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3 Figure 4 Figure 5 150 CHAPTER 13 Case Reports could not be obtained. At the second attempt, we were Case 31 able to vizualize the lesion using a UM - 3R probe with a guide sheath. The margins of the target lesion are Moderately differentiated adenocarcinoma (two blood well - defi ned but irregular. At the edge of the lesion, vessels entering the lesion detected). we can see two round hypoechoic structures, thought Moderately differentiated adenocarcinoma of the right to be blood vessel passing through the lesion (yellow S5 b region. arrows). Leaving the guide sheath in position, we removed the ultrasonic probe, introduced an endo- Presenting Complaint: E Result from bronchial cytology brush into the guide sheath, and Sputum Cytology at Municipal Health Check we were able to identify adenocarcinoma cells from History: Adenocarcinoma cells detected on sputum the brushings. cytology at municipal health check. The patient Histopathological examination (low magnifi cation, underwent right middle lobectomy + R2 a: sT1N0M0, Figure 3 ): The target lesion is a moderately differenti- P0, D0, E0, PM0: s - stage IA. We compared the preop- ated adenocarcinoma. In this specimen, sliced in the erative EBUS images and the histopathological same plane as the EBUS image, we can see two bron- fi ndings. chial arteries in the periphery of the tumor, corre- CT scan chest (Figure 1 ): A nodular opacity of largest sponding to the two round hypoechoic structures in diameter 15 mm can be seen in the right S 5 b region. the EBUS image (yellow arrows). Preoperative EBUS fi ndings (Figure 2 ): At the fi rst One of the merits of EBUS for periphery pulmonary bronchoscopy, the endobronchial cytology brush lesions is that it can be used in the place of fl uoroscopy passed through the lesion, and a defi nitive diagnosis to identify the location of a lesion. Figure 2 Figure 1 Figure 3 151 Endobronchial Ultrasonography from the tumor that had been taken up by the nearby Case 32 alveoli. Fluoroscopy at the time of EBUS (Figure 2 ): Although Moderately differentiated adenocarcinoma (detectable the nodular opacity could not be seen under fl uoros- using EBUS, but not fl uoroscopy). copy, the probe introduced into the left B3 a bronchus Moderately differentiated adenocarcinoma of the left was successful in delineating the target lesion. S3 a region. Preoperative EBUS fi ndings (Figure 3 ): The margins of the target lesion are well - defi ned but irregular. A Presenting Complaint: Abnormal Opacity plaque - shaped hyperechoic area can be seen in one Seen on Plain Chest Radiograph at part of the lesion, but the majority of the target lesion Municipal Health Check shows an irregular heterogeneous internal echo History: A nodular opacity was seen in the left S 3 a pattern, with no blood vessels or hyperechoic areas. region on plain chest radiograph at municipal health Histopathological examination (low magnifi cation, check. A class V adenocarcinoma was diagnosed from Figure 4 ): The target lesion is a moderately differenti- the endobronchial brushing cytology. The patient ated adenocarcinoma. It is a highly cellular tumor, underwent left upper lobectomy + R 2 a: sT1N0M0, P0, with only one air- containing area. The plaque - shaped D0, E0, PM0: s - stage IA. We compared the preopera- hyperechoic area corresponded to compressed blood tive EBUS images and the histopathological fi ndings. vessels and bronchioles. CT scan chest (Figure 1 ): A nodular opacity of One of the merits of EBUS for periphery pulmonary largest diameter 20 mm can be seen in the left S 3 a lesions is that it can be used in the place of fl uoroscopy region. The tumor was surrounded by hemorrhage to identify the location of a lesion. Figure 1 Figure 3 Figure 2 Figure 4 152 CHAPTER 13 Case Reports compared the preoperative EBUS images and the his- Case 33 topathological fi ndings. CT scan chest (Figure 1 ): A nodular opacity of Poorly differentiated adenocarcinoma (no blood vessels largest diameter 8 mm can be seen in the right S5 b or bronchioles detectable within the lesion). region, drawing in the adjacent pleura. Poorly differentiated adenocarcinoma of the right S 5 b Preoperative EBUS fi ndings (Figure 2 ): We intro- region. duced an UM- 3R ultrasonic probe into the right S5 b bronchus, and visualized the target lesion. The margins of the target lesion are well - defi ned but irregular. Presenting Complaint: Abnormal Opacity Collapse of the pleural surface has been delineated on CT Scan Chest During Follow- Up after (arrow). No blood vessels, hyperechoic spots or lines Surgery for Left Lower Lobe Moderately can be seen. Differentiated Adenocarcinoma Histopathological examination (low magnifi cation, History: The patient underwent left lower lobectomy Figure 3 ): The target lesion is a poorly differentiated (t2n0m0, stage IB) for left lower lobe moderately dif- adenocarcinoma. It is a solid tumor, with no air- ferentiated adenocarcinoma. An 8 mm opacity was containing areas. seen in the right S 5 b region on follow- up CT scan chest EBUS fi ndings of no blood vessels or hyperechoic 3 years 6 months after surgery. The patient underwent spots within a lesion are characteristic of poorly dif- right middle lobectomy + R 2 a: t1n2m0, stage IIIA. We ferentiated adenocarcinoma. Figure 1 Figure 3 Figure 2 153 Endobronchial Ultrasonography diameter 30 mm can be seen in the right S3 b Case 34 region. EBUS fi ndings (Figure 2 ): We introduced an UM - 3R Poorly differentiated adenocarcinoma (no blood ultrasonic probe into the right S 3 b bronchus, and vessels or bronchioles detectable within the lesion). vizualized the target lesion. The margins of the target Poorly differentiated adenocarcinoma of the right S3 b lesion are well - defi ned. No blood vessels, hyperechoic region. spots or lines can be seen. EBUS fi ndings of no blood vessels or hyperechoic Presenting Complaint: Abnormal Opacity spots within a lesion are characteristic of poorly dif- on CT Scan Chest ferentiated adenocarcinoma. CT scan chest (Figure 1 ): A nodular opacity of largest Figure 1 Figure 2 154 CHAPTER 13 Case Reports pared the preoperative EBUS images and the his- Case 35 topathological fi ndings. CT scan chest (Figures 1 , 2) : A nodular opacity of Moderately differentiated squamous cell carcinoma largest diameter 25 mm can be seen in the left S9 a (hyperechoic spots caused by tumor invasion of region, invading the adjacent emphysematous lung. emphysematous area). Preoperative EBUS fi ndings (Figure 3 ): The margins Moderately differentiated squamous cell carcinoma in of the target lesion are indistinct, with no identifi able the left S 9 region. border. A few hyperechoic points, refl ecting the pres- 25 × 22 × 20 mm. ence of air, can be seen in the central part of the lesion, and some hyperechoic points are scattered Presenting Complaint: Abnormal Opacity irregularly around the tumor margins. Seen on Plain Chest Radiograph at Histopathological examination (low magnifi cation, Municipal Health Check Figure 4 ): This is a squamous cell carcinoma with a History: Abnormal opacity seen on plain chest radio- tendency in one area towards keratinisation, forming graph at municipal health check. CT scanning and invasive nests if large and small irregular sheets as it bronchoscopy revealed a nodular lesion in the left S 9 proliferates. At its periphery, it invades the adjacent region. A class V squamous cell carcinoma was diag- emphysematous lung. nosed from the endobronchial brushing cytology. The The hyperechoic points in the EBUS image corre- patient underwent left lower lobectomy + R 2 a: spond to air contained in emphysematous lung that sT1N1M0, P0, D0, E0, PxM0: c - stage IIA. We com- has been invaded at the periphery of the tumor. Figure 1 Figure 2 Figure 3 Figure 4 155 Endobronchial Ultrasonography We compared the preoperative EBUS images and the Case 36 histopathological fi ndings. CT scan chest (Figure 1 ): A nodular opacity of Metastatic squamous cell carcinoma (areas of cystic largest diameter 45 mm can be seen in the left lower change within the tumor). lobe, compressing the pulmonary artery at its edge. Metastatic squamous cell carcinoma in the left lower Preoperative EBUS fi ndings (Figures 2 , 3) : The lobe. margins of the target lesion are well - defi ned but irreg- ular. Multiple round anechoic areas are seen within Presenting Complaint: Abnormal Opacity the lesion. Seen on Plain Chest Radiograph after Histopathological examination (low magnifi cation, Surgery for Cancer of the Floor of Figure 4 ): This is a squamous cell carcinoma with a the Mouth tendency in one area towards keratinization, forming History: Abnormal opacity seen on plain chest radio- invasive nests if large and small irregular sheets as it graph during follow- up after surgery for cancer of proliferates, consistent with metastatic oral cancer. the fl oor of the mouth. Bronchoscopy revealed a Multiple necrotic fl uid fi lled cysts are seen within this nodular lesion in the left S 9 region. Class V squamous tumor. cell carcinoma, thought to be metastatic oral cancer, The multiple round anechoic areas in the EBUS was diagnosed from the endobronchial brushing cytol- image correspond to the histopathological fi nding of ogy. The patient underwent left lower lobectomy + R2 . necrotic fl uid- fi lled cysts. Figure 1 Figure 2 Figure 3 Figure 4 156 CHAPTER 13 Case Reports CT scan chest (Figure 1 ): An elongated nodular Case 37 opacity of largest diameter 15 mm can be seen in the left S 8 a region. Small cell carcinoma in a peripheral bronchus (direct Preoperative EBUS fi ndings (Figure 2 ): The target invasion of adjacent pulmonary artery). lesion was rounded with well - defi ned margins. At its Small cell carcinoma (intermediate type) in the left periphery it contains a ribbon - like hypoechoic struc- S8 a region. ture, thought to be a blood vessel passing through the 15 × 10 × 5 mm lesion (arrow). Histopathological examination (low magnifi cation, Figure 3 ): The target lesion is a small cell carcinoma, Presenting Complaint: Abnormal Opacity intermediate type. In this specimen, sliced in the same Seen on Plain Chest Radiograph At plane as the EBUS image, we can see a pulmonary Municipal Health Check artery corresponding to the ribbon - like hypoechoic History: Abnormal opacity seen on plain chest radio- structure in the EBUS image (arrow). graph at municipal health check. The patient then The fi ndings in this case were of a small cell carci- underwent left lower lobectomy + R2 a: s- T1N0M0, noma, arising in the bronchial wall, directly invading s - stage IA. a pulmonary artery running beside the bronchus. Figure 1 Figure 2 Figure 3 157 Endobronchial Ultrasonography CT scan chest (Figure 1 ): A snowman - shaped Case 38 nodular opacity can be seen in the left S 1 + 2 c region. Bronchoscopic fi ndings (Figure 2 ): A polypoid lesion A snowman - shaped carcinoid tumor. is seen obstructing the right B1 + 2 c bronchus. Typical carcinoid in the left S1 + 2 c region. Preoperative EBUS fi ndings (Figures 3, 4 ): We intro- duced an UM- 3R ultrasonic probe into the left B1 + 2c Presenting Complaint: Enlargement of bronchus between the polypoid lesion and the bron- Abnormal Opacity Seen on Plain Chest chial wall. The tumor is snowman- shaped (Figure 4 ), Radiograph During Follow- Up for with a hyperechoic line at the snowman ’ s neck corre- Diabetes Mellitus sponding to the bronchial cartilage (Figure 3 ). History: Abnormal opacity seen on plain chest radio- Hyperechoic plaques are seen within the lesion (arrow). graph during follow- up for diabetes mellitus with Histopathological examination (Figure 5 ): The target previous doctor 2 years earlier. Referred this year with lesion is snowman - shaped. Bronchial cartilage corre- enlargement of the opacity. Bronchoscopy and biopsy sponds to the hyperechoic line at the snowman ’ s neck, yielded the diagnosis of typical carcinoid in the left indicating that the tumor has invaded the bronchial S1 + 2 c region. The patient then underwent left upper wall from the lumen. The hyperechoic plaques cor- lobectomy + R2 a: t1n0m0, stage IB. respond to hemorrhagic foci. Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 158 CHAPTER 13 |
Case Reports Conclusion Analysis of internal structures in peripheral Bleeding pulmonary lesions using EBUS Calcification Bronchiole Our experience with a large number of cases has Dilatation of shown us that with EBUS we can visualize the internal Vessel bronchus structures in peripheral pulmonary lesions. Analysis of WD the cases where we were able to compare EBUS images Multiple cysts Adenoca with the histopathological fi ndings showed that EBUS can delineate the following structures (Figure 1 ): 1 Blood vessels (with diameters greater than 0.65 mm as measured histopathologically). 2 Normal bronchioles. Figure 1 3 Intratumor hemorrhage (carcinoid tumors). 4 Calcifi cation (moderately differentiated adenocarci- noma, papillary thyroid carcinoma metastases). 5 Dilated bronchi (infl ammatory pseudotumor). 6 Multiple necrotic cysts (squamous cell carcinoma). 7 Alveolar air (well- differentiated adenocarcinoma). blood vessels. The internal echoes are heterogenous. The following characteristics were seen in EBUS 4 Squamous cell carcinoma: Multiple necrotic cysts images related to the histological type and degree of are seen. When a tumor is located between the hilum differentiation of lung cancers: and pleura, the probe can be passed through the 1 Well - differentiated adenocarcinoma: Hyperechoic middle of the lesion (bronchial lumen) and the tumor dots and lines (usually less than 1 mm in size), repre- can be seen to compress the bronchial cartilage and senting alveolar air, are irregularly distributed though adventitia as it proliferates. these lesions. Patent blood vessels may or may not be 5 Small cell carcinoma: Thickening of the submucosal present. tissue is seen due to tumor infi ltration. Tumor some- 2 Moderately differentiated adenocarcinoma: Hypere- times involves a bronchial artery running alongside choic dots and lines (greater than 1 mm in size), repre- the affected bronchus. senting compressed blood vessels and bronchioles, are With its superior tissue resolution, EBUS can deline- see within these lesions. The internal echoes are het- ate structures that cannot be visualized using CT or erogeneous. Patent blood vessels are rarely seen. other imaging modalities. EBUS is a tool that can 3 Poorly differentiated adenocarcinoma: No hypere- provide new information to the fi eld of diagnostic choic dots or lines are seen within lesions, nor patent imaging. 159 Appendix: Videos Video clip A1: EBUS - TBNA for No.4L lymph node. 1:07 –1 :17 seconds 0 – 0:6 seconds After puncturing, the stylet was advanced into the end of the A lymph node of No.4L was enlarged. needle to prevent plugging of the bronchial wall. 0:6 – 0:19 seconds 1:17 –1 :31 seconds A lymph node of about 2cm in diameter was observed at A - P The needle was moved back and forth in the lesion. window between aortic arch and left pulmonary artery. 