FUNDACION UNIVERSIDAD DE CARABOBO

IDIOMAS MODERNOS

UNIVERSIDAD DE CARABOBO

BY PROF. GOBERDAN MATLOO

BELONGS TO:

Fundauc Presencia Universitaria En

Toda Venezuela
 PREFACE TO THE TEACHER
................................................................................................................................................................
The purpose of this Medical Work Book is especially designed for doctors, medical students in the
clinical phase of their studies and other medical professional who have to use English to communicate
with patients and their relatives and with medical colleagues.

The aim is to develop speaking and communication skills primarily but attention is also given to
reading and writing skills, in particular the use of reference material and journal articles. Practice is
also provided in writing referral letter and completing a range of medical documents.

Medical Work Book is a comprehensive and up – to – date course in medical English . It is for
doctors and medical students and other medical professionals at an intermediate language- level who
have to used English to communicate.

The use of grammar is also emphasized at the beginning of each unit, focusing of the correct use of
structures and other similar patterns. All material is presented in class before the students attempt to
study it. i.e. A grammatical explanation is given to familarize the students with the construction of
sentences and questions in the affirmative and negative forms. Also a run down on vocabulary is given.

The Work is divided into six units, each focusing on one area of doctor – patient communication
form history –taking to treatment. Section 1 introduces new language related to the unit theme. Section
2 provides further practice and introduces a variety of medical documents. Section 3 focuses on reading
and Section 4 brings together the language studied earlier in the unit in the context of a case history
which runs form Unit 1 to 6.
This book has been suggested and created at Fundauc for the purpose of teaching English for
Medical purposes.

Medicine is a field where innovation and development are constant. This edition of Medical Work
Book had been prepared to ensure that the content reflects the advances in medicine over to past years.

The organization of the book and the objectives of each type of activity are explained in more detail
in “To the student”. A specialist knowledge of medicine is not required , but you do require an interest
in the language needs of the medical professions and a grasp of communication and teaching
techniques . You provide the teaching expertise; the learner provides the medical knowledge. With a
little practice, you can devise supplementary activities of your own based of the models in this work

2
 TO THE STUDENT
.............................................................................................................................................................

The purpose of this work is to help you develop skills in communications in English with patients
and their relatives and medical colleagues. It will also assist you with medical reading of all kinds from
case notes to journal articles. Medical students will find this book useful in the clinical phrase of their
studies.
This work is divided into six units. The units are sequenced to match your own dealings with a
patient. You start with the English needed for consultations and continue with examinations – both
general and specialist. Next you study the language required to discuss investigations, diagnoses and
treatment both with the patient and with English – speaking colleagues. Finally you examine the
English treatment - medical, surgical and physiotherapy.

The first unit consist of various sections. The first section introduces grammar and structure and
provides practice activities in its context. The second practices further language items on the same
general themes and includes reading and writing practice involving medical documents. The third also
deals with reading skills and aims to develop the skills needed to understand a range of medical texts
including hospital documents, textbooks, reference materials and articles. The final section consolidates
the material covered in the first two sections in the context of a continuing case history which provides
a link from unit to unit.

3
Medical Work Book

Instrumental English in Medicine

Prof. Goberdan M. Matloo

Contribution:

Prof. Carlos Romero

RIGHTS RESERVED (MCMXCIX)

THIS MEDICAL WORD BOOK CAN NOT BE PARTLLY O FULLY DUPLICATED

WITHOUT A WRITTEN AUTHORIZATION OF FUNDAUC.
WRITTEN IN FUNDAUC MARACAY WITH THE CONTRIBUTION AND SUPERVISION
OF PROF. CARLOS R. ROMERO O.

FUNDAUC MARACAY 1999

4
 Unit I

Task 1
Focus on Grammar
Section 1
INTRODUCTION

The verb To Be is used in the nominal case and must be used with an adjective or a noun in the
complement to give sense to its meaning. The conjugation of the verb to Be must be in agreement with
its respective personal pronoun.

SUBJECT PRONOUN TO BE
I AM
YOU ARE
HE IS
SHE IS
IT IS
WE ARE
THEY ARE

Put is or are in each blank space:

1. I hope everybody ........... happy today ; the holidays ............. about to start and this ......... the end of
the term.
2. Some of the branches on that tree over there.......... old and dangerous. ............ there any chance
of getting them cut down?
3. Her hands ........... small ; the shape of his hands ......... unusual.
4. The traffic .......... at a standstill. Something ....... wrong.
5. All this equipment ......... old-fashioned but some of it ....... still quite useful.
6. .......... the news good today or bad ? How ......... the triplets getting on ?
7. He wants to buy one of these houses which ......... opposite the school. It ......... in a rather
convenient position.
8. Nobody ......... there and nothing .......... ready. Where ....... everybody today? ............ there anything
wrong?
9. ............ these the shoes you were looking for?
10. Where ....... the ones you borrowed from me yesterday?

5
Task 2

The auxiliary verb DO,DOES are used to form questions, short affirmative and negative answers and
sentences.

SUBJECT PRONOUN AUXILIARY VERBS

I DO
YOU DO
HE DOES
SHE DOES
IT DOES
WE DO
THEY DO

Put in do or does:

1. .......... you know his brother. What .......... he do these days?

