Иностранных языков
РУДН - участник государственной программы Российской Федерации 5 - 100
Самостоятельная работа (Аспирантура)



English in
























Eric H. Glendinning Ron Howard

Подпись:  Cambridge


Health and illness



Asking about health

Health  is the state of the body . When doctors want to know about a patient's usual health, they ask questions such as:



What is your general health like?

Hows your health, generally?


If you are in good health, you are well and have no illness (disease). It you are healthy you are normally  well and can resist illness. If you are til, you are well and strong.


Sickness has a similar meaning to illness. It is also used in the names of a few specific diseases, for example sleeping sickness and travel sickness. Patients also talk about sickness when they mean nausea and vomiting.


Patient says

I was sick this morning.

I was ill ihis morning.

I felt unwell this morning.

I vomited this morning.

I feel sick.

I  feel ill.

I feel unwell.

I am nauseous.

I feel the need to vomit.

The combination sickness and diarrhoea means vomiting and diarrhoea.



When  patients  reiurns  to normal  health after illness, they  have recovered.  We can also say:






The patient patient

made a







If a patient's health is in the process of returning to normal, the patient is improving. The opposite is deteriorating. We can also say that the patient's condition improved or deteriorated.

In speech, we often use the verb get to talk about change:




over (an illness)

= to recover


= to improve


= to deteriorate

If a patient is belter, but then gels worse again, the patient has relapsed. Another word for improvement, especially in recurring conditions such as cancer is remission.

I ‘ve  got over the illness very quickly.

  Подпись:    Подпись: I ‘ve  got over the illness very quickly.

Two years later she remains in complete remission.

1.1   Complete the table with words from  A and В opposite. The first one has been done for you.

Noun                          Adjective









1.2    Make word combinations using a word from each box. Look at It and С opposite to help you.

















1.3   Complete the conversation, look at В opposite to help you.

Doctor: How are you feeling today?
Patient: Not  very (1)

Doctor: How long have you been feeling (2)...       ?

Patient: About a week.

Doctor: What is your (3) ………………like normally?

Patient: Very good. I'm usually quite (4)_____ ……..and (5)___ ………...

Doctor: What is the problem now? Patient: It’s my stomach.

Doctor: Do you feel (6)  ………………………….?

Patient: Yes.

Doctor: Have y<u actually been (7)……………………….?

Patient: No.

Doctor: Have you had any serious (St ........ in the past?

Patient: No, note at all.


1.4   Choose the correct word to complete each sentence. Look at В and С opposite to help you.

1   Her condition               (deteriorated/improvedI) and she died

2   He .............  (relapsed/recovered) and was allowed to go hone from hospital.

3   The cause of deeping. (illness/sickness) was discovered in 1901

4   The patient made a full……………………….(remission/recovery).

5   I have been in…………………………(poor/good) health for months and feel very  fit.

6   It was a month before I……………………………(got over / got better) the illness.

7   He seems to be rather………………………(unhealthy/unwell) - his diet is bad and he never


OVER to You

What advice did vou give people for keeping fit and welll?

Parts of the body 1


Parts of the body

Most external parts of the body have ordinary Enghsh names .as well as anatomik. names. Doctors normally use the English names. even when talking to each other. There are a few exceptions where doctors use the anatomical name; these are shown in brackets below.

1    jaw (mandible)

2    neck

3    shoulder

4    armpit (axilla)

5    upper arm

6    elbow

7    back

8    buttock

9    wrist





13chest (thorax)


15stomach, tummy


16navel (umbilicus)


18groin (inguinal region I

19knee (patella = kneecap )



Limb means arm (upper limb) or leg (lower limb). The trunk is the body excluding the bead and limbs.

For a more detailed diagram showing parts of the body, see Appendix 1 on page 00.


Referring to parts of the body

When patients speak about their problem they often reler to a part of the body:

I'm having trouble with my


shoulder, knee.

The doctor often needs to ask about a part

of  the body:

  Подпись: The doctor often needs to ask about a part
            of  the body:

Describing radiation of pain

Л patient is telling the doctor alxmt his back pain and the parts ot the body it radiates to.


It starts in the back,  then it seems to go into the right buttock and down the back of the right thigh to the knee.



2.1    Write the ordinary English words for the corresponding anatomical terms in the table using your medical knowledge. Look at  A opposite to help you.


Anatomical term

Common word

















2.2    Complete the sentences using ordinary English words. Look at A ard С opposite to help you. a

                          A male patient describing angina pectoris:

It's like a tightness across my (1).......... , and it goes up

(2)……………..my (3)........... and into my left

(4)…………………..and (5).. the left (6)................


 A male patient describing renal colic:


It starts (1)............. the loin and goes into the

(2)……………………and (3)……………………..into the testicle.


2.3    Complete the sentences. Look at A opposite to help you.

Anatomical term

1  inguinal swelling

2  abdominal pain

3  periumbilical rash

4  thoracic pain

5  enlarged axillary node

6  mandibular pain

Patient's statement

I've got a lump in the……

My little boy's got a…………..ache.

I've got some spot around my  ….

I've got a pain in the middle of the............

There's a painful swelling in my.... _.....

I've got a pain in my

2.4   Complete the table with words from the box. The first one has been done for you.














Upper limb

Lower limb




OVER to You

Make a list of Ihe words from A opposite that  you find it hard to remember or that you need mosf often. Try to learn at least one of them every day.

Parts of the body 2


The abdomen

gall bladder

The main organs of the body have ordinary English names and doctors use these words. But when an adjective is needed they often use an anatomical word. For example, we can sav disease of the liver or hepatic disease. Some abdominal organs, tor example the pancreas, have no ordinary name.





left kidney


right kidney


When doctors talk about the main parts ot the digestive system, they use the words bowel or intestine: the small intestine or the small bowel, the large intcstne or the large bowel. When speaking to patients, doctors may refer to the anus and rectum as the back passage.


The chest

The chest (thorax) contains the organs of respiration and the heart. The main parts of the respiratory systrm are the airways and the lungs. Ihe left lung is divided into two lobes, and the right into three. The airways consist of the larynx, the trachea (or windpipe), the right and left bronchus, and the bronchioles. The chest is separated from the abdomen by the diaphragm.


The pelvis

A doctor is explaining the function of the bladder to a patient.


The bladder is situated in the pelvis, as you know, and it is connected ю each kidney by a long tube called the ureter - one on each side. The ureters carry the urine from the kidneys to the bladder, where it is stored until you decide to empty yout bladder. When that  happens the urine passes down another tube, called the urethra, to the outside.







3.1    Label the diagram using words from the box. Look at В opposite to help you.











3.2    Match the conditions (1-8) with the organs affected (a-h). using your medical knowledge.


2  pneumonia

3  nephritis

4  gastric ulcer

5  cystitis

6  angina pectoris

7  cholecystitis

8  ulcerative colitis a  

a   bladder

b gall bladder

с heart

d kidney

e.       liver

f lung

g stomach

h large bowel


3.3   Complete the textbook extract. Look at A and С opposite to help you.

Examination of the abdomen

To examine the patient for enlarged abdominal (1)........................... , first feel for the (2).......................................

and the (3)................... _................................ on the right side. To do this, ask the patient to take a deep

breath, while pressing with the fingers upwards and inwards. Next feel for the right (4)............................................

and then cross over to the other side for the left (5).............................. Still on the left side, palpate for an

enlarged (6) ………..Finally, moving to the lower abdomen, feel for the (8).._.....................................................

which is only felt ii it is full.

