#8 - 63 L4 Practice Scenarios - Eng - 2018

63 - L4 PRACTICE SCENARIOS
1) ASTHMA ATTACK
LEP:
INT: I need some help urgently! My husband is suffering from an asthma attack. He is really having
trouble and gasping for air. This has been going on for a few minutes and I don’t have a ride to the
hospital. I really don’t know what to do.
Nurse: Has this happened before? When did the attack start?
INT:
LEP:
INT: Yes, he suffers from asthma, but he had never had an attack like this before. I guess it started
at 10, but please hurry!
Nurse: Call 911 and tell them you have an emergency and to take both of you to the nearest
emergency room, please have him ready and leave the door open so they can come in. Try to keep
him calm and relaxed, loosen his clothing and don’t give him anything to eat or drink until the
ambulance arrives.
INT:
2) ASTHMA
LEP:
INT: My husband suffers from asthma and we never know when the next attack is coming and how
long it is going to last.
Doctor: The level of severity of asthma suffered by each individual and the severity of each attack,
are different.
INT:
LEP:
INT: Yes, I have noticed that, also when there are weather changes. How can I tell when he is going
to have an attack?
LanguageLine Solutions Confidential Information

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Doctor: You may notice symptoms such as wheezing, shortness of breath, a feeling of tightness in
the chest, and coughing. Unfortunately, there is no cure for asthma once it has developed. In some
cases, it may limit the patient’s activities.
INT:
3) LUNG CONDITION
LEP:
INT: Doctor, I am worried because I have trouble and some pain when I take a deep breath. I also
have a cough, a fever and I feel tired most of the time. Do you think this has something to do with
my lungs?
Doctor: It could be a number of things, such as pneumonia, bronchitis, emphysema or tuberculosis.

Have they ever told you that you suffer from any of those?
INT:
LEP:
INT: In my country they said that it could be tuberculosis, but I don’t know now.
Doctor: Well, the test results indicate that you do have TB. I wanted to make sure.
INT:
LEP:
INT: Is that serious, Doctor, and is there a treatment or medicine for that?
Doctor: Yes, there is a treatment that lasts 9 months. You have to take the medicine faithfully for 9
months. If you skip one month or if you interrupt the treatment, we have to start all over. And
another thing: once the illness is detected, if they ever ask you to have a TB skin test done, you
need tell them that you suffered from TB and they should not take another one.
INT:
4) UPPER RESPIRATORY TRACT INFECTION

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Doctor: It appears that your mother suffers from Upper Respiratory tract Infection, one of the most
common acute illnesses. We need to conduct an evaluation. We will make an appointment and it
will be done as an outpatient procedure.
INT:
LEP:
INT: Is that dangerous, Doctor?
Doctor: It could be, if we don’t treat it appropriately. It ranges from the common cold to life-
threatening illnesses such as epiglottitis. It could be caused by viruses or by bacterial infections.
INT:
LEP:
INT: Oh, my God, Doctor, that sounds terrible. What do you recommend we do?
5) PULMONARY HYPERTENSION
Nurse: On scale of very good, good, okay, bad or very bad, how do you feel today?
INT:
LEP:
INT: Good.
Nurse: Can you breathe easily when you are showering or bathing? Do you frequently wake up at
night due to shortness of breath? Please answer: sometimes, occasionally or never.
INT:
LEP:
INT: Sometimes.
Nurse: Have you fainted or lost consciousness in the last month?
INT:
LEP:.

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INT: No.
Nurse: In general, does your family or friends say that you appear better, the same or worse than
when you started the treatment?
INT:
LEP:.
INT: The same, nobody has noticed any change, not even me.
Nurse: Overall, how do you feel today in relation to your pulmonary hypertension?
INT:
6) FLU SHOT
Nurse: Mrs. Hung, you are due for a flu shot. Would you like to have it today?
INT:
LEP:
INT: If I don´t get it what is going to happen? The thing is that people tell me that when they get
the shot, they get the flu for sure.
Nurse: You are at risk of acquiring illnesses such as gastroenteritis, and influenza, to severe, life-
threatening diseases such as meningitis, sepsis, and leukemia.
INT:
LEP:
INT: I didn’t know that. I guess I’d better get the shot today. I hate shots, but I’d rather get it than
getting any of those illnesses.
Nurse: You may have a negative reaction, but it will disappear in a few days.
INT:
7) FLU SHOT

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LEP:
INT: I hear everybody talking about the flu shot these days, but I don’t always pay attention.
Doctor: We have to take it seriously, especially during the flu season. It is very common. In the
United States adults can average 1–3 episodes per year and children can average 3–6 episodes per
year.
INT:
LEP:
INT: I’d better be careful then, because when I get it, I think it´s going to go away. However, this
time I thought it was something more than a common cold.
Nurse: That is a wise decision, Mrs. Smith, please take your sweater off. I will be using your right
arm.
INT:
8) HEART MURMUR
Doctor: Have you been told you have a heart murmur or any heart disorder?
INT:
LEP:
INT: What´s that? I think that my father had a heart murmur; I know I have something in my heart.
They said something like a functional murmur or a physiological murmur. The truth is that I don’t
know what a murmur is exactly.
Doctor: A heart murmur is a whistling sound I can hear with the stethoscope when I listen to your
heart. It’s usually present when there is a heart valve problem. I can order a variety of tests to
determine what kind of valve problem you have, and how serious the valve problem is. I will order
an echocardiogram, a chest x-ray, and if I see there is a need, I may even order a cardiac
catheterization.
INT:
9) LAB TESTS
Doctor: How long have you had this chest pain and shortness of breath?

