《医学英语》五年制教学课件
医学英语五年制教学课件,医学英语,医学,英语,五年制,教学,课件
Chapter22PuttingtheExaminationTogetherLiuboDept.ofRheumatologyandImmunologyCJUHlAphysicianisnotonlyascientistoragoodtechnician.lPhysician,doctorlTechnician,mechanicdoctor,physicianlDoctor比比physician更通用,主要是指博士更通用,主要是指博士学位,哲学博士、经济管理学博士等。如学位,哲学博士、经济管理学博士等。如果特别强调医学博士,应该用果特别强调医学博士,应该用physician。l内科医生内科医生l外科医师外科医师physician;internistsurgeonlDoctor主要是指拥有博士学位,哲学博士、主要是指拥有博士学位,哲学博士、验光博士、骨科博士、牙科博士、教育学验光博士、骨科博士、牙科博士、教育学博士、神学博士、药学博士、工商管理学博士、神学博士、药学博士、工商管理学博士等。博士等。lPh.D.DoctorofPhilosophy哲学博士,哲学博士,lDOdoctorofoptometry验光博士验光博士,ldoctorofosteopathy骨疗法博士骨疗法博士,骨科博士,骨科博士,lDDSdoctorofdentalscience牙科学博士,牙科学博士,doctor,physicianlDoctor主要是指拥有博士学位,哲学博士、验光主要是指拥有博士学位,哲学博士、验光博士、骨科博士、牙科博士、教育学博士、神学博士、骨科博士、牙科博士、教育学博士、神学博士、药学博士、工商管理学博士等。博士、药学博士、工商管理学博士等。lEdDdoctorofeducation教育学博士,教育学博士,lDDdoctorofdivinity神学博士神学博士,lDPHDoctorofPharmacy药学博士药学博士doctorofpublichealth公共卫生学博士,公共卫生学博士,lDBADoctorofBusinessAdministration工商管工商管理学博士。理学博士。doctor,physiciantechnician,mechanicltechnician技师,技术员;技巧纯熟的人技师,技术员;技巧纯熟的人lmechanic技工,机修工技工,机修工lmechanic的职位低,机械工的职位低,机械工,修理工,劳力劳动修理工,劳力劳动者,而者,而technician所掌握的技术层面高。所掌握的技术层面高。lHemustbemorethanthathemusthavegoodhumanqualities.lHehastohaveapersonalunderstandingandsympathyforthesufferingofhumanbeings.lAlbertEinstein(18791955)humanqualities人文素质sympathylhavesympathyforlexpresssympathyforlinsympathywithloutofsympathywithlwinsympathyof同情*人对*表示同情(慰问)同情、赞成不赞成博得*的同情TheTechniqueslThepreviouschaptersdealtwiththeindividualorgansystemsandthehistoryandphysicalexaminationsrelatedtoeachofthem.Dealwithldealwith主要有以下用法:主要有以下用法:l1)totreat;totakeactionaboutl2)todobusinesswith.l3)tobeabout1.Childrenarehardtodealwith2.Ivedealtwiththisstorefor20years3.ThisnewbookdealswiththeWarinIraqIndividual,personallindividualadj.个人的个人的;独特的独特的;个别的个别的;n.个人个人;个体个体;lPersonaladj.个人的,私人的个人的,私人的lpersonal个人的个人的,一般形容和人有关的一般形容和人有关的lindividual可用在人也可用在事务上可用在人也可用在事务上lThepurposeofthischapteristohelpthestudentassimilateeachoftheindividualexaminationsintoonecompleteandsmoothlyperformedexamination.lassimilatevi.吸收,消化;同化;vt.透彻理解;使吸收lIdeally,acompleteexaminationisperformedinanorderly,thoroughmannerwithasfewmovementsaspossiblerequiredofthepatient.Perform,operationlperformanoperation动手术动手术performanoperationonsb.foradisease给某人实施某个疾病的手术给某人实施某个疾病的手术lperformingthephysicalexaminationexaminationisperformedPerform,operationlputintooperationlbringintooperationloperateonsb.operateuponsb.lundergoanoperation实施实施,施行施行实施实施,施行施行给某人动手术给某人动手术给某人动手术给某人动手术接受手术接受手术Patient,Case,SubjectlApatientreferstoaparticularpersonundermedicalcare,whoisadmittedfortreatment,examined,givenmedicationanddischarged.lAcasemeansaparticularinstanceofadisease,whichisevaluated,documentedorreported.lAresearchsubjectisonewithaparticularcharacteristicorbehaviorexaminedinascientificinvestigation,whichisrecruited,selected,sometimessubjectedtoexperimentalconditions,observed,andthanked.lMosterrorsinperformingaphysicalexaminationresultfromalackoforganizationandthoroughness,notfromalackofknowledge.lEvaluateeachpartoftheexaminationcarefullybeforemovingontothenextpart.lThemostcommonerrorsinperformingthephysicalexaminationarerelatedtothefollowing:TechniqueOmissionDetectionInterpretationRecordingBedueto,Resultfrom,ResultinlBedueto由于,起因由于,起因lResultfrom,betheconsequenceof由由造成造成Hisfailureintheexamresultedfromhislaziness.