临床医学英语浙江-考试重点

1、2012年 住院医师规范化培训 临床医学英语 医学英语 考试重点 考试内容 考试精华Evidence-based medicine 循证医学 Healthy lifestyles 健康生活方式 Obesity 肥胖症 Palliative care 姑息性治疗Hospice 临终关怀 Immunization 免疫 Screening tests 筛查试验 Susceptibility 易感性 Health promotion 健康促进Osteoporosis 骨质疏松 Life expectancy 预期寿命 Geriatric patients 老年病人 Comorbidities 并存病

2、Subclinical disease 亚临床疾病 Cognitive impairment 认知缺陷 Arthritis 关节炎 Weight loss 体重减轻Atherosclerosis 动脉粥样硬化 Heart failure 心脏衰竭 Physical therapy 理疗 Iron deficiency anemia 缺铁性贫血Inflammatory bowel disease 炎性肠病 Endoscopy 内窥镜检查 Angiography 造影 Asthma 哮喘 Chronic bronchitis 慢支Pulmonary embolism肺栓塞 Lung complia

3、nce 肺顺应性 Diabetic nephropathy 糖尿病性肾病 Hyperglycemia 高血糖症Microalbuminuria 微量蛋白尿 Proteinuria 蛋白尿 Nephrotic syndrome 肾病综合征 Renal failure 肾功能衰竭Etiology 病因学 Autopsy 尸检 Fine needle aspiration 细针穿刺 Epidemic influenza 流行性感冒Imaging tests 影像学检查 Acute cholecystitis急性胆囊炎 Gallstones 胆结石 Acute abdominal pain 急腹症Bo

4、wel obstruction 肠梗阻 Contrast material 造影剂 Cardiac arrhythmia 心律失常 Coronary artery disease 冠心病Myocarditis 心肌炎 Echocardiography 超声心动图 Elective surgery 择期手术 Antibacterial spectrum 抗菌谱Peritonitis 腹膜炎 Tenderness 压痛 Gastrointestinal perforation 胃肠穿孔Immunosuppression 免疫抑制 Multisomatoform disorder 多重躯体形式障碍

5、Intestinal anastomoses 肠吻合术Intra-abdominal abscess 腹腔脓肿 Nosocomial infection 院内感染 Aspiration 误吸 Catheter sepsis 导管热、脓毒症The increasing availability of evidence from randomized trials to guide the approach to diagnosis and therapy should not be equated with “cookbook” medicine. Evidence and the guidel

6、ines that are derived from it emphasize proven approaches for patients with specific characteristics. Substantial clinical judgment is required to determine whether the evidence and guidelines apply to individual patients and to recognize the occasional exceptions. Even more judgment is required in

7、the many situations in which evidence is absent or inconclusive. Evidence also must be tempered by patients preferences, evidence when presenting alternative potions to the patient. The adherence of a patient to a specific regimen is likely to be enhanced if the patient also understands the rational

8、e and evidence behind the recommended option.但是，不断增多的可用于指导临床诊断与治疗的随机试验资料不应当做“烹调书”使用。因为随机试验获得的现象和思路是侧重于求证某些特征病人而来的。实际的判断需要确定这些临床表现和诊断标准是否能应用于病人个体，并找出列外。许多情况下，临床表现缺乏或不典型，需要考虑更多到判断。虽然医生的职责是在给病人提供治疗方案的时候应该强调证据，但病人肯定会根据自己的倾向作出选择。假如病人同样知道医生提供的治疗方案背后的基础原理和证据，则病人很有可能遵循一种特别的养生之道Even sa physicians become incr

9、easingly aware of new discoveries, patients can obtain their own information from a variety of sources, some of which are of questionable reliability. The increasing use of alternative and complementary therapies is an example of patients frequent dissatisfaction with prescribed medical therapy. Phy

10、sicians should keep an open mind regarding unproven options but must advise their patients carefully if such options may carry any degree of potential risks, including the risk that they may relied on to substitute for proven approaches. It is crucial for the physician to have an open dialogue with

11、the patient and family regarding the full range of options that either may consider.甚至当医生越来越容易知道新发现的同时，患者也能够通过资源得到他们的消息，当然，某些信息是不可靠的。替代疗法和辅助疗法的应用不断增加就是病人对常规疗法经常不满意的一个列子。医生对未证实的疗法应该保持开放的思想，但是，如果这些疗法具有任何程度的潜在风险，都必须细致的告知病人，包括可能需要用已证实的常规疗法去替代的风险。对医生来说，对病人及家属开诚布公的介绍所有可考虑的治疗选择，是非常重要的。Many aspects of palli

