医生诊疗英语会话

English for doctors：Authentic consulting－room activities for doctors,dentists,studentsand nursesFrom 1PAST MEDICAL HISTORYi'd like to ask you about your past medical history.can you me whether you have had any childhood diseases?for example chickenpox,measles,mumps or rubella when i was small,i had measles,chickenpox and whooping cough.but i don't think i ever had rubella have you ever been in hospitalized for anything?or have you ever had an operationwell,i had my tonsils taken out when i was a child have you had any major health problems since then yes,i have diabeteswhen were you first diagnosed with diabetes?what were your simptomsi was diagnosed when i turned14.i was always thirsty,tired and depreassedare you receiving any treatment for thisi have been getting insulin shots ever sinthhave you had your vaccinationsyesgooddid your referring physician give you a letter for me yes,here it is2FAMILY HISTORYas far as you know,are there any illnesses that run in your family?none that i know of,doctornothing like diabetes,high blood pressure,heart disease,stroke,cancer,mental illness or anything like that?oh i see!my father had a heart condition,and i have two my aunts who have diabetesand is your father still aliveno,he isn'thow old was your father when he diedhe was68what did he die offhe had a heart attackdid he suffer for a long time with this heard cindition before he died oh no,it was very suddenand your aunts?do you know what kind of diabetes they have?do they have to take insulin or tablets or are they just on a dietthey just take some pills,i thinkyou are married,i see,have you any childrenyes,a boy and a girlare they healthyyes,they are3SOCIAL HISTORYare you working right nowno,i have just been laid offoh,i am sorry.what was your jobi was a manager for an import and export company i see.was it an office job or were you on your feet all dayi worked behind a deskwas it managerial,did you have a lot of responsibility yes,i was in charge of a large departmenti see,quite stressful.now,tell me,do you smoke yes,i do.unfortunately,quite a lotoh,really?how muchall about2packs a dayhow long have you been smokingsince i was about fourteenhave you ever try to quit smokingyes,i have tried several times.but without success what about driking?do you drinkyes,sometimes with my friendshow much alcohol do you drink a daylet see.a couple of glasses of beer at lunch time.a wisky in the evening.and about half a bottle of wine with my dinnerthat's quite a bit.how old were you when you start drinkingoh,about17ir18,i supposewhat about your living conditions?where do you live we living in a small apartment.we own it.but of course we are still paying the morgage on it 4PRESENT COMPLAINTS4present complaints1-4-1what's the problem todaycan you tell me what your symptoms are have hou ever had these complains before what's seems to bring this condition onwhen did you start feeling poorly1-4-dialogue a(1-4-dialogue b)what seems to be the problem at the moment(today) well,i have been feeling so poorly recently(ill lately) i see.feeling poorly(ill).(now)what do you mean by thati have been getting very short of breathhm...how long has this been going onfor about18months,i thinkand were there any other symptoms before then or did it(this condition)start quite suddenlyi hadn't notice anything before thenso you haven't(didn't have any of)experence this symptom beforeno,not that i can remember,doctori see.was there anything that seems to cause this(have caused these symptoms)well,nothing(no,not)really.except maybe it gets really bad when i go up to london(new york)to see my sisiterlet's take a look(to begin with).i'll listen to your heart and lungs to begin with1-4-5a.what can i do for you todayhow can i help you mr.jonesb.what do you mean by thatcan you describe that in more detailc.what are your symptomscan you describe the changes that have occurredd.did it start suddenlydid your condition change without any warninge.what brings it onwhat do you think causes your condition5PAIN5pain1-5-1headdo you have a splittingheadache/throbbing/band-like/dull/aching/burning/sh arp/stabbing/colicky/migraine/blinding/stress-induced/tension toothdo you have a sharp toothacheis your toothache dull/throbbing/stabbing/pulsating is your tooth sensitive/aching/tenderlower backis the pain in your back slow in onset\long in duration/dull/diffused/aching/steady/constant/severe/ progressing poorly/localised/crushing/deep/mildchestis the pain in your chest burningdo you have a constricting pain in your chest bursting/choking/squeezing/griping/pressing/cruschin g/sticking/jabbing/sharp/knife-like/fleeting/throbbing/dull/severe/stabbing/like a weight on it/like a band across itabdomendo you fell a sharp pain in your abdomendull/aching/gnawing/burning/cramping/colicky/diffus