TCH English in Medicine Course & Question Bank 22march16

TCH Language Training Unit – Key to effective communication
Essential English for Medical Purposes
Hospital Mission, Vision and Values
Mission
Through partnership with the Republic of Cuba and the State of Qatar, we provide distinctive
and high-quality patient-centered care to the surrounding communities. We provide best
practice education and research to facilitate the delivery of a continuously improving service.
Our vision is to be internationally recognized for our excellence and leadership in healthcare
Vision
innovation and accessible, integrated care. Through developing international collaborations in
specialized services, we aim to be a destination hospital for local communities and for the Gulf
region.
Distinct quality care
Essence
Responsibility
Values
Community
Collaboration
Quality
Trust
1|Page C o m p i l e d a n d a r r a n g e d b y S e i f Z o h d y – 2 2 / 3 / 2 0 1 6
INTRODUCTION
The aims of TCH Essential English Course for Medical Purposes are to Improve
Effective Communication and skills of healthcare professionals and staff in direct
contact with patients, enabling them to work more confidently and efficiently, with an
emphasis on the productive skills; speaking and writing, encouraging the use of
patient-friendly language when giving instructions or discussing treatment options.
The focus in this training course is the ordinary spoken and written English by
containing medical and clinical details in accurate English contexts. Language
boxes interspersed throughout each unit highlight useful expressions and questions
while authentic texts – patient notes and doctor–patient dialogues are used to
introduce language and present the essential concepts of communication.
This course is not intended to teach you about medicine as a health professional, but
to help you use your medical knowledge and terms effectively in correct English
context although we have been careful to ensure that all the medical content is
accurate in order to help those in need of a foundation course. We have gathered a
number of authentic materials in addition to common medical forms in order to
simulate work environment by including health professionals – patients’
dialogues of history taking, examinations & other medical procedures.
Cultural awareness is also covered in snapshot boxes in order to widen your

understanding of cultural issues and the impact of your own cultural background on
both your patient and the interview itself.
Information, questions and answers, and quizzes on JCI are also included in JCI boxes
for staff to be ready long enough before JCI is here.
Communication Skills in English for the Medical Practitioners
Consider the following points prior to consultations or

any medical procedure:
 Put yourself in the patient’s shoes.

Prior to a consultation or medical procedures, some patients
experience strong feelings of anxiety.
 The kindly word, the cheerful greeting, the sympathetic
look – these the patient understands.*
* Quotation from a celebrated 19th-century physician –
William Osler (1849–1919)
 The way you greet a patient can determine the rest of the
consultation.*
*Bickley (2003)
 The initial contact with the patient sets the foundation for
the relationship.
 Be prepared to give your undivided attention.
 Spend enough time and energy on your greeting
and the patient’s response to achieve a level of
comfort on the part of the patient.*
*Bickley (2003)
I- The Essentials – Body Parts

Label the parts of the human body (1 – 19) using the words in the box:
ankle – chest – elbow – fingers – forehead – heel – hip – knee – navel –

neck – palm – shin – shoulder – sole – thigh – chin – waist – wrist
For A, B, C, & D, complete using the following words in the box below.
back of the knee – upper back – lower back – back of the hand
Body parts – categories

In this table there are 38 words for parts of the body and six categories. Decide which category or categories
each part belongs to. The first one has been done for you as an example.
arm hand leg foot torso head

Abdomen X
Achilles tendon
Ankle
Buttock
Calf
Chest
Chin
Ear
Elbow
Eye
Eyebrow
Eyelash
Eyelid
Finger
Forearm
Forehead
Gum
Hip
Knee
Knuckle
Lip
Nail
Navel
Neck
Nipple
Nose
Palm
Rib
Scalp
Shoulder
Sole
Temple
Thigh
Thumb
Toe
Tongue
Tooth
Wrist
Label the diagram using words from the box.
diaphragm – lobes – trachea – heart – lung – airways

bronchioles – nasal cavity – larynx – oesophagus
Write the ordinary English words for the corresponding anatomical terms in the table using your medical
knowledge.
Snapshot; Referring to parts of the body
When patients speak about their problem they
Anatomical term Common word often refer to a part of the body (anatomical
abdomen terms are never used)
axilla
carpus I’m having trouble with my
coxa hip/shoulder/knee.
cubitus
mamma
nates
patella
Language Focus The main organs of the body have ordinary English names and doctors use these words.
But when an adjective is needed they often use an anatomical word. For example, we can say disease of the
liver or hepatic disease. Some abdominal organs, for example the pancreas, have no ordinary name.
Label the diagram using words from the box.
pancreas – stomach – spleen – right kidney – liver – duodenum – gall bladder – left kidney
Match the conditions (1–8) with the organs affected (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 f lung
7 cholecystitis g stomach
8 ulcerative colitis h large bowel
Complete the table with words from the box. The first one has been done for you.
Abdomen elbow loin wrist thigh

knee chest arm leg finger
Trunk Lower limb Upper limb
SNAPSHOT Explanations should be given in words the patient will understand by avoiding medical
jargon. Using lay terms (words familiar to people without medical knowledge) can help patients
understand
7 | P a g e explanations and conditions. C o m p i l e d a n d a r r a n g e d b y S e i f Z o h d y – 2 2 / 3 / 2 0 1 6
Medical Conditions Lay Term

acute cerebrovascular event stroke
arrhythmia palpitations/irregular heartbeats that you can feel
dyspnoea breathlessness
fractured neck of femur broken hip
haematemesis vomiting blood
haematuria blood in urine
insomnia trouble with sleeping
intermittent claudication pains in the back of the legs when walking
myocardinal infraction heart attack
nocturia needing of passing urine
phlebitis inflammation of a vein
stomatitis mouth sores; inflammation of the mouth
Some lay terms for medical conditions (Ask your instructor for the complete list)
Some lay terms for medication
Medication Lay Term

