五年制專業(yè)外語課putting examination together

Chapter22

PuttingtheExaminationTogetherLiuboDept.ofRheumatologyandImmunologyCJUHAphysicianisnotonlyascientistoragoodtechnician.Physician,doctorTechnician,mechanicdoctor,physicianDoctor比physician更通用，主要是指博士學(xué)位，哲學(xué)博士、經(jīng)濟管理學(xué)博士等。如果特別強調(diào)醫(yī)學(xué)博士，應(yīng)該用physician。內(nèi)科醫(yī)生外科醫(yī)師physician；internist

surgeonDoctor主要是指擁有博士學(xué)位，哲學(xué)博士、驗光博士、骨科博士、牙科博士、教育學(xué)博士、神學(xué)博士、藥學(xué)博士、工商管理學(xué)博士等。Ph.D.DoctorofPhilosophy哲學(xué)博士，DOdoctorofoptometry驗光博士,doctorofosteopathy骨療法博士,骨科博士，DDSdoctorofdentalscience牙科學(xué)博士，doctor,physicianDoctor主要是指擁有博士學(xué)位，哲學(xué)博士、驗光博士、骨科博士、牙科博士、教育學(xué)博士、神學(xué)博士、藥學(xué)博士、工商管理學(xué)博士等。EdDdoctorofeducation教育學(xué)博士，DDdoctorofdivinity神學(xué)博士,DPHDoctorofPharmacy藥學(xué)博士doctorofpublichealth公共衛(wèi)生學(xué)博士，DBADoctorofBusinessAdministration工商管理學(xué)博士。doctor,physiciantechnician,mechanictechnician技師，技術(shù)員；技巧純熟的人

mechanic技工，機修工

mechanic的職位低，機械工,修理工，勞力勞動者，而technician所掌握的技術(shù)層面高。

Hemustbemorethanthat—hemusthavegoodhumanqualities.Hehastohaveapersonalunderstandingandsympathyforthesufferingofhumanbeings.AlbertEinstein(1879–1955)humanqualities人文素質(zhì)sympathyhavesympathyforexpresssympathyforinsympathywithoutofsympathywithwinsympathyof同情**人對**表示同情（慰問）同情、贊成不贊成博得**的同情TheTechniquesThepreviouschaptersdealtwiththeindividualorgansystemsandthehistoryandphysicalexaminationsrelatedtoeachofthem.Dealwithdealwith主要有以下用法：

1)totreat；totakeactionabout2)todobusinesswith...3)tobeabout1.Childrenarehardtodealwith．2.I’vedealtwiththisstorefor20years．3.ThisnewbookdealswiththeWarinIraq．Individual,personalindividualadj.個人的;

獨特的;

個別的;

n.個人;

個體;

Personaladj.個人的，私人的personal個人的,一般形容和人有關(guān)的individual可用在人也可用在事務(wù)上Thepurposeofthischapteristohelpthestudentassimilateeachoftheindividualexaminationsintoonecompleteandsmoothlyperformedexamination.assimilatevi.吸收，消化；同化；vt.透徹理解；

使吸收Ideally,acompleteexaminationisperformedinanorderly,thoroughmannerwithasfewmovementsaspossiblerequiredofthepatient.Perform,operationperformanoperation動手術(shù)

performanoperationonsb.foradisease給某人實施某個疾病的手術(shù)performingthephysicalexaminationexaminationisperformedPerform,operationputintooperationbringintooperationoperateonsb.

operateuponsb.undergoanoperation實施,施行實施,施行給某人動手術(shù)給某人動手術(shù)接受手術(shù)Patient,Case,SubjectApatientreferstoaparticularpersonundermedicalcare,whoisadmittedfortreatment,examined,givenmedicationanddischarged.Acasemeansaparticularinstanceofadisease,whichisevaluated,documentedorreported.Aresearchsubjectisonewithaparticularcharacteristicorbehaviorexaminedinascientificinvestigation,whichisrecruited,selected,sometimessubjectedtoexperimentalconditions,observed,andthanked.

Mosterrorsinperformingaphysicalexaminationresultfromalackoforganizationandthoroughness,notfromalackofknowledge.Evaluateeachpartoftheexaminationcarefullybeforemovingontothenextpart.Themostcommonerrorsinperformingthephysicalexaminationarerelatedtothefollowing:TechniqueOmissionDetectionInterpretationRecordingBedueto,Resultfrom,ResultinBedueto由于，起因Resultfrom,betheconsequenceof由……造成

Hisfailureintheexamresultedfromhislaziness.考試失敗是由懶惰造成的。Resultin,導(dǎo)致

in介詞,因此后面跟名詞或動名詞,即:resultinsth./doingsth.