ed/localised/recurrent/constant/flank/intermittent/stab bingdo you get bloateddo you feel bloateddu you have any heartburndo you have any indigestionkidneys and urinary tractdo you have a sharp paindu you have a dull achedu you have severe discomfortburning/stinging/nagging/nigging/splitting/flank/back /abdominal/steady/low gradedo you have slight discomfortextremitiesdo you have a sharp pain in your shoulderdo you have a tingling pain in your handdo you have a shooting pain in your footdull/burning/severe/pulsating/throbbingdo you have weakness in your handsdo you have numbness in your armsdo you have crampdo you have an ache on your hand1-5dialogue a(dialogue b)do you feel any painoh,yes.quite a bitcould you show me where it hurtsright here,doctor,in my chesthere,hm...is it always just in that spotno,sometimes it moves around to herei see.what kind of pain is it.can you descrie the pain well,most of the time it feels like a cramp.but occasionally it is sharp and stabbingdoes it come and go or do you have it all the time well,it worse at times.it seems to come over me in waves.but mostly it's there all the timedoes it start suddenly or build up slowlyit seems to build up graduallywhat do you do when you get the(feel this)pain well,there isn't much i can do.i just have to put up with itand does anything in paticular seem to bring the pain on or make it worsewell,i find going upstairs difficult(it is more intense when climbing stairs).also when i have to cough or take a deepbreath it's terrible like a knife stabbing me1-5-6a.can you show me where it hertsb.could you describe what the pain feels likec.how long have you had this paind.when does it come,when,does it goe.does anything relieve the symptoms or make them worthf.does the pain move to another part of your bodyg.what brings it on6HEADACHE6headache1-6-11do you feel the pain at the top of your head2do you feel any pain in your temples3is the pain around your eyes 4is the pain at the back of your head5do you have any pain in your forehead6does the pain move to your face7do you feel any pain around your ears8does the pain spread to your neck9does the pain seem to be comeing from your neck 10does the pain travel to your shoulders1-6dialogue a(dialogue b)tell me about your headacheit comes and goescan you point out the painful areait seems to be on the right side of my headhow long does the headache last when you get it(it comes)it varies.it can be between half an hour and four or five hourswhen you get a headache,does anything else happen at the same timeyes.often i feel sick(i am often nauseous).sometimes i actually vomit(throw up)does the headache ever upset your eyes,for example, does your vision get blurredit's not blurry.but i get flashing lights that seems to be in the right eyewhat do you do when you get the headachewhll,i'm not ususlly able to carry on with what(i ususlly have to stop wtatever)i am doing,i have to go to a dark room and lie downhave you found any tablets(medication)that seems to have helpedsometimes if i take an aspirin early on,it seems to help.at other times nothing seems to help much does anybody else in your family have this type of a headacheyes,my mother used to suffer from migraines when she was youngercan you describe the(character of he)pain.is it stabbing or more band-like,kind of pressingit throbs.sort of stabbing,i suppose(guess)1-6-6a can you point out the painful areab how long does the headache last when you get itc can you describe the paind when you get the headache,does anything happenat the same timee what do you do when you get the headachef have you found any medican that seems to have helpedg does anybody else in your family have this type of headache7VERTIGOHow would you describe your dizziness?It’s as if I am falling to the left.what does the disease spell constist for you?A kindof imbalance.How long does the episode of dizziness last? Sometimes an hour,sometimes a whole day.In what body position do you feel dizzy?Every time I squat or bend down and try to get up too quickly.Do you ever suffer from dizziness?(get dizzy?) Yes,quite often.When does this happen?When I get up too quickly.Do you feel as if you are falling in a certain direction?No,not really.Does this dizziness feel like spinning or is it just a kind of unsteadiness.It feels more like spinning.How would you describe it?Is it as if the room is going around or do you feel as if it’s you that's going around.It feels as if I am going around.Do you have any other problems such as ringing in the ears.Yes,sometimes.Have you seen a consultant(specialist)about this? Yes,she prescribed some medication for it,but it didn’t help at all.Do you have any associated symptoms like blurred vision.No,but I haven't noticed(not that I have noticed.)8BODY TEMPERATURE AND SWEAT8body temperature and sweat1-8dialogue