2012-12-11 MedSci MedSci原创
P: Good morning, doctor.D: Good morning, please sit down. What seems to be the matter?P: I think I might have caught a cold.D: How long have you been sick?P: For two days.D: What symptoms do you have?
P: Good morning, doctor.
D: Good morning, please sit down. What seems to be the matter?
P: I think I might have caught a cold.
D: How long have you been sick?
P: For two days.
D: What symptoms do you have?
P: I have a runny nose and I ache all over.
D: What was the discharge like?
D: Is it the same today?
P: No, it is yellow and thicker today.
D: Do you have a fever?
P: I haven't taken my temperature yet, but I feel feverish.
D: Let me take your temperature. It will take 10 minutes. ... Yes, you do have a fever. Were you exposed to cold temperatures?
P: Yes, the day before yesterday when I went to work, the weather was warm so I didn't wear extra clothes. In the evening the temperature dropped down rapidly. On the way home I felt very cold. After arriving home I began to sneeze. When I got out of bed the next morning my nose was stuffy and running.
D: Do you have a cough?
P: I just started coughing today.
D: Do you have phlegm?
P: Yes, but not much.
D: What color is it?
P: Pale yellow.
D: Is it easy to cough up?
P: Not very. I have to use effort to cough it up. The phlegm is a little sticky.
D: Have you been sweating?
P: I sweated a little after taking some medicine for fever last night.
D: Are you thirsty?
P: Yes, I feel like drinking cool water.
D: Do you have a sore throat?
P: Yes, I do.
D: I want to look at your throat. Please open your mouth.
D: Do you feel any other discomfort?
P: I feel sore everywhere and I feel very tired too.
D: Please stick out your tongue and let me have a look. You have a red tongue with thin and yellow coating, which indicates wind and heat in the superficial area. Please put your hand here and let me feel your pulse. ... The pulse is superficial and rapid.
P: What does a superficial and rapid pulse mean?
D: A superficial pulse means the attack of pathogens to the exterior layer of the body which is called exterior syndrome in Traditional Chinese medicine, while a rapid pulse indicates heat.
P: What is the diagnosis of Chinese medicine for me?
D: It is a common cold. According to the symptoms, the manifestation of the tongue and pulse, you have got a common wind-heat type cold.
P: Can you explain it more in detail?
D: Pathogenic wind heat often attacks the body through the nose and mouth. The lung is involved first. Pathogenic wind of yang nature is characterized by upward and outward dispersion. When a fight goes on between the pathogenic wind heat and the body resistance, fever, slight aversion to wind and sweating result. When the pathogenic wind heat attacks the head, symptoms like pain and distending sensation occur in head.
P: That's interesting.
D: When the lung fails to disperse and descend, a ten-year-old patient has a cough with yellow, thick sputum. When the pathogenic wind heat stifles the air passage, the patient experiencing a congested sore throat with thirst. Thin, white or yellowish tongue coating, and superficial rapid pulse are the signs showing the lung and the defensive system being attacked by the pathogenic wind heat.
P: I see. I'd like to be treated with Traditional Chinese medicine. That is why I came here. What kind of treatment will you give to me?
D: I suggest the prescription Yin Qiao San for you. It is a typical formula for treating wind heat type of common cold. We may modify it by adding some more herbs to relieve the sore throat and the runny nose. I will give you four doses. Every day take one. Every dose brings to a boil and drain off the liquid. Add cold water and bring it to a boil the second time. Drink the liquid from both times. Do you understand?
P: Yes, I do.
D: Also, I'll now give you acupuncture treatment on the points of the lung, large intestine and bladder meridians, using the reducing method. This will be very effective in relieving your headache and runny nose.
P: Will it be painful?
D: No, just like a mosquito bite. After that we may apply cupping to your upper back.
( After the treatment)
P: Oh, I feel much better after the acupuncture treatment. My headache has gone and the sore throat has lessened. Thank you.
D: After returning home be careful to rest and drink more hot water. This is your prescription. Go to the Chinese medicine pharmacy and fill your prescription.
P: Ok. Thank you very much, doctor.
D: You are welcome.
医生：让我先帮您测体温。大概需要十分钟。 ... ... 是的，您确实是发热。您怕冷吗？
D: Good morning, what seems to be the problem today, Mr. Chen?
P: Well, I've had nocturia for six months and I started losing weight four months ago.
D: Any other problems? Have you noticed any changes in your urine?
P: Yes, it's darker, reddish. I wonder if it could be blood.
D: Have you noticed anything else?
P: Yes. I've felt sick several times in the morning and I've noticed my legs are swollen after work in the evening. Also, I've felt really groggy for some weeks now. I don't seem to enjoy my food any more and I've lost weight.
D: How much?
