- •English: listening comprehension for medical students
- •International English
- •1. Complete the following sentence. Use the words from the list if you like. Then compare with other people in the class.
- •2. Why are you learning English? Complete the sentences below and number them in order of importance for you. Compare with a partner.
- •I. Dialogue
- •1. Vocabulary:
- •2. Are statements true or false?
- •3. Answer the questions:
- •II. 1. Listen to a student phoning a language school to find out about summer courses for her friend. Find this information.
- •2. Listen to the dialogue again. Complete the Function File with these words:
- •III. 1. Listen and follow the consequences. Can you continue the chain?
- •2. Make chains from these beginnings.
- •1. Try to predict answers to the questions. More than one answer is possible.
- •II. Listen to the people describing their holidays and correct the wrong information.
- •Vocabulary:
- •III. Listen to the short story. What happened a lovely summer day?
- •Vocabulary:
- •IV. Listen to four points of view about travelling and choose one that is close to you.
- •I. Listen to Conversations a to c. Complete Alicia's boarding pass. Then practice the conversations.
- •VII. Listen to useful advice about choosing the seats in the plane. What of them are the most important for you?
- •VIII. Discuss the following questions with other people in the class.
- •IX. Listen to the tape and fill in the gaps.
- •X. You use indirect questions to sound more polite. Complete the dialogue below. Then listen to see if you are correct.
- •I. Listen to the dialogues and find the words from your vocabulary
- •1. Conversation a
- •2. Conversation b
- •3. Conversation c
- •II. On the airplane there are instructions on video about the immigration form. Listen to the instructions, and complete the u.S. Arrival Record with true information.
- •III. Immigration control in San Diego, California. Listen and practice in groups of three.
- •1. Conversation a
- •2. Conversation b
- •2. Listen to the rest of Edgar's conversation at the hotel, and check (√) the boxes. What facilities does Edgar's room have?
- •3. Fill in the gaps, then listen to the dialogue to check it:
- •2. Conversation b
- •3. Conversation c
- •6. Conversation f
- •It's eleven thirty. Jack Hudson is at a fast food outlet in a mall.
- •VII. Listen to the tape and write down what food is in the fridges of different people.
- •VIII. Nutritionists say that breakfast is the most important meal of the day, but most people don't have a good breakfast. A market researcher is asking people about their breakfasts.
- •IX. Listen and say which sentences are true for you?
- •X. 1. Listen to the dialogue. Who says these things? Write f (the father), d (the daughter), or s (the son).
- •2. Listen. Tick (√) the things that the father orders.
- •Vocabulary:
- •XI. The following things were said during a business lunch. Who do you think probably said them - the host, the guest or could it be either? Write h, g or e next to each sentence.
- •Vocabulary:
- •XII. Listen to the tape and fill in the gaps.
- •XIII. You will hear an interview with Dr Cooper, a prominent dietician, talking about the British diet.
- •XV. 1. These are some of the instructions for making the food. They are in the wrong order.
- •2. Look at these verbs used to describe how food is prepared and cooked. Using your dictionary if necessary, divide the verbs in the box into those that talk about:
- •3. Use the verbs above to help you write the recipe for a dish from your country.
- •2. Read the opinions and match them to the speakers.
- •XVII. Nowadays there are too many choices.
- •XVIII. Listen to business people from different countries chatting over lunch and answer the questions.
- •III. Listen to the conversations and write down the addresses.
- •Internet
- •1. You are going to listen to a radio documentary on the history of the Internet. Choose the correct answers.
- •2. Listen to the radio documentary once again and fill in the gaps.
- •2. Conversation b
- •2. This is the voicemail of Bernard Lalo. Number these sentences from the message in the correct order.
- •3. Think of a colleague or client. Imagine you are leaving a voicemail message and complete this message in your own words.
- •V. Telephone manners
- •1. Phone etiquette
- •2. In the conversation, Sally shows interest and understanding. Read sentences 1-9 from the listening and tick what Sally says next: a or b. Then listen again and check your answers.
