CHAPTER 4.

MEDICAL INVESTIGATIONS AND

EQUIPMENT

A physician once said: “The best medicine for humans is love”

“What if it doesn’t work?”
“Increase the dose”

BASIC VOCABULARY
Label the following medical equipment/instruments:

1...................... 2.............................

3. ...................................... 4.........................................

1
5. ...................................... 6................................................

7......................................... 8.........................

9.......................... 10.............................

2
 11...................................... 12...................................

13. ........................... 14....................... 15.......................

16................................ 17.................................... 18........................

MATCH each of the following definitions with the medical instrument/device to which it
refers:

1. TOURNIQUET A. to passively evacuate the rectum of

faeces; vide link
2. PIPETTE/DROPPE B. to look inside anal canal and
R lower part of the rectum
3. MICROSCOPE C. to test motor reflexs of the body
4. KIDNEY DISH D. to measure out doses of liquid,
specially in children
5. CARDIOVERTER/ E. to look at the retina
DEFIBRILLATOR
6. OPHTHALMOSCO F. a kind of a needle that is used to
PE create a permanent pathway to a vein
(or artery) for the purpose of
repeated injections or infusion of
intravenous fluids
7. THIN BEAM G. to cover and protect certain areas of
ELECTRIC TORCH the body such as recent injury
8. ENDOSCOPE H. A rubber tube used for applying

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 pressure. It leads to engorgement of
the veins allowing them to be seen
better; used for intravenous
injections and cannulation.
9. PROCTOSCOPE I. to look into the external ear cavity
10. TONGUE J. to remove toxic materials from the
DEPRESSOR blood that are generally removed by
the kidneys; used in case of renal
failure
11. CANULA K. used for visualising minute structures
including
microbes.
12. ENEMA SET L. used to hear sounds from movements
within the body, like heart beats,
intestinal movement, breath sounds,
etc.
13. DIALYSER M. A spoon used for use in oral
examination
14. OTOSCOPE N. used to transfuse blood and blood
products
15. REFLEX TESTING O. to correct arrhythmias of the heart or
HAMMER to start up a heart that is not beating
16. TRANSFUSION P. to look inside the oesophagus,
SET stomach, upper intestines, bile duct,
larynx, trachea, bronchi-through the
mouth; anal canal, rectum, colon-
through anus; used mainly in Surgery
or by surgical consultants
17. BANDAGE Q. to see into the eye, body's natural
orifices, etc., and to test for pupillary
light reflex, etc
18. STETHOSCOPE R. a tray for instruments, gauze, tissue,
etc.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

LISTENING
Spinal tap (lumbar puncture) procedure. Listen to a doctor explaining the lumbar
puncture procedure. Then give instructions to your partner about how to take up the
correct position and explain what you are going to do:

1. Please move the edge of the bed.....

2. ...........................................................

3. ...........................................................

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 4. ..........................................................

Barium enema (barium meal) You have a 35 year-old male patient presenting with
duodenal ulcer. Listen to the barium enema procedure and then give instructions to your
patient about what to do and what you are doing.

1..........................................................

2..........................................................

3..........................................................

4..........................................................

How is coronaroghaphy performed? The procedure is performed in the angiography laboratory,

in a sterile environment with a special equipment (angiographer) that uses X-rays.

Rearrange the next stages of a coronarography as they are in wrong order:

1. contrast substance is injected, in order to evidence the coronaries.

2. patient is lying on the special bed
3. local anesthesia is performed.
4. the catheter is removed
5. patient is covered with a sterile field, which leaves uncovered just the right (or left) inguinal
area or the radial area
6. pressure is applied on the punctured area for 20 minutes
7. patient is discharged
8. catheters are introduced (specific long thread-like devices) and pushed toward the coronaries,
9. patient may start a careful mobilization
10. a cannula is introduced in the femoral/radial artery
11. tight bandage is applied onto the area
12. patient lies in bed, without moving his/her leg.

1 2 3 4 5 6 7 8 9 10 11 12

DIAGNOSTIC TESTS. Write the name of the diagnostic test illustrated in each picture:

1.............................. 2......................................
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 3…………………. 4. ………………………..

5……………………… 6………………………..

