Professional ------,

English in
Use

Medicine
Eric H. Glendinning
Ron Howard
CAMBRIDGE
l.NrVERSITY I'KL~S
Contents
INTRODUCTION 8 o Allied health professionals 24
A (ommunl('\ ""';11th
B Tecbmcran ..
C Pto~rh~"~c~drld onnoosrs
D
BASICHealth and illness 10 o ()prk.~.ln'"

A AslU1g .bou, baloh o Hospitals

26
B Srlne»
 C Reanm A tmrodccnon H) ;I hc~pital
B Ourpanemv
c
II
1a1r.1hC'nl ..
Parts of the body 1 12
A P.lIb 0I.t.. t...J, 1m Primary cart' 28
B Rtfttn~ h) J'ln ...... rht
C l~nhlltA f.JJllIIC-w1 61
bu.J\
rain
A I"" :-.;......III<~th ""'ICC
B 11\C' rrJ""t., l('oJnl
C II (,1)\ d.l)
II Parts of the body 2 14
A The.bdum<n
8 Thrd EDUCATION AND TRAINING
C Thr pd,,,
m Medical education 1 30
II functions of the 16
A ~ tedical cducmoo In tnt- UK
8 Extract frocn an ul1derpadua~
A Eating prospectus
8 Tbe file' \It1' ....n C .\ ~rudcnl·~,,~
C Other tUIk.'."'"\
o I~ ('('ImnlCMl tun..._--uon~ Medical education 2 32
A '1111:"Found.uuH1 Prufl,l"an"li(
B I'''-'uplt In 1Il4...JK:.,r1Juwuon
MEDICAL AND PARAMEDICAL
C \tNK:.JIl;ju.,hh... .. ltcllO\
PERSONNELAND PLACES
1:1 Medical practitioners I 18
m The overseas doctor 34
A 1),1'(.... HI ~1 ..I(JIKtI\
A PracuuullC'f\
6 I'I.AII
6 5p«.1.1t"" C PI AS ~IJrM"\.. JnJ .
1"h~r: C CJ-ooo.,... ,!,<,u In

III Medical practitioners 2 20 SYSTEMS, DISEASESAND

A Hospnal , •• 11 SYMPTOMS
m,
B Mod,.:.,1 ...
C m Symptoms and signs 36

U A o...:n~ proNnn,
22 B Pr<srnUtMWl

Nurses
A :-;ursm~ ",.do
B ~uPJ'On" "rI.""
1mC lalklng ahc;~ul ,\ mrc-oms
Blood
C Spt(';lllI~tlUn
0 l"he nurw" r",k- A 1"lIblo,," ""',,.
8 \fUltmU
C l)m'k.'lCM.h ..l1U<ml.l

m
1m Bones 40 m Mental Illness
A 11<01<\ A 1\)<hlJr .... d,,ordtn
58
8 .r ....""turn a SutK(J,n..~ abcse
C r rtJ.Ullt'flC ctl trAlurn C Aff.",,,. d,<O<den
o Nruroric and "",",,,.m,.ed J,.onitrs
m Childhood 42 E Orher .ypes of !un..".,.w ~
A ~hbrone\
8 uwnmon tnfC\..,_IOU .. JI~W'\
m The nervous
system
A Sensory loss
1 60
C <.:udt.k' dl!la)(
a )'IIXO< loss
Ill) The endocnne system 44 c 1.0<>of ronsoousness
A I '""'\ .lnd ddk~.."
a l\;<'IlJ"\< l....Jh.o..k
m The nervous system 2 62
e (.",.,,'(' A The nlOrOf' ~\~t1T1
o \ kr ..... "I I'rI ......1 a Tendon rrlle" ..
C Coma
1m The eye 46
A I'.n, 01 It.. <)<
Em Oncology 64
8 I \,&I1UnAUUn of ahe (')(' A Nroplas1ns
C Rc..°I,nC)p.1Ih) 8 Symp.oms and SIgnS of n",lowu",)
C Treannenr or rumours
fI!) The gastrointestinal system 48
A F'=31111nJ1IOn of ,he ;ahdoult11 em Pregnancy and 66
a Th. f.""", A Childbirth

m Gynaecology 50
B Labour
C Presentation and 1.(

A The (elflJk
B \lcn ..c.ruJIH'W1
rq'fnd"'-1I\t \\'fC'm
m The respiratory system 68
C A ~)'".It'\.(*"'h..J1 "nn ..uh.uKln A Cough
o "onlriktl'urMl B Au~ulc.;tuon

m Thr heart a d circulation I 52 m The skin I 70

A \hurtnc .., ut ~.lIh A 'i<>me1\ "'" o( d,n in_
a Itdn rh\lhm a R.",",

m The skin 2
C I tC.ln tlllurC'

m The and circulation 2 54 A InlUtKS ro me stln

72

heart

5
 A Ph"~CU~I'" 8 Case repo«
B FYmlnlrtA tht- ht-~n ;anJ 1,.1,rl.'1Jbnon C Sores

fD Infections 56 m The urinary ystem 74

A F('\C'r A Urinary ~}mptC)ttlS
8 \ 1I(nl(~nl\.fn\ s B UrLna)ysls
C ~'UI'Ct.and ,prt'Jd _.II"'(\.U(1oO

6
INVESTIGATIONS m Therapies 92

7
 I'D BasIc investigations 76 A IUd...ch<r'J').nJ .hmwxh<r.J')
8 A do) In rbe Irl< or • ph),lOCher.lplSl
A Ophlh.Ir""",,,,!,>
C ~Il'" 8eho ... "ur>1 'I'h<r.1rr
8 8100d 1"<'''''''
C Tal; .. "Iood
PREVENTION
1m Laboratory tests 78
CD Screening and 94
A A ~ IJcrol>oolog) I'" r<qtJ<Sl form
8 A Biocheuu",y ill1d 11a<=llolog)
immunization
!.h Jq'O" A Screeurra
C rcnm used to dc-cnhe bb rnul" 8 Comm< .. "'-rttrullIt Inn
C hninunl1..lhOftfor IrJl\dkn
1m Endoscopy 80
A .UI'IQ1Il"', 4'/ mdI ....(.~
8 I nrno..",,) EPIDEMIOLOGY
C R.po" of. d,ow.o,l ... <noo,.op>
e Epidemiology 96
m X-ray and CT 82 A Rot ..
8 Incidenl~ and prevalence
A R.d,l)!ttJph) and r.ldlolog)
C As.socJOlu(,n aod ~"'UUhQn
8 \ -ra,' cunuru:non
C ComPUlrd Tomogr.aph)

m MRI and ultrasound 84

ETHICS
eLl Medical ethics 98
A .\I"1!Jldl< R_"", lmagu>g IMRII
8 Ulrrasound A GMC~ulddi nes
C Prep.~ f<ormrd".1 tmagllllt 8 s..."h""I!S1Un
o D<s<n"'~ mrdgl '="'1111 C As..,,,rd d, inS

ImECG 86
f«, RESEARCH
em Research
A IJ ... 01 .n
8 I (c, p..... rdu re
100
c \ no ....ul fCC;
A c..., ....
oIIlrui sru.)""
B CAhon 'ludtt'\
TREATMENT C rri31~

em Medical treatment 88
0 vu""""
A Prescnpnons and drult'
8 Tbe Bnush :-:"UQn.\1 formub~ TAKING A

m Surgical treatment 90
CD Taking a history 1

102
A A full <.1'>< h"'<>n
A 11>< optranng theal",
B PenoNl drt .. l,
8 In.')(T'UJDC'flr"
C T.lk,"~ ,houl I",n

em Taking a history 2
C 11>< (ll"'r.",,"
o .\ " br<'t ,1'1("1 I'C'POf1
104
A On11t h"fU"
8 F:HIlIh h,,,,tnn
C Socul.nd ptN...w ht':lJ<\

6
em Taking a history 3 106 mil Data presentation 2 120
A R('\It" '1Illlht ,,-rtllh A LIlIt !t'3 pbs
8 Ad •••". ~hc1lU11hr ,,('fIetal ntf'\OUS S\'-'ml 8 p", cham 2nd bar ch2ns
C PJltml kit;}\. t.~ .1nJ co'ra-'_.lIKln\ C Dcsc:nbmg tr<n<k
0 Ph,."'I ...... III h,,,,,,, ~1.lm1I
m
 Research articles 122
A no. S<tIICnIR oi • research .nod<
EXAMINATION B Obi<a,..'S
c
lim Physical examination 108
Main findon8S

A .. \..,1nllnl~' r.aucnt lim Abstracts 124

B (,1\ '''It In ....Nt.:oun ..
A ~rucrur<d .Iostr...,..
'n.c 8~ 1J .l:>,tr.KI
liD Mental state examination 110
B

A 'some ,)ml"'nm, ui f'l'\,,,hl.u ..... 41wwdel')

B 'Ie.",
m Conference presentations 126
A The \rn.crurt' of .1 rrornl.luon
c 1)r',-JI '10("".,"' l,,'Ifll J nlC1l1JI B The Inrroduerl041
\I.lle' ('\.UfllnJtHM1
C S'gn:olhng
0 The conchmon

EXPLANATION miJ Case presentations 128

m Explaining diagnosis 112

A Sections of :I CA~
8 Bedside presenrarion
pteSt'1\f3000

and management c Slides

A r"rl;an:utOn\
B ll\1I1j.tI~l t""l\ 10 c\planauon.)
c An expl .. n311()n C)( J.njtlru Appendix I 130
Parts of the bod)
liD DiSCUSSingtreatment 114
Appendix II 131
A ()'fcnll'; c'f"-"''' , Iedical abb .... ·.. non'
8 Ad\ 1\ln~.a \.(JUN' Ct' -,,,nun
C \d\ l).In~I"fI('nl, tu J ... Md ~hUllit Appendix III 143
0 \\.amln~\
T) P<' of m<doanon
m GiVing bad news 116 Appendix IV 144
A Pn""rW- 01 J:I\I~ Iud "'"'' s~mptoms and pain
8 A "".",,1"',,1 mr.l ... I .....-.oInt;o .... rqx>rt
Appendix V 145
Verbs used in insm.K:nor15
RESENTATIONS
Appendix VI 146
PData presentation 1 118
m
l.ay terms and dtfinl(tOrlS

A Rrf<tTUtll to ... 1>1< or Iif:u'"

B (:o.".,.nn~ u .... ~1n
C ApP«"lnU1Inl( Answer key 147

Index 168
i1 Health and illness
1m Asking about health
Heahh ","" S(3,' 01 ,"" bodv. '''''hen doctors "Jill '0 know 'OOU' ~ ".111en ';. usual
""ahh, ,~. asL.qursuon\ w.:h as:

II
 \Vhat I~) our general How ., lour bealth,
health like? gt'OCr3l1y?

If IOU ore in good bealth. )'OU are weU and have 110 illoess (disease]. If IOU arc healthy
you are normall) well and can resist illness, If )'0" are fit. you are ".II,lOd srrOf1g.
health) fil unhealthy u"li,

lil~nd~
"ell -~
".11 in good health lull well
h ./
poorl)
~

in poor heahh
I cry "ell nOI "cry well

III Sickness
ickn .. s has a similar me.nlO!: to Illness, h " .11", used 10 I"" namt'\ uf .. '<11 >!'COlic
d'''''J;c<.. for example .I..,)lng <icl'l1tSS and Ir" el sickness, Pallen" ~I,otalk aoout
sl.knt<O. when the). mean nausea and vomiting,

POSSlhk mcanmqs
I was iIIlhi, morning.
I felt unwell this morning.
I vomited Ih" mommg,
I feel ill.
I feci unwell,
l am nauscouv.
I feel rhe need tf) "om;I,
---'---
111<cornbinanon .iclo .. , Jnd drarrhoea 111<,"""""'IIng and diarrhoea.

m Recovery
When f'J1lC1'I1Smum 10 normal "".Ith after IlIn"", Iht) hale recovered, \\'. an also
say:

good
'11,< panenr made a full recovery.
complete
-,

If. panenrs health IS 1Il I"" process of rrrurnlllg '0 normal, tbe paneru IS Improriog. The

llf
= 10 recover

0\ er (an pauem 1\ berrer; but [hen gel'

IlIn.,\,)

opposite IS detc:rioratin(l. W. can also sa)' rhar the parient's condition unproved or deteriorated,
In speech, we ofren use I"" verb gel to talk about change:
IIct ~tlcr
a
, worse rbe patient has relapsed,
J!:JIII.
= (0 unprove Another word (ur improvement,
1
0 = 10 detenor.ne espe.IJlh In rt\:umng condItion, \I ... h
 a;;;'.);.. .:I.:X; er, 1'\ renu

lie gOI 01 cr !he 1"0 )edrl I.IIer ,he remain' ~ ~

IlIn.,." \<1')qUlcll),
in complclc relllill;O~

II
1.1 Complete the tahle "lIh ",.ros from A and 8 opposuc. The fim one hJ'> been dum for IOU.

1.2 Make word combuuno'b uStng a word from each box. Look at Band C <>ppOS1I. to help IOU.

complete Sldtness
rrel htallh
get rcml,sion
poor sick
lra~1 CM'r

1.3 Complcre the """eNt""'. I ooL at B OPPC""( tn help )·OU.

Doctor: 110\\ 3,.. ) nu Icdlll8 toda) ?

Panenc 1'0:01 'C<\ (II
Doctor: 110\\ long hoi,. )00 been feelmg (21
Patient: About. week.
 Doctor: Wh.t " your Il) .._ like norm .•lly?
Parienr: Very good. I'm usually quite (4) _ _ and (5) .
Doctor: Wh.t is the problem now?
Parienr: It's my stomach.
Doctor: Do ),OU feel (6) ?
Parienn Yes.
Doctor: Ha\.)ou lh been (7) ?
...'w. P3t1mt: No.
Doctor: H.\< )'''' h.d Jnl >moos (SI H' the pJSt?
Panem: '10. none at .11

1.4 Choose the (orr(\.t "nrc;.) II) (omplete each M!IIWI"C. t.ook .11 8 and C OppmllC to help IOU.

Iller condiuon (deterrOmtl'(Vnl1pruvcd) and she died.

2 He (,..IJf""d/rtcO,.red) and \Y."
allowed to go horne from h'''pII.,I.
,kq>IIl~
3 The cause of (11Int\v",Ln.,,1 \Y'"
discovered III 1901
4 The panmt "",de • full (""",,,'UIVfClO' cry).
5 1M". been on (poor/good) health for months and feel, tr) fit.
6 IIwas J momh hel~ I (gOl over / got berrer] the Illness.
7 He seems to be rather (unheahhy/unwcll) - his diet is bad and he never
exercises,
 Parts of the body 1
~ Parts of the body
~Io<. t\'tenul ""IT> 01.1\.- ... .d> have onhnary I::n):l"h n.m«;~, ,,<11.5 .n,uomlC3llU1lln.
Doctors no~II, use dk: I n~"h names, co,en when taIling to eJ,h (l(~. Tbere art a fn'
evcepnons "h .. re docrors "I< the anatomical name; rhese are ,hI'" II In braeke!> below,
I ,aw (mandible)
2 neck
I --- :Q,. 3 shoulder
2---~1-'~ 4 armpit (.",lIl)
5 upper arm
3--,c, 6 dbo"
---13 7 back
14 8 bunod<
9 'H;S'
10thigh
II air
12kg
9 13cht'St (thom,)
14 br e m

8--+-+
15 uomadt, tumm)
Jbdomm)
10---+-
16 n3,d (umbshcus)
17 hip
18 groin
-4----19
mguma! rtgJonl
ll---J
19 Lon«
12---\- tparella = kneecap)
20 shin

I imb mean, .1011 (upper hmbl or Iqt (lo\Vcr limb). lhe trunk " the ... .d) e,d"dlllg the
head .00111111>0.,
I or J mort' cktJIkd dIagram -hQ"'''1l pan, of rhe I~Kly.see Appendl\ Ion I'd!:e 00.

Referring to pam of the body

When p3lk11r, speak aboo. their problem the I
I sboulcJer.
h,p.
I'm ha, ing trouble \\ uh m)
often refer tn a parr or the bod): I knee.

~
cbrst?
Ote doctor ohm needs to Jsl about parr Do you get an) pain in 1M" stomach?
I
J
e,f the bod)': lour b ac k'.

7/
Describmg radiation of pain
/I pauent l) .rllmg the do ..tor about h" back pain .111<1 the pam or thr bod) I( radiates to.

It s.artS III the hack. Tben I( ~~ tel go into the right _ L:;:7'
"u"(Xl aoo down the No.1. of the ngllt thigh to the L.n~
2.1 Write the ordinal) fnghsh word. for rhe corrc'p()nding .marormcal terms 10 the table
using your medical knowledge. Look .11 ,\ opposite to help you.

Anatomical trrrn Common I;vord

abdomen
axilla I
carpus I
coxa
cubitus
n1i1111111a

03ICS

patella

2.2 Cornplere the sentence' USlnl; ordinary Engli,h words. Lookn A and (. opposue 10 help you.
a A male panent describmg angma pecrori«

It's like. nghrness across my (1) , and it goe, III'

(2) ••••• m) (3) and into m)' left
(41 • and (5) .•. ...• the left (6) ......•....•.•..••..•.

b A male patient describing renal colic:

It starts (I) the loin and goes into the

(2) ••• and (3) • .•......i.nto the testicle.

2.3 Complete the sentences. Look at A opposite to help you.

Anatomical term Patient's statement
I inguinal swc1hns I've gOt a lump in the ..........•
2 nbdommal J).1In My little boy's gOI .1 •....._. ......
3 periumlnlical rash ache. J\iC goe some SpOIl!> around Ill)'
4 rboracic pam _
5 enlarged aXlllal)' node I've gor a pain in the middle of the
6 mandibular pain There's a painful s\Vcllin~ in my _
l've gOt a pain in my ..... ..

2.4 Complete the tablt! with words from the box. The first one has been done for you.
abdomen elbow loin wrist thigh
knee chest ann leg finger

,,~domtn

over .f-o '10tl ,~

Makt, ;1 h\1 (If the wlltd, Inun A "PI)lI\lh' thaI YIlU find ,I hard III u-nu-mbr ur Ih;11 VUU
ne•.'d n"t,1 nfll'n. Try In Il'~)rn ;11 Il'<I,1 urn- of them ,'v('ry d••y.

1
3
 Pa rts of the body 2
The abdomen
The main org;tns 01 lM bod, have ordon31') Fnghsh names and doctors use thoe
"ord\. But when an adjecnve u needed thet of len "o,e an .maromical word. l-or example,
"e C3n '" disease of the liver or hepatic disease. Some abdominal organs. for e,ample
the pancreas, have no ordinary name.

Idt kidne)

WMn decsoes ta1k about tM mnn p.ln, of 1M digesnve S)Slem. tM\ u'"' the "or.l, bowel
or inlcstine: tbe smaJI inlesl,"e or Ihe small bowel, the large intestine or 1M l;tlltc bowel
\\'hm ,peakIng 10 PJloml~ <k><'tllrsm.l) ",f"r In rbe anus and rectum ~>lhe bad. paSSJII~.

The chest
The chcsl (Ihora,' contams the orllo"" of "'I',r.llon and rbe heart. The main pan, of the
re'I',r.1IOI') system are the .irna)~ and the hllt~~.The le(, lung is divided into rwo lobes.
and rhe nghl into three. The alrs'Jy~ con>lM of the larynx. the trachea (or windpipe). rhe
righr and ,~ftbronchus. and 'he bronchiolec, The chesr is separated (rom the abdomen h)
rhc diaphragm.

The pelvis
A doctor is explaining tbe fWlCtlOrtof the bladder to 3 patient.

The bladder is situated on tM pc"

I~ a, ) ou know, and" IS connected 10 eac h "!dnC) b) 3

long [U~ ealkd ~ urc-ter - OM on e... h "de. fhe ureters """' ibe unne from tM kodOC»
'0 rM hladdn:. wbere 11 ,,~ored unnl lOU decrde '0 emply lour bladder. \\'hm dUI
hJPpcn~ 1M IIl\M 1'-">0 do" n another lui ...., called the urethra. 10 tM OlINde.

14 Pro{ernonoI Engirlo It u..-..

3.1 L.bel the di.grom usong words from the box. Look or B opposite to help you.

diaphragm lobes windpipe heart

lung bronchiole.

I ...'..'..''.'''.'_'_''_
6 _
2 ......".."..."....,,_.

3 .."".."" ,,""
4 .........." _

3.2 March the conditions (1-8) with the organs nffecred (a-h), using your medical knowledge.
1 hepatitis a bladder
2 pneumonia b gall bladder
3 nephritis c heart
4 gastric ulcer d kidney
5 cystitis e liver
6 angina pectoris r lung
7 cholecyMiti, 9 stomach
8 ulcerative colitis h large bowel

3.3 Complete the rexrbook extract, Look al A and C opposite to help you.

Examination of the abdomen

To examine the paliEnl for enlarged abdominal (1) .." first feel for the (2) _
and the (3) .." ......on the right side. To do this. ask the patient to 1aIte a
deep breath. while pressing with the fonger> upwards and inwards. Next, feel for the right (4)
_
and then cross over to the other side for the left (5) " Still on the left side. palpate for an
enlarged (6)._".. .. . Finally. moving to the lower abdomen., feel for the (8) _
which is only felt if it is Iu~.

over -to !:i0U ~

M;1I1Y pa1tl'nl\ do not know the tocannn or tuncuon (If tht' vpk-r-n or Iht, P.lIl('(('<I\.
How would VUU l'xpl.un Ihrm to a patient, In Engli~h?

Pro(... j.nol EJ>glish .. 15

the
Functions of the body
 Eating

'011 vncIlf.

. .
It You rvdltod)(
, ce' ,,"->. You t .. ke I bee Youal~.
toilet. md ~ thrl'<
'tnu'rt' a """"" ... your 01 rt ... food. but ruse runt bc-htR'
In Ir
appftlt(' - ) OIl dom
~I\\-
UII

l'f'\4.auranl and ~;encto at. t.l.!tt('~good

tntC' sornrIhll'tt
\"Omlrin@; all thr
and food f()u'~ eaten.
tbe "3ttet' br'tngs Your mouth )'OUehew il and
onple.&tnl. You
your food. ,,;alm.6I1ulg swallow it. Somcthu'll h..
.,lhqll\.1..
em
~wllhl""

The five senses

In ••ddillon to smdl ~nd 13.1<.
Sighl
rhe Itll'o("\ IIldu&' sigh I (or \ "Ion). W)',\I " j-our hko?
hearlll~
hearing, and !Ouch (.1'0()<ailed --of sense of "nell 1------1
,cl,,"liun or fedintl). To ."k .1hour sense oj I.hl< nonnal?
the "'" .....,. dOCto~ Ult Ihe Iluc-.uon,:

To .,' abour W strut' of u>U.h. donors

1••11,.houl
Have lOU fMKk:.nJ3n\ numbnt-\.,
numho ess loss of ......... uonl:
(Ill your nn!\d' or lonl?
Other functions

lunrtuin V",h Noun

speakmg speak speech
".lklllS walk g;ttt
b"'.lhlllll lnIul<' breathe in' take • breath in beearh
rt<iJlIr3t1on nhJI., breathe OUI
urmauon urinate unne
nncumnon 1111c.tur,UC
pass urine I pass water
--,--
defecanon dc(""JIC 1• eces
pass (a«on I Sioois ,,0015
rtltf1\.(t'Uanon men", t\L11 e pass (mmsuu3.l) period
ba\ 0 3 period (monthly) penod
-
When m~IIlIl a hlslol"). dO<lorS can "k: ~

I
'--- <,
When .u,,:ultanng a p3.O<'I1I;'
I trouble walking?
lungs, rbe doctor Idls the panent:
diffiC\llty breathing?
Do lOU have an) problrms passmg unne? T. ke • deep brearh in. hold
wirh your speech? ) our breath, thm breathe
OUI ,ompktrl).
I p .. n when )'OU breathe In?

tess common functions

There Me """" thlll!:> \\C do b, otten. Whell we Me hor, \\c 5\\0.1
nrn<>u, we shako. \\'hro \\< J"" ,,-,d. we Cf).
Ix)(wt> an .<1..;
llx
{

\Cit. more rhnn usual?

16
4.1 Murch the ')M1"IO,"~ (1-5110 the qucsnons (a-e), """fI your rncdical knowledge.

1
7
 I dysuna a \\1lJt" vour breathing lik,·?
2 d),,,haI:'3 b 0., IOU hale an) p3111when )Oll p3SS water?
3 .11,,101'13 c Do IOU have an) dIfficult) wuh vour spc<,<:b?
4 d),ph3>1. d 0.')00 have any rrouble swallowing?
5 dyspnoea e b )our \\StOO nonnal?

4.2 Parients art describing S)M1PtI)lTlS of the conditions shown in brackets. Complete rhe
sentence s. Look a, C and D opposite '0 help you,
I 1\" lIot p.on and _ to both feer. (peripheral "europa thy)
2 I'm h;",nj: dlfficull)_ • solid food. (oesophageal Stricture)
3 1 hal" • toe of problem, _ _ . (prostatic h) pettrorh~}
4 1\,,11<,:11 me,... than usual, even when II'> no' hOI. (h)perth,modtunl
5 l'vc nouced that m) hand, when I'm nil! usmg th"m. (PJrlm ..on"ml
G 1 have lrilUble_. . • \lhen I chrnb rhe \(.11". (I<·flheart f.oolure)

4.3 Complete Ihe "''''e",,<''. 1..0 k .11 /\. II. C ,lI1dn 01'1)(";'. '" help )'ou.

I ~'hen I eat solid food. 1 h.,,, 10 _ (hllc/dlew) II

fo r a lonl; time before I can (s\\allow/e.lI) II.

2--------
hale parn
I)" you an) when you . (pJWh"'e) 5,001,?

3~----------~
I have (Iaslc/appetite) and
no
rIC lost fil" I:ilos In lhe t;,,, fm weeks,

4 ,_---------------------------
Iha\'c/p3ss) J perooJ?

5 [nleof "111:11 h.s ISd, ....

Il.orden full of Iklll"". hut "') •• ... (,cn,c/;cn\3l1l,n)
ppeJred and I 'In', enlO) 110"perfume.

(hreJlhelh"",h) on. J
OVu .rO '1011 ~
You Ihlnk ~ patient m ..y have diabetes, Think uf five questions you can .a\k the patient to
mvesnqatr furthtr. Try to u\(' the question tyPl",) presented In tms unit

1
7
 Medical practitioners 1
_ Practitioners
In IlmJIIl. docroes, .1>0 lllC)\\n 3~medical practition ers, IIllhl be qUaliJied: Ju\. J
umv ."'11) degree III med"'"lM, The) must also be rlWstered - mcluded III the (~
~ledlCll Couool', list, or rq;jster - In order '0 practise (see Uni, 131, A doctor ,,00 treats
panems, as opposed '0 one who only does research. is called a clinician, A doeror who
provides pnmary care (or panenrs is known as a general practitioner (CPl. or family
docror, (.1'. usually work In a group practice, Lorge" group practices work III a building
called a health centre,
Note: In BmlSh English. 1M YCrtlIS<pdt pr.>ctise and the noun IS spelt ~ti«,

Speciatties
peciahsi dlI(IO .... (or cymplc J'.Ied'.ltlcian" gener,llIy work III hosplI."- I 11)\\ever, ,
00"., who work oursrde ,he )\11\. pro\ldmll private heahh care, may h ave ronwhi"l1
rooms ourvnle u hO'I)II.I- (or "",lIlIplo m the (,Imoll' 11,,"'ey Street in I ondon,
lhe IwO rnam hr.lnc~ "f lned"mo are ,urgery .Ind inlerllal medicine. and tho dOctors
who pr.llu\c t~ branc~.re <"lied surgeon. n",1 ph)~ici:lns. r"'~"I;'d), In 8t1laln,

and
~" <'mllh
.
mak ,urgtOn~ are .ddlh..ed" \lr and females a' ~I;- '0() Dr Smllh ". ph) ",un.

,urgt'Ol'l,
 r--
A cardiologiSl
diseases ()( rhe heart and crrculanoo, or cardiology,
A gerialrician speoahzes '" diseases of elderly parienrs, or geriatrics,
An anaesthetist is a specmhst In
anaesthetics.

Note: Namn of spetialbcs usually end in -ology; namn of specialists usually (f\(j .n -oIogisl
If the name of a Sjl«ialty ends .n -ICS. the name of the specialISt ends m -ioan There a~ some
exctptlOM. e,g, anaesthetics and anaesthetist

Choosmq a specialty
Jill "",1\ he" , ha; iusr jIr,lduJted [rum medical 'eh(>(li .uul i, talking JboUI her future.
'1 h.l\en'l deoded wh .. 10 \p«I,h,. in rer. I ne..x. l
moee expc .. "n« hefore I <la..,.k, but I'm quue
Jllr.I<"I",,11<) ebe ItlCJ of P.,ed13IOCS""-,u",,, I hke
"ori<inlt wuh children, I'd c... ,1111)prefer ro "nrl wuh
children
than, \J), clderl) pancnlS - '<) I don't fancy genatncs.
I \\'.1!1 never \'cr) interested in dct3i1rd 3n3(On1)', \U
the ,urgical specialties hke ncuro,urgery don', re.llly
appeal, You have to be good wirh your hands. which
I don't ,h,nk is 3 problem for me -1\. assisted a'
operanoes several times, and I've (Veil done some
minor ops b)' mysdf - bul SUrgt'OI'IS have to be able
to do the same thing again and again without
gemng boned, hke ryll1g off CUtan<ne; and so on, I
don 'I dunk rhm would be a problem (or me. but
they need ro make decisions (ast and I'm not too
good at th.l\,
l like In h.ive time 10 Ihllll, "h."h means surgery\
pmbJhll nor tlghl for me:
Note' The roIlocatoon good w.th IS f(~lowed by a noun
He's good w,lh children II\( coIloCatoon good al
IS(ollowl'd by the -,ng f()(m (!)(fUnd) o( a Yl'rb. ()( by a
noun - 511.'5 good 01 explommg ptOCf'durrs. She'5 good at
e)(plonal,o'l~

18
5.1 \XIme >CI1lelKe\ to ~nh< Ihe work of the ,pc"JI"1 In each branch 01 medxine, I ."JI. ~I 8
opposire 10 help) ou.
1 dcnn.lolOA)
2 rheul1lalolOA)
3 [raul1larolog)'
4 paediatrics
Sobstemcs

5.2 Complete me
table ",m
"ords (rom A. 8 and C opposite and related (onn" Put ~ streSS marl:
Infront o( t be srressed ~~Il.blIen each word, The firsl one has been done (or \lIU.

V"rh Noun (person) Noun (artlvlty 0' thinq]

'specialize
~
practise
consult
3ssiSl
graduate I
qU3hf)

5.3 Find preposition> In ( opposue that can be ."ed ro m.ikc word cornbmanonv with the
words in the box. Then use the correct (Orlll' of rhe words to complete rhe =Iencc~,

interested specialize work I

Prof es....,., Entfrth WI Use 1

-.. 9
 1 A pathologist d13gnoslnll disease through "3mlOIOIl cells and nssue.
2 A paediatrician must en",) _ children,
3 An oneologJ<t IS _
the d,.lgnosls and treatment of cancer.
4 A ps)ch.atn>1 mu>! be _ c..mnselling.
5 A neurosul'l!<OrI mu,t be her hands.

5.4 Make word lOl1lblllJllC,m U''''1t a word (rolll each box. Two words can be u~ I" I,e.
Iook at A. II and (. "pl'O'lIr to help YOLI.

consulting cenlrc
general practla'
group spmaltoes
health ~,C"~
internal practlt~
surgi<21 rooms

Over .f-o /:f0tl

Re-read wh .. t D, Jill Malhl"w'io \ay\ about vurqeuuv 111St'('linn C. Mala' ;1 11\1 of Iht, qU4Jhtl('\
she thlnk\ •m- needed In hr ,1 qood surqr-on. Iheu make if vumtar 1t\1 of qU.illtltt·.., for
another \pt·f.· ... ItV
If vou art' "I \tud("""I. wh.(-h hranl'h nf ""'«flt'lnc' ttu you th.nk yuu have tht, (IU.Jhtu·, for1 If
you h4lYt, dln',H'V lonlplt·tt'd your tr~"lIfHJ, why ctld vuu ('hno\(' vuur p.ult(ul.u hr.ln,·h 01
medn-rm-?

Prof es....,., Entfrth WI Use 1

-.. 9
Medical practitioners 2
Hospital staff
The J'«)ple who "od. In .In, 1)1'" o( workplace, IIldudUlIl h"'plI.l" ar<' called .he staff.
The medical s.ill m a Bnn.Jo h"'pllal belong to one of (our rnam group"
• .\ pre-registrarion house o((;e.". (PRHO), or house officer, IS • new I) Itraduared doctor 111
ihe firs. rear o( posrgradua re [raining. After .1 year, he or she becomes a registered medical
pracririoner; In thc current system of rraming, Ihe Foundatiun Programme, the name for
these junior docrorv is Foundation Year I doctor (FYI). (See Unll 12)
• A senior bouse officer (SHO) " in [he second ) ear o( posrgradune tr.OIlIng. The I> tit'"
now Foundation Y.", 2 doctor ,FY2). bUI rhe old terms seruor bouse oln.-er and SHO
are snll used,
• A <p<aalisl n:g.strJr (~R) IS , doctor who h." completed lhe .... lind.""" ProgrdrnrtlC'.
,lnd I' training In C~ ()f rhr medical ~1)C'I.lhlc,. There are Jlw ,,)Inc non ..{r.a.ininlt rt'fC,i,crat'\
- tltl<lOl'> wilt) h••\c completed ,hcor rroininll h"l do nOI w"h 10 '1'<... ".llIe )e t,
• A comuh"", 1\ J (ull) '1l1.111Ii<v,<p1ec•• livt, lhere n1.ly "I,,, he \(lme .. ,\00".
speciali'"
- \colordCX-'tor\ \\he) de. nflC \\I,h eo become ,()n\Uh.lnt~. In Jddltlun. rbere IS 3t k--.l\( one
mediClllor diniClh dor<CIO<.who IS re-;pc)ll>lblc lor all o( the 111C..J",.1 '1.((.

MedIcal teams
Consultam phrsician$ and surgeonv are responsible for a specific number o( panenrs on
rhe hospual, Each consultant h., a ream of junior doctors to help cart (or rbose patients.
In many hospitals, there a« muhidisciplinary teams which consist no, onl> o( doctors bUI
also of physlo,herapistS and olher allied beahh professionals (see Unot 8).
When panenrs tor.". - Or are admined 10 - hospnal, 'hey are usually seen "<>I b) one of
lhe IUlllor doctors on the ward wbere thc) will receive rrearmenr and care, The IUmor
doctor ckrks them - w.ts Ihof medical hislory (see Unl" 47-49) - and evanunes rhem.
~11~ umc l;al~r.. rhe f'tlV~lrJr 31.,u sees rbe pauentv, and 111.ly order in'nli~.alions or rests,
(or .\.mple X'(3)'> or an H.(., 111J~e J provision ••1 diagnosis, and h<'!t1O treatment. The
 CC"""h.ll1l """"l the new odmi"ion> - people who have recently been adnuned 10
Ihe w.ird - (or Iht first I"'", on (Inc of the «"gul"r ward rounds. whtn rbe 01.1I1a!t"mel1lo(
rhc p.tllent, " tl,\(Ussctl ,,"h lhe «w"rar. C",,,,,h.1I11\ ••1,,) deeide w hen J p;lllenl 's «3d)
10 he di\Charged (sent 1lt.IOC). On lhe ward round. the consulranr IS ."olOp;lnl<'ll b\
rbe le.110 and ~ nu,.,." and 1i1C."I ""I all rbe pancn" III Ihe """uham\ care.

_ Shifts
jumor doctors now norm. II) wor], III shifts, which meuns they normallj work (or elgh,
hours every day, for ", .. mple 7 am to 3 prn, and arc rhen free unril 7 am the nex, day.
Af,er. week [he), change 10 a d,f(erenc Shifl, (or example 3 pm to II pm or II pm 10
- .lm. The ahemJriye S)>lem IS 10 \\ork from 9 am 10 5 pm C\"err day 3nd 10 tak< rums
10 be on call - avaibbk 10 mum ro the bosplt.llf n«ess",.)' - from 5 pm '0 9 am rite
ne" da,. Day> on call ar< ~ OUI In a rota, Or h" o( names and timo. Doctors on call
carry J radio pager. or bleeper. J device which make. a noise when somron< .s tryIng ro
conl.ll.:l Ih(,fll.

20
6.1 Make word combinanons '''lOll a word (rom each box. Look at A, Sand C opposue ro help
you.
associate call
house on diagnosis
provisional officer
radio pager
ward round
specialist

6.2 ~la[Ch the description> 0-5) with the job tides (a-e). Look at A and B opposite to help you.
I Dr G ra ham has been a paediatrician for eight years and is respcnsible (or treanng me
children admitted [0 Ward 60.
2 Dr ~te",.lrt has lu~t starred the second ye", of her Foundation Programme.
3 Dr \lnlth has starred lus trammlt J, a surgeon.
4 Dr 1'llIlhp> has rust gr.du.tt'<l and I< working in u lurge hovpiral rn StrlllinghJm.
5 Dr \hlbr I> In charge o( the medical ~t,,(( in the l~irl1linl!ham hospital.
a 'f"l"~lah,t registf3r
b medical director
c consultant
d '>HO
e PRHO or house officer

6.3 Are the following statements true or false? Find reasons for your answers in A. Band C opposite.
1 A medical graduate becomes registered two years after graduation.
2 The S) Stem of training doctors in Brirain is called the Foundation Programme.
3 The name senior house officer is no longer used in Britain.
4 The consultant is usually the first docror to see new patients.
5 \\nen work mg in shifts, all doctors take turns to be on call.

6.4 Complerc [he text of a PRIIO describing her job. Look at A, B and C opposite to help you.

\\ hen I g~[ to [he ward, the first thmg I do is talk 10 rhe house officer who was on dUI}
durmg tht I"st (I) • to lind Out if [here have been any new
, . 110enI generall)' sec the charge nurse. lie [ells one i( there is
.11\ thing that needs 10 be done IIrgentl)', such as intravenous lin", to put up or take
down. Larer in the moming,l (3) .._.. ..............• ny new patients, which basically
_..._...
involves taking a history. On Tuesday and Friday morning the consultant does her ward
4 _.._. , and I have to make Sure I'm completely up to date on her
patients. Arter that. rhere are usually lors of rhtngs to do, like writing up request forms
(or blood
-' . and so on. In the afternoon, I have to prepare for any parienrs who
are to be (6) the next day. They're usually happy to be going home!
And then of course there are me lectures and tutorials in the (7) ._. ...
proararnrne on ~tonday and Wednesday.

ova- "'0 ':lOU ~

Uti\\< dtJt..~ the hu",.ul.11 n.uumq nf IllIrlll'\ 111vunr rllunhy Ihllt" Iuun !Ill' Rrll"h wvn-tu?
How would V"U vxpl.nn II In ,I "Olll';UJUl' tnun ;1I1!lIIH" "lItllllty!

Pro(ession.' f.ntIirJt in Use 21

-
~ Nurses
ril Nursing grades
Nurses working in a hospital have the following grades:

student nurse :l nurse who is still in training

staff nurse a nurse who has completed rhe training course
charge nurse a more experienced nurse who is in charge of, or responsible
for, 3 ward or department
nurse manager a nurse who is in charge of several wards

Note: The old term sister is still sometimes used for a female
 charge nurse. A kmale nurse manager may be called matron. Dr James IS talkmg to
Sister Watkins.

rn Support workers
The clinical suppon work er, who has done a short course nnd obtained basic
qualifications, and the nursing auxiliary, who i~ ,,,ually unqualified, both aSSISt nursing
"mff. There on.y also be word clerks, whose duties include making sure parienrs' norco;
and information are up (0 dare, and answering the telephone.

[!I Specialization
Like doctors, nurses can specialize:
• A midwife has specialized from the beginning b)' doing a course in midwifery, the
management of pregnancy and childbirth.
• District nurses visit patients in their homes.
• Health visilors also work in the community. giving advice on rhe promotion of health and
the prevention of iIIn es s,

00 The nurse's role

The nurse's role has changed considerably in recent ),C31·S. In addition 10 general patient
care, checking temperatures, pulse "lies and blood pressures, changing dressings. &i,ing
injections and removing sutures, nurses now do some of the Ihing' previously 1'="'00 for
doctors, such as prescribing drugs, and ordering lnbornrory rests, More responsibihry for
nurses is planned, as the following article demonsrmres.

HIIr'S6 any out surgery in effort to cut patient wallin, lists

Nurses in Scotland trained to peri""" mino< surgety have entered the operating theatre to< the fir<t Orne in an
effort to art patienl waiting lima FM nerses wIlo have passed a new course at Glasgow caledonian
University are now qualified 10 cany out such procedures as the removal 01 small lesions. benign moles and
cysts.

1hr SoolSmOn
The verbs perform and carry OUIare used with all types of procedures. They are often
used in the passive form.

an exammation performed
an cperaucn The procedure was by a nurse.
carried Out
perform • procedure
carr)' OU1 an expenrnenr y
a test
a b,oPSY

22
7.1 Complete rhe senrenees. Look at 1\, 8.lIId C opposite to help you.
I Someone who specialrzes In delivering babies is a .
2 Someone who is qualified to assist nurses is a - -----
3 Someone who is nOt qualified but IS able to assist nurses is a _-- -----
4 A nurse who has qualified is a _ nurse.
S A nurse who specializes in health promotion is a --.- .
6 A nurse who looks after a ward is a nurse.
7 A nurse who works in (he community is a .._ _ _ nurse.
8 Someone who answers me ward relephone is a •

7,2 Make word combinations using a word or phrase from each box. Look ar 0 opposire ro
help )'ou.

eany out sutures

change a prottdure
check an injection
give a dressing
remove the temperature

7.3 Complete me sentences wnh the COrrect grammatical lorm of /Ierform.

I An isotope brain SC:ln15 pamless and C<lSy _.
2 Biopsy of rhe pancreas ._ last March.
3 If the parienr's condition dereriornrcs, a laparotomy should _ .. _
4 If a diagnosis of meningitis is suspected a lumbar puncture rnusr ..
5 Last year we _ a randomized, double blind group srudy,

7.4 Complete the sentences with the correct grammatical form of carry out,
I I now intend _ ........a larger study.
2 Unfortunately few properly controlled trials so far.
3 A number of studies recently to look at this quesrion.
4 A right hemicolectomy .._ and the patient mad e ,1 full rtCO,.r)'.
5 This procedure can _ in the emergency dcparnnenr.

over 1-0 ~Otl ~

Wh;it kind of lask'i do nur')('\ l"lury out in your l"ountry? Art.· nurses' rt'spnn)lhililil'')
inrrcasing? What are the Implications of Uli\?