- •3. Listen to four telephone calls and match them to their description.
- •VI. Making appointments
- •Задания для I курса на видеоносителях
- •2. Watch and fill in the gaps.
- •3. Act the dialoque
- •4. Watch and fill in the gaps.
- •5. Watch the dialogue and act the meeting at the medical conference.
- •6. Watch the dialogue and remember the way to the Business Centre.
- •7. What food do the visitors order? Remember some exotic dishes from the menu.
- •8. Act the dialogues and make your own ones according to these models.
- •1. Listen to the dialogue and fill in the card.
- •6. Listen to the dialogue “At the doctor’s”. Write are these statements true or false?
- •What is Stroke?
- •3. Listen to the tape and complete the following statement.
- •Vocabulary:
- •Can You Prevent a Stroke?
- •4. Round table discussion.
- •1 Liz Hartley gives the following advice and recommendations. Complete the sentences from memory and then listen again to check your answers.
- •2 Work with a partner. Which piece of advice seems the most sensible? Which piece of advice would you find the most difficult to follow?
- •3. Listen to Sam and Catherine talking about a time when they dieted for a special occasion. Find out what the special occasion was in each case.
- •1. Read these conversations. Use the table to make sentences to describe the different body ailments.
- •2. Look again at the conversations in 1. What advice do you think each friend gives? Work in pairs and complete the conversations with a suitable piece of advice.
- •3. Listen. Was the advice similar to your advice in 2?
- •4. Match the complaints to the reasons below. Then listen and check.
- •1. Listen to the talk about the human brain. Fill in the gaps.
- •2. Discuss these questions:
- •1. Work in pairs before you listen to the recording, look at the sentences below. Can you guess what some of the missing words are?
- •2. You'll hear an interview with a doctor. Complete these notes summarizing what he says.
- •1. Work with a partner and discuss these questions:
- •3. Work with a partner. Look at the verbs in the box. Which refer to ability? Which refer to an action? Which can refer to both?
- •1. Listen to the text paying attention to the important details and making a list of professionally useful words. Write their Russian equivalents.
- •Vocabulary:
- •4. Work with a partner. Which points in 3 do you agree with?
- •5. Cindy Jackson talks about why she had several years of cosmetic surgery in her attempt to create the perfect face and body. Complete her account using had, have or having.
- •6. Five people were asked the question, “What do you think makes a face attractive?”
- •1. An ancient disease
- •2. Early links to diet
- •1) Listen to the second part and answer the questions:
- •2) Complеtе the statements.
- •3. Invasive techniques. Conventional treatment problems.
- •1) Agree оr disagree with the following statements. Begin with the words:
- •4. The paradigm changes. What we can do.
- •1) Listen to the fourth part and answer the questions
- •2) Complete the following statements
- •5. You are in control of your health. Act accordingly!
- •Introduction
- •Vocabulary:
- •Vocabulary:
- •Vocabulary:
- •1. Answer the following questions:
- •2. Read and translate a passage from “The Home Medical Encyclopedia”:
- •1) Listen to the 1st section of the talk and answer the questions.
- •1) Listen to the 3rd section of the talk and list the names of the agents that can cause asthma.
- •2) Listen to the section, again and complete the sentences:
- •1) Listen to the 4th Section of the talk and say what it is about.
- •2) Listen to it again and answer the questions:
- •3) Listen to the part devoted to basic immunology. Say if these statements are true or false:
- •1) Listen to the part and answer the questions:
- •2) Listen to the same part again and choose the right statement:
- •3) Answer the following questions:
- •1) Listen to the 6th section of the talk and say what the two «musts» are for allergic people.
- •2. Listen to the part again and complete the sentences:
- •3. Answer the questions:
- •1. Read this short text on asthma and answer the questions:
- •1) Listen to the 1st part of the talk. Say if these statements are true or false:
- •2) Answer the questions!