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INT:
LEP:
INT: For about three months, but these last two weeks have been worst.
Doctor: Don’t worry, but follow my instructions. I will send an order to the lab with all the tests
they have to perform. This slip is for you to make an appointment at the front desk in about a
week. That way, the lab has time to give me the results and we will be able to discuss them during
your next appointment.
INT:
LEP:
INT: Do I have to fast for those tests or follow a special diet?
Doctor: No, it is not necessary, but make sure to have them done as soon as possible.
INT:
10) BLOOD PRESSURE
Doctor: Your blood pressure is out of control. Both, your systolic and diastolic readings are very
high. The systolic shows the maximum pressure in the arteries when the heart contracts. The
bottom number is the diastolic pressure, which shows the minimum pressure in the arteries when
the heart is at rest. You have 180 over 100.
INT:
LEP:
INT: But doctor, I try to follow my diet, control my temper and avoid getting all stressed out, but
things are tough and it is very hard. What else can I do to bring it down?
Doctor: Follow my instructions concerning diet and exercise. I can prescribe some medicine, but
medicine alone is not going to cure it.
INT:
Doctor: For a young adult like you, a healthy reading would be 120 over 80. That is why you have to
be careful.
INT:

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11) HEART CONDITION
Doctor: With your heart condition and your family’s health history, you are at risk of having a heart
attack. That is why I insist that you follow my instructions carefully.
INT:
LEP:
INT: I know that a heart attack can kill you, but I don’t understand how it happens. Some people
can anticipate it, but some don’t even know.
Doctor: It occurs when blood doesn’t get to part of the heart and that part becomes damaged. It
could happen by a blood clot in one of the heart arteries.
INT:
LEP:
INT: And how would I know that it is coming? What should I do?
Doctor: Watch for these symptoms: a strong pain in the middle of the chest that radiates to your
arms and neck. If a person suffers from high blood pressure, high cholesterol, chest angina, blood
clots, or bad circulation, and arteriosclerosis, he is more likely to have a heart attack.
INT:
12) HYPERTENSION / CHOLESTEROL
Doctor: The results of your test are not very good. Your cholesterol is still very high and your blood
pressure is 160 over 90, which is still high. I know you have been working on this, but it is not
enough and if those figures don´t go down, you may have a heart attack.
INT:
LEP:
INT: Can you recover from a heart attack?
Doctor: It depends on the amount of damage and how quickly you can get help. There will be a
series of tests to determine the damage and the treatment for recovery.

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INT:
Doctor: Remember we talked about staying away from liquor, cigarettes, greasy or fatty diets,
street drugs, and taking your medicine as prescribed.
INT:
13) SEIZURES
Doctor: The effects of seizures depend on their location in the brain and their extent. Not all types
of seizures include convulsions.
INT:
LEP:
INT: And how did I get this doctor? Is there a cure for this?
Doctor: There are many causes for seizures. In general, any injury to the brain can lead to seizures,
including trauma, tumors, vascular lesions, hemorrhage and developmental anomalies.
INT:
LEP:
INT: Is there a treatment or a medicine I can take for this?
Doctor: It could be controlled and/or prevented by proper drug treatment, which should be taken
at regular times. In some cases surgery could be recommended. However, there may be unpleasant
side effects.
INT:
14) STROKE
LEP:
INT: Doctor, I guess I am lucky after that stroke I suffered.

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Doctor: You sure are. I don´t mean to be sarcastic, but sometimes we only learn after we have had
a bad experience. Do you remember how many times I recommended you to watch your blood
pressure, your weight, to control the stress, and to quit smoking? Now we are facing the
consequences.
INT:
LEP:
INT: Doctor, you are so right. I need to say I learned my lesson. However, I seem to forget many
things and I have difficulty moving my right arm and my right leg.
Doctor: Yes, those are the effects from a stroke: some people are not able to talk, they cannot
walk, they cannot feel, they cannot remember anything and some even die. You are going to need
all the support from your family and some physical therapy. Your right side is the one that was
affected.
INT:
15) LUMBAR PUNCTURE
LEP:
INT: Did you say that you have to do a lumbar puncture? And what is that?
Doctor: A lumbar puncture is used to diagnose or exclude meningitis. This involves inserting a
needle into the spinal canal to extract a sample of the fluid that envelops the brain and spinal cord
and send it to the lab. We use antibiotics and sometimes antiviral drugs. It could have been
prevented by immunization.
INT:
LEP:
INT: Is it very painful, Doctor?
Doctor: No, he won´t feel anything. We prepare the area and give him local anesthesia.
INT:

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Doctor: Meningitis can be life-threatening because of the inflammation's proximity to the brain and
spinal cord; therefore the condition is classified as a medical emergency.
INT:
16) DEPRESSION
Doctor: Please tell me what is going on and how you are feeling. Also tell me the reasons why you
feel that way.
INT:
LEP:
INT: I feel very sad and very depressed. I don’t want to do anything. Things happen around me and
I don’t care. I even think “Why am I feeling this way?” and I cannot find the reason. My husband
and my children don’t understand me and I know it is affecting them, but I feel helpless.
Doctor: And for how long have you been feeling this way?
INT:
LEP:
INT: For about six months.
Doctor: You are suffering from depression and I am glad you came, so we can help you. Depression
is commonly treated with antidepressant medications. They work to balance some of the natural
chemicals in our brain that can affect our mood and emotional responses.
INT:
17) SUICIDAL THOUGHTS 1
Nurse: Have you had any suicidal thoughts or do you want to hurt yourself or others?
INT:

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LEP:
INT: Yes, I want to hurt myself. When I was little, my father hurt me a lot all the time and now I
hurt myself before anybody else hurts me.
Nurse: Do you have a plan to commit suicide? Do you suffer from anxiety attacks?
INT:
LEP:
INT: No, I just think that nobody cares and if I kill myself, nobody would miss me. Yes, I guess I also
suffer from anxiety attacks.
18) SUICIDAL THOUGHTS 2
Doctor: Tell me about your suicidal thoughts. Do you have any plans to kill yourself?
INT:
LEP:
INT: Yes, doctor, since about twenty years ago when I had my last daughter. It seems that I have
not been able to overcome those feelings, even though I try. Everything makes me sad and I think
“why did I come into this world if I am not useful to anyone?”.
Doctor: Is there anything else that makes you sad and depressed? What is the situation at home?
INT:
LEP:
INT: Yes, doctor, sometimes I think I should kill my daughters. Their husbands left them and I only
see them suffer. I think they should also pay. I would like to end their lives so they don´t suffer
anymore. My husband is very good and I cook for him, clean the house, I do everything, but
sometimes I don´t feel like doing anything.
Doctor: You are going to need intensive therapy, so I will refer you to a psychiatrist, because a few
sessions with me are not going to be enough.

