22

Contents

1 Perspectives on personalityIntroduction Vices versus virtues (and vice versa) A moral primer Vices and virtues: A sketchy sampler 8

Writing (1) Paragraph development Supporting a topic sentence with generalizations and specific examples 10

Vocabulary (1) It takes all kinds (Part I) Using context clues Personality portraits A-F Time out for review 11

Grammar (1) Adjectives: Frequently tested topics Order of adjectives: Mnemonics to the rescue Adjectives that are not adjectives 15

Vocabulary (2) It takes all kinds (Part II) Personality portraits G-P Time out for review 17

Cloze A closer look How to handle a cloze passage Practice: Amelia Earheart: The lady vanishes 21

Grammar (2) Predicate adjectives Using adjectives after stative verbs (predicate adjectives) 24

Vocabulary (3) It takes all kinds (Part III) Personality portraits Q-Z Time out for review 26

Reading Skimming and scanning The importance of skimming and scanning Practice: Presidents at gunpoint 30

Writing (2) The importance of clear structure The Tell Them prototype Topic: Early role models 32

Exam practice (1) 34

3 Health and medicineIntroduction First day of med school Weve come a long way, baby! A sickness by any other name Whats up, doc?

Time out for review70

Writing (1) Paragraph development Linking: The power of complex sentence structure 73

Vocabulary (1) Anatomy 101 In the beginning All systems go! Other systems in brief 74

Grammar (1) Clauses (Part 1) Noun clauses Relative clauses From theory into practice 78

Cloze Easily confused words and word forms

Practice (1): Easily confused word forms (Passage: Epidemic in the Sudan) Practice (2): Easily confused words (Passage: Whooping cough)

81

Vocabulary (2) In sickness and in health ... until death do us part

Sicknesses and symptoms Routine check-up (preposition and particle practice) Anatomical idioms

84

Grammar (2) Clauses (Part II) Adverbial clauses and related structures Participle clauses From theory into practice 87

Vocabulary (3) Daunting developmentsThe conquest of disease Diagnostic technology Surgical advances Reproductive medicine Time out for review

90

Reading Visualizing metaphors Practice (1): Drug abuse Practice (2): Commando viruses to the rescue 93

Writing (2) The for and against essay Topic: Genetic engineering 96

Exam practice (3) 98

Skill area Topic Featured subjects Page

Introduction ....................................................................................................................................................................................................... 4

About the Michigan ECPE: Overview Results ECPE writing criteria ....................................................................................................... 6

2 Flora and faunaIntroduction Biodiversity What on earth is biodiversity? Home sweet home Biodiversity under attack

On the brink38

Writing (1) Paragraph development Earth Day contest: wildlife threat (jumbled paragraph) 40

Vocabulary (1) The plant kingdom (flora) Our debt to plants Plant points to ponder Plants in action Get the picture? Itchy eyes, sneezing, and the sex life of flowers Time out for review

41

Grammar (1) Verb alert! (Part 1) Handling ECPE verb-tense questions Back to basics: Commandments 1-5 From theory into practice

45

Vocabulary (2) The animal kingdom (fauna) Whats what and whos who? The phylum Chordata Be fruitful and multiply A guide to -vores A pictures worth a thousand words Beyond zoology Time out for review

48

Cloze Reference words Tracking down reference words Practice: Close encounters of the natural kind 53

Grammar (2) Verb alert! (Part II) Back to basics: Commandments 6-10 From theory into practice 55

Vocabulary (3) Animal language in action Animal movements Actions speak louder than words! Animal idioms 58

Reading Tracking down technical terms Losing your fear of technical writing Practice: Co-evolution 61

Writing (2) The problem/solution essay Topic: Wildlife at risk: analysis of local problem + steps to correct it 64

Exam practice (2) 66

33

Contents

Skill area Topic Featured subjects Page

4 Environmentalism 101Introduction In the beginning ... The biosphere and the forces that have helped to shape it In praise of erosion:

Waxing eloquent in Nevadas Valley of Fire Enter Homo sapiens ...102

Writing (1) Paragraph development Writing introductions Which is better: objective or imaginative? 107

Vocabulary (1) Pandoras box Global warming Declining air quality Declining water quality Time out for review 108

Grammar (1) Emphatic structures: Inversion Inversion with negative adverbials and so/such Inversion in emphatic conditionals From theory into practice

112

Vocabulary (2) Disasters wrought by nature Kobe earthquake Volcanoes, melting glaciers, and flooding in Iceland Hurricanes Andrew and Katrina Time out for review

114

Cloze Linking words Finding missing links in a writers train of thought Practice (1): Establishing relationships within short contexts Practice (2): Finding missing links in a text analyzing cause and effect

117

Vocabulary (3) Disasters wrought by man Chernobyl Mumbais urban nightmare Sea of Japan oil spill Time out for review 120

Grammar (2) The subjunctive and other message-intensifying phrases

The subjunctive mood Common colloquial intensifiers 123

Reading Coping with texts that describe a process

How to handle process descriptions Practice: Whats an El Nio? 125

Writing (2) The opinion essay Acknowledging the complexity of an issue Topic: Pesticides 128

Exam practice (4) 130

5 Technological transitionsIntroduction Technology and innovation What is technology? What drives technology forward? Ingenious 19th-century

innovations Techno adjectives for a brave new world134

Writing (1) Paragraph development The importance of mechanics 137

Vocabulary (1) 20th-century milestones Mass production Radar Laser Integrated circuits Time out for review 138

Grammar Gerunds and infinitives Handling ECPE questions with gerunds and infinitives From theory into practice 141

Vocabulary (2) Techno buzz words Interlocking revolutions High-tech computer spin-offs Time out for review 144

Cloze Parallel structure Dealing with cloze items testing parallel structure Practice: Robo-revolution 147

Vocabulary (3) Other hot techno themesFood technology and the Green Revolution Medicine and biotechnology Time out for review

150

ReadingCoping with typical ECPE techno passages

Characteristics of typical ECPE techno passages and questions Practice: Seeing is believing (past ECPE techno extracts)

153

Writing (2) Time management Developing a time-management approach to ECPE writing Topic: Automation 156

Exam practice (5) 158

Grammar reference ......................................................................................................................................................................................... 162

ECPE?Follow me!

70

Health and medicine3Introduction First day of med school

Weve come a long way, baby! The purpose of the text below is not only to introduce you to the early history of medicine, but also to remind you that you can usually understand the gist (or general meaning) of what the writer is saying without understanding every single word.

STEP 1: Skim through the text in the blue box. Then circle the choice that best sums up the main idea:

a) Early humans were surprisingly bad at treating and preventing illness.

b) Before the 5th century B.C., little was known about the real nature of disease.

1. In the view of our early ancestors, what was the cause of most diseases?

2. List 3 ways that the ancients tried to prevent illness and 5 methods of treatment.

Prevention:

Treatment:

3. What important contribution did Hippocrates make in the 5th century B.C.?

STEP 3: Now read the text again and find the words that correspond to the meanings below. (The meanings reflect the order in which the words appear in the text. For verbs, use the base form.)

a. say (sth) is caused by

b. evil, intending harm

c. keep away, turn aside

d. make, cause to become

e. not fit to live in

f. force to leave, drive out

g. magical drinks or liquids

h. produce, cause, bring about

i. broken

j. important development

k. doctor

l. unclean and unhealthy

STEP 2: Read through the text again, and scan for the answers to the questions below. As you read, circle any unfamiliar words, but dont worry about them yet. Focus only on finding the details you need to answer the questions.

