UNIT 3. Diagnostic Tests and Medication

UNIT 3.
Diagnostic tests and Medication

Name ____María ____ Surname: Férnandez Sevilla__Degree_________
Due date: 3rd June 2016
1. Reading: Match the following terms with their definitions
1. developing a. the study of drug-related adverse effects carried out by pharmaceutical

countries industries
2. to boost b. to control, to check, to supervise
3. to monitor c. a secondary and usually adverse effect of a drug or therapy
4. pharmacovigilance d. non industrialized countries that want to become more advanced by

developing its resources by industrialization
5. morning sickness e. to increase or raise
6. side-effects f. the nausea and vomiting of early pregnancy
7. harm g. damage, impairment, loss
1 2 3 4 5 6 7
D E B A F C G
2. Listen to the following radio programme on drug monitoring in developing countries

and read the article below
More is being done these days to get new medicines to developing countries. But researchers
say little is being done to monitor the possible adverse side effects. They say millions of people may
be put at risk as a result.
A British Medical Journal article says developing countries bear almost 90 percent of the
world’s disease burden.” So when new drugs are developed that could fight illnesses, there’s great
demand and pressure to get them to African and other developing countries as soon as possible.
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UNIT 3. Diagnostic tests and Medication
However, while the side effects of those medicines are monitored fairly well in developed
countries, not so elsewhere. Dr. Munir Pirmohamed is a physician and professor of clinical
pharmacology at the University of Liverpool.
“Unfortunately, all medicines at the moment come with some degree of risk. But what we don’t
know is what that risk is in the African population or in other developing countries because they
have different degrees of nutrition. They have different diets and also the genetic factors may also
be important. And so therefore we need comparable structures in developing countries to be able to
monitor any drug safety issues, which may be occurring there,” he says.
Western nations developed what’s known as “pharmacovigilance” in the 1960’s, after the drug
Thalidomide caused disabilities or deformities in 10,000 babies.
The drug had been developed as a remedy for morning sickness during pregnancy. However,
even today, drugs can be on the market for years before all the side effects are known. So the
system in the West isn’t perfect. But in the developing world, it’s basically non-existent.
Dr. Pirmohamed tells of a drug developed in the West having an adverse reaction in
Africa.“For example, there was one drug called Thiacetazone, which is used for TB.
In the African population it caused a horrendous skin reaction in a large percentage (of the
patients), up to 10 percent in some studies. Whereas when it’s been used in other countries in the
Western world and so on, the reaction rate was much lower. So there are definitely examples,” he
says. Dr. Pirmohamed and the other authors of the British Medical Journal article say developing
nations need to be brought up to speed in drug monitoring.
“To be able to develop the structures, obviously it’s going to take decades and enormous
amount of expenditure. And we can’t wait decades.
We can’t be exposing drugs, which may be causing harm to the population there. So we
need to develop new ways of thinking and new ways of working together so that we could try to
identify any answers now. So that we can try to make sure that the patients (are) getting the drugs
they need, but also at the same time we’re maintaining safety of the drugs,” he says.
In the short term, the researchers recommend setting up programs to boost local expertise in
drug monitoring, possibly through exchange programs. They say the World Health Organization
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and the US National Institutes of Health should take the lead in promoting pharmacovigilance in the
developing world.
Source: VOA News: http://www.voanews.com/content/a-13-2007-09-10-voa9-66590877/555724.html
3. Complete the sentences below with the following words
sickness rate pharmacovigilance side
developing adverse monitoring
 Thiacetazone, which is used for TB caused an __adverse__ reaction in a large percentage of

the patients.
 Thalidomide was developed as a remedy for morning ___sickness____ during pregnancy.
 The reaction __rate__ was much lower in other countries in the Western world.
 __Pharmacovigilance____was developed in the 1960’s, after the drug Thalidomide caused

disabilities or deformities in 10,000 babies.
 Acoording to a British Medical Journal, __developing___ countries bear almost 90 percent

of the world’s disease burden.
 Even today, drugs can be on the market for years before all the __side__ effects are known.
 The researchers recommend creating programs to increase local expertise in drug

____monitoring___ .
4. Vital signs vocabulary. Click on each of the words below and read the information on
Medline Plus. Then match the terms with their definitions.
Organ Function
a. the pressure of the blood exerted in the vessels as it circulates through
the body, usually measured with a sphygmomanometer or blood
1. Body temperature
pressure cuff and reported in millimeters of mercury.
2. Pulse b. the number of heartbeats per minute or the speed of your pulse
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measured in beats per minute (bpm).
c. the temperature of the body (normally 98.6 F or 37 C in humans),

3. Blood pressure usually measured to obtain a quick evaluation of a person's health.
1 2 3
C B A
5.Watch the following video on how to take blood pressure and put the instructions in the
order you hear them. Start listening at second 0:54
USING A MANUAL BLOOD PRESSURE CUFF
8 squeeze the valve to inflate the cuff; continue to inflate the cuff until you reach about 30 units
above the estimated systolic pressure
1 when you hear the first sound, note the number and the gauge
0
3 make sure the cuff is securely fastened around the arm
1 stretch out your arm and position it at your heart level with the palm facing up
6 place the diaphragm of the stethoscope at the bend of your elbow and tuck it underneath the
cuff
5 position the stethoscope so that the ear pieces are pointing away from you, then
place the stethoscope into your ears as shown here
9 deflate the cuff by slowly spinning the dial to the left
2 place the inflatable cuff around your arm about one inch above your elbow
1 finally you can deflate the cuff completely and remove it from your arm
4
2
4 securely fasten the gauge as shown here
1 continue to deflate the cuff gradually
1
7 lock the valve by spinning it all the way to the right
6. Listen the video how to take blood pressure again, read the instructions and complete
the gaps with the correct verbs. Start listening at second 0:54
0:54 Now, we will discuss a manual blood pressure cuff. Stretch out your arm and position
it at your heart level with the palm facing up, you want to expose the upper arm fully. Do not 2.
___place___ the cuff over clothing. The side of the cuff that should be in direct contact with the
skin is labeled “this side against limb”. Place the inflatable cuff around your arm about one inch
above your elbow. 3. __Make sure____ the cuff is securely fastened around your arm. Securely
4. ____fasten__ the gauge as shown here.
Next 5. _____position___ the stethoscope so that the ear pieces are pointing away from you.
Then, place the stethoscope into your ears as shown here.
You can tap the diaphragm of the stethoscope to make sure that is 6. ___placed_______
correctly in your ears. Then place the diaphragm of the stethoscope at the bend of your elbow
and 7_____tuck______ it underneath the cuff. Next 8_____lock_____ the valve by spinning it
all the way to the right.
Then 9____squeeze____ the valve to inflate the cuff. Continue to 10____inflate_______