- •1) Listen to the 2nd section of the talk and answer the questions:
- •2) Listen to the 2nd part of the talk again and say if the following statements are true or false:
- •3) Practice the reading of the passage. Imitate the speaker.
- •1) Listen to the 3rd section of the talk and say what kind of asthma it is about.
- •2) Answer the questions:
- •3) Translate the passage at sight:
- •1) Listen to the 4th section of the talk and say what it is about.
- •2) Listen to it again and choose the correct statements:
- •3) Answer the questions:
- •4) Listen to the passage on the danger of smoking for asthmatic individuals and then read aloud. Try to imitate the speaker:
- •1. Vocabulary:
- •2. Listen to the text.
- •3. Answer the questions:
- •1. Vocabulary:
- •2. Listen to the text
- •3. Answer the questions:
- •1. In the sentences below a woman is talking about her annoying work-mate.
- •2. How does the woman express her annoyance? What verb structures does she use?
- •3. Work with a partner. Which of the habits would most annoy you? Put them in order of most to least annoying.
- •1. Fill in the gaps:
- •2. Fill in the table:
- •3. What is your opinion about the following statements?
- •2. Is the procedure in the reception room the same in Britain and Russia? If not, what differences are there?
- •Учебное издание
Vocabulary:
harbour – место, убежище,
notorious – печально известный,
«peau d’orange» - апельсиновая корка.
What are - in general - the complaints or symptoms, concerning one or both breasts, which will bring the patient to the doctor? And which points are important in the taking of the patient’s history?
The symptoms of breast abnormalities are:
tenderness or pain in the breast
palpable lumps
skin or nipple retraction
nipple discharge
eczema of the nipple
infiltration.
We shall now discuss these symptoms, some of which will alert you to malignancy earlier than others.
Always be aware of the fact that the patient may give an indirect signal by coming to the doctor with another complaint, only mentioning the breast casually. The reason for this may be:
fear of the consequences of the diagnosis
embarrassment.
Many patients consult their doctor with complaints of tenderness or pain in one or both breasts, with or without feeling a lump. The patient then often expresses a "feeling of heaviness". It is important to know whether this is related to the menstrual cycle. If it is, then it is most likely to be benign. However, a carcinoma still remains a possibility.
As a general rule, complaints and symptoms which completely disappear after menstruation are rarely caused by a malignant process. Even so, it is still sensible to make a second check after several months, as changes in the biological behaviour of a breast tumor can occasionally be brought about by hormonal fluctuations.
Palpable nodules can be the result of cysts or solid tumors. Solid tumors can be either benign or malignant. Cysts only very rarely harbour carcinoma in the walls. Palpable tumors in young women are often benign. With increasing age, and definitely above 45, the chance of carcinoma is much greater.
Skin retraction is often presented by the patient as a small "dent" in the breast. In the case of skin retraction breast cancer must always be considered, even if no lump is palpable.
Skin retraction can be seen better if the patient raises her arms during the examination. The examination will be discussed later in the program.
Nipple retraction occurs frequently, it is important to ask whether the nipple has been like this for a long time, or whether it changed recently. Whenever there is a recent change in the shape or the form of the nipple, you must always suspect a carcinoma, even if no lump behind the nipple or areola can be felt.
Complaints of spontaneous nipple discharge are not uncommon. However, they are seldom caused by a carcinoma. Serous nipple discharge, on one or on both sides, usually results from the use of certain medicines. The most notorious of these are: aldomet, digoxin, thyroid gland preparations and tranquillizers However, if the discharge contains blood, then breast cancer must be suspected.
This is the clinical appearance of Paget’s disease of the nipple. There is a superficial erosion of the nipple and the areola.
Sometimes the patient consults her doctor when the lesion is still very small, as shown here.
In cases of inflammation of the breast you must always think of inflammatory carcinoma, which can mimic all the characteristics of a harmless infection. The classical history is: pain, swelling, redness, fever and general malaise. It is therefore essential to examine and follow up every infection with extreme care and attention.