  Подпись: 3.3   Complete the textbook extract. Look at A and С opposite to help you.

Many patients do not know the location or function of the spleen or the pancreas. How would you explain them to a patient, in English?

  Подпись: Many patients do not know the location or function of the spleen or the pancreas. How would you explain them to a patient, in English?

OVER to You




Functions of the body


The five senses

In .addition to smell  and taste, the sense, include sight (or vision), hearing, and touch (also called sensation or feeling). To ask about the senses, doctors use the questions:





What is your



Is  your






sense of smell

sense of taste 





To ask about the sense of touch, docors talk about numbness (loss of sensation):


Other functions

Have you noticed any numbness (in your fingers or toes)?












inhale / breathe in / take a breath in



exhale / breathe out









pass urine / pass water






pass faeces / pass stools




(menstrual) period


have a period

(monthly) period

Do you have any







 passing urine?

with your speech?

when vou breathe in?


When taking a history, doctors can ask:


When auscultating a patient's lungs, the doctor tells the patient:

Take a deep breath in, hold your breath, then breathe out completely.


Less common functions

There are some things we do less often. When we are hot, we sweat. When we arc nervous, we  shake When we are sad, we cry.

Dioctors can ask:

4.1   Match the symptoms (1-5) to the questions (a-e). using your medical knowledge.

1   dysuria              a  What is your breathing like?

2   dysphagia          b Do you have any pain when you pass water?

3   diplopia             с  Do you have any difficulty with your speech?

4   dysphasia          d Do you have any trouble swallowing?

5   dyspnoea          с  Is your vision normal?

4.2    Patients are describing symptoms of the conditions shown in brackets. Complete the

1   I've got pain and …….in both feet, (peripheral neuropathy)

2   I'm having difficulty ……………..solid food, (oesophageal stricture)

3   I have a lot of problems…………….(prostatic hypertrophy)

4   I've been............. more than usual, even when it's not hot. (hyperthyroidism)

5   I've noticed that my hands........... when I’m not using them. (Parkinsonism)

6   I have trouble………………..when I climb the stairs (left heart failure)

Over to you

You think a patient may have diabetes. Think of five questions you can ask the patient to investigate further. Try to use the question types presented in this unit.



Medical practitioners 1



In Britain, doctors, also known as medical practitioners, must be qualified: have a university degree in medicine. They must also he registered - induced in the General Medical Council's list, or register - in order to practise (see Unit 13). A doctor who treats patients, as opposed to one who only does research, is called a clinician. A doctor who provides primary care for patients is known as a general practitioner (GP), or family doctor. GPs usually work in a group practice. Larger group practices work in a building called a health centre.

Note: In British English, the verb is spelt practise and the noun is spelt practice.



Specialist doctors, for example paediatricians generally work in hospitals. However, tlms, who work outside the NHS, providing private health care, may have consulting rooms outside a hospital - lor example in the famous Harley street in London.

The two main branches of medicine are surgery and internal medicine, and the doctors who practise these branches are called surgeons and physicians, respectively. In Britain, male surgeons an- addressed as Mr and females as Ms - so Dr Smith is a physician, and Ms Smith is a surgeon.




A cardiologist

specializes in is a specialist in

diseases of the heart and circulation, or cardiology.

A geriatrician

diseases of elderly patients, or geriatrics.

An anaesthetist


Note: Names of specialties usually end in -ology. names of specialists usually end in -ologist If the name of a specialty ends in -ics. the name of the specialist ends in -ician There are some exceptions, e.g. anaesthetics and anaesthetist.


Choosing a specialty

Jill Mathews has just graduated from medical school and is talking about her future.

I haven't decided what to specialize in yet. I need more experience before I decide, but I'm quite attracted to the idea of paediatrics because I like working with children. I'd certainly prefer to work with children than, say, elderly patients - so I don't fancy geriatrics. I was never vers interested in detailed anatomy, so the surgical specialties like neurosurgery don't real appeal. You have to be good with your hands, which I don't think is a problem for me – I”ve assisted at operations several times, and I've even done some minor ops by myself - but surgeons have to be able to do the same thing again and again without getting bored, like tying off cut arteries and so on. I don't think that would be a problem for me, but they need to make decisions fast and I'm not too good at that. I like to have time to think, which means surgery's probably not right for me.'

Note: The collocation good with is followed by a noun -He's good with сhildren.  The collocation good at is followed by the -ing form (gerund) of a verb, or by a noun - She's good at explaining orocedures. She's good at explanations.

5.1    Write sentences to describe the work of the specialist in each branch of medicine. Look at В
opposite to help you.

1  dermatology              

A dermatologist specializes  in the diseases of the skin

2  rheumatology

3  traumatology

4  paediatrics

5  obstetrics

5.2    Complete the table with words from Л, В and С opposite and relate.! forms. Put a stress mark
in front of the stressed
syliable in each word. The first one has been done for you.



Noun (person)

Noun (activity or thing)




















Find prepositions in С opposite that can be used to make word combinations with the words in the box. Then use the correct  forms of the words to complete the sentences.



interested     specialize in  work










1  A pathologist…………………………………… diagnosing disease through examining cells and tissue.

2  A paediatrician must enjoy………………… children.

3  An oncologist…………………………………… the diagnosis and treatment of cancer.

4  A psychiatrist must be ……………….counselling.

5  A neurosurgeon must be……………………her hands.

Make word combinations using a word from each box. Two words can be used twice. Look at А. В and С opposite to help you.















Over to you

Re-read what Dr Jill Mathews says about surgeons in Section C. Make a list of the qualities she thinks are needed Ito be  a good surgeon. Then make a similar list of qualities for another specialty.

If you are a student, which branch of medicine do you think you have the qualities for? If you have already completed your training, why did you choose voir particular branch of medicine?


Medical practitioners 2


Hospital staff

The people who work in any type of workplace, including hospitals, are called the staff. The medical staff in a British hospital belong to one of four main groups:

        A pre-resist ration house officer (PRHO), or house officer, is a newly graduated doctor in the first year of postgraduate training. After a year, he or she becomes a registered medical practitioner. In the current system of training, the foundation Programme, the name for these junior doctors is Foundation Year I doctor (FY 1). (See Unit 12}

    A senior house officer (SHO) is in the second year of postgraduate training. The title is now foundation Year 2 doctor (FY2), but the old terms senior house officer and SHO are still used.

        A specialist registrar (SpR) is a doctor who has completed the Foundation Programme, and is training in one of the medical specialties. I lure are also some non-training registrars -         doctors who have completed their training but do not wish to specialize yet.

             A consultant is a fully qualified specialist. There may also be some associate specialists -        senior doctors who do not wish to become consultants. In addition, there is at least one medical (or clinical) director, who is responsible for all of the medical staff.


Medical teams

Consultant physicians and surgeons are responsible lor a specific number oi patients in the hospital. Each consultant has a team of junior doctors to help care for those patients. In many hospit.aIs, there are multidisciplinary teams which consist not only of doctors but also of physiotherapists and other allied health professionals (see Unit 8).