23
t;] Allied health professionals
m Community health
The health of the commumry depends on a large number of people other than medical
practitioners and nurses, These can be grouped under the heading of allied health
professionals. They include the following:
• l'hysiorber'pistS (physios) help people to move by getting them to do exorcists Or by
treating their body with heat Or massage - treatment by manipulating muscles and joints
with the hands. (See Unit 42)
• Occupational therapisrs (OTs) help people with a disability [0 perform tasks at home
and at work. A disability is a physical or menrnl condition that makes It difficult to
live normally. for example blindness or deafness.
• Social workers help people to solve their social problems - for example poor houslIlg or
uncmployonem - or f.,n,ly problems.
• Chiropodists, 310;0 know as podi.rrisls, rrear conditione .ff('cling the feet,

III Technicians
There arc numerous technicians - people who work with scienrific equrpmem - such as
radiographers, who are known as X·ray technicians. Ambulance technicians work in the
emergency medicine service. An ambulance rcchnician with more advanced qualifications
is called 3 paramedic.

[!l Prosthetists and orthotists

Prostherists and orthorists provide care for anyone who needs 30 artificial limb. (a
prosthesis), Or a device to support Or control pan of the body (an orthosis). They also
advise on rehabilitation - helping parienrs rerum 10 nonnal life and work after treatment.
Prosrhetisrs provide artificial replacements for patients who have had an amputation or
were born wirhour 3 limb.
Orrhorists provide a range of spliOls
and other devices to asd movement,
correct defonnity from an abnormal
development of pan of the bod),
for example dub foot (rahpes), and
relieve pain.
 A prosthesrs Splrots

ill Opticians
Optician .. resr C) esight and prescribe glasses - also know l1S spectacles - and contact
lenses, when necessary, The exanunarion includes n1c;'I'iuril1f!, intraocular pressure - the
pressure of flu,d"".de the c)e - and cvamming the rerina. Ir rhe opucia» ;U5p«:1' 311
"yc disease, such as glaucoma. they refer the parien: III their GI) for treatment. The GI'
may then refer tile panent to an ophthalmologist, a doctor who specializes in diseases
of the eye.

24
8.1 Make word ",mhlll.1II(>o' u,mg ~ word from eac h h",. look al A, B. (' .nd I) O"",XII e 10
help )'OU.

ambulance fOOl
artificial lens
club limb
contact worker
health pressu",
intraocular trdonician
occupational prorrs.sional
social tIlttapist

8.2 Which alhed health profesSIOll.lls could best help the following people? l ook .1 '\, 8, C and 0
opposne 10 hell' ) Oil,
t a young unmarned "oman who ha; IU\l h.1I1.1 h.llly
2 a woman \\ 1><. " Iu\ dIfficult) u~inlt her roltlll Mill following a frauure
IIllt
3 ~11ltOIl<" ho _.I, s:b,'>n
4 an eldffl) "<M1lJn \\h<.Iu\ Iud a belo" knee JmpUl.IIlon
5 a man "hlX<' ",f. Iu, .\Uh<,mer\ disea-e
6 a man wuh • tun):.'1 onf<CIKKI of his ft""

8.3 Complete rhe revrs. I ool ar A and C opposite II) hell' you.
A prosrherisr worl. wuh parienrs of all ages 31 a member of" clinical ream, based 31 a large
hospital. The panenrs may need a prosthesis 3< the result of an accident, or

1
5
(I) . . following a disease such 3; diabetes. Alternatively Ihe) 11\.')' have
been born wuhour a 121 . Orthoti;,; work alongside doctors, nurses,
phrsiotheraplslS and OLCUp.100naJ (3) 10 give the people under thetr com
the best passlhie 14) . Therr onJIII 31m ,,10 enable lhe ",1Ilml 10 lead a
normal hfe al "ark .nd lruurt.
An onhonsr often "on., sn J chnK as part of In OUlp.IIIOn! service and .1", ""I, lllher
centres 10 provide J \C1'\kC for people wuh '",'''''1111<0<1,. The) deal wllh J'C'I.ple cof.III,'~l".
I;or IIlSI.IIl<e. children who have cerebral 1',11,1'm.IY require (S) ro
help Ihelll wall and 111.111) old,'r people need ~pe<l,11,hu"\ 10 correct (6)
If damaged, 011)' pan 01 rbe human skeleton m.lY re(luire some form o( nnho\I\,
lloe nnho,i, mal be AeC'drd 10 reposmon the hod)' or tel (7)
pJ1I1.

1
5
m Hospitals
m Introduction to a hospital
jordi Pons is a fourth-lear medical student from Barcelona. He has come ro Bntain on an
elective attachment to the Royal Infirmary, Edinburgh. Dr Barron is introducing him 10
the hospital,
Dr Barron: The Royal Infirmary is Ihe name of the university hospital for Edinburgh
University. II is a general bospiral, dealing wilh all types of parienrs and illnesses. except
paediatrics. We have a specialist hospital for that in another part of Edinburgh, the
Hospiral for Sick Children, You can see some of rhe departments in our hospital on [be
sign. Of course, there all' many
 others, for «ample rhe Intensive
Care Unit (lCU), ••nd [he Surgical
High I)cpcndl..,CY Unil (HOU).
jordi: Whal does 'ourpatieu' mean?
Dr Barron: Ouipauenrs are the
people who come 10 hospual 10
attend a clinic or 10 h., e ItslS Or
rrearment and then rerum home
on the same day. lnpatieus stay in
rhe hospital for one or more days.
The rooms where rbey Stay are
called wards. If a patient's treatment
requires only one day, such as
a simple operation, they can be
admitted 10 the day surgery unit.
Welcome to the Royal Infirmary
South Entrance
Car Parks C & 0 (visitors & staff) -
The Simpson Centre Jf
for Reproductive Health
- Cynaecology (Emergency)
- Maternity (Emergency)
- Neonatology (Emergency)
Outpatient Departments +
All Wards _
Day Surgery Unit 8. Endoscopy +
... X-ray Department
... Combined Assessment

m Outpatients
Dr Barron: The Accident and Emergency Department (A&E), .1<0 called Casuahy, is
where pal ients who are ,culcly ill - wITh a sudden, serious condition - come for
nssessmem and treatment, Ourparieurs who have nil appointment ro see n specialist go to
n clinic in one of the OUlpaliml Departments (OI'Os). They have usually been referred
to rhc hospital by Iheir GP, who writes a referral letter 10 the consulranr e"plaining the
patient's problem.

m Inpatients
Dr Barron: The inpatients in a hospital are admitted in one of rhree main ways. They
may be seen in one of the ourparienr clinics and admitted from there or, if there is a lot of
demand (or the treatment they need, as in rhc case of a hip replacement, the)' are pUI on a
waiting list for admission. Alternatively, their GP may arrange rhe admission by telephone
because rhey are acutely ill. for example with suspected myocardial infarction. Or they
arc seen in the A&E Department, where the doctor on duty - working at that time-
arranges the admission. This would happen in the case of 1I patient with a Iracrured
neck o( femur, for example. Larger hospitals may have an asscssmcm unit where panents
can be admiued Icmpor.uily while their condition i< assessed.
jordi: A<se~~?
Dr Barron: Yes - decisioos all' made about their condition, and whar needs 10 be done 10
help rhem. Afrer rrearmem .s cornplered, rhc patient is discharged back 10 rhe GP's care.

26
9.1 Complete the tJhle "orh \Hlrd, from A. B and (, OPP(hI[C. Pur a >II'(>~ mark m lru", o(
the stressed ;) IIJhle III each word, The first one hns been done (or you.

V,'rh NOLIn
ad'mir
assess
discharge
operate
refer
treat

9.2 Make word cornbmanons O>IIIS a word (rom e.icb box, Look at C 0Ppel"IC ro hrlp lOU.

aculely unit
as~sm~nl kl1er
on list
refftTllI duty
waiting ,II

9.3 Which hospual department> would be most nppropn.ne for the following parocn,,? look
at A. Band C opposore 10 help you,
1 a woman in diabenc CQn13
2 a parienr who has IU>! bad a radical prosrarecromy
3 a patient ,,00 's 10 have a skin lesion removed
4 a man wirh a (omll" bod} lJ) his eye
5 a woman \\11h a mreoltn<d abortion

9.4 Complete the .\lra,'t (rum an mformatlon I~Jfkl (Of p.lt1Cl1ts. look at A. Band (
opposite 10 help vou,

".1IIIIon far 0UIpatients

27
 ~ J :: 11 1 (1) , please tell the receptionist who will

: ~:
M . ..
cIeIaiIs" and direct you to the waiting iIIN. The length of your
"
.,,----- - C you're going to hwe. You may need 10
D
,sudI JllllIaf be (5)
X~ which ax*! mean going to another
15 III
.- to ochef proIessionaIs.
-. mar need to n!IIisit the clinic. If staff at the cflnK
.. ,. • sbaent wi be .,.1gIld
for you. If you need to
be
far men trHbSlent. either as an inpatient or for
Ihis is likely to happen.
to yow GP's care.

Ovu-"'o tjOU
How do hOlonlLII .. 111"'litH countrv or ;lfll/l' ;1("111.... 10"" How would you (·.. pl.un Iht, prul.Tdur{'
10 .1 t Ullt',HJUl' "lIn1 ,Inulht" lnuntry

28
iDJ Primary care
II The National Health Service
11,c National Heahh Service ( HS) is responsible (or health cnre (ur everyone in the UK,
although a small number choose to pay (or private care. Treannenr i~ free bur there is a
prescription charge for drugs and appliances, such as a cervical collar, wirh exemptions
for some patients, such as children and [he elderly.
Primary care is provided by general practitioners, or GPs, (sometimes known as family
doctors), nurses, dentists, pharmacists and opticians. GPs work in practices of I 1020.
Practices are based in a surgery and look after the health of (rom 1,000 to 15,000 people
in their local community. The)' also provide health cducarion in areas such as smoking
and diet, run clinics, give vaccinations, for example for influenza. and may perform minor
surgery such '5 removal o( warts and moles. If a patient needs speciahst care, the GI)
wiU make a referral - refer the patient to a consultant in secondary care.
PJt1Cl'Il~are normally seen on ••n appeintmcnt h.,~i~. Horne visits arc made when p,luenlS
arc housebound - una hie to leave their homes - or tOO ill CO arrend surgc!,)·. Out-of-hours
(OOH) rreannenr, from 6 pm to 8 am, i< provided hy the local Primary Care Trust, which
orgnnizes shift. o( GP, and locum GP, to cover i( someone i" absent.
Note: The noun surgeoy has three meanings:
• the building where 61's wOf1c - Th~ proctic~ has moved to 0 ncw sU'9cry on the High St~L
• a rime when 61's see parients - Morning sU'gery is from 8.30 to 12.30.
• the worlc of surg~s - Tht: potknt needs u'gent surgery on 0 burst oppendi/(,

m The practice team

A typical GP practice employs receptionists. They are responsible for initial patient contact,
making appoinrmenrs, raking requests (or repeat prescriptions, taking messages from
paricnrs and other health care providers, and (or filing and scanning documents into patient
records. The practice manager has responsibility (01' fin. nee and sometimes (or IT.
supervises reception ,iliff. hires 10(.'uI115a,nd helps prepare the pracnce development plan.
Practice nurses run asrbm a, diabetes. and cardiovascular diseuse clinics as well as one-to-
one clinics for those who '\'1')1\ (0 gsvc up smoking.
In nddinon to practice ~t.I((,CPs work with a number of health rro(e .. ional~ ("'" Unit 8):
• District nurses visit temporarily housebound patients, such ,I~rece",ly discharged
hospiral patients, to change dressings, such ns ulcer dressing'.
• Heal'h visitors visit fnmilies to carry out check-ups on young children - p.1nicol.rll'
under-fives - ro make sure they're healthy. Special attention i~ paid to families in need,
such as rhose living in poverty, They also do baby immunization •.
• Midwives run clinics for anrenaral paricnrs.
• Physiotherapists provide hands-on treatment but also teach patients exercises me)' can do
to improve rheir condition after an accident or operation.
 A GP's day i.oo ()~A anivt at t-~t: s.lo4.te'~
ek~~ tVleOOf-t~~a ~t
Dr Stuart works in 3 practice in a c.ku~fot "V~'.....t ar.rJ t'!oCIo'\ ·w~t'I.t. ~.::es
small marker town wirh three -:.3() ~M c.hccJe,""",i.4 ;'(,No ttl, ,-'ltln ~r? fiN) P"~'S
other fanuly doctors. The surge!')' f""CJlDI"C fC'l $W-recr ~
i, in the centre of the town and ~ ~ lOSOQI'\\ ~"""'''''9''''f'9Ctl1 {ttl -"'" '!P':·~m~l
is shared by three pracnces. (. pre boolUd "'So" Wit ..

This is" typiC',,! workmg :l boolWl .'~' .""' ..

monnng • booitObLt .... the ".11
when she IS not rhe dury doctor,
.1D 50 • 10 "",,r; ",y, Ght~ wit;, ~ J~ rn ., ~

responsible (or emergencies and

~"pre<e.iptiD.....Qv.d d~. .,,' rq.urt ~pe.... rt<l,'«&t<
111>0 11 ,:to QYloI. eof{tc Q ~(I~ ~ r", It. ~~t " • te :,(!
urge", problems. tY~
ll-'""O 1.1_'10 Q~ c~,e~h~ vis4t ~kt$t$ ljl':]I ,I If erUta~~
~J.

28 1:1 .~..:') a ..o\ ·1.00 ~V'o\ hew..! ~Lt:s

10.1 Complete the sentence-. look at A opposite to help you.
I Children, o,.r-6o.. and people" uh some chronic diseases do not have
to pay _ _ . in the UK.
2 Patients with mobillt)· problems may be unable to go out. They arc _
3 The average GP _ is ten minutes long.
4 A .. is someone who takes the place of a staff member who is on
leave. SCare outside working hours is known .s _._ _ _ _ - .-.
_
treatment.

10.2 Make word combinations using a word or phrase from each box. One word can be used
TWice.Look at A and B opposite to help you.

29
 change messages
make staff
perform appointments
refer home visits
run dressings
supervise a dinic
tnke a patient
minor surgery

10.3 Which member of a practice team would be responsible for each of the following?
Look at B opposite 10 help you,
1 Running a clinic for pregnant women
2 Teaching a patient how to strengthen his broken leg
3 Letting [he GP know rhar a patient can't come to her appointment
4 Running a clinic for people who want to lose weight
S Visiting a patient who has just returned home after a hernia operation
6 Carrying Out check-ups on children in. poor neighbourhood
7 Organizing cover for an absent doctor

lOA Complete rhe diary for Dr Stu.trt·, afternoon. L.ook at A and C opposite 10 help you,

t-oo »-oo r.... p>!tIU te'''', ._.,~ we, sa...awi.eh I" ... h
:;>.00 .oop..... ar:!'-'" (I) _ _ ..
1:) ~'Y..rM~r\4.("'~ (2) . . ..

-400- ".20 toy,," ecfu Cr~'R

".:;>.0 .. 5.co 1"" e<'ez" '-., (3) .....-.--.--- ...-- ......(tw ~ees· peal with ""not
(.. ) • ...a rtj>1IIt (.S') .. _ _ rtq~ts.

5.00 .. (,.00 ......,. 1"0/-" W!>'>l.~. (.. ) . .._._ _ to SlUI...aQ'1:j eart.

,,,, ...... ~ ::t'tJ>~ calls to PQt~I'\.I:S,
prl'.D'""..e ..~l w:at'..u.II\.QUo~
c..OO rw.. ~ S ~t:ed ~ t~-) _ ~_ stTVi.et.

30
iI1 Medical education 1
m Medical education in the UK
Medical education in (he UK covers:
• undergraduate education - four or five years ar medical school, me section of 3 university
responsible for medical education
• a two-year Foundation Programme which provides training for new doctors after
graduation through a series of placements in differenr specialries (see Unir 121
• postgraduate training which doctors rake [0 become GI's or consuhams - senior
specialisrs - often delivered rhrough colleges (or different specialties, for example the
Royal College of Physicians
• continuing professional devclopmesu in the form of courses and seminars. which doctors
undertake throu!\hou, meor working lives ro keep up to date.

m Extract from an undergraduate prospectus

The MBChB (Bachelor of Medicine, Bachelor of Surgery) is a five-year

undergraduate medical degree course. Most of your learning takes place in
small groups. The main components are:
 Core (Years 1-3) Vocational Studies and Cinical Skills
An imegIaIed PlCY_ .. 'E 01 dncaI and scientific topics This <OtItflOIl'!Ilt flI"PIRS you !of the ...... skills
mainly presern;ed 1ImIgh poobleioHlOSeci learning required for contact .... patients from '1M 1 01 'PI
(PBl). wilen! you wert .... 0Iher5 on a series of case ~ throrq, periods 01 pOOU !raining where you
problems. are anadled 10 a hospital depanmont Of general
practice.
Student Selected Modules
Student seIecIed ......... (SSMs) IiIItM you to dIoose Clinical Attachments (Years 4 and 5)
from a menu 01 saq.cts sudt IS Spons ~ne A series of Iow....elt dinkaI atladunelllS " Medcine.
Of Surgery. Psydlologkal Medicine. Child HHIfI. CJIsIeIrics
MIl $1UtIy a Ianguoge IS ~ !of ., _ &G~ andGeMral ~
elective, a hospIaI ~ of 'PI own chokf.
~YNB4andS.

Ii A student's view
Ellen, a medical srudenr, describes her course.

'I'm just finishing my first year of Medicine. What I like abour rhis course is rhar you're
involved with parienrs from the very beginning. Even in our first )'ea~ we spend rime in
hospital. Much of me course is PBL. We have IWO 2-hour sessions a week where we work
ill groups of eight ro len solving clinical problems. We decide rogerher how to tackle me
problem, look up books and online sources, make notes and discuss the case together. It's a
great way of learning and getting to know the other srudenrs, In rhe past, medical srudents
had lectures with the whole class taking norcs from lecturers from 9.00 to 5.00. but now it's
mainly group work, although \\c do have some lectures and seminars, where \\~Cwork in
small groups with • tutor. I like all of it. even rhe dissection. We gel '0 cur up cadavers from
rhe second month of the course:
11.1 I'>IJt,h thnc 3ClI\I[l(> to t~ ~aJ:n 01 mc:dc<.11 educanon In I~ UK given In A <>r1't"1I~.
1 dw;~nng cadavers
2 k~pong 3 log o( SUrgJCll pro..'nlureo. observed and performed
3 workmg (or (our momhs III 3<(Idenl JIlII cmcrgent)' 10 expenence tlus Sp«lall)
4 I.lkln!\ a fOur-\\ eek attammenl III OJ>.ICtrl'... and Gynaecology
5 taking an onhne course on recent developments in cardiovascular disease

3
1
 11 .2 Complere [he sentences. look at Band C opposite to help you.
1 Ju;, before their final fear, students have ,he chance ro take an . _ III 3 hO'ipII.1 of
their choice anywhere in Ihe world.
2 comrnsrs with an approach where each ~Ub'CCI 's
taughl separald).
3 Ihese days _ are often mteracnve, wtrh regular opporrumnes (0< I~ ~Iudcn"10
a,k quesnons.
4 In ~ ""denl' learn how (() lreal and mamJ:~ patl<1ll'-
5 can be a topIC from ou~tdc med ..~. nt'. 'u<h ., •
(O""J:Il language.
6 J)o;'Ic..' Ion of _ " an Impon.tnl I"lfl ,,( the In.lom) component.
7 Th. 31 lbe Un"Cf\11} of I'.dlllburgh '" 0"" 01 I~ ClIdc.1 "' lhe
UK.
8 She's a ar rhe Roy.ll; one of the Ie.,ding paediatric heart Spoct.Io,I, III lhe
country.
9 'I he Royal of Surgeons 111 "dinburllh dares (rom 1505.
10 We have 3 . each week where we discuss topics in a small group wuh our
lecturer,

11.3 Match each of rbese acnvmes 100"" of the components of rhe undergraduate course
descnbed III Band C opposite.
1 Jul", ,pend, weeks working m a ,m.11I hospua! "' the Himalayas.
SIX
2 ,\ group o( srudenrs dISCUSS rogC'lhcr the 1'0~~lblc "'.>OIlS (or abdomonal paon aftcr ~I, In In
obese 44-\-e~r-()1d male.
3 A >I1IJIIgroup of student; IU~'"lhe ",,1111011"1).tncr} on. CJd.. 'er,
4 Ouu ,pends ~ monm \\orllOjl on rbe paclIJIrt<; ward of ehe local ho;p'l.1l.
5 Anne ICJm, ho\\ 10 take blood lrom an rlderl} 1'.'''<111.
6 juma "hoo<es 10 srud~ Tu\rI ~Icll"'nt' "' h" (ollnh ycar.

32 Prof es 'io"'" .. u.e _

~
Medical education 2
The Foundation Programme
The Foundation Programme is a rwo-year training programme which forms rhe bridge berween
university-level srudy at medical school, and specialist or general practice rraining. h consisrs
of a series of placements, each lasring four monrhs, which allow rhe [unior doctor, known .5
a trainee, 10 sample different specialties, for example paediatrics. A year one trainee (FYI)
corresponds to pre-registration house officer (PRHO) POStSand a year tWO trainee (FYI) to
senior house officer (SHO) posts. Each trainee has an educational supervisor who ensures
that more senior doctors deliver training in different ways, including clinical and educational
supervision. To progress. trainees ha .r.e to demonstmte a range of clinical competencies
which are assessed through observarion in their workplace.
IBMJ CO""'" 2005; AmmdC'dw,.h p«m""'" hom Ih< 8MJ -"'9
Croup)

People in medical education

tutor An ac ••demic, or in some cases a posrgrnduare student, who
leads rueorials.
demonsrrator In anaromj' reaching, someone who demonstrates how to dissect.
Demonstrators are often postgraduate students p.ymg rberr way
through medical school.
lecturer I senior lecrur er An academic with reaching and rcsea reh responsibilities who
contributes to the reaching of a particular discipline.
professor A senior academic with teaching and research responsibilities for
a particular discipline. Usually a leading figure in their discipline.
college rutor A consultant responsible for delivering a college training
programme.
clinical trainer A consultant assigned to a trainee who provides training dunng
periods of direct clinical Care.
educational supervisor A consultant who supervises a rrainee's period of trainmg.

Medical qualifications
BMSc Bachelor of Medical Science •. A degree ofren ta ken after three )ears of
BMed Sci medical studies by srudcnrs who may wish to follow a career in medical
research.
MBChB, MBBS Bachelor of Medicine, Bachelor of Surgery. Bachelor degrees a",
BMBeh, BMBS undergraduate degrees. This is the first degree (or UK doctors.
MD,DM Doctor of Medicine
DRCOG Diploma of the Royal College of Obstetrics and G) naecology
MRCP Member of rhe Royal College of Physicians or Member of the Royal
MRCS College of Surgeons. Doctors become ~ lembe rs It)'
successfully completing the assessment procedures in their
college.
FRCS Fellow of the Royal College of Surgeons of Fngland. Other colleges are
I'IlCS(Ed) mdl<7Jled b) the letrers which follow, for example Edinburgh. Glasgow or
~RCS(Gla') Ireland.
mcsi Ilow doerors become 'I Fellow depend, on thelt college. for the
FRCS. further exarnmanons muvr he passed. For other colleges II .s by
nomination or work assessmenr.
12.1 Complete the phrases with 'er~ from the box. Two phrases can be completed in 1'10
different ways. Look nt A and B opposite to help you.

deliver provide supervise rake

, ...••".••_. .._. a comperence or how 10 do something

2 . • _ ... a rrainee by ensuring she successfully comple,es her training
3 _ a course or a rraining programme (as a teacher)
4 _.._ a course or a rraining programme (as 3 student)
5 _.._ progress or comperence

12.2 Match (be rwo pans of (he sentences. Look a' A, Band C opposite ro help you.
1 An FY I "3 doctor
2 A demonsrraror 1~an anatomy teacher
3 A cluneal rrnmer is 3 consultant
4 A supervisor is :I consulram
5 A medical scbool u
6 A placement is
7 A college is
8 A Fellow is a spec •• hsr
a a bod)' of specialists responsible for delivering and assessing training in their specialry,
b responsible for the training programme of a trainee.
c a period spent as a trainee in 3 hospiral or in General Practice.
d in rhc nrS( year of the Foundation Programme.
e who has reached rhe highesr level in rheir specialty.
f who provides training during periods of direct clinical care.
9 pan of 3 university responsible for medical education.
h who reaches dissection.

12.3 Write an full the quahficallons of the doctors and surgeons. Look a' C opposite '0 help you.
1 Mr A. H. Younghusband, MBChB. FRCS, FRCSI

2 Or C Do\,I e. U;\led Sc r, OM • .\IRCP

3 x Is F In"II>. MBBS. FRCS

4 Dr E .\lem,\l·carher. BM. MD. FRCP

OVer "'0 '10lA ~

How do you become a specialist in your country? list the st;_jgl·~.

Pro(euio",,' en,,,,,, .. Use 33

-..
The overseas doctor
Types of registration
To manage and treat pancnts in rhe UK, all doctors must register with [he Ceneral
Medical Council (CMC). There are several rypcs of registration:
• Provisional registration is for doctors who have just qualified from medical school in ehe
UK or frorn certain European Economic Area (EEA) member Slates.
• FuU registration is for doctors who have completed their year's clinical training.
• Limited registration is for inrernarional medical graduates who hav not completed the
equivalenr of a rear's clinical training in the UK.
• Speciaiisl registration is for doctors who have completed specialisr medical training and
have a Cerrinc)(e of Completion of Training (CCT).
11,c Gi' Rl-gislcr is a regmer of all those eligible to work in general practice in the NHS.
Note: For full details of the ()cneral Medical Council S(C www.gmc·uk.org

PLAB
llefore they C3n obtain full regisrrarion, some cnregorics of overseas doctors are
required to take the Professional and Linguistic Asscss111clm Board (PLAB) ICSt. I)LAB
is designed ro ensure rhose who pass can practise 5.1fel),ar the level of an SHO in. first
appointment ill a UK hospital.
Part I consists of a written rest of knowledge, skills and arrirudes. Part 2 is an Objective
Structured Clinical Examination (OSCE). It consists of 16 five-minute clinical scenarios,
known as stations, to assess professional skills.
Note: For a full description of PIAB. see http:}/www.9mc·uk.or9/docto~plab/

PLAB stations and advice

OSCEs assess these skills:
• Clinical exarrunanon: Your .bilit) to carry OUI 3 physical examinanon of a simulated
padenr, an actor trained 10 play Ihi, role, will be .,M:S....
:d. Unccmfonablc or mnmare
cxaruiuarions will be earned Out u)lng, J manikin, an nnaronucal 1110deL
• Practical skills: You will be assessed on practical skills such as surunng and gtVlIlg
mrravenous mjeceions,
• Communicanon skills: Your ability to interact with 3 simulated patient, Or in some cases
the examiner, ,,,II be assessed. Skill, rested may include breaking bad news and giving
advice on lifesryle.
• History taking: Your ability to take an accurate history and make a reasoned diagnosis
will be assessed.
Advice on tbe Stations from a successful candidate:
 Read the instructions outside each station Don't forget the ABC (airways, breathing,
carefully. You have One minute for this. circulation) PTOIOGO) in every emergency station.

Keep in mmd s.fcty precautions Check the patient understands what is happening; then
like Ihrowins the sharps in rhe ask them about any concerns Ihey may have, Don't JUSt (
sharps bin. give. lecture. l.isrcn carefully 10 what the actor says.

Note: Sharps are needles and blades which must be disposed of safely In a special container
called a sharps bin.

34 fro(essiM<Jflnttish ., Use
13.1 \'(Ihal kind of registranon might these doctors obmin? Look at A opposite to help lOU,

1 A newt)' qualified Spamsh doctor

2 A newt)' qualified Nigerian doctor

3 A docror who has successfully completed the first Foundation Year (FY1)

4 An $HO who has successfully completed the Foundation Programme and gained a Certificate
of Completion of Training after several specialise registrar posrs

13,2 Write the abbreviations in words. Look ar A, Band C opposite to help you,
1 Any doctor who wants 10 work in the UK must register with the GMC.

2 Some overseas doctors must pass the PLAB 1<'Stbefore they can r(WSler.

3 Part 2 of the le<t consisrs of an OSeE.

4 In allY emergency, remember the ABC protocol,

5 Before you can obtain speoahsr registration, you must have a CCT,

13.3 Complete the rexr, Look 31 A. Band C opposite 10 help you.

My name's Musa and I come from Yemen. I came to the UK about tWO years ago.
after graduating. Because Vemen is outside rhe EEA, I could only obtain (I) .
_
......._.._..... ._ with the (2) . , at firsr, II was very difficult for me 10 obtain
a place on a foundation Programme. Alrhough I speak good English, I had to take the
(3) ..._...._. . resr to show that I could work safely in rhe UK. If I had to give
some
advice to other candidates. it would be that at counselling (4) ..... ._ • you shouldn't
simply memorize a set of phrases, It's bene, to really think about what you're saying to the
actor and get the inronnnon right.
After completing 111) year's clinical training, I was able I() obtain (5) _
, But I found it difficult to get an Sl lO post in my chosen >pt..;.lty,
paediatrics •• s hO<pital. now have to demonsrrare rhere isn't a suitable candidate from the
EEA, Once I've completed my second Foundation YeM, I should obtain a
(6) which will allow me to proceed ro (7) _ _ wnh
rhe G.\ IC, an Important step on the road to becoming a paediatric consultant.

Over .rO ':SOU

(xplain how a foreign doctor can reqister to work in your rnuntrv. Find out how you ran
rcqistvr to \'\'ork 111 another country of vour choice.

36 prormioool Enpsh ., IM-'"

Symptoms and signs
Describing problems
The problems which. patient "'POrtS 10 rhc doctor 3rC called symptoms, for example
pain or nausea. Signs arc what the doctor finds. also known ;15 findings" on examining (he
patient, for example high blood pressure or a rapid pulse rare. Symptoms are also known
as complainrs. To report a patient's symptoms Or complaints, doctors say:

3S
 In case notes, the abbreviation do is used:
Mr Farnsworth \\'3.$ admitted
complaining of chest pain,
CIO C nest pG! ~""

Presentation
P:ltiCnlS $ay they went 10 (sec) the doctor, doctors .oy the pariem presented. The »"'1'10'"
which causes 3 pauent 10 v'SI! 3 doctor - or to present - i> called the presentin!: symptom,
presenting complaint Or presematio».

· presenting symptom
H's I. was chest pain.
presentin. g comp "10

He presented 10 his GP with chest pain. The usual presenration is chest pain.

Talking about symptoms

Sympturn Ml·an.ng Patil'nt, say
tiredness loss of cncq:y I feel tired all the time.
lethargy I feel completely worn out.
("tigue 1""e1y I've been fethng completely
lassitude exhausted at the end of the d.).
malaise general feeling of being I feel '"1
well.
unwell I don't feel well.
I've been feeling off-colour for IWO days,
I haven' been feeling myself for a week.
I've been OUI of sorts all day.
anorexia loss of apperire My appetite is very poor.
I've been off my food for days.
weigh! gain increase in weight I've PUI on eight kilos in [he last rear.
I've gained five kilos.
weight loss decrease in weigh! I'm I10t eating an)' less than usual but I've
1(»( a lor of weight recently,
consripation hard. infrequent faeces My mot ions arc very hard.
I've b(''C11 quite ccnstiparcd lately,
I'm nOI very re'S","r.
Note: The verb (eel ISalso usro WIth other adjectives. such as hot, cold, nervous, anxious, dizzy,
-
weak - She said sht ftll dizzy.

36 prormioool Enpsh ., IM-'"

 14.1 Complete the rable wuh words from C opposue. Put a stress mark in fronl of rhe stressed
syllabic in tach word. The 6rsl one has been done fo,' you.

Nuun AtI,tTlovl'
ex'hausrion
farigue ,
lethargy I
tiredness I
14.2 Make word combmanons using a word from each box. Look at A. Band C opposite 10 help YOII.

complain with
off- of
out of out
p"csent on
pul colour
worn sorts

14.3 Complere rhe sentences wuh the correct (om, of Ihe verb present,
I A 67·year-old man with a 9-molllh history o( increasing shortness of breath.
2 The most common _ is loss of consciousness.
3 Cranial arteritis may as fever without any obvious causes.
4 The parient usually ... with a severe SOre throat.
5 The _ symptoms in (his parienr could perhaps he due to renal failure.
6 Other conditions wirh 3 similar _ .._ _ include acute cholecysriris.
7 Reduced growth is an important complaint of coeliac di5<'35<'.
8 Two months (ollowing the patient was able ro walk.

14.4 Read the patient's descripnon of her symptoms then complete the case report. Look 31 C
opposite ro help you.

I WaS well until a few months ago. In

rhe bcg,nnlll!\. I lUSt (elt off-colour and A so-vear-otd housewife. who had been well
" bir tired. BUI laldy I've been feeling until four months previously,
completely worn OUI at rhe end of the <I.,y. (1) _ of tiredness and
1'111 not eating an)' more than usual bur (2) _ _ _ .. She had (3) .
I've pur on nine kilos in the last year. My 9 kg in weight in the year before she
motions are hard and my hair has smrred (4) _ to her GP although she
[0 fall out. denied eating more than usual She was
(5) and she noticed that
her hair had started to fall out,

pror."iOl1ol Enefish in Use Medione 31

-
 Blood
Full blood count
In rhe invesngarion of blood diseases, rhe simplest test is" full blood count (FBCI. A
full blood count measures the following in a sample of blood:
• the amount of haemoglobin
• the number of tbe different cells - red blood cells (erythrocytes), while blood cells
(leucocyres) and platelets (rhrombocyres)
• the volume of the cells
• rhe erythrocyte sedimentation rate (£SR) - a measurement of how quickly red blood cells
full to the bonom of 3 sample of blood.

Anaemia
Anaemia i, one of the commonest diseases of the blood. It may be due to:
• bleeding - loss of blood
• excessive desrruenon of red cells
• low producrion, for example because rhe diet i, lacking, or deficient in, iron (re).
A medical student has examined an elderly patient wirh a very low level of haemoglobin
and is discussing rhe case wirh her professor:

38
 Professor: \,(fhafs rile mOSI likely diagnosis in rhis case?
Srudenr: Mosr probably carcinoma of the bowel with chronic blood loss.
Professor: \Vhafs against that as a diagnosis?
Student: Wcll, he hasn't had any change in his bowel habit, or lost weight.
Professor: \Vhat else would you indude in the differential diagnosis of se vere anaemia in a
man of this age?
Srudem: He mighr have leukaemia of some SOrt, or aplastic anaemia. but that's rare - it
would be ,'cry unusual. Another cause is irOI1 deficiency. bur he seems 10 have an
adequate dret.
Professor: OK. No". there's another cause of anaemia which I rhink " 1110re Irk.!)'.
Srudenu Chrome bleeding ulcer?
Professor: Yes. Ih,I', nghr, But what about pernicious anaemia? Can )'011 ex elude ,h.l?
Srudenr: Well, he', gor none of the rypical neurological symptom s, like par ••esthesiae.

Pernicious anaemia
jordi Pons, the medical student (rom Barcelona. has made some language nores on hrs textbook.

O~tt = bt9t..~~
Pernicious anaemia (PAl is a condition in which there
is atrophy of the gastric mtKosa with consequent failure ......'d"'«.< = slcwtll d"'&r";~~
l'~U,Dr = U!t~'" 0DlcI<r
of inuinsk factor production and vitamin 811
malabsorption, The onset is insidious, with
~~;: su.ekt
jOK...di.ot = hiLi.n<cW),~
progressively increasing symplo~ of anaemia.
brtA~()VoI"", m: d~.' .~.s.LC_".. ~SrkDU(rP'trts
Patients are somebmes said to heve a
bD~ ..... rrow = soft t=1<t w.~,.A,,(tll
lemon·yellowcolour _ng to a combination of pallor
and mild jaundice causEd by excesSIVebreakdown of GC"'(S
of haemoglobin because of IneffectM red (ell production '1:l .... ~ ....... L eo" $"'e '" S<lrAl
,n the bone marrow. A red sore tongue (gloslllis) is ",brat",,,, st"-$e - AbU; '1:1 tr {tel
Vlt~"-$
sometimes present. Patients pr~t WIth symmetrical
paraesthesia. In the fIngersand I~ earty 10ss of l'ro9OUS'''t e~v.t"' ••<,~ tD ,:fevtlcp
vibration sense, and progressive weakness and 1'.Ll'~btt c.v. be {t,t ••\t, 'M ".""
atax,a The spleen may be palpable.

38
15.1 hnd words III I~ he" ,,"h opposue nlC.nlll~'. I oo], .11B and C cppoore 10hrlp )"u,
 adequate mild common 1I1;,d,ou, for
3s.-1in,r rare ,udden inadequate hkel-y-l

15.2 Make word cornbmanons usmg a word from each box. Look 01 Band C 0pPOSIIC 10 help you.

bont diagnosis
differential sense
insidious ~I
iron marrow
pernicious 'ntreasing
progressively ddicicncy
vibration anaemia

15.3 Complete the ...-.ntenc .... I ocoL.,t A. Band C "pro,ite I() help) ou,
I A 39')car-old man ~Ied '\lth J h"wl') of abdommal dhlen\lc>tl o'er J
penod o( '" 11)('l1Ih,.
2 Bhndnts, m.) he, ,",u-.cd h, \ namm A
J The bleeding and purpur, are caused b) .bnorm.1 funcflon.
4 The white cell count " normal so we can acure leukaemia.
5 The yello" colour o( her skill and comuncnvae i, probably due to _.
6 There was a mass in the right upper quadrant of the abdomen.
7 Treatment is aimed JI restoring lIuid balance with intravenous Ilurds,
8 The anaemia m3)' be due 10 increased red cell.,., .. .

15.4 Complete the com ersanon. Look at C opposite to help you.

Professor: Wh31" a<\.JlIl>trhe diagnosu of permoous anaemia on physlCll e'dnlllUUOO?
Srudene The prubkm >t.ltted quite suddenl). so II d,dn'l have the f) plCll (11_-----
. He ~n'l have an) ,kIn (2) and he doesn't have
( 1) paraesrhesiae, or ahsem (41 sense, and I couldn'l
feel h" \1'1«0.
Professor: Whal .,OOUIhl~ Inngue?
Studeut: HI' I"n"ue "., normal and nor inflamed or (5)

over 1-0 ~Oll

l ...t. tht' r au~("'louf anaerma m('ntlont'd In the ,'onv(·r\i.ltlun In 8 oppusue Ihrn lhc")~t·
another ,'ondlllnn Ihdt rHU encounter rt"gul.;.Hly ;Jnd makr- a sumtar II\{ nf thr r.ilU\t·~ In
l nqlrsh. U~t' the Ind(':a:In bctp ynu.

39
Bones
Bones
Some common English names for bones:

l nqhvh 11.II1U· An.llolllll"'11 namv

skull cranium
jaw bone mandible
spine vertebral column
breastbone sternum
rib costa
collarbone clavicle
shoulder blade scapula
thigh bone ftmllr
kneecap patella
shinbone ubia

Fractures
A fracture is a break in a bone. Some of the different rypes of fracture:
 greenstick displaced comminuted impacted open (compound)

A pathological fracture IS frootu'" III a diseased bone. A fatigue or mess fracture IS due to
repeated minor trauma, (or example long-distance marching or running.

Treatment of fractures
When the fragmencs of a broken bone heal and
join together; they unite. Union may be promoted,
or helped. by reducing rhe fracrure - replacing the
fragmencs in their anatomical position if rhey are
displaced. Aftcr reduction, excessive movement of
rhe broken bone is prevented by fixation - either
exrernal, for example a splint or plaster of Paris
cast.
{ L
or internal. for example a pin or a plate and screws. ... ,
A displaced fracrure which IS not reduced may result
in mnlunio« - Incomplete or mcorrect union.
o plastrr eIIst • pm a pta te and 5a""
Note: The verb Itduee has ~I meanings In
medicine:
• to make smaller - I think Wf'd bttt~r reduce th~ closeor your labl~ls.
• (in surge..,.) to return to anatomical position - A bemlo can Ilormally b~ redumJ by manipulation.
• (in chemist..,.) to IttlIOVt oxygen or add hydrogen - Nitric acid is a reducing ag~nt

40 p,.ressiono&l Ips!> II> Use M<dIone

16.1 Label the diagram "'lOA \\0«1, from I~ 00\. I ClO~.11A opposue to help >00.

breastbone
collarbone
6
law bone
kneecap 2
nb
shinbone
4
shoulder blade
skull 5
spine
thigh bone
\
I,..,
8

16.2 Malch the I)"n of fr.Kt\Jre I-51 wirh rhe descnpuons (a-e), Look at 8 opposue 10 help lou.
1 open
2 comminoted
3 displaced
4 greensnck
5 impacted
a There" a break on Ihe skm,
b The bone " 1"'111. It """" m.llnl} 10 children.
c The bone I< brcllo.cn 1010 st' eral P'CCe\.
d The broken P'('Ce\~'" separated,
C The broktn p~-n are pu,hed rogeth er,

16.3 Complete ,he revrboo], extract. Look ar C opposue 10 help you.

(1) . a fracture involves trying to return the bones to as near to their original
position as possible. If a fracture is allowed to heal in a displaced position the fraclure
will (2) . but II may go on to (3). . _ _ .

Ovu .f-o ljOU

You havr dl.uIUU\t"cI,1 ,tfl'" f"ulurt' uf tfu- 11111.1111 ,I YOIIII'! ft'n1JI.' d.HHI' UUW 'Nuuld vuu
r-xpl.un 10 he" th,' t.IU\t· .tnd ,n.ln;Hlc"l1t'nl III H,.\ rUflil,lIon'

Pro(ess ioool Enpsh .. lis. 4I

M..,.,.
 •

Childhood
Milestones
Childhood I~ lhe peood dunng "hoch a person I~ a child, It ends wirh pub<rt) - ODS« me
of sexual m3tunl). Infanl I> a_her word (or a young child; infanc), is rbe ~od from
bmh unnl aboet Ii'e )Qt'S of age.
The milestones on a ch,ld', dc\dopmml and me ages at which the) usually occur art:
• sitting - by 9 months
• cr,mling - by 12 months
• firsl "ords -II} 18 months
• "alking - h) 18 fTl(>nths
• 1.lldlll! (I\\.,.."oru .....,1<1k.<» - bl 1 ) e,ltS.

