医学专业英语课件9.ppt

A Dialogue in the HospitalJay ZhuangJay ZhuangGeneral Surgical DepartmentGeneral Surgical DepartmentRen Ji HospitalRen Ji HospitalClinical Dialogue Three 1Sentences Commonly Used by Sentences Commonly Used by Medical PersonnelMedical Personnel l lWhat can I do for you?What can I do for you?l lMay I help you?May I help you?l lPlease take a seat!Please take a seat!l lWait a moment, please.Wait a moment, please.l lSorry to have kept you waitingSorry to have kept you waiting. .l lIt is not serious.It is not serious.l lDon’t worry. / There is nothing to worry about.Don’t worry. / There is nothing to worry about.l lYou need a thorough examination.You need a thorough examination.2Sentences Commonly Used by Sentences Commonly Used by Medical PersonnelMedical Personnel l lYou You will will have have to to stay stay in in hospital hospital for for several several days. days. / / We We think think that that you you had had better better be be hospitalized.hospitalized.l lYou should stay in bed for a few days.You should stay in bed for a few days.l lYou You can can keep keep on on working. working. / / You You can can carry carry on on with your work.with your work.l lYou should be very careful for a week or two.You should be very careful for a week or two.l lTry to relax and keep calm.Try to relax and keep calm.3Sentences Commonly Used by Sentences Commonly Used by Medical PersonnelMedical Personnel l lYou’ll soon be all right.l lI’m sure this medicine will help you a great deal. l lFeeling well again is a rather slow process, I’m afraid.l lYou will have to wait for twenty minutes.l lComplete recovery will take a rather long time.4Sentences Commonly Used by Sentences Commonly Used by Medical PersonnelMedical Personnel l lIf you feel worse, please come back to the clinic right away.l lIf you feel worried, don’t hesitate to go to the clinic anytime, day or night.l lI’ll come right away.l lI’m going to make arrangements for your admission 5Sentences Commonly Used by Sentences Commonly Used by Medical PersonnelMedical Personnel l lPlease come with your interpreter next time.l lDo you understand what I’m saying?l lIs there anything else you would like me to explain to you?l lShall I explain it again?6Sentences Commonly Used by Sentences Commonly Used by Medical PersonnelMedical Personnel 1. 1.If the trouble persists, come back again.2. 2.There doesn’t seem to be anything serious, but we’ll take an x-ray just to be certain.3. 3.Please wait until we get the result of the x-ray (blood-test).7Sentences Commonly Used by Sentences Commonly Used by Medical PersonnelMedical Personnel 1. 1.It’s It’s difficult difficult to to say say just just now now exactly exactly what’s what’s wrong.wrong.2. 2.This This is is quite quite common common among among people people of of your your age. age. / / This This often often happens happens to to people people of of your your age. age. / This often occurs at your age./ This often occurs at your age.3. 3.This This kind kind of of illness illness usually usually occurs occurs among among people people whose whose work work requires requires a a lot lot of of concentration (who undergo a lot of stress).concentration (who undergo a lot of stress).8Sentences Commonly Used by Sentences Commonly Used by Medical PersonnelMedical Personnel 1. 1.I suggest you do some light exercises.I suggest you do some light exercises.2. 