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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

↓ ↓ ↓ ↓

*We use 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

↓ ↓ ↓ ↓

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*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.

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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?

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Synonyms: 1. Differentiate = distinguish = tell the difference

between 2. Precipitants =factors which cause something 3. Productive = producing a substance 4. Siblings = brothers and sisters 5. Water-works = the urinary system 6. Perform = do something 7. Suffering from = has\have got = enduring 8. Refrain from = avoid 9. Susceptible = prone 10. Intermittent = comes and goes

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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