考试考试失败是由懒惰造成的。失败是由懒惰造成的。lResultin,导致导致in介词介词,因此后面跟名词或动名词因此后面跟名词或动名词,即即:resultinsth./doingsth.Failurewillresultinfrustration.失败会导致挫败心理失败会导致挫败心理Hislazinessresultedinfailingintheexam.他的懒惰导致考试失败他的懒惰导致考试失败dueto,becauseof,owingtol三者均可表示三者均可表示“由于由于”、“因为因为”,按照传统语法:,按照传统语法:dueto主要引导主要引导表语,而表语,而becauseof,owingto两者都主要引导状语。如:两者都主要引导状语。如:Hisillnessisduetobadfood.他生病是由于吃了不好的食物。他生病是由于吃了不好的食物。Theaccidentwasduetocarelessdriving.这次车祸起因于驾驶疏忽。这次车祸起因于驾驶疏忽。Hecantcomebecauseofthebadweather.他不能来是因为天气不好。他不能来是因为天气不好。Owingtotherain,thematchwascancelled.比赛因雨被取消了。比赛因雨被取消了。l但是在现代英语中,但是在现代英语中,dueto也可用来引导状语,而也可用来引导状语,而owingto也可以用也可以用来引导表语。如:来引导表语。如:由于交通拥挤他迟到了。由于交通拥挤他迟到了。正:正:Hewaslateduetoowingto,becauseoftheveryheavytraffic.正:正:DuetoOwingto,Becauseoftheveryheavytraffic,hewaslate.lbecauseof通常只用来引导状语,若引导表语,主语通常应为代词。通常只用来引导状语,若引导表语,主语通常应为代词。Itisallbecauseofwhatyousaid.那完全是因为你说的话。那完全是因为你说的话。lErrorsintechniquearerelatedtolackoforderandorganizationduringtheexamination,faultyequipment,andpoorbedsideetiquette.lErrorsofomissionarecommoninexaminationsoftheeyeandnose;auscultationoftheneckvessels,chest,andheart;palpationofthespleen;rectalandgenitalexaminations;andtheneurologicexamination.letiquetten.礼仪、礼节、规矩、礼数lgenitaladj.生殖的,生殖器的;n.生殖器,外阴部lErrorsofdetectionarethoseinwhichtheexaminerfailstofindabnormalitiesthatarepresent.lThemostcommonerrorsofthistypeinvolvethyroidnodules,trachealdeviation,abnormalbreathsounds,diastolicmurmurs,hernias,andabnormalitiesoftheextraocularmuscles.ltrachealadj.气管的,导管的,呼吸管的ldiastolicadj.心脏舒张的;lhernian.疝气;突出;lErrorsininterpretationoffindingsoccurmostcommonlywithtrachealdeviation,venouspulses,systolicmurmurs,fremituschanges,abdominaltenderness,liversize,eyefindings,andreflexes.lThemostcommontypesofrecordingerrorsarerelatedtodescriptionsofheartsizeandmurmurs,improperterminology,andobscureabbreviations.lsystolicadj.心脏收缩的;lfremitusn.震颤;lThefollowingexaminationsequenceistheonetheauthorusesandisdemonstratedintheDVD-ROMenclosedwiththisbook.lThereisnorightorwrongsequence.lDevelopyourownapproach.lJustbesurethatattheendofwhichevertechniqueyouuse,acompleteexaminationhasbeenperformed.DevelopDevelop发展、开发。发展、开发。ltostudy,thinkout,ortalkaboutindetailltobegintobeseenorbecomeactive例句:例句:lThesymptomsofCRFoftendevelopslowly.lThegeneralconsensusisthat60%oflupuspatientswilldevelopclinicallyrelevantnephritisatsometimeinthecourseoftheirillness.lMostSLEpatientsdevelopnephritisearlyinthecourseoftheirdisease.lInmostsituations,thepatientwillbelyinginbedwhenyouarrive.lAfterintroducingyourselfanddocumentingacompletehistory,youshouldinformthepatientthatyouarereadytobeginthephysicalexamination.lAlwaysstartbywashingyourhands.lThereaderisadvisednowtowatchthevideopresentationontheDVD-ROMtoreviewthecompletephysicalexaminationofthemanandthebreastandpelvicexaminationsofthewoman.lTheDVD-ROMwillhelpyouputtheexaminationtogether.l pelvic adj.