a(dialogue b)have you got a temperature(had any fever recently) yes,doctor,i have been feeling quite flushed(warm) latelyis your temperature(constantly)high all the time or does it go up and downit ususlly goes up(it is uaually higher)at night.but it is still high even during the daywhat's the highest and the lowest it has been in the past few daysthe highest was104.the lowest was100and where did you take your temperature,under your arm or under your tongue(orally)under my tongue(i measured it orally)do you also have the shivers(chills)yes,sometimesdo(did)your teeth chatter(rattle)or are theshivers(chills)milder than thatoh yes,they chatter(rattle).i've bitten my tongue several times alreadydo(did)you take anything for the feveraspirindoes it helpno not reallyhave you been abroad(traveled)to any tropical or developing countries recentlyyes,i just came back from tailand a few months ago i see.do you perspire more than usualyes,a lot,i am afraidjust when your work hard or also at other times well,i never used to sweat much.but now i seems to break out in a sweat(at the drop of a hat)easily.my clothes often get soaking wetdo you feel shaky or weak at allyes,practically all the time`9NAUSEA AND VOMITINGDo you just feel sick/nauseous/or have a actually vomited?/thrown up/oh,I am vomiting and it seems(I’m throwing up)allthe time.When did it all started?About two months ago.And how often does this happen?About once a day,sometimes more.When are you sick?Is it in morning or after you've eaten.Well,it isn't really regular.But does it get better or worse if you eat something? Worse,I think.When you vomit,do you bring up digested food, undigested food or bile?Oh,it is usually more like bilewhat colour is it?Green,black,yellow or red?It seems to be a sort of yellowish green color.Does it ever have blood in it or look like ground coffee?no,neverDo you belch a lot/burp a lot/or have a bad/a nasty/ taste in your mouth?Well,yes,doctor.I do belch a lot and I seem to suffer from a lot wind just lately./and I have had alot of gas lately/10DYSPN(O)EADyspneaDo you have any difficulty breathing?What’s harder breathing in or breathing out?Are you short of breath when you are resting?Can you lie flat in bed?Is it relieved by sitting up in bed?Do you have to stop frequently when you climb the stairs?Have you ever had any breathing tests?Dialogue aHow long have you had difficutly breathing?Since last week,doctor.Is it very bad?Yes,I feel as if I can’t get enough air.Which is more difficult,breathing in or breathing out?It is harder to breathing in.Are you short of breath when you are resting or only when you doing something?When I am rest,but it is worse when I try to do anything.Can you lie flat in bed?Oh,no.How many pillows do you use?Three.Do you ever wake up night feeling short of breath? Yes,I do.(If frightens me because when i wake up feeling as if i cann't breath.What do you do when this happens?I mean,do you sit or stand up,does some movement help?If I sit up,it helps a little.Let me listen to your chest.I can hear few crackles and it sounds a big wheezy.Dialogue BHow long have you had difficulty breezing?. Scince last week,doctor.Is it very bad?Yes,I feel like I can't get enough air.What’s harder,breath in or breath out?It’s harder to breath in.Are you short of breath,when you are resting,or only when you are doing something physical.A little when I am resting,but it’s worse when I try to do anything physical.Can you lie flat in bed?Oh,no.How many pillows do you use?Three.Do you often wake up night feeling short of breath? Yes,I do.It’s scares me because I wake up feeling as if I can’t breath.What do you do when this happens.I mean,do you sit or stand up?Does some movement help you breathe easier?If I sit up,it helps a little.Listen to your chest...I can hear a few crackles and it sounds a big wheezy.how long have you had difficulty breathing?/how long have you been short of breath?i've had difficulty breathing for about two weeks. when is your breathing most diffcult?i wheeze in the early hours.which is more difficult,breathing in or breathing out? breathing out is harder.are you short of breath when you are resting or only when you are working?i'm short of breath when i'm working.can you lie flat in bed?/can you sleep on your back? yes,i can sleep on my back.can you ever wake up at night because you are shortof breath?