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Sách anh văn chuyên ngành Y Đa Khoa, dành cho các bạn sinh viên y dược mới bắt đầu tiếp cận đến tiếng anh chuyên môn. Với từng chủ đề dễ dàng tiếp cận trong lâm sàng sẽ giúp các bạn dễ dàng ghi nhớ và tiếp thu tốt kiến thức MEDICAL ENGLISH Than Lan Con English Center Learning material is made by Hoang Bao Long, MD and is the property of Than Lan Con English Center
Than Lan Con English Center Version 3.0 MEDICAL ENGLISH This learning material is made by Hoang Bao Long, MD and is the property of Than Lan Con English Center Introduction Some of you may have seen the second version of this document This time, we decided to something different So here you are looking at Than Lan Con’s study material for the Medical English course, version 3.0 Am I suitable for the course? Read the checklist below and check you match all criteria If you do, you are a candidate for the class 1 I am a medical/nursing student or graduated from a medical/nursing school 2 I can understand the main points of conversations or writing pieces about common matters in work, school, leisure, etc (equivalent to CEFR B1/IELTS 5.0) 3 I want to learn medical English to read medical literature and write about medicine in English What can I learn from the course? Our course is designed: To provide learners with common English medical terms and expressions in clinical practice; To provide learners with skills for active and efficient learning; To introduce self-study methods and encourage learners to continue self-study after the course You, therefore, will be provided with (1) fundamental context-based vocabulary and structures, (2) brief instructions on relevant skills, and (3) exercises to guide you on self-study We recommend you review this document carefully before and after going to the ME class at TLC How is this document arranged? Contents briefly presents the knowledge points given in each lesson Vocabulary will be the most important part in medical English; however, Writing/Speaking and Skills enable you to use medical English more efficiently The lessons are divided into sections and exercises The Reading and Vocabulary sections introduce new words and structures, which will be explained in detail in following exercises We also review essential grammar points to strengthen your reading and writing skills Other skills are integrated into exercises Reading and listening materials are taken from case reports, books, journal articles, and websites All documents used in the study material are listed in References Where should I start? The simplest way is to register a class at TLC You have a teacher and your classmates, and there are lectures and homework that limit boredom and improve your skills If you are unable to join the class (e.g., living in a distant town), start with checking the material is suitable and reviewing the contents thoroughly Once you feel ready, start learning the lessons one by one You not have to (and should not) rush—make sure you understand everything in the lessons OK, let’s go! We wish you joy while learning medical English with our study material and wish you success Contents VOCABULARY WRITING / SPEAKING SKILLS Visiting the hospital page > Hospital > Latin medical terms Your first case report > Words for describing a symptom page 10 > Describing history of present illness > The SVO structure Where does it hurt? > Quality of pain page 13 > Taking a history > Modifiers > Describing history of present illness The past also matters > History page 16 > Taking a history > Describing past history Anatomy > Body systems and anatomical positions page 19 > Describing the relationship between body organs > Describing the components of an organ On examination > Examination > Examination instruments and supplies page 22 > Describing examination findings > Presentation skills > Presenting case reports A beating heart > Heart anatomy and physiology page 25 > Presenting case reports > Cardiovascular signs and symptoms > Illustrating knowledge > Presentation skills > Valvular heart diseases > Thromboembolism I can’t breathe page 29 > Skimming and scanning > Anatomy of the respiratory system > Respiratory signs and symptoms > Some imaging methods and interventions You need some blood tests page 33 > Blood cells and conditions relating to changes in cell counts > Reading flow diagrams > Laboratory tests and test results 10 The lungs and the pleura > Lung and pleural conditions: signs and symptoms, treatment > Arterial blood gas page 36 > Describing laboratory results VOCABULARY WRITING / SPEAKING SKILLS 11 The differential diagnoses > Diagnosis and diagnostic criteria page 39 > Explaining diagnostic approach 12 Scopy what? > Anatomy of the gastrointestinal system page 44 > Presenting case reports > Acute abdomen > The suffices -scopy and -graphy 13 Hematemesis et al page 47 > Cirrhosis > Presenting case reports > Making flow diagrams > Peptic ulcer disease > Introducing a disease > Presentation skills 14 An abdominal pain’s story page 51 > Prefixes of position > Appendicitis > Statistics > Anatomy of the