常用英语问诊.doc

69English for doctors：Authentic consultingroom activities for doctors, dentists, students and nursesFrom DXY.CN1 PAST 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 rubellawhen i was small ,i had measles,chickenpox and whooping cough .but i dont think i ever had rubellahave you ever been in hospitalized for anything?or have you ever had an operationwell,i had my tonsils taken out when i was a childhave you had any major health problems since thenyes,i have diabeteswhen were you first diagnosed with diabetes?what were your simptomsi was diagnosed when i turned 14.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 meyes ,here it is2 FAMILY HISTORY as 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 isnthow old was your father when he diedhe was 68what did he die offhe had a heart attackdid he suffer for a long time with this heard cindition before he diedoh 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 are3 SOCIAL HISTORY are 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 panyi 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 responsibilityyes ,i was in charge of a large departmenti see,quite stressful.now,tell me ,do you smokeyes,i do. unfortunately, quite a lotoh ,really? how muchall about 2 packs a dayhow long have you been smokingsince i was about fourteenhave you ever try to quit smokingyes , i have tried several times .but without successwhat 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 dinnerthats quite a bit.how old were you when you start drinkingoh,about 17 ir 18, i supposewhat about your living conditions? where do you livewe living in a small apartment.we own it .but of course we are still paying the morgage on it 4 PRESENT PLAINTS 4 present plaints1-4-1whats the problem todaycan you tell me what your symptoms arehave hou ever had these plains beforewhats 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 about 18 months ,i thinkand were there any other symptoms before then or did it(this condition) start quite suddenlyi hadnt notice anything before thenso you havent (didnt 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 sisiterlets take a look(to begin with).ill 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 condition 5 PAIN 5 pain1-5-1headdo you have a splitting headache/throbbing/band-like/dull/aching/burning/sharp/stabbing/colicky/migraine/blinding/stress- induced/tensiontoothdo you have a sharp toothacheis your toothache dull/throbbing/stabbing/pulsatingis your tooth sensitive/aching/tenderlower backis the pain in your back slow in onsetlong 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 chestbursting/choking/squeezing/griping/pressing/crusching/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/diffused/localised/recurrent/constant/flank/intermittent/stabbingdo 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 disfortburning/stinging/nagging/nigging/splitting/flank/back/abdominal/steady/low gradedo you have slight disfortextremitiesdo 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 painwell,most of the time it feels like a cramp.but occasionally it is sharp and stabbingdoes it e and go or do you have it all the timewell,it worse at times.it seems to e over me in waves.but mostly its 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) painwell,there isnt 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 its 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 e,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 on6 HEADACHE6 headache1-6-11 do you feel the pain at the top of your head2 do you feel any pain in your temples3 is the pain around your eyes4 is the pain at the back of your head5 do you have any pain in your forehead6 does the pain move to your face7 do you feel any pain around your ears8 does the pain spread to your neck9 does the pain seem to be eing from your neck10 does the pain travel to your shoulders1-6 dialogue a (dialogue b)tell me about your headacheit es 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 es)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 blurredits not blurry.but i get flashing lights that seems to be in the right eyewhat do you do when you get the headachewhll, im 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 muchdoes 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 happen at 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 headache7 VERTIGOHow would you describe your dizziness?Its as if I am falling to the left.what does the disease spell constist for you?A kind of 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 its you thats 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 didnt help at all.Do you have any associated symptoms like blurred vision.No, but I havent noticed(not that I have noticed. )8 BODY TEMPERATURE AND SWEAT8 body temperature and sweat1-8 dialogue 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 daywhats the highest and the lowest it has been in the past few daysthe highest was 104.the lowest was 100and 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 the shivers(chills)milder than thatoh yes, they chatter(rattle).ive 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 agoi see.do you perspire more than usualyes, a lot, i am afraidjust when your work hard or also at other timeswell,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 9 NAUSEA AND VOMITINGDo you just feel sick /nauseous/ or have a actually vomited?/thrown up/oh, I am vomiting and it seems (Im throwing up) all the 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 youve eaten.Well, it isnt 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 a lot of gas lately/ 10 DYSPN(O)EADyspneaDo you have any difficulty breathing?Whats 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 cant 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 cannt 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 cant get enough air.Whats harder, breath in or breath out?Its 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 its 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. Its scares me because I wake up feeling as if I cant 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?ive 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?im short of breath when im 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 short of breath? /is your sleep disturbed?yes,i eake up seve