Than Lan Con English Center
Version 3.0
MEDICAL
ENGLISH
This learning material is made by Hoang Bao Long, MD
and is the property of Than Lan Con English Center.
Introduction
Some of you may have seen the second version of this document. This time, we decided to do something
different. So here you are looking at Than Lan Con’s study material for the Medical English course, version 3.0.
Am I suitable for the course?
Read the checklist below and check you match all criteria. If you do, you are a candidate for the class.
1
I am a medical/nursing student or graduated from a medical/nursing school.
2
I can understand the main points of conversations or writing pieces about common matters in work,
school, leisure, etc. (equivalent to CEFR B1/IELTS 5.0).
3
I want to learn medical English to read medical literature and write about medicine in English.
What can I learn from the course?
Our course is designed:
1.
To provide learners with common English medical terms and expressions in clinical practice;
2.
To provide learners with skills for active and efficient learning;
3.
To introduce self-study methods and encourage learners to continue self-study after the course.
You, therefore, will be provided with (1) fundamental context-based vocabulary and structures, (2) brief
instructions on relevant skills, and (3) exercises to guide you on self-study. We recommend you review this
document carefully before and after going to the ME class at TLC.
How is this document arranged?
Contents briefly presents the knowledge points given in each lesson. Vocabulary will be the most important
part in medical English; however, Writing/Speaking and Skills enable you to use medical English more
efficiently.
The lessons are divided into sections and exercises. The Reading and Vocabulary sections introduce new words
and structures, which will be explained in detail in following exercises. We also review essential grammar
points to strengthen your reading and writing skills. Other skills are integrated into exercises.
Reading and listening materials are taken from case reports, books, journal articles, and websites. All
documents used in the study material are listed in References.
Where should I start?
The simplest way is to register a class at TLC. You have a teacher and your classmates, and there are lectures
and homework that limit boredom and improve your skills.
If you are unable to join the class (e.g., living in a distant town), start with checking the material is suitable and
reviewing the contents thoroughly. Once you feel ready, start learning the lessons one by one. You do not have
to (and should not) rush—make sure you understand everything in the lessons.
OK, let’s go! We wish you joy while learning medical English with our study material and wish you success.
Contents
VOCABULARY
1
WRITING / SPEAKING
SKILLS
Visiting the hospital
page 7
> Hospital
> Latin medical terms
2
Your first case report
> Words for describing a symptom
3
page 10
> Describing history of present
illness
> The SVO structure
Where does it hurt?
> Quality of pain
page 13
> Taking a history
> Modifiers
> Describing history of present
illness
4
The past also matters
> History
page 16
> Taking a history
> Describing past history
5
Anatomy
> Body systems and anatomical positions
page 19
> Describing the relationship
between body organs
> Describing the components of
an organ
6
On examination
> Examination
> Examination instruments and supplies
page 22
> Describing examination
findings
> Presentation skills
> Presenting case reports
7
A beating heart
> Heart anatomy and physiology
page 25
> Presenting case reports
> Cardiovascular signs and symptoms
> Illustrating knowledge
> Presentation skills
> Valvular heart diseases
> Thromboembolism
8
I can’t breathe
page 29
> Skimming and
scanning
> Anatomy of the respiratory system
> Respiratory signs and symptoms
> Some imaging methods and interventions
9
You need some blood tests
page 33
> Blood cells and conditions relating to changes in
cell counts
> Reading flow
diagrams
> Laboratory tests and test results
10 The lungs and the pleura
> Lung and pleural conditions: signs and
symptoms, treatment
> Arterial blood gas
page 36
> Describing laboratory results
VOCABULARY
WRITING / SPEAKING
SKILLS
11 The differential diagnoses
> Diagnosis and diagnostic criteria
page 39
> Explaining diagnostic
approach
12 Scopy what?
> Anatomy of the gastrointestinal system
page 44
> Presenting case reports
> Acute abdomen
> The suffices -scopy and -graphy
13 Hematemesis et al
page 47
> Cirrhosis
> Presenting case reports
> Making flow diagrams
> Peptic ulcer disease
> Introducing a disease
> Presentation skills
14 An abdominal pain’s story
page 51
> Prefixes of position
> Appendicitis
> Statistics
> Anatomy of the genitourinary system
> Causes of acute abdominal pain
15 The bean-shaped guys
> Urology: symptoms, investigations, procedures
page 56
> Introducing a disease
> Kidney disease
16 A bowl of tiet canh
> Microbiology and infectious diseases
page 59
> Presenting case reports
> Skin lesions
> Presentation skills
> Bar chart
> Epidemiological concepts
17 Mr. Meningitis
page 64
> Anatomy of the nervous system
> Making mind maps
> Common neurologic conditions
> Epidemiological concepts
18 Esomeprazole 40 mg qD
> Management
page 68
> Describing treatment
> Making medical charts
> Drug information
19 Emergency!!!
page 73
> Intervention
> Making flow diagrams
> Emergency medicine
> Presentation skills
20 A pinch of research
> Clinical trials
page 77
> Presenting statistics
Visiting the hospital 7
1 Visiting the hospital
Reading
Chung, a 40-year-old officer, had been experiencing a high fever for several days. He had thought it was just
some viral infection until he started to feel short of breath. He was taken to the emergency room (ER) in a
provincial hospital. Upon examination, he had a high fever, pulse rate and blood pressure were within normal
ranges, his breathing was fast, and oxygen saturation was low. His chest X-ray showed lung consolidations.
Chung was diagnosed with pneumonia and respiratory failure, so he was given supplemental oxygen. However,
his condition did not improve and required mechanical ventilation. Because the hospital did not have
ventilators, the ER doctor transferred him to a central hospital.
At the central hospital, Chung was admitted to the intensive care unit (ICU). He was intubated and ventilated.
Further investigations also revealed anemia. Chung was treated with antibiotics and blood transfusion. He
recovered after two weeks staying in the ICU and was transferred to the Respiratory department. Two weeks
later, he was discharged home with some prescription medications and the ward doctor asked him to return to
the outpatient clinic (OPC) after one month for follow-up.
Exercise
New words
Choose a word from the text to fill in the gaps.
1
1
2
Words to describe “a place for receiving and
treating patients”.
(1) room
(2) ____________
(3) ____________
(4) ____________
2
to ask patients about
their symptoms and
previous illnesses
_____________________
temperature, pulse
rate, blood pressure,
breathing rate
_____________________
(5) ____________
3
admission
_____________________
Two places in a hospital where a patient can
come for check-up.
4
to send patients to
another hospital for
evaluation, but not
discharge them
_____________________
medication
_____________________
(1) _______________________________
(2) _______________________________
5
3
_________________________ treats critically
ill patients.
4
Some patients can return home, but some
have to be _______________ to the hospital.
admission
_____________________
assessment
_____________________
5
Blood tests and imaging like chest X-ray are
called ___________________________.
discharge
_____________________
6
He was _______________ with pneumonia.
____________________
diagnose
7
If a hospital is unable to manage a patient,
they can _______________ the patient to
another hospital.
____________________
examine
____________________
improve
____________________
manage
____________________
treat
8
Patients who have completely recovered can be
_______________.
Nouns and verbs
Types of hospitals
In Vietnam, there are district, provincial/town, and regional/central/national hospitals. Many are general
hospitals—they manage patients with all sorts of medical conditions. The others specialize in a group of
diseases and are often called by the group of diseases that they treat (e.g., a surgical hospital treats patients
with surgical conditions).
Name some hospitals you know and classify them.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
8 Unit 1
Vocabulary
Warm-up
Underline the part you think is in common.
Which part is equivalent to the following words?
1
endoscopy, endovascular, endothelium
________________________
heart
2
cardiac, pericardiectomy, cardiovascular
________________________
inflammation
3
cellulitis, retinitis, meningoencephalitis
________________________
inside
Can you guess what is “an inflammation inside the heart”?
Latin medical terms
Exercise
There are three major components of a Latin medical How do you explain the following terms?
term: roots, prefixes (before the roots), and suffixes
(after the roots).
pericarditis
_____________________
HYPERGLYCEMIA
prefix
root
suffix
hyper-
glyc(o)-
-emia
elevated
glucose
condition of
the blood
Elevated blood glucose
-logist
a person who studies something
-logy
the study of
peri-
surrounding
Can you guess the meaning of these roots?
arthro-
__________________________
dermo-/dermato-
__________________________
entero-
__________________________
gastro-
__________________________
hemo-/hemato-
__________________________
myo-/myos-
__________________________
nephro-
__________________________
neuro-
__________________________
onco-
__________________________
ophthalmo-
__________________________
uro-
__________________________
dermatology
_____________________
urologist
_____________________
nephritis
_____________________
gastritis
_____________________
endophthalmitis
_____________________
Find an appropriate Latin term for each of the
following descriptions.
_____________________
inflammation of the
nerves
_____________________
the study of tumors,
especially cancer
_____________________
a doctor who studies the
blood
_____________________
inflammation of the
stomach and intestine
_____________________
inflammation of the skin
and muscles
_____________________
a doctor who studies the
nervous system
_____________________
inflammation of the
joints
What are the names of other medical specialties that you know? Can you explain the roots in those
names?
Than Lan Con English Center
Visiting the hospital 9
Vocabulary
Reading
Jobs in the hospitals
A full course in Vietnamese medical schools takes six
years. We begin clinical rotations in the second
semester of the third year with Internal Medicine and
Surgery. One rotation often lasts six to ten weeks. In
these rotations, we learn how to take history, detect
clinical signs, and summarize patients’ clinical
presentation.
Read the job descriptions below. Who will do these
works?
managing and dispensing
medicines to medical staff or
patients
_______________
2
assisting pregnant women in
giving birth
_______________
3
responding to emergency
calls and giving first aid
_______________
1
4
taking and reading x-rays and
other images
_______________
5
performing surgeries
6
providing temporary loss of
sensation for surgery or other
procedures
_______________
7
treating children
_______________
8
examining and taking care of
pregnant women
_______________
9
processing and analyzing
samples
_______________
10 giving drugs to patients and
taking care of them
_______________
A typical day starts at 7:30 AM when we join the
morning meeting. In the meeting, doctors present
newly admitted patients and severe patients who need
monitoring during their night shift.
Afterward, we divide into small groups to different
rooms and ask some patients about their disease and
examine them. We usually need to write case reports
and submit them to our teachers. The cases can also
be presented in front of the class during clinical
lectures in the morning. In the afternoon, we return to
our school to study theoretical lectures.
We have one to three shifts every week. Students do all
sorts of activities during the shifts. We monitor severe
patients, complete medical records, send samples to
the lab, get the test results from the lab, and transfer
patients to other units. We learn a lot in a shift, but it
can also be very boring sometimes.
Choose a word from the text to fill in the gaps.
_______________
Exercise
Below are the stories of some doctors. Can you guess
what their jobs are?
“The patient was sent to us in cardiac arrest
for 15 minutes. But no one among us gave
up. His heart beat again somehow. Since
then he visits us every year on this day.”
“She was a tiny angel, born with an extremely low
birth weight. Her heart stopped beating every now
and then. They told me I was wasting my time doing
CPR. This is the picture she drew when she started
primary school.”
“Two years ago, a young man shot himself to his
head. I quickly sent him to the operating room.
Last week, he sent me a photo of his newborn
son.”
“A young, very thin girl with severe lupus
nephritis came to us in distress. Others believed
she didn’t have much time. I told them it’s not the
end. Now she plays tennis on the days she
doesn’t have to go to the Dialysis center.”
1
We plan to submit a _______________ to the
BMC Gastroenterology.
2
Blood _______________ should be taken and
sent to the _______________ for culture within
two hours.
3
To review these cases, we’ll need to borrow
their ___________________ from the General
Planning Department.
4
I’ve been having night _______________ every
Sunday.
5
When’s your next _______________? It’s
Infectious diseases, isn’t it?
Writing
Tell us about your life as a student and a doctor or
nurse.
Think about your first day at the hospital:
-
What did you expect before you started?
What have you actually learned, and did they
meet your expectations?
One of your most impressive experiences in the
hospitals.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
10 Unit 2
2 Your first case report
Reading
Read the following paragraph in a case report1 and fill in the gaps.
A 23-year-old unemployed Caucasian man presented to our Emergency Department with a twelve-hour
history of severe right upper and lower quadrant pain. This pain originated in his epigastrium and was
associated with nausea, multiple episodes of non-bilious vomiting and anorexia. His background history was
unremarkable. He was on no regular medications, did not smoke and was a social drinker.
 talks about _________________ (CC):
 complain of + CC
 be admitted + with / due to / because of CC
 __________ + __________ CC
Tick details about the symptoms that can be found in
the paragraph. In the gaps, write the number of the
phrases describing the details.
 timing/onset __
 location/radiation __
 talk about history of _________________ (HPI)  severity/intensity __  quality __
or history of _________________ (HPC).
 associated symptoms __
 talk about _________________ history (PMH).
 aggravating/relieving factors __
Exercise
Write a complete sentence using the prompts.
1
2
3
43, M, Sri Lankan, acute febrile illness, 3
days2
4, F, Caucasian, fever, rash, bilateral
conjunctival injection3
_______________________________________________________
_______________________________________________________
52, F, Korean, edema, dry mouth4
_______________________________________________________
4
71, M, white, French, bilateral blurry
vision, epistaxis, nausea, two weeks5
_______________________________________________________
Vocabulary
Describing a symptom
Add the words in the box to the mind map. How will you arrange words with opposite meanings?
pain acute moderate intermittent chronic generalized fatigue severe
sudden nausea constant episodic mild vomiting localized malaise
Than Lan Con English Center
Your first case report 11
New words
Choose an appropriate word in the box to fill in the
gaps. Change word forms if needed.
last
1
2
3
4
His wife _______________ that he was
unresponsive, “gurgling,” and diaphoretic in
the early morning.9
5
Approximately 6 weeks before admission,
severe pain developed that _______________
down her left leg to her ankle.10
6
On further history, he _______________ any
dyspnea, shortness of breath, or cough.11
7
She had had a sore throat, which lasted for a
few days, _______________ by fever, rigors,
and myalgia.12
8
A 31-year-old Caucasian female smoker was
admitted to the hospital with a 7-week history
of fever _______________ with night sweats,
joint pains, myalgia and nasal congestion.13
associate report radiate note deny
develop accompany occur relieve
Fourteen days before the current admission,
anorexia and fatigue _______________, along
with pain and tightness in the back and
calves.6
Bowel movements _______________
approximately every hour, and the patient was
unable to sleep.7
She _______________ a weight gain of 4.5 kg
during the previous month, occasional
episodes of confusion, and two episodes of
burning chest pain during exercise that had
_______________ for 2 minutes each and were
_______________ with rest.8
Review of grammar
The SVO structure
subject (S) + verb (V) + object (O)
Examples
Analyzing sentences using the SVO principle
1. HIV is an infectious disease.
2. The doctor prescribed atenolol.
3. Severe post-splenectomy infection has an
incidence of 0.42–7.16/100 persons per year.
 Locate the verb(s)
 The subject(s) precedes the verb(s)
 The object(s) follows the verb(s)
Exercise
Exercise
Circle the verbs and underline the subjects.
Underline grammatical errors in the following
sentences.
(1) Intravascular hemolysis is the destruction of red
blood cells in the circulation with the release of cell
contents into the plasma. Mechanical trauma from a
damaged endothelium, complement fixation and
activation on the cell surface, and infectious agents
may cause direct membrane degradation and cell
destruction.14
(2) The goal of the clinical examination is to identify
patients who require immediate surgical evaluation
and those whose symptoms suggest a more serious
underlying condition such as malignancy or
infection. Patients with signs of cauda equina
syndrome, require urgent surgical referral.15
(1) The one needs the most care is the patient in bed
number 6.
(2) If there is even only one patient complain that
he/she does not receive adequate anesthesia, we
should review our protocol.
(3) We aimed to evaluate the performance of this new
scoring system for liver fibrosis compare to histologic
evaluation of liver biopsies.
(4) Appendicitis has different progressions and
among them, generalized peritonitis which is
dangerous because it might cause sepsis.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
12 Unit 2
Writing
Warm-up
Use the prompts to write a complete sentence. Add more words if needed.
1
2
3
4
45 years old, male,
abdominal pain
1 day, acute, severe,
constant, generalized
to the back, nausea,
fever
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
no painful urination
______________________________________________________________________
Exercise
Below are patients’ answers. Rewrite them in the language of medicine.
1
2
3
I have been feeling so tired for
two weeks.
It doesn’t hurt much. And only
around my belly button. The
pain started 3 days ago.
No, I don’t see any blood in my
stool.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
4
When I felt that pain in my leg, I
took a pill of paracetamol and
_____________________________________________________________
the pain’s gone.
5
Yes, she also complained of
headache and dizziness. (the
patient’s mother)
_____________________________________________________________
Review
What did you learn in this unit? Complete this table.
________________ (CC)
__________________________________________________________________
Timing/onset
__________________________________________________________________
Location/radiation
__________________________________________________________________
Severity/intensity
__________________________________________________________________
Associated symptoms
__________________________________________________________________
To say that someone has /
does not have a symptom
__________________________________________________________________
Than Lan Con English Center
Where does it hurt? 13
3 Where does it hurt?
Listening
Listen to the dialogue16 and write the order of the details which the doctor asks the patient about.
__ Aggravating factors
__ Associated symptoms
__ Chief complaint
__ Location
__ Onset
__ Quality
__ Radiation
__ Relieving factors
__ Timing
New words
Listen to the dialogue again and fill in the gaps with missing words. Then, match each question in the left
column with one question in the right column17.
1
What’s ________________ you along today?
__ When did it start?
2
How ________________ have they been bothering __ Is it sharp, dull, pulsating, cramping, or pressureyou?
like?
3
Which part of your head is ________________?
__ How can I help you today?
4
Can you ________________ the pain?
__ Where does it hurt?
Writing
Listen to the dialogue again and write your notes.
Based on the notes, write a summary.