Common infectious diseases

DI\l",I\\" Commuu nann-
l1lurbdlolrubcola measles
rubella Cerman measles
varicella chickenpox
infecnous paronns mumps
pertussis whooping cough
acure laryngorrachellls croup
scarlatin. scarlet fever
rhcumanc fe'er rheumatic fever
tttanu\ lockjaw
pollol1l)eloll\ polio
'-

Coeliac disease
A mod",,1 ,IlIUmt h., nu.Jc ...,,"" language nOIl~ while reading her t."bool. ..
 CoeilICd~ IS, II Sfa 01 tIlf ~vitl:l to • ,""'~. 'J.~"
WltfStJ~ GlUIfd br sMsitivity to giw:tn.1t con
,~~~
pttSfnt at arrt age bu1 WI >tIfarq ot ~ wta~ ~ .'"~ U'! u. .......
af:e<_aning _.... ~ soW foe'*.
on lO ctrtals con. ""'9 gtul«I Tht dinical ~l ~ = ':I'! st:'4··.-..saNi
features lIldIIcIr Urtoota. malabsorption ~ .... c:: a :f~Si
and failure to thrive 1hm may be !I9flS of ..... labso."ao... = """ 'cs.or.OCo'I.
malnutrition and !here may be some abdomonal .....r.-tritio ...= J>I't'r a.e (1'I4<m:u-- ... )
distension Theft IS delayed growth and Q.".Jectt\#:;: w.a~
delayed puberty leadng to shalt stature In
adulthood thrive - ~Ort'M strr"""'
...A. J j"I

d~tt~w..... ~ $' ~~-e

dtlal:led (Qt" tka" t"t"''''
fatt..n: - w~I"U>l<tt~ ~~Il1t.$
e.<putt<;l ~'(~ ~ ~ ...
'tQb<n: - aze, e.<f'tWIlIJ:l ~,~"

42 I'ro(euionol £II,...,. .. Us. M<doone

17.1 Complete Ih. table ,,"h \\cmh from A and ( ClI'JI'''".' '1hen complete I~ ..mlro.:e\
wuh words from the table,

Verb NUll"", Adl''l'tlVl'h'

delay
develop
disu-nd disrended
fail
nourish

Pro(...- enpsto .. Us. M<doone 43

 I Babies wuh Iht felJI akohol s)odrome may present with . 10Ih"'t.
2 Abdomonal m.!) be due 10 an enlarged _.....
liver.
3 Small amOUI1I, of Jkohollll prq;nancy (.In affl'Cl f.,ol _ _.
4 Monalo!) frol1l mta,1c.-\ <.In be reduced by better
5 on 0"" or n""" of tbe O1lk",lOno, 111.1)'be Ihe fir... ign of d,\e.",.

17.2 Complete thr ~ICI'lCn. I ool 31 A and C 0ppQ\lIe III help you,
I After slmnlt- Nb"" learn 10 and I~" 10 walk.
2 A child" ho ha, " .•ned eanng solid food ha~ been
3 Someone who IS 1101\<1') ,.111is snd 10 be of -hon
4 The srag'" In 3 <hlld\ developrnenr 3re known a, the ....... ... .
5 A child who is begonnong10 develop sexually hns reached .. .. ... .

17.3 Wri,e me common English name for each disease. usiug your medical knowledge.
1 enlarged parond ¢ands
2 difficuhy opening Ihr mouth
3 rash and enla'lted J>OStcnor OCCIpitalnod ..
4 paroxysmal (ou!lh \\ Ith \OI1Utmg
5 papules and \..,,,k-. tiN on trunk
6 cough and cold fullo"ed b) rash
7 sore Ihrn." and r.l,h
8 swollen 101m, Jnd J hean murmur
9 fever followed hy 11111,,1. weakness
10 cough wilh , ... dor

44 ProfesSional &!gfish .. Use Medione

The endocri ne system
Excess and deficiency
An excess - tOO much, or a deficiency - tOO little, of circulating hormones Causes a wide
range of medical conditions, for example hyperthyroidism and hypothyroidism. Whe re
there is an excess of hormone, one form of treatment consists of giving me patient
something which inhibirs rhe production of that hormone, as in the use of carbimazole
to treat hyperthyroidism. When a hormone is deficient, treatment may be by replacement
therapy, for example injections of insulin in the treatment of Type I diabetes.
DOctors sa)':
Sufferers of rype I diabetes
arc deficient in insulin.

Negative feedback systems

1 TRH (thyrotrophtn-releaslng homlonel is

.. e in the hypothalamus end tri .. , ... the
p etie. of TSH (thyrotd·stlmulating hormone)
in the pitull:ary.
2 TSH 11i •• lltes the TSH receptol' in the thyroid
to increase qIItIIesis of both T4 (thyroxine) and
T3 h:niodothyrorlne) and a4so to reIa .. stored
hormone. ~ increased plasma levels of
T. and Ta.
3 T3 fedl Nell on the piwitary end pemaps the
hypothalamus to InhibIt TRH and TSH .. eretia •.

Goitre
All enlarged th)'roid gland IS called a goitre. lhe enlargement may be diffuse - involvmg
mOM of the gland, or localized hmhcd to a pal·ticular area, "' in a solitary (smgle)
=

nodule. The Increased blood 110\\ In diffll"" enlargement, for example III Cra"e;' disease,
may give rise to a palpable thrill- vibranon felt with the hand. and an audible bruit
- noise heard through a Stethoscope, oyer the gland.

A letter of referral
Mrs Davis's doctor has referred her [0 an endocrinologist.

Dear Doctor.
Iwould be grateful if you would see this 50-year-old woman
GV':"'cti\'(:: ~ore
acnve than IS
who has lost 20 kilos in weight in spite of eating mote than
usual
usual. She describes herself as over~ctive and at first
site thought the weight loss was due 10 this. But rpalpilalions:
more _tty She has developed palpitations. diarrhoea, awareness of
and heat intolerance. She has noliced that her hands rapid or irregular
hear intolerance: heanbear
have a tendency to shake.
inability to
cope With high Her symptoms suggosted hyperthyroidism and this was
conlinned by my examination which revealed an enlarged
rfine tremor: very
temperatures slight involuntary
thyroid. red sweaty palms and a fl~e tremor of the hands. I
movements
18.1 Complete the table with words from A, 8 and C opposite and related forms. Put a stres>
mark in from o( the stressed syllable In each word. The first one has been done (or you,

Verb Noun
in'hibir
produce
release
replace
secretion
stimulation

18.2 Complete the passage from a textbook, using the illustration

and your own knowledge. Look at B opposite to help you.

Pulses of GnAlI (gonadolropllin·relcaslng hormone) Ilre

roroascd from the hypothalamus and (1) .
L11 and FSB (2) from the pituitary. L11
(3) _ testosterone (4) from
Leydig cells of the WS1is.
Testosterone (5) back on tho
hypothalamuszpnuuary to (6) GnRH
(7) . FSH (8) _................... the Sertoli
cells in the seminiferous tubules to (9) .
mature sperm and the inhibins A and B. lnhibin
causes feedback on the pituitary to decrease FSH
(10) ._........ .

18.3 Complete the sentences. Look at A and C opposite to help you.

I A change .ffecrs many pam of an organ or gland.
2 A _ _ change affec", only one part.
....
3 Ilis diet is on rron: he doesn't get enough iron.
4 _.......... .. T, and T. mcrease rhe basal metabolic rnte,

18.4 Match Mrs Davis's S)'1Tlplom<(1-71 with the questions her docror asked (a-g], Look at 0
opposite to help you.
I diarrhoea a Do you prefer hOI weather or cold'
2 eating more b Is your weight steady?
3 heat intolerance c Whal is your appetite like?
4 overacriviry d Are your bowels normal?
5 palpitations e Are you able 10 sit and relax?
6 weight loss f Do your hands shake?
7 tremor 9 Have you ever fell your heart bearing rapidly or irregularly?

Ove.r +0 '10tl
Wrltt' ;1 n·h·rral It'll tor 111an t'fHlorflnlJlflCjI\! lor a natu-nt \1,110YOII Iu-ln-vr

h;1' hypolhyrolcll\1l1, 11\(' the h-ttrr In () 0flPIl\III' ;1\ a murh-l

p",r... ionol fnglish In lM _ 45

The eye
Parts of the eye

eyelashes
pupil

Examination of the eye

J tere i~ an extract from 3 rexrbook descriprion of how to examine Ihe cleo

Lode ,., squinl (~dtoopilg 01 dIf _lid (pt""') or O$elll.Uon of th. 4!jtS ~.In lid lag. dIf_
eyelid inogulally _ 01 ~ when dIf patienl b asked 10loci< down.
NexT, mint dIf pupils and .... --.."
• 1hey oquoI in size
• 1hey are regular in outline (ownly <iI<Wr)
• 1hey are abnom1aIy dilated Oargr) (If constricted (Small
• 1hey react normally II> I9>t and a«~ (focus on near objoos).
To IeSI dIf...man II> accommodation...t dIf paden! to look into dIf distance. Hold "Pi' linger in front 01 ......... and
"" the palimt II> loci< at it. Tht .,.. shouti ""'" ocgelher. (If converge. and the pupils should cons1rict .. the pa1ioI1IlooI:s
al the fongEl,
Chedc also ,., calMOd (apocdy 01 dIf len<).

Retinopathy
Hypcrrcnsrve changes m rhe retina can be classified from grades I 104:
• grade I - siher "iring [increase on rhe light reflex) or the anenes onl)'
• grade 2 - grade I plus arreriovenous nipping (indentation or veins where rhey nrc crossed
by arteries)
• grade 3 - grade 2 plus flame-shaped haemorrhages and corronwool exudates
• grade 4 - grade 3 plus papilloedema.
19.1 Complete the table wnh words from B opposite and rclarcd rorm~.

Vnh NOlin Adll'('llv('

accommodare
constriction
convergence
dilation,
dilatation
droop
oscillate
reacr

19.2 Mnrch the pictures (1-6) with the conditions (a-f). Look at B opposite to help you,
1 a drooping of hds
4 b dilared pupil>
e irrq;ubr pupil
d cataract
e squint
r constricted pupils

19.3 Complete the extract from a textbook. L.ook at C opposite to help you.

Retinoscopy
Examine !he retina with an ophthalmoscope, If possible wilh the (1) . _
dilated 10 obtain !he maximum view. Look for papilloedema, and for (2) _
...- ...---.----.-- haemontlages and (3) .•._.....•_...._ exudales. Assess !he stale of
.•.
the (4) and note !he presence of any narrowing. as well as
(5) ._. at arteriovenous CfOssings.

OvM" -4-0 '10lA

Irtllh1lunally, ,'yt'\I(Jht pruhh'nl\ ;Hl' rurn'{'h'c! with '1)t'{'la{'h" fir ('III1I"rl h'u\t'\. In n-vr-n!
yt'ar\. 1;I\t:r Iht'r<lpy hav ht,t'tllnt' a Ilnpul;H ;11It'rnaIIV(', What an' Iht' ;UIV;U1LU,t" ;IfHI
dl\iltlv.1nla(j('\ (I Ihl\ h'('hnl(IUt'~

-
Pro.(.. ionol £nrIish '" 1M M_ 47
 The gastrointestinal system
Examination of the abdomen
Here is an exrracr from 3 textbook description of how ro examine the- abdomen,

Note if the abdol'llell is dis1etoded by fluid or gas. The presence of fluid can be coonmed by
demonstrating shifting duIk1ess: percuss. or tap, first with the palientlying supone - IIat on their
back; then ask the patient to lie on one side and percuss again. If fluid is pnosent, the cUI note
heard on percussion moves. Palpate each region, feeling for ~ - pain when toucI1ed,
or masses - palpable enlargement of tissue. Note also any guarding or rigidity, shown by
contraction of the abdominal muscles. Guarding may be due to tenderness or M><ieIy and can
be reduced if the paIlent is persuaded to relax. Rigidity, however, Is constant and is due to
penloneal irritation. Rebound tet odemess is pain when the palpating hand is suddenly removed.
" Is a S9' of peritonitis. Listen for bowel sounds.

The faeces
There arc scvera I word> for the f.eces.
Doctors sometime; $0')': Patients somcrimes sa)':

There was blood on rhe stools. My motions have been very loose lately,

( Have you pa~ black stools? 7'

Bowel movement is used ro refer ro defecation:

( Have your bowels moved today? 7' Have YOll h.d a bowel rnovernenr rod.),?

Howel habit is a medical expression meaning the pattern of defecation.

Have you noticed any change of bowel habit?

Are )'OU going to rhe toilet 1110reoften than normal?

Change in bowel habn could be constipation - hard, infrequent srools, or diarrhoea -

frequent soft or liquid stools.
Normal stools are brown in colour, and semi-solid, or formed. The consistency, Or degree
of hardness and softness, can be shown On a scale:

48
 hard formed semi-formed soft (loose) liquid/watery

The colour can vary (Tom black, due to altered blood as in melaena, to yellow, grt') or c\ en
whirc, Melaena stools are often described as carry -like l1lr, the black sficky substance that i.
used in road makmg. The stools on,,), be red when fresh blood i. present. Blood that can oilly be
detected with special testS IS called f.ecal occult blood (FOil). When there is a high fat content,
rhe ,,001; are pale, and are sornenmes described as clay-coloured. Stools that arc large to volume
are described as bulky. A bad smell is described as foul or offensive.

49
20.1 Complete rhe (J>C <qlC1MI. ,,m ~I A Op~I(C 10 help you.

Physical examination revealed a thin girl with slight pallor. She was not obviously
dehydrated. The temperature was 38·C, pulse lOO/min, blood pressure 110/80 mmHg.
Examination of the rest 01 the cardiovascular and respiratory systems was normal The
abdomen was not (1) . There was generalized (2) ,which was
most marited in the right lower (3) and was associated with
 (4) but not (5) . There was no rebound (6) _ and
no (7) were felt. (8) sounds were reduced.

20.2 Match the d("o<;ropllol1>of ebe stools (1-6) Wllh the cOl1dilion. most likely 10 cause them
(a-f), using your n.. ell(.11 knowledge. Look 31 II cppositc to help you.
Type of stools Condition
1 loose, hlood) a 1I.'ltle ulcer
2 loose, pale, hulk) b rrruable bowel ,y"dromc
3 clay-eolcured c ukerauve cohll'
4 black, (311) d chol era
5 <mall, hard e coehac dl>cao;c
6 clear; wOIltl) wuh mu..u\ f oh<rnl<uvc lnund~

20.3 March rhe features (1-~)10 rhe doctor's qUC<IIon.(a-g). Look ar 8 opposue to help
IOU.

I blood a How often do you open your bowels?

2 bowel habit b Are you going 10 rhe toiler more often rhan normal]
3 change in bowel habn c Are the motions hard Or loose?
4 bulk d Do the motions have an unusual smell?
5 colour e W1u1 abour the appearance of the slools?
6 COllSlSttll<') r Have you pa~>ed black stools?
7 offens;,'entSs 9 Is the SOle or the ••mount of the stool nOrm.lI?

'oghl
upprr
quad",nt

roghl
"'-
quadranl
1lIt abdoo1en ('On be dnnded
Into four quadr.ilnts.

over .f'o '1011

l nuk ha('k .1110] ;lh4l\'l' In \'I;hat otht" 1..'011(11110'" lhat you eucounte n-qularlv ., the
appr.uancv of lht· ,1110" tYPu:dl' Huw \'I;CHlldyou dvvrtthr thl'I' ~lppt'~Hdnl·l·1
 Gynaecology
The female reproductive system
Fallopian tube
(salpinx)

neck of womb-
[cervix)

Menstruation
A period i> the COmmon name for. menstrual (monthly) period. The onset of
mensrruarion is known 3$ menarche. The I.,. menstrual period is commonly abbreviated
in doctors' nores. I.MI' US2 ago means the lasr menstrual period was two weeks ago,
The menstrual cycle, Or length and frequency of periods, is usually written in (he form
4/28, which means lasting 4 days and occurring every 28 days. If a period lasts more
[han four or five days ir can be described as prolonged. The term heavy periods means
excessive blood loss - menorrhagia, often with rhc passage of clOIS - coagulated blood.
The term period pains means dysmenorrhoea, or painful mensrruarion.
The rime when a woman Stops menstruating, normally at about the age of 50. is called
rbe menopause or climacteric. In everyday English it is known as rhe change of life, Or
simply the change. Symptoms of the menopause include hot flushes - sudden sensation of
heat - and night sweats.

A gynaecological consultation
A gynaecologist i, ralking to a 30-),I-:1r·olcl woman.

5 ","( es ,ioool English .. Use

0 MediCIne
 G,- ynaet'Ologist //I,_ Patient
A,
A re your periods regular? Yes.
I low often do you get Every four weeks.
them?
How old were you when )"OU starred [0 get them? About 12.
When was your last period? A week ago.
How long do the periods 1351 usually? 4 or 5 days.
Would ),OUsal' rhey are light or heavy? Light.
Do )'OU get dots? No.
Do you get period pains? Not really.
Is there an)' discharge between the periods? A little.
What colour is it? Whire.

Contraception
1'0" women, method, to pre, em pregnancy include the oral contraceptive pill (known .,
the Pill], the diaphragm. and the intrauterine device (IUD) or copper coil. Condoms arc
nvnilablc for both men and women.

5 ","( es ,ioool English .. Use

0 MediCIne
21 .1 \'iIr'te 3 simple Enghsh phrase (or each of rhe medical terms below using your medical
knowledge. Look ar i\ and B opposue ro help you.
I hysterectomy
2 menorrhagia
3 salpingitis
4 cervical biopsy

21.2 Read the conversation between me gynaecologist and rhe patient in C opposite, and complete
rhe nores about the patient.
menarche:
menstrual cycle:
LMP:
menorrhagia?
dysmenorrhoea?
discharge?

21.3 Now write the quesnons Ihal the doctor asked. Look ar C opposite '0 help IOU.
menarche:
menstrual cycle:
LMP:
menorrhagia?
dysmenorrhoea ?
discharge'

21 .4 Complete the case report, One word is needed twice. Look 31 Band C opposire to help you.

A 45-year-old woman had been hailing (I) periods lasting for 8 days. with me
passage of (2) • for 9 months. There was no bleeding between (3) _
or after intercourse. Her (4) were not particularly painful. She had not noticed
any hot (5) _ ... _ Of night sweats. and her general health had always been good.
She had taken me (6) contraceptive (7) until a year previously.
when
a copper (8) was fitted. She had had a normal pregnancy when she was 25.

coodoms

IUD

OVer .f-o '10U ~

What ,\ Ih .., attuude 10 centraccptrun 111 yuur rnulllry? At what ag(' dn you think f('mtJll~
~h(luld be pn:"\(,flbcd contraccpnvcs?
The heart and circulation 1
Shortness of breath
Shortness of breath, or breathlessness, is dyspnoea. At ~rst rhis is caused by exertion
- physical JrtIVIf) ,uch ,. chmbing stai" - but 111 ,evere cases it may be present even at
rest. A panenr who IS brearhless when lying fl,t (orthopnoea). for example In bed. ",II
rend to sleep ~ up on tWO or more pillows. The abbreviation SOBOE 'lands for
shorrness of breath on exercise (or on exertion, or on effort),
Patients say:

I Set tembl) soon of breath climbing sta~.

Doctors can »k:

I low man) plllo,,, do } 011 -Ieep on?

Heart rhythm
The notm3ll"CSung heart roue IS 65-75 bears per minute. In athletes II rna) be ~\ k", as
40 beats per minute. In exrreme arhlenc .em Ity, rhe hean rate can go as high as lOO1mm.
The heart rh)lhm rna) be regular or irregular. In all irregular rhythm (arrb)d\mlal, lhere
Ina)' be earl}, bears whIch Interrupt the regular rhythm (premature beats); or lhe rhythm
may vary with respiration; or it may be completely irregular, .5 in fibrillation. When
patients are aware o( Irregularif), they describe the symptom as palpitations.

A 22-year-old student was admitted to hospital with a long history of heart prol*ms.
She had been incr~asingly tired, with shortness of breath on e.ertion. orthopnoea. and
palpitations. A Mitral ".Ift ~ had been carried out 3 years preYtOUSlyand this
had stabilized the symptoms of heart faIlure but was followed by episodes (attacks) of
.vi.1 flbrilJ.tlon, whICh had been particularly severe for the 6 months before admission.

Heart failure
Heart (allure OlW" "ben Ihe heart IS unahle 10 111.1'"t,1I1s1uffiCient cardiac OUIPUI-.he
amount of blood pumped b) the hearr each minure - for the hod) 's needs. It ma) 1000),C
rbe kit side of lhe bean. rht nglll SIde, or both. In Icll heart failure the main "mpcOfO IS
breathlessness, Tht-~, mpeoms of righl heart f.. ilure Include peripheral oedema s" dlingl,
begonning on .he fret and ankles. ThIS IS known .. pilting oedema If. wben • finger "
pushed into tbe ",.IIIng. II causes a small depression or pi I.
22.1 Complete the conversanon based 011 the case history ill B opposite.
Doctor: Wh.t seems to be the problem?
Pntienr: I've been getnng (1) ._ .
Doctor: How long have you had them?
Patient: For about six months. But I've had heart problems for years, wirh tiredness and
(2) _.. of (3) _ _ In the end I couldn't walk
more than a hundred metres without having to srop, I had ro sleep on three
(4) . I had a (5) _
replacement three years ago, and that improved things for a while.

22.2 Make word combinations using a word from each box. Two words can he used twice. look at
Band C opposite 10 help you,

at output
atrial failure
cardiae oedema
heart fibrillation
on beats
pilling effort
premature rest

22.3 Write rhe words a patient would use to describe the symptoms below. look ar A, Band
C opposite to help you.
I dyspnoea
2 arrhythmia
3 orthopnoea
4 oedema

22.4 Complete the case report. look at A. Band C opposite to help you.

A 60-year-old woman allended her GP's surgery complaining 01 breathlessness on (I)

............................This had been increaSing over the previous eight months until it was produc-
ing problems at around 500 metres walking on the level. There was no history of chest pain.
She had had several (2) of last (3) which lasted 20-30 minutes
and were associated with some (4) . _ 01 breath. She had noticed some
(5) ... ... of her ankles by the end of the day. This disappeared overnight
._.

over -rO '1011 "

How would you manaqc the treatment of thv woman in 22.4 above?

53
The heart and circulation 2
Physical examination
Medical examination is normally carried our in four srnges: inspection (looking),
palpation (fee~ng with the hands), percussion (tapping with a finger) and auscultation
(listening with a stethoscope).
Note: The verb is palpate; the noun is palpation (not palpitation - see Unit 22).

Examining the heart and circulation

Here is a" extract from a textbook description of how", examine the cardiovascular
system,
 Look al the lips. longuc and nail. for the
blue di>coloration of c,onosis. Cyanosis
may be eentral or peripheral, 11l>-pcctthe
hand;, for clubbing. f'CCl the rudinl pulse al
the wriSI and note lhe rule (for example
701min) and rhythm (regular or irregular).
The pulse may be irregular in (OIU as well
as time. Check thar the Other peripheral
pulses rue present. Measure the blood
pressure. and "',""'SS the jugular \'eDOUS
pressure (JVP). Palpate the chest for the
ape." beat - the nonnal position is the fifth Fing<rdubbing
left intercostal space. one centimetre medial
to tbe midclavicular line. Feel for any thrills.
Heart size may be measured by
percussion. Listen for murmurs and other
abnormal sounds. for example friction rubs.
beginning at tbe mitral area. Murmurs may be
son or loud. A harsh murmur is loud and
rough.
Note Ih" lime of any murmur in relation to
the cardinc cycle. The mosI common
murmurs arc:
• mid-systolic (in tbe middle of ,y.tole)
• pan-systolic (lasting for tbe whole
of systole)
• enrly diastolic Areas of auscultarion. The letters Indatt tht
• mid-diastolic approximate! position of the heart va.tves:
• late diastolic (pre-systolic) P Pulmonary valve: A Aortic valve: M Mitral valvt';
T Triscupid valve. The circles indicat( the position
Continue by listening at 1.be tricuspid. aortic
for auscultation for cardlac murmurs indicating
and pulmonary 3rC3S.
valvular heart disease. The nbs art num~rt'd.

54 Pro(essJonai English .. Ute ...-

23.1 Complcrc rhe table with words from A opposite. Put a Stress mnrk in (ront o( rhe
stressed syllable in each word. The first one has been done for you,

Vnh Nuun
'auscultate

inspect
palpate
percuss

23.2 Pur the steps (or examining the heart and circulation in order, according to the four-stage
system. Look at A OPPOSite 10 help you.
a Measure the heart Sll~.
b Art there any murmurs?
C Feel rhe radial pulse,
d Look (or clubbing.
e Locate t he apex beat.
f Nore "ny rhnll,.

13.3 A doctor is presenting rhe case of a 43·year·old woman at a meering in rhe Cardiology
Department. Complete the rexr o( her presenrarion, Look at B opposite to help you.

On examination she was pyrexial with • temperature of 38.5. She was short of breath.
Her pulse was variable between 100 and 180 and was irregular in time and
(I) _._.._. .
Her blood pressure was 130180 and her ]VI' was up 5 centimetres showing normal
rnovemenr wirh respiration. Her peripheral (2) were all present and there
was no (3) _ or (4) . cyanosis. Her apex (5) was
displaced to the anterior axill.!'}' line but still in the fifth intercostal (6) _, _
Her heart sounds were \'ct)' interesting, \Vllen she was inirinlly examined 1C\\I;IS noted
that she had pan-sysrohe and nud-dinsrollc (7) _ _. heard be.1 at the ape x,
When she was examined some hours later. there was a harsh pericardia] friction
(8)... . ... all over the precordium. Our diagnosis ar Ihnl rime was of mirral
stenosis and incompetence with a recent onset of pcricardiris and nrrial fibrillanon.

ova: .f'o '1011 .!J1

How many siqns of heart disease fan you find in B uppnsitc? Can you add (:iny \i9n\ of
heart disease to the tot?

Pr.(esslOroolE.n"~h nUs. veeo- 55

e
 Infections
Fever
A medical student has made some language nores on a case report,

S8
 fever = pyrexia (8150 re~ PlIO - pyre>da of
A 24-year-old man presented with a fever unknown origin)
which he had had for three days. On the fever alec known a,; temperature -"f"" ~ a
third day he had had a severe attack of tcnperature·.
fever with sweating and rip's. The only = feveri"hlfel>rile and f')"'<'I<ial
aeljecti""iS
past history of relevance was hepatitis opf'O"ite9 = aful>rile/af')"'<'l<ial
four years earlier and ctAmdular fever
(infection with Epstein-8arr virus) at the GQm, tWmrztgm, qf fmrr
age of 18 years. He had returned from
eweaelng
Africa three weeks previously.
rlgore (eevere ehlverlng.nd ~ of c:okf_
Dlea known ... chllle)

Microorganisms
Infecrions differ from other diseases in a number of aspects:
• Most importantly rhey are caused by livins microorganisms - such as viruses or bacteria
- rhar can usually be identified, rhus establishing the aetiology early in rhe illness. Many of
these organisms, including all bacteria, are sensitive '0 anribiorics and mosr infections are
porentially curable, unlike many non-infectious degenerative and chronic diseases.
• Communicabiliry is anorher factor which differentiates infections from non-infectious
diseases. Transmission of pathogenic organisms '0 other people, directly or indirectly, rna)'
lead ro an outbreak or epidemic.
• Finally, many infections are prevenrable by hygienic measures, b)' vaccmcs, (0JX-'<:1311)'
live attenuated vaccines such as rubella vaccine) 0" by drug prophylaxis (for example.
chloroquine '0 prevent m.I.".I).
M icroorgarusms include bacteri a, \'lfUSC>, fungi, protozoa (such .1; 'he
parasite Ih.1 causes malaria). Another general word for these pathogens
is microbes. 1)3nem~often refer ro microbes n< germs or bugs.
Notice rhe common expressions for acquiring an infectious disease:

caught I rhmk 1\. caught

Could he have some disease from the dog?
picked up rhe lIu bug ,hal's
going round.

Source and spread of infection 1/

Here is an extract from a medical rexrbook,

Infechon may originate from the patIent (endogenous), usually from skin. nasopharynx Of bowel. Of'rom
outside sources (exogern>Us). often another person whO may be either $uHenng from an infect;on or canY'ing
a pathoQenlc mkroorgan;sm. caRil,S ale usually ooalthy and 'nay harbour the organism in the throat (for
example. dlphthGna)._lsalmonenal. or blood (hepatitis B or HIV). Non·human _roes oIlnlecllOO
Include water (o.g. choIoral. mn~ ("0 luOOrcuol slo). food (e.g. botulism). an,mals (e.g rabies). blods (e·o
pslllocosls) and 01>0the..,,1 (o.g Ieg"",ell. - Legloonaloe.· dl ..... )
Theln.ubation period OSlhe period between thelnv.sloo 01 tho tissue. by pathogens and lhe appearance
01 clinical features oI,nfecl_ The period of Infectivity Is tho time tMttlle pallent Is ,nfectlOUSto OIhefS.

Pr.(esslOroolE.n"~h nUs. veeo- 55

e
24.1 March Ihe IWO p.,"' of the senrenc ..... look 31 A, II .nd C opposire 10 hell' lOU.
1 198M 'ow Ihe UK launch of hve arrenuared
2 Chickenpe», ('311<~1t..1 "a common mfecnous
3 Rab~ ha\ an IIlcuhmon
4 'The panenr remsmed febnk
5 He "as admmed wirh a four-dav history of influenza-ry pe symptoms of (e- er ",m
6 Quue a propomon of paoenrs who recover from hep31 iris II
1 The central pan of Afno " on rhe midst of an epidemic
8 Measles (rubeola) is most
9 Lyme disease is caused bl rransmission
10 PUO stands for
a period ,..nllmg from four ob, ~ 10 man) monrhs.
b ngo rs, m'alg.a and gen<nl nulalsc.
e become (Jrrl('r\ of thr \ Iru\
d 11I(C<IIUlI\ dunng tbe cJ1Jrrhai ".lgC.
e di,c.\C 1)( chrldbood.
f o( A 11)\.
9 of 8. hurgd(lrfen (rom animal ... man by ixodrd nckv,
h wuh peak, o( remperarure of 19S'C.
i p) re\OJ (If unknown ongin.
j mca,ks. mumps, and rubella (\I\IR) vaccine.

24.2 Complete the case report on the panenr m A opposite, Look at A, 8 and C opposite to
help you.

On examination. he looked unwelL Hi.spulse rate was lOO/minute. He had a palpable

spleen. The combination of (I) and (2) in a patient who has
recently returned from Africa stIong1y suggests a diagnosis of malaria. The (3)
period is usually 10-14 days. In this case, the patient admitted he had not been taking
(4) regularly. The diagnosis was confirmed by the presence of
(5) in his blood film.

24.3 Complete lhe -emeoces, LooL..t .\. II and C opposue 10 help you,
1 An on(,,,"on \\ h"h can he ""~Ied " ...\~,full) "uh anlll1'01"'" IS
2 Another \\ ord (or an q>t<kml<." an
3 Bacrero. and \ iruses are ",amp1c<> o(
4 Someone whose remper3turc " normal is . . .
5 The COmmon mfeerion With I IXltln-B.1rT virus i, known 35 _ ..

57
Mental illness
Psychiatric disorders
Psychiatric disorders can be divided into organic and functional. Dementia IS a mental
disorder due to organic brain disease. The commonest form of dementia is that associated
with old age: senile dementia. Disorders in which there is no obvious pathology or
anatomical change in an organ are termed functional. These are described below.

Substance abuse
Abuse of a substance means using it in a way that is harmful. 11,e commonest forms of
substance abuse are alcoholism and drug abuse.

Affective disorders
Here is an extract from a medical textbook.
 AlTectlllld mood are \imilat in meaning
tUld refer to the emotIon> (for example.
happiness or sadness), Affect tend. to
be used for temp<Jr.ll) emotions. lIIId i.
expressed through manner of speaking. facial
expression. or behaviour. Mood is used to
refer to a more pennanent emotional state.
The most common fonn of affective
disorder is depression. the symproms of
which are:
• poor appetite or significant weight loss
• sleep disturbance (for example, insomnia
- inability to sleep)
• fatigue (loss of energy)
• ",,),chonlOlor at:ftalion(.,cc,,,'.
mOVCII1CnlIIIId thought) or II§)
c:bomoIor retardation (slowing of
J1\O\ement and thought)
or
• loss interest in stimulating eeuvuies
• decreased ability to think and coocentr.ne
• feeling that one is of no valoe to others.
or that one has done something wrong
• recurrent thoughts of deaIh or suicide.
Five. or possibly four. of the above symptoms.
occurring nearly every day for at least two
weeks, constitute a major depressioo.

Neurotic and stress-related disorders

An example of neurone disorder is obsessive compulsive disorder. An obsession IS an
,de. rhrn is so pcrsisrent that II inrerferes with the patient'. life. A compulsion ,s an
obsessrve idea that for= the pancnt to act even though rhey recognize that It i,
unnecessary A common form of th,s 'S compulsive washing of the hands. Stress is a
fechng of bemg unable to cope. It can lead to anxiery or fear of problems. A sudden
arrack of anxiety's called a panic arrack.

Other types of functional disorder

These include:
• behavioural syndromes associated with physiological disturbance (such as eating
disorders)
• disorders of adult personality and behaviour (for example. personaliry disorder)
• mental retardation - delayed mental development
• schizophrema and other disorders in which there arc delusions lfalse beliefs).
25.1 Complere Ih. table wuh "ord, trom A, C, l) and I opposue.

Noun AdJl'l'llVl'
.,((ective
;anxIOUS

behavioural
demented
disrurbed
suicidal

25.2 Make word comlnnanons usmg a word from each bo x, Two words can be used 1\\1< e. Look at
fl, C and f. oppovue 10

behavioural abuse
eating disturbance
major mentat ~tartlatlOO
pe~hty dt1Oftk'r
psychomotor ~SIOf1
sleep syndrotllf
substance

25.3 Complete the sentences. Look ar A, C, D and E opposite 10 help you.

1 The way 3 person behaves is hIS or her
2 A persistent ernononal sore .s a _
3 A sudden arrack of an'~ 1>.
4 The form of demen,,.
dSSOCI3,ed with Jgctng I) c••lled
5 A disorder whICh I) II(l( J>S003ted with parholOjll<al changes IS _
6 An idea "hKh for«" • pallent 10 repeat unneces ..."y allton< .s •

~5.4 Which symp'olll' or ckl' ......"on w's Ih,s pauenr ,,,ffcrll'lI from] Look a C o!,pus"e
to help you.

A 56-year-old wormn presented to her GP complaining of increasing tiredness ~r the past

few months. She had lost interest in most things. She was sleeping poorly and tended to
wake up early, but denied any suicidal tendencies. She was thirsty and was passing urine

~ - - - - - - - - - -------~~~~~'.
m ore ofte n. She wa s her wei ght

- - - - -- -- - -
e atin g n orm ally an d wa s s tead

y.

Over fo ':i0U ~
On you think Ihl' wmuan tn 150 4 ahovt" wa" \ulft'ril1'1 trntu major d('prt'\\lvt' IIlrll"'}
GiVl' your n';J\(lI1\
The nervous system 1
Sensory loss
The cenrral nervous system control, the sensory and 1110tor functions of rhe body. DI5<'3ses of
this system therefore lead to loss of some of these functions.

Function loss Other symptom,

hearing deafness butting or ringing in the ear (tinnitus)
sight blindness double vision (diplopia)
blurring (loss of visual acuity - clarity of vision)
sensarion numbness (anaesthesia) tingling or pins and needles (paraesthesiacl
(feeling)
balance unsteadiness (ataxia) dizziness (vertigo)

Note: Thert art no common wOtds ror loss or. or conditions relating to. taste and smell.

Molor loss
Moror loss symproms and sign' mclude:
• weakness - loss of power
• paralysis - complete 10>'5of power
• tremor - involuntary rhythmic movement, especially of rhe hands
• abnormal gait - unusual manner of walking.
Speech may also be affected, for example with hoarseness - a rough, deep voice as in
vocal cord paralysis, Slurred speech means poor arricularion, as in cerebellar disease.

Loss of consciousness
Paricnrs may describe sudden loss of consciousness in 3 number of W3)'S:
 passed out. fit.
had a blackout. I had a seizure,
fainted. convulsion,

Fit, seizure and convulsion are 311used ro refer co violcnr involunmry movcmems, 35
in epilepsy.
Doctors may say:
When did you lose consciousness?

Here is a passage from a rexrbook on rhe causes of loss of consciousness.

The principal differential diagnosis is between an epileptic fit and a syncopal atladt, or
fainting. Syncope is a sudden loss of consciousness due to temporary failure of the cerebral
circulation. Syncope is distinguished from a seizufe principally by the circumstances in which the event
occurs. For example. syncope usually occurs whilst standing. under situations of severe stress. or in
association with an arrhythmia. Sometimes a oonwlsion and urinary incontinence -Iess of control
of the bladder - occur even in a syncopal anack.Thus. neither of these is spe<iflc for an epileptic attack.
The key is to establish the presence or absence of prodromal symptoms. or symptoms that oceUt
immediately belole the attack. Syncopal eptSOdes ale usually preceded by symptoms of dizziness
and light·headed~ss In epilepsy. people may get a warning. known as an aura. that an attack is
going to happen.

Not~: The noun convulsion is often used in plural form - He hod convulsions os 0 child.

60
26.1 Complete the t••ble \\l1h "onJ, trorn A. B and C opJ'(hitc.

AdJ"cllv,' Noun
blind
conscious
deaf
dizzy I
numb

light-beaded I
unsteady
-
26.2 Make word combmauonv '''1fI1t a word from each hox. t.ook al A. II "lid c.. opposue 10
help you.

double _,ty
epileptic alt~
prodromal IncGntintntt
syncopal l'fIlIptom
urinary vts.on
visual fit

26.3 A doctor is trying 10 determme the cause of 10$.' of consciousness in a 52-year-old man,
Complete the docror's quesnons, look at C opposiee and nr rhe table in 26.1 above 10 help you.

Did you lose (I) suddenly or gradu.llly?

Did you gC1 a (21 of the 3ltJck?

Wh.1 were lOU doi"lt befon' Iou (3) _ OUl?

Were you wornt'd or under an)' (4)
at Ihe Ilme?
Did you fed (5) or (6)
"ltack?
Did you lose (7) of your bl.lddcr?
Did your Wife n()(I<C 3n) (8) _ rnovementv while )'OU \\ ere Ufk:()I1~M)u~?

Pro(euiollol Enpsh .. Us. "'...,. 61

-
 The nervous system 2
The motor system
Examiuarion of the moror system should include assessment of rhe following:
• muscle bulk (amount of muscle tissue). Look for signs of wasting (muscle atrophy)
• muscle tone (amount of tension in a muscle when it is relaxed). Tone can be increased
(spasticity), or decreased (flaccidity)
• muscle power (srrengrh)
• coordination (the ability ro usc several muscles at the same time to perform complex
actions)
• gait (the manner of walkmg)
• reflexes (Set' B below)
• inveluntary movements, (or example a tic or o tremor,
l lere i~an cxrr~lCCfrom a case report abour n patient wirh a tremor,

On examination, her face showed little or no expression., There was a tremor .Hedln,
mainly her right hand. She had ,eneraUy Increased muscle tone. Power, reflexes. coordina-
tion and sensation were within nonnaillmlts, Examination of her gait showed that she was
slow to start walking and had difficulty stopping and turning.

Tendon reflexes
Examination of rbe nervous sysrern normally
includes testing the tendon reflexes, for example
the knee jerks, with a tendon hammer (also
known as a reflex hammer). The reflexes
mal' be absent (0). diminished (-), normal (+)
or brisk (+++). The plantar reflexes are also
checked, The normal pl3ntar response i. a
downgoing (.) movement [plantar flexion) of
the big tOC. All upgoinS (1'1 lot (ex.enwr or
Babinski response) t$ abnormal,
Testing the knC't' JC'B with a lendon hammrr

Coma
Coma is unconsciousness wirh a reduced response 10 external stimuli.
Doctors sa)': ( Th e paoe..n. ( IS m a coma. f~ ( Th e pauc. n{ I.S comatose..

The Glasgow Coma Scale (GCS) score is calculated as follows:

EYl' nfll'fllng Verbal response Mntor response

Spontaneous 4 Oriented 5 Obeys 6
To speech 3 Confused 4 Localizes 5
11, pain 2 Inappropriate 3 Withdraws 4
None I lneomprehensible 2 Flexron 3
None Fvtcnsrcn 2
None I

62
27.1 Complete rbe IJl>lr \\ IIh \\or.J\ Imm A and B "PPC,,"e.

NOUIl AdWdlVl'
absence
diminunon
flaccid
spastic
wasted

27.2 A doctor is 8" "'It tnSlfUcnons 10 a panenr dunng cxaminanon of the motor SYSlem. Jden"£)
what the doctor IS 3sSC>Stnll to each case. Look .11 A opposite to help you.
I I'd like you to reb". I'm IU<I go,"& 10 move your '1'111 lip and down.
2 Can J sec ),our halllh?
3 Now, I'm ItOIllIlIO \lrdljl)llcn your arm OUI. Try I" 'WI' me.
4 Can )'OU I", ...h m) finger wuh lOurs Jnd then touch your nose] Good. "l,,\\ .II) II Jg3ln wuh
your Clcs closed.

27.3 Complete lhe ~Irn.. ..... J ool 31 A, 8 and C oPJ'O>"e and .1 Ihe table m 27.1 .oo,c 10
help you.
I A hand droops limply to form" nght angle with me "TIS!.
2 ." ,..... refk,cs .re reflexes thar are stronger rhan normal.
3 Muscle ...,,_"'_"" means e
muscle is reduced in bulk.
4 A tic is a form of movement.
5 A key is often used ro ICSIme . response.
6 His "as poor: he could not perform rapid alternating movements.
7 A IS used 10 ICSI reflexes.
8 When something lS . illS bs Ihan normal.

'27.4 A patient IS bro~1 10 \&(: In coma. When her name I~ spoken, she 01"'"' her C)CS bUI
she docs nOI answer 'lUC\lIOn" 0' obC) IIlS"UW""'. Wh.1I "he, GCS "ore?

Thepian"" ",nto<

ovo: .r0 /101.1

l',ln Villi ".11111" \It trndun '('1""1".,'
\\lh~lt "vou' (tl.IIII1O'" IlIr thr patu-nt 111,\ 01'1)11\111')

63

-
 Oncology
Neoplasms
A neoplasm is an abnormal ~ growth of nwue. Malignant neoplasms - C'Il<.~ -.~
II~eI) 10 spread and cause senous 11111<,»or death. Benign neoplasms do nor spread
and arc less harmful.
When speaking [0 patients, doctors generally say growth Or tumour.

64
 growth
YOIl have a small III the bowel.
tumour

A lump or S\\elling is. coIItct,on of nssue or flUid which IS \,,,,ibl. Or palpable - C3n be
palpated or felr wuh rhe fing'", A lump m.IY be due to a neoplasm. but t~1T .IT ocher
<JU~ such 35 Inf1amm.1uon or fluid J«\lmUIJlloll.

Mahgnanr rumours are ,hat;lcte~l1ed by r,tpld growth and invasi'·(IIe<s. The tumour
nul invade local [ISSues or mal spread to d"I.II11 PMt,> of [he body (metastasis).
--:eoplasm; which are the result of mcra>r."" are CJIk-d sexondaries, "5 opposed [0 [he
ongmal
tumour which is the primary.

