臨床醫(yī)學(xué)英語(yǔ)浙江-考試重點(diǎn)

1、2012年 住院醫(yī)師規(guī)范化培訓(xùn) 臨床醫(yī)學(xué)英語(yǔ) 醫(yī)學(xué)英語(yǔ) 考試重點(diǎn) 考試內(nèi)容 考試精華Evidence-based medicine 循證醫(yī)學(xué) Healthy lifestyles 健康生活方式 Obesity 肥胖癥 Palliative care 姑息性治療Hospice 臨終關(guān)懷 Immunization 免疫 Screening tests 篩查試驗(yàn) Susceptibility 易感性 Health promotion 健康促進(jìn)Osteoporosis 骨質(zhì)疏松 Life expectancy 預(yù)期壽命 Geriatric patients 老年病人 Comorbidities 并存病

2、Subclinical disease 亞臨床疾病 Cognitive impairment 認(rèn)知缺陷 Arthritis 關(guān)節(jié)炎 Weight loss 體重減輕Atherosclerosis 動(dòng)脈粥樣硬化 Heart failure 心臟衰竭 Physical therapy 理療 Iron deficiency anemia 缺鐵性貧血Inflammatory bowel disease 炎性腸病 Endoscopy 內(nèi)窺鏡檢查 Angiography 造影 Asthma 哮喘 Chronic bronchitis 慢支Pulmonary embolism肺栓塞 Lung complia

3、nce 肺順應(yīng)性 Diabetic nephropathy 糖尿病性腎病 Hyperglycemia 高血糖癥Microalbuminuria 微量蛋白尿 Proteinuria 蛋白尿 Nephrotic syndrome 腎病綜合征 Renal failure 腎功能衰竭Etiology 病因?qū)W Autopsy 尸檢 Fine needle aspiration 細(xì)針穿刺 Epidemic influenza 流行性感冒Imaging tests 影像學(xué)檢查 Acute cholecystitis急性膽囊炎 Gallstones 膽結(jié)石 Acute abdominal pain 急腹癥Bo

4、wel obstruction 腸梗阻 Contrast material 造影劑 Cardiac arrhythmia 心律失常 Coronary artery disease 冠心病Myocarditis 心肌炎 Echocardiography 超聲心動(dòng)圖 Elective surgery 擇期手術(shù) Antibacterial spectrum 抗菌譜Peritonitis 腹膜炎 Tenderness 壓痛 Gastrointestinal perforation 胃腸穿孔Immunosuppression 免疫抑制 Multisomatoform disorder 多重軀體形式障礙

5、Intestinal anastomoses 腸吻合術(shù)Intra-abdominal abscess 腹腔膿腫 Nosocomial infection 院內(nèi)感染 Aspiration 誤吸 Catheter sepsis 導(dǎo)管熱、膿毒癥The increasing availability of evidence from randomized trials to guide the approach to diagnosis and therapy should not be equated with “cookbook” medicine. Evidence and the guidel

6、ines that are derived from it emphasize proven approaches for patients with specific characteristics. Substantial clinical judgment is required to determine whether the evidence and guidelines apply to individual patients and to recognize the occasional exceptions. Even more judgment is required in

7、the many situations in which evidence is absent or inconclusive. Evidence also must be tempered by patients preferences, evidence when presenting alternative potions to the patient. The adherence of a patient to a specific regimen is likely to be enhanced if the patient also understands the rational

8、e and evidence behind the recommended option.但是，不斷增多的可用于指導(dǎo)臨床診斷與治療的隨機(jī)試驗(yàn)資料不應(yīng)當(dāng)做“烹調(diào)書(shū)”使用。因?yàn)殡S機(jī)試驗(yàn)獲得的現(xiàn)象和思路是側(cè)重于求證某些特征病人而來(lái)的。實(shí)際的判斷需要確定這些臨床表現(xiàn)和診斷標(biāo)準(zhǔn)是否能應(yīng)用于病人個(gè)體，并找出列外。許多情況下，臨床表現(xiàn)缺乏或不典型，需要考慮更多到判斷。雖然醫(yī)生的職責(zé)是在給病人提供治療方案的時(shí)候應(yīng)該強(qiáng)調(diào)證據(jù)，但病人肯定會(huì)根據(jù)自己的傾向作出選擇。假如病人同樣知道醫(yī)生提供的治療方案背后的基礎(chǔ)原理和證據(jù)，則病人很有可能遵循一種特別的養(yǎng)生之道Even sa physicians become incr

9、easingly aware of new discoveries, patients can obtain their own information from a variety of sources, some of which are of questionable reliability. The increasing use of alternative and complementary therapies is an example of patients frequent dissatisfaction with prescribed medical therapy. Phy