0:19 – 0:28 seconds Power Doppler mode revealed vessels in the lymph node. Video clip A3: EBUS - TBNA for left No.10 lymph node 0:28 – 0:42 seconds with the Navigation System. The TBNA needle was advanced into the tracheal wall. 0 – 0:6 seconds 0:42 – 0:53 seconds A lymph node of left No.10 was enlarged. We could see the real- time movement of the needle in the lymph 0:6 –0 :35 seconds node. The Navigation System (Olympus) showed the location of the 0:53 – 1:20 seconds target lymph node beside the left main bronchus. Seven or eight strokes of the movement of needle were 0:35 –0 :55 seconds performed. The probe of the bronchoscope was attached at the inner surface beside the lymph node. 0:55 –1 :09 seconds The lymph node was located between left main pulmonary artery Video clip A2: EBUS - TBNA for No.12m lymph node. and descending aorta. 0 – 0:7 seconds 1:09 –1 :20 seconds A lymph node of No.12m was enlarged. The bronchoscopist decided the angle of the scope providing the 0:7 – 0:13 seconds largest area of the lymph node. The lymph node was located just beside the middle lobe 1:20 –1 :55 seconds bronchus. Using power Doppler mode, we should not puncture the bronchial 0:13 – 0:28 seconds artery outside the lymph node. The tip of the bronchoscope was introduced into the middle lobe bronchus. 0:28 – 0:51 seconds Video clip A4: Lesion “ peripheral ” to EBUS miniprobe. The EBUS image revealed the enlarged lymph node beside the 70 - year - old man with lesion in RS10. The EBUS- GS appearance vessel. is of a lesion “ peripheral ” to the probe. This would be expected 0:51 – 1:07 seconds to some extent based on the CT appearance. Biopsies showed Power Doppler mode revealed vessels in the lymph node. adenocarcinoma. Video clip A5: Large white points on EBUS due to air Endobronchial Ultrasonography, 1st edition. spaces within consolidated lung. By Noriaki Kurimoto, David I. K. Fielding and Ali I. Musani. 65 - year - old man. EBUS GS biopsy showed bronchiolitis obliterans Published 2011 by Blackwell Publishing Ltd. organizing pneumonia. Resolved with steroid treatment. Note the 160 Appendix: Videos large white areas around the probe at 1– 2 o’ clock, corresponding Video clip A7: Respiratory movement of EBUS to the air spaces seen on CT. probe in RB10a. (see enclosed JPEG) 55 - year - old man with rounded lesion in S10. note on video there Video clip A6: Changing placement of miniprobe. is a lot of respiratory movement, moving the EBUS probe (in RB10) Lesion in LUL. Notice fi rst entry of EBUS miniprobe shows only the in and out of the lesion. The lesion is homogenous and at the probe next to a pulmonary vessel (at 3 o’ clock in relation to bottom of the lesion open vessels can be seen. Biopsies showed probe.) Probe then removed and placed in 1 subsegment laterally benign atelectasis; no change on CT with 4 years follow - up. and clear difference in EBUS appearance is apparent with probe See accompanying CT. well - centered in 2 cm lesion. 161 Index Note: The following abbreviations are used in the index: EBUS: endobronchial ultrasonography; EUS-FNA: endoscopic ultrasound-guided fi ne needle aspiration; GS: guide sheath; PPL: peripheral pulmonary lesion; TBNA: transbronchial needle aspiration adenocarcinoma 159 Boyer and Icheda’s numerical biopsy forceps 29, 30, 36, 86 case reports system 85–6 bleeding left S3a region 150, 152 EBUS-TBNA 20–5, 53–4 conventional transbronchial lung left S5 region 149 frequently asked questions 25 biopsy 74, 75, 84 left S9 region 147 left bronchi 18–19 EBUS-GS 30, 32, 93, 96, 98 right S1 region 148 lymph nodes 20–5, 36, 37, 53–4 EBUS-guided PPL biopsy 76, 84, 86 right S3b region 154 radiological 53–4 clinical trials 77, 78, 79 right S5b region 151, 153 right bronchi 16–18 EBUS-TBNA 25, 58 EBUS and histopathological anesthesia 12, 27 post-biopsy 97–8 examination, correlation EBUS-TBNA 55–6 TBNA 36, 41, 58 between 63–4, 65–8 aortic arch 24, 25, 38, 54, 112 B-mode ultrasonography 3, 34, 118 EBUS-GS 91–2 aortic root 112 brachiocephalic vein 54 echo strength 73 argon plasma coagulation (APC) 115 brachytherapy 114 endobronchial brushing 28 ascending aorta 36, 112 breast cancer 137 Type II 72, 83 asthma 115–6 brightness (gain) 5, 6–7 IIa 69 atrium 18 bronchi, anatomy IIb 69 attenuation of ultrasound waves left 18–19, 25 Type III 82 31, 96 right 16–18, 25 IIIa 69, 72 axial resolution 3–4 bronchioalveolar carcinoma 73 IIIb 72 azygous vein 54, 112 bronchiolitis obliterans organizing adenoid cystic carcinoma of the pneumonia 160–1 trachea 132 bacteremia 58 bronchitis, chronic 86 adenopathy 59–60 balloon method of examination 7 bronchoscopes 8–10 airway wall assembling the balloon probe 10–11 compatibility with ultrasound probes 9 bronchial tree invasion from outside, equipment 8, 9, 10, 26 EBUS-TBNA 14, 55–6 diagnosis 112 frequently asked questions 15, 36 depth of tumour invasion 98, 99, 100–6, preparation 26–7 carcinoid tumours 118 procedure 26–8 case report 158 diameters, measurement of 106–12, tips 27–8 depth of invasion 102 114, 115 video clips 26, 27 EBUS and histopathological frequency of probes 112–3 benign versus malignant PPLs 72–3, 83 examination, correlation infl ammatory diseases 106–7 biopsy between 68 integrity and tumor involvement 96, peripheral lung 75–6 central airway stenosis 115 113 clinical trials 76–81 children, EBUS-guided PPL biopsy 76 interventional bronchoscopy 112–3 conventional 73–5 cisatracurium 56 laminar structure 96–106 future 84–5 colorectal cancers 104 photodynamic therapy 106 side effects and tolerability 84 computed tomography (CT) thickness, measurement of 115 tips 85–7 abnormal opacities on chest scans alveolitis, infl ammatory 87 transbronchial (TBB) 63, 73–5 adenocarcinoma 147, 153, 154 anatomy of mediastinal and hilar area 16, EBUS-GS 28, 29, 30, 93 breast cancer 137 36, 37 side effects 74, 75, 83–4 squamous cell carcinoma 140 162 Index airway diameters, measurement of 108 future 84–85 image orientation 12 airway involvement by tumors 108, internal structure, analysis of 81–83 pancreas 62 112–13 side effects and tolerability 84 endoscopic ultrasound-guided fi ne anatomy 52, 53 tips 85–87 needle aspiration (EUS-FNA) EBUS-GS 95 PPLs 89, 92, 94 59, 61 EBUS-guided PPL biopsy 75, 79–80, changes in techniques 91–92 endotracheal tubes (ETTs) 33, 54 84, 85 equipment 89 equipment 7–10 EBUS-TBNA 52, 60 procedure 89 balloon probes for central lesions 26 lung cancer diagnosis 60–61 tips 92 EBUS-GS 29, 89 orientation 27 video clip 160 EBUS-guided PPL biopsy 75–76 TBNA 39 preparation 28 EBUS-TBNA 14–15, 32 tracheobronchial wall 96 procedure 29 EUS-FNA 59 contrast, image quality adjustment 5–7 tips 30–32 operation 12–14 cough EBUS-TBNA 42–5 preparations 10–12 adenoid cystic carcinoma of the anatomy 36, 37, 38–39 TBNA 37–39, 40 trachea 132 anesthesia 54 esophageal carcinoma 104, 112–13 needle breakage due to 57 bronchoscope case report 134 organizing pneumonia 141, 142 passing the 54–55 esophagus prevention 26, 56 reach 55 anatomy 18 squamous cell carcinoma 122, 129 set-up 53–54 avoiding the 35 cough technique, TBNA 40, 42 equipment 14–15, 32 interventional bronchoscopy 112 cryptococcosis 144 frequently asked questions 25, 35 etomidate 56 cyst, mediastinal 115 future 118 EUS-FNA 59, 61 cytology, on-site 35, 42, 51, 57 interventional bronchoscopy 115 exertional dyspnea 133 lymph nodes 20–25 depth of tumor invasion, assessment 98, accessible 59, 61 fentanyl 54 99, 100–6, 126 aspirations per target lymph node fever 58, 142, 146 case report 120 station 56 fl uoroscopy 73 future directions 118 most commonly sampled 53 conventional transbronchial lung optimum image quality 13–14 sampling for lung cancer diagnosis biopsy 73–74 depth penetration 5 and staging 59–61 EBUS-GS 91, 92 descending aorta 18 on-site pathology 57 EBUS-guided PPL biopsy 76, 84 diagnostic yields procedure 33, 45–51 clinical trials 77–78, 80 conventional transbronchial lung passing the bronchoscope 54 frequently asked questions 35 biopsy 74 passing the needle through limitations 28 EBUS-GS 29–30, 90–91 the wall 55 frequency 2 EBUS-guided PPL biopsy 77–78, 80–81, radiological anatomy 52 30 MHz versus 20 MHz 112–13 84, 85 samples, obtaining 56 future directions 118 EBUS-TBNA 56 side effects and risks 56 fungal infections, chronic 87 diameters, measurement of airway 106–8, tips 52 future directions 114, 115 electromagnetic navigation bronchoscopy depth of tumor invasion, direct contact method of examination 8, 9, (ENB) 85, 92 evaluation of 118 27 electronic scanning 3, 118 EBUS-guided PPL biopsy 84–85 Doppler mode scanning 33, 118 endobronchial brushing 28, 29, 30, EBUS-TBNA 118 drainage bronchus leading to target lesion, 62, 93 PPLs 84–85, 118–19 identifying the 92 diagnostic yield 30 training 119 dynamic magnetic resonance imaging 71 frequently asked questions 35 dysphagia 134 risks 84 gain (brightness) 5, 6–7 dyspnea, exertional 133 tips 86 gray scale bar 6–7 endobronchial stenting 107, 114 EBUS-GS endobronchial ultrasonography (EBUS) hemomediastinum 58 advantages and benefi ts 32, 91 transbronchial needle aspiration see hemoptysis 121, 124 diagnostic yield 30 EBUS-TBNA hemorrhage see bleeding equipment 9, 28 guide sheath see EBUS-GS hertz (Hz) 2 frequently asked questions 35 endoscopic ultrasonic probes see probes histopathological and ultrasonography history 73, 74 endoscopic ultrasonography (EUS) 1, 59 fi ndings, comparison of peripheral lung biopsy 75–76 advantages 72 depth of tumor invasion 98, 99, 101, clinical trials 76–81 equipment 10 102–4 163 Index laminar structure of airway wall 98, 100 EBUS and intraoperative fi ndings pediatrics, EBUS-guided PPL biopsy 76 PPLs, examination of 62–7, 81 compared 139 penetration, depth 5 history small cell carcinoma 136 performing EBUS 26 of EBUS 1–2 squamous cell carcinoma 135, 140 balloon probes for central lesions 26–8 of EBUS-GS 73, 74 EBUS-TBNA 20–5, 45, 47–51, 52, 54–6 EBUS-TBNA 32–5 hub technique, TBNA 40, 41 video clips 160 frequently asked questions 35 frequently asked questions 25, 35 guide sheath method for peripheral image interventional bronchoscopy 112 pulmonary lesions 28–32 |
Lippincott Williams & Wilkins now offers online teaching advice and student tutoring with this textbook! Instructors – have you ever wanted to: …get help generating classroom activities or discussion ideas from an expert in your discipline? …ask questions about the content of your adopted textbook or ancillary package, and have someone get back to you right away? …have your lesson plans evaluated? Students – have you ever needed: …help studying for a test at a time your instructor was not available? …questions answered outside of class? …feedback on assignments before turning them in? If so, Smarthinking™ is the service you need! Our tutors are handpicked educators that we train to help you. They are very familiar with the textbook you are using in class and the text’s ancillary package. You can connect live to a tutor during certain hours of the week, or send e-mail style messages to which the tutor will respond quickly – often within 24 hours. And the best part - the service is free with the purchase of your textbook! Instructors – to use this service, please visit http://connection.LWW.com/go/smarthinking Students – see the codebook in the back of this book for more details. In it you’ll find instructions for using this great service, along with your own personal code to log on and get started. Medical Terminology The Language of Health Care Second Edition Medical Terminology The Language of Health Care Second Edition Marjorie Canfield Willis, CMA-AC Program Director Medical Assisting/Medical Transcription Programs Orange Coast College Costa Mesa, California Editor: John Goucher Managing Editor: Rebecca Kerins Marketing Manager: Hilary Henderson Production Editor: Bill Cady Designer: Risa Clow Compositor: Maryland Composition Printer: R. R. Donnelley & Sons (Willard) Copyright © 2006 Marjorie Canfield Willis Lippincott, Williams & Wilkins 351 West Camden Street Baltimore, MD 21201 530 Walnut Street Philadelphia, PA 19106 All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system with- out written permission from the copyright owner. The publisher is not responsible (as a matter of product liability, negligence, or otherwise) for any injury resulting from any material contained herein. This publication contains information relating to general prin- ciples of medical care that should not be construed as specific instructions for individual patients. Manufacturers’ product information and package inserts should be reviewed for current information, includ- ing contraindications, dosages, and precautions. Printed in the United States of America First Edition, 1996 Library of Congress Cataloging-in-Publication Data Willis, Marjorie Canfield. Medical terminology : the language of health care / Marjorie Canfield Willis.—2nd ed. p. ; cm. Includes bibliographical references and index. ISBN 0-7817-4510-1 (alk. paper) 1. Medicine—Terminology. I. Title. [DNLM: 1. Medicine—Terminology—English. W 15 W735m 2006] R123.W476 2006 610.14—dc22 2005001177 The publishers have made every effort to trace the copyright holders for borrowed material. If they have inad- vertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 824-7390. International customers should call (301) 714-2324. Visit Lippincott Williams & Wilkins on the Internet: http://www.LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. 