2. Where ......... she live now? ............ you know her address?
3. It ......... not matter much. What .......... you think about it?
4. Where ............. the organizers live? .......... Mr. Coles know their address? David and John
............know it.
5. .......... all the dust worry you at all? It ........ n’t affect me.
6. How ....... they manage to get home so early? ........... somebody give them a life?
7. When ........ the secretary want to see us? ........... the other members of the committee know about
this?
8. How much ...... those cost? How many .......... you want?
9. When .......... the rest of the team arrived ?
10. ....... your brother’s friends want to come as well.

6
Task 3
The use of the verb To Have: have ,has
Put in has or have:
1. There ........... been a considerable increase in epidemic in rural areas but it ............ not had
much effect in the sub-urbs.
2. Everybody ........... the flu now and then.
3. Most of us ............... headaches when we ........ a bad indigestion. Some people .......... to lie down.
Others .......... to take an aspirin.
4. .......... anybody been here today? Yes, some people ........... called to see the doctor and there .........
been a lot of telephone calls for you.
5. What is the matter with your little brother. He .......... the measles.
6. Peter ........... been very sick lately. He ........... the mumps.
7. Joan is not feeling well. She ........ the scarlet fever and Pedro ......... the whooping cough.
8. Where is Carla today? She is not here. She ........... the tonsillitis.
9. Ben and Ana aren’t feeling well today. He ............ a headache and she ............ a toothache.
10. Tony is at the doctor. He .......... had a headache for a week now.
11. Maria is very uneasy. She.......... had a stomach ache for sometime.
12. Tom ............. a backache. He lift a lot of heavy bags yesterday.
13. That boy is vomiting a lot. He must ......... an upset stomach.
14. Mr. Jones can’t speak very well. It seems he ................... a sore throat.
15. That patient ............... a bad cough. He also ................ a pain in the chest.
WORD STUDY
Repeat these sentences after your teacher.
How are you today?
Not very well. I have a bad cold. My nose is stopped up, and my throat is sore. I have a headache.
Do you have a fever?
Yes, I have a high fever and I think my temperature is not normal .
I have a bad cough and my chest aches a lot due to coughing.
Do you know if Mr. Ryan has just been operated on?
Yes, he was operated on a few days ago. He’s in bed now. I think he’s feeling a little better than before.
Mr. Mitchell has a heart attack. He is in the hospital now. His wife says he’s had heart trouble for
sometime now.

7
Task 4
Exercises 1
Put in the verb to Be:
Thomas is sick.
(Mr. Lucky ......... tired)
1. Mary isn’t feeling well. I think she ....... dizzy.
2. Adele has an upset stomach. she .......... feeling bad.
3. Miss Vaughn feels like vomiting. She ........ nauseated.
4. Barbara and Mae look like they were at the beach. They ...... sunburned.
5. Mrs. McNeil is at the doctor today because she ..... pregnant.
6. Mrs. Roberts and her husband are on a diet, They ...... losing weight.

Practice these sentences with your teacher in the class.

Example A. Gene fell off her bicycle last Saturday.
He hurt himself very badly, and he sprained his ankle.
1. Peter fell down the steps.
He hurt himself very badly, and he fractured his shoulder.

2. Elena is at home now.

She is in bed. She fell and bruised her back and it pains.

3. That patient is in bad condition.

His face is cut and it is bleeding badly.

4. That man is my boss.

His arm is broken, and he is in a lot of pain.

5. That patient sprained his wrist.

He fell down from his bicycle and is in pain

B. Practice this exercise with your teacher.

What is the matter ?
Do you have a stiff neck?
No, I have the hiccoughs and I have something in one of my eyes.
Aren’t you hoarse?.
No, my back pains and my foot is sore.

8
Task 5
Pronunciation practice I
Common Disease and Ailments:
1. appendicitis 10. high blood pressure
2. arthritis 11. indigestion
3. cancer 12. low blood pressure
4. cold 13. malaria
5. diabetes 14. pneumonia
6. dysentery 15. polio
7. flu 16. rheumatism
8. heart trouble 16. sinus trouble
9. hepatitis 17. tuberculosis

Exercise 3.

Repeat these sentences after your teacher .

1. Does Mr. Jones have the appendicitis?

Yes, he does. He is not feeling well.

2. Does Mrs. Rodriguez have the arthritis?

No, she doesn’t. She has the rheumatism

3. Are Mr and Mrs. Smith diabetes?

Yes, they are. They are under their doctor’s care.

4. Do you have the flu?

No. I don’t. I have the cold.

5. Is tuberculosis a very bad disease?

Yes it is. It is a terrible disease.

6. Does your boss have low blood pressure?

No, he doesn’t. He has the high blood pressure.

7. Do Mr. Johnson and Mr. Anderson have the polio?

No, they don’t. They have the malaria.

8. Is hepatitis a contagious disease?

Yes, it is. It is an easily contagious disease.

9. Do you know anyone with heart trouble?

Yes. I do. My neighbour has heart trouble.

10. Does Jose have a headache?

Yes, he does. He has a bad indigestion.