10、sicians should keep an open mind regarding unproven options but must advise their patients carefully if such options may carry any degree of potential risks, including the risk that they may relied on to substitute for proven approaches. It is crucial for the physician to have an open dialogue with

11、the patient and family regarding the full range of options that either may consider.甚至當(dāng)醫(yī)生越來(lái)越容易知道新發(fā)現(xiàn)的同時(shí)，患者也能夠通過(guò)資源得到他們的消息，當(dāng)然，某些信息是不可靠的。替代療法和輔助療法的應(yīng)用不斷增加就是病人對(duì)常規(guī)療法經(jīng)常不滿意的一個(gè)列子。醫(yī)生對(duì)未證實(shí)的療法應(yīng)該保持開(kāi)放的思想，但是，如果這些療法具有任何程度的潛在風(fēng)險(xiǎn)，都必須細(xì)致的告知病人，包括可能需要用已證實(shí)的常規(guī)療法去替代的風(fēng)險(xiǎn)。對(duì)醫(yī)生來(lái)說(shuō)，對(duì)病人及家屬開(kāi)誠(chéng)布公的介紹所有可考慮的治療選擇，是非常重要的。Many aspects of palli

12、ative care, as with any specialty, are relevant to the general practice of medicine and to all clinicians who tend to dying persons. Palliative care has a role in the earliest phases of a life-threatening illness but assumes a more prominent or even dominant role in the final 3 to 6 months of common

13、 terminal conditions：advanced cancer，heart and lung failure, end-stage liver and renal disease, acquired immunodeficiency syndrome, and life-limiting neurologic diseases. 4章（第二段）姑息治療是一門(mén)全科醫(yī)學(xué)，涉及所有醫(yī)學(xué)學(xué)科，與參與治療危重病人的所有醫(yī)護(hù)人員息息相關(guān)。姑息治療不僅適用于危重疾病早期治療，在常見(jiàn)末期疾病患者的最后3到6個(gè)月作用更加凸顯，比如癌癥末期，心肺衰竭，晚期肝腎疾病，艾滋病和威脅生命的神經(jīng)性疾病。A se

14、cond way in which older adults differ from younger adults is the greater likelihood that their diseases present with nonspecific symptoms and signs. Pneumonia and stroke may present with nonspecific changes in mentation as the primary symptom. Similarly, the frequency of silent myocardial infarction

15、 increases with increasing age, as does the proportion of patients who present with a change in mental status, dizziness, or weakness rather than typical chest pain. As a result, the diagnostic evaluation of geriatric patients must consider a wider spectrum of diseases than generally would be consid

16、ered in middle-aged adults. 8章（第二段）老年與青中年的第二個(gè)差異是更容易出現(xiàn)非典型的癥狀和體征。肺炎和中風(fēng)時(shí)可出現(xiàn)非特異的精神狀態(tài)改變?yōu)橹饕Y狀。同樣的，隱匿性心肌梗死發(fā)生頻率隨著年齡的增大而增加，這些病人相應(yīng)到頻發(fā)精神狀態(tài)改變、眩暈、虛弱而而不是典型的胸痛癥狀。因此，對(duì)老年病人的診斷應(yīng)考慮更廣泛的疾病，要超過(guò)通常對(duì)中年病人所考慮的范圍。Finally, a serious and common outcome of chronic diseases of aging is physical disability, defined as having diffic

17、ulty or being dependent on others for the conduct of essential or personally meaningful activities of life, from basic self-care (e.g., bathing or toileting) to tasks required to live independently (e.g., shopping, preparing meals, or paying bills) to a full range of activities considered to be prod

18、uctive and/or personally meaningful. Of older adults, 40% report difficulty with tasks requiring mobility, and difficulty with mobility predicts the future development of difficulty in instrumental activities of daily living (IADL; household management tasks) and activities of daily living (ADL; bas

19、ic self-care tasks). 8章（末段部分）最后，老年人慢性病嚴(yán)重又常見(jiàn)的結(jié)果是身體能力不足，描述為個(gè)人最基本的或有意義的日?；顒?dòng)有困難或不得不依靠別人幫助指導(dǎo)，從基本自我照顧（例如，洗澡和如廁）到獨(dú)立生活需要的各種任務(wù)（例如，購(gòu)物，做飯，或支付帳單）到具有集體/或個(gè)人意義的所有活動(dòng)。在老年人中，40%對(duì)需要運(yùn)動(dòng)的任務(wù)有困難，運(yùn)動(dòng)困難提示將來(lái)開(kāi)展日常工具鍛煉（IADL；家庭護(hù)理項(xiàng)目）和日常鍛煉（ADL；基本護(hù)理項(xiàng)目）的困難。The initial approach to a patient with iron deficiency anemia depends on the pr

