1、Clinical dialogue fiveXiao Xiong LiDepartment of neurological SurgeryRen Ji Hospital1Part oneD:I see from your notes you were in hospital 10 years ago with thyroid trouble.P:Yes,thats right.D:What has actually been happening since that?P:All sorts of things.Ive been feeling very depressed for a year
2、.D:Did you go to your doctor?P:Yes,he gave me some Valium tablets to slow me down but they slowed me to a halt.I did nothing but sleep.2D:Did they affect you in any other way?P:Yes,I got stomach trouble,maybe indigestion,I think.D:What symptoms?P:All the food stays up here.(indicating chest)D:When d
3、o you get it?P:Two to three hours after food.3D:Burning or stabbing pain?P:It feels like some wind there and I want to get rid of it.D:Do you belch?P:Not much.D:Does it bother you at night?P:No,it comes on when I was hungry and I feel Ill collapse if I dont eat straight away 4D:How about your appeti
4、te?P:Very poor,it started to deteriorate 10 years ago.D:What about your weight?P:Im loosing weight.D:What about your bowels?P:Im constipated.5D:How often do you have them opened?P:Only when I take medicine.D:Every day?P:No,every other day.D:Do you always sweat?P:Yes,but more recently.D:All over you
5、body?P:Yes,all over.6D:Any depressed,nervous,edgy,irritable?P:Yes,it started one month ago before I got my job.D:Periods regular?P:Every month since I had my baby five years ago.7D:Is there anything else youve noticed?P:No.D:Has anyone in your family had thyroid trouble?P:No,I have one sister and tw
6、o brothers,they are well.8Part twoD:I see youve been anaemic and you had a blood test last May.Has anything else trouble you?P:Ive kept getting a roaring in my ears and giddiness.D:All the time?P:Most of the time.D:How long has all this gone on?P:Say,about six months.9D:Since your treatment with iro
7、n?P:Yes,I keep getting dizzy spells.D:Does anything bring them on?P:Rushing about.Sometimes I know Im falling but I cant stop myself.D:Do your legs give way?P:Yes.D:If you stand still,do you hold on?P:Yes.10D:Are you all right between spasms?P:Yes.D:Does it affect your ears?P:I get roaring in my ear
8、s.D:How long?P:Minutes.D:Do you feel sick?P:Yes,first thing in the morning.Terribly.11D:Do you suffer from headaches?P:My periods are only half a day and I get terribly headaches.D:How often do you have your periods?P:It varies,every two or three weeks.D:Is it always like that?P:Yes.D:You say you ar
9、e breathless?P:Yes,I get puffed if I go upstairs.12D:Do you have any bowel trouble?P:No.D:Water?P:No.D:Do you get up at night?P:No.13Part threeD:I see from your notes you came to us a year ago with an overactive thyroid gland.P:Yes,and I had a miscarriage in May and Im now pregnant again.D:When is y
10、our baby due?P:Roughly 10th July.D:Have you been taking pills for your gland?P:I stopped about six months ago.14D:How are you at the moment?P:I keep feeling queer and my doctor suggested I had a check-up.D:Do you ever faint?P:No,but I feel faint.D:Do you actually flush or sweat?P:No,not as before.15
11、D:Have you been gaining weight?P:Yes,I didnt realise I was pregnant.D:Are your bowels regular?P:Yes.D:Do you go more than once a day?P:No.D:They are quite well-formed,are they?P:Yes.16D:How are your nerves?Are you jittery,fidgety?P:No.D:Do the family get on your nerves?P:Not now.D:Were your eyes always prominent?P:Yes.17D:Are you particularly bothered by weather?P:No,I used to be before.D:You suffer from palpitations?P:Yes,but Ive had them since I was a child.D:In yourself,you feel different?P:Oh,yes.18放映放映结束！结束！无悔无愧于昨天，丰硕殷实无悔无愧于昨天，丰硕殷实的今天，充满希望的明天。的今天，充满希望的明天。19
