Unit 11. Phthisiology

&Pulmonary tuberculosis

Pulmonary tuberculosis is a specific widespread communicable disease usually chronic but occasionally acute.

The disease may result from the inhaling of dust containing basillus tuberculosis, from droplet infection and from the contact with contaminated objects.

The early symptoms are usually very insidious. Loss of weight, appetite, and strength, a chronic cough, and a low temperature, which is usually more elevated toward night, persistent night sweats are common complaints. As the condition progresses the patient may start to expectorate material after a paroxysm of coughing. In case of the caseous change of the affected lung tissue, erosion of blood vessels by the pathogenic process may occur and the expectoration of some amounts of blood results.

If the patient secures the proper treatment and if his resistance is good the disease process may be checked and fibrosis will occur in the diseased area with the improvement in the clinical symptoms.

Every year TB is contracted by 8 million people throughout the world and kills up to 3 million.

Tuberculosis being a social disease, experts account for it (объясняют это) by declining living and sanitary conditions, poor nutrition, the appearance of new risk groups – refugees, tramps (беженцы, бомжи) and the growing number of people who have not been integrated into society.

1 Word-box

1. acute – острый

2. occasionally – иногда

3. inhaling – вдыхание

4. droplet infection – воздушно-капельная инфекция

5. contaminated – зараженный

6. insidious – коварный

7. toward – к

8. expectorate – отхаркивать, откашливать

9. paroxysm – приступ

10. caseous – казеозный

11. erosion – эрозия, разъедание, разрушение

12. secure – получать

13. fibrosis – фиброз, образование волокнистой ткани

14. contract – подхватить (болезнь)

15. declining – ухудшение

16. integrate – составлять единое целое

Упр.1. Найдите в тексте английские эквиваленты следующих словосочетаний:

туберкулез легких; заразное заболевание; хроническое, острое; вдыхание пыли; воздушно-капельная инфекция; зараженные объекты; хронический кашель; потоотделение в ночное время; откашливать; казеозное изменение; пораженная ткань легкого; поражение кровеносных сосудов; отхаркивание некоторого количества крови; соответствующее лечение; фиброз; больной участок; улучшение клинических симптомов; приступ кашля.

Упр. 2. Продолжите предложения

1. Pulmonary tuberculosis is …

2. The disease may result from …

3. Common complaints are …

4. The early symptoms are …

5. As the condition progresses the patient may …

6. In case of the caseous change of the affected lung tissue …

7. If the patient secures …, and if his resistance is good …

Приложение

Unit 2. Ex. 9.

A - Will you pass me my glasses? Then I'll be able to see the television.

B -Here you are.

A -Thanks. Oh, and will you do me another favour?

B - What now?

A -Will you help me stand up? I want to switch it on.

B- You'll probably fall over. I'll do it.

A -Thank you. I won't trouble you again.

Unit 3, Ex 3.

P = Presenter, A = Dr Adam Petrou

P - First on today's show, we'll be talking about congestive heart failure, which affects around one million people in the UK. I have with me cardiologist Dr Adam Petrou... Adam, what is heart failure?

A - Congestive heart failure occurs when the heart's ventricles are unable to pump enough blood to the body - the left one is usually the first to fail. This leaves the body short of oxygen, and also causes fluid to build up in the body's tissues and in the lungs.

P - What are the common symptoms?

A - It usually leaves sufferers extremely tired and breathless. The ankles often swell up, too.

P - So what causes heart failure?

A - Often, the heart has been damaged by a heart attack or by coronary heart disease, or simply by high blood pressure. These things can change the shape and thickness of the heart muscle, reducing its efficiency. Also, if the rhythm of the heart is irregular, over time this can cause heart failure.

P - How is heart failure diagnosed?

A - The best way is by echocardiogram, which is an ultrasound examination that gives us a clear image of the chambers of the heart in action.

P - And the treatment?

A - As with most heart problems, self-help is vital; by following an exercise programme, patients can greatly increase their energy and improve their breathing. Diuretics help reduce the fluid build-up, and make patients more comfortable too. The main drugs that work on the heart are ACE inhibitors and beta-blockers. ACE inhibitors dilate the blood vessels and bring down blood pressure. This reduces the pressure on the heart. Beta blockers have a calming effect on the heart -they keep it beating with an efficient, regular rhythm.