the cuff until you reach about 30 units above the estimated systolic pressure. After that, you can
11_____deflate_______ the cuff by slowly spinning the dial to the left. Make sure the needle
and the blood pressure gauge moves at about two increments per second. When you hear the
first sound
12. ____note____ the number and the gauge. This is your systolic blood pressure.
5
Continue to deflate the cuff gradually. Note the number where you last hear the sound. This
is your diastolic blood pressure. Finally you can deflate the cuff completely and 13.
_____remove_______ it from your arm.
7. Continue watching the video on how to take blood pressure and put the instructions in
the order you hear them. Start listening at minute 3: 07
USING AN AUTOMATIC ARM BLOOD PRESSURE CUFF
9 the screen will then read your systolic pressure, your diastolic pressure and your
heart rate
6
using your hand that does not have the cuff on your arm, squeeze the inflation valve
and continue pumping until a down arrow appears
3 pull the end of the cuff so that it tightens evenly your arm
2 position the cuff about one inch above the elbow
7
you should then wait as the cuff automatically deflates. If at any time you wish to
stop the blood pressure reading you can press the start/stop button
1 open the arm cuff so that you may place your arm to it
8 when the measurement is complete the cuff will deflate entirely
5
you can then press the start/stop button to power on the machine.
6
4 the symbols shown here should line up with the middle of your arm
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you can now remove the cuff from the arm
8. Listen the video how to take blood pressure again, read the instructions and complete
the gaps with the correct words. Start listening at 3:07
3: 07. Now we will move on to an automatic blood pressure cuff. Open the arm 1._cuff___
so that you may place your arm through it. Position the cuff about one inch above the 2.
____elbow___. Pull the end of the cuff so that it tightens evenly around your arm. The symbols
shown here should line up with the 3. _____middle____ of your arm. You can then press the
start/stop button to power on the machine. After about three seconds the display will read 00.
This indicates that the 4.______monitor____ is ready to measure.
Using your hand that does not have the cuff on your arm, squeeze the inflation 5.
_________bulb______ and continue pumping until a down arrow appears. You should then
wait as the cuff automatically 6. _______deflates_____. If at any time you wish to stop the 7.
______blood pressure_____ reading you can press the start/stop button. When the
8._________measurement____is complete the cuff will deflate entirely. The screen will then
read your 9. ______systolic_______ pressure, your diastolic pressure and your 10.___heart
rate _____ . You can now remove the cuff from the arm
9. Explaining procedures
Healthcare professionals need to explain procedures before they perform them. The clearest and
most direct way to give an explanation is to use the structure “be + going to”
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Examples:
 I’ m going to take your blood pressure.
 I’ m going to take your pulse.
 I’ m going to take your temperature
The imperative is used in English to give instructions. To make the imperative, use the infinitive of
the verb without to.
 Example: Sit down and place your arm on this table
However, in many cases the imperative can sound too harsh, so these commands can be softened in
the following ways:
 You can add for me or please

 It is also frequent to use can/could and also just
 Or even a conditional if
Could you stand up for me, please?
If you could just stand up, please
Please don’t sit down
See how instructions are given for a procedure using polite language:
I´m going to take your blood pressure.
 roll up your sleeve:

 Could you roll up your sleeve for me please?
 place your right arm on the table.
 Could you just place your right arm on the table?
 sit with legs uncrossed.
 If you could just sit with your legs uncrossed please.
 try not to speak/move during the test.
 Please don´t move during the test/ Please try not to speak during the test
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10. Writing exercise: Write the instructions you would give to a patient on two procedures
that you normally perform in your job. Use polite language.
Procedure 1: Take the blood pressure.
Good morning! How are you? I’m going to take your blood pressure. If you could roll up your
sleeve for me please and would you mind sitting down and placing your arm on this table, please? It
is important to you sit with your legs uncrossed and don’t move and speaking during the test,
please. Thank you.
Now, I’m going to open the arm cuff. Could you place your arm to it? I’m going to press the
start/stop button to power on the machine and to proceed to take your blood pressure. We have to
wait a few seconds and when the monitor indicates 00., it is ready to measure your blood pressure.
I’m going to squeeze the inflation bulb until we see a down arrow in the monitor. Could you see it?
Then, the cuff will automatically deflate and the screen will read your systolic and diastolic pressure
and your heart rate. This is your blood pressure. Could you now remove the cuff from your arm and
roll down your sleeve, please? Thank you, we’re done!.
Procedure 2: Take the pulse.
Good morning! How are you today? I’m going to take your pulse.
For doing so, could you place your right arm on the table for me, please? Please don’t speak during
the test.
Now, I’m going to place my index and middle fingers on the inside of your wrist, below your
thumb. In my watch, I’m going to count your pulse for 60 secons. Once I have it, I’m going to write
down you pulse rate, date, time, which side was used to take the pulse and, if so, your weak, strong
and missing beats.
That’s all! Thank you for your cooperation!
11. Explaining procedures. We normally use the Present Passive to describe how a procedure
is carried out.
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12. Watch how an ocular implant is explained using the Passive structure
During normal vision, light passes through the cornea, which is the clear covering of
the eye, and then through the pupil, which is actually a hole in the colored part of the eye, or
the iris. Light then passes through the lens where the image is focused onto the retina at the
back of the eye. The image is then converted to electrical signals that are sent to the brain.
Cataracts can cause the lenses to become cloudy or opaque, preventing light from passing
clearly to the retina.
A surgical procedure can restore vision that has been compromised by cataracts.
During this procedure, an ultrasound probe is used to soften the natural lens, which is then
suctioned from the eye. Next, a plastic lens is inserted into the capsule that previously
contained the natural lens.
The new lens is secured via two flexible plastic struts that curve out from the central
plastic lens. An implanted lens functions similar to a natural one, focusing light on the back
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of the retina and restoring vision for those with cataracts. There are several potential
complications associated with this procedure that should be discussed with a doctor prior to
surgery
13. Watch how a hearing test is explained using the Passive structure.
When sound waves reach the ear, they are gathered by the funnel-shaped outer ear
and are channeled into the middle ear. At the entrance to the middle ear, sound waves hit
the tympanic membrane, or eardrum. The resultant vibrations then travel through the middle
ear and into the fluid filled inner ear where they are converted to signals that are sent to the
brain. In order to test a person's hearing, an audiologist, or hearing specialist, will perform a
series of hearing tests. Today these tests are often performed by using a combination of
electronic equipment and a tuning fork. A tuning fork is a fork-like instrument made of
aluminum or metal that makes a musical note when struck. The hearing test where a tuning
fork is used is called a Rinne test. During this test, the tuning fork is struck and is held close
to the ear but without touching the head. This tests whether sound waves are able to enter
the ear and travel through the middle ear to reach the cochlea via air conduction, which is
normal hearing. Next, the tuning fork will be struck and then held against the skull behind
the ear. This test bypasses the conduction of sound through the outer and middle ear and
focuses on the reception of vibrations by the cochlea via bone conduction. Through the use
of this test combined with speech testing, an audiologist can determine whether a hearing
impairment exists and what the cause may be.
13.b Watch and read how insulin is delivered using the Passive structure.
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Diabetes is a condition that develops because of elevated levels of glucose or blood

