Tài liệu Tlc me learning document v1.0

MEDICAL ENGLISH THAN LAN CON ENGLISH CENTER This learning material is made by Hoang Bao Long, MD and is a property of Than Lan Con English Center. Contents Language Points.................................................................................................................. 4 Skills .................................................................................................................................. 6 Introduction ........................................................................................................................ 7 Chapter 1: Medical Terminology........................................................................................ 11 Chapter 2: Hospitals And Medical Schools ......................................................................... 15 Chapter 3: History Taking.................................................................................................. 22 Chapter 4: Anatomy .......................................................................................................... 35 Chapter 5: The Systems ..................................................................................................... 45 Chapter 6: Physical Examination........................................................................................ 50 Chapter 7: Cardiovascular Diseases.................................................................................... 53 Chapter 8: Investigations ................................................................................................... 61 Chapter 9: Respiratory Diseases ......................................................................................... 70 Chapter 10: Diagnosis ....................................................................................................... 77 Chapter 11: Abdomen and Pelvis ....................................................................................... 84 Chapter 12: Other Conditions............................................................................................. 89 Chapter 13: Management ................................................................................................... 97 Chapter 14: Medical Research...........................................................................................112 Appendix 1: Presentation ..................................................................................................121 Language Points Û Point 1: Latin-based medical terms ............................................................................... 11 Û Point 2: Vocabulary – Some first Latin roots ................................................................. 12 Û Point 3: Hospitals ........................................................................................................ 15 Û Point 4: Vocabulary – Terms about hospitals ................................................................. 17 Û Point 5: Medical schools .............................................................................................. 19 Û Point 6: Topics of questions.......................................................................................... 22 Û Point 7: Some common terms of past history ................................................................. 24 Û Point 8: Summarizing symptoms................................................................................... 27 Û Point 9: Vocabulary - Symptoms .................................................................................. 28 Û Point 10: Divisions of Anatomy .................................................................................... 35 Û Point 11: Vocabulary – Common anatomical terms ........................................................ 38 Û Point 12: Describing anatomical details ......................................................................... 41 Û Point 13: Physical examination ..................................................................................... 50 Û Point 14: Writing description of signs ........................................................................... 51 Û Point 15: Valvular heart diseases .................................................................................. 53 Û Point 16: Thromboembolism ........................................................................................ 54 Û Point 17: Vocabulary – Thromboembolism.................................................................... 56 Û Point 18: Cardiovascular examination ........................................................................... 56 Û Point 19: Describing heart sounds ................................................................................. 58 Û Point 20: Types of investigations .................................................................................. 61 Û Point 21: Vocabulary – Some more Latin roots .............................................................. 65 Û Point 22: Describing and interpreting laboratory findings ............................................... 67 Û Point 23: Vocabulary – Some more Latin roots .............................................................. 68 Û Point 24: Vocabulary – Some more Latin roots .............................................................. 76 Û Point 25: Types of diagnosis ......................................................................................... 77 Û Point 26: Vocabulary – Diagnosis ................................................................................. 77 Û Point 27: Explaining your diagnostic approach .............................................................. 77 Û Point 28: Diagnostic criteria ......................................................................................... 