Shadowing Practice: Renal Colic History | OSCE Guide | UKMLA | CPSA | PLAB 2 - Learn English Speaking with Video
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173 משפטים
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1
Hi my name is Grace, I'm one of the medical students in A &E today.
2
Hello.
3
Hi, could I just confirm your name and date of birth?
4
Yeah it's Imogen Mann, it's the 13th of August 91.
5
Okay nice to meet you Imogen, how can I help you today?
6
I've just been having this really severe pain in my lower back.
7
It's like nothing I've ever experienced before. So yeah.
8
Okay.
9
Just before we begin, are you comfortable enough for me to be asking you some questions or do you need some painkillers?
10
No, I've been given something.
11
I'm still uncomfortable if I'm honest, but yeah, I'm happy to chat to you.
12
Okay.
13
If that changes Imogen's, just let me know because I want you to be comfortable.
14
Okay.
15
Thank you.
16
Okay, Imogen.
17
So you mentioned you've been having this pain.
18
Do you want to tell me a bit more about your symptoms?
19
Yeah, it just came on suddenly this morning in my side of my back.
20
Yeah, just a really severe pain that I've never experienced before.
21
Okay, and what does that feel like?
22
It's like a cramping pain.
23
Yeah, it's really awful.
24
Okay, and I mean it sounds really uncomfortable.
25
If you had to grade it on severity where 10 out of 10 was the worst pain, how would you place it on that scale?
26
Definitely a 10 and I've got a pretty high pain threshold generally
27
but like I say this is nothing I've ever experienced before.
28
Okay and is it that all the time?
29
No it sort of comes on in in waves is the best way to describe it but yeah it's awful.
30
Yeah it sounds really uncomfortable.
31
You mentioned that the pain is on the right hand side, where's that exactly?
32
Like kind of my right lower back here.
33
Is it going anywhere else?
34
Yeah, it goes into the groin area.
35
Okay, and have you noticed anything that makes it better or worse?
36
No, I did take a couple of painkillers, but that didn't really do anything.
37
And what did you take painkiller -wise?
38
Cocodomol and ibuprofen.
39
Okay, and what time was that?
40
That was earlier this morning.
41
Okay, and with this pain that you're having, have you noticed any other symptoms alongside it?
42
It's so bad, it's making me feel sick when the pain comes on.
43
Okay and have you been sick?
44
I have yeah I've been sick twice this morning.
45
Was there any blood when you were vomiting?
46
I didn't know I didn't say anything like that no. Okay so it's definitely got you feeling quite unwell.
47
Have you noticed any other symptoms?
48
Um kind of my main worry is I think there's blood in my urine.
49
Okay can you describe that for me?
50
Um just the last two times I've been to the toilet for a week uh
51
it's been this like reddish color um which is obviously a worry okay
52
so let me find out a bit more about that
53
so the color of the urine you said it's reddish is it more in the pink kind of color
54
or more like a deep dark red no more more pinkish
55
yeah pinkish okay have there been any blood clots in the urine
56
so any kind of red dots no okay and
57
when you're going for a wee does that feel unusual at all no
58
that that all feels fine all normal yeah okay so no burning or stinging
59
No. Are you weeing more often than usual?
60
No. And when you're peeing the flow of it does that feel okay?
61
That's all normal yeah.
62
Okay and obviously you're quite worried about the blood in your urine have you had blood in your urine before?
63
No never.
64
Okay so something new.
65
Yeah.
66
Have you noticed any other symptoms at all?
67
No not that I can think of.
