Unit 1 Reading

The Skin

The integumentary system consists of the skin

and its accessory organs: the hair, nails, sebaceous
glands, and sweat glands. The skin is the largest organ in
the body and performs many vital functions: It shields
the body against injuries, infection, dehydration, harmful
ultraviolet rays, and toxic compounds. The skin is a
protective interface between the body and the external
environment. Beneath the skins surface is an intricate
network of sensory receptors that register sensations of
temperature, pain, and pressure. The millions of sensory
receptors and a vascular network aid the functions of the
entire body in maintaining homeostasis, a stable internal
environment of the body. The skin is considered an
organ and is composed of two layers of tissue: the outer
epidermis, which is visible to the naked eye, and the
inner layer, the dermis. The epi/derm/is forms the
protective covering of the body and does not have a
blood or nerve supply. It is dependent on the dermis for
its network of capillaries for nourishment. As oxygen
and nutrients flow out of the capillaries in the dermis,
they pass through tissue fluid supplying nourishment to
the deeper layers of the epidermis. The epi/derm/is is
thick on the palms of the hands and the soles of the feet
1

but relatively thin over most other areas. Although the

epidermis is composed of several layers, the stratum
corneum and the basal layer are of greatest importance.
The stratum corneum is composed of dead flat cells that
lack a blood supply and sensory receptors. Its thickness
is correlated with normal wear of the area it covers. Only
the stratum germivatum is composed of living cells and
includes a basal layer where new cells are formed. As
new cells form in basal layer, they move toward the
stratum corneum to replace the cells that have been
sloughed off, they die and become filled with a hard
protein material called keratin. The relatively waterproof
characteristic of keratin prevents body fluids from
evaporating and moisture from entering the body. The
entire process by which a cell forms in the basal layers,
rises to the surface, becomes keratinized, and sloughs off
takes about 1 month. In the basal layer, specialized cells,
called melan/o/cytes, produce a black pigment called
melanin. The production of melanin increases with
exposure to strong ultraviolet light. This exposure
creates a suntan that provides a protective barrier from
the damaging effects of the sun. The number of
melan/o/cytes is about the same in all races. Differences
in skin color are attributed to production of melanin. In
people with dark skin, melanocytes continuously
produce large amounts of melanin. In people with light
skin, melanocytes produce less melanin. The accessory
organs of the skin include the integumentary glands,
2

hair, and nails. Each nail is formed in the nail root and is
composed of keratin, a hard fibrous protein, which is
also the main component of hair. As the nail grows from
a matrix of active cells beneath the cuticle, it stays
attached and slides forward over the epithelial layer
called the nail bed. Most of the (5) nail body appears
pink because of the underlying blood vessels. The lunula
is the crescent-shaped area at the base of the nail. It has a
whitish appearance because the vascular tissue
underneath does not show through.
(sault.eup.k12.mi.us/site/handlers/filedownload.ashx?...3
526&dataid)
Exercise 1
Combine the following statements to make complete
sentences. Add conjunctions and relative pronouns of
your own and omit the words or phrases in italics.
Model
1 The combination of a damp, foggy climate and
intensive use of soft coal in inefficient household
fireplaces does not seem to have been repeated on such a
scale elsewhere.
2 Similar conditions may have occurred in Eastern
European countries and in Istanbul (although)

The combination of a damp, foggy climate and intensive

use of soft coal in inefficient household fireplaces does
not seem to have been repeated on such a scale
elsewhere, although similar conditions may have
occurred in Eastern European countries and in Istanbul.
1 In the United Kingdom, airborne particles are thought
to be associated with about 10 000 extra deaths every
year.
It is salutary to consider how much effort is put into
controlling outdoor concentrations of air pollutants.
(and)
2 Studies in the United States have shown interesting
results.
Living in a city with a comparatively high level of
particles leads to a reduction in life expectancy. (that)
3 Calculating the extent of the impact at an individual
level is impossible.
We do not know how many in a population are affected
(because)
4 In developing countries both air and water pollution
remain important problems
A large effort will be needed before these are removed.
(and)
4

5 The impact of air pollution on health is large.

Some three million deaths each year are attributed by
WHO to air pollution. (because)
Exercise 2
Translate
Fiina uman este un sistem integrat acionnd tot timpul
prin trei niveluri distincte: mental, emoional i fizic,
nivelul mental fiind cel mai important urmat de cel
emoional.Din momentul naterii fiina uman triete
ntr-o continu dinamic cu mediul, care i afecteaz
organismul n diferite moduri i este deci obligat s se
adapteze continuu n vederea obinerii unui echilibru
dinamic. Nivelurile mental, emoional i fizic nu sunt
complet separate ntre ele, aflndu-se ntr-o permanent
interaciune. Gradul de sntate sau de boal al
individului poate fideterminat evalund aceste niveluri.
Exist o ierarhizare i n cadrul acestor trei niveluri de
baz . Planul mental este vzut ca fiind cel mai central,
cel mai ntai ierarhic pentru c pe acest nivel exist
funciile cruciale exprimrii individului. Planul fizic,
dei important, este totui listat ca cel mai periferic sau
mai puin semnificativ n aceast ierarhie. n interiorul
fiecrui plan exist o ierarhie a funciilor individuale. n
cazul unui stimul morbid, mecanismul de aprare al
organismului creeaz cea mai bun aprare posibil la un
anumit moment ncercnd ntotdeauna s limiteze
5

simptomele la nivelurile cele mai periferice. Ce

nelegem ns prin mecanism de aprare al organismului
voi ncerca s clarific mai departe. Aceast noiune
destul de vag la prima vedere are o expresie bine
cunoscut la nivel fizic pentru orice medic lund forma
sistemului imunitar, endocrin i nervos. Dar exist o
expresie a mecanismului de aprare att la nivel
emoional, ct i la nivel mental sub forma unui tot nalt
sistematizat care funcioneaz unitar i coerent aprnd
organismul n cea mai bun manier posibil i n orice
moment. Funcia mecanismului de aparare este s
protejeze regiunile interne ct i pe cele psihice nalte i
spirituale ale organismului durerea musculara si osteoarticulara este cel mai frecvent symptom din practica
reumatologica.
(http://www.homeopatie-srh.ro/wpcontent/uploads/2010/10/Caiet-Modul-1.pdf)
Exercise 3
What is wrong with the following sentences and why
1. I opened the letter and it contained an important
information.
2. I have come to perfect my knowledge of English.
3. The news are good this night.
4. Can you give me any in formations and advices on
diabetes.
6

5. I went to my physician for an advice.

6. I have several shirts but only one trousers.
Exercise 4
Fill the gaps with the definite article or the indefinite
article a or an.
It was _____ day in July last year.
I remember _____ day really well.
It was _____ bright sunny morning.
I took _____ thin pullover, just in case it turned
chilly.
By two oclock in ____ afternoon, it felt like
mid-December.
Dont stay out in ____hot sun for too long.
After that you can double ____ time of ____
previous day.
Thats ____ phone, Ill get it.
He wants to know if you can pick him up at____
station.
Exercise 5
Recognize the patients anxiety.
7

Study this dialogue. Practice this dialogue

The nurse should encourage the patient to face anxiety
and assist him in finding constructive ways to deal with
it.
Nurse
are you feeling today?

Hello, Mrs. Brown, how

Mrs Brown
Just miserable. I feel so
weakI just havent got the strength to do anythingI
feel weak when I try to get out of bed
Nurse
upset by all this.

You must feel pretty

Mrs Brown
Yes, I do. The stitches
are killing me and I feel so weak
Nurse
Its too bad that you
feel this way. You seem to be filling fine until a few
days ago.
Yes, its trueI was

Mrs Brown
feeling fine.

Nurse
Well, then, what
happened that made you feel worse?
Gee, I dont know.

Mrs Brown

Nurse
Well, before all of this
began to happen, do you remember being upset or
concerned about anything?
Mrs Brown
No (then, with some
surprise) yesyes, maybe I was.
Nurse

You were worried?

Mrs Brown (hesitantly)

About going home

Nurse
going home?

You felt anxious about

Mrs Brown (with relief)

Yes, yes, I did.

Nurse
Do you think you might
have been concentrating on your weakness and pain too
much? May be just so you wouldnt have to think about
going home?
Its true I didnt want to

Mrs Brown
think about going home.

Nurse
And may be youve been
so annoyed with everyone these last few days just
because you were really upset about going home?
Mrs Brown

Yes, that could be true.

Nurse
You must feel pretty
concerned about going home.
9

Mrs Brown
I just feel so helplesshaving
to take care of a baby and everythingI never had a
baby before
Nurse
youll manage?

Youre worried about how

Mrs Brown

Yes

Nurse
Most mothers are anxious
about that,, especially the first time. But you must feel
particularly anxious. I wonder why?
Mrs Brown (beginning to cry)
Oh, I never do
anything rightIts like my mother in law always
saysI cant even take care of myself properly. And
now with a baby, how will I ever manage?
Nurse
You sometime thinks of
yourself as less able to manage than most women?
Mrs Brown

Yes I do

(pdfs.journals.lww.com/ajnonline/1965/.../Programmed_
Instruction.45.pdf)
Exercise 6
Translate
i acum exist un puhoi de idei cu privire la natura
sufletului, ce nseamn el, unde este locuina lui. De
10

altfel, a cules succes mare un film denumit chiar 21 de

grame, n care se vorbea c sufletul poate fi cntrit.
Asta s-a i ntmplat. A existat un experiment n care s-a
cntrit un om chiar n pragul morii i, imediat dup ce
i-a dat sufletul, a fost din nou cntrit. S-a constatat c
sczuse n greutate cu 21 de grame, cu alte cuvinte c i sa nlat sufletul la Ceruri i el a pierdut aceast greutate.
Filmul american era chiar incitant, fiindc un brbat
bolnav de inim a suferit un transplant de cord,
montndu-i-se n piept inima unui alt brbat clcat de o
main. Scurtnd fascinanta poveste, brbatul cu inima
nlocuit a nceput s simt brusc sentimente de dragoste
fa de nevasta decedatului cruia i se prelevase cordul.
Exist teorii care spun c sufletul este o form de energie
foarte concentrat. De altfel, o mulime de savani susin
c totul este energie, de la lemnul de la mas pn la
esuturile corpului nostru.Enigma s-a amplificat atunci
cnd marii academicieni ai lumii au constatat c exist o
particul mai mic din celul, mai mic dect neutronul,
care se numete neutrino. Aceast frm de Univers
este greu de stpnit, dificil de analizat i imprevizibil
ca manifestare. Ei bine, se zice c Dumnezeu dirijeaz
acest neutrino.Teoriile medicinei energetice, denumit i
cuantic, dar i ale celei vibraionale, susin c boala l
atac pe om n diverse etape i la anumite niveluri.
Pasmite, primul atac al bolilor se petrece n cmpul
informaional, pentru c se spune c totul este
informaie. Cu alte cuvinte, orice particul a
11

organismului, adic orice unitate celular, motenete o

soart, o cale pe care trebuie s o urmeze n destinul ei.
Informaia ntiprit fiecreia i spune cnd s se
nmuleasc, precum i cnd i ct s mnnce, cnd s
moar i aa mai departe.Boala bruiaz aceast
informaie primar, adic viruseaz datele privind
destinul celulei. Medicii energetici susin c este prima
faz de atac a unei afeciuni. Atunci, omul nu simte
neplceri n corpul fizic, ns n cel concret celula este
bramburit. n aceast faz, nc nesesizat prin durere,
pierdere de snge sau inflamaie, i au locul rugciunile,
optimismul i ncrederea. Dar aici se strecoar i
pesimismul, gndurile negre, blestemele sau deochiul.
Dac medicina ar putea domoli atacul bolii la nivelul de
informaie a celulelor, ar frna i boala, n fazele ei de
nceput.Se spune c medicina energetic, biorezonana,
cu aparatele ei sofisticate, poate detecta derapajul
vibraiilor energetice n orice esut. i dac descoper
cum s-a perturbat vibraia ntr-un col de organ poate
readuce la normal respectivul esut, introducndu-i
vibraii cu sens invers, ca s se ajung la plafonul
obinuit.A doua treapt de atac a bolii se susine c este
n corpul energetic. Afeciunea d peste cap curgerea de
energie n organism, blocheaz unele canale de curgere a
acesteia i asta nseamn c bolile au avansat. n aceast
etap, chinezii intervin prin terapiile lor. Acupunctura,
aplicat n anumite noduri, intersecii de meridiane, are
menirea de a da drumul la curgerea de energie, de a
12

spulbera barajele ce stopeaz mersul ei. Ba mai mult,

asiaticii spun, i au confirmri de mii de ani, c aceast
tehnic poate mbogi cu energie un organ aflat n
suferin. i, n fine, teoria susine c faza naintat a
afeciunilor lovete n corpul fizic. Sunt afectate
organele, apar leziunile, rnile, hemoragiile, inflamaiile
i, peste toate, durerile. Cu aceast etap naintat a
bolilor se lupt medicina clasic [F Condurateanu Cum
i arat colii bolile www.taifasuri.ro Editoriale
Florin Condureanu]

13

Unit 2 Reading
Bones

Bones are complete organs chiefly composed

connective tissue called osseous (bony) tissue plus a rich
supply of blood vessels and nerves. Osseous tissue is a
dense connective tissue that consists of osteocytes
(bones cells) surrounding by a hard, intercellular
substance filled with calcium salts. The formation of
bone is dependent to a great extent on a proper supply of
calcium and phosphorus to the bone tissue. These
minerals must be taken into the body along with a
sufficient amount of vitamin D. Vitamin D helps the
passage of calcium through the lining of the small
intestine and into the bloodstream. Once calcium and
phosphorus are in the bones, osteoblastic activity
produces an enzyme that causes the formation of calcium
phosphate, a substance giving bone its characteristic hard
quality. If the proper amount of calcium is lacking in the
blood, nerve fibers are unable to transmit impulses
effectively to muscles. Heart muscle becomes weak, and
muscles attached to bones undergo spasms. The
necessary level of calcium in the blood is maintained by
the parathyroid gland, which secretes a hormone to
release calcium from bone storage. There are 206 bones
of various types in the body. Long bones are found in the
14

thigh, lower leg, and upper and lower arm. These bones
are very strong, are broad at the ends where they join
with other bones, and have large surface areas for muscle
attachment. Short bones are found in the wrist and ankle
and have small, irregular shapes. Flat bones are found
covering soft body parts. These are the shoulder bone,
ribs, and pelvic bones. Sesamoid bones are small,
rounded bones resembling a grain of sesame in shape.
They are found near joints. The kneecap is the largest
example of this type of bone. The shaft, or middle
region, of a long bone is called the diaphysis. Each end
of a long bone is called an epiphysis. The epiphyseal line
or plate represents an area of cartilage tissue that is
constantly being replaced by new bony tissue as the bone
grows. Compact (cortical) bone is a layer of hard, dense
tissue that lies under the periosteum in all bones and
chiefly around the diaphysis of long bones. Within the
compact bone, there is a system of small canals
containing blood vessels Cancellous bone, sometimes
called spongy or trabecular bone, is much more porous
and less dense than compact bone. The mineral matter in
it laid down in a series of separated bony fibres called a
spongy latticework or trabeculae. It is found largely in
the epiphyses of long bones and in the middle portion of
most other bones of the body as well. Spaces in
cancellous bone contain red bone marrow. In an adult,
the ribs, pelvic bone, sternum (breastbone), and
vertebrae, as well as the epiphyses of long bones, contain
15

