Shadowing Practice: How to Present a Patient: Inpatient Bedside Teaching Rounds (Group 12) - Learn English Speaking with Video
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Jonathan, this is Dr. Jones and our internal medicine service team.
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Hi.
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Hi Jonathan.
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We're going to be, I'm going to be presenting your case to them.
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Is that alright if I do that in the presence of your girlfriend and co-worker here?
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Yes, this way.
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Thanks Jonathan.
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So this is the first UMC visit for Jonathan, who is a 24-year-old African-American
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with a history of sickle cell disease who presented to the emergency department with a two-day history of bilateral knee pain.
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He's ectomorphic and is in moderate distress.
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The pain began Tuesday at approximately 4 a.m while he was working a night shift at Walmart.
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He had difficulty sleeping because of the pain that night, that night and the pain gradually continued to increase due to a severity of 8 out of 10 today.
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The pain was exacerbated with walking and standing and was not significantly relieved with Percocet,
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which he received from another physician that we aren't sure who it was.
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Jonathan has never experienced knee pain to this extent before, but he did say that he's had a few episodes in the distant past of knee pain.
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He reports some chills and a mild shortness of breath, but he denied fever, nausea,
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vomiting, cough, chest pain, abdominal pain, or recent trauma to the knees.
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He has no other known medical illness and isn't on any chronic medication for sickle cell disease either.
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In the ED, he was given an IV bolus and received two doses of morphine at 6 mg and 8 mg doses.
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For past medical history, he was diagnosed with sickle cell disease at age six
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and has had six to eight previous hospitalizations for that.
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He has a history of lower extremity ulcers as well, but he has never had a pneumococcal vaccine which is interesting.
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His social history includes, he lives with his mother and four siblings.
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He works at Walmart as a stalker but denies any IV drug use or tobacco use.
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He does consume alcohol occasionally, and last time was this last weekend.
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He has two siblings that also have sickle cell disease.
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In the review of systems, it was negative except for lower extremity ulcers and intermittent left hand pain.
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In his vitals, he had a temperature of 36.3 degrees Celsius, heart rate of 96, a respiratory rate of 16,
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blood pressure of 108 over 70, and his O2 saturation was 89% on room air.
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For Hent, he's normocephalic, atraumatic, perle, and extraocular movements are intact.
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With lungs, they're clear to auscultation and percussion with no wheezes, rails, or bronchi.
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CV, his S1, S2 were normal.
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He is tachycardic with a soft flow murmur heard at the base.
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There was no S4, but he does have decreased pedal pulses.
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For abdominal exam, bowel sounds are normal the spleen tip was not palpable.
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GU, he didn't have any urethral discharge either.
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For skin, he had a silver scaly rash on the flexor surface of the right elbow,
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and there are non-healing bilateral ulcers of one centimeter diameter on both medial malleoli.
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For musculoskeletal, he has mild swelling of the right knee and small effusion.
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There's no erythema, and it's not tender to palpation, but there was pain on full extension his left knee didn't have any significant swelling or tenderness.
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He did have full range of motion bilaterally with his knees.
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Now in the lab work we have a CBC, BMP and liver function test pending.
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And so in conclusion or in summary, Jonathan, he's a 24-year-old African-American man with a history of sickle cell disease and hypoxia.
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He presented the emergency department with bilateral knee pain and minor right knee effusion.
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On the differential diagnosis, we have vaso-occlusive disease, periarticular infarct, septic arthritis, and gout.
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Vaso-occlusive disease is most likely due to the afebrile presentation of the patient.
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And the pending CBC results will likely rule out septic arthritis due to a gram-negative Neisseria, Staph, or Salmonella.
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Potential plans of treatment include knee pain.
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Well, for knee pain, we would consider NSAID treatment with morphine for breakthrough pain.
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For sickle cell disease, we should monitor closely for acute chest syndrome, splenic sequestration, and aplastic crisis,
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and consult a hemonch for a sickle cell referral after he is released from the hospital.
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And then we should also obtain a chest X-ray to rule out new infiltrates and consider oxygen therapy
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if he becomes symptomatic in his lungs again.
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All right, any questions?
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Would I also recommend adding two liters of oxygen via nasal cannula?
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I think that'd be a great idea.
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And great job, Bryce, you really were very thorough.
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Thank you for letting us present in front of you.
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That was really great.
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Thank you.
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Thank you.
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Woordenschat en spreektips bij deze les
Deze video bevat 61 zinnen en 789 woorden om na te spreken. Het gesproken deel duurt 5:50. De spreker praat in een gelijkmatig tempo van ongeveer 135 woorden per minuut, prettig om te shadowen. Slechts 71% van de woorden hoort bij de 3.000 meest gebruikte Engelse woorden, dus de woordenschat is pittig.
Belangrijke woorden in deze video
15 minder gangbare woorden uit de video, met uitspraak en betekenis:
- knee /ni/ (zelfstandig naamwoord) — knie. In humans, the joint or the region of the joint in the middle part of the leg between the thigh and the shank.
- bilateral /baɪˈlætəɹəl/ (bijvoeglijk naamwoord) — tweezijdig. Having two sides.