05 06 07 08 09 1 2 3 4 5 6 7 8 9 10 Dedicated to the students and faculty of the School of Allied Health Professions Orange Coast College Costa Mesa, California Preface The second edition of Medical Terminology: The Language of Health Care continues in its design to provide a framework for building a medical vocabulary, using an applied approach. Emphasis is on understanding basic medical terms and learning how they are used in documenting and reporting patient care procedures. Practical applications are provided by exercises and medical record analyses in each chapter. The goal is to develop a basic “working” knowledge of the language of health care to serve as a basis for individual expansion. Text Overview Chapter 1 identifies the need for the personal commitment that is required to develop a basic knowledge of medical language. Included are methods of time management, techniques for making use of the senses to reinforce memory, and preparation and use of flash cards. Chapter 2 starts with the origin of medical language, then introduces basic term components (prefixes, suffixes, and a selected number of combining forms) illustrat- ing how these structures are combined to form medical terms. Rules of pronuncia- tion, spelling, and formation of singular and plural forms are included. Medical word components covered in this chapter are used repeatedly throughout the book. Chapter 3 examines the evolution of the physician in medicine and identifies fields of medical practice, including scopes of practice and the expansion of allied health professions. Chapter 4 establishes the basis for the application of learning medical terms covered throughout the text by introducing common forms, formats, abbreviations, symbols, and methods of documenting patient care. This enables the student to understand basic communication between professionals, including physician’s orders and prescriptions. The content of this chapter is reinforced in medical record analyses in succeeding chapters. Periodic review of Chapters 2 and 4 is essential for successful use of this book. Term components first encountered in these chapters are revisited in subsequent chapters to reinforce memory of common term components. Chapters 5 through 17 cover terms related to the body systems. In each chapter, basic anatomical terms are outlined, additional combining forms related to the sys- tem are identified, and common terms and abbreviations related to symptoms, diag- noses, tests, procedures, surgeries, and therapies are identified. Practice exercises at the end of each chapter are designed to reinforce the memory of basic term compo- nents by repetitive word structure analysis. Answers to practice exercises are includ- ed in Appendix D. Another feature of Chapters 5 through 17 is the medical record analysis. Each analysis requires reading a particular medical record and answering questions specific to each. Knowledge of Chapter 4 is a prerequisite for understanding ques- tions presented in the medical record analyses. ix x Preface New to This Edition • Full color throughout • Updated photographs of pathologies and images illustrating the latest in health care technology • Additions and clarifications of pertinent terms • Elimination of the possessive form of ’s in all eponyms to match standardiza- tion initiated in medical dictionaries, e.g., Alzheimer disease, Kaposi sarcoma, and Cushing syndrome • Current information regarding medical abbreviations and symbols deemed error prone • Practice exercises now include a guided system of term analysis, addition of mini medical records, and anatomical labeling exercises BONUS CD-ROM The CD-ROM that accompanies this text provides a wealth of fun and interactive activities for learning reinforcement: • A pronunciation glossary with audio pronunciations • Spelling bees to help recognize and correctly spell terms • Labeling exercises to reinforce and test knowledge of medical terms and anatomy • Games in which terms or components are matched with definitions • Scored and unscored section and chapter quizzes for knowledge assessment • Interactive medical record exercises ADDITIONAL BONUS: QUICK STUDY REFERENCE CARD The laminated Quick Study Reference packaged with this textbook provides a portable study resource that includes key rules for learning medical terms and a summary list of term components with definitions. This invaluable tool facilitates “on the go” learning of critical information. Other Special Features Ancient Artifacts provide historical information about the origins of selected medical terms. More than 50 ancient artifacts are sprinkled in the margins throughout the text. Appendix A summarizes medical term components (prefixes, suffixes, and combin- ing forms) in two lists: (a) term component to English definition and (b) English def- inition to term component. Appendix B provides a glossary of abbreviations and symbols. Appendix C lists commonly prescribed drugs, including therapeutic classifications. Appendix D includes answers to the practice exercises. Answers to medical record analyses are provided in the CD-ROM packaged with the book. Acknowledgments I am so proud of the success of this text and hope the second edition will continue to play an important role in teaching medical terminology. I want to thank the dedicated staff of Lippincott Williams & Wilkins who have combined their many talents to prepare this revision. In addition to those who are appropriately recognized on the copyright page, I especially want to thank my editor, John Goucher. His help was instrumental in the revision and the development of the many ancillaries. We will all benefit from the additional resources that enhance the original text. I continue to enjoy the support of my colleagues at Orange Coast College and many others from professional and technical areas. Particularly, I’d like to acknowl- edge: Kevin Ballinger, Walt Banoczi, Dan Farrell, Fredra Kodama, Ann McClanahan, Eleanor Huang, Linda Harloe, Chrysty Hodson, Richard Reed, MD, Brian Coyne, MD, and Michael J. Deimling, RPh, PhD. I’d also like to recognize the thoughtful assessment and suggestions submitted by the following reviewers: Thomas J. Falen, MA, RHIA, LHRM Tomma Parco, BA Education Undergraduate Program Director Department Chair, Business Health Information Management Technologies Health Services Administration Pueblo Community College University of Central Florida Pueblo, Colorado Orlando, Florida David Pearce Joan Fobbs, PhD Baker College of Cadillac University of Maryland Eastern Shore Cadillac, Michigan Princess Anne, Maryland Charlene Thiessen, CMT Alicia A. Hill, CMA, BS GateWay Community College Ivy Tech State College Northeast Phoenix, Arizona Fort Wayne, Indiana Suzanne Trump, MDiv, OTR/L Craig Kallendorf, PhD University of the Sciences in Professor of Classics and English Philadelphia Texas A&M University Philadelphia, Pennsylvania College Station, Texas Pam Ventgen, CMA, CCS-P, CPC Merrilee McDuffie, MPH Professor, Medical Assisting Front Range Community College– University of Alaska Anchorage Westminster Anchorage, Alaska Westminster, Colorado Flynn W. Warren, MS Theresa Offenberger, CMA-C, PhD University of Georgia Professor, Medical Assisting College of Pharmacy Cuyahoga Community College Athens, Georgia Cleveland, Ohio xi xii Acknowledgments I have enjoyed an incredible relationship with my students, and it is their feedback that has been incorporated in several of the clarifications and additions to this revi- sion. Since the textbook was published, I have found myself responding to an even larger audience of students—all with the same need to learn and grow in the knowl- edge of the language of health care. I thank all these students and appreciate the fact that my book has played a part in their learning success. Last to recognize is my family, who have been steadfast in their caring. I thank them with hugs and kisses: XXOO. M.C.W. Medical Terminology: The Language of Health Care Second Edition Marjorie Canfield Willis USER’S GUIDE edical Terminology: The Language of Health Care, Second Edition M is not just a textbook, it is a complete learning resource that will help you to understand important information and master medical terminology. To achieve this, the author and publisher have included features and tools throughout the text to help you work through the material presented. Please take a few Objectives at moments to look through this User’s Guide, the beginning of each chapter outline the skills which will introduce you to the features that you must know by the end of the chapter. will enhance your learning experience. System Overviews give a review of the anatomy and physiology in order to better understand the medical terminology in the chapter. Ancient Artifacts boxes in the margins provide historical background for commonly used terms. Word Tables outline anatomical terms clearly and concisely with term, pronunciation, and meaning. USER’S GUIDE Medical Terminology: The Language of Health Care Second Edition Numerous Illustrations, photographs, radiographs, micrographs, and images help to illustrate medical terminology and promote greater understanding. Summaries of Acronyms/Abbreviations appear at the end of each chapter. Summary of Chapter 6 Acronyms/Abbreviations A ................anterior MRI...........magnetic resonance imaging AKA ..........above-knee amputation NSAID.....nonsteroidal anti-inflammatory AP...............anterior-posterior OA ............osteoarthritis BKA ..........below-knee amputation ORIF ........open reduction, internal fixation CAT ...........computed axial tomography P ..................posterior CT...............computed tomography PT ...............physical therapy DEXA ......dual-energy x-ray absorptiometry RA ..............rheumatoid arthritis DJD ..........degenerative joint disease ROM.........range of motion EMG .........electromyogram Tx ..............traction Fx ..............fracture x-ray .........radiography USER’S GUIDE Medical Terminology: The Language of Health Care Second Edition 178 Medical Terminology: The Language of Health Care Chapter 6 • Musculoskeletal System 179 30. __________________ myoma smooth muscle tumor 55. arthritis caused |
by hyperuricemia____________________________________________ 31. osteo __________________ softening of bone 56. a partial dislocation ________________________________________________________ 32. __________________ listhesis slipping of a vertebra 57. toward the beginning of a structure __________________________________________ 33. arthro __________________ x-ray of a joint 58. osteomalacia in children ____________________________________________________ 34. __________________ tomy incision into bone 59. physician specializing in x-ray technology ____________________________________ Chapter 6 • Musculoskeletal System 183 35. epiphys __________________ inflammation of the ends of the long bones Match the following terms related to muscles with their meaning: 36. __________________ al pertaining to the neck 60. ________ atrophy a. uncontrolled, stiff, and awkward muscle contractions 37. bony __________________ osis dead bone tissue 61. ________ tremor b. flabby muscle Write in the missing anatomical terms on the blank lines in the following 38. __________________ oma tumor of cartilage 62. ________ spasm c. involuntary muscle contraction illustrations. 39. arthro __________________ puncture for aspiration of a joint 63. ________ rigidity d. prolonged, continuous muscle contraction 40. osteo __________________ repair or reconstruction of bone 64. ________ spastic e. stiff muscle 119–143. For each of the following, circle the combining form that corresponds to the 65. ________ hypertrophy f. rhythmic muscle movement meaning given: 66. ________ flaccid g. increase in the size of a muscle 41. cartilage crani/o cost/o chondr/o 67. ________ tetany h. shrinking of muscle size 120. 42. vertebra myel/o spondyl/o lumb/o 119. Briefly describe the difference between the following terms: 43. bone marrow my/o myel/o muscul/o Face 68. arthrogram/arthroscopy_____________________________________________________ 44. neck thorac/o crani/o cervic/o _______________________________________________________________________________ 45. joint oste/o arthr/o ankyl/o Hyoid 69. rhabdomyoma/rhabdomyosarcoma __________________________________________ 1 46. chest thorac/o cervic/o spondyl/o 122. _______________________________________________________________________________ 47. muscle 2 my/o myel/o lei/o Manubrium 70. osteoarthritis/rheumatoid arthritis ___________________________________________ 3 48. rib stern/o chondr/o cost/o _______________________________________________________________________________ 123. 4 124. Write the correct medical term for each of the following: 71. osteomalacia/osteoporosis___________________________________________________ 5 Ribs _______________________________________________________________________________ 49. lateral curvature of the spine ________________________________________________ 6 7 125. 72. orthosis/prosthesis__________________________________________________________ 50. bone tumor ________________________________________________________________ _______________________________________________________________________________ 8 126. 51. grating sound made by movement of broken bones ____________________________ 9 73. closed reduction, external fixation of a Fx/open reduction, internal fixation of a Fx 10 Vertebral column 52. synonym for bony necrosis __________________________________________________ _______________________________________________________________________________ 11 Iliac crest 53. plane that divides the body into right and left portions _________________________ 74. ankylosis/spondylosis _______________________________________________________ 12 127. 54. application of a pulling force to a fractured or dislocated joint to maintain proper _______________________________________________________________________________ position during healing _____________________________________________________ 128. 129. 130. N 131. umerous Practice Exercises 132. reinforce learning and retention. 133. 121. Pubic bone 134. 141. 142. 135. PRACTICE EXERCISES 136. 137. For the following terms, on the lines below the term, write out the indicated word parts: prefixes (P), combining forms (CF), roots (R), and suffixes (S). Then define the word. 138. 139. 143. EXAMPLE 140. hypertrophy Anterior view Posterior view Color key: Appendicular skeleton _______ / _______ / _______ Axial skeleton P R S hyper/troph/y P R S DEFINITION: above or excessive/nourishment or development/condition or process of 1. thoracic __________________ / __________________ Chapter 6 • Musculoskeletal System 191 M E D I C A L R E C O R D 6 . 3 Jay Dorn, a retired construction worker, has had intermittent back pain for the last 2 months. When he began also having shooting pains in his legs, he went to his doctor at Central Medical Center. After a physical examination, Mr. Dorn underwent a series of back x-rays. Directions Read Medical Record 6.3 for Jay Dorn (page 191) and answer the following questions. This record is the radiographic report dictated by Dr. Mary Volz, the radiographer, af- ter studying Mr. Dorn’s x-rays and later transcribed for the record. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 6 . 3 Write your answers in the spaces provided. 