sugar in the bloodstream. Many people with diabetes take insulin to keep their blood sugar
at a normal, healthy level. There are several methods of insulin delivery including: syringe,
pen, jet injector, and pump.
The most common type of insulin delivery is through a syringe. An insulin dose is
drawn up into the syringe from a vial and injected directly into the skin. The syringe should
be disposed of in a puncture-proof "sharps" container designed for medical waste. Insulin
pens contain pre-filled cartridges of varying doses which are injected directly into the skin.
A jet injector does not use a needle to inject insulin. Instead, a high-pressure air mechanism
is used to push a fine spray of insulin into the skin.
Each of these methods of insulin delivery can be used to inject insulin in several areas of
the body including the thighs, hips, abdomen, and upper arms. They are usually used several
times a day. However, an insulin pump delivers insulin continuously throughout the day and
can be worn on a belt or in a pocket. Insulin pumps allow people to more tightly control
their glucose levels.
No matter which method of insulin delivery is chosen, it is important that a person with
diabetes still checks their blood sugar 3 to 4 times a day.
14. Watch the following video on blood pressure and listen to the description of how
the procedure is carried out. Then fill in the gaps with the verbs in the Present Passive
form
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1. The stethoscope 1. _____is placed_____ (to place) gently over the artery at the
point of maximum pulsation.
2. It 2. ____must not be pressed____ (must not press) too firmly or touch the cuff or
the diastolic pressure 3. ____may be underestimated______ (may underestimate).
3. The pressure 4. ___is then raised_________ (to raise) by inflating the bladder to 30
millimeters of mercury above the systolic blood pressure as estimated by palpation.
4. Next the pressure 5. ______is reduced________ (to reduce) at two to three
millimeters of mercury per second. The point at which repetitive clear tapping
sounds first appear for at least two consecutive beats gives the systolic blood
pressure. You should hear this now. The point where the repetitive sounds finally
disappear gives the diastolic blood pressure. You should hear this at a 138
millimeters of mercury.
5. Both measurements 6. ________should be taken______(should take) to the nearest
two millimeters of mercury. This helps to avoid digit preference.
6. If face four 7. ___is used __( to use) this 8. __should be clearly recorded _(should
record).
15. Identify the 8 passive verbs in this text on cholesterol.
Cholesterol is a fat-like substance (lipid) that is present in cell membranes and is a precursor
of bile acids and steroid hormones. Cholesterol travels in the blood in distinct
particles containing both lipid and proteins. These particles are called lipoproteins. The
cholesterol level in the blood is determined partly by inheritance and partly by acquired
factors such as diet, calorie balance, and level of physical activity.
Three major classes of lipoproteins are found in the blood of a fasting individual: low
density lipoproteins (LDL), high density lipoproteins (HDL), and very low density lipoproteins
(VLDL). The LDL typically contain 60-70 percent of the total serum cholesterol and both
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are directly correlated with risk for CHD. The HDL normally contain 20-30 percent of the
total cholesterol, and HDL levels are inversely correlated with CHD risk. . The VLDL
contain 10-15 percent of the total serum cholesterol along with most of the triglyceride in
fasting serum; VLDL are precursors of LDL, and some forms of VLDL, particularly VLDL
remnants, appear to be atherogenic.
Since most cholesterol in serum is contained in LDL, [4] the concentration of total

cholesterol in most people is highly correlated with the concentration of LDL-cholesterol. .
Whereas LDL-cholesterol is the major atherogenic lipoprotein and thus is the primary target of
cholesterol-lowering efforts, total cholesterol can be used in initial testing for detecting a
possible elevation of LDL-cholesterol. Initial testing for serum total cholesterol has several
advantages: it is more readily available and less expensive, and does not require that the patient
be fasting.
1. These particles are called lipoproteins.

