filehost_professional english in use medicine

8/13/2019 Filehost_Professional English in Use Medicine

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BASICS

8 Thrd .....

II functions of the

m

m

C Shim

1m Blood 3

Contents

I!"R#$%C"I#! 8 oAllied health &rofessionals '(A (ommunl('\ ""';11th

B Tecbmcr! ..C "#$~rh~%~c~drld onnoosrs

$ Health and illness )* $ +&r..ln/0A A&l1( .b$)* bl$h o Hos&itals'1B Srl!e+

C Re!m A tmrodccnon H) ;I hc~,i#l

B -)r,!em

II 2arts of the od4 ) )'c 1a1r.1hC'nl ..

A ".lIb /I.#.. #...0* 1m 2rimar4 cart/ 'B Rtfttn h) J'ln ...... rht bu.J\ A I00 5-.6......III7th%%'ICCC lnhlltA f.JJllIIC!" #" rain B 11\C' rrJ""t., l('oJnl

C II +,)8 d.l

II 2arts of the od4 ' )(A The.bd)m2!

E$%CA"I#!A!$ "RAI!I!GC Thr ,d*** m 9edical education ) 3*

)1A tedical cducmoo In tnt- U$

8 E3#rc# frocn ! )l1der,d)~

A E#i!( ,r$&,ec#)&

8 "e file' \It"' ....n C .8 ~r)dc!l4~**~

C %ther tU!.'."'"\$ I ('('ImnlCMl #)!...566)$!~ 9edical education ' 3'

A '1111"&ound.uuH" #rufl,l"an"li(

9E$ICA: A!$ 2ARA9E$ICA: I''''ult In "Il...J$*.+r"Ju!uonC \t$%.Jl;&u.,hh... .. ltcll\

2ERS#!!E:A!$ 2:ACES

)5)9edical &ractitioners I ) "he o;erseas doctor3(

A 1),1'(.... HI ) ..I+


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1m Bones (* m 9ental Illness @A 112/12: A )87hl


4/178

A .:I%1

I!ES"IGA"I#!S m "hera&ies F'I/$ BasIc in;estigations

A -,hlh.Ir%%%**** ,h*l-Cher.l,lSl

C ~Il'% 8eh$ ...%)r1 'I'h2r.1rr

2REE!"I#!1m :aorator4 tests

A A ~ I


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C S$c)l.!d &t!...w h#';l02:


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8 A %%.%**1%'**1 mr.l ... I .....6.$I!#?$.... rJ3r#A&&endiL Verb& )&ed i! insm.=5nor)@

)(@

RESE!"A"I#!SA&&endiL I )(1

$ata &resentation ) )) l. #erm& !d d#Ei!l@#-rlSA Rrf7t"%tll to ... 112 or Iif5u/0B

C

@;$.%.*.!!~ ) .... ~1!A,"9%l!1I!l@ Answer e4 )(

IndeL )1

8 Bed&ide,re&e!rri$!

em "aing a histor4 3 )*1 mil $ata,re&e!##i$! ' )'*A R@':I#% '1Illlh# **6r#llh A LIlI# t/3 &s

8 Ad >>>%. ~hc1l11hr **@'Ie#l !#E':-S S:'6'ml 8 &0, chm O!d br chO!&

C "0l#ml kit;}\. #.~ .)n< c$'r6'5.lIKl!: C Dc&c;!bm( #r2!2

/ "h*.%'I ...... IIIh******* ).lm)I mEKA9I!A"I#!

Research articles )''

A no.S2#IIC!IR oi M research .!$d2B #i7a,../S

lim 2h4sical eLamination )* c Mi! i!d$!8S

A .. 8..,)nllnl/ r.aucnt lim Astracts )'(B @*1: '''I# I! ....N#.;$)! ..

A ~r)cr)r2d .I$r...*..

li$ 9ental state eLamination ))* B /n.c 10.l;*#r.KI

A '&$me *ml%'!m* )i 'l':***hl.) ..... 1HHdel' m Conference &resentations )'1B 'Ie.%* A "he 8rn.crurt/ of .) rr$r!l.l)$!c )r/,-


7/178

I I

i1 Health and illness1m A&i!( b$)# hel#h

=ehh %*%% S@*' /1 *%% b$d. '''''he! d$c#$r& 0


8/178


9/178

1.1 C$m,le#e #he #hle %lIh %*.r$& r$m A !d 8 $,,$&)c. The im $!e h0'bee! d)m $r I-.

1.O Me H$rd c$mb))!$'b

c$m,le#e Sldtness

)S#!( H$rd r$m ech b$3. L$$ # B!d C 2,,-S1I. #$ hel, I-.

rrel h#llh

(e# rcml*&i$!

&oor &iclr~1 CM'r

1. C$m,lcre #he %%%eN#%%'. I$$L # B -""C%%@ #! hel, 4-.

D$c#$r; 11/:: *.. nu Icdlll8 #$d "!e!c 1'/;/1 'C2: @IID$c#$r; 11/:: l$!( h$i*. // bee! eelm( @O1"#ie!#; Ab$)#. Hee.

D$c#$r; Qh.# % $)r Il ..5 lie !$rm .>ll"rie!r; Ver ($$d. I'm )&)ll J)i#e @ 5 5 !d @ .D$c#$r; Qh.# i& #he ,r$blem !$H

"rie!r; I#'& m $mch.D$c#$r; D$ *- eel +1 "rie!! Ye&.D$c#$r; =:.$)

...'H. "#1m#; N$.

lh bee! @U

D$c#$r; =.:2 '''' h.d 0!l m$$& @SI

"!em; '1/. !$!e # .11=' #he ,0S#

1. Ch$$&e #he @$rr@:.# %!rc?. II @$m,le#e ech M


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I

Parts of the bo4 "

2arts of the od4

~I$2. #:'#e!)l %%IT /1.1:.6 ... .d he $!h!r I;;!;l%h !.m9?~* **211. .!*)$mlCll1ll!.D$c#$r& !$~II* )&e d; I !~%h !me&* c$*e! Hhe! #Ili!( #$ e0*h +l+. "ere r# !'

ece,!$!& %h .. re d$cr$r& 0I7 #he !#$micl !me? rhe&e re *hI'% II I! bree


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)3

O.1 Qri#e #he $rdi!l !(h&h H$rd. $r rhe c$rrc',@!di!( .mr$rmcl #erm& 1/ #he #ble

)&i!( $)r medicl !$Hled(e. L$$ .11 *: $,,$&i#e #$ hel, $).

A!#$micl #rrr! Common I;ord

bd$me!

3ill Icarus Icoa

c)bi#)&

n"i"""""""a

/ICS

,#ell

O.O C$r!,lere #he &e!#e!ce' Sl!l? $rdi!r E!(li*h H$rd&. L$$! A !d @. $,,$&)e 1/ hel, $).

A mle ,!e!# de&cribm( !(m ,ecr$ri9

I#'& lie. !(hr!e&& cr$&& m @1 * !d i# ($e* III/+' MMMMM m +3 !d i!#$ m/ le#@1 > !d @ .>. ...> #he le# @7 ......>....>.>..>>..>.

b A mle ,#ie!# de&cribi!( re!l c$lic;

I# r#& @I #he l$i! !d ($e& i!#$ #he

+' MMM and +3 M .M......i.!#$ #he #eicle.

O. C$m,le#e #he &e!#e!ce&. L$$ # A $,,$&i#e #$ hel, $).

A!#$micl #erm

I i!()i!l &Hc1h!&

O !bd$mml 0.1I! ,eri)ml!licl r&h

rb$rcic ,m

e!lr(ed llll' !$de

7 m!dib)lr ,i!

"#ie!#'& #eme!#

I'e (-# l)m, i! #he ..........>

M li##le b$'& (-I .1 >.....5. ......che. 0:iC oe &$me 90l: around ll)'

+

I'e ($r ,i! i! #he middle $ #heThere'& ,i!)l &:Vclli!~ i! m 5

l'e (-# ,i! i! m ..... ..

O. C$m,le#e #he #bl#< Hi#h H$rd& r$m #he b$3. The ir $!e h& bee! d$!e $r $).

adomen

!eeelb$H

che

l$i!

!!

Hri

le(

thigh

i!(er

**~d$m#!

over .f-o '10tl ,~

Mat+ ;1 h\" (f #he *llt, I!)! , 0PI)lI\lh' thaI :IlU find +I hard III )6!)6mbr ur h;11


12/178

#a rts of the bo4

"he adomenThe mi! $r(?#!& /1 lM b$d* he $rd$!1' !(h&h !me& !d d$c#$r& )&e #h$e

%$rd:. B)# Hhe! ! dPec!e ) !eeded #he# $le! %$*e ! .mr$micl H$rd. l6$r e3m,le*%e C! '% di&e&e $ #he lier $r he,#ic di&e&e. S$me bd$mi!l $r(!&. $r e*m,le

#he,!cre&* he !$ $rdi!r !me.

Idt id!e

QM! dec&$e& #1 b$)# t9 m!! ,.l!* $ 1M di(e&!e SSlem. #M: )'%' #he %$r.l* b$Hel$r i!lci!e; #be &m0I i!le&l*%e $r Ihe &mll b$Hel* #he lr(e i!#ei!e $r 1M l?#ll#c b$Hel

::'hm *,eI!( 1/ "0l$ml~ 22'#llr&m.l %*%r I! rbe !)& !d rec#)m lhebd. ,SS0II~.

"he chest

The chc&l @Ih$r*' c$!#m& #he $rll$%% $ %'I'*r.ll$! !d rbe her#. The mi! ,!* $ #here'I'*r.1I-I' &em re #he .ir!~ !d #he hll#~~.The le@* l)!( i& diided i!#$ rH$ l$be&.!d rhe !(hl i!#$ #hree. The lr&'0~ c$!lM $ #he lr!3. #he #rche @$r Hi!d,i,e. rhe

ri(hr !d *~#br$!ch)&. !d 'he br$!chi$lec* The che&r i& &e,r#ed @r$m #he bd$me! hrhc di,hr(m.

"he &el;isA d$c#$r i& eL&laining #be QlC#l-r#$ #he bldder #$ M ,#ie!#.

Thebldder i& &i#)#ed $! t9,c%I * $) !$H* !d% IS c$!!ec#ed 1/ ec h %


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2ro+... Q.nol EJ>glish .. #he )@

.1 L.bel #he di.(r$m )&$!( H$rd& r$m #he b$3. L$$ $r B $,,$&i#e #$ hel, $).

di,hr(m

l)!(l$be& Hi!d,i,e

br$!chi$le.

her#

I .../../..//.///./C/C//C

6 _O ......%..%...%....**5.

..%%..%% **%%

..........% 5

.O Mrch #he c$!di#i$!& @168 Hi#h #he $r(!& !ecred @6h* )&i!( $)r medicl !$Hled(e.

1 he,#i#i& bldder

O ,!e)m$!i b (ll bldder

!e,hri#i& c her#

(ric )lcer d id!e

ci#i& e lier

7 !(i! ,ec#$ri& r l)!(U ch$lecMi#i* W $mch8 )lcer#ie c$li#i& h lr(e b$Hel

. C$m,le#e #he re3rb$$ e3#rc#* L$$ l A !d C $,,$&i#e #$ hel, $).

E>amination of the a?domen

"o eLamine the &aliEnl for enlarged adominal @1 ..% first feel for the +'

and the +3 ..0......on the right side."o do this. as the &atient to 1I#e a

dee& reath. while &ressing Hi#h the $!(er u&wards and inwards. !eLt, feel for the right +(

and then cross o;er #$ the other side for the left +@ 0 Still on the left side. &al&ate for an

enlarged +1.0.. .. .inall4. mo;ing to the lower adomen., feel for the +

which is onl4 felt if it is Iu.

over -to 5i*% M;"I":a"tl'nl\ do not no! the tocannn or tuncuon (f tht' ;&-r-n or Iht+ P.lIl('(('/I\.

=$H H$)ld


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deec!$! dc@%%0IC )M ece&,&& @9$! I Si$$i& **//1

em !)K'@Mb.

I

ll3*

.. ..

unctions of the od4

Eating

, ce/ **%6./tnu/rt/ In a

'/11;ncIlf. It00000 ... 4our Y$)

t ..e I bee Y$)l~.b)#d$m

Y$) rdl#$d@

#$ile#. md ~ #hrl'2a&&ftlt+/ - #Il /1 r#... $$d.Ir

l'':.)r!l and ~?e!c#$ #. t.l.tt+/($$d!d

#be %M##e#' br'#!(& Y$)r m$)#h '- eheH il !d

I88-#!#C' &$r!rIhll'##

r)&e %II r)!# bc6h#R':%-mlri!? ll #hr

$$d @)'~ e#e!.

4our food. **?lm.7I1)l( &Hll$H it.$!,le.Z#!l. Y$)

S$mc#h)'ll h...,lhOll8.).. ~Hllhl%%

"he fi;e senses

I! >>ddill$! #$ &mdl ~!d 1.12.rhe I#ll'$@%: IIld)Z' &i(h I @$r : %I$!.heri!(* !d dee, brerh i!. h$ld$)r bre#h* thm bre#he-I *$m,#rl.

tess common functions

There Me %%%% #hlll


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)

3~----------~

.1 M)rch #he 'M1%I-*%~ @1611/ #he J)c&!$!& @6e* 000fI$)r r!cdicl !$Hled(e.I d&)!

O d***hI;'

.11**1/1'1

d*,h1.

d&,!$e

::1l0#% $)r bre#hi!( li*4

b /.* I- hle ! ,111Hhe! -ll ,SSH#erc D$ I- he ! dIic)l# H)h $)r &,c2*2;b

d /.'// he ! rr$)ble &Hll$Hi!(e b )our \\9t nonnal &$lid $$d. @$e&$,h(el S#ric#)re3 )hl% > #$e $ ,r$blem* 5 5 . @,r$#ic h,e##r$rh~F 1:**112*;11 me*... #h! )&)l* ee! Hhe! II' !$' h-I. @h,er#h*m$d#)!l l'c !$)ced #h# m h!d* Hhe! I'm !il< )&m( #h%m. @"0rlm ..$!%ml

G 1he lrilble5. . > :lhe! I chr!b rhe :@.11%. @I24lher# .$$l)re

. C$m,le#e Ihe %''''e%**2''. 1../ .11 :. II. C *lI1dn /1'1@%?'. '% hel, '$).

I ~'he! I e# &$lid $$d. 1h.*** 1/ 5 @hllcdleH IIf$r l$!l? #ime be$re Ic! @&::ll$He.lI II.

2--------I0 $) hle ! ,r! Hhe! $) . @,0Qh%'e *//1*

I he !$ @I&lc,,e#i#e !d

rIC l$ il% I;il$& I! lhe #?*** m Hee&*

4 ,_---------------------------Ih:'c,&& < ,er$$0

!le Il.$rde! IS)ll $ Illl%%. h)# %' >> ... @*c!*c?c!:l1l*!$ %111;11 h.& d* ....,,e0red !d I 'I!'* e!l- 11/%,er)me.