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
Speaking
Read the dialogue below and practice with the prompts.
Doctor:
Good morning, Mr. Henderson. How
can I help you today?
Patient:
Well, I’ve got a terrible leg pain lately.
Doctor:
When did it start?
Patient:
A few days ago.
Doctor:
Where does it hurt?
Patient:
My two calves.
Doctor:
Is it constant, or does it come and
go?
Patient:
It comes and goes, but it gets worse
after I walk a few blocks.
(1) chest pain, 3 weeks, middle chest, come and go.
(2) swollen ankles, 2 months, both feet.
(3) stomachache, 10 hours, epigastric, constant,
cramping.
(4) back pain, 7 days, low back, dull but sometimes gets
sharp.
REVIEW
1. Which terms can be used to describe a pain that
started a few hours/days ago?
2. Which terms can be used to describe “come and go”?
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
14 Unit 3
Review of grammar
Using modifiers
How do you analyze the structure of a twelve-hour history of severe right
upper and lower quadrant pain? Look at the flow diagram on the right.
“History” is the central noun and “twelve-hour” provides additional meaning
to the noun—or we say “twelve-hour” modifies “history”. And “severe” and
“RUQ/RLQ” modify “pain”. These elements are called modifiers.
Modifiers can help shorten the sentences and make your expression sound
more “scientific”. However, excessive use of modifiers also creates complicated
sentences and often brings about confusion for readers.
Types of modifiers
Adj + N
The patient complained of severe chest pain.
N + V-ing/V-ed
The patient complained of severe chest pain radiating to the back, accompanied
by dyspnea and fever.
N + relative clause
The patient complained of severe chest pain that occurred while he was lifting a
heavy box.
N + prep + N
The patient complained of severe chest pain behind the sternum.
N + adj + prep + N
The patient complained of severe chest pain unresponsive to nitroglycerin.
Exercise
Read the text, underline the central nouns, and highlight their modifiers.
(1) In patients with advanced HIV infection, the most common causes of focal brain lesions with mass effect
are toxoplasmosis and lymphoma.18
(2) When there is an associated aneurysm of the aortic root, conventional surgical therapy has consisted of
the combined replacement of the aorta and valve with reimplantation of the coronary arteries. 19
(3) Children have a proportionately greater body surface area to weight ratio, and as a result, have a higher
degree of absorption for the same amount applied.20
(4) Examination of her skin and oral cavity reveals violaceous, polygonal papules, mainly on the flexural
aspect of the wrists and ankles and in the lumbar region, as well as erosions associated with a lace-like,
white-line network apparent in the posterior buccal mucosa.21
(5) A total of 352 patients with unstable ischemic symptoms, ECG changes, or troponin elevation were
randomized at 13 hospitals to immediate (at a median 70 minutes after enrollment) versus delayed (at a
median 21 hours) angiography and revascularization.22
Rewrite the following sentences using modifiers.
1
2
3
Adolescents with Crohn’s disease often have a
history of weight loss. It precedes the onset of
abdominal symptoms by 18 months.23
______________________________________________
On the 6th day, MRI of the lumbar spine revealed
multiple abscesses. They involved the psoas
muscles bilaterally.24
______________________________________________
Four days before hospitalization, she developed
fever and a rash on her extremities and trunk. The
rash was diffuse, non-itchy, and erythematous.3
______________________________________________
Than Lan Con English Center
Where does it hurt? 15
Writing
Read the notes written by the doctor in the case above. Answer the questions.
AGE 32
SEX M
OCCUPATION Lorry driver
PRESENT COMPLAINT
frontal headaches, 3mos
worse in a.m. – “dull, throbbing”
relieved by lying down
also c/o deafness
1. What do the abbreviations stand for?
M
_____________________________
a.m.
_____________________________
c/o
_____________________________
2. Why is “dull, throbbing” in quotation marks?
Rewrite your summary using modifiers.
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Vocabulary
Exercise
Quality of pain
Highlight the details about symptoms and
write a summary.
Match the terms relating to quality of pain with their definitions.
1
burning
__ low intensity, unclear about location
2
colicky
__ medium to significant intensity, clearly
located
3
cramping __ feeling like a knife stabbing into the body
4
crushing
__ feeling like something is crushing/squeezing
the organ
5
dull
__ hot as if exposed to fire or chemical agents
6
insidious __ feeling like something is punching into the
body, can be associated with a feeling of a
beating pulse
7
sharp
__ a pain that runs quickly, directly, and severely
across a region of the body
8
shooting
__ low intensity but persisting, often gradually
increasing, and sometimes comes and goes
9
stabbing
__ severe, feeling like an internal organ is being
gripped
10 tearing
__ feeling like needles are punching into the skin
11 throbbing __ a sudden painful tightening in a muscle
12 tingling
__ a very painful feeling as if the body part were
torn apart
(1) Our patient was a woman. She was 56
years old. She came to our ER because
she had a fever. She said that she had
been having it for three days. The
maximum temperature was 40oC and
never below 38oC.
(2) A construction worker came to our ED
last night. He was 32 years old. He had a
pain in the region of the appendix five
days ago. The pain was mild, but it did
not come and go.
(3) A 22-year-old student suddenly had a
feeling of shortness of breath while he
was hitting the gym one day ago. The
shortness of breath was severe and never
stopped, and he also felt chest pain.
(4) A retired officer came to the ED with
an extremely severe chest pain. He
experienced the chest pain 45 minutes
before admission. The chest pain was
sudden and most prominent behind the
sternum and radiated to his left
shoulder.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
16 Unit 4
4 The past also matters
Reading
Read the following case reports. Before each type of history, write the number of the phrase that describes it.
The patient had a long history of leg pain that was associated with activity and was relieved with rest,
attributed to claudication, which was different from his current symptoms. He had had diabetes mellitus,
hypertension, and hyperlipidemia for more than 10 years.25
His medical history includes diabetes mellitus, hypertension, and hyperlipidemia. He has a family history
of diabetes and hypertension. His medication history includes subcutaneous Novomix®, telmisartan 20 mg
once a day, amlodipine 10 mg once a day, atorvastatin 20 mg once a day and aspirin 150 mg once a day. He
underwent saucerization surgery to remove carbuncles in Jan 2011.26
Her menstrual periods were usually regular in interval and she rarely suffered from menorrhagia. She had
two myomectomies about 25 years ago.27
He had a long history of alcohol abuse (up to 1 liter of vodka per day). He had declined detoxification treatment,
disulfiram therapy, and referral to support groups for alcoholism. He did not smoke or use illicit drugs. He
had no known allergies.18
A 55-year-old man of East African descent presented to our community hospital with a history of repeated falls,
postural dizziness, progressive fatigue, generalized weakness and 30-lb weight loss over the course of three to
six months. He is a vegetarian.28
Types of history
Past medical history (PMH) __ __
Ob/Gyn history __
Allergy __
Past surgical history (PSH) __ __
Social history (SH) __
Family history (FH) __
Medications __
Diet __
Exercise
Fill in the gaps with one word.
1
The patient had a ________________ of injected drug use and unprotected sex.
2
She had ________________ hypertension and chronic kidney disease for about 5 years.
3
He ________________ appendectomy in 2014.
4
Her menstrual periods ________________ often prolonged and painful, and sometimes associated with
severe low back pain.
5
His past medical history ________________ COPD, congestive heart failure, and diabetes mellitus.
New words
Write a term that corresponds to the definition.
_________________
Consuming too much ethanol, resulting in health problems.
_________________
Blood discharge from the uterus via the vagina, often happening monthly.
_________________
Use of tobacco, cigarettes, or equivalents.
_________________
People who avoid meat in diet.
_________________
Enabling the body to recognize an organism so the body can protect itself against the
organism.
Than Lan Con English Center
The past also matters 17
Speaking
Ask appropriate questions for the following answers.
(1) Yes. Last year, I had my appendix removed.
(5) Yes. I am taking amlodipine for hypertension.
(2) Yes. I am allergic to penicillin.
(6) No, I don’t drink.
(3) I have two brothers. They are both living healthy.
(7) I have two children. One is 5, and the other 2.
(4) My period is not regular.
(8) Yes, my son hasn’t missed any vaccination.
Writing
Describing past history
Purpose
To say the patient
has a history
Structure
Example
his/her history includes +
history
Her history included type 2 diabetes and
hypertension.
have/report + history
The patient was diagnosed with heart failure 3 years
ago.
be diagnosed with +
diagnosis
To say the patient
does not have a
history
deny + (any) + history
She denied any rash or blisters on the skin.
report no + history
The child’s mother reports no history of neonatal
jaundice.
To talk about
medications
his/her medication history
includes + medications
Her medication history includes tacrolimus, Cellcept,
and dexamethasone.
be on drug name
He has been regularly on enalapril 10 mg/day.
Exercise
Read the stories told by the patient/family member. Describe their cases using key words, then write a concise
summary.
(1) I am 20 years old. I have had this constant fever for 4 days. The maximum temperature I took reached 40 oC
and it’s never fallen below 38 oC. I took 5-6 paracetamol pills every day, but it felt like the fever didn’t go away.
Then I went to a health center near my house, they wanted to give me paracetamol, but I told them that I had
already taken one two hours ago, so they gave me an infusion with normal saline. I didn’t see any rash. No
headache, no chest pain or shortness of breath. I didn’t vomit or feel nauseous, either. I was diagnosed with
alpha-thalassemia 3 years ago. It was mild, the doctor didn’t give me any treatment.
(2) My husband is 58 years old. He kept complaining about his knee pain for nearly two weeks. He has had
this joint pain for 10 years. Every time it became red and swollen, he said it was very painful and he would go
to a private doctor in the village. The doctor gave him some injections and the pain went away after several
days. This time, it came back. He also developed a fever as his knee joint became painful and swollen. I told
him to go to the hospital, so we went to our district hospital. He said his fever got worse and the joint was
very painful. They treated him with some drugs, both injected and oral. I can’t remember their names, but I
kept the bottle (you check the bottle, they are dexamethasone, piroxicam, and gentamicin). He stayed in the
district hospital for 12 days, and his fever and joint pain didn’t get better. He told me that he felt extremely
unwell. We were very worried, so the doctor transferred him to the provincial hospital. There he stayed there
for several hours and suddenly fainted. I called the doctor, they checked his blood pressure and told me that
he was in shock. They gave him fluid, then transferred him to this hospital.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
18 Unit 4
ID/CC
_________________________________________________________________________________
HPI
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
PMH
_________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
ID/CC
_________________________________________________________________________________
HPI
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
PMH
_________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Than Lan Con English Center
Anatomy 19
5 Anatomy
Vocabulary
Systemic anatomy
Look at the pictures and name the following systems and their specialties. See the examples.
(1) skin
(2) _________________________
(3) _________________________
____________________________
rheumatology
____________________________
(4) _________________________
(5) _________________________
(6) _________________________
____________________________
____________________________
____________________________
(7) _________________________
(8) _________________________
(9) _________________________
____________________________
____________________________
____________________________
Exercise
Complete the following sentences using the above terms.
1
Myocardial infarction is a _______________ disease. A lot of MI patients are diabetic; therefore, they
should also be managed by an _______________.
2
Systemic lupus erythematosus involves the skin and joints, so patients often visit _______________ or
_______________ when they first have symptoms. At times, they might develop lupus cerebritis, which
requires consultation of a _______________.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
20 Unit 5
Terms of anatomical position29
Tips
-
Superior and superficial both have “super” (above). Superficial means “above the surface”.
Anterior and posterior come from ante (before) and post (after). Refer to AM and PM (before and after
midday).
Distal relates to “distance, distant” (far).
Than Lan Con English Center
Anatomy 21
Writing
Describing anatomical relationship
Use the following structure to write sentences about positional relationship of anatomical details.
A + be + term of position + to + B
1 head/neck
_____________________________________________________________________________
_____________________________________________________________________________
2 shoulder/hand _____________________________________________________________________________
_____________________________________________________________________________
3 thigh/foot
_____________________________________________________________________________
_____________________________________________________________________________
4 radius/ulna
_____________________________________________________________________________
_____________________________________________________________________________
5 heart/vertebra
_____________________________________________________________________________
_____________________________________________________________________________
Describing components of an organ
The following table explains how to describe the components of an organ.
Structure
Example
organ + be divided into + (number of
parts:) + components
The nervous system is divided into the central nervous
system (CNS) and the peripheral nervous system (PNS).
organ + include / be composed of / consist
of + components
The CNS includes the autonomous nervous system (ANS) and
the somatic nervous system (SNS).
there is/are + number of parts + unit + (in
the organ): components
There are three meningeal layers: dura mater, arachnoid
mater, and pia mater.
Exercise
Describe the following anatomical details.
1
2
3
4
5
vertebra, region: cervical spine, thoracic
spine, lumbar spine, sacrum, coccyx
hand, finger: thumb, index finger, middle
finger, ring finger, little finger
cerebral cortex, lobe: frontal lobe, parietal
lobe, temporal lobe, occipital lobe
stomach, part: cardia, fundus, body,
antrum, pylorus
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
electrical conduction system of the heart,
main structures: SA node, AV node, Bundle
of His, Purkinje fibers
_____________________________________________________
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
22 Unit 6
6 On examination
Vocabulary
Examination techniques
Complete the terms of examination techniques and match them with the pictures.
(1) I N __ __ __ __ __ __ __ __
(2) P A L __ __ __ __ __ __
(3) P E R __ __ __ __ __ __ __
(4) A U S __ __ __ __ __ __ __ __ __
(A) LISTEN
(B) TOUCH
(C) LOOK
(D) TAP
Exercise
Which examination techniques can detect the following signs? In the examination of which organ/system can
you detect them? You will have to look for the definition of the signs. There is no need to memorize their
meanings right now. You just need to understand the definitions to answer the questions in this exercise.
Sign
Techniques
Organ/System
1
Hyperresonant chest
________________________
____________________________
2
Rebound tenderness
________________________
____________________________
3
Kyphosis
________________________
____________________________
4
Late-inspiratory crackles
________________________
____________________________
5
Decreased fremitus
________________________
____________________________
6
Subcutaneous emphysema
________________________
____________________________
7
A liver span of 15 cm
________________________
____________________________
8
Ascites
________________________
____________________________
9
Murmur at the right renal artery
________________________
____________________________
________________________
____________________________
10 Facial nerve paralysis
Examination instruments and supplies
Match the name of examination instruments and supplies with the pictures.
(1)
gloves
(2)
(3)
(4)
(5)
medical mask
sphygmomanometer
stethoscope
thermometer
_____________ _____________ _____________ _____________ _____________
Than Lan Con English Center
On examination 23
Writing
Describing examination findings
Read the sentences and write the number of the structure used to describe examination findings.
1
sign + was/were present/absent
2
organ/parameter + was/were +
status
3
the patient was + adj (describing
a sign)
4
the patient had + sign
5
physical examination
showed/revealed + sign
6
there was/were + sign
__ (1) A physical examination showed erythematous, violaceous
plaques that involved more than 90% of the patient’s body-surface
area.30
__ __ (2) On examination, the oxygen saturation was 99% while
the patient was breathing ambient air. Ankle, knee, and
brachioradialis reflexes were absent.31
__ __ (3) There was ptosis of the left upper eyelid, and the patient
was unable to elevate the left eyelid.32
__ __ (4) Scaly, erythematous plaques were also present on the
extensor surfaces of both elbows and both knees. The patient had
no joint tenderness, swelling, or stiffness.33
Exercise
Use the above structures to describe the following physical findings.
Findings
1
Description
hepatomegaly, no splenomegaly
_________________________________________________________
2
3
4
5
6
7
jaundice, multiple scratches, all over
the body
heart: S1, S2: normal; audible S3, no
S4; murmur: systolic, 3/6, apex,
radiating to left axilla
chest: symmetrical; no use of
accessory muscles
admission: deep coma, no response
to voice and pain stimuli
liver span: 17 cm (right midclavicular
line)
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
abdomen: firm, tender, guarding.
_________________________________________________________
8
9
abdomen: no enlarged kidneys, no
costovertebral angle tenderness.
both knees: good range of motion,
moderate crepitus
10 alert, try to answer questions,
difficult in finding words
_________________________________________________________
_________________________________________________________
_________________________________________________________
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
24 Unit 6
Speaking
Present these case reports using the prompts.
Case 1—Portal venous gas34
Case 2—Aortic regurgitation35
-
72 M
-
58 M
-
C/O: periumbilical pain, inability to pass flatus
(11 hours).
-
C/O: exertional dyspnea.
-
-
PMH: chronic lymphocytic leukemia (on
ibrutinib), type 2 DM, chronic Hep-B.
PMH: 12 years—aortic stenosis, bioprosthetic
aortic valve replacement.
-
O/E: PR 155, BP 83/52. Abdomen: diffusely tender
(most severe pain: RUQ).
-
O/E: BP 142/57. Auscultation: holodiastolic
murmurs. Corrigan’s pulse, Quincke’s pulse.
Case 3—Stroke36
Case 4—Polyarteritis nodosa37
-
61 M
-
84 M
-
C/O: right eye vision loss, ptosis (4 days).
-
-
PMH: type 2 DM, coronary artery disease,
hypertension.
C/O: fever, malaise, discoloration and pain of
fingers and toes (2 weeks).
-
PMH: no smoking.
-
O/E: Fingers and toes—discoloration and
necrosis. Peripheral pulses (+) both sides.
-
O/E: No fever. Right eye: ptosis, right pupil—
fixed, mydriatic, non-reactive to light.
Writing
Choose a patient in the hospital where you are working/studying. Summarize his/her clinical presentation with
key words and using the key words to write a summary.
Age, sex
_________________________________________________________________________________
HPI
_________________________________________________________________________________
PMH
_________________________________________________________________________________
PE
_________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Than Lan Con English Center
A beating heart 25
7 A beating heart
Vocabulary
Anatomy of the heart
Complete the table of heart anatomy.