Failurewillresultinfrustration.

失敗會導(dǎo)致挫敗心理

Hislazinessresultedinfailingintheexam.

他的懶惰導(dǎo)致考試失敗

dueto,becauseof,owingto三者均可表示“由于”、“因為”，按照傳統(tǒng)語法：dueto

主要引導(dǎo)表語，而becauseof,owingto

兩者都主要引導(dǎo)狀語。如：Hisillnessisduetobadfood.他生病是由于吃了不好的食物。Theaccidentwasduetocarelessdriving.這次車禍起因于駕駛疏忽。Hecan’tcomebecauseofthebadweather.他不能來是因為天氣不好。Owingtotherain,thematchwascancelled.比賽因雨被取消了。但是在現(xiàn)代英語中，dueto

也可用來引導(dǎo)狀語，而owingto

也可以用來引導(dǎo)表語。如：由于交通擁擠他遲到了。正：Hewaslatedueto[owingto,becauseof]theveryheavytraffic.正：Dueto[Owingto,Becauseof]theveryheavytraffic,hewaslate.becauseof

通常只用來引導(dǎo)狀語，若引導(dǎo)表語，主語通常應(yīng)為代詞。Itisallbecauseofwhatyousaid.那完全是因為你說的話。Errorsintechniquearerelatedtolackoforderandorganizationduringtheexamination,faultyequipment,andpoorbedsideetiquette.Errorsofomissionarecommoninexaminationsoftheeyeandnose;auscultationoftheneckvessels,chest,andheart;palpationofthespleen;rectalandgenitalexaminations;andtheneurologicexamination.etiquetten.禮儀、禮節(jié)、規(guī)矩、禮數(shù)genitaladj.生殖的，生殖器的;

n.生殖器，外陰部Errorsofdetectionarethoseinwhichtheexaminerfailstofindabnormalitiesthatarepresent.Themostcommonerrorsofthistypeinvolvethyroidnodules,trachealdeviation,abnormalbreathsounds,diastolicmurmurs,hernias,andabnormalitiesoftheextraocularmuscles.trachealadj.氣管的，導(dǎo)管的，呼吸管的diastolicadj.心臟舒張的;

hernian.<醫(yī)>疝氣;

突出;

Errorsininterpretationoffindingsoccurmostcommonlywithtrachealdeviation,venouspulses,systolicmurmurs,fremituschanges,abdominaltenderness,liversize,eyefindings,andreflexes.Themostcommontypesofrecordingerrorsarerelatedtodescriptionsofheartsizeandmurmurs,improperterminology,andobscureabbreviations.systolicadj.心臟收縮的;

fremitusn.震顫;

ThefollowingexaminationsequenceistheonetheauthorusesandisdemonstratedintheDVD-ROMenclosedwiththisbook.Thereisnorightorwrongsequence.Developyourownapproach.Justbesurethatattheendofwhichevertechniqueyouuse,acompleteexaminationhasbeenperformed.DevelopDevelop發(fā)展、開發(fā)。tostudy,thinkout,ortalkaboutindetailtobegintobeseenoreactive例句：ThesymptomsofCRFoftendevelopslowly.Thegeneralconsensusisthat60%oflupuspatientswilldevelopclinicallyrelevantnephritisatsometimeinthecourseoftheirillness.MostSLEpatientsdevelopnephritisearlyinthecourseoftheirdisease.Inmostsituations,thepatientwillbelyinginbedwhenyouarrive.Afterintroducingyourselfanddocumentingacompletehistory,youshouldinformthepatientthatyouarereadytobeginthephysicalexamination.Alwaysstartbywashingyourhands.ThereaderisadvisednowtowatchthevideopresentationontheDVD-ROMtoreviewthecompletephysicalexaminationofthemanandthebreastandpelvicexaminationsofthewoman.TheDVD-ROMwillhelpyouputtheexaminationtogether.