9
11. Is tuberculosis very common these days.
Yes, it is. It is very common in some Latin American countries.

12. Does cancer have a cure.

No, it doesn’t. They are still looking for a cure.

Task 6

Special Medical Terms

Practice this word study with your teacher.

Medicine: Science of diagnosing, treating, and preventing disease.

The word also refers to a drug used to treat an illness or injury.
Physician or Doctor: Person trained and licensed to practice medicine; one who treats the entire body
is a general practitioner (G.P.).
Surgery: Medical specialty of cutting into, or performing operative procedures on., the patient.
Doctor who does this is a surgeon.
Acupuncture: Method of curing illness or relieving pain by inserting needles into the body at certain
points; originally developed by the Chinese.
Epidemic: Contagious disease which spreads rapidly throughout large portions of the population.
Skeleton: Bony framework of the body, including the spinal column, the ribcage, the skull, and the
bones and of the arms and legs. .
Anatomy: Science of the structure of organisms, including the human body; can be studied by
dissecting , or cutting into, organisms.
Disease: Pathological condition which causes abnormal body functions and presents certain
symptoms or signs; can be caused by a germ, such as a bacterium or a virus.
Drug: Substance used to treat illness. Antibiotics, such as penicillin and tetracycline, are familiar
examples.
Microscope: Instrument which uses a series of lenses to produce magnified images of objects to
small to see well by the eye alone. Laboratory technicians use microscopes to analyse
specimens of blood, urine, and tissue.
Diagnosis: Identification of a disease or ailment after careful examination and analysis. A doctor
always diagnoses the patient’s ailment before treatment.
Communicable disease: Disease in which the causative organism factor can be transmitted from one
person to another; the common cold is the most familiar example.
Family Practice: A certified primary care specialty emphasizing general medical care for the entire
family.
Biopsy: Portion of tissue removed from the living body by an operation and examination to aid in
diagnosing a disease
X-ray: Form of radiation used to create photographic images of bones and internal organs and, in some
cases, to treat them when they are diseased; overexposure can be dangerous.
Health insurance: Form of protection against the high cost of health care. Payment of a premium
guarantees medical coverage to the insured person.
First aid: Emergency medical treatment given when professional medical advice is not available.
Hospital: Place where medical and surgical care is provided for sick and injured persons.

10
SECTION 2 Asking basic questions

Task 1

Read the dialog carefully between a doctor and a patient and then answer the questions given
below. Teacher’s guidance

DOCTOR: Good morning, Mr. Sanchez. What brings you here today?
PATIENT:Well, you see, doctor, I’ve been having these bad headaches.
DOCTOR: And how long have they been bothering you?
PATIENT:Well, they started about, well it must have been about three months ago.
DOCTOR: I see. And which part of your head is affected?
PATIENT:Well, it’s , it’s right across the front here.
DOCTOR: And can you describe the pain?
PATIENT: It’s a sort of dull, dull and throbbing kind of pain.
DOCTOR: I see, and do they come on at any particular time?
PATIENT:They seem to be , They ‘re usually worse in the morning. I notice them when I wake up.
DOCTOR: And is there anything that makes them better?
PATIENT:Well, if I lie down for a while, they seem to go away.
DOCTOR: Yes, and has there been anything else apart from these headaches?
PATIENT:Well, my wife, she says that I seem to be getting a bit deaf.
DOCTOR: Oh? Well, Mr. Sanchez, I think at this stage I’ll start by checking your ears to see if
there’s any wax . .

1. What is patient’s surname?

_______________________________________________________________________________

2. What’s the patient’s last name?

_______________________________________________________________________________.

3. What’s the patient’s age.

_______________________________________________________________________________.

4. What the patient’s marital status?

_______________________________________________________________________________.

5. What’s the patient’s present occupation?

______________________________________________________________________________

11
6. What’s the patient’s PRESENT COMPLAINT?
______________________________________________________________________________.
______________________________________________________________________________.
______________________________________________________________________________.
______________________________________________________________________________.
______________________________________________________________________________.
______________________________________________________________________________
______________________________________________________________________________.

Language focus 1

The teacher should explain the many ways how questions are formed and asked.

Pay special ATTENTION to the doctor’s interview

 What brings you here today?

The many other ways of starting an interview are:

 What can I do for you ?
 What is the problem?

Another way of asking about problems:

 How long have you had these problems?

Task 2

Classwork
Study this short dialogue and practice it in the form of repetition along with your teacher.

DOCTOR: Well, Mrs Early. What brings you here today?

PATIENT:I have a bad whooping cough. (1)
DOCTOR: How long has it bothered you?
PATIENT:Two or three days. (2)

Now practice this dialogue with a classmate. One classmate should play the part of the patient. He or
she can select replies form lists (1) and (2) below. Use all the ways of starting an interview and asking
how long the problem has lasted. The teacher should help with ideas when he feels it is necessary.

(1) (2)
a bad whooping cough two or three days
terrible constipation since Tuesday
swollen ankles a fortnight (two weeks)
a pain in my stomach for almost a month

(Taken from English in Medicine p.6)

12
Language focus 2

Note how the doctor in the dialog asks where the problem is:
 Which part of your head is affected?