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INT:
19) MEDICAL HISTORY (PSYCHOLOGICAL)
Nurse: I am going to take your medical history and then the doctor will see you.
INT:
Nurse: Do you suffer from any neurological disorders such as seizures, blackouts, brain tumor,
epilepsy, Alzheimer’s, Parkinson’s, fibromyalgia, bipolar disorder, or schizophrenia?
INT:
LEP:
INT: No, I don’t think so. I mean I don’t know which one of those. I feel sad, I feel that nobody
cares about me, they make fun of me, and everyone wants to hurt me. It is very sad!
Nurse: Do you hear voices? Do you see or hear things that nobody else sees or hears?
INT:
LEP:
INT: Yes, sometimes, and those voices get louder and louder and they tell me to hurt myself.
20) ALZHEIMER'S
LEP:
INT: Doctor, I brought my mother because I am very worried, I noticed that she is forgetting some
things. I would like to know if she may be getting Alzheimer’s or something like that.
Doctor: Let me explain to you what Alzheimer’s is. It is a neurodegenerative disease typically found
in people 65 or older. The clinical sign of Alzheimer’s is progressive cognition deterioration. Is the
most common form of Dementia and there is no cure.
INT:
LEP:
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INT: Is that why she gets so irritable and tries not to participate in activities? She also seems
confused and has trouble speaking. How can we determine if that is the problem?
Doctor: Concerning the symptoms, they could be different depending on the individual, but she
may lose control of her bodily functions and may withdraw from people. The diagnosis is usually
confirmed with tests that evaluate behavior and thinking abilities, often followed by a brain scan, if
available.
INT:
21) HEARTBURN AND ACID REFLUX
Doctor: How are you feeling today and what seems to be the problem?
INT:
LEP:
INT: I have many problems. I cannot sleep and I have a sore throat. When I lie down, I feel like a ball
of fire in my chest, I start sweating, my stomach hurts, my heart wants to jump out, you cannot
imagine. I also have nightmares. On top of that I have to get up to go to the bathroom four or five
times during the night.
Doctor: How long have you had these symptoms?
INT:
LEP:
INT: I have had these problems for a long time when I go to bed.
Doctor: At what time do you eat your last meal every day? And can you give me an example of
what you eat at dinner time? Because it could be indigestion, acid reflux, gastric ulcer, or a hiatus
hernia.
INT:
LEP:
INT: I eat at 10 in the evening when I come from work and I eat whatever I can find in sight. Then I
drink a couple of beers to help me digest the food and to sleep well.

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Doctor: You are suffering from heart burn and acid reflux. The way to prevent that is by reducing
your intake and eating your last meal before 6 p.m. Avoid rich and spicy food, as well as fatty and
fried foods. Instead of beer, drink a lot of water, but before 7 pm so you don’t have to get up
during the night.
INT:
22) LIVER ENZYMES
Doctor: The test results indicate that your liver enzymes are extremely high.
INT:
LEP:
INT: What do you mean, doctor and what are enzymes?
Doctor: Liver enzymes are normally in the bloodstream in small amounts, but are elevated
whenever there is damage in the liver cells and are normally caused by heavy drinking, hepatitis
and obesity. However, it is possible to suffer from non-alcoholic fatty liver diseases. Fatty liver is a
disorder where fats accumulate in the liver.
INT:
LEP:
INT: But I quit drinking four years ago!
Doctor: What we have to do now is to lower your enzymes with a good diet, medication and other
treatments.
INT:
23) CHOLESTEROL AND DIET
Dietician: The test results indicate that your bad cholesterol and your triglycerides are very high, so
we need to review the foods that you are eating now. Have you heard the saying “you are what you
eat”? What comes into our bodies is going to affect our health in many different ways.

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INT:
LEP:
INT: I just eat regular food, whatever my mother cooks. It´s the same for everybody in the family.
Dietician: Many changes have to be implemented and they will even benefit the rest of the family.
There are several killer diseases related to what we eat or drink: heart disease, cancer, stroke,
diabetes, liver disease and arteriosclerosis or hardening of the arteries.
INT:
Dietician: You are only 20 pounds overweight. It is not only how much we eat, but what we eat, the
combination of foods, such as fruits, vegetables, vitamins, minerals, protein, etc. and the time we
eat. Besides that, exercise is very important for our health and to counteract the effects of an
unbalanced diet.
INT:
24) DIABETES 1
Doctor: Have you been taking the Glucophage as prescribed? Because your sugar level is very high,
according to the A1C test we performed. That shows us an average of the sugar readings during the
last three months.
INT:
LEP:
INT: Yes, doctor, and I have also paid attention to my diet and exercise like you told me.
Doctor: We may have to adjust the dosage, because we don´t want for you to end up depending on
insulin shots everyday a couple of times a day.
INT:
LEP:
INT: Thank you, doctor, neither do I. I don´t want to depend on insulin. Please tell me what else I
should do.
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25) DIABETES Type 2
Doctor: Most diabetics suffer from Type 2 diabetes. It is most often associated with old age,
obesity, family history, previous history of gestational diabetes, physical inactivity, and certain
ethnicities. Most people with Type 2 diabetes are overweight.
INT:
Doctor: When Type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but
for unknown reasons the body cannot use the insulin effectively, a condition called insulin
resistance.
INT:
LEP:
INT: I wonder if that is why I feel so tired all the time, so thirsty and the need to go to the bathroom
many times. It is a little embarrassing.
Doctor: Yes, those are the symptoms of this type of diabetes, which develops gradually. Besides,
you may have blurred vision, increased thirst and hunger, and weight loss. But on the other hand,
some people may not notice any changes.
INT:
26) GESTATIONAL DIABETES
LEP:
INT: What do you mean by glucose levels?

