Keys

Key:
for, since, ago
-for or since: 3. for, 4. since, 5.since, 6. for, 7. for, 8. for...since
-ago: Examples:
-for or ago: 2. a year ago, 3. a few days ago, 4. Two hours ago, 5. Six months ago.
3. For twenty years, 4. 20 years ago, 5. 10 minutes ago, 6. an hour ago, 7. for 6 months, 8. for a long time, 9. a few days ago.
-2. been here since Tuesday
3. raining for an hour
4. known Sue for 2 years
5. had a/my camera since 1989
6. been married for 6 months
7. been studying medicine for 3 years
8. played/been playing the piano since he was 7 years old.
-1.I’ve lived in………….all my life
2. I’ve been in the same job for 10 years
3. I’ve been learning English for 6 months
4. I’ve known Chris for a long time
5. I’ve got a headache since I got up this morning.

How long, for and since (please, click to enlarge)






Past tense:
Key: 2. When did they sell their home? 3. What time did the meeting begin? 4. How much did the tickets cost? 5. How did he pay for the car? 6. How much did she invest in the stock market? 7. In which row did they sit? 8. In what language did he speak to them? 9. How long did the meeting last? 10.What time did it begin? 11. What time did I telephone her? Why did he go to Denver? How many times did you mention it to him? Where did they eat lunch? 15. How many years did we work here? 16. Where did I put the mail? 17. How long did she wait for them? 18. What time did we get home? 19. Who did he walk to school with? 20. Where did you go after the lesson?

Questions:
Simple present tense: Questions:
2. What time does the lesson begin?, 3. When do they get home every night?, 4. How well does the travel agent speak French?, 5. How much do those books cost?, 6. How do they travel?, 7. How often does he come here?, 8. How does she feel?, 9. Why does Francine want to learn English?, 10. Where do they meet every morning?, 11. How often do we go to the movies? 12. Where does the banker go after the lesson? 13. How many new words do we learn everyday? 14. Where do they eat lunch?, 15., What kind of car does he drive?, 16. Where does this book belong?, 17. In which room does the class meet? 18. What does she teach us?, 19. When does it rain? 20. What time does he get up every morning? 21. When does she go to bed?

Making an appointment with the doctor

A 35 year-old woman with fever and a generalized rash

Once a month Dr Linda Miller, consultant dermatologist, holds a clinic in the health center where GP Dr Paul Robertson works. Dr Miller has just finished seeing her last scheduled patient when Dr Robertson enters the clinic room.

Dr Robertson: Hello, Linda. I’m very glad to find you’re still here. I thought I might have missed you.

Dr Miller: Hello, Paul. luc•ky', 'If you say it’s lucky something happened, you mean that it has effects or consequences, although it happened by chance and not as a result of planning or preparation. ', 'It’s lucky you didn’t come to see me yesterday because I wasn’t here.','')" onmouseout="hide()" onclick="playerToggle()">It’s lucky you caught me. I’ve just finished dictating the letter on the last patient and I was on my way back to the hospital. What can I do for you?

Dr Robertson: It’s about a woman who’s in my consulting room at the moment. Her name is Mary Davies and she’s 31. I don’t see her very often, but she came to see me about a week ago. She’d not feeling yourself, you feel slightly ill.', 'I haven’t been feeling myself since I stopped taking the medicine.','')" onmouseout="hide()" onclick="playerToggle()">not been feeling herself for a few days and I thought she had a respiratory tract infection.

Dr Miller: So, what did you do?

Dr Robertson: I started her on a course of amoxycillin, 250 mg three times a day.

Dr Miller: That sounds very reasonable. How is she now?

Dr Robertson: Not at all well, I’m afraid. She came back to see me because she’s feeling very unwell and yesterday, she developed a rash is an area of red spots that appear on your skin when you are ill or have an allergy.', 'The baby developed a rash after eating some strawberries.','')" onmouseout="hide()" onclick="playerToggle()">rash on her arms, the palm of your hand is the flat surface which your fingers can bend toward. ', 'Some people believe that the future is written in the lines on the palm of your hand.','')" onmouseout="hide()" onclick="playerToggle()">palms of her hands and the sole of your foot is the underneath surface of it. ', 'There was a cut on the sole of his foot where he’d stepped on the broken glass.','')" onmouseout="hide()" onclick="playerToggle()">soles of her feet. She’s also got a very sore, it causes you pain and discomfort. ', 'Her back was very sore from carrying the baby.','')" onmouseout="hide()" onclick="playerToggle()">sore mouth.

Dr Miller: I see. Is there any other relevant history? Has she been abroad or has she been in contact with anyone with a similar problem?

Dr Robertson: I didn’t ask her about going abroad but she doesn’t know anyone else who’s had a similar problem.

Dr Miller: Would you like me to have a look at her?

Dr Robertson: I’d be very grateful if you would. If you hadn’t been here today I would have sent her up to the hospital immediately anyway.

Ten minutes later, Dr Miller and Dr Robertson are back in the clinic room.

Dr Miller: Well, she certainly is quite well', 'If you are unwell, you are ill.', 'John looked tired and pale. I really thought he was unwell.','')" onmouseout="hide()" onclick="playerToggle()">unwell. Your nurse checked her temperature and it’s 38.7°C. She’s got an erythematous macular rash on her arms, palms, and the soles of her feet. She’s also got ulceration of her oral and genital mucosa, jec•ted', 'If your eyes are injected, the parts that are usually white are red or pink. ', 'Her eyes were injected because of conjunctivitis.','')" onmouseout="hide()" onclick="playerToggle()">injected eyes and some small ulcers on her conjunctivae.