@hre0lhelh%%*h $!.J

!" .r- '1011 ~:ou Ihln 1 ,#ie!# m ..4 he dibe#e&* =hin uf ie J)ei$!& 3ou can .a\ #he ,#ie!# tome&!J#r furthtr. =r3 to u\(' #he J)ei$! t3Pl0+) ,re&e!#ed In #m& unit


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.s.

Medical ractitioners "

5 "rc#i#i$!er&I! Ilm0IIl. d$cr$e&* .1/ lllC::! 3medicl ,rc#i#i$! er&* IIllhl e Jli0ied; 0):. A &e!i$r b$)&e $icer @S=- % i! he &ec$!d er $@ ,$&r(rd)!e #r.-IlI!(. The #i#'%IB!$H $)!d#i$! Y.%* O d$c#$r *YO. bI rhe $ld #erm& &er)$r b$)&e $l!.6er !d S=-

re &!ll )&ed*

> A 2,2li&l !;(.r0r @~R IS* d$c#$r Hh$ h.% c$m,le#ed lhe ....li!d.%%% 2rogrdrnrtlC/.+lnd ' training n C1 ()f rhr eical ~1C'I.lhlc*. There re Jl* ++)Inc non..>r.a.ininlt rt'fC,i,crat'\6 #l#l2l-l' Hil# h>>:c c$m,le#ed *hc$r rr$i!i!ll h%l d$ !-I H%h 1/ '1'2...%.llIe et,

> A c$m)h%%* 1: < @)ll '1l1.111Ii2*2,1ec>> li#* lhere !1.l %I*** he :@lme ..*://%. &,ecili'%- \color C6-'tor\ \\he) e. nflC \\,h e$ bec$me *@!:h.l!#~. n Jltlun. rbere 9 =t !--.l\( $!emediClll$r di!iClh d$r2CI-2.Hh$ IS re6?,clllblc l$r ll $@ #he 111C..0%*.1 '1.@@.

MedIcl #em&C$!&)l#m ,hr&ici!] !d &)r(e$! re re&,$!&ible $r &,eciic !)mber $@ ,!e!r& $!

rhe h$&,)l* Ech c$!&)l#!# h.* rem $P)!i$r d$c#$r& #$ hel, cr# @$r rb$&e ,#ie!#&.I! m! h$&,i#l&* #here 9 m)hidi&ci,li!r #em& Hhich c$!&i !$* $!l $@ d$c#$r& bI

l&$ $ ,h&l$*her,iS !d $lher llied behh ,r$e&&i$!l& @&ee !$# 8.

Qhe! ,!e!r& #$r.%. 6 -r re dmi!ed 1/6 h$&,!l* 'he re )&)ll &ee! %2I b $!e $lhe Illl$r d$c#$r& $! #he Hrd Hbere #hc Hill receie rrerme!r !d cre* The Im$r

d$c#$r cr& #hem 6 H.#& Ih$ medicl hi&l$r @&ee !l% U6W 6 !d e!)!e& rhem.~11~ )mc l?l~r..rhe '#lV~lr0r =1.,u &ee& rbe ,)e!#* !d """.l3 order i!'!li~.li$!& or re&*@$r .:.m,le '@' $r ! =.@.* 1110~e < ,r$i&i$! >>1 di(!$&i&* !d h2'


19/178

7.1 Me H$rd c$mbi!!$!& '''l-ll H$rd @r$m ech b$3. L$$ # A* S!d C $,,$&)e r$ hel,

4ou.

associate

h$)&e $!

0ro3isionalrdi$Hrd

cll

di(!$&i&

$icer,(er

r$)!d

&,ecili

7.O ~lCh #he de&cri,#i$! /6 Hi#h #he P$b #ide& @6e. L$$ # A !d B $,,$&i#e #$ hel, $).

I Dr Gr hm h& bee! ,edi#rici! $r ei(h# er& !d i& re&,c!&ible @$r #re!!( me

childre! dmi##ed P* Qrd 7/.O Dr ~#e%*.lr# h& l)~# rred #he &ec$!d e%* $ her $)!d#i$! "r$(rmme. Dr :l!l#h h& rred l)& #rmml# 0* &)r(e$!. Dr 1'llIlh,h& r) (r.d).##'2l !d I7 H$ri!( i! ) l)r(e h$,irl r! S#rllli!(h0m.

Dr :hlbr I I! chr(e $@ #he medicl ~#**@@ i! #he l~irl1li!l


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6


21/178

1 Burses

ril N)r&i!( (rde&N)r&e& H$ri!( i! h$&,i#l he #he $ll$Hi!( (rde&;

)de!# nurse *l nurse who is still in trainin

staff nurse !)r&e Hh$ h& c$m,le#ed rhe #ri!i!( c$)r&e

chr(e !)r&e a ore e0erience nurse who is in chare of, or res0onsible

$r* = Hrd or de,r#me!#

nurse anaer a nurse Hh$ is in chare of se3eral Hrd&

N$#e; The $ld #erm &ier is still &$me#ime& )&ed $r emlecharge !)r&e. A mle !)r&e m!(er m e clled matron.

rn S),,$r# H$rer&

Dr 0me& IS#lm( #$

Sier Q#i!&.

The cli!icl &),,$! H$r er* Hh$ h& d$!e &h$r# c$)r&e !!d $b#i!ed b&ic

J)liic#i$!&* !d #he !)r&i!( )3ilir* Hh$ i~ ***)ll )!J)liied* b$#h SSIS#!)r&i!(%m. There $!. l&$ be H$rd cler&* Hh$&e d)#ie& i!cl)de mi!( &)re ,rie!r&' !$rc$?

an i!$rm#i$! are u0 (C are, an !&Heri!( the tele0hone.

PI S,ecili\#i$!

Lie d$c#$r&* !)r&e& c! &,ecili\e;

> A midHie h& &,ecili\ed r$m #he be(i!!i!( b' d$i!( c$)r&e i! midHier* #hem!(eme!# $ ,re(!!c !d childbir#h.

> Diric# !)r&e& i&i# ,#ie!#& i! #heir h$me&.

> =el#h i&il$r& l&$ H$r i! #he c$mm)!i#. (ii!( dice $! rhe ,r$m$#i$! $ hel#h !d#he ,ree!#i$! $ iII!e&&*

** The !)r&e'& r$leThe !)r&e'& r$le h& ch!(ed c$!&iderbl i! rece!# *C14S. I! ddi#i$! 1/ (e!erl ,#ie!#

cre* checi!( #em,er#)re&* ,)l&e %lie& !d bl$$d ,re&&)re&* ch!(i!( dre&&i!(&. Zi*i!(

i!Pec#i$!& !d rem$i!( &)#)re&* !)r&e& !$H d$ &$me $ #he Ihi!(' ,rei$)&l 1'%'// $r

d$c#$r&* &)ch & ,re&cribi!( dr)(&* !d $rderi!( l!b$r!r$r re&* M$re re&,$!&ibihr $r

!)r&e& i& ,l!!ed* & #he $ll$Hi!( r#icle dem$!&rmre&.

HIIr'S6 an4 out surer4 in effort to cut 0atient *allin, listsN)r&e& i! Sc$#l!d#ri!ed #$ ,eri%%% mi!$2 &)r(e# he e!#ered #he $,er#i!(#he#re to7 the ir2# -r!e in !e$r# #$ r# ,#ie!l Hi#i!( lima M !er&e& HIl$ he,&&ed !eH c$)r&e # Gl&($H cled$!i!!ier&i# re now J)liied 1/ c! out &)ch ,r$ced)re& & #he rem$l /1 &mll le&i$!&. enign m$le& andc4sts.

The erb& ,er$rm !d crr -Ire )&ed Hi#h ll #,e& $ ,r$ced)re&. The re $#e!)&ed i! #he ,&&ie $rm.

1hr %ool%&n

,er$rm

carr)' %U"

an e3mm#i$!

an c&eraucn

> ,r$ced)re

! e3,e!r!e!r #e

b*$"SY

The ,r$ced)re H&,er$rmed

carried -)#b !)r&e.

B

OO


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23

U.1 C$m,le#e rhe &e!re!ee&. L$$ # 1:* 8.lIId C $,,$&i#e #$ hel, $).

I S$me$!e Hh$ &,ecilr\e& In delieri!( bbie& i& .O S$me$!e Hh$ i& J)liied #$ &&i !)r&e& i& 6 66666

S$me$!e Hh$ i& !-# J)liied b)# IS ble #$ &&i !)r&e& i& 566 66666

A !)r&e Hh$ h& J)liied i& 5 !)r&e.S A !)r&e Hh$ &,ecili\e& in hel#h ,r$m$#i$! i& 66.6 .

7 A !)r&e Hh$ l$$& #er Hrd i& !)r&e.U A nurse Hh$ H$r& in (he c$mm)!i# is a ..+ + + nurse. S$me$!e Hh$ !&Her& me Hrd rele&hone i& a M

,' Me H$rd c$mbi!#i$!& )&i!( H$rd $r ,hr&e r$m ech b$3. :oo r * $,,$&ire r$

hel, '$).

e! $)#

ch!(e

chec

(ieremoe

&)#)re&

a &rottdure

! i!Pec#i$!

dre&&i!(#he tem&erature

U. C$m,le#e me &e!#e!ce& H!h #he C-rrec# (rmm#icl l$rm $/Ieror.

I A! i&$#$,e bri! SC;l!1,mle&& !d C2lS 5 .

O Bi$,& $ rhe ,!cre& .5 l Mrch.3 If #he ,rie!r'& c$!di#i$! dereri$r!rc&* la&arotom4 &h$)ld 5 .. 5 I di(!$&i& $ me!i!(i#i& is &)&,ec#ed l)mbr ,)!c#)re rnusr ..

L er He 5 r!d$mi\ed* d$)ble bli!d (r$), &r)d*

.( C$m,le#e #he &e!#e!ce& with #he c$rrec# (rmm#icl $rm $ c$rr o(#,

I I !$H i!#e!d 5 ........ lr(er )d.O !$r#)!#el eH,r$,erl c$!#r$lled #ril& &$ r.

A !)mber $ )die& rece!#l to l$$ # #hi& J)e&ri$!.( A ri(h# hemic$lec#$m ..5 !d #he ,#ie!# md e *))ll r#C-*.r'. Thi& ,r$ced)re can in #he emer(e!c dc,r!!e!r.

over 1-5 ~-#l ~9h;it ind of las'i do nur')('\ l"lur4 out in 3our l0ountr3D ,rt.E nurses/ rt'snn)lhililil'')

inrrcasin< @hatare

#heImlications

of Uli\


23/178

t;F ,llied health rofessionals

m C$mm)!i# hel#hThe hel#h $ #he c$mm)mr de,e!d& $! lr(e !)mber $ ,e$,le $#her #h! medicl

,rc#i#i$!er& !d !)r&e&* The&e c! e (r$),ed )!der #he hedi!( $ llied hel#h,r$e&&i$!l&. The i!cl)de #he $ll$Hi!(;

> l'h&i$rber',iS +&h4sios hel, ,e$,le #$ m$e 4 (e##i!( #hem #$ d$ e3$rci& -r 4#re#i!( #heir b$d Hi#h he# -r m&&(e 6 #re#me!# b m!i,)l#i!( m)&cle& !d P$i!#&

Hi#h #he h!d&. @See !i# ('

> -cc),#i$!l #her,i&r& @-T& hel, ,e$,le Hi#h di&bili# P*,er$rm #&& # h$me

!d # H$r. A di&bili# i& ,h&icl $r me!r!l c$!di#i$! #h# me& It diic)l# #$

lie !$rmll. $r e3m,le bli!d!e&& $r de!e&&.

> S$cil H$rer& hel, ,e$,le #$ &$le #heir &$cil ,r$blem& 6 $r e3m,le ,$$r h$)&lIl( $r)!cm,l$$!em 6 $r .*!*l ,r$blem&.

> Chir$,$di&* 3)*6* !$H & ,$di.rri&l&* rrer c$!di#i$!e .@'cli!( #he feet,

III Tech!ici!&There rc !)mer$)& #ech!ici!& 6 ,e$,le Hh$ H$r Hi#h &cie!riic eJ)r,mem 6 &)ch &

rdi$(r,her&* Hh$ re nown & KUra4 #ech!ici!&. Amb)l!ce #ech!ici!& H$r i! #he

emer(e!c eicine ser3ice. An mb)l!ce rcch!ici! Hi#h m$re d!ced ualificationsi& clled M ,rmedic.

Pl "r$he#i& !d $r#h$#i&"r$heri& !d $r#h$ri& ,r$ide cre $r !$!e Hh$ !eed& M/ r#iicil limb. @

,r$he&i&* -r deice #$ &),,$r# -r c$!#r$l ,! $ #he b$d @! $r#h$&i&. The l&$

di&e $! rehbili##i$! 6 hel,i!( ,rie!r& rer)m 1/ !$!!l lie !d H$r #er #re#me!#.

"r$&rhe#i&r& ,r$ide r#iicil re,lceme!#& $r ,#ie!#& Hh$ he hd ! m,)##i$! $rHere born Hirh$)r = lib.

-rrh$ri& ,r$ide r!(e $ &,li-l&!d other deice& to &d m$eme!#*

c$rrec# de$!!i# r$m ! b!$rml

deel$,me!# $ ,! $ #he b$d*$r e3m,le d)b $$# @rh,e&* !d

reliee ,i!.

ill -,#ici!&

A &rosthesrs S,lr$#&

-,#ici! .. re&r C e&i(h# !d ,re&cribe (l&&e& 6 l&$ !$H l1S &,ec#cle& 6 !d c$!#c#

le!&e&* Hhe! !ece&&r* The e3!)!ri$! i!cl)de& n"c;'I'iuril"fA+ i!#r$c)lr ressure the

,re&&)re $ l)*d %%.de #he ce 6 !d cmmi!( #he reri!. Ir rhe $,)ci+ ?,9;1' 11%c di&e&e* &)ch & (l)c$m. #he reer #he ,rie!; III #heir GI $r #re#me!#. The GI'm #he! reer #ile ,!e!# to ! $,h#hlm$l$(i* d$c#$r Hh$ &,ecili\e& i! di&e&e&

$ #he ee.

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24/178

15

8.1 Me H$rd %*mhlll.1II@$' )*m( ~ H$rd r$m ec h h%*. l$$ l A* B. @' .!d I -%%*II e 1/hel, '-.

mb)l!ce --l

r#iicil le!&

clu limbc$!#c# worer

hel#h ,re&&)%*

i!#r$c)lr #rd$!ici!