P - And pacemakers can help with this too, can't they? Can you say a word about them?

A - Yes, we do use pacemakers. These are small electrical devices that are implanted under the skin and attached to the heart by two wires. They send impulses that make sure the heart keeps a steady rhythm.

P - So what's the prognosis for people with heart failure?

A - The prognosis is not great - between 10 and 60 per cent of patients will die within a year of being diagnosed, so in many cases, the treatment aims to improve the quality of life rather than cure the problem.

P - Dr Adam Petrou, thank you.

Unit 3, Ex.8

D = Doctor, M = Marie

D – Hello, Marie, Thomas?

M – Yes, that’s me.

D – Hi, Mrs Thomas. Do you mind if a student observes the examination?

M – No, that’s fine.

D – Great. So Mrs Thomas is 35.

M – That’s right.

D - And can you tell us what the problem is?

M -Well, the main thing is my breathing. I find it very hard to breathe when I go to bed. I have to stop to have a rest halfway up the stairs.

D - I see. Does anything make it easier to breathe?

M-Yes, it's easier if I sit up in bed, so that's how I sleep.

D - How long have you had this problem?

M -For about a year, I'd say. It's been bad for about two months.

D- Do you have any pain?

M -Yes. In the last three weeks or so, I've been getting pains down my left arm. I decided to come and see you when it got really bad.

D - Can you describe the pains?

M -Well, shooting pains, really. Starting at the top and going down to the bottom.

D - OK. Any other problems?

M -I've been sweating a lot, even though the weather's not hot.

D Have you been eating OK?

M -No, not really. I've lost my appetite.

D- Do you take exercise?

M- No. I avoid doing exercise when possible. That's why I'm so overweight! I tried walking for ten minutes a day, but it almost killed me.

D- We've got your weight here. 92 kilos. Do you drink?

M- I enjoy having a glass of wine with dinner. That's all.

D - Smoke?

M -I'm afraid so - about a packet a day.

D - Of course, I'd advise you to stop smoking.

M -Yes, I know. My kids are always asking me to give up. I've tried to stop lots of times, but I haven't managed to kick the habit.

D - Does anyone in your family have heart problems?

M -Yes, my mother has angina, and my dad died of a heart attack.

D - Any diabetes in the family?

M -No.

D - And your blood pressure was taken earlier and was... 160/80.

M -I've always had high blood pressure.

D- Right, I'm checking the ankles for oedema, and yes, they're very swollen. Now let's have a listen to your heart... and there are clear murmurs there. I'll have a listen to your lungs now. And I can hear abnormal sounds right and left. That sounds like there's some fluid there. And finally I'll listen to the abdomen. Bowel sounds present. If I press it, is there any tenderness?

M -No - it's a bit swollen though.

D - Yes, no masses, but some oedema.

Unit 4, Ex. 3

O = Ophthalmologist, T=Teri, D=Dean

O - Teri, have a look at this and tell me what you see.

T - The patient's eyes are bloodshot and watery.

O - Yes, clearly an inflammation of the surface membrane.

T - Do your eyes itch, Dean?

D - Yes. I want to rub them all the time.

T - Well, you mustn't do that.

O - Has anyone else in your family got the same problem?

D - Yes, my sister and my mum. They've both got it.

PI = patient

O - Have you been fighting?

PI - No, doctor, it was an accident. I fell out of a tree.

O - You've got some nasty bruising around your eye. Have a closer look, Teri.

T - I can see blood in the eye and something else, some foreign body embedded in the cornea, just next to the tear duct.

P2 = patient

O -First of all, is there any pain?

P2 - No, none at all, just blurred vision. I haven't been able to see well for over a year.

O - Any ideas, Teri?

T - Well, blurred vision is often the result of a clouding of the lens. You can see that from

here.

O -Do you get double vision - when you see two of everything?

P2 - Sometimes I do, yes. I need a bright light to read and all colours look dull.

P3=patient

O -So, tell me what happened.

P3 -Well, I've gone almost completely blind in my right eye. If I close my left eye, I can't see

much at all. At the best, everything looks misty and with haloes.