genitourinary system > Causes of acute abdominal pain 15 The bean-shaped guys > Urology: symptoms, investigations, procedures page 56 > Introducing a disease > Kidney disease 16 A bowl of tiet canh > Microbiology and infectious diseases page 59 > Presenting case reports > Skin lesions > Presentation skills > Bar chart > Epidemiological concepts 17 Mr Meningitis page 64 > Anatomy of the nervous system > Making mind maps > Common neurologic conditions > Epidemiological concepts 18 Esomeprazole 40 mg qD > Management page 68 > Describing treatment > Making medical charts > Drug information 19 Emergency!!! page 73 > Intervention > Making flow diagrams > Emergency medicine > Presentation skills 20 A pinch of research > Clinical trials page 77 > Presenting statistics Visiting the hospital Visiting the hospital Reading Chung, a 40-year-old officer, had been experiencing a high fever for several days He had thought it was just some viral infection until he started to feel short of breath He was taken to the emergency room (ER) in a provincial hospital Upon examination, he had a high fever, pulse rate and blood pressure were within normal ranges, his breathing was fast, and oxygen saturation was low His chest X-ray showed lung consolidations Chung was diagnosed with pneumonia and respiratory failure, so he was given supplemental oxygen However, his condition did not improve and required mechanical ventilation Because the hospital did not have ventilators, the ER doctor transferred him to a central hospital At the central hospital, Chung was admitted to the intensive care unit (ICU) He was intubated and ventilated Further investigations also revealed anemia Chung was treated with antibiotics and blood transfusion He recovered after two weeks staying in the ICU and was transferred to the Respiratory department Two weeks later, he was discharged home with some prescription medications and the ward doctor asked him to return to the outpatient clinic (OPC) after one month for follow-up Exercise New words Choose a word from the text to fill in the gaps 1 Words to describe “a place for receiving and treating patients” (1) room (2) (3) (4) to ask patients about their symptoms and previous illnesses _ temperature, pulse rate, blood pressure, breathing rate _ (5) admission _ Two places in a hospital where a patient can come for check-up to send patients to another hospital for evaluation, but not discharge them _ medication _ (1) _ (2) _ _ treats critically ill patients Some patients can return home, but some have to be _ to the hospital admission _ assessment _ Blood tests and imaging like chest X-ray are called _ discharge _ He was _ with pneumonia diagnose If a hospital is unable to manage a patient, they can _ the patient to another hospital examine improve manage treat Patients who have completely recovered can be _ Nouns and verbs Types of hospitals In Vietnam, there are district, provincial/town, and regional/central/national hospitals Many are general hospitals—they manage patients with all sorts of medical conditions The others specialize in a group of diseases and are often called by the group of diseases that they treat (e.g., a surgical hospital treats patients with surgical conditions) Name some hospitals you know and classify them M E D I C A L E N GL I S H | S t u d y M a t e r i a l V Unit Vocabulary Warm-up Underline the part you think is in common Which part is equivalent to the following words? endoscopy, endovascular, endothelium heart cardiac, pericardiectomy, cardiovascular inflammation cellulitis, retinitis, meningoencephalitis inside Can you guess what is “an inflammation inside the heart”? Latin medical terms Exercise There are three major components of a Latin medical How you explain the following terms? term: roots, prefixes (before the roots), and suffixes (after the roots) pericarditis _ HYPERGLYCEMIA prefix root suffix hyper- glyc(o)- -emia elevated glucose condition of the blood Elevated blood glucose -logist a person who studies something -logy the study of peri- surrounding Can you guess the meaning of these roots? arthro- dermo-/dermato- entero- gastro- hemo-/hemato- myo-/myos- nephro- neuro- onco- ophthalmo- uro- dermatology _ urologist _ nephritis _ gastritis _ endophthalmitis _ Find an appropriate Latin term for each of the following descriptions _ inflammation of the nerves _ the study of tumors, especially cancer _ a doctor who studies the blood _ inflammation of the stomach and intestine _ inflammation of the skin and muscles _ a doctor who studies the nervous system _ inflammation of the joints What are the names of other medical specialties that you know? Can you explain the roots in those names? Than Lan Con English Center Visiting the hospital Vocabulary Reading Jobs in the hospitals A full course in Vietnamese medical schools takes six years We begin clinical rotations in the second semester of the third year with Internal Medicine and Surgery One rotation often lasts six to ten weeks In these rotations, we learn how to take history, detect clinical signs, and summarize patients’ clinical presentation Read the job descriptions