We have the results of the scm back now and I'm afraid rhey show rhar you hav a
small growth in the prosrare. Forruna[cly, ir appears 10 be at an early Stage and
rhere j, no sign of spread, So if \\ e remove II, there i, every chance of a complete
cure.

Not.: To inva« (~) is 10 tiller and spread throughout a part of the body, and IhlS prOttSS IS
invasion (noun~ If a tumour ISdnrnbed as Invasive, II has the abthty 10 spread

~ Symptoms and signs of malignancy

Ihe ') mptoms of mallJUUnl dbO'.S< may be related 10 the sue and locanon of t~ rum()ur.
lilt "ample. a space-occuP)'ing 1""00 In [he hr. "' C.1I1e> raised rnrracrarual pre<,un: and
'ympwm\ ,,,,h a~ headache. vonunng, or v",I1.1 d"lurb,nce. Tumours of the "oJon mal
obstruct (block) rbe lum(ll and <'.111'" ,hJl1l1e "' bowel habit. Other pOS>lble ,)mpto,m of
1I1.11'I(I1,nq'include bleeding, pam. and weighr I,,,, .

.9J.55~
A 33·year-old man presented to his GP complaining of a painless lump on the right side of
his neck. which had been preRnt for about two months and was enlarging. He had been
feeling generally uowen and had lost about 5 kg in weight He was also complaining of nighl
sweats. He had no significant past medical history.

Treatment of tumours
\ tumour can !oOITIttlI11CS he (omplctd) remo\ ed or excised bv surge". It th" " "'"
",""hi e, for .-ample If II M' .I=d) ""'IJ"J,"ed to other part' of I~ bod). II ma) he
""'\lbk to destrO) II b) radtOlhcrap) or hy <hemmhcr.,p) (see Unu 411. \\'brn 3 cure "
nOt f'M"ble, palliao\C tn::Iltncnt"w'cn. whsch " onl) uuended to reheve ~)mpt()m'.

65
28.1 Complete rhe table wuh word« from A. S and C opposite and related form~.

V~rb Noun(s) Adjectivcls]

cure curative
excision
gro\v growmg
invasive
obstruction obstructive
palliate palliarion
palpable
spread spreading
swell swellinB·
swollen

28.2 The notes below are about Ihe panent described ill II opposite. Usc them to put the sentence,
(1-9) ill the correct order. ro make rhe nexr paragraph of rhe case report. Usc Appendix II on

C
page XX i( you need help wirh Ihe abbrevmrions.

OET'!J7.8'C
_ finn 3.4..., .......1rI1t ",,~ul'irf ......
node6 1-2 em 1ft ~ palpable in both axilla. and i~ullUll a......
~NAD
P 100/""" tQjlUr 1lI'112I66
CYS NAD ItS NAD
AAl """'" ~ '!J em """"" L C<l5t81 m8rgin
06NAD

1 Examination of the central nervous system was normal.

2 His mouth and throat were normal.
3 There was a smooth. firm 3 x" em mass in rhe righr supraclavicular (0<501.
4 His cardiovascular and ne;pi~Jlory .y"ems were normal.
5 On nbdoruinal exammanon. there was a mass palpable 3 em below the len costal margin.
6 On exanunarion, his temperature was 37.S·C.
7 1here were enlarged lymph nodes III both axillae and inguinal areas.
8 Ilis pulse rare was 1000min regubr and blood pressure 112166.

t/8.3 Complere rhe senrences. Look ar A, 8 and C opposite ro help you.

 1 Distant of rumour coils is known as metastasis.
2 Many symptoms of cancer, such as difficulty swallowing, are due ro . ...
3 The opposire of painful is _
4 A ..._...._. ... neoplasm is called a cancer.
...
S Tumours which do nor invade or rnerastasize are _ _ .
6 ._ rumours are those which result from the spread of a primary.
7 If a cure is not possible, .._... rrearrnenr should be given.
8 A _. liver suggests metastasis.

over -4-0 '10l4

Ilu Inn!"!l lik ...ly (11111(.11(haqno!il!i in the patu-nt {dl'Sl'rihl'd in B "1'11"""ll' and 28.2 above} rs
lymphoma. How would you explam lus condition to him?

6S
 Pregnancy and childbirth
Childbirth
The expected date of delivery (EDD) i. the date on which a woman is cx!X"CtOOto
give birth to the child she is carrying (pregnant with). It is calculated by addinl;l280
days or
40 weeks to the first do)' of rhe lasr menstrual period (LMI'). Cbildbirth is also referred
to by doctors as parturition, Delivery is the process of helping the child to be born. A
spontaneous vaginal delivery (SVO) is a normal delivery. If there are complications. rhe
baby may be delivered by caesarean section (surgically removed).
A full-term pregnancy is 40 weeks. divided into three trimesters. A baby who is born
before this is premature, and one born after 40 weeks is posunarur e. A baby who is born
dead, for example because rhe umbilical cord is around its neck, is stillborn, A pregnancy
may end before term spontaneously. with a miscarriage (spontaneous abortion), or be
deliberately terminated WIth an induced abortion (termination of pregnancy).
Note: the ~rb induce means to cause something to happen.

Labour
The process by which the fetus and placenta are pushed our of the uterus i, called labour.
It is divided into four srages, Some words which are combined with labour are:

66 Pro( es ,"'oaI Engfish III Use

_
 premature
prolonged
spontaneous labour
induced
false

Presentation and lie

Fetal lie is [he position of the
(etu> in tho uterus, The norm ••1
lie is longitudinal. and the
abnormal lie i, rrans\(!tSe. Fetal
presentation refers to 'the part
of rhe fcrus which occupies the
centre of the pelvic canal
and which rhe exammmg
finger feels 011 vaginal
exammanon' (Butterworth).
The normal presenrarion is
with me head (vertex
presenrarion]. Breech
presentation means the buttocks
are presenting (breech is an old
word (or buttocks). Abnormal
presentations may require
delivery with forceps.

67 Pro( es ,"'oaI Engfish III Use

_
19.1 Complete lhe ;('111<0<.--. look 31 .\. 8 and C OPI'O>IIC 1(1 help you.
I A b.b)' thai 1\ hom 3 week before the FDD I~ . ...... _.
2 A ..._.... of Pl'tllll.nc), rna)' he necessary for medical reasons.
3 The firsr rhree monlh~ of pregnancy arc known '" the first.
4 Feral distress III the firo "age of ..._. . i, ,III indication for caesarean
 5 It was a breech and detivery was b) forecps.
6 A I) ~l'lOIbttterm for a spontaneous aborrion.
7 The ". wound rigbdy around rhe baby's neck and it was unforrunaltl)

29.2 Complete the rabk \\ IIh words (rom A opposu e.

VI',h Noun
aborr
dehver
ondurnoo
nl1SClIT)'

p~nt
rerminanon

129.3 Dr Bennett, an SIlO, ' .. presennng a panent at a weekly meeting in the obstetric unu of a
hospital. Complete the presenration wirh the correct form< of verbs from 29.2 above,

This is Clara Davis. She came ro the antenatal clonic ar nine weeks, In her p'S! obstcrrIC
history. sbe had a ptqlnan..-, "ben she W3, 18. which was (I) and
another OM a year 1a,.... "hId, spooraneously (2) . Since then w has IL,d
rhr ee prquu~ In the first. me, baby was (1) IlOI'Ol3U) .t 40 w ee ls.
In the second. she had an 14 of labour ., 39 weeks because of fC131
disrress, The Ihlrd Nh, (~) J\ a b reexh and was (6)
b) caesarean seeuon.

-
67
 The respiratory system
Cough
Cough IS a common symptom o( upper respiratory tract infection (UR") and lung
disease. A cough may be productive. where the patient coughs up Sputum, or
non-productive, where there is no sputum. A productive cough is often described 3S loose
and a non-producrive cough as dry. Sputum (or phlegm) may be clear or white (mucoid),
yellow due ro the presence o( pus [purulent), or blood-stained (as in haemoprysis).
A doctor is examining a patient who is complaining of a cough.

68
 Doctor: How long ha ve you had the cough?
Mr Hamilron: Oh, for rears.
Doctor: Do you smoke?
Mr Hamilron: I used 10 smoke heavily, but I gave up a year ago.
Doctor: Do you cough up any phlegm?
M r I I. milton: Yes.
Doctor: Wh31 colour 1\ II?
M r Hamilton: Usuall)' yello«.
Doctor. 113"e you e'er noticed any blood in it?
Mr Hnrmhon: No.
Doctor: Any problems with your brealhing?
Mr Hamilton: Yes, I ger very shon o( breath. I have to StOP halfway up the srairs to gel
my breath back.
The doctor writes in me patient's case notes: clo dyepnoea & cough c. purulent
eputum for yearf>. No haemop¥is.
Note: The noun phleqm is pronoun<:ed /Oem/.

Auscultation
'11,. doctor is exarmning Mr Hamilton S chest.

Take deep breaibs in and oul through your

mouth, Good. No\y sa)' ·nincty ..nine',

Listening 10 the chest wuh 3 srethoscope may reveal the presence of sounds. apart (rom
the normal breath sounds. There are rwo 111311k1inds o( added sounds:
• crackles. which sound hke hairs being rubbed rogerher and ,uggesr the presence o( fluid in
the lungs
• wheezes, which are more musical sounds, like whistling, and indicate narrowing o( the
airways. The sound of an asthma parienr's breathing is also called wheeze.
The sound heard when rhe pleural surfaces are inflamed, as in pleurisy, is called a pleural rub.
The doctor asks Mr Hamilron 10sa)' 'ninety-nine' [0 check vocal resonance, which may
be increased (as in pneumonia), Or decreased (as in pneumothorax).
Afrer examining Mr Hamilron, the doctor adds ro his nores.

OE Che5t: early in5piratory cracklee

l10th lu ng i:>a5e5+ expiratory wheeze
I

69
30.1 J\hk~ word mml>on.u"'f1\ u\lng. word fmm c.l.h 1M". J ook '1 A and 8 opr ....I1~II> hdr ~"U.
blood- rough
breath rub
pleural stained
productive ~antt
vocal sounds

30.2 Rewrite rbe qut'StlOlls.. u>lng word. that are better known to patients, tool ~I A oppostlt' to
help rOU.
I Is your cough prod"""e?
2 Whal colour I~the sputum?
3 lili it rver purulent]
4 Have you ncr had h.ell1opI}<;s?
5 1)0 you ,uff er (,nm d)'l'lIt",.I'

30.3 Are the (ollo,,,ng \lJlem.-n", true or f3he? (,,,. (l·.I'>()II,fnr your ans we". u"n~ lour mcdo<:.1
knowledge and A and 8 "pf'C"'le to help )"U.
t A panern ....ho h., a 1<lC ...... -ough produc ... rhlqtrn.
2 Crackles are heard \\ hen rbe a",\\"3)-'; are narr'() ....rd.
3 A patienl ....ho ha,. non-productive cough produces 'I""UIII.
4 Wheezes arc lypoc.,1 or pleum).
5 A pleural rub is a s'ltn or asthma.

Over .f-o ~ol.l

U~t' the "ot('\ o{"loWil til ....nte J C~\(" report ,l"d .Idri your pfl1\l1\ltlnal d'Jgno\',\ of !hl- l.J~(,
U\l' A.ppend•• II 41n P~Q(' ') 1 If yoU need hl"lp With tht' ...hhrl'\>I'lttlln",

Brqm: 'A ](,-V{'.H-old man complamed of sudden rI~lht-"ldl'd l-hl'",t p.un

36yroldd
ao &u.:i<len R clv:ot ",. n ... t11 e.o.I>. while w.","'''0 Tv.
pain + I>y dup t>ruthe ."<1 cough'fIg
6.Ob. p"re..ted CM'r tl'~4 hour!!""'" te ""_ to"~ MrI.. lln ME
61. nor-prod..octM' COUOJ'
PH &. FH "d re_..:
3152 hoIoby "M~" 3152 ~
Of -r 37.4"C RP. 241""" .M +3 BPllO/64

em
R5 che&t """"r$On t ~.- of pain
plour'al rul> R lower """" poeteriottf
Ot/IeIwIecNAD

Pro(."ional Enrlosh .. u~ M_ 69
--
 The skin 1
Some types of skin lesion
M~(IIl'al term C001"10n word Features
macule spot no. raised above me surface of the skin
papule spot raised above the surface of the skin
nodule lump a large papule
vesicle smaU blister filled with fluid
bulla blister a large vesicle
pustule - filled with pus
crust sc.. b dried blood etc. on the surface of the skin
scales scales a thin layer of epidermis separated (rom
the skin
cicatrix I SCOlr n murk on the skill afrer healing
(plum I: cicatrices)
naevus birthmark 3 coloured skin lesion present a. bmh
fleshy naevus mole a raised brown naevus
verruca wart a nodule produced by HPV
furuncle boil a large pustule, or skin abscess

Note: The liquid (often ytllow) formed as a result of infection is pus. If a lesion is pustular. il is
filled with pus.

Rashes
A single skin lesion can be regulnr or irregular in shape. When there are many (multiple)
lesions, especially rnacules or papules. the result is a rash, (or 'POL' in common language);
for example the rash of an infeenous disease such as rubella. A rash IS snd to erupt. or
break out.

7 Prof .... ..,., English ., ~ ~

0
 to spots
My linlc boy has broken all over his body.
out
to a rash

The following features of 3 skin lesion arc usually nored:

• location
• size
• shape
• colour
• type.
for a rash, note also:
• distribution (widespread - on rnJny parts of the body. or localized - on one part only)
• grouping (scattered - more or less evenly spread (Jut, or in clusters - small groups).

7 Prof .... ..,., English ., ~ ~

0
31.1 Complete the descnpnon of herp<!s soster «hll1l\les) hy replacing the medical words
wirh ordinary English words. Look at A and B opposite 10 help you.
111 brackers
I
(I)
(2)
_ (herpes zoster) usually starts with pain and soreness. Then red
_ .._ .. (maculesl appear thar develop inro groups of (3) _
I
(vesicles) over a particular area on one side of the body. In rnosr patients, new (4) _
(lesions) continue to appear for 3 to 5 days. The (5) _ .._ (vesiclesl
become (6) ._....... .._ _ (pustular) and then form (7) ._
(crusts). In severe cases. there mal' be (8) _ (cicatrices) afterwards.
IBMl2005; 331: 148 Amcnde<j with perm;";"" f.... 1ht 8MJ Nllishing Groupl

31.2 Read the description of the rash of rubella and complete the notes, Look at A and B opposite to
help you.
The spots are scattered pink macules which appear fir>! behind the cars and on the
forehead. The rash spreads rapidly, Ii"'t to the trunk :111" then to the limbs.
location and drsrnbuuon:

grouping;

type o( lesion:

colour:

31.3 Complete the notes for the rash in the

photograph, and suggCSt a diagnosis.
Look at A and B opposite to help
you.
location and distribution:

grouping:

type of lesion.

colour:

31.4 Complete the nores (or the lesion in the

photograph, and suggest a diagnosis.
Look at A and B opposite to help you.
location and distribution:

grouping:

rype of lesion:

colour:

over -to tj0lA

Whill Iypl" of ';I\ht" an- [U111n1011 In your \'IHllIlry? I, then- any n-avun why Ihl'V an-
common?

Prof<>.ionol EnglJsh m tn. fA_"""" 71

The skin 2
Injuries to the skin
Here is an extract (rom 3 medical website.

- <t-
 Mechanical injuries to the skin are
divided into those caused by a blunt
force, such as a punch from a fist, and
those caused by a sharp force, such as
a knife.
Injuries from blunt rerees
• An abrasion (also called a graze or
a scratch) is a superficial (surface)
• A laceration (also called a tear) is a
wound involving both the dermis and
epidermis. It Is usually distinguished
from penetrating or Indsed wounds by
Its irregular edges and relative lack of
bleeding.
Injuries from sharp forces
• An Incised wound (also called a cut)

which has been removed by friction. 0' wound on the surface Is greater

injury Involving only the epidermis, 15 a break In the skin where the length
the
A scratch Is linear, as In fingernail than the depth of the wound - for
scratches, whereas a graze Involves example, a wound caused by a razor
a wider area, as In abrasions caused blade.
by dragging part of the body over a
• The depth of a penetrating wound
rough surface.
is greater than the superfioat length
• A contusion (also called a bruise) of the wound - for example, a stab
is an injury that occurs when blood wound caused by a knife.
vessels in the skin are damaged.

Case report
Read the case repon and compare it with the illustration.

A 9-year-old boy presented to the Accident and

Emergency department after he stumbled and fell
while running in a wood. He had received a blow
to the head from a rode and had been scratched by
bushes. On examination, a vertical laceration 1 cm
long was noted on the bridge of his nose just right
of the midline. There were a number of superficial
scratches on the right side of his forehead. His right
upper lid was mildly contused.

(8M) 1998; 316; 1364

Arntndtd .nth ptrmission from the 8MJ PubliMung Group)

Sores
, he word SOre IS a popular term (or many different types o( skill lesion. especially
ink xrred lesions, A pressure sore" 3 skin ulcer caused by pressure, (or example the
pressure of 1)'11111 111 bed (or long periods 13bo known 3> 3 bedsore, or decubitus ulcer). A
cold sore IS 3 lesion caused by herpes simplex.
Notr: lhe adjective SOremeanspainful. for example 11sore throat.

72 Profess-OIl", Engfish ., Use Mediont

32.1 Wrile rhe corresponding medical terms for the ordinary Engli,h word, and say "hal kmd of
force i~ involved. Look at A OPPOSlrC to help you.

Common word Medical term Type of fO"T

bruise
CU(

graze
scratch
stab wound
t('ar

32.2 Choose rhe correct word. 10 complete the description

of the injuries shown in the ,lIu'olr.llion. Look at A
and II oJlpmile 10 help )n".
There 3~ ( I ) (scf3"hr<lllf37C')
3 hove rhe Icfl eyebrow and on the left ,,,Ie of rhc
neck, 3 (2) _ (conrm,onlbcef3non) «) rhe lefr
side of the lower lip and (3) (cursllcars)
to rhe left check.

32.3 Write a description of the injuries shown in the

illustration. Look ar A and 8 opposite and ar 32.2
above to help you .

•...•........ _ ... _---

.......................... _._----
.......... _ .... _-------
••

32.4 Complete the sentences. Look ar ,\, 8 and C opposite to help you.
I Frequent changes of position are necessary in [he immobile parienr [0 prevent [he development
of a pressure _
2 He had several wounds in the abdomen from the knife.
3 He was knocked unconscious by a heavy _ 10 the head.
4 The wounds were onl) _.._ and required no treatment.

-
Prof.ssOMo' Engfis/l ., 1M MMtoM 73
 The urinary system
Urinary symptoms
Urine is formed on the kidne) sand stored in the bladder until it is passed (or voided).
Patients may say: Doctors may say:

7 ProfesSiona£l ntish .. lb.

4 M_
 I have some pain when I pass water. Are you having any trouble with your
pee. waterworks?

Doctor: Arc you having any trouble with your waterworks?

Mr Jones: Well. I do seem to have to go to the toilet more often [hall I used to.
Doctor: How often IS th.u?
Mr Jones: It depends, but sometimes it's every hour Or even more often.
Doctor: What about at night? Do you have to gcr up at night?
Mr Jones: Y(''S. Ncarl)" alway> two or rhree times.
Doctor: 00 you get any burnmg or pain when you pnss water?
Mr Jones: No, not u,u311).
Docroo Do you have any trouble gerring srarred?
Mr jones: No.
Doctor: Is the stream nonnal? I mean IS there still a good strong Oow?
l'vlr Jones: Perhaps nor quue so good as it used to be.
Doctor: Do you ever lose control of your bladder? Any leaking or dribbling?
Mr Jones: WeIl. perhaps a lime dribbling from rime to time.
Doctor: Have )"OU ever passed blood in the urine?
Me Jones: No, never,
Common urinary symproms and their definitions:

frequency frequent passing of urine

dysoria burning or scalding P" in in the urethra when passing urine
nocturia urinanon at night
urgency urgent need to pass urine
hesitancy difficulty St.trtinlt ro pa>' urine
urinary incontinence mvolunrary p.ls~il1g of urine
hacmarurin macroscopic blood in the urine

Urinalysis
Urinalysis is the analysis of urine. Simple screening rests of rhe urine are carried our with reagent
strips, for example Clinisrix for the detection of glucose. More detailed rests are carried out in
a laboratory on a specimen of urine. Typical specimens are a midstream specimen (MSU) and a
catheter specimen (CSU). Microscopic examination may reveal [he presence of red blood cells,
pus cells. or casts. Casts are solid bodies formed by protein or cells.
Plus signs arc used in case notes co indicare abnormal findings. A small amount (+) is
described as a trace. For 3 large amount (+++), [he words gross or marked e.1I1 be used,
(01' example gross haematuria, \'(!hen there is nothing, the word nil i.) common.

Sl<ellr ~L
l'rotei", There \"\1.) no sugar, a trnce or
+ protein and gross hacrnnrurin.
bLood +++

7 ProfesSiona£l ntish .. lb.

4 M_
33.1 Look nt the conversanon on A opposite .1I1dcomplete the notes about Mr jones.
Usc medical terms where possible.
I
e10 (1) _ OM (2) ..---.-- -- - - - {at 1 11"
No (3) eN (+) _- -- - - - .
(5) . 0 ..ttil >.tOI<lr.

NO ~...ti.i'\i~ rAn .!n:t,.". oc.c.a.s4Gl<\Ql (6) _ _.

33.2 Match the pauenrs' descriptions of their symptoms (1-7) wirh the medical terms (a-g].
Look at A opposite to help you.
1 '1 have to pee every half hour or '0:
2 'I gCt a scalding pain when I pass water:
3 '1 have 10 get up several times to pas, water at night:
4 'I have to rush 10 So 10 the roder.'
5 'I have trouble gelling sraned.'
6 'I cnn'l hold my warer,'
7 'I passed SOme blood in m) urine:
a dysuria
b frequency
c haernaruria
d hesitancy
e nocturia
f urgency
9 incontinence

33.3 Write the doctor's questions Foreach of the symptOms in 33,2 above, Look at A opposite 10 help
you, You will need to think of your own question for urgenc)'.

33.4 Describethe findinss of th. laboratory report in words. Look nr II opposite 10 help you.
blcoc( +
prote,,,,, +++
CQsts ..l..

over .f'o ~OlA .~

What i~your flrOVI\lunal dla9n()~I\ fur Mr Jones?

Professional Enpsh HI Use M.-,. 75

 Basic investigations
Ophthalmoscopy
An ophth31moscOJ'l' .110" > the doctor to
examIne all pam of me C)t': the ms, lens,
retina and OP[ICdisc. For besr results,
the exarninarion is done , ..irh dimmed,
or lowered, lights [0 allow the pupil to
maximally dilate Or widen. A topical
mydriatic solution may be applied to the
eye re aid dilation. The patient ... then
.isked to fixate on a taq:et for the durunon
of the t ... r.

Blood pressure
A sphrgmom:ll1ometC1'

A "ethoscor< IS used to hear the ",und o(

blood ruvhmg back through the amI") lhe
I,,,t thumping sound 1\ the \)stolle blood
pressure (S81»). \\'hen the thumpIng
,()lInd" no longer heard. thot" the dio5tolic
hlood pressure (081').

_ Taking blood
During venipuncture, me phlebotomist. .1 technician who takes blood. inserts a n .....II.
nuo a vern and wuhdraws blood mto a specimen tube. which is sent to the baematolog)
laboratory for anai)-sis. lJsuaJl) the phlebotomIst can lind a vein in tbe moer part o( the
elbow, the anrecubstal fossa, thaI IS e."I) ac =5Ihl e. She may apply a toumiquct -.
Ughl band - above the sire, or ,he ""tlmt nul he a,kcd to clench lheir hand to make a
list. In order to nuke the vein more prorruncnt. Af,ct\'Mds, the pato""t mal be • .l.c:d to
~ Ioghtlyon a dressing, us ua 1I) • ~. of I\3UI<. ttl help the blood 10 dot and to pmmt
"'cliong and a h.Ct1Utonu (3 bl... k and hlue mark. or a bruise) where the vesn "35
puncr ured.
Note: A bruise IS a Sfl«Ifl( mart. Bruising can be used to descnbe a number of bruoscs or a larger
area - The polienl exhibiled bruiSing on Ihe flghl forrorm.

76 Pro{<niollol EnfIi<Io in ~ M<dioto<

34.1 A doctor is talking to 3 patient dunng an ophthalmoscopy. Match the underhncd
expressions she USC'> (1-4) to expressons with similar meanings from A opposue (3-<i).
I,
Right, Mr Gold, because you've been having these headaches I'm going to have a look
at your eyes, particularly the back of your eye - the retina. I'm going ro put (1) a couple
of drol'K in your eye, (2) ,"hich will Wilke jt easier (o!' IDe fO see d,e rerina. Mer 3 few
minutes you may find your vision a bit blurry. This will wear off after abour an hour.
(3) I need ro gO[ rid of as much ('xremal light as possible. This means closing the blinds.
Now, I'd like you ro (4) look straight ahead at that clock. This takes a few minutes and
your eyes might feel a bit tired so you can blink if you need to. , don'r want ),OU to look at
me, look at the dock.

a the examination is done with dimmed lights

b " topical mydnaric solution
C I() .tid dilation
d fixate on a target

34.2 Complete the insrrucnons. Look at 80ppo:.itc to help you.

I Wmp the around the parienr's upper arm.
 2 Place the _. over the area of the brachia I artery. Raise [he parienrs ann so
that [he brachial artery is at the same height as the heart.
3 Close the valve on rhe _
4 Pump up the pressure to at least 150 mmHg. Open the _ _ _ a linle and
slowly deflare the cuff while listening and watching the pressure . _. _
5 The first sound you hear is rbe dow of blood through the brachial artery. The value
011 the gauge ar that point is [he . . .
6 Continue listening while you slowly ..._.._ _ _. the cuff.
7 The ...._. blood pressure is measured when the sound completely disappears.
.._._... .

34.3 Complere rhc text. look at C opposite to help you.

(I) Me ~pec1.II)' trained in I.king blood. TIle)' are skilled .t (2)
puncturing the vern to rake a blood sample. lhe wrist, hand and foot can be used bUI more
often a vein an rhe inner part of the elbow is used, If it i, difficult to locate a suuable vein, the
patient mny be "hod to make a (.3) _ , 01' a (4) _ _ may be apphed on the
upper arm (0 make rhe vern more apparent. Aftcrw:trds, a (5) is applied and the
patient is asked 10 press gently. This help« to stop the bleeding and prevent (6) ar
the site. It is important that (7) are labelled correctly before they arc
senr to the haernarology (81 .._..._, where. full blood COUIlt or orher invesrigarions will
be ca rried out.

over .f-o '10ll ~

Pra('tI~l' talkinq a patu-nt thruugh ;10 mvevtiqatum that you carry (Jut regularly.

Pro(.ssiono'English WI 0.. M_ 71
 Laboratory tests
A Microbiology request form
A Microbiology request form uses a number of abbreviations (or specimen I)')X"S (see
Appendix IJ on page 131 (or an explanation of these abbreviations).

7
8
 Date collected .. J .. J .
TIme collected (241v)

D MSU D Nosesw D Blood Culture

D CSU D Throat sw D Clotted Blood
D Urine - Othet. specify D Axillasw DEDTAbIood
D Urine fltSt voided - lor cNamydia D Groinsw DCSF
D Faeces D Eyesw
D Sputum D EndoceMcal sw
D NP secretions D Sw In ViNS ™.
(give
DeAL sile)
D Induced sputUm D Sw for chlamydia (give site)
Other. 'speclal medium

A Biochemistry and Haematology lab report

\'aNt R410ge URic \'31U('

Rms< Unll
Full blood count (fBC) Urc.'l and electrolytes
Hacmos1obm (lib) 143 115-165 gIL (U&EI
Haematocrit (Hen 0.2.24 OJ7..().47 UL Urea 4.5 2.5-6.6 mmoIIL
~1C"an«0 volume (~1CV) n.s 78.~98J) n, Crc'111nine 58 ~1l0 wnolIl
Will,. cell COUnl (U'CC) 7.4 4.~11.0 109/L Sodium (Na) U8 135-145 mmollL
Potassium (K) 4.5 3.6-5 mmollL
Li,'(.'1' function ICSt (lFI1
Uilirubin 7 3-16 umolil.
At:r 9 1~50 IJ/I.
Alk~linc l)hosp·h;lllbC 131 ~1l.S IJ/I.
(Alk.I'h.51

Terms used to describe lab results

up~high OW
down
elcvatcd~r.1iscd I reduced

When (he result'S are within the normal

within normal limits.
range, doctors say:
Potassium is normal.
unremarkable.

Ul1It ahhn-viauon Full form

slL granl1{ per litre
UL lures per litre
10'/1. times ten to the power nine per litre
fL fenuolhrcs
""1101/1. millimols pCI' litre
"molll. or micromols per litre
~molll units per litre
U/L

7
8

-
35.1 Wrire the name of lhe specimen for each of the ,U<pt:CfCU condition s, Look at A opposite
ro help you.

Suspected condition \Pt."'ltllt'l1

]
anaemia
bacterial conjunctivitis
genital herpes
meningitis
septicaemia
urinary infection
urinary infection (catheter in place)

35.2 Complete the sentences describing rhe results of the report in B opposite. look at C opposite to
help you.
1 Haemoglobin i, . , one hundred and forry-rhree
per litre.
2 Creatinine is slighrly , fiery-eight " " " ..", . Ii" •.
J Alkaline Phosphatase IS ,one hundred and rhirry-one _

4 A LT is slightly reduced, nane " ._ " " "" " _ .

5 Bilirubin is .._." , seven _ " _ " .

35.3 Write full descriptions of the foUowing results from a case history, Look ar Band e
opposite and ar 35.2 above to help you.

No 138, K 4.5, wee 12.2, HCT 0.224, MCV 72.5, Alk.Phos 72. ALT 9

_
~.oo:lI..m.~.r.!Q!.11],@~J2I)e..bU!lP~r<I
t:hl~l9.~~.m. illimQ!~.~r..Ii~ "."... .-------
................................... _---
._---_ _ .._-----
-_ _ _-
---_ _._---
" " ,

............................ _._-------- " .._ ---

,

over .ro /101.1 ~

Describe the lab results of a recent case YIIU'Vl' been involved In.

79
 Endoscopy
Functions of endoscopy
Endoscopy is a way of examuung parts of rhe body which nrc not visible from
the
outside. A typical endoscope IS a flexible rube which is inserted through one of the
natural orifices - openings - sud! as the anus or mouth. Rigid endoscopes, which canner
be bent,
are also used but are inserted through small incisions - surgical curs. The shaft contains
several channels (0 transmit lighr from the outside and images from inside and (0
allow differenr instruments to be used.
Endoscopes can be used for the following:
• to provide diagnostic information
• [0 excise - CUt Out - diseased tissue or
growths such as polyps
• to clear olmrllcrion;

8 P,.(essloool English ., Use

0 _
 ~x,blt shall c:ont.,nlng
• to take. biopsy Imag< "".nn<l ond
• to caureriae a site of bleedmg by ""annels to< light, ."
lind W3ltt. Instruments
applying heat. and WlrtS

Enteroscopy
Dr Jardine is talking her patient through an entcroscopy,

Now, I'm iusr lubricating rhe rube wirh a [elly which contains a local anaesthetic. It'll help
'0ensure a smooth passage as i( passes down and you shouldn't feel tOO much.

I'm going to feed the rube through your nose. This is rhe most uncomfortable part of the
procedure but it's very brief. You'll gei used to rhc tube in a few rrunures' time. OK. when it
hits the back of lour rhroar, take a deliberate swallow. I'll tell you when.

/
Now! Swallow. swallow, That'> it. Well done.

Report of a diagnostic endoscopy

£.IIAMINAIQI PII!1oIllIC.IJIJN
Informed consent was obtiined from the patioot after Throat spray
discussing risks and benefits of the procedure. The patient was
connected to the PIIIse oJimeter and plaoed in the left lateral
position. Oxygoowas provided through a nasal cannula and
the premedication administered as stated, Theendoscope was
introduced into tile oesophagus. At the ood of the examination
the patient was transferred to the recovery area to recuperate .

..~..J

8 P,.(essloool English ., Use

0 _
36.1 Complete the table wnh words from A. Band C opposite.

\Jtlh Noun
consent
excisson
incise
insertion
recover
swallow

36.2 Find words in A and 8 opposite \\11h rhe (ollowing meanings.

1 to pas> (an mstrumenr .hrough an orifice]
2 n subsmnce used on procedures (or lubrication
3 the Ile.. hle pan o( ,he endoscope
4 10 srcp somcrhing bleeding h) applymg hC.1
5 "growth Ih31 prorrude-, (roon a mucous membrane
6 to remove diseased IIS>UC
7 taking. sample o( a tissue (or analysiv
8 nOI flexible
9 • drug that numbs 3 particular pan o( the body
10 become accustomed to

36.3 Replace the underlined words and phrases with alternative words and phrases from C opposite.
After connecting the parienr (0 an (J) inSrrnnlcnt \vhich 111CaSLJreslevels of Qi\'\'grn in the-
blood and pulse rate and placing him (2) on his lefr sjde, oxygen was provided rhrough
a (3) rubs: in his nOK and rhe (4) drue rre;lemont prior to the procedure adminislered as
stared. Shorrly afterward. meendoscope was (5) insensd into rhe oesophagus. After me
examination, the panent \\>35 (6) ~ (0 the recovery area,

Nasal c;lnnula

Ovu.r0'1011
What would yuu ').IY to .1 patu-nt uunnq it hrunrho\t,opy. or dunllq ;,Ilfltht'r ,nh'rn'll
mvcvnqanun \...lnch you rarry out requl •.,ly?

Pro(euionol English on Us. -.. 81

 X-ray and CT
Radiography and radiology
Radiography involves exposing a part of me body to a small dose of radiation to produce
an image of the internal organs. Organs with high density such as the ribs and spine are
radiopaque, meaning rhey do nor absorb radiation, and appear white or light grey on rhe
image. Lung tissue is radiolucent - absorbs radiation - and appears dark on the image.
Before some rypes of X-rays, patients ace given a liquid called a contrast medium, such
as barium or iodine, which is radiopaque and allows the organ or tissue ir fills '0 be
examined. The contrast medium may be swallowed, introduced through the anus as an
enema, Or given as an injection.
Radiology" me use of radiation III the diagnosis and treatment of disease, such as cancer,

X-ray examination
The chest X-ray IS the commonest di,'gl1o>li( X-i','r cxamlmuion. Normally a frOI1l,,1
(nmeroposrcriorl VIew I; obtained. The paricnr stands (.ciI18 rhe phorograph«; plate WIth
the chest pressed ro tbe plate, wirh hands on hips and elbow, pushed out in fronr, The
radiographer, the technician who takes the X-ray, asks ihe patiem not 10 move, then to
brcnrhe in deeply and no, '0 brearhe our. This makes a blurred, unclear X·ra)' image less
likely and improves rhe quahry of rhe image, as it is easier to sec abnormalities in air-
filled (inflated) lungs rhan in deflated lungs.

CKecps,b Now. rake a deep breath and hold your breath.

For a side, Or lateral view, the patient is asked ro stand sideways '0 (he photographic
plate wirh arms raised. A chest X-ray may be repeated", intervals to track for any
changes. These repeated examinanons arc called serial chesr X-rays.

Computed Tomography
l Icre i, an extract from a hospital", pres; release.

The Western General has Installed a new GE LlghtSpeed 16 Computed Tomography

(CT) Scanner. CT uses an X-ray source which rotates around the body to
produce cross-sectional ,mages.
The new scanner takes up to 16 simu~aneous cross-sectional images (slices) and
transmits more data In less time than ever before. Each slice can be less than one
millimetre thick. making it possible to find very
small abnormalities.

The scanner will be used for.

• diagnosing muscle and bone disorders
• locating tumours, infections and clots
• monitoring the progress of malignant diseases
and the ''''-_ to IhenIpy (treatment)
• providing accurate guidance for Interventlonal
pra c....... such as biopsies. and drainage
- NmOYInO ftuId from the Site of an Injury or

82 ProfesSional English .. tho _

37.1 Choose the correct word or phrase to complere each sentence. Look a. A and 8opposur
to help you.
1 In radiography, banum .s used a. a contrast "".." " (image/medium).
2 Tissue which absorbs radianon and appears dark on an X·ray is ..._ ..-
...._- (radiolucentlr.ldiopaque).
3 An _ _ _ (enemaJinjecnon) is a liquid introduced into the bowel by way of !he anus.
4 X-rays used ro measure rhe progress of. disease are called
(repeated/serial) X-rays.
S If a patient moves during an X-ray. the image may be " (blurred/abnormal).
6 It's easier to see abnormalities when the lungs ate (deAaredruubted).

37.2 Complete the words. Each begms with radio. Look at A and 8 opposite to help you.
1 Using radiarion to diagnose and treat disease is radio .
2 Using radiation to make Images ,s radio, " .
3 Using radia lion to pro, ide .re;mnem 1\ mdio., " " " .
4 If some.hing " nOI penetrable by radmnon, il is radio, ........•....
S If is penc<rable by radiation, it is radio " .
6somerhmg
A technician who admuusrers X.ray, is a radio, "" .

37.3 Complete the radiographer'S msrrucnons, Look at B opposite to help you.

Please stand (1) . rhss board.
PUt your hands on the back of your hips and your elbows forward. I'll help
you. (2) _ _ ),our elbows (3) _ .._ .
Keep (4) •
ln a moment I'll ask you to (5) _ _ a deep breath in and hold it.
Breathe in, (6).... it.
That's it. Fine. You can breathe out now.
Thank you, I'll need to check the film.
Now )'111 going (0 take a SIde view,
 Can you stand (7) with your right side close 10 the machine and your arms raised?

87.4 Complete the rable '\1lh words from 8 and C opposite.

V"rh Nuun AdJl· .. (1Vl·

abnormal
brearhc
drain
intervene intervention
therapeutic

OVe,(' .f-o '101l .~

Explain to .1 patient what an X-ray is. and what a CT s('aI1IH'r dOt",.

Prof."'MO' Entfr</1 '" Us. M~ 83

 MRI and ultrasound
Magnetic Resonance Imaging (MRI)
MRI is safer [han X·ra)~ because it does nor use radiation. Ir provides "lore information
than Computed Tomography (se-c Unit 37) about some head, neck and spinal disorders
because the images are more derailed and have mort contrast. meaning the differences
between dark and Iighl areas are stronger, Unlike CT, rhe images can be taken on any
plane - any surface of the body seen from an angle. II is now used for imaging -
raking images of - the brain and heart, and in oncology.
Contraindications, cases in which it should nor be used, include patients with metallic
foreign bodies in the orbits. and pauenrs with pacemakers - electronic devices surgically
implanted 10 regulate heartbeat. MRI is also nor approved during [he firs[ rrimesrer of
prl'jjn.ncy.

Ultrasound
Ultrasound cxa mmanon uses high-frequency sound waves 10 view organs and srruceures
inside rbe body. The WJV<'S are generated and received hy a hand-held device called a
trnnsducer. The reRected \\3' es arc processed by a computer which produces derailed
images for di<play on a monitor, Ultra<ound is safe as il does nor employ ionizmg
radiation like X-rays. II is a cheap, quick and non-invasive investigation - with no
surgical procedure - for a wide range of referrals, although results can be unsatisfactory
in obese (overweigh I) parienrs.

Preparing for medical imaging

Prtparing for an MRI scan
You will need 10 have completed a safery questionnaire and have ir with you" . It is
imporranr that there is no meral on your clothing or person'". Prior 10 the scan you can
cat and drink normally') . Your details and safety questionnaire will he checked with you
by the radiographer, who will explain the procedure and answer any questions you may
hove"'. You will be asked 10 remove any metallic objccrs •• s well as credit cards'",
You will be asked to he on Ihc ~IRI scanner ruble and make yourself comfortable 6 •
The radiographer will posilion the part 10 be scanned carefully in the scanner'-'. Dunng
the
,\IIRl scan you will nOI feel afl)~hing bUI you will be required 10 SI.y srill eo achieve lhe
best possible im'ges'·'. The whole examinnrion process rakes approximately 45 minules'''.
You will nor require' any inlCClionsllU',
Prtparing for an ultrasound
You will be asked 10 lie on an examination table" Ii. A special gel is applied 10 your
skin(l2'. This ensures there arc no air pockets between the transducer and your bod),lIJ'.
The transducer is moved over the area 10 be examined''''. You 1113), feel some pressure
and experience SOme discomfort, especially if the resr requires you to have a full
bladder"s,. You may be asked 10 change your position for clearer piClures('6,. When the
radiologist is satisfied with the picture quality. the rest is done and rhe gel is wiped off"- .
A typical test rna)' rake between 20 minutes and one hour(18).

Describing medical imaging

8 Prof""_' english ., Us<_

4
 An ultrasound <Can of the liver An ultrasound SCan of the abdomen
revealed reduction of metastases. demonstrated a small right renal tumour.

An ultrasound scan showed an intm-abdominal abscess.

8 Prof""_' english ., Us<_

4
38,1 Match the tWO pan, of the ",1II<n.:e", Look a' A opposite 10 help YOu,
I MRI provides more derasled mforma lion than cr because
2 MRI is nor approved for use III
3 MRI is safer than X'r"y. because
4 MRI allows imaging on man)' planes
a rhere is no radiation.
b unlike er.
c of high conrrasr sensuiviry,
d rhe firs, three months of pregnancy,

38,2 Match what the radiographer says during an MRJ scan with a numbered point in C opposite.
a YI)U don't need any '"I<CUO"",
b I want ),OU 10 lie down and IUSI relax,
cit', imponant that you If)' nOI 10 move.
d l'm ~oin!! U) go tbrough lour qucsnonnaire with yuu.
e It will he o'er m three-quarters of an hour;
f lr's vcry important Ihal lOU put an) metal object< into thi, Iray.

~8.3 Match what the radiographer ..,.)', during a" uhrasound with n numbered point m C
opposite. a I'm going to pur some gel on your abdomen. You might find ir a bit cold.
b That's it. All done. I'U JUStdean you up.
c I'd like you to lit- flat on your back on the table.
d The gel is [0 make sure there's a good contact with your skin.
e I'll move this back and forwards to COver the whole area.

bS.4 Make word combinations using a word from each box. You may need to look at Unirs
34 to 37. Then use some of me word combinations [0 complete the sentences.

breathe anaesthetic
excise your brrath
expertence are.
foreign diseased tissue
hold discomfor1
informed in
introduce bodies local
c:onscnt recovery the
endoscope

1 I'm going [0 give ),OU a ._ _ _ so that YOli won 'I feel any pain.
2 With an MRI, it's important there are no metallic _ in the eyes,
3 After an operation, patients are moved (0 a _ _ ._. ro recuperare..
4 Endoscopes can be used to •• _, _ .
5 Before an endoscopy the patient's _ must be obtained.

over -to ':SOll

Lxptam to ;) patn-nt whv ynu arc n-teennq til" fur ;111 ultra~ound vrnn or an "-1RI \l'~1I1, and
\Vh,ll,IH' l'.JI1 expect III happen dUrln(1 tfn- prll", r dun-.