O - Uh huh. Teri, can you describe the patient's right eye?

T - The pupil is enlarged, oval-shaped, and bulging.

O - OK. Let's find out about other symptoms. Do you ever get toothache?

P3- I do sometimes, yes.

O - And nausea?

P3- Yes, that's right, I do.

Unit 7, ex. 6

N=Nurse, S =Student nurse

N Nadine Hartmann’s colonoscopy and biopsy results have arrived from Pathology. I’ve got them here. Shall we go through them together?

S Right. I'll be glad of your help understanding them. Path lab reports are like a secret code!

N Like everything, they're easy when you know how. Look at this, for example, at the top of the page; 'polyp of sigmoid colon'.

S 'Polyp of sigmoid colon'?

N That's the specimen they analysed.

S I see - a polyp from her lower colon.

N So... it goes on... 'polyp of sigmoid colon, measuring nought point six by nought point four by nought point three centimetres'. That's the size of the specimen.

S Right.

N Next bit; 'mushroom-shaped specimen surrounded by mucus' - that's what the specimen looks like. Then it says; 'No evidence of stromal invasion.'

S What does that mean?

N That means there is no cancer.

S So does it give a diagnosis?

N Read what it says at the bottom of the page. Under 'Summary', it says 'Colon, sigmoid, endoscopic biopsy: tubular adenoma.'

S Let me work it out. The organ involved is the lower colon. That's where they got the biopsy using an endoscope. The diagnosis is a tubular adenoma.

N That's right; a benign tumour. She hasn't got cancer, but there is a danger of getting it in the future. The next thing we have to do is to write to Mrs Hartmann, explain all this, and arrange an appointment for her to see Dr Monroe to discuss treatment options.

Unit 8, ex. 10

a

D=Doctor, I=Irena

D Mm, that looks nasty.

I Look, the skin's all purple and scaly here.

D That looks quite sore. Is it tender if I press it?

I Ah... yes, it is. It just doesn't seem to be getting better, doctor. It's getting worse, if anything.

D Yes, well, these can be slow to heal.

I What can you give me for it? Antibiotics?

D It's not infected, so antibiotics wouldn't do any good. These are caused by poor

circulation, so you need to do everything you can to help the blood flow out of the leg.

I So I have to put my leg up when I sit down.

D That's right. But also take plenty of exercise and bandage the leg firmly every day - I'll show you how. That will also make it a bit less swollen. Make sure you change the bandage every day, so you don't get an infection. Have you been wearing compression stockings?

I No, I haven't.

D Well, I'll prescribe you some - they should help clear it up.

b

Z = Zak, D = Doctor

Z My wife made me come along because she says this looks a bit suspicious.

D Let's have a look. Have you always had this?

Z Yes, I have. But it used to be round, more or less. It seems to have changed over the last

few months.

D Mm, the shape's fairly irregular, isn't it? And the edge is not clearly marked. How about the

colour? Has that changed too?

Z It has, yes. It was always brown, but now it's much darker in parts.

D Right. And just feeling it with my finger, it feels quite hard and crusty on the top. Does it

itch at all?

Z Yes, it's extremely itchy. It bleeds sometimes when I scratch it. Is it something to worry

about?

D Well, it's certainly worth checking out, especially as you have really fair skin. What

I'll do is make an appointment for you to have a biopsy, so they can have a look at the

skin cells under the microscope.

c

D = Doctor, M = Mother of little boy

D So how's Josh's skin doing?

M It's much worse. It itches so much it drives him crazy. And now he's come out in little blisters.

D Yes, I can see. The skin is quite inflamed.

M It's even bleeding in some places, where he's scratched.

D Ah yes, that looks pretty sore.

M I'm worried about him. Is it going to carry on getting worse?

D No, in fact it will almost certainly get better when he gets older. But it will flare up from time to time. Watch what he eats, in case a particular food makes it worse, and try not to let him get too hot and sweaty.

M Is there anything we can do to make it less uncomfortable?

D I'll prescribe a topical corticosteroid cream for the itching. And keep his fingernails nice and short. Use moisturizing cream on the skin regularly to make it less dry and flaky, but don't use it where the skin is cracked, and avoid clothes made of scratchy materials such as wool.

Unit 9, ex. 9

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