这个婴儿心脏有杂音

这个婴儿心脏有杂音 一、会 话 篇 1(看病 Seeing a Doctor (1) Doctor:The baby has a heart murmur。but this may be normal(Does he seem to be pretty active? 医生: 这个婴儿心脏有杂音，但杂音可能是正常的。他平时看起来很活泼吗? Mother:Oh，yes( 母亲: 哦，很活泼。 Doctor:Does he ever turn blue after eating or after crying? 医生: 他吃奶或哭闹后有发青紫的现象吗? Mother:Well。I haven't noticed anything like that( 母亲: 哦，我没有注意到那样的情况。 Doctor(Does he seem to get tired very often? 医生: 他经常显得疲劳吗? Mother:When he cries a lot he does( 母亲: 当他哭多了就显得疲劳。 Doctor:We'll watch this condition(Is he on any other food than the formula? 医生: 我们要注意这种情况。他除了吃配方奶以外还吃其他食物吗? Mother:No( 母亲: 不吃。 How much formula is he taking? Doctor: 医生: 他吃多少配方奶? Five ounces( Mother: 母亲: 五盎司(注:一盎司等于28(35克)。 Doctor:I mean the total，in a day(Is he up to a quart? 医生: 我的意思是一天的总量多少?能吃到一夸脱吗? Mother:Just about that( 母亲: 差不多一夸脱(注:一夸脱约合1136克)。 Doctor:Well，we usually don't like them to get more than a quart a day. We'll start him on some solids(He's gaining weight nicely，I see„(No other problems? 医生: 呃，我们一般不愿意让他们一天吃一夸脱以上。要开始给他们吃些固体食物。他的体重会增加得很好，我看„„没有其他问题了吧? Mother:I don't think so( 母亲: 没有了。 (2) Doctor:Well，how are you today? 医生: 噢，你今天好吗?、 1 Patient:Not so good( 病人: 不怎么好。 Doctor:I understand you have some pain in the chest? 医生: 我听说你有些胸痛，是吗? Patient:Yes，it's pretty bad( 病人: 是的，相当严重。 Doctor:When did it start? 医生: 什么时候开始痛的? Patient:During the night( 病人: 在晚上。 Doctor:How long have you had the cold? 医生: 你感冒多长时间了? Patient:About a week，I guess( 病人: 我估计大约一周了。 Doctor:Have you been bringing up any phlegm? 医生: 你经常咳痰吗? Patient:Quite a bit( 病人: 咳的相当多。 Doctor:Does it have any blood in it? 医生: 痰里带血吗? Patient:Yes，it does( 病人: 是的，带血。 Doctor:How much? 量多少? 医生: Patient:About half and half( 病人: 痰和血大约各一半。 Doctor:Is it spread a11 through the phlegm，or is it in clots? 医生: 血全散布到痰里呢，还是凝成块? Patient:In cl0ts( 病人:凝成块。 Doctor:I see(Now(on which side have you been having this pain? 医生: 原来如此。你经常在哪一侧胸痛7 ( Patient:Here(Right along here( 病人: 这一侧，就沿这一侧痛。。 Doctor:Have you been short of breath? 医生: 你有过气短吗? Patient:Yes，a little( 病人: 有一点。 Doctor(All right(Now，take a deep breath with your mouth open„(Let it out„( 医生: 好了。现在张嘴做深呼吸。„„呼气„„。 (3) 2 Doctor(Come in(Mr(Papa( 医生: 帕帕先生，进来。 Cousin:Mr(Constantin，Sir(And„ 亲戚: 我是康斯坦丁。嗯„„ Doctor:I'm sorry，the appointment is for Mr(Papa„ 医生: 对不起，约的是帕帕先生。 Cousin:Mr(Papa is my cousin(Uh，he does not speak English(So I come along to explain for him( 亲戚: 帕帕先生是我的亲戚。唔，他还不会讲英语。所以我陪他来为他翻译。 Doctor:Oh，fine，fine( 医生: 哦，好，好。 Cousin:Uh，but you must understand，my English is not so good either and„ 亲戚: 唔，但是你要知道，我的英语也不是太好的，而且„„ Doctor:I'm sure we'll have no trouble at a11(Right，now，what seems to be the problem? 医生: 我肯定我们不会有什么困难的。好，现在请你说说他有什么毛病。 Cousin:Uh，he says he feels dizzy in the head( 亲戚: 唔，他说他觉得头晕。 Doctor:Right(Well，we'll just have a look(Uh，Sir，has he been a bit off colour lately? 医生: 好。我们就来看一看。唔，先生，他近来是不是精神有点不好(身体有些不舒服)? 2(感冒 Cold Doctor:What seems to be the problem? 医生: 有什么问题吗? Patient:I think I have a cold( 病人: 我想我感冒了。 Doctor: How long have you been sick? 医生:您病了多久, Patient: For two days. 病人:两天了。 Doctor:What symptoms do you have? 医生:您有什么症状, Patient: I have a runny nose and I ache all over. 病人: 流鼻涕并且全身痛。 Doctor: Do you have a fever? 医生:您发烧吗, Patient:I haven’t taken my temperature yet，but I feel feverish. 病人: 我还没量过体温，但是我觉着发热。 Doctor: Do you have a cough? 3 医生: 咳嗽吗, Patient: No, I don’t. 病人: 不咳嗽。 Doctor: Do you have a sore throat? 医生: 嗓子痛吗, Patient: Yes ,my throat feels swollen. It’s sore. 病人: 是的，我觉着嗓子肿了，很痛。 Doctor: I want to look at your throat. Open your mouth. Please say ”Ah”. 医生: 检查一下您的嗓子。请张开口说“啊”。 Doctor: It’s only a common cold. Nothing to worry about. You should rest for ’ll write you a certificate for three days’ leave. Here a few days , I is some Chinese traditional medicine, which is very effective for treating cold. You’ll be fine in a few days. 医生:只不过是普通感冒。不要紧的。您需要好好休息几天，我给您开个三天的假条。 这是一些中药，治感冒很有效。我看用不了几天你就会好的。 3(流行性感冒 Influenza (1) Intern: Good Morning，Dr(Zhang. 实习医生: 张医生，你好。 Dr(Zhang: Good Morning(Let’s make the morning ward—round. 你好，咱们查房吧。 张医生: Intern : OK. This is a new patient who was hospitalized last night because of feold boy( brile convulsion. He is a two-year-实习医生:好的，这是一名昨天夜里新收的病人，因高热惊厥入院，是个两岁的男孩。 Dr. Zhang:How about his temperature? Have any antipyretics and Sedatives been given? 张医生: 他的体温情况如何?给过解热药和镇静抗惊厥药了吗? Intern:His temperature is as high as 40(2。C(centigrade)(Aspirin has been given orally(The dose is 150mg(And Sodium Luminal was given intramuscularly(The dose is 75mg(Drugs have already quieted him down( 实习医生: 他体温高达40.2~C，已给阿司匹林150mg口服及鲁米那75mg肌注，药物已经使他安静下来了。 Dr(Zhang:Anything else? 张医生:还给什么了? Intern:Also gave him some fluid，I mean，500rnl of 10, glucose solution with vitamine C 1.0g by intravenous drip，and placed an ice bottle on his forehead( 实习医生: 还给他静点了液体，10,葡萄糖液500ml加维生素C 1g，并在他前 上放置了冰袋。 Dr(Zhang: Well done(Pass me his medical record，please( 4 张医生: 干得好，请把他的病历递给我。 Intern: Here it is( 实习医生: 好。 Dr(Zhang: Thank you(Let me see„present illness( 张医生: 谢谢，让我来看一下„„现病史吧。 Intern: The boy had a fever the day before yesterday，with clear nasal discharge，mild cough，headache，sore throat，anorexia，vomiting and mild diarrhea(His parent regarded it as common cold(and gave him some Aspirin(The following day，Penicillin was given by intramuscular injection，with dose of 400 000U each time, twice a day(It seems not effective( 实习医生: 这孩子前天开始发烧，伴流清涕，轻咳，头痛、咽痛、食欲不振、呕吐 及轻微腹泻。家长认为是感冒，服了阿司匹林。次日肌注青霉素40万U， 每日二次，看起来没什么效果。 (2) Dr(Zhang:Has he ever had the history of febrile convulsion? 张医生: 他既往有高热惊厥史吗? Intern: Yes(The attack occurs each time his temperature is over 39~C(centigrade)( 实习医生:有，每当他体温超过39~C时，就会发生高热惊厥。 Dr(Zhang:Is there an epidemic fever in his kindergarten? 他们幼儿园里有发烧流行吗? 张医生: Intern: Yes，Two-thirds of children in his kindergarten have fever this They have the symptoms similar to his( week( 实习医生: 有，这周幼儿园里有三分之二的孩子都发烧了，症状与他相似。 Dr(Zhang:I see,1et me take physical examination for him( 张医生: 我明白了，来给他查体吧。 Intern: No abnormal signs except for redness and enlargement of his tonsils( 实习医生: 除了双侧扁桃体充血、肿大外，无其他异常。 Dr(Zhang: No rashes? 张医生: 无皮疹吗? Intern: No( 实习医生: 没有。 ( Dr(Zhang: Any blood test? 张医生: 做血液检查了吗? Intern: Yes(White blood cell show WBC 4000,mm3，N 34,，L 66,(May I think of this case as the infection of upper respiratory tract? 9实习医生: 验过了，白细胞总数4000,mm3(4×10,L)中性34,，淋巴60%,我 以认为这个病例是上呼吸道感染吧? Dr(Zhang: Yes，but what’s the causative pathogen? 5 张医生: 可以，但病原是什么呢? Intern: Upon analysis of clinical characteristic，laboratory and epidemic data，we can almost confirm the diagnosis of influenza(The causative pathogen is surely influenza virus，do you agree? 实习医生: 依据临床特征，实验室及流行病资料，我们几乎可以确诊为流感了， 那病原当然是流感病毒了，你同意吗? 。 Dr(Zhang: Yes，I think so(It’ll be much more perfect that we have the evidence about isolation of virus( 张医生: 同意，要是有病毒分离的依据就更完整了。 Intern: May I consider the prognosis of influenza is generally good? 实习医生: 可否认为流感的预后一般说来是良好的? Dr(Zhang: Yes，in general speaking，it's not poor，but it's no harm to keep an eye on the underlying problems，for example，brain damage，myocarditis，etc(Oh，it’s time for us to give our orders(Stop here( 张医生: 一般说来，预后良好，但留心那些潜在的问题是有益处的，如脑损害， 心肌炎等，哦，我们该开医嘱了，就到这里吧。 4(肺炎 Pneumonia (1) I can’t stop coughing，doctor( Patient: 病人: 大夫，我止不住地咳嗽。 Doctor:When did the cough begin? 医生: 什么时候开始咳嗽的? Patient:It started a week ago，but it has been getting worse since yesterday( 病人: 一个星期前开始的，但是从昨天起加重了。 Doctor:Do you cough up any phlegm? 医生: 咳嗽时有痰吗? Patient:Yes( 病人: 有。 Doctor:What color is it? 医生: 是什么颜色的? Patient:Yellow( 病人: 是黄色的。 Doctor:Do you have a fever? 医生: 您发烧吗? Patient:Yes，I feel feverish( 病人: 是的，我觉得发烧。 Doctor:Have you felt shivery? 医生: 您发冷吗? 6 Patient:Yes，sometimes( 病人: 是的，有时候我发冷。 Doctor:Do you smoke? 医生: 您吸烟吗? Patient:Yes，I do. I'm a heavy smoker( 病人: 是的，我吸得很多。 Doctor:Let me examine you(Lie down on the bed please(Take your shoes off and unbutton your shirt please( 医生: 让我替您检查一下，请躺在床上，脱下鞋子，解开衬衣的扣子。 Doctor:Your heart seems to be normal(Your breathing is low(I can hear moist rales over the left lung base(I’ll take a white blood count and give you a fluoroscopic examination immediately( 医生: 您的心脏看来是正常的。您的呼吸音低。在左肺底部能听到湿啰音。我要 立即给您查白细胞记数，作个胸部透视。 Doctor:Here are the slips for blood test and fluoroscopic examination(First， please go to the cashier to pay the fee，then go to the laboratory for blood test and x-ray room for the fluoroscopic examination(I'll wait here for the reports( 医生: 这些是化验血和做胸部透视的单。请先到收费处交费，然后到化验室 验血，到放射科去做胸部透视。我在这里等。 * * * Patient:Here are the reports，is there anything wrong? 病人: 这是报告单，有什么不正常吗? I am sure it's pneumonia(Don't be alarmed，but you should be admitted Doctor: to hospital and treated with penicillin and streptomycin(For the time being you should stop smoking(After several days you'll feel much better( 医生: 我可以肯定您得了肺炎。不必害怕，您应当住院用青霉素和链霉素治疗。 您应暂时停止吸烟。几天后您一定会好得多。 (2) Intern: How are you，sir? I'm Doctor Martin. 实习医师: 先生，你好吗?我是马丁医生。 Patient: Hello，I've been coughing an day，Doctor. 病人: 你好。医生，我整天都在咳嗽。 Intern: When did the cough begin? 实习医师: 什么时候开始咳嗽的? Patient: It started about three hours or so after we got home from the lake. 病人: 我们从湖边回家后大约三小时就开始咳嗽了。 Intern: What were you doing? Fishing? 实习医师:你们去干什么?钓鱼吗? Patient: No，we just went swimming(The water was kind of cool,and I might 7 have taken a little cold( 病人: 没有，我们只是去游泳。水有一点凉，我可能有点感冒了。 Intern: That was yesterday? 实习医师:那是昨天的事吗? Patient: Yes( 病人: 是的。 ’ Intern: Are you bringing anything up when you cough? 实习医师: 你咳嗽时咳出什么东西来了吗? Patient: Yes，some thick，rusty colored stuff. 病人: 是的，咳一些黏稠、铁锈色的痰。 ( Intern: Here's a cup(The next time you bring some of it up.I want you to save it for me( 实习医师: 给你一个杯子。下次咳痰时，请给我留痰。 Patient: All right( 病人: 好的。 Intern: Have you had any chills? 实习医师: 你有过寒战吗? Patient: Yes，about an hour ago，and I thought I'd shaken the house down. 病人: 有过，大约在一小时以前，我感到我要把房子摇倒似的。 Intern: How long did this last? 实习医师: 寒战持续了多长时间? Patient: About a minute or two. 病人: 大约一两分钟。 Have you had any chest pain? Intern: 实习医师: 你有过胸痛吗? Patient: Yes，I have a little here，but mainly it hurts here on the right side of my belly( 病人: 有，这儿有点痛，但主要是在我的右侧腹部痛。 