本文有两篇文章，3-4均为呼吸系统疾病，故而放在一起。
CASE 3:
CHRONIC COUGH
慢性咳嗽
History
A 19-year-old boy has a history of repeated chest infections. He had problems with a cough and sputum production in the first 2 years of life and was labelled as bronchitic.
sputum痰液（统称），粘痰则可以用phlegm，中医的痰质，可用semha。固定搭配：吐痰spit sputum，咳痰 expectorate sputum
bronchus 支气管（plu bronchi），trachea 气管
Over the next 14 years he was often ‘chesty’ and had spent 4–5 weeks a year away from school. Over the past 2 years he has developed more problems and was admitted to hospital on three occasions with cough and purulent sputum. （脓痰）
On the first two occasions, Haemophilus influenzae （流感嗜血杆菌）was grown on culture of the sputum, and on the last occasion 2 months previously Pseudomonas aeruginosa was isolated from the sputum at the time of admission to hospital.
culture表示培养，如培养细胞，细菌等，
pseudo—假，mono—单个（的），pseudomonas aeruginosa 铜绿假单胞菌/绿脓杆菌
isolate 文中表示分离，近似于separate，seclude，insulate等，但也可表示隔离，近似于quarantine，但quarantine本身有检疫的意思在里面，如用于因为疫情而产生的隔离，更贴切。
He is still coughing up sputum. Although he has largely recovered from the infection, his mother is worried and asked for a further sputum to be sent off.
The report has come back from the microbiology laboratory showing that there is a scanty（少量） growth of Pseudomonas on culture of the sputum.
There is no family history of any chest disease. Routine questioning shows that his appetite is reasonable, micturition （排尿，书面语）is normal and his bowels tend to be irregular.
Examination
On examination he is thin, weighing 48 kg and 1.6 m (5 ft 6 in) tall.
The only finding in the chest is of a few inspiratory crackles over the upper zones of both lungs. Cardiovascular and abdominal examination is normal.
in—在xxx里的，spiratory参考respiratory，所以inspiratory 表示吸气性的，相反的是expiratory呼气性的
crackle本身表示劈啪作响，这里表示湿啰音，如粗湿啰音 coarse crackle。与之相对的，干啰音rhonchi。
呼吸过程中，肺会收缩扩张，进行气体交换，产生呼吸音，通过听诊器听呼吸声音来判断有误呼吸系统异常。是临床上常见的初步检查手法之一。
（因胸片等图片无法上传，这里缺失，但不影响上下文）
ANSWER 3
The chest X-ray shows abnormal shadowing throughout both lungs, more marked in both upper lobes （上叶）with some ring shadows and tubular shadows representing thickened bronchial walls.
肺左侧两叶，右侧三叶
These findings would be compatible with a diagnosis of bronchiectasis（支气管扩张）. The pulmonary arteries are prominent, suggesting a degree of pulmonary hypertension.（肺动脉高压）
The distribution is typical of that found in cystic fibrosis where the changes are most evident in the upper lobes.
cystic 囊的，fibro—纤维的，—sis xxx病变，cystic fibrosis 囊性纤维化
Most other forms of bronchiectasis are more likely to occur in the lower lobes where drainage（引流） by gravity is less effective. High-resolution（高分辨率） computed tomography (CT) of the lungs is the best way to diagnose bronchiectasis and to define its extent and distribution.
In younger and milder cases of cystic fibrosis, the predominant organisms in the sputum are Haemophilus influenzae（流感嗜血杆菌） and Staphylococcus aureus（金黄色葡萄球菌）.
Later, as more lung damage occurs, Pseudomonas aeruginosa is a common pathogen. Once present in the lungs in cystic fibrosis, it is difficult or impossible to remove it completely.
Cystic fibrosis should always be considered when there is a story of repeated chest infections in a young person.
Although it presents most often below the age of 20 years, diagnosis may be delayed until the 20s, 30s or even 40s in milder cases.
