医学英语(规培).doc

临床医学英语【题型】词组中译英、英译中10个，段落英译中八选五段alternativeandcomplementarytherapies补充和替代疗法nutrition营养healthylifestyles健康生活方式immunizations免疫接种systolic收缩期的diastolic舒张期的respiratory呼吸(作用)的。dyspnea气急呼吸困难tachypnea呼吸急促hypopnea呼吸减弱comorbidity并存病subclinicaldisease无明显临床症状的疾病adverseoutcomes不利结果pepticulcer消化性溃疡arthritis关节炎myocardialinfarction心肌梗死spectrumofdiseases疾病谱weightloss减肥atherosclerosis动脉粥样硬化chronicdisease(e.g.,heartfailure)心力衰竭physicaltherapy理疗bioartificialliver生物人工肝autologouscells自体细胞growthfactors生长因子lowergastrointestinaltracts上消化道和下消化道premenopausalwomen绝经前妇女biopsy活检inflammatoryboweldisease炎性肠病angiography血管造影capsuleenteroscopy胶囊小肠镜asthma哮喘chronicbronchitis支气管炎emphysema肺气肿hypoxia低氧缺氧pulmonaryemboli栓子lungcompliance肺顺应性diabeticnephropathy糖尿病性肾病lifeexpectancy预期寿命nephropathy肾病hyperglycemia高血糖高血糖症microalbuminuria微量白蛋白尿primarytumor原发肿瘤etiology病因学advancedcancer晚期肿瘤pretermlabor未足月产epidemicinfluenza流感imagingtest影像学acutecholecystitis急性胆囊炎gallstones胆结石endoscopicultrasonography内窥镜超声检查pancreatictumors胰腺肿瘤preoperativestaging术前分期chronicpancreatitis慢性胰腺炎arrhythmia心率失常coronaryarterydisease冠脉疾病myocarditis心肌炎hypertrophiccardiomyopathy肥厚性心肌病vetntriculartachycardia室性心动过速idiopathicdilatedcardiomyopathy特发性扩张型心肌病gastrointestinalperforation胃肠穿孔celiotomy剖腹术immunosuppression免疫抑制intestinalanastomoses肠吻合术electivegastrointestinalsurgery择期手术postoperatively术后的woundinfections切口感染intra-abdominalabscess腹腔脓肿nosocomialinfection院内感染aspiration误吸1.第一课P1Thepatient-physicianinteractionproceedsthroughmanyphasesofclinicalreasoninganddecisionmaking.Theinteractionbeginswithanelucidationofcomplaintsorconcerns,followedbyinquiresorevaluationtoaddresstheseconcernsinincreasinglypreciseways.Theprocesscommonlyrequiresacarefulhistoryorphysicalexamination,orderingofdiagnostictests,integrationofclinicalfindingswiththetestresult,understandingoftherisksandbenefitsofthepossiblecoursesofaction,andcarefulconsultationwiththepatientandfamilytodevelopfutureplans.Physiciansincreasinglycancallonagrowingliteratureofevidence-basedmedicinetoguidetheprocesssothatbenefitismaximized,whilerespectingindividualvariationsamongdifferentpatients.医患沟通贯穿于临床推论和临床决策的各个阶段。医患沟通始于主诉的阐述或关心的表达，并以越来越精确的方式，通过学问或评估得以继续。这一过程通常需要仔细的病史(采集)和体格检查,安排诊断性实验,并使实验结果与临床发现一体化,以及对可能所采取行动的风险和好处的理解，与病人及其家庭之间细致的商讨以产生将来的计划。医生越来越（趋于）访问日益增多的循证医学文献去指导这个过程，以使取得最大的收益，同时对于不同的病人充分考虑个体的不同变化。2.第八课P22Fourth,cognitiveimpairmentincreasesinprominenceaspeopleage.Cognitiveimpairmentisariskfactorforawiderangeofadverseoutc。omes,includingfalls,immobilization,dependency,institutionalization,andmortality.Cognitiveimpairmentcomplicatesdiagnosisandrequiresadditionalcaregivingtoensuresafety.第四，认知的损害，随着人们年龄的增长日益显著。认知的损害是很多的不良结果的危险因素，包括衰弱，不能活动，不能自理，？