Medicine has come a long way since prehistoric times, when early humans attributed most diseases to the influence

of malevolent demons who entered the body of unsuspecting victims. Paleopathologists have found evidence

indicating that preventive medicine in those days involved the use of magic, dancing, and lucky charms to ward off

evil spirits. If demons did manage to enter the body, then efforts were made to render it uninhabitable by beating,

torturing, or starving the patient. Attempts were also made to expel demons by using potions that induced violent

vomiting or by drilling a hole in the skull from which a demon could be driven out. Not surprisingly, such therapies

had limited success, but to their credit our Neolithic ancestors were better at dealing with wounds and fractured

bones. Limited progress was made by the Egyptians and other Mesopotamian cultures, but the real breakthrough was

made by the Greek physician Hippocrates in the 5th century B.C. Challenging the idea that disease was punishment

sent from the gods, he is believed to have been the first to suggest a connection between disease and unsanitary

environmental conditions such as poor water and food quality.

71

Health and medicine 3

affliction ailment disability disease disorder illness impairment

1. The word is an uncountable noun meaning the condition of being ill (i.e., not in good health): e.g., If your son shows signs of ~, take him to a doctor. Mental ~ is a taboo subject for many people. It can also be used as a countable noun to refer to a period of ill health: e.g., He died after a prolonged ~.

2. A(n) is a specific illness such as influenza or chicken pox or a condition involving the improper functioning of an organ or system: e.g., ~s like hepatitis and asthma, a heart/lung ~.

3. The word is used for an illness that is not very serious (e.g., the common cold); it derives from ail, which means to trouble in body or mind: e.g., Whats ~ing you?

4. A(n) is a disturbance of the normal workings of the body or mind: e.g., a rare nerve ~, an eating ~.

5. The word refers to an injury, illness, or condition that restricts the way a person lives: e.g., paralysis is a physical ~, dyslexia is a learning ~.

6. When ones speech, hearing, or sight has been damaged but not totally destroyed, the word is used: e.g., a speech ~. It derives from impair, meaning to damage or weaken.

7. is a formal word meaning something that causes great physical or mental suffering: e.g., AIDS is a terrible ~. It derives from the verb afflict, which is often used passively to mean suffer from: e.g., She is afflicted with diabetes.

C Whats up, doc? The meaning of most of the words in the green boxes below will already be familiar to you. Discuss them, and then use them to complete the two texts.

diagnose fatigue fever fracture rash swelling symptoms tenderness

A doctors ability to (1) (or identify) a disease depends on an accurate recognition of its

(2) (signs of illness). These may range from signals such as pain, (3)

(higher than normal body temperature), (4) (extreme tiredness), or (5)

(soreness) of muscles or organs to visible signs such as a (6) (red spots on the skin) or (7)

(enlargement). X-rays and routine lab tests may turn up a wide variety of other problems, such as a bone (8)

(break) or changes in the cells, nerves, or blood that can only be detected with the aid of a microscope.

alleviate anesthetize cure inject operate prescribe preserve set stitch treat

New doctors must take the Hippocratic Oath, a promise that they will do their best to (9)

(reduce, lessen) suffering and (10) (maintain) life. Doctors can (11)

(give medical care to) their patients in a variety of ways, but there is no guarantee that they will

(12) everyone (bring about a full recovery). If the problem is minor, they can

(13) (recommend the use of) medication or use a syringe to (14)

you with antibiotics. If you cut yourself deeply, they can (15) (sew) up the wound. If

your leg or arm is broken, they can (16) it (put it back in place) and immobilize it in a

plaster cast. If the problem is more serious, they may be forced to (17) you (make you

unconscious) and (18) (perform surgery).

B A sickness by any other name Use the words in the box to fill in the blanks. Some are very close in meaning, but dont give up: items 1, 3, 6, and 7 contain clues that will help you start to work things out.

72

Health and medicine3Time out for review First day of med school

Prosthetic surgery (verbs nouns) Change each verb to a noun by adding on one of the noun suffixes in the box and making other spelling changes as necessary. Then use ten of the nouns to complete sentences 1-8.

ail

expel

treat

swell

afflict

impair

starve

prevent

preserve

diagnose

prescribe

disable

-ability -ation -ing -is -ment -sion -tion

1. Both of his legs were crushed in the accident, leaving him with a permanent .

2. Since the explosion, shes suffered from a serious hearing .

3. Look at your finger! Its twice the size it usually is. What caused the ?

4. His refusal to study resulted in his from medical school.

5. In the United States, you can buy medicines for common s (e.g., colds or the flu) without having to get a from your doctor.

6. My family doctor is fond of saying that is by far the best for disease.

7. Doctors sometimes face a difficult moral dilemma. Which should be their higher priority: the alleviation of suffering or the of life?

8. The civil war in this poor African nation is a terrible . If food supplies dont reach the area soon, many villagers will die of .

B Medical mix and match In part 1, pair up the adjectives and nouns to fill in the blanks with common adjective + noun combinations. In part 2, pair up the verbs and nouns.

1.

a. Theres nothing wrong. Shes just seeing her physician for a .

b. The writer died after years of suffering from a .

c. Dyslexia is a common .

d. X-ray technicians frequently deal with patients who have .

e. The goal of is to avoid disease by promoting strategies for healthy living.

a. Modern imaging techniques such as CAT scans and MRIs enable doctors to

much more accurately than they could in the past.

b. New doctors must in which they promise to do their best to

and suffering.

c. If you suspect that someone has accidentally swallowed poison, call the Poison Center immediately. Do not

unless a qualified person tells you to do so.

d. The Smiths were relieved when the surgeon told them it would not be necessary for him to

on their year-old infant.

Adjectives fractured learning preventive prolonged routine

Nouns bones disability examination illness medicine

Verbs alleviate diagnose induce perform take

Nouns an oath disease pain surgery vomiting

2.

73

Health and medicine 3Paragraph development Writing (1)

Warm-up In pairs, combine each set of sentences into one sentence. Then compare answers with several other pairs. Discuss the different solutions and decide whose is the most effective. What structures did you use to combine your ideas?

In addition to assessing your ability to organize and develop your ideas in a series of well-structured paragraphs, ECPE examiners will also be looking for evidence of your ability to use a range of complex sentence structures. This section will give you practice in combining simple ideas into complex sentences. It will also remind you of some of the structures you can use to make your writing richer and more varied.

Linking: The power of complex sentence structureSKILLS FOCUS How can I link thee? Let me count the

ways ...

1. The first category includes certain diseases. Some of these are pneumonia, cholera, AIDS, and influenza. These are caused by microscopic organisms. The microorganisms are known as germs.

The first category includes

2. Sometimes a disease can be communicated or passed from one person to another. This kind of disease is known as a communicable disease.

When a disease

3. There is another word. It is commonly used to describe such diseases. The word is contagious. It means catching or able to be spread by direct or indirect contact.

Another word

Try it! On notebook paper, combine the simple sentences below into a paragraph with fewer, but more complex sentences. When you finish, compare answers with several other students, and decide whose answer is most effective.