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record and define below: Medical Record 6.3 eburnation _________________________________________________________________ lipping _____________________________________________________________________ Medical Records and Edxisceogrecnics e___s__i_n_ _e_v__e_r_y_ _c_h__a_p__t_e_r_ _w__i_ll_ _h_e_l_p_________________________________ you to apply medical terminolo2.gWy hatn pdh rbausei lidn tchrei triecpaolr tt hinidnikcaintegs tshkati lmlso. re than one x-ray was taken? ____________________________________________________________________________ Does the report state how many x-rays were taken? __________ no __________ yes If yes, how many? ________________________________ 3. In your own words, not using medical terminology, describe the three diagnoses Dr. Volz makes. USER’S GUIDE Medical Terminology: The Language of Health Care Second Edition Laminated Quick Review Guide is a great reference tool with Term Basics, and a comprehensive list of commonly used term components and their meanings. A Bonus CD-ROM packaged with the book includes assessment exercises and Stedman’s audio pronunciations. Contents Preface ..............................................................................................................ix Acknowledgments..............................................................................................xi User’s Guide .....................................................................................................xiii 1 Building a Medical Vocabulary: Getting Started..........................................1 2 Basic Term Components ............................................................................9 3 Fields of Medical Practice ........................................................................38 4 The Medical Record ................................................................................54 5 Integumentary System ..........................................................................107 6 Musculoskeletal System ........................................................................144 7 Cardiovascular System ..........................................................................192 8 Blood and Lymph Systems ....................................................................241 9 Respiratory System................................................................................269 10 Nervous System ....................................................................................310 11 Endocrine System ..................................................................................358 12 Eye ........................................................................................................386 13 Ear ........................................................................................................415 14 Gastrointestinal System ........................................................................437 15 Urinary System ......................................................................................482 16 Male Reproductive System ....................................................................509 17 Female Reproductive System ................................................................535 APPENDICES A Glossary of Prefixes, Suffixes, and Combining Forms ............................585 B Abbreviations and Symbols ..................................................................591 C Commonly Prescribed Drugs ................................................................594 D Answers to Practice Exercises................................................................604 Figure Credits ................................................................................................627 Index ............................................................................................................631 xvii Chapter 1 Building a Medical Vocabulary: Getting Started OBJECTIVES After completion of this chapter you will be able to Make a personal commitment to learn medical terminology Describe methods of study time management Explain the value of positive thinking in the learning process Choose a relaxing environment in which to study Explain how a healthy diet and regular exercise are beneficial to learning Use all senses to reinforce memory Prepare and use flash cards List suggested study tips Identify the learning tools that best fit your individual style Personal Aspects of Successful Learning To begin learning medical terminology, organize your study time and examine meth- ods for efficient memorization. Consider the following personal aspects of successful learning. COMMITMENT Personal commitment is key to developing a solid knowledge of medical language. A strong pledge and lots of practice are necessary to memorize the basic building blocks of medical terms. Make that promise now! TIME MANAGEMENT Effective time management is essential. Other activities will always compete with the time available for study. Once committed to your goal, you must outline a reasonable plan for completion. Follow the study path this text and your instructor provide, and incorporate the necessary study time into your personal schedule. Set aside prime time for study. Prime time is time during the day or evening when you feel most alert and at your finest, and it is when learning is best accomplished. Identify your personal prime time, and try your best to allot a concentrated block of it for memory work. 1 2 Medical Terminology: The Language of Health Care MEDICAL TERMINOLOGY Figure 1.1 Focus on goals and plan for success. The most common time-management problem is procrastination—putting tasks off until later. If you suffer from this affliction, you will need to act to curb this inef- fective habit pattern and keep yourself on target. When you catch yourself procrasti- nating, focus immediately on the positive aspects of your commitment and the learn- ing goals you have set. Try easing your way in by dividing studies into small segments you can reasonably complete. Take time to notice what you have accomplished, and reward yourself periodically for a job well done! Focus on your goals and the many re- wards of accomplishment (Fig. 1.1). ATTITUDE Positive thinking is vital for effective learning. Feeling confident stems from positive thoughts. Negative thoughts always lead to defeat. Replace all negative thoughts with “can do” affirmatives that make confident thoughts a habit. A positive approach will help you to stay balanced when you encounter the inevitable hurdles and problems of life. Concentrate on what is “good”! RELAXATION Mental relaxation is indispensable for successful learning. The tension resulting from fear of failure or any other cause makes learning difficult or impossible. Give yourself a comfortable, relaxing atmosphere for studying. Consider listening to music you en- joy and find relaxing. FITNESS Regular, moderate exercise has been proven to reduce stress. Include it in your overall plan for successful learning. A healthy diet also provides the “fuel power” necessary for mental stamina. Learning Tools Part of setting the stage for learning is laying out effective tools and identifying the method of approach that meets one’s individual needs. Sort out the following sugges- tions, and customize the ones that work best for you. USING YOUR GOOD SENSES When learning, the brain reinforces and retains facts as a result of interaction with the senses. The senses form mental images that are the basis for thought. We see (visual sense), we hear (auditory sense), we feel (kinesthetic sense), and, to a lesser degree, we taste (gustatory sense) and smell (olfactory sense). An effective memory depends on intricate processes that recall mental images of sights, sounds, feelings, tastes, and smells. For this reason, try to include as Chapter 1 • Building a Medical Vocabulary: Getting Started 3 many senses as possible in the process of reinforcing learning. Remember the three basics: SEE IT For visual reinforcement SAY IT For auditory reinforcement WRITE IT For kinesthetic reinforcement FLASH CARDS FOR PREFIXES, SUFFIXES, AND COMBINING FORMS Make a 3 5 card for each prefix, suffix, and combining form listed in Chapter 2. Write each component on the front and its meaning on the back. Include a sample word or a drawing depicting the component to reinforce your visual sense (Fig. 1.2). Use cards with different colors for each category, e.g., prefixes on blue cards, suf- fixes on green cards, and combining forms on pink cards. You can use pens of differ- ent colors for special emphasis, such as the prefix (blue card) in blue ink and the mean- ing on the reverse in red ink. Choose colors that are most pleasing to your visual and kinesthetic senses. Also, within a category you can make distinctions; e.g., use green cards for all suf- fixes, but use different colors when writing meanings to indicate the types of suffixes [symptomatic suffixes (blue ink), diagnostic suffixes (green ink), operative/surgical suffixes (red ink), and general suffixes (black ink)]. These are just suggestions. Be as creative as you wish, and use colors that you find most pleasing or eye-catching. Organizing Flash Cards Punch a hole in the top of each flash card, and loop each card through a key chain or ring holder to make a “rotary file.” This method keeps groups of cards together and prevents them from becoming lost or scattered. Within this file, you can group associ- ated cards for components related to color, size, position, direction, etc. Frugal Flash Cards Preparing flash cards for each prefix, suffix, and combining form in Chapter 2 is well worth your effort and will pay off in memory reinforcement. Continue to make flash cards for each combining form added in Chapters 5 to 17. EPI- UPON CARDI O -ECTOMY HYPO- Figure 1.2 Preparing flash cards. 4 Medical Terminology: The Language of Health Care Figure 1.3 Using the frugal flash card. Also include abbreviations, symbols, and terms found throughout the text; how- ever, if your stack of flash cards has become cumbersome, you may want to try the fru- gal flash card, so named because it consolidates paper and is inexpensive. Fold a piece of 81/2 11 lined paper in half lengthwise. Write the word component, symbol, or term on the first line of the first column and its definition on the same line in the second column. Skip a line and write the next word component, symbol, or term with its definition on the same line in the second column. Continue listing terms with corresponding definitions until you reach the bottom. Then fold the paper at the lengthwise crease so that the word component, symbol, or term is listed on one side and the definition appears on the same line on the other side. This lets you flip from one side to the other, “flashing” |
and reinforcing the meanings of the terms. Use the other side of the paper in the same way (Fig. 1.3). Snatching Moments Carry your flash cards with you at all times. During most days, there are times when you can snatch a moment to use your flash cards. You will feel less stress when wait- ing in a line or for an appointment if you know that you can use that time for study (Fig. 1.4). Remember to use your good senses: SEE IT Employ your visual sense by making and repeatedly reviewing flash cards. SAY IT Pronounce each component out loud three times as you flash each card to reinforce your auditory sense. WRITE IT Make each flash card by hand using pleasant colored paper and ink to satisfy your kinesthetic sense. DON’T HESITATE TO ANNOTATE! Annotating simply refers to making notes as you read. Learning and reading research indicates that students retain information best after reflecting on what they’ve read and physically making notes with a pen or pencil that organize the material, clarify questions, and link new information to old. It is not enough to highlight or underline. As you read each chapter, and during lecture on related material, make notes in the Chapter 1 • Building a Medical Vocabulary: Getting Started 5 EPI- Figure 1.4 Snatching moments. margins and look carefully at every new term or definition you encounter. Draw lines to separate the component parts of key terms, and write out their meanings. MNEMONICS CAN HELP Mnemonics, referring to any device for aiding memory, is named for the goddess of memory in Greek mythology. Mnemonic techniques link things to be remembered with clues for their recall using the stimulus of images, sounds, smell, touch, etc. Con- sider the following applications: Draw pictures of word components for reinforcement. Often the most absurd as- sociations can help you to remember. It does not matter if they make sense to no one but you (Fig. 1.5). Make up rhymes or stories that help to differentiate between meanings. For exam- ple, “peri-,” the prefix meaning around, is often confused with “para-,” the prefix mean- ing alongside of. Use the two components in a sentence to compare their meanings; e.g., I sat “para” (alongside of) Sarah on the merry “peri” go-around. Figure 1.5 Draw pictures of word components for reinforce- ment. 6 Medical Terminology: The Language of Health Care Make up songs and rhythms to help remember facts. Take a song you are familiar with like “Row, row, row, your boat” and insert words with definitions that are in tune with the song. Other Study Tips Give yourself a memory drill by listing word components, symbols, or terms on one side of a paper and then filling in the definitions from memory. Write corrections in red ink. List the incorrectly defined components on a separate paper, and repeat the drill. Repeat this process until you have identified a list of those most continually found incorrect. Spend additional time on those troublesome terms. Tape record lectures, and listen to pronunciations included in the CD-ROM that accompanies the text. Find a study “buddy” or group from class. Compare notes, study techniques, quiz each other, and enjoy healthy competition. Take advantage of the many fun and interactive learning activities this text pro- vides in the CD-ROM, including: • A pronunciation glossary with audio pronunciations • Spelling bees to help you recognize and correctly spell terms • Labeling exercises to reinforce and test your knowledge of medical terms and anatomy • Games in which you match terms or components with definitions • Scored and unscored chapter quizzes for knowledge assessment • Interactive medical record exercises Let your imagination be your guide. Be creative and make learning fun! Chapter 1 • Building a Medical Vocabulary: Getting Started 7 PRACTICE EXERCISES 1. Name the personal aspect that is key to developing a solid knowledge of medical language. __________________________________________________________________ ___________________________________________________________________________ 2. Identify your personal prime time. ___________________________________________ 3. Identify at least three methods for confronting procrastination._________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 4. How can a positive attitude help you with learning? ___________________________ ___________________________________________________________________________ ___________________________________________________________________________ 5. Give an example of a positive affirmation. ____________________________________ ___________________________________________________________________________ 6. List at least three ways you can provide a relaxed environment in which to study. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 7. How can a healthy diet and regular exercise help you learn? ___________________ ___________________________________________________________________________ ___________________________________________________________________________ 8. List the three basic sensory rules for memorizing facts. ________________________ ___________________________________________________________________________ ___________________________________________________________________________ 9. Describe the usefulness of preparing flash cards. ______________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 8 Medical Terminology: The Language of Health Care 10. Explain what it means to annotate text material. ______________________________ ___________________________________________________________________________ ___________________________________________________________________________ 11. Identify at least three other study tips described in Chapter 1. __________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Chapter 2 Basic Term Components OBJECTIVES After completion of this chapter you will be able to Describe the origin of medical language Analyze the component parts of a medical term List basic prefixes, suffixes, and combining forms Use basic prefixes, suffixes, and combining forms to build medical terms Explain common rules for proper medical term formation, pronunciation, and spelling Most medical terms stem from Greek or Latin origins. These date to the founding of ETYMOLOGY. modern medicine by the Greeks and the influence of Latin when it was the universal The Greek root language in the Western world. Other languages, such as German and French, have etymon refers also influenced medical terms, and many new terms are derived from English, which to that which is true or is considered the universal language. Most terms related to diagnosis and surgery have genuine. Etymology is the Greek origin, and most anatomical terms can be traced to Latin. study of the origin and development of words from Once you learn the basic medical term structure and memorize the most common the source language, term components (prefixes, suffixes, and combining forms), you can get the meaning original meaning, and of most medical terms by defining their parts. Those mysterious words, which are al- history of usage. most frightening at first, will soon no longer be a concern. You will analyze each term with your newly acquired knowledge and the help of a good medical dictionary. This chapter lists common prefixes, suffixes, and a selected number of common combining forms. More combining forms and other pertinent prefixes and suffixes will be added in following chapters as you learn terms related to the body systems. The ba- sic rules for proper medical term formation, pronunciation, and spelling are also pre- sented here. The key to success in building a medical vocabulary is the groundwork you do now by making flash cards and memorizing the basic term components in this chapter. The work will pay big dividends if you do. Analysis of Term Components ROOT PREFIX SUFFIX Most medical terms have three components: root, suffix, and prefix. 9 10 Medical Terminology: The Language of Health Care ROOT AND SUFFIX Each term is formed by combining at least one root, the foundation or subject of the word, and a suffix, the ending that modifies and gives essential meaning to the root. For example, in lipemia, l i p / e m i a ROOT SUFFIX fat blood condition Lip (fat), the root, is the subject. It is modified by the suffix (emia) to indicate a condition of fat in the blood. Note that each component is dependent on the other to express meaning. Note: lipemia is synonymous with lipidemia (formed from lip, oid, and emia) PREFIX The prefix is a word structure placed at the beginning of a term when needed to further modify the root or roots. For example, in hyperlipemia h y p e r / l i p / e m i a PREFIX ROOT SUFFIX excessive fat blood condition The addition of the prefix, hyper, modifies the root to denote excessive fat in the blood. ADDITIONAL ROOTS Often a medical term is formed of two or more roots. For example, in hyperlipoproteinemia h y p e r / l i p / o / p r o t e i n / e m i a PREFIX ROOT VOWEL ROOT SUFFIX excessive fat protein blood condition In this term, the additional root, protein (joined to lip by the vowel “o”), further defines the word to indicate an excessive amount of fat and protein in the blood. COMBINING VOWELS AND COMBINING FORMS When a medical term has more than one root, each is joined by a vowel, usually an o. As shown in the term hyper/lip/o/protein/emia, the o links the two roots and fosters eas- ier pronunciation. This vowel is known as a combining vowel; o is the most common combining vowel (i is the second most common) and is used so frequently to join root to root or root to suffix that it is routinely attached to the root and presented as a combining form: l i p ROOT l i p / o COMBINING FORM (ROOT WITH COMBINING VOWEL ATTACHED) This text lists combining forms for easier term formation and analysis. Chapter 2 • Basic Term Components 11 QUICK REVIEW Complete the following sentences: 1. Most medical terms have three basic parts: the _______________________________, ___________________________________, and ____________________. 2. The root is the _________________________ of the term. 3. The _________________________ is the word ending that modifies and gives essential meaning to the root. 4. The _________________________ is a word structure at the beginning of a term that further modifies the root. 5. Often a medical term is formed of _________________________ or more roots. 6. When a medical term has more than one root, it is joined together by a _________________________ (usually an _____). 7. A combining form is a _________________________ with a ______________________ attached. QUICK REVIEW ANSWERS 1. root, suffix, prefix 4. prefix 7. root, vowel 2. foundation or subject 5. two 3. suffix 6. combining vowel, o Required Activity Using the guidelines found in Chapter 1 (see “Flash Cards for Prefixes, Suffixes, and Combining Forms”, page 3), prepare flash cards for the basic term components listed in this chapter: prefixes (pages 20–22), combining forms (pages 23–25), and suffixes (pages 25–28). Memorize them in preparation for analysis of medical term formations, spelling considerations, and rules of pronunciation. Rules for Forming and Spelling Medical Terms Memorizing and spelling basic medical word components are the first steps for learn- ing how to form medical terms. The next step is to construct the words using the fol- lowing rules: 1. A combining vowel is used to join root to root as well as root to any suffix beginning with a consonant: e l e c t r c a r d i - g r a m ROOT ROOT SUFFIX electric heart record e l e c t r / o / c a r d i / o / g r a m e l e c t r o c a r d i o g r a m (ELECTRICAL RECORD OF THE HEART) 12 Medical Terminology: The Language of Health Care 2. A combining vowel is not used before a suffix that begins with a vowel: v a s e c t o m y ROOT SUFFIX vessel excision v a s / e c t o m y v a s e c t o m y (EXCISION OF A VESSEL) 3. If the root ends in a vowel and the suffix begins with the same vowel, drop the final vowel from the root and do not use a combining vowel: c a r d i i t i s ROOT SUFFIX heart inflammation c a r d / i t i s c a r d i t i s (INFLAMMATION OF THE HEART) 4. Most often, a combining vowel is inserted between two roots even when the second root begins with a vowel: c a r d i e s o p h a g e a l ROOT ROOT SUFFIX heart esophagus pertaining to c a r d i / o |
/ e s o p h a g e a l c a r d i o e s o p h a g e a l (PERTAINING TO THE HEART AND ESOPHAGUS) 5. Occasionally, when a prefix ends in a vowel and the root begins with a vowel, the final vowel is dropped from the prefix: p a r a e n t e r a l PREFIX ROOT SUFFIX alongside of intestine pertaining to p a r / e n t e r / a l p a r e n t e r a l (PERTAINING TO ALONGSIDE OF THE INTESTINE) Breaking down and defining the components in a term often clues you to its mean- ing. Frequently, however, you must consult a medical dictionary to obtain a precise definition. Take a moment to look up parenteral, so you understand the complete meaning. Note: There are many exceptions to these rules. Follow the basic guidelines, but be prepared to accept exceptions as you encounter them. Rely on your medical dictionary for additional guidance. Chapter 2 • Basic Term Components 13 Defining Medical Terms Through Word Structure Analysis You can usually define a term by interpreting the suffix first, then the prefix (if pres- ent), then the succeeding root or roots. For example, in pericarditis, p e r i / c a r d / i t i s PREFIX ROOT SUFFIX 2 3 1 around heart inflammation p e r i c a r d i t i s (INFLAMMATION AROUND THE HEART) You sense the basic meaning of this term by understanding its components; how- ever, the dictionary clarifies that the term refers to inflammation of the pericardium, the sac that encloses the heart. Note: Beginning students often have difficulty differentiating between prefixes and roots (or combining forms) because the root appears first in a medical term when a prefix is not used. It is important to memorize the most common prefixes so that you can tell the difference. Also, keep in mind that a prefix is only used as needed to fur- ther modify the root or roots. QUICK REVIEW 1. A combining vowel is used to join root to root as well as root to any suffix begin- ning with a consonant. 2. A combining vowel is not used before a suffix that begins with a vowel. 3. If the root ends in a vowel and the suffix begins with the same vowel, drop the final vowel from the root and do not use a combining vowel. 4. Most often, a combining vowel is inserted between two roots even when the second root begins with a vowel. 5. Occasionally, when a prefix ends in a vowel and the root begins with a vowel, the final vowel is dropped from the prefix. Identify which of the rules listed above were applied when forming the following terms: 1. angi -ectasis angi/ectasis _____ 2. hemat -logy hemato/logy _____ 3. oste -ectomy ost/ectomy _____ 4. electr encephal -gram electro/encephalo/gram _____ 5. para- umbilic -al par/umbilic/al _____ 6. vas -ectomy vas/ectomy _____ 7. arteri -itis arter/itis _____ 8. gastr enter -cele gastro/entero/cele _____ 9. gastr -tomy gastro/tomy _____ 10. hypo ox -ia hyp/ox/ia _____ 14 Medical Terminology: The Language of Health Care QUICK REVIEW ANSWERS 1. 2 5. 5, 2 9. 1 2. 1 6. 2 10. 5, 2 3. 3 7. 3 4. 4, 1 8. 4, 1 Formation of Medical Terms Most medical terms build from the root. Prefixes and suffixes are attached to the root to modify its meaning. Often two or more roots are linked before being modified. The following are examples of the various patterns of medical term formation using the root cardi (heart) as a base. Note the rules used for forming each term. Root/Suffix c a r d i / a c HEART PERTAINING TO (pertaining to the heart) Prefix/Root/Suffix e p i / c a r d / i u m UPON HEART TISSUE (tissue upon the heart, i.e., external lining of the heart) Prefix/Prefix/Root/Suffix s u b / e n d o / c a r d i / a l BENEATH WITHIN HEART PERTAINING TO (pertaining to beneath and within the heart) Root/Combining Vowel/Suffix c a r d i / o / l o g y HEART STUDY OF (study of the heart) Root/Combining Vowel/Root/Suffix c a r d i / o / p u l m o n / a r y HEART LUNG PERTAINING TO (pertaining to the heart and lungs) Root/Combining Vowel/Suffix (symptomatic) c a r d i / o / d y n i a HEART PAIN (pain in the heart) Root/Combining Vowel/Suffix (diagnostic) c a r d i / o / r r h e x i s HEART RUPTURE (a rupture of the heart) Chapter 2 • Basic Term Components 15 Root/Combining Vowel/Suffix (operative) c a r d i / o / r r h a p h y HEART SUTURE (a suture of the heart) A FEW EXCEPTIONS As noted above, most medical terms are formed by the combination of a root or roots modified by suffixes and prefixes. Occasionally, terms are formed by a root alone or a combination of roots. EXAMPLES d u c t ROOT to lead o v i / d u c t ROOT ROOT egg to lead Oviduct refers to the uterine tube. Sometimes, you will find a term formed from the combination of a prefix and a suffix. EXAMPLE m e t a / s t a s i s PREFIX SUFFIX beyond, after, stop or stand or change Metastasis refers to the spread of a disease, such as cancer, from one location to another. QUICK REVIEW Analyze the following terms by separating each component, and then define the in- dividual elements: 1. gastric _____________________________________________________ 2. epigastric __________________________________________________ 3. gastrocardiac ______________________________________________ 4. epigastralgia _______________________________________________ 5. gastroscopy ________________________________________________ 6. epigastrocele _______________________________________________ 7. gastrotomy ________________________________________________ 8. epigastrorrhaphy ___________________________________________ 16 Medical Terminology: The Language of Health Care QUICK REVIEW ANSWERS 1. gastr/ic pertaining to the stomach 2. epi/gastr/ic pertaining to upon the stomach 3. gastr/o/cardi/ac or gastro/cardi/ac pertaining to the stomach and heart 4. epi/gastr/algia pain upon the stomach 5. gastr/o/scopy or gastro/scopy examination of the stomach 6. epi/gastr/o/cele or epi/gastro/cele pouching or hernia upon the stomach 7. gastr/o/tomy or gastro/tomy incision in the stomach 8. epi/gastr/o/rrhaphy or epi/gastro/rrhaphy suture upon the stomach Spelling Medical Terms Correct spelling of medical terms is crucial for communication among health care pro- fessionals. Careless spelling causes misunderstandings that can have serious conse- quences. The following are some of the pitfalls to avoid. 1. Some words sound exactly the same but are spelled differently and have different meanings. Context is the clue to spelling. For example, i l e u m (PART OF THE INTESTINE) i l i u m (PART OF THE HIP BONE) s i t o l o g y (STUDY OF FOOD) c y t o l o g y (STUDY OF CELLS) 2. Other words sound similar but are spelled differently and have different meanings. For example, a b d u c t i o n (TO DRAW AWAY FROM) a d d u c t i o n (TO DRAW TOWARD) h e p a t o m a (LIVER TUMOR) h e m a t o m a (BLOOD TUMOR) a p h a g i a (INABILITY TO SWALLOW) a p h a s i a (INABILITY TO SPEAK) 3. When letters are silent in a term, they risk being omitted when spelling the word. For example, pt has a “t” sound if found at the beginning of a term [e.g., pterygium, but both the “p” and “t” are pronounced when found within a term [e.g., nephroptosis (nef-rop-tō’sis)] ph has an “f” sound (e.g., diaphragm) ps has an “s” sound (e.g., psychology) 4. Some words have more than one accepted spelling. For example, o r t h o p e d i c ORTHOPAEDIC (BRITISH) l e u k o c y t e LEUCOCYTE (BRITISH) Chapter 2 • Basic Term Components 17 5. Some combining forms have the same meaning but different origins that compete for usage. For example, there are three combining forms referring to the uterus: h y s t e r / o (GREEK) m e t r / o (GREEK) u t e r / o (LATIN) ACCEPTABLE TERM FORMATIONS As you learn medical terms, you can have fun experimenting with creating words, such as glyco (sweet) cardio (heart) sweetheart! However, in the real medical world, the word is formed when the term is coined. Often there seems to be no reason why a par- ticular word form became acceptable. That is why you should check your medical dic- tionary when in doubt about the spelling, formation, or precise meaning. Rules of Pronunciation When you first learn to pronounce medical terms, the task can seem insurmountable. The first time you open your mouth to say a term is a tense moment for those who want to get it right! The best preparation is to study the basic rules of pronunciation, repeat the words after hearing them pronounced on the CD-ROM accompanying this text and/or after your instructor has said them, and try to keep the company of others who use medical language. There is nothing like the validation you get from the fact that no one laughed or snarled at you when you said something “medical” for the very first time! Your confidence will build with every word you use. Following are some helpful shortcuts: Shortcuts to Pronunciation Consonant Example c (before a, o, u) k cavity colon cure c (before e, i) s cephalic cirrhosis ch k cholesterol g (before a, o, u) g gallstone gonad gurney g (before e, i) j generic giant ph f phase pn n pneumonia ps s psychology pt t ptosis pterygium 18 Medical Terminology: The Language of Health Care Consonant Example rh r rhythm rrh r hemorrhoid x z (as first letter) xerosis THE PHONETIC SYSTEM Phonetic spelling for pronunciation of most medical terms in this text is in parenthe- ses below the term (beginning with Chapter 3). The phonetic system used is basic and has only a few standard rules. The macron and breve are the two diacritical marks used. The macron (¯) is placed over vowels that have a long sound: ā day ē be ı̄ kite ō no ū unit The breve (ˇ) is placed over vowels that have a short sound: ǎ alone ě ever ı̌ pit ǒ ton ǔ sun The primary accent (´ ) is placed after the syllable that is stressed when saying the word. Monosyllables do not have a stress mark. Other syllables are separated by hyphens. QUICK REVIEW 1. The pt in pterygium has a/an ____ sound. 2. The ch in the word chronic has a/an ____ sound. 3. The c in the word cirrhosis has a/an ____ sound. 4. The x in xerosis has a/an ___ sound. 5. The g in genital has a/an ___ sound. 6. The pn in pneumatic has a/an ___ sound. QUICK REVIEW ANSWERS 1. t 4. z 2. k 5. j 3. s 6. n Chapter 2 • Basic Term Components 19 Singular and Plural Forms Most often, plurals are formed by adding -s or -es to the end of a singular form. The following are common exceptions. Singular Plural ENDING EXAMPLE ENDING EXAMPLE -a vertebra -ae vertebrae -is diagnosis -es diagnoses -ma condyloma -mata condylomata -on phenomenon -a phenomena -um bacterium -a bacteria -usa fungus -i fungi -ax thorax -aces thoraces -ex apex -ices apices -ix appendix -ices appendices -y myopathy -ies myopathies aViruses and sinuses are not exceptions. QUICK REVIEW Convert the following singular forms to plural: 1. |