81 Û Point 29: Vocabulary – Some more Latin roots .............................................................. 87 Û Point 30: Nervous system ............................................................................................. 89 Û Point 31: Infectious diseases ......................................................................................... 92 Û Point 32: Kidney diseases ............................................................................................. 94 Û Point 33: Vocabulary – Emergency medicine ................................................................. 95 Û Point 34: Drug information......................................................................................... 100 Û Point 35: Writing a prescription .................................................................................. 104 Û Point 36: Vocabulary – Monitoring and prognosis ........................................................107 Û Point 37: Vocabulary – Management ...........................................................................108 Û Point 38: What is research? .........................................................................................112 Û Point 39: Common biostatistic terms ...........................................................................115 Û Point 40: Expressing numbers, proportions and percentages ..........................................117 Skills ` Skill 1: Looking up the terms ....................................................................................... 14 ` Skill 2: Different word classes of a word....................................................................... 18 ` Skill 3: Types of questions ........................................................................................... 22 ` Skill 4: Searching for terms in a topic ........................................................................... 24 ` Skill 5: Writing English ............................................................................................... 29 ` Skill 6: Review of noun modifiers ................................................................................ 31 ` Skill 7: Skimming ....................................................................................................... 37 ` Skill 8: Reading flowcharts .......................................................................................... 65 ` Skill 9: Reading tables and charts ............................................................................... 118 Introduction Welcome to Than Lan Con English Center. You are looking at the learning document specifically designed for students studying medical English at TLC. Please read this chapter very carefully. (I) This is not a reference book; hence, we do not cover everything about medical English in this document (and actually we do not wish to do so). What we are doing is trying to provide you a solid foundation to base your continuity of learning on. Thus, a learner who wishes to learn everything about medical English shall never feel satisfied with the course (and once again, we do not wish you to do so). Medical English is extremely broad since it is composed of jargons from all the fields of science, and learning every term over a short course is impossible and insensible. At TLC, we help you start with some basic knowledge, serving as a good example for self-study, then, over time, you will maintain your own research into medical English. (II) The most appropriate people to participate in this medical English course are general doctors and medical students who have an acceptable level of general English (equivalent to B1 or IELTS 5.0) and want to learn medical English for daily use (e.g., to read medical literature in English, to discuss with English-speaking colleagues, or to write medical notes in English). If your level is inferior to this requirement, we strongly recommend you to start your learning with a basic course of general English. If your purpose is other than daily use, for instance, to pass the examination in the medical schools, we suggest you to find another course. And since we focus on English for clinical medicine, people working in dentistry, pharmacy, nursing and other specialties less related to clinical practice might not sufficiently benefit from the course. (III) Our course is designed: 1. To provide learners with basic English medical terms and expressions that are required for clinical practice in the Vietnamese hospital settings; 2. To facilitate learners to use learning tools to study medical English (i.e., preparing and delivering presentations, looking up in the Internet and medical textbooks, and teamwork); 3. To introduce self-study methods and encourage learners to continue self-study after finishing the course. The document, therefore, will reflect our three educational goals. You 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. Since this document has a supportive nature, it cannot replace the actual learning with lecturers at TLC. We have, of course, tried to make it as ready as possible for you so that even if you miss a learning session, you will still be able to review the document and learn from it. In this course, medical English is developed within the framework of clinical medicine. Therefore, we will take you through all the fundamental and clinical subjects. This is not necessarily a review of clinical medicine, but you will feel that learning medical English is easier and more profound if you have already possessed a certain amount of clinical knowledge. (IV) There are two main sections in this document: 14 learning chapters where you find new knowledge points, exercises and skill introduction, and 01 appendices where additional but helpful topics are discussed. Learning sessions at TLC might not fully cover all the knowledge points mentioned in the document; however, learners