2. The cholesterol level in the blood is determined partly by inheritance and partly by
acquired factors.
3. Three major classes of lipoproteins are found in the blood of a fasting individual.
4. Both are directly correlated with risk for CHD.
5. HDL levels are inversely correlated with CHD risk.
6. Since most cholesterol in serum is contained in LDL.
7. Most people are highly correlated with the concentration of LDL-cholesterol.
8. Total cholesterol can be used in initial testing for detecting a possible elevation of
LDL-cholesterol
16. Change the following sentences describing a clinical trial from active to passive.
Active voice
1. Researchers test a new drug or treatment in a small group of people. They determine a safe
dosage range and they identify the side effects.
Passive voice
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1. A new drug or treatment is tested in a small group of people. A safe dosage range is
determined and side-effects are identified.
Active voice
2. They give the drug to a large group of people. They study its efficacy and evaluate its safety
again.
Passive voice
2. The drug is given to a large group of people. Its efficacy and safety are studied and evaluated
again.
Active voice
3. They monitor its side effects and compare it to commonly used treatments. They collect
information that will allow it to be used safely.
Passive voice
3. Its side effects are monitored and commonly used treatments are compared. Information is
collected to be used safely.
Active voice
4. They launch the drug on the market. They conduct studies after they have marketed the drug
to gather information about its effects in different populations. They identify side effects
associated with long-term use.
Passive voice
4. The drug is launched on the market. Studies are conducted after the drug has been marketed
to gather information about its effects in different populations. Side effects associated with
long-term use are identified.
17. Listen to the following talk from TED on vaccines and answer the following
questions.
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https://www.ted.com/talks/seth_berkley_hiv_and_flu_the_vaccine_strategy
1. Professor Vaclav Smil calculated that hat sudden disaster had the highest probability (close to
100 percent) to change history?
A. A typhoon
B. A severe flu pandemic
C. An steroid hitting the earth
D. A terrorist attack
2. At the time of Berkley's talk in 2010, how many diseases were treatable with vaccines?
A. Approximately 30
B. All diseases in the world
C. 150
D. 500
3. According to Berkley, what is unique about the virus that causes AIDS?
A. It has decoys to evade the immune system
B. It mutates furiously
C. It quickly hides itself in your genome
D. All of the above
4. For the first time, where was research found that an AIDS vaccine worked in humans, according
to Berkley?
A. Thailand
B. Mexico
C. Vietnam
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D. South Africa
5. Seth Berkley points out that almost nothing has changed to make the flu vaccine. Where do we
get our flu vaccines?
A. From cow dung
B. From fetal tissue
C. From chicken eggs
D. All of the above
7. Explain how vaccines work to assist your immune system tackle invaders in your system.
A vaccine trains the body in advance how to recognize and neutralize a specific invader. After
HIV penetrates the body's mucosal barriers, it infects immune cells to replicate. The invader
draws the attention of the immune system's front-line troops. Dendritic cells capture the virus
and display pieces of it. Memory cells generated by the HIV vaccine are activated when they
learn HIV is present from the front-line troops. These memory cells immediately deploy the
exact weapons needed. Memory B cells turn into plasma cells, which produce wave after wave
of the specific antibodies that latch onto HIV to prevent it from infecting cells, while squadrons
of killer T cells seek out and destroy cells that are already HIV infected. The virus is defeated.
8. Finding a vaccine for AIDS is at the forefront of medical research. Explain how retro-
vaccinology works in finding a vaccine for AIDS.
Retro-vaccinology is a technique within the ambit of so-called rational vaccine design. Once,
new antibodies have been identified and it is known that they latch onto many variations of the
virus as well as they latch onto a specific part, we can figure out the precise structure of that
part, present that through a vaccine. Hence, we can prompt the immune system to make these
matching antibodies and create an universal HIV vaccine.
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18. Read the text below on types of medication and complete the gaps with the following
words.
over-the constipation prescription pills opiates oral

counter
subcutaneously pharmacy dispensed bacterial ill quickly
Medicines can be classified by their chemical properties, e.g. (1)_____opiates_____ are a well-
known example of a group of medicines and so are benzodiazepines. They can also be classified
according to their mode of administration. They may be taken orally in the form of (2)
_____pills____ or capsules or under the skin, (3) ____ subcutaneously _____, by injection. When
patients are very (4) _____ill________ and cannot take (5) _____oral_____ medication or when we
want the drugs to act very (6) ___quickly______, these may be given intravenously.
The most common classification for medications is according to the type of clinical
condition they treat. For example laxatives treat (7) ______constipation___and antibiotics treat
(8)______bacterial_____infections. A doctor may prescribe medication, commonly referred to as
drugs, and will give the patient a (9) _______prescription________. The patient will take this to
the (10)______pharmacy_______, where the medication will be prepared and (11)
____dispensed___ by a pharmacist. Medicines that can be purchased directly in the pharmacy
without a prescription are called (12) ___ over-the counter____ drugs.
19. Reading prescriptions. Read the following extract about a medication called
SULCONAZOLE NITRATE and answer the questions below:
SULCONAZOLE NITRATE
Indications: Fungal skin infections
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Cautions: Contact with eyes and mucous membranes should be avoided.
Side-effects: Occasional local irritation and hypersensitivity reactions include mild

burning sensation, erythema, and itching. Treatment should be discontinued if these
are severe.
Dose: Apply 1-2 times daily, continuing for 2-3 weeks after lesions have healed.
Exelderm® (Centrapharm)
Cream, sulconazole nitrate 1%
19a Answer the following questions about the text on Sulconazole Nitrate (S.N.).
i. (1) ________Side-effects______ are unwanted things that may happen to you if you take a
medication.
ii. The (2) ____dose____________is how much and how often you take a medication.
iii. Another term for allergic reaction is (3) ________hypersensitivity reactions_______.
iv. If you are allergic to Sulconazole Nitrate you can get an (4)_____erythema_____or rash.
v. The lining inside your mouth or nose can be called (5) ___________________.
vi. Sulconazole Nitrate is used to treat (6) _______ fungal skin infections____.
vii. You should (7) _____continue____taking Suconazole Nitrate after lesions have healed.
viii. You should (8) _____stop _________taking Suconazole Nitrate if you have an allergic
reaction.
19b Decide if the following are True (T) or False (F), and correct them if they’re false.
i. If you take S.N. you will probably get an allergic reaction. F

Occasional local irritation and hypersensitivity reactions
ii. If you have any symptom of an allergic reaction to the medication you should stop taking it.
T
iii. You should take S.N. for 2-3 weeks. T
iv. S.N. is for external use only. T

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20. Types and forms of medications. Match the terms on column A with the definitions in
column B.
Term Definition
1. a painkiller a. kills bacteria.
2. an antihistamine b. prevents you from contracting an infectious disease.
3. an antibiotic c. gives pain relief.
4. an antidepressant d. reduces swelling.
5. a sedative e. helps you to pass a stool.
6. an anti-inflammatory f. provides a substance that is deficient in the body.
7. a vaccine g. treats allergies.
8. a laxative h. increases the body’s metabolism
9. a supplement i. alleviates feelings of intense sadness.
10. a stimulant j. makes you feel relaxed and happy.
1 2 3 4 5 6 7 8 9 10
C G A I J D B E F H
21. Study the following prescription:
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2 1
3 1
a. The name, formulation and strength of the medicine __1__

b. The quantity to be dispensed by the pharmacist _2___
c. How the medication should be taken by the patient __3__
1. Rx or Recipe (translates as Take thou) This appears at the start of most prescriptions and
basically means “Please dispense” – it is an instruction to the pharmacist
Rx Tab. Paracetamol 500mg
This first part of the prescription includes:

 Formulation: e.g. caps (capsules), tabs (tablets), supp (suppositories), etc.
 Name of medicine: Paracetamol
 Strength of medicine: 500 mg (milligrams)
2. The second part of the prescription specifies the quantity to be dispensed by the pharmacist
and it is traditionally prefaced by Mitte or M (Mitte means give in Latin).
Mitte 30 (thirty tablets)
3. The third part of the prescription are the instructions that go on the label.
It traditionally begins with Sig.
This is short for Signa which means mark or write.
Sig. 2 tablets, 6 hrly for pain, p.c.
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This part specifies how the medication should be taken by the patient.
22. Match the following abbreviation or acronym with the terms on the right related to
medication and doses. Click on this link from the Eshelman School of Pharmacy to check
Latin terms and common abbreviations.
Term Definition
1. b.i.d (bis in die) a. by mouth

2. c.c (cum cibum) b. every morning
3. aur./a. (auris) c. twice a day
4. i.v./I.V. d. drops
5. o.m. (omni mane) e. syrup
6. p.c. (post cibum) f. right
7. p.o. (per os) g. ear
8. p.r.n (pro re nata) h. after meals
9. q.i.d. (quarter in die) i. capsules
10. S.C./subc. j. intravenous
11. stat. (statim) k. as required
12. tab. (tabella) l. with meals
13. syr. (syrupus) m. subcutaneously
14. gtt (guttae) n. four times a day
15. d. (dexter) o. immediately
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
C L G J B H A K N M O I E D F
23. Group the terms above into the following types of information:
i) referring to route of administration:
p.o. (per os) , aur./a. (auris), d. (dexter)
ii) referring to when to take the medication:
c.c (cum cibum), p.c. (post cibum)
iii) referring to frequency of dose:
o.m. (omni mane), p.r.n (pro re nata) , q.i.d. (quarter in die), stat. (statim)
iv) referring to the mode of administration:
tab. (tabella), syr. (syrupus), gtt (guttae), . i.v./I.V, S.C./subc
IMMUNOTHERAPY
24. Watch the following video on immunotherapy and complete the gaps below.
Throughout our lives the cells in our bodies grow and divide. But when cells start dividing
and ____spreading____1 uncontrollably they become cancerous. There are more than 200 different
23
types of cancer, and scientists are continually developing and testing new ways to treat them. Most
cancer therapies involve drugs designed to _____kill____2 the rapidly-dividing cells. This is what
chemotherapy does. But there is a different approach called immunotherapy. Immunotherapy uses
the body’s own immune system to _____fight__________3 cancer. This involves activating
immune cells and getting them to recognize the cancer tissue as different from normal body cells.
This isn’t easy but recently the field has had some success. The FDA has _____approved _______4
several new drugs, and with more drugs in clinical trials some say we are entering a new era of anti-
cancer immune therapy.
The idea goes back to the late nineteenth century, to an American surgeon named William Coley.
He injected bacteria into tumors and watched them ______shrink_____5. The bacteria, it seemed,
were provoking an immune response. But our immune system is highly complex and for most of the
20th century scientists struggled to turn Coley’s observations into _______effective_____6 cancer
treatment. But after decades of learning about the immune system, a variety of immunotherapies are
finally making their way toward the ______clinic_____7.
We can divide them into four general strategies: non-specific immune stimulation, __adoptive __8
cell transfer, immune checkpoint ____blockades____9, and vaccination strategies.
The first non-specific immune stimulation is used to give a general _________boost_______10 to