When patients enter — or are admitted to - hospital, they are usual у seen first by one of the junior doctors on the ward where they will receive treatment and care. The junior dioctor clerks them - takes their medical history (see Units 47-49) - and examines them. Some time later, the registrar also sees the patients, and may order investigations or tests, for example X-rays or an ECG, make a provisional diagnosis, and begin treatment. The consultant usually sees the new admissions - people who have recently been admitted to the ward – for the first time on one of the regular ward rounds, when the management of the patients is discussed with the registrar. Consultants also decide when a patient is ready to he discharged (sent home). On the ward round, the consultant is accompanied by the team and a nurse, and they visit all the patients in the consultant's care.



Junior doctors now normally work in shifts, which means they normally work for eight hours every day, for example 7 am to 3 pm. and are then free until 7 am. the next day. After a week they change to a different shift, for example 3 pm to 11 pm or 11 pm to 7 am. The alternative system is to work from 9 am to 5 pm every day and to take turns to be on call - available to return to the hospital if necessary - from 5 pm to 9 am the next day. Days on call are set out in a rota, or list ol names and times. Doctors on call  carry  a radio pager, or bleeper, a device which makes a noise when someone is trying to contact them.










Make word combnations using a word from each box. Look at А, B and С opposite to help you.





















Match the dcscriprions (1-5) with the job titles (a-e). Look at A and В opposite to help you.

1   Dr Graham has been a paediatrician for eight years and is responsible for treating the children admitted to Ward 60.

2   Dr Stewart has just started the second year of her Foundation Programme.

3   Dr Singh has started his training as a surgeon.

4   Dr Phillips has just graduated and is working in a large hospital in Birmingham.

5   Dr Millar is in charge of the medical staff in the Birmingham hospital.


a.             specialist registrar

b.           medical director

c.            consultant

d.           SHO

e.             PRHO or house officer


Are the following statements true or false? Find reasons for your answers in А, В and С opposite.

1   A medical graduate becomes registered two years after graduation.

2   The system of training doctors in Britain is called the Foundation Programme.

3   The name senior house officer is no longer used in Britain.

4   The consultant is usually the first doctor to see new patients.

5   When working in shifts, all doctors take turns to be on call.

Complete the text of a PRPIO describing her job. Look at А. В and С opposite to help you.


When I get to the ward, the first thing I do is talk to the house officer who was on duty
during the last (1)
............... to find out if there have been any new

(2)....... Then I generally see the charge nurse. He telIs me if there is

anything that needs to be done urgently, such as intravenous lines to put up or take

down. Later in the morning, I (3).. any new patients, which basically

involves taking a history. On Tuesday and Friday morning the consultant does her ward

(4)   ............... , and I have to make sure I'm completely up to date on her patients.

After that, there are usually lots of things to do, like writing up request forms for blood

………………………………………………….. and so on. In the afternoon. I have to prepare for any patients who

are to be (6)................. the next day. They're usually happy to be going home.

And then of course there are the lectures and tutorials in the (7)----

programme on Monday and Wednesday.





Nursing grades

Nurses working in the hospital have the following grades:


student nurse

a nurse who is still in training

staff nurse

a nurse who has completed the training course

charge nurse

a more experienced nurse- who is in charge of or responsible for  a ward or department

nurse manager

a nurse who is in charge of several wards

Dr James is talking to I   Sister Watkins.

  Подпись: Dr James is talking to I   Sister Watkins.

Note: The old term sister is still sometimes used for a female charge nurse. A fenale nurse manager may be called matron


Support workers

T he clinical support worker, who has done a short course and obtained basic qualifications, and the nursing auxiliary, who is usuallv unqualified, both assist nursing staff. There may also be ward clerks, whose duties include making sure patients' notes and information are up to date, and answering the telephone.



Iike doctors, nutses can specialize:

       A midwife has specialized from the beginning by doing a course in midwifery, the management of pregnancy and childbirth.

       District nurses visit patients in their homes.

       Health visitors also work in the community, giving advice on the promotion of health and the prevention of illness.


The nurse's role

The nurse's role has changed considerably in recent years. In addition to general patient care, checking temperatures, pulse rates and blood pressures, changing dressings, giving injections and removing sutures, nurses now do some of the things previously reserved tor doctors, such as prescribing drugs, and ordering laboratory tests. More responsibility for nurses is planned, as the following article demonstrates.


Nurses carry out surgery in effort to cut patient waiting lists

Nucses in Scotland trained to perform minor surgery have entered the operating theatre for the first time in an effort to cut patient waiting times. Five nurses who have passed л new course at Glasgow Caledonian University ate now qualified to carry out such procedures as the removal ot small lesions, benign moles and cysts.



The werbs perform and carry out are used with all types of procedures. They are often used in the passive form.


an examination


an operation


a procedure

carry out

an experiment


a test


a biopsy

7.1   Complete the scniences. Look at А, В and С opposite to help you.

1Someone who specializes in delivering babies is a.......

2  Someone who is qualified to assist nurses is a......

3  Someone who is not qualified but is able to assist nurses is a...................

4  A nurse who has qualified is a.......... nurse.

5  A nurse who specializes in health promotion is a........................

6  A nurse who lixiks after a ward is a nurse.

7  A nurse who works in the community is a........ nurse.

8  Someone who answers the ward telephone is a..


7.2 Make word combinations using a word or phrase from each box. Look at D opposite to
help you.

carry out





sutures a procedure an injection


the temperature










Complete the sentences with the correct grammatical form of perform.

1  An isotope brain scan is painless and easy.........

2  Biopsy of the pancreas    .. _ last March.

3  If the patient's condition deteriorates, a laparotomy should...........

4  If a diagnosis <if meningitis is suspected a lumbar puncture must.............

5  Last year we............ a randomized, double blind group study.

Complete the sentences with the correct grammatical form of carry out.

1  I now intend............................ a larger study.

2  Unfortunately lew properly controlled trials........................ so far.

3  A number of studies.......................... recently to look at this question.

4  A right hemicolectomy.......................... and the patient made a full recovery.

5  This procedure can.......................... in the emergency department.


What kind of tasks do nurses carry out in your country? Are nurse.' responsibilities increasing? What are the implications of this?

Over to you




Allied health professionals


Community health

The health of the community depends on a large number of people other than medical practitioners and narses. These can be grouped under the heading of allied health professionals. They include the following:

        Physiotherapists (physios) help people to move by getting them to do exercises or by treating theii body with heat or massage - treatment by manipulating muscles and joints with the hands. (Sec Unit 42)

        Occupational therapists (OTs) help people with a disability to perform tasks at home and at work. A disability is a physical or mental condition that makes it difficult to live normally, for example blindness or deafness.

        Social workers help people to solve their social problems - for example poor housing or unemployment - or family problems.

        Chiropodists, also know as podiatrists, treat conditions affecting the feet.



There are numerous technicians - people who work with scientific equipment - such as radiographers, who are known as X-ray technicians. Ambulance technicians work in the emergency medicine service. An ambulance technician with more advanced qualifications is called a paramedic.


Prosthetists and orthotists

Prosthetists and orthotists provide care for anyone who needs an artificial limb, (a prosthesis), or a device to support or control part of the body (an orthosis). They also advise on rehabilitation - helping patients return to normal life and work after treatment.