2.I suggest you have a course of acupuncture. I suggest you have a course of acupuncture. 3. 3.I suggest you take Chinese herbs. I suggest you take Chinese herbs. 4. 4.I suggest that you get physiotherapy treatment. I suggest that you get physiotherapy treatment. 5. 5.I I would would like like to to transfer transfer you you to to the the gynecology gynecology (surgery,dermatology, urology) department.(surgery,dermatology, urology) department.9Sentences Commonly Used by Sentences Commonly Used by Medical PersonnelMedical Personnel 1. 1.Your WBC (RBC, hemoglobin, urine, stool, sputum) should be checked.2. 2.A smear should be taken. A culture should be done.3. 3.Please don’t eat anything tomorrow morning before blood test.4. 4.Please wait for the result of your hemoglobin test.10Sentences Commonly Used by Sentences Commonly Used by Medical PersonnelMedical Personnel 1. 1.What’s your trouble?2. 2.How long have your been feeling unwell?3. 3.What medicine did you take?4. 4.Have you taken any medicine?5. 5.Did you take your temperature?11Sentences Commonly Used by Sentences Commonly Used by Medical PersonnelMedical Personnel 1. 1.Do you smoke (drink)?2. 2.Have you any temperature (a cough, a bad headache)?3. 3.Have you ever had jaundice (low grade fever, any chronic ailments, cold sweats at night, attacks of asthma)?12Sentences Commonly Used by Sentences Commonly Used by Medical PersonnelMedical Personnel 1. 1.Do you suffer from heartburn stomachaches (loose bowel movements, chest pains)?2. 2.Do you want to have your tooth extracted (tooth filled, dressing changed, blood pressure checked)?3. 3.Let me examine you please.13Sentences Commonly Used by Sentences Commonly Used by Medical PersonnelMedical Personnel 1. 1.Please take off your shoes and lie down.2. 2.Please unbutton your shirt and loosen your belt.3. 3.Please take off your trousers.4. 4.Please lie on your back (stomach, right side, left side).5. 5.Please bend your knees.14Sentences Commonly Used by Sentences Commonly Used by Medical PersonnelMedical Personnel 1. 1.Please relax.2. 2.Please breathe deeply (normally).3. 3.Please stick out your tongue.4. 4.Please let me feel your pulse.5. 5.Let me take your blood pressure.6. 6.Please lift your left leg (right leg).15Sentences Commonly Used by Sentences Commonly Used by Medical PersonnelMedical Personnel 1. 1.Please open your mouth and say “Ah”.2. 2.It is normal (essentially normal).3. 3.Have you ever received any treatment before?4. 4.Has it gotten worse?5. 5.Has it happened before?16Sentences Commonly Used by Sentences Commonly Used by Medical PersonnelMedical Personnel 1. 1.Are you feeling better?Are you feeling better?2. 2.Is the pain getting less?Is the pain getting less?3. 3.Does it still hurt?Does it still hurt?4. 4.How long have you had this pain?How long have you had this pain?5. 5.What kind of pain is it?What kind of pain is it?6. 6.Please tell me something of your past illnesses.Please tell me something of your past illnesses.7. 7.Is Is there there any any blood blood in in your your stool stool (urine, (urine, sputum)?sputum)?17Admission and Discharge Admission and Discharge l lDoctor: We are going to do the operation on you tomorrow. I hope you don’t worry.l lPatient: I will try not to, but will it hurt?l lD:We’ll give you anesthesia. If you feel any pain during the operation, just let us know. Have you handed in your consent yet?18Admission and Discharge Admission and Discharge l lP: How should I write it?l lD: “I (name) the undersigned have requested and consented to a certain operation.” That’s all. We need the seal of your embassy and the signature of your Ambassador on the consent form.19Admission and Discharge Admission and Discharge l lNurse:I’d like to shave off the hair around the operation area.l lP: I have never been in a hospital before. I’m so scared. 