- Hello. Are you studying anything?
- Yes, I’m trying to remember everything about the heart and the vascular system.
- Oh, that’s good. Let’s do it together and check each other. So what do you know about the heart?
- Well, it’s an inner hollow muscular organ, placed within the chest and included in the pericardium. The weight of the heart is about 300 gr in the male and about 220 gr in the female. How many parts does the heart consist of?
- Let me think… it consists of 2 separate chambers divided by the septum. Each chamber has 2 connected parts: the atrium and the ventricle. By the way, the right atrium is larger than the left one, but the walls of the left atrium are thicker than the walls of the right atrium.
- Right you are. Speaking about the ventricles, the left ventricle is longer and more conical than the right one and its walls are 3 times as thick as the walls of the right one. Do you know what the muscular structure of the heart consists of?
- Well, it consists of fibrous bands of two groups. They are the fibrous bands of the atria and those of the ventricles. What can you say about the vascular system?
- It consists of 3 groups of vessels – arteries, veins and capillaries. The general system is composed by systemic vessels, carrying blood to and from the tissues of the body. Pulmonary system is formed by the vessels, carrying blood to and from the lungs. The portal system is formed by the veins passing to the liver.
- Right. Moreover arteries dilate and contract simultaneously with the action of the heart. The contractions of the heart pump the blood through the arteries to all the parts of the body. Physiologists have determined that in the adult the heart makes from 60 to 72 beats per minute. In children the rate of heartbeat is much higher.
- By the way, each wave of contraction and a period of rest following it compose a cardiac cycle, which consists of 3 phases: the atrial systole (phase of short contraction of both atria), the ventricular systole (a more prolonged contraction of both ventricles) and the diastole (the period of rest of the cardiac muscle).
- Have you ever heard that the role of ventricle was estimated to serve as the main pump?
- Yes, I have. And I also know that the atria act as receiving chambers. The contraction of the atria which sends the final portion of the blood into the ventricle is considerably less.
- You see, we’ve discussed almost everything.
- Yes, thank you for helping me.
11. Анатомия и физиология опорно-двигательной системы
- Hi, how are you doing?
- Very good, thank you.
- Did you go to the lecture on the skeleton and muscles yesterday? You know I was surprised to know that there are more then 200 bones in the adult skeleton.
- Yes, and 26 of them are only bones of the skull, which consists of cranial and facial parts. The bones of the trunk are the spine and the chest. The spine consists of the 7 cervical, 12 thoracic, 5 lumbar and 5 sacral vertebrae and … and…
- And a coccyx. I know that. By the way, what are the largest vertebrae in the spine?
- Let me think… the lumbar vertebrae are the largest ones. Do you know that the chest (thorax) consists of 12 thoracic vertebrae, the breastbone and 12 pairs of ribs? And the breastbone is composed of 3 main parts.
- I know. I know that the basic part of the chest is formed by ribs. On each side of the chest 7 ribs are connected with the breastbone by cartilages. The cartilages of 3 other ribs are connected with each other and with the 7 ribs but are not connected with the breastbone. But I don’t remember anything about the 11th and the 12th ribs.
- Oh, they are not connected with the breastbone either, they are not even connected with other ribs. They are free. I wonder if you know how many parts the lower and the upper extremities consist of.
- Certainly. The lower extremity consists of the thigh, leg and a foot and the upper extremity is formed by the arm, forearm and hand. Our body is also composed of about 600 skeletal muscles and they all are divided into the muscles of trunk, head and extremities.
- Yes, and according to their form they may be divided into long, short and wide muscles. Long muscles form the free extremities, wide muscles lay on the trunk and the walls of the body cavities are formed by short muscles. Am I right saying that skeletal muscles are formed by a mass of muscle cells?
- Yes, you’re. The muscular fibers are connected together by connective tissue and there are blood vessels and the nerves in the muscles.
- Certainly. I think we’ve mentioned everything. I must go now.
- Oh, sure. Thank you.
12. Анатомия и физиология дыхательной системы
- Hello. What are you doing? Are you free now?
- Yes, I’m.
- Then let’s prepare our Anatomy lesson on the lungs for tomorrow.
- Ok. So… the lungs are the main organs of the respiratory system and there are 2 of them in the human body.
- Right! They are separated from each other by the Mediastinum and covered with the pleura. By the way, each lung has the base, apex, two borders and three surfaces. Do you know what the weight of the lungs and their vital capacity is?
- Well… their weight varies according to many conditions. It’s about 1350 gr in the adult male. Their vital capacity is about 3-4 liters.
- Yes. That’s right. Moreover, the right lung consisting of 3 lobes is heavier than the left one, because the latter consists only of 2 lobes. What does the structure of the lung consist of?
- Let me think … it consists of an external serous coat, the visceral layer of the pleura, a Subserous elastic tissue and the parenchyma or proper substance of the lungs. Do you know that the physiology of the lungs is associated with their structure?
- Yes, I do. There are over 700 000 000 alveoli in the lungs. The lungs have also many capillaries. This particular structure of the lungs enables the exchange of gases between the alveolar air and the blood.
- But not all the alveoli and capillaries of the lungs are opened when one breathes normally. But their number increases, when respiration becomes deep. Moreover, when the depth of respiration increases the vital capacity may be 6 liters and even more.
- Sure, the regulation of the vital capacity of the lungs is of particular importance to the exchange of oxygen and carbon dioxide taking place in the lungs. Do you know that the lungs take part in the production of physiologically active substances?