Prosthetists provide artificial replacements for patients who have had an amputation or were born without a limb.

A prosthesis                                        Splints


Orthotists provide a range of splints and orher devices to aid movement, correct deformity fiom an abnormal development of part of the body, for example club foot (talipes), and relieve pain.


Opticians test eyesight and prescribe glasses - also know as spectacles - and contact lenses, when necessary. The examination includes measuring intraocular pressure - the pressure of fluid inside the eye - and examining the retina. If the optician suspects an eye disease, such as glaucoma, they refer the patient to their GP lor treatment. The GP may then refer the patient to an ophthalmologist, a doctor who specializes in diseases of the eye.

Make word combinations using a word from each box. Look ai А, В. С and D opposite to help you.


























Which allied health professionals could best help the following people? Look at А, В, С and D opposite to help you.

1  A young unmarried woman who has just had a baby

2  A woman who s having difficultv using her right arm following a fracture

3  Someone who needs glasses

4  An elderly woman who has had a below knee amputation

5  A man whose wife has Alzheimer's disease

6  A man with a fungal infection of his feet


Complete the texts. Look at A and С opposite to help you.

A prosthctist works with patients of all ages as a member of a clinical team, based at a large hospital. The patients may need a prosthesis as the result of an accident, or

(I)…………………………….following a disease such as diabetes. Alternatively they may have

been born without a (2)…………………... Orthotists work alongside doctors, nurses.

physiotherapists and occupational (3)………………………………to give the people under their care

the best possible (4)……………………… Their main aim is to enable the patient to lead a

normal life at work and leisure.

An orthotist often works in a clinic as part of an outpatient service and also visits other centres to provide a service for people with special needs. They deal with people of all ages.

For instance, children who have cerebral palsy may require (5)……………………….to help

them walk and many older people need special shoes to correct (6)............

If damaged, any part of the human skeleton may require some form of orthosis. The
orthosis may be needed to reposition the body or to (7)
.. pain.

Over to yои

Britain is introducing a new member to Ihe healthcare team, called a medical care practitioner (MCP). similar  to the physician assistant in the United States and other countries. The MCP will be able to carry out some of the functions of a medical practitioner, such as history-taking and examination, and diagnosis and treatment of certain illnesses, without having a medical degree. What are the advantages and disadvantages of this in your opinion?



Introduction to a hospital

Jordi Pons is a fourth-year medical student from Barcelona. He has come to Britain on an elective attachment to the Royal Infirmary, Edinburgh. Dr Barron is introducing him to the hospital.

Welcome to the Royal Infirmary

South Entrance

Car Parks С & D (visitors & staff) The Simpson Centre    

 for Reproductive Health

-Gynaecology (Emergency)

-  Maternity (Emergency)

-  Neonatology (Emergency) Outpatient Departments + All Wards

Day Surgery Unit & Endoscopy f X-ray Department Combined Assessment

Dr Barron: The Royal Infirmary is the name of the university hospital for Edinburgh University. It is a general hospital, dealing with all types of patients and illnesses, except paediatrics. We have a specialist hospital for that in another part of Edinburgh, the Hospital for Sick Children. You can see some of the departments in our hospital on the sign. Of course, there are many others, for example the Intensive Care Unit (ICU), and the Surgical High Dependency Unit (HDU).

Jordi: What does 'outpatient' mean?

Dr Barron: Outpatients are the people who come to hospital to attend a clinic or to have tests or treatment and then return home on the same day. Inpatients stay in the hospital for one or more days. The rooms where they stay are called wards. If a patient's treatment requires only one day, such as a simple operation, they can be admitted to the day surgery unit.



Dr Barron: The Accident and Emergency Department  (A&E), also called Casualty, is where patients who are acutely ill - with a sudden, serious condition - come for assessment and treatment. Outpatients who have an appointment to see a specialist go to a clinic in one of the Outpatient Departments (OPDs). They have usually been referred to the hospital by their GP, who writes a referral letter to the consultant explaining the patient’s problem.



Dr Barron: The inpatients in a hospital are admitted in one of three main ways. They may be seen in one of the outpatient clinics and admitted from there or, if there is a lot of demand for the treatment they need, as in the case of a hip replacement, they are put on a waiting list for admission. Alternatively, their GP may arrange the admission by telephone because they are acutely ill, for example with suspected myocardial infarction. Or they are seen in the A&E Department, where the doctor on duty - working at that time -arranges the admission. This would happen in the case of a patient with a fractured neck of femur, for example. Larger hospitals may have an assessment unit where patients can be admitted temporarily while their condition is assessed.

Jordi: Assessed?

Dr Barron: Yes - decisions are made about their condition, and what needs to be done to help them. After treatment is completed, the patient is discharged back to the CP's care.

9.1    Complete the taЫе with words from А. В and С opposite. Put a stress mark in front of the stressed syllable in each word. The first one has been done for you.
















9.2    Make word combinations using a word from each box. Look at С opposite to help you.

















9.3    Which hospital departments would be most appropriate for the following patients? Look
А, В and С opposite to help you.

1  a woman in diabetic coma

2  a patient who has just had a radical prostatectomy

3  a patient who is to have a skin lesion removed

4  a man with а foreign body in his eye

5  a woman with a threatened abortion

9.4   Complete the extract from an information leaflet tor patients. Look at А, В and С
opposite to help you.


Information for outpatients

When you arrive at the (1)……………..please tell the receptionist who will

welcome you, check your details, and direct you to the waiting area. The length of your

visit will depend on the (2)…………….you're going to have. You may need to

have some (3)………………., such as an X-ray, which could mean going to another

(4)………………….or you may be (5)…………………….to other professionals,

such as a physiotherapist or dietician. You may need to revisit the clinic. If staff at the clinic want to see you again, another appointment will be arranged for you. If you need to be

(6)........... to hospital for more treatment either as an inpatient or for

(7)…………………surgery, you will be told when this is likely to happen.

do not need further treatment you will be (8)……………….to your GP's care.


Over  to you

How do hospitals in your country organize admissions? How would you explain the procedure to   colleague from another country?


Primary care


The National Health Service

The National Health Service (NHS) is responsible for health care for everyone in the UK, although a small number choose to pay for private care. Treatment is  free but there is a prescription charge for drugs and appliances, such as a cervical collar, with exemptions for some patients, such as children and the elderly.

Primary care is provided by general practitioners, or GPs, (sometimes known as family doctors), nurses, dentists, pharmacists and opticians. GPs work in practices of I to 20. Practices are based in a surgery and look after the health of from 1,000 to 15,000 people in their local community. They also provide health education in areas such as smoking and diet, run clinics, give vaccinations, for example for influenza, and may perform minor surgery such as removal of wans and moles. If a patient needs specialist care, the GP will make a referral - refer the patient to a consultant in secondary care.

Patients are normally seen on an appointment basis. Home visits are made when patients are housebound - unable to leave their homes - or too ill to attend surgery. Out-of-hours (ООН) treatment, from 6 pm to 8 am, is provided by the local Primary Care Trust, which organizes shifts of GPs and locum GPs to cover if someone is absent.