20Admission and Discharge Admission and Discharge l lN: There is nothing to worry about. The doctor who will operate on you is very experienced and considerate. If you have any discomfort during the operation, please don’t hesitate to tell him. l lI will give you an enema tonight. After that please don’t take any food or water before the operation. 21Admission and Discharge Admission and Discharge l lP:How do you do it? Does it hurt?l lN:I will insert a rubber tube into your anus and let the soap suds solution flow into your rectum. Please let me know if you feel distension. I’ll stop the flowing. Hold it for several minutes before you expel it. That may produce a better result. 22Admission and Discharge Admission and Discharge l lN:The operation went very well. Please turn from side to side every two or three hours.l lP:I only feel a mild pain. I don’t think a pain-killer is necessary.l lThe pain is very severe. I can’t stand it. Please give me a pain-killer at once. 23Admission and Discharge Admission and Discharge l lN:N:I’ll I’ll help help you you get get up. up. You You can can try try walking around the room or corridor.walking around the room or corridor.l lP:P:I think I’m quite all right now.I think I’m quite all right now.l lN:N:You You are are going going to to be be discharged discharged the the day day after tomorrow.after tomorrow.l lP:P:Is that so? I’m so happy.Is that so? I’m so happy.l lN:N:You You have have been been in in the the hospital hospital for for two two weeks, Haven’t you?weeks, Haven’t you?l lP:P:Exactly, but the doctor told me I still Exactly, but the doctor told me I still have to rest for one more week.have to rest for one more week. 24Admission and Discharge Admission and Discharge l lN:The doctor has written a certificate for you. There are two suggestions. First, avoid any mental stress and have a good rest. Secondly, examinations fasting sugar and an EKG should be done regularly.l lP: My organization (doctor) needs my medical history. May I have it tomorrow?l lN:Certainly.25Open Injury Open Injury l lDoctor:Doctor: How were you injured?How were you injured?l lPatient:Patient:I I tripped tripped and and fell, fell, banging banging my my forehead forehead quite quite hard. hard. My My wife wife wrapped wrapped a a bandage bandage around around it to stop the bleeding.it to stop the bleeding.l lD:D:Did you lose a lot of blood?Did you lose a lot of blood?l lP:P:Not too much.Not too much.l lD:D:Were you unconscious?Were you unconscious?l lP:P:No.No.26Open Injury Open Injury l lD:D:Did Did your your nose nose or or ears ears bleed bleed after after the the accident?accident?l lP:P:No.No.l lD:D:The The wound wound is is rather rather large, large, so so I’’ll I’’ll stitch it up.stitch it up.l lP:P:Will it hurt?Will it hurt?l lD:D:Oh, no. It won’t be painful. We’ll give Oh, no. It won’t be painful. We’ll give you a local anesthetic. You’re a brave fellow. you a local anesthetic. You’re a brave fellow. Well, we’re all finished. That wasn’t so bad, Well, we’re