the immune system in vivo. To do this, some of the many cells that make up the immune system,
such as these antigen-presenting cells, need to be activated. Researchers can do this by injecting
molecules that _____bind____11 to receptors in the cell membrane. The activated cells then alert
other immune cells, such as these T-cells. T-cells are the main ______players_______12 in the fight
against cancer, When activated they can attack and kill tumor cells. For full activation, small
signaling molecules called cytokines are needed. Two cytokines, interferon-alpha and interleukin-2
have been developed as drugs and approved for use against some forms of cancer including
____melanoma_______13.
Another way to stimulate immune cells ____in vivo_____14 is to inject bacteria like William Coley
did. This has led to a rather surprising use of the BCG vaccine. BCG is usually given to children as
protection against tuberculosis, but scientists have found that the _____weakened_____15 bacteria
in the vaccine can also help children with bladder cancer. The bacteria appear to cause
inflammation, which increases the number of immune cells around the cancer helping them to
____home in_______16 on their target.
24
Non-specific immunity can also be achieved by removing so-called immune check-point blockades.
These blockades normally ____dampen____17 down the immune response to prevent collateral
damage to healthy tissue. But to fight cancer, scientists need to remove some of these blockades, to
make the immune response stronger. The antibody ipilimumab, also known as Yervoy, targets a
blockade called CTLA4, it got FDA approval for advanced stage melanoma in summer 2011 and it
´s being tested on several other types of cancer.
Activating immune cells inside the body can be difficult, but the next strategy, adoptive cell transfer
___combats __18 this by extracting the immune cells from the patient and activating them outside
the body. It enables researchers to specifically target the cancer tissue. One approach is to take
immune cells directly from the tumor. It’s difficult to extract enough cells, but the advantage is that
the cells have already learnt to recognize the tumor. Taking cells from the blood is much easier but
then you’ve got to use genetic engineering to ____arm____19 them with tumor specific receptors.
Either way the cells are activated using cytokines and then multiplied in Petri dishes before being
____reintroduced_______20 to the patient. At the moment, this approach is experimental.
The fourth strategy uses vaccinations. Unlike the BCG vaccine that we mentioned earlier, and
which targets the immune system in a general way, these vaccines are used to direct immune cells
very specifically to the cancer __tissue__21. Several viral vaccines have shown promising results in
clinical trials. For example, a weakened version of the Herpes simplex virus, modified to produce
an immune-stimulating factor is being developed for melanoma and head and neck cancer. It’s also
possible to ____vaccinate_____22 with a patient’s own tumor cells. Some cells are extracted,
irradiated to stop them from spreading, and then engineered to ___secrete____23 activating growth
factors. When the cells are injected back into the patient, the growth factors alert the immune
system to the cancer. But it’s also possible to vaccinate with a person’s own immune cells. For
example, antigen-presenting cells can be taken from patients, matured outside the body and
_____loaded____24with tumor antigen. When the cells are reintroduced to the patient the antigen
stimulates other immune cells and helps them to recognize the tumor. The first vaccine of this type
received FDA approval in 2010 for the treatment of some ____prostate_____25 cancers, it´s known
as Provenge or SipuleucelT. The other vaccination approaches are still experimental. The last few
years have seen many promising developments in anti-cancer immunotherapies. But there is still
much work to do, to help get drugs from the ______bench_________26, through clinical trials and
to the bedside, scientists need to find better ways to judge the success of immunotherapies in
patients and to work out the best ____dose______27. Right now, it’s difficult to predict who might
25
respond to a particular treatment and some responses are only _____short-lived_____28. If these
hurdles can be overcome, then many more patients could benefit from strategies that boost their
immune system.
25. Reading: Put each of the following titles above the appropriate paragraph in the reading
below. The first one is done for you.
A. Prevention better than cure
B. Where is personalized medicine helping most?
C. Mapping of the human genome
D. Prevention or treatment in medicine today (par. 1)
E. What is personalized medicine?
F. A success story
G. Examples of mutations in cancer
Personalized medicine
If you are lucky, you’re on your way to a diagnosis and a path to feeling better. How much more
personal does it get? In fact, much more.
Par. 1 PREVENTION OR TREATMENT IN MEDICINE TODAY
Most often today, your treatment plan doesn’t have all that much to do with you specifically.
It’s identical to what doctors would hand over to anyone with the same condition — your neighbor,
the hot dog vendor, or the prime minister. That’s because medicine as we know it revolves around
“standards of care,” the best courses of prevention or treatment for the general population, or the
average person on the street. With breast cancer, for example, those standards mean self-exams and
mammograms after a set age and the usual chemotherapy to treat a tumor if one is found. If the first
treatment doesn’t work, doctors and patients move on to the next one and the next. It’s trial and
error, and you can die if it doesn’t work.
26
Par.2__ What is personalized medicine?
A growing number of researchers, some healthcare clinicians, and an increasing number of

patients are calling for a more personalized approach aimed as much at preventing disease as at
tailoring treatment once it’s there. Call it what you will — personalized medicine, genomic
medicine, precision medicine. It’s an approach that emphasizes the ways in which your disease risks
are unique and different. Those disease risks are based on your genome, combined with your
lifestyle and environment. In the case of cancer, the disease has its own genetic makeup, giving
each tumor a unique character with unique tendencies and vulnerabilities. And perhaps there is, or
soon will be, a drug or treatment or tailored combination of the two that will work better for you
than it would for someone else.
According to the definition preferred by the National Human Genome Research Institute a
personalized approach to medicine includes “using an individual’s genetic profile to guide decisions
made in relation to the prevention, diagnosis, and treatment of disease.”
Par. 3___ Mapping of the human genome____
By 2003, scientists had a complete sequence and map of all the genes in the human body.
Advances in technology have since accelerated the rhythm of discovery and lowered the cost so
much that scientists have now sequenced the genomes of more than 1,000 individuals in all their
variations. These days, individual patients — and sometimes healthy people, too — can have their
personal genomes scanned or fully sequenced. This knowledge about the basic elements of human
genomes and their differences, both common and rare, is central to the concept of personalized
medicine.
Par. 4____Prevention better than cure

There have been recent, high-profile examples: Angelina Jolie made headlines with a
proactive double mastectomy last year after tests showed she carried BRCA1, the same genetic
marker for breast cancer that her mother, who died from the disease, carried. The National Cancer
Institute puts the risk of breast cancer for those carrying a BRCA1 mutation at 65 percent and the
risk of ovarian cancer at 39 percent. While it’s important to remember that genes are not destiny,
they do provide information that can lead us to make more informed decisions about our health and
healthcare, and, as in Jolie’s case, that can change the future.
27
Par. 5_ Examples of mutations in cancer
If you get sick, knowing your genome or the molecular basis of your disease can be an
important piece of evidence for doctors seeking the most favorable treatment plan for you. In the
case of cancer, genetic tests could lead to successful drug treatment rather than radical surgery. For
instance, melanoma can be BRAF positive, meaning the tumor has a specific gene mutation that
sets it apart from other melanomas. Your lung cancer can be EGFR or ALK positive. Your colon
tumor may be KRAS positive.
Par. 6__ A success story
While more evidence about the promise of personalized medicine is certainly called for,
individual stories are already pointing the way. In 2005, Stephanie Haney, now 45, had a pain on
her right side that wouldn’t go away. It hurt when she coughed or sneezed. She was pregnant, so she
didn’t investigate the cause, assuming perhaps she’d broken a rib.
Two years later, she was diagnosed with stage 4 lung cancer and began taking
chemotherapy. Haney was first given Tarceva (erlotinib) in 2008. But three years later, the drug was
no longer keeping the tumor away. Persuaded by friends and an insistent doctor, she had genetic
testing on her tumors, which showed they were ALK (anaplastic lymphoma kinase) positive. This
gave her doctor a major clue as to which drugs were most likely to work (or not). Haney was able to
start taking Xalkori (crizotinib), designed specifically for ALK-positive lung cancer tumors. She
joined a clinical trial for Xalkori in Philadelphia, two and a half hours away. Three years later, her
tumors were barely visible.
Par. 7 Where is personalized medicine helping most?
Personalized medicine’s greatest developments have been in cancer. Consider these statistics
on the percent of tumors containing genetic mutations that could be targeted by drugs, as reported
by the Wall Street Journalin 2011:
Melanoma: 73 percent
Thyroid: 56 percent
Colorectal: 51 percent
28
Lung and pancreatic: 41 percent
Breast: 32 percent
“Cancer is a genetic disease,” Ginsburg says. “it is the perfect example of a disease that has used
personalized medicine strategies. It has used them in everything from risk assessment in healthy
people — from screening, diagnosis, and prognosis — to selecting therapies based on genetics and
the biology of the tumor.”
Vocabulary. Find words for the following synonyms or definitions in the text.
a) to experiment, rejecting what does not work and adopting what does. (par.1)  to move
on to the next one.
b) routine treatments or prevention programs given to the general population (par.1) 
Standards of care
c) a full set of chromosomes (par 2)  Genome
d) weak aspects of something (aspects that can be attacked) (Par 2)  Disease risks
e) modifying the dose or type of treatment (Par 2)  Personalized approach to medicine
f) removal of the breast (Par 4)  mastectomy
g) a serious operation that removes a large amount of tissue or organs (Par 5)  radical
surgery
h) medication given to treat cancer (Par 6)  chemotherapy
i) an experiment which tests a medication in a group of patients (Par 6)  clinical trial
j) attacked by (e.g. by a medication) (Par 7)  targeted by
29
k) looking for something (e.g. an illness) in a healthy population (Par 7)  risk
assessment in healthy population
l) the patient’s probability of recovery (Par 7)  risk assessment
Look at the definition for personalized medicine in the text (Par. 2) and explain it in your own
words.
Personalized medicine is an approach that focuses on the study and analysis of each person’s
genome or genetic profile in order to carry out a more precise diagnosis and treatment as well as the
prevention of the disease.
Some mutations are associated with tumors in the body and if present can be targeted (attacked) by
specific medications? Which mutations are associated with tumors of the following organs?:
 Lung  Lung tumors can be targeted by specific medications such as LDK378.