20、esence of symptoms referable to either the upper or lower gastrointestinal tract. Regardless of the findings on the initial upper or lower endoscopic examination, all patients should have bath upper and lower endoscopy because the complementary endoscopic examination has a yield of 6% even if the fi

21、rst one was positive. For premenopausal women, a positive FOBT requires full evaluation, as does iron deficiency anemia. Barium radiographs of the upper and lower gastrointestinal tract have limited utility in the setting of occult bleeding because of their inability to biopsy or treat lesions that

22、are identified.21章(第三段)缺鐵性貧血病人的早期檢查方法要根據(jù)存在的癥狀是提示上或下消化道。無(wú)論首次上消化道或下消化道內(nèi)窺鏡檢查會(huì)有何發(fā)現(xiàn)，所有患者都應(yīng)該做上部和下部?jī)?nèi)鏡兩個(gè)檢查，因?yàn)榛パa(bǔ)的內(nèi)鏡檢查有6%的再發(fā)現(xiàn)，即使第一次檢查是陽(yáng)性的。對(duì)絕經(jīng)前婦女，大便隱血試驗(yàn)陽(yáng)性需要全面評(píng)估，缺鐵性貧血也一樣。鋇X光片的上部和下部消化道對(duì)隱匿性出血應(yīng)用有限，因?yàn)樗麄儾荒芑顧z或治療發(fā)現(xiàn)的病損。In the face of continued blood loss and no identified etiology, intraoperative endoscopy may provide

23、 simultaneous diagnosis and therapy。During the procedure, the surgeon plicates the bowel over the endoscope. As the scope is withdrawn, endoscopic findings can be identified for surgical resection or treatment. The yield of this procedure exceeds 70%. In some clinical situations, the site of bleeldi

24、ng cannot be identified, and the patient requires long-term transfusion therapy.碰到進(jìn)行性出血查不到病因，應(yīng)用術(shù)中腸鏡可以同時(shí)進(jìn)行診斷和治療。操作時(shí)，外科醫(yī)生把小腸套到內(nèi)窺鏡上。內(nèi)鏡退出時(shí)，內(nèi)鏡的發(fā)現(xiàn)可以決定是外科切除或保守治療。這個(gè)措施70%以上有結(jié)果。某些臨床病例，出血部位無(wú)法發(fā)現(xiàn)，病人而要長(zhǎng)期輸血治療。A new device for visualizing the entire gastrointestinal mucosa consists of images to receivers attached

25、to the patients abdomen and mapped to identify the location of the image. The diagnostic yield of capsule enteroscopy is not yet clear, but this approach may potentially visualize segments of the small bowel that were previously inaccessible. No therapeutic maneuvers are possible with the device.一種新

26、的裝置能顯示全部胃腸粘膜，這種裝置由一顆裝有小型攝像機(jī)能咽下的膠囊組成，他將影像信號(hào)傳到附著在病人腹部的接收器，并繪制出圖像來(lái)識(shí)別影像的位置。膠囊小腸鏡的診斷效率現(xiàn)在還不清楚，但是，這種方法可能可能顯示以前難以接近的小腸腸管。但這個(gè)裝置不可能有任何治療性操作。The first signs or cancer are frequently due to metastases to visceral or nodal sites. In most such patients, routine clinical evaluation with a comprehensive history, ph

27、ysical examination, examination, complete blood cell count, screening chemistries, and directed radiologic evaluation of specific symptoms or signs identifies the primary tumor. Patients who have no primary tumor located after this routine clinical evaluation are defined as having cancer of unknown

28、primary site. Further clinical and pathologic evaluation will identify the primary site in only a small minority of patients, and about 80% will never have a primary site identified during their subsequent clinical course. 25章（第一段）腫瘤的首發(fā)癥狀或體征通常由于臟器或淋巴結(jié)轉(zhuǎn)移引起的。對(duì)此類(lèi)病人需要進(jìn)行常規(guī)臨床檢查和全面的病史回顧、體格檢查，完整的血液細(xì)胞計(jì)數(shù)，生化篩查

