Oxford English for Careers : Medicine 2 : Students Book ( PDFDrive )

C eri atrics51 i ! er : r c g r . : p l : ! r(sn )s t u d yo f (herklist populatio na ndp op ula t ion change s Assesysourprogressin this unit. Tick(/) the statementswhicharetrue. wffErns I canunderstandsi gnsandsymptoms A shortessay I canusepurposeandreasonto support advice Workin groups.Usethesequestionsto helpyou analysethe essay l can usew oul dandusedto,qetusedto topicsa-c below. andbe usedto I cantal kaboutrehabi l i tati on 1 Would you write about the topicsin the sameway or I canw ri tean essayw i th reasons differentiy?How? Keywordr 2 Aretheythe sametypeof essay? 3 Arethey factual? Adjectives 4 Doesonerequiredescriptiononly? ageing 5 Do any of them require an evaluationwhere you statean impromptu s hu f f li n g oplnion and support it by giving reasonsor examples? 6 Canyouusethe factualinformationin onet^ crrnnnrthp Nouns anosognosia reasonsin another? apathy bradykinesia a How can governmentsovercomethe problemsassociated disability with ageingpopulations? di si nhi bi ti on e v aIu a t i o n b Explainhow the changing demographj.cisn the world are gait affecting health careprovision. handi cap impairment c As the worid's population ages,priority hasto be given marche) petit pas to the young and ablebodiedin allocatinghealth care rehabi l i tati on budgets.Rationingof heaith careis thereforeinevitable. rigidity Doyou agree? th read tremor Discussthe topicsandprepareat Ieastthreeideasfor eachone. Eachgroupshouldthen present heir ideasto the whole class. Verbs an al y s e Fortopic c,which adjectivebestsumsup your attitude to the pi ckup topic? usefulr*fsren(* acceptable flawed immoral lndefensible objectionable unethlcal OxfordHandbookof GeriatricMedicine, rrnirrstifiahle offensive unacceptable watertipht Bowkeret al,ISBN978-019-853029-9 wrong rrnreesonable untenable Write about 200words abouttopic c. USEFUI FRAMES [Themain reqsontsthat] [...]isunethicalbecaus.e.. Forexample,if welookat ...Moreovert,hepurposeof healthcare isto ...Therefore.,.. USEFUL EXPRESSIONS Themain reasonis A n o t h e rr e a s o ni s Governmentns eedto / should Take,forexample, If wetake,forexample,where... ...can(not)bejustifed (by)...(because)

5 2 R eadingbank R e a dnig b a n k t Triage Triage T Work in pairs.Explain what you Thenatureof triageof Emergencdyepartmenwt orkmeansthatsome understandby the term triage.Compare sortingsystemis requiredtoensurethatpatientws iththemostimmediately your answerwith other students. life-threatenicnognditionasreseenfirst.A triageprocessaimstocategorize p a ti entbsasedonthei rmedi canl eedandtheavai l abldeepartmental Readthe text. Completethe sentences r e s o u r c e sT.h em o s tc o m m o n luy s e dp r o c e s si nt h eU K i s t h eN a t i o n a l beiow usingwordsfrom the text.You TriageScalewherethescaleof urgencyrsindicatedbya colourforeaseof may haveto changethe form of the reference. word. 1 Triageis a systemwhere patients Timeto beseenbydoctor areprioritizedfor treatment to make Within5-'10 minutes surethosewhose problemsaremost Wtltn t how are seenimmediatelv W i thi n4 hours Thepurposeofthe triage processis to put patientsinto - Assoonasa patjenat rrivesintheemergencdyepartmenhteorsheshould accordingto their needmedically beassessedbya dedicatedtriagenurse(asenio[experienceidndividual and the resourcesavailablein the w i thconS i derabcloemmonsense)T. hi snurseshoul dprovi deanyi mmediat e department. i n terventi onneeded(egel evati nignj uredl i mbsa, ppl yi ngi cepacksorsplint s, Patientswho needto be seen a n dg i v i n ga n a l g e s i aa)n di n i t i a t ei n v e s t i g a t i otnoss p e e dt h ep a t i e n t 'jso u r n e y instantly areindicatedin throughthedepartmen(tegorderingappropriatXe-rays)P. atientsshouldnot havetowaitto betriagedl.t isa briefassessmenwthichshouldtakenomore If patients do not needto be thana fewminutes. seenwithin two hours,they are categorizedas on the Threepoints requireemphasis: scalewiththe colour Triageisa dynamicprocessT. heurgency(andhencethetriagecategory) w i thw hi cha pati enrtequi retsobeseenmaychangew i thti me.Forexample, Answerthe following questions. a m i ddl e-agemdanw hohobbl esi nw i thani nversi oannkl ei nj uryi sl i keltyo 1 What qualitiesof atriage nurseare be placedintriagecategory4 (green)l.f inthewaitingroomhebecomes pale,sweatyandcomplainosf chestdiscomforht,ewouldrequireprompt mentioned? re{riageintocategory2 (orange). 2 What examplesof instant treatment Placemenint a triagecategorydoesnotimplya diagnosisn,oreven arementionedfor all patients? thelethalitoyf a condition(eganelderlypatienwt ithcolickyabdominal 3 How long doestriage normallytake? discomforvt,omitinga,ndabsoluteconstipatiownouldnormallby e placedin 4 Why is triage describedasa dynamic category3 (yellowa)nda possiblediagnosiws ouldbe boweol bstruction). Thecausemaybea neoplasmwhichhasalreadymetastasizeadndishence process? l i k e l vtobeul trmal eflavl al . 5 Whatcategorychangeisquoted to illustratethe dynamicprocess, standardto very urgent or very urgent to standard? Work in pairs.Completethe text in the TriagehasitsownproblemsI.nparticulapI atientsin last paragraph,using the words below: caregonems aywarr l o n g p e r i o d so f t i m e ,w h i l s tp a t i e nts whohaveoresentedlaterb. utwithconditionoserceivetdo be more uncomplaining urgent aware areseenbeforethem.Patientnseedto be nnn-rrroenf inordinniplrr of thisand to be informedof likelvwaitinotimes, elderly patientcsanoftenbe poorlyservedbytheprocess.

R eadi ngban k 53 3 Presentinginjurfi*s Preventinignjuriews henworking with hydraulicexcavatorasnd t Work in pairs.Are accidentsat work b a c k h o el o a d e r s easilypreventable?Givereasonsand examplesfrom the field of medicine. Summary 2 Readthetext.In pairs,findverbsthat Workerswho operateor work nearhydraulic excavatorsand backhoe meanthe sameasthe following. The loadersareat risk of being struck by the machineor its componentsor verbsin the text will bein different by excavatorbucketsthat detachfrom the excavatorstick.The National forms. Institutefor OccupationalSafetyand Health (NIOSH) recommendsthat injuriesand deathsbe preventedthrough training, proper installationand 1 put maintenance,work practices,and personalprotectiveequipment. 2 avert 3 find / isolate Descriptioonf exposure 4 hit 5 suggest A NIOSH reviewof the Bureauof Labour Statistics(BLS)Censusof Fatal 6 disconnect OccupationalInjuries (CFOI) dataidentified 346deathsassociatedwith 7 connect excavatorsor backhoeloadersduring 1992-2000INIOSH 2002].Review 8 get down of thesedataand of NIOSH FatalityAssessmenat nd Control Evaluation 9 check (FACE)casesINIOSH 2000,2001]suggeststwo common causesof injury: 10 declare ( 1) being struckby the moving machine,swingingbooms,or other machine components;or (2) being struckby quick-disconnectexcavatorbuckets * Work in pairs.AIIof the statements that unexpectedly detach from the excavatorstick. Other leading causesof below arefalse.Findthe evidencein fatalitiesarerollovers,electrocutionsa, nd slidesinto trenchesaftercave-ins. the text. Casestudy1 1 TheSummarymentionsthe A 28-year-oldlabourerdied afterhe wasstruckby the bucketofa recommendationsasregards hydraulicexcavatorT. he victim, a co-worker,and the operatorwere health and safetyin allwork usingan excavatorequippedwith a quick-disconnectbucketto load situations. concretemanholesectionsonto a truck. The victim wason the ground to connectthe manholesectionsto the excavatorwhile the co-workerwas 2 Threemain causesof injury by on the truck to disconnectthe sectionsafterthey had beenloadedon the excavatorsor backhoeloadershave truck. The operatorhad positionedthe excavatorbucketneara manhole beenidentifiedfrom the data. sectionwhile the victim attacheda three-leggedbridle to the manhole sectionfor lifting. The bucketdisconnectedfrom the excavatorstick 3 Cave-insarethe only other mdn (Figure l) and struckthevictim. He waspronounceddeadat the scene factorsmentioned asIeadingto INrosH 2001]. death. Casestudy2 4 In Casestudy 1,the victim was A32-year-oldconstructionlabourerdied afterbeingstruck in the head rushedto hospital. by a backhoebucket.The victim waspart of a two-man crew clearing earth awayfrom the foundation footing ofa house.The backhoe 5 In Casestudy 2,the victim was operator begandigging an approximately 60 cm-wide by 60 cm-deep climbing a building when the excavationaround the foundation while the victim useda hand shovelto accidenthappened. remove extra earth after the backhoe had passedthrough. The amount of footing protruding was decreasing.The operator lowered the backhoe's bucket to reston a pile of earth approximately 8 ft from the victim; he then dismountedfrom the backhoeto inspectthe trench.When the operatorreturnedto the machineand steppedoverthe tyre to sit down, he inadvertentlycontactedthe boom swing control, swingingthe boom toward the victim standingin the trench.The boom struckthe victim, pinning him againstthe house.He waspronounceddeadat the scene fNIOSH20001.

5 4 Readingbank S #4mwdmmgemmw$s The Big Question:Is skiing now so dangerousthat speedlimits should etu€$re9? be imposed? Work in groups.Readthe text, then match the paragraphheadingsbelow A It'sallrelativTeh. eraerenooverasltlatistiocnsskiinignjurieascrosthse to the paragraphsA-E. worldb,utindividusatul diessuggepset oplefe'sarms aybeexaggerated. 1 Aretheretoo many peopleon the TheAviemore-basspeodrtisnjuryresearfcahcilitsyki-injury.croemports t h a to n l y1. 7 4a l p i nsek i e rpse r1 , 0 0w0 i l ls u s t aai nni n j u r ys,os t a t i s t i c a l l y slopes? it'ssafetrhanagameoffootbaIlln.additioonn, lytenpercenot fskiing 2 Why areboardersand skiersin injurieasrecausethdrougchollisionMso. sat recausebdytheskieerither fallingoveor rskiinigntoatreeorotheor bject. conflict? 3 Sohasskiingbecomevery high- Mosat ccidenhtasppewnhenpeoplgeet ireds,othelasrtunoftheday istraditionaqlluyitebusfyoremergensceyrviceEsv.eonnthewidesotf risk? skiinmg otorwaiytsis,verypossibtloecollidweithanothesrkie-r spatial 4 Arehelmetsthe answer? awareneissaskeyelemetnotmasterianlgpinsekiingC.ertarinesorhtsave 5 How hard is it to avoidskiing into ' p i n cpho i n t s ' w h earl oeto ft r a f f ipc a s s eastt h ee n do ft h ed a ya sp e o p l e funnedlownthemountaiann, dwhenboyracelrossepatiencaenddecide someone? t0queue-jumthpeorderplyrocessipoeno, plgeetknockeodver. Workin palrs.Useno morethan three AccordintogtheSk(ilubofGreaBt ritain(SCGBsi)n, ce2001thetotalsnow words from the text to completeeach sportsraveml arkehtasincreasbeyd23percenTt.hatn'searlayquarter senrence. additionsaklierussingin, mancyasetsh,esamaecreagoefspacIen.many 1 Accordingto researchs,kiingis resortist i,ssimplnyotpossibtl0ecreatme orerunsa,sthelandisoften privateolywnedb,elongtosprotectendationpaal rkso,rdoesnh'tavtehe lessdangerousthan playinga rightopograpthoyallowforeasayc(esLsa. ssteasownasabumpeyrear forskierws,ithsupersbnowconditioancsrosmsuchofEuropaendNorth 2 Acruciaifactorinbecoming A m e r i ctaot;h i se n ds, o m e, l . 3 5 mt r a v e l l ehres a d ef odrt h es l o p e s . proficientin mountain skiing is D Atthemomentht,eriesnolawonwearinag'lid'otnheslopebsu, t he Sometimesmoreski slopes S(GrBecommetnhdastchildreunndetrhirteewneaor neandleaveits cannotbe createdbecausethe upt0thediscretiofntheindividufarol mthereonupT. hehelmehtas becomaefashiosntatemeinrtecenytearasndisusedbyallprofessional of the land makesaccessto the freeridearnsdboardewrsh,ospentdheier ntirteimejumpin0gutof helicopteinrtshemosrtemotsekfiieldisntheworldB. ywearinogneyou clnncc diffirrrlt canassociawteiththisromanticismev,enifyounevesrtrayfromthepiste, sothisisaforcfeorgoodH. avinsgaidthatt,hehelmedtoelseadsome 4 Wearinga helmetincreasesthe peoplteothinkthat heycantakemoreriskasstheyareprotectesdoi,t chanceof peopletaking more leadtsoafalsesensoefsecurity. 5 Snowboardersaremore exposedto Whyareboardearnsdskierssuchacombustimbliex?Thiscoulbdethe subjeoctfitsownBigQuestiobnu,tgeneratlhlyetwoapproatchhe nn<cihle mountaiinntwoentiredlyifferewntaysA.skiehrastohavaettainead leveol fproficienincoyrdetrotacklteheslopethsatasnowboarwdeillr i ------- nothavehadto.Inshorth, erearemore'bad'amastenuorwboarders w h ot a k et ot h es l o p et hs a nt h e r ea r e ' b a d ' a m ast ekui er rSs .n o w b o a r d s than skiers. - whichattractht eyoungaenr dpossibmlyorereckletshsrill-seeker - simpldyon'ht avtehesamceontroalndgripastwoindependently Workin groups.Shouldgreater controllsekdisa,ndwithouatsetofpolesa,boardwerhowantasrest controlsbe introducedinto sports simplsyitsdownw, hichmakethsemlesvsisiblaendtherefomreore to reducethe risk of injuries?Give vulnerabtolepotenticaol llisions. reasonsD. o controlsfor children reducethe enjoymentof sports? Doessuchrisk aversecontrolreduce children'sdevelopment)

R eadi ngbank 55 @Fm*fuesessedrys*#ffi#ffi#H T h er o l ef a t h e r sp l a yi n s u p p o r t i ntgh e i r p r e g n a npta r t n e r s T Wor k inpair s . lsit c o m m o n fo r fathersto bepresentat the birth of A socialrevolutionunimaginable50 yearsagois takingplaceeveryday in their children in your country?why / the UK's maternityunits- a hugemajority of fathersnow attendthe birth Why not?What doyou think of the of theirchildren. l d e a ?G i v er e a s o n s . One analysisof nationalstatistics(Kiernanand Smith,2003)putsthe J Readthe text.In pairs,matchthe overallpercentageat 86%.This figureroseto 93\"/\"for fathersliving names1-7to the list of itemsa-g. with their child'smother(morethan four out of fivecouplesareliving togetherat the time of the birth).Among thecouplesnot livingtogether 1 Kiernanand Smith,2003 at that time,but still havinga positiverelationshipwith eachother (one 2 Scottet al,2001 in tencouplesl,64Y\"of fatherswereat the birth. Evenwherefathers 3 Wolfberget ai,2004 weredescribedas'not in a relationshipw' ith the mothers(onecouplein 4 Vennerset aI,2005 twenty),10% of the fatherswerepresentat the birth (Kiernanand Smith, 5 Mcleod et a1,2002 2003). 6 Changetal,2006 7 PennandOwen,2002 Thereis a public debateaboutthe importanceof fathers,with politicians on both sidesof theAtlantic- notablyBarackObamaandDavid a showedthat mother'ssmoking is Cameron- focusingon the threatsposedby absentor disengaged relatedto a father'ssmoking. dads,especiallythosein minority ethniccommunitiesA. nd yetthe very servicesthat arebestpositionedto kick-starta morepositive,engaged b statedthat childhoodleukaemiais relationshipbetweenfathersandthe State- maternityservice-s only ask connectedwith fathers'smoking. two formal guestionsaboutfathers:if thereareanygeneticabnormalities on their sideof the family andwhethertheyareviolent. c showedthatprenatalinformation for fathershasan effecton This cannotbethe bestwe cando, givenwhat we know aboutthe mothers'breastfeedinghabits. significantpositiveimpactsthat engagingwith fatherscanhaveon the healthof motherand baby. d showedthat the majorityof fathersarenrcsentat their child's Takebreastfeedin-g a numberof studieshavefound that fathers' birth. behaviourand attitudesinfluencemothers'decisionsto initiateand/ or sustainbreastfeedin(gScottet al,2001).Wolfberget al (2004)conducted e statedthat earlypregnancylossis a smallrandomizedcontrolledtrial that consistedof a two-hour prenatal greaterwhen fathers smoke. interventionwith fathers,wheretheyweregiveninfant careinformation andencouragedto advocatebreastfeedinagndassistheir partner.It f statedvariousstudiesshow resultedin a 74\"/\"breastfeedinignitiation amongwomenwhosepartners fathershavean effecton mothers' had attendedtheclassc, omparedwith 41,o/foor the controlgroup. b r e a s t f e e d i n gd e c i s i o n s . Fatherss' mokingis associatedwith increasedrisk of earlypregnancy g statedthat mothers stop loss(Vennerset al,2005),earlycessationof breastfeedin(gcorrelation breastfeedingearlywhen fathers independenotf maternasl moking)(Mcleod et aL,2002),ancdhildhood smoke. leukaemia(Changer a|,2005\\.It is alsothe biggestpredictorof the mother'ssmokingstatus(Pennand Owen,2002),andmotherswho 3 Work in pairs.Hasthe text changed stopsmokingareconsistentlayssociatewdith fathers'provisioonf your answersto the questionsin ; supportandquittingthemselve(sMcBrideet al,2004).Researcshuggests a b o v e ?G i v e nr e a s o n s . that becominga fathercanbea'significantlife event'that increases receptivenestos smokingcessationinfluencesa, nd that providing expectantand new fatherswith targetedinformationaboutthe effectsof passivesmokingon babiescanhelpthemquit (Burgess,2007D).oesyour maternityservicefocuson fathers'andmothers'smokingbehaviouar t thistime?

