(规培)英语重点

2021年2月11日发(作者：spta)

临床英语考试要点（

2011

年）

Chapter 1 patient-physician interaction

（第二四段）

The increasing availability of evidence from randomized trials to guide the approach to

diagnosis and therapy should not be equated with

“

cookbook

”

medicine. Evidence and the

guidelines that are derived from

it emphasize proven approaches for patients with specific

characteristics. Substantial clinical judgment is required to determine whether the evidence

and guidelines apply to individual patients and to recognize the occasional exceptions. Even

more judgment is required in the many situations in which evidence is absent or inconclusive.

Evidence

also

must

be

tempered

by

patients

preferences,

evidence

when

presenting

alternative potions to the patient. The adherence of a patient to a specific regimen is likely to

be

enhanced

if

the

patient

also

understands

the

rationale

and

evidence

behind

the

recommended option.

但是，

不断增多的可用于指导临床诊断与治疗的随机试验资料不应当作< /p>

“烹调书”

使用。因为随机

试验获得的现 象和思路是侧重于求证具有某些特征病人而来的。

实际的临床判断需要确定这些临床表现

和诊断标准是否能应用于病人个体，

并能找出例外。在许多情况 下，临床表现缺乏或不典型，需要考虑

更多的判断。

虽然医生有 责任要提出选择性问题让病人回答，

但病人肯定会根据自己的倾向调节临床症

< p>
状。假如病人懂得基本原理和表现，对医生提出的问题，有特殊生活方式病人的固执容易被强化。< /p>

Even

as

physicians

become

increasingly

aware

of

new

discoveries,

patients

can

obtain

their own information from a variety of sources, some of which are of questionable reliability.

The increasing use of alternative and complementary therapies is an example of patients

’

frequent

dissatisfaction

with

prescribed

medical

therapy.

Physicians

should

keep

an

open

mind regarding unproven options but must advise their patients carefully if such options may

carry any degree of potential risks, including the risk that they may relied on to substitute for

proven approaches. It is crucial for the physician to have an open dialogue with the patient

and family regarding the full range of options that either may consider.

甚至，

当医生越来越容易知道新发现的同时，

病人也能够通过各种资源得到 他们的信息，当然，

某

些信息是不可靠的。替代疗法和辅助疗法 的应用不断增加就是病人对常规疗法经常不满意的一个例子。

医生对未证实的疗法应该保 持开放的思想，

但是，

如果这些疗法具有任何程度的潜在风险，

都必须细致

地告知病人，

包括可能需要 用已证实的常规疗法去替代的风险。

对医生来说，

对病人及家属 开诚布公地

介绍所有可考虑的治疗选择，是非常重要的。

临床英语考试要点（

2011

年）

Chapter 4 (

第二段

)

Many aspects of palliative care, as with any specialty, are relevant to the general practice

of medicine and to all clinicians who tend to dying persons. Palliative care has a role in the

earliest phases of a life-threatening illness but assumes a more prominent or even dominant

role in the final 3 to 6 months of common terminal conditions

：

advanced cancer

，

heart and

lung

failure,

end-stage

liver

and

renal

disease,

acquired

immunodeficiency

syndrome,

and

life-limiting neurologic diseases.

姑息性治疗的特性通常与药物治疗和所有治疗临终病人的医生相关 的。

姑息性治疗可以用于临终病

人的早期治疗，但其最重要和突 出的使用是针对终末期的最后

3

至

6< /p>

个月时间

:

如患有晚期癌症、心肺

衰竭、晚期肝肾疾病，艾滋病和致命的神经系统疾病的病人。

Chapter 8(

第二段，末段部分

)

A second way in which older adults differ from younger adults is the greater likelihood

that their diseases present with nonspecific symptoms and signs. Pneumonia and stroke may

present

with

nonspecific

changes

in

mentation

as

the

primary

symptom.

Similarly,

the

frequency of silent myocardial infarction increases with increasing age, as does the proportion

of patients who present with a change in mental status, dizziness, or weakness rather than

typical chest pain. As a result, the diagnostic evaluation of geriatric patients must consider a

wider spectrum of diseases than generally would be considered in middle-aged adults.

