医学英语-慢性阻塞性肺疾病.pptx

医学英语医学英语BozhouPeoplesHospitalRheumtologyandimmunologydepartment张玉慧张玉慧BedsideteachingBedsideteachingisseenasoneofthemostimportantmodalitiesinteachingavarietyofskillsforthemedicalprofession,whichgreatlyimprovescertainclinicaldiagnosticskillsinmedicalstudentsandresidents.WardroundA.A.A.A.早交班早交班早交班早交班 morning meetingmorning meeting：住院总医师；住院总医师；住院总医师；住院总医师；外称外称外称外称 Senior Residents Morning ReportSenior Residents Morning ReportB.B.B.B.引言引言引言引言 introductionintroduction：主治医师；提出重点查房病例，主治医师；提出重点查房病例，主治医师；提出重点查房病例，主治医师；提出重点查房病例，简述棘手问题简述棘手问题简述棘手问题简述棘手问题C.C.C.C.病史报告病史报告病史报告病史报告 case presentationcase presentation：实习医生，可有无诊实习医生，可有无诊实习医生，可有无诊实习医生，可有无诊断，诊治计划须系统断，诊治计划须系统断，诊治计划须系统断，诊治计划须系统D.D.D.D.教学查房对话教学查房对话教学查房对话教学查房对话 teaching dialogueteaching dialogue：在上下级医生之在上下级医生之在上下级医生之在上下级医生之间进行；着重纠错间进行；着重纠错间进行；着重纠错间进行；着重纠错E.E.E.E.小结小结小结小结 summarysummary：主治医师对主任查房作应答，提出主治医师对主任查房作应答，提出主治医师对主任查房作应答，提出主治医师对主任查房作应答，提出整改措施整改措施整改措施整改措施Chief physician 主任医师主任医师 Attending physician 主治医师主治医师Chief resident 住院总医师住院总医师 lResident 住院医师lIntern 实习医师 lPatient 病人 ChronicObstructivePulmonaryDiseaseCOPD,orchronicobstructivepulmonarydisease,isaprogressivediseasethatmakesithardtobreathe.Progressivemeansthediseasegetsworseovertime.IntheofficeChiefResident:Yourattention,please.TheteachingwardroundbyChiefphysicianProfessorClarknowbegins.Firstly,letshavethecasepresentedbyDr.Grey.住院总医师：请各位注意了，主任医师Clark教授的教学查房现在开始，首先由实习医师Grey医生汇报病史。Intern(Dr.Grey):This70-year-oldmanwasadmittedbecauseofaone-weekhistoryofbreathlessnessandcoughwithpurulentsputum.实习医师：病人，男性，70岁，因气急、咳嗽、咳痰1周入院。Hehadalwaysbeencoughingwithsputumduringthepastthirtyyearsandtendedtogettingworseoverrecentfiveyears,withbreathlessnessdeveloping.病人近30年来一直有咳嗽、咳痰，近5年来有所加重，伴气急。Thesymptomswereusuallyaggravatedbycoldweatheroralternationsofseasons,whiletendedtoeasewhentheweatherwasgettingwarm.症状通常于天气寒冷时或季节更替时发作，天气回暖后好转。Almosteveryyearhehadtosufferforonetothreemonths.Hewascontinuouslyusingsalbutamolinhalationwhichdidrelievethesymptomsmostofthetime.几乎每年都有发作，持续13个月。病人一直使用沙丁胺醇吸入治疗，症状多能缓解。Oneweekbeforeadmission,hecaughtacoldandsufferedarelapsethereafter.Meanwhile,hehadlargevolumesofpurulentsputumandwheezedaftermoderatemovement.Heinhaledsalbutamolasusual,butitdidntworkthistime.Sohecame.入院前 1 周，病人感冒后症状又有发作，伴咯大量脓痰，动则气急。吸入沙丁胺醇后症状无缓解。为求进一步诊治，入我院。Thepatienthasasmokinghistoryof100packyears.Andhisfamilyhistorywasunremarkable.Mainlythatsall.病人有吸烟史，100 包每年，家族史无特殊。汇报完毕。Chiefphysician:Yourpresentationisquiteclear.Werethereanysignificantphysicalfindings,Dr.Grey?主任医师：你的汇报很清楚。查体有什么有意义的发现吗?Intern(Dr.Grey):Yes.Weexaminedthepatientcarefullyandfoundsignsoflungdisease,includingbucket-like-chestandbronchi.Buttherewasnocyanosisinthelipsandnoedemaofthelegs.实习医师：我们仔细检查了病人，发现一些肺部体征，包括桶状胸和肺部干啰音。无口唇发绀和双下肢水肿。ThelaboratorytestsreportedthatPaOwas10kPaandPaCOwas5kPa.However,WBCcountwas9.9X10/L,andtheneutrophilswere90%.实验室检查报告：PaO 10 kPa，PaCO 5kPa；白细胞计数 9.910/L，中性粒细胞 90%。Apreviouspulmonaryfunctionexaminationshowedthattheforcedexpiratoryvolumein1second(FEV1)was1.5litersandFEV1/forcedvitalcapacity(FVC)was50%.病人过去的肺功能检查示第1秒用力呼气量（FEV1）是 1.5 L，第 1 秒用力呼气量/用力肺活量（FEV1/FVC）是 50%.ChiefPhysician:Whenwasthepulmonaryfunctiondone?