تدريب Shadowing: Gynaecological Examination - تعلم التحدث بالإنجليزية عبر الفيديو
جارٍ إنشاء الدرس...
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The gynecological examination.
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So continuing on our examination series, we're going to be taking a look at the gynae examination.
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So when performing any examination on the patient, we always need to have a discussion prior, explain what we're going to be doing and obtain verbal consent.
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We need to inform her that she will need to get undressed from the waist down, therefore we need to have an appropriate room where the patient will be able to get undressed in privacy
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and we should provide the sheet so that she can cover herself.
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We can ask her if she would like to empty her bladder
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and also perform a pregnancy test before proceeding with the examination.
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For this examination we will need to have a chaperone present with us.
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Finally we need to ensure we have all our equipment prepared for the examination including a Cusco speculum,
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lubricant gel, swabs used to assess for any infections and possibly a cervical smear brush.
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Now we also need to prepare the couch.
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This time we need to position the couch completely flat.
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Then we need to make sure we wear disposable gloves as you can see here.
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And then we would always start with the abdominal examination.
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So here we will assess for tenderness, rebound guarding and any masses.
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If you would like to see a detailed video on the abdominal examination, let me know in the comments.
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Okay, so now we can start off the proper gynae examination.
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So we start off by asking the patient to bend her legs and bring her heels to her buttocks, and allow her knees to fall to the sides.
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This is called the modified litotomy position, and is preferred nowadays to placing the patient's legs in stirrups.
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Now we can uncover the patient, and start off with inspection of the vulva.
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So, here we are looking for any scars,
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erythema, discoloration, masses, warts or ulcers and discharge or bleeding from the entroitis.
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We can also part the labia a bit to improve our inspection.
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At this point, we can also ask the patient to cough to assess for any prolapse.
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Again, if you'd like to see a video from me about vaginal prolapse, leave a comment down below.
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next up we've got the speculum examination
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so first let's take a look at the instrument
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so this is a cusco's speculum over here we have the blades the fixation screw and the handles
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i like to hold the speculum as you can see here with my thumb
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and index finger above the anterior blade
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and my third finger below the posterior blade this gives me good stability
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when handling the speculum and prevents the blades from opening before I want them to.
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So next we'll look at how to insert the speculum, so of course on an actual patient we'll need to lubricate the blades of the speculum.
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Then part the labia, insert the speculum on its side slowly with the blades closed
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and then rotate the speculum with the handles positioned at the top.
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I prefer this approach rather than having the handles facing downwards and having to fiddle with them close to the anus.
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Once the speculum has been inserted all the way in, we start to open the blades under direct vision until the cervix has come into view.
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Of course you must have some form of light available to see properly.
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When we are happy, we can use a fixation screw to keep the speculum in place.
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Once we have done this, we can inspect the cervix and the vaginal walls.
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First of all, looking at the cervix, we want to identify any cervical ectropion,
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any obvious masses any discharge or bleeding then we want to look at the vaginal walls
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and inspect for any vaginal tears or lacerations
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that is one advantage of using these transparent speculums as you
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can still inspect all vaginal walls during the examination now here
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i've also shown how to take a high vaginal swab
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so essentially we are guiding the swab into the posterior fornix
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which is location underneath the cervix and here we're taking a cervical smear
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so here we are using a cervical broom the tip is inserted into the cervical loss
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and is brushed in a circular motion over the cervix by
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360 degrees for five turns some pressure should be applied to make sure
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that the cells are sticking to your cervical broom for more
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information on smears i have created a video all about this subject next we need to remove the speculum
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so first we will retract the speculum slightly keeping the blades
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open until we have passed the cervix then we can close the blades
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and then we draw the speculum gently in the same position or rotate it again and withdraw it completely.
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To perform the bimanual vaginal examination, we first lubricate two fingers.
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Again, part the labia using our left hand and insert the fingers of our right hand gently into the vagina.
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Now, our left hand will be placed on the abdomen so that we can bellow the structures between our two hands.
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Starting off with the uterus, we want to assess the position, size and mobility of the uterus.
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so back to some revision here so
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when we talk about the position of the uterus we refer to version
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and flexion of the uterus but what are these
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so these refer to angles created by the curvature of the uterus
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so the first is how the long axis of the uterus
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is bent over the long axis of the vagina this refers
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to version then we've got the angle created by the long axis of uterus, bent over the long axis of the cervix,
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and this is referred to as flexion.
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So keeping these two diagrams in mind, here we have got an antiverted uterus, with the uterus bent forwards over the vagina.
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Then we have a retroverted uterus, with the uterus bent backwards over the vagina.
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an anti -flexed uterus with the uterus bent forwards over the cervix
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and a retroflexed uterus with the uterus bent backwards over the cervix.
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So during a bimanual examination from these two images, you can appreciate how the cervix will be positioned in a different direction
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and the uterus will be much harder to palpate when in a retroverted position.
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now we also want to assess ferny masses
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or cervical excitation cervical excitation refers to acute tenderness on palpation
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of the cervix these patients might literally jump off the couch
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so be careful when listing this sign some causes include pelvic inflammatory disease
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or ectopic pregnancy we will then move over to the right at nexa again feeling ferny masses or adnexal tenderness,
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a normal ovary will not be palpable in examination and will repeat the same on the left.
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When talking about adnexal tenderness, this could be secondary to an ovarian cyst accident, such as ovarian cyst structure or ovarian torsion.
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I hope you found this helpful.
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If you haven't watched my previous video on the obstetric examination, you can have a look at it here.
