住院医师培训英语考试重点.doc

英翻中110Anemia贫血Nosocomial infection院感Etiology病因学Hypoxemia低氧血症Immunosuppressant免疫抑制剂Contrastmedium造影剂Proteinuria蛋白尿Peritonitis腹膜炎Inflammatory bowel disease; IBD炎性肠病Transfusion输血Urinalysis尿分析Elective surgery择期手术Placebo安慰剂Perforated ulcer溃疡穿孔Anesthesia麻醉Health promotion健康促进Malpractice医疗过失Pulmonary embolism肺栓塞Acute abdomen急腹症中翻英110切口感染wound infection脓肿abscess心肌梗塞myocardiac infarction肠梗阻intestinal obstruction哮喘asthma牵涉痛referred pain体力活动physical activity三级预防tertiary prevention绝经前期premenopause并发疾病complication生存率survival rate寿命life-expectancy抗菌谱antibacterial spectrum老年病人geriatric patient关节炎arthritis结肠息肉colonic polyp体重减轻weight loss腹腔镜laparoscope压痛tenderness段落翻译165/8CHAPTER-1The physician does not exist in a vacuum but rather as part of a complicated and extensive system of medical care and public health. In premodern times and even today in some developing countries, basic hygiene, clean water, and adequate nutrition have been the most important ways to promote health and reduce disease. In developed countries, the adoption of heath lifestyles, including better diet and appropriate exercise, are cornerstones to reducing the epidemics of obesity, coronary disease, and diabetes. Public heath interventions to provide immunizations and to reduce injuries and the use of tobacco, illicit drugs, and excess alcohol collectively can produce more health benefit than nearly and other imaginable health intervention.医生不是存在于真空，而是作为复杂而广泛的医疗保健体系和公共健康的一部分而存在。在近代以前，甚至今天的一些发展中国家，基本卫生、清洁水和足够的营养一直是促进健康和减少疾病的最重要的方法。在发达国家，健康的生活方式，包括合理的饮食、适量的运动，是减少肥胖、冠状动脉硬化性心脏病、糖尿病流行的基石。公共卫生干预措施，通过提供免疫接种，减少损伤，减少烟草、不合理药物的使用，减少过量饮酒，可以产生比其它可以想象的健康干预措施更多的健康收益。CHAPTER-4Hospice regulations in the United States require that a patient agree to forgo measures with curative intent and focus on comfort. Although hospice programs vary in their policies, many “aggressive”, expensive interventions, such as surgery, radiation therapy, total parenteral nutrition, and transfusions, tend to be excluded. To many patients and families, hospice seems to signify “giving up”, rather than being viewed as a model of compassionate care and of making the best of a situation with limited options. Also, to be eligible for a Medicare-certified hospice program, the primary physician must certify that the patient is likely to die within 6 months if the illness runs its usual course. No penalties exist, however, for referring a patient too early to hospice, and physicians generally use hospice care much later in the course of an illness than appropriate.在美国，临终关怀法规要求病人同意放弃治疗措施，重点关注病人舒适度。尽管临终关怀的政策在不断修正，很多“侵犯性的”、昂贵的干预措施，如外科手术、放射治疗、全静脉营养和输血，往往被排除在外。对于很多病人和家属来说，临终关怀似乎意味着“放弃”，而不是被作为一种有同情心的照顾和在有限情况下选择最佳效果的模式。此外，要获得进入临终关怀程序的资格，主治医生必须证明病人按照正常的疾病发展过程将在6个月内死亡。然而，对于安排病人过早的进入临终关怀程序，并没有相应的处罚措施，而且，医生使用临终关怀通常都是在疾病发展晚期而不是合适的时候。Another option is palliative care in inpatient units, which are furnished in a homelike fashion; are quieter than the typical noisy hospital ward; are decorated with personally important objects from each patient; and typically lack, minimize, or obscure hospital paraphernalia. Patients are encouraged to wear their own clothes, pets are allowed, and families (including children) have unlimited visiting privileges and are encouraged to stay overnight and to cook there or bring food.另一种选择是在非急救病房行姑息性治疗，这种病房布局像家一样，比普通的医院环境安静，并根据每个病人的情况做了个性化布置，尽量减少、淡化在医院的感觉。在这里，通常鼓励病人穿自己的衣服，可以养宠物，家庭成员（包括小孩）可以随时探视，鼓励探视家属留下来过夜，在这里做饭或带食物过来。