bulla___________________________________ 2. speculum ______________________________ 3. fungus _________________________________ 4. stoma__________________________________ 5. anomaly _______________________________ 6. prognosis ______________________________ QUICK REVIEW ANSWERS 1. bullae 4. stomata 2. specula 5. anomalies 3. fungi 6. prognoses 20 Medical Terminology: The Language of Health Care Common Prefixes A list of commonly used prefixes organized within categories follows. A hyphen is placed after each prefix to indicate its link at the beginning of a medical term. Each includes a term example. Appendix A and the Quick Study Reference include a summary list of prefixes in alphabetical order. Prefix Meaning Example NEGATION a-, an- without aphonia (without voice or sound) anaerobic (pertaining to without air) anti-, contra- against or opposed to anticoagulant (against clotting) contraception (opposed to becoming pregnant) de- from, down, or not decapitate [separation of the head (caput) from the body] POSITION/DIRECTION ab- away from abnormal (pertaining to away from normal) ad- to, toward, or near adhesion (to stick to) circum-, peri- around circumvascular (pertaining to around a vessel) periosteum (pertaining to around bone) dia-, trans- across or through dialysis [dissolution across or through (a membrane)] transmission (to send across or through) e-, ec-, ex- out or away edentia (condition of teeth out) [dent/oteeth] eccentric (pertaining to away from center) excise (to cut out) [cis/oto cut] ecto-, exo-, extra- outside ectopic (pertaining to a place outside) exocrine (denoting secretion outside) extravascular (pertaining to outside a vessel) en-, endo-, intra- within encapsulate (within little box) endoscope (instrument for examination within) intradermal (pertaining to within skin) Chapter 2 • Basic Term Components 21 Prefix Meaning Example epi- upon epidermal (pertaining to upon the skin) inter- between intercostal (pertaining to between the ribs) [cost/orib] meso- middle mesomorphic (pertaining to middle form) meta- beyond, after, or metastasis [beyond stopping or change standing (spread of disease from one part of the body to another)] metamorphosis (condition of change in form) para- alongside of or paramedic (pertaining to abnormal alongside of medicine) paranoia (condition of abnormal thinking) retro- backward or behind retrograde (going backward) sub-, infra- below or under infraumbilical (pertaining to below the navel) [umbilic/onavel] sublingual (pertaining to under the tongue) [lingu/otongue] QUANTITY OR MEASUREMENT bi- two or both bilateral (pertaining to two or both sides) hemi-, semi- half hemicephalic (pertaining to half of the head) semilunar (pertaining to half moon) [lunamoon] hyper- above or excessive hyperlipemia (excessive fat in blood) hypo- below or deficient hypothermia (condition of below normal temperature) [therm/oheat] macro- large or long macrocyte (large cell) micro- small microlith (small stone) mono-, uni- one monochromatic (pertaining to one color) [chromat/ocolor] unilateral (pertaining to one side) oligo- few or deficient oliguria (condition of deficient urine) pan- all panacea (a cure-all) 22 Medical Terminology: The Language of Health Care Prefix Meaning Example poly-, multi- many polyphobia (condition of many fears) multicellular (pertaining to many cells) quadri- four quadriplegia (paralysis of all four limbs) super-, supra- above or excessive suprarenal (pertaining to above the kidney) supernumerary [excessive numbers (too many to count)] tri- three triangle (three angles) ultra- beyond or excessive ultrasonic (pertaining to beyond sound) TIME ante-, pre-, pro- before antepartum (before labor) premature (before ripe) prognosis [before knowing (prediction of course and outcome of a disease)] brady- slow bradycardia (condition of slow heart) tachy- fast tachycardia (condition of fast heart) post- after or behind postoperative [after operation (surgery)] re- again or back reactivate (to make active again) GENERAL con-, syn-, sym- together or with syndactylism (webbing together of toes or fingers) [dactyl/o finger or toe] symbiosis (presence of life together) [biolife] congenital (pertaining to being born with) dys- painful, difficult, dysphonia [condition of difficult or faulty voice or sound (hoarseness)] eu- good or normal eugenic (pertaining to good production) neo- new neoplasia [a new (abnormal) formation] Chapter 2 • Basic Term Components 23 Common Combining Forms Following are selected combining forms (roots with combining vowels attached) to give you a start toward building medical terms. Additional combining forms are intro- duced at the beginning of Chapters 5 to 17 on body systems. Each is presented with a slash between the root and the combining vowel along with a term example. Appendix A and the Quick Study Reference include a summary list of combining forms in al- phabetical order. Combining Forms Combining Form Meaning Example abdomin/o abdomen abdominal (pertaining to abdomen) lapar/o laparotomy (incision into the abdomen) acr/o extremity or topmost acrodynia (pain in an extremity) acrophobia [exaggerated fear of topmost places (heights)] aden/o gland adenoma (gland tumor) aer/o air or gas aerobic (pertaining to air) angi/o vessel angioplasty (surgical repair of a blood vessel) vas/o vasectomy (excision of a vessel) vascul/o vascular (pertaining to a vessel) carcin/o cancer carcinogenic (pertaining to CANCER. production of cancer) Cancer is Latin for crab. The cardi/o heart cardiologist (one who specializes word is derived from the in treatment of the heart) Greek word karkinos that was used by Hippocrates cephal/o head cephalic (pertaining to the head) and other early writers and cyan/o blue cyanotic (pertaining to blue) also means crab. Some authorities say the word was cyt/o cell cytology (study of cells) used because it describes the appearance of the derm/o skin dermal (pertaining to the skin) disease; i.e., just as the dermat/o dermatology (study of the skin) crab’s feet extend in all directions from its body, so cutane/o cutaneous (pertaining to the skin) can the disease extend in the human. Other authorities dextr/o right or on the right side dextrocardia (condition of the relate the term to the heart on the right side) obstinacy of a crab in erythr/o red erythrocyte (red cell) pursuing prey. fibr/o fiber fibroma ( fiber tumor) gastr/o stomach gastric (pertaining to the stomach) gen/o origin or production osteogenic (pertaining to origin or production in bone) 24 Medical Terminology: The Language of Health Care Combining Form Meaning Example gluc/o sugar glucogenesis (origin or production of sugar) glucos/o glucose (sugar) glyc/o glycolysis (breakdown or dissolution of sugar) hem/o blood hemogram (record of blood) hemat/o hematology (study of blood) hepat/o liver hepatoma (tumor of the liver) hydr/o water hydrophobia (exaggerated fear of water) leuk/o white leukocyte (white cell) lip/o fat lipoid (resembling fat) lith/o stone lithiasis (formation or presence of a stone) melan/o black melanoma (black tumor) morph/o form morphology (study of form) nas/o nose nasal (pertaining to the nose) rhin/o rhinitis (inflammation of the nose) necr/o death necrocytosis (condition or increase of cell death) or/o mouth oral (pertaining to the mouth) orth/o straight, normal, orthostatic (pertaining to standing or correct straight) oste/o bone osteal (pertaining to bone) path/o disease pathology (study of disease) ped/o child or foot pediatrics (treatment of child) pedal (pertaining to the foot) phob/o exaggerated fear or hydrophobia (exaggerated fear sensitivity of water) photophobia (sensitivity to light) phon/o voice or sound phonic (pertaining to voice or sound) plas/o formation dysplasia (condition of faulty formation) pod/o foot podiatry (treatment of the foot) psych/o mind psychology (study of the mind) py/o pus pyopoiesis (formation of pus) ren/o kidney renal (pertaining to the kidney) nephr/o nephrosis (condition of the kidney) Chapter 2 • Basic Term Components 25 Combining Form Meaning Example scler/o hard sclerosis (a condition of hardness) sinistr/o left or on the left side sinistropedal (pertaining to the left foot) son/o sound sonometer (an instrument to measure sound) sten/o narrow stenosis (a condition of narrow) therm/o heat thermometer (instrument for measuring heat) tox/o poison toxemia (poison in blood) TOXIN. The Greek root toxic/o toxicology (study of poison) toxicon means troph/o nourishment or trophocyte (a cell that arrow poison and is derived development provides nourishment) from the word for the archer’s bow. The Greeks hypertrophy (condition of often used darts and arrows excessive development) coated with a poisonous substance. ur/o urine urology (study of urine) urin/o urinary (pertaining to urine) Common Suffixes Suffixes are endings that modify the root. They give the root essential meaning by forming a noun, verb, or adjective. There are two types of suffixes: simple and compound. Simple suffixes form basic terms. For example, ic (pertaining to), a simple suffix, combined with the root gastr (stomach) forms the term gastric (pertaining to the stomach). Compound suffixes are formed by a combination of basic term components. For example, the root tom (to cut) combined with the simple suffix y (denoting a process of) forms the compound suffix tomy (incision); the compound suffix ectomy (excision or removal) is formed by a combination of the prefix ec (out) with the root tom (to cut) and the simple suffix y (a process of). Compound suffixes are added to the roots to provide a specific meaning. For example, hyster (a root meaning uterus) combined with ectomy forms hysterec- tomy (excision of the uterus). Noting the differences between simple and compound suffixes will help you analyze medical terms. Suffixes in this text are divided into four categories: • Symptomatic suffixes, which describe the evidence of illness • Diagnostic suffixes, which provide the name of a medical condition • Operative (surgical) suffixes, which describe a surgical treatment • General suffixes, which have general application Commonly used suffixes follow in alphabetical order except for groups with the same meaning. A hyphen is placed before each to indicate their link at the end of a term. Appendix A and the Quick Study Reference include a summary list of suffixes in alphabetical order. 26 Medical Terminology: The Language of Health Care Suffix Meaning Example SYMPTOMATIC SUFFIXES (WORD ENDINGS THAT DESCRIBE EVIDENCE OF ILLNESS) -algia pain cephalalgia [pain in the head (headache)] -dynia cephalodynia [pain in the head (headache)] -genesis origin or production pathogenesis (origin or production of disease) -lysis breaking down or dissolution hemolysis (breakdown of blood) -megaly enlargement hepatomegaly (enlargement of the liver) -oid resembling lipoid (resembling fat) -penia abnormal reduction leukopenia [abnormal reduction of white (blood cells)] -rrhea discharge rhinorrhea (runny discharge from nose) -spasm involuntary contraction vasospasm (involuntary contraction of a blood vessel) DIAGNOSTIC SUFFIXES (WORD ENDINGS THAT DESCRIBE A CONDITION OR DISEASE) -cele pouching or hernia gastrocele ( pouching of the stomach) -ectasis expansion or dilation angiectasis (expansion or dilation of a blood vessel) -emia blood condition hyperlipemia (blood condition of excessive fat) -iasis formation or presence of lithiasis (formation or presence of a stone or stones) -itis inflammation hepatitis (inflammation of the liver) -malacia softening osteomalacia (softening of bone) -oma tumor carcinoma (cancer tumor) -osis condition or increase sclerosis (condition of hard) leukocytosis (increase of white cells) -phil attraction for basophil (cell with an attraction for basic dyes) -philia pneumophilia (condition that has an attraction for the lungs) Chapter 2 • Basic Term Components 27 Suffix Meaning Example -ptosis falling or downward gastroptosis (downward displacement displacement of the stomach) -rrhage to burst forth (usually blood) hemorrhage (to burst forth blood) -rrhagia -rrhexis rupture hepatorrhexis (rupture of the liver) OPERATIVE SUFFIXES [WORD ENDINGS THAT DESCRIBE A SURGICAL (OPERATIVE) TREATMENT] -centesis puncture for aspiration abdominocentesis (puncture for aspiration of the abdomen) -desis binding arthrodesis (binding together of a joint) [arthr/ojoint] -ectomy excision or removal nephrectomy (excision or removal of a kidney) -pexy suspension or fixation gastropexy [fixation of the stomach (to the abdominal wall)] -plasty surgical repair or rhinoplasty (surgical repair of the reconstruction nose) -rrhaphy suture osteorrhaphy (suture of bone) -tomy incision laparotomy (incision into the abdomen) -stomy creation of an opening gastrostomy (creation of an opening in the stomach) -tripsy crushing lithotripsy (crushing of stone) GENERAL SUFFIXES (SUFFIXES THAT HAVE GENERAL APPLICATIONS) Noun Endings (suffixes that form a noun when combined with a root) -e noun marker erythrocyte (a red blood cell) -ia condition of phobia (condition of an exaggerated fear or sensitivity) -ism alcoholism (condition of alcohol abuse) -ium structure or tissue epigastrium [structure upon the stomach (region in the abdomen)] pericardium [tissue around the heart (sac enclosing the heart)] -ation condition or process of starvation (condition or process of starving) -y adenopathy (condition or process of gland disease) 28 Medical Terminology: The Language of Health Care Suffix Meaning Example Adjective Endings (suffixes that mean “pertaining to” and form an adjective when com- bined with a root) -ac cardiac (pertaining to the heart) -al pedal (pertaining to the foot) -ar glandular (pertaining to a gland) -ary pulmonary (pertaining to the lung) -eal esophageal (pertaining to the esophagus) -ic toxic (pertaining to poison) -ous fibrous (pertaining to fiber) -tic cyanotic (pertaining to blue) Diminutive Endings (suffixes meaning “small”) -icle ventricle (small belly or pouch) -ole bronchiole (small airway) -ula |
