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1、lWomen: Doctor, my husband tripped and fell, hitting his head quite hard. He has a headache, so I thought Id better bring him in and see whats wrong with him.lDoctor: When did it happen?lW:This morning. About two hours ago.lD:Does he have high blood pressure or diabetes?lW:No.lD:Did he lose consciou
2、sness after the injury?lW:Yes, he did. He blacked out for about half an hour. Then he regained consciousness.lD:(asking the patient) Do you remember how you were injured?lP:Oh, oh. (patient vomits)lD:Well, he is unconscious again now. Has he been vomiting all the time before coming to hospital?lW:Ye
3、s.lD:Now, let me have a look at him. The pupil on the right is dilated and does not react to light. Theres no reaction to pain in the left extremities. Im afraid your husband has torn a blood vessel when he hit his head, and the blood is compressing his brain, causing his present condition. Ill talk
4、 over his problem with the neurosurgeon and decide what to do.lW:Thank you, Doctor. Im so worried. Do you think my husband will live? lD:Dont worry. Well do everything we can to save him. lIve just finished talking to the neurosurgeon. Your husband is in a coma due to extradural hemorrhage. In order
5、 to save him, we think we should operate on him. (In order to be more certain what has happened to him, a lumbar puncture is necessary). We need your permission to do this.lW:Anything you say, Doctor, as long as he gets well.lD:Well, the operation has certain risks with the anesthetic and your husba
6、nd may not be able to stand the operation. Post-operative complications could also occur. But well do all we can for him.lW:Yes, I understand. Please help him. I agree to the operation. lD:Well. Could you sign this paper to give your consent for the operation? I think everything will be all right.lW
7、:Shall I stay here?lD:If you want to, you can wait, and Ill let you know the result of the surgery. (Please wait in the sitting room. Ill keep you informed of what is going on).lPatient: Doctor, Ive had abdominal pains and vomiting for the past three days.lDoctor: What kind of a pain is it?lP:Like c
8、olic, with spasms every 4 or 5 minutes.lD:When did the vomiting first start?lP:Two days ago. Ive had about five bouts of nausea and vomiting up to now.lD:How about your bowel movement?lP:Nothing for two days.lD:Any wind?lP:No, not since last night.lD:Have you ever had any abdominal surgery?lP:I had
9、my appendix out, but that was a long time ago.lD:Have you had anything like this before?lP:No, its the first time.lD:Now, please lie on your back, bend your knees and relax. Let me examine you. Im afraid you have an intestinal obstruction. Well do some x-rays to confirm this.lP:Will an operation be
10、necessary?lD:Since you have a fever and some muscle rigidly in the abdomen, there is the possibility of intestinal strangulation. Immediate surgery is necessary.lP:Is there any danger?lD:No, dont worry, just leave everything to us. Everything will be all right. lPatient: I bleed quite a bit when I h
11、ave a bowel movement. Im really worried about it.lDoctor: What color is the blood?lP:Its bright red.lD:Is it mixed with the stool?lP:No, it isnt.lD:Do you have constipation often?lP:Yes, all the time.lD:Have these been any change in the pattern of your feces?lP:No.lD:Now, lets have a look at you. Pl
12、ease undress and lie in the knee-elbow position. Im going to examine you with an analscope. Youve got hemorrhoids and a prolapse of the rectal mucosa.lP:Is there any way to cure it? If possible, Id rather not have an operation.lD:Dont worry. Heres a prescription. Use the suppositories and laxative.
13、The bleeding should stop in two or three days. lP:Anything else I should do?lD:Eat more fruit or vegetables. Sit in warm water when you feel pain and if possible, avoid alcohol and spicy food.lP:Thank you. Ill follow your advice.lDoctor: Is there anything worrying you?lPatient: Yes, I have a lump (m
14、ass) in my left breast.lD:How long have you felt it?lP:About three weeks.lD:Have you had any pain in this area, especially during menstruation?lP:No.lD:Have you had any accident to this area?lP:No.lD:Have you had any discharge from it or any itching of the nipple?lP:No.lD:Have you noticed any swelli
15、ng under your left armpit?lP:No.lD:Has anyone in your family ever had a lump or tumor of the breast?lP:No, not that I can remember.lD:Do you mind if I examine you briefly?lP:No, not at all.lD:Would you please take off your blouse. Thats fine. Sit up straight. Now rest your arm on mine. Let me examin
16、e your armpit. Put your right arm over your head. Now lets do the same with the left. Good. Thats all. How old are you?lP:Im fifty. Is serious?lD:No. Nothing serious. Just a cystic disease of the breast (Adenofibroma). Its a benign hormone-dependent disease. lDo you have any relatives here?lP:Yes. My husband is just outside, shall I ask him to come in?lD:Yes. Will you please go to the laboratory to check up a white blood cell count? lDoctor to patients husband: lAs you know, your wife has a lump
