Professional -

English in
Use

Medicin
e
Eric H. CAMBRID GE
. U NTVE RSITY l'll ESS
Glendinning Ron
Howard
 Conten ts
INTRODUCTION 8 O Allied health professionals 24
A (:on1mun1n h'Jhh
B Ttchnic1Jn\
BASICS C PtolithfflSt'.111d 01·rhorirs
O Health and illness 10 O ()pu.;1.in'

A Asling Jbout hdrh

B Srln<>•
llJ Hospitals 26
e Roco\ery A lnrrodua1011 10 J ho!ipaJI
B Outpat1t1n..
e lnp.ltlC nt'
IJ Parts of the body 1 12
A Pam of ch< li<Mli IIiJ Primary can: 28
8 Rcftmn¡¡10 p.ln> of th< bod) A Tu l'an<>IUI 1l<alch ,,.,
e Descnb1ng rad1:uion of pa1n 8 The pr::u.:01-.-e tc:.un
C A GP's da)
11Parts of the body 2 14
A Tu abdom<-n
EOUCATION ANO TRAINING

8 Tu
e Tu pe"••
D Functions of the
A Eacing
8 1ñe fi\t" \(11-.t'\
e Othcr luoo"""
O Less comnW»t funnions
MEDICAL ANO PARAMEDICAL
PERSONNEL ANO PLACES
11Medícal practitioners 1
A 8 Pl.A B
Prac11r1oncr)
8 Special11e..
e Choos'" J •J'C.'<:Oalry
O Medical practitioners 2
A H05p11al >1.111
6 Medu .1l 1e.un'
C Shift.
m Medical education 1
30
16 A 1\ ledic.a l c.-. ducat1on 111 rhe UK
8 Fxtracr fro1n Jn undcrg:raduarc:
prospe.-i "
e .\ srudnn ). ,.te...,
m Medical education 2 32
A ·rhc Found.nion Proranure
8 People 111rued1.1I edocJtion
C ledH.. I qu.ah.;u1on..
18
m The overseas doctor 34
A Types of rt"g1\tl'Jtton
e PLAB S(JtlOn!I> .111J ad\'i<:c
20 SYSTEMS, DISEASES ANO
SYMPTOMS
m Symptoms and signs 36

A
8 L>rscnbmg
l3t1on prublcm'
U Nurses 22
A 1'urs1n1t, p.r.1 C 1";tlk1ng bou1 Olptoms
B Support \\'Orkcr'
C Specinli1..u1on l.'m Blood 38
O The nuro,e\ role A Full blood counr
8 .\naemu
e Pmltl... Jn.ae1n1l

4
11!) Bones 40 fD Mental illness 58
A llo<i<> A Psychiarric di>orders
8 fr.u.1ur 8 Subsranc< abuse
e Írt llK'llt of Ír 14..IUI e Affective disordcrs
o N('uroóc and srrcss--rtlated JJSOrden
m Childhood 42 E Oth« l:}p<S oí íunrnonal d1sordcr
A 1\hln1"""'
B (:ornrnon 1nÍC\". t.OU\ J1..r'\ f1B The nervous system 1 60
e Cur:l1Jc.: J1)C;l'J(' A Sensory loss
8 ;\lcxor loss
IE) The endocrine system 44 e Loss of consctousness
A E-'.<'>> ••d Jdi.,..,._)
8 1\rg;Jll\"C fttdb.11..:k \, -.ttn1't
fD The nervous system 2 62
e Goutt A Thc 1uoror systern
o A lcttc:t oí r<Íc:tr•I 8 Tendon rcAcxcs
e Coma
lllJ The eye 46
f1l) Oncology 64
A P.arc oí che C)'C'
e E\:.tr11u1.auo11 of 1he e)'l' A Neoplas1ns
e RctnlOl'>;\ I hy 8 Syn1pro1ns and signs of n13f ignancy
e Treun1ern of tumours
fl!> The gastrointestinal system 48
A Ean1ln.11io11 of thc .1hdo1ncn m Pregnancy and childbirth 66
8 Thc í.t<'l".C< A Childbirrh
8 Labour
m Gynaecology 50 e Presenr:irion and liC'
A The: Íc1n.1Je rerrodtK'.fl\C 't)\fCl1\
8 1cttilru.111011
iiiJ The respiratory system 68
e A yn.1c'.\:olt1.1I..:on.,ult1t1nn A Cough
o Contr.11:cpt1on 8 Auscuh.atioo

&J The hcart and circulation 1 52 m The skin 1 70

A h<>nnc<> ni hrc.uh A Sorne 1ypcs of skin kst011
8 Hc n rhthn1 8 Rashcs
e l lc01n f.\llutt
m The skin 2 72
fD The heart and 54 A ln¡u ro rht: skin
c1rculat1on 2
A J>h,a-.::.tl rununJt101 8 C...,repon
8 f,J.1nu11n¡.t 1 Jn ;and 1n.:ul<1uon e Sorts
m lnfections 56 ID The urinary system 74
A lt'\'('f A Urinary syn1proms
8 \11t:rooflt.Jn'''n' 8 Urinalrsis
e Sourcc ,1nd f'Ht"tJ ot 1nfocr1on

5
INVESTIGATIONS aJ Therapies 92
@D Basic 76 A Rad>0<h<rJp)' and d>emoihenp)
8 A day "' the liíe oí n physio1hcr.1pisr
investigations
e Cogn111"·e Behavioutal Ther.apy
A Ophthalmoscopy
8 81ood pmsur<
C Takmg blood

m Laboratory tests
A A .\licrob1oloj!) t<'it r<qu<st
78
PREVENTION
CD Screening and 94
fonn
B A Bioche1n1tl'!' and llaeina1ology
immunization
lab repon A Scrccnui.¡t
e ícrms u!<d to dc,cnbc lab ""''" 8 Comn'W.>f'I scrttruntt tb
e l1n1nun11;i11on for 1ravllers
mA Endoscopy
Functoons of
80
<ndosrop)
B Emeroscopy EPIOEMIOLOGY
C Repon oí n dingno\lic endoscopy
eJ Epidemiology 96
m X-ray and 82 A Rates

CT
8 lncidcne and prcvaleno:
A Radio¡;rnphy and rnd1ology
C As.sóc1JUOn and CJUSl.tion
B X·ray ('\.Jnunauon
C Compuo<d Tomogr•pbl'
ETHICS
lllJ MRI and ultrasound 84
A Magoct1<. Resonancc lmaging (MRI)
ID Medical ethics 98
B Ulcrasound A GMC guidclines
e Prcpanng for ottdocJI unag¡ng 8 Btocth1<JI issll<1
o Dtscnhong m<dal un•ging e AsS111«l di·mg
m ECG 86
RESEARCH
A Uses of •n t:CC
e ECC pr0<tdure
C A normal FCC
Cii9 Research studies 100
A C.ast--1.;ontrol srud
e Cohon <tud1es
TREATMENT C Trials
O VJriablo
CiiJ Medical treatment 88
A Prescr1¡">tions and druJ:t)
8 The llnt1>h i':abonJI formulal') TAKING A

m Surgical treatment
A The op<ranng
90
CD Taking a history 1
A A ful! ca« h1Stof\
102
8 Pcnorl.11 Jer.¡ib
thwrc
8 lnStTUl1lCl\tS
C Talkina ahout pa1n
e Thc opcra11on
o An opcr.u1on repon
Cii) Taking a history 2 104
A Dn1g hl\to
8 Fanlil}' hitory
C Social Jnd pmonJI h1>tOI'
E) Taking a history 3 106 mlJ Data presentation 2 120
A Re-1t"1n¡¡rhc S)Sttnt; A Line graphs
8 Ask1n ahou1 thr 1".CftCt.ll ncn·ou yMcm 8 Pie chans and bar chans
e PJ.11ttu 1dtas.<'OllCtms and t'\f>t'". tJ.uons e Dcscnbing tr<nds
o
m Research articles
pt,....,1,.,1» on h1>1>1)·t>kon
A TI.. suuaurc of a rcscarch anod< 122
EXAMINATION B Ob,<ct"es
C Main lindings
€!) Physical examination 108
A l \;un1n1ng a p;lltent lmJ Abstracts 124
8 G1'1ntt 1n'Sfrurnon)
A Srrucrurcd absrraru
m Mental state examination 110 8 n..BMJ absmm

A \orne ))rnpconl., of )'h1,11n' doordcrs

B Mood
lmJ Conference presentations 126
A The scn»CtUrt of a presenrauon
e l')pl<.:Jl que1J11ons frorn a O'K'lllJI B The Lntroducrion
sratc cx.irn1n;u1011 e S1giulling
o ·me conclus-ion
EXPLANATION mi) Case presentations 128
A 5<'.<".tio11s of :l c.1e presenrarion
@) Explaining diagnosis 112 B Bcdsidc prcsentation
and management e $lides
A F\:pl uu1non
B U;,ing la)' u·nn., 111 l'xplann11on.i
e An cplanauon of a1gu1a Appendix 1 130
Paru oí rhc body
(!D Discussing 114
131
Appendix 11
treatment
A Offtnn oru1on..
Medical abbr.,..;ations
8 Ad' 1s1ng a ('()Ul'4ie' ot actton
e Adv1s1n pannu .. 10.l\ o.d 1nrthu1g Appendix 111 143
o \'( Jm1ns
Types oímedication

m Giving bad ne'NS

A Pnoc1pi..oí lll""lt hd "'"
116 Appendix IV
s ·mpcoms and pain
144
8 A coosulron1 ,,,..¡._,,¡ 011<olo¡psfs repon
Appendix V 145
\ c:rbs u.sed in instrucrions
PRESENTATIONS
Appendix VI 146
G:l Data presentation 1 118 Lay tcm•s and defin1rions
A R eícrnng ro a tJblc: or fiurc
B Co1npanng \ Jrlabl<'I
e Approln•arln Answcr kcy 147

lndex 168
11 Health a nd illness
lfJ Asking about health
Hcahh is thc state <>Í the boJ). \Vhen doctors wJnr IO know about a p.ment"s usual
hcahh, ther ask qu.-.suons such as:
\Vhat ")OUr general Ho"\ )·nur healch,
health l1ke? gencrally?

lf you ore in good hcahh. you ore well and havc 110 illncss (disca\c). l f )Oll are hcalthy
you ;trC norrnally wcll.10d can resist illness.lf )OU are lit,vou a re \\Cll .rnd srrong.

""'"' """
lit and not 111
wcll
well not wcll poorly in poor heahh
in good
heahh
very well not vcry wcll

[\) Sickness
Sickncss has a simibr nlt'aning ro illness.lt is also uscd in thc "ª"'"' of a fe" specific
d1scases, for cxampe sleeping sickness and t11l\ cl <ickncss. Paciems also talk atout
s1e.:kncs.s \vhen they mean nausea and vomitinµ.

Poss1hl t•
1nt•an1nqs
1 "as <ick this morning. 1 was ill thb mornmg.
1 fclt unwdl 1h1s morning.
1 vomited th1s mommg.
1 feel sick. 1 feel 111.
1 fccl unwcll.
1 an1 naueou,.
1 feel thc nccd ro vomit.

TI1c combinarion sidmcs> and diarrhoea mcans •on11nng and d1arrhoe.1.

6 Recovery
Whcn p.1nents rerun 10 normal healrh after 1lln<>. ;;, rhcy have ree<l\ercd .We can also say:

goo
l11c paricnt madc a d rccovcry.
full
complete
lf a p;inenr's health is 111thc process of retummg ro nomial. the p;illl'llt 1s improving. Thc
opposire rs dctcriorating. We can also sai·that the panmt"s rondmon impro•cd or deicrioratcd .
In spc«h, wc often use thc •crb gct to ralk abour change:
l lc gor nver the
1ll11css very quickly.

1
1
 l f a paticnr i rclapcd. Anorher word for
bcrrer, hut improveme111, especialli in rteurring
rhenllnc«)
gcts conditions uch as cancer. 1s
ovcr (an = to rccover rcmi4¡;4¡;ioa.
\\rorsc
gct benerag.11n, t he = co in1provc
= co deteriorJtt -

-
Two years IJrt'f she remains
pattl"nt has
\VOíSC
in complete rcmission.

10
1.1 Complete rhe tJ hlc l\lth words from A and B oppos11c.Thc firSt one has bren done for you.

fitness
healrh
illness
sickness

1.2 2 Make word combmauons ustn!l a word from e.Kh box. Look at B and C oppos11e to help¡·ou.
complete sickncss health rcmission sick
feel gct poor travel ovcr

1.3 Compltte the come• on. Look at B opposue 10 htlp

you. Doetor: How are )ou freling roday?
Patimt: Not ver) ( 1)
Doctor: How long h.tv. you bern íreling
(2) Pacient: A bour a wcck.
Doctor: What i' you r (j) . ........................... l ike 11or111ally?
Patienr: Very good. 1'111 usually quite (4) ......_ .................. and (5) .......... .................... .
Uoctor: Whnt 1s the problcm now?
Paricnr: Jr's rny 1.1 to1nach.
Doctor: Do you fecl (6) ·-·------- ?
Patimt: Yes.
Doetor: Have you actu•ll)' bren (7) _
Patimt: No.
DOt'tor: Have )ou had·'"l scrious (8) m the pasr'
- Patienr: No, nonc ar.111.

1.4 Choose the correct word w complete each senrcncc.1.ook ar B and C oppositc w l1clp you.
1 Her condition ... ... .......(deteriorare<Vimpr ovcd) and shc dicd.
2 He....... (reLipsed/reco"ered) and was allowed to go home from
ho,piul. 3 The cause oí slcepm¡; ..................... (illnessl icknt<>') was discovertd
in 1901.
4 The patimt made a full (rem1<s1on/rcco1ery ).
5 1ha1e bren in (poor/goodl heahh íor months and íeel \Cí)' fü.
6 Ir was a momh bcfore 1 (got O\'er I got bcttrr)
thc 11ness. 7 He seems to be rather ------·--...(unhcalthy/unwcll)
-his ditt is b. d and he ne>er
exerciscs.
 Parts of the body 1
Pa rts of the body
i\losr °'"tem.il partS oí rhc bod) havc ordinal) En¡:Ji>h names.1 \\ell as ana1t•n11cal
names. l)ocrors nonnall) use thc b1glish na mes, t"\ en when 1alkmg 10 cach other.There
are a fcw C\ctption\ 'vhere Jocro111 U\e rhe anuo1nical na1ne;1hese are sho,vn in
bracklt!. bel<)\v.
1 jaw (mandible)
2 ncck
1 ----U. 3 shoulder
4 armpir (axilla)
2 --.!-'-,
5 uppcr arm
6 clbow
4 --+-..i.. -#- 7 back
s--1- --13 8 burtock
-"l ---14 9 'vrisr
6
10 thigh
_.¡._ ---15 11 calf
-+.>..-4---16 12 kg
9 l--\--:0 -11 13 chesr (thorn •)
/-4--i. ---18 7 --i-- 14 breas•

8-'--+
15 stomach.
10--_JI-- tummy
(ahdomen)
16 "ª''el (umb1hcus)
17 hip
\ , '4----19 18 groi n
(inguinal rq;ionl
11 ---' 19 lmcc
12 ;parella =
'-----20 kncccap) 20 ihin
---

l.imb means arm (uppcr limb) or leg (lowcr limb). The trunk is thc body cxdudin¡;rhc
hcad and limbs.
1or a more dctailed diagran1showing p>rt> of rhe body.see Appcndi• 1 on pa'C 00,

Referring to parts of the body hip.

Whcn panerm spcak abour rheir problem rhe) J'm ha•ing irouble "ith myshouldtt
onen refer lC) a part o( rhc hodr: kncc.

thcchcst?
Do )ou get an) pain inyourc;ro1nach?
l'hc doaor oftcn needs to ask about a part back?
of 1hc body:

Oescrib1ng radiation of pai n

A parienr is tell1ng thc doctor about h1s back pa in a nd thc parts oí thc body ir mdiarcs 10,

Ir starts in rhe back.Then ir seems ro go into rhe righr

bunock and down thc bark oí thc n¡;)u thigh to thc kncc.
2.1 Write the ordinary English words for thc corresponding anatomiC<J I rerms in the ta ble
uiug your 111edit<c1l kuuwlc<lgc. louk "' A upposirc ro hclp you.

Ana lom kal ll'rm Common wnrd

abdon1en axilla carpus coxa cubitus
n1an1111n
nates
parella

2.2 Complere rhe senrences using ordina ry Engl ish words. look at A and C opposite to help you.
a A male parienr describi11g angi na pecroris:

lt's like a rightness across my ( l )........ .... ...

......... ..., and it goes up
......•.... my (3)....... ..... ..........
(2)................ ......and into my left
(4) .. ·-·-· ·· ···· and (5) ···· ··· -··-··-·· ···· the lcft (6) ...
.... .................

b A male patient describi11g renal colic:

lt srarrs ( 1) .... .... ......... ..... thc loin and goes into the
.....
(2) ·-··- · ··········· and (3) ····- -······
····-·imo the resricle.

2.3 Complete the senrcnces. Look a t A opposite to hclp you.

Anatomical term Paticnt's statement
1 inguinal S\velling l've gor a l ump in rhe .. ..... ..
....... .......
2 abdominal pain My lirrlc boy's gor a ........... ..............ache.
3 periumbilical rash l've gor some spots around my ...........................
4 thoracic pain l 've got a pain in the middle of rhe ... ...............•.......
... •
5 enlarged axillary There's a painful swdling in my .............. ... ..
node l've got a pain in 1ny ........w-................... .
6 mandibular pain

2.4 Complete the table with words from thc box. The firsr one has been done for you.
abdomen clbow loin \vrist thigh
knee chest arm lcg finger
· Ove-r .f-o
t h.11 ynu
11ou
l'vlakt· a l ist uf t ht· worrls frorn A npp·IJlih· t h;1 t you find i t hard lo
rl·rnt·n1lu:r nr
necd tnost often. Try to lcarn at lcast nlll' nf thl'lll l'Vt:ry day.

Proftssjooo l Engfish in Use 1'- 13

Aedicine
 Pa rts of the body 2
The abdomen
The mam organs of the bod)' havc ordmary Engltsh names and doctors use rhcsc words.
Bur when an adjectivt is necded thcy ofren u..e an anatomical word. for eample, we
ca n sai diseasc of the livcr or hepa1ic dieasc.Somc abdominal organs. for cxamlc
1hc p:tnc.:re.1), have no ordinary nan1c.
pancreas
duodenum tornach

gall bladder

lt 'cr---

splecn

righ 1 kidney l<oft kidncy

When doctors talk about the m•m pan> o( the d1gesrhe system, thcr 11>e rhe words bo" el
or inu:stin<: the small intesrine or thc small bowd, 1he large inresrine or thc large bowel.
When speaking to paoenrs, docto<'l mai rcfcr ro rhe anus and rectum as th< back pasogc.

The chest
The chcst (rhorax ) conrains the orgam of respiranon and rhe hear1. The mam pa ru; of rhc
respi rarory system are thc airways and 1he lungs. The lefr lung is dividcd into rwo
lob. and rhe right inro rhree. Thc a irways consist of 1hc larynx, rhe rrachea (or
windpip<:), 1hc righr and lcfr bronchus, and thc bronchiolc;. Thc che" is separarcd
from rhc abdomen by thc diophragm.

The pelvis
A doctor is explaining the function of thc bladdcr ro a parienr.

Thc bladder is sirua:ed in thc pelvi a )ou lno\\, and ir 1s connccred to cach kidncy bi a long rubc caUed thc we

14 Pro(essional English in u,.M<didnt

3. 1 Label rhe diagram using words from rhe box. Look ar B opposire to help you.
diaphragm lobes windpipe hea rt
lu ng ainv:;ys bronchioles

5 ...... ............ ...........

1 .....
.................
.....

2 ............................... 6 ............................

3 ......................... .....
4 ................................

3.2 Match che conditions ( 1-S) wirh rhc organs affecred (a-h), using your medica( knowlcdgc.
1 hcpariris a hladder
2 pneumonia b gall bladder
3 ncphriris e hearr
4 gasrric ulcer d k idney
5 cysriris e liver
6 angina pecroris f lung
7 cholocysriris g sromach
8 ulcerarive col itis h large bowel

3.3 Complere rhe rexrbook extraer. Look ar A and C opposirc ro help you.

Examination of the abdomen

To examine the pat ent forenlarged abdominal (1).. ... ......................first feel for the (2)............ ..................
and the (3)............. ...... ............................ ..........on the ñght side.To do this, ask the patient to take a dee
and then cross over to the other side for theleft (5)..............................Still on the left side, palpate for an
enlarged (6) .•.-......... .. .-......Finally,moving to thelower abdomen,feelfor the (8).._....................... whichis

Ove. .f- /
rpantrl·as.tients10lA
Many pao do not know the l ota tion or f unct ion of thl' spleen or t hl'
How l'JOu ld you t'xpla in thl'm to a palil'nl. i n
English?

Professionol Engfish ;n Use M? 1

dic.1'ne 5
 Functions of the body
Eating

'°" imdl 11. h You c.1t You rush to 1k

'ou'tt hungry. 'fou'tt an .a rt"Slaur.11n1 and 1hc \\ ;urtr bnngs
)'t.)llf (ood. "'°"'.
scu11ub1t$ yout You t.1kt a b'1c- •oikt, ..el !l".......
buo ohm
apperitr -)'OU ol oht food. h JUSC IR llft'I( btf6tt
\\ ;101 10 t'JI.
Your 1nooth
w"tm, filhng
r.utc11
)'OU che'"' 11 and
s()()d and
\"\V:IJIO\\' lt.
• suddC'n1y
unpkant. You
'ou
la.SIC' !;Omcd·uni' \'omiting all
thc
(ood you've ttUC'n.
Somnhing has
(cd naucoui.
w11h ah\·J, disag.rc:cd wuh )'OO.

The five senses

In add1roon ro smcO and 1as1e, sighr
rhc Whal is our likc?
><:n:.cs include sigh1 (or hearmg
"'sion), hcnring, and 1ouch scnse oísmcll
Js your sense of rare normal?
(al>o callcd
sc1"ation or feeli ng). To a<k
a bour
rhc ;enses, docrors u>e 1hc qucs1ions:

about noc1<'.td an¡numbncS> (in your fingcr.. or roes)?

To asl abour rhe s-nse oí 1ouch, docrors ralkHavc¡ou
numbness (loss o( !<'.nsanon):

Other functions
f unrtio Vt·r N'
n h un
speak Sptecb
- >pcak ing
\\ a(king walk gait
breathmg inhale I brca 1hc in / takc a brta ih
rt>Sp1ration brea th in exhale / brcarhe out
unn:irion urina tc urine
n1icruririon nlicrur01tc
pass urinc I pass'vatcr
dcfr\"ation deíe.:atc fooces
pass faeo:s I pass srools srools
n1wstruanon nienstruate (menstrual) pcriod
ha'e a 1icriod (momhl)') pcriod

Whcn ra king a history, dcx:tors can

ask:
\'(lhen ausculra1ing a parie11c·
\\•alking? lung,, rhe doctor teUs thc p.1tien1:
1roublc
brcarhing?
diíficuliy
Do you ha"e an¡ problems pass1ngtnt?
ur wirh 'fW<'h? 1.1kc a d.,.,p brcarh m. hold
>---- your
pain brc:uhe in? ¡·our brearh, rhen breathe
'''hen )'OU out complerely.

Less common functions

Thcrc are sorne rhif"G' we do less often. When "e.1re hot, wc swcar.When we are
ncl"'·ous. "'" shake.Whcn we are s. d.we cry.
Doctors can ask: S:\\'C31
Do )'Oll shake more than usual?
16 Pro(.,sionol Enf/ish an Use Med>Clne
 4.1 Match che symprom; ( l-5) ro rhe que;rions (a-e), usin¡: your medica! knowledge.
1 dysuria d \Vlial I') )UUr bre.iching hkt:?
2 d)sphagia b Do rou hJ\ c an) pain when pass warer?
)OU
3 diplopía e Do rou h3\c any difficult) w11h your
4 dysphasia spctXh? d Do you havc any trouble
5 dyspnoea >wallowing?
e Is your vi!tion norrna 1?

4.2 º'
Patiems are descrih111g S)Tl1proms thc condirions sho\\ n in brackct>. cimplere
the sentcnces.U>ok at ( and D OpJ'O'U• to hdp you.
1 l"ve ¡:ot pain ami --·-···-·111 both feet. (peripheral neuropathy )
............ . .... solid food.(ocsophage:il srricturc)
2 l"m having difficu lty_.....
3 1 havc a lot of problcms · -···· · ..... ...... ........ .....
........... .(prostatic hypcrt rophy)
4 l"\'C bcen _ _ . more rhan u;ual, c,•en whcn 11"> nor hor. (hypcrthrroidisrr)
--···.
5 l\ c noticed that nt) hands whcn l"m not u;mg rhem. (Parkinsonism )
6 l havc rrouble ·-. when 1 d1mb rhc sta1r..(left heart failure)

4.3 Complete the semence>. Look at A. B. C a nd O opp<>•ire ro hclp rou.

1
When 1 ear o;ol1d food. 1 have ro _ ..(bitc/chew) it
for a long tin before 1 can _ -- -(swallow/cat) it.

Do you ha\e .111y p<m whcn you ··-- - --·······(p.1>s/have) srool'?

3
1 have "º-- _ _ (tasrc/appetitc )
and l\·c lost fi,e k1IO\ m the last fr" \\
ttks.

When did you ltm ............................

.... ( have/pass) a period?

s The-----------------
garden full oí flowc,,., hur
i> 111) ---- (srnsc/scnsanon)
o( smcU ha> d1sapprared and 1 can·r cn1or th< perfume.

6
(...._i_:a_k_e_a_d_ccr_-_.·_--_-_·-_·_····_<h__r•_•_r1_1c_11__c•__rh_l_i'_'_ _,'y

0Vtr .f-o /:iOU

Yuu think a pat il'rl l rnay have diahl'll'. Thi nk of fivt·c1ul· tions you l'an <i\k thl'
. ipat
nvt il·nt to
stigall' Try to US[' "\lion typ·rs '!\l'llled í n this
furthl·r tht·<IUl prl unit.
 Medica! practitioners 1
-Practi tioners
In Bruain, doaors, also known as medical practitioners, musr be qualified: ha•c a
uni' crsll) dcgrtt in me.lic1ne. Thc) mus1also he r stered - mduded in thc
General
led1cal Council"s list, or rcgister - in ordcr 10 procrisc (scc Unir IJJ. A doctor who creats
pat1cn1s, as opposed to onc who only docs rcscarch, is called a clinicinn.A docror who
provide; primary care for paticni< is known a> a general pracririon cr (GI'), or fumil y
doctor.Gl's usua lly work in :1 ¡¡roup practico.Largcr group practices work in a building
callcd a hcalth centre.
Note:In Bri11sh English. the vtrb is spelt practise and thc noun 1s spelt practice.

Spec1alties
peciali<t docrors, for examplc paodiarricians.gcnerally work in hospnals.Howevcr,
thosc who work ourside thc NH, priwiding privare hcahh cnrc, may havc consulting
rooms
ourside a hospital - for cxa mple in the famous Ha dcy Strect in London.
The rwo mai n branchcs oí medicine are surgcry an<l in tcmal medicine.Jnd rhc
doaors who prJctisc rhese branches are callcd surgeons and physicians,
resp<."<:thel)·.Tn Brmin, male surgeons •re addnssed as Ir and fcmales as llls - so
Dr Smirh 1s a ph)s1cian. and
Is Smuh "a surgeon.

A cardiologist diseases oí t hc hea n and c1rcula11011, or cardiology.

A gcriacricüan spccia l11c' in diseascs of eldcrly patienrs, or gcriarrics.
An anacsthctist is J s1x:ciali'lt in
anacsthctics.
Note: Namcs of specialtio usually cnd in -ology; namcs of spec.alists usually tttd in -ologisl
lf the name ol a spccialty cnds in -ics.lhe name of the s¡>tt13hst cnds in -ioan.There are !Orne
exctpt1ons. c.g. anacsthetics and anacsthetist

Choosi ng a special ty
Jill Marhcws has jusr graduatcd frorn medica! school .111d is rnlking ahout her Íu turr.
'I havcn"t decidcd what 10 s¡x:ciali1c in yer. 1necd
more exper1encc before 1decide, bur rm quite
attracted to rhc idea oí paediarrics b<cau>e 1 hke
working with ch1ldrcn. l"d ccnainly prcfrr to work
with children than, S. ), eldcrly parienrs -<o 1 don"t
fancy geriatr1<'.l>.
1 \vas ncvcr very interesttd in dcrailed anaron1rt u
rhc •u rgical spccialtics lik c ncu ro<urgcry clon·r
really appe.11. You have to be good wi th your
hands, which 1 don"t rhink is a problem for me -
l°•e assisted ar opcrat1onsse'eral times, and l">e
cvcn done sorne minor op; by mrself - but
surgeon> have ro be ablc to do thc same thing agam
and agam without gettm¡; borcd, hkc t)•mg off cut
anerie' and so on. 1 do1ú rhink 1ha1 would be a
prohlcrn for me. but thcy nc".<'d ro 1nake
dcci'li ons fasr and 1 '111 nor too good at ch.u.
1 like ro have rime ro rhink, wluch means surgery\
probJ bl) not righr for mt."
Note: The cofloonion good with IS followcd by a noun -
He's good w1th chifdten.Th collocation good at IS
followcd by thc -1ng form (gerund) of a vtrb. or by a noun
- She's good ot eploining procrdLrrs. Shr's good ot
explonotio11s.
18 Proftnlonol Engfi<h in Ust Medo<"1t
5.1 \Vrire scnrences ro dcscmc rhe work of rhc spedal1sr m cach branch of med1cmc. l<>0k ar 8
opposirc ro hclp you.
1 dcrmatoloAy A oermatologl& epeclsliu& in dii;ea,;e5 of we &kln.
2 rhcumatology
3 traumarology
4 paediarrics
5 obstctrics

5.2 Complete rhc ral>lc "1rh words from A, 8and ( opposue and relared forms.l'ut a suess
mark m fronr of rhc srresscd >)llable in cach word. The first onc has bttn done for )OU.

Ve b Noun Nou art1v1ty ur lh m9)

r (persnn) n
'spccialize
pracrise
consulr
assist
graduare
qualify

5.3 Find preposirions 111 C oppo>1te that rnn be used ro make word combinarion> wuh
1hc words in rhc box. 111c11 use rhc correcr form< of rhc words ro complete rhc
<cmcnccs.

inrcfC<litcd pcciali c '\YOrk 1

1 A parholo¡;isr .·---------·-- diagnosmg diseasc rhrough examin ing cells and

2 A paediarrician musr rissuc. childrcn.
mjO)'··----
3 An oncologm is thc d1agnos1s and rrcarmcnt of can«r.
4 A psrchiamsr musr be counsclling.
5 A ncurosur¡;con mu>r be her hands.
-----
-

5.4 Makc word cornb1nation; using a word from c:tch bo•. Two words can be used
rwice. Look at A, B and C oppositc to help you.
consulting general group health intemal surgical

ctnlrc prcctice spteialties medici pr;ct1tioner rooms

Pro(essionol En¡lnh In 19
u.."1tdki'1t
Over +o '1ºª
Re- read what Or J1 ll Mathews says ahoul \urql'Ol1\ 111 St..'rl inn C. Makt· <-J ll\I of l hr qualit il'S
she thinks an· nt·t•ch.-d to be a good surqcon . lhl·n 1nakc a sim ilar list of quaht1l·''or another sp·l t:1alty.
lf you arl·a o,tudl·nt , "h1rh hranch of m·l d1cuu·dn you t h1nk you havc t ht:" qua ll tit·o, for? lf you havt· alrt·;1dy t·o
 Medica! practitioners 2
Hospi tal staff
Thc pcople who work ul ani l)pe oí workplace.1ndud1ng hospitals.are <all<d 1he staff.
Thé medica! sraff in a Bnnsh ho<ip1tal belong ro one of four mam grOUJ":
• A pre-registration house officer (PRHO).or house officer, is " newly graduared doctor m
the firsr year of posrgrad uatc training.Af1er J ycar,he or she hccornc' a re¡;istercd
med1cal pr;lcririoner. In thc currenr sysre1n of traininH, che Foundarion Pr<>8r
1111n1c, thc nante for
t hcse junior d0<.10"' is Foundario n Year 1 doctor (FY I). (See Unit 1 2)
• A senior house officcr (SHO) "in rhe saond )Car of posrgraduJtc training The titlc
1s now Foundarion Ycar 2 doctor (FY2J. but rhe old 1erms semor housc offiar and
SHO are srill used.
• A specialist rcgi•trar ( pR) is a doctor who ha> complered rhe l oundanon Programn\C',
and itraining in onc oí 1he n1edical specialnc,, There are also Mnnc non-craining rcgitrars
-docrors who havc complcted thcir train ing hut do nor wish ro spccialize yet.
• A oonsultant is o íully qual ificd specia list. Thcrc may also be somc associat< specialis1s
-senior doctors who do not wish ro lx-comc consultanrs.ln .1dd111on. rhere is ar least
one rnedical (or diniral) director. who is rC$pons1Me for all of 1he medi<JI s1aff.

Med ical tea ms

Consulrant physician> and <urgeons are responsihle for a specific number of p"'1enrs in
1he hospirnl. Each con>u lram has a 1earn of junior docrors ro help carc íor rho-;c
patienrs. I n 1n Hl)' hpitnl s:, therc !lrC tnultidiscipli nary tcnn1.s \vhi ch ce)nsist not only
of doaors bul also oí physio1herapisu and other allied healrh proícs<ionals (see Unir 8).
Whcn parienrsenrer -or are admined ro -ho.p1tal, rhe) are usuallr seen first by onc
of 1he ¡umor doctors on 1hc "ard wherc rhe) will re<CI\ e rrearmenr and carc. The
junior doctor dcrks rhem - 1okcs thcir medical hisrory (see Unn< 47-49) -and
e-.mmes rhem. Some umc larcr, rhe rq;istrar al;,o SCC$ 1he parienr.and may order im-
esiiga1ionsor 1ests, for example X-rays or '" ECG, make a provisional diagnosis,
and begin t rcanncm. The con,ulrnnt u<ually sees 1hc ncw admissions - peoplc who
have recenrly bccn :tdmitted ro rhc ward - for 1he first time on one oí thc regular
ward rounds, when rhe m•nagcmenr of
1he patienr< is discussed wirh rhe registrar. Consulranr- also decide when a parienr is
ready ro he disdiarged (sent home).On rhe ward round, rhe consultant is accomp:>nied
hr rh" 1eam and a nurse, and 1he) • 1s11 all 1'1., parients m 1hc rnnsul1anr's care.

Shifts
J u111or docrors now norm:i lly work in shifts, which mc•ns they norma lly work for
eighr hour> cvery day, for examplc 7 .1111 ro 3 pm, ancl are rhen free unril 7:11n 1hc
ncxr day. Afrcr a wcek rhey changc ro a d1fferenr shift, for example 3 pm ro l l pm or
1 1 pm to
-.m1. The altcmarive system 1s 10 work from 9 am to 5 pm every day and to 1akc
rums 10 he on eall -a•·ailablc ro recum 10 1he hospual if nect"SS. 1)' - from 5 pm
ro 9 am ch., n"r da¡. Days on call are ser out in a rota, or hst of names and times_
Doctors on call
.:. rry J radio pager, or blecper, a device which makcs a noise when sorncone 1s rrrns ro
cont;lcl rhe111.

20 />ro(tss.onol Eng1ish in u,. Mt<OOnt

6.1 MJke word combinacions using a word from cach box. Look ar A, B and C opposire ro help
) uu.

associate eall diagnosis officer pager round speeialist

house on
provisiona l
radio ward

6.2 .\!J1<h 1hc descriptions (1-5) wirh r he j ob rirles (a-e). Look ar A and B opposire ro help you.
1 Dr Graham has bccn a paediatrician for cight years and is responsible for 1reating 1he children
aJmitted ro Ward 60.
2 Dr Sre\\lart has jusr S[arted thc sccond year oí her Foundarion Progra1nme.
3 Dr Singh has srarred his rra ining as a surgeon .
4 Dr Phillips has jusr grnduaied :md is work ing in a large hospiral in Birmingha m.
5 Dr .\lillar is in charge of 1he medica! staff in the Birmingham hospital.
a >pt.:1alist regimar
b med1cal dirt'Ctor
e consuhanr
d SHO
e PRHO or house office1
6.3 Art> rhf' follo\viog r:'ltf'l1ltnr rrue or fulse? Find reaS< OS for your anS\V('íS in A. B and e opposire.
1 A medica!graduare bccomes registered rwo years after graduarion.
2 The sysrem of rraining doctors in Brita in is called 1he foundation Programme.
3 The name senior housc officcr is no longcr used in Brirain.
4 The <onsultant is usuaU y the first docror ro see new
pariems. 5 \"l;"hen working in shifts, ali doctors take turns
to be on call.

6.4 Comrlete 1he rext of a PRHO describing her job . Look ar A, B a nd C opposite to help you.

\\nen 1 ge110 1he ward , the fim thing 1 do is talk ro thc house officer who was
on duty dunng the last ( 1) .........-............................ , ro find our if rherc havc
been any new
2 . ............................... . Then 1 gcncrnlly sce rhc charge nurse. He rells me if there is
Jll' rhing rhar needs ro be done urgemly, such as inrrnven<>us lincs to pur up or take
do,,-n. Later i n thc n1orning, 1 (3) ..................................-....any ne'v parienrs, \\lhich basical l y
rn'oh·es raking a hisrory.On Tuesday and Frida y morning the consulrnnt <loes her ward
4 ...................................., and 1 have to rna kc sure J'm cornplerely up ro dare on
her patien!S. Aiter tha1, rhere are usually lo!Sof things 10 do, likc writing up
request forrns for blood
5 .................... ..... .... ,and so on. In the aften1oon, l have ro prepare for any parienrs \vho
Jre ro be (6) ........................................ rhe nex1day.They'rc usually happy to be going home!
And thcn of course there are rhe lccrures and rurorials in rhe (7)
........................................ prmrammc on Monday and \'(lednesday.

Pro(essionot Engfilh in Use 21

Medidne
OVe..r .f'o
11ou
How docs tht• hospital training of dnrtors in your rountry dif frr f ro111 Hll' British
sstt·111?
HlH\' \vould you explain i t to a t·nlll·agur fro1n anothl'r
rountry?
 fJ Nurses
Nu rsing grades
:-=urscs working in a hospital ha'e thc follo"mg grades:

studcnt nurse a nur!le \vho l'i still in training

;taff nurse a nurse '''ho h:.l co111pleted rhe uaining coursc
cha'lle nurse :• more cxpcrienced nurse 'vho is in charge of, or respon:,.iblc
for n \vnr<l or dcpart 111cnr
nurse manager a nurc '"ho ¡, in charge of seve.ral ,,rards
-
Note :The old term sistcr is still somct1mcs used ror a femare
charge nu.A female nu manager may b( callcd matron. Dr James is ialkmg 10
Sister Watkins.

[l] Support workers

·me clinical suppon wotkcr, who ha; done a ;hon course and obtain<d ba>ic
qu•lific•tions, and rhe nursing auxiliar)'."ho •> u,ually unqualificd, both assist
nursmg
;raff. There may also be ward clcrks, whose duries include making surt' pat1cnrs' notes
and infor1nation are up todate, nnd an\\'Cnng thc rclcphone.

Spccializa tion
Like doctors. nurses can specialitc:
• A midwife has specialize<I fro111 thc beginning hy doing • course in midwifcrr,
rhe managernent of p-egnancy ;111d childbirrh .
• Ditrict nurses visir parienrs 111 thc1r ho1ne.
• Healch visitors al!O work in thc corn111uno1y, givmg advice on 1he promotoon of
health and 1he prevenrion of illness.

lil The nu rse's role

The nurs6 role has changcd cons1derabl1 111 rm iears. In addirion to general paiicnt
care, checking tcmperanm:s , pulse ratcs and blood pressurt'S, changing dressings,gi1 ng
injections and rcmoving sutures, nurses now do sorne of the things prev1ousl)' re;ened for
doctor;, such as prt'Scribiog drugs, and ordcring laboratory tests.More rt'Sponsibo lory for
1111rses is planned, as the íollowin¡;•rticle demonmares.

Nurses ainy out suraery In effort to cut patlent waltlnc llsu

Nurses in Scotland trained to perform minar sorgcry have entered the operating theatre for the firs1 time in
an effort to rut patient waiting times. Five nuwho have passed a new coorse at Glasgow úiledonian
University are now qualílied to cany out such procedurH os lhe remcwal of small lesions, benign moles
and cyst5.

TSco1smon
fhe verbs perform and carry out are u5Cd with all l) pe> of proccdurcs. Thei are
oftcn used in the passive forrn.
.in CX.lfllÚldltQJl
an opcrahon
perforrncd
a procedurc an cxriment a res1
perforrn a biop;y
lne proccdurc was camed out
by a nurse.
carry out
j/

22
7.1 Complete the senrences. Look ar A, B and C opposite to help you.
1 Somcone who specialiies 111 delivenng bab1es 1s a ... ................ .....
........
2 Someone who is qualified to assisr nurses is a ............. . . .. ........
............... .................................................. . 3 Someonc who is nor
qualified bu t is able 10 assist nurscs is a ........... ........ .................................... ...... .
4 A nurse who has qua lificd is a .............................. .nu rse.
5 A nurse who specializes in hea lth promoiion is a ..................... .................. ...................... .
6 A nurse who looks after a ward is a ........ .......................nurse.
7 A nurse \\ h<> \VO rks i n rhe co1lln1unity is a .............. .....
1 .._........ nurse.
8 Someone who a nswer.. rhc ward tclephone is a ...... ....
..................... ............ ................... .

7.2 Make word combinarions using a word or phrase from each box. Look ar D oppos1te
to hclp you.
carry out change check give remove sutures
a procedure an injection a dressing
the temperaturc

7.3 Complete rhe sentences wirh rhc corrccr grammatical form of /Jerfor m.
1 An isotope brain sean is pa in less and easy ...............................................................
2 Biopsy of the pancrcas ............................................................... lasr March.
3 If rhc pa tient's condition deteriorares, a la¡>a rot0my should ............................... .... ........................ .
4 _lf a di gnosis of n1í'ningi ti i(; (;111\pN'rrci :a hunhnr puncturc n1ust ................. ....... ....
..........................
5 Last year we .......................................
.......................a randomized, double blind group srudy.

7.4 Complete the sentences wirh the correct grammarical form of carry 0111.

1 now inrcnd .... .......................................................... a larger srudy.

2 Unfortunately few prope rly controllcd rr ials ................. ..................... ..........
.........
.....so far.
3 A numbcr of studics .............................................................. recemly to look ar this quesrion.
4 A right hem icolectomy ............................................................ and the parienr ma de a fu ll recovcry.
5 This proccd ure can ........................................................... ... in rhc cmcrgency dcparnncnt.

23
 Over .+-o 11ou '1
What kind of tasks do nurses carry out in your country? Are:nurst•s' rl'Sponsibilities
increasing? What are the implications of this?

24
[;] Allied health professiona ls
r.i.1 Community health
The health of the cornmuniry depends on a large nu mber oí peoplc othcr than medica !
prnctitioncrs and nurses. Thesc can be gr<>upcd undcr thc hcading of allicd hcalth
proíessionals. They indud:the following:
• Pbysiorherapisrs (physios) help people to move by gening rhem to do cxcrciscs or by
trcating their body with hcat or massage -treaanent by manipulating musclcs and joi nrs
with the hands.(Sec Unit 42)
• Occupational rberapis<s (0Ts) help people with a disabiliry to perform tasks at home
and at work. A disability is a physical or mental condition that makcs it diíficulr ro live
normally, for example blindness or deafness.
• Social workers help people to solve rheir social problems - for example poor
housing or uncmploymcnr -or family problcms.
• Chiropodists, also know as podiarrim, rrear conditions affecring rhe feet.

[;] Technicians
Thtrc are numerous tcchnicians - pcoplc \vho \Vork \virh scienrific equipn1enr -
such as radiographers, who are known as X-ray rechnicians.Ambulance technicians work
in thc en1ergency medicine service. An an1bulance rechnician \virh more advanced
qualificarions is c-alled a paramedic.

l!i Prosthetists and orthotists

l'rosthetists and orthotistsprovide care for anyonc who needs an artificial limb, (a
prosthesis), or a dcvice to supporr or control part oí rhc body (an orthosis). Thcy also
advise on rehabilitation - helping patiems rerurn to normal l ife and work afrer
trearrr.enr.
Prosrhetists provide artificial rcplacements for patienrs who have had an amputation or
\Vere born '''ithour a lin1b.
Orrhorisrs provide a range oí splints
and orher devices to aid 1mven1entJ
correct defonniry fron1 an abnorn1al
developmenr of pan of rhe body,
for example club foot (ralipes), and
relieve pain.