are encouraged to study the remaining knowledge points as a practical exercise for self-study. (V) We divide each chapter into several sections, and you will realize them by the symbols: Symbol Section Description Û Knowledge points We provide knowledge points in a variety of formats – most of them will be in a context. Context-based learning has been proved to facilitate the memorization of knowledge. We also provide you a small group of most commonly used medical terms and expression, with some fundamental language points at the beginning and, over time, more extensive sets of medical terms. This will help you get acquainted with the breadth and depth of medical English. J Exercises You will practice the use of knowledge points with a set of dynamic exercises. They do not only help you repeat the knowledge points you have learned, but also guide you on selfstudy. We do not provide keys for the exercise (and usually, due to the nature of the exercises, keys are not required). There are two types of exercises: individual tasks and group tasks (marked with INDIVIDUAL or GROUP at the beginning of the exercises’ description). For individual tasks, you can do them yourselves and even before going to the class. For group tasks, it is recommended to work in groups for the information exchange and collaboration can promote better understanding of the language points. ` Skill introduction To serve the third educational goal, we dedicate a separate section guiding you on several skills. They will support you on your self-study activities after you have finished the learning course with TLC. (VI) Learning terminology Medical terminology is the utmost part of importance in learning medical English, but also the biggest challenge for learners. It is nevertheless not insurmountable if you understand the learning method. Please keep in mind the following points: 1. Many medical terms are the combination of Latin roots, prefixes and suffixes. Instead of learning individual words, you are therefore recommended to spend time on learning these Latin elements and how to combine them. Again, context-based learning helps reduce the boring quality as well as the time spent on this study. 2. Many Latin roots are the equivalent words for body parts. You will need to take a short course over gross anatomy to memorize all the important body structures (both the common English terms and academic Latin roots) before continue to learn terms related to symptoms, signs and diseases. 3. What are covered in this document? - Basic anatomical terms, and names and Latin roots of important body structures. - Symptoms and signs, and relevant terms about history taking and physical examination. - Names of common diseases. - Some common investigations. - Basic terms regarding patient management. The following topics are covered: cardiovascular system, respiratory system, gastrointestinal system, urinary system, nervous system and infectious diseases. (VII) You might wonder why the document is purely in English. We do have several reasons: 1. The easiest way to understand English is to use it. Circumventing your learning by taking all the words through Vietnamese will slow down your progress, and more importantly, prevent you from feeling the language’s common sense which is essential for a reflexive, natural and fluent English. We want you to memorize in English, think in English and respond to English in English. 2. Many medical terms are not the same in Vietnamese. For example, sepsis is not “nhiễm khuẩn huyết” (possibly roughly translated as bacteremia) as many doctors usually call it. Sepsis is an infection (caused by any pathogen infected in any organ) resulting in the systemic inflammatory response syndrome (SIRS). Both the word “nhiễm khuẩn huyết” and its definition currently used in the Vietnamese contexts do not correctly reflect the definition of sepsis. 3. Learning medical English in this way requires you to refer to English textbooks. There is a discrepancy between the clinical knowledge in Vietnam and in other countries. We encourage you to explore the clinical knowledge in English textbooks because we personally feel that this knowledge is more systematic, structural, clear, concise, precise and practical. It firstly solidifies your medical knowledge, then provides you a common language to interact with international experts. Changing your mindset in learning foreign languages might be difficult at first, but over time, your reflex will quickly grow. As soon as you have get acquainted with handling an English document without support from Vietnamese, you will memorize the language points faster, more easily and for a longer term. Finally, we wish you good luck. Please use the document wisely! TLC ENGLIS H CENTER | Medical English | Learning Document V1.0 Chapter 1: Medical Terminology J EXERCISE 1 (INDIVIDUAL) Look at the following terms and underline the part that you think to be in common. 1 hematology, hemolysis, hematemesis, hemoptysis, hemopneumothorax 2 cardiovascular, endocarditis, cardiac arrest, cardiectomy, cardiopulmonary resuscitation 3 urinalysis, urolithotomy, pyuria, dysuria, urology 4 cystectomy, nephrectomy, gastrectomy, hepatectomy, thyroidectomy 5 anaphylaxis, anemia, apnea, asystole, anuria J EXERCISE 2 (INDIVIDUAL) Match each word in the left column with ONE word in the right column that you think to be the most relevant. 