Intern: Mr(Wilson，this is Dr(Adams，another doctor who is interested in your case( 实习医师:威尔逊先生，这是亚当斯医生，是关心你病情的另一位医生。 Attending:Hello，Mr. Wilsor. The doctor tells me that you are feeling a lot better today( 主治医师: 你好，威尔逊先生。这位医生告诉我今天你感觉好多了。 Patient: That's right(I certainly am(Do you think I'll be able to go home soon? 病人: 对了。我确实好多了。你看我能够很快回家吗? Attending: Your doctor will discuss that with you as soon as we're finished here(Tell me，have you lost any weight recently? 主治医师: 我们这里的工作做完了，你的医生就会和你商讨这件事。请问，最近你 的体重减轻了吗? Patient: No( 8 病人: 没有减轻。 Attending:Have you had night sweats or a cough prior to this? 主治医师: 在这以前你有过盗汗或咳嗽吗? Patient: Well，I occasionally cough，but it's nothing bad(I've never had any night sweats( 病人: 噢，偶尔咳嗽，但不怎么严重。我从来没有过盗汗。 Attending: Have you had any contact with anyone who has had tuberculosis? 主治医师: 你与结核病人接触过吗? Patient: Not that I know of( 病人: 据我所知没有接触过。 Attending: Would you mind taking off your shirt? 主治医师: 请你脱掉衬衣好吗? Patient: Not at a11( 病人: 好的。 Attending: Take a deep breath，please(„That's fine(Just continue breathing through your mouth(„Now whisper，“99，99，99(”„All right， si r(Thank you(That'll be a11(You can put your shirt on( 主治医师: 请敞深呼吸。„„好极了。用嘴继续呼吸。„„现在低声说“99，99， 99”。„„好啦，先生。谢谢你。检查完了，你可以穿上衬衣了。 (A few minutes later) (数分钟后) Attending:I think he should have a tuberculin test，just to be sure(Have any reports come back on the cultures? 主治医师:我认为病人应该做一次结核菌素实验，以确定患的是什么病。痰培养结果 已回报了吗? Yes(Diplococcus pneumonia was cultured( Intern: 实习医师:回报了，培养出肺炎双球菌来了。 Attending:Well，it seems that you have everything under contr01(See you next Wednesday( 主治医师:唔，看来该做的你都做了。下星期三见。 (3) Intern: Have you had a cold recently? 实习医师: 最近你感冒过吗? Patient: Yes，I did，but I figured 1 was over it，so 1 went swimming(Boy， the water sure was cold(I guess that wasn't so smart，was it， Doc? 病人: 是的，感冒过，但我以为病已经好了，所以就去游泳了。好家伙，水真 凉。我想游泳不合适，对吗，医生? Intern: It doesn't look like it( 实习医师: 看来游泳不合适。 Patient: It's nothing serious，is it? 9 病人: 病得不严重，是吗? Intern: Well，it's a good thing you came in right away(Mr(Wilson have you had any fever today? 实习医师: 哦，幸亏你马上来了。威尔逊先生，你今天发热了吗? Patient: After I had that chill my wife took my temperature，and she told 。me that it was 103(F)(So I got kind of worried after that chill and decided to come in( 。病人: 那次寒战以后我妻子给我量了体温。他告诉我体温是103(F)。在寒战等 症状之后我有点担心，所以就决定到这儿来。 Intern: Is you neck stiff? 实习医师:你的颈部强直吗? Patient: No( 病人: 不强直。 Intern: Do you smoke? 实习医师: 你吸烟吗? Patient: No( 病人: 不吸烟。 Intern: Have you ever coughed up blood? 实习医师: 你咯过血吗? Patient: No(Doc，I'm beginning to feel pretty bad(It even hurts now when I take a deep breath( 病人: 没有咯过血。医生，我正在开始感到很不舒服。现在我深呼吸时就感到 很痛。 All right，Mr(Wilson(Let's just examine you briefly，and then Intern: we'll see if we can make you more comfortable( 实习医师: 好吧，威尔逊先生。让我们给你简单的检查一下，然后看看能不能使你 舒服些。 * * * Resident:1t sounds like he has pneumonia( 住院医师:看来病人像得了肺炎。 Intern: It sure does( 实习医师:确实是得了肺炎。 Resident:Did you culture and Gram stain the sputum? 住院医师:你做了痰培养和革兰氏染色吗? Intern: I sent it off for culture(There were numerous WBCs，RBCs and pneurnococcal-like organisms( 实习医师:我把痰送去培养了。’(痰中)有大量白细胞、红细胞和肺炎球菌样的细菌。 Resident:Did you get a white count? 住院医师:你做了白细胞记数吗? Intern: Yes(It was 30 000，with predominantly polys present( 实习医师:做了。白细胞数是30 000，其中多形核占优势。 Resident:How about blood cultures? 住院医师:血培养怎么样? 10 Intern: I was going to draw those as soon as the media come up to the floor from central supply( 实习医师:培养基从中心供应室一送到病房我就抽血做培养。 Resident:Did you look at the chest films? 住院医师:你看过胸片吗? Intern: Yes(He's got a patchy infiltrate in the right lower lobe( 实习医师:看过。病人的右下肺叶有一个斑片状浸润。 Resident:How do you want to treat this patient? 住院医师:你打算怎样治疗这个病人呢? Intern: I think he should get 95,oxygen，and I'd prefer using a soft rubber facial mask to give it(I've started an IV of 5,dextrose and water， and 100 000 units of aqueous penicillin every three hours( 实习医师:我认为他应该吸95,氧气，最好用一个软橡皮面罩给病人吸氧。我已经开 始(给病人)静脉点滴5,葡萄糖溶液，并给100 000单位水剂青霉素，每三 小时注射一次。 Resident:You'll observe the patient，of course，and raise the penicillin as necessary(We should also continue the therapy until he's been a febrile for 72 hours and the WBC is normal(The complications that we'll be especially on the lookout for are empyema，lung abscess， endocarditis，and meningitis( 住院医师:当然，你要观察病人，必要时要加大青霉素的剂量。并应继续治疗到病人 已退热达72小时和白细胞恢复正常时为止。要特别注意的并发症是脓胸、 肺脓肿、心内膜炎和脑膜炎。 5(高血压 Hypertension Patient: I get terrible headaches( 病人: 我头疼得厉害。 Doctor: When did they begin? 医生: 什么时候开始的? Patient: About a week ago( 病人: 大约一个星期前。 Doctor: Where is the pain?In what part of your head? 医生: 哪儿痛?在你头的什么部位? Patient:All over the front here( 病人: 整个前额部这儿都痛。 Doctor: Do they come at any special time of the day? 医生: 头痛在一天中有特定发作时间吗? Patient:No(They seem to come on any time I get nervous( 病人: 没有。似乎是在我精神紧张时才头痛。 Doctor( How long do they last? 医生: 头痛持续多长时间? 11 Patient:About an hour or two( 病人: 约一两个小时。 Doctor: Does it help to take aspirin or to lie down? 医生: 吃阿司匹林或躺下能减轻吗? Patient:No(They just seem to go away by themselves( 病人: 不能减轻。不过头痛好像是可以自行消失的。 Doctor: Have you ever had this kind of headache before? 医生: 你以前患过这种头痛吗? Patient:Well，I've had headaches off and on for the last several years， but none as bad as this( 病人: 哦，最近几年来我断断续续地有过头痛，但是没有像这次这么厉害。 Doctor: Have you noticed that your vision is any worse lately? 医生: 你有注意过最近你的视力有什么不好吗? Patient:I think I have(When I read，the words sort of run together( 病人: 我感到视力不好。当我看书时，字迹好像重叠到一起了。 Doctor: You mean they seem blurred? 医生: 你的意思是说字迹模糊不清吗? Patient:Yes( 病人: 是的。 Doctor: How long have you been noticing this? 医生: 你注意到这种现象有多久了? Patient:For about two weeks( 病人: 大约两周了。 And before this you had no trouble with your eyes? Doctor: 医生: 在这以前你没有患过眼病吗? Patient:No，none that I noticed( 病人: 没有，我没发觉患过眼病。 Doctor:Have you ever fainted or had convulsions? 医生: 你有过晕倒或惊厥吗? Patient:No( 病人: 没有。 Doctor:Do you ever feel dizzy，as if you or the room were moving? 医生: 你常感到你自己或房子好像在晃动那样的眩晕吗? Patient:No，never( 病人: 没有，从来没有过。 Doctor:Has a doctor ever told you that you had a murmur，or a heart attack or high blood pressure? 医生: 医生告诉过你有心脏杂音、心脏病或高血压吗? Patient:No( 病人: 没有。 Doctor:Have you ever had any chest pain? 医生: 你有过胸痛吗? Patient:No( 12 病人: 没有。 Doctor:Do you have trouble climbing steps? 医生: 你上楼有困难吗? Patient:Well，yes(Climbing up the steps at home，I have to stop and catch my breath( 病人: 哦，有。我在家上楼时，必须停下来喘口气。 Doctor: About how many steps can you make before you have to stop? 医生: 你大约上几级楼梯就得停下来喘口气? Patient:Oh，ten or twelve，maybe( 病人: 噢，大概是10至12级楼梯。 Doctor: Had you visited a doctor before? Did he say anything about it? 医生: 你以前看过医生吗?他说些什么没有? Patient:Three years ago 1 went to the local hospital for a swimming certificate(They told me that I had hypertension( 病人: 三年前我去当地医院作游泳健康检查，医生告诉我我患有高血压。 Doctor: Have you ever had swollen ankles? 医生: 你的脚腕肿过没有? Patient:Not that I can remember( 病人: 我不记得脚腕肿过。 Doctor: What kind of treatment did you have in the past? 医生: 你以前曾做过什么治疗? Patient(I took“reserpine'’occasionally( 病人: 我有时吃“利血平”。 Let me take your blood pressure( Doctor: 医生: 让我量一下你的血压。 Doctor: It’s 200 over 120(That’s moderately high(1 would like you to do an urinalysis，blood urea nitrogen test，chest X-ray and electrocardiogram examination( 医生: 你的血压是200,120，中等程度升高，我要给你做尿的常规化验，血的 血尿素化验，还要照X线胸片和做心电图检查。 Doctor: You should have a good rest，avoid nervous tension or stress， and give up smoking and alcoh01(In addition。I'll give you some medicine( 医生: 你应该好好休息，避免精神紧张或思想负担，忌烟酒。此外我要给你些 药。 Doctor: Come back again next week for the results and another check of your blood pressure. 医生: 一周后来复诊看化验结果和复查血压。 6(心力衰竭 Heart Failure (1) 13 Doctor:What is troubling you? 医生: 你觉得怎么不舒服? Patient:I have great difficulty in catching my breath(My heart is beating very fast( 病人: 我呼吸很困难，心跳得很快。 。 Doctor:When did you begin to notice these symptoms? 医生: 你什么时候发现这些症状的? Patient:Well，five years ago in a routine check-up my school doctor told me that I had heart trouble(But it didn't bother me and I could carry on as usual(About the last two years，I have noticed when I climb stairs my heart beats faster and I have to stop and catch my breath( 病人: 五年前在常规体格检查时校医告诉我我的心脏有问题。但是我毫无 适，能照常活动。最近两年我发现上楼梯时心跳得很快，并且不得不停下 来喘气。 Doctor: How many pillows do you use when you sleep? 医生: 你睡觉时用几个枕头? Patient: Two(I used to need only one，but since last year I had to add another( 病人: 两个。我以前都是枕一个枕头，但从去年起，我必须增加一个。 Doctor: Do you ever have to get up at night to pass water? 医生: 你夜里需要起来小便吗? Patient: No( 病人: 不需要。 Doctor: Have you had any swelling of your ankles? 你有过踝部水肿吗? 医生: Patient: No，I don't think so( 病人: 没有，没有水肿过。 Doctor: Have you ever had any pain in the small of your back? 医生: 你有过腰背部局限性疼痛吗? Patient: Yes，every once in a while(But it doesn't last long( 病人: 有过，偶尔有过。但是疼痛持续时间不长。 Doctor: On both sides? 医生: 两侧都痛吗? Patient: Yes( ’， 病人: 是的。 Doctor: Have you had this recently? 医生: 近来你有过这种疼痛吗? Patient: Once about a week ago，I believe( 病人: 大约一周前确实有过一次疼痛。 Doctor: Did you have chills and fever at the same time? 医生: 与此同时你有寒战和发热吗? Patient: Yes(For a couple of days I felt as if I had some fever( 病人: 有。近两三天来我感觉好像有点发热。 Doctor: Have you had any burning when you urinate? 14 医生: 你小便时有过灼烧感吗? Patient: No( ( 病人: 没有。 Doctor( Has your urine ever been cloudy or bloody? 医生: 你的尿液有过浑浊或血样颜色吗? Patient: Well，I haven't noticed( 病人: 哦，我没有注意到。 Doctor:Has anyone in your family ever had kidney or heart disease? 医生: 你家里有人得过肾脏病或心脏病吗? Patient:Well，my mother died of high blood pressure(And my father had what they alled kidney cysts( 病人: 呃，我母亲死于高血压。而我父亲患过他们所说的肾囊肿。 Doctor: Lie on the bed please(I'll examine you( 请躺在床上，我给你检查一下。 I'll give you an ECG and a chest x-ray( 我要给你做一个心电图再做一个X线胸部检查。 It seems you had better be hospitalized( 看来你最好还是住院。 Patient:Is it that bad? 病人: 有那么严重吗? Doctor: No，it is not very serious，but I don't want t0 take any risk(You'll be all right soon( 医生: 不，情况不很严重，可是，还是小心点好，你很快就会好的。 (2) Physician:Mr(Scott，how are you? 内科医师: 斯考特先生，你好吗? Patient: A little better than this morning( 病人: 比今天早上稍好一点。 Physician:Has the chest pain decreased a little? 内科医师: 胸痛减轻了一些吗? Patient: Yes，it has( 病人: 是的，减轻了。 