A prosthcsis Splints

lll Opticians
Opticians test cycsight and prescri be glasses -also know as spectacles -and contact
lcnses, \vhen necessary. 11"1e exan1ination includes n1c-. asuring intraocu lar prc'.:Ssure -
the pressure of fluid inside the eye -and exa mini11g rhe retina. 1f rhe oprician suspecrs
an
eye disease, such as glaucoma, rhey refer rhe parient ro their GP for trearmcnt. The GP
may then reíer the parient ro an ophthalmologist, a doctor who special izes in diseases
of rhe eye.
8.1 Make word combinauon; us111g a word from each box. Look a1A, B,C and O opp:>site
to help you.
a1nbulancc artificial club rontact health intraocular foot lens limb wOt'ker
oc:cupational social pressu technician professional therapist

B.2 Which allied hea lrh probsionals cou ld bes1 hclp 1hc following people? l.ook ar A, 8, C and O
opposire to hcl p you.
1a young unma rried wman who has just had a h:ihy
2 a woman who is havii ,g d ifficuhy using her nght arm following a fracmrc
3 someone who needs ¡tbsses
4 an dderl) woman "ho has had a bdow kntt amputanon
5 a man whose w1fc has Alzheimer's d1sease
6 a man "irh a fungal onfcrt1on of bis feet

B.3 Complete rhe rex1s. 1 ook ar A and C opposire ro hcl p you.

A prosrhcris1work< wilh parienrs of a li agcs as a mcmber of a clinical ream, li:1'cd 01 a large
hospital. The pnticnr.. 1n:ay nccd a prosthesii; nE 1 he rc(ult oí an accident, or
1
( l)···--·--······· ollowing a disease such as dia betes. Alrernarively rhcy may ha\•e
bttn born wi1hour a (21 ------------ . Orthorim work alongside doctors,nuíl>CS.
physiocherap1s1s and cx-...,,parional (3) ro gi,·e che peopl e under 1heir
care
the best JlO'Sible (4) .T heir ma111 aom IS ro enable rhe p. 11cnt 10 lead a
normal life a1 work anJ leisure.
An orrhoris1of1en work• in a dinic as part of an outp 1t1cnt service and also '1s1ts
o:hcr centres ro provid e .1 serv ce for people wi1h spco. e1al needs.They deal wnh
people of 111 ages. For insrance, choldren who have cerebml palsy ma y rcquorc (5) ..
............ ...... .to hdp
rhcm walk and many ol<lcr people need specia l ;hoes to correct (6) ...... ....
....
....................... .
lf damagcd, an y pan of thc human skeleron ma y req ui rc sorne form of
ortho<i<. 1 h< orthosis may be needed 10 reposition 1he body or 10 (7) ..
...............................pain.
 Hospita ls
lntroduction to a hospital
Jordi Pons is a fourrh-ycar medica! srudem from Barcelona. He has come ro Brirai n on
an elccti\•e attachmcnt ro thc Royal lnfirmary, Edinburgh . Dr Barron is introducing him
to
che hospiml.
Dr &rron: The Royal Lnfirmary is the name of rhe universiry hospital for Edinbur¡;h
Universi ty.lt is a general hospiial, dcaling with all rypes of patienrs and illnesses,
except paediatria;.\V/e have a spo:cialist hospital for that in another part of Edinburgh,
thc Hospiml for Sick Children. You can see some of the departmcnts in our hospital on
che sign. Of coursc, there are many
orhers, for exa1nple rhe lntensive Welcome to the Royal
C. e Unit (ICU), and thcSurgical
lnfirmary
High Dcpcndcncy Unir (HDU). South Entrance
Jordi: \V/hat does 'outpatient ' Car Parks C & D (visitors & staff) -
mean?
The Simpson Centre Jf
Dr Barron: Ourpatiems are che
people who come to hosital to
for Reproductive Health
anend a cliojc or to have tests or
trcatment and rhcn rtrurr.
hon1c on the same day.
- Gynaecology (Emergency)
Lnpatientssrny in thc hospital for
one or more days. - Matemity (Emergency)
er

- Neonatology
The rooms where they sray are
callcd wards. lf a paticnt's (Em
Departments +
treatmcnt requires only one day, gency) Outpatient
such as
a simple operation, they can be All Wards -
admined 10 rhe day surgery unit.
Day Surgery Unit & Endoscopy +
+- X -ray Department
+-Combined Assessment

fil Outpatients
Dr Barron: The Accidcnt and Emcrgcncy Depanmcor (A&E), also called Casualty,
is 'vhere pari enrs 'vho are acurely ill - 'virh a suddcn, scrious condirion - come (or
assessn1cnr and trcatmcnr. Outpatients \\lhO have an appoinonenr to see a specialisr
go ro a clinic in one of rhc Outpatient Oepartmcnts (OPDs). Thcy havc usually been
referred
to thc hospital by rhcir GP, who wrires a referra l lcner 10 the consulianr cxplaining the
paticnr's problcm.

[i lnpatients
Dr Barron : The inpatienrs Ln a hospital are ad_n1irted in one of rhree 1nai11 \Vays. Thcy
may be seen in one of thcourparicnt clinics and admitred from chere or, if there is a lot of
dcmand for rhe crearmem rhey need, as in rhc case of a hip rcplaccmcnt, thcy are pul on a
waitin¡; list for admission. Alrernativcly, their GP may arrange rhe admission by relephone
bccause they are acutely ill,for cxample with suspected rnyocardia l infarcrion. Or they
are secn in thc A&E Department, where the doctor on dury -working ar thar time -
arranges rhe admission. This would happcn in the case of a patient with a fracrured neck
of femur, for examplc. Larger hospirals may have an assessmcnt unit where parients can
be admined remporari ly while rhei r condition is asscsscd.
.)ordi: Assessed?
Dr Barron:Yes - decisions are made about their condirion, and whar needs ro be done
ro help them. After treatmem is complercd, the paticm is discharged back ro the GP's
care.
9.1 Complete rhc table wirh words from A, B and C opposire.Pur a stress mark on front of
the stressed'yl bhl' in r:ich word . The rr onc has bccn done for you.

V«r Nuu
'
h n
ad 'n1it
assess
discharge
operare
rrfrr
treat

9.2 Make word comhinarioni using a word from c:ich oox. Look ar C opposire ro help rou.
acutely assessment on unit lettcr list
referral waiting duty
11

9.3 Which hospital departmt11ts would be mosr appropriate for che following pancms?
Look ar A, B and C opposirc ro help you.
1 2 \YOm:inin cli'1hC't ic ('onl:-1
2 a patienr who ha> ju>1 had a radical pro"artx:romy
3 a paticnr who is ro ha'"a skin Jcsion
removed 4 a man wirh a forc1gn body in his
eye
S a woman with a thrca"'ned abonion

9.4 Complete rhe cxrrntt from an mformation kalkt for pa11enrs. Look ar A, B
and C opposire ro hclp you.

lff nnllon far oulpatien1s

JlllHIM at the (1)---·--·--····-- ....• please tell the receptionist who Vlill
Jllll, dlldc )'11111' details, and direct you to the waiting area. lhe length of your
lidll_.•. (2) as an you're
X whichgoing to mean
could have. You may
going need to
to another
lllflPI -----·sud!
Or JOll lllilf be (5) to other professiooals.
!P(ll!!Jlllll•ar ddcm You lllilf need ID revisit the dinic.lf staff at the clinic
&'*5 a,•,.•. •••it
will be anmiyed for you. lf you need to be
n
...11 1far mcn ll9ll'llent. either as an inpatient or for
JOll wl be IDldwhen 1hisislikely to happen.
JOll wil be (8) -·---·----... . to your GP's care.

81\11im.ma111.11&1DiMilfill!lllCMP!Filhd!!"Hllli!
M*llll
iDJ Primary ca re
E The National Health Service
The National Heal1h Service (NHS) is responsible for healrh care for everyone in the
UK, although a small numbtr choosc to pay for privare care. Treatmcnt is fr<'<! bur
therc is a prc.scription chargc for drugs and applianccs, such as a cervical collar, \Vith
exen1prions for some parienrs, such a; children and che elderl)'·
Primary care is provided by general pracritioners, or GPs, (somctimes known as family
docrors), nurscs, dcnrisrs, pharn1acisrs and opticians. GPs '''ork in practices of J ro
20. Pracrices a re based in a surgery a nd look afrer rhe health of from 1,000 ro 15,000
people in thci r local community.Thcy also providc hcalth education in arcas such as
sm<>khg
and dier, run clinics, give vaccinations, for exan1ple for influenza, and 111ay perforn1
n1i_nor surgery such as removal of warrs and moles. lf a patient needs specialisr care, the
GP will makc a rcferral - refer rhc paticnt to a consulranr in seconda ry care.
Parlenrs are nonnally seen on an appointn1ent basis. Hon1e visits are n1ade \Vhen
patients are housebound - unable to leave their homes - or too ill to attend
surgery.Out-of-bours (00H) rreatmenc, from 6 pm to 8 am, is provided by the local
Primary Care Trusr, wh ich orga niies shifrs of GPs and locum GPs ro cover if someone
is absenr.
Note: The noun surgery has three meanings:
• the building where GPs work - Theproctice hos moved to o new surgery on the High Street.
• a time when GPs see patients - Morning surgery is from 8.30 to 12.30.
• the work of surgeons - The potient needs urgent surgcry on o burst oppendix.

[¡J The practice tea m

A typical GP practice employs rcccptionim. They are responsihlc for inicial parient
concact, n1aking appoinnnents, taking requests for repeac prescriprions, raking n'lcssagcs
from paticnts and orhcr health carc providcrs, and for filing and scanning docu mcnts
into pariern records.ll1e practice manager has respo11sibiliry for finance and
sometimes for IT, supervises receprion staff 1 hires locun1s, and helps prepare rhc
pracrice developn1enr plan. Practi ce nurses run asrh1r,a, diabetes., and cardiovascular
disease clinics as \vell as one-co onc cl inics for thost \vho'vish ro give up s1noking.
I n addition to practice staff, GPs work with a number of hea lth professionals (see Unit 8):
• District nurses visit temporarily housebound parients, such as recently discharged hospiml
parients, to changc drcssings, such as ulccr dressings.
• Hcalth visicors visic families ro carry out check-ups on young children - parr icularly
under- ves - to make sure thcy'rc hcalrhy.Special attention is paid to familics in nccd,
such as those living in poverty. Thcy also do baby immunizarion s.
• M id,vives run cli nics for antenata l parients.
• Physiorherapists provide hands-on trearmenr bur also ceach parienrsexercises they can do
ro irnprove rhei r condition after an accidcnr or operarion.
a.oo OY'A arrivt Qt ti-le S<A.trtt
A GP's day ek<el> t>io OOH '"""¡¡ f'i"'""t
Dr Stuart \VOrks in a pratricc in c...uk fOt ".,e,v..t av.d Yl() l.(tg.elo'lt r\O.tSSQees
rt sn1all nlarket to\vn \Vith three .30 a eh U.s Pt>l-'A- tht tellt boa a f'Qrbttrs
ocher family docrors.The surgery rt fCr' "e''!::l
i s in rhc centre of [ht tO\\ln i'..30 J.0,5(> O'l'\i. nJ_'""f'9Ul:j (ttn.·Mit1Mtt: c:!poV'A.t:ill.ts)
and "'1"" boolwl u. ;""'"'
is shared by three pracrices. This 2 bootwil ,._. ...tMrS ahM
A booblt ....th< <IAij
is a typical \VOrking inorr.ing
when she is nor the dury UJ.50 • UJ.55 .... '"""' witli fer l'l<lSS•etS
doctor, responsible for "'presCl1'.ptio"" a,,a tal •Alith prtsc-ti r<q«lSIS
11.00 ·!!.:::W o wf{tt {ttt...-..U. tOOM ;tth cclU091.<.ts
b-'tl'l ..... tt\t
emcrgencies and
1.l..2ó - 11.30 "4 er.ee home vi.sí.t- rtqt«Sts avi.tt di•.ídt t<f' ,..t.sl.ts. ....if.i1
u rgent problems. ccUea91A.tS
11..30 a>"-A ·1LX> Y'A Viov..-.t vi.si.ts
28
¡¡ r
10.1 Complete rhe senrences. Look at A opposire 10 help you.
1 Childrcn, over 60s, and people \Vith son\e chronjc diseas<-.'S do not hove
10 pay ....................
.............. ........
........................ .... ......in the UK.
2 Patients with mobility problems may be unable ro go out. Thcy are -···-··--
··········. 3 The average GP ............. .......... ............is ren minutes long.
···········
4 A · ···-········-·····-········is someone who takes rhe place of a sraff mcmber who is on leave.
5 Care outside \vorking hours is kno\vn as···-···-·····--·····-·····-·····-·.................-........... .......···-······-··-···· ···
········-..
treatment.

10.2 Make word combinarions using a word or phrase from each box. One word can be
used rwice. Look at A and B oopositc to help you.
niessages staff appointments ho1ne visits dressings
change make perform refer run a clinic
supervise take a patient n1inor su rgery

10.3 Which member of a practice team would be responsi ble for each of the
following? Look a< B opposire 10 help you .
1 Running a clinic for pregnant women
2 Tcaching a patient how ro srrengrhen his broken leg
3 Lerring rhe GP kno\v chat a paricnr can'r come ro her appoinnncnt
4 Running a clinic for people who wanr to lose weight
5 Visiring tl parient \vho has just returned home afrer a hernia opcrarion
6 Carrying out check·ups on children in a poor neighbourhood
7 Organizing cover (or an absent doctor

10.4 Comple1e rhe diary for O·Srua rt's afrernoon . Look at A and C opposite ro help you.

1.00 - 2.00 p>1< prac:ict tea"' "<efü"'0 wer so...:twi<:ll l«""'h

2.00 - ".00 «ftemco"- (:1.) ·-
P"" ·..··-................-....
1.2 tl"-·l'l<Í""<tt (2)·····-
···············
'!.oo - 4.20 ccf(u breo
P'"
'1.20 - s.oo ckec wí.th (3) ................. .....-...··- g¿s. !>talwí.tk
P"' ·fcv
(4) ···-····-····..····-··ol'\tt rtpe«t (5) ..........-...................
ho"<e req«t&\:s.
wo, t.9. ('-) .................-.....to ste<>l'\t!•>ti eart.
5 .00 - '- pw.
·00 a,;,,.."tos,ttl.tph01<t coUs to i>•tit....ts,
prlv•te tl<U(í.col e<a..0.l'\tltlc""
'-·001'"' phovswittke&t to (;<) ..........-................... S(rví.ct.

. ;n;o11;;u11,;;a11;u11,;e;"",oª'"§191111141111
29
ill Medica l education 1
r.J Med ica! education i n the UK
Medica! education i n rhe UK covers:
• undergraduatc cducation - four or five years ar medica! school, rhe secrion ol a
universiry responsible for 111edical educarion
•a l'\\fO year Foundarion Prograrn mc \vhich providcs training for nC\V docrors a hcr
graduarion through a series of placemenrs in differenr specialries (see Unir 121
• postgraduat e trair.ing which docrors rnke to become GPs or consuhants - serior
specialiscs - often delivered rhrough collcges for different specialties, for example
the Royal College of Physicians
• continuing professional devclopment in rhe form of courses and seminars, which
docrors undertake rhrouglu>ur rhcir working livcs to keep up to date.

13 Extract from an u nderg rad ua te prospectu s

The MBChB (Bachelor of Medici ne, Bachelor of Surgery) is a five-year

undergraduate medica! degree course. Most of your learning takes place in
small groups. The main components are:

Core (Years 1-3) Vocational Studiesand Clinical Skills

An integrated me ol clinical and sóentific This a>mlJO"'fll prepares you for the dlnkal sldlls
topics
mainly presented
(Pll), where you work with other5
leaming "'"' ause. thr.,.q,
on a series of where you are attadled
º periods practical
required lor ConUICI W!lh patJenls trom 'leaf 1 ol

to a
hospital
traíning
depanmert «
case general
problems. practice.

Student Selected Modules Clinical Attachrnents (Years 4 and 5)

Stuclent sele<:ted modules (SSMs) allow you to A series of IOll:-weel< dinical attadlrnents in
lrom a menu ol subjects !UCh as Spo<1S Medicine. Surgery,Psydlological MedicÍlle, Clüld He<lth,
Medicine « ewn study a 1anguage as pn!pill'aOon Obstetri<s
for an overseas electlve, a attactment of your & Gynaecology and General Practice.
.,..,,, choice.
between Yeats 4 and 5.

[!I A studen t's view

Ellen, a medica !smdenr,describes her course.

•rm jusr finish ing my first year of Medicine. Whar 1 like abour chis course is char you're
involved \.V irh parienrs fro1n rhe very bcgi nning. Evcn in our firsr year, \ve spend ri1ne i n
hospita l. Much of the course is PBL. We have rwo 2·hour sessions a week whcre wc work
in groups of eighr to ren solving dinical problems. We decide rogerher how ro tackle che
problem, look up books and online sources, make notes and discuss the case togcther. lt's
a great way of lea rning and getting to know the other srudents. In che past,medica(
students had lecturcs with the whole class taking notes from lectur<rs from 9.00 to 5.00,
but now it's mainly group \Vork, alchough \VC do have sorne lecrures and scn1inars,
\Vhere \ve \\ 0rk in smnlJ groups \virh a ruror. 1 like ali of ir, cvcn rhc <lis)ci.:don .\'e gel 10 c.:ut
1

uµ \.:l:uh1vcr f10111
rhe second monrh of 1he course.'
11.1 Match th<"S<' activiries to the scages oí med1cal cJucauon m the UJ( gfren in A opposttc.
1 J1»e<:ting Cdd.n-.:1"$
2 kttpmg a log of surgic2I pures obsc.-.cd and performed
3 workmg for four months in amdent and cmcr¡:cncy 10 cxperience this specialry
4 t.1king a four-week attachmenc in Obstcrri< and Gynaecology
5 caking an online coursc on recent dcvclopmcnts in cardiovascular disease

11.2 Complete rhe sencences. Lo!Jk ar B and C opp!JSitc to hclp you .

J ust before their final ycar, studcnt< have thc chance ro takc an ...•.....•.............,....i n a
hospirn l of their choice anywhere i n che world.
2 contrasts with an approach where cach suhjc'C't is rought separately.
3 These days ·--·---·-------·are often inrcractivc, woth regular opporrunicies for thc
studcnt; to ask quescions.
4 In _ srudent, lcarn how to tteac and managc pancms.
5 can be a topic from outside medicine, nich as •
fore1gn language.
6 Dosscetoon of _ is an omponant pan of the anatom)' componem.
7 The ------ at thc Um,crsiry·oí F.dinburgh is one of thc oldm 111 thc
·--
UK.
8 Shc's a . ... .......... ........u thc Roya l: one of the lcading pacdiatric hean specialisrs in the
country.
9 1he Royal ................. ..............o( Surgeons in Edin bur¡¡h datl'S frorn 1505.
10 \Y/e have a ... .... ....... ........cach wcck whcrc wc discuss topics in a sma ll group with our
lecrurer.

11.3 Match cach of rhese activiri<' ro one of thc componcnrs of thc undergraduate
course describcd in B and C opposite.
1 julte spends six weeks workmg in a mall hospotal m thc Himalaras.
2 A group of srudents dilCUss togerhcr rhc possoblc reasons for abdominal p>1n afrcr mcals 111 an
obcse 44-rear-old malc.
3 A small group oísrudems rraee rhc pulmon•t) anct) in a cada, cr.
4 Otto >pends a month working m thc p.1ed1atric ward of rhc local
hospital. 5 Anne le-arns how ro rake blood from an cldcrl) paucm.
6 Juma chooses ro srud y Travel Medic111e m h1s founh year.

"'111m 11mmgmti mm11sm ¡;11

31
Medica! education 2
The Foundation Programme
The Foundalion Progra ntrne is a f\\roayear training progra111n1c \vhich forn1s rhe bri e
lX't\vten
univcrsiry-level study at medieal school, and spocialisr or general pracrice rra ining. l t
consists of a series of placements , each lasring four 1nonrhs,'vhich allo'v rhe junior
doctor, kno,vn as a trainee, to sample differenr specialries, for exarnple paediarrics. A
year one traince (FYl ) corresponds to prc-registration house officer (PRHO) posrs a nd a
ye1. r two tra inee ( FY2) to senior house officer (SHO) posr.;.Each rrainee has an
educarional supervisor who ensures that n1orc senior doctors deliver tra ining i n different
\vays, including clinical and cducariona l supervision.To progrcss, trainccs have ro
demonsrrare a range of clinical co1npetcncies \Vhich are assessed through observarion in
their workplacc.
{BMJ Cartt:f'S 2005;Amt'1'1ded wirh ptrm on from the 8ti.1J Publishing
Group)

People in medica! education

tutor An academic, or in sorne cases a posrgraduate student, who

leads
rurorials.
den1onsrraror I n anaron1y reaching, so1neonc '''ho demonsrrates ho\v 10
dissecr. De1nonsrracors are often posrgraduate students
paying rheir \vay chrough medica) school.
lecturer / senior lecrurer An acaden1ic \V Í th rcachi ng ancl rtsearch responsi bilities \Vho
contribuces to rhe reaching of a pa rticular discipli ne.
professor A senior ac.'.l<l t:nli<.: \vi rh H::;H. ;lti11g and rt:an.:h rt':,opo11)iliilidt:!)
ívr
a particular discipline. Usually a lcading figure in thci r discipline.
college tutor A consulranr responsible for dclivcring a collcge
training programme.
clinical rrainer A consu1ranr assigned ro a rrainee 'vho provides rraini_ng during
periods of direcr clinical carc.
tducarional supervisor A consu1tanr \Vho supervises a tra inec's pcriod of training.

Medica! qualifications

BMSc Bachelor of Medica) Scicnccs. A dcgrec often taken after rhree years of
BMed Sci medica) srudies by srudenrs who may wish to follow a ca recr in
medica) research.
MBChB, Bachdor of Medicine, Bachelor of Surgery. Bachelor degrees
MBBS are undergra duare degrees. This is the firsr degree for UK
BMBCh,
MD, DM docrors.
Doctor of Medicine
DRCOG Diploma of rhe Royal College of Obstetrics and Gynaecology
MRCP Mernber of rhe Royal Collcgc of Physicians or Member of rhe
MRCS Royal Collegc clf Surgeons. Doctors become 1'lember.; by
succcssfully
corn lering rhe asscssmcnt ptocedures in rheir college.
FRCS Fellow of the Royal College oí Surgeons of England. Orher collcges a
FRCS(Ed) re indicared by the letters which follow.for example Edinburgh,
FRCS(Glas) Gl1sgow or lreland.
FRCSI J Jow doctors become a Fellow depencls on their college.Fot the
FRCS, further exa rninarions rnust be passed . For orher colleges ir is by
no111ination or \\IOrk assess1nent.
12.1 Complete the phrascs with verbs from rhe box. Two phrases can be complered in rwo
differenr w•ys. Look >r A ond B opposite to help you

assess delivcr de1nonsrrace provide supervise rake

1 ..................... .. a competence or how ro do somerhing

2 ...............................a trainee by ensuring she successfolly completes her training
3 ··-··· ......................a cou rse or a rraining progra mn1c (as a teacher)
4 .................... ...--···a cou rse or a rraining progra n1n1e (as a stu dent)
5 .......... ..... .............progress or competence

12.2 Match the two parrs of rhe senrences. Look at A, B and C opposite co help
you. An FY 1 is a doctor
2 A den1onstrator is an anaromy rcacher
3 A clinical rrainer is a consulranr
4 A supervisor is a consulrant
5 A medica! school is
6 A placement is
7 A college is
8 A Fellow is a specialist
a a body of specialisrs responsible for delivering and assessing training in their
specialry. b responsi ble for the train ing programmc oí a trainee.
e a period spenr as a rra inee in a hospital or in General Practicc.
d in the first year o( the Foundation Program me.
e \vho h,1s rc lchccl rhc hishest lcvcl i n thcir spccialry.
f \vho providcs training during periods of d irect clinical
carc. g parr of a universiry responsiblc for medica!
education.
h \vho rcachcs disscction.

12.3 Write in full thc qualifications of thc doctors and surgeons.Look at C opposite 10 help you.
1 Mr A. H. Younghusband, M BChB, FRCS, FRCSI

2 Dr C Doyle, BMed Sci, DM, M RCP

3 Ms E Jnglis, M BBS, FRCS

4 Dr E '.\lerryweather.BM, MD, FRCP

0VU .f-o ':fOU "1

HovJ do you becon1r a sorcial ist i n you r country? list lhl' st;_igl'S.
The oversea s doctor
Types of registration
To 1nanagc and trcat patic:nts in thc UK, ali docrors n1usr registcr \vith rhe General
Medica !O,uncil (GMC).There a re severa! types of regisrrarion :
• Provisional rc-gisrrarion is for docrors who have j usr q ualified from mediC31 scool in
the UK or from cerra i.n European Economic Area ( EE/\) member states.
• Full regisrration is for doctors who have completcd thcir year'sclinical train ing.
• Limited regisrration is for inrcrnational medica! graduares who have not complered
the equivaler1t of a year's cliniC31 rrai ning in the UK.
• Specialisr regisrrarion is for doctors who have cornplered specialisr medica! training
and have a Certificare of Complcrion of Training (CCT).
Thc GP Rcgisrcr is a regisrer of all rhose eligible ro work in general pracrice in rhe
NHS. Note: For full details or lhe General Medieal Council see www.gmc-uk.org

PLAB
Before rhey can obrain full registration , some carc¡¡ories of overseas doctors are
required ro rakc the Professional and Linguistic Asscssmcnts Board (PLAB) test. PLAB
is designcd ro ensu1e rhose who pass can pracrise saíely ar the leve!of an SHO in a
first appoinm1enr in a UK hospiral.
Part 1 consisrs of a wrirren test of knowledge, skills and attit11des. Part 2 is an
Objeaive Strucru.red Clinical Exa111inarion (OSCE). lt consi srs of l 6 five- n1Lnute
clinic:ll scenario!:, known as stations, to asscss professional skills.
Note: For a full description of PlAB. S<'.( http://www.gmc-uk.org/doctors/plab/

PLAB stations and advice

OSCE.s assess rhese skills:
• Clinical examinarion: Your abiliry ro carry our a physiC31 examinarion of a
simulared parienr, an actor traincd ro play rhis role, \Vill be assc-.•ssed .
Unco111forrablc or indn1ate exan1inarions \vill be carried our using a n1anikin.
an anaron1ical nlodel.
• Practica! skills: You will be assesscd on practiC31 skills such as sururing and giving
inrravenous injecrions.
• Comn1unicarion skills: Your abiliry ro inreracr \virh a si1r1ulared parienr, or in
son1e cases rhe examiner,will be assesscd. Skills rcsml may indudc breaking bad news
and giving advice on lifesryle.
• Hisrory raking: You.r abiliry ro rake an accurare hisrory and make a reasoned
diagnosis will be assessed.
Advice on tite srarions from a successful candidare:

Read the insrructions ourside each Don'r forger rhe ABC (airways, brea thing,
srarion carefully. You have one 1ninure circulation} protocolin cvery cn1crgcnty
for rhis. srarion.

Keep in mind safcty Check rhe patient undersra nds whar is happen ing;
precautions like rhrowing rhe rhen ask thcm about any conccrns thcy may havc.
sharps in rhe sharps bin. Don't just give a lecture. l.isren carefullr ro ,vhar rhe
actor says.
 Note: Sharps are needles and blades which must be disposed of safely in a special container
called a sharps bin.

34 Professional English in Use M edicine

1 3.1 Whar kind of regisrrarion mighr rhese doctors obrain? Look ar A opposire to help you.
1 A newly qualified Spanish doctor

2 A newly qualified Nigerian

doctor

3 A doctor who has successfully complcred the fim Foundation Year ( FYI )

4 An SHO who has succcssfully complered the Foundarion Programme and gained a
Certificare of Complerion of Tra in ing after severa !specialisr registrar posrs

13.2 Writc the abbrev iations in words. Look ar A, B and C opposite ro help you.
1 Any doctor who wants to work in rhe UK musr regisrer with the

GMC. 2 Some overseas docrors musr pass die PLAB resr before rhey

can register. 3 Parr 2 of rhe rest consis1s of an OSCE.

4 In any emergency, remember the ABC protocol.

5 Before you can obtain specialist registration, you must have a CCT.

13.3 Complete the rext. Look ar A, B and C opposire ro hclp you.

,.---- --/
/J -
M y names Musa and 1come from Yemen. 1 came to the UK about rwo years
ago.a fter graduating. Beca use Yemen is ourside rhe EEA, 1 could cmly obrain
( 1) ········-············
...... ...........·--······· wirh the 12) ............................... ar firsr. Ir was very di fficulr for me ro obll!in a
place on a Foundation Programme.Alrhough lspeak good English, l had ro rake rhe
(3) ················-········resr to show rhat 1 could work safely in rhe UK. Jf 1 had ro give
sorne advice ro orher candidares, ir would be rhat ar counselling (4) ······ ···--····-
···- , you shouldn't simply mcmorizc a set of phrases. lr's berter to rca lly rhink abour
whar you"re saying ro the acror and ger rhe intonarion righr.
After complering my years' clin ical rraining, 1 was able to obrain (5)·········-···············
········ ·······-····-··.Bur 1 fou nd ir difficult to get an SI 10 post in my chosen specialty,
paediarrics, as hospitalsnow have ro demonsrrare chere isn'r a suirable candidare from
che EEA. Once l've compleced my second Foundarion Year, 1 should obrain a
(6) ..............................which will a llow me to proceed to (7)
....................... ....... .··· ···············-··wirh rhe GMC.an imporram srep on rhe road
to becoming a paediatric consultanr.
Professiono l &tg/ish in Use Medicine 35
Symptoms and signs
Describing problems
The problents which a faficnt reports to the doctor are callcd symptoms, for cxamplc
pain or nausea. Signs an.: '"har rhc docror finds, also kno,vn as findings, on
ex:in1ining rhe patien t, for examplc high blood pressure or a rapid pulse
rare.Symproms are also known as complaints. To repori a patient's symptoms or
complaints, doctors say:

In case notes, the abbreviation do is used:

Mr Farns,vorth ''':lS
a.dmitted
complaining of chest pain.

Presen ta tion
Parients say they wcnt to (see) the doetor; doctors say the parienr prescmed. The symptom
\vhich causes a patienr tC> visi r a doctor - or ro prescnt - is ca lled the presenring syrnpto nl,
presenting con1plainr or prcsenfation.

. prt>s<:nring symptom \Vas chest pain.

HIS prcscnu.ng
con1pIa1.nt

( He presented 10 his GP wirh chest pain. ) ( The usual presentation is rhcst pain. )

Talking abou t symptoms

Symplom M Paltrnls say
tircdnt'SS raning
loss of energy 1 focl tired all the rime.
lethargy 1 feel completely wom out.
fatigue L.ately l've been foding
lassi iude complctcly exbausted ar rhe end
n1alaise general íeeling of of rheunwell.
l feel day.
being unwcll ldon't fecl well.
J've been feeling off·colour for rwo days.
lhaven been fceling myself for o weck.
!'ve becn out of sorts ali day.
anorexia loss <>f appctiro M y appctitc is vcry poor.
l've been off my food for days.
weight gain increase in \veighc l've put on eight kilos in the
las1year. l'vc gaincd fivc kilos.
weight loss decreasc in \VCighr l'n1 not earing any less than usual but l'vc
lost a lot of weight rocently.
cons6pation ha rd, i1tlrequen t taoces My motions are vcry hard.
J've been quite constipa rcd lately.
l'rn nor very regular.
 Note :The verb feel is also used with other adjectives, such as hot cold, nervous, anxious, diuy,
weak - She soid she felt dizzy.

36 />rofessionol English in US< Medicine

14.1 Complete the table with words from C opposire.Put a stress mark in fronr of the srrcsS<'.<i
syllnblc in cach word. The first one has been done for you.

Nuu Acljl'rl
n 1w
ex'hausrion
fatigue
lcthargy
ti redncss

14.2 Make word combinationsusing a word from each box. Look at A, B and C opposire ro help you.
compla in with of out on
off- out of present put oolour
worn sorts

14.3 Complete rhe senrences wirh rhe correct form of thc vcrb prese nt.
1 A 67-year-old man ............................ with a 9-momh history of incrcasing
shortness oi breath. 2 The most common ·················· ····-···is loss of
consciousness.
3 Cranial arrcriris n1ay ...-.......................... as fever'virhout any obvious causes.
4 The patie1lt usu:llly ........ .. ·········-···with :l cvcrc sore throa.r.
5 The····-····-············
··-··symptoms in this pariem could perhaps be due to renal
foilure. 6 Orher conditions wirh a simila r ....................... ...... include acure
cholecysriris.
7 R educed growrh is an important ....-..........................complaim of codiac
disease. 8 Two momhs following·················· ····-··, rhe patiem was able
ro walk.

14.4 Read rhe parienr's descri ption of her symptoms thcn complete rhe case reporr. Look
at C opposire ro help you .

1 \\ras 'vell until a fe,v monrhs ago.

lo the beginni ng, 1 just fel: off- A 50-year-old housewife, who had been well
colour and a bit tired. But lately l've until four months previously,
been feeling
(t )···-···-···········..··of tiredness and
completely worn out at the end of the
(2) ...•.......•...•............ . She had
day. l'm not earing any more than usual (3) ··--······· ········ 9 kg in weight
bur l've put on nine kilos in the last year. in the year before she
My motions are hard and my hai r has
(4) ···········-····· to her GP although
sraned ro fati out. she denied eating more than usual. She
was (5) ..............
................ and she
notic.ed that her
hair had started to fati out
Pro(es-sionof Engtish in Use Medi<:ine
Blood
Full blood count
I n rhe invesrigation of bloo<l diseases, rhc simplcsr test is a full blood counr (FBC).A
full blood counr measures re following in a sample of blood:
• thc amounr of hatmoglobin
• rhe number of rhe diffcrcnr cells - red bloo<l ce!Js (erythrocyres ), white bloo<l
ce!Js (leucocytes) and plarclcrs (rhromb<>eyres)
• rhe vol1m1e of rhe cells
• the eryrhrocyre sedimenrarion rare (ESR) -a measuremenr of how qu ickly red blood
cells fall w the borrom of a sample of blood.

Anaemia
Anaemia is one of rhe commonest diseases of rhe blood.Ir may be due ro:
• blccding - loss of bloo<l
• exccssive desrrucrion of red cclls
• lo\v producrion, for exa111ple because rhc dicr is lacking, or deficient in, iron (Fe).
A medica! srudenr has examined an elderly pacienr wirh a very low leve!of haemog.obin
and is djscussing rhe case \Vith her profts.. r:
Professor: Whar's che mosr likely diagnosis in rhis case'
Srt1denr: Mosr probably c:arcinom:t of t.he bo"vel wich chronic blood Joss:.
Professor: Whac's agaiHst rhar as a diagnosis?
Srudcnr: Well, he hasn't had any change in his bowel habic, or losr weighc.
Professor: Whar else "ould you include in rhe diffcrcntial diagnosis of sevcrc anacmia in a
man of rhis age?
Studenr: He rni ghr have leukaen1ia of son1e SQn, or aplasric anacmia, bur thar's
rare - i t would be vcry unusual. Anocher cause is iron deficiency, bu e he
seems 10 have an adequate dier.
Profem>r: OK. No,v, rhere's anorher cause of anaen1ia ,,,hich 1 rhi nk is 1nore l ikely.
Srudenr: Chronic bleeding ulcer ?
Profossor: Yes, thar·s righc. But \Vhac about pernicious anaen1ia? Can you cxcludc rhar?
Srudenr: Well, he's gor none of the typical ncurological symproms, like paraesrhesiae.

Pernicious anaemia
Jordi Pons, rhe medica!srudent from Barcelona, has made sorne languagc notos in his
tcxtbook.

Pernicious anaemia (PA) is a condition in which there ataxia. The spleen may
is atrophy of the gastric mucosa with consequent be palpable .
failure of intrinsk lacta< prnduction and vitamin 812
malabsorption. The onset is insidious,with
progressively increasing symptoms of anaemia.
Patients are sometimes said to ha a lemon-yellow
colour o.ving to a combination of pallor and mild
jaundice ca•sed by excessive brea kdown of
haemoglobin because of ileffeaive red cell proouction in
the bone marrow.A red sore tongue (glossitis) is
sometimes piesent. Patients present with symmetrical
paraesthesiae in the fingers and toes, earty loss of
vibration sen.se,and progressive weakness and
Pro(essionol E.ngtish in Use Mtd1one 39
Ott = be9t1o1. W..the eovít!:I of OCl'\tS
t....tolí.o«.< = slo·N\1:1 tlevelop 'ti""iM.ttL = ••eh se tllt s•w.t
,,aLlor = tac of eolo«r víbrotí.o"' st"-St = obiüt!:I te feel
,...l.tl = slí.0ht vibrotio
joi..wjí.Ge = btLtrubtv.ne"'ia proeressive = eo....ttiM< tidevelo¡>
brtaR.<low"' = olivisio"" t....to S"'4•Utrp•tts be ,..,•..,.""' = 5* tlss«t p•Lp11bu = eav.. be fett wi.th the h••

38 Professional Engflsh in
Uv.Medidn<!
15.1 Fmd words tn <he box ";,¡, opposite rneanongs. l .ook at B and C opposite 10 hdp you.

adcquatc unlikeli mold common insidious for

aga1nst sevcre rare sudden inadcquare hkdy

15.2 Make word combinations using a word from each hox. Look ar B and C opposirc 10 hclp you.
diagnosis sense onsel marrow
bone diffcrcntial insidious iron pemicious inereasing deficiency anacmia
progressively vibralion

15.3 Compktc thc sentenccs. look ar A, B and C opp<Xitc to hdp you.

l A 39-rear-old man pr<S.-.nted wirh a hi>tor¡ of abdominal disrcnsion o•·cr
a pcnod oí SL'< momhs.
2 Blmdness may be causeJ br viumin A
3 rhc blceding and purpura are crn<ed by abnormal ·· ·-···--··- function.
_
4 The whire cell count is normal so we cm ·······-·acute leukaemia.
5 The yellow colour of her skin and con¡uncrivac is probably due ro·······--····-···· ···...
6 Thcre was a ·· ········ -···
··-···.... mass in rhe right uppcr quadrant of rhe abdomen.
7 Trcarn1enl is ain1ecl ar restori ng fluid bnln11cc \Vith ....................... -......inrravcnous fluid.
8 Thc anacmia ma y be due 10 i ncreased red ccll .............·--···-.....

1 5.4 Complete the conversarion. Look ar (.opposue 10 hclp you.

1>rofessor: Whar is againsr rhc diagnosis oí pcmocious anaemia on phrsical examinarion?
S111dent Thc problem 1taned quite suddcnly. So 1t d1dn·1havc the cypical ( 1)
: ----·He docsn'r ha>e an)' skm (2) and he docsn) ha•c
(3) J><1raesrhcs1ac, or abscnt (4) scnse,and l couldn·1
fecl his splecn.
What about js rongue?
Professor: His rongue w.1< nonnal and nor mflamed or (51 .----------.
Srudenr:

Ove.r .f-o 11ou

li'I lht· rauses of anaen1 ia 111ent 1ont•d 1n Hu· t·onvt•r5a lion in B opposite. Tht·n rhout·
anolht•rl nrountt·r ou and rn;1kt· a 5imilar list of tht· l'<JU'it'<i n1
fl'lJUl;nly
c:nndit i nn
l nc¡ll h·l.pthal
you.
sC' the index to ht
U
 Bones
Bones
Sorne conunon English names for bones:

lnqll\h An;1torn1t·al .
nanu· n 1n1t·
skull cran1un1
jaw bone mandible
spine vertebral column
brcasrbonc srernun1
rib cosra
collarbonc davide
shoulder blade seapula
rhigh bonc femur
kneecap parella
shinbon c tibia

Fractures
A fracrure is a break in a bone. Some of rhe differenr rypes of fracture:

"\
greenstick displaced impacred open (compound )
con1n1inuted

A pathologica l fracture is fracture in a diseased bone. A fatigue or stress fracture is duc ro

rcpearcd minor trnu1na, for exarnple l ong·disr3nce rnarching or running.

Trea tmen t of fractures

When the fragmenrs of a broken bone heal and
join rogether, rhcy unirc. Union may be promored,
or helped, by reducing the fracture - rcplacing
the Írag.rnenrs in their anaro111ical position if
rhey are displaced. Afrer reducrion , excessivc
movcmenr of rhc broken bone is prevenred by
fixarion -eirher

or inrernal, for exa1nple a pin or a platc and scrC\YS. d(

externa!, for example a splini or plastcr of París casr,
,,
A displaced fracture which is not reduced may result a plastr cast a pin a plate and setews
in tnalunion - incon1plere or incorrecr union.
Note: The verb reduce hassevera! meanings in medicine:
• to make smaller - I thir.k we'd better reduce the dose of Your
toblets.
• (in surgery) to return toanatomical position -A hernio con normal/y be reduced by monipulotion.
• (in chemistry) to removt oxygen or add hydrogen - Nitric ocid is o reducing ogent.
40 Professionol Enflish in Use M edH:ine
 16.1 collarbonc
brcastbone Label the diagram
jaw boneusing words from the bo\.Loo at A opposire ro help you.
kneecap
rib shinbone
shoulder bladc skull 6
spine
thigh bone
2

..,>.
:e .•

9 ,.
J

' "
10 r

16.2 Match the I)' oí fra<tLtt (l-5) wirh rhe dcscripuons (a-;,). Look ar 8 OPP'"'" 10help you.
1 Oprn
2 comminured
3 displaced
4 greensrick
5 impacred
a There is a break in 1hc sk in.
b Thc bone is benr. I r C>C<ur> mainly in
children. e The bone is brokcn in10 several
pieces.
d The broken pieces are scparated.
e The broken pi are pushed rogcther.

16.3 Complete rhe rexrbook C\tr.tct. l.ook ar C opp<»11c ro hdp you.

(1) ·----·---..·--·.. ·a fracture involves trying to return the bones to as near to thelr
original position as posslble. lf a fractureis allowed to heal in a displaced
positlon the fracture

will (2) ·-··-····.............. butit may go on to (3) .···

············-···-··.
Pro(essioool En¡!osh 1n Use 4
/11cd>0nc 1
 Childhood
Milestones
Childhood i thc pcriod durang which a pcrson is a child.lt cnili with pubcrty -
thc onsct o( se ual maruruy.lnfant is anothcr word for a young child; infancy is the
period from binh unul about fi•e )Cars of agc.
Thc milcston cs m a choldi. d.-clopmcnt and the agcs at which they usually occur are:
• siuing - b) 9 momhs
• era"ling - b)' 12 roonths
• first words- by 18 months
• walking - by 18 moruhs
• talkin¡¡(two-word sent cn-es) - by 3 years.

Com mon infectious diseases

01)\'¡j\t' Cornn1on
nan1t·
morbilli/rubeola rncalcs
rubclla Gcrrnan n1caslcs
v:1ricella chickcnpox
infecrious paroritis 1nun•ps
pcrtu'l'lis v..·hooping cough
acure laryngorrachcitis croup
".Cttrlnti nn scnrl cl fe,rer
rheumaric fcvcr rhcurnati c fc,·cr
retanus lockjaw
poliomyclit is polio

Coeliac disease
A med1c1. I srudcnt ha m:dc somc languagc notes whole reading her 1e:1-. tbook.

1a1111ng gluten. The dinical features onclude d1arrtcea. malabsorption and failure vittl
to thrive
to Thele -' ol malnutrition and thete ..
may• be signs
z'2'' ''°'9
rtaetici'\. to
= •.,. , t¡,t c:t Í"''"
MÍ CW\.o to soli.d focas
L = te s¡j'4"-SQ..,;i
S4<_!i<.S <f O >.UDSl
.....,U.bsorptíc" = J>l'C' Qllsc<;.t.c..
......i......tñtio... = PI"" di(t (l'\Wt.o':U'....)
tldJtefat = ha(
thrivt = erow str...gt1:1
dLste:: s." "tiliK'9
dtU.!jed = !tlter · t"ª"
"'l'teted
faU..rt = wkt" "'""" t•at '5
tiq>tcted d Mt ht!pf'"
stot1<rt = siu, tspteialLtJ •eht

42 Pro(esslonol Enil•sh In Use Medi<i

 17.1 Complcre thc rnble wirh word> from A and C oppositc.Then complcrc rhc senrcnccs
with words frorn the toble.

Verl> Nu Ad¡t·r11w
un(,) hl
dda¡
devrlop
di<rend distended
foil
nourish
1 Babi \\ 1th 1he feral akohol S) ndrome may prrsem wnh 10 1hme.
2 Abdominal _ rn•> br due 10 an enlargcJ ll\ cr.
3 Small amounis of alcohol m prq¡nancy can aff'f fetal ·-
·--- 4 Mona hry from measles can be reduced by bener
5 ......... ...........in onc or more of thc milcstones may be thc first sign of di<e.1>c.