red bone marrow within cancellous tissue. The red

marrow in the long bones is plentiful in young children
but decreases through the years and is replaced by
yellow marrow.
Exercise 1
Say whether these statements are true or false
1. Connective tissue is surrounded by a hard,
intercellular substance filled with calcium salts.
2. The formation of bone is dependent to a great extent
on a proper supply of calcium and phosphorus without
vitamin D.
3. The red marrow decreases through the years.
4. The shoulder bone, ribs, and pelvic bones are
sesamoid bones.
5. Trabeculae are found in cancellous bone
6. Sesamoid bones are small, rounded bones.
Exercise 2
Translate
The Skeletal System serves many important functions; it
provides the shape and form for our bodies in addition to
supporting, protecting, allowing bodily movement,
16

producing blood for the body, and storing minerals. Its

206 bones form a rigid framework to which the softer
tissues and organs of the body are attached. Vital organs
are protected by the skeletal system. The brain is
protected by the surrounding skull as the heart and lungs
are encased by the sternum and rib cage. Bodily
movement is carried out by the interaction of the
muscular and skeletal systems. For this reason, they are
often grouped together as the musculo-skeletal system.
Muscles are connected to bones by tendons. Bones are
connected to each other by ligaments. Where bones meet
one another is typically called a joint. Muscles which
cause movement of a joint are connected to two different
bones and contract to pull them together. An example
would be the contraction of the biceps and a relaxation
of the triceps. This produces a bend at the elbow. The
contraction of the triceps and relaxation of the biceps
produces the effect of straightening the arm. Blood cells
are produced by the marrow located in some bones. An
average of 2.6 million red blood cells are produced each
second by the bone marrow to replace those worn out
and destroyed by the liver. Bones serve as a storage area
for minerals such as calcium and phosphorus. When an
excess is present in the blood, buildup will occur within
the bones. When the supply of these minerals within the
blood is low, it will be withdrawn from the bones to
replenish the supply. The human skeleton is divided into
two distinct parts: the axial skeleton ( it consists of bones
17

that form the axis of the body and support and protect
the organs of the head, neck, and trunk) and the
appendicular skeleton (it is composed of bones that
anchor the appendages to the axial skeleton).
(billpalmer.pbworks.com/.../Lect.+6+Skeletal+S..)
Exercise 3
Translate
Rheumatic fever is a sequel to infection of the throat
with beta- haemolytic streptococci; any serological type
can be responsible. In epidemic conditions, such as
formerly occurred in institutions and army barracks, the
attack rate can rise as high as 3%, but in non-epidemic
conditions it is very much lower. Rheumatic fever occurs
largely in those who develop a high antibody titre
following the infection; but, for reasons that are unclear,
even of such individuals only a minority become
affected. In someone who has suffered one attack the
risk of recurrence following further streptococcal
infection mat be as high as 50%: hence the importance of
secondary prevention.
The risk of subsequent chronic rheumatic heart disease
depends on the number of attacks of rheumatic fever,
which again underlines the importance of effective
secondary prevention. Unfortunately, in those countries
where rheumatic heart disease is still a major public
18

health problem it is often the exception of rheumatic

fever to be brought to medical attention; and even in
western countries about a half of all newly-recognized
patients with rheumatic heart disease do not recall any
history of rheumatic fever.
The incidents and distribution of rheumatic fever and
rheumatic heart disease are a simple reflection of the
personal and environmental factors which promote the
spread of streptococcal throat infections, with a
concentration of cases in cities, slums, large families and
the winter season. This is a classical disease of poverty,
with domestic overcrowding as the primary factor.
Throughout the western world the mortality and
incidents of rheumatic fever have been falling
throughout this century-from long before the availability
of chemotherapy or antibiotics. What was once a mass
disease is now a comparative rarity, new cases being
mainly confined to city slums. This fall is due largely to
improved housing which has reduced the risk of multiple
streptococcal infections. Streptococci of course, are still
prevalent: the great fall in the attack rate for subsequent
rheumatic fever implies that the organism has lost much
of its virulence. There is a parallel here with the
corresponding decline in scarlet fever.
In many developing countries and particularly in the
cities, conditions remain favorable for the spread of
19

streptococci and rheumatic heart disease is often the

commonest form of heart disease. It tends to appear
much earlier in life and to progress more rapidly than in
the western world.
Exercise 4
Translate
A muscle cell not only has ability to propagate an action
potential along its cell membrane, as does a nerve cell,
but also has the internal machinery to give it the unique
ability to contract. Most muscles in the body can be
classified as striated muscles in reference to the fact that
when observed under a light microscope the muscular
tissue has light and dark bands or striations running
across it. Although both skeletal and cardiac muscles are
striated and therefore have similar structural
organizations, they do possess some characteristic
functional differences. Skeletal muscle contraction, for
example, is made up of the contraction of many motor
units. A motor unit consists of a single motor neuron
coming from the spinal cord of the central nervous
system and all the muscle fibers which it innervates. In
contrast to skeletal muscle, cardiac muscle is a
functional syncytium. This means that although
anatomically it consists of individual cells the entire
mass normally responds as a unit and all of the cells
contract together. In addition, cardiac muscle has the
property of automaticity which means that the heart
20

initiates its own contraction without the need for motor

nerves. Motor nerves may alter this inherent rhythm but
the resource for initiating the contraction lies within the
special cardiac cells called pacemaker cells. Here an
action potential is initiated and spreads to other cardiac
cells. Non striated muscle consists of multi-unit and
unitary (visceral) smooth muscle. Visceral smooth
muscle has many of properties of cardiac muscle.
(books.google.ro/books?isbn)
Exercise 5
Fill in the gaps
already, attempts, care, common, completely, cure,
cures, devices, disease, diseases, efforts, field,
medications,
permanently,
remove,
sickness,
specifically, still, term, therapy
Medical therapies or treatments are 1
efforts to
cure or improve a 2
disease or other health
problem. In the medical 3
field, therapy is
synonymous with the word "treatment". Among
psychologists, the 4
term may refer 5
specifically to psychotherapy or "talk therapy". 6
. Common treatments include 7
medications, surgery, medical 8
devices, and self
9
care.

21

A prevention or preventive 10
therapy is a way
to avoid an injury, 11
sickness, or disease in the
first place. A treatment or12
cure is applied after
a medical problem has 13
already started. A
treatment 14
attempts to improve or 15
remove a problem, but treatments may not produce
permanent 16
cures, especially in chronic diseases.
Cures are a subset of treatments that reverse 17
diseases 18
completely or end medical problems
19
permanently. Many diseases that cannot be
completely cured are 20-still treatable.
Exercise 6
Translate
The names of some muscles may appear strange; the
naming, however, is based essentially on anatomical
position, function, shape, or other feature. Here are some
examples:
Position and Location:
a. Pectoralis major and minor means pectoral region of
thorax; the major is larger
b. Temporalis means temporal region of head
c. Infra-and supraspinatus means below and above spine
of scapula
d. External and internal intercostals can refer intercostal
spaces
Principal Action:

22

a. pronators (e.g., pronator quadratus) and supinatours

pronators refers to palm down and supinator to palm up;
quadratus refers to the shape
b. Flexors and extensors (e.g., flexor and extensor
digitorum) refer to flexors and extensors of digits
c. Levator scapulae means elevator of the scapula
(shoulder)
Shape:
a. Trapezius means trapezoid in shape
b. Rhomboid major and minor means rhomboid in shape
Number of Divisions (Heads) and Position:
a. Biceps branchii can refer to two-headed muscle in
anterior branchium (arm)
b. Triceps branchii can refer to three-headed muscle in
posterior branchium (arm)
Size, Length, and Shape:
a. Flexor pollicis longus and brevis can refer to long and
short flexors of the thrumb
b. Rhomboid major and minor means major is larger in
size; rhomboid in shape.

23

Unit 3 Reading
Circulation of Blood Arteries

Arterioles, veins, and capillaries, together with

the heart, from a circulatory system for the flow of
blood. Blood deficient in oxygen flows through two
large veins, the venae cavae, on its way from the tissue
capillaries to the heart. The blood became oxygen-poor
at the tissue capillaries when oxygen left the blood and
entered the body cells. Oxygen-poor blood enters the
right side of heart and travels through that side and into
the pulmonary artery, a vessel that divides in two, one
branch leading to the left lung, the other to the right
lung. The arteries continue dividing and subdividing
within the lungs, forming smaller and smaller vessels
(arterioles) and finally reaching the lung capillaries. The
pulmonary artery is unusual it is the only artery in the
body that carries blood deficient in oxygen. While
passing through the lung (pulmonary) capillaries, blood
absorbs the oxygen that entered the body during
inhalation. The newly oxygenated blood next returns
immediately to heart through pulmonary veins. The
pulmonary veins are unusual in that they are the only
veins in the body that carry oxygen-rich (oxygenated)
blood. The circulation of blood through the vessels from
the heart to the lungs and then back to the heart again is
24

known as the pulmonary circulation. Oxygen-rich blood

enters the left side of the heart from the pulmonary
veins. The muscles in the left side of the heart pump the
blood out the heart through the largest single artery in
the body, the aorta The aorta moves up at first
(ascending aorta) but then arches over dorsally and runs
downward (descending aorta) just in front of the
vertebral column. The aorta divides into numerous
branches called arteries that carry the oxygenated blood
to all parts of the body. The names of some of these
arterial branches will be familiar to you: brachial
(brachi/o means arm), axillary, splenic, gastric, and renal
arteries. The carotid arteries supply blood to the head
and neck. The relatively large arterial vessels branch
further to from smaller arterioles. The arterioles, still
containing oxygenated blood, branch into smaller tissue
capillaries. Which are near the body cells. Oxygen leaves
the thin capillary walls to enter the body cells. There,
food is broken down, in the presence of oxygen, and
energy is released. One metabolic product of this
chemical process is carbon dioxide (CO2). CO2 is
produced in the cell but is harmful to the cell if it
remains. It must thus pass out of the cells and into the
capillary bloodstream at the same time that oxygen is
entering the cell. As the blood makes its way back from
the tissue capillaries toward the heart in venules and
veins. It is full of CO2 and is oxygen-poor. The circuit is
thus completed when oxygen-poor blood enters the from
25

the venae cavae. This circulation of blood from the body

organs (except the lungs) to heart and back again is
called the systemic circulation.
(eskwela-apc-nstp.wikispaces.com/The+Circ)
Exercise 1
Translate
Allopathic Medicine, also referred to as scientific
medicine, is the type of medicine practiced in the US by
physicians who have the initials MD after their name.
The majority of medical schools in the US and Canada
are allopathic medical schools, though the term allopathy
(Gr. allos ~ against, and pathy ~ disease) is rarely used,
only appearing in medical documents. The initials MD
stand for the Latin Medicinae Doctoris, which appears
on the diplomas of US medical (allopathic) schools.
Osteopathic Medicine is the closest to allopathic
medicine, though osteopathy is based on the belief of its
founder, Andrew Taylor Still, that most diseases are
related to problems in the musculoskeletal system
(bones, muscles, and nerves). The founder of osteopathy
devised and taught manual manipulations to restore
proper musculoskeletal function that are still taught and
used. Otherwise, MDs and DOs in the US practice
medicine the same way. There are 24 osteopathic
medical schools in the US (2) that grant a DO (Doctor of
26

Osteopathy) degree. MDs and DOs are equally

recognized by the various US certifying Boards of
medical specialties and subspecialties upon successful
completion of the appropriate examinations.
Conventional Medicine is the general title given in the
US to the type of medicine practiced by MDs and DOs
and their allied health professionals, such as nurse
practitioners, physician assistants, registered nurses,
physical therapists, psychologists, dietitians, speech,
occupational, and other certified therapists.
Traditional Hindu Medicine (THM), also known as
Ayurveda, is the ancient Hindu science of health and
medicine in which diseases result from disharmony
between the person and the environment (7). Beneficial
effects of yoga and meditation are regularly reported by
those who practice them regularly; both have become
integral parts of most comprehensive rehabilitation
programs.
Chiropractic practitioners are not medical providers.
Under current law, chiropractors are considered "limited
providers" who perform spinal "manipulations" and
"adjustments" to correct vertebral column misalignments
referred to as "subluxations." This is an area of
controversy, since conventional medicine defines
subluxation as a partial dislocation of a joint structure for
which any "adjustment" or "manipulation" would be
27

strictly contraindicated. In addition to "spinal

manipulations", chiropractors prescribe nutritional
products, homeopathic products, and various types of
physical therapy.
Personalized Medicinealso called genome-based or
genomic medicine (16) (17) is the most recent healthcare
concept being talked about in medical circles. The basic
premise is that a person's genomic information can be
used to determine the kinds of treatments most beneficial
to a particular personbe they preventive measures
before a disease presents or actual therapy for an existing
condition. Genetics is the study of heredity and genetic
medicine, it examines the role of individual genes as
they relate to biology and medicine. Genomic medicine
makes use of our own personal (thus the name,
personalized medicine) genome, our individual genetic
structure encoded by the nucleotide sequences, etc to
determine individual vulnerability to disease and
responsiveness to medication. Medications have
traditionally been prescribed only after clinical trials
show benefits. After that, individual physicians decide
on the usefulness, or lack thereof, of the medication for
their own patients. If a particular medication doesn't
work, another will be tried.
(www.ata-divisions.org/.../fall-2008-winter-200.)
Exercise 2
28

Complete these sentences with words from the list.

Use only one word in every gap.
abnormal, ballooning, brain, drooling, headache,
stroke, tingling, weakness
1. A ___________ results from impaired oxygen
delivery.
2. There can occur an abnormal ___________ out of the
wall of the vessel
3. The sudden onset of ___________ on one side of the
body.
4. A ___________ sensation on one side of the body.
5. Subarachnoid hemorrhages cause severe ________.
6. Weakness causes ___________.
7. Major neurological consequences are coma,
and___________ death.
8. The ___________ blood vessel leaks.
Exercise 3
Render the following sentences in your own words.
Pay attention to the use of down
1. The child is down with scarlet fever.
29

2. When the nurse saw the broken doll she came down.
on her ward who was unhappily hiding under the table
3. Your shoes are down at heel. Its high time you
bought a new pair.
4. Hes so used to ups and downs in his fortune that he
simply cant be discouraged by such trifles as a light
sickness or temporary loss of job.
Exercise 4
Adverbs of manner occur most frequently just after
the verb, except that they never come between a verb
and its object. If there is an object, they follow it.
Insert the suggested adverb after the verb, or object,
in each sentence below.
Model

charmingly

She sings folk songs charmingly

1. David washed the windows

well

2. Please put the dishes away.

carefully

3. The children came into the room

noisily

4. She closed the door

quietly

5. He agreed to our proposal

6. The boy climbed the tree
Exercise 5
30

willingly
easily

Adverbs of place normally precede adverbs of time

after a verb. Insert the adverb or adverbial phrase in
the right accordingly.
Model
They go to the movies.

on Sunday

They go to the movies on Sunday.

They go to school

every day

They go to school every day

1 Mr. M went downstairs

before dinner

2 Mr. H. telephoned his wife from mall.

oclock
3 She puts the dishes in the cabinet

about 8

after every meal

4 Well send a representative within the next few

months to your district
5 The sun will go down in a little while it is
behind the mountains
6 The boys played tennis in the park.
7 The cat stood by the window
8 They took Bob to the hospital
31

for a few hours

all day long
at once

Exercise 6
Put each verb in brackets into the most appropriate
perfect or past tense.
Im sorry I havent come / havent been coming (not
come) to class lately.
I __ _ _
fortnight.

(work) late in the evenings for the past

So far we ______ (not notice) anything unusual, but we

_____ (not pay) very close attention.
I wonder if Mary ____ (reach) home yet? She ____
(leave) too late to catch the bus.
Here is the news. The Home Office ______ (announce)
that the two prisoners who ____ (give themselves up) to
local police.
________ (you make up) your minds? What ____ (you
decide) to do ?
Harry _______ (leave ) home rather suddenly and we
_____(not hear) from him since.
Recent research ______ (show) that Columbus ____ (not
discover) America, but that Vikings ______ (land) there
five hundred years before him.

