Tropi cadli seaseslO l Rememb earlwaysto ma int ain p a t i e n tc o n f i d e n t iIai t y . o languagespot o tinking words (os.hi.ont Keo Dtood cetl f{i*#o&,oti/i&\"e, -\"o,::: .m,ie, \"''\" od, o Merozoites/' b t*.t*vt'1fl? € G _*Q)M[a\"le#Gxamt\"eoto.cyytet. Sporozoite Mosquito HUMAN +i M OSQ UrTO . MosquitoFl -vt \\o &;. @ *ffir9..':\". F e m a l eC a m e t e L /) Zveote. I Male Gamete o,/ AF oi Work in pairs.Lookat the diagram of the life cycleof S Work in pairs and describesteps6-10. the malarial parasite.Describesteps1-5in your own words. \",+ Glem*ier l*i*:*:tf ;: . 3 Readthis descriptionof the samesteps.Underlinethe Wrifing words that are suitablein eachcaseI.n somecases morethan oneis suitable. Describinga life cycle Thesexual part of the life rycle of the malarial Work in pairs.Write about 150words describingsteps mosquitotakes placeinthe invertebrate host (the 6-10in the life cycleof the malarial parasitein the Anopheles mosquito) and the asexual rycle occurs diagram in Ia nguagespot. inthe vertebrate host (the human). At the vertebrate stage,lwhen / where/ then the Compareyour answerwith another pair of students. mosquito needsblood for her eggs,shebites the Checkeachother'swriting for mistakes. human host and at the sametime injects motile sporozoitesinto the blood stream.2,4Jtetrhat / Next USEFUL WORDS AND EXPRESSIONS / Thenthese invade hepato cytes,3where/ when / then they developinto liver schizonts.aWhen / As At the next step/ stage/ phase... soonas/ Next eachschizont ruptures, thousands Followingthat ... of merozoitesarereleased.sAfierthat/ Once/ After Afterwards... this happens,the merozoites invade red blood cells. Before... 7aE0 qfter that / next / then triggers the part of the rycle which is responsiblefor all the clinica. manifestationsof the disease.
1 O2Unit11 d e o x y g e n a t e(da d j )h a v in g d a c t y l i t i s( n )i n f l a m m a t i o no f oxygenremoved thefi ngersandtoes i n f a r c t( n )a n a r e ao f c e l ld e a t h/ necrosiws hichiscausedby anobstructionofthe local bloodsupplyA. notherwordfor infarction. Reading Sickle-celal naemia .,';: \\ ---i I Work in groups.Beforeyou look at the text, look at the DisilillL,tr,'r (,1Ilie titles and pool your knowledgeon sickle-cellanaemia. SCile Ci- | rerre r Predictwhat you expectto seein the reading passage. iite l,lea r!r fiIrctf; aiC i::ialsAi i ir I Find words in the passagewhich mean: D lfefflfrt 1i) r)irf! fePfescrrl \\,irr1)lrr: 1 to breakdown or disintegrate Iraplcitpe.i 2 combinewith anothercompoundto form a polymer 3 characteristic Thesickle-cellgene is commonin equatorialAfrica(frequency 4 interchange 25%),SaudiArabia,and southAsiabut lesscommonin the 5 blocking Mediterraneanand the mixedpopulationsof the Americas 6 accompanyingor occurringwith (frequency5%). lt is due to a singlepoint mutationin the Hb 7 broughton p-globingenechain.WhendeoxygenatedH, bSmolecules 8 developslater polymerizeintoelongatedstructurescausingerythrocytesto 9 change. deformand haemolyzeS. ickledred cellsare rigidand block the micro-circulationin variousorgans,causinginfarcis. The inheritanceof the diseaseis autosomalco-dominant (i.e.sickle-celdl iseaseis due to heterozygousinheritance HbAS).The traitis generallyasymptomaticS. ickle-celdl isease occurswith homozygousinheritanceof the gene (HbSS)or co-inheritancoef anotherB-globinchaindisordersuchas HbC (seebelow).Sickle-celdl iseasq?andg lucose-phosphate dehydrogenase(G6PD)deficiencymayoccur together becauseof the high prevalenceof both conditionsin some regions.Theyprovideprotectionagainstmalaria. Clinical featuresof sickle-cellanaemia Severehaemolyticanaemiais punctuatedby severepain crises.Youngpatientsalternateperiodsof good healthwith acute crises.Laterchronicill healthsupervenesdue to organ damage.Symptomsbegin aftersix monthsof age as the HbF leveldeclines.Thefirstsignsare oftenof acute dactylitisdue to occlusivenecrosisof the smallbonesof the handsand feet,resultingin digitsof varyinglength.The long bonesare affectedin olderchildrenand adults.Anaemia(Hb 6-8 g/dl; reticulocytes10-20%ois) well toleratedbecauseof cardiac compensationand a loweraffinityof HbSfor oxygen.
Tropi cal di seas elOs3 CN5centranl ervoussystem {XR chestX-ray Theseverityof complicationdsependson a numberof 3 Work in pairs.Are the statementstrue or false? factorsincludingthe proportionof non-sickleHb molecules (e.9.HbF)and the ratiod to 13chainsw, hichmaybe modified 1 Thesickle-celgl eneis aswidespreadinthe by concomitanct thalassaemitaraitor conditionsaffecting Americasasit is in Africa. p-globinchainproduction(Bantuhaplotypeis associatedwith severediseasew, hilstSenegaleseand Asianhaplotypesare 2 Infarctscanbe causedwhen sickledred cells l e s ss e v e r e ) . obstructcirculationin cedain organs. Typesof crises 3 Sickle-cedlliseaseand G6PDcombinedprotect sufferersagainstmalaria. o Painfuvl ascular-occlusivfere: quenat nd precipitated by infectionsa,cidosisd, ehydrationo,r hypoxiaI.nfarcts 4 Theflrst signsof severehaemolytic anaemiaare oftenoccurin the axialskeletonl,ungs,and spleen, alwaysseeninthe bonesand hands of the feet. Repeatedsplenicinfarctionleadsto hyposplenismin adulthood.Crisescan involvethe CNS (in 7o/oof the 5 Theseverityof the complicationsis linked to the patientsa) nd spinalcord. proportion of non-sickleHb molecules. Patientscandie when a chestcrisisoccursduring a o Viscerasl equestrationd:ue to sicklingwithinorgansand painful crisis. poolingof blood. During an aplasticcrisis,a bloodtransfusion always Chest:pulmonaryinfiltrateosn CXR,fevel chest saveslives. pain,tachypnoeac,ough,wheeze.Thereis often concomitanitnfectionm, icrovasculaorcclusiona, nd Work in groups.How common is sickle-cellanaemiain bronchoconstrictioCnh. estcrisescan ariseduringa your country?Haveyou treated casesof this condition? painfulcrisis;patientsshouldbe monitoredcarefullyfor Giveexamples. thiscomplicationw, hichcan be fatal. Haemolyticr:aisedrateof haemolysiws itha fallin Hb listening2 Usuallyaccompanyinga painfucl risis.Concomitant G 6 P Dd e f i c i e n c ym a yw o r s e nh a e m o l y s i s . M a i n t a i n i n gg o o d h e a l t h AplasticA: rrestof red cellproductiondue to infection withparvoviruas nd / or folatedeficiencyl.t is f) Listento the conversationbetween Dr Lindt and characterizebdy a suddenfallin Hb and reticulocytes, Mrs BoyceW. hat is the subjectof the conversation? emergencybloodtransfusiocnan be life-saving. I (lt fisten again.Write down asmanydetails asyou can. f) Work in palrs.Compareyour answerswith a colleagueand if necessarylisten again. Work in groups.Describethe bestways for patients with sickle-celdl iseaseto maintain goodhealth.Make notesand shareyour information with the class. Work in pairs.Youare a GPand you are going to talk to apatient,Mr(s)Dillon,aboutthe bestwaysto maintain goodhealth for himself / herself.Usingthe notesfrom 2 and tl above,take turns role-playingthe conversation. USEFUI EXPRESSIONS It'simportant.., Youneedto... Wherepossibletry to ... If you (do this)...,then... If you get (sicke, speciallyhighfever)..., contact... immediatelyD. on't wait.
lO4 Unit1l P h y s i o t h e r a psyh o u l dn e v e rb e Stroke painful.Theexp ressio n' Npoain,no gain'hasno placein physiotherapy. Oneof the complicationosf sickle-cellanaemiisastroke. - OxfordHandbookofTropical Rehabilitationand physiotherapayfterstrokeisessentia2l 4hoursa dayandasthe physiotherapcyanbeundoneby badpostureduring Medicine the nightandat othertimesi,t isa goodideatoteachthe relatives the basicsof physiotherapy. PatientGare Speaking I Work in pairs.Lookat the diagrams,which show YOU60 FIRST positioning and movementsfor hemiplegicpatients lying down. Decidewhat instructions you would give to someoneto explain how to position a hemiplegic relative. tr Herrrp leg ic sid e= biu e Work in groups.Lookat statements 1-10and match themwitha-g. Match thesesentencesto the picturesin l. 1 Do you want to add anything to that? 2 Ahmed,what aboutyou? 1 HelpAndrew to getup to sit on the bed. 3 I agreewith what you said but, what about ...? 2 PositionAndrew onthe stroke(hemiplegic)sidelike 4 CanI just saythat ...? 5 I think you're right, but we alsoneedto think about ... this with a cushionunder the headand leg like this. 6 I think that's it exactly. 3 RolIAndrew onto his normal sidewhile supporting I'm not sosure if that's going to work. his weak shoulder. 8 Any more suggestionsor ideasfrom anyone? 4 LayAndrew on the normal sidelike this with 9 No,I'm sorry.It's OK.You go first. l0 Shallwe appoint someoneto take notes? cushionsunder the stroke(hemiplegic)arm and leg. 5 Positionand cushionAndrew in the supineposition. a agreeing Work in pairs.Taketurns explaining to a relative how b disagreeing to position and supportapatient who hassuffereda stroke.Usethe dlagramsaboveto help you. L agreeingand disagreeing d irwiting someoneto speak e adding information f apologizingfor speakingoversomeone a taking the leadin the discussion b Canyou add any more expressionsof your own to the Iist above?
Trooi cadli seaseslO 5 Lookat the task below,which is an awarenessexercisefor Cherkllst GPsworking in areaswith patientsfrom a wide rangeof backgrounds.Spendseveralminutes thinking about the task. Assesysourprogressin this unit. Make mental notesaboutthe measuresb, ut don't write anything Tick(/) the statementswhich aretrue. down. I cantal kabouttropi cadl i seases Youareworking in a generalpracticein the UK which covers an areawhere there aremany patientswho havecomefrom or I canunderstanadnd usevocabul ary whosefamilies havecomefrom SouthAmerica.Africa.and relatedto travellersd' iarrhoea south-eastAsia.Youdo not feelthat the GPpracticeis catering well for thesepatients.What arethe three bestmeasuresto I canusel i nki ngw ordsl i kenext,then,when improvethe situation? indescriptions 4 Work in groupsof three or four. Eachgroup shouldpair with l cantal kaboutsi ckl e-ceal lnaemi aand another group,one asgroup A and the other asgroup B.Group r e h a b i l i t a t i o na f t e rs t r o k e A discussesthe task in 3 and decideson the three best solutions. Eachstudent in GroupB monitors the performanceof a student I canshowrespecitn di scussi ons in groupA.After fifteen minutes of discussiont,he studentseach givefeedbackin pairson the performanceusing the following F{eywords criteria:ability at turn taking,respectforcolleaguesc,ontribution to the discussion,teamwork. Adjectives notifiable i; sweetened unhygienic ir 't?, ' f;ti. i: u np e e l e d Nouns epidemic gametocyte haemolyze host life cycle malaria merozoite milestone pandemic rigor s c hi z o n t si ckl e-ceal lnaemi a sporozoite stopover t r a v e l l e r sd' i ar r h o e a v ar i o l a t i o n Changerolesand this time the studentsin group B discusswhile [$sefurl eference thosein A monitor. OxfordHandbookof TropicalMedicine, 6 Choosethe bestmeasureto improvethe situation. 3rd edition,Eddleston, r S B N9 7 8 - 0 1 9 - 9 2 0 4 0 9 - 0
105 Unit12 €kec$<erp 3 Describethesepictures E tr Eltl 0r6a .:*..z! taJlrNlt:'!r' Work in groups.What arethe main advantagesand 4 Why do peopleoften resistthe introduction of new disadvantagesof technology? technology?Giveexamplesfrom your own experience. What arethe reactionsto innovationsin scienceand Somepeoplethink that deskilling and losing sight medicinein particular in your country? of the patient arethe main downsidesof the useof technologyin medicine.Do you agree?
Technol og1y 07 r.1 : -l:: r.--- e usi ngvocabul arayboutchange a eval uati ngchangeanddevel opment + aski nganddeal i ngw i th negati vequesti ons + w ri ti ngaboutarguments V**ahuiary il$*€*nim'g?i Change Technologicadl vances X Work ln pairs.Which two adjectivesin italics canyou (-) Wort<in groups.Listento two doctors,a male and usetogetherto completeeachsentenceA? rethe two female,discussingtechnologicaal dvancesin medicine. adjectivesyou chosein the correctorder? Two students(StudentsA) concentrateon what the female doctorsaysand two students(StudentsB) 1 Technologylike computershasbrought about concentrateon the male doctor.Make notesasyou structural/ big/ far-reachingchangein the listen. provisionof health careinternationally. 2 Thefirst facetransplantrepresenteda diplomatic/ medical/ realbreakthrough. 3 In recentyears,someverydramatic/ enormous/ technologicaal dvanceshavebeenmade in medicine. 4 Throughout hlstory,many important / recent/ medicaldevelopmentshavebeencurtalled out of fearandignorance. 5 Keyholesurgerywas a(n)ingenious/ modern/ latest invention. 6 Societyat large,not just the medicalfield,is undergoinga computing/ complete/ technological revolution. 7 Aradical/ whole/ suddentransformationoccurred in the way patientsweretreated. 8 Stifling constant/ scientifc/ important innovations in medicinethrough lackof funding is indefensible. 9 I'dliketo find somethingtracingthe constant/ biological/ technologicael volution of medical sctence. 10 Thegovernmentsponsoredapioneering/ Iatest/ joint initiative betweenthe medicalschools. E Work in pairs.What arethe verb forms of the nouns ln boldin 3? ,1 StudentsA, checkyour noteswith eachother.Students B,do the same.Then combineyour information. Q fhen listen again and checkyou haveunderstood everythlng. Make a list of developmentsyou would like to seein mediclne.Describeand evaluateyour predictlonsfor the future. Givereasonsfor your comments.
lO8 Unit12 xeno-transplan(nt )animalto humantran so lan t Vocabulary Speaking EvaluatingGhange ! Workingroupsoffour. Discusswhich of these Work in groups.Lookat the adjectiveson page107in issuesyouthink are VocabularyLWhich adjectlvesevaluatethe nouns? controversialor sensitive Which describe? mattersforyou andfor the general public. Work out which adjectivesarebeing describedbelow. Thewords arejumbled upsidedown below. * Animal experiments/ vivisection 1 a synonym of the word dangerous _z_ * Xeno-transplants 2 to dowith being advantageous _nl r Facetransplants r Genetic manipulation t a synonym for convincing p_e r Growing sparebody 4 to do with causingharm f parrs to do with having great worth VC Choosea topic from I and divide into two sides,for and against.Prepareat leastthree argumentsfor each 6 to do with being easyto useat side.Thendebatethe issue.Discussalsowhether the procedureis acceptableinyour own country. anytime USEFUL XXPRESSIONS a synonym for frightening a arouseemotion/ controversy/ debate 8 to do with not being ableto controversia/l sensitive/ debatableissue outweigh/ offset/ bemore important than any/ supportsomething l_e_ compensatefor 9 a synonym for damaging dI Choosea member from one group to summarizeboth sidesof the argument for the rest of the class.Other 10 to dowithdistastetul o_J_e groupmembersshouldlend support. alqeuorpalqo alqenlB^ur anrsensrad snoprEZeq alqlsuaJspur ]uarua^uoJ lnJurreq IEDrJaueq IEluaruulap Sururrep Which of thesewords are synonyms of the words in I? Lirtening2 Oneword may beusedtwice. Tryingto persuadethe doctor compeiling halnfirl incalculable offensive risky f) Listento the five short conversationsbetween a shocking l^/-r^4-L+tir-L^Al r unsafe doctor and a patient. Write down the patient's first question in eachconversation. unjustifiable 2 Work in pairs.Compareyour answers. 3 Work in pairs. Discusswhy you think the patients askedthe questionsthat they did.Then checkyour answersin the Grammarreferenceonpagel26. 4 Q fisten again.Writedownthedoctor's reply. 5 Taketurns askingeachother questionsand replying.
