Практика Shadowing: Gynaecological Examination - Изучайте разговорный английский по видео
Создание урока...
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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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Лексика и советы по произношению к этому уроку
Этот урок разговорной практики построен на видео «Gynaecological Examination». Чаще всего повторяются слова: uterus, examination, speculum, cervix, blade. В этом видео 84 предложений и 1203 слов для шедоуинга. Речь длится 7:37. Говорящий говорит в естественном темпе, около 158 слов в минуту, близком к повседневной речи. Только 74% слов входят в 3000 самых частых слов английского языка, поэтому лексика сложная.
Ключевая лексика этого видео
15 слов из видео, которые стоит выучить, с произношением и значением:
| Слово | Произношение | Значение |
|---|---|---|
| examination существительное | /ɪɡˌzæm.ɪˈneɪ.ʃən/ | прове́рка, иссле́дование |
| blade существительное | /bleɪd/ | ле́звие |
| bend глагол | /bɛnd/ | сгиба́ть, изгиба́ть |
| refer глагол | /ɹɪˈfɜː/ | ссыла́ться, сосла́ться |
| assess глагол | /əˈsɛs/ | определя́ть, определи́ть |
| insert глагол | /ɪnˈsɝt/ | вставля́ть, вста́вить |
| finger существительное | /ˈfɪŋɡɚ/ | па́лец, перст |
| axis существительное | /ˈæksɪs/ | ось |
| vagina существительное | /vəˈdʒaɪ.nə/ | влага́лище, же́нский полово́й о́рган |
| couch существительное | /ˈkaʊ̯t͡ʃ/ | дива́н, куше́тка |
| inspect глагол | /ɪnˈspɛkt/ | осма́тривать, осмотре́ть |
| angle существительное | /ˈæŋ.ɡəl/ | у́гол |
| pregnancy существительное | /ˈpɹɛɡnənsi/ | бере́менность |
| brush существительное | /bɹʌʃ/ | щётка, кисть |
| inspection существительное | /ɪnˈspɛkʃən/ | инспе́кция, прове́рка |
Грамматика в этом видео
Конструкции, которые говорящий использует чаще всего, с точными словами из видео:
| Конструкция | В видео |
|---|---|
| Пассивный залог be + причастие прошедшего времени — важно, что происходит, а не кто это делает | is called · has been inserted · is inserted |
| Present Perfect have/has + причастие прошедшего времени — прошлое действие, важное сейчас | has been inserted · have done · i've also shown |
Произношение, на которое стоит обратить внимание
Говорящий использует 10 сокращённых и редуцированных форм, например we're, we'll, we've. Произносите их коротко, так, как слышите.
- Звуки «th»: underneath /ˌʌndɚˈniθ/, withdraw /wɪðˈdɹɔ/, thumb /ˈθʌm/, erythema /ˌɛɹɪˈθiːmə/
- Звуки «sh» и «zh»: examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, brush /bɹʌʃ/, inspection /ɪnˈspɛkʃən/, essentially /ɪˈsɛnʃəli/, sheet /ʃit/
- Длинные слова — следите за ударением: examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, essentially /ɪˈsɛnʃəli/, stability /stəˈbɪlɪti/, mobility /mə(ʊ)ˈbɪlɪti/, inflammatory /ɪnˈflæmət(ə)ɹi/
Звуки, трудные для русскоязычных:
- /w/ — губы округлены, это не /v/: backward /ˈbækwɚd/, withdraw /wɪðˈdɹɔ/, waist /weɪst/, swab /swɒb/, downwards /ˈdaʊnwɚdz/
- /h/ — лёгкий выдох, а не русское «х»: helpful /ˈhɛlp.fl̩/, heel /hil/
- Звонкие согласные в конце слова — не оглушайте их: blade /bleɪd/, bend /bɛnd/, discharge /dɪsˈtʃɑɹdʒ/, bleed /ˈbliːd/, backward /ˈbækwɚd/
Как заниматься с этим видео
- Прослушайте всё видео один раз молча и выпишите незнакомые слова.
- Начните со скорости 0,75×, повторяйте предложение за предложением и вернитесь к обычной скорости, когда станет легко.
- Запишите себя и сравните с оригиналом, обращая внимание на такие слова, как examination, blade, bend.
Что такое техника Shadowing?
Shadowing — это научно обоснованная техника изучения языка, изначально разработанная для подготовки профессиональных переводчиков и популяризированная полиглотом доктором Александром Аргуэльесом. Метод прост, но эффективен: вы слушаете аудио на английском от носителей языка и немедленно повторяете вслух — как тень, следующая за говорящим с задержкой в 1–2 секунды. В отличие от пассивного прослушивания или грамматических упражнений, Shadowing заставляет мозг и мышцы рта одновременно обрабатывать и воспроизводить реальные речевые паттерны. Исследования показывают, что это значительно улучшает точность произношения, интонацию, ритм, связную речь, понимание на слух и беглость речи — что делает его одним из самых эффективных методов для подготовки к IELTS Speaking и реального общения на английском.