analgesics pain killers
anti-depressants tables to improve your mood
anti-inflammatories medicine to reduce swelling
broncho-dilator a substance which causes the airways to open up
DMARDS (disease modifying anti-rheumatic drugs) medicine that helps stop arthritis progressing
diuretics Medicines that help reduce the amount of water in the
body.
hypertension medication medicines for blood pressure
hypnotics sleeping tablets
oral contraceptives (OCs) The pills;
medicines taken by mouth to help prevent pregnancy.
birth control pills
Medical Conditions Lay Term
anorexia loss of appetite
arteries tubes which carrying blood around the body
benign not due to cancer or infection
cholesterol fat clogs the arteries
hypercalcemia high blood calcium level
hypocalcemia abnormally low levels of calcium in the circulating blood
inter-vertebral disks shock absorbers which separate the bones in your back
myalgia muscle aches
pulmonary relating to the lungs
Simple definitions most patients do not have any medical knowledge, so it is important to use simple words
they will understand when talking about certain parts of the body or medical condition
II- Effective Communication - Taking a history 1
A- Personal Details - Identifying Patients
Language Focus Normally, patients’ personal details have been entered in their records by a nurse or
administrative staff before a doctor sees them. However, on later consultation a doctor may wish to check
8 | P asuch
details g e as address, date of birth, occupation or marital status. In addition, according to International
C o m p i l e d a n d a r r a n g e d b y S e i f Z o h d y – 2 2 / 3 / 2 0 1 6
Patient Safety Goals (IPSG1), patients are to be identified before providing treatments and before any
diagnostic procedures are carried out.
Make questions to check the following details; name, date of birth, occupation and marital status.
1- ___________________________________________________________________________________
2- ___________________________________________________________________________________
3- ___________________________________________________________________________________
4- ___________________________________________________________________________________
Note how the doctor starts the interview:
What’s brought you along today?
Other ways of starting an interview are:
What can I do for you?
What seems to be the problem?
Note how the doctor asks how long the problem has lasted.
How long have they been bothering you?
B- Taking notes Another way of asking about this is:
How long have you had them?
Asking about symptoms

(Gathering information)
Language Focus Pain is one of the commonest symptoms. For backache/back pain (for example) a doctor
would expect to establish questions to ask about different features related to pain such as; the frequency,
duration and sites of the pain etc….
Make questions to ask about the features of pain in the table below. The first one has been
done for you. For each of the features, you may form more than one question:
Feature Question
Main Site Where is the pain? Or Can you show me where the pain is?
Radiation
Character
Precipitating factors
(make happen)
Time of onset
Time of resolution
Frequency
Aggravating factors
(make worse)
Relieving factors
(make better)
Associated features
(Other health problems
connected to this)
Duration
Severity
(pain level)
NB If you need any help with grammar and/or on how to form accurate questions that carry no ambiguity, please you ask your teacher’s help.
C- Description of pain
Underline the correct explanation/meaning of pains; A, B or C. The first one has been done for you.
Patient’s
description of Explanations/meanings
pain
A- Like boiling water
Aching B- A general pain usually in muscles and joints; not too painful but always there
C- Like an insect sting
A- like a drill
Boring B- like a knife
C- A feeling of tightness
A- A feeling of tightness
Burning B- Acute
C- Feels like fire; with heat
A- A severe but not continuous pain in the bottom part of the stomach or bowels,
especially of babies, comes and goes in waves.
Colicky
B- A background pain, opposite of sharp
C- Biting
A- A sudden painful tightening in a muscle, often after a lot of exercise, which limits
movement.
Crampy/cramp
B- Feeling as if a lot of sharp points are being put quickly and lightly into your body
C- A feeling of pressure
A- A feeling of pressure
Crushing B- like a drill
C- Sudden pain
A- With a pulse or beat.
Dull B- With a heat
C- Like an insect sting
10 | P a g e C o m p i l e d a n d a r r a n g e d b y S e i f Z o h d y – 2 2 / 3 / 2 0 1 6
A- With a pulse or beat

Gnawing B- Biting
C- Feels not too painful but always there
Gripping B- A background pain, opposite of sharp
C- Feels like a knife is stuck into you
A- Feels like it stops/starts in time with your heart
B- A severe but not continuous pain in the bottom part of the stomach or bowels,
Scalding
especially of babies, comes and goes in waves.
C- Like boiling water
A- A feeling of pressure
Sharp B- Acute, sudden pain
C- Feels like a knife is stuck into you
A- Feels like a knife is stuck into you
Stabbing B- A general pain usually in muscles and joints; not too painful but always there
C- Biting
A- Like an insect sting
Stinging B- Like a knife
B- Feeling as if a lot of sharp points are being put quickly and lightly into your
Tingling
body
C- Feels like fire; with heat
A- Feeling as if a lot of sharp points are being put quickly and lightly into your
body
Throbbing
B- Feels like it stops/starts in time with your heart
To identify the pain level doctors usually ask:

Can you tell me on a scale of 0 to 10 what is the worst pain you’ve had in the last 24 hours in
each area?
Language Focus Q: In the dialogues on the next page (P12), what questions do doctors use to ask
about description of pain?
Complete: Q: What _______ the pain __________ like?
Q: What _____ the pain ______________?
Complete the dialogues below.