Heart chambers
Heart valves and vessels
(1)
(3)
___________
___________
From
To
Valve
(3) ______________
(4) ______________
________________
(4) ______________
________________
________________
(2)
(4)
(1) ______________
(2) ______________
________________
___________
___________
(2) ______________
________________
________________
Heart sounds
Draw a cardiac cycle that includes all the following terms.
systole
diastole
S1 (first heart sound)
S2 (second heart sound)
M1 (valve)
T1 (valve)
A2 (valve)
P2 (valve)
Valvular heart disease
Fill in the gaps with an appropriate term.
Description
Term
An abnormality of the heart valve causing it to be unable to fully open,
thus restricting the blood flow pumped through its orifice.
___________________________
An abnormality of the heart valve causing it to be unable to fully close,
thus letting the blood flow leak through its orifice.
___________________________
3
The valve between LA and LV does not fully open; therefore, the blood
cannot flow properly into the LV.
___________________________
4
The valve between LV and aorta does not fully close; therefore, blood
flows backward into the LV during systole.
___________________________
5
The valve between the RA and RV does not fully close; therefore, blood
flows backward into the RA during systole.
___________________________
The valve between the RV and pulmonary artery does not fully open;
therefore, the blood cannot flow properly into the PA.
___________________________
1
2
6
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
26 Unit 7
Describing a murmur
Warm-up
Study the example and write the correct number before each characteristic of the murmur.
Cardiac examination revealed a __ soft __ 2/6 __ systolic __ crescendo-decrescendo murmur __ loudest at the
right upper sternal border __ preceded by an ejection click.38
Characteristics of a murmur
1
Timing
systolic/diastolic/continuous
pre-, mid-, holo-, pan-, early, late
2
Location
loudest at, heard best at
3
Radiation
radiating to; non-radiating
4
Intensity
(grade) X/6 (4/6: thrill present)
5
Quality
soft, harsh, machinery-like, etc.
6
Shape
crescendo, decrescendo
7
Pitch
low-, mid-, high-pitched
8
Associated sounds
preceded by, followed by, accompanied by
Exercise
Describe the murmurs in the table. Which diseases cause these murmurs?39
(1)
(2)
(3)
Apex → left axilla, 3/6, medium
Tricuspid valve area, no radiation,
3/6, medium
Left 3ICS, medial to apex, no
radiation, 2/6, soft
(4)
(5)
(6)
Right 2ICS → carotids, 4/6,
medium, harsh
Left 4ICS, no radiation, 2/6, high,
blowing
Apex, no radiation, 3/6, low,
rumbling
(7)
(8)
Left 2ICS → left clavicle, 5/6, harsh, machinery-like
Left 3,4,5ICS → surrounding, 5/6, high, harsh
Than Lan Con English Center
A beating heart 27
Reading
Thromboembolism
A woman is cooking dinner in the kitchen. While cutting a carrot, she accidentally cuts her finger and bleeds.
The bleeding is stopped after several minutes by the vessels forming a blood clot or thrombus (pl. thrombi).
Blood clot formation (coagulation) stops bleeding (hemostasis) and helps repair the damaged vessels.
Thrombi are constantly created in the vessels but fibrinolysis—a process to break down the clots—helps clear
up these tiny blood clots. The balance between coagulation and fibrinolysis helps the blood flow smoothly
inside the vessels. If the fibrinolysis is weakened, or the coagulation pathways are more activated, a person is
at higher risk for thrombosis.
Sometimes, fragments of thrombi can break down, move along the bloodstream, and are stuck in smaller
vessels. The blood cannot flow through these blocked vessels, and the tissues supplied by the vessels become
short of oxygen and nutrition. This condition is called ischemia. If ischemia is not resolved, the tissues will
eventually die and be replaced by fibrotic tissues, a condition called infarction.
Other materials, such as air bubbles, fat, or tissues, also behave the same way with thrombi and cause tissue
ischemia and infarction; they are generally called emboli. These materials can move inside the bloodstream
and get stuck somewhere, causing a blockage. This is called embolism.
Vocabulary
Exercise
Fill in the gaps with an appropriate term.
1
2
3
4
5
A 71-year-old male patient complained of substernal chest
pain. PCI showed a segment of the coronary artery completely
narrowed by thrombus. Heart ultrasound after several weeks
showed a hypokinetic left ventricle (meaning a part of the
heart muscles is dead). He was diagnosed with myocardial
_________________.
thrombo-
thrombus (blood clot)
emboli-
embolus
-osis
condition
(1) abnormal formation,
accumulation, or increase
of tissues, cells, or
substances.
A woman with a history of type-2 diabetes mellitus presented
with numbness and pain in her left diabetic foot. She was
diagnosed with peripheral arterial disease (PAD), a condition
where arteries become damaged and narrowed, and blood
flow is reduced to the limbs. PAD has caused limb
_________________.
Examples
A patient with thrombophilia was admitted due to difficulty
breathing. Doppler ultrasound showed a large thrombus
running along the inferior vena cava. Subsequent chest HRCT
scan revealed a significant loss of blood supply to the right
lung. A/an _________________ is the cause of his dyspnea.
This condition is called pulmonary _________________.
-ism
(2) infection.
-
A young girl was admitted with a syncope. Heart ultrasound
showed large damage to the aorta, which the doctors believed
was caused by bacteria. Her neurologic symptoms are probably
due to septic _________________.
Ventilated patients are often immobilized for a long time.
Blood clots might form in the deep veins of the lower
extremities, then break down and move to the lung vessels,
causing cardiovascular and respiratory compromise.
Therefore, these patients need prevention of venous
___________________.
mycosis (myco-: fungi) = fungal
infection.
fibrosis (fibro-: fibrous tissues) =
increasing formation of fibrous
tissues.
condition
N-ism: N is the name of
(1) the cause or (2) the
description of the
condition.
Examples
-
embolism = a condition caused by
emboli.
hyperaldosteronism (hyper-:
increase) = an abnormal
condition where the level of
aldosterone is increased.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
28 Unit 7
Speaking
Present these case reports using the prompts.
Case 1—Dyspnea on exertion40
Case 2—Dyspnea41
-
79 M
-
78 M
-
C/O: progressive dyspnea on exertion (3
months), no palpitation.
-
C/O: dyspnea at rest, orthopnea, paroxysmal
nocturnal dyspnea (PND).
-
PMH: hyperlipidemia.
-
PMH: coronary artery disease.
-
O/E: bradycardia (HR 49), normotension (BP
127/50), normal S1 & S2, no murmur.
-
O/E: tachycardic (HR 105), normotensive (BP
120/55); 4/6 diastolic murmur (left sternal
border).
Case 3—Atrial fibrillation42
Case 4—Idiopathic SCLS43
-
58 M
-
65 F
-
C/O: weight loss, dysphagia (2 months).
-
C/O: face and limb edema, severe fatigue.
-
PMH: hypertension (on valsartan &
hydrochlorothiazide).
-
PMH: cold and fever (1 week before admission).
-
-
Admission: regular heart rhythm (HR 81).
-
After 4 hours: irregular rhythm, EKG: atrial
fibrillation.
O/E: confused, shock: tachycardic (HR 130),
hypotensive (BP 80/40), severe edema (arms and
legs). Heart sounds: normal.
Vocabulary
Hemodynamic status
Complete the table.
Vital sign
Root (noun)
Root (adjective)
Increased
Normal
Decreased
Pulse / heart rate
_____________
_____________
_____________
(no term)
_____________
Blood pressure
_____________
_____________
_____________
_____________
_____________
Heart rhythm
Cardiovascular symptoms
Match the rhythm in the EKG records with the correct
term.
Choose an appropriate term in the case reports to fill
in the gaps.
regular regularly irregular
irregularly irregular
(1)
(2)
(3)
heart beating fast and strong
(e.g., when worried)
_____________
2
shortness of breath (SOB)
_____________
3
SOB when doing physical
activities
_____________
4
sudden SOB at night
_____________
5
SOB that forces patients to sit
up to breathe
_____________
swelling due to fluid
accumulation
_____________
1
6
Than Lan Con English Center
I can’t breathe 29
8 I can’t breathe
Vocabulary
Anatomy of the respiratory system
Number the parts of the respiratory tract.
__ bronchus __ larynx __ lung
__ nose __ pharynx __ trachea
Complete the text with appropriate terms.
The serosa covering the lungs is called ______________,
consisting of two layers. Between these two layers is the
____________________________. Normally, it only has a
small amount of fluid.
The lungs are ______________ to the heart and the
______________________, which is the compartment
containing the heart.
The lungs are ______________ to the _________________—
the main respiratory muscle. Other muscles involved in the
breathing function (e.g., intercostal muscles), are called
_________________ respiratory muscles. Together they
produce the two main respiratory movements: breathing in
(______________) and breathing out (______________).
Both the heart and the two lungs are protected by the rib
cage (______________).
Examination of the lungs include:
-
______________ for chest asymmetry and abnormal
movements.
______________ to check ______________.
______________ to look for changes in lung resonance.
______________ to breath sounds and for any added
sounds.
Reading
Skimming and scanning
> Skimming is reading a text to provide a brief understanding of the content by identifying the main ideas.
Main ideas are often extracted from the headings, key sentences (usually first and/or last lines of a
paragraph) or the first and/or last paragraphs.
> Scanning is reading a text quickly to find specific information, such as figures or names. Information
collected by scanning is used to answer questions (true/false, what, how, etc.).
> Reading often serves two purposes: (1) to learn
new knowledge, and (2) to look for an answer for
a question.
In any case, reading begins with skimming so
that readers can know briefly what the
document is about, often by making a mind
map. Then depending on the reading purpose,
readers can either continue to build the mind
map or scan the document to look for the
content related to the question.
A mind map under development during skimming.44
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
30 Unit 8
Exercise
Read the following text39 and answer the questions.
Added sounds
Listen for any added, or adventitious, sounds that are superimposed on the usual breath sounds. Detection of
adventitious sounds—discontinuous sounds: crackles (a.k.a. rales), and continuous sounds: wheezes and
rhonchi—is an important part of your examination, often leading to a diagnosis of cardiac and pulmonary
conditions.
Crackles
If you hear crackles, especially those that do not clear after coughing, listen carefully for the following
characteristics. These are clues to the underlying condition:
-
Quality (loudness, pitch, and duration), summarized as fine or coarse crackles
Number, few to many
Timing in the respiratory cycle
Location on the chest wall
Persistence of their pattern from breath to breath
Any change after a cough or change in the patient’s position
In some normal people, crackles may be heard at the anterior lung bases after maximal expiration. Crackles
in dependent portions of the lungs may also occur after prolonged recumbency.
Crackles have two leading explanations. (1) They result from a series of tiny explosions when small airways,
deflated during expiration, pop open during inspiration. This mechanism probably explains the late
inspiratory crackles of interstitial lung disease and early heart failure. (2) Crackles result from air bubbles
flowing through secretions or lightly closed airways during respiration. This mechanism probably explains
at least some coarse crackles.
-
Late inspiratory crackles may begin in the first half of inspiration but must continue into late
inspiration. They are usually fine, fairly profuse, and persist from breath to breath. They appear first
at the bases of the lungs, spread upward as the condition worsens, and shift to dependent regions
with changes in posture. Causes include interstitial lung disease (such as pulmonary fibrosis) and
early heart failure.
-
Early inspiratory crackles appear and end soon after the start of inspiration. They are often coarse
and relatively few in number. Expiratory crackles are sometimes associated. Causes include chronic
bronchitis and asthma.
-
Mid-inspiratory and expiratory crackles are heard in bronchiectasis but are not specific for this
diagnosis. Wheezes and rhonchi may be associated.
Wheezes and rhonchi
If you hear wheezes or rhonchi, note their timing and location. Do they change with deep breathing or
coughing?
Wheezes occur when air flows rapidly through bronchi that are narrowed nearly to the point of closure.
They are often audible at the mouth as well as through the chest wall. Causes of wheezes throughout the
chest include asthma, chronic bronchitis, COPD, and heart failure (cardiac asthma). In asthma, wheezes
may be heard only in expiration or in both phases of the respiratory cycle. Rhonchi suggest secretions in the
larger airways. In chronic bronchitis, wheezes and rhonchi often clear with coughing.
Occasionally in severe obstructive pulmonary disease, the patient is unable to force enough air through the
narrowed bronchi to produce wheezing. The resulting silent chest is ominous and warrants immediate
attention.
Persistent localized wheezing suggests partial obstruction of a bronchus, seen with a tumor or foreign body.
It may be inspiratory, expiratory, or both.
Than Lan Con English Center
I can’t breathe 31
A wheeze that is entirely or predominantly inspiratory is called stridor. It is often louder in the neck than
over the chest wall. It indicates a partial obstruction of the larynx or trachea and demands immediate
attention.
Pleural rub
Inflamed and roughened pleural surfaces grate against each other as they are momentarily and repeatedly
delayed by increased friction. These movements produce creaking sounds known as a pleural rub (or pleural
friction rub), usually during expiration.
Pleural rubs resemble crackles acoustically, although they are produced by different pathologic processes.
The sounds may be discrete, but sometimes are so numerous that they merge into a seemingly continuous
sound. A rub is usually confined to a relatively small area of the chest wall, and typically is heard in both
phases of respiration. When inflamed pleural surfaces are separated by fluid, the rub often disappears.
Mediastinal crunch (Hamman’s sign)
A mediastinal crunch is a series of precordial crackles synchronous with the heartbeat, not with respiration.
Best heard in the left lateral position, it is due to mediastinal emphysema (pneumomediastinum).
Skimming
1
What is the text about?
______________________________________________________
2
List the added sounds described in the
text.
______________________________________________________
Classify the added sounds.
______________________________________________________
3
Scanning
1
a. Which characteristics of
crackles should be listened
for?
(1) _________________ (2) _________________ (3) _________________
(4) _________________ (5) _________________ (6) _________________
b. Number the characteristic __ profuse __ late inspiratory __ fine __ not cleared with cough
that has the descriptions.
__ inferior 1/3 portion of the right lung
2
Explain the mechanisms of added sounds.
Crackles: (1) __________________________________ (2) _______________________________________
Wheezes: ______________________________________________________________________________
Rhonchi: _______________________________________________________________________________
Pleural rub: ____________________________________________________________________________
Hamman’s sign: ________________________________________________________________________
3
True (T) or False (F)?
__ A. Crackles might not reflect an abnormal condition because they are also heard in normal people.
__ B. In interstitial lung diseases, the inflammatory and fibrotic processes of the pulmonary membranes
result in crackles heard during the early inspiration.
__ C. Both crackles and wheezes can be detected on lung auscultation in patients with asthma.
__ D. Mid-inspiratory crackles are not specific for bronchiectasis.
__ E. The Hamman’s sign is also a type of crackles.
__ F. Because the pleurae move during inspiration and expiration, pleural rubs are always discontinuous.
__ G. Wheezes can be heard in obstruction of the bronchial lumen due to a lung tumor.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
32 Unit 8
Vocabulary
Respiratory signs and symptoms
“Dyspnea” is difficulty (dys-) breathing
(pnea). Write the terms for other conditions.
_______________
fast breathing
_______________
slow breathing
_______________
no breathing
This device is a pulse __________. It measures
oxygen saturation in the capillary blood (SpO2).
This method is called __________.
A patient with low SpO2 (__________) might have
blue discoloration of the skin, or __________. It’s a
sign of respiratory __________.
What are other instruments that have the same root (“a device to measure”)?
Chest imaging
Provide the name of the following imaging methods.
(1)
(2)
(3)
Things to do with respiratory failure patients
Provide the name of the following interventions/investigations.
(1)
(2)
(3)
(4)
Review
Interpret the following parameters. Then write a summary.
Case report: 50 M, C/O: SOB, chest pain, fatigue
HR 110 bpm
________________
Summary: __________________________________
BP 150/100 mmHg
________________
____________________________________________
RR 26/min
________________
____________________________________________
Temp 38.9oC
________________
____________________________________________
SpO2 93% on oxygen mask 5L/min ________________
____________________________________________
Which instruments do you use to evaluate these vital signs?
Than Lan Con English Center
You need some blood tests 33
9 You need some blood tests
Vocabulary
Blood cells
Match the names of blood cells with the pictures.
basophil eosinophil erythrocyte leukocyte lymphocyte macrophage mastocyte
monocyte neutrophil reticulocyte plasmocyte thrombocyte
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
Exercise
Read the descriptions and guess which term they describe.
1
leukonychia
__ generalized skin redness
2
erythroderma
__ (belonging to) lysis of blood clots
3
lymphadenopathy
__ difficulty swallowing
4
macrocytic
__ white nail
5
thrombolytic
__ enlarged lymph nodes
6
dysphagia
__ (belonging to) big cells
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
34 Unit 10
Reading
Flow diagram
A flow diagram (or flowchart) is a type of diagram that represents an algorithm, workflow, or process,
showing the steps as boxes of various kinds, and their order by connecting them with arrows. Reading flow
diagrams is simple: start from the single box (often on the top), then, based on the actual situation (guided by
the next question), follow the appropriate arrows to see what to do next.
In medical practice, flow diagrams are used to approach patients with a certain condition. They help doctors
narrow the list of diagnoses and guide what investigations to include in the workup. Therapeutic flow
diagrams also help doctors choose the most appropriate therapy for patients.
Exercise
Use the flow diagram45 to interpret the clinical pictures and the complete (full) blood count results.
1
26 M, sudden pallor and jaundice, associated with dark urine, flank pain
and chills. Hb 90 g/L, MCV 83, MCHC 316, Ret 4.2%, PBS: RBC fragments.
__________________________
2
30 F, gradual pallor, and fatigue, also c/o menstruation disorders. Hb 110
g/L, MCV 73, MCHC 290, RDW 17.1%, Ret 1.5%, serum iron: decreased.
__________________________
3
45 M, history of total gastrectomy, pallor, loss of appetite, fatigue. Hb 78
g/L, MCV 115, MCHC 340, PBS: megaloblasts.