below Who will these works? managing and dispensing medicines to medical staff or patients _ assisting pregnant women in giving birth _ responding to emergency calls and giving first aid _ taking and reading x-rays and other images _ performing surgeries providing temporary loss of sensation for surgery or other procedures _ treating children _ examining and taking care of pregnant women _ processing and analyzing samples _ 10 giving drugs to patients and taking care of them _ A typical day starts at 7:30 AM when we join the morning meeting In the meeting, doctors present newly admitted patients and severe patients who need monitoring during their night shift Afterward, we divide into small groups to different rooms and ask some patients about their disease and examine them We usually need to write case reports and submit them to our teachers The cases can also be presented in front of the class during clinical lectures in the morning In the afternoon, we return to our school to study theoretical lectures We have one to three shifts every week Students all sorts of activities during the shifts We monitor severe patients, complete medical records, send samples to the lab, get the test results from the lab, and transfer patients to other units We learn a lot in a shift, but it can also be very boring sometimes Choose a word from the text to fill in the gaps _ Exercise Below are the stories of some doctors Can you guess what their jobs are? “The patient was sent to us in cardiac arrest for 15 minutes But no one among us gave up His heart beat again somehow Since then he visits us every year on this day.” “She was a tiny angel, born with an extremely low birth weight Her heart stopped beating every now and then They told me I was wasting my time doing CPR This is the picture she drew when she started primary school.” “Two years ago, a young man shot himself to his head I quickly sent him to the operating room Last week, he sent me a photo of his newborn son.” “A young, very thin girl with severe lupus nephritis came to us in distress Others believed she didn’t have much time I told them it’s not the end Now she plays tennis on the days she doesn’t have to go to the Dialysis center.” We plan to submit a _ to the BMC Gastroenterology Blood _ should be taken and sent to the _ for culture within two hours To review these cases, we’ll need to borrow their _ from the General Planning Department I’ve been having night _ every Sunday When’s your next _? It’s Infectious diseases, isn’t it? Writing Tell us about your life as a student and a doctor or nurse Think about your first day at the hospital: - What did you expect before you started? What have you actually learned, and did they meet your expectations? One of your most impressive experiences in the hospitals M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 10 Unit 2 Your first case report Reading Read the following paragraph in a case report1 and fill in the gaps A 23-year-old unemployed Caucasian man presented to our Emergency Department with a twelve-hour history of severe right upper and lower quadrant pain This pain originated in his epigastrium and was associated with nausea, multiple episodes of non-bilious vomiting and anorexia His background history was unremarkable He was on no regular medications, did not smoke and was a social drinker talks about _ (CC): complain of + CC be admitted + with / due to / because of CC + CC Tick details about the symptoms that can be found in the paragraph In the gaps, write the number of the phrases describing the details timing/onset location/radiation talk about history of _ (HPI) severity/intensity quality or history of _ (HPC) associated symptoms talk about _ history (PMH) aggravating/relieving factors Exercise Write a complete sentence using the prompts 43, M, Sri Lankan, acute febrile illness, days2 4, F, Caucasian, fever, rash, bilateral conjunctival injection3 _ _ 52, F, Korean, edema, dry mouth4 _ 71, M, white, French, bilateral blurry vision, epistaxis, nausea, two weeks5 _ Vocabulary Describing a symptom Add the words in the box to the mind map How will you arrange words with opposite meanings? pain acute moderate intermittent chronic generalized fatigue severe sudden nausea constant episodic mild vomiting localized malaise Than Lan Con English Center 70 Unit 18 Vocabulary Drug information Provide the information about the following drugs capsule cream ointment powder solution spray tablet Routes of administration: intramuscular (IM), intravenous (IV), oral (PO), topical If topical, please specify (1) Formulation: _; strength: _ Routes of administration: _ (5) Formulation: _; strength: _ Routes of administration: _ (2) Formulation: _; strength: _ Routes of administration: _ (6) Formulation: _; strength: _ Routes of administration: _ (3) Formulation: _; strength: _ Routes of administration: _ (7) Formulation: _; strength: _ Routes of administration: _ (4) Formulation: _; strength: _ Routes of administration: _ Than Lan Con English Center Esomeprazole 40 mg qD 71 Writing Read the dosage section and write a paragraph to explain your