Proros,lo.m Engtish In Us. ",_ 85

!

39 ECG
Uses of an ECG
An e1oorocardiOjlram (EeG) IS a tracing, or drawll1!1, produced h), an clOCIroeardiogroph - a
device which records electncal activiry 10 the heart. An ECG can be used for:
• dooding If lbe bean I> performing normally or suffering from abnomuhoes, for example
cardiac a .mythm .. - extra or skipped beanbeau
• indio"ing danuge 10 bean muscle. such as h e.art attacks, Or ischaemia o( bean muscle
(anginal
• derecnng conduction sboormafines. hearr bl<x~; and bundle branch blo..k; (8881
• screening for llo<.hoem", bean disease dunng 311exercise tolerance 1051.often earned out on
3n e,.rci'iC hIke or treadmill
• previdmg ,n(oml.u,on On the physical couduio» (I( the heart, (or evample 10 pa"e"I, with
I." venmcular h) pcnroph) (I VHI
• del«'Itnlt .I«trol)I. dlsturbanas. (or evample low plo,ma potas;oulIl Jc,ek

ECG procedure
l Iere is an ","'ou (mm a mc:dl.:al Ie XlbooL..

I The patient should Ue down and relax,

2 Calibrate Ilw lice machine - a standard signal ,,(, I mV should move Ihe SI)IUS I"" large
squares (1 cml ,er'licaU).
3 Auach ihe limb leads: left arm (lA), righl arm (IIA), left leg (1.1..). and righl leg fRLI
4 Record tbe si,\ standard leads: L II. III. 8ugmrnL('d voltage righl ann 1.\\ RI. augnwnll'<l
,'oltagt' k>ft ann (..\\1.1, and augmented ,ohaK~ rool IA\,!,) - three or rour tomplt', ....
(see C belo\\) for each.
5 Appl) Iht ell'CU'Od.. 10 !he six chest po>itlon. I.. tum. recording!h1'H' 10 four ",",pI~."..
or
Mrh If Ih, riI) ihrn dO<'SnOI app":lr 10 00 sh",. (normnl rb~'lhmt. a riI)'lhm 'lnP "r
6-10 romplr\'" In 3 ~Ingl~ lead should 1M, r{'('urd('d,

Profession.! E.nrJ"" '" 1M ,...~ 87

 A normal ECG
fhe P'OU'" ~h(),,,an l'C(. tracmg of ORS
3 beanbcJI shu\\ 109 • I'
001'0131 ..... pIn
wave, 3 QRS rompk\ .nd • T wave. R
Each largr "'I""'" ~
equn almt ro
0.2 seconds. The R-R interval gives
rhe heart rate, In Ih,s case -SlmlO. In
the case of aboormahues, me QRS
complex can be widened Or 100 tail.
The ST segment can be elevated
or depressed, The 1 "J'C can be
the nght "a)' up. or IO' .... ed - the lwa~
wrong \\ 3) up. Pwa~

PA ,nltrval

86
39.1 rind words and phrases m A and 6 opposire with the following meamngs.
I the marks produced hl all ECG stylu~
2 a rest which determmes how well a patient CO,,",5 with physical exercise
3 a missed heart beat
4 a change in the chemical composition of body nuids
5 the now of electric current in the heart d _
6 resting fOT disease
7 check or adjust an instrument before IISC
8 the pen which produces the drawing

39.2 Label the limb leads (a-d) on the first

diagram, and write a rirle (e) for the
second diagram. Look at B opposite
I() help ),011.

V6
b _
VS
c _

39.3 Complete the text using words from the box. Look at C opposite to help you.

I complexes leads wave interval r:ltC

This very abnormal ECC show. a (I) . . of approximately 33/mll1; a single

long pause of approxunarely 4 seconds bcrween ventricular complexes with atrial aCtivlf)':
widened QRS (2) in keeping with (R)IlIlIl. Deep T (3)
inversion in II, III, A\lF and some chest (4) (\14-\16). Deep QRS complexes
in \/2 and \15 in keeping with I.VII, One atrial ectopic. QT (5) ... .... IS normal.

I.t'Od II

Profession.! E.nrJ"" '" 1M ,...~ 87

 Medical treatment
Prescriptions and drugs
As part of rrearmenr, " doctor may prescribe medication, commonly referred ro as
medicine or drugs. A prescription may rake rhese forms:

8 Prof es SIO.1lI Enflish .. lM Medoan<

8
 TIl b. NlIbL<>'Io\ltooo\t SOD ...q Nabumetone Tab 500 mg
l'IoI.~tte5b send 56
$<0. ::/.t~O. NOGt! label 2 tablets at night

Oldscyte New style

In the UK, patients lake prescription> I() ,I chemist's shop, which ""II; J wide range
of non-prescription medicines ,and other product> such a. cosmetics, for dislK'Ibing
b)
a ph.rmaci>! (Ihe person who prepare, rhe medicines). In ho,pi,al" prescnpnonv are
dispensed by the phaml'<j (the department where the drul:> arc prepared).
Drugs come in m311)'different forms_ 5<,,,, Appendix ilion page 143 for de-cnpnonv and
illusrrarions, and Appendix II on page 131 for 0 lisr of nbbrcvuuionv used in prescnpnons.
Note: Latin abbrevcations ,n prescriptions are being replaced by EngliSh, bUI may slill be seen.

The British National Formulary

The Brirish National Formulary provides information on prescribing and administering
prescription drugs in rhe UK.

SULCONAZOLE NITRATE
Indications: Fungal skin infections
Cautions: Contact with eyes and mucous membranes should be avoided.
Side-effects: Occaslonallocal irritation and hypersensitivity reactions
include mild buming sensation. erythema, and itching. Also blistering.
Treatment should be discontinued if these are severe.
Dose: Apply 1-2 times daily. continuing for 2-3 weeks atter lesions have
healed.
Exeld~ (Centrapharm)
Cream, sulccnazole nitrate 1%

An indication is 3 situation or a sign rhar suggests a specific treatment should be given. A

contraindication is a situation Or sign rhar a specific drug or rrearmenr should nor be used
Or is conrraindicared.
Exelderm® is a proprietary - commercial - name for a medication containing sukonazole
nitrate. The same drug rna)' have both '-' proprietary name and a generic name. For
example, Prozac and Fluoxerine are rhe proprietary and generic I1;Il11es for me same drug.

89
40.1 March rbe ahhr.",u.un, (1-'1' wnh Ihelr mc.1nmll' (.1-'). I ook 31 Appendl\ II un J'.IIlC
131 10 help IOU.
1 p.c,
2 q.d.s,
3 s,c.
4 s.l.
5 p.o,
6 c.c,
7 p.r,n,
8 i.v,
9 infus"
a by mourh
b sublingual
C with 111caf ..
d a, requrred
e .,fler food
t Illtr3\C1l0U'"
9 four (lnlC< • dJ\
h mfus.on
i subcuraneou ..

.2 Complete the 1CfI1<1I<<I. I oo~ .11 A and B OPP()~uC m help you.

I _ o( rbe 'kllll1l3) be caused by drug, such as aspirin which can produce a rash.
2 At a )OU can get your prescription and all sorts of other hcahh products,
3 Gasrro ..inresnnal irrnanon 15 3 . .. of aspirin.
4 Aspirin is (or patients with previous or active peptic UJcer:IIIOO.
5 When bubbles .I'I"'Jr on tbe skin due 10 hear or irritaucn. [his is called
6 The maximum of paracetamol (or an adult 's 4 grammes da,I).
7 mean, ~ dt'U8 b 1\0{ conrramdx.ued bUI care mUSl he IJkm to U, u-e,
8 rt>r "Kki""
phosphale are nnld 10 moder.lIe pam and cough ~urrr<l'I<>n.
9 " person \\ he>d"J>MIo,n drult' '5 J
10 The pia ce "here drug, .lre drspensed .n J ht),pu.,1 " .1

.3 Describe e,u.h of IhN.' prNrtp"on'> for J pancnr wirh suspected ncure COr()nM) \)nc.lrome.
l ook ar Apllend" II on P"It. Ililo help you, The lirM one h.. been done for )ml.

M"dll',nr Dose Ml'thod of adnlU11\lr,iltOtl

Srreprokmase 1 500000 U 1.\', infu~· over 60 min, I

Asp.rin 300 mil p.o. Sl31
Diamorphine 1.5-5 mg I.V. Stat

Meroclopramide 10 mg i.v, STar

GTN 300 mcy/5 ml i.v, infus" stan @ 40 mcgfm,n
Surgical treatment
The operating theatre
Surgery i~curried our In an operating theatre. Creal care is rakcn
10 make sure that operanons rake place in sterile conditions - free
from microorganisms, The surgeon and his or her assistant wash or
scrub
up, and put on surgical gO\VOS masks, and gloves. The patient'S skin is
J

prepared by disinfecting ir wirh an anrisepric solution. This is known

as prepping (preparing) the patient. They are then covered with sterile
drapes, $0 that only rhe area of the operation is exposed.

Instruments
The 111OS( basic surgical insrrumenrs are shown in the picrure .

-
 _
.... . .;::::::::)
refractor

dissecting forceps
scissors
==
o
'0
The operation
The operation begins when the surgeon makes an incision or cur. Control of bl~ing is
very important. A swab is 3 pad of corron or other materinl used to !.OJk up blood from
the operauou site. A sucker is a mechanical device which aspirates - sucks up - blood.
Bleeding vessels are ned with ligatures or scaled by all elexnric current (di.,hcnn)').
Drains may be inserted to cart} awal fluid which mighr act ns a culture medium for
bacteria. Various methods arc US<.-d to close the wound, (or example sutures (also known
as sriiches), or staples. Finally. the wound is covered with a dressing.

An operation report

This patient had an indirect right inguinal hernia.

Anaesthesia: Spinal anaesthetic with local anaesthetic infiltration
Incision: Right inguinal
Prooedure: The external oblique aponeurosis was divided and the spermatic cord mobilized. The hernial
sac was identified and separated from the spermatic cord. The hernial sac was then mobilized back to ils
neck where it was transfixed and the redundant tissue excised. The fascia at the neck of the spermatic
cord was dIVided. carefully preservinlthe vessels, the genital branch of the IlelVe and the vas deferens.
Thereafter the posIerior wall of the inguinal canal was repaired in two layers.
Closure: The wound was closed in layers with Dexon suture material to the external oblique apooetJrosis
and staples to the skm.
41. 1 Wh,ch of the ,nmu",ent, -hown on 8oppo>'t. " nee...lex 1 fur each of the foUow,nR rro-rdurcs?
1 making an ,n(l\o<ln
2 keeping the "d~ of thr wound open
3 cutting surure-,
4 holding rhe CUI rod, of blood vessels before they "'C lied

~ 1.2 A surgeon is tall..'l1jt to ~ m<dJcaI student about 355'~lIngat operations. Compkte h,\
advice using words from A. 8 and C opposite.

91
 An (1)
must be able to orT} Out the following tasks to help the
surgeon, Fond). he or sbe must help in (2) the patient and purnng the
(3) . In place to provide (4) ._ .._ conditions. h".,n handling
of .1(5) I, essennal to allow the ,u'ge(m to see what he .5 domg,
lhc assistant must .ll'>tlkeep the operation site free of blood, by careful use of tilt'
(6) or PI . The surgeon ,,1.0 needs assistance \\ 1110
tying and <uninll (H) •• md wuh .he in-cnion of a (9)
.f n=l'). ) onalh. the .,\lstant mav be .-k,'tl .cod",c the wound with
(10) cor.>ther 00 KC'i•

.& 1.3 Find words m ( and I) OI'P''''t< \\1th the 10110\\11111 meamngs.
I cut into (\\-0 pa"~
2 corrected (<omrth.nll th.1t \\35 damaged)
3 freed from surroundmg nssues
4 removed by cumng out
5 spread of liquid mro an area
6 making sure something IS not damaged
7 small metal de> ,,;'" to hold rhe edges of a wound together
8 unoecessary
9 sewing up of the \\ound
10 flat. thin pO<CCo\ f t",,,,, thJt I., on top of one .mother

Ov er to l:i0lA
kt"vholt· \lHIJt"Y (t'fl(iO\(OJ)lI \Urqc:r,') h.l., ht,tol1't· I'npul.1f lin"" In11)0'I.II11 1\ 11 In \lH'II-ry'
~'\ihy]

92
 Therapies
Radiotherapy and chemotherapy
Radiotherapy is me use of mdiarion 10 controlled doses ro treat cancers. h works b)'
damaging rhe DNA of malignant cells. Radiotherapy may be used:
• 3S curative treatment, for example to shrink tumours
• as adjuvant treatment, alongside or following chemotherapy - rrearmenr with anti-cancer
drugs
• in lower doses as palliative rrearmenr 10 reduce pain and other symptoms of cancer or
disease, but not as a cure.
A radiologist determines the dose and the exact target for the radiation beams, Dosage
is measured III grays (Gy). A dail) dose i, a fraction. Radiotherapy Can also he
delivered internally by radioactive implants such as needles, or by liquids such as
stronnum for
~OIl'lC hone cancers,

A day in the life of a physiotherapist

Sam i; • hospual ph)'siotheropist. She work, 1II,linly
wirh paticl1l) who have condmons or injuries
nffccnng rile lower exrrenunes such as fractures,
rom ligaments, and cartilage rears, Mosr of her
patients are referrals from other departments
in her hospital. She also works wirh patients in
rehabilitation following orthopaedic surgery. Some
are young people with sports injuries, others are
elderly people who have had bip replacements.
Among her therapies are manipulation, massage,
and exercise 10 keep rhe ioinrs mobile and 10
strengthen muscles. Rehabilitating some patients
means helping them 10 walk again using crutches or
Zimmer frames.

• •
•
•
•
A ZimlTl(r frame

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy (CBT) is one of the 'talking therapies' for mental health
conditions. It aims 10 elinunare negative thoughts and change behaviour in response
to these rhoughrs, h can help with anxiety, panic arrncks, depressive disorders, post-
rroumatic Stress disorder and chronic fatigue. Thcl'JPY C.1II be provided in face-to-face
sc."ion> wirh a thcrnpiSl, but delivery by computer C,1II also be effecnve, It " more
effective than oounselling for some and can provide long-term protection ag.1m,1 relapse,
n return of symploms afrer improvement. However, parienr, mUSt be commirred 10
solviog rherr problems and prepared 10 work on rhcm between sessions.

92 Prof_ Engfish .. Use Me60ne

4.1.1 Name the therapy helOg described. rho same therapy "':oy be described more than once. Look at
A, Band C opposue to help you,
1 Trearmenr with drugs toxte to cancer
2 Treatmem of cancer by radianon
3 May include massage
4 Aims to eliminate negarive rhoughrs
5 Can involve helping people to walk again
6 Can help with panic arracks

.12.2 Complete rhe sentences. Look ar A opposite to help you.

, rrearmenr is gIVen in larger dOM'S than palliative treaunem.

Profess,."ol Englt$/> on Us< M<doone 93

 2 Radiotherapy can be used alongside other rrearruents as therapy;
3 trcarment " treatment which helps relieve the symptoms of a condition but
docs nOI cure 1(.
4 Radioactive _ are wires or needles placed into the area to be treated,
5 A rypical (or .10 adult i, 1.8 to 2 Cy.

2.3 Complete the rexr describmg a typical working d.y for Sam. Look at B opposue 10 help you.

Work begin< around 8.00 am. I check for new ( I ) . .. _ on the computer
and prepare for my morning appoimmenrs. Between 9.00 and 12.00 I <eo new patients
around rhe hospiral. I carry out assessments on them and decide what rhe appropriate
form of
(2) .. is. I work with broken limbs, joint (3) _ .._ and ligament
repairs. I deal wirh A&E patients as well as patients referred to me by their CPs
or specialists.

After lunch I see regular patients.

Their rhemp), includes exercises 10
increase range of monon and to
strengthen muscles,

Whllt do I like about bemS a

(4) _? Cemng
people back In normal.
(5) people 50 the)
can gel on with their lives .fter an
injury or an operation.

over "'0 '10ll

T'llk ;Ihuur twu fOr1tra!!o',og rht'rap/l's yuu havt' l')(,)l'rit'nrl'd, and Iht, ;ldv,H11.1Cjf') and
di\advanta9t·~ of each.

Profess,."ol Englt$/> on Us< M<doone 94

Screening and immunization
Screening
Screening is a way of idennfymg people a' increased or greater risk for a condition.
alrhough they do no, yet have any signs or symptom s. In some cases. mass screening
- screening larg ... numbers of people - is appropriate, for example on the pas, for
tuberculosis, In other cases, only 'hose with high risk factors. like a family history of
conditions such as cancer and diabetes, arc screened, However; there are a number of
problems with screening. There are always false negatives, cases where a patient has a
disease but screening docs not identify it, There are also false positives. where someone is
told they have a disease when in fact they do nor, Furthermore, with some diseases. early
identification is of no bene6t to the patient ;IS there is no treatment available,

Common screening tests

CondIt I(H1 Ievt SUhJITl, Frl'qul'm'y
Neural tube AFl) prcgnnnr women between 16 and 17
defects and Down's weeks
Syndrome ri,l<
B rea Sf ca ncer mammography women, 50-70 c\ el') J years
Cervical cancer smear ICSt women, 20-60 every J years
Cardiovascular blood cholesterol >40 with high risk every year
disease factors
Secondary prevention
Cholesrerol >4 blood cholesterol patients with heart every 6 months
disease
Diabetic ophthalmoscopy patients with every year
retinopathy (see Unit J4) diabetes

Immunization for travellers

T~e lollowingvaccinalions are recommen~e~lor travellers to Sou1~Asia:

 I n:tA1T11S A OR i).llftN GLOIl'l.L' (1(.' r..lAI..j\RIA
Transmi!ltsKm of Mp;.11t'b A \IM an
occur through Your risk or lltalari, Il\a)' be fugh m chtiic COt,InrOC$,.
direer ptrSOlH"o..person rontXt; through esposure including ciries, Tr.aveUet'$ shoukl rak~ 3ft df«n~--e
(0 oontaminaled wares, ee, or shd16sh harvested iJ~ itn6n1al"riaJ dreg.
coetaminated W3ttr; or from uoccoked Eruirs. ,·egetab&es.
or Other feeds. R,AJIIF$
If you might have extensive, UlIproceacd ourdoor
I O:rATfTIS I exposure in rural areas.
Upocially u you moab. be exposed to blood or body
Ouids (for examp&e. health<:oan" "uktn" have sexual TYI'l-k'ltO
CUUt;3(:1 With, he kK:aJ populaoon, oc be exposed through
'r)'phoid fever can be rontraeted through <ootuninatcd
n\Cd)Q1 rreannem, drinking water or food. lartc' outbreah art most ohen
related 10 rm.ul contaminaoo.. of '''.....ler supplt(1: 01'
jAJ'ANI~. L~ (O<x)s,old by Slrt<t "",don. V_non "
If )'ou plan 10\ I~IIrural r..mllftl ams and under pamcubrly
special llnpon;lfll ~~I~ of the rromcr of s. ryphl )(taJ.ns
circunlStanccs. such " a known oucimOlk of JlIran~ rcsiSlIlIlIlO mulnple anUblQhC\ IR thti ~
tncc-phahus.

A.\ "1)))1J:)
Roosttt' ~ tor ttunu\.. dlptuhcn;1 and lne;a~Je\.Ilnd a one-tinu~ clost elf polio 1M J.duh,

94
43,1 Complete rhe sentences Look JI A. B and C opposiee to help )'OU,
I ."................... for heart diSC11Sicnclude smoking, high cholesterol and a
fnmily hisrory of heart disease.
2 In" small number of cases screening will nor identify pnrienrs wirh rhe early signs of a disease.
These arc " ".
3 Some people without signs of the disease will be wrongly idenrified as having the disease.
These are.. _ "........
4 People "............... ...._ blood or body fluids should be immunized against
Hepariris B.
5 J\ ~ . vaccination is given some time after the first vaccination ro make sure the
level of antibodies remains high.
6 Hepatitis B can be through exposure to body Auids.
7 Penicillin now has no effect against some hospira l-ncquired infections as they are
........"" .." .... penicillin,
8 An ,.,..",.."",..,, _ _ o( n",aslc. ha> affeered a number of children who had no(
been immunized wuh the ~I~IR v..«inc.

43.2 Complete the sentences usmg mformarion (rom II opposite. The fit>I one has been
done for you.
I Women aged from 50 10 70 ~~I.1lI~.n:1l1.mII1Qer.llp,h.l.iyY.t!r.f.~bm.~oIIr:lI..I<II~U~.l<~ .
2 rodents wirh heart disease """" ,." " " , _
3 Women berween 20 and 60 ..
4 Patients over 4() with high fisk factors " _

P,o(essi0l101 Enpsh .. Us. Moe.".. 9S

 5 Patients with diabetes _ .. _
6 Pregnant \\'omen ._~ " ,." _ _. .

43.3 Which of the immunizations listed in C opposite would you recommend (or the (oUowiog
visitors to South Asia?
A tourist who will stay for a few nighrs in five-star hotels in major cines
2 A backpacker who will travel b)' local transport from one ciry to another
3 A medical student domg an elective in 3 city hospital
4 J\ volunreer who will hve for a year In a rural community
5 A traveller who has not had 3 letanu~ vaccination (or len years

ova: .f-o 110/.A

What 1111nllllll/dtl()l1\ art' .Hh'l\l·d fnr v ,"Iof\ 10 vuur ruuntrv, or a vuuntr v vou would hkc to
'VI"I!

P,o(essi0l101 Enpsh .. Us. Moe.".. 9S

Epidemiology
Rates
The srudy of rhe spread and comrol of diseases ill the community (epidemiology) requires
analysis of frequency - me number of times sornerhing occurs in a parncular period. We
talk about frequenc) using word combinations with rate:

binh = [he number of births in a population (group of people)

death (monaliry) = rhe number of deaths in a population
case fatality rare = [he number of dearhs (rom a panicul nr disease
survival = [he number of patients still alive after rrearmenr for a
particular disease
 The birrh rare an Smgapore i, 11,. infant morraliry rate III ingapore Y
10.2 per 1.000 population. is 3.0 per 1,000 hve borths.

Other words used 10 talk about frequency.

common in many developing countries.

Malaria is uncommon
in developed countries.
rare

Incidence and prevalence

The prevalence of a disease is me number of people in a population who have me disease
at a particular rime. The incidence of the disease is the number of new cases of me disease
during a particular rime.

high in many developing countries.

The incidence of malaria IS
low in developed COuntries.

nie incidence of IIiV mfeenon The incidence of IIiV infeenon

IS is lowest in Ihe Caribbean,
higloosl in sub-Saharan Africa.

Notc: You don't say The Incidence of malaria is common'

The incidences of a disease in different groups are often compared.

Rheumatoid arthritis Rheumatoid arthritis is Men and women are

is more common in less CO"ln10n in males equally affected by
females rhan in males. than in females. restless leg syndrome.

Association and causation

Studying the incidence of disease in particular groups of people can lead [0 [he discovery
of causation - what makes ir occur. For example, [he high incidence of lung cancer ••mong
cigarene smokers suggests that smoking is a causative foetor in lhe development of lung cancer.
However, c.", rnusr be taken not 10 assume every association between a disease and 3 measured
variable I; CaU5al;' e. To loa) there is an associarion between rwo [hing.> <impl)' means Ihal Ihey
occur rogerher in a ccrrum Sltuanon, For CX,II11PIc, sever,,' scudics h,,'c indlClCl!d hIgh mle< of
lung cancer in cooks. Although this could be a consequence of their work (perhaps C3u~ by
carcinogens In fumes from ftyong), 11 may be simply because professional cooks smoke more
than the average. In other words, smoking might confound rhe associanon with cookong.
96 1',.(ess _ Enp.h .. Use Median<
44.1 (olllpll'lt .he ~.~ I ook ~r ,\ ~nJ 8 III'PC"'''t II) hdp vou.
1 Ibe I'ropomon of tpI>OCks ollllnr-, .h.J.
end fa.all) IS the rate,
2 The I'ropomon of people "00 d~ '" J parncular period rs the me.
3 Ihe proporuon of bsbes bom '" ~ particular period I> rhe rare,
4 The propomon of patients who are , .. II ahve ~,. ye.rrs af.er treatment IS rbe h'e'lear
f3rC'.

5 Ten per cenr of rhe popularion h ave perennial rhinitis a. 'lily rime. This is me _
6 Every year, 0.5-1.0% develop rhe condition. This is the _ . .

.2 Complete the text, using me correct grammatical (orm o( each word. Look 3' me rable and 3'
A, 8 and C opposite 10 help you.

IlIcld...ce 0( lu", .,..".,.,.

I~,<iIIaI"",.nd _"" .. , ''''iIOn""' CO)P,II<aJII, C8n(ldo)

Count,., • 1nridC'1~ Cpn I 00. OOC»

~1I111'
"1ft!
67..5
\\un14,'"
lI>b
(,wn .. da S'li lOR
UM SS-, .1.1 s
U~ 51.2 22,0

Pro(essfO<1o' Enpsh WI Us. 97

IIItdome
 Jdll3Jl .....6
.
n.J
Sweden 22.0 12.9
India 12.1 3.6

In aUCO\lnlJ'b.Jung c:ancer was (I) _. _,+ ,+, ••• " •••••• ~ ••••• _ ••• • ••• • in men than in ~rnen.
The (2) udc.kt..::e among men \\11' in Olin{l where 67.s men per 100.000 ¥lotte ~
w1th lung c:ao<e< in Ibo penod.iJ1 womm. ""'--.vcr. lunll collcer was Iess (3) III Oil".
thou In Ibo USo\ and ComdL
The I., ioodt,o:< In both men ond women "'lIS in Ill<m. lM,." .....lad. foIrty
1$) .>cidb ..... in both ......... Lu"1l co,"'" " Irrobably (6) In Indlo ...
cuI.u,", ond _,_ .. _In <;"'<Clcn II .. II.. It'5Uh 0( on .UOOIh-..'-Ith _ t'IUTlpOIlp.

,3 1,,1<1p'(l'O'lIIon; rn A. 8 and C oppc"'''c IhJI can be used '0 make word comblllJllon> '" nh lhe
"(lrd, In Ihe 00,. Then use rhe correct Inrm' of the word, 10 complete rhe seDl('lk;".

[ .,(fee.ed 3ssociarlon Incidence rare

Recenr surv cys showed Ih3. the ._._ ". """ .."""_....._,,._..... H TV cases had come down
in the southern Slates of Indi a.
2 Epidemiologic dara suggCSl an _.._""._..... . obesity and depression, bUI
further studies are oeeded,
3 Appropriate preventive measures should a reductIOn m the
I1mnahty rare.
4 Thabs;;aCl1ll<lI> _
people of :>:orthrnt European ongm.
5 1II.I<: and femal<: soIdlaS are equall) _ _ posI-InUm.olr.: >t .... ,
d,,,,rdcr.

ove« -to '10ll

Whllh d.\t'.I\t'\ havr Ifu- hUJht'\1 Iftt'Uh'IHt' III ytllif l'cltllllry! Wh~11 1\ ttu- 111I11111111U',1 t .11t'l'
of th-af h In nu-u and HI Wllnlt'n)

98 Pro(essionof Enpsh .. Use Medoane

Medical ethics
GMC guidelines
ca.re = protecting and.,
looking after someone ! The duties of a dOCb>t registered wIth the General Medo<al Counol Include:
1 Make the a:re of your patient your first coocem.
professional competence
= level of specialized
knowledge and skills
confidential = private,
sectee
..
2 Treat patient politely and consld.... teIy.
every
3 Give patients information in a way they can under>tand.
4 Keep your professional knowledge and skills up to dare.
5 Rec::ogn~ethe limits of your profeSsional competence

prejudice = have a 6 Be honest and trustworthy.

negative influence on 7 Respect and protect confidential Information.

ri
risk = possibility of • - SUre that your personal behers do not prejUdice your pacients'
something bad happening-l- ; .=..re~. ..,
• All quIddy to P<Otect patients from Ifyou have good reason to
fil 10 practise = an • you or your colleague may not be fit to pnoctl ...
suirobl. condition to work
Note: For a full list of the guidelines. see www.gmc·uk.o'g

Bioethieal issues
Euthanasia
Should the medical profession help the terminally ill ro end their lives when mel' choose?
Generic engineering
Should we permit an embryo '0 be cloned - copied exactly - to replace a child wbo has died?
Should parents be able to select [he generic makeup of their children 10 produce so-called
designer babies?
Human fenilit)'
IVF - in vitro fertilization - has made it possible for inferrile women to have children. but
should this include women long past the norm, I as. of childbearing?
Embryo. can be frozen and Implanted on the mother at a later dare bUI should Ihis «quire
the consent or perrmssion of both parents if the marriage has broken down?
Wh,t are the nghrs 0(. surrogate mother, one who carrie " child for 3 woman who I~unable
'0 do so, over rhar chIld?

Trnnsplanr surgery
Who should give eonsenr (or the removal of body part' for transplant surgery?

Assisted dying
A medical student has made some language notes on a journal article.

A 53-year old woman rnusaoIat dyWophy ~ trff = '!AC'~ ~ V~Q.4C .~

flew to Switzerland to end ..... ife. A • Ie.:! dying is legal in Il~ bQ ....-a .r,.,......lrlI~~ lAt,.(
Switzetland but illegal on !he UK. ()pp>nen1S ot eufllanasia.
or 'men:y ~', _ lhaf IogaIizaOOn would lead to ""
c.an = .
abuse and call tor_ Who ~ to be struck oft.
pAU4ativt.
r"" ... tout "t:.-~"t'_'f""'-
~!D !.OI.tw-t. ,lrJb

What Bntain !hoy daom, 1S better pall.tIve .... and

mom hospices lor !he ~ 11110allow SUCI1palient$ ~-b t ... ~~Co1"~.t,'b"MI.~
10 die with dignity. I.< ll!l""~.~..•.

TNt loIIowa • recent US .... """'"' !he h<JsbM<I of 0 t:e~Lttt iLl oCIt "1'· •t l-' #

woman Who had been WI • petMIent YGQet8tIve _

pc~~ ~ MIItC - ...... to,.(,.. 'tdlit,.
for 16 ye!W$ was tuec:eS$IuI In haVIng tttilicial feeding fe. n;.t' M ~ ;I" .-.tt ru"'rM" t,.
wfihdl8W11 In spite 01 0I]p0IIitJ0n 110m his wile'S parents. "I'~1- c:cr t1 ~",Nti w.o,ii
5,1 Which of the G~tC guoddmcs In A OPPO;ltC ;, breached in each of the-e ca-es?
a A GP falls asleep regularly during consultations, His colleagues do nothing,
b A doctor is aware mat a parienr has a history of violence against women, She informe a friend
whose daughter has luSt become engaged to this man,
c A docror arremprs ro dissuade a patient from having an abornon as rhis procedure is against
his religious beliefs.
d A doctor refers a parienr to a medical textbook for an explanation of his pancreatic cancer.
e A doctor fails to complete the number of days of professional development training advised
annually.
f A docror tells a seriously overweight patient who has ignored his advice to diet that she
deserves any ill effects that might result from her obesiry.

5.2 Match each headline to an operung lone from a newspaper report. look at 8 and C
opposite to help )'ou.

Prof.ssional £nrIish '" Us. "'_ 99

 1 5
66-year-old becomes oldest mother Using body parts without consent

2 6
Frozen embl}'o case to go to Europe UK full face transplant search on
3
Surrogate mother sued by couple 7 'Designer baby' rules are relaxed

4
Embryo doning - where will it take us? 8 Doctors back infant merc), killing
a A woman of 30 who agreed to bear a child for a childless couple then refused to pan with the
child has been ...
b A surgeon has been accused of removing organs from patients without their knowledge .. ,
c Three-quarters of Belgian doctors nre willing to assisr in the death of Critically III babies to
end their suffering.
d A woman hoping to StOp the destrucnon of six embryos created with ber eggs and her
ex- partner's sperm launched 3 case at the European Courr of Human Righrs ...
e A woman has given brrrh In Romani. following IVF rrearmcnr.
( Consultant plasric surgeon Dr Perer Burlcr has been given rhe go-ahead by a hospital ethics
commirree to lind 3 panenr who meets selection criteria (or a full face transplant,
9 If your favourite pet dies, it is technically possible to produce exact replicas - but what abour
hunlans?
h lr is now legal to select embryos to provide blood cell transplants for sick siblings.

I Pro(essionol English If) I.M _

00
Research studies
Case-control studies
Here arc some extracts from a medical rexrbook,

lila kll...., .• JPUUP of people suffering from a disease (tbe cases) is compared
with alPDlP.dtJ_~dledisease. but are similar in other ways (tbe controls). The two
groups,
........ ill tllelllllly,_ compared to see if they were erpesed to a possible risk ractor
or
DOl. A ri*
is
o8III.aI
..,iII
is'. C' • which may contribute to the cause of disease. This type of study

the cause of a disease.

Cohort studies

lila ..... ...., •• sroup (coIoort) of people (.ubJt'Cb) who are similar I> .tudlC<! O\CI' a penod
of,... (a: J • '1hIdy) to dct''I'"""e if there I, (I !'cimionship between npoourt to a nsk
tiIc:IIar did : pH" of. ~. At the beginning of a prospectJ"e study. none of the
wbjC(.1•
.... 1hD TiIay_ 'II cd.p fora number of years. and at tbecnd of the period. those
who
1PII'o'" : , I _ compared with those who have not. In a ....'l"OSJl«lh-e <;rudy. ,he
W :M' Iaat lPIdI, by IIIIIiyina hosp.1A1records for example. ot what has happened on the
past.
01.... ' •• 'lJ I ell wiPo ._ ~ doc disease with those who have 11()(. In a cohon s,udy
and
in • ..1II11111iy die ....... ' an: only observed and there is no inten-enlion such as drug
0- Mi' ar....". A calion IIIIIiy is a more reliable method of identifying doc cause of
disease daD • (I II e ..... ....:,. RIa _ pmof of cause, a trial is needed.

Trials

In a trial. a group of people "00 are suffering from a disease are given a panicuJar
treaImenI.
To dclmnine the effecuveeess of the treatment, " <onlroll('ll trial is performed, T"o gtClUpO>
811:
8Iudicd: one group (the ~ group) is given the treatment and the other (the control
group)
is DOl.The conuol. may be 8J'eIl a placebo something which seems to be idcDlical to
the
0_ buI .. htch ha.~no elfect. If there is un equal possibilhy thaI pulienls may be selected
for
die IIUtIy poup or for the controls. the Itinl h said to be randoml7.t.'d. A randomiud
tolIlroII<d
 crill 111M error on a study which influences the reslIils - less likely. An addilion:ll way of
Rl1ItJViIIcbill .. ' 7 Cae portents do nol know if'thcy are receiving the trearment or the pl_bo.
if, in .hn .1IIe r the .. do not know "ho is receiving the treatmenl, the trial is a double
.......... R 'I '1 1CXIIIIIOlledtrials are used to tcsi treannents or preventive measures.

Variables

If the subjects in • studY are .11 aged SO, then age is a constant in the studY. If tbcir ages nnse
fiom 20 to 70, then age is a , .. riable. A confounding variable is any variable which is assoa-
I with both doe disease and the risk factor being studied (for example, smoking in the case of
cooks uti ..... csncerdtscussed in Unit 44). Ifsuch variables exist there is no .....y for
the.-...:archer to
~ wbcIhcr doe ddferenee in tbe risk factor or the confounding variable is the one tbul IS truly
CIIIIIioc rhc --.
 46.1 Complete the table \\ IIh words (rom A. Band C opposite.

Noun Verb
bias
control
exposure

[person) participate
intervene
stud)

.16.2 Complete the sentences with. word from A, B. C or D opposite.

People who are not receiving the experimental rreauuenr, but who are otherwise the Same 3\
those receiving it art
2 A trial in which neither the ,ub,C\."1Snor the researchers know who i. receiving the
treatment is n tri.)I.
3 A study rhar follows the participant' over many yen rs is n >cud).
4 A.... IS a group of people wirh similar choracrerisrics.
5 Allocation to group''' _ .... if .111 parricipauts have equal chance of being in either
group.
6 A harmless substance given to SOme participants to resr the effect of a trial substance is a

7 Something rhar might be a part of the cause of a disease is a ........ maor.

8 Something rhar might cause confusion about the C1Use of a disease is
a variable.

I:lO.J Study the research questions below, and in each case decide which of the research study
types menrioned in A. Band C opposite would answer the questions best. Use rhe index or a
dictionary to look up an)' unfamiliar words.

To .xamIDe !he outcomes of an unwanted first pregnancy

(abortion v five de9very) and rKIc of depressioo.

(BMl2OO5:331: 1303 FIq>ovd_.,,1h _ from the BMI ""I>"""og Groupi

2
Th '0<1 tbe h)1lCllhes.s Ihm ",,,,,,,,menlll' oxygen reduc ..s
infection ri,~in pa'1(11" (oIlowing 0010"""131 surgery.
(lAMA 2005; 294: 2035)

3
To develop a relatively ~ inexpensive. and occurate test that measures telomerase activity
in voided \line to apply 10 large-scale screening programs for bladder cance< detectioo.
(lAMA 2005; 294: 2052)

4
To evaluate the relative risk of being responsible for a
falal crash while driving \Mlder !he influence of cannabis.

(BAU 2005;)31: 137\ ~ ",Ih pmn_ 'rom the B>.IJI'Ublish"'9 Group)

over .f'o '10lA

Ol.'\('nhl.' ;1 rt'\I.';Hl-h \Iudy that vou'vr carm-d out Of would br mtrrcvh-d In r~Hrvlllq nul.
In your t-xpt-rn-urv, wh;1t ;1(1,' Ih\.' matn prllhh ..mv vnruuntvn-d rn dl'\II,lllnfl a 1I,'\I,';I,,'h \Iudy?

Pro(ession.' Enp.h in Us. "'_ (0

(
Taking a history 1
A full case history
A full case hi"o,) cov ers:
• personal de13i1s
• prtSall:ing romplailn
• past medical bisloe') (PMH)
• drug hisloe') tsee UOlI
• family hi;cory (see Unil 48)
• social and personal history see Unn -IS,
• parienl ideas. concerns and cxpea.rions [see Unit 49,
48, • review of systems (see Unit 49,.

Personal details
Normally, p.lIlelll'· person ••1del.lil, have been entered ill their record, hy .1 IlUI'>C or
administr.uivc \,,(( before J doctor S<'t.'S them, l Iuwevcr; 011 later consuhauon« a doctor
may wi~h 10 <h",k delJll~ ,ueh 3S address, dale of hirth, occupation or rnantal ".1111\.
Io find OUI or 10 che<k a patient'. occupanon. d(K"''' .I<k:
Do IOU "OrL.?
Wh.1 do IOU do (or a Ii,ing?

Pan et irs
m.) '0, I'm uncmplo)'ed. No, 1'111 retired. Ye,, I "OrL. for J oonk.
respond: I'm OUI of work, 1'111 a pensioner, I work in J (acto').

To find OUI or ro check a patient's marital srarus, doctors ask: (

. Do you h.,'e 3 p~
WtIler?)
Parienrs may respood:

.. ngle, ( Yes, I'm m.rri~

No.l"m separated,
divoeeed,

widow,
My 'l'OII.e pawed
\\ioo"et. away h,'1 year.
di'oreed.

Not.: A spouse can lit a """ or husband. A wido", IS a woman whose husband IS no Iongtr IMng; a
widower 1$ a man .. hose WI'. 1$ no longer living To 3YOtdsaYIng someone IS dead, patocnlS IlQ'( say
thai person has passed aw"'f.

Talking about pain

Case notes are kept for each consulrarion. The Prescnriug Complainr secnon of case notes
records (he p.llent'. \) mpeoms. For example:

R. si.d~ teMpera. "eo.~o.c"e.

severe. ~flYCI:t1l~
Ulsts :>4.4~ :'-:rs.

In this case, the panem complams of 3 headache. l-or u I,,,

01 the qu,,",uun, rhe doctor asked
this parient, and for p.II,cms' descriptions of Other kinds of pam, set Append" 1\ on page 144.
7 1 \t",h thr w", nOl~ ~ nte the q.....t.lClO' the docror ."kw to obram the
numhrrnl onl"m!JlIon. LooI. at Appnldl\ IV 00 P.l~C 144 to help yOIl.

D.O.B. szx • MARITAL Sl'A'l'US ...... ,

Professlonoi Eng,,", .. Us. "'_ 103

 OCCUPATION !•• '

Presenting complaint
!,,_, ~ II~ 13~"....J" IV~~!
It. b.Mt .""" ~f\VC'tLjL" 'AI,;)~~J :+ $ ""-Ie~". "",._~- .
.... ~.-"'''
2 Read the connnuanon of the CI'" not ... (or the p.Il,cnt ,n C oPJX)'IIC. \X'ntc the tJo..,or\
<juN,on,.look a, Awcn<h 1\' 00 paj;. 144 ro help you.

l)'l<.,or: Can you rell me what rbe problem ,,1

I),\lielll: I've gOl a ternble headache,
Docror: (1) ..•.----
Patienr: JUSt here,
Doctor: (2) ••.•
Parienr: Well. ir's really bad. And" throbs.
Doctor. Have you had anything like this before]
I'"uonl: Yes. about .. ery three monrhs. l've had them (or the lasr fen years or so.
Doctor: (31
,
fl.tt,,,n,, U,uall) 00(.' or ('\\0 til,>. 1111s00(.' stanw )csterdav mormng,
f)octor: (41 ,
P.'IIt'ftt: Th .. u",;alh sun IU>I betort rnv pcrood. '\omelllllC'> if I eat chocobr e. I'm not \Ute.
n,...",r: (~I )
If I II. down In a tilr!.. room It help' I ,ltht m.ikev them
('.lIIrlll: "0 rse.
~w~) ?
".IlIrol: I( I move m) head. It get> more ".1Inlul.
[)'l<.lOr: AI"" from the beadache, 17) ,••• ,
1',1IIent: Yo" my eye fed, strange. )omrllme, I <.111',see clearly, things gel blurred, I re..r \.",", Jnu
somenmec I am sick .

•3 Complete the sentences. Look at Appeudix IV on page 144 ro help you.