One of the lung mutations is the so-called CFTR that causes mucus to the lungs
and obstruct the pancreas; therefore, food cannot be absorbed by the body.
There are different mutations of the CFTR that provoke cystic fibrosis such as
the G551D whose treatment is the “Kalydeco”. Another mutation is the ALK
that is treate with the drug Xalkori (crizotinita).
 Colon  KRAS positive
 Skin  BRAF positive
 Which genetic marker increases your risk of breast cancer? BRCA1
Source: http://genomemag.com/what-is-personalized-medicine/#.VxoTePmLTIU
26. Complete the text using the words in the box. (6 marks)
diagnosis neurosis taste complications throat

malignant physiology tracts cord senses cervical differentiate
Otorhinolaryngology is not only concerned with sensory organs involved in the 1.___ senses
of hearing, balance, smell, and 2.___taste___, but also the entrances to the respiratory and digestive
30
3.___tracts____, which play extremely important roles in human life. The ENT module will
provide basic knowledge in the areas of otorhinolaryngology, head and neck oncology, and
communicative disorders as well as interdisciplinary areas. The objective is to give students the
ability to understand the regional anatomy and 4.___ physiology ___ of the nasal and paranasal
cavities, oral cavity, pharynx, salivary glands, larynx, face, neck, trachea, and esophagus, explain
the meaning and results of various types of examinations of these organs, and apply this knowledge
to 5.__ diagnosis ____ and treatment.
In rhinology, for instance, deviation of the nasal septum, rhinitis, sinusitis, nasal polyps, and
various benign or 6.___malignant__tumors of the nasal and paranasal cavities are all disorders
which may result in nasal congestion, and students will learn how to 7._____differetiate____
between these to establish the correct diagnosis. To give another example, in the case of a patient
who presents with an abnormal sensation in the 8.___throat___, the condition might involve local
inflammation, such as chronic pharyngolaryngitis, allergic pharyngolaryngitis, or postnasal drip
associated with sinusitis, or one might detect a fish bone or other foreign body, or a thyroid tumor
or pharyngolaryngeal cancer. The condition might also be associated with a bone abnormality, such
as styloid process syndrome or 9.____cervical_______ spondylosis, or it may be associated with a
systemic disease such as Plummer-Vinson syndrome. In addition, we should also consider the
possibility of cancerophobia or anxiety 10.____neurosis____, or side effects of drugs such as ACE
antagonists. Some of these disorders can be life-threatening, and a basic knowledge of each of these
disorders is therefore indispensable.
The section on laryngology will deal with recurrent nerve paralysis, vocal
11._____cord______ polyps, and cancer, and that on tracheoesophagology will cover foreign
bodies and dysphagia. In the section on voice and speech, students will acquire the ability to explain
the hierarchical system of speech and hearing as well as disorders that may result in dysphonia. In
the section on head and neck oncology, students will learn the sites, symptoms, etiology and course
of various types of tumors, and their relation with neighboring organs, as well as their pathological
characteristics, basic therapy, prognosis, and postoperative 12.___complications__ and
rehabilitation.
Find words and phrases in the text with similar meanings to the definitions below. (6 marks)
a. The branch of medicine that deals with the causes or origins of disease.  etiology
b. The windpipe.  trachea
c. Drugs or chemical substances that interfere with the physiological action of another. 
ACE antagonist
d. A mucus secretion from the rear part of the nasal cavity into the nasopharynx, usually as the
result of a cold or an allergy  postnasal drip
31
e. Usually non malignant growths or tumors protruding from the mucous lining of an organ
such as the nose.  benign tumors or polyps
f. A cartilaginous and muscular hollow organ which contains the vocal cords. larynx
g. Degeneration of the spinal column, especially that resulting in abnormal fusion and
immobilization of the vertebral bones.  spondylosis
h. Any unwanted nontherapeutic consequences caused by drugs side-effects
i. Of no danger to health; not disease-causing.  no life-threatening
j. A dividing partition between two tissues or cavities  nasal septum
k. Any of the paired sinuses in the bones of the face adjacent to the nasal hollows that are lined
with mucous membrane.  paranasal cavities or sinuses
l. The gullet.  esophagus
Transcripts
Drug monitoring in developing countries
More is being done these days to get new medicines to developing countries. But researchers say little is
being done to monitor the possible adverse side effects. They say millions of people may be put at risk as
a result.
A British Medical Journal article says developing countries bear almost 90 percent of the world’s disease
burden.” So when new drugs are developed that could fight illnesses, there’s great demand and pressure
to get them to African and other developing countries as soon as possible.
However, while the side effects of those medicines are monitored fairly well in developed countries, not
so elsewhere. Dr. Munir Pirmohamed is a physician and professor of clinical pharmacology at the
University of Liverpool.
“Unfortunately, all medicines at the moment come with some degree of risk. But what we don’t know is
what that risk is in the African population or in other developing countries because they have different
degrees of nutrition.
They have different diets and also the genetic factors may also be important. And so therefore we need
comparable structures in developing countries to be able to monitor any drug safety issues,
which may be occurring there,” he says.
32
Western nations developed what’s known as “pharmacovigilance” in the 1960’s, after the drug
Thalidomide caused disabilities or deformities in 10,000 babies.
The drug had been developed as a remedy for morning sickness during pregnancy. However, even today,
drugs can be on the market for years before all the side effects are known.
So the system in the West isn’t perfect. But in the developing world, it’s basically non-existent.
Dr. Pirmohamed tells of a drug developed in the West having an adverse reaction in Africa.“For
example, there was one drug called Thiacetazone, which is used for TB.
In the African population it caused a horrendous skin reaction in a large percentage (of the patients), up
to 10 percent in some studies. Whereas when it’s been used in other countries in the Western world and
so on, the reaction rate was much lower. So there are definitely examples,” he says.
Dr. Pirmohamed and the other authors of the British Medical Journal article say developing nations need
to be brought up to speed in drug monitoring.
“To be able to develop the structures, obviously it’s going to take decades and enormous amount of
expenditure. And we can’t wait decades.
We can’t be exposing drugs, which may be causing harm to the population there. So we need to develop
new ways of thinking and new ways of working together so that we could try to identify any answers
now. So that we can try to make sure that the patients (are) getting the drugs they need, but also at the
same time we’re maintaining safety of the drugs,” he says.
In the short term, the researchers recommend setting up programs to boost local expertise in drug
monitoring, possibly through exchange programs. They say the World Health Organization and the US
National Institutes of Health should take the lead in promoting pharmacovigilance in the developing
world.
Source: VOA News: http://www.voanews.com/content/a-13-2007-09-10-voa9-66590877/555724.html
33