- I do. They also take part in the regulation of blood coagulation, in the metabolism of protein, fats and carbohydrates.
- Right you are. I think that’ll do. I’m sure tomorrow we will answer.
6. Первичный прием больного, направление к специалисту
- Come in, …, come and sit down here. Your doctor’s told me that you’ve been having pain in your chest.
- Yes, and in my arm and …
- Now when did you first notice this pain?
- Well, if I’m not mistaken about 5-6 month ago.
- Can you remember when it first came on?
- Well, I got a bad pain in my chest when I was shopping. It was so bad that I even couldn’t breathe.
- In which part of your chest did you feel the pain?
- Right across my chest.
- And how long did it last?
- About 10-15 minutes.
- What did you do when it happened?
- I had to stop and wait for it to go away.
- Have you had the pain again since then?
- Yes, I often get it when I overdo things.
- I’d like to examine you, your chest now. Strip to the waist, please. I’ll check your pulse first of all. Oh, that’s fine. Now your blood pressure. 130 over 80 – that’s quite normal too.
- I’m glad to hear that.
- Now I’m going to listen to your heart. I want you to breathe normally. Your heart sounds quite normal.
- Well, that’s a relief.
- Now I want you to take deep breaths in and out while I check you lungs. In… out… in… out…thank you. Well you have angina and this occurs when not enough oxygen is getting to the heart. Well I think you should go and see cardiologist. He’ll examine you again and prescribe you an adequate treatment. So this is an appointment card to the cardiologist. He is seeing his patient right now.
- Thank you, doctor.
20. Система медицинского обслуживания в разных странах мира: сопоставительный анализ
- Good afternoon. I am a correspondent of the magazine “Health”. I know that you have experience observing medical practices in American and British hospitals. So would you tell our readers about your impressions in comparing Russian, American and British medical facilities, practices, and systems?
- Oh, with great pleasure. In these three courtiers different qualities of facilities exist. Generally, those I saw in the U.S. were better in all respects than those in Russia. Facilities on the level of American ones do exist here but few are within reach of the average person. For example, a small, local city hospital in New England is no better than the presidential Kremlin hospital in Kountzevo, and Kountzevo may even be better. But not many people have access to the Kremlin hospital. Speaking about GB, 70 % of their hospitals are small with only about 200 beds. Such hospitals are not economical and can not provide a full range of service.
- What about technology? What advances have you seen in America and Great Britain that have not yet come to Russia?
- Russia, America and Great Britain are still on the same planet Earth, and we are aware of most technological advances practiced overseas. The fact remains, however, that many sophisticated diagnostic tools and treatments now routinely used in America are rarely used in Russia, and are available only to a few individuals. American healthcare, in general, seems less centralized technologically than in Russia. For example, a procedure done here in Russia by a specialist in a specialized facility would probably be handled by an ordinary hospital in America. In GB they have over 150 health centers, providing all the special diagnostic, therapeutic services and consulting services.
- What about differences in admitting patients to hospitals and billing them for their treatment? How do procedures vary? I know that in GB most medical treatment is free, but charges are made for drugs, spectacles and dental care. Free emergency medical treatment is even given to any visitor from abroad who becomes ill while staying in this country. Can you say anything about the US system?
- There are deep problems with health care costs in the U.S.A. because public health programs cover only the poorest citizens, while people of moderate incomes with no insurance are vulnerable to financial ruin should they become ill. And medical insurance doesn’t necessarily cover all expenses in a serious illness. Only after a person or family runs out of money will Medicaid, America’s public health program for the indigent, take over.
- As far as I know every Russian citizen is supposed to be able to obtain free medical care in the local hospital near where he or she is registered. If he or she chooses to get treatment somewhere else, he/she has to pay before or while being treated. The hospital never chases the patient with unpaid bills after discharge.
- In Great Britain the National Health Service provides free medical care both in hospitals and in the out-patient clinics. There are also some private hospitals which people may use.
- Oh thank you very much. Sorry to say that but our time is up. Thank you again for answering my question.
- You are quire welcome.
Вызов врача на дом
(SITUATION: you are talking to a clerk of the registration department on the telephone)
- Good morning.
- Good morning. Can I help you?
- Yes. May I call in a doctor?
- Sure. What’s the matter with you?
- I’ve got a very high temperature, a bad cough and a splitting headache and a terrible sore throat.
- So what is your full name?
- I am … …
- Where do you live?
- CCC Street, 11, flat 16.
- Ok. Your local doctor will come in the afternoon.
- Thank you very much., good-bye
- You are welcome, good-bye.
(The doctor comes to your place in the afternoon)
- Good afternoon
- Good afternoon
- Are you … …? What are your complaints?
- Well, I’ve got a splitting headache, a sore throat, an elevated temperature (it is over 38C) and profuse sweating. My nose is running. Actually I felt rotten two days ago, but I didn’t consult a doctor because my temperature was normal all the time.
- Strip to the waist please. Let me examine you. Stick out your tongue. Say “Ah!” I want to check your throat.
- Ah!
- Thank you. Now I want to listen to your heart and lungs. Please, take a deep breath and hold it. Now breathe in and out through your mouth. Enough. I can hear moist rales. I think you’ve got bronchitis. I’ll give you a sick leave for 3 days and after that you’ll come to the polyclinic.
- Should I follow a strict bed regimen?
- Yes. You’d better stay in bed.
- That’s all right doctor.
- Here is your prescription for antibiotics, order them at the chemist’s.
- Thank you doctor. I’ll do everything you’ve told to me.