pelvic

adj.骨盆的，關(guān)于骨盆的TheWrittenPhysicalExaminationAftertheexaminationhasbeencompleted,theexaminermustbeabletorecordobjectivelyallthefindingsofinspection,palpation,percussion,andauscultation.Bepreciseinstatinglocationsofabnormalities.Negative,positive,normal,abnormalExaminationandlaboratorytestsarenotnegative,positive,normalorabnormalinthemselves.Thesewordsonlyapplytoobservations,resultsorfindings.Thethroatculturewasnegative.Correct:Thethroatculturewasnegativeforβ-hemolyticstreptococci.thephysicalexaminationwasnormal.Correct:Theresultsofthephysicalexaminationwerenormal.Theelectrocardiogramwaspositive.Correct:Theelectrocardiogramshowedabnormalitiesinthealphawaveactivity.Smalldrawingsmaybeusefultodescribeashapeorlocationbetter.Whendescribingthesizeofafinding,statethesizeinmillimetersorcentimetersratherthancomparingitwithafruitornut,forexample,becausethesecanvarygreatlyinsize.Itisbestnottousemostabbreviationsbecausetheymaymeandifferentthingstodifferentreaders.However,theabbreviationsusedinthefollowingexamplesarestandardandmaybeused.Finally,donotmakediagnosticstatementsinthewrite-up;savethemforthesummaryattheend.Forexample,itisbettertostatethat‘‘a(chǎn)gradeIII/VIholosystolicmurmurattheapexwithradiationtotheaxilla’’ispresentratherthan‘‘a(chǎn)murmurofmitralinsufficiency.’’holosystolicadj.全收縮（期）的;

apexn.頂;

頂峰;

尖；脈尖;

尖端;

axillan.咯肢窩，腋窩;

mitralinsufficiency二尖瓣關(guān)閉不全;

Patient:JohnHenryGeneralappearance:Thepatientisa65-year-oldwhitemanwhoislyinginbedontwopillowsandisinnoacutedistress.Heiswelldevelopedandthinandappearsslightlyolderthanhisstatedage.Thepatientiswellgroomed,alert,andcooperative.Vitalsigns:Bloodpressure(BP),185/65/55rightarm(lying),180/60/50leftarm(lying),175/65/50leftarm(sitting);heartrate,90andregular;respirations,16.Skin:Pink,withsmallhyperkeratotic

papulesovertheface;nailbedsslightlydusky;hairthinonhead;hairabsentonlowerportionoflowerextremities;normalmaleescutcheon(distributionofpubichair).vitalsign生命體征hyper-,hypo-,kerat/o-,keratolytic,keratosis,

keratinpapulen.丘疹，長瘡;

小乳頭escutcheonn.有花紋的盾，鎖眼蓋，孔罩;飾框pubichair陰毛Head:Normocephalicwithoutevidenceoftrauma;notendernesspresent.normo-,Eyes:Visualacuitywithglassesusingnearcard:righteye(OD),20/60,lefteye(OS)20/40;visualfieldsfullbilaterally;extraocularmovements(EOMs)intact;PERRLA[pupilsareequal,round,andreactivetolightandtomodation]xanthelasmapresentbilaterally,L>R;eyebrowsnormal;extra-xanthelasman.黃斑瘤;

瞼黃斑。bilateralarcussenilispresent;conjunctivaewithoutinjection;opacitiespresentinbothlenses,R>L;leftdiscsharpwithnormalcup–discratio;normalarteriovenous(AV)ratioOS;noAVnickingpresentOS;arcussenilis老年環(huán);

conjunctivaen.（眼球）結(jié)膜(conjunctiva的名詞復(fù)數(shù));opacityn.不透明性;

費解;

難懂;

模糊;

lensn.透鏡，鏡頭(lens的名詞復(fù)數(shù));

眼的晶體;thereisaflame-shapedhemorrhageatthe6o’clockpositionOS;severalcotton-woolspotsarealsopresentatthe1and5o’clockpositionsOS;rightfundusnotwellvisualizedasaresultoflenticularopacity.fundusn.基底，底部，底;

lenticularadj.透鏡的，小扁豆似的;

構(gòu)詞法n+n+-edflame-shapedstraw-colored,disk-shaped,sickle-shaped,chicken-heartedadj+n+-edbad-tempered,warm-heartedEars:Pinnaeinnormalposition;notendernesspresent;smallamountofcerumeninleftexternalcanal;canalswithoutinjectionordischarge;Rinnetest,BC>ACrightear,AC>BCleftear;Webertest,lateralizationtotherightear;bothtympanicmembranesaregraywithoutinjection;normallandmarksseenbilaterally.pinnaen.,羽，翼，鰭(pinna的名詞復(fù)數(shù))cerumen耵聹，耳垢，耳屎

lateralizationn.（尤指腦部的）偏側(cè)性，偏側(cè)優(yōu)勢，偏利;tympanicmembranes鼓膜Nose:Nosestraightwithoutmasses;patentbilaterally;mucosapinkwithacleardischargepresent;inferiorturbinateontherightslightlyedematous.patentn.專利;

adj.專利的;