Physician:Do you feel short of breath at all? 内科医师: 你是否感到气短? Patient: No( 病人: 不。 Physician: Do your legs hurt when I do this? 内科医师: 我这样检查时，你的两腿痛吗? Patient: No，they don't( 病人: 不，腿不痛。 15 Physician: Let's unbutton your shirt for a minute so I can listen to your heart„(That's fine(You just 1ie still and 1et me do all the work(„Now take a few deep breaths„(Fine„(Has your wife been in to see you yet? 内科医师: 让我们把你的衬衣解开一会儿，以便能听你的心脏。„„很好。你就躺 着别动，让我做全部检查。„„现在做几次深呼吸。„„好。„„你妻 子来看过你吗? Patient: She'll be here in about an hour( 病人: 大约过一个小时她会到这儿来。 Physician: Fine(Dr(English will be here if you should feel any shortness 0f breath or have difficulty lying on one pillow(Let the nurse know and she'll tell Dr. English about this(Remember，it's very important( 内科医师: 好。如果你觉得气短或枕一个枕头感到呼吸困难，英格利斯医生会到这 儿来。你告诉护士，她就会把你的情况告诉英格利斯医生。记住，这很 重要。 Patient: I certainly will，Doctor.Thank you for stopping by( 病人: 我一定照办，医生。谢谢你来看我。 (A moment later) (过了一会儿) Physician:Dr(English，please let me know if anything happens( 内科医师:英格利斯医生，如果发生了什么情况请告诉我。 Intern: I certainly will( 实习医师:我一定照办。 Physician:1f he should go into failure and you can't get me，start treatment right away(See you tomorrow( 内科医师:如果病人发生了心力衰竭而你找不到我的话，要立刻开始进行治疗。明天 见。 7(心肌梗死 Myocardial Infarction (1) Intern: Have you ever had any heart trouble that you know about? 实习医师:你知道你得过心脏病吗? Patient: None( 病人: 没有。 Intern: Did you ever have rheumatic or scarlet fever as a child? 实习医师:你小时候得过风湿热或猩红热吗? Patient: No( 病人: 没有得过。 Intern: I see here in your previous history that you've never been short of breath on exertion，have slept on one pillow all of your life， 16 never had swelling of the ankles，nor had to get up during the night t0 pass your water(Is that all correct? 实习医师:从你的既往病史中，我了解到你在用力时从来没有气短，一直是枕一个枕 头睡觉，踝部从来没有肿过，晚上也不起来小便。以上说的全对吗? Patient: Yes( 病人: 对。 Intern: Have you noticed any of these symptoms recently? 实习医师:最近你注意到有这些症状吗? Patient: No，I haven't( 病人: 没有，没有注意到这些症状。 Intern: Have you ever had any chest pain before? 实习医师:以前你有过胸痛吗? Patient: No，this is the first time( 病人: 没有，这是第一次。 Intern: Is there any history of heart disease in your family? 实习医师:你的家庭成员中有心脏病史吗? Patient: Yes，my father died of a heart attack，and so did my uncle( 病人: 有，我父亲死于心脏病，我的叔父也是死于心脏病。 Intern: You said you felt light-headed(Is that right? 实习医师:你说过你觉得头晕，对吗? Patient: Yes，it is( 病人: 对，是那样。 Intern: Then you didn't actually experience unconsciousness? 实习医师:那么你实际上没有过不省人事吧? Patient:That's correct( 病人: 对的。 Intern: I'll be back in a few minutes(and we'll examine you then( 实习医师:我一会儿就回来，然后我们给你检查。 (2) Physician(patient's family doctor): Hello，D r(English(now's Mr(Scott doing? 内科医生(病人的家庭医生): 你好，英格利斯先生。斯考特先生病情怎么样? Intern: Just fine，considering what he had( 实习医师: 就他的病来说，病情还好。 Physician:What do you think he had? 内科医师: 你认为他得了什么病? Intern: A myocardial infarction( 实习医师: 心肌梗死。 Physician:I have to agree with that. Why don't we go to the lounge and discuss the problem? Then we can come back and see Mr(Scott again( 17 内科医师:我同意你的意见。我们到休息室去讨论一下这个问题好吗?然后再回来看 斯考特先生。 Intern: Fine( 实习医师:好。 Physician:What did you find on the physical exam? 内科医师: 体格检查你发现了什么? Intern: There really wasn't anything remarkable( 实习医师: 确实没有什么异常的体征。 Physician:Does that surprise you? 内科医师: 那使你感到意外吗? Intern: No，not really( 实习医师: 不，确实不。 Physician(What conditions would you think of in ruling out an MI? 内科医师: 在排除心肌梗死时，你要考虑哪些病? Intern: Pulmonary embolus，cardiac neurosis，dissecting aneurysm，and acute pericarditis. 实习医师:肺栓塞、心脏神经官能症、夹层动脉瘤和急性心包炎。 Physician:That's quite good(1 would also consider hiatal hernia(He wasn't in shock when l saw him，nor was there any evidence that he was going into acute pulmonary edema?Would you expect to see fever at the onset of this condition? 内科医师:很好。我还要考虑食管裂孔疝。当我看他时，他并没有休克，也没有即 将发生急性肺水肿的任何征象。在心肌梗死初起时你认为会有发热吗? : Yes，1 would( Intern 实习医师:是的，我认为会有的。 Physician:It's usually absent at the onset，in contrast to acute pericarditis(It usually will rise within 24 hours and remain about a week( 内科医师:与急性心包炎相反，心肌梗死时一般不发热。心肌梗死的发热通常在24 小时内升高，大约持续一周。 8(贫血 Anaemia Patient: I have felt weak recently(These last few days I’ve felt worse(I don't know what is the matter with me( 病人: 我最近觉得乏力，这几天更重。我不知道出了什么问题。 Doctor: You look very pale(I'll give you a thorough check-up( 医生: 你看起来很苍白。我给你详细检查一下。 Doctor: Now，first of all，1 would like t0 have a detailed history(How long have you felt sick? 医生: 现在，首先我想知道你详细的病史。你病了多久了? Patient:I'm not quite certain(I've been feeling fatigued(tired)for 18 a year or so( 病人: 我不能肯定。我感到疲乏已经有一年左右了。 Doctor:Any other complaints? How is your appetite? ? 医生: 还有其他的不舒服吗?你的食欲怎样? Patient:My appetite's all right(I just feel tired(My legs are so weak sometimes，I can't even climb the stairs(Occasionally。I feel short of breath and giddy( 病人: 我的食欲还好。我只是感到疲劳。有时我的两腿特别无力，我甚至不能爬 楼梯，有时候我觉得气短和头晕。 Doctor: What about your periods? Are they very heavy? 医生: 你的月经怎样?量很多吗? Patient: Usually they last about a week(They seem heavy(Sometimes there are clots(During my period，I feel a lot of pain( 病人: 一般持续一周左右。量是很多的。有时有血块。在经期中我感到很痛。 Doctor: I want you to have a blood test now and I'll wait for the result( 医生: 我希望你做一次血液检查，我在这里等结果。 * * * Doctor: According to the blood test，you are suffering from an iron deficiency anaemia， probably due to your heavy periods( 医生: 根据血液检查，说明你得的是缺铁性贫血，可能和你的月经过多有关。 Patient: What should I do? 病人: 我该怎么办呢? Doctor: I am going to prescribe some iron tablets for you，which should Then 1 be taken after meals 0r they will spoil your appetite( would like you t0 see a gynecologist. We'll make an appointment for next Tuesday at 8:00 a .m. 医生: 我给你开一些铁剂，应在饭后服，否则会影响你的食欲。另外我想你 应去妇科检查一下。我们给你约在下周二早晨8点钟。 9(急性白血病 Acute Leukemia Doctor:Sit down，please(What's troubling you? 医生: 请坐，你哪儿不舒服? Patient:I often have vertigoes，dizziness and fatigue( 病人: 我经常感到头昏、眼花和疲劳。 Doctor:How long have you been feeling like this? 医生: 有多长时间了? Patient:About a month( 病人: 一个月左右。 Doctor:Did you have a fever? 医生: 你发烧了吗? 19 Patient:Yes，I faint from time to time( 病人: 是的，经常头昏乏力。 Doctor:Well，let me take your temperature( 医生: 来，给你测一下体温。 Patient:Do I have a temperature，doctor? 病人: 医生，我发烧吗? 。 Doctor:Yes，a little，3 7.5C(thirty-seven point five degrees centigrade)(Did your nose bleed? 。 医生: 有低热，37.5C，你的鼻子流过血吗? Patient:Yes，it bleeds sometimes，but it didn't bleed much( 病人: 有时流血，但量不多。 Doctor: DO you often have bruises on your limbs? 医生: 你的四肢经常有紫斑吗? Patient:Yes，I do( 病人: 是的，常有。 Doctor: DO the bruises occur spontaneously or after trauma? 医生: 这些紫斑是自发的还是受伤后出现的? Patient:They appear spontaneously( 病人: 是自发的。 Doctor: Do you feel a pain in your bone? 医生: 你感到骨痛吗? Patient:Yes，I have a pain in my sternum when I press hard( 病人: 是的，当我用力压胸骨时有疼痛。 You'd better have a blood test，the laboratory is on the first floor( Doctor: 医生: 你需要检查血象，化验室在二楼。 * * * Patient: What's the result，doctor? 病人: 医生，化验结果怎么样? ‘ Doctor(The laboratory report is not so good(It showed leukocytosis， thrombocytopenia and anemia(There are some blast cells in the peripheral blood(I think you have to take bone marrow examination( 医生: 血象回报的结果不太好，白细胞计数增高，血小板减少，且有贫血，周围 血中发现幼稚细胞。我看你得做骨髓象检查。 Patient:Does the bone marrow examination have any complication? 病人: 骨髓象检查有并发症吗? Doctor:It is safe and no complication(It should help for diagnosis of diseases( 医生: 这种检查很安全，无并发症，它有助于疾病的诊断。 Patient:Is my condition serious，doctor? 病人: 医生，我的病情严重吗? Doctor: Don't worry about that(A variety of disorder can be found out anemia or thrombocytopenia，such as aplastic anemia，acute leukemia， 20 macrocytic anemia， paroxysmal nocturnal hemoglobinuria and so on(You should be treated soon while the diagnosis is clear( 医生: 别担心，有许多疾病可以出现贫血或血小板减少，如再生障碍性贫血、急 性白血病、巨幼细胞性贫血、阵发性睡眠性血红蛋白尿等。把诊断 搞清 楚后，马上给你治病。 Patient: Would you tell me what trouble do I suffer from，doctor? 病人: 医生，能告诉我患了什么病吗? Doctor: According to the symptoms and laboratory findings，your disease may be diagnosised as acute leukemia( 医生: 根据症状和实验室检查结果，你患了急性白血病。 Patient:Oh! Dear! I know it is a serious disease! 病人: 噢!我知道这是一种严重的疾病! Doctor: You should be admitted to hospital immediately( 医生: 你应该立即住院治疗。 Patient:Can acute leukemia be cured，doctor? 病人: 医生，急性白血病能治疗吗? Doctor: We're determined to try our best to cure you( 医生: 我们一定尽力把你的病治好。 Patient:Which method should I be treated with? 病人: 用什么方法为我治疗? Doctor:The chemotherapy should be used for you(Another assistant therapy is administered as well，including antibiotics and blood transfusion( 医生: 我们将给你应用化学疗法，其他的辅助疗法如抗菌药物和输血也要应用。 Patient:Is there anything I should or shouldn't do? 病人: 对我的病还有什么限制吗? Doctor: I advice you to take a good rest(I'm sure you'll recover soon(You could call at the in-patient department tomorrow( 医生: 你要好好休息，我想你的病很快就会好的。明天你到住院部来。 Patient: Thank you for your advise，I'll come t0 hospital tomorrow， doctor(Good-bye! 病人: 医生，非常感谢您的劝告，明天我就来住院。再见～ 10(血小板减少性紫癜 Idiopathic Thrombocytopenic Purpura(ITP) Attending: Anything interesting to talk about today? 住院医师: 今天有什么感兴趣的问题要谈吗? Intern: A case of ITP came in last night( 实习医师: 昨天夜间住进了一名特发性血小板减少性紫癜患者。 Attending: Why do you say it's ITP? 住院医师: 你根据什么说他是特发性血小板减少性紫癜? 21 Intern: Well，both the history and the physical examination seem to substantiate this feeling( 实习医师: 嗯，不论是病史还是体检都支持这一印象。 Attending:What did you find? 住院医师: 你都发现了些什么? ’ Intern: This is a fifteen-year-old boy who was apparently in good health until about four days prior to admission(At that time he began to find some petechiae on the surfaces of his neck and epistaxis happened(On physical examination the vital signs were within normal limits，some petechiae and ecchymoses were found on the surfaces of the legs。arms and chest(The lab examination showed that his HB and WBC were normal(But the platelet count was very 9low，only 20×10,L( 实习医师:患者是一名15岁的男孩。以往身体健康，人院前4天在颈部皮发现一 些瘀点，并有鼻衄。体检时生命体征均正常，在其大腿、手臂及胸部皮 表可见及瘀斑。实验室检查血红蛋白及白细胞均正常。但血小板计数很9低，仅20×10/L。 Attending:Has his bone marrow been examined? 住院医师: 做骨髓检查了吗? Intern: No( 实习医师: 没做。 Attending:What could you find in the bone marrow if this case was suffered from ITP? 