五年制专业外语课putting examination together

Chapter22

PuttingtheExaminationTogetherLiuboDept.ofRheumatologyandImmunologyCJUHAphysicianisnotonlyascientistoragoodtechnician.Physician,doctorTechnician,mechanicdoctor,physicianDoctor比physician更通用，主要是指博士学位，哲学博士、经济管理学博士等。如果特别强调医学博士，应该用physician。内科医生外科医师physician；internist

surgeonDoctor主要是指拥有博士学位，哲学博士、验光博士、骨科博士、牙科博士、教育学博士、神学博士、药学博士、工商管理学博士等。Ph.D.DoctorofPhilosophy哲学博士，DOdoctorofoptometry验光博士,doctorofosteopathy骨疗法博士,骨科博士，DDSdoctorofdentalscience牙科学博士，doctor,physicianDoctor主要是指拥有博士学位，哲学博士、验光博士、骨科博士、牙科博士、教育学博士、神学博士、药学博士、工商管理学博士等。EdDdoctorofeducation教育学博士，DDdoctorofdivinity神学博士,DPHDoctorofPharmacy药学博士doctorofpublichealth公共卫生学博士，DBADoctorofBusinessAdministration工商管理学博士。doctor,physiciantechnician,mechanictechnician技师，技术员；技巧纯熟的人

mechanic技工，机修工

mechanic的职位低，机械工,修理工，劳力劳动者，而technician所掌握的技术层面高。

Hemustbemorethanthat—hemusthavegoodhumanqualities.Hehastohaveapersonalunderstandingandsympathyforthesufferingofhumanbeings.AlbertEinstein(1879–1955)humanqualities人文素质sympathyhavesympathyforexpresssympathyforinsympathywithoutofsympathywithwinsympathyof同情**人对**表示同情（慰问）同情、赞成不赞成博得**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.个人的;

独特的;

个别的;

n.个人;

个体;

Personaladj.个人的，私人的personal个人的,一般形容和人有关的individual可用在人也可用在事务上Thepurposeofthischapteristohelpthestudentassimilateeachoftheindividualexaminationsintoonecompleteandsmoothlyperformedexamination.assimilatevi.吸收，消化；同化；vt.透彻理解；

使吸收Ideally,acompleteexaminationisperformedinanorderly,thoroughmannerwithasfewmovementsaspossiblerequiredofthepatient.Perform,operationperformanoperation动手术

performanoperationonsb.foradisease给某人实施某个疾病的手术performingthephysicalexaminationexaminationisperformedPerform,operationputintooperationbringintooperationoperateonsb.

operateuponsb.undergoanoperation实施,施行实施,施行给某人动手术给某人动手术接受手术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.考试失败是由懒惰造成的。Resultin,导致

in介词,因此后面跟名词或动名词,即:resultinsth./doingsth.

Failurewillresultinfrustration.

失败会导致挫败心理

Hislazinessresultedinfailingintheexam.

他的懒惰导致考试失败

dueto,becauseof,owingto三者均可表示“由于”、“因为”，按照传统语法：dueto

主要引导表语，而becauseof,owingto

两者都主要引导状语。如：Hisillnessisduetobadfood.他生病是由于吃了不好的食物。Theaccidentwasduetocarelessdriving.这次车祸起因于驾驶疏忽。Hecan’tcomebecauseofthebadweather.他不能来是因为天气不好。Owingtotherain,thematchwascancelled.比赛因雨被取消了。但是在现代英语中，dueto

也可用来引导状语，而owingto

也可以用来引导表语。如：由于交通拥挤他迟到了。正：Hewaslatedueto[owingto,becauseof]theveryheavytraffic.正：Dueto[Owingto,Becauseof]theveryheavytraffic,hewaslate.becauseof

通常只用来引导状语，若引导表语，主语通常应为代词。Itisallbecauseofwhatyousaid.那完全是因为你说的话。Errorsintechniquearerelatedtolackoforderandorganizationduringtheexamination,faultyequipment,andpoorbedsideetiquette.Errorsofomissionarecommoninexaminationsoftheeyeandnose;auscultationoftheneckvessels,chest,andheart;palpationofthespleen;rectalandgenitalexaminations;andtheneurologicexamination.etiquetten.礼仪、礼节、规矩、礼数genitaladj.生殖的，生殖器的;

n.生殖器，外阴部Errorsofdetectionarethoseinwhichtheexaminerfailstofindabnormalitiesthatarepresent.Themostcommonerrorsofthistypeinvolvethyroidnodules,trachealdeviation,abnormalbreathsounds,diastolicmurmurs,hernias,andabnormalitiesoftheextraocularmuscles.trachealadj.气管的，导管的，呼吸管的diastolicadj.心脏舒张的;

hernian.<医>疝气;