17.2 Complete the senrences. Look at A and C opposite ro help you.

1 After s1ttmg, babies lea-n ro and 1hen ro
walk. 2 A ch1ld "hohas sraned earmg solid food has bren
3 Someone who is noi •ery rall i 1d to br of shon
4 The >tages in a child'< dcveloprnenr are known a the . .................-.....
5 A chile! who is beg.inni ng ro dcvclop sexually has reachcd · ········-·········-·.
17.3 Write rhc common English namc tor each d1scasc, usmg yom medica!
knowlcdge. 1 enbrged parorid glands
2 dofficulry opening che mou1h
3 rash Jnd enlarged posterior OCClpital
nodes 4 paro,ysmal cough wirh \'Omnmg
5 papules.rnd "csiclcs, 6rsr on
trunk 6 cou¡:h and cold followed
hy ra>h 1 sore throat and rash
8 swollcn ¡oinrs and a hearr
111ur111u r 9 fe-.r followcd by
muscle wcakne>> 1O cough "uh
srridor

· OV(..r .f- l;jOt

Wh;_i l arl·lht·l n1ain childhood 1ll1u·\l'\ in your rountry? Wha t are lht t·1i111ral f t·;_i
o
turt·s1llnt"\!ioC'!>?
tho\t' of

Pro(essionol EJ>psh In Uso 4

M<didn< 3
 The endocrine system
Excess and deficiency
An cxcess - roo n1uch,or a deficiency - too litrle, of circulari.ng hom1ones causes a
'vide range oí medical condirions, for example hypcrthyroidism and hypothyroidism.
Where rherc is an cxccs.s of hormone, one form of rrearmenr consists of giving rhe
parienr somerhing which inh ibirs rhe producrion oí rhar hormone, as in thc use of
carbimazolc
ro rrear hyperrhyroidis1n. When a hormone is dccicnr, treatmcnt may be by replacemcnr
thcrapy, for example injtctions of insulin in rhc rrearmenr oí Type 1 diaberes.
Oocrors say:
Sufferers of rype 1 diabetes
are dcficicnt in insul in.

Negative feedback systems

1 TRH (thyrotrophin-releasing hormonel is

secreted in the hypothalamus and tri11ers the
production of TSH lthyroid stimulating hormonal
in the pituitary.
2 TSH 1tim•llltes the TSH receptor in the
thyroid to increase 1pthnil of both r.!
thyroxinel and
T3!triiodothyroninel and also to reluse
stored hormone. produc1ng 1ncreased plasma
levels ot T4 and T3.
3 T3 fwd1 llack on the pituitary and perhaps the
hypothalamus to inlibit TRH and TSH
secretio•.

Goitre
An enlarged rhyroid gland is called a goirrc. The enla rgemenr may be di ffusc -
involving mosr of the gla nd, or localizcd - limited ro a particular arca, as in a
solitary (single)
nodule. The incrcased blood ílow in diffuse enlargemcnr, for example in Graves' disease,
may give rise ro a palpable thrill - vibra rion felr with rhe hand, and an audible bruir
-noise heard rhrough a srethoscope, over rhe gland .

A letter of referral
Mrs Oavis's docror has rderred her ro an endocrinologisr.

Oear Doctor,
ovemcrivc:more
1 woud be grateful n you would see thls 50-year-
acrive rhan is
woman who has lost 20 kilos In weight old in spite of eating usual
more than usual. She describes herself as overactive and at first she thought the weight losswas due to this. But
moro recently she has developed palpitntions, diarrhoea. palpirarions:
and heat intolerance. She has noticed that her hands have a tendency to shake. a\varcncss of
Her syrnptoms suggested hyperthyroidlsm and lhis was rapid or irregular
confirmed by my hcat intolcrance:which revealed an enlarged thyroid , red sweaty palms and a heanbeat
examination fine tremar of the hands.
inabil ity to
cope with high fine tremor: very
temperarurcs slight involunrary
mo\'emcnts
44 Pro(essional English in Use Medidne
 18.1 Complere rhe rabie wirh words from A, B and C opposire and relared forms.Pur a
srress mark in fronr of the messed syllable in cach word . The first one has bccn done
for you.

vrl Noun
l
in'hibit
produce
release
replace
secrerion
stinlulacion

18.2 Complete the passage frorn a textbook, using the illusrrarion

and your own knowledgc. Look ar B opposire to help you.

Pulses of GnRll (gonadotroplún-releasing bormone) are

released from the hypothalamus 1md (1) ... ...................... .
U1 and FSH (2} ........ ....... ........... from lhe pituit.ary. LI 1
(3) ................................ testosterone (4) ...................... ........ from
LeycUg ceUs of the testis.
TcsLOsterone (5) ......................... back on the
hypolhalamus/pituitary to (6) ................................
GnRH (7) ................................ . FSH (8)
. .............................. the SertoU
cells in lhe seminiferous tubules to (9) ................................
mature sperm and the inhibins A and B. lnhibin
causes feedback on the piluitary to decreas0 FSH
(10) . ........................... .

18.3 Complere rhe sentences. Look ar A and C opposite to help you.

t A ................................change affecrs many parrs of an organ or gland.
2 A ................................change affecrs only one part.
3 His diel is ............................ in iron: he doesn't gct cnough iron.
4 ................................ T1and T, incr!"JSC rhe basal merabolic rate.

18.4 Match Mrs Davisºs symptoms ( 1-7) wirh the quesrions her doctor asked (a-g). Look at
D opposire to help you .
1 diarrhoca a Do you prefer hor wearher or cold?
2 earing n1ore b Is your weight steady?
3 hear inrolemnce e What is your appetire like?
4 overacriviry d Are your bowels normal?
5 palpirarions A re you able ro sít and relax?
e Do your hands shake?
6 wcight loss f Have you ever felt your hearr bearing ra pid ly or irregula rly?
7 rremor g

Ove.r .f-o 11ou

Wrih· a fl'fl'rr;1I ll·lt t·r t11 an t·ndot·rinolog1-.t for a pat tt·nt \•Jho you hl'lit·vt ha\
hyrothyro icli\m. lJ\t' tht· lt·tfl·r 111 O oppo\il« ;_i .., a n11H.Jc l.

46 Professionol Engfi"1 in Use M

edicine
The eye
Pa rts of the eye

eyelid
cyelashcs
pupil

Exa mi nation of the eye

Here is an exrracr fron1 a rexrbook descrlption of ho\v ro exarnjne che eye.

l<>Oi< lor squint (sirabismus).4rooping ol !lleuppe< lid (ptosis) or oscillation of lhe eyos !he...,.,...
us).In lid lag,
eyelld movos írregularty instea:f olsmoo<lily when lhe patient is asked to lool< clown.
Next. examine the pupils and note vmettier:
they are equal in $ize
they are regular in oudine (eventv citculat)
lhey ar•abnoonally dilato<I (ia.'go) or constricted (sma
lhey react normolly to light and accommoda tíon (fools on ,_objoos).

To test the reaction to accommodation, ast tllé patien1 to look lnto the dis1ance. Hold your finger in front of their n»e, and
tlle pationt to lool< at n.The e)OS should como togethe<. or converge. and tlle pupilsshould con<trict as !he patietit lool<s at tlle fin
Chl!Ck also for cataract (opaciy ol tlle leos).

E 1
Reti nopa thy
Hypenensive changes in the reri11a can be classified from grades l to 4:
• grade 1- sil ver wiring (incrcase in the light reílex) of rhc ancries only
• grade 2 -grade l plus artcriovcnous nipping (indenrarion of veins where they are
crossed by a rrcrics)
• grade 3 -grade 2 plus flamc-shapcd haemorrhagcs and cottonwool exudares
• grade 4 -grade 3 plus papilloedema.

cottonwool exudate
19. 1 Complete rhe rabie with words from B opposire and relared forms.
Vn Nou AcljtTl l
h n Vl'
accommodare
cons:trlcrion
convergence
dilat(>n,
dilamrion
droop
oscillate
reaet

19.2 Match rhe picrures (1-<i) wirh che condirions (a-f). Look ar B opposire ro hclp you.
1 a drooping of lids
4 b dilared pupils
e irregular pupil
d cararact
e squint
f consr:ricred pupils

19.3 Complete rhe extraer from a rextbook. Look ar C opposite to help you.
Retinoscopy
Examine the retina with an ophthalmoscope,if possible with the (1) .......... ............._....
dilated to obtain the maximum view. Look for papílloedema,and for (2) ............ ..... . ...........-
..................................haemoohages and (3) ..... ............. ..................exudates. Assess the state of
the (4) ............. ..................and note the presence of any narrowíng, as wellas
(5)......................... .........at arte<iovenous crossings.

-
Pro(essionol EngfM in Use Meéidne 47
 The gastroi ntesti na l system
Examination of the abdomen
Here is an extract from :t textbook dl'SCription of ho\v to examine the abdon1en.

Note if the abdomen is distended by fluidor gas.The presence of f uidcan be

coofirmed by demonstraling shíftlng duffness:percuss, or tap,first with lhe patient lying
supine - llat on their back;thenask the palient tolie on one side and percuss again. lf
fluid is pA>Sent, the ullnote heard on percussion moves.Palpate each region,feeling
for tendem asa - pain when touched, or masses - palpableenlalgement of tissue.Note
also any gumding or rigidity, shown by
contraction of lhe abdominalmuscles.Guarding may be due to tendemess or anxiety
and can be reduced if the palien!is persuaded to relax. Rigidty,however,is constant and
Is due to peritoneat irritation.Rebound tendemess is painwhen lhe palpating hand is
suddenty removed 11 s a sígn of periton is. Listen for bowelsounds.

The faeces
There are severa! words for rhe faeces.
Doctors sOnleti1nes say: Patienrs son1erin1es say:

There was blood in the srools. M¡• motioos have been very loose larely.

Have you passed black srools?

Bowcl movcmcnt is use<l ro refcr to defecarion:

Have your bowcls moved today? Have you had a bowel movemenr roday?

Bowel habit is a mcdical exprcssion meaning rhe pattern of defecarion.

Have you noriced any changc of bowc,I habir? How ofren do you open your bowds?

Are you going ro the roilet more oftcn than normal?

Cha nge in bowel habit could be constipation - hard, infrequenr srools, or diatrhoea -
frequent soft or liquid srools.

4 Pro(essionol English in Us. M

8 edidM
Norma l srools are brown in colour, and semi·solid, or formcd. Thc consistcncy, or dcgrec
of hardness a nd softness, can be shown on a scale:

hard formcd scmi formed sofr (loose) liquid/warcry

TI'e colour can vary fr(Hn bl:ick, due to alrered blood <lS in n1el::iena , to ycllO\v, grey or cven
whitc.Melaena stools are ofren described as rarry - like mr, rhe black sricky substance rhat is
used in road making. Thc srools may be red when fresh blood is prcsent. Blood that can only be
dctccted wirh special resrs is called faccal occult blood (FOB). When rhere is a high fat content,
the siools are palc, and re somerimes described as day colourcd. Stools that are large in
volume are described as bulky. A bad smell is described as foul or offcnsivc.

4
9
20.1 Complete rhe case reporr. Look ar A oppos1re ro hclp you.

Physical examina tion rel'ea led a thin girl with slighl pallor. She was not obviously
dehydrated. The lemperatu re was 38ºC, pulse 100/min, blood pressure 110/80
mmHg. Examination of the resl of the cardiovascular and respiralory systems was normal.
The abdomen was not (1) · --·There was generalized (2)
, which was most marked in the right lower (3) and was
associated with
(4) but not (5) There was no rebound (6) _ --and
no (7) were felt. (8) sounds were reduced.

20.2 March rhe dcscripuon; of rhc srools ( 1-6) wirh rhe condirions mosr likcly ro cause
rhem (a-f), using your me<l ical <nowlcdge.Look ar ll opposite to help you .
Type of stools Condilion
1 loose, bloody a ga<rr1c ukcr
2 loose, p;ilc, bulky b irrirahlc bowel syndromc
3 clay-<:olourro e ulccrame coliris
4 black, ralT)' d cholcra
5 small, hard e coelOJc d1sease
6 cica warery wuh mucus f ob'imicuvc¡aundice

20.3 Match rhc fcarurt-;, ( 1-7) ro rhe docror's qucsr1on; {a-g). Look ar B opposire ro
hclp rou. 1 blood a How ofren do you open your bowcls?
2 lx>\vel habit b Are you going 10 1he roiler 1nore ofren rhan 11un111I?
3 change in bowel hahu e Are the morions ha rd or loosc?
4 bulk d Do rhc morions ha\·c an un usual smell?
5 colour e \Vhar abou1 rhc appcarancc of the srools?
6 consisrrnq f Ha»e you pa;;cd black srools?
7 offensiveness g Isthe siie or rhe amount of the srool normal?

right left
upr
quadrant

right i(ft
lowtr lowtf
quadrant cuadran!
The abdom<n can be: dMd<d
1nto tour quadrants.

Ove.r +o
1101.4
L nnk hack <11 70.7
ahnvr
. In \\lhat ot her rondil1eu1' t h;it you t•nrotu1trr rt· 1ul,;11 lv "
lht·
1ppearanrt· of lht· ...tool; lyp1t·al? How would you dt•,rnht·tht·1 r 1

appt·aranrt·
Gyna ecology
The female reproductive system

Fallopian 1ube
(salpinx)

ovary

neck of womb
(ccrvix)

Menstruation
A period is rhe com mon r1111e íor a menstrual (monthly) period. The onsct of
mcnstruation is known as mcnarche. The lasr menstrual period is commonly
abbreviared in docrors' nores: LMP 2/52 ago rneans rhc lasr menstrual pcriod was two
wceks ago.
Thc menstrual cyclc,or length and frequency of periods, is usually writren in rhe form
4/28. which rneans lasring 4 days and occurring cvcry 28 days. lf a period lasrs more
rhan four or fivc days ir can be described as prolonged. The rerrn heavy periods mean s
excessive blood loss - menorrhagia, ofren wirh rhc passagc of dots-coagulared blood .
·rhc rcrm pcriod pains rncans dyS1nenorrhoea, or pa inful rnenstruarion.
The rime when a woman ;rops menstruating, normally ar a bour the age oí 50, is ca lled
rhe menopa use or climacreric.In everyday English ir is known as the change of life, cr
simply rhe change.Symproms of rhe menopause includc ho1flushes -sudden sensation
of heat -and night swca1s.

A gynaecological consultation
A gynaecologist is talking ro a 30-year-old woman.
Gynaecologist Patient

Ale your periods rc'gular' Yes.

l low often do you gcc them? Every four weeks.
Ho\v old \\'ere you \Vhen you startcd to gec Abou r 12.
then'I? J\ week ago.
When was your las1 period? 4 or 5 days.
How long do rhe periods lasr usua lly? Light.
Would you say rhey are light <>r hcavy? No.
Do you ge1clo1s? Nor rea lly.
Do )'OU ger period pains? A little.
Is rhere any discharge berween che periods? Whire.
Whar colour is ir?

Contraception
For women, methods ro prcvcm pregnancy include che oral conrraccptivc pill (known
Professional Entl sh ti'> Use SI
N
 as 1hc Pill), rhc diaphragm, and che intrau rerine devicc (fUD) or coppcr coil.
Condoms are available for borh nlcn and \vo1ncn.

5 Profe$5;onaJ Englis-h in Ust

0 Mtdlcine
21.1 Wrirc a simple EngJish phrase for each of rhe medica! rerms bclow using your med
ica! knowlcdgc. Look ar A ond B opposirc ro help you .
1 hysrcrccromy
2 n1cnorrhagia
3 salpingitis
4 cervical biopsy

21.2 Read the convcrsation bctween rhe gynaeco logisr and rhe pariem in C opposire, and complere
rhe notes abour rhe parient.
menarche:
111enstrual cyclc:
LMP:
menorrhagia?
dysn1enorrhoea?
discharge?

21.3 Now wrire rhe quesrions thar rhe doctor asked . Look at C opposirc to help you.
rnenarche:
menstrual cydc:
LMP:
n1enorrhagia?
dysrnenorrhoe.a?
discharge?

21.4 Complete thc case rcporr.Onc word is needed t\Vice. Look ar B and C opposire ro help you.

A 45-year-old woman had been having (1) ... .... ..... .....periods lasting for 8 days.with the passage of (2) ..
any hot (5) ..... ....... .. ... .or night sweats,and her general health had always been good. She had taken th

condonl5

IUD

OVer .f-o ':jOl.I

What i.;, the atti tude to con traception in your country? At wha t agc do you think ft·malt·s
should bt• prl·scribrd con trat'l'ptivl·s?
 The hea rt and circulation 1
Shortness of brea th
Shonness of brcad1, or brcath lessness, is dy>pnoca. A< firs< this is causcd by cxcrtion
- physical activiry uch as climbing stairs - bu< in scvcre cases it may be prl n< c\'cn at
rest. A patient who is breathless wh<n lyin¡; llat (orthopnoea), for example m bed, w1ll
tend <o sleep ra1std up on two or more p11lows. Tht abbreviation SOBOE >iands for
shormess oí brtath on exercisc tor oo excrtion, or on cífon).
Patients say:

1get terribly shon ol brearh climbing sta1rs.

Docrors can ask:

How many pillows do you sleep on?

Hea rt rhyth m
The nonnal resting heart ra<e as 65-75 beats per minu<e. In arhleres u may be as low as
40 beats r nunurc. I n extreme athletic Jet" 1t), rhe hcan ra<e can go as h1gh as
200/min. Thc hean rhy1hm may he regular or irregular.In an irregula r rhychm
(arrhyth1111a). rhcre may be carly bea<s which imerrup< the regular rhyrhm (prcmarure
bcats); or 1he rhythm may vary \Yith rc,piration; or ir may be co1nplctcly irregular, as in
fibrillarion . \Xlh<'.fl pariems are awa re oí i riegula riry, they dc!>Cribe rhc symprom as
palpitations .

A 22-year-old student was admitted to hospital with a long history of heart problems.
She had been increasingly tired, with shortness of breath on exertion, orthopnoea, and palpitations.A mltr.1 v•lve repla

Heart failure
Heari failure occurs whtn rhe heari is unablc to mainrain sufliciem cardiac outpu < - the
amount oí blood pump<d by the hearr cach manutc - íor the body's nttds.1< may
1nvolve the left side oí the hcan, the riglu side, or both. In leh heart fuilure the main
S) mpDm is breathlcssncss.The '> mptoms oí right hcart failure 111dude periphcral
ocdema ts"e!ling), hq¡inning in the íeci and anklts.This is known as pi11ing ocdema
ií, when J lingcr is pushed into the fücilm!l. 11 causes a small depress1on or pat.

<roruspod vaM

septum

52 Pro(tulonal En¡rosli ltl Use

Mtdacint
22.1 Complete rhe conversarion based on rhe case hisrory in B
opposire. Uocror: Whar seems ro be rhe problem ?
Patient: l've been gerring (1) ... ....... ..... ................ ....-···-··.
Doctor: How long havc you had rhem?
Parienr: For abour six monrhs. Bur l've had heart problcms for ycars, wirh riredness
and (2) ...............................................o( (3) ................................................ . In
rhe end l couldn'r wa lk
more rhan a hundred merrcs wirhour having ro srop.l had ro sleep on rh ree
(4) ............................................... . 1 had a (5) ................................................................................................
replacemenr three years ago, and thar improvcd things for a whilc.

22.2 Makc word combinations using a word from cach box. Two words can be used !\vice. Look
ar B and C opposire ro help you.

at atrial cardiac heart on pitting

premature output fail ure oedema
fillrillation beats effort
rest

22.3 Wrire che words a paricm would use ro describe che symptoms below. Look ar A, B and
e(lpposite ro help you.
1 Jy!lpnoca
2 arrhythmia
3 orrhopnoea
4 ocdema

22.4 Complete rhe case reporr. Look ar A, B and C opposire ro help you.

A 60-year-old woman attended her GP'ssurgery complaining of breathlessnesson (1)

................................ . This had been increasing over the previous eight months until it was produc­ing problems at around 5
(5) ................................of her ankles by the end of the day.This disappeared overnight.

Ove.r .f-o '1º"'

How \tJould ynu 1nanage the lre1tn1t·nt uf l ht· \•1om;c1n in 22.4
<lhnvt.'?
 -

2
'

The heart and circula tion 2

3 Physical examination
Medical examination is norma lly carric'() out in four srages: iuspection (looking),
palpation (feeling wirh rhe ha11ds), percussion (tapping with a finger) and ausculrarion
(lisrening with a stcthoscopc).
Note:Thc verb is palpare; the noun is palpat ion lnot palpitation - sce Unit 22).

Examining the heart and circulation

Here is an exrracr froi-n a rextbook description of hO\\' ro examine the cardiovascular
sysren1.

Look at >e lips, tongue and nails for the blue

disc"Oloration of cyanosis. Cyanosis may
be central or peripbcral. lnsped the hand.
for clubbing. Fecl thc radial pulse ar the
wrist and note the rate (for example
70/min) and rhytltm (regular or
irregular).The pulse may be irregular in
fort".e as well as time. Check tltnt thc othcr
pcriplteral pulses are present. Measure the
blood pressure, and assess thc jugular
"enous pressure (JVP). Palpate thc chest
for the a1>ex bcat - the nom1al p0si1ion finger clubbing
is thc fifth lefl intercostalspacc.011ecent.imetre
medial to the midclavicular líne. Feel for any
thrills. Hean size may be measured by
percussion. Listen for 111urmurs and
01he1· ubnormal sounds, for example
friction rubs, beginning at thc mitral area.
Munnurs may be sofl or loud. A harsh
munnur is loud and rough.
Note thc ti1nc of any n1unnur in relntion
to the w"lfdiac cycle. The 1n
L"Omn1on 111unnurs are:
• mid-systolic (in the niddlc or systole)
• pan-systolic (lasting for the whole
of systole)
• early diastolic
• mid-diastolic
• late diastolic (pre-sysrolic)
Continue by listening at the tricuspid, aonic
and pulmonary arc'.l. .

e i Jkj
Areas of auscultation.The letters indicate the approximate position of the heart valves:
P Puln1onary valvc; A Aortic valve;M Mitral valve: T Triscupid valve. The circles indic:ate lht position for auscultation for c
valvular heart discase. The ribs are nul'nbered.

5 Proft<sional English in Use Medídne

4
23.1 Complete rhc rabie wirh words from A opposire.Pur a stress mark in fronr of the srressed
syllable in cach \VO• d. The fi1sr one has beco donC' for you.

Vn Nou
n
•auscu1rarc
h
examine
inspect
palpare
percuss

23.2 rur rhe srcps for exa1nining rhe heart and circularion in order, according ro rhc four-
srage sysrcm . Look at A oppositr ro hclp you.
a Ñleasure rhe hearr
size. b Aie rhere any
nlurn1urs? e Fcel rhe
radial pulse.
d Look for dubbing.
e Locare rhe apex bear.
f Norc any thrills.

3.3 A doctor is presenti ng rhe case of a 43-year-old woman ar a meeting in thc Cardiology
Departmenr. Complete rhe rexr of her presentarion. Look ar B opposire ro help you.

On cxan1ination shc \Vas pyrcxial \Vith a rcn1pcrarurc of 38.5. Shc \vas shorr of brcath.
Her pulse was variable berween 100 and 180 and was irregular in rime and
( 1) ................
Her blood prcssure was l30/80 and her JVP was up 5 cenrimetres showing norma l
movemcnr wirh respirarion. Her periphcral (2) ................................werc all prcsent and
rhcre was no (3) ...........................or (4) ................................cyanosis. Her apex (5)
................................was
displaced ro rhe anterior axillary line but still in thc fifrh intercostal (6)
................................ . Her heart sounds were'ery inrcrcsting. When she was initia lly
examined ir was nored that she had pan-systolic and mid-diastolic (7)
................................ , heard besr at the apex.
When she'vas exan1ine<l so1ne hours larer, rhere 'vas a harsh perica rdial fricrion
(8) ................................ all ovcr rhc prccordium. Our diagnosis at that time was of
mitral stenosis and incompeiene with a recenr onset of pericarditis and arrial
fibrillation.

Ove.. .f- 11o

o..,ignu oí hl·art di st:ast• ran you íind in B oppo..,itl·? C<.tn you add <Jny "i.ign1i.
rofht:art d isl·asl·
liow rnany
lo lht· l
ist?
 lnfections
Fever
A n1cdical srudcnr has madc sorne language notes on a case reporr.

mm- ·;-..-- fever = pyrexla (aloo rememl>er PUO - pyrexla of

unknown origin)
A 24-year old man presented with a
feve. which he had had for three fever aleo known a& temperature -'Fve gal' a
days.On the third day he had had a umperature'.
severe attack of fever with sweating and adjective.s = feveri&h/fel>rilo and pyroxial
ñgors. The only past history of relevance oppo6ites = afel>rile/apyrexial
was hepatitis
tour years earlier and glandular fever Sóm.; eym$m5 pf feyer 1
(infection with Epstein-Barr virus) al 6weating
the age of 18 years. He had returned
rlgor6 (,;evere 6'1ivering and ,;eneation of coldnes,;,
from Africa three weeks prously.
al!!O known a& chille)

Microorganisms
lnfecrions differ from orher diseascs in a numbcr of aspecrs:
• Mosr in1porrantly, rhey are caused by living 1nicroorganisn1s - such as viruses or bacteria
- rhar can usually be idenrificd, thus esrablishing the actiology early in thc illncss.Many
of rhse nrg:t 11is1l1 . i11cluding all hacreria, are sensirive ro anribiorics and 1n<>sr
infecrions are potentially curable, unlike many non-iu fectious degenerative and chronic
diseases.
• Con1n1unicability is anorhcr factor \vhich di fferentiates infections from non-infcctious
diseases. Transmission of pachogenic organisms ro ocher people, directly or indirecrly,
may lead to an outbreak or epidernic.
• Finally, ma ny infeccions are prevenrable by hygienic measurcs, by vaccincs,
(csp<'.Cially live arrenuatcd vaccincs such as rubella vaccine) or by drug prophylaxis
(for example, chloroquine ro prevent malaria ).
Micro(>rganisms include bacreria, viruses, fungi, prorozoa (such as rhe
parasi1e rhar causes malaria). Another general word for rhese
parhogens is n1icrobcs. f>atienrs often refer ro microbcs as gcnns or
bugs.
Norice rhe con1111on ex1>ressions for acquiring an infcctious discasc:

1 rhink !'ve
caught caughr thc ílu
Could he have sorne diseasc from thc
picked vug that's going
up dog? round .
Source and spread of infection j
Here is an exrract from a medica!
rexrbook.

lnfection may originate from the patient (endogenous), usually from skln, nasopharynx or bowe, or from
outside sources(exogenous), often another person who may be either suffering from an infecticn or
carrying
a pa.thogenie mieroor110.ni3m. Carrier& are usuolly heolthy and m.oy h.:1rbour thc org.:1ni::;.m in thcthroa.t (for
example. diphtlleria), bcw.<el (salmooella), or bloocf (hepatitis 8or HIV). Non.humansources of lr1fection
include water (e.g.choler'l). milk (e.g. tuberculosis), food (e.g. botutism), animals(e.g. rabies), birds
56 Professionol EJigfl•h on Use
Med•cm<:
(e.g. ps.ittacosis) and also the soil (e.g. legionella - Legionnaires' disease).
The incubation period isthe period between the invasion of the tissues by pathogens and thie appearance of
clinical features of infection. The period of infectivity is the time that the patient isínfectious to others.

Pro(tsSJonai En¡I sh n Ust Mt<1<.: S7

24.1 Match thc rwo parts of the scntcnces.L.ook at A, B and C oppositc to hclp you.
1 1988 saw thc UK launch of li vc atrcnuated
2 Chickcnpo• (varicdla) is ,t common
infecrious 3 Rab has an 1ncubation
4 'The paucnt rtmained ftbrik
5 He was adm1ttrd with a four-da) history of influc1111-1ypc si·mptoms of fe "er \\ ith
6 Quite a proporrion of paricnrs who =over from hcparnis B
7 Thc central parr of Afrk:a i< in 1he midst of an cpidcmic
8 Measlcs (rubcola ) is most
9 Lymc discasc is c. used by tran\mission
10 PUO stands for
a pcnod rangmg from four dJ>-S 10 many momhs.
b rigors, m)alg1a and gcri:ral mala1sc.
e becornc carriers of rhe \irus.
d iníecuous during che ca:arrhal stage.
e disca>e oí childhood.
f of AJOS.
g of B. burgdorferi from Jnimal 10 man by ixod1d
ucks. h \\1th pcaks of tcmperalllre of J9.5"C.
i pyrtx1a of unknown º'll'"·
j mcasks, mumps, and nbella (M:\I R) vaccine.

24.2 Complete 1he case reporr on 1he parienr in A opposi1c. Look ar A, B and C oppo<ire ro
help you.

On examination, he looked unwell.His pulse rate was 100/minute.He had a palpab'e spleen.The combination of (1)and (2)in a
(4) ................................regularly. The diagnosis was confirmed by the presence of (5) ................................in his blood film

24.3 Complete 1hc scnrcnccs. Look a1 A. B and C oppositc 10 htlp )'Ou.

1 An mfoct1on which cm he trta1ed >ucccssfully wi1h annb1oncs
is------ 2 Ano1hcr word for an ep1cem1c 1s an ............. _
3 Bac1eria and viruscs a re cxamplc of ................................
4 So1neo1ic \\1hosc rernpcraturc i nor1nal is ........................................ .
5 The co1nnlon infec[ion \vith Epstein-Barr virus is kno,vn a'i ······-···········• ··-
Mental illness
Psychiatric disorders
Psychiatric disordcrs can be divided inro organic and functional. Dcmcntia is a men tal
disorder duc to organic hrain disease. ll1c cor11n1onesr fonn of den1enti:i is rhar
assc:x:iared wirh old age: senile demenria . Disorders in which thcrc is no obvious
parhology or anaromical change in an organ are rermed functional. These are described
below.

Substance abuse
Abuse of a subsra nce means using ir in a '"ªY 1hat is har1nful. The co111monest fonns of
subsrance abuse are alcoholism and drug abuse.

Affect ive disorders

Here is an extraer from a medica! rextbook .

Affect and mood are similar in meaning pSychomotor agitation (cxccssivt

and refer to thc cmotions(for cxarnplc. happiness or sadness).
movememA.ffect
andtends to be used
1hough1) for'cho""'tor
or Pl> temporary emotions.and
rctardalion (slowis
cxpresscd lhrough manner of speak.ing, facial expression. orOÍ
los, behavioor.
interest inMood is uscdactivit
Slimulating to refericsto a 1nore permaren
The m051 common fonn or alfcc1ivedisorder dccreascd abili1y to think and con::entrate
is depression.the symptoms of which are: fecling that onc isof no vnlue 10 olhers. or lha1 one has don
poor appetilc or significan!weight loss recurrent thoughts of deaUt or suicide.
sleep disturbance (for examplc, insomnia Five, or possib ly four,of lhc abovc symptoms, occuning nea
-inability 10 sleep)
ratigue (loss of energy)

Neurotic and stress-related disorders

A.n cxamplc of ncu rotic disorder is obsessivc compulsivc disordcr.An obscssion is an
idea rhat is so persisrem rhar ir imcrferes with the pat ient's life. A compulsion is an
obsessivc
idea that forces the parien r ro acr even though thcy rccogni1.c that it is unnt"Cessary.
A common form of rhis is rompulsive washing of the hands. Stress is a feeling of being
unable 10 cope.lt ei.n lead ro anxicty or fear of problems.A sudden attack of anxiery
is called a panic attack.

Other types of functional disorder

These indudc:
• bchavioural syndromes associaied with physiological disturbance (such as
eating djsorders)
• disorders of adulr personaliry and beha viour (for example, personaliry disordcr)
• mental retardation - delayed mcnral devclopmcnt
• schizophrenia and othcr disorders in whjch there are dclusions (false beliefs).
125.1 Complnc rhr rabie \\icb "ords from A, C. O and I' opposire.

Noun AdJl' t 1w
r
offeahc
anxious
behaviourul
dcmcntcd
d isturbcd
su icida!

25.2 Makc word tombinations using a word from c 1th box. Two words can be used rwic<. Lool at
8,C and E opposire ro
behavioural cating major mental personality
psythomotor slccp substancc

abuse dsturbantt mardation dsorder deprcssion syndrome

25. Cv111plc1c 1111: 11tc1n.:es. Lvok ar J\,C. 1) ¡111d I! oppoire to help you.
3 1 The way a person beha•es is his or her . ... ........ .
2 A persi rcnr emorional s:are is a
3 A suddcn orrack of anxiet)' is a ......
4 The form of dcmenria associoted wuh Jgcmg i;called
S A d1wrder which is nor assoaared with parholog1cal chonges is ------
6 An idea "hich forces a panent ro repear unn.,.,"tSSJry aroons is a ----

"'h1ch S) mproms of depression was th1s pallen! suffenng from? Look ar C opposuc 10
25. help you.
4

A 56·year-old woman presented to her GP complaining of increasing tiredness over the past
few months.She had lost interest in most things. She was sleeping poorly and tended to wake up early, but

more often. She was eating normally and her weight was steady.
'- -

Ovt-r -4- /10LI

oo you th1nk lhl·woman i n 2S.4 .iho\lt'
D w. .1\ \uf frnm n1a1or drprt ss1vt· lll nt'\\'
ft·rinq
(i1vt· vour rt•as ons.
 --
ProfeslJono/ Enzt;s.h ;.n Ust Mt<: 59
The nervous system 1
Sensory l oss
The central nervous system controls che scnsory and motor function s of rhc body.Oiseases
of this sysrem rherefore lead to loss of some of rhese funcrions.

Fu Los Ot hcr symptom'

heri11g deafness buning or ringing in 1he ear (tinnitus)
sight blindncss doublc vision (diplopia)
blurring (loss of visual acuity - clari1y of vision)
sensation n umbness (anaesrhesia ) tingli ng or pins and necdles (paracsthesiae)
(fceling)
balance unsteadmess (ataxia) dizi;iness (ver1igo)
Note: There are no common words for loss of, or conditions relating to, taste and smell.

Motor loss
Motor loss symproms and signs include:
• weakness - loss ol power
• paralysis -complete loss of power
• tremor - involunrary rhychmic movemenc, especially of 1he hands
• abnonnal gait - unu.sudl ntanncr of \Vdlking.
Specch may also be affecced, for cxample wirh boarseness -a rough, deep voice as u1
voca l cord paralysis.Slurred spccch mcans po<>r a rticulati(m, as in ccrcbcllar disease.

r
Loss of consciousness
Pa1icnrs may describe sudden loss clf consciousness in a number of ways:
r fir.
passed OUI. '
1 had aseizure.
had a blackout.
convulsion.
fainred.

Fit, seiz:ure and convulsion ace all used ro refer to violenr involuntary n1oven1ents, as
in epilcpsy.
Doctors may say:
When did you lose consciousness?

Here is a passage from a rexrbook on rhe causes of loss of consciousness.

The principal differential diagnosis isbetween an epileptic lit and a syncopal attack, or
fainting. Syncope isa sudden Iof consciousness due to temporary failure of the cerebra l
circulatio1.Syncope isdistinguished from a ieizure principally by the circumstances in which the
event occurs.Fer example, syncope usua lly occurs whilst standing, under situations of severe
stress, or in association with an
arrhythrnia.Sometimes a convulsionand urinary incontinence - los uf control or tite blddder -occur
even in a syncopal attack..Thus. neither of these isspecific for an epilepticattack.The key is to
establish the presente or absence of prodromal symptoms, or symptoms that occur
immed iately before the attadc.Syncopal episod?s are usually preceded by symptoms of
dizziness and light·headedness. I n epilepsy, people may gel a warning, known as an aura, that
an attack is going to happen .

Note: The noun convulsion is often used in plu ral form - He had convulsions as
a child.
60 Professional English in Use Medicine
26.1 Comple1e rhc rahle w11h wrds from A, B and C oppo,11c.
Ad¡cctiv Nou
c n
blind
conscious
deaf
ditty
numb
liglu-headcd
unste.1dy

26.2 Make word combinarion < u<ing " word from each bo<. l.ook ar A, B and C opposire to
help you.
double epileplic prodromal syneopal urinary visual aruity
atladt íncontinentt synptom vision
fit

26.3 A doctor is trying 10 determine rhe cause (>Í los' oí cono;ciousness in a 52-yca r-<ild man.
Complete che doctor'> qucsoons. Look ar C oppo;11c and nr 1he ra bie in 26. l abovc ro help
you.

Did you lose {1) ·-·-·---suddenly or gradually?

Did you gct a - ----of the attack?
(2)
Wbar were ,-ou do1ng bc:fore you (3) ou1?
---- Were you worncd or undcr any at 1hc time?
(4) .. . .
Did you feel (5) ...... ...or (6) ........-................. ..... ........... bcforc 1hc
. arrack? ..........
Did you lose (7) ........ .......... ...............of your bladdcr?
Did your wife no1ke nny (8) . ..·------·--·- 111ovc1ncnt.¡ \\•hile you \vere unconsc1ous?
61

-
 The nervous system 2
The motor system
Exarni nacion of lhe n101or sysre1n should include assess1nent o( thc follo\\ ing:
1

• muscle bullc (amounr of muscle tissue). Look for signs of wasting (muscle atrophy)
• muscle tone (amount of tension i n a muscle whcn it is rclaxcd). Tone can be
increased (spasticity ), or decreased (flaccidiry)
• muscle power (srrength)
• coordination (rhe abiliry ro use severa!musclcs at thc same time to perform
complex actions)
• gait (the manncr oí wa lking)
• reflexes (see B bdow)
• in"oluntary 111ove1nents, for cxan1ple a tic or a trcmor.
Herc is an cxrract fron1a case report abour a parienr \virh a rremor.

On examination, her lace showed little or no expression.. There was a tremor affecting mainly her right hand.

Tendon reflexes
Exan1inar1on of rhe ncr.rous sysre1n normally
includes testing the tcndon rcflexcs, for example
the knee jerks, wich a t<ndon hamm er (also
known as a rcílcx hammcr). Thc reílexes
rnay be absent (0), diminished (-), normal
(+) or brisk (+++). The plantar reflexcs are
also checked. The norma l plantar response
is a downgoing (+) movemenr (plantar
ílexion) of the big toe. An upgoing (t) toe
(extensor or Babinski response) is abnormal.

Coma
Testing the kncc jrrk with a ttndon hammer
Con1 1 is unconsc-iousness 'virh a reduced response 'º exrernal sti1nuli.
Doctors sa y: ( The pan.enr -1s ·1_n a \f¿o- The pau·enr ·1s con1arose.
coma.

The Glasgow Coma Scalc (GCS) score is calcuhned as follows:

Eyr opc111ng Verba l rt· sponsc Motor response

Sp<>ntaneous 4 Orientcd 5 Obeys 6
To speech 3 Confused 4 Localizes 5
To pain 2 l nappropriate 3 \Xli thdraws 4
None Incomprehensible 2 Flexion 3
None 1 Extension 2
None l
62 Profenioool English in Use
Medicine
 27.1 Complrre rhe rabie wuh words from A and B oppos1rc.

Noun Adjl"CllVl'

a bsence
diminution
flaccid
spastic

wasred
-
27.2 A doetor is g1vin¡¡inrrucóons to a patienr du ring cxamination of rhe motor system. ldennfy
what the doctor is assc>Si 11g in each case.Look ai A opposirc ro help you.
1 J 'd like you to rcbx. J ºrn ju" going to movc your a r111 up and down.
2 C111 1 sec your lrnnds?
3 Now, l'm going to >traighrcn your arm out. Try to stop me.
4 Can you touch rny finger wirh yours and rhen touch rour nosc? Good. Now do 11 again wirh
)'OUt C)'es cJosed.

27.3 Compl<tc the scntcnces.1)()k ar A, Band C opposuc and ar thc rabie in 27.1 ahove to
hdp you.
1 A ·-----------··- hand droops limply ro forrn a righr angle with the wrist.
2 · ···-··-···- ........reílcx('S are rcflexes that are strongcr than norn1a l.
3 Muscle .....................-........ ..... means rhe mu>clc is rcduccd in bulk.
4 A tic is a fortn of ... .........····-··-··n1ovc111c1n.
5 A key is oftcn used to rcsr rhc ......·--·---·--.............. response.
6 His ---·---·---..·- W•S poor: he could not pcrforrn rapid alrcmaring movcmtnt>.
7 A is used to test rcflcxes.
8 When somcrhm¡:1s , 11 is less rhan normal.

27.4 A patient is brought to A&F in coma. \Vhcn her namc is spoken, she opcns her c)es hur
she does nor answrr qucsnons, or obe)• insrructions. Whar IS her scorc? ces

The plantar rtflcx

63

-
 Oncology
Neoplasms
A ncoplasm is an abnormal new growrh of tissue. Malignan< ncoplasms -cancers
-are likely ro spread and cause scrious i ll ncss or dearh. Benign neoplasms do nor
spread and are lcss harmful.
\'Uhen speaking ro parienrs, docrors generally say growrh or rwnou r.

growrh
You have a small in thc bowel.
tu1nour

A lump or swclling is a collecrion of rissue or fluid which is visible or palpab le

-can be palpared or felr wirh the fingers.A lump may be due ro a neoplasm, bur
rhere are orher causes such as inllanunation or íluid accun1ularion.

Parienrs say: Oocrors say:

1 havc a lump in my lefr breasr. Thcrc was a firm, palpable mass in rhe liver.

Malignane nJnlO\lrs are characterizcd by rapid gro\vth and invasiveness. The ru111our may
invade local rissues or may spread ro disranr parts of the body {mctasrasis). Neoplasms
which are rhe resulr of nerasrasis are called sccondaries, as opposed ro rhe original
run1our'vhich is the prin1ary.
We have rhe resulrs ot rhc sean back nO\V and l'rn afra1d rhey .sho\v rhar you have a small growrh in rhe pr

Note: To invade (verb) is to enter and spread throughou t a part of the bo<ly,and thisprocess is
invasion {noun). l f a tumour is described as invasivc, it has the ability to spread.

-- Symptoms and signs of malignancy

The symproms of malignanr disease may be relared ro thc size and locarion of the
mmour. For exa1nple, a space·occupying lesion in the brain causes raised intracranial
pressurc and S)'n1ptoms such as headache, vonliting, or visual d isrurbancc. Tun1ours of
rhe colon n1a y obsrruc1 (block) rhe lumen and cause change in bowel habir. Other
possiblc symproms of malignancy include bleeding, pain, and weighr loss.

A 33-year-old man presented to his GP complain ing of a painless lump on the right side of
his neck, which had been present for about two months and was enlarging, He had been leeling generally un
sweats.He had no significan!past medica ) histoiy.

Treatment of tumours
A run1our can so111eti1nes be con1plecely removed or excised by surgery. lf rh1s is
not possible, for example if ir has alrcady merasrasized to orher parts of rhc body, ir
may be possible ro destroy ir by radiorherapy or by chemothcrapy (see Unir 42).
When a cure is not possible, palliative trcarrncnr is givcn, which is only imended ro
relieve symproms.

64 Pro(essionol &igfh in ()<_e

Medicine
28.1 Complete the table with words from A, B and C opposite and related forms.

Ver Nou Adjertive(s)

b n[s)
cure curarivc
excision
grow gro,v1ng
invasive
obstrucrion obstrucrive
pallia te pallia1ion
palpable
spread spreading
swell S\vell ing,
S\VOllcn

28.2 The notes below are abour che parienr described in B opposire. Use rhem to pur the senrences

e
(1-9) in the correct order, to make thc ncxt paragraph of thc case rcport. Use Appcndix 11 on
page XX if you need help with the abbreviarions.

OE f 37.8ºC
5rt'looth. flrm 3)( 4 cm ma% in R 6upract.Mcular f056a.
nodte 1-2 cm Ú1 dia.mettr. palpal>le: fn both a:&lae a.nd ingujnaJ arta§
OropM,,.,.NAD
P 100/min "°'Jlor 6f' 112166
CVS NAO R& AO
Al><l m•Ot> palP"l>fe Z, cm l>elow L coetal margin
CN& NAD

1 Examination of rhe central nervous sysre1n \Vas normal.

2 His n1ourh and throat \\'ere norinal.
3 Thcre was a smooth, firm 3 x 4 cm mass in the righr supraclavicular fossa.
4 His cardiovascular and respiratory syste1ns 'vere nonnal.
5 On abdominal examina tion, there was a mass palpable 3 cm below the left costal margin.
6 On exan1inarion, his re1nperan1re'vas 37.SºC.
7 There wcrc enlarged lymph nodes in borh axillae and ingui nal
areas. 8 His pulse rate was 100/min regular and blood pressurc
112166.

