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, 2013.
1. .
Imagine you are a doctor. Give your recommendations to an expectant mother how to care about her own health and the health of her future baby during pregnancy.
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Your mental and physical health during pregnancy is of great importance for your future child. You should undergo regular gynecologic obstetric examinations at the district womens consultation. You should give up your harmful habits in nutrition and follow a diet rich in vitamins. Constant supervision and care during pregnancy will help in preventing possible complications of this period and difficulties of labor.
1. .
Imagine you are an obstetrician. Explain the importance of her preparation for the delivery and nursing of her child.
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Its necessary in your case to prepare for the delivery and nursing of your future baby. You should learn to behave yourself during the labor pains and try to relieve pain. I can offer you the courses for future mothers organized in our womens consultation. Your studying at the courses will help you to avoid mistakes during labor and nursing of the baby.
3. .
Imagine you are an obstetrician. Give your recommendations to a pregnant woman admitted to a maternity home for labor. Explain her behaviour during the series of contractions of the uterus prior to the birth of her infant.
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To relieve the pains you should do special exercises, keep composure during the contractions and deep breathing.
4. .
Imagine you are an obstetrician. Give your recommendations to a pregnant woman admitted to a maternity home for labor. Inform the woman ready to give birth about three stages of labor. Pay attention of the woman to regular special exercises, deep breathing, composure during the contractions, etc.
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Labor is divided into three stages. The first stage begins with onset of true pains and ends with full dilatation of the cervix. The second stage begins after full dilatation of the cervix and ends with the expulsion of the fetus. The third stage begins after the expulsion of the fetus and ends with the expulsion of the placenta and membranes.
5. .
Play the role of the pediatrician. Below are the findings on examination of a patient attending for her 32-week appointment. Base your comments to the patient on these findings:
Weight 87,5;
Blood pressure 140/90;
External examination swelling of the ankles;
Give the recommendations to the future mother.
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Im not satisfied with your condition. Youve gained too much weight for a short period of time, your ankles are swollen and blood pressure is a bit higher. I think you eat too much fats and carbohydrates and drink too much water. All this may do harm to your future baby.
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First of all you should limit the amount of liquid and salt. Fats and carbohydrates must be taken in very limited doses. Do not forget to measure your blood pressure regularly. Sleep not less than 8 hours and walk before going to bed.
6. .
You are a patient attending your 28-week appointment. You are concerned about your baby.
1. Ask the doctor if it is all right with the baby.
2. Clarify your regimen.
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1.
What is his weight (height)?
- Is his position right or wrong?
- Can you hear the babys heartbeat clearly?
- Are you sure of the date of labor?
2.
How much time a day should I walk?
- May I eat spicy food?
- May I take medicine in case of a headache or a stomachache?
- What blood pressure is normal for me?
7. .
Imagine you are a pediatrician.
1. Explain young mother the importance of feeding her baby with breast milk.
2. Tell her why cows milk is not recommended for babies under one year.
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1. Breast milk is rich in all the vital nutrients and provides a baby with energy for the all round growth. It enhances immunity and fosters a bond between the mother and the child. Its the only natural, physiological food for babies.
2. Cows milk is not recommended for babies under one year because it contains protein thats difficult for them to digest. It also doesnt contain enough iron for babies and it contains too much sodium.
8. .
A newborn, whose mother suffered from a febrile illness during first trimester, is found to have multiple congenital malformations including mental retardation and hepatosplemegaly.
1. Comment the case-history.
2. Clarify the prognosis.
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1. The most possible diagnosis of the child is Rubella syndrome. Most likely he is a premature baby. I m afraid he may have serious complications, such as hypoglycemia, haemorrhagic disease, etc.
2.
Does my baby have the chances of recovery?
Will he be treated in the maternity home?
What specialist should I apply after his discharge from the hospital?
9. .
A ten-day-old baby has suddenly stopped accepting feed and has developed a generalized rash and high fever. He has slight jaundice too. His umblicus is septic.