$cc),#i$!l ,r$rr&.&i$!l&$cil #Il##,i

8.O Qhich lhed hel#h ,r$e&SI-ll.ll& c$)ld be hel, #he $ll$Hi!( ,e$,le l $$ .1 ':* 8* C !d /$,,$&!e 1/ hell' -il*

t $)!( )!mr!ed %$m! Hh$ h? I%8l h.1I1.)h.lllO H$m! :: 12. % I): IIll# dIic)l# )~i!l# her r$l#lll Mill $ll$Hi!( r))re

~11l#-Il2% h$.I, &;b*'! ! eldl %2M1l0! ::h2.I): I)d bel$% !ee 0m,l.IIl$! m! %hl2' 0,f.I)* .:h2*mer: di&e6e7 m! H)h > #)!;.'1 $!2CIKKI $ hi& #%%

8. C$m,le#e rhe rer&. I $$l r A !d C $,,$&i#e II hell' $).

A ,r$&rheri&r H$rl. H)h ,rie!r& $ ll (e& 1 member $% cli!icl rem* b&ed 1 lr(e

h$&,i#l. The ,!e!r& m !eed ,r$he&i& 37 #he re&)l# $ ! ccide!#* $r

@I . . $ll$Hi!( di&e&e &)ch ? dibe#e&. Al#er!#iel Ihe 11:.'' he

bee! b$r! H)h$)r 1O1 . -r#h$#i?*? H$r l$!(&ide d$c#$r&* !)r&e&*,hr&i$#her,l&lS !d -LC,.1//!0@ 1/ (ie #he ,e$,le )!der #he#r c$m#he be ,&&lhie 1 . Therr $!0III 1m **1/ e!ble lhe %*1Ilml 1/ led

!$rml he l %r .!d lr))r#.A! $!h$!&r $#e! %$!.* &! < ch!K & ,r# $ I! -l,.III-!< &erice !d .1%* %%I* lllher

ce!#re& 1/ ,r$ide 0 :C1':C $r ,e$,le H)h '%*'''''11112/21*. The del Hllh 0'C'I.,le c$.III*'~l%.I?$r IIlSI.IIl2e. childre! Hh$ he cerebrl 1'*11*1'm.IY reJ)ire @S r$hel, Ihelll Hll !d 111.111 $ld*'r ,e$,le !eed ~,e2l*11*h)%: 1/ c$rrec# @7

I dm(ed* /11' ,! /1 rbe h)m! &ele#$! m.lY re@l)ire &$me $rm $@ !!h$:I:*

ll$e !!h$*i* ml be AeC'drd 1/ re,$&m$! #he h$d' $r tel @U,01I1.


25/178

) Hositalsm Introduction to a hos&ital

P$rdi "$!& i& $)r#h6ler medicl )de!# r$m Brcel$!. =e h& c$me r$ B!#i! $! !

elec#ie ##chme!# #$ #he R$l I!irmr* Edi!b)r(h. Dr Brr$! is i!#r$d)ci!( him 1/#he h$&,i#l*

Dr Brr$!; The R$l I!irmr is Ihe !me $ #he )!ier&i# h$&,i#l $r Edi!b)r(h

!ier&i#. II i& (e!erl b$&,irl* deli!( Hilh ll #,e& $ ,rie!r& !d ill!e&&e&. e3ce,#

,edi#ric&. Qe he &,ecili h$&,i#l $r #h# i! !$#her ,r# $ Edi!b)r(h* #he

=$&,irl $r Sic Childre!* Y$) c! &ee &$me $ rhe de,r#me!#& i! $)r h$&,i#l $! be

&i(!. - c$)r&e* #here ll' m!

$#her&* $r 9m,le rhe I!#e!&ie

Cre !i# @lC* >>!d he S)r(icl=i(h Ic,c!dl..*CY !il @=-.

P$rdi; Qhl d$e& '$)r,#ie)' me!

Dr Brr$!; -)i,)e!r& re #he

,e$,le Hh$ c$me 1/ h$&,)l 1/##e!d cli!ic $r 1/ h.* e I#&lS -r

rrerme!# !d #he! rer)m h$me

$! #he &me d. l!,#ie)& i!

rhe h$&,i#l $r $!e $r m$re d&.

The r$$m& Hhere rbe S# re

clled Hrd&. If ,#ie!#'& #re#me!#reGuires onl3 one da3+ such as

&im,le $,er#i$!* #he c! e

dmi##ed 1/ #he d &)r(er )!i#.

m #ut&atients

9elcome to the 5o3al Infirmar3

South Entrance

Car 2ars C V * +;isitors V staff -

"he Sim&son Centre J*for Re&roducti;e Health C3naecolog3 (Emergenc3)

Maternit3 (Emergenc3)

Beonatolog3 (Emergenc3)%utatient eartments All Qrd& 5a3 -urger3 Unit . Endosco3 ... Kra3 eartment

... Com?ined ,ssessment

Dr Brr$!; The Accide!# !d Emer(e!c De,r#me!# @AZE* .12/ clled C&)h* i&

Hhere ,l ie!#& Hh$ re *c)lcl ill - HITh &)dde!* &eri$)& c$!di#i$! 6 c$me $r!&&e&&mem and #re#me!#* -)r,rie)r& Hh$ hae nil ,,$i!#me!# ro &ee ! secialist go to

! cli!ic i! $!e $ #he -l,liml De,r#me!#& @-I'-&. The he )&)ll bee! reerred

#$ rhc h$&,i#l b Iheir G"* Hh$ Hri#e& reerrl le##er 1/ #he c$!&)lr!r e%,li!i!( #he

,#ie!#'& ,r$blem.

mIn&atientsDr Brr$!; The i!,#ie!#& in h$&,i#l re dmi##ed i! $!e $ rhree mi! H&. Them be &ee! i! $!e $ #he $)r,rie!r cli!ic& !d dmi##ed r$m #here $r* i #here i& l$# $

dem!d @$r #he #re#me!# #he !eed* & i! rhc c&e $ hi, re,lceme!#* #he' re ,I $!

Hi#i!( li $r dmi&&i$!. Al#er!#iel* #heir G" m rr!(e rhe dmi&&i$! b #ele,h$!e

bec)&e rhe re c)#el ill. $r e3m,le Hi#h &)&,ec#ed m$crdil i!rc#i$!. -r #herc &ee! i! #he AZE De,r#me!#* Hhere #he d$c#$r $! d)# 6 H$ri!( # #h# #ime6rr!(e& #he dmi&&i$!. Thi& H$)ld h,,e! i! #he c&e $ )I ,#ie!# Hi#h Ircr)red

!ec $@ em)r* $r e3m,le. Lr(er h$&,i#l& m he ! &&c&&mcm )!i# Hhere ,!e!#&

c! be dmi)ed Icm,$r.)il Hhile #heir c$!di#i$! i2&&e&&ed.

P$rdi; *se~~+

Dr Brr$!; Ye& 6 deci&i$$& ll' mde b$)# #heir c$!di#i$!* !d Hhr !eed& 1/ e d$!e 1/hel, rhem. Arer rrermem .& c$r!,lered* rhc ,#ie!# i& di&chr(ed bc 1/ rhe G"'& cre.

26


26/178

27

W.1 C$m,le#e #he #0hle %$rh :=lrd* r$m A. B !d @* -""@hIC. ")r II'@~mr m lr)%* $@

#he re&&ed ? II0hle III ech H$rd* The ir $!e h!& bee! d$!e @$r $).

V*'rh N-LI!

d'mir

&&e&&

di&chr(e

$,er#e

reer

#re#

W.O Me H$rd c$r!bm!$!& -IIIS H$rd @r$m e.icb b$3* L$$ # C /",el%IC r$ hrl, l-.

c)lel )!i#

&~&m~!l l1er

$! lire#TllI d)#

Hi#i!( ,II

W. Qhich h$&,)l de,r#me!# H$)ld be m$ !,,r$,!.!e $r #he $ll$Hi!( ,r$c!** l$$# A. B!d C $,,$&$re )* hel, $)*

1 a woman in dibe!c Cn)3

O ,rie!r Hh$ h& I< bd rdicl ,r$&rrecr$m

,#ie!# **// '& )* he &i! le&i$! rem$ed

m! Hirh @$mll% b$dF lou m !eed 1/

1 III K which 3< me! going #$ !$#her


27/178

28

&v-"'o #&=$H d$ h-l$!lLII .. 111%'li#= c$)!#r $r ?llll' ?1@%111.... 1/%% How would $) @4.. ,l.)! Ih#* ,r)l.Td)r['

1/ .1 t ll#'*=0l' %lI!1 *I!)lh#% l!)!#r


28/178

111>0 11 ,to >loI. e$[#c ~(I~ ~ r", It. ~~# t> 0 M #e ;*@'>l.~. (.. ) . ..@.@ @ #$ SlI...'1;P er#.**** ......~ ;;#'#0~ cll& #$ "#~I':.I;S*(rl'.H'00..e ..l w5at/..u.II8.%o

c..OO r*.. A S ~#;ed ~ t- st=


30/178

iI) 9edical education )m 9edical education in the %=

Medicl ed)c#i$! i! @he K c$er&;

> )!der(rd)#e ed)c#i$! 6 $)r $r ie er& r medicl &ch$$l* me &ec#i$! $ M )!ier&i#re&,$!&ible $r medicl ed)c#i$!

> #H$6er $)!d#i$! "r$(rmme Hhich ,r$ide& #ri!i!( $r !eH d$c#$r& #er

(rd)#i$! #hr$)(h &erie& $,lceme!#& i! diere!r &,ecilrie& @&ee !ir 1O1

> ,$(rd)#e #ri!i!( Hhich d$c#$r& re P* bec$me GI'& $r c$!&)hm& 6 &e!i$r

&,ecili&r& 6 $#e! deliered rhrough c$lle(e& @$r diere!# &,ecil#ie&* $r e3m,le #he

R$l C$lle(e $ "h&ici!&

> c$!#i!)i!( ,r$e&&i$!l decl$,me&) i! #he $rm $ c$)r&e& !d &emi!r&. Hhich d$c#$r&

)!der#e #hr$) .. 'E *) dncaI and &cie!#iic #$,ic&mi!l ,re&er!?ed 1ImI(h ,$$blei$=l-Seci learning@"Bl. wilen $) wert .... /Iher $! series of c&e&rolems.

S#)de!# Selec#ed M$d)le&S#)de!# seIecIed ......... @SSM& IiII#M $) #$ dI$$&er$m me!) /1 saO.cts &)d# IS S&ons ~!e-

MIl ]1#I I!()$(e IS ~ of ., elec#ie* hos&IaI of '"I $H! chof.~YNB!dS.

V$c#i$!l S#)die& !d Ci!icl Sill&"his 2-#I#l-Il' #)#$r. I lie ll $ i#. ee! rhe di&&ec#i$!. Qe (el '/ c)r ), cder& r$m

rhe &ec$!d m$!#h $ #he c$)r&e;


31/178

3)

11.1 I'I0#*h #h!c ClI:Il@ #$ #~ ~0;! /1 mc;dc2.11 ed)c!$! I! I~ K (ie! I! A 2r1'#%1I~.

) dH?~!!( cder&

O ~,$!( log $@ Sr(0Cll ,r$.. '!l)re$. $b&ered !d ,er$rmed H$rm( @$r @$)r m$mh& III 2@Ide!l 0IlII cmcr(e!#' 1/ e3,e!e!ce #l)& S,9lll

I.ll!

% ! Im,$!.#!l I%ll **@ #he I!.l$m c$m,$!e!#.

1 lbe !%C:11F $ I'.dlllb)r(h '% /%% /1 I ClIdc.1 %' lhe

8 She'&

countr3.

r rhe R$.ll? $!e $ #he Ie.*di!( ,edi#ric her# S,$c#.I$*I* III lhe

F /I he Ro4al of S)r(e$!& 111 %di!b)rllh dares @r$m )@*@.

1/ Qe he M . ech Hee Hhere He di&c)&& #$,ic& i! &mll (r$), H)h $)r

lec#)rer*

11. M#ch ech $ rbe&e c!me& 1//%% $ #he c$m,$!e!#& $ rhe )!der(rd)#e c$)r&e

de&c!bed III B!d C $,,$&i#e.

1 0)l%* *,e!d* SIK wees H$ri!( m *m.11I h$&,)< %' #he =iml&.O *: (r$), $@ &r)de!r& dISCSS r$(C'lhcr #he 1'/~~lblc %'.-IlS @$r bd$m$!l ,$! #cr ~I* I! I!

$be&e 6:6e~r6@1d mle.

3 A I)I


32/178

Medical education @

"he oundation 2rogramme

The $)!d#i$! "r$(rmme i& rH$6er #ri!i!( ,r$(rmme Hhich $rm& rhe brid(e berHee!

)!ier&i#6leel &r)d # medicl &ch$$l* !d &,ecili $r (e!erl ,rc#ice rri!i!(. h c$!&i&r&$ &erie& $ ,lceme!#&* ech l&ri!( $)r m$!rh&* Hhich ll$H rhe )!i$r d$c#$r* !$H! .! #ri!ee* )* &m,le diere!# &,ecil#ie&* $r e3m,le ,edi#ric&. A er $!e #ri!ee @YI

c$rre&,$!d& #$ ,re6re(ir#i$! h$)&e $icer @"R=- "-S#S!d er #Q- #ri!ee @YI #$&e!i$r h$)&e $icer @S=- ,$&. Ech #ri!ee h& ! ed)c#i$!l &),eri&$r Hh$ e!&)re&

#h# m$re &e!i$r d$c#$r& delier #ri!i!( i! diere!# H&* i!cl)di!( cli!icl !d ed)c#i$!l

su0er3ision. Bo 0roress. #ri!ee& h .r.e to dem$!m#e a rane of cli!icl co0etencies

Hhich re &&e&&ed #hr$)(h $b&erri$! i! #heir H$r,lce.

IBM0 :&""'" O//? AmmdC'dH*.h ,9m%%'% h$m Ih7 8M0 0'LCr$),

2eo&le in medical education

tutor A! c>>demic* $r i! &$me c&e& ,$&r(r!d)re )de!#* Hh$led& r)e$ril&.

dem$!&rr#$r In !r$mP' rechi!(* &$me$!e Hh$ dem$!r#e& h$H to di&&ec#.Dem$!r#$r& re $#e!,$(rd)#e )de!#& ,.m( rberr H#hr$)(h medicl &ch$$l.

lec#)rer I &e!i$r lecr)r er An acaeic Hi#h reachin an rc&e reh res0onsibilities Hh$c$!#rib)#e& #$ #he rechi!( $ ,r#ic)lr di&ci,li!e.