5 6 Readingbank iE#€.9\"F Brainpattern r Workln groups.Whatdoyouknow associatewdith aboutthe causesof obsessive compulsivedisorder(oCD)?Have geneticriskof OCD you treatedany patientswith OCD? Describethe presentationofthe C a m b r i d gree s e a r c h ehrasv ed i s c o v e r e d disorder. th a tindi vi duawl si thobsessi ve c o m p u l s i vdei s o r d e(rO C D )a n dt h e i r 'i Readthe text. Answer the questions c l o s ef a m i l ym e m b e rhsa v ed i s t i n c t i v e yesor no. patternisn theirbrainstructureT.his isthefirst imethatscientishtsave 1 Hasa link between OCDand the a s s o c i a t eadna n a t o m i c at rla i tw i t h structureofthe brain in sufferers familiarl iskforthedisorder. and their near relativesbeen established? Thesenewfindingsr,ecentlryeporteidnthejournaBl ralnc, ouldhelp predicwt hetheirndivicluaalsreatriskofdevelopinOg CDandleadto more 2 Doesas iz eab l e p ro p o rti oonfth e a c c u r a tdei a g n o s oi sf t h ed i s o r d e r . population haveOCD? Obsessivceompulsivdeisordeirsa prevaleniltlnestshataffects2-3'ohf 3 Isthefearof dirt oneofthe thepopulationO. CDpatientssuffefrromobsession(usnwantedre, current obsessionssufferedby patients thoughtsc,oncernws iththemeos fcontaminatioannd'germst',heneed withOCD? to checkhouseholidtemsin caseofiireorburglaryth, esymmetricoarl der ofobjectso,rfearsof harnrinogneseolfr othersa)swellascompulsions 4 Is OCDinherited? (repetitivbeehaviourselatectol theobsessionsus chaswashingandcarrying 5 Wereonly brainsof healthy o u t h o u s e h o lsda f e t cy h e c k sT) .h e s es v m p t o n rcsa nc o n s u m teh ep a t i e n t 'lsi f e , c a u s i n sge v e r de i s t r e sas l,i e n a t i o na,n da n x i e t y . parentsof OCDsuffererstestedin the Cambridgeresearch? OCDisknownto runin familiesH. oweverth, ecomplexsetofgenes 6 Wasthe completionof a u n d e r l y i ntgh i si n h e r i t a b i l iat yn de x a c t l yh o wg e n e sc o n t r i b u tteo t h ei l l n e s s questionnaireon the computerby areunknownS. uchgenesmayposea riskforOCDby influencinbgrain the patientspart ofthe research? structur(ee.9t.heamounat nclocationofgreymatteirnthebrainw) hichin 7 Didthe nearrelativesof OCD turnmayimpacut ponanindividuala'sbilityto performmentatlasks. sufferersdo better than the control group? I no r d e rt o e x p l o r et h i si d e a t, h er e s e a r c h eurs e dc o g n i t i v ae n db r a i n measuretosdeterminrevhethetrherearebiologicaml arkerosfgeneticriskfor Givethe correctinformation for the developinOg CD.Usingmagnetircesonanciemaging(MRl)t,heCambridge questionsin I where the answerwas researchecraspturepclictureosf OCDpatients'brainass,wellasthoseof no. healthycloserelativetsasiblingp, arento, rchild)anda groupof unrelated h e a l t h yp e o p l e . Work in pairs.As quickly asyou can, flnd adjectivesin the text which have Participanatlssocompleteadcomputerizetedst hatinvolvedpressinag the samemeaningas: leftor rightbuttonasquicklyaspossiblwe henarrowsappearedW. hena beep noisesoundedv,olunteerhsadto attemptto stoptheirresponseTsh. istask 1 unconnected objectivelmy easuretdheabilitytostoprepetitivbeehaviours. 2 domestic 3 common B o t hO C Dp a t i e n tasn dt h e i rc l o s er e l a t i v efsa r e dw o r s eo n t h ec o m p u t e r 4 characteristic taskthanthecontrogl roupT. hiswasassociatewdithdecreaseosfgreymatter in brainregionismportanint suppressinregsponseasndhabits. 5 rerrrrrino L a r aM e n z i e si ,n t h eB r a i nM a p p i n gU n i ta tt h eU n i v e r s i toyf C a m b r i d g e , 6 rnmnrrehle explains'l,mpairedbrainfunctionin theareasofthebrainassociatewdith stoppinmg otorresponsemsaycontributteothecompulsivaendrepetitive 7 enhanced behaviourths atarecharacterisotifcOCD.Thesebrainchangeasppeatro run 8 causative in familieas ndmayrepreseantgeneticriskfactofrordevelopintghecondition. 9 fundamental. Thecurrendt iagnosoisfOCDavailablteo psychiatrisistssubjectivaend thereforkenowledgoeftheunderlyincgausems ayleadto bettedr iagnosaisnd ultimateliymprovecdlinicatl reatments. 'Howeverw, e havea longwayto goto identiftyhegenescontributintgothe distinctivberainstructurfeoundin OCDpatientasndtheirrelativeWs. ealso needto identifyothercontributinfgactorfsorOCD,to understanwdhyclose relativetshatsharesimilabr rainstructuredson'talwavsdeveloothedisorder.'

R eadi ngbank 57 € l{ifty *fter fifty M o r es e n i o r s - o n fl yi t n e s sc e n t e r s p oppingup 'i Work in groups.Thetext is about gyms for elderlypeopleor'seniors'. NEW YORK - Marshall Kahn a special'gentle yoga' classfor its Why doyou think gymslike this are attends a gym with yoga. tai chi lesslimber members. beglnning to be opened?Are such and Pilates classes,weight train- gyms common in your country?If ing, and treadmills. It also has a 'I think more than half the calls not,would they be popular?Give driving simulator, where members I get, and there's no regionalit_vto examplesand reasons. can keep their skills from deterio- this, are about doing a senior-only rating. health club,' said John Atwood. 2 Readthe text. As quickly asyou can, who runs Healthfit and the consult- find words and phrasesin the text The gym, Nifty After Fifty, is one ing firm Ciub ManagementGroup, which havethe samemeaning asthe of many fitnesscenterspoppingup which advises small or mid-size following: aroundthecountry aimedatserving clubs.'There was very little of this older clients. 'I'm 80,my wife is 48. in the 90s.' 1 weakening SoI haveto stayfit.' saidKahn, who 2 appearing signedup at one of the company's The businesspotential is huge, 3 do exercise four Los Angeles locations earlier and expanding. Club 50, a fitness 4 hectic this year and pays about $50 per chain for the over-40crowd that has month to work out three times a mushroomedto more than 40fran- ( frinl-r+anaz] week. 'I joined a gym about three chisessinceit began in 2003p, oints or four years ago,and I didn't like it out that seniorscontrol more than 6 focusingon at my age it was young,noisy,and 70per cent of the country's dispos- 7 agile frenetic. They were doing all these ableincome. 8 expanded crazy things I couldn't participate 9 availabletospend in. Here, I'm not intimidated. I'm And the oldest of the baby 10 attracts. more inclined to go.' boomers, born between 1946and 1964,started turning 60 last year. 3 find the personor organizationthat When it comes to designinga In lessthan 25years,there lvill be gavethe information below.Youmay gym,it's not all aboutattracting the more than 71 million 65-year-olds. useeachname more than once. hard bodies any more, and when twice asmany astherewerein 2000. it comes to senior fitness. there's accordingto the National Associa- 1 therewere not many gymsfor more out there than water aero- tion of Area Agencieson Ageing. elderlypeopleat the end ofthe last bics. As more of America's baby cenrury boomers start entering their 60s, The US health club industry more startup gyms are homing in pulls in about $16billion in annual 2 the numberof peoplejoining on a more mature market. revenue,accordingto datafrom the healthclubsis increasing International Health, Racquet & Gentler atmosphere Sportsclub Association. Over the 3 olderpeoplearefrightenedbythe 'As we getolder,we're sort of intim- last twenty years, the number of music and the very fit peoplein idated about going into a 25,000 peopiewith club membershipshas gyms square-footgym with rock music more than doubledand the number and people in tight leotards and of clubshasnearly tripled, IHRSA's 4 the numberof elderlypeopleis muscles bulging from every aspect data show. increasing of their T-shirts,' said 74-year-old Sheldon Zinberg, who openedNifty 5 the queriesabout gyms for older After Fifty last year. peoplearenot restrictedto one area Nifty After Fifty plays softer music than the typical gym, and 4 Work in groups.What is your opinion uses smooth, air pressure-driven aboutthe developmentof gyms for equipment for strength training senior/ elderlypeople?Givereasons as opposedto your typical metal andexamples. weights. So does Healthfit, a club based in Needham, Mass., where paintings adorn the walls and the average client is over 50.FitWright - a club that opened last fall in Dedham, Mass., which has seen particular interest recently lrom people in their 60sand 70s- offers

5 8 R eadingbank 7 Romanfacecream Roman face Gary Brown, managingdirec- Work in pairs.Lookat the title and creamfound at tor of Pre-ConstructArchaeology, skim the text. What is the text about? which discoveredthe por, said: 'I Readthe text. Replacethe text in bold London temple don't think we could haveexpected below with words and phrasesfrom that it would be so full, or that it the text. site would be somekind of cosmetic, A small tin which was a gift to moisturizingcreamor.wharevreit is. Roman godswas found recently. Thecontents of the tin were found Clearly Roman creamsof any type, to be intact. Theexperts were very surprised paint or cosmeticd, o not normally by the contents of the tin. Creamsfrom the Romanperiod survive..i.t'sprettyexceptional.' usuallyperish. An analysis will take place Teststo be carriedout soonwill shortly to ascertainthe purposeof the cream. reveailf the ointmenris facecream, 6 Historianssuggestedthegiftwas possiblydonated by a wealthy a form of face paint daubed for Briton ratherthan a Roman. 7 Thearchaeologicasl itewill religious services,or somerhing become a building complex. completelydifferent. Make questionsforthe information in eachstatementin 2.Usewho and NansiRosenbergs,eniorarchaeo- what. logical consultanton the project, 1 uncover lately? said: 'lVe know they [Romans] 2 contentstin? were very Keen on aPPearance, 3 reactionwhenopentin? 4 happenRomancream? usedearlobescraperas nd tweezers, 5 perform inthe nearfuture? 6 historiansproposewho madethe and therearea lot of Romanbaths donation? A SMALL TIN can hidden in a around.' 7 happento the archaeologicasl ite? ditch at a Romanrempleasan of- Historians said that rhe offer- 4 Work in groups.Do you think fering to the godswasopenedfor ing may well havebeenmade by a cosmeticsareusedmore now than in the past?Doesadvertising the first time in nearly2,000years member of the emergingBritish persuadepeopleto buy cosmetics unnecessarily? yesterdatyo reveawl hatappearetdo 'bourgeoisiew' ho had got wealthy besmellyold facecream. through the rise of the Roman The sulphurous-smellingoint- Emoire. m€ntwasdiscoveretdo becomplete The temple site was built at a with a genuine fingerprint of a point wherethe roadsto London Romansubjecot n thelid. hom Chichesterand Dover mer - The sealedconrainer- the size suggestinag stoppingpoint on one of a tin of sweetcorn- wasfound sideofLondon. It hasprovidedrare more than a week ago during an evidenceof organizedreligion in archaeologicadlig at the first remple thecaoital. complex of its kind discoveredin The complex,which datesfrom London. chemiddle of the secondcentury The can - which museumstaff en, is believedto haveDeena re- suspceted mighr have contained ligious meeting point from when gold,beadso, r a smallstatue- had native Celtic and Roman cultures beenburiedin an old drain at the had becomeentwined.The rem- sitein Southwarks, outhLondon. nants of cwo small squaretemples It was unsealedyesterdayat the were found, alongwith a possible Museum of London. After Liz guesthouse,an area for outdoor Barham, a conservator,carefully gatheringsp,linths for starutesa, nd unwrappedthe containerand un- a column base.Items of historical screwedthe lid, expertssaid they importancehavebeenremovedand werestunnedto discoverwhat was the site will now be convertedto inside. homeso, fficesa, ndshops.

R eadi ngbank 59 * €rxEning$*,r6uvffi###€6 N e wt r a i n i n gm e t h o d h e l p ss u r g e o n s ? Work in groups.Doyou think that it is e v a l u a t et h e i r o w n diff,cult for surgeonsto keepup with m i n i m a l l yi n v a s i v e modern surgicaltechniques?Give s u r g e r ys k i l l s reasonsH. ow do you keepup to date? Recentyearshaveseenthe rapid 3 Work in pairs.Underlinethe phrases emergenceof minimally invasive surgery in thetext which youcanreplace proceduresin operatingtheatres. with the following: However, the training of surgeonsin this field still leavesmuch to be desired. 1 donothaveanysensationoftouch 2 a standard ResearcherMagdalena Chmarra has 3 not an objectiveappraisal changedthis stateofaffairs by developing a realistic training systemwhich records and 4 it ic nni nrnclienf analysesthe surgeon'smovements. As a result there is now, for the first time, an objective benchmark for measuring a surgeon'sbasicskills in the field of 5 hashad an impact on cuttent minimally invasive surgery.Chmarra will receiveher PhD for this researchat Delft University of Technology in The Netherlands on Monday 12January. nrnrcdrrrec Despite its considerableadvantages,the relatively recent technique of minimally igvasivesurgery still hasa number of drawbacks.One such 6 is not wholly effective disadvantagerelatesto the training of surgeons,which is still, for the most part, delivered in a rather unstructured manner and, moreover,without any 7r iI-J ri-r^Ll4^q-,c,^![+u^4ttr objectivebenchmarkwith which to measurethe progressmadeby trainee surgeons. 3 Scanthe text for the answersto the Training questionsasquickly aspossible.Time Broadlyspeaking,therearecurrently two safetraining methodsfor yourselfand compareyourtime with minimally invasivesurgery.The first is the so-calledbox trainet an enclosed other students. rectangularbox in which traineesurgeonscanpractiseperforming basic manipulativetaskswith the surgicaldevices,suchaspicking up and moving 1 What hashappenedswiftly in the objects.As they do this, they can be assessedby an experienced surgeon. Clearly,this is a somewhat subjectiveprocess. reeenf nref) The other option is the virtual reality trainer, employing computer simulations, which allows for excellentrecording and analysisof the 2 Which downsidesof Chmarra's surgeon'sactions.Howevet this training method still hasthe major training systemarementioned? disadvantagethat it lacks realism. For example,usersfeel no tactile response when performing surgical tasks. 3 Howmanytrainingmethods TrEndo areusedfor minimally invasive Thus both of thesetraining methods havetheir drawbacks.The Delft surgery?What arethey? doctoral candidate MagdalenaChmarra hassought to chanfe this situation by developing a training tool that is realistic for the surgeonand at the same 4 What criticismsarevoicedof the time records and analysesthe motion of the instruments manipulated by trainingmethods) the surgeon.This is accomplishedwith an inexpensiveand relatively simple tracking deviceknown asthe'TrEndol A TrEndo incorporatesthreeoptical 5 DoesChmarra'sdevicework? computer-mouse sensorswhich record the movements made by the surgeon in all directions. 4 Work in groups.Howdo you prefer to le_arnewtechniques and proceduress, urgicalor otherwise? Giveexamples.

