1. Present perfect and past simple *We use the Present Perfect for actions which happen in the past at any time up to now . The exact time is not known or not defined. a- ? ? ? Now ↓ ↓ ↓ ↓ *Weuse the Past Simple for specific times in the past .The exact time is known or defined. b- Last Year/Two days ago/ Yesterday ,etc. Now ↓ ↓ ↓ ↓

2. *When you take a history , pay attention to the patient’s use of the Past Simple and the Present Perfect. Look at this statement: • In recent years many developments both technological and social, have occurred. The time of the occurrence of each event is not specific . • I started work as a GP in this area over 20 years ago. The tense is the Past Simple. The time is specific. Look at diagram B above.

3. Pronunciation2 Questions : Rising and falling intonation • Spoken questions usually either rise or fall at the end. Short questions used in taking general history usually rise. The doctor is asking for a quick yes or no. If falling intonation were used, it could make the patient feel that the doctor is expecting a certain answer. Ex: DOCTOR: Is your appetite OK? PATIENT: Yes, I never seem to have any problems on that score. DOCTOR: Bowels OK?

4. Synonyms: • Differentiate = distinguish = tell the difference between • Precipitants =factors which cause something • Productive = producing a substance • Siblings = brothers and sisters • Water-works = the urinary system • Perform = do something • Suffering from = has\have got = enduring • Refrain from = avoid • Susceptible = prone • Intermittent = comes and goes

5. 11. Persistent = constant = there all the time 12. Adhere = stick to 13. Hospitalized = admitted 14. Scheduled = booked 15. Precipitate = trigger 16. Deprivation = poverty 17. Factors = causes 18. Plateau = level 19. Pronounced (adj.) = evident 20. Volunteer = a person who works without payment