1 Gastric ulcers are assooared wnh a ,.,.,.,
,_,.. _ pain.
2 Cystins causes ,.,._, , pain on passing urine.
3 I';tt«nts wtth a prptic uktt rna, 5;1) the) have ••.•.•.••..• _. • pain.
4 Recurrent abdommal pam (RAP, may be descnbed a< ....•• or
5 \I'ltran", IS often desenbed 3S a pain.
6 I'ropk- \\'lb OSIeoartbnros ohen rompla,n or .,
U<'CP centred III rile ,. .. nr,
7 "',dO(.') stone pain I> sodden, s...ere.ntl
8 ""Jotln;] I~ usu;]l1~ described 01\ a (ru,nloJ,l or hr.I\) or JQln~

Professlonoi Eng,,", .. Us. "'_ 103

Taking a history 2
Drug history
Here i. an extract from a medical textbook.

It is essential to obtain full details of all the drugs and medications taken by the patient.
Not infrequently patients forget to mention, or forget the name of, drugs they take, Some
may be over-the-counter remedies unknown to the general practitioner, The signifICance
of others, such as herbal remedies or laxatives, may not be appreciated by the patient.
It is necessary to determine the precise identity of the drug. the dose used, the frequency
of administration and the patient's compliance or lack of it.
II is important to ask about known drug allergies or suspected drug reactions and to
record the information on the front of the notes to be obvious to any doctor seeing the
patient. Failure to ask the question or to record the answer properly may be lethal.

'10 find OUI abour drug h,sIo')', doctor-, ask:

Details of drugs and medications
• Are you laking any medication .1 • Which rablet do you rake?
the moment?
• Do you use an)' over-rhe-ccunrer remedies or herbal or homeopathic medicines?
 FrequenlY of administration Compliance
• Hew many rimes a day? • Do you always remember 10 take il?
Side-effects and allergies
• Do ),OU gel any side effects? • Do you know if )'OU are allergic 10 any drug?
If rhe answer is Yes: \Vbal symptoms do you gcr after laking il?

Family history
Note Ihe age. health or cause of death of parents. ~ibling, (brothers and sisters), spouse
(husband or wife). and children. To find OUI about family history, doctors ask:
• Do you have any brothere and sisters] • How old was he when he died?
• 1)0 you have any children? • Do you know the cause of death? I
• Are.1I your dose relatives alive? \Vb"t did he die or?
• Are your parents alive and well? • Doe. anyone in your family have a
• Is anyone laking regular medication? serious illness?

Social and personal history

Record [he relevant informarion about occupation, housing and personal habits including
recreation, physical exercise. alcohol and tobacco and. in rhe case of children. abour school
and family relationships. Typical questions in raking a social and personal history art:

• \Vba. kind of house do you live in? • Do you smoke?

• \Vbo shares
Do you live alone?
• Have you rried giving up?
How many a day?

• How old areyour home with you?

• What about alcohol?
• Are any of them nursery or school?
children? • \Vine.
•• Whal;' your occupation? •• Can youbeergiveor upspirits?
alcohol when you want?
• Do you
you have any problems at work?
•• What's the
How milch do )'OU drink in week?
3

• 1)0 have any financial problems? mOSI )'OU would drink in a week?
• alcohol consumption over the pasl five years?
• \Vhalaboulcxercisc?
you have any hobbies or intereStS?
I)C) Arc you aware o( any difference in your

•
104 I'ro(ess_ Enpsh WI Us. MedicIne
 48.1 Complete Ihe ","rC"''''. I ""L..II \. II .Intl C oppel'lIe
1 Pharmaoe ... sell a wide vanetv elf
If)
help you.
I
rcmed~.1\ ,,<II a, d"ptn"n~ I'~npno",
2 The
from I'h)\ld.n,.
" I~ quannn 01 rhe medicanon to I~ taken 31 3n1 one nme,
t
3 A drug " hI ptr<;Cnsln"l}' to a parncular drug.
4 A h a m.JK";IIIOI1 prepared from plan!>. "'ptC13l1y a
rradmonal remedy,
5 Your brothers and your !tl.)rers are your .. ...~ '" ....._. ...._. ..
6 is Wh31 vou do for physical or menta I stimulus outside work.
7 can '.lke mar» forms: aparrmem-, single rooms. hou ........ho;,t<l,.
8 The rallenl'> 10 drug treatment, hI' WIllingness or 3bllon 10 , ..lot rbe nghr
dose 31 the rij,!ht ttmt and Ircqutn<'\. I> essennal.

48.2 \X'rue Iht d(,.'tor'> qUC>1l0"'. (,",L. ., B opposue 10 help )011.

I)tlllOr: II) ?
('''IIl'1l1: M) f,lIher died ""'111) H.I" JIl" bue my mOlller " 111good health ,"11. \hc'> 'Ie"CIlI)
11()". ()""Im: III
? P,lllelll: I w.l\ ,1111al "h"ul. lit "J~forrv-one.
Doctor- 0,
1'.,1<11,; lit had .. hean 1n.,L..
Docron 141
Panenr: I've gOI J sosltr 01 tom filt and 3 brother who'v rlnrry-six,
Doctor: 1;1 . . ?
Pariern: No. I had an elder brother bur he died ill IIi, forties. He was forty-two.
Doctor: 161 _................ ., - ------?
Parienr: IIL.t rnv father, a hean JIIJcl.

10 Professional Enpsh II Use

6 MedIono
 Docron ~- ?
Panenr: "01 m.1 I """" oi.
Docton III A, fu J5 lou 1.no" ----------- ?
Pancnr: Ar~lnfrom me .. no,
Doctor: (9, ?
1',licl1l: VC,•• I hoy and 31(1rl. 11.\ fnurtcen and ,he" twelve.

48.3 \IUcJ) the \()<I.I hl>lO<\ of Mr Bl.I,k. \\'mt the ,[UC'1I01" Iht cJoctor .-ked In "hl.lIn I~
numbered onfomunon. l...,oL. JI ( "pJ'(Nte to help) ou,
500al hosla<y Mr G 8b<J<
Home - I 1\ t\ on J detached hUIlICII IIh J 13rge II' rden I ,

FamIly-I our cluldren: rwo gIrl, .ll:l'(l 3 and 4, IWO hoy, aged 6 and S. All are bemg
raughr at home by his Wlft !',
OccUpatlOO - Manager of 3 OJ) warehouse. Stressful job involving dealing wuh frequent
staff problemv and meenng month I) sales targets. Large mortgage h.
PnsonaI,nttftStS - Has lInk lIont lor exercise or ult.~ts outsIde worl. • .
Habtts - r~lllh smolmg 10 per til) , • Has med I1ICOIIIlC patches \I ithoul ~uc....., "',
Av.r.IItC alcohol mtake 3 unll, per d.l) at \Veekend~I'I, No problem WIth alcohol
withdrawal ~ .

over +0 l;f0ll
W,.h'.1 ,utl .. 1 h"lfJ~ of .. 1).Ilu"nl V"U know ~1.lkt" .1 II .. ft' .. ' Iht" qlH"'!lfJ'" .,0\1 "'lJlJlci ",k
10 ohl.1I1l Iht" Infllfnl.llllJfl

i',.(n.ionoI fnpsh .. (.he M..... IOS

Taking a history 3
Reviewing the systems
Once you know the main reason why ehe parient wants medical attention, I( is sensible
to ask abour rhe systems to determine the patient's general stare or
health and [0 check
for any additional problems. The patient should be encouraged to describe symptoms
spontaneously, Inirial questions should be open-ended and as general as possible. Follow
up with more specific quesrions if needed, but avoid putting words in the patient's mouth.
Open-ended questions Closed questions
What's your appetite like? Have you eaten today?
How's your vision? Is your vision ever blurry?

Asking about the central nervous system

1 00 you suffer from headaches?
2 Have you ever had a blackout?
3 Wh.t "bout fir<?
4 Have you had .ny diuincss?
5 Do )'OU get ringing in the cars?
6 Have you ever experienced any numbness or ringling in your hands or (""t?
7 Do you have .n)' problems sleeping?
Patient ideas, concerns and expectations
It is important during the consultation to give patients the chance to express their own
ideas and concerns about their problem and to determine what their expectarions are.
The leners ICE [Ideas, Concerns and Expectations} are a way o( remembering this.
Typical questions are:
Ideas
• What do you know about this problem/condition/illness?
• Do you have any ideas about this?
• How do )'OU think you got this problem?
• What do you mean by ... ?
Concerns
• Wh.t arc lour worries about lhis?
• Do you have any concerns!
• How might this affect the rest of
your r~lI11ily?
Expcclntions
• \'(Ih~t do you think will happen?
• Wh:1I do you expect from me?
• What were you hoping we could do
(or you?

Phrasal verbs in history-taking

Phrasal verbs are often used in informal spoken English. Both patients and doctors rna)' use
them in consultations. A phrasal verb may have several meanings according to context,
 49.1 Mnl<h Ihe numbered qU"'ltcon, I I-~) In 6 OPPOIIiC to the 'ymptom~ for Ihe «l1Ir.1
nervous ,)\lcm (a-f). There 31\' 1"0 quesnons for (Inc uf the I)'01ptOI11\.
a h~3d3d>n
b heanng 5) mptoms
c (allu\
d nnllll nil I paraestbesae]
e fits
f sleep parrerus

49.2 Read rhe extract from 3 consuharion. In rhe numbered questions (1-4), is the docror
encouragma tlK- patient to talk about her ideas (I), her concerns Ie) or her expectanons
If)? look .c C opposite to help '00.
1"11<111: I'm J bit coocnnnl .hout 01) cohc, I had .1 friend with somerhlll1! slmlw;and it
turned OUt to he mol\' '>Cnoo... It·s gor me WOrried.
Docron I I) Wh.1I do IOU 11ll'.ln b) «lire?
Pnncm: A pam III the ,Iolnac.:h.
Doctor: (2) What do lOU Ihlnk mlilin have broughr Ihi, (lll?
1)'11<111: Ii IU\l seemed to come nn. I don't know what II ".
Oo<IOr: You \dId )00 were • 1>11worried because your frlcnd had. simll.r problem. III \\'ILlI
31\' 'our"~ .hoot thiS?
Panent: '~I had J fnend. \he turned out to have IlOm.leh cancer. he ac'tu.11I dted m the end,
Doctor: (4) \Xnat were)ou hopmgl could do for you IOday?
Patient: I lust want to kilo" th.1 I don't have anythmg 100 serious.

49.3 Complete the sentences with phrasal verbs. Look at I) opposite 10 bell' you.
1 The headaches . in the morning.

10 Prof<ttiOlloi E.rtgIish .. Use Medic:vI<

8
2 However much I eat, l don't 'iCC1l'IIO an) "'''1g):u.
3 l've trted to vmokmg several times.
4 I'm \0 depressed I don't (""II can
5 When I coujlh, I phlegm,
6 fie Ihou!!hl he had stomach ... he bUI it It> be cancer,

ProfeSSlonol Enrllsll ., Use ~ f 07

 Physical examination
Examining a patient
When examining 3 patient, you should:
1 Introduce yourself, if necessary,
Good morning, I'm Or Mason.
2 Brief the patient on what heshe should eXJX'Ctin a clear and simple way.
00 you know what we're going to do this morning?
What we're going to do today is ...
l'm going to examine your ... so Ican find out what's causing this ...
What we do is ...
What happens is that ...
1"11ask you to ...
Arc )'OU ready?
OK?
3 lnsrruo the pariem on .1 dear bill pohre manner (sec B below).
4 Show <ensimlty 10 rhe panenr's needs Jnd respond to discomfort, rc.""nng If appropnare.
You mighl recl a lillie bit of discomfo«.
Thi, might hun a lillie bUI I'll be quick.
Tell me if it hurts,
Let me know if it~ sore.
Ie will be over very quickly.
Ie won't lake long.
You're doing very well,
5 Talk rhe parienr rhrough (he procedure.
I'm [ust going 10 ...
First I'll ...
Then I'll ...
Now I'm going to ...
You'lI reel ...
When ii's over, I'll ...
That's il. All 0\ er.
G Share your ~ndin8> with the panent.
Well, I'm fairly certain you've gOI a ...
One possibility is il could be what we call ...
I haven' found anything 10 suggesl any problems.

Giving instructions
When examining a parient, polite forms are often used for the initial insrruction:
Could you bend forward as far as you can?
If you could cross your arms in front of your chest.
Whal I'd like 10 do is examine you standing up.
After that direcr instructions may be used:
Stand with your feel logether.
Lie perfectly still.
To son-en an instruction:
Can you jusl turn 10 the side agam?
Could you jusl he on the couch?
For a liS! of verbs commonly used in instructions eluting exurninarions and mvesrigarions,
sec Appendix Von page 145.
50.1 Complete the IO"ruCII(III> U''''1t ,ulI.lhle verb s, l.ook ar Appendix V em JI.I~e 14~ to help IOU.

Prof.""""" £nrInIo ., 1M 109

 'Ir~ll:hl Jhe.1I1 and ),our nose with your fI~1 forefinger;
then wuh your ~ft fort'finf,\tt.
2 on rbe cd~t of the couch and
3 your ... el •.!., l1~d~.
4 311~our dochcs down to your underwear,
5 your Chesl wnh your chin.
6 . slow I) and look over your le(1 .houldcr.
7 ....... on your srde,
8 looking 'I onc.
9 lour sleeve.
10 the pm, nOI Ihe Ioghl.

50.2 Wrotc .nm, ...nons 10 ~....,he rhe nIC)'....".,.,ts en Ihe 9

>
picrurev, I 'XII. JI Append" \ <In I'J~C 145 10 heir) ou.

r )
'c7~~'~
•
10
2
13 -...

J
3
• 11

50.3 Complete th. msrrucuons (or.1 lumb.ir puncture with word, und phrn ..., (mm A and 8
OI'I'''''le, A
~ ~--------------
\lomonll \lr \b""cll •• 11
(21 ""nwu'
'111\,. (I)
J 11It~ncc:d~ mro lour
: \\.11.
'1''''.
and 13l. ~mt flu.d off lour
bac], In find our "h31\ It.\lnlt IOU these headaches, You In.ghl feel (3)
bur II won't (4) • When '1\ (.S) • we'll JSI.
YOII 10 10. ,nil (or 3 (e" hou". ~OW Mr Maxwell, (6) .. roll onto
your left side? I want you 10 curl up into 3 litrle ball, So could )'OU hend )'our knees
up and luck your bead m for me, Thai's fine, lovely, OK, 'oW (7)
swab down your back "'lh some annseptic, 311ri~l? 1t'1I be a bit cold, Art')ou (8)
? ="0\\ I'm going (0 give )'ou ,. 10Cl1 anaesrhctic so II won't be
sore. You'll ftd iUS( 3 sl,Plll.b. OK, scratch coming now. There. \~'e'li,.. " (or a
Ie" nunures for rhat to take cffect. R'ght now. he ~till,Ihat's very rmporrant. 'ow
(9) me pm'lnS down as I pll' the needle in. You're domg (10)
.0", Inat\ rt. All(II) ,." " " .

OvU' -to '10Ll

fhllik "' r ••munatrun
.lfl ,IIU trt'fjlH'rlfly r<lrry out. Wort' down fht, II1\I"H 1'011\ \,UU ","lIuld
'IIVl' ttn- patu-nt.

II Professional Entfish .. !he

0

,'.1_
Mental state examination
Some symptoms of psychiatric disorders
• A delusion i< a finnly held belief which i< wrong but nor open to argument. For example,
a deluded patient may not accept that his psychiatrist is in fact a psychiatrist,
• Dementia is significant mental deterioration due to physical changes in the brain.
• Disorientation is mental confusion about time, place or idenriry,
• Hallucinations are apparently normal perceptions which happen without rhe appropriate
stimulus. An)' of the senses C.lO be involved but especially vision and hcaring.
• lllusions ore misinterpretations of real stimuli.
• Obsessional symptoms are stereotyped ideas Or impulse. which the panent cannot resisr.
They mclude obsessional thou~h~ and obsessional rituals.

Mood
When describing 0 parienr's mood, It 15 berrer for doctors to usc the patient 's own words
rather than their own sub,ect"e description of the patient', mood, Panenrs mal' So')':
restless miserable low
 anxious
tense sad
unhappy
worried

wound up dejected
panicky

( I've been feeling very low. y

Parienrs may also use the following adjectives to describe their condit ion:

I set very confused about time, Ican't remember what day it is,
People make me angry, Tbey're '" irn!3t1ns,
I'm tOO embarrassed bl m)' appearance to go Out. I Stay at home,
I get muddled when I'm shopping, I go out for milk and I come back wuh cheese,

Typical questions from a mental state examination

1 Can you describe your mood at the moment?
2 How long have you been feeling like this?
3 00 you take pleasure in anything?
4 How arc yOUT energy levels?
5 What's your appetite like?
6 Have you noticed any change in yOUT weight?
7 How arc you sleeping?
8 Can you keep your mind on things?
9 What do you feel the future holds (or you?
'0 Have you ever f<lt that )'OU don't wont to go on?
l' Hove you ever thought of suicide?
51.1 Complete the -emc","'. I nok .If t\ opro,lte 10 help YUII.
I The patieru beheves Ihal people can '>CC through walls. 11<\ ~ulfc"n!\ fr0111a
2 The panenr sees her iong-ckad "\Ie" on her garden, \hc', wffering from
3 The panenr pen:r" es rree br~nd1<... as snakes, lie\ expenenong an
4 lbe p3l1ml \\ ashes her ron.l,
11\t' (lrne before t'>cl') meal, Her behaviour ,, _
5 The panenr rhinks the nurse " her daughter, She\
6 A panent IS confused about where she is. She', >uffering from .

51,2 Complete the [able with words frOIll A opposite. Theil complete the sentences below,

Noun AdJI'l'IIVI'
confusion
 deluded
depr ... "on deprewve ullne-, )
- [panent]
I--
disoricmcd
oh-e"'t>n ('I "'J'lnm~ thought,)
nb'C';l\e <ompul<,,·c rdrsorder
I------:-
p,)<hIJtl) (fidd
(pracnnoner!
'---
1 Parienrs H' hospuals receive fewer get-well cards rhan others.
2 Impaired concenrrarion is a characrerisric symptom of , .....~. ..._..... .
3 The porenrial risk of suicide sbould always be assessed in the severely
4 A person mal be confused about who rhe) are or wht're I.....are.

51.3 Write the doctor, q~ns 111tbe mental stale evarmnauon. look at C 0rposue 10 bell'
rou.
D0<1or: III
Patient: I feel low, I'm nOI enloYlIl1l hfe,
Doctor: (21
POltlt'nl: No, nothing.
Doctor: (11
Palltnt: I fee 1run dC)\\lI. I'm «Jill ured.
0<..10r: 14, ?
Panenn I'm month~ now,
Doctoe ("
Patient: I C,lII't get to sleep and when I do sleep I wake "I' c",I)'. ------------------,
Doctor: (6,
Patient: 1\, gOI no appenre. I don't enjoy food.
"" " .
---,
Doctor: CI
Patient: I'm loslCll! \\~t.
----------------------,
Doctor: (S,
Patient: I can't remember where 1\. put
anything. Doctor: (91 ------- ?
Pnrienr: I)on't hke t111nklCll•l•holll II,
Doctor: (101
I'allent: 1\. thoughl abour n hut I don't have the courage, ----------------,

over .f-o '1011 \,

O"\t'nh,' .1 p'v\'hlOttric Cot,,' vnu h;III\' e-nrounten-d Ifl yflllr IIfuh'\\lonJlt;JH'('r
Explaining diagnosis and management
Explanations
The final part o( a consulrarion IS the explanation which should cover:
The diagnosis - identification of a disease from irs signs and syrnprorns,

proreuionol£.rtr/islo in 1M II
101_ 3
 You're suffering from ... This is (mainly) because ...
You've developed ... This is why ...
You have ...
2 The management plan, including invesrigarions and treatment.
I'll make )'OU an appoinrmenr with ... You'll be given ...
I'm going 10 Stat! you on medication .0 ••• I expect you'll have ...
I'm going 10 have you admirted '0 ... They rna)' advise ...
I'll arrange for you 10 ...
3 General advice about any change in li(eslrle rhar 1113y be needed, (or .,ample gl"ng up
.mokin); or drinking 10; alcohol,
The nurse will ghe you advice on ... I want you 10 ...
You should try '0 gh'e up ... It's imporranr Ih.1 )'OU ...
4 The prognosis - wh at is likel) 10 happen because o( a disease, srressing that nothmg i< cerram.
J expect the rrcarmcnt will ... We can never be absolulcly certain about ...
Hopefully we can ... You should remain optimistic.
5 Question time - where the parienr can ask questions about hislbcr illness.
Do ),OUhave any questions? Is there anything you'd like to osk?

Using lay terms in explanations

Explanations should be given in words rhe parienr will undersrand, avoiding medical
jargon. Using I.y .erms - words familiar 10 people without medical knowledge - can help
patients understand cxplananons. For a list of some C0l111n0l1 lay terms for condnions,
purrs of the body and medicauon, see Appendix VI on page J 46.

An explanation of angina

I laving examined you, I'm confidenr rhar you're /)ul(cring [rom angma,
The bearr is" pump. The more you do phy>ically. the harder ir ha, 10 work. BUI as
we Set older. rhe blood vessels which supply oxygen to rhc heart begin 10 harden and
gtt furred up. so rbey become narrower. They can't supply all rhe oX1'gcn rhe heart
needs.
11,e resulr is rhe pam you feel 3S angina.
Because you're experiencing pain at reSI.S well as Oil exertion, I'm going to have you
admitted to rhe coronary care unit right away SO that your rrearmenr can starr at once.
You'll be given drugs 10 ease me pain and I expect you'll have an angiogram. TOO)
may advise surgery Or angioplasty - that's a way of opening up the blood vessels to the
heart so they can provide more oxygen.
You should try to give up smoking. You won't be able 10 smoke ar all In hospnal so it's
a good rime 10 stop.

I expect the treatment will improve your pain at lea" and ilia)' Bet rid of il completely,
We can never be absolulcly certain aboor rhe future hut you should remain oprirmsnc,
Do you have an) queslton,?

II Pro(ess lonol Engfish .. Use Me6on<

2
52.1 MMCh the stages of J coosulr.mon (1-4) with the sentences used (n-i). Look ar \ and C
opposite to help you.
I diagnosis
2 managemenr
3 general advice
4 prognosis
a I'm going ro have you admitted to [he coronary care unit.
b I expect rhe treatment will improve your pain at least and may get rid o( it completely
c Having examined you, I'm confident that you're suffering from angina.
d You should rry to give up smoking.
e We can never IX' absolutely certain about the future but you should remain oprimisric,
f You'[l be given drugs to ease the pain and I expect you'll have an angiogram.

52.2 Replace the underloned words and phrases with appropriate lay terms. look .11 Appendix VI on
page 146 10 help you.
I Mr l larnv, 1'111 afr.ud )our \Yl(e'~ suffered 3n aClUl' ccrc.bfoya5CUI,,( ""(Ilt,

2 The w:s:dua runs Ihrough the middle of rhe prosrare.

3 The reason lor your nQ<"furta IS rhnr your prostate is enlarged.
4 Do you <ufler from dlSPn<X>lwhen yQU exert yourself]
5 l'm gomg (0 give )'OU an an;)IGcslc and an aori-ioO;l!llnl;)[Or)' (or your sprained ankle.
6 ('m purring you on illlIi:deprr:;s;!01S (or a short time to help you gel back to normal life.

52.3 Complete the explananon of diabetes, Look ar A opposite to help you.

You've (I) ...,... Type 2 diabetes, This is (2) """",,,,,..,,,,,,,,,, .....
_ very overweight. Your body isn't producing enough insulin. (3) you feel
so thirsty and why you pass urine so frequently. It's also the reason you have this very Itch)'
rash and you have a problem with your eyes.
The nurse will (4) _ your diet and I'll (5) ."" ..."..,.. ,
a dietician. I'm (6) tablets to control your high blood sugar. You don't need
insulin right now but il is possible you miltht need it in the furure.
You (7) , lose weighr and I (8) ..,,,..,..,,",...,. ,..,' ,...
a podiarris]. It'; unponanr with d,.,bet<'> rhar you take good care of your feer, You should •• "'
sec your optician ever)' "X 1II0"ths for eye checks,
l)i"I>CI(,' I< u <eftou< condmon and can ntfect your heart, blood pressure, circulanon, k,dney,
nnd vision bUI we can limit thl"" problems by controlling your blood sugar;
No case o( diabetes can be described as mild, I'll (9) " _ to attend the diabenc
clinic every rwo months SO we can check your progress.
( I 0) "" ......."..... reduce thIS to six monthly visits once your condition is under control.
..
ls there ( I I) _

OVe-r to ~OLl
Explain a ('(lndltuul uf your ('hUll"'" tn a patient. Your l'xplan;tfiun vhuuld ('(lYt'r thr- prnntv
li\ll'd In A 0ppo\lh' and uw I;:ty Il'rm\ whr-n- ,)I)\\lhll'.
 Discussing treatment
Offering opuons
When diS<"us,inl: option, ",rh d pallenl. doctors "':I)' ,.1)':
1

II Pro(tu;",,'" Ent/tIh .. Use

4 101_
( Th ere arc' couple 01 oprions we em l.d h can he caused b) dlt"l or srress. There
usc. Tbe firsl option b ro II) I3b1ets like /' are some quire simple lem we can do.
Prozac th'l laft 'ou up .. bit. Tbe ocher I( you·..., still roo=ned, we can reler
option is eoun~lhn!l- ) ou 10 a hospual.

Advising a course of action

\~hen adVI\lnjt.1 (uurw of acnon, docror-, m.iy \.1)':

Some ume off "ork ml)tlll help. II IOU Carry 011 drlnklOl!! 1,,1\
leh thnt would he helplul. IOU could o( l1uld~.
take. "ccl olf ~nd-ee 00" )00 (ell
.ftrr rhar.
I( IOU snll ha' .... >me plln. '''''
(311 keep laking plrJ,,,,.mol.

Other IhinS' mi)tlll help, like raising rhe head of your bed. 'That's one o( rbe "mple IhUlgs we
could start you 0(( with, You said you haven't tried indigestion remedies. 11131. sornerhing
you could try.

AdviSing patients to avoid somethmq

When .d\1<lOg plllt1l" 10 J'old somethUlll. dex", .... """
""}:

There are a (e" Ihln~ .boUI vour -1

hfc~ryle "t' could .dd....,.. Perh.""
CUI down 011 Ih e .""(lunl you're
CUI nUl f.1I1) IC><.d:)
drmkmg. Giving up ""01:1011:would
help.

You should II') 10 .'OId nghl dOlhmllo "mnll,n deep

annchalr. aod hendlO!\.e5pa:uIl) after 01".1,.

Warnings
When a doctor "an" 10 warn .. parienr rhar the consequence of ignoring rhe advice could
be serious, h. 0' she rnav ....):

I(you aren't (eelonll bener on - 10 14 days, If you keep damaging u, you're going
you really muSI come back and sec me again. 10 end up with a long-rerm probkm.

I( )OU feellh.lllhonl:' .,m·1s<tding. ,,,,,,'1 It\ 'ct' rmportam ,uu don' Slop
gc:mng ball", 1lOtTn.a.1.. \ Importanl 1.,konS lhe labl e" ,,,Jde-nl, or l"ur
Ih.1I ycu see Ole .1~\ln. ,)ll1plOnls w iII return

Pro{."lonol E.nrllsh WI Use _ II

S
53.1 Complete rbe a.III«. «101. al .\, 8, C and D 01'1'''''''< 10 hdp )·OU.
I If )'OU SIUOI.II% YOIIincrease the nsk of (unR cancer
and heart disease.
2 Your health would IInpr",. if YOII._ "" '"'' ""., alcohol cornplcld).
3 You could with n serious drug problem.
4 I'm going 10 you with <orne tablets. If Ihe) don 'I help, we'll
need to rhmk about su~.
5 on rbe amount of sail you take with your food.
6 I expect thing> ",11 in 3 few days and you'll be able to get up.
7 Try to snuanons where lOU feel stressed,

53.2 Match the two parr, of Ihe ",01=, Look at A, Il, (. .md 0 opposite to help you,
I If you still have 1'.1111,
2 If you find II d,ffin,h III R". up smokinll,
3 Your symptom .. WIll return
4 If) ou can't St, 10 ..ittI',
5 Corne back and see me JRJIIl
6 If you'ee snll coocerned,
a II) 10 avoid caltrlne later III I~ cia).
b If )·ou find jour brrJlhk<;,nc:<;s h3s iocreased.
c keep raking paracetarnol.
d I can refer you 10 • (On<uI1301.
C if you starr smokmg agam,
( I can arrange for mccune replacement therapy,

53,3 Advise a patient" uh hl~ blood pressure about phy,ical acriviry, Look at the inforrnanon
in the table. and at ( OPf"Xlte to help you.

AdVI( (' tor pt:Upll' wrth hvar t dl""t\" or tuqh hlond pn-vvun
.----~ -- - ----- ------
Do Avoill
Modemte, rh) thmll la"ml>..:) .,,,rel><' lnrcn« ",eI"CI'" such ....... rcghl hfunlt- pres,
"ceh up~. he.1vy diggins and 1.!t()rnctrlC,.:r\cnl~.
Q\ hri)k ,\·.. Iklll~~ l)lhn~ or \\\1010H08_
Ally '1'01"1 (II' acnvity thai "rmlt' on angma,
An)' regulnr l,h)'",.11 .Ilt" II) th.lI lOU art
used roo
I-Iovln!: from floor to standlllg (\erctSC' 100
Eal 3 low cholesterol d,<" qUlcll)
~----------------~
YQlU!l(lIIkt.~ If- 'lC
Vou :!bou:at'l< do a"Y tr.I!!'yl/ltf,liIItIII.11<"eil- _
rOU.'-<1l.ik! tor I>r:~l\dir.. _

Over +0 ':iOll
A P;III1..'"1 of YOU"'. ~11' Whl!t', ,Hlt'd 44. h.l\ ln-r-u ("01111'''"1111111 of Vl'P( tn-avv ,H'flod .. '\11
ultr;,\ountf ,,,-,Ill III hr"I'I't'.\ ,hll~' ,ht' h.r-, .1 "n.11I hhnud .11lu-r utcruv \'H' .j,\;., .rbout
1r",llllI,'"1 'hl"'- optilln, .lft' I)u..". hlt,

[lo nolhu1(1 I"t- hh,",d will ,hflllk wtu-n vlu- htTIIIIU" I1U'I10p.IU ... I'
J "T .1 qvn.llTlllull,,1 who 111"" ,I(t\ll',' "'1I10v,1I1I1 lilt, '.h,onl .11.1 hy,It"ITlllfI1V

P';lrt,\" wh.rt \,011 ","uhf \,,1\1 III ""1,, ~\lllIh' III ,lthll\t, ln-r til Iht",· 01'11111"
Giving bad news

Pro( •• sioroal Etttbsh '" 1M 1

_ 17
 Principles of giving bad news
",(-,1\ e warnmg, --J.. A ----.,.
I'm afraid lour rest results aren't '<I") good.
l'm sorry to have to t<ll you that the ne\\, .;n't good.

2 Choose an appropriate setting and have" friend or relative of the patient present,
3 Take rime.
4 U"" appropriate language.
S "l11rhas.~ thc pos.",e. ~

There's still a 10' \\C can do to help IOU.

t hemotherapl will rnal.. IOU more eomfonablc.

G 1).;<,,;\ the PI'OgI>O>l>.

It
One can nevee be con"in about thest thin", hut I'd
a matter of months fJth<r than ).,11'\.
',I)

7 Supplement ,h. verbal ITlOSlge.

l'd hke to record this consuhanon \0 )011 <,III hvrcn again if anyrhmg Isn't clear.

8 Arrange a fo"ow·up session.

I'd like to see you again next week,
Can lOU rom. in again next \\ee~?

9 Q)I\finn tOOt m. paoent undtl'5t.nd;. ~

Could lOU tdJ me "bat we're gOll1g to do for IOu?
Is t\ <I') thing dear to IOU?

A consultant medical cncoloqtst's report

M r Harl'y Soott.

Olagnosls: PreviOUS p&rul1'8aI.la cancer

I reviewed Mr Soot!. In the Oncology Clinic toda.y. He has been less wen and haa
lost 12 kg In tile past few montJl.s. Unfortun&tely. his CT scan shows an area of
IU-deftned low attenuation In the ta1I of the pancreas. Although t.hJs Is consistent
with focaJ. pancreatitis, the general feeling &t the Multillisclpl.!nary Team meeting
was thai. t.hJs represents recurrent disease. ThIs Is especlally likely In view of hl.s
cllnlcal deteMol'&l.lon and rising CA 19.9. I cIbcna.- t.hJs wiUl Mr Soou. and hl.s
w1/e. He was obviously diMppoIa_ .nUl the scan results but stIU tries to 1 .ID
J Illri. We dlscussed the f~ thai. ........,._.,u.optioDand I71DJI'Om
was Important We al80 dl8cuB88d the role of peJ.llative 0emc!1.AbIne The
poUIntJaibeneftts &re small but It Is usually wel1 &olera_ and he wu !leen to
prooeed with UIlS. I wIU therefore ~ bim iDto Warot. to mttt In the
next. few weeks and b&ve re-cheaked hl.s bloods toda.y. In the mo&ntlme. I wouI4 be
very grateM II you would ..., .. bim to your dletJcIan. He hlmself 18 .... tor thls
to h&ppen. We wIU _ him back In Cl1nlo onoe his treatment has st&M.ed.

II Pro(... iono/ fftrIish .. ~ M<diar><

6
54.1 Complete rhe e "r.l,1 Ir .. m rbe elfl<:oIOll"I\ <nll,"II.lIOCIl1wub Mr Scon. I em JI ..\ Jllel
8 opposir« 10 help vou,
Oncologist: .\Ir \<nll. (I) so you and .\t~!.c:nll (.III
1'101' h,"~ bIer .l1I\ thmg rhar may nor be clear (() you rodny,
(21 Ih.OI 'he scan results aren't "I") good. II',
Iok.h IhJ, \00'\. go< a recurrence o( (01I<,<,rill your pancreas. Th.1 would explain
\\h) \00\. been feeling so nred, and your loss o( appetite and weighr,
;\Ie Scott: \\ ,II I need ,tor!l<l")'?
Oncologisr. Surg<l") , II ar this stage. Alrhough we <In',
 oper,It •• rbere ".nil 14) .. ,'ou\ell()( IJblen (or
_
pain rtlu:f and we can 81\e you \()lnc'hill~ stronger if you need It. We (an also
Man )"u nll.l course o( chemo,her,1py Ie) help with your sympromv, I h" won't
cure yuu hUI It , ..III (5) .. , ,., .,. .. 1t\ unusual '0 have an)'
un"I<.'\,1011 "dr t((CCI> wtth ,h" kiml of che,nmher.Pl', I'd like you Ino 10 see 3
0.11('.'.'.. 111 lor \(lOll< Jd, ICC on "h.OI w e.u .111d HI help gel your ~ppt~OI' 1>.1lk,
.'IIr Seon: \\ 1u1" m\ 10(e e '",,"Tan<)? 110" IOllg have I !\OI?
Onrologm: <)nco can ,iii ' People ",Ih IhO\ ",no.lllKIII \31") 3
grtal dr.l. I "oukl he wrong 10 W\. you ,1 definne nme ;c,k 0011'0.1 ~\
I~' . (8) .. U
Ih". bUI nn feeling IS u's alwal'~ hhl eo he honest with people and Ihrn IOU know
whal\ "hal.
If you're m agreement, I'd like 10 (91 \~"trd 2 to
SIan )'0111chemo. You'll need to come ill every week for the next month.
Is nCf).hlnll <kar '0 you? (101,.. . treatment we're
gO'r1jt 10 gt\e you? Are there anI particular worries you h.,.?

I'll he .... "nl! lOU fqtularly ro keep an rIC 011 'hing; so you Com;a\l0ll< JO\ otber
q""_'lOIl, 'ou mJ' have,

54.2 Complere rhe ;em.lIl" ,,"h words from the 00'. look JI i\ and B opposue In help lOU.
I (or 11110 10 Wili.]

1 These re~lIl";l1"C ~()n\I\ICnt rccorrerucancer.

2 Hes GI' referred h,OI an '"l<ol"A""
3 The panent \\3\ d''''l'p",med _ Ih. news.
4 The pr~'5 "3' o.I,,,u,sed the pauent and his ",fe,
S The parsent "3S booked lhe ward (or further chemorherap"
6 He was rhrs to happe».
keen

over +0 tj0tl
What wuuld you ~.IV tn ~I patrent who has a non-mahqnant brain tUITIOUr, ahuut fuur
ccntrmetres In dlanll'h,,1
 Data presentation 1
Referring to a table or figure
111.111art,de.)oo can wnt", In a prescnranon, )OU can U~ tM
s..tl11eexpressIons.. or you can 11\3):

II Pro(esmnoI &>psh II Us.

8 Medoat>e
 hgurt I
shows X.
Table I ( As you can see in Table:=Y
Figure 1.
X is shewn in
Table I.

Comparing variables
When you rt'ftt to 3 oble '00 ",II often need In compare nne variable with .nOl he.,

I effC<tl\e
common

Or lOU 01,)\ need to comp.l'" I.... "ml<' ..... ble.1I J,ffcrem limo:

double ~
_Tb_en_un_'_be_r_o_f'n_~2ooo " J~ trip~le Ilhrcc ~_I_h .I,n 1990.
~ rimes
L

twofold
There was. increase in rhe number of X between 1990 and
2000. threefold

twofold
The number of X increased
threefold
between 1990 and 2000.
doubled
111( number of X
trebled

Approximating
When «fernn!: 10 tbe <illJ prncnted on ,I,de-.. numbers are of len rounded. lur n~ml'k"1.1
bC<OI11t'>41 or even 40. \\1I<'n !h" " done, II " common 10 U\C e'pre-.,K)n, nl 'pprcl\lm3I1on'

.OOUI
around
Side-effects w crt' reponed b) •Ipproxim"tcly forry patients .
roughly
some

umbers are frequendy presented as fractions or percentages, even when rhe c,act
number is given.

Roughly rwo-rhirds of paoenrs Fifr)'.6~e. or some rwo-rhrrds,

reported si~ff=:s. of pancnts reponed sKk-efftclS.

\\'hen '00 want to ttnP/U>I1C' number. for example 9.8%. you Can !.1):

.Imosl 10' more than 9·" ju" under 10'.

nearl) 10' O'Ct 9""
and when lOU want 10 make lbe number seem small:
less than 10·.

II Pro(esmnoI &>psh II Us.

8 Medoat>e
55.1 Complete rhe d"",nl'r"," "I rhe dara In rhe rabl e. I')elk .11 A and B opposue r" help '''''.

Table 1: Incidence of uker perf()(ation 1967-1982

Paba ..... MbmonI 1967

1982
No. of ~ (Mon) 1967 290
1982 820
Ptrf<lliltions (Mtf1) 1967 36 11
1982 28 6S
 Table 1 (1) trends in the frequency of hospilal admission lor perfotaled peptic ulcer
in the United Kingdom (2) with changes In the annual presoipbon rates for non·
steroidal antHnflammalOfy drugs.
For womttI 0Vff 6S tht antlIIaI......ur 01 prescrIPtions ",creased (3) from 1967 to
1982. during wI1Id1 riles 01 pMora1Jon 01 cIuodMaI ulcm (4) for theM igfd 6S 10
14 and more 1IIan (5) for theM aged 7S and 0Vff. For men 0Vff 65. pttsenp1lOnS
showed a simdar lIIONSf.. Ahho<JrjI perfora1Jon rates were actually I<Jo.oM IOf theM aged 6S 10 74 II
1982. there was a (6) incr~ in those aged 1S and abooJe

(BW 198G.l'92: 61. Am<n.l<d with pt'fm,,,",,, r.... til< 8'-0 """"""9 Gtoupl

55.2 The data in rhe table IS adapted from an article entitled 'Alcohol drinking in rmddle .(te·.
Choose the correct words to complete rhe description below. Look ar C opposite to help) 00.

(follow up)

Only 54. or (1) than 20'", of the non-dmlc .... ~

(underlless) ~
with 204. or Q) (almostJover) 70'", of the frequent dnnlcers. 41. or J<lR
(3) (lesYunder) 14% of the non-drlnke~ had had a myocandlal onf_ althe
end of the follow·up penod. compared w,th 54, or (4) ".""" " _ (aImostIOIIef) 18%. of the
frequent dnnkm, At the end of the follow-up period. (5) " (abouUOIIef) 90% In
aJlthree groups had no cogrubve Impairment There was mild impaim>ent in (6)
(under/around) 8% of the non-dnnk ers, and ,n 7% of the frequent drink..... but on (7)._
~slunder) than 4% of the Infrequent dnnk"" 14. or (8) (approx.mately/OIIef) S%. of the non-
dmlc .... had dementia. whole 17. or 4% of the""-'""' dnnken. and (9) (more
tIwl/ne.u1y) 6% of the t..quent dnnbt\ .... dothtt.
 Data presentation 2
Line graphs

.:
Notice the verbs used to describe changes over a period of time.

I Pro(es,,,,ooI English .. Use Mtdi6ne

20
 rise fall reach a peak remain me same
increase drop
go up decrease
go down

Notice the difftrcntt:

I
rise sharply
steeply
~
nse steadily
gradually
rapidly

A line graph

Pie charts
Pie cham are an effective way of showing the relationship of
parts to a whole: the complete circle or pie represents the whole,
while the pam are represented by segments or slices. In this pie
chart, which shows a health authority's costs, the orange slice
represents cosrs of hospir, ..1I services. So, hospital services
account
for 60~" of the ,-0,,,.
Describing trends
The bar chan below <ho\\> the prevalence of IIIV ill differcnt COIIlIl<lO;.

HIV rares have fallen '" some countries HIVaround the world
a, result of safer sex, bill rhe overall
;l Nurt!! AI,fC7I WId
Mllkllrr..lot AdlJui5..~n
trend is an mcrease III HlV infl,,'tions. The .. Ih Ktv. 2005
steepest increases in HJV infections occurred "" ""
1
Ct n t~ 1

in Eastern Europe, Central Asia and EaSt

Asia; but sub-Saharan Africa continued 10 " '"
(1I t'O fI t"
b ..
2003-2005
w,lki.
be the most affected part of the world. Adult
infection rates in Kenya have dropped from
a peak of 10 per cent in the late 1990s to
7 per cent in 2003. HIV rates in pregnant
women m Znnbabwe also fell over the pasr
years.

~Tim ..

I Pro(es,,,,ooI English .. Use Mtdi6ne

20
 56.1 Complere rhe rable "orh "or.t, Irom .\ OPPC"'I<'. I'UI ., 'It,..,.rnark m from .,t rhe
\l1T">"-.l
'yllabl~ of rlHh) Hable "or.l~. The hrse one ha, been done for you.