In this patient you can see, apart from the inflammation, the so-called «peau d’orange». This condition appears when the tumor blocks the lymph drainage from the skin and from the subcutaneous tissues.
And beware? Breast cancer can also occur during pregnancy or the lactation period! It can mimic the symptoms of an infection, or can accompany one. Breast complaints must therefore also be taken seriously during pregnancy and the lactation period.
Ulceration is a late characteristic of breast cancer. Some patients, however, come to the doctor in such a late stage of the disease.
Outline of the patient history
In taking the history the following information is required:
the type of complaints
the duration of complaints
the relationship with the menstrual cycle
the use of medication
the previous history of the patient, especially whether she has previously had a breast operation - the family history.
High risk factors
The high risk factors for breast. cancer are as follows:
A family history of breast cancer, especially in mother or sister(s).
Previous breast cancer in the other breast.
A previously biopsied breast lesion which was diagnosed as premalignant.
The literature reports several other factors which could enhance the risk of breast cancer, such as early menarche and breast feeding. However, in 1986, these factors are not considered to be important determinants.
Summary
Early diagnosis of breast cancer increases the chance of cure.
The larger the tumor, the greater the chance of metastatic disease.
The warning signs for breast cancer are:
a palpable nodule in a woman elder than 45 years of age
skin retraction
nipple retraction
Breast cancer can also develop during pregnancy or during the lactation period.
The physical examination
For the physical examination the patient should be requested to remove her upper clothing.
While the patient is sitting or standing opposite you, inspect both breasts according to a fixed pattern, systematically comparing right and left, first the one breast, and then the other. You must look for differences in contour and in skin retraction: and you must look to see whether the nipples and areolas appear normal. Also notice whether there are differences in contour below and above the collar bone, resulting from sub and supraclavicular lymph node metastases.
Examine the breast from the side, both from the left... and from the right…
Ask the patient to raise her arms and compare, again systematically, the right and left breast. A previously invisible swelling or skin retraction may now be seen. You are looking for differences in contour or retraction.
Ask the patient to place her hands on her hips... and to press firmly. This action makes the pectoralis musculature -contract, and a tumor attached to the muscle layer may now come into view. Pay attention to any differences in contour.
Ask the patient to bend forward and take her hands in yours. Again examine systematically. Skin retraction in the upper areas, which was not visible earlier, may now be seen.
Palpation can be carried out while the patient is sitting or lying down. Each doctor has his own technique. First examine the normal breast. Than examine the other breast, starting at the non-pathological area and working towards the point where the patient has indicated the complaint. The palpation should be carried out systematically, quadrant by quadrant, and with as little finger pressure as possible. If necessary, you can compare the quadrants one at a time, in both breasts.
Skin retraction or «dimpling», which you had not noticed before, can be revealed by a bimanual examination, gently manipulating the indicated section of the breast. A palpable breast tumor can be sharply defined. But often, especially when malignant, the shape can be irregular and ill-defined. Palpation can be especially difficult in young women, whole glandular area, or a large part of it, can feel lumpy.
When the patient is lying down, some irregularities can also be felt more clearly when the arm is raised.
When palpating the axillary region for the presence of lymph node metastases, it is essential that the muscles be as relaxed as possible. Make sure that both the upper and lower levels of the axilla are thoroughly examined.
The examination of the axillary region can be carried out while the patient is sitting or standing. It is important that each individual doctor becomes accustomed to his own particular methods of examination.
If you prefer to palpate the axilla with the patient in a sitting or standing position, then you can ask the patient to rest her lower arm on your lower arm in order to achieve the necessary muscle relaxation.
To examine the supraclavicular areas you can stand behind the seated patient and compare both areas simultaneously while palpating. The medial corners of these areas are especially important; since it is here that the first supraclavicular lymph node metastases arise.
Always be alert to the fact that breast cancer usually occurs in one breast, but it can arise in both, either at the same time or later on.
And another warning: it only happens sporadically, but breast cancer can also occur in men.