1 post-surgical complication glomerulus A 2 Dengue hemorrhagic fever hemorrhage B 3 pansystolic murmur interstitium C 4 glomerulonephritis systole D 5 interstitial lung disease digestive surgery E Û POINT 1: LATIN-BASED MEDICAL TERMS A large portion of medical terms shares the Latin and Greek origin. You can understand a term by breaking it into word parts and combining their meaning. There are three major components of a term: roots (some can stand alone but most are combined with prefixes and/or suffixes), prefixes (they stand before the roots and can never stand alone), and suffixes (they stand after the roots and can never stand alone). Roots themselves have meanings, but prefixes and suffixes modify the roots by adding further meaning to them. ENDO/CARD/ITIS endo- = “inside” cardio- = “heart” -itis = “inflammation” Prefix Root Suffix = an inflammation inside of the heart (the inner layer of the heart is called “endocardium”) 11 TLC ENGLIS H CENTER | Medical English | Learning Document V1.0 J EXERCISE 3 (INDIVIDUAL) You now will see a chart presenting the annual income of doctors in different specialties1 . Look at the terms in the chart and use any tools to understand the meaning of these specialties. Try to explain the meaning of the roots. Many names of the specialties end with -logy. This suffix means “the study of”; for example, cardiology can roughly be translated into “the study of the heart”. A cardiologist is a scientist who studies about the heart (and its diseases); so, the -logist suffix implies a specialist. Û POINT 2: VOCABULARY – SOME FIRST LATIN ROOTS Root Explanation cardiodermato-/dermo- skin entero- intestine gastro- stomach hemo-/hemato- blood immuno- immune system myo-/myos- muscle nephro1 heart kidney http://www.medscape.com/features/slideshow/compensation/2015/public/overview/ 12 TLC ENGLIS H CENTER | Medical English | Learning Document V1.0 neuro- nerve onco- tumor ophthalmo- eye patho- disease uro- urine -itis inflammation -logist a person who studies about -logy the study of endo- inside peri- surrounding J EXERCISE 4 (INDIVIDUAL) What do the following terms mean? Latin term 1 pericarditis 2 endophthalmitis 3 pathologist 4 nephritis 5 Explanation gastritis 6 inflammation of the stomach and the intestine 7 a doctor who studies about tumors 8 inflammation of the nerve 9 a doctor who studies about the urinary system 10 inflammation of the skin and muscle 13 TLC ENGLIS H CENTER | Medical English | Learning Document V1.0 ` SKILL 1: LOOKING UP THE TERMS When you meet a new term and you cannot guess its meaning (because you do not know the roots, for instance), it is best to look it up in English. Do not try to ask anyone for its definition in Vietnamese, because the two terms in English and Vietnamese might not be equivalent. There are several ways to look up the words: 1. Googling the term: Just type the term in Google. Most simple terms will give you a simple explanation in the several first results. See the image below for the search results of cardiologist. Even if you cannot understand the whole sentence, you can still guess the meaning of the term by looking for keywords; in this example, “doctors” and “heart and blood vessels” suggest that a cardiologist is simply called a “heart doctor”. 2. Looking for the meaning of the roots: Try to look up cardiologist on http://en.wiktionary.com. In addition to the explanation of the term, you can refer to the Etymology section for the structure of the term and click on each word part for further explanation. 14 TLC ENGLIS H CENTER | Medical English | Learning Document V1.0 Chapter 2: Hospitals And Medical Schools Û POINT 3: HOSPITALS Types of hospitals The hospitals in Vietnam manage patients within a district, a province, a region or the entire nation; hence, there are district hospitals, provincial/town hospitals, and regional/central/national hospitals. Most of the hospitals are general hospitals, which mean they manage patients with all sorts of medical conditions. There are some hospitals specialized in only one group of diseases, for instance, surgical conditions; they are called specialist hospitals. The story of Mr. Chung Mr. Chung, a 40-year-old officer, had been experiencing high fever for several days. He had thought it was just some viral fever until he started to feel short of breath. He was taken to the emergency room (ER) in a provincial hospital. A junior doctor did the initial evaluation with history taking and physical examination. On measuring vital signs, he had high fever, pulse rate and blood pressure were within normal ranges, his breathing was fast, and the oxygen saturation was low. These abnormal breathing signs indicated respiratory failure, an emergency condition. She requested the team to initiate the management for Mr. Chung with oxygen therapy. However, his condition appeared not to improve. Because the hospital did not have ventilators, the ER doctor decided to transfer the patient to a specialist hospital. She wrote a referral letter, mentioning the provisional diagnosis of pneumonia. At the specialist hospital, Mr. Chung was admitted to the intensive care unit (ICU). The definitive/final diagnosis of pneumonia was made after a bedside chest X-ray was ordered. Further investigations also revealed anemia which required some more testing for differential diagnosis. He was put on ventilation and treated with antibiotics. Blood tests were done every day to monitor his inflammatory response and anemia. He was lucky that no other interventions, such as arterial line, were required. After two weeks staying in the ICU, Mr. Chung had recovered very well. He was then transferred to the Respiratory Department to continue treatment. Two weeks later, he was discharged home with some prescription medications and the ward doctor required him to return to the outpatient clinic (OPC) after one month for follow-up. J EXERCISE 5 (INDIVIDUAL) Tick “X” in the appropriate types for the following hospitals. District hospital Provincial/town hospital Central/national hospital General hospital Specialist hospital Bach Mai Hospital National Hospital for Tropical Diseases Vietnam National Children’s Hospital Viet Duc University Hospital Ba Vi Hospital Hung Yen Hospital 15 TLC ENGLIS H CENTER | Medical English | Learning Document V1.0 J EXERCISE 6 (INDIVIDUAL) Fill in the blanks with appropriate words (refer to the Reading section). 