Associated problems occur in the pancreas (malabsorption, diabetes), sinuses and liver.
pancreas 胰腺
mal—xxx不良的，malabsorption 吸收不良
diabetes 糖尿病，diabetes mellitus简称
sinus，窦，窦道，不同器官表示不同窦道，如鼻部，鼻窦，血管中表示（动）静脉窦，心脏表示窦房结的窦，需要联系上下文。
It has become evident that some patients are affected more mildly, especially those with the less common genetic variants.
These milder cases may only be affected by the chest problems of cystic fibrosis and have little or no malabsorption from the pancreatic insufficiency. （胰腺功能不全/分泌不足）
Differential diagnosis
鉴别诊断
The differential diagnosis in this young man would be other causes of diffuse bronchiectasis such as agammaglobulinaemia or immotile cilia.（不动纤毛）
a表示与单词本身相反的，gamma希腊字母γ，可以翻译为甲乙丙的丙，global—球状的
——in，表示xxx素，如毒素，toxin，globulin雪球素，但是这么翻译比较拗口，故常译作球蛋白
—emia，血液中发生xxx，如anemia，贫血
所以agammaglobulinaemia表示丙种球蛋白缺乏症
Respiratory function should be measured to see the degree of functional impairment. Bronchiectasis in the upper lobes may occur in tuberculosis（肺结核病） or in allergic bronchopulmonary aspergillosis （曲霉菌病）associated with asthma. 哮喘
The common diagnostic test for cystic fibrosis is to measure the electrolytes（电解质） in the sweat, where there is an abnormally high concentration of sodium and chloride.
At the age of 19 years, the sweat test may be less reliable. It is more specific if repeated after the administration of fludrocortisone.（氟氢可的松）
An alternative would be to have the potential difference across the nasal epithelium measured at a centre with a special interest in cystic fibrosis.
epi— upon，on，over等，这里表示xxx之上，epithelium上皮细胞
Cystic fibrosis has an autosomal recessive inheritance with the commonest genetic abnormality ΔF508 found in 85 per cent of cases.
The gene is responsible for the protein controlling chloride transport across the cell membrane. The commoner genetic abnormalities can be identified and the current battery of genetic tests identifies well over 95 per cent of cases.
However, the absence ofΔF508 and other common abnormalities would not rule out cystic fibrosis related to the less common genetic variants.
In later stages, lung transplantation（肺移植） can be considered. Since the identification of the genetic abnormality, trials of gene-replacement therapy （基因替代疗法）have begun.
CASE 4:
SHORTNESS OF BREATH
气短
History
A 26-year-old teacher has consulted her general practitioner (GP) for her persistent （持续性/反复发作性）cough.
She wants to have a second course of antibiotics（二级抗生素） because an initial course of amoxicillin （阿莫西林）made no difference.
The cough has troubled her for 3 months since she moved to a new school.The cough is now disturbing her sleep and making her tired during the day.
She teaches games, and the cough is troublesome when going out to the playground and on jogging.
In her medical history she had her appendix （附器，单独出现则表示阑尾）removed 3 years ago. She had her tonsils （扁桃体）removed as a child and was said to have recurrent episodes of bronchitis between the ages of 3 and 6 years.
She has never smoked and takes no medication other than an oral contraceptive.
口服避孕药。个人观点：英语口语使用spoken English表达，虽然也有袋鼠国朋友使用oral English，但是总觉得有点奇怪。
Her parents are alive and well and she has two brothers, one of whom has hayfever. 花粉症
Examination
The respiratory rate（呼吸频率） is 18/min. Her chest is clear and there are no abnormalities in the nose, pharynx, cardiovascular, respiratory or nervous systems.
INVESTIGATIONS
• Chest X-ray is reported as normal.