There is the second large category. It includes diseases. Some of these are cancer, diabetes, cirrhosis, and heart disease. There are also others. They are not caused by living organisms. They are known as non-infectious disease. They are now the leading cause of mortality (or loss of life) in the industrialized world. Not all causes of these diseases are known. Scientists have found out some things. Some can be traced to long-term exposure to harmful substances. These substances are found in the workplace or environment. Here is an example. Miners breathe in coal dust. They do this for many years. They may develop a disease. It is called black lung. Other diseases may stem from another thing. It is known as harmful lifestyle. The following is now widely accepted. Smoking, alcohol, overeating, lack of exercise, and stress are harmful habits. They make people susceptible to a wide range of chronic and potentially fatal disorders.

B Analyze it! Look at your work and see if you used any of the following. If not, what other structures did you use?

compound sentence impersonal passive noun clause prepositional phrase

pronoun reference relative clause reduced participle clause

Asking for trouble ...

74

Health and medicine3Vocabulary (1) Anatomy 101

Warm-up In pairs or small groups, discuss the questions, and then share your answers with the class.

1. How does human life begin and what happens as the single-celled life starts to develop in its mothers body?

2. What do you know about DNA, genes, and chromosomes?

In the beginning Read the two texts below. Then match the boldfaced words with their meanings.

1. Human life is the sum of many individual cells organized in specific ways. It begins with fertilization, when the nucleus of a sperm cell combines with the nucleus of an ovum (or egg). The result is a zygote, a single cell that contains hereditary (or genetic) material from both parents: 23 pairs of chromosomes, each of which consists of a single, long, thin, twisting bit of DNA. DNA is an amazingly complex chain of chemicals that is uniquely different in each and every living thing. This is because the genes that we inherit from our parents are incorporated into the DNA molecule that makes up each chromosome. How the zygote develops is determined by the unique combination of genes that are in its DNA. Its as if the genes carry with them a detailed genetic blueprint (or building plan) that controls what happens at every stage of the new organisms development.

a. deoxyribonucleic acid

b. small unit of living matter

c. female reproductive cell

d. male reproductive cell

e. thin structures of DNA that

carry genetic information

f. baby starter cell

g. conception, start of new life

h. central part of cell

i. inherited, passed on

j. subunits of DNA that contain

inherited characteristics

2. About thirty hours after conception, the single-celled zygote divides into two cells, which divide into four, then eight, and so on until a hollow ball of cells called a blastula is formed. The blastula attaches itself to the wall of the mothers uterus, where it continues to develop: first into an embryo and later into a fetus, until it is born as a human infant nine months later. Development within the uterus occurs in the amniotic sac, through which the embryo receives nourishment from its mothers body via the umbilical cord. The process is nothing short of miraculous. Following the blueprint in the genes, the new cells are like do it themselves building blocks. By the second week, they have already formed into groups and become specialized units known as tissues, from which the skin, bones, nerves, muscles, blood, and other parts of the body will form. By the end of the first month, all major organs have begun to develop. The eyes are visible, arms and legs have begun to bud, and the heart has already begun to beat.

a. baby early prenatal1 phase

b. baby later prenatal phase

c. baby birth to two years

d. food needed for growth

e. specialized masses of cells

f. organ in which baby develops

g. sac in (f) where baby develops

h. what ties baby to mother

1 before birthFetus in amn

iotic sac.

Can you see the umbilical

cord?

75

Health and medicine 3B All systems go! This section is designed to acquaint you with the major systems and organs of the body so they come as

no surprise if you encounter them on an exam.

Warm-up Work in pairs or small groups, and then share your answers with the class.

1. Without looking at the texts in this section, make a list of the vital organs you know in English. What function does each one perform?

2. Describe some of the systems that help the body function. Which do you find most fascinating?

circulatory digestive muscular nervous respiratory skeletal

As you work through the texts on pages 75-77, use a word from the box to fill in the name of each system. Then label the diagrams with the boldfaced words. (You may want to write equivalents in your own language next to the English labels.)

1. The system provides the body with support and protection of its vital organs and the system enables us to move. The adult human skeleton is composed of 206 bones that are bound together by tough bands of tissue called ligaments. The places where bones join together are known as joints. Movement depends on the contraction (or tightening) of the skeletal muscles, which are attached to the bones by tendons. The bones are filled with a fatty substance called bone marrow, where red and white blood corpuscles (cells) are produced.

a.

b.

2. The system is a vast network in which billions of neurons (or nerve cells) in the brain communicate with millions more in the rest of the body to transfer sensory impressions, control muscle movement, and regulate involuntary processes such as heartbeat, breathing, digestion, and hormone production. The system is divided into two subsystems: the central nervous system (consisting of the brain and spinal cord) and the peripheral nervous system (which extends throughout the body). The three main areas of the brain are: the cerebrum (or forebrain, which includes the cerebral cortex or brain surface); the brain stem (midbrain); and the cerebellum (hindbrain).

a.

c.

d.

b.

e.

f.

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Health and medicine3

3. The (or cardiovascular) system serves a dual purpose: first, to circulate oxygen-rich, nutrient-laden blood to all parts of the body and, second, to carry carbon dioxide (CO2) and other waste away from the cells. The system includes: the heart, a four-chambered muscular organ that pumps blood through the system; the lungs, or breathing organs, which filter CO2 from the blood and replace it with oxygen; and a complex network of blood vessels through which the blood flows. The latter consists of arteries, which carry oxygen-rich blood away from the left side of the heart; veins, which carry oxygen-poor blood back to the right side of the heart, where it is sent to the lungs for oxygenation; and tiny, hair-like capillaries that connect the arteries and veins.

a.

a.

b.

c.

d.

e.

f.

g.

4. The system is responsible for breathing. Air is sucked into the nose and mouth and down through the trachea (or windpipe), which divides into two long, hollow tubes called bronchi (plural of bronchus), which extend into the lungs. Inside each lung, the bronchus branches out into smaller and smaller tubes called bronchioles, which end in small air balloons known as alveoli (plural of alveolus). These are surrounded by tiny blood vessels known as capillaries, through which oxygen enters the blood and carbon dioxide is removed. Inhalation (breathing in) and exhalation (breathing out) are controlled by the diaphragm, a large muscle under the lungs.

a.

b.

c.

d.

e.

f.

g.

b.

c.

d.

77

Health and medicine 35. The system breaks food down so it can be absorbed by the bodys tissues. The

process begins in the mouth, where food mixes with saliva from the salivary glands and is broken up by the teeth and tongue. After it is swallowed, the food travels down the esophagus to the stomach, where it is acted on by gastric acid. It then passes into the small intestine, where much of it is absorbed into the blood. Other organs help out by producing chemicals called enzymes that flow into the small intestine: the liver (a large organ on the right side of the abdominal cavity that produces bile, which breaks down fats); the gall bladder (a small sac under the liver, which stores bile until it is needed); and the pancreas, which produces fluids that break down protein, fat, and starches. Unabsorbed food passes into the large intestine, where water and minerals are absorbed into the blood. The remaining solid waste exits the body through the rectum.

a.

b.

c.

d.

e.

f.