1 Check your information for
JCI
DOCTOR: .....................................................................? 1. What are the International Patient Safety
Goals?
11 | P a g e C o m p i l e d a n d Goal
a r r a 1:
n gIdentify
e d b y Patients
S e i f Z oCorrectly.
h d y – 2 2 / 3 / 2 0 1 6
Goal 2: Improve Effective Communication.
Goal 3: Improve the Safety of High Alert

Medications.
PATIENT: It’s right here. (2)
DOCTOR: ......................................................................?
PATIENT: It’s a gnawing kind of pain.
DOCTOR: ......................................................................?
PATIENT: Yes, if I eat, it gets better.
DOCTOR: ......................................................................?
PATIENT: Down here. (3)
DOCTOR: .......................................................................?
PATIENT: It’s a sharp, stabbing pain. It’s like a knife.
DOCTOR: .......................................................................?
PATIENT: If I take a deep breath, or I cough, it’s really sore.
DOCTOR: Well, Mrs. Black……………………………………………………?
PATIENT: I’ve got a bad dose of flu. (1)
DOCTOR: …………………………………………………………………..?
PATIENT: Two or three days. (2)
D- Vocabulary in Medical Reports & Forms

Useful verbs in medicine
The sentences in Column A contain examples of useful verbs in medicine. In Column B there are definitions of
the verbs. Read the examples and match the verbs (in italics) with the definitions. Then write the infinitive
12forms
| P ainto
g e the spaces in the definitions in ColumnC B. The first one has been done for you as an example.
o m p i l e d a n d a r r a n g e d b y S e i f Z o h d y – 2 2 / 3 / 2 0 1 6
1. He was admitted this morning. a) _________ means to pass from one place to
another
2. The cancer is not responding to drugs.
b) _________ means to damage or hurt someone
Nouns and Adjectives
Language Focus Sickness has a similar meaning to illness. It is also used in the names of a few specific
diseases, for example sleeping sickness and travel sickness. Patients also talk about sickness when they mean
nausea and vomiting.
Complete the table with words. The first one has been done for you.
Noun Adjective
fitness Fit
health
illness
sickness
Language Focus If a patient’s health is in the process of returning to normal, the patient is improving. The
opposite is deteriorating. We can also say that the patient’s condition improved or deteriorated.
If a patient is better, but then gets worse again, the patient has relapsed. Another word for improvement,
especially in recurring conditions such as cancer, is remission.
Make word combinations using a word from each box.
1- complete sickness
2- feel health
Write your answers on the lines below
3- get remission
4- poor sick
5- travel over
1- ____________________________
2- ____________________________
3- ____________________________
4- ____________________________
5- ____________________________
Choose the correct word to complete each sentence.
1 Her condition (deteriorated/improved) and she died.
2 He (relapsed/recovered) and was allowed to go home from hospital.
3 The cause of sleeping (illness/sickness) was discovered in 1901.
4 The patient made a full (remission/recovery).
5 The patient has been in (poor/good) health for months and feels very fit.
6 It was a month before he (got over / got better) the illness.
7 He seems to be rather (unhealthy/unwell) – his diet is bad and he never exercises.
Check your information for the JCI survey

Goal 2: Improve Effective Communication
Standard IPSG.2
The hospital develops and implements a process to improve the effectiveness of verbal and/or telephone
communication among caregivers.
Standard IPSG.2.1
The hospital develops and implements a process for reporting critical results of diagnostic tests.
Standard IPSG.2.2
14 | P a g e The hospital develops and implements
C o map process
i l e d afor
n d handover
a r r a n g communication.
e d b y S e i f Z o h d y – 2 2 / 3 / 2 0 1 6
Effective communication, which is timely, accurate, complete, unambiguous, and understood by the recipient,
reduces errors and results in improved patient safety. Communication can be electronic, verbal, or written.
Patient care circumstances that can be critically impacted by poor communication include verbal or telephone
Essentials to remember
Consider the following point prior to consultations or any medical procedure:
 Put yourself in the patient’s shoes. Prior to a consultation, some patients experience
strong feelings of anxiety.
 The kindly word, the cheerful greeting, the sympathetic look
– these the patient understands.*
* Quotation from a celebrated 19th-century physician – William Osler (1849–1919)
 The way you greet a patient can determine the rest of the
consultation.*
*Bickley (2003)
 The initial contact with the patient sets the foundation for the
relationship.
 Be prepared to give your undivided attention.
 Spend enough time and energy on your greeting and the
patient’s response to achieve a level of comfort on the part
of the patient.*
E. Taking a history 2 – Gathering Information

SNAPSHOT A full case history mainly covers:
 Personal details
 Presenting complaint/illness
 Past Medical History (MPH)
 Drug history
 Family history
An over-the-counter drug is bought from a
 Social and personal history
 Patient ideas, concerns and experiences shop without visiting a doctor first
 Review of systems
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, frequency of administration and the patients’
compliance or lack of it. It 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.
Language focus
A. Details of drugs and medications
To find out about drug history, doctors ask:
 Are you taking any medication at the moment?
 Which tablet do you take?
 Do you use any over-the-counter remedies or herbal or homeopathic medicines?
To find out about frequency of administration , doctors usually ask:
 How many times a day?
Homeopathy is a system of treating diseases in
To ask about side-effects and allergies say:
which ill people are given very small amounts of
 Do you get any side effects?
natural substances which, in healthy people,
If the answer is Yes:
would produce the same effects as the diseases
 What symptoms do you get after taking it?
produce.
B. Family history
Note the age, health or cause of death of parents, siblings (brothers and sisters), spouse (Husband or wife), and
children. To find out about family history, doctors ask:
 Do you have any brothers or sisters?
 Are your parents alive and well?
 Is anyone taking regular medication?
 How old was he (your father) when he died?
 Do you know the cause of his death? Or, what did he die of?
 Does anyone in your family have a serious illness?
C. Social and personal history
Record the relevant information about occupation, housing and personal habits including recreation, physical
exercise, alcohol and tobacco and, in the case of children, about school and family relationships. Here are some
typical questions in taking a social and personal history: Give up = to stop trying
What kind of house/accommodation do you live in? Do you smoke?
Do you live alone? How many (cigarettes) a day?
Who shares your home with you? Have you tried giving up?
How old are your children? What about alcohol? Wine, beer or
spirits?
What’s your occupation? How much do you drink a day? In a
week?
Do you have any problems at work? Can you give up alcohol when you can?
Do you have financial problems? Is there any difference in consumption over the past 5
years?
Do you have any hobbies or interests? What about exercise? How often do you exercise?
F- Asking about the functions of the body
Language Focus To ask about the senses, doctors usually use the questions;
What’s your sense of taste like? Or Is your sense of taste normal?
What’s your hearing like? Or Is your hearing normal?
To ask about the sense of touch, doctors talk about numbness (loss of sensation):
Have you noticed any numbness (in your fingers or toes)?