,r$e&&$r A &e!i$r cdemic Hi#h #echi!( !d re&erch re&,$!&ibili#ie& $r

,r#ic)lr di&ci,li!e. &)ll ledi!( i()re i! #heir di&ci,li!e.

c$lle(e r)#$r A c$!&)l#!# re&,$!&ible $r delieri!( c$lle(e #ri!i!(

,r$(rmme.clinical trainer A c$!&)l#!# &&i(!ed #$ #ri!ee Hh$ ,r$ide& #ri!i!( d)!!(

,eri$d& $ direc# cli!icl Cre.

ed)c#i$!l &),eri&$r A c$!&)l#!# Hh$ &),eri&e& rri!ee'& ,eri$d $ #ri!m(.

9edical Oualifications

BMSc Bchel$r $ Medicl Scie!ce >. A de(ree $re! # e! #er #hree er& $

BMed Sci medicl )die&b &r)dc!r& Hh$ m Hi&h #$ $ll$H creer i! mediclre&erch.

MBChB* MBBS Bchel$r $ Medici!e* Bchel$r $ S)r(er. Bchel$r de(ree& %*

BMBeh* BMBS )!der(rd)#e de(ree&. Thi& i& #he first de(ree @$r K d$c#$r&.

MD*DM D$c#$r $ Medici!e

DRC-G Di,l$m $ #he R$l C$lle(e $ -be#ric& !d G !ec$l$(

MRC" Member $ rhe R$l C$lle(e $ "h&ici!& $r Member $ #he R$l

MRCS C$lle(e $ S)r(e$!&. D$c#$r& bec$me ~lembe r& It/&)cce&&)ll c$m,le#i!( #he &&e&&me!# ,r$ced)re& i! #heirc$lle(e.

RCS ell$H $ #he R$l C$lle(e $ S)r(e$!& $ !(l!d. -#her c$lle(e& re

I'IlCS@Ed mdl2U0ledb #he le#rer& Hhich $ll$H* $r e3m,le Edi!b)r(h. Gl&($H $r

~RCS@Gl' Irel!d.

mcsiIl$H d$er$r& bec$me /I ell$H de,e!d* $! #hel# c$lle(e. $r #he


33/178

RCS. )r#her e3r!m!$!& m)r he ,&&ed. $r $#her c$lle(e& II .& bnomination or H$r &&e&&me!r.


34/178

2ro+euio0,,/ en,,,,,,.. %se -..

1O.1 C$m,le#e #he ,hr&e& Hi#h 'er~ r$m #he b$3. TH$ ,hr&e& c! be c$m,le#ed i! 1'1/diere!# H&. :oo !# A !d B $,,$&i#e #$ hel, $).

delier roide &),eri&e re

* ...>>%.>>5. ..5. c$m,ere!ce $r h$H 1/ d$ &$me#hi!(O . > 5 ... rri!ee b e!&)ri!( &he &)cce&&)ll c$m,le*e& her #ri!i!(

5 c$)r&e $r rri!i!( ,r$(rmme @& #echer

5..5 c$)r&e $r rri!i!( ,r$(rmme @& M )de!#

5..5 ,r$(re&& $r c$m,ere!ce

)'.' M#ch @be rH$ ,!& $ @he &e!#e!ce&. L$$ ' A, B!d C $,,$&i#e r$ hel, $).

1 A! Y I %M d$c#$r

O A dem$!&rrr$r )an anato4 #echer

A cl)!el rr!mer i& M c$!&)l#!#

A su0er3isor is *I c$!&)lrm A medicl &cb$$l )

7 A ,lceme!# i&U A c$lle(e i&

8 A ell$H i& &,ec >>h&r

b$d' $ &,ecili& re&,$!&ible $r delieri!( !d &&e&&i!( #ri!i!( i! #heir &,ecilr*

b re&,$!&ible $r #he #ri!i!( ,r$(rmme $ #ri!ee.

c ,eri$d &,e!# & #ri!ee i! M h$&,irl $r i! Ge!erl "rc#ice.

d i! rhc !rS@ er $ #he $)!d#i$! "r$(rmme.

e Hh$ h& reched rhe hi(he&r leel i! rheir &,ecil#.

f Hh$ ,r$ide& #ri!i!( d)ri!( ,eri$d& $ direc# cli!icl cre.

W ,! $ M )!ier&i# re&,$!&ible $r medicl ed)c#i$!.h Hh$ reche& di&&ec#i$!.

)'.3 Qri#e ! )ll #he J)hicll$!& $ #he d$c#$r& !d &)r(e$!&. L$$ ' C $,,$&i#e '/ hel, $).

1 Mr A. =. Y$)!(h)&b!d* MBChB. RCS* RCSI

O -r C D$:*Ie. ?:led Sc r, -M > .:IRC"

3I& I!%II. MBBS. RCS

Dr E .:lem*:l4crher. BM. MD. RC"

OVer 0'C '10lA ~o* o 4ou bec$me a &,ecili in 4our countr4< list #he ?5P(l4~.


35/178

=he oerseas doctor

"4&es of registrationo m!(e an treat ,!c!#& in rhe U%, all octors m) reister Hi#h Dhe Ceneral

Medicl C$)!cil @CMC. There re &eerl r,c& $ re(ir#i$!;

> "r$i&i$!l re(ir#i$! is $r d$c#$r& Hh$ he P) J)liied r$m medicl &ch$$l i! ehe%= $r r$r! cer#i! E)r$,e! Ec$!$mic Are +EEA member Sl#e&.

> ) re(ir#i$! is $r d$c#$r& Hh$ he c$m,le#ed #heir er'& cli!icl #ri!i!(.

> Limi#ed re(ir#i$! i& $r i!rer!ri$!l medicl (rd)#e& Hh$ h !$# c$m,le#ed #he

eJ)ile!r $ rer'& cli!icl #ri!i!( i! #he K.

> S,eciii&l re(ir#i$! i& $r d$c#$r& Hh$ he c$m,le#ed &,ecili&r medicl #ri!i!( !d

he Cerri!c@e $ C$m,le#i$! $ Tri!i!( (CC/).

11*c Gi' Rl6(i&lcr i$ re(mer $ ll #h$&e eli(ible #$ H$r i! (e!erl ,rc#ice i! #he N=S.

N$#e; $r )ll de#il& $ #he @c!erl Medicl C$)!cil S@C HHH.(mc4).$r(

2:AB

lle$re #he C! $b#i! )ll re(i&rrri$!* &$me c!re($ric& $ $er&e& d$c#$r& rereJ)ired #$ #e #he "r$e&&i$!l !d Li!()iic A&&c&&111clm B$rd @"LAB ICS#. ILAB

i& de&i(!ed r$ e!&)re rh$&e Hh$ &ass c! ,rc#i&e .1el*r #he leel $ ! S=- i!. ir,,$i!#me!# ill %= h$&,i#l.

"r# I c$!&i& $ Hri##e! re $ !$Hled(e* &ill& !d rrir)de&. "r# O i& ! -bPec#ie

S#r)c#)red Cli!icl E3mi!#i$! @-SCE. It c$!&i& $ 17 ie6mi!)#e cli!icl &ce!ri$&*!$H! & #i$!&* #$ &&e&& ,r$e&&i$!l &ill&.

N$#e; $r )ll de&cri,#i$! $ "IAB. &ee h##,;FHHH.Wmc4).$rWd$c#$~,lb

2:AB stations and ad;ice-SCE& &&e&& #he&e &ill&;

> Cli!icl e3rr)!!$!; Y$)r .bili# #$ crr -IM,h&icl e3mi!!$! $ &im)l#ed,de!r* ! c#$r #ri!ed 1/ ,l Ihi* r$le* Hill be .*M;S....;d.!ccm$!blc $r m!mrec3r)i)ri$!& Hill be er!ed %ut u)ln, J m!ii!* an !!r$!)cl """de2

> "rc#icl &ill&; Y$) Hill be &&e&&ed $! ,rc#icl &ill& &)ch & &)r)!!( !d (#VlIl(mrre!$)& mPecei$!&*

> C$mm)!ic!$! s!ills Eour abilit4 to i!#erc# Hi#h 8 &im)l#ed ,#ie!#* %r in &$me c&ehe e3mi!er* ***II be &&e&&ed. Sill* reed m i!cl)de brei!( bd !eH& !d (ii!(

dice $! lie&rle.

> =i$r #i!(; Y$)r bili# #$ #e ! cc)r#e hi$r !d me re&$!ed di(!$&i&

Hill be &&e&&ed.Adice $! #be S##i$!& r$m &)cce&&)l c!did#e;

Red #he i!r)c#i$!& $)#&ide ech #i$!

cre)ll. Y$) he #ne mi!)#e $r #hi&.D$!'# $r(e# #he ABC @irH&* bre#hi!(*circulation) #BF) in eer eerenc4 #i$!.

Kee, i! mmd &.c# ,rec)#i$!&lie Ihr$Hi!& #he &hr,& i! rhe

&hr,& bi!.

Chec #he ,#ie!# )!der!d& Hh# i& h,,e!i!(? #he!

& #hem aout ! concerns Ihe ma4 ha;e, D$!'# 0S# @

(ie. lec#)re. l.i&rc! cre)ll )* Hh# #he c#$r &&.

N$#e; Shr,& re !eedle& !dblde& Hhich m)be di&,$&ed $ &el I! &,ecil container

clled &hr,& bi!.

3( r$@e&&iM20flnttish ., %se
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rorioool A$h ., I9-/07

)3.) :'@Ihl i!d $ re(ir!$! might #he&e d$c#$r& $bmi! L$$ # A $,,$&i#e #$ hel, l-*

1 A !eH#' J)liied S,m&h d$c#$r

' A !eH#' J)liied Ni(eri! d$c#$r

3 A docror Hh$ h& &)cce&&)ll c$m,le#ed #he ir $)!d#i$! >ear +>)

A! ]=- Hh$ h& &)cce&&)ll c$m,le#ed #he $)!d#i$! "r$(rmme !d (i!ed Cer#iic#e

$ C$m,le#i$! $ Tri!i!( #er &eerl &,ecili&e re(irr ,$&r&

)3,' Qri#e #he bbrei#i$!& i! H$rd&. :oo r A* B!d C $,,$&i#e #$ hel, $)*

1 A! d$c#$r Hh$ H!#& 1/ H$r i! #he K m) re(ier Hi#h #he B3C.

O S$me $er&e& d$c#$r& m) ,&& #he P;< 12'S#be$re #he c! r@QSler.

"r# O $ #he le2# c$!&i&r& $ ! #SeE.

I! llY emer(e!c* remember #he


37/178

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6

S

940tos an sins

De&cribi!( ,r$blem&The ,r$blem& Hhich. ,#ie!# %'"-r#S 1/ rhc d$c#$r rC clled &m,#$m&* $r e3m,le

0ain or nausea. 9ins arc Hh# the octor fins. also !$H! ;1G finins" on e8ainin (he,#ie!#* $r e3m,le hi(h bl$$d ,re&&)re $r r,id ,)l&e rre. Sm,#$m& re l&$ !$H!

& c$m,li!r&. T$ re,$r# ,#ie!#'& &m,#$m& -r c$m,li!#&* d$c#$r& &;

Hr r!&H$r#h \\'=.I dmi##edI! c&e !$#e&* #he bbrei#i$! do i& )&ed;

c$m,li!i!( $ che ,i!*:I& C!e ,G


38/178

,

1.1 C$m,le#e #he rble H)h H$rd& r$m C $,,$&)e. ")# re&& mr i! r$!l $ rhe re&&ed&llbic i! #ch H$rd. The 7r&l $!e h&bee! d$!e $*' $).

$uun A#I*#Tl$l'

eL/hausrionri()e

le#hr( Itireness I

1.O Me H$rd c$mbm!$!& )&i!( H$rd r$m ech b$3. L$$ # A. B!d C $,,$&i#e 1/ hel, Y-II.

c$m,li! Hi#h

$6 $

$)# $ $)#

,%c&e!# $!

,)l c$l$)r*orn sorts

1. C$m,lere rhe &e!#e!ce& H)h #he c$rrec# @$m* $ Ihe erbresen#,

I A 7U4er6$ld m! Hi#h W6m$lllh hi$r $@ i!cre&i!( &h$r#!e&& $ bre#h.

O The m$ c$mm$! 5i& l$&& $ c$!&ci$)&!e&&.= Cranial r#eri#i& a4 as fe3er Hi#h$)# an4 ob3ious causes.

The,rie!# )&)ll ...Hi#h &eere S-re#hr$#. The 5 &m,#$m& in @hi& ,rie!r c$)ld ,erh,& he d)e #$ re!l il)re.7 -#her c$!di#i$!& wirh M &imilr 5 ..5 5 i!cl)de c)#e ch$lec&riri&.

U Red)ced (r$H#h is ! im,$r#!# c$m,li!# $ c$elic di2'2'.

8 TH$ m$!#h& @$ll$Hi!( #he ,#ie!# H& ble r$ Hl.

1. Red #he ,#ie!#'& de&cri,!$! $ her &m,#$m& #he! c$m,le#e #he c&e re,$r#. L$$ 1 C

$,,$&i#e r$ hel, $).

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39/178

8

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ull lood countI! rhe i!e&!(ri$! $ bl$$d di&e&e&* rhe &im,le #e i&% )ll bl$$d c$)!# @BCI. A

)ll bl$$d c$)!# me&)re& #he $ll$Hi!( i! &m,le $ bl$$d;> #he amount $ hem$(l$bi!

> #he !)mber $ #be diere!# cell& 6 red bl$$d cell& @er#hr$c#e&* Hhile bl$$d cell&

@le)c$cre& !d ,l#ele#& +rhromoc4res

> #he $l)me $ #he cell&

> rhe er#hr$c#e &edime!##i$! r#e @^SR 6 me&)reme!# $ h$H J)icl redbl$$d cell&)ll #$ #he b$!$m $ M &m,le $ bl$$d.

AnaemiaA!emi i* $!e $ #he c$mm$!e di&e&e& $ #he bl$$d. I# m e d)e #$;

> bleedi!( 6 l$&& $ bl$$d> e3ce&&ie de&rr)e!$! $ red cell&

> l$H ,r$d)cri$!* $r e3m,le bec)&e rhe die# i* lci!(* $r deicie!# i!* ir$! @re.

A medicl )de!# h& e3mi!ed ! elderl ,#ie!# Hirh er l$H leel $ hem$(l$bi!

!d i& di&c)&&i!( rhe c&e Hirh her ,r$e&&$r;

"r$e&&$r;Sr)de!r;

"r$e&&$r;S#)de!#;

"r$e&&$r;

Sr)dem;

"r$e&&$r;Sr)de!)"r$e&&$r;Sr)de!r;

:*@h& rile m-SI liel di(!$&i& i! rhi& c&eM$&r ,r$bbl crci!$m $ #he b$Hel Hi#h chr$!ic bl$$d l$&&.

:Vh& (i! #h# & di(!$&i&Qcll* he h&!'# hd ! ch!(e i! hi& b$Hel hbi#* $r l$ Hei(h#.