• Spirometry is carried out at the surgery and she is asked to record her peak flow rate （峰值流速）at home, the best of three readings every morning and every evening for 2 weeks.
spiro—参考respiratory，—ometry xxx测量术，spirometry 肺功能测定
Spirometry results are as follows:
| 项目 | 实际值 | 参考值 |
|---|---|---|
| Actual （实际值） | Predicted （参考值） | |
| FEV1 (L) | 3.9 | 3.6–4.2 |
| FVC (L) | 5.0 | 4.5–5.4 |
| FER (FEV1/FVC) (%) | 78 | 75–80 |
| PEF (L/min) | 470 | 440–540 |
| FEV1: | forced expiratory volume in 1 s; | 第1秒用力呼气容积 |
| FVC | forced vital capacity | 用力呼气量 |
| FER | forced expiratory ratio | 用力呼气比值 |
| PEF | peak expiratory flow | 最大呼气流速 |
（图表上传不能显示，所以用表格表示，但不影响上下文）
ANSWER 4
The peak flow pattern shows a degree of diurnal（日间的） variation. This does not reach the diagnostic criteria for asthma but it is suspicious.
The mean daily variation in peak flow from the recordings is 36 L/min and the mean evening peak flow is 453 L/min, giving a mean diurnal variation of 8 per cent.
There is a small diurnal variation in normals and a variation of ＞15 per cent is diagnostic of asthma. In this patient the label of ‘bronchitis’ as a child was probably asthma.
The family history of an atopic condition (hayfever in a brother), and the triggering of the cough by exercise and going out in to the cold also suggest bronchial hyper-responsiveness （高反应）typical of asthma.
Patients with a chronic persistent cough of unexplained cause should have a chest X-ray. When the X-ray is clear the cough is likely to be produced by one of three main causes in non-smokers.
Around half of such cases have asthma or will go on to develop asthma over the next few years. Half of the rest have rhinitis（鼻炎） or sinusitis （鼻窦炎）with a post-nasal drip.鼻后滴漏
In around 20 per cent the cough is related to gastro-oesophageal reflux.胃食管反流
A small number of cases will be caused by otherwise unsuspected problems such as foreign bodies,（异物） bronchial ‘adenoma’, sarcoidosis or fibrosing alveolitis.（肺泡炎）
adeno—腺有关的，如adenine腺嘌呤，oma—瘤，adenoma腺瘤
sarco—肉有关的，
oid 像xxx的，如Android，andr，人有关的，Android就是像人一样的
所以sarcoidosis类肉瘤
Cough is a common side-effect （副作用）in patients treated with angiotensin-converting-enzyme (ACE) inhibitors.血管紧张素转化酶抑制剂
angio—血管有关的，tense紧张，in xxx素，angiotensin血管紧张素
In this patient the diagnosis of asthma was confirmed with an exercise test which was associated with a 25 per cent drop in peak flow after completion of 6 min vigorous exercise.
Alternatives would have been another non-specific challenge such as methacholine or histamine, or a therapeutic trial of inhaled （吸入）steroids.
methyl甲基，acetyl 乙酰基，choline胆碱，methacholine乙酰甲胆碱
histamine 组胺，histology组织学，amine 胺，amino acid 氨基酸
After the exercise test, an inhaled steroid was given and the cough settled after 1 week. The inhaled steroid was discontinued after 4 weeks and replaced by a β2-agonist（β2（受体）激动剂） to use before exercise.
However, the cough recurred with more evident wheeze and shortness of breath, and treatment was changed back to an inhaled steroid with aβ2-agonist as needed.
If control was not established, the next step would be to check inhaler technique and treatment adherence and to consider adding a long-acting（长效）β2-agonist.
In some cases, the persistent dry cough associated with asthma may require more vigorous treatment than this.
Inhaled steroids for a month or more, or even a 2-week course of oral steroids may be needed to relieve the cough.
The successful management of dry cough relies on establishing the correct diagnosis and treating it vigorously.
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