谭录临床症状英语.doc

毕业生报到时用人单位拒绝接收怎么办？
　　来源：　　作者：　　2001-01-01　　大　中　小
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　　国家规定："经过协商落实和国家毕业生分配主管部门审批的毕业生分配计划必须认真执行，未经高校和用人单位双方复议并报地方主管部门批准，学校不得随意改派毕业生，用人单位不得接收和退回毕业生"。

　　当遇到用人单位拒绝接收时，毕业生应主动向用人单位说明情况，不要与对方争吵，更不要贸然返校，应及时与学校取得联系，由学校分清责任，按有关规定妥善处理。

　　若属因学校工作失误造成计划不落实，误派毕业生的，应由学校负责提出调整意见报批。

　　由于用人单位发生重大变化（如撤并、破产、倒闭等），无接收能力的，应及时与学校协商，合理调整。
　　若是用人单位对毕业生提出难以达到的又不符合政策规定的过高要求，则不能作为退人理由。
　　属于毕业生本人身体有病而提出退回的，若是学生在校期间就有传染病史，精神病史，用人单位不知道，待毕业生报到时才被发现的，应允许提出退回；若是报到后才患病的，应按在职人员病假的有关规定处理。
　　如果是因毕业生离校后违法或严重违纪，被用人单位拒绝接收的，则取消其毕业生分配资格。
推荐阅读：
Fever and chills (Rigor)
发热与寒战

“Recently, I’ve had (developed) a fever accompanied by chills.
My teeth chattering!
The temperature rose (elevated) to a high as thirty-nine point six degrees centigrade.
I’ve just been feeling terrible!
Three days later it declined (dropped) a little but still fluctuated from thirty-seven point eight degrees centigrade to thirty-eight point four degrees centigrade for two days, after that it gradually returned to normal.”

“最近我发了一次热，还伴有寒战，我的牙齿打战！
体温上升高达39.6℃，我真感觉糟透了。
三天后体温有所下降，但两天内仍波动在37.8℃和38.4℃之间，以后逐渐恢复到正常了。”

We say “Fever” is an elevation of body temperature above the normal variations.
The mean oral temperature for healthy adults is 36.8±0.4℃ (98.2±0.7F) with a maximal high of 37.2℃ (98.9F) at 6 a. m. ; and a maximal high of 37.7℃ (99.9F) at 4 p. m.
Rectal temperatures are 0.5℃ (1.5F) higher and axillary temperatures are 0.5℃ (1.0F) lower than oral readings.

我们说“发热”是指体温上升到正常变化以上。
健康成人在早晨六时平均口温是摄氏36.8±0.4°（华氏98.2±0.7°），最高是摄氏37.2°；下午四时最高，是摄氏37.7°（华氏99.9°）。
肛温较口温高0.5℃（1.5F）；腋温较口温低摄氏0.5°（华氏1.0°）。

Fever can be classified into 4 types, they are:
1. Intermittent fever – High spikes of fever which returns to normal within 24 hours.
2. Remittent fever – Like Intermittent, but never returns to normal within 24 hours.
3. Sustained (continuous) fever – Like remittent, but with less marked swings of temperature.
4. Relapsing (undulant) fever – Several days of fever alternating with periods of normal temperature.

发热可分为4型，即：
1. 间歇热——发热有高峰，但在24小时内降到正常。
2. 弛张热——与间歇热相似，但在24小时内不降到正常。
3. 稽留热（持续热）——与弛张热相似，但体温波动幅度较小。
4. 回归热（波状热）——连续数日发热与正常体温交替出现。

Pyrogens are substances that cause fever; they may be expgenous or endogenous.
Chill sensations due to peripheral vasoconstriction to decrease heat loss may accompany fever, along with malaise, myalgia, and headache.