T e c h n o l o g y1 0 9 Whyinnovate?Withinthreeyearsof introductionof the first antiretrovirIatreatmentsA, IDSdeathsdropped byTO%. lmprovementisntreatmenthavehelpedcut cancedr eathrates in half. Vaccinehsavesavedcountlescshildrenfrom diseasessuchaspolio, rubellam, easlesa,ndtetanus. - CounciflorAmericanMedical nnovation . languagerpot Work in pairs.Match the meaningsa-k to the statements1-11in 2. Negativequestions a Youshouldhave. 1 Lookat the faces.What feelings do you think they are b He'slate. showing? c I don't likethis new one. d I can't afford to pay for it. 2 Work in pairs.Lookat thesestatementsmade by e lt'smissing. patients.What feelingsor thoughts couldlie behind f Iwantone. the questions? g I feel angry becauseit's beencancelled. 1 Couldn'tI just keepusing the samedevice? h Ithinkyou've left me offthe waiting list. 2 Isn'tthis availableonthe NHS? i You'vekept us waiting too long. 3 Wouldn't it be better for me just to continue with j I don't want to stop. medication? k I think you've forgotten. 4 Doesn'tthis devicecomewith a capon it? 5 Shouldn'tmydaughterbenext? 4 f) aU of tne statementsin I aremade by a patient. 6 Won't I be having the operationtoday either? 7 Can'tIhaveanMRIscan? Work in pairs.Listen and decidewhich you would put 8 Hasn'tthedoctorarrivedyet? into the categoriesbelow.Somemay fit into more than 9 Haven't you donethat referral letter yet? one category. 10 Didn't you sayI couldgohometoday? 11 Aren't I next onthewaiting list? a a strongcriticism b amildcriticism c areminder d avoidingcriticism e showing shock/ surprise f persuasion/ademand 5 Decidehowyouwould replyto eachstatementin 2. USEFUL EXPRESSIONS Youcould/ can.but.. I'm afraid not,because... Oh,yes,sorry... Oh,yes,you'reright. I'mverysorry,but... Yes,wehave. I did,but... 6 Work in pairs.Taketurns askingand replying to the questions.Developthe answersin your own way. 7 Canyou think of acceptableand unacceptable examplesof situationswhere you canusenegative questionslike thosein 2 with colleagues?Givereasons. Lookat the audio scriptfor Listening2 on page137. D Gr.to Grammar referencet; LI(r
110Unit12 Speaking I Work in pairs.Lookat the photos.Youhavetwo patients.Onepatient is insisting on having eachof the proceduresor items in the photosand the other is reluctantto havethem. Decidewhat the patient might sayin eachcase. tr 2 Work in pairs.Taketurns role-playingthe conversation betweenthe doctorandthe patient.Thepatient canbe il _a, difficult and insistent. t--r*.'- Reading ttt. Work in pairs.Lookat the three extractson page111. What do you think is the sourceof eachtext? ,h.e ..* Match thesesourcesto the extracts1-3. -.:i.<:- A newspaper A websitefor patients $--- A specialistwebsite on stem cell research '\\---r_\"a== Replacethe highlighted words in thesesentenceswith -^ aword from the extracts. 1 Scientistslearnt how to grow stem cellsin the <T laboratoryafter yearsof experimentation. 2 Stemcelltreatment involveshazardsaswell as beingharsh. 3 ProfessorDhillon'sreactionis unambiguous when askedif the researchat Edinburghmet any resistance. As it is connectedwith the useof foetuses,the term stemcellis quite sensitiveto many people. Patientsare given information asto when the advantagesare greaterthan the dangersin a stem celltransplant.
Technol og1y 11 harvest(v)(oftissueor organsc) ollect Donot gowherethe pathmayleadg, o instead unspecialize(dadj)of cel s,not differentiated wherethereisno pathandleavea trail. - RalphWaldoEmerson,rSo3-t882 Stem Cell Transplant Stemcellresearcihsa subiect The specific factors and A stem cell traisplant is used to almosgt uaranteetdo prompmt ixed conditions that allow stem cells to increasethe chanceofa cure or reactionsA.sifto illustratethatfact, remain unspecialized are of great remissionfor a number of cancers twohigh-profitSecottishstemcell interest to scientists. It has taken t r i a l sw e r ea n n o u n c et hdi sw e e kt,o scientists many years of trial and ts: and blood disorders. It usually v e r yd i f f e r e nr te s p o n s eWs .h i l eo n e error to learn to grow stem cells involves intense chemotherapy w a sb ra n d ed' i mmoarnadlunethi cal ' in the laboratory without them followed by an infusion of stem b yc r i t i c st,h eo t h e rw a sw a r m l y spontaneously differentiating into cells.The treatment requires w e t c o m eadso f f e r i n ag p o t e n t i a l c u r e specific cell types. For example, closenursing and medical care f o rs o m et y p e so f b l i n d n e s s . it took twenty years to learn how for a number ofweeks. It can be a to grow human embryonic stem gruelling treatment and there are Thedifferenciesthattheforme-r a cells in the laboratory following risks. Your specialist can advise trialinGlasgotwoinserst temcells the development of conditions when the likelybenefits of this i n t ot h eb r a i n so f s t r o k ev i c t i m s- for growing mouse stem cells. procedure can outweigh the risks. Therefore an important area of r e l i e so ns t e mc e l t sh a r v e s t ef rdo m h u ma ne mbryows,hi chmusbt e What is a stem cell transplant? r destroyetdoenablethebeginninogf research is understanding the signals in a mature organism I- A stem cell transplant may be used F*t{es a c e tl[i n e . that cause a stem cell population E d i n b u r g hu s e ss t e mc e l t sf r o m to proliferate and remain so that you can haveintensive unspecializeduntil the cells are high dosechemotherapy (and v o l u n t a r ya d u l td o n o r s ,h a r v e s t e d sometimes radiotherapy) to kill t aftertheirdeath.to treatcornear } cancerouscells.The chemotherapy wtuird blindnessl.t istheuseofvoluntary l- needed for repair of a specific adultdonorsthat makesal[the [: tissue. Such information is critical ris higher than conventional differenceto thosewith moraI for scientists to be able to grow andet hic aol b l e c t i o ntso s t e mc e l l Iarge numbers of unspeciaiized ; chemotherapy and also kills the therapy. stem cells in the laboratory for As k edif he h a de n c o u n t e r e d further experimentation. stem cells in the bone marrow that would normally make blood cells.Therefore, following the chemotherapy, you are given back any oppos it i o nP, r o fD h i t l o ni s i.q(transplanted) stem cellswhich i can then make normal blood cells ffi .fagain. A stem cell transplant is sometimes Ncalled a bone marrow transplant. However, stem cells can be obtained from blood aswell asfrom the ffibone marrow. So,the term stemcell unequiv oca l . 'N oB.e c a u swe e 'r e us ingt is s uet h a t 'sb e e ng e n e r o u s t y d o n a t e db y a d u l td o n o r sa f t e rd e a t h , t hos eis s ue sd o n 'ta r i s ew i t ht h i st y p e ofresearch. 'l thinkthetermstemcellhas becomeratheremotivein thatit's tinkedwith a numberofimages transplantisnow used. wandissuesb, othethicalandmoral, associatewd iththe useoffoetuses, andthistrialis notusingfoetalstem cetts.ButI thinkit'simportanftor clinicianss,cientistsa, ndthe public to havean opendebate.' 4 Answerthesequestions. 3 What differenceis mentioned between normal chemotherapyand that usedin stem cell 1 Why is it important for scientiststo understandthe transplants? signalsin a mature organismthat causea stemcell population to proliferateand remain unspecialized 5 Work in groups.Are you interestedin genetics?Give until the celisareneededfor repair of a specifictissue? reasonsand exampies. 2 Why hasthe Edinburghtrial not had a negative responseto its work?
1 1 2Unit12 . . , . ,,t ::, (v)ta ke awa y t he i' ; : ' r i: ; , . .r,.','-(, n)a f ic t iOn a l ThenovelFrankenstein, m y s t e r ya b o u ts o m e t h i n gt;o doc t orwho as s em bleadh u m a n p u b l i s h e di n 1 8 1 8w, a sw r i tte n makeso meth ingclea r from the partsofdeadpeople, byMaryShelley. :.::,. :: . (n )a p roc es s resultingin a creatureoften t hat,if starte d,willcausmeany c alled' Fr ank ent eiMn'osn s t e r ' proble msth at ca nn otb es olv ed '5per*k***6 ;€ Discussthe main argumentsfor and againststem cell research/ therapy from the ethical and scientificview Work in pairs.Lookat the picture and describewhat is Lookat the words and ideasbelow. h' ':*nrn ern-i n o\" _ 'D' Jisp\"lfear.l ' iln{$ ,=i\" pvt F.eoFle's /:,, I mi nJsof eos\"-. | i+ + . 4*- - toke aL/*r.{ bh'n.gstu{ Work in pairs.Is eachstatementfor or againststem cell 'f hn ofi,,a d.[*.,J therapies? * , +createo\"vnonster 1 Stemcellresearchis the breakthroughthat sufferers noie of illnessesand paralysishavebeenwaiting for. #re OL&Cnng 2 Thebestway to approachthe issueis to clarify vnno\"rtvi.tL how the procedureworks to makepeoplefeei at easewith stem cellresearchO. nceit hasbeen demystified,peopleare more likelyto acceptit. 3 Stemcellresearchand therapiesareindefensible becausethey interferewith nature. 4 Many peopleare apprehensiveabout haruesting stem cellsfrom embryosto usein any kind of treatment. 5 I canunderstandthe faith peoplehavein stem cell therapy,but I think it is a steptoo far both ethically and scientifically. 6 Providedthere are suffi.cientsafeguardsin place, stem cellresearchis surelya welcomedevelopment. 7 A developmentlike stem cellresearchis scientiflcallycomplexand hassuchdangerous consequencetshat it's impossibleto allay people's fears. 8 Stemcellresearchand therapy givehopeto thousandsof sufferers. Decidewhich categoryof statementsyou agreewith. X Make a masterlist of ideasin 4 for the whole class. Then compareyour answerswith another pair of students.
Technology 113 Discovercyonsistsof seeni g what everybodeylsehasseen andt hinkin gwha t n ob od yels e hasthou gh t. - Albert vonSzent-Cyorgyi 1893-1986H, ungarian biochemist &ffi#p{#edew* dih*€fu€i:ii.. S t e mc e l l t h e r a p y Assesysourprogressin this unit. Tick(/) the statementswhicharetrue. Work in pairs.Lookat the text on stem ceiltherapy.Completethe text by insertingthesephrases. I canunderstandand usevocabul araybou t c h an g e a theseinnovations I caneval uatechangeanddevel opment b not just objectionableb, ut dangerous l can askanddeal w i thnegati vequesti ons c a majorbreakthroughin medicalscience l can w ri teaboutarguments d the knock-oneffect e and otherimportant medicaladvances ffi*pwmnd* Stemcelltherapy is 1- which offersnew hopefor stroke Adjectives alarming victims aswell asfor sufferersof many other conditrons. beneficial compelling However,the benefltsarenot just Iimited to the patient,but emotive f a r - r e a c hi n g extendto the carer,often a family member,and the health hazardous i ngeni ous caresystem.Fromthe family's point of view the patient objectionable persuasi ve would be giventhelr livesbackand would possiblyevenbe radi caI reckless ableto Ieadan activelife and work again.Forthe carer,there sensitive uneasy is the releasefrom the burdenofcareandthe possibiiitvof u n e qui v o c aI unjustifiable finding work. Nouns Thecostof medical carewili be brought down with a b r e ak t hr o u g h criticism reductionin community support,the supply of medications development revolution and equipment like hoists,and home modiflcations.The #se$n:$ sffifffiffi'mffiffiffi time spentin hospital will alsobe reduced.Soin a short time the researchwill soonpay for itself.Thenthere is 2-of OxfordHandbookof ClinicalMedicine, 7thedi ti onL, ongmoret al , being ableto usethe money savedto pay for other areasof lSBN978-0-19-85683-77 treat-ment.It must be emphasizedthat the health caresystem will only gainfrom 3- if any changesarewell managed and the benefltsspreadaround. Somepeople,however,havereservationsaboutthis 4- that havetaken placein recentyears,primarily from the ethicalpoint ofview. Theyfeelthat stemcellresearch is 5-. Work on your own and continuethe third paragraph.Compare your answerwith a partner.
1 1 4S peak ingac t iv i ti e s S p e a k i nagc t i v i t i e s StudentA Unit7 p.69 Unit1 p.7 Chooseone ofthe picturesand show it to the doctorat the appropriatemoment. Youarethe brother / sister of a 22-year-oldmale / femalewhom you witnessedpassingout in a shop. This is the first time it happened.Yourbrother / sister had no prodrome;a cry followed by tonic / clonic movements;post-ictaldrowsiness,confusion,cyanosis, frothing from the mouth, incontinence,achinglimbs; slow recoverylasting about twenty minutes. Add any further information from your own medical knowledge. Possiblediagnosis:epilepsy,but needto rule out other possibilities. Unit3 p.23 Unit9 p.85 Yournotes Youarea 45-year-oldpatient who haspericarditis.You are anxious and havethe following: 30yurs (olt r,ttz/*I funnl4 ?a/irLit4 r+ t/42sd6ow1,2ft-/ur4/2igl,ou tofu y^, Sharpchestpain,centralretrosternai,worse on deepinspiration,changein position,exerciseand /ays / sqou,*han/ wtuzareAfut,ha,snst swallowing,pericardiaieffusionmay causedysphagia iltfun at wwk, ?eint h tlu wrt{t, d^oesn? by pressingthe oesophagus. t6etaffort, tut *th, nztgototfugym, At the appropriatepoint show the doctorthe ECG. ?/A/ in tlu parb fare upjar:nn Unit5 p.42 v2 YouareMrs Buxton. Yougavebirth to a baby ten days T1-r-t--Ftl1- ago.Youpresentto the GP'ssurgerywith a Iittie bit of tearfulnesswhich hasgoneon longer than the first few ffi days after giving birth, but is nothing serious.Youare getting a lot of support from your friends and family. +Tfft+l You r laugh at things asper normal o look forward to things a know things not your fault evenif get on top of you t aresometimesanxious / worried but normal s aresometimespanicky,but no more than normal t arecopingquitewell a haveno problem sleeping * arenot sada lot JF cried a little first few days,then perkedup,then started again; not a lot, but it's there havenever thought of harming yourself.
Li steni ntgempl ate '115 Listeningtemplate Unit 1 page4 Names Patient: Doctor: P*\"^.d* Sequenceofevents Place: Descriptionof the event Reactionto the event: Beforethe event: Afterthe event: P a s te v e n t s :
1 1 6S peak inagc t iv i ti e s StudentB Unit7 p.59 UnitI p.7. Chooseone ofthe picturesand show it to the doctorat the appropriatemoment. Youarethe husband/ wife of a 5O-year-oldmale / femalewhom you witnessedcollapsingat the entrance Unit9 p.85 to a cinema.Theonsetwas sudden;there was pallor and sweating,rapid recoveryf,lushing,no nausea, Youarea 4O-year-oldpatient who presentswith atrial arrhythmia, no incontinence;severalsimilar episodes fibrillation. Youare anxious and have a slight chest pain with palpitations and dyspnoea.Youfainted nrcrri nr rclrr beforeyou cameto the hospital. At the appropriatepoint show the doctorthe ECG. Add anyfurther information from your own medical knowledge. Possiblediagnosis:cardiacsyncopalevent,but needto rule out otherpossibilities. Unit3 p.23 Yournotes 4Syearst'ogt ua,lzI feualz, kl4re/ woer [.ea,runn*r a.alem^eflta*iloln/4a/d. tt J' 't road6ca,?L*top h\"a,tso nL/1,/awerbanka,s wtdl .t trantn^a {or r,u^arath\"on JJ an*h4z nap .tt Unit5 p.42 YouareMrs Chaplin.Yougavebirth to a baby ten days ago.Youpresentto the GP'ssurgerywith a little bit of tearfulnesswhich hasgoneon longerthan the first few days after giving birth. Youare getting no support from your frlends and family and you arefeeling panicky. You r don't laugh at things aspernormal r look forward to things,but definitely lessthan before * know things not your fault evenif get on top of you but sometimesreproachyourself * areoften anxious/ worried s aresometimespanicky,but more than normal * arenot copingwell * haveproblemssleeping * aremiserablea lot of the time e cri.eda little first few daysthen it got worse a areunhappy and crying a lot * haveneverthought of harming selforthe baby.
Speakingchecklist S peaki ncgheckl i s tll7 Comments Unit 3 page26 Unit 5 page39 Unit 5 page42 Unit8 page77 Unit 8 page80 Unitg page85and 88 Unit 10 page93 Criteria Candidate: Grade* 'Grades A Good B Satisfactory C Needsimprovement ThisPagePhotocopiable@Oxford University Press
1 18Cr am m arr ef e re n c e Grammar reference Unit1 Wecanusetime markerssuchaswhenot aftertolink actionsB. everycarefulaboutthetenseyouuse. Rapidtensechange I wascleaningthewindowswhenI slippedandbroke Whendescribinga seriesof actionsi,t isvery my leg.or WhenI wascleaningthewindows,sI lipped importantto conveyaccuratelythe sequenceof a n d b r o k em y l e g . eventsI.t ishelpfulto rememberthat thePast ContinuousandPastPerfecCt ontinuousprovidea Nor I eleenedthewiftdewswh backgroundto otheractions. ffiy-lefr PastContinuous:w.I aslifting a box... AfterI hadrested,Ifelbt etter. = Subjec+t PastSimpleof be+ -ingform Hedoesn'tremembear nythingaftertheambulance PastPerfectContinuousM: y motherhadbeenfeeling arrived. dizzyforafew days. = Subjec+t PastSimpel of have+ been+ -ingf.orm Notethe useof the commawhen afteror whencome atthebeginningofthe sentence. Weoftenusethe PastSimplefor eventsthat interrupt otheractionsorwhich areconnectedto a contextthat C o m p a r a t i v ea n d s u p e r l a t i v ea d j e c t i v e s hasbeenprovided. andadverbs PastSimpleI: wasliftinga boxwhenIfeII over. Comparative and superlative adjectives My motherf ainted thismorning.Shehad beenf eeling Adjective Comparative5uperlative dizzyforafew days. Short + -er/ -est short shorter the It is commonto usethePastSimpleto describea shortest seriesof consecutiveventsW. eoftenusewordssuch adjective a ss u d d e n l ya n d t h e n l o p r o v i d ec o n t i n u i t y . Adjective +-r/-st rarge larger the I gotonthebusandthenlsatdownS. uildenly,Ifelt l ar g e s t sick. endi ngi n -e WeusethePastPerfecto referbackto anearlier actionthat isfinished. Short doubl ethe wet wetter tne wettest PastPerfectM: yfather hailfallen earlierthat day. adjective consonan+t = Subjec+t PastSimpleof have+pastpartlciple endi ngi n -er/ -est WeusethePresenPt erfecto talk aboutsomething vowel+ that happenedat anytime in thepastup to the presentmoment. conS 0nnaI, PresentPerfect:Shehasn'teatenanythingtoday. e x c e p -r w = Subjec+t PresenSt impleof have+ pastparticiple Adjective more/most mooern more themost Weusethe PresenPt erfecCt ontinuousto talk about of two somethingthat hashappenedcontinuouslyor ormore + adjective modern modern repetitivelyfrom a pointin the pastright upto the syl l abl es presentS. ometimesw, e canuseeitheraPresent e x p e n s i v em o r e themost Perfecot ra PresenPt erfecCt ontinuousform.The importantthing to rememberisthat thelatter expensive expensive emphasizetshe continuousaspecot f the action. Adjective change-yto lively livelier the PresenPt erfecCt ontinuousS: he'sbeenhavingdizzy endi ngi n -i+-er / -est liveliest spellfsor sometime now. c o n5 0 nan I = Subjec+t PresenSt impleof have+ been+ -ingform +-y l rregul ar good better best adjective bad far worSe worst f a r t h e r/ further f a r t h e s/t f ur t h e s t Comparative adjectives We use than after the adjectivewhen directly comparing two things. In the UK,this treatment is more expensivethan in the USA.