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Nurse: They are the level of sugar in your blood and since you are pregnant, we want to make sure
they are correct.
INT:
Nurse: Glucose levels are done because some women could develop gestational diabetes and we
need to watch for any signs to protect your health and the baby’s health. Also, we would give you
advice regarding your diet and exercise.
INT:
27) HEADACHE
Nurse: Doctors usually want to know what the pain level is and the description of the pain, so they
can prescribe the medicine and the treatment that best helps you.
INT:
Nurse: You are telling me that you have a head ache. I am asking you what is the level and exact
location. Is it on your forehead, on the top of your head, on the right or left side, on the right or the
left temple, on your scalp, etc.? Do you know what I mean?
INT:
LEP:
INT: Oh, yes it is on my forehead, right in the middle. And from one to ten, it's like a six. I cannot
sleep, it is really annoying.
Nurse: All right, and is it burning, constant, dull, numbing, sharp, tingling? Does it feel like pins and
needles?
INT:
LEP:
INT: Well, I would say it is sharp, it seems to go all the way to the inside of my head, coming from
my forehead. Also I notice that it bothers me when there is too much light or noise. Like a migraine
headache.
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Nurse: Thank you. That gives me a good idea. The doctor will come in to see you. It may be a
migraine headache, but he will confirm that.
INT:
28) PAIN LEVEL/INTENSITY
Nurse: For the last two weeks have you had a headache everyday all day?
INT:
LEP:
INT: Yes, I can’t rest or sleep. I am getting desperate.
Nurse: I see you had a CT scan. Is the pain the same as before, does it come for a few hours, then
goes away for several hours? Show me exactly where the pain is.
INT:
LEP:
INT: Yes, they sent me for some x- rays and a CT scan and they have not given me the results. I have
never had a pain like this before. It hurts right here, right in the middle, in my nape and behind my
ears.
Nurse: Is it worse when you bend over? Is it worse in the morning or in the afternoon? Have you
experienced any vision problems? Is the Ibuprofen helping you at all?
INT:
LEP:
INT: Not very much. When I sit down to rest is when I feel it more, perhaps because I am
concentrating on the pain. It is a very sharp pain; I would say an 8…
29) DESCRIBE THE PAIN
Doctor: I need to determine how severe the pain is that you are experiencing right now. On a scale
from 1 to 10, with one being no pain and ten being the most excruciating pain you have ever
experienced, what is the intensity of the pain right now?
INT:

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LEP:
INT: I would say 8, maybe 9.
Doctor: If that were a 9, you would be screaming your head off and on a stretcher on your way to
the emergency room.
INT:
Doctor: Look at this chart where I am showing you. Which one of these would you say?
INT:
LEP:
INT: I guess it is between 4 and 5.
Doctor: That makes a big difference. Is it a shooting or a stabbing pain?

(Note to translator: A shooting pain is a severe pain that starts in one place then quickly moves to another.
A stabbing pain is a sudden sharp pain.)
INT:
LEP:
INT: Do you mean is the pain killing me? It hurts a lot and is bothering me, but it is not killing me.
30) DESCRIBE THE PAIN
Doctor: Can you describe the pain you are experiencing right now?
INT:
LEP:
INT: I don’t know, doctor, it’s really bad and hurts all over.
Doctor: In order to treat you, I need to know if it is severe, dull, acute, constant, or intermittent?
Do you have any cramps?
INT:

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LEP:
INT: Well, I don’t know how to describe it. It is right here in my chest all the time, it feels as if
someone were on top of me putting pressure. Do you know what I mean?
Doctor: Alright, then it is constant and feels like pressure. Is it sickening, like you want to vomit? Is
it burning, is it crushing that makes you bend over due to the pain?
INT:
LEP:
INT: No, doctor, now I understand. It is constant and feels like pressure, like I cannot breathe.
Doctor: So you don’t feel cramps?
INT:
31) PRE-OP INSTRUCTIONS
Nurse: You are scheduled for surgery next week. I am going to give you instructions and tell you
what medications you should discontinue as of right now to prevent you from bleeding, or have
any other complications that could come up during surgery.
INT:
Nurse: As of right now, stop taking Aspirin, Advil, Ibuprofen, Alive, Motrin and any other
antihistaminic or anti-inflammatory medication. If you need something for the pain, you can take
Tylenol.
INT:
Nurse: You should also stop taking any blood thinners, such as Warfarin, or Coumadin. We don’t
want to put you in any danger. The day of the surgery, you can only take the Diovan for your blood
pressure with a little sip of water. Do not eat or drink anything after midnight the night before.
INT:
LEP:

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INT: Yes, thanks, no problem.
32) ENDOSCOPY
Doctor: In order to find out what is bothering you, we will conduct an Endoscopy, so that we can
see all of your digestive tract.
INT:
LEP:
INT: Oh, no, I wouldn’t want to have that done, doctor. Is that the one that you introduce
something through my rectum or my privates?
Doctor: No, that would be a Colonoscopy or a Cystoscopy. The difference is that with the
Endoscopy we introduce a thin fiber tube through your mouth instead of through the rectum and
we can see on a TV monitor your digestive tract. We look for ulcers, irritations, tumors, etc.
INT:
LEP:
INT: Is that going to hurt a lot?
Doctor: No, this is a simple outpatient procedure performed at a surgery center. We apply just
enough anesthesia for the duration of the procedure. You won’t even know. It takes only a few
minutes and you will be ready to go home with no pain.
INT:
33) COLONOSCOPY
Doctor: We have to schedule you for a colonoscopy because it is recommended to have it done
every three years. I will give you a prescription for a liquid that you have to drink the night and the
morning before the procedure. It is used to clean your intestine. You should have a liquid diet, with
clear liquids, like chicken broth, coffee or tea and water.
INT:

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LEP:
INT: And what did you say you will find out with this procedure?
Doctor: If you have ulcers, tumors, maybe polyps. And by the way, if you have polyps; we will
remove them to test them for cancer. In addition, if we notice anything else, we may also take a
biopsy and send it to the lab. After the procedure, we will have a follow up appointment to give
you the results.
INT:
Doctor: The nurse will give you further instructions on how to prepare for the colonoscopy.
INT:
34) BONE RESETTING
Doctor: Mrs. Lee, I just reviewed the x-rays I ordered after you fell down. It shows that you
fractured your right elbow, your humerus, your forearm and your right femur. This was due to your
osteoporosis. Your bone density is very low, so you need to be very careful when you walk, and
should always use your walker.
INT:
LEP:
INT: Yes, doctor, I was afraid of that and you cannot imagine how much it hurts all over my body on
the right side: my elbow, my thigh, my calf, my hip. It’s horrible.
Doctor: I am going to prescribe you Hydrocodone - Acetaminophen for the pain, up to two tablets
every six hours as needed. In the meantime, please continue taking your calcium and vitamins. Use
your walker around the house. Right now we are going to reset the head of the femur into its cavity
on your pelvis. That will ease the pain.
INT:

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35) GALLBLADDER STONES
Doctor: Are you the husband? Your wife needs emergency surgery. She has gallbladder stones
obstructing her bile duct.
INT:
LEP:
INT: Wouldn’t it be better to do some kind of a treatment instead of opening her stomach?
Doctor: The MRI shows one of her gallstones impelled itself at the mouth of her gallbladder; it is
blocking the flow of bile causing the sickening pain. Her gallbladder surgery will be performed by
laparoscopy, a minimally invasive technique not requiring a large incision. If we do it before noon
today, she will return home tomorrow morning, and can resume her normal routine within a week.
INT:
LEP:
INT: Oh, my God, Doctor what was all of that? Is the gallbladder the same as the bladder? And
what does that ‘’laparos…” mean?
Doctor: The gallbladder works with the liver and is connected to the bile duct. Laparoscopy means
that we don’t need to make a large incision, just a few minor incisions, about an inch long. She will
be able to go home tomorrow.
INT:
36) EKG – ELECTROCARDIOGRAM
Doctor: In order to prepare for your upcoming surgery, I am going to order an EKG. We want to
make sure your heart is strong enough. We don’t want to take any chances.
INT:
Doctor: An EKG or electrocardiogram is a recording of the electricity flowing through your heart.
When you go to the clinic, they will stick some round plastic caps to your chest and back that are

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connected to wires. You will not feel anything. In the meantime, we are taking a recording which
goes into a chart.
INT:
LEP:
INT: And how long would I have to lay there with those things on my chest?
Doctor: Only a few minutes. It would not hurt. That is how we can read the electricity going
through your heart.
INT:
37) MRI, CT SCAN AND X-RAY
Doctor: I am sorry to tell you that we have to perform an MRI now, because the CT scan did not
show enough for us to determine the cause of your problem.
INT:
LEP:
INT: What is the difference? Why do you think this “whatever you call it” test will tell you what it
is?
Doctor: The X-rays don’t penetrate deep enough into the muscle. They show bone structure,
fractures, etc. The CT scan or computerized tomography is a type of X-ray that is beamed through a
patient at many different angles around a specific section of the body. It shows tissues that the X-
Ray does not show.
INT:
Doctor: A Magnetic Resonance Imaging (MRI) is a medical imaging technique used in radiology to
visualize detailed internal structures. It does not use X-rays. What we use here is magnetic and
radio waves to point at the specific area we need to examine.

24
INT:
38) PAT AND MRI
Doctor: Prior to your upcoming surgery, I am going to order several tests to make sure everything is
going well and that you recover easily.
INT:
Doctor: First of all there will be a PAT Pre-anesthesia Testing. You don´t have to be fasting for this
exam, but please bring all the medications you are taking in their original containers, including
vitamins and minerals. Bring the results of any EKG, Echo, Stress Test, Pacemaker, and any other
information related to your heart.
INT:
LEP:
INT: When would that be, doctor? Can you tell me the date, the time and the location of where
this will be done?
Doctor: The nurse will give you the complete schedule, along with the other tests that we are going
to need. The second one is a thoracic MRI from the neck down. If you are claustrophobic, we may
order a mild sedative, because you will be lying on a table and then they will slide you into a
cylinder like tube. You have to remain there for about 20 minutes and you will hear instructions to
be still, inhale, exhale, etc. while you hear some banging noises while we take the images that we
need.
INT:
39) MAMMOPGRAPHY
LEP:
INT: I am calling to make an appointment for a mammography.

25
Nurse: Do you have an order from your PCP? Is this a routine exam or is there a specific code on
the order?
INT:
LEP:
INT: No, it is a routine exam. Can I have an appointment on a Monday because that is the day my
husband can take me, please?
Nurse: Yes, how about Monday the 15th at 9 am? Can your husband bring you then?
INT:
LEP:
INT: Yes, that is fine, thanks.
Nurse: Then it is confirmed for that date. Please bring a picture ID, your insurance card and the
order from the doctor. Do not use any deodorant, lotions or powder in that area. You will also have
to sign a release form so that we can send the results to your PCP. Do you have any questions?
INT:
40) BIRTH CONTROL
Nurse: What type of birth control are you going to use after you leave the hospital?
INT:
LEP:
INT: I am not sure, like what? Can you explain it to me?
Nurse: There are different birth control methods. There are birth control pills which you take every
day at the same time. Also, the Depo-Provera, which is a shot given every three months. The IUD, a
metal device introduced into the vagina. Also, the diaphragm, which is a rubber dome introduced
into the vagina. There are also condoms that the man would use. Lastly, there is a Tubal Ligation,
which is an irreversible surgical procedure.
INT:

26
LEP:
INT: I am not sure yet. I will talk to my husband and let you know later.
Nurse: I just need to let you know that if you have sex before you start your birth control method,
you may get pregnant again. I am not sure if you are planning on that or not.
INT:
41) PREGANCY TEST
LEP:
INT: I did a home pregnancy test and it came out positive. I need to know for sure if I am pregnant
and for how long. What should I do to start my prenatal care?
Nurse: Yes, we just did a urine test and it indicates that you are pregnant. You have 4 weeks
already. Do you want to keep the pregnancy?
INT:
LEP:
INT: What do you mean? Do I want to have my baby? Of course, I am very happy with the news! I
will take care of myself in order to have a healthy baby.
Nurse: Good! We have to examine you to establish your health condition, the condition of the fetus
and to schedule prenatal appointments. We will give you a prescription for prenatal vitamins.
According to the results, the baby should come on December 31. The doctor who is going to follow
up with you is Dr. Smith.
INT:

27
42) PRENATAL EXAMS
LEP:
INT: They sent me here because they say I need a Pap smear because I am 6 months pregnant and I
have never had it done.
Nurse: Yes, we are going to do the Pap smear test and a blood test for STDs and HIV. OB exams will
be done every four weeks until week 26th.
INT:
LEP:
INT: That is fine; I want everything to go well with the pregnancy.
Nurse: We will be checking the baby’s heart beat and your weight gain to make sure everything is
going well. The doctor will be here to see you and to give you more information concerning
ultrasounds, blood pressure, diet, glucose levels, etc.
INT:
43) POSTPARTUM DISCHARGE INSTRUCTIONS
Nurse: Mrs. Ray, you are ready to go home. I am going to give you the discharge instructions. As
you know, you have to make an appointment with your gynecologist in six weeks. If you experience
any heavy bleeding, vaginal discharge, foul odor, or severe pain that does not go away with the
medication, you should call the doctor´s office.
INT:
Nurse: You should not lift anything heavier than your baby. Try to rest as much as possible while
the baby is sleeping and don´t worry about the house chores, just you and the baby.
INT:

28
Nurse: If you are going to nurse the baby, feed him every two or three hours or on demand. When
you put him in his crib, put him face up. Never lie him face down, because he could suffer sudden
infant death.
INT:
44) POSTPARTUM APPOINTMENTS
LEP:
INT: When did you say I have to make the appointment with the pediatrician?
Nurse: The appointment with the Pediatrician should be within the two days following your
hospital discharge. Make sure to take the immunization chart with you, so the pediatrician knows
what shots the baby has had and which ones should be given at the pediatrician´s office.
INT:
Nurse: And for you, you need to make an appointment with your gynecologist six weeks after you
leave the hospital. In the meantime, no douches, no sex, no tampons, nothing inside the vagina
until you see the gynecologist. Continue taking the prenatal vitamins if you are going to breastfeed
the baby.
INT:
45) AMNIOCENTESIS TEST
Nurse: Since you are over 35 years of age, I have to explain to you a special test that we offer to
detect any birth defects, mental retardation, or the possibility of the baby having Down syndrome,
or mongolism.
INT:

29
Nurse: This is a procedure called Amniocentesis and consists on checking if you have the correct
number of chromosomes. I need to let you know the risks of this exam, so that you can make a
decision with the correct information.
INT:
LEP:
INT: What kind of risks? Is this going to hurt my baby? No, I don’t want that.
Nurse: Let me explain and then you will have time to think about it. It consists of introducing a
needle into the uterus through your abdomen. We remove about one ounce of the amniotic fluid
which is the one around the baby, we send it to the lab for a chromosome and fetal protein level
analysis.
INT:
Nurse: There is a possibility of a miscarriage. But you don’t have to have this test if you don’t want
to. I will give you some information for you and your husband to read over and then you can make
an informed decision.
INT:
46) TUBAL LIGATION
LEP:
INT: Yes, I want a tubal ligation. I already have three children and my husband doesn´t want
anymore.
Nurse: Are you absolutely sure? Because this procedure is irreversible, but if you are sure, let me
explain the risks of this procedure.
INT:
Nurse: First of all, you should not get pregnant again and if you do, there will be a lot of
complications. This procedure does not guarantee 100% that you will not get pregnant again. As far

30
as the procedure, there are several risks as in any other type of surgery. The risks are bleeding,
infection, the possibility of damaging some of the surrounding organs, bladder and bowels.
INT:
LEP:
INT: And how long does the surgery take?
Nurse: The surgery itself takes about 10 or 15 minutes. It takes us longer to clean and prepare the
area. We make a small tiny cut around the belly bottom, no longer than 2 inches. It will require
several weeks for recovery and you will be sore for a couple of weeks. You will need anesthesia
that will last just enough time for the procedure.
INT:
47) PEDIATRICS – SCABIES
LEP:
INT: Doctor, I brought my child because he has a very strange rash. He has had it for several days
and it does not go away.
Doctor: Yes, I scraped part of his skin and what he has is called scabies. It’s caused by a microscopic
dust mite that hides underneath the skin and lays eggs. The rash that you see is a skin reaction. It
takes two to four weeks for the scabies to develop.
INT:
LEP:
INT: Yes, doctor, it is like little hives and then they seem like blisters all over his body. His skin is
red. It started on the palm of his hands and then on the bottom of his feet.
Doctor: Yes, those are the symptoms. It is very uncomfortable, causes a lot of itching and it is
difficult to identify until it has developed. It is very contagious. I am going to prescribe a lotion that
should be applied all over the body, including between the toes and the fingers. Don´t remove it for
24 hours and then he can take a shower.

31
INT:
Doctor: I would also recommend for the whole family to be examined avoiding spreading the illness
even more.
INT:
48) PEDIATRICS – PKU AND SHOTS
Nurse: We did the baby’s hearing screen test. We also did the PKU test. Would you like for us to
give him the Hepatitis B vaccine?
INT:
LEP: Po.
INT: Yes.
Nurse: We usually give the babies the first dosage of the Hepatitis B here. The second and third
doses are given at the pediatrician’s office. Here is the chart so that they know what we gave him
here. Immunizations have to be current to prevent the baby from getting sick with communicable
diseases. That’s why we have so many, such as German measles, mumps, polio, booster shot,
tetanus, flu, DPT, etc.
INT:
LEP:
INT: What is PKU?
Nurse: PKU stands for phenylketonuria. The test consists of sticking the baby’s heel to see if he has
the enzyme needed to use phenylalanine in his body and it came out OK.
INT:

32
49) PEDIATRICS – IMMUNIZATIONS
Nurse: How old is your baby and are his shots current?
INT:
LEP:
INT: Well, the truth is that I don’t know. He just turned 15 months last week. Let me see if I brought
it. I believe he already had the ones for chicken pox, mumps and German measles, the DPT, polio,
and hepatitis. I don’t know about the rotavirus. Here is the record with all the ones he has had.
Nurse: I can see the German measles, also DTP (diphtheria, tetanus and pertussis), Hepatitis B,
polio, rotavirus. What about any Booster shots?
INT:
LEP:
INT: I don’t know. That’s what they gave me at the health department. Should I go and check or
get a copy of what they have?
Nurse: No, it is not necessary. I can check and find out what is missing, so we can give them to him
today.
INT:
50) PEDIATRICS – COLD
LEP:
INT: I am calling because my daughter has been coughing; she has a stuffy nose and has difficulty
breathing.
Nurse: Is she wheezing? Has your child ever been diagnosed with asthma?
INT:

33
LEP:
INT: No, I am not sure what you mean by wheezing. Her chest is tight, her nose is stuffy, and she
has a temperature.
Nurse: How high is the fever and did you measure it with a thermometer?
INT:
LEP:
INT: I don’t know because I don’t have a thermometer, but she feels very hot to the touch. She
doesn’t seem to understand what is going on. By the way, what do you mean by ‘uizin’ in her chest
and why would she get something like that?
Nurse: Wheezing means there is a noise coming out of her chest when she breaths. In addition to
asthma, the most common causes of wheezing in children include allergies and infections.
INT:
51) PEDIATRICS – SINUSITIS
LEP:
INT: The baby has had this infection since Saturday. What can I do, doctor?
Doctor: Your son has an infection in the sinuses and the nasal passages. If we don´t take care of
that right now, it could develop into sinusitis.
INT:
Doctor: It is an inflammation of the sinuses and the nasal passages due to the infection, but we can
treat it with antibiotics.
INT:
Doctor: I am going to write a prescription for antibiotics. He has to take one pill each day until the
medication is all finished. Then the infection will clear up.
INT:

34
52) PEDIATRICS - ALERGIES
LEP:
INT: Doctor, why does my daughter have so many allergies? They told us that she has asthma.
Doctor: There are many reasons. Within our household there could be many situations that make it
worse. There are numerous factors, such as dust mites, pet dander, cockroach debris, mold, and
tobacco smoke. It is important to control exposure to these and other triggers in the environment.
INT:
LEP:
INT: I am very concerned about that. She gets sick so frequently that we have to take her to the
clinic a lot.
Doctor: Yes, asthma is a chronic disease in which the airways of the lungs become inflamed or
narrowed, resulting in disruptions to normal breathing patterns, often called "attacks" or
"episodes."
INT:
53) PEDIATRICS - FLU OR COLD
LEP:
INT: I brought my son because he has a fever, does not want to eat, and he seems very lethargic. I
wonder if he has a cold.
Nurse: When did the symptoms start? Did you take the temperature?
INT:
LEP:
INT: I noticed it this morning, but he says it was last night. I guess the temperature is 98 degrees.
What do you think he has?

35
Nurse: That´s not high. It is normal. It could be either a cold or the flu.
INT:
LEP:
INT: What is the difference?
Nurse: A cold is caused by different germs that may attack any part of the respiratory system, such
as nose, throat or lungs and it clears up in several days. We recommend rest; drink a lot of fluids
and medicine for the pain.
INT:
Nurse: On the other hand, the flu is caused by a variety of viruses from other people when they
cough and sneeze. We get them through the nose or the mouth and they spread to other parts of
the respiratory system and into the blood. The symptoms may last for up to two weeks.
INT:
54) PEDIATRICS - EPILEPSY
Doctor: I understand your daughter suffers from epilepsy and that is why they sent you here.
INT:
LEP:
INT: Yes, doctor, that’s what they told me, but I am not sure what it is.
Doctor: Epilepsy is a condition characterized by recurring seizures in an individual. Seizures are an

abnormal over-activity of the cells of the brain which can affect some regions of the central
nervous system, primarily in the forebrain.
INT:
LEP:
INT: Oh, yes, sometimes she doesn´t know what is happening to her and after a while she wakes up
all confused. People make fun of her. They think she is making it up.

36
Doctor: Yes, you are right, when people are not familiar with this condition; they think that it is a
mental illness, because there are no visible signs, except when the seizure is taking place.
INT:
55) PEDIATRICS – COLIC
LEP:
INT: My baby has been crying constantly and we cannot sleep. What is the problem?
Doctor: When an infant cries for more than three hours a day, she probably has a condition known
as colic. Colic is very common among newborns, and usually goes away without treatment after
some time. But excessive crying also could mean that your baby is sick.
INT:
Doctor: Sick babies typically have little appetite, and have little or no sucking reflex. A colicky baby
will still have a strong need to suck and will be hungry and eat normally. Snuggling and comforting
a colicky baby may soothe her crying and make her feel better, but a sick baby does not usually
respond well to cuddling.
INT:
Doctor: Vomiting is not associated with colic. Although it is normal for babies to spit up
occasionally, your baby is probably sick if she is vomiting. Sick babies may also be losing weight,
while colicky babies typically continue to gain. A sick baby may have diarrhea or bloody stools,
while a colicky baby should have normal stools.
INT:

37
56) PEDIATRICS – DAIPER RASH
LEP:
INT: What happens is that he is very red in the diaper area, I don´t know why he got that, it seems
that it hurts.
Doctor: Diaper rash can be caused by ill-fitting diapers or a soiled diaper being left for too long. The
irritation may simply be reddened skin, or the skin may break out in blisters or pimples. If your
baby gets diaper rash, you should change a soiled diaper immediately, and keep the irritated skin
clean and dry. Leave your baby without a diaper for short periods, allowing air to reach the skin.
INT:
Doctor: Let me see, yes, this is a diaper rash. You may also want to wash your baby's bottom with
only warm water and mild soap until the rash has disappeared and apply a diaper rash ointment.
Very red or swollen skin may indicate that the baby has an infection.
INT:
LEP:
INT: Thank you, doctor, the thing is that I don´t want to wake him up to change his diaper.
57) PEDIATRICS - MENINGITIS
Doctor: Your son suffers from Meningitis.
INT:
LEP:
INT: And what is that, Doctor?
Doctor: It is an inflammation of the protective membranes covering the brain and spinal cord,
known collectively as the meninges. The inflammation may be caused by infection with viruses,
bacteria, or other microorganisms, and less commonly by certain drugs.
INT:

38
LEP:
INT: Is that why he has all those headaches, stiffness in his neck, fever and confusion?
Doctor: Exactly. He may have also had loss of consciousness, vomiting, difficulty to tolerate bright
light, loud noises, some irritability and drowsiness. It’s caused by bacteria.
INT:
58) BLADDER PROLAPSE
LEP:
INT: Doctor, I am suffering from a very embarrassing condition. I feel the urge to go to the
bathroom very often to urinate.
Doctor: Yes, it is called urinary incontinence or loss of bladder control and you are not the only one.
The bladder is a hollow organ in the pelvis that stores urine. The pressure created when the
bladder fills with urine is what causes the urge to urinate. During urination, the urine travels from
the bladder and out the body through the urethra.
INT:
Doctor: It is very common in women your age. The front wall of the vagina supports the bladder.
This wall can weaken or loosen with age. Significant bodily stress such as childbirth can also
damage this part of the vaginal wall. If it deteriorates enough, the bladder prolapses, meaning it is
no longer supported and descends into the vagina.
INT:
LEP:
INT: Okay, that explains what is happening to me. I also notice the problem when I sneeze, when I
laugh or when I have to strain myself.
Doctor: Yes, there are other situations such as urinary difficulties, discomfort, and incontinence,
which is urine leakage caused by sneezing, coughing, or exertion.