Complete the table below.
function verb noun
speaking ____________________ speech
_____________________ walk gait
breathing inhale / breathe in / take a breath in
__________________
respiration exhale / breathe out
urinate
urination
micturate __________________
micturition
pass urine / pass water
defecate faeces
______________________
pass faeces / pass stools stools
menstruate (menstrual) period
______________________
have a period (monthly) period
Take a deep breath in, hold your breath, and then

breathe out completely.
When asking about the functions of the body , doctors can ask:
walking?
trouble
breathing?
difficulty
Do you have any passing urine?
Match the symptoms (1–5) to the questionsproblems
(a–e), using your
with medical knowledge.
your speech?
pain when you breathe in?
1. dysuria a What is
When auscultating your breathing
a patient’s lungs, thelike?
doctor tells the patient:
2. dysphagia b Do you have any pain when you pass water?
3. diplopia c Do you have any difficulty with your speech?
4. dysphasia d Do you have any trouble swallowing?
5. dyspnoea e Is your vision normal?
Complete the sentences.
1- When I eat solid food, I have to …………………………… (bite/chew) it for a long time before I can (swallow/eat) it.
2- Do you have any pain when you …………………………… (pass/have) stools?
3- I have no …………………………………………… (taste/appetite) and I’ve lost five kilos in the last few weeks.
4- When did you last ……………………………… (have/pass) a period?
5- The garden is full of flowers, but my …………………………………............... (sense/sensation) of smell has disappeared
and I can’t enjoy the perfume.
6- Take a deep ……………………………… (breathe/breath) in.
Check your information for the JCI survey

Goal 3: Improve the Safety of High-Alert Medications
The hospital develops and implements a process to improve the safety of high-alert medications.
Standard IPSG.3
IPSG 3: Implement a process to improve the safety of High Alert Medications including lookalike and sound-alike medications.
Standard IPSG 3.1
Implement a process to manage the safe use of concentrated electrolytes.
Intent of IPSG.3 and IPSG.3.1 When medications are part of the patient treatment plan, appropriate management is critical to ensuring
patient safety. Any medication, even those that can be purchased without a prescription, if used improperly can cause injury. However, high-
alert medications cause harm more frequently, and the harm they produce is likely to be more serious when they are given in error. This can
lead to increased patient suffering and potentially additional costs associated with caring for these patients.
High-alert medications include medications that are involved in a high percentage of errors and/or sentinel events, such as insulin, heparin, or
chemotherapeutics; and medications whose names, packaging and labeling, or clinical use, look alike and/or sound alike, such as Xanax and
Zantac or hydralazine and hydroxyzine. There are many medication names that sound or look like other medication names. Confusing names
is a common cause of medication errors throughout the world. Contributing to this confusion are:
 incomplete knowledge of drug names;

 newly available products; similar packaging or labeling;
 similar clinical use;
 similar strengths, dosage forms, and frequency of administration; and
 illegible prescriptions or misunderstanding during issuing of verbal orders.
Now try to find answers for the following questions in Employee Guide to Joint Commission - International Hospital
Standards 5th Edition – Accreditation Survey Readiness 2015-2016
1- What do we mean by high alert medications?
2- What are the types of concentrated electrolytes that are considered as high alert medications?
3- How do you ensure the safety of high alert medications?
4- What extra precautions are taken with the high alert medications?
Insert the following questions in the appropriate spaces in the dialogue below.
A. Where did it start?

G. How strong is it at the moment?
B. Does it go anywhere else?
H. Is it constant, continuous?
C. When did it come on?
I. And have you had the pain before?
D. And do you still have it?
J. How severe was the pain?
E. Can you show me where it is?
K. Can you tell me what the problem is?
F. Can you describe the pain for me?
DOC: Good morning, Mr. Fitt DOC: _________________9________________

PAT: Good morning doctor. PAT: Just after dinner.
DOC: How can we help you? DOC: What did you have to eat?
PAT: I’ve not been feeling very well. PAT: The usual, steak and chips.
DOC: _______________1_________________ DOC: And to drink?
PAT: Well, I’ve got this terrible pain. PAT: A couple of beers.
DOC: ________________2________________ DOC: Pints?
PAT: Yesterday evening. PAT: Yes.
DOC: _________________3_______________ DOC: Do you have a couple of pints every
PAT: Yes, but it’s not as bad as it was. evening?
DOC: ________________4________________ PAT: Yes, more or less.
PAT: Yes just here [at the top of my tummy]. DOC: And do you ever have more than a couple?
DOC: ________________5________________ PAT: Oh, yeah, especially at weekends
PAT: Yes. It feels as if it’s going straight through DOC: _________________10_______________
to my back. PAT: Yes. But not as bad as this.
DOC: ________________6________________ DOC: _________________11_______________
PAT: Well. It feels as if it’s boring right through PAT: I don’t know, it was really bad
me. DOC: Did it make you double up?
DOC: ________________7_________________ PAT: Yes.
PAT: Yes DOC: Does anything make the pain better?
DOC: ________________8_________________ PAT: No, not really. Well, maybe if I don’t eat.
PAT: It’s eased off a bit, but it’s still bad.
G- Charting and documentation – Writing up case reports
Study this letter from a GP to a consultant. Write down the questions which a doctor might ask to obtain the
information underlined in the letter.
CLINICAL DETAILS
Date: __ February 17th 2016______
Dear ___Dr Scott___________________
I would be grateful for your opinion and advice with regard to
(Name) GREEN, Peter

