临床带教与英文查房 | 慢性阻塞性肺病（二）

小白老师说：Bedside teaching is seen as one of the most important modalities in teaching a variety of skills for the medical profession, which greatly improves certain clinical diagnostic skills in medical students and residents.

ll. In the Ward 在病房

Chief Resident**:** Hello, Mr. Black. Our Chief Physician and the Attending Physician are coming to see you.

住院总医师：你好，Black 先生，我们主任医师和主治医师都来看你了。

Patient**:** Good morning, doctors.

病人：早上好，医生们。

Chief Physician: Good morning, Mr. Black. l’m Dr. Clark. Could you tell me why you are here?

主任医师：早上好，Black 先生，我是 Clark 医生，能告诉我你为什么住医院的吗?

Patient**:** If only I know why. Anyway, I’m not as young as I was. Only a bit cold has brought me here. I feel so terrible!

病人：我知道就好了！确实是老了，得一点小感冒就得住院。真是糟透了!

Chief Physician**:** But you look not as old as you are. I suppose you were all well until this outbreak, weren’t you?

主任医师：不过你看上去可不老。我想你平时身体不错吧？

Patient**:** Nol at all. In fact, I’m always coughing and wheezing in the past decades. But it’s the first time I had to stay in hospital. You know, at the beginning, I was merely coughing, but it developed so fast that I couldn’t stand it any more. ( Coughing )

病人：才不是呢！其实，我都喘了几十年了。不过住院倒是头一回。要知道，一开始我也就是咳嗽，但是后来发展得太严重了，我实在受不了了！（咳嗽）

Chief Physician**:** Don’t worry, Mr. Black. What medication did you take before admission?

主任医师：别担心，Black 先生。你这次住院前有用什么药吗?

Patient**:** ( Taking out the bottle of salbutamol ) Here it is, but it did work anyway, except this time.

病人：（拿出沙丁胺醇的瓶子）就是这个，挺管用的，不过这次没用。

Chief Physician**:** Anything else other than it?

主任医师：除了这个还有其他的吗?

Patient**:** Mainly this, and sometimes the doctor gave me a few drugs or intravenous injections when I was badly coughing or wheezing.

病人：就是这个，有时候咳、喘得严重时，医生会给我一些药或者静脉注射。

Chief Physician**:** Have you felt better since admission?

主任医师：住院以后好点了没有?

Patient**:** Yes. I feel much better this morning.

病人：是的。今天早上我觉得好多了。

Chief Physician**:** You have done the test of pulmonary function, haven’t you?

主任医师：你以前做过肺功能检查吧？

Patient**:** Yes, several times.

病人：做过好几次了。

Chief Physician**:** Do you remember whether you were well when doing the previous one?

主任医师：你记得上一次做的时候有没有发病呢?

Patient**:** I remember that was six months ago in this summer. I was fairly well then.

病人：嗯，我记得那是 6 个月前，是夏天，当时我还挺好的。

Chief Physician**:** Mr, Black, you arc smoking, aren’t you?

主任医师：Black 先生，你抽烟是吧?

Patient**:** Yes, l have been smoking for 50 years.

病人：是的，我都抽了 50 年了。

Chief Physician**:** You know, guys, his smoking history is 100 pack a year, that is, if he smokes 1 pack per day, he has been smoking for 100 years. Now he said he had been smoking for 50 years, so we can conclude that he consumed 2 packs per day on average. Mr. Black, could we give you an examination?

主任医师：你们看，他吸烟史为100 包每年，也就是说，如果他每天吸烟 1包，那么烟龄为 100 年。现在他说自己烟龄为 50 年，因此我们可以得出结论，他平均每天吸烟 2 包。Black 先生，可以给你做个体检吗?

Patient**:** Sure.

病人：当然可以。

Chief Physician**:** Now Dr. Grey, could you do the examination?

主任医师：Grey 医生，你来做一下体检吧。

Intern**:** Certainly.

实习医生：好的。

( Intern is examining the patient. )

（实习医师检查病人）

Intern**:** The patient is a medium-sized male. He’s in consciousness and breathes at a regular rate of 22 per minute. The oral temperature is 36.7 ℃ and the pulse rate is 90 beats per minute ( bpm ).

The blood pressure is 155/95 mmHg. No edema in the face and eyelids. Cyanosis can be seen in the finger tips. And he has clubbed fingers. There’s no jugular varicosity or enlargement of superficial lymph nodes. The neck feels soft and the trachea is in the center.

There’s no three depressions sign or thyroid enlargement. He has bucket-like-

chest and pervasive rhonchi can be heard in bilateral lungs with a little wheezing rales. The vocal fremitus symmetrically decreases in bilateral lungs.

The heart rate is 94 beats per minute with no arrhythmia or murmurs. The abdomen feels soft with no tenderness or rebound tenderness. Murphy’s sign is negative and nothing special in neurological examination.

实习医生：病人体格中等。神清，呼吸频率为 22 次 / 分，节律规则。口温 36.7 ℃，脉搏 90 次 / 分。 血压 155 / 95 mmHg。面部及眼睑无水肿。指端有发绀，可见杵状指。颈静脉无怒张，浅表淋巴结无肿大。颈软，气管居中。无三凹征。甲状腺无肿大。可见桶装胸，两肺可闻及广泛干啰音及少量哮鸣音。双侧触觉语颤减弱、对称。心率 94 次 / 分，律齐，未闻及杂音。腹软，无压痛、反跳痛，Murphy 征阴性。神经系统检查无异常。

Chief Physician:All right. Done. Thank you for your cooperation, Mr. Black. Have a nice day.

主任医师好了，谢谢你的配合，Black 先生。再见。

Patient: Thank you, doctor.

病人：谢谢你，医生。