1. Words to describe “a place receiving and treating patients”: room 2. Blood pressure, pulse rate, respiratory rate, and temperature are called _______________. 3. When you have a new patient, you need to _______________ him/her. This includes ______________________________ and ______________________________. 4. You find that a patient has respiratory failure. It is considered an ______________________________ and he needs immediate _______________. 5. There are three kinds of diagnoses. We make a _______________ diagnosis when we first examine a patient. However, patient’s clinical picture can suggest other conditions; therefore, we need to make a list of _______________ diagnoses and order some investigations to confirm our diagnosis. In most cases, we will come to a final conclusion, and this is called _______________ diagnosis. 6. When patients have a health problem, they can come to the ______________________________ or the ______________________________ for check-up. Some patients can return home, but some have to be _______________ to the hospital. In the hospital, doctors can _______________ some _______________, including blood _______________ and medical imaging such as X-ray. Patients will be _______________ with _______________ (e.g., antibiotics, antacids, antidiabetics, or antihypertensives, etc.) or _______________ (e.g., intubation, arterial line insertion, etc.). The doctors will _______________ the patients’ progress to see if they are _______________ or get worse. If the patients _______________ well, they can be _______________. Some patients are required to return to the hospital for _______________. 7. Fever, respiratory failure, and anemia can be called _______________ in general. 8. If a hospital is unable to manage the patient’s condition, they can _______________ the patient to another hospital. They will write a ______________________________ which mentions all necessary information. 16 TLC ENGLIS H CENTER | Medical English | Learning Document V1.0 Û POINT 4: VOCABULARY – TERMS ABOUT HOSPITALS Noun Verb Description admission to admit (reg.) To receive a patient to the hospital or the ward for further evaluation and treatment. assessment to assess (reg.) Can be interchangeably used with “to evaluate”. condition The state of a patient. cure to cure (reg.) To treat a patient to result in recovery. diagnosis (pl. diagnoses) to diagnose (reg.) To evaluate a patient and reach the conclusion about his/her condition. Adjective: diagnostic. Abbreviation: Dx. discharge to discharge (reg.) To send a patient home because he/she has recovered and is no longer required to stay in the hospital. evaluation to evaluate (reg.) Often including history taking and physical examination; then coming to a decision about what to do next. history taking to take (one’s) history (irreg.) To ask a patient for the present illness and other health-related information in the past. “to take” is an irregular verb: take, took, taken. hospitalization to hospitalize (reg.) Can be interchangeably used with “to admit”. Also means “staying the hospital”. improvement to improve (reg.) To make things better. intervention to intervene (reg.) Any methods (by using drugs, surgery, or psychotherapy) to change the patient’s condition. investigation to investigate (reg.) Methods (clinical, laboratory …) to elucidate patient’s problems. We also use “workup”. management to manage (reg.) To make a plan about what interventions, medications and care are required for a patient, then implement and monitor it day-to-day until the patient is discharged. There is also outpatient management. medication Drugs. physical/clinical examination to examine (reg.) To use techniques to look for abnormal signs. recovery to recover (reg.) To get better. referral to refer (reg.) To send a patient to another ward or hospital for further evaluation. For example, an endocrinologist can refer a diabetic patient with heart failure to a cardiologist for evaluation of the cardiovascular condition. 17 TLC ENGLIS H CENTER | Medical English | Learning Document V1.0 Noun Verb Description transfer to transfer (reg.) To send a patient to another ward or hospital for management (mostly due to lack of capacity to manage). For example, a hospital without dialysis machine will transfer a patient with acute kidney injury to a center where acute hemodialysis can be carried out. treatment to treat (reg.) To provide drugs or interventions. Treatment is a component in patient management. ` SKILL 2: DIFFERENT WORD CLASSES OF A WORD It is better not to learn a single word but its other forms as well. For instance, beauty is a noun, and it has a verb (beautify), an adjective (beautiful) and an adverb (beautifully). In the academic language, knowing different word classes allows you to express your ideas in a variety of styles. The following three sentences have a similar implication but are written in different ways with different word classes of “diagnosis”: 1. Only a positive HIV rapid test is not adequate to diagnose a patient with HIV infection. 2. A diagnosis of HIV infection cannot be made solely with a positive HIV rapid test. 3. A single positive HIV rapid test is not diagnostic for HIV infection. When you learn a word, try to find all related words (belonging to different word classes or having opposite meaning formed by adding prefixes or suffixes) and look up the way to use them (e.g., “the patient is diagnosed with + N” but “a diagnosis of + N + is made”). J EXERCISE 7 (INDIVIDUAL) Fill in the blanks with appropriate words. 