致热源是引起发热的物质，有外源性和内源性两种。
由于周围血管收缩使热丢失、减少，产生寒冷感，可伴随发热，同时还有身体不适、肌肉疼痛和头痛。

Headache
头痛

When dealing with a patient with headache, you should first “rule out fever (cold, meningitis, encephalitis), head trauma; problems of eyes, cars, sinuses or teeth, and seizures.
Then pay attention to the following:

在处理一患头痛的患者时，首先应排除发热（感冒、脑膜炎、脑炎），颅脑损伤，眼、耳、鼻窦或牙齿问题和癫痫。
然后注意下列情况：

(1) Hypertention, moderate elevation of blood pressure alone seldom causes headache; however, severe hypertension as seen in hypertension crisis and eclampsia is associated with headache;
(2) Temporal arteritis with temporal artery tenderness and usually with sudden monocular blindness;
(3) Intracranial space occupying lesion (tumor, hematoma, abscess);
(4) Subarachnoid hemorrhage and other cerebrovascular accident.

（1）高血压，单纯的中度升高的高血压很少引起头痛，然而重度高血压如见于高血压危象和子痫时会伴有头痛；
（2）通常伴有突发单眼失明和颢动脉压痛的颢动脉炎；
（3）颅内占位病变（肿瘤、血肿、脓肿）；
（4）蛛网膜下腔出血和其他脑血管意外。

Undoubtedly, tension headache, headache due to substance withdrawal and metabolic disorders should be seriously considered.

无疑，还应认真考虑紧张型头痛，以及由药物脱瘾和代谢病变引起的头痛。

Fatigue
疲乏

Fatigue is either a normal human response or a symptom of physical or psychological disease.

疲乏可以是人体的正常反应，也可以是身体或心理疾病的症状。

Upon physical examination, particular attention should be paid to the presence of pallor, cardiac arrhythmia, dyapnca, fever, weight loss, lymphadenopathy, occult blood loss, organomegaly or mass, goiter, dry hair or skin, hemoptysis or pregnancy.

体格检查时，要特别注意面色苍白、心律不齐、呼吸困难、发热、体重减轻、淋巴结病变（肿大）、隐性失血、器官肿大（内脏巨大）或肿块、甲状腺肿、皮肤毛发干燥、咯血或妊娠等情况的存在。

Symptom of depression or anxiety, suicidal ideation and psychomotor retardation may also be present.

抑郁或焦虑、自杀或精神运动性迟缓的症状都可出现。

Sore Throat and Stuffed Nose
咽喉痛与鼻塞

A sore throat is an inflammation caused by bacterial or viral infection or by irritation.
A sore throat associated with a stuffed-up or runny nose, coughing and sneezing is probably caused by a cold.
咽喉痛是一种由细菌或病毒感染或刺激引起的炎症。
咽喉痛伴鼻塞或流涕、咳嗽和喷嚏可能是由感冒引起的。

A sore throat, if accompanied by swallowing difficulty, red, swollen tonsils, fever and perhaps swollen glands in the neck, may suggest tonsillitis.

咽喉痛如伴有吞咽困难、扁桃体红、肿、发热和颈淋巴结肿大，则提示扁桃体炎。

A sore throat, it associated with fever and with white or yellow spots at the back of the throat, may suggest “Strep throat” (Streptoccocal infection of the throat).
Strep infections can lead to serious disorders of the heart and kidney.

咽喉痛如伴有发热，咽喉部后方出现白色或黄色斑点，则提示“链球菌性咽喉炎”（咽喉的链球菌感染）。
链球菌感染可导致心脏和肾脏的严重病变。

Cough and Sputum
咳嗽与痰

The doctor told me if I have a no-productive (dry, no sputum) cough with a stuffed-up, runny nose, sneezing and sore-throat, I may have a common cold or Flu.

医生告诉我假如我出现无痰（干性）咳，伴有鼻塞、流涕、喷嚏和咽喉痛，则可能患普通感冒或流感。

If the cough is accompanied by sputum production, it is “productive cough” (moist cough).
Sputum may be thin, thick, fetid, frothy, rusty, blood-streaked, purulent, etc.
If the cough is accompanied by chest pain, fever and breathing difficulty, I might have bacterial or viral infection of the bronchial tree or even the lung parenchyma.
Always remember the first symptom of lung cancer may be cough (29% --K. Turley).