:Vh# el&e H$)ld $) i!d)de i! #he diere!#il di(!$&i& $ &eere !emi i!

m! $ #hi& (e

=e mi(hr he le)emi $ &$me S-r#* $r ,lic !emi. b)# #h#'& rre 6 i#H$)ld e *'cr )!)&)l. A!$#her c)&e i& ir-I1deicie!c. b)r he &eem& )* he !

deJ)#e dre#.

#=. N$%. #here'& !$#her c)&e $ !emi Hhich I rhi! % 111/re Ir.>ehe& ie.

2ernicious anaemia

P$rdi "$!&* #he medicl )de!# @r$m Brcel$!. h& mde &$me l!()(e !$re& $!hr& #e3#b$$.

"er!ici$)& !emi @"Ali& c$!di#i$! i! Hhich #herei& #r$,h $ the gastric m#K$& with c$!&eJ)e!# il)re

$ i!)i!& c#$r &roduction and i#mi! 811mlb&$r,#i$!* The $!&e# i& i!&idi$)&* Hi#h

,r$(re&&iel i!cre&i!( &m,l$~ $ !emi."#ie!#&re &$mebme& &id #$ hee lem$!4ell$Hc$l$)rng #$ c$mbi!#i$! $ ,ll$r!d mild P)!dice causEd b e3ce&SIVebred$H!$ hem$(l$bi!bec)&e of I!eec#M red @ell,r$d)c#i$!*!#he b$!e mrr$H. A red &$re #$!()e @(l$&llli&i&&$me#ime& ,re&e!#. "#ie!#&,r~# ?Ith &mme#ricl

,rehe&i . I! #he I!(er&!d I~ er#1/&& $

ibr#i$! &e!&e* !d ,r$(re&&ie He!e&& !d#3* The &,lee! ma4 be,l,ble.

~tt Nb#W#..~~

......'d%'9.2 N &lcH#ll d%'Zr%?~~

l/%,$rN


40/178

1.1 h!d H$rd& III I he% **%h $,,$&)e nlC.nlll/. I$$* .))B!d C c,,$$re )*hrl,%)*

deJ)#e&.61i!*r

mild

rrecommon*)dde!

1I1?*d*$)*

i!deJ)#e$rhel

DDl

1.O Me H$rd c$r!bm!$!& )&m( H$rd r$m ech b$3. L$$ /1 B!d C /,"-SIIC1/ hel, $).

bont di(!$&i&

diere!#il sensei!&idi$)& I

ir$! arro*,er!ici$)& '!#re&i!(,r$(re&&iel ddicic!cibr#i$! !emi

1. C$m,le#e #he ...6.!#e!c .... I $c$L.*# A. B!d C %,r$*i#e I+ hel, $)*

I A W'cr6$ld m! ~Ied ':l#h 0 h%Hl' $ bd$mml dhle!:lc#l $'er 0&enod o+ /0 11@'l1Ih*.

O Bh!d!#&* m. he* *%*)6.cd h* : !mm A

0 The bleedi!( !d ,)r,)r* re c)&ed b .b!$rm.1 )!cl$!.

The Hhi#e cell c$)!# % !$rml &$ He c! c)re le)emi.

The ell$% c$l$)r $@ her &ill !d c$m)!c!e i, ,r$bbl d)e #$ 5.7 There H& m&& in #he ri(h# ),,er J)dr!# $ #he bd$me!.

U Tre#me!# i& imed 0I re$ri!( lI)id bl!ce Hi#h i!#re!$)& Ilurds,8 The !emi m' e d)e 1/ i!cre&ed red cell.*.* .. .

1. C$m,le#e #he c$m er&!$!. :oo # C $,,$&i#e #$ hel, $).

"r$e&&$r; Qh1% 2:.0lIl#rhe di(!$&) $ ,erm$$)& !emi $! ,h&lCll e'd!lll--

Sr)de!e "he,r)bm #.l##ed J)i#e &)dde!l. &$ II d*d!'l he #he ,lCll @11566666. =e ~!'l he ! *I! +' !d he d$e&!'# he

+ )

eel h% :1'19/.

,re&rhe&ie* $r h&em @1 &e!&e* !d I c$)ld!'l

2rofessor5

S#)de)#;

Qhl .*--Ihl~ I!!()e

=I' I%!%)e %.* !$rml !d !$r i!lmed $r (,)

over 16/ ~-lll ...t. #h#' r au+0/louf anaerma m+/ntlont/d In #he ,/on;+Ur8i.ltlun I! 8 $,,)&)e Ihr! lhc%~#4

!$#her ,/ondlllnn Ihd# rH% e!c$)!#er rt0gul.6.Hl4 6


41/178

:[

Bones

B$!e&S$me c$mm$! E!(li&h !me& $r b$!e&;

l !Jhh "".II"U An.llolllll"'11 !m

&)ll craniu

PH b$!e m!dible

s0ine er#ebrl c$l)m!

breb$!e sternu

ri c$

c$llrb$!e clicle

&h$)lder blde sca&ula

#hi(h b$!e #mllr

!eec, ,#ell

&hi!b$!e )bi

rc#)re&A rc#)re i& bre i! b$!e. S$me $ #he diere!# r,e& $ rc#)re;

(ree!ic di&,lced c$mmi!)#ed im,c#ed $,e! @c$m,$)!d

A ,#h$l$(icl rc#)re IS r$$#)'% III di&e&ed b$!e. A #i()e $r me&& rc#)re IS d)e #$

reeated mi!$r #r)m* (or e3m,le l$!(6di!ce mrchi!( or running.

Tre#me!# $ rc#)re&

Qhe! #he r(me!c& $ br$e! b$!e hel !dP$i! #$(e#her? #he )!i#e. !i$! m e ,r$m$#ed*

$r hel,ed. b red)ci!( rhe rcr)re 6 re,lci!( #her(me!c& i! #heir !#$micl ,$&i#i$! i rhe re

di&,lced. A#cr red)c#i$!* e3ce&&ie m$eme!# $rhe br$e! b$!e i& ,ree!#ed b i3#i$! 6 ei#here3rer!l* $r e3m,le &,li!# $r ,ler $ "ri&c.

$r i!#er!l. $r e3m,le ,i! $r ,l#e !d &creH&. ... *A di&,lced rcr)re Hhich IS !$# red)ced m re&)l#

in m!l)!i$9 6 Incomlete or mc$rrec# union.

!ote5 "he ;er I#d)ee hasI me!i!(& In

medici!e;

$ ,lrr eII M &m a,# te and %%

M to mae&mller 6 I thik :*'& bttt~r re&"ce th~ clo$eor yo"r l-bl~l$.

M +in surge..,. to return to anatomical &osition - A belo c- Ilor-lly b~ re&"J -i"l-tio.M +in chemist..,. to I##lI-V# oL4gen or add h4drogen - 9itric -ci& is - re&"ci% -%~t

40 ,.re$$iooZl I,&


42/178

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breb$!ec$llrb$!elH b$!e!eec, O!b

17.1 Lbel #he di(rm %'l-A ::/91* r$m I~ //:. I Cl-~.11A $,,$&)e #$ hel, //.

7

&hi!b$!e

&h$)lder blde

&)ll

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W

17.O Mlch #he I0n $ r.K#:0re I61 Hirh rhe de&c!,)$!& @6e* L$$ # 8 $,,$&)e 1/ hel, l$).

) o&enO c$mmi!$#ed di&,lced (ree!&!c

im,c#ed

There% bre $! Ihe &m*

b The b$!e % 1%'111. It 0000 m.ll!lF 1/ childre!.c The b$!e I7 brcll$.c!1/1/ 'erl "'CCe:.d The br$e! "'@'Ce:~'% &e,r#ed*

C The br$#! &-n re &u,hed r$(e#h er*

17. C$m,le#e *he rerb$$* e3#rc#. L$$ r C $,,$&)e 1/ hel, $).

+) . fracture in;ol;es tr4ing to return the ones to as near to their original

&osition as &ossile. If a fracture is allowed to heal in a dis&laced &osition the fraclure

will +' . ut IIma4 go on to +3. . .

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43/178

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Childhood

Mile$!e&Childh$$d I~ lhe &eood d)!!( %h$ch ,er&$! I~ child* I# e!d& Hirh ,)b2r# 6 me -DS9$ &e3)l m#)!l. I!!l I 5her H$rd @$r $)!( child? i!!c* i& rbe ~$d r$m

bmh )!!l b$e# Ii'e t/S $ (e.

The mile$!e& $! ch*ld'* dc:d$,mml !d me (e& # Hhich #he )&)ll $cc)r r#;> &i##i!( 6 b W m$!#h&

> cr*mli!( 6 b )' m$!#h&

> ir&l %$rd& -IIX ) m$!#h&

> %li!( 6 h ) f"l+nths

> 1.lldlll< @I::.*..%$r) .....*121.2+ 6 bl 1 e*l#S.

C$mm$! i!ec#i$)& di&e&e&

$I8l0,I880 C$mm)) !!!6

l1l)rbdl$lr)bc$l me&le&

r)bell Cerm! me&le&

ricell chice!,$3

i!ec!$)& ,r$!!& mum&s

,er#)&&i& Hh$$,i!( c$)(h

c)re lr!($rrchelll& cr$),

&crl#i!. &crle# eer

rhc)m!c e'er rhe)m#ic eer

tttanu8 l$cPH

,$ll$l1lel$ll: ,$li$'6

C$elic di&e&eA m$d%**1 *IlIm# h.* !).0c ... **%% l!()(e !-Il~ Hhile redi!( her #.%b$$l. ..

C$eilICd~ IS* II Sfa /1 tIlfQl#S#0~ Gl%Ifd br &M&i#ii# #$ giw5tn.)t c$!

,##S!# # -rrt age b)1 QI >tI*-rF $# ~;e25!i!(

$! l- c#r#l& c$!. %%'W (#)l9I "ht di!icle#)re& lIldIIcIr r#$$#. mlb&$r,#i$!

and failure to thri;e )hm ma4 be IFflS ofml!)#ri#i$! and *%%'~. 'J.~",

wta ./0 %/ u............ so? foe/Y.

~l ~ N /5I/ '44.6..&Ni~ .... c 5fSi

..... lb&$.%$... N 000 /cs.or.#Co/I.

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44/178


45/178

=he endocri ne s3stem

ELcess and deficienc4A! e3ce&& 6 #-- m)ch* $r deicie!c 6 #-- li##le* $ circ)l#i!( h$rm$!e& Causes Hide

r!(e $ medicl c$!di#i$!&* $r e3m,le h,er#hr$idi&m !d h,$#hr$idi&m. Qhe re#here i& ! e?cess $ h$rm$!e* $!e $rm $ #re#me!# c$!&i& $ (ii!( me ,#ie!#&$me#hi!( Hhich i!hibir& rhe ,r$d)c#i$! $ #h# h$rm$!e* & i! #he )&e $ crbim\$le

#$ #re# h,er#hr$idi&m. Qhe! h$rm$!e i& deicie!#* #re#me!# m be b re,lceme!#

#her,* $r e3m,le i!Pec#i$!& $ i!&)li! i! #he #re#me!# $ T,e I dibe#e&.

D-c#$r& &';S)erer& $ r,e I dibe#e&

arc eficient in insulin.

Ne(#ie eedbc &em&

1 TR= +th4rotro&htn-releaslng h$ml$!el i&.. e in #he h4&othalamus e!d tri .. , ... #he0 etie. of "SH +th4rotdUstlmulating hormone

in #he &itull5ar4.

O TS= 11i lltes #he TS= rece&tol/ i! #he #hr$idto increase OIItIIesis $ oth T +th4roLine andTh;!i$d$#hr$rl!e !d a(so to rea .. storedhormone. increased &lasma le;els $T. and Ta.

3 " fel $ell on #he &iwitar4 end &ema&s the

h4&othalamus to InhiIt "RH and "SH .. eretia M.

G$i#reAll e!lr(ed #h'r$id (l!d IS clled ($i#re. lhe e!lr(eme!# m be di)&e 6 i!$lm(

m-M $ #he (l!d* $r l$cli\ed N hmhcd #$ ,l4#ic)lr re* %' i! &$li#r @&m(le!$d)le. The I!cre&ed bl$$d 11/:: In dill%% e!lr(eme!#* $r e3m,le III Cr%e?' di&e&e*m (ie ri&e #$ ,l,ble #hrill6 ibr!$! el# Hi#h #he h!d. !d ! )dible br)i#6 !$i&e herd #hr$)(h S#e#h$&c$,e* $er #he (l!d.

A letter $ referralMr& Di&'& d$c#$r h& reerred her / ! e!d$cri!$l$(i.

her i!#$ler!ce;

i!bili# #$

c$,e Qi#h hi(h

#em,er#)re&

$ear D$c#$r.Iwould e grateful if 4ou would see this @*-4ear-old woman

Hh$ has lost O/ ilos in weight in s&ite of eating m$#e than

)&)l. She descries herself as $er~c#ie and at first

&i#e thought the weight loss was due 1/ this. B)#

m$rett4 She has de;elo&ed &al&itations. diarrhoea,and heat intolerance. She has noliced that her hands

ha;e a #e!de!c to shae.

Her s4m&toms suggosted h4&erth4roidism and this was

conlinned 4 m eLamination which re;ealed an enlargedth4roid. red sweat4 &alms and a fle tremor of the hands. I

GV';%'c#i:'@;; ~$rec!e than I-

)&)l

r&al&ilalions5

Hre!e&& ofr,id $r irre()lr

he!ber

ri!e #rem$r; er&li(h# i!$l)!#r

m$eme!#&


46/178

48

18.1 C$m,le#e #he #ble Hi#h H$rd& r$m A* 8 !d C $,,$&i#e !d rel#ed $rm&. ")# re&mr i! r$m $@ #he re&&ed &llble In ech H$rd. The ir $!e h&bee! d$!e @$r $)*

er N$)!

in/hiir,r$d)ce

rele&e

re,lce

&ecre#i$!

im)l#i$!

18.O C$m,le#e #he ,&&(e r$m #e3#b$$* )&i!( #he ill)r#i$!!d $)r $H! !$Hled(e. :oo # B $,,$&i#e #$ hel& 4ou.

")l&e& $ G!AlI @($!d$lr$,lli!4relc&l!( hormone Ilreroroascd from the h4&othalamus and +) .:)) and SB @O from #he ,i#)i#r. :))@ 5 testosterone @ from

Ledi( cell& of the ?S)is.

Te$er$!e +@ ac on #h$

h,$#hlm)&\,!))r #$ @7 G!R=

@U . S= @8 5................... #he Ser#$li

cells in #he &emi!ier$)& tuules #$ +F .

mature s&erm and the inhiins A and B. lnhiin

c)&e& feedac $! #he ,i#)i#r #$ decre&e S=+)* ......... .