1. A patient was _______________ to the Department of Gastroenterology, presenting with hematemesis and melena. On _______________, his blood pressure was 100/60 mmHg and pulse 100/min. 2. Mr. Trung has been transferred to Bach Mai Hospital with a _______________ of acute liver failure. The doctors in Bach Mai Hospital will do further evaluation to _______________ the cause of liver failure. 3. We think that this patient can be safely _______________ today. However, two weeks after _______________, she has to return to our ward for check-up. 4. Most of influenza episodes should be self-limited. The symptoms will _______________ without any medications. But there are also cases with severe influenza where antivirals are not shown to contribute to patient’s _______________. 18 TLC ENGLIS H CENTER | Medical English | Learning Document V1.0 Û POINT 5: MEDICAL SCHOOLS Studying medicine in HMU Hello, I am Tuan, a sixth-year medical student studying in the Hanoi Medical University (HMU). Today I will tell you about how we study medicine in HMU. A full course takes six years. We begin with fundamental subjects, including Anatomy in the first year, Physiology, Histology, Biochemistry, and Microbiology in the second year, and Pathology, Pathophysiology, Parasitology, Psychology and Pharmacology in the third year. These subjects are the basis for clinical subjects including Internal Medicine, Surgery, Pediatrics, Obstetrics and Gynecology, and other specialties. To learn clinical subjects, we need to go to the hospitals for clinical rotations. We often study one rotation in six to ten weeks, then we will move on to the next rotation. We first start thirdyear clinical rotations in the second semester with Internal Medicine and Surgery. We are taught about signs and symptoms and techniques in physical examination. The study objectives include to know history taking, to know how to detect clinical signs, and to provide a summary of clinical presentation of patients. These rotations are fundamental to medical students because they are the foundation to build up the list of diagnoses. A typical day starts at 7:30 AM when we join the ward round or grand round. In a round, doctors hand over all newly admitted patients and severe patients who need monitoring during their night shifts. Afterwards, we divide in small groups to different patient’s rooms and start to ask some patients for their history and examine them. Each medical student needs to prepare for one or two cases. We often write them down in a medical record or note. Sometimes we submit the notes to our teachers, and sometimes, when we have a clinical lecture, they have us present the cases in front of the whole team. Our lectures often begin at 10 or 10:30 AM, and can last until 12. Students are often very hungry and exhausted, so we hurriedly leave the hospital for a quick lunch before returning to the theoretical lectures at school at 1:30 PM. The afternoon sessions often end at 5 PM. We have one to three night shifts every week. I personally find Internal Medicine more interesting than Surgery because I love paying attention to details. In the medical wards, you must ask and examine the patients very carefully because their medical conditions are very complicated. There are many symptoms and signs I can learn and some of these, such as heart murmurs and lung rales, are very difficult to examine. Patients in surgical wards are often post-surgical, therefore, leave us no signs or symptoms to detect. We can only learn to examine patients with surgical conditions during the 24-hour shifts in the emergency room. J EXERCISE 8 (INDIVIDUAL) Answer the following questions. 1. 2. 3. 4. 5. 6. 7. 8. When do medical students start their clinical rotations? What are the fundamental subjects in the first, second, and third year? What are the clinical rotations in the third year? What do students have to achieve after finishing third year rotations? What do students do during clinical rotations? How many night shifts a week do medical students have? Which rotation dose the writer prefer? Why? How do medical students learn during the Surgery rotation? 19 TLC ENGLIS H CENTER | Medical English | Learning Document V1.0 J EXERCISE 9 (INDIVIDUAL) Think back about when you started the first clinical rotation. Write about it. Consider the following topics: 1. 2. 3. 4. J One typical day of yours (the whole day). What did you expect to learn? What did you imagine about the hospitals? What did you actually learn? Did it meet your expectations? Why? Anything interesting or memorable you would like to share? EXERCISE 10 (INDIVIDUAL) The following conversation is between two doctors in the emergency department. Fill in the blank with appropriate words. Dr. Huyen: Good morning, Dr. Tuan. Are there any new patients _________________ (1) to our _________________ (2)? Dr. Tuan: Morning, doctor. We have two new patients, one 70-year-old female patient with chest pain and a _________________ (3) of coronary arterial disease, and one 30-year-old male patient with 3-day hematemesis. Dr. Huyen: What have we done to them? Dr. Tuan: The old woman has a _________________ (4) diagnosis of acute myocardial infarction. We have done some initial _________________ (5) to her. She will be immediately transferred to the Department of _________________ (6) for PCI. Dr. Huyen: Good, how about the young man? Dr. Tuan: His vital signs were stable. On _________________ (7), we found that he has mild jaundice, ascites and some spider nevi. Dr. Huyen: Has he ever been _________________ (8) with cirrhosis before? Dr. Tuan: Yes. 5 years ago. We think this is a ruptured esophageal varices and prepare to send him for endoscopy. Dr. Huyen: What are the _________________ (9) you have done before endoscopy? Dr. Tuan: CBC and biochemistry already. He seems anemic. Do you need to _________________ (10) any other investigations? Dr. Huyen: I don’t think so. How about the patient with abdominal pain admitted four hours ago? 20