医学英语-慢性阻塞性肺疾病.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,1,Bedside teaching,Bedside teaching is seen as one of the most important modalities in teaching a variety of skills for the medical profession,which greatly improves certain clinical diagnostic skills in medical students and residents.,2,Ward round,早交班,morning meeting,：,住院总医师；,外称,Senior Residents Morning Report,引言,introduction,：,主治医师；提出重点查房病例，简述棘手问题,病史报告,case presentation,：,实习医生，可有无诊断，诊治计划须系统,教学查房对话,teaching dialogue,：,在上下级医生之间进行；着重纠错,小结,summary,：,主治医师对主任查房作应答，提出整改措施,3,Chief physician,主任医师,Attending,physician,主治医师,Chief resident,住院总医师,Resident,住院医师,Intern,实习医师,Patient,病人,4,Chronic Obstructive Pulmonary Disease,COPD,or chronic obstructive pulmonary disease,is a progressive disease that makes it hard to breathe.Progressive means the disease gets worse over time.,5,In the office,Chief Resident:,Your attention,please.The teaching ward round by Chief physician Professor Clark now begins.Firstly,lets have the case presented by Dr.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。,6,Intern(Dr.Grey):,This 70-year-old man was admitted because of a one-week history of breathlessness and cough with purulent sputum.,实习医师：病人，男性，,70,岁，因气急、咳嗽、咳痰,1,周入院。,7,He had always been coughing with sputum during the past thirty years and tended to getting worse over recent five years,with breathlessness developing.,病人近,30,年来一直有咳嗽、咳痰，近,5,年来有所加重，伴气急。,8,大家学习辛苦了，还是要坚持,继续保持安静,9,The symptoms were usually aggravated by cold weather or alternations of seasons,while tended to ease when the weather was getting warm.,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。,10,Almost every year he had to suffer for one to three months.He was continuously using salbutamol inhalation which did relieve the symptoms most of the time.,几乎每年都有发作，持续,1,3,个月。病人一直使用沙丁胺醇吸入治疗，症状多能缓解。,11,One week before admission,he caught a cold and suffered a relapse thereafter.Meanwhile,he had large volumes of purulent sputum and wheezed after moderate movement.He inhaled salbutamol as usual,but it didnt work this time.So he came.,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。,12,The patient has a smoking history of 100 pack years.And his family history was unremarkable.Mainly thats all.,病人有吸烟史，,100,包每年，家族史无特殊。汇报完毕。,13,Chief physician:,Your presentation is quite clear.Were there any significant physical findings,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,?,14,Intern(Dr.Grey):,Yes.We examined the patient carefully and found signs of lung disease,including bucket-like-chest and bronchi.But there was no cyanosis in the lips and no edema of the legs.,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。,15,The laboratory tests reported that PaO was 10 kPa and PaCO was 5 kPa.However,WBC count was 9.9 X 10/L,and the neutrophils were 90%.,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%,。,16,A previous pulmonary function examination showed that the forced expiratory volume in 1 second(FEV1)was 1.5 liters and FEV1/forced vital capacity(FVC)was 50%.,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%.,17,Chief Physician:,When was the pulmonary function done?,主任医师：肺功能是什么时候做的,?,Intern(Dr.Grey):,(Looking through the chart),Er.6 months ago.,实习医师：,（翻看病历）,嗯，,6,个月前。,18,Chief Physician:,Well,since we have learned about the history,its the very time to visit the patient.,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。,Chief Resident:,OK.Lets go to the ward.,住院总医师：好，那就去病房吧。,19,20,In the ward,Chief Resident:,Hello,Mr.Black.Our Chief Physician and the Attending Physician are coming to see you.,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:,Good morning,doctors.,病人：早上好，医生们。,21,Chief Physician:,Good morning,Mr.Black.lm Dr.Clark.I suppose you were all well until this outbreak,werent you?,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？,22,Patient:,Not at all.In fact,Im always coughing and wheezing in the past decades.But its the first time I had to stay in hospital.You know,at the beginning,I was merely coughing,but it developed so fast that I couldnt stand it any more.(,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,）,23,24,Chief Physician:,Dont worry,Mr.Black.What medication did you take before admission?,主任医师：别担心，,Black,先生。你这次住院前有用什么药吗,?,Patient:,(,Taking out the bottle of salbutamol,)Here it is,but it did work anyway,except this time.,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。,25,Chief Physician:,Anything else other than it?,主任医师：除了这个还有其他的吗,?,Patient:,Mainly this,and sometimes the doctor gave me a few drugs or intravenous injections when I was badly coughing or wheezing.,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。,26,Chief Physician:,Have you felt better since admission?,主任医师：住院以后好点了没有,?,Patient:,Yes.I feel much better this morning.,病人：是的。今天早上我觉得好多了。,27,Chief Physician:,Mr,Black,you arc smoking,arent you?,主任医师：,Black,先生，你抽烟是吧,?,Patient:,Yes,l have been smoking for 50 years.,病人：是的，我都抽了,50,年了。,28,Chief Physician:,Mr.Black,could we give you an examination?,主任医师：,Black,先生，可以给你做个体检吗,?,Patient:,Sure.,病人：当然可以。,Chief Physician:,Now Dr.Grey,could you do the examination?,主任医师：,Grey,医生，你来做一下体检吧。,Intern:,Certainly.,实习医生：好的。,29,视触叩听,percussion,pkn,叩诊,n.,auscultation,sk()lte()n,听诊,n.,inspection,nspekn,视诊,n.,Palpation,plpen,触诊,n.,30,Intern:,The patient is a medium-sized male.Hes in consciousness and breathes at a regular rate of 22 per minute.The oral temperature is 36.7 and the pulse rate is 90 beats per minute(bpm).The blood pressure is 155/95 mmHg.,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,155/95 mmHg,。,31,No edema in the face and eyelids.Cyanosis can be seen in the finger tips.And he has clubbed fingers.Theres no jugular varicosity or enlargement of superficial lymph nodes.The neck feels soft and the trachea is in the center.,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。,32,Theres no three depressions sign or thyroid enlargement.He has bucket-like-chest and pervasive rhonchi can be heard in bilateral lungs with a little wheezing rales.The vocal fremitus symmetrically decreases in bilateral lungs.,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。,33,The heart rate is 94 beats per minute with no arrhythmia or murmurs.The abdomen feels soft with no tenderness or rebound tenderness.Murphys sign is negative and nothing special in neurological examination.,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。,34,Chief Physician:,All right.Done.Thank you for your cooperation,Mr.Black.Have a nice day.,主任医师：好了，谢谢你的配合，,Black,先生。再见。,Patient:,Thank you,doctor.,病人：谢谢你，医生。,35,36,37,38,39,Chief Physician:,Now,let,s talk about the treatment of COPD,would you please tell me your plan?,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？,40,41,42,43,Chief Physician:,You all have done a good job.And I suggest the pulmonary function reexamined later.Well,this is all for this case today.See you next week.,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。,44,45,