Special diagnostic procedures
The policy for special diagnostic procedures When can you say, after the first examination, that there is nothing wrong? The answer is: never! You can, of course, say. «I can't find anything wrong at the moment».
As a general rule it is advisable to adopt the following policy. All women over the age of 45 with breast complaints should be referred to a surgeon for further examination. Younger women, when there is no reason to suspect breast cancer at the first visit, should be asked to come back for a routine, checkup after the next menstruation. Whenever there is a consistent complaint, the safest policy is referral to a specialist. Even if the complaint seems to disappear after the menstruation, another check up in several months time is still important, since - as said before - breast cancer occasionally changes its biological behaviour under hormonal fluctuations.
Referral
You ought to take into account that breast cancer, at the time of clinical detection, has already been present for some years. In general, carcinomas grow at a steady rate, which is specific for each type of carcinoma. The growth of breast cancer is usually slow. The average doubling time is two to three months. A breast carcinoma becomes clinically detectable when it teaches the size of about 1 cm in diameter. Assuming a doubling time of three months, the development of such a carcinoma takes about 8 years. Therefore, at the time the clinical diagnosis is confirmed, the tumor is several years «old», and has already had the opportunity to metastasize for a long time.
An emergency referral and treatment is therefore unnecessary. However, extra delay is undesirable, especially for psychological reasons.
Make sure that your patient is seen for further examination by the specialist within 3-4 days. In your referral letter, give the relevant information about the history, including the family history, your findings, and your specific request. Also, make sure that this further consultation actually takes place. The further examination requires:
diagnostic radiology
histopathological diagnosis.
The patient is usually referred to a surgeon. But sometimes the family physician refers the patient to a diagnostic radiologist. This depends on the regional set-up, and the agreements made within the local medical group there. A good rule is: if there is a palpable lump, send the patient to the surgeon.
Diagnostic radiology
The diagnostic radiology consists of:
mammography
ultrasonography.
Mammography is by far the best method for detecting a breast tumor.
Ultrasonography can be useful in the diagnosis of cysts and is therefore especially important in the differential diagnosis of breast cancer.
The reliability of mammography is determined by two factors!
the quality of the radiograms
the age of the woman.
It is important to realize that mammography is not a routine procedure. The radiologist needs to know some information about the patient's history in order to interpret the mammograms properly. For example, a scar or earlier mastitis could be mistakenly interpreted as a malignancy. The radiologist will, if a lump is present, also carry out palpation himself. This permits a more accurate interpretation of the mammograms.
This is what a normal mammogram of a postmenopausal woman looks like. The glandular tissue has completely regressed. The connective tissue ligaments and. the blood vessels are easily visible is the fatty tissue. In such a breast even very small carcinomas can be easily seen.
From this picture you can see that functioning mammary gland tissue, before the menopause, gives a much denser picture. This mammogram of the same woman as that of the previous picture was taken two years before the menopause.
In women younger than 30 the density of mammary gland tissue can make interpretation of the mammograms difficult. The radiologist should always mention in his report whether the tissue structure hampers the reliability of his judgement of the films. The reason for this is, that in the case of a palpable tumor and a mammogram which is difficult to interpret, it would be essential to carry out further diagnostic tests, such as histopathological examination.
This is a large carcinoma in atrophic mammary tissue in an older woman; the tumor does not have a sharp border and shows extensions, called spiculae. Since functioning mammary gland tissue is absent we see a so-called «empty» picture.
This is a mammogram showing a small carcinoma situated against the thorax wall.
A good example of the importance of clinical examination by the radiologist is that, when a tumor feels larger by palpation and is actually smaller on the mammogram, it is highly suspect for carcinoma.
Small carcinomas, whether they are infiltrating of not, can be detected by mammography, even before they are palpable. This is a magnification detail of a small intraductal carcinoma that was not palpable at the time.
Breast tumors as small as 0.5 cm in diameter can be detected by mammography. It is therefore an important tool in early detection. The period between seeing the breast cancer of the mammogram and the time that the tumor becomes palpable is called the «lead time».