diagnosis and treatment See the example Dx: erosive reflux disease (ERD); Rx: esomeprazole Dosage 20-40 mg PO qDay for 4-8 weeks If oral therapy inappropriate or not possible: 20-40 mg qDay IV up to 10 days; switch to PO once patient able to swallow Dx: community-acquired pneumonia; Rx: ceftazidime Dosage: 0.5-1 g IV q8hr Dx: allergic rhinitis; Rx: levocetirizine Dosage: mg PO qDay in evening The patient was diagnosed with erosive reflux disease He was given oral esomeprazole 40mg once daily for weeks _ q every _ b.i.d twice daily _ t.i.d three times daily _ prn as needed _ _ Dx: anxiety disorder; Rx: lorazepam _ Dosage: 2-3 mg PO q8-12hr PRN; not _ to exceed 10 mg/day _ Dx: atopic dermatitis; Rx: _ betamethasone dipropionate cream _ Dosage: apply to affected areas bid for days, then qD for days _ Reading Read the case report68, then answer the questions and fill in the chart A 29-year-old Caucasian woman affected by a schizoaffective disorder, treated with haloperidol 2mg per day and olanzapine 10mg per day, was admitted at a Psychiatric Unit for a reacutization of her psychotic symptoms (hallucinations, delusions, and catatonic behavior), due to a lack of medications adherence Her past medical history was characterized by a previous hospitalization for acute psychosis year earlier, incomplete right bundle branch block (RBBB), and ovarian cysts Her family medical history revealed that her mother had an anxiety disorder and her grandmother had a major depression She was on long-term oral contraceptives (OCs)—ethinyl estradiol/drospirenone 0.03mg/3mg per day—and denied smoking tobacco products and any substance use A physical examination showed a temperature of 37.2°C and blood pressure of 150/100mmHg, whereas all the other parameters were within normal range The results of blood tests and electrocardiography (ECG) were normal, except for RBBB Her hospitalization lasted months and during the first month she was treated orally with olanzapine 20mg per day and haloperidol 9mg per day for 23 days On the 23rd day of hospitalization, since a poor response to treatment was observed, antipsychotics were interrupted and aripiprazole 30mg per day was administered for days In addition, on the same day, she was diagnosed with oral candidiasis and treated simultaneously for a week orally with fluconazole 100mg per day and miconazole oral gel 2% 20mg, two times per day Since her psychotic symptoms did not seem to improve, 29 days after admission and on the last day of antifungal treatment, aripiprazole was replaced by clozapine Clozapine was started at 25mg per day orally and was gradually increased, within 16 days, to 225mg per day with the resolution of psychotic symptoms After weeks the plasma level of clozapine was 542ng/mL (range 350 to 450ng/mL) and the level of its active metabolite norclozapine was 216ng/mL Blood tests showed M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 72 Unit 18 eosinophilia and an increase of C-reactive protein (5.73mg/L) She experienced the first symptoms (nausea, vomiting, palpitations) days before the plasma level of clozapine was measured, while she was being treated with clozapine and OCs At that point, long-term OCs treatment was discontinued, and no other form of contraception was administered to her She was referred to a cardiologist A physical examination showed tachycardia and gallop rhythm and she complained of nausea and vomiting An ECG revealed sinus tachycardia (135 beats/minute), QTc 0.43 seconds, and S-T segment depression and inversion of T-waves in inferior and lateral leads An echocardiography showed a small pericardial effusion suggestive of iatrogenic pericarditis Due to those findings, week after discontinuing OCs, clozapine was also interrupted, and she was not rechallenged Within days, she showed resolution of clozapine side effects, normalization of ECG and complete recovery of pericardial effusion Her symptoms continued to improve and days after discontinuing clozapine she was discharged The plasma level of clozapine measured week after discontinuing clozapine (2 weeks after interruption of OCs) was undetectable At 1-month follow-up, transthoracic echocardiography and inflammatory markers were normal Choose a word from the text to fill in the gaps taking a drug on time and never missing a dose change in clinical picture after treatment begin using a drug get better stop using a drug (1) _ return to normal (2) _ symptoms disappear (1) _ switch to another drug disease caused by medical errors (2) _ 10 estimate the level of a chemical substance Fill in the chart Use the given signs -: drug used; -: negative/absent; +: positive/present; ↑ or ↓: increased/decreased; N: normal Timeline (Admission) OC olan/halo aripiprazole antifungals clozapine psychosis nausea / vomiting HR CBC CRP EKG ECHO Than Lan Con English Center 23 29 45 50 (↑plasma clozapine) 57 63 90 (Followup) Emergency!!! 