Other ways of finding this out are:

 Where does it hurt?
 Where is it sore?
 How often do you have the pain?

Note how the doctor asks about the type of pain:

 Can you describe the pain?

Other ways of asking this are:

 What’s the pain like?
 What kind of pain is it?

 Hurt is a verb. We use it like this: My feet hurts.

 Sore is an adjective. We can say: My foot is sore or I have a sore foot .
English in Medicine p.6

Task 3

Practice finding out information like this. Work in the same way as in Task 2. Use all the methods
given in Language focus 2 in your questioning. Work with the help of the teacher.

DOCTOR: Which part of your head (chest, back, etc.) is affected?

PATIENT:Just here.
DOCTOR: Can you describe the pain?
PATIENT: It’s a hard pain. It comes very often. (1)

(1)
a hard pain. It comes very often.
a feeling of pressure
very sore, like a needle
a burning pain

Language focus 3

Note how the doctor asks if anything relieves the pain:

 Is there anything that makes it better?*

Similarly he can ask:

 Does anything make it worse?

Doctors often ask if anything else affects the problem. For example:
 What effect does food have?
 Does lying down help the pain?.

13
Task 4

Work in pairs. In each of these cases, ask you partner where the pain is.
Then ask two other appropriate questions to help you reach a diagnosis. Use all the ways of questioning
we have studied in this section. Teacher’s guidance

For example.

DOCTOR: Where does it hurt?

PATIENT:Right across here. (indicating the central chest area)
DOCTOR Can you describe the pain?
PATIENT:It’s like a heavy weight pressing on my chest.
DOCTOR: Does anything make it better?
PATIENT:If I stop for a bit, it goes away.

In this example, the patient’s symptoms suggest angina

(English in Medicine p.7)

Now try each of these four cases in the same way.

1 DOCTOR: .................................................................................................................................
PATIENT:Here, just under my ribs. (1)
DOCTOR: ..................................................................................................................................
PATIENT:It gets worse and worse. Then is goes away.
DOCTOR: ..................................................................................................................................
PATIENT:Foods makes it worse.

2 DOCTOR: ..................................................................................................................................
PATIENT:It’s right here. (2)
DOCTOR: ...................................................................................................................................
PATIENT:It’s gnawing kind of pain .
DOCTOR: .....................................................................................................................................
PATIENT:Yes. If I eat, it gets better.

3 DOCTOR: .....................................................................................................................................
PATIENT:Down here. (3)
DOCTOR: .....................................................................................................................................
PATIENT:It’s a sharp, stabbing pain. It’s like a knife.
DOCTOR: ....................................................................................................................................
PATIENT:If I take a deep breath, or I cough, its really sore.

4. DOCTOR: .....................................................................................................................................
PATIENT:Just here (4)
DOCTOR: ....................................................................................................................................
PATIENT:My chest feels raw inside.
DOCTOR: ....................................................................................................................................
PATIENT:When I cough, it hurts most.

14
Task 5

Work in pairs. Student A should start.

A. Play the part of the doctor. Repeat Task 4 but add two or three more questions in each case to help
on a diagnosis. For instance, in the example where the patient’s symptoms suggest angina, you
could ask:
 Does anything make it worse?
 How long does the pain last?
 Is there anything else you feel at the same time?

B. Play the part of the patients. Use the replies in Task 4 and the extra information in the Key to help
you. (English in Medicine p.8)

Section 3 Taking notes

Result of Mr. Sanchez’s General Condition after the doctor’s examination from the above dialog.

On Examination:

General Condition :- obese, 1.65m tall, 85 kg

Ear, Nose, Throat = ENT :- wax ++ on both sides

RS =Respiratory = NAD :- Nothing abnormal detected

CVS= cardiovascular accident, cerebrovascular accident : pulse 80/min; blood pressure 180/120

HS = Heart Sound ---normal

GIS = Gastro – intestinal system

GUS = Genito – urinary system

CNS= Central nervous system

INVESTIGATION:- Urine –ve for sugar and albumen; ve= negative

DIAGNOSIS :- hypertension

15
Task 6

Study this letter from a GP to a consultant. Write down the questions which a doctor might ask to
obtain the information ringed in the letter. For example:

4 How long did it last?

8 What was the cause of death?

CLINICAL DETAILS

Dear Dr. Rodriguez. Date ............19...............

I would be very pleased for you opinion and advice with respect to

Patient Rogers, Roy

A brief outline of the patient’s present history, symptoms and signs and present therapy is given below.
This old man is his forties, a salesman had a sever attack of central chest pain about six months ago
which lasted 20 minutes and was relieved by rest. This has recurred several times after exertion. His
father died aged 56 of a coronary thrombosis. Physical examination was normal and I refer him to
you for further assessment in view of his age.

Diagnosis: angina
Thank you in advance.

Task 7

The hospital consultant made these notes of her interview with Mr Fernandez. Complete of the
gaps as you can with the help of the letter. Now listen to the dialog the teacher reads and
complete the remaining gaps.

