临床医学英语培训.doc

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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培训.精品文档.题型往年重点章节Chapter 1 Patient-Physician InteractionChapter 4 Palliative Care and Hospice of Dying PatientsChapter 5 Clinical Preventive Services Chapter 6 Chapter 8 Why Geriatric Patients Are DifferentChapter 21 Occult and Obscure Gastrointestinal BleedingChapter

2、22 Shortness of BreathChapter 23 Diabetic NephropathyChapter 25 Cancer of Unknown Primary Origin题型单词或词组英翻中10%101分/题10单词或词组中翻英10%101分/题10段落英翻中80%8016分/题共段，任选段，如多选，计前段分题型举例（附参考答案）一、将下列单词或词组译成汉语：（每题1分，记10分）1、hypoxia缺氧2、anuric renal failure无尿性肾衰竭3、advanced neoplastic disease晚期肿瘤4、muscle relaxant肌松药物5、si

3、de effect副作用6、rectal examination直肠指检7、proximal bowel obstruction近端肠梗阻8、abdominal tenderness腹部压痛9、fatal complication致命性并发症10、elective operation择期手术二、将下列单词或词组译成英语：（每题1分，记10分）难度大1、症状和体征symptoms and signs2、阑尾切除术appendectomy3、腹水ascites4、大手术major operation5、中风sroke6、无病生存disease free survival7、肺水肿pulmonary

4、 edema8、脓肿abscess9、化疗chemotherapy10、营养不良malnutrition三、英译中(每题20分，计80分，任选4题，如多选，计前4题分)1、The signs and symptoms of ovarian cancer may be only those of an enlarging tumor in the pelvis. Paker reported that 56 per cent of patients complained of pain and 46 per cent of abdominal swelling. He also reported

5、 that 31 per cent had experienced at least a 10-pound weight change, usually loss, and 22 per cent had either abnormal or postmenopausal bleeding. There may be ascites with unilateral or bilateral pleural effusion. Anemia is frequently seen in advanced disease. Pelvic examination may reveal firm, no

6、dual implants of metastatic tumor in the cul-de-sac and pelvic viscera. As noted, often there are no early symptoms of ovarian cancer. Every woman should have an annual pelvic examination before age 40 years and more frequently thereafter. The diagnosis is made histopathologically, and the different

7、ial diagnosis between benign and malignant ovarian tumors cannot be made until operation.卵巢癌的症状和体征可能只是增大的盆腔肿块。帕克尔报道：56的病人主诉有疼痛，46的病人有腹胀。他也报道：31的病人经历过至少10磅的体重变化，通常是体重减轻，22的病人有异常或是绝经后的阴道出血。病人可能同时有腹水伴单侧或双侧胸水。贫血在进展期中最常见。盆腔检查可能提示在阴道穹隆和盆腔脏器上出现转移性肿瘤，呈固定小节结样播散。要注意的是，卵巢癌通常都不会出现早期症状。在40岁前，妇女应该每年进行一次盆腔检查，40岁后则

8、更应频繁。诊断依靠组织病理，良恶性卵巢肿瘤的鉴别诊断只有通过手术才能确定。2、It is often difficult radiographicallly to distinguish paralytic ileus from mechanical obstruction. One radiographic feature of paralytic ileus is that gaseous distention occurs somewhat uniformly in the stomach, small bowel, and colon. Gas-fluid levels may be

9、seen in paralytic ileus. Examination after a barium meal may assist in distinguishing between paralytic ileus and mechanical obstruction but should be avoided if colon obstruction cannot be excluded. Considerable attention has been directed toward the fact that if the clinical symptoms indicate inte

10、stinal obstruction, reliance should not be placed upon abdominal films, because in a number of instances these may appear to be within normal limits at a time when the patient has strangulation obstruction.用x光片鉴别麻痹性肠梗阻和机械性肠梗阻通常很难。气体弥漫的充溢在胃、小肠和大肠中是麻痹性肠梗阻x线片中的一个特征。麻痹性肠梗阻可出现液气平。钡餐造影可能对鉴别麻痹性肠梗阻和机械性肠梗阻有帮

11、助，但如果大肠梗阻不能排除，则此检查为禁忌。我们应该注意到以下情况：如果临床症状提示有肠梗阻，不应该依赖腹部平片，因为在很多情况下，当病人有绞窄性肠梗阻时，平片仍会显示正常。3、Surgical infections are distinguished from medical infections by the presence of an anatomic or mechanical problem that must be resolved by operation or other invasive procedure to cure the infection. Such proce

