Aleksandra Žmegač Horvat: MEDICAL ENGLISH WORKBOOK MUSCULOSKELETAL SYSTEM OSTEOPOROSIS Work in pairs. One of you should look at version A of the text on osteoporosis on this page, the other at version B on the next page. To get the missing information, you will have to put questions to your partner, and answer his/ her questions with the information from your text. Write your questions below the text (the first one has been done for you): Version A Osteoporosis is a condition in which bones lose their normal strength and become (1) ____________. It is caused by (2) ____________. During this process, there is a continuous cycle of breakdown and repair which takes place in (3) ____________. Special cells called (4) ____________ eat away or resorb areas of old, damaged bone. Other cells called osteoblasts then fill in the empty spaces with new bone. Osteoporosis can be caused either by (5) ____________ or ____________. The result is a bone that is weaker than normal and may break with a minor injury, or even spontaneously. Two of the most important risk factors for osteoporosis are (6) ____________ and ____________. The most dramatic bone loss (about 3 – 5% per year) occurs at the time of menopause. The most common bone fractures that occur in women with osteoporosis are fractures of the hip, vertebrae and wrist. Prevention is the best approach to osteoporosis. When bone loss has occurred, even the best treatments available are not enough to restore normal bone density. Some medications can improve it by 10% and possibly more, but will not make the bones as strong as they would be if preventive steps had been taken from the beginning. The key features of osteoporosis prevention are getting enough calcium and vitamin D, regular exercise, and, for some women, hormone replacement therapy after menopause. It is also very important to stop smoking, since it increases the risk of osteoporosis significantly. 1. What do bones become like in osteoporosis? 2. ____________________________________________________________ 3. ____________________________________________________________ 4. ____________________________________________________________ 5. ____________________________________________________________ 6. ____________________________________________________________

Version B Osteoporosis is a condition in which bones lose their normal strength and become porous and weak. It is caused by an imbalance in the process called remodelling. During this process, there is a continuous cycle of breakdown and repair which takes place in all bones throughout life. Special cells called osteoclasts eat away or resorb areas of old, damaged bone. Other cells called osteoblasts then fill in the empty spaces with new bone. Osteoporosis can be caused either by too much resorption of old bone, or too little formation of new bone.The result is a bone that is weaker than normal and may break with a minor injury, or even spontaneously. Two of the most important risk factors for osteoporosis are female sex and increasing age. The most dramatic bone loss (about 3 – 5% per year) occurs at the time of (1) ____________. The most common bone fractures that occur in women with osteoporosis are fractures of the (2) ____________, ___________ and ____________. (3) ____________ is the best approach to osteoporosis. When bone loss has occurred, even the best treatments available are not enough to restore normal bone density. Some medications can (4) ____________, but will not make the bones as strong as they would be if preventive steps had been taken from the beginning. The key features of osteoporosis prevention are (5) ____________, ____________ and, for some women, ____________. It is also very important to (6) ____________, since it increases the risk of osteoporosis significantly. 1. When does the most dramatic bone loss occur? 2. ____________________________________________________________ 3. ____________________________________________________________ 4. ____________________________________________________________ 5. ____________________________________________________________ 6. ____________________________________________________________

ACETABULAR RECONSTRUCTION I Read about the most complicated kind of orthopedic surgery and mark the passages which answer the following questions: 1. What does the procedure of acetabular reconstruction involve? 2. Why does it have to be done ‘within 2 millimeters of perfection’? 3. Why do some patients develop arthritis after this operation? 4. What about the timing and the duration of the operation? 5. In planning the operation, as well as in assessing the postoperative outcome,

what is the relation of X-rays and CT scans?

6. How long does the postoperative period usually take and what does it involve?

Acetabular reconstruction in patients whose hips have been shattered in an accident are considered the most complicated, technically demanding kind of orthopedic trauma surgery. To access the patient's shattered hip socket, the medical team – composed of surgeons, anesthesiologists, skilled nurses and X-ray technicians – has to avoid critical arteries, veins and nerves. Any mistake could cause serious bleeding or nerve injury that might mean permanent weakness or paralysis. When they reach the socket, surgeons must move in from behind and piece it together like a jigsaw puzzle. Then they fix it in place, screwing in plates up to eight inches long that remain in the body. It is critically important to get this reconstruction just right, ideally within two millimeters of perfection. Any displacement in the articular surface – the place where the ball and socket meet or articulate – will expose the injured cartilage to stresses that will eventually lead to its deterioration. And there are other potential complications as well. The surgeons must make sure the screws don’t enter the joint space, because for the patient that would feel like walking with a pebble in his shoe. Still, some patients will nevertheless develop arthritis later just because of the trauma to their cartilage. Performing this type of surgery requires enormous stamina and concentration, since operations may be up to 12 hours long. One advantage is the timing. Unlike some surgical procedures that must be done immediately, acetabular fractures can often wait for several days, or even a few weeks. In a procedure like this, with so many potential complications, planning is crucial. But X-rays alone may not be enough since bones block good views of the acetabulum; it is also hard to roll an injured, hurting patient into position for the necessary images. So CT scans are usually added to the planning mix. CT scans have also proved to be more accurate in assessing patients’ postoperative outcome. During the postoperative recovery period – which often lasts nine months or more – the team carefully monitor each patient's progress. They use video cameras and other tools to measure stride length, walking speed and body angles, and compare that with data on people who have not been injured. They also assess muscle strength in various ways. In studying the results, they have found that a good outcome seems to correlate with strength in particular muscles around the hip. What is the English term for acetabulum (paragraph 1)? __________________

Put the various stages of the procedure in sequence and then tell your partner about it: A fixing the acetabulum in place with plates B avoiding critical arteries, veins and nerves C monitoring the patient’s postoperative progress D planning the procedure with the help of X-ray and CT-imaging E putting the acetabulum together like a jigsaw F accessing the patient’s shattered acetabulum II Complete the table with other forms of the words from the text: NOUN VERB ADJECTIVE access add assess _ displacement injury length necessary perform _ strength weakness

ARTHRITIS Work in pairs. Take turns to read about the four forms of arthritis to your partner, who should simultaneously fill in the table on the next page: Ankylosing spondylitis Ankylosing spondylitis is a chronic inflammation and stiffening of the vertebrae. It is characterized by bilateral sclerosos of the sacroiliac joints. The changes that occur in the joints are similar to those found in rheumatoid arthritis. The disease is treated with corticosteroids and anti-inflammatory drugs.