12、ative care, as with any specialty, are relevant to the general practice of medicine and to all clinicians who tend to dying persons. Palliative care has a role in the earliest phases of a life-threatening illness but assumes a more prominent or even dominant role in the final 3 to 6 months of common

13、 terminal conditions：advanced cancer，heart and lung failure, end-stage liver and renal disease, acquired immunodeficiency syndrome, and life-limiting neurologic diseases. 4章（第二段）姑息治疗是一门全科医学，涉及所有医学学科，与参与治疗危重病人的所有医护人员息息相关。姑息治疗不仅适用于危重疾病早期治疗，在常见末期疾病患者的最后3到6个月作用更加凸显，比如癌症末期，心肺衰竭，晚期肝肾疾病，艾滋病和威胁生命的神经性疾病。A se

14、cond way in which older adults differ from younger adults is the greater likelihood that their diseases present with nonspecific symptoms and signs. Pneumonia and stroke may present with nonspecific changes in mentation as the primary symptom. Similarly, the frequency of silent myocardial infarction

15、 increases with increasing age, as does the proportion of patients who present with a change in mental status, dizziness, or weakness rather than typical chest pain. As a result, the diagnostic evaluation of geriatric patients must consider a wider spectrum of diseases than generally would be consid

16、ered in middle-aged adults. 8章（第二段）老年与青中年的第二个差异是更容易出现非典型的症状和体征。肺炎和中风时可出现非特异的精神状态改变为主要症状。同样的，隐匿性心肌梗死发生频率随着年龄的增大而增加，这些病人相应到频发精神状态改变、眩晕、虚弱而而不是典型的胸痛症状。因此，对老年病人的诊断应考虑更广泛的疾病，要超过通常对中年病人所考虑的范围。Finally, a serious and common outcome of chronic diseases of aging is physical disability, defined as having diffic

17、ulty or being dependent on others for the conduct of essential or personally meaningful activities of life, from basic self-care (e.g., bathing or toileting) to tasks required to live independently (e.g., shopping, preparing meals, or paying bills) to a full range of activities considered to be prod

18、uctive and/or personally meaningful. Of older adults, 40% report difficulty with tasks requiring mobility, and difficulty with mobility predicts the future development of difficulty in instrumental activities of daily living (IADL; household management tasks) and activities of daily living (ADL; bas

19、ic self-care tasks). 8章（末段部分）最后，老年人慢性病严重又常见的结果是身体能力不足，描述为个人最基本的或有意义的日常活动有困难或不得不依靠别人帮助指导，从基本自我照顾（例如，洗澡和如厕）到独立生活需要的各种任务（例如，购物，做饭，或支付帐单）到具有集体/或个人意义的所有活动。在老年人中，40%对需要运动的任务有困难，运动困难提示将来开展日常工具锻炼（IADL；家庭护理项目）和日常锻炼（ADL；基本护理项目）的困难。The initial approach to a patient with iron deficiency anemia depends on the pr

20、esence of symptoms referable to either the upper or lower gastrointestinal tract. Regardless of the findings on the initial upper or lower endoscopic examination, all patients should have bath upper and lower endoscopy because the complementary endoscopic examination has a yield of 6% even if the fi

21、rst one was positive. For premenopausal women, a positive FOBT requires full evaluation, as does iron deficiency anemia. Barium radiographs of the upper and lower gastrointestinal tract have limited utility in the setting of occult bleeding because of their inability to biopsy or treat lesions that

22、are identified.21章(第三段)缺铁性贫血病人的早期检查方法要根据存在的症状是提示上或下消化道。无论首次上消化道或下消化道内窥镜检查会有何发现，所有患者都应该做上部和下部内镜两个检查，因为互补的内镜检查有6%的再发现，即使第一次检查是阳性的。对绝经前妇女，大便隐血试验阳性需要全面评估，缺铁性贫血也一样。钡X光片的上部和下部消化道对隐匿性出血应用有限，因为他们不能活检或治疗发现的病损。In the face of continued blood loss and no identified etiology, intraoperative endoscopy may provide

23、 simultaneous diagnosis and therapy。During the procedure, the surgeon plicates the bowel over the endoscope. As the scope is withdrawn, endoscopic findings can be identified for surgical resection or treatment. The yield of this procedure exceeds 70%. In some clinical situations, the site of bleeldi