__________________________
4
32 M, CBC accidentally revealed RBC 7.68 T/L, Hb 167 g/L, MCV 65.5, MCHC
332, RDW 19.9%.
__________________________
5
18 F, brought to ED after a traffic accident in shock, Hb 50 g/L, MCV 83,
MCHC 310, Ret 1.1%, WBC 9.1 G/L, PLT 343 G/L.
__________________________
Than Lan Con English Center
You need some blood tests 35
Vocabulary
Changes in cell counts
Match the names of conditions with the complete
blood count results.
anemia leukocytosis leukopenia neutrophilia
polycythemia thrombocytopenia
What are the correct terms for the following blood
conditions?
1
↑ lymphocytes
__________________
2
↑ eosinophils
__________________
3
↑ monocytes
__________________
4
↑ platelets
__________________
5
↓ lymphocytes
__________________
1
WBC 20.2 G/L
_____________________
2
Hb 5.2 g/dL
_____________________
3
NEU 12.5 G/L (81%)
_____________________
4
Hb 185 g/L
_____________________
5
PLT 75 G/L
_____________________
Given “pan-” is the prefix for “all”, what is the term
for “decreased cell counts of all three lineages”?
6
WBC 0.5 G/L
_____________________
__________________
Biochemistry testing and urinalysis
How do you name these conditions?
a-/an-
no, not, without
1
↑ AST/ALT
_______________________________
hypo-
2
↑ serum creatinine
_______________________________
3
↑ blood glucose
_______________________________
decrease (adj. decreased),
diminution (adj. diminished),
decline (adj. declined), fall,
reduction (adj. reduced), low
4
↑ blood triglyceride
_______________________________
hyper-
5
↓ blood potassium
_______________________________
6
↓ blood sodium
_______________________________
increase (adj. increased),
elevation (adj. elevated), rise,
raise, high
7
protein in urine
_______________________________
-ia
abnormal condition
8
RBC in urine
_______________________________
-
-emia: blood condition
-uria: urine condition
Other tests
Can you name these tests?
(1)
(2)
(3)
(4)
(5)
(6)
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
36 Unit 10
10 The lungs and the pleura
Vocabulary
Name the conditions. In each condition, which signs and symptoms do patients have?
pleural effusion pneumonia pneumothorax
(1)
(2)
(3)
1
Sharp chest pain, triggered every time a patient breathes.
_____________________________
2
Wet cough
_____________________________
3
Two sides of the chest do not look the same.
_____________________________
4
The patient’s breathing looks labored. You can see very clearly the
retraction of the intercostal muscles.
_____________________________
5
Percussion on the half of the chest affected by pneumothorax can
produce this sound.
_____________________________
Percussion on the part of the chest affected by pleural effusion can
produce this sound.
_____________________________
6
Exercise
Name these conditions.
1
The patient’s pleural cavity is severely infected with bacteria and the
pleural fluid is purulent.
_____________________________
2
Cytology of the pleural fluid drained from an injured patient shows
many RBCs.
_____________________________
3
Analysis of the pleural fluid confirms that its milky white presence
is due to chyle.
_____________________________
4
Cirrhosis, heart failure, and nephrotic syndrome might cause this
type of pleural effusion.
_____________________________
5
Pneumothorax that happens spontaneously in young, thin males.
_____________________________
6
Pneumothorax that occurs due to medical errors.
_____________________________
7
Pneumothorax that is caused by a one-way valve, leading to
cardiopulmonary compromise.
_____________________________
Than Lan Con English Center
The lungs and the pleura 37
Vocabulary
Procedures
Name the procedures.
aspiration pleurodesis thoracentesis thoracotomy tube thoracostomy
(1)
(2)
(3)
(4)
(5)
Exercise
Fill in the gaps with an appropriate term.
centesis
puncture
-ectomy
making an excision,
removal
-ostomy
making an opening/a
hole
taking venous blood by making
an incision of the vein (phlebo-)
_________________________
2
making an opening into the
trachea to insert a tube
_________________________
3
removal of a portion of the
pericardium
_________________________
4 removal of a lobe (lobo-) of the
lungs
_________________________
5 a puncture into the joint cavity
_________________________
6 removal of the stomach
_________________________
pancreaticoduodenostomy = making
an opening connecting the pancreas
and the duodenum.
_________________________
-otomy
1
7
making an opening into the
kidney
if there are names of two
organs before -ostomy:
making an opening
connecting two organs
Examples
making an incision
Exercise
Complete the following sentences using the above terms.
1
We need some pleural fluid for analysis. Let’s prepare _____________________.
2
Talc, tetracycline, or povidone iodine can be used for _____________________.
3
We’ll consider _____________________ because the patient needs drainage for several days.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
38 Unit 10
Reading
Interpreting an arterial blood gas
Below is a case adapted from a NEJM interactive case46. Read the case and answer the questions.
A 72-year-old woman with a history of dementia is found in a park in a confused state, with empty
medication bottles.
Arterial Blood Gas
1. Does the patient have an acidemia or an alkalemia?
Result
Normal
Range
Since the pH is greater than 7.4, the patient has an
alkalemia.
7.48
7.35–7.45
2. Is the primary problem metabolic or respiratory?
Pco2 (mmHg)*
20
35–45
Po2 (mmHg)*
95, while
breathing
ambient air
80–100
Variable
pH
Since the Pco2 is low, the patient has a respiratory
alkalosis.
3. Is the anion gap normal?
Result
Normal
Range
The range for a normal anion gap is usually considered
to be 10 to 12, but values of 9 to 14 may be considered
normal in some laboratories. An anion gap that is
greater than 20, even in the presence of alkalemia,
suggests a metabolic acidosis.
Sodium (mmol/liter)
138
136–142
4. Is the metabolic compensation appropriate?
Chloride (mmol/liter)
101
98–108
-
Bicarbonate (mmol/liter)
13
23–31
Anion gap
24
10–12
Laboratory Results
Variable
Pco2 denotes the partial pressure of carbon
dioxide, and Po2 the partial pressure of oxygen.
-
*
-
If the patient had an acute respiratory alkalosis,
the expected bicarbonate compensation would be:
24 − (40 – Pco2) ÷ 10 × 2 = 20 mmol/L.
If the patient had a chronic respiratory alkalosis,
the expected bicarbonate compensation would be:
24 − (40 − Pco2) ÷ 10 × 4.5 = 15 mmol/L.
Since this patient’s bicarbonate level is 13 mmol/L,
there is a superimposed metabolic acidosis. Since
the anion gap is elevated, she has a respiratory
alkalosis with a superimposed anion-gap metabolic
acidosis.
Exercise
Speaking
True (T) or False (F)?
Use the following structures to report the
test results in the case.
1
__ The first step to interpret a blood gas is evaluating the pH.
2
__ In alkalosis, a high partial pressure of carbon dioxide
suggests a respiratory disorder.
1
test + was/were negative/positive
2
test + was/were + value
3
__ The anion gap is not important in evaluating alkalosis.
3
4
__ We need to evaluate compensation because it can reveal a
superimposed disorder.
test + showed/revealed +
component + of + value
4
test + showed/revealed* +
condition
5
test + was/were normal/within
normal range
5
6
__ In a patient with compensated respiratory alkalosis, the
bicarbonate in the acute condition is higher than in the
chronic condition.
__ The patient’s ABG reveals a respiratory alkalosis mixed
with a respiratory acidosis.
Than Lan Con English Center
*:
for imaging, “to demonstrate” is also
commonly used.
The differential diagnoses 39
11 The differential diagnoses
Reading
Read the case17 and answer the questions.
History
HPI
46 y.o. M c/o chest pain. Chest pain started 40 minutes before the patient presented to the
ER. The pain woke the patient from sleep at 5 A.M. with a steady 7/10 pressure sensation in
the middle of his chest that radiated to the left arm and the neck. Nothing makes it worse
or better. Nausea, sweating, and dyspnea are also present. Similar episodes have occurred
during the past 3 months, 2–3 times/week. These episodes were precipitated by walking up
the stairs, strenuous work, sexual intercourse, and heavy meals. Pain during these
episodes was less severe, lasted for 5–10 minutes, and disappeared spontaneously or after
taking antacids.
ROS
Negative except as above.
Allergies
NKDA.
Medications
Maalox, diuretic.
PMH
Hypertension for 5 years, treated with a diuretic. High cholesterol, managed with diet.
GERD 10 years ago, treated with antacids.
SH
One PPD (pack per day) for 25 years; stopped 3 months ago. Occasional EtOH, occasional
cocaine (last used yesterday afternoon). No regular exercise; poorly adherent to diet.
FH
Father died of lung cancer at age 72. Mother has peptic ulcers. No early coronary disease.
Physical Examination
Appearance
Patient is in severe pain.
VS
BP 165/85 (both arms), RR 22.
Neck
No JVD, no bruits.
Chest
No tenderness, clear symmetric breath sounds bilaterally.
Heart
Apical impulse not displaced; RRR; normal S1/S2; no murmurs, rubs, or gallops.
Abdomen
Soft, non-distended, nontender, BS (+), no hepatosplenomegaly.
Extremities
No edema, peripheral pulses 2+ and symmetric.
Summarize the case with few keywords.
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Speaking
Present the case using the keywords above.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
40 Unit 11
Use the following flow diagram47 to support your diagnostic approach.
What are potential diagnoses?
Diagnosis
Rationale
1
_____________________ ___________________________________________________________________
2
_____________________ ___________________________________________________________________
3
_____________________ ___________________________________________________________________
4
_____________________ ___________________________________________________________________
5
_____________________ ___________________________________________________________________
6
_____________________ ___________________________________________________________________
7
_____________________ ___________________________________________________________________
8
_____________________ ___________________________________________________________________
9
_____________________ ___________________________________________________________________
10 _____________________ ___________________________________________________________________
Than Lan Con English Center
The differential diagnoses 41
What is your diagnostic workup?
Investigation
To rule in…
To rule out…
1
_____________________
________________________________
________________________________
2
_____________________
________________________________
________________________________
3
_____________________
________________________________
________________________________
4
_____________________
________________________________
________________________________
5
_____________________
________________________________
________________________________
6
_____________________
________________________________
________________________________
7
_____________________
________________________________
________________________________
Exercise
Read how the list of differential diagnoses is built and how they are justified.
Differential Diagnosis
Myocardial ischemia or infarction: The patient has multiple cardiac risk factors (including smoking,
hypertension, and hyperlipidemia), and his symptoms are classic for cardiac ischemia.
Cocaine-induced: Cocaine can predispose to premature atherosclerosis or can induce myocardial ischemia and
infarction by causing coronary artery vasoconstriction or by increasing myocardial energy requirements.
GERD: Severe chest pain is atypical but not uncommon for GERD and may worsen with recumbency overnight.
Other atypical symptoms may include chronic cough, wheezing, or dysphagia. The classic symptom of GERD
is heartburn, which may be exacerbated by meals.
Aortic dissection: With the sudden onset of severe chest pain, aortic dissection should be suspected given the
high potential for death if missed (and the potential for harm if mistaken for acute MI and treated with
thrombolytic therapy). However, the patient’s pain is not the classic sudden tearing chest pain that radiates to
the back. In addition, his peripheral pulses and blood pressures are not diminished or unequal, and there is
no aortic regurgitant murmur (although physical exam findings have poor sensitivity and specificity to
diagnose aortic dissection).
Pericarditis: The absence of pain that changes with position or respiration and the absence of a pericardial
friction rub make pericarditis less likely.
Pneumothorax: This diagnosis should be entertained in a patient with acute chest pain and difficulty
breathing, but it is less likely in this case given that breath sounds are symmetric.
Pulmonary embolism: As above, this is on the differential for acute chest pain and difficulty breathing, but
this patient has no apparent risk factors for pulmonary embolism.
Costochondritis (or other musculoskeletal chest pain): This is more typically associated with pain on palpation
or pleuritic pain.
Diagnostic Workup
ECG: Acute myocardial ischemia, infarction, and pericarditis have characteristic changes on ECG.
Cardiac enzymes (CPK, CPK-MB, troponin): Specific tests for myocardial tissue necrosis that can turn positive
as early as 4–6 hours after onset of pain.
CXR: A widened mediastinum suggests aortic dissection and can also diagnose other causes of chest pain,
including pneumothorax and pneumonia.
Transthoracic echocardiogram (TTE): Can demonstrate segmental wall motion abnormalities in suspected
acute MIs (infarction is unlikely in the absence of wall motion abnormalities).
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
42 Unit 11
Cardiac catheterization: Can diagnose and treat coronary artery disease.
Transesophageal echocardiogram (TEE): Highly specific and sensitive for aortic dissection and can be done
rapidly at the bedside.
CT-chest with IV contrast: Another rapidly available diagnostic study that can rule out aortic dissection or
pulmonary embolism.
Upper endoscopy: Can be used to document tissue damage characteristic of GERD. However, it can be normal
in up to one-half of symptomatic patients; esophageal probe (pH and manometry measurements) together
with endoscopic visualization constitutes an effective diagnostic technique.
Cholesterol panel: Can identify a critical risk factor for cardiovascular disease.
Answer the following questions.
(1) Why is MI included in the differential diagnosis?
(2) Is the clinical picture consistent with GERD? Why?
(3) Is the patient’s chest pain consistent with aortic dissection? Why?
(4) Which chemical substance can cause vasoconstriction and thus induce myocardial ischemia?
(5) Why is the diagnosis of pericarditis less likely?
(6) Is this chest pain likely to be caused by a respiratory etiology?
(7) In conclusion, which diagnoses are more likely? Which can you not rule out by clinical judgment?
(8) What is the purpose of chest X-ray?
(9) Which laboratory investigations provide further information about myocardial infarction?
(10) How do you rule out pulmonary embolism?
Vocabulary
Choose an appropriate word in the box to fill in the gaps. Change word forms if needed.
approach differential establish idiopathic result in result from rule out suspect unlikely
1
HLH should be _____________ in cases of an unexplained sudden onset of an SIRS, including fever,
malaise, hepatosplenomegaly, jaundice, generalized lymphadenopathy, and cytopenias. 48
2
Our patient was initially diagnosed with lung cancer. The _____________ diagnosis included lung
abscess, tuberculoma, lymphoma, or granulomatosis with polyangiitis.49
3
Generalized weakness can _____________ disease processes involving any level of the peripheral motor
unit.25
4
Although lung cancer mostly involves patients aged > 50, younger patients with lung cancer have been
reported. Thus, our patient’s age could not _____________ this possibility.49
5
Physical examination alone is _____________ to detect a BAV, particularly in young people.38
6
The diagnostic _____________ for this group of patients is summarized in two algorithms. One algorithm
is targeted at areas with access to endoscopy and functional testing.50
7
These findings _____________ the diagnosis of a necrotizing noninflammatory myopathy that is
consistent with exposure to statins.25
8
Brain-stem lesions often impair consciousness and _____________ disturbances of sensation or
coordination.25
9
_____________ pulmonary fibrosis is a disease of unknown etiology.
Than Lan Con English Center
The differential diagnoses 43
Reading
Diagnostic criteria
Read the diagnostic criteria of hemophagocytic lymphohistiocytosis (HLH)48. Then, read the following pediatric
case. Is the patient diagnosed with HLH?
History
HPI
36-month-old F, c/o 14-day high fever (T max: 40oC), no other symptoms.
Other history
1st child, C-sect, BW 3.2 kg. No PMH, SH, no history of allergy or exposure to vectors. Fully
vaccinated, normal physical growth and mental development. No diet and sleep pattern
abnormalities.
Physical Examination
Appearance
Alert, cooperative. Pale, no purpura.
VS
BP 86/57 (both arms), HR 122, RR 38, temp: 39oC.
Abdomen
Soft, non-distended, non-tender, BS (+), hepatomegaly (liver edge 4cm below the costal
margin), splenomegaly (spleen edge 3cm below the costal margin).
Others
Intact.
Investigation
CBC
WBC 3.26, NEU 19.1%, LYM 72.1%; Hb 92 g/L; PLT 30
Biochemistry
-
Coagulation
PT 57%, APTT 45.7s, fibrinogen 0.63 (21.4 mg/dL), D-Dimer 1129
Ab US
Hepatosplenomegaly
Others
-
Urea 4.5; creatinine 48.4; Na+ 127; K+ 3.98
AST 434; ALT 481; triglyceride 4.09 (361.95 mg/dL); LDH 1124
CRP 43.2; ferritin 13672
Blood, urine, stool, throat swab culture: (-)
Multi-template PCR (-); HBsAg, CMV, HIV (-), EBV (+) with EBV-DNA 107 copies/mL
C3: 0.94, C4: 0.35
Bone marrow aspirate: decreased density of BM cells, no abnormal cells.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
44 Unit 12
12 Scopy what?
Vocabulary
Anatomy of the gastrointestinal system
Match the anatomical details with their functions.
1
anus
__ entrance of food, contributing to sound formation
2
appendix
__ swallowing, taking food to the stomach
3
cecum
__ mixing food with acidic fluid, killing bacteria, digesting carbohydrates
4
colon
__ breaking down food by pancreatic enzymes
5
duodenum
__ absorbing small nutrients
6
esophagus
__ absorbing vitamin B12, bile salts, and the remaining nutrients
7
ileum
__ beginning absorbing water
8
jejunum
__ absorbing water, making feces
9
liver (hepato-)
__ temporarily storing feces, contributing to defecation
10
mouth (oro-, stomato-)
__ passage for feces expulsion
11
pancreas
__ detoxification, synthesizing proteins and other substances
12
peritoneum
__ secreting enzymes to digest food and two important hormones
13
rectum
__ covering the abdominal organs
14
stomach
__ not a useless portion, but maintaining gut flora and having immune
function
The abdomen can be divided into (1) four quadrants or (2) nine regions.
(1)
(2)
Right
Left
Upper
Lower
Exercise
Name the techniques.