Gouty arthritis

Gouty arthritis is a metabolic disease caused by accumulation of uric acid crystals in the blood, joints and soft tissues near them, which damage the articular cartilage and synovial membrane. It can involve any joint, although it typically affects the big toe, which is usually very painful. Treatment consists of drugs which lower the production of uric acid, as well as anti-inflammatory drugs. Besides, a special diet to avoid foods rich in uric acid is recommended. Osteoarthritis (OA) Osteoarthritis, also called degenerative joint disease (DJD), is the most common type of connective tissue disease. The typical signs are destruction of articular cartilage and new bone formation (hypertrophy of bone, or formation of bone spurs) at the edges of joints. It mainly occurs in the hips and knees of older patients. Aspirin and other analgesics and anti-inflammatory drugs are used in treatment, as well as physical therapy to exercise the stiff joints. In the case of complete immobilization of a joint in end-stage osteoarthritis, joint replacement surgery is performed.

Rheumatoid arthritis (RA)

Rheumatoid arthritis is a chronic inflammatory disease of joints and their related structures characterized by painful and crippling deformities. Usually the small joints of the hands and feet are affected first, while the larger joints follow later. It is believed to be caused by an autoimmune reaction of joint tissue. It is most common in women. The painful and swollen joints, often accompanied by fever, can become completely immobile. As there is no cure for RA, it is treated by heat applications, drugs to reduce inflammation and pain, as well as antirheumatic drugs.

Ankylosing spondylitis

Gouty arthritis

Osteo- arthritis

Rheumatoid arthritis

Which structures does it affect?

Whom does it affect?

Symptoms

Causes

Treatment

Translate:

Primjenom Exogena 2000, ultrazvučne sprave koja koristi neinvazivni pulzirajući ultrazvuk niskog intenziteta, uspješno je zacijeljeno 86% nezglobnih prijeloma kod kojih su prethodna liječenja bila bezuspješna. Posebice se ističe važnost liječenja prijeloma u starijih osoba. U SAD se, primjerice, više od polovine od ukupno 900.000 prijeloma godišnje zabilježi kod starijih od 65 godina.

CASE REPORT: MUSCULAR DYSTROPHY Explain the underlined medical expressions from the first part of the case study and supply the appropriate medical terms in the second part from the definitions below: Physical examination: On examination, the patient appeared fatigued. Vital signs: HR = 104, RR = 28, temperature (oral) = 102.4 degrees F, BP = 138 / 74. Pupils were normal and reactive to light, with (1) ocular movements intact. No (2) dysphasia or facial muscle weakness was noted. (3) Percussion of the thorax suggested (4) pulmonary infiltrates bilaterally in the lower lung fields. The patient complained of occasional (5) dyspnea. Heart sounds were normal, with no murmur. Bowel sounds were normal. Musculoskeletal exam revealed a scoliotic deformity of the spine when the patient sat up. (6) ______________, (7) _______________ and (8)_______________ muscles were significantly (9) _______________, but the (10) ________________ muscles appeared enlarged. Bilateral elbow contractures limited elbow extension to 80 degrees. Bilateral (11) _______________ contractures were also present. Muscle strength was reduced in the (12) ____________ muscles bilaterally, and he was not able to move either thigh into (13) ___________ or ____________. 1 _____________________________________________________ 2 _____________________________________________________ 3 _____________________________________________________ 4 _____________________________________________________ 5 _____________________________________________________ 6 chest muscles 7 shoulder muscles 8 thigh muscles 9 diminished in size, wasted away 10 calf muscles 11 heel tendon 12 upper arm muscles 13 bent or stretched out position

INTEGUMENTARY SYSTEM I Read about the integumentary system and provide the correct form of the words in brackets: The skin is a dynamic interface between the body and the external environment. It is considered an organ because it consists of various tissues (1) ___________ (STRUCTURE) arranged to function together. Together with its (2) ___________ (ACCESS) organs (hair, nails, sudoriferous and sebaceous glands) it constitutes an independent body system with a variety of functions, ranging from mechanical and chemical protection against external influences and pathogens to protection against (3) ____________ (LOSE) of fluids, thermoregulation and receiving sensations. Covering a surface of 2 square meters on average, the skin is the largest organ in surface area. Its (4) ____________ (THICK) varies from 6 mm on the soles and palms to only 0.5 mm on the tympanic membrane in the ear. The skin is (5) ____________ (CLINIC) important because on the basis of its (6) ____________ (APPEAR) conclusions can be made about certain conditions and dysfunctions. For instance, pale skin may indicate shock, whereas erythema and warm skin may indicate fever or infection. Cyanosis occurs when there is a lack of oxygen, which is (7) ____________ (SYMPTOM) of some cardiovascular or respiratory diseases; if there is (8) ____________ (EXCESS) bile pigment in the blood (hyperbilirubinemia), the skin turns yellowish (jaundice). An exanthem may suggest allergies or local infections. Abnormal skin texture may be the result of (9) ____________ (NUTRITION) problems. Even the state of a person’s nails can be a source of information for a physician. Abnormalities in texture and coloring usually indicate dietary or (10) __________ (GLAND) dysfunctions, while chewed nails may suggest emotional problems. II Spot the medical words for the following structures and conditions in the text: 1. sweat glands 6. red, flushed skin 2. oil glands 7. bluish shade of the skin 3. disease-producing organism 8. pertaining to the heart and vessels 4. eardrum 9. pertaining to breathing 5. abnormality of function 10. rash

