住院医师规范化培训英语

1、1.发热 Fever由F致热原的作用使体温调定点上移而引起的调 节性体温升高，称为发块。发热本身不是疾病，而是一 种症状。引起发热的常见原因包括感染、结缔组织病、 恶性肿痛以及药物反应等。治疗发热应主要针对病因 治疗°详细询问病史(包括流行病学资料)和认真系统 的体格检杳对于疾病诊断非常重要.Warm upNormal body temperature ranges 36.537.5XI (98 100"卜)Fever (also known as pyrexia or temperature colloquially) occurs when the body tempe

2、rature is 37.5TI or above. Fever may be present in many different conditions, commonly in infections, connective tissue disorders, cancer or drug-reaction of certain cjrugs are the common clinical reasons of fever.Treatment is aimed at: CDsyinptomatic relief using an anti-pyretic, e.g., acetaminopha

3、nc (also known as paracetamol), or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen; and treating the underlying cause, e.g., antibiotics for bacterial infection- caused fever.Clinical assessment should include a review of the patients' past medical and drug history, and physical

4、examination. Investigations may include routine blood tests, culture and sensitivity analysis of the blood, urine, sputum, and chest X-ray. where appropriate. Patients with neutropenia may not show the usual symptoms/sig;ns of infection, they should be assessed more closely.Check RoomCase IO: Good m

5、orning. How may I help you?P: I have a tcmpcratuA: from time to time, doc tonO: When did it begin?P: It started 3 days ago.O: Did you take your temperature?P: Yes. Most 0f the time it was around 38. But last nightit was as high as 39.2P.1 took some paracetamol and drank lots of water. After that, th

6、e temperature came back down.O: I low often do you feel feverish?P: Not very otten.Sometimes ! feel feverish in the morning when I woke up. and sometimes in the afternoon.I): Have you taken any other medication?P: I have been taking the antibiotic amoxil and Chinese medicine against viruses, but the

7、y do not work.O: Do you have any other symptoms or problems apart from fever?P: I have sore throat for a week, and a little bit of dry cough. Each time temperature goes above 38, my head aches but not too severely.L>: I low is your appetite?P: Okay.D: Any problems with your water works or bowels?

8、第二1L病史采集Hist。"aki吧第一章病史采集 History TakingP: No.D: Do you feel weak or lethargic?P: Not exactly. But these days I nod off easily. 1 sleep more and feel tired during the day which is not normal for me.D: May I examine you, please?P: Yes, of course doctor.D: Thank you. Picasc take off your shirt an

9、d socks, and lie down on the bed. There is a blanket here fbr you to cover yourself. Let me know when you are ready. Close the curtain and wait. After the examination.D: You have an inflamed throat and swelling of the tonsils, which I suppose is making you feverish. In addition, I find rash (tiny re

10、d spots, tiny pctcchiae) spreading on your legs. And you looked pale, that's why I asked if you felt tired.P: Is there something seriously wrong with me. doctor*?D: I don't know yct.Wc should do a blood test in the first instance to find out more. Picasc take this blood form to the phlebotom

11、ist to have your blood taken.One hour later, after the blood test.D: I am sorry that your blood test is abnormal. I am afraid it*s not very good. Both your red blood cell and platelet counts arc low. Your white cell count is high with immature blood cells. You may have leukemia, wc need to do more t

12、ests to be sure whether this is the case or not. I recommend that you be admitted to hospital fbr us to do the tests and start the right treatment fbr you, as soon as possible.Case IID: Hello! Miss. Sit down picasc. Can I help you?P: 1 feci very bad recently.D: What's troubling you?P: I have int

13、ermittent fever. My joints ached a lot, and my face turns red especially after been in the sun.D: For how long have been having this problem?P: About two weeks.D: Did you take your temperature? Whal's the highest?P: 39 degrees.D: Do you have fever every day?P: Almost every day? Sometimes druing

14、the day and sometimes at night. I took acetaminophen which lowers the temperature.D: Do you feel hot and cold (shivering)?P: Sometimes I feel cold before the temperature goes up.D: Tell me about your joint ache.P: My knees hurt so much. I went to a Community Health Center yesterday. The doctor did s