假如咳嗽伴痰，则为“痰咳”（湿性咳）。
痰液可为稀薄性、稠厚性、恶臭性、泡沫性、铁锈针色性、血丝性或化脓性等。
如咳嗽伴有胸痛、发热和呼吸困难，则可能患有支气管感染，甚至肺实质的细菌性或病毒性感染。
永远要记住肺癌的第一症状可能是咳嗽（占29%——K. Turley）。

Wheezing
喘鸣

“My child has asthma, he always wheezes.
Can you give me brieve explanation?”
“Wheezing is an abnormally high-pitched noise resulting from a partially obstructed airway.”
The usual causes are bronchospasm, such as in asthma, and mucosal edema.
Always remember: Asthma is associated with wheezing, but not all wheezing is asthma.

“我孩子患哮喘，他常有喘鸣，你可简单解释一下吗？”
“喘鸣是因为气道部分梗阻而产生的一种高音调的异常声音。”
常见原因是支气管痉挛如哮喘和粘膜水肿。
要永远记住，哮喘会伴发喘鸣，但不是所有喘鸣都是哮喘。

Hemoptysis
咯血

He was frightened by coughing out (expectorate) blood.
I told him “Coughing out of blood” is called hemoptysis.
It is defined as “Expectoration of blood or blood-tinged material arising from the lungs or tracheobronchial tree.”

他因咳出血液而感到恐惧。
我告诉他“咳出血液称为“咯血”。
其定义是“指咳出从肺或气管、支气管道产生的血液或染有血液的物质”。

True hemoptysis is usually produced as a result of coughing.
Once happened, one should pay special attention to the existence of pulmonary tuberculosis and pulmonary neoplasm, besides bronchitis and bronchiectasis.

真正的咯血常由咳嗽引发。
一旦发生，除应注意气管炎和支气管扩张症以外，还应特别注意是否存在肺结核和新生物。

In addition, pulmonary suppuration, pulmonary infarction and certain heart trouble, such as mitral stenosis may also give rise to hemoptysis.

此外，肺化脓、肺梗死和某些心脏疾患，如：二尖瓣狭窄也可引起咯血。

Dyspnea
呼吸困难

“What is Dyspnea? Is it rapid breathing?”
“No, Dyspnea is defined as difficult or labored breathing.”
The term “Dyspnea” is derived from Greak “Dyspnoia” meaning difficulty of breathing, whereas rapid breathing is what we called “Tachynea”.
Dydpnea is most often described as “tightness in the chest”.

“什么是呼吸困难？是呼吸加快吗？”
“不，呼吸困难的定义是困难的或费力的呼吸。”
“呼吸困难”一词来自希腊语“Dyspnoia”意为呼吸的困难，而呼吸加快被称之为“呼吸急促”，而呼吸困难最常被描述为“胸部收紧感”。

Dyspnea is an important manifestation of cardiopulmonary disease, although is may be found in other states, such as neurologic, metabolic, and psychological conditions.
So we may have the Cardiac Dyspnea, that is a distressful breathing caused by heart disease;
Exertional Dyspnea, that is provoled by physical effort or exertion;
and Functional Dyspnea, in which the respiratory distress is not caused by organic disease and unrelated to exertion, but associated with anxiety states.

呼吸困难是心肺疾患的重要表现，虽然它也可在其他情况时出现，如神经性、代谢性和心理问题等情况下出现。
所以存在心源性呼吸困难，它是一种由心脏疾病引起的窘迫性呼吸、劳累性呼吸困难；
因身体过度用力或劳累引发；
而功能性呼吸困难，并非由器质性疾病引起，也和劳累无关，但可伴随焦虑状态出现。

Chronic Obstructive Pulmonary Disease (COPD)
慢性阻塞性肺部疾病

Chromic Obstructive Pulmonary Disease or Chronic Asmatic Bronchitis is a generalized persistent airways obstruction problem associated with varying combinations of chronic bronchitis, bronchiolitis, asthma, and emphysema.
Gradually progressive exertional dyspnea is the most common presenting complaint.
A mild “smoker’s cough” is often present many years before the onset of exertional dyapnea.
Cough, wheezing, recurrent respiratory infections may also be initial manifestations.

