Shadowing Practice: How to Present a Patient: Inpatient Bedside Teaching Rounds (Group 12) - Learn English Speaking with Video
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Her mod tam ekran bir pratik odası açar.
61 cümleler
Cümleler çok kısa veya çok uzun ise, ayarlamak için Düzenle'ye tıklayın.
1
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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Bu dersin kelimeleri ve konuşma notları
Bu videoda gölgeleme çalışması için 61 cümle ve 789 kelime var. Konuşma bölümü 5:50 sürüyor. Konuşmacı dakikada yaklaşık 135 kelimelik dengeli bir hızla konuşuyor; gölgeleme için rahat bir tempo. Kelimelerin yalnızca %71’i İngilizcede en sık kullanılan 3.000 kelime arasında, bu yüzden kelime dağarcığı zorlayıcı.
Bu videodaki önemli kelimeler
Videodan daha az kullanılan 15 kelime, telaffuzu ve anlamıyla:
- knee /ni/ (isim) — diz. In humans, the joint or the region of the joint in the middle part of the leg between the thigh and the shank.
- deny /dəˈnaɪ/ (fiil) — inkâr etmek. To disallow or reject.
- oxygen /ˈɑksɪd͡ʒən/ (isim) — oksijen, müvellidülhumuza. 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/ (isim) — doz. A measured portion of medicine taken at any one time.
- lung /ˈlʌŋ/ (isim) — akciğer. A biological organ of vertebrates that controls breathing and oxygenates the blood.
- pending /ˈpɛndɪŋ/ (sıfat) — beklemede. Awaiting a conclusion or a confirmation.
- swell /swɛl/ (fiil) — şişmek, şişirmek. To become larger, fuller, or rounder, or expand in size or shape, usually as a result of pressure from within.
- arthritis /ɑːˈθɹ(a)ɪtɪs/ (isim) — artrit, eklem iltihabı. 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/ (isim) — kardeş. A person who shares a parent; one's brother or sister who one shares a parent with.
- abdominal /æbˈdɑm.ə.nl̩/ (sıfat) — karın ile ilgili. Of or pertaining to the abdomen; ventral.
- extension /ɪkˈstɛnʃən/ (isim) — uzatma, teşmil. The act of extending; a stretching out; enlargement in length, breadth, or time; an increase.
- worker /ˈwɝ.kɚ/ (isim) — işçi, emekçi. One who works: a person who performs labor for a living; traditionally, especially, manual labor.
- illness /ˈɪl.nəs/ (isim) — hastalık, maraz. An instance (episode) of a disease or poor health.
- conclusion /kənˈkluːʒən/ (isim) — son. The end, finish, close or last part of something.
- obtain /əbˈteɪn/ (fiil) — elde etmek, almak. To get hold of; to gain possession of, to procure; to acquire, in any way.
Dikkat edilecek telaffuzlar
Konuşmacı didn't, aren't, I'm gibi kısaltılmış biçimleri 8 kez kullanıyor. Bunları duyduğunuz gibi kısa söyleyin.
- “th” sesleri: arthritis /ɑːˈθɹ(a)ɪtɪs/, breathe /bɹiːð/, thorough /ˈθʌɹoʊ/, breakthrough /ˈbɹeɪk.θɹuː/, erythema /ˌɛɹɪˈθiːmə/
- “sh” ve “zh” sesleri: extension /ɪkˈstɛnʃən/, conclusion /kənˈkluːʒən/, occasionally /əˈkeɪʒənəli/, presentation /ˌpɹɛzn̩ˈteɪʃn̩/, examination /ɪɡˌzæm.ɪˈneɪ.ʃən/
- Uzun kelimeler — vurguyu doğru yere koyun: bilateral /baɪˈlætəɹəl/, arthritis /ɑːˈθɹ(a)ɪtɪs/, occasionally /əˈkeɪʒənəli/, difficulty /ˈdɪfɪkəlti/, examination /ɪɡˌzæm.ɪˈneɪ.ʃən/
Bu videoyla nasıl çalışılır
- Videonun tamamını konuşmadan bir kez dinleyin ve bilmediğiniz kelimeleri not edin.
- Normal hızda cümle cümle tekrar edin; ritminiz konuşmacıyla aynı olana kadar her cümleyi yineleyin.
- Kendinizi kaydedin ve orijinaliyle karşılaştırın; knee, deny, oxygen gibi kelimelere özellikle dikkat edin.
Bu videodaki dil bilgisi
Konuşmacının en çok kullandığı yapılar, videodaki sözcüklerin aynısıyla:
| Yapı | Videoda |
|---|---|
| Present perfect have/has + fiilin üçüncü hâli — geçmişte olan ama şimdi de önemli olan bir eylem | has never experienced · has had · has never had |
| Edilgen yapı be + fiilin üçüncü hâli — kimin yaptığı değil, ne olduğu önemli | was exacerbated · was given · was diagnosed |
Gölgeleme Tekniği Nedir?
Gölgeleme, başlangıçta profesyonel tercüman eğitimi için geliştirilen ve çok dilli Dr. Alexander Arguelles tarafından popüler hale getirilen, bilim destekli bir dil öğrenme tekniğidir. Yöntem basit ama güçlüdür: ana dili İngilizce olan bir sesi dinler ve hemen yüksek sesle tekrar edersiniz — konuşmacıyı 1-2 saniye gecikmeyle takip eden bir gölge gibi. Pasif dinleme veya dilbilgisi alıştırmalarının aksine, gölgeleme beyninizi ve ağız kaslarınızı gerçek konuşma kalıplarını eşzamanlı olarak işlemeye ve yeniden üretmeye zorlar. Araştırmalar, telaffuz doğruluğu, tonlama, ritim, bağlı konuşma, dinleme anlama ve konuşma akıcılığını önemli ölçüde geliştirdiğini göstermektedir — bu da onu IELTS Konuşma hazırlığı ve gerçek dünya İngilizce iletişimi için en etkili yöntemlerden biri yapar.