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1、Clinical dialogue fiveXiao Xiong LiDepartment of neurological SurgeryRen Ji Hospital1Part oneD: I see from your notes you were in hospital 10 years ago with thyroid trouble.P: Yes, thats right.D: What has actually been happening since that?P: All sorts of things. Ive been feeling very depressed for
2、a year.D: Did you go to your doctor?P: Yes, he gave me some Valium tablets to slow me down but they slowed me to a halt. I did nothing but sleep. 2D: Did they affect you in any other way?P: Yes, I got stomach trouble, maybe indigestion, I think.D: What symptoms?P: All the food stays up here. (indica
3、ting chest)D: When do you get it?P: Two to three hours after food.3D: Burning or stabbing pain?P: It feels like some wind there and I want to get rid of it.D: Do you belch?P: Not much.D: Does it bother you at night?P: No, it comes on when I was hungry and I feel Ill collapse if I dont eat straight a
4、way 4D: How about your appetite?P: Very poor, it started to deteriorate 10 years ago.D: What about your weight?P: Im loosing weight.D: What about your bowels?P: Im constipated. 5D: How often do you have them opened?P: Only when I take medicine.D: Every day?P: No, every other day.D: Do you always swe
5、at?P: Yes, but more recently.D: All over you body?P: Yes, all over. 6D: Any depressed , nervous, edgy, irritable?P: Yes, it started one month ago before I got my job.D: Periods regular?P: Every month since I had my baby five years ago. 7D: Is there anything else youve noticed ?P: No.D: Has anyone in
6、 your family had thyroid trouble?P: No, I have one sister and two brothers, they are well.8Part twoD: I see youve been anaemic and you had a blood test last May. Has anything else trouble you?P: Ive kept getting a roaring in my ears and giddiness.D: All the time?P: Most of the time.D: How long has a
7、ll this gone on?P: Say, about six months. 9D: Since your treatment with iron?P: Yes, I keep getting dizzy spells.D: Does anything bring them on?P: Rushing about. Sometimes I know Im falling but I cant stop myself.D: Do your legs give way?P: Yes.D: If you stand still, do you hold on?P: Yes.10D: Are y
8、ou all right between spasms?P: Yes.D: Does it affect your ears?P: I get roaring in my ears.D: How long?P: Minutes.D: Do you feel sick?P: Yes, first thing in the morning. Terribly. 11D: Do you suffer from headaches?P: My periods are only half a day and I get terribly headaches.D: How often do you hav
9、e your periods?P: It varies, every two or three weeks.D: Is it always like that?P: Yes.D: You say you are breathless?P: Yes, I get puffed if I go upstairs. 12D: Do you have any bowel trouble?P: No.D: Water?P: No.D: Do you get up at night?P: No. 13Part threeD: I see from your notes you came to us a y
10、ear ago with an overactive thyroid gland.P: Yes, and I had a miscarriage in May and Im now pregnant again.D: When is your baby due?P: Roughly 10th July.D: Have you been taking pills for your gland?P: I stopped about six months ago.14D: How are you at the moment?P: I keep feeling queer and my doctor
11、suggested I had a check-up.D: Do you ever faint?P: No, but I feel faint. D: Do you actually flush or sweat?P: No, not as before.15D: Have you been gaining weight?P: Yes, I didnt realise I was pregnant.D: Are your bowels regular?P: Yes.D: Do you go more than once a day?P: No.D: They are quite well-formed, are they?P: Yes. 16D: How are your nerves? Are you jittery, fidgety?P: No.D: Do the family get on your nerves?P: Not now.D: Were your eyes always prominent?P: Yes. 17D: Are you pa
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