128.3 Complete the senrences. Look ar A, B and C opposire ro help you.

1 Disrant .......................,_..,_......._ of tumour cells is kno\vn as n1C'tastasis.
2 Many symproms of cancer, such as difficulry swallowing, are due ro
........................................ 3 The opposire of pa i nful is........................................ .
4 A ........................................ neoplasm is ca lled a cancer.
5 ·rumours \vhich do nor invade or metastasize a.re ···· ···········-············ ·...... . .
6 ........................................ rumours are those which result from the spre-Jd of a primary.
7 Lf a cure is nor p<>ssible, ........................................ rrearment should be given.
8 1\·········-······················liver suggesrs 1nerasrasis.

Ove.r .f- '1º

o most li kely clinical d iagnosis in thc pa t irn t (d<·scrihl'd in B nppnsi te and 28.2
The ) is
above
lymphnma. How would you rxplaín his condition to hin1?

Pro(essionol E.ng11sh in Use MtdiCJf'!e 65

 Pregnancy and childbirth
Childbirth
Thc cxpcc1cd date of dclivcry (EDD) is thc date on which a woman is cxpccrcd to
give binh w 1hc ch ild shc is carrying (prcgnant wi1h). Ir is calcularcd by adding 280
days or 40 weeks ro 1he firsr day of 1he last menstrual period (LMP).Childbirth is a
lso referred to by doctors as parturi1ion. Delivcry is che proccss of helping the child to
be born. A spontaneous vaginal dchvcry (SVD) is a normal dclivcry. Jf therc a re
complications, rhe baby may be delivered by caesarean section (surgically removed).
A fuU-1erm pregnancy is 40 wceks. divided imo 1hree trimes1ers. A baby who is bom
beforc this is prcmarurc, and onc born aftcr 40 wecks is poscmarure.A baby who is born
dead, for example because the umbilical cord is around its neck, is srillborn . A
pregnancy may end before rerm sponroneously, wi1h a miscarriage (spontaneous
abonion), or be dc)iberaicly tcnninatcd wirh an induccd abortion (tcrmination of
prcgnancy).
Note: the verb induce meaos to cause something to happen.

Labour
Thc process by which rhc forus and placenta are pushcd out of thc menos is callcd
labour. 11 is divided inro four mges.Sorne words which are combinecl wi1h labour are:

pren1ature prolongcd spontaneous induced

fa)se
labour

Presentation and lie

Fcial e is 1he position of 1he
fcrus in thc utcrus.Thc normal
lie is longi1udinal, and che
abnorma ) líe is transversc.
Fetal preseoiarioo refers to 'ti-e
pan of rhe ferus which
occupics rhc centre of rhe
pelvic cana and
\vhich the exa1nining finger
feels on vaginal examination'
( Butterwonh ). The norma)
presenration is with the
head (vcrtcx presen tarion).
Breech
prcscntarion mcans rhe
buttocks are presenring Obstetric forceps
(breech is an old word for
buttocks). Abnormal
presentations n1ay require
dclivcry with forccps.
19. 1 Complete rhc scmence-.Look ar A, B and C opposuc ro help you.
1 A baby rhar is bon1a week before rhc l:UIJ is ·······-
···-·.
2 A .......................................of p1cgnancy may be ncccssary íor medica! reasons.
J Thc first three 1110111hs oí prcgna ncy are knuw11 a < rhe first .... ..... .......................... .
4 Fetal distress in thc firsr srage of ..--··--··-···...... i< an indicarion for caesa rcan

5 Ir was a brcech ----and delivery was b) for.-eps.

6A 1s an;)ther term for a spontaneous aborrion.
----- was wound cightly around the hab)'s neck and it was unfortunatel y
7 --

29.2 Complete rhc roble wirh words from A opposite.

Vl'rh Nou
n
abort
deliver
inducrion
miscarry
pr<sen1
rermination

129.3 Dr Bennctt, an SI 10, is pre<cnti ng a parienr ar a wcek ly meeting in thc obsrerric unir oi a
hospit.al. Coanpl etc thé pr<:'lenrarion ...vith rhc corrcct forni of vcrb.s fron1 29.2 ul.>oYc.

This is Clara Davis. 5he carne to 1he antenatJ I clmic ar nine weeks.In her past
obstcrric history,she had a prcgnancy "hen shc was 18. wh1<h \V3< (1) and
anorher onc a ycar later. which sponraneously (2) .Sincc thm <he ha<
had three prtgnancics. In 1he fim, che baby was (3) nonnally a1 40 we<ks.
ln che second, she had an (4) of labour al 39 weeks bccausc of fetal
distress. The chird baby (51--------·---·as a br=h and was (6) ·---·---- ..
...by caesare.an scct1on.
ProfessKJnol E.n1tish rn Use M td<1nt 67

-
 The respiratory system
Cough
Cough is a common symprom of up¡>cr respiratory rract infection (URTI) and
lung disease.A cough may productive, where the patiem coughs up sputum, or
non-producti vc, \vhcrc therc is no spurun1. A producrivc cough is ofren described zs
loose and a non·productive cough as dry.Spurum (or phlegm) may be clear or white
(mucoid ), yellow d ue ro the presence of pus (purulent), or blood-staincd (as in
hacmoptysis).
A doctor iscxamining • patient who iscomplaining of a cough.
Doctor: How long have you had thc cough ?
Mr Ha111i Oh, for years.
lron: Do you smoke?
DoclOr: 1used ro smokc hcavily, bm 1 gave up a year ago.
Mr Hamilton: Do you cough up an)' phlegm?
Doctor: Yes.
Mr Hamilton: What colour is ir?
Doctor: Usually yellow.
Mr Hamilton: Have you ever noticcd any blood in ir'
Doctor: No.
Mr Hamilton: Any problems with your breathing'
Doctor: Yes, 1ger very short of brearh. 1 have ro stop halfway up rhe stairs ro gcr
Mr Hamilton: my br<ath back.
The doctor writes i n rhe patiem's case notes: clo dy pnota & cough c. purulent
6putum for ye;a r6. No hae;mopti6.
Note: The noun phlcgm ¡¡pronounccd /flcm/.

Auscu ltation
The docror is exan1i ning Mr f--lan1ilron's chesr.

Take decp bréaths in and out th rough your

mourh. Good. Now say 'ninety-nine'.

Listening to the chest with a stethoscope may revea! rhe presence of sounds, apart from
the normal breath sounds.There are two main kinds of addcd sounds:
• crackles, which sound likc hairs being rubbed tc gcther and suggest the presmce of /luid
in rhe lungs
• wheezes, which are more musical sounds, like whistling, and indicare narrowing of
thc airways.TI1c sound of an asthma patient's brearhing is also called whceze .
TI1e sound heard when the pleural surfaces are in/lamed, as in pleurisy, is called a pleural rub.
TI1e doctor asks Mr Hami lton to say 'njnety-n ine' to check vocal resonance, which
may be increased (as in pneumonia), or dccreased (as in pncumothorax ).
Aft-er exan1ining Mr Ha1nilton, rhe docror adds ro his notes:

OE Che:,,: c:;;<rly i n!:>pir;< Cury c;r;<c;klc::,;

11oth lung 11aeee + expiratory wheeze

6 Pro(essionol Engfis-h in U$e

8 Medidne
30.1 Make word comhinonon u<ing a word fmm c,1ch OO\. 1.ook ar A and 8 opposuc ro help rou.
blood- hreath pleural productive vocal cough rub stained
resonance sounds

30.2 Rewrice thc qucs11ons, usirg words rhar are bener kno'"'10 paticnrs. look ac A opirc ro
hclp rou.
1 Is your cough producm·e?
2 What eolou r is rite spurum?
3 Is ic evcr pu rulcnt?
4 Have you cver had haemoprysis?
5 Do you suffer from dy<pnoca?

30.3 Are che following siaremenh true or false? Gi'e rrJ;on; íor your answers.usrng your medica!
knowledge and A and B opposore ro hclp i·ou.
1 A patiem who has a loose cough productS phlegJll.
2 Crackles arr heard when the airwars arr narrowed.
3 A patient who ha; a non·producrive cough produces sput urn.
4 Wheezes are rypical o( p eurisy.
5 A pleural rub is a sign oí asthma.

36',¡r old ó
clo sudden R cheet palnwftll M.o.while watchlng 1Y.
pain t l>y deep t>reathe and coughing
5-0.l>.pereleted CNe<' 4 houre from ite oneet to heamvalIn A&E
51. non·pro.:luc:Uve cough
f'H & FH nJ relevant
3152 holWy in M t<a:\a 3152
OE T 37.4'C RR 24/min JVP t : 6P ll0/64 P12a/mn
3 cm
RS chost oxpanelon + b<cause of pain
pleural rut> R lowor zono posriorly
Otherwi,;e NAD
 -
Pto(tssional Engl1sh 1n Ust M td l"Jnt 69
The skin 1
Sorne types of skin lesion
Mccloca l Common word Featu
term
macule spot res
1101 raised above rhe surface of rhe skin

papulc spot raised above the surface of rhe ski n

nodule lump a large papule
vesicl e smaU blister filled with fluid
bulla blister a large vesicle
pusrule - lillcd with pus
crust scab dried blood etc.on the surface of the skin
seales scales a thin !ayer of epidermis separated
from the skin
cicatrix scar a mark on the skin after healing
(plural:cicatrices)
naevus birthmark a coloured skin lesion present at birth
íleshy naevus mole a raised bro,vn naevus
vcrruca \\'art a nodule prod uced by HPV
furunclc boil a large pustule, or skin abscess

Note: The liquid (often yel ow) formed as a resull of infection is pus. l f a lesion is pustular.
it is filled with pus.

Rashes
A single skin lesion can be regular or irregular in shape. When there are many
(mulriple) lesions, especially macules or papules, the resulr is a rash, (or spots in
common language); for examplc rhc rash of an infcctiousdisease such as rubella. A
rash is said ro erupt,or break our.

in spors
M y Little boy has broken out ali over his body.
in a rash

The following fearures of a skin lesion are usually nored:

• location
• size
• shape
• colour
• rypc.
For a rash, nore also:
• Ji.)u·iUulio11 ( ,.,.¡Jt:v• t:ad - vu 111any pili-ts of rhe body, or loc._1ljted - on onc '\'.l rt
only)
• grouping (scanered - more or less evenly spread out, or in clusrcrs - small groups).
31.1 Complete the descriprion of herpes zoster (shingles) by replacing the medica! words u1
brackets with ordinary English words.Look at A and B oppositc to hdp you.
(1) ······
········· ··-······(herpes wsrer ) usually starts with pain and soreness. Then red
..... .....
(2) ...... .......... ....(macules) appear thar devclop inro groups of (3) ··· ··-······ ···· ···-··.....
.............. ..... .. (vesicles) over a particular area on one side of the body. ln most
pariems, new (4)........................... ... (lesions) conrinue ro appear for 3 ro 5 days.Thc
(5)................... ....... ............................... (vesicles)
become (6) ............... ....................................................................... ... ( pustular) and then form (7) ....................
.......
(crusts).In severe cases, there may be (8) ..... ................... ....(cicatr ices) afrerwards.
f8MJ2005; 331: 148 Amcnd with pcrmissioo fro1n tht BMJ P\blishing Group)

31.2 Read the descriprion of thr rash of rubella a nd complete the notes.Look at A and B opposite
to help you.
The spots are scattered pink macules which appear firsr behind the ea rs and on the
forehead. The rash spread rapidly, first to rhe trunk and then ro the lirnbs.
locarion and distribution:

grouping:

rype of lesion:

colour:

3 1.3 Complete tite notes for thc rash in rhe

phorogr::i ph, n<l llggf."st a diag:nos:iS:.
Look ar A a nd B opposite to hclp you.
locarion and distri bution:

grouping:

rype of lesion:

colou r:

31.4 Complete the notes for rhe lesion in

rhc photograph, and suggesr a
diagnosis. Look ar A and B opposire
10 help you.

location and distribution:

grouping:

rype ol lesion:

colour:

Ove.r -4-o 11ou

What typl'"i of rasht'"i 01rr ron1nHHl in your rountry? Is tht•n·any rra5on why they art·
l'0111mon?

Pro(essional English in Use M ediane 71

 The skin 2
I njuries to the skin
1- Jcre is an exrract Cronl a
rnedical'vebsire.
Mechanicalinjuries to the skin are
divided into those caused by a
blunt force, such as a punch from a
fist, and those caused by a sharp
force,such as a knife.
Injuries from blunt forces
• An abrasion (alsc called a graze
or a scratch) is a superficial
(surface)
injury involving only the epidermis,
which has been removed by
friction. A scratchis linear, as in
ñngernail scratches, whereas a
grazeinvolves a wider area, as in
abrasions caused by dragging part
of the body over a rough surface.
• A contus on (also called a
bruise) is an injury that occurs
when blood vessels in the skin are
damaged.
• <1·
J
• A laceration (also called a tear )is a
wound involving both the dermis and
epidenmis.Itis usually distinguished
from penetrating or incised wounds
by its irregular edges and
relatlvelack of bteeding.
Injuries from sharp forces
• An lncísed wound (atso called a
cut) is a break in the skin where the
tength of the wound on the
surfaceis greater than the depth of
the wound - for example,a wound
caused by a razor
blade.
• The depth of a penetrating
wound is greater than the
superficiallength of the wound -
for example, a stab wound
caused by a knife.
(Amcndoed with pc:rmission rrom thc BMJPublishing Group)

Case report
Read the case reporr and compare it wirh rhe illusrrar on.

A 9-year-old boy presented to the Accident and Emergency department alter he stumbled and fell while running in a
to the head from a rock and had been scratched by bushes. On examination,a vertical laceration 1 cm long was not

(BMJ 1998; 316:1364

Amendcd wit' ptrmis:sion trom thc BMJ PubUtung Group)

Sores
The word sorcis a pc¡pular term for many differenr iypes of skin lcsion,csp<'Cially
ink'Ctcdlesions. A pressure sore is a skin ulcer causcd by pressure,for example rhe
pressure oflyingin bed'orlong pcriods (also known as a bedsore.or docubitus
 ula:r). A cold soreis alesion caused by /Jerpes simplex.
Note: The adjective sore rreans painful,for example a sore throat.

72 Pro(es$ional Engtish in Use

Medicine
32.1 Wrire rhe corresponding medical rerms ior rhe ordina ry English words and say whar kind of
force is lnvolved. Look ar A. opposite to help you.

Common word Med ca l Type uf

term forCl·
bruise
cut

graze
scrarch
stab wound
rcar

32.2 Choose che correcr words 10 complere rhe

description of thc injuries sho\vn in rhc
illustration. Look ar A m1d B opposite ro help
you .
There are ( 1) ..............................(scrarches/grazes)
a bove rhe left cycbrow and on rht left side of the
neck, a (2) ................................
(conrusi<lilacerarion) t(> rhc left
side of rhe lower lip and (3) ................................ (cuts/tears)
to rhc left check.

32.3 Writc a description of thc injuries shown in the

illustrarion.Look ar A and B opposire and ar
32.2 above to help you.

32.4 Complete the scnrences. l<.'Ok at A, B and C opposirc r<> hclp you.
Frequent changes of position are necessary in che i111111obile parienr ro prevcnr rhc dc·vclopn1cnr
of a pressure ........................................
2 He had severa) .......................................wounds in thc a bdomen from the knifc.
3 He was knocked u nconscious by a heavy ........... ........................... ro the head.
4 The \\/Ounds 'vere only .. ..........-........................ lnd rcqui red no rrearn1enr.

Ovr .f-o
tjot1
The pollee have asked you to exanline a rnan who has been involved
restaurant. What type of injuries \vould you expect to find, and how· 1n a fight 111 a m1ght they have
hl'l·n
l'ausl·d?

Pro(essl011ol Engtish in Use Medft'.1t1e 73

-
The urinary system
Urinary sympto ms
Urinc is form cd in rhe kidneys and srored in the bladder unril ir is passed (or
voided). ¿
¡//
Paticnrs rnay say: D<>erors n1ay say:
[ havc sorne pain \vhcn 1pass \varer.
pee. Are you having an
\Vatenvorks ?

Doctor:

Are you
having
any
trouble
wirh
your
warerwo
rks?
Mr
Jones:
Well, 1
do seem
ro have
ro go to
thc
toilct
more
ofren
cha n l
used to.
Doccor:

How
often is
rhat?
Nlr
Jones:
Ir
depcnd
s, bur
so1neri
n1es it's
cvery
hour or
even
1nore
ofren.
Docror:

Whac
abou1
ar
nighr?
 Do you have to get up ar nighr? Mr jones:
Yes.Ncarly always rwo or rhree times.
Oocror: Do you ger any burning or pain \vhen you pass \Vater?
Mr jones: No, not usua lly.
Doctor: Do you have any trouble
gctting srarred ' Mr joncs: No.
Docror: Is che strci.m normal? J mea n is rhere still a
good strong flow? Mr joncs : Pcrhaps nor quite so good as
ic used ro be.
Oocror: Do you ever lose control of your bladdcr ? Any leaking
or dribi>ling? Mr jones: Wcll, perhaps a litrle dri bbLlng
from rime to time.
Docror: H:i ve )'011 rvl'r pa e<l hlooci i n thc ll rine?
Mr J ones: No, never.
Con1n1on urinary syn1pro111s and their dcfinitions:

frcquency frequent passing of urine

dysuria burning or scalding pa in in thc urerhra \\ hen passing uri
1

nocruria urination ar nighr

urgcncy urgenc need to pass urine
hcsitancy difficulry srarring to pass orine
urlnary inconrine.oce i nvolu ncary passing of urine
hacn1aruria 1nacroscopic blood in rhe urine

Urinalysis
Urinalysis is rhc analysis of urine. Simple screeni ng resrs of lhe urh1e are carried
out with reagent
strips, for example Cl in isrix for the detecrion of glucose. More derailed tests a re car-
ied out in
a laborotory on a specimcn of urinc. Typical specimens a re a midstrc. 111 specimcn
(MSU) and a catheter specimcn (CSU). Microscopic cxaminarion rnay revea) rhc
prcscnce of red blood cells, puscells, or casrs. Casrsare solid bodics formed by
prorcin or cells.
Plus signs are uscd in case nores ro i ndicare abnormal findings.A small
amount (+) 1s clescribcd as a trace. For a la rge amounr (+++), che words
gross or markcd ca n be used, for exan1ple gross hae111:auria. \'<lhen
thcrc is nothing. rhe 'vord nil is conunon.

sug 111.íl
ar +
protel ·n1ere was no suga a trace of
++ prorein and gross haem aru ria.
111.
+
bloo
c:I

7 Pro(essional English in Ust M

4 edicint
33.1 L.ook at thc convcrsa tion in A opposite and complete the notes about M r jones.
Lfse 111edical terins \vh('r(' pr> iblr.
l
c 1o ( ) ········-····· ·····-·····--··· ª""'
(:2) ··-···-·····-·········-···-·····-······fer 1l:J'·
No (3)····················-·or () ···-······················-···.
(5) ·-······-···-········--····Q littlt '.lffilur.
No ""°""-"'l'\t""'e et¡>Qrt f11i""- occasic"'-"l (¡;) ··--·····-···-·······-·······- .

33.2 Match the patienrs' descriptions of their symproms ( 1-7) wirh the medica! terms (a--gt.
Look ar A opposite to help you.
1 'Ihave to pee every half hour or so.'
2 'I get a scalding pain whcn 1 pass water.'
3 ·1 have ro ger up several rin1es ro pass \varcr at night.'
4 '1 have to rush ro go ro the roilet."
5 'Ihave trouble gctting started .'
6 'Ican't hold my water.'
7 'Ipassed sorne blood in m¡• llf ine.·
a dysuria
b frequency
e hacmaturia
d hesira ncy
e notturia
f urgency
g inconrinence

33.3 Writc thc docwr's qucsrions for each (Jf rhc sympwms in 33.2 above. W(Jk ar J\ opposite
10 hclp you. You will need ro rh ink of your own q uesrion for urgency.

33.4 Describe rhe findings of rh:laboratory repon in words. Look at B opposire ro hclp you.

bloovl +
prote"" +++
casts Vl.iL

Over -i-o '1º

What is your provisional diagnosis for Mr Jonrs?
ProfessJonol Engtish in Use Medicine 75
 Basic investigations
Ophthalmosropy
An ophthalmoscope allows 1he doctor
10 examine all parts of rhe eye:the tris,
lcns, renna and optic disc. Foc l:1C$r
rc>ul.
the ex:t 1ninarion is done \\ ith 1

dinln1ed, or lowcrcd. lighrs ro allow

1hc pupil to maxima lly dilate or
widrn. A 1opical
m ydriatic <olurion may be appli<.-d to thc
cyc to aid dilation. The pa1icnt is thcn 01rttlophlholmO!<Opy
a<ked to fixate on a rarg<t for the
clur.uion oí thc test.

Blood pressure

A smhoscopc
,, .
A sphygm o m anomctcr

A srethoscopc is uscd to hcar tht sound oí blood rushing back through thc ancry.
Thc first rhumping sound 1s 1hc 1ys1olic blood prcssure (SBP).Whcn thc 1hump1
;ou nd is no longer heard, that's 1hc d iasiolic hlood pressu rc (DBP).

-Taking blood
l)uring vcnipuncrure, the phlebotomi>t, a 1cchnicia n who rakcs blood. inscns a nccdlc
11110 a vein and wi1hdraws blood imo a spccimen 1ubr, which is sem to 1he
haematolog} laboratory for analysis..U,ually thc phlcbo1omist can find a •ein in thc
inner pan oí'h• doo\\, the antccubiral fossa, that IS e.sil} a=ss1ble.She may apply a
1oumiquct -a ught band - abo-. the si1e.or the p;mem ma} be asked 10 dench rheir
hand 10 make a fui. tn ordtr 10 rnake 1he •«in more promincnt. Aftcrwards, 1he
patient may be asked to pre.s hghtly on a dressing, usuaUy a piccc oí g;iuzc, to hclp
the blood 10 dot and 10 pm·tm S\\elling and a hacmatoma (a black and bluc mark, or a
bruisc) whcrc the vein was punctured.
Note: A bruise is a specific mark. Bruising can be uscd to describe a number of bruiscs or a larger
arca - The paticnt exhibited bruising on thc ríght farf:Drm.

76 Profmionol Engfish in Use Medicine

34.1 A doctor is ralking to a patient during an ophthalmoscop¡•. Match thc underlined
cxprc-ssions shc uses ( t-4) «> expressions \Vifh similar meanings from A opposi rc (a-d}.

Righr, Mr Gokl, because you've been having rhcse headaches l'm going to have a
look at your eycs, particularly thc back oí your cyc - the retina. l'm going to put (
1) a cwole of drons in your eye, (2) ,yb jch will n1ake j e easjer for n1e ro see r h e
retina. After a fc\v 111inutes you niay find your vision a bir blurry. This \YÍll \Vl-ar
off aftcr about an hour.
(3) 1uced to grr rid oí as much externa! l ight as oossible. This meaos closing the blinds.
Now, l'd like you 10 (4) look srra ight ahead at that dock . This takcs a few minutes and
your eyes might feel a bit tired so you can blink if you nced 10.l don't want you ro
look at me, look at the dock.

a 1he examination is done with dimmed

lights b a topical mydriatic solmion
e t(> aid d ilation
d fixare on a rarger

34.2 Complete 1he insrruciions. Look at B oppositc to help

you. 1 Wrap the ................................ around thc patient's
uppcr a rm.
2 Place the ................................over 1he arca oí the brachia l arrery.Raise the patient's
arm so
that the brach ial arrery is ar the samc hcight as the hcart.
3 Close the valve on the ................................ .
4 Pump up the prcssurc to >t least 150 mmHg. Open thc .................................a linlc and
slowly dcílate the cuff while listening and wa rching 1he pressure .................................. .
5 The firsr sound you hear is the ílow oí blood through the brachial artcry. The
valuc on the gauge at that poim is 1he
..................................................................................................
6 Continue listening while you slowly ................................... thc cuff.
7 The ................................ blood pressure is measured when the sound completely disappears.

34.3 Complete the CX!. Look ª'e opposite O help you.

( 1) ................................ are specially trained in raking blood. Thcy are skilled at (2)
.............. puncruring the vein to rakc a blood samplc.The wrist, hand and foot can be used
but more OÍ!en a vein in the inner pan of the elbow is used. H it is diílicult to locate a
suitable vcin, the
patiem may be asked 10 make a (3) ........... ....................., or a (4) ................................. may be
appl ied on rhe upper arm ro make che vein more apparenr. Afrerwards, a (5)
............................is appl icd and the
patient is asked to press gcntly. This hclps 10 stop thc bleeding and prevent (6)
............................... at rhc site. lt is imporranr thar (7) .................... .................... ...................are la
belled correctly before they are sem ro the haematology (8)................................. , where a íull
blood count or other invcs1iga1ions will be carried our.

OVe-r +o 11ou
Prarlisr talki ng a p<.1l il·nt through an inVl''iot igation t ha t you rarry out
rrgularly.
7 Professionol English ;n Use
8 Medicine
Proftffionol Engti.sh in Use Mtdant 77
 Laboratory tests
A Microbiology request form
A M icrobiology reques1 form uses a number of abbreviarions for specimcn types (sec
Append ix U on page 131 for an explanation of thcse abbrcviations).

Date collected ...!.../...

Time collected ............ (24hr)
0 MSU O Blood Culture
o csu
O Nose sw
O Throat O Clotted Blood
O Urine -Other, specífy
O Urine first voided -br
sw O Axílla o EDTA blood
sw O Groin 0 CSF
chlamydia sw O Eye
O Faeces sw
O Sputum O EndoceMcal sw
O NP secretions O Sw in Virus TM' (give
O BAL site)
Olnduced sputum O Sw for chlamydia (give
Other: site)
'special medium

A Biochemistry and Haematology lab report

Valu R;tl'lgC Unit VaJue Ron¡;< Unit
Fullblood coun 1 (FBC) c Urc'.l :1nd dccrrolyrC$
Hacmoglób1n (Hb) }4j 1 1 .S-1 6.S g/L (U&t)
Hacn1atocrit {HCI') 0.224 0.37- l/L Utca 4.5 2.5-6.6 mmoUL
'lt". an cdl ,·olun1c n.5 0.47
78.0- fl. Crcari ninc 58 60-120 umoUL
(MCV)t'.t'll l-ount
\Vh.itc :'.4 98.0
4.0-11.0 IO IL Sodium (Na) 138 13$-145 mmoVL
(\VCC) rowsiu111 (K) 4.$ 3.6-5 mmoVL
Li,·er funaion 1cst
(Lfi')
llilirubin 7 3-16 u1noVL
ALT 9 10-50 U/L
AlkaUnc Phosphatasc 131 40-125 U/L
(Alk.Phos)

Terms used to describe lab results

up high

ckvatcd raiscd

When the results are within the norma l \Vithin norn1al lin1iu.
range, doctors say: Porassitnn isnor1_nal.
unrc.n1arkablc.
U111 t ahhrl'v1a t 1on Fu ll form
g/L UL 109/L grams per litre
fL litres pcr rrc
mmol/L ri111es ten to the po\ver nine per litre
umol/L or!"nol/L fcmtolirrcs n1illi111ols per lirre micromols per lirre unirs per litre
U/L
35.1 Write rhe namc of rhc spa1men for each of rhe >u>pectcd condirions. Look ar A oppo:.ire
ro help you.

Suspt·rkd Spt·t·1nu·
rnnd1t1011 n
anaemia
bacteria! conju ncrivim
genital herpes
meningitis 1
scpócarmia
urinary infccrion
urinary infccrion (carhcrcr in place)

35.2 Complete rhe scntences dcscribing rhe resulrs of thc repon i n B opposirc. Look a r C opposire
ro help you.
1 Haemoglobin 1s • onc hundrcd and forty·thrtt
per lure.
2 Cn:arininc "shghtl) • fih}·e1ghr lirre.
3 Alkaline Phosphata'i<'
·----, one hundred and thirty-one _
11

4 ALT is sl ightly rcd ucecl, mnc ·--·--··--··-··

5 Bil irubin is . ... , M:ven··-·······-····· ····
35.3 \Vritc full dcscripiion' uf thc follu,\•ing r::.uh) Í1 0111 ,l 1.-J)C l1i!'!lufy. Look .lr D ,
1ocl C
opposire and ar 35.2 ahovr to hdp you.
Na 138, K 4.5, WCC 12.2, HCT 0.224, MCV 72.5, Alk.Phos 72.ALT 9
5oró!Lm is IXl(l!lll1,C'".b11!1Pml.11r<1 -att-ir ,,,., per- 'Vli. _

······--···--·····-·····--···--··---·--···--·---·----·--···----·----····---···---
···--···--·--··- -·····--·

----··---·-------·--------

8 Pro(essionol Engfish in Ust

0 Medicine
 Endoscopy
Fu nctions of endoscopy
Endoscopy is a way oí rxamining parts of rhe body which are nor visible from rhe
ourside. A typical cndoscopc is a ílexible tube wh ich is ioserted rhrough one oí the
natural orifices -opcnings - such as rhe an us or mourh . Rigid cndoscopcs, which
cannor be benr, are also used but are inserred through small incisions-surgical
curs. The shafr conrains severa!channcls ro transmir light from rhe ourside and images
from inside and ro allow differenr instrumenrs tO be used.
Endoscopes ca n be used for rhe following: flexible ti p fitted with
• ro provide diagnosric informa tion • lilli-...:.l_<ens or camera
• ro excisc - cut our - discased rissue or
growths such as Jl()lyps
• to dear obstrucrions
flexible shaíl containing
• w rake a biopsy image channel and
• ro cautcrizc a sitcof blecding by channels ror light, air
applying heat. and water. instrumc::nts
and wires

En teroscopy
Or ja rdine is ralking her parienr dtrough an
enteroscopy.

Now, l 'm jusi lubricarinl( thc rube with a jclly which conrains a local anaesrhcric.
lt'll help ro ensu re a smoorh passage as ir passes down and you shouldn't fcd roo
much.

J 'm going t<> fecd rhe tube through your nose. This is rhe mosr uncomfortable part <lf thc
procedure bur ir's ver¡bricí. You 'll gcr uscd ro thc tube in a few minutes' time.OK.
when ir hits rhe back of your throar, takc a deliberate swallow. 1'11 rell you when.

I
Now !Swallow, swalbw. That's ir. Well done.

Report of a diagnostic endoscopy

El'AMINAlllH
lnformed consent was obtained fromlhe palieot after discussing risks and benefits of the procedure.The
the premedication administered as stated. The endoscope was introduced ínto theoesophagus.Al the e
the patieot was transferred to the recovery area to recuperate.
36.1 Complete the table with words from A, B and C opposite.

\/rb Nou
n
consent
cxcision
incise
insertion
recovcr
swallow

36.2 Find words in A and B opposire wirh rhe following meanings.

1 to pass (an insrrumenr rhrough an orifice)
2 a subsrance used in procedurcs for lubricarion
3 rhe ílexible part of rhe mdoscope
4 ro srop somerhing bleed ing by applying hear
5 a growrh rhar prorrudes from a mucous membrane
6 to re1no\ e dise-J- scd rissuc
1

7 taking a sample of a rissue for

analysis 8 nor ílexible
9 a drug thar numbs a particular part of rhe body
10 become accusromed to

36.3 Rcplacc rhc undcrlincd'vords and phr 1.scs 'virh altcrnari ,c '''tJ1J!) auJ µlua írona Coppositt.
Afrer connccting rhc patienr ro an { 1) jnsrru n1cnr \Vhich 111easures levels of oxygen jn t'Je
blood and pu lse tate and placing him (2) on bis lefr sjde, oxygen was provided
rhrough H (3) tuf>r in his nosc and rne (4) dru" rrearmt·nr prjor ro rhe procedure
adn1i11iscered as stared. Shortly afrerward, the endoscope was (5) inserred inro rhe
oesophagus. Afrer rhe exan1inarion, the paticnt \vas (6) to rhe recovery area.

Nasal cannula

Over .f- 11o

o \."lould you
What u !>ay to a nl during a bronchoscopy, or during anothl·r
palil·
investigation intt·rnal
\vhirh you crirry out regularly?

Pro(essionol fngJJsh in Use 81

Me«ine
X-ray and CT
Radiography and radiology
Radiograph y involves exposing a pa rr of the body to a small dose of radiarion ro produce
an image of rhe inrernal organs.Organs with high densiry such as the ribs and spine are
radiopaque, meaning they do not absorb radiarion, and appear whire or lighr grey on rhe
image. Lung rissue is radiolucen t - absorbs radiarion -and appea rs da rk on the inuge.
Bcfore sorne rypes oí X-rays, paticnts are given a liquid callcd a contras< mcdium ,
such as ba rium or indi ne, which is radiopaquc and allows rhc organ or rissuc ir fills ro
be examined . The conrrast medium may be swallowed, inrroduced through the anus
as an c.ncn1a or given as an irjcction.
1

Radiology is thc use of radiarion in thc diagnosis and trearmcnt of discascs such as canccr.

X-ray examination
The chesr X-ray is the commonesr diagnosric X-ray exa minarion. Normally a frontal
(ameroposrerior) view is obrained. Thc paticm stands facing thc photographic plate with
the chest pressed to rhc ?lare, with hands on hips and elbows pushed out in fronr. The
radiographer , thc rechnician who rakcs thc X-ray, asks thc patient not to movc, thcn to
brearhe in deeply and not to breathe out. This makes a blurred. unclear X-ray i mage less
l ikcly and improvcs the qua liry of thc irnagc, as it is casicr to see abnormalitics in air-
filled (inAated ) lungs than in deflated lu ngs.

e Kccp stb Now, t•kc • dccp brearh and hold your brcarh.

For a side, or lateral view, the paticnt is asked to srand sidcways to the photographic plate
wirh arms raiscd. A chest X-ray may be rcpcared at inrervals to track for any changes.
Thesc rcpeatcd cxa111ina1ions are called serial chest X· rays.

Computed Tomography
riere is an extraer írom a hospital's press release.

The Western Genera! has installed a new GE LightSpeed 16 Computed Tomography (CT) Scanner. CT uses anX-ra
The new scanner takes up to 16 simultaneous cross-sectional images (slices) and transmits more data in less time
smallabnormalities.
The scanner will be used for:
diagnosing muscle and bone disorders
locatlngtumours,infections and clots
monitoring the progress of malignan!diseases and the l'9llpoM9 to therapy (treatment)
providingaccurate guidance for nterventional
.ocedl...such
. as biopsies, and dra nage
-rwnovlng fluid trom the site of an injury or
3 7.1 Choose me correa word r phrasc to rnmplctc cach scntence. Look at A and 8 oppositc
10 hclp you.
1 In rad1ogr.1phy, barium is uscd as a contras! ·--(image/mediuml.
2 'lis.ue which absorbs radianon and appcars dark on an X-rar is·---·---
·---..
(radiolucenr/radiopaqur ).
3 An ........................--....(enema/injecrion ) 1s a liqu1d inrroduced into the bowel by way of the anus.
4 X·rays used ro measure rhc progress o( n dise.1sc.1rccallcd
................-.....-....·- (rcpcatcdlserial) X-rays.
5 1( a paticnt moves during an X ray, rhc i ma¡;c may be ................_.............. (blu rrccVahno11n al).
6 lt"s easier to see abnormaliric< when 1hc l ungs are .........-.....-.............(deílatedlin ílaied).

37.2 Complete rhe words.Each lx-.gins with r<1d10. 1.ook at A and B opposite to
help you. 1 Using radiation ro diagnose and trcat d1scasc 1s radio.·----------- .
2 Using radiation 10 make images is radio
3 Us1ng radiar-ion ro pro,ide rreatn-.ent t5 radio. .
4 1( sonlC'lhing is n0t pcnttrablc by rad1anon, 11 1s radio
5 1( som<:thmg is penetrable by rad1anon, 11 1s rad1
----
6 A tcchnician \\•ho admi,1srrr X-r..l)\ ,.. a radia

37.3 Complete the radiograph<rs instrumon>. 1oo at B oppositc ro help you.

Picase stand ( 11 -- ··..····--....·--.... this board.
Put your hands on the back o( your hips and your clbows forward. 1'11 hclp you.
(2) ................................ your elbows (3) ........... .................
Kcep (4) .. ...... ..... .. ............. .
In a moment 1'11 ask you ro (5) .................. a dcep brcath in and hold it.
llrcathe in, (6) ....-.......................... it.
That"s i1. Fine. You can breathe out now.
lhank you. rll ne<"d ro check the film.
l\ow rm going 10 rake a side v1ew.
Can you srand (7) "11h )'Our ro¡tht s1dt dose 10 tbe machine and your arrns ra1><d?

D7 4 Complete the rabie with words from B and C oppo;11c.

Vnh Nuun AdJtTf

lVl'
al>normal
brcathc
dra in
intcrvcnc intervention
1hcrapcutic

Ovu .f- 11ou ·

fow. ; n lo a pa tit·nt wh•t an X ty 1\;1nd w h,11 .1 CT \C'annt.·r doc:\.
pl 11 -r;

Pro(ess1onof Enft;s.h 1n Ust Mtd<int 83

MRI and ultrasound
Magnetic Resonance lmaging (MRI)
MRI is safcr than X-rays because ir <loes nor use radiarion. I r provides 111ore
ínfonnation rhan Com pured Tomography (sce Unir 37) about some head, neck and
spinal disorders because rhe i1nages are nlore decai led and havc more contrasr,
111eaning the differences berween dark and light areas are srronger. Unlike CT, rhe
images can be raken on any plane - any surface of the body seen from an angle. Ir
is now used for imaging - raking images of -rhe brain and hea rt, and in oncology.
Contraindi cations. cases in which ir should nor be used, include parienrs with merallic
forcign bodies in the orb.rs, and pariems wi rh pacemakers -electronic deviccs
surgically i mplanred ro regulare heartbear. MR I is also not approved during rhe firsr
rrimcster of prcg:nancy.

Ultrasound
Ulrrasound exarni narion uses high-frequcncy sound \vavcs to vie'v organs and
struc1ures i nside rhe body.The wavcs are generated and received hy a hand -held
device called a rransducer. The reílecred waves are processcd by a computer which
produces dera iled
images for d isplay on a monitor.Ulrrasound is safe as ir <loes nor employ ionizing
radiarion li ke X·rays. Ir is a cheap, quick and non-invasive investiga.rion - \virh no
surgical proced urc - for a wide range of referra ls, a lrhough T'lSu lrs can be
unsarisfactory i n obesc (overweight) patienrs.

Preparing for medical imaging

Preparing for an MRI sean
You will necd to have complctcd a safery qucstíonnaire and have it with you< '1• Ir
is i1nporranr thar rhcre is no mera! on your clorhing or person 12•. Prior ro rhe sean
you can car and drink normallr°'·Your derails and sa fery quesrionnairc will be
chccked wirh you
by the radiographer, who will explain the procedure and answer any quesrions you may
have< 41• You will be asked to remove any merallic objects, as well as crcdir cards<51•
You wiJI be asked ro lie cm thc MRI scanner rabie and make yourself comforrabl el61.The
radiographer will posirion rhe parr ro be seanncd carefully in the • During rhe
71
scanner'
MRI sean you will nor feel anything but you will be required ro sray still to achieve
the best possible images<81. The whole examination process takes approximarely 45
minutes<9J. You ,,,¡JI nor requirc any injcctionsl•Ol.
Preparing for an ultrJsound
You will be asked to lie on an examination rablel 1 ll. A spc'.Cial gel is applicd ro your
skin°21• This ensures thcre are no a ir pockers berween rhe rransducer and your bodyllJJ.
The transducer is 111oved over the ar'l ro be >_ You l'nay feel so1ne pressure
4
cxan1inedll
and expcricn ce some discomfort ,especially if rhe test requires you to have a full
bladder' 151• You may be asked ro changc your posirion for clearer picrures< '61.
When rhe radiologist is sarisfied with rhe pictu re qualiry, rhe test is done and rhe •
gel is wipcd offl '71
A rypical test may takc bctwc..,n 20 minutes and one hour081.

revcaled reduction of
Describing medical imaging n1erasrnses.

An ulrrasound sean of rhe liver

 An ultrasou nd sean of the abdomen
dcmonstrared a sma ll righr renal
tumour.

An ultrasound sean showcd an intra-abdomi nal abscess.

38.1 Match thc two pa rrsof thc senrcnces.Look ar A opposite ro help you.
1 MRI provides more deiailed information tha n CT because
2 MRJ is nor approved for use i n
3 MRJ is safcr than X-rays because
4 MIU allows imaging on many planes
a rhcrc is no radiation.
b unlike CT.
e oí high conrrasr sensitiviry.
d rhe first rhrcc monrhs of prcgnan cy.

38.2 Match whar rhe radiographcr says during an MRI sean wirh a nu m bered point in C opposire.
a You don•r nced any injoctions.
b 1 want you ro lie down and just relax.
e lr's importanr that you try not to 1nove.
d 1'111 going ro go rhrough your qucsrionnaire \Vith you.
e Ir will be over in th ree-quarrers of an hour.
f lr's very i111porranr thar you put any metal objecrs inro chis tray.

j]8.3 Match what thc radiographcr says during an ultrasound wirh a numbered poinr in C
opposite. a l'm going to pur sorne gel c)n your abdomen. You mighr find ir a bit cold.
b Tiiat's ir. All done. 1'11 jusr dean you up.
e l'd likc yc¡u ro lic flar on your back on thc rabie.
d The gel is to make sure rhere's a good conracr wirh your skin.
<:: 1'11 movc this back and ÍOn\•ard$ ro covcr thc ,vholc arca.

"8.4 Makc word combinations using a word from cach box. You may nc.::d to look at
Unirs 34 ro 37. Then use some of the word combinarions ro complete rhe
sentences.
breathe cxcisc experience forcign hold ínformed íntroduce local rccovcry

anaesthetic your brcath irea

diseascd tissue discomfort
ín bodíes consent
the cndoscope

t l'm goíng ro gi ve you a .......................

........................................so rhar you won'r feel any pa in.
2 With an MRI, ir's imporrant rherc are no mctallic · ·····-····-····-·-····-·-···-·-···-·-·-··-··-·--·in rhe cyes.
3 After an operation. parienrs are nloved ro a ................ ................······-···........ ..........ro recuperare.
4 Endoscopes can be used to ........................................................................... .
5 Bcforc an endoscopy.t.e parienr's ......................................
..................... musr be obtained.

8 Pro(mionol E.n¡hsh in U1e

6 Medicine
Ove,r .f-o tfou,,,
Expl;Jin to <.l patil·nl v\'h · you ;:1rt· n:f,:rring ht·r for an ult rasounct sran nr ;:in MRI \f;;n, and
\Vh 1t sht' ran cxpect to '1;1ppen during tht' proredurl'.

Pro(essionol English on 85
u..Mtd10nt
 ECG
Uses of an ECG
An dccirocardiogram (ECC) is a iracing, or drawmg. produced by an clecirocardiogmph -a
device which records clectrical acriviry in thc hcar1. An ECC can be used for:
• deciding 1f 1hc hcan is pcrforming normall)' or suffering from abnormali1ics, for
cxample cardiac arrhithn"1 -extra or skip heanbcat>
• indicating damag< to hcan muscle, such as he.in attacks, or ischacm1a of hcan
muscle (angjna)
• derecring conduction abnormalitics: hcan blocks and bund le branch block> (B88)
• scrccning íor ischaen1ic heart diseasc during an cxcrcise 'olerancc 1cs1, oftcn tnrrled out on
an exerci<e bi ke or trcadmi ll
• providing informmion on rhe physical condition of the hea rt, for ex:unplc in pa 1iems
wirh left "emricular hypertrophy (LVH)
• derecting elearoli1e di>turbances, for cxamplc low plasma potassium le,cls.

ECG procedure
1 kre is an e\rract from 1 medica) tcxtbool.

l The paLicnt should lie down and relax.

2 Calibrato c ho l\CG mnchi ne - a standard signa!ol' l mV should mo•e llw s1ylus 1wo
large squares ( 1 cm) vt•rUcaUy.
3 Altach Lh e limb lcatls: lcl\ arm OA). right nrm (RA). len lcg (LL), and righ1 lt•g (RL).
4 Record lhe sí• standard lcads:l.U .111.augmemt'd \ Oltage rigbt arrn (A\ ll J. 8'«"1en1t'd
mltag<> Jcl\ ami (>WL).a11d augn1en11'd \Ohage foo1CAVFI - lhree or four rompk'"-s
e
(see below) for each.
5 Apply thc ell'Ctrode 10 tbe six chcs1 position> in tum. recording lh 10 four
comple<cs of each. ir 1he rhythm docs not appcar LO
rh) thm strip of
oo sinus (nom1al rhythml. a
6-10 complcxes in u single lund should be rerordt>d.