住院医师: 如患者确为ITP，其骨髓象会有什么改变? Intern: The erythropoiesis and myelopoiesis should be normal and megakaryocyte number should be very high( 实习医师:红系和粒系造血正常，巨核细胞数目增高。 Attending:O(K(Let's go in and see him( 住院医师:很好!让我们一起去看看病人吧。 11(甲状腺功能亢进 Hyperthyroidism Patient:I'm easily moved to anger with the onset of palpitation for the past two months( 病人: 近两个月来我净爱发火并且心慌。 Doctor:Have you been feeling this way before? 医生: 以前有过这样的感觉吗? Patient:No，this has been happening for the past 2 months only( 病人: 没有，这只是近两个月来才发生的事。 Doctor:Have you lost any weight recently? 医生: 你最近体重减轻了吗? 22 Patient:Yes，I have，in spite of increased intake of food，I lost 10 pounds in weight over a period of 2 months( 病人: 是的，尽管我饭量增加，但两个月来我已掉了10磅。 Doctor: Do you sleep well? 医生: 你睡得好吗? Patient:I have been suffering from insomnia lately( 病人: 我近来一直失眠。 Doctor:Have you been sweating as much as you usually do? 。 医生: 你最近出汗和往常一样多吗? Patient:My sweating has increased notably(I just can't stand warm weather at a11. 病人: 我比原先汗出的多了。我简直受不住热天。 Doctor:All right，would you please get undressed now? Let me examine you(Now， swallow，please( 医生: 好，请脱下衣服好吗?我检查一下。现在请做一个吞咽动作。 Doctor:There are some tests you'll have to get done and we'll see you in one week(At that time we'll start on a definite therapy for your condition( 医生: 你还得做些试验。一周后再来。那时我们要开始对你的病进行确切的治疗。 Patient:Thank you，Doctor，but tell me what's wrong with me? 病人: 谢谢你，医生，请告诉我得了什么病。 Doctor: I suspect that you might have hyperthyroidism(Take this paper to the office the nurse will arrange a time for you to have some thyroid function tests made( 医生: 我估计你得了甲状腺功能亢进病。拿这些化验单到办公室去，护士会给 你安排时间，做一些甲状腺功能的检查。 * * * (After a few days) (几日后) Doctor:The results of the thyroid scanning and protein-bound-iodine show that you have hyperthyroidism((The thyroid scanning reveals that the nodule of thyroid is a “cold”nodule，that means nonfunctional， you just have a goiter() 医生: 根据甲状腺扫描和蛋白结合碘检查结果说明你得了甲状腺功能亢进病。(甲 状腺扫描发现甲状腺结节是“冷结节”，也就是无功能的，你正是得了 甲状腺肿。) Patient:Can something be done about it? 病人: 有什么办法治吗? Doctor: I think a subtotal thyroidectomy is necessary( 医生: 我想需要做个甲状腺次全切除术。 Patient:The operation will make a scar on my neck，won't it? 病人: 手术会在我颈部留下瘢痕吗? Doctor: Yes，I'm afraid so( 23 医生: 是，会留下的。 Patient: Is there any way to avoid surgery? If possible，1 would rather not have surgery( 病人: 有什么方法能避免手术吗?如果可能的话，我不想做手术。 Doctor:Of course，antithyroid drugs，such as propylthiouracil and tapazole are used to control the symptoms(Their advantages are the avoidance of a surgical procedure with its attendant rare complications of recurrent nerve paralysis 0r hypopara-thyroidism，and reduced cost( 医生: 当然，抗甲状腺药物如丙硫氧嘧啶和他巴唑可以控制症状。他们的优点 动手术，并防止由之引起的罕见并发症，如喉返神经麻痹或甲是:免得 状旁腺功能减退等， 而且费用低廉。 Patient:Thank you，Doctor(Let me discuss it with my husband(Then we'll decide what to choose( 病人: 谢谢你，医生，请让我跟我丈夫商量一下，我们再决定采取什么办法。 12(甲状腺功能减退 Hypothyroidism (1) Intern: How are you，Mr(Wilson? I'm Dr(Roberts What brings you to the clinic today? 实习医生:威尔逊先生，你好吗?我是罗伯特医生。你今天到诊所来有什么病? Patient: I'm just feeling really tired lately( 病人: 最近我感觉很疲劳。 Intern: How long have you been feeling this way? 实习医生:你有这种感觉多长时间了? Patient: About six weeks( 病人: 大约六周。 Intern: Do you feel weak? 实习医生:你感觉虚弱吗? Patient: Yes，I do( 病人: 是的，感觉虚弱。 Intern: Have you gained any weight recently? 实习医生:你最近体重增加了吗? Patient: Yes，I have( 病人: 是的，增加了。 Intern: How many pounds? 实习医生:增加多少磅? 24 Patient: About twenty pounds over the past six weeks( 病人: 六周来大约增加了20磅(注:l磅约为9072克)。 Intern: Have you always spoken this slowly? 实习医生:你说话总是这样慢吗? Patient: No，this has come on over the past three weeks( 病人: 不，说话慢才三周。 Intern: Have you had any chest pain? 实习医生:你有过胸痛吗? Patient: Just very slightly( 病人: 只是很轻微的痛。 Intern: Could you point to the spot where you get this pain7(((Does it just stay there? 实习医生:你能指出胸痛的位置吗?„„胸痛只固定在那儿吗? Patient: Yes，it does( 病人: 是的，只固定在那儿。 ， Intern: What kind of pain is it? 实习医生:是什么性质的疼痛? Patient: It's just a dull ache which usually comes when I overexert mysell. I've had it about eight weeks or so( 病人: 只是一种钝痛，当我过度劳累时通常就会发生。我患胸痛大约有八周左 右了。 Intern: Do you have to get up at night to catch your breath? 实习医生:夜间你有不得不起来喘气的情况吗? Patient: No( 病人: 没有。 Nurse: Excuse me，Doctor(You're wanted on the phone( 护士: 对不起，医生。有人叫你接电话。 Intern: Excuse me，Mr(Wilson(I'll be with you in just a moment( 实习医生:对不起，威尔逊先生。我一会儿就来。 Intern: Now，Mr(Wilson，Let's continue(About how many steps can you climb before becoming short of breath? 实习医生: 威尔逊先生，现在我们继续谈吧。你登上几级楼梯以后才发生气短? Patient: I guess around thirty to forty(Then I don't actually get short of breath，but get that dull pain in my chest( 病人: 我估计30至40级左右。那时我实际上不气短，而是感到胸部钝痛。 Intern: How many pillows do you sleep on? 实习医生:你睡觉枕几个枕头? Patient: One( 病人: 一个。 Intern( How many times a night do you have to get up to pass your water? 实习医生:你一晚上得起来解几次小便? ，。 Patient: Sometimes once a night，and at other times I don't have to get 25 up at a11( 病人: 有时候一晚上一次，平时我根本不必起来。 Intern: Have you been sweating as much as you usually do? 实习医生:你出汗像平常那样多吗? Patient: No，I've hardly been sweating at a11( 病人: 不像，我几乎一点也不出汗了。 Intern: It's been quite cool recently(How has that affected you? 实习医生:近来天气很凉了。这对你有什么影响吗7 ( Patient: This has really been the worst winter! I just can't stand cold weather at a11(There's something else，Doctor(I just don't feel like doing anything(Doing any little thing just seems to take all the strength I have( 病人: 这真是个严寒的冬天啊!我根本不能忍受这样寒冷的天气。还有另外的 情况，医生，我只觉得什么事都懒得做。做任何一点小事就好像得用全 身力气似的。 Intern: Have your bowels been moving all right? 实习医生:你的大便通畅吗? Patient: They were，up to about two months ago(Then I became real constipated and have had to use a laxative( 病人: 直到大约两个月之前，大便还通畅。可是以后就真的发生了便秘，只好 服用轻泻药。 Intern: All right，Mr(Wilson(Would you please get undressed now? I’ll be back in five minutes to examine you( 过五分钟我就回来给你检查。 实习医生:好了，威尔逊先生。现在请你脱衣服好吗? (2) Resident:What does the patient have? 住院医师:病人患什么病? Intern: Well，from the history and physical，I think it's a case of hypothyroidism( 实习医师:哦，从病史和体格检查来看，我认为这是一个甲状腺功能减退的病人。 Resident:What kind of lab studies do you propose to do? 住院医师:你打算做什么样的检查? Intern: CBC，urinalysis，BUN，VDRL，and FBS(1 would also like to get an ECG and PA and lateral of the chest(In regard to the thyroid status， I am going to order a BMR，PBI，cholesterol，and follow these with an RAI uptake study( 实习医师:做全血细胞计数、尿分析、血尿素氮测定、VDRL梅毒血清学试验以及空 腹血糖测定。我还要(给病人)做心电图和拍后前位与侧位胸部X线片。 关于甲状腺的情况，我将安排做基础代谢率、蛋白结合碘测定、胆固醇 测定。接着做放射性活性碘吸收检查。 26 13(糖尿病 Diabetes Patient:Recently I've been feeling very thirsty and passing a lot of urine(Is there anything wrong with me? 病人: 最近我总觉得口渴和尿量很多。是有了什么毛病吧? Doctor:How is your appetite? How do you feel otherwise? 医生: 你的胃口怎么样?一般健康状况好吗? Patient:I've lost weight despite my good appetite,and I feel weak all the time( 病人: 尽管我的食欲很好，我的体重还是减轻了。我整天觉得很疲劳。 Doctor:Let me examine your urine(You may have diabetes( 医生: 我给你检查一下吧。很可能你得了糖尿病。 Patient:What is that? Can it be cured? 病人: 这是什么意思?糖尿病能够治愈吗? Doctor: Diabetes is a chronic disease due to poor functioning of the pancreas(It upsets the metabolism 0f sugar，fat and protein(Right now，it can't be cured，but it can be controlled so that you can enjoy life and feel well(You should stick to a special diet and avoid sugar and sweets( 医生: 糖尿病是一种慢性病，由于胰腺功能不全引起。它使糖、脂肪和蛋白质 的代谢发生异常。目前还没有治愈办法，但是可以被控制。因此你能生活 得很愉快。你应坚持控制饮食，不吃糖和甜食。 Patient:Can I smoke? 病人: 我能吸烟吗? Doctor: Smoking is harmful to anyone’s health(Better give it up( 医生: 吸烟对任何人都是有害的。我劝你戒烟。 Patient:Can I drink alcohol? 病人: 我能饮酒吗? Doctor:In moderation(As you know alcohol contains calories and must be counted in your meal plan( 医生: 可适当喝一点。你知道酒精能增加热卡，因此必须计算在你的食谱之内。 Patient: How can I keep to a good diet? 病人: 我怎样才能保持一个良好的饮食呢? Doctor:You should learn as much as you can about diabetes, have your urine tested regularly，stick to your diet，take your medicine and have some regular exercise(Then you can live a full，useful and meaningful life( 医生: 你应当尽量学习一些有关糖尿病的知识，定期检查你的小便。坚持食谱中 的规定，按时服药，要有定量的运动。这样你就能生活得美满、有益和有 意义。 27 14(上消化道出血 Upper Alimentary Tract Hemorrhage Doctor:Where do you feel a pain? 医生: 你哪里痛? Patient:I feel a pain in my abdomen( 病人: 我腹痛。 Doctor:Point out the place where you feel a pain(Do you have a good appetite? 医生: 用手指出你痛的部位。你胃口好吗? Patient:No，I've no appetite( 病人: 不，我没有食欲。 Doctor:How long have you lost your appetite? 医生: 食欲不好已有多久了? Patient:For two weeks( 病人: 二周了。 Doctor:Do you have a sense of gastric distention after meals? 医生: 饭后有腹胀感吗? Patient:Yes，I have a feeling of distention in my stomach after meals( 病人: 是的，我在饭后感觉腹胀。 Doctor:Do you have a stomach-ache before meals? 医生: 饭前胃区疼痛吗? Patient:Yes，I have a bad stomach-ache( 病人: 是的，我胃很痛。 How long after meals do you feel a stomach-ache? Doctor: 医生: 饭后多久感到胃痛? Patient:About three to four hours( 病人: 大约3,4小时。 Doctor:Do you feel a pain when you are hungry? 医生: 饥饿时你感到疼痛吗? Patient:Yes( 病人: 是的。 Doctor:May your pain be relieved if you take some food? 医生: 吃过饭后你的疼痛好些吗? Patient:Yes，it is a little relieved( 病人: 是的，好一些。 Doctor:What kind of pain do you have? 医生: 你感觉怎样痛? Patient:It's like burning( 病人: 像灼烧一样痛。 Doctor:When does it feel most painful? 医生: 什么时候最痛? Patient:At midnight( 病人: 午夜。 28 Doctor:Do you have the taste of sour liquid in your mouth? 医生: 反酸水吗? Patient:Yes，terrible( 病人: 是的，很厉害。 Doctor:Do you belch? 医生: 嗳气吗? Patient:A little( 病人: 有一点。 Doctor:Do you ever vomit? 医生: 呕吐吗? Patient(Not frequently，but I vomited yesterday seriously( 病人: 不经常，但是昨天我呕吐得很严重。 Doctor:What did you vomit，food or blood? 医生: 你呕吐的是食物还是血? Patient:I vomited food with a lot of blood( 病人: 我呕吐的是混有很多血的食物。 ( Doctor:Was the blood you vomited red or black? 医生: 呕吐的血是红的还是黑的? Patient:Like coffee( 病人: 像咖啡。 Doctor:Have your motions changed in colour? 医生: 大便的颜色有变化吗? Patient:I have melena for two times( 我排了两次黑便。 病人: Doctor:Well，I think you have hemorrhage in upper alimentary tract(This is due to the gastro-duodenal ulcer，but another diseases must be excluded:gastric cancer，cirrhosis and so on( 医生: 我想你是上消化道出血，这是由于胃十二指肠球部溃疡所致，但应该排除 其他疾病，如胃癌、肝硬化等。 Patient: Oh l Is that serious?Couldn't I have an operation? 病人: 噢!病情很严重吗?