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1、【精品文档】如有侵权，请联系网站删除，仅供学习与交流临床医学英语.精品文档.临床医学英语Chapter 1 Patient-Physician Interaction Page 1第一章 医患沟通 第页The patient-physician interaction proceeds through many phases of clinical reasoning and decision making. proceed 进行、开展 reasoning 推论、推理 clinical reasoning 诊断 clinical decision 确定治疗方案 making decision

2、做出决定医患沟通在临床诊断和治疗决策的许多时期进行着。The interaction begins with an elucidation of complaints or concerns, followed by inquiries or evaluation to address these concerns in increasingly precise ways.elucidation 说明、阐明 inquire 询问、调查 evaluation 评估、评价这种沟通开始于病人主诉或所关注问题的阐明，然后通过交流、评估不断精确地确定这些问题。The process commonly r

3、equires a careful history or physical examination, ordering of diagnostic tests, integration of clinical findings with the test results, understanding of the risks and benefits of the possible courses of action, and careful consultation with the patient and family to develop future plans.integration

4、 综合 consultation 磋商、会诊 这个过程通常需要细致的询问病史和体格检查，开具诊断性化验医嘱，综合临床发现和化验结果，理解分析拟行治疗过程中的风险和疗效，然后与病人及家属反复磋商以完善治疗方案Physicians increasingly can call on a growing literature of evidence-based medicine to guide the process so that benefit is maximized,while respecting individual variations among different patients

5、respecting 注意到、关系、说到 evidence-based medicine 循证医学 尽管考虑到不同病人中个体差异是存在的，但医生们越来越容易查阅不断增长的循证医学文献来指导这个过程，使得疗效最大化。The increasing availability of randomized trials to guide the approach to diagnosis and therapy should not be equated with “cookbook” medicineavailability可利用性， 可得到 randomize 随机的cookbook 食谱，烹调书

6、approach 接近 但是，不断增加的可用于指导临床诊断与治疗的随机试验资料不应当作“烹调书”使用。Evidence and the guidelines that are derived from it emphasize proven approaches for patients with specific characteristics.Evidence 证据，迹象 guideline指导方针 emphasize 强调 那些随机试验获得的临床表现和诊断思路是侧重于求证具有某些特征病人而来的。Substantial clinical judgment is required to de

7、termine whether the evidence and guidelines apply to individual patients and to recognize the occasional. substantial clinical 真实的，实在的 individual 个体 occasional 偶尔的，特殊的实际的临床判断需要确定这些临床表现和诊断依据标准是否能应用于普通病人的个体，并能找出例外。Even more judgment is required in the many situations in which evidence is absent or inc

8、onclusive.inconclusive 不确定性，非决定性在许多情况下，临床表现缺乏或不典型，甚至需要考虑得更多。Evidence also must be tempered by patients preferences, although it is a physicians responsibility to emphasize when presenting alternative options to the patient. temper 脾气，调音 preference 偏爱 presenting 提出 alternative 可选择的，二选一虽然医生喜欢提出选择性问题让病

9、人回答，但病人肯定会根据自己的倾向调节临床症状。The adherence of a patient to a specific regimen is likely to be enhanced if the patient also understands the rationale and evidence behind the recommended option.adherence 坚持、固执 regimen 养生法、食物疗法enhance 提高、加强 rationale 基本原理假如还懂得所提供问题的基本原理和表现，有特殊生活方法病人的固执容易强化这种倾向To care for a

10、patient as an individual, the physician must understand the patient as a person. care for 喜欢、照料 为了把病人作为一个个体进行治疗，医生必须理解病人是一个人（不是一群人）。This fundamental precept of doctoring includes an understanding of the patients social situation, family issues,financial concerns, and preferences for different types

11、of care and outcomes, ranging from maximum prolongation of life to the relief of pain and suffering. precept 训戒 doctoring 行医 prolongation 延长 这个最基本的行医原则包括了解病人的社会地位，家庭问题，资金状况以及正确理解病人对不同治疗方法、不同治疗结果的选择，从最大限度地延长生命到临时缓解疼痛和症状。Even as physicians become increasingly aware of new discoveries, patients can obt

12、ain their own information from a variety of sources, some of which are of questionable reliability.questionable 可疑的、成问题的、不可靠的 reliability 可靠、可信赖的 甚至，当医生越来越容易知道新发现的同时，病人也能够通过各种途径得到他们的信息，某些信息是不可靠的。The increasing use of alternative and complementary therapies is an example of patients frequent dissatis