P: About 6Kg.
D: How long have you had this trouble?
P: About 4 months really.
D: Have you ever had trouble with your urine before?
P: Yes. Two years ago I had a burning sensation when I passed water. The doctor said that I had high blood pressure as well and he put me on tablets and it cleared up.
D: Well, I'd like to examine you. Please come to the examination room, remove your clothes except your underpants, and lie on the table.
D: You can get dressed now ... well, it looks like you have some reduced kidney function. I want you to take some blood tests, X-rays and kidney function tests. I'd like you to collect your urine for 24 hours. The nurse will tell you exactly how to do it. Then we'll ask you to come in for an ultrasound examination of the kidneys. This is a very simple procedure to make sure there is no obstruction.
P: Can you tell me exactly what is wrong with my kidneys?
D: Well, the tests show that you are in a condition called chronic glomerulonephritis, which has damaged the kidneys.
P: Is the chronic glomerulonephritis severe? Are there any good treatments to repair the kidney damage?
D: Yes, of course. You'd better stay in the hospital for treatments, and observation. We'll have to insert a tube into your abdomen to flash out toxic substances in the blood stream.
P: How long will I have to stay in hospital? Will I have to stop working?
D: For about 3-4 weeks. Just remind me. What's your job?
P: I'm a teacher.
D: Well, I should advise you to have a 2-month rest.
P: Thank you doctor.
D: Not at all.
D: What's the matter with you?
P: I have been feeling thirsty recently, and I am always tired.
D: How about your urination?
P: I pass more urine than I used to.
D: How many times a day?
P: About eight times.
D: How about your appetite?
P: My appetite has been good, but I still feel I am losing weight.
D: Any other symptoms?
P: I can't concentrate on anything for long, and I always feel weak. I have said that, I guess. Sometimes I also feel dizzy.
D: How old are you?
P: I'm 45 this year.
D: Sir, do you have anyone in your family who has diabetes?
P: Yes, my father has had diabetes for nearly 15 years. What do you mean, doctor? Do you mean I have got diabetes?
D: According to your symptoms and your father's history, there is a strong possibility that you have got diabetes, as the disease runs in families. Of course, we need to do some checks. First please go to the Laboratory Department and examine your urine and blood sugar. Come back to me with the report.
(Later with the results of the examination)
D: The examination shows an elevation of blood sugar and you have sugar in your urine. You have got diabetes.
P: Is it serious? What's a normal blood sugar level?
D: It is <130mg%, Generally it is 80—120mg%. Diabetes is a disease due to the poor function of the pancreas, which brings about metabolic disorder of sugar, fat and protein. It's a chronic disease. At the time being there is still no way to cure it. But as I said your case is not serious now. If you pay attention to treatment your diet and you will get better gradually.
P: What else should I pay attention to? Is there a diet for diabetes?
D: Having your urine tested regularly to see how your disease is going is very important. On the other hand, you should try to omit sugar from the diet. This includes candy, cake, ice-cream, etc. High starch foods such as bread, potato, rice, etc should be limited, too.
P: Thank you very much, doctor. Godbye.
D: Good morning! Please have a seat. I just need to get some information from you. Could I have your name please?
P: My name is Wang Ping.
D: What kind of work do you do?
P: I am a taxi driver.
D: That's fine. Now, tell me what's bothering you.
P: Well, I've got a dreadful stomachache and I've lost my appetite.
D: How long have you been feeling this way?
P: For about one year. First it was just a slight a pain, but it's got much worse recently.
D: Could you tell me exactly where the pain is?
P: Yes, it's right here. This is the worst spot.
D: Is it a fixed pain?
P: Yes, it doesn't seem to move.
D: Does the pain ever spread to any other area?
D: What sort of pain is it? Sharp? Dull?
P: It's a distended feeling, and it gets worse if I eat anything cold.
D: Do you ever fell it when you're hungry?
P: Yes, often, but it gets better if I eat something.
D: If you rub or massage it, does it help?
P: Yes, it does.
D: Do your hands and feet often feel cold?
P: Yes, often ... and very cold too.
D: Is the pain constant, or does it come and go?
P: It comes and goes.
D: And how long does each attack last for?
P: Oh ... about two hours.
D: Do you feel the most painful in the daytime?
P: Yes, I think so. Usually about three hours after meals. But sometimes it wakes me up at night.
D: Are you aware of anything that brings the stomachache on?
P: It's hard to tell. First, I think it comes after I eat raw and cold food. Recently I've felt it when I'm busy at work or I'm in a bad mood.
D: Generally, how's your appetite?
P: Not so good. I always feel bloated. So I don't feel like eating anything. What's more, no matter what I eat, it's tasteless.
D: Do you have any burping or acid regurgitation?