我是否需要手术治疗? Doctor: No，but you'd better do an X-ray on the stomach and fibrogastroendoscopy(We'll check on the blood as well(You should be given some fluid by intravenous drip immediately(Don't eat anything for 24 hours and take a good rest(I'm sure you'll soon be up and about( 医生: 不用手术治疗，你需要做胃肠透镜和纤维胃镜检查，还要做血液化验。立 即给予输液治疗，24小时内不要进食，好好休息，我想你的病很快就会好 的。 15(十二指肠溃疡 Duodenal Ulcer 29 (1) Intern: Hello，Mr(Morgan(I’m Dr(Mills( 实习医师:你好，摩尔根先生。我是米尔斯医生。 Patient: Hello，Dr(Mills( 病人: 你好，米尔斯医生。 Intern: What seems to be your trouble? 实习医师:你有什么不舒服吗? Patient: My bowel movements have been kind of black for the past two days， and I feel weak，too( 病人: 两天来我的大便有点发黑，同时还感到虚弱。 Intern: Have your bowel movements ever been this black before? 实习医师:以前你有过这样黑的大便吗? Patient: No(This is the first time( 病人: 没有，这是头一次。 Intern: How many bowel movements have you had? 实习医师:你大便了几次? Patient: One yesterday and one today( 病人: 昨天一次，今天一次。 Intern: Have you had any pain with this? 实习医师: 你大便时痛吗? Patient: Well，the pain that I always have( 病人: 哦，经常疼痛。 Intern: Where is that? 哪儿痛? 实习医师: Patient: Right here( 病人: 就在这儿? Intern: Does it stay in that one place? 实习医师: 疼痛只固定在那一个地方吗? Patient: Yes，it does( 病人: 是的，只固定在那一个地方。 Intern: What kind of pain is it? 实习医师: 是什么性质的疼痛? Patient: It is sort of burns( 病人: 烧灼样痛。 Intern:How long have you had this pain? 实习医师:这种疼痛有多长时间了? Patient: I've had it off and on for the past two years，but it's never been this bad before( 病人: 断断续续地痛了两年，但以前从来没有这样厉害过。 Intern: When do you get this pain? 实习医师:在什么时候发生这种疼痛? Patient: Usually when I get very excited and worried about things( 病人: 通常当我对一些事情很激动和烦恼时就发生这种疼痛。 30 (2) Intern: Does this pain come on after meals? 实习医师:这种疼痛是在饭后发生的吗? Patient: Why，yes，it does( 病人: 噢，是的，是在饭后发生。 Intern: About how long after meals，would you say? 实习医师:你能说说大约是在饭后多长时间发生吗? Patient: About an hour to an hour and a half( 病人: 大约一至一个半小时。 Intern: How do you get relief? 实习医师:你是怎样使疼痛得到缓解的呢? Patient: Normally a glass or two of milk will quiet things down( 病人: 一般喝一、两杯牛奶就会使疼痛止住。 Intern: Have you had any nausea or vomiting? 实习医师:你有过恶心或呕吐吗? Patient: No( 病人: 没有。 Intern: Has this distress ever come on before breakfast? 实习医师: 在早饭前发生过这种疼痛吗? Patient: No，not that I can remember( 病人: 没有，我记得没有发生过。 Does it usually get worse as the day goes on? Intern: 实习医师:疼痛通常会变得越来越严重吗? Patient: Yes，it does(And I'll tell you，Doc，the worst one was last night about one o'clock(It took four glasses of milk to quiet that one down( 病人: 是的，疼痛变得越来越重。我告诉你，医生，最厉害的一次疼痛是在昨 晚大约一点钟的时候。喝了四杯牛奶才使疼痛止住。 Intern: Have you felt faint or chilled? 实习医师: 你感觉无力或怕冷吗? Patient: No，just a little weak( 病人: 不，只感觉有点虚弱。 Intern: Have your stools been loose? 实习医师: 你拉过稀便吗? Patient: No，they j just look like tar( 病人: 没有，大便看起来像柏油样。 Intern: Have you ever vomited up blood? 实习医师: 你呕过血吗? Patient: No( 。 病人: 没有。 31 (3) Physician(patient's private doctor):Are you Dr(Mills? 内科医师(病人的私人医生):你是米尔斯医生吗? Intern: Yes，I am( 实习医师:是的，我是。 Physician:I'm Dr(Harris(Have you had a chance to look over Mr(Morgan yet? 内科医师: 我是哈里斯医生。你仔细检查摩尔根先生了吗? Intern: Yes，I just finished( 实习医师: 检查了，我刚检查完。 Physician:Why don't we sit down and talk about him for a few minutes? 内科医师: 我们坐下来谈一下他的病情好吗? Intern: Fine( 实习医师: 好的。 Physician:What do you think he has? 内科医师: 你认为他患什么病? Intern: A duodenal ulcer( 实习医师: 十二指肠溃疡。 Physician:Yes，I think I agree with that(What did you find on the physical exam? 内科医师: 是十二指肠溃疡，我同意你的意见。体格检查你发现了什么? Intern: The only positive signs were tenderness in the epigastrium，to both deep and superficial palpation，and voluntary epigastric muscle guarding(The stool was positive(and there were no gross findings that would lead me to believe that the patient was in shock( 实习医师: 仅有的阳性体征是在深部和浅表触诊时有上腹部触痛和上腹部随意性肌 肉防卫性收缩。大便隐血试验阳性。我认为病人没有显著的休克体征。 Physician: These are the only things I found when I examined him this afternoon(What are the five complications of a duodenal ulcer? 内科医师: 今天下午我给他检查时，发现的也就是这些。十二指肠溃疡症的五个并 发症是什么? Intern: Intractability t0 treatment，obstruction，perforation，hemorrhage， and penetration( 实习医师: 是难治疗、梗阻、穿孔、出血和侵蚀。 (4) Physician:What drugs aggravate the ulcer? 内科医师:什么药可以使溃疡加重? Intern: Steroids，ACTH，rauwolfia，and phenylbutazone( 实习医师:类固醇、促肾上腺皮质激素、萝芙木和保泰松。 Physician:Don't forget aspirin(All 0f these should be discontinued on a 32 patient with duodenal ulcer(if possible( 内科医师:别忘了阿司匹林。如有可能，应该对患十二指肠溃疡病人停止使用这些药 物。 16(急性肾炎 Acute Nephritis Intern Wang: Good morning(What seems to be bothering you? 实习医生王: 早上好，你哪里不舒服? Patient Zhang:Well，I j just feel a dull pain in the loin and puffiness of eyes，especially in the morning these days(I feel a11 pooped Out( 病人张: 我觉得最近几天腰部钝痛，眼睑水肿，尤其是早上，我全身疲劳 极了。 Wang: How long have you been like this? 王: 你这样有多久了? Zhang: About 5 days( 张: 大约5天了。 Wang: Did you have palpitations and shortness of breath lately? ’ 王: 最近有无心悸、气急? Zhang: No( 张: 没有。 How about your urination? Wang: 王: 你小便怎么样? Zhang: The urine is small in quantity。dark and soon grows cloudy( 张: 尿少，颜色深且很快变浑。 Wang: Have you got any chronic disease in the past? 王: 你过去得过慢性病吗? Zhang: No，1 was very strong before(Ur，I caught cold 2 weeks ago(After having rested for a couple of days，I felt better，but still had a sore throat(I haven't taken any medicine( 张: 没有，我以前身体很壮，两周前我感冒了，休息几天后好转，但仍嗓子痛。 我没有吃过什么药。 Wang: Then how old are you? 王: 你多大了? Zhang: I am 48( 张: 48岁了。 Wang: Now let me take your blood pressure(Oh，160,100mmHg，hypertension， of course(Would you come towards me just a little? Open your mouth， please，stick your tongue out，let me examine your throat? Oh， enlargement of right tonsil (2胡degree)(You still get edema of the lower limbs( 33 王: 现在让我来测血压。哦，160,100mmHg，当然是血压高。你能向我这边挪 一点吗?请张开嘴、伸舌，让我检查一下咽喉部。哦，右侧扁桃体二度增 大，你还有下肢水肿。 Zhang: What's the trouble? 张: 有什么问题吗? Wang: Not know until examination(Please go and take a urine test，then I'll call the resident( 王: 等检查完了再说，去做尿检查，我就向住院医生。 * * * Resident:Here is the urine report Sp(gr:1(020，colour dark，albumin(++) RBC whole field of vision(What do you think of the diagnosis， Wang? 住院医生:这是尿检查报告:比重1(020，颜色:深、蛋白(++)，红细胞满视野， 王医生，你看如何诊断? Wang: It looks like acute nephritis( 王: 像是急性肾炎。 Resident:I think it's appropriate to diagnose“acute nephritis'’at present(Bring him into the hospital( 住院医生:我觉得目前诊断“急性肾炎”较合适，应当叫他住院治疗。 。 Wang: Yes((turn to the patient)Zhang，I've just finished talking to other doctor(We both think you should be brought into the hospital( 王: 好的。(转向病人张)，我与另一位医生商量了一下，觉得你应住院治疗。 Whatever you say(Thank you，doctor( Zhang: 张: 听你的，谢谢你医生。 Wang: Don't mention it(Nurse，will you please take the patient to the admission office? 王: 不必客气，护士，请带病人去住院处。 17(急性肾盂肾炎 Acute Pyelonephritis Patient:I feel pain when urinating( 病人: 我排尿时痛。 Doctor:How long have you had it? 医生: 有多久了? Patient:About two or three days( 病人: 大约两三天了。 Doctor:What kind of pain is it? 医生: 是什么样的疼痛? Patient:It's a kind of burning pain(It seems to be getting worse( 病人: 是一种烧灼痛。而且好像越来越重。 Doctor:Any other s)mlptoms? 34 医生: 还有其他什么症状吗? Patient:I have a terrible headache and a backache(I feel feverish and shivery(I also want to pass water more often than usual( 病人: 我有严重的头痛和腰疼。我觉着发冷还发烧。我还有尿频现象。 Doctor:How many times do you have to pass urine each day? 医生: 你每天要排多少次尿呢? Patient:I can't say(Almost hourly( 病人: 我说不清。几乎每小时一次。 Doctor:Have you any blood in your urine? 医生: 你尿里带血吗? Patient:No( 病人: 没有。 Doctor:You may have an acute pyelonephritis(1 want a routine urine and a mid-stream clear catch urinalysis(I'll also send a urine specimen for culture and sensitivity( 医生: 你得的也许是急性肾盂肾炎。要做个尿常规检查，同时要做清洁中段尿分析。 再送个尿标本做培养和敏感试验。 * * * Doctor:There is no doubt that you have acute pyelonephritis(a kind of urinary tract infection( 医生: 毫无疑问你患的是肾盂肾炎，一种泌尿系感染。 Patient:What shall I do? 病人: 我该怎么办呢? You should rest in bed and drink plenty of water(You need inj ections Doctor: and also some tablets( 医生: 你应卧床休息并且大量喝水，应接受一些注射和口服药物。 Patient:When should I come back? 病人: 我什么时候再来复诊呢? Doctor:1 would like to see you in three days(If the symptoms get worse。 come to the emergency clinic immediately( 医生: 三天后再来门诊。如果病情恶化就马上来急诊。 18(急性胰腺炎 Acute Pancreatitis (1) Patient:Doctor，I suddenly developed a sharp pain in my upper abdomen( 病人: 医生，我上腹部突然剧痛。 Doctor( When did it begin? 医生: 什么时候开始的? Patient:About three hours ago( 病人: 约三小时前。 Doctor: Have you ever had any pains like this before? 35 医生: 你以前这样疼痛过吗? Patient:No，never( 病人: 不，从来没有过。 Doctor: What kind of pain is it? Intermittent or persistent? 医生: 是怎样的疼?是问歇的还是持续的? Patient:It's a kind of sharp pain(It was off and on，but now it's all the time( 病人: 是剧痛。本来是一阵子一阵子的，可现在是一直在疼。 Doctor:Does the pain go in a particular direction? 医生: 疼痛往一定的方向放射吗? Patient:Sometimes it goes towards my back( 病人: 有时放射到我的背部。 Doctor:Do you feel nausea? 医生: 你觉着恶心吗? Patient:I feel like vomiting( 病人: 我想吐。 Doctor:Please show me where you feel the pain( 医生: 请指给我看你觉着哪儿疼。 Patient:Here( 病人: 就在这里。 Doctor: Let's take a white blood count and a blood amylase test，a kind of test for acute pancreatitis( 医生: 让我们做个白细胞计数和淀粉酶试验，即一种检查急性胰腺炎的试验。 According to your history，physical examination and laboratory tests，Doctor: you have an acute pancreatitis(It would be better if you could stay in hospital until you are well( 医生: 根据你的病史、体检和实验室化验，你得的是急性胰腺炎。在病好以前，要 是可能，你最好住院。 (2) Intern:Hello，Mr(Martin(How are you? 实习医师:你好，马丁先生，你身体好吗? Patient: I feel really bad，Doctor( 病人: 医生，我感到很不好。 Intern:How do you feel bad? 实习医师:你感到怎么不好? Patient: Oh，I've been throwing up the past few days( 病人: 哦，我一直吐了数天。 Intern: Is it what you eat? 实习医师:呕吐物是你所吃进去的东西吗? Patient: Oh，I haven't eaten anything for a while( 36 病人: 哦，我有一段时间没有吃过什么东西了。 Intern: Is it bloody? 实习医师:呕吐物带血吗? Patient: No，just kind of whitish and thick( 病人: 不，仅有点发白和黏稠。 Intern:How many days ago did this first start? 实习医师:第一次呕吐是在几天前开始的? Patient: About three days ago( 病人: 大约三天前。 Intern:Have you been drinking at all? 实习医师:你是否一直喝酒? Patient: Yeah(I had a lot to drink then(I lost my job and felt kind of down in dumps( 病人: 是的。当时我喝了很多酒。我失业了，感到有些精神沮丧。 Intern: How long have you been drinking? 实习医师:你喝酒有多长时间了? Patient: About ten years( 病人: 十年左右。 Intern:How much do you drink? 实习医师:你有多大酒量? Patient:About a pint a weekend( 病人: 周末喝一品脱左右(注:一品脱约合0(57升)。 Intern:Have you had any pain? 