突出;

Errorsininterpretationoffindingsoccurmostcommonlywithtrachealdeviation,venouspulses,systolicmurmurs,fremituschanges,abdominaltenderness,liversize,eyefindings,andreflexes.Themostcommontypesofrecordingerrorsarerelatedtodescriptionsofheartsizeandmurmurs,improperterminology,andobscureabbreviations.systolicadj.心脏收缩的;

fremitusn.震颤;

ThefollowingexaminationsequenceistheonetheauthorusesandisdemonstratedintheDVD-ROMenclosedwiththisbook.Thereisnorightorwrongsequence.Developyourownapproach.Justbesurethatattheendofwhichevertechniqueyouuse,acompleteexaminationhasbeenperformed.DevelopDevelop发展、开发。tostudy,thinkout,ortalkaboutindetailtobegintobeseenoreactive例句：ThesymptomsofCRFoftendevelopslowly.Thegeneralconsensusisthat60%oflupuspatientswilldevelopclinicallyrelevantnephritisatsometimeinthecourseoftheirillness.MostSLEpatientsdevelopnephritisearlyinthecourseoftheirdisease.Inmostsituations,thepatientwillbelyinginbedwhenyouarrive.Afterintroducingyourselfanddocumentingacompletehistory,youshouldinformthepatientthatyouarereadytobeginthephysicalexamination.Alwaysstartbywashingyourhands.ThereaderisadvisednowtowatchthevideopresentationontheDVD-ROMtoreviewthecompletephysicalexaminationofthemanandthebreastandpelvicexaminationsofthewoman.TheDVD-ROMwillhelpyouputtheexaminationtogether.

pelvic

adj.骨盆的，关于骨盆的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‘‘agradeIII/VIholosystolicmurmurattheapexwithradiationtotheaxilla’’ispresentratherthan‘‘amurmurofmitralinsufficiency.’’holosystolicadj.全收缩（期）的;

apexn.顶;

顶峰;

尖；脉尖;

尖端;

axillan.咯肢窝，腋窝;

mitralinsufficiency二尖瓣关闭不全;

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生命体征hyper-,hypo-,kerat/o-,keratolytic,keratosis,

keratinpapulen.丘疹，长疮;

小乳头escutcheonn.有花纹的盾，锁眼盖，孔罩;饰框pubichair阴毛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.黄斑瘤;

睑黄斑。bilateralarcussenilispresent;conjunctivaewithoutinjection;opacitiespresentinbothlenses,R>L;leftdiscsharpwithnormalcup–discratio;normalarteriovenous(AV)ratioOS;noAVnickingpresentOS;arcussenilis老年环;

conjunctivaen.（眼球）结膜(conjunctiva的名词复数);opacityn.不透明性;

费解;

难懂;

模糊;

lensn.透镜，镜头(lens的名词复数);

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

lenticularadj.透镜的，小扁豆似的;

构词法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，鳍(pinna的名词复数)cerumen耵聍，耳垢，耳屎

lateralizationn.（尤指脑部的）偏侧性，偏侧优势，偏利;tympanicmembranes鼓膜Nose:Nosestraightwithoutmasses;patentbilaterally;mucosapinkwithacleardischargepresent;inferiorturbinateontherightslightlyedematous.patentn.专利;

adj.专利的;

显露;

inferiorturbinate[医]下鼻甲;

supraturbinal上鼻甲Sinuses:Notendernessdetectedoverfrontalandmaxillarysinuses.frontalsinuses额窦maxillarysinuses上颌窦Throat:Lipsslightlycyanoticwithoutlesions;patientwearsanupperdenture;buccalmucosapinkwithoutinjection;alllowerteetharepresentandareinfaircondition;noobviouscaries;gingivaenormal;tonguemidlinewithoutfasciculations;cyanotic紫绀denturen.假牙buccaladj.（面）颊的，口的，口腔的;

口甲;

cariesn.龋齿，骨疡gingivaen.齿龈fasciculationn.束状;

簇生;

（肌肉、神经的）自发性收缩;

