air into your stomach to help us see a bit better
7 If we see anything, what we can do is take a tiny tissue sample.

Vocabulary p31
 sentences 5and 7 
1 simple — straightforward
2 some — a little
3 slightly — a little bit
4 tiny — small, scratch pinprick
6 only — just
8 hardly — barely

Listening 3 p31
1 simple
2 just
3 just
4 tiny
5 ten
6 only
7 pleasant
8 anything
The doctor emphasizes the words to reassure the patient.

2 Possible answer
The doctor could acknowledge that it is scary and then emphasize that it won’t take long or that it isn’t as bad as it sounds. The doctor needs to explain the procedure so that he / she can obtain informed consent, but giving all the detail can scare the patient?

3 Possible answer
The doctor might talk about the feeling afterwards, point out the risks of the procedure, and answer the patient’s questions.

Language spot p31
Explaining procedures with be going to future
1 We’re going to remove a tiny piece of tissue from your bowel.
2 What we’re going to do then is attach the end of the gut to an opening in your tummy wall.
3 We’re going to take a tiny piece of tissue from the neck of your womb.
4 What we’re going to do after that is (to) pass this tube through the urethra.
5 What we’re going to do then is (to) remove the glands in your armpit.
6 What happens next is that a tiny piece of your lung is removed / What we are going to do next is (to) remove a tiny piece of your lung.
7 What happens next is a tube is then passed down / What we are going to do next is to pass a tube down past the prostate into your bladder.
8 What happens next is that we / What we are going to do next is (to) inject a dye into the pancreatic and bile ducts so that we can see them.
9 We’re going to use a mesh to repair the muscle.

a7 b5 c2 dl e3 f8 g4 h6 i9

Speaking p32
1 appendicitis: it’s a condition where the appendix is inflamed and it has to be removed.
2 Alzheimer’s disease: it’s a condition where someone has memory loss and mood changes, for which the cause is not known.
3 haemorrhoidectomy: it’s a procedure where piles are tied or cut out.
4 diverticulitis: it’s a condition where sacs or pouches form at weak points in the gut. When the sacs are infected, inflammation occurs and causes pain, diarrhoea, and constipation.
5 sigmoidoscopy: it’s a procedure where we look at the colon and take a sample if necessary.
6 anaesthesia: it’s a procedure where you are given a general anaesthetic to put you to sleep before an operation and then you come round after it is over.

Informed consent is given after the patient has been made aware of what is going to happen and why. Implied consent is not explicitly stated but clear from the patient’s actions, for example, if the patient offers you their arm when you are about to take blood. Expressed verbal consent is when information about a procedure is explained and the patient verbally agrees to have it done. Expressed written consent is when an extensive explanation is given and the patient and the doctor both sign a consent form. Consultant consent is given by two senior doctors where a patient lacks capacity to consent themselves, for example in cases of severe mental illness.

Reading p32-33
1 Don’t eat
2 relaxed
3 operate machinery
4 somebody to accompany you home
5 not foolproof
6 a mild sore throat

1 What do you need to do for 4—6 hours before the procedure?
2 How will the sedative make you feel?
3 What should you not do for 24 hours after the sedative?
4 What do you need after the operation?
5 How successful are the results of the test?
6 What do some people have afterwards?

Vocabulary p34
Explaining complications and reassuring the patient
1 usually
2 often
3 never
4 rarely
5 always
6 sometimes
Order of frequency: never, rarely, sometimes, often, usually, always
rarely: seldom, almost never, not often sometimes: occasionally, now and then often: frequently, regularly usually: typically, habitually, generally, commonly

Listening 4 p34
Discussing complications
1 a mild sore throat
2 you may feel a bit tired afterwards
3 [some people can get] a chest infection or pneumonia
4 some bleeding or infection in the gut
5 [it] can also puncture the gullet or stomach
So the patient is aware of them before he signs the consent form.
occasionally — on the odd occasion
automatically — necessarily
seldom — rarely
1 I can assure you that in most cases the procedure is problem-free.
2 But remember this does not mean that you will necessarily get these as well.
3 ... but this happens very rarely.

Speaking  p34
1 a3 b6 c1 d2 e5 f4
lb 2e 3c/f 4f/c 5a 6d
a constipation, infection
b abdominal discomfort, perforation
c pain, bleeding
d headache, nausea, paralysis
e (depending on the drugs): vomiting / nausea, hair loss
f pain, bleeding, collapsed lung
g pancreatitis, bleeding

Writing p35
ABG: bleeding, haematoma, arterial damage and peripheral ischaemia, infection, pain, local tendon / nerve change IV injections: anaphylaxis, drug overdose, local irritation, thrombophlebitis, leakage of drug from tissued cannula, haematoma