Wrh Noun
'decrease
drop
fall
I increase
I~ -
56.2 Choose the correct \H",I> 10 complete rhe descnpnon of the bar chart. l.ouk.1I \ .111.1 C
OPPOSite '0 help you.
Figure 6 ,ho" , ,h.1I 'he 1".,.,11 number of <.,,,.,
CI( IIiV (I) ._ (drnp~ I
remamed the ,,111lel~Nrh unnl 1988. rhen (1) (roscJdroppNl
PI "ha'1'h/llr.lduJII) I. (.,\C; "' hc,ew\C"J.lIIT",n and women
(4) h....r... ~f~1I1 (51 (,,~ply/sr~Jd"ll. "'''''''Jill for
people exposed 3M ...d. The number of IIlhled pe o ple 1II1~1I111dlru!:s
(6) IIdV,,~) atrer (-) (reJchlllg a peal I dmI'P'11j!11Il
1987. nilS "'-1\ he ~.,u .... ot rbe dC:'\elopmcnr uf needl e exchange scheme:'\.
Morher-ro-mfanr rnn,nllSSIOtl (8) (represcnred/accountedl (ur J \In. II
number of else" (.1relul management o( labour grearly reduced the number 10 rbe
lare 1990s.
 ...-
Ollitrs
Mother to Infant
.Thtro~t ..
.Ini«l'og
"'1..-"",,'
.1ic>mow .... 1

--
e'"e :8
- . .. e
i
e
e'" ;
•
N
; ;
M

'" '"

., ... r".l,rr 6
'" e '"
s ~ '" '"
56.3 Which rype of graph would besr represent rhe following data?
1 Birth rare. ill the VI( from 1980 [0 2010
2 lncapaciry due 10 (il. different causes from 1995 10 2005
3 Sources o( ionl1ll11: rJd'.l"on III the UK

over .f-o '101l

Or;IW .1 pu- char t IIf h.u ,'h.It' whl(-h \huw, ttu- d"IHUXIIlI;lh' ('0\1\ of Ihl' ht·.lllh 'I·P~I("t· In
your {'ollnlr" Pr.fl 11\1'dC'\I·"tllnq thv (·h.ur

Pro(tJSionoI E.nfIi<h ., 1M _ I2I

 Research articles
The structure of a research article
Research arncles art ryplolly divided into four
main sections:
Introduction
Methods
Results
Discussion
This is sometimes called the IMRaD structure of
articles.
The Introduction conrams background information;
in other words, it reminds the reader what is
already known about the subject. It includes
information about previous studio, and explain> whnr has not been investigated
previously. Finally, there is usuallt • statement of the objective, or purpose of the research
(why they did it).
In the case of clinical research, the Methods section gives derails of the people \\ ho were studied
- rhe participants in the research. The method section also conrnins information about an)'
intervention carried out. (or example medication, advice. operations. It gives details of the steps
taken in the study how (he participants were chosen, and includes the main things measured,
such as blood levels. Finall),. there is informarion about statistical analysis.
The Results section tells what was found, rhe findings of [he srudy.
The Discussion section contains explanations, and claims for the importance of the stud)'.
It may also list limitations, or parts of the study which were unsatisfactory, and suggest
what research needs to be done in the future. There is usually a Conclusion. which is
sometimes a separate section,
At rhe end of most arncles, th~f( is a short section called Acknowledgements. III this the
authors thank people who have helped them in their research. Fin.lly. rhere is a list of
References - the books and arucles which the authors hove used.

Objectives
Statements about obiecnvcs often contain the following verbs:
assess We assessed whether ...
determine The aim of our srudy was to determine whether ...
invesrigare \'(/e invesngared the ...
evaluate This study evaluated the ...

Main findings
The Discussion section usually begins with a summary of the main findings. This is
related to the objective of the study. Typical verbs include:
show \'(Ie have shown that ...
confirm Our srudy confirmed that ...
provide evidence These findings provide strong evidence rhar ...
If Ihe resulrs are less ccrt .. n:
bugge>t These results suggest that ...
and with neganve results:
fail to This stud)' failed to show that ...

122 Profess,,E,n,,g,li,s,h Of
IM_
57.1 Read rhe ellthl 0"ra,1, trom an ~",de on Ihe Brou,h l\I<d".11 journal enntled 'Palomal
age and schrzophrenu: a populanon based cohort 'rudy'. Decide which secnon 01
rbe(rom. There are rwo e~tr.ll" from each o( the (our secnons.
article each extract (Ol11l..,
Look at Unil ~6 "!:ollOll( lOU need more help.
1 People with older (,nhers were more likely 10 Ime Iheit pnrenrs befo re lhe) reached rbe .ge of
18 years.
2 Using a large \\t<!,sh record hnkage database. we mvestigared (he assooaoon between
paternal age and schuorhrcnoa on offspring.
3 We used Cox\ proporuonal haunts model, to assess the infloence of paternal J<:C on ~'chosis.
4 Our coho" comprised -54,.3.10 people born on Sweden berween 19-3 and 19 0 and Stlll.lhe
and resident on S\\rom JI the age of 16 }""".
5 Our find,ngs confirm an a\SOC130on between increased paternal age and <ehllOphrctllJ on
offspnng, which rem.nned even ••flcr we controlled for II wide range of potennal confounding
(.CIOrs.
6 There i, grow 1011<1, Idrlkc Ihal (arlo" oper.nin!: .11 differelH POInts in hfe comnbure 10 In
Indlvldual\ ",k nl <k, rinponll schllophrcOl.1.
7 The onaon Iomu.uon of nur Jnal"" I~lhal la\( "".","ll11enl was based on J'Il"lpie adnutred
10 hosplt.1 onl) wuh dlJ~ recorded on .111adl11lnl\ltau,e daIJOO'C.
8 Table I ,how, lhe <har~<le",Ik." o( >ub,...., III relauon to the age o( tlx-or ("her.
 (8AC/lOI)4J29 IOJO ",'h .... IM "" ...., Goau!oI

57.2 Look 31 the research qoesoons (1-4) and "me a srarcmem of rhe obiecnve of .. <h ... u<l\-.
using an appropnare form of rhe verb in brackets. l.ook nr B opposite to help you,
1 Can calcium and "ramon D supplernenrarion red lice rhe risk of fractures in postmenopausal
women? (assess)
2 Does the way doctors d"'5S influence parienrv' confidence and rrusr in them? (deierrnine)
3 Is there a risk of herpes \1tU, 8 (HHV·S) rransnussion by blood rransfuslOfl? (.. aluarel
4 Is the", an assooaoon between never bemg marned and Increased nsk o( dealh? hmcsno:;Jrel

57.3 Now wnre a sen t<11<. e a "'lUl tbe main findong on each of the studies on 5-.1 above,
nssurrung a resuh as ,oo\\n In brackers bolo". [001. al C opposue 10 help )OU.
J (no)
2 (yes)
3 (yes)
4 (uncertain)

Pro( ... 10001 E.rtt1lsJo .. Use "'_ 123

 Abstracts
Structured abstracts
An abstract is 3 type of summary, and may be found in special collecrions of absrracts, such
as Medline, or in conference programmes. 3S well as ar t he beginning of a research anicle.
Many journals require contributors (authors wishing to publish the ir arricles in the loum.l)
to provide 3 structured abstract - an abstract which is divided into specific sections.

The BMJ abstract

The British Medical JOlmUlI structured abstract is divided into the following sections:
Objective
Design
Setting
Subj('CIS
Main outcome" measure
RL'>ul"
Conclusion
H"I'e i< all example:

AGE. AT RETlR[\IF.Nr ASO LOse; TF.R.\1 SURVIVAL OF AN INI)US'fRIAll'OJttJLATK)': PROSf'f<"T1\T COU()RT STltD"1'

OflJECTrVF
To assess \\ hether early retirement is associated with beuer survival.
DESl("lf\.
Long tenn prospecrive cohort StUdy.
SEnlSG
Petroleum and petrochemical industry. United Stares.
SlIlllLCTS
rUM cmployccs of Shell Oil \\ho retired .1 ages 55. 60. and 65 between I January
1973 and 31 December 2003.

MAIN OUKO"L "lAS\.Rf

I lazard rauo of dealh adJusled ror sex. year of entry to sludy. and socioecoromic SUlIU>.
ItLSU'TS
Subjects ,,110 rerired carll' at 55 and who were "iii alive lit 65 hod. significantly higher monahty than
~\OSCwho retired 3165 (h3zard rauo 1.37.95% confidence interval 1.09 to 1.73). Monalit) "115also
signifieantly higher for subjects in the firsl 10 years aflcr retirement al 55 compared with those who
continued working (1.89. 1.5810 2.27). Afler adjustment. mortality was similar bcr\\..:u those who
retired at 60 and those ,,110 retired al 65 (1.06.0.92 10 1.22). Mortality did 1101 differ for the first
five years after retiremenl at 60 compared with continuing work at 60 (1.04.0.82 10 131).
CONCLllSIO"S
Retiring early al 55 or 60 was 00( associated with beucr survival than retiring al 65 in a cohort of
pastemployees of the petrochemical induslry. Monality was higher in employees "110 rerired at 55
than in those who continued working.

l/JMJ 2005:331: 99511m<ndc<lwith permo,"," from.'" SW I'IAIll>h ng Groupi

Note: Slightly dIIferent h~dlngs are used in some journals. For example. Th~N(W Englond
loumal of MNlictn~ d.vldes articles Into Background. Methods, Results and ConcluSions. You
must consult the GUide to Contributors for the precise requirements of the Journal you wISh to
contribute to.

12 Professional EnfI&h .. 1M -...

4
58.1 Completerhe senre0.. .... I "ul Jt 8 OPI'O'It< It) help )UlI.

Pro( ess IO<IO' Enpsh on Use I

M<doone 25
 I The " the .IIm or purpose of the re-c.irch.
2 The .. , "tht locanon - the country, or parr of n country (e.g. J hc)\pu.ll.
school, erc.).
3 The . are rhe people that the researchcr-, studied,
4 An _. " d result,
5 The I) the 1\1'<' of srudy, for "ample randomized controlled nul.

58.2 Answer me qu<stIOf .. about the abstract in 8 opposite.

1 Who took pan on the ,tud, ?
2 What was the 31m of the 'IUd)?
3 \Xlhere was It carried out?
4 What did the) mt,mlt'''?
5 What type of stud) W.I\ OI?
G According to th" "ud" dllt'> retlnng early prolong life?

58.3 111<>' eaion, of the ..... tr.l<. hrkl\\ Jrt' .n tht wrong order, and the head.nlt> have been
removed, Occult- the "~1 ,>nkr. and grve each 'oC\.t.on J rule from 80ppo\ltt.
1 I ngland, Scotbnd, and \\ ab.
2 l hsrory of asthma, whee" bronch.t;", or "herlln!; obt.nncd (rom onten,<", wuh ,u1>",,'1>'
parents ar 3ge< ." II, and 16 and repoered at .ntervlew h) subjects at as... 23 and II.
3 To describe rhe mcidence ] ... 1 of wheezing illnes from hlrth to age 33 and the relanon
01 incidence to pennaral, medical, social, environment .•), and lifestyle (actor>.
4 The cumulative mcidence of wheezing illness was 18% by age 7, 24% by age 16, and 4J~o
by age 33. Incidence dunng childhood was strongly and independently associated with
pneumonia, ha) (e>cr. and ecaema.] .. .l lncidence from age 17 to 33 was associated ~troogly
with active c.prme \lnolonll and a hisrory of hay fe,er. 1... 1
5 Atopy and acnve c.~rm~ ~ong 3« major .nflueIl<-e;, on the incidence .. nd ....:u rreoc'" of
whetlinlt dunng adulthood.
6 18.559 people born (>II \-'1.\l.m:h 19.>8. >SOI 01"'0) conmbured onfOnn.ltlOl1 .. t JIlC> -. II,
16,23. and 33 )eJI'>.
7 Prospecnve longlludlnal \Iud"
IBMJ 200~. N"flldrc' with j)<,m"_ 'rom ..... 8>.4)""" """'I G.... pl

58.4 Some journal, u....d.fferent hrJdon,:~ to rh,,,. III the IIM/. Mnrch the hc.don!:, (I-I) tel
the correspondmg 8M} hr.dong, (.-el.
I hndings
2 Purpose
3 Il"ckground
4 Imerprernnon
5 Participants
a Introduction
b Objective
c Subjects
d Results
e Conclusion

12 Professional EnfI&h .. 1M -...

4
Conference presentations
The structure of a presentation
Conference (or congress) presenranons arc typically divided inm IMRaD secnons (see
Unit 57).
If the presentation has a differem form, the speaker may Start by outlining irs structure,
This helps to orientate the audience:
I'll begin by ...
First of all, I'll ...
I'll then ...
Secondly. I'll ...
Finally, I'll ...
Many speakers like ro starr a new section with a signal:
Now, ...
Moving on to X ....
A~ for a~ X is concerned, ...
An .ilrernnnve technique 1$ to use 3 question.
How did we invesrignre this problem? (to introduce Method)
What did we find? (to mtroduce Results)
How does this compare with previous studies? (10 introduce Discussion)

The introduction
A formal way of beginning is:
I'd like to present to you the results of our research into ...
Many speakers prefer to begin in a less formal way:
When we first began to look into the question of X, we thought ...
You may wish to begin with a generali"ttion or reference to shared knowledge:
It is well known that ...
Many studies have shown that .. ,
X has established clearly that ...

Signalling
Other signal, th at IOU may wish to give include:

Profe•s.,,,,,, English In 1M 127

M_
 Emphasizing Giving examples
• I'd like to emphasize ... • For instance .
Listing points • ... such as .
• Firstly, ... Contrasting
• Secondly, ... • On the other hand ...
Referring to slides • In contrast ...
• This slide shows ... • However, .•.

The conclusion
It is important to end well, for example by summing up the main conclusions.

So,
In conclusion, we can see ...
To sum up, I'd like to 5.1)' end by ...
Finally, these srudies show ...

12 I'ro(essionol En""" 11 u..

6
-..
59.1 Hcre arc .(JIllC exrracts from ~ presentanon on cnrbon monoxide poisoning, After
announcing hrs ropx, the speaker talked about rhe p.lIhophysiology of CO poisomng,
then rhc possible sources of rhe gas, and finally diagnosis and rrearmenr. Pur Ihe extracts
in rhe correct order.
1 There is, however, no evidence at all rhar giving steroids in pharmacological doses IS of any
proven prophylactic value ....
2 How do we diagnose II: The early clinical appearances of carbon monoxide poisoning can
be very non-specific ....
3 $0, the actual diagnosis of the condition can be very difficult ....
4 I'd like to tell you about some of our experiences in relation to carbon monoxide
poisoning ....
S On the slide here, you'll see that there are a variery of SOUI'CCoSf carbon monoxide. such 3S
car exhausts, fires, and so on ....
G First of all. I want to concenrrare on smoke from fires as one of rhe most unportant sources
of carbon monoxide ....
7 Now. III relation 10 rhe treatment of carbon monoxide poisoning, 100 per cent o'<}gcn
ndrniuisrercd rhrough a nght-fitting face mask or endormchenl robc i; essennal. ...
8 I think il\ importam 10 empha<i7.c ,hal rbe presence (If cherry-red mucous membranes IS.
very. very poor sign ....
9 Now, you witt remember thar carbon monoxide strongly binds wirh haemoglobin 10 produce
cnrboxyhaemoglobm. .. _
10 The only accurate way of detecting wherher rhe patient has been exposed to carbon
monoxide is to measure carboxyhaernoglobin in, usually, the venous blood _

59.2 Wrile rhe word or phrase used b)' (he speaker in the presentation in 59.1 above nexr to irs
function. Look at S, C and D opposite '0 help you.

Emphasizing
Listing
Exemplifying
Contrasting
Sunlllling up
Changing 10pie
Referring to a vlide
Announcing rhe lOP'C
 Case presentations
Sections of a case presentation
In a case presentation, a doctor presents the derails of II patient's case ro colleagues ar 3
clinical meeting In a hospiral, A ')pic.1 case presentation is divided i11l0 the followiog
sections:

Section Example language

Inrroduction I'd like '0 present Mr Simpson,
Patient's age and occupation a 34-year-old plumber,
Presenting sympromts) and who presented with a one-month history of breathlessness.
duration
Associated symptoms He also complained of ankle bwcllin!! which he'd had for
[\\'0 weeks.
"O\t medical h.stol'j' There \V~lSno relevnnr I)ost history.
Social hislory He wav married with one <on. He smoked 25 cigare rr ",
a day and drank abour 50 units of alcohol per week.
Family h.srory I Its !'ather died of myocardial infarcnon 31 the age of 42.
His mal her was alive and well. Findings
on examinanon On exnminarion, he was OI>eSl' ••• Investigation

results We did a chest X-ray which showed ... Diagnosis

So we thought he had ...
Trearmenr \Ve gave hirn intravenous furosemide and , ..
Outcome - what happened He responded to treatment and was discharged home.

Bedside presentation
A les~ formal type of ease presemarion Can take place at a patient's bed. for example
during ward rounds. when the house officer presents a new patient (0 'he consultant: or
in a reaching ward round. when a medscal srudenr presents a en," to 'he rutor, 1111S type
of presenmrion begms ks> formally: ~
~ ~ft
This is Mr Simpson. He', 34. and he's a plumber. He came iuro hcspirnl )'tSttrday.
senr by his GP. He's complaining of brcarhlessocss, which he's had for one month ...

Slides
III a formal presenrarion, the main points arc usually summarized on slides.

Mr Simpson 34, plumber

cIa dyspnoea 1112; ankle swelling 2152
SH married with 1 son
25 cigslday: 50 units alcohoVweek
PH nil relevant
FH father d. 42 MI; mother a&w
OE obese; 2 spider naevi on chest
P 11 O/m.n reg.
BP 100/60
CXR enla~ hear1 and hila!. pleural effusions

12 Prof.... .".' Engfish in the_

8
60.1 Write rhc abbrevianons III words. Look at Look at A and C opposite 'lIld nI Append,x II
on page 131 ro help you.
do ..
2152 _ _
PH _ _
 FH _ .. ._. _
MI
BI'
1112
nil

a&\v
--_ ..... ......_--
SH ...._ ....... _ ..... _--_._---
OF.
CXR

60.2 Pill the secrions of 3 shan mform .• 1CdSC presentation in the correct order. Look 31 A opposue to
help you.
1 Mr Collin' I< a 60'year-old secU<l1) guard.
2 There was no relevam previous medical hisrory,
3 He smoke, 20 cij:.,,,,tTe'> per da) and drinks 15-20 units of alcohol each week.
4 On examination. there was marked tenderness around rhc lower legs above the ankle:. and
knees. There were crackles ar rhe left base posteriorly in the chesr. There was nothing else
abnormal to find on examination except for clubbing of the fingers.
5 He presented with a six-week history of pain in rhe legs.
G Chest X·ray showed consolidation in the left lower lobe. Bronchoscopy and biopsy showed
adenocarcinoma of me lung and computed tomography (CT) scan showed that rhis was nor
resectable.
7 Trcarmenr with chemotherapy has resulted in temporary improvement in [he chest X-ray bUI
the leg pain has continued 10 prove difficulr to conrrol.
8 The pain, which was located around the ankles, had been increasing in iruensiry and w
••s associated wuh local tenderness.
9 On rounne quesuomng, he said IhJI he had had" morning cough wirh small amounts o(
while sputum for man)' years, He produced, once, some streaks of blood In Ihe spurum.

60.3 Read the present.men below and make notes for" slide, Look 31 C opposite to help you.

I'd like ro present /\Ir :>IcN.rnara who's a 63·year-old mxi driver who presented 10 rhe
Ourparicnr Clinic with a rhree-rnonrh history of increasing shortness of brearh and ankle
swelling. He had a chronic cOllgh wirh purulent sputum and occasional hacmoprysis, Of
nore in his past medical historj was that he'd had a partial gastrectomy in 1980.
On examination, he was pale. He was apyrexial. He had leg oedema. but 00 dubbing
or lymphadenopathy. And examination of his chest was entirely normal. His liver was
palpable 5 centimetres below the costal margin, and was smooth and non-render; and mere
was also a scar from his previous operation.

over .f"o /10ll ~

Makt' nutrs abuut ~IP~lllt"'1 VUU knuw ;uHI pr;u:tt.,l' IlH'''l'lltilu, hun or her.

ProfeSSIon.' fnps~in Us. _ 129

-
APIJl",ull ..

I Parts of the body

 1 ear
21 2 cheek
3 jaw (m~ndll>l<'
4 ned.
5 shoulder
6 armpit (axilla'
5 7 upper arm
8 elbow
9 loin
10 fo rearm
11 buttock
~27
12 "n;t
13 hand
14 thumb
IS nrn:tt
29 161hlgh
30
17 calf
18 leg
19 fool
20 IOC
21 half
22 forehead
23 nose
24 chin
16 25 Adam's apple
(Ial")ngeal prommeoce)
26 chest (thorJ~)
27 nIpple
35 28 b re as.t
\
29 ssomach, remmv, hell}
(abdomen)
11 30 n ave I. helh ""1((00 (ul11hll"'UII
31 hlp
36
32 palm
33 IlTOm (1I1l\ulllal tqlIon)
34 genil.l;
(penis and IC\"d~)
37
35 knee
(patella = kneecap)
36 shin
37 ankle
40 39
38 big tOC
/
, 39 sole
40 1>«1

back

bUIlOCk---l--t
Medical abbreviations
Ahh"'v,a"(l11 (I, M""nong
symhlOl

,
t mcreased/raised
ckcreascdImluctd
? frmale
0'" m.ak
~moVL mKromols per lure

~A mxrogram
1/12 I month
lin • wee],

IO'/L lin ..... ren '0 ,he power none per lure Inoce ~u""r\<np, '11
A&E ~«,den,aod eme'l:.~)
a&\\' ahve and "ell
.I.C. before mealslfood (I..",,)
a.rn. on the mornong (L.",,)
A:C albumen globulin rnrio
All apex beat
ABC auways, breathing, circulation
.hd/.hdo. abdomen
ACTI-l acltenoconiccxrophoc hormone
AF a trul libn II. IIOIl
AFP alphJ(etoprotCln
-

'" IA Are •• I tealrh AuthorIty

AI .iornc tnccompereuce
AIDS a,qu,mIlmmunodetk,cncy di..co ...
AJ ankk Jerk
alk. phos. alkaline phosphatase
ALT alamoe aminoc:ransferJsc
AMA American :l.ltdieal AsSOCI.I,ion
AN antenatal
AP antero-pesrerior
APH antepartum hnernorrh;tf4C
ARM JIt,6ct.1 rupture of membranes
AS 3bmcnlM) system
ASO 310.1 sepul def
ec" ASO an"strq>CoIY>ln 0
A1'$ annretamc serum: enure •••nu~
serum
AV~ JUl\mellled \,01,31\0 fom

p",r.. ,ionol Efttlislo .. 1M _ •3I

 Ahbn-viation IIr M"anm9
>ymhol
AVL augmented voltage left arm
AVR augmented voltage right arm
b.d. I b.i.d. twice 3 day (Larin)
SAL blood alcohol level
SB bed bath; blanket barh
IlIIII bundle branch block
IlC bone conduction
IlCG bacille Calmenc-Guerin
Ill' breast fed
III bone mjury
1110 brought in d e,id
BII'P bismuth iodoform and paraffin pnsre
BM bowel movement
BMA British Medical Association
BMJ Brirish Medical journal
BMR basal metabolic rate
IlMS<: Bachelor of Medical Science
BNF British National Formulary
BNO bowels no. opened
80 bowels opened
BP blood pressure
8PC Bnnsh Pharmaceutical Codex
IWD b"pantt,,1 diameter
8S breath sounds; bowel sounds
8S Bachelor of Surgery
BWr birth wtlghr
C head presenrarion, centigrade; Celsius
c I c. wirh (Latin)
c.c, wirh meals/food (latin)
do complains of
CA/Ca cancer; carcinoma; calcium
CAI~G coronary artery bypass graft
CAl) coronary artery disease
c.•pt. head PI'<';<:I1I.\IIon
reAl' coaxial or cernputcrised axial tomography
CIlT cognirive behavioural rhc.'..!'y
CCI' congest;' e cardiac failure

132 Professionoj EngflSh.. 1M M.mc..e

 Ahhr"VI.lt Ion or ~kar"nq
Iioynlhlll

CC1 Urt,n.:ate of Complttron of rrarnrng

cn complement fixation ''"''
ChB Bachelor of Surgery
CIiF chrome heart failure
Chr.cr chrome cardiac failure
css morral nervous system
CO u~u.tlt) ofti..~r
-

~()AI) chron .... obstrucnve :llr\Y.I)' di"('\I~

COP <h.,nlte "I pl,,;ter
(.PN commumry ps\'(hiactic nurve
crepe ll"t'plfJUnn\

CS~ ,",,"rosp'nJlllu,d
CiSO Centr.1 Srenl e Suppl) Depo'
CSU carbeter specimen o( Linne
CSW cluneal support worker
cr cerebral tumour; coronary thrombosis, computerized ,omography
CV cardiovascular
CV\ card,o\J'lCular aoodenr; cerebrovascular acodent
CVS (.;1r<llo\ J)f.:ular system; cerebrov ascular sYS,C(1l1

Cx crr\ .,
CXR (h.-, )I..r.lY
I) .11\ oreed; dlcdlde.d
~&( d,b'J'Kln and curettage
D&V dlJrrhc)('.l and vommng
DO d.n!!erou, drugs
OOA Dangerous Drugs Act
decub. Iyrnll down (Latin)
DlC drunk on charge
dl deotnre
ON ~rn.;, ,","",
DNA did nOt Jttend
DNA dco\)rrbonucleic acid
DOA dead on .rr1\31
DOR date of birth
OR( (X. Orrk'rtU flf ,he Ro).1 College of O"-'etnO.ns and (.jrun.-ol<o!:u",
ORO 1>,,,,b1emenr Rt\tnleme", Of';".
d,,<cnlln.,ed ",Ier,,,,,
~

Pro,....ionoI fIIPsh .. Use ......... III

 Ahhrl'vlal!on or Mcaninq
symbul
DTs delirium tremens (Latin)
OU duodenal ulcer
OVT deep venous thrombosis
OWl' Deparrmenr for Work and Pensions
Ox diagnosis
E electrolytes
EBV Epstein-Barr virus
CCI' extracellular fluid
ECG eleerrocardiog
mrn
ECf electroconvulsive therapy
i--
EDC expected date of confincmenr
EDD expected dale of delivery
EOM early diastolic murmur
EEC electroencephalogmm
ENT car, nose and throat
ESN educationally sub-normal
ESR erythrocyte sedimentation rate
Err exercise tolcra nee test
EUA examination under anaesthesia
F female
fb finger breadth
I'll fore.gn body
1:IlC full blood <OUIlI
~H feral heart
FH farmly history FHH
feral heart heard FHNH feral
heart not heard n f fL
femrolirre
F.'vlFF fetal movement first fclt
FOB faecal occult blood
FPC family planning clinic
FRCS Fellow of the Royal College of Surgeons
fSH follicle stimulating hormone
FrAT fluoreseem rreponcmal nnrihody resr
1:-rIlD fit to be derained; full term born dead
FTND fullterm normal delivery
FUO fever of unknown origin

I 34 PrD{os.lonol fnrIish .. Use Medoane

 AhhrrVI.111l1n or ~k.ln"l(J
~v'nhul
FYI , Fouodauon Year I
I'Y2 Foundanon Year 2
S gram
G gra\ldlt)
gIL grams per litre
Gi\ f;~rJI anaestheoc
j:J1I bladder
~
f;enddl condmon
~
~r gonococcal complcmcnr fixnuon fe",
GCS GIl,It,,,, ('clllla Scale (,1\
p"l'< ...ntesnnal system
G~I(. <..m.-ul \lnll""
COIIII"I
GnRH SooJd.>trophm.releaslllg hormone
GOT gluln.ttk O, .. loaceric rransamin
.,.se CI' C.encral Practirioner
GI'I general paralysis of the insane
GPT gluramh.: P) ruvic transanunase
GN ghcen I mrutrate
err glucose 101, ra 0<.., rest
~
GU gJ"trk,; ulcer
~U~ genuo-unn .•r) ~)'s,elll
('l' (.ra),
~
GIn. S) IIJc<ol'lIl)
11&1' hl\lot) Jnd "",'Sical exammauon
lib fllgh hJc""'!:i,)hm
HilI' high blood pressure
He, I Hcc haematocrir
HDU high depeodeney unir
HHV·S berpes virus 8
rhuman]
HI8 HarmophllU$ mIIUCIWe B
HIV human nnmunodcficiency virus
HO house officer
HI' hou~ ph)'~I'IJn

~II'V hunun paplliOlna viruv

hrdn rare
~
hr.n "lUnd,
~
l1V~ high ','1:111.11
swab
I'ro(euionol En""" .. Use _ IJ5
 Abbrrviation ur Ml'"nm9
symbul
18S irritable bowel syndrome
ICF intracellular Auid
ICS intercostal space
ICU intensive care unit
to infectious disease
Ig immune globulin
i.m./IM intramuscular
IMRnD introduction. method. results and diSCUSSIon
in(u~1'I infusion
IOFIl mrra-ocular foreign body
II' m-parient; interphalangeal
IQ mrelligence quotient
ISQ condition unchanged I in sraru quo (Larin)
IU international unit
IUD intrauterine (contraceptive) device
i.v./1V intravenous
IVC inferior vena cava
IVF in vitro fertilization
IVP intravenous pyelogram
(VU intravenous urogram
Ix mvestigarion
IZS msuhn zrnc suspension
JA,\IA Journal of the American Medical Association
JVI' jugular venous pressure
K potassium
KUB kidney, ureter and bladder
L lefr
LIL lirres per lirre
LA left atrium; local anaesthetic
LAO leh axis deviation; leh anterior descending
LBP low back pain: low blood pressure
LOH lactic dehydrogenase
LIS lupus erythematosus
LFT 11\er (unctIon test
til luteinizing hormone
LHA Local Health Aurboriry
til' le(, Iliac (ossa
 nuJdfmuk
mlr

o( Mc."(lu:inc
d,ameter

medical care practitioner

Mev mean corpuscular volume
MD Doctor of Medicine
MOM murmur

: myocardial

I'ro(eulonol En""" .. Use _ 137

 Abbn.·vlallon or Mcaninq
symbol
MMR mass miniature radiography; measles, mumps &
rubella
MO Medical Officer
MOH Medical Officer of Health
MOP medical out-patient
MRC Medical Research Council
MRCI' "!ember of the Royal College of Physicians
,vIRI lnagncnc resonance imaging
MS nur ra 1 stenosis. multiple sclerosis: usculoskekral
MSSU m
rmd-stream specimen of urine
MSU mid-vrream urine
MSW Medical Social Worker
MV!' mum I valve prolapse
NA not applicable
Na sodium
NAD no abnormality detected
NBI no bone injury
ND normal delivery
:>1£ nor engaged
NHS "'ational Health Service
NIC Narional Insurance Certificarc
NMC Nursmg and Midwifery Council
NNI) neo-natal death
UOCIC JI nighl (latin)
NOt' neck of femur
NP nOI palpable: nasal passage
N!'O nothing by mouth (Larin}
"'PU nOI passed urine
NS nervous system
NSA no significant abnormality
NSpCC Xational Society for the Prevention of Cruelty to Children
NYD not )el diagnosed
o.d. dailj (Latin)
OlE on examination
OA on adnussion: osrco-arrhriris
OAP old age pensioner
Obs. obstemcs
OIlS organic brain syndrome

138 Profmioool En"..,. II Ust -..

Ahhrt'VI.I(tOI1 or Mr arunq
symhol
oed, loedenu
0,\1 orili> nltdla
0011 OU' 01 hours
OI'D ourpanent department
oscr Obieenve Srrucrured Clinical Fxanuuanon
OT opn'OIunlt'i1carrc
OT o.;,'Upauon.,llheraplsl
p pul~ pro"con: p.lrof)
p.c. .,(,er 01c,,1..111l1li1(LJrn,)
P,II1. on ih e a frernoon
(LlIin) p.(). h) m"ulh
II.mn}
p.r. h) rectum LaMI
p.r.n. 3S required
p.v. b) \ agona (l.ann]
PA pt'miC:IQu.) anaemia
Para. 2 + I full term pregnancies 2, oborrions 1
PAT 1"'.0'1>11\31 amal tachycardia
1'81 protein bound oodine
1'81 probkm-bJ>ed learning
rOA patem d"ctu, artenosus
PFRL.A pupIls equal and reaetivc 10 liHll1"",I nceonunodanon
PET pre-eclampr« lo,acmi.1
I'll pa" h'''(lf)
1'10 probr-N mterverrebral <1,,,,: pel"" mllammatory d, .... ,<
PI. plJ-=
PLAll Profc>sion.,1 and Lmguisric
A,,,,,,mel1[BSoard
PM postmortem
PMB postmenopausal bleeding
P.\Ui past medJol hssrory
PI' postnatal
('ND pos""".1 dcpre.slon: p.roxY'IlI,,1 nocturnal dyspnoea
POl pressure ()f oxygen
POP pla".r of Pans
1'1'11 pchlpartUIlI haemorrhage
PRIIO I'ro\o5o<..... II, ·I'qtl'trred hou""
oftker
PROM prem."u", rupeure o( membrane,
rsw Po,),h'JIfI, Sooal Worker

I'ro(euionol fnp.h on Use Me60ne 139

 Ahbrcviation or Ml"anlO9
symbol
PU passed urine; peptic ulcer
PUO pyrexia of unknown or uncertain origin
PVf paroxysmal ventricular tachycardia
PZI protamine zinc insulin
q.d.s. I q.i.d. four nOlI'S a day (Latin)
R righr; respiration
RA rheumatoid arthritis; right arrium
RAO fight axis deviation
RBC red blood cell (count); red blood corpusclev
RIIS random blood ~Ul\r'
RCA fight coronary artery
ref. refer
reg. regular
RGI': Registered General Nurse
Rh. Rhesus factor; rheumatism
RHA Regional Health Authority
Rl respiratory infection
RlF right iliac fossa
RIH fight inguinal hernia
RLI fight lower lobe
RLQ right lower quadrant
RM registered midwife
~MO Regional or Residenr Medical Ornecr
RN regisrered nurse
ROA right occipital anterior
ROM range of motion
ROP right occipital posterior
RS respiratory system
RTA road rraffic accident
RTC return (0 clinic
RTI respiratory tract infection
RUA right upper arm
RUQ right upper quadrant
RVE fight ventricular enlargement
RVII fight ventricular hypemuphy
Rx rake (in prescriptions); rrearment (in case norcs) (Larin]
5 single; '1I~1r

I 40 Pro(essionol English II! Use Mediane

Ahhrt'VI,ltuln or Mt'.lfllng
'Yl1lhol

s.1. ' subhngual

SAH I subarachnoidal haemorrhage
SB snll-born
SBE sub-acute bacrenal endocarditis
sep, "'1'.Jr.tW
SG spec,fic gravity
SH '(1(1.11hl<tory
SHO ""111(1rI louse Officer
51 \,Jl,.ro--llt;ll

'.g. ...ntclbbd un prc-.;roPU01l\) (Lann)

sl. ,I,dtt
SM ..~\(oll": murmur

SMR sub-mucous resection

SN srudenr nurse
SOB shorr of breath
SOBOE \hun of breath on everncn
SOP "'''Il''"'l our-pancnts
SpR ,,,,,,, .. h,,, rtgisrrar
SRl': "~te Rqmttred I\:u""
SRO!.I 'I'<lIlWlCQUS rupture ot membrane,
'tat. 1000lwl.nei) (Larin)
-
~r. "'''"t.I1') row cis
SVC \uprrl()r vena cava
SVD 'pon(~ll('()uS vertex dcIIVtt)'; sponr .m. eous vagmal drh\t'"
sw I S\\'. w.~b
SWO ,!ton \\J\C durherrn)
T temperature
T&A I roosrls and adenoids
t.d.s.! t.i.d. three rimes a day (Larin)
T, trHodothrronine
T. t<1rJ',ooOthrronine
tab> tJblet,
T8 ruhercul""s
II t"''''rod '",'Ompetm.:c
riA trao\tent I",haeml": .1tt.H.;~

'1M transpon medium

-
Prof."io"'" fnrIoSh .. Use _ '4 ,
 Abbreviation or Meanmg
symbol
TMJ remporo-mandibular [oinr
TNS rranscuraneous nerve stimulator
TOP termination of pregnancy
TI'HA treponema pallidwn haemagglurinarion
TPR temperature, pulse, respiration
TR temporary resident
TRH thyrOirophin-releasing hormone
TS tricuspid stenosis
T'SH thyroid-snmularing hormone
TT tetanus to)(old: tuberculin rested
TURI' transurethral prosrare resection
TV rnchomonas vaginalis
U urea; unit
U&E. urea and elecrrolytes
U/L units per litre UGS
urogenital system
UMN upper motor neurone

URTI upper respiratory traer infection

USS ultrasound scan
UVL ultra-violet light
VD venereal disease
VDRI. venereal disease res earch laboratory
ve vagm.,.1 cxanunarion
VI virgo intacrn
VI' venous pressure
VSD ventricular septal defect
VV varicose veints)
Vx vertex
W widow/widower
WBe white blood cell COUn!; whire blood corpuscles
wee white cell count
WHO World Healrh Organization
WNL within normallirnits
WR \'('a.ssc.rmann rca cri on
XR X-ray
YOI~ year of birth

14 Profe.sionoI¥h III Use

2 M<diane
Types of medication
capsules uuecnon omrment

solution spray suppository

,)'rup inhaler

Oinrmenrs are 1t~~"C" than <~~" ~ ~ ndhave J thllk er revture. ,,"S makes thrm .dhnr ro
thr Jllmrd 3= Iol~r. Croms J~ mo~ 3Cttp(Jblr <o~mrllcJII)' and rend 10be used on Ihr I~
as Ihc) are los ",,,blr. Paslo J'" \tllfn p"'p;lrnuon, wh,d. <0011311m1ore powdered WlIo.d..
Locions arc hquid and u~ ,n a",., sl"h JS tbe scalp where nn ointment or cream would Jdhr~
Ie) Ihr
l1.Iir.

Professional Enfll$l> .. Use _ 141

App,',ull.

IV Symptoms and pain

Asking about symptoms
Pain is one of me commonest symproms,
For headaches, a doctor would expect to establish mosr of rhe feaiures below, Similar
questions can be used for other forms of pain.

Feature TYPIcal question

Main Site Where does il hurt?
Show me where it hurts.
Radiation Does il go anywhere clse?
Character Can you describe the pain?
Precipiraring facto" Does anYlhing bring rhciu on?
lime of onSCI Whl'll do Ihey !l[\rt?
lime of resolution When do Ihey stop]
Frequency How often do you gel them?
Aggravating factors Does anything make them worse?
Is there anything else that affects them?
Relieving facrors Does anything make them bcuer?
Associated features 1)0 you «"Ianything else wrong when irs there?
Have you any other problems related to the pain?
Duration How long do they last?
Severity How bad is it?

Description of pain
Patient's drwription of p.un ExplanatIon
aching / an ache a general pain, often in muscles and 101nt'S
boring like a drill
burning with hear
colicky an interrnirtenr pain which varies in intensity, comes and
goes in \VaVCS
crampy/cramp an involuntary spasmodic muscle contraction
crushing a feeling of pressure
dull a background pain, opposite of sharp
gnawing biting
gripping a feeling of rightness
scalding like boiling water
sharp acute
<tabbing like a knife
sringing sharp, burning, like an insect snng
throbbing wit It •• pulse or beal

14 Pro{.SStOOOIEJ>pth ., IM
4
Verbs used in instructions

Pro.(.e;M.' fnglis~in 14
5
Ike_
 bend down put your head down
put out YOUT tongue

breathe in raise your leg

breathe Out

dose your eyes roll on to your back/lronr

roll over
roll up your sleeve

curl up sit
sit up

do this slide you,' hand down

your side

follow my fingenip slip off your coat

with your eyes

keep your knee srraighr stand straight

stand up

let your wrist go floppy take off your top things

lie on your .ide/back

lie on the bed/conch
lie down

look srraighr ahead touch your shoulder with

look at something your chin

open your mourn turn your head to the left

turn on your side

point to the finger that Other insrructions:

moves
relax
show Inc what movemenrs you can manage
pull .5 hard .5 you can tell me if it hurts

push ns hard as )'OU can

14 Pro{.SStOOOIEJ>pth ., IM
4
AfJ,Jl'lullx

VI Lay terms and defi n itions

F.xplanarions should be given in words rhe paricnr will undersrand, avoidmg medical
jargon, Using la)' terms - words familiar co people without medical knowledge - can help
patients understand explanations,

Some lay terms for medical conditions

Ml'dical conditions Lay term acute

cerebrovascular event stroke arrhythmia
palpitations dyspnoea
breathlessness fractured neck of femur
broken hip hnemaremesis
vomiting blood
haematuria blood in the urine
insomnia trouble wirh sleeping
-
inrermiuenr claudication pain' in the back of the legs when walking
myocardial infarction heart arrack
nocturia needing to pass urinc (water) at night

Some lay terms for medication

Medical conditions Lay term
analgesics pain killers
anti-depressants tablets to improve your mood
a nri-infla mmarories medicine to reduce swelling
broncho-dilator a substance which causes the airways to open up
DMARDs (disease modifying pills that help stop arthritis progressing
anri-rheumanc drugs]
diuretics water tableis
hypertension rnedicanon pills (or blood pressure
hypnotics sleeping rableis
oral conrmcepnves rhe pill

Simple definitions
Most patients do nor ha, e an)' medical knowledge, so ir is imporranr 10 use simple words
they will understand when mlking abour certain parts of rhe body or medical conditions.

Medical term SImple definition

arteries rubes which carry blood around rhe body
benign not due to cancer or infection
bronchi airways that connect your windpipe to your lungs
cholesterol (ar rhar clogs the arteries
intervertebral disks shock absorbers which separate rhe bon", In your back
oesophagus the tube rhat connects the back of rhe throar to rhe stomach
I- -
 pancreas a gland rhar helps digestion and makes in;ultn to control blood sugar
rhyroid a gland rhar produces some of rhe hormones required III dally 11ft
urethra the rube rhar carries urine [rom rhc bladder

I 46 Pro(e$$ionoI English .. list Medictne

 Answer key
1.1 Nuun Adl<rtIVl'
~tness ~r
health h""lrhy
Illness III
sickness "ck

1.2 cornplererermssion
feel sick
get over
poor healr h
travel siekne«

1.3 well 2 IIn".IViIVpoorhl, ...l 3 he.hh 4 fir 5 well 6 '>el 7 ""k 8 IlInn'oC'>

1.4 dereriornied 2 recovered 3 ~lCkne<;, 4 recovery 5 good 6 !lor over 7 unhrahh)

2.1 Anatomical term Common word

abdomen sromach, rummy
axilla armpit
carpus \\ rist
coxa hip
cubitus dhow
mamma breast
nares hll"ock~
patella kl><=lp
2.2 .1' che« 2 mto 3 _klj." 4 ,hmlld.r 5 dow" G arm
h 1 in 2 !lMIII 3 down

2.4

loin wnst
.rm

3.1 'windpipe 2 lung 3 lobes 4 diaphragm 5 airways 6 heart 1 brcnchroles

3.2 te, u. 3d. 4jt. Sa. &C, 1b, 8h

3.3 'organs
2 liver
3 AnII bladder
4 kldn.)
5 kldne,
6,plrm
7 bladder
 ()\ er to ) OU- \..lInpk anvwer

11,. spleen ",,,u>ted em !he upper letr "de of rUtor .ilxlomen, under vour n!>.. h .I.!>.'. filter.
helplng!Cl d!'>!ro) old. \\Om-(IU! blond cells. It ul-o produce, cells !h.lt help "ro!C\.! )'our bod)'
from mfeeuon.
The pancre as I~ a gland deep mside your abdomen, behmd your liver, It nunTl.II) produces
insulin. which lour bod) needs to help it store .II1d u!ili/t glucose. and \0 " " rmponanr III
controlling the amoent of sugar in your blood.