，死亡率，认知的损害诊断复杂，需要额外的关爱以确保安全。3.第二十一课P62Anewdeviceforvisualizingtheentiregastrointestinalmucosaconsistsofasmallcamerainaningestablecapsulethattransmitsimagestoreceiversattachedtothepatientsabdomenandmappedtoidentifythelocationoftheimage.Thediagnosticyieldofcapsuleenteroscopyisnotyetclear,butthisapproachmaypotentiallyvisualizesegmentsofthesmallbowelthatwerepreviouslyinaccessible.Notherapeuticmaneuversarepossiblewiththedevice.以种新的可以可视化整个胃肠粘膜的装置，包括一个不可消化的胶囊里的相机，这个相机把相片转化至附着于腹部的接受器上，定位与识别图像的位置。胶囊小肠镜的诊断意义尚不明确，但这种方法可以看到以前进不去的小肠的肠段。用这种装置目前不能治疗。4.第二十二课P64Anincreaseddrivetoventilatemayalsocausedyspnea.Suchstimuliincludehypoxia,usuallywhenarterialoxygentensionsarelessthan60mmHg,andstimulifrominflamedlungparenchyma,asoccurinbacterialpneumoniaoralveolitisandthatdrivetherespiratorycentersofthebrain.Thesestimulioftenlowertherestingcarbondioxidepressure(Pco2)tolessthanthenormallevelof40mmHgandcausedyspnea,especiallyonmildexertion.过度通气也可以导致呼吸困难。兴奋呼吸中枢的刺激因素有动脉氧分压低于60mmHg时的低氧以及细菌性肺炎或肺泡炎时肺实质产生的炎性产物。这些刺激因素常常使静息时的二氧化碳分压降至40mmHg的正常水平以下而导致呼吸困难，在轻微活动时更加明显。5.第二十三课P68Afterseveralyears,mostdiabeticpatientsexhibitdiffuseglomerulosclerosis,althoughaminorityhavepathognomonicKimmelsteil-Wilsonnodularlesions.Althoughpathologicchangescontinuetomountthroughoutthedisease,glomerulosclerosisextensiveenoughtocauseESRDdevelopsinaminorityofpatients;inthesecases,overtalbuminuria(300mg/day)beginsapproximately15yearsafterdiagnosis.Soonafter,followingavariableperiodontheorderof3to5years,theGFRbeginsarelentlessdecline(=10ml/min/year),whichiseventuallyreflectedbyanincreaseinserumcreatinine.TheappearanceofmassiveproteinuriaandthenephrotiosyndromeiscommoninthiscontextandoftenheraldsprogressiontoESRD.Oncetheserumcreatininerises(reflectinganapproximately50%declineinGFR),ESRDdevelopsinmostpatientswithin10years.Thiscourseishighlyvariable,however,particularlyintype2dieabetics,whomayexhibitmoderateproteinuriaforseveralyearswithoutasubstantialdeteriorationofrenalfunction.Asimplebutusefulmethodofmonitoringrogressiontorenalfailureistoplotthereciprocaloftheserumcreatinineasafunctionoftime.Thistechniqueallowsbetterassessmentofboththerapeuticinterventionsandthetimewhenrenalreplacementtherapywillbecomenecessary.几年以后，大多数糖尿病患者出现弥漫性肾小球硬化症，而少数患者出现特异性K-W结节损害。尽管病变进展持续贯穿疾病始终，少数患者肾小球硬化广泛足以引起ESRD的发展，在这些情况下，糖尿病肾病诊断后15年患者开始出现明显的白蛋白尿（大于等于300mg/天）。不久，大约3到5年的可逆期过后，肾小球滤过率开始不停下降（大于等于10ml/分钟/年），最终表现为血清肌酐的上升，在这种情况下，通常大量蛋白尿和肾病综合症开始出现，并宣告肾病已经进入到一旦血清肌酐上升（反映肾小球滤过率大约降低），大部分患者在年内发展成为这个过程是极具可变性的，然而，尤其在型糖尿病患者，他们可能表现为持续好几年的中等量蛋白尿而肾功能不恶化一个简单但有用的监测肾功能衰竭进展的方法是绘制血清肌酐倒数和时间的函数曲线这个技术能更好的评估治疗干预的效果和需要进行肾移植的时间6.