6 O Readingbank 9 Poweringparemakerj Heart's surplus energy may help power pacemakers,defibrillators Readthe text. Work in pairsto answer the questions. In an experimentalstudy researchersshow a beating heartmay produce enough energy to power a pacemaker or defibrillator. t Whichtwo of thesearementioned as findings of the Southampton study? NEW ORLEANS,LA., Nov.10,2008- Surplusenergygeneratedby the heart a Harvestingsurplusenergycaused may one day help power pacemakersand deflbrillators tmplanted in cardiac considerabledamageto the heart patients,accordingto researchpresentedat the American HeartAssociatlon's in somepeople. S c i e n t i f i c S e s s i o n s2 0 0 8 . b Asthe heart increasedsodid the energyharvestedfor the In a trailblazingexperiment,a microgeneratorpoweredby heartbeats microgenerator. producedalmost17 per cent of the electricityneededto run an artificral c The amount of energy harvested pacemaker.'This was a proof-of-concepst tudy,and we provedthe wasvery erratic. d Increasesin the energyharvested concept,'saidPaulRoberts,MD, first author of the study and a Consultant still rosewhen the blood pressure was reduced. Electrophysiologist at Southampton Universlty Hospital in the United e Thelining of the heart'schambers Klngdom. 'Harvestingsurplusenergymight be a majortransitionrn was not noticeablydamagedby implanting the microgenerator. implantable pacemakersand deflbrillators becauseengineers will have more I which of thesetwo predictionsabout on6r^rr i^ rarnrlz rarith ' the findings of the Southampton study doesRobertsmake? in their study,researchersfound. a Pacemakersmight soonhave much smallerworking parts. . At a heart rate of B0beatsper mrnute(bpm),the deviceyieldedan average b Thecapabilityof pacemakers harvestedenergyof 4.3microjoulesper cardiaccycle. couldbeincreased. c Pacemakerscouldbe powered . Increasingchangesin the heartrateproducedcorrespondingincreasesin indefinitely by micrognerators. d Pacemakerswill savethe livesof onorarr At l OA t 1 )Q l-rnm i ho harrroctod enarnrr lerrpl incrarcod 1 4O nor everyonefitted with the devices. ^ cent. I Whichtwo ofthese arementioned as drawbacks of the increasein battery . Decreasesoccurredwhen the researchersslowedthe heartbeator lowered sizeto powerthe devices? bloodpressure. a Thediscomfod b Thecost . Implantationand surplusenergyharvestrngcausedno srgnrficantinjury to c Theshape d Theweight the lining ofthe hearts chambers. e Thethickness 'What thls might mean is that in the next eraof pacemakers,you'd get 4 What isthe currentfocusof the researchers? devicesthat lastedsignlficantlylongerand we could add morefunctionsto help monror the heart. Robertssaid. 'lt's possiblethey could be elficient enoughto allow completeand indefrnitepowering of pacemakers.'Sincetheir introductioninto clinicalmedicine,implantablepacemakersand defibrillators havesavedlives and becomemoresophisticated.However,addrngnew moniloring capabiliLieslo the devrceshasled designersto a crilical point. 'The smalldevicesnow arereallyvery good,but power consumptionmust increaseif we want to take them to the next level,'Robertssaid. 'Battery technology has plateaued and the only way we are going to rncreasepower is to increasesize.'This, in turn, would increasethe units' welght, making them moreuncomfortableand lesscosmeticallyacceptableto patrentsbecausethe devicesareimplantedunder the skin, The innovativegenerator calledthe self-energizingimplantablemedical microsystem(SIMM)- helpsthe heartproducemorethan enoughenergywrth eachbeat to pump blood.The SIMM usestwo compressiblebiaddersand a microgeneratormountedon the leadof a pacemakeror defibrillator,the wire that connectsthe deviceto the heart.The leadis attachedto the end of the right ventricle,and the bladdersrelaythe energyfrom the pressureof each heartbeat to the microgenerator,which transformsit into electricity for use by the battery. A consortium of companies including InVivo Technology,Perpetuum and Zarlink Semiconductor developedand tested the SIMM microgenerator with United Kingdom governmentfunds.Researchersusedan rn-vivoporcine model to evaluatethe study. The researchersare now working to improve the materialsused ln the SIMM microgenerator. 'With differentmaterials.we're seeingevengrearerenergyharvesring,' Robertssaid. 'While at the moment we seeabout twenty per cent harvesting, we're anticipating that will be significantly more in the next iteration of the device.'

R e a d i n gb a n k 6 1 Workin pairs.What ethicalissues Most ethicalissuesfacedby doyou think might arisein the doctorsariseat the end ofa fieidof respiratorymedicine? patient'slife. This particularly Giveexamplesfrom your own appliesto respiratoryphysicians. wheredifficult decisionsaboutthe avh6ri 6h .6 appropriatenesos f treatmentandthe prolongationof life in patientswith Readthe text.Workin groupsand chronicunderlyinglung drseases asquickly asyou canfind nouns may needto be made.In some that areconnectedin meaningwith s it uat io nas r t i f l c i a lv e n t i l a t i o nm a y t h e s ev e r b s . prolongthedying processl;if'ehas a naturalend and the potentialto 1 makeworse prolonglifb in the intensivecare 2 suit unit cansolxetimescairsedilemmas. 3 lengthen 4 revive The CeneralMedicalCouncil 5 necessitate (GMC) in the UK statesthatdoctors 6 llmit havean obligation to respecthunran 7 differ l i f e .p r o t e c tt h e h e a l t ho f t h e i r patients,and put their patients'best Answerthe questrons. interestsfirst. This meansofl'ering thepatientt,hereis no ethical treatmenrtvherethe benefits distinctionbetweenstoppingthe 1 What ariseat the endof a outu,eighany risks,and avoiding treatnlentor not startingit in the treatmenttshatcanJ no netgainto first place(thoughthe fonner may naticnt'q lifc) the patient.Ifa patientwishesto be more difficLrltto do), and this havea treatmentthat in the doctor's shouldbe usedasan argumentfor 2 What canthe effectof artiflcial consideredview is not indicated,the f-ailingto initiate the treatmentin the v e n t i l a t i o ns o m e t i m e sb e ? doctor and medicalteamareunder first place. no ethicalor legalobligationto 3 What canthe patientaskfor provideit (butthepatient'srightto a S o m ec l i n i c a ls c e n a r i o sa r em o r e evenif the medicalteam denies secondopinion must be respected). commonly encounteredby the treatment? respiratoryphysicianC. OPD is The decisionaboutresuscitation the founh commonestcauseof 4 When shoulddecislonsabout andfbrmalventilationis neveran deathin America and rnostpatients r e s u s c i t a t i o na n d f o r m a l easyone,but shouldideallybe die ofrespiratoryfailureduring v e n t i l a t i o nb e t a k e n ? takenwith the nursingstaf_ft.he an exacerbationA. commonly pat ienta. n dr h e i rn e x ro f k i n . i n e n c o u n t e r e cdl i n i c a ls i t u a t i o rirs 5 What doesnot improve adranc eo f a n e m e r g e n c ys i t u a t i o n . wherea patientwith COPD is r e s p i r a t o r ya c i d o s i s ? In practicalterms.this is clearly a d m i t t e dw i t h a n e x a c e r b a t i o r r . not ahvayspossible.ldeally.all and it is type II respiratoryfailure. d e c i s i o n sr e g a r d i n gr e s u s c i t a t i o n Standardtreatmentdoesnot andtheceiling of treatment irnprore respiratoryacidosis. (particularlyrelatingto ventilation) s o n o n - i n v a s i v ev e n t i l a t i o nr s shouldbe documentedin advance commenced.Befbre startin-e and handedover to the on-call team. NIV a decisionmustbe clearly Most possibleoutcomescan be documentedasto u hetheror not anticipated. NIV is theceilingtreatrnentI.t may be ifthe patienthassevereor end Where it is decidedthe treatment s t a g eC O P D . is not in the bestinterestsof

6 2 R eadingbank 1l Copingin the tropics Tropicaflorests Work in groups.Haveyou ever Tropicaral inforestcsovear dwindlingsixpercentoftheearth's[andmass work6d in difficult conditions andaredefinedbytheirlocation(betweetnheTropicofCancezr3' z7'Nand where you hadto'sleeprough'? theTropicofCapricor4n' z7'S)andtheirhighrainfallw, hichcanbeseveral Giveexamples.If you haven't, how metresa year.Duringtheday,theforestsarehotandhumido, ftenwithlittle do you think you would cope? breezeto giverespiteb, ut1-. Theforesftloormaybeunderwatefor r m u c ho f t h ey e a r .P r i m a rrya i n f o r e swt ,h e r et h e h i g ht r e ec a n o p sy u p p r e s s e s Readthe text. In groups,complete groundgrowthi,smoreopenthansecondarfyorestH. ereprevioufselting the text using a-g. allowslightto reachtheforesftloorandpromotegrowthofdensefungle. a youriskcuts,insectbitesor Clothingandfootwear snakebltes,larva migrans, . Accepdt aytimewetnessR. insekitin campandre-weawr etnextday.Keep jiggers,etc. a d rysetofctothi nign a pl astibc agforeveni nagndbedti muese b to preservecomfort and skin L at night they becomemuch o Nevergo barefootor wearsandalsas 3-. . Usebootswith goodtreadsthat dry quickty.De-roofedblisterscould cooler,and travellersin upland forests may require a blanket or developinto ulcers,so 4-. lightweight sieepingbag . Coverup as longsleevesand trousersprotectyoufrom irritantplantsand thereis apotential source of infectionssuchas i n s e c tb i t e s . histoplasmosisand Chagas' o Wearglovesas 5-'. disease . Vliar a hatto protectyou againstthe sun,rain,and barbedleaves. this is bestclearedfrom the ground beneathhammocksand Basesand campsites aroundtent enttances they protect againstsawgrass Choosewith care: cuts,especiallywhen using a r Avoidriverbanks,whichcanftashftoodfromdistantrainsupstream.Low machete ensurethat bootsareproperly riverbanksareaccesspointsto and fromthe waterfor witd animals.Check worn in beforeentering the po t e n t i acI a m p s i t ef o r a n i m a ls p o o ra n d d r o p p i n g s . jungle o AvoidabandonedlocalsheltersT. heymaybe structuraltyunsoundand canharbourspiders,ants,rodents,and snakeswhichfeedoffthem. Even whenthe faunahas[eft,o-. o Lookup: sitesheltersawayfrom rottingtreesor branchesthat couldcrash down(so-called'deadfatt'). r Sleepoffthe groundto avoidsnakes,scorpionse, tc.Construcat raised s le e p i n gp l a t f o r mo r s l i n gh a m m o c kU. s ea m o s q u i t on e ta n d ,i f o u t s i d e, protectyourselffrom rain usingplasticsheetingor tarpaulin. Clearingenoughgroundfor tentscantakea lot of energyand it canbe difficultto removestumpseffectivelyl.f used,tentsshouldhavea midge mesh,sewnin buckettype groundsheetand zipsthat seaIthe entrance. Theycanbe stiftinglyhot and are heavywhenwet. a Leaflittercanhidesnakesand scorpionss, o 7-. a Protectgroupareasfrom rain by tarpaulin.

R eadi ngbank 63 12Smartfabrig Smarftabricms akeclever ( m e d i c acl )o t h i n g Work in pairs.Which of the following doyou think arethe most likely uses EUROPEAN rese'arche.rhsave developcd r- that car-r of technologyin'smart (medical) clothing'? monitormuscnlaroverloadand helppreventrepetitivestrair-inr juni or RSI.But that is just tlre beginningT. he tcam is alsocxploring . temperaturecontrol o monitorlng ababyandthe mother a pregnancvbelt to uronitor a bab1.'sheartbeat,clothing to hclp during pregnancy c o a c hh o c k c r ;a n r ls h i r t st h a t r l o n i t o r l - d u r i n gt r a i n i n g . o monitoring the heart o detectinglllness Sm.trt f.rbrtcs Lrrotrisc to rcvolutionize clothing by in- o collectinggeneralmedical data corporating sensors into cloth for health, lifestvlc, ancl Readthe text. In pairs,completethe business applications. In the long term, thev could text using a-h. consist of circr-ritsancl scnsors that provide all oi thc a cruclalhurdles -r- we carryaroundtoday,li(g rnobilephonesar-rcPlDAs. b arecuperativebreak c chailengingproblems Current,first-generatiora-rpplicationsarefar more modest,aud d a seriouswork safetyissue e a smart fabric pionecringmedicalsmart fabricsare used to monitor vital signs f typical electronics g musclefatigue Iikc heart rate and tcmperatrlreB. ut two +- - unobtrusive- h a mature field of research ne.ssanclrcliabilih'- impcdc r'r'iclcspreaaddoptionof such clever Work in pairs.Underlinethe correct alternativeto makethe sentences clotl-res. true. Now one European researchteam has dcveloped ground- 1 Accordingto the writer, smart fabricresearchisin itsinfancy/ old breakingmcrljcal-sensingsmartfabricsa, nd its work couldleadto technology/ not worth investingin. pregnancvmonitoringbelts,sportsclothingthat providestraining 2 Theuseofcleverclothing is beingheld backby its lackof tips,a wearablephvsicalgamecontroller,and a vest that helps to dependabilityand obtrusivenes/s dep endability alone/ obtrusiveness prevcrltrcpetitivestraininjury. alone. The Contcrt f. rojectinitially sough t to developan RSi to 3 Among the potential usersof tackle s-. Rcpetitive actions can, over time, le'easdt to smartfabricsin clothing are dancers/ singers/ sportspeople. permanentinjr-rryanclthe problem costsbillions of eurosa vear. It affectsovcr 40 nrillion workers acrossthe continent and is 4 RSIismainlycausedbysmall amounts of stressovera short / rcsponsiblefor 50pcr cc.ntof all work relatedill health. Iong/ modestperiodof time Musclecontraction,the very quiet metric 5 Measuringtheheartisaffected bythe sound/ electricity/ heat The team had to tacklethree6-. First,they wcrc using a producedby the clothesmoving. relativelvnovel sensor that dernandedsophisticatedelectronics 4 Work in groups.What would you located in the clothing. Sccond,they were aiming to measure Iiketo seesmart clothing usedfor in the medicalfield?Givereasonsand musclecontractiona, very'cluietrnctric'.Third,theywcrevcnturing examples. on a researchpath se'ldorntrodden: muscle contraction as a predictorfor stress.Long-term, low-key stressis the leaclingrisk factorior RSL 'Eachof the issueswas vcry clifficult.We choseto use a capa- citativesensor,becauseit does not need to be attachedto the skin like resistiveserlsorst1o,lvhic[-racidsto the comfort.lt nccc]s controllingelectronicscloseto thc sensorto work effectivehiantl that presentsa rcal challerrgefor tcxtile integration,'explainsBas FeddcsC, ontext'sco-ordinator. Sinrilarlv rneasuringclectron-ryographoyr, electricalactir.ih' in the rnuscle,is more subtle and triclg, than electrocardioga ph1',which measuresthe heart.The rustlc of clothing.causedbr movementcandrolvn out the signal.Contexthasgonea long n ar to solvingthat problembut it is not asrobnstasthe.'w- ould like. Finally'm, edicalundcrstandingof mr-rsclcstressas a predictor fbr RSI is not 7 , so it is difficultto saywith certainh'that specificactivitiescouldleadto RSI.Despitetheschurcilest,he team successfulldvesignctlan RSIvest,and thel' arecurrentll inrprroilllg its reliability. Context'sarnbitiousprogrammetackled pioneeritrg;rrrdvcn complcxissucsin sn-rart-fabrircesearchw, hich resr-rlteicnl a useful, unobtrusive,anclreliableRSI vest that can warn wearcrsto take t)

5 4 Readingbankk e y R e a dnig b a n kk e y I Triage 4 Fatherrandpregnancy 1 Students'ownanswers. 1 Students'ownanswers. ? ld 2f 3c 4e 59 6b 7a 4 1 life,threatening 2 categories 3 Students'ownanswers. 3 red 4 non-urgent/ blue 5 OCD 1 a senior,experiencedindividual with considerable 1 Students'ownanswers. common senseN. otethat dedicatedmeans'assignedoniy 1 1 Yes +L^U +trL^td+L u1u,,l+y.., 2No 3 Yes 2 elevatinginjured 1imbs,applying icepacksor splints,and 4 Yes giving analgesia 5No 6No 3 nomorethanafewminutes 7No 4 becausethe urgency (andhencethe triage category)with 3 2 It affects2-3%ofthepopulation. which a patient requiresto be seenmay changewith time 5 aswell asthoseofhealthy closerelatives(asibling,parent, 5 standardtoveryurgent or child) 6 Participantsalsocompleteda computerizedtest. non-urgent categoriesi,nordinately long periods,perceived 7 Both OCDpatientsand their closerelativesfaredworseon to bemore urgent,awareof this,Uncomplainingelderly the computertaskthan the controlgroup. patients. 4 i unrelated 2 Preventinginjuries 2 household 3 prevalent I Students'ownanswers. 4 distinctive I 5 repetitive 6 similar z 1 load 7 improved 8 contributing 2 prevent 9 underlying 3 identify 5 tiftyafterfifty 4 struck 1 Students'ownanswers 5 recommends ? 1 deteriorating 6 detach -? rn-nr rn-n- 'ibno r\"rrn 7 attached 3 work out 4 frenetic 8 dismounted 5 intimidated 9 inspect 6 hnmino in nn 1O nvnnarrnnarl 7 limber 8 mushroomed 1 relatesto hydraulic excavatorsand backhoeloaders 9 disposable 2 suggeststwo common causesof injury 10 pulls in 3 Otherleadingcausesoffatalities are... 4 Hewaspronounceddeadatthe scene 3l JohnAtwood 5 ...toward the victim standing in the trench 2 International Health, Racquet& SportsclubAssociation 3 SheldonZinberg t Howdangerourisrkiing? 4 National Associationof AreaAgencieson Ageing 5 JohnAtwood lc le ta 40 )D 4 Students'ownanswers. I 1 game of football 2 spatialawareness 3 topography 4 risks 5 collisions Students'ownanswers.