A normal ECG
The picrure show an ECG tracing ORS
oí a normal hcanbea1 sho" ng a P complcx
wave, a QRS comple, and a T R
""'e, Each largc square 1s «Jll\
alenr ro
0.2 seconds. Thc R -R in1er>al
gi•·es
the hcart mte, in th1s CJ>e 75/rnin.In
the case of abnormali1ie•. rhe QRS
complex can be widcncd or tuo tall.
The ST segmcnt can be clcvatcd
or dcpresscd. Thc r W.l"C can P
be waw
the righr way up, or inwrtcd -the
'"''rong '''ªY up.

º
PR inl irrval
1
 1wavt"

OJ nt<rval
s
39.1 l'ind words and phrases in A and B opposire wirh rhc following
meanings.
1 the marks produccd by an l:CG styl us
2 a test which determines how well a paticnt copes with physicil
exercise 3 a misscd hearr bear
4 a change in rhc chemid composirion of body íluids
d ...............................
5 rhe ílow of elecrric cumnr in the heart
6 tesring for discase
7 check or adjust an i nstrumenr before
use 8 thc pen which produces the
drawing

39.2 L,bcl the limb leads {a-d) on rhe

firsr diagramJ and \Vrite a ritle (e) e ................................
for rhc second diagram. Look at B
opposire ro hclp you. 39.3 Complete rhe
texr using words from
rhe box. Look ar C
opposire to help you.
a ........................
........ com l \ inr rar
xes e V e
a a
d .
v
b ............................... s
e
e ................................

This very a
bnormal
ECG¡hows a ( 1)
.............................
... of
approximarcly
33/min; a single
long
pause
of
approxi
martly 4
scconds
berween
venrricu
lar
complex
es wirh
arria!
acriviry:
widened
QRS (2)
..............
..............
... in
keeping

8 Professionol Engtish in Use Medicine

8
wirh (R)lllíB.Dccp T (3) ................................
inversion in rt , 111, AVF and some chesr (4) ................................(V4-
V6).Deep QRScomplexes
in V2 and V5 in keepi ng wirh LVl-1. One arria!ecropic. QT (5)
................................is normal.

le:id 11

OVe.r .f-o 11ou

Describe an ECG tracing 11f one oí your patients to a collt"agur.

Professiono l Englrsh rn Use M 8

edoone 7
Medica! treatment
Prescriptions and drugs
t s parr of rreannenr, a doctor n1ay prescribe n1cdication , con11nonly referred ro as
medicin e or drugs.A prescription may take theS<> forms:

T&ib.N a bu»<eto soo Yl<.0

IM.tte so,
sg. :i tab. Noctt

Nabumetone Tab 500 mg

send 56
label2 tablets at night

Old styte New style

In the UK, parienrs rake presc-riptions ro a chcmist's shop, \\lhich sells a 'vide range of
non prescription medicines and other producrs such as cos1netics, for di.s-pcnsing by
a pharmacist (the person who pre1>ares the medicines). In hospirn ls, prescriptions are
dispensed by che pharmacy (rhe departmem where the drugs are prcpared).
Drngs come in many diffcrcnt forms.See Appendix 111 on page '1 43 for descriptions and
illustrations, and Appendix JI on page J 31 for a list of abbreviarions used in prescriprions.
Note: Latín abbreviations in prescriptions are being replaccd by English,but may still be sn.

The British National Formulary

The British National Formulary provides infonnarion on prescribing and adminisrering
prescripuon drugs 111 the UK.

SULCONAZOLE NITRATE
lndications: Fungalskininfections
Cautions: Contact with eyes and mucous membranes should be avoided.
Side-effects:Occasional local irritation and hypersensitivity
reactions include mild burning
sensation,erythema,andiching.Also bl stering. Treatment should
be discontinued if these are severe.
Dose:Apply 1-2 times daily,continuing for 2-3 weeks alter lesions
have healed.
Exelderm® (Centrapharm)
Cream, sulconazore nitrate 1%

1\11 indication is a siruarion or a sign rhar suggcsts a specific rrearn1enr should he

gh·en. A conrraindicarion is a situation or sign lhat a specific drug <>r rrtatment shouJd
nor be used or is contraindicatcd.
Exeldcrn1® is a proprietary - conunercial - nan1e for a rnedicarion conraining
sulconazole nirrre. l11e same drug may have both a proprierary na111e and a gcncric
nan1c. For exan1ple, Prozac and FILoxerine are rhe proprictary and gencric nan1es for
the saine drug.
.1 Maccb 1he ahhrevianons ( 1-91 wi1h che1r meamngs (,1-1). 1.ook •• Append1x 11 on P·'
"
131 co hclp you.
1 p.c.
2 q.d.s.
3 s.c.
4 s.1.
S p.o.
6 e.e.
7 p.r.n.
8 i.v.
9 infus"
a by mou1h
b subli
ngual e 'virh
rneals d as
rcquircd e
after food
f intravenous
g four rimes a da)·
h infusion
i $Ubcutaneous

.2 Complere the o;cntcnce>. Look ac A and B oppo51tc co help you.

1 .......................... .. of 1hc ;k in may be ca used hy drug;;,u h as aspirin which can
produce a rash. 2 Ar a .......... ......... ... you can ger your prc'iCri p1io11 and all sorrs of orhcr
hca lth produeis.
3 Gasrro·inrerinal irrita:ion is a _,..........,.,_,.,., ,_ .. ..of aspirin.
4 Aspirin is Íor paricncs'"ith previous or active peptic ulceranon.
S When buhbles appear on the skin due to heat or 1rmauon, chis is called
6 The ma,imum of paran-ramol for an adult 1s 4 grnmrnes d31l)'.
7 mc.rns J drug is nor conrrarndicated bue care mUSt be '3kcn in "'use.
8-- for mdl'lnc phosphate are m1ld to moderare pain and cough
supp"'°''º"· 9 A person who d1spen>e> drugs is a ·-----
10 The place whcrc drug' are dispcnsed in a h<Xp1ta l ".t ...............................
.3 Describe each of rhc<c prcscriprions for a paticnt with su;poctcd acure coronary syndromc.
1.ook ar Appcndix 11 on page 131 ro help you. Tite fi r.1 one has been done for you.

Mcd1c1 nc Dose Mcthod uf adn11n"l ral111 n

1 Srreprokinase 1 500 000 u '·'·infus" O\'Cr 60 min>
1 Aspirin JOO mg p.o.Sl3t
Oiamorphinc 2.5-5 mg
' ·· tat
Metoclopramide I O mg i.v. srar
GTN 300 mcg/5 mi i.v.infus"starr @ 40 nicg/m11

over .f-o tjoti

Practise wnt1n<1 prt·srn¡>llons 1n English for n1·ld1r;1t1on you often havt' to prl"\t·rihl·1nyour
o\vn languagl'.
Professiono l Entfrsh 1n Ust Mtd1C1M 89
 Surgical treatment
The operating thea tre
Su rgery is carried out in an opcrating thcatrc. Crear carc i s rakcn to
1nake sure char operations rake place in srerile condirions - free
fro1n rnicroorganisms. The surgeon and his or her assista1lt \vash or
scrub up, and pur on surgi cal go,vns, masks, and glovcs. Thc
paticnt's skin is prepared by disinfecring ir \Yith an anrisepric
solurion. This is kno\vn
as prcpping (preparing) rhe patient. They are then covered with srerile
drapes, so rhar only rhc arca of rhc opcrarion is cxposcd.

lnstrum ents
The nlost basic surg.i ca 1 insrrun1enrs are sho,vn in rhe

scalpcl
picn1re. rcrractor

diss('cring forceps
scissors

The operation
Thc opcration begins when the surgeon makes an incisioo or cut. Control of bleeding
is very i1nporranr. A S\Vab is a pad of corroo or orhcr n1arcrial uscd ro soak up
blood frorn the opcration site. A suckcr is a mechanical device which aspiraces
-sucks u p - blood. Bleecling vessels are tied with ligatum; or scalcd by an cle<'.tric
current (diathcrmy).
Drains may be inserred:o carry away fluid wh ich mighr act asa cu lture mediu m for
bacteria. Various mctho1s are uscd to close the wound, for example su1ures (also
known as sti1ches), or staples. final! •, die wound is covered with a dressing.

An opera tion report

9 Pro(essionol Engfish in Use

0 Medióne
This patient had an indirect rightinguinal hernia.
Anaesthesia:Spinal anaesthetic with localanaesthetic infiltration lncision: Right inguinal
Procedure:The externa!oblique aponeurosis was divided and the spermatic cord mobilized.Th
Closure:The wuund was closedin layers with Dexon suture material to the externa! oblique apo
41. 1 Which of che instrumcnt> ,hown in B opposue "noolcd for each of the followmg procedu res?
1 rnaking an IOCISIOl1
2 keeping the sides of rhc wound open
3 curring suturc'i
4 holding rhe cut cnds of blood vessels beforc rhcy are tied

.
A surgcon is talking 10 a ntdical srudent abour asfüung at operarions.Complete his
¡1.2
advK:e using word< from A, B and C opposire.
An 111 - rrust be able to carry out the following tasks to hclp thc
surgeon. Firsily, he or <he must hclp in (2) --- the paticnt and punmg the
(3)-···-··--····. 111 ploce to providc (4) ·------ condirions. Experr
handling of a (5) -...-........... is l'Ssenrial ro allow rhc
;ur¡;eon to Sl'C what he is doing.
Thc as. istanr musr al<o kt'ép rhc operation sirc free of blood, by careful uo;e of rhc
(6) .......-.....-............ .... .. or (71 .........................-......... .Thc < 11rgco11 al>o needs assisrnnce with
tying and curring (8) ...... .... -. ....,and with r hc insertion of a (9) ' ,.,.'
......
if nocessary.Finally. rhe asMstant may be asked 10 close the wound
wirh
(10) or uhcr cJe,'ices.

-1 . Find words m C and O oppos11e "ith rhe followmg meJnings.

3 1 cut into º"'º pans
2 correcred (somc1h111g tnat was damaged)
3 frecd from surrounding ti>sues
4 removed by cucring m«
S sprcad <> f liquid into nn aren
6 making sure <-0mc1hing is 1101damaged
7 small metal devoces to hold che edgcs of a wound to¡;cthcr
8 unnecessar y
9 sewing up of the "ound
10 flat, thin poeces of 11..sue that lie on rop of one an01hcr

OVe.r .f-o /10LI

kt·vholt·\Urgt·ry (t·ndo\f •p1r \Urgt·rv) h¡j't l>t·t·nnll· popul ar. How 1mpor tant 1\ 11 111 'urqt·ry?
l\'hy '

91
 Therapies
Radiotherapy and chemotherapy
Radiotherapy is rhe use of radiarion in conrrolled doses 10 trear canccrs. Ir works by
damaging rhe DNA of malignanr cells. Radiotherapy may be uscd:
• as curari vc treatnX'nt, for exanlplc to shrink tu1nours
• as adjuvant treatn1ent, alongsidc or follo\ving chen1orhcrapy - rrean11enr 'viril anri-
cancer
drugs
• in lo\ver doses as palliati ve rrearn1enr ro reduce pain and other syn1ptoms of .:ancer or
disease, bur nor as a cure.
A radiologisr derermines the dose and thc exact rarger for the radiarion bea ms.Doslge
is measured in grays (G¡).A daily dose is a fracrion. Radiorherapy can also be
deli,ercd inrerna lly by radioacrive implanrs such as needles, or by liquids such as
srronrium for son1c bone cnncers.

A day in the life of a physiotherapist

Sam is a hospira l physiorhcrapisr. She works mainly
\vith paticnts'vho havc condirions or i njuries
a ffecring rhe lo,ver extren1iries such as fractures,
ton1 ligan1cnrs, and ca rtilage rears. Mosr of her
parienrs a re referrals froni orher dcpamnenrs
in her hospiral. Shc also works wirh patienrs in
rehabilitation following orthopaedic surgery.Some
are young proplc w1th sports injuries, othcrs are
elderly people who have had hip replacemems.
Arnong her therapies are manipulation, mas:sagc.
and exercise ro keep rhe joinrs mobile and ro
strengthcn n1uscles. Rchabilitatin g sorne parienr.s
n1eans helping lhern ro '"ªlk again using crutches or
Zimmcr framcs.

•
,¡ •
•
• A Zimmer fran1e

Cognitive Behavioural Therapy

Cognirivc Bchavioura l Therapy (CBT) is one of rhe 'ralking rhera pies' for menra l
healrh cond irions. Ir aims ro eliminare ncgativc rhoughrs and changc bchaviour in
response
ro rhese rhoughrs. Ir can help wirh anxiery, panic anacks, depressive disorders, posr
traurnaric srress disordcr and chronic fatigue.Therapy can be provided in face-to-
face scssions wich a therapist,bur delivery by compurcr can also be effective.lt is
more cffective tha n counselling for somc and can provide long-rerm prore<:tion againsr
relapse, a rerurn of symproms afer improvemenr. However,parienrs musr be
commincd ro solving rheir problems and prepared ro work on rhem berween sessions.

92 Pro(essionol English in Use Medicin•

J.2.1 1 Name the therapy being dc'SCribed. Thc samc thcrapy may be descri bed more than
once. Look at A, R and C. nppn<ire ro hdp you.
1 Trean11enr with drugs roxic to cancer
2 Tremment of cancer by radiarion
3 May indudc massage
4 Aims to eliminare negarive thoughtS
5 Can involvc hdping pcople to walk
again 6 Can help wirh panic ar.acks

-12.2 Complete rhe senrences. Look at A <>pposite to hdp you.

1 ,_,..,.................................rreannent is given in larger doses than palliative treatn1enr.
2 Radiorherapy can be used alongside other rrearmenrs as·-········ ····· ······-····-···rhcrapy.
3 . .....
......... ......... ........trcarmenr is rreatmént \\ hich helps relieve rhe syn1pron1s of a condirion bur
1

does nor cure ir.

4 Radioacrivc····-···......... ........ are \vires or needles placed inro rhe area ro be treared.
M ...

5 A rypical · -····-·····················-·for an adulr is 1.8 ro 2 Gy.

2.3 Complete rhe texr dcscribing a rypical working day for Sam. Look ar B opposite to help you.

Work begins a round 8.00 am. 1 check for ncw ( 1 ) ................................... 011 rhe compurer and
prepare for my morning appoinnnenrs. Berween 9.00 and 12.00 1 5"" ncw paticnts around rhe hospiral. 1 carry out a
(2).. ............... ........... is. 1 work wirh broken limbs, joinr (3)........................................ and tigament repairs. 1 deal wi
or specialisrs.

After lunch 15"" r

Their rherapy ínc
increase range
•trcngthen muscl

\%at do l likc ab
(4) ......................
pcople back to no
(5) ··········-···-·····
can get on \virh
injury or an oper:.

ovr .f-o 1:1ou '1

Talk about two rontrasting therapi es you havr rxpt•rit·nrl'd, and lht• adva
disadvantages of each.
 Screening a nd immunization
Screening
Screening is a way of idmrifying péoplc at increased or grearer risk for a condirion,
alrhough rhey do nor ye1 have any signs or symproms.In sorne cases, mass screeniog
-scre<:ning large numbets of péOple - is appropriare, for examplo in the past for
rubercu losis. In orher cases, only those with high risk facrors. like a family history
of conditions such as cancer and diabcres, are screcned. 1-IO\vever, there are a n
lunber of problems'vith screening. There are ahvays false nc-.gativcs) cases'vhere a
paticnt has a
disease but screening docs nor idcntify it. There are also false positives, where someone
is told they have a d isease when i n facr rhey do not. Furrhermo re, wirh some
diseases,early idenrificarion is of no benefit ro rhe parienr as there is no rreatmenr
availablc.

Com mon screening tests

Cond1t1on Tes Suhiecls Frcqurn<y
Neura l mbe tAFP pregnanr \VQ 111en bcrw<'<!n 16 and
defecrs and 17 weeks
Down's Syndromc
risk cancer
Breast 1nan1n1ography women, 50-70 every 3 ycars
Cervical cancer smcar cesr \VOl11Cll, 20-60 every 3 ycars
Cardiovascular blood cholcstcrol >40 wirh high risk every year
disease factors
Srrnndary prevent1or
Cholesrerol >4 blood cholcstcrol parienrs \virh hearr every 6 monrhs
disease
Diaberic ophthalm oscopy parienrs 'virh every year
rerinoparhy (see Unir 34) diabetes

lmmuniza tion for travellers

ne lollowing vaccinations are recommended lor lravellers !o Soufü Asia:

Hf:PA1TI15 A OR l.M.MUNt GLOWUN (tC}
tAJ_.\RIA
Transmission of l\epaliris A virus c.-n ()l"."CUr Your ris:k of 1nalari<l may be high in thcse
through direet J)í.'tSOO•;(O-pet'$0n contac1.; rhrough counrracs., incJudin.g cirjes, Travellers sh()Uld r:tkt
txposurt 10 conrunin:.ucd v.•atr. ict, or shcllfish nn effecrivc antima101ri•d dM.1g.
harvtd in ron1a.01ln;a1cd·water;or from unrooked
f'ruits, \·tgttabks. or 01hcr foods. RAlllF-S
lf you might ha\'C txttnsivt, unproccc•ed ourdoor
1U:PA1TI1S 8
expoSure in rural are-.as.
EspcciaJJ y if you mighr be cxposcd to biood or
bódy flujds (fot examp&e. he:alrhcrc v·.orkcrs}, 'JYl'l-tOID
have se. uaJ mnaa with the IOCtl popubrion, or be ·ryphoid fe-.·cr can be oontractcd thruugh
exposed through medica! rrc:nmcnt. oontam.in;ntd drink ing "'atcr or food. Urge
outbrtaks ;are 1nos1 ofte11 rdated co la1".Cal
JAPA1"' FQ: TNf'l'PMAl.n1\
c:ont:11nina1ion of watrr s.upplics or fuod!> sold by
1( )·ou plan to visit rural furmi1tg areas and un<lcr street ve:ndors.. Vaccil\3rion is pan-icularly i1nportaut
spa-jal cirtumsran(:fS, such as a knowo 01nbrcak f)Í be-cause of tbe prescocc of S. ryphi str-ains resisuuu
J:1panrse t11ccphalitis. to muhiple annbiotics in ihis rcgion.

AS 1''F.fDFD
Boos1cr doses for 11. .anus.diphtht'ria a1ld nleas)es 1and a ooe-rimc dosc of polio f<>r 1duhs.

94 Pro(essioool Engfish in Use Medicíne

-13.1 C-Omplcre rhc senrences. Look ar A, B and C opposire ro help you.
1 ............................... ...................... .......................for hearr disease include smoking, high cholesrerol
and a
family hisrory of heart disease.
2 In a small nurnber of cases screening will not idenrify parienrs wirh rhe e-•rly signs of a
dise-•se. Thesc are ............................... ................................................
3 Some people wirhour signs of rhe disease will be wrongly idenrified as having rhe
disease. Thesc a re ................................................................................
4 People ............................................................................... blood or body Au ids should be immunizcd
against Hepariris B.
5 J\ ............... ..... .............vactination is givcn so111e rime afrcr rhc first vaccinarion to n1akc surc the
leve!of anribodies remains high .
6 Hepatitis B can be ........................................ rhrough cxposure ro body íluids.
7 Penicillin 110\V has no effect againsr sorne hospiral acqu ircd infecrions as rhey are
...............................................................................pen icillin.
8 An ........................................of mcasles has affecred a numbcr of childrcn who had not lx'.Cn
in1111uni1..ed \\'ith rhe MMH. vaccine.

..13.2 Complete rhe senrences using informarion from B opposire. The firsr one has
been dooe for you.
1 Women aged from 50 ro 70 :;.IJQu.l<il.11.ª'll:..mª.mmQer.<ip.hY.. .tbl.'"-!'.'ii.W. lib."k.f.Qr..m:;,1;,c.ª.n
r..
2 Parienrs wirh hearr disease
...........................................................................................................................................................
3 \\!fornen bctwcen 20 and 60
........................................................................................................................................................ .
4 Patienrs over 40 with hi¡;h risk facrors
................................................................................................................................
5 Parierirs with diaberes
.......................................................................................................................................................................
6 Pregnanr women
................................................................................................................................................................................ .

43.3 Which of the immunizarions listed in C opposire would you recommend íor rhe íollowing
visirors to South Asia?
A tourisr \vho 'vill stay for a fe\v nights in five-star hotels in
1najor ciries 2 A backpacker who will travcl by local rransporr from
one city ro anorher 3 A medica! studenr doing an elective i n a ciry
hospital
4 ¡\ volunreer \\1ho 'viJI live for a year in a rural con1munity
5 A traveller \vho has nor had a reranus vacc ination for ren ycars
Ove.r .f-o 11ou
Wha t in1111u111zat1011s art:' adviS L'd f or v 1 itor l o yo u r roun t ry. or <-1 rnun t ry ynu \vou ld l i k e tu
VISl t ?

Pro(essionol EngJ,sh m Ust M 95

t<ront
 Epidemiology
Rates
TI>e srudi• of rhe spread a nd control of diseases in rhc communiry (epidemiology)
requires analysis of frcquency -rhe number of rimes somerhing occurs in a particular
period . \'lle ralk about frcquency using \VOrd corr1binarions \Vith rate:
birth = rhe number of birrhs in a population (group of people)
= rhe
dearh (mortaliry) case forafüy number of dearhs in a popularion
survival
= rhe nun1ber of dearhs froJn a parricular disease
rare
= rhe n umber of parienrs srill alive after rrearmenr for a particular disease

11>e birth rare n Singapore Thc infant morraliry rare in Singapore

is is 3.0 per 1 ,000 live birrhs.
10.2 per 1,000 popularion.

Orher words 11sed ro ralk about frcquency:

co1nnJon in n1any dc\•eloping counrrles.

Malaria is unco1n1no
in developed counrries.
n rarc

lncidence and prevalence

The prcvalcnce of a disease is rhe number of pcoplc in a p0pularion who have rhc
disease ar a particular rime. The incidencc of rhe disease is rhe number of new cases
of rhe disease during a particular rime.

high in many developing countries.

Tiie incidence of 1nalaria is
low in developed countries.

111e incidence of H 1V The incidence of HJV

infection is highcst in sub- infecrion is lowest in the Ca
Sahal'lln /\frica . ribbea n.

Note: You don'\ say'The incidence of malaria is common'.

The incidences of a discase in diffcrenr groups a re often compared.

Rheumaroid anhritis is more common in fernales than

Rheumatoid arthritis
in 111ales. Men and wo1nen are
is less con1n1on in equally affcctc<l by
rnalcs than in fen1ales. resrless leg syndrome.

Association and causation

Srudying the incidence of disease in particular groups of peoplc can lead to the discovery
of ca.usation - 'vhat 1nskcs ir occur. For cxnnlple, che hish i ncidence of l ung canccr among
cigarctte smokers suggesrs [hat s1noking is a causarivc factor in rhc de\lelopn1enr oilung
 cancer. Ho\vever, ca re rnusr be rakcn not to assunle every associatioo bel\veen a disease and a
measured variable is causativc. To say rhere is an associarion bef\vL'<'n t\vO things simply
n1eans thar d1e)r occur rogecher in a cerra in siruation. For example, severa/ studies ha ve
indicared h1gh rares of lung cancer in cooks. /\Jrhough rhis could be a conscquence of rheir
work (perhaps caused by
ca rcinogcns in fumes from frying), ic may be simply lx>.Causc profcss ional cooks smoke
more rhan rhc average. In oc.er words, smok ing might confound the associacion wirh
cooking.
96 Profession<JI Engl"hin Use Medicine
 .1 Complere rhe senrences. Look ar A and B opposire ro help you.
l The proporríon of epíS<Jdes of illncss char end farally is che ..........
......
............................._... ...·-······· rntc. 2 11ie proporrion of pcople who die in a
particular period is che··-···-····· ·········· ····-·rate.
3 The proporrion of babi<s born in a particular period is rhe -····· -········-·.............. rare.
4 Thc proporrion of parieors who are srill alivc five years afrer rrearment is rhc fivc·yrar
................ .... ... ..... .... rare.
5 Ten per ccnr of che popu larion have perennial rhinitis ar:my rime. This is rhe
...................................... . 6 Every year,0.5-1.0% d<vclop thc condirion. This is rhe
········· ··""..."............. .

JZ-4.2 Complere the tcxt, using thc correcr gronuna rical form o( cach word. Look a r rhe rabie
and ar A, B and C opposire ro help you.

lncldenceorlu.ng c.:ance.r
(Su.r\'eillance and Hisk Assessrne1u Divlsion.CCDP. Health Ca.nada)

Cou11try Incidence (per 100,000)

Men \\'01nc1'1

China 67..i 26.6

Canada 59.1 30.8
USA 55.7 33.5
UK 5 1.2 22.0
Japan 44.ó 13.3
S\\'Cdcn 2W 12.9
l11•.Jh1 12.1 3.0

Ln all countries. lu.ng canccr,vas ( 1)......·-···-··---··-···-··...... ......... ..,_..,.._.............íl'11ncn than in \\101nen.

The (2) .........-................incldencc an1011g 1nen \'o'aS in China\vhere 67.5 men per 100.000 ,.,'Crc diagnosed
\Yith lungcancer in the period. In'v.>men,hQ\\'e\ler, fungcancer'vas less (3)........................................10 Chlna
than in the USA and Canada.
The (4) ·-·····-·····-·····..............-..incidente in bolh mcn and \\'001en \'o'aS in India. 5,.,·eden aJso had a fairty
(5) .......·-·······-·····-·····-·····- incidence in both sexes. Lung ca11cer is probabl y (6)........................................in India ror
culruralandeconomic reasons.\\Thereas in S'"eden il is the re:suh oran cffective heaJth educalion CJ.n1paign.

.3 Find preposirions in A, B and C opposite rhar ca n be used ro make word combinarions

wirh rhe words i n the box. Then use the correct forms of the words ro complete rhe
senrences.

affecred association incidence lead rarc

Recenr surveys showed that rhe ............................................................................. HJV cases

had come clown in rhe southern statcs of India.
2 Epidcm iologic dara suggesr an . ........ ............................. ........................................obesiry and
depression, but
furrher studics are needed .
3 Appropriare prevcnti\•c n1easures should ......................,.........................-............................ a reduo:ion in
the
morraliry ra re.
4 Thalassacmia is ................................................................................ people of Northern European
origin.
5 Ma le and female soldiers are cq ually ................................................................ .............. post
traurnatic stress
disoi-dcr.

Ove..r .f-o 11ou

Which d isl'ast·s havt·the h iqht·'!lt i nt·idt·nrt· in your rount ry? What is t hl' rnnunont'\ I t·au\r of cJt·;it h i n ml'n <.1n

Pro(essionol Engli$h in Use M 97

edicint
Medical ethics
GMC guidelines
care = prorecring and
looking after someone The duties of a doctor regístered with the General Medical Counol indude: 1
1 Make the c. e of your patient your tirst concern.
profcssional competence 4

2 Treat every iwtttent politely and consldetately.

= le,•el of
!

specialiied 3 Glve patients information in a'"'ªY they can understand.

knowledge and
skills
4 Keep yoor professlonal knowk?dge and skills up to date.
confidenrial = privare - :

seeret 5 Recognize the limits of your profeS'sionat competence .

' 6 Be honest and trustworthy.
7 Respect: and protect conft'dential lnformation. .
prejudice = have a 1

negatíve inAuence on 1Make sore that yoor personal beliefs do not prejudice your patients'

risk = possibi liry of

somcthing bad happcning """
9 Ad. qUddy to protect patie:nts from rik if you have good reason to
fü 10 practisc = in a beleYe that: you or your colleague may not be tit to practiH.
suirable condicion ro 1
\VOrk

Note: For a full list of the guidelines. see www.gmc-uk.org

Bioethical issues
Euthanasia
Should the medical profession help 1he renni nally i ll to cnd rhcir livt'$ whcn rhcy choosc?
Gcnctic cnginccring
Shou ld we permir an embryo ro be cloned - copied exacdy - to replace a child who has
died? Should parcnts be able ro selecr rhe genetic makeup of their children to produce so-
called designer babies ?
Human fcrtiliry
!VF- in ,;tro fertilizati on -has mad c it possiblc for infertile women 10 have children, bur
should this include womcn long pasr the normal age of childbeari ng'
Embryos can be frozen and implamcd in rhe mother ar a latcr date but shou ld this require rhe
conscnt or pcrmiss ion oi borh parenrs if rhe marriage has broken down?
What are che righrs of a surrogatc morhcr, one who carries a child for a woman who is
unable ro do so, over rhar child?
Transplant surgcry
Who should give consenr for rhe removal of body parrs for transplant surgery?

Assisted dying
A medical srndent has madc some language nores on a journal arride.

A 53-year old woman wtti Incurable muscular "1 off = tM.C'Je&i Í'(W!A. tke Qvl.C '"te'Stlr
d)'s110phy llew to Switzerland to endher lije.Aa9isted .Ql'\d bQ ¡;,'N""- ¡.rO ,.,_ tht

dyir1g is legal in Switzerland btJt illegal in tlle UK.

Opponents of eulhanasla. or ·merey lólling', rugue thal
""'
fl'll!útttw. e.Qrt =!>-to rditvt. r'4"Ó'!T
legalization woold load to tll-1.\. '60't st:......4
abuse andcall for doctorswho participate to be struck
olf. h= ¡.rtl\l\di..o\9 c+lre: 'ftw ttl'DUJ::I
What Britainneeds, UWty caim,is better paliative care i.l.4. W.ll
and
temÚ."'-'lUt:f Ut te:d tD h.e
more hospices for me tennlnally ill to allow sucll
patients to diewtth dignity. ptrs.Lstt ve $tQtt v.t'.iltf.t w s.tita c.
This follows a recent US caS& wt-.ere me husballd of {cw..... ii.,.,..;..t uw.M-A dctS M:rtS¡:.ot'4 u,,
a " el' l.C"''4t1 w.M...LM.91\<I wa
98 Pro(essioool English in Use M edlCine
5.1 Which of the GMC guidelines in A opposite is breached in each of these cases?
a A GP falls aslccp regu larly du ring consultations. His colleagucs do norhing.
b A doctor is aware that a parient has a history of violence againsr women. She infotms a friend
whose daughtcr has jusi bccome engaged ro rhis ma n.
e A docror arre1nprs ro dissuadc a paricnr fron1 having an abortion as rhis procedure i s againsr
his rcligious bcliefs.
d A doctor refers a patiem ro a medica! textbook for an explanarion of his pancrea tic
cancer. e A doctor foils ro complete rhe number of days of professional developmcnt
training advised
annually.
f A doctor tells a seriously overweight patient who has ignored his advice to diet thar she
deservcs any ill effecrs rhat mighr rcsulr from her obesiry.

5.2 Match each he-•dlinc ro an opcning linc from a newspaper report.Look ar B and
C opposire to help you .
1 5
66-year-old becom es oldest mother Using body parts without consent

6
2
Frozen embryo case to go to U!full tace transplant search on 1
Europe

3
Surrogate mother sued by coue 7 'Designer baby' rules are relaxed

4 8
Embryo cloning - wherewill it take
us? Doctors back infa nt merey killi ng

a A woma n of 30 who agreed ro bear a child for a childless couple rhcn rcfused to part with the
child has been ...
b A surgeon has been accu sed of rcmoving organs from parients wirhout their knowledge ...
e Three-quarrers oí llelgian doctors are wifüng ro assist in rhc dearh of critically ill babics ro cnd
thcir suffering.
d A woman hoping ro srop rhe desrrucrion of six embryos creared wirh her cggs and her ex
parmer's sperm launched a case at rhc Europca n Court of H uman Righrs ...
e A \\I01nan has given birdl in Ron1ania folJo,ving I VF rrearmenr.
f Consultan!plasric surgeon Dr Pctcr Butlcr has been given the go-ahead by a hospir I erhics
con1rnjrree ro find a parienr \vho 1neers selection crireria for a full facc transplan t.
g lf your fovourite pcr dies, ir is rechnically possible ro produce exacr replicas - but whar abour
hun1ans?
h Ir is now legal ro selecr embryos ro provide blood cell 1ra nsplanrs for sick siblings.
Research studies
Case-con trol studies
Here are sorne exrracts fron1 a medica) texrbook.

ln a C•I 1 11,.llMy, agroup of peoplc sulTering from a disease (the cases) is compared with
•ll'CJUP wbo do 11111 llMI the disease. but are similar in othcr ways (thc conrrols). Thetwo
groups, the¡JllWJ¡• H• inthelllldy. aie compared 10 see if they were cxpo!Sed to a
,_...is
possiblc risk factor or not. A rllk Hldhi1ig which may contribute 10 the cause of
disease.This lype of study is ollilil u.I•a fint 11ep ia idlllllifying the cause of a disease.

Cohort studies
Ina -..111111y . a group (cohort) of people (subjects) who are similar is studicd ovcr a
period of)WS (a la ¿ 1 dh 1study) 10 determine if there is a relationsltip between
exposure to a risk ÍICIDl' lllddeRlupiW of a disease. Al lhe beginning of a prospectfre
study, none oi 1hc subjoc1s haslhedileue.Tbey se wi-cl up for a number of years, and
a1 thc eod of the period, those who lla\'ll clrw' p die dilC1lse me compare<! wilh 1hose who
have not In a retrospecti\'e study. the m ucbela look beck, by SIUdying hospital records for
example, at whal has happencd in the pas1. cou¡wiu¡¡ •ibjetU ñlb8lle developed the
disca.'>C with those who havc not. In a cohon srudy and in a c1n cWlllOI 8lud¡r die subjccls
arc only observed and there is no intcrvention such as drug a• 1m1 ar lllllP'IY- A c:obort
llUdy is a more rcliable method of idcntifying tbe cause of disease dllllac•e SIUdy.8ut
filrproofof cause. a trial is needed.

Trials

In a 11'1111. a group of people who are suffcring from a discase are gjven a panicular
lreatment. To determine lhe elTCCliveness of 1be treaunent,a controUro tria!is
performcd. Two groups are SIUdied: one group (the study group) is given 1he rreatmem and
the other (the conrrol group)
is DOI. 1beconrrols may be given a placebo -something which sccms to be idcntical to the
a- but whicb has no elfect. lf there is an cqual possibility lhat pa1ien1S may be !
elected for the SIUdy IJJOUP or for the controls, lhe rrial is said 10 be randomized. A
randomized contn>lled lrW malra bla- error in a study which inftucnces the resullS -less
li.kely.An additional way of
n:movinc bias is hl!Mllng·patienlS do nol know if lhey are reccMng thc trea1ment or tl1e placebo.
lf, inIAliritm,die rescarcher.; do not know wbo is receiving lhe trea1ment, the ttial is a
double llllBd trllll Reebni...t conttolled ttials are tc'>Cd ro test ireaunents or preventivo
measures.

Variables

lf the subjeclS in a study are all aged 50, thcn age is a constan in the study. lf thcir ages
range from 20 to 70, lhen a is a variable. A confoundíng variable is any variable
wbich is associated with bolh the diseasc and thc risk factor being studied (for example,
smoking in the case of cooks llld lung cancer discussed in Unit 44). lf such variables cxisl
there is no way for thc rcseareher to knaw whether tbc diffm:nc.:c in llti; rik fac.:Lv1 ur Lhc
confou11 di11g var1able is tbc oac dll;\t is truty Cllllingtbe disease.
100 Pro(e.sioool Engsh in Uio Mtdidne
 46.1 Complete the table with words from A, B and C opposire.

Noun Ver
b
bias
control
exposure
(person) participare
inrcrvcnc
Study

16.2 Complete the sentences with a word from A, B, C or D oppositc.

Pcoplc \vho ar<." nor rcceiving rhe experi1nenrol rrearn1enr, but \vho are orhenvise the
same as rhosc recciving ir are ··
···· ···············-···· -···.
2 A rri:;tl in \Vhich neirher the subjects nor the rescarchers kno\v \vho is rccciving rhc treaunenr
is a .................................. ....-.......................................tria!.
3 A srudy that follows tho participants over many ycars is a ........................................study.
4 A ..... ................................. is a group oí people with similar cha racteristics.
5 Allocation ro groups is ............_.......................... if ali participanrs have cqual chance of being
in either group.
6 A harn1less substance given ro so1ne participants ro rcsr rhe effecr of a rrial subsrance is a

7 Something that might b<' a part of thc ca use of a disease is a ........................................ facrcr.
8 Son1crhlng rhar nlig.hr cause confusion about rhc enuse of a discasc is a ....... ·····-····-····-······
variable.

.J Study the rescarch questions below, and in cach case decide which of thc rcscarth study
rypes menrioned in A, B and C opposire would answer rhe quesrions best. Use the i n<lex or a
dictionary ro look up any unfa1niliar \vords.

To examine the outcomes of an unwanted ftrst pregnancy

(abortion v live delivery) and risk of depressíon.
(8M/ 200S;331: 1303 Rtprodu«j wilh ll<""""°" from 1hc BMJ Publishing Group)
st the hypothesis th::a 2
SUPJ>lemen1al oxygen reduces infcction risk in paticnts follo\ving colorectal surgcry.
A 2005;294: 20351

3
To develop a relativefy simple, inexpensivt>., and accurate test lllat measures telomerase activity
in voided uñne to apply to large-scale screening programs for bladcler cancer detection.
(JAMA 2005;294: 20521
4
To evaluate the relativa nsk of being responsible for a
fatal crash while driving under theinfluence of cannabis.

(8MJ 2005;331 : 1371 Rtproduffl with ptormission from l.he BMJ Publishing Groop)

Ove.r .f-o 1101.1

Describe a research slud•1 t hat you've carritd out or wou ld be interested in rarrying
out.
In your l'Xpl·ri l·nrt·, \vha l art t hl· n1ain prohll·ms "rl·d in dl·signi ng a rl·st·arf h
l'nrounll study?
Pro(essionol Eng#sh in Use 101
Medicine
Taking a history 1
A full case history
A full case hi<tory cover;:
• persona l detoils
• fomily history (see Unir 48)
• presc"llring cornplaiot
• social and personal hisrory (see Unu 481
• past mcdic:al histary (PMH)
• patiem idc:as. cooccrns aod cxpcaations •Stt Unit 49)
• drug history (see Unit 48)
• review o( S)'Stcms (Stt Unit 49).

Personal details
Normally, patienrs·pcrwnal derails have lx-cn emered in rhei r record< by a n urse or
:.tdn1inistrnrivc srJÍÍ bcforc a docror secs rhen1. llo,vcvcr, on larer consultation a dt'ICtor
may wish to check dcrnils;uch as address, da te oí hirrh, occupation or marit.11
status. To find our or to check a patiem·s occupation, doctors ask:
Do you

work?
What do )'OU do for a li,ing?

Parienrs
may
respond: No, rm o, l'm rctired.
º
1

uocmployed. rm 1'111 a pcnsioncr. Yes, 1work for a bank.

1 work in a bctory.
out work.

Parienrs may respond:

( Yes, rm mamcd'Jpanncr
single. 1 tive with 111)'spouse.
l':o. l'm separntoo. divorccd. husband.
wik

\Y idO\V, My spou;c passcd

No, l'm a\Yidov.rtr. a\vny );1S1 year.
dh·orccd.

Note:A spouse can br a wofe or husband.A widow IS a wornan whose husband IS no long¡:r living;
a widower is a man whose wofe is no longer living To :woid 53'1'"9 sorneone is dead, patoen1S may
say that person has passed away.

Talking about pain

Case noll< are kcpr for each consulrariM. Thc Presenting Complaim secri1m of case nores
records rhe paricnr·s symproms. For example:

R. úcled tt"'-poYal iliea clad1e,

severe,tilirobb .
uists 24--4- g ilirs.
 In rhis case, the paticnr complains of a headache. For a lm of the que,uons the d0<. or asked
this parienr, and for paricnrs·descriprions of orher kinds of pain, see Appendo< IV on page
144.

102 Professionol Enrlis/o ., Use Medicine

1 1 \tud) 1hc case noces.\X 'rice che quesnons 1hc doctor ascd 10 obcain che
numbcrcd onfomunon. Look at Append1x IV nn f'. rl' 144 rn hrlp you.

D .o.e. SEX r MARITAL STATUS:iv .1_ 1

OCCUPATION c.i.t:r • °""'

Preeenting complaint
''' 1":•:it1e.11.MI t ....-.,,,
!J )wj i.1rt'l,.....J t.' lV'

o\ ' !Al'• f""(r-,tPíl l'."!'Yl. l>t'"11t ' 11 Cl1°"VOt!::j W. 1-o11:l:.M! ::-.-s,Nt> Jl"tti.f.1,t'1' N> "' •t •f

"'""' .... ,.

2 RcaJ 1hcconcinuacion of 1hc case no1es for 1hc paum1 in C opposi1c.Wri1c che
docto1-. questtons. l.ook a1Appcn<ix IV on pagc 144 10 hclp you.

J
Doc1or: C1. n you tell me what 1he problcm is?
Pa1icnr: l'vc go1a 1errible headache.
Doc1or: ( 1) ········-···-····-····-··.....
P,uicnr: J ust here.
l)octor : (2) ···· ··········· ···-············ ..... .......................
........... ....... .......... .... ......... ..........
....... -.......... ...... ........ . ?
P,uicnt: Well, it's really b:td. And it 1hroh.
Doctor: Have you had an thing like 1hi> hcforc?
J>,1ucnr: Yes, about every chree monrhs.l'vc had thcm for 1he Jase cen years or •o.
Doetor: (3) - . ·-··--·---·----·---·-· - -·--··--·----·---·-·... ,
PJucnt Usually one or two days. Th1 one siancd yestcrday moming.
Ooctor: (4) >
Paucnt Thcy usuall)' sran jusc bcforc 111 · rcriod. eumes if 1 eat chocolace. l'm noc surc.
Do.tor: (5) '
PJttcnt: lf l l1e down in a aark room 11 hclps. l 1h1 makes 1hem worse.
Doc1or (6) -------- ----------- ------
PJttcnr: lf l move my head, it gets more pamíul.
[)ocwr: Apan from the he1dache, (7) . ·····-·--···-···---···--····· ?
P,uicm: Yes, my eye feels srrange.Someumc-; 1 CJ n't sec clcarly, things get blurred. 1 ícel
;,ick Jnd
01nctin1cs 1 an1 sick.

.3 Complete thc scmcnccs. Look ar Appcndix IV on pagc 144 ro hclp you.

1 Gac;tric ulcers a re associarcd \\ irh :t . ••••,···--··-··-··-··-···pa111.
1

2 Cystitis causes --··--··-··- -·---··-··,··-·.. ·- pain on passing urine.

3 Pat1entS with a ptptic ulcer may say rhey ha' e a .·--·---·----·---·- ,---·-· _ ..
pa1n. 4 Rccurrcnt abdominal pam (RAP) may he de><:nbed as ·-
·-------or
5 \l1grame is oftm descril:ed as a pam.
6 Prople "'ch os1eoo.rchricis often complam oí a dccp cencttd in 1hc
1om1. 7 "•dnev tone pam is sudcn. seo.ere and
8 Angina is usually descril:ed as a cmshmg or hea'' or pam.

OVt..r .f-o 110

Choo...t' 1t lt•ast three comrnon ronch t1ur1'lo .ind 1n 1kt·¡1 nott· of how pa t 1t'nts \vould dt\l'rlht•
thr p;11n in English.
Taking a history 2
Drug history
Hcre is an extraer from a mcdical rexrbook.

lt is essential to obtain full details of ali the drugs and medications taken by the patient. Not infrequently pa
lt is necessary to determine the precise identity of the drug, the dose used, the frequency of administration
lt is importa ni to ask about known drug allergies or suspected drug readions and to record the information

To fi nd out ab<>ur drug hisrory, docrors ask:

Oetails of drugs and mecications
• Are you raking any medicarioo ar • \Vhich rablct do you rake?
the n10111cnt?
• Do you use any over-rbe-counter remedies or hcrbal or homeopath ic mcdiciu
es? Frequency of administraMn Compliance
• Ho'v rnany t.Unes a day? • Do you al\\•ays remcn1ber co take it?
Sidc-eífects and allergies
• Do you get any sidc effects? • Do you know if you are allergic to any
drug?
lf the answcr is Yes: What symptoms do you gct after taking it?