/is your sleep disturbed?yes,i eake up several times because i'm short of breath.what do you do then?i usually get up and walk around when it happens11COUGHDialogue ADo you have a cough?I have a cough,but I also seem to wheeze a lot.Is this a recent symptom,or have you had it for some time now?I’ve had it for some time,Doctor.Do you suffer form coughing fits?Yes,a lot.Do you bring up phlegm or is it a dry cough?I bring up quite a bit of phlegm,I am afraid I might have asthma.What is it like?What do you mean?Can you describe the phlegm for me?What color is it? Is it white,yellow,or greenish,and is itfrothy/foamy/or sticky?Yes,it’s yellowish and feels kind of like jelly?Does it have a strange smell or taste?No,I don’t think so.Has there ever been blood in it?Yes,just once I noticed some blood in it.Have you taken any medicine or tablets lately?Yes,I was on something to thin my blood.Dialogue BDo you have a cough?I have a cough,but I also seem to wheeze a lot.Is this a recent symptom or have you had for sometime now?I’ve had it for some time,doctor.Do you cough a lot?Yes a lot.Do you bring up phlegm,or is it a dry cough?I bring up quite a bit of phlegm.I am afraid I might have asthma?What is the phlegm like?What do you mean?Can you describe for me what colour it is,whether it is white,yellow or greenish,and what is it foamy, thick and sticky?Yes it is yellowish and feels kind of like a jelly. Does it have strange smell or taste?No I don’t think so.Has there ever been blood in it?Yes,just once I noticed some blood in it.Have you take any medication lately?Yes I was on some medication to thin my blood.Yes,it smells very bad.It is frothy!I’ve had this cough for3weeks.Yes,I bring up a lot of phlegm.If I sit up or use two pillows I feel better.It’s a barking cough.12HEARTheart symptomsAwhat seems to be the problem at the moment?i seem to be getting very short of breath nowadays, so i thought it best to come in to see you.i also feel a tightness in my chest.how long has this been going on?it seems to have been getting worse over the last few weeks.are you short of breath all the time or is it just when you walk up the stairs?well,it is hard work going up the stairs,the pain feels like a knife.does the pain move to other area as well?yes,it moves to my neck,my left arm,my back andmy should.do you ever feel sick or sweaty when that happens? well,i don't feel sick but i often break out in a sweat. do you ever feel that your heart beats usually fast or slow?yes,sometimes it beats really slowly.then from time to time it skips a beat,then continues to beat very rapidly.can you tap out with a finger what the rhythm feels like to you?..good,have you had any swelling in you ankle?yes,both my feet have been somewhat swollen. does this go down overnight or are they still swellon in the morning?oh,my feet feel much better and they aren't as swollen in the morning.Bcan you tell me,...what are yous complaints?i seem to be getting very short of breath lately,also i feel tightness in my chest,so i thought it would be wise to come in and see you.how long has this been going on?it seem to have been getting worse of last few weeks. are you short of breath all the time or it is just when you exert yourself?well,the pain gets worse when i exert myself,it feels kind of like a knife.does the pain radiate to other areas as well or is the pain localised.no,it moves to my neck,my left arm,my back and my should.do you ever feel sick or sweety when this happens? well,i don't feel sick but i often break out in a sweet. do you ever feel that your heart beats unusually fast or slow?yes,sometimes it beats really slowly,then from time to time it skips a beat,then continues to be very rapidly.can you tap out with a finger what the rhythm feels like to you?..good,have you had any swelling in you ankles?yes,both my feet have been somewhat swollen. does this go down overnight or are they still swollen in the morning?oh,my feet feel much better and they aren't swollen in the morninghave you ever had any heart problems?i've never been diagnosed whit angthing,but i think something can be wrong my heart.what seems to be the problem with your heart?it beats irregually especially when i smoke.what kind of pain do you get during you exercise?i get pressure in my chest sometimes when i have to walk a long distance.do you often get short of breath?absolutely,i am alway short of breath when i go upstair.do you ever feel sweaty when this happens?yes,i break out in a really bad sweat when my chest hurts.where does the pain move?down my left arm.and have you had any swelling in your feet or ankles?yes,my ankles seem to be swollen all the time.do your feet hurt all the time?yes,the pain is fairly constant,but it helps when i put my feet up.13BODY WEIGHT AND DIETWhat’s your appetite like?Are you on a special diet?(Have you ever follow a diet?)(Have you tried to lose weight?)Have you had your cholesterol checked?Is your weight steady?Tell me,what’s your appetite like?/how's your appetiti?Sometimes it’s good,but at other times I don’t feel like eating at all.How do you feel about your eating habits?