1. Comment the case-history.
2. What factors could predispose to the disease?
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1. The infant is surely a preterm one. All the symptoms including the absence of the most important reflexes such as sucking and swallowing point out to intrauterine pneumonia.
2. Complicated pregnancy and delivery, maternal infections and other factors contribute to the development of the disease.
10. .
You are a pediatrician. You are going to examine a 3-year-old girl. She has high temperature, a headache and a sore throat. Her face is flushed.
1. Ask the girl all possible questions about her condition.
2. Address to the mother and tell her the results of your examination.
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1. You may start the examination with the words: Can you sit on Mommys knee? Im going to have a look at your throat. You wont feel anything at all. Can you put your head back to help me?
Does it hurt here?, Is it painful?, Do you feel pain on swallowing?, etc.
2. Im not absolutely sure about all the symptoms indicate to scarlet fever. This is an infectious disease and may bring about serious complications. Ive to refer your daughter to the infectious department of the hospital. Dont trouble, the disease is not in an advanced stage and I think shell respond to the treatment well.
11. .
Your child was admitted to the hospital with bronchopneumonia 2 days ago. You are anxious about his health.
1. Ask the ward doctor about the childs condition.
2. Ask the doctor about the methods of treatment and prognosis.
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1.
What is his general condition?
Does he sleep well?
How does he respond to the treatment?
2.
What medicine does he recieve?
Does my child have the chances of recovery?
What specialist should I apply to after his discharge from the hospital?
12. .
You are examining the boy ill with a respiratory disease.
1. Ask his mother about the condition of the child and the symptoms he has.
2. Assess the patients condition and give your recommendations.
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1.
Does he often have a runny nose?
- Is it difficult for him to breathe through the nose?
- Is his cough continuous or intermittent?
Do you harden his body?
2. The boys condition is not poor. His temperature is not high and hes no rales in the lungs. The only symptoms are a runny nose and a slight cough. He has probably caught cold. Let him follow a bed regimen for 2 or 3 days and put mustard plasters on his feet. Dont give him any medicine except vitamins.
13. .
Imagine you are a doctor and you came to your first call. The patient is a five-year boy. He has high fever, a runny nose and cough. He has rash on neck and around ears.
1. Ask his mother the additional information about the boys condition.
2. Diagnose a disease.
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1.
How long does the cough continue? Is it frequent?
- When did the rash appear?
- Is the boy restless during night sleep?
Was he in direct contact with infected children?
2. The boy has fever, frequent and harsh cough, his eyes are red and painful, rash begins spreading to the rest of the body. In addition I see Koplicks spots on the mucous membrane. All the symptoms are evident for measles.
14. .
Imagine you are working as a doctor at the infectious hospital. Explain your adult patients ill with tuberculosis how dangerous is this disease for their children.
Use the following word combinations:
to be caused by, to retain viability, to be susceptible to, the source of infection, to observe personal hygiene, etc.
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Tuberculosis is an infectious disease, especially dangerous for children. This infection may be acquired at any stage of childhood, but babies and young children are most susceptible to it. This disease may be very slow and silent in appearing and involves lungs, bones, joints, kidneys and other organs. The most frequent source of infection are adults with the open form of tuberculosis.
15. .
Imagine you are working as a doctor at the infectious hospital. Tell your patients how to prevent children from the disease.
Use the following word combinations:
to be caused by, to retain viability, to be susceptible to, the source of infection, to observe personal hygiene, etc.
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The patients ill with tuberculosis must observe strict personal hygiene in order not to contaminate their children.
16. .
You are a pediatrician. The blood analysis of one of your patients detected the raised sugar level. Tell the mother how to prevent her child from diabetes.
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First of all you should change his diet. Foods like sweets, chocolate, cakes and biscuits should be avoided as they usually contain high amounts of sugar and fat. Give your child a lot of fruit and vegetables. Beans and lentils help to slow down the rise of blood sugar level after meals.
17. .
You are a pediatrician. The blood analysis of one of your patients detected the raised sugar level. Explain why diabetes is a dangerous disease.