Family history
Note thc agc, health or cause of death of parenrs, siblings (brothcrs and sisters).spouse
(husband or wife), and child ren. To find out about fomily history, doctors ask:
• Do you have any brorhers and • How old was he whcn he died?
sisters? • Do you know the cause of dcath? /
• Do you havc any childrcn ? Whar did he die of?
• Are all your closc relarives alivc? • Does anyone in your fomily have
• Are your parenrsalivc and well? a serious illness?
• Is anyone raking regular medication?
Social and personal history
Record the releva nr informaricm abour occupatioo, housing and personal habits induding
recrcarion, physical exercise. alcohol and robacco and, in the case oíchildren, about school
and fomily relarionships. Typical qucstions in raking a social and personal hisrory are:
• \Vhat kind of house do you live in? • Do you smoke?
• Do you live alone? • day?
HO\Y 111any a

-• \Vho
• sharcs your bome with you ? • Havc
or S("hool ? •
How old are your children?
Are any of thenl :tt nurs('ry
Whar
-you rried giving up?
about alcohol?
\Vi rle, heer or spirits?

• Can you givc up alcohol when you want '

•• Do you have any problems at work? • Ho' n1uch do you drink in a wcck ?
What's your occuparion?

• Do you have any financia!problcms? • Whar's rhc m<>sr you would drink i n a
• Do you have any hobbies or week?
inrcrcsts?
• Are you a\!•'are of any diffcrcncc in your

• What abour exercise? alcohol consumprion ovcr rhc past fivc years?
104 Pro(essionol English in Use M edicine
 1
48.1 Complete rhc scnrcnces. Lool ar A, B and C oppo<irc ro help you.
1 rharmacies sell a wide va ricry oí ................... ..-
....................-.
ª'
remedi e; well as dispens111g prescriprions from phi;icians.
2 Thc "t quannry oí rhe medocanon to 1"' rakcn ar an) onc rime.
3 A drug 1s h•P'rsens1ri•iry ro a pant<ular drug.
4A "a medica non prcpattd from plant>. csp<e••lly a
tr.1d1t1011 1I ren1Cd).
5 Your hrorhcrs and your'i"ers a re your .............
6 , ..... ···· is 'vhar you do for physical or 111c11ta l ti111ulu s outsidc '''ork.
7 ...can t.tke ni;u1y for111s:aparrmenrs, ingle roon1s, hou\C'l, hostels.
8 Thc pa11ent"s ----- . to drug rrcamienr, h" w1llingness or abil it)' to takc rhc
right d°"' at t nghr time rnd írcq°"11C\·.is essennal.

48.2 Write thc r"> qucsnons.l .ool at B oppos11c to help )OU.

d<><w.
Doctor: ( 1) ..................... ..... ............. ....................... .................. >
Paticnr: My forher died c.vcnty year;a¡;o but my mo1hcr "m good healrh >1ill. Shcºs sevenry
now. Docror: (2) .................. . .. .. .................. .......................... ........................
..... ?
Pancnt : 1 was srill ar <ehool. l le wa; forry-one.
Doctor: (3) ?
Pancnr : l le had a hean.nacl.
Doctor: (4) ?
Pancnr: l">c go• a sisier of torry-live and a brorher who\ th1rry-six.
Docror: (5) ...................... .... .... .................. .. .. ?
................
Paricnt: No. 1 had an dder bro1hcr hur he dicd i n hi< fortics.He was forry-
rwo. Doctor: (6) ...... ............ ..... ..................
Panent : l1lc m)' fothcr. a hean attacl.
Doctor. (7) _ _
Pancnr: :'\ot thar 1kno" of.
Doctor: (81 As far as lou knm•
Panent: Ap 1rt fro1n me, no.
Doctor: (9) ......... ...................
Pmicnt: Ye>, a boy and a girl. l le\ fourreen and <he\ rwclvc.

8.3 Srud) t hc w..-ial his1ory of M r Block. Wnre rhe que<>11on' rhc doctor asked to
ohtain rhe numhered mfom1arion. Lool at C opposire ro help )OU.
Social hist0<y:Mr G.Bladt
Home - l.1H-s in a derached hou;c '"th a large gardcn 1 .
Fam1ly - Four children: rwo gi rl1:tgl-d 3 and 4,two hO)> aged 6 and S. AH are
bcin raught ar home by his w fc111.
Occupation - Manager oía DIY wa rehouse. Srres<ful job irwolving dealing with
frequcnr sraft prohlem' and mccmg monthly .ales rargers. l.trge mongage ' 11.
al 1ntertSts - Has li:tle 11111e for excrcise or mt<tt<tS ours1dt' work •.
Habits - l'rl-sentl) smoking 20 pcr day '.Has m<-d 111co1111e parches without "icces»•1.
Aver.tgc Jlcohol inrakc J un11'pcr d.1y ar weekend>' "'. No problem wirh alcohol
\\1irhdra\val1M1•

Professionol Entl"h in Use 1OS

Medidnt
106 ProfessK>ool English in UseMedicine
Ta king a history 3
Reviewing the systems
Once you kno\v thc main rea.son 'vhy rhe parient'vanrs med ica) arrenrion, ir is
sensible ro ask abour rhe sysrcm s ro determine the paticnt's general srate of he. lth and
to check for any addirional problems . The parient should be encouraged ro describe
symproms spontaneously.ln irial qu<srions should be opcn-cnded and as general as
possible.FoUow
up \virh 1nore spec-ific quesrions if needed, bur avoid purring \vords in the parienr's n1outh.
Open-ended questions Closed questions
What's your appcrire like? Havc you caten toda y?
Ho,v's your vision? is your vision ever bl urry?

Asking about the central nervous system

1 Do you suffer from headaches?
2 Have you cvcr had a blackout?
3 What about fits?
4 Havc you had any di:cincss?
5 Do you ger ringing in 1he ears?
6 Havc you cvcr cxperienced an)r nun1bness or ri ngling in your hands or feet?
7 Do you have any problcms slceping?

Patient ideas, concerns and expectations

h is in1porranr during rhe consulration ro givc patitnts rhe chance ro express their
O\vn ideas and concerns abour their problen1and ro derernline \vhar their
expectations are. The letters ICE (Ideas, Concerns and Expecta tions) are a way of
remcmbcring th is.
Typical qucstions are:
Ideas
• What do you know about this problem/condition/illuess?
• Do you have any ideas about this?
• How do you think you got this problem ?
• What do you mean by ...?
Concerns Expectations
• What are your worrics about this? • What do you think will happen?
• Do you have any concerns? • What do you cxpect from me?
• How might this aífoct thc rcst o( • What were you hoping we cou.ld
your fomily? do for you ?

Phrasal verbs in history-taking

Phrasal verbs are ofren used in i nformal spoken English. Both paticnrs and doctors c1ay use
rhem in consultations.A phrasal verb 111ay have several 111eanings according ro conrext.

Ph rasa l Exa Meanin

verb mple g
bring on Is rhere anything spccial that brings on the pain? c1. use, induce
bring up Whrn you cough, do you bring up any phlegm? expectorare, von1ir
carry on Carry on tak ing thc painkillcrs for another weck. conrinue
C(>l11C 011 Wh<n does the pain come on? co1n1ncnce
give up My ad••ice is to givc up smoking. Stop
pur 011 l've put on a lor of weight in the last month or so. gain wcighr
rurn out She had all the tesis and ir tumed out to be cancer. happcn in rhe end
turn up The rash jusr turncd up out of nowhere. appear urexpected ly
49.1 Match thc nurnbcred que>tions ( 1-7) in B opposire ro thc symproms for rhc <"entra)
ncrvou 1;y(té111 (a-f). Thf'rt- :irr t\YO qucsrions for one of che syn1pron1s.
a headctches
b he3nng symproms
e fomrs
d nnglmg {paraesthesiaeJ
e IS
f sk-ep parrcrns

49.2 Read thc cx<rJct from a con<uhation. In the numbered quc;tions (1-4), i 1hc d0ctor
cncouragon¡;thc patienr ro ralk ahout her ideas (1), her conccrns (C) ar her
expcctati<>ns
{E)? 1 ook at C opposirr to heJp )OU.
Pancnt: J"m a bi1 conccrned ahout tll) colic. 1 had 3 fnend worh somethong s1m1lar
and it tu rncd out to be more serious. Ir"s gor me womcd.
Ooc1or: ( 1) What do you me.111 by colic?
Patient: A pain in rhe s1cmach.
Doc1or: (2) What do you think mi¡;ht have brough1 1hi< on?
l'aricm: Ir just secmed 10come on. 1 do1ú know whot 11 is.
DOctor: You said you wtre a t>11 worried because your fr1cnd had a similar problem. (3) \Vhat
are )'OUr '''orrteS about th1s?
Parienr: Yes, 1had a friend. Shc rurned out to ha•·c s1onl.ich canccr. She anuall) died in rhc
e11d. DOctor: (4) What were ynu hop111g 1 could do for you 1oday?
P.uicnt: 1 ¡ust want 10 krow 1h.11 1 don·r have a11y1h111g too serious.

49.3 Complete the'cnrenccs with phra<al vcrbs. Look a r 1) opp<»ite ro hdp luu.
1 Thc hcadaches ---·-- -·- 1n the n1orning.
2 Howe.rr much 1 car, 1don·, secm to -----an) weigu.
3 l"vc med 10 ----smoking se•eral
times. 4 J"m so deprcss«l 1 don't fed 1 can ---
5 Whcn 1 cough, 1 ···-····· _ ·······-····-· phlegm.
6 l le rhou¡:ht he had sromach achc but it ········-····· .... to be C\lncer.

Ovu .f-o tjou

Wrih·vour own qut">t1on\ thnut tht·alimt·ntarv "V'h·n1 U\1ng tht:' rht·rkh'it. Lnok a· B
oppo\ltt· to ht·lp you. Lnok al lh11t 20 1f you nl't"cl n1on· hrlp.
Co11d1lu111 of rnouth
Oif fil·ult y w1lh SYJa llo\vinJ (dy,pha9ia)
lnd1qt·...t11111 Hi:arthurn

Ahd11n11no.1I pa1n
Wt·1qht In''
Chotnqt· 111 hcn- hah1t
ifcl (t'. palt". hlack. frt'sh blood)
Cnlour of mot1on g . d<irk,

Profmionol En¡N•hin Use 107

Medicine
 Physica l examina tion
Exa mi ni ng a patient
\Xthen exan1ining a patient, you should:
I ntroduce you™' l í, ií ncccssa ry.
Good morning, l'm l)r Mason.
2 Brief rhe parienr on whar he/she should expect in a dear and simple way.
Do you kr10\Y \vhat 'vc' rc going to do this n1orning?
\Vhat 'vc'rc going ro do roday is ...
rm going ro examine your ... so lcan find out \vhat's causing dtis ...
Wha1 wc do is ...
What happens is rhar ...
1'11 ask you 10 ...
Are you ready?
OK?
3 lr1struct the paticnr in a clear bur poli1e ma11ner (see B below).
4 Show sensiriviry ro rhe Jl1lrient's needs and respond ro discomfori, reassuring ií appropriaro.
You mighr íccl a littlc bit oí
discomfor1. This mish1 hur1a linlc bur
1'11 be quick. Tell me i( i1 hurtS.
Let me kno'v if it's sorc.
h wi ll be over vcry q uickly.
h won '1rake long.
You'rc doing "C'Y \VCIJ.
5 Talk rhc parienr rhroug1rhe proccdure.
ltn1 just going ro ...
Fim 1'11 ...
Thcn 1'11 ...
NO\V r1n going ro ...
You'll feel ...
When ir's over, J'll ...
Thar's ir. Ali over.
6 Share your findi ngs wirh rhe parienr.
Well, J'm foirly ccrrain you've gor a
...
One possibiliry is ir could be whar we call ...
1haveni found anything to suggcst any problcm s.

Giving instructions
\Xlhen exan1i ning a parienr, politc íom1s are oftcn used for rhe initial insrrucrion:
Could you bend forward as fa r as you can?
Jf you could cross your arms in fronr of your chesr.
Whar l'd likc 10 do is examine you standing up.
Aftcr rhar dircct insrrucric:»ls n1a)' be used:
Stand with your feer rogerher.
Lie pcríecdy srill.
To soften an instruction:
Can you jusr rurn ro rhe side again?
Could you jusr lie on the couch?
For a lisr oí verbs commonly uscd in instrucrions during exami nations and
invesrigarions, sce Appcndix V on page 145.
50.1 Complcrc rhc i11;trut ions u<i ng ;mrable verbs. Look a r Appendix V 011 page 145 10 help you.
1 .... ....···--··srraighr nhe1d and . .......... _ . . )'HUf nosc '\'irh your r1ghc-:orefinger¡
rhen w1th your lcft fordingcr.
2 -on 1iw, rdgc of rhe couch and your ltgs h3ng loosely.
J ----rour erchds ughtl).
4 _ all your clothes do"n to )'Our undcrwcar.
5 . ....--..·--·you r chcst w1th your
chin.
6 ...... ....-.................. slo"ly ami lnok over your left <hou ldcr.
7 ......................... ............011 your side.
8 .. -- ............-... looking nt me.
9 -·- . your slecve.
10 the pin, nor thr light.

50.2 9

r
e_

8
"
10
2
13

S1 r\
3 ,J 6 r.::
1
11

50.3 Complete thc instrucrions íor a lumba r puncturc wirh words nnd phrase< from A and
B
oppo<ire.

lommi: Mr Maxwel all nght? Now, (I) _ -- ? Wdl,

(2) put a l11tlc needle into your spmc and take somc ílu1d off your
back to find out what',!\"'"11 you these headachc>. You might fed (3) --·-------·
bur it won'r (4) ...-......... . ... \Vhen it's (.)) ......................_.................., wc'll ask
you to l ir still for a few hours. Now Mr Maxwell, (6) .. . ..... ............................. roll
onto your lcft side? 1 want you to curl u p into a littlc ha ll. So could you bc11d you
r knees up nnd ruck your head in for me. Tltat's fine, lovely, OK. 'ow (7) .........
swab down your back \\ ith '>Omc anusrptic, all right? lt'll be a bit cold. Are )OU (81
? No" l'm going ro ghr )'OU a local anaesthetic so 11 won't be
sorc.You'll frd just a slight 1ab. OK.scr:nch commg now.There. \l;'c"ll wa11 for
a few min utes for thar to talr cfftct. R1ght now. he srill, that's very important.
Now (9) ...... ... ...............................me pre>si ng down as 1 pur thc ncedle
in.You're domg ( 10)
............................................... .OK. That's it. All ( 1 1) ................................................ .

Profmionol Eni'l$h ln Use Medicine 109

 Ove..r .f-o ':f Oll
Thtnk uf an t·xam1 na t111n you fn·c¡ut·nt ly carry ouL Wrih· do wn t ht• H1'ifrt1t·r 111n' you would
CJ IVl' fht· J>l ll lºtl f.

1 Professionol English in Use Medídne

1O
Mental state exa mination
Sorne symptoms of psychiatric disorders
• A dclusion is a firmly hdd bdief which is wrong bur nor open ro argumenr. For
cxamplc, a deluded parienr rnay nor accepr rhar his psychiarrisr is in facr a psychiatrist.
• Den1entia is sign.ificanr nlenral deteriorarion due ro physical changcs in rhe brain.
• Disorientation is nlCntal confusion abour time, place or idenriry.
• Hallucinations are apparenrly normal perceprions which happen wichour rhe
appropriare srimulus. An)• of che senses can be involved bur especiaUy vision and
hcaring.
• Wusioos are misinterpreracions of real srimuli.
• Obsessiona l symptoms are stcrcotyped ideas or impulses which the parienr cannor
resisr. They include obsessional thoughrs and obsessiona l rirua ls.

Mood
When describing a parie nr's mood, ir is berrer for doctors ro use rhe pariem's own words
rarher rhan rheir own subj ecrive dcscriprion of rhe patient's mood. Patienrs may say:
agitatcd
m low
restlt-'SS anxious iserable sad
I
anxiery unhappy
\VOrricd
vound up dcprcssed

dejcc1cd
panícky

( l've been feeling very low. y

Patienrs may a lso use the following adjecrives ro describe rheir condi rion:

1 ger very confused abour time.1 can'r remember whar day ir is.
People makc me angry. Thcy'rc so irrirating.

l 'm roo cmbarrassed bv my appearance ro go our. 1 sray ar home.

1ger muddled when f 'm shopping. 1 go our for milk and 1 come back wirh che<'.SC.

Typical questions from a mental state examination

1 Can you describe your mood ar die momenr?
2 How long havc you beco fccling likc this?
3 Do you take pleasure in anyrhing?
4 How are your cncrgy
lcvcls? 5 Wha1's your
appctite li ke?
6 Have you 1101iccd any cbange in your wcigh1?
7 How are you skcping?
8 Can you kccp your mind on things?
9 \Vhot do you fccl thc future holds for you?
10 Have you cver fel1 1ha1 you don'1wam 10 go on?
11 Have you ever 1hough1 of suicide?
51.1 Complete rhc sentcnces. Look nr A opposite to help you.
1 The parient bclicvcs rha1 pcuplc "'-'"' !tt-.-C chrough '''·111$. 1 lc's suffcrlng fronl o
2 Thc paticm sees her long-dcad >i'>ters 111 her g¡irdcn. Shcºs suffcring from
3 Thc JXln<.'nt pen::e,.·es me branchc-. as snakes. Hcºs cpericncing an
4 Thc panem washes her hand; li•e nme hcfore ner¡ mcJI. Her bcha•iour 11
5 The pnuent thmks the nurse 11her daughter. Sheºs
6 A paricm 1s confused about whrn:she is.She's •uffcrin¡; from ·--·---··

51.2 Complcrc thc rabie wirh word• from A opposirc.Then complcre thc senrcnccs bclow.

Noun 1 Ad ·11v
w r
confus1on
dcluded
dcpres1ion depr<."llVC (illn)
(parienr)
di•oric1111-d
obsess1on (srmptoms,thoughrs)
oi><.h>l\ C compulsi»e (disorder)
ps)Ch1atr¡ (fiddl

-
1 Paricnr• in ............
(pracmioner )

.............. ho•pita ls receive fewcr gct wcll cards rhan othcr<.

............
l ln1pairl.'CI concenrrarion is a char.1crerisric symp10111 uí , ,.. ........·-····· . ....
3 The potcnt ial risk of suicide ;hould always be a1se<.>ed in rhe se»erdy
4 A person mny he confused about "ho they are or wherc rhey are.

51.3 \Vtite thc doetor's questions IO the mental StatC C.X3m103110n. Look 3t C Oppos1tC tO )p )'OU.
Doctor: ( 1) . -···-····-· ·····--···-·· ·--···-··---·· ?
Pa rienr: 1 fccl low.l"m not en1oyin¡¡li fc.
Doctor: (2) ........
.... ·-···
·· .. M . . . .. . . . . . . •• • . ... . ?
Parienr: No, norhing.
Doctor: (3) ?
Panem: 1 frd run down. rm reall} ured.
Doctor: (4)
Panenr: for months now.
Doctor: (51 · ···---······ ·········--···
Paricnr: 1 c.rn'r get ro sleep and whcn 1 do slee(> 1 wake up early.
Doctor: (6) ...................-......... .. .............H. ........ ........ .................. ........... ..
............... ...................... ?
Patienr: l"ve ¡;or no appenre. 1 don'1enjoy food.
Doctor: CI ?
Patienr: l"m lo1mg wcight.
Docror: (8) ---
Parienr: 1can't remember where l"ve pur anythin¡;.
Doctor: (9) ·-··-···-···. . .·-····-
···-···. Pnrienr: Don·r l ike thinki ng aoour ir.
Doctor: ( 1 0) ..········-······ . ...········-········.. ...... ................................................................
Parient: l\ e thou¡;hr about u hut 1 donºt have rhe ......:
couragc.

Pro(essionol E.n íosh 1n Use Medicine 11

1
1 12 Pror.ssionol Englh in Use
Medicine
 Explaining diagnosis a nd management
Explanations
The final part of a consu.tation is thc cxplanation which should
covcr: Thc diagnosis - idcntification of a discasc from iis signs and
symproms.
You're suffcring from TI1is is (mainly) beca use
... You've devcloped ... TI1is is why ...
...
You havc ...
2 1 he n1anagen1ent plan. including i nvesrigarions and rrearn1enr.
1'11 make you an appoinnnent with ... You'IJ be givcn ...
l'm going 10 start you on mcdication to ... 1 cxpect you'll havc
... l'm going to havc you admitted 10 ... They may advisc ...
l'll arrangc for you to ...
3 General advicc about any changc in lifcstylc thar may be nt"Cdcd, for cxamplc giving
up smoking or drinking less alcohol.
Tite n urse will give you advicc on I \\'anr you ro ...
... You should try to gi ve up ... lt's important tha1 you ...
4 The prognosis - whar is li kely to happcn because of a discasc, strcssing thar nothing is
ccrtain.
l cxpcct rhc trcatmcnt \vill ... Wc can ncver be absolurely certain about ...
Hopcfully we can ... You should remain optimistic.
5 Question rime - where the parient can ask questions about hislhcr illncss.
Do you havc any qucs1ions? Is thcrc anyth ing you'd like 10 ask?
-- Using lay terms in explanations
Explanarions should be gi \•cn in words che paricnr will undersrand, avoiding mcdical
iargon. Using lay 1crrns -words familiar to people withour medica! knowledge -
can hdp paricnrs undersrand cxplanarions . For a lisr oí so111c co111n1011 lay rerms for
condirions, parrs of rhe body and medication, see Appcndix VI on page 146.

-- An explanation of angina A
--// /
Having cxamincd you, l'rn confidenr that you'rc suffering from angina.
TI1c heart is a pump. Thc more you do physically, rhc hardcr ir has <O work. Sur
<S we ge1olde 1he blood vesscls which supply oxygen to 1he hear1 begi n to
barden and get furred up, so rhey btx:omc narrowcr.They can't supply all che
oxygen rhe hearr needs. TI1e resul1 is che pain )'OU feel as angi na.
Beca.use you're experiencing pain ar resr as \vell as on exerrion, J'n1 going to have you
ad1nirred ro rhe coronary care unir righr a\vay so rhar your rrcarn1enr can srarr ar once.
You'll be gi ven d rugs 10 case che pain and 1 expccr you 'll have an angiogram. Tiiey
may advise surgery or M1gioplasty - thar's a "'ªl' of opening up the blood vessels to
the hean so chey can provide more oxygcn.
You should try to give up smoking. You won't be able to smoke at a ll in hospital
;o it's a good time ro stop.
J expccr che rreatmenr will improve your pain ar leasr and may ger rid of ir
complc1ely. Wc can nevcr be absolutely ccrtain about rhc futurc but you should
remain oprimistic. Do you have any ques1ions?
52.1 Match rhe srages of a consulrarion {1-4) wirh rhe seorences used {a-f). Look ar A and C
opposite to help you.
diagnosis
2 1nanagement
3 general advice
4 prognosis
a l'm going ro have you adm irred ro rhe coronary care unir.
b 1 expecr the trearmenr w1ll improvc you r pain ar leasr and may ger rid of it
complcrdy. e Having examincd you, l'm conJidenr rhar you're suffering from angi
na.
d You should rry ro give up smoking.
e \V/e can nevcr be abs.<>1urely cerrain about the furure bur you should rc111ain opri1nistic.
f You'll he given drugs ro ease the pa in and 1 exp<"Cr you ºll have a n angiogra m.

52.2 Replace the underlined words and phrascs wi th appropriare lay rerms.Look at Appendix
Vl on page 146 ro help you.
1 Mr Harris, I'n1 afraid your \vife's suffered ao acure cerebroyagular evcnr.
2 Thc runs rhrough rhe middle of thc prosrare .
3 The reason for your nocmria is rhat your prosrare is enlarged.
4 Do you suffer from dyspnoea when you cxert yourself?
5 1'1n going to give you an analgesic and an anrj-jnOa1nn 1arorv for your spraincd anklr.
6 l'm putting you on anri· depressaors loe a short time to help you ger back ro norma l life.

52.3 Complete rhe expla nation of diabetes. L..ook at A opposite to help you.
Youºvc ( 1) .. ...... .. ............. ....................Ty¡x 2 Ji"U<t<>. Th i> ;, (2) ...........................................
..........................................
very overweight. Your body isn'r producing enough insulin. (3) ................................................
you feel so rhirsry and why you pass urine so frequenrly. lt's also the reason you have this
vcry irchy rash and you ha vc a problenl \\'ith your eyes.
The nurse will (4) ................................................your dier and 1'11 (5) ......................................................
..........................
a dierician. l'm (6) ................................................ra blets ro control your high blood sugar. You
don'r need i nsulin right now but ir is possible you might need ir in rhe future.
You (7) ............................................... lose weighr a nd 1 (8)
...............................................................................................see
a podiattist. lt's importanr with diabetes that you takc good care of your feet. You should also
see you r opticlan every six 1nonths for eye checks.
Diabetes is a scrious condirion and can affect your hcart, blood pressure, circulation, kidneys
and vision bur we can limit thcsc problems by conrrolling your blood sugar.
o case of diabetes can be described as mild. 1'11 (9) ................................................ to attend
rhe diaberic clinic evcry nvo n1onrhs so -.ve can check your progress.
{ 10) ...................... ....... ...................reduce this to six monthly visits once your cond irion is under control.
Is thcre ( 1 1 )................................. .......... ?

Ove.r .f-o /10LA '.,

Expl;11ncondition uf your <·hoit·t.·to a palil nt. Your l'xplan;.1linn \hnuld <·ovt·r l ht·po1n ls
li\ll'tl i n A uppo..i l r anrl ll\t' l;iy ternn. wht•rt• p..:n,..ihlt·.

Professional Engfis.h in Use Medíjne 113

 Discussing treatment
Offering options
When discussing oprio1h with a paticnr, docrors may "'>"

1ions we can use. The fimop1ion 1;10 11')' rablers likc Prozac chat lift )ou up a bit. Thc olher oprion 1s counll111g.
1t can be caused by d1e1or st rtss.
There t\t'C sorne quite simple 1cs1s
''ecan do. lf )Ou'rc súll conccmed, "e
""" rcfcr
)ou ro a hosp11al.

Advising a course of action

When advising a cour;.c of aetion, docrors may ;.. y:

Somc rime off work m\¡ht help. lf you Carry on drink ing lor>
of íluid..
feh that would be hclpful, you could take a week off and ltt how you fdt after cluit.

lf )ou srill ha.-e somc pam. )ou

can kttp taking pam<Ttamol.

Other rhing< miglu hclp, like raising rhe hcad of your bed. 'That's onc of rhc ;i mpl rhings we
could s1art you off with . You said you haven'r rricd indi¡;esrion remedies. TI1nr'> SM1cthing you co

Advising patients to avoid something

When ad•·ismg pancnts to a•o1d somedung, docto,.., rna)
say:

There are a few rhrng; about your

lifcsryle we could addrr;;. Pcrhaps Cu t out forry íood,.
cut do,vn on rhe íHnount )'ou"re
drinking. Giving up smoki ng would
hclp.

You should rry ro ª'oid right dorhing, sirring 111 dcep armchairs and bendm¡:. t>pcc1ally after meals.

Warnings
Whcn a doctor''""" ro wJrn a pacienr rhat thc con.equence of ignoring thc advicc
wuld be serious, he or he may ;ay:
lí you aren't íecl in¡; hcucr in 7 to 14 days, l f you keep damaging ir, you 'rc
you really mus1 come hack and see me going ro cnd up with a lon¡;·term
again. p•oblem.

lf you feel tha1 1h111gs rcti'I serrling, lt';"') imponant )'OU don) s1op
aren·, gctting back 10norm.1 1t"> taking tite cablers suddenl• or )OUr
1mporomt that you see me agam. >ymp1oms will recurn.
53.1 Complete the adv1cc.l ook at A, B, C and D opp<»11c to help you.
1 lf you ................... ... ..... ..••.....•...•.....•...•••..smokmg, you increasc rhe risk
of lung ca11ccr a nd hearr disease.
2 Your hea lth would i mprove if you ... ....... ..... .... .............................alcohol
complcrel)'. 3 You could ••........ . .•.••.•.........•..... with a
erious drug problem.
4 l'm going <0 ---·you.... .. wirh sorne rablers. lf they don'r help,
we'll need to thmk abour ""l<I).
5 _ on rhe amounr of salt rou rake wirh your
food. 6 1 expea things w11l --in a fcw days and you'll be able to get up.
7 Try to <1ruarions where rou feel srrtssed.

53.2 Match the rwo pam of 1he senrences. Look at A, ll. <.. .111d O oppositc ro
hclp you. 1 lf you still havc pa in,
2 lf you find it difficulr ro give up smoking,
3 Your syn1prom.) \vill rerurn
4 lf you can"t ger to lecp,
5 Come back and see me a;;.
in 6 lf you're still concemed.
a cry co a•o1d caff<mc larer m rhe da).
b 1f you find your brcarhle<.>ncss has increased.
e keep caking paracc1amol.
d 1 can rcfer you to a
consulram. e if you start smoki
ni: agai n.
f 1 C!ln rrange íor nicotinc rcpl'-1oenlent thcropy.

53.3 Advise a patiem with h1gh blood pressure about phy 1cal acriviiy.Look at the
i nformarion in the table, and ar eop)lO'iÍte to help you.

Adv1l·t· lor :it·oplt·\.V1th ht·art cl1\t'.l \t· e n h1qh hlood prt'\\llrt

------------------ --------
Do Avoul
Moderare, rhyrh mic (acrohic) exercisc such ln1ense exercise such as weigh1-l1f11ng, prc<s·
as brisk'va lking, cychng or S\virni-ning. up .heavy d igging and isometric excrcise.
Any regular phyical acrivity rhat you are used ro.Any sport or activiry that brings on angina.

Eat a low cholesterol d1et. Movmg from íloor to scanding cxcr.:i.es too q111ckl).

..bm:tA.ea ---
v.111.1 .t ¡y oo ne,._ _
YC. 1l.Lk!.MY.m:K.Wll 1<1r.
4, ·· ···---- ··-

Ove•.r .f-o 11ou

A patll'tl l of yotir\, t\i1r' Wt11l l'. ;tql·d 44, hJ\ hl'l'tl ro1t1pl;111111111 of Vl'f'V hl·;1vy pt·r111d' An ult r1-.>ound .,,·0111 uf IH-r pl-1'"' 'how'>

l Profmionol English in US<

l6 Medicine
1 Do noth1nq_ lht· hhn11d wdl "lhrink whl'fl 'hr ht·t-orth'' rtll·noµ;1uJI
] St'l' J 9yn;1t·t·ol11q...,I wht: rnJy •1dv1"it' rt·n1ov,1l 11I tlH· l1hr111d or a hy\lt·n·t·ton1y
Pr;1t·t1...t· \Vh;1I you w-ould ''y to "-'1r"i Wh1h· to ,uf v...,t· ht·r 111 lht'\l' option\.

Prof•ssional Engfish ;,, Utt 1

Medldn• 1S
Giving bad news
Principies of giving bad news
Givt \V:lrning. A
--------------' '------
l'm afraid you r test resulrs aren't very good.
l'm sorry 10 havc 10 ull you that 1he news is11" good.

2 Choose an appropriate setting and have a friend or relativc of thc patient presem.
3 Take time.
4 Use appropriate languagc.
5 Emphasi1,e the positivc.

There's still a lor we can do 10 hclp you.

Chemothcrapy will make you more comfortablc.

6 Oiscuss the prognosis.

One can never be certain about thcsc 1hings but l 'd say
it's a n1attcr of n1onth; rather chan years.

7 Supplcmcnr 1he verbal message.

l'd like ro record this consultation so you can listen again if anything is1i't clear.

8 Arr:tnge follo"v up se-s<:ion.

l'd like ro see you again nexr \vcek .

Can you come Ln again next \veek?
9 Confirin 1hat rhe pa rienr understands. ,1
'----
Could you te.11 me what we'r< going ro do for you?
Is cvcrything clear co you?

A consultant medica! oncologist's report

Mr HaI'!'y Scott
Diagnosis: Prevlous pancreatlc cancer
I reviewed Mr Scott Inthe Onco ogy Cllnic toda.y. He ha.s been less well and ha.s
Jost 12 kg Inthe past few months. Unfortunately, hls CT sca.n shows an a.rea of i!
J.<letlned low attenuatlon In the tail of the pancrea.s.Although thls Is conslstent
Wlth focaJ pancreatitis, the general fee!lng at the Multidlscipllna.ry Te8.m meeting
wa.s that thls repretents recurrent d.isease.Thls Is especlally Ukely in view of hls
cllnica.l deterioration and rtstng CA19.9. I d.l.scu.ued thls with Mr Scott arid hls
wife. He wa.s obvlously dlaappointed with the sca.n results but still tries to
remal.n poaltive. We dlscussed the fa.et that ery wun't an option and
aymptom control was lmportwt. We alSo d.iscussed the role of palllatlve
Gemcitablne. •me potentlal benetlts are small but lt Is usually well tolerated and he
wa.s 1™1n to prooeed w!th thls. I W1ll therefore book him lnto Ward 8 to
atantreatmanl in the next few weeks and have re-ehecked hls bloods toda.y. In the
meantlme, I would be V&J'Y grateful 1f you would reter him to your d!etlclan. He
hlmself is keeD. ror thls to happen. We wi1l see hlro back In Cllnic once bis
treatment has started.
54.1 Complete tbc ntract from rbc oncolo¡i1<1\ <On>ulm1on "nh Mr Scon. Look at A and B
oppouc- ro hclp you.

Oncologisr: ;\IrScon. ( lt _ ·-so¡ou and ;\lrs Scon can

pla) back later an)thong rhat ma) 1101be dcar ro you today.
(2) ····-··-·-- . thJt thc sean resulrs aren·r •cry ¡:cKI. Ir'>
likely that you·ve gor a rccu rrcncc of cam.-er in your pancreas. Tnat wou ld
e<pl.un whr you'vc becn feding so tired• •111d your los. of apperi re and
weight.
Mr 5<:011: Will 1 need surgery?
Oncolo¡:isr: Surgcry (3) . .. .... ar rh is stage.Alrhough wc c:m"t
operare, rhere is srill (4) .....·-··- ....·--····- . You"ve gor
1ahlc1; for pain relief ard we can g11c )Oll something sironger if you need it.
We c:n also srart you on a couN of chemot hemp) to hclp with your
symproms.TI11> won't
cure you but it will (5) ---.lr"s unusual tO ha•c
any unpleas:mr stde dfect\ wnh th1;kond oí chemorhcrap)'·l'd like )OU too ro
scc a doctician for sorne •d•icc on wha1 ro eat and ro help ger rour appetne
hocl.
Mr Sc:ott: \'C'hat"s my life expecranc ? llow long ha.e 1gor?
Oncologist: One can (6) • People wirh rhis condouon \'JI') a
grear deal. 1would be wrong !O give you a defimrc rime scale but l'd s. 1
(7) ··---··--......... .. . (8) ·- ·· ···---··---...............-....... ali
this, bur my feeling ;, ir"> always bcst ro be honesr wirh people and rhen you know
\vhat"s \vhar.
l f you'rc in agrccmenr, l'd like ro (9) ................... ...................._............................... Wnrd 2
to
sr::tr( your che1no. u'11 net'C.I to con1e in C\'ery \veek for rhe ntxr rnonrll.
Yo'
Is everyth ing clear ro you? ( 1 0) ......................... ...............-...... ...... rreatment
wc'rc
going ro give you? Are thcre .any particular \vorries you havc?
l"lJ be seeing )'OU regular() tO kccp an C)'C on 1hings SO you can ask me 311)'
Other quesaons you may ha.e.

54.2 Complete rhe srnrences wi:h words from thc box. Look at A and B opposire ro help )

OU. J for in ro 10 w11h 1

Thcse resulcs are consisrenr ........... rccurrem cancer.

2 H1s GP rcfcrred him···--··-··· an oncolo :i>t.
3 Thc pa11e 111 was dis. ppcintcd ... the news.
4 The prognosis was discussed .............. ... ..............thc paticnt and his wife.
5 Thc paticnr was booked ...................................... t hc wa rd for furrher chcmorhcrapy.
6 1 lc was kccn ....................................... this ro ha ppcn.

118 Pro(essioll<ll En¡hsh m lile

Median•
 Data presentation 1
Referring to a table or figure
ln an arlicle, you C;lll \\Tite: In n préntation, you crin u rhe
une expressions, or you can ay:
Figure 1
shows X.
Table 1 ( As you can see in Table}J
X is sho,,·n in hE:un- l.
Table l.

Compar ing variables

Whcn you rcfer ro .1 tJl>ic you will oftcn nccd 10 compare one variable with nnmlwr:
l\\•icc cffoctive
X was
1hrcc 1imcs
as
common
as Y.

Or rou nuy need 10 compare me saine ,aroable ar d1ffcrtn1 times:

doublc
The number of X m 2)()() was 1h•1'" 1990.
triple / 1hrce rimes

1wofold
There was a incrcasc in che number of X berwccn 1990 nnd 2000.
th rccfold

rwofold
lne number of X 1ncrta'ied
thrcefold
littween 1990 and 2000.
doubled
Tu number oí X
trcbled

Approximating
When refemng m che d.u,1 presenred on slide-;, 11u111hcrs are often roundcd, for c<w1ple 41 .
3
!J<,comes 4 1 or cvcn 40. When rhis is dt1nc, ir is common 10 use e><pres>ion' of
approx:i nrncion:
aboue
around
Sid.xffecrs wcre reponed by approximaicly ÍOrt) pariems. /
roughly
sorne

Numbers are frequcndy prcsenred as frac11on1 or pcm:ncages, even when che C\Jct
rllUl'lber is gi ven.

Roughly rwo chirds oí pacicncs Fifty·five, or son1e f\VO ·third,

reponed side-cffocts. of p.11icnts reported side-effcet>.

When rou wam co emphas1zc a numbe for exa mp 11.8°0, rou can sa :
almosc 10º• nearly 10º• more than 9°o
over 9°0 jusi under 1Oºo

and when )OU \\ Jnt 10 11ake the number Sttm

smJll: less chao 10%
55.1 Complete rhe de-scripuon o' rhe dara in rhe rabie.Look a1 A and 8oppos11e ro hclp you.

Table 1:Jncidence of ulcer perforation 1967-1982

l'eloalion s ('Nomen) 1967 7 10

1982 14 33
No. of presaip11ons(Mfn) 1967 290
1982 820
l'Morations (Men) 1967 36 32
1982 28 65

Table 1 (1) ........................... ........trends in 1he frequency of hospital admission for peóorated peptic
uker
in the Uni1ed Kingdom (2) ..........................-...........with changesin the
annualprescription rates for non· steroidal antHnflammatOI}' drugs.
For women O\'er 65 the annual number of prescriptions increased (3).. lrom t
967 to 1982.during which rates ot perfuration of duodenal ulce<s (4) for !hose agtd
65 to 74 and mon? than (5) for !hose aged 75 and O\'er.For men O\'er
65.prescnptJons showEd a simikY increase.Al1hough perfuration rates were actually for !hose
aged 65 to 74in 1982.there was a (6)............-.......increase in those aged 75 and ab<M!.

(BMJ 1986;292:614 Amcn<kd w1th ptrmission from tht 8MJ Puthh1n9 Group)
55.2 The data in rhc rnblc i i,. :ld.1ptt".CI from :io "rticle ent iclc'.<'I •Alcohol drinking in nlidd lc ._1!!.e'
Choosc the corrt word> ro complete rhe de;criprron below. Look ar e oppo,itc 10 hel p )'OU.

Chvacteristlcs (n•300) lnfrequent fftquenl

(n=423) (nal95l
193 (45.6) 204 (69 2}
No. (%) of smol<ers 54 (18.0)
Old age measuroments (follow up)
No.(%) who have had myocardialinfarction Results of cognitivo a.smsment
41(13.7)
No. (%) with no impalment (controls) No.(%) wrth mdd cognibve ompa;nnent 60 (14.2) 54 (18.3)
No.(%) Wlth demenba
261(87) 391(92 4) 257 (871)
25 (8.3) 15 (3.5) 21 (7 1)
14 C4 n 17 (4) 17 (5 8)

Only 54.°'(1) _ (under/less)than 20%, of the non dmkers smol<ed

compared with 204,°' (2) . ............. (almosVover) 70%, of the frequent
dnnkers.41,°'jusi
(3) ............. .... (less/under} 14% of the non drinkers had had a myocardial 1nfarc!Jon at
the end of the follow up period, compared with 54, or (4) ..... . ........... ....
(almost/over) 18%, of the frequent drinkers.At thc end of the follow up period, (5).....
................................. (about/over) 90%In alithree groups had no cognitiveimpairment.
There was mild impairment in (6) ....
(under/around) 8% of the non dnnkers, and in 7% of the frequent drinkers, but rn
(7)........-...
(approximately/ovel'J,%, of the non-dmkers had deml:r1U... wt1ile 17, "' 4,.vi u..,.,,,.,.....,,
Cless/underJ than 4% of the lnfrequent drinkers. 14.°'(8) .

dnnkers.and (9) -(m()(O than/nearly) 6% of the frequent dnnlcen Md dementia.

Son1e peoph.·

OVe..r .f-o
 1 ' ... 1
"

':fOll
Jroxin1ating ft•t•I lh.i l
b unrit•nl1 f ap
i t·. What do
you th ink?

Pro
Us•

1
 Data presentation 2
Line graphs
Norice rhe verbs used to describe changes ovcr a period of rime.

/
rise fati
I
reach a peak remain thc samc
increase drop
go up dccrease
go dO\\'n
Norice rhe difference:

I
rise sbarply
stecply
rise srcadily
gradually
rapidly

A line graph

Pie charts
Pie charrs are an effecrive way of showing thc relarionshi p of
parrs ro a wholc: the complere circle or pie represems rhc
whole, while the parrs are represenred by scgmcnrs or slices.
In 1his pie charr, which shows a health aurhoriry's costs, rhe
orange slice rcpresems cosrs of hospiral services. So, hospital
services accoum for 60% of rhe cosrs.

Hospital scrvicc-.s
Describing trends
Thc bar chart below shows rbe prevalence of 1 rrv in di ffcrenr counrries.
HIV rares have fallen in somc countries as a rcsult of safer sex, bu1 rhe ovcrall trend is an increasc in HTV infccrions. Th
 56.1 Complrie 1he 1ahlc "11h words from A oppo;ue.Puc a ;trt mark in from of 1he messed
syllabk of rwo >yllnhlc words. The firs< onc has bcen done for you.

Vrrh Nou
n
'decreasc
drop
fa])
locreasc
risc
-
56.2 Choose rhe corree< words io co111ple1e 1he dcscropuon of 1he har charr. Look .11 A
aoKI C opposite to hclp yc>u .
Figure 6 shows that 1he over;11l 11umber of c:i<e' uf HIV ( 1) ·--·········· . .... (dropped I
remained che same) )CJrly untol 1988, 1hen (2) ·-··-·(rosc/dropped)
(3) ------·- (;harply/¡¡r:idually ). Cases 111 hecerosexual men and wornen
(4) _ _ (ln.a>N/fell) (5) _ (steeply/steadily), especoallr
for people exposed abro.id. The number of infocted pt'Oplc 1111trong drugs
(6) (fclho'-C) after (7) _ (rc-aching a peak I droppon) on
1987.This ma) be beca use of che development of nttdle e>.change scheltlC".
Mother 10-infon1 cran;mo;sion (8)··--··--···-··· (rcpresemed/accounted ) for a sorull
number of case<. C1reÍUI management of la bou r grcatly reduced 1he number in
che
lace 1990s.

3000
Ochcrs

••
Mothtr to 1nfant
2500

•• •• Thc,.p<uh<

l) 2000
• •'"""'"9
Htttrwxual
'¡;
1500 •Homos<J<ual
"E'
z 1000

500
.. .,,
"'
....... g¡
"""' " ' ::;:
a>
;
"s:' "
s:'
o !!? !!? !!? !!? !!? !!? fogu 6
2 C
""'' "'
C>

56.3 Which rype of graph would best represen! 1he following

data? 1 llinh ra tes in thc UK from 1980 !O 2010
2 lncapacity duo ro five diffcrem causes from 1995 to
2005 3 Sources of ion i1in¡t radiation in the UK

Olu .f-o 15ou

Oraw a pu:· your C'ountry.
l·har
l ProJrll\t"
or hou C'hart which
\h0\11\ Un·
Jpprox1matt· l'OSts
of tht" ht·;1lth
\rrv1rt· 1 n
c:t·\rr1h1ng t
ht·t·hart.