WHAT IS IT IN ENGLISH? Match the medical terms for skin conditions and symptoms with their general English names: 1 ALOPECIA A damage 2 CALLUS B corn 3 COMEDO C hives 4 CONTUSION D pimple 5 DECUBITUS ULCER E redness of the skin 6 ERYTHEMA F blister 7 EXANTHEM G thickened scar 8 KELOID H wart 9 LESION I baldness 10 MACULE J mole 11 NEVUS K bedsore 12 PAPULE L blackhead 13 PRURITUS M bruise 14 SEBORRHEIC DERMATITIS N rash 15 URTICARIA O freckle 16 VERRUCA P itching 17 VESICLE R dandruff MALIGNANT MELANOMA How does melanoma differ from an ordinary mole? Check for the ABCDs of melanoma: ASYMMETRY - one half is unlike the other

BORDER - irregular

COLOR - varied (combinations of brown, black, white, red, blue)

DIAMETER - larger than 6 mm

Work in pairs. One of you should look at version A of the text on malignant melanoma, the other at version B on the next page. To get the missing information, you will have to put questions to your partner, and answer his / her questions with the information from your text. Write your questions below the text (the first one has been done for you):

Version A Melanoma develops when pigment-producing skin cells called (1) ___________ turn cancerous, a process that can be triggered by (2) ____________, especially severe blistering sunburns during childhood. There is also evidence that ultraviolet radiation used in indoor tanning equipment may cause melanoma. If (3) ____________, the chance of recovery is over 95 percent. However, if the tumor is allowed time to grow vertically down into the skin, reaching blood and lymphatic vessels, it will easily (4) ____________, most typically the lungs or brain. In that case, the five-year survival rates are (5) ____________. Treatment: The first step is to surgically remove the cancerous lesion (melanoma in situ) and a small patch of healthy skin surrounding it (a procedure called taking margins). To determine if the melanoma has spread to the adjacent lymph nodes, a technique called sentinel node biopsy is usually performed. In metastatic cases, the affected nodes are excised. But if melanoma cells have spread beyond the lymphatic system, prognosis is poor. Risk factors: Light-colored skin and hair, freckles, moles. People with more than 50 moles (especially atypical/dysplastic moles) are at an increased risk (for the appearance of the moles, see the ABCDs of melanoma above). Melanoma also runs in families, so if you have a blood relative who has had it, you are at a greater risk yourself. Prevention: Early detection is key. Therefore, perform a monthly self-exam, looking for irregular lesions that are growing and changing, and use the ABCD rules. Melanoma can occur anywhere on the skin, even in places not directly exposed to the sun, as well as in the oral cavity or the eye, but it is most common on the backs of men and the legs of women. If you have an atypical mole, see a dermatologist immediately and insist on a biopsy. In any case, visit a dermatologist at least once a year for a complete skin exam. 1. What are pigment-producing skin cells called? 2. __________________________________________________________ 3. __________________________________________________________ 4. __________________________________________________________ 5. __________________________________________________________

Version B Melanoma develops when pigment-producing skin cells called melanocytes turn cancerous, a process that can be triggered by excessive sun exposure,

especially severe blistering sunburns during childhood. There is also evidence that ultraviolet radiation used in indoor tanning equipment may cause melanoma. If the cancer is removed before it penetrates a full millimeter into the skin, the chance of recovery is over 95 percent. However, if the tumor is allowed time to grow vertically down into the skin, reaching blood and lymphatic vessels, it will easily metastasize into tumors in other body tissues, most typically the lungs or brain. In that case, the five-year survival rates are much smaller and drop dramatically to below 50 percent. Treatment: The first step is to (1) ____________ (melanoma in situ) and a small patch of healthy skin surrounding it (a procedure called taking margins). To determine if the melanoma has spread to the adjacent lymph nodes, a (2) ____________ is usually performed. In metastatic cases, the affected nodes are excised. But if (3) ____________, prognosis is poor. Risk factors: Light-colored skin and hair, freckles, moles. People with more than 50 moles (especially atypical/dysplastic moles) are at an increased risk (for the appearance of the moles, see the ABCDs of melanoma above). Melanoma also runs in families, so if you have a blood relative who has had it,(4) ____________. Prevention: Early detection is key. Therefore, perform a monthly self-exam, looking for irregular lesions that are growing and changing, and use the ABCD rules. Melanoma can occur anywhere on the skin , even in places not directly exposed to the sun, as well as in the oral cavity or the eye, but it is most common on (5) ____________. If you have an atypical mole, see a dermatologist immediately and insist on a biopsy. In any case, visit a dermatologist at least once a year for a complete skin exam. 1. What is the first step in treating melanoma? 2. __________________________________________________________ 3. __________________________________________________________ 4. __________________________________________________________ 5. __________________________________________________________

BURNS Burns are heat injuries caused by thermal, chemical, electrical or radioactive agents. They occur on the skin, but can also involve the respiratory or digestive tract lining. They can have a local, or, much more seriously, systemic effect. Burns are classified into 3 categories according to how deeply the tissue has been damaged.