1
2
3
making an opening into the
jejunum
4
removal of the appendix
_________________
_________________
removal of the pancreas and
5
the duodenum (Whipple
procedure)
_________________
tracheal intubation
through the mouth
removal of the esophagus
removal of the liver
Than Lan Con English Center
_________________ 6
_________________
_________________
Scopy what? 45
Reading
Acute abdomen
Read the case51 and answer the questions.
A 48-year-old woman presented to the ED with significant periumbilical abdominal pain and left lower
extremity pain, which she rated an “8” on a scale of 1 to 10. She stated that the pain worsened with movement
and change in position. The claudication in the patient’s left lower extremity began a few weeks prior to
presentation. The patient noted that when the abdominal pain began, the pain in her leg became more
frequent and of higher intensity, with intermittent numbness. She reported some nausea, paresthesia, and
sensory changes to the left lower extremity; however, she denied diarrhea, headache, fever, back pain,
urinary symptoms, chest pain, and shortness of breath.
Regarding social history, the patient admitted to smoking half a pack of cigarettes a day and drinking alcohol
socially. She denied any significant family history of disease. The patient had been diagnosed with stage II
colon cancer 4 years earlier, for which she had undergone a colon resection.
During the physical examination, the patient was diaphoretic, uncomfortable, and in severe distress. Her vital
signs were: blood pressure, 146/77 mm Hg; respiratory rate, 18 breaths/minute; heart rate, 129 beats/minute;
and temperature within normal limits. Oxygen saturation was 94% on room air.
The abdominal examination revealed a distended abdomen that was severely tender to palpation, with
rigidity, guarding, and rebound tenderness. Examination of the lower extremities revealed an absent palpable
dorsalis pedis pulse to the left lower extremity. The right lower extremity had palpable 2+ dorsalis pedis and
posterior tibial pulses.
Find the appropriate terms in the text above.
An examiner places some pressure on the abdomen and then releases. Pain is
produced upon removal of pressure but not during the application of pressure
to the abdomen.
_____________________
Substances, such as air or fluid, accumulate in the abdomen causing its
outward expansion beyond the normal girth of the stomach and waist.
_____________________
3
When an abdominal region is pressured, there is a tensing of the abdominal
wall muscles.
_____________________
4
On examination, the doctor finds the abdominal muscles very stiff and it
seems impossible to apply pressure to the region.
_____________________
5
There is increased pain upon the doctor’s abdominal palpation.
_____________________
1
2
True (T) or False (F)?
1
__ The patient had a history of malignancy and surgery.
2
__ Pain was her only symptom when she complained of the leg problem.
3
__ The pain occurred at the same time with her abdominal pain.
4
__ The abdominal pain was severe and relieved by changing positions.
5
__ On examination, she was tachycardic and normotensive.
6
__ She had an acute abdomen.
7
__ She did not have respiratory failure.
8
__ Pulses of the lower extremities were symmetric on both sides.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
46 Unit 12
Writing
Use the prompts23 to write a case summary.
-
17 M, c/o: abdominal pain, weight loss
-
HPI:
o
-
-
6 weeks, intermittent crampy
abdominal pain.
o
3 weeks: non-bloody diarrhea (for
1 week, also vomiting)
o
After diarrhea: abdominal pain →
daily, RLQ pain, radiating to right
flank, also lower back discomfort,
borborygmi, constipation.
PE:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
o
VS normal, weight 60 kg.
o
Abdomen: soft, mildly distended,
mildly tender (deep palpation)
RLQ/LLQ, no rebound/guarding.
Upper GI endoscopy: duodenitis;
esophagus & stomach normal
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
Vocabulary
The suffix -scopy
Endoscopy = endo- (inside) + scopy (a method to look/examine; -y means a method or a procedure). The tool
to perform endoscopy is an endoscope (a tool to look/examine).
What are the names of these endoscopic methods?
1
ear
____________________________
6
bladder
____________________________
2
larynx
____________________________
7
skin
____________________________
3
nose
____________________________
8
joint
____________________________
4
retina
____________________________
9
upper GI
____________________________
5
bronchi
____________________________
10 colon
____________________________
The suffix -graphy
Endoscopic retrograde cholangiopancreatography (ERCP) is a GI diagnostic and therapeutic intervention. It can
view the gallbladder, bile duct, pancreas, and pancreatic duct. The suffix -graphy means a method to record,
and the suffix -gram means the record of the method.
Interpret the following terms.
1
electrocardiogram (EGC/EKG)
5
echocardiogram
2
electroencephalography (EEG)
6
ultrasonography
3
electromyography (EMG)
7
angiogram
4
bronchography
8
cholangiography
Than Lan Con English Center
Hematemesis et al 47
13 Hematemesis et al
Vocabulary
Cirrhosis
Fill in the gaps with an appropriate word.
ascites collateral circulation esophageal varices gynecomastia hemorrhoids jaundice (icterus)
palmar erythema portal hypertension spider nevi splenomegaly subcutaneous hemorrhage
Exercise
Write a term that corresponds to the definitions.
1
The study of female
reproductive diseases
___________________
2
Removal of the
(female) breast
___________________
3
Increased pressure in the
pulmonary circulation
4
Removal of the spleen
___________________
___________________
Speaking
Present the following case52.
-
35, M, teacher, c/o: severe anemia
-
Hb 6.1 g/dL, Hct 22%; PBS: normal RBC
-
HPI: fatigue, pallor for 10 years
-
-
PH: 2y: hematemesis, melena →
esophageal varices; no alcohol abuse, no
medications
Bilirubin 25 mcmol/L; ALT 96 U/L; normal ferritin,
vitamin B12, folate
-
Abdomen US: shrunken liver, splenomegaly
-
EGD: non-bleeding grade I esophageal varices;
Colonoscopy: normal mucosa, no bleeding
-
Hb electrophoresis: normal; Coombs test (-)
-
Bone marrow biopsy: ring sideroblasts
-
Dx: cirrhosis, sideroblastic anemia
-
FH: no one in the family had anemia
-
PE: pallor, mild jaundice; VS normal;
abdomen: mild ascites, splenomegaly, no
hepatomegaly; spider nevi, collateral
circulation
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
48 Unit 13
Puzzle
Solve the puzzle using the cues below.
E
1
2
H
3
4
S
H
G
5
6
R
7
S
M
8
9
H
10
R
11
A
Cues
1
The mental disorder relating to cirrhosis is called hepatic ___________.
2
Vomiting blood.
3
A type of telangiectasia found slightly beneath the skin surface, often containing a central red spot and
reddish extensions which radiate outwards like a web.
4
Kidney failure developing in decompensated cirrhosis patients is called ___________ syndrome.
5
Disease of the stomach that relates to portal hypertension is called portal hypertensive ___________.
6
During digital ___________ examination (DRE), look for any mass or swelling, and palpate the prostate
gland (in male patients).
7
Liver ___________ is the size of the liver measured by percussion.
8
Black stool.
9
Bloody stool.
10 Sudden break of varices, leading to bleeding.
11 Loss of appetite.
Writing
Introduce clinical manifestations and complications of cirrhosis. Prepare a PowerPoint slide first, then use the
following structures to write an introduction.
-
Cirrhosis presents with …
Examination can show/reveal …
Complications of cirrhosis include …
Patients with ruptured esophageal varices have …
Than Lan Con English Center
Hematemesis et al 49
Reading
Peptic ulcer disease53
Introduction
The term “peptic ulcer” refers to acid peptic injury of the digestive tract, resulting in mucosal break reaching
the submucosa. Peptic ulcers are usually located in the stomach or proximal duodenum.
Traditionally, a hypersecretory acidic environment together with dietary factors or stress were thought to
cause most peptic ulcer diseases, but the discovery of Helicobacter pylori infection and the widespread use of
nonsteroidal anti-inflammatory drugs (NSAIDs) in the second half of the 20th century have changed this
perception.
Clinical presentation and diagnosis
Symptoms of peptic ulcer disease are non-specific. Patients with duodenal ulcers typically feel hungry or have
nocturnal abdominal pain. By contrast, patients with gastric ulcers have postprandial abdominal pain,
nausea, vomiting, and weight loss. Patients with untreated peptic ulcer disease typically have relapsing
symptoms because of spontaneous healing and relapse while the causal factor persists. Elderly patients with
peptic ulcer disease are frequently asymptomatic or have only mild symptoms.
Bleeding, perforation, or gastric outlet obstruction are the main complications of peptic ulcer disease.
Bleeding, which manifests as melena or hematemesis, can occur without any warning symptoms in almost
half of patients. Hospital admissions for peptic ulcer bleeding have declined steadily worldwide, but the case
fatality rate remains stable at 5−10%. Dependent on age and comorbidity, mortality can be as high as 20%.
Endoscopy is the gold standard for diagnosis of peptic ulcer disease. Apart from exclusion of malignant
disease, detection of H. pylori infection with histology or rapid urease tests is essential to the subsequent
treatment plan. Non-invasive H. pylori tests (e.g., urea breath and stool antigen tests) are used in some
certain groups of patients.
Management of peptic ulcer bleeding
Bleeding peptic ulcers account for 40−60% of all causes of acute upper gastrointestinal bleeding. Timely
endoscopic treatment and acid suppressive therapy are key for successful outcomes. Although surgery is the
cornerstone for management of patients with uncontrolled or massive recurrent bleeding, radiological
intervention has also gained importance in recent years.
Patients presenting with upper gastrointestinal bleeding should be assessed promptly and resuscitation
should begin with crystalloid solutions. Transfusion policy should be restrictive and aimed to maintain
hemoglobin concentrations over 70 g/L, as this approach has been associated with reduced mortality. Risk
stratification should identify high-risk patients for early intervention and reduce the duration of hospital stay
for low-risk patients. The Rockall and Glasgow-Blatchford scores have been extensively studied. A GlasgowBlatchford score of zero accurately identifies patients not requiring treatment in hospital.
Maintenance of a neutral gastric pH seems essential to prevent platelet disaggregation and clot lysis over the
eroded artery of a bleeding peptic ulcer. Peak acid suppression after intravenous administration of a PPI
occurs within hours, compared with several days later after oral administration. Prokinetic agents, such as
intravenous erythromycin and metoclopramide, given before endoscopy have improved endoscopic view and
reduce the need for a second look endoscopy.
Early endoscopy done within 24 hours provides prognostic information based on endoscopic stigmata and
effective therapy. Endoscopy also identifies low-risk patients suitable for early hospital discharge. Endoscopic
treatment is indicated in ulcers showing active bleeding, a non-bleeding visible vessel, or an adherent clot.
Acid suppression has a crucial role in prevention of recurrent bleeding after initial endoscopic hemostasis. PPI
therapy reduced recurrent bleeding and need for surgery. A substantial reduction in mortality was also noted
in a subgroup of patients with active bleeding or non-bleeding visible vessels. The optimum dose of a PPI after
endoscopy continues to be controversial. Whether intermittent high-dose PPI is as effective as continuous
high-dose PPI infusion in all high-income populations remains uncertain. Continuous high-dose PPI infusion
is still the preferred post-endoscopic adjuvant treatment for high-risk patients.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
50 Unit 13
Answer the questions.
(1) What are common peptic ulcers?
(2) What factors contribute to the development of peptic ulcer disease?
(3) What are the main complications of peptic ulcers?
(4) What is the diagnostic purpose of endoscopy?
(5) How can we test for H. pylori infection?
True (T) or False (F)?
1
__ In peptic ulcer disease, the lesion is limited to the mucosa.
2
__ Symptoms of peptic ulcer disease are vague in the elderly.
3
__ Few patients with upper GI bleeding are found to have peptic ulcer disease.
4
__ If a patient with peptic ulcer bleeding has a Glasgow-Blatchford score of 0, he/she can be sent home
safely.
5
__ Intravenous PPI is preferred over oral PPI because it suppresses gastric acid better.
6
__ Erythromycin is useful for endoscopy.
7
__ Ulcers with a clean base do not need endoscopic treatment.
8
__ PPI use after endoscopy helps prevent recurrent bleeding, and the optimum therapy is continuous
high-dose PPI infusion.
Suggest a management algorithm for peptic ulcer bleeding based on the text.
Than Lan Con English Center
An abdominal pain’s story 51
14 An abdominal pain’s story
Vocabulary
Prefixes of position
This is a figure in a study54 determining the frequency of various positions of the appendix. Write an adjective to
describe its positions.
1 ___________ to the cecum
_______________
2 ___________ and superior to the ileum _______________
3 ___________ and superior to the ileum _______________
4 ___________ to the cecum
_______________
5 in the pelvic
pelvic
6 ___________ to the cecum
_______________
7 other
ectopic
Which positions are most common? Which positions are
rare?
Exercise
Choose the right prefix of position.
epi- extra- inter- intra- mid- para- peri- pre- retro- post- sub- supra1
Patients with angina pectoris often experience a pressure-like ______sternal chest pain, radiating to the
left side of the neck, jaw, and the left arm and shoulder.
2
The study was done ______spectively on patients admitted to the hospitals over the last five years.
3
The heart apex was found left to the ______clavicular line.
4
The thyroid glands produce T3 and T4, while the ______thyroid glands produce PTH.
5
Dysuria and pain in the ______pubic region suggests inflammation of the bladder.
6
In addition to GI diseases, acute myocardial infarction and pneumonia are differential diagnoses of
______gastric pain.
7
A ______term newborn is born at the gestational age of fewer than 37 weeks.
8
Some women can experience ______natal depression after giving birth. Symptoms include persistent low
mood and sadness, lack of enjoyment or energy, and trouble sleeping.
9
The ______costal muscles are also accessory respiratory muscles.
10 Dental plaques can result in ______odontitis—inflammation of the gums and structures surrounding the
teeth.
11 Medications given ______venously enter the bloodstream directly and can exert their effects quickly.
12 ECMO, an ______corporeal life support technique, replaces the lungs and the heart to exchange oxygen
and carbon dioxide outside the body.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
52 Unit 14
Reading
Appendicitis55
History
Variations in the position of the appendix, age of the patient, and degree of inflammation make the clinical
presentation of appendicitis notoriously inconsistent. Statistics report that 1 of 5 cases of appendicitis is
misdiagnosed; however, a normal appendix is found in 15-40% of patients who have an emergency
appendectomy.
Symptoms
The classic history of anorexia and periumbilical pain followed by nausea, right lower quadrant (RLQ) pain,
and vomiting occurs in only 50% of cases. Nausea is present in 61-92% of patients; anorexia is present in 7478% of patients. Neither finding is statistically different from findings in patients who present to the
emergency department with other etiologies of abdominal pain. In addition, when vomiting occurs, it nearly
always follows the onset of pain. Vomiting that precedes pain is suggestive of intestinal obstruction, and the
diagnosis of appendicitis should be reconsidered. Diarrhea or constipation is noted in as many as 18% of
patients and should not be used to discard the possibility of appendicitis.
The most common symptom of appendicitis is abdominal pain. Typically, symptoms begin as periumbilical
or epigastric pain migrating to the right lower quadrant (RLQ) of the abdomen. This pain migration is the
most discriminating feature of the patient's history, with a sensitivity and specificity of approximately 80%, a
positive likelihood ratio of 3.18, and a negative likelihood ratio of 0.5. Patients usually lie down, flex their hips,
and draw their knees up to reduce movements and to avoid worsening their pain. Later, a worsening
progressive pain along with vomiting, nausea, and anorexia are described by the patient. Usually, a fever is
not present at this stage.
The duration of symptoms is less than 48 hours in approximately 80% of adults but tends to be longer in
elderly persons and in those with perforation. Approximately 2% of patients report duration of pain in excess
of 2 weeks. A history of similar pain is reported in as many as 23% of cases, but this history of similar pain, in
and of itself, should not be used to rule out the possibility of appendicitis.
In addition to recording the history of the abdominal pain, obtain a complete summary of the recent personal
history surrounding GI, genitourinary, and respiratory conditions, as well as consider gynecologic history in
female patients. An inflamed appendix near the urinary bladder or ureter can cause irritative voiding
symptoms and hematuria or pyuria. Cystitis in male patients is rare in the absence of instrumentation.
Consider the possibility of an inflamed pelvic appendix in male patients with apparent cystitis. Also consider
the possibility of appendicitis in pediatric or adult patients who present with acute urinary retention.
Physical Examination
It is important to remember that the position of the appendix is variable.
The most specific physical findings in appendicitis are rebound tenderness, pain on percussion, rigidity, and
guarding. Although RLQ tenderness is present in 96% of patients, this is a nonspecific finding. Rarely, left
lower quadrant (LLQ) tenderness has been the major manifestation in patients with situs inversus or in
patients with a lengthy appendix that extends into the LLQ. Tenderness on palpation in the RLQ over the
McBurney point is the most important sign in these patients.
A careful physical examination, not limited to the abdomen, must be performed in any patient with suspected
appendicitis. Gastrointestinal (GI), genitourinary, and pulmonary systems must be studied. Male infants and
children occasionally present with an inflamed hemiscrotum due to migration of an inflamed appendix or
pus through a patent processus vaginalis. This is often initially misdiagnosed as acute testicular torsion. In
addition, perform a rectal examination in any patient with an unclear clinical picture, and perform a pelvic
examination in all women with abdominal pain.
Rectal examination
There is no evidence in the medical literature that the digital rectal examination (DRE) provides useful
information in the evaluation of patients with suspected appendicitis.
Than Lan Con English Center
An abdominal pain’s story 53
Statistics
The numbers summarizing the data of a population are called statistics. Data that can be grouped are called
“categorical”. Categorical data are often summarized by measures of frequency.
Number (N)
Count of subjects (total, group A, group B, etc.)
50 students, 20 males, 30 females
Proportion
= NA / N total
(male) = 20 / 50 = 0.4
Percentage (%)
= proportion x 100%
(male) = 40%
Ratio
= NB / NA
female : male = 3 : 2 = 1.5
Fill in the table with frequency (in percentage) of signs and symptoms. Answer the questions.