Pr
Use

1
 Resea rch articles
The structure of a resea rch article
Research artides are rypkally divided inro four
nin.in secrions:
lntroduction
Methods
Resuhs
Discussio n
11iis is somerimes called 1he IMRaO srructure of
arrides.
lñc lntroduction conrains background informarion;
in other \vords, ir re1ninds rhe reader \vhat is
already known about thc subjcct. lt includes
inforn1arion abour previous studies, and expla i ns \vhat has nor bctn invcstigatcd
previously.Finally, thcrc ·s usually a statemenr of rhe objecrive., or purpose of rhe
research (why rhey did it).
In rhe case of c11ical research, rhe Med1ods section gives derai ls of rhe p<". Ople who werc
srudied
- rhe participanrs i n the research. The mcthod section also conrains informarion about any
intcrvcntion carried out, for exan1ple 1nedication, advice, operacions. Ir gives derails of che
steps caken in che srudy, ho\v the participanrs \vcrc choscn, and includes rhe main things
rnea.sured, such as blood levels. Finall)', there is informa tion about statistical analysis.
"íhe J ci:ults section tells wh3t \V3S found, rhe findi_ngs of rhe srudy.
The l)iscussion secrion conrnins explanarions, and daims for the importancc of the
m1dy. lt may also J ist Jimitations, or par!S of rhe study which were unsa risfacrory, and
sug¡>, esr whar research needs ro lx done in rhe fururc. Thcrc is usually a Condusion,
which is son1edmcs a separare section.
At rhe cnd of mosr arride", rhcrc is a short secrion c•.lled Acknowlcdgeme nts. ln
rhis che a uthors thank people who have helped thcm in their research. Finally, thcrc
is a l isr of
Refercnces -che books and arrides which the authors have used.

Objecti ves
Srarcmenrs about objectives oftcn contain che following verbs:
assess Wc assessed whethcr ...
determine The aiin of our srudy was ro determine wherher
investigare
... We invt'Stigarcd thc ...
evaluare ·1nis srudy evaluared rhe ...

Mai n findi ngs

The Oiscussion secrion usually begins with a summary of the main findings. This is
rdarcd to thc objective ol the srudy. Typical verbs include:
show We have shown that ...
confirm Our study confirmed rhat ...
provide cvidcncc Thcsc findings provide strong evidence rhar ...
lf the results are less certain:
suggcst These results suggest thar ...
and \Vith negarive rcsults:

122 Pro(essionol English in Use

Medicine
fail to This srudy failed ro show rhar ...
57 .1 Read rhe tighr "'racrs from an arride in rhe Bri111h 1cd1cal Journal enrirled
'Paremal agc t.lnd schi¿ophren 1n: n population lxised cohorr ¡rudy'. Decide \Vhich
secrion ní rht• a rtide each exrracr comes lrom. There are rwo cxrr.KI> from cach of
rhe four secrions. Look a r Unir 46 a¡;ai n ií you need more hclp.
1 People wirh older fothcrs were more likely to lo;c thcir parenrs beforc rhey reachcd 1he
age oí 18 years.
2 Using a large Swed1sh rtrord lutkage da1ab1. <e• .-e 11wes1igared rhe assoc1arion hcrw,.,n
paremal age and sch11ophrrn1a m ofkpring.
3 We used Co'< propomoial hazards modch ro a«SS the mílucnce oí paremal age on psichosis.
4 Our cohon compnscd "'H,.330 people hom m Swedcn between 1973 a nd 1980 and sall
ave and residenr in Swcden at rhe age of 1 6 ye•"·
5 Our finding.s confirm an associarion between 111crcast-d parernal age and schi1ophrcnrn in
offspring, which rcmained even after wc cnnrrollecl for a wide rangc of porenrial
confounding fucrors.
6 Thcrc is gro\\1Íng evidcncc that factors oper ui ng :ti different points in li íe concrihut( to an
individua l 's ri<k oí dc,eloping schirophrema.
7 Thc main lim1ranon of our analysis is rhar case asccrtar nmcm was based on people
admirred ro hospnal onli wnh di;1gnoses recorded on an admmisrrarive darabase.
8 Table 1 shows rhe charanrnsttcs oísubjeas m rela11on 10 the age oí rhetr fathcr.
(&U2004;32' 10J0Am<nó<d ""' rrom m.81.U """"'ne¡Groupl
57.2 Look ar rhe rcscarch qucrions 0-4) and writc a wc111cm of the objecnve oí cach
m1dy, using an appropriare form oí thc verb in brnckers. Look at B opposire 10
help you.
Can calciun1 :tncl vitan1i11 D supplen1entarion reduce thc risk of fractures in porancrop1usal
\von'len? (assess)
2 Does che way doct0r> dress iníluence p.1ric1m' confidence and trust in rhem? (determine)
3 Is Lhere a risk of herpes •irus 8 (HHV-8) rransmission by blood cransfusion? (c•aluarc)
4 Is rhere an assoc1a11on bttween OC\'Cr bemg marned and increased risk oí dearh? (m>csrigate)

57.J :-low \\Tire a scnrencc abour Lhc main finding m t"Jch oí rhc srud in 57.2
aho•e, assuming a result 3S shown 111 bracktts bdow.1 OOl 31C Opposite 10
hclp }OU.
1 (no)
2 (yes)
3 (yes)
4 (uncenain)

Professionol Enrtish In Use Medo<ine 123

Abstra cts
Structu red abstracts
An abstrae!is a rype of mmmary , and may be found in spedal colleetions of absrracrs,
such as Medl ine, or i n conference progran1n1es, as \\ ell as a{ rhe beginning of a research
1

ilrticle. Many jou rna ls rcquirc contributors (a urhors wishing ro publish thcir arricles in rhe
jou rnal) ro provide a structured abstraer -an abstraer which is divided inro specific
secrions.

The BMJ abstract

Thc British M edica/ joumal mueturcd abstraer is dividcd into the following secrions:
Objcetivc
Design
Setting
Subjecrs
Main outcome measure
Resuhs
Conclusion
Here is an exa 1nple:

AGE AT RETIREr>.·t ENT ANO LONG TERJ.4 SURVIVAL OF AN INDUSfRIAL POPULATK)N: PROSPECTIV'E COHORT $TUDY

OOJECTIVE
To asscss nhcthcr early :ctirc1ncnt is assocíaled ''ri1 h be-Her survlval .
DESIOI\
Long 1erm prospec1ive cchon srudy.
SETnNG
Petroleu1n and pelrochen1ical industry. United States.
SllOJECTS
Past cmployccs oí Shcll Oil who rctircd at agcs 55, 60, and 65 bctwccn 1 January
1973 and 31 December 2003.
r-.lAIN OUTCOME MEASURE
Hazard ratio oíde lh adjusted for sex. yer of entry 10 study, and socioeconom ic status.
RESULTS
Subjccts who rctircd carly at 55 and who wcrc s1ill alivc at 65 had a significantly higllcr
monal ity titan 1hose who rc1ired a1 65 (hazard ratio 1 .37, 95% confidence in1erval 1 .09 10 1 .
73). Monaliry was also significant ly highcr for s.ubjccts in thc first 1 O ycars aftcr rcürcmcnt a1
55 co1nparcd \vith th•:>SC \\•ho continued working (1.89, 1.58 10 2.27).After adjus1me111.
monaliry was similar between those who rctircd at 60 and 1hosc who rctircd at 65 ( 1 .06. 0.92
10 1.22). Monality did 1101 diffcr for thc firs1 fivc
years after retircment a1 00 comparcd with cominuing work al 60 (1.04, 0.82 10 1.31).
CONCLliSIONS
Rcriñng carly at 55 or 60 \vaS not assoc iatc".<I \vith bcncr survival than rctiring at 65 in a
cotx>rt of past employ.'.es of the pe1roche111ical industry.Monality was higher in employees who
rctircd at 55 1han in those \vho continued \vorting.

(BMJ 2005;331: 995 Amend<d w;th ¡><fm;ss;on ímm the 8MJ l'ublish;ng Group}

Note :Slighlly ditferent headings are uscd in sorne journal For example. The New
Pro(«•íoool Engsh In Use 1
Medklne lS
 Englond Journol of Medicine divides articles into Background, Methods, Results and
Conclusions. You must consult the Guide to Contributors for the precise requirements of the
journal you wish to contribute to.

124 Pro(essionol English in Us< Medidne

58.1 Complete rhe senrenccs. 1 O<h ar B opposire ro help you.
1 The ·····-··-·, ¡,th 11m ur purpu oí 1lic 1c)C,1n:. h.
2 The .....................
..... i; the location - rhe counrry, or part oí a cou nrry (c.g. a
hospital, school, ere.).
3 The ................. .1rc the proplc rhat rhc researchcr>'tudicd.
4 An ..-....-....... 1\.1 r<>ult.
5 The i> th' rype of srudy,for examplc randomiud ronrrollcd mal.

58.2 Answcr the qucst1011> abour rhe abstract in B opposne.

1 Who rook pan m rhe '1ud1?
2 What was rhe aom of thc 'tudy?
3 \X'here \Va'\ ir carr1c<l out?
4 What did rhey measu rc?
5 Whar !)'pe of srudy WJ> ir1
6 According ro rh is srudy, d()('s reriring early prolong lifc?

58.3 Thc secrions of rhc ab>rrn<"t below are in the wrong order.and thc hcadings have
littn removed. D<cide rhe corre". !ordcr,and gi'e each secroon a 11tle froon B
oppos11e.
England, Scotland. and \\•les.
2 l listor¡·oí asthma. whttz¡bronchiris.or whee11ng obtaoncd from interview "uh'ub¡c<"ts·
pa renrs at agc. 7, 1 1, and 1 6 and reponed ar 1111crv1ew hr subj<'CIS ar agcs 23 a nd H
3 To describe rhe oncidcncc J•••J oí wheezing illness fron• b1nh ro age 33 and rhc rda11on of
incidencc ro pcrinaral. medical, social, environmen1.1l, and liíesryle factors.
4 Thc cumulnrivc incidencc "í whcezinJ1, il lness was 18% by agc 7, 24% by age 16, and
43% by age 33. l ncidence during childhood was mongly.111d indepcndenrly a'lsociarcd with
pncumonia, hay fevcr, ond eczema. J...J lncidence from agc J 7 co 33 was a<sociarcd
mongly with active cogarcuc >mok ng and a hisrory oí ha) fe, er. 1- ..)
5 Atopy and acrwe Clga rette smoking are mator míluco..'é!o on the incidence 3nd rocurreice of
wheezing dunng adulthoo.l.
6 18.559 pcople bom on .l-9 March 1958. 5801 (31%) .:onrribured informanon ar.1gts -. 1 1.
16, 23, and 33 > ears.
7 Prospecrive longimdin.11'n1dy.
(8MJ200S; Amcndrd Wlltl pt'fmissiOf'I rrom lht BMJ Pubhhn1CJ Group)

58.4 Some jou rnals use d iffcrcnt he'1di ngs ro thosc in the BMJ. Ma tch rhc headings (
1-5) ro thc corresponding BM} hcadmgs (a-e).
1 Findings
2 Purpose
3 Background
4 lnrerprecarion
5 Panicipanrs
a l nrroduction
b Objecrive
e Subjccts
d Results
e Condusion
Conference presentations
The structure of a presentation
Omference (or congressi presenrations are iypically dividcd into IMRaD secrions (sec
Unir 57).
lf rhe presenration has a differenr form, rhe speaker may sra rr by ourlining irs
srructure. This helps ro orientare rbe audience:
1'11 begin by ...
First of ali, l'll ...
l'll then ...
Secondly, 1'11 ...
finally, l'll ...
Many speakers like ro sta rr a ne\v section \Vi th a signa!:
NO\\', ...
Moving on to X, ...
As far as X is coocerned, ...
An alrernarive- rechnique is ro use a question:
How did wc investigare this probkm? (ro introduce Merhod)
What did we find? (ro introduce Resulrs)
How does rhis compare with pre••ious srudics? (to introduce Discussion)

The introduction
A formal way of bcginning is:
J'd like to present to you the rcsults of our research into ...
Many speakers prefer 10 begin in a less forma l way:
When we first bt,,¡an 10 k>ok into thc qucstion of X, wc thought ...
You may wish ro begin wirh a generalisarion or reference ro shared
knowledge: lt is well known that ...
Man y srudies have shown rhar ...
X has establishcd clearly that ...

Signalling
Orher signals rhat you may wish to give include:
Emphasizing Giving examples
• l 'd like 10 ernphasize ... • For instance ...
Listing points • ·.. such as ···
• Firsdy, ... Contrasting
• Sccondly, ... • On the other hand
... Rcferr ing to siides • In contrast ...
• This slidc shows ... • However, ···

The conclusion
Ir is in1PQrtanr ro end well, for exan1plc by sun1n1in up rhe main conclusions.
So, \Ve can see ...
In conc1usion, To sun1 up, l'd
Fina Uy,10 say end by ... rhese srudies show ...
like

Pro(essk>nol EngJish in UM 127

tdicnt
59.1 Hcrc are some extracts from a presemarion on carbon monoxidc p<>isoni ng. After
announcing his topic, the spea1c.er ralked nbour rhe porhophysi ology of CO poisoning,
rhen the possible sources of rhc gas, and fina lly diagnosis and trearment.Pur the
extracts in rhe correct order.
There is, howcver, no C\•idcncc ar ali thar giving steroids in pharmacological doses is of
any proveo prophylacric value. ...
2 How do wc diagnosc ir? The early clinical appeara nces of ca rbon monoxide poiso11ing can
be very non-.specific. ...
3 So, rhe actual diagnosis of thc condirion can be vcry difficu lr. ...
4 l'd likc to tell you abour some of our experiences in relarion ro carbon monoxide
p<>isoning. ...
5 On rhe slide here, you'll see rhat rhere a re a variery of sou rces of carbon monoxidc, such as
car exhausrs, fires, and so on. ...
6 First of all, J \Vant ro concentrate on s111oke íron1 fires as one of the n1ost in1portant sources
of carbon monoxide....
7 Now, in relarion ro thc rreatmem of carbon monoxide poison ing, 100 per cent
oxygen administered through a tighr-füring foce mask or endotracheal tubc is
csscntial. ...
8 1 think it's imporrant to cmphasize rhat rhe prcsence of cherry·red mucous membranes is a
very, vcry poor sign. ...
9 Now, •ou will remembcr that ca rbon monoxide srrongly binds wirh haemoglobin to
produce carboxyhaemoglobi n....
10 The only accurare way of dctccring whcrher rhe paticnt has been exposed to
carbon monoxidc is ro me'1sure ca rboxyhaemoglobi n in, usually, the venous
blood . ...

59.2 \Xliilc d1t: \vvrd vr plan.1 U-!tt::d lJy che speaker in rhc prcscnrarion in .59. 1 above nexr ro irs
fu nction. Look at B, C and D opp<>site to help you .

Emphasizing
Listing
Exemplifying
Conrrasring
Summing up
Changing topic
Referring to a slidc
Announcing rhe topic

Over ..f-o 11ou

What n1akes a good presentation , in your 011inion? Think ahout:

• loudness of voice

• speed of delivery
• usl of tmphasis and pausing
•l'Vt' contact wi th the au 1ience 1

• body language - postu" and

•
gesturt"S
visual aids.
Case presentations
Sections of a case presenta tion
In a case presentarion, a docror presenrs rhe derails of a parient's case ro colleagucs ar a
dinical mt'<!ting in a hospiml. A typical case presenrnrion is divided inro rhe following
secrions:

Sed1on Example
language
lnrroducrion l'd like ro prc.;cnr M r Simpson,
Parienc's age and occuparion a 34-yca r-old plumber,
Presenring symprom(s) and who prc.;ented wirh a one monrh hisrory of brea:hlessness.
durarion
Associa red S)'mproms He also complained of ank le swelling which he'd had for
f\\IO 'veeks.

Past medica l hisrory There was no rclcvant past hisrory.

Social hisrory He \Vas married \Vith one son. He sn1oked 25 cigarcttcs a
day and drank abour 50 unirs of alcohol per we<k.
Fami ly hisrory His farher dicd of myocardial in farcrion ar rhe age of 42.
His n1other 'vas alive and 'vell.
Findings on exan1inarion On examination, he \vas obesc ...
lnvcsrigation results We did a chesr X-ray which showed ...
Diagnosis So we rhoughr he had ...
l'rcarmcnt We gave hin1 inrravenous furosen1ide and ...
Outcome - what happened He rc.;ponded ro rrcatmcnt and was dischargcd home.

Bedside presen tation

A less formal type of ca prescnrarion can rake place ar a pariem's bed, for exa mple
during'vard rounds, \vhen the house officer presenrs a nt\v patient ro the
consultant; or in a tcaching 'vard round, 'vhcn a medica l srudenr presenrs 3 case to
rhe tutor. This rype of presenrarion begins less formally: ,¡
//
This is Mr Simpson. He's 34, and hc's a plumber. He came inro hospital yesrerday,
seor by his GP. Hc·s complain i ng of brearhlessness, which he's had for one
montb ...

Slides
Ln a formaJ presenra rion, rhc 111ain poinrs are usually surn1narized on slides.

Proffflionol English ;,, Use 129

Medkiile
 Mr Sirnpson 34, plumber
e/o
dyspnoea 1/12; ankle swelling 2152 '

SH with 1son
married
25 cigs/day; 50 units alcohol/week '

nilrelevant
PH FH OE ·.
father d.42 MI; mother a&w obese; 2 spider naevion ches! P 11O/min reg.
BP 100/60
enlarged heart and blat. pleural effusions

CXR

128 Pro(essionol English in

Us• Medicine
60.1 Wrire rhe abbreviari<ms in words. Look ar Look ar A and C opposire a nd ar Appcndix 11
on page 131 to help you .
do
2/52
PH
FH
MI
BP
1/12
nil
SH
a&\\r
OE
CXR

60.2 Put rhe scc1ions of a short informal case presentarion in rhc correcr order.Look ar A opposire t0
help you.
1 Mr Collins is a 60-year-old securiry guard.
2 There 'vas no relevant previous n1edical history.
3 He smokes 20 ciga mres pcr day and drinks 15-20 urlits of alcohol each week .
4 On examinarion, rhere was marked renderness around rhe lower legs abovc the anklcs and
knecs.There were crackles ar rhc kft base postcriorly in rhe chcst. 111ere was nor hing else
abnormal ro find on exam inarion excepr for dubbing of rhe fingcrs.
5 He presented wirh a six-week hisrory of pain in the legs.
6 Chest X-ray showed consolidarion in the lefr lower lobe.Bronchoscopy and biopsy showcd
adenocarcinoma of rhe lung and computcd romography {CT) sean showed rhar rhis was
nor resecrable.
7 Trearmenr with chemorhera py has rcsulrcd in rcmporary improvcment in rhe chesr X·ray
bur rhe leg pain has conrinued ro prove d ifficulr ro conrrol.
8 The pain, \vhich \vas l ocared around the ankles, had been increasing i n inrensi ty and \•1as
associared wirh local renderness.
9 On romine qucsrioning, he said that he had had a morning cough wirh small amounrs of
'vhire spuru1n for i-nany years. He produced, once, so1ne srrcaks of blood i n thc spururn.
60.3 Read the prcsenration below and make notes for a slide. Look ar C opposirc ro hclp you.

l'd like ro presenr M r McNa mara who's a 63·year-old taxi driver who prcsenred ro the
Ourpaticnt Clinic with a thrcc-monrh hisrory of increasing shorrness of brearh and ankle
swelling. He had a chronic cough with purulenr spurum and occasional haemoprysis. Of
note in his pasr medical history was rhat he'd had a pari ial gasrrecromy in 1980.
On examinarion, he was pale. 1 lc was apyrexial. He had leg oedema, bur no clubbing
or lymphadenoparhy. And examinarion of h is chest was cnrirely mlrmal. His liver was
palpable 5 centimetrcs below rhe costal margin, and was smoorh a nd non tender, and rhere
\Vas also a scar fron1 his previous operarion.

Over ..f-o ':jot1

Mala.·notl·s ahout ;1 p.atil·nt you kno\v and prn·ti'!il' prl'Sl'nting h im ur
her.
Appl·nd1x

1 Pa rts of the body

1 tar
21 2
check
22 3 jaw (mand1blc)
4 neck
23
2 5 shouldcr
3 24 6 armpit (axilla)
4 25 1 uppcr tlrn1
8 elbow
5 9 loin
26 10 fortarm
6 11 butrock
28 27
12 \\JíÍSt
1 13 hand
14 thumb
8
15 finger
9 30 29 16 th1gh
17 calf
10 18 leg
19 foor
20 roe
34 21 ha ir
22 forehcad
15 23 nose
24 chin
16 25 Adam's applc
(laryngeal prom1ncnce)
26 chesr
(thor.1)
27 rupple
\ J
35 28 breast
29 sromach, tummy.bcll)
(abdonl<'n)
17 30 na, I, belly bu·ron (umb1l1cus
)
31 h1p
36 32 palm
18 33 grom (inguinal reg1on)
34 genirnls
(pcni> and tcsticles)
19 37 35 knee
20 38 ( parella = knccrap)
36 shin
40 39 37 anklc
38 big roe
, 39 sole
' 40 heel

130 Pro(essional Eng6sh in U.e

Medldne
back

burrock-+--t

ProfessionaJ fnglish in Use 131

M'd1dne
Medical abbreviations
Ahhrt v1a t1on Meanonq
symhnl
# fracture
t inc-re;;1sccUra 1scd
decreasedircduccd
9 iemale
el' rnale
µ1110VL rnicron1ols per li1rc
µ¡: microgram
1112 1 month
JI.U 1 """k
10•/L nmrs ten to thc pü\\Cr mne p<'r htr< (note supcrscript 9)
A&E :.1cc1dcnr and cmcrgrnc)'
.i&w alive and wcll
t.c. bcfore me.tls/food ( latín)
a.rtl. n rhe morning ( Latín)
A:G albumen glohulin ra tio
Ali •pex licar
A BC ainv:iys, breuhint-t, circularion
ahd I ahdo. abdomen
ACrH adrenoconocorrophíc honnone
Ar Jtrial librillotoon
AFP alphafetoprotem
AllA .\rea Healrh Aurhom¡
Al JOrtic incomperencc
AIDS acquired 1mmu11odeficicnq discasc
AJ .rnkle jerk
al k. pho>. Jlkaline phosphara..c
AI T alani ne a1nino1rani;;Ícr.1c
Ai'vtA American 1edícal J\r.sociation
1

AN Jnrenaral
AP Jntero-posrerior
APH antepanum haemorrha¡:c
ARM Jrtílicíal ruprur< oí membranes
AS alomcntar¡ S)S em
ASO mial <ep1JI dcíect
ASO anrisrreptolysm O
ATS {lnritetanic scrun1; anutcranus serum
AVF augmenrcd volragc foor
 Ahbrt'v 1ation Mcaning
symhol
or

AVL augmcnted voltage left arm

AVR augmenrcd voltagc right arm
b.d. / b.i.d. nvice a day (Larin)
BAL blood alcohol leve!
BB bed bath; blanker barh
BBB bundle branch block
BC bone condut ion
BCG bacille Ca lmerte·Guérin
BF breast fed
BI bonc inj ury
BID brought in dead
BIPP bismuth iodoform and paraffin paste
BM b0\\ el 1novemenr
1

BMA Brirish Medica!Association

BMJ British Medica! Journal
BMR basal rnerabolic rar(.
BM Sc Bachclor of Medica! Science
BNF British Narional Formulary
BNO bowels nor opened
BO bowels opened
BP blood pressure
BPC British Pharmaccurica l Codex
BPO bi-parieral diamerer
BS brcarh sounds; bowel sounds
BS Bachelor of Surgcry
BWt birth weight
e head presenrarion;ccnrigrade; Cclsius
e I c. with (Latin)
e.e. wirh meals/food ( Latín)
do compla ins of
CA / C, cancer; carci non1a; calciu111
CA BG coronary ariery bypass grafr
CAD coronary artery disease
capr. head prescntarion
CAT coaxial or computerised axial romography
CBT cognitive bchavioural therapy
CCF congesrive cardiac failure

132 Professionol Engfish in Use Medicine

Abbrcv i atoon Mca
symbo
l
CCT Certificare oí Complcrion oíTraining
CT con1plemenr ñxanon H."">t
ChB Bachelor oí Surge')'
CHF chronic hean fuolurc
Chr.CF chronic cardiac foilurc
CNS central nervou.s systen1

co casualry officer
COAD chronic obsrrucrive nir,vays diseasc
COP change oí plasrer
CPN communiry psychiorric nurse
creps crepirarions
CSF cercbrospinal fluid
CSSD Central Sterile Supply Depot
csu c;.nheter spccimen of ur111c
csw cl inical supporr workcr
CT cerebral tumour; coronary th roonbosis; compureri1cd romo¡;raphy
cv cardiovascular
CVA cardio\'ascular accident; cerebrovascular accident
cvs cardio,ascular system: cerebro,ascular S)'Stem
Cx cerv1x
CXR chest X-ray
D divorced; diecVdead
D&C dilatation and curcrrnge
D&V dh1rrhoea and von1iring
ºº dangerous drugs
ODA Dang«<>us Drugs Aa
decub. lrmg clown (L1rin)
DIC drunk in charge
di decilirre
DN Districr Nurse
DNA did nor attend
DNA dcoxyribonucleic acid
DOA dead on arri\lal
008 dare oí birrh
DRCOC Diploma oí rhe Royal Collc¡te oí Obsrerricians and C)naecologists
ORO Dis. blement Re<;etrlcment Oífice
DS disseminared sclcro'1S

Professíonol Enrsh In Use Medi<:ine 1 JJ

Abbrev1at mn or Mean i ng
symhol DTs DU DVT DWP
Dx E EBV ECF ECG delirium tremens (Latin)
ECT duodenal ukcr
EDC EDD EDM EEG ENT ESN ESR ETT EUA F
fb FB FBC FH FH deep venous thrombosis
FHH FHNH A I fL FMFF FOB FPC FRCS Department for Work and l'ensions
FSH diagnosis
FTAT FTBD FTND
electrol)'tes
FUO
Epstcin-Barr virus
exrracellular fluid
electrocardiogram
elecrroconvu lsive cherapy
expecred date oí confinement
cxpected dace oí delivery
early diastolic murmur
electroencephalogram
CJ' .r, nose and throat
educa tionally sub·normal
eryrhrocyre sedimenrarion rate
excrci se u)lerance tesr
cxa1ninarion under anaesrhesia
female
finger breadth
forcign body
ful! blood count
fetal heart
family history
fera 1 hearr heard

feca l heart noc heard fe1molitre

fetal movement first fclt faccal occult blood
family planning di11ic
Fellow of the Royal College of Surgeons follicle stimulating hormonc
fluoresccnt trepone1nal anti body resr fü to be decained; ful! cerm born dead full rcrm normal deliver
fever of unkno\vn origin
Ahlm·v1a l1on or M1·;rn1ng
'>ymhul FYI FY2
s Foundauon Ycar 1
G ound.rnon Year 2
g/L GA GB GC GClT GCS GIS G.\IC GnRH GOT GP gram
GPI
GPT GN G"IT GU GUS grnvidity
Gy Grn. H&P gra111' per litre
Hb /1 lgb HBP general anaesthetic
HCT I Her HDU
HH\1 8 ¡;ali bladdcr
1118 general cond1rion
HIV HO HP HPV HR gonococca l complcmcnr fixalion resr
11$
I IVS Gl.hgow Coma Scalc
gasrro mresrinal sysrem
General .\lcd1cal Council
gonadorrophm-rdcasing hormone
glun1J11c O\aloacetic tra11-,. rnin._1se

Gcncrol Practitioner
genera l p.ira lysis of the in<;. 11c
glu1a1111('. p)·ru,•ic rransan11nasc

gl) cer¡·I rnmrrnte

gluco.e rolerance test
gatrtc ulccr
geniro urinary sysren1
Grays
Sl na<eology
h1;ror¡ and physical exammanon
hacmoglob1n
high blood pressu rc
hacn1n tocrit
high dcpcndency unit
(human) herpes'irus 8
Hacmoph1lus mlluenz1. e B
hu1nan 11nn1unodrficicnc} \ 1rus
houc officer
houphys1c1an
human pap1lloma virus

hcan rate hcan ;ounds

h1gh v,1gmal swab

Professional Enth•h In Ust M<dicine 1J 5

Abbreviat ion or Mea no ng
symbol IBS
ICF ICS ICU ID irrirable bowel syndrome
lg
intracel lular /luid
i.m. / LM IMllaD infus" IOFB
IP IQ ISQ I U intercostal space
JUD inrensive care unir
i.v. / IV IVC IVF IVP infectious disease
rvu in1n1une g.lobuUn
lx
IZS JAMA JVP intra111usc-ular
K inrroduction, 1nethod, resuks and discussion
KUB L LJL LA LAD LBP infusion
LDH LE LFT LH
inrra ocular foreign body
LHA
UF in -pa rienr; inrerphalangea l
inrelligence quorienr
condirion unchanged / in sraru quo (larin)
internarional unir
inrraurcrinc {contraccptivc) dcvicc

inrravenous
inferior vena cava
in virro ferr ilizarion
intravcnous pyclog.ram
inrravenous urogram
invesrigation
insulin zinc suspension

Journal of rhe American Medica! Associarion

j ugular venous pressure
porassiun1
kidney, urettr and bladder
left
litres per l itre
left atrium; local a11aesrhetic
left axis de,•iation; left anterior descending
low back pain; low blood prcssurc
lactic dehydrogenase
lupus eryrhemarosus
l iver function test
lureinizing horn1one Loca l Health Authority lcfr il iac fossa
Ahhrev1at1011 or M c·;m
symllul
UH ldt mguinal hernia
LKS l h-er.kidney and splttn
LLL lch lower lobe
LLQ lch lower quadrant
LMN lo·Ner motor neurone
LMP lasi menstrual period; lcft mcnto ¡xmerior position o( íeru
LOA lcfr occipiro amerior posirion of fcms
LOP lcfr uccipito-posterior po<i rion of forus
LP lumbar puncture
LSCS IO'Ner segmcnr caesarean section
1 UA lch upper arm
LUQ lch upper quadrant
LV le& vcnrriclc; lumbar vencbra
LVD le& venrricula r dysfunction
LVE lclt venrr icula r enlnrgcmcm
LVF le& ventricular foil
LVH ure
le& ventricular hypenroph)
M m1le
;\VF ffilldíemale
mir mxl1ficd rdease
lvV\YllS m 1rriecVwidow(er)/singlc
n1ane in rhe morni ng (Larin)
MB ll:chclor of Med icine
t-ICD rnean corpuscular díarncter
mcg m crogram
MCH mean rorpuscular haemqdob1n
1\ICHC m<an corpuscular harmo¡:lobm concentrntion
MCL 1111d-clavicular hne

MCP n1edica1 care practirioner

MCV niean corpuscular volun1c
MD 01>etor of Medicine
MDM rntd-diasrolic murn1ur
mg mdl1gram
;\ti rrutrnl incomperencc/insuffic1COC); mrocardial inforctoon
mine Jll'elsend (Lacin)
mi milloloere
mmoVL millimols per l irre

Pro(mional EnglJSh m Use M«kine 1J 7

Abbrcv 1a t1on Mranin
symbol
MMR n1ass 111iniaturc radiography; n1easlcs, n1unlpS & rubclla
MO Medica) Officcr
MOH Medica) Officer of Healrh
MOP medical om-patienr
MRC Medica) Rcsearch Council
MRCP Mcmbcr of rhe Royal College of Physicians
MRI 1nagneric rcsonancc in1aging
MS 1nirral srenosis; 1nulriple sclerosis; n1usculoskeleral
MSSU n1id-scrca1n specilnen of urine
MSU mid-strea1n urine
MSW Mcdical Social Workcr
MVP m itral valve prolapse
NA nor applicable
Na sodiun1
NAD no abnorrnal iry detecred
NBI no bone injury
-
ND normal dclivcry
:>J E nor engaged
NHS Nariona l Healrh Service
NIC National lnsurance Certificare
NMC Nursing and Midwifcry Council
NND neo-natal dearh
nocre ar nighr ( Larin)
NOF neck of fcmur
NI' nor palpa ble; nasal passagc
NPO norhing by mouth ( Larin)
NPU nor passed urine
NS nervous syste1n
NSA no significanr abnonnality
NSPCC Narional Sociery for rhe Prevenrion of Cruclry ro Children
NYD nor yer diagnosed
o.d. daily (Larin)
O/E on cxan1inatio11
OA on admission; osreo-arrhriris
OAP old age pensioner
Obs. obsrerrics
OBS organic brain syndrome
Abbrrvi;1t111n nr M raninq
sym bol oed.
0.\1 oedcma
001 1
OPD OSCI: oriris 1ned1a
our of hou rs
outp:11icn1 dcparunent
Ob1ecn\'c Srrucrured Clin ical l'xanunacion
OT Op ratm¡:rhcatre
OT occupattonal therapisr
p pulse; prote1n; pariiy
p.c. afrer mca b/food (Larin)
p.111. in rhc afrcrnoon (Larin)
p.o. by mou1h (L1tinl
p.r. by rcctum (lJtinl
p.r.n. as rcquorcd
p.v. by va¡;ma (L1tin)
PA pcrniciou' anaernia
Para. 2 + 1 fu ll renn pregnancics 2, abonions 1
PAT paroxrsmal atnal tachycard1a
PBI pn>tcm bound 1odine
PBL pmblcm-bascd learning
POA parenr ductus trteriosus
PERLA pupils cqu.11 and reactive to li¡;ht and accommodarion
PET pn·ccl:unptic roxaeniia
PHpast h1S1ory
PID prt>lapstd mtcn·=cbral disc; p<h te mflammatol') d1scasc
PI. pl•sma
PLA B Pmfc«iona l and Ling11isric As;cmenrs Board
PM po<innorce1n
PM B pcsrmenopausal bleeding
PMH past mcdteal histOI')'
PN P"'>maral
PND posmatal deprcssion; paroxysmal noc'.turnal drspnoca
PO¡ presurc oí oxygen
POP plasrer of P;iri;
PPll postpanum haemorrhage
PRliO prm'isionally· rtgisrered hou"' officer
PROM pren1Jturc n1pture of mrmbrano
PSW Psychiatrk Social Worker

l'ro(cssíonal Engllsh In u..M- 1J9

 Ahbrev1a t1on Meanong
symbol
PU passed urine; pepri c ulcer
PUO pyrexia of unkno\vn or uncerrain origin
PVr paroxysonal ventr icula r rachycardia
PZI prota1nine zinc insulin
q.d.s./ q.i.d. four times a day (L1rin)
R right; respirarion
RA rheu1naroid arrhriris; righr arriu1n
RAD right axis deviation
RBC red blood cell (count); red blood corpusdes
R BS random blood sugar
RCA right coronary arrery
ref. refer
rcg. regular
RGN Registercd General Nurse
Rh. Rhesus factor: rheumarism
R HA Regional liealth Authoriry
RJ respiratory infecrion
RJ F right i liac fossa
RIH right inguinal hemia
RLL righr lower lobc
RLQ righr lower quadrant
RM registered midwife
RMO Regional or Residcnr Medica! Officcr
RN registered nurse
ROA right occipital anterior
ROM rangc of morion
ROP right occipita l posterior
RS respirarory sysren1
RTA road rraffic accidem
RTC return ro clinic
RTI respiratory tract infection
RUA right uppcr arm
RUQ right uppcr quadrant
RVE right ventricular enlargemenr
RVH right vcnrrlcular hypertrophy
R.x take (in prescriptions}; rreatmcnt (in case notes) (Latín)
s si ngle; sugar

140 Pro(essioool Englh in Us< M tdid""

 Ahhreviat ion M1 ;1111119
' ym
hol
s.c. )ubcuta.neous
s.1. ;u blingual
SAH .,uiarachnoidal hacmorrhagc
SB "'l·bom
SBE \u l-JCUte bacterial endocard1us
Sep. '><pJratéd
SG ;,pecific gravity
SH Mxia 1 h istory
SHO Senior House Officcr
SI cro-1hac
s1g. "otcllabcl (in prcscripnons ) (l. ton)
si. 'light
SM \ystohc munnur
SMR !.U1-mucous resection
SN tudent nurse
SOB >hort oí brearh
SOBOE sh<>rt of breath on e'ernon
SOP ;u-g1cal out pancn
SpR ;pccial1>t rcgis1r.1r
SRN Sute Rcgistered Kursc
SROM \J")ntmeous ruprure of membranes
srat. 1111111ed iarcly (Latín)
STs snn itnry tO\vels
SVC up<:rior vena cava
SVD ¡»ntaneous verrex delivrr)'; spont.1neou ,·aginal del h,er)
S\\f I S\\T. ;\\Jb
swo ; h)n \\ ave diathcnni
T tcmperature
T&A ron.,ib and adcnoids
t.d .s./ t.i.d. rhrc'C rimes a day (l "11in)
T1 tri·iodothyronine
,-. tctra-iodorhyronine
tabs tabk-r;
TB n1'><:rculosis
11 tr1.:u.)p1d 1ncomperence
TIA trzns1cnt 1schacm1c Jtt.11..:k
TM 1r:insport medium

Pro(C$sional English in Use Med(one 141

Abbrev1at1on or Mea no ng
symbol
TMJ ren1poromandibular joint
TNS rranscuraneous nerve srimularor
TOP ccrminarion of pregnancy
TPHA rreponc1napallidu1n haentagglurinarion
TPR ren1perarure-, pulse, respiration
TR ren1porary residenr
TRH thyrorrophin-releasing hormone
TS tricuspid srenosis
TSH rhyroid·stimulating hormone
TI reranus roxoid; ruberculin rcs:rcd
TURP rransurerhral prosrare resecrion
TV trichon1onas vaginalis

u urea; unir
U&E urea and elecrrolyres
U/L units pcr litre
UGS urogeniral sysrem
UMN upper n1oror neurone
LJRTI upper respirarory traer infection
ulrrasound sean
uss
UVL ulrra-violet light
VD venereal disease
VDRL vcnercal discase research la borarory
VE vaginal examination
VI virgo inracta
VI' vcnous prcssure
VSD ventricular sepral dcfect
vv varicose vein(s)
Vx vertcx
\VÍd0\\1/\vidO\\le'f
w
WBC white blo<><l ccll count; white blood corpusdes
wcc white cell count
WHO World Healrh Organizarion
WNL \virhin norn1al li1nirs
WR Wasscnnann rcacrion
XR X-roy
YOB year of bi rth

Pro(Wionol E.ngsh in Use 143

Medidne
Types of medication
capsules injection

..... •re .,.,,,,..-...... - oinrmenr

paste pessary powder

.•

lution spray supposirory

tablets inhaler

Oinrmems are greasier than ttt:11ns and ha,c a thicker 1exrure. lbis makes 1hcm adhcre:o
tbe aff= arca longer.Crcam> 1re more acccptable cosmetrcally and tend to be used on
th< face as thcy are lcss visible. Pastes .m stiffcr preparations whrch contain more powdrrcd
solids.Lotions are liquid and uscd in are.is s,rch as rhe scalp whcre an oimmem or cream
would adhcrc to 1he ha ir.
Appcnd
IV Symptoms and pain
1x

Asking about symptoms

Pain is one of rhe con1n1onesr sy1nproms.
For headaches, a docror would expecr ro cscablish mosr of rhe fearures below. Sirrilar
questions can be used íor orher forms of pain.

Feature Typ1ca l
quL·st1on
Main Sitc Whcrc docs it hurt?
ShO\V n1c \vhcrc it hurtS.
Radiation Does it go anywhere clsc?
Cha racter Can you describe rhe pain?
Procipiraring factors Docs anything bring thcm on ?
Tame of onset When do they start?
Tame of resolution When do they stop?
Frequency How often do you get thcm?
Aggrava ring foctors Docs anyrhing make them worse?
Is thcre anything else that affects rhem ?
Relieving facrors Docs anything make them better?
Associated fearures Do you fed anything else wrong whcn it's there?
Hnvc you riny other problc1ns rclatcd to thc pain?
Duratíon How long do rhey lasr?
Scverity How bad is it?

Description of pain
Pa t1en t"s desm pt ion of Expl an
pa111 allon
aching / an ache a general pnin, ofren in rr1uscles and joinrs
boring like a drill
burnin g with heat
colicky an inter1nittenr pain \vhich varies in inrensiry, co1nes and
goes in \vaves
crampy/cramp an involunrary spas1nodic 111uselc conrractio:i
crushing a feeling of pressure
dull a background pain, opposite of sharp
gna\v1ng biring
grippi11g a feeling of righrness
scalding likc boiling water
sharp acure
srabbing li ke a knife
stingjng sharp, burning, like :an lnsccr sring
throbbing \virh a pulse or beat

Pro(mionol English in Use 14S

Medkine
Ver bs used in instructions
bend down put your head down
put out your tongue

breathe in raisc your lcg

breathe out

close your eyes roll on ro your back/front ..f

rol! over
roll up your slceve

curl up sit
sit up

do this slide your ha nd

clown your side

follow my fingcrtip slip off your coat

,vifh your e)'CS

keep your knec srraighr Stand Strnight

stand up

let your wrisr go floppy take off your rop things

lic on your side/back tilt your head back

¡'
lie on the bcd/couch
lic down

look straight ahcad touch your shoulder wirh

look ar somerhing your chin

open your mourh turn your head to the left

turn on your side

poim ro rhe finger rhar Other insrructions:

1noves relax
sho'v me ,vha1 moven1ents you can manage
1------------==----==-l tell me if it hurts
pull as h.., rd as you can

push as ha rd as you can

Apprnd ix
VI Lay ter ms a nd definitions
Explanations should be gjven in \Vords the patienr \vill undersrand, avoiding 1nedica l
j argon.Using lay 1erms - words fomi liar co people wirhour medica) knowledge -can help
patients understand explanations.

Some lay terms for medica! conditions

ML"!lic,11 Lay
rnndi t1ons
acure cerebrovascular evtnt tcrm
stroke
arrhyrhmia palpitarion s
dyspnoea brearhlessness
fracrured neck of fem ur broken hip
haemaremesis vomiring blood
hae111aruria blood in the urioe
inson1nia trouble with sleeping
inrern1jrrenr ck•udicarioa pains in tbe back of the legs when walking
n1yocardial infarcrion heart anack
nocruria oeeding to pass urine (water) ar night

Sorne lay terms for medication

M rd1«a l Lay
ana lgesics pain killers
¡l nti-depressanrs tablets ro improve your mood
anri·inflanli-narories n1edicioe ro reduce S\Velling
broncho-d i lator a substance which causes rhe airways 10 open up
OMAROs (disease modifying piUs that help stop arthritis progressi.ng
anti-rheumatic drugs)
diurerics '''ate.r rablets
hypertension medicarion pills for blood pressure
hypnorics sleepi.ng tablets
oral contraceprives the piJI

Simple definitions
Mosr parienrs do 1101 have any med ica! knowledge, so ir is imporranr ro use simple words
rhey will undcrsrand whcn ral king about certain parts of rhc body or medica! condirions.

Mcd1ca l Simple defirntion

ll'rm cs
arteri rubcs which carry blood around the body
bcnign nor due to cancer or infecrion
bronch i air\vays rhar connect your \vindpipc to your lungs
cholcsrerol fur rh:ir clogs rhc :irterics
inrervertebral disks shock a bsorbcrs which separare the bones in your back
oesophagus rhe rube rhat connecrs rhe back of rhe throar ro the sromach
pancreas a gland thar hdps digesrion and makcs insulin to control blood
rhyroid asugar
gland that produces some of the hormones required in daily life
 urcthra the tube rhar carries urine from rhe bladder

146 Pro(essionol EngBsh in Uie M

tdidnt
 Answer key
1.1 Nou Adirrt1vt
n
fim<SS fü
lrh hcalrhy
illn<SS ill
sick nes sick

1.2 complcrc rcm1ssion

fed sick
gc1o•cr
poor hcahh
"'"el s1ckncss
1.3 wcll 2 unwcll/ill/poorly/sick 3 health 4 fit 5 wcll 6 sick 7 ;ick 8 illnesscs

1.4 dereriornrc<l 2 recovcred 3 1ckness 4 recovcry 5 goo<l 6 gor ovtr 1 unlrhi

2.1 Ana t om1r.1I Comn1on

trrm word
abdomen sto1nach, tunm1y
axilla armp11
Ctl.rpu9 \YI i"it

coxa hip
cubirus clbow
mamma brca<r
nates buuock<
p;nella kncecap

2.2 a 1 chesr 2 inro 3 neck/jaw 4 shouldcr 5 clown 6 arm

b 1 in 2 groin 3 do•rn

2.3 1 groin 2 rummy/stomach 3 na\'cl 4 chcs1 5 annpu 6 jaw

2.4 Tru n k U pp < r hmb Lowrr h mh

abdomen clhow knec
chcs1 fingcr leg
loin \\'fl\t 1hig
Jrm h

3.1 1 windp1pc 2 lung 3 lohcs 4 diaphragm 5 a1rways 6 hcart 1 bronchiolcs

3.2 le, 2f, Jd, 4¡;, Sa, Ge, 7b, 6 splccn

8h 7 bladder

3.3 1 organs
2 li..cr
3 gall bladdcr
4 kidM)'
5 k1dncy
Pro(...ionol Engt.sh 111 Ust Mtd""1t
147
 Over to you -sample answer
The splt'(·n 1.s s1tu;ucd on rhe upper left 1dc of your abdo111<.>n. undcr )·our r1hi.. Ir :ic" '' ::t
filre-r. helping to destroy old, worn-out blood cells. h al>o produces cells thar hel p prorect your
body fron1 infecrion.
The pancreas is a gland decp inside your "bdomcn, bch ind your liver. Ir normally produces
insulin, which your lxxly needs to help ir More and utiliLe ¡;lucose, and "°
1t "imrortJnt in
conrrolling the a mount of sugar in your blood.