24、ng cannot be identified, and the patient requires long-term transfusion therapy.碰到进行性出血查不到病因，应用术中肠镜可以同时进行诊断和治疗。操作时，外科医生把小肠套到内窥镜上。内镜退出时，内镜的发现可以决定是外科切除或保守治疗。这个措施70%以上有结果。某些临床病例，出血部位无法发现，病人而要长期输血治疗。A new device for visualizing the entire gastrointestinal mucosa consists of images to receivers attached

25、to the patients abdomen and mapped to identify the location of the image. The diagnostic yield of capsule enteroscopy is not yet clear, but this approach may potentially visualize segments of the small bowel that were previously inaccessible. No therapeutic maneuvers are possible with the device.一种新

26、的装置能显示全部胃肠粘膜，这种装置由一颗装有小型摄像机能咽下的胶囊组成，他将影像信号传到附着在病人腹部的接收器，并绘制出图像来识别影像的位置。胶囊小肠镜的诊断效率现在还不清楚，但是，这种方法可能可能显示以前难以接近的小肠肠管。但这个装置不可能有任何治疗性操作。The first signs or cancer are frequently due to metastases to visceral or nodal sites. In most such patients, routine clinical evaluation with a comprehensive history, ph

27、ysical examination, examination, complete blood cell count, screening chemistries, and directed radiologic evaluation of specific symptoms or signs identifies the primary tumor. Patients who have no primary tumor located after this routine clinical evaluation are defined as having cancer of unknown

28、primary site. Further clinical and pathologic evaluation will identify the primary site in only a small minority of patients, and about 80% will never have a primary site identified during their subsequent clinical course. 25章（第一段）肿瘤的首发症状或体征通常由于脏器或淋巴结转移引起的。对此类病人需要进行常规临床检查和全面的病史回顾、体格检查，完整的血液细胞计数，生化筛查

29、和对特定症状体征进行放射学检查以确定原发病灶。经过常规临床检查后不能发现原发病灶到被称为原发灶不明的肿瘤。进仅有小部分病人经过进一步到临床和病理检查将确定原发部位，约80%的病人在后续的临床诊疗中无法确定原发病灶。Since all patients with cancer of unknown primary site have advanced disease, therapeutic nihilism has been common. However, it is now evident that this heterogeneous group contains subsets of

30、patients with widely diverse prognoses; some cancers are highly responsive to treatment, and some patients may have a substantial chance of achieving long-term survival with appropriate treatment. The initial clinical and pathologic evaluation should therefore focus on identifying a primary site whe

31、n possible and on identifying patients for whom specific treatment is indicated. 25章（第四段）由于原发灶不明肿瘤病人往往为晚期病人，治疗效果往往受到质疑。但是现在比较明确的是这类特殊患者的预后差别很大，一些患者对治疗高度敏感，也有部分患者通过适当治疗生存期很长。因此临床和病理检查的出发点应当是寻找原发病灶和识别对特殊治疗有效到患者。Complications can occur for a variety of reasons. A surgeon can perform a technically perfe

32、ct operation in a patient who is severely compromised by the disease process and still have a complication. Similarly, a surgeon who is sloppy, is careless, or hurries through an operation can make technical errors that account for the operative complications. Finally, the patient can be doing well

33、nutritionally, have an operation performed meticulously, and yet suffer a complication because of the nature of the disease. The possibility of postoperative complications is a part of every surgeon s thought processes-something with which all surgeons will be required to deal. 28章(第二段)外科并发症发生的原因有很多

34、。有时外科医生手术技术上非常成功，但病人的病情严重可导致并发症的发生。同样，手术中医生的马虎。粗心或仓促可导致技术上的错误从而导致手术并发症。最后，即使病人营养状况良好，手术也很成功，疾病本身也可导致并发症的产生。术后并发症的可能性是每一个外科医生考虑治疗计划的一个组成部分，因为所有外科医生都将面临这些并发症中的一部分。Pneumonia and influenza (P+I)-related deaths fluctuate annually, with peaks in the winter months. When such P+I deaths exceed the predicted

35、 number, it is due to influenza A or occasionally to influenza B virus or respiratory syncytial virus activity. Although mortality is greatest during pandemics, substantial total mortality occurs with epidemics. Over 85% of P+I deaths occur among persons aged 65 and older. Other cardiopulmonary and

36、chronic diseases also result in increased mortality after influenza epidemics, so that overall influenza-associated mortality is about two-to fourfold higher than P+I deaths. 30章（末段）肺炎和流感（P+I）相关的死亡人数每年都在波动，高峰期在冬季。当这P+I的死亡超过预计数值，这是由于甲型流感或偶尔因为乙型流感病毒或者呼吸道合胞病毒的活动所致。虽然大流行的时候病死率最高，普通流行时病死率也非常可观。超过85%P+I死亡