第二十五课P76ClinicalandPathologicEvaluationSinceallpatientswithcancerofunknownprimarysitehaveadvanceddisease,therapeuticnihilismhasbeencommon.However,itisnowevidentthatheterogeneousgroupcontainssubsetsofpatientswithwidelydiverseprognoses;somecancersarehighlyresponsivetotreatment,andsomepatientsmayhaveasubstantialchanceofachievinglongtermsurvivalwithappropriatetreatment.Theinitialclinicalandpathologicevaluationshouldthereforefocusonidentifyingaprimarysitewhenpossibleandonidentifyingpatientsforwhomspecifictreatmentisindicated.临床和病理评估由于所有原发灶不明肿瘤患者都会到疾病晚期，姑息治疗就变得很普遍然而，现在很显然的是这些特殊病人有很多不同的结局有些癌症对治疗高度敏感，这使得有些病人通过适当治疗可能存活很长时间因此最初的临床和病理评估应该集中于在可能的情况下识别原发灶以及识别那些需要特殊治疗的病人7.第二十六课P78Inthemanagementofthepregnanttraumapatient,thecriticalpointisthatresuscitationofthefetusisaccomplishedbyresuscitationofthemother.Therefore,theinitialevaluationandtreatmentofthepregnantinjuredpatientisidenticaltothatofthenonpregnantinjuredpatient.Rapidassessmentofthematernalairway,breathing,andcirculationandensuringanadequateairwayavoidsmaternalandfetalhypoxia.Inthelaterstagesofpregnancy,asalreadydescribed,uterinecompressionofthevenacavamayresultinhypotensionfromdiminishedvenousreturn,sothepregnanttraumapatientshouldbeplacedinleftlateraldecubitusposition.Ifspinalcordinjuryissuspected,thepatientmaybesecuredtoabackboardandthentiltedtotheleft.Theincreasedbloodvolumeassociatedwithtiltedtotheleft.Theincreasedbloodvolumeassociatedwithpregnancyhasimportantimplicationsinthetraumapatient.Signsofbloodlosssuchastachycardiaandhypotensionmaybedelayeduntilthepatientlosesnearly30%ofherbloodvolume.Asaresult,thefetusmaybeexperiencinghypoperfusionlongbeforethemothermanifestsanysigns.Earlyandrapidfluidresuscitationshouldbeadministeredeveninthepregnantpatientwhoisnormotensive.在处理孕期创伤病人时，关键点是胎儿的复苏能够通过母亲的复苏来实现因此，孕期创伤病人最初的评估和治疗跟非孕期受伤病人是一样的对孕妇气道、呼吸和循环的快速评估并确保足够的通气能够避免母婴低氧血症。在妊娠晚期，如被描述的那样，子宫压迫腔静脉使静脉回流减少可导致低血压，所以孕期创伤病人应该置于左侧卧位。如果怀疑脊髓受损，那么应该把病人固定在脊骨矫正板上后再向左侧倾斜。妊娠期血容量增加在外伤病人中是一个重要暗示。失血体征比如心动过速和低血压直到病人失血量达到全血的30%才会出现。这样一来，胎儿可能在母亲出现任何征象之前很久就已经处于低灌注状态了，补液复苏甚至在血压正常的妊娠病人中也应尽早和尽快地执行。8.第二十八课P83Postoperativesurgicalcomplicationsrepresentoneofthemostfrustratinganddifficultoccurrencesexperiencedbysurgeonswhodoasignificantvolumeofsurgery.Regardlessofhowtechnicallygifted,bright,andcapableasurgeonis,surgicalcomplicationsareavirtuallyguaranteedaspectoflife.ThecostofsurgicalcomplicationsintheUnitedStatestodayrunsintomillionsofdollarsandisassociatedwithlostworkproductivity,disruptionofnormalfamilylife,andunanticipatedstresstoemployersandsocietyingeneral.Frequently,thefunctionalresultsoftheoperationarecompromisedbycomplications;insomecases,thepatientneverrecoverstothepreoperativeleveloffunction.Themostsignificantanddifficultpartofcomplicationsisthesufferingbornebythepatientwhoentersthehospitalanticipatinganuneventfuloperationbutisleftsufferingandcompromisedbythecomplication.