R eadi ngbankkey 65 7 Roman face Gleam to Ethicalissuet 1 Students'ownanswers. I Students'ownanswers. 1 discovered 7 1 exacerbation 2 complete 2 appropriateness 3 stunnedto discoverwhat was inside 3 prolongation 4 do not normally survive 4 resuscitation 5 Teststobecarriedoutsoon 5 obligation 6 saldthat the offering may well havebeen made 6 ceiling 7 be convertedto homes,offices,and shops 7 distinction 1 What was uncoveredlately? 1 most ethicalissues 2 What condition were the contents of the tin in? 2 prolongthedyingprocess 3 What was the reactionof the expertswhen they opened 3 asecondopinion 4 in advanceof an emergencysituation the tin? 5 standardtreatment 4 What normally happensto Roman cream? 5 What will be performed in the near future? tl Copingin the tropics 7e 6 Who did historians proposemade the donation? I Students'ownanswers. 7 What will happento the archaeologicasl ite? 2 1c 2b 3a 49 5f 6d 4 Students'orarnanswers. 8 Trainlngfor surgeons t2 Smartfabrics 1 Students'ownanswers. t Students'ownanswers. L 1 feelnotactileresponse z 1e 29 3f 4a 5d 6c 7h 8b 2 an objectivebenchmark 3 a somewhatsubjectiveprocess l 1 in itc infannr 4 it lacksrealism 2 lackof dependabilityand obtrusiveness 5 haschangedthisstateof affairs 3 sportspeople 6 sti1lhas a number of drawbacks 4 long 7 leavesmuch to be desired 5 sound 1 the (rapid)emergenceof minimallyinvasive surgery Students'ownanswers. proceduresin operatingtheatres 2 the unstructuredtraining of surgeonsand lack of any objectivebenchmarkto measuretraineeprogress 3 two: the so-caIIedbox trainer and the virtual realitv trainer 4 subjective,lackof realism,and no tactile response 5 It recordsand analysesthe motion of the instruments m_anipulatedby the surgeon 4 Students'ownanswers. 9 Poweringpacemakers I bande 2 bandc 3 aandd 4 to improvethe materialsusedin the SIMMmicrogenerator

tr I. . it' I IL' i,ii,.r(', |.l: I',I| l I rlr : lii.i .iir .t i.r lli)lt,('ill . (\".L)r'i I lll!

D ermatol o gy67 ,,commenti ngon the past usi ngverbsw i th fo or -i ng taIki ngaboutdermatol ogy , understandi npgati entl anguage ,, understandi npgati entsat natural speed i r +il;:: ill;tntt$,ii\", 'ti tr tr Lesions E Workin pairs.What lesionsdothe diagramsshow? Whenyou haveansweredasmany asyou can,look atthe list atthe bottomto helpyou. E tr E E tr *iil' ,,S*q\" tr E 1.11i:-i:,r;',l?j L Listeningfor details (s] Listento the extract of aconversatlon betweenDr Jacksonand lohn DoddsW. rite as many detailsaspossible. Youmay haveto listen twice. \\A/nrir in n:irq Onp studentreadstheir notes to their partnerandthey rherfz e nrr diff atcrea< crust ecchimosis macule patch /\\ t:^r^'^ L d^ ^B^diL- r r d^l* , L U nrrrnrrrn nr:qtrrlc ulcer vesicle rl IP Ll> LCl wheal scale checkfor detail. Canyou improveon the doctor'squestrons? In groupsd, iscusshow you distinguishbetween Map the doctor'squestionso: pen,closedI,eading,etc. lesionsf,or exampleb, etweena wheal and a plaque? Givean exampleof a condition in whlch you would see What otherreassuringstatementscouldthe doctorhave e a c hof t hes eles io n s . used? Which iesionswould you associatewith theseverbs: Which dlagramrnVocabularymatchesthe itch,ooze,discharges, pread,scab,harden? conversation?

68 Unit7 ;:, ;il: i;q ij q,.;11,r,;: -: In which sentencesin is the patientvery upset? Workin pairs.Matchthe two partsof the patients' ::, When the patient sayssomething that lndicateshow they feel,it is importantto be ableto acknowledgethe statements. cuesgivenby the patient.Thesecuesmay beverbal, vlsual,intuitive,or aural.Youneedto acknowledge 1 I found the whole a but I don't reallycare them to showthat you arelistening andthen follow them up with reassuranceC.hoosetwo or more ewneri en ne qo b but I'm worriedabout statementsin i and decidehow you would reassurethe ulll->+t*r^tr->^i>-^1rr5 them. patient. 2 I couldn'tleaveit c andtherearea lot more USEFUL EXPRESSIONS u n s i g h t l yt h i n g s t h a n elnne Tirrqi lrcnl- this,but I am always It sounds/ Iooks/ seemsasif ... nlerrino rnrifh it Yousound/ Iook/ seem...(ifI am right?) Thetreatmentcanmakeit lookworsethan it is. 3 It scabbedoverand I awareof it. With children,it'sdfficult to stopthem scratching. pickedat it and made Youmust have(beenitchinga lot with this). it bleed.I know d I s h o u l d n ' th a v ebut l ' Workin pairs.Taketurns reassuringeachother. rnrrlin't heln it ;:r Stlllin pairsuseoneor moreof the otherstatementsin 4 I know it'scoveredup e hprp nn hnth mrr : to do a role-playwithout any preparation. ( I lzcen fcllino him fn wristsandelbows. leaveit alone Thev're reallv itchv.a nd 6 Tcrrnnncc: lnf nf irritating. nonnle rarnrr'ld ha f I don't know if I have hnthered hrr it e v e rb e e ns od i s t r e s s e d in my life. 7 I'm almostbeside g I'mjustworriedthatit mrrqclf urith it will Ieavescarson my face. 8 My husbandsays it'sonly afew white h andI couldn'tstop myselffrom scratching. netrhpc i and stoprubbing it, but 9 I'vecomeout in these he'sjust very workedup by it. littlc red cnnic rl Findwordsand exoressionisn : that meanthe sameas these. i form a crust 6 terrified 1t blemish La ^ylt^d,y' 4^Lu^v\"u+L 'v^v'ir+LLrr 8 macule 9 cicatrix 3 ugly 4 consclous 5 agitated

rash(n )eru ptio nofth e sk inin <n6i< nr na+.hp< flareup (v)erupt o Languagespot Speaking Commentingon the past 1 Identifythe two skin conditionsand givereasonsfor your diagnosis. 1 Work in pairs.Correctthe sentenceswhere necessary. €aJesoer uJ€ q 1 I must've knockedmy arm on something and then o8qadur e theseIumps havecomeup. Work ln groups.Preparea role-play.A patient is going 2 I should'vecomesoonerand then the rashwould be to presentwith a skin complalnt.Make a list of the s ob a d . questionsyou would askthe patient under these headings: 3 I should'veput anything on asthat'swhat's made it Thepresentingcomplaint flare up. P a s tm e d i c a l h i s t o r y Aliergies 4 When I was stung,I couldgo into shock.I wish I d Drug history known. Familyhistory Socialhistory 5 Hedidn't needto pay for his treatment. Psychosociailmpact 6 Surely,I can't havepickup scabies. Compareyour list with another group or the rest of the 7 i would comeearlier,but I had to take the childrento class. school. 4 Work in pairs.StudentA, goto page114S. tudentB,go 8 I should'vepay closerattention and kept the box the to page116I.n the role-play,the patient answersthe tabletswere in. doctor'squestionsaccordingto the diagnoslsofthe 9 Yesy, ou're right. It should'veclearedup by now. skin condition on the picture.Thepatient showsthe 10 Shouldn'tit havegobynow? picture to the'doctor'at the appropriatemoment. 11 I needn'thavepaidfor the prescription. Make surethe doctordoesnot seethe picture with the diagnosis. 2 Which of the statementsin 1describethings that did When you finish, checkhow many questionsin not takeplace? exercise2 you asked. 3 What would bethe effecton the patient if the doctor 6 Givefeedbackon your own and your partner's said:Youshould'vepaid attention to what you were doingand ,..;youshouldn'thaveusedthat cream... performance. 4 think of three things that you havedonerecentlyor you haven't donerecently.Describethem to a partner. USETUl EXPRESSIONS WhatI should(n't)have donewas... What I couldhavedone was... I needn'thave/ I didn't needto ...b, ut ... I would've...but I couldn't... D Cc io Grammar referencep 123

70 Unit7 Cross-section oftheskin Reading 3 Lookat theseanswers.Readthe text and decidewhat questionsyou would askfor eachone. Beforeyou readthe text, work in pairs.Answer these questions. 1 the integumentary system 2 prevention of water loss,antigen presentation,and 1 What functions doesthe skin perform? 2 What arethe layersof the skin? sensation 3 What functions do glandsperform? 3 unsightlyblemishes 4 aboutthreemonths Findwords in the text which aremadefrom these: 5 thesuperficialfascia 6 puberty 1 societv 3 sipht 5 lie 7 mix 2 thesis 4 out 6 append 8 number A p p l i e da n a t o m ya n dp h y s i o l o g y The skin, nails,hair, glands,and Almost 90%of epithelialcells Iayeror the superficialfascia, associatednerveendingsmake up arekeratinocytes.Thesecellsare this consistsofadiposetissue the'integumentary system'. producedin the basallayerand and servesboth asa lipid store Skin then rieeto the surfaceasmore andprovidesinsulation. It also The skin actsasa physical, areproducedbelow and the outer contributesto the body contours biochemical,and immunological cellsareshed.The time taken and shape. barrier betweenthe outsideworld from forming in the basallayerto Glands and the body. It alsohasa role in sheddingis usuallyaboutthree After infancy,sebaceousglands temperatureregulation,synthesisof months. becomeactive againat puberty vitamin D, prevention of waterloss, Melanocytesresidein the basal and secretesebum.a mixture of antigenpresentation,and sensation. layerand secretemelanin into fatty acidsand salts,directly onto surrounding keratinocytesvia the skin or into the necksofhair It is important to rememberthat long projections.This, alongwith follicles.This waterproofsand the skin alsohasan important the underlying fat andblood, lubricatesthe skin and hair. They psychosocialfunction. When we givesthe skin its colour.In this areparticulady numerousin the Iook atanotherperson,we are way,skin tone is determinedby upper chest,back,face,and scalp. in fact looking at their skin. As the sizeand number of melanin Sweatglandssecretea mixture our skin representsour outward granulesand not by the number of of water,electrolytes,urea,urate, appearanceto the world, unsightly melanocltes. ammonia, antl mild acids.Eccrine blemishes,despitetheir small size, Dermis sweatglandsarefound all over the canhavea significantimpact on a Belowthe epidermisliesalayer body surface,besidesthe mucosa. person's elfesteem. ofconnective tissueconsistingof Apocrine sweatglandsarefound collagen,elasticfibres,and ground in the axillaeand pubic regions, The skin is madeup of three substanceI.t is herewherethe secretea more viscoussweat, layers- epidermis,dermis, and 'skin appendagesm', uscles,nerves, a n d a r e u n d e r c l e a ra u t o n o m i c hlpodermis. and blood vesselslie. control. Thesedo not function until Epidermis Hypodermis puberty. Also known asthe subcutaneous This is the outermostlayer and is formed of amodified stratified squamousepithelium. Work in groups.Describea casewhere you dealtwith a patient with a dermatologicalcomplaint and where you feelthat you could've/ should've/ couldn't have donethings differently.

D ermatoi og -7v1 listening2 . languagespot Dealingwith teenagers Verbswith to and-ing Work in groups.look at thls scenarioW. hat would have 1 look at this extract from lfsteni ng 2 and underline the beenthe management andwhat advicedoyouthink verbsin the -ing form. Canyou usethe infinitive with to shouldhavebeengiven?Make a llst. instead? A sixteen-year-oldmale patient,Brian Collins, ...il4i.1don't l,tkzqillg outa,s?+o?l, presentedwith spotson his face,neck,back,and 1\"0&at A ani. tdunk\"x's furE. An^dtt chest.Examinationrevealsblackheads(comedones) and whiteheads,red papules,pustuies,and cysts. f*n ftt*l wort4. I'ae h4zl cuthitE out certa,Lnfnd,,t, h,* %fi4/44 wfik's, a*d Q tisten to an extractfrom the consultationafterthe doctor,DrAimee Preston,hasexaminedthe patient. , dtrt,/fferentcrenouasndrtu/f. Checkwhich items on your list were mentioned and ^*A addthosewhich were not. Completethe sentencesusing the -ing form or the fo- Q tisten again.Answer the questionsand sayhow infinitive of the verbsin brackets.Theremay be more the doctordoesit in eachcase. than onepossibleanswerfor someitems. 1 Isthe doctorsympathetic? 1 I haveto admit to (notuse)the 2 Isthe doctorreassuring? 3 Isthe languagesimpie? ointment you gaveme. 4 Doesthe doctorseekcooperation? 5 Doesthe doctorseekto ensurecompliance? 2 I stopped (apply)the creambecauseit 6 Doesthe doctorwarn the patient about the duration mademy skinveryangrylooking ofthe treatment? Doesthe doctorseekto invoivethe patient in the I forgot (make)an appointment to see management? 8 Doesthe doctoruse'safetynetting'? thenurse. Y Doesthe doctorarrangea follow-up? 4 Yes.I remember ( g e t ) t h em e d i c i n e . 4 f) Comparenoteswith partner and if necessarylisten again. 5 I always avoid (sit)in the sun. Work in pairs.Taketurns talking to the patient in the o I regretnot (come)in sooner. scenarioin I above. 7 I dldn't finish (take)themedication. 8 Imeant (apply)it everymorning,but it meant (getup) earlierand it made me latefor work. 9 Followingthe treatment requires (plan) and a lot of effort. 3 Work in pairs.Taketurns being the d,octorand a patient with acne.Thepatient shouldchooseat leastthree of the statementsabove.Thedoctorshould givea responseand developthe conversation. USEFUL EXPRXSSIONS Yes.It'snot easy.,. It takestime ... Doyou think you could...? Is thereany way round this...? Wasthereanyparticular reason...? )) CrrIi, Grammarreferencefr ilI3

72 UnitT Pronunciation Z a h r aE l - A s h t y Main stressin a sentence My nameisZahraEl-Ashryl'm a practicenurseworking in a CPsurgerya,nd l'vegot a postgraduatdeiploma (s] tisten to the patient speaking.Write the exact in dermatologyI.becameinterestedin this particular wordsthat the patient says. areawhen I saw how distressedpeoplewerewhen they cameto the surgeryw hereI w orkw i th vari ousski n 2 Compareyour answerswith a partner. probl emsl t.' sbadenoughfor adul tsb, ut for chi l drenand t e e n a g e r si t ' s p a r t i c u l a r l yu p s e t t i n g . 3 f) Llstenagain and mark the main stressin the S ometi mejsu,st a few w ordshel pto makethi ngs sentenceI.f you needto,listen for a third time. betterB. utthe mai nthi ng i s hel pw i th the treatmen t itselfasit is sometimescomplexl.t iseasyto get Practisesayingthe statementsto eachother.Did your annoyedat the pati ent' spoorcompl i ancuenti l you partner sayail the syllables? reframethi s asa l ackof concordance;thewne ashe alt h professionalms ayget annoyedwith ourselvews hich is Followthe sameprocedureasinLanguagespot3.This time concentrateon the pronunciation. j ust asbad.In orderto encourage the patientto complywith It'smyjob anyregimenthat the doctor agreeswith the patientw, e Beforeyou read,discussthis questionin pairs. havefoundthat concordance ;\" What do you think is the value of the practicenurse worksif the patientseesme afterthe doctorto hel oi n in helping patientsstickto their treatment? pl anni ngtreatment hroug h di al ogueandunderstanding Readthe text and answerthe questions. lifestyleconstraintsW. e 1 How did Zahrabecomeinterestedin dermatology? havefoundfrom talking 2 Why doyou think skin problemsmight be to otheroracticetshat nursesarei nval uable particularlyupsettingfor childrenandteenagers? indemonstrating 3 What two things canhelp patientswith skin topi catl herapi esand in opti mi zi ngconcordnace. problems? 4 What is the differencebetween complianceand Project concordance? Work in groups.Eachgroup choosesone of the items 5 HowdoesZahraencourageapatienttofollowa below.Checkthe suggestedsourcesand useyour own experienceto coliectinformation onthe management reglme? of the condition.Youmay checkinformation with studentsin other groups.Lookat thesewebsites: Work in groups.Describecaseswhere you know that you havebeensuccessfuiln encouragingpatients 1 psoriasis:wvwv.psoriasis-association-org.uk to keepto a treatment regime.Saywhy you were 2 eczemaw: vwv.eczema.org.uk successful. 3 solarkeratosisw: vwv.SkinCancer.org 4 Also checkwww.patient.co.uk What arethe main factorsaffectingcompliancein your 5 ElectronicDermatologyAtlaswww.Dermis.net for country or where you areworking? photosensitivity/ sunlight andthe skin

D ermatol ogy73 Speaking Checklist Work in groups.Collatethe information from Projectthat you Assesysourprogressin this unit. collectedabout your chosentopic.Createa scenariowith which Tick(/) the statementswhicharetrue. you aregolngto test fellow studentsin another group.In the scenariosyou may chooseto takea historyand discussthe l can commenton the oast management,or discussonlythe managementwith a patient. I canuseverbswith to or -ing Givethe patient: a name,an age,an attitude,a levelof anxiety. l cantal k aboutdermatol ogy Discusshow the patient will think and reactto the diagnosisand I canunderstandpati entl anguage management.Write down the scenarioon a pieceof paper. I canunderstandpati entsat naturalspeed As a group,gothough the information for the scenarioonce Keywords quickly. Adjective Workwith a partnerfrom anothergroupwith a different p s y c h o s o cIi a scenarioC. hoosewho shouldgo flrst. Giveyour partner the paperwith your scenarioon it. Taketurns taking the history and Nouns discussingthe management or discussingthe management only. acne(vul gari s) Usethe checkh.sot n page117and chooseat leasttwo criteriafor blemish your partnerto useto assesysour performancee,.g.reassurance, compliance sympathy,empathy,beingpatient centred. concordance crust Rememberto be reassuring,sympathetic,and empathetic. cue dermatology USEFUL EXPRESSIONS purpura Y o um u s t h a v eb e e n. . . 5CaD Weneedto bepatient... It takestime to work ... vesicle It looks/ seems/ sounds... wheal Writing Verbs avoid Reflectionon professionaelxperience itch keep Work in groups.Talkabout the decisionsyou havemade in your mean careersofar.In your considerationt,alk aboutwhether you pi ckat shouldhavechosenor would choosedermatologyasa specialty. p l a yw i t h srop Within your group,describecaseswhere you treated a patient with a dermatologicalproblem.Explainwhat happenedand Urcful reference sayhow you would improve on what you did.Giveexamplesof what you shouldhaveand shouldn't havedoneand saywhat you OxfordHandbookof ClinicalExamination learnt from it. Rememberto maintaln patient confldentiality. andPracticoSl kll/s,ThomaasndMonaghan ( e d s )l,S B N9 7 8 - 0 1 9 - 8 5 6 8 3 8 - 4 When you apply for jobs,you may be askedto give examplesof your own experienceand what you havelearnt from it. Using your own ideasonly,write between 150and 200words describing the casein 2 and rememberto savwhat vou learnt from it.