Sort out the jumbled notes about the various degrees of burns under the following headings: - symptoms: whitish appearance, also deep red, brown, black, charred - usually no blisters - also called full-thickness burn injury - affects epidermal and dermal layer - also called superficial burns - skin grafts (dermoplasty) used to assist recovery - example: sunburn - symptoms: erythema, hyperesthesia, blistering, edema; moist - affect the epidermal layer - destroy epidermis and dermis, damage subcutaneous layer, sometimes even

underlying muscular and bone structures - also called partial thickness burn injury - initially nerve sensation lost, but later severe pain - symptoms: erythema, hyperesthesia; dry 1st degree burns 2nd degree burns 3rd degree burns CASE REPORT: ACNE

Explain the underlined medical expressions by using general English terms:

The patient presented with (1) multiple acneform lesions in the (2) buccal and periorbital areas. Both cystic and (3) comedonal lesions were present, most ranged between 3 and 6 mm in diameter, especially along the (4) nasolabial folds. Some were (5) edematous and (6) erythematous. There were also developing areas of (7) folliculitis on the patient’s chest and forearms. A (8) topical antibiotic was prescribed, and a serum biochemical and hematologic profile was ordered.

1 ________________________________________________ 2 ________________________________________________ 3 ________________________________________________ 4 _________________________________________________ 5 ________________________________________________ 6 ________________________________________________ 7 _______________________________________________ 8 ________________________________________________

SKIN NEWS Work in groups of 3. Read the texts and suggest headlines for them. Compare the suggested headlines and take turns to tell your group about one item each. Then use the underlined collocations in sentences of your own and write them down. _________________________ According to the British Journal of Dermatology, a new light treatment has shown promising results in the treatment of mild to moderate acne. In clinical trials, a combination of red and blue light treatment led to an average improvement of 76% in the number of spots after 12 weeks. Dermatologists believe that the blue light kills off bacteria, while the red light helps the skin to heal. _________________________ To refresh’ the appearance of skin, chemical peels have been common for some time now, but laser resurfacing is becoming more and more popular. In this procedure, outer layers of skin are vaporized, diminishing wrinkles, spots and scars and sometimes tightening skin as well. However, too aggressive treatments can result in burns, scarring and permanent changes in skin color. It may also trigger dormant herpes infections and allergies, so caution is advised. _________________________ Dermatologists know that inactive hair follicles aren’t dead, but just catatonic; a search for an agent that would activate them again seems logical. Experiments on mice appear promising. Scientists know that a gene named SHH controls brain development in embryos, but in mature animals, as well as in humans, it governs natural on-off cycles of hair growth. When researchers inserted SHH into mouse hair follicles, the dozing follicles woke up and started growing again. Can SHH wake human cells in the ‘off’ position? Dermatologists won’t know until they try. However, they’ll have to consider side effects – it is known that SHH in big doses can trigger skin cancer. Still, the research suggests that the new hope genetics is bringing to victims of cancer and other devastating diseases may also cover the bald.

RESPIRATORY SYSTEM I Match the sentence halves to get a description of the process of RESPIRATION: 1 Respiration, the process of gas exchange, is conducted 2 The first part of the process is called external respiration (breathing or ventilation) 3 During external respiration oxygen passes from the inhaled air into the lungs 4 At the same time, carbon dioxide passes 5 During internal respiration the cells within all body structures take oxygen from the blood A from the capillaries back to the lungs to be exhaled. B while the second part is referred to as internal respiration (cellular or tissue breathing). C and give back carbon dioxide, which is a waste product from the energy- liberating process that takes place within each cell. D at various levels between the environment and the body, as well as within the body. E and then to the blood through capillaries by a process called diffusion. II Match some of the structures of the respiratory system with their functions: 1 NOSE A place of gas exchange between air and blood 2 PHARYNX B cartilaginous flap that prevents food to enter the trachea 3 LARYNX C conduct air from the trachea to the lungs 4 EPIGLOTTIS D acts as a filter to warm and moisten the inhaled air 5 TRACHEA E air passageway and place of voice production 6 BRONCHI F vibrate to produce sound 7 ALVEOLI G separates the thoracic from the abdominal cavity 8 DIAPHRAGM H food and air passageway 9 VOCAL CORDS I air passageway DID YOU KNOW THAT...? Work in pairs. Read the following items and take turns to tell each other what you have read.

• the internal surface of each lung is more than 40 times greater than the external surface of the entire body?

• compared to a toy baloon, a lung is about 100 times more distensible? • it is impossible for a person to commit suicide by holding their breath,

because the rising CO2 levels in the blood are such a powerful respiratory stimulant that, when they are high enough, breathing will start automatically, whether we want it or not?

• it was reported that over 300 prescription drugs, ranging from antidepressants

and beta-blockers to headache pills, could lead to breathing difficulties and permanent lung damage?

• in Eastern Europe and central Asia tuberculosis is still a major public health

issue, not only something associated with drug addicts, prisoners, or the homeless, and that people in those areas are 10 times more likely to be infected with multidrug-rasistant TB than in the rest of the world?

Translate:

Tuberkuloza je uzrok 2 milijuna smrti godišnje širom svijeta. Liječenje zahtijeva striktni šestomjesečni režim koji uključuje 4 različita antibiotika. Bolesnici često prekidaju liječenje nakon 2 ili 3 mjeseca, nakon što im se stanje popravi, time zapravo ubrzavajući razvoj sojeva otpornih na lijekove. FIGHT THE COLD I Read about the chances of finding a vaccine against the common cold and then decide if the statements below are true or false, marking the lines which helped you decide:

Colds are considered incurable today because it would take months to come up with a vaccine for every new strain. Colds viruses mutate even while they are infecting you, and new strains appear so often that by the time drugmakers create a vaccine against one variation, the serum is already outdated. However, research on flu viruses, which only mutate every few years, may point the way toward a cold cure. Researchers have isolated a protein called M2 that seems to be present in virtually every flu strain known to man. Using that knowledge, they have made a vaccine that they think could protect against all flus - old, new and those not yet in existence. If a similar protein is found in cold viruses – a protein present no matter what strain is involved – then it is possible that in the next decade children could be routinely vaccinated against the common cold.