29、和對(duì)特定癥狀體征進(jìn)行放射學(xué)檢查以確定原發(fā)病灶。經(jīng)過(guò)常規(guī)臨床檢查后不能發(fā)現(xiàn)原發(fā)病灶到被稱為原發(fā)灶不明的腫瘤。進(jìn)僅有小部分病人經(jīng)過(guò)進(jìn)一步到臨床和病理檢查將確定原發(fā)部位，約80%的病人在后續(xù)的臨床診療中無(wú)法確定原發(fā)病灶。Since all patients with cancer of unknown primary site have advanced disease, therapeutic nihilism has been common. However, it is now evident that this heterogeneous group contains subsets of

30、patients with widely diverse prognoses; some cancers are highly responsive to treatment, and some patients may have a substantial chance of achieving long-term survival with appropriate treatment. The initial clinical and pathologic evaluation should therefore focus on identifying a primary site whe

31、n possible and on identifying patients for whom specific treatment is indicated. 25章（第四段）由于原發(fā)灶不明腫瘤病人往往為晚期病人，治療效果往往受到質(zhì)疑。但是現(xiàn)在比較明確的是這類(lèi)特殊患者的預(yù)后差別很大，一些患者對(duì)治療高度敏感，也有部分患者通過(guò)適當(dāng)治療生存期很長(zhǎng)。因此臨床和病理檢查的出發(fā)點(diǎn)應(yīng)當(dāng)是尋找原發(fā)病灶和識(shí)別對(duì)特殊治療有效到患者。Complications can occur for a variety of reasons. A surgeon can perform a technically perfe

32、ct operation in a patient who is severely compromised by the disease process and still have a complication. Similarly, a surgeon who is sloppy, is careless, or hurries through an operation can make technical errors that account for the operative complications. Finally, the patient can be doing well

33、nutritionally, have an operation performed meticulously, and yet suffer a complication because of the nature of the disease. The possibility of postoperative complications is a part of every surgeon s thought processes-something with which all surgeons will be required to deal. 28章(第二段)外科并發(fā)癥發(fā)生的原因有很多

34、。有時(shí)外科醫(yī)生手術(shù)技術(shù)上非常成功，但病人的病情嚴(yán)重可導(dǎo)致并發(fā)癥的發(fā)生。同樣，手術(shù)中醫(yī)生的馬虎。粗心或倉(cāng)促可導(dǎo)致技術(shù)上的錯(cuò)誤從而導(dǎo)致手術(shù)并發(fā)癥。最后，即使病人營(yíng)養(yǎng)狀況良好，手術(shù)也很成功，疾病本身也可導(dǎo)致并發(fā)癥的產(chǎn)生。術(shù)后并發(fā)癥的可能性是每一個(gè)外科醫(yī)生考慮治療計(jì)劃的一個(gè)組成部分，因?yàn)樗型饪漆t(yī)生都將面臨這些并發(fā)癥中的一部分。Pneumonia and influenza (P+I)-related deaths fluctuate annually, with peaks in the winter months. When such P+I deaths exceed the predicted

35、 number, it is due to influenza A or occasionally to influenza B virus or respiratory syncytial virus activity. Although mortality is greatest during pandemics, substantial total mortality occurs with epidemics. Over 85% of P+I deaths occur among persons aged 65 and older. Other cardiopulmonary and

36、chronic diseases also result in increased mortality after influenza epidemics, so that overall influenza-associated mortality is about two-to fourfold higher than P+I deaths. 30章（末段）肺炎和流感（P+I）相關(guān)的死亡人數(shù)每年都在波動(dòng)，高峰期在冬季。當(dāng)這P+I的死亡超過(guò)預(yù)計(jì)數(shù)值，這是由于甲型流感或偶爾因?yàn)橐倚土鞲胁《净蛘吆粑篮习《镜幕顒?dòng)所致。雖然大流行的時(shí)候病死率最高，普通流行時(shí)病死率也非?？捎^。超過(guò)85%P+I死亡

37、發(fā)生在65歲以上人群。流感流行后，其他心肺和慢性疾病也導(dǎo)致死亡率增高，以至于總體流感相關(guān)的死亡率比P+I導(dǎo)致的病死率高出2 -4倍MRI can be useful for the cooperative patient in renal failure who cannot receive intravenous contrast material because it can provide tissue and vascular detail not achievable without contrast-enhanced. Patient cooperation is required

38、 because of the longer imaging times and respiratory motion artifacts. MRI is also useful in specific situations to image the biliary tree, liver parenchyma, and male and female pelvis. 35章（末段）病人合作情況下，磁共振成像對(duì)于無(wú)法接受靜脈造影劑的腎衰病人是有用的，因?yàn)樗芴峁┙M織和血管細(xì)節(jié)，而這些細(xì)節(jié)不借助增強(qiáng)CT就無(wú)法看到。因?yàn)樾枰L(zhǎng)時(shí)間的成像以及呼吸運(yùn)動(dòng)偽差，病人的合作對(duì)于磁共振成像是有必要的。在特定情