URGENT
Please indicate in the box
A brief outline of history, symptoms and signs and present therapy is given below:
This 42-year-old salesman (1) had a severe attack of central chest pain (2) six months ago (3) which
lasted 10 mins and was relieved by rest (4). This has recurred several times after exertion (5). His
father died aged 56 (6)__of a coronary thrombosis (7). Physical examination was normal and I refer
him to you for further assessment in view of his age.
Diagnosis: angina
Thank you for seeing him.
Write the questions you have formed on the lines below
1- __________________________________________________________________?
2- __________________________________________________________________?
3- __________________________________________________________________?
4- __________________________________________________________________?
5- __________________________________________________________________?
6- __________________________________________________________________?
7- __________________________________________________________________?
Form of all passive verbs:

Grammar Focus Passive Voice be + past participle
Be can be in any of its forms: am, is, are,
was, were,
20 | P a g e Formation: VerbCto Be
o m l eP.P.
p i+ d a n d a r r a n g e d b y S e i f Z o h d y – 2 2 / 3 / 2 0 1 6
has been, have been, will be, etc.
Mr. Farnsworth was

admitted complaining of
chest pain
am, is, was, have/has

are were been
Verb Be
Verb Be + P.P.
Ms. J. K. is an 83 year old retired nurse with a long history of hypertension that was previously well
controlled on diuretic therapy. She was first admitted to CPMC in 2012 when she presented with a
complaint of intermittent mid-sternal chest pain.
P.P.
Mr. H. seeks care for the pain at this time because he is now covered by Medicare. The
pain is located in the epigastric region and left upper quadrant of the abdomen.
Be + PP
Be + PP
Change the sentences from active to passive. The first one has been done for you. Begin with the underlined
word/s. You may ask your English language instructor in case you need any further clarification.
1. Ms. Hopkins invited me to dinner.
- I was invited to dinner by Ms. Hopkins.
2. We gave a course of antibiotics to the patient.
………………………………………………………………………………………………………………
…………………………………………………
3. We replaced the patient's hip.
………………………………………………………………………………………………………………
………………………………………………….
4. I examined the patient fully.
………………………………………………………………………………………………………………
………………………………………………….
5. A doctor has already examined the patient in room 34.
………………………………………………………………………………………………………………
………………………………………………….
6. A large number of patients don’t speak Spanish.
………………………………………………………………………………………………………………
………………………………………………….
7. The doctor gave him an injection to relieve the pain.

………………………………………………………………………………………………………………
………………………………………………….
Change the sentences below from active to passive tense. For example:
Active: The GP referred the patient to a consultant.
Passive: The patient was referred to a consultant by the GP.
Remember that it is not always necessary to mention the subject in a passive sentence. For example:
Active: We have identified the cause of this outbreak of dysentery.
Passive: The cause of this outbreak of dysentery has been identified.
1. The nurse noticed a rise in the patient's pulse rate.
Passive:
………………………………………………………………………………………………………………
……………………………..
2. The consultant is allowing him to watch the operation.
Passive:
………………………………………………………………………………………………………………
……………………………..
3. The doctor diagnosed appendicitis.
Passive:
………………………………………………………………………………………………………………
……………………………..
4. The paramedics comforted the injured person until the ambulance arrived.
Passive:
………………………………………………………………………………………………………………
…………………………….
5. The gland was producing an excess of hormones.
Passive:
………………………………………………………………………………………………………………
……………………………
6. We examined the tissue under the microscope.
Passive:
………………………………………………………………………………………………………………
……………………………
7. You cannot take the lotion orally.
Passive:
………………………………………………………………………………………………………………
………………………….
8. Toxic fumes poisoned the workers.
Passive:
………………………………………………………………………………………………………………
………………………….
9. Doctors are predicting a rise in cases of whooping cough.
Passive:
………………………………………………………………………………………………………………
…………………………
10. The drug suppresses the body's natural instinct to reject the transplanted tissue.
Passive:
………………………………………………………………………………………………………………
…………………………
Read the following case history. Then find and underline the following information about the patient. Then write
them below.
1 Previous occupation:
________________________________________________________________
2 Initial symptoms: ___________________________________________________________________
3 Initial diagnosis:
____________________________________________________________________
4 Condition immediately prior to admission:

_______________________________________________
5 Reason for emergency admission:

______________________________________________________
6 Duration of increased thirst and nocturia: ________________________________________________
7 Father’s cause of death: ______________________________________________________________
8 Alcohol consumption:
________________________________________________________________
CASE HISTORY
Mr. Wildgoose, a retired bus driver, was unwell and in bed with a cough and general malaise when he
called in his general practitioner. A lower respiratory tract infection was diagnosed and erythromycin
prescribed. Two days later, at a second home visit, he was found to be a little breathless and
complaining that he felt worse. He was advised to drink plenty and to continue with his antibiotic.
Another 2 days passed and the general practitioner returned to find the patient barely rousable and
breathless at rest. Emergency admission to hospital was arranged on the grounds of ‘severe chest
infection’. On arrival in the ward, he was unable to give any history but it was ascertained from his wife
that he had been confused and unable to get up for the previous 24h. He had been incontinent of urine
on a few occasions during this time. He had been noted to have increased thirst and nocturia for the
previous 2 weeks. His past history included appendicectomy at age 11 years, cervical spondylosis 10
years ago, and hypertension for which he had been taking a thiazide diuretic for 3 years. His father had
died at 62 years of myocardial infarction and his mother had had rheumatoid arthritis. His wife kept
generally well but had also had a throat infection the previous week. Mr. Wildgoose drank little alcohol
and had stopped smoking 2 years previously.
Make corrections to the word/words in bold in the following patient profile/history that was written by a trainee
nurse. The first one has been done for you. Write the correct answers in the boxes provided.
Year-old
Ms. Sylvia Smythe is a 27-years-olds who diagnosed with Type 1 diabetes after a sudden onset of
increase thirst and frequent urination. She also loosed a lot of weight despite having an increased
appetite. She have a family history of hipertension and has recently noticed that him blood pressure
is quite high. Ms. Smythe admitted to hospital after experiencing some serious hypoglycaemic
attacks. One occurred while she was on the bus going to work. She was very lucky that a young nurse
was sit next to she and recognise the acetone smell of her breath as a symptom of diabetic
ketoacidosis.
During this hospital admission him insulin use, diet and exercise program will be reviewed.
Listen to a presentation on the latest developments in diabetes self-management. Then match the beginnings of
the sentences (1–5) to the endings (a–e).
1. This new treatment for diabetes a include low blood glucose, dry mouth and chest discomfort.
2. The insulin b then pump the handle and press a button.