12、dures include, but are not limited to, incision and drainage of an abscess, opening an infected wound, removing an infected foreign body, repairing or diverting a bowel leak, or draining an intra-abdominal abscess with a percutaneous catheter. Antibiotic treatment of a surgical infection without thi

13、s mechanical solution does not resolve the infection. The most important aspect of the initial approach to a surgical infection is the recognition that operative intervention is required.外科感染不同于内科感染，常必须需要借助手术或气体侵入性手段来治疗感染，以解决解剖或机械（功能）问题。这些手段包括脓肿的切排，感染创口的开放，引起感染异物的清除，肠瘘的修补和转道，或是经皮插管引流腹腔内脓肿，但不仅仅不限于这些。

14、不用机械方法解决而只靠抗生素疗法并不能治疗外科感染。最初处理外科感染最重要的是认识到手术干预是需要的。4、For the determination of operative risk and factors requiring specific preoperative correction, a simple list should be made part of each physical examination, including(1)personal and familial history of any past bleeding tendency, with laborator

15、y definition of its significance; (2)allergic responses to medication or prior treatment; and(3)current medication, with awareness that patients often forget to list some drugs or to recognize that nonprescription products may contain active medicinal agents. Examples are the intermittent use of cor

16、ticosteroids, with the real possibility of adrenal insufficiency at the time of stress, and the use of diuretics associated with induced hypokalemia and its obvious systemic effects at the time of anesthesia and operation.为了确定手术风险和特殊的术前所需的修正因素，应该在每项检查中加人一张简单的列表，包括（1）任何曾出现的出血倾向的个人史和家族史，其意义由实验室检查确定；（2

17、）对药物或者先前治疗的过敏反应；（3）目前正在使用的药物，必须意识到病人会常常忘记罗列一些药物或者辨认出可能包含有活性药理成分非处方药。比如皮质类固醇的间歇性使用，可能导致应激情况下肾上腺功能不足，利尿剂的使用可引起继发性低钾血症，从而在手术和麻醉期间可产生明显的系统效应。5、Potassium has an important role in the regulation of acid base balance. Increased renal excretion occurs with both respiratory and metabolic alkalosis. Potassium

18、 is in competition with hydrogen ion for renal tubular excretion in exchange for sodium ion. Thus, in alkalosis, the increased potassium ion excretion in exchange for sodium ion permits hydrogen ion conservation. Hypokalemia itself may produce a metabolic alkalosis, since an increase in excretion of

19、 hydrogen ions occurs when the concentration of potassium in the tubular cells in low. In addition, movement of hydrogen ions into the cells as a consequence of potassium loss is partly responsible for the alkalosis. In metabolic acidosis the reverse process occurs, and the excess hydrogen ion excha

20、nges for sodium with retention of greater amounts of potassium.钾在人体的酸碱平衡中起到了重要的作用。在呼吸性碱中毒和代谢性碱中毒中钾离子的肾排泄增加。钾离子和氢离子在肾小管排泄中相互竞争和钠离子交换。因此在碱中毒中，钠钾交换的增加使氢离子保留。低钾血症可引起代谢性碱中毒，因为当在肾小管细胞中钾离子浓度降低时氢离子的排泄就增加了。此外，钾丢失的引起氢离子向细胞内转移，这也是碱中毒的其中一个原因。在代谢性碱中毒中，会出现相反的过程，过多氢拿交换使得大量的钾离子保留在体内。医学英语翻译在翻译之前，必须先搞清从句与主句的关系，掌握关系代词

21、或关系副词与主句先行词的关系，然后考虑汉语的表达习惯，进行恰当的翻译。合译法：就是将从句译为主句中先行词的修饰语，即译成“的”。分译法：即将从句译成与主句并列的一个分句顺序译法：就是将从句的关系词省略不译，将主句与从句顺序而下译为一个整句构词法医学英语构词.ppt常用句型长句先确定框架主语，谓语（动词）再根据连接词划分从句从属关系Of ，for，which，that并列关系 and，or ，whereas，but 1强调句“It is (was) .that.”w hich who (whom )是一种强调句型, 用来强调that 从句前面的成分(主语、宾语、状语等), 翻译时可把这种强调结构

22、译为“是.”、“正是.”、“就是.”等。It is the breast that is the leading organ site for cancer in American women乳房是美国妇女癌症的首先好发的器官位置。It is when the body temperature is rising rapidly that the affected person may feel chilly 正是在体温上升时患者可感觉发冷。2被动句被动语态在医学英语中使用极广, 凡是在不必、不愿或无从说明动作的主体时, 在强调被动行为以及在便于连贯上下文的情况下, 都可使用被动语态。英语被动