C rammarreference1 19 We can alsouse less+ adjectiveto mean the opposite PresentPerfect of more. Theinjury islessseriousthanwethought. Weusethe PresenPt erfectto talk aboutsomething Nor Twesffierioeseh that hashappenedrecentlyW. esometimesusejustto emphasizeaveryrecentevent. We use more and/essbefore nouns.Note that it is Thepatienthas(just)itischargedhimself. more correcttousefewer rather than lessbefore countablenouns. Y o uh a v e n ' tb r o k e ny o u r a r m . Thereis more information availablenow,and more = have/ has(+not)+ pastparticiple people expectafull explanation. WealsousethePresenPt erfectto referto atime span In thepast,therewas lessinformation available,and from anytime in the pastup to the present. fewer people expectedafuII explanation. He'sbrokenhisarm severatlimes. We use(not)as...asto describetwothings or =during hislife situationsthat are (not)the sameaseachother. Theoutcomeisasgood as it possiblycan be. She'fsallen overtwicethismonth. Themedication isn't as strong as the oneyou were PresentContinuous taking before. Weusethe PresenCt ontinuousto describean Superlative adjectives actionor situationthat ishappeningnow.Wedon't generallyusethe PresenCt ontinuouswith verbs We don't usethan after a superlativeadjective. of perceptiosnuchasthink,know,sounodr look+ Restis the besttreatment we can offer him. adjective. My head'sthrobbing. The superlativeforms of more and lessare the most I'mgettingpainsinmy shoulder. andthe least. This is the most seriouscaseI've seen. Hisarm isn't achingasmuchasit wasbefore. That hospital hasthe least up-to-datefacilities in the = am/ is/ are/ (+not)+ -ingf orm region. PresentSimple Comparative adverbs Weusethe PresenSt impleto describea stateW. ecan usetheverbbeor averbofperceptiono, rverbssuch We canusemore,lessand(not)as...asinthe same a sn e e do r h a v eg o t . wayfor adverbsasfor adjectives. Thewoundisverysore. Sheisshaking more violently now. Itlooksserious. He is bleedinglessprofusely than before. Thatdoesn'tsoundgood. Mr Janssen'sheart isn't beating asfast as it wasthirty Heneedsstrongepr ainkillers. m i n u t e sa g o . Wecanalsousethe PresenSt impleto talk abouta habitorrepeatedaction.Thisis sometimescombined We generally don't use adverbsin the superlative with an adverbof frequencysuchasolftenor regularly. form. Shefalls oververyeasily. Hedoesn't akehismedicationeveryday. Unit2 D o y o ug e tp a i n si n y o u rb a c k ? Talkingaboutthe present With someverbsw, e canuseeitherthePresent ContinuousorPresenSt implewith no realchangein Thereare severalways to talk about actions in the meaning,e.g.hurt,showo, rwork. presentor recentpast.
1 2 0 Cr am m arr ef e re n c e It hurtsjust here. U n i t3 = It'shurting justhere. Typesof questions TheX-ray showsa hairlinefracture. = TheX-ray'sshowinga hairlinefracture. Weusedifferenttypesof questionsaccordingto the kind of informationwewant. Thetabletsdon'twork. --Thetabletsaren'tworking. Yes/ no questions Sayingwhat'snecessarpyolitelybut firmly TheseareclosedquestionsT. heydon'tbeginwith a questionword,andgenerallyrequirea'yes'or'no' Togiveapoliteinstructionw, e oftenuseYouneedto + answerW. ith yes/noquestionsw, e invertthe subject i n f i n i t i v e .T h i si s l e s sd i r e c t ,a n dt h e r e f o r em o r ep o l i t e , andverb. than usingthe imperativeon its own. Haveyou got themedicationwithyou? Youneedto takea courseof tablets. I s y o u r k n e ep a i n f u l ? Nor@ Doyou takeyour medicationeveryday? C a n y o u b e n d y o uarr m ? Wecanusethe negativeforrr.ronf eedtosaythat somethingisn't necessary. lVh-questions Youdon'tneedto maketheappointmenyt ourself. Whenwe needto havemoreinformation,we ask However,we dousethe affirmativeandnegative openquestionso, ftenbeginningwith a question imperativeaspart of aninstructionf,or example word such aswhere,what,when,how,why.Theword combinedwith an r/-clause. orderisthe sameasfor yes/noquestions. Askyour GPif you.'reconcernedo. rIf you're W h a t ' s t h ep r o b l e m ? Wheredoesithurt? concerneda, skyour GP Howlonghasyourlegbeeninfected? Don't waitfor thepain togetworsebeforecontacting Howeverw, e canmodifythesequestionsto make your doctoragain. them evenmoreopen.Wecaninvitesomeoneto talk aboutordescribesomethingby usingCanyoutellme TheexpressoinDon'thesitateto + infrnitivewithout ...?or Whatdoyouthink...? to isafixedphraseandindicatesa desireto behelpful. Don't hesitateto caIIme. C a n y o u t e l lm eh o wi t h a p p e n e d ? Whatdoyou think theproblemis? Otherstructureswe usewith an r/-clauseor other contextareYouhaveto / Youmust+infinitive without to. Notethat in the sentenceasbovet,he questionform is Ontheir own,they aremuchtoodirect. indirect. If thepaingetsworsey,ou must/ haveto letusknow NOT immediately. Wecanuseawordsuchaselsein yes/noor wh- Alternativewaysof making a directinstructionsound questionsto elicitalongerrepiyfrom apatient.Note morepolite,or of making unwelcomeinformation the positionof.else. soundmoreacceptablea,reYou'regoingto haveto / YouI'Ihaveto / YouI'I need to + infrnitivewithout to. Doesithurt anywhereelse? You'regoingto haveto beadmittedl,'m afraid. Whereelsedoesit hurt? He'IIhavetowaitsometimeforabed. Is thereanythingelseyou'dliketo talk about?
C rammarreference'121 Unit4 ought tototry to persuadesomeoneto do something. Youshould eat morefruit and vegetables. G i v i n ga d v i c ea n dt a l k i n ga b o u t Youought to attend all the antenatalappointmentsif expectation you can. Thereareseveraw).aysof talkingaboutthe bestthing Youshouldn't try to do too much housework. to doin a situationW. egenerallyusemodalverbs, which arefollowedby infinitive without to. We canalsousethe negativequestionform Can'tasa persuasivedevice. Possibility Can'tI havean appointmentsooner? Can'tyou referme to a different clinic? Weusecan andmayto talk aboutpossibility. Eatingcertaintypesof cheesienpregnancycan/may Note that we often usenegativequestionforms when we are (orwant to sound)lesscertain about b ed a n g e r o u s . qorncihino In the questionform,we tendto onlyusecan,asmay isusedmorecommonlywhen requestingpermission. Shouldn'tI betaking any othersupplements? C a nd r i n k i n gr a wm i l k a f f e c tt h e b a b y ? Can't exercisebe harmful to the baby? Permission Expectation Wealsousebothcanandmayto requestpermission. We also ts e should/ shouldn't and ouaht to lo talk Youcan/maycontinuetoplay mostsports. about expectation. Youshould/ought to becarefulabout drinking too In the questionform,we usemayto askabouta specificrequests, uchasopeningawindow.Weuse much caffeine. canwhenwe areaskingabouta generasl ituation. Youshouldn't havemore than threecupsof coffeeper CanI drinkanyalcohodl uringpregnancy? butMay I haveaglassof waterp, lease? day. Necessity Conclusion Weusuallytalk aboutnecessityby usingtheverb We usemustor can'tto cometo a conclusionor make need+ inflnitive. a deduction. YouI'Ifind you need to rest morefr equently. An epiduralmust bequitepainful,surely? DoI needto starttakingfolic acidnow? I can't bemorethan sixweekspregnant. Obligation Unit5 Obligationis a strongerform of necessityW. e generallyusemust/mustn'tandhaveto to taik about Phrasavlerbs- separablaendinseparable obligation. Pregnanwt omenmust/haveto takeevery Phrasalverbs are verbs usedwith different particles which changethe meaning of the verb,e.g.get in and opportunitytoputtheirfeet up. get over.Themeaning of thesetwo phrasal verbs is Youmustn'tdoanythingthat risksraisingyour blood easyto understand. Somephrasal verbs are more idiomatic, sothe combination of verb.+particle gives pressurfeurther. a specialmeaning,e.g.getoveralsomeans'recover'. Notethat the questionform of mustisMust+ subject, but it ismorecommonto useDo+ subject+ haveto. Somephrasal verbs have an object.Often,the verb DoI haveto havea speciadl iet? and the particle areseparable. NorW Thesurgeonput onhis gloves. Thesurgeonput hisgloveson. Persuasion However,a pronoun always goesbeforethe particle. Asaform of advicew. e useshould/shouldn'at nd He took them off again.
1 2 2Cr am m arr ef e re n c e Nor lle+eer4f+heffingah+ The negativeform is didn't useto. Theredidn't useto bea direct busfrom hereto the With somephrasal verbs,the verb and particle can't be separated.This dependsentirely on the meaning hospital. of the phrasalverb.Forexample: get usedto get someonedown = depresssomeone We useget usedto + noun or -ing formlo talk about becoming accustomedto a person,thing, or situation. NOT We can useget usedto in any tense,and form the negativeaccordingly. getdownthestairs He'sgetting used.tothenew rota atwork. =walk downthe stairs They'vegot usedto working together. Nor ge++M{i+ I won't get usedto living in a city veryeasily. but Shecan't get usedto thesenew uniforms. getsomefooddown = eatsomefood be usedto Thesephrasavl erbshaveto belearntindlvidually. Weusebeusedto+ noun or -ing formlomeanthat we are accustomedto a person,thing, or situation. We Unit6 alsouse be usedto in different tenses. would, usedto,get usedto, be usedto We'reusedto a more dynamic environment. Shewon'tbe usedto running sucha largedepartment. would Purposeand leason We use would + infinitlve without to to talk about a habitual orregularactlonin the past. We use to and in order tobefore a clausethat WhenIworked at the hospital,Iwould oftentake the explains a purposeor givesa reason.ln orderto is often regardedasbeing more formal than to and train becausethe parking wassobad. can carry more emphasiswhen the opening clause He would.get through a packet of cigarettesa day. is long. However,in many casest,hey can be used interchangeably. We canusethe negativeformwouldn't. Youneedto take regularexerciseto / in order to Whenshewasalive,shewouldn't answerthephone impr ovey our generalfitne ss. unlessshewasexpectinga caII. I'll giveyou aprescriptionfor sometabletsto / in order used to to helpeasethepain. We use usedto + infinitive to talk about habitual or Note that to / in orderto must befoilowed by the reguiar actionsin the past. infinitive without to.We can't introduce a pronoun. WhenI wasdotng an earlyshift,I usedto have Nor You need to take regular exercisete/jnerderle breakfastat the hospital Nor Youneed to take regular exercisetel-inerdetle Sheusedto eattwo chocolatebarseveryday. yefr+v;11@M+e+ We can alsouse usedto + infinitive to talk about a stateor continuous action in the past. He usedt.o bea heavysmoker. Nor@ Theyusedto work in my department. NOT
C rammarreference123 Unit7 doctor to explain,but it was unnecessarybecause they later found a leaflet.In the secondsentence, Commentingon the past didn't needto suggeststhat the peopledidn't askfor an explanation becausethey d alreadyfound the We often usethe conditional perfectformwould 1eaflet. have+ pastparticiple to talk about situations in the past happening differently. In informal language,we Verbswith fo and-ing sometimesusethe contractedformof have. Iwould've gone to seethe doctorsooner,butlwason Someverbs arefollowed by the infinitive, and others arefollowed bythe -ing form. holiday. Verbs followed by the infinitive: It wouldn'thave made much dlfference. We canuseother verbsin this structure: T h e s ei n c l u d e : agree,qrrange,ask,choosed, ecide,expectf,orget, hope, musthave manage,offer, plan, prepare,promise,threaten,want, wish s to talk about deduction Sheneverpicked up herprescription.Shemust've Weofferedto give the man a Iifi to the hospital. got better. He didn't want to seeafemale doctor. can'thave Verbs followed by the -ing f.orm r totalkabout a negativededuction Thereare stillpatients waiting. Doctorlarvin can't T h e s ei n c l u d e : haveleft already. admit (to),avoid,carry on, consider,deny,dislike,enjoy, fnish, give up,imagine,involve,keep(on),mention, could.lcould.n't have practise,regret,remember,risk,suggest r to talk about possibility in the past or a lack of He denied wasting the surgery'stime. opportunity in the past It's just aswell the notesmention her allergy.She Payattention to the position ofthe negative could have beentaken seriouslyill. form. This dependson whether the main verb or I couldn't havegone to the hospitalthat day evenif subordinateverb is the negativeelement. I'd wanted to. I regret not telling myfamily sooner. shoul d/ shouId.nt' have N.B.this is the oppositeof I don't regret telling my * to talk about past obligation or to adviseon a family sooner. courseof action in the past Youshould have asked.forclarification if you had Verbs followed by the infinitive or -ing fotm any doubtsaboutyour treatment. Therearesomeverbsthat canbefollowed by either Theywerequite hostile.Theyshouldn't have spoken the infinitive orthe -ingform, with no changein meanrng. to you like that. Theseinciude: need.n'thave (didn't needto + infinitive without to) continue, intend,Iike,Iove,mean,pr efer,start,try r to talk about a courseof action in the past that I'll continue working / to work herefor aslong asI can. Theytried talking / to talk reasonablyto the man,who wasn't necessary Weneedn't haveashedt.he doctor to explain the wasbeingveryaggressive. condition,astherewasa very helpful leaJlet. Instead of needn'thave.we can use didn't needto + inflnitive without to. Wed.id.n'tneedto ask the doctor to explain the condition,astherewasa veryhelpful leaJlet. However,the difference is that in the first sentence, needn't have suggeststhat the peopledid askthe
1 2 4 Cr am m arr ef e re n c e U n ESt UnitS Relativepronounsin explanations Thefuture We often userelative pronouns to connecta seriesof Thereareseveradl ifferentwaysof talking aboutthe sentencesdescribing an activity or situation. future. Thesepronouns are who,which,where,and when.The wiII pronounswho andwhich canbe replacedby that. Weusewf//to talk aboutthefuturein general. Who Thepresentationwillfinisaht about4 o'clock: Therewon'tbemuchtimefor questionasfterwards. r usedfor people,and can be combined wlth a Wecanalsousewill in the main clauseof afi.rst conditionalsentence. nrenncit i nn If thepresentationfinishesearlier,there'll bemore Thep atient, to who(m) the consentfor m wiII be timefor questions. given,must besufficientlyalert to slgn it. PresentSimple Which Weusethe PresenSt impleto talk aboutthefuturein * refersto things, procedures,or situations. Which the f-clauseofa first conditionasl entence. can alsobe combined with a preposition. WealsousethePresenSt imnleto talk aboutfuture Thetube is then connected.whichenablesthe timetabledevents. p atient t o breathe normaIIy. Dr Carlin'strain leavesLondonat 1.30andgetsinto Thepatient is connectedto a monitoring device,to which other tubesareattached. Oxfordat 2.10. Thisis a procedureinwhichwe removepart of the bowel. Wealsousethe PresenSt implewith time expressions suchasbefore,after,asos onas,andwhen. Where Weneedto makesurethat everythingisreadybefore r = 'in which'. We use whereto talk about what is Dr Carlinarrives. involved in a procedureor situation. Thisis an operation where we removepart of the NOT bowel. Whenhegetshere,couldyou let me know? When NOT r ='after which time' or'at which poinl'.When PresentContinuous describesa point in a sequenceof eventsat which somethingis expectedto occur. WeusethePresenCt ontinuousto talk about Theanaestheticis reducedand thepatient taken to somethingthat hasbeenplannedor arrangedW. hen the recoveryroom,when he or shewill start to come this includestimetabledeventsi,t ispossibleto use round. eitherthePresenSt impleorthe PresenCt ontinuous. Theceremonyistakingplacein November. Sometimes,we can omit the relative pronoun and have a participle asa connector.This is common or TheceremonytakesplaceinNovember. when we are connecting more than two clausest,o However: avoid having a sentencethat is too long and clumsy. We'resendingout invitationsoverthenextcoupleof Thisis a complexprocedure.It isperformed under weeks. g e n e r a la n a e s t h e t i c . Nor Wesendeatinvitations... Thisis a complexprocedure,performed undergeneral Future Continuous anaesthetic.(='which is performed') Weusethe FutureContinuousto talk aboutan We'regoing to do a procedurewhich will involvemajor actionthat will behappeningat a givenpointin the future.Thiscanbepart of a scheduleor canbea surgery. We'regoing to do a procedureinvolving major surgery. (='which will involve')
C rammarreference125 continuous action.However,this tense must always Weusethe when there is only one of the thing we're be usedwith atime reference. talking about. W|II the doctor bestarting her roundsbefore10.30? Thegovernment iscutting spendingon health. Thistime next week,y ou' II beJlying back to the USA. (=the government of a particular country) = Subject+will+be + -ingform The sun isa major sourceof vitamin D. Future Perfect a,an We usethe Future Perfectto talk about an action that wlll havefinished at a given point in the future. Weusethe indefinite articlesa andan beforeslngular countablenouns when it isn't necessaryto make D r Singh wiII have finished his rounds by lunchtime. clear which particuiar thing we aretalking about. = Subject+ will + have+ pastparticiple Weneedto make a decisionabout thefuture of this W|II he have left intensivecareby then? unit. (=any decision) Future Perfect Continuous Comparewith: We usethe Future PerfectContinuousto talk about an actionthat leadsup to a given point in the future. The Thedecisionwasnotvery popular. action isn't necessarilyfinished at that future point. (=the decisionthat was eventually made) Thisis a longpresentation.Byfve o'clock,Dr Schwartz Anumber ofpeoplehavepresentedwiththesame wiII havebeentalking for an hour and a half. symptoms. (= it's possiblethat Dr Schwartzwill contlnue beyond (=several) five o'clock) = Subject+ will + have+ been+ -ing form Bingedrinking is the major causeof liver disease. (=it is a significantly greaterfactor than other U n i t1 O p o s s l b l ec a u s e s ) T h ed e f i n i t ea n d i n d e f i n i t ea r t i c l e zero article We useno article (zeroarticle)before plural or Therulesfor using the,a,an,orzeroarticleareas uncountabie nouns when we aretalking about follows: somethingin general. the Diseaseis a majorfactor in early mortality in many developingcountries. Weusethe definite article the beforesingular or (=diseasein general) plural countablenouns when we want to make it clearwhich personor thing we're referring to. Peopleneedto be informed about safelevelsof consumption. Thediseaseisspreadingvery quickly. (=peopleeverywhere) (= a specificdiseasew, hich we havetalked about in a previous sentence) Comparewith: Thepeople who drink and smoketo excessare the Thenumber ofpeoplebeingadmitted to hospitalwith oneswho costthegovernment most. 'flu has increased dramaticaIIy. (= a specificgroup of people) (= a specificquantity) Governmentsare looking to reducehealth costs. Bingedrinking is a major causeof liver disease. (=the governments of severalor all countries) (=there are other factors,but we don't know how significant they are)