P: Yes, I burp a lot.
D: Have you been very thirsty lately?
P: No, I'm not interested in drinking anything.
D: Do you prefer hot or cold drinks?
P: Oh, definitely something hot.
D: Have you got any unusual tastes in your mouth?
P: Yes, a sour taste, and I get acid regurgitation, too.
D: What are your bowel movements like?
P: They're soft and sometimes I have diarrhea.
D: Any problems with passing water?
P: No, I don't think so.
D: Have you lost any weight lately?
P: No, my weight is the same as it was.
D: Have you ever had any other problems?
P: I'd always been in good health and never had any serious problems, not even a cold.
D: Do you smoke or drink or have any other habits that might affect your health?
P: I don't smoke, but drink a little.
D: Have you ever had an X-ray or ultrasound B for this problem?
P: Yes, last year I had an X-ray and the doctor said I had a duodenal ulcer.
D: Have you ever had any treatment before this?
P: Yes, I've taken lost of tablets, but they haven't had much effect. So this time I'd like to try some Chinese herbs.
D: All right. Now let me look at your tongue, and then take your pulse. Mm ... the tongue is pale and a dull purple color. The coating is thin and white. Your pulse is deep, slow and uneven. According to the theory of Traditional Chinese Medicine, the stomachache you've got is caused by deficient cold affecting the Spleen and Stomach. The treatment principle is to warm the center and dispel the cold. I'll write a prescription for you ... .Here you are.
P: Thank you. I'll go and get the prescription filled right away.
D: Come to see me again after you have taken the medicine.
P: Yes, I will. Goodbye!
医生：好的。让我看看您的舌头。然后给您把把脉。嗯，舌紫淡暗，苔薄白，脉沉缓结。根据中医理论，您这种胃痛属于脾胃虚寒证。治疗原则是温中袪寒，我会写张处方给您。 ... 给您。
D: Good morning. What's the trouble?
P: I've been getting terrible headaches recently.
D: Is there anything else?
P: Yes. Sometimes I feel a bit nauseous. But that's it.
D: When did the headache exactly begin?
P: About two weeks ago. I've had slight headache on and off for the last few years, but none has been as bad as recently.
D: Have you ever visited a doctor or taken any medicine for it?
P: Ten years ago I went to the local hospital for a check-up, they told me that I had hypertension. Five years ago I was diagnosed with coronary heart disease and stayed in hospital for about one year, during which I also tried some TCM herbs. Since then things seem alright. However, two weeks ago I had a urinalysis taken and the test for proteinuria was positive.
D: Have you ever had any other diseases? For example, any renal diseases?
P: No. Nothing else.
D: What kind of medication have you had in the past?
P: I took capoten regularly and Nitroglycerin occasionally. They used to be helpful, but they don't work any more. According to the advice of the doctor, I added other antihypertension drugs, but it doesn't seem ... Well, anyway they don't work.
D: What about your blood pressure?
P: It used to be around 150/95 mmHg. But recently it has gone up to about 200/120 mmHg.
D: Have you taken any other tests recently?
P: Yes. Many, like urinalysis, blood tests, chest X-ray, electric cardiogram examination, ultrasonic cardiogram and even a CT. I've brought all the reports with me. Here you are.
D: Let me have a look. Yes. There is something wrong with your kidneys and the renal function is deteriorating, though not seriously, according to the results of the urinalysis and the blood test. But nothing abnormal was found on the CT of your kidneys. Let me give you a physical examination ... .Well, there is nothing unusual. But I think we need to do further examination, otherwise, without definite diagnosis your renal function it may continue to deteriorate.
P: Oh, is that serious?
D: No. It's not, but we can't resolve it if real cause is not found.
P: What kind of examination should I take?
D: I like you to have a renal angiography by interventional Radiology so as to examine the renal artery, because according to the data available, I think that your hypertension is caused by renal artery stenosis, which usually results in renovascular hypertension.
P: You mean I need an operation?
D: No, not exactly. Interventional Radiology is not surgery after all.
P: Is it safe?
D: Yes. It is a minimal traumatic method.
P: Isn't there any other alternative, like MRI?
D: Sorry, I'm afraid not. Up to now, interventional Radiology is considered to be the top standard for vascular examination, especially arterial examination. Besides, subsequent therapy may be explored during the operation if the stenosis of renal artery is confirmed.
P: What kind of therapy?
D: Once the diagnosis stenosis of renal artery is confirmed usually doctors perform a PTRA or percutaneous transluminal renal angiography. They'll plant a metal stent as part of the procedure. PTRA is simple but effective and so is considered the preferred therapy for secondary hypertension caused by renal artery stenosis.
P: Will I have to stay in hospital? I'd really prefer not to.