骨盆的,关于骨盆的TheWrittenPhysicalExaminationlAftertheexaminationhasbeencompleted,theexaminermustbeabletorecordobjectivelyallthefindingsofinspection,palpation,percussion,andauscultation.lBepreciseinstatinglocationsofabnormalities.Negative,positive,normal,abnormallExaminationandlaboratorytestsarenotnegative,positive,normalorabnormalinthemselves.Thesewordsonlyapplytoobservations,resultsorfindings.lThethroatculturewasnegative.lCorrect:Thethroatculturewasnegativefor-hemolyticstreptococci.lthephysicalexaminationwasnormal.lCorrect:Theresultsofthephysicalexaminationwerenormal.lTheelectrocardiogramwaspositive.lCorrect:Theelectrocardiogramshowedabnormalitiesinthealphawaveactivity.lSmalldrawingsmaybeusefultodescribeashapeorlocationbetter.lWhendescribingthesizeofafinding,statethesizeinmillimetersorcentimetersratherthancomparingitwithafruitornut,forexample,becausethesecanvarygreatlyinsize.lItisbestnottousemostabbreviationsbecausetheymaymeandifferentthingstodifferentreaders.lHowever,theabbreviationsusedinthefollowingexamplesarestandardandmaybeused.lFinally,donotmakediagnosticstatementsinthewrite-up;savethemforthesummaryattheend.lForexample,itisbettertostatethatagradeIII/VIholosystolicmurmurattheapexwithradiationtotheaxillaispresentratherthanamurmurofmitralinsufficiency.lholosystolicadj.全收缩(期)的;lapexn.顶;顶峰;尖;脉尖;尖端;laxillan.咯肢窝,腋窝;lmitralinsufficiency二尖瓣关闭不全;lPatient:JohnHenrylGeneralappearance:Thepatientisa65-year-oldwhitemanwhoislyinginbedontwopillowsandisinnoacutedistress.Heiswelldevelopedandthinandappearsslightlyolderthanhisstatedage.Thepatientiswellgroomed,alert,andcooperative.lVitalsigns:Bloodpressure(BP),185/65/55rightarm(lying),180/60/50leftarm(lying),175/65/50leftarm(sitting);heartrate,90andregular;respirations,16.lSkin:Pink,withsmallhyperkeratoticpapulesovertheface;nailbedsslightlydusky;hairthinonhead;hairabsentonlowerportionoflowerextremities;normalmaleescutcheon(distributionofpubichair).lvitalsign生命体征lhyper-,hypo-,lkerat/o-,keratolytic,keratosis,keratinlpapulen.丘疹,长疮;小乳头lescutcheonn.有花纹的盾,锁眼盖,孔罩;饰框lpubichair阴毛lHead:Normocephalicwithoutevidenceoftrauma;notendernesspresent.lnormo-,lEyes:Visualacuitywithglassesusingnearcard:righteye(OD),20/60,lefteye(OS)20/40;visualfieldsfullbilaterally;extraocularmovements(EOMs)intact;PERRLApupilsareequal,round,andreactivetolightandtoaccommodationxanthelasmapresentbilaterally,LR;eyebrowsnormal;lextra-lxanthelasman.黄斑瘤;睑黄斑。lbilateralarcussenilispresent;conjunctivaewithoutinjection;opacitiespresentinbothlenses,RL;leftdiscsharpwithnormalcupdiscratio;normalarteriovenous(AV)ratioOS;noAVnickingpresentOS;larcussenilis老年环;lconjunctivaen.(眼球)结膜(conjunctiva的名词复数);lopacityn.不透明性;费解;难懂;模糊;llensn.透镜,镜头(lens的名词复数);眼的晶体;lthereisaflame-shapedhemorrhageatthe6oclockpositionOS;severalcotton-woolspotsarealsopresentatthe1and5oclockpositionsOS;rightfundusnotwellvisualizedasaresultoflenticularopacity.lfundusn.