3. Insert a capsule of the insulin into the c is taken ten minutes before meals and comes in powdered
inhaler form
4. The potential side effects d should have their lungs tested by their doctor first.
5. Diabetics with lung disease or asthma e is in the form of an insulin inhaler.
Snapshot Treating Patients of Different Cultures; Discussing sex with patients can be awkward and
uncomfortable even in the best of circumstances. You want patients to be open with you so you can get accurate
information. However, not every culture treats sex the same way.
What can you do as a health professional? One starting point is, understanding. Your perspectives and
those of your patients aren’t always going to match. Try to see where your patients are coming from.
Remember that what’s “wrong” in your culture isn’t necessarily “wrong” in another and vice versa.
H- English Collocations for effective medical communication

Language focus A collocation is two or more words that often go together. These combinations
just sound "right" to native English speakers, who use them all the time. On the other hand, other
combinations may be unnatural and just sound "wrong". Look at these examples:
Make an examination × perform an examination √ carry out an examination √
The verbs perform and carry out are used with all types of procedures. They are often used in the
passive form
The procedure was carried out by a nurse
The surgery was performed by Dr. Haliberto Cos Perez

an examination
an operation
Collocations
Perform a procedure
More collocations
Carry out an experiment
a test
a biopsy
Make word combinations using a word or a phrase from each box. Ask your instructor if you need help.
___________________________________
Write your answers here
carry out sutures ___________________________________

change a procedure
check an injection ___________________________________
give a dressing
remove the temperature __________________________________
__________________________________
Link each verb on the left with a noun on the right to make 10 'partnerships'(Collocations). The first one has been
done for you as an example.
Verb Noun
administer an improvement
analyse a baby
arrange antibiotics
burp the treatment
catch some infections
detect an appointment
discontinue a sample
ease the pain
resist a drug
prescribe a cold
Complete these sentences using the partnerships from the Exercise above. You may have to make some changes
to fit the grammar of the sentences. The first one has been done for you as an example.
1. The doctor will administer a drug to the patient.
2. She was …………………………………………………………………………..
3. As soon as the patient reported severe side-effects, the doctor ………………………………………..
4. I've ……………………………………………………….. from one of my colleagues at work.
5. The laboratory …………………………………….. of the food and found traces of bacteria.
6. A healthy body can……………………………………………...
7. I would like to ………………………………………………..with the dental hygienist for 10.00am tomorrow.
8. She had an injection to ……………………………………………..in her leg.
9. The health visitor advised the new parents to ………………………………………………………….. after feeding.
10. The nurses …………………………………………………………..in the patient's condition.
Use the notes below to write out a case report. Remember to divide the notes in sentences.
35 year-old woman Mrs. Bentley telephoned A&E - 3am c/o severe vomiting - five hours duration - very loose
motions several times - same period - some cramping pains – central/ lower abdomen - started about six hours
prior - call. - smoke and alcohol no -previous evening egg mayonnaise sandwiches -way home from work.
no dysuria - periods regular - last menstrual period two weeks ago - appendicectomy 15 years before - nullipara.
examination - temperature 38.1C- not anaemic -pulse 110/70/min/ regular - blood pressure 108/82 - respiratory
rate 19/min - tongue dry - some tenderness centre abdomen/left iliac fossa -no guarding -auscultation bowel
sounds prominent no lymphadenopathy
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Listening: You will hear a discussion between a general practitioner and a consultant. Complete the
case notes below.
SURNAME FIRST NAMES

AGE SEX MARITAL STATUS
OCCUPATION
PRESENT COMPLAINT
IMMEDIATE PAST HISTORY
Complete the sentences with the phrasal verbs below
care for give up look after

a- You should ________________ this application form
fill in put on take off
b- That's a ward for the elderly patients so you have to _________________ them most of the
time.
c- As you are suffering from mild hypertension, you only need to ___________ fatty food.
d- If you're ill, I will ____________________ you on the night shift.
e- Would you _______________ your blouse, so I can examine your breasts?
Proofreading – A Focus on prepositions and verb to BE
Adult History and Physical Examination Form
Chief Complaint:
1. Rectal bleeding.
2. Anemia.
History of Present Illness:

The patient is previously seen for GI consultation in January 5, 2014 for
evaluation for rectal bleeding and anemia. The patient was scheduled to a
colonoscopy, but due to personal reasons the study has not yet been
performed. She returns today by ongoing anemia but the most recent lab
data is not available for review. In addition, less than a week ago she
began having loose stools, but this appears is improving. She voices no
other GI-related complaints, without nausea, vomiting and/or evidence for
active blood loss. She has no other comments or medical complaints.
REVIEW OF SYSTEMS:
The patient’s review of systems questionnaire were reviewed and there is no
additional pertinent positives.
PHYSICAL EXAM:

Proofread the following Physical Examination report and correct the prepositions and word/s in Bold.
III- Body Systems - Explaining and instructing

Aim: Explaining and informing of syndromes, symptoms, diseases and injuries in the patients’ language
Co I'm really stuck – Would you
A- Orthopedics m mind completing the list of the
common English names for
Bones pl bones for me?
et
Anatomical name Common English name
cranium skull
mandible
vertebral column spine
sternum
costa rib
clavicle
scapula shoulder blade
femur
patella kneecap
tibia
Fractures
A fracture is a break in the bone. Some of the different types of fractures are:
Match the types of fracture (1 – 5) with the description (A – E). Look at the diagram above to help you.
open A. There is a break in the skin.

comminuted B. The bone is bent. It occurs mainly in children
displaced C. The bone is broken into several pieces.
greenstick D. The broken pieces are separate.
impacted E. The broken pieces are pushed together.
Snapshot Other types of fractures are;