老年与青中年的第二个差异是更容易出现非典型的症状和体症。

肺炎和中风时可出现非特异性意识

变化作为主要的症状。

同样地，

隐匿性心肌梗塞发生频度随着年龄的增大而增加，

< br>这些病人相应地频发

精神状态改变、眩晕、虚弱而不是典型的胸痛症状。因此，老 年病人的诊断应考虑更广泛的疾病谱，要

超过通常对中年病人所考虑的范围。

< p>

Finally, a serious and common outcome of chronic diseases of aging is physical disability,

defined

as

having

difficulty

or

being

dependent

on

others

for

the

conduct

of

essential

or

personally meaningful activities of life, from basic self-care (e.g., bathing or toileting) to tasks

required to live independently (e.g., shopping, preparing meals, or paying bills) to a full range

of activities considered to be productive and/or personally meaningful. Of older adults, 40%

report difficulty with tasks requiring mobility, and difficulty with mobility predicts the future

development

of

difficulty

in

instrumental

activities

of

daily

living

(IADL;

household

management tasks) and activities of daily living (ADL; basic self-care tasks).

最后，

老年人慢性病严重又常见的结果是身体能力不足，

描述为个人最基本的或有意义的日常活动

有困难或不得不依靠别人帮助指导，

从基本的自理

（如洗澡或如厕）到独立生活需要的各种任务

（如购

物、做饭、支付各种账单）

，到具有集体和／ 或个人意义的所有活动。在老年人中，

40%

对需要运动

的任务有困难，运动困难提示将来开展日常工具锻炼（

IADL

；家庭护理项目）和目常锻炼（

ADL

；基

本自理项目）的困难。

临床英语考试要点（

2011

年）

< br>

Chapter 12(

第三六段

)

The initial approach to a patient with iron deficiency anemia depends on the presence of

symptoms

referable

to

either

the

upper

or

lower

gastrointestinal

tract.

Regardless

of

the

findings on the initial upper or lower endoscopic examination, all patients should have bath

upper and lower endoscopy because the complementary endoscopic examination has a yield

of 6% even if the first one was positive. For premenopausal women, a positive FOBT requires

full evaluation, as does iron deficiency anemia. Barium radiographs of the upper and lower

gastrointestinal

tract

have

limited

utility

in

the

setting

of

occult

bleeding

because

of

their

inability to biopsy or treat lesions that are identified.

缺铁性贫血病人的早期检查方法要根据存 在的症状是提示上消化道还是下消化道。

无论首次上消化

道或下 消化道内窥镜检查会有何发现，所有病人两个检查都应该做，因为互补的内窥镜检查有

6 %

的再

发现，

即使第一次检查是阳性的 。

对绝经前妇女，

大便隐血试验阳性需要全面分析，

< p>
缺铁性贫血也一样。

隐匿性出血时，上、下消化道的钡剂造影应用有限，因 为它们不能活检或治疗发现的病损。

A

new

device

for

visualizing

the

entire

gastrointestinal

mucosa

consists

of

images

to

receivers

attached

to

the

patient

’

s

abdomen

and

mapped

to

identify

the

location

of

the

image. The diagnostic yield of capsule enteroscopy is not yet clear, but this approach may

potentially

visualize

segments

of

the

small

bowel

that

were

previously

inaccessible.

No

therapeutic maneuvers are possible with the device.

一种新的装置能显示全部胃肠粘膜，

这种装置由一颗装有小型摄像机能咽下的胶囊组成，

它将

（数< /p>

字）

影像信号传到附着在病人腹部的接收器，

并绘制出图像来识别影像的位置。

胶囊小肠镜的诊断效率

现 在还不清楚，

但是，

这种方法可能显示出以前难以接近的小肠肠 管。

但这个装置不可能有任何治疗性

操作。

Chapter 25(

第

1< /p>

、

4

章

)Def inition

The

first

signs

or

symptoms

of

cancer

are

frequently

due

to

metastases

to

visceral

or

nodal sites. In most such patients, routine clinical evaluation with a comprehensive history,

physical

examination,

complete

blood

cell

count,

screening

chemistries,

and

directed

radiologic evaluation of specific symptoms or signs identifies the primary tumor. Patients who

have

no

primary

tumor

located

after

this

routine

clinical

evaluation

are

defined

as

having

cancer

of

unknown

primary site. Further

clinical

and

pathologic

evaluation

will

identify the

primary site in only a small minority of patients, and about 80% will never have a primary site

identified during their subsequent clinical course.