CHAPTER-5Clinical preventive services include counseling, immunization, screening tests, and reduction of the susceptibility to disease by interventions such as therapeutic lifestyle changes and pharmacotherapy. Preventive services often are classified as primary, secondary, or tertiary. Primary prevention is directed toward preventing disease or injury before it develops, whereas secondary prevention deals with early detection and treatment to impede the progress of overt disease. In contrast, tertiary prevention refers to rehabilitative activities after the onset of disease to minimize complications and disability. Because of considerable overlap, distinguishing among these phases of prevention may be confusing. Detecting and treating hypertension could be considered secondary prevention of hypertensive cardiovascular disease but primary prevention of heart failure and stroke. Prevention may be perceived best along a continuum from modification of predisposing factors, to preventing a disease, to avoiding premature death and disability. The sooner the prevention, the more likely unnecessary illness, disability, and premature death can be avoided. Increasing emphasis has been placed on preventing risk factors themselves. The term primordial prevention has been introduced for this concept.临床预防服务包括预防咨询、免疫接种、筛选试验和降低疾病易感性的干预措施，如改变生活习惯和药物疗法。预防服务通常被分为初级预防、二级预防和三级预防。初级预防是直接预防疾病和损伤的发生，而二级预防则是针对显性疾病进行早期检查和治疗以阻止其进展。相反的，三级预防则是在疾病发生后进行康复治疗，努力使并发症和伤残降到最低。由于很多的交叉重叠，要区分预防的三个阶段有时候显得很困难。检测和治疗高血压可以被看作是高血压性心脏病的二级预防，但也是心衰和中风的初级预防。预防被认为最好根据诱因进行持续改正，以预防疾病，避免过早死亡和伤残。预防越早，越有可能避免不必要的疾病、伤残和过早死亡。强调的重点被放在了预防危险因素本身。预防的原始一词已经引入了这个概念。Indiscriminate screening for risk factors or disease without adequate advice and follow-up serves no useful purpose. The periodic health examination has evolved from an annual, broad-based, uniform protocol to an approach that targets the prevention, detection, and treatment of specific diseases or risk factors for particular age, gender, and ethnic groups at appropriate intervals. Current recommendations by the U.S. Preventive Services Task Force are based on systematic evidence reviews that distinguish procedures likely to prove effective and to have substantially more benefit than harm.对疾病或危险因素不加选择的进行筛查，没有后续的健康指导和随访服务对预防是没有意义的。定期健康检查已经从每年次、范围广泛、标准统一的普查逐渐转变为根据年龄、性别、种族对特定的疾病、危险因素进行随访间期合适的预防、检查和治疗。美国预防工作小组最近基于系统证据回顾的建议指出：有区别的进行预防可以调高有效性，从本质上来说也是利大于弊的。CHAPTER-8Older patients differ from young or middle-aged adults with the same disease in many ways, one of which is the frequent occurrence of comorbidities and of subclinical disease. As a function of the high prevalence of disease, comorbidity (or the co-occurrence of two or more diseases in the same individual) is also common. Of people age 65 and older, 50% have two or more chronic diseases, and these diseases can confer additive risk of adverse outcomes, such as mortality. In some patients, cognitive impairment may mask the symptoms of important conditions. Treatment for one disease may affect another adversely, as in the use of aspirin to prevent stroke in individuals with a history of peptic ulcer disease. The risk for becoming disabled or dependent also increases with the number of diseases present. Specific pairs of diseases can increase synergistically the risk of disability. Arthritis and heart disease coexist in 18% of older adults; although the odds of developing disability are increased by three-fold to four-fold with either disease alone, the risk of disability increases 14-fold if both are present.对于同一种疾病，老年人与青年人或中年的不同表现在很多方面，其中之一就是常伴有合并症或亚临床疾病。由于这个年龄段的高患病率，合并症（或是一个个体有两种或多种疾病同时存在）是非常常见的。65岁以上的人群，50%有两种或更多的慢性疾病，这些疾病往往增加不良事件的风险，例如死亡风险。在一些病人中，认知障碍常常会掩盖一些重要的临床症状。对一种疾病的治疗可能会对其它疾病不利，例如对有消化道溃疡病史的病人使用阿司匹林预防中风。存在这些疾病的病人出现残疾或生活依赖的风险也相应增加。一些特定的疾病同时存在对伤残风险的增加起到协同作用。有18%的老年人同时患有关节炎和心脏病，尽管其中任何一种疾病单独存在时，伤残风险会增加3到4倍，但是如果两种疾病同时存在，伤残风险会增加到14倍。CHAPTER-21Occult bleeding is defined as the detection of asymptomatic blood loss from the gastrointestinal tract, generally by routine fecal occult blood testing (FOBT) or the presence of iron deficiency anemia. Obscure gastrointestinal bleeding is defined as bleeding of unknown origin that persists or recurs after a negative initial endoscopic evaluation of both the upper and lower gastrointestinal tracts. Both of these entities may be presentations of recurrent or chronic bleeding.