Note: The noun surgery has three meanings:

·        the building where GPs work – The practice has moved to a new surgery on the High Street.

·        a time when GPs see patients - Morning surgery is from 8.30 to 12.30.

·        the work of surgeons - The patient needs urgent surgery on a burst appendix.


The practice team

A typical GP practice employs receptionists. They are responsible for initial patient contact, making appointments, taking requests for repeat prescriptions, taking messages from patients and other health care providers, and for filing and scanning documents into patient records. The practice manager has responsibility for finance and sometimes for IT, supervises reception staff, hires locums, and helps prepare the practice development plan. Practice nurses run asthma, diabetes, and cardiovascular disease clincs as well as one-to-one clinics tor those who wish to give up smoking.

In addition to practice staff, GPs work with a number of health professionals (see Unit 8):

       District nurses visit temporarily housebound patients, such as recently discharged hospital patients, to change dressings, such as ulcer dressings.

       Health visitors visit families to carry out check-ups on young children - particularly undcr-fives - to make sure they're healthy. Special attention is paid to families in need, such as those living in poverty. They also do baby immunizations.

        Midwives run clinics for antenatal patients.

        Physiotherapists provide hands-on treatment but also teach patients exercises they can do to improve rhcir condition after an accident or operation.

A GP's day

Dr Stuart works in a practice in a small market town with three other family doctors. The surgery is in the centre of the town and is shared by three practices. This is a typical working morning when she is not the duty doctor, responsible for emergencies and urgent problems.

8.00 am


8.30 am


8.30-10.50 аm.



10.50 –10.55



11.00–11.20 am 11.20-11.30 am

arrive at the surety

Check the ООН e-mail printout

crieck for urgent and non-urgent messages

check emails  from the Health board and partners

prepare for surgery

morning surgery (ten-minute appointtwents)

6  pre booked  Last week

2 booked 48 hours ahead

4 bookable  on  the day

check  with Reception for messages.

Sign  prescriptions  and deal with repeat prescription requests

coffee break in the conference row with colleagues

check home visit requests and divide up visits with colleagues

11.30 am -  1.00 pm home visits

10.1    Complete the sentences. Look at A opposite to help you.

1 Children, over-60s, and people with some chronic diseases do not have

to pay……………………in the UK.

2   Patients with mobility problems may Ik unable to go out. They are……………………………….

3   The average GP............... is ten minutes long.

4   A.. ……………………….is someone who takes the place of a staff member who is on leave.

5   Care outside working hours is known …………………………….


10.2    Make word combinations using a word or phrase from each box. One word can be used twice. Look at A and В opposite to help you.






supervise take



appointments home visits dressings

 a clinic

a patient

minor surgery


10.3   Which member of a practice team would be responsible for each of the following?
Look at
В opposite to help you.

1   Running a clinic for pregnant women

2   Teaching a patient how to strengthen his broken leg

3   Letting the GP know that a patient can't come to her appointment

4   Running a clinic for people who want to lose weight

5   Visiting a patient who has just returned home after a hernia operation

6   Carrying out check-ups on children in a poor neighbourhood

7   Organizing cover for an absent doctor


10.4 Complete the diary for Dr Stuart’s afternoon. Look at A and C opposite to help you











Over to you


Describe a ty pica I day for a GP in your country or in the country where you work





Medical education 1

Medical education in the UK

Medical education in the UK covers:

        undergraduate education - four or five years at medical school, the section of a university responsible for medical education

        a two-year Foundation Programme which provides training for new doctors after graduation through a series of placements in different specialties (see Unit 12)

        postgraduate training which doctors take to become CPs or consultants - senior specialists - often delivered through colleges for different specialties, for example the Royal College of Physicians

        continuing professional development in the form of courses and seminars, which doctors undertake Throughout their working lives to keep up to date.


Extract from an undergraduate prospectus

The MBChB (Bachelor of Medicine, Bachelor of Surgery) is a five-year undergraduate medical degree course. Most of your learning takes place in small groups. The main components are:

Core (Years 1-3)

An integrated progamme of clinical and scientific topics mainly presented through problem-based learning (PBL), where you work with others on a series of case problems.

Student Selected Modules

Student selected modules (SSMs) allow you to choose from a menu of subjects such as Sports Medicine or even study a language as preparation for an overseas elective, a hospital attachment of your own choice, between Years 4 and 5.

Vocational Studies and Clinical Skills

This component prepares you for the clinical skills required for contact with patients from Year 1 ot your course, through periods of practical training where you are attached to a hospital department or general practice.

Clinical Attachments (Years 4 and 5)

A series ol four-week dinical attachments in Medicine, Surgery, Psychological vledicine, Child Health, Obstetrics & Gynaecology and General Practice.





A student's view

Ellen, a medical student, describes her course.

I’m just finishing my first year of Medicine. What I like about this course is that you're involved with patients from the very beginning. Even in our first year, we spend time in hospital. Much of the course is PBL. We have two 2-hour session a week where we work in groups of eifthr to ten solving clinical problems. We decide together how to tackle the problem, look up books and online sources, make notes and discuss the case together. It's a great way of learning and getting to know the other students. In the past, medical students had lectures with the whole class taking notes from lecturers from 9.00 to 5.00, but now it's mainly group work, although we do have some lectures and seminars, where we work in small groups with a tutor. I like all of it, even the dissection. We pet to cut up cadavers from the second month oi the course.'

11.1  Match these activities to the stages ot medical education in the UK given in A opposite.

1  dissecting cadavers

2  keeping log of surgic procedures observed and performed

3  working for four months in accident and emergency to experience this specialty

4  taking a four-week attachment in Obstetrics and Gynaecology

5  taking an online course on recent developments in cardiovascular diseaw


11.2   Complete the sentences. Look at В and С opposite to help you.

1.            Just before ther final year, students have the chance to take an…………………………..in a hospital of their choice anewhere in the world.

2.            ………………………………….contrasts with an approach where each subject is taught separately.

3.            These days............... are often interactive, with regular opportunities for the students to ask questions.

4.            In……………………students learn how to treat and manage patients.

5.            ………………………………………can be a topic from outside medicine, such as a foreign language.

6.            Dissection of…………is an important part of the anatomy component.

7.            The…………………………..at the University of Edinburgh is one of the oldest in the UK.

8.            She's a………………………at the Royal; one of the leading paediatnc heart specialists in the country.

9.            The Royal……………..of Surgeons in Edinburgh dates from 1505.

10.    We have a……………..each week where we discuss topics in a vmall group with our lecturer.

11.3   Match each of these activities to one of the components of the undergraduate course
described in
В and С opposite.

1  Julie spends six weeks working in a small hospital in the Himalayas.

2  A group of students discuss together the possible reasons for abdominal pain after meals in an obese 44-year-od male.

3  A small group of students trace the pulmonary artery in a cadaver.

4  Otto spends a month working in the paediatric ward of the local hospital.

5  Anne learns how to take blood from an elderly patient.

6  Juma chooses to study Travel Medicine in his fourth year.

Over to you

Describe the main components of your undergraduate course

Medical education 2



The Foundation Programme

The Foundation Programme is a two-year training programme which forms the bridge between university-level study at medical school, and specialist or general practice training. It consists of a series of placements, each lasting four months, which allow the junior doctor, known as a trainee, to sample different specialties, for example paediatrics. A year one trainee (FY1) corresponds to рге-registration house officer (PRHO) posts and a year two trainee (FY2) to senior house officer (SHO) posts. Each trainee has an educational supervisor who ensures that more senior doctors deliver training in different ways, including clinical and educational supervision. To progress, trainees have to demonstrate a range of clinical competencies which are assessed through observation in their workplace.