7………………… 8…………………… 9…………………

Find the purpose (a-j) for each of the tests on the left (1-10):

TEST PURPOSE
1.Midstream specimena.to examine a sample of secretions from the
of urine test (MSU) uppermost part of the throat, behind the nose, to detect
organisms that can cause disease.
2.First-void urine b.an X-ray examination that visualizes the trachea,

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 specimens bronchi, and the bronchial tree.
3.NP secretions c.to detect digestive problems, such as the
malabsorption of certain sugars, fats, or nutrients,
bleeding inside of the gastrointestinal tract; to
determine whether a type of bacteria or parasite may
be infecting the intestines
4.BAL d.to test for Chlamydia trachomatis
5.Nose sw = e.to
nasal/ measure:the number and variety of red and white blood
nasopharyngeal cells,
(NP), swab test presence of bacteria or other organisms, substances, su
ch as glucose, that usuallyshouldn't be found in the uri
ne, the pH, which shows how acidic or basic the urine
6.Lumbar f.to give important information about the current status
puncture of the kidneys as well as electrolyte and acid/base
balance and level of blood glucose
7.Bronchography, g.to show the blood alcohol level
bronchogram
8.Urine culture h.to collect cerebral spinal fluid and measure spinal
fluid pressure. The procedure involves inserting a
needle into the lower back
9.Basic metabolic i.to confirm the diagnosis of a urine infection
panel = chemistry
panel
10.Stool test j.to test secretions in the nose for the presence of the
flu
Guess the conditions illustrated below (1-6) and brainstorm what type
of tests doctors would recommend:

1……………….. 2……………………..

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 3………………….. 4…………………..

5………………….. 6……………………….

PROJECT - Talking a patient through an investigation

 What do you say as you are taking a patient’s blood pressure, pulse and temperature?
Rehearse with your partner and make notes of your exchanges.

 A new patient has been admitted to your ward. You need to find information in order to
complete the medical form.Ask questions for the following information:

Name, date of birth, reason for visit, current medication, current medical conditions, allergies,
blood group, substance use (cigarettes, alcohol, coffee)

Taking patient’s blood pressure

Hello Mr. Brown. I’m dr.Cotescu. How are you feeling today?

Better, thank you.

That’s great. I’m going to take your pulse, temperature and blood pressure today. Is that ok?

Sure. First let’s take your temperature and pulse. Please place this thermometer under your
tongue. Now I’m going to take your pulse. Great! They are normal. Now let’s see your BP.
Please take a couple of deep breaths. I’m going to place this cuff around your arm. It will be a

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 little tight. Please relax. OK, your BP is a little over normal, 140/90, so I’ll report this to the
senior consultant.

Now rehearse with your partner on:

a) Giving a shot (use: swab arm with alcohol, cold, don’t tense up, feel dizzy/nauseous,
tingling/numbness)
b) Taking a blood sample (use: tourniquet/tight, disinfect area, fist/squeeze, slight
sting, relax hand, press)
c) Giving medication (use: type of medication – steroid, sedative, antacid, antibiotic,
fever reducer – FOR: sleep, allergy, infection, stomach acid, etc.; TO: stop pain, lower
BP, reduce cholesterol, prevent nausea, prevent blood clot, etc; how many times a day,
when.
What is epidural anesthesia?
Finish the following sentences by matching column A with column B:
A B
1.Epidurals block the nerve impulses from the lower a regional anesthesia that blocks pain in a particular
spinal segments. region of the body.
2.Epidural medications fall into a class of drugs to provide analgesia, or pain relief, rather
called than anesthesia, which leads to total lack of feeling.

3.This produces opioids or narcotics such

4. Epidural anesthesia is
5. They are often delivered in combination with
6. The goal of an epidural is
Re-oreder the following stages of an epidural:
as fentanyl and sufentanil in order to decrease the
required dose of local anesthetic.
pain relief with minimal effects.
local anesthetics, such
as bupivacaine, chloroprocaine, orlidocaine.
which results in decreased sensation in the lower
half of the body.