Anorexia
_________
Nausea
_________
Classic history of anorexia and periumbilical pain,
followed by nausea, RLQ pain, and vomiting
_________
Diarrhea / constipation
_________
Onset < 48 hours
_________
History of similar pain
_________
RLQ tenderness
_________
(1) What is the proportion of failure to
diagnose appendicitis? What is the
proportion of normal appendix in
patients with appendectomy?
(2) What is the proportion of patients
with an onset of > 2 weeks?
(3) What are the proportions of the
most three common positions of the
appendix (see Vocabulary: Prefixes of
position in page 51)?
Answer the questions.
(1) Describe the type of abdominal pain that is best at discriminating appendicitis with other conditions.
(2) List the urinary symptoms in which the clinician should consider the possibility of appendicitis.
(3) In addition to abdominal examination, what else should we examine? Why?
(4) In summary, what should we notice when examining and diagnosing appendicitis?
Vocabulary
Anatomy of the genitourinary system
Complete the text with appropriate terms.
The urinary system is composed of the (1) _________________, the (2)
_________________, the (3) _________________, and the (4)
_________________.
The (4) in men lies in the _________________, which is the external
sexual organ and the passage for semen to be released. Semen is a
fluid mixed of products from the two _________________ (producing
seminal fluid and sperms) and the _________________. The latter
gland can be palpated in some people if enlarged.
Different from men, the (4) in women does not share the same
passage with the sexual organ. The _________________ is connected
to the vagina through the _________________ and is the place for the
fetus to reside during pregnancy. A fetus is the result of
fertilization—the union of a sperm and an egg (produced by the
_________________).
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
54 Unit 14
Vocabulary
Stones
Fill in the gaps with an appropriate term.
chole-
bile
1
urinary stone (disease)
_________________________________
cysto-
bladder, cyst, sac
2
kidney stone (disease)
_________________________________
docho-
duct
3
ureteral stone (disease)
_________________________________
-iasis
an abnormal condition
4
gallstone (disease)
_________________________________
litho-
stone
5
bile duct stone (disease)
_________________________________
oophoro-
ovary
6
gallbladder stone (disease) _________________________________
orchi-
testicle
7
stone made of feces
pyelo-
pelvis (e.g., of the
kidney)
salpingo-
fallopian tube
_________________________________
Inflammation
Provide the medical term for the inflammation of the following organs.
1
esophagus
5
liver
9
bladder
2
stomach
6
gallbladder
10 urethra
14 testicle
3
colon
7
bile duct system
11
15 prostate gland
4
pancreas
8
kidney (due to infection)
12 ovary
vagina
13 fallopian tube
16 peritoneum
Other emergency conditions
Choose the most appropriate term for each description.
__ abdominal aortic aneurysm __ aortic dissection __ bowel obstruction __ ectopic pregnancy
__ intra-abdominal bleeding __ mesenteric ischemia __ perforated hollow viscus __ ruptured ovarian cyst
__ spontaneous bacterial peritonitis __ strangulated hernia __ testicular torsion
1
a complication of cirrhosis, where bacteria enter the peritoneal cavity and cause inflammation.
2
the fetus does not reside in the uterus
3
abdominal pain after a blunt or penetrating trauma to the abdomen
4
separation of layers of aorta
5
emboli of the mesenteric vessels
6
a tumor compresses the lumen of colon
7
fluid sacs develop inside the ovary and then burst, which might cause intense pain and shock
8
twisted vessels of the testes
9
abnormal enlargement of the aorta
10 an ulcer erodes through the stomach wall and gastric fluid enters the peritoneal cavity
11 part of the intestine enters the inguinal canal and gets stuck, leading to ischemia
Than Lan Con English Center
An abdominal pain’s story 55
Reading
A 73-year-old woman presented to the emergency department with a
painful umbilical nodule that had been enlarging over the past 4
months. Physical examination revealed a painful and firm
erythematous umbilical nodule measuring 2 cm in its largest
diameter.
She was diagnosed with Sister Mary Joseph's nodule, which is a
metastatic umbilical lesion typically associated with gynecologic and
gastrointestinal cancers. CT of the abdomen and pelvis showed a
heterogeneous pelvic mass, moderate ascites, peritoneal
carcinomatosis, and a nodule in the umbilical region. She was
diagnosed with high-grade serous ovarian carcinoma.56
Exercise
Choose a word from the text to fill in the gaps.
1
a solid lump often
detected on palpation
2
a malignant (epithelial)
4
tumor
_____________________
_____________________
3
cancer cells invade and
migrate to other areas _____________________
fluid in the peritoneal
cavity
_____________________
How do you describe the following masses?
1
2
3
4
5
firm, tender, unmovable, 3 cm by
4.5 cm, under the areola of the left
breast
__________________________________________________________
__________________________________________________________
firm, mobile, nontender, right
lower quadrant
__________________________________________________________
immobile, tender, left lower
quadrant
__________________________________________________________
well-defined, solid, anterior
vaginal wall, 5 cm by 5 cm
__________________________________________________________
mobile, irregular, tender, right
flank, 20 cm by 10 cm
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
Provide the following terms in other word classes.
Noun
Verb
Adjective
1
______________________
______________________
metastatic
2
______________________
diagnose
______________________
3
______________________
______________________
invasive
4
response
______________________
______________________
5
______________________
itch
______________________
6
decrease
______________________
______________________
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
56 Unit 15
15 The bean-shaped guys
Vocabulary
Urine symptoms
Read the descriptions and guess which term they describe.
1
anuria
__ typical abdominal pain caused by kidney stones
2
dysuria
__ urine output < 100 mL/24 hours
3
oliguria
__ abnormally large urine output
4
polyuria
__ painful urination
5
pyuria
__ cloudy urine, often suggesting pus
6
renal colic
__ low urine output
Diagnostics
Provide the name of the following diagnostic methods.
KUB pyelogram renal ultrasound urinalysis
(1)
(2)
(3)
(4)
Surgical procedures
Construct the Latin terms from their descriptions.
1
a method to make an opening into the kidney through the skin
______________________________
2
a method using shock wave to crush (-tripsy) the stones from
outside the body
______________________________
3
a method to make an incision to get the stone through the skin
______________________________
4
a method to look at the ureter
______________________________
Writing
Introduce clinical manifestations, complications, and management of nephrolithiasis. Prepare a PowerPoint
slide first, then use the following structures to write an introduction.
-
Nephrolithiasis is …
The common/classic presentation is … It often manifests with … Other symptoms include … Some
patients may also have/report …
Workup includes … Ultrasound is used to … Marked leukocytosis suggests …
Serious complications include …
Treatment of nephrolithiasis involves …
Than Lan Con English Center
The bean-shaped guys 57
Vocabulary
Kidney disease
Fill in the gaps with appropriate terms.
Each human body has two kidneys, each
consists of the parenchyma and the
(1) ___________________. The parenchyma
consists of (2) _______________________ and
(3) _______________________, formed by
multiple units called “nephron”. Each nephron
has one (4) ____________________, functioning
as a blood filter. Blood is supplied to the kidneys
via the (5) _______________________ and
returns to the circulation after being filtered via
the (6) _______________________.
acute kidney injury chronic kidney disease end-stage renal disease intrinsic
nephritis nephrotic syndrome pre-renal post-renal systemic disease
_____________________ is defined by hematuria, variable degrees of proteinuria, usually dysmorphic RBCs,
and often RBC casts on microscopic examination of urinary sediment. Often ≥1 of the following elements are
present: edema, hypertension, elevated serum creatinine, and oliguria.
_____________________ is the combination of a loss of ≥3 grams/day of protein into the urine with a low
serum albumin level and edema. Nephrotic syndrome can be primary, being a disease specific to the
kidneys, or it can be secondary, being a renal manifestation of a _____________________.
The Kidney Disease Outcomes Quality Initiative (KDOQI) established a definition and classification of
_________________________ in 2002. Their guidelines define CKD as either kidney damage or a decreased
glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2 for at least 3 months. The last stage of CKD is
called _________________________________.
_________________________ is defined as an abrupt or rapid decline in renal filtration function. This
condition is usually marked by a rise in serum creatinine concentration or by azotemia (a rise in blood urea
nitrogen [BUN] concentration). AKI may be classified into 3 broad categories, as follows:
-
_______________: As an adaptive response to severe volume depletion and hypotension, with
structurally intact nephrons;
_______________: In response to cytotoxic, ischemic, or inflammatory insults to the kidney, with
structural and functional damage;
_______________: From obstruction to the passage of urine.
True (T) or False (F)?
1
__ A patient with edema and 24-hour proteinuria of 4g has nephritic syndrome.
2
__ A patient with serum creatinine level of 458 mcmol/L has chronic kidney disease.
3
__ Shock can cause decline in renal function.
4
__ Inflammatory processes of the kidney parenchyma can lead to acute kidney injury.
5
__ A bladder tumor that blocks two ureteral orifices can cause acute kidney injury.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
58 Unit 15
Vocabulary
Risk factors of chronic kidney disease
Fill in the gaps with appropriate terms
1
high blood sugar over a long period
______________________________
2
high blood pressure
______________________________
3
inflammation of the glomeruli
______________________________
4
a disease where the kidneys develop many cysts
______________________________
5
bacterial infection to the kidney
______________________________
6
inflammation of the kidney’s tubules and surrounding structures
______________________________
7
reflux from the bladder (vesico-) to the ureters
______________________________
Renal replacement therapy
Match the therapies with the pictures.
hemodialysis peritoneal dialysis transplantation
(1)
(3)
(2)
intermittent
RRT done in several
hours
IHD (intermittent hemodialysis): a
common therapy for ESRD patients;
each dialysis session often lasts for 3-4
hours, patients often have 3 sessions
per week.
continuous
RRT done over days,
non-stop
CVVH (continuous veno-venous
hemodialysis): a continuous RRT
modality for AKI patients, often in ICU,
to replace the injured kidneys until they
recover.
Than Lan Con English Center
A bowl of tiet canh 59
16 A bowl of tiet canh
Speaking
Use the prompt to write a summary for the following case.57
-
53, M, butcher, c/o: fever, rash
-
CBC: Hb 170 g/L, WBC 22 G/L, NEU 90%, PLT 15 G/L
-
HPI: 2 days, fever, diarrhea, vomiting,
numbness in both feet, erythematous rash on
face, trunk, and hands.
-
D-dimer > 2,000 ng/mL, prolonged PT
-
Creatinine 265 mcmol/L, urea: 16.7 mmol/L
-
Blood culture: Streptococcus suis, susceptible to
penicillin, ampicillin, cephalexin,
erythromycin, and co-trimoxazole
-
CT brain: normal
-
PH: 5y: pulmonary tuberculosis, completed full
course of treatment
-
PE: VS stable, diffuse erythema, petechiae and
bullae on trunk and extremities; other systems:
intact
Vocabulary
Microbiology
Match the groups of microorganisms with the pictures.
bacteria fungi helminth protozoa virus
(1)
(2)
(3)
(4)
(5)
Match the microbiological methods with the pictures.
antibiotic susceptibility test culture ELISA identification microscopy PCR rapid test
(1)
(5)
(2)
(3)
(6)
(4)
(7)
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
60 Unit 16
Vocabulary
Skin lesions
Read the classification of skin lesions and match them with the right pictures.
Flat
lesions
Raised
lesions
Depressed
lesions
(1)
macule
change in surface color
petechiae
hemorrhage, 1–2 mm in diameter
purpura
hemorrhage, 3–10 mm in diameter
ecchymosis
hemorrhage, > 1 cm in diameter
papule
round, solid, < 1 cm in diameter
nodule
solid, > 1 cm in diameter
vesicle
fluid-filled, < 1 cm in diameter
bulla
fluid-filled, > 1 cm in diameter
pustule
pus-filled
wheal
pale red, swollen
erosion
discontinuity of skin, incomplete
loss of the epidermis
ulcer
discontinuity of skin, complete loss
of the epidermis
fissure
skin crack, usually narrow but deep
(2)
(3)
d = 0.5 cm
(4)
d = 1.2 cm
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
Than Lan Con English Center
A bowl of tiet canh 61
Reading
Bacteremia is the presence of bacteria in the bloodstream. Other pathogens can also infect the blood, causing
viremia or fungemia. Sepsis is the systemic response to these infections but dysregulated, leading to lifethreatening organ dysfunction. Septic shock is a subset of sepsis in which underlying circulatory and
cellular/metabolic abnormalities are profound enough to substantially increase mortality.58
True (T) or False (F)?
1
__ Only bacteria cause sepsis.
2
__ A patient with a suspected infection, altered mental status, and a respiratory rate of 25 definitely has
sepsis.
3
__ A patient with sepsis and BP of 80/40 mmHg can be diagnosed with septic shock.
4
__ A patient with a suspected infection, normal mental status, normotension, and a respiratory rate of 23
does not have sepsis.
Vocabulary
The root immunoFill in the gaps with an appropriate noun.
1
immuno___________________
the immune system lacks certain immune cells or components, either
acquired or congenital
2
immuno___________________
a weak immune system, either due to lack of components of the
immune system or functional deficits
3
immuno___________________
activity of the immune system is reduced, often by drugs or infection
4
immuno___________________
healthy immune system
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62 Unit 16
Reading
Two brothers 10 and 12 years of age presented together to the emergency department with a 2-day history of
fever and headache the day after returning from a trip to South Africa, Mozambique, and Zambia. They did
not recall having any tick bites. On examination, the older brother had an eschar on the calf (Panel A), and the
younger brother had an eschar behind the ear (Panel B) and on the eyebrow. Both brothers had a nontender,
maculopapular rash on the wrists, legs, and trunk, as well as regional lymphadenopathy adjacent to the
eschars. Malaria smears and blood cultures were negative. Amoxicillin–clavulanate therapy was initiated for
presumed superinfected mosquito bites; however, the finding of multiple eschars and the fact that two family
members were affected aroused suspicion of African tick-bite fever. African tick-bite fever is caused by
Rickettsia africae and is transmitted by ticks of the genus Amblyomma, the feeding patterns of which lead to
multiple eschars and clustered cases within travel groups. Doxycycline therapy was added empirically, and
the fever resolved in both children within 24 hours. Doxycycline was administered for 7 days, and the eschars
resolved within 2 weeks after treatment was initiated. Serologic tests for rickettsia, which were initially
negative, were positive in both patients at follow-up 3 months later.59
Exercise
Choose a word from the text to fill in the gaps.
a piece of black crusty
dead tissue that sheds
from healthy skin
_____________________
an injury caused by
animals making a hole
in the skin
_____________________
2
enlarged lymph nodes
_____________________ 7
study of the serum
_____________________
3
infection occurring on
another infection
_____________________
8
treatment by
experience
_____________________
4
a parasite living in red
cells, causing fever
when destroying them
9
a sample spread on a
microscopy slide, or the
microscopy procedure
_____________________
1
5
6
_____________________
to pass something from
10 check patients again
one to another
_____________________
after discharge
Than Lan Con English Center
_____________________
A bowl of tiet canh 63
Reading
Epidemiology concepts
Read an extract of an epidemiological study60 on pediatric sepsis and answer the questions.
The SPROUT study was a prospective, cross-sectional study of the point prevalence, therapies, and outcomes
for pediatric patients with severe sepsis admitted to a PICU, conducted on 5 days over the course of 1 year from
June 2013 to March 2014.
Overall, 6,925 children were screened and 569 met consensus criteria for severe sepsis, yielding a point
prevalence of 8.2%. Point prevalence varied across regions (P < 0.001): North America 7.7%, Europe 6.2%,
Australia/New Zealand 6.8%, Asia 15.3%, South America 16.3%, and Africa 23.1%.
The most common primary sites of infection were respiratory (40%) and bloodstream (19%). An infectious
organism was isolated in 65% of patients, and blood cultures were positive in 26%, including patients with
secondary bacteremia. There was a similar proportion of Gram-positive (26.5%) and Gram-negative (27.9%)
infections, with Staphylococcus aureus being the most commonly isolated bacteria. Fungi, mainly Candida
species, were isolated in 13.4%.
Ninety-eight percent of patients were treated with antibiotics, 19% with antivirals, and 33% with antifungals.
For the 421 patients (74%) who received invasive mechanical ventilation, median duration was 13 (IQR, 6–28)
days. Vasoactive medications were used in 55%.
Exercise
Exercise
Choose a word from the text to fill in the gaps.
Answer the questions.
1
a study design that
observes a population
at a specific point in
time
(1) Where was the study conducted?
(2) What data did the study collect?
_____________________
2
the proportion of a
population affected by
a condition
_____________________
3
a word describing “a
lot of people have the
same thing”
4
a word describing
“two things that look
alike or the same”
(3) What was the overall prevalence of severe sepsis?
How can we calculate the number?
(4) What were the proportions of respiratory infection
and bloodstream infection?
(5) What was the prevalence of positive culture?
_____________________
(6) Was the proportion of Gram-negative and Grampositive infections different?
(7) What was the prevalence of IMV?
_____________________
(8) Was antibiotic therapy common?
Bar chart
Bar charts are used to describe the data by
categories or time series and to point out the
most different category among them. When you
read a bar chart, ask “Which category has the
lowest/highest value?”.
Bar charts look like a two-dimensional graph,
with two axes (vertical and horizontal). One axis
represents the categories and the other
represents the expressed data. There might be
more groups of data expressed in the same
category. In such cases, bars might be in distinct
colors or patterns, and there will be a legend to
help readers distinguish the groups.
Draw a bar chart to describe the point prevalence among
regions in the SPROUT study.
Figure 1. Point prevalence across regions.
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64 Unit 17
17 Mr. Meningitis
Reading
Anatomy of the nervous system61
The nervous system has two parts: the central nervous system (CNS) includes
the nerves in the brain and spinal cord, and all the other nerves in the body are
part of the peripheral nervous system (PNS).
The nervous system is made up of all the nerve cells in your body. There are
many billions of nerve cells, also called neurons, in the nervous system. The
brain alone has about 100 billion neurons in it. Each neuron has a cell body
and various extensions. The shorter extensions (called dendrites) act like
antennae: they receive signals from, for example, other neurons and pass
them on to the cell body. The signals are then passed on via a long extension
(the axon), which can be up to a meter long.