DOCTOR: Come in, Mr. Fernandez. Come and sit down here. I’ve had a letter from your doctor and
she tells me that you’ve been having pain., pain in your chest.
PATIENT: Yes, and in my arm, and also tingling in my fingers and . . .
DOCTOR: Yes, now when did you first notice this pain?
PATIENT:Well, I suppose about six months ago.
DOCTOR: And can you remember when it first came on ?
PATIENT: Yes, well I remember, I got a bad pain in my chest when I was shopping. It was so bad I
couldn’t breathe and I had to rest for a while.
DOCTOR: And where, in which part of your chest did you feel the pain?

16
PATIENT: Well, right across my chest.
DOCTOR: And how long did it last?
PATIENT: About ten minutes.
DOCTOR: And what did you do when it happened?
PATIENT: I had to stop and wait for it to go away.
DOCTOR: So, have you had this, the pain again since then?
PATIENT: Yes, I often get it when I overdo things, and when I stress to much .
DOCTOR: Well, I think at this stage I’d like to examine you, your chest. So if you could strip to
your waist.
PATIENT: Right. There we go.
DOCTOR: That’s fine. I’ll just check your pulse first of all. Fine. That’s fine. It’s quite normal,
seventy per minute.
PATIENT: Right.
DOCTOR: Now your blood pressure. Fine. That’s quite normal too. 130 over 80.
PATIENT: OH, I’m pleased to hear it
DOCTOR: Now I’m going to listen to your heart, so I want you to breathe normally . . . Mm, your
heart sounds quite normal.
PATIENT: Oh, that’s a relief.
DOCTOR: Well now, I want you to take deep breaths in and out while I check you lungs. In. Out.
In. Out. Fine. They’re completely clear. Well, Mr. Fernandez, the pain you’ve been
having sounds very much like the pain of what we call angina, and this occurs when not
enough oxygen is getting to the heart. Now I’d like to check a few tests, and, following
that I’ll be able to advise some treatment for you . . (Adapted from English in Medicine )

Patient’s Name. .........................................................................................................................................

Patient’s age................................................................................................................................................

Marital Status ...........................................................................................................................................

Patient’s occupation...................................................................................................................................

Patients Present Complaint ............................... chest pain radiation to L arm. Started with sever
attack with dyspnoea. Pain lasted ................................. relieved by rest. Has occurred since on
exertion.

Adapted from English in Medicine p.12

17
 ON EXAMINATION
PATIENT’S GENERAL CONDITION

ENT .......................................................................................................................................................

RS Chest ..........................................................................................................................................

CVS ................................................... 70/min ........................................................................130/80

............................................. normal

GIS .......................................................................................................................................................

GUS ......................................................................................................................................................

CNS ........................................................................................................................................................

NOTE: See abbreviations from previous exercises.

Task 8

Study these cases. Then complete the following with the information given below.

a) PEREZ, Juan, age 46 and single. A construction worker who complains of a series of frontal
headaches 4/7 = 4 days following a bad cold. It worsens in the early morning and especially
when bending down. He also complains that the cold is being “off colour” and feverish. He has
taken some analgesic and have had some relief.

SURNAME:....................................................... FIRST NAME..........................................................

AGE: .................................................................SEX ............... MARITAL STATUS...................
OCCUPATION.......................................................................................................................................
PRESENT COMPLAINTS: .................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................

POINTS OF NOTE
................................................................................................................................................................

18
(Adapted for Medical Work Book)
b) RODRIGUEZ, Ana Maria, age 32 and divorced. A teacher who has complained of episodic
headaches for many years, lasting 1-2 days every 3-4 months. This causes her to have sever pains
behind her eyes which causes a state of nausea. She feels a tightness at the back of her head with
strain on her shoulder muscles. It’s a depressing pain and it interferes with her daily routine.

SURNAME ...................................................... FIRST NAME ......................................................

AGE .................................................... SEX ............... MARITAL STATUS ................................
OCCUPATION ................................................................................................................................
PRESENT COMPLAINT ................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
(Taken, modified and adapted from English in Medicine p.12)

Task 9

Work in pairs and try to recreate the consultation. Student A should start.
A. Play the part of the patients. Use the case notes

B. Play the part of the doctor. Find out what the patient is complaining of .

Do not look at the case notes

19
SECTION 4 Reading and Comprehension skills. Scanning a case history

Task 11

Read the following case history and find and answer the following questions about the patient as
quickly as you can.

1. previous occupation
2. initial symptoms
3. initial diagnosis
4. condition immediately prior to admission
5. reason for emergency admission
6. duration of increased thirst and nocturia
7. father’s cause of death
8. alcohol consumption

CASE HISTORY
Mr. Wilder, a retired bus driver, has been in bed with a bad
whooping cough and general malaise when he called in his general
practitioner. An upper respiratory tract infection was diagnosed and
erythromycin prescribed. Two days later, at a second home visit, he
was found to be a little breathless and complaining that he felt
worse. He was advised to drink plenty and to continue with his
antibiotic. Another 2 days passed and the general practitioner
returned to find the patient barely rousable and breathless at rest.
Emergency admission to hospital was arranged on the grounds of ‘
severe chest infection’. One arrival in the ward, he was unable to get
up for the previous 24h. He had been incontinent of urine on a few
occasions during this time. He had been noted to have increased
thirst and nocturia for the previous 2 weeks.