C Other systems in brief Match the words in the box with the descriptions

endocrine system immune system reproductive system urinary system

a. helps the body defend itself against antigens (disease-causing germs). Includes various white blood cells, such as phagocytes and macrophages (which surround lymphocytes, which make antibodies).

b. relieves the body of liquid waste known as urine via the bean-shaped filters called kidneys and the bladder (a muscular organ that stores urine until it is ready to be expelled).

c. secretes hormones into the blood by means of chemical-producing sacs called glands. Included are the pancreas and glands such as the pituitary, thyroid, and adrenals.

d. enables the body to produce new life (see page 74 for more information).

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Health and medicine3

Notes

Practice 1 Underline the errors and make corrections on the right, as needed.

1. Did she say was he in which hospital?

2. I wonder does he know a good pediatrician?

3. Who told you that were they seriously mistaken?

4. What does he say and what does he do are two different things!

5. Id like to know what doctor did you see.

6. Its unclear how long has he been ill.

Grammar (1) Clauses (Part I)

Noun clauses A noun clause always acts as part of a main clause. It functions in one of these ways:

as subject How a patient will react is of great concern to the doctor.

as complement The real test is whether or not hell listen to the doctor. It seems/appears (that) the patient will live.

as object of a verb I believe (that) hes putting his health at risk. We just dont understand why people continue to smoke.

as object of a preposition Shes afraid of what the doctor is going to say.

after opinion adjectives Im sure (that) the doctor will be here soon. Hes afraid (that) his injuries are serious.

in reported speech He said (that) he would have to operate. She asked me where the pain was.

Links that, how, however, if/whether/whether or not, what, when, where, which, who, why, whatever, whenever, whichever, whoever

1. Subject noun clauses are singular and require a verb in the third-person singular. Exception: sentences with compound subjects (see examples on blackboard).

2. Many of the linking words used with noun clauses are question words, but the structure remains: link + subject + verb. In other words, there is no need for inversion.

1. What I asked him were confidential.

Where I went and what I did is not your concern. ^

was

^

are

2. I dont understand why does he keep on doing that.

How will a patient react is of great concern to a doctor.

Im worried about what will she do when she finds out.

s^

Practice 2 Underline the noun clause in each sentence. Then choose the correct linking word.

1. I promise to do exactly the doctor says. that what whatever how

2. the doctor suggests is all right with me. That When Whatever How

3. Can they explain the patient died so suddenly? whether what that why

4. shes still alive is something of a miracle. That However If That which

5. you begin treatment is up to you. Is next week OK? However Whatever That When

6. Its not clear they are going to operate or not. when whether where that

79

Health and medicine 3B Relative clauses A relative clause describes a noun or pronoun, and is positioned directly after the word it describes. It

may also serve as the object of a prepositional phrase that relates back to a noun or pronoun. A relative clause is linked to the word it modifies by means of a relative pronoun or a relative adverb (see Links below). There are two main types:

Links Relative pronouns For people: who, that, whom, whose For things/animals: which, that, whose

Relative adverbs when, where, why

The defining relative clause provides information that is essential to the meaning of the noun or pronoun it modifies. It is never set off with commas. For example:

Dr. Smith was the surgeon who/that performed the heart transplant. The doctor whom/who/that you recommended is excellent. She saved a patient whose kidneys were failing. Thats the hospital where I was born / in which I was born / (that/which) I was born in.

The non-defining relative clause provides information that is extra and not essential to the meaning of the word it modifies. It is always separated from the main clause by commas. For example:

The AIDS epidemic, which once affected mainly gay people, has spread to heterosexuals. Mary, whose sister is a cardiologist, has decided to specialize in orthopedics. The two men, both of whom are gynecologists, are close friends.

Notes 1. That can be used instead of who, whom, or which, but it is never used after commas or prepositions.

2. Whom (for people) and which (for things) must be used after a preposition.

3. When a relative pronoun acts as the subject of a relative clause, the clause cannot have a second subject.

1. Ann Lee, that lives on my block, is a nurse.

2. Shes the doctor on who I depend.^

who

^

whom

3. It was Dr. Smith who he performed the operation.

Hes afflicted with a disease that it has no cure.

Practice Underline the word or phrase that best completes each sentence.

1. The patient was waiting for a heart transplant. died which died that he died who died

2. The disease, once in decline, is now back in full force. that was which it was which was it was

3. Thats Dr. Green, in charge of the Emergency Room. whose whose wife is his wife is who he is

4. Shes a doctor you can put your complete trust. that whom in whom in who

5. The pills prescribed for me have terrible side-effects. who were she whom she which

6. The woman you are speaking is a pediatrician. that who to who about whom

7. The disease suffers from is incurable. from which he which he that he is that

8. Psoriasis is a skin disease is unknown. its cause the cause whose cause which

9. Ten cases were reported, seven were fatal. whose in whom which of which

10. Hes the patient Dr. Casey operated. on whom that on which whose

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Health and medicine3C FROM THEORY INTO PRACTICE Now lets look beyond the basics and see how noun clauses and relative clauses might

be tested on the exam. For items 1-12, circle the correct choice (a-d).

1. He ought to admit the window.

a. he broke c. he break

b. that he breaks d. him breaking

2. The report showed to smoke.

a. how is it risky c. that it is how risky

b. how risky it is d. that how it is risky

3. Did the physical therapist give you exercises for your back?

Not yet, but she told me .

a. not what to do c. that I shouldnt do

b. not what I should do d. what I shouldnt do.

4. a vacation this year depends on how much money I save.

a. If I dont take c. Whether or not I take

b. Should I not take d. To take

5. We couldnt decide to the party or stay home.

a. whether we should go c. whether we go

b. if we went d. between going

6. You should call him you want to or not.

a. even if c. either

b. whether d. in case

7. Ann Baxter is the name of the doctor son I live next door to. a. that her c. to whose b. whose d. whom her

8. Can you apply for the nursing program at any time? No, theres a special date your application must be submitted. a. when by c. in that b. at which d. by which

9. Ive read a lot of articles lately, the most interesting was about new cancer treatments. a. of which c. of that b. that d. it

10. Bob just graduated medical school, no one else in our family has ever done. a. that c. which b. who d. from which

11. The hospital has hired ten new lab technicians, just finished college. a. who most had c. the most of them had b. most of whom have d. that most have

12. One issue that is the reappearance of diseases like malaria and smallpox. a. it is concerning us c. concerns us b. is concerned about d. it is of concern to us

Noun clauses Expect a range of questions testing topics such as: appropriate tense in a that clause (especially after modals or wishes); word order with noun clauses introduced by interrogative words; clauses with if/whether and equivalent structures; and noun clauses as subjects in long complex sentences. Also expect questions to contain wrong choices based on alternative structures (e.g., with gerunds or infinitives).

Relative clauses Common question types range from simple items that test a missing relative pronoun or adverb with or without a preposition (e.g., who, to whom, whose, in which, where) to more complex items that test both structural and lexical issues.

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Health and medicine 3Cloze Easily confused words and word forms

ECPE multiple-choice cloze questions often ask you to distinguish among words and word forms that are easily confused with each other. For example:

At sentence level, you may be asked to choose among different forms of the same word (e.g., cure curative curable incurable or decimated decimate decimation decimating) or words that are similar in meaning but collocate with different prepositions and/or verb structures (e.g., afflicted with vs. suffer from or capable of doing vs. able to do).