1 2 5 Cr am m arr ef e re n c e UnitlI Thepatient is taken into recoveryA. fter this,he or she isreturnedto the ward. [inking words next Thereare severalways of linking ideaswithin sentencesand between one sentenceand the next. Next is similar to aft er that. However,we tend to use next at the beginning ofthe sentence. when Next,the patient is returned to the ward. Whenreferslo a particulartime or stagein a process. once When a person is bitten by the tsetseJIy,he or shemay Onceasa time referencemust be followed bi a clause. experiencesymptomssuchasfeverand headaches. It means that the next stageof the processcan't begin At a later stage,sleepingsicknessentersa neurologtcal until the previous stageis completed.The second stagefollows on immediately. phase,when the parasitepassesthrough the blood- Oncethepatient recoversh, e or sheis taken backto the brain barrier. ward. where NorW Whereexpandson a processor procedure. The PresentSlmple and PresentPerfectcan be used In a biopsy,wherea sampleof tissueis removedfor after oncewith no real differencein meaning. Oncethe patient has recoveredh.,e or sheis taken back further testing,thepatient is ofien given only a local anaesthetic. tothe ward. Where canalso describea location, as soonas Thecamera is Insertedinto the stomach,whereit is As soonasis similar to oncein meaning and use. able to take imagesof the lining. However,assoonas+ PresentSimple suggeststhat two stagesare happening almost at the sametime. then .Assoonas thepatient comesround,let me know. Ihen introducesthe next stagein a processor As soonas+ PresentPerfectsuggeststhat the first procedure.Lookat how the punctuation is used. action is completed beforethe secondone begins. Then,theparasite entersthe bloodand lymph systems. As soonasthe doctorhasconsultedwithhiscolleaque. Thelymph nodesthen swellup. If left untreated,other symptomssuchasanaemiawill hewill speaktoyou. appear,and then the diseaseentersa neurological Unit12 phase. Negativequestions after that We often usenegative questionsto avoid being overly After that is a generalterm, signalling the next stage direct when making a demand or criticism, or when in a processor procedure.Thereis no indication of reminding or persuading someoneto do something. how much time has passedbetween the two stages. Its meaning and useis similar to then.We can say Thechoiceof a negativequestioncan suggestthat the aJterthat happensto refer more specificallyto an speakerhas expectations and wants to avoid a direct action that hasjust beendescribed. 'yes'or'no'responseA. lessdirectquestioncanalso Thediseasehad practically disappearedbetween1969 showthat the speakerls trying to avoidcriticism.For example,beginning a questionIsn't the consultant and 1965A. fter that, screeningand surveillancewere going to betalking to my daughterlis much less relaxedand the diseasehas now returned. assertivethanls the consultantgoing to talk to my dauqhter? after this A J t e rt h i si s s l i g h t l ym o r es p e c i f i ct h a n a f t e rt h a t , a n d meansmoreimmediatelyafterthelastpointor stage made.Wecanalsosayafterthishappens.
C rammarreference127 Themost straightforward type of negative question is one that appearsto be requesting information. Aren't thesetabletsvery expensive? The speakerknows that they're expensiveand is checkingthat this is understood.Comparewith the more open affirmative question:Arethese tabletsvery expensive? When we expectsomething to have happened,we canusethe negativeformHaven't / Hasn't.The addition ofyet makesthis a stronger criticism. Haven'tlhey found my recordsyet? A questionbeginning with Can'tor Couldn'tis an attempt to persuadea personin a decision-making role to agreeto their demand or request.The choice of an affi.rmativequestion would risk inviting a'no' response. Can't/ Couldn'tI (just)caIIin andget the results myself? An alternativeisWouldn'tit bebetter...? Wouldn't it bebetter if I phoned the hospital myself? We often conveyshockor surpriseaswell as criticism by beginning a questionwlth Shouldn't. Shouldn'tyou havetold usabout thissooner? It would not make senseto begin this question with Should.The speakeris implying that the other personis acting irresponsibly.We could also useCouldn'there,to indicate that it was within another person'scapacityto do somethlng. Toremind someoneabout something,we canuse Didn'tyou say...?This is followed by an indirect speechclause,but endsin a questlon mark. Didn't you saythat I would benearthe top of the waiting list?
1 2 8 Lis t eninsgc r ip ts L i s t e n i nsgc r i p t s Unit T D When shefell,how did shefall? it most probably made the difference P Shejust crumpled to the ground between life and death. listening t slowly.In fact,it all happened so Daveemphasizedthe importance of D=Doctor,P=Patient abruptly and silently I didn't realizeit quick intervention when someone D Hi, Mr Stone,I'm Dr Tariq,one of the had happened. suffersa cardiacarrestand took the D Soshe didn't cry out or anything? opportunity to remind members doctorsin A&E.How areyou? P No,there was no warning sign at all. of the public that they can Iearn P I'm OK,but I'm a bit worried about my D Justa few more questions. cardiopulmonary resuscltation- or CPR P OK. - at free'Heartstart' classesgiven across wife. D Has she ever had anything like this the capital by the LondonAmbulance D Your wife's OK. before? Serviceand supported by the British P That'sgood. P When I cometo think of it, shepassed Heart Foundation. Effective CPRbuys D Amir, one of the paramedics,saysyou out oncebefore about a month ago. time for a patient and doublesa person's Shehasn't been feeling well off and chancesof survival. were walking along the streetwhen on overthe summer. We thoueht it your wife coliapsed.Can you tell me was the heat. Unit2 a bit more about what vou actuallv D At the moment it lookslike ... saw? listening 1 P Mmm. Yes,sure.We were shopping Listening 2 in CambridgeStreetin town, when D=Doctor,P=Patient suddenly Barbara,my wife, just Gary Edwards,a Brltish Airways fainted. Mmm, we tried to get her c u s t o m e rs e r v i c ea r r i v a l sa g e n t ,h a d D Youlook asif you arein quite a lot of upright and shestartedtwitching been sitting with hls work colleagues pain. quite violently. it was quite scary. ln a rest room at Heathrow Airport's D Yes,it certainly can be,but it can Terminal One when he suffered severe P Yes,I thlnk I've hurt my hip badly. it's happen when peoplefaint like thls. pain in his chestand arms.Within giving me a lot of pain. Did anything elsehappen? seconds,he Iost consciousnessand P No.Nothing at all. Shecame round stoppedbreathing.His British Airways D I think we needto get you some very rapidly.But we dialled 999 and a colleaguesimmediately dialled 999 for painkillers. So...can you tell me a bit paramedic appearedalmost instantly an ambulance and began attempts to more? and then the ambulance almost resuscitatehim. immediateiy afterwards. Do you think P Oh,I slipped on the kitchen floor.I she had a seizureor something like All he can remember is that he had must have spilled somewater and I epilepsy? got up from the sofaand saidto his was coming into the living room with D We don't think so.But can I ask coileaguesthat his chest and arm hurt. a cup of tea and I just went down on you a few more questions?Did she After that, everything went blank. my bottom and twisted my leg. complain of anything before that? Within secondsof the 999 call being P Mmm. Shehad been complaining of made,cycleparamedic DaveParks D Oh,dear.That sounds bad. feeling a bit unwell, and had almost reachedMr Edwards.Davewas able to P It was. I couldn't move. Fortunately, fainted and shefelt a bit woozy? She continue resuscitationand re-start Mr ...yes,er...shewas abrt dizzy and she Edwards'sheart after three attempts I had my mobiie in my apron pocket was yawning repeatedly and then all using the portable deflbrillator that is and I phoned my neighbour who of a sudden,there she was, lying on carriedon ambulancebicycles. had the key to come in. Shecaliedan ambulance. +ha nrnrrnz] Paramedics,dispatchedin an ambulance D Fallslike this happen so easily.You at the sametime asthe bicycle may just have pulled a joint out of D Anything else?Was she ill or anything ambulance, arrived a few minutes later placerather than breaking anything. before shefell? to continue treatment and took Mr 2 Edwardsto hospitai.This resuscitation D What's brought you heretoday? P No.lust tired. showshow well-suited bikesareto P My wrist is really hurting. I think I've D What about her eyesight? reachingpatients quickly inside the broken it. P Nothing, but shesaidher hearing airport.As they arebasedat the airport D OK.How did it happen? and were able to get to him so quickly, P Weil, I was coming out of a shop and was a bit funny - shewasn't hearing I was trying to avoid someoneand I clearly. didn't notice the paving stonewas D Anyvomiting? P No.
Li steni nsgcri pts1 29 raisedand I just tripped and of course it is too late to go back and take P Idon'tknow. Itmaybethework. I I put out my hands to protect myself precautions. type a Iot. and break my fall. My wrist took the full force of my fall. There are many simple piecesof advice D OK.Soyou sit at a desk a1lday. D It certainly looks quite bad,yes.I think that can be given to prevent accidents P Yes. we needto do an X-ray. in the home like fitting stairs with D Mm. Now the pain,doesit ...? banistersor rails and making sure 3 that halls and stairways are well lit. Conversation B D = Doctor, ! = Patient's father Encouragingpeopleto climb up only D What's happenedhere? on something firm and strong canhelp D Sowhat has happened to you, Mrs F Shefell down from a tree at school reducethe risk of falls.Another thing to Skinner? avoid is looserugs and flooring in order and they calledme and I camehere to reducethe rlsk of slipping or tripping P Well,I've hurt my hand. from work asthe ambulancewas especiallywhen old people or children D Tellme a bit more about it. bringing her here. are around.And if small children are P I've had it sincethe week before last D Oh,I see. about,ponds and swimming poolsin F She'scrying a lot and Ithink she's the gardenneedto be covered. here on the heel of my hand, and I'm fractured something in her leg. flnding it difflcult to work and also D Shemay not have broken anything, DIY at home or home improvements to go to the gym. I've tried painkillers but let's have a look at her. is another areawith potential for and that, but they haven't worked. accidents.When using power tools, When the tablets wear off, it's still [anguagespot people need to be encouragedto use there.I don't have a touch of arthritis, adequateprotection including sturdy do you think? 1 Soyou'vetakensomepainkillersb, ut shoes,gloves,and goggles. D At this stageit's difflcult to say.It's something we have to try and rule they don't work,andyour arm'sstill U n i t3 out. But can I just askyou what you hurtingyoujust here. think causedit? [istening 1 P I don't really know. It may be the 2 Mytoe is throbbingwith pain.I don't work. D=Doctor,P=Patient D Canyou tell me when it is worst? know what I'vedone.It looksasif it's P Mmm. When I'm at the gym, when Conversation A I'm typing, and when the bossis broken. around! D Sowhat has happenedto you, Mrs D Yes,I can imagine the bossmaking it 3 He'shadseveraflallsrecentlyand Skinner? worse.Youmentioned the gym. P Yes. hehasseveraflracturesb. ut he'snot P Well,l'vehurt my hand D Doyougoalot? D Right.When did it happen? P Yes,I do. cn r i _n_q' b *a _l n- t_' P I've had it sincethe week beforelast. D Id just like you to put your arm ... D Hm,wheredoyou getthe pain? -_j P Here on the heel of my hand. listening 2 D Isthatbothhands? Listening2 D=Doctor,P=Patient D l\\ln irrcl thi< nnp D Alexander, you've had quite a bang on As health professionals, we give advice about healthy lifestyles, which should D And have you taken anything for it? your head. inciude accident prevention. When P I'vetried painkillers and that, but they P Yeah,and I'm surprisedI feel OK.I we use tfre word accident,it seemsto lmply that accidents are unavoidable. It haven't worked.When the tablets thought it might give me a really bad is true that we do not live a life free of wear off, it's still there. I don't have a headacheor something, but I really risk,but the danger of accidentscan be touch of arthritis, do you think? feel fine. I'm just a bit shaken,really. minimized by simple precautions ...and D At this stage it's difficult to say.It's D Yes.Thesethings can knock you quite thinking ahead. something we have to try and rule a bit. Youstill needto be careful over out. But can I just ask you what you the next twenty-four hours, even We can,for exampie,make patients think causedit? though you feel flne. aware of the potential for risk.All risk P I don't really know. P What? Youmean I haveto stay inthe situations including those in the home D Anything at work? hospital? or garden,in the workplace,on the road,or during leisure activitiessuch as hillwalking or mountain climbing should be treated with due respect. Peopleneed to be reminded to think of others,especiallychildren and the elderly.Oncean accidenthas happened
1 3 0 Lis t eninsgc r lp ts D Oh,no,you don't needto stay in U n i t4 D Well since it's your flrst, it's probably hospital,but we needyou to look after best.We'll checkyour details Iater and yourself and rest for the next twenty- Iistening sod out the hospital. four hours. D=Doctor,P=Patient P Soyou'll iet me know which hospital P Rest?But I can't. I have to go to my it']I be? bestfriend's party this evening.I just Exercise4 can't miss it. He'sgetting married D Good morning, Mrs Canterbury.How D Yes,that's right. Now I just want to tomorrow. ask you a few questions about your areyou enjoying this flne weather Iifestyle. Do you eat sensibiy? D But I'm afraid you do needto be we're having? careful. And you need to have P I love it. It's beenthe bestwe've had P Generallyyes,though I do skip meals someoneto go home with you and for a long time. sometimeswhen I'm rushed stay with you for the next twenty- D Yes,it's been remarkable.Let'shope it four hours aswell. continues. D Well, it's very important now that you P Well, I think it may. make sure you eat nutritious food P But I feel OK.I mean, why allthe fuss? D Yes.It looks like it. So,what can we do regularly. D Yes,you may feel well, but some for you? P Mmm, well, doctor, it's not really P I realizethat. Um, doesit matter what things may develop afterwards. trouble, I think... I think I'm expecting. I eat? P Like what? D Ah, I see,and are you happy about D Youmay get a headache. that? D Yes,there are certain things you need P Well,I can take a paracetamol. P Oh,yes,we've been trying for ages. to steerclearol like shellfishand soft D Yes,butotherthings couldhappen D OK.Weil,let'stake some details.Can cheese.You don't want to risk any you remember when your last period kind of food poisoning. Now what like blurred vision or vomiting. was? about alcohol? P OK,but I can come back if anything P Mmm, not exactly, but probably about six weeks ago. P A couple of glassesnow and then, but Soeswrong. D Soyou think you've missedone? I haven't been on a binge for ages. P Yes.I'm as regular as clockwork. Pronunciation D Any other changesyou've noticed? D Good,well keep it that way. Alcohol P Er,I do feel a bit sick most mornings, should really be avoided in pregnancy, 1 Can you tell me a little bit more about and my breastsfeel a bit tender. but the occasionaldrink will do no how it all happened? D Right, if I give you a little bowl, can harm. Do you smoke? you just pop to the toilet and bring 2 But if your child's mood changes in back a samplefor me? P Occasionallyb, ut it's not a real habit. any way, make sure you contact us D Well, try to cut down, if not give up immediately. Exercise5 D Well, congratulations,Mrs Canterbury altogether.With a growing baby 3 But I can't.I haveto go to my best inside you,you needto be very careful friend's party this evening. you were right, you are expecting, what you are putting into your body. and ifyour dates are correctyou're Are there any questions you d like to 4 But I'm afraid you do needto be probably about four weeks gone. ask? careful. P Oh,sothe baby'll probably be born in P No. October. D And congratulations, Mrs Canterbury. 5 I'm not sure but I think I've torn a D Around then, yes.We'lI be abieto be P Thankyouverymuch. ligament in my foot. It's swollen and I more preciseafter you've had a scan. can't get my shoe on. P Whenwillthatbe? Pronunciation D It's usually done at about twelve 6 i've had it sincethe week beforelast, weeks. By that time we can usually 1 At vaginal hysterectomy, the uterus is here on the heel of my hand. get a clearpicture of the baby.Now, brought down through the vagina. I take it you'll haveyour baby in 7 And you need to have someoneto go hospital? 2 What happens is the womb is brought home with you and stay with you for P I haven't really thought about it. down through the vagina. the next twenty-four hours as weil. 3 Pre-eclampsiaispregnancy-induced hypertension with proteinuria with or without oedema. 4 It's a condition where the blood pressureis raisedwith protein in the urine and possibly swelling. 5 Normal labour is often heraldedbv a show.