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First of all diabetes is characterized by metabolic abnormalities of carbohydrates, proteins and fats in the body. This disease affects almost all organs and systems of the body. A diabetic child is susceptible to serious rale complications: vascular hypertension, atherosclerosis, chronic infections, etc.
18. .
Imagine you are a pediatrician and now you are delivering a lecture for young mothers. The subject is childrens allergic diseases. Answer the question mothers ask you: What factors may influence the frequency and severity of allergic attacks?
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The definite state of health of the sufferer, intercurrent diseases, climatological factors, locality environment, etc. may influence the frequency and severity of allergic attacks.
19. .
Imagine you are a pediatrician and now you are delivering a lecture for young mothers. The subject is childrens allergic diseases. Answer the question mothers ask you: What measures should be taken to prevent the onset of allergic symptoms?
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Much can be done to prevent the development of allergic symptoms in children. The homes should be free from dust and allergens. New foods should be tried one at a time, at least a week apart, to see if symptoms occur. Exposure to colds should be minimized. Psychosomatic factors, if present, should be taken into consideration.
20. .
You are going to place your child in a modern hospital for the thorough examination. Try to imagine all the needs your child would have as a patient in a hospital.
1. What services would you expect the hospital to provide to meet those needs?
2. Convince him to stay in a hospital for some days.
Use the following word combinations:
high-qualified specialists, skilled nurses; large, clean wards; adequate patient care; modern equipment; close relationship with the medical staff; etc.
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1. Ive chosen this hospital for my child because only high-qualified specialists and skilled nurses work there. They have modern equipment at their disposal and I think the medical staff will take adequate care of my child.
2. You need to undergo this examination. The medical staff is very polite and qualified. Dont be afraid they wont do you harm. The doctor cant make a correct diagnosis without a complete examination. As soon as your diagnosis is determined youll leave the hospital.
21 The presence of heart valve disease is suspected from a heart murmur. How will you prove the diagnose?
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An ECG and chest X-ray may provide additional clues, but the main diagnostic technique for valve disease is echocardiography. Doppler echocardiography is particularly useful in establishing the severity of valvular stenosis or regurgitation.The diagnosis in adults is usually confirmed by cardiac catheterization and angiography.
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22 Explain why the muscle layer in the left ventricle is thicker than in the right ventricle.
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It is thicker because the left ventricle has to pump blood around the systemic circulation, whereas blood from the right is only going as far as the lungs.
23 .
You need to undergo immunization, but you dont want to do it. Explain your reasons.
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Of all things you can do to protect your child against ill health, perhaps nothing is more important than immunizations. Immunizing your child offers him or her protection against a number of potentially deadly infectious disease. Without immunity to these diseases, exposure to them can cause lifethreatening sickness and even death. Immunizations work effectively only when given at very specific times in your childs life. Though side effects are rare, they can occur with any vaccine. The type of reaction and its timming varies with each vaccine.If you are concerned about possible side effects, discuss this with your childs doctor before the immunizations are given. In general the protective effects of immunity far outweight the risks. Infectious diseases are spread from person to person by direct contact and by inhaling respiratory secretions from infected individuals.
24 .
You are a doctor. Explain why radical correction of congenital heart defect in infants, when performed for the tetralogy of Fallot, is associated with great risk.
Describe the situation with regard to congenital heart disease in our country. What measures are being taken to control it?
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It affected children invariably died before the advent of complete surgical repair of both the septal defect and stenosis. Before surgery, patients are cyanosed and require repeated venesections for polycythaemia. They are susceptible to endocarditis and cerebral abscesses.Total correction of the lesions is required and this may be done in two stages.
25 .
Imagine you are an obstetrician. Give your recommendations to an expectant mother.
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If you want your child to be healthy first of all you must go to the district womens consultation for regular gynecologic and obstetric examinations. Constant supervision and care during the prenatal period may help in detecting and preventing possible complications of pregnancy, difficulties of labor7 neonatal morbidity and mortality. I advice you to visit Schools for young mothers. The experienced doctors will help you to overcome the difficulties of labour and to preserve your own health and the health of your future child.
