II. Lead in. Work with the text.

1. Answer the following questions:

1. Whcre do people usually go if they need medical treatment?

2. What must the GP do first to establish a reliable diagnosis?

3. What do patients most commonly complain of?

4. What do the abbreviations BSR and ESR stand for?

5.. What is usually the subject of routine laboratory investigation?

6. What is the urine (the feces) usually examined for?

7. What is a blood count and what are its two main types?

8. What is the point of examining the cerebrospinal fluid?

9. What are the four classic methods of examining a patient?

10. What are the aim of palpation?

11. How are different types of pain described?

12. What Instruments does the doctor use while examining the patient?

13. What helps a doctor to make a diagnosis?

14. When is the patient sent to the hospital?

2. Experess agreement with the following statements using short responses of the “so do P/ neither do ” type:

Example: I go to our GP every year (my mother).

So does my mother. I can't see it well Neither can she.

1. Mrs. Parkin son is running a temperature (her daughter).

2. The GP must learn about the patient's symptoms (every specialist).

3. My brother never complains of sore throat (my father).

4. The frees have to be examined for colour (urine).

5. Constipation belongs to the most common symptoms of disease (breathlessness).

6. I don't want to have, yon X - rayed (my colleague).

7. We may not get results in time: (the other department).

8. She wont agree with your diagnosis.

9. He should have his teeth examined.

10. I never had to consult a dentist (may friend).

11. We didn't think his condition was that serious (Dr. Lee).

12. Mr. Wilson has difficulty in passing his water (Mr. Dixon).

13. She invited the patient for another interview (the nurse), l4. We didn't refer him to any specialist (I).

III. Read and translate the text,. Medical Examination at the gp s Surgery

Patients in need of medical treatment usually go to see their family doctor in his consulting

Room or surgery. As a rule, they have to wait In the waiting room until their tare conies.

In order to make the patient's diagnosis, the GP must first' learn about die common symptoms, the subjective manifestations of the patient's chief complaint He will want to know if the patient is running a temperature, and if so, he will take it or ask the patient to take it, using a thermometer.

Apart from attacks of fewer, the most: common symptoms include: sweating, general body ache, headache, muscle or joint ache, malaise, nausea, diarrhoea, constipation and breafhlessness. The

patient may also complain of sore throat, cough, giddiness, weakness, tremor and pain.

On examination (0/E in clinical notes), the doctor may find rash, swelling, distention or tumour.

These belong among objective* findings called signs which also include the results of routine laboratory examinations of the Hood, sputum, urine and stools and possibly the cerebrospinal fluid, too.

Thus, for instance, the blood sedimentation rate (BSR or ESR - erythrocyte sedimentation .rate] and blood count, simple or differential, are important guides for the establishment of a reliable diagnosis. So is the examination of the sputum for bacilli of tuberculosis, pneumococci, staphylococci, pus or blood. It may be found frothy, mucoid or mucopurulent.

The urine is analyzed for the presence or exact proportion of albumin, sugar, acetone, blood, bilirubin, as well as for colour, specific gravity and total quantity per 24 hours. The stools (feces), which may be anything from loose to hard and painful to pass, have to be examined for consistency and colour and again for the presence of Mood, parasites and .fat (split, unsplit, .and total fat). In examining the cerebrospinal fluid (taken by means of a lumbar puncture), the pressure and the proportion of chlorides, glucose and protein have to be established.

In order to obtain a dear clinical picture, the doctor may want to ha¥e the patient X-rayed, or to have him undergo an ECG (electrocardiographic) or EEG (electroencephalographic} investigation. He may want to have his gastric juices analyzed, bronchoscopy, proctoscopy, cystoscopy etc. performed.

In his surgery, the GP is much more likely to use, first of all, the four classical methods of: inspection - to ascertain visible signs of the patient's condition; thus for instance, the appearance of the patients tongue (furred, florid or pale, moist or dry or glazed as in fewer) is a valuable sign;

palpation - to feel tumour, swelling, distention, the presence of tenderness etc;

percussion - by tapping the chest" or other parts of the body and listening to the quality of the note, whether resonant or dull, impaired, and so on;

auscultation - to hear chest sounds, irregularity of heart beat, peristaltic sounds in the abdominal. cavity etc

In the course of the examination in his surgery, the doctor makes use of his stethoscope, speculum, magnifying glass, sphygmomanometer and other aids, to make the diagnosis as accurate as possible. To do this, he has to rely on what the patient himself can tell him about his condition; e.g. how often he has his bowels open, if he has any difficulty in passing his water etc. If the patient has pains, the doctor is interested to learn whether it is sharp, dull, constricting, gnawing, lancinating, boring, shooting, throbbing, deep or superficial, transitory or chronic, whether the patient, complains of cramp or spasm. He has to find, out if the fever is just subfebrile, slightly, moderately or highly febrile, whether it is continued, remittent, intermittent, fluctuating, or relapsing etc.

In examining the patient,, the doctor proceeds, as a rule, from the top of the head down the neck, to the chest and. abdomen, and finally to the extremities.