UNIT 2.5.

MEDICAL EXAMINATION_______________
In this unit
 describing the procedure of clinical examination of
patient, its stages and essence
 formation and using of the present and past participles
 using Simple Passive
Warm up II.2. Put the pictures in the correct order.
Do you agree with Sir Dominic J. Corrigan Write 1-5 in the boxes.
saying? Why/why not?
“The trouble with doctors is not that they don’t
know enough, but that they don’t see enough.”
Video Activity:
The University Health Network showed us what
happens in emergency rooms asking if people
have COVID-19.
What it's like to get tested for
COVID-19
(https://www.youtube.com/watch?v=14mRmD8zHOk)

I. Before you watch

Match the terms with the images.

A. Gloves B. Respiratory Mask

D. Gowns C. Protective Goggles
II. While you watch
II.1. Describe the picture.

III. After you watch

Make up the dialogue: “At the airport”. Person
A is a nurse, Person B is an ER doctor (an
emergency room doctor) and Person C is a
patient.
“The trouble with doctors is not that they don’t know "Always listen to the patient, they might be telling you
enough, but that they don’t see enough.” the diagnosis."
Sir Dominic J. Corrigan Sir William Osler
___________________________________________________________________________________
Reading
Clinical Examination
Doctors who are directly involved in the care
of patients have four fundamental tasks:
 making a diagnosis
 discovering the cause of the problem
 determining treatment
 establishing prognosis.
Everything the clinicians do to and for the
patient – includes one or another of these
basic jobs.
History Taking
Progress in making the diagnosis depends on Percussion technique
taking a good history and doing a careful
physical examination. in that order. You look first then feel; when you
During the course of history, the physician have felt, you may tap, but not before; and last of
gathers full information about the patient: his all comes the stethoscope.
biographical data (age, race, sex, occupation, The examination will cover most of the basic
education, habits), chief complaints, data on systems of the body, including the heart system,
past illnesses (major acute and chronic lung system, gastrointestinal system and nerve
diseases, operations and injuries the patient system examination.
had in the past), and data about chronic
illnesses of the immediate family. The way Investigations
and manner the physician asks the patient After physical examination the physician makes an
questions is of particular importance. initial diagnosis which must be confirmed by
Physical Examination laboratory findings and imaging technologies
History taking is generally followed by before the treatment is decided upon. The most
physical examination or clinical common laboratory findings are biopsy, blood
examination - the process by which a doctor and urine testing. Imaging studies include
investigates the body of a patient for signs of radiograghy (X-ray), ultrasound investigation,
disease. computed tomography (CT), electrocardio-
Generally, there are 4 parts of physical graphy (ECG), electroencephalography (EEG),
examination: magnetic resonance imaging (MRI).
 Inspection: looking for signs It is said that over 80% of diagnoses are made on
 Palpation: feeling for signs history alone, a further 5-10% on examination and
 Percussion: tapping for signs, used the remainder on investigation. Whether this
when doing a lung and/or gut saying is true or not may be open to debate but it
examination. is clear that history and examination skills remain
 Auscultation: listening using the at the very core of clinical practice.
stethoscope, or in olden times, purely Lung auscultation
listening with direct ear.
Whatever part of the patient is examined,
whatever disease is suspected, the four
motions must be done
Palpation
 Vocabulary Practice 7. Fill in the correct word(s) from the list below,
synonyms to which are given in the brackets.
1. Look at the words in bold type on p. 71 and
explain their meaning. causes sign chronic
involves palpate confirm
2. Decode the following abbreviations. specimens auscultation suspects
ICU, A&E, EEG, MRI, CT, ECG; initial
1. Radiography ________ (includes) exposing
3. Supply the definitions to the following words and a part of the body to a small dose of radiation to
word combinations. produce an image of the internal organs.
2. X-ray is the commonest diagnostic
1. examination a. a diagnostic procedure examination used to _______________
designed to determine the (establish the truth) lung abnormalities.
density of a part by the sound 3. Drunken driving is one of the commonest
produced by tapping the ___________ (reasons) of traffic accidents.
surface with the finger or a 4. Headaches may be a ________ (indication)
plessor of stress.
2. palpation b. listening to the sounds 5. The doctor may decide to have blood, urine
made by various body or tissue _____________ (samples) analysed.
structures and functions as a 6. It is difficult to cure ___________ (continual)
diagnostic method, usually bronchitis.
with a stethoscope. 7. ____________ (listening) is one of the most
3. percussion c. any investigation or important diagnostic techniques for examining
inspection made for the such organs as lungs, heart, vessels.
purpose of diagnosis 8. To _____________ (touch) means to
4. auscultation d. examination with the examine with hands.
hands, feeling for organs, 9. The doctor _____________ (supposes) that
masses, or infiltration of a the patient has problems with the gut system.
part of the body, feeling the 10. The physician should be able to make an
heart or pulse beat, ________________ (primary) diagnosis after
vibrations in the chest, etc. examination of a patient.