13、faction with prescribed medical therapy.alternative 选择，替代 complementary 补充的、相配的 prescribe 规定、指定、开处方 不断增加的替代疗法和辅助疗法的应用就是病人对常规疗法经常不满意的一个例子。Physicians should keep an open mind regarding unproven options but must advise their patients carefully if such options may carry any degree of potential risks, in

14、cluding the risk that they may relied on to substitute for proven approachessubstitute 代替、代用 rely on 依赖、信任 医生对新疗法应该保持开放的思想，但是，如果这些疗法具有任何程度的潜在风险，都必须细致地告知病人，包括可能需要用已证实的常规疗法去替代的风险。It is crucial for the physician to have an open dialogue with the patient and family regarding the full range of options th

15、at either may considercrucial 严酷的、决定性的 either 两者任一对医生来说，对病人及家属开诚布公地介绍所有可考虑的治疗选择，是非常重要的。The physician does not exist in a vacuum but rather as part of a complicated and extensive system of medical care and pubic health.vacuum 真空 extensive 广阔的、大量的 医生不是生存在真空中，而是作为一个复杂而庞大的医疗和公共健康体系中的一部分。In premodern tim

16、es and even today in some developing countries, basic hygiene, clean water, and adequate nutrition have been the most important ways to promote health and reduce disease.adequate 足够的、恰当的 在未发达时代，甚至当今在一些发展中国家，基本卫生条件、清洁饮用水和最低营养保障是促进健康的最重要方法。In developed countries, the adoption of healthy lifestyles, in

17、cluding better diet and appropriate exercise, are cornorstones to reducing the epidemics of obesity, coronary disease, and diabetes.adoption 采纳、采用 epidemic 流行、传染 在发达国家中，健康的生活方式包括良好饮食和适当锻炼，是减少肥胖、冠心病和糖尿病的基础。Public health interventions to provide immunizations and to reduce injuries and the use of toba

18、cco, illicit drugs, and excess alcohol collectively can produce more health benefit than nearly any other imaginable health intervention.illicit 非法的、违禁的 collectively 全体地、共同地 produce 生产、创造公共健康干预如进行疫苗接种、减少损伤、减少吸烟、减少吸毒、减少酗酒等措施共同产生的健康效果比几乎可想象的任何其它健康干预措施都要好得多。Chapter Vital signs Page 15第六章 生命体征 第页A nurse

19、 or assistant often obtains the vital signs.护士或护士助手经常可得到生命体征Traditionally the vital signs include pulse rate, blood pressure, respiratory rate, and body temperature.传统的生命体征包括脉搏（率）、血压、呼吸（频率）和体温。More recently, advocates of various causes have advocated for a “fifth vital sign”. advocate 提倡、主张最近，人们以多种理

20、由提出 “第五生命体征”的建议。The most cogent of these “new” vital signs is the patients quantitative assessment of pain.cogent 今人信服的，切实的，有力的这些“新”的生命体征中，最今人信服的是病人疼痛的定量评判。The pulse should be recorded as not just the rate but also the rhythm. 脉搏不仅要记录频率，而且要记录节律。Physicians may prefer to initiate the examination by ho

21、lding the patients hand while palpating the pulse.initiate 开始，创始医生喜欢握住病人的手，触摸脉搏，开始检查。This nonthreatening initial contact with the patient allows the physician to determine whether the patient has a regular or irregular rhythm. 这个对病人无威胁性的最初接触让医生确定了脉搏是否具有节律性。When the blood pressure is abnormal, many p

22、hysicians repeat the measurement.当测得的血压不正常，许多医生重复这个测量。The instrument error that contributes to the greatest variability is the cuff size of the sphygmomanometer. variability 变化，易变性 sphygmomanometer 血压计变异性中占比例最大的设备误差是血压计袖套的大小。Many adults require a large-size adult cuff; using a narrow cuff can alter

23、systolic/diastolic blood pressure by -8 to +10/+2 to +8mmHg. mmHg: millimeter of mercury许多成人需用大号的成人袖套，如果使用窄袖套能够影响收缩压-810mmHg ，舒张压28mmHg。The appearance of repetitive sounds (Korotkoff sounds, phase 1) constitutes the systolic pressure. constitute 构成，设立，指定重复脉搏音（Korotkoff 音，第相）的出现定为收缩压。After the cuff i

24、s inflated about the palpated pressure, the Korotkoff sounds muffle and disappear as pressure is released (phase 5).inflate 充气、膨胀 muffle 含糊不清当袖套充气压力约在可触摸脉搏压力的2030mmHg上方，Korotkoff音变钝，当压力释放， Korotkoff音消失（第相）。The level at which the sounds disappear is the diastolic pressure.声音消失的水平就是舒张压The American Hea