(BMJ Careers 2005; Amended with permission from the BMJ Publishing Group)

People in medical education



An academic, or in some cases a postgraduate student, who leads tutorials.


In anatomy teaching, someone who demonstrates how to dissect. Demonstrators are often postgraduate students paying their way through medical school.

lecturer / senior lecturer

An academic with teaching and research responsibilities who contributes to the teaching of a particular discipline.


A senior academic with teaching and research responsibilities for a particular discipline. Usually a leading figure in their discipline.

college tutor

A consultant responsible for delivering a college training programme.

clinical trainer

A consultant assigned to a trainee who provides training during periods of direct clinical care.

educational supervisor

A consultant who supervises a trainee's period of training.


Medical qualifications


BMSc BMcd Sci

Bachelor of Medical Sciences. A degree often taken alter three years of medical studies by students who may wish to follow a career in medical research.


Bachelor of Medicine, Bachelor of Surgery. Bachelor degrees are undergraduate degrees. This is the first degree for UK doctors.


Doctor of Medicine


Diploma of the Royal College of Obstetrics and Gynaecology


Member of the Royal College of Physicians or Member of the Royal College of Surgeons. Doctors become Members by successfully completing the assessment procedures in their со lege.


Fellow of the Royal College of Surgeons of England. Other colleges arc indicated by the letters which follow, for example Edinburgh. Glasgow or Ireland.

1 low doctors become a bellow depends on their college. For the FRCS, further examinations must be passed. For other colleges it is by nomination or work assessment.

12.1   Complete the phrases with verbs from the box. Two phrases can be completed in two different ways. Look at A and В opposite to help you.

assess         deliver          demonstrate         provide         supervise        take


1 .............. a competence or how to do something

2 ............... a trainee by ensuring she successfully completes her training

3…………………a course or a training programme (as a teacher)

4……………………a course or a training programme (as a student)

5…………………….progress or competence

12.2    Match the two parts of the sentences. Look at А, В and С opposite to help you.

1   An FY1 is a doctor

2   A demonstrator is an anatomy teacher

3   A clinical trainer is a consultant

4   A supervisor is a consultant

5   A medical school is

6   A placement is

7   A college is

8   A Fellow is a specialist

a  a body of specialists responsible for delivering and assessing training in their specialty.

b        responsible for the training programme of a trainee.

с a period spent as a trainee in a hospital or in General Practice.

d in the first year of the Foundation Programme.

e who has reached the highest level in their specialty.

f who provides training during periods of direct clinical care.

q        part of a university responsible tor medical education.

h who teaches dissection.

1 2.3    Write in full the qualifications of the doctors and surgeons, look at С opposite to help you.

1   Mr A. H. Younghusband, MBChB. FRCS, FRCSI

2   Dr С Doyle, BMed Sci, DM, MRCP

3   Ms E Inglis, MBBS, FRCS

4   Dr E Merryweather, BM. MD, FRCP

The overseas doctor



Types of registration

To manage and treat patients in the UK, all doctors must register with the General Medical Council (GMC). There are several types of registration:

        Provisional registration is for doctors who have just qualified from medical school in the UK or from certain European Economic Area (EEA) member states.

        Full registration is for doctors who have completed their year's clinical training.

        Limited registration is lor international medical graduates who have not completed the equivalent of a year's clinical training in the UK.

        Specialist registration is for doctors who have completed specialist medical training and have a Certificate of Completion of Training (CCT).

The GP Register is a register of all those eligible to work in general practice in the NHS.

Note: For full details of the General Medical Council see www.gmc-uk.org



Before they can obtain full registration, some categories of overseas doctors are required to take the Professional and Linguistic Assessments Board (PLAB) test. PLAB is designed to ensure those who pass can practise safely  at the level 1 of an SHO in a first appointment in a UK hospital.

Part 1 consists of a written test of knowledge, skills and attitudes. Part 2 is an Objective Structured Clinical Examination (OSCE). It consists of 16 five-minute clinical scenarios, known as stations, to assess professional skills.

Note: For a full description of PLAB, see http://www.gmc-uk.org/doctors/plab/


PLAB stations and advice

OSCEs assess these skills:

        Clinical examination: Your ability to carry out a physical examination of a simulated patient, an actor trained to play this role, will be assessed. Uncomfortable or intimate examinations will be carried ourt using a manikin, an anatomical model.

        Practical skills: You will be assessed on practical skills such as .situring and giving intravenous injections.

        Communication skills: Your ability to interact with a simulated patient, or in some cases the examiner, will be assessed. Skills tested may include breaking bad news and giving advice on lifestyle.

        History taking: Your ability to take an accurate history and make a reasoned diagnosis will be assessed.

Advice on the stations from a successful candidate:

 Read the instructions outside each station carefully. You have one minute for this.

Don't forget the ABC (airways, breathing, circulation) protocol in every emergency station.


Keep in mind safety precautions like throwing the sharps in the sharps bin.

Check the patient understands what is happening; then ask them about any concerns they may have. Don't just give a lecture.  Listen carefully to what the actor says.


Note: Sharps are needles and blades, which must be disposed of safely in a special container called a sharps bin.


13.1    What kind of registration might these doctors obtain?  Look at A opposite to help you.

1  A newly qualified Spanish doctor

2  A newly qualified Nigerian doctor

3A doctor who has successfully completed the first Foundation Year (FY I)

4An  SHO who has successfully completed the Foundation Programme and gained а С crtificatt of Completion of Training after several specialist registrar posts


1 3.2    Write the abbreviations in words. Look at А. В and С opposite to help you.

1   Any doctor who wants to work in the UK must register with the CMC.

2 Some overseas doctors must pass the PLAB test before they can register.

3   Part 2 of the test consists of an OSCE.

4   In any emergency, remember the AВС protocol.

5   Before you can obtain specialist registration, you must have a CCT.

1 3.3    Complete the text. Look at  А, В and С opposite to help you.

My name's Musa and I come from Yemen. I came to the UK about two years ago, after

graduating. Because Yemen is outside the ЕЕA, I could only obtain (I)…………………….

with the (2)…………at first.  It was very difficult for me to obtain a

place on a Foundation Programme. Although I speak good English. I had to take the

(3).............. test to show that I could work safely in the UK. If I had to give some

advice to other candidates, it would be that at counselling (4) .....        , you shouldn't

simply memorize a set of phrases. It's better to really think about what you're saying to the actor and get the intonation right.

After completing my year's clinical training, I was able to obtain (5).....

............ But I found it difficult to get an SHO post in my chosen specialty,

paediatrics, as hospitals now have to demonstrate there isn't a suitable candidate from the EEA. Once I've completed my second Foundation Year, I should obtain a ……………………….(6)       which will allow me to proceed to (7)………………………….. with the GMC, an important step on the road to becoming a paediatric consultant.