4.1 Ib, zd, ~ 4c. 5.1

4.2 numbness 2 >\\~IIO\\lng 3 pa~lIl!t urme/w.ller 4 sweanng 5 >h.le 6 breathing

4.3 chew, ." .lIow 2 ".» 3 appenrc 4 have 5 sen", 6 breath

Over '0 )OU - sarnple ."'wer

I Do lOU P'" water more than u,u.,I?
2 Do )OU dnnk m()r. than u>ual?
3 ~'ha.\ )ClUr .ppclll< hle'
4 Is your \1gb'" I,aclll nc>mul?
5 H,.·. )OU nocl<ed .0\ numbness In lour h.neh or I""I?

5.1 I A dcrmalOlOSl>l ,,,,,,,,ahu<' b 3 speciahsi In d,\C,..." of rbe sian.

2 A rheumJ.oIOj:l" spec •• hzes' is a 51'<"",1". "I do<.a<;e<; of me ioinrs,
3 A traum,!oIOSl'! spec .. IIl'" I is a specialisr In accident and emergency medlune.
4 A paediatrician specializes' is a specialist in diseases affecting children.
5 An obstetrician specsalizes I is a specialist in managing pregnancies.

5.2

5.3 1 speoahzes In 2 "<>rllllg •."h 3 mrcre-red rn 4 good a' 5 good ""h

5.4 consulang I"OOIlll.

general prscnnoner
general pracnee
group practice
health centre
infernal rnedione
surgical speculnes

O'er to IOU - ~lInplc dn,"er

To be ~ 'U'l!eClO )00 need to ~:
good \\ IIh ) uur h.nd,
mreresred In .llUt("">
abl e t o "'pcJ' II>.: .... 'ne 'hll\1: \\lIhoUI g<"II\): h<,rcd
able ro make d""MK" I.,!

148 Pro(ewonol &tpsIl .. 1M M<dion<

6.1 ",,<)C,.tle'I'<·(,.Io't prU\"\lnn.,1 (_h.1StIlO'I\
house Orfill'r r...ho I'.~cr
011 CJII
waed round
6.2 tc, 2.1. 3,. "". 51>

6.3 1 false - After a yell; be or she becomes 3 registered medical practitioner

2 (rue
3 fal"" - the old tenus senior bouse officer and SHO 31"estill used
4 foist - the)' art usuall) seen fir;t Il) one of the junior doctors
5 Ialse - Junior doctors no" nonn.lh work in shift, ... fur example 7 am to l I'm ... or 11
pm to - am. Ibe altemanv ">!em', to wor], from 9 am to ~ I'm t,tr) d.~.nd 10 "I.
turns 10 be on <.111 •

6.4 .Iuf, 2 .<lm.",.on> 3 d.rl. 4 round 5 to>" G drscharged 7 tramIllWlounda"o"

7.1 lIudw,I,· 3 nur,enll .lUxiliolf)' 5 hcnh h visitor 7 d"trcll

2 dill,.,,1 ,ul'l'on worker 4 " ••11 G clurgc 8 \\ ard clerk

7.2 ,arl) Oil' • I'",,,dure

change a dre",ng
check tbe temperarure
give an 11l1l"\.110n
remov e )uturt-\

7.3 to perform 2 W3S performed 3 be performed 4 be performed 5 performed

7.4 10 (J~ Out 3 have been earned out 5 be earned out

2 have been earned OUI 4 \\a, .. rned OUT

8.1 ambulance rechruc••n

art,ficiallll"h
dub (001
contact 11.:11\
he ••lrh I'",fcwunal
mrraocular I'"",ure
occupanonal theral""
social \\ orker

8.2 1 soc ra1wnrktr 3 opncun 5 social worker

2 physiotheraprsr 4 pro.tbeu\I I occuparional therapi,t 6 chiropodisllpod,.rriST

8.3 1 arnputanon 3 rhcraptSt> 5 splints 7 reli eve

2 limh 4 rdJabtloul1OO 6 deformit)ldeformines

9.1 Vl'fh Noun

ad'rnu Jd'ml~slon
n'sse» ••·\~\nl('nt

~1.ItI(C ·d."h.rg<
'oper.lle' c1rt'r· ...non
re'frr -i rc'tcrrJI
'{1'C'.11 I 'tITJlmmr

Prof.....".' En""" '" Use M<done I 49

 9.2 acutely ill
assessment unit
on dury
referral Jerrer
waiting Ijsl

9.3 1 lntensive Care Unit (ICU) / assessment unit 4 Gynaecology (Emergency)

2 High Dependency Unit (HDU) 5 Accident & Emergency (A&E)
3 Day Surgery Unit

9.4 1 clinic/hospital 3 rests 5 referred 7 day

2 rrea unen ( 4 department 6 admitted 8 discharged

10.1 prescription charges 2 housebound 3 uppoinunem 4 locum 5 out-of-hours

10.2 change dressings make

appointtllClll'S mnke
horne vi)it~ perform
rumor surgery refer 3
patient
run 3 clinic
supervise Sta((
rake messages

1 0.3 1 midwife 3 receptionist 5 disrricr nurse 7 practice manager

2 physiotherapist 4 practice nurse 6 health visitor

10.4 surgery 2 appointments 3 Reception 4 visits 5 prescription 6 referrals 7 OOH

11 .1 1 undergraduate 3 foundation programme 5 continuing professional development

2 postgraduate 4 undergraduate

11 .2 1 elective 4 clinical arrachmenrs 7 medical school 10 seminar

2 problem-based Icanung 5 srudcnt selected modules 8 consuharn
3 lectures 6 cadavers 9 College
11.3 1 overseas elecnve 3 dissection 5 clinical .k,ll;
2 problem-based Icamong / PBI 4 clinical orrachmenr G "udent selected module

12.1 1 demonstrate 2 supervise 3 deliver/provide 4 take 5 assess/dernonsrmre

12.2 1d, 2h, 3f, 4b, Sg, se, 7a, lie

12.3 Bachelor of Medicine, Bachelor of Surgery, Fellow of the Royal College of Surgeons of England,
Fellow of rhe Royal College of Surgeons of Ireland
2 Bachelor of Medical Sciences. Doctor of Medicine, Member of the Royal College of Physicians
3 Bachelor of ~Iedicine. Bachelor of Surgery, Fellow of rhe Royal College of Surgeons
4 Bachelor of Medicine, Doctor of Medicine, Fellow of the Royal College of Physicians

13.1 1 provisional regisrranon 3 full regisrra ri0 II

2 limited regutranon 4 specialisr registration

13.2 1 General Medic.1 Council

2 I)rofc,';onal and I..mgulStoc ASSC<SrTlC"'< Board
3 Objective Structured Clon0.:31Examination
4 airwayv breathmg, circulanon
5 Cerrificare of Completoon of Traonong
13.3 limited regrsrranon 4 SWlonS 7 specialisr regisrranon
2 GMC 5 full regisrrnrion
3 ['LAB 6 ccr I Cerrificare of
Completion cf Training

14.1

14.2 complain of
off-colour out
of SOrt,
present wit h
pur on
worn our

14.3 t presented 3 present 5 presenting 7 presenting

2 presentation 4 presents 6 presenrarion 8 prescnrarion

14.4 1 complained 2 malaise 3 gained 4 presented 5 constipated

Over to you - sample answer

A 60·year·old man presented to his GP with malaise and fatigue for several months, He
also complained of anorexia and weight loss of 10 kg.

15.1 adequate - inadequate

against - for
insidious - sudden
likely - unlikely
severe - mild
rare - CO"1"10n

15.2 bone marrow

differcnrial diagno<i~
insidious on see
iron deficiency pernicious
anaemia progressively
increasing vibration
sense

15.3 1 progressive 3 plarelel 5 jaundice 7 adequate

2 deficiency 4 exclude 6 palpable 8 breakdown

15.4 1 insidious onset 2 pallor 3 symmetrical 4 vibration 5 sore

Over to you - sample answer

Cause, of anacmra mentioned: chrome blood loss associated with carcinoma of the bowel (I
chronic bleeding ulcer. leukaemia. aplastic nnnemi n, iron deficiency. pernicious nnaemu

Pro(f!SsionaJ English '" ~ 101_ 1SI

16.1 1 skull
2 in'" bone
3 spine
4 breastbone
5
rib
6
collarbone
7 shoulder blade
8 thigh bone
9 kneecap
10 shinbone

16.2 l a, 2e, 3d, 4b, 5e

16.3 1 Reducing 2 unue 3 malunion

17.1 Verh NUlI"(') Ad )I'!'t IVI'(')

delay dela) delayed
develop developmem developed,
developing
distend distension distended
fail failure failing
nourish nourishment, nourished
nutrition

failure 2 distension 3 development 4 nutrition 5 Dela)'

17.2 crawl 2 weaned 3 stature 4 milestones 5 puberry/marunry

17.3 1 mumps 3 German measles 5 chickenpox 7 scarlet fever 9 poho

2 lockjaw 4 whooping cough 6 measles 8 rhcumanc fever 10croup

18.1 Vt'fh Noun

in'hibir inhs'birion
pro'ducc pro'd ucrion
re'lease re'lease
re'place re'placemenr
se'crere se'crerion
'stimulate stimu'Iarion

18.2 Answers given arc the words USL-d in the original text; possible alternatives are shown in
brackets.
1 stimulate (mgger) 4 production (secretion) 7 secretion (production) 10 secretion (production)
2 release (secretion) 5 feeds 8 srimulnres (rnggers)
3 snmulates (mgg ers ) 6 mhibn 9 produce

18.3 1 dilfuse 2 locahzed 3 defiocnr 4 Excess

18.4 ld, ze, 3., 4<, 5g,6h, 7(

 Over to ~'OU- '-J111plt" In,\\('r
Dear Doctor
I would he ~ratdullJ )OU would see thl~ 60·yc:or.()ld WOon,1IIwho complamv of t.. t.!,\r'>\ and
consripauon. She h., I{.on<d 5 kIlos m the 1"'" three momhs although she 'ay' her appenre
i, poor. She 103\ nonced th,1I her haor h.; Ix');un tn r.11I Ollt and rh at her ,kin 1\ "Cr) .I",. I am
wondering if she 1> h, po.h, rmd,

19.1 Vnb Noun AdJ,·,llv,·

accommodate accommodanon
constrict ..:on\(1l('bOO consrnctcd
converge convergence
dilate d,IJIIOII. dll.lIcd
d,I.II.llIon
droop d ron)' 1111{

0;< Ilia re .,,,,11.000

rt'act rt'J,-tl00
19.2 re, 2e. 310.41, sd, 6J

19.3 pupil 2 fbm.,.,h.pcO 3 couonwool 4 ,1Ncrieyarterloles 5 noppln~

20.1 distended 3 qUJdr.nt 5 rigidiry 7 masses

2 tenderness 4 Iluardonll 6 tenderness 8 Ilowcl

20.2 rc, ze, 3f, 4a. Sb. 6J

20.3 If. 201.3b, 4g, se. s... 7d

21.1 1 (surglcall nenlO,.1 01 the "C)mb
2 hc,vl pen....J,
3 11If1~\lnm3!1011of nn< of the .uhe- .hJ. ,00n.<I rhc ".M)' W the womb
4 hlop<), of (""311 piece of uwue removed Imm) the neck of the womb

21.2 menarche: 12 Y"

menstrual cyd.: ~II~

L'\ IP: 1/52 ago

menorrhagoa? no
dysmenorrhoea! no
discharge? a hrtle whne dl.,dl~

21.3 menarche: I low old "crt' "OU when you starred tel gel.heonl your periods?
menstrual cycle: Are your penods regular? How long (ill the periods lasr u5",,1I)?
LMP: Whtl) \\3' lour 1.1\1pcnod?
menorrhagia? W'ould vou ....' the, are li):h! or h.,",,)? 1)0 you gCI clors?
dysmenorrhoea! r)" Inu!ttl period paIns?
dlschal'j:c? I, llonT In, d,,,,lun:. between the per" ..h? WIo.1lcolour " II?

21.4 prolonlledlheal\ 2 dOh 3 penod, 4 rerllKl, 5 Jlu<hes 6 nr.1 7 poll 8 ""I

22.1 palprranons 2 ,hnnne-\ 3 b~.lIh 4 plllnw, 5 mural \all.

Pro(Ol.ionai fntItsh .. I.M 101..... I S3

22.2 ., fe~1
arrinl fibrillation
cardiac ourpur
cardiac failure
heart failure
on effort
pirri ng oedema
premature beats

22.3 1 brearhlessnesI sshormess of breach

2 palpitations
3 breathlessness when lymg flat
4 swelling

22.4 1 cxcrriorvexerciseeffort 2 cplsoc!e".ltacks 3 palpitations 4 shormess 5 swelling

 23.1 V",h Noun
'nusculrnte nuscul'rarion
r-; .
e xammc exnmi'narion
in'spect in'specrion
pal'pare pal'parion
per'cuss per'cussion

23.2 d Look for clubbing. (inspection)

c Feel rhe radial pulse. (palpation)
e Locate the apex beat. (palpation)
r Note any thrills. (palpation)
a Measure the hearr size. (percussion)
b Arc there any murmurs? (ausculrcdonl

23.3 1 force 3 ccntl"JVperopheral 5 bear 7 murmurs

2 pulses 4 penphetaV~ltrol 6 space 8 ru b

Over to you - sample answer

Mentioned in n: central and penpheral cyanosis, clubbing, irregular pulse lin nrne and force),
thrill, murmur. friction rub

24.1 lj, 2e, 3a. 4h, Sb, se, 7f, Bd, 9g, 10i

24.2 fever 2 rigors 3 incubation 4 prophylaxis 5 parasites

24.3 curable 2 OUTbreak 3 microorganisms 4 afebrile/apyrexial 5 glandular fever

25.1 Noun Adjective

affecr affective
an.xiety anxious
behaviour behavioural
dementi. demented
disturbance disturbed
suicide suicidal

I S4 ProfessionalEngfi<h in ~ 1>1_
25.2 I 1lth;a"ourJI »~ 5 1"'",,.,.111) d,,,order
2 t~tm~ disorder 6 I"'),homocor retardanon
3 maier dq>~SIOO 7 .,k.:p d"turb.lnct
4 111('111011 rerardanon 8 ,uJ>..tJI1<C.Ib"",

P'.(eulonol fnPsh on Use _ 155

25.3 I behaviour 2 mood 3 PJ"'c arrack 4 senile dementia 5 funmonal 6 compulseon

25.4 11,C parienr has three of the listed s)mptoms:

tiredness (fatigue)
loss of interest
sleeping poorl)' (insomnia I

Over to you - sample 3os".r

She does nOl ",.... tbe roqUlrtmmh (or major dcprC->1on " she has onl) three of tilt wm~o,1I'>.
(In faC1. In,,">u!:'Ihoos m«1kd Ihat ,I>e ,,~., .,uf(cr"'~
fr0111 hypercalcaemia due ttl pn111lf')
h) I"'rpa rat h) t'OId,<m. ,

26.1 Ad,tTtIVt· Noun hllnd

blmdn... , consoous
con"I()u\nc\s deaf
de-.fnc" dial'
d'llln\.·~~ numb
numbness
light-headed lighr-headedness
unsteady unsreadmess

26.2 double VI;1OII

tplkpuc ht
I'rOOro111.11 j,\ mpeom
,)ll<;opJlanJck
unn.lr) Ill(onttnt1k.~
\ ,.,uJI JCUII)

26.3 1 consciousness 3 passed 5 dIU) 7 control

2 warning 4 srrtft, 6 "WII·hc."lcd 8 involuntary

Over 10 you - sample answer

According to the article, the smell~ Jr. ,,,.wberry, smoke, soap, menthol, cloves, P"lt.ppl e,
natural gas. lilac, lemon and Iea ther.

27.1 Noun AdJ'·I'IIVt·

absence absent
dunmunon dumnisbed
fl.ICC,d'l) flac"d
'Jl.I~'k.Jt) I ~~\'k

"J'lIn~ , \\J;led

27.2 I 1I1u'>Cletone 3 power

2 muscle hulk and po5"bl) ",voluntary mOVe11lent> 4 coordinanon

P'.(eulonol fnPsh on Use _ 155

 27.3 1 tlaccid 2 Iln,k 3 wa-ring 4 mvoluntary 5 Ilnhll"kul'lal1lJr 6 coordmanon
7 Icndon/reOe< hammer 8 dummshed

27.4 GCS 5 (ere opening: ro speech = 3. \ «hal response: none = I, 111010rresponse: none = I)

Over 10 you - sample answer

jaw jerk, biceps jerk, triceps jerk, supinator (wrist) jerk, knee jerk, ankle jerk
Diagnosis: the patient has Parkinson's disease,

28.1 Vnb Nounls] Adjectivels)

cure cure curative
excise excision
grow growth growing
Invade mvasron, in\ .... ivcnl"'») invasive
obsrrucr ohslOlction ohsrrucuve
palluue p.111'JIIOn pallinrive
palpate palpanon palpable
spread spread spreading
swell swelling swelling. swollen

28.2 6,3,7,2,8,4.5, I

28.3 1 spread 3 painless 5 benign 7 palliative

2 obstruction 4 malignant 6 Secondary 8 palpable

Over 10 you - sample answer

I'm afraid )'OU have 3 condmon called lymphoma, which is a tumour of cerrain while blood
cells called lymphocytes. There are different type, of lyrnpbornn and we need 10 do more lest'>
to lind (lui wluch particular rype lOU have, Some types require no immediate treatment. For
others you may need drllg treatment or ra dlorherapy,

29.1 1 premnrure 3 rrnnester 5 prcsenmrion 7 (umblhcat) cord. snllborn

2 rerminarion 4 lahour. 6 miscarriage
secnon

29.2 Vl'fh Noun abort

abortion
deliver delivery
induce induction
miscarry miscarriage
present presentation
terminate termination

29.3 I terminated 2 aborted 3 delivered 4 induction 5 presented 6 dehvered

30.1 blood-stained
breath sounds
pleural run
productive cough
vocal resonance:
I 56 Prof ...... ., Engfish III Use _
30.2 I Do you cough up any phlegm] II~ it a 100" cough?
2 What colour is the phlegm?
3 1< it ever yellow?
4 I lave you noneed an)' blood In II?
5 Any problems with your breathing?

30.3 1 rrue - A productive cough is often described 3Sloose ... A cough may be productive,
where the parienr coughs up sputum (or phlegm)
2 false - crackles ... suggest tbe presence of fluid in rhe lungs
3 false - A cough may be ... non-productive, where there is no sputum
4 false - wheezes ... indicate narrowing of the airways. The sound of an asthma patient's
breathing is also ailed
whc...z..c
5 false - The sound heard when the pleural surfaces arc inflamed. as in pleurisy. is called a
pleural rub

Over to )'OU - sample Joswer

A .l6·yenMlld man complamed of sudden righr-sidcd che« 1>.111w1nh shortness of hre.uhf
brcorhlcs>llcsvdy'pI1Ol'3. whrle watching lelc\ision.lhe pain WaS made worse by deep breathe
and by coughing. The shormess of breath persisted over the 4 hours from ItS onset to h,s arrival
in Ihe Accidenr & Fme'ltenC)' department. l le had a slight non-productive cough. There was no
relevant past medical h!>to,> or fa'",I) history, He had had a three-week holiday on Ausrrnlia
three weeks previously,
On examination hi.s temperature was 37.4°C. his respiratory rare was 24/ntin, his jugular venous
pressure was raised 3 ern, his blood pressure was 110/64, and his pulse rare 1281min. In the
respiratory system, expansion was reduced because of pain. There was a pleural rub over the
right lower zone posteriorly, There were no other added sounds, Orherwise no abnormaliry was
derecred,
Diagnosis: This man had a pulmonary embolus.

31.1 1 Shingles 3 small bhsters 5 small blisters 7 scabs

2 spots 4 spot<lbhslc" 6 filled with pus 8 scars

31.2 location and d,stnbullon: first behmd Ihe ears and on rhc forehead then the trunk
and Iimbs
grouping: scattered
type of levron: macul<..,
colour: pink

31 .3 location and disrrihution: widespread on rhe chest and" bdomen

grouping: scattered
type of lesion: small macules with some scales
colour: pink
(guttate psoriasis)

31.4 location and disrriburion: below lateral tingle of rhe left

eye grouping: single
rype of lesion: nodule
colour: whire'pink
[bnsal cell carcinoma]

P",( ... iono' en".." In Use IS

-.. 7
 32.1 M,:dll·.JI term
C01111110n word TYPl' 01 lo,n'
bruise conrusson, blunt
haemaroma
cur incised wound sharp
graze abrasion blunt
scratch linear abrasion blum
stab wound peoerrating sharp
wound
tear laceration blunt

32.2 , grazes 2 contusion 3 tears

32.3 There il a laceration/lear on the lefl shoulder "lid nn incised wound /. cut appro<im'lciy 6 em
in length above the lefl mpple,

32.4 sore 2 srablpt'nctr.lting 3 blow/punch 4 superficial

33.1 frequency 2 nocturia 3 dysuria 4 hesitancy 5 srrearnrflow 6 dribbling

33.2 , b, 2a, 3<, 4f, 5<1, 6g, 7c

33.3 Possible questions:

frequency: How ofren is rhar How often do you pass urine,
dysuria: Do you get an)' burning or pain when you pass water?
nocturia: Do you have 10 gCIup at night?
hesitancy: Do you have any trouble swing started'
incontinence: Do you ever lose control of your bladder?
haernaruria: I lave )'00 ever passed blood in the urine?
urgency: Do you have to rusMlurry to gel to the toilet in lime?

33.4 There was a trace of blood. gross proteinuria, and no cnsrs.

Over 10 you - sample answer

M r Jones has early prosranc hypenrophy.

34.1 , b, 2c, 3., 4d

34.2 , cuff 3 pump 5 systolic blood pressure 7 diastolic

2 diaphragm 4 valve, gauge 6 deflate

34.3 , Phlebotomists 3 fist 5 dressing 7 specimen rubes

2 venipuncture 4 tourniquet 6 bruising 8 laboratory

I 58 Pro( ... ionol Enpslt WI Use M<didnt

35.1 Suspected rondrtron k,'
anaerma I or \ blood
bacrena] COOluncnYl ..... I)e ",.Ib
genital herpes S" J~ rn Virus T:'I
mcninguis C~~
scpricacrma Blood culture
urinary infection :'-ISU
urinary infection (carherer rn place) ("~U

Pro(essional £nrIosh .. Us< _ I

59
35.2 'wlthlll normal limus, grams 3 elevated, ,",,1\ per litre 5 normal, n"cromoh per III,e
2 low. mlCromols per 4 UIl"\ per III rt.'

3 5.3 I)o'~rbl. a,,,"tr.

'><>d,um" nomul. ooe hundred and Ih,") ..""hl rn,II11l1ol~per htre.
1'00a",um 's wnhm nomulhn"". lour ro"" five Illlll,mol, per lure,
\X'h".<ell COUnt" " eva red, " ve I,. pcMI 1\\0 IIIt1~ len 10 the power moe per I" re.
t Iaernarocru I) 10\.., U'f'O polnl r".) (\'tU lour lure ....per lure.
Mean corpuscular volome « down, -evenry-two poinr live femlolitres.
Alkahne phosphatase ss unremarkahle, ""ellt) I\YO units per lure.
Alarnne aminotransferase 'S reduced, rune U'UI;, per litre.

36.1

recover I recovcrv

[ '" all(,,, S" ali""

36.2 1 f,'t'dIrnsenJintrod ece 3 ,haft/lube 5 pc,l}1' 7 )"O",} 9 IO<JI JIUNh<11<

2 Idl) 4 ,.1UIC'fI/C
6 .,""" 8 rr!l,d 10 j;tl u~.J t()

36.3 1 pulse oxuueter 3 0."..11 t.:JnnulJ 5 inrroduced

2 III I h. left lateral posinon 4 premed.cation 6 transferred

37.1 medium 2 radiolocenr 3 enema 4 seria I 5 blurred 6 inflated

37.2 1 radiology 3 radiotherapy 5 r.idioluceur

2 radiography 4 radiopaque 6 rad'OJ.:raphcr

37.3 1 (Jon!: 2 Push 3 OUt 4 snll 5 lake 6 hold 7 silkways

Pro(essional £nrIosh .. Us< _ I

59
 37.4

38.1 tc, 2d. 3a. 4b

38.2 a 10, b6, es, d4, e9, f5

38.3 aI2,bl-,c1I,dl3.d4

38.4 !>"'Jlhe m
(""I\It dl1tC~stdU~~
"'peroc,,,c d,,,,'Omton
1orc'll" hod oes
hold your breath
mformed consent
introduce the endoscope
recovery area
local anaesthetic
local anaesthetic 3 recovery area 5 informed consent
2 foreign bodies 4 excise d,,,-,,,sed nssue

39.1 I tracong
2 C\CI'C';C loleranex ttSI
3 J ,k,l'f't'd heart bear
4 cle.:trol) re ~
5 'llf,dlk.'"hOn
6 14rtt1oonlt
7 ,.llohr.1<
8 ,tyh"

39.2 a itA I roght arm

b 1(1 I roght ItIl
c I Lllrfl leg
d I.A I left ann
e ChCM posmons

39.3 rate 2 complexes 3 wave 4 I<'td~ 5 interval

40.1 I e, 2g. 3 •. 4b. Sa. 6c. 7d. 8f, 9h

40.2 I trruanon 5 hlo\lerlllll 7 Cannons

2 chemost', 6 deN' 8 Jnd.cano",

40.3 'trel'lOktn~;c, ooe aod .. hollf m,lIoc,n Ulllh h) IIIIr,I\C""'" on!,,\lon mer "'I) mmute-,
A'plton, three hundred m,II'Il'Jn\\. ">
mmllh. 1II'l1Icd'Jtcf).
1)I.ullnrphlnr. rwo pouu 11\(' It) h\r ""Ih~rlltn\. Il1tr~lvc"uu~I). """)lXII.llth.
MCllldol'ram,de, ten m,II,yam" oncr,l\ el1o",I), rmmedurclj.
e, 1N, three hundred mt<"lf(rJIIl' per Ii'e 11001l,III'C', hy iurr.ivcnous IIlfu,"on. ~I,,",11'Ort)
nll~r()ltr'lIns per nunure.

160 Pro.(...onolEnf'sh .. ~ M_
41 .1 scalpel 2 rerracror 3 'l<l<S01"I 4 .lnr~ tnr,.p,

41.2 nssisranr 6 sW3b,J",.I..rr

2 p,'cpp,nglp"'parllll\ 7 ~uckerl"\'.lh,
3 drapes 8 ligatures
4 sterile 9 dram
5 retractor 10 surures/,nrchN'tJl'b

41.3 1 divided 3 mobihzed 5 inlilmtnon 7 «Jplc. 9 closure

2 repaired 4 "',"~ 6 preservmg 8 redundant 1013)=

Pro(e.-01 EnPsh ., Us< _ 16 1

42.1 1 chernotherapj 3 ph,slatherap) 5 ph)slothemp)
2 r.rdiorhcrapj 4 (")tOlln,e BehJ>lour.11 Ther.lp) 6 Cogmnve Beh., lour.1 Ibc....IP)

42.2 Curative 2 JdIU,.1I11 3 PalliJllve 4 11111'10"" 5 traction

42.3 rc:ferral, 2 Iher.,p) 3 repIJl=><"" 4 ph)"OlhcrJp'M 5 RehJbllll.llln~

43.1 Risk ('<10" 3 1.1.... "''''I1\<S "'""crr 7

"4''''.... 4 .,,,,...J to
~1)lant to
5
2 fa I\( 6 contracted 80ulbreak

43.2 Possible .n",,,\!

1 Women aged trorn SO 10 -0 should have nlJmnlUllr.lphy ever) rhree yea .... to check tor breast
cancer.
2 Patients with hean disease should have a blood cholcsrcrol test every so. month, 10 chock their
cholesrcrol level.
3 Women between 20 and 60 should ha ve a smea r rest every three years to chock (or cervical
canar:
4 Patients o'er 40 \\.th IuclJ nsk factors should have Ih.,r blood cholestl'fOl checked C-C'1 lear,
5 Paoenrs \\ Jlh d •• I><1.- w.uld have ophlhalon'l'oCnpl .,el') year {O chccL. (or d",l><1", I'<'tII1Op3th),
6 Pregnant "omen ,"'>IIld h.a'e the AFP rest between 16 and 17 weeks ICHhc..L. tnr ncur.1 tube
dcftl.'I>and 1)<I\,n\ ~\ndmme nsk.

43.3 hepauusA, nl.,lJroJ

2 hel"lill< A, " ... I.ItO.I. I) phold
3 hep"i", A, hCI'JIIII\ II. m.IJt13, typhOid
4 hepalin< A. rah,,,,. ,.11'-"'''''
encephahnv, m.ilnri.i, IYI,hold
S a booster do-e lor Itt.",,>

44.1 case (atalol) 2 <k3Ihilll(>nal'I)' 3 hlnh 4 <1m rval 5 prevalence 6 """den.;.

44.2 more common 2 hl~ 3 common 4 lowest Slow 6 u,,"ommon/rare

44.3 affected by
association between
incidence of
lead (0
rare in
1 incidence 01 2 ~" ... o;nlOn berween 3 lead 10 4 rare on 5 .If<<led h)

45.1 .9. b", cS. d 1. <4. 12

45.2 re, 2d. 3a. 4!:. SIl.6t. 7h.s-

Pro(e.-01 EnPsh ., Us< _ 16 1

 46.1 NfJUtl Vl'rh
bias bias
control conrrol
exposure expose
participant (person) participate
intervention intervene
stud), srudy

46.2 1 controls 3 longitudinal 5 randomized 7 risk

2 double-blind 4 cohort 6 placebo 8 confounding

46.3 1 longirudinal cohort srudl' 3 cusc-comrol stUd)'

2 double-blind, randonuzed controlled rria I 4 case-control study

47.1 1 Do you have a partner?

2 What do you do for. 1"'lIlg?
3 Can )'OU desenbe the pain?
4 Where does " hurt?
5 Does it go anywhere else?
6 When does ir stan?
7 How long does it 13SI?
8 Does anything bring it on?
9 Does anything make it bener?
10 Have you an)' other problems related to the pain?

47.2 Which pan o( your head is affected?

2 Could you describe the pain?
3 Ilow long do they last?
4 Does anything bring them on?
5 Does anything make them berter?
G l> there ;\I.)thll1g else thaI .,ffrel< rhcrn]
7 do )'OU (cd '1I)lhIll8 else wrong when it', there?

47.3 1 gnn wing. burtling 3 sharp, burrung 5 I hrobbing 7 sharp

2 Stinging. scalding 4 crampy, colicky 6 ache 8 gnpping

48.1 1 over-tbe-counrer 3 .lIerg)' 5 siblings 7 Housing

2 dose 4 herbal remedy 6 Recreation 8 compliance

48.2 1 Arc your parents alive and well?

2 How old was your father when be died?
3 Do you know the cause of death? I What did he die of?
4 Do )'OU have any brothers and sisters I siblings?
5 Are all your close relatives alive'
6 Wh,t did h. die or?
7 Does anyone to your fam.ly have .1 serious illness?
8 (As rar as you know) is anyone raking regular medication?
9 Do )'OU have .10), ch.ldren?

48.3 1 Wh.1t kind of housedo lOU I" e in? 5 1)0 you >llIokc? llow m,IIIY , d.l)?
2 Are :tny of them at nursery or 6 I lave you tried givinlt up?
school? 7 How milch do )'011 drink III a week?
3 Do have .n)' financial problems?
)'011 8 Con you give up alcohol when ynu want?
4 Do you have an)' hobbies or mrerests?

162 Profess"""" Engish., Use_

49.1 la. 2<. 3., 4<:, sb. 6d. n

49.2 I 1.2 I, 3 C. 4 E

49.3 I come on 2 pur on 3 give lip 4 cJrry on 5 bring up 6 turned out

Over to you - sample answer

I Have you had any pain or probkn», with your mouth?
2 Is it difficult for you to swallow food or drink?
3 I lave ),OU had any discomfort .ftcr eating?
4 1)0 you ever get a burmng f.d,ng 111 your chesr]
5 Do you have any ""'OS III
lour stomach?
Gila,. IOU losr 3n) woght?
7 HM. )'ou noucrd ~n' clung. 111 'our bowel habit?
8 What colour are ) Our bowel lTIt"ffl1<:nt'?
9 II., )OU noclad 3m blood m lour ,uK,I?
10 1)<,."..thl> come m".cd ,,,th the \tnol n r hero re or .,fter?

1'.0(es ,10001 EIIpsIt .. Usc 163

_
50.1 I I ook, rooch 3~ S lock.h 9 Roll up
2 ~It.lel <4 T3k e, off 6 Tum 10 l.ook at

50.2 1 Touch your sboelders with lour h,",'"

2 Pur your hands behind your head,
3 Put your hands behmd your back,
4 Raise your arms above your head.
5 Bend your head forward ... back ward.
6 Bend your head to the right to the left.
7 Tum your head to the right to the lefr,
8 Bend backwards.
9 Touch )'our tOG.
10 W,th ) Out hed on the pound. tum lour foot ... far •.,. you can.
II Bend your knee.
12 Bend to lhe kft ... to the Ofo\ht.
13 Bend ~our toes up and d<mll,

50.3 1 do you kno" what we' re It0Il1!: to del th" l11o",illll

2 what w" do IS
3 3 hrrle bit of discomfon
4 ra ke 'cry long
5 over
G could you (just)
7 I'm going to
8 ready
9 you'll feel
10 very \\'ciI
II over

51.1 1 dclu""" 3 IIiUSIOO S deluded

2 h.,IIIKIOatlOn> 4 ob>e>"onal 6 d,,,mcnf"tlon

1'.0(es ,10001 EIIpsIt .. Usc 163

_
51.2 N()UIl AdJlTI'Vl'
confusion confused
delusion deluded
depression depressive (illness)
depressed (panenr)
disorientation disoriented
obsession obsessional (symptoms. rhoughrs)
obsessive compulsive (disorder)
psychiatry (lield). psychiarris. (practitioner) psychiatric

I p-ychiarnc 2 depression 3 depressed 4 disoriented

51.3 I C1n lOU describe)'our mood J' the

2 Do you I ••ke pleasure
1lI01flCIlI? an)thing?
III
3 I low are your eneq:) Ie, eI,?
4 I low long have lOU been f""IIIlS like thi,?
5 How are lOU sleepmg?
6 What's your appenre like?
7 Have you noticed any change in your weight?
8 Can you keep your mind On rhmgs?
9 What do you feel me (unite holds for you?
10 Have you ever thought of suicide?

52.1 1 c
2 n, f
3 d
4 b.e

52.2 1 a stroke 4 brcarhlcssne ..

2 tube which came> urme from the bladder 5 .1 painkiller. medicine to reduce swelling
3 needing to pass unne fmtueRlI) lit night 6 tablets to unprovc your mood

52.3 1 developed
2 (mainly) because ),OU are
3 TI,i. is why Ilt's the reason why
4 give )'OU advice on
5 make ),OU an appoinrrnent with I arrange for you to see
6 going to Start you on
7 should I should rl)' to
8 \V3 or you to
9 arrange for ),OU
10 Hopefully we can
11 anything you'd like to ask

53.1 1 carry on 2 gave up 3 end up 4 start. off 5 Cur down 6 serrle 7 avoid

53.2 1c, 2f, 3e, 4a, ss, 6d

53.3 Powrblc an,\\('I'\,
Ynu ,hc",l.! keep to10\\ ,Ik>lc....trml d,et.
J
You should keep up Jill rq:ubr ph, " •• 1 .,,11\ II) you are used to.
You vhouldn] do anv a ..I.1\I(\ th.lt hnnJt~ ou ."l~l.n,..
You should avoid mom'S trom lloor to \(an<lon); exerctse-, '00 qu,d").

Over to lOU - sample answer

11,. fi"" option is to do nothing. The fibro,d w,1I shrink when you become menopausal,
alrhough we can', be sure when thac will he.
If you prefer, I can refer l nu '0 a g) n.,<ml''l\"t ro discuss surgical tt<a(I\1(,11I.There are three
J'O,,,I,,hUt.,,, one LSembolizanon which " rel.mvcly minor. It means dO<II11l off the In.r)
Ih,1I (l't'd, rhe fihm,d. The second \\",,1<1 be remov.rl (If the fibro,d .Ione wubour ",mo\lnll
your
woml» 111l~ needs abdominal 'lI~('n ••1\ de)('\..l hvvterecromy when your womb IS removed.
'em don'l have 10 de..,.;k redav, I <an It"e lOU Ie.,fle" and recommend we"",,, .. lur vou '" l(luk
.lI. Then mID(" !>xl and 'ott me m 1\\" \\eel,' ume,

54.1 1 I'd hl.e (0 record (h,., <oo,uh.lloo

2 I'm .dr.,td I I'm <Orr} 1I11u,. In tell ,,1\,
3 1\"" an opnon
4 a lot \\C CJn do (0 help '00
5 mak c lOU more comlon.ble
6 never be cerram about th~ (hln~'
7 it's J matter of months rather rhan yea....
8 I'm sorry (0 have (0 rell IOU
9 book ),OU into
10 Could IOU rell me what

54.2 1 \\ nh 2to 3 wnh 4 wuh 5 Into 6 for

Over 10 \00 - \ample am\\~r

Ihere Jre IWO q ..... non, .bout lumou" In rbe brarn - '15 It d.ngerous?· .nd '(..>n II be
re m()\ed?· \~" ~OO\\ dUI ~oor> 1>11'1cancero u s, (".111we ":1110'< It? Well. It\ qune U"I!<' bUI I
""It.. e Ih.1 If we can I:"t .., m",h nf It "UI ., pt""hl<. Ihe«'<. good chaoce we can <UI'<'vou, It
we do nothlnJt. then I'm .tr.td 1I "",lcJ 1.,11'ClII- nOl on the 'hon term bu, ~h.1" In Iive )<.,,'
'line. An cperanon hke Ih" on the br.lln (.trill" "!:Il,fic.lnl tl51.. You could be d'\Jbled. or "our
)1(' ..... '".111) could be .(f(,(led. !In )n u need eo rhm], caref u lI)' about whether IIr nOI "'" \\.IIlI '"
go ahead wuh rbe operauon.

55.1 ,how, 2 compared 3 threefold 4 doubled 5 trebled 6 twofold

55.2 1 less 3 under 5 about 7 le« 9 nearly

2 almosr 4 0"('( 6 around 8 approximately

56.1 V"rh Noun

de'crease 'decrease
drol' dmp
fJlI r..11
1-.
In t:1't"3~ 'U"'-~J\e

mc
"""
56.2 1 dropped 3 gmdually 5 stead ill' 7 reaching a peak
2 rose 4 mcreased 6 fell 8 accounted

56.3 line graph I bar chan 2 bar chan 3 pie charr

57.1 1 Results 5 Discussion (Main finding)

2 lnrroduction (Objective of the research) 6 Introduction (Background)
3 Method [Srarisrical analysis) 7 Discussion (Limitation)
4 Method (Subjecrsl 8 Results

57.2 Possible answers:

1 We as sessed wherher cakium and vitamin D supplemental ion reduce the risk offracrures 10

postmenopausal women,
2 The aim of our srud)' was 10 determine whether rhc way doctor, dress ,nAuenc~ patients'
confidence and trust 10 them.
3 This study evaluated the risk of IIIIV-8 rransmission by blood Iran;(U>lOIl.
4 We invesngared the assocmnon between never being married and increased nsk of death.

57.3 Possible answers:

1 This stud)' failed 10 show that calcium and vitamin 0 supplemenranon reduce lhe fisk of
frncrures in pcsrrnenopausal women.
2 We have shown mat (he way doctors dress influences patients' confidence and crust in them.
3 This study provides strong evidence of HH V-8 transmission by blood transfusion,
4 These results suggest mar there is an association bcrw ce n never being married and
increased risk of death,

58.1 objective 2 setting 3 subjects 4 outcome 5 design

58.2 Past employees of Shell Oil who retired at ages 55, 60, and 65 between 1 January 1973 and
31 December 2003
2 To asses whether carl) retirement is nssociared wirh bener survival
3 Petroleum and peltochemknll11duSlry, United Stares
4 Hazard rano of death adJusled for ;CA, year of entry to study and socioeccnonuc Status
S Long term prospective cohen stlldy
6 No

58.3 The correct order IS: 3 (Obieenve), 7 (DC"ign), I (Swing), 6 (Subjects), 2 (Main outcome
mc",ure),4 (Results), 5 (Conclusion)

58.4 ld, 2b, 3a, 40, 5c

59.1 The correct order is: 4 (Topic), 9 (Pathophysiology), 5 (Sources). 6 (Sources), 2 (Diagnosis),
8 [Diagnosis], 3 (Diagnosis), 10 (Diagnosis), 7 (Trearmenr), 1 (Treatment)

59.2 Emphasizing I rhink it's important to emphasize that ...

Lisring First of all ...
Exemplifying such as ...
Contrasting however ...
Summing up So ...
Changmg topic f low do \VC diagnose it? Now in relauon (0 ••.

Referring to a slide On the slide here you 'I) set ...

Announcing rhe 10PIC I'd like to tell you about ...
60.1 do comphioed 01
2152 l'H"h
PH pa~, h,\tory
FII (am,ly h",ory
MI myocardial m(Jrcno"
lIP blood pre-sure
1112 one month
nil noeh'"l!
SH social hlSlOf)
a&\\t ahve and well
OE on evarmnanon
CXR che« "·~a\

60.2 11,e correct order ,,: 1.5.8,9,2,3,4,6,7

(1 hi~ pauem had (an;1II0fl1J of the bronchuv.)

60.3 'vir McNamara, 6l,

'.l~d'nver do ,honne\' o(
b~Jth lIlZ ankle swelhng lIIl
chrome coogh, purulent 'purum. occa>lOf1al haemopt)"~
PH pam. 11lJ"""'Ofl1l. 1980
OEp3le 13-'('
leg oedema
110 clubbing or i)mph.ldt'llopamr
chesr NAD
liver Scm palpable smooth and non-render
scar of prev ious operanon
(:>Ir ~IcNama~ Iud pulmonary ruberculosis.)