25、rt Association recommends that each measure should be rounded upward to the nearest 2mmHgbe round up to the nearest whole number取最近的整数美国心脏病协会建议每次测量取最近的mmHg整数。The respiratory rate should be assessed at the same time the patient is observed to determine whether there is any respiratory discomfort (dys

26、pnea).dyspnea 呼吸困难测量呼吸频率的同时要观察病人以确定是否存在呼吸困难。The subjective sensation of dyspnea is caused by an increased work of breathing. subjective 主观的呼吸困难的主观感觉是由于呼吸功增加起的。The examiner should decide whether patients have tachypnea (a rapid rate of breathing) or hypopnea (a slow or shallow rate of breathing).tach

27、ypnea 呼吸急促 hypopnea 呼吸减弱检查者要确定病人是否存在呼吸急促（呼吸频率快）或呼吸减弱（呼吸频率慢或浅）Tachpnea is not always associated with hyperventilation, which is defined by increased alvealar ventilation resulting in a lower arterial carbon dioxide level. hyperventilation 换气过度 resulting in 导致、引起呼吸急促不是都伴有过度换气，过度换气的定义是肺泡通气量增高引起动脉血二氧化碳水

28、平降低。In the evaluation of patients suspected of having pneumonia, examiners agree on the presence of tachypnea only 63% of the time.agree on 对取得一致意见对一组疑为肺炎患者的评估中，检查者认为当时呼吸急促的出现率仅为63%。The body temperature of adults usually is measured with an oral electric thermometer.成人体温通常用口腔电子体温计测定。These thermomete

29、rs correlate well with the traditional mercury thermometer and are safer to use.mercury 汞这种体温计与传统的汞体温计高度相关，使用安全。Rectal thermometers reliably record temperatures 0.4 higher than oral thermometers.直肠体温计可靠地记录了高于口表0.4的温度。By comparison, newer tympanic thermometers may vary too much compared with oral the

30、rmometers (-1.2 to +1.6 versus the oral temperature) to be reliable among hospitalized patients.tympanic 鼓膜的、鼓室的 too much to be 太以致于不相比较，新型的鼓式体温计相对口表可能误差太大（与口表相差-1.21.6度），不宜用于住院病人。Chapter 8 Why Geriatric Patients Are Different Page 20第八章 老年病人的特殊性 第20页Older patients differ from young or middle-aged a

31、dults with the same disease in many ways, one of which is the frequent occurrence of comorbidities and of subclinical orbidities 并存病 subclinical 亚临床的同样的疾病，年龄大的病人在许多方面与青中年病人是有区别的，其中之一是并存病多和亚临床疾病多。As a function of the high prevalence of disease, comorbidity (or the co-occurrence of two or more disease

32、s in the same individual) is also common. prevalence 流行、普遍 co-occurrence 同时发生作为高发疾病的结果，并存病（两个或更多的疾病在同一个体同时发生）也是多见的。Of people age 65 and older, 50% have two or more chronic disease, and these diseases can confer additive risk of adverse outcomes, such as mortality. confer 授予、给予 additive 附加的、附属物65岁以上的

33、老年中，50%患有两种以上的慢性疾病，这些疾病能够增加不利预后的风险，如死亡率。In some patients, cognitive impairment may mask the symptoms of important conditions. cognitive 认知的、认识的 impairment 损害 mask 口罩、假面具、掩饰在一些病人中，认知损害可以掩盖重要病情的症状。Treatment for one disease may affect another adversely, as in the use of aspirin to prevent stroke in ind

34、ividuals with a history of peptic ulcer disease. stroke 中风 peptic ulcer 消化性溃疡对一种疾病的治疗可能加重另一种疾病，例如，对有消化性溃疡病史的病人使用阿斯匹林预防中风。The risk for becoming disabled or dependent also increases with the number of diseases present. disabled 残废的、有缺陷的 dependent 依靠的、依赖的病残或生活不能自理发生的风险也随着并存的疾病数而增高。Specific pairs of dis

35、eases can increase synergistically the risk of disability. synergistic 协同的特殊的成对疾病可以协同增加病残的风险。Arthritis and heart disease coexist in 18% of older adults; although the odds of developing disability are increased by three-fold to four-fold with either disease alone, the risk of disability increases 14-

36、fold if both are present. arthritis 关节炎有18%的老年人同时患有关节炎和心脏病，虽然每个疾病可以增加34倍的病残率，但两个疾病同时存在，可使病残率提高14倍。A second way in which older adults differ from younger adults is the greater likelihood that their diseases present with nonspecific symptoms and signs. likelihood 可能性老年与青中年的第二个差异是更容易出现非典型的症状和体症。Pneumon