32

I think that people ______ (become) tired of the poor

quality of television programmes, though they ______
(improve) lately.
________ (something happen) to the lines? I ______
(try) to get through to Glasgow for the past hour.
Bill _______ (get) that new job, but he ______
(complain) about it ever since

33

Unit 4 Reading
The Digestive System

The digestive system, also called the alimentary

canal or, begins with the mouth, where food enters the
body, and ends the anus, where solid waste material
leaves the body. The primary functions of the organs of
the digestive system are three fold.
First, complex food material taken into the mouth must
be digested mechanically and chemically. Digestive
enzymes speed up chemical reactions and help
breakdown (digestion) of complex nutrients. Complex
proteins are digested to simpler amino acids.
Complicated sugars are reduced to simple sugars, such
as glucose; and large fat molecules (triglycerides) are
broken down to fatty acids and glycerol.
Second, the digested food must be absorbed into the
bloodstream by passing through the walls of the small
intestine. Cells then catabolize (burn) nutrients in the
presence of oxygen to release energy stored within the
food. Cells also use aminoacid nutrients to anabolize
(build) large protein molecules needed for growth and
development needs for growth and development.
Although the walls of the small intestine also absorb
fatty and glycerol, these nutrients enter into lymphatic
34

vessels rather than blood vessels. Digested fats

eventually enter the bloodstream as lymph vessels join
with blood vessels in the upper chest region.
Third, the digestive system is the elimination of the solid
waste materials that cannot be absorbed into the
bloodstream. The large intestine concentrates these solid
wastes, called feces, and the wastes finally pass out of
the body through the anus. The pharynx or throat is a
muscular tube, lined with a mucous membrane. It serves
as a common passageway for air traveling from the nose
(nasal cavity) to the windpipe (trachea) and food the oral
cavity, the esophagus, extends from the pharynx to the
stomach. Rhythmic contractions of muscles in the wall
of the esophagus propel food toward the stomach. The
stomach is composed of an upper portion called the
fundus, a middle section as the body, and a lower
portion, the pylorus. Rings of muscles control the
opening into and from the stomach. The cardiac
sphincter relaxes contracts to move food from the
esophagus into the stomach, whereas the pyloric
sphincter allows food to leave the stomach when it has
been sufficiently digested. Folds in the mucous
membrane (mucosa) lining the stomach are called rugae.
The rugae contain digestive glands that produce enzymes
and hydrochloric acid. The small intestine (small bowel)
extends from the pyloric sphincter to the large intestine.
It has three parts. The duodenum receives food from the
stomach. The second part of the small intestine, the
35

jejunum. The jejunum connects with the third section,

the ileum. The ileum attaches to the first part of the large
intestine. The large intestine extends from the ileum to
the anus. It is divided into four parts: cecum, colon,
sigmoid colon, and rectum. The cecum is a pouch on the
right side that attaches to the ileum by ileocecal valve
(sphincter). The appendix hangs from the cecum. The
appendix has no clear function, but it causes problems
when inflamed and infected. The transverse colon passes
horizontally to the left toward the spleen, and turns
downward (splenic flexure) into the descending colon.
The sigmoid colon lies at the distal end of the
descending colon. The rectum terminates in the lower
opening of the gastrointestinal tract, the anus.
[mtshine.com/Digiestive.aspx]
Explanations
1. alimentary canal The digestive tract (canal); aliment
means food.
2. amino acids
Small substance that are the
building blocks of proteins and are produced when
proteins are digested.
3. Anus
Opening of digestive tract to the outside
of the body.
4. appendix Blind pouch haning from the first part of
the colon (cecum)
It literally means hanging (pend/o) an (ap-).
Usually found in the RLQ.
36

5. bile Digestive juice made in the liver and stored in the

gallbladder.
6. bilirubin Pigment released by the liver in bile:
produced from the destruction of hemoglobin, a blood
protein (-globin).
7. bowel
Intestine.
8. cecum
First part of the large intestine.
9. colon
Large intestine; ascending, transverse, and
descending parts.
10. deglutition Swallowing.
11. duodenum First part of the small intestine. Duo = 2,
den = 10; the duodenum measures 12 inches in length.
12. emulsification
Physical process of breaking up
large fat globules into smaller globules, thus increasing
the surface area that enzymes can use to digest the fat.
13. esophagus Tube connecting the throat to the
stomach.
14. fatty acids Substances produced when fats are
digested.
15. insulin
Hormone produced by the endocrine cells
of the pancreas.
16. lipase
Pancreatic enzyme necessary to digest
fats.
17. papillae (singular: papilla) Small elevations on the
tongue.
18. saliva
Digestive juice produced by salivary
glands.
37

19. salivary glands Parotid, sublingual, and

submandibular glands.
20. villi (singular: villus)
Tiny microscopic
projections in the walls of the small intestine to absorb
nutrients into the bloodstream.

Exercise 1
Translate
1. A bridge, a really good one, is not simply a
convenience, but a work of art. 2. Until he was eighty
my grandfather enjoyed very good health.3. Women of
today enjoy equal rights with men. 4. I don't like this
wallpaper too much. 5. She was so upset she could not
find the right words, she just stood there speechless and
looked at us. 6. The new plan excited interest. At once,
everybody wanted to know the details. 7. "It gives me
great pleasure to announce the prizewinners", Mr Kent
said. 8. The realization of my mistake came too late, the
harm had already been done. 9. He has been living in the
Far East. I haven't seen him for the space of three years.
10. When he is in a hurry he never spaces the words, he
writes all of them together. 11. It won't make much
difference whether you go today or tomorrow. They're
expecting you any time.12. Somebody must do the work
by Wednesday. It makes no difference who does it. 13.
There has been continuous rain for the last few days,
we're sick and tired of it. 14. He is an instance of a poor
38

boy who became a famous scientist. 15. He has never

helped anyone. He is too busy looking after his own
interest.16. The climate there will be very bad for you,
not to mention the baby. 17. The many interruptions
made her so angry that she did not want to finish the
story. 18. I don't like sausage .Give me a piece of cheese
instead. 19. Tell her everything, she will understand, she
has a heart of gold. 20. I'm sure you'll have no trouble
with Bess, the child is as good as gold. 21. Henry knew
full well that nothing good would come of it. 22. Sid is
one of the best students but French is his weak point. 23.
He was always respectful to older people.
Exercise 2
Complete the second sentence so that it has a similar
meaning to the first sentence, using the word given
Use between two and five words.
a.

I think you should give up smoking immediately.

Had
I think you ___ had better give up ______smoking
immediately.
b.
I expect we will get there by 5.00, if there isnt
too much traffic.
Should
39

We _____________ 5.00, if there isnt too much traffic.

c.

Is it necessary for me to bring my passport?

Have
Do _________________ my passport?
d.

I am sure that the cat is in the house somewhere.

Be
The cat _______________ in the house somewhere.
e.

An aerial is not required with this radio.

Have
You dont ________________ an aerial with this radio.
f.

It is very inconvenient if you cant drive.

To
Its very inconvenient if _____________ drive.
g.

I am sure that John is not the thief.

Be
John _______________________ the thief.
h.

I am certain that Norman will be late.

Bound
40

Norman ________________________ late.

i.
All students should report to the main hall at
9.00.
Are
All students _____________________ to the main hall
at 9.00.
j.

I thought that you would know better!

Ought
You _____________________________ better!
Exercise 3
Complete each sentence so that it contains might,
might not, must, mustnt, can or cant. More than
one answer may be possible.
a.
Dont stand up in the boat! You ___ might ___
fall in the river!
b.
Sue says shes stuck in the traffic and she
___________ be late.
c.
You really _________________ start spending
more time on your work.
d.
Tell Peter he ______________ stay the night here
if he wants to.
41

e.
Thats a really stupid idea! You _____________
be serious, surely!
f.
You ______________ realise it, but this is very
important to me.
g.
Dont be silly. You _____________ expect me to
believe you!
h.
Were not sure but we _____________ go to
Prague for Christmas this year.
i.
Me learn to fly! You ________________ be
joking!
j.
Bill cooked the lunch, so you __________ expect
anything special!
Exercise 4
Translate
The endocrine and nervous systems work together like
interlocking supersystems to control many intricate
activities of the body. Together they monitor changes in
the body and in the external environment, interpret these
changes, and coordinate appropriate responses to
reestablish and maintain a relative equilibrium in the
internal environment of the body (homeostasis). The
endocrine system comprises a network of ductless
glands, which have a rich blood supply that enables the
42

hormones they produce to enter the bloodstream.

Hormone production occurs at one site, but their effects
take place at various other sites in the body. The tissues
or organs that respond to the effects of a hormone are
called target tissues or target organs. In contrast to the
endocrine system, which slowly discharges hormones
into the bloodstream, the nervous system is designed to
act instantaneously by transmitting electrical impulses to
specific body locations. The nervous system controls all
critical body activities and reactions. It is one of the most
complicated systems of the body. The nervous system
coordinates voluntary (conscious) activities, such as
walking, talking, and eating, and involuntary
(unconscious) functions, such as reflexes to pain, body
changes related to stress, and thought and emotional
processes. Hormone secretion to a target organ is
determined by the bodys need for the hormone at any
given time and is regulated so that there is no
overproduction (hyper/secretion) or underproduction
(hypo/secretion).There are times when the bodys
regulating mechanism does not operate properly, and
hormonal levels become excessive or deficient causing
various disorders. Hormones are chemical substances
produced by specialized cells of the body. Because they
travel in the blood, hormones reach all body tissues.
Only target organs contain receptors that recognize a
particular hormone, however. The receptors maintain the
tissues responsiveness to hormonal stimulation.
43

Some characteristics of hormones can be: they are

chemical substances produced by specialized cells of the
body; they are released slowly in minute amounts
directly into the bloodstream; they are produced
primarily by the endocrine glands.
The parathyroid glands are located on the posterior
surface of the thyroid gland. The parathyroid glands are
so called because they are located around the thyroid
gland.
Exercise 5
Fill in with both or too
1. A wheelchair can facilitate social activity
o
out of the home.
2. It is recommended not to raise
above head level.
3. The nurse holds the neck and head with
4. The intact sacral reflex arcs are important
the anal
bulbocavernosus reflexes.

in

of the arms

hands.
for

5. Shoulder pain can be managed withp

physiotherapy
analgesia.

6. The patient can suffer lordosis if he uses a

thick lumbar pillow.

44

7. This sore can take

long to heal.

8. The step must be short; if

taken.

large a step is

9. The patient falls if the doctor chooses

treatment.

long

10.
often disabled people do not receive
beneficial services.
11. There is a
footplates are

high force
high.

on the sacrum when

Exercise 6
A What is about in the below text?
B Explain the following terms: pharmacists, general
practitioner, patient that is about in this text?
They are becoming increasingly recognised, by the
public and government alike, as key players in looking
after the health of people. They provide extended
services such as health checks, pharmacist-run clinics
and, in Scotland, the innovative 'Minor Ailments
Service.'
Through this service, they can access free advice and
where appropriate, prescribed medicines for a range of
ailments, without having to wait for his appointment.
45

The public is now recognizing the valuable resource they

have right there on their high street, where accessibility
is a major advantage.
But that's only part of the story. What most people don't
see is the crucial contribution pharmacists make to
patient care and, indeed, patient safety in hospitals.
(news.bbc.co.uk/2/hi/health/8574806.stm)
Exercise 7
Translate
general practitioner,
blood count,
phlebotomist,
take enough blood for a clotting screen,
disseminated intravascular coagulation,
to the ward on which I was house officer,
drug chart,
equanimity
I was out of my depth
acute cervical injury
46

thoracolumbar injuries
renography
be at risk of cardiac arrest
recurrent suprapubic catheter blockage
absence of calculus debris
hyperpyrexia
patient outcomes

47

Unit 5 Reading
The Respiratory System

The lungs are the paired organs of respiration.

Each lies in its pleural sac attached to the mediastinum at
the hilus. The lung is spongy and elastic in texture and
cone-shaped to conform the contours of the thoracic
cavity. The right lung weighs about 620 g and the left
about 560 g. The clear areas are lung tissue and the
dense shadows at the hilus and radiating outwards are
caused by hilar tissues (lymph nodes) and by blood
vessels .Each lung has an apex in the root of the neck
and a base resting on the diaphragm. The base in
separated by a sharp inferior border from a lateral
convex costal surface and a medial concave
(mediastinal) surface. In the centre of this latter surface,
the structures forming the root of the lung are seen to be
surrounded by a collar of pleura. The concavity of the
medial surface is accentuated on the left to accommodate
the left ventricle of the heart. The anterior border on the
left side is deeply indented by the heart to from the
cardiac notch. The posterior border is rounded and lies in
the paravertebral sulcus. The lungs are divided into lobes
by fissures which extend deeply into their substance. An
oblique fissure divides the left lung into an upper and a
lower lobe; oblique and horizontal fissures divide the
48

right lung into upper, middle and lower lobes. The

oblique fissure of both lungs may be marked by a line
curving around the chest wall from the spine of the 3rd
thoracic vertebra to the 6th costochondral junction.
The lower lobes of both lungs lie below and
behind the oblique fissure and comprise most of the
posterior and inferior borders and parts of the medial and
costal surface. The upper lobe of the left lung lies above
and in front of the oblique fissure and comprises the
apex, substantial portions of the mediastinal and costal
surfaces and the whole of the anterior border including
the cardiac notch. The equivalent part of the right lung is
divided by the horizontal fissure into a large upper lobe
and wedge-shaped anteriorly placed smaller middle lobe.
A thin antero-inferior part of the left upper lobe, adjacent
to the cardiac notch, is known as the lingula and
represents the middle lobe. Variation exists in this lobar
pattern. Fissures, especially the horizontal, may be
incomplete or absent, and occasionally additional lobes
are present. The hilus of each lung contains a main
bronchus, pulmonary artery, two pulmonary veins, the
pulmonary nerve plexus, and lymph nodes, all
surrounded by the collar of pleura whose narrow inferior
extension is known as the pulmonary ligament. On both
sides, the brochus lies behind the pulmonary artery, the
two pulmonary veins lie anterior-inferior to both other
structures. We usually think of respiration as the
mechanical process of breathing the repetitive and, for
49

the most part, unconscious exchange of air between the

lungs and the external environment. This exchange of air
at the lungs is also called external respiration. In external
respiration, oxygen is inhaled (air inhaled contains about
21 per cent oxygen) into the air spaces (sacs) of the
lungs and immediately passes into tiny capillary blood
vessels surrounding the air spaces. Simultaneously,
carbon dioxide, a gas produced when oxygen and food
combine in cells, passes from the capillary blood vessels
into the air spaces of the lungs to be exhaled (exhaled air
contains about 16 percent oxygen).While external
respiration occurs between the outside environment and
the capillary bloodstream of the lungs, another form of
respiration is occurring simultaneously between the
individual body cells and the tiny capillary blood vessels
that surround them. This process is called internal
(cellular) respiration. Internal respiration is the exchange
of gases not at the lungs but at the cells within all the
organs of the body. In this process, oxygen passes out of
the bloodstream and into the tissue cells.
(www.mcqueens.net/mcqueen-ntl/dis/toc_/Pt20.html)
Debate
Statements
1 Smokers can relax by having a cigarette
50

2 Smoking is a good source of money for the

government
3 Smoking should be banned in all public places
4 the peer group has more influence than the family on
smoking habit
5 Smoking is a sign of weakness
6 Smoking helps you concentrate
7 Smokers have a right to smoke
8 Those who contribute to their own illness e.g.
smokers,alcoholics-should have lower priority for their
health care than the others
9 Smoking is fashionable
10 The sale price of cigarettes should be increased
Writing
Why dont you try to give it up ?
Write a letter to a friend-a pregnant woman who is a
smoker.
Explain to her why she should stop smoking.
Working in small groups, use these ideas to plan and
write your letter.
51