23、句的翻译一般有以下几种处理方法:2. 1可在动词前加“被”、“给”、“由”、“受”等词, 译成汉语中带有被动意义的句子。The disease is caused by a virus 此病是由一种病毒引起的。2. 2采用“把”、“将”、“使”等动词, 置于原文主语(受动者) 之前的方法, 译成汉语的主动句。The blood flow maybe increased by more rapidandvigorousheartaction1 心脏活动加快和增强可使血流增加。2. 3一般带有情态动词can,may,must, should 等的被动句, 可译成汉语的无主语句。The patien

24、t with chronic bronchitis must be urged to stop smoking1 必须力劝慢性支气管炎患者戒烟。2. 4医学英语中使用以“it”作形式主语, 以被动语态作谓语, 其后接以由“that”引起的主语从句的表达方式是很常见的。这类习惯用语可一律汉译为主动结构, 即将原文中的主语从句置于译文中的宾语位置。有的可以不必加主语, 有的则必须加上表示泛指的主语, 如“有人”、“人们”或采用带有“据”字的结构。It has been suggested that early treatment of streptococcal infections with p

25、enicillin may preventnephritis.有人认为, 用青霉素对链球菌感染作早期治疗可以预防肾炎。3倒装句 采用倒装词序的原因有二: (1) 由于一定语法结构的需要, 如在疑问句中或在there be 句型中; (2) 由于强调某些词的需要, 采用倒装词序, 常见的有以下几种情况。3. 1在以only,never,no, little, rarely,hardly 等否定词或w ell,often 等肯定词开头的句中。On no account should any medicine be given in such cases1 对这类病例决不应投用任何药物。Often

26、did we warn him not to smoke too much1 我们曾经常告诫他不要吸烟过多。3. 2在以so 开头的肯定句, 表示“.也如此”的概念时, 句子必须倒装。以nor 或neither 开头的肯定句, 表示“.也不”的概念时, 句子也应采取倒装词序。She studies hard and so do other interns 她学习努力, 其他实习医生也如此。3. 3当句子以many a time 开头时, 应采用倒装词序。Many a time did we make blood count for the patient 我们曾多次为那病人作血细胞计数。4比较

27、句 形容词和副词比较级的一般情况在翻译时较容易处理, 但它们也可用来表示一些其他的情况。4. 1比较级+ than 用于同一主体的比较, 表示对than 后面成分的否定, 可译为“不.而.”。“是.而不是.”相当于rather than 。The emphasis of this report lies in prevention more than in early detection of cancer 这个报告的重点在于预防癌症, 而不是早期发现癌症。4. 2比较级前面有否定词(no, not 等) 时, 实际上具有肯定的最高级含义, 常可按最高级来翻译。In no area of me

28、dicine is accurate diagnosis more important or, in many instances, more difficult 在医学领域内, 准确诊断是最重要的问题, 在许多情况下也是最困难的问题。4. 3比较级+ than (主要为more than) 有时也可译为“不仅”, 如果前面有否定词, 则可译为“仅仅”,“不过. Such operation requires more than the skill of a surgeon 这种手术不仅仅需要外科医生的熟练技巧。5虚拟语气 虚拟语气, 又称假设语气, 用以表示所述内容并非事实, 而只是一种假设

29、、愿望、建议而已。一般有以下几种情况:5. 1虚拟语气在非真实条件句中的应用在非真实条件从句中的动词虚拟语气可分为三类: (1)w ere 型(表示与现在事实相反); (2)should be 型(表示与将来事实相反); (3)had been 型(表示与过去事实相反)。如果将这类条件从句中的w ere, should 、had提前置于句首, 则可将连词if 省略而成为不完全省略句。If he had been inoculated against smallpox, he would not have contracted the disease 如果他真的种过牛痘的话, 他就不会得病了。5

30、. 2w ere 型虚拟语气可用于w ish 后接的宾语从句中表示动作不可能实现或实现可能性不大; 也可用于asif, as though 引起的方式状语从句, 表示并非真实情况。I wish Iwereyounger1 但愿我年轻些。5. 3should be 型虚拟语气在其他从句中的应用should be 型虚拟语气可用在主语从句中, 常见的句型有: It is necessary that., It is recommended that., 表示“建议”、“要求”、“必须”做的事。从句中的should 有时可省略。should be 型虚拟语气还可用在lest 引起的目的状语从句和由连