15、ome blood tests and X-ray. He said my X-ray was OK, but there was something wrong with my blood test results. So I come here.D: IX)you feci any other discomfort?P: I get mouth ulcers. Can you tell me what's wrong with me?D: Well, according to your symptoms and the blood test results, there is a

16、strong possibility that you have SLE, short for systemic lupus erythematosus.P: What is SLE?D: SLE is an autoimmune disease. This means that the body's immune system attacks healthy tissues instead of attacking only bad things like bacteria and viruses. This causes inflammation. Common symptoms

17、and signs include lethargy, joint pain or swelling, fever and skin rash. The rash often happens after you have been in the sun. You may also get mouth uiccrs/sorcs (ic broken skin inside the mouth) and hair loss. Some people with lupus also develop problems with the heart, lungs, kidneys, blood cell

18、s, or nervous systemP: Oh no, am I in a serious condition?D: SLE can respond well to treatment. 1 recommend trying steroids in the first instance.P: Thank you. Ok. doctor.D: Please come back to see me again after you have taken the medicine fbr one week.P: Yes, I will. Goodbye!D: Goodbye.(P:Patient;

19、 D:Doctor)重点语句 Case IDid you take/measure your temperature?How often do you feel feverish?Do you have any other symptoms or problems apart from fever?Any problems with your water works or bowels?Case IIHow long have you been having this problem?Do you have a fever every day?Do you feel hot and cold

20、(shivering)?Do you feel any other discomfort?2.水肿、少尿、尿检异常Edema,Oliguria and Abnormal Urine水肿,少尿、尿检异常是临床上诊断有无肾脏疾病 的主要依据。水肿可由内分泌系统、心血管系统、消化 系统、泌尿系统等全身各系统疾病引起。问诊应明确 水肿的部位、性质、持续时间，诱发因素、加重与缓解因 素,尿策,尿液颜色以及诊疗经过。患者的病史、伴随 症状均有助于病因学的诊断6Warm upEdema refers to the accumulation of fluid in the tissue interstitia

21、l space caused by fluid extravasation, due to inflammation, low intravascular oncotic pressure (e.g., when blood albumin level is low), or fluid overload (eg, excessive fluid intake in heart/renal failure patients).Oliguria refers to a clinically significant decrease in urine output, defined as when

22、 the urine output is less than 0.5ml/(kg*h) in adults.Anuria is present when urine output is less than 50ml per day. Poor urinary output (oliguria/anuria) may be a sign of dehydration, circulatory shock, heart or renal failure, urinary obstruction or retention. The etiology of renal failure can be c

23、ategorized into prc-rcnal (e.g.t dchydration/circulatory failure), renal (e.g., glomerulonephritis) and post-renal (eg, urinary obstruction by renal stone/prostatc).When a patient comes to us complaining about abnormal urine test, the first thing we should ask is if he第一袁 病史采集History Taking第一章 病史采集H

24、istory Takingthe urine sample in the right way and also ensure that the urine was taken under these conditions: morning, fasting, cleansing, midstream urine, before or after the menstruation three days at leastt take the urine after it stored in the bladder for more than three hours, finally send it

25、 to check promptly. Besides, to test it repeatedly is important.Check RoomCase ID: Nice to meet you, Mr Smith.P: Nice to sec you doctor.D: How can I help you?P: My eyelids and legs arc swollen.D: How long have you been like this?P: Six years on and off.D: Have you noticed anything or any symptoms th

26、at led to the swelling? For example, a cold?P: Not exactly, but when I have a cold or do strenuous work, the swelling comes on or gets worse.D: What time of the day is the swelling worse?P: 1 notice some swelling in the mornings, and it gradually gets worse as the day goes on.D: How much water or fl

27、uid arc you drinking per day?P: May be one and half liter. I'm not sure. I usually drink 5 cups of tea per day.D: How much urine are you passing per day?P: I don't know. 1 haven't measured it. May be half of a bottle or 300ml per day?D: Do you have any discomfort urinating or passing wat

28、er?P: No. But I have been passing water frequently at night in the last 2 months.D: Have you gained or lost any weight?P: I have lost 4kg in the last two months.D: Do you have any other symptoms, like nausea, vomiting, palpitations, or breathlessness?P: No, but I feel exhausted most of the time.D: D