- deny /dəˈnaɪ/ (werkwoord) — ontkennen. To disallow or reject.
- oxygen /ˈɑksɪd͡ʒən/ (zelfstandig naamwoord) — zuurstof. The chemical element (symbol O) with an atomic number of 8 and relative atomic mass of 15.9994. It is a colorless and odorless gas. Sometimes called elemental…
- dose /ˈdəʊ̯s/ (zelfstandig naamwoord) — dosis. A measured portion of medicine taken at any one time.
- mild /ˈmaɪld/ (bijvoeglijk naamwoord) — mild, zacht. Gentle and not easily angered
- lung /ˈlʌŋ/ (zelfstandig naamwoord) — long. A biological organ of vertebrates that controls breathing and oxygenates the blood.
- pending /ˈpɛndɪŋ/ (bijvoeglijk naamwoord) — in afwachting. Awaiting a conclusion or a confirmation.
- swell /swɛl/ (werkwoord) — zwellen, opzwellen. To become larger, fuller, or rounder, or expand in size or shape, usually as a result of pressure from within.
- arthritis /ɑːˈθɹ(a)ɪtɪs/ (zelfstandig naamwoord) — gewrichtsontsteking, artritis. Inflammation of a joint or joints causing pain and/or disability, swelling and stiffness, and due to various causes such as infection, trauma, degenerative…
- sibling /ˈsɪb.lɪŋ/ (zelfstandig naamwoord) — brus, sibling. A person who shares a parent; one's brother or sister who one shares a parent with.
- abdominal /æbˈdɑm.ə.nl̩/ (bijvoeglijk naamwoord) — abdominaal, buik-. Of or pertaining to the abdomen; ventral.
- extent /ɪkˈstɛnt/ (zelfstandig naamwoord) — bereik, mate. A range of values or locations.
- extension /ɪkˈstɛnʃən/ (zelfstandig naamwoord) — uitbreiding, extensie. The act of extending; a stretching out; enlargement in length, breadth, or time; an increase.
- worker /ˈwɝ.kɚ/ (zelfstandig naamwoord) — arbeider, arbeidster. One who works: a person who performs labor for a living; traditionally, especially, manual labor.
Phrasal verbs die je zult horen
- rule out (werkwoord) — uitsluiten. To cross an item out by drawing a straight line through it, as with a ruler.
Uitspraak om op te letten
De spreker gebruikt 8 samentrekkingen en verkorte vormen, zoals didn't, aren't, I'm. Spreek ze kort uit, zoals je ze hoort.
- De “th”-klanken: arthritis /ɑːˈθɹ(a)ɪtɪs/, breathe /bɹiːð/, thorough /ˈθʌɹoʊ/, breakthrough /ˈbɹeɪk.θɹuː/, erythema /ˌɛɹɪˈθiːmə/
- De klanken “sh” en “zh”: extension /ɪkˈstɛnʃən/, conclusion /kənˈkluːʒən/, occasionally /əˈkeɪʒənəli/, presentation /ˌpɹɛzn̩ˈteɪʃn̩/, examination /ɪɡˌzæm.ɪˈneɪ.ʃən/
- Lange woorden — let op de klemtoon: bilateral /baɪˈlætəɹəl/, arthritis /ɑːˈθɹ(a)ɪtɪs/, occasionally /əˈkeɪʒənəli/, difficulty /ˈdɪfɪkəlti/, examination /ɪɡˌzæm.ɪˈneɪ.ʃən/
Zo oefen je met deze video
- Luister de hele video één keer zonder te spreken en noteer de woorden die je niet kent.
- Spreek zin voor zin na op normale snelheid en herhaal elke zin tot je ritme gelijk is aan dat van de spreker.
- Neem jezelf op en vergelijk met het origineel; let daarbij op woorden als knee, bilateral, deny.
Grammatica in deze video
De structuren die de spreker het meest gebruikt, met de exacte woorden uit de video:
| Structuur | In de video |
|---|---|
| Present perfect have/has + voltooid deelwoord — iets uit het verleden dat nu nog telt | has never experienced · has had · has never had |
| Lijdende vorm be + voltooid deelwoord — het gaat om wat er gebeurt, niet om wie het doet | was exacerbated · was given · was diagnosed |
Wat is de Shadowing-techniek?
Shadowing is een wetenschappelijk onderbouwde taalleermethode die oorspronkelijk is ontwikkeld voor professionele tolkentraining en gepopulariseerd door polyglot Dr. Alexander Arguelles. De methode is eenvoudig maar krachtig: je luistert naar native Engelse audio en herhaalt het onmiddellijk hardop — als een schaduw die de spreker volgt met slechts 1–2 seconden vertraging. In tegenstelling tot passief luisteren of grammaticadrills, dwingt shadowing je hersenen en mondspieren om echte spraakpatronen tegelijkertijd te verwerken en te reproduceren. Onderzoek toont aan dat het de uitspraaknauwkeurigheid, intonatie, ritme, verbonden spraak, luisterbegrip en spreekvaardigheid aanzienlijk verbetert — waardoor het een van de meest effectieve methoden is voor IELTS Speaking-voorbereiding en echte Engelse communicatie.