26 .
You are a pediatrician. Prove the statement Maternal breast milk is the best food for infants.
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Use the following lexics: to contain, more fats and lactose, less proteins and salts, albumin, the structure of human milk, to compose the cells, antibodies, to sustain the infants immunity, a sufficient amounts of vitamins.
The only natural, physiological food for babies in their first five-six months of life is maternal breast milk. Studies made of breast milk and the milk of various animals have shown that human milk contains more fats and lactose and much less proteins and salts than animal milk. But the principal distinction of human milk is the structure of its proteins, fats, complex amino acid compounds (tryptophan, cystine, tyrosine, etc.). The structure of human milk proteins is close to that of the proteins which compose the cells of the infant's body. An important biological feature of human milk is the presence in it of antibodies (immune bodies), that sustain the infant's immunity to a number of childhood infect' during the first months of life.
27 .
You are a pediatrician. Prove the statements.
- Proper prenatal care is of great importance for the health of the infant and mother.
- Proper antenatal care plays a great role in the health of future generation.
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Constant supervision and care during the prenatal period may help in detecting and preventing possible complications of pregnancy, difficulties of labor neonatal morbidity and mortality.
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28 .
You are working as a doctor at the infectious hospital. Explain your adult patients ill with tuberculosis how to prevent their children from this dangerous disease. Use the following word combinations the open form of tuberculosis, to disseminate the tubercle bacilli, to be careful, to observe strict personal hygiene, to contaminate smb, to be transmitted by, etc.
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The disease you are infected is very dangerous first of all for your own children. The disease may be acquired at any stage of childhood, but babies and young children are most susceptible to it. When you cough, sneeze or simply talks with your children you disseminate the tubercle bacilli info the air.
Tuberculosis of the lungs in children is less frequent than in adults, but it is much more serious. You must be very careful and the lock of appetite, the complaints of your child of weakness and fatigue, worse progress at school must alarm you. You must follow the necessary preventive measures: avoid direct contact with your children, do wet cleaning regularly, observe strict personal hygiene, strengthen the immunity of your children.
29 .
You are delivering a lecture to the students. Your topic is Cerebral injuries and possible serious sequelae. Use the following words: Hemorrhage, rupture, seizure, mental deficiency.
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The main point of my lecture is cerebral injuries. You know such injuries obtained during deliveries may be very dangerous for the childs health and influence him through entire life span. The yarious types of cerebral injuries include concussion, congestion and edema.of the brain substance; hemorrhage, generally venous| in origin; ruptures of the dural septa; and,, sometimes laceration of brain. Intracranial lesions may oceur both in normal and complicated deliveries. They are considered to be very dangerous to the child's health as they may bring about very serious immediate and remote sequelae, such as hydrocephalus, seizures, convulsions, mental deficiency and spastic paralysis.
30
Who of the patients should call in a doctor?
A) Patient X. caught a bad cold. His temperature was high. He complained of a bad headache and was very weak. He even could not sit up in his bed.
B) Patient Z. looked ill and was very pale. But his temperature was normal. His appetite was poor. He complained of nausea and pain in the stomach.
: Patient X. as he was seriously ill and could not go to see a doctor himself.
31
Who should be examined by a therapist?
A) When my younger brother was playing in the yard, he fell down and badly injured his right arm. There was a deep laceration on the lateral surface. He developed a bad pain in the elbow joint and could not move his arm.
B) Mr. Jones complained of a bad pain in the left side of his chest. He had difficulty breathing and became pale. He remembered that he had been working in the garden all the morning. He had to take to his bed.
: Mr. Jones should be examined by a therapist and the boy should be examined by a traumatologist.
32 .
A patient was treated at the hospital. His temperature was regularly taken both in the morning and in the evening. He was given the prescribed medications and an intramuscular injection of vitamin B6. Who carried out the doctors administrations?