Li steni ngscri ptsl3l When an induction is being planned, [istening 2 way and down she goes.I don't know the state of the cervix will be how shehasn't hurt herselfat all. assessed. D=Doctor,P=Patient 2 Ankle swelling is very common when D Now, I want to askyou about some M=Man,W=Woman you're pregnant. M It was really exciting,the whole It tends to worsen at night? Well,if experienceswhich sometimes people experience.But I'm not sure I d want you use a firm mattress and wear flat have but find it difficult to talk about. to go through it that often. shoes,it will help. Theseare questions I ask everyone.Is W How many peoplewere there? that OK? M Fiveor six others,l think. They were U n i t5 P Yeah. very high calibre.A coupleof them D Have you ever had the sensation that had years of experienceworking in listening I you were unreal or that the world had careofthe elderly.One used to run a becomeunreal? geriatric hospital in his own country. He'sCaucasian,around about fifty years P lt's like ...I don't know how to explain I don't think I stood a chance. of age.His ciothes are very extravagant it. It's ...I supposeit's like being in a with iots of clashing bright colours. But play somehow.That maybe sounds as 3 he is not very clean in himself, and he W=Woman,M=Man doesn't look as if he's eating properly. It's irfr rr'*rrr E^^vir-r^r5 r*r^rlqu. W Thereare a coupleof things that the f,rst time that I've seenthe patient, but he looks just a little thin. D Have you ever had the experience of could be done to help this patient. hearing noisesor voiceswhen there We could get in occupational health He'snot very aggressivej,ust elated was no one there to explain it? to get things like a perching stool and is talking rather fast.Thereis installed and grab rails. copiousrapid speech,which is hard D Vpc cnmetimp< M Yes,and alsoflooring and lighting. to interrupt. He talks at a much faster And I don't think all the clutter helps. rate than normal, which may reflect D Is it OKto talk about this further? As the placeis full of rubbish, small the accelerationof speedof thought in P Yeah,if you want. changeslike that will help a lot. affective illnesses.The patlent stutters D When did it happen? slightly and speaksrather Ioudly. P The last time was a coupleof days 4 D = Doctor, C = Consultant His speechhas a rhythmic pattern and ago. D And apart from the expressionthere he usesa range of intonation patterns D Were you fully awake? appropriately.The speechis appropriate P Yeah,it was during the day. are other tell-tale signslike diffculty to the situation,though it is fast.It is at D How often has it happened? in swallowing, a decreasein the blink times pointlesswith digressions. P Recentlyonly onceor twice. rate,and Iead-piperigidity. D And where did the sound appearto C Did you pick up anything elsewith There are no word-finding diftrcuities this patient? nor any neologisms. comefrom? D Mmm... the handwriting. P I don't know. From someonein the C What about it? Pronunciation D It was really small.His wife saidin room. the past he would write very long 1 I can laugh at the problems I have. elegantletters and now... 2 It's difficult to distinguish one day Unit5 listening 2 from another at the moment. [ i s t e n i n g1 3 Of course I care for the child. D=Doctor,P=Patient 4 I'm not trying to hint at anything. I D Can you tell me how it affects you, 5 Sheinsistedon going home. 6 I sometimesblame myself for the M=Man,D=Doctor Mrs Day? M Sheusedto be able to get around P I don't know where to start.I feel tired day-to-dayproblems. 7 The child dependson me for quite easily.In fact, she would often a lot of the time becausethe pain go out all overthe placein the bus. keeps me awake at night. And at work everything. And I think she finds it difficult I can't sit for long. I haveto get up and getting used to the changesin her walk around.At work, peopledon't life. But now she saysthat she gets know how bad it is and it upsetsme a bit muzzy in the headwhen she's when they make comments. standing at times and then when she managesto sit down it all passes. D Has shefallen at all? M Mmm, yes.Sometimesshe doesn't make it to a chair and her legs give
1 3 2L i s t e n i nsgc r i p t s D Unfortunately, unless people have D Sowhat can we do for you? P OK. things like this themselves,they don't P Well,I've got this rash with big D From what I can seeit's acne. realizehow badlt is. P Can you do anything for it? wheals all over.And it's quite itchy D Oh,yes. P No,I'm afraid not. and getting worse. P That'sa relief. D Isthere anything else? D Oh,yes.It doeslook quite dramatic. D Hasthis beenupsetting you? P Mmm... it stopsme doing certain Canyou tell me some more about it? P Yes,a little. P Well,I just suddenly came out in it D Canyou tell me how? things ...like I can't catch the bus, last night. It started on my back and P I get teasedat collegeabout it, and I becauseI'm afraid of falling if the bus then it just spread.I put some lotion suddenlyjolts,and I can't reaily go out on it, and it helped for a while ...and don't like going out aspeoplelook at and enjoy myself. then I thoughtthey aregetting sobad, it ...and I think it's dirty. And it keeps D What about the tablets your GP I'm itching all over.Andwith the heat getting worse.I've tried cutting out prescribed?Have you been taking it's unbearable. certain foods,but nothing works, and them? D Soyou have them everywhere?OK, using different creams and stuff. P Not really.Sometimes. we'll have a look in a moment. But can D Well, I can assure,it's nothing to D Sometimes. you just tell me ...you said you used a do with being dirty. And it's more P Yeah. Iotion? common than you think. Youare D Canyou tell me why that is? P Calaminelotion. It was all I had,and nearly seventeennow? P I don't like taking them in caseI get then this morning I came straight P Yeah. hooked or anything like that or in case here. D Weii,the peak age is about eighteen. they affect my stomach. D Yousaiditching. Is there any pain And diet doesn't affect acneeither. D But when you do take them, do they with it? P Ah,OK. help? P No,just itching. D But the creamsyou'vebeenusing P Yes,for awhile. When the pain is so D OK,just itching. Have you had it might just make it worse. bad I can't bear it, I take them. before? P Mmm, yeah,I shouldn't haveused D Soyou take them when the pain's P Yes,once I had it, and i came here and them. I should'vecome here. intolerable. they gaveme some antihistamine, D Yes,but you're here now - that's the P Yeah. and it went away,but it wasn't as D Have you been doing any bad asthis. I should'vekept the name r'.^rihr a r r r +r}r\\ihr^u r E , . physiotherapy? of the tablets or kept some asthey P No, not really. helped before.They just seemto be P Yeah. D What about exercise? spreading all over. D Sowhat we need to do first is to P When I start to do anything it hurts a D Werethe tablets Piriton? Iot. Soit puts me off. P Yes,I think they were. reducethe number of spots. D WelI,you know, to help improve your D OK.Is there anything you think that P OK. strength and build up your muscles, might havetriggered this? D Acne'snothing to do with poor exerciselike swimming reaiiy helps. P Not that I'm aware of. D Pets? hygiene, but if you wash twice a day U n i t7 P I don't have a pet, and I haven't been and then put on a moisturizer like near any. aqueouscream,that will help. listening I D What about drugs? P Aque... P No,I'm not on anything. D Aqueous cream.It'sthis. It comes D=Doctor,P=Patient D Are you aware of being allergic to in tubs like this.And cream here. D Goodmorning, John.How are you anything? I'm going to giveyou some cream- P No,I don't think so. benzoyl peroxide - to put on twice a today? day and this antibiotic cream.I take it P Fine,doctor,exceptfor the weather! listening 2 you are not taking antibiotic tablets D Yes,it's a bit uncomfortable at the or capsules. D=Doctor,P=Patient P No,I'm not. moment. We'renot usedto the heat. D Now, I must point out that thesecan We want it, but when we get it, we D OK,thank you. You can put your shirt take weeksto work, soyou needto be can't cope. patient. P Yes,you're right there. We're never P Buttheywillgoaway? happy L^^1. ^U-r r d^^S^dir-r r . u4L^
Li steni nsgcri pts133 D We will certainly do our best to Listening 1 mesh.What we do is make one or make surethey do.Do you think two small holesin your tummy, one you'll be ableto keepgoing with the D=Doctor,P=Patient around the belly button and the other treatment? D Good afternoon,Mr Blackstone.My on the left side.It's a day-casesurgery, so you'1lbe in and out qulte quickly. P Ithink so. name is Dr Petrov.How are you today? How do you feel about having the D Would you like to seethe nurse who P Fine,thank you, doctor. operatlon? D You'recoping with all this rain we're P Oh,yeah,no problem.Will I be put to can go through it with you? sleep? P Yeah. having? D Well,we can do this under a local D And I'm going io give you this print P Yeah.It's a bit much at the moment. anaestheticor general. D Yes,it's slowing down everything. P I don't fancy being awake and hearlng out from an acnesupport group.It's and seeingeverything. got their website on it. Youcan check Right.I seefrom your GP'sletter that D Yes,I can understand why you it out. you've got a hernia.Am I right? wouldn't want that. It canbe a bit P OK,thanks. P Mmm. Yes.I've got this swelling in my off-putting to some people,but we'll D Soyou think you'll be OK with this? groin. seewhat the anaesthetisthas to P Yeah,Ifeelbetter. D OK.Canyou tell me about it? saywhen he doesthe assessment. D OK.You can take this prescription P It'sjust down here in my groin on the Er,we'll need you to sign a consent and make an appointment to seethe right side.It's been there for about form if you're happy with everything nurse and come back and seeme in a three or four months now. It's a bit when you comefor a pre-operation coupleof months, but if you needto uncomfortable when it is sticking out; assessment. come back sooner,by all means do. I'm aware of it. I try to sort of put it P Yeah.I'm OK with that. back in, but it only happenswhen I'm D is there anything youd like to askme? Pronunciation Iying down. I'm a...I'm a driver soI P Mmm, er,what about the pain? sometimeshaveto do a lot of lifting D We cantalk about the pain at the 1 I should'vekept on using the cream and that. assessment. you gave me. D Yousaidthe hernia popsback in again when you're lying down? Listening 2 2 I should'vetaken it all more seriously. P Yes. 3 I haveto sayI regret not applying the D Hasthere everbeen anytime when D=Doctor,P=Patient cream now. it'c ctrrred nrrt) 1 4 I shouldn't have put anything on it as P No,though sometimesit takesits D Would you like me to go over that's what's made it worse. time going back in again. 5 I meant to get up and do it flrst thing d^-r,L+yLi(hr^ru16 a-^6-di-r)rr: D Hm, right. OK.Shallwe have a look? in the morning but I didn't. P OK. P No,I don't think so. 6 I must've pickedit and made it bleed. D Do you feel OK about signing the 7 I stoppedusing it becauseit made my D OK,as your GPsays,you've got what is calledan inguinal hernia. form? skin itchy. P I'm not sure.I'm a bit worried about P Mm-hm. U n i t8 D Do you know what a hernia is what might happen afterwards. It's a big step and a bit drastic.I'm ...I'm not Pronunciation exactly? sure I want to go through with it. P Not really. D Would you like sometime to think 1 laparotomy D Youcan get a hernia like you have about it and perhapstalk to other 2 nephrectomy women who've had their womb where there is a weaknessin the removed? ? cnlnctnmrr membrane or the lining that holds in 2 all the gut. Part of the gut then sticks P Can't you squeezeme in at all today? 4 hysterectomy out at the weak point and forms a This is the secondtime this has 5 thoracoplasty bulge,which is what has happened happened. 6 mastopexy here.Let me just draw it for you. D I'm afraid we can't. There'san 7 cystorrhaphy P O K.I . . .I s ee. C a n y o u f i x i t ? emergency,and there're no beds 8 cholecystectomy D Yes.We can do an operation called a available. 9 pyelolithotomy herniorrhaphy, where we repair the weak part of the gut using a special 1O nnlnnewrr
1 3 4 Lis t eninsgc r ip ts P But the samething happenedthe last of his chest.He d had it several times time. Forthe moment he just needsa time. before and he used the spray thing bit of rest. he'sgot. D Unfortunately, ybs,it did, but the D The GTN spray? Pronunciation situation's unavoidable. WYeah ...yeah that's it. And so he gave himself a few puffs but the pain 1 He'Il havebeen in the theatre for P OK.Canyou guaranteethis won't wouidn't go and I coujd seethat he over three hours in a few minutes' happen the next time? was getting breathlessand agitated time. and he said he felt sick.He started 3 vomiting a little ...and he was 2 Dr Nur isn't starting his clinic till P Will they come back? beginning to sweat.And he said he two p.m. D I'm afraid we can't guarantee they thought he was going to die. D OK.Socan you tell me what time that 3 He'Il be in and out in no time. won't. was? 4 All being well, he'Il be ableto go P Is it common? WWell, I called for an ambulance at sevenishand it came like a shot,...so home by the weekend. 4 it was lessthan an hour ago in total. 5 The operation's scheduled for five D I can seeyou're a bit apprehensive D Sohas he had any other pain? WHe saidthe pain was in both arms. this afternoon. about this. 6 You'rehaving the veins on the right P I am,yes. D Your husband is-doing very well. D What are you worried about in It's good you got him straight into Ieg stripped this afternoon, am I hospital, but I need to ask you a few right? -P^a+ri- , , 1L^rYLU) lAr : quickquestions. 7 The doctor saidI'll be having a general anaesthetic. P Well, a number of things. Feeling woK. 8 He'll havebeen coming to the clinic pain, seeingwhat's going on,hearing D Hasyour husbandhad any -tn-'l)u-n\".-e-s- o--r off and on for the past three years. everything, and the smell. If I'm awake, will I feel any pain? anyothermajorillnessT listening 2 WNo. D No. You won't feel any pain, but you'II D Anybleeding? D=Doctor,P=Patient feel your insidesbeing touched. WNo. D OK,Mary. Your blood pressure is quite D Any majorsurgery? P And what about seeing what's WNo,nothing like that. high, one-forty over eight-five. I think happening? D Anything elseyou canthink of? the lasttime it was fairly normal. WNo. Nothing. P Yes,it was. That was about a year ago. 5 D OK.What we're going to need to do, D Mmm, it was a year ago last July. A = Anaesthetist, P = Patient P At least I've been healthy all this time, A Have you had a general anaesthetic with your consent, is to give your apart from theseheadaches. husband something to help get rid D Yes.Well, everything elseseemsto be before? of any blood clots.There is a risk of OK,so there may be no other cause.I'll P Yes. strokewith the procedure,and... run a few testsjust to make surethat A Recently? ...but the benefit can be dramatic if your kidneys,etc.are OK and we can P No, not for a couple of years. we get it down quickly. It can have refer you for an ECGat the hospital. A Did you have any problems with the a considerableeffect.There doesn't P OK. seem to be any reason why he D Is there anything you think might be anaesthetic? shouldn't have the medication, but we the causeof the high blood pressure? P No,nothing. But I don't like having needto give it assoon aspossibleand P Well, since I took early retirement I've we needyour consent. been lessactiveand I've put on quite a general anaesthetics. WOK. CanI just ask ... bit of weight. I usedto be quite active, but I've let things slip a little. Unit9 D By the looksof it, it's all gonevery D Sowhen did you retire? well and he'li be up and about in no P About ayear and a halfago. listening I D Do you know how much you weigh now? W = Patient's wife, D = Doctor P Mmm, I weighed myself about two WHe's not very well at all, is he doctor? weeks ago and I was a hundred and D He's actually OK.He's a bit more twelve kilos which for my height I think is quite heavy, I know. stable. WThat's a relief. D I just needto askyou a few quick questions.Canyou tell me what happened? WWe were sitting at home and he started getting this pain in the centre
Li steni ngscri pts135 D OK,let'sjust checkyour weight and D OK.Sothe cough'sbeen getting worse. b How many flights of the stairs can height. Tell me a little bit more about it. you manage generally? D For your height, which is five foot P Well,I've had this coughfor a week or 4 a Have you had chestdiseasein past? eleveninches,or about one point so,and it's been getting worse.I didn't b Haveyou had chestdiseasein the eight metres, your weight which is think anything of it asi tend to get past? now a hundred and fifteen kilos is something at this time of year.But quite high, ifyou look on this chart - it'sthere all the time and the phlegm 5 a Is it triggered by situation or it should be somewherehere. I bring up - it's a greenish-yellow particular activity? colour and it's streakedwith blood. P Oh.That is quite a lot over.I do need And I have a touch of fever. b Is it triggered by a situation or to get it down. particular activity? D Yousaidthe phlegm was streaky? D Yes.I seefrom your family history P Yes,but only a little. Exercise3 your father had heart problems and D And how much phlegm do you 1 Yes.My father had problem with his there's a family history of heart disease. produce? lungs. P Not that much. It would be lessthan a 2 The shortnessof breath came on P Yes,on my father's side, ali his brothers and sistershad problems t e a s p o o ne a c ht i m e . practically immediately. with angina. D Sonot much. 3 I can walk for quite a distance- P No.And it comesup quite easily.I try D If nothing shows up in the tests,you maybe a hundred yards or so- and seem to be generally quite healthy, to get it up to try and keepmy chest then i get short of breath. but the problem is hypertension, clear. 4 The cold air at moment makes the which can leadto other problems. D And is there any smell7 breathlessnessworse,so I stay at P No.Not that I've noticed.It'sjust the home when it's very cold. P Mmm, I'm aware of that. look of it that's not nice;it's rubbery 5 I've usednebulizer. D Do you think you can get your weight or sticky like mucus from the nose.It's 6 i've had it for week now. horrible. 7 Doesthe wayyou lie make it worse? down easily? D Any pain? Or is it worse when you do the P i can try. Well I just have to ... P No,not really. particular exercises? D It soundsasif you've got a touch of ... somehow. listening 3 D Did you do any sport before? [istening 2 P Well,I usedto swim and walk a lot. N=Nurse,P=Patient D Haveyou thought of starting up E x e r c i s e1 N There are different inhaler devices 1 a It normally occursearly in the again? to suit different people and the one P Yeah,I supposeI could. morning and sometimeslate at the I'm going to show you how to use D You'llfeel the benefit of it quite night or after I do any exercise,but is this breath-activatedPressurized at moment it's bad with the cold MDI, which standsfor Metered Dose quickly and if you're careful with Inhaler. Are you familiar with this? what you eat,you'll be back to what b It normally occursearlyin the P No,not really.I've seenthem, but not you were before. morning and sometimesIate at used one. P Ihope so. night or after I do any exercise,but N Well, it's an autoinhaler, which D Would you like to ... at the moment it's bad with the releasesa doseof the drug when a cold air. breath is taken.This means that you U n i t1 O don't worry about breathing and 2 a Doesthe breathiessnessyou've hand coordination,and it means Vocabulary got have any effect on your daily that you know that a dosehas been activities?Your lifestyle?Your successfully delivered. Coughs:1dry 2hoarse3, barking, work? First of all, you remove the cap and 4 productive,5wheezy shakethe inhaler severaltimes like b Doesbreathlessnessyou've got this. [isteningI have any effect on your daily Youthen prime the deviceby pushing activities?Your lifestyle?Your this leverhere right up, keepingthe D=Doctor,P=Patient work? canisterupright at the sametime P I've got this reallybadcough,doctor, like this. If you find it diftrcult to push 3 a How many flights of stairs can you andI can't shakeit off. manage generally?
