English in Medicine 9789646874

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English in Medicine Authors: M. Rafatbakhsh,MA S. Sajjadi,PhD N. Shokrpour,PhD F. Seddigh,MA A. Amalsaleh,PhD G. Kamyab,PhD A. Mahboodi, PhD

Edited & Supervised by: N. Shokrpour,PhD

Publications of Shiraz University of Medical Sciences

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English in Medicine Authors:

M. Rafatbakhsh,MA S. Sajjadi,MA N. Shokrpour,PhD F. Seddigh,PhD A. Amalsaleh,PhD G. Kamyab,PhD A. Mahboodi,PhD Edited & Supervised by:

N. Shokrpour,PhD Production Manager Saeed Nemati,DDS Publisher: Publications of Shiraz University of Medical Sciences Lithography: Parvaz

Printed by: Parvaz

Price:100000 Rials Circulation: 500 5th Reprint: 2015 ISBN: 978-964-687 4-48-0

Address: Publication Center, Shiraz University of Medical Sciences, Central Building, Zand st., Shiraz, Iran Tel: 071-32122443 Web Site: http://nashr.sums.ac.ir

Tel Fax: 071-32351865 Email: [email protected]

FOREWORD This textbook is designed to be used by the students of medicine and related fields at the universities in Iran. The main objective of the text is to help medical students develop an ability to handle the kind of written English that they will encounter during the pursu'it of their academic education. It is assumed that the student is thoroughly familiar with English orthography. Several types of exercise have been chosen to provide practice in the sub-skills as basic ingredients of reading materials. The primary objective of the exercises ( presented in the form of TIF questions, multiple choice comprehension questions, word •.formation practices and cloze tests) is building and expanding students' knowledge of vocabulary items, developing-their reading comprehension, and to lesser extent, improving their reading speed. The passages used in this volume are exclusively taken from D.V. James, Medicine, Prentice Hall, Hertfordshire, 1992. As to the reading passages, all the colleagues familiar with the book were in favor of their authenticity, variety and usefulness. So, a compromise was resorted to and suitable exercises were develope~. The . pilot edition of this volume issued in 1998 and underwent testing at shiraz University of Medical Sciences for 3 academic semesters and was revised on the basis of the pilot results.

Members of Publications Council of Shiraz University of Medical Sciences (Alphabetical) Manijeh Abdollahi , PhD Fatemeh Alishahian,BS Alireza Choobineh , PhD Mohammad Hassan Eftekhari, PhD Mahmood Haghighat, MD Seyed Basir Hashemi, MD Nahid Hatam, PhD Akram Jamshidzadeh , Pharm. D&PhD Seyed Mansour Kashfi, MD Seyed Fakhroddin Mesbah Ardekani , PhD Fakhraddin Naghibalhossaini, PhD Saeed Nemati, DMD Hammid Reza Pakshir , DMD. MScD Mohammad Reza Panjeshahin , PhD Ramin Ravangard, PhD Zahra Rojhani Shirazi, PhD Farkhondeh Sharif, PhD Nasrin Shokrpour, PhD

CONTENTS Section I 1. Epidemiology ( 1)

7

2. Medicine in an Unjust World

23

3. Malnutrition of Affluent Societies

41

4. Agency Nurses and Violence in Psychiatric Wards 5. The History of Drug Abuse 6. Infectious Diseases 7. Adrenergic Nerve Ending 8. A Case from the Out-patient Clinic

59 75 91

9. Mania

137 147

·

1O. Cystic Fibrosis 11 . Medical Oncology 12. Hernia 13. The Eyeball

14. The Importance of Biochemistry 15. Recent Progress in Health Care

Section II

Medical Terminology

107 121

163

182 199 213 229

247

Unit 1

Section One; Reading Qpmprehension Epidemiology (1)