实习医师:你有过疼痛吗? Patient: Yes( 病人: 有过。 Intern: Where does it start? 实习医师:从哪儿开始痛的? Patient: Right here( 病人: 就从这儿开始的。 Intern:Does it go anywhere? 实习医师:疼痛向别处放射吗? Patient: Yes，it feels like it goes towards my right shoulder( 病人: 是的，感觉疼痛好像向我的右肩放射。 Intern: What kind of pain is it? 实习医师:是什么性质的疼痛? Patient: It feels like somebody is boring a hole through to my back( 病人: 感觉好像有人向我背部钻洞一样的痛。 Intern: And how long have you had it? 实习医师:那么你痛了多长时间了? Patient: Oh，I've had this for the past three days( 病人: 噢，痛了三天。 Intern:How long does小is pain last? 37 实习医师:这种疼痛持续多长时间? Patient: It lasts about half an hour，but it comes and goes( 病人: 疼痛持续半小时左右，但时好时犯。 Intern:Have you ever had any pains like this before? 实习医师:你以前有过类似的疼痛吗? Patient: No( 病人: 没有。 Intern:Do you feel bloated after a heavy，fatty，or greasy meal? 实习医师:你吃了大量的脂肪性或油腻的食物后感到饱胀吗? Patient: No，I can't say that I d0( 病人: 不，我不觉得饱胀。 Intern: Have you ever vomited up any blood? 实习医师:你呕过血吗? Patient: No( 病人: 没有。 Intern: Have you ever passed any blood from the rectum? 实习医师:你便过血吗? Patient: No( 病人: 没有。 Intern: Have you ever turned yellow? 实习医师:你发过黄吗? Patient: No( 病人: 没有。 Have you been nauseated at all? Intern: 实习医师:你是否有过恶心? Patient: Well，just before I vomit I get real nauseous( 病人: 哦，就在呕吐前感到非常恶心。 Intern: About how many times a day have you vomited over the past three days? 实习医师:三天来你一天大约吐几次? Patient: About ten or fifteen times( 病人: 大约10至15次。 Intern: What have you been living on? 实习医师:你靠吃什么东西维持生命呢? Patient: Well，the only thing that'll stay down is whiskey(Doe please do something(This pain is killing me( 病人: 噢，只有威士忌酒，喝了不吐。医生，请给治治吧。痛死我了。 Intern: We'll just ask a few more questions(Have you had any chills or fever recently? 实习医师:我们再问几个问题。最近你有过寒战或发热吗? Patient: No( 病人: 没有。 * * * 38 Resident:What do you think he has? 住院医师:你考虑他患什么病? Intern: It sounds like acute pancreatitis( 实习医师:看来像急性胰腺炎。 Resident:Are there any other conditions you would think about? 住院医师:你还考虑别的病吗? Intern: You would have to think of appendicitis，alcoholic gastritis， and peptic ulcer( 实习医师:还必须要考虑到阑尾炎、酒精性胃炎和消化性溃疡。 Resident:We should try to get a careful peptic ulcer history，as this might be what's causing his present condition(Let's just go back for a minute or two and see how he's doing( 住院医师:我们应该设法取得详细的消化性溃疡病史，因为消化性溃疡可能 引起他目前病情的原因。让我们回去一下，看看他的病情怎样了。 19(肺结核 Pulmonary Tuberculosis Patient:I have had a cough for about two years(I paid no attention to it because I thought it was from smoking(Two weeks ago I caught a cold(Since then I have felt very weak and feverish(My temperature is always a little higher in the afternoon( 病人: 我已经咳嗽两年了。我没有重视它而认为是和吸烟有关。两周前我得了 一次感冒，从此以后我感到疲乏无力而且有发热感。我的体温在下午总是 高一些。 Doctor:When you cough do you bring up any phlegm? 医生: 你的咳嗽带痰吗? Patient:Just a small amount。usually whitish(Occasionally I notice some blood(This worried me(so I came to consult you( 病人: 只有少量白痰。偶尔我发现有少量的血。这使我害怕了，所以我来找你。 Doctor: Blood in the sputum strongly indicates tuberculosis(We must take a chest X-ray( 医生: 痰中带血表明很可能是结核病。我认为需要照一张X线胸片。 * * * Doctor( The X-ray suggests the likelihood of tuberculosis( 医生: 胸片提示可能是结核。 Patient:Is it serious?Can I be cured? 病人: 病情严重吗?能治好吗? Doctor:Don't worry(Nowadays(even those advanced cases with proper treatment can be cured within 6 months.Drug treatment should be continued for 2 years,however. 医生: 不必焦虑。目前即使是重症肺结核，在正确治疗下，半年内也可以恢复健 康。当然 39 Doctor:Please send a fresh specimen of your sputum for testing(I'll prescribe rimifon 0.lg three times a day and injections of streptomycin lg once a day(By the way( 医生: 请你送一个新鲜的痰标本来做检查。我给你开药。雷米封0(1克一天三次， 链霉素注射1克一天天一次。另外，你需要彻底休息和好的营养。 Patient: When should I return? 病人: 我什么时候来复诊, Doctor: In about two months. 医生: 两个月以后。 20.慢性肺炎 Chronic Hepatitis Patient: I feel very tired and worn out all the time. 病人: 我总觉得非常疲倦，虚乏无力。 Doctor: How is your appetite? 医生: 你的食欲怎样, Patient:Not good.I force myself to eat，but every time I look at food，I feel sick( 不好。我强迫自己吃东西，可我一看见饭就想吐。 Docotor: Have you lost any weight? 医生: 你的体重是否下降了, Patient: Yes,quite a bit. 病人: 是的，我瘦多了。 Doctor: When did you begin to feel unwell? 医生: 什么时候开始病的, Patient: I don’t know .But recently I’ve felt really bad. 病人: 我没有注意，储电量最近加重了。 Doctor: Any other symptoms? 医生: 还有些什么不适, Patient: I feel a kind of pressure around the right side of my stomach( 病人: 我觉得我肚子右边有一种压迫感。 Doctor: Do you drink a lot of alcohol? 医生: 你喝酒多吗, Patient : Yes,I drink some every day. 病人: 是的，我每天喝酒。 Doctor: How long have you been drinking? 医生: 你喝醉有多久了, Patient: About eight years. 病人: 大约八年了。 Doctor: Have you ever had any trouble with your liver? 医生: 你的肝脏出过毛病吗? Patient: Yes，two years ago in check-up，the doctor told me that my liver was enlarged and my liver function on test abnormal( 病人: 是的，两年前在一次普通查体时医生告诉我说我的肝脏肿大，肝功能不 40 正常。 Doctor: You'd better have another liver function test(Will you please come to the clinic tomorrow morning before breakfast with an empty stomach to have a blood test(Don't eat or drink anything(Nor even coffee or tea( 医生: 最好再做一次肝功能检查。请你明早不要吃早饭来取个空腹血，不能吃 东西喝水，就连茶和咖啡也不要喝。 Patient: What's wrong with me? 病人: 我得了什么病? Doctor: Your liver is enlarged and tender to the touch(It seems to be chronic hepatitis(You'll need absolute rest and avoid strenuous physical exertion(You can't drink any alcohol，and you should take the medicine I prescribe(There is no special treatment(It will take you some time to recover，so you have to be patient( 医生: 你的肝脏肿大，有压痛。看起来像慢性肝炎。你需要完全休息，避免重体 力劳动。应完全禁酒，并服用我给你开的药。没有特殊治疗方法，需要较 长时间才能恢复， 因此你必须有耐心。 21(肝硬化 Cirrhosis of the Liver Intern: Good morning(What seems to be the trouble? 实习医师:早安。有什么不舒服吗? I've got an awful ache in my belly( Patient: 病人: 我腹痛得厉害。 Intern: Oh(How long have you had this ache? 实习医师:噢。你腹痛有多长时间了? Patient: About three weeks(But it got really bad last night，and I threw up some blood( 病人: 大约三周了。但昨晚腹痛变得很厉害，并吐了些血。 Intern: Does the pain stay in that one place? 实习医师:疼痛固定在那一个地方吗? Patient: Yes( 病人: 是的。 Intern: When does it come on? 实习医师: 腹痛在什么时候发作? Patient: No special time(It just comes and goes( 病人: 没有特定的时间。时好时犯。 Intern: Is this the first time you've vomited up blood? 实习医师: 这是你第一次吐血吗? Patient: That's right(I never had that before( 病人: 对啦。我以前从来没有吐过血。 41 Intern: Was it dark l;ed or brown ? Do you remember? 实习医师: 呕出的血是暗红色还是棕色?你记得吗? Patient: Well，I'm not sure(Dark red，I guess( 病人: 哦，我不能肯定。我估计是暗红色的。 Intern: Have your stools been black lately? 实习医师: 近来你的大便发黑吗? Patient: Stools? 病人: 大便? Intern: Your bowel movements( 实习医师: 你排的大便。 Patient: Oh，no( 病人: 噢，不发黑。 Intern: Have you ever passed blood from your rectum? 实习医师: 你便过血吗? Patient: No，not that I ever noticed( 病人: 没有，我从来没有发现过便血。 Intern: Have your stools been light in color? 实习医师:你的大便颜色变浅了吗? Patient: Well，for the last week they've been kind of sandy colored( 病人: 唔，上周以来大便稍呈沙土色。 Intern: Has your urine been dark? 实习医师:你的尿颜色变深了吗? Patient: Yes，sort of like tea( 是的，有点像茶水色。 病人: Intern: How has your appetite been? 实习医师: 你的食欲如何? Patient: Every time I look at food I feel sick( 病人: 我每次看到食物都感到恶心。 Intern: Do you smoke? 实习医师: 你吸烟吗? Patient: Yes(But not much lately(Cigarettes taste different，somehow( 病人: 吸烟，但近来吸的不多。不知怎么的，香烟的味道不同了。 Intern: Have you felt weak? 实习医师: 你感觉乏力吗? Patient: A little( 病人: 有一点。 Intern: Have you lost any weight? 实习医师: 你体重减轻了吗? Patient: I don't think so(My belly's been kind of swollen( 病人: 我认为没有减轻。我的腹部有点胀大。 Intern: How long have your eyes been discolored? 实习医师: 你的眼睛变色有多协寸间了? Patient: What do you mean? 42 病人: 你说的是什么意思? Intern: Your eyes are rather yellowish( 实习医师: 你的眼睛有点发黄。 Patient: They are?Well，I never noticed( 病人: 眼睛发黄?哦，我从来没有注意过。 Intern: Have you been having any diarrhea? 实习医师:你一直在腹泻吗? Patient: Any what? 病人: 有什么? Intern:Have your bowels been loose? 实习医师:你拉稀吗? Patient: Oh(No( 病人: 噢，不拉稀。 Intern: Have you been near a freshwater stream lately?Fishing or swimming? 实习医师:近来你接触过河水吗?钓鱼或游泳吗? Patient: No，not for a long time。 病人: 没有，好久没有去了。 Intern: Do you work in an area where there are dangerous chemicals? 实习医师: 你在有危害性化学物品的地方工作吗? Patient: No，I used to work in a gas station but I haven't been working for about eight months( 病人: 不。我过去一直在加油站工作，但已有八个月左右不工作了。 Intern( Why is that? 那是为什么呢? 实习医师: Patient: Well，I just can't seem to hold a job( 病人: 唔，我实在不能坚持工作。 Intern: How long have you been drinking? 实习医师: 你喝酒有多长时间了? Patient: About five years( 病人: 大约五年了。 Intern: How much do you ordinarily drink? 实习医师: 你平常喝多少酒? Patient: Oh，about a quart of whiskey on the weekend( 病人: 噢，周末大约喝一夸脱(注:一夸脱约合1(36升)威士忌。 * * * Attending: You say you have a case of cirrhosis? 主治医师: 你说你有一位肝硬化的病人，是吗? Intern: It looks like it(This is a 57一year-old male who carrie in with a history of “aching'，right upper quadrant abdominal pain of three weeks’duration?This is rather sporadic in occurrence，and about three weeks ago he had a bout of hematemesis(The vomitus was dark red in color，and the patient denies previous bouts of this( 实习医师: 看来像肝硬化。病人是一位57岁男性。因有右上腹“痛”达三周之久的 43 病史而人院。疼痛稍呈间断性发作，大约三周以前呕过一次血。呕吐物 呈暗红色，病人否认以前呕过血。 Attending: It sounds as though this is a case of portal cirrhosis with ascites and possibly ruptured esophageal varices( 主治医师: 看起来这像是一位门脉性肝硬化伴有腹水的病人，可能有食管静脉曲张 破裂。 Intern: I agree with that，although I’m not sure whether the hematemesis is 0n the basis of the varices 0r perhaps some gastritis that he might have had? 实习医师: 虽然我不能肯定呕血是否由静脉曲张还是由他可能患过的胃炎而引起 的，但我同意这个诊断。 22(肝昏迷 Hepatic Coma Attending: Well，how are you feeling today? 主治医师: 呃，今天你觉得怎样? Patient: Just awful( 病人: 很不好。 Attending: What do you mean? 主治医师: 你说的是怎么不好? Patient: I had a bad night，I asked the other doctor for something to make me sleep, and he wouldn't give me anything( 我一夜睡不好觉。我要求另一位医生给点药使我入睡，而他什么药也不病人: 愿给我。 Attending: Would you hold your hands out in front of you，like this?„That's right. 主治医师: 请你把双手像这样伸到你的前面好吗?„„对了。 Patient: They shake like that sometimes，when I need a drink? 病人: 当我要喝酒时，有时两只手就像这样颤动。 Attending: Did you ever have an attack like this before? 主治医师: 以前你有过像这样的颤动吗? Patient: I had something like this about three years ago(For about a week I didn't even know where 1 was(The doctors said I had some kind of coma，and I had to stop drinking or it would kill me( 病人: 大约三年前我有过像这样的颤动。