Support your arguments with explanations, to be more

convincing.
In giving advice, use phrases from below
To my mind, you shouldnt
I really think you should try and
If I were you
Youd better
Why dont you
You should avoid + gerund
Youd better off without= to have more mney than you
had in the past
Its worth + gerund
Exercise 1
Read the text and answer:
All living things need to have a source of chemical
energy in order to live. A fuel is a substance that can be
used as a source of chemical energy. Animals eat food as
their fuel. Plants make food to act as their fuel, using the
energy of sunlight and a process called photosynthesis.
Both animals and plants then release the energy from
food by using the process of respiration.
52

Aerobic respiration
Respiration means the release of energy from food. This
is a process carried out by all living things. The chemical
process involved works most efficiently if oxygen is
used. Just like a fire needs an oxygen supply to burn the
fuel, so aerobic respiration needs oxygen. Without
oxygen the respiration does not release all the energy
and is called anaerobic respiration. If there is a plentiful
supply of oxygen then aerobic respiration takes place.
The aerobic respiration equation
When food is burned to release energy using oxygen
there are two waste products produced. These are carbon
dioxide and water. These are the same waste products
produced when a fuel, such as coal or wood is burned.
The food usually used as an energy supply is glucose, a
type of sugar produced when most carbohydrates are
digested.
Location of aerobic respiration
Aerobic respiration takes place inside the cell. All cells
need an energy supply to carry out their functions. The
food and oxygen are transported to the cells in humans
by the blood in the circulatory system. The oxygen
comes from the lungs of the respiratory system and the
food comes from the small intestine of the digestive
53

system. Parts of the cell called the mitochondria is the

actual location for aerobic respiration.
1. What do we use as a fuel for our body ?
2. Which system of our body absorbs this fuel ?
3. What process breaks this fuel down to produce energy
?
4. Where does this breakdown of the fuel take place in
the body ?
5. What other substance is needed to help break down
the fuel efficiently ?
6. What are the two waste products when the fuel is
broken down efficiently ?
Exercise 2
Read the text and answer:
The lungs are the organs where gas exchange takes
place. The breathing movement occurs when the
diaphragm and intercostal muscles move causing the
chest cavity to change in size. An average individual
takes about 15,000 breaths per day. The lungs
themselves do not move but are inflated and deflated by
changes in pressure. Inside the lungs the bronchi tubes
split into smaller and smaller tubes called bronchioles.
These finish in a dead end formed from a cluster of small
54

microscopic bubble-like sacs called alveoli. It is in an

alveolus where gas exchange takes place. In the alveolus
oxygen diffuses from the air into the blood and carbon
dioxide diffuses in the opposite direction. This structure
of about 300 million alveoli greatly increases the surface
area of the lungs so speeding up the rate of gas
exchange. The typical human lungs have a surface area
of about 70m, about the size of a tennis court. The
alveoli are kept moist by a liquid called mucus. This
allows the oxygen from the air to dissolve and so also
speeds up the gas exchange. The walls of the alveoli are
very thin so gases do not have far to move to get through
to the blood. Finally the alveoli have a very rich
deoxygenated blood supply embedded within their walls
as a network of blood capillaries. This means the blood
and the air are separated by a membrane only one micron
(0.001mm) thick.
Gas exchange occurs by diffusion which is a slow
process. Diffusion occurs because of the movement of
particles. Gases diffuse from the air into the blood in
solution. The lung structure greatly enhances the rate of
diffusion in the following four ways:
millions of alveoli to increase surface area for diffusion
moist alveoli surface to dissolve oxygen and aid
diffusion
thin walls of alveoli reducing diffusion distance
55

 rich deoxygenated blood supply to absorb oxygen

As well as oxygen diffusing into the blood from the air,
carbon dioxide also diffuses out of the blood into the air.
This is one of the processes of excretion.
1. Which system of our body functions to absorb oxygen
?
2. Describe four ways in which lung structure makes gas
exchange more efficient ?
3. By which physical process does gas exchange take
place ?
Exercise 3
Translate
Carbohydrates have become surprisingly divisive. Some
people swear by them, others swear against them. But it
is important to understand that carbohydrates are a
diverse group of compounds that have a multitude of
effects in the body. Thus, trying to make blanket
statements about carbohydrates is probably not a good
idea. Carbohydrates are named because they are
hydrated carbon. Carbohydrates are produced by plants
through a process known as photosynthesis. In this
process, plants use the energy from photons of light to
synthesize carbohydrates. There are many different types
of carbohydrates as shown in the figure below. The first
56

way that carbohydrates can be divided is into simple,

complex, and sugar alcohols. As the names imply,
complex carbohydrates contain more sugar units, while
simple carbohydrates contain either 1 or 2 sugars.
Sugar Alcohols (Sugar Replacers)
Sugar(s) can provide a lot of calories and contribute to
tooth decay. Thus there are many other compounds that
are used as alternatives to sugar that have been
developed or discovered. We will first talk about sugar
alcohols and then the alternative sweeteners. Sugar
alcohols are also known as "sugar replacers", because
some in the public might get confused by the name sugar
alcohol. Some might think a sugar alcohol is a sweet
alcoholic beverage. Another name for them is nutritive
sweeteners, which indicates that they do provide
calories. Sugar alcohols are nearly as sweet as sucrose
but only provide approximately half the calories. Sugars
are fermented by bacteria on the surfaces of teeth. This
results in a decreased pH (higher acidity), that leads to
tooth decay, and ultimately cavity formation. The major
advantage of sugar alcohols over sugars, is that sugar
alcohols are not fermented by bacteria on the tooth
surface.
http://www.asu.edu/courses/css335/caries.htm
Exercise 4
57

Turn the following words into adjectives: adenoids,

asphyxia
Exercise 5
Join these pairs of sentences using one of the words in
brackets and making any other necessary changes:
Example:
The pulmonary valve remains closed.
The pressure in the right ventricle forces the pulmonary
valve open. (until )
The pulmonary valve remains closed until it is forced
open by the pressure in the right ventricle.
a) Carbon dioxide is not given up by the blood. The
blood reaches the lungs. (until )
b) The pressure inside the left ventricle increases. The
opening of the aortic valve occurs. (meanwhile )
c) Pressure forces blood into the aorta. Blood flows to
the tissues. (as)
d) The pulmonary valve opens. The blood flows into the
pulmonary arteries. (when)
e) The blood reaches the lungs. Oxygen is taken up.
(during)
58

Exercise 6
Translate
Asthma, in spite of considerable clinical and
epidemiological research, remains a poorly understood
condition. Of the number of reasons for this, probably
the main one is the lack of a wholly satisfactory
definition of asthma. Unlike chronic bronchitis and
emphysema, mortality from asthma is very low. Thus
mortality studies are unlikely to prove a potent source of
clues to etiology, although as will be seen late, mortality
comparisons have provided important information about
the effect of treatment.
Asthma refers to the condition of subjects with
widespread narrowing of the bronchial airways, which
changes its severity over short periods of time either
spontaneously or under treatment, and is not due to
cardiovascular disease.
American Thoracic Society (1962) defined asthma as a
disease characterized by an increased responsiveness of
the trachea and bronchii to various stimuli and
manifested by a widespread narrowing of the airways
that changes in severity either spontaneously or as a
result of therapy.

59

Unit 6 Reading
Nervous System

The reception of stimuli is the function of special

sensory cells. The conducting elements of the nervous
system are cells called neurons; these may be capable of
only slow and generalized activity, or they may be
highly efficient and rapidly conducting units. The
specific response of the neuronthe nerve impulse
and the capacity of the cell to be stimulated make this
cell a receiving and transmitting unit capable of
transferring information from one part of the body to
another.
Each nerve cell consists of a central portion containing
the nucleus, known as the cell body, and one or more
structures referred to as axons and dendrites. The
dendrites are rather short extensions of the cell body and
are involved in the reception of stimuli. The axon, by
contrast, is usually a single elongated extension; it is
especially important in the transmission of nerve
impulses from the region of the cell body to other cells.
The cranial nerves connect to the brain by passing
through openings in the skull, or cranium. Nerves
associated with the spinal cord pass through openings in
the vertebral column and are called spinal nerves. Both
60

cranial and spinal nerves consist of large numbers of

processes that convey impulses to the central nervous
system and also carry messages outward; the former
processes are called afferent, the latter are called
efferent. Afferent impulses are referred to as sensory;
efferent impulses are referred to as either somatic or
visceral motor, according to what part of the body they
reach. Most nerves are mixed nerves made up of both
sensory and motor elements.
The cranial and spinal nerves are paired; the number in
humans are 12 and 31, respectively. Cranial nerves are
distributed to the head and neck regions of the body,
with one conspicuous exception: the tenth cranial nerve,
called the vagus. In addition to supplying structures in
the neck, the vagus is distributed to structures located in
the chest and abdomen. Vision, auditory and vestibular
sensation, and taste are mediated by the second, eighth,
and seventh cranial nerves, respectively. Cranial nerves
also mediate motor functions of the head, the eyes, the
face, the tongue, and the larynx, as well as the muscles
that function in chewing and swallowing. Spinal nerves,
after they exit from the vertebrae, are distributed in a
bandlike fashion to regions of the trunk and to the limbs.
They interconnect extensively, thereby forming the
brachial plexus, which runs to the upper extremities; and
the lumbar plexus, which passes to the lower limbs.

61

Among the motor fibers may be found groups that carry

impulses to viscera. These fibers are designated by the
special name of autonomic nervous system. That system
consists of two divisions, more or less antagonistic in
function, that emerge from the central nervous system at
different points of origin. One division, the sympathetic,
arises from the middle portion of the spinal cord, joins
the sympathetic ganglionated chain, courses through the
spinal nerves, and is widely distributed throughout the
body. The other division, the parasympathetic, arises
both above and below the sympathetic, that is, from the
brain and from the lower part of the spinal cord. These
two divisions control the functions of the respiratory,
circulatory, digestive, and urogenital systems.
Diseases of the nervous system include genetic
malformations, poisonings, metabolic defects, vascular
disorders, inflammations, degeneration, and tumors, and
they involve either nerve cells or their supporting
elements. Vascular disorders, such as cerebral
hemorrhage or other forms of stroke, are among the most
common causes of paralysis and other neurologic
complications. Some diseases exhibit peculiar
geographic and age distribution. In temperate zones,
multiple sclerosis is a common degenerative disease of
the nervous system, but it is rare in the Tropics.
[Frederick A. Mettler
www.thehormoneshop.com/.../nervoussystem]
62

Exercise 1
Read the text and then write your essay:
Cancer Illness Prevention
The good news is, cancer deaths are declining.
According to the American Cancer Societys "Cancer
Statistics, 2010" report, around 767,000 cancer deaths
have been avoided since the 1990s. The bad news?
Cancer is still a big problem. American Cancer Society
researchers estimate that some 569,490 people will die
from cancer this year.
What to include in your essay
1. What is cancer illness?
2. Symptoms of illness.
3. Foods which might cause illness.
4. Ways of avoiding the risk of infection.
Resources:www.controlcancer.ca/yhm/;info@lungusa.or
g; www.asiaone.com/(http://stao.ca/resources/MLFGr12.pdf)
Exercise 2
Use the following words in your own sentences:
63

complicate-complication
concentrate-concentration
hour-hourly
aggress -aggressive
Exercise 3
Translate
The patient, in his late 70s, had survived prostate cancer
and had a new diagnosis of leukemia. A few days before,
he'd been healthy and fine, but now his white blood cell
count was so high that it was clogging his circulatory
system, making it hard for him to breathe.
We brought his white count down and relieved his
shortness of breath. At that point, he could have opted
for palliative care and gone home on hospice with a
decent enough quality of life to enjoy what little time he
had left. However, the patient, encouraged by his family
and urged on by his oncologist, chose aggressive
treatment instead.
This is a hard case. In his recent New Yorker article
"Letting Go," Dr. Atul Gawande explains how the first
impulse of doctors, patients and family members to
"fight" cancer or other serious illnesses makes it very

64

difficult to have honest discussions of what treatment

can and cannot do.
I understand why physicians find these conversations
difficult, why it's preferable to focus on the good we can
possibly accomplish rather than the likely futility of the
struggle
But there's another story to be told in these cases, and it's
usually the nurse who's the observer of that narrative: the
suffering caused by these well-intentioned treatments.
Chemo was risky for this patient because of his age and
medical history, and the damage done was unbelievably
bad.
The problems began when cells killed by the
chemotherapy spilled their contents, overloading my
patient's kidneys and throwing him into renal failure.
The intravenous fluids he'd needed had been too much
for his circulatory system, and he developed heart
failure, too.
One morning, I came in with his pills, and he said,
"You're doing too much. I can't take it." The next week,
he was on dialysis, but it wasn't working, and his entire
lower body was hugely swollen with fluid. That day, he
accosted me with, "What the hell are you doing to me?"
Both times, I told the medical team what he'd said and
asked whether it was ethical to continue chemotherapy.
65

Several members of the team shared my concerns, and as

a group, we talked the situation over with the attending
doctor. Our view was that the treatments were eroding
the patient's quality of life with little promise of good in
return.
The attending physician, whom I know to be
conscientious and caring, disagreed, as did the patient's
family. When the doctor prodded the patient, saying,
"You want to keep going, right? Right?" the patient
himself concurred, "Yes, let's keep going."
So the chemo finished. Then, blood began to appear in
the patient's urine. His bladder was brittle because of the
radiation treatments he'd had for prostate cancer, and
because of the chemo, he had too few platelets. Without
enough platelets, that fragile tissue would not stop
bleeding, but it also formed blood clots in his bladder
that caused excruciating pain.
Watching this patient suffer, not from his disease but
because of what we did to him in the name of helping
him, was agonizing. He'd wanted to "keep going," to
"keep on fighting," but what did he really mean?
Always when I hear these phrases applied to oncology
patients, I think of Peter Weir's 1981 film "Gallipoli."
The film portrays two Australian sprinters, Archy and
Frank, who enlist together during World War I and end
up fighting the Turkish army at the Battle of
66

Gallipoli.(Theresa Brown, ,bags212.com/our_news_list93)