all finished. That wasn’t so bad, was it?was it? 27Open Injury Open Injury l lP:P:No, not very.No, not very.l lD:D:Have Have you you had had an an anti-tetanus anti-tetanus injection injection lately?lately?l lP:P:I I think think the the only only one one I I have have had had was was about five years ago.about five years ago.l lD:D:Well, Well, I I think think you’d you’d better better have have another another one. one. l lP:P:Whatever you say, Doctor.Whatever you say, Doctor.l lD:D:Come Come again again after after three three days days and and we’ll we’ll examine the wound.examine the wound. 28Fracture Fracture l lD:D:Hello, Hello, I’m I’m an an orthopedic orthopedic surgeon. surgeon. What happened to your leg?What happened to your leg?l lP:P:I I fell fell down down the the stairs. stairs. Immediately, Immediately, I I felt felt a a bad bad pain pain in in my my left left hip hip and and I I couldn’t couldn’t stand at all.stand at all.l lD:D:When did it happen?When did it happen?l lP:P:Two hours ago.Two hours ago.l lD:D:Have you taken any pain-killers?Have you taken any pain-killers?l lP:P:No, I came directly here.No, I came directly here.29Fracture Fracture l lD:D:Please Please lie lie on on the the bed, bed, loosen loosen your your belt. belt. Point to the spot where you feel the most pain.Point to the spot where you feel the most pain.l lP:P:It’s here, Doctor, around the left hip.It’s here, Doctor, around the left hip.l lD:D:I’m I’m afraid afraid your your femur femur is is broken. broken. We’d We’d better better x-ray x-ray it, it, just just to to be be sure. sure. Take Take this this paper paper to to the the office; office; the the nurse nurse will will show show you you the the x-ray x-ray department.department.l lThe x-ray shows a fracture of your left femur.The x-ray shows a fracture of your left femur. 30Fracture Fracture l lP:P:Doctor, will it heal properly?Doctor, will it heal properly?l lD:D:Of Of course, course, it it will, will, don’t don’t worry. worry. I I think think you you should should be be admitted admitted to to hospital. hospital. You You need need an an operation to fix it.operation to fix it.l lP:P:I I have have hurt hurt my my right right elbow. elbow. I I can’t can’t move it because of the pain.move it because of the pain.l lD:D:How did it happen?How did it happen?l lP:P:When I was getting into the bus, I fell When I was getting into the bus, I fell on my elbow. That happened this morning.on my elbow. That happened this morning. 31Fracture Fracture l lD:D:Is it still painful?Is it still painful?l lP:P:Yes. Yes. Since Since the the accident accident it it has has been been stiff stiff and and looks looks black black and and blue. blue. At At times times it it feels feels numb.numb.l lD:D:Can Can you you feel feel this, this, when when I I put put it it in in your your hand?hand?l lP:P:Yes.Yes.32Fracture Fracture l lD:D:I’m I’m afraid afraid you you may may have have broken broken your your elbow, elbow, I’ll I’ll send send you you to to the the x-ray x-ray department department to to check.check.l lThe The x-ray x-ray reveals reveals a a fracture fracture of of the the lower lower humerus. humerus. We’ll We’ll give give you you a a “U” “U” type type plaster plaster cast cast on your elbow and shoulder.on your elbow and shoulder.l lP:P:How long will I have to have it?How long will I have to have it?33Fracture Fracture l lD:D:About