差不多有一周的时间我不知道我在哪 儿。医生们说我有点昏迷，并说我必须戒酒，否则就会死。 Attending: Do you remember whether they called it a hepatic coma? 主治医师: 你还记得是否医生们把那次昏迷称为肝昏迷? Patient: That might be it，but I’{h not sure( 病人: 可能是称为肝昏迷，但我不能肯定。 Attending: All right，Thank you(Your doctor will be in to see you later? 主治医师: 好啦。谢谢你。你的医生不久会来看你。 44 Patient: Doc，1’ve got a terrible headache(Do you suppose I could have some aspirin or something? 病人: 医生，我头痛得很厉害。你想我可以吃点阿司匹林或其他药吗? Attending:We’ll have the nurse bring you something( 主治医师: 我们会让护士给你拿点药来。 * * * Attending:Now，let’s think about this problem a little further(What are the things you look for in a patient who might be in pre-hepatic coma? 主治医师:好啦，让我们稍微进一步考虑一下这个问题。对一个可能是肝昏迷前期的 病人你要注意些什么问题呢? Intern: Generally 1 would look for some lethargy and disorientation(Also asterixis，increased clonus，and possibly a Babinski( 实习医师:一股隋况下，要注意昏睡和定向力障碍。也要注意扑翼样震颤、逐渐加重 的阵挛，并尽可能地注意巴宾斯基征。 Attending: That’s correct(As you probably know，there are EEG abnormalities which might also give you a clue(Is the flapping tremor，or asterixis，as you called it，found in other conditions? 主治医师: 对了。你大概知道，脑电图异常也可以给你提供一个线索。你所说的扑 翼震颤，即扑翼样震颤，可见于其他疾病吗? Intern: I can't think of any other states( 实习医师: 我想不出别的病了。 Attending:It's also found in cerebral disorders，uremia，and hypokalemic If the patient had ascites and impending coma，would you states( give diuril? 主治医师:患大脑疾病、尿毒症和低钾血症时也可以发现扑翼样震颤。如果病人有腹 水并即将发生昏迷，你打算给他用氯噻嗪吗? Intern: No，1 wouldn't( 实习医师:不，不给他用。 Attending:That's right(Diuril may cause a potassium deficit，which may in turn cause a relative alkalosis and result in a lowered blood brain barrier to ammonia(What are the two complications of a Blakemore tube? 主治医师: 对了。氯噻嗪可以引起缺钾，缺钾又可以引起相对性碱中毒，并引起氨 的血脑屏障低下。下布氏管的两个并发症是什么? Intern: You might get regurgitation of saliva，since it can't go down the esophagus' and this in turn may lead to pneumonia( 实习医师:由于唾液未能下行到食管，所以可能引起唾液反流，而唾液反流又可以导 致怖炎。 Attending:The other important thing is that once the tube has been down 48 hours，you may begin td get pressure necrosis(Well there are a great many more things we might discuss(Maybe we can go on with this next time( 45 主治医师: 另一个重要的并发症是:一旦布氏管下了48小时，就可能开始引起压迫 性坏死。好啦，我们还有许多问题可以讨论，也许下一次还有可能继续 讨论这个问题。 23(细菌性痢疾 Bacillary Dysentery Patient:Doctor，I have had a terrible diarrhea for two days( 病人: 医生，我患严重腹泻已经两天了。 Doctor:What are your stools like?Watery or soft?Is there blood or mucus in the stools? 医生: 你的粪便是什么样的?水泻还是软便?有没有血和黏液? Patient:Watery with blood and mucus( 病人: 水泻带有血和黏液。 Doctor:How frequent are they each day? ‘ 医生: 你每天大便几次? Patient:They are very frequent(I don't know how many( 病人: 许多次，数不清有多少次了。 Doctor:Do you have a temperature? 医生: 你发烧吗? Patient:I feel hot and sometimes shivery( 病人: 有时觉得发烧，有时发冷。 Doctor:Have you had any abdominal pain? 你肚子疼吗? 医生: Patient:Yes，I have lower abdominal cramps( 病人: 是的。我下腹部绞痛。 Doctor:Give a stool specimen to the laboratory please(I'll wait for the results( 医生: 送一个粪便标本去化验室，我在这里等化验结果。 * * * Doctor:The stool shows blood，mucus and pus as well as some ascams eggs. 医生: 粪便里有血、黏液和脓，还有蛔虫卵。 Doctor:It looks like bacillary dysentery，I like to send a stool specimen for culture? 医生: 看起来像是细菌性痢疾。我要送个粪便标本做培养。 Patient:Is it serious? 病人: 严重吗? Doctor:It isn't serious(I'll give you pipemidic acid，which is very effective(You should have a complete rest and drink large amounts of fluids，otherwise you will be dehydrated(You should have a liquid or semi-liquid diet。easily digestible(Eat small quantities frequently(Avoid spicy。fibrous residue or greasy foods for(a few days(It's an infectious disease(You should wash your hands 46 thoroughly after going to the toilet( 医生: 并不严重。我给你吃吡哌酸，这药很有效。你需要全休并且多喝水(饮料); 不然的话，你会脱水的。你应该吃流质或半流质和易于消化的饮食。少 吃多餐。在近几天，忌食辛辣、多渣和油腻食物。这是传染病，便后要 把手洗干净。 Patient:Thank you，1 will follow your advice( 病人: 谢谢，我一切照办。 24(痛风 Gout Patient:Doctor，I've a terrible pain in my foot( 病人: 医生，我的脚疼得厉害。 Doctor:Now tell me exactly what is wrong? 医生: 请告诉我确切情况。 Patient:I suddenly began to feel a severe pain in the joint of this toe( 病人: 我突然感到这个脚趾的关节很疼。 Doctor:Can you describe the pain? 医生: 你能描述一下是怎么疼法吗? Patient:It feels like a red-hot knife stabbing my toe( 病人: 好像烧红的刀子在我脚趾上戳一样。 How long have you had it? Doctor,: 医生: 疼多久了? Patient:Since last midnight(It hurt so much I couldn't sleep at a11(This morning I saw that the skin was red，hot and swollen( 病人: 从昨晚半夜开始。疼得我睡不着觉。今天早晨患趾表面的皮肤又红、又热、 又肿。 Doctor:Have you had it before?(Does this often happen?) 医生: 以前有过这种情况吗?(经常发作吗?) Patient:No(This is the first time(It's never happened before( 病人: 这是第一次。以前从来没有疼过。 Doctor:Have you noticed any lumps on your ear? 医生: 你是否注意过你耳朵上有小肿块? Patient:No( 病人: 没有。 Doctor: Do you drink a lot? 医生 : 你喝酒喝得多吗? Patient:Yes，I drink often( 病人: 是的，经常喝。 Doctor:Do you eat a lot of meat? 医生: 肉吃得多吗? 47 Patient:Yes，I love meat( 病人: 是的，我喜欢吃肉。 Doctor:Has anyone in your family had the same trouble? 医生: 你家里有人得过这种病吗? Patient:Yes，my father and my elder brother(They died ten years ago( 病人: 有，我父亲和我哥哥都有过这样的疼痛，他们10年前都去世了。 Doctor:I think it's probably gout(You'd better have your foot X-ray and have a blood test for blood uric acid level，j ust to be sure(Take this paper to the office;the nurse will tell you what to do( 医生: 我看是痛风。为了证实，你得拍张你脚的X线片，查查血中的尿酸含量。把 这张申请单拿到办公室去，护士会告诉你怎样做的。 Patient:When shall I come back? 病人: 我什么时候再来门诊呢? Doctor: Come back the day after tomorrow for the results( 医生: 后天来看结果。 * * * Doctor: Your X-ray and raised blood uric acid level show you have gout( 医生: X线片和血尿酸浓度升高都证明你得的是痛风。 Patient:Can it be cured? 病人: 能治好吗? Doctor: Yes(Here's your prescription(In addition，the affected toes should be rested and protected from any contact(Have regular meals， keep to a diet of salads and fruit(and eat very little meat(Avoid ( all alcoh01 医生: 当然能治好。这是你的处方。另外，患趾尽量少动，不要有东西压它。饮 食要有期律，多吃蔬菜水果，少吃肉类，不要喝酒。 25(风湿热 Rheumatic Fever Intern: Hi，Jimmy(Hello，Mrs(Brill(I'm the intern(Have you got troubles? 实习医师:嗨，吉米。你好，布里尔太太。我是实习医师。你有什么不舒服? Mother:Hello，Doctor( 母亲: 你好，医生。 Patient:Hello(I've got a pain in my chest( 病人: 你好。我胸痛。 Intern: When did you first notice this pain，Jimmy? 实习医师:吉米，你第一次感到胸痛是在什么时候? Patient: About two days ago( 病人: 大约两天前。 48 Intern: What kind of pain is it? 实习医师:是什么性质的疼痛? Patient: It's kind of sharp needles( 病人: 有点像针扎那样痛。 Intern: Would you point to dhe spot where it hurts the most? 实习医师:请你指出最痛点在哪儿好吗? Patient: Right here(But sometimes I even feel it in my left shoulder( 病人: 就在这儿。但有时我也感觉左肩痛。 Intern:Does it hurt more when you breathe? 实习医师:当你呼吸时痛得更厉害吗? Yes，it sure does( Patient: 病人: 是的，呼吸时确实痛得更厉害。 Intern: Can you do anything to make it less painful? 实习医师:你能用什么方法使疼痛减轻吗? Patient: Yes，when I lean over，the pain seems to g0 away slightly( 病人: 能，当我斜靠着的时候，疼痛好像轻点。 Intern:Does the pain last all the time? 实习医师:一直痛吗? Patient: No，it comes and goes(1t usually lasts about 1 5 to 20 minutes then goes away for maybe a couple of hours，and then returns( 病人: 不，时好时犯。疼痛通常持续15,20分钟左右，然后可能两、三个小时不 痛，接着又痛。 Intern: Have you been short of breath at all? 实习医师:你是否有气短? Patient: No，I haven't( 病人: 没有，没有气短。 Intern: Have your ankles been swollen? 实习医师:你的踝部肿了吗? Patient: No( 病人: 不肿。 Intern: Have you had a cold or sore throat recently? 实习医师:最近你患过感冒或咽炎吗? Patient: Yes，I had a bad sore throat about four weeks ago(It was so bad that I had to stay home for a week(Gee，I surely feel awful( 病人: 患过，大约四周前我得过一次严重的咽炎。咽炎如此严重，我不得不在 家休息了一周。哎呀，我确实感觉难受。 Intern: Did you have any fever or headache at that time? 实习医师: 那时你有发热或头痛吗? Patient: Yes，I had them both( 病人: 有，发热和头痛都有。 Intern: Did you vomit at all? 实习医师: 你是否有过呕吐? Patient: Yes，but only the first few days( 49 病人: 有过，但仅在最初几天有过。 Intern: Did you have a rash then? 实习医师: 当时你出皮疹了吗? Patient: No，I didn't( 病人: 没有，没有出皮疹。 Intern: Did you see a doctor at that time? 实习医师: 那时你请医生看过病吗? Patient: No(It didn't seem like anything very important? 病人: 没看过病。因为病似乎不太重。 Intern: Have you noticed anything on your skin recently? 实习医师: 最近你注意到皮肤上有什么东西没有? Pat(ient:What do you mean? 病人: 你说的是什么意思? Intern: Well，like little bumps on an area that looked like there was a red ring around a clear center( 实习医师: 哦，就是在皮肤上出现一些小隆起，看起来像环形红斑。 Patient: No(Nothing like that( 病人: 没有，没有出现过像环形红斑那样的皮疹。 Intern: Have you noticed any movements of your body that you didn't intend? 实习医师: 你注意到你的身体有任何不自主的运动吗? Patient: No，I haven't( 病人: 没有，我没有注意过有不自主的运动。 Intern: Have you had any swelling or pain in your joints? 实习医师:你有过关节肿胀或疼痛吗? Patient: Yes，I had some yesterday，all of a sudden(It still hurts over here. It’s swollen(and when I touch it，it really hurts(I think it's just a bump. 病人: 有过，昨天就有一些关节肿痛，全是突然发生的。这儿还痛呢。关节肿了， 当碰到它时感觉很痛。我还以为是碰的呢。 Intern: Have you had any fever at all, 实习医师:你是否有过发热? Patient: That began yesterday，and my mom told me that it was pretty high’oaround，102F(That's when she brought me to the hospital? o病人: 发热是昨天开始的，我妈妈告诉我体温相当高，大约102(F)。这 是她送我到医院时的情况。 Intern: Have you lost any weight lately? 实习医师:最近你体重减轻了吗? Patient: No. 病人: 没有。 Intern: How’s your appetite been? 实习医师:你的食欲怎样? Patient: Just fine(I feel hungry right now( 病人: 很好。现在我就感觉饿了。 50 Intern: Do you have any pain anywhere in your stomach? 实习医师: 你有胃痛吗? 。 Patient: No( 病人: 没有。 Intern: Have you ever had any bloody noses? 实习医师:你曾有过鼻出血吗? Patient: Only when I get into fights( 病人: 只是在打架时才有鼻出血。 Intern: Have you ever had any that just started to bleed by themselves? 实习医师:你有过自发性出血吗? Patient: Not that I remember( 病人: 我记得没有。 Intern: Now，Jimmy，have you ever had anything else like the things we've been talking about? 实习医师:嗯，吉米，你有过像我们一直在谈论着的任何其他病情吗? Patient: No( 病人: 没有。 Intern: Have you noticed any puffiness around your eyes? 实习医师:你曾注意到你眼睛周围出现过水肿吗? Patient: No，I haven't( 病人: 没有，没有出现过。 Intern: Has your urine become any darker 0r redder than it previously was? 实习医师:你的尿色比以前变得较深或较红了吗? Patient: No，I don't think s0( 病人: 没有，我看没有那种现象。 Intern: Mrs(Brilt，do any of the other children at home have anything similar to this? 实习医师:布里尔太太，家里其他孩子有谁患过与这个孩子相似的疾病吗? Mother: There's only his sister，and she’s been away at college( 母亲: 他只有一个姐姐，但她已经离开家上大学去了。 Intern( All right，Jimmy(I'll be back in a few minutes to examine you( 实习医师:好了，吉米。