D: I suggest you stay in the hospital for at least a week. We'll need to confirm your condition just before the operation. Will that work for you?
P: Ok, Let's get it over before holiday.
D: Very well. We'll contact you soon. Take care and don't worry about the operation.
P: Thanks a lot. Goodbye.
D: You are welcome.
病人：我定期服用卡托普利，并偶尔吃硝酸甘油。它们以前都挺管用的，但现在不再起作用了。按照医生的建议，我又加了些降压药，但好像 ... ... 总之，作用都不大。
P: Hello, doctor.
D: Hello, come in please! How are you feeling today?
P: Not great. I was just playing with my classmates, and all of a sudden I fell down. My right elbow hurts and my hand is bleeding. It happened really suddenly. I'm still in shock. Do you think I'll be Ok?
D: Let me have a look at your arm. Is it still painful? When did it happen?
P: Yes, it is. I hurt it about half an hour ago.
D: Would you please roll up your sleaves. ... That's fine. That's it. Sit traight. ... Now put your arms on your hips. ... fine. ... Now rest your arm on mine, that's right. I just want to feel under your arm ... Good. Now the other one. ... Now would you please lie down? Let me put this pillow under your right shoulder. ... Now put your right arm over your head. Fine. ... Do the same with the left. ... Good ... Get up please.
D: Well, the radial pulse is present, and the sensation was intact. Shake my hand as hard as you can ... ... Oh! The strength is slightly diminished. I think we'd better do an X-ray.
P: Can we do that here?
D: No, the nurse will take you to the X-ray department. I'll be there in ten minutes.
（Later with the result of the examination）
P: Here is the X-ray result. Is it serious?
D: From the picture, you have a supracondylar fracture of the transcondylar type. It's not serious but it won't get better of its own accord. I think you'll have an operation.
P: But I have to go to school. I'll have a final exam in a month. Doctor, please help me!
D: Don't worry. You'll only be in for ten days or so and once the operation is over, you'll feel much better. Shall I put you on the waiting list?
P: All right.
D: I'll take you to the admissions office and make the necessary arrangements. Well, before that let's talk for just a few minutes about your condition. I've already written the orders to watch you carefully for the first 48 hours, and the nurse should report to me if the hand becomes painful, cold, pale, dusky, or swollen.
Nurse, please give me a suture set.
P: Are you going to sew up the wound on my hand?
D: Yes, just three stitches, I think. It won't be very painful, I'll fix you right up ... Okay, it is done. That wasn't so bad, was it?
P: No, not very.
D: Have you had a tetanus shot recently?
P: No. Do I need one?
D: Yes, Tetanus is a type of toxemia. That toxin diffuses throughout the tissues and involves the neuromuscles end-organs, causing spasm. Masseter muscle spasms are one of the earliest symptoms; the most serious is the spasm of the respiratory muscles. It's best if you have it. Have you had this shot before?
P: Yes. I had one about five years ago.
D: Well, I think you'd better have another one.
P: No problem.
D: Please come again five days later and so I can take the stitches out. Don't worry about your hand. It is going to be fine.
Nurse, Pay attention to the situation of this patient, and I'll show you how to do Dunlop's traction, as soon as he gets into the ward. Oh, yes. We will continue the traction for three weeks until the fracture is healed, or after ten days, when the fragment's become fixed together. Then we can replace the traction by plaster with the arm in flexion.
Feel free to contact us if anything happens!
P: Thank you, doctor. What should I do now?
D: First, you should get some rest, and get some regular sleep. Second, you shouldn't worry about your situation. I shall prescribe some medicine and tonic for you to quiet your nerves and increase your energy. That's all.
P: Ok, doctor. Thanks again.
医生：你能把袖子挽高一点吗？ ... ... 好 ... ... 就这样。坐直点 ... ... 把手放在臀部 ... ... 好 ... ... 现在把手放在我的臀部，对。我想检查你的肘 ... ... 好。现在轮到另一边 ... ... 你现在躺下。把枕头放在右肩下 ... ... 把右手举过头。好 ... ... 左手也做同一动作 ... ... 好 ... ... 请起来。
医生：脉搏、感觉都没事的。出力握住我的手 ... ... 哦！握力轻微减退。我想您最好拍个片。
医生：我带你到入院办公室，作些必要的安排。好，让我们用几分钟讨论你的病情。我已经下医嘱在两天内密切观察你的病情，如果手变痛了，或变冷、变苍白、暗黑或肿胀了，护士会及时向我汇报。 ... ... 护士，给我一个缝合包。
医生：是的，我想缝三针。不会很痛的，我会帮你固定好 ... ... 好，行了，不是太痛吧？
医生：行，最好还是再打一次 ... ... 你认为怎样？