18. C$m,le#e #he &e!#e!ce&. :oo # A !d C $,,$&i#e #$ hel, $).

I A ch!(e .ecr& m! ,m $ ! $r(! $r (l!d.' A ....

ch!(e ec%* $!l $!e ,r#.

Ili& die# i& $! rr$!; he d$e&!'# (e# e!$)(h ir$!. 5.......... .. T* !d T. mcre&e rhe asal me#b$lic r!#e*

18. M#ch Mr& Di&'& S'1Tl,l$m2+)-) with #he J)ei$!& her d$cr$r &ed +a-gT, :oo # /

$,,$&i#e #$ hel, $).

I dirrh$e O e#i!( m$re

he# i!#$ler!ce c

$ercriir d

,l,i##i$!& e

7 Hei(h# l$&& f

U tremor W

D$ $) ,reer h-I He#her $r c$ld'

I& $)r Hei(h# edQhl i& $)r ,,e#i#e lie

Are $)r b$Hel& !$rml

Are $) ale 1/ &i# !d rel3D$ $)r h!d& &he

=e $) eer ell $)r her# beri!( r,idl $r irre()lrl

-e.r [* /)*tl?rltt/ 6) !4h4rrl It/ll #$r )))an t/fHlorflnl#II Iu-ln-;r h6)/

h4&olh4rolcll8)l), ))8+/the h-ttrr In + *fl2Il8III/ 6)8 a murh-l


47/178

=he e3e

2arts of the e4e

eel&he&

,),il

ELamination of the e4e

0 #ere i~! e3#rc# r$m M re3rb$$ de&cri,ri$! $ h$H #$ e3mi!e Ihe cle$

L$de *.* &J)i!l @~d#$$,il( /1dIfClid (#""') or -]elll.$! $ #h. 1he $J)$I in&i\e> 1he are regular in $)#li!e @$H!l 2iI2Qr> 1he re anom)aI4 dil#ed -r(r +If c$!ric#ed @Smll> 1he rec# normall4 II IW# !d 9~ @$c)& on near $bP$$&.

T$ IeSI dIf...man II cc$mm$d#i$!...# dIf,de!< to loo i!#$ dIf di!ce. =$ld %"i' li!(er in r$!# /1......... !d%% #he ,lim# IIB l$ci2 # it. Th# .*.. shouti 00/0 $c(elher. +If c$!er(e. !d #he &u&ils &h$)ld c$!&1ric# .. #he &a)ioI)IlooI5sl #he $!(El*

Chedc also ,., clM-d +a&ocd4 /1dIf le!2.

Retino&ath4

=,crrc!&re ch!(e& m rhe re#i! c! e cl&&iied r$m (rde& I 1/;

> (rde I 6 &iher %iri!( i!cre&e $! rhe li(h# rele3 $r #he !e!e& $!l'

> (rde O 6 (rde I ,l)& rreri$e!$)& !i,,i!( @i!de!##i$! $r ei!& Hhere rhe !rc cr$&&edb r#erie&

> (rde 6 (rde O ,l)& lme6&h,ed hem$rrh(e& !d c$rr$!H$$l e3)d#e&

> (rde 6 (rde ,l)& ,,ill$edem.


48/178

+I/

6

1W.1 C$m,le#e #he #ble H!h H$rd& r$m B $,,$&i#e !d rclrcd r$rm~.

Vnh N-li! Adll'@'ll@'

cc$mm$dre

droo&

$&cill#e

recr

constriction

c$!er(e!ce

dil#i$!*

dil##i$!

1W.O M!rch #he ,ic#)re& +)-1 Hi#h #he c$!di#i$!& @6. :oo # B $,,$&i#e #$ hel, $)*

)

dr$$,i!( $ hd&

b dilred ,),ile irrO6ur &u&ild c#rc#e &J)i!#

r c$!ric#ed ,),il&

1W. C$m,le#e #he e3#rc# r$m #e3#b$$. L.$$ # C $,,$&i#e #$ hel, $).

Re#i!$&c$,

ELamine


49/178

48

The (r$i!#ei!l &em

ELamination of the adomen

=ere i& ! e3rrcr r$m M #e3#b$$ de&cri,#i$! $ h$H r$ e3mi!e #he6 bd$me!*

!ote if #he adol/llell i& di&1e#$ded 4 l)id or gas. "he &resence of l)id canbe coonmed 4

demonstrating &hi#i!( d)I1e&&; ,erc)&&. $r #,* ir with #he ,lie!#li!( su&one - II# $! #heirac6 then & #he &atient to lie on one side and &ercuss again. If fluid i& ,!$&e!#* #he cI !$#eheard on &ercussion m$e&. 2al&ate each re(i$!* eeli!( $r ~ 6 ,i! when #$)cI1ed*or masses - ,l,ble enlargement of tissue. !ote also an4 ()rdi!( or ri(idi#* shown 4

contraction of #he bd$mi!l m)&cle&. Guarding ma4 be due to tenderness or M2ieI and c!be reduced if #he &aIlent i& ,er&)ded to relaL. Rigidit4, howe;er, Is constant !d i& due to,e!l$!el irri##i$!. Reound #e# $deme&& i& ,i! when the &al&ating hand is suddenl4 rem$ed.% I& a SW' of &eritonitis. :isten for owel sounds.

"he faeces

There rc &cer IH$rd $r #he .ece&.

D$c#$r& &$me#ime? ]/''; "#ie!#& &$mcrime& &';

There H& bl$$d $! rhe $$l&. M m$#i$!& he bee! er l$$&e l#el*

@ =e $) ,~ blc $$l& /B$Hel m$eme!# is )&ed r$ reer r$ deec#i$!;

@ =e $)r b$Hel& m$ed #$d U' =e Y-ll h.d b$Hel r!$er!e!r r$d.*=$Hel hbi# i& medicl e3,re&&i$! me!i!( #he ,##er! $ deec#i$!.

=e $) !$#iced ! ch!(e $ b$Hel hbi#

Are /#% ($i!( #$ rhe #$ile# 111/re$#e! #h! !$rml

Ch!(e i! b$Hel hb! c$)ld be c$!i,#i$! 6 hrd* i!reJ)e!# &r$$l&* $r dirrh$e 6reJ)e!# &$# $r liJ)id $$l&.

N$rml $$l& re br$H! in c$l$)r* !d &emi6&$lid* $r $rmed. The c$!&ie!c* -r de(ree$ hrd!e&& !d &$#!e&&* c! be &h$H! -! &cle;

hrd $rmed &emi6$rmed &$# @l$$&e liOuidJwater4

The c$l$)r c! r @T$mblc* d)e #$ l#ered bl$$d & i! mele!* #$ ell$H* (r#' $r c: e!

Hhirc* Mele! $$l& re $#e! de&cribed & crr 6lie l1lr*#he blc &ic &)b!ce #h# i.

)&ed i! r$d mm(. The $$l& $!*** be red Hhe! re&h bl$$d i. ,re&e!#. Bl$$d #h# c! $ill bede#ec#ed Hi#h &,ecil #eS IS clled .ecl $cc)l# bl$$d @-il. Qhe! #here i& hi(h # c$!#e!#*rhe **//1? re ,le* !d re &$r!e!me& de&cribed & cl6c$l$)red. S#$$l& #h# rc lr(e to $l)me

re de&cribed & b)l. Abd &mell i& de&cribed & $)l $r $e!&ie.


50/178

O/.1 C$m,le#e rhe @0C 2JlC1MI.**m ~I A -,~I@C 1/ hel, $).

"h&icl e3mi!#i$! reeled #hi! (irl Hi#h &li(h# ,ll$r. She H& !$# $bi$)&ldehdr#ed. The #em,er#)re H& 84C* ,)l&e l--mi!*bl$$d ,re&&)re 11/8/ mm=(.E3mi!#i$! $ the re /1 #he crdi$&c)lr !d re&,ir#$r &em& H& !$rml Thebd$me! H& !$# @1 . There H& (e!erli\ed @O *Hhich H&m$ mri#ed i! the ri(h# lower @ !d H& &&$ci#ed with@ ut !$# @ . There H& !$ reb$)!d @7 5 !d!$ @U Here el#. @8 &$)!d& Here red)ced.

O/.O M#ch #he d@%$2?r$,ll$l1$ ebe $$l& @167 Qllh #he c-l1dili$!. m$ liel 1/ c)&e #hem@6* )&i!( $)r !.. [email protected] !$Hled(e. L$$ 1 II c,,$&i#c to hel, $).

"4&e of $$l& C$!di#i$!1 l$$&e* hl$$d 1I.'l#le )lcer

O l$$&e* ,le* h)l b rrr)ble b$Hel *%dr$mc

cl6e$lc)red c )er)e c$hll' blc* @11 d ch$ler 2mll* hrd e c$ehc dlc$?c7 cler? H-Il#l H)h m)..): f $h2r!l2)c l!)!d~

O/. Mrch rhe e#)re& +)-1/ rhe d$c#$r'& JC2II$!.@6(. L$$ r 8 $,,$&)e #$ hel,I-.

I bl$$d =$H $#e! d$ $) $,e! $)r b$Hel&O b$Hel hbi# b Are $) ($i!( 1/rhe #$iler m$re $#e! rh! !$rml ch!(e i!b$Hel hb! c Are #he m$#i$!& hrd -r l$$&e b)l d $o #he m$#i$!& he ! )!)&)l &mell c$l$)r e Q1)1 b$)r #he ,,er!ce $ #he &l$$l&

7 C-llSlS##ll2' r =e $) ,~edblc $$l& $e!&?*'e!#S& W I& #he S#le $r #he >>m$)!# $ #he $$l !-rm.lI

'$(hlu&&rr

Ouad0,nt

r$(hl

%'6J)dr!l

)lIt bd$$1e! @'-! e d!!ded

Into four Ouadr.ilnts.

over .f/o '1011l nu ha+/ .)))*T ?lhl:'l' In 8/I6hat otht0 1..'/11@1111/'% lh# 4ou eucounte n-Oularl; ., the

,,r.)!c of lh#4 *111/% #Y");dl' =)H 8/I6CHlld4ou d;;rtthr #hl'I' ~l,,#'~=d!l4l41


51/178

50 %*%@e&*i$$$l English .. %se

3naecolog3

The emle re,r$d)c#ie &em

ll$,i! #)be

@&l,i!3

!ec $ H$mb6

ceri3

Me!r)#i$!A ,eri$d i#he C-mm$! !me $r. me!r)l @m$!#hl ,eri$d. The $!&e# $me!&rr)ri$! i& !$H! M] me!rche. The I.*. me!r)l ,eri$d i& c$mm$!l bbrei#edi! d$c#$r&' !$re&. I.MI' %@ ($ me!& #he l&r me!r)l ,eri$d H& #H$ Hee& ($*

The me!r)l ccle* -r le!(#h !d reJ)e!c $ ,eri$d&* i& )&)ll Hri##e! i! @he $rm

A/@B, Hhich me!& li!( d& !d $cc)rri!( eer O8 d&. I ,eri$d l& m$re

h! $)r $r ie d& ir c! be de&cribed & ,r$l$!(ed. The #erm he ,eri$d& me!&

e3ce&&ie bl$$d l$&& 6 me!$rrh(i* $#e! Hi#h rhc ,&&(e $ cl-IS 6 c$()l#ed bl$$d.

The #erm ,eri$d ,i!& means d4smenorrhoea, $r ,i!)l me!&rr)ri$!.

The rime Hhe! H$m! S#$,& me!r)#i!(* !$rmll # b$)# #he (e $ /. i& clled

rbe me!$,)&e $r climc#eric. In eerd E!(li&h i# i& !$H! & rhe ch!(e $ lie* -r&im,l #he ch!(e. Sm,#$m& $ #he me!$,)&e i!cl)de h$# l)&he& 6 &)dde! &e!i$! $

he# 6 !d !i(h# &He#&.

A (!ec$l$(icl c$!&)l##i$!A (!ec$l$(i i* rli!( #$ /6*I6;1r4$lclH$m!.

G*6!e#'-l$(i

A re $)r ,eri$d& re()lr

I l$H $#e! d$ $) (e##hem

I*5)*

"#ie!#

Ye&.

Eer $)r Hee&.

=$H old Here 3ou Hhe! )0%U rred N get #hemQhe! H& $)r l ,eri$d

=$H l$!( d$ #he ,eri$d& 11 )&)llQ$)ld *-&l' rhe re li(h# $r heD$ /#% (e# d$#&

D$ $) (e# ,eri$d ,i!&

I& #here !' di&chr(e be#Hee! #he ,eri$d&

Qh# c$l$)r i& i#

Ab$)# 1O.

A Hee ($.

$r d&.Li(h#.

N$.

N$# rell.

A li##le.

Qhire.

C$!#rce,#i$!1'/% H$me!* me#h$d* #$ ,re* em ,re(!!c i!cl)de #he $rl c$!#rce,#ie ,ill @!$H! .*#he "ill* #he di,hr(m. !d #he i!#r)#eri!e deice @ID $r c$,,er c$il. C$!d$m& rc

!!ilblc $r b$#h me! !d H$me!.


52/178

O1 .1 :'iIr'#e M &im,le E!(h&h ,hr&e @$r ech $ rhe medicl #erm& bel$H )&i!( $)r medicl!$Hled(e. L$$ r i\ !d B $,,$&)e r$ hel, $).

I herec#$m me!$rrh(i

&l,i!(i#i& cericl bi$,&

O1.O Red #he c$!eri$! be#Hee! me (!ec$l$(i !d rhe ,#ie!# i! C $,,$&i#e* !d c$m,le#erhe !$re& b$)# #he ,#ie!#.

me!rche;

me!r)l ccle;LM";

me!$rrh(i

d&me!$rrh$edi&chr(e

O1. N$H Hri#e #he J)e&!$!& Ihl #he d$c#$r &ed. L$$ r C $,,$&i#e '/ hel, I-.me!rche;

me!r)l ccle;LM";me!$rrh(i

d&me!$rrh$e di&chr(e'

O1 . C$m,le#e #he c&e re,$r#* -!e H$rd i& !eeded #Hice. L$$ 1 B!d C $,,$&ire #$ hel, $).