1. A small area on your back will be injected with a local anesthetic to numb it.
2. The needle is then carefully removed, leaving the catheter in place to provide medication
either through periodic injections or by continuous infusion.
3. You can expect to receive 1-2 liters of IV fluids throughout labor and delivery.
4. This position is vital for preventing problems and increasing the epidural effectiveness.
5. Intravenous (IV) fluids will be started before active labor begins and prior to the procedure of
placing the epidural.
6. A needle is then inserted into the numbed area surrounding the spinal cord in the lower back.
7. The catheter is taped to the back to prevent it from slipping out.
8. An antiseptic solution will be used to wipe the waistline area of your mid-back to
minimize the chance of infection.
9. You will be asked to arch your back and remain still while lying on your left side or sitting up.
10. After that, a small tube or catheter is threaded through the needle into the epidural space.
11. An anesthesiologist (specialist in administering anesthesia), an obstetrician, or nurse-
anesthetist will administer your epidural.
1 2 3 4 5 6 7 8 9 10 11

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READING
A.Learning a Lesson. Read the text and then do the multiple choice below:
Although I'm a registered nurse, I didn't realize then how much one intervention would affect
the course of my entire labor. But I knew that breaking my water would make my contractions
more intense, so I insisted on an epidural. The cascade of interventions had begun. Soon I had
an external fetal monitor around my middle, an epidural in my back, an IV in my left arm, and
a blood pressure cuff around my right arm. When the doctor determined that a full bladder was
blocking the baby's descent, they inserted a catheter. And when my baby's heart rate dropped
while I was pushing, they strapped an oxygen mask to my face and used forceps to pull my
son into the world. My back ached for days at the epidural insertion site, my hand was sore
from the IV, and I couldn't sit normally for weeks. I didn't feel like myself for almost a month.

Later, I couldn't help but wonder, What if I'd never let the doctor break my water or had the
epidural? I started to read books such as The Birth Book by Dr. Sears, and Natural Childbirth
the Bradley Way. What I learned made sense to me: When you work with your body instead of
fighting it, labor is marvelously efficient. I learned that each intervention has side effects,
often leading to more interventions, a fact supported by my own experience.

For my second labor, I decided to surrender to my contractions instead of fighting them. Still,
when I arrived at the hospital, I began to doubt my ability to give birth. I considered an
epidural. We tried a small dose of IV Nubain instead. The drug made me feel sleepy. I found
the hot tub a much more effective form of pain relief. I felt less pain than during my first birth,
and while some might say it's because subsequent labors are shorter and therefore less painful,
I think the tub played the bigger role. My nurse-midwife monitored me while I labored in the
tub, and when I felt the urge to push, she helped me out onto the bed. Five minutes later, our
second son was born -- pink, healthy, and happy. I felt 100 percent better than I did after my
first birth. Seconds, not weeks, after delivery, I felt like myself again.Later, I wondered if the
Nubain had really been necessary. I realized that in my helpless moment I'd simply wanted
someone to do something; maybe I'd needed reassurance more than drugs.

For my third labor, I relied on the support of my midwives and the wisdom of my own body.
While my labor was intense, I wouldn't describe it as painful. I spent each contraction
relaxing, allowing my body to do its necessary work. Our third son was born shortly after
midnight in a peaceful, powerful water birth. The feeling of triumph I experienced was
tremendous. Through my own labor, I brought my son into the world. I gained an appreciation
for my body and a sense of personal confidence that persists to this day. I know that deep
within me I have the capacity and strength to deal with anything. That's a gift no drug can
give.

1. The epidural caused:

a) More intense contractions

b) Gall bladder catheter to be introduced
c) Ache at the site of insertion

2. Having an epidural in the nurse’s perception means:

a) Fighting with your body

b) Working with the body
c) Marvelous efficiency

3. The nurse patient considers that second labors are:

a) Less painful
b) Shorter and less painful

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 c) More efficient in tubs

4. Tub labor was preferred because:

a) It Helped the patient to recover more rapidly

b) It Helped the patient feel the midwife’s support
c) She received a pain reliever (Nubain)

5. Natural drug-free labor is described as:

a) Intense and painful

b) Shorter and more powerful
c) Invigorating, fortifying and empowering

B.No Regrets (Story of Marisa Cohen)

Now read the other story and decide if the statements below are true or false:

After spending the better part of a year researching a book on childbirth (I interviewed close to 100
women) and listening to moms passionately explain to me why they chose to go through childbirth
without any drugs, I absolutely understand why it was the best possible choice for them, and how it
made their day of labor an incredible, empowering experience. I sit here in awe of their perseverance
and willpower. And I think about everything I went through during my first labor -- the Pitocin and the
epidural, the catheter and the blood pressure cuff -- and I realize that while it wasn't quite as beautiful
and inspiring a scenario, it worked for me, and if I were to do it all over again, I would still choose a
medicated birth.
Mind you, it's not like my preference for a medicated labor is based on nothing. I did experience
natural labor for a good six hours with my first daughter's birth. The first couple of hours after my
water broke were manageable -- the contractions were mild as my husband and I walked around the
corridors of the labor and delivery ward, showing off my new leopard-print slippers to the night-shift
nurses and practicing how we were going to tell all our friends the story of my water breaking right
after the creme brulee had been cleared.
But by hours three and four, I could not walk. I could hardly breathe. The herculean effort of moving
my body even one tiny inch was rewarded by an invisible gremlin twisting a steak knife even deeper
into my back. I have dug deep into my psyche and come to the conclusion that for me there was
nothing empowering about my stint of natural labor. The only thing I learned about myself was this: I
really don't like extreme pain.
And yes, after talking to natural-birth moms, I do acknowledge that my perception of the pain could
have been affected by listening to all those stories passed around our culture about the agonies of
childbirth. But you know what? It just didn't matter that much to me. Achieving a powerful, organic
birth experience was not as high on my list of priorities as having a comfortable delivery, which in my
case meant having an epidural.
The thing that really bothers moms like me who opt for medicated births is the idea that this kind of
scenario is somehow second-rate. Medicated-birth moms reject the idea that their kind of birth can't be
as rewarding as a natural birth. Though we may not experience that rush of triumph that so many
natural-birth moms describe, most of us are still pretty blissed out.

1. This mom does not understand why mothers choose to T F suffer

2. Despite being a harsh experience, medicated child birth was a great experience
T F
3. Her advice is based on experience of a six hours’ labor and stories collected
from mothers giving birth naturally T F

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 4. Medicated birth can’t be as blissful as natural birth. T F

VOCABULARY PRACTICE
LABORATORY. Taking blood. In gaps 1-10 below insert one of the terms in the box:

phlebotomist specimen antecubital fossa

clench dressing gauze
haematology haematoma tourniquet
clot

During venipuncture, the 1)................ , a technician who takes blood, inserts a needle into a
vein and withdraws blood into a 2)............ tube which is sent to the 3)................. laboratory for
analysis. Usually the the vein can be found in the inner part of the elbow, the 4)................ ,
that is easily accessible. She may apply a 5).............. – a tight band – above the site, or the
patient may be asked to 6)......... their hand to make a fist, in order to make the vein more
prominent. Afterwards, the patient may be asked to press lightly on 7)............. , usually a
piece of 8)..............., to help the blood to 9).............. and to prevent swelling and a
10)................. where the vein was punctured.

Fasting Blood Sugar (FBS or Fasting Glucose). Choose the best item (a-c) below to fill
each gap (1-10):

A test that measures blood sugar levels. 1)………… levels are associated with
diabetes and insulin resistance, in which the body cannot properly 2)……………
sugar (e.g. obesity).
G OAL VALUES :
 Less than 100 mg/dL = normal
 Between 110–125 mg/dL = 3)…………. fasting glucose (i.e., prediabetes)
 Greater than 126 mg/dL on two or more 4)…………… = diabetes
Preparation. This test requires a 12-hour 5)…………... You should wait to eat and/or take
a hypoglycemic agent (insulin or oral medication) until after test has been 6)………… ,
unless told 7)…………….. . Eating and digesting foods called carbohydrates forms
glucose (blood sugar). Glucose is needed by your body to provide energy to carry out your
normal activities. Insulin is needed by the body to allow glucose to go into the cells and be
used as energy.8)…….. insulin, the levels of glucose in the blood will rise. Diabetes is a
disease that occurs when 9)…………. the pancreas (an organ in your body) is not able to
produce insulin or the pancreas makes insulin, but it does not work as it should. Fasting
blood sugar is a part of diabetic evaluation and management. 10)………… FBS greater
than 126 mg/dL on more than one occasion usually indicates diabetes.

1. A.elevated B.normal C.low

2. A. respond to B. fight C. handle
3. A. bad B. weak C. impaired
4. A. samples B. specimens C. tests
5. A. abstinence B. time C. fast
6. A. drawn B. made C. taken
7. A. so B. otherwise C. accordingly
8. A. with B. without C. based on
9. A. either B. both C. only
10. A. a B. one C. an

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