31 | P a g e
 C o m p i l e d
A pathological fracture: a diseased bone.
a n d a r r a n g e d b y S e i f Z o h d y – 2 2 / 3 / 2 0 1 6
 A fatigue or stress fracture is due to repeated minor trauma, for example long-
distance marching or running
Label the diagram using the words form the box
breastbone – collarbone – jaw bone – kneecap – rib – shinbone – shoulder blade

– skull – spine – thigh bone
Snapshot Treatment of fractures

When the fragment of a broken bone heal and join together, they unite. Union may be promoted or
helped, by reducing the fracture – replacing the fragments in their anatomical position if they are
displaced. After reduction, excessive movement of the broken bone is prevented by fixation – either
external, for example a splint or plaster of Paris cast, or internal, for example a pin or a plate and
screws. A displaced fracture which is not reduced may result in malunion – incomplete or incorrect
union.
B- The Gastrointestinal System

The faeces: There are different words for faeces. Doctors usually use the word “stool” for the faeces.
Here are some examples;
Choose: Do
Doc: Have you passed black stool? you have any pain when you ……………… (pass/have) stools?
Doc: Have you had blood in the stools?
Doctors may also use the word “bowel movement” for defecation.
Doc: Have your bowels moved today? How often = how many times
Or: Have you had a bowel movement today?
Bowel habit is a medical expression meaning the pattern of defecation.
Doc: Have you noticed any change of bowel habit?
Doc: How often do you open your bowels? Or,
Are you going to the toilet more than usual? How many times?
Change in the bowel habit could be constipation – hard, infrequent stools, or diarrhea – Frequent soft or
liquid stools. Normal stools are brown in colour, and semi-solid, or formed. The consistency or degree
of hardness can be shown on a scale:
Hard Formed Semi-formed soft (Loose) Liquid/watery
In medicine, melena or melaena refers to the black "tarry" feces or faeces that are usually associated

with upper gastrointestinal bleeding. The black color is caused by the hemoglobin in the blood being altered by
digestive chemicals and intestinal bacteria. The most common cause of melaena is peptic ulcer disease. Any
other cause of bleeding from the upper gastrointestinal tract, or even the ascending colon, can also cause
melaena. Melaena stools are often described as tarry – like tar (the black sticky substance that is used in road
making)
The stools may be red when fresh blood is present. Stools that are large in volume are described as bulky. A
bad smell is described as foul or offensive. Blood that can only be detected by special tests is called faecal
occult blood (FOB).
Match the features (1 – 7) to the doctor’s questions (A – G)
1. blood A. How often do you open your bowels?

2. bowel B. Are you going to the toilet more often than normal?
3. change in the bowel habit C. Are the motions hard or loose?
4. bulk D. Do the motions have unusual smell?
5. colour E. What about the appearance of the stools?
6. consistency F. Have you passed black stools?
7. offensive G. Is the size or the amount of the stool normal?
Snapshot
Working with Interpreters – 1
Positioning
C- Gynaecology
A period is the common name for a menstrual (monthly) period. The onset of menstruation is known as
menarche. The last menstrual period is commonly abbreviated in doctors’ notes: LMP 2/52 ago means the last
menstrual period was 2 weeks ago. The menstrual cycle, or length and frequency of periods, is usually written in
the form 4/28, which means lasting 4 days every 28. If a period lasts more than four or five days it can be described
as prolonged. The term heavy periods means excessive blood loss – menorrhagia, often with the passage of clots –
coagulated blood. The term period pains means dysmenorrhoea, or painful menstruation.
The time when a woman stops menstruating, normally at about the age of 50, is called the menopause or
climacteric. In everyday English it is known as the change of life, or simply the change. Symptoms of the
menopause include hot flushes – sudden sensation of heat – and night sweats.
A gynaecologist is talking to a 30-year-old woman.
DOC: Are your periods regular? Comprehension skills:
PAT: Yes. Read the above and the conversation (opposite)

between the gyaenacologist and the patient and
DOC: How often do you get them? complete the notes about the patient:
PAT: Every four weeks. Menarche: ……………………………………….............
DOC: How old were you when you started to get them? Menstrual cycle: …………………………………………..
PAT: About 12. LMP: …………………………………………………………….

DOC: When was your last period? Menorrhagia: ……………………………………………….
PAT: A week ago. Dysmenorrhea: …………………………………………….
DOC: How long do the periods last usually? Now write the questions that the doctor asked for
the following:
PAT: 4 or 5 days?
Menarche:
DOC: Do you say they are light or heavy.
……………………………………………………………………..
PAT: Light.
Menstrual cycle:
DOC: Do you get clots?
……………………………………………………………………..
PAT: No.
LMP:
DOC: Do you get period pains?
……………………………………………………………………..
PAT: Not really.
Menorrhagia:
DOC: Is there discharge between the periods?
……………………….…………………………………………….
PAT: A little
Dysmenorrhea:
DOC: What colour is it?
………………………………………………………………...
PAT: White.
D- Contraception; Birth Control
For women, some methods to prevent pregnancy include the oral contraceptive pill (known as the pill),
the diaphragm, and the intrauterine device (IUD) or copper coil. Condoms are available for both men
and women.
prolonged/heavy – clots – periods – periods – flushes – oral – pill – coil
Complete the case report with the words in the box. One word is needed twice.
A 45-year-old woman had been having (1) ………………………….…. periods lasting for 8 days, with
the 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) ………………………….... or night sweats, and her
general health had always been good. She had taken the (6) ………………………..…… contraceptive
(7) …….……………………………. until a year previously, when a copper (8)
……………………………… was fitted. She had had a normal pregnancy when she was 25.
E- The Heart and the Circulation
Write the words a patient would use to describe the symptoms below.
Dyspnoea …………………………………………………….
Arrhythmia …………………………………………………….
Orthopnoea …………………………………………………….
Oedema …………………………………………………….
Based on the case history below, complete the conversation beneath.