39、況下，MRI對(duì)于膽道系統(tǒng)，肝實(shí)質(zhì)，男性和女性骨盆的成像檢查同樣是有用的。In assessing prognosis and planning a treatment strategy, it is useful to classify SCD sa either primary (without a clear trigger) or secondary. A primary episode has a 10 to 30% 1-year recurrence rate, whereas most secondary episodes are associated with recurrenc

40、e rates of less than 2%. Identifiable reversible precipitants of secondary ventricular fibrillation (VF) include transient ischemia possibly related to vasospasm; hypokalemia resulting from diuretics, hyperkalemia secondary to renal failure, angiotensin-converting enzyme inhibitors, prostaglandin se

41、condary to antiarrhythmics, tricyclics, and antihistamines; or substance abuse with drugs such as cocaine and amphetamines. 41章（第二段）在評(píng)估預(yù)后和制定治療方案時(shí)，將心源性猝死分為原發(fā)性（無(wú)明確的誘發(fā)因素）或繼發(fā)性是實(shí)用的。原發(fā)性發(fā)作在1年內(nèi)有1030復(fù)發(fā)率，而大多數(shù)繼發(fā)性的復(fù)發(fā)率小于2%。已知的可逆性繼發(fā)性心室顫動(dòng)（室顫）的發(fā)作包括小血管痙攣性的短暫缺血；利尿劑引起的低鉀血癥，腎功能衰竭，血管緊張素轉(zhuǎn)換酶抑制劑，前列腺素抑制因子、或保鉀利尿所至的高鉀血癥；抗心律失常

42、藥、三環(huán)類(lèi)藥與抗組胺藥引起的心率失常；或?yàn)E用藥物，如可卡因和安非他明。Prophylactic antibiotic therapy is clearly more effective when begun preoperatively and continued through the intraoperative period, with the aim of achieving therapeutic blood levels throughout the operative period. This produces therapeutic levels of the antibiot

43、ic agents at the operative site in any seromas and hematomas that may develop. Antibiotics started as late as 1 to 2 hours after bacterial contamination are markedly less effective, and it is completely without value to start prophylactic antibiotics after the wound is closed. Failure of prophylacti

44、c antibiotic agents occurs in part through a neglect of the importance of the timing and dosage of these agents, which are critical determinants.43 章(第一段)起始于手術(shù)前以及持續(xù)于手術(shù)中的預(yù)防性抗生素治療，對(duì)于貫穿整個(gè)手術(shù)階段達(dá)的抗生素治療劑量血藥濃度顯然十分有效。這可以使得在手術(shù)區(qū)域出現(xiàn)的漿液腫和血腫中的抗生素達(dá)到治療濃度?？股赜糜诩?xì)菌污染后1至2小時(shí)則有效性會(huì)大大降低，而傷口閉合后進(jìn)行預(yù)防性抗生素治療已毫無(wú)價(jià)值。預(yù)防性抗生素失敗的部分歸咎于

45、忽略了時(shí)機(jī)和給藥劑量的重要性，而這兩點(diǎn)正是關(guān)鍵的決定因素。Many patients fail to receive needed prophylactic antibiotics because the system for their administration is complex at the time of multiple events just before a major operation. This problem has been made worse by the trend of admitting patients directly to the OR for p

46、lanned operations, which intensifies the pressures to accomplish a large number of procedures during a short interval before the operations, the possibility that prophylactic antibiotics will be unintentionally omitted can be minimized by establishing a system with a checklist. One member of the ope

47、rative team (usually the preoperative nurse or a member of the anesthesia team) should be responsible for initialing a portion of the operative record that states either that the patient received indicated prophylactic antibiotics or that the surgeon has determined that states either that the patient received indicated prophylactic antibiotics or that the surgeon has determined that antibiotics are not indicated for the procedure. 43 章(第三段)許多患者并未給予預(yù)防性抗生素，這是由于在一個(gè)主要手術(shù)前的多種事件中，他們的管理系統(tǒng)過(guò)于復(fù)雜，由于允許病人直接去手術(shù)室進(jìn)行計(jì)劃內(nèi)的手術(shù)，這個(gè)問(wèn)題已經(jīng)越來(lái)越嚴(yán)重，這加劇了手術(shù)前短時(shí)間內(nèi)完成大量操作規(guī)程的壓力。可以通過(guò)建立一個(gè)帶有清單的系統(tǒng)來(lái)盡量減少預(yù)防性抗生素被無(wú)意識(shí)遺漏的可