Dr Robertson: The rash appears to vary quite a bit, and some of the lesions have what looks like a blis•ter', 'A blister is a painful swelling, containing clear liquid, on the surface of your skin. ', 'His new shoes gave him a blister on the heel.','')" onmouseout="hide()" onclick="playerToggle()">blister in the center.

Dr Miller: Yes, that’s right. She mentioned that the lesions develop over a few days and you could see that the macules were in different stage is a part of a process. ', 'The disease is only contagious in the early stages.','')" onmouseout="hide()" onclick="playerToggle()">stages of evolution.

Dr Robertson: So, what do you think, is it related to her recent illness or to the antibiotic therapy?

Dr Miller: Well, it could actually be either. This is a fairly typical, and quite severe, case of erythema multiforme or what’s called Stevens-Johnson syndrome. The lesions with the central blister are quite characteristic.

Dr Robertson: Oh yes. Is that what they call target lesions?

Dr Miller: That’s right. In about half the cases we can’t discover the etiology of erythema multiforme but one of the most common causes is drug hypersensitivity.

Dr Robertson: And, no doubt, penicillins are frequently implicated.

Dr Miller: Yes, and sulfonamides as well. However, we also see it in response to streptococcal infections, and viruses such as herpes simplex can be responsible, especially in recurrent cases.

Dr Robertson: There certainly isn’t any known allergy to penicillins in Mrs Davies’ case. Are you going to mit', 'If a physician admits a patient to hospital, the patient is kept at the hospital for test or treatment. ', 'The doctor admitted the patient the day before the operation.','')" onmouseout="hide()" onclick="playerToggle()">admit her to the ward?

Dr Miller: I think we should. Patients with the severe form like her can be quite sick. We also need to do some investigations and make sure we’re not missing anything. I’ll phone my Senior House Officer. ', 'In the British hospital system, a senior house officer is a young doctor who has completed one year as a house officer and is now beginning to train in different aspects of hospital medicine before specializing. (In the United States, Resident 1st year)','')" onmouseout="hide()" onclick="playerToggle()">SHO and then I can see her again when I get back to the hospital.

Dr Robertson: Thanks. I’ll go and pic•ture', 'If you put someone in the picture, you tell them about a situation which they need to know about. ', 'Before you go in to see the patient, ask the nurse put you in the picture about her condition.','')" onmouseout="hide()" onclick="playerToggle()">put her in the picture and then I’ll organize transport for her admission.

Three hours later, Dr Miller is in her office at the hospital and talking to her Senior House Officer, Dr Tan.

Dr Miller: Has Mrs Davies settled in?

Dr Tan: Yes, although she’s really not very well.

Dr Miller: No. It’s lucky that my clinic at the Health Center was today.

Dr Tan: Are you sure she’s got Stevens-Johnson syndrome or could this be something else?

Dr Miller: It’s a fairly classical case and any other diagnosis is quite unlikely, but we do need to check a few other things, just to be on the safe side, you do it as a precaution, in case something unexpected happens. ', 'I will be back in an hour, but just to be on the safe side, I’ll give you a number you can call in case you need me.','')" onmouseout="hide()" onclick="playerToggle()">to be on the safe side.

Dr Tan: What other differential diagnoses are there?

Dr Miller: Well, with lesions on her palms and soles, we must exclude secondary syphilis, although it’s obviously unlikely.

Dr Tan: Since she’s got bullous lesions and orogenital ulceration, I suppose we need to consider diseases like pemphigus and pemphigoid.

Dr Miller: We do, although she’s rather young for both conditions and pemphigus tends to have a much more trac•ted', 'If something is protracted, it lasts a long time.', 'You may not be better for several months, it is a very protracted illness.','')" onmouseout="hide()" onclick="playerToggle()">protracted course. Pemphigoid and one other possibility, bullous dermatitis herpetiformis, are usually more chronic, the mucous membrane involvement is less and there isn’t generally much systemic up•set', 'If you have an upset in some part of your body, you have a slight disturbance or disruption. ', 'I have a stomach upset because of what I ate last night.','')" onmouseout="hide()" onclick="playerToggle()">upset.

Dr Tan: Could she have Behçet’s syndrome?

Dr Miller: It’s fairly uncommon and usually associated with more systemic symptoms. The only other possibilities are systemic lupus erythematosus, septicemia, and very rarely, something like a lymphoma.

Dr Tan: I’ve organized a throat swab, he uses a small piece of cotton wool on a stick or wire to collect bacteriological material. ', 'Let’s do a swab to collect some pus from the infection.','')" onmouseout="hide()" onclick="playerToggle()">swab, an Anti-streptolysin O.', '','')" onmouseout="hide()" onclick="playerToggle()">ASO titre and the initial blood for sequential viral studies. What else should I do?

Dr Miller: She ought to have some blood cultures, and we should culture some of the lesions to exclude secondary infection. Can you do the serological tests for syphilis as well?

Dr Tan: Does she need a skin biopsy?

Dr Miller: I don’t think so. Not at this stage, anyway. I would only do a skin biopsy if there was some doubt about the diagnosis and then it would be a question of excluding some of the rarer conditions we’ve just talked about.

Dr Tan: Does she need intravenous fluids?

Dr Miller: It may be necessary if she’s having problems drinking. I’ll come and see her with you again now and then we can think about that.

Dr Tan: Thank you.

To test your listening skills, use the Exercise version of the text to fill in words in the blank spaces provided as you hear them.