Exercise 4
Translate
Ventilated patients generally require sedation to tolerate
both ventilation and the presence of an endotracheal
tube. The aim is for the patient to be comfortable at all
times. In the past, ventilation could be controlled only if
the patient was heavily sedated or even paralysed.
Sophisticated ventilators now allow less sedation but
patients still require analgesia for pain and relief of
anxiety and distress.
Patients have individual needs and different indications
for analgesia and sedation. Muscle relaxants are now
used infrequently. Compassionate care and effective
communication help patients, but drugs are often
necessary to keep them comfortable. Sedatives, however,
have some adverse effects. The parent drug or active
metabolites may accumulate because of renal failure and
have prolonged action. There may also be circulatory
effectsfor example, hypotension. Tolerance sometimes
occurs. Patients may develop withdrawal syndromes
when the drug is stopped, while altered sleep patterns
may produce sleep deprivation. Some patients develop
ileus, which may impair feeding. Because critically ill
patients cannot usually say whether they are
67

comfortable, anxiety, depression, and even pain may be

difficult to assess. This assessment tends to be subjective
and various scoring systems are used, most being based
on the patients response to different stimuli.
Conclusion
Many patients who would previously have died from
respiratory failure now survive. Improved understanding
and management of acute lung injury will hopefully lead
to further improvements in survival. Appropriate
treatment of hypoxia, and early referral to intensive care
before complications arise, will also hopefully improve
the
outcome
of
critically
ill
patients.
(news.bbc.co.uk/2/hi/health/8574806.stm)
Exercise 5
Translate
A variety of important medical problems, both infective
and non-infective in nature, are associated with injection
drug use (IDU) including the blood-borne viruses such
as HIV, hepatitis B (HBV) and hepatitis C (HCV), all of
which may be transmitted via the sharing of injection
equipment. Consequently the medical care of patients
using drugs requires a knowledge of both drug- and
infection-associated conditions. The use of recreational
drugs either occasionally or continually should not be a
bar to or be used as a means of discriminating against
68

access to health care in the UK as has been alleged

recently. The difficulties of engaging drug users for
medical care should not be underestimated. There are
some particular characteristics of IDU that it may be
helpful to be aware of, and the details will vary with
geographical location. Drug users usually require a
substantial supply of money to fund their addiction
habit, which in itself results in other problems. Not
surprisingly the problems and illegality associated with
the use of recreational drug use is associated with a
number of difficulties for any health service in delivering
medical care for drug users. For the health service these
numerous crises, whether social, financial, legal, etc.,
lead to the impression of a chaotic lifestyle; in reality
hospital appointments usually have a fairly low priority
because of the enormity of their problems. The social
effects of HIV infection are similar for all risk groups
the infection effectively impoverishes the patient;
however in the case of drug users these effects may be a
little more dramatic. More importantly the inability to
fund a drug habit can have important consequences for a
health service which are often not appreciated: a need to
find additional sources of income benefits fraud, drug
dealing, hospitalisation (save money on food, etc.) all
of which increase the pressure on the NHS to prescribe
addictive drugs (which may be greater than actual habit
in order to provide additional funds); the physical
69

weakness and
victimization.

mental

slowing

leads

to

peer

Exercise 6
Fill in with even, in fact, since
1 Flu is met ----------- in the absence of temperature.
2 This pain can be brought --------by a small burn.
3 A good treatment is possible ------------ with severe
injuries
4 However, ------------- when this time has come, the
surgeon can manage
5 --------- the patient-surgeon relationship may last a
lifetime.
6 The trained doctors provide an ------------- even
improved condition of the patient
7 His heart is normal when----------- he has
atherosclerosis.
8 But----------------- weight loss is very important.
9 -------------- then, improvements have succeeded.
10 It is essential for the patient -------------- there is some
risk of mental disability
70

Unit 7 Reading
Acute renal failure

Acute renal failure is defined as a sudden,

normally reversible impairment of the kidneys ability to
excrete the bodys nitrogenous waste products of
metabolism. Acute renal failure is usually accompanied
by oliguria. However, a daily urine volume above 500
ml does not necessarily imply normal renal function in
critically ill patients. The plasma urea concentration rises
with the breakdown of soft tissue or blood (which may
be within the gut) or a high protein intake. Uremia is a
less reliable indicator of underlying renal function than
creatinine concentration. The rate of production of
creatinine is related to lean body mass, except in
rhabdomyolysis. The concentration of creatinine in the
blood reaches the upper limit of normal after 50% of
function is lost and then doubles for each further 50%
reduction in renal function. Urine dipstick testing can
detect hematuria and proteinuria, which may signify
primary renal disease or other systemic disease. If
primary glomerular disease is suspected a urine sample
should be sent for microscopy. Although there are now
direct tests for myoglobinuria, microscopy can help
diagnose rhabdomyolysis and hemolysis. The stick test is
strongly positive for hem pigment but no red cells are
71

visible on microscopy. Simultaneous measurement of

urinary and plasma urea, creatinine, and sodium
concentrations and osmolality may help differentiate
physiological oliguria of renal hypoperfusion from acute
renal failure. Concurrent drug treatmentfor example,
diuretics or dopaminewill make values difficult to
interpret. However, the findings will not generally alter
management greatly. Patients with absolute anuria must
be assumed to have lower urinary tract obstruction until
proved otherwise. Always remember to check for a
blocked catheter. Established acute renal failure is
confirmed by the lack of response to correction of any
cardiorespiratory deficit, urinary tract obstruction, or
septic process and rising concentrations of urea and
creatinine. In critically ill patients it commonly results
from a number of combined insults: hypovolaemia
(absolute or relative), impaired renal perfusion (low
perfusion pressure, low cardiac output), sepsis, drugs
(including radiocontrast agents), hepatic dysfunction,
obstruction of the collecting system (partial or
complete), vascular occlusion (large or small vessel), or
primary renal disease. Standard guidelines exist for
intensive care of patients with established or impending
renal dysfunction. A window of opportunity exists
between the onset of the insult(s) and the onset of
established acute renal failure. Rapid identification and
correction of these insults is essential and further
72

potential
insults
must
be
www.themedicalquestions.com ... Illness

avoided.

Explanations
anuria
failure of the kidneys to produce
urine.
catheter
a flexible tube inserted through a
narrow opening into a body cavity, particularly the
bladder, for removing fluid.
dipstick
a graduated rod for measuring
the depth of a liquid
diuretics
dopamine
dysfunction
fault in a part of the body
hematuria
the presence of blood in the
urine
hemolysis
the rupture or destruction of
red blood cells
hypovolaemia
a decreased volume of
circulating blood in the body
insult
an event which causes
damage to a tissue or organ
lean
not enough
obstruction
the action of obstructing or
the state of being obstructed.
osmolality
concentration of a solution
expressed as the total number of solute particles per
kilogram
perfuse
supply (an organ, tissue, or
body) with a fluid, typically treated blood or a blood
73

substitute, by circulating it through blood vessels or

other natural channels
proteinuria
the presence of abnormal
quantities of protein in the urine, possibly indicating
damage to the kidneys
rhabdomyolysis
destruction of striated muscle
cells
hem prefix for an iron-containing compound of the
porphyrin class which forms the non-protein part of
haemoglobin myoglobinuria is a red protein containing
hem, which carries and stores oxygen in muscle cells

Exercise 1
Fill in with either or neither
1. They are
officers

anaesthetic senior house

specialist registrars.

2. Patients require
passive movements.

active assisted

3. The scoring system is

physiological.

anatomical

4. In the absence of
exposed to a spinal lift .

device, patients are

5. Antibiotics are not indicated for

pulmonary infection.
74

urinary or

6. Forced expiration is achieved by pushing on

side of the lower ribs.
7.
the use of the implant
of the bladder trigger dysreflexia.
8. As
achieved.

emission

overfilling

ejaculation will be

Exercise 2
Write sentences to bring out the difference between
the following pairs of words
cease/seize; rise/raise; raise/receive; take/ask for ;
prescribed/proscribed; accept/agree
Exercise 3
Put the verbs in brackets into the correct tense:
present simple and continuous; past simple and
continuous; present perfect simple and continuous
Example Each vein I tried---------- ballooned and--------- bled into his skin
Stand

I--------- near the door with some relief.

Take

I -------- stilboestrol.

Diagnose
He----------------- 22 years before with
prostatic cancer.
75

Tell

He-------- about the new development.

Try

He ------------- to make sense of me.

Have, Try

I---------- no idea what I----------- to do.

Take

He------------ on board his diagnosis.

Use

It -------- used as a reliable flap.

Prepare
My training---------- not --------- me- to
know what to do.
Exercise 4
Translate
Directly nephrotoxic drugs such as aminoglycosides
should be avoided when possible.
Investigations that may help to differentiate renal
hypoperfusion from acute renal failure in oliguric
patients should be measured regularly. Many drugs
indirectly affect renal function by their effects on the
circulation, and their concentration may build up as renal
function deteriorates. In critically ill patients, especially
those with sepsis, adrenergic blocking drugs, angiotensin
converting enzyme inhibitors, other vasodilators, and
diuretics will potentiate any systemic circulatory
disturbance and impair the intrarenal mechanisms that
normally maintain glomerular filtration and medullary
blood flow.
76

Non-steroidal anti-inflammatory drugs can produce an

allergic interstitial nephritis, but more commonly in
patients with a septic, systemic inflammatory, or
hypovolaemic insult they impair the compensatory
mechanisms that maintain glomerular perfusion and
medullary blood flow to the ascending limb of the loop
of Henl. A single dose may be sufficient to precipitate
failure of a stressed kidney. These drugs are thus
contraindicated in critically ill patients
Exercise 5
Write sentences using the following expressions
In charge of, dispose of, advise on, the need for,
prescribed for, suffer from, benefit in
Exercise 6
Fill in with also, as well or as well as
1 Useful investigations---------------- monitor the
treatment of the kidney
2 Good community support and--------- the provision of
resources can enable the person to participate in
community activities.
3 The manner of withdrawal may ---------vary
considerably.
77

4 The needs of uninjured victims of the accident have---------- to be considered.

5 The disability benefits can ------------ be a financial
deterrent.
6 Stress is -------------- disabling.
7 ---------- being used to treat patients who have apnea.
8 The United Kingdom takes care to this ------------ to its
number of emergency.
9 The patient with a single condition may be cared by
the nurse better such----------- controlled hypertension.
10 ----------- the physician is likely to avoid distress if he
uses all details in the consultation.

78

Unit 8 Reading
Oliguria and renal dysfunction

Oliguria and renal dysfunction are common in

critically ill patients. In most cases the kidney is an
innocent bystander affected secondarily by the primary
disease process. As patients with acute renal failure
usually have multiple organ dysfunction and often
require respiratory or circulatory support, they are
increasingly referred to intensive care units rather than to
specialist renal units. Nevertheless, close liaison with
nephrologists is advisable, particularly when primary
renal disease is suspected. It is rare for patients to
develop acute renal failure after admission to intensive
care unless a new problem has occurred or the primary
process has not been controlled.
Urine is produced by glomerular filtration, which
depends on the maintenance of a relatively high
perfusion pressure within the glomerular capillary and an
adequate renal blood flow. Glomerular blood flow is
autoregulated by the pre-glomerular arteriole until the
mean arterial pressure falls to 80 mm Hg. Below this
pressure the flow decreases. The autoregulation is
achieved by arteriolar dilatation (partly mediated by
prostaglandins and partly myogenic) as pressure falls
and by vasoconstriction as pressure rises. If perfusion
79

pressure continues to fall glomerular filtration pressure is

further maintained by constriction of post glomerular
arterioles, which is mediated by angiotensin. The
proximal tubules reabsorb the bulk of the filtered solute
required to maintain fluid and electrolyte balance, but
elimination of potassium, water, and nonvolatile
hydrogen ions is regulated in the distal tubules. As renal
perfusion
and
glomerular
filtration
diminish,
reabsorption of water and sodium by the proximal
tubules rises from approximately 60% of that filtered to
over 90% so that minimal fluid reaches the distal tubule.
This explains why hypotensive or hypovolemic patients
cannot excrete potassium, hydrogen ions, and water.
Similar defects in excretion of potassium and hydrogen
ions occur in patients with distal tubular damage caused
by drugs or obstructive uropathy. The energy required
for tubular function comes from aerobic metabolism
within the mitochondria of the tubular cells. Tubular
cells deep within the medulla operate at the limit of
oxidative metabolism and are particularly sensitive to the
effects of ischemia and hypoxia. Blood flow to the
medulla is threatened as renal perfusion falls and is
maintained by the action of prostaglandins produced by
the medullary interstitial cells. The cells of the thick
ascending limb of the loop of Henl are the most
metabolically active in the deep medulla and thus the
most vulnerable.
80

[. www.ncbi.nlm.nih.gov/pmc/.../PMC111614.]
Exercise 1
Translate
1 nephrotoxic drugs
2 Their concentration built up as renal function
deteriorates.
3 Patients with sepsis take adrenergic blocking drugs.
4 They normally maintain glomerular filtration and
medullary blood flow.
5 Non-steroidal anti-inflammatory drugs can produce an
allergic interstitial nephritis.
6. A single dose may be sufficient to precipitate failure
of a stressed kidney.
7 Medullary blood flow to the ascending limb of the loop
of Henl.
8 These drugs are thus contraindicated in critically ill
patients.
Exercise 2
Fill in with effects ,to affect, to convert, to impair, to
maintain, to potentiate
81

1 Many drugs indirectly ------------ renal function.

2 They have -------------- on the circulation.
3 Angiotensin -------- enzyme inhibitors.
4 Vasodilators -------- systemic circulatory disturbance.
5 They ---------- the intrarenal mechanisms.
6 They --------- glomerular perfusion
Exercise 3
Translate
Fever is the outcome of a generalized infection and
inflammation is the result of a localized infection. There
is a special group of illnesses caused the communicable
or infectious diseases, all of which cause fever and the
inflammation of the skins or glands. The characteristics
of communicable diseases are the following: each illness
is capable of being transmitted to others, there is a
specified time, known as the incubation period, between
the infection of the body by the organism and the
appearance of signs and symptoms. In each illness, every
patient has the same signs and symptoms, although these
may vary in the degree of severity, most of them have a
characteristic skin rash, each disease lasts a certain
number of days and is liable to cause complications,
some of which are mild and some of which may be
serious.
82

Communicable diseases are caused by micro-organisms

eaten with food or drink breathed in from the air or
entering through a break in the skin .They are spread by
people and objects. They are carried by air and dust, by
infected food, water and milk, by flies and rats, by
infected bedlinen, crockery and books, by other people
carrying the diseases. Not everyone who is in contact
with micro-organisms will contract the disease, because
the body has defenses against harmful organisms .It uses
the white blood cells to destroy invading microorganisms and the lymphatic glands to act as filters and
remove them from the body for good.
Malaria
Malaria is an infectious disease caused by a minute
animal parasite (protozoon) transmitted by mosquitoes,
one of the commonest causes of sickness and death in
the world.
(A) But how does malaria develop?
First the mosquito sucks blood from an infected person.
Then the parasites breed in the mosquito's stomach, and
after about ten days their offspring invade the salivary
glands. At this stage the mosquito is infectious: when it
bites a human subject it gives an injection of parasites in
a droplet of saliva. When this happens the young
parasites are carried in the patient's blood to the liver and
other organs where they multiply without causing
symptoms.
83

After this period of incubation (B) parasites return to the

blood stream and invade red blood cells. There they
multiply rapidly and rupture the cells, releasing countless
parasites to invade other red cells (C).
Finally, when this happens, the patient has an attack of
fever. The attack commonly begins with headache and
violent shivering (rigor).
(D) After anything from an hour to a day the symptoms
disappear until the next batch of parasites is released,
with further destruction of red cells. All types of malaria
cause attacks of fever at more or less regular intervals,
and increasing anemia from loss of blood cells. (E)

Exercise 4
Fill in with above, over, while, yet
1 Hospitals retain their memory ------------ while
merging with other institutions.
2 Screening tests avoid ----------false negative results.
3 A cat is hiding --------- over a car.
4 Sebaceous glands extend ----------over the entire body.
5 ------------While one examiner explains, a nurse takes
notes.
6 ----------- yet these constitute a small amount of DNA.
84

7 ----------Yet that prove is used for curable recurrences.

8 The layers ---------------------- over them are thick.
9 ----------yet I couldnt dream of refusing him.
10 ------------while she spoke she handed me lancet.
11 ------- yet there was no denying the urgency.
12 I could see top of church ------------- above the trees.
13 Its no use crying ---------- over the spilt milk.
14 A blanket ------------- over the injured man.
15 Epithelial cells lye ------------ over the papilla.
16 Gossips listened to the rising music ----------while
they exchanged news.
www.coursehero.com/.../Anatomy-Exam-3/
Exercise 5
Fill in with below, beside, by, near, next to , opposite,
under
1 were getting ------ near Sam
2 all day, one saw pitchers ---------- under the jet of
water.