1 3 5 Lis t enings c r ipt s the lever up by hand, you canusethe A full examination should be given, at times, soI haveto usea walking edge of the table to push it against.Is checking particularly for fever,jaundice, stick. this OK sofar? abdominal tenderness,chest signs, D Youseemto be doing very well. You've P Yeah.It's clear. rashes,and lymphadenopathy. been doing all the right things we N OK.Soyou sit upright with your head talked about when you first became a up and breatheout. Then you seal Exactinvestigationsdepend on your lips around the mouthpiece here. symptoms and examination findings, netipnf hprp You inhale slowly and deeply.Breathe but considerFBC,thick and thin in steadilyrather than quickly.When bloodfllms for malaria, LFTsv, iral P Well, yes,I've done my best. the inhaler clicks,don't stop - just serology,blood culture, stool culture - D Lookingthrough your notes you've continue taking a really deepbreath. ensureit is fresh - and MSU. Youwon't feeithe sprayhitting the only had one blood transfusion,am I back of your throat although the taste And on this slide we have information right? in your mouth might change.is this on malaria,which incidentaily comes P Yes.That was a while back. The only all OK sofar? from a sixteenth-century Italian term thing really is my hip and now this P Yeah,flne. - mal'aria - meaning 'foul or bad alr'. parn. N Then you removethe inhaler and hold Thereare about two thousand cases D OK,flrst we're going to give you your breath for aslong aspossible, notified eachyear in the UK.Malaria painkillers. mm, up to ten seconds.Youthen push is of coursevery easyto miss,one P OK... the lever down and replacethe cap. reasonbeing that it's a great mimic, Wait a bit and then when you have and soit can presentwith virtually U n i t1 2 recovered,take the next dose.But any symptoms. It usually consists remember to prime it before each of a prodrome of headache,malaise, Listening I dose.Do you have any questions? myalgia, and anorexia, foliowed by P No,none.It all seemsvery clear. recurring fevers,rigors,and drenching A, B = Doctors N OK,can you expiain to me how to do sweats,which last for eight to twelve A There are many advantagesto it? hours at a time. The examination may be normal, but one needsto look for new technology.Recentmedical U n i t1 1 anaemia,and jaundice with or without breakthroughs like keyhole surgery hepatosplenomegaly. aretransforming the livesof [istening 1 patients,especiallyas regardsthe If we had a caseof a patient, say a improvement in the speed of delivery In addition to the usual differential businessman,who had been to South of servicesand the speedof recovery diagnosis,in all returned travellerswho America and presentedwith ... on the part ofthe patient. But there's presentunweli, it's crucial to consider alsothe increasedconveniencefor imported disease.And as tropical Listening 2 the patient in all this. Let'ssaywe medicine is a specializedfleld, when have a patient with long established you're unsure,seekexpert adviceby D=Doctor,P=Patient diabetes, and we are able to offer a telephone or admit the patient. D You haven't had any problems for simple solution like a sprayinstead of injecting,then there is going to be OK,now if we turn to the next slide here, quite a while, have you? Ilttle resistance. it shows what we need to ask about P No,nothing serious.I've been quite B Well, the spray may not benefit every the history.As well asthe symptoms, patient. lt's essentialto flnd out about the lucky, really. I keep myself nice and A Maybe not, but it's a stepin the area or areastravelled to, including warm, especiallyat this time of year, right direction.Can't you eversee brief stopovers,the duration of travel, and I make sureI eat properly and the beneficialsideof anything immunizations receivedprior to travei, drink well. I've never been a big coffee rather than always dwelling on the malaria prophylaxis,health of members drinker, but I like a cup of tea, and I downside?Wouldn't you evenfeel of the travel party, sexualcontacts drink plenty of water aswell. And better in yourself if you were a bit whilst abroad,and medical treatment eventhough I've had a flujab, I keep recelvedabroad. away from people. And I always take mnvc nncitirre) vitamins every day without fail, so it keepsmy folic acid up. My friend had B I'm not always negative.I'm just leg ulcers,so I'm very careful - I'm playing devil's advocate. trying to avoid that, but my hip is bad A And surely anything that makes taking medication easieris going to increasethe likeiihood of oatients
Li steni nsgcri pts137 remembering to take medication listening 2 and sticking to it in the long term, if D=Doctor,P=Patient needed. L P Can'tI just havethe antibiotics I But no matter what, you have to had the last time? admit that there are downsidesto D Well, what you've got is different new technology. It's not all rosy. from the last time. This is a virus. A Likewhat, for instance? P But won't they work against B Well,I canthink of at leasttwo viruses? things, one being that with increased 2 P Won't an MRI scanshow if there's life expectancyalsocomesincreased anything there or not? morbidity and not everyone wants to D An MRI scan'snot suitable here.It's live with a poor quality of life. I know clear from what you've said that I wouldn't. there'snothing sinister here. You say that now, but maybe not later P But my friend had the same and he on, and as medical scienceprogresses, died of a brain tumour. so will quality of life for those who 3 P Won't these steroidsmake me put are living longer. I would say that by on weight if I take them? the time we reachour sixth decade, D They can make peopleadd weight, the quality of life from the medical but it's only a short course. point of view will be what it is for the P OK. averageforty-year-old now. 4 P Isn't that new stem celltreatment Maybe, and I hope you're right, but I availabiefor peoplewith strokes? think that there is always the danger D It's still at the trial stage,I'm afraid. with technology of losing slght of P Can'tmyhusband be part of the the patient. The information that trial? peoplehave is being lost aswe switch 5 P Wouldn't it be better if I just stayed on machines and the machine does on this treatment for my diabetes? the work for us.A simple example D Youcan,but you might find this is is taking blood pressure.The old more convenlentfor you. Do you sphygonometeris being replacedby want to think about it for a while? digital machines and I'm not sure P Yeah,OK.I'm just worried about everyonecould even read the BP u p s e t t i n g e v e r y t h i n g ,t h a t ' s a l l . correctly. Well, you have a point there. Languagespot Deskilling is a problem,but this is 1 Couldn't I just keepusing the same all about managing change.I know device? it arousesdebate and at times some 2 Isn't this availableon the NHS? aspectsare sensitive,but i don't 3 Wouldn't it be better for me just to resistit and by and large I think the continue with the medication? dramatic technological advancesin 4 Doesn'tthis devicecomewith a cap recent years have been invaluable. on it? And I wouldn't want to stifle change. 5 Shouldn't my daughter be next? Me neither. I think we agree generally 6 Won't I be having the operation today but just can't agreeon some of the either? finer detail. 7 Can't I have an MRI scan? Yes,I supposewe ... 8 Hasn't the doctor arrivedyet? 9 Haven't you done that referral letter yet? 10 Didn't you sayI could go home today? 11 Aren't I next on the waiting list?
138Clossary G l o s sray Vowels ,, book iu line u: mood il() gOWn r: breech .rI avoid r surgery LL lfllfflUfllZ€ r. Period r disability c.r flare c sensitive r bump irJ feaSsute ru paramedic (r: alarming r: CUfl h hollow D stop nr impairment r: Warnlng r percepllon t) mania cr ageing q alarming Consonants r() COpe I malaria I rapi dresponse p hypertension t- affect j yourself lr bronchitis \\ stopover \\\\ Woffy t telescope (t afterbirth tl radical n with k consent . dislocate 1 anatyze !l glove .l revolution tl dispatch I conclusion rll binge a b n or m apl er c ept io n ' runbr:n rlp ' :c p ,ni a n o s o g n osi au ul rsr)rn;.rrsi . n a avoidr rrrrl vtotry nottodo n awayof s eeingo r e x p e ri e n c i n g me n ta l condi ti oi nnw hi cha pati ent somethi nbgecausiet i sharmfu lor e v ent st hat isnotn o rm a le, s p e c i a l l y i su n a b l eto recogni stheattheyhave unpleasant whenit isharmfuol r notwanted losta physicaslenseor ability avulsionr r rl,nl n the actor process a b rupt f yr ' lr lr pt li a d v s u d d e n l y a n te n a ta lruntirrcrtladj rel ati ngto of teari ngapi ecefroma bonebya a ndunex pec t edel ys,p e c i a lilnya n th e m e d i caclaregi vento pregnant tendonor a l i gamenat:navul sion u n pleas anwtay women fracture acne(vulgaris)rul'rrr r1tlu:rt: n a anxietyrcr.z1rrr:rtni the stateof feeling babyblues b.'rbjblu:z n a depressed sk inc ondit ioinn w h i c hy o u rfa c e , n e rv o uosrw orri edthatsomethi ng feel i ngthatsomew omengetaft er necke, tc.iscovereidn pimples badisgoingto happen the birthof a baby (=spots)A. cneiscommonamong yo ungpeople. apathy, icp.r0in,'thefeelingof not ball br;l n (ofthefoot)the part b e i n gi n teresteidn or enthusi asti c underneath e bi gtoe affect r.-lcktn emotionsorfeelings, a b o u ta n y t h i n g e spec ialwlyhenc o n s i d e ri nhgo wth i s bang biur.lvto hit a partof the body i n f l u e n c ebse h a v i o u r a p p ra i s a,rl prcrzln a meeti ngi n w hi ch agai nsst omethi ng a doctordiscussewsith a moresenior afterbirth tr:ljrb:;:0n the placenta doctorhowwellheor shehasbeen barking'bo:krr.a1dj(ofa coughv) ery a n dot herm at er iatlh a tc o me so u to f d o i n gth ei rj ob;thesystemof hol di ng loudandproducewd ith a lotof a woman'sbodyaftera babyisborn s u c hm e e t i n g s energy ageing crtltq adjbecomingolder arrhythmiar rriilir n a condition beneficia,'lbcurlr.l adjimprovinga afarmingr lrr:nrrr.a1dj causingworry in whichthe heartdoesnot beat situationh; avinga helpfuol r useful normally effect andfear a n a ly s er c n. . llr zv,to s tu d yo re x a m i n e a tri a l fi b ril l ati o,nertri rl l rrrtrnl cn' r,ln benefi tfrom' bcnel 'ljlt.rnr ytore ceive a c o n d i ti oinn w hi chtheatri a(=the hel por anadvantagferomsomet hing so m et hinge,s pec i a lbl yys e p a ra ti nigt intoitspartsi,n orderto understand two upperspaceisn the heart)do not bi ngebrntl, n anoccasi ownhen or explainit beatnormallyc,ausingthe patient someboddyoestoo muchof an to d e v e l oap rapi dpul sethati snot activitytheyenjoys, uchaseatingor regulara,commontypeof arrhythmia dri nki ngal cohol
C l ossary139 blemish lrlcnrI n a markon the skin c onc or danc el \\ J l l . . r : ( l , r n .n a g r e e m e n t development tir relrprn.rrrtnlthe t hat spo ilsits a pp ea r anc e processof creatingsomethingnew by a pat ien tt o f o l l o w a p a r t i c u l a r o r m o r ea d v a n c e da; n e w m e t h o d , blist er b lr'i..tt ) n a sw ellingon t he p r o d u c t ,e t c . surfaceof the skinthat is filled with c our s eof t r e a t m e n t a f t e r d i s c u s s i n g 2 a n e w s t a g ei n a c h a n g i n gs i t u a t i o n liquida nd is ca usedby r ubbingor 3 t h e g r a d u a lg r o w t h o f s o m e t h i n g burning t he c hoic esa v a i l a b l et o t h e m w i t h a so that it becomesmore advanced, strongere, tc. bradykin esia I't rt,l,l,t tt i: t ' . . n a doctoror nurse conditionin which a D er s onm ak es c ons ent [ . - n . . I L n o f f i c i a la g r e e m e n t , disability tlr...h'1.'i n an inabilityto unusuallyslow movements,often d o s o m e t h i n gs u c ha sw a l k ,s p e a ko, r associatedwith Parkinson'dsisease givenby a patientto a doctor,tohave l e a r nn o r m a l l yd, u e t o a n i m p a i r m en t breakth rou gh b r.crli() r . rnr :an a par t ic ula rm e d i c a lt r e a t m e n t s u c h disinhibition tlrrrrlr l.rrr nthestate important new discoveryor o r a c t o f e x p r e s s i n gy o ur t h o u g h t s achievement t< an nnerzttnn a n d f e e l i n g so p e n l yw i t h o u t c o n c er n aboutthe opinionofother people breath-activated [rlcOrul.trrcrtttl C o n t i n u i n gP r o f e s s i o nDa le v e l o p m e n t odj (of a n in ha ler)re leas ings pr ay dislocate rlrslrkcrt vto put a boneout automa tica llywh en a per s ont ak esa irill ill l.l - I'ri tir rulr|rtrrnt o f i t s n o r m a l p o s i t i o ni n a j o i n t breath n a systemfor staff who arealready dispatch tlr sprut,lvto senda person breech br i:t I n usedto describethe o r t h i n g s o m e w h e r ei n o r d e rt o d o positionof ababy within the mother qualif iedin w h i c h t h e y r e c e i v e something in whichwhen it isborn,thebaby's feet or bottom come out first r egulart r ai n i n g a b o u t n e w m e d i c a l d i u r e t i c r l u r j , i | c t r l i n a s u b s t a n c et ha t c a u s e sa n i n c r e a s ei n t h e f l o w o f u r i n e bronchitisl)r'l)rl\\iil1r\\ n an pr oc edur e sc o n n e c t e dw i t h t h e i rj o b inflammatio no f th e b r onc hiatl ubes , D W . l i : r i : t i : n ( d e e pv e i n resu ltingin cou gh ingand dif f ic ult yin contraindication,., r.'.-rriir Ietlrt t h r o m b o s i s )a s e r i o u sc o n d i t i o n breathing c a u s e db y a b l o o dc l o t ( = 3 t h i c k m ass n a pos s ibl er e a s o nf o r n o t g i v i n ga o f b l o o d )f o r m i n g i n a v e i n bump b rnrp vto hit something, especiallya part of your body,against pat ienta pa r t i c u l a rd r u g o r t r e a t m e n t d y n a m i ce x e r c i s et l l rr r t : c r n r l ' or on something c 1 \\ \\ r \\ r u . /n p h y s i c a l a c t i v i t yl n w h i ch copewith vto deal t h e m u s c l e sa r ec o n t i n u o u s l ym o v i n g , bystander birrsticntlrr(') n a person f o r e x a m p l es w i m m i n g o r w a l k i n g w ho see san even t,su c has a c r im eor s u c c e s s fl yuwl i th somethnigdi ffci ul t an accide ntb, ut wh o is not dir ec t ly e l a t i o n i l c r , ln n a f e e l i n g o f g r e a t involvedin it c ra c k l e sl .r., . n smal ls, harpsounds h a p p i n e s sa n d e x c i t e m e n t cholesterolI'r lcstrrnl n a substance th a ta reh eardw henl i steni ntgo the embarrassinglytnr l.rtt-..'ttlli adv used similar to fa t tha t isfound in blood s o u n d sw i thi nsomeoneb' sody(= to saythat somethingmakesyou feel and most tissuesof the body.High shyor ashamed levelso f cho lesteroiln t he bloodar e a u s c u l ta ti ono)f,tenassoci atewdi th associatedwith heart disease. e m p h y s e m(a=ai ri ntheti ssues) emotive i nrr,irr adj causingpeopleto feelstrongemotions col- k nl- pref x relatingto the colon criticism n the act of compef ing krnr |cl1v1adj (of anidea, epidemic cpr rlcnrrk n alargenumber ex pr es s ingd i s a p p r o v aol f s o m e b o d y o f c a s e so f a p a r t i c u l a rd i s e a s e an a rgu men t,e tc.)a blet o c onv inc e h a p p e n i n ga t t h e s a m et i m e i n a you tha t so meth ingis t r ue or s om et hi n g ; as t a t e m e n ts h o w i n g p a r t i c u l a rc o m m u n i t y compliance l\\ilil |liurt\\ n the act of following the instructionsgivento d isapprovaI et al ct tel abbreviation(usedafter you by a doctor or nurseconcerning t h e n a m e so f t h e m a i n w r i t e r so f a your tre atme nt,suchas by t ak ingy our crust [.r - n a hard layerthat coversa report,researchpaper,etc.)and other medicine s of t s ubs t a n c eo r l i q u i d ;a s c a b p e o p l en o t m e n t i o n e d .e t a / c o m e s conclusionlirn l.lu:;n n ajudgement from the Latinphraseet alii/alia= and or a de cisionm, a deaft er c ons ider ing c ue L r . n s o m e t h i n gt h a t y o u s a yo r others allth e info rmatio nconnec t edwit h the situation do in or dert o s h o w s o m e b o d yw h a t e v a l u a t i o n r r r r , l i L re r l n n a j u d g e m en t o f t h e v a l u eo r q u a l i t yo f s o m e t h i n g y ou ar et hin k i n g o r f e e l i n gs o t h a t afterthinkingabout it carefully t hey m ay r e s p o n dg, i v ea d v i c ee, t c . curl t,:: vto form or makesomething f or m a c ur v e ds h a p ef,o r e x a m p l ey o u r toes cysto- pre.i5xrelating to the b la d de r day - c as es ur g e r y , i - r l '. r . \\ : ; : \\ l l ) r i / l oper at ionst h a t a r e p e r f o r m e di n a s ingleday ,w i t h o u t t h e n e e df o r t h e pat ientt o s p e n dt h e n i g h t i n h o s p i t a l a f t e r w ar d s dependor r l t p 1 '1 1lii1l v t o r e l y o n s om ebodyfo r h e l po r i n o r d e rt o d o s om et hing dermatology tl:r;nr..trrl.rtlJi n the area of m edic in ec o n c e r n e dw i t h t h e s t u d y and treatmentof skindiseases