At discourse level, you may be asked to choose among words with closely related meanings (e.g., treatment remedy cure or rise arise arouse) or words that sound or look somewhat alike but have different meanings (e.g., infect infest invest). You may also have to discriminate among phrasal verbs or collocations to see which best fits the context.

You can maximize your chances of answering such questions correctly by following a few simple rules.

Always take the time to analyze the choices and the context surrounding each blank to determine whether you are being tested at the sentence level or discourse level.

At sentence level:

w Always check to see what part of speech is missing. This is particularly important if you are asked to choose between different forms of the same word. Eliminate any choices that are obviously wrong. Then study the context carefully to make sure the meaning of the form you choose is logical and appropriate.

w Note whether or not a preposition follows the blank. If it does, then make sure your choice agrees with it. Test-makers frequently test collocations (or set phrases) with this type of question.

At discourse level:

w Try to predict the meaning of the missing item. You can do this by studying the surrounding context.

w Use the context and what you know to rule out any obviously wrong choices. Of course, theres no better medicine than knowing what all the choices mean. But if you do come across unknown phrasal verbs or other lexical items in the choices, then there is nothing wrong with narrowing down the choices based on knowledge that you do have and then making an educated guess. Each choice you can rule out improves your chance of answering correctly by 25%!

Tackling easily confused words and word formsSKILLS FOCUS

Which one?

Part of speech?Preposition after the blank?Obviously wrong choices?Which choices can be ruled out?

Dont panic!

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Health and medicine3 CLOZE PRACTICE (1): Easily confused word forms

STEP 1: Skim the text without looking at choices 1-5. Then answer the following questions.

1. What problem do villagers in southern Sudan face?

2. How does the current situation compare to the situation during the 1980s?

STEP 2: Now work through the text. Use hints 1-5 to help you narrow down your answers.

Droves of villagers throughout Western Equatorial Southern

Sudan are being screened and entered into treatment for sleeping

sickness by doctors and nurses from the International Medical

Corps. An estimated 12,000 people in the Tambura region are

__(1)__ with sleeping sickness, and hundreds of thousands more are at extreme risk of contracting the potentially __(2)__ parasitic disease from infected tsetse flies. Since October 1997, treatment

and __(3)__ efforts have been focused on the town of Ezo in southern Sudan, the presumed epicenter of this recent __(4)__ of sleeping sickness. The disease has remained uncontrolled since

1989 when civil war in Sudan forced the __(5)__ of a Belgian healthcare team who had been working for almost ten years to

eradicate it.

1. a. suffering c. afflicted

b. suffered d. afflicting

2. a. fatality c. deathly

b. fatalistic d. deadly

3. a. eradicated c. eradicable

b. eradicate d. eradication

4. a. resurgence c. stimulated

b. resurgent d. stimulation

5. a. withdrew c. withdrawn

b. withdrawal d. withdraw

1. Note the with after the blank and the fact that youre being asked to choose between the -ed and -ing forms of two different verbs. Also note the are before the blank. Now ask:

Which two choices collocate with from and can thus be ruled out?

Which of the others fits the context: the active -ing form or the passive -ed form?

2. Careful! An adjective is needed to complete the phrase potentially ... parasitic disease, but two of the choices look like adverbs as they end in -ly. Before you panic, remember that some adjectives do end in -ly (daily, monthly, etc.). Consider the following:

Which is clearly a noun and should be ruled out?

Which means pessimistic and should be ruled out?

Which means fatal, likely to cause death and thus fits the context?

3. Logically youre looking for an adjective (or perhaps a noun that acts as an adjective) to collocate with the word efforts. That rules out the verb eradicate (meaning totally destroy, put an end to). Try writing definitions for the phrases below, and choose the one that logically suits the context.

eradicated efforts

eradicable efforts

eradication efforts

4. Review your answers to the questions in Step 1. Then consider the following:

What part of speech is needed to complete the prepositional phrase before the blank?

Which two choices can you rule out?

Which of the others implies a sudden strong reappearance of an old problem?

5. What part of speech is needed in the blank?

Which three choices can automatically be eliminated?

Hints

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Health and medicine 3B CLOZE PRACTICE (2): Easily confused words

This exercise contains discourse-level questions that test vocabulary. Finding the right answers depends not only on your ability to discriminate among the meanings of the four choices but also on your ability to understand the text well enough to determine the meaning that is required in each blank.

STEP 1: Skim the text without looking at choices 1-6. Then answer the following questions.

1. Why is it that whooping cough is not the killer childhood disease that it once was?

2. Why does it now affect so many adults?

STEP 2: Now work through the text. Before choosing an answer, match each choice to its meaning in the hints below. Then check the surrounding sentences carefully, and choose the word that best fits the context.

If you have a cough that just wont go __(1)__ , it could be

pertussis, more commonly known as whooping cough. According to

a recent medical report, one quarter of adults who see their doctor

for __(2)__ cough actually have this bacterial __(3)__ . Once a

killer childhood disease, whooping cough has been in decline for

years due to widespread vaccination of children. But the immunity

can wear __(4)__ in time, and the number of reported adult cases

has been on the __(5)__ recently. In an otherwise healthy adult,

symptoms include coughing, low-grade fever, and runny nose. The

bacterial infection can be treated with antibiotics, which renders it

less contagious and therefore less of a threat to __(6)__ infants.

1. a. back c. down b. away d. off

2. a. resistant c. consistent b. defiant d. persistent

3. a. infestation c. infection b. inflammation d. infraction

4. a. out c. away b. off d. down

5. a. wane c. rise b. verge d. move

6. a. unvaccinated c. resisting b. irresistible d. inoculated

1. go decrease

go return

go leave

go explode

2. rebellious

unchanging, steady

continuing, chronic

(things) unaffected

3. redness, soreness

disease, illness

breaking of a rule/law

invasion of insects or animals

4. wear become weak, thin, useless

wear become thin/hard to see

wear become weak, tired, strained

wear become ineffective, disappear

5. on the about to experience/happen

on the in motion

on the increasing

on the decreasing

6. charming, attractive

not immunized

opposing, fighting back

immunized (protected against illness)

Hints

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Health and medicine3Vocabulary (2) In sickness and in health until death do us part

Sicknesses and symptoms Hippocrates would have recognized some of the ailments in the box from his knowledge of Greek. Which ones are you familiar with? Share your knowledge with your classmates.

arteriosclerosis epilepsy hemophilia sinusitis sleeping sickness stroke

Now skim each text and fill in the missing disease. Then read each one a second time and match the boldfaced words with their meanings. (Note: Unless noted, the boldfaced words are nouns.)

a. light-headed, spinning feeling

b. ability to control arms/legs

c. lack of brightness

1. (or brain attack) is Americas third leading cause of death (after heart disease and cancer) and the leading cause of adult disability. More than 500,000 Americans are afflicted and nearly 150,000 die each year. Despite this grim toll, however, it ranks low in the publics awareness. Many lives might be saved if more people recognized the following warning signs: difficulty speaking or understanding even simple sentences; sudden weakness, numbness, or paralysis of the face, arm, or leg; sudden dimness or loss of vision, particularly in one eye; a sudden, severe headache; and temporary dizziness or loss of balance or coordination, especially if occurring along with one of the other warning signs.

