1、Clinical Dialogue Three lWomen:Doctor,my husband tripped and fell,hitting his head quite hard.He has a headache,so I thought Id better bring him in and see whats wrong with him.lDoctor:When did it happen?lW:This morning.About two hours ago.lD:Does he have high blood pressure or diabetes?lW:No.lD:Did
2、 he lose consciousness after the injury?lW:Yes,he did.He blacked out for about half an hour.Then he regained consciousness.lD:(asking the patient)Do you remember how you were injured?lP:Oh,oh.(patient vomits)lD:Well,he is unconscious again now.Has he been vomiting all the time before coming to hospi
3、tal?lW:Yes.lD:Now,let me have a look at him.The pupil on the right is dilated and does not react to light.Theres no reaction to pain in the left extremities.Im afraid your husband has torn a blood vessel when he hit his head,and the blood is compressing his brain,causing his present condition.Ill ta
4、lk over his problem with the neurosurgeon and decide what to do.lW:Thank you,Doctor.Im so worried.Do you think my husband will live?lD:Dont worry.Well do everything we can to save him.lIve just finished talking to the neurosurgeon.Your husband is in a coma due to extradural hemorrhage.In order to sa
5、ve him,we think we should operate on him.(In order to be more certain what has happened to him,a lumbar puncture is necessary).We need your permission to do this.lW:Anything you say,Doctor,as long as he gets well.lD:Well,the operation has certain risks with the anesthetic and your husband may not be
6、 able to stand the operation.Post-operative complications could also occur.But well do all we can for him.lW:Yes,I understand.Please help him.I agree to the operation.lD:Well.Could you sign this paper to give your consent for the operation?I think everything will be all right.lW:Shall I stay here?lD
7、:If you want to,you can wait,and Ill let you know the result of the surgery.(Please wait in the sitting room.Ill keep you informed of what is going on).lPatient:Doctor,Ive had abdominal pains and vomiting for the past three days.lDoctor:What kind of a pain is it?lP:Like colic,with spasms every 4 or
8、5 minutes.lD:When did the vomiting first start?lP:Two days ago.Ive had about five bouts of nausea and vomiting up to now.lD:How about your bowel movement?lP:Nothing for two days.lD:Any wind?lP:No,not since last night.lD:Have you ever had any abdominal surgery?lP:I had my appendix out,but that was a
9、long time ago.lD:Have you had anything like this before?lP:No,its the first time.lD:Now,please lie on your back,bend your knees and relax.Let me examine you.Im afraid you have an intestinal obstruction.Well do some x-rays to confirm this.lP:Will an operation be necessary?lD:Since you have a fever an
10、d some muscle rigidly in the abdomen,there is the possibility of intestinal strangulation.Immediate surgery is necessary.lP:Is there any danger?lD:No,dont worry,just leave everything to us.Everything will be all right.lPatient:I bleed quite a bit when I have a bowel movement.Im really worried about
11、it.lDoctor:What color is the blood?lP:Its bright red.lD:Is it mixed with the stool?lP:No,it isnt.lD:Do you have constipation often?lP:Yes,all the time.lD:Have these been any change in the pattern of your feces?lP:No.lD:Now,lets have a look at you.Please undress and lie in the knee-elbow position.Im
12、going to examine you with an analscope.Youve got hemorrhoids and a prolapse of the rectal mucosa.lP:Is there any way to cure it?If possible,Id rather not have an operation.lD:Dont worry.Heres a prescription.Use the suppositories and laxative.The bleeding should stop in two or three days.lP:Anything
13、else I should do?lD:Eat more fruit or vegetables.Sit in warm water when you feel pain and if possible,avoid alcohol and spicy food.lP:Thank you.Ill follow your advice.lDoctor:Is there anything worrying you?lPatient:Yes,I have a lump(mass)in my left breast.lD:How long have you felt it?lP:About three