/describe your eating habits to me?well,I usually eat five or six times a day.Lots of foods and vegetables,but when I am anxious/nervous/I can’t eat at all.Have you lost or put on/gained/any weight recently or does your weight stay at same?I’ve been putting/gaining/on quite a bit/lot/of weight likely.How many pounds have you gain do you think/you've gained?About10pounds or so.Over how long a/what/period of time has this happened?Since about charismas,so in the last6months.Are you trying to do anything to control your weight, for example,are you on a diet?Yes,but it doesn’t seem to work.Are there any foods you dislike or is there anything that you particularly like to eat?I eat lots of pasta dishes,but I can’t have anything with nuts in them because I am allergic to most kinds of nuts.Do your eating habits change for any reason? Yes,I eat quite a bit more when I feel good.I am losing my appetite a bit.Yes,I am getting very thin.I have lost20pounds.I’d say,during the last3months or so.Yes,I can’t stand a sight of meat.14BOWEL MOVEMENTSBowel movements1-14dialogue A-Do you have regular bowel movements?-No,(Yes,but)sometimes I get constipated and sometimes I have diarrhea.-When you say you have diarrhea,do you mean the stool is very loose,or that you have to go to the toilet(bathroom)more frequently?-I have to go four or five times a day.-When you have to go,do you have to go quickly? -Yes,I have real problems holding it.-Could you describe your stool?-The last time it was loose and watery,but very dark. -Do you have any problems flushing it down at all? -No,I haven't noticed anything like that.-Has there been any blood or mucus in the stool?-Yes,I have noticed some blood,but no mucus.-Is it mixed in with the stool or is it just there on the paper when you wipe yourself?-It seems to be mixed in with the stool,Doctor.-I see.and when you are constipated,do you take laxative,or do you give yourself(use)anenema?-If I can't go for three days,only the laxative helps. -Do you feel bloated when you are constipated?-Yes,occasionally.But the laxative helps with that too.Do you have any problems with excessive wind or belching(gas or burping)?No,not particularly.1-14-5AIs it actually painful to have a bowel movement?= Does it hurt when you open your bowels?BHave you ever tried taking any laxatives that you can get at a chemist's?=Do you take anything for your bowels?CDoes your stomach ever feel distended?=Do you ever feel bloated when you are constipated?DDo you have wind moving aroud in your bowels?= Do you feel gassy?EDo you pass wind?=Do you break wind?FDo you have a tendency towards flatulence?=Do you ever suffer from excessive wind?15BLOODbloodDialogue A:A:So you say that you are having problems with bleeding or bruising?B:Yes I am.A:Can you tell me what you mean by that?Do you bleed or bruise easily?B:B:Yes,everytime I scrape myself or bump into something I get bruised.A:Have you always had this problem or is it recent development?B:I noticed the problem started about the time I started shaving.A:Do your gums bleed when you brush your teeth? B:Yes,quite a bit.A:Do you have any trouble stopping the bleeding? B:Oh,yes,even from the most minor cutsA:How long dose it take to stop the bleeding?B:At least10or15minsA:Are there any other members of your family with bleeding tendencies?B:No,no that I know of.A:Have you ever needed the blood transfusion,or have you given blood recently?B:I don't like needles,so I don't give blood.But I needed a transfusion after a car accident a few years ago when I was15.A:Do you remember how many units of blood you received?B:No,I don't remember sorry.A:Do you know what your blood type is?B:I think it's AB negative but I am not sure. Dialogue BA:So you say that you are having problems with bleeding or bruising?B:Yes I am.A:Can you tell me what you mean by that?Do you bleed or bruise easily?B:Yes,everytime I scrap myself for bumping to sth I get bruised.A:Have you always had this problem or is it just recent development?B:I noticed that the problem started about the time I started shaving.A:Do your gums bleed when you brush your teeth? B:Yes,quite a lot.A:Do you have any trouble stopping the bleeding? B:Oh,yes,even from the most minor cutsA:How long dose it take to stop the bleeding?B:At least10or15minutesA:Are there any other members of your family with bleeding tendencies?B:No,not that I know of.A:Have you ever needed the blood transfusion or have you given blood recently?B:I don't like needles so I don't give blood.But I needed a transfusion after a car accident a few years ago when I was15.A:Do you remember how many units of blood you received?B:No,I don't remember sorry.A:Do you know what your blood type is?B:I think it's AB negative but I am not sure.16MEDICAL EXAMINATION16、medical examination1Now Mr Jacob,I'd like to examine you.I just want to check one or two things,your heart and your lungs and abdomen.Would you just take off yourclothes/just/down to your underwear and put on this gown with the opening at the back.2Hop on/please get on/the table for me,can you manage or shall I give you a hand?