1. Flu viruses mutate faster than cold viruses. 2. It is impossible to produce a vaccine against any strain of the common cold. 3. A protein present in all known flu strains has been found. 4. Researchers assume that the new vaccine involving M2 will not be effective against future flu strains. 5. Scientists have isolated a protein present in all strains of the common cold. II Complete the text with appropriate words: WORKING OUT WITH A COLD? When you get your first cold of the year, should you exercise extra hard to _____________ your immunity, shift your workout to a lower intensity, or rest until you feel better? Take this advice from fitness professionals: Check your symptoms. Moderate exercise is safe if you have above-the-neck signs, such as a _____________ nose, sneezing or a _____________ throat. If you have below-the-neck signs, such as chills, diarrhea, or muscle ___________, it’s time to rest. Don’t exercise with a temperature. This is evidence you are _____________ with a virus, and exercising would _____________ your risk of dehydration. Modify exercise intensity. If you exercise hard, you’ll reduce your body’s ability to _____________ infection. During the workout, make sure your ____________ rate and body _____________ do not increase excessively. Don’t let illness stop you altogether. Use your downtime to focus on flexibility and stress management. It could be a good time to try meditation, yoga or Pilates.

RESPIRATORY SYMPTOMS AND PROCEDURES Match the symptoms and procedures on the left with their definitions: 1 AUSCULTATION A pleural effusion containing serous fluid 2 CREPITATION B expectoration of blood or blood-stained sputum 3 EPISTAXIS C accumulation of air or gas in the pleural space 4 EXPECTORATION D presence of fluid in the pleural space 5 HEMOPTYSIS E spasm / seizure 6 HEMOTHORAX F harsh, high-pitched breath sound 7 HYDROTHORAX G coughing up and spitting out matter from lungs, bronchi or larynx 8 PAROXYSM H inhalatory sound like that made by throwing salt into fire

9 PERCUSSION I pleural effusion containing pus 10 PLEURAL EFFUSION J listening for sounds within the body 11 PNEUMOTHORAX K high-pitched whistling breath sound 12 PYOTHORAX L mucus ejected from lungs, bronchi or larynx 13 SPUTUM M nosebleed 14 STRIDOR N short, sharp taps on body parts for diagnostic purposes 15 WHEEZE O pleural effusion containing blood

ABDOMINAL THRUST MANEUVER Work in pairs. Each of you should read one description and then describe the procedure to the other: If a person is choking on food that got lodged in their trachea, a simple technique called the abdominal thrust or Heimlich maneuver can save their life. Just do the following: If the victim is standing or sitting: - stand behind the victim and put your arms around their waist - make a fist with one hand, grasp it with the other, and place the fist on the

victims abdomen above the navel and below the rib cage - press your fist into the victim’s abdomen with a quick upward thrust - if necessary, repeat several times

If the victim is lying: - put the victim on their back - sit astride their hips - place your hands one on top of the other on the victim’s abdomen above the

navel and below the rib cage - press into the victim’s abdomen with a quick upward thrust - repeat several times if necessary

If you are alone and choking, do whatever you can to apply force just below your diaphragm. Press into a table, or use your own fist.

SMOKING

I Get into groups of 4-8, half smoker, half nonsmoker.

Smokers – discuss: How much do you smoke? On which occasions? When and how did you start? Would you like to stop? Why? Have you ever tried quitting? Do your parents smoke? How do they feel about your smoking? What would you do if your boy/girlfriend was a non-smoker and asked you to stop?

Nonsmokers – discuss: Have you ever smoked? If yes, why and how did you stop? How do you feel about so many of your smoker friends and colleagues? Have you ever tried to persuade any of them to stop? Do your parents smoke? If yes, does it bother you? Can you imagine having a boy/girlfriend who smokes?

Both – discuss: How do you feel about the strong anti-smoking trend that started in the US and is now spreading in EU countries, some of whom have put a ban on all smoking in public places? What about attempts like the anti-smoking campaign started by the Andrija Štampar School of Public Health in Zagreb a few years ago? Should students of medicine and doctors display a greater readiness to be an example in this matter? II The debate on decriminalizing the possession and use of marijuana has repeatedly been raised in various European parliaments, including the Croatian. What is your standpoint in this matter? Discuss in small groups. How many colloquial expressions for marijuana can you think of? Read the short interview with a neuroscientist and say whether you agree. Explain the play on words in the title: A DOPEY IDEA Q. How can marijuana “blow the mind”?

A. Drugs interfere with the careful interplay of chemical and electrical impulses between cells, throwing out the balance of the brain either by causing too many chemicals to be released or by stopping the cells' chemical transmitters reaching the vital receptors. The reason marijuana is so potent is that is has its own receptor in the brain. The more you smoke, the less sensitive the receptor becomes.

Q. How is a person's behavior affected? A. Research shows that the drug leads to impaired memory and coordination. These effects may be long-term and irreversible. There is strong evidence that marijuana can trigger schizophrenia. Then there's demotivational syndrome, an inability to focus on anything beyond the next fix. Q. Is it addictive? A. That depends how we define addiction. Cannabis users have to take ever-larger quantities to achieve the desired effect. Studies show that about 10% of users can't stop their habit, despite wanting to do so. PLUS... Translate one of the following items:

• Smoking not only causes bad breath, but also discolors teeth and fillings, diminishes taste and smell, increases the risk of gum disease, and consequently of tooth loss and failure of dental implants, as well as the risk of mouth cancer.