His past history included appendicectomy at age 11 years,

cervical spondylosis 10 years ago, and hypertension for which he
had been taking a thiazide diuretic for 3 years. His father had died at
62 years of myocardial infarction and his mother had had
rheumatoid arthritis. His wife kept generally well but had also had a
throat infection the previous week. Mr Wildgoose drank little
alcohol and had stopped smoking 2 years previously.
(Taken from English in Medicine p. 13)

20
COMPREHENSION

Answer the following questions taken from the extract above.

1. What was the patient’s previous occupation prior to his illness?

_______________________________________________________________________________

2. What are the patient’s initial symptoms?

_______________________________________________________________________________.

3. What are the initial diagnosis?

_______________________________________________________________________________.

4. Describe the patient’s condition prior to his admission?

_______________________________________________________________________________.

5. Explain the reason for emergency admission?

_______________________________________________________________________________.

6. How long had the patient’s been noted to have an increase thirst and nocturia?
_______________________________________________________________________________.

7. State his father’s cause of death.

_______________________________________________________________________________.

8. Do you think consuming of alcohol might have to do with Mr. Wilder’s illnesses?

21
SECTION 5 Case history: James Canaan
Task 12

In this section you will follow the medical history of James Canaam. In this dialog he is visiting his
new doctor for the first time. As you read, complete the personal details and Present complaint section
of the case notes below. Teacher’s guidance

DOCTOR: Good morning, Mr. Canaan. I see from your card that you have just moved into the
area and perhaps you could tell me a little about your previous health as I won’t get your
records for another month, month or two, and then we can deal with your present
problem.

PATIENT:Well, I’ve actually, I’ve always been very fit up till now but . . .

DOCTOR: Have you ever been in the hospital?

PATIENT:Oh, only when I was a child. I had an appendicitis when I was eight.

DOCTOR: And what’s your job, what do you do?

PATIENT:Well, I work for the post office. I’m a postmaster.

DOCTOR: And I see that you’re 58, now, and have you are retired?

PATIENT:Yes.

DOCTOR: Have you always been with the post office?

PATIENT:Yes, well apart from my time in the army you know . . .

DOCTOR: I see. And you’re married. Any family?

PATIENT:Yes, two girls and a boy.

DOCTOR: Fine. That’s fine. Now can you tell me what seems to be the problem today?

PATIENT:Well, it’s this terrible pain. I’ve got this terrible pain in my back. I’ve had it for more
than a week now and it’s . . .
DOCTOR: I see, and can you show me exactly where it is?

PATIENT:It’s down here, here.

DOCTOR: And does it go anywhere else?

22
PATIENT:Yes, it goes down my left leg. And I feel pins and needles in my foot.

DOCTOR: I see., and is it there all the time?

PATIENT:Yes, yes it is. It keeps me awake, awake at night and I can’t get out into the garden.
I’ve been taking aspirins but the pain, it just comes back again.

DOCTOR: And was there anything that started it off?

PATIENT:Well, yes, yes. I’ve been trying to sort out the garden at my new house and I don’t know.
I have been overdoing things a bit

SURNAME.......................................................... FIRST NAME...........................................................

AGE .................................................. SEX ....................... MARITAL STATUS ..................................

OCCUPATION.........................................................................................................................................

PRESENT COMPLAINT.........................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
..................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................

Task 13

Work in pairs and try to recreate the consultation. Student A should start.

A: Play the part of James Canaan. Use the case notes to help you.

B: Play the part of the doctor. Find out what the patient is complaining of. Do not look at the case
notes.

The case of James Canaan continues.

(Taken from English in Medicine p.14)

23
Task 14

VOCABULARY PRACTICE

Study again the meanings of the words in the following list. This exercise cannot be completed
satisfactorily unless the meanings are known.

medicine physician doctor

surgery acupuncture epidemic
skeleton anatomy pharmacy
disease drug microscope
diagnosis communicable disease family practice
biopsy x-ray nurse
patient health insurance hospital
first aid

1. The science of diagnosing , treating, and preventing disease is known as .....................................

2. Person trained and licensed to practice medicine is called a ...........................................................

3. Medical specialty of cutting into , or performing operative procedures on, the patient is .............

4. Contagious disease which spreads rapidly throughout large portions of the population. ...............

5. Bony framework of the body, including the spinal column, the rib cage, the skull. etc. ...............

6. Pathological condition which causes abnormal body functions and presents certain symptoms or

signs; can be caused by germ, such as a bacterium or a virus is known as .....................................

7. Substance used to treat illness....................................................

8. Instrument which uses a series of lenses to produce magnified images of objects to small to see

by the eye alone. ................................

9. Form of radiation used to create photographic images of bones and internal

organs. .................................

24
SECTION 6 Reading Comprehension: Visiting a Doctor

Task 15

DOCTOR: You said on the phone that you were feeling listless. What’s wrong?

PEDRO: I don’t feel good, Doctor. I don’t seem to have any energy.

DOCTOR: Can you be more specific?

PEDRO: It’s nothing I can put my fingers on specifically. I feel generally run-down, tired all the
time; yet I have trouble sleeping.

DOCTOR: Do you eat well? How’s your appetite?

