医学英语BozhouPeople´sHospitalRheumtologyandimmunologydepartment张玉慧Bedsideteaching•Bedsideteachingisseenasoneofthemostimportantmodalitiesinteachingavarietyofskillsforthemedicalprofession,whichgreatlyimprovescertainclinicaldiagnosticskillsinmedicalstudentsandresidents.WardroundA.早交班morningmeeting：住院总医师；外称SeniorResident’sMorningReportB.引言introduction：主治医师；提出重点查房病例，简述棘手问题C.病史报告casepresentation：实习医生，可有无诊断，诊治计划须系统D.教学查房对话teachingdialogue：在上下级医生之间进行；着重纠错E.小结summary：主治医师对主任查房作应答，提出整改措施•Chiefphysician主任医师•Attendingphysician主治医师•Chiefresident住院总医师Resident住院医师Intern实习医师Patient病人ChronicObstructivePulmonaryDisease•COPD,orchronicobstructivepulmonarydisease,isaprogressivediseasethatmakesithardtobreathe.Progressivemeansthediseasegetsworseovertime.Intheoffice•ChiefResident:Yourattention,please.TheteachingwardroundbyChiefphysicianProfessorClarknowbegins.Firstly,let'shavethecasepresentedbyDr.Grey.•住院总医师：请各位注意了，主任医师Clark教授的教学查房现在开始，首先由实习医师Grey医生汇报病史。•Intern(Dr.Grey):This70-year-oldmanwasadmittedbecauseofaone-weekhistoryofbreathlessnessandcoughwithpurulentsputum.•实习医师：病人，男性，70岁，因气急、咳嗽、咳痰1周入院。•Hehadalwaysbeencoughingwithsputumduringthepastthirtyyearsandtendedtogettingworseoverrecentfiveyears,withbreathlessnessdeveloping.•病人近30年来一直有咳嗽、咳痰，近5年来有所加重，伴气急。•Thesymptomswereusuallyaggravatedbycoldweatheroralternationsofseasons,whiletendedtoeasewhentheweatherwasgettingwarm.•症状通常于天气寒冷时或季节更替时发作，天气回暖后好转。•Almosteveryyearhehadtosufferforonetothreemonths.Hewascontinuouslyusingsalbutamolinhalationwhichdidrelievethesymptomsmostofthetime.•几乎每年都有发作，持续1～3个月。病人一直使用沙丁胺醇吸入治疗，症状多能缓解。•Oneweekbeforeadmission,hecaughtacoldandsufferedarelapsethereafter.Meanwhile,hehadlargevolumesofpurulentsputumandwheezedaftermoderatemovement.Heinhaledsalbutamolasusual,butitdidn'tworkthistime.Sohecame.•入院前1周，病人感冒后症状又有发作，伴咯大量脓痰，动则气急。吸入沙丁胺醇后症状无缓解。为求进一步诊治，入我院。•Thepatienthasasmokinghistoryof100packyears.Andhisfamilyhistorywasunremarkable.Mainlythat'sall.•病人有吸烟史，100包每年，家族史无特殊。汇报完毕。•Chiefphysician:Yourpresentationisquiteclear.Werethereanysignificantphysicalfindings,Dr.Grey?•主任医师：你的汇报很清楚。查体有什么有意义的发现吗?•Intern(Dr.Grey):Yes.Weexaminedthepatientcarefullyandfoundsignsoflungdisease,includingbucket-like-chestandbronchi.Buttherewasnocyanosisinthelipsandnoedemaofthelegs.•实习医师：我们仔细检查了病人，发现一些肺部体征，包括桶状胸和肺部干啰音。无口唇发绀和双下肢水肿。•ThelaboratorytestsreportedthatPaOwas10₂kPaandPaCOwas5kPa.However,₂WBCcountwas9.9X10/L,andthe⁹neutrophilswere90%.•实验室检查报告：PaO₂10kPa，PaCO₂5kPa；白细胞计数9.9×10⁹/L，中性粒细胞90%。•Apreviouspulmonaryfunctionexaminationshowedthattheforcedexpiratoryvolumein1second(FEV1)was1.5litersandFEV1/forcedvitalcapacity(FVC)was50%.•病人过去的肺功能检查示第1秒用力呼气量（FEV1）是1.5L，第1秒用力呼气量/用力肺活量（FEV1/FVC）是50%.•ChiefPhysician:Whenwasthepulmonaryfunctiondone?•主任医师：肺功能是什么时候做的?•Intern(Dr.Grey):(Lookingthroughthechart)Er...6monthsago.•实习医...