• Recent research suggests that the reason why some people are hopelessly

addicted to cigarettes may be the fact that nicotine triggers a pattern of activity in their brains that makes quitting impossible for them. Also, this strong neurobiological reaction to nicotine seems to be associated with hostile personalities marked by anger, aggression and anxiety.

• Scientists believe to have found a physiological reason why nicotine and

alcohol so often ‘go together’- it seems that even a small amount of alcohol significantly boosts the pleasurable effects of nicotine. That could explain the statistics according to which more than 80% of alcoholics smoke, and alcoholism is 10 times as prevalent among smokers as among nonsmokers.

CASE REPORT: ASTHMA Explain the underlined medical terms using general English: The patient is a 12-year-old girl who has had a nocturnal nonproductive cough two to three times per month for the past 3 months associated with increasing episodes of shortness of breath that resolve spontaneously. Past medical history: The patient has had recurrent upper respiratory

infections,

bronchitis 2 years ago, and intermittent runny nose. A review of systems reveals that she has had numerous episodes of sneezing, itchy eyes, and clear discharge from the nose. The patient states that she does not smoke cigarettes or any other inhaled substances such as marijuana. Physical examination: Vital signs as follows: T = 98.6 degrees F, RR = 17, HR = 82, BP = 118 / 75 mmHg. No (1) dyspnea or (2) stridor is evident. Her color is normal, without (3) cyanosis. The (4) tympanic membranes are mobile and without (5) erythema or air / fluid levels. Inspection of the chest does not show accessory muscle use or (6) intercostal, (7) suprasternal, or (8) supraclavicular retractions. (9) Pulmonary auscultation reveals (10) inspiratory and expiratory wheezing scattered throughout both lung fields. 1 _____________________________________________________________ 2 _____________________________________________________________ 3 _____________________________________________________________ 4 _____________________________________________________________ 5 _____________________________________________________________ 6 _____________________________________________________________ 7 _____________________________________________________________ 8 _____________________________________________________________ 9 _____________________________________________________________ 10 ____________________________________________________________

When does it happen? nocturnal __________________________ recurrent __________________________ intermittent __________________________ CASE REPORT: AVIAN INFLUENZA

Provide the missing medical terms from the definitions below:

Day 1: 13-year-old symptomatic female admitted to pediatric ward from emergency department. PMH: Previously healthy. Sore throat, (1) ____________, dry cough 1 week prior to admission. Fever 4 days prior to admission. Examination: Alert, (2) ____________, no respiratory distress. Lung auscultation: decreased breath sounds and (3) ____________ in right lung base. CBC: WCC 4700/microL, platelets 62000/microL Blood culture: negative Sputum culture: nil of note

Viral (4) ____________: nil of note Diagnosis: atypical pneumonia Day 2: (5) ____________. Increasing respiratory rate and distress; (6) ____________ despite oxygen therapy. Admitted to ICU. Mechanical ventilation 6h after admission. Auscultation: audible ‘rub’ in middle lobe. Days 3 –5: Rapid deterioration with (7) ____________ and multiple organ dysfunction. Day 6: Upper gastrointestinal bleeding. Worsening respiration requires prone position ventilation for 7 days. Day 26: Died. Cause of death: (8) ____________ ____________ ___________. 1 discharge of nasal mucus 2 with raised body temperature 3 inhalatory sound like that made by throwing salt into fire 4 quantity of a substance required to react with a given amount of another substance 5 expectoration of blood or blood-stained sputum 6 low oxygen supply to tissues 7 suddenly occurring signs of breathing difficulties (4-letter acronym) 8 incurable breakdown of respiration

NERVOUS SYSTEM NEUROLOGICAL SYMPTOMS AND DISORDERS I Sort out the following symptoms and disorders into the categories below and say what you know about some of them: ALZHEIMER COMA MULTIPLE SCLEROSIS BRAIN TUMORS HERPES ZOSTER PARKINSON CEREBRAL CONCUSSION HYDROCEPHALUS SPINA BIFIDA CEREBRAL CONTUSION MENINGITIS SYNCOPE CEREBROVASCULAR ACCIDENT Symptoms ____________________ ____________________ Disorders • congenital: _______________ ________________ • degenerative: _______________ ________________ ________________ • infectious: _______________ ________________ • neoplastic: _______________ ________________ • traumatic: _______________ ________________ • vascular: _______________ II Work in pairs. Take turns to read about the 3 types of CVA to your partner, who should simultaneously fill in the table on the next page: 1. Thrombotic CVA: Due to a thrombus (blood clot) in the cerebral arteries, which causes an occlusion (blocking) of the vessel. The blood vessels become narrower over time due to atherosclerosis (accumulation of fatty plaques on the inner arterial walls). Before total occlusion, the patient sometimes experiences short episodes of neurological dysfunction known as TIAs (transient ischemic attacks). Treatment: anticoagulant drug therapy, or surgical (endarterectomy – removal of plaque from the inner arterial lining). 2. Embolic CVA: Occurs when a blood clot breaks off from somewhere in the body (embolus) and travels to the cerebral arteries occluding a small vessel. Embolic CVAs are usually very sudden. 3. Hemorrhagic CVA: Caused by bleeding from a cerebral artery. The bleeding results from advanced age, atherosclerosis or high BP, all of which cause degeneration of blood vessels. Trauma to the head or the bursting of an

aneurysm can also be the cause of cerebral bleeding. If the bleeding is large, the stroke is often fatal; if it is small, good recovery with or without consequent disability is possible. Risk factors for all CVAs: hypertension, diabetes, heart disease, smoking, obesity, high cholesterol levels.