The Clinical Spectrum I In the field of health care, normality and health are synonymous. Both states are difficult to define and are, therefore, not easy to measure. The World Health Organisation has defined health as 'a state of complete physical, mental and social well-b~ing and not merely the absence of disease or infirmity.' This is an idealistic definition and, if it were possible to quantify any of these terms, perhaps few people could be regarded as truly healthy. 2 However, in the population at any one time the majority of people will probably •.have no detectable abnormality and would, therefore, be regarded as normal. Some of the remainder will be apparently normal and yet will possess some characteristic, for example overweight, which will put them in a high risk category in relation to· the future chances of developing disease. Others will possess some precursor morbid state like atheroma, which has not yet given rise to any clinical circulatory impairment. A further group will show, on examination, signs of disease no~ previously r~ognised and not yet giving rise to symptoms. Some will have overt, recognisable signs and symptoms of disease and a few will have such advanced disease that they are in the process of cfying. There is thus a 'clinical spectrum' of disease in populations, ranging from health to terminal illness. In general, it is only those with recognised disease that tend to be seen as patients in hospital. They represent the tip of what has become known as the 'clinical iceberg'. Much disease, and most people who are at high risk of developing disease, remain undetected in the community (Fig'.1 ). Many people with health problems do not consult a doctor. 3 They either treat themselves or seek help from a neighbour or perhaps the local chemist (Table 1).

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4- Of the people who seek medical advice and help, most will first of all consult a general medical practitioner. Some two-thirds:\64 per cent, of illnesses seen can be considered minor and do not require referral to hospital (Table 1). On the other hand 15 percent are major, life threatening illnesses (Table 2) and the remainder chronic illnesses. As can be seen from these two tables respiratory illnesses, mostly of the upper respiratory tract, and mental disturbances make up the two main illness groups seen in general practice. Against the

Patients presenting to G.P. Patients with ' preclinical' disease

morbid states

People at high risk Nonnal people

Fig 1 The clinical iceberg. Table 1 S~ptoms self-treated and doctor-treated (Wadsworth, Butterfield and Blaney, 1971)

Groups ofsymptoms

Respiratory Mental Locomotor Gastrointestinal Central nervous system Skin Cardiovascular system Accidents

Others

percent self-treated

Percent doctortreated

26 21 15 11

63 80

37 20

61

39

78

22

8

59

5 4 3 7

73

41 27 42

Percent of all symptoms

58

78 47

22 53

(9)

background of such minor illness skill is needed to recognise patients in the early stages of more serious diseases~ a time when symptoms and clinical signs may be inconclusive. 5 Patients with serious illnesses or whose illness is difficult to diagnose will tend to be sent to hospital for either outpatient or inpatient treatment. Thus the hospital clinician is confronted with a highly selected. sample of patients and disease states. A house surgeon working in a general hospital may see and deal with two or three cases of acute appendicitis each day, whereas a general practitioner-will only come across four or five cases in the course of a year. 6

The tip of the 'iceberg' are those who are in a terminal state.

The importance of a disease in medical practice, in terms of how common and how severe it is, thus varies markedly from one level of presentation to another. 7

Table 2 Persons consulting for minor illnesses m a year m a hypothetical average practice of 2,500 Minor illne~s Conditions

'Consultations per 2,500 patients

General Upper respiratory infections Emotional disorders Gastrointestinal disorders Skin disorders

500 300 250 225

Specific Acute tonsilitis Acute otitis media Cerumen Acute urinary infections 'Acute back' syndrome Migraine Hay fever

100 75

50 50 50 30 25

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Part I. Comprehension Exercises '\

A. Using the information in the text, decide .whether the followtng sentences are true or false. -------1. Many people are not healthy according to WHO's definition of health. -------2. Some think that the absence of disease or infinnity is equal to health. -------3. Those who lack any signs and symptoms of disease are normal. -------4. The tip of the clinical iceberg includes only those with recognized disease. -------5. Most people who consider themselves ill are usually healthy. -------6. Many people turn to self-treatment as far as possible. -----••7. Specialists are more referred to than general practitioners. •------ 8.The tables show that respiratory illnesses are more prevalent than other kinds of diseases. ------· 9. According to paragraph 5, a GP faces more cases with appendicitis than a surgeon working in a hospital. ------10. The clinical spectrum covers the same population as the clinical iceberg. •····· 11 . In health care, there is no difference between health and normality,