a. enemy

b. state of deep unconsciousness

c. things that causes great suffering

d. state of total indifference

d. loss of physical feeling

e. number killed or injured

f. (pp) made to suffer

3. , officially called African trypanosomiasis, has again become one of Africas biggest public health scourges. It begins with the tsetse, a fly with a nasty taste for blood. If your fly is carrying the trypanosome parasite, its bite can transmit the disease. If left untreated, it can put you on course for a slow, agonizing, and certain death. An unpleasant, flulike feeling sets in as you fight a foe that multiplies and tricks your immune system by changing its outer coat. Sooner or later, parasites inflame your brain, causing weird changes in your behavior, personality, and sleep patterns. You sink into a zombielike apathy and eventually lapse into a coma that ends in death. The World Health Organization estimates that each year 250,000 to 300,000 are left to suffer and die because their illness has gone undiagnosed and untreated.

e. (adj) causing great suffering

f. (v) pass along to sb/sth

g. (v) pass/fall (into a worse state)

h. (v) cause swelling, pain, redness

a. wound, injury

b. sudden, quick moving

c. emissions, things sent out

2. is a chronic brain disorder characterized by repeated seizures (or convulsions). The seizures can occur as a result of underlying brain damage or a structural brain lesion or as part of a systemic medical illness; in some cases they appear to have no organic cause. Seizures differ with the type of condition and may consist of loss of consciousness, jerking of parts of the body, emotional explosions, and/or periods of mental confusion. In individuals suffering from the disease, the brain waves, which are manifestations of electrical activity in the cerebral cortex, have an abnormal rhythm produced by excessive nerve-cell discharges.

d. sudden attacks (of this disease)

e. clear indications

f. state of being aware

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Health and medicine 3

a. skull, head bone

b. painful redness and swelling

c. distinctive characteristics

d. state of being blocked/full

4. (or inflammation and congestion of the cavities of the cranium around the eyes) may follow a cold or occur independently but be misdiagnosed as a lingering cold. As with ear infections, several strains of bacteria that cause this condition have developed resistance to older antibiotics, resulting in chronic and recurrent infections. Fever, chills, thick nasal discharge, and pain around the eyes are the hallmarks.

a. repetition, happening again

b. layers of built-up matter

c. recovery process

d. blockage

e. empty spaces in something solid

f. kinds, types, breeds

g. (adj) slow to leave; drawn-out

h. (adj) repeated, reappearing

6. The major form of heart disease in the West is atherosclerosis, in which fatty deposits called plaque (made up of cholesterol and fats) build up on the inner walls of the coronary arteries. Atherosclerosis is actually a form of , or hardening of the arteries. In atherosclerosis, narrowing of the arteries gradually restricts the blood flow to the heart. Symptoms may include shortness of breath and a tight pain in the chest called angina pectoris. The plaque may become thick enough to totally obstruct the artery, causing a sudden decrease in the hearts oxygen supply. Obstruction can occur when a piece of plaque breaks away and lodges further along in the artery. This is the major cause of heart attack, which is often fatal. Survivors must undergo extensive rehabilitation, and there is always the risk of a recurrence.

e. (v) limits, confines

f. (v) becomes stuck

g. (v) block, impede

h. (v) experience, be put through

a. bleeding in large amounts

b. blackish-blue marks on skin

c. arrival of sth important

d. ( v) thicken, form lumps

e. (adj) inherited

f. (adj) continuing non-stop

Symptoms synonymous Each group contains three words that have something in common and a fourth that is unrelated. Underline the odd one out, and be ready to explain what the other three have in common.

1. lingering temporary chronic persistent

2. resistance protection immunity susceptibility

3. seizure wound injury lesion

4. scourge rehabilitation suffering affliction

5. symptom manifestation diagnosis hallmark

6. restriction recurrence obstruction blockage

5. is a hereditary blood disease characterized by the inability of the blood to clot. This leads to massive bleeding, even from minor injuries. The disease is caused by an insufficiency or absence of certain blood proteins that aid in blood clotting. The bleeding may occur as excessive bruising or persistent bleeding after a simple cut. Hemorrhaging into joints and muscles can be disabling. Before the advent of modern therapy, the chance of surviving to adulthood was poor.

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Health and medicine3B Routine check-up (preposition and particle practice) The paragraphs below contain useful health phrases. Use the

words in each box to fill in the blanks. Some may be used more than once.

1. down in over to under up

If youre healthy, you can say youre good health or good shape/condition. If youre feeling ill, you can say youre feeling the weather, run , or not quite par. In extreme cases, you may feel like death warmed (or warmed , in British English).

2. above down from in of out over to under up with

If you think youre coming something, youd better have a check- to see whats

wrong you. Chances are youre only suffering a common cold or a touch the flu,

but most doctors will want to look you carefully. Theyll ask you if your temperature is normal or if

you are pain. They may also ask if you are short breath or if you are stress at work.

Then theyll subject you a physical exam. Before prescribing anything, theyll ask if you are allergic

any medications.

3. at for from in of on to under

If doctors suspect something serious, they may refer you a specialist, who may want to operate you. In this case youll need to be scheduled surgery and admitted a hospital. Before the operation, you will be put anesthesia. If all goes well, you will be discharged the hospital a matter days and back your feet no time all.

4. against from in to up

Children are vaccinated early life to build their resistance (or immunity) certain

diseases. Elderly people who have weak immune systems and are susceptible respiratory infections may want

to get an annual flu shot to protect themselves (or ) infection.

5. at for of to

A great number of ailments are attributed smoking. Smokers run the risk developing heart disease and

cancer the lungs. Passive smokers are also risk these diseases.

chest ears elbow finger heads lungs nose stomach shoulder thumbs

All but two of the body parts in the box are shown in the picture. Which are not?

C Anatomical idioms Complete the sentences with words from the box. When you finish, go back and underline the idioms and discuss what each means. Do any have equivalents in your own language?

1. She finds it hard to movies that have a lot of violence.

2. Perhaps I can help. Two are better than one.

3. If you need to, you can always cry on my .

4. Youll feel better if you get your problems off your .

5. Upon seeing the mouse, she screamed at the top of her .

6. Tell me the good news. Im all !

7. Michael is always dropping things. Hes all .

8. The spoiled girl has her parents wrapped around her little .

9. The eager photographer had to his way through the crowd.

10. Good journalists know how to out a good story.

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Health and medicine 3Grammar (2) Clauses (Part II)

Adverbial clauses and related structures Adverbial clauses and related structures (e.g., prepositional phrases and infinitives of purpose) can be used to express a wide range of functions, such as time or place, reason or purpose, and so on (see chart below). When tackling a grammar or cloze item that involves one of these structures, its important that you focus on the incomplete clause or phrase and try to work out what its role is. For example:

Does it express an action that happens before or after an action in the main clause?

Does it present information that contrasts with the main idea?

Does it explain why something happens in the main clause?

Recognizing the function and, in turn, knowing what linking words can be used to introduce this function will help you choose the option that best fits the meaning of the gapped sentence.

Here is a summary of the main functions and their links. (For examples of sentences in which these links are used, see Grammar Reference, page 171.)