14、weeks.lD:Have you had any pain in this area,especially during menstruation?lP:No.lD:Have you had any accident to this area?lP:No.lD:Have you had any discharge from it or any itching of the nipple?lP:No.lD:Have you noticed any swelling under your left armpit?lP:No.lD:Has anyone in your family ever ha
15、d a lump or tumor of the breast?lP:No,not that I can remember.lD:Do you mind if I examine you briefly?lP:No,not at all.lD:Would you please take off your blouse.Thats fine.Sit up straight.Now rest your arm on mine.Let me examine your armpit.Put your right arm over your head.Now lets do the same with
16、the left.Good.Thats all.How old are you?lP:Im fifty.Is serious?lD:No.Nothing serious.Just a cystic disease of the breast(Adenofibroma).Its a benign hormone-dependent disease.lDo you have any relatives here?lP:Yes.My husband is just outside,shall I ask him to come in?lD:Yes.Will you please go to the
17、laboratory to check up a white blood cell count?lDoctor to patients husband:lAs you know,your wife has a lump in her left breast.I think it could be a carcinoma of the breast.The only way to be certain is to do a biopsy.If she has cancer,she ought to have her breast removed.Thats called a radical ma
18、stectomy.lHusband:Please do everything you can to help her,Doctor.l病人：我肚子疼得很厉害我恶心想吐病人：我肚子疼得很厉害我恶心想吐lPatient:Ive got an awful pain in my stomach.I feel like vomiting.l医生：这样疼有多久了医生：这样疼有多久了?lDoctor:How long have you had it?l病人：从昨天晚上开始，疼痛先在肚子当中，今天病人：从昨天晚上开始，疼痛先在肚子当中，今天早晨就转移到了右下腹早晨就转移到了右下腹lP:Since last n
19、ight,it was in the middle at first around my belly.But this morning it moved to the right.l医生：疼向别处窜吗医生：疼向别处窜吗?lD:Has it moved again?l病人：疼固定在这儿四个小时了病人：疼固定在这儿四个小时了lP:No.Its been steady for 4 hours.l医生：疼一直持续不断吗医生：疼一直持续不断吗?lD:Is it there all the time?l病人：不，这疼好一阵，坏一阵病人：不，这疼好一阵，坏一阵lP:No,it just comes and
20、goes.l医生：有腹泻吗医生：有腹泻吗?lD:Have you had any diarrhea?l病人：没有，我已经两天没有大便了病人：没有，我已经两天没有大便了lP:No,I havent had a bowel movement for two days.l医生：你恶心和呕吐吗医生：你恶心和呕吐吗?lD:Have you had any nausea and vomiting?l病人：现在已好些了昨天晚上我差不多每病人：现在已好些了昨天晚上我差不多每2小时吐小时吐一次，一疼就吐一次，一疼就吐lP:Well,now its a bit better.But last night I vo
21、mited every two hours,soon after the pain began.l医生：你有发烧吗医生：你有发烧吗?lD:Have you had a temperature?l病人：昨晚我试表是病人：昨晚我试表是380ClP:Last night I took my temperature.It was 38oC.l医生：请指出目前最疼的部位医生：请指出目前最疼的部位lD:Show me where it hurts most right now?l病人：就在这儿病人：就在这儿lP:Just here.l医生：请躺下让我检查一下你的肚子我按这个医生：请躺下让我检查一下你的肚子
22、我按这个地方疼吗？我突然抬手时是否疼得更重？我想你得地方疼吗？我突然抬手时是否疼得更重？我想你得了阑尾炎需要手术治疗了阑尾炎需要手术治疗lD:Please lie down.Let me examine your abdomen.Do you feel any pain when I press here?Does it hurt you when I withdraw my hand suddenly?I think that you have appendicitis.You must have an operationl病人：危险吗病人：危险吗?lP:Is it serious?l医生：
23、如果不做手术，可能有危险医生：如果不做手术，可能有危险lD:It could be if we dont operate.l病人：好吧，我同意病人：好吧，我同意lP:All right,I agree.l医生：我们必须征得你同意，请在这张单子上签署医生：我们必须征得你同意，请在这张单子上签署你同意做手术吧你同意做手术吧!lD:We must have your consent.Please sign this paper consenting to have the operation.l病人：好的病人：好的lP:All right.l医生：不要焦急，一切都会好起来的医生：不要焦急，一切都会好
24、起来的lD:Dont worry,everything will be OK.l病人：我希望如此，医生病人：我希望如此，医生lP:I hope so,Doctor.l产品质量是宗旨，客户如云企业兴。22.10.3022.10.30Sunday,October 30,2022l品管不是空想，乃是起而行的工作。1:13:271:13:271:1310/30/2022 1:13:27 AMl专业代理，优势尽显，素质提升，你能我也能。22.10.301:13:271:13Oct-2230-Oct-22l环境与人类共存，开发与保护同步。1:13:271:13:271:13Sunday,October 3
25、0,2022l树立企业安全形象，促进安全文明生产。22.10.3022.10.301:13:271:13:27October 30,2022l卓越的产品和服务是员工的成就和自豪。2022年10月30日上午1时13分22.10.3022.10.30l以一万次的遵章守纪，防止事故的万一发生。2022年10月30日星期日上午1时13分27秒1:13:2722.10.30l防范胜于救灾，隐患险于明火，责任重于泰山。2022年10月上午1时13分22.10.301:13October 30,2022l只有绷紧安全之弦，才能弹奏幸福之音。2022年10月30日星期日1时13分27秒1:13:2730 October 2022l生产再忙安全不忘。上午1时13分27秒上午1时13分1:13:2722.10.30l安全规程字字是血，严格执行句句是歌。22.10.3022.10.301:131:13:271:13:27Oct-22l质量-带给您看得见的未来，说不尽的精彩。2022年10月30日星期日1时13分27秒Sunday,October 30,2022l严格质量、优良出品。22.10.302022年10月30日星期日1时13分27秒22.10.30谢谢大家！谢谢大家！