肿瘤首发症状和体征通常 是由于脏器或淋巴结转移引起的。对此类

病人，需要进行常规 临床检查

和全面的病史回顾、

体格检查、

全血计数、

生化筛查和对特定症状体征进行放射学检查以确定原发病灶。

经过常规临床检查后不能发现原发病灶的被称为原发灶不明的肿瘤。

仅有小部 分病人经过进一步的临床

和病理检查可以确定原发病灶，约

80 %

的病人在后续的临床诊疗中无法确定原发病灶。

临床英语考试要点（

2011

年）

Since all patients with cancer of unknown primary site have advanced disease, therapeutic

nihilism

has

been

common.

However,

it

is

now

evident

that

this

heterogeneous

group

contains

subsets

of

patients

with

widely

diverse

prognoses;

some

cancers

are

highly

responsive

to

treatment,

and

some

patients

may

have

a

substantial

chance

of

achieving

long-term survival with appropriate treatment. The initial clinical and pathologic evaluation

should therefore focus on identifying a primary site when possible and on identifying patients

for whom specific treatment is indicated.

由于原发灶不明肿瘤病人往往为晚 期病人，

治疗效果往往受到质疑。

但是，

现在比较明确的是这类

特殊患者的预后差别很大，

一些癌症患 者对治疗高度敏感，

也有部分患者通过适当治疗生存期很长。

因

此临床和病理检查的出发点应当时寻找原发病灶和识别对特殊治疗有效的患者。

Chapter 28(

第二段

)

Complications

can

occur

for

a

variety

of

reasons.

A

surgeon

can

perform

a

technically

perfect operation in a patient who is severely compromised by the disease process and still

have

a

complication.

Similarly,

a

surgeon

who

is

sloppy,

is

careless,

or

hurries

through

an

operation can make technical errors that account for the operative complications. Finally, the

patient can be doing well nutritionally, have an operation performed meticulously, and yet

suffer a complication because of the nature of the disease. The possibility of postoperative

complications

is

a

part

of

every

surgeon

’

s

thought

processes-something

with

which

all

surgeons will be required to deal.

外科并发症的发生有多种原因。

有时，

外科医生 手术技术上非常成功，

但病人的病情严重可导致并

发症的发生。 同样，

手术中医生的马虎、

粗心或仓促都可以导致技术上的错误 从而导致手术并发症。

即

使病人营养状况良好，

手术也很成功，

疾病本身也可导致并发症的产生。

手术 后并发症的可能性是每一

个外科医生考虑治疗计划的一个组成部分，因为所有外科医生都 将面临这些并发症中的一部分。

Chapter 30 (

末段

)

Pneumonia and influenza (P+I)-related deaths fluctuate annually, with peaks in the winter

months.

When

such

P+I

deaths

exceed

the

predicted

number,

it

is

due

to

influenza

A

or

occasionally to influenza B virus or respiratory syncytial virus activity. Although mortality is

greatest during pandemics, substantial total mortality occurs with epidemics. Over 85% of P+I

deaths occur among persons aged 65 and older. Other cardiopulmonary and chronic diseases

also

result

in

increased

mortality

after

influenza

epidemics,

so

that

overall

influenza-associated mortality is about two-to fourfold higher than P+I deaths.

与肺炎和流感

(P+I)

相关的死亡每年都在波动，冬季达到 高峰。当肺炎和流感的死亡超过了预期数

值，是由于

A

型流感或者偶尔因为

B

型或者呼吸道合胞病毒的 活动性所致。尽管大流行的时候病死率

最高，普通流行时候的病死率也非常可观。超过< /p>

85%

的

P+I

死亡发生于

65

岁以上的人群。流感流行

之后，其它心肺疾病和慢性病同样导致病死率有所增高，以至于总体流感相关的病死率比

P+I

导致的

病死率高出

2-4

倍。