85

3 patrons from the ---------- next table complained that

theirs was inevitable
4 they shift to the side ----------- opposite the injury
5 a table --------- by the bed
6 It was supported -------- by a rampart of trimmed stone
7 The rampart of trimmed stone was finished off with a
parapet --------- under a row of plane trees.
8 from the plane we see the hills ------------ below
9 Hypodermic injections are placed ---------- under the
skin.
10 In H-shaped organ can be seen in the neck just -------- below the larynx.
11 he sits ---------- next to Bob
12 she stands up ---------- beside my cousin
13 ------------- beside being a special procedure,
transposition can also be applied within a language.
14 the carcinoma of left forearm is -------- near elbow.
15 ------------- under the seventh cervical vertebra you
can see the thoracic vertebrae

86

16 spinal cord injuries can appear in paralysis --------below the injury.

17 he hung his coat ----------- under the back of the chair
18 there is usually a specialist ------------ by the big
hospital
19 the pulmonary capillaries lie ------ next to the thin
tissue s of the alveoli.
20 his opinion is probably correct, but quite ---------beside the point.
21 the church is ---------- opposite the opera
22 he seated ----------- opposite to you
Exercise 6
a) Read this:
In other patients, however, further features develop if
treatment is not begun quickly enough. The tissues,
although receiving liberal supplies of glucose from the
blood, are unable to utilise it effectively in the absence
of insulin and so the diabetic feels weak and tired. This
causes two main compensator) mechanisms to operate,
both of which lead to loss of body tissue. Protein is
broken down to provide energy and fat replaces
carbohydrate as a fuel. Since the fat must be transferred
from the body stores to the liver to be broken down, the
87

fat content of both the blood and the liver is increased;

thus a plasma sample from an untreated diabetic is often
fatty. In severe cases of diabetes the disproportionate
metabolism of fat results in the overproduction of ketone
bodies* (acetone, acetoacetic acid, and /Miydroxybutyric
acid) leading to ketonaemia and ketonuria. Furthermore,
as acetoacetic and /-hydroxybutyric acids are produced
faster than they can be metabolised, the patient develops
acidaemia, one of the effects of which is to stimulate
breathing so that clinically 'air hunger' is observed.
Ketone bodies are intermediate products in the
breakdown of fats to C02 and H2 02: a process only
completed if carbohydrates are being metabolised.
www.fbcb.unl.edu.ar/catedras/ingles/.../bioq-ing2-2.d..
b) Answer these:
a) What are the 'further features' referred to in line 1?
b) Why can the muscles of a diabetic not provide enough
energy?
c) What is the cause of loss of body tissue in a diabetic?
d) Why is there an increase in protein catabolism?
e) What will the effect of this be on wound healing if
that process requires proteins?
f) Why docs the increase in lipolysis affect the blood?
88

g) What does 'disproportionate metabolism of fat' refer

to?
h) How docs an increase in lipolysis lead to ketosis?
i) Why does an excess of ketone bodies produce excess
acid in the blood?
j) Why is hyperventilation sometimes observed in a
diabetic?

89

Unit 9 Reading
Anatomy of the Oral Cavity
A smile is the facial expression that most engages
others. With the help of the teeth which provide
structural support for the face muscles the mouth also
forms a frown and other expressions that show on your
face.The mouth also plays a key role in the digestive
system, but it does much more than get digestion started.
The mouth especially the teeth, lips, and tongue is
essential for speech. The tongue, which allows us to
taste, also helps form words when we speak. The lips
that line the outside of the mouth both help hold food in
while we chew and pronounce words when we talk.With
the lips and tongue, teeth help form words by
controlling air flow out of the mouth. The tongue strikes
the teeth as certain sounds are made.The entrance to the
digestive tract, the mouth is lined with mucous
membranes. The membrane-covered roof of the mouth is
called the palate. The front part consists of a bony
portion called the hard palate, with a fleshy rear part
called the soft palate. The hard palate divides the mouth
and the nasal passages above. The soft palate forms a
curtain between the mouth and the throat, or pharynx, to
the rear. The soft palate contains the uvula, the dangling
flesh at the back of the mouth. The tonsils are located on
either side of the uvula and look like twin pillars holding
90

up the opening to the pharynx.A bundle of muscles

extends from the floor of the mouth to form the tongue.
The upper surface of the tongue is covered with tiny
bumps called papillae. These contain tiny pores that are
our taste buds. Four main kinds of taste buds are found
on the tongue those that sense sweet, salty, sour, and
bitter tastes. Three pairs of salivary glands secrete saliva,
which contains a digestive enzyme called amylase that
starts the breakdown of carbohydrates even before food
enters the stomach.
Teeth, hard, bony structures in the mouths of humans
and animals used primarily to chew food, but also for
gnawing, digging, fighting, and catching and killing
prey. Teeth are the bodys hardest, most durable organ
long after bones and flesh have dissolved,
archaeologists find well-preserved teeth from humans
and other animals that lived thousands of years
ago.Humans use of teeth: to tear, grind, and chew food
in the first step of digestion, enabling enzymes and
lubricants released in the mouth to further break down
food. Teeth also play a role in human speech the
teeth, lips, and tongue are used to form words by
controlling airflow through the mouth. Additionally,
teeth provide structural support to muscles in the face
and form the human smile.
.Human teeth are made of four distinct types of tissue:
enamel, dentin, pulp, and cementum. Enamel, the
91

clear outer layer of the tooth above the gum line, is the
hardest substance in the human body. In human teeth,
the enamel layer is thick and protects the inner layers of
the teeth from harmful bacteria and changes in
temperature from hot or cold food. Directly beneath the
enamel is dentin, a hard, mineral material that is similar
to human bone, only stronger. Dentin surrounds and
protects the pulp, or core of the tooth. Pulp contains
blood vessels, which carry oxygen and nutrients to the
tooth, and nerves, which transmit pain and temperature
sensations to the brain. Pulp is the innermost portion of
the tooth and consists of connective tissue, nerves, and
blood vessels, which nourish the tooth. The pulp has two
parts the pulp chamber, which lies in the crown, and
the root canal, which is in the root of the tooth. Blood
vessels and nerves enter the root through a small hole in
its tip and extend through the canal into the pulp
chamberThe outer layer of the tooth that lies below the
gum line is cementum, a bonelike substance that
anchors the tooth to the jawbone. Cementum is also as
hard as bone. The visible portion of the tooth is called
the crown. Projections on the top of each crown, used
primarily for chewing and grinding, are called cusps.
The portion of the tooth that lies beneath the gum line is
the root.
Exercise 1
Translate
92

Frequently maxillary first premolars have two roots, one

buccal and one lingual, which are distinguishing
characteristics of these teeth. The bifurcation occurs in
the apical third to half of the root. In the two-root type of
maxillary first premolar, the buccal and lingual roots are
usually relatively straight, except for a frequent distal
curvature of the buccal root near the apex (facial view).
Second premolars usually have one root.
The roots of the premolars, when viewed from the mesial
or distal aspect, often have root depressions of varying
depths. Knowledge of the frequency with which these
depressions occur, as well as the relative location and
depth of these depressions, can be helpful clinically
when evaluating root surfaces for the presence of
calcified depositions which contribute to periodontal
disease, and when identifying areas of decay on the
roots.
The maxillary first premolar, as stated previously, is the
only premolar with an obvious concavity or depression
on the mesial surface of the crown, and this depression
continues onto the root. Recall that this tooth usually has
two roots [61% of 100 teeth] with a bifurcation in the
apical third of the root. Even when there is only one root,
there is a mesial root depression. On the distal root
surface, near the cervix, the root is usually convex or flat
with little or no depression. However, apical to the
convex area, on the middle third of the undivided portion
93

of the root, there is a depression that is found on both

double- and single-rooted teeth. This distal longitudinal
root depression is less deep than the one on the mesial
side.
The maxillary second premolar is likely to have a
longitudinal depression on the mesial root surface, but it
does not extend onto the crown. On the distal surface,
there is usually a longitudinal depression in the middle
third of the root, where it tends to be deeper than on the
mesial root surface. This feature is the opposite from the
maxillary first premolar which usually has the deepest
mid-root depression on the mesial cavity.
Exercise 2
Translate
The alimentary canal begins with the oral cavity,
or mouth. The major parts of the oral cavity are the
cheeks from the walls of the oval-shaped oral cavity, and
the lips surround the opening to the cavity; the hard
palate forms the anterior portion of the roof of the
mouth, and the muscular soft palate lies posterior to it.
Rugae are irregular ridges in the mucous membrane
covering the anterior portion of the hard palate. Hanging
from the soft palate is a small, soft tissue called the
uvula. The word uvula means little grape. The structure
functions to aid in producing sounds and speech.
94

The tongue extends across the floor of the oral

cavity, and muscles attach it to the lower jaw bone. It
moves food around during mastication (chewing) and
deglutition (swallowing). Papillae, small raised areas on
the tongue, contain taste buds that are sensitive to the
chemical nature of foods moves across the tongue.
The tonsils are masses of lymphatic tissue located in
depression of the mucous membranes on both sides if the
oropharynx (part of the throat near the mouth). They act
as filters to protect the body from invasion of
microorganisms and produce lymphocytes, which are
white blood cells able to fight disease.The gums are
made of fleshy tissue and surround the sockets of the
teeth.
Dentists use special terms to describe the surface of
teeth. The labial surface (labi/o means lip), for incisor
and canine teeth, is nearest the lips. The buccal surface
(bucc/o means cheek), for premolar teeth, is adjacent to
cheek. Some dentists refer to labial and the buccal
surface as the facial surface (faci/o means face).
Opposite to the facial surface, all teeth have a lingual
surface (lingu/o means tongue). The mesial surface of a
tooth lies nearest to the median line and the distal
surface, farthest from the medial line. Premolars and
molars have an additional occlusal surface (occlusion
means to close) that comes in contact with a
corresponding tooth in the opposing arch. The incisor
95

and cuspid have a sharp incisal edge.The pulp lies

underneath the dentin. It is soft and delicate tissue and
fills the center of the tooth. Blood vessels, nerve endings,
connective tissue, and lymphatic vessels are within the
pulp canal (also called the root canal). Root canal
therapy is often necessary when disease or abscess (pus
collection) occurs in the pulp canal. A dentist opens the
tooth from above and cleans the canal of infection,
nerves, and blood vessels. The canal is then disinfected
and filled with material to prevent the entrance of
microorganisms and decay.
Exercise 3
Translate
All the facial bones, except one, are joined together by
sutures, so that they are immovable. The mandible
(lower jaw bone) is the only facial bone capable of
movement. This ability is necessary for activites such as
mastication (chewing) and speaking.
Nasal bones two slender nasal (nas/o means nose)
bones support the bridge of the nose, they join with the
frontal bone superiorly and form part the nasal septum.
Lacrimal bones two paired lacrimal (lacrim/o means
tear) bones are located one at the corner of each eye.
These thin,, small bones contain fossae for the lacrimal

96

gland (tear gland) and canals for the passage of the

lacrimal duct.
Maxillary bones two large bone compose the massive
upper jaw bones (maxillae). They are joined by a suture
in the median plane. If the two bones do not come
together normally before birth, the condition known as
cleft palate results.
Mandibular bone this is the lower jaw bone
(mandible). Both the maxilla and the mandible contain
the sockets called alveoli in which the teeth are
embedded. The mandible joins the skull at the region of
the thetemporal bone, forming he temporomandibular
joint (TMJ0 on either side of the skull.
Zygomatic bones two bones, one on each side of the
face, form the high portion of the cheek.
Vomer this thin, single, flat bone forms the lower
portion of the nasal septum.
Sinuses, or air cavities, are located in specific places
within the cranial and facial bones to lighten the skull
and warm and moisten air as it passes through.
(quizlet.com/7214594/new)
Exercise 4
Translate
97

Characteristically, a central developmental groove runs

mesiodistally across the center of the tooth with a pit at
both ends. The length of the central groove of the
maxillary first premolar is more than one-third the
mesiodistal width of the occlusal surface. This length is
one of the distinguishing characteristics of the maxillary
first premolar (longer than the central groove on the
maxillary second premolar).
The central groove is longer on the maxillary first
premolar, the mesial and distal pits are relatively closer
to the marginal ridges than on maxillary second
premolars.There are fewer supplemental grooves on
maxillary first premolars that on maxillary second
premolars (type trait). On seconds, there are usually
supplementary grooves radiating buccally and lingually
from the pit at the depth of each triangular fossa. These
are named mesiobuccal supplementary groove,
mesiolingual
supplemental
groove,
distobuccal
supplementary groove, and distolingual supplementary
groove.
On the first premolar, a marginal groove crosses the
mesial marginal ridge on. The mesial marginal groove
connects with the central groove in the mesial triangular
fossa. The mesial marginal groove is one of the
distinguishing characteristics of the maxillary first
premolar, where it occurs with much greater frequency
than on second premolars.
98

The asymmetrical oblong crown of the maxillary first

premolar outline is greater buccolingually than
mesiodistally. From the occlusal aspect, the shape of the
buccal surface is a wide and inverted V because of the
prominent buccal ridge. This is the only part of the
occlusal outline that looks symmetrical. The lingual
three-fourths portion of the tooth seems to be bent
mesially. This asymmetrical occlusal design is a
distinguishing feature of maxillary first premolars and is
not found on most second premolars (type trait) .The
mesiobuccal cusp ridge joins the mesial marginal ridge
at an almost right angle (not so on second premolars).
The second premolars are less angular, more oval
shaped.
On first premolars, the lingual side of the tooth is
narrower than the buccal side. This lingual side taper is
slight in second premolars.
The lingual crest of curvature is usually mesial to the
center line of the tooth for both first and second
premolars, with the tip of the lingual cups always mesial
to the center of the tooth.
Exercise 5
Translate
Aphthous stomatitis (canker sores) is a common form of
mouth ulcer, canker sores occur in women more often
99

than in men. Although their cause isn't completely

understood, mouth injuries, stress, dietary deficiencies,
hormonal changes (such as the menstrual cycle), or food
allergies can trigger them. They usually appear on the
inner surface of the cheeks or lips, under the tongue, on
the soft palate, or at the base of the gums. They begin
with a tingling or burning sensation followed by a
painful sore called an ulcer. Pain subsides in 7 to 10
days, with complete healing usually occurring in 1 to 3
weeks.
Cleft lip and cleft palate are birth defects in which the
tissues of the lip and/or mouth don't form properly
during fetal development. Children born with these
disorders may have trouble feeding immediately after
birth. Reconstructive surgery in infancy and sometimes
later can repair the anatomical defects, and can prevent
or lessen the severity of speech problems later on.
Enteroviral stomatitis is a common childhood infection
caused by a family of viruses called the enteroviruses.
An important member of this family is coxsackievirus,
which causes hand, foot, and mouth disease. Enteroviral
stomatitis is marked by small, painful ulcers in the
mouth that may decrease a child's desire to eat and drink
and put him or her at risk for dehydration.
Exercise 6
Translate
100

A painful stimulus can draw an immediate response,

such as rapid pulling away from the source of
stimulation or can draw a delayed response such as
physical activity to avoid further stimulation. Autonomic
response is the pain sensation that travels via the afferent
nerves to the central nervous system.Certain kinds of
pain appear to originate entirely in the individuals
mental state.This type of pain, as real as that originating
from neurophysiological state.This type of pain is termed
as psychogenic and hysteria is an example of
that.Melzacks gate-control theory states that smalldiameter fibers carry the pain signals.The transmission
of the pain impulses from the spinal cord to the brain is
inhibited by afferents or large-diameter fibers.This is due
to a gating mechanism that regulates the afferent patterns
before they influence the central transmission cells in the
dorsal horn of the spinal cord.The patient perceives pain
and responds to it when the output of the central
transmission cells reaches a critical level.
Superficial somatic structures include skin, subcutaneous
tissue, fascia, and fibrous tissue etc.Deep somatic and
visceral structures make pain be felt more diffuse and
less well localized.A patient suffering an attack of
angina pectoris may feel the pain in his right arm.The
term radiating is often used to describe pain from the
deep structures and especially from the viscera.