29、o you sleep well?P: No. even with sleeping tablets.D: What kind of sleeping tablets have you been taking?P: Melatonin.D: How much melatonin do you take?P: I used to take one tablet every night for three years, but in the last four weeks Pve been taking two tablets every night.D: Have you seen any do

30、ctor about your swellings before?，P: I have gone to “People's Hospital" to take the following inspections: blood and urine routine, thyroid function tests, renal ultrasound and so on.D: Were any tests carried out?P: I had a few tests. They tested my blood and urine. They also did an ultraso

31、und scan of my kidneys.D: What were the results?P: The blood test showed that my kidneys were not good, the crcatin in was 160 two years ago. They also found blood and protein in my urine before that. However, I have never seen blood in my urine.D: Have you taken any medication or received any treat

32、ment since being unwell?P: Yes, I took traditional Chinese medicine.78第一章 病史采集History Taking任:“D: Did it work?P: Well, the urine test showed the amount of blood and protein stayed the same. However, the blood test showed the creatin in continued to rise.D: Do you have any other medical condition?P:

33、Yeah, twelve years ago I was diagnosed with high blood pressure (hypertension). Since then I have been taking blood pressure tablets. Now my blood pressure is kept in a level that it doesn't bother me any more.D: What led to the finding of high blood pressure?Did you have any symptoms, like dizz

34、iness or headache?P: Yes, 1 had a bad unbearable headache at the time and my blood pressure was found to be as high as 200/l00mmHg.D: Was the blood pressure measured when you got a headache? What's the highest number of your blood pressure?P: Yes, I had measured it every time that I felt uncomfo

35、rtable. The most serious, it could reach to 200/1 OOmmHg.D: What medicine are you taking to control your blood pressure now?'P: 1 am taking one tablet of Adalat in the morning and evening.D: Did you ever have nephritis as a child?P: No. as far as 1 am aware.D: Do you have any family members or r

36、elatives who also have high blood pressure or kidney disease?P:my father and sister have high blood pressure,but none of them has kidney disease.D: Have you had any operations or allergies in the past?9嬉一 病史采集History TakingP: No.D: Please may I examine you?P: Yes, please doctor.D: Ok, please take of

37、f your clothes, keep your underwears on, and lie on the bed. You may cover yourself with the blanket. After the examinationt you may go and have some tests, including blood test, urine routine, renal function« ion and ultrasound scan of the kidney.P: Doctor, is it that bad?D: Wc need to complet

38、e the examination and investigations to find out what is wrong, so that wc can plan the best treatment for you.After the examination and tests.D: Mr Smith, from the examination and test results, you have a condition called "chronic renal failure" . This means your kidneys have been damaged

39、 for quite some time, and so they arc not able to remove water and toxins from your body properly. It explains why you feel nauseous because of the toxins in the body, and become swollen because of too much water in the body. Your renal ultrasound shows that both your kidneys have shrunk, while the

40、blood test results suggest that you now have a mild anemia, disorder of electrolyte metabolism. Now your serum creatinine has reached 460mmol/L. which suggests the renal failure have progressed to the renal failure stage. The declining of renal function that leads to the reducing ability of excludin

41、g water and toxins causes your symptoms of edema and nausea now.I recommend that you be admitted to hospital right away to start trealment. First, you will need medication巳)第一章 病史采集History Taking第一章 病史采集History Taking by injection to help remove the excess water in your body, this will get rid off o

42、r reduce the swellings. During your hospital stay, we'll also perform a more detailed evaluation of your kidneys.You will need to take low salt, low protein diet, and restric fluid intake to 1-1.5 liters per day. Wc will explain everything again and answer any questions you may have during your

43、inpatient stay. I expect the treatment will make you feel better. Do you have any question?Case IID: Hi, I am Doctor Li. What can 1 do for you and your little boy?P: 1 think my child is sick. He is only four years old, what can 1 do?D: What is the problem? P: He is all swollen up.D: How long has thi

44、s been going on?P: At least 2 months.D: Have you noticed anything different about him before the swelling?P: No, nothing special.D: Please tell me more about the swelling in detail.P: About two months ago. his checks and eyelids started to swell gradually 1 noticed his legs have also become swollen.