73 19 Emergency!!! Vocabulary Intervention Match the interventions with the clinical situations abscess drainage arterial line placement blood transfusion central venous catheterization debridement hemodialysis infusion intubation jejunostomy laparoscopy lumbar puncture mechanical ventilation nasogastric tube insertion open surgery paracentesis peripheral IV cannulation phlebotomy thoracentesis urinary catheterization ventriculostomy A nurse is taking blood for some laboratory tests The patient’s wound has a lot of dead tissue that should be removed They insert three trocars in the patient’s abdomen and then start the surgery Fluid resuscitation requires at least one peripheral line You now ask the nurse to a procedure If feeding via the stomach is avoided, they can feed the patient directly from a lower segment of the GI tract by opening a passage to it In a patient with end-stage renal disease, the kidneys have totally lost their function, that is filtering toxins from the blood Renal replacement therapy can improve this condition by connecting the blood vessels with a machine to filter the blood outside of the body A patient is suspected to have bacterial meningitis, so his cerebrospinal fluid (CSF) needs to be collected The patient is in shock and the doctors are discussing an invasive hemodynamic monitoring method The doctor performs an abdominal examination and finds an extremely distended bladder, which should be managed 10 On ultrasound, the left pleural cavity is shown to be filled with 200 mL of fluid with heterogeneous echotexture A procedure is done 11 On arrival, a patient with multiple trauma exhibits signs of severe blood loss Hemoglobin level is 50 g/L 12 Some intravenous medications such as cyclophosphamide or potassium should only be given centrally 13 You admit a comatose patient and the first step is to secure his airway 14 This patient is unable to eat but enteral nutrition is still indicated 15 A patient who is diagnosed with perforated hollow viscus and peritonitis will be taken to the operating room The surgeon decides that operation with endoscopy is impossible 16 An 81-year-old female patient with a history of diabetes is seen in the Endocrinology department with a large skin infection to her buttock She is given intravenous antibiotics and source control is performed 17 The doctor starts to measure the intracranial pressure for a patient with subarachnoid hemorrhage 18 A desaturated patient is brought to you with an endotracheal tube in place She needs breathing support 19 After finding a medium amount of ascites, the gastroenterologist asks his intern physicians to take out 500 mL of fluid for diagnosis and therapeutics 20 A patient is diagnosed with GI bleeding due to gastric ulcer He is continuously given esomeprazole M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 74 Unit 19 Reading Emergency medicine69 Every time you see a new patient or a patient who suddenly deteriorates, check the patient is unconscious If he/she is unconscious, immediately palpate the carotid pulse to see if this is a cardiac arrest Call for help if it is Immediately provide basic-life support (BLS) to a patient in cardiac arrest This is called cardiopulmonary resuscitation (CPR) CPR begins with chest compression, then airway control and breathing support if there is another person with adequate experience The mnemonic of CPR is CAB In some countries, when people notice a person who collapses, one will look for an automated electronic defibrillator (AED) which is often available in public places (such as supermarkets and offices) AEDs can detect ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), and automatically generate electric shocks to stop the arrhythmia, allowing the heart to re-establish an effective rhythm For patients not in cardiac arrest, doctors should follow a procedure called triage to effectively evaluate patients, especially in the ED where there is always a long line of patients waiting for a check-up Triage classifies patients into three categories: emergency (patients who need immediate treatment, otherwise they will die), priority (patients who need rapid assessment, otherwise they will develop emergency conditions), and queue (patients who can safely wait until their turn) Always look for signs of emergency conditions first These signs include: AIRWAY / BREATHING - Obstructed airway Central cyanosis Severe respiratory failure (measured by pulse oximeter) CIRCULATION - Weak or fast pulse Capillary refill longer than seconds Heavy bleeding from any site Severe trauma CONSCIOUSNESS / CONVULSION - Altered level of consciousness Convulsion PAIN FROM LIFETHREATENING CAUSES - Severe abdominal pain and surgical abdomen Severe headache Stiff neck Trauma to head/neck New onset chest pain Major burn Snake-bite DEHYDRATION - Dehydration in pediatric patients If there is a sign of an emergency condition, immediately call for help and start emergency treatment If there is no emergency sign, continue to look for signs of urgent care: - Any respiratory distress/complaint of difficulty breathing (but not severe respiratory distress) Violent behavior towards self or others or very agitated Very pale Very weak/ill Recent fainting Bleeding: large hemoptysis, GI bleeding (vomiting or in stools), external bleeding Fractures or dislocations Burns Bites from suspected venomous snakes or from rabid animals Frequent diarrhea >5 times per day Visual changes Than Lan Con English Center Emergency!!! 