Exercises:
1. Write the abbreviations in words. Look at A and C to help you.
c/o ……………………………
2/52 ……………………………
PH ……………………………
FH ……………………………
MI ……………………………
BP ……………………………
1/12 ……………………………
nil ……………………………
SH ……………………………
a&w ……………………………
OE ……………………………
CXR ……………………………
Put the sections of a short informal case presentation in the correct form. Look at A to help you.
Mr. Collins is a 60-year-old security guard.
There was no relevant previous medical history.
He smokes 20 cigarettes per day and drinks 15-20 units of alcohol each week.
On examination, there was marked tenderness around the lower legs above the ankles and knees. There was nothing else abnormal to find on examination.
He presented with a six-week history of pain in the legs.
Chest X-ray showed consolidation in the left lower lobe. Bronchoscopy and biopsy showed adenocarcinoma of the lung and computed tomography (CT) scan showed that this was not resectable.
Treatment with chemotherapy has resulted in temporary improvement in the chest X-ray but the leg pain has continued to prove difficult to control.
The pain, which was located around the ankles, had been increasing in intensity and was associated with local tenderness.
On routine questioning, he said that he had had a morning cough.
3
.
Read the representation below and make notes for a slide. Look at C
to help you.
tenderness - болезненность
consolidation - уплотнение
apyrexia - отсутствие температуры
costal – реберный
Review of Systems.
In this part of medical history, the physician asks a number of systematic questions about all major organ systems to double-check any possibly forgotten items or complaints. One should not repeat the chief complaint or any symptoms mentioned above.
General: ask about any recent weight change, fever, bleeding, lumps, syncope, dizziness, rashes, intolerance for heat and cold.
Head: any visual changes, loss of hearing, dental problems, sore throat or a hoarse voice.
Respiratory system: any cough, shortness of breath, asthma, chest pain, chronic lungs disease.
Cardiovascular system: any edema of the ankles, angina pectoris, paroxysmal nocturnal dyspnea, palpitations, dizziness, dyspnea on exertion, blood clots; any history of rheumatic fever, hypertension, or heart disease in the past.
Gastrointestinal system: any heartburn or dyspepsia, nausea, abdominal pain, appetite changes, food intolerance, pancreatitis, or peptic ulcer disease in the pas.
Central nervous system: any seizures, loss of consciousness, paralysis, numbness, tremor, and headaches.
Psychology: check the patient’s sleep, any anxiety, depressions, fatigue, change of memory.
Unit 23 Explaining Diagnosis and Discussing Treatment
Lesson 1
Explanations
The final part of a consultation is the explanation which should cover:
The diagnosis – identification of a disease from its signs and symptoms.
You're suffering from …
You've developed …
You have …
This is (mainly) because …
This is why …
The management plan, including investigations and treatment.
I'll make you an appointment with …
I'm going to start you on medication to …
I'm going to have you admitted to …
I'll arrange for you to …
You'll be given …
I expect you'll have …
They may advise …
General advice about any change in lifestyle that may be needed, for example giving up smoking or drinking less alcohol.
The nurse will give you advice on …
You should try to give up …
I want you to …
It's important that you …
The prognosis – what is likely to happen because of a disease, stressing that nothing is certain.
I expect the treatment will …
Hopefully we can …
We can never be absolutely certain about …
Question time – where the patient can ask questions about his/her illness.
Do you have any questions?
Is there anything you'd like to ask?
Using lay terms in explanation.
Explanations should be given in words the patient will understand, avoiding medical jargon. Using lay terms – words familiar to people without medical knowledge – can help patients understand explanations.
An
explanation of angina
Having examined you, I'm confident that you're suffering from angina.
The heart is a pump. The more you do physically, the harder it has to work. But as we get older, the blood vessels which supply oxygen to the heart begin to harden and get furred up, so they become narrower. They can't supply all the oxygen the heart needs. The result is the pain you feel as angina.
Because you're experiencing pain at rest as well as on exertion, I'm going to have you admitted to the coronary care unit right away so that your treatment can start at once. You'll be given drugs to ease the pain and I expect you'll have an angiogram. They may advise surgery or angioplasty – that's a way of opening up the blood vessels to the heart so they can provide more oxygen.
You should try to give up smoking. You won't be able to smoke at all in hospital so it's a good time to stop.
I expect the treatment will improve your pain at least and may get rid if it completely. We can never be absolutely certain about the future but you should remain optimistic. Do you have any questions?