Symptoms and signs


Describing problems

The problems which a parient reports to the doctor are called symptoms, for example pain or nausea. Signs are what the doctor hnds, also known as findings, on examining the patient, for example high blood pressure or a rapid pulse rate. Symptoms are also known as complaints.


Patients say they went to see the doctor; doctors say the patient presented. The symptom which causes a patient to visit a doctor - or to present - is called the presenting symptom, presenting complaint or presentation.



Patients say

tiredness lethargy fatigue lassitude

loss of energy

I  feel tired all the time.I feel completely worn out. Lately I've been feeling completely exhausted at the end of the day.


general feeling of being unwell

I feel unwell. I don't feel well.

I've been feeling off-colour for two days. I haven't been feeling myself for a week. I've been out of sorts all day.


loss of appetite

My appetite is very poor.

I've been off my food lor days.

weight gain

increase in weight

I've put on eight kilos in the last year. I've gained five ki.os.

weight loss

decrease in weight

I'm not eating any less than usual but I've lost a lot of weight recently.


hard, infrequent faeces

My motions are very hard.

I've been quite constipated lately.

I'm not very regular.

Note: The verb feel is also used with other adjectives, such as hot. cold, nervous, anxious, dizzy, weak - She said she tell dizzy.


presenting symptom presenting complaint was chest pain.



Talking about symptoms

14.1   Complete the table with words from С opposite. Put  a stress mark in front of the stressed syllabic in each word. The first one has been done for you.













1 4.2    Make word combinations using a word from each box. Look at  A, В and С opposite to help you.







complain  off-out of present put worn


1 4.3    Complete the sentences with the correct form of the verb present.

1  A 67-year-old man........... with a 9-month history of increasing shortness of breath.

2  The most common.......... is loss of consciousness.

3  Cranial arteritis may............. as fever without any obvious causes.

4  The patient usually............ with a severe sore throat.

5  The.............. symptoms in this patient could perhaps be due to renal failure.

6  Other conditions with a similar....... include acute cholecystitis.

7  Reduced growth is an important.......... complaint of cocliac disease.

8Two months following.......... the patient was able to walk.



I 4.4    Read the patient's description of her symptoms then complete the case report. Look at С

opposite to help you.

I was well until a few months ago. In the beginning, I just felt  off-colour and a bit tired. But lately I've been feeling completely worn out at the end of the day. I'm not eating any more than usual but I've put on nine kilos in the last year. My motions are hard and my hair has started to fall out.


                                                                                                                                   A 50-year-old housewife, who had been well until four months previously,

(1)............... of tiredness and

(2)................ She had (3).............

9 kg in weight in the year before she

(4)............... to her GP although she

denied eating more than usual. She was

(5)............... and she noticed that her

hair had started to fall out


Over  to you

I haven't been myself for several months now. I feel completely worn out  after doing anything. I've been off my food and I've lost ten kilos in weight.

Write a short CMC report about this 60-year-old man:


Write in the past tense and use medieal terms for the underlined expressions

Practise writing similar case reports for your own patients.




Full blood count

In the investigation of blood diseases, the simplest test is a full blood count (FBC). Л full blood count measures the following in a sample of Mood:

·                the amount of haemoglobin

·                the number of the different cells - red blood cells (erythrocytes), white blood cells (leucocytes) and platelets (thrombocytes)

·                the volume of the cells

·        the erythrocyte sedimentation rate (HSR) - a measurement of how quickly red blood cells fall to the bottom of a sample of blood.


Anaemia is one of the commonest diseases of the blood. It may be due to:

        bleeding - loss of blood

        excessive destruction of red cells

        low production, for example because the diet is lacking, or deficient in, iron (Fc).

Pernicious anaemia

Jordi Pons, the medical student from Barcelona, has made some language notes in his textbook.

Pernicious anaemia (PA) is a condition in which there is atrophy of the gastric mucosa with consequent failure of intrinsic factor production and vitamin B12 malabsorption. The onset is insidious, with progressively increasing symptoms of anaemia. Patients are sometimes said to have a lemon-yellow colour owing to a combination of pallor and mild jaundice caused by excessive breakdown of haemoglobin because of ineffective red cell production in the bone marrow. A red sore tongue (glossitis) is sometimes present. Patient; present with symmetrical paraesthesiae in the fingers and toes, early loss of vibration sense, and progressive weakness and ataxia. The spleen may be palpable.





onset = beginning

insidious = slowly developing

pallor = lack of colour

mild = slight

jaundice = bilirubinaemia

breakdown= division into smaller parts

bone marrrow = soffc tissue in the cavity of bones

sy mmetrical=each size the same

vibration abrsense = ability to feel vibrations

progressive = continuing to develop

 palpable = can be felt with the band


1 5.1    Find words in the box with opposite meanings. Look at В and С opposite to help you.














1 5.2    Make word combinations using a word from each box. Look at В and С opposite to help you.
























Complete the sentences. Look at Л, В and С opposite to help you.

1 A 39-year-old man presented with a history of………………………..abdominal distension over a

period of six months.

2  Blindness may be caused by vitamin A    …………………

3  The bleeding and purpura arc caused by abnormal...... function.

4  The white cell count is normal so we can... acute leukaemia.

5  The yellow colour of her skin and conjunctivae is probably due to----

6  There was a mass in the right upper quadrant of the abdomen.

7  Treatment is aimed at restoring fluid balance with........ intravenous fluids.

8  The anaemia may be due to increased red cell……………………….






5.4   Complete the conversation. Look at С opposite to help you.

Professor: Student:




Professor: Student:

What is against the diagnosis of pernicious anaemia on physical examination?
The problem started quite suddenly. So it didn't have the typical (1)  …………….He doesn’'t have any skin (2)………………………………and he doesn't have

(3)……………….paraesthesiae. or absent (4)..... sense, and I couldn't

feel his spleen.

What about his tongue?

His tongue was normal and not inflamed or (5).................. .

Over  to you

List Ihe causes of anaemia mentioned in the conversation in В opposite. Then choose another condition that you encounter regularly and make a similar list of the causes in English. Use the index to help you.








Some common English names for bones:


English name

Anatomical name

jaw bone



vertebral column









shoulder blade


thigh bone








A fracture is a break in a bone. Some of the different types of fracture:







Open (compound)



A pathological fracture is fracture in a diseased bone. A fatigue or stress fracture is due to repeated minor trauma, for example long-distance marching or running.



Treatment of fractures

When the fragments of a broken bone heal and join together, they unite. Union may he promoted, or helped, by reducing the fracture - replacing the fragments in their anatomical position if they are displaced. After reduction, excessive movement of the broken bone is prevented by fixation - either external, for example a splint or plaster of Paris cast, or internal, for example a pin or a plate and screws. A displaced fracture which is not reduced may result in malunion - incomplete or incorrect union.

Note: The verb reduce has several meanings in medicine.

·                to make smaller - I think we'd better reduce the dose of your tablets.

·                (in surgery) to return to anatomical position - A hernia can normally be reduced by manipulation.

·                (in chemistry)to remove oxygen or add hydrogen - Nitric acid is a reducing agent.


1 6.2    Match the types of fracture (1-5) with the descriptions (a-e). Look .it li opposite to help you.