37、发生在65岁以上人群。流感流行后，其他心肺和慢性疾病也导致死亡率增高，以至于总体流感相关的死亡率比P+I导致的病死率高出2 -4倍MRI can be useful for the cooperative patient in renal failure who cannot receive intravenous contrast material because it can provide tissue and vascular detail not achievable without contrast-enhanced. Patient cooperation is required

38、 because of the longer imaging times and respiratory motion artifacts. MRI is also useful in specific situations to image the biliary tree, liver parenchyma, and male and female pelvis. 35章（末段）病人合作情况下，磁共振成像对于无法接受静脉造影剂的肾衰病人是有用的，因为它能提供组织和血管细节，而这些细节不借助增强CT就无法看到。因为需要长时间的成像以及呼吸运动伪差，病人的合作对于磁共振成像是有必要的。在特定情

39、况下，MRI对于胆道系统，肝实质，男性和女性骨盆的成像检查同样是有用的。In assessing prognosis and planning a treatment strategy, it is useful to classify SCD sa either primary (without a clear trigger) or secondary. A primary episode has a 10 to 30% 1-year recurrence rate, whereas most secondary episodes are associated with recurrenc

40、e rates of less than 2%. Identifiable reversible precipitants of secondary ventricular fibrillation (VF) include transient ischemia possibly related to vasospasm; hypokalemia resulting from diuretics, hyperkalemia secondary to renal failure, angiotensin-converting enzyme inhibitors, prostaglandin se

41、condary to antiarrhythmics, tricyclics, and antihistamines; or substance abuse with drugs such as cocaine and amphetamines. 41章（第二段）在评估预后和制定治疗方案时，将心源性猝死分为原发性（无明确的诱发因素）或继发性是实用的。原发性发作在1年内有1030复发率，而大多数继发性的复发率小于2%。已知的可逆性继发性心室颤动（室颤）的发作包括小血管痉挛性的短暂缺血；利尿剂引起的低钾血症，肾功能衰竭，血管紧张素转换酶抑制剂，前列腺素抑制因子、或保钾利尿所至的高钾血症；抗心律失常

42、药、三环类药与抗组胺药引起的心率失常；或滥用药物，如可卡因和安非他明。Prophylactic antibiotic therapy is clearly more effective when begun preoperatively and continued through the intraoperative period, with the aim of achieving therapeutic blood levels throughout the operative period. This produces therapeutic levels of the antibiot

43、ic agents at the operative site in any seromas and hematomas that may develop. Antibiotics started as late as 1 to 2 hours after bacterial contamination are markedly less effective, and it is completely without value to start prophylactic antibiotics after the wound is closed. Failure of prophylacti

44、c antibiotic agents occurs in part through a neglect of the importance of the timing and dosage of these agents, which are critical determinants.43 章(第一段)起始于手术前以及持续于手术中的预防性抗生素治疗，对于贯穿整个手术阶段达的抗生素治疗剂量血药浓度显然十分有效。这可以使得在手术区域出现的浆液肿和血肿中的抗生素达到治疗浓度。抗生素用于细菌污染后1至2小时则有效性会大大降低，而伤口闭合后进行预防性抗生素治疗已毫无价值。预防性抗生素失败的部分归咎于

45、忽略了时机和给药剂量的重要性，而这两点正是关键的决定因素。Many patients fail to receive needed prophylactic antibiotics because the system for their administration is complex at the time of multiple events just before a major operation. This problem has been made worse by the trend of admitting patients directly to the OR for p

46、lanned operations, which intensifies the pressures to accomplish a large number of procedures during a short interval before the operations, the possibility that prophylactic antibiotics will be unintentionally omitted can be minimized by establishing a system with a checklist. One member of the ope

47、rative team (usually the preoperative nurse or a member of the anesthesia team) should be responsible for initialing a portion of the operative record that states either that the patient received indicated prophylactic antibiotics or that the surgeon has determined that states either that the patient received indicated prophylactic antibiotics or that the surgeon has determined that antibiotics are not indicated for the procedure. 43 章(第三段)许多患者并未给予预防性抗生素，这是由于在一个主要手术前的多种事件中，他们的管理系统过于复杂，由于允许病人直接去手术室进行计划内的手术，这个问题已经越来越严重，这加剧了手术前短时间内完成大量操作规程的压力。可以通过建立一个带有清单的系统来尽量减少预防性抗生素被无意识遗漏的可