75 - New loss of function (possible stroke) Rape/abuse (maintain a high index of suspicion) New extensive rash with peeling and mucous membrane involvement (Stevens-Johnson) Acute pain, cough or dyspnea, priapism, or fever in patients with sickle cell disease Patients without these signs can wait for further investigations You have a lot of patients waiting in line Triage these patients A 33-year-old asthmatic with severe respiratory distress, unable to speak in complete sentences An 18-year-old male with pain and swelling to left ankle for days A 50-year-old female with severe headache and confusion A 30-year-old female with severe abdominal pain who is in her first trimester of pregnancy A 38-year-old male who is too weak to stand A 26-year-old female with cough and mild respiratory distress A 30-year-old male with severe abdominal pain after a motorbike accident A 17-year-old pregnant female with convulsions A 54-year-old male with rashes to the legs for month 10 A 22-year-old female with depression and suicidal ideation Choose a word from the text to fill in the gaps the heart does not beat what is provided in basiclife support measures to ensure a secure airway measures to support a patient with respiratory failure first thing to with a patient in cardiac arrest suddenly faint and loses consciousness two conditions that require defibrillation (1) _ classify patients conditions that need quick intervention, otherwise patients will die 10 worsen Draw a flow diagram to demonstrate how to approach a new/deteriorating patient (2) _ M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 76 Unit 19 Review Present these case reports using the prompts Case - 20, M, medical student CC: headache after motorbike accident hour: o Motorbike accident: crashing into an electricity pole, no helmet o Headache, dizziness, nausea, vomiting o No hemorrhage, no dyspnea, no pain in other regions Case - 64, M, retired teacher CC: pyuria, suprapubic pain days: pyuria, normal urine output, suprapubic pain: constant, radiating to the back No fever PMH: o Type-2 DM: 17y, Tx: insulin o months ago: urinary incontinence → suprapubic catheter Case - - 43, F CC: painful periods (dysmenorrhea) 2-3y: o Periods: heavy & painful, regular, 24 days, bleeding 7-9 days, heavy d2–6 o Hypogastric pain: 2ds before bleeding → d5; constant, dull, severe, could not any housework Taken paracetamol, mefenamic acid (NSAID) → not improved Ob/Gyn Hx: normal deliveries Case - - 71, M CC: fever, myalgia 21d: o Fever: mild, 2-3 episodes/day o Myalgia, malaise No cough or chest pain 8d: → BM Hospital, Dx: pneumonia, Tx: moxifloxacin + azithromycin; not improved → NHTD Than Lan Con English Center - - - - GCS 14, BP 100/60 mmHg, PR 90, SpO2 99% Head: right temporal painful swelling, no bleeding Nervous system: no paralysis, no sensory deficits Other systems: intact CT head: acute subdural hematoma CBC: Hb 135, Hct 40% hours: GCS 8, left-sided hemiplegia, CT: enlarged subdural hematoma → emergency surgery Conscious, Pale, BP 120/80, PR 90, RR 21, temp 37.2 No enlarged kidney, no CVAT, suprapubic tenderness UO: 1.5 L/24h, cloudy, white CBC: Hb 106, Hct 30%, WBC 6.98, Neu 68% Urea: 52.8, creatinine 615 mcmol/L Na 128, K 4.1 Urinalysis: WBC 500, RBC 80, protein g/L Abdomen US: hydronephrosis, ureteral dilation, thickened bladder wall Urine culture: A baumannii Dx: uncomplicated cystitis, ESRD, neurogenic bladder, type-2 DM Suprapubic area: vague tenderness Cervix: normal Bimanual palpation: uterus—size ~10 weeks of pregnancy, soft, bulky Transvaginal ultrasound: Asymmetrical uterine enlargement, thickened posterior myometrial wall, normal ovaries Dx: Adenomyosis Tx: hysterectomy Conscious, BP: 130/80, P: 80, t: 37.8, SpO2: 98% Other systems: intact CBC: HGB: 127, WBC: 15.9, Neu: 77%, Lym: 12%, PLT 507 PT 60%, INR: 1.23, aPTTr: 1.1, Fib: 6.5 ESR 1h/2h: 55/65mm CRP: 248, PCT: 0.06 AST/ALT: 34/54, Na/K/Cl: 133/4.3/92 Urinalysis: LEU: 100, Pro: 0.25, BLD: 10 Imaging: normal; microbiology: normal Ferritin > 2000 Dx: adult-onset Still’s disease A pinch of research 77 20 A pinch of research Reading Clinical trials How we evaluate the effectiveness of a new drug? We a clinical trial Before After 100 50 recovered New drug We can choose a group of patients with the disease of interest and give them the new drug After finishing treatment, we evaluate the improvement of the patients Before After New drug (intervention) 100 50 recovered Control 100 30 recovered But if there is an improvement, can we conclude that the new drug is effective? We can’t! One might argue that even if the patients are not treated with the drug, they will still improve naturally For example, uncomplicated sinusitis is self-limiting and does not require antibiotics Or one might compare the new drug with another drug and find that the old drug is actually more effective, thus discredit the benefit of the new drug Therefore, we need to compare the new drug (the intervention) with a control: either a placebo (it looks, smells, and tastes exactly the same as the new drug but has no active substance) or with another drug that is already approved for treatment But if there is a superior effect observed in the intervention group, can we conclude that the new drug is effective? We can’t, again! 