74 Unii8 C h e c ku p Vocabulary 1 Work in groups.Describethe pictures. Medicalterminology lor surgery l. 1 ltatch the prefixeswith their meanings. 3:_t*r t LayqLv- a nose b breast What is involvedin scrubbingup prior to an operation? 2 nephro- c largebowel How doyou gown and glove? d chest Haveyou everpractiseddoing sutureson manikins? ? nrrpln- e uterus What manikins haveyou used? f bile / the biliary system 4 What minor / major operationshaveyou performed or 4 nrcin- g kidney beenpresentat? h abdomen 5 What arethe benefitsof day-casesurgeryto the 5 chole- patient,the surgeon,and the hospital?Is day-case 6 col(on)- i rpnel nclrric surgerycommon in your country? 7 hystero- 8 thoraco- j bladder 9 rhino- 10 masto-/ mammo- 2 Completethe sentencesby combining one of the prefixes abovewith one of the suffixes below.Youmay usesomeof the suffrxesmore than once. -ectomy -lithotomy -pe)ry -plasty -otomy -rfh)enhrr -nsfnmrr 1 We'regoingto do something calieda to havealookinsideyour tummy. 2 I'm afraidwe're goingto haveto do an operation called a to removeyour right kidney Theonly option left to usis a-, where we removepart of your largebowel andthen make an openingin your tummy wall. Sohow do you feel about having yourwomb removedby laparoscopic-? We'regoing to do a procedurewhich wili involvea ,where we removeseveralribs 6 Wecandobilateral where we ]ift bothbreasts. 7 Wecandoa where we stitchthe bladder. 8 We'regoing to haveto removethe gall bladder.The technicalnamefor this operationis-. 9 What we're going to do is destroysomestonesin the kidney in a procedurecalled 10 We'regoing to do a procedurecalleda to fix the largepart ofyour gut.

S urger y75 ' , understandi nmg edi cal termsi n surgery ri usi ngrel ati vepronounsw hereandw heni n expl anati ons . expl ai ni ngoperati onasndi nformedconsent ' ,.tal ki ngaboutpai nmanagement i. 'f -= - i : . ; : . ' ' I : ,, r r. i :.,::,: -ft Secondarsytress Wordsthat are polysyllabicusually havea nucleusand #3-tt-'@ l qernnderrr ctreqs Lookat the wordsin Vocabulary', andin pairsdecide wh e r et he nuc leusa n d s e c o n d a rsytre s so c c u r. (11)ListenC. irclethe nucleusandunderlinethe secondarystressof eachword whereappropriate. 1 ii.,n@r$:it 6 .r. r 'r, : & 2 u'ft,!+ ft: J .t:,,,:, .'rr:, 3 1,,'),:,,,,i, 8 1,,i '. r.-\".-@-l { 4 :\\.it i !, \", 9 ,-, ., ' 10.:iji, \\' I 5 '.''r,tr' t Work in pairs.Usingthe sentencesinVocabulary , \\ taketurns informlng eachotherwhat operationis -- onino tn he dnnc tr\"s6a$-d\" i :, t l. ,,,r -:: ,, .t . : -:' :::': :i; , .- ' P a t i e n tr e s p o n s e fi Listento the conversationbetweenDr Irlna Petrov Workin groups.Studythis scenarioW. hat arethe andMr BlackstoneD. ecidewhetherthe patientis similaritiesbetweenthls scenarioandthe scenarioin apprehensiveor relaxedaboutthe operation. from the communicatlonpoint of vlew?What isthe Qp Listenagarn.Answerthe questionsbelowandnote frf her lilrelrr f n feel 2 down evidence. 1 Which adjectivesdescribethe doctor'smanner/ 'A 3\" S-)v\" -ear-oldfather nrecenlswith a seven-vear-old child,Arthur,who hasperforatedappendixE. xplarn + n n a r, r ri n n +1 -a, .^ -.,gl.53l j6n) brusque canng friendly to the fatherthat the childhasto havean emergency honest patronizing reassuring operationE. xplainwhat youthink it is andexplaln 2 Isthe doctorpatientcentred?Doessheinvolvethe ihet rn nnpreiinn i,c- n.o, , c e s s a r y . p at ientint he de c i s i o nma k i n g ? USEFUL EXPRESSIONS 3 Doesthe doctorgivethe patienta chanceto ask questions? Arthur'sgot what is... Wecando an operationcalleda ...,wherwe e... 4 Isthe lnformationpresentedin a way that the Whatwedo is... p a t i e n t c a n u n d e r s t a n d ?H o w ? HowdoyoufeelaboutArthur havingtheoperation? We'llneedyou to signa consenftorm ifyou'rehappy 5 Doesthe doctoraskaboutconsentfor the operation? with everything. 6 Doesthe doctorexplainthe operationclearly? Isthereanythrngyou'dliketo askme? 7 Doesthe doctorcheckthat the patientunderstands? 8 Is t hedoc t or r ea s s u ri n g a b o u tthpea i n ? Choosetwo peoplein your groupto role-piaythe 9 Isthe doctorawarethroughoutof the patient's scenari ow hi l e the othersw atch.U sethe questi onsi n asa checklisto givefeedback. feelinss?

75 Unit8 X - r a yo f a p p e n d i x andc olon o Languagespot PatientGare Relativepronounsin explanations Putting yourself in the patient's shoes,what would you askin responseto the explanationsinLanguagespot? Work in pairs.Connectthe sentencesusing oneor more of the words in brackets and / or'zero relative'.Youwill Match theseresponsesto the explanations1-6 in needto add and removesomewords. L a n g u a g es p o t . EXAMPLE a Willitpass? b Are there complicationsif it is removed? Herniorrhaphy'san operation.It'sdoneunderlocalor c Will that get rid of the cancer,then? generalanaesthetic.Thme uscleinthe tummy waIIis d Butwillitbe permanent? strengthenedusinga specialmesh.(where/ when) e Doesthat mean it will be difficult to see? f Canyougetitbacktonormal? Herniorrhaphy'san operation,doneunder localor generalanaesthetic,whertehe muscleinthe tummy Taketurns explaining the terms inLanguagespotand waII isstrengthenedusinga specialmesh. respondingusing the phrasesin 2,then developingthe conversationin your own way. 1 We'regoing to do something.It is calleda mastectomy.A breastis removed.(when / where) Proiect 2 It's a type of stitch.It is doneunder the skin sothat Work in groups.Usingyour own knowledge,describe there is only a faint scarIeft at the end.Thewound how pain is managedafter an operation. heals.(which / when) Find out aboutthe organizationsand sitesbelow and 3 A colostomyis a procedure.Thebackpassageis what they do.Dothey give any adviceabout pain closedand the end ofthe gut is attachedto an management after operations? opening in the wall of the tummy. A bag is attached ,w colostomy-colostomyassociation.org.uk to the opening.(towhich / where) ss kidney / kidney stones- kidney.org,medlineplus.gov * hysterectomy-hysterectomy-association.org.uk 4 It's a type of shock.It happens when the volume of * mastectomy-medlineplus.gov blood in the body decreases(.which / who) o tonsillectomy-patient.co.uk c hernia-hernia.org 5 Oliguria is a condition. An abnormally small amount of urine is produced.(where / that) In groups,discussdifferent reactionsto paln.How do peoplemeasurepain? 6 It's an operation.Theappendixis removed.There is colicky pain in the centre of the tummy followed 4 Checkyour answers about pain in the Oxford Textbook by vomiting and then a shift of the pain to the right iliac fossa.(where/ when) of PalliativeMedicine,3rdedition,(Doyleet aI,2OO5, OUP)A. Isolook at pages172-181otfhe OxfordHandbook ) Goio Grammar referencep 124 of PalliativeCare(Watsonet al,2005,OUP). Work in pairs.Choosea procedureT. aketurns being the doctortalking to the patient about post-operativepain. USEFUL XXPRESSIONS sore hurt discomfort

S urger y77 Speaking I Work in groups.Decidehow you would expiainto a patient that he is going to needa permanent colostomyafter removalof the part of the bowel. Discusswhat information a patient would want to know in orderto give consentfor the operation,especiallyaboutthe future, e.g.pain management Usethe questionsin 2 inlistening 1asaguide. Work with a partner from another group.Decide Youhavefive minutes to think about the scenarioby on a name,age,and sexfor the patient.Taketurns yourself,focusingon both the doctor'sand the patient's roie-playingexplaining the operationto the patient roles.Note in exam situationsyou will usually have and obtaining consent.If you arenot happy with the only one minute to walk between stations,read,and explanation,decllneto giveconsent. prepareto role-playthe scenario. When you haveflnished,asa whole classdiscussany Two volunteersrole-playthe scenarioin front of the medicalproblemsor queriesthat aroseduringthe role- class.Studentssit around sothat they canseeboth the play. doctorand the patient.Thedoctorswho arewatching usethe speakingcheckliston page117to choosea In exam situations,you arefacedwith role-playswhich criterion eachto assessthe performance.Agreeall the you peedto do without any preparation.Lookat this criteria beforehand.Somestudentsshould alsoobserve role-playscenarioby yourself. the doctorto seeif their performanceis sympathetic / empathetic.Studentstake turns role-playingand Mr Cordobesa, 30-year-oldman,hasa ten-year-old giving feedback.Thefeedbackshouldbe constructive. sonwho hasbeeninvolvedin a car accident.The child'sspleenhasbeendamagedand his femur has beenfractured.His spleenis sobadly damagedthat it needsto be removed.Youhaveto tell the patient's father and explainthe procedureto him. What wouldyou say? USEFUL EXPRESSIONS emergencyoperatlon nochoice W ec a nb o o s th i si m m u n es v s t e ms t a r t i n an o w u n t i l he'san adult. It ispossibleto livewithoutthespleen.

78 Unit8 Reading 1 Skimthis summary text.What doyou think it is describing? Themajority of cystsin the ovariesareharmlessand 5- is frequently downto luck,soif you ,but sometrigger changesinthe have any symptoms that 6 that you aswell asin the nature of the periods. havean ovariancyst,an internal examination may be Cystscan alsobecomesobig that they causeurine performedby your doctor.Treatmentls 7 problemsor make people3 ,Despitebeing on variousfactorslike ageand the cystsize generallyharmless,somecanturn to 4 Readthe text below.Completethe summary in I using the correctform of a word from the text. Whatarethe . Althougmhosct ystasrebenignso, me sucahsyouar gew, hetheyrouarepastthe symptomsp, roblems, typehsdvaeriskofbecomincagncerous. menopautsheea, ppearanacnedsizeofthe andpossible . Rareslyo,moevariacnystms akaebnormal cysftromtheultrasousncdana,ndwhether amounotsffemal(eormaleh) ormones youhavseymptoms. complications? whichcancausuenusualsymptoms. 0bservation Howisanovariancystdiagnosed? Mansymaollvariacnystws illresolvaend Mosot variacnystasresmalbl,enig(nnon- Asmosot variacnystcsausne0symptoms, disappearovfewramonths.Ymoauybe cancerouasn)dc, ausneosymptomSso.me mancyystasrediagnosbeydchancFeo. r a d v i s et odh a v aer e p e autl t r a s o usncda inn o v a r i acny s tcsa u sper o b l e mwsh i c hm a y exampldeu,rinagroutineexaminati0orn, amontohrsol.fthecysgt oeaswayth, enn0 i n c l u doen eo rm o r eo ft h ef o l l o w i n g : ifyouhavaenultrasousncdafnoranother furthearctioinsneeded. . Paionrdiscomfoinrtthelowearbdomen. reasolnfy.ouhavseymptomsusggestoivfe 0peration Thepainmaybec0nsta0nrtintermittent. anovariacnysty,oudr octomr ayexamine Removoaflanovariacnysmt aybeadvised, Paimn ayonlyoccuwrhenyouhavseex. yourabdomaenndperforamvaginal e s p e c i ai flyl yo uh a v sey m p t o mo rsi ft h e . Periosdosmetimbeescomirereguloar , (internaelx)aminatiHoneo.rshemaybe cysitslargeS.ometimtehsespecialmisat y m aybec omhee a v i e rl iogrh te rthuasnu a l . abletofeeal nabnormsawl elllnwghichmay wantt0removitetodetermienxeactwlyhich . Sometimaecsysmt aybleeidntoitseolfr beacyst. t y p e0 f c y ni t i sa n dm a kseu r teh e raer en o bursTt.hicsancausaesuddesnevepreain Anultrasousncdacnanconfiramnovarian cancecer llisnit.Mosst mallecyr stcsanbe i nt h el o w ear b d o m e n . cystA. nultrasousncdainsasafaend r e m o v ebdyl a p a r o s c o( 'pkiecy h o lseu' )r g e r y . . Occasionarlylys,twhichisgrowinogn painletsesswt hichusessounwd avetso Somceystrsequiaremoretraditionsatyl leof astalfkromanovarmy aytwisthestalk creatime ageosforganasndstructurienside operalr0n. onitsel(fa'torsioTnh')i.stoptsheblood youbr odyT.heproboefthescannmeraybe I h et y p eo f t h eo p e r a t idoenp e n do sn flowintghrougth estaltkothecysat nd placeodnyouar bdometonscatnheovaries. factorsuchasthetypeofcysty, ourage,and causetshecystt0loseitsbloosdupply. Asmapllrobiesalso ftenplaceidnsidtehe whethecranceisrsuspectoerrduleodutI.n Ihiscancausseuddesnevepreaininthe vagintaoscatnheovarietosobtaimn ore s O mcea s ejsu,s t h ec y sitsr e m o v eadn dt h e l o w ear b d o m e n . detaileimd ageYso. udroctomr ayalsotakea OvartiyssupereservIends.omceasetsh,e . Largceystcsancauseyourabdot0men s a mpol efbl ood. o v a riysa l s or e m o v eadn,ds o m e t i moetsh e r swelol rpresosnnearbsytructurFeOs.r Whatisthetreatmentforovarian n e a r bsyt r u r t u rseusc ha st h eu t e r uasn dt h e examplteh,eymaypres0snthebladder cysts? o t h eor v a r Yy .0 usrp e c i a lwi si ltla d v i soent h e o rr e c t u mw h i c hm a yc a u suer i n a r y Y o usrp e c i a lwi si ltla d v i soent h eb e s t 0pti0nfos ryouirndividusaitluation. s y m p t o m0 rsc o n s t i p a t i o n . c o u r soef a c t i o n . Tdhei sp e n do snf a c t o r s

Surgery 79 3 Match the two oarts of the sentencesbelow Vocabulary 1 Many small cysts a leavetheovarytissue. Technical simply b ascertaincysttype. vocabulary c dictatethe surgical 2 Sizeand symptoms 1 Work in pairs.Describe someti.mes. removal of ovarian the conditi.onshown cysts. inthe diagram.Canit 3 Cystremovalmaybe d go away in a matter of occurat any age? d o n et o 4 Sometimesit is months p o s s i b l et o 2 Work ln groups.Completethe sentencesI.f necessary 4 Work in groups.Talk about the fi.rsttime you were Iookat the words in the upside-downbox below. involvedin an operationandyour reaction(s). 1 Thesmallbowel asif it were listening2 swallowing itself by invagination. Gettinginto conversations 2 Thepatient presentswith episodicintermittent Q tisten to the five short conversationsand decide crying and drawing his legsup. what eachoneis about.Time how long it takesyou to work out what ishappening andput your hand up Thechild may passbloodper (Iike when you haveworked it out, but do not interrupt the playing of the recording. redcurrantjam or merely flecks- iate stage). Q tisten again and match the five conversationswith 4 A sausage-shaped maybe felt t h e s ed e s c r i p t i o n s . q The child may be and moribund. a - Anaestheticassessment b - Worried about recurrenceof a problem 6 TheIeast approachis ultrasound c -Postponement d -Awakeindaysurgery with reductionby air enema (preferredto barium). e -Refusingconsent 7 Pneumatic ,where aballooncatheter Q tisten again.Work in pairs.Onepartner concentrateson the patient and the other on the is passedPRunder radiographiccontrol,is another doctor.Write down howthe patient puts pressureon the doctorand howthe doctorresistspressurefrom the option that is effectivein up to 80%of cases. patient.Compareyour answerswith another pair. 8 Theremaybe right lower quadrant 4 Work in pairs.Createa scenarioaround one of the + perforationon plain abdominalfilm. conversationsg, iving the patient a name,age,and so on.Taketurns role-playingthe situationsand then 9 If reductionby enemafails,reductionat laparoscopy developingthem in your own way.Forexample,for extract5,you couldtake a pre-operativeassessment, isneeded. askingaboutthe drug andfamily history. 10 Anvnecrotic bowel shouldbe sadorsalal pa{roqs palJasar uorlJnper urnlJar dluedo sseur du;o1orede1 alrselur alqelosuoJur Checkwith other groupsfor help with sentencesyou cannotcomplete. 4 Work in pairs.Choosea sentencefrom 2 for your partner to explainto you what it meansin lay terms. Useyour own experienceif possible. USEFUI EXPRESSIONS getridof doesn'tworkfoldinsideitselJ whatwe'regoingto needto do remove