68
Okay so you've woken up today
69
and as you were getting ready you developed this severe pain that's coming in waves it's got you feeling sick
70
and you've been sick a couple of times
71
you've also had this probably blood in your urine a bit
72
pinkish urine yeah let me just check for any other symptoms
73
so specifically have you noticed a fever at all no okay
74
and you talked about vomiting can i just check your bowels are there any changes
75
there that's all been normal okay
76
when did you last open your bowels uh yesterday evening okay have you been unwell recently with anything
77
i've been absolutely fine until this came on this morning okay
78
and just to double check any injuries
79
you've not fallen onto this side at all no okay um
80
have you had anything like this before in terms of the
81
pain oh no never had anything like this before okay
82
and recently have you been feeling more tired than usual
83
or run down no have you lost any weight no
84
and you've not mentioned this
85
but just to double check any difficulty breathing any pains in your chest no it's all fine any feeling lightheaded
86
or dizzy no
87
and have you noticed any bleeding from anywhere else from your
88
back passage for example no can i ask do you have periods no i've got the marina coil
89
so i don't have periods fine and have you had any unscheduled bleeding with that no so
90
what are your thoughts about what's going on um my initial thoughts are
91
because where the pain is um possibly something to do with my kidneys my my worry is
92
that you know with the blood in my urine and my first thoughts is cancer really, but I know I'm quite young, so I don't know.
93
Yeah and I can understand why you might think cancer because that is sort of a red flag isn't it?
94
There's lots of different causes for blood in the urine
95
so we'll be doing some tests today but I just want to reassure you
96
that there's lots of other things that could be the cause.
97
Okay yeah thank you.
98
Is there anything else specifically that you're worried about?
99
The pain really, I'd say it's such a severe pain and I'm really worried about
100
that coming back on
101
and to be honest
102
I really need to get back to work as quickly as I can okay what do you do for work Imogen?
103
I'm a police officer right okay
104
so I'm guessing you're quite busy on your feet a lot yeah okay um
105
you're here in A &E we're here to help you you've had some painkillers in terms of any specific things
106
that you wanted us to definitely do in A &E today did you have anything in mind
107
that I should know about um I guess just get the relevant tests um
108
and get this sorted so I can get back on my feet
109
and back to work as soon as I can yeah I think so especially with you being so uncomfortable.
110
Yeah.
111
Okay.
112
So Imogen, what I'm going to do now is ask you a few more questions about your background
113
because I've not met you before.
114
Do you have any other medical conditions?
115
Yeah, I've got hypothyroidism.
116
Okay.
117
Anything else?
118
No. Have you had any surgeries before?
119
No. And have you ever had any scans of your tummy?
120
No. Okay.
121
Do you take medication?
122
Yes, levothyroxine.
123
Do you know what dose you take?
124
150, I think it is.
125
Okay.
126
Do you take any other medications? um nothing more prescribed i occasionally take gaviscone
127
but that's it okay and are you allergic to anything no are there any medical conditions
128
that run in the family no and specifically in the family are there any bladder
129
or kidney problems no okay
130
and you mentioned already
131
you're a police officer what's your living situation uh just live
132
on my own okay do you smoke at all no do
133
you drink alcohol um a couple of glasses of wine in a week okay
134
and do you take any recreational drugs at all no okay
135
so I'm just going to summarize back to you Imogen to make sure we've not missed anything
136
so you've come to A &E today because you um you wake up
137
and you develop this severe pain on the right hand side going into the groin yeah um
138
it's coming in waves it makes you feel quite sick
139
when it comes on and you've been sick a couple of times
140
and you've also noticed some pinkishness to your urine and you're worried
141
that there's some blood there that's right you're worried
142
this is something to do with your kidneys
143
you were a bit worried about cancer although we know there's lots of different causes for blood in the urine
144
and your main concerns the pain
145
and getting back to work absolutely yeah okay is there anything you feel
146
that i've missed there no i think that's everything do you have any questions for me no okay in
147
that case that's all my questions
148
so thanks for your time imogen thank you today
149
i spoke to imogen mann a 32 year old police officer
150
who is presented to the a e department with right -sided
151
lower back pain Imogen describes sudden onset day of episodic right -sided loin to groin pain
152
which has a severity of up to 10 out of 10.
153
This pain is cramping and has been severe enough to cause vomiting.
154
Imogen has also noticed two episodes of pinkish hematuria without clots.
155
She doesn't have dysuria or fever.
156
Imogen has a past medical history of hypothyroidism for which she takes levothyroxine.
157
She has no other medical conditions and takes no other regular medications.
158
She has no known drug allergies.
159
Imogen lives alone.
160
She drinks up to 10 units of alcohol per week.
161
She doesn't smoke or take recreational drugs.
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Imogen suspected that this could be a kidney problem.