无论一个外科医生如何有天赋、如何聪明、如何有能力，在其生涯中外科并发症其实是不可避免的一个方面，在美国外科并发症所引起的费用已达到数以百万计，并引起劳动生产力的损失，扰乱正常的家庭生活，对雇主和社会带来预想不到的压力。由于手术并发症，手术后功能恢复大打折扣，有些病例其功能永远不能恢复到术前水平。（发生）并发症的最重要和最困难的方面是遭受痛苦的病人，他（她）进入医院是期待做一个顺利的手术，但却（被迫）处于遭受痛苦和受并发症侵害的境地。9.第三十课P88Epidemicsoccuralmostexclusivelyduringthewintermonthsintemperateareas,butinfluenzaactivitymaycontinueyear-roundinthetropics.Outbreaksmayoccurintourgroups(landorship)andinfacilitiesduringsummermonths,particularlyaftertheappearanceofadriftvariant.Regionaldifferencesinthetimeandmagnitudeofoccurrenceofinfluenzaoutbreaksarecommon.Duringepidemics,theoverallattackratestypicallyaverage5to20%inadults.Attackratesof40to50%arenotuncommoninclosedpopulations,includingthoseinhospitalsandnursinghomes,andincertainhighlysusceptibleagegroup.Twodifferentstrainswithinasinglesubtype,twodifferentinfluenzaAsubtypes(H1N1andH3N2),orbothinfluenzaAandBvirusesmaycocirculate.Inaddition,stimultaneousoutbreaksofinfluenzaAandrespiratorysyncytialviruseshavebeenfound.Strainscirculatingattheendofoneseasonsepidemicaresometimesresponsibleforthenextseasonsoutbreak(theso-calledheraldwavephenomenon).Furthermore,therthantheassociationofinfluenzaoutbreakswithcolderseasons,thefactorsthatallowanpidemictodeveloporthoseresponsibleforthetaperingoffofanepidemicwhenonlysomesusceptiblepersonshavebeeninfectedareunknown.温带地区流感几乎都发生在冬天的几个月，但在热带地区流感活动却常年不断。流感爆发可能发生在夏季的旅行团和设施建筑里，尤其在漂移变异出现以后。流感爆发流行的发生在时间和数量上的地区差异是很常见的。在流行期间，成人的总发病率通常是5-20%。在人口密集地方包括医院和小型医院以及某一高度易感人群中，发病率达40-50%也不罕见。单一亚型内的两个不同菌种之间，A型流感病毒的两个不同亚型（H1N1和H3N2）之间，以及A型流感病毒和B型流感病毒之间均可以互相转染。另外，我们也已经发现A型流感病毒和呼吸道合孢病毒同时爆发。某一季节疾病流行末期传播的菌种有时对下个季节的疾病爆发有一定的影响（所谓先驱波现象）。此外，除了流感爆发跟寒冷季节有关外，流行病的诱发因素或者那些引起流行病逐渐减少至只有少数几个易感者发生感染的因素均不得而知。10.第三十五课P102HowshouldthechoicebetweenCTorultrasonographybemadeinapatientwhopresentswithacuteabdominalpain?Morespecifically,whenisitappropriatetomovedirectlytoCT?Ingeneral,ifthepainisnotbiliaryincharacter,isnotlocalizedtotherightupperquadrant,oroccursinanobesepatient,CTispreferredbecauseitoftenrevealspreviouslyunsuspectedabnormalities.Atleastthreeotherimagingchoicesexist:(1)noimagingstudy;(2)aplainradiographicseriesoftheabdomen(technicallyandeconomicallysimilartothechestradiographbutgenerallynotasuseful);and(3)MRIoftheabdomenorpelvis(usuallyreservedformorecomplexsituationsorafterfailuretodiagnosewithothermethods).Otherthanidentifyingfreeintraperitonealair(perforatedviscus),gaspatternsofbowelobstruction,andradiodenseureteralcalculi,thetraditionalabdominalseries,althoughtheleastexpensivetest,isconsideredgenerallyinferiortoCTandhasbeenlargereplacedbyCT.Acurrent-generationmultislicehelicalCTscannercangenerate5-mmsectionsoftheentireabdomenandintravenouscontrastmaterialtoopacify(andidentify)loopsofbowelandvascularstructures.