80 Unit8 5p*a*cing Frojeet Work in groups.Look Usethesereferencesto find out what you can about at the scenariobelow OSCEexams,especiallyfor the PLABU, SMLEa, nd Decidewhat the patient fellowshlp examsfor the RoyalCollegesin the UK: is likelyto be concerned ' www.gmc.org about,for example, the recurrenceofthe ForDOPS(directlyobservedproceduralskills)see cysts,whether they are the RoyalCollege-www.rcplondon.ac.uk cancerousw, hat caused USMLE-www.usmle.org them, why it happenedto How many stationsarethere in an OSCEand how long her,the length of time off doesa stationlast? work. What is shelikely Which of the following stationsarenormally found in to sayand what would be anOSCE? your reply? TL--_-t _-lal K, rng Drooqpressure E Dolngcln MissTanakaw, ho is 22yearsold,hasbeenadmitted ! civing a presentation to hospital after being diagnosedashaving a right ! Explainingproceduresto a patient ovariancyst.A laparotomyis goingto be performed L__lai Krnga casenlsrory and shehasto stayin hospitalfor four daysand ! Recitingmedicaldetail subsequentlystayat home for six weeks.Explain ! Dealingwith difficult situations the situation to her.Note that a sub-cuticlesutureis I Suturing goingto beusedfor skinrepair. I Usingmanikins for clinicalexaminations Decidehow you aregoing to explain what a cystis, where it is,what is going to be removed,and what is going to be donewith the removedcyst.Then decide how to describethe sub-cuticlesuture,and finally when to askthe patient to sign the consentform. Taketurns role-pLayingthe scenarioin the'goldfish bowl'settingdescribedln Unit 5.Thistime,however, the doctoror the patient may interrupt the role-play to askquestionsor clarify speciflcdetails.Limit each interruption to a maximum of two minutes. Givefeedbackto the doctorand the patient using the speakingcheckliston page117. When two or three pairshavedonethe role-p1ayw, ork on your own. In two minutes,preparewhat you would sayto the patient for the scenariobelow and repeat steps3and tl above. Mrs Brodie'seight-month-oldbaby hasbeen crying / screamingfor the past eight hours,i.e.ail night.Thefindings showthe babyis sufferingfrom intussusceptionE. xplainto the mother what it is andhow it will betreated.

WritEreg frhm$es$&st D e s c r i b i nag c o m p l i c a t eodp e r a t i o n Assesysourprogressin this unit. Tick(/) the statementswhicharetrue. Work in pairs.Describea complicatedoperationwhich you have beeninvolvedin, focusingon pre-operativevisit,assessmenbty l can understansdomemedi cal terr: ' the anaesthetistt,he day of the operation,andpost-operative sur g e r y care,includingpain management.Mention anything that went particularly well, anythlng that couldhavegonebetter,and what l can userel ati vepronounsi n expl anat,c\"s you would havedonedifferently. l can expl ai noperati onasndgai ni nformecj consent Work on your own. Write a descriptionof no more than 200 words,usingthe phrasesin ltalicsin 1asa step-by-stepguide. l c a n t a l k a b o u tp a i nm a n a g e m e n t USEFUL EXPRESSIONS Ke3wr ords ..-an operationwhere... Adjective Moreover,.../ Furthermore,... i nconsol abl e Thebenefitof ...wes... Themain thing I learntfrom this was... Nouns ...workedwell/ ...wentsmoothly/ Whatcouldhavegonebetter conSenr was... o a y - c a s es u r g e r y herni orrhaphy Workin pairs.Checkfor mistakesR. emembernot to copyeach intussuscepti on other'swriting and to maintain anonymity and confidentiality. laparotomy p e r f o r a t e da p p e n d i x Giveyour descriptionto another partner to read.Ask eachother reduction questionsabout the description:Why didyou ...?Whatfactors made...?Couldvou have...? Verbs Srove gown reSecI s c r u bu p telescope Prefixes col(on)- cysro- hystero- l ap ar o - masto-/ mammo- n e p hr o - Usefw* trffi$ffirffiffi€e OxfordHandbookof ClinicalSurgery 3rdedi ti onM, cl atchi eet al (eds), lsBN978-019-856825-4

82 Unit9 C h e c ku p I Work in pairs.Describethe pictures. ' r ; r l i i_ . 1 -- tr---*-.-!-1, -{-ir\\.-',.-,1---,-- l--- l- Match thesecaptionsto the ECGsin I. ListeningI * Acute anterior myocardiallnfarction \" Completeheart block A heartcondition 3 Lookat thesestatisticsfor the UK taken from the Q tisten to ivtrLawson'swife talking to the doctor OxfordHandbookof GeneralPractice.lsthe incidence in A&E.What doyou think the patient'sconditionis? of heart diseasehigher or lower ln your country?Why? why? Coronaryheart disease(CHD)is the most common Describethe doctor'smanner and the mood of the causeof death inthe UK (1:4deaths)M. ortality is pati.ent'swife. Givereasons. falling,but morbidlty is rising. Q tisten again and write dovrrnnoteson what is said, about 1 theGTNspray 2 the time whenthe pain started 3 thrombolysis rA P r^f^^a u 6 r r u^-; > r )- . Q Work in groups.Compareyour notesand listen again.Discussthe possibledifferential diagnosisof the patient'scondition. 5 Chooseone member to report backto the whole class. 6 Work in pairs.Taketurns role-playingthe conversation between a patient'sspouseand a doctorwith the same presentationasln 1.

C ardi ol ogy83 ln thisunit € usi ngtechni caal nd non-techni ctael rms i * tal ki ngaboutthe futureandreassuri npgati ents aboutthe prognosi s r tal ki ngaboutheartdi sease 3 tal ki ngaboutsi gnsandsymptoms * understandi npgeopl espeaki ngat naturasl peed V o ea b u l a r y Work in pairs.Readall the sentences1-6below,then Avoidanceof technicatlerms match them with the relevantpoints or periodson I In thesesentencest,he speakeris trying to avoidusing +trL^rE uJit^d^B-l^4*l t L. one of the technicalwords or phrasesin the list below. Match eachword to a sentence. a hypokalaemia f line 1 We'il havehad eight hourson duty by the end of b +I li+I I-^a+t^e +t o^ e^gf^i-e+ c t the day. c diuretic g secule venous access A contraindication 2 We'rehavinganhourforlunch. e arrhythmia h reperfuse 3 We'Il havejust finished lunch by the time the i thrombolvsis j tolerate consultantarrivesfor her ward rounds. 4 Theweekly presentation,which will iast two hours, 1 If we can,we givehim a drug to dissolveany clots, then we increasehis chancesof getting better. will endjust beforelunch. 5 Dr Ian Garfieldwill be starting the presentationas 2 My heart is not beatingin anormal rhythm. Thereare severalreasonswhy this drug shouldnot soonashe arrives. D eu s e o . 6 Theshift today startsat 10.00with a presentation. 4 Youhaveno sideeffectswiththis drug. Work in pairs.Putthe verbsin bracketsinto the correct 5 We'regoingto giveyou somethingto help reduce future form in the activeor passive. the swellingin your ankles. 1 If his progresssofar is anything to go by, 6 As soonasthe patient is brought in, we needto get he (be)up and about in a few days. into avein. 7 We'll increasethe painkiller bythe sameamount 2He (send)home this Saturday. eachtime until it kicksin. J 5ne (soonmove)out of intensivecare. Thisdrug will getthe bloodflowing backagain through the heart. If this doesn'twork, we'l1move onto the next stage of treatment. 10 You'vegot very low levelsof potassium. 4 Thatmeansinten minutes,it (be) Work in groups.Choosea drug that is recommendedfor roughly 60 minutes sincethe pain first cameon usein thrombolysisor treating myocardialinfarction or hypertension(e.g.aceinhibitor, a diuretic,(simva) 5He (walk)aroundwithout any statin,aspirin.)Discussyour own experienceof prescribingthe drug. problemin amatter of days. (hebe able)to go into a rehabilitation unit beforehe comesout? o languagespot 7 What (hehave)toeatbythe time I T h ef u t u r e get there today? 1 Work in pairs.What tensesareusedin thesesentences? 8 Theconsultant (come)round at 1 Theward round startsat 10,sowe havehalf an hour. a b o u t1 . 0 0p . m . ,s ow e (see)himthen. 2 Shenormally stopsat 12,but today,I think she'll 4 Work in pairs.Preparethree or four questionsabout havefinished her roundswell before11.30. what you will havedone,areplanning to do,will be 3 Theward round is flnishing at 12noon. doing,and will do today.Giveyour questionsto your 4 Sowe'll definitely be sitting in the canteenat 1.10. partnerandthen askeachotherthe questions. 5 We'll havebeenworkingfor 72hours by 1.00this )} (,rrl {,#rarnmarreferencei :,,+ afternoon.

84 Unit9 PronuRciatlcn Fstiere(tare Speakingat naturalspeed Work in pairs.How would you respondto the statementsbelow,made by the spouseof a patient who hasjust beenbrought into A&E sufferingfrom a heart attack? 1 He'sbeenin the theatre for agesnow. 2 Thingsarelookingbad,aren'tthey? 3 Will hebeOK? 4 He looksratherwell. 5 I'm abit anxlousaboutwhat'll happenwith the procedureyou described. 6 How long'she goingto be in here? 7 Hethinks he'sgoingto die,doctor. When peoplespeakat natural speed,it is possibleto Compareyour statementswith other students.Then catchthe gist of what they say,but sometimesthe discussthem with the class. exactwords canbe difficuit to work out. Work in pairs.What type of word is missing in the ? f) fisten and completethe sentencesN. ote that blank spaces(noun,verb,etc.)?Completethe responses contractionsareused. belowwith oneword theatrefor over a Oh.It's only a of daysnow. In fact, threehoursin afew minutes'time. he'll be seeingthe consultanttomorrow mornins 2 DrNur his clinic and if he'shappy,you can ... t i l l 2 . 0 0p . m b Yes,hedoes.Andif goesaccordingto plan,this time next week I expecthe'll be sitting at l in notime. homewithvou. 4 Allbeingwell, c lt's not to feeLthis,but you got him home bvthe weekend herequickly,which'll helphim 5 Theoperation d It's actuallv not asbad asit seemsT. hemachines 5.00this afternoon a n d t u b e s ,I ' m don't makethings the veinson the Iookgood,but they're there to help him. He'll be like this for alittle andthen... right Iegstrippedthis afternoon,am I right? YesW. e expecthe'll be readyto leavein a couple of days.lt'sthe anaestheticand the painkillers; 7 Thedoctorsaid they're making hlm a bit confused,but that'll soon generalanaesthetic. off. to the clinicoff and onfor the pastthreeyears. f It alwaysseemslongerwhen you're sitting waiting. x Work in pairs.Compareyour answers. I'm surehe'ilbe shortly;in fact,here's the nursenow. 3 f) tlsten again.Checkyour answers. g lt'sonly to feelworried;everybody € Q listen again.In eachsentence,4qgblglln4erUnethe would be,but I can assureyou it'll help him. nucleus.Singleunderline the secondarystresses. { Match eachresponsea-g to a statementin 1. Work in pairs.Taketurns sayingonly the stressed 5 Work in pairs.Taketurns sayingthe statementsin 1to words in eachsentenceT. hen saythe whole sentence eachother and respondingin your own way. using the stressedwords to giveyou the rhythm.

C ardi ol ogy85 R ememb etrh e Dialoguecantransforma symptomfrom airynothingnestso a fact m n e m o n i cS O C R A T E S f o r q u e s t i o n sr e l a t e d Dialogue-transformseydmptomsexplainoneof thejuniordoctor's to parn. mainvexations:whepnatientsretellsymptomsto a consultanitn the lightof daytheybear no resemblanceto whatyouoriginally heardB. utdo not bevexed:youdr ialoguemayhavehelpedthe patientmorethan anywardround. - OxfordHandbookof ClinicaI Medicine S i g n sa n d s y m p t o m s Proiect Competition Work in groups.Make a list of cardiacrisk factors. Searchfor information at wvwv.americanheart.org. 1 Work ln groups.Usingyour own experienced, ecide what conditionsthe following signsand symptoms Speaking represent.Competeto seewhich group fi.nisheswith all the correctanswersfirst. Work in groupsof four. Make a list of questionsyou would askthe patient in the scenariobelow.Think 1 Symptoms:dyspnoea,coughproductiveof frothy about how the patient would feel,what his / her pink sputum,palpitations (oftenassociatedwith anxietiesmight be,and howyou differentiatethe pain atrial fibrillation and resultantemboli) from anginapectoris. Signs:palmar erythema,malar flush,tapping apex beat,Ieft parasternalheave,Ioud S1,mid-diastolic Mr Gregorya 57-year-oldpatient,presentswith a murmur + openingsnap. severeretrosternalburning pain which the patient is convincedis connectedwith the heart.Thepain 2 Symptoms:shortnessof breath and breathing worse comesafter eating and drinking alcoholandthere on lying flat is a history of dyspepsiaT. hepain is relievedby GTN Signs:collapsingpulse,sustainedapexbeat spray,but only after about twenty minutes. Takethe displacedto the left,left parasternalheave,soft history and reassurethe patient that the pain is not Sl,loud S2(pulmonary component),pansystoiic connectedwith his heart,but is oesophageasl pasm. murmur heardatthe apexand radiatingto the Ieft axilla + mid-systolicclick,3rdheart sound. Taketurns role-playingtaking the history and reassuringthe patient.During eachrole-play,the two 3 Symptoms:calf pain,swelling and lossof use other studentsusethe checkliston page117to monitor Signs:warm, tense,swollenlimb, erythema,dilated the performanceof the patient and the doctor,who superficialveins,cyanosisT. heremay be palpabie chooseat leasttwo criteria to be assessedon: asking thrombus inthe deepveins.Often pain on palpating questionse, mpathy/ sympathy,reassurancep,rognosis, the calf. a n d c l a r i t yo f p r o n u n c i a t i o n . 4 Symptoms:constantretrosternal'sorenessw', orse Oneof the monitoring doctorstimes the roie-play:a on inspiration (pleuritic),relievedslightly by sitting maximum of five minutes. forwards,not relatedto movement or exertion Signs:If chronic,constrictive,may causeKussmaui's 4 Thedoctorand the patient eachgivefeedbackabout s i g n ,i m p a l p a b l e a p e xb e a t ,S 3 ,h e p a t o m e g a l y , splenomegalya, scites(pseudo-cirrhosis). themselvesand eachother.Themonitors alsogive feedback.Thenthe rolesarerotatedto allow each srlrpreJrreo t group member a chanceto role-playthe doctor. (lnc) stsoqruorqlurandaaP 6 Onepair of students(ormore)volunteersto role-play uor1elr3:nSarlerlrur z the scenariowhile the restof the classwatchesand srsoualsI€rlnu I givesfeedback. Work in groups.Chooseoneof the conditionsin l. 6 StudentA,go to page114S. tudentB,goto page115. Present he detailsto the rest of the classY. oumay do this asa formal PowerPointpresentationwith a StudentB,take the history from student A and reassure questionand answersessionat the end,or informally the patient and viceversa.At the relevantpoint the on behalf of your groupswith questionsat the end. patient givesthe doctorthe ECG.