肌震束颤;nolesionsseenorpalpatedontongue;mildinjectionofposteriorpharynxwithyellowish-whitedischargepresentonposteriorpharynxandtonsils;tonsilsminimallyenlarged;uvulaelevatesinmidline;gagreflexintact.pharynx咽tonsiln.扁桃体;

uvulan.悬雍垂，小舌;gagreflex咽反射Neck:Supplewithfullrangeofmotion;tracheamidline;small(1-to2-cm)lymphnodesarepresentinsuperficialcervicalandtonsillarnodechains;thyroidborderspalpable;nothyroidnodulesorenlargementnoted;noabnormalneckveindistentionpresent;neckveinsflatwhilepatientissittingupright.trachea气管superficialcervical颈浅Chest:Anteroposterior(AP)diameterincreased;symmetricexcursionbilaterally;tactilefremitusnormalbilaterally;chestresonantbilaterally;vesicularbreathsoundsbilaterally;coarsebreathsoundswithoccasionalcracklespresentatthebases.tactilefremitus触觉震颤chestresonant语音共振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）心尖搏动intercostalspace（ICS）肋间midclavicularline(MCL);锁骨中线normalphysiologicsplittingpresent;noheavesorthrillsarepresent;S1andS2distant;agradeII/VIhigh-pitchedholodiastolicmurmurisheardatthe2ICSattherightuppersternalborder;agradeI/VImedium-pitchedsystoliccrescendo-decrescendomurmurisheardintheaorticarea;thesystolicmurmurismidpeakingsternaladj.胸骨的crescendo-decrescendo递增递减

Vascular:Acarotidbruitispresentontheright;nobruitsareheardovertheleftcarotid,renal,femoral,orabdominalarteries;lowerextremitiesareslightlycoolincomparisonwithupperextremities;carotidn.&adj.颈动脉（的）bruitn.[医学]（听诊时所听到的）杂音;

femoraladj.股骨的，大腿骨的，大腿的;

n.股动脉

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

varicosities[医]静脉曲张，静脉曲张状态;calfn.牛犊;

犊皮;

腓，腿肚子;

stasis瘀Abdomen:Theabdomenisscaphoid;arightlowerquadrant(RLQ)appendectomyscarandaleftlowerquadrant(LLQ)herniorrhaphyscararepresent;bothscarsarewellhealed;a3×3cmmassisseenintheRLQaftercoughingorstraining;noguarding,rigidity,ortendernessispresent;scaphoidadj.船状的-oiddiscoid,rheumatoidappendectomyn.阑尾切除术herniorrhaphynovisiblepulsationsarepresent;bowelsoundsarepresent;percussionnoteistympaniticthroughouttheabdomenexceptoverthesuprapubicregion,wherethepercussionnoteisdull;liverspanis10cmfromtoptobottomintheMCL;bowelsounds肠鸣音tympanitic气鼓的，鼓响的suprapubic耻骨弓上的;

spleenpercussedinleftupperquadrantbutnotpalpated;kidneysnotfelt;nocostovertebralangletenderness(CVAT)present;aneasilyreduciblerightindirectinguinalherniaisfeltattheexternalring.costovertebral肋椎的：属于肋骨与椎骨的inguinalhernia腹股沟疝;Rectal:Analsphincternormal;nohemorrhoidspresent;nontenderprostateenlargedsymmetrically;prostatefirmwithoutnodulesfelt;noluminalmassesfeltinrectum;stoolnegativeforblood.rectal直肠sphincter括约肌hemorrhoid痔疮prostate前列腺Genitalia:Circumcisedmanwithnormalgenitalia;peniswithoutinduration;lefthemiscrotum4to5cmbelowtheright;palpationoflefthemiscrotumrevealsdilatationofthepampiniformplexus;softtestes2×3×1cmbilaterally.genitalia生殖器circumcised割礼

penis阴茎induration硬化、结节pampiniformplexus精索静脉丛Lymphatic:Nodesinanteriortrianglechainsalreadynoted;twofirm,1-to2-cm,rubbery,freelymobilenodesinleftfemoralarea;noepitrochlear,axillary,orsupraclavicularnodesfelt.anteriortriangle颈前三角.rubbery橡皮样的、弹性femoral股骨epitrochlear肱骨内上髁axillary腋窝supraclavicular锁骨上窝Musculoskeletal:Distalinterphalangealjointenlargementonbothhands,causingpainonmakingafist,L>R;notendernessorerythemapresent;proximaljointsnormal;neck,arms,hips,knees,andankleswithfullrangeofactiveandpassivemotion;musclesappearsymmetric;mildkyphosispresent.distalinterphalangealjoint远端指（趾）间关节erythema红斑kyphosis脊柱后凸Neurologic:Orientedtoperson,place,andtime;cranialnervesItoXIIintact;grosssensoryandmotorstrengthintact;cerebellarfunctionnormal;plantarreflexesdown;gaitnormal;deeptendonreflexesasshowninTablecerebellar小脑plantar跖gait步态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