37、ia and stroke may present with nonspecific changes in mentation as the primary symptom. pneumonia 肺炎 mentation 精神作用、心理活动 primary 初始的、首要的、主要的肺炎和中风时可出现非典型意识变化作为主要的症状。Similarly, the frequency of silent myocardial infarction increases with increasing age, as does the proportion of patients who present w

38、ith a change in mental status, dizziness, or weakness rather than typical chest pain. silent 沉默的、静止的 proportion 成比例的、相称的同样地，隐匿性心肌梗塞发生频度随着年龄的增大而增加，这些病人相应地频发精神状态改变、眩晕、虚弱而不是典型的胸痛症状。As a result, the diagnostic evaluation of geriatric patients must consider a wider spectrum of diseases than generally wou

39、ld be considered in middle-aged adults.spectrum 谱、光谱因此，老年病人的诊断应考虑更广泛的疾病谱，要超过通常对中年病人所考虑的范围。A third condition that is found primarily in older adults is frailty, frailty is thought to be a wasting syndrome that presents with multiple symptoms and signs, including reduced muscle mass, weight loss, weak

40、ness, poor exercise tolerance, slowed motor performance, and low physical activity. primarily 起初、首先、原来 frailty 脆弱、虚弱、意志薄弱tolerance 宽容、忍耐、耐受主要出现在老年人的第三个情况是衰弱，衰弱被认为属于衰竭综合症，它有许多症状和体征中，包括肌肉萎缩、体重下降、虚弱、运动耐受差、动作慢、身体活动少。Some estimates indicate that the full syndrome is found in 7% of community-dwelling peop

41、le age 65 and older, and in 25%of community-dwelling people age 85 and older. estimate 估计、评价、看法 indicate 指出、表时、象征、适应征一些人估计7%的65岁以上社区老人和25%的85岁以上社区老人上述症状全部出现。 Many institutionalized older adults also are frail.institutionalized 使成公共团体、将收容在公共设施里frail 身体虚弱的、易损坏的、意志薄弱的许多老人院里的老人也是衰弱的。Frailty is a state o

42、f decreased reserve and increased vulnerability to all kinds of stress, from acute infection or injury to hospitalization, and may identify individuals who cannot tolerate invasive therapies. reserve 保存、克制 vulnerability 易受伤、易受责难衰弱是对各种压力耐受下降、损害增加的一种状态，从急性感染、损伤到住院治疗，都可以发现一些人不能忍受侵入性诊疗措施。The syndrome of

43、 frailty is associated with high risk of falls, needs for hospitalization, disability, and mortality. fall 跌倒、下降 frail 身体虚弱的、易损坏的、意志薄弱的衰弱的症状与易于病倒、需要住院治疗、病残、死亡的高风险是相关的。There is early evidence that a core component of frailty is sarcopenia, or loss of muscle mass associated with aging, which occurs in

44、 13 to 24% of persons age 65 to 70 and in 60% of persons age 80 and older. component 成分、构成要素 sarcopenia 肌减少（症）、与年龄相关的骨骼肌质量下降衰弱一个主要成分的早期表现是肌肉减少，或说随年龄增长的肌肉减少，它发生在1324%的6570岁的老人，60%的80岁以上的老人。 It is likely that dysregulation of multiple physiologic systems, including inflammation, hormonal status, and g

45、lucose metabolism, underlies the syndrome, with resulting decreased ability to maintain homeostasis in the face of stress. dysregulation 失调 homeostasis 内环境稳定多种生理系统易于失调 ，包括炎症、激素状态、糖的代谢，结果是在压力面前保持内环境的稳定的能力下降。Subclinical disease (e.g., atherosclerosis), end-stage chronic disease (e.g., heart failure),

46、or a combination of comorbid diseases may precipitate the syndrome. atherosclerosis 动脉粥样硬化亚临床疾病(如动脉粥样硬化), 晚期慢性疾病(如心力衰竭），或多种疾病并存可共同形成症状。Evidence from randomized, controlled trials shows that resistance exercise, with or without nutritional supplements, and home-based physical therapy can increase lea

47、n body mass and strength in even the frailest older adults. 随机对照试验的迹象显示无论有无营养支持和家庭身体疗法，即使是最虚弱的老年人，对抗运动能够增加瘦弱躯体的质量和力量。This evidence suggests that earlier stages of frailty may be remediable, although end-stage frailty likely presages death.remediable 可挽回的 presage 预兆、预示这个结果提示早期衰弱是可挽回的，尽管末期衰弱常提示死亡。 Fourth, cognitive impairment increases in prominence as people age. prominence 突出、显著第四，人们变老时认知损害显著增加。Cognitive impairment is a risk factor for a wide range of adverse outcomes, including falls,