/can you do it yourself or would you like me to help?3Right,give me your wrist,will you.I am going to take your pulse.That is fine.4Now let's take your blood pressure.Will you straighten your arm for me,please.5Now let's have a look at your eyes.Look up for me. please.6Let me check the reflexes in your arms and legs. Relax.7Turn your head to the right to look at the wall.I want to check the pulse in your neck.8Let me feel your windpipe…Let me just feel your glands.That’s fine.9Stick your tongue out for me,please.Open your mouth and say“ahh“.10Right,now I want to listen to your heart.Just breathe out quietly11Now sit forward when I listen at the back,hold your breath....Good.Now let's listen to your lungs. Take deep breaths through your mouth--in....out... keep going.12I’d like to feel your abdomen.Put your arms down by your side and let your tummy/stomach/relax…that’s it.Are there any places that are tender or painful?Now I want to check your liver and spleen so take deep breath in,hold it...fine.13I'd just like to examine your prostate and rectum. Now this will be slightly uncomfortable,but it shouldn't hurt.Lie down on your left side and bend your knees right up to your chest…fine.I am going to insert a finger into your rectum.Don’t worry,you won't lose any control.17ISOTOPE SCANNING1,you will receive an intravenous injection,make a tight fist,now open it,this injection contains the medicine which can be seen by the machine so that it is possible for us to scan your organ.you have to wait so the medicine can reach the organ.you must not move during the scan.we will sent the results to your doctor.2,have you drunk anything today?you must drink four glasses before the scan.we will give you a water tablet during the scan,after which you will have to urinate more often then usual.do you take anything to keep your blood presure down?3,a,before you get the injection you need lie on your back for ten minutes.b,now you have to inhale a vapour for the test.this has no taste or smell.you'll need to sit in front of an inhaler,you'll get a clip for your nose so that you breath through your mouth.4,before the examination you need drink a litre of the fluid over the period of twe hours.before we call you you should go to the toilet to empty your bladder.otherwise we cann't scan your hip correctly. 5,you'll have to drink a sweetened solution which will contract your gallbladder,this tastes very sweet and in some people causes diarrhea6,my colleage the cardiologist will explain the procedure,after you are given the isotope injection you have to consume fatty food or drink,such as milk,cheese or sandwish.this is so that the medicine passes through your liver quickly for us to get correct picture of how the heart muscle are supplied with blood.7,you'll get four small injection where you have changes on your skin.we'll take three pitures.the last will be taken in24hours'time.we will mark the location of the lymph nodes.so please don't wash the marks off.before the injection,you will need to a lie in a dark place for forty-five minutes with your eyes closed, only after the injection can you open your eyes.B1.you will be given an intravenous injection,make a fist,then let it go.this injection contains a substance to make necessary organs visible on the machine.there'll be some waiting time before the actual examination.This is necessary so that the test substance can reach the appropriate organ..you must remain completely still during the examination.the results will be given to your regular physician.2.have you drunk any liquids today?you'll have to drink about4glasses of fluids before the examination,you‘ll also be given the substance which will make you have to go to the bathroom frequently.What blood pressure medication are you taking?3.A)before receiving the rejection,you should lie on your back for10minutes,Now you must inhale the spray.it resembles water vapour and has no taste or smell,in these cases you'll have to sit in front of inhaler.we’ll clip your nose shut and you will have to breathe through your mouth,4.the waiting time is about2hours,during which you should drink approximately a liter of fluid,please go to the bathroom before you are called,so that your bladder will be empty,otherwise we will not be able to make a precise examination of the pelvic bones.5.you will have to drink a sucrose solutions to constrict your gallbladder,it is very sweet.for many people it may cause diarrhea.6.the cardiologist will inform you about the procedure.after you have received the isotope injection.you should eat or drink something containing fat,such as cheese,milk or sandwich,this is necessary in order to stimulate the substance being。