39
INT:
59) PROSTATE ENLARGEMENT
Doctor: After examining you, I see that your prostate gland is enlarged, causing difficulty to urinate
because the flow of urine is reduced. The walls of the bladder get thicker, making it very
uncomfortable.
INT:
LEP:
INT: Yes, doctor, that is exactly the problem. It is painful, it is frequent and when I go, it is very
little. What can I do?
Doctor: You have a very mild case that could go away on its own, but if it does not, we will perform
a prostatectomy, consisting of removing the excess gland. It is a common and safe procedure for
older men. Let’s give it some time and come back to see me in one month to see if surgery is
recommended.
INT:
LEP:
INT: Is there anything I can do in the meantime?
60) LIST OF MEDICATIONS
Nurse: Let me tell you what we have in our records and you can tell me if you are still taking them
or not.
INT:
Nurse: Metformin, 40 milligrams to control high blood sugar because you still are non-insulin-
dependent, once a day. I believe you were taking Glipizide before, right? You also use an inhaler for
your asthma and the medication is Albuterol. You take several minerals and vitamins, including
calcium to prevent osteoporosis, Glucosamine and Omega 3, Nexium, 40 milligrams for heartburn,
once a day. Anything else I have not mentioned?
INT:

40
LEP:
INT: Yes, I also take Premarin for the hot flashes, 1.25 milligrams once a day. And the Doctor
changed the Nexium to Pantoprazole Sodium because it is cheaper and he says it is the same thing.
I just have to watch my bone density because it takes away calcium from my bones.
61) MEDICATIONS - MEDFORMIN
LEP:
INT: Are you going to give me medication for diabetes?
Doctor: Yes, absolutely. It´s Metformin, 20 milligrams, twice a day. Would you like for me to send it
to the pharmacy downstairs, or would you like a prescription on paper that you can take to any
pharmacy?
INT:
LEP: It’s okay to send it to the pharmacy downstairs.
INT:
Doctor: Very well, it´s done. Please pick it up on your way out and start taking it as prescribed. In
addition, I am going to recommend that you get a glucometer, so that you can take your sugar
levels three times a day: once before breakfast, once after lunch and once before you go to bed.
You should keep a log of these readings and a nurse will be calling you every couple of days to
check on those readings and on your diet. I will see you in two weeks.
INT:

41
62) CONFIRMING MEDICATIONS
Nurse: Please confirm name, address, date of birth, telephone number and the name of your PCP.
INT:
LEP: Mary Smith, 124 Ave, NY, NY 40098, my phone is 656-987-0046 my Dr's name is Paul Smith.
Nurse: According to our records, you are taking TriClear. How many times a day, and how many
milligrams?
INT:
Nurse: How many do you have left? Did you take the one for this morning?
INT:
Nurse: Are you taking any other medications, herbal supplements, vitamins, OTC, any changes or
any new medication? Have you added, stopped or changed any medications in last three orders?
INT:
LEP:
INT: No, everything is the same.
Nurse: Remember to always notify your doctor of any new or changes in medication.
INT:
63) MEDICATIONS – ANTIDEPRESSANTS
Doctor: I am going to prescribe you some antidepressants to help you with your condition. They
work on neurotransmitters such as serotonin, and dopamine.
INT:
LEP:
INT: But doctor, I´ve heard that some medications could make you worse instead of helping you.

42
Doctor: Yes, they have some side effects, but we are going to control them. We are going to start
with a small dose of Prozac. If you notice any unusual reactions or side affects you should let me
know.
INT:
Doctor: The most common side effects are headache, nausea, difficulty sleeping or drowsiness, but
they go away after a few days. If not, we can adjust the dose. You may also notice that your mouth
is very dry.
INT:
LEP:
INT: Doctor, I am not very familiar with that medical terminology.

43

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63 - L4 PRACTICE SCENARIOS

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Doctor: It could be a number of things, such as pneumonia, bronchitis, emphysema or tuberculosis.

4) UPPER RESPIRATORY TRACT INFECTION

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INT: Is that dangerous, Doctor?

Nurse: Have you fainted or lost consciousness in the last month?

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INT: Do I have to fast for those tests or follow a special diet?

10) BLOOD PRESSURE

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11) HEART CONDITION

12) HYPERTENSION / CHOLESTEROL

INT: Can you recover from a heart attack?

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INT: Is there a treatment or a medicine I can take for this?

INT: Doctor, I guess I am lucky after that stroke I suffered.

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15) LUMBAR PUNCTURE

INT: Is it very painful, Doctor?

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INT: For about six months.

17) SUICIDAL THOUGHTS 1

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18) SUICIDAL THOUGHTS 2

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19) MEDICAL HISTORY (PSYCHOLOGICAL)

21) HEARTBURN AND ACID REFLUX

Doctor: How long have you had these symptoms?

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22) LIVER ENZYMES

INT: What do you mean, doctor and what are enzymes?

INT: But I quit drinking four years ago!

23) CHOLESTEROL AND DIET

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25) DIABETES Type 2

26) GESTATIONAL DIABETES

INT: What do you mean by glucose levels?

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28) PAIN LEVEL/INTENSITY

INT: Yes, I can’t rest or sleep. I am getting desperate.

29) DESCRIBE THE PAIN

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INT: I would say 8, maybe 9.

INT: I guess it is between 4 and 5.

Doctor: That makes a big difference. Is it a shooting or a stabbing pain?

30) DESCRIBE THE PAIN

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Doctor: So you don’t feel cramps?

31) PRE-OP INSTRUCTIONS

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INT: Yes, thanks, no problem.

INT: Is that going to hurt a lot?

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34) BONE RESETTING

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35) GALLBLADDER STONES

36) EKG – ELECTROCARDIOGRAM

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37) MRI, CT SCAN AND X-RAY