Regardless of where they are in the body, a distinction can also be made
between the voluntary and involuntary nervous system. The voluntary
nervous system (somatic nervous system) controls all the things that we are
aware of and can consciously influence, such as moving our arms, legs, and
other parts of the body. The involuntary nervous system (vegetative or
autonomic nervous system) regulates the processes in the body that we cannot
consciously influence. It is constantly active, regulating things such as
breathing, heartbeat and metabolic processes. The involuntary nervous system
is made up of three parts: sympathetic nervous system, parasympathetic nervous system, and enteric
(gastrointestinal) nervous system. Both the central and peripheral nervous systems have voluntary and
involuntary parts.
The brain, the most amazing organ located inside of the
skull, is composed of the cerebrum, cerebellum, and
brainstem. The cerebrum has two hemispheres, and each is
divided into four lobes: frontal, parietal, temporal, and
occipital. The surface of the cerebrum has a folded
appearance called the cortex. The cortex contains about 70%
of the nerve cells. The nerve cell bodies color the cortex greybrown giving it its name – gray matter. Beneath the cortex
are bunches of axons which make up the white matter. The brain communicates with the body through the
spinal cord and twelve pairs of cranial nerves.
The brain and spinal cord are covered and protected
by three layers of tissue called meninges. From the
outermost layer inward, they are the dura mater,
arachnoid mater, and pia mater. The brain has
hollow fluid-filled cavities called ventricles. Inside
the ventricles is a ribbon-like structure called the
choroid plexus that makes clear colorless
cerebrospinal fluid (CSF).
Than Lan Con English Center
Mr. Meningitis 65
Draw a map to describe the anatomy of the nervous system.
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66 Unit 17
Exercise
What are the most likely conditions in the following situations?
1
2
3
4
A 30-year-old bank teller was brought to the emergency room after a motorbike
accident. She did not wear a helmet and crashed her head into the electric pole.
She had been unconscious for about 20 minutes then regained her consciousness
later. After two hours in the ER, the patient fell into a coma.
_________________
An 18-year-old male student was taken to the ED by his family members. His
sister reported that he had been complaining of a terrible headache that forced
him to skip classes on the same day. She then found him lying unconscious in
the bed. He was reported to be a healthy athletic person without any prior
surgery, trauma, or social history.
_________________
A 20-month-old girl presented to a pediatric hospital with fever and seizures. Her
mother said she had been well until two days ago when she developed a high
fever accompanied by seizures in both arms and legs. JEV-IgM ELISA was positive.
_________________
A 35-year-old man was brought to the ED with seizures, fever, and altered mental
status. His wife said that he had eaten some raw pork several days before
admission. There were multiple necrotic petechiae and purpura all over his body.
CSF analysis showed elevated protein and white cell count, and low glucose.
_________________
5
A 42-year-old man came to the ED with a mild right-sided hemiplegia. He had a
head trauma six weeks ago and was discharged from the hospital after admission
for monitoring over several days. He did not notice anything until one week
before this visit when he felt some weakness in his right hand and the weakness
became gradually dissipated. A head CT scan showed a hypodense mass between
the inner table of the skull and the surface of the cerebral hemisphere with no
midline shift.
_________________
6
A 56-year-old woman with a longstanding history of hypertension was admitted
to the ED due to loss of consciousness. Physical examination revealed left-sided
hemiplegia. A head CT scan demonstrated a hyperdense mass inside the
parenchyma of the right occipital lobe.
_________________
Vocabulary
Level of consciousness
Paralysis
Arrange the levels of consciousness in the scale.
Name some common terms relating to paralysis.
__ comatose __ confused __ conscious
__ lethargic __ obtunded __ stuporous
1
Alert and aware of the surroundings
2
Disoriented to surroundings, impaired judgment
3
Drowsy, can be woken up by gentle stimuli
4
Responds slowly to stimulation, and needs
repeated stimuli
5
Responds very little to strong stimuli, moaning
6
No response at all
What scales are available to assess level of
consciousness? Can you explain how to use them?
Than Lan Con English Center
1
One extremity
___________plegia
2
One side of the body
___________plegia
3
Two legs
___________plegia
4
Four extremities
___________plegia
5
On one side
___________lateral
6
On both sides
___________lateral
7
On the same side
___________lateral
8
On the other side
___________lateral
9
Eye paralysis
___________plegia
In addition to paralysis and -plegia, what other
terms do you know?
Mr. Meningitis 67
Vocabulary
Epidemiological concepts
Read an extract of a cohort study62 on viral meningitis and answer the questions.
In this multicenter, prospective, observational cohort study, patients were recruited from 42 hospitals
throughout England. Patients were eligible if they were aged 16 years or older, had clinically suspected
meningitis, and either underwent a lumbar puncture or, if lumbar puncture was contraindicated, had
clinically suspected meningitis and an appropriate pathogen identified either in blood culture or on blood PCR.
All CSF samples were examined by microscopy, culture, and PCR.
1126 patients were enrolled between Sept 2011 and Sept 2014, with 1113 included in the analysis. 638 (57%) of 1126
patients fitted the meningitis case definition. The cause was shown to be viral in 231 (36%) of 638 patients, and
bacterial in 99 (16%) of 638 patients.
The incidence of viral meningitis was estimated to be 2–73 per 100 000 per year and that of bacterial
meningitis 1–24 per 100 000 per year in UK adults. When all cases were considered, including those with no
identified cause, the annual incidence of all meningitis in UK adults was 13–47 per 100 000.
The median length of stay for patients with viral meningitis was 4 days (IQR 3–7). Seven (1%) of 1113 patients
died before discharge, five (71%) of whom had meningitis (three had pneumococcal, one had tuberculous, and
one had malignant meningitis). No patients with viral meningitis died or required admission to critical care.
Exercise
Exercise
Choose a word from the text to fill in the gaps.
Answer the questions.
1
2
3
4
a study design that
observes a population
with the same
characteristics over
time
(1) Where was the study conducted? Was it singlecenter or multicenter?
(2) What tests were done on CSF samples?
_____________________
the occurrence of new
cases in a population
over a specified
period of time
_____________________
invite a patient to join
the study, then collect
data from them
_____________________
a word describing
“patients that meet
selection criteria and
can join the study”
(3) How many patients were recruited?
(4) What was the proportion of meningitis?
(5) What were the proportions of viral and bacterial
meningitis?
(6) What were the incidences of viral, bacterial, and
all meningitis?
(7) What was the in-hospital mortality of meningitis?
True (T) or False (F)?
_____________________
1 __ The study duration was four years.
2 __ Incidence was calculated by month.
5
a procedure to obtain
cerebrospinal fluid
_____________________
6
number of days in
hospital/a ward
_____________________
3 __ Viral meningitis did not contribute to inhospital mortality.
4 __ Patients were followed up until discharge.
Exercise
Which patients would NOT be eligible for this study?
 (1) A 15-year-old male with clinically suspected meningitis, who already had an LP.
 (2) A 43-year-old female who was suspected meningitis and had an LP.
 (3) A 32-year-old male with clinically suspected meningitis, who had neither LP nor other blood tests.
 (4) A 66-year-old female who was suspected meningitis, did not have an LP, and had a blood PCR positive
with S. suis.
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68 Unit 18
18 Esomeprazole 40 mg qD
Reading
Principles of management
Read the summary of COPD management63 and answer the questions.
The goal of COPD management is to improve a patient’s functional status and quality of life by preserving
optimal lung function, improving symptoms, and preventing the recurrence of exacerbations. Once the
diagnosis of COPD is established, it is important to educate the patient about the disease and to encourage
his or her active participation in therapy.
Indications for intensive care admission are confusion, lethargy, respiratory muscle fatigue, worsening
hypoxemia, and respiratory acidosis (pH < 7.30), as well as clinical concern for impending or active
respiratory failure.
Oral and inhaled medications are used for patients with stable disease to reduce dyspnea and improve
exercise tolerance. Most of the medications used are directed at the following 4 potentially reversible causes
of airflow limitation in a disease state that has largely fixed obstruction:
-
Bronchial smooth muscle contraction
Bronchial mucosal congestion and edema
Airway inflammation
Increased airway secretions
In the 2016 update of the GOLD guidelines, a rubric is used that assesses symptoms, breathlessness,
spirometric classification, and risk of exacerbations to classify patients according to the following groups:
-
Group A (low risk/fewer symptoms): Stage I or II, 1 or fewer exacerbations per year no hospitalization,
modified Medical Research Council (mMRC) 0-1 or COPD Assessment Test (CAT) less than 10.
Group B (low risk/more symptoms): Stage I or II, 1 or fewer exacerbations per year no hospitalization,
mMRC 2 or higher or CAT 10 or higher.
Group C (high risk/fewer symptoms): Stage III or IV, 2 or more per year 1 or more exacerbations with
hospitalization, mMRC 0-1 or CAT less than 10.
Group D (high risk/more symptoms): Stage III or IV, 2 or more per year 1 or more exacerbations with
hospitalization, mMRC 2 or higher or CAT 10 or higher.
The GOLD patient group-based management recommendations include the following:
-
Group A-D: Reduction of risk factors (influenza and pneumococcal vaccine); smoking cessation;
physical activity; short-acting anticholinergic or short-acting beta-adrenergic agonists as needed.
Group B: Long-acting anticholinergics or long-acting beta-adrenergic agonists; cardiopulmonary
rehabilitation.
Group C: Inhaled corticosteroid and long-acting beta-adrenergic agonists or long-acting
anticholinergics; cardiopulmonary rehabilitation.
Group D: Inhaled corticosteroid and long-acting beta-adrenergic agonists and/or long-acting
anticholinergics; cardiopulmonary rehabilitation; long-term oxygen therapy (if criteria met);
consider surgical options such as lung volume reduction surgery (LVRS).
Tick the management strategies mentioned in the guideline.
 lifestyle modification
 nutrition
 pharmacologic
 psychological care
 rehabilitation
 surgery
Than Lan Con English Center
Esomeprazole 40 mg qD 69
True (T) or False (F)?
1
__ Goals of COPD management include functional improvement and quality of life improvement.
2
__ Rehabilitation is recommended in all four groups of COPD.
3
__ A COPD patient shows dyspnea and an oxygen saturation of 93% on arrival at the outpatient clinic.
After one hour, despite oxygen therapy, his oxygen saturation decreases to 85%; therefore, the OPC doctor
decides to admit him. This patient can be safely transferred to the Respiratory Ward.
4
__ The 2016 GOLD guideline provides management approaches by stages.
5
__ Since airway obstruction in COPD is almost irreversible, medications are used to improve patient’s
symptoms and support rehabilitation.
Complete the following table.
Approach
Grp. A
Grp. B
Grp. C
Grp. D
Smoking cessation
__
__
__
__
Vaccination
__
__
__
__
Physical activity
__
__
__
__
As-needed short-acting bronchodilators (SABA)
__
__
__
__
As-needed short-acting anticholinergics (SAAC)
__
__
__
__
Long-acting bronchodilators (LABA)
__
__
__
__
Long-acting anticholinergics (LAAC)
__
__
__
__
Cardiopulmonary rehabilitation
__
__
__
__
Inhaled glucocorticoids (ICS)
__
__
__
__
Oxygen therapy
__
__
__
__
Surgery
__
__
__
__
Vocabulary
Reading the following case reports and answer the questions.
Naproxen, acetaminophen, and cyclobenzaprine had been administered, and the pain partially decreased.64
Vecuronium, fentanyl, and midazolam were given for sedation and analgesia.65
For treatment of the neuropathic pain, we initially administered gabapentin, but she had an inadequate
response. Pregabalin was used and had some benefit.66
The patient had an autoimmune overlap syndrome with polymyositis, treated with prednisone and
mycophenolate mofetil.67
He reportedly had been treated for tuberculosis 17 years earlier.31
1
Verbs used with
medication names
treat with _______________ _______________ _______________
2
A verb used with diseases
_______________
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70 Unit 18
Vocabulary
Drug information
Provide the information about the following drugs.
capsule cream ointment powder solution spray tablet
Routes of administration: intramuscular (IM), intravenous (IV), oral (PO), topical. If topical, please specify.
(1) Formulation: ___________; strength: _________
Routes of administration: _____________________
(5) Formulation: ___________; strength: _________
Routes of administration: _____________________
(2) Formulation: ___________; strength: _________
Routes of administration: _____________________
(6) Formulation: ___________; strength: _________
Routes of administration: _____________________
(3) Formulation: ___________; strength: _________
Routes of administration: _____________________
(7) Formulation: ___________; strength: _________
Routes of administration: _____________________
(4) Formulation: ___________; strength: _________
Routes of administration: _____________________
Than Lan Con English Center
Esomeprazole 40 mg qD 71
Writing
Read the dosage section and write a paragraph to explain your diagnosis and treatment. See the example.
Dx: erosive reflux disease (ERD); Rx: esomeprazole
Dosage
20-40 mg PO qDay for 4-8 weeks. If oral therapy inappropriate or not
possible: 20-40 mg qDay IV up to 10 days; switch to PO once patient
able to swallow.
1 Dx: community-acquired
pneumonia; Rx: ceftazidime
Dosage: 0.5-1 g IV q8hr.
2 Dx: allergic rhinitis; Rx:
levocetirizine
Dosage: 5 mg PO qDay in evening.
The patient was diagnosed with
erosive reflux disease. He was given
oral esomeprazole 40mg once daily
for 8 weeks.
___________________________________
q
every
___________________________________
b.i.d.
twice daily
___________________________________
t.i.d.
three times daily
___________________________________
prn
as needed
___________________________________
___________________________________
3 Dx: anxiety disorder; Rx: lorazepam ___________________________________
Dosage: 2-3 mg PO q8-12hr PRN; not ___________________________________
to exceed 10 mg/day.
___________________________________
4 Dx: atopic dermatitis; Rx:
___________________________________
betamethasone dipropionate cream
___________________________________
Dosage: apply to affected areas bid
for 7 days, then qD for 7 days.
___________________________________
Reading
Read the case report68, then answer the questions and fill in the chart.
A 29-year-old Caucasian woman affected by a schizoaffective disorder, treated with haloperidol 2mg per day
and olanzapine 10mg per day, was admitted at a Psychiatric Unit for a reacutization of her psychotic
symptoms (hallucinations, delusions, and catatonic behavior), due to a lack of medications adherence. Her
past medical history was characterized by a previous hospitalization for acute psychosis 1 year earlier,
incomplete right bundle branch block (RBBB), and ovarian cysts. Her family medical history revealed that her
mother had an anxiety disorder and her grandmother had a major depression. She was on long-term oral
contraceptives (OCs)—ethinyl estradiol/drospirenone 0.03mg/3mg per day—and denied smoking tobacco
products and any substance use.
A physical examination showed a temperature of 37.2°C and blood pressure of 150/100mmHg, whereas all the
other parameters were within normal range. The results of blood tests and electrocardiography (ECG) were
normal, except for RBBB. Her hospitalization lasted 3 months and during the first month she was treated
orally with olanzapine 20mg per day and haloperidol 9mg per day for 23 days. On the 23rd day of
hospitalization, since a poor response to treatment was observed, antipsychotics were interrupted and
aripiprazole 30mg per day was administered for 6 days. In addition, on the same day, she was diagnosed with
oral candidiasis and treated simultaneously for a week orally with fluconazole 100mg per day and miconazole
oral gel 2% 20mg, two times per day. Since her psychotic symptoms did not seem to improve, 29 days after
admission and on the last day of antifungal treatment, aripiprazole was replaced by clozapine.
Clozapine was started at 25mg per day orally and was gradually increased, within 16 days, to 225mg per day
with the resolution of psychotic symptoms. After 3 weeks the plasma level of clozapine was 542ng/mL (range
350 to 450ng/mL) and the level of its active metabolite norclozapine was 216ng/mL. Blood tests showed
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
72 Unit 18
eosinophilia and an increase of C-reactive protein (5.73mg/L). She experienced the first symptoms (nausea,
vomiting, palpitations) 5 days before the plasma level of clozapine was measured, while she was being treated
with clozapine and OCs. At that point, long-term OCs treatment was discontinued, and no other form of
contraception was administered to her. She was referred to a cardiologist.
A physical examination showed tachycardia and gallop rhythm and she complained of nausea and vomiting.
An ECG revealed sinus tachycardia (135 beats/minute), QTc 0.43 seconds, and S-T segment depression and
inversion of T-waves in inferior and lateral leads. An echocardiography showed a small pericardial effusion
suggestive of iatrogenic pericarditis.
Due to those findings, 1 week after discontinuing OCs, clozapine was also interrupted, and she was not
rechallenged. Within 4 days, she showed resolution of clozapine side effects, normalization of ECG and
complete recovery of pericardial effusion. Her symptoms continued to improve and 6 days after discontinuing
clozapine she was discharged. The plasma level of clozapine measured 1 week after discontinuing clozapine (2
weeks after interruption of OCs) was undetectable. At 1-month follow-up, transthoracic echocardiography and
inflammatory markers were normal.
Choose a word from the text to fill in the gaps.
1 taking a drug on time and
never missing a dose
__________________
6
change in clinical picture
after treatment
__________________
2 begin using a drug
__________________
7
get better
__________________
3 stop using a drug
(1) _______________
8
return to normal
__________________
(2) _______________
9
symptoms disappear
(1) _______________
4 switch to another drug
__________________
5 disease caused by medical
errors
__________________
(2) _______________
10 estimate the level of a
chemical substance
__________________
Fill in the chart. Use the given signs.
---: drug used; -: negative/absent; +: positive/present; ↑ or ↓: increased/decreased; N: normal
Timeline
0
(Admission)
OC
olan/halo
aripiprazole
antifungals
clozapine
psychosis
nausea /
vomiting
HR
CBC
CRP
EKG
ECHO
Than Lan Con English Center
23
29
45
50
(↑plasma
clozapine)
57
63
90
(Followup)
Emergency!!! 73
19 Emergency!!!
Vocabulary
Intervention
Match the interventions with the clinical situations.