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Let me know what you think in the comments, like and subscribe.
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المفردات وملاحظات التحدث لهذا الدرس
هذا الدرس في المحادثة مبني على الفيديو “Gynaecological Examination”. أكثر الكلمات تكرارًا في الفيديو: uterus, examination, speculum, cervix, blade. يحتوي هذا الفيديو على 84 جملة و1203 كلمة للتدرب على الترديد. مدة الكلام 7:37. يتكلم المتحدث بسرعة طبيعية، نحو 158 كلمة في الدقيقة، قريبة من المحادثة اليومية. 74% فقط من الكلمات ضمن أكثر 3,000 كلمة شيوعًا في الإنجليزية، فالمفردات صعبة نسبيًا.
أهم المفردات في هذا الفيديو
15 كلمة من الفيديو تستحق التعلّم، مع النطق والمعنى:
| الكلمة | النطق | المعنى |
|---|---|---|
| examination اسم | /ɪɡˌzæm.ɪˈneɪ.ʃən/ | اِخْتِبَار, اِمْتِحَان |
| blade اسم | /bleɪd/ | شَفْرَة, نَصْل |
| bend فعل | /bɛnd/ | ثَنَى |
| refer فعل | /ɹɪˈfɜː/ | أَشَارَ |
| assess فعل | /əˈsɛs/ | يُقَدِّر |
| insert فعل | /ɪnˈsɝt/ | أَدْخَلَ |
| finger اسم | /ˈfɪŋɡɚ/ | إِصْبَع, بَنَان |
| axis اسم | /ˈæksɪs/ | مِحْوَر |
| vagina اسم | /vəˈdʒaɪ.nə/ | مَهْبَل, مَهْبِل |
| couch اسم | /ˈkaʊ̯t͡ʃ/ | فِرَاش, أَرِيكَة |
| angle اسم | /ˈæŋ.ɡəl/ | زَاوِيَة |
| pregnancy اسم | /ˈpɹɛɡnənsi/ | حَمْل |
| brush اسم | /bɹʌʃ/ | فُرْشَاة |
| inspection اسم | /ɪnˈspɛkʃən/ | تَفَقُّد |
| bleed فعل | /ˈbliːd/ | نَزَفَ |
القواعد في هذا الفيديو
أكثر التراكيب التي يستخدمها المتحدث، مع العبارات نفسها من الفيديو:
| التركيب | في الفيديو |
|---|---|
| المبني للمجهول be + اسم المفعول — التركيز على ما يحدث لا على من يفعله | is called · has been inserted · is inserted |
| المضارع التام have/has + اسم المفعول — حدث ماضٍ ما زال له أثر الآن | has been inserted · have done · i've also shown |
نطق يحتاج إلى انتباه
يستخدم المتحدث 10 من الصيغ المختصرة، مثل we're, we'll, we've. انطقها بصيغتها القصيرة كما تسمعها.
- أصوات “th”: underneath /ˌʌndɚˈniθ/, withdraw /wɪðˈdɹɔ/, thumb /ˈθʌm/, erythema /ˌɛɹɪˈθiːmə/
- أصوات “sh” و“zh”: examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, brush /bɹʌʃ/, inspection /ɪnˈspɛkʃən/, essentially /ɪˈsɛnʃəli/, sheet /ʃit/
- الكلمات الطويلة — انتبه لموضع النبر: examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, essentially /ɪˈsɛnʃəli/, stability /stəˈbɪlɪti/, mobility /mə(ʊ)ˈbɪlɪti/, inflammatory /ɪnˈflæmət(ə)ɹi/
أصوات يجدها متحدثو العربية صعبة:
- /p/ — ليس /b/: انطقه مع نفخة هواء: inspect /ɪnˈspɛkt/, pregnancy /ˈpɹɛɡnənsi/, inspection /ɪnˈspɛkʃən/, helpful /ˈhɛlp.fl̩/, privacy /ˈpɹaɪ.və.si/
- /v/ — ليس /f/: مع اهتزاز الأوتار الصوتية: vagina /vəˈdʒaɪ.nə/, privacy /ˈpɹaɪ.və.si/, verbal /ˈvɜː.bəl/, revision /ɹəˈvɪʒ.ən/, glove /ɡlʌv/
- تتابع الصوامت — لا تضف حركة بينها: blade /bleɪd/, bend /bɛnd/, inspect /ɪnˈspɛkt/, pregnancy /ˈpɹɛɡnənsi/, brush /bɹʌʃ/
كيف تتدرب بهذا الفيديو
- استمع إلى الفيديو كاملًا مرة واحدة دون أن تتكلم، ودوّن الكلمات التي لا تعرفها.
- ابدأ بسرعة 0.75×، وردّد جملة جملة، ثم عُد إلى السرعة العادية عندما يصبح الأمر سهلًا.
- سجّل صوتك وقارنه بالأصل، مع الانتباه إلى كلمات مثل examination, blade, bend.
ما هي تقنية التظليل الصوتي؟
التظليل الصوتي (Shadowing) تقنية تعلم لغة مدعومة علمياً، طُورت أصلاً لتدريب المترجمين الفوريين المحترفين. الطريقة بسيطة لكنها قوية: تستمع لصوت إنجليزي أصلي وتكرره فوراً بصوت عالٍ — كظل يتبع المتحدث بتأخير 1-2 ثانية. تُظهر الأبحاث تحسناً كبيراً في دقة النطق والتنغيم والإيقاع وربط الأصوات والاستماع والطلاقة.