PEDRO : I probably don’t eat well. I eat a lot of fried foods and junk food. I don’t eat enough fresh
vegetables. I don’t even eat many cooked vegetables.

DOCTOR: You’ve gained some weight since I last saw you. According to my chart, you’re about
Twenty pounds overweight. Those junk foods you mentioned aren’t helping. Do you
Exercise?

PEDRO: Naturally, I’m not as physically active as I used to be. I’m at my office all day long. I ‘ve
my own business, and I work pretty hard at it.

DOCTOR: I suspected maybe you work too hard at it. Take off your coat and roll up your sleeve,
please. I want to check your blood pressure. How old are you, Pedro – about fifty?

PEDRO: I’m fifty-two.

DOCTOR: (The doctor takes Pedro’s blood pressure reading.) Your pressure is high. It’s nothing to
be already about yet. But I’m going to have to restrict your salt intake and ask you to
exercise more. Are you short of breath at all?

PEDRO: Yes, I sometimes get dizzy after climbing stairs, and I can’t walk long distance or lift
heavy objects without panting. I probably should give up smoking .

DOCTOR: You’re still smoking! After promising to give it up six months ago! Pedro, what
happened?

PEDRO: I went to that class that was guaranteed to make a person stop smoking, but then I
suffered some business loses and I began to worry. I guess I always associated smoking

25
 with worrying, so I started puffing again. The funny thing is now that I’ve started again,
I’m smoking even more than I was before. I’m up to two packs a day now.

DOCTOR : You’re worried, you don’t sleep well, you smoke two packs of cigarettes a day, you don’t
exercise, and your diet is terrible. And you why you’re not healthy? I wonder why you’re not dead!

PEDRO: Oh, it’s not that bad, is it, Doc?

DOCTOR: Almost. We’ve got to get you back on a healthy track. You were healthy when you were
born, you know, Pedro. It’s unnatural to be unhealthy.

PEDRO: What can I do?

DOCTOR: You can start by taking your health more seriously than you have been. I’m going to give
you a diet plan, and I want you to stick to it. You heart sounds healthy when I listen to it,
but I suspect all that extra weight you’re carrying around is putting a strain on it. The diet
will help you to lose weight and help to relieve some of the strain. It’s a high fibre, low
cholesterol, low salt diet. You get all the protein and minerals you need with it.
PEDRO: It’s hard to stick to a diet with my busy schedule.

DOCTOR: Your health is more important than your business. The next step will be exercise. I know
it’s hard to find the time, but you can at least start walking more. If your office is on the
third floor, stop taking the elevator up and down; walk the three flights instead. Walk
around the block after dinner. Find ways to increase your physical activity every day.
Join a swimming club. Swimming a few times a week is the best exercise you can get.

PEDRO: I joined a health club last year, but I quit because I never had time to go there.

DOCTOR: Find the time. It’s important. And for heaven’s sake, stop smoking! Back in the old days,
we used to call cigarettes “coffin nails” because we knew they weren’t good for the
health. Now it’s medically proven that they can cause cancer and a host of other things.
PEDRO: Okey, I’ll try again, but I’m not promising. It’s a difficult habit to break. What about my
run-down feeling? Can you give me something for the problem? There must be some
drug I can take.

DOCTOR: I’d rather not give you any drugs, but temporarily, I will give you a prescription for
something that will help you sleep. When your diet and exercise program start to
improve your health, through, I’m going to take you off the medicine. Do you
understand?

PEDRO: Yes, thanks a lot Doc. I appreciate what you’re saying and doing.

26
 COMPREHENSION AND CONVERSATION PRACTICE

1. Why was the patient seeing the doctor?

____________________________________________________________________________
2. What was the doctor’s attitude toward the patient’s lifestyle and habits?
____________________________________________________________________________.
3. When did you last see the doctor? Why did you go?
____________________________________________________________________________.
4. Do you smoke? What do you think of smoking?
____________________________________________________________________________.
5. What is blood pressure? Do you know what your blood pressure reading is?
____________________________________________________________________________.
6. How is salt related to one’s blood pressure?
____________________________________________________________________________.
7. What is a stethoscope?
____________________________________________________________________________.
8. What other devices does a doctor use to help him or her learn about one’s body and it’s function?
_____________________________________________________________________________.
9. What are some examples of junk food?
_____________________________________________________________________________.
10. What can a person do to lose weight?
_____________________________________________________________________________.
11. Describe a healthy diet?
_____________________________________________________________________________.

VOCABULARY PRACTICE

1. A person who is listless has very little (energy, money, breath, pressure).
2. To put one’s finger on something is to (press it, identify it, ring it, accuse it).
3. To pant is to ( walk, lift, smoke, breathe rapidly)
4. Which of the following activities does not constitute exercise? ( walking, swimming, smoking )
5. A person who is run-down can be said to be (healthy, in poor physical condition, surprised,
serious).
6. A diet which is harmoniously proportional is called (temporary, busy, full, balanced).
7. Which of these words do not rhyme with strain? ( rein, deign, crane, drain, lien, Maine).
8. To get dizzy is to (walk up stairs, exercise, feel light-headed, understand).