4.1 lb, 2d, Je, 4c. 5a

4.2 numbness 2 O\\ allowing 3 passin¡¡unne/w.uer 4 sweanng 5 shakc 6 breathing

4.3 chcw.swallow 2 pas 3 appctire 4 have 5 sense 6 hre.11h

Over ro you - '>rt 1nple nns:,vcr

1 Do you pass \Y uer 111orc than usua l?
2 Do ynu drink more than usual?
3 What's your .1ppetue likc?
4 Is your s1ghtf,is1on normal?
5 Ha\-e you not1ccd anr numbn<SS m your hand; or fttt?

5.1 1 A dermatolog1s1s¡>eoalizcs I is a specialist m Jisca of rhe skin.

2 A rheu1narolog 1sr spociali' I is a spcciah;i 111d1seases of rhe joints.
3 A rraun1arologit spe.;-in.liLCS J is a spt.ocial i:.t in accidenr and cn1crgency 111cd1ci11e.
4 A paediatrician s1x:ci lizes I is a speci"lisr i n disca"M.'S a ffecring childrcn.
5 An obtcrrici.111 spcci:ilÍl('S I is a spccia list i n 1nanaging prtgnancil"$.

5.2

'pracrisc prac'nnoner 'practace

con'suh con'suhan1 consul'lauon
a'ssisr a'ssistanr a'S!i:i>ltancc
'graduare roncd3u1/ gradu'aiion
'grad uaie /'gncd3uc11/ - +- ...,-,,- -;
---"r--
'qualify qualifi'catio11

5.3 1 spcciahzes m 2 working with 3 in1crrs1ed rn 4 good at 5 good w11h

5.4 consulting rooms

general
practmoner general
pracncc
group practicc
health centre
inrernal n1edicine
surgica l spccialtic'

Over 10 you - s..1. 1nplc nns,ver

To be a surgeon )'OU ne.d to be:
good with )Our hands
1nreres1ed 10 anatont)
able to repeat the same 1hrng wichou1 genrng bored
able ro make dem1011' f 1st

Pro(Msíonal Engt.sh m Use 14

Medidne 9
 6.1 associarc >pc<:ial rrov"ional diagnosis
isr r1clio pJg(r
house oíficcr VlJrd round
011 c-Jll

6.2 1c.2d.3a, 4",

5b
6.3 1 false -After • year,he or she lic.:omcs a registered rned1ca l practitioner
2 rrue
3 fubc - the old tcrms se111or hou;.<: oflicer and SHO a re <rill u<ed
4 false - thcy a re usunlly Se'<'•• firt hy one of thc ju nior docto
5 false -Junior doctors now normall) work in shifrs ... for e<ample 7 am ro .l pm ... or 1 1
prn ro 7 am. The alremanve S)'Stcm i> to work from 9 am ro 5 pm e"er¡ da¡a nd to
tal<r rums ro ()¡, on t.1ll ...

6.4 shift 2 admissions 3 clerk 4 round 5 tests G d1scharged 7 rr;un ing/Foundation

7.1 midwifc 3 nursing 5 heahh 7 dimicr

2 clinic.11 ;upport auxiliary visiror 8 ward clerk
worker 4 >iaff 6 cha'lle
7.2 carf'} out a pro.-.,,Jure
change a dressing
check rhe tcmperarure
give an 1n1ecrion
re1nove utures

7.3 ro perform 2 was performcd 3 be performed 4 be performed 5 perform:d

7.4 !O carr¡ Olll

J haH httn earried 5 he <-.arri<d OUI
2 ha' e bttn earried out
our 4 WJ) <arm<J OUT
8.1 ambulance
technician a rtificia l
lirnb
clu b foot
conract lens
health profe<;ional
intraocular pure
occup;111onal
1herapist social ,,·orler

8.2 1 >oeml worker 3 opridan 5 socia) \\1nrkcr

2 physiorhcrnpi<r 4 pr0>thcti1t I occuparional G chiropodisúpod inrrist
ther.1pist

8.3 1 ampu1.11ion
3 thernpists 5 splines 7 relieve
2 limb 4 rehab1hL111on 6 deformity/deform mcs

9.1 Vt·r Noun

ad'n11t ad'nl1ssion
:t'c¡;c¡;e,c¡; ti' !Ol>lilillHllt

dis'chirgc 0d1scharge
.'operatc oper'anon
re'fcr re'ferral
'rreat 'trt3Cllle0f
 9.2 acurel)' ill
asscssn1cnr uni l
on duty
referral lerrer
\vairi11g l.isr

9.3 1 lnrensive Care Unir (ICU) I assessmenr 4 Gynaecology (f.rnergcncy)

unir 5 Accident & Ernergency (A&E)
2 High Dependency lnir (HDU)
3 Day Surgery Unir

9.4 1 clinidhospiral 3 tests 5 referred 7 day

2 rrcatn1enr 4 cepamnenr 6 admitted 8 discharged

10.1 prescri pcion charges 2 housebound 3 appointment 4 locum 5 out of-hours

10.2 change dressings

n1ake appoinnncnts
n1akc ho1ne visirs
perforn1 n1inor surgery
refer a parienr
run a clinic
supervise sraff
rake rnessagc.'S
10.3 midwife 3 receptionisr 5 districr nurse 7 practice manager
2 physiothcrapist 4 pr::tcticc nurse 6 heolth visiror

10.4 surgcry 2 appoinunents 3 Reccption 4 visirs 5 prescriprion 6 referra ls 7 OOH

11.1 1 undergraduate 3 foundarion programme 5 conrinuing professional developmenr

2 posrgraduare 4 u ndergraduate

11.2 1 elecrive
2 problem-based lea rning 4 dinical arrachments 7 medical 10 senlinar
5 srudenr sclccrcd school
3 lecrures
modules 6 cadavers 8 consulranr
9 Collcge

11.3 1 overseas elecrive 3 dissecrion

2 problem·bascd lea rning I PBL 4 clin ical 5 clinical skills
arrachmcnt 6 studcnr selecred module

12.1 1 demonstratc 2 s"pervise 3 deliver/providc 4 take 5 assess/demonsrrate

12.2 1d, 2h, Jf, 4b, 5g, &, 7a, 8e

12.3 Bachelor of Medicii:e, Bachelor of Surgery, Fcllow of the Roy,11 College of Surb>eons of
England, Fcl low of the Royal College of Surgcons of l reland
2 Bachelor of Medica! Sciences, Docror of Medicine, Member of the Roya l Collcge of Physicia
ns 3 Bachelor of Medicire, Bachelor of Surgery, Fellow of the Royal Collcgc of Surgeons
4 Bachelor of Mcdicir.e, Docror of Medicine, Fcllow of rhe Royal College of Physicians

13.1 1 provisional rcl(istra tion 3 full regisrration

2 linlited regisrration 4 spccialist regisrrarion
13.2 General Medica!
Council
2 J>rofcssional and Linguisric Assessn1enrs Board
3 Objccrive Saucru re<I Clinical Examinarion
4 airways, brearh ing, circulacion
5 Certificate of Complction of Train ing
15O J>ro(es.sionol English in 1),.Medicine
13.3 1limired regisrrarion 4 srarions 7 specialist regisrration
2 CMC 5 full registration
3 PLAB 6 CCT I Certificare of
Complerion of Tra
ining
14.1 Noun Adjcctovc
ex'haustion ex'hausrcd
fa'rigue fa'rigued
'lcthargy lc'rhargic
'riredness 'rired
14.2 complain of
o
f
f
-
c
o
l
o
u
r

o
u
r

o
f

s
o
r
r
s

p
r
e
s
e
n
r

\
\
'
i
r
h

Proftssionol English in Use Med1cne 15 1

 u f
t o
r
o
n i
\Vorn our
n
s
14.3 1 3 7 presenring i
pre pres 8 d
sent em prescntation i
ed pres o
2 emi u
pres ng
s
entat
4
ion
prcs -
cnts s
prC'S u
C
d
nrari
d
on
c
n
14.4 complained 2
malaise 3
gained 4 l
prcsented 5 i
constipated k
e
Over to you l
-san1plc ans,ve y
A 60-year-
old man -
presenred ro
his GI' wirh u
malaise and n
fatigue for l
severa! i
monrhs. He k
a lso e
complained l
of anorexia y
and weighr
loss of 1O s
kg. e
v
15.1 adequate - e
inadequate r
a c
g
a -
i
n m
s i
r l
d
- rare - con1n1on
15.2 bone n1arro'v i
differcmia l diagn<>sis o
insidious onser n
iron deficiency
p s
e e
r n
n s
i e
c
i 15.3 progressive 3 7 adequare
o plarelet 5 8 breakdown
u jaun dice
s 2 deficiency 4 4 vibrarion 5 sore

a exclude 6 pa lpable 15.4 1

n
insidjous onser 2
a
e pallor 3 symmcrrical
n Over ro you -san1ple ans,vcr
1 Causes of anacn1ia n1cnrioncd: ch ronic blood loss
i associared \virh carcinoma of rhc bo\vel or chronic bleed
a ing ulcer.leukaen1ia, aplasric an;.te1nia, iron deficiency,
pern icious a naen1ia
p
r
o
g
r
e
s
s
i
v
c
l
y

i
n
c
r
c
a
s
i
n
g

v
i
b
r
a
r
Proftssionol English in Use Med1cne 15 1
 16.1 1 skull
2 j 1\v bonc
3 spine
4 breastbonc
5 rib
6 collarbone
7 shouldcr
blade 8 rhigh
bone
9 kneecap
10 shinbone

16.2 1a, 2c, Jd, 4b, Se

16.3 1 Reducing 2 unire 3 malunion

17.1 Vcr Noun(s Adjert

h ) iw(s)
delay delay delayed
dcvelop devclopment dcveloped,
developing
distend distension distended
foil fail ure foiling
nourish nourish1nenr, nourished
nurrition

foilure 2 distcnsion 3 dtvcloprnenr 4 nutrition 5 Delay

17.2 cra\vl 2 weaned 3 staturc 4 milcstones 5 pubcrty/maturity

17.3 1 1nu 3 Gcn11an 111casles 5 chickcnpox 7 scarlct fever 9 polio

2 lockjaw
n1ps 4 whooping cough 6 measles 8 rheun1atic fever 10 croup

18.1 vrb Nou

n
in'h ibit inhi'birion
pro"duce pro'duction
re'lease re'lease
re"place re'placemem
se'crete se'crcríon
'srin1ulate sri111u'larion

18.2 Ans\vers given are rhe \\fOrds uscd in rhc origina l rexr; possi ble alternativcs are sho,vn in
brackets.
1 srimulare (trigger) 4 production (seeretion) 7 secrerion {prod 10 secretion {production )
2 release {secretion) 5 feeds uction)
3 stimulares (tnggers) 6 111h1b1t 8 stimulares (triggers)
9 prod uce

18.3 1 diffuse 2 localized 3 dclicicnt 4 E.xcess

18.4 ld, 2c, 3a, 4e, 5g, Gb, 7f

1S2 Professionol English in Use Med>Cim:

 Over to you -s1. mplc .tnmcr
Deor Doctor
1 would be gratcful if you would scc rhis 60-year-old wom.m who complarns of ri rcdnm
and constipation. She hJ> Hª"'"I S kilos in rhe pa<t rhrC\! month> alrhough she says her
appctirc i;poor. Shc ha> noriccd 1h1.1 her ha ir has lx,;un w fa ll out and thar her skin i<
vcry dry. 1 am
wondering if she "h)po1hyroid.
1 9.1 Vn Nou Ad¡.-< t1v.-
b r
accommodatt
consrricr consrnct1on consmctcd
converge f.:Onvergence
dilate dila1iu11, dilared
dil.u.1tio
droop n drooping
oscillare o..c1llauon
re:m tt" 1ct10n

19.2 le, 2c, Jb, 4Í.5d, 6"

1 9.3 pupil 2 ílame-sh.1ped 3 cononwool 4 artcrics/a rterioles 5 nipping

20.1 distende 3 5 rigid ity 7 1n 1::.ses

d q11.1dr.rn 6 rendeme 8 llowcl
2 t ss
renderness 4
guardin :

20.2 le, 2e.Jf, 4a, Sb, 6d

20.3 lf,2a. Jb, 4g, Se, &, 7d

21.1 1 (surgical) remov.11 ol thc womb
2 heavy period,
3 inflammarion of onc of rhc tubes thar connecr rhc ovJ ry to
thc womb 4 biopsy of (small pit-cc of rissue removed from)
rhc ncck of the womb
21.2 menarche: 12 yrs
menscrual cydc: 4-'
28
L\IP: 1/52 ago
menorrhagia? no
drsmenorrhoca? no
d1scharge? a liule wh 11e d1sch.1rgc

21.3 menarche: llow old wcrc )Oll when you srartcd m gc1 rhem / you r
periocl<' menstrual cycle: A re you r pcriods regular? How long do thc
pcriods lasr usually? L\4P: When was )'Our lo>t pcriod?
menorrhag1a? Would )'OU 'ªl' they are l ighr or hcavy? Do you ger dors?
dysmcnorrhoc:n? Oo )<>u et pcnod pains?
dascharge? Is there an) d1;<hargc berwccn thc pcriod;? Whar colour is 1t?

21 .4 prolonged/he3\ l 2 do>t> 3 pcnods 4 pcnod; 5 flushes 6 oral 7 p1ll 8 co1I

Professkinol Engrlsh in Use Medicine 153

22.1
lpimri
ons
short
n"'
breat
h
ptllo
ws
mitra
l
valve
 22.2 ar resr
arrial fibrillarion
cardiac ourput
cardiac failure
hcart fuilure
on cfforr
pirring oedema
prernature bears

22.3 1 brearhlessness I shorrness of brearh

2 1>alpirations
3 brearhlessness when lying Aar
4 swclling

22.4 1 excrrion/exercise/efforr 2 episodes/arracks 3 palpirarions 4 shorrness 5 swclling

23.1 Vcr Nou

b n
'ausculratc auscul'rorion
e'xamine exan1i nation
1

in'spcct in'specrion
pal'pare pal'parion
per'cuss per'cussion

23.2 d Look for clubbing. ( inspecrion)

e Feel the radial pulse.
(palparion) e Locare rhe apex
bear.(palpation) f Note any
thrills. (palpation)
a Measure the hearr size. ( percussion)
b Are rhere any murmurs? (ausculration)

23.3 1 force 3 ccntral/pcripheral 5 bear 7 nlu nnurs

2 pulses 4 6 spacc 8 rub
peripbecai/cemral

Ovcr ro you - sample aoswer

Menrioned in B: central and periphcral c¡•anosis, clubbi ng, irregular pulse (in rime and
force), thrill, murmu fricrion rub

24.1 l j, 2e, Ja, 4h, 5b, Ge, 7f, 8d, 9g, 10i

24.2 fever 2 rigors 3 incubarion 4 prophylax is 5 parasires

24.3 curable 2 ourbreak 3 microorganisms 4 afebrilc/apyrexial 5 gla ndular fever

25.1 Nou Adject1ve

n
affecr affecrive
anxiery anxious
behaviour bchaviou ral
dcmenria demented
disrurbance disrurbed
suicide suicida)

1 54 Pro(essionol Engfish in Use Medicine

25.2 1 behavioural syndromc S pcr..onahl) d1sordcr
2 eauns disorder 6 pi) hon\OC.or rttardanon
3 ma¡or deprcss1on 7 slttp d1srurb.1ncc
4 nlenrol rrtardation 8 sub.tancc Jbu>e

25.3 1 lx:haviour 2 mood 3 pan ic anack 4 scnile demenria 5

functional 6 cornpul\ion

25.4 i·hc
paticnr
has
three of
the
listed
sympto
ms:
tircdncs
s
(fatigue)
lo oí intercs1
sleeping poorly (insomni•)

Over to you -sample answer

Shc docs not meer rhe requiremenrs for ma1or
dcpress1on as she has only three oí c h ymptoms. (In
faa,invesrigarions re•cal<d 1ha1 shc was suffcr111g
from hypercalcaemia duc to p-1mary h)'pcrparnth)
Ad¡<Tllw 26. roidism.J
Nou
1
n
bhnd bhndnes
conscious consc1ounf.". )S
deaf deafne"
diay dí21inC\\
nu1nh nun1bncs
lighc headcd light hcadednc>s
unsteady UIViteridinffi

26.2 double v1s1on

cp1lep11c fü
prodromal S)mprom
S
)

n
c
o
p
a
l

a
n
 a 7 control 8 involuntary
c
k Ovcr 10 you -sample answer
According to thc article, the smells are mawbcrry,
u >moke, soap, me111hol, clovcs. pinea pplc, nacu
r ral gas. lilac, lemon and learhcr.
1 Nf )Utl 27
Adjt'l'llVt'
n .1
aabsc1vcc ab<enr
r d1m1nuhon d1m111"h<d
} fbcc1dirv flacc1d
spasucil) spa<ric
1
n\\ JSUng wasted
c
o
n 27.2 1 mu;clc rone 3 powcr
t 2 muscle bulk and possibly 4 coordinarion
i involumary movcmencs
n
e
n
c
c
:

v
i
s
u
a
l

a
c
u
1
t
)

26. hcadcd
3
J s
p
cons a
d
ciou .
snes s l
c l
s d
2 4 l
'vars )
ningt 6
r
e h
s g
s h
r

Pro(essionol Engsh in US<! / 1

edklne SS
 27.3 1 flaccid 2 Brisk 3 wasting 4 involuntary 5 Babinski/plantar 6 coordination
7 rendon/reflex ha1nmer 8 di1ninished

27.4 GCS 5 (eye opening:to spe<'Ch = 3, verbal response: none = 1, motor r<'Sponse: none = 1)

Ovcr to you - san'lple ars,ver

jaw jerk, biceps jerk, rriceps jcrk, supinator (wrisr) jerk, knce jcrk, ankle
jerk Diagnosis : me parient h;;s Parkinson·s d isease.

28.1 Vcr Noun(s) Adjective(s)

b
cure cure curarive
excise excison
grow growth gro\ving
invade invasion, invash eness
1
invasivc
obsrrucr obstn1crion obsrructive
palliare palliar ion palliativc
palpare palparion palpable
spread spread spreading
swell s'velling swelling. swollen

28.2 6, 3, 7, 2, 8,4. 5, 1

28.3 1 spread 3 pain less 5 benign 7 palliative

2 obstrucrion 4 6 Secondary 8 pa lpable
1nalignanr

Over ro you - san'lple ans,ver

l'm afraid you have a nmdirion called lymphoma, which is a rumour of certain whire blood
cells called lymphocyres. There are differenr rypes of lymphoma ;rnd we need ro do more rcsts
to find our \vhich particular typc you havc. So1ne types require no im1nediare rrea.nnenr. For
orhers you may nced drug rreatmeni or radiotherapy.

29.1 1 premarure 3 trimesrcr 5 presenrarion 7 (umbilical) cord, stillbom

2 rern1inarion 4 6 1niscarriage
labour.secrion

29.2 Vrr Nou

b
abort
n
aborrion
deliver dclivcry
induce inducrion
n1iscarry n1isc1rriage
presenr prescnrarion
tenninare rern1inarion

29.3 1 terminatcd 2 abomd 3 delivered 4 induction 5 presenrecl 6 dclivcred

30.1 blood-stainecl
brearh sounds
pleural rub
productive cough
vocal resonance
156 Pro(essionol English in Ust Medicine
30.2 1 Do you cough up any phlegm? / Is it a loose
cough? 2 Wh,u colour is rhe ph egrn?
3 Is it ever yellow?
4 Havc you noriccd any blood in ir?
5 Any problcms with your breathing?

30.3 true - A productivc cough is often described as loase ... A cough may be productivc,
where the parienr coughs u p spurum (or phlegm)
2 false -crackles ... sug¡;est the presence of ílu id in the lungs
3 false - A cough may be ... non·producrivc, whcrc thcre is no spuru m
4 false - wheezes ... indicare narrowing of the airways.The sound of an asrhma
paticnt's brearhing is also callcd whcczc
5 false -TI1e sound heard when rhe pleura l surfoces are inílamcd, as in plcurisy, is called a
pleural rub

Over to you - san1plc anS\ver

A 36·year old ma n c<Jmplai ncd of suelden right sided chest pain with shorrness of b:earh/
breath lessness/dyspnoea, while warching relevision. The pa in was madc worse by deep breaths
and by coughing. TI1e shorrness of brearh persisted over the 4 hours from its onser 10 his
arrival in rhe Accident & Emergcncy departmenr. He had a slight non·productive cough.
There was no rclcvanr past medica! history or family hisrory. He had had a thrce week
holiday in Australia rhree weeks previously.
On examinarion his te111perarure \vas J7.4ºC, his respirarory rate \vas 24/111in, his jugu lar
venous pressure was raised 3 crr, his blood prcssurc was 1 10/64, and his pulse rate 128/min. I n
rhe rc:spirarory sysrcn1 c:xpansion \v;1::. re;:<luc..:c:t.I bc:ca uM: uf µ i11. TI1 n'"'':-, ;;1 µleu1al 1ul• ove1
thc right lowcr zonc posreriorly.There wcre no orher added sounds. Orherwise no abnormaliry
was derecred.
Diagnosis: This man had a pulmonary embolus.

31.1 1 Shinglcs
3 small 5 small blisrers 7 sca bs
2 spors
blisrers 6 filled with pus 8 scars
4 spotslblisrers

31.2 locarion and distriburion: first behind the ears and on the forchcad then thc tnmk
and limbs
grou ping:sca"ered
typc of lcsion :
macules colour: pink

31.3 locarion and distribution: widespread on the chest and abdomen

grouping:scarrered
rypc of lesion: small macules with sorne seales
colou r: pink
(guttate psoriasis)

31.4 locarion and distriburion: below larera l a ngle of rhe lefr eye
gr(>uping:single
rype of lesion: nodule
colour: ,vhire/pink
(basal cell carcinoma)

Pro(ess.ional English in Use M 157

edkine
 32.1 Common Med 1cal Typc of
term force
bruise conrusion, blunr
haen1aro1na
cut incised \VOund sharp
graze abrasion blunr
scrarch linear abrasion blunr
srab wound penetrating sharp
\VOUnd

rear lacrration blum

32.2 1 grazes 2 conrusion 3 rears

32.3 There is a laceration/tear 011 rhe lefr shouldcr and an incised wou nd I a cur approxinately 6 cm
in length abovc the lefr nipple.

32.4 sorc 2 stablpcn crra1ing 3 blowlpunch 4 superficial

33.1 frequency 2 nocturia 3 dysuria 4 hesirancy 5 srreamlflow 6 dribbling

33.2 1 b, 2a, Je, 4(, Sd, 6g, 7c

33.3 Possiblc qucsrions,

frequency: How oftcn is rhat? How ofren do you pass urine?
dysuria: Do you gl!t any burning or pain when you pass water?
nocruria: Do you have to get up at night?
hesirancy: Do you have any rrouble gerring started '
inconrinence: Do you ever lose control oí your
bladder? haematuria: l lave you ever passed blood in rhc
urine?
urgency: Do you havc ro rushlhurry ro ger ro rhe roilec in rime?

33.4 There was a crace of blood, gross protcinuria, and no casrs.

Ovcr ro you - sarnple an;,ver

M r jones has early prostatic h)•percrophy.

34.1 1b, 2c, 3a, 4d

34.2 1 cuff 3 pun'lp 5 syscolic blood pressurc 7 diasrolic
2 diaphragm 4 valve, gauge 6 dcflate

34.3 1 Phlebotomisrs 3 fis1 5 dressing 7 spccimen cubes

2 vcnipuncture 4 rourniquer 6 bruising 8 laboratory

158 Professional Eng/1sh in Ust Medicino

35.1 Susp<·ctcd k\
rond1t1on t
FDT.-\ blood
anatmia
bacrerial conjuncriviris F.)e ""b
genital hcrptS SwJb in Virus T:\I
rncningjcis es
M'.ptic.iemia lllood culture
urinary infcction MSU
urinary infect ion (carhercr in place) csu
35.2 1 within nonnal l imits, 3 clnared. units pcr litre 5 norma l, micromols per l itre
graom 4 ""'" per htr1'
2 lov.•, m1cromols per

35.3 Possoble answer:

'>odoum os normal. one hundred and th1rt)'1ght m11l1mols per lirre.
Potassium is wirhin normal limits, four poont fivc molhmols per Lirrc.
Whue cell count is elc,ared, rwekc poonr rwo tunes ren ro rhe powtr nine per Jure.
Hacmatocrar is Jo,v, zcro point f\ O l'\\O four litres pcr litre.
Mean corpuscular volume os down, \CVtnty·two point fivc
femtolitres. Alk.1linc phospharase is unremarkah le, cvcnty·two
unirs per lirre.
1\laninc anlinorransferase is rcduccd, n1nc unit pcr lirre.
36.1 V<'r Nnu
h n
COll)Cnt con<oenr
excisc exc1\ ion
1nci.sc inc1ion
lll!!lerl in.se-rt1on
r<CO\Cf r<CO\ CI')

swallow S\\ allO\\

36. 1 3 5 7 9 local
2 jell) 4 6 8 rigid 1o ger u<;«!
caureri1e c'cise ro
36.3 1 pulse oxin1eter 3 n.t\:tl cannul:.i 5 inrroduced
2 i n thc left lareral posi1ion 4 preonc<lica rion 6 rransferred

37.1 rnediurn 2 radiolucenr 3 encina 4 <eria l 5 bl urred 6 inílarccl

37.2 1 radiology 3 radiorhera 5 radoolucem

2 py 4 6 rad10)traphcr
radio¡¡raphy radiopaque
37.3 ÍJcon¡¡ 2 Push 3 our 4 snll 5 rake 6 hold 7 sideways

Professionol EnglJSh on Use Me<ilcln< 1

S9
37.4 Vt·r h Not1n 1 t·t t 1vt·
abnormal1ry abnormal
brcJthe breuh
dra1n drainage
nuervcne inttrvennon inrcrvencional
rhera py rhcrapcutic

38.1 k, 2d. 3a. 4b

38.2 a 1 O, b6, c8, d4, e9, f5

38.3 a12, b17, cl l , d l3, el 4
38.4 hreathc m
""se d1>eased cissue
c\pc:rrrnce discomforc
fore1gn bodies
huid )Our breath
1níorn1ed consenr
1n1roducc the endoscope
re&:o\lery arca
local anacstheric
1 loc<JI anal".! 3 rocovery ;.1rc;e S i11Íu1 11 n.:J \.-Ufl::i.Clll
trhcric
4 txd..e discad
2 foreign bodies
tissue
39.1 tracing
2 C\tn'.isc rolerance resr
3 J ;k ipped hearc beat
4 tlectr0lyre disrurbance
5 conducrion
6 serrenmg
7 <Jhbrate
8'rylus

39.2 a RA / righr arm

b RI / righr leg
e LL/ lcft leg
d J.A /lcft arm
e Chcsr posirions
39.3 rJte 2 complexes 3 wavc 4 le.id; 5 interval
40.1 1e. 2g. 3i, 4b.Sa.6c, 7d, Bf, 9h

40.2 1
3 side-cffoct 5 bl"term¡: 7 Caunoru. 9 pharrmci'r
lrru.mon 4 com:r:undoc;ired 6 dose 8 lndic:irions 10 pharrmC\
2 chtrn15t\

40.3 treptokmasc.one and a half n11ll1on unn b) mrra,·enou> mfusion O\-Cr StXI)' mmut.
A;pirm. rbree hundred milligram,.h) mouth. 11nmed1a1el).
l)1.1111orph1nc, t\vo poinr five ro five n11ll1KrJn1 , u1ttJ\oc11ou);ly.i1nn1ed1<1tel).
Mcroclopramide, ren milligra m;, mrra•enou;ly, 1mmed1ately.
GTN, three hundred miuogram> per livc milli litrc;, hy intravcnous infu1ion. Sr.1rt ar forty
1nicrogrnnls per n1inure.

160 Pro(e$s10nal English in Ust Med1<1ne

41.1 1 scalpd 2 rttractor 3 SCISSOI'> 4 anc tor<cP>

41.2 1 J>SISt.mt 6
2 prcppingfprcp iring swaIW,ud..cr 7
3 drapcs 't":ker/,,,·.1th
4 >tcrilc 8 logaru res
5 rctractor 9 drain
10 >11rurc.J,11rchc.J,r.1pb

41.3 1 dividcd 3 mobilizcxl 5 infilrrat1on 7 ,t1pb 9 closurc

2 rcpaired 4 excised 6 prc..·\crv111lt 8 redundanr 10 layers

42.l 1 chcmorherapy
3 phy,iorhcrapy 5 physiorherapy
2 radiothcmpy
4 Cognitive Bchav1oural 6 Cogniti, c Behavioura l Therap)'
111erapy

42.2 Curati•·c 2 adjuvanc 3 Palloame 4 omplanrs 5 fracrion

42.3 rcferrals 2 rherapr 3 replacc1nen1> 4 phy"othcrapist 5 Rehabolomnn¡:

43.1 1 Ros!.. f.1C1ors 3 fal"' 5 booster 7 rrsisran t ro

2 false ¡>OSillH'S 6 rnnrracted 8 ourbreak
ncgatives 4 exposed ro

43.2 Possoblc answers:

1 Women aged from 50 ro 70 should h.ive 1n.1111mogrnphy every chree years ro check for brc.1sr
c¡1nce
r.
2 l'aricnrs wirh hca rr dis•asc hould ha vc a hlo()(I chobtcrol test every six monrh< ro chc"Ck
thcir cholcstcrol lcvcl.
3 Women berween 20 and 60 should h,1\'ca smear tc\t evcry threc years ro check for cervica l
CJOCcr.
4 l'atienrs ovcr 40 wirh high nsk facro"' should have rhcor blood cholesterol checked C\ CI)' )C;tt.
5 Patocnts with diabetes 1hould have ophrhalmoscop)' e'ery rear ro check for diabeuc rctinoparhy.
6 l'rq:nam womcn should have rhc AFP test between 16 and 17 weeks to check for neura l tube
defecrs and Down's S)ndrome ri<.

43.3 hepmus A. malaria

2 hcparins A, malaria, ryphoid
3 hepat111s A. hepatitis B. malaria, rypho1d
4 hepari11s A, rabies, Jaranese encepha loti.m"laroa,
typhoid 5 a booster <lose for rernm1s

44.1 case fota liry 2 death/morraliry 3 hirth 4 survival 5 prevalencc 6 in iclencc

44.2 1nore COll lllOn 2 highe"lt 3 conunon 4 lo\vesr S lo\v 6 unconunortlr:.rc

44.3 .1ffCClcd by
as.oc1at1on bef\veen
1nc1dcncc of
lead to
ral't' 1n
1 1nadcncr oí 2 asso.;iation lJr:&'\\l-,:u 3 kJJ 1v 4 .-an: in 5 .iffcx.:rcd b)

45.l a9, b-, c8. d3.e4. f2

Pro(moonol Engfish ln Use 16
ledlclne 1
45.2 l e, 2d, 3a. 4g.Sh, Gf, 7h, 8c
46.1 Noun Vrrh
bias bias
conrrol conrrol
exposure expose
participanr (pcrson) participare
intervenrion intervene
srudy smdy

46.2 1 comrols 3 5 7 risk

2 double-blind longitudinal randornized 6 8 confounding
4 cohorr placebo

46.3 1 longirudinal cohorr study 3 case-control srudy

2 double-blind, rondo1nized conrrolled 4 case-conrro l study
rrial

47.1 Do you have a partner?

2 Whar do you do for a l iving?
3 Can you describe rhe pa in?
4 Where does ir hurr?
5 Does ir go anywhere else?
6 Whcn does ir srart?
7 How long does ir los1?
8 Does anyrhing bring ir on ?
9 Docs anythi11g 111<.ik il bc::ttt:r ?
10 Havc you any orher problems relared ro 1he pain?

47.2 1 Which parr of your hzad is

affecred? 2 Could you describe rhe
pain '
3 How long do rhey lasr?
4 Ooes anything bring 1hem on?
5 Does anyrhing make rhem bener?
G Is rhere anytlting else rhar affects thcm'
7 do you feel anything tlse wrong when ir's 1here?

47.3 1 gn3\ving, burning 3 sharp, burning 5 1hrobbing 7 sharp

2 sringing, scalding 4 crampy, colicky 6 achc 8 gripping

48.1 1 over-the<ounrer 3 allergy 5 siblings 7 Housing

2 <lose 4 herbal remedy 6 Recrcatic)n 8
cornpliancc
48.2 1 Are your parenrs ali vc and well?
2 How old was your fathcr when he died?
3 Do you know the cause of death? / What did he die of?
4 Do you have any bro:hers and sisrers I si bl
ings? 5 A re ali your close rebives alivc?
G What did he die of?
7 Does anyone in your fan1ily havc a serious illness?
8 (As far as you know,) is anyone raking regular
mcdicarion? 9 Do you have any children?

48.3 1 What kind of housc do you live in?
2 Ase any of rhem ar nursery or
school? 3 Do you havc an)' financia !
problems?
4 Do you have an)' hobbies or
inreresrs?
5 Do you s1noke? HO\V n1any a day?
6 Have you tricd giving up?
7 How much do you drink in a week?
8 C111 you give up alcohol whcn you want?
162 Pro(essioool Eng6sh in Ure M edicine
49.1 la, 2c. Je, 4c, Sb, 6d, 7f

49.2 1 1, 2 l. 3 C, 4 E

49.3 1 come on 2 pur on 3 give up 4 carry on 5 bring up 6 rurned out

Ovcr ro you - san1ple an-.\ver

1 Havc you had any pain or problcm< with you r mouth?
2 Is ir difficulr for you to swa llow food t>I' drink?
3 l lave you had any cliscomfort alter ca ring?
4 Do you ever ger a bu rning focling in your chest?
5 Do you have any pains in your sromach ?
6 l lave you losr any weighr?
7 Have you noticed any change 111 ·our bowcl habit?
8 \Vhat colour are your bowel mmemcnts?
9 l la•« you nociced any blood m your s1ool?
10 Does rhis comc mixtd wirh the tool or bcfore or after?

50.1 1 Look, touch 3 Clas< 5 IOuch 7 Loe 9 Roll up

2 Su. Jet 4 Take, off 6 Turn 8 Kl'Cp 10 Look at

50.2 1
Touch your shoulders with ynur hands.
2 Put your hands behind your hcad.
3 Put you r hands behind your b.1ck.
4
R"i"' your arms above you r hcad.
5 Bcnd your head forwa rd ... backward.
6 Bcnd your head ro ne right ... ro 1hc
7
lcft. Turn your head ro 1he right ... to
8 1he lcft. Bcnd backwards.
9 Touch rour toes.
10
With¡our hcel on che ground, tum ¡our!001as for as you
11
can. llcnd your knce.
12
llcnd to thc left ... r» 1he ng/11.
13 lknd your toes up and down.

50.3 1 do you know what we're gomg to do 1h1s morning

2 what we do is
3 .1 little bit of discomfort
4 cake very long
5 over
G could you (just )
7 l'm going to
8 ready
9 you'll ícel
10 vcry wcll
11 O\·er

51.1 1 dclus1on 3 il!usion 5 deludcd

2 h.illucmanons 4 01onal 6 Jawr1c11lJl1011

Pro(essionol Eng,sh In Use 163

/edlc'"e
51.2 Nou Adjcct
1w
confusion confused
delusion deluded
dcprcssion depressive (illness)
dcpresscd (paricnr)
disorienrarion disoriemed
obsession obsessional (symproms, rhoughrs)
obscssi,•c compulsive (disorder)
psychiarry (field), psychiarrisr (pracririo11er) psychiatric

1 psychiarric 2 dcpression 3 dcpressed 4 disorie11red

51.3 1 Can you describe our mood ar rhe momenr?

2 Do you rake pleasure in a11ythi11g?
3 l low are your ene1gy )cvds?
4 How long have you lx..,n fed ing likc rhis?
5 How are you sleeping?
6 Whar's you r appetire like'
7 Have you noriced any change in your \veighr?
8 Can you keep you1 mi11d 011 rhings?
9 Whar do you feel rhe furu re holds for you?
10 J l.:ive you cvcr thought oí suicide?

52.1 1 e
2 a, f
3d
4 b,e

52.2 1 a srrokc 4 brearhless11ess

2 rube which carrit>s urine from rhc 5 a painkiUer, medicine ro redue<
bladder 3 needing ro pass urine frequenrly
swelling 6 rabkrs ro imprcl\'C your mood
ar nighr

52.3 1 devcloped
2 (mainly) because you a re
3 This is why / lr's rhe reason why
4 give you advice on
5 rnake )'OU an appoinrn1enr \Vith I arrange for you to sce
6 going ro srart you on
7 should I should rry ro
8 \\ ant you to
1

9 a rrange for you

1O Hopefull y we can
11 anyrhing you'd likr to ask

53.1 1 carry 011 2 gavc up 3 end up 4 srarr, off 5 Cur down 6 scttle 7 avoid

53.2 1e, 2f, 3e, 4a, Sb, 6d

 53.3 P0>;1ble answer;:
You should keep 'º a 'º"" cholcscerol d1<t.
You should keep up an) ...guiar ph),ll'JI.1<11.-.t) you Me usrd to.
You ,houldn "t do any aoh it) tha< lmn¡:s 011 Jn¡:1na.
You should.woid movm frnm !loor to >1.111d111¡; e'crc1''" too quickl).

Ü>cr 10 you -sample answcr

Thc first option is to do nothing. The lihro1d w1ll sh rink when you hecomc menop.1.osal,
.1ltho11¡¡h we rn n't be surt whcn that will he.
lf you prefer, 1 can refer t ou ro a gynaccologi'l ro di scus.s surgical trearrnenr. Thcre 1rc
1

1hrl'c ros..ib1litics: onc is embol izarion which '' rel.111\'cl)' minor. Ir means closing off thc
:mery that feed; the fihroid. Thc $CCOnd would l>e rcm0\.11 oí thc fibroid alone wirhout
rcmoving your
\\Omb. This needs ahdominal \ur¡:cr , "'d a h)sterectomy whcn your womb os remo•cd.
You don't ha•e to decide toda). 1 can g1"c lou leaflets and recommend web;1tC\ for )·ou to look
a1. The-n come back and Stt n1r- 1n f'\\·o \\ ttk·11n1c.

54.1 l'd hkc to rttord thb consultauon

2 l'm afraid I l'm som·ro ha•c ro tell "º"
3 1.s.n't an oprlon
4 1 lot we can do ro hclp you
5 mJke you more comfortable
6 ncver be cenain abour rhce things
7 it's a matter of momhs rather rha n ycar;
8 l11n sorry ro have ro tell you
9 book you imo
10 Could you tell me what

54.2 1 \\lth 2 O 3 with 4 \\'ilh 5 111[0 6 for

Q,·er to )·ou - sampl allS\\·er

lñerc are rwo questions abour rumour<; in thc bram -'Is i1 dangerous?' and 'C:m 11 l>e
rcmO\ cd?' Wc know rha: yours 1sn'1 caocerous.Can wc rcmo'e it? \'(cll, it's qu11e l r¡:e
b111 1 beh e that if we can ge1 as much of 11 out • poss1ble. there's a good chance wc
can cure )OU. lf wc do nothmg. then l'm afra1d 11 could k11l you - n0t 111 thc short term
but perhaps 1n füe iears' time. An operation like dus on thc bra m .:arm-s s1gnilicanr risk.
You could l>e di<ablcd, or your person.1hty could be aff<'l'.ted. So )Ou necd to th111k
c.1rcfully about whether or nor )011 want to so ahead with the operarion.

55.1 ;hows 2 compared 3 threefold 4 douhlctl 5 rrebled 6 rwofold

55.2 1 lcss 3 under 5 about 7 le« 9 nearly

2 ahnosr 4 O\'Cr 6 around 8 appro,imately

56.1 Vn Nou
h n
56.2 dropped
dc'crcase 3 gradually 'decrca'>C
5 stcadily 7 reaching a peak
2
droprose
4 incre3sed drop 6 tell 8 accounrcd
fall fati
56.3 l ine
rn'c:re.. scgraph I bar chart 2 ba r chan 3 pie chart
'incrcasc
-

risc rise
57.1 1 Results 4 Mcth0<I (Subjecrs)
2 lnrroduction (Objt'Ctivc of thc rcscarch)
3 Method (Starisrical analysis) 57.2 Possible answers:
Pro(euional Entlish In Use 165
Medone
 5 Oiscussion (Main finding) 7 Di scussi on (Li111itarion)
6 lnrroducrion (Background) 8 Results
1 Wc asscssed 'vhether t:alciun1and virarnin D supplen1entar ion reduce rhe risk of
fractures in posnnenopausal \von1en.
2 The ai1n of our srudy 'vas ro dercrrni ne \vherher rhe'vay docrors dress influences patienrs'
confidence and rrusr in rhem.
3 This study eva luared die risk of HH V-8 transmission by hlood rransfusion.
4 We investigarcd thc association bctween never being married and i ncreased risk of dearh.

57.3 Possible answers:

1 This study failed ro show thar calcium and viramin O supplementarion reduce th< risk of
fractures in posrmcno?ausal \VO rnen.
2 We have shown rhar the way docrors dress iníluenccs paticnrs' confidcncc and trust in them.
3 Th is srudy providcs strong evidence of HH V-8 rransmission by blood rransfusion.
4 These results suggesr thar rhere is an association ber,veen nevcr being married and increased
risk of dearh.

58.1 objcctive 2 scrring 3 subjecrs 4 outcome 5 design

58.2 Past employees of Shcll Oil who rcti rcd at ages 55, 60, and 65 berween 1 ja nuary J 973 and
3 1 December 2003
2 To assess whcrher carly retirement is associa ted wirh berrer survival
3 Pctroleum and perrochemical indusrry, Un ired Srares
4 Hazard rario of dearh adjustcd for scx, year of enrry ro srudy, and socioeconomic srarus
5 Long tcrm prospecrive cohort srudy 6
No
58.3 The correct order is: 3 (Objecrive), 7 (Dcsign), 1 (Setting), 6 (Subjccts),2 (Main
outcome measure), 4 ( Resulrs), 5 ;Conclusion)

58.4 Id, 2b, Ja, 4e, Se

59.1 The corrccr ordcr is: 4 (Topic), 9 ( Pathophysiology ),5 (Sclurces), 6 (Sources), 2 (Diagnosis),
8 (Diagnosis), 3 (Diagnosis), 1 O (Diagnosis), 7 (Trea tmenr), 1 (Treatmenr)

59.2 En1phasiz.ing 1 rhink it's important ro cmphasizc that ...

Listing Fi rst of all ...
Exemplifying such as ...
Conrrasting ho,vever ...
Summ ing up So ...
Changing topic Ho''' do'"e diagnose it? No,v, i n rela ti on ro ...
Referring to a slide On thc slidc here you'11 see ...
Announcing rhe topic l 'd like ro tell you abour ...

166 ProfessJonol English in Use

Medicine
60.1 e/o complaaned oí
2/52 2 \veeks
PH pasr hisrory
FI 1 family history
MJ myocardial ir farction
BP blood prCS\lllC
1112 onc 111onrh
nil nothin¡:
SH social h1stol")
3&\V ahve and \\ Cll
OE on e'\am1nat1c>n
CXR chc<t X·m}

60.2 TI1e correct orclcr ;., 1, S , 8, 9, 2, 3, 4, 6, 7

(This parienr had carcinoma of rhe bronchus.)

60.3 McNama ra, 63, ta 1

driver e/o shortness oí breath
.l/12 ankle swdling 3/12
chronic cough, purolem spurum. occasional haemoptys1s
PH partial ga<trectom}. 1980
OE pale ·1 37"C
lcg oedema
no cl ubbing or lymphadenopa 1hy
chcst Nt\ D
liver 5cm palpa hlc smo<•th and non-render
scar oí pre\lious npcrat1011
( Ir Mc1'amara had pul monary ruberculosis. )

Pro(euionol fne/,sh on Use 16

Med1<me 7