主任医师：肺功能是什么时候做的?Intern(Dr.Grey):(Lookingthroughthechart)Er.6monthsago.实习医师：（翻看病历）嗯，6个月前。ChiefPhysician:Well,sincewehavelearnedaboutthehistory,itstheverytimetovisitthepatient.主任医师：好，既然我们已经了解了病史，现在该去看看病人了。ChiefResident:OK.Letsgototheward.住院总医师：好，那就去病房吧。InthewardChiefResident:Hello,Mr.Black.OurChiefPhysicianandtheAttendingPhysicianarecomingtoseeyou.住院总医师：你好，Black先生，我们主任医师和主治医师都来看你了。Patient:Goodmorning,doctors.病人：早上好，医生们。ChiefPhysician:Goodmorning,Mr.Black.lmDr.Clark.Isupposeyouwereallwelluntilthisoutbreak,werentyou?主任医师：早上好，Black先生，我是Clark医生，我想你平时身体还不错吧？Patient:Notatall.Infact,Imalwayscoughingandwheezinginthepastdecades.ButitsthefirsttimeIhadtostayinhospital.Youknow,atthebeginning,Iwasmerelycoughing,butitdevelopedsofastthatIcouldntstanditanymore.(Coughing)病人：才不是呢！其实，我都喘了几十年了。不过住院倒是头一回。要知道，一开始我也就是咳嗽，但是后来发展得太严重了，我实在受不了了！（咳嗽）ChiefPhysician:Dontworry,Mr.Black.Whatmedicationdidyoutakebeforeadmission?主任医师：别担心，Black先生。你这次住院前有用什么药吗?Patient:(Takingoutthebottleofsalbutamol)Hereitis,butitdidworkanyway,exceptthistime.病人：（拿出沙丁胺醇的瓶子）就是这个，挺管用的，不过这次没用。ChiefPhysician:Anythingelseotherthanit?主任医师：除了这个还有其他的吗?Patient:Mainlythis,andsometimesthedoctorgavemeafewdrugsorintravenousinjectionswhenIwasbadlycoughingorwheezing.病人：就是这个，有时候咳、喘得严重时，医生会给我一些药或者静脉注射。ChiefPhysician:Haveyoufeltbettersinceadmission?主任医师：住院以后好点了没有?Patient:Yes.Ifeelmuchbetterthismorning.病人：是的。今天早上我觉得好多了。ChiefPhysician:Mr,Black,youarcsmoking,arentyou?主任医师：Black先生，你抽烟是吧?Patient:Yes,lhavebeensmokingfor50years.病人：是的，我都抽了50年了。ChiefPhysician:Mr.Black,couldwegiveyouanexamination?主任医师：Black先生，可以给你做个体检吗?Patient:Sure.病人：当然可以。ChiefPhysician:NowDr.Grey,couldyoudotheexamination?主任医师：Grey医生，你来做一下体检吧。Intern:Certainly.实习医生：好的。视触叩听视触叩听percussionpkn叩诊叩诊 n.auscultation,sk()lte()n听诊听诊 n.inspectionnspekn视诊视诊 n.Palpationplpen触诊触诊 n.Intern:Thepatientisamedium-sizedmale.Hesinconsciousnessandbreathesataregularrateof22perminute.Theoraltemperatureis36.7andthepulserateis90beatsperminute(bpm).Thebloodpressureis155/95mmHg.实习医生：病人体格中等。神清，呼吸频率为22次/分，节律规则。口温36.7，脉搏90次/分。血压155/95mmHg。Noedemainthefaceandeyelids.Cyanosiscanbeseeninthefingertips.Andhehasclubbedfingers.Theresnojugularvaricosityorenlargementofsuperficiallymphnodes.Theneckfeelssoftandthetracheaisinthecenter.面部及眼睑无水肿。指端有发绀，可见杵状指。颈静脉无怒张，浅表淋巴结无肿大。颈软，气管居中。Theresnothreedepressionssignorthyroidenlargement.Hehasbucket-like-chestandpervasiverhonchicanbeheardinbilaterallungswithalittlewheezingrales.Thevocalfremitussymmetricallydecreasesinbilaterallungs.无三凹征。甲状腺无肿大。可见桶装胸，两肺可闻及广泛干啰音及少量哮鸣音。双侧触觉语颤减弱、对称。Theheartrateis94beatsperminutewithnoarrhythmiaormurmurs.Theabdomenfeelssoftwithnotendernessorreboundtenderness.Murphyssignisnegativeandnothingspecialinneurologicalexamination.心率94次/分，律齐，未闻及杂音。腹软，无压痛、反跳痛，Murphy征阴性。神经系统检查无异常。ChiefPhysician:Allright.Done.Thankyouforyourcooperation,Mr.Black.Haveaniceday.主任医师：好了，谢谢你的配合，Black先生。再见。Patient:Thankyou,doctor.病人：谢谢你，医生。ChiefPhysician:Now,letstalkaboutthetreatmentofCOPD,wouldyoupleasetellmeyourplan?主任医师：现在让我们来讨论慢阻肺的治疗，谁来说一下你们的治疗方案？ChiefPhysician:Youallhavedoneagoodjob.AndIsuggestthepulmonaryfunctionreexaminedlater.Well,thisisallforthiscasetoday.Seeyounextweek.主任医师：你们都回答得很好。我建议再复查一下肺功能。今天的讨论今天结束了，下周再见。