A6er6$ld H$m! hd bee! hili!( @I ,eri$d& li!( $r 8 d&. with me

,&&(e $ @O > $r W m$!#h&. There H& !$ bleedi!( be#Hee! @ 5$r #er i!#erc$)r&e. =er @ Here !$#,r#ic)lrl ,i!)l. She hd !$# !$#iced! h$# @ 5 ... 5 #f !i(h# &He#&. !d her (e!erl hel#h hd lH& een ($$d.She hd #e! me @7 c$!#rce,#ie @U )!#il er ,rei$)&l.Hhe! c$,,er @8 H& i##ed. She hd hd !$rml ,re(!!c Hhe! she H& O.

coodoms

ID

!er .f-o '10 ~9hat +\ Ih ..+ ##))de " centracc&trun 1113uur rnulllr4< ,t Hh# ag(' dn 3ou thin @'m#0ll~

~h@l)ld be n*0\(+fl?cd c$!#rcc,!c&


53/178

=he heart and circulation "

Shortness of reath

Sh$r#!e&& $ bre#h* $r bre#hle&&!e&&* is d&,!$e. A# ~r rhi& i& c)&ed b e3er#i$!6 ,h&icl 0r#IVI *)ch *. chmbi!( i% 6 b)# 111 *eere c&e& i# m e ,re&e!# ee! #

re. A &anenr Hh$ ISbrerhle&& Hhe! li!( l*# @$r#h$,!$e. $r e3m,le I! bed. %*IIre!d #$ &lee, ~ ), $! #Q-$r m$re ,ill$H&. The bbrei#i$! S-B-E 'l!d& $r

&h$rr!e&& $ bre#h $! e3erci&e @$r $! e3er#i$!* $r $! e$r#*

"#ie!#& &;

I Se# #embl &$$! $ bre#h climbi!( ~.

D$c#$r& c! +;

I l$H m! ,lll$*** d$ F/11 6Iee, $!

Heart rh4thm

The !$#mll%CS)!( her# r$)e IS76U ber& ,er mi!)#e. I! #hle#e& II r! e 8 %* &

/ be#& ,er mi!)#e. I! e3rreme rhle!c .em I#* rhe he! r#e c! ($ & hi(h & l--1mm.The her# rhlhm r! be re()lr $r irre()lr. I! ll irre()lr rh#hm @rrbd:mll* lhere

I!' be erlF* ber& HhIch I!#err),# #he re()lr rh#hm @,rem#)re be#&? $r lhe rh#hmm r Hi#h re&,ir#i$!? $r i# m be c$m,le#el irre()lr* . i! ibrill#i$!. Qhe!

,#ie!#& re Hre $@ Irre()lri* #he de&cribe #he &m,#$m & ,l,i##i$!&.

A OO6er6$ld )de!# H& dmi##ed #$ h$&,i#l Hi#h l$!( hi$r of her# &rolYms.

She hd bee! i!cr~&i!(l #ired* Hi#h &h$r#!e&& $ bre#h $! e.er#i$!. ortho&noea. !d,l,i##i$!&. A Hitral ".ft hd bee! crried $)# er& ,reY#-Sl!d #hi&hd bili\ed #he &m,#$m& of her# Il)re b)# H& $ll$Hed 4 e0isoes @##c& $.3i.1 lbril0.#l$!* HhICh hd bee! ,r#ic)lrl &eere $r #he 7 m$!#h& be$re dmi&&i$!.

Heart failure

=er# @ll)re -lQ% %be! Ihe her# IS )!hle 1/ 111.1'%#*1I1&1)iCie!# crdic -I"I6.hem$)!# $ bl$$d ,)m,ed b #he herr ech mi!)re 6 $r #he h$d '& !eed&. It m 1///*Crbe i# &ide $ lhe be!. rh# !(lll SIde* $r b$#h. I! Icll her# il)re #he mi! %m,c-- IS

bre#hle&&!e&&* Th#6~* m,e$m& $ ri(hl her# ..il)re I!cl)de ,eri,herl $edem &% dli!(l*

be($!!i!( $! .he re# !d !le&. ThIS IS !$H! .. ,il#i!( $edem I. Hbe! > i!(er %,)&hed i!#$ te %*.III!(. II c)&e& &mll de,re&&i$! $r ,iI.


54/178

OO.1 C$m,le#e #he c$!er&!$! b&ed /11 #he c&e hi$r ill B $,,$&i#e.

D$c#$r; Qh.# &eem& #$ be #he ,r$blem"!#ie!r; I'e bee! (e#!!( @1 .5 .

D$c#$r; =$H l$!( he $) hd #hem

"#ie!#; $r b$)# &i3 m$!#h&. B)# I'e hd her# ,r$blem& $r er&* Hirh #ired!e&& !d+' .. $ +3 In #he e!d I c$)ld!'# Hl

m$re #h! h)!dred me#re& Hi#h$)# hi!( #$ &r$,* Ihd r$ &lee, $! #hree+( . I hd +@ re,lceme!# #hree er& ($* !d #h# im,r$ed #hi!(& $r Hhile.

OO.O Me H$rd c$mbi!#i$!& )&i!( H$rd r$m ech b$3. TH$ H$rd& c! he )&ed #Hice. l$$ #B!d C $,,$&i#e 1/ hel, $)*

# $)#,)##ril il)recrdie $edemher# ibrill#i$!

$! be#&,illi!( e$r#

,rem#)re re

OO. Qri#e rhe H$rd& ,#ie!# H$)ld )&e #$ de&cribe #he &m,#$m& bel$H. l$$ r A* B!dC $,,$&i#e #$ hel, $).

I d&,!$e

O rrh#hmi

$r#h$,!$e

$edem

OO. C$m,le#e #he c&e re,$r#. l$$ # A. B!d C $,,$&i#e #$ hel, $).

A 7/6er6$ld H$m! lle!ded her G"'& &)r(er c$m,li!i!( /1 bre#hle&&!e&& $! @I

............................Thi& hd bee! i!creSi!( $er #he ,rei$)& ei(h# m$!#h& )!#il i# H& ,r$d)c6

i!( ,r$blem& # r$)!d // me#re& Hli!( $! #he leel. There H& !$ hi$r $ che ,i!.

She hd hd &eerl @O $ l @ Hhich led O/6/ mi!)#e&

!d Here &&$ci#ed Hi#h &$me @ . 5 /1bre#h. She hd !$#iced &$me

@ ....5.

... $ her !le& 4 #he e!d $ #he d. Thi& di&,,ered $er!i(h#

over 6r- '1011 "Ho! H$)ld 3ou m!Jc the #re#me!# of #h H$m! in @@. b$e


55/178

=he heart and circulation

2h4sical eLamination

Medicl e3mi!#i$! i& !$rmll crried $)r i! $)r &r!(e&; i!&,ec#i$! @l$$i!(*

,l,#i$! @ee~!( Hi#h #he h!d&* ,erc)&&i$! @#,,i!( Hi#h i!(er !d )&c)l##i$!@lie!i!( Hi#h e#h$&c$,e.

N$#e; The erb i&,l,#e? #he !$)! is,l,#i$! @!$# ,l,i##i$! 6 &ee !i# OO.

ELamining the heart and circulation

=ere i& % e3#rc# r$m #e3#b$$ de&cri,#i$! $ h$H%* e3mi!e #he crdi$&c)lr&em*

:oo l #he li,&. l$!()c !d !il. for the

bl)e dic$l$r#i$! $ c*$!$&i&. C!$&i&

m be ee!#rl $r ,eri,herl* 11l6,cc##he

h!d?* $r cl)bbi!(. 'CCl #he r)di!l ,)l&e l#he HriSI and !$#e lhe r)le +for eLam&le

U/1mi! and rh#hm @re()lr or irre()lr.

"he,)l&e m be irre()lr i! @-I & Hell& #ime. Chec #hr #he -#her ,eri,herl

,)l&e& r)e ,re&e!#. Me&)re #he bl$$d

,re&&)re. and %'*%%'SS #he P)()lr 8/e$#%S

&ressure @0V". "l,#e the che for #he

,e.% be# 6 #he !$!!l ,$&i#i$! i& #he i#hle# i!#erc$l &,ce. $!e ce!#ime#re medil

#$ #be midclic)lr li!e. eel $r ! #hrill&.=er# &i\e m be me&)red b

,erc)&&i$!. Lie! $r m)rm)r& and $#herb!$rml &$)!d&. $r e3m,le ric#i$! r)b&.

be(i!!i!( # #be mi#rl re. M)rm)r& m be

son or l$)d. A harsh m)rm)r is l$)d !d

r$)(h.

N$#e Ih0 lime $ ! murmur i! rel#i$! #$#he cardinc ccle. "he m$&I c$mm$!

m)rm)r& arc> mid6&$lic @i! #be middle $ *.#$le

> ,!6&$lic @li!( for #be Hh$le$ &$le

M enrl4 diastolic

M mid-diastolic> l#e di$lic @,re6&$lic

Continue 4 lie!i!( at ).e #ric)&,id. $r#ic

!d,)lm$!r rCS.

ing7rduing

,reas of )&c)l#ri$!. The le##er& Indatt tht

a00ro8iate &osition of the heart 3a.t3es# ")lm$!r 3al3e A Aortic 3al3e H Hitral 3al3t';

= =riscuid ale. =he circles indicat( the osition

for auscultation for crdlc ururs inicatin

3al3ular heart disease."henbs art numrt/d.

54 Pro(essJon$i E!(li&h .. #e ...6


56/178

Pr.(e&&l&roolE.n"~h !&. ee$6e

O.1 C$m,lcrc rhe #ble Hi#h H$rd& r$m A $,,$&i#e. ")# S#re&& m!r i! @r$!# $@ rhere&&ed &llble i! ech H$rd. The ir $!e h&bee! d$!e $r $)*

nh !uun

'auscultate

i!&,ec#

,l,#e

,erc)&&

O.O ")r #he e,& @$r e3mi!i!( #he her# !d circ)l#i$! i! $rder* cc$rdi!( #$ #he $)r6(e&em. L$$ # A -""-Si#e )* hel, $).

Me&)re #he her# Sll~.

b Art there an4 m)rm)r&C eel rhe rdil ,)l&e*

d :oo @$r cl)bbi!(.e L$c#e t he ,e3 be#.f N$re %! rh!ll*.

1. A d$c#$r i& ,re&e!#i!( rhe c&e $ 4er4$ld H$m! # meeri!( i! rhe Crdi$l$(

De,r#me!#. C$m,le#e #he re3r $@ her ,re&e!rri$!* L$$ # B $,,$&i#e #$ hel, $).

-! e3mi!#i$! &he H& ,re3il Hi#h > #em,er#)re $ 8.. She H& &h$r# $ bre#h.

=er ,)l&e H& rible be#Hee! 1// !d 18/ !d H& irre()lr i! #ime !d+I C.C..C..

=er bl$$d ,re&&)re H& 1301B0 !d her VI' H& ), ce!#ime#re& &h$Hi!( !$rmlr!$eme!r Hirh re&,ir#i$!. =er ,eri,herl +' Here ll ,re&e!# !d #here

H& !$ @ 5 $r @ . c!$&i&. =er ,e3 +@ H&di&,lced #$ #he anterior 3ill.


57/178

S8

Infections

eer

A medicl )de!# h& mde &$me l!()(e !$re& $! c&e re,$r#*

A O6er6$ld m! ,re&e!#ed Hi#h eerHhich he hd hd $r three d&. -! #he

#hird d he hd hd &eere ##c $

eer Hi#h &He#i!( !d ri,'&. The $!l

, hi$r $ rele!ce was he,#i#i&

$)r er& erlier !d ctAular fe3er@i!ec#i$! Hi#h E,ei!68rr ir)& # #he

(e $ 18 4ears. =e hd re#)r!ed r$m

Aric #hree wees ,rei$)&l.

*ever N &4reLia @81/ re "lI- 6 ,red ofunnown $ri(i!

eer alec nown *? #em,er#)re -0f00

tcn&eratureU.

aelQecti00iS N eeri%hlelrile !d '%'2'I2il

$,'-%i#eW N )lrile'%'2'l2il

FK, t@rLt, qf fmrr

eHeel!(

rl($re @eeere ehlerl!(.!d ~ $ c5of$lea !no*n ... chllle

Micr$$r(!i&m&I!ecri$!& dier r$m $#her di&e&e& i! !)mber $ &,ec#&;

> M$ im,$r#!#l rhe re c)&ed b lii!& micr$$r(!i&m& 6 &)ch & ir)&e& $r bc#eri

6 rhr c! )&)ll e ide!#iied* rh)& ebli&hi!( #he e#i$l$( erl i! rhe ill!e&&. M! $

#he&e $r(!i&m&* i!cl)di!( llbc#eri* re &e!&i#ie '/ !ribi$ric& !d m$&r i!ec#i$!& re

,$re!#ill c)rble* )!lie m! !$!6i!ec#i$)& de(e!er#ie !d chr$!ic di&e&e&.

> C$mm)!icbilir i& !$rher c#$r Hhich diere!#i#e& i!ec#i$!& r$m !$!6i!ec#i$)&

di&e&e&. Tr!&mi&&i$! $ ,#h$(e!ic $r(!i&m& '/ $#her ,e$,le* direc#l $r i!direc#l* r!'

led r$ ! $)#bre $r e,idemic.

> i!ll* m! i!ec#i$!& re ,ree!rble b h(ie!ic me&)re&* b' ccmc&* @/06'2;111'

lie ##e!)#ed cci!e& &)ch & r)bell cci!e /% b dr)( ,r$,hl3i& @$r e3m,le.chl$r$J)i!e '/ ,ree!# m.I.%.I.

M icr$$r(r)&m& i!cl)de bc#eri * :'lSC* )!(i* ,r$#$\$ @&)ch .1? 'he,r&i#e Ih.1 c)&e& mlri. A!$#her (e!erl H$rd $r #he&e ,#h$(e!&i& micr$be&. 1!em~$#e! reer r$ micr$be& !2 (erm& $r b)(&.

N$#ice rhe c$mm$! e3,re&&i$!& $r cJ)iri!( ! i!ec#i$)& di&e&e;

C$)ld he hec)(h#

,iced u&&$me di&e&e r$m #he d$(

I rhm )8. c)(h#rhe lI) b)( *hl'&

($i!( r$)!d.

S$)rce !d &,red $ i!ec#i$! 1/=ere i& ! e3#rc# r$m medicl re3rb$$*

Infechon ma3 originate from the atIent (endogenous)+ usuall3 from sin. nasohar3n> %f bo*el. %f'rom

outside sources (e>ogernOUs). often another erson !h% ma3 ?e either uHenng from an infect;on or can:'ing

a0athoKenlc !rooran;s. ca?il,9 ale usuall4 ooalth4 an 'na4 harbour the oranis in the throat (foreLam&le. dl&hthGna.lsalmonenal. or lood +he&atitis B or HI. !onUhuman roes oIlnlecll##

Include water +o.g. ch$I$rl. mn +0* lu##rcuol slo. food +e.g. otulism. an,mals +e.g raies. lods +eUo&slllocosls and *)*the..,,) +o.g Ieg00,ell. - :egloonaloe.U dl .....

"heln.uation &eriod #Slhe,eri$d etween theln;.sloo *) tho tissue. 4 &athogens and lhe a&&earance

*) clinical features oI,nfecl "he &eriod of Infecti;it4 Is tho time t9ttlle &allent Is ,nfectl#%Sto #IhefS.