Time When? before, after, as, as long as, as soon as, by, by the time, the minute, the moment, once, since, till, until, when, whenever, while

Place Where? where, wherever

Reason Why? as, since, because, for, now that, because/due to/owing to the fact that Related structures: because of/due to/owing to + noun/-ing

Purpose For what purpose? in case + present/past; so that + can/will or could/would; for fear (that)/lest + might/should Related structures: to/in order (not) to/so as (not) to + base form; in case of + noun; with a view to/with the aim of + -ing; for + -ing, for fear of sth /-ing sth, to prevent sb from + -ing, to avoid + -ing

Result So/Such that what happens? that (after so/such), so

Concession and Contrast

Although what contrasting condition exists? although, even though, though, in spite of/despite the fact that, while, whereas, however/no matter how , whatever/no matter what , adj/adv + though/as + subject + verb Related structures: in spite of/despite + noun/-ing, regardless of

Manner How? In what way? as, as if, as though, in that

Function Question prompt and common links

Practice Underline the adverbial clause in each item, decide its function, and underline the best answer. Function

1. The baby was born they got to the clinic. whenever until before while

2. doctors go, people ask them for advice. However Wherever When Though

3. Ann eats so much she is overweight. because despite in case that

4. He coughs a lot his excessive smoking. in case of due to for fear of despite

5. She gave me her number an emergency. in case of despite as to avoid

6. She looks she is going to faint. though although if as though

7. ill he was, he insisted on going to work. Whenever However Though As

8. She studied hard becoming a doctor. so as to with a view to to for

9. He put off seeing the doctor he was ill! in that despite due to for fear that

10. he begins treatment, hell feel much better. Once Before Since Now that

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Health and medicine3

Relative clause (active voice) Reduced form (with -ing participle)

Ed is on the train that is arriving now. Ed is on the train arriving now.

Anyone who attended the class was bored. Anyone attending the class was bored.

Eve, who lives in a village now, is very happy. Living in a village now, Eve is very happy.

Note 1 To reduce a clause whose subject is different from the subject of the main clause, we must place the subject before the participle.

Since it was dark, they walked quickly. It being dark, they walked quickly.

B Participle clauses Participle clauses are formed with present (or -ing) participles and past participles. They are reduced forms of relative and adverbial clauses.

Study the examples, and discuss the differences you see between each full and reduced form.

1. PARTICIPLE CLAUSES that are reduced forms of RELATIVE CLAUSES

Relative clause (passive voice) Reduced form (with past participle)

Als wearing a tie which was bought by Sue. Als wearing a tie bought by Sue.

Ed, who was born on July 4th, is a real patriot. Born on July 4th, Ed is a real patriot.

Clauses with while and active clauses Reduced form (with -ing participle) with because, as, since

They discussed work while they had lunch. While having lunch, they discussed work.

Because/Since I felt ill, I stayed home. Feeling ill, I stayed home.

As/Since Im not rich, I cant buy a Porsche. Not being rich, I cant buy a Porsche.

2. PARTICIPLE CLAUSES that are reduced forms of ADVERBIAL CLAUSES

Note 2 To emphasize that the action in a reduced clause occurs before the action in the main clause, we use the perfect form of the participle: i.e., having + past participle:

He felt better as he had seen her. Having seen her, he felt better.

Passive clauses with because, as, since Reduced form (with past participle)

Because/Since he was fed up, he quit his job. Fed up, he quit his job.

As he was exhausted, he went straight to sleep. Exhausted, he went straight to sleep.

Practice: Anatomy of a not-so-broken heart Complete the story with the present (-ing) or past participle form of the verbs in parentheses. Pay special attention to the time markers in bold (see Note 2 above).

(1) (determine) to work things out, the quarreling couple had agreed to meet. Now, (2)

(sit) in his home, they chatted quietly. When the mood seemed right, he pulled her close and thats when everything

changed! Without warning, she pulled away, (3) (slap) him hard. (4) (discover)

the day before that he had another girlfriend, she knew that her love for him had died. (5) (stun), he

watched her slam the door and walk out of his life forever. On the street below, it now (6) (be)

3 a.m., our heroine failed to find a taxi, so she set out on foot. (7) (trudge) through the darkness, she

contemplated her stupidity. After all, (8) (end) her last relationship in the same way, she should

have known better. (9) (arrive) home after a two-hour trek, she grabbed her diary and wrote in

disgust: Women (10) (decide) to break off a relationship should do so early in the evening.

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Health and medicine 3

Adverbial clauses Question types range from items that ask you to fill in the correct link to more complex items that test both structural topics (e.g., word order, tense, related structures) as well as lexical issues. Answers often contain lower-frequency linking words (e.g., once instead of as soon as, or since instead of because), while wrong choices are often structurally possible but illogical in context.

C FROM THEORY INTO PRACTICE Now lets look beyond the basics and see how adverbial clauses and participle clauses might be tested on the exam. For items 1-12, circle the correct choice (a-d).

1. he cancelled tomorrows meeting, lets meet to discuss sales. a. Since c. Once b. After d. When

2. We can leave you finish packing. a. until c. afterwards b. since d. once

3. I planted a hedge, people could see into my yard. a. Whenever c. Until b. Since d. Because

4. the doctors optimism, the patient did not recover. a. Although c. Regardless b. Despite d. On the contrary

5. Eve ran she could to help the old man. a. so fast that c. faster so b. as fast as d. faster than

6. The nurses are on strike because of happy with pay cuts. a. they werent c. they hadnt been b. not to be d. their not being

Participle clauses Items testing participle clauses seem to be on the rise in recent years. Always start by analyzing what is in the question stem. Then try to predict the full form of what is missing. If choices start with both past and present participles, use what you know about participle reductions to help you narrow down the choices.

7. from working six hours straight, she finally took a break. a. She was tired c. Tired b. Had she been tired d. Tiring

8. The people for the bus looked tired and upset. a. waited c. are waiting b. waiting d. have been waiting

9. The conclusion in the article is that the drug is harmful. a. is presented c. presenting b. is presenting d. presented

10. happy in his new job, John missed his old colleagues. a. Although c. Despite b. Usually d. Even

11. Did the aide give Mr. Smith his medicine? No, told it was necessary, she didnt. a. not having been c. had she not been told b. she hadnt been d. her not being

12. She works long hours, difficult to see her friends. a. making c. makes b. makes it d. making it

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Health and medicine3Vocabulary (3) Daunting developments

The conquest of disease Read the following text, taking note of the boldfaced words. When you finish, check the accuracy of statements 1-7. If a statement is true, write T. If it is false, correct it.

Thanks to stunning advances in preventive medicine and technology, the 20th century saw a major increase in life expectancy (how long an average person lives) and a great decline in infant mortality (i.e., a statistic that compares the number of babies who die to the number of babies born). Scientists managed to eradicate (totally destroy or put an end to) diseases like smallpox and the bubonic plague, which could once decimate (or destroy a large part of) major segments of the population. A major factor has been improved sanitation i.e., providing safe water supplies, regulated food sources, and adequate rubbish-disposal and sewage systems (or underground networks that remove human and industrial waste). A major role has also been played by advances in immunology (the study of how the body protects itself against disease) and the introduction of mass immunization, whereby large groups (e.g., school-age children) are vaccinated (or inoculated) with substances that protect them against various infectious diseases. Finally, vast improvements in hospitals, health clinics, and health-insurance plans guarantee that basic health care is now available to many more people than ever before. In the 21st century, scientists will continue to combat old foes like cancer (a disease marked by abnormal cell growth) and new diseases like AIDS. They will also have to cope with a resurgence (i.e., a reappearance or renewed wave) of old diseases as microorganisms evolve and develop resistance (immunity) to 20th-century antibiotics.