: The nurse did.
33 .
Mrs. Jackson has a high temperature. Her blood analysis shows leucocytosis. On auscultation her heart sounds are badly heard. Her electrocardiogram shows considerable changes. Besides she has pains in the chest on exertion. What doctor should she apply to?
: S he should apply to a cardiologist.
34 .
The patients temperature was irregular. It persisted for about a week. His breathing was rapid and he complained of breathlessness. His face was cyanotic. The chest pain was especially sharp on deep breathing in. He had cough with purulent sputum. His erythrocyte sedimentation rate was accelerated. On auscultation there were moist rales in the lungs. Which diagnosis should be made to this patient?
: He has pneumonia as all the symptoms are typical of this disease.
35 .
The patient complained of a general malaise, fatigue and cold profuse perspiration at night. His temperature was 37.3C. It had been persisting for about a month. He had been coughing for almost two months though he had given up smoking. Sometimes he noticed streaks of blood in the sputum. On examination he said that he had lost about 6 kg. Which examination should he be referred to first of all?
: First of all he should go to an X-ray examination as all the symptoms are characteris- tic of TB.
36 .
The patient complains of pain in the epigastrium, and then the pain generalizes in the abdomen. The pain becomes worse on deep breathing in and coughing. The pain does not radiate and is accompanied by nausea, retention of stools and gases. The temperature is normal or subfebrile. The blood analysis shows leucytosis. The pulse is quick. The tongue is coated and dry. What should be done in this case?
: The patient should be operated on as he evidently has an attack of acute appendicitis.
37 .
This disease is treated surgically. The operation is performed under general or local anesthesia depending on the condition of the patient. The operation should be performed immediately as any delay can result in the development of peritonitis. What disease is spoken about?
: It is probably appendicitis as in this case the operation can be performed either under general or local anesthesia.
38 .
This disease is most commonly observed in nervous people. Such factors as mental and emotional overstrain contribute considerably to its development. The incidence of this disease is higher in men than in women. The symptoms include hemorrhage, nausea, vomiting, and pain in the abdomen which usually grows worse after meals. This disease is characterized by a chronic cyclic course. What disease is spoken about?
: It is ulcer disease of the stomach as all the signs are typical of this disease.
39 .
When the doctor examines the patient with this disease he reveals severe tenderness in the right upper part of the abdomen and in the umbilical area. The doctor also notes slight jaundice of the sclerae. The patient complains of dryness in the mouth, vomiting, nausea, and constipation. What diagnosis will be made?
: It is cholecystitis because all the symptoms and especially jaundice of the sclerae are evident of inflammation of the gallbladder.
40 .
The patient came to the doctors study and the doctor asked him to take off his clothes and began examination of the patient. What was wrong?
: The doctor should not begin his consultation with examination. First of all the patient should be asked a number of questions about his condition and complaints and according to the complaints the examination should be done.
41 .
Patient with cholecystitis complains of bad pain in the right hypochondrium and in the umbilical area. An attack of pain is usually preceded by mental and physical overstrain, sharp movements, fatty food and alcohol. The pain may radiate to the right shoulder, rightarm, sternum, and lumbar area, its intensity depending on the form of cholecystitis and the patients sensitivity. On auscultation the doctor hears rales in the lungs. The pain grows worse when the patient is lying on his right side. What symptom should be excluded from the description?
: If the patient complains of pain in the abdomen, the doctor should palpate the abdomen. There is no need to auscultate the lungs. That is why rales must be excluded from the description.
42
A blue color to the skin means lack of oxygen in the tissues. Lack of oxygen (called hypoxia) can occur for a variety of reasons, including lung problems, heart problems or circulation problems. When hypoxia is moderately severe, blue color can be limited to the lips, the fingers and toes. Severe hypoxia causes a blue or gray color to appear over the entire body. Cyanosis should always lead to an evaluation by a doctor and often means an emergency situation. If it develops suddenly, call paramedics if the person seems very ill pr go to an emergency facility.