58/178

57

O.1 Mrch Ihe IQ-,.*%' $ #he &e!re!c ..... l$$ 1 A* II .!d C $,,$&ire 1/ hell' l-.

) )F9 '$H Ihe K l)!ch $ he rre!)redO Chice!,e+* +/3))7)t..)% c$mm$! mec!$)& Rb~ h: ! IIlc)hm$!

/"he ,!e!r rem&med eb! =e %& dmmed Hirh $)r6d hi$r $ i!l)e!\6r ,e &m,#$m& $ @e6 er %*m7 ))e ,r$,$m$! $ ,$e!r& Hh$ rec$er r$m he,1 iri& II1 The ce!#rl ,! $ A!$ % $!rhe mid $ ! e,idemic8 Me&le& +rueola i& m$W Lme di&e&e i& c)&ed bl rr!&mi&&i$!

1/ "- !d& $r

,eri$d *..!llm( from $)r $b* ~ 1/ m! m$!rh&.b !($ r&* m'l(. !d (e!2!l !)ll&c.e bec$me (Jrrl('r\ of thr \ Iru\d 11I@C2IIlI: d)!!( #be c010rrhi %.l(C.

e di*c.:C 1@ chrldb$$d.

f o+ A 11:.W $ 8. h)r(d@lre! @r$m !iml ... m! b i3$drd !c*h H)h ,e* $@ rem,err)re $ 1WS'C.i & re:-0 +If )!!$H! $!(i!.

Q mc*&. m)m,&* !d r)bell @:I:IR cci!e.

O.O C$m,le#e #he c&e re,$r# $! #he ,!e!r m A $,,$&i#e* L$$ # A* 8 !d C $,,$&i#e #$hel, 4ou.

-! e3mi!#i$!. he l$$ed )!HelL =i.&,)l&e r#e H& l--mi!)#e. =e hd ,l,ble&,lee!. The c$mbi!#i$! $ @I !d @O i! ,#ie!# who h&

rece!#l re#)r!ed r$m Africa I$!(1 &)((e& di(!$&i& $ mlri. The @,eri$d i& )&)ll 1/61 d&. I! #hi& c&e* #he ,#ie!# dmi##ed he hd !$# bee! #i!(@ re()lrl. The di(!$&i& H& c$!irmed b #he ,re&e!ce $@ i! hi& bl$$d ilm.

O. C$m,le#e lhe 6eme$ce&* L$$L..# .:. II !d C $,,$&)e 1/ hel, $)*1 A! $!@***%$! :: h%h c! he %%~Ied % ...8,full%)h !lll1'/1%'% ISO A!$#her :: $rd @$r ! J#2ml2.% ! Bcrer$. !d : ir)&e& re %*m,1c2 $@ S$me$!e Hh$&e rem,er#)rc % !$rml i& . . .

The C-mm$! meeri$! Qi#h I Il#l!6B.1rT ir)& i* !$H! 5 ..


59/178

Mental illness

"&chi#ric di&$rder&"&chi#ric di&$rder& c! be diided i!#$ $r(!ic !d )!c#i$!l. Deme!#i IS me!#l

di&$rder d)e #$ $r(!ic bri! di&e&e. The c$mm$!e $rm $ deme!#i i& #h# &&$ci#edHi#h $ld (e; &e!ile dementia. $isorders i! Hhich #here i& !$ o;ious ,#h$l$( $r!#$micl ch!(e i! ! $r(! re #ermed )!c#i$!l. The&e re de&cribed bel$H.

S)b!ce b)&eAb)&e $ &)b!ce me!& )&i!( i# i! H #h# i& hrm)l. 11*e c$mm$!e $rm& $

&)b!ce b)&e re lc$h$li&m !d dr)( b)&e.

Aec#ie di&$rder&=ere i& ! e3#rc# r$m medicl #e3#b$$.

AlTec#lllld mood re :imil# i! me!i!(t%ld reer #$ #he emotIon @$r e3m,le.

h,,i!e&& $r &d!e&&* Aec# #e!d. #$

be )&ed $r #em,20r.ll em$#i$!&. lIIId i.

e3,re&&ed #hr$)(h m!!er $ &,ei!(. cile3,re&&i$!. $r behi$)r. M$$d i& used #$reer #$ a more,e!!!e!# em$#i$!l #e.

The m$ c$mm$! $!! $ ec#iedi&$rder i& de,re&&i$!. #he &m,r$m& $Hhich re;

> ,$$r ,,e#i#e $r &i(!iic!# Hei(h# l$&&> &lee, di)rb!ce @$r e3m,le* i!&$m!i

6 i!bili# #$ &lee,

> #i()e @l$&& $ e!er(

> %***ch$!l-l$r #;#li$!@.*cc***'.m-VCII1C!lIIIId #h$)(h# or II`c5omoIor re#rd#i$! @&l$Hi!( $01:-:eme!# and #h$)(h#

loss or interest in im)l#i!( ee))ie&> decre&ed bili# #$ #hi! and c$$ce!#r.!e> eeli!( #h# $!e i& $ !$ l$e #$ $#her&.

$r #h# $!e h& d$!e &$me#hi!( Hr$!(

> rec)rre!# #h$)(h#& $ deaIh or &)icide.

ie. $r ,$&&ibl $)r. $ #he ao;e s4m&toms.

occurring !erl eer d for # le #H$wees, constitute a mP$r de&ressioo.

Ne)r$#ic !d re&&6rel#ed di&$rder&A! e3m,le $ !e)r$!e di&$rder i& $b&e&&ie c$m,)l&ie di&$rder. A! $b&e&&i$! IS!*de. rhr! i& &$ ,cr&i&re!# #h# II i!rerere& Hi#h #he ,#ie!#'. lie. A c$m,)l&i$! *& !

$b&e&&re ide #h# $r #he ,!c!# #$ c# ee! #h$)(h rhe rec$(!i\e #h# I# i*

)!!ece&&r A c$mm$! $rm $ #h*& 'S c$m,)l&ie H&hi!( $ #he h!d&. S#re&& i& ech!( $ bem( )!ble #$ c$,e. It c! led #$ !3ier $r er $ ,r$blem&. A &)dde!

rrc $ !3ie#'& clled ,!ic rrc.

-#her #,e& $ )!c#i$!l di&$rderThe&e i!cl)de;

> behi$)rl &!dr$me& &&$ci#ed Hi#h ,h&i$l$(icl di)rb!ce @&)ch & e#i!(

di&$rder&

> di&$rder& $ d)l# ,er&$!li# !d behi$)r @$r e3m,le. ,er&$!lir di&$rder

> me!#l re#rd#i$! 6 deled me!#l deel$,me!#

> &chi\$,hrem !d $#her di&$rder& i! Hhich #here rc del)&i$!& ll&e belie&.


60/178

O.1 C$m,lere Ih. #ble H)h %$rd* #r$m A* C, l !d I $,,$&)e.

!oun Ad0l'l'llVl'

.*@@ec#ie

;an>I%U-

behi$)rl

demented

di&r)rbed

&)icidl

O.O Me H$rd c$ml!!!$!& )&m( H$rd r$m ech b$ 3* TH$ H$rd& c! e )&ed 1::12 e. L$$ #fl, C !d f. $,,$)e 1/

behi$)rle#i!(

mP$r me!##,e~h#

,&ch$m$#$r&lee,

&)b!ce

ausedi)rb!ce

~#r#l#l--

d#1-#'r

~SI-E1

&!dr$#ll

O. C$m,le#e #he &e!#e!ce&. L$$ r A* C* D !d E $,,$&i#e 1/ hel, $).

1 The H ,er&$! behe& i& hIS $r herO A ,er&ie!# er!$!$!l &$re .& 5

A &)dde! rrc $ !'~ 1.

The $rm $ deme!**. dSS-CI*ed with 0(c#!( I c>>lled A di&$rder HhICh I II+l+ 0S//#ed Hi#h ,rh$l-Pll2l ch!(e& IS 5

7 A! ide %hKh $r9% > ,lle!# 1/ re,e# )!!ece& ...%B ll#$!2 .& >

~. Qhich &m,'$lll' $r cl' ......%$! H'& Ih*& ,)e!r ***crll'lI r$m L$$ C $


61/178

=he nerous s3stem "

Se!&$r l$&&The ce!rrl !er$)& &em c$!#r$l* #he &e!&$r !d 111/#$r )!c#i$!& $ rhe b$d. DI2'&e& $

#hi& &em #here$re led #$ l$&& $ &$me $ #he&e )!c#i$!&.

)!c#i$! l$&& -#her &m,#$m*

heri!(

&i(h#

de!e&&

bli!d!e&&

b)##i!( $r ri!(i!( i! #he er @#i!!i#)&

d$)ble i&i$! @di,l$,i

bl)rri!( @l$&& $ i&)l c)i# 6 clri# $ i&i$!

&e!&ri$!@eeli!(

!)mb!e&& @!ehe&i #i!(li!( $r ,i!& !d !eedle& @,rehe&icl

bl!ce )!edi!e&& @#3i di\\i!e&& @er#i($

N$#e; Ther# r# !$ c$mm$! H-#d& r$r l$&& $r. $r c$!di#i$!& rel#i!( #$. #e !d &mell.

M$l$r l$&&M$r$r l$&& &m,r$m& !d &i(!' mcl)de;

> He!e&& 6 l$&& $ ,$Her

> ,rl&i& 6 c$m,le#e 1/'$ ,$Her

> #rem$r 6 i!$l)!#r rh#hmic m$eme!#* e&,ecill $ rhe h!d&

> b!$rml (i# 6 )!)&)l m!!er $ Hli!(.

S,eech m l&$ be ec#ed* $r e3m,le Hi#h h$r&e!e&& 6 r$)(h* dee, $ice & i!

$cl c$rd ,rl&i&* Sl)rred &,eech me!& ,$$r rric)lri$!* & i! cerebellr di&e&e.

L$&& $ c$!&ci$)&!e&&"ric!r& m de&cribe &)dde! l$&& $ c$!&ci$)&!e&& i! !)mber $ Q'S;

,&&ed $)#.

hd blc$)#.i!#ed.

i#.I hd &ei\)re*

con;ulsion,

/it, seiLure an con3ulsion are =11use ro refer co i$lc!r i!$l)!mr m$cmem&* =Gi! e,ile,&.

D$c#$r& m &;Qhe! did $) l$&e c$!&ci$)&!e&&

=ere i& ,&&(e r$m re3rb$$ $! rhe c)&e& $ l$&& $ c$!&ci$)&!e&&.

The ,ri!ci,l diere!#il di(!$&i& i& be#Hee! ! e,ile,#ic i# !d &!c$,l #ld#* $ri!#i!(. S!c$,e i& sudden l$&& $ c$!&ci$)&!e&& d)e #$ #em,$rr il)re $ #he cerebrlcirc)l#i$!. S!c$,e i& dii!()i&hed r$m &ei\)e ,ri!ci,ll b #he circ)m!ce& i! Hhich #he ee!#$cc)r&. $r e3m,le. &!c$,e )&)ll $cc)r& whilst !di!(. )!der &i#)#i$!& $ &eere re&&. $r i!&&$ci#i$! with ! rrh#hmi. S$me#ime& oonwlsion !d )ri!r i!c$!#i!e!ce 6Ie&& $ c$!#r$l$ #he bldder 6 $cc)r ee! i! &!c$,l !c.Th)&. !ei#her $ #he&e i& &,e2ilc$r ! e,ile,#ic ##c."he e i& to ebli&h #he,re&e!ce $r b&e!ce $ ,r$dr$ml &m,#$m&. $r &m,#$m& #h# $ce#

immedi#el bel$le #he ##c. S!c$,l e,#S-de& le )&)ll ,receded b &m,#$m& $ di\\i!e&&!d li(h#4heded~&& I! e,ile,&. ,e$,le m (e# Hr!i!(. !$H! & ! )r. #h# ! ##c i&

going #$ h,,e!.

N$#~; The !$)! c$!)l&i$! i& $#e! )&ed i! ,l)r l $rm 6 #e ho& cov"l$io$ o$ / chil&.

60


62/178

O7.1 C$m,le#e #he #>>ble ::l1h %$!0* #r$r! A. B !d C $,0'@hi#c.

Ad0%cll*' Noun

bli!d

consciousde

di\\ I!)mb

li(h#6beded I)!ed

6

O7.O Me H$rd c$mbm)$! '''1I1# H$rd r$m ech h$3. #.$$ l A. II %lid c.. $,,$&)e 1/hel& 4ou.

doulee,ile,#ic

,r$dr$ml

&!c$,l

)ri!r;isual

,t4altIncMntintntt

l'IlI,#$m

#&.$!

i#

O7. A d$c#$r i& #ri!( 1/ de#ermme #he c)&e $ 1/].' $ c$!&ci$)&!e&& i! O6er6$ld m!*

C$m,le#e #he d$cr$r'& J)e&!$!&* l$$ # C $,,$&iee !d !r rhe #ble i! O7.1 b$e )* hel, $).

Did $) l$&e @I &)dde!l $r (rd).lll

Did $) gC) @O1 $ the l#0c

Qh.1 Here l- d$i%l# efon/ I$) @

?ere 4ou H$r!#'d $r under an/ +(

$id $) ed +@ $r +1

%l#c

+ Ul. 9o haemo&]is.

!ote5 "he noun &hleOm i& &ronoun75ed J#emJ.

Auscultation

'11*. d$c#$r i& e3rm!i!( Mr =mil#$! S che.

Te dee, breib& i! !d $)l #hr$)(h $)r

m$)#h* Foo. $o\4 sa)' Nninct4 ..!i!e'*

Lie!i!( 1/ #he che H)h &re#h$&c$,e m reel #he ,re&e!ce $ &$)!d&. ,r# @r$m

#he !$rml bre#h &$)!d&. There re rH$ 111111i!d& $@ dded &$)!d&;

> crcle&. Hhich &$)!d he hir& bei!( r)bbed r$(erher !d *)((e&r #he ,re&e!ce $@ l)id i!

#he l)!(&

> Hhee\e&* Hhich re m$re m)&icl &$)!d&* lie Hhili!(* !d i!dic#e !rr$Hi!( $@ #he

irH&. The &$)!d $ ! hm ,rie!r'& bre#hi!( i& l&$ clled Hhee\e.

The &$)!d herd Hhe! rhe ,le)rl &)rce& re i!lmed* & i! ,le)ri&* is clled ,le)rl r)b.

The d$c#$r && Mr =milr$! 1/ &' '!i!e#6!i!e' P* chec $cl re&$!!ce* Hhich m

be i!cre&ed @& i! ,!e)m$!i* -r decre&ed @& i! ,!e)m$#h$r3.

Arer e3mi!i!( Mr =milr$!* #he d$c#$r dd& r$ hi& nores.

#E Che@t5 earl4 in@&irator4 craclee Il)*th lung i5a@e@[ eL&irator4 wheee


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