85 Unit9 Reading E Findtheseitems in the rexr. 1 a definition I Workin pairs.Discussthesequestions. 2 an effectof treatment 1 What doyou know abouthypertension? 3 prevalenceofhighBP 2 What arethe causes?What is the usual 4 precipitatingfactors/ aetiologyofthehighBP presentation? 5 a connectionwith other illnesses 3 Haveyou treated a patient with hypertension?Was it drug or non-drugtreatment? Hypertensio(nHT)is commonlycalled omega-3fattyacidsis protectiveagainst to continuethemforlife.Thesetabletsare verysuccessfual t preventingheartattacks highbloodpressuren, owadays(2005on) highbloodpressureand heartdisease. and strokesand haveveryfew sideeffects. definedas above140/85mm Hg;or if oneis diabetico, ver135/80A. bout38% Hypertension- why worryif you of UKadultshavehypertensionA.dvice feelOK? andtreatmenitncludesexercisel,ifestyle Highbloodpressuredoesnotnecessarily Five self:help rneasures are' suggested: changesa, nd/ or dietchangesa, s wellas makesomeonefeelunwell;howevelif drugs. untreatedit tendsto causedamageto blood f Avoidbeingoverweight. Possiblays manyas 16millionUKpeople vesselsandthe heart.Thelinkbetween havehighbloodpressurea, ndthe proportlon hypertensioanndcoronaryheartdisease I Reducesaltintake. of thepopulationis slowlyincreasing and strokeis verywellestablished. I Keepalcohodl own. overtheyears.About5% havean obvious Correct reatmenot f hypertension 'I Exercisecan reduceyourblood pressureand helpto keepyourweight underlyingcausesuchas kidneydisease. reducesthe riskof a hgartattackby Mostof theresthavenosingleobvious about20%and reducesthe riskof stroke down.Startslowlyand build up. cause.Somehavea geneticcornponent, by about40%.Hereriskis basedon the , Walkingis exoellenlAirnfbr 20 to 30 , minutes'activityalet astthreetimes withhypertensiotnendingto runrnfamilies. observedreducedoccurrencesintreated I n a d d i t i o nt h e r ea r ee n v r r o n m e nat anld pastpatientsT. hepurposeof treating a week.Or evenbetterw; alkforhalf lifestylefactorsT. hemostimportanct auses hypertensioins to preventhisdamageto an hourfire timesperweek,whichis ' betterthanmore'intenseexercisefor a arebeingobese,smokingt,oomuchalcohol, bloodvesselsandthe heartfromoccurrrng too muchsalt,stress,lackof exercisep, oor andso heloto oreventheseillnessesM. ost shortertime. I Don'tsmoke. diet,too littlepotassiuma,ndfamilyhistory peoplewithhypertensioneedtabletsto a of relativews ithhypertensionO. ilyfishwith lowertheirbloodpressureU. suallyt,heyneed j !l Completethesenotesusing a word or a number from the text 4 Discussin groups: . Uf fw ilalrc{tc pafb?ttsl How common is hypertensionin your . Modtfr.atirnrtoz country or where you work? ?k6/zot'ti/r{/ dizt '' What measuresarebeing taken to reduceit? anl aari\"oc*wn recout'nm7.cd. Arethev effective?Givereasonsand , Fm3 fapk n\"rtju*t ow caaa examples. L afnil/r. yhn^aen htl( luth dlcann^talr'ttt b'{oodpretture , Connz&\"onwlth cmoa^a.rhyzart d*s.ennan/. etrokts-

., 6j \"You'vegot the blood pressureof a teenager- who livesonjunkfood, TV andthecomputer.\" w.Cartoonstock.com Lktening2 Haveyou thought about taking this tablet oncea day after meals? A d v i c ea b o u t l i f e s t y l ec h a n g e s (fr Listen.Write The suggestionhere doesn'twork becauseyou want to directthe patient.It would be better to say:Youtake/ down asmany Takethistablet...or You'llneedto take thistablet oncea detailsasyou can day after meals. aboutthe patient. Thencompare I Workin groups.lookatthesestatements.Whereand your detailsin when canyou saythem without annoying a patient? groupsoffour. Which are appropriatefor making suggestionsto patients about changingtheir lifestyleto reducethe Beforeyou listen again,canyou answerany of the risk offuture heart attack?Givereasons. questionsbelow from the information you have? 1 What evidencecanyou find of the doctor'sgood 1 You'llneedto stop smoking from now on. 2 Youcouldstopdriving for a while, saysixweeks. bedsidemanner? 3 Haveyou evertried to do any kind of sport? 2 What evidencecanyou find of the patient's 4 Don't takeany alcohol. 5 I'd strongly adviseyouto take the medication. cooperativemanner? 6 It's better for you if you avoid salt. 3 How doesthe doctor seekto involvethe patient in 7 Youneedto make sureyou take this regularly. 8 Youmight want to take thls medication from now on Iifestylechanges? 9 Youshouldn't eat fatty food like sweetsand cakes. 4 How doesthe doctormake a suggestionabout 10 Try and glveup smokingif you can. 11 Youtake this one oncea day,preferablyin the lifestylechanges? 5 How doesthe doctorreassurethe patient ofthe evening. 12 Youneedto comebackand seeme after one month. effectofthe lifestyle changesuggested? 2 Work in pairs.Write at leastthree sentencesgiving Q tisten again.Answer the questions. a d v i c ea b o u t t h e s et o p i c s . 4 What other lifestyle changescouldthe doctor 1 caffeine and caffeine-rich products 2 relaxation / stressmanagement encouragethis patient to make?How elsecouldthe 3 dynamic exercise-walking, swimming, cycling doctorphrasehis suggestions? 4 saltintake 5 fruit and fibre Patientcare 3 Work in pairs.Usingthe notesyou madeinlistening When patients arehypertenslve,they may haveno 2,take turns role-playingthe conversationbetween symptoms.It is thereforenot alwayseasyfor them to Mary and her GPC. ontinuegiving adviceto Mary acceptor follow any therapy or evenrememberto keep about changesto lifestyle.Emphasizethe benefitsthe to it. You,therefore,needto be ableto givepatients changeswill bring. adviceand information in away that fits the situation and doesn'tput them off. Lookat the following examples: Stopsmoking. USXFUL EXPRESSIONS Theimperativehereis inappropriatefor giving If you... patients adviceabout lifestyle changes. II'IImakeyou.,. You'IIsoonnoticethe dffirence. It'lI reduce... AII being weIIy, ou'II have...

88 Unit9 Cardiovasculdairseaseisestimatedto costthe EUeconomy€192billiona year. 57%isdueto directhealthcarecosts,zlyotporoductivitylossesand22%tothe informacl areof peoplewith CVD. CostsvaryhugelybetweenEUmemberstates- percapitaannuallyB, ulgaria costsunder€60 but Cermanyandthe UKcostover€600. - EuropeonHeart Network Speaking Project Work in groups.Searchfor information on the web or in booksor poolyour own experienceE. achgroup shouldresearcha different subjectfrom: 1 drug treatment for hypertension 2 prescribingstatinsforhypercholesterolaemia, especiallyany contraindicationsand sideeffects 3 non-drugtherapyforcholesterol Typein the words statfn,hypertensionc, holesterool n the internet or checkthesesources. a www.bhsoc.org * www.nice.org.uk e www.patient.co.uk * wvwv.yourtotalhealth.ivillage.com + www.bhf.org.uk AIsocheckthe OxfordHandbookof GeneralPractice, 2ndedition pages324-5 Seiectwhich information to talk about and sharethe information with the class. Work in pairs.Taketurns talking to a 65-year-old, Vincent Fournier,who presentswith hypertension, aboutthe medicationhe needsto take. Checkfor any contraindicatlons. Expiain: * howtotakethemedication e whentotakeit * the benefitsof taking it e anyside effects. Arrangeforfollow-up in onemonth'stime. Two studentsvolunteerto role-playthe part of the doctorand the patient in the scenariobelow in front of the class.Usethe Checkliston page117to givefeedback using the following two criteria:ability to encourage the patient and spontaneity. A 55-year-oldpatient,Mr(s)Slaterh, ashigh cholesterolG. iveadviceabout non-drug therapyfor high cholesterolwith written instructionsand / or drug therapy with benefits and sideeffects. Givefeedback.Rememberto be constructive.

C ardi ol og y89 Writing Checklist Difficultiesin persuasion Assesysourprogressin this unit. Tick(/) the statementswhicharetrue. Work in pairs.Make a list of the difficulties doctorsfacetrying to persuadepatientsof the needto take medication.Explain I canunderstandand usetechni caal nd the difficulties,giving examplesfrom your own experience. non-technicalterms Rememberto maintain confidentiality. I cantal kaboutthe futureandreassure Compareyour list with other studentsin the classand addto pati entsaboutthe prognosi s your own list. I cantal kaboutheartdi sease Work on your own. Write between 200and 250words explaining l can tal kaboutsi gnsandsymptoms the difficultiesyou listed in t. Usethe useful expressionsand I canunderstandpeopl espeaki ngat suggestedplan to guideyou asyou write your answer. n a t u r a ls o e e d USEFUL EXPRXSSIONS Keywordr mainobstacles Adjectives problemsfaced by doctors frothy Firstof all / second(ly/) third(Iy) In addition,/ furthermore / similarly Nouns In conclusion/, aswe haveseen, arrhythmia atri alfi bri l l ati on Introduction:an overview or exampleof the topic cholesterol contrai nidcati on Themain barrier... diuretic DVT Another difficulty... d y n a m i ce x e r c i s e hypertension . . .c a n a l s oe f f e c tp a t i e n t ' sc o m p h a n c e . lifestyle line Conclusionor summary mitralstenosis morbidity mortality pericarditis SOCRATES s t a t in thrombolysis Verb tolerate Urefulreference Oxford HandbookoJ ClinicalMedicine 7th edition,Longmoreet al, lsBN 978-0-19-856837-7

90 Unit10 (heckup 1 Work in groups.Describethe photos.What is the Iink betweenthe photos?Givean examplerelating to eachphoto. Work in groups.Describeinteresting presentati.ons Vocabulary involvi.ngrespiratorymedici.nethat you dealtwlth successfullyD. escribehowyou might improve your Coughs performanceif you were to seethe samecaseagain. I Choosethe adjectivethat bestfits the diagnosisin What is the definition of asthma?What symptoms italics in eachcase. would you expectto see? 1 Laryngitis:I've got this really bad cough and my 4 Asthma affects5-8%of the population in the UK.What voicels high-pitched/ hoarse/ smooth. is the percentagein your country?Is it increasingor Tracheitis:I've got a dry coughandit's slightly decreasing?What arethe causesin your country? painful / painless/ reallypainful. Pleurisy:my chestreallyhurts when I cough.I get Ihis stabbing/ dull / sharppain right herein the chestwhen I cough. Post-nasadl rip: I've not got any pain or anything; justadry,barking / tickly/ painful cough.I'm always trying to clearmy throat at night. Asthma:I'vebeengetting this wheezy/ tickly/ painful coughafter doing exerciseand sometimesin thc mornino Oesophagearleflux:flrst thing inthe morning i get this dry / tickly / hollow coughand it often makesme feel sick. 7 Epiglottis:she'sreally pooriy with this terrible tickly/ barking/ dry cough. 8 Laryngeainervepalsy:the coughsoundsrealiy barking/ hoarse/ hollow, 9 Bronchitis:he'shad this productive/ mild / hollow coughfor daysnow with somefeverbut no breathlessness. (fi Listenand identify the coughswhich you hear 1-5 aswheezy,hoarsep,roductive,barking,dry.Checkyour answerswith a partner.

R espi ratormyedi ci ne9l Inthisi.r*it n l anguagefor coughandsputum m expl ai ni ngi nvesti gati ons r usi nga / an,the,andzeroarti cl e I checki ngthe pati entunderstanddsevi ces * descri bi ndgata 3 VVOrlKn palrs.laKe Vocabulary turns asklnga patient to describeoneof Natureof the sputum the coughsin 3 and E Coverthe causesa-h in the right hand column with ih en d crrel nn th e your hand anduseyour own knowledgeto diagnose the causeofthe sputum 1-8. c o n v e r s a t i o nu s i n g yourown knowledge. Nature of sputum Causes 1 white / grey a bronchiectasl/s [ $ s t e n i n gE 1 aroan / rrollnrar abscesses S i g n sa n d b congestivecardiac symPtoms 3 greenandoffensive failure Work in pairs.Decidewhat the most likely diagnosis 4 ctirkrr rrrcfrr c asthma/ smoking is of a patient who presentswith recurrentepisodes d severebronchiectasis of bronchitis severalyearsprior to presentationwith ( fvn+hrr ninlz c bronchitis/ thesesignsand symptoms: 6 separatetsothree bronchiectasis Signs layers f asthma 1 coarseinspiratory and expiratory crackleson 7 verysticky,oftengreen a l l e r g i ca s p e r g i l l o s i s auscuitation 8 sticky,withplugs h lobarpneumonia 2 airflowobstructionwithwheeze -J.i /l Symptoms -:'-if t 1 cough 2 chronicsputum production(typicallytenacious, Match the nature of the sputum to the causesin $. purulent,and daily) Apart from the nature of the sputum,what 3 intermittent haemoptyses investigations/ testswould you do tp establishthe 4 breathlessness causesin a-h? 5 intermittent pleuritic pain (usuallyin association Work in pairs.Chooseone of the conditionsin tr.Then with infections) take turns taking the history from eachother. 6 lethargy / malaise (/1'\\p:.W. ork in pairs.Listento the conversationbetween Dr ZoltanandMrs Fitzgeraldw, ho is not asthmaticand is a non- smoker.StudentA,Iistento the questionsthe doctorasksand write them down in note form. Student B,write down what the patientsays. Usingthe doctor'squestionsasa guide,explainwhat the patientsaysand decideon a possiblediagnosisI.sit the sameasin t above?If not.whv not? Work in pairs.Chooseseveralof the conditionsa -h. Explainto the patient what you think the diagnosis might beandwhat testsyou aregoingto do.

92 Unit10 afferent(adj)carryingor directing Pulmonary somethingtowardsa bodypart embolism c e s s a t i o n( n )s t o p p i n g l o d g e d( a d j )s t u c k OSAObstructivSe leepApnoea C O P DC h r o n i cO b s t r u c t i v e P ulmon arDy isea se o Languageipot I In the sentencesbelow,put the words in italics in the correctorderto completethe texts.Payparticular 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 attention to the articles. I Work in pairs.Completethe sentencesusing the,a,an, 1. The/ majority / chest/ patients/ of / with / pain / referred/ to / have/ acute/ either/ pleuritic / the / aer^ qer r i i rla /O\\ respiratory/ team / well-localized/-pain/ pain / or / ^r persistent. rrLr! \\vr, Not all patients needtreatmenl. evidence/ breathlessnessrefersto significant/ treatment / the / for / on / benefits/ sympt oms/ rests,/ whi ch / drive/ t reat ment,r ather abnormal and uncomfortable than the degreeof OSAon a sleepstudy.decisions/ require/ a / dialogue/ treatment / close/ between/ awarenessof breathing.Its physiological patient / physician/ and. mechanismsarepoorly understood; In addition to supportivecare,antiviral treatment possibleafferent sourcesfor of pneumonia with amantidine or rimantidine may shortenthe / an / of / illness/ if / started/ duration / sensationinclude of / symptom / within / hours/ 48 / onset. receptorsin respiratorymuscles. }) i rl :., Grammar refeteRce i; l. AII patientsneed full history and examination. smoking is main causeof chronic obstructivepulmonary diseaseand lung cancer. NHSspendsf 1.7billion per year Listening2 caring for peoplewith smoking- Mistakerecognition r e l a t e dc o n d i t i o n s .G o v e r n m e n tt a r q e t s h a v eb e e n f) Listento the recordingof five pairsof statements. Decidein which statement (aor b) the useof the articles setto reduce number of smokers is correct. ln UK.and health authoritieshave 2 Q Checkyour answerswith a partner and listen again. beenallocatedfunding for smoking Q Work in pairs.Listento sentences1-7inturn and decidetogetherwhether the articlesin eachsentenceare cessationservices. correct.Checkyour answerswith another pair. In the sentencesbelow,find the four extra definite 4 Q tisten again and checkyour answers. articles. Speaking 1 Themortality for patients with the pneumonia who aremanagedin the community is lessthan Work in pairs.Rankthesecausesof breathlessnessin 1%,butonelnfour patientswith pneumonia is admitted to hospital andmortality for those orderof speedof onset:Instantaneous,Acufe(minutes- admittedis around9%\". hours),Subacute (days),Chronic(months-years).Check your answerswith another pair. 2 TBis spreadby the airbornedropletscontaining mycobacteriumtuberculosis(MTB).Dropletscan pleural effusion pneumothorax remain airbornefor hours afterthe expectoration becauseof their small size.Infectiousdropletsare fibrotic lung disease exacerbationsof asthma inhaled and becomelodgedin the distal airways. COPD pulmonaryembolism 3 Pulmonary emboh.smis a clinically significant obstructionof part or all of the pulmonaryvascular asbestosis tree,usually causedby the thrombus from a different site.

R espi ratormyedi ci ne Signsandsymptoms Speaking Lungconditions Work in pairs.Write down a scenariofor a patient presentingwith the symptoms and signsinSignsand Work in pairs.Chooseone of theseclinical conditions symptomsanddecideon a cause. and symptoms 1-6.What questions would you askto reacha possiblediagnosis? Work with a pairwho haveprepared a different 1 Pneumonia scenario.Swapscenariosand prepareyour role asa patient for your new scenario. f e v e r ,r i g o r s m a l a i s e ,a n o r e x i a ,d y s p n o e a ,c o u g h , purulent sputum,haemoptysis,and pleuritic pain Taketurns taking the history from the patient and 2TB explaining the testsin Signs and symptoms2.Then productivecough,haemoptysis,breathlessness, explainthe resultsandtreatment. weight loss,night sweats,malaise,chestpain 3 COPD Work in groups of four. While two doctorsdo the role- cough,sputum, dyspnoeaw, heeze play,one doctorusesa copyofthe speakingchecklist 4 Lungtumour on page117to monitor the doctor and givefeedbackat c o u g h ,h a e m o p t y s i s ,d y s p n o e a ,c h e s tp a i n , r e c u r r e n t the end on agreedcriteria.Thefourth doctorlistensfor or slowresolving pneumonia,anorexia,weight loss correctexamplesof the useof the articlesand incorrect 5 Pulmonaryembolism use. acutebreathlessnessp,leuritic chestpain, haemoptysis,dizzinesss, yncope 5 Two doctorsvolunteer to do a role-play in front of the 6 Mesothelioma chestpain (dull ache,'boring'd, iffuse,occasionally class.Theclasschoosesa scenariowhere a patient pleuritic),dyspnoea,weight loss,profusesweating, thinks he / shehas one of the conditions 1-6 in Signs asymptomatic and symptomsbut the diagnosisis bronchitis or a bad viral flu. Thedoctorreassuresthe patient that it is not the condition he / shefears.Therole-playmay include all or part of the following: the history the investigations,the diagnosis,or the treatment. USEFUL XXPRESSIONS From what you havetold me,... It looksasif you have... IJyouhad...,you'd... Patientswith ...usuallyhave... It doesn'tsoundpleasant,bu.t.. Becauseyourfriend had ... If it doesn'tgo away,comebackand seeme. What tests / investigations would you want to do for the conditionyou havechosen? What treatment would be suitablein eachcase?