six weeks.About six weeks.l lP:P:Is there anything else I should do?Is there anything else I should do?l lD:D:You’d better rest in bed and keep your You’d better rest in bed and keep your elbow higher than your heart. Move your elbow higher than your heart. Move your finger joints from time to time. finger joints from time to time. Keep an eye onKeep an eye on the color of the fingers. If you have pain and the color of the fingers. If you have pain and numbness or if the color of the fingers turns numbness or if the color of the fingers turns pale or dark, come right away.pale or dark, come right away. 34胆石病胆石病胆石病胆石病 l l病人：医生，我突然觉着右上腹疼痛．病人：医生，我突然觉着右上腹疼痛．病人：医生，我突然觉着右上腹疼痛．病人：医生，我突然觉着右上腹疼痛．l lPatient:Patient: Doctor, Doctor, I I suddenly suddenly felt felt a a pain pain in in the the right right upper side of my stomach.upper side of my stomach.l l医生：什么时候开始的医生：什么时候开始的医生：什么时候开始的医生：什么时候开始的? ?l lDoctor:Doctor:When did it first start?When did it first start?l l病人：大约在三天前．病人：大约在三天前．病人：大约在三天前．病人：大约在三天前．l lP:P:About three days ago.About three days ago.35胆石病胆石病胆石病胆石病 l l医生：疼还向别的地方窜吗医生：疼还向别的地方窜吗医生：疼还向别的地方窜吗医生：疼还向别的地方窜吗? ?l lD:D:Does the pain move anywhere else?Does the pain move anywhere else?l l病人：是的，向右肩部窜．病人：是的，向右肩部窜．病人：是的，向右肩部窜．病人：是的，向右肩部窜．l lP:P:Yes, it goes towards my right shoulder.Yes, it goes towards my right shoulder.l l医生：是什么样性质的疼痛医生：是什么样性质的疼痛医生：是什么样性质的疼痛医生：是什么样性质的疼痛? ?l lD:D:What kind of pain is it?What kind of pain is it?l l病人：先是绞疼，很快就变为持续性的疼了．病人：先是绞疼，很快就变为持续性的疼了．病人：先是绞疼，很快就变为持续性的疼了．病人：先是绞疼，很快就变为持续性的疼了． l lP:P:It’s colic at first, but soon it became constant.It’s colic at first, but soon it became constant. 36胆石病胆石病胆石病胆石病 l l医生：你发冷还是发烧医生：你发冷还是发烧医生：你发冷还是发烧医生：你发冷还是发烧? ?l lD:D:Have you had any chill or Have you had any chill or temperature?temperature?病人：我仿佛觉着发烧．病人：我仿佛觉着发烧．病人：我仿佛觉着发烧．病人：我仿佛觉着发烧．l lP:P:I feel as though I have a temperature.I feel as though I have a temperature.l l医生：发热在先还是疼在先医生：发热在先还是疼在先医生：发热在先还是疼在先医生：发热在先还是疼在先? ?l lD:D:Which Which came came first, first, the the temperature temperature or or the pain?the pain?l l病人：疼在先．病人：疼在先．病人：疼在先．病人：疼在先．l lP:P:The pain.The pain. 37胆石病胆石病胆石病胆石病 l l医生：你胃口好吗医生：你胃口好吗医生：你胃口好吗医生：你胃口好吗? ?l lD:D:How is your appetite?How is your appetite?l l病人：我一看见食物就想吐．病人：我一看见食物就想吐．病人：我一看见食物就想吐．病人：我一看见食物就想吐．l lP:P:When I look at food, I feel sick.When I look at food, I feel sick.l l医生：三天来你吐过吗医生：三天来你吐过吗医生：三天来你吐过吗医生：三天来你吐过吗? ?l lD:D:Have you vomited in the past three days?Have you vomited in the past three days?l l病人：是的，一共吐了病人：是的，一共吐了病人：是的，一共吐了病人：是的，一共吐了1010到到到到1515次．我总感到疼次．我总感到疼次．我总感到疼次．我总感到疼 l lP:P:Yes, about 10 to 15 times. I always felt pain.Yes, about 10 to 15 times. I always felt pain. 38胆石病胆石病胆石病胆石病 l l医生：吐过血吗医生：吐过血吗医生：吐过血吗医生：吐过血吗? ?l lD: Have you vomited blood?D: Have you vomited blood?l l病人：没有，只是一些白的粘稠的东西．病人：没有，只是一些白的粘稠的东西．病人：没有，只是一些白的粘稠的东西．病人：没有，只是一些白的粘稠的东西．l lP:P:No. Just a kind of whitish, thick stuff.No. Just a kind of whitish, thick stuff.l l医生：吃得过多或吃得油腻你肚子胀吗医生：吃得过多或吃得油腻你肚子胀吗医生：吃得过多或吃得油腻你肚子胀吗医生：吃得过多或吃得油腻你肚子胀吗? ?l lD: Did you feel full after eating heavy or greasy food?D: Did you feel full after eating heavy or greasy food?l l病人：是的，三天前我连续参加了两次宴会．以后病人：是的，三天前我连续参加了两次宴会．以后病人：是的，三天前我连续参加了两次宴会．以后病人：是的，三天前我连续参加了两次宴会．以后我就感到腹胀．暴食后似乎就带来疼痛．这是发病我就感到腹胀．暴食后似乎就带来疼痛．这是发病我就感到腹胀．暴食后似乎就带来疼痛．这是发病我就感到腹胀．暴食后似乎就带来疼痛．