顯露;

inferiorturbinate[醫(yī)]下鼻甲;

supraturbinal上鼻甲Sinuses:Notendernessdetectedoverfrontalandmaxillarysinuses.frontalsinuses額竇maxillarysinuses上頜竇Throat:Lipsslightlycyanoticwithoutlesions;patientwearsanupperdenture;buccalmucosapinkwithoutinjection;alllowerteetharepresentandareinfaircondition;noobviouscaries;gingivaenormal;tonguemidlinewithoutfasciculations;cyanotic紫紺denturen.假牙buccaladj.（面）頰的，口的，口腔的;

口甲;

cariesn.齲齒，骨瘍gingivaen.齒齦fasciculationn.束狀;

簇生;

（肌肉、神經(jīng)的）自發(fā)性收縮;

肌震束顫;nolesionsseenorpalpatedontongue;mildinjectionofposteriorpharynxwithyellowish-whitedischargepresentonposteriorpharynxandtonsils;tonsilsminimallyenlarged;uvulaelevatesinmidline;gagreflexintact.pharynx咽tonsiln.扁桃體;

uvulan.懸雍垂，小舌;gagreflex咽反射Neck:Supplewithfullrangeofmotion;tracheamidline;small(1-to2-cm)lymphnodesarepresentinsuperficialcervicalandtonsillarnodechains;thyroidborderspalpable;nothyroidnodulesorenlargementnoted;noabnormalneckveindistentionpresent;neckveinsflatwhilepatientissittingupright.trachea氣管superficialcervical頸淺Chest:Anteroposterior(AP)diameterincreased;symmetricexcursionbilaterally;tactilefremitusnormalbilaterally;chestresonantbilaterally;vesicularbreathsoundsbilaterally;coarsebreathsoundswithoccasionalcracklespresentatthebases.tactilefremitus觸覺震顫chestresonant語音共振vesicularbreathsounds肺泡呼吸音

crackle爆裂音Breasts:Mildastia,L>R;nomassesordischargepresent.astiaadj.<美>男子女性型乳房;

Heart:Pointofmaximumimpulse,sixthintercostalspace(PMI6ICS)2cmlateraltomidclavicularline(MCL);pointofmaximumimpulse（PMI）心尖搏動intercostalspace（ICS）肋間midclavicularline(MCL);鎖骨中線normalphysiologicsplittingpresent;noheavesorthrillsarepresent;S1andS2distant;agradeII/VIhigh-pitchedholodiastolicmurmurisheardatthe2ICSattherightuppersternalborder;agradeI/VImedium-pitchedsystoliccrescendo-decrescendomurmurisheardintheaorticarea;thesystolicmurmurismidpeakingsternaladj.胸骨的crescendo-decrescendo遞增遞減

Vascular:Acarotidbruitispresentontheright;nobruitsareheardovertheleftcarotid,renal,femoral,orabdominalarteries;lowerextremitiesareslightlycoolincomparisonwithupperextremities;carotidn.&adj.頸動脈（的）bruitn.[醫(yī)學(xué)]（聽診時所聽到的）雜音;

femoraladj.股骨的，大腿骨的，大腿的;

n.股動脈

1+pretibialedemaispresentontherightlowerextremity;2+pretibialedemaispresentontheleft;mildvenousvaricositiesarepresentfrommidthightocalfbilaterally;noulcerationorstasischangesarepresent;nocalftendernessispresent.pretibial脛骨前的;

varicosities[醫(yī)]靜脈曲張，靜脈曲張狀態(tài);calfn.牛犢;

犢皮;

腓，腿肚子;

stasis瘀Abdomen:Theabdomenisscaphoid;arightlowerquadrant(RLQ)appendectomyscarandaleftlowerquadrant(LLQ)herniorrhaphyscararepresent;bothscarsarewellhealed;a3×3cmmassisseenintheRLQaftercoughingorstraining;noguarding,rigidity,ortendernessispresent;scaphoidadj.船狀的-oiddiscoid,rheumatoidappendectomyn.闌尾切除術(shù)herniorrhaphynovisiblepulsationsarepresent;bowelsoundsarepresent;percussionnoteistympaniticthroughouttheabdomenexceptoverthesuprapubicregion,wherethepercussionnoteisdull;liverspanis10cmfromtoptobottomintheMCL;bowelsounds腸鳴音tympanitic氣鼓的，鼓響的suprapubic恥骨弓上的;