27
 Poisons
Task 16
READING COMPREHENSION

READ THIS PASSAGE CAREFULLY AND ANSWER THE QUESTIONS WRITTEN BELOW.

Basic principles of treatment

Common errors in treatment
Guide to poisonous substances and treatment

Basic principles of treatment

In all cases of poisoning , certain general principles should be followed. It is a common misconception
that for each poison there is a specific antidote. In practice, a true pharmacological antagonist is
available in only 2.0 % of poisonings. In the great majority of instances, therefore, the treatment
consists primarily in the application of basic principles of supportive treatment. If the poison is a gas,
or the vapour of the volatile liquid, the patient must be removed at once to fresh air and given oxygen
and artificial respiration if needed.
Subsequent treatment is supportive to maintain vital functions. It the poison has been ingested in most
cases it is necessary to remove as much as possible of the unabsorbed substance from the stomach.
Outside hospital this is best achieved by pharyngeal irritation using the finger or a blunt spoon handle.
In hospital, gastric aspiration and ravage should be given provided the patient retains an adequate
cough and gag reflex, or is sufficiently unconscious to allow the introduction of a cuffed endotracheal
tube to protect the airway. These procedures should only be performed with the patient lying on his side
with the head dependent. An adequate size of tube must be used, e.g. in an adult 30 English gauge, and
300 ml quantities of lukewarm water should be used for ravage until the recovered fluid runs clear. As
a general rule nothing should be left in the stomach after the lavage for fear of subsequent vomiting
and pulmonary aspiration. Emetic drugs have been enthusiastically recommended to avoid the use of
gastric aspiration and lavage. Apomorphine, common salt, mustard and copper sulphate have been used
as emetics, but are now regarded as dangerous, and should not be used. Syrup or ipecacuanha is quite
widely used in a dose of 15 ml followed by 200 ml of water, and provided its limitations are
recognised is the treatment of choice in children. The onset of its emetic effect is usually delayed for
about 18 min and occasionally it may produce undesirable toxic effects after absorption.

COMPREHENSION

1. According to the passage. Is there a specific antidote for each case of poisoning?
______________________________________________________________________________.

2. What is meant by supportive treatment?

______________________________________________________________________________.

3. State some of the methods used in supportive treatment?

_______________________________________________________________________________.

4. What sort of drugs are now regarded as dangerous and not to be used in the case of poisoning?

28
 _______________________________________________________________________________.

VOCABULARY PRACTICE

Common errors in treatment

1. Analeptic therapy
Bemegride is not a specific barbiturate antagonist and its use in poisonings due to hypnotic drugs is
associated with frequent serious side-effects including cardiac arrhythmias, convulsions and even
irreversible brain damage. The use of analeptics cannot be justified.

7. Bladder catheterization
This highly dangerous procedure is seldom necessary even in deeply unconscious patients. With
adequate nursing care, there should be no undue risk of skin breakdown due to incontinence of urine.
Bladder catheterization is justified in prolonged bladder distension and occasionally when forced
diuresis therapy is being given.

8. Prophylactic antibiotics
With good nursing care, including frequent turning of the patient and careful attention of mouth
hygiene prophylactic administration of antibiotics is unnecessary. These drugs should be given only
when there is clear clinical or x-ray evidence of infection.

Taken ,revised and adapted from “Pocket Medical Dictionary” p..359

29
Appendix I

Task 5
B: Use this additional information to answer any questions the doctor asks.
1 Greasy food, like fried eggs, upsets you most. The pain lasts several hours.
2 The pain wakes you at night. Around 2 or 3 in the morning. Spicy food brings on the pain. Too
much to drink also makes it worse.
3 The pain is really bad. You’ve been coughing up brownish spit. You’ve had a temperature.
4 You’ve had a cold. You’re not coughing up phlegm.

Diagnoses

1 gall bladder
2 duodenal ulcer
3 pneumonia
4 tracheitis

Task 6

O/E on examination
BP blood pressure
CNS central nervous system
-ve negative
? query/possible
1/52 on week

Task 7

Suggested questions:

1 What’s your occupation?

What do you do?
What’s your job?

2 Whereabouts was the pain?

Show me where the pain was.

3 When did the pain first happen?

4 Did anything make it better?
5 Does anything special bring it on?
6 Are your parents alive?
How old was your father when he died?
What age did your father die at?

30
Task 8

1 ROGERS
2 42
3 Salesman
4 Central
5 10 mins
6 clear/normal
7 P (pulse)
8 BP (blood pressure)
9 HS (heart sound)

Task 9

Possible questions:

a) What’s your name?

How old are you?
Are you married
What’s your job?
What’s brought you here today?
How long have you had it?
Did anything special bring it on?
Is it worse at any particular time?
Does anything make it better or worse?
Have you any other problems?
Have you taken anything for it?
Did the paracetamol help?

b) How long have you been suffering from these headaches?

How long do they last?
How often do you get them?
Do they ever make you feel sick?
Have you noticed any other problems?
How does the pain effect you?

Task 11

1 truck driver
2 cough and general malaise
3 upper respiratory tract infection
4 barely rousable and breathless at rest
5 severe chest infection
6 two weeks
7 myocardial infarction
8 drank little alcohol

31