这是发病的原因吗的原因吗的原因吗的原因吗? ?l lP:P:Yes, Yes, I I went went to to two two parties parties in in succession succession three three days days ago. ago. I I felt felt bloated. bloated. Heavy Heavy eating eating seems seems to to bring bring on on the the pain. Could this be the reason for it?pain. Could this be the reason for it?39胆石病胆石病胆石病胆石病 l l医生：暴饮暴食可以引起这些症状．医生：暴饮暴食可以引起这些症状．医生：暴饮暴食可以引起这些症状．医生：暴饮暴食可以引起这些症状． 你的皮肤和眼你的皮肤和眼你的皮肤和眼你的皮肤和眼球发黄过吗球发黄过吗球发黄过吗球发黄过吗? ?l lD:D:overeating overeating or or drinking drinking too too much much can can cause cause these these symptoms. symptoms. Have Have your your skin skin and and eyeballs eyeballs turned turned yellow?yellow?l l病人：没有．病人：没有．病人：没有．病人：没有．l lP:P:No.No.l l医生：你的大便的颜色变浅过吗医生：你的大便的颜色变浅过吗医生：你的大便的颜色变浅过吗医生：你的大便的颜色变浅过吗? ?l lD:D:Have your stools been light in color?Have your stools been light in color?l l病人：是的，昨天我发现我的大便是沙土色的．病人：是的，昨天我发现我的大便是沙土色的．病人：是的，昨天我发现我的大便是沙土色的．病人：是的，昨天我发现我的大便是沙土色的． l lP:P:Yes, I found my stool was a sandy color yesterday.Yes, I found my stool was a sandy color yesterday. 40胆石病胆石病胆石病胆石病 l l医生：你的尿色深吗医生：你的尿色深吗医生：你的尿色深吗医生：你的尿色深吗? ?l lD:D:Has your urine been dark?Has your urine been dark?l l病人：是的，象茶一样．病人：是的，象茶一样．病人：是的，象茶一样．病人：是的，象茶一样．l lP:P:Yes, just like tea.Yes, just like tea.l l医生：让我给你检查一下．请躺下．放松．深呼吸医生：让我给你检查一下．请躺下．放松．深呼吸医生：让我给你检查一下．请躺下．放松．深呼吸医生：让我给你检查一下．请躺下．放松．深呼吸．好．看起来你象是胆石症．我们给你照一．好．看起来你象是胆石症．我们给你照一．好．看起来你象是胆石症．我们给你照一．好．看起来你象是胆石症．我们给你照一X X线片以线片以线片以线片以明确诊断．明确诊断．明确诊断．明确诊断．l lD:D:Let Let me me examine examine you. you. Please Please lie lie down. down. Relax. Relax. Take Take a a deep deep breath. breath. Fine. Fine. You You may may have have gallstones. gallstones. We’ll do an x-ray to see if that’s so.We’ll do an x-ray to see if that’s so.41胆石病胆石病胆石病胆石病 l l病人：需要做手术吗病人：需要做手术吗病人：需要做手术吗病人：需要做手术吗? ?l lP:P:Would an operation be necessary?Would an operation be necessary?l l医生：在没有看到医生：在没有看到医生：在没有看到医生：在没有看到X X线片和试验结果之前，我还不能线片和试验结果之前，我还不能线片和试验结果之前，我还不能线片和试验结果之前，我还不能做结论．你最好住几天院以便观察．做结论．你最好住几天院以便观察．做结论．你最好住几天院以便观察．做结论．你最好住几天院以便观察．l lD:D:I I can’t can’t say say until until I’ve I’ve seen seen the the x-rays x-rays and and done done some some tests. tests. You’d You’d better better come come into into hospital hospital for for a a few few days of observation.days of observation.42Coma, Extradural HemorrhageComa, Extradural Hemorrhage lWomen: Doctor, my husband tripped and fell, hitting his head quite hard. He has a headache, so I thought I’d better bring him in and see what’s wrong with him.lDoctor: When did it happen?lW:This morning. About two hours ago.lD:Does he have high blood pressure or diabetes?lW:No.43Coma, Extradural HemorrhageComa, Extradural HemorrhagelD:Did he lose consciousness after the injury?lW:Yes, he did. He blacked out for about half an hour. Then he regained consciousness.lD:(asking the patient) Do you remember how you were injured?lP:Oh, oh. (patient vomits)lD:Well, he is unconscious again now. Has he been vomiting all the time before coming to hospital?lW:Yes.44Coma, Extradural HemorrhageComa, Extradural HemorrhagelD:Now, let me have a look at him. The pupil on the right is dilated and does not react to light. There’s no reaction to pain in the left extremities. I’m afraid your husband has torn a blood vessel when he hit his head, and the blood is compressing his brain, causing his present condition. I’ll talk over his problem with the neurosurgeon and decide what to do.lW:Thank you, Doctor. I’m so worried. Do you think my husband will live? 45Coma, Extradural HemorrhageComa, Extradural HemorrhagelD:Don’t worry. We’ll do everything we