101

Pain and its relief need to be given a high priority in

care, and health.
professionals should be given adequate education and
accountable for the pain relief of people in their care.The
theory-practice gap may have arisen because the type of
knowledge which is valued by nurse theorists and nurse
researchers are not seen as relevant by practicing nurses,
who use a different type of knowledge in practice.A
fundamental prerequisite for the provision of culture
based pain assessment tool is that the nurse must be
proficient in collecting and discussing cultural
information that will help her to give competent nursing
care.
(After Margo McCaffery, Nursing Management of the
Patient with Pain, Lippincott, 1972 p 42)

102

Unit 10 Reading
Oral examination

Examination of the oral cavity is part of every

general physical examination .Oral findings in many
systemic diseases are unique, are sometimes
pathognomonic, and may be the first sign of the diseases.
Early detection of oral cancer may be possible.A dental
history is obtained first. It may indicate a particular
dental problem or neglect of dental care. A complaint of
difficulty in chewing food suggests insufficient teeth for
proper mastication, losse or painful teeth, poorly fitting
dental appliances, or disorders of the temporomandibular
joint or the masticatory muscles. Slight bleeding after
brushing suggests mild gingivitis; frequent, spontaneous,
or profuse bleeding may indicate a blood dyscrasia.
Recurring oral infections may indicate diabetes mellitus
(the most common cause), agranulocytosis, neutropenia,
leukemia, immunoglobulin defects, or disorders of
leukocyte function. Immunosuppressed persons may
experience painful reactivation of oral herpes simplex or,
other infections, with pain, oral ulcerations, and
consequent interference with foodintake. A thorough
evaluation requires good illumination, a tongue blade,
gloves, and a gauze pad. A dental or laryngeal mirror, if
available, is helpful. The examiner initially looks at the
103

face for appreciable asymmetry, skin lesions, and other

abnormalities, such as restricted movement during
speech, as occurs in scleroderma or acromegaly.
Numerous congenital syndromes produce characteristic
facts. For example a very thin upper lip suggests the fetal
alcohol syndrome or Prader-Willi syndrome. Trauma in
youth, particularly blunt trauma to the point of the chin,
can damage growth centers in the condyles and lead to
unilateral or bilateral impairment of mandibular growth.
Idiopathic hypertrophy of one or both sides of the
mandible or other parts of the face may distort the face,
as may acromegaly or a salivary gland or jaw tumor.If
the posterior teeth or dental prostheses are missing, the
cheeks may be sunken, producing a prematurely aged or
cachectic appearance. One or both cheeks may appear
swollen due to cherubism, parotitis, Sjgrens syndrome,
tumor an excessively thick denture flange, or cellulites
from an abscessed tooth.Multiple basal cell carcinomas
on the face may indicate the nevoid basal cell carcinoma
syndrome, which alerts the examiner to look for multiple
odontogenic
keratocysts
on
xrays.
(www.hel.hbi.ir/.../Dentistry%20in%20Medicine.)
Exercise 1
Translate
Root canal treatment can help save your damaged tooth.
When the pulp (the soft tissue inside the tooth that
contains nerves and blood and lymph vessels) is diseased
104

or injured and unable to repair itself, the pulp dies. The

most common cause of pulp death is a fractured tooth or
a deep cavity, which can expose the pulp to the bacteria
found in saliva. The bacteria cause infection inside the
tooth. If the damaged or diseased pulp is not removed,
the tooth and surrounding tissues become infected.
Without treatment, your tooth could eventually have to
be removed. If the problem is caught early enough,
however, your dentist can save your tooth using root
canal treatment. What do I do if I get an abscess? When
the pulp of a tooth becomes infected (often from a deep
cavity or a deep crack), the infection can spread
throughout the pulp. If root canal treatment is not done,
the infection may travel into the tissues near the root tip.
This can cause the adjacent bone to erode. The pocket of
pus that forms is the abscess. If the abscess increases in
size, it can become more painful. An endodontic
procedure or root canal is actually a specialized filling.
When the nerve (pulp tissue) of the tooth is damaged and
is dead or dying, it is cleaned out of the tooth. The area
which the nerve once occupied is enlarged and a special
filling is placed to seal it off. The main difference
between a regular tooth and an endodontically treated
tooth is that without the internal tissue in the tooth, it
becomes brittle and must be restored with a crown to
remain strong in most situations.
Exercise 2
105

Translate
The incidence of buccal mucosal sores and infection is
also increased because of a decreased or absent oral fluid
intake, mucosal dehydration, decreased saliva
production, the effects of drugs such as antibiotics, and
the orotracheal tube hindering oral hygiene.
Mucosal care is also mainly preventive with frequent
moisturising, teeth brushing, and removal of debris,
saliva, and sputum. Oral candidiasis is common and
requires early recognition and treatment with nystatin
mouthwashes. Gingivitis should be treated with
chlorhexidine
mouthwashes.
Factors
increasing
likelihood of developing pressure sores in critically ill
patients.
Maintenance of nutritional intake
Most patients in intensive care are too sick to sustain an
adequate oral diet. They therefore require enteral or
parenteral nutrition, or a combination. The potential
complications of parenteral nutrition mean that enteral
feeding is attempted in most patients.
Unless there are specific reasons to the contrary, all
patients likely to remain in intensive care for more than
48 hours should be started on enteral nutrition. Most
patients can be enterally fed, sometimes with the use of
prokinetic drugs. A feeding protocol is a useful means of
106

closing the gap between the volume of feed prescribed

and that actually delivered to the patient. If patients
cannot tolerate enteral nutrition, mixed feeding with
minimal enteral feed plus parenteral supplementation or
parenteral nutrition alone may be used. Critically ill
patients need about 0.7 -1.0 g protein/kg/day, a
minimum of 1 litre protein energy is usually given in a
fat:carbohydrate ratio of 1:2. Absolute contraindications
to enteral nutrition are gastrointestinal obstruction,
prolonged paralytic ileus, and enterocutaneous fistulae.
Relative contraindications include malabsorption and
short bowel syndrome, inflammatory bowel disease,
pancreatitis, and cholecystitis.
Mechanisms of infection include contamination of
inspired air (through respiratory equipment), spread from
neighbouring tissue, blood borne spread from a distant
focus, and oropharyngeal gastric colonisation followed
by transfer to the trachea. The most important preventive
measure against the spread of infection is hand washing.
As many as 40% of infections are transmitted on the
hands of hospital staff. Cross infection rates can be
reduced by a vigorous infection control policy covering
antibiotic use, timing and reasons for changing central
venous catheters, isolation techniques, and use of
disposable components (such as ventilator tubing and
filters). Regular staff education and audit help to
reinforce good practice.
107

(Sheila Adam, Sally Forrest, Other supportive care in

ABC of intensive care)
Exercise 3
a
Find the relevant ideas in the next article.
Mark them in some way - write them down,
underline them or highlight them.
b
Make sure you identify the meaning
relationships between the words/ideas.
c

Read what you have marked very carefully.

Nutrition and Dental Caries

The incidence of buccal mucosal sores and infection is
also increased because of a decreased or absent oral fluid
intake, mucosal dehydration, decreased saliva
production, the effects of drugs such as antibiotics, and
the orotracheal tube hindering oral hygiene. Mucosal
care is also mainly preventive with frequent
moisturising, teeth brushing, and removal of debris,
saliva, and sputum. Oral candidiasis is common and
requires early recognition and treatment with nystatin
mouthwashes. Gingivitis should be treated with
chlorhexidine
mouthwashes.
Factors
increasing
likelihood of developing pressure sores incritically ill
patients. Most patients in intensive care are too sick to
sustain an adequate oral diet. They therefore require
enteral or parenteral nutrition, or a combination. The
108

potential complications of parenteral nutrition mean that

enteral feeding is attempted in most patients. Unless
there are specific reasons to the contrary, all patients
likely to remain in intensive care for more than 48 hours
should be started on enteral nutrition. Most patients can
be enterally fed, sometimes with the use of prokinetic
drugs. A feeding protocol is a useful means of closing
the gap between the volume of feed prescribed and that
actually delivered to the patient. If patients cannot
tolerate enteral nutrition, mixed feeding with minimal
enteral feed plus parenteral supplementation or
parenteral nutrition alone may be used. Critically ill
patients need about 0.7 -1.0 g protein/kg/day, a
minimum of 1 litre protein energy is usually given in a
fat:carbohydrate ratio of 1:2. Absolute contraindications
to enteral nutrition are gastrointestinal obstruction,
prolonged paralytic ileus, and enterocutaneous fistulae.
Relative contraindications include malabsorption and
short bowel syndrome, inflammatory bowel disease,
pancreatitis, and cholecystitis. Mechanisms of infection
include contamination of inspired air (through
respiratory equipment), spread from neighbouring tissue,
blood borne spread from a distant focus, and
oropharyngeal gastric colonisation followed by transfer
to the trachea. The most important preventive measure
against the spread of infection is hand washing. As many
as 40% of infections are transmitted on the hands of
hospital sta
109

as ventilator tubing and filte

)
Exercise 4
Express your surprise on the following statements by
using should.
Model
A Paul is in the library.
B Why should he be there?
A As he is reading for his reexamination, Mary went to
the outpatients.
B ------------A The doctor is coming in a minute or two.
B -----------A I saw Bob in the reception room.
B ---------------------A You are wanted on the phone.
110

B ----------A The doctor seems to be displeased with you.

B ---------------A You must go and ask the nurse to be here
immediately.
B ---------------A There were pictures of exotic animals on the walls of
the room.
B --------------------Exercise 5
In the following sentences, fill in the gaps with one of
the following quantifiers:
much, many, few, little, most.
When you've gotten all the answers right, see if you can
substitute other quantifiers from the list. (HINT: Three
of the last four sentences could have two different
answers.)
a. Our yard looks awful this summer. There are too -----weeds.

111

b. I didn't use -------- fertilizer last spring, and that has

made a difference.
c. Also, I've paid -------- attention to how -------- rain
we've had.
d. I'm afraid it's rained --------- times this summer, and
the grass is turning brown and dying.
e. --------- experts say you should fertilize your lawn in
the fall.
f. It didn't seem to do my lawn --------- good.
g. ---------- advice you get from experts doesn't seem to
help.
h. ----------- of my neighbors ignore their grass, and they
have better lawns this year.
Exercise 6
Comment upon the following proverbs and
quotations:
- Art is long, life is short.
- Nothing is so poor as art that is interested in itself and
not in its subject.
- He that is full of himself is very empty.
112

- Tastes differ.
- Oh God, how poor a man can be with nothing in this
world but gold!

113

Unit 11 Reading
History and classification of different
materials used in dentistry

Dentistry, as a specialty, is believed to have

begun about 3000 B.C. Gold bands and wires are
examples used by the Phoenicians (after 2500 B.C.).
Although inscriptions on Egyptian tombstones indicate
that tooth-doctors were considered to be medical
specialists, they are not known to have performed
restorative dentistry.Modern dentistry began in 1728,
when Fauchard published a treatise describing many
types of dental restorations, including a method for the
construction of artificial dentures made of ivory. At that
time, gold foil had also been employed for dental
restorative purposes. The dentists of Prussia in 1750
used foil to cap the pulp chamber. Using fillings from
silver coins mixed with mercury, Taveau (1816)
developed in France what is most likely the first dental
amalgam. Many dentists criticized the poor quality of the
early amalgam restorations. This controversy led to the
amalgam war, during which heated debates occurred
over the benefits and drawbacks. Research over the next
years greatly improved the handling properties and
clinical performance of amalgam-filling materials. In
1885 Logan patented porcelain fused to a platinum post,
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replacing the unsatisfactory wooden posts used

previously to build-up intraradicular (within the tooth
root) areas of teeth.Prior to the 20th century, fillings
were of rather poor quality and did not fit well within
20the teeth. However, a refined method for producing
cast inlays was developed in 1907. Cast alloys were then
introduced later, further developing the required
technology. Commercially-pure titanium, noble alloys,
and base-metal alloys of nickel-chromium, cobaltchromium, or cobalt-nickelchromium are now available
for use in the production of cast inlays, onlays, crowns,
and frameworks for fixed all-metal or metal-ceramicdentures, and removable dentures. Little scientific
information about dental restorative materials has been
available until recently. Prior to this knowledge, the use
of these materials was entirely an art, and the only
testing laboratory was the mouth of the patient. Today,
despite the availability of sophisticated technical
equipment and the development of standardized testing
methods for evaluating the biocompatibility of
preventive and restorative materials, this testing
sometimes still occur in the mouths of patients.
Nowadays four groups of materials are used in dentistry:
metals, ceramics polymers, and composites. Despite
recent improvements in the physical properties of these
materials, none of these are permanent. Dentist and
material scientists continue research in the 21st century
for the ideal restorative material. An ideal restorative
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material would be biocompatible, bond permanently to

tooth structure or bone, match the natural appearance of
tooth structure and other visible tissues, exhibit
properties similar to those of tooth enamel, dentin, and
other tissues, and be capable of initiating tissue repair or
regeneration of missing or damaged tissues. Historically,
a wide variety of materials have been used as tooth
crown and root replacements, while restorative materials
for the replacement of missing portions of tooth structure
have evolved more slowly over the past several
centuries.
(www.metalurgija.org.rs/mjom/vol14/.../REBEKA.pdf)
Exercise 1
Fill in the blank spaces with below words or group of
words from 1-10
Dental materials fulfill an important role 1 --------dentistry is delivered today.
2 ------- the most appropriate dental material depends on
3 ---------- decay, 4 -------- defect in the tooth, 5 --------an entire mouth, whether the restoration will be visible
and cost factors. 6 -------- dental restorative materials
used in todays dentistry are amalgam, composite resins,
glass ionomers, temporary materials, tooth-whitening
products, gold alloys, ceramic castings. Restorative is a
term used to describe the ability to replace or bring
something 7 -------- its material appearance and function.
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The types of dental materials 8 --------- restore a tooth

must 9 --------- and withstand specific factors 10 --------oral conditions.
1 the extent of
2 used to
3 associated with
4 condition of
5 Selection of
6 respond to
7 back to
8 The most common
9 in the way
10, type of
Exercise 2
Translate
It is important to remember that infection control does
not stop at the chairside. Any items or materials placed
in a patients mouth that are subsequently removed and
processed elsewhere can be considered biologically
contaminated and must be handled in a safe manner.
Everyone concerned in the provision of dental treatment
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should be aware that there is a small but significant

potential for transmission of infection when dealing with
dental laboratory work.It is also essential that staff are
protected from accidental exposure to contaminated
material. As it is impossible to guarantee that an
impression is perfectly clean and free of blood and saliva
many of the items generated in the clinic cannot be
rendered biologically safe. If there are residues of blood
and saliva on an impression and this impression is
poured by someone with a cut on their hands and no
barrier protection then the risk of developing an infection
from a blood-borne virus such as hepatitis C does exist.
It is a very small risk but there must be protocols for
handling these items at every step, both at the dental
surgery and at the laboratory. In simple terms clinicians
should ensure that the work is as clean as it can possibly
be and there should be a protocol for transfer of items to
and from the dental surgery to the laboratory. Dentists
and managers of dental laboratories need to liaise with
each other so that all are aware of infection control
procedures.
www.ada.org.au/.../m240735_v1_the%20practical%20g
uides%207th%20e
Exercise 3
Do you agree that A bore[noun] is a person who talks
when you wish him?

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And do you agree that "We are interested in others when

they are interested in us"?
Exercise 4
Choose the most suitable word or phrase underlined.
a.
it.

