医学英语 慢性阻塞性肺疾病ppt课件

医学英语慢性阻塞性肺疾病,1,医学英语,BozhouPeoplesHospitalRheumtologyandimmunologydepartment,医学英语慢性阻塞性肺疾病,2,医学英语慢性阻塞性肺疾病,3,Bedsideteaching,Bedsideteachingisseenasoneofthemostimportantmodalitiesinteachingavarietyofskillsforthemedicalprofession,whichgreatlyimprovescertainclinicaldiagnosticskillsinmedicalstudentsandresidents.,医学英语慢性阻塞性肺疾病,4,Wardround,早交班morningmeeting：住院总医师；外称SeniorResidentsMorningReport引言introduction：主治医师；提出重点查房病例，简述棘手问题病史报告casepresentation：实习医生，可有无诊断，诊治计划须系统教学查房对话teachingdialogue：在上下级医生之间进行；着重纠错小结summary：主治医师对主任查房作应答，提出整改措施,医学英语慢性阻塞性肺疾病,5,Chiefphysician主任医师Attendingphysician主治医师Chiefresident住院总医师,Resident住院医师Intern实习医师Patient病人,医学英语慢性阻塞性肺疾病,6,ChronicObstructivePulmonaryDisease,COPD,orchronicobstructivepulmonarydisease,isaprogressivediseasethatmakesithardtobreathe.Progressivemeansthediseasegetsworseovertime.,医学英语慢性阻塞性肺疾病,7,Intheoffice,ChiefResident:Yourattention,please.TheteachingwardroundbyChiefphysicianProfessorClarknowbegins.Firstly,letshavethecasepresentedbyDr.Grey.住院总医师：请各位注意了，主任医师Clark教授的教学查房现在开始，首先由实习医师Grey医生汇报病史。,医学英语慢性阻塞性肺疾病,8,Intern(Dr.Grey):This70-year-oldmanwasadmittedbecauseofaone-weekhistoryofbreathlessnessandcoughwithpurulentsputum.实习医师：病人，男性，70岁，因气急、咳嗽、咳痰1周入院。,医学英语慢性阻塞性肺疾病,9,Hehadalwaysbeencoughingwithsputumduringthepastthirtyyearsandtendedtogettingworseoverrecentfiveyears,withbreathlessnessdeveloping.病人近30年来一直有咳嗽、咳痰，近5年来有所加重，伴气急。,医学英语慢性阻塞性肺疾病,10,Thesymptomswereusuallyaggravatedbycoldweatheroralternationsofseasons,whiletendedtoeasewhentheweatherwasgettingwarm.症状通常于天气寒冷时或季节更替时发作，天气回暖后好转。,医学英语慢性阻塞性肺疾病,11,Almosteveryyearhehadtosufferforonetothreemonths.Hewascontinuouslyusingsalbutamolinhalationwhichdidrelievethesymptomsmostofthetime.几乎每年都有发作，持续13个月。病人一直使用沙丁胺醇吸入治疗，症状多能缓解。,医学英语慢性阻塞性肺疾病,12,Oneweekbeforeadmission,hecaughtacoldandsufferedarelapsethereafter.Meanwhile,hehadlargevolumesofpurulentsputumandwheezedaftermoderatemovement.Heinhaledsalbutamolasusual,butitdidntworkthistime.Sohecame.入院前1周，病人感冒后症状又有发作，伴咯大量脓痰，动则气急。吸入沙丁胺醇后症状无缓解。为求进一步诊治，入我院。,医学英语慢性阻塞性肺疾病,13,Thepatienthasasmokinghistoryof100packyears.Andhisfamilyhistorywasunremarkable.Mainlythatsall.病人有吸烟史，100包每年，家族史无特殊。汇报完毕。,医学英语慢性阻塞性肺疾病,14,Chiefphysician:Yourpresentationisquiteclear.Werethereanysignificantphysicalfindings,Dr.Grey?主任医师：你的汇报很清楚。查体有什么有意义的发现吗?,医学英语慢性阻塞性肺疾病,15,Intern(Dr.Grey):Yes.Weexaminedthepatientcarefullyandfoundsignsoflungdisease,includingbucket-like-chestandbronchi.Buttherewasnocyanosisinthelipsandnoedemaofthelegs.实习医师：我们仔细检查了病人，发现一些肺部体征，包括桶状胸和肺部干啰音。无口唇发绀和双下肢水肿。,医学英语慢性阻塞性肺疾病,16,ThelaboratorytestsreportedthatPaOwas10kPaandPaCOwas5kPa.However,WBCcountwas9.9X10/L,andtheneutrophilswere90%.实验室检查报告：PaO10kPa，PaCO5kPa；白细胞计数9.910/L，中性粒细胞90%。,医学英语慢性阻塞性肺疾病,17,Apreviouspulmonaryfunctionexaminationshowedthattheforcedexpiratoryvolumein1second(FEV1)was1.5litersandFEV1/forcedvitalcapacity(FVC)was50%.病人过去的肺功能检查示第1秒用力呼气量（FEV1）是1.5L，第1秒用力呼气量/用力肺活量（FEV1/FVC）是50%.,医学英语慢性阻塞性肺疾病,18,ChiefPhysician:Whenwasthepulmonaryfunctiondone?