spleenpercussedinleftupperquadrantbutnotpalpated;kidneysnotfelt;nocostovertebralangletenderness(CVAT)present;aneasilyreduciblerightindirectinguinalherniaisfeltattheexternalring.costovertebral肋椎的：屬于肋骨與椎骨的inguinalhernia腹股溝疝;Rectal:Analsphincternormal;nohemorrhoidspresent;nontenderprostateenlargedsymmetrically;prostatefirmwithoutnodulesfelt;noluminalmassesfeltinrectum;stoolnegativeforblood.rectal直腸sphincter括約肌hemorrhoid痔瘡prostate前列腺Genitalia:Circumcisedmanwithnormalgenitalia;peniswithoutinduration;lefthemiscrotum4to5cmbelowtheright;palpationoflefthemiscrotumrevealsdilatationofthepampiniformplexus;softtestes2×3×1cmbilaterally.genitalia生殖器circumcised割禮

penis陰莖induration硬化、結(jié)節(jié)pampiniformplexus精索靜脈叢Lymphatic:Nodesinanteriortrianglechainsalreadynoted;twofirm,1-to2-cm,rubbery,freelymobilenodesinleftfemoralarea;noepitrochlear,axillary,orsupraclavicularnodesfelt.anteriortriangle頸前三角.rubbery橡皮樣的、彈性femoral股骨epitrochlear肱骨內(nèi)上髁axillary腋窩supraclavicular鎖骨上窩Musculoskeletal:Distalinterphalangealjointenlargementonbothhands,causingpainonmakingafist,L>R;notendernessorerythemapresent;proximaljointsnormal;neck,arms,hips,knees,andankleswithfullrangeofactiveandpassivemotion;musclesappearsymmetric;mildkyphosispresent.distalinterphalangealjoint遠端指（趾）間關(guān)節(jié)erythema紅斑kyphosis脊柱后凸Neurologic:Orientedtoperson,place,andtime;cranialnervesItoXIIintact;grosssensoryandmotorstrengthintact;cerebellarfunctionnormal;plantarreflexesdown;gaitnormal;deeptendonreflexesasshowninTablecerebellar小腦plantar跖gait步態(tài)Summary:Mr.Henryisa65-year-oldmaninnoacutedistress.Physicalexaminationrevealssystolichypertension,retinalchangessuggestiveofsustainedhypertension,amildcataractinhisrighteye,aconductivehearinglossinhisrightear,tonsillopharyngitis,andastia.Cardiacexaminationrevealsaorticinsufficiency.Peripheralvascularexaminationrevealspossibleatheroscleroticdiseaseoftherightcarotidarteryandmildvenousdiseaseofthelowerextremities.Thepatienthasaright,easilyreducibleinguinalhernia.Aleft-sidedvaricoceleispresent.Mildosteoarthritisofthehandsisalsopresent.Patient:MaryJones*Generalappearance:Thepatientisa51-year-oldAfrican-Americanwomanwhoissittingupinbedinmildrespiratorydistress.Sheisobeseandappearstobeherstatedage.Sheiswellgroomedandalert,butsheconstantlycomplainsabouthershortnessofbreath.Vitalsigns:BP,130/80/75rightarm(lying),125/75/70leftarm(lying),120/75/70(sitting);heartrate,100andregular;respirations,20.Skin:Upperextremitiesslightlyduskyincomparisonwithlowerextremities;goodtissueturgor;patientiswearingawigtocoverhermarkedtotalbaldness;normalfemaleescutcheon.Head:Normocephalicwithoutevidenceoftrauma;faceappearsedematous;notendernessnoted.Eyes:Visualacuityusingnearcard:OD,20/40,OS,20/30;visualfieldsfullbilaterally;EOMsintact;PERRLA;eyebrowsthinbilaterally;conjunctivaeredbilaterallywithinjectionpresent;lensesclear;bothdiscsappearsharpwithsomenasalblurring;thecup–discratiois1:3bilaterally,andthecupsaresymmetric;theretinalveinsappeardilatedbilaterally.Ears:Pinnaeinnormalposition;nomastoidorexternalcanaltenderness;canalswithoutinjectionordischarge;Rinnetest,AC>BCbilaterally;Webertest,nolateralization;bothtympanicmembranesclearlyvisualized;normallandmarksseenbilaterally.Nose:Straightwithoutdeviation;mucosareddish-pink;inferiorturbinateswithinnormallimits.Sinuses:Notendernessdetected.Throat:Lipscyanotic;allteethpresentexceptforallthirdmolars,whichhavebee