UNIT 3. Diagnostic Tests and Medication

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UNIT 3. Diagnostic Tests and Medication

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UNIT 3.

Diagnostic tests and Medication

Due date: 3rd June 2016

1. Reading: Match the following terms with their definitions

1. developing a. the study of drug-related adverse effects carried out by pharmaceutical

3. to monitor c. a secondary and usually adverse effect of a drug or therapy

4. pharmacovigilance d. non industrialized countries that want to become more advanced by

6. side-effects f. the nausea and vomiting of early pregnancy

7. harm g. damage, impairment, loss

2. Listen to the following radio programme on drug monitoring in developing countries

Source: VOA News: http://www.voanews.com/content/a-13-2007-09-10-voa9-66590877/555724.html

3. Complete the sentences below with the following words

sickness rate pharmacovigilance side

developing adverse monitoring

 Thiacetazone, which is used for TB caused an __adverse__ reaction in a large percentage of

 Thalidomide was developed as a remedy for morning ___sickness____ during pregnancy.

 __Pharmacovigilance____was developed in the 1960’s, after the drug Thalidomide caused

 Acoording to a British Medical Journal, __developing___ countries bear almost 90 percent

 The researchers recommend creating programs to increase local expertise in drug

c. the temperature of the body (normally 98.6 F or 37 C in humans),

USING A MANUAL BLOOD PRESSURE CUFF

9 deflate the cuff by slowly spinning the dial to the left

1 continue to deflate the cuff gradually

Then 9____squeeze____ the valve to inflate the cuff. Continue to 10____inflate_______

USING AN AUTOMATIC ARM BLOOD PRESSURE CUFF

2 position the cuff about one inch above the elbow

8 when the measurement is complete the cuff will deflate entirely

 Example: Sit down and place your arm on this table

 You can add for me or please

Could you stand up for me, please?

If you could just stand up, please

Please don’t sit down

I´m going to take your blood pressure.

 roll up your sleeve:

Procedure 1: Take the blood pressure.

Procedure 2: Take the pulse.

That’s all! Thank you for your cooperation!

Diabetes is a condition that develops because of elevated levels of glucose or blood

point of maximum pulsation.

the diastolic pressure 3. ____may be underestimated______ (may underestimate).

millimeters of mercury above the systolic blood pressure as estimated by palpation.

4. Next the pressure 5. ______is reduced________ (to reduce) at two to three

5. Both measurements 6. ________should be taken______(should take) to the nearest

two millimeters of mercury. This helps to avoid digit preference.

15. Identify the 8 passive verbs in this text on cholesterol.

Since most cholesterol in serum is contained in LDL, [4] the concentration of total

1. These particles are called lipoproteins.

over-the constipation prescription pills opiates oral

Indications: Fungal skin infections

Side-effects: Occasional local irritation and hypersensitivity reactions include mild

Cream, sulconazole nitrate 1%

i. If you take S.N. you will probably get an allergic reaction. F

iii. You should take S.N. for 2-3 weeks. T

iv. S.N. is for external use only. T

2. an antihistamine b. prevents you from contracting an infectious disease.

3. an antibiotic c. gives pain relief.

4. an antidepressant d. reduces swelling.

5. a sedative e. helps you to pass a stool.

6. an anti-inflammatory f. provides a substance that is deficient in the body.

7. a vaccine g. treats allergies.

8. a laxative h. increases the body’s metabolism

9. a supplement i. alleviates feelings of intense sadness.

10. a stimulant j. makes you feel relaxed and happy.

 Thiacetazone, which is used for TB caused an adverse reaction in a large percentage of

 Thalidomide was developed as a remedy for morning _sickness__ during pregnancy.

 Pharmacovigilance__was developed in the 1960’s, after the drug Thalidomide caused

 Acoording to a British Medical Journal, developing_ countries bear almost 90 percent

Then 9squeeze the valve to inflate the cuff. Continue to 10inflate___

the diastolic pressure 3. may be underestimated__ (may underestimate).

4. Next the pressure 5. is reduced__ (to reduce) at two to three

5. Both measurements 6. __should be taken(should take) to the nearest

a. The name, formulation and strength of the medicine 1

The first non-specific immune stimulation is used to give a general ___boost_10 to

Par. 3_ Mapping of the human genome__