4. Match the synonyms to the given words 8. Find the odd word out.
1. specimen, illness, pattern, sample, example
information 2. chronic, acute, constant, permanent,
investigations continual
symptom 3. involve, consist of, include, contain, study
radiography 4. initial, first, primary, final, elementary
touch 5. investigate, examine, research, explore,
gut system remain

9. Complete the sentences forming present or past

5. Make up word combinations Verb – Adj – Noun
participle from the verbs in brackets.
to cause acute pains
1. The initial diagnosis is _____________
to complain of chronic illness
(confirm) by laboratory findings.
to prevent physical symptoms 2. I went to the lecture but I felt_______ (bore).
to develop unusual complaints 3. It was very _______________ (disappoint)
to describe suffering not to get the results of blood testing in time.
injuries 4. When the surgeon performed his first
operation he felt ________________ (frighten).
6. Word formation. Make up as many words with 5. Doctors who are directly ____________
the root –graphy as possible. (involve) in the care of patients have four
fundamental tasks.
e.g. angiography_____________________________ 6. Radiography and ultrasound investigation are
___________________________________________ _______________ (include) in imaging studies.
___________________________________________ 7. The result of biopsy test was ____________
___________________________________________ (surprise).
___________________________________________
Language Development 8. The tumour was found out by x-ray
examination.
1. Finish the following sentences. _________________________________________
1. The main tasks of every physician involved in _________________________________________
patent care are
_________________________________________ 3. Answer the questions to the text “Clinical
_________________________________________ Examination”.

2. Case history includes information about 1. What tasks does the doctor have before
_________________________________________ treating the patient?
_________________________________________ _________________________________________
_________________________________________
3. The main parts of physical examination are
_________________________________________ 2. What are the main methods of physical
_________________________________________ examination of the patient?
4. Laboratory findings include _________________________________________
_________________________________________ _________________________________________
_________________________________________
3. What is the sequence of these methods?
5. The most common imaging studies are
_________________________________________ _________________________________________
_________________________________________ _________________________________________
4. What is the initial diagnosis confirmed by?
2. Read the following sentences, make up
questions to the words in italics. _________________________________________
1. The activity of the heart can be studied by _________________________________________
means of electrocardiography. 5. What are the most common laboratory
_________________________________________ procedures?
_________________________________________
_________________________________________
2. The x-ray examination was necessary to _________________________________________
confirm the initial diagnosis. 6. What do imaging studies include?
_________________________________________
_________________________________________ _________________________________________
_________________________________________
3. The doctor found a small lump on the
patient’s head.
_________________________________________ 4. Fill in the table and retell the text according to
_________________________________________ the scheme.

4. The patient suffered from polio in his Clinical Examination

childhood. ↓
_________________________________________ History Physical Lab Imaging
_________________________________________ taking exam studies studies
↓ ↓ ↓ ↓
5. Biopsy is necessary in case of tumour
removal.
_________________________________________
_________________________________________

6. The consultant asked to make biopsy of the

injured organ in this patient.
_________________________________________
_________________________________________
7. The presence of blood or protein in urine
indicates some pathology.
_________________________________________
_________________________________________
5. Read the following dialogue, explain the new b. New words
words in it. blood work =blood testing
a. to roll up sleeves
A Physical Examination overweight - underweight
Doctor: When did you last come in for a balanced diet
physical exam? well-balanced meals
Patient: I had my last physical two years ago. to breath in
to breathe deeply
Doctor: Have you had any other exams breath
recently? Blood work, an ECG or an ultrasound? to hold one's breath
Patient: Well, I had a few X-rays at the dentist's. to pull on one's shirt
to look shipshape - in good order (state);
slip
Doctor: How have you been feeling in general? front desk
Patient: Pretty well. No complaints, really. to arrange an appointment
с. Quiz
Doctor: Could you roll up your left sleeve? I'd
like to take your blood pressure. 1. Has the patient had any other exams
Patient: Certainly. recently?
a. No
b. Yes, for dental work
Doctor: 120 over 80. That's fine. You don't c. Yes, for a broken bone
seem to be overweight, that's good. Do you
exercise regularly? 2. How has the patient's health been in general?
Patient: No, not really. If I run up a flight of a. Poor
stairs, it takes me a while to get my breath back. b. Fine
I need to get out more. 3. Which might be a problem for the patient
according to the physical exam?
a. weight
Doctor: That would be a good idea. How about
b. lack of exercise
your diet?
с. high blood pressure
Patient: I think I eat a pretty balanced diet. You
know, I'll have a hamburger from time to time, 4. Which action bothers the patient a little?
but generally I have well-balanced meals. a. The use of the stethoscope
b. Taking his blood pressure
c. Taking a look at his throat
Doctor: That's good. Now, I'm going to listen to
your heart. 5. What does the doctor ask him to do?
Patient: Ooh, that's cold! a. Lose weight
b. Take a ship
c. Have some blood work done
Doctor: Don't worry it's just my stethoscope.
Now, breathe in and hold your breath. Please d. Reproduce the dialogue in pairs.
pull up your shirt, and breathe deeply... e. Make up a dialogue on the situation:
Everything sounds good. Let's take a look at
You have a sore throat and a headache. Your
your throat. Please open wide and say 'ah'.
temperature is not high but you feel unwell. So
Patient: 'ah'
you have decided to go to the outpatient
department to consult a doctor.
Doctor: OK. Everything looks ship shape. I'm
going to order some blood work and that's about Project Work
it. Take this slip to the front desk and they'll Do the project according to the theme of the
arrange an appointment for the tests. unit.
Patient: Thank you doctor. Have a nice day.
Grammar in Use Future Simple Passive
Positive
Simple Passive Voice
Present Simple Passive I / He / She / It will be examined tomorrow.
/ We / You /
Positive/Negative
They
I am
Negative
He / She / It is (not) examined
every day. I / He / She / won’t be examined
We / You / They are
It / We / You (will tomorrow
Questions / They not)
am I Questions
is he / she I / he / be tomorrow?
(Where) / it examined (Why) will she / it / examined
we /
are we / you every day? you /
/ they they