We cant be lost. It isnt allowed / I dont believe

b.
be.

Jane is bound to be late. She always is / She must

c.
Late-comers are to report to the main office. Its a
good idea / Its the rule.
d.
You dont have to stay unless its necessary / if
you dont want to.
e.
Astronauts must feel afraid sometimes. Theyre
supposed to / Its only natural.
f.
You cant come in here. It isnt allowed / I dont
believe it.
g.
All motorcyclists have to wear crash helments.
Its a good idea / Its the rule.
h.
I ought not to tell Jack. Its not good idea / Its
the rule.

119

i.
We should be there soon. I expect so / Its
absolutely certain.
j.
Youd better leave now. Thats my advice /
Thats an order!
Exercise 5
Translate
Gura este la nceputul canalului alimentar; este o cavitate
n form aproape oval, n care are loc mestacarea
mncrii. Este nconjurat, n fa, de buze; lateral de
obraji i de procesele alveolare ale flcilor de sus i jos;
deasupra de puternicul cer al gurii i dinii flcilor de
sus; dedesubt de limb, i de membrana mucoas prins
ntre suprafaa de jos a organului i suprafaa interioar a
flcilor, i de dinii flcii de jos; nuntru de cerul moale
al gurii i fauces?
Membrana mucoas de-a lungul gurii, n continuarea
integumentului de la marginea buzelor, i cu linia
mucoas a fauces-ului din spate, este de nuan roztrandafirie n timpul vieii, i foarte groas acolo unde
acoper prile puternice de la marginea cavitii.
Buzele sunt dou ndoituri crnoase, care nconjoar
orificiul gurii, formate n afar din integumente, i
nuntru din membrane mucoase, ntre care se gsete
muchiul Orbicularis oris, vasele capilare, civa nervi,
esturi areolare i grase, i numeroase glande labiale
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mici. Suprafaa interioar a fiecrei buze este conectat

n linia de mijloc la gingia flcii corespunztoare de un
ndoitur a membranei mucoase, denumite frenum labii
superioris i inferioris, cel anterior fiind mai larg.
Glandele labiale sunt situate ntre membrana mucoas.
Exercise 6
Explain with your own words in English:
dystrophy, dysphasia, eccentric, ectoplasm, ectoderm,
endocrine, endo angium, endoderm, enteritis,
dysentery, epiglottis, epithelium, eupepsia, eupnoea,
excretion, exopathic, faciolingual, fibromaparalysis,
perfusion, periphery, pericardium, podiatry, polyspermis,
postnatal, postoral, prenatal, prolapse, pseudoparaplegia,
retraction, remission, retroperitoneal, semiconscious,
sublumbar, supermotility

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Unit 12 Reading
Nutrition

Increasing awareness of the importance of

nutrition and avoiding malnutrition has encouraged
earlier introduction of feeding for critically ill patients.
Recent laboratory studies have shown various nutrients
to have positive immunomodulatory effects, including
glutamine, polyunsaturated fatty acids, and arginine.
Immunoenhanced diets have been given to intensive
care patients, surgical patients, burn patients, and those
having bone marrow transplantation. Reduced morbidity
and, occasionally, mortality have been shown, although
confirmatory large scale multicentre studies are
awaited.Other areas under investigation include the
concept of protecting the gastrointestinal surface with
probiotic bacteria. Shortening the catabolic phase of
injury and enhancing anabolism by infusion of growth
hormone and insulin growth factor was recently tested
but produced an adverse outcome Treatment in intensive
care should always be guided by adequate monitoring.
Advances have enabled cardiorespiratory function to be
monitored continuously and, increasingly, by non
invasive or minimally invasive techniques. These
techniques are being continually refined and some are
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now being commercially marketed. Further efforts are

being made to measure regional organ perfusion (and its
adequacy) through tissue or arteriovenous oxygen or
carbon dioxide pressure, lactate concentration, or other
markers such as the cytochrome
redox state, and
hepatic clearance of indocyanine green. Although the
importance of raised plasma concentrations of
circulating inflammatory mediators such as interleukin
and procalcitonin is not yet fully understood, kits are
being developed to allow measurement at the bedside.
The results may be used to predict sepsis or to indicate
the correct timing for giving immunomodulating drugs.
Finally, paperless monitoring with sophisticated
computers interfaced with physiological monitors, fluid
infusion pumps and drainage sets, pathology
laboratories, and pharmacy should not only facilitate
data collection and patient management but provide a
sophisticated and comprehensive database for audit and
research. Early versions are already in operation in over
100 intensive care units worldwide, but continual
refinement and technological advances should produce
widespread uptake of these systems and prevent
deterioration; prevent secondary complications; facilitate
maximal functional recovery; support patients and
significant others in learning to adjust to the patients
changed physical status; be aware of the effect of the
injury on the patients perception of self worth; give high
priority to empowering patients, enabling them to take
123

control of their life through formal and informal

education. Nurses need to recognise that patients will
spend a long time in hospital, probably between four and
nine months. Most patients are male aged between 15
and 40 years, but an increasing number of older people
are sustaining injuries. Patients will initially be very
dependent on others, and those with high lesions or from
the older agegroup may continue to be dependent and
have a disappointing level of neurological recovery and
functional
outcome.www.bmj.com/content/319/7208/501.full
Exercise 1
Translate
Frequently in hospital and sometimes at home a patient
may be given oxygen to assist his breathing. Oxygen is
supplied in a black and white cylinder. In the home a
small size is used, but in hospital cylinders either stand
beside the patients bed or are stored outside the ward,
the gas being conveyed to the patient along pipes set into
the wall. The oxygen is under considerable pressure
inside the cylinder. Because of this, a special valve is
fitted, called a reducing valve which prevents the gas
from coming out too quickly. The amount of oxygen in
the cylinder is measured by a pressure gauge indicating
full, half full or quarter full. In hospital, oxygen may be

124

given through nasal catheters, by face mask or by

placing the patient in an oxygen tent.
Exercise 2
Translate
The term anoxia literally means without oxygen and is
commonly used to indicate conditions in which there is a
shortage of oxygen. It is more appropriate to refer to a
condition of too little oxygen as hypoxia. There arc four
commonly defined causes for lack of sufficient oxygen
for the cells of the body, which will be stated in the
commonly used terms. Anoxic anoxia, or hypoxic
hypoxia, refers to decreased oxygen saturation of blood
hemoglobin because of insufficient oxygen in thealveolar air. It is associated with low tension of oxygen
in the arterial blood. This condition will be produced by
obstructions of lung passages or situations where the
oxygen supply is inadequate. The second type of anoxia
is anemic anoxia which occurs in individuals whose
hemoglobin content is too low to carry the required
amount of oxygen. The oxygen tension will be normal
but there will be a shortage of oxygen carried by the
blood due to the lack of hemoglobin. The third type of
anoxia is stagnant anoxia. This is due to the blood
flowing too slowly round the circulation. Although the
oxygen tension and oxygen content leaving the lungs are
normal, the supplies of fresh oxygen are delivered too
slowly to provide the tissues with sufficient oxygen. The
125

fourth type of anoxia is histotoxic anoxia, of which

cyanide poisoning is the only important example. The
cyanide destroys the enzyme system of the cells and
prevents their utilisation of the oxygen present in the
blood. Anoxia is more dangerous than asphyxia, in
which not enough oxygen reaches the tissues and carbon
dioxide is not expelled quickly enough. The
accumulation of carbon dioxide produces a marked
stimulation in respiration. In pure anoxia.however,
although respiratory stimulation may initially be
produced, there is no accumulation of carbon dioxide
and in severe cases respiration subsequently ceases
altogether.
Exercise 3
Complete these sentences with can, may, present tense
where is necessary
a) to produce

Pellagra--- niacin deprivation.

b) to cause
circulation.

Stagnant anoxia--- slow blood

c) to be
Slow blood circulation --- localised in
obstruction of the arteries.
d) to lead to
Changes in the epithelial tissue of the
skin ---vitamin A deficiency.
Exercise 4
126

Read and translate

Oedema can be caused by increased production of tissue
fluid.
Oedema may be due to decreased reabsorption of tissue
fluid.
Oedema may occur because of water retention in the
tissue fluid.
Exercise 5
Choose the correct answer to each question. Each
question has only one correct answer.
1. Don't push so hard on that toy, or you _____ it!
might break
might to break
might breaking
2. _____ Be careful!
Watching out!
Look at!
Watch out!
3. Work hard _____ you'll fail your exam.
127

otherwise
although
despite
4. _____ force the door, you'll break it.
Not
Don't
No
5. Watch out! _____
Be careful!
To be careful!
You be careful!
6. _____ otherwise you'll make a mistake.
To pay attention
Pay attention
Don't pay attention
Exercise 6
a) Read the passage and choose a suitable title: (say
why the others are not suitable)
128

Diabetes

The causes of diabetes

Diabetes Mellitus

The effects of diabetes

Diabetes mellitus is a clinical syndrome involving a

variety of metabolic disorders characterized by
hyperglycemia. The hyperglycemia results from the fact
that insulin secreted by the pancreas is either insufficient
in amount or ineffective in action and arises from two
main sources, namely a reduced rate of removal of
glucose from the blood by the peripheral tissues and an
increased rate of release of glucose from the liver into
the circulation.
As a result of the hyperglycemia large amounts of
glucose are excreted in the urine. Because of the increase
of glucose in the kidney filtrate water reabsorption is
prevented. In this way the volume of urine is markedly
increased in diabetes; this in turn leads to loss of water
and minerals, thereby making the diabetic very thirsty so
that he drinks large amounts of fluid (without however
satisfying his thirst).
b) Answer these:
a) What is the cause of diabetes mellitus?
b) What is the primary clinical sign of diabetes mellitus?
c) What is hyperglycaemia due to?
129

d) Why does glycosuria occur?

e) What are the effects of glycosuria?

Language focus
Meeting people
A

Good morning, Scott.

Morning, Adrian. How are you?

Fine. Is that Mr. Harley over there?

Yes,it is.

A Let me introduce youExcuse me, Mr. Harley.

May I introduce you to Jim Nicholson?
C

How do you do?

B Pleased to meet you, Mr. Harley. Please call me

Michael.
D

And please call me Jim.

Good morning. My name is

I have an appointment with
Excuse me. Are you Mr./Mrs Im
130

Showing interest
Ne aratam interesul fata de un interlocutor folosind
expresii in urmatoarele exemple:
Im an accountant.

Oh, are you?

She lived in Sighet.

Oh, did she?

Hes looking for his wife.

Oh ,is he?

Shes only thirty.

Oh, really?

Checking meanings
We often need to check things when we are listening
to someone:
When we havent heard
A

Im sorry?
Im sorry, could you repeat that, please?
What did you say?

When we want to understand something more clearly

A

What doesmean?
What exactly do you mean?
131

When we want to check a fact

A

When exactly did you do?

How do you spell that?

In the dialogue between doctor and patient

Checking if information is accurate
Doctor: That's tender ?
Down here?
The back of your leg ?
Confirming information you know
Doctor: That's tender,
Down here.
The back of your leg.
Commenting/reassuring
Doctor: I'm checking your (heart) now,
That's fine,
OK, we've finished now
Request
132

MORE FORMAL
LESS FORMAL
Would or could used to make a request.
Will or can
is used informally in speech to make a request.
Would you please smoke outside?
Would you mind smoking outside please?
Could you smoke outside please?
Will you smoke outside please?
Can you smoke outside please?
I'd
like
you
to
smoke
outside
(would+like Is used by a person of authority)
GOING

TO

THE

DOCTOR

FOR

HEALTH

PROBLEM
REQUEST A FOLLOW-UP APPOINTMENT
Can I schedule an appointment about___?
Can I schedule another appointment?
Can you give me an appointment to see a doctor?
When can I see the doctor again?
Can I set-up an appointment for___?
133

please.

Do I need another appointment?

Can you help me with an appointment? (etc.)
When should I come back here?
Giving advice
There are several expressions we use when we give
people advice.
A
I /you should/ought to

B
yes, I know but

C
no ,

I dont think so
If I were you Id withYoure quite right, but
I would advise you to.

Youre right and I will

Giving Warnings in English.

There are a number of formulas used when Giving
Warnings in English. Here are some of the most
common:
Don't push so hard on that toy, or you might / will break
it!
Watch out! Be careful!
Work hard otherwise you'll fail your exam!
134

Surprise
You can express your surprise by the following
phrases:
Indeed?
Really?
Is that so?
Is that what it is?
You dont say so?
Just fancy that
Story telling
The beginning
First

The middle
then

The end
finally

First of all

and then

in the end

At first

after that

at last

Investigations
Explaining purpose
I'm going to ( lake a sample of your bone marrow) find
out what's causing (your anaemia).
135

Reassuring
It won't take long.
It won't be sore.
I'll be as quick as I can.
Warming
You may feel (a bit uncomfortable).
You'll feel a jab).
Discussing investigations
Essential
should
must
be + required/ essential/ important/ indicated
Possibly useful
Could
Not required
need not
be + not necessary
136

not required
not important
Essential not to do
should not
must not
be + contraindicated
Checking, clarifying, summarizing
Checking, clarifying you have understood by
paraphrasing or repeating what someone says as a
question, or by picking up a statement and adding a
question.
So you would say that
So what you re saying is that
You mean just
Im not sure I understand/see what you mean
And/but how do you?
Can you?
Does that help?
Are you saying that?
137

Summarizing what someone says.

So if I can/could summarize what youre saying/what
youve said
Id like sum up what Ive/youve said/were saying
So were/youre saying that
I think i/we could summarize it in this wayWould
rather

138

References
Barnes PM et al. Complementary and alternative
medicine use among adults and children: United States,
2007. CDC National Health Statistics Report Number
12, Dec 2008.
http://www.cdc.gov/nchs/data/nhsr/nhsr012.pdf
Beardsley Robert S. Communication Skills in Pharmacy
Practice, 5th edition.2007
Gunarsson, B.L., Linell, Per, and Nordberg, Bengt, The
Construction of
Professional Discourse, Longman.1997
Hoey, M. Patterns of Lexis in Text, OUP.1991
Hoey, M., 2001, Textual Interaction, London, Routledge.
Holliday, M. and Hasan, R. , Language, context and text:
aspects of language in
a social-semiotic perspective, OUP.1989
Leech G., J. Svartvik, A Communicative Grammar of
English, Longman, London, 1979.
Lucey Catherine, Standardized Patients
https://www.med.illinois.edu/m2/ClinicalTutorials/State
ments/standpat.php
139

McPhee, and Rabow Medical Diagnosis &

Treatmenteds. Papadakis, McPhee, and Rabow. 2012
Palmer Harold, F.G. Blandford, A Grammar of Spoken
English, Third Edition, Cambridge
University Press, Cambridge, 1969.
Quirk Randolph, Greenbaum S., Leech G., Svartvik J., A
Grammar of Contemporay English
Longman, London, 1972.
Quirk Randolph, Greenbaum S., A University Grammar
of English, Longman, London, 1973.
Schibsbye Knud, A Modern English Grammar, Second
Edition, OUP, London, 1970.
Thomson A.J., Martinet A.V., A Practical English
Grammar, 2-nd Edition, OUP, London, 1969.
Zandvoort R.W., A Handbook of English Grammar,
Longman, London, 1957.
Andrew Heenan's Nurse's Dictionary 2011
Dictionary of Medical Terms, fourth edition. A & C
Black. London. 2005. www.acblack.com
Useful internet websites:
- http://www.onestopenglish.com/
140

- http://www.developingteachers.com/
- http://www.bbc.co.uk/worldservice/learningenglish/
- http://www.etprofessional.com/
- http://www.iatefl.org/
- http://www.flashcards.php.html
- http://www.English Reading Exercises _ English
Jump!.html

141