对急性腹痛病人来说，超声波检查和CT检查该怎么选择呢？更具体地说就是什么时候把病人直接送去做CT更合适？一般来说，如果疼痛性质不像在胆囊，不定位在右上腹，或者发生在肥胖病人上，CT更可取，因为它常常可以发现先前未知的异常。至少还存在三种其他成像方式可选择：（1）（2）腹部扫描系列（技术上和经济上与胸片相似，但通常不够有用）；（3）腹部或骨盆MRI（通常在更复杂的情况或用其它方法无法诊断的时候才用）。除了能识别腹部游离气体（内脏穿孔），肠梗阻的气体形态和输尿管结石的密度增高影，尽管传统的腹部扫描系列是最廉价的试验，但它通常比CT差，而且大部分被CT所取代。现代多层螺旋CT扫描可以在一秒钟那产生腹部和骨盆的每5mm一层的截面。口服或静脉给予造影剂对XX（而且识别）肠袢和血管结构很有用的11.第四十一课P118Inassessingprognosisandplanningatreatmentstrategy,itisusefultoclassifySCDaseitherprimary(withoutacleartrigger)orsecondary.Aprimaryepisodehasa10to30%1-yearrecurrencerate,whereasmostsecondaryepisodesareassociatedwithrecurrentratesoflessthan2%.Identifiablereversibleprecipitantsofsecondaryventricularfibrillation(VF)includetransientischemiapossiblyrelatedtovasospasm;hypokalemiaresultingfromdiuretics,hyperkalemiasecondarytorenalfailure,angiotensin-convertingenzymeinhibitors,prostaglandininhibitors,orpotassium-sparingdiuretics;proarrhythmissecondarytoantiarrhythmics,tricyclics,andantihistamines;orsubstanceabusewithdrugssuchascocaineandamphetamines.Therapyisdirectedtowardremovingortreatingtheacuteprecipitant.SCDrelatedtoacuteischemiaintheabsenceofpriorMIoftenisassociatedwithsevereproximalocclusivedisease,normalleftventricularfunction,normalsignal-averagedECG,andnoninducibilityabsenceofventriculartachycardia(VT)duringelectrophysiologicstudy.在评估预后和计划治疗时，对SCD分为原发性（没有明显诱因）或继发性是有益的。原发性SCD的I年内有10-30的复发率，但多数继发性SCD的1年复发率不到2。由继发性室速导致明确可逆转的SCD，常由下列原因引起；冠脉痉挛相关的短暂缺血，利尿剂引起的低钾血症、继发于肾功能衰竭的高钾血症、血管紧张与转换酶抑制剂/前列腺抑制剂、保钾利尿剂、抗心率失常药引起的致心律失常作用、三环类抗抑郁药、抗组胺药，或者可卡因、苯异丙胺等药物的滥用等。治疗上应针对去除或处理这些引起急性事件（的诱因）。在缺少早期心梗表现的急性缺血相关的SCD常常与下列情况相关，严重的冠脉近端的阻塞性疾病，左室功能正常，正常均值信号心电图，以及电生理检查中的不可诱导性（不能诱导出室速）。12.第四十五课P131Somepatientswithclearfindingoftheacuteabdomenmaybetreatedwithoutsurgicaloperation.Forexample,patientswithperforatedduodenalulcerwhoseekattentionlateinthecourseoftheirdiseaseaftertheyhavebeensickforseveraldaysmaybetreatedbestbycarefulsupportivecareincludingnasogastricsuction,intravenousfluids,andpainrelief.Certainpatientswithempyemaofthegallbladder,especiallythosewithotherseriousconcomitantillnesses,canbetreatedbypercutaneousdrainageoftheinfectedgallbladderandcarefulsupportivecareratherthanwithcholecystectomy.有些腹痛原因明确的病人也可以进行非手术治疗。举个例子，有些穿孔性十二指肠溃疡患者，在发病几天以后才寻求治疗，那时最佳的治疗就是细心的支持护理包括胃肠减压、静脉补液和减轻疼痛。某些胆囊积脓尤其是那些有合并症的病人，可以通过对感染胆囊经皮穿刺引流和细心的支持护理来治疗，不必采取胆囊切除术。13.第五十四课P159Thestudiesthatcomparedenteralandparenteralnutritioninthetraumapopulation,asdiscussedearlier,concludedthatenteralnutritionwassuperiorbecauseofanattenuatedinflammatoryresponseandad