__ abscess drainage
__ arterial line placement
__ blood transfusion
__ central venous catheterization
__ debridement
__ hemodialysis
__ infusion
__ intubation
__ jejunostomy
__ laparoscopy
__ lumbar puncture
__ mechanical ventilation
__ nasogastric tube insertion
__ open surgery
__ paracentesis __ peripheral IV cannulation
__ phlebotomy
__ thoracentesis __ urinary catheterization
__ ventriculostomy
1
A nurse is taking blood for some laboratory tests.
2
The patient’s wound has a lot of dead tissue that should be removed.
3
They insert three trocars in the patient’s abdomen and then start the surgery.
4
Fluid resuscitation requires at least one peripheral line. You now ask the nurse to do a procedure.
5
If feeding via the stomach is avoided, they can feed the patient directly from a lower segment of the GI
tract by opening a passage to it.
6
In a patient with end-stage renal disease, the kidneys have totally lost their function, that is filtering
toxins from the blood. Renal replacement therapy can improve this condition by connecting the blood
vessels with a machine to filter the blood outside of the body.
7
A patient is suspected to have bacterial meningitis, so his cerebrospinal fluid (CSF) needs to be collected.
8
The patient is in shock and the doctors are discussing an invasive hemodynamic monitoring method.
9
The doctor performs an abdominal examination and finds an extremely distended bladder, which should
be managed.
10 On ultrasound, the left pleural cavity is shown to be filled with 200 mL of fluid with heterogeneous
echotexture. A procedure is done.
11 On arrival, a patient with multiple trauma exhibits signs of severe blood loss. Hemoglobin level is 50 g/L.
12 Some intravenous medications such as cyclophosphamide or potassium should only be given centrally.
13 You admit a comatose patient and the first step is to secure his airway.
14 This patient is unable to eat but enteral nutrition is still indicated.
15 A patient who is diagnosed with perforated hollow viscus and peritonitis will be taken to the operating
room. The surgeon decides that operation with endoscopy is impossible.
16 An 81-year-old female patient with a history of diabetes is seen in the Endocrinology department with a
large skin infection to her buttock. She is given intravenous antibiotics and source control is performed.
17 The doctor starts to measure the intracranial pressure for a patient with subarachnoid hemorrhage.
18 A desaturated patient is brought to you with an endotracheal tube in place. She needs breathing support.
19 After finding a medium amount of ascites, the gastroenterologist asks his intern physicians to take out
500 mL of fluid for diagnosis and therapeutics.
20 A patient is diagnosed with GI bleeding due to gastric ulcer. He is continuously given esomeprazole.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
74 Unit 19
Reading
Emergency medicine69
Every time you see a new patient or a patient who suddenly deteriorates, check the patient is unconscious. If
he/she is unconscious, immediately palpate the carotid pulse to see if this is a cardiac arrest. Call for help if it
is.
Immediately provide basic-life support (BLS) to a patient in cardiac arrest. This is called cardiopulmonary
resuscitation (CPR). CPR begins with chest compression, then airway control and breathing support if there is
another person with adequate experience. The mnemonic of CPR is CAB.
In some countries, when people notice a person who collapses, one will look for an automated electronic
defibrillator (AED) which is often available in public places (such as supermarkets and offices). AEDs can
detect ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), and automatically generate electric
shocks to stop the arrhythmia, allowing the heart to re-establish an effective rhythm.
For patients not in cardiac arrest, doctors should follow a procedure called triage to effectively evaluate
patients, especially in the ED where there is always a long line of patients waiting for a check-up.
Triage classifies patients into three categories: emergency (patients who need immediate treatment,
otherwise they will die), priority (patients who need rapid assessment, otherwise they will develop
emergency conditions), and queue (patients who can safely wait until their turn).
Always look for signs of emergency conditions first. These signs include:
AIRWAY / BREATHING
-
Obstructed airway
Central cyanosis
Severe respiratory failure (measured by pulse oximeter)
CIRCULATION
-
Weak or fast pulse
Capillary refill longer than 3 seconds
Heavy bleeding from any site
Severe trauma
CONSCIOUSNESS /
CONVULSION
-
Altered level of consciousness
Convulsion
PAIN FROM LIFETHREATENING CAUSES
-
Severe abdominal pain and surgical abdomen
Severe headache
Stiff neck
Trauma to head/neck
New onset chest pain
Major burn
Snake-bite
DEHYDRATION
-
Dehydration in pediatric patients
If there is a sign of an emergency condition, immediately call for help and start emergency treatment. If there
is no emergency sign, continue to look for signs of urgent care:
-
Any respiratory distress/complaint of difficulty breathing (but not severe respiratory distress)
Violent behavior towards self or others or very agitated
Very pale
Very weak/ill
Recent fainting
Bleeding: large hemoptysis, GI bleeding (vomiting or in stools), external bleeding
Fractures or dislocations
Burns
Bites from suspected venomous snakes or from rabid animals
Frequent diarrhea >5 times per day
Visual changes
Than Lan Con English Center
Emergency!!! 75
-
New loss of function (possible stroke)
Rape/abuse (maintain a high index of suspicion)
New extensive rash with peeling and mucous membrane involvement (Stevens-Johnson)
Acute pain, cough or dyspnea, priapism, or fever in patients with sickle cell disease
Patients without these signs can wait for further investigations.
You have a lot of patients waiting in line. Triage these patients.
1
__ A 33-year-old asthmatic with severe respiratory distress, unable to speak in complete sentences.
2
__ An 18-year-old male with pain and swelling to left ankle for 2 days.
3
__ A 50-year-old female with severe headache and confusion.
4
__ A 30-year-old female with severe abdominal pain who is in her first trimester of pregnancy.
5
__ A 38-year-old male who is too weak to stand.
6
__ A 26-year-old female with cough and mild respiratory distress.
7
__ A 30-year-old male with severe abdominal pain after a motorbike accident.
8
__ A 17-year-old pregnant female with convulsions.
9
__ A 54-year-old male with rashes to the legs for 1 month.
10 __ A 22-year-old female with depression and suicidal ideation.
Choose a word from the text to fill in the gaps.
1
the heart does not beat
__________________
2
what is provided in basiclife support
__________________
3
measures to ensure a
secure airway
__________________
4
measures to support a
patient with respiratory
failure
__________________
5
first thing to with a
patient in cardiac arrest
__________________
6
suddenly faint and loses
consciousness
__________________
7
two conditions that
require defibrillation
(1) _______________
8
classify patients
__________________
9
conditions that need quick
intervention, otherwise
patients will die
__________________
10 worsen
Draw a flow diagram to demonstrate how to approach
a new/deteriorating patient.
(2) _______________
__________________
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
76 Unit 19
Review
Present these case reports using the prompts.
Case 1
-
20, M, medical student.
CC: headache after motorbike accident.
1 hour:
o Motorbike accident: crashing into an
electricity pole, no helmet.
o Headache, dizziness, nausea, vomiting.
o No hemorrhage, no dyspnea, no pain
in other regions.
Case 2
-
64, M, retired teacher.
CC: pyuria, suprapubic pain.
4 days: pyuria, normal urine output, suprapubic
pain: constant, radiating to the back.
No fever.
PMH:
o Type-2 DM: 17y, Tx: insulin.
o 4 months ago: urinary incontinence →
suprapubic catheter.
Case 3
-
-
43, F.
CC: painful periods (dysmenorrhea).
2-3y:
o Periods: heavy & painful, regular, 24
days, bleeding 7-9 days, heavy d2–6.
o Hypogastric pain: 2ds before bleeding
→ d5; constant, dull, severe, could not
do any housework.
Taken paracetamol, mefenamic acid (NSAID) →
not improved.
Ob/Gyn Hx: 4 normal deliveries.
Case 4
-
-
71, M.
CC: fever, myalgia.
21d:
o Fever: mild, 2-3 episodes/day.
o Myalgia, malaise. No cough or chest
pain.
8d: → BM Hospital, Dx: pneumonia, Tx:
moxifloxacin + azithromycin; not improved →
NHTD.
Than Lan Con English Center
-
-
-
-
GCS 14, BP 100/60 mmHg, PR 90, SpO2 99%.
Head: right temporal painful swelling, no
bleeding.
Nervous system: no paralysis, no sensory
deficits.
Other systems: intact.
CT head: acute subdural hematoma.
CBC: Hb 135, Hct 40%.
6 hours: GCS 8, left-sided hemiplegia, CT:
enlarged subdural hematoma → emergency
surgery.
Conscious, Pale, BP 120/80, PR 90, RR 21, temp
37.2.
No enlarged kidney, no CVAT, suprapubic
tenderness. UO: 1.5 L/24h, cloudy, white.
CBC: Hb 106, Hct 30%, WBC 6.98, Neu 68%.
Urea: 52.8, creatinine 615 mcmol/L. Na 128, K 4.1.
Urinalysis: WBC 500, RBC 80, protein 3 g/L.
Abdomen US: hydronephrosis, ureteral dilation,
thickened bladder wall.
Urine culture: A. baumannii.
Dx: uncomplicated cystitis, ESRD, neurogenic
bladder, type-2 DM.
Suprapubic area: vague tenderness.
Cervix: normal.
Bimanual palpation: uterus—size ~10 weeks of
pregnancy, soft, bulky.
Transvaginal ultrasound: Asymmetrical uterine
enlargement, thickened posterior myometrial
wall, normal ovaries.
Dx: Adenomyosis.
Tx: hysterectomy.
Conscious, BP: 130/80, P: 80, t: 37.8, SpO2: 98%.
Other systems: intact.
CBC: HGB: 127, WBC: 15.9, Neu: 77%, Lym: 12%, PLT
507. PT 60%, INR: 1.23, aPTTr: 1.1, Fib: 6.5.
ESR 1h/2h: 55/65mm. CRP: 248, PCT: 0.06.
AST/ALT: 34/54, Na/K/Cl: 133/4.3/92.
Urinalysis: LEU: 100, Pro: 0.25, BLD: 10.
Imaging: normal; microbiology: normal.
Ferritin > 2000.
Dx: adult-onset Still’s disease.
A pinch of research 77
20 A pinch of research
Reading
Clinical trials
How do we evaluate the effectiveness of a new drug? We do a clinical trial.
1.
Before
After
100
50 recovered
New drug
We can choose a group of patients with the disease of interest and
give them the new drug. After finishing treatment, we evaluate the
improvement of the patients.
2.
Before
After
New drug
(intervention)
100
50
recovered
Control
100
30
recovered
But if there is an improvement, can we conclude that the new drug
is effective? We can’t!
One might argue that even if the patients are not treated with the
drug, they will still improve naturally. For example, uncomplicated
sinusitis is self-limiting and does not require antibiotics. Or one
might compare the new drug with another drug and find that the
old drug is actually more effective, thus discredit the benefit of the
new drug.
Therefore, we need to compare the new drug (the intervention)
with a control: either a placebo (it looks, smells, and tastes exactly
the same as the new drug but has no active substance) or with
another drug that is already approved for treatment.
3.
But if there is a superior effect observed in the intervention group,
can we conclude that the new drug is effective? We can’t, again!
200 patients
RANDOMIZATION 1:1
Before
After
New drug
(intervention)
100
35
recovered
Control
100
45
recovered
One might argue that there are more females in the intervention
group, or patients in the control group are older. In general, the
two groups might not be similar, so we cannot compare them.
Therefore, we need to find a method to distribute the patients into
two groups so that they are similar. The best method so far is
randomization. It limits the chance the two arms are different,
thus allows a valid comparison between them.
4.
Even if there is now a superior effect observed in the intervention
group, we will still have to be careful before concluding that the
new drug is effective. Why?
200 patients
RANDOMIZATION 1:1
MASKING
Before
After
Group A
100
40
recovered
Group B
100
40
recovered
One might argue that because the doctor knows a patient is in the
intervention group, and he thinks that the new drug is effective,
his evaluation is biased. Or in many cases, the patients believe that
the drug is effective, so they report more improvement.
Since this is a problem originating from the awareness of the
random allocation, masking/blinding is introduced. The doctors,
patients, and other people in the study team do not know which
arm the patient is assigned to. This limits the chance their
evaluation is affected by personal belief or subjective feelings.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
78 Unit 20
Our study is a randomized controlled trial (RCT). It can be single-masked, double-masked, or even triplemasked. An RCT without masking is called open-label or non-blinded. A well-designed RCT provides the best
evidence about effectiveness of a drug.
Before designing an RCT, the investigators must think over their research question. Forming appropriate
research questions is simple but important since it provides the foundation to decide how to conduct the
trial. A PICO question is a format used for clinical trials, consisting of:
P
Population (patients or people who participate in
the study)
“patients with mild to moderate acute respiratory
infection visiting primary care clinics”
I
Intervention or Indicator (the topic of interests)
“C-reactive protein point-of-care test”
C
Comparison (other measures to compare with
the intervention)
“no CRP POC test”
O
Outcome
“reduce antibiotic use”
In the example above, the PICO question can ask: “In patients with mild to moderate acute respiratory
infection visiting primary care clinics [P], does the CRP POC test [I] reduce antibiotic use [O] compared with
not using the CRP POC test [C]?”.70
Exercise
Match the techniques with their purpose.
1
randomization
__ to limit biases due to personal belief or subjective feelings of patients or study staff.
2
control
__ to ensure the two arms are similar, and thus any difference at baseline is only due
to chance.
3
masking
__ to act as a reference to compare with the intervention.
Write your research question.
P
QUESTION: ___________________________
________________________________________________
_____________________________________
I
________________________________________________
_____________________________________
C
________________________________________________
_____________________________________
O
_____________________________________
________________________________________________
_____________________________________
Provide the term for the following descriptions.
1
A study design used to evaluate the effectiveness and/or safety of an
investigational product (e.g., a new drug, a device, a diagnostic algorithm).
_______________________
2
A kind of product that has the same quality as the investigational product
except the active compound and is often used as a control.
_______________________
3
The arm including patients taking the investigational product.
_______________________
4
Errors made during measurement of trial outcomes.
_______________________
5
An RCT without blinding
_______________________
6
A condition that can spontaneously stop without any intervention.
_______________________
Than Lan Con English Center
A pinch of research 79
Exercise
Read the abstract70 and complete the table.
Background
Inappropriate antibiotic use for acute respiratory tract infections is common in primary health care, but
distinguishing serious from self-limiting infections is difficult, particularly in low-resource settings. We
assessed whether C-reactive protein point-of-care testing can safely reduce antibiotic use in patients with
non-severe acute respiratory tract infections in Vietnam.
Method
We did a multi-center open-label randomized controlled trial in ten primary health-care centers in northern
Vietnam. Patients aged 1–65 years with at least one focal and one systemic symptom of acute respiratory tract
infection were assigned 1:1 to receive either C-reactive protein point-of-care testing or routine care, following
which antibiotic prescribing decisions were made. Patients with severe acute respiratory tract infection were
excluded. Enrolled patients were reassessed on day 3, 4, or 5, and on day 14 a structured telephone interview
was done blind to the intervention. Randomized assignments were concealed from prescribers and patients
but not masked as the test result was used to assist treatment decisions. The primary outcome was antibiotic
use within 14 days of follow-up. All analyses were pre-specified in the protocol and the statistical analysis
plan. All analyses were done on the intention-to-treat population and the analysis of the primary endpoint
was repeated in the per-protocol population. This trial is registered under number NCT01918579.
Design
 cross-sectional
If trial, is the study
 cohort
 randomized
 case-control
 controlled
 clinical trial
 masked?
Study sites
___________________________________________________________________________
Population
___________________________________________________________________________
___________________________________________________________________________
Intervention
___________________________________________________________________________
Comparison
___________________________________________________________________________
Outcome
Primary: ___________________________________________________________________
Secondary: _________________________________________________________________
Study procedures
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Can you explain the reason the authors conducted this study?
Writing
Presenting statistics
1
Structure
Example
number/proportion/percentage + of + population + V
Ninety percent of cases with
hypertension in the general
population are primary.
V: be / be affected / have / suffer from / complain of / develop / etc.
2
N + V + in + number/proportion/percentage + of + population
V: be seen / be found / occur / happen / be present / etc.
MCR-1 is present in one third of the
environment bacterial strains.
M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 3 . 0
80 Unit 20
Exercise
Write full sentences using the suggested words.
1
25% / patients / this hospital / insurance /
not covered
2
US / 20%–30% / patients with acute
pancreatitis / necrosis71
3
4
0.6%–1.0% / population worldwide / celiac
disease72
25% of patients in this hospital are not covered by
insurance.
_________________________________________________
_________________________________________________
1/2 / diabetic patients / neuropathy73
_________________________________________________
5
6
7
8
9
approximately / 2/3 / patients with alopecia
areata / younger than 30 years of age74
CRP trial / antibiotic activity in urine / 581 /
902 patients / control group70
between 50 and 90% / dialysis patients /
blood pressure / greater than 140/90
mmHg75
paraneoplastic syndrome / estimate / 7%–
15% / patients with cancer76
90% / children / infect / RSV / first 2 years of
life77
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
10 a study on children with idiopathic
thrombocytopenic purpura / 3 / 505 children
/ severe bleeding / after 28 days78
_________________________________________________
Review
Below are the preliminary results of a study. Provide the type of statistic for these results.
Sample
1500
________________________
Gender
male = 1200, female = 300
________________________
Year of birth
1989 = 80%, 1990 = 20%
________________________
Height
160-169 = 0.4, 170-180 = 0.6
________________________
BMI
underweight : normal : overweight = 4 : 43 : 3
________________________
Level of English
good = 150, medium = 1000, bad = 350
________________________
True (T) or False (F)?
1
__ The prevalence of students who are underweight is 4%.
2
__ There are no incidences mentioned in the data.
3
__ From the data, we can calculate the number of students born in 1990.
4
__ The proportion between students with good English and medium English is 15%.
Than Lan Con English Center
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