慢性阻塞性肺部疾病或慢性支气管炎是一组综合性持续气道阻塞问题，它伴有慢性支气管炎、细支气管炎、哮喘和肺气肿的不同组合。
逐渐进行性劳累性呼吸困难是最常见主诉。
轻度“吸烟者咳嗽”常在劳累性呼吸困难发生之前数年即已出现。
咳嗽、喘鸣、反复呼吸道感染也可以是其初始表现。

Gross pulmonary hyperinflation, prolonged expiration, pursed-lip breathing, stooped posture, calloused elbows from repeated assumption of the “tripod position” and marked use of accessory muscles of respiration are seen in the later stages.
Late in the disease, there may be frank cyanosis from hypoxemia; barrel chest and dependent edema from prolonged sitting and elevated intrathoracic pressure.

后期会出现明显的肺过度充气、呼气延长、缩唇呼吸、曲背姿势、由反复采取“三脚架”体位形成的胼胝和呼吸时明显应用辅助肌的现象。
晚期可出现因低氧血症导致的明显紫绀，桶状胸和由于长期坐位和胸内压升高所致的坠积性水肿。

Adult Respiratory Distress Syndrome (ARDS)
成人呼吸窘迫综合征

ARDS is the respiratory failure associated with various acute pulmonary injuries and characterized by noncardiogenic pulmonary edema, respiratory distress, and hypoxemia.
The causative “injuries” include septicaemia bacterial or viral pneumonias, chest trauma, profound shock, aspiration, burns, near-drowning, massive blood transfusion, cardio pulmonary by pass, oxygen toxicity, and acute hemorrhagic pancreatitis.
Although termed as “adult” the distress syndrome also occurs in children.

成人呼吸窘迫综合征是各种急性肺部损伤所致的呼吸衰竭，以非心源性肺水肿、呼吸窘迫和低氧血症为特征。
所谓“损伤”包括败血症、细菌性，或病毒性肺炎、胸外伤、深度休克、误吸、烧伤、溺水、大量输血、心肺分流术、氧中毒和急性出血性胰腺炎。
虽然冠以“成人”，此窘迫综合征也发生于儿童。

The initial lung injury is poorly understood.
It is suggested that activated WBCs and platelets accumulate in capillaries, the interstitial, and airspaces, they release mediators that injure cells promoting fibrosis and leakage of blood into the interstitial and intra-alveolar spaces; and then leading to broncho alveolar inflammation.
Finally, low lung compliance, pulmonanary hypertension, decreased functional residual capacity, ventilation/perfusion maldistribution and hypoxemia result.

对于起始的肺部损害，人们知之甚少。
通常认为是活化的白细胞和血小板积聚于毛细血管、间质和气腔内，它们释放损伤细胞的介质，促进纤维化和血液逸漏入间质和肺泡腔内，以后导致支气管肺泡炎症。
最终导致肺顺应性下降、肺动脉高压、功能残气量下降、通气/灌注比例失调和低氧血症发生。

ARDS usually develops within 24 to 48 hours after the initial injury or illness.
Dyspnea occurs first, usually accompanied by rapid, shallow respiration.
Intercostal and suprasternal refraction may be present on inspiration.
Cyanosis and mottled skin may be present.
Auscultation may reveal rales, rhonchi, or wheezes.

ARDS通常在最初损伤或疾病后的24~48小时内发生。
首先出现呼吸困难，常伴以呼吸短促，吸气时可出现肋间隙和胸骨上窝凹陷，可出现紫绀和斑驳皮肤。
听诊可闻及啰音、鼾音或喘鸣音。

Asphyxia is caused by severe upper airway obstruction.
The patient complains of inspiratory and expiratory stridor.
His ineffective inspiratory efforts are characterized by suprasternal, supraclavicular, and intercostal retracions; and often coupled with cyanosis.
The diagnosis may be confirmed by aasking the patient to speak; patients with complete upper airway obstruction are unable to speak even in a whisper.

窒息由严重上气道梗阻引起。
患者诉吸气性和呼气性喘鸣。
其无效吸气努力的特征是胸骨上窝、锁骨上窝和肋间隙的下陷，并常伴有紫绀。
诊断可通过让患者说话而得到确认。
完全上气道梗阻的患者是不能说话的，甚至耳语也不行。

Stupor in a patient with obvious respiratory distress is commonly due to CO2 retention or profound tissue hypoxia.
If the patient’s condition is stable enough to permit brief evaluation, either the absence of a gag reflex (unprotected airway) or an arterial blood gas sample showing severe hypercapnea or hypoxia (ie, respiratory failure) supports the necessity for endotrachial intubation in the emergency department.