1. Diseases like smallpox have been immunized in the 20th century.

2. Sanitation is the study of how the body protects itself from disease.

3. Immunity to disease is the same thing as resurgence.

4. Life expectancy has fallen off dramatically in the past century.

5. AIDS is a disease that is characterized by unusual cell growth.

6. Sewage systems contribute to a safer, more sanitary environment.

7. We decimate or eradicate children to build up their resistance to disease.

Diagnostic technology You should be able to unlock the meaning of most of the words in the box by searching out their Greek and Latin roots. Underline the roots that you recognize. After discussing the possible meanings with your classmates, use the words to complete the text.

Technology now allows us to diagnose a wide array of diseases with great precision. If a patient has a(n)

(1) (i.e., an abnormal growth), a(n) (2) can be performed in which tissue is removed and analyzed under a microscope to determine if it is

(3) (harmless) or (4) (cancerous). Heart disease may be detected by a(n) (5) (a test that records the electrical impulses of the heart). If doctors suspect blocked blood vessels, they may send you for a(n) (6) (an X-ray taken after injecting dye into blood vessels around the heart). Another exciting advance is (7) technology, which uses sound waves to project images on a video screen. Neurological diagnosis has greatly been aided by the (8) , which traces electrical activity in the brain. Even more (9) (complex, advanced) are techniques such as Computerized Axial Tomography (CAT scans) and Nuclear Magnetic Resonance Imaging (NMRI).

Nouns angiogram biopsy electrocardiogram electroencephalogram tumor

Adjectives benign malignant sophisticated ultrasound

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Health and medicine 3C Surgical advances You can get a feel for some of the boxed words (a) by looking for clues in the roots and (b) by looking

for words that remind you of words in your own language. Share your observations with your classmate, and then use the words to complete the text.

bloodless bypasses cataracts incision microsurgical prosthetic devices severed transplant

Astounding advances have also been made in surgical procedures. Surgeons

can now reattach (1) (completely cut off) limbs

with the aid of (2) techniques that allow them

to repair nerves and blood vessels with high-powered microscopes. In

addition, people who have lost arms or legs can be surgically fitted with

battery-powered artificial limbs called (3) .

Heart surgeons can not only repair leaky heart valves, but they can also

construct (4) (or detours) around narrowed

segments of arteries or veins. Great strides have also been made in

(5) medicine, where an organ (e.g., a heart,

liver, or kidney) is taken from one person and placed into another. Finally,

thanks to advances in laser technology, high-tech (6)

surgical techniques are now being used to repair bone and joint

damage, remove (7) from the eyes, and treat

hard-to-reach brain tumors without surgeons having to make even the

tiniest (8) (surgical cut).

D Reproductive medicine When it comes to having babies, women now have a wide range of options that were not available fifty years ago. Explore the roots and possible meaning of the words in the box, and then use the words to complete the text.

amniocentesis artificial insemination conceiving congenital fertility oral contraceptives

The development of (1) (or birth-control pills) in 1960 now seems old hat compared

to other developments that have occurred in reproductive medicine. Thanks to (2)

(analysis of the fluid in the amniotic sac) and other forms of prenatal testing, doctors are now able to diagnose

a wide array of illnesses in unborn children that are either inherited or (3) (resulting

from faulty fetal development). Women who have trouble (4) (becoming pregnant)

may be helped by drugs that increase their (5) (ability to produce

life). They may also try (6) , where

ova are fertilized by sperm outside the body under laboratory

conditions. With gene therapy, cloning, and other feats of genetic

engineering now coming into their own, who knows what

advances will be made over the next few decades?

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Health and medicine3Time out for review Anatomy Symptoms Developments

Disease control center The goal of this exercise is to remind you that medical terminology in many languages draws heavily on Greek. Use your knowledge of your own language to help you match the diseases in the box with their descriptions.

Its all Greek to me!

anemia arteriosclerosis asthma arthritis bronchitis cirrhosis diabetes hemophilia leukemia pneumonia

1. a condition in which there are too few red blood cells in the blood

2. type of cancer marked by the overproduction of white blood cells

3. hardening of the arteries, often caused by old age and/or a high cholesterol count

4. the bleeders disease: people who have this bleed extensively, even from a small cut, because their blood clots more slowly than normal

5. respiratory disease often brought on by allergies (e.g., to dust, pollen, and animal fur); symptoms include a tightness in the chest, shortness of breath, and wheezing

6. infection and inflammation of the inner lining of the airways in the lungs, characterized by a bad cough

7. infection and inflammation of one or both lungs

8. liver disease in which healthy cells are replaced with thick scar tissue

9. disorder of the metabolism, characterized by underproduction of insulin, which results in undesirably high levels of sugar in the blood

10. condition causing pain, stiffness, and swelling of the knee, wrist, and/or other joints of the body

B Word forms Fill in the blanks with nouns derived from the boldfaced words in the definitions on the right.

1. the state of being mortal _ _ _ _ _ _ _ _ _

2. the substance that people are vaccinated with _ _ _ _ _ _ _

3. a place through which sewage is channeled _ _ _ _ _

4. the act of eradicating (or putting an end to) something _ _ _ _ _ _ _ _ _ _ _

5. the act of conceiving something (e.g., a baby or an idea) _ _ _ _ _ _ _ _ _ _

6. the act of avoiding or protecting against conceiving _ _ _ _ _ _ _ _ _ _ _ _ _

7. another word for a prosthetic device _ _ _ _ _ _ _ _ _ _

8. another word for a malignant tumor _ _ _ _ _ _ _ _ _ _

9. what you have if you are immune to something _ _ _ _ _ _ _ _

10. what you have if you are resistant to something _ _ _ _ _ _ _ _ _ _

11. the study of genes and inherited characteristics _ _ _ _ _ _ _ _

12. the passing on of hereditary (i.e., inherited) traits from _ _ _ _ _ _ _ _ one generation to the next

When you come across technical vocabulary, remember to slow down and look for clues within the words that will help you unlock their meanings.

Exam tip

93

Health and medicine 3Reading Visualizing metaphors

In Unit 2 we saw how writers help their readers follow them by defining technical terms the first time they are used. Another technique they use is to describe an object or process with figurative language that is, with metaphors or comparisons that create a lasting image in the readers mind. Think back, for example, to the first time you learned about the human body in science class. Your teacher probably introduced you to some parts of the body by comparing them to machines or building materials.

Warm-up See if you can match the words in the box to the devices, systems, or other objects to which they are commonly compared.

brain cell DNA heart nervous system urinary system

a. computer CPU

b. electrical wiring

c. pump

d. building block

e. plumbing/drainage system

f. genetic blueprint

Writers often use metaphors to help them explain complex subjects. When you encounter one, do your best to visualize the image the writer describes. The more clearly you can see it in your mind, the easier it will be to understand and remember.

No magic bullet can eradicate drug abuse overnight, but treatment does bring sustained reduction in drug use.

The metaphor of a war on drugs is misleading, however. It implies a lightning, overwhelming attack. We defeat

an enemy. But who is the enemy in this case? Its our own children. Its our fellow employees. The metaphor

starts to break down. The United States does not wage war on its own c