macula (small spot) -ule pustule (small pimple) Other General Suffixes -gram record sonogram (record of sound) -graph instrument for recording sonograph (instrument for recording sound) -graphy process of recording sonography (process of recording sound) -iatrics treatment pediatrics (treatment of children) -iatry psychiatry (treatment of the mind) -logy study of cytology (study of cells) -logist one who specializes in the psychologist (one who specializes study or treatment of in the study or treatment of the mind) -ist one who specializes in pharmacist (one who specializes in drugs) -meter instrument for measuring spirometer (instrument for measuring breathing) [spir/o breathing] -metry process of measuring spirometry (process of measuring breathing) -poiesis formation hemopoiesis ( formation of blood) -scope instrument for examination endoscope (instrument for examination within) -scopy examination endoscopy (examination within) -stasis stop or stand hemostasis (stop blood) orthostasis (stand straight) Chapter 2 • Basic Term Components 29 Don’t Be Rolled Over by the We have the Greeks to thank for the suffixes with double rr’s. Take a careful look at each so that you rr will spell them correctly in a term! Suffix Meaning Example 's -rrhea discharge pyorrhea—a discharge of pus -rrhage or to burst forth hemorrhage—a -rrhagia (usually blood) bursting forth of blood menorrhagia—a bursting forth of blood during menstruation -rrhexis rupture angiorrhexis— rupture of a vessel -rrhaphy suture nephrorrhaphy— suture of the kidney Also note that each component also has an h and -rrhaphy has two! 30 Medical Terminology: The Language of Health Care PRACTICE EXERCISES For the following words, draw a line or lines to separate prefixes, roots, combining forms, and suffixes. Then define the word according to the meaning of: Pprefix; Rroot; CFcombining form; Ssuffix. EXAMPLE hyperlipemia _______ / _______ / _______ P R S hyper/lip/emia P R S DEFINITION: above or excessive/fat/blood condition 1. pancytopenia __________________ / __________________ / __________________ P CF S DEFINITION: _________________________________________________________________ 2. leukemia __________________ / __________________ R S DEFINITION: _________________________________________________________________ 3. toxoid __________________ / __________________ R S DEFINITION: _________________________________________________________________ 4. mesomorphic __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 5. acrodynia __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 6. metastasis __________________ / __________________ P S DEFINITION: _________________________________________________________________ Chapter 2 • Basic Term Components 31 7. ultrasonography __________________ / __________________ / __________________ P CF S DEFINITION: _________________________________________________________________ 8. tachycardia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 9. pyopoiesis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 10. adenitis __________________ / __________________ R S DEFINITION: _________________________________________________________________ 11. macrocephalous __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 12. paracentesis __________________ / __________________ P S DEFINITION: _________________________________________________________________ 13. microlithiasis __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 14. orthopedic __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 15. angiomegaly __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 16. psychiatry __________________ / __________________ R S DEFINITION: _________________________________________________________________ 32 Medical Terminology: The Language of Health Care 17. carcinogenesis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 18. nephrologist __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 19. rhinostenosis __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 20. hypohydration __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 21. aerogastralgia __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 22. fibroma __________________ / __________________ R S DEFINITION: _________________________________________________________________ 23. necrophilia __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 24. sclerosis __________________ / __________________ R S DEFINITION: _________________________________________________________________ 25. hemolysis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 26. acrophobia __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ Chapter 2 • Basic Term Components 33 27. cytometer __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 28. cyanotic __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 29. extravascular __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 30. hypertrophy __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ Write in the appropriate prefix to complete the following terms: 31. ________ nasal above the nose a. para b. peri c. supra d. infra e. sub 32. ________ activate make active again a. de b. retro c. pro d. re e. hyper 33. ________ operative before surgery a. intra b. post c. pre d. peri e. circum 34. ________ hydrated not watered a. anti b. de c. ec d. dys e. contra 35. ________ dermal across or through the skin a. ecto b. endo c. intra d. epi e. trans 36. ________ acute excessively severe a. sub b. hypo c. super d. oligo e. pan 37. ________ umbilical below or under the navel a. hyper b. infra c. peri d. para e. pre 38. ________ cardia outside the heart a. exo b. endo c. retro d. para e. peri 39. ________ phonia difficult voice a. ab b. dys c. a d. eu e. para 40. ________ duction to turn away from a. ad b. ab c. ecto d. pro e. ante 41. ________ phylaxis to guard before a. retro b. pro c. post d. peri e. anti 34 Medical Terminology: The Language of Health Care 42. ________ vascular around a blood vessel a. intra b. inter c. para d. circum e. endo 43. ________ plegia half paralysis a. quadri b. peri c. hemi d. bi e. mono Match the following: 44. ________ away from a. retro- 45. ________ between b. peri- 46. ________ alongside of c. anti- 47. ________ around d. ecto- 48. ________ behind e. dia- 49. ________ within f. ab- 50. ________ against or opposed to g. inter- 51. ________ without h. para- 52. ________ outside i. an- 53. ________ across or through j. intra- Give the meaning of the following prefixes: 54. poly- ________ 60. bi- ________ 55. hypo- ________ 61. quadri- ________ 56. oligo- ________ 62. semi- ________ 57. mono- ________ 63. infra- ________ 58. pan- ________ 64. hyper- ________ 59. ultra- ________ Match the following: 65. ________ before a. brady- 66. ________ after b. re- 67. ________ fast c. ante- 68. ________ slow d. post- 69. ________ again e. tachy- Chapter 2 • Basic Term Components 35 Circle the correct meaning for the following term components: 70. a- a. double b. both c. two d. without e. against 71. pod/o a. child b. foot c. voice d. sound e. pus 72. or/o a. lip b. nourishment c. gland d. mouth e. normal 73. neo- a. birth b. death c. origin d. new e. disease 74. -plasty a. surgical repair b. cancer c. tumor d. excision e. incision 75. -ation a. measure b. disease c. tissue d. pain e. process 76. -tripsy a. nourishment b. poison c. crushing d. incision e. stone 77. -ectasis a. blood condition b. formation of c. expansion d. rupture e. discharge 78. dextr/o a. hard b. straight c. right d. left e. long Match the following: 79. ________ black a. tri- 80. ________ three b. leuk/o 81. ________ red c. cyan/o 82. ________ four d. dextr/o 83. ________ white e. uni- 84. ________ one f. melan/o 85. ________ blue g. quadri- 86. ________ two h. sinistr/o 87. ________ few i. oligo- 88. ________ right j. erythr/o 89. ________ left k. bi- 36 Medical Terminology: The Language of Health Care Circle the appropriate suffix for each of the following meanings: 90. record a. -meter b. -metry c. -gram d. -graph e. graphy 91. condition or increase a. -itis b. -iasis c. -osis d. -ium e. -ous 92. excision a. -tomy b. -stomy c. -ectomy d. -centesis e. cele 93. pertaining to a. -ia b. -ar c. -ism d. -ium e. -icle 94. rupture a. -rrhagia b. -rrhea c. -rrhagia d. -rrhexis e. -megaly 95. small a. -ous b. -eal c. -ula d. -ia e. -ary 96. condition of a. -ism b. -ium c. -ule d. -ic e. al Match the following terms related to the kidney with the definitions listed below: nephrolysis nephrostomy nephroptosis nephrotomy nephritis nephropexy nephroma nephrocele nephrogenous nephrolithiasis nephrorrhaphy nephrectomy 97. inflammation of the kidney_________________________________________________ 98. dissolution or breakdown of the kidney______________________________________ 99. incision in the kidney ______________________________________________________ 100. developing from the kidney ________________________________________________ 101. surgical fixation of the kidney ______________________________________________ 102. creation of an opening in the kidney ________________________________________ 103. excision of the kidney______________________________________________________ 104. presence of kidney stones __________________________________________________ 105. kidney tumor _____________________________________________________________ 106. hernia of the kidney _______________________________________________________ 107. suture of the kidney _______________________________________________________ 108. downward displacement of the kidney ______________________________________ Chapter 2 • Basic Term Components 37 Circle the operative term in each of the following lists: 109. a. nephroptosis b. hemolysis c. angiectasis d. colostomy e. necrosis 110. a. vasorrhaphy b. hematoma c. gastrocele d. endoscope e. cardiorrhexis 111. a. morphologic b. adenolysis c. abdominocentesis d. osteomalacia e. polyrrhea Fill in the blanks for the following regarding singular/plural forms: 112. An ovum is an egg produced by an ovary. There are two ________________ in the female that produce eggs or ________________. 113. The spread of cancer to a distant organ is called metastasis. The spread of cancer to more than one organ is ________________. 114. A verruca is a wart. The term for several warts is ________________. 115. Condylomata are genital warts. One genital wart is a ________________. 116. Indices is a plural form of ________________. 117. A thrombus is a clot. Several clots are termed ________. Circle the correct spelling: 118. a. nephoraphy b. nephorrapy c. nephrorrhaphy d. nephorrhapy 119. a. abdominoscopy b. abdemenoscopi c. abdomenscopy d. abdominoschope 120. a. perrycardium b. pericardium c. periocardium d. parcardium Chapter 3 Fields of Medical Practice OBJECTIVES After completion of this chapter you will be able to Define combining forms used in naming medical specialties Trace the evolution of medicine Identify the purpose of the American Board of Medical Specialties Define diplomate and fellow Describe the scope of medical practice for the medical specialties recognized by the American Board of Medical Specialties Identify other medical practitioners with the title of doctor and list their scope of practice List titles of other health professionals Combining Forms Combining Form Meaning Example cardi/o heart cardiology kar-dē-olō-jē chir/o hand chiropractic kı̄-rō-praktik crin/o to secrete endocrinology endō-kri-nolō-jē dent/i teeth dentist dentist dermat/o skin dermatology der-mă-tolō-jē enter/o small intestine gastroenterology gastrō-en-ter-olō-jē esthesi/o sensation anesthesiology anes-thē-zē-olō-jē gastr/o stomach gastroenterology gastrō-en-ter-olō-jē 38 Chapter 3 • Fields of Medical Practice 39 Combining Form Meaning Example gen/o origin or production gene jēn ger/o old age geriatric jer-ē-atrik gynec/o woman gynecology gı̄-nĕ-kolō-jē hemat/o blood hematology hēmă-tolō-jē immun/o safe immunology imyū-nolō-jē laryng/o voicebox otolaryngology ōtō-lar-ing-golō-jē nephr/o kidney nephrology ne-frolō-jē neur/o nerve neurologist noo-rolō-jist obstetr/o midwife obstetric ob-stetrik onc/o tumor oncology ong-kolō-jē ophthalm/o eye ophthalmology of-thal-molō-jē opt/o eye optometry op-tomĕ-trē orth/o straight, normal, or correct orthopedics ōr-thō-pēdiks ot/o ear otolaryngologist ōtō-lar-ing-golō-jist path/o disease pathologist pa-tholō-jist ped/o child or foot pediatrics pē-dē-atriks orthopedics ōr-thō-pēdiks physi/o physical physiatrist fiz-ı̄ă-trist plas/o formation plastic surgery plastik serjer-ē pod/o foot podiatry pō-dı̄ă-trē psych/o mind psychiatry sı̄-kı̄ă-trē 40 Medical Terminology: The Language of Health Care Combining Form Meaning Example radi/o x-ray radiology rā-dē-olō-jē vascul/o vessel vascular vaskyu-lăr The Evolution of Medicine Today’s practice of medicine evolved from the customs of ancient times. Care for the patient (one who suffers) was often given by priests who gave homage to mythological gods and performed rituals designed to appease those gods to rid the body of disease. Hippocrates, the ancient Greek physician who lived about 400 B.C., is known as the “Father of Medicine.” He was the first to attempt to separate medicine from myth, and his writings include the first rational documentation of disease. He also wrote the Hippocratic Oath, which was the standard of medical ethics for physicians in his day and is the basis of modern ethical codes (Fig. 3.1). Curiosity about the body and the causes of disease led to the study of anatomy and physiology and the art of healing practiced by medieval physicians. Scientific progress led to the development of surgery, pharmacy, pathology, and other aspects of medi- cine. Hospitals were built to care for the sick and dying, and universities were estab- lished to study disease (Fig. 3.2). Medieval methods have evolved into the modern sophisticated health care system that provides comprehensive care. Physicians have branched out into many specialties of medicine and have been joined by a team of other health care professionals with highly developed training and skills. The Physician Today, health care is delivered by a complicated system involving many types of pro- fessionals. The most |