94 Unit10 Reading 3 Work in pairs.Findthesephrasesin the text. Are they causesor effects? Work in groups.Beforeyou look at the text, describe 1 and hencethe airways areat their most open Figure1,which showsthe flow-volume loop. 2 the highestflow ratesarepossibleat the beginning of the blow Usethesewords to complete1-7in the text. 3 and areiessabieto resistdynamic compression peakexpiratoryflow rate inspiration 4 Also,increasingiywith age,the smali airways may closingvolume dynamiccompression actually cioseoff flxed upperairway narrowing 5 the inspi.ratorymusclesareapproachingthe end of expiration peakflow their'travel' F l o w - v o l u ml oeo p tissuea,repullingthehardesatnd maximaalirflowobtainablree,gardleossf supportintgheainruayasgains2t - effort,fallstoo. A goodstartingpointto the d u r i n gt h ee x h a l a t i omna n o e u v r e . Eventualltyh,eexpiratormy uscles u n d e r s t a n d ionfgl u n gf u n c t i otne s t s Thismeantshatthehighesfltowrates cometo theendoftheir'traveal'nd istheflow-volumleoopT. hisplots arepossiblaetthebeginninogftheblow, cannost queeztehechesat nymoreA. lso, inspiratorayndexpiratorfylowagainst hencethesudderniseto a 3- in increasingwliythagethesmalal irways lungvolumeduringa maximaelxpiratory the100msorsoof theforcedbreathout. mayactuallcyloseoff,preventinagny andmaximainl spiratomryanoeuvre. (B)T. hisisthe+- andisessentially moreemptying(D. )T. hevolumeatwhich At thebeginninogfthe1- from whata peakflowmetermeasures. t h i sb e g i nissc a l l e dt h es - . a fullbreathin,theexpiratomryuscles A st h el u n ge m p t i e sa,n dt h el u n g Asmaxima6l - startsa, lthough areattheirstrongestht,elungsattheir volumedropst,hedilatorpyullonthe theinspiratomryuscleasreat their biggesta,ndhencetheainruayasreat airwayfsromtheradiaal ttachmenotsf strongestth,eainruayasreat their t h e i rm o s to p e n(.A ) .B e c a u st heel u n g s thesurroundinlugngtissuereduce(sC. ). smallesTt.husf,lowratesstartlowand areat theirlargest,heradiaal ttachments Hencetheairwaysnarrowandbecome increasaestheainvayospenup.However, to theainvayse,ffectiveltyhealveola/r lesssupporteda,ndarelessableto resist astheainruayospenup,theinspiratory capillarmy embranaens dtheirconnective dynamiccompressiTonh.ismeantshatthe muscleasreapproachitnhgeendof their'traveal'ndareweakeninTgh. is meantsheflowratesfallagainh; ence, thedifferenrtoundedappearancoef the I Expiratcry i n s p i r a t o rl yi m bo f t h ef l o w - v o l u mceu r v e . ;. TLc fior,v RV Thusn,ormalltyheinspiratory Inspiratory andexpiratorfylowratesdependon flow D lungvolumeandaretermed'volume- dependentlf'.thereis7-, such asfroma fibroutsumouirnthetrachea. t h e nt h es i z eo f t h ea i r w a ya t t h i sp o i n t maybecomesonarrowthatit nowlimits m a x i m af llo w s .

R espi ratormyedc -: 95 Itisnowestimatedthatasmanyas3oomillionpeoplesufferfromasthma.Britishchildren areth reetimesmorelikelyto sufferasthmathan thosefrom France,Cermany,or ltaly. Thehighestprevalenceratesfor asthma inthe worldarefound in the UK,NewZealand, A ust ralia ,lre lan d,an d Can adaN. epal,Rom ania,Albania,I ndon e s i aa,n d M a c au h a v et h e lowestprevalencreatesof asthma. - GINA(GlobalnitiativeforAsthma) Speaking P E A KFLOWR E A D IN GCSH A R T t Work in pairs.Describethe devicebelow. ._UF _E F 3 Notes Make a list of the stepsinvolvedin expiaining EEB=nE to a patient how to usea peakflow meter.Take turns explaining to eachother usingthe picture iE.=EF5 in I andtheseexpressions. Dateandrimegs:g=5 USEFUL EXPRESSIONS Mon0, 'lAug200512:00PM 503 879b XX Youneedto... Canyou standor situpright? Sunl,1lul2005l 2:00PM 480 83qbX X X X Ensurethe meterissetat ... Takea deepbreath. S at,30Ju|21020:500P M 541 94orc Seayl our lipsaround it. BIowout ashardand asfastpossible. Fri ,29j2u0l 0152:0P0M 516 89qr XX Recordthe bestofthree efforts. Thu,28Ju|200512:004P8 M84ak XXX Repeat. Expiainto the patient how to recordthe W e d , 2 / J u | 2 0 0 5 1 2 : 0 50 6P5M9 8 0 0 X XX XXX readingsappropriatelyusing the chart. Tue,26Ju1200512:0409P7MB 6ok X XX M0n,25Ju|200512:0207P1M470lXo X X X XXXXX X S un,24]u|200512:005P0M1 8790X X Sat2, l Ju2l 00512:00Pl/ 540 9l0o X X XX tri ,22i u|200512:00P513\\47 93%X X X Thu,2J1u2l 00152:0P0M 471 8'l orX X Wed,2.0lu2l 00512:0P0M 547 95r)o Tue.19Jul 2005l 2:005P4M4 94ooX X Mon,1i8u|200512:00P4ii\\04 8l % Sun1,7JL2rl005I2:00Pl\\,1 500 860r X XX sat,16Ju1200512:004P8M0839/0X X X X Fri ,15Ju|200512:004P7M5 82rLr X X X Thu,14j ul 201025:00P M520 900/o X t:V ed.'l l l ul 21020:500p[']170 .;4'r,X X X X X X X X X Tue,l 2l ul 200512:00P49j \\6tl 86-sXb X X l /on,11Ju1200512:0506P2M97oo . \\ - i i l ( l o r o { ( n s r o n a5 yn p t o m s X X= l \\ 4 . d i r r nor r t r e ( t u e nrl y r fp t o n r s XXX = Se!ert o'cofl,n!oLrs sy rrl)toni! Proiect Work i.npairs.Find information on the internet on explaining the useof inhalersto patients.Or choose one of the sitesbelow. ': wvwv.patient.co.uk |' Asthma UK:\\MrMw.asthma.org.uk 'i American Societyof ChestPhysicians: www.chestnet.org ,-. British ThoracicSociety:www.brit-thoracic.org.uk ::::EuropeanRespiratorySociety:www.ersnet.org . Societyof ThoracicSurgeonsw: vuw.sts.org ,. BTStraining site:www.chestnet.net {,: Forsimplethoracicanatomy and other anatomy see:anatomy.uams.edu Aiso checkthe OxfordHandbookof Clinical ExaminationandPracticaSl kiIIs. Shareand comparethe information with other studentsand choosethe bestresource.

95 Unit10 ListeningI Speaking Explaininga device Work in pairs.Taketurns explaining to the patient how to usethe breath-activatedinhaler and then askthe 1 Q ristentoanurseexplainingtoa patient to explain it to you. Thepatient should make patient how to usea breath-activated somemistakes.Correctthe patient politely. pressurizedMDI (MeteredDose Inhaler).Write down the verbsthe USEFUL EXPRESSIONS nurseusesto explain how to usethe deviceafter she says:Firsot f aII,you OK,that'sfine,buttry to do itlike this. removethe cap... Doyouwantto showmeagain? Finej,usttry doing itlike this. Workin pairsC. omparelistsand OK,just seeif you can do it like this. checkwithotherstudentsto That'snearly it. completeyourlist. Canyoutryit againforme? Q the nurseasksthepatient Writing to explaintheprocedurteo her. Thefollowing illustrations show what the patient Describingdata explainedto the nurse.Listenagainto the nurse's explanation.Which three stepsarenot illustrated? Work by yourself. Lookat the chart opposite which showstrends in annual ratesof primary care 4 Work in pairs.Compareanswers. consultations,hospital admissions,and mortality for asthma among childrenunder five.Which line or lines on the chart do thesewords and phrasesrelateto? 1 trends overall 2 experiencea steadydeclinealmostto zero 3 increasesubstantially during 4 halve 5 morethanhalve 6 reacha high,throughout the period 7 hospitaladmissionrate 8 risesharply 9 upwardtrend 10 downward trend overall with thb excention of

R espi ratormyedi ci ne97 A s t h m a ndalle r g iedse: creasien hospitaaldmissionins1 9 9 0 s Check*Est 30 Assesysourprogressin this unit. Tick(/) the statementswhicharetrue. t0 \\ \\ I canunderstandl anguagefor coughand 20 / \\ s p u t um f S I canexpl ai ni nvesti gati ons 0 19 9 3 1994 1995 1996 1997 1998 1999 2000 I canusea / an,the,andzeroarti cl e 1990 1991 I cancheckthe pati entunderstanddsevi ces A n n u a l h o sp i ta la d mi s sionsper 10,000( England& Wales) I candescri bedata Annualdeathsper million(UK) Pa ti e n tstre a te dfo r a sthmaannuallyper 1,000( England& W ales) Keywords W e e kl yGPe p i so d e sp er 100,000( England& Wales) Adjectives T rendsin ann ua lra tesof p r im ar yc ar ec ons ult at ionsh,os pit a la d m i s s i o n s , b ar k in g and mortalityfor asthmaamong childrenaged underfiveryears breath-activated expiratory n o ar s e hollow inspiratory offensive productive purul ent tenacious tickly Nouns bronchitis crackles expectoration high malaise MDI sputum trend Work in groups.Checkyour answers.Togetherprepareorally Usefulreference a descriptionof the data of between 150and 200words,using the phrasesbelow.At this stagedo not write, but you may make OxfordHandbookof RespiratoryMedicine notes. 2ndedi ti onC, hapmanet al , lsBN978-019-954516-2 USEFUL EXPRESSIONS Thegraph / chart shows/ illustrates/ providesinformation about / providesa breakdownof ... Generallyspeaking,the trends...,with the exceptionof ..., Forexample,/ Forinstance,./..Take...,forexample. Similarly,/ Likewise/, Furthermore,... As regards/ Regarding/ With regardto / As can beseen/ T u r n i n gt o . . . By contrast/ Comparedto / In comparisonwith / By comparison Pocnerfivolrt As against/ As opposedto On your own, write a descriptionof the data using the simple past.Quotethe data to support your description.Youdo not need to describeeverychangein the chart.

98 Unit11 C h e c ku p 1 Describethesepictures.What relevancedo they have for the spreadof infectiousdiseases? Work in groups.In the UK certaindiseasesare Proiect notifiable.What types of diseasesdo you think have to benotified to the authoritiesandwhy dothey have Work in groups.Useyour own knowledgeand the to be notified?Do you havethe samesystemin your lnternet to find out more information aboutthese country? milestonesin public health practicenationaily and internationally. What epidemics/ pandemicsdo you know in the world 1 1600s-Variolation (theinduction of mild smallpox sincethe beginning of the twentieth century? to reducemortality, an ancientpracticein Asia) spreadsto Africa,Europe,theOttoman Empire,and the Americas. 2 1796-EdwardJennerimmunizes JamesPhippswith cowpoxvrrus. 3 1854-JohnSnowshowsthat choleraspreads through contaminateddrinking water. 4 1873- Henrik Arnhauer Hansenidentiflesthe bacilluscausingleprosyunder microscope. 5 1882- Kochdiscoversthe bacilluscausing tuberculosis. 6 1887- RonaldRossin India describesthe malaria- mosquitolife cycle. 7 1928- Flemingdiscoversthe antibacterialeffectof penlcillin. 8 1953-Polio vaccineintroduced. Sharethe information you havefound with the class.

Trooi cadli seases99 ln thisunit o tal ki ngabouttropi cadl i seases I usi ngvocabul arryel atedto travel l ers' di arrhoea O usinglinkingwordslikenext,then,whenin descrpi tions o tal ki ngaboutsi ckl e-ceal lnaemi aandrehabi l i tati on after stroke o show i ngrespecitn di scussi ons Speaking 4 (frt tistenagainandcompletethenotesmadeby a studentduringthepresentationIn. eachspacewrite no Work in pairs.Choosethe three most important morethanthreewordsfromthetalk. developmentsinProjectl.Rankthem in orderof importance. wtrl.\"tavellzrs ornug taoh-frvrn hn\"A4yt Compareyour rankingswith other pairs.Are their Lt^frt'(4^i'tT fl\"t*'\"[- ato^f ' rankingssimilar to yours? Choosethe most important developmentfrom the list. twh,stvry,rwed,tt atLatr*r USEFUL EXPRESSIONS th.eyrnytvw . arc4rrravelhd,tr (uhtludry truf stywcrs) If it werenotfor ,.. $ ...hadn't..,. ...isthesinglemost... Byfar,themost... aA'6d,.urattawrf rhz rravel ListeningI trnmu*1lzltft aru rec4tved,' Treatingreturningtravellers rrwl.arnyrcyAk*o hzokl\"rf nzn&eruf rhz Q tisten to the talk on treating illnessamong returning travellers.Lookat the notesand the picture texrrqLorht4pfJ wldsr atrva/\" aboveand decidewhat the illnessis. Work in pairs.Lookat the notesmade by a student. nzlaqL fre4ft^eht reqwed, otrvqrL. What is the part of speech(noun,verb,etc.)of each trall zxaw\"n-af6lt Jhr^A tc qwc*. ofthe missingwords? What do the abbreviationsstandfor?Usea dictionarv thvcJfgt4fLrhJ, rklrL- atwq- c?c, ,l\"rf aa/,7htn or aska partner. far nalav6, cFTs, vtral scrclgy, tl,ovdo,akure, srcvlo^lt^re krurqe ttr u f'rc:lo, r'rtsv. rwalnna, are nattfud, eachjcar w rh.evK Ealy tt tnussd,tryrwtw 6rc4f \" - aq.n/rcscnt wuth ^z^rb 4A Vt\"FtTw\"J 7_ rf hzad.aohzr,nakLsc, nyqb^, q.n-da'.Mrttrua,ftU'swedtJ' ,et^rru7 fevers,rgrvs, an/'e. wluch Lar frr e-, z l*'*s ar a rLr^c What questionswould you askin taking the history of a businessmanwho had beento SouthAmerica and presentedwith fever? Work in pairsandtaketurns taking the history from eachother.

I O O U n i t1 1 TheHealthProtectioAn gencyhasa usefuAl -Zof I .*r.xff\",Y.'futopicsatwww.hpa.org.uk tl @ V o ea b * E a r y Travellers'diarrhoea 3 Completethe text using theseadjectives. chlorinated contaminated reputable hyper-osmolar preferable unhygienic self-limiting sweetened unpeeled Management * Most episodesare1 * IncreasefluidintakeE. atinge.g.broth with noodles $p*atuing or salty crackerswith 2-drinks will providea balanceof carbohydrateand salt * Oralrehydrationsolution (ORSi)s I ifthe diarrhoeais frequent or severeor ifthere are signsof dehydration,weakness,or musclecramps. * Drinks designedfor rehydrationduring sports activitiesdo not contain the correctbalanceof salts for diarrhoeatreatment. Sodasand fruit iuicesare often a or havehigh sugarcontent and canmake diarrhoeaworse. Prompt antibiotic treatment reducessymptom duration. Loperamideshortensthe episodein olderchildren and adultswith s smallvolume stools. (Donot useloperamideif there is blood in the stools, fever,tenesmus,or other signsof dysentery.) rj Prevention Avoid 6 fruit, uncookedvegetables, sauceswhich arenot freshly preparedand handled in 7 conditionse.g.by streetvendors Work in groups.Describean interesting case Wherethere is no reliablesourceof 8 presentationof a patient who had a diseasethat is water,sterilizewater by boiling or with chlorine finot prevalentin WesternEuropeor onethat is not tabletsor drink bottled water from a e prevalent in your country. Saywhat you learnt source.Avoid bottled water where the bottles are from the caseand what you would do differently if you hadto do it again. immersedin water or iceto keepthem cool.Beware iceor icecream,which may be made using 10 Chooseone student from eachgroup to describe their caseto the restof the class.If possible,use water.When trekking or in isolated PowerPointor the electronicsmartboard. places,it is advisableto carrypacketsof ORSand a courseof treatment. Hand sanitizersareuseful when hand-washingis impossible. Work on your own. Write a descriptionof no more than 150-200words ofthe caseyou described. Work in pairs.Taketurns explaining to another doctor Describethe sequenceof eventsand addwhat you { the managementor preventionof travellers'diarrhoea Iearnt from it and how you would improve your performanceif you did it again. Thenexplainthe managementor preventionto a patient.