English Language Connected Speech and Pronunciation Elements
"How are you?" in this question, the inflection or accent is important. The speakers tone rises on "are" since they are the first to inquire over the other person. When responding as in "Fine, how are you?" the accent or rising tone shifts to the word "You."
The word "terrible" can present two specific problems. One is with the pronunciation of the "ble" ending in which the tongue is curled upwards to touch the hard palate lightly. The second problem might be with learners confusing "terrible" with "terrific" which of course are antonyms though they are similar in pronunciation.
The phrase, "… when you’re really sick" presents the grammatical use of adverbs before adjectives. How adverbs like extremely, really, very, pretty, fairly and somewhat are used in context as adjective modifiers makes for an excellent separate grammar lesson. So really then, what’s the difference between being extremely sick, really sick, very sick, fairly sick and somewhat sick as compared to just plain sick?
"Really?" This confirmation discourse marker is very similar in concept to those used in other foreign languages. It is always interesting to review how, when and where these can be used in a variety of conversational situations. This sort of English grammar point often does not appear in textbooks, courses or conversation club practice, yet is an integral element in colloquial conversations in English. "Yeah" is another confirmation discourse marker that can be applied over a broad range of conversational situations.