prominent professional responsible for meeting the medical needs of the patient is the physician, also called a medical doctor (Fig. 3.3). HIPPOCRATES. Born on the island of Cos about 400 B.C. and known as the founder of medicine, this Greek physician created the art and science of medicine and removed it from the realm of superstition and magic. Our medical terminology really begins with Hippocrates because he was the first to write terms. Figure 3.1 Hippocrates. Chapter 3 • Fields of Medical Practice 41 HOSPITAL. Hospital is derived from the Latin word meaning guest house. The words hospital, hospice, host, hostel, and hotel have the same origin but now have different meanings. It is unknown where special institutions for sick people originated. The Romans had military hospitals by 100 A.D. Christian hospitals seem to have originated from the tradition of a guest house for travelers. In 6th century France, an institution for the sick was called hostel Dieu Figure 3.2 Three photographs (God’s hotel). Most hospitals of Hostel-Dieu, Beaune, France, a were run by religious orders medieval hospital founded in 1443; whose members devoted it is now a museum. A. Entrance. themselves to the care of the B. Grand salle (“great room”—com- bination hospital ward and church). sick. In the 19th century, C. Bedsides. hospitals became centers for treating disease for all classes of society, and they operated for both profit and The Doctor of Medicine (M.D.) degree is earned by successfully completing nonprofit. medical school. To practice medicine, however, the graduate with an M.D. must be li- censed. The license to practice medicine is granted after the applicant passes a speci- fied medical licensing examination and meets any other requirements established by the medical board in the state where the applicant wants to practice. The Doctor of Osteopathic Medicine (D.O.) is a medical practitioner similar to an M.D. but with a traditional emphasis on the role of the musculoskeletal system in Figure 3.3 Luke Fildes’ The Doctor. 42 Medical Terminology: The Language of Health Care maintaining function and balance in the body. Osteopathic physicians are trained at osteopathic colleges and are often affiliated with osteopathic hospitals. The licensing requirements for the osteopath are also similar to the M.D. and are established by med- ical boards in each state. American Board of Medical Specialties The licensed physician in the past was often both physician and surgeon. Today, with the rapid expansion of technology and the greater knowledge required to be proficient in treating patients, physicians have entered various nonsurgical and surgical specialty PHYSICIAN. areas. Physician is With increasing medical specialties, standards and monitoring of specialty prac- derived from a tices were required. The American Board of Medical Specialties (ABMS) was founded Greek word for natural or in 1933 for this purpose. The 24 individual specialty boards recognized by ABMS have according to the laws of established criteria for specific training after medical school (3 to 7 years depending nature. In ancient Greece, on the specialty). After the specialty training (called a residency or fellowship), the natural science, which physician gains eligibility to take the specified board examination. A physician who included biology and has completed specialty requirements and passed the board examination is designated medicine, was concerned with speculation about the “board certified” and referred to as a “diplomate” (e.g., Joan Jones, M.D., Diplomate, origin and existence of American Board of Family Practice). A board’s standards extend beyond the usual re- things. Physic, in the sense quirement for licensure. of drug, especially a Other organizations, such as the American College of Physicians (ACP) and the laxative made from herbs American College of Surgeons (ACS), recognize members who have met set published and natural sources, has criteria for standards of distinction. These include Fellow of the American College the same origin. The of Physicians (F.A.C.P.) and Fellow of the American College of Surgeons (F.A.C.S.) teaching of medicine came (Fig. 3.4). under the general heading ABMS-approved specialty boards of the United States follow: of physicus, and practitioners were called American Board of Allergy and Immunology physicians. American Board of Anesthesiology Figure 3.4 The early days of surgery and anesthesiology. Thomas Eakins’ The Agnew Clinic. Chapter 3 • Fields of Medical Practice 43 American Board of Colon and Rectal Surgery American Board of Dermatology American Board of Emergency Medicine American Board of Family Practice American Board of Internal Medicine American Board of Medical Genetics American Board of Neurological Surgery American Board of Nuclear Medicine American Board of Obstetrics and Gynecology American Board of Ophthalmology American Board of Orthopaedic Surgery American Board of Otolaryngology American Board of Pathology American Board of Pediatrics American Board of Physical Medicine and Rehabilitation American Board of Plastic Surgery American Board of Preventive Medicine American Board of Psychiatry and Neurology American Board of Radiology American Board of Surgery CADUCEUS. The word for the American Board of Thoracic Surgery staff of Mercury, American Board of Urology an emblem in Greek mythology represented by Each specialty or subspecialty has its own scope of practice as follows. All earn the two serpents twined around M.D. or D.O. degree. Ph.D. degrees are accepted by a few specialties/subspecialties, a staff, is the most common e.g., medical genetics, public health. symbol of the medical Special note: The American Osteopathic Association (AOA) also provides certi- profession. From earliest fication of osteopaths who have expertise in the following approved specialty and sub- history, serpents have been specialty areas: anesthesiology, dermatology, emergency medicine, family practice, symbols of wisdom and internal medicine, neurology and psychiatry, neuromusculoskeletal medicine, nuclear health and objects of medicine, obstetrics and gynecology, ophthalmology and otolaryngology, orthopedic worship. They appear as surgery, pathology, pediatrics, preventive medicine, proctology, radiology, rehabilita- regular shrine equipment tion medicine, and surgery. and were involved in ancient healing rituals. The significance of the caduceus for the medical profession is said to lie in the fact that the serpent symbolizes healing—some say because of its long life, others because the annual shedding of its skin suggests a renewal of youth and health, others because of its keen eyesight. The earliest representation of serpent and staff was the rod of Aesculapius, the god of medicine, which shows a single serpent twining A B around a rod or stick. Some argue that it is the Figure 3.5 The caduceus. A. Staff of Mercury. true symbol of the medical B. Rod of Aesculapius. profession (Fig. 3.5). 44 Medical Terminology: The Language of Health Care Physicians’ Specialty Fields of Medical Practice Specialty and Specialist Scope of Practice allergy and immunology diagnosis, treatment, and prevention of allergic aler-jē and imyū-nolō-jē diseases, including asthma, and diagnosis, management, and therapy of immunologic diseases, e.g., autoimmune disorders allergist/immunologist ANESTHESIA. anesthesiology comprehensive medical management and Anesthesia is a condition in anes-thē-zē-olō-jē anesthetic care before, during, and after which there is an absence surgery and long-term pain management and of sensation [an critical care related to cardiac and respiratory (without)/esthesio emergencies (sensation)/ia (condition)]. anesthesiologist The inhalation of various vapors to produce a sort of colon and rectal surgery diagnosis, medical care, and surgical treatment intoxication or stupefaction of conditions related to the small intestine, is an ancient practice. By colon, and rectum the 14th century, methods of inducing sleep for colon and rectal surgeon surgical operations included the inhalation of hemlock, dermatology medical and surgical treatment of disorders of mandrake, and lettuce. der-mă-tolō-jē the skin and its appendages, e.g., hair, nails, Other attempts to produce including cosmetic care anesthesia included the use dermatologist of snow and ice. Interest in chemistry at the end of the emergency medicine prehospital emergency medical care of acutely 18th century resulted in the ill or injured patients; most commonly rendered investigation of various in an emergency department of a hospital or a chemicals that could be free-standing urgent care facility used for inhalation anesthesia. Early anesthetics emergency physician included nitrous oxide, ether, and chloroform. family practice comprehensive general medical care of individuals of all ages and their families, with emphasis on disease prevention and health promotion family physician internal medicine nonsurgical care centered around prevention, diagnosis, and treatment of diseases of adults internist COMMON SUBSPECIALTIES OF INTERNAL MEDICINE cardiology diagnosis and management of conditions kar-de-olō-jē related to the heart and blood vessels (cardiovascular disease) cardiologist endocrinology diagnosis and management of diseases of the endō-kri-nolō-jē endocrine glands, e.g., diabetes, obesity, thyroid dysfunction endocrinologist Chapter 3 • Fields of Medical Practice 45 Specialty and Specialist Scope of Practice gastroenterology diagnosis and management of conditions related gastrō-en-ter-olō-jē to the digestive system gastroenterologist geriatric medicine diagnosis and medical management of conditions affecting the elderly; also a subspecialty of family practice geriatrician jer-ē-ă-trishŭn hematology diagnosis and treatment of blood disorders hē-mă-tolō-jē hematologist nephrology nonsurgical treatment of kidney disorders ne-frolō-jē nephrologist oncology treatment of tumors and cancer ong-kolō-jē oncologist rheumatology treatment of arthritis and related disorders rū-mă-tolō-jē rheumatologist medical genetics diagnosis, treatment, and prevention of genetic jĕ-netiks (inherited) disorders; includes research, laboratory testing, and counseling geneticist jĕ-neti-sist neurology nonsurgical treatment of diseases of the nervous nū-rolō-jē system neurologist SURGEON. The Greek word neurological surgery surgical and nonsurgical treatment of diseases chirurgeon of the nervous system and supportive (chiro, the hand; urgeon, to structures, including blood vessels work) refers to one who neurosurgeon works with the hands. The earliest conception of nuclear medicine use of radioactive substances to diagnose and surgery was that diseases treat disease; a dual specialty in other fields of an external nature were such as radiology, internal medicine, neurology, suitable for treatment by and cardiology is common manual operations, as opposed to internal nuclear medicine physician conditions that were treated obstetrics and gynecology with drugs, etc. The name surgeon has been in English (OB/GYN) since the 14th century. obstetrics care and treatment of mother and fetus There was no distinction ob-stetriks throughout pregnancy, childbirth, and between barbers and immediate postpartum period surgeons until 1745 when the barbers and surgeons of obstetrician London were separated and ob-stĕ-trishŭn given individual charters. 46 Medical Terminology: The Language of Health Care Specialty and Specialist Scope of Practice gynecology medical and surgical treatment of disorders of gı̄-nĕ-kolō-jē the female reproductive and urinary system gynecologist ophthalmology medical and surgical treatment of the eye, of-thal-molō-jē including vision care and services ophthalmologist orthopedic surgery medical, surgical, and rehabilitative treatment ōr-thō-pēdik of disorders of the musculoskeletal system, including the bones, joints, muscles, ligaments, tendons, and nerves orthopedic surgeon orthopedist (orthopaedist) otolaryngology medical and surgical treatment of diseases and ōtō-lar-ing-golō-jē disorders of the ear, nose, throat, and adjoining structures of the head and neck otolaryngologist ōtō-lar-ing-golō-jist ENT (ear, nose, throat) physician pathology study of disease emphasizing examination of pa-tholō-jē tissue for diagnosis, e.g., biopsy, autopsy pathologist pediatrics comprehensive medical care of infants, children, pē-dē-atriks and adolescents, with emphasis on disease prevention and healthful physical and mental development pediatrician physical medicine and treatment of patients suffering from rehabilitation physiatry neuromusculoskeletal disorders caused by fi-zı̄ă-trē illness or injury, e.g., stroke, spinal cord injury physiatrist fiz-ı̄ă-trist plastic surgery surgery for restoration, repair, or reconstruction of body structures, e.g., body contouring, skin grafting plastic surgeon preventive medicine medical care that focuses on prevention of disease and health maintenance; specialty areas include: aerospace medicine, occupational medicine, public health, and general preventive medicine psychiatry diagnosis, treatment, and prevention of mental, sı̄-kı̄ă-trē emotional, and behavioral disorders psychiatrist Chapter 3 • Fields of Medical Practice 47 Specialty and Specialist Scope of Practice radiology use of ionizing and nonionizing imaging rā-dē-olō-jē modalities, including x-ray, radionuclides, magnetic resonance, and ultrasound, to diagnose disease, or in therapies that involve imaging guidance; primary fields include diagnostic radiology, radiation oncology, and radiation physics radiologist surgery treatment of diseases and trauma requiring an operation;—subspecialty areas include vascular, pediatric, hand, and critical care surgery general surgeon thoracic surgery treatment of diseases, deformities, and trauma thō-rasik requiring an operation within the chest, including the heart and lungs thoracic surgeon urology surgical and nonsurgical treatment of the male yū-rolō-jē urinary and reproductive system and the female urinary system urologist Other Fields of Medical Practice Many other medical specialists are called doctors, even though they do not have an M.D. or D.O. degree. They have graduated from a college of podiatry, chiropractic, op- tometry, or dentistry and are licensed to practice. Because they commonly provide health care services in hospitals and/or medical clinics, you need a basic knowledge of their scope of practice. Degree Field of Practice |
Scope of Practice doctor of chiropractic chiropractic treatment centered on manipulation medicine (D.C.) medicine of the spine to maintain function kı̄-rō-praktik and balance in the body chiropractor (chir/o hand; prattein to do) kı̄-rō-praktor doctor of dental oral surgery treatment of dental disorders surgery (D.D.S.) requiring surgery oral surgeon (or/o mouth; dent/i teeth) doctor of podiatric podiatry diagnosis and treatment (including medicine (D.P.M.) pō-dı̄ă-trē surgery) of disorders of the foot pō-dı̄ă-trik podiatrist doctor of optometry optometry diagnosis and nonsurgical (O.D.) op-tomĕ-trē treatment of the eye, including vision care and services optometrist op-tomĕ-trist 48 Medical Terminology: The Language of Health Care Degree Field of Practice Scope of Practice doctor of psychology psychology counsel of patients with mental (Psy.D. or Ph.D.) or emotional disorders sı̄-kolō-jist sı̄-kolō-jē clinical psychologist sı̄-kolō-jist Other Health Care Professions As a result of the major advances in health care technology, various licensed and non- licensed allied health professionals with specialized training and skill have emerged to meet the increasing needs of the population. They are integral to today’s health care team. The following is a list of professions for which formal training is available. acupuncturist massage therapist anesthesiologist assistant medical assistant art therapist medical coding specialist athletic trainer medical illustrator audiologist medical laboratory technician cardiovascular technologist medical technologist clinical exercise specialist medical