can to save him. lI’ve just finished talking to the neurosurgeon. Your husband is in a coma due to extradural hemorrhage. In order to save him, we think we should operate on him. (In order to be more certain what has happened to him, a lumbar puncture is necessary). We need your permission to do this.lW:Anything you say, Doctor, as long as he gets well.46Coma, Extradural HemorrhageComa, Extradural HemorrhagelD:Well, the operation has certain risks with the anesthetic and your husband may not be able to stand the operation. Post-operative complications could also occur. But we’ll do all we can for him.lW:Yes, I understand. Please help him. I agree to the operation. lD:Well. Could you sign this paper to give your consent for the operation? I think everything will be all right.47Coma, Extradural HemorrhageComa, Extradural HemorrhagelW:Shall I stay here?lD:If you want to, you can wait, and I’ll let you know the result of the surgery. (Please wait in the sitting room. I’ll keep you informed of what is going on).48Intestinal Obstruction Intestinal Obstruction lPatient: Doctor, I’ve had abdominal pains and vomiting for the past three days.lDoctor: What kind of a pain is it?lP:Like colic, with spasms every 4 or 5 minutes.lD:When did the vomiting first start?lP:Two days ago. I’ve had about five bouts of nausea and vomiting up to now.49Intestinal Obstruction Intestinal Obstruction lD:How about your bowel movement?lP:Nothing for two days.lD:Any wind?lP:No, not since last night.lD:Have you ever had any abdominal surgery?lP:I had my appendix out, but that was a long time ago.50Intestinal Obstruction Intestinal Obstruction lD:Have you had anything like this before?lP:No, it’s the first time.lD:Now, please lie on your back, bend your knees and relax. Let me examine you. I’m afraid you have an intestinal obstruction. We’ll do some x-rays to confirm this.lP:Will an operation be necessary?51Intestinal Obstruction Intestinal Obstruction lD:Since you have a fever and some muscle rigidly in the abdomen, there is the possibility of intestinal strangulation. Immediate surgery is necessary.lP:Is there any danger?lD:No, don’t worry, just leave everything to us. Everything will be all right. 52Hemorrhoids (Piles) Hemorrhoids (Piles) lPatient: I bleed quite a bit when I have a bowel movement. I’m really worried about it.lDoctor: What color is the blood?lP:It’s bright red.lD:Is it mixed with the stool?lP:No, it isn’t.lD:Do you have constipation often?lP:Yes, all the time.53Hemorrhoids (Piles) Hemorrhoids (Piles) lD:Have these been any change in the pattern of your feces?lP:No.lD:Now, let’s have a look at you. Please undress and lie in the knee-elbow position. I’m going to examine you with an analscope. You’ve got hemorrhoids and a prolapse of the rectal mucosa.lP:Is there any way to cure it? If possible, I’d rather not have an operation.54Hemorrhoids (Piles) Hemorrhoids (Piles) lD:Don’t worry. Here’s a prescription. Use the suppositories and laxative. The bleeding should stop in two or three days. lP:Anything else I should do?lD:Eat more fruit or vegetables. Sit in warm water when you feel pain and if possible, avoid alcohol and spicy food.lP:Thank you. I’ll follow your advice.55Tumor of the Breast Tumor of the Breast lDoctor: Is there anything worrying you?lPatient: Yes, I have a lump (mass) in my left breast.lD:How long have you felt it?lP:About three weeks.lD:Have you had any pain in this