140 Clossary exasperatedr(lziusprlcrtrdd,d' j g e to v e r (l ct .U \\r(r' )yl to returnto host/l rrost,n anani maol r a ol ant extremelaynnoyede,specialliyf you yourusuasl tateof healthafteranillness onw hi chanothelri vi ngthi ng(=a cannodt oany t hin gto i mp ro vteh e 2 to d e a lwi thor gai ncontrool f a p a r a s i t el )i v e sa n df e e d s situation problemor difficultsituation hypertensioin,harp:r'1cnn'.'ln blood expectation,ckspclticr.nl , n l a belief g e tth ro u g hto cl et 0r' Lrt:r yl to make pressurtehat i shi ghetrhani snor m al th at s om et hinwg ill h a p p e nb e c a u s e contacwt ithsomebodbyytelephone,tc. hystero- lil\\t.r-au prefixrelatingtolhe it seemslikely 2 to ma kesomeboduynderstanodr uterus 2 a strongbeliefaboutthe way accepwt hatyousaye, specialwlyhen impactedr,rrrp' rclitrcal' dj usedto som et hinsghouldh a p p e no r h o w y o ua retryi ngto hel pthem describaetypeof fracturein which som ebodsyhouldbe h a v e giddy c rdi adjfeelingdizzy(=that thetwo brokenendsofthe boneare b ee x pec t ingbi: r l.s p c k trrlv to b e e v e ry th inigsmovi ngaroundandthat pushedi ntoeachother pregnanr y o ua reg oi ngto fal l ) impairmentnn l)L'.nrrlltn a condition expectorationll{.\\l)ekt.rrcrln n the g l o v etl l rr yto puton surgi cal gl oves i nw hi chyouarenotabl eto usea par t a ctof c oughingup m a te ri aflro my o u r beforeanooeration ofyourbodyor brai nnormal l y l u n gsandt hens pitti n gi t o u t g o n e rl r)n adj havi ngbeenpregnantfor imprompturrnrplnnrpt.ju:adj,adv expiratoryr'L: pirn.-rli adj relatingto th el e n g t hof ti mementi oned donew i thoutpreparati oonr pl an ning th eac tof br eat hinogu t a i rfro mth e gown'rJl()u,vrto put on a gOwn(=a i nconsol abl e,rnl .srnro,l rbla, dj lungs pieceof clothingthat iswornover extremelsyadandunableto accept fa i n t t . ' int v t o s udd e n lbye c o me o th e rc l o theds uri nganoperati on) helpor comfort u n c ons c ioubsec au sneo te n o u g h groggy r1locyia,djfeelingweakand ingeniousnr'cl5r:ni.rasdj(ofa devicea, b l oodisgoingt o y o u rb ra i n u n a b l eto thi nkcl earlby ecauseyou plana, methode, tc.)verysuitablefor fanout llrrr lr,t yto spread areill orverytired a parti cul aprurposaendusi ngcl ever so m et hinogut ,lik ea fa n haemolyzehi:nrclliz vto destroyred newi deas far-reachinglir: r'i:t.rlr1adj havinga b l o o dc e l l sbycausi ntghemto break inspiratory rnspr.rrr':rtlai dj relatingto lot of significanetffectsand o p e na n drel eastehei rhaemogl obi n; theactof breathi nign ai rto the l u ngs i mplic at ions to bedestroyeidn thisway intussusceptior nltJ\\.'scpln /, a flareup1't1c.rrlp' v (ofan illnessin, jury, h a i rl i n e h crl rrrnn, a verythi ncrackor pai nfucl ondi ti onm, ostcommon etc.)to suddenlsytartagainorto l i n ei nth esurfacoef a bonea: hai rl i ne amongyoungchi l dreni n, w hi cha b e c o m ew o r s e fracture sectionof the intestinebecomes fracture 1il:kt.lrr(')in abreakin a bone h a n d i c a p' hruntl i ki epn i n i nabi l i ty foldedwithinitselfwith the result frothy,''l'r'o0ia,dj(ofa liquid)full of or to d oc e rt ai nthi ngssuchasdoa that it becomebslocked co v er ewd it h a m as so f s m a l lb u b b l e s p a rti c u l a rj ogbe, taneducati one,tc., itch rtI vto havean uncomfortable fro zens houlder1r, ' r ozn ,l ri i l c l r(r' )t becausoef a disability feel i ngonyourski nthat makeyso u n a painfucl onditionin whichthe hazardous'hrcz:rclarsd\"j dangerous, want to scratchit;to makeyourskin sh o uldejor intbec o messti ffa n d especialtlyo somebodyh'sealthor f e e ll i k et h i s difficulto move safety job specificatiorntl3nb spcsrfk'rer.rlr n Sa i t \\ t c r l n awayof w a l k i n g h e e l h i :l n the rai sedpartof the i nsi de a descriptioonf the skillsk,nowledge, g a me t oc y t e. ' qllr i: t : rs i l rnt a c e l l th a ti s o f th e h a n dw herei tj oi nsthew ri st andexperienctehat arerequiretdo do in the procesosf becominga gamete hernia,'h:;:nil n a conditioinnwhich a particularjob keep,'l i i :ptv to conti nudeoi ng g a met e ( lium r : tn a m a l eo rfe ma l e p a r to f a no r g a ni sp u s h etdh r o u g ht h e s e xc e i l bodywalal roundit something g e ta t , t lc t ' : r t v l t o ke e pc ri ti c i z i n g h e rn i o rrh a phyi ,hl :rnrirrtl n an land lrunti yto comedownto the somebody operationto repaira hernia groundafterfal l i ngj,umpi ngo, r b eing 2 to lear nor dis c ov esro me th i n g h i g h h a r n t he hi gheslteveol r l argest thrown getdown, tJct claun yI to make n u m b eor f somethi ng laparo- liup:rr:rtp, re,Jfrxelatingto the somebodfyeelsador depressed hoarse,rhr:r'sadj(ofa cougha, voice, abdomen 2 to s walloworeats o m e th i n gu,s u a l l y e tc .s) o u ndi ngroughandunpl easant, laparotomy,lreprlnrnri n a procedurienw hi cha cuti smade withdifficulty becausoefa sorethroat geton qct nn y I to havea friendly h o b b l e ,\" h n tryl ,to w al kw i thdi ffi cul ty, i ntheabdomenu,sual l yi n ordetro re lat ions hwipit hs o me b o d y especilalybecausyeourfeetor legs exami nteheorgansi nsi de 2 (geton somebodyn'servest)o hurt l i e,l l r' n the posi ti oni nw hi cha bab yis i rrit at eor annoys ome b o d y hoflow holrtt, adj(ofa cough)making l yi ngw i thi nthe mother a low,emptysound
C l ossary1 41 life cycle larl'srrrlil n the seriesof ( = t he openi n gt h a t c o n n e c t st h e l e f t persuasion|J \\\\\\ L-r:r'nl the act change sin the life o f a n anim al,plant , of convi nci nsgomebodytdoo etc. at r ium and t h e l e f t v e n t r i c l eo f t h e something lifest yle,\"lirrl.stu rnl'the way in whic h hear t )bec om e sm o r e n a r r o w t h a n i s persuasivelr. \\\\\\ cr\\r\\ adj ablelo a perso nlive si,n clu din gt heir wor k , persuadseomebodtyo door bel i ev e hobbiesd, iet,physicaI activity,etc. normal somethi ng line llin n a cou rseo f tre at m ent mood nru:cl n the wayyou arefeeling pi ckat prL.rr yto touchsomethi ng fongitudin al inr1 11 l't.ju: r lrandl'j ( of a several ti mewsi thyournai l sor at a par t ic ul a rt i m e fi ngerse,speci albl yyrepeatedl y babywith in the mo the r )ly ingin an removi nsgmal lpi eceosf i t upwardor downward positionrather morbidity rnr: brtlrtr n the numberof than acrossthe mother'sbody pi ckup prk rp v1to takehol dof malaise rrrr lcrz n a ge ner alf eelingof peoplewho h a v ea p a r t i c u l a ri l l n e s s somethi nagndl i ft i t up beingill malariarnrr lr-rn e n a d is eas et hat m or nings ic k ne s sn r r : l r l l : r l 'r r r : n t h e 2 to startagai nc; onti nue causesfever,causedby a blood pl ayw i th pl crrrri ) vto keeptouchi ng parasitethat is passedto peopleby needto vomit that somewomen feel the biteof a mosquito or movi ngsomethi ng mania rlcrnra n a me ntalillnes sin when they are pregnant,often only in P OP pi : .1r( pi : n (pl asteorf pari sa) which a personbehavesin a very excitedand activeway and may also the morning w hi tepow detrhat becomehsard haveexaggeratedbeliefsabout their whenit ismixedwith waterandleft abilities mortality nrr:'tiul.tii n the number to dry.POPisusedto makeplaster marche ip etitp as rtt\\r:i) 11. ' r 1Dr r : l\"l casts(=a sol i dcasethati sputona a wayof walkingin whichthe person of peoplewh o d i e f r o m a p a r t i c u l a r person'bsodyin orderto coverand t akesu nu su allysma lls t epso, f t en protecat brokenbone)a; castmadeof associate dwith Pa rkin s on'dsis eas e illness t h i sm a t e r i a l masto-/ mammo- lriu\\ll{ ) nr.Lnr,',r negotiate nr (lio.licrt vto agree pre-ecl ampsIitai : t I' l ,trttl ..i ..n a prefx relatingto the breast condi ti oinn w hi cha pregnanwt oman MD I ern tii: irr n (me ter eddos e s om et hingb y f o r m a l d i s c u s s i o n hashi ghbl oodpressure,w hiccahn inhaler)a type of inh al ert hat r eleas es becomeseriousif it isnottreated a spec ifica mou nt o f medic ineeac h nephro- ncl'rtit prefx relatingto the productive'plr ri rktrr adj(ofa cough) time it isused produci nsgputumor mucus(=a thi ck mean nri:n vl to in ten dtodos om et hing kidney(s) l i qui dthati sproduceidn partsof the 2 to involvet;o haveas a consequence bodys, uchasthe nose) membrane n.rcrrlrrcrnn a thin layerof notifiable n..r.trlirrrbl adj (ofa pronetosth plr()n ll adjlikelyto skinor tissu eth at con nec t sor c ov er s s u f f e rf r o m s o m e t h i n gs,u c ha sa organsor o the r pa rtsins idet he body dis eas es) o se r i o u st h a t i t m u s t b e parti cul ai lrl ness mentalstatee xa mina tion lr r c ll11\\ t ill psychosoci a:rlrrkr,,.r,;j l adf r(1,/iulrrrcr.fn n an interviewbetween reportedto the authorities concerni nthge mentaal ndsoci al a docto ran d a pa tien ti n or dert o aspectosfsomethi nagndhowthey judge th e pa tien t'sp res entm ent al objectionablerl. tl.cl.Irurl.l adj i nfl uenceeachother condition unoleas anto r o f f e n s i v e PurPur,ap:r:p.ji,r,r n an areaof redor merozoite nr!'r'i./J(,irl n a stage purpl espotsontheski nc, ausedby in the life cycleofthe parasitethat offensive .i l!'n\\r\\ adj extremely bl eedi nugnderneath esurfacoef c a u s e sm a l a r i a .M e r o z o i t e sa r e f o r m e d theskin in largen umb ersb y a s c hiz ontand unpleas ant purufent lr.i(irt'rlilt adjcontaining eitherbe co mean oth ers c hiz ontor a or produci npgus(=3 thi ckyel l ow i sh sexcell(= gamete). on edge :r,r -rr , adjtobe nervous, l i qui dthati sproduceidn ani nfected mif esto n e 'n rr.rrl:tr,rnn av er y ex c it edo. r ba d - t e mp e r e d wound) important stageor event in the radical ltclrkl adj newandvery developmentof something on top of the world differenftromwhat isusuallydone mitralstenosig nllrt|rl :tr n.r.rsr\\/, , . ' . : , : t .ai djv e r y h a p p yo r p r o u d rapidresponse.r'tuPrtIlr \\ir)ns n a conditio nin which the m it r alv alv e theactor procesosf deal i ngw i tha pandemic .-r .,.. naserious medi cIaemergencqyui ckl y dis eas et hat s p r e a d so v e ra w h o l e r egionor a la r g ep a r t o f t h e w o r l d par am edic i- . t :. ' t :'. '. 1Ll . n a p e r s o n whos ejob in v o l v e sg i v i n ge m e r g e n c y m edic alt r ea t m e n tt o s i c ko r i n j u r e d peoplein t he i r h o m e ,a t t h e s c e n eo f an ac c idente, t c . ,b e f o r et h e y a r et a k e n to hosoitaI pat c h |iul i n a s m a l la r e ao f s o m e t h l n g that isdifferentfrom the areaaroundit perforatedappendix l.:;:lrlertrtl . r l' r c nt lr i. ' n a s e r i o u sc o n d i t i o n in whic h t he a p p e n d i xb u r s t sa f t e r bec om inginf e c t e da n d t h e n s w o l l e n per ic ar dit is l) i l r l . u : r l r r r t r sr , ta s e r i o u s inf lam m at io no f t h e o e r i c a r d i u m ( = t he t hin la y e ro f t i s s u es u r r o u n d i n g the heart) period prrrirtl n the flow of blood eachmonth from the bodyofa woman who isnot pregnant