200 patients RANDOMIZATION 1:1 Before After New drug (intervention) 100 35 recovered Control 100 45 recovered One might argue that there are more females in the intervention group, or patients in the control group are older In general, the two groups might not be similar, so we cannot compare them Therefore, we need to find a method to distribute the patients into two groups so that they are similar The best method so far is randomization It limits the chance the two arms are different, thus allows a valid comparison between them Even if there is now a superior effect observed in the intervention group, we will still have to be careful before concluding that the new drug is effective Why? 200 patients RANDOMIZATION 1:1 MASKING Before After Group A 100 40 recovered Group B 100 40 recovered One might argue that because the doctor knows a patient is in the intervention group, and he thinks that the new drug is effective, his evaluation is biased Or in many cases, the patients believe that the drug is effective, so they report more improvement Since this is a problem originating from the awareness of the random allocation, masking/blinding is introduced The doctors, patients, and other people in the study team not know which arm the patient is assigned to This limits the chance their evaluation is affected by personal belief or subjective feelings M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 78 Unit 20 Our study is a randomized controlled trial (RCT) It can be single-masked, double-masked, or even triplemasked An RCT without masking is called open-label or non-blinded A well-designed RCT provides the best evidence about effectiveness of a drug Before designing an RCT, the investigators must think over their research question Forming appropriate research questions is simple but important since it provides the foundation to decide how to conduct the trial A PICO question is a format used for clinical trials, consisting of: P Population (patients or people who participate in the study) “patients with mild to moderate acute respiratory infection visiting primary care clinics” I Intervention or Indicator (the topic of interests) “C-reactive protein point-of-care test” C Comparison (other measures to compare with the intervention) “no CRP POC test” O Outcome “reduce antibiotic use” In the example above, the PICO question can ask: “In patients with mild to moderate acute respiratory infection visiting primary care clinics [P], does the CRP POC test [I] reduce antibiotic use [O] compared with not using the CRP POC test [C]?”.70 Exercise Match the techniques with their purpose randomization to limit biases due to personal belief or subjective feelings of patients or study staff control to ensure the two arms are similar, and thus any difference at baseline is only due to chance masking to act as a reference to compare with the intervention Write your research question P QUESTION: _ _ I _ C _ O _ _ Provide the term for the following descriptions A study design used to evaluate the effectiveness and/or safety of an investigational product (e.g., a new drug, a device, a diagnostic algorithm) _ A kind of product that has the same quality as the investigational product except the active compound and is often used as a control _ The arm including patients taking the investigational product _ Errors made during measurement of trial outcomes _ An RCT without blinding _ A condition that can spontaneously stop without any intervention _ Than Lan Con English Center A pinch of research 79 Exercise Read the abstract70 and complete the table Background Inappropriate antibiotic use for acute respiratory tract infections is common in primary health care, but distinguishing serious from self-limiting infections is difficult, particularly in low-resource settings We assessed whether C-reactive protein point-of-care testing can safely reduce antibiotic use in patients with non-severe acute respiratory tract infections in Vietnam Method We did a multi-center open-label randomized controlled trial in ten primary health-care centers in northern Vietnam Patients aged 1–65 years with at least one focal and one systemic symptom of acute respiratory tract infection were assigned 1:1 to receive either C-reactive protein point-of-care testing or routine care, following which antibiotic prescribing decisions were made Patients with severe acute respiratory tract infection were excluded Enrolled patients were reassessed on day 3, 4, or 5, and on day 14 a structured telephone interview was done blind to the intervention Randomized assignments were concealed from prescribers and patients but not masked as the test result was used to assist treatment decisions The primary outcome was antibiotic use within 14 days of follow-up All analyses were pre-specified in the protocol