隐匿性出血的定义是胃肠道无症状性血液丢失，一般通过常规的大便隐血试验或者有缺铁性贫血表现而发现。不明原因的消化道出血是指消化内镜检查时找不到明确出血来源的持续性或反复性失血。这两种情况可能频发或慢性失血的表现。CHAPTER-22Because of the high prevalence of heart disease and heart failure in the general population, many patients with dyspnea have cardiac abnormalities. The basis of the dyspnea is usually a high filling pressure of the left ventricle, which causes high left atrial pressures and high pulmonary capillary and pulmonary arterial pressures, which in turn increase the pulmonary blood volume and reduce lung compliance. If the pulmonary capillary wedge pressure is in the range of 25mmHg, capillary fluid transudates into the pulmonary matrix, thereby reducing lung compliance, increasing the work of breathing, and causing dyspnea. Echocardiography is usually diagnostic of abnormal ventricular or valvular function and should be performed in any patient in whom the cause of dyspnea is not readily apparent.由于普通人群中心脏病和心衰的高患病率，很多病人出现呼吸困难都伴有心脏活动异常。呼吸困难的基础通常是由于左心室灌注压增高，导致左心房灌注压、肺毛细血管压、肺动脉压增高，从而使肺血容量增加、肺顺应性下降。如果肺毛细血管楔压在25mmHg范围内，毛细血管液体渗入肺组织，使得肺顺应性下降，增加呼吸做功，导致呼吸困难。心脏超声检查可以诊断心室或瓣膜功能的异常，而且可以用于任何原因不明的呼吸困难的病人的检查。CHAPTER-23End-stage renal disease (ESRD) from diabetic nephropathy is a major cause of morbidity and mortality, particularly in patients with type 1 diabetes, affecting 30 to 35% of patients in the United States. Although nephropathy is about one half as frequent in type 2 diabetics (partially due to a shortened life expectancy), type 2 diabetics still makes up the vast majority of diabetic patients seeking therapy for ESRD. Overall, diabetes is the leading cause of ESRD in the United States, accounting for more than one third of cases.糖尿病肾病来源的终末期肾疾病，是患病率和病死率的主要影响因素，特别是在美国的1型糖尿病患者中，影响到30%35%的患者。尽管在2型糖尿病患者中有近二分之一出现肾病（部分由于生存预期缩短），2型糖尿病仍然构成了糖尿病患者寻求ESRD治疗的主要群体。总之，美国统计有超过三分之一的患病率，糖尿病已经成为ESRD的重要因素。CHAPTER-25In the majority of patients with cancer of unknown primary site, the diagnosis of advanced cancer is strongly suspected after the initial history and physical examination. A brief additional evaluation, including complete blood cell counts, chemistry profile, and computed tomography of the chest and abdomen should be performed. In addition, specific symptoms or signs should be evaluated with appropriate radiologic and endoscopic studies. If a primary site is located, management should follow guidelines for the specific cancer identified. In patients with no obvious primary site, the most accessible metastatic site should be biopsied.对于大多数原发部位不明的癌症患者，在初始的病史和体格检查之后，诊断癌症多是强烈的推测。做一些简要的附加检查，如血细胞计数、生化检查和计算机扫描胸、腹部都是必要的。此外，特殊的症状和体征应当结合适当的放射学和内镜检查帮助确定。CHAPTER-28Surgeons can do much to avoid complications by the careful preoperative screening process. When the surgeon sees the potential surgical candidate the first time, a host of questions come to mind, such as the nutritional status of the patient and questions about the health of the heart and lungs. The surgeon will make a decision regarding performing the correct operation for the appropriate disease. Similarly, the timing of the operation is often an important issue. Some operations can be performed in a purely elective fashion, whereas others have some urgency about an expeditious surgical solution. Occasionally, the surgeon will demand that the patient lose weight before the operation so that the likelihood of a successful outcome is improved. Occasionally, the wise surgeon will request preoperative consultation from a cardiologist or pulmonary specialist to make certain that the patient will be able to tolerate the stresses of a particular procedure.外科医生通过细致的术前检查可以避免并发症的发生。当一个外科医生第一次去访视术前病人的时候，应该注意许多问题，如病人的营养状况和健康情况，心肺功能状况。然后针对该患者的疾病确定一个正确的手术方案。同时，手术时机的确定也是非常重要的。有些手术有很多种手术方式可供选择，也有一些急症病人需要外科紧急处理。有时候，外科医生需要病人术前减轻体重，从而提高手术的成功率。有时候，一些聪明的外科医生，会邀请心内科和呼吸内科专家术前会诊，以确定病人能否承受手术的打击。