area, especially during menstruation?lP:No.56Tumor of the Breast Tumor of the Breast lD:Have you had any accident to this area?lP:No.lD:Have you had any discharge from it or any itching of the nipple?lP:No.lD:Have you noticed any swelling under your left armpit?lP:No.57Tumor of the Breast Tumor of the Breast lD:Has anyone in your family ever had a lump or tumor of the breast?lP:No, not that I can remember.lD:Do you mind if I examine you briefly?lP:No, not at all.lD:Would you please take off your blouse. That’s fine. Sit up straight. Now rest your arm on mine. Let me examine your armpit. Put your right arm over your head. Now let’s do the same with the left. Good. That’s all. How old are you?58Tumor of the Breast Tumor of the Breast lP:I’m fifty. Is serious?lD:No. Nothing serious. Just a cystic disease of the breast (Adenofibroma). It’s a benign hormone-dependent disease. lDo you have any relatives here?lP:Yes. My husband is just outside, shall I ask him to come in?lD:Yes. Will you please go to the laboratory to check up a white blood cell count? 59Tumor of the Breast Tumor of the Breast lDoctor to patient’s husband: lAs you know, your wife has a lump in her left breast. I think it could be a carcinoma of the breast. The only way to be certain is to do a biopsy. If she has cancer, she ought to have her breast removed. That’s called a radical mastectomy.lHusband:Please do everything you can to help her, Doctor.60阑尾炎阑尾炎阑尾炎阑尾炎 l病人：我肚子疼得很厉害．我恶心想吐．病人：我肚子疼得很厉害．我恶心想吐．lPatient: I’ve got an awful pain in my stomach. I feel like vomiting.l医生：这样疼有多久了医生：这样疼有多久了?lDoctor: How long have you had it?l病人：从昨天晚上开始，疼痛先在肚子当中，今天病人：从昨天晚上开始，疼痛先在肚子当中，今天早晨就转移到了右下腹．早晨就转移到了右下腹．lP:Since last night, it was in the middle at first around my belly. But this morning it moved to the right. 61阑尾炎阑尾炎阑尾炎阑尾炎 l医生：疼向别处窜吗医生：疼向别处窜吗?lD:Has it moved again?l病人：疼固定在这儿四个小时了．病人：疼固定在这儿四个小时了．lP:No. It’s been steady for 4 hours.l医生：疼一直持续不断吗医生：疼一直持续不断吗?lD:Is it there all the time?l病人：不，这疼好一阵，坏一阵．病人：不，这疼好一阵，坏一阵．lP:No, it just comes and goes. 62阑尾炎阑尾炎阑尾炎阑尾炎 l医生：有腹泻吗医生：有腹泻吗?lD:Have you had any diarrhea?l病人：没有，我已经两天没有大便了．病人：没有，我已经两天没有大便了．lP:No, I haven’t had a bowel movement for two days.l医生：你恶心和呕吐吗医生：你恶心和呕吐吗?lD:Have you had any nausea and vomiting?l病人：现在已好些了．昨天晚上我差不多每病人：现在已好些了．昨天晚上我差不多每2小时吐小时吐一次，一疼就吐．一次，一疼就吐．lP:Well, now it’s a bit better. But last night I vomited every two hours, soon after the pain began. 63阑尾炎阑尾炎阑尾炎阑尾炎 l医生：你有发烧吗医生：你有发烧吗?lD:Have you had a temperature?l病人：昨晚我试表是病人：昨晚我试表是380C．．lP:Last night I took my temperature. It was 38oC.l医生：请指出目前最疼的部位．医生：请指出目前最疼的部位．lD:Show me where it hurts most right now?l病人：就在这儿．病人：就在这儿．lP:Just here.64阑尾炎阑尾炎阑尾炎阑尾炎 l医生：请躺下．让我检查一下你的肚子．我按这个医生：请躺下．让我检查一下你的肚子．我按这个地方疼吗？我突然抬手时是否疼得更重？我想你得地方疼吗？我突然抬手时是否疼得更重？我想你得了阑尾炎．需要手术治疗．了阑尾炎．需要手术治疗．lD:Please lie down. Let me examine your abdomen. Do you feel any pain when I press here? Does it hurt you when I withdraw my hand suddenly? I think that you have appendicitis. You must have an operationl病人：危险吗病人：危险吗?lP:Is it serious?l医生：如果不做手术，可能有危险．医生：如果不做手术，可能有危险．lD:It could be if we don’t operate. 65阑尾炎阑尾炎阑尾炎阑尾炎 l病人：好吧，我同意．病人：好吧，我同意．lP:All right, I agree.l医生：我们必须征得你同意，请在这张单子上签署医生：我们必须征得你同意，请在这张单子上签署你同意做手术吧你同意做手术吧!lD:We must have your consent. Please sign this paper consenting to have the operation.l病人：好的．病人：好的．lP:All right. 66阑尾炎阑尾炎阑尾炎阑尾炎 l医生：不要焦急，一切都会好起来的．医生：不要焦急，一切都会好起来的．lD: Don’t worry, everything will be OK.l病人：我希望如此，医生．病人：我希望如此，医生．lP:I hope so, Doctor.67。