142 Clossary r ap po rt rit l).r:l l) naf r iendly a p ersonbecomeusnconsci oauns d t h e n p a s s e st h e m t o h u m a n sw h e r e rela tion sh ipin whic h people th e i rbodyshakevsi ol entl y=;a fi t they travelto the livercellsto form a un de rsta ndea c hot her v er ywell s e n s i ti ve\\cn\\rtr\\ adj l (of a subj ect) schizont. needingto betreatedcarefuIly s p u t u m s 1 r - j L r : t r rnr t h i c k l i q u i dfr o m reckless lcklrs adfshowinga lack becausiet mayoffendor upsetpeople t h e t h r o a t o r l u n g st h a t i s c o u g h e d ofcare a bo ut the dangeror t he 2 (ofpeoplee) asilyoffendedor upset u p b e c a u s eo f d i s e a s ee, t c .I n n o n - co nseq ue nceosf y our ac t ions shuffling .lr11rr.a1dj (ofthe way m e d i c a ls i t u a t i o n ss, p u t u m i s o fte n somebodwy alks)slowlywithout c a l l e dp h l e g m l l t r r . reduction lr tl ri'.1n ,?the act or process l i f t i n gy o u rf e e tc o m p l e t e loyf f t h e s q u a s h : k u n . l v t o p r e s so r c r u sh of returninga part ofthe bodyto its ground5; EEmarchei petitpas somethingso that it becomes no rmal po sitio nf,or ex am pleaf t er a s i c k l e -cealnl aemi a.rl ,l ' ,' l r ni :nri r d a m a g e do r c h a n g e ss h a p e hernia,by performingan operationor n a seri oufsormof anaemi am, ostl y statin \\tiutilr natypeofdrugthat other medicaI procedure a J fecti npgeopl eof A fri canori gi ni,n helpsto lower cholesterol w h i chtheredbl oodcel l sl osethei r stop s11r| vto preventsomebodyfrom r e ha bilita tion li : : r [ r r lrt c r .rJr n t he n o rm asl hapew henoxygenl evelas re doingsomething pro ce ssin which a per s onlear nst o low SIOPOVeT.ll,p r,,\\ ''t I Lt a ShortStay havea normal life again afterthey simpfe .rnrirl adj(ofa fracture) somewherebetweentwo oarts of a ha vebe enveryill or had a s er ious involvinga breakof the bonebut with jou rney injury l i ttl edamageto thesurroundi nsgki n straighten stlcrtlr vto become a n om uscte s t r a i g h t ;t o m a k es o m e t h i n gstr a i g h t resect li .il,t vto cut out partofan s l i p (o ver)' l i P r,,r.rr(' ) vtosl i dea stub :t rlr vto hurtyourtoe by o rga no r a p ieceof t is s uef r om t he s h o r td i s t a n c eb y a c c i d e nst ot h a t y o u a c c i d e n t a l l yh i t t i n g i t a g a i n st Dooy fa l lo r nearlfyal l s o m e t h i n gh a r d stumble :t rnrbl vto fallor almostfall revolution lci .. lrr:.l1t n a major smalol ftheback,:nrr:l t\\ i).r lrel\\ whileyou arewalkingor running cha ng ein meth ods ,idease, t c .t hat n the lowerpartofthe backwhereit sweetened :u i:tntl adj (offoodor affectsmany people c u r v e isn a drink) madeto taste sweeterby a d d i n gs u g a re, t c . rigidity fr ii:r(irti n the stateof being s m a ltl al k :nr.r:1l .r:l (n pol i te telescope tc'lrskrt,p v (ofthe different stiff anddifficultto moveor bend c o n versati oanboutordi naroyr p a r t so f s o m e t h i n g )t o s l i d ewi th i n unimportantsubjectsf,or examplein e a c ho t h e r r ig or frrli(r) n a s uddenat t ac kof orderto makea patienfteelrelaxed tenacious tr nr.r.lr\\ adj stickyand shiverin g(= shak ingof t he body ) , d i f f i c u l tt o p u l l a p a r t a ccomp an iedby a f eelingof c oldnes s s m a s h)r)]l u.yl to breaksomethi ng t h e P i l l , \\ r p r l n t h e c o n t r a c ep ti vep i l l and a rapidrisein bodytemperature, violentlyintomanypiecesto; be (= a pillthat somewomen taketo usua llyin dicatingt hes t ar t of a f ev er brokenin thisway preventthem becomingpregnant) thread 0r'ctl n an ideathat connects rupture r'\\ptlr{r') yto burstor break SOCRATE.Snl.rrti:z /l usedasa way the differentpartsof a conversation, ap art some thi ngins idet he body ;t o o f re memberi nhgowto j udgethe a r g u m e n t ,e t c . b e b rokeno rto bur s t apar t natureof a patient'spain.Eachletter thrombolysis {llrrrr [rnl]:r: n the act or of SOCRATrEeSfersto a wordwhich processof dissolvinga bloodclot (= 3 safetynet scrl t r nc1,n usedto describe relatesto a question,thwe ords t h i c k m a s so f b l o o d ) anyarrangementhat isintended are:SiteO, nsetC, haracterR, adiation, tickfy iil.1i adj (of a cough)producing to protecta patientand prevent Assocaitions,Timing oJpain/duration, a n i r r i t a t i n gs e n s a t i o no n y o u r th r o a t problemsfrom developingafter they Exacerbatni g/ ReIievingfa ctors,Severity t h a t m a k e sy o u w a n t t o c o u g h fin ish co nsulti nga doc t oror hav ing tingling lrrtrtlrrtn an uncomfortable treatment s o i l \\.1r1yto acci dentalrleyl easseol i d feelingin a part of your bodyas if a w a s t ef r o my o u rb o d yo n t oy o u r l o t o f s m a l ls h a r pp o i n t sa r e p u sh i n g scab :l.iuh n ahard layerof dried blood c l o t h e sb, e ds h e e t se,t c . into it that forms overa cut asit heals tolerate tirl.rlert yto be ableto be spiraf :l)uilrl adj(ofa fracturec) aused affectedby a drug without being scabover sl.iulr.r.r r( r'l vto form a bytwistingthe bonesothat it breaks harmed scab S Po n taneousslpyr)ntcrni ..:l iady schizont tLltrznnt d/so lrLiznntn a h a p peni nngatural lwy,i thouttheneed stagein the life cycleofthe parasite fo rm edi catlreatmenot r assi stance th at ca usesma lar ia,dur ingwhic h it re pro du ce sit s elfm any t im es sPofozoiteslll)r-/,;rr(rilrl,?a stage by d ivid ingto for m new c ells( = in the lifecycleof the parasittehat merozoites) causems alariaS. porozoitefosrm w i th i nthe bodyof a mosqui tow hi ch scrubup :Iilrb ip v(ofadoctor, nu rse ,etc.)to was hy our handsand arms beforeperformingan operation se izu re \\L :,r r') n a s uddenat t ac kof an illn esss, u chas epileps yi,n whic h
C l ossary1 43 travellers'diarrhoea tltr;.lrz tllrl rrr warningsign $r:nrt \\.rll n a change n an illn essin wh ich you pas ss olid in a per s on' sh e a l t ho r b e h a v i o u r wastefrom your bodyfrequently,and that indicatesthat they may havea in liquidform,and which is developed par t ic ularill n e s s=; a p r o d r o m e w hile travellin gin a fo r eignc ount r y wet n cr I v to urinateby accident tremor rlenr.rr(') n a sli ghts hak ing 2 adj (of weather) rain movementin a part of your body, often associatedwith Parkinson's wheal olsoweal ri r:l n a sorered d isease s wellingon t h e s k i n ,a s s o c i a t e dw i t h s k inc ondit io n ss u c ha s u r t i c a r i a trend t lcrrtl n a ge ne raldir ec t ionin w hich a situa tionis changingor wooz y \\ \\ u: t i a d j f e e l i n gu n s t e a d ya n d developing confused trip (over/up) | trip (over/on sth) tr i1r worry about ir rri rlrrr,,t vto keep . rr, \\r ( l ) - \\lr - rrrr y t o c at c hy our thinkingabout unpleasanthingsthat foot o n so meth inga nd f all or alm os t m ight happe no r a b o u t p r o b l e m st h a t fall you have try (for a baby) rr.rr v to attempt to wryneck rrrrcl. i\"ta condition conceive af f ec t ingt he n e c km u s c l e sw h i c h c aus est he n e c kt o t u r n s o t h a t twist t rrist v to injure part of your body, ev ent uallyt h e h e a di s p e r m a n e n t l y especia llyyouar nkle,w r is t ,or k nee,by heldt o one s i d e := t o r t i c o l l i s bendingit in an awkwardway twitch rl rt.l v (of a person'sbody)to makea su dd enqu ickm ov em ent , especia llyon e tha t you c annotc ont r ol uncooperative \\ul\\.r(,r)l-).rt'.r1attdj not w illing to be he lpfu lto ot her peopleor dowhat theyask uneasy |t i:ti od jfee lingwor r iedor unhap pya bo ut a pa rtic ulars it uat ion unequivocal \\nr l\\\\\\r\\ tl'l adj expressingyou r o pin ionor int ent ion veryclearlyand firmly unhygienic rnlrrr rl ,i:nrl' adj not cleana nd the refo relik elyt o c aus e diseaseor infection unjustifiabfe rn rl , r:trlr.rrrlrladj (of an action)impo ssibleto e x c us eor ac c ept becausethere is no good reasonfor it unpeefed rn p1;l1ladj (of a fruit or vegetable)with a skinthat hasnot been removed variolation r cr.ir 1li,l'nn (historical) the p racticeof de libe r at elygiv ing someb od ya smalla mount of t he smallp ox(= vario la)vir uss o t hat t hey cannotca tchthis diseas ein f ut ur e vesicle rc:rl,l r a smallblisterfilled wit h cle arliq uid ,asso c iat edwit h s k in condition ssuchas e cz em a warning \\\\.r:nrrl n an instruction tellin g some bo dywh at t o do or what not to do
OX,FORD (Mid section view ofyoung nan/lmageDJ). 86 (Pouring salt/Banana Stock). 87 (Measuring blood pressure/Claude Cortier/AcE Photostock), 88 (Doctor with patient/Heru6 cyssels/Photononsrop), 88 UNIVERSITY I'RESS (Woman taking pills/Stockbroker), 90 (Living room/David ceorgeiRed Cover). 90 (Woman sneezing/ Martin Leigh/OSF),90 (Crowded public transpon/White), 90 (Waiting room/Science Photo Library GreatCiarendon Street,Oxford ox2 6Dp RF),93 (Testing forTB/CDC/Phototake Science),98 (SpaTooDMAISANT Ludovic/Hemis), 9E (Blue Oxford University Pressis a department ofthe University ofOxford. Poison Daft Frog/Chris Mattison/age fotostock), 99 (Mosquito biting/P&R Fotos/ageforosrock), 1OO It furthers the University's objective ofexcellence in research,scholarship, (Medical seminar/Banana Stock), 100 (Star fruit/nurke Triolo/Brand X Pictures), 100 (Kebab/Ciaran and education by publishing worldwide in Griffitr/trVhite), 100 (Cola/FoodCollection), 103 (Blood transtusioniYoav Le!y/Phorotake Science), 106 (Blood Pressure Sphygmomanometer/Ron Chapple Stock/Photolibrary RF),110 (MRl Scanner/ Oxford New York Corbis), 110 (tntiasound Machine/Corbis). 110 (Lmbar Punctule/tAURENT/B HOPAME/BSIPMedical), 112 (Stem cell illustration/GILLESiBSIP Medical); Punchstock p.7 (Battery/Phorodisc): Rex Features Auckland CapeTown Dares SalaamHongKong Karachi pp.4 (london Motorcycle Paramedic/lTv), 4 (Paramedic using a bicycle), 106 (Futuristic ambulance): KualaLumpur Madrid Melbourne Mexico City Nairobi Science Photo Library pp.16 (hteGl X-Rayof the Elboqliving Art Enterprises. LLC),'16(Fractured NewDelhi Shanghai Taipei Toronto fibula x-ray/Athenais, ISM). 16 (Fractured pelvis, x-ray/Du Cane Medical Imaging Ltd), 28 (Obstefic With officesin consultation/Ian Hooton), 28 (Newbom babyixeith/Custom Medical St@k Phoro),40 (Emil Kraepelin/ Argentina Austria Brazil Chile CzechRepublic France Greece National Libmry ofMedicine), 66 (Vitiligo skin disorder/Maria Platt-Evans).66 (Rash/Drp. Marazzi), Guatemala Hungary ltaly Japan Poland Portugal Singapore 66 (Scabies/Drp. Marazzi), 69 (lmpetigo/Dr p. Marazzi), 71 (Acne rulgilis/Sr. Baftholomew's Hospital), South Korea Switzerland Thailand Turkey Ukraine Vietnam 71 (Acnewlgaris/Dr p. Malazzi). 71 (Ame on chin/Dr p. Marazzi), 74 (Hospital recovery room/Simon Fraser),76 (X-ray ofappendix and colon/LunaFafix), 78 (Demoid ovarian cyst[SM), 80 (Removal of oxFoRDand oxrono ENGLTsHareregisteredtrademarks of an ovarian g/st/Dr Najeeb Layyous),82 (X-rayofenlarged heart/Dr p. 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Reproduced by permissioni p.34 Extract fron'Third Stageof Labour' rs B N :9 7 8o 1 94 5 6 9 5 69 from M.nct.org.uk. Reproduced by pemission: p.40 From Oxford Handbook of Psychiatry by Printed in china Semple, D, Oxford University Press2006. Reproduced by pemission: p.47 From Oxford Handb@k AC KNOWLE DGEM ENTS ofCeriatric Medicine by Bowlef, L et al., Oxford University Press2006. Reproduced by pemission; lll6trdtionsby:Julian Bakerpp.19,31,45,49,62,70,79,91,96,1O1, 102(map);w.cartoonsrock,com p.52 From Oxford Handbook ofEmergency Medicine 3rd Edition byWyart,J. p. et al., Oford p.87; Mark Duffin pp.16 (pan fire, knife, tin cu, plug), 35; Mehyn Evans pp.42, 71:Joy Cisney pp.38, 1l2 {Pandora s box): Andy Hammond p.104 (caftoon); lan Moores pp.21, 56, 104 (patient care):Oxford University Press2006. 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Reproduced by pcrmission; p.63 From 'Smart Getty Images pp.20 (lnjured rugby player Shane McDonald), 40 (Sigmund Freud), 66 (Sunburn/Peter Cade), 106 {Pacemakers):OUP pp.32 (woman/Photodisc),44 (Birthday celebrations/image100),46 fabrics make clever lmedical) clothing' fiom ICT Results, http://cordis.europa.eu/ictresults: p.70 Oames Parkinson/Cj Sword), 54 (Skier/Photodisc), 86 (scalesrDigital Vision),86 (cyclists/Phorodisc), 86 (salad/lmage Source), 86 (ashtray,tsananastock), 98 (Crowd/Photodisc).98 (Aircraft landing/ From Oxford Handbook ofClinical Examination and Practical Skills by Thomas, J et al. Oxford DigitalVision). 100 (tomatoes/Photodisc), 100 (strawberies/Photodisc), 100 ($apes/Ingram), 1OO(ice University Prcss2008. Reproduced by pemission: p.78 From 'Ova.ian Cyst' hom w.patient. creamA4ark Mason), 107 (Couple talking at table/Photodisc). 110 (Medicine/Photodisc); Photolibrary pp.4 (Paramedics/White), 6 (Using a mobile phone/Clow Images), 6 {Doctor with patientlndex Stock co.uk. Reproduced by permission; p.79 From Oxford Handbook ofClinical Medicine 7th Edition Imagery), 7 (X-my/Scoft Camazine/Phototake Science),8 (Cyclist/Nicole Hill/Rubberball), 15 (Docror smiling/SethJoeuwhite), 20 {Dehydratcd/BlueMoon Images/Bluemoon Stock Inc.), 24 (School spofts by Longmore. M. Oxford University Press2007. Reproduced by pemission; p.86 From 'High Blood day/Coco Images), 28 (Woman in doctor's office/Monkey BusinessIrnages Ltd/Stockbroker), 33 (Doctor with patientlAsia Images Croup), 34 (Cutting umbilical cord/HeNe cyssels/Photononstop), Pressure - H'?eftension' by Dr Richard Maddison, 2008, liom M.bcpa.co.uk , The British Cardiac 44 (Elderlywoman in chair/lmage Source),66 (Psoriasis^,ledicimage). 67 (Allergf/ testilmage Source), 74 (Day surgery unit/lmage Source), 81 (Group ofdtrtors studying[avier Lanea/age fotostock), 82 Patients Association. Reproduced by pemission; pp.90, 91 From Oxford Handbook ofClinical Examination nnd Pmctical Skills byThomas,J et al., Oxford University Press2008. Reproduced by permission: p.99 From Oxford Handbook ofCeneral Practice 2nd Edition by Pencheon, D et al., Oxford UniveNiry Press2006. Reproduced by pemission: pp.100. 101, 102, 103 From Oxford Handbook ofTropical Medicine 3rd Edition by Eddlestone, M et al., Onford University Press2008. Reproduced by permission; p.111 From 'Stem Cell TransplaDt' ftom w.patient.co.uk. Reproduced by pemjssion; p.I 11 From 'SueGj,ford: A new vision ofhope for the blind'by Suecyford, 21January 2009. fiom hftpt/news.scotsman.com. Reprcduced by pemission: p.111 From 'Stem Cell Basics'by National lnstitutes of Health, fiom http://stemcells.nih.gov Sourcesp: p.5, 6. 12. 15 Oxford Handbook ofEmergency Medicine 3rd Edition by Wyatt,J. p. et al., Oxford UniveNity Press2006; pp.22, 45, 47, 85, 90, 93 Oxford Handbook ofclinical Medicine 7th Edition by Longmore, ct al., Oxford University Press2007; pp.28, 29 Oxford Handbook ofCtinical Specialities 7th Edition by Colliel Longmore and Brinsden, Oxford Unive$ity Press2006; pp.39,41, 42 Oxford Handbook ofPsychiatry by Semple, D, Oxford University Press2006: p.50 2004 figures from Eurostat; p.66 Oxford Handbook ofClinical Examination and Practical Skills by Thomas, J et al.. Oxford University Press2008; p.78 Oxford Handbook ofClinical Surgery 3rd Edition by Mclatchic, C et al., Oxford University Press2007t pp.82, Oxford Handbook ofceneml Pradice 2nd Edition by Pencheon, D et al., Oxford University Press2006: pp.91, 92, 93, 94 Oxford Handbook ofRespiratory Medicine by Chapmm, S,Oxford University Press2006; p.98 Oxford Handbook of Public Health Practice 2nd Edition by Pencheon, D, et al., Oxford University Press;p.104 Oxford Handbook ofTropical Medicine 3rd Edition by Eddlestone, M et al., Oxford Unive$ity Pless 2008 Althou9h Nery effort h6 beenfrade to trace and contad coryig|lt holders before publication, this h6 not beil porsible in rofld c6es. We a?ologEefor an! Warent irfingemnt of coryigit antl.if notifed, the Wblishtr will bepleasedto rectify any eftors or omksiffi at the earliest Wtrtunity. Thea[thorandpublisherwouldlik tothmkthefol'J'wingpeoplewhoNiiedintheddeliprwtofthistitle: Dr Mark Fenton MA(Oxon) PhD MB BSMRCP(IX), Consultmt Cardiologist, Kent and Canterbury Hospital, EastKent HospitalsTrust; Deil Wang, Escolad'ldiomes, University ofvic, Spain. Specialthanksorealsodrc to: Eileen Flamigan (autho!: Crammar Reference), Ben Francis (author: Clossary, Website), Anna Gunn, Diane Winkleby, and Lewis Lansford for his consideruble editorial suppoft and guidance. Oxftrd Unirersity PressMkes no represdtatim, exprcssor inplied, that the drug dosagesifl this bookare cofted. Readersmust therefore always checkthe product infomation and clinical procedures with the frost up to date Wblished Wodrd iifomation and data sheetsprovded by the Mnufacttrers dnd the most recent coclesof condilct and safery regulatiorc. The authoB and publishe5 do not accept respo6ibility or leg,alliability for onf nore in the text or for the misbe or misapplication of material in this Nork.
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