主任医师：肺功能是什么时候做的?Intern(Dr.Grey):(Lookingthroughthechart)Er.6monthsago.实习医师：（翻看病历）嗯，6个月前。,医学英语慢性阻塞性肺疾病,19,ChiefPhysician:Well,sincewehavelearnedaboutthehistory,itstheverytimetovisitthepatient.主任医师：好，既然我们已经了解了病史，现在该去看看病人了。ChiefResident:OK.Letsgototheward.住院总医师：好，那就去病房吧。,医学英语慢性阻塞性肺疾病,20,医学英语慢性阻塞性肺疾病,21,Intheward,ChiefResident:Hello,Mr.Black.OurChiefPhysicianandtheAttendingPhysicianarecomingtoseeyou.住院总医师：你好，Black先生，我们主任医师和主治医师都来看你了。Patient:Goodmorning,doctors.病人：早上好，医生们。,医学英语慢性阻塞性肺疾病,22,ChiefPhysician:Goodmorning,Mr.Black.lmDr.Clark.Isupposeyouwereallwelluntilthisoutbreak,werentyou?主任医师：早上好，Black先生，我是Clark医生，我想你平时身体还不错吧？,医学英语慢性阻塞性肺疾病,23,Patient:Notatall.Infact,Imalwayscoughingandwheezinginthepastdecades.ButitsthefirsttimeIhadtostayinhospital.Youknow,atthebeginning,Iwasmerelycoughing,butitdevelopedsofastthatIcouldntstanditanymore.(Coughing)病人：才不是呢！其实，我都喘了几十年了。不过住院倒是头一回。要知道，一开始我也就是咳嗽，但是后来发展得太严重了，我实在受不了了！（咳嗽）,医学英语慢性阻塞性肺疾病,24,医学英语慢性阻塞性肺疾病,25,ChiefPhysician:Dontworry,Mr.Black.Whatmedicationdidyoutakebeforeadmission?主任医师：别担心，Black先生。你这次住院前有用什么药吗?Patient:(Takingoutthebottleofsalbutamol)Hereitis,butitdidworkanyway,exceptthistime.病人：（拿出沙丁胺醇的瓶子）就是这个，挺管用的，不过这次没用。,医学英语慢性阻塞性肺疾病,26,ChiefPhysician:Anythingelseotherthanit?主任医师：除了这个还有其他的吗?Patient:Mainlythis,andsometimesthedoctorgavemeafewdrugsorintravenousinjectionswhenIwasbadlycoughingorwheezing.病人：就是这个，有时候咳、喘得严重时，医生会给我一些药或者静脉注射。,医学英语慢性阻塞性肺疾病,27,ChiefPhysician:Haveyoufeltbettersinceadmission?主任医师：住院以后好点了没有?Patient:Yes.Ifeelmuchbetterthismorning.病人：是的。今天早上我觉得好多了。,医学英语慢性阻塞性肺疾病,28,ChiefPhysician:Mr,Black,youarcsmoking,arentyou?主任医师：Black先生，你抽烟是吧?Patient:Yes,lhavebeensmokingfor50years.病人：是的，我都抽了50年了。,医学英语慢性阻塞性肺疾病,29,ChiefPhysician:Mr.Black,couldwegiveyouanexamination?主任医师：Black先生，可以给你做个体检吗?Patient:Sure.病人：当然可以。ChiefPhysician:NowDr.Grey,couldyoudotheexamination?主任医师：Grey医生，你来做一下体检吧。Intern:Certainly.实习医生：好的。,医学英语慢性阻塞性肺疾病,30,视触叩听,percussionpkn叩诊n.auscultation,sk()lte()n听诊n.,inspectionnspekn视诊n.Palpationplpen触诊n.,医学英语慢性阻塞性肺疾病,31,Intern:Thepatientisamedium-sizedmale.Hesinconsciousnessandbreathesataregularrateof22perminute.Theoraltemperatureis36.7andthepulserateis90beatsperminute(bpm).Thebloodpressureis155/95mmHg.实习医生：病人体格中等。神清，呼吸频率为22次/分，节律规则。口温36.7，脉搏90次/分。血压155/95mmHg。,医学英语慢性阻塞性肺疾病,32,Noedemainthefaceandeyelids.Cyanosiscanbeseeninthefingertips.Andhehasclubbedfingers.Theresnojugularvaricosityorenlargementofsuperficiallymphnodes.Theneckfeelssoftandthetracheaisinthecenter.面部及眼睑无水肿。指端有发绀，可见杵状指。颈静脉无怒张，浅表淋巴结无肿大。颈软，气管居中。,医学英语慢性阻塞性肺疾病,33,Theresnothreedepressionssignorthyroidenlargement.Hehasbucket-like-chestandpervasiverhonchicanbeheardinbilaterallungswithalittlewheezingrales.Thevocalfremitussymmetricallydecreasesinbilaterallungs.无三凹征。甲状腺无肿大。可见桶装胸，两肺可闻及广泛干啰音及少量哮鸣音。双侧触觉语颤减弱、对称。,医学英语慢性阻塞性肺疾病,34,Theheartrateis94beatsperminutewithnoarrhythmiaormurmurs.Theabdomenfeelssoftwithnotendernessorreboundtenderness.Murphyssignisnegativeandnothingspecialinneurologicalexamination.