Past Simple Passive Basic uses:

Positive/Negative
I / He / She / was 1. When we don’t want to take responsibility for
It (not) examined something: The patient will be examined during
We / You / were yesterday. the ward round.
They
Questions 2. When we want to focus on the happening: The
was I / he / MRI was performed last Monday.
(Where) she / it examined
were we / you / yesterday? 3. When we don’t want to use subjects like one,
they someone, they, etc.: In what order are patients
seen in the Emergency Department?
4. Rewrite these sentences in the passive. The 5. Use the proper form of the simple passive
first one is made for you: instead of the verbs in brackets.

e.g. They organise a meeting every 1. History taking _____ generally

month. – _____________ (to follow) by physical
A meeting is organised every month. examination.

1. They usually make an initial diagnosis after 2. Every time fracture

______________________ (to suspect), x-
the physical examination.
ray_____________________ (to perform).
_______________________________________
_______________________________________ 3. Yesterday blood pressure in this patient
2. One described principles of ultrasound to the ___________________ (to take) three times.
students yesterday.
_______________________________________ 4. As biopsy takes quite long, the diagnosis
_______________________________________ ___________________ (to confirm) next
3. Someone will invent the time machine in Wednesday.
future.
5. What medical appliances
_______________________________________
_________________ (not to use) anymore
_______________________________________ nowadays?
4. They did the first patient’s brain-scan on
1 October, 1971. 6. This patient’s specimens of blood
_______________________________________ ______________ (to analyse) in an hour.
_______________________________________
_______________________________________ 7. These students ____________________ (to
5. They always ask a patient about his teach) the main principles of palpation last year.
biographical data and chief complaints. 8. The methods of tomography ______________
_______________________________________ (to propose) by Alessandro Vallebona in the early
_______________________________________ 1900s.
6. In each pair of sentences use one of the verbs in Checklist
the active form, another in the passive form. Assess your progress in this unit. Tick () the
statements that are true.
1. to suspect  I can talk about the procedure of clinical
The experienced physician examination of patients
____________________ asthma as soon as he  Ican express the results of the physical
had a look at the patient. examination of patients
If fracture ___________________________, x-  I can form and use the present and past
ray is performed immediately. participles
 I can use the Passive
2. to prevent
Thanks to the efforts of the WHO, spread of the Key Words
epidemics in 2000 ______________________.
Unfortunately, all the taken efforts _________ auscultation n / /
not _______________ spread of the grippe last biopsy n / /
winter. blood testing / /
cause n, v / /
chronic adj / /
3. to involve
complain v / /
Many patients _________________________ complaint n / /
in the research next year. computed tomography (CT) /
A surgeon’s job ____________________ long /
hours and hard work. confirm v / /
electroencephalography (EEG)
4. to accompany /, /
Fractures _________ not usually ___________ follow v / /
by bleeding. history taking / /
Both students and junior doctors usually imaging studies / /
_________________ the professor during his initial adj / /
ward rounds. inspection adj / /
investigate v / /
5. to remove involve v / /
I remember well when I ___________________ laboratory findings / /
sutures myself for the first time. magnetic resonance imaging (MRI) /
Don’t worry. All the sutures ________________ /
next Monday. palpation n / /
percussion n / /
physical examination / /
7. Write 5-7 sentences about what takes place radiography (X-ray) /, /
during a patient’s visit to a doctor. Use the sign n / /
following verbs in the passive form only! You suspect v / /
may connect the ideas with the help of such ultrasound investigation /
words: at first, then, after that, in the beginning, in /
the end, at last. urine testing / /
to ask to listen to look at
to use to feel to take
to determine to make to establish Look back through this unit. Find other words
e.g. After the examination, the initial and expressions that you think are useful and
diagnosis is made. worth learning
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________