31、词w hether (不论) 引起的让步状语从句。It has been decided that an operation be performed on the cancer patient 已经决定对那个癌症患者动手术。6w hat 引起的名词性从句w hat 常可用来引起主语从句、宾语从句和表语从句。但应注意w hat 引起这几种从句时有两种情况。(1)w hat 用作疑问代词性的连接代词,w hat 表示的是一个问题, 应汉译为“什么”,“什么样的”, 有时也可不译出。The difficulty is to know what we mean by a virus1 困难在于懂得病

32、毒指的是什么。(2)w hat 用作关系代词性的连接代词, 意义相当于that w hich (those w hich) 或the thing which,the man(men)w ho, 可以译为“所.的(事物)。”W hat has been found by necropsy is of utmost importance1 尸检所发现的(问题) 是极其重要的。7It 作形式主语的句型当动词不定式、动名词或从句作主语时, 通常把它们放在谓语之后, 而用一个引导词it 放在句首, 作形式主语。此处的it 没有实际意义, 可以省略不译。It is necessary to have hi

33、s chest X rayed1 有必要让他作胸透。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 做出决定医患沟通在临床诊断和治疗决策

34、的许多时期进行着（同时发生）。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述说，然后通过交流、评估不断精确地确定这些问题。The process commonly requires a ca

35、reful 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 综合 consulta

36、tion 磋商、会诊 这个过程通常需要细致的病史询问和体格检查，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 patientsrespecting 关

37、注，考虑到 evidence-based medicine 循证医学 意译当考虑到不同病人中存在个体差异，医生们越来越容易查阅不断增长的循证医学文献来指导（个体诊疗）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 approach 接

38、近 但是，不断增多的可用于指导临床诊断与治疗的随机对照试验不应当作“烹调书”使用。Evidence and the guidelines that are derived from it emphasize proven approaches for patients with specific characteristics.it （RCT）Evidence 证据，迹象 guideline指南 emphasize 强调 因为获得的现象和思路是。来自（随机试验）的证据和临床指南侧重于求证特殊类型的病人。Substantial clinical judgment is required to d

39、etermine whether the evidence and guidelines apply to individual patients and to recognize the occasional. 本句直译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证据和指南是否能应用于病人个体，并能找出例外。Even more judgment is required in the many situations in which evidence is absent or inconcl

40、usive.被动主动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，需要考虑更多的判断。倒装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，二选一当存在可选择的（诊疗）方案

41、时，虽然推荐（方案）是医生的职责，但（应用）证据必需符合病人的偏好。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，依从性 regimen 养生法、食物疗法，治疗方案enhance 提高、加强 rationale 基本原理假如病人也理解推荐选项背后的基本原理和证据时，病人对这个治疗方案的依

42、从性会增强。To care for a patient as an individual, the physician must understand the patient as a person. care for 喜欢、照料 individual 个体，person 人，有社会性的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。This fundamental precept of doctoring includes an understanding of the patients social situation, family issues,financial conce

43、rns, and preferences for different types 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 直译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、不同治疗方案及结局选择的喜好，从最大限度地延长生命到临时缓解痛苦排序。If the physician does not apprecia

44、te and address these issues, the science of medicine cannot be applied appropriately, and even the most knowledgeable physician fails to achieve appropriate outcomes. 直译appreciate 欣赏、感谢、评价 appropriate 适当的、恰当的 假如医生没有正确理解和重视这些问题，医学就不可能恰当地应用于（临床），甚至知识最渊博的医生也不能取得理想的治疗结果。Even as physicians become increas

45、ingly aware of new discoveries, patients can obtain 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 甚至当医生变得更多地关注于新发现的同时，病人也能够通过各种渠道获得他们自己的信息，其中有些信息是不可靠的。The increasing use of alternative and complementary t

46、herapies is an example of patients frequent dissatisfaction with prescribed medical therapy.直译alternative 选择，替代 complementary 补充的、相配的 prescribe 规定、指定、开处方 替代疗法和辅助疗法的应用不断增加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 suc

47、h options may carry any degree of potential risks, including the risk that they may relied on to substitute for proven approachessubstitute 代替、代用 rely on 依赖、信任 倒装医生对未证实的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，包括他们可能信赖方案替代证实的（常规）疗法的风险，都必须建议其谨慎对待。It is crucial for the physician to have an open dialogue with the patient and family regarding the full range of options that 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 v