and the statistical analysis plan All analyses were done on the intention-to-treat population and the analysis of the primary endpoint was repeated in the per-protocol population This trial is registered under number NCT01918579 Design cross-sectional If trial, is the study cohort randomized case-control controlled clinical trial masked? Study sites _ Population _ _ Intervention _ Comparison _ Outcome Primary: _ Secondary: _ Study procedures _ _ _ _ Can you explain the reason the authors conducted this study? Writing Presenting statistics Structure Example number/proportion/percentage + of + population + V Ninety percent of cases with hypertension in the general population are primary V: be / be affected / have / suffer from / complain of / develop / etc N + V + in + number/proportion/percentage + of + population V: be seen / be found / occur / happen / be present / etc MCR-1 is present in one third of the environment bacterial strains M E D I C A L E N GL I S H | S t u d y M a t e r i a l V 80 Unit 20 Exercise Write full sentences using the suggested words 25% / patients / this hospital / insurance / not covered US / 20%–30% / patients with acute pancreatitis / necrosis71 0.6%–1.0% / population worldwide / celiac disease72 25% of patients in this hospital are not covered by insurance _ _ 1/2 / diabetic patients / neuropathy73 _ approximately / 2/3 / patients with alopecia areata / younger than 30 years of age74 CRP trial / antibiotic activity in urine / 581 / 902 patients / control group70 between 50 and 90% / dialysis patients / blood pressure / greater than 140/90 mmHg75 paraneoplastic syndrome / estimate / 7%– 15% / patients with cancer76 90% / children / infect / RSV / first years of life77 _ _ _ _ _ 10 a study on children with idiopathic thrombocytopenic purpura / / 505 children / severe bleeding / after 28 days78 _ Review Below are the preliminary results of a study Provide the type of statistic for these results Sample 1500 Gender male = 1200, female = 300 Year of birth 1989 = 80%, 1990 = 20% Height 160-169 = 0.4, 170-180 = 0.6 BMI underweight : normal : overweight = : 43 : Level of English good = 150, medium = 1000, bad = 350 True (T) or False (F)? The prevalence of students who are underweight is 4% There are no incidences mentioned in the data From the data, we can calculate the number of students born in 1990 The proportion between students with good English and medium English is 15% Than Lan Con English Center References 81 21 References Sahebally SM, Burke JP, Nolan N, Latif A Synchronous presentation of acute acalculous cholecystitis and appendicitis: a case report Journal of Medical Case Reports 2011;5:551 Karunarathne S, Udayakumara Y, Fernando H Epstein-Barr virus co-infection in a patient with dengue fever presenting with post-infectious cerebellitis: a case report Journal of Medical Case Reports 2012;6:43 Bal AK, Kairys SW Kawasaki disease following Rocky Mountain spotted fever: a case report Journal of Medical Case Reports 2009;3:7320 Yoon S-H, Cho J-H, Jung H-Y, et al Exceptional mucocutaneous manifestations with amyloid nephropathy: a case report Journal of Medical Case Reports 2018;12(1):241 D'Aveni-Piney M, Divoux M, Busby-Venner H, Muller M, Broséus J, Feugier P Idelalisib in a patient with refractory Waldenström's macroglobulinemia complicated by anuric renal failure: a case report Journal of Medical Case Reports 2018;12(1):164 Sacks CA, Kilcoyne A, Wallace ZS, Glomski K Case 20-2018: A 64-Year-Old Man with Fever, Arthralgias, and Testicular Pain The New England journal of medicine 2018;378(26):2518-2529 Kao AY, Sagar P, Klig JE, Sharma A, Tomaszewski KJ Case 19-2018: A 15-Year-Old Girl with Acute Kidney Injury The New England journal of medicine 2018;378(25):2421-2429 Pallais JC, Fenves AZ, Lu MT, Glomski K Case 18-2018: A 45-Year-Old Woman with Hypertension, Fatigue, and Altered Mental Status The New England journal of medicine 2018;378(24):2322-2333 Ziperstein JC, Churchill TW, Hedgire SS, Dec GW, Stone JR Case 13-2018: A 53-Year-Old Man with Cardiomyopathy and Recurrent Ventricular Tachycardia The New England journal of medicine 2018;378(17):1622-1633 10 Choy E, Hornicek FJ, Chen Y-L, Rosenthal DI, Kerr DA CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL Case 26-2016 A 28-Year-Old Woman with Back Pain and a Lesion in the Lumbar Spine The New England journal of medicine 2016;375(8):779-788 11 Jevremovic V, Yousuf A, Hussain Z, Abboud A, Chedrawy EG A rare presentation of myxofibrosarcoma as a Pancoast tumor: a case report Journal of Medical Case Reports 2017;11(1):61 12 Sivakumar R, Pavulari S, Ellis S Fever of unknown origin: case presentation BMJ 2006;333(7566):484.1 13 Vella S, Coleiro B, Mallia Azzopardi C Fever of unknown origin: a challenging case BMJ case reports 2018;2018 14 GILLILAND BC Hemolytic Anemia In: The Autoimmune Diseases: Elsevier; 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Quality of pain page 13 > Taking a history > Modifiers > Describing history of present illness The past also matters > History page 16 > Taking a history > Describing past history Anatomy > Body systems