You must always realize that when there is clinical suspicion of breast cancer, a negative mammogram (i.e. «no tumor visible») is certainly no guarantee that there is nothing wrong! Histopathological examination should be carried out whenever there is a cause for suspicion. Referral to the surgeon in these cases is therefore essential.
Histopathology and cytology.
Material for the pathological diagnostic evaluation is obtained by:
fine needle aspiration cytology
and/or biopsy
The procedure used depends on what the surgeon and the pathologist have previously agreed upon together.
For aspiration cytology the tissue is punctured with a fine needle with an exterior diameter of 0.6 mm. A positive result confirms carcinoma. A negative result, i.e. «no tumor cells seen» must always be interpreted with caution. If there is clinical suspicion of breast cancer, then a biopsy - usually performed under general anesthesia - is always essential.
Clinical staging – general remarks.
Once the diagnosis of breast cancer has been established, careful staging follows. This work up is important in order to design a tailored treatment plan.
It is advisable to explain to the patient that there is no standard treatment for breast cancer, and that a careful choice will be made from the different possibilities of therapy based upon the thorough staging procedures.
Therapy – general remarks.
Discussion of the therapeutic possibilities and the indications for them do not fall into the subject of this program. Here are just a few general remarks. A curative treatment can consist of:
– Radical mastectomy, with or without radiotherapy and sometimes supported by systemic chemotherapy. Radical mastectomy includes removal of the regional lymph nodes. In some cases, a breast conserving therapy is possible. This treatment combines limited surgery and intensive radiotherapy.
Palliative treatment can consist of:
Radiotherapy, both for recurrent tumor control in the breast area and for control of distant metastases.
Hormonal therapy, chemotherapy or a combination of these treatments.
Summary.
If a woman has complaints associated with one or both breasts, you can never merely dismiss them as unimportant.
Women older than 45 should be referred to a specialist for further examination.
If your clinical examination of a woman younger than 45 shows no suspicion of breast cancer, then it is a good policy to repeat the examination after her next menstruation.
When there are clinical symptoms of breast cancer it is essential to carry out pathological examination, even when the result of the mammography is negative.
Epilogue.
In the Netherlands there are more than 7000 new cases of breast cancer diagnosed every year. In 1984 the yearly death rate was approximately 3000. This accounts for more than a quarter of the deaths attributed to all the malignant tumors in women. Although the incidence and mortality rates of breast cancer, very considerably from country to country, breast cancer is often the chief cause of death for women. Many countries are therefore confronted with a serious Public Health problem.
Although it would be desirable to screen all high risk populations with mammography, currently, this is legitimately and economically impossible in most countries.
What can be recommended in the meantime is:
to encourage the technique of breast self-examination
for family doctors to contact and examine the women who fall into the high risk category for breast cancer.
The high risk category consists of women with breast cancer in their family, especially in first degree relatives.
Answer the questions, please.
1. Is breast cancer a common disease in women?
2. Is early recognition of breast cancer important?
3. How can breast cancer manifest itself?
4. Is it easy to diagnose breast cancer?
5. What are the symptoms of breast cancer?
6. What is “Paget’s disease of the nipple”?
7. Where do the metastases spread?
8. What are the general complaints concerning breast?
9. What things must the doctor pay attention?
10. What information is important in taking the history?
11. What are the risk factors?
12. How must the doctor examine the breasts?
13. Is it important to compare both right and left breasts while examining? Why?
14. In what positions should the patient stay during the examination?
15. When does breast cancer change its biological behaviour?
16. What are the special diagnostic procedures?
17. What does diagnostic radiology consist of?
18. What is the best method for detecting a breast tumor?
19. What are the main factors of reliability of mammography?
20. What are the procedures of the breast pathological diagnostic evaluation?
21. What are the therapeutic possibilities of breast cancer?
22. Why is breast cancer considered as a serious medical problem?
Allergy
Before listening.