基底,底部,底;llenticularadj.透镜的,小扁豆似的;构词法构词法ln+n+-edlflame-shapedstraw-colored,disk-shaped,sickle-shaped,chicken-heartedladj+n+-edbad-tempered,warm-heartedlEars:Pinnaeinnormalposition;notendernesspresent;smallamountofcerumeninleftexternalcanal;canalswithoutinjectionordischarge;Rinnetest,BCACrightear,ACBCleftear;Webertest,lateralizationtotherightear;bothtympanicmembranesaregraywithoutinjection;normallandmarksseenbilaterally.lpinnaen.,羽,翼,鳍(pinna的名词复数)lcerumen耵聍,耳垢,耳屎llateralizationn.(尤指脑部的)偏侧性,偏侧优势,偏利;ltympanicmembranes鼓膜lNose:Nosestraightwithoutmasses;patentbilaterally;mucosapinkwithacleardischargepresent;inferiorturbinateontherightslightlyedematous.lpatentn.专利;adj.专利的;显露;linferiorturbinate医下鼻甲;lsupraturbinal上鼻甲lSinuses:Notendernessdetectedoverfrontalandmaxillarysinuses.lfrontalsinuses额窦lmaxillarysinuses上颌窦lThroat:Lipsslightlycyanoticwithoutlesions;patientwearsanupperdenture;buccalmucosapinkwithoutinjection;alllowerteetharepresentandareinfaircondition;noobviouscaries;gingivaenormal;tonguemidlinewithoutfasciculations;lcyanotic紫绀ldenturen.假牙lbuccaladj.(面)颊的,口的,口腔的;口甲;lcariesn.龋齿,骨疡lgingivaen.齿龈lfasciculationn.束状;簇生;(肌肉、神经的)自发性收缩;肌震束颤;lnolesionsseenorpalpatedontongue;mildinjectionofposteriorpharynxwithyellowish-whitedischargepresentonposteriorpharynxandtonsils;tonsilsminimallyenlarged;uvulaelevatesinmidline;gagreflexintact.lpharynx咽ltonsiln.扁桃体;luvulan.悬雍垂,小舌;lgagreflex咽反射lNeck:Supplewithfullrangeofmotion;tracheamidline;small(1-to2-cm)lymphnodesarepresentinsuperficialcervicalandtonsillarnodechains;thyroidborderspalpable;nothyroidnodulesorenlargementnoted;noabnormalneckveindistentionpresent;neckveinsflatwhilepatientissittingupright.ltrachea气管lsuperficialcervical颈浅lChest:Anteroposterior(AP)diameterincreased;symmetricexcursionbilaterally;tactilefremitusnormalbilaterally;chestresonantbilaterally;vesicularbreathsoundsbilaterally;coarsebreathsoundswithoccasionalcracklespresentatthebases.ltactilefremitus触觉震颤lchestresonant语音共振lvesicularbreathsounds肺泡呼吸音lcrackle爆裂音lBreasts:Mildgynecomastia,LR;nomassesordischargepresent.lgynecomastia adj.男子女性型乳房;lHeart:Pointofmaximumimpulse,sixthintercostalspace(PMI6ICS)2cmlateraltomidclavicularline(MCL);lpointofmaximumimpulse(PMI)心尖搏动lintercostalspace(ICS)肋间lmidclavicularline(MCL);锁骨中线lnormalphysiologicsplittingpresent;noheavesorthrillsarepresent;S1andS2distant;agradeII/VIhigh-pitchedholodiastolicmurmurisheardatthe2ICSattherightuppersternalborder;agradeI/VImedium-pitchedsystoliccrescendo-decrescendomurmurisheardintheaorticarea;thesystolicmurmurismidpeakinglsternaladj.胸骨的lcrescendo-decrescendo递增递减lVascular:Acarotidbruitispresentontheright;nobruitsareheardovertheleftcarotid,renal,femoral,orabdominalarteries;lowerextremitiesareslightlycoolincomparisonwithupperextremities;lcarotidn.&adj.颈动脉(的)lbruitn.医学(听诊时所听到的)杂音;lfemoraladj.股骨的,大腿骨的,大腿的;n.