我一会儿就回来给你检查。 Mother: Could I talk to you，Doctor? 母亲: 医生，我可以和你谈谈吗? Intern: Why，sure( 1期医师: 呃，当然可以。 (A moment later) (过了一会儿) Mother: Is it serious? 母亲: 病严重吗? Intern: It’s hard to tell right now，without further examinations，but I think everything will work out all right( 实习医师:没有进一步检查，现在很难给你回答。但我认为一切会进行得很顺利的。 51 Resident:Did you work up that 1 5一year-old yet? 住院医师:你检查过那位15岁的病人吗? Intern: Yes，I did( 实习医师:是的，我检查过了。 Resident:What do you think he has? 住院医师:你考虑他患什么病? Intern: Rheumatic fever( 实习医师:风湿热。 Resident:Why do you think he has that? 住院医师:你为什么考虑他患风湿热呢? Intern:He has two major criteria( 实习医师:(因为)他具备两个主要诊断标准。 Resident:What are the major criteria? 住院医师:主要诊断标准都是些什么? Intern: Carditis，Sydenham's chorea，subcutaneous nodules，erythema margmatum polyarthritis( 实习医师: 心脏炎、西登哈姆氏舞蹈病(小舞蹈病)、皮下结节、环形红斑和多关节 炎。 Resident:What laboratory finding would help you in making the diagnosis? 住院医师:哪些化验结果会有助于你作出诊断? Intern: Sedimentation rate，C-reactive protein，and antistreptolysin 0 titer. 实习医师:血沉、C-反应性蛋白和抗链“0”滴度。 Resident:I would also get a throat culture，as it will be positive m about ses of rheumatic fever(Well，go ahead and get an ECG 50% ca and anything else you think necessary(and start therapy on him(We will discuss the therapy tomorrow with our attending( 住院医师:还要做咽拭子培养，因为大约50,的风湿热病例会出现阳性。好，就这黛 螋并做一个心电图和你认为必要的其他检查，开始给他进行治疗。明天我 们将与我们的主治医师一起讨论治疗问题。 26(一氧化碳中毒 Carbon Monoxide Polsoning Patient:Doctor，I've come to you because of a terrible headache?I'm afraid I have a gas Poisoning. 患者: 医生，我来看病是因为头痛得厉害，恐怕是煤气中毒吧。 Doctor: Really?What makes you think so? 医生: 是吗?你这样想有什么根据? Patient:I live with my wife in the small house without radiator(We fire coal stove to get warm in the winter(Last night I banked up the 52 fire and fell into sleep alone after my wife went to night job(I didn't wake up this morning until my wife came back(opened the windows and removed me from the room to the outside(Hardly had I opened my eyes when I felt headache and nausea( 患者: 我和妻子住在一间没暖气的小房子里。冬天靠点煤火来取暖。昨晚我妻子 上夜班走后，我一个人封了炉子就睡觉了。今晨直至我妻子回来打开窗户， 并把我挪到屋 子外面，我才醒来。我一睁开眼睛，就感到头痛和恶心。 Doctor:When did you go to bed last night? 医生: 昨晚你什么时候去睡觉的? Patient:I went to bed at the midnight(I usually sleep very late( 患者: 我午夜时分才睡觉。我通常睡得很晚。 Doctor: Did you drink alcohol before the sleep? 医生: 睡觉前你喝酒了吗? Patient:No，I don't like drinking alcohol 患者: 没有，我不喜欢喝酒。 Doctor:What kind of headache do you have? 医生: 你的头痛是什么性质的? Patient:I feel tightness and throbbing pain in my forehead and temples( 患者: 我感到前额和两侧颞部胀跳痛。 Doctor:Have you ever had any headache like this before? 医生: 你从前有过这类头痛吗? Patient:No，I've never had this kind of headache( 患者: 我从未有过这类头痛。 Doctor:Did you feel dizzy when you got up this morning? 医生: 今天早上你起来时感到头昏吗? Patient:Yes，as a matter of fact，I’m still having this uncomfortable sensation now( 患者; 是的，事实上，我现在仍有这种不舒服的感觉。 Doctor:Did you vomit when you felt nausea? 医生: 当你感到恶心时你呕吐了吗? Patient:I vomited two times，only threw up some sour fluid and mucus( 患者: 我吐了两次，仅吐出一些酸性液体和黏液。 Doctor:Have(you noticed anything else? 医生: 你还注意到其他异常吗? Patient:Yes，things grew up black before my eyes when I stood up(My breath was shortness，and my legs became so weak that 1 was hardly able to drag myself along in the morning. 患者: 有，今早我站起来时眼前发黑，呼吸急促，双腿无力，拖也拖不动。 Doctor:How long did the symptoms last? 医生: 这些症状持续了多久? Patient:About half an hour( 患者: 大约半个小时。 Doctor(to patient's wife): I want to ask you some questions(Do you think 53 your husband lost his consciousness in the morning? 医生(对患者的妻子说):我想问你几个问题。今天早晨你丈夫昏迷了吗? Wife: No，I thought of it at first，but later he woke up soon after inhaled fresh air(So I consider he was j ust lethargy in the morning( 患妻: 没有。起初我以为他昏迷了，但他吸人了新鲜空气后很快就醒了。所以我 想今天早上他只不过是昏睡。 Doctor:Have you noticed what color his skin was at that time? 医生: 当时你注意到他皮肤的颜色了吗? Wife: Yes，I found his face and lips were in the pink color which reminded me of the cherry-red of gas poisoning(Then I immediately gave him some emergency managements because I'm a nurse( 患妻: 注意到了。我发现他的面部和双唇呈粉红色，这使我想起一氧化碳中毒的 樱桃红色。因为我是一名护士，马上就给了他一些急救措施。 Doctor:You are an excellent nurse(Your witness is very helpful to the diagnosis(Well， I'll give your husband a brief physical examination(After that，please send him to laboratory for a carboxyhemoglobin test，bring back the result as quickly as possible( 医生: 你真是一位好护士。你的亲眼目睹对诊断很有帮助。好，我将给你丈夫 做一个简单的体检。然后请你送他去化验室查一下碳氧血红蛋白，尽快 把结果送回来。 * * * Wife: Doctor，here is the report you ordered( 患妻: 医生，这是你要的报告单。 According to the history，physieal examination and elevated level Doctor: of carboxyhernoglobin in the blood，the patient is surely suffering from carbon monoxide poisoning(By the way，do you smoke? 医生: 根据病史、体检和患者血液中碳氧血红蛋白的增高，患者确实是一氧化碳 中毒。顺便问一下，你抽烟吗? Patient:Yes，I do(I don't know what's the relationship between smoking and gas poisoning? 患者: 是的，我抽烟。我不明白与一氧化碳中毒有什么关系? Doctor:In general，the poisoning symptoms depend entirely on the concentration of carboxyhemoglobin in the blood(But many cigarette smokers with some tolerance to elevated carboxyhemoglobin levels have usually no symptoms in a slight carbon monoxide poisoning( 医生: 一般说来，中毒症状完全取决于血液中的碳氧血红蛋白浓度。而许多吸烟 者由于对碳氧血红蛋白增高有一定耐受性，轻度一氧化碳中毒时通常没有 症状哦。 Patient:Oh，I see(Is my condition serious? 患者: 哦，原来是这样。我的情况严重吗? Doctor:You are just lucky(The concentration of carboxyhemoglobin in your 54 blood is thirty percent。belongs to a middle abnormality(If you had continued to sleep in that room containing much carbon monoxide(your life would have been in danger( 医生: 你还算幸运。你的血液中碳氧血红蛋白的浓度是百分之三十，属于中度异 常。如果你继续在那间含有大量一氧化碳的房间里睡下去，你的生命就危 险了。 Patient:Yes，thanks to my good wife(What shall I do next? 患者: 是的，多亏我的好妻子。下一步我该怎么办呢? Doctor: Now you must stay in the hospital for therapy(I'll intend to give you further examinations and offer some special treatments including hyperbaric oxygen chamber，intravenous Nicotinic Acid， Dexamethasone and other medicines(All of these measures will help you to get rid of the acute symptoms(On the other hand,they are beneficial to preventing from the delayed neurological damages of carbon monoxide poisoning( 医生: 现在你必须住院治疗。我打算给你再做进一步的检查;并给你一些特殊治 疗，包括高压氧舱，静脉输注烟酸、地塞米松和其他药物。所有这些治疗 将帮助你消除急性期症状。另一方面，也有助于预防一氧化碳中毒引起的 晚发神经系统损害。 Patient:Thank you for your advice( 患者: 谢谢你的忠告。 Wife: I’ll register to the admission office for my husband right away(Please give me his history sheet(Hope you to see him often in the hospitalization( 患妻: 我马上就去住院处给我丈夫办手续。请给我他的病历单。希望你在他住院 后常去看他。 Doctor: Certainly.I'll do( 医生: 当然，我会的。 27(撕裂伤 Laceration (1) Nurse:Doctor，we have a patient in Room 4 who has a laceration on his right forearm( It's a boy(His mother is with him and seems quite concerned( 护士: 医生，在4号诊室有一位病人，他的右前臂有一撕裂伤。是一个男孩。他母 亲带他来的，看来她很担心。 Doctor:Thank you，Nurse(I'll go down and see them right away( 医生: 谢谢你，护士。我马上下楼去看他们。 (A few minutes later) 55 (几分钟后) Doctor: Yes，Mrs(Moore(It looks as though Billy's had a little trouble here. 医生: 你好，穆尔太太。毳来比利到这儿来好像有点病。 Mother: Yes，Doctor(I got him here as soon as I could( 母亲: 是的，医生。我尽快带他到这儿来了。 Doctor: Well，Billy，what happened? 医生: 噢，比利，怎么啦? Billy: I was fooling around out in the garage and fell against an old piece of window pane. 我正在汽车房外面玩时，摔倒在一块旧窗的玻璃上啦。 比利: Doctor: I see(Well，this doesn't look too serious(Nurse，will you please get me a suture set? 医生: 明白了。嗯，看来伤不太严重。护士，请你给我准备一套缝合器材好吗? Mother: Are you going to have to take stitches? 母亲: 必须缝几针吗? Doctor: Three，I think(It won't be very painful，but I think it'd be better if you stepped out of the room for a few minute(..(Now，Billy， we'll see,we can't fix you up( 医生: 我看，得缝三针。这不会太痛的，但如果你到房间外面去等一会儿我想就 好了。„„好，比利，看看能不能把你的伤口缝好。 Billy: Will it hurt? 比利: 会痛吗? Oh，not much(Anyway，I think you're a pretty brave fellow. Doctor: 医生: 哦，不太痛。不管怎样，我认为你是一个很勇敢的小伙子。 Intern: Well，Billy，we're through(That wasn't so bad，was it? 实习医师:好啦，比利，缝完了。不太痛，是吗? Billy: No，not very( 比利: 是的，不太痛。 Intern: Mrs(Moore? You can come in，now(Has Billy had a tetanus shot recently? 实习医师:穆尔太太呢?现在你可以进来了。最近比利注射过破伤风针吗? Mother: No( 母亲: 没有。 Intern: Is he allergic to it? 实习医师:他对破伤风针过敏吗? Mother: Not that I know of(I think the only one he's had was about five years ago. 母亲: 据我所知不过敏。我记得他唯一的一次注射大约是在五年前。 Intern: Well，I think he'd better have another one. 实习医师:哦，我想最好再注射一次。 Mother: Whatever you say，Doctor( 母亲: 照你说的办吧，医生。 56 Intern: Nurse，will you please bring me a syringe with O(5 cG 0f tetanus toxoi&„O(K， Billy，just pretend there's a rmsquito sitting here on your m He'll take one little nip and ny away(„Just like that(See? We're all finished„(Now, Mrs(Moore， I'11 give you an appointment to come back in five days，and we'll take the stitches out at that time(So long，Billy( 实习医师: 护士，请给我一个抽上0(5毫升破伤风类毒素的注射器。„„好，比利， 就像一只蚊子落在你的胳臂上，轻轻地一咬就飞走了。„„就像那样。 懂吗?注射完了。„„哦，穆尔太太，我约你过五天再来，那时我们要 拆线。再见，比利。 Bye( Billy: 比利: 再见。 Intern: Goodbye，Mrs(Moore(Don't worry(This arm's going to be fine( 实习医师: 再见，穆尔太太。别担心。胳臂的伤口会好的。 Mother: Thank you，Doctor( 母亲: 谢谢你，医生。 (2) Doctor: How were you injured? 医生: 你是怎样受伤的? Patient: I tripped and fell，banging my forehead quite hard(My wife wrapped a bandage around it to stop the bleeding( 病人: 我滑倒了，前额部碰得很重，我妻子用绷带给我止住了血。 Doctor: Did you lose a lot of blood? 出了很多血吗? 医生: Patient: Not too much( 病人: 不太多。 Doctor: Were you unconscious? 医生: 受伤时你昏过去了吗? Patient: No( 病人: 没有。 Doctor: Did your nose or ears bleed after the accident? 医生: 受伤时有没有耳、鼻出血? Patient: No( 病人: 没有。 Doctor: The wound is rather large，so I'll stitch it up( 医生: 这伤口相当大，我来把它缝上。 Patient: Will it hurt? 病人: 疼吗? Doctor: Oh，no(It won't be painful( We'll give you local anaesthetic(You're a brave fellow(Well，we're all finished(That wasn't so bad，was it? 医生: 不，不会疼的。我给你局部麻醉。你是个勇敢的人。好了，全完了，怎么样? 不太疼吧! Patient: No，not very( 57 病人: 不怎么痛。 Doctor:Have you had an anti-tetanus injection lately? 医生: 你最近打过抗破伤风针吗? Patient:I think the only one I have had was about five years ago( 病人: 我记得五年前打过一次。 Doctor:Well，I think you'd better have another one( 医生: 我想需要重打一次。 Patient:Whatever you say，Doctor( 病人: 大夫，按你说的做吧。 Doctor:Come again after three days and we'll examine the wound( 医生: 三天以后来看伤口。 58