CEREBROVASCULAR ACCIDENTS THROMBOTIC EMBOLIC HEMORRHAGIC immediate cause

underlying cause

symptoms

prognosis

treatment

risk factors

III Translate: Prema nedavno objavljenoj studiji danskih znanstvenika, snižavanje tjelesne temperature za oko 1ºC u prvih nekoliko sati nakon moždanog udara može smanjiti oštećenja mozga i rizik od smrti. ALZHEIMER DISEASE II As you read about current research on Alzheimer disease, mark the Lines which answer the following questions: 1. Which two aspects of dealing with Alzheimer can give us hope of a cure for this disease in the future? 2. What happens in the brains of Alzheimer sufferers? 3. According to many scientists, what is the underlying cause of Alzheimer? 4. List the 5 pharmaceutical approaches to Alzheimer that are currently

investigated: • ____________________________________________________________ • ____________________________________________________________ • ____________________________________________________________ • ____________________________________________________________ • ____________________________________________________________ NEW HOPE FOR LOST MEMORIES Alzheimer disease has traditionally been diagnosed only post mortem. Now technology is transforming our understanding of this neurological disease. Armed with state-of-the-art PET scanners and MRI machines, specialists are learning to spot and follow the disease in people who haven’t even developed the distinctive symptoms yet. The diagnostic revolution began during the 1990s, as researchers learned to monitor neurons with an imaging technique called PET, or positron-emission tomography. Unlike an X-ray or CT imaging, PET records brain activity by focusing on glucose, and it can spot significant pathology in people who are still functioning normally. In its long run, Alzheimer replaces the brain's sophisticated tissues with sticky plaque and dead, twisted neurons. No drug can repair that kind of damage as yet, but fortunately the possibilities for therapy are changing almost as fast as the diagnostic arts. And if the new treatments work as anticipated, they will be able to stop or slow the destruction while the mind is still intact. Though experts still can’t agree about the ultimate cause of Alzheimer, many believe that the trouble starts with a bit of junk protein called amyloid beta (A-beta for short). Each of us produces it, and small amounts are harmless. But as A-beta builds up in the brain, it replaces healthy tissue with the plaques seen in Alzheimer sufferers. In 1987 researchers discovered A-beta was part of a larger molecule they called the amyloid-precursor protein (APP). The ideal Alzheimer remedy would simply slow the production of A-beta by disabling the enzymes (secretases) that produce it. Secretase inhibitors may be our best hope of preventing Alzheimer, but they're not the only hope. Compounds are now being tested that are supposed to keep A-beta from forming fibrils, and others to keep fibrils from aggregating to create plaque. All of the experimental drugs have helped reduce amyloid buildup in mice, suggesting they might help people as well. But human studies are just now getting underway. Scientists are also researching several strategies for clearing deposits from the brain. One idea is to mobilize the immune system. It was shown that animals given an antiamyloid vaccine started attacks on their plaques. Unfortunately, the vaccine proved toxic in people, triggering attacks on normal tissue as well as

plaque. But the dream isn't dead. Some pharmaceutical companies are now developing ready-made antibodies that, if successful, will target amyloid for removal from the brain without triggering broader attacks by the immune system. If even half of these treatments fulfill their promise, in the future old age may prove more pleasant than today's projections suggest. II Alzheimer, Parkinson and multiple sclerosis are examples of DEGENERATIVE neurological diseases. Unfortunately, many other negative adjectives apply in cases of such diseases. Make negatives of the listed adjectives by adding the following prefixes: AB DIS IM IN IR MIS UN able _____________________ abled _____________________ aware _____________________ balanced _____________________ coherent _____________________ conscious _____________________ continent _____________________ controlled _____________________ curable _____________________ emotional _____________________ interested _____________________ known _____________________ mobile _____________________ normal _____________________ rational _____________________ treated _____________________ visible _____________________ voluntary _____________________ Now use some of the negative adjectives in sentences of your own. CASE REPORT: MULTIPLE SCLEROSIS Supply the missing medical terms from their definitions below: A 38-year-old woman presented with tingling, numbness and clumsiness of both hands for 1 week, with a band of numbness from the (1) ____________ to the (2) ____________. Six months earlier, following an upper respiratory tract infection, she had experienced (3) ____________ in the feet, numbness from the waist downwards and ‘burning’ pains behind the right ear. She was anxious because her maternal grandmother had suffered from multiple sclerosis.

On neurological examination, she had absent (4) ___________ ___________ with brisk tendon jerks and (5) ____________ ____________ ____________ responses. Blood investigations were normal, including (6) ____________, white-cell count and differential, (7) ____________ ____________ ____________, vitamin B12 and folate levels, and syphilis serology. A (8) _________ ________ was carried out. The (9) ____________ ____________ investigation results allowed a likely clinical diagnosis of multiple sclerosis.