163
She did have concerns that there could be a cancer given the blood in her urine.
164
Her other concerns are the level of pain and that she wants to get back to work.
165
Her expectations are analgesia and investigations in A &E.
166
Based on the information gathered so far the most likely differential diagnosis here is renal colic due to a ureteric stone.
167
Other possible diagnoses would be a palonephritis.
168
To complete my assessment today I would perform an abdominal examination and check vital signs.
169
I'd perform bedside tests including urinalysis and and urinary pregnancy test.
170
I will check bloods, including full blood count, user knees and CRP.
171
Based on the likely diagnosis, it would be appropriate to consider further imaging, such as a CTKUB.
172
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אוצר מילים והערות הגייה לשיעור הזה
שיעור הדיבור הזה ברמה C1 מבוסס על הסרטון “Renal Colic History”. המילים שחוזרות הכי הרבה: pain, imogen, blood, urine, noticed. בסרטון הזה יש 173 משפטים ו-1799 מילים לתרגול Shadowing. הדיבור נמשך 9:25. הדובר מדבר מהר, כ-191 מילים בדקה, אז צפו לצלילים מחוברים ומקוצרים. 84% מהמילים נמצאות בין 3,000 המילים הנפוצות ביותר באנגלית; כדאי ללמוד את השאר לפני שמתחילים. 31 מתוך 173 המשפטים שלו הם שאלות, כך שזה תרגול טוב לאינטונציה של שאלות ולתשובות קצרות.
אוצר מילים מרכזי בסרטון הזה
15 המילים המתקדמות ביותר בסרטון, עם ההגייה והמשמעות שלהן:
| מילה | הגייה | משמעות |
|---|---|---|
| urine שם עצם | /ˈjʊɹɪn/ | שֶׁתֶן, שתינה |
| symptom שם עצם | /ˈsɪm(p)təm/ | תַּסְמִין, סִימְפּטוֹם |
| painkiller שם עצם | /ˈpeɪnˌkɪlə(ɹ)/ | משכך כאבים |
| pinkish שם תואר | /ˈpɪŋkɪʃ/ | ורדרד |
| kidney שם עצם | /ˈkɪdni/ | כִּלְיָה, כְּלָיוֹת |
| groin שם עצם | /ˈɡɹoɪ̯n/ ~ /ˈɡɹɔɪ̯n/ | מפשעה |
| vomit פועל | /ˈvɑmɪt/ | הֵקִיא |
| hypothyroidism שם עצם | /ˌhaɪpəˈθaɪɹɔɪˌdɪzəm/ | תת פעילות של בלוטת התריס |
| reddish שם תואר | /ˈɹɛdɪʃ/ | אֲדַמְדַּם |
| bowel שם עצם | /ˈbaʊ.əl/ | מְעִי |
| bleed פועל | /ˈbliːd/ | דִּימֵּם |
| recreational שם תואר | נופש | |
| ibuprofen שם עצם | /ˌaɪ.bju.ˈpɹoʊ.fən/ | איבופרופן |
| summarize פועל | /ˈsʌməˌɹaɪz/ | סיכם |
| allergy שם עצם | /ˈæl.əɹ.d͡ʒi/ | אַלֶרגִיָה |
Phrasal verbs שתשמעו
| מילה | הגייה | משמעות |
|---|---|---|
| wake up פועל | /ˌweɪk ˈʌp/ | התעורר |
| check out פועל | בדק | |
| run down פועל | דרס |
משפטים שכדאי לחזור עליהם
משפטים קצרים ושלמים מהסרטון שאפשר להשתמש בהם בשיחה יומיומית:
- Was there any blood when you were vomiting?
- Have you noticed any other symptoms?
- Are you weeing more often than usual?
- Have you noticed any other symptoms at all?
- Is there anything else specifically that you're worried about?