由明显呼吸窘迫产生的木僵（或昏迷）常由于二氧化碳潴留或深度组织缺氧引起。
如果患者情况稳定，可以进行简单检查。
如出现呕吐反射消失（气道失去保护），或动脉血气分析提示有严重高碳酸血症或缺氧（呼吸衰竭）时，需在急诊室作气管插管。

Chest Discomfort, Chest Pain
胸部不适，胸痛

“Do you have any discomfort or disagreeable sensation in your chest?”
Angina is characterized by recurrent oppressive (squeezing) retrosternal chest pain; while pain from myocardial infarction is more intense and usually associates with sweating, nausea, vomiting, dizziness and dyspnea.

“你有胸部不适或不舒服的感觉吗？”
心绞痛的特征是反复发作的压榨性（挤压性）胸骨后胸痛；而源于心肌梗死的胸痛更严重，并通常伴有出汗、恶心、呕吐、头晕和呼吸困难。

Chest pain from noncardiogenic origin include pleurisy, pneumonia, chest wall pain, esophageal spasm, rib fracture, etc.

非心源性胸痛可由胸膜炎、肺炎、胸壁痛、食管痉挛、肋骨骨折等引起。

Pleuritic pain is a common symptom of inflammation of the parietal pleura.
It is described as a sharp, stabbing pain, which is typically made worse by deep breathing or coughing.

胸膜痛是壁层胸膜炎症的常见症状。
它是一种锐利刀刺样痛，咳嗽或深呼吸时加重是其典型表现。

Edema
水肿

Edema is defined as clinically apparent increase in interstitial fluid volume (generalized or localized).
It is also called “dropsy”.
The most common location and description of edema is “swelling of the feet”.

水肿的定义就是在临床上出现（全身或局部的）组织间液量明显增加。
它也称为“浮肿”。
水肿最常见的部位和对水肿最多的描述就是“脚肿”。

For the generalized edema, hypoalbuminemia plays an important role in different kinds of nephritis or nephrosis, malnutrition, and cirrhosis.

低蛋白血症对不同类型的肾炎或肾病、营养不良和肝硬化的全身性水肿起着重要作用。

Whereas sodium and water retention, as in right hear failure, is the main factor in the pathogenesis of edema.

钠、水潴留是水肿发病机制中的主要因素，右心衰时就是如此。

Other causes of edema include pregnancy, sodium overload and prolonged dependent position; hypothyroidism can present with pretibial myxedema.

水肿的其他原因还包括妊娠，钠负荷过多和长时间处于下垂体位；甲状腺功能减退可表现胫前黏液性水肿。

Palpitation
心悸

“What is palpitation? Is it increase in heart rate?”
“No, we call the increase in heart rate ‘Tachycardia’.
Palpitation is the perception of heart action by the patient.”

“什么是心悸？是心率加快吗？”
“不，我们称心率加快为‘心动过速’。
心悸是患者感觉到心脏跳动。”

Abnormalities in cardiac rhythm constitutes the most common cause of palpitations.
Atrial or ventricular extrasystols are often described as “skipped beats” while atrial fibrillation is identified as an irregularity.
Atrial tachyarrhythmias’onset is often associated with the need to urinate because of increased production of natriuretic factor.

心律异常是构成心悸的最常见原因。
房性或室性期前收缩常被描述为“漏跳”，而房颤则为极不规则的心律。
房性心动过速发作时因心钠素产生过多而常需排尿。

Palpitations associated with light-headedness or syncope indicate on abrupt drop in cardiac output and denotes a serious arrhythmia or serious underlying organic heart disease.

心悸有头晕或晕厥者则提示心输出量的突然下降，并意味着存在严重心律失常或严重的心脏器质性疾病。

Cyanosis and Clubbing
紫绀与杵状变（指、趾）

“I noticed there was a bluish discoloration of my skin and mucous membrance, and