1  open

2  comminuted

3  displaced

4  greenstick

5  impacted


a There in a hrt.it in the skin.

b The bone is bent. It occurs mainlv in children.

с The bone is broken into several pieces.

d The broken pieces are separated.

e The broken pieces are pushed together.


16.3    Complete the textbook extract. Look at С opposite to help you.


(1)………………….a fracture involves trying to return the bones to as near to their original

position as possible. If a fracture is allowed to heal in a displaced position the fracture
will (2)
…………………….but it may go on to (3)………………..

Over  to you

You have diagnosed a stress fracture of the tibia in a young female dancer. How would you explain to her the cause and management of this condition?




Childhood is the period during which a person is a child. It ends with puberty - the onset of sexual maturity. Infant is another word for a young child; infancy is the period from birth until about five years of age.

The milestones in a child's development and the ages at which they usually occur are:

        sitting - by 9 months

        crawling - by 12 months

        first words - by IK months

        walking - by 18 months

        talking (two-word sentences) - by 3 years.

Common infectious diseases



Common name




German measles



infectious parotitis



whooping cough

acute laryngotracheitis



scarlet fever

rheumatic fever

rheumatic fever






Coeliac disease

A medical student has made some language notes while reading her textbook.

Coeliac disease is a disease of the small intestine caused by sensitivity to gluten. Ii can ptesent at any age but in infancy it appears after weaning on to cereals containing gluten. The clinical features include diarrhoea, malabsorption and failure to thrive. There may be signs of malnutrition and there may be some abdominal distension. There is delayed growth and delayed puberty, leading to short  stature in adulthood.

·        Sensitivity  to = having a negative

·        reaction,

·        to weaning = changing the diet from milk only to solid foods clinical features

·        the symptoms and signs of a disease malabsorption = poor  absorption

·        Malnutrition = poor diet (nutrition)

·        adjective = malnourished

·        thrive = grow strongly

·        distension= swelling

·        delayed = later than expected

·        failure = when something that is expected does not happen

·        stature = size, especially heigh1



Complete the table with words from A and С opposite. Then complete the sentences with words from the table.




Adject ive(s)























1  Babies with the fetal alcohol syndrome may present with...... to thrive.

2  Abdominal may be due to an enlarged liver.

3  Small amounts of alcohol in pregnancy can affect fetal …………………..

4  Mortality from measles can be reduced by better………………………..

5  ……………………..in one or more of the milestones may be the first sign of disease.


Complete the sentences. Look at A and С opposite to help you.

1   Alter sitting, babies learn to             and then to walk.

2   A child who has started eating solid food has been .......

3   Someone who is not very tall is said to be of short-----

4   The stages in a child's development arc known as the ……………………………….

5   A child who is beginning to develop sexually has reached………………………………..



Write the common English name for each disease, using your medica knowledge.

·                enlarged parotid glands difficulty opening the mouth rash and enlarged posterior occipital nodes

·                paroxysmal coagh with vomiting papules and vesicles,

·                first on trunk cough and cold followed by rash sore throat and rash

·                swollen joints and a heart murmur

·      fever followed by muscle weakness

·      cough with stridor


What are the main childhood illnesses in your country? What are the clinical features of those illnesses?

Over to you




The endocrine system


Excess and deficiency

Sufferers of type I diabetes are deficient in insulin.

An excess - too much, or a deficiency - too little, of circulating hormones causes a wide range of medical conditions, for example hyperthyroidism and hypothyroidism. Where there is an excess of hormone, one form of treatment consists of giving the patient something which inhibits the production of that hormone, as in the ase of carbimazolc to treat hyperthyroidism. When a hormone is deficient, treatment may be by replacement therapy, for example injections of insulin in the treatment of Type I diabetes.

Doctors say:


Negative feedback systems





TRH (thyrotrophin-releasing hormone) is secreted in the hypothalamus and triggers the production of TSH (thyroid-stimulating hormone) in the pituitary.

1        TSH stimulates the TSH receptor in the thyroid to increase synthesis of both T4 (thyroxine) and T3 (triiodothyronine) and also to release stored hormone, producing increased plasma levels of Т4 and T3.

2        T3 feeds back on the pituitary and perhaps the hypothalamus to inhibit TRH and TSH secretion



An enlarged thyroid gland is called a goitre. The enlargement may be diffuse - involving most of the gland, or localized — limited to a particular area, as in a solitary (single) nodule. The increased blood flow in diffuse enlargement, for exampb in Graves' disease, may give rise to a palpable thrill - vibration felt with the hand, and an audible bruit - noise heard through a stethoscope, over the gland.

A letter of referral

Mrs Davis's doctor has referred her to an endocrinologist.

Dear Doctor.

I would be grateful if you would see this 50-year-old woman who has lost 20 kilos in weight in spite of eating more than usual. She describes herself as overactive and at first she thought the weight loss was due to this. But more recently she has developed palpitations, diarrhoea, and heat intolerance. She has noticed that her hands have a tendency to shake.

Her symptoms suggested hyperthyroidism and this was confirmed by my examination which revealed an erlarged thyroid, red sweaty palms and a fine tremor of the hands.


1 8.1   Complete the table with words from А, В and С opposite and related forms. Put a stress mark in front of the stressed syllable in each word. The first one has been done for you.

Verb                         Noun















1 8.2    Complete the passage from a textbook, using the illustration and your own knowledge. Look at В opposite to help you.

Pulses of GnRH (honadotrophin-releasing hormone) are released fron hypothalamus and………………………………………..

Lfl and FSH (2) ...............  from the pituitary. LH

(3) ...............  testosterone (4) .........  from

Leydig cells of the testis.

Testosterone    (5)    ..............     back    on    the

hypothalamus/piluitary to (6) ...................  GnRH

(7) .... FSH (8) .  the Sertoli cells in the seminiferous tubules to (9)       …….mature sperm and the inhibins A and B. Inhibin
causes feedback on the pituitary to decrease FSH


18.3   Complete the sentences. Look at Л and С opposite to help you.

1   A... change affects many pans of an organ or gland.

2   A.. change affects only one part.

3   His diet is............. in iron: he doesn't get enough iron.

4............ Т3 and T4 increase the basal metabolic rate.

1 8.4    Match Mrs Davis's symptoms (1-7) with the questions her doctor asked (a-g). Look at D

opposite to help you.

1  diarrhoea                 

2  eating more              

3  heat intolerance         

4  overactivity              

5  palpitations               

6  weight loss               

7  tremor                     

a. Do you prefer hot weather or cold? Is your weight steady?

b. What is your appetite like?

c. Are your bowels normal?

d. Are you able to sit and relax?

e. Do your hands shake?

 f. Have you ever felt your heart beating rapidly or irregularly?


Write a referral letter to an endocrinologist for a patient who you believe has hypothyroidism. Use the letter in D opposite as a model.

Over to you


The eye

Parts of the eye


Examination of the eye

Here is an extract from a textbook description of how to examine the eye.


Look for squint (strabismus), drooping of the upper lid (ptosis) or oscillation of the eyes (nystagmus). In lid lag. the upper eyelid moves irregulirty instead of smoothly when the patient is asked to look down.

Next examine the pupils and note whether:

they are equal in size

they are regular in outline (evenly circular)

they are abnormally dilated (large) or constricted (small)

they r