CHAPTER-30An epidemic is an outbreak of influenza confined to one geographic location. In a given community, epidemics of influenza A virus infection often have a characteristic pattern. They usually begin rather abruptly, reach a sharp peak in 2 or 3 weeks, and last 6 to 10 weeks. Increased numbers of schoolchildren with febrile respiratory illness are often the first indication of influenza in a community. This indication is soon followed by illnesses among adults and about a week later by increased hospital admissions of patients with influenza-related complications. Hospitalization rates in high-risk persons increase two-to five fold during major epidemics. School and employment absenteeism increases, as does mortality from pneumonia and influenza, especially in older persons. The latter finding is a highly specific indicator of influenza activity.流行是指流行性感冒在一定范围内爆发。在一个特定的区域范围内，A型流行性感冒病毒的流行常有一个特定的模式。他们通常起病迅速，23周达到顶峰，持续610周。学龄期儿童发热和呼吸道疾病人数增加通常是流感发生的第一个迹象。这些症状随后在成人群体中发生，大约一周以后，因流感相关并发症住院的人数增加。在主要的流行病区域，高风险人群的住院率增加25倍。学校和就业矿工人数增加，同时，肺炎和流感的病死率增加，尤其是在老年患者当中。而且发现，后者是流感活动的一个非常具体的指标。CHAPTER-41Most patients should undergo comprehensive evaluation of myocardial function and coronary anatomy. Echocardiography is useful for excluding hypertrophic cardiomyopathy and valvular heart disease; magnetic resonance imaging, for diagnosing arrhythmogenic right ventricular dysplasia; and myocardial biopsy, for identifying infiltrative diseases such as myocarditis, amyloidosis, hemochromatosis, and sarcoidosis. Coronary angiography should be performed to assess for the presence of coronary occlusive disease and to exclude coronary artery anomalies. Myocardial perfusion scintigraphy provides complementary data for assessing ischemic burden. Left ventricular function can be assessed by contrast ventriculography, radionuclide ventriculography, or echocardiography.大多数病人需要通过心功能测定和冠状动脉解剖进行综合评估。心脏超声检查可用来排除肥厚型心肌病和心脏瓣膜疾病；MRI可用来诊断心律失常性右心室发育不良；心肌活检可用于鉴别浸润性疾病，如心肌炎、淀粉样变、血色病和伯克氏病。冠脉造影可以评估冠脉闭塞性疾病，同时可以排除冠脉异常。心肌灌注显像技术对心肌局部缺血损伤的评估提供了补充证据。左室功能可以通过心室造影，放射性核素心室显像技术和心脏超声检查进行评估。CHAPTER-47Believe the patients complaint of pain. Despite decades of effort, there is no neurophysiologic or chemical test that can measure pain in individual patients. The most promising technique, functional brain imaging, so far shows only rough correlation with reports of acute pain and has been disappointing for chronic pain. Objective observations of grimacing, limping, and tachycardia may be useful in assessing the patient, but these sings are often absent in patients with chronic pain caused by large structural lesions. The clinician can acknowledge the patients report of pain before understanding its cause. Acceptance of the patients reality of pain does not obligate the physician to provide strong opioids or other particular types of treatments.相信病人的疼痛主诉。尽管经过了几十年的努力，仍然没有一项神经生理或化学测试能够衡量病人的疼痛程度。最后前途的技术，脑功能成像，到目前为止，也只有对急性疼痛的一些粗略的相关性的报告，对慢性疼痛的研究依旧是令人失望的。对面部表情、跛行和心动过速的客观评价，对于评估病人的疼痛程度可能有用，但是这些症状在慢性疼痛病人常常因为机体巨大的结构病变而无法进行评价。临床医生在了解疼痛的病因之前，应该相信病人的疼痛主诉。接受病人疼痛的事实，并不是要求内科医生提供强力镇痛药物或其他特殊类型的治疗。Record the severity of pain and functional impairment with a measure simple enough for repeated use. Extensive work in many diseases has shown that changes in a 0-to-10 scale for pain intensity are valid and sensitive for detecting meaningful relief. Pain-related functional limitations can be assessed either by using the patients choice of important activities or by asking the patient how much, on a 0-to-10 scale, pain has interfered with domains such as general activity, mood, walking, work, relations with other people, sloop, and enjoyment of life.用一种可以重复使用，操作的简单的测定方法记录疼痛和功能障碍的严重程度。对多种疾病的大量的研究工作表明，疼痛强度的010分制的变化对于疼痛缓解程度的评估是敏感而有效的。疼痛相关性功能障碍的评估可以通过观察病人选择的一些重要的活动指标来完成，或者询问病人疼痛程度，以010分为标准，判断对活动范围的影响程度，如日常活动、情绪、步行、工作、与他人的关系，以及生活的愉悦程度，从而对疼痛进行评估。CHAPTER-54The studies that compared enteral and parenteral nut