דקדוק בסרטון הזה
המבנים שהדובר משתמש בהם הכי הרבה, עם המילים המדויקות מהסרטון:
| מבנה | בסרטון |
|---|---|
| הווה מושלם ממושך (Present perfect continuous) have/has been + -ing — פעולה שהתחילה בעבר ועדיין נמשכת עכשיו | I've just been having · you've been having |
| הווה מושלם (Present perfect) have/has + past participle — פעולה שקרתה בעבר ועדיין יש לה חשיבות או השפעה עכשיו | I've ever experienced · I've been given · I've never experienced |
| סביל (Passive voice) be + past participle — הדגש הוא על מה שקורה, לא על מי שעושה את הפעולה | I've been given · is presented |
הגייה ששווה לשים לב אליה
הדובר משתמש ב-56 קיצורים וצורות מקוצרות, כמו I've, I'm, you're. אמרו אותם בצורה הקצרה, כפי שאתם שומעים אותם.
- הצלילים של “th”: hypothyroidism /ˌhaɪpəˈθaɪɹɔɪˌdɪzəm/, levothyroxine /ˌli.voʊ.θaɪˈɹɑkˌsin/, threshold /ˈθɹɛʃ(h)oʊld/
- הצלילים של “sh” ו-“zh”: pinkish /ˈpɪŋkɪʃ/, reddish /ˈɹɛdɪʃ/, analgesia /ˌæn.əlˈd͡ʒiː.ʒə/, reassure /ˌɹi.əˈʃʊɹ/, differential [dɪfəˈɹənʃəɫ]
- מילים ארוכות — שימו לב להטעמה: hypothyroidism /ˌhaɪpəˈθaɪɹɔɪˌdɪzəm/, levothyroxine /ˌli.voʊ.θaɪˈɹɑkˌsin/, severity /səˈvɛɹ.ə.ti/, analgesia /ˌæn.əlˈd͡ʒiː.ʒə/, episodic /ˌɛp.ɪˈsɒd.ɪk/
צלילים שדוברי עברית מתקשים בהם:
- /w/ — שפתיים מעוגלות, לא /v/: unwell /ʌnˈwɛl/, wee /wiː/
- /æ/ — פתוח יותר מה-“אֶ” העברית, לא כמו “a” ב-“cup”: cramp /kɹæmp/, analgesia /ˌæn.əlˈd͡ʒiː.ʒə/, urinalysis /jʊəɹɪˈnælɪsɪs/, abdominal /æbˈdɑm.ə.nl̩/, allergy /ˈæl.əɹ.d͡ʒi/
- /r/ — הלשון לא נוגעת בשום מקום, לא ה-“ר” הגרונית: urine /ˈjʊɹɪn/, painkiller /ˈpeɪnˌkɪlə(ɹ)/, groin /ˈɡɹoɪ̯n/ ~ /ˈɡɹɔɪ̯n/, cramp /kɹæmp/, hypothyroidism /ˌhaɪpəˈθaɪɹɔɪˌdɪzəm/
איך לתרגל עם הסרטון הזה
- הקשיבו לכל הסרטון פעם אחת בלי לדבר, ורשמו את המילים שאתם לא מכירים.
- התחילו במהירות 0.75×, תרגלו Shadowing משפט אחר משפט, וחזרו למהירות רגילה כשזה מרגיש קל.
- הקליטו את עצמכם והשוו למקור, תוך תשומת לב למילים כמו urine, symptom, painkiller.
מהי טכניקת השאדואינג?
שאדואינג היא טכניקת למידת שפה מבוססת מדע שפותחה במקור להכשרת מתורגמנים מקצועיים ופופולרית על ידי הפוליגלוט ד"ר אלכסנדר ארגואלס. השיטה פשוטה אך עוצמתית: אתה מקשיב לאודיו באנגלית ילידית וחוזר עליו בקול רם מיד — כמו צל העוקב אחרי הדובר עם עיכוב של 1–2 שניות בלבד. בניגוד להאזנה פסיבית או תרגילי דקדוק, שאדואינג מכריח את המוח והשרירים בפה לעבד ולשחזר דפוסי דיבור אמיתיים בו זמנית. מחקרים מראים שזה משפר משמעותית את דיוק ההגייה, האינטונציה, הקצב, הדיבור המחובר, הבנת השמיעה ושטף הדיבור — מה שהופך אותו לאחת השיטות היעילות ביותר להכנה לIELTS Speaking ולתקשורת באנגלית בעולם האמיתי.