股动脉l1+pretibialedemaispresentontherightlowerextremity;2+pretibialedemaispresentontheleft;mildvenousvaricositiesarepresentfrommidthightocalfbilaterally;noulcerationorstasischangesarepresent;nocalftendernessispresent.lpretibial胫骨前的;lvaricosities医静脉曲张,静脉曲张状态;lcalfn.牛犊;犊皮;腓,腿肚子;lstasis瘀lAbdomen:Theabdomenisscaphoid;arightlowerquadrant(RLQ)appendectomyscarandaleftlowerquadrant(LLQ)herniorrhaphyscararepresent;bothscarsarewellhealed;a33cmmassisseenintheRLQaftercoughingorstraining;noguarding,rigidity,ortendernessispresent;lscaphoidadj.船状的l-oiddiscoid,rheumatoidlappendectomyn.阑尾切除术lherniorrhaphylnovisiblepulsationsarepresent;bowelsoundsarepresent;percussionnoteistympaniticthroughouttheabdomenexceptoverthesuprapubicregion,wherethepercussionnoteisdull;liverspanis10cmfromtoptobottomintheMCL;lbowelsounds肠鸣音ltympanitic气鼓的,鼓响的lsuprapubic耻骨弓上的;lspleenpercussedinleftupperquadrantbutnotpalpated;kidneysnotfelt;nocostovertebralangletenderness(CVAT)present;aneasilyreduciblerightindirectinguinalherniaisfeltattheexternalring.lcostovertebral肋椎的:属于肋骨与椎骨的linguinalhernia腹股沟疝;lRectal:Analsphincternormal;nohemorrhoidspresent;nontenderprostateenlargedsymmetrically;prostatefirmwithoutnodulesfelt;noluminalmassesfeltinrectum;stoolnegativeforblood.lrectal直肠lsphincter括约肌lhemorrhoid痔疮lprostate前列腺lGenitalia:Circumcisedmanwithnormalgenitalia;peniswithoutinduration;lefthemiscrotum4to5cmbelowtheright;palpationoflefthemiscrotumrevealsdilatationofthepampiniformplexus;softtestes231cmbilaterally.lgenitalia生殖器lcircumcised割礼lpenis阴茎linduration硬化、结节lpampiniformplexus精索静脉丛lLymphatic:Nodesinanteriortrianglechainsalreadynoted;twofirm,1-to2-cm,rubbery,freelymobilenodesinleftfemoralarea;noepitrochlear,axillary,orsupraclavicularnodesfelt.lanteriortriangle颈前三角.lrubbery橡皮样的、弹性lfemoral股骨lepitrochlear肱骨内上髁laxillary腋窝lsupraclavicular锁骨上窝lMusculoskeletal:Distalinterphalangealjointenlargementonbothhands,causingpainonmakingafist,LR;notendernessorerythemapresent;proximaljointsnormal;neck,arms,hips,knees,andankleswithfullrangeofactiveandpassivemotion;musclesappearsymmetric;mildkyphosispresent.ldistalinterphalangealjoint远端指(趾)间关节lerythema红斑lkyphosis脊柱后凸lNeurologic:Orientedtoperson,place,andtime;cranialnervesItoXIIintact;grosssensoryandmotorstrengthintact;cerebellarfunctionnormal;plantarreflexesdown;gaitnormal;deeptendonreflexesasshowninTablelcerebellar小脑lplantar跖lgait步态lSummary:Mr.Henryisa65-year-oldmaninnoacutedistress.Physicalexaminationrevealssystolichypertension,retinalchangessuggestiveofsustainedhypertension,amildcataractinhisrighteye,aconductivehearinglossinhisrightear,tonsillopharyngitis,andgynecomastia.lCardiacexaminationrevealsaorticinsufficiency.Peripheralvascularexaminationrevealspossibleatheroscleroticdiseaseoftherightcarotidarteryandmildvenousdiseaseofthelowerextremities.Thepatienthasaright,easilyreducibleinguinalhernia.Aleft-sidedvaricoceleispresent.Mildosteoarthritisofthehandsisalsopresent.lPatient:MaryJones*lGeneralappearance:Thepatientisa51-year-oldAfrican-Americanwomanwhoissittingupinbedinmildrespiratorydistress.Sheisobeseandappearstobeherstatedage.Sheiswellgroomedandalert,butsheconstantlycomplainsabouthershortnessofbreath.lVitalsigns:BP,130/80/75rightarm(lying),125/75/70leftarm(lying),120/75/70(sitting);heartrate,100andregular;respirations,20.lSkin:Upperextremitiesslightlyduskyincomparisonwithlowerextremities;goodtissueturgor;patientiswearingawigtocoverhermarkedtotalbaldness;normalfemaleescutcheon.lHead:Normocephalicwithoutevidenceoftrauma;faceappearsedematous;notendernessnoted.lEyes:Visualacuityusingnearcard:OD,20/40,OS,20/30;visualfieldsfullbilaterally;EOMsintact;PERRLA;eyebrowsthinbilaterally;conjunctivaeredbilaterallywithinjectionpresent;lensesclear;bothdiscsappearsharpwithsomenasalblurring;thecupdiscratiois1:3bilaterally,andthecupsaresymmetric;theretinalveinsappeardilatedbilaterally.lEars:Pinnaeinnormalposition;nomastoidorexternalcanaltenderness;canalswithoutinjectionordischarge;Rinnetest,ACBCbilaterally;Webertest,nolateralization;bothtympanicmembranesclearlyvisualized;normallandmarksseenbilaterally.lNose:Straightwithoutdeviation;mucosareddish-pink;inferiorturbinateswithinnormallimits.lSinuses:Notendernessdetected.lThroat:Lipscyanotic;allteethpresentexceptforallthirdmolars,whichhavebeenextracted;occlusionnormal;nocariesseen;gingivaenormal;tonguemidlinewithmarkedlydilatedtortuousveinsonundersurface;nofasciculationsoftonguenoted;posteriorpharynxappearswithinnormallimits;uvulamidlineandelevatesnormally;gagreflexintact.lNeck:Fullwithnormalrangeofmotion;tracheamidline;neckveinsdistendedtoangleofjawwhilesittingupright;noadenopathyofnecknoted.lChest:APdiameternormal;symmetricexcursionbilaterally;increasedtactilefremitusatrightbaseposteriorlycorrespondstoareaofbronchialbreathsounds;percussionnoteinthisareaisdull,allotherchestareasareresonant;bronchophonyandegophonypresentinareaofbronchialbreathsounds;cracklesandwheezespresentinareaatrightposteriorbase.lBreasts:Leftmastectomyscar;rightbreastwithoutmasses,dimpling,ordischarge.lHeart:PMI5ICSMCL;normalphysiologicsplittingpresent;noheavesorthrillspresent;S1andS2withinnormallimits;nomurmurs,gallops,orrubspresent.lVascular:Therearenobruitspresentoverthecarotid,renal,femoral,orabdominalarteries;theextremitiesarewithoutclubbingoredema.lAbdomen:Theabdomenisobesewithoutguarding,rigidity,ortenderness;novisiblepulsationsarepresent;bowelsoundsarenormal;percussionnoteistympaniticthroughouttheabdomen;liverspanis15cmintheMCL;spleennotpercussedorpalpated;kidneysnotpalpated;noCVATpresent.lRectal:Refused.lPelvic:Deferreduntilpatientmorestable.lLymphatic:Noadenopathyfeltintheneckchainsorintheepitrochlear,axillary,supra-clavicular,orfemoralregions.lMusculoskeletal:Markededemaofbothupperextremities,LR;neck,arms,knees,andankleswithfullrangeofactiveandpassivemotion;musclesappearsymmetricexceptforupperextremities.lNeurologic:Orientedtoperson,place,andtime;cranialnervesItoXIIintact;grosssensoryandmotorstrengthintact;cerebellarfunctionnormal;plantarreflexdownbilaterally;deeptendonreflexesasshowninTable22-2
收藏