45、 The swellings arc getting worse or more obvious.D: Arc there any other symptoms?P: He urinates less, may be only a cup-full per day. His urine has also turned very dark, especially in the last 3 to 4 days.D: Docs he have pain when he urinates?P: No.D: Have you noticed any bright red blood in the ur

46、ine?P: No.D: Did he have fever or sore throat before these symptoms?P: No.D: Has he had a rash or other symptoms like asthma or shortness of breath?P: No.D: Has he seen any doctor?P: Wc have gone to the hospital in the vicinity of our home.D: Good. What did the doctor say (or what was the diagnosis)

47、?P: The doctor said he has nephritis. His blood pressure was normal. There were protein in the urine,“+ +” and ,+ + +” 【cannot remember other details.D: What treatment has he received?P: He took traditional Chinese medicine for half a month. He also took water tablets (diuretics) when the swelling w

48、as very bad. but it did not work.D: How is his energy and appetite?P: He looks tired all the time, he feels weak. His appetite is poor and feels nauseated.D: How is his bowel motion?P: Yes. as usually.D: I am going to ask you a few questions relating to his growth and development, then I will examin

49、e him and arrange for blood and urine tests. I will then explain to you what is wrong and the treatment11第一章 病史采集History Takingoptions. ok?心叱章.，呼Taking重点语句Case IHave you noticed anything or any symptoms that led to the swelling? How much urine are you passing per day?Have you taken any medication or

50、 received any treatment since being ill?Case IIHave you noticed anything different about him before the symptoms (swelling)?Are there any other symptoms?What did the doctor say (or what was the diagnosis)?(刘峰)3.胸痛 Chest Pain胸痛是临床常见症状，主要是胸部疾病所致,多数 由呼吸系统和心血管系统疾病引起也可以是胸壁疾 病或来源腹部腑器病；包括钝痛、除痛J 性病. 刺痛、灼痛或压

51、迫痛。胸痛的原因有很多.H胸痛的部 位和严肃程度，并不一定和病变的部位和严丽程度相 一致。丑点采集疼痛的发作时间、性质、部位、频率、持 续时间、诱发因素及伴随症状等OWarm upChest pain is an important and common presenting symptom in our daily clinical visits. Many patients worry that their chest pain is due to a serious heart problem, such as a heart attack. However, the different

52、ial diagnosis for chest pain is wide, many of which are non-cardiac in origin (c.g., musculoskeletal pain, gastro-esophageal reflux disease, esophageal spasm, chest infection, pulmonary embolism). Cardiac causes of chest pain include myocardial infarction, angina and pericarditis.A careful history o

53、f the symptom of chest pain helps to determine or narrow down the causes (differential diagnosis) of the patient's chest pain and choice of appropriate investigations. In the history, one should determine:(1) The location of the pain. Eg. central, across the chest, to one side, at the front or b

54、ack, located diflusely or in a small spot?(2) The nature of the pain. Eg. dull, pressing, squeezing, sharp, stabbing, burning.(3) Whether the pain radiates, and if so. where. E.g. to the neck. jaw. throat, or arm.(4) Duration of the pain each time it occurs. Eg. a few seconds, minutes, hours or days

55、.(5) Frequency of the pain. E.g., a few times a day. once a week, present all the time.(6) Any exacerbating and relieving factors. Eg, is the pain brought on or made worse by physical exertion/ exercise food, cold weather, emotional upset, deep breathing, coughing, or touch? Is the pain relieved by

56、resting, change in posture/position, or medication (such as GTN spray, pain killers, antacids)?(7) Any associated symptoms. E.g.，cough (dry1314第一章 病史采集History Taking第一章 病史采集History Taking15or productive, and nature of the product in the latter), breathlessness, orthopnoea, para nocturnal dyspnea, au

57、tonomic symptoms, water-brash, symptoms suggestive of infection.Check RoomCase ID: How may I help you?P: I have chest pain and I get very short of my breath nowadays, so I thought it best to come in and see you.D: How long have you had this problem?P: Two weeks now, and it seems be getting worse.D:

58、What does your chest pain feel like?P: It feels like a dull ache across the center of my chest.D: Docs the pain move to any other area?P: Yes, it moves up my neck, left shoulder and down the lefl arm.D: Is the pain there all the time?P: Well, the pain comes and goes often.D: Does anything make it worse, for example when you exert yoursclPP: Yes, it gets worse when 1 walk too tast or climb the stairs.D: Do you feel sick or sweaty when you get the chest pain?