1 navel 2 armpits 3 abnormal touch sensation (burning, prickling) in the absence of an external stimulant 4 contractions of the muscles of the area between the thorax and the pelvis upon scratching this area 5 pertaining to the extension of the sole of the foot on both sides 6 oxygen-carrying pigment of erythrocytes 7 the rate at which red blood cells precipitate out from a specimen of venous blood 8 withdrawal of fluid from the subarachnoid space in the region between L3-L4 9 watery fluid flowing throughout the brain and around DYSLEXIA Scan the text on some new findings concerning the neurological basis of dyslexia and mark the parts which tell you: - what dyslexia is - how the brain ‘reads’ - where the problem lies for dyslexics - the relation between dyslexia and intelligence - why reading certain languages (e.g. Italian) takes less effort than reading

others (e.g. English) COMPLEX WRITING English is notoriously illogical. For example, if ‘tongue’ is pronounced tung, why isn't ‘argue’ pronounced arg? And if ‘enough’ is enuff why isn't ‘bough’ pronounced buff? The arbitrary rules of English spelling and pronunciation have always been a major problem for students of the language. But such frustrations are small in comparison with those suffered by dyslexics, who live with a learning disability that can make reading and writing almost impossible. In the past two decades, scientists have learned a great deal about the neurological causes of dyslexia. But what they hadn't yet explained is why its incidence varies so from country to country. Now Italian, French and British

researchers suggest an answer. They offered the first convincing evidence that the disorder has a common neurological basis across linguistic and cultural borders. The brain does not have an innate reading ability – as it does for speech – so it deals with the written word by converting it into a familiar phonetic language. According to prevailing theory, the reading centers of the brain break words down into sound units known as phonemes and recognize them as the elements of a phonetic code. Then the centers assemble that code to derive meaning from the symbols on the page. Most of us learn to do this by the time we're seven years old. Dyslexics, however, often can't get past the first step – breaking written words down into phonemes. This in no way reflects on their intelligence – there are countless famous and successful dyslexics. Historical figures who may have had the disorder include the poet W.B.Yeats and Leonardo da Vinci. Nevertheless, it can be a lifelong challenge. In their study, the scientists compared the reading ability of dyslexics from Britain, France and Italy and found that Italian dyslexics read far better than their French and English counterparts. Brain scans conducted during reading exercises confirmed that the boundary between language and visual processing areas was inactive in dyslexics, no matter what language they spoke. So why do Italian dyslexics read better? The difference seems to be not in the languages themselves, but in their writing systems, which vary in complexity. English has 1,120 different ways of spelling its 40 phonemes. By contrast, Italian needs only 33 combinations of letters to spell out its 25 phonemes. As a result, reading Italian takes a lot less effort, and that's probably why the reported rate of dyslexia in Italy is less than half of that in the US, where about 15% of the population is affected to some degree. By some estimates, Americans spend more than $1 billion a year to help their children cope with dyslexia. Explaining this discrepancy isn't all that the study has accomplished. By establishing a universal neurological basis for dyslexia, the scientists make it clear that teachers should more often consider that children with reading problems may be suffering from dyslexia, and treat them accordingly. Based on this article, do you suppose that the percentage of dyslexic children in Croatia is bigger or smaller than in the mentioned countries? Why? Vocabulary check – match the words from the text with their meanings:

1 arbitrary A current, present 2 incidence B difference 3 innate C put together 4 converting D random, not systematic 5 prevailing E inborn 6 assemble F occurrence 7 discrepancy G changing BIONICS – NEW HOPE FOR THE PARALYZED? bionics - science that studies the functions, characteristics and phenomena of the living world and applies that knowledge to new devices and techniques in the world of machines (biomechanics) COMPUTER CHIPS FIGHT SENSORY LOSS Researchers in Europe, America and Japan are implanting electrodes into the bodies of patients to restore vision, treat brain disorders and help victims of paralysis get back motor function, while engineers are creating hybrid prosthetic body parts such as ankles, legs and knees in which silicon ships are melded with living tissue, thus making our bodies bionic. For one young man at least, technology has already become a part of his body. Eight years ago he broke his neck in a motor accident, which made him a tetraplegic. Except for some minor movement in his shoulders, right arm and hand, he was paralyzed below the neck. He underwent an experimental surgical procedure to implant a neural prosthesis – an interface between an electronic device and the human nervous system – to bypass the damaged stretches of his spinal cord and restore some movement of his limbs. From the following description of how the device works, draw a scheme using the listed words and phrases – DOWNWARDS, HAND CLOSES, MUSCLES CONTRACT, UPWARDS, POSITION SENSOR, MUSCLES RELAX, HAND OPENS, MUSCLES IN RIGHT ARM AND HAND, MOVING LEFT SHOULDER, CHEST STIMULATOR To get back basic function to his right arm, the patient uses a device that restores the ability to grasp, hold and release objects. During a seven-hour operation, surgeons made incisions in his upper arm, forearm and chest. Eight flexible electrodes, each about the size of a small coin, were attached to the muscles in his arm and hand that control grasping. These electrodes were then connected by ultrathin wires to a stimulator – a kind of pacemaker for the nervous system –

implanted in his chest. The stimulator was in turn linked to a position-sensing unit attached to his left shoulder, over which he retains some motor control. When he wants to pick up a glass, he moves his left shoulder upward. This movement sends an electrical signal from the position sensor, which is worn under his clothing, to the stimulator in his chest, which amplifies it and passes it along to the appropriate muscles in his arm and hand. In response, the muscles contract and his right hand closes. When he wants to release the glass, he moves his left shoulder downward, and by the same process his right hand opens. This device is not for everyone, though. To benefit from it, patients must have use of a shoulder and upper arm and partial use of their hands. Also, patients must be constantly on guard against infection around the implanted electronics. Another drawback is that the system provides no tactile feedback for things like temperature, so users also have to be careful when handling hot objects such as cigarettes or coffee. To get around this problem, researchers are developing neural prosthetics that can actually feel the texture of objects and transmit this information back to the user. This kind of sensitive prosthetic would stimulate afferent nerves to send tactile information from paralyzed limbs to other parts of the body, where the sensations could be perceived. At present, all of this may seem like science fiction, but the numerous scientists enthusiastically working all over the world will surely make the fantasies real, maybe even sooner than we think. II List the drawbacks and limitations of the described device.