B. Circle the letter next to the best answer. 1. The first paragraph implies that normality and health .can be measured if they are •-·~·-····. A. acquired B. complete D. examined C. definable 2. According to table 2, upper respiratory infections and emotional disorders are •-··. A. more common B. less curable C. hypothetical D. irregular 3. The WHO,s definition of health•···-·--- a person's personality. A. excludes B. covers C. rejects D. extends

(11)

4. Atheroma may lead to circulatory - - A. defect B. perfection C. nonnality D. recovery 5. Most people fall------ of the clinical spectrum. A. on the left-side extreme B. on the right-side extreme C. in the middle D. on the margins 6. According to the text and table 1, when a person feels sick, it is most likely that he ----. A. turns to self treatment B. consults a general practitioner C. goes to the nearest hospital D. hides his abnonnal state

7. Overweight people fall in the category -----. A. of those having no detectable abnonnality B. with signs of disease not previously recognized C. with a high risk of developing disease D. of those having some precursor morbid state 8. The terms used in WHO's definition of health are -------· A. not definable

B. not quantifiable C. idealistic D. difficult to qualify

Part II. Lanauage Practice

A. Circle the letter next to the best answer. 1. Nurses should ------- the necessary patience and tact to do their job well. A. avoid B. possess C. contain D. establish 2. Some sounds cannot be---- by the human ear.

A. determined

B. supplied

C. detected

D. dislocated

(12)

3. The findings were - - - ; the researchers could not find any solution to the problem. A. inconclusive B. convincing C.persuasive D. definite 4. Nothing can---------- what she lost during the war. A. accumulate B. aggregate C. conform to D. compensate for

5. The symptoms were --------; so the doctors could not diagnose what the disorder migh! be. A. sufficient B. inadequate C. acute D. mild 6. A community in which health care is-------- only rich people can have access to it. A. rehearsed B. purchased C. prompted D. rendered 7. If wealth is----------- ewnly, poverty will come to an end.

A. distributed C. accumulated

B. modified D. supplied

8. The------------ growth in the patient's body resulted in his death.

A. mild · C. morbid

B. rough D. benign

9. Once the medical. examination had----that there was nothing

seriously wrong with me, I felt much better. A. recognized , B. determined D. distinguished C. diagnosed 1O. Is health or w~th the main -------- in following a happy life? A. observance B. obstacle C. determinant D. barrier

(13)

11 . Although his family were very worried, the patient --------- the disease with great determination. B. scared A. confronted D. prolonged C. impaired 12. You had better ---- ------ a doctor about your rash. A. threaten B. endanger C. convince D. consult 13. Their enthusiasm might work to their ----------, because they do not consider the problems. A. benefit B. quality C. merit D. disadvantage

14. Most people don't want their children to----------- drug addicts and alcoholics. A. withdraw from B. disapprove of C. associate with D. refrain from 15. In this article the author tries to ----------- different aspects of

health. A. deal with C. carry on

B. pick up D. meddle in

(14)

Section Two: Further Reading The Epidemiological Approach to Medicine

Populations and Diseases . Epidemiology may be defined as the study of the distribution and determinants of disease in populations. The study of disease patterns in human populations is an early step in a chain of processes that ends in identifying the cause of disease. If cause can be identified, then it may be a relatively easy matter to prevent a disease from occurring. It makes sense to prevent, rather than to try to treat, often inadequately, the late effects of disease processes. Yet at present, and in most countries, far more money is spent on 'curative medicine' than on 'preventive medicine' . Time, Place, Persons It has been known since the time of Hippocrates that personal, place and time factors influence whether or not people become ill. Age and Sex Of the personal factors, age is one of the most important. In developed countries death rates, except in the first year of life, are very low until middle age or late middle age, when they begin to rise steeply (Fig. 1). Because of this marked association, the age structure of populations must be taken into account when attempts are made to compare death rates. Various standardisation techniques are available to make this possible. In developing countries, death rates in' the first few years of life are usually very high: in some areas more than 50 per cent of children die before the age of five. Infant mortality rates -- deaths in the first year of life -- are a useful index of the 'healthiness' or otherwise of a country.

The sex of an individual is also an important determinant of health or disease. The male appears to be the biologically weaker sex, and death rates are higher for males than for females at almost every age. •

( 15)

Death rates/ 100 000 2000 1000

I i

100

)

I

10

1