A 22-year-old student was admitted to hospital with a long history of heart problems. She had been increasingly
tired, with shortness of breath on exertion, orthopnoea, and palpitations. A mitral valve replacement had been
carried out 3 years previously and this had stabilized the symptoms of heart failure but was followed by episodes
(attacks) of atrial fibrillation, which had been particular severe for the 6 months before admission.
DOC: What seems to be the problem?
PAT: I’ve been getting …………………………………..
DOC: How long have you had them?
PAT: For about six months. But I’ve had heart problems for years, with tiredness and
…………………………….of ………………………. In the end I couldn’t walk more than a hundred
meters without having to stop. I had to sleep on three …………………….. I had a
…………………………………… replacement three years ago, and that improved things for a while.
Complete the case report. Use the words in the box below.
Episode – palpitations – shortness – swelling – exertion
A 60-year-old woman attended her GP’s surgery complaining of breathlessness on ………………………. This
had been increasing over the previous eight months until it was producing problems at around 500 metres walking
on the level. There was no history of chest pain. She had had several …………………….of fast
……………………….. which lasted 20-30 minutes and were associated with some ……………………….. of
breath. She had noticed some ..............………….. of her ankles by the end of the day. This disappeared overnight.
How would you manage the treatment of the condition above?

…………………………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………………………
Revision 1 - language used in writing up medical case reports

Insert the items in the column below in an appropriate place in the sentences below. One has been done for you as
an example.
1. The patient was admitted to hospital at 2 am.

a) exacerbated by
2. She was ____________hospital three days later
b) booked for
3. Mrs Jones was ____________pain in the lower abdomen.
c) be elicited
4. The pain was ____________cold weather. d) manifested by
5. The pain was ____________ the new drugs. e) admitted to
6. There is anecdotal evidence that some people f) discharged from
g) benefit from
_________________ homeopathic medicine in this case.
h) alleviated by
7. The pain was not ____________paracetmol.
i) diagnosed as
8. He was ____________hypotension.
j) mitigated by
9. The family history also needs to ____________in this case. k) operated on
10. He was ____________having Parkinson’s disease. l) suffering from
m) hospitalized with
11. The effects of the syndrome can be ____________medical care.
n) ameliorated by
12. The patient was ____________as soon as possible after the operation.
o) mobilized
13. The patient was ____________three days ago.
14. The boy was ____________the operation immediately he came in.
15. The disease is ____________a number of signs,
Notes for teachers Aim: Help trainees to write a case report.

• Give the students the exercise to do in pairs. You may wish to do the exercise as a filler at the beginning or the end of
lesson.
• When they have checked their answers ask the students to write sentences in pairs using as many of the verbs as
possible.
• You can ask the students to write their sentences on large sheets of paper which you can put up on the wall so the whole
class can look at them
• You can also ask the class to do the corrections and you can go round checking and correcting.
Match each of the suspected problems in the first column with a suitable question from the second
column.
Suspected problem Question

1- depression A- have you had any pain in your chest?

2- cardiac failure B- Do you ever get wheezy?
3- asthma C- What sort of mood have you been in recently?
4- prostate D- Any problem with your waterworks?
5- Coronary thrombosis E- have you ever coughed up blood?
6- cancer of the lung F- have you ever had shortness of breath?

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TCH Language Training Unit – Key to effective communication

Essential English for Medical Purposes

Hospital Mission, Vision and Values

Distinct quality care

Cultural awareness is also covered in snapshot boxes in order to widen your

Communication Skills in English for the Medical Practitioners

Consider the following points prior to consultations or

 Put yourself in the patient’s shoes.

I- The Essentials – Body Parts

ankle – chest – elbow – fingers – forehead – heel – hip – knee – navel –

Body parts – categories

arm hand leg foot torso head

Label the diagram using words from the box.

diaphragm – lobes – trachea – heart – lung – airways

2 pneumonia b gall bladder

4 gastric ulcer d kidney

6 angina pectoris f lung

8 ulcerative colitis h large bowel

Abdomen elbow loin wrist thigh

Medical Conditions Lay Term

Some lay terms for medication

Medication Lay Term

Asking about symptoms

A- With a pulse or beat

To identify the pain level doctors usually ask:

Complete: Q: What _______ the pain __________ like?

Q: What _____ the pain ______________?

Complete the dialogues below.

Goal 2: Improve Effective Communication.

Goal 3: Improve the Safety of High Alert

PATIENT: It’s right here. (2)

PATIENT: It’s a gnawing kind of pain.

PATIENT: Yes, if I eat, it gets better.

PATIENT: Down here. (3)

PATIENT: It’s a sharp, stabbing pain. It’s like a knife.

PATIENT: If I take a deep breath, or I cough, it’s really sore.

DOCTOR: Well, Mrs. Black……………………………………………………?

PATIENT: I’ve got a bad dose of flu. (1)

PATIENT: Two or three days. (2)

D- Vocabulary in Medical Reports & Forms

Nouns and Adjectives

Choose the correct word to complete each sentence.

1 Her condition (deteriorated/improved) and she died.

2 He (relapsed/recovered) and was allowed to go home from hospital.

3 The cause of sleeping (illness/sickness) was discovered in 1901.

4 The patient made a full (remission/recovery).

6 It was a month before he (got over / got better) the illness.

7 He seems to be rather (unhealthy/unwell) – his diet is bad and he never exercises.

Check your information for the JCI survey

E. Taking a history 2 – Gathering Information

Have you noticed any numbness (in your fingers or toes)?

Take a deep breath in, hold your breath, and then

2. dysphagia b Do you have any pain when you pass water?

3. diplopia c Do you have any difficulty with your speech?

4. dysphasia d Do you have any trouble swallowing?

5. dyspnoea e Is your vision normal?

Complete the sentences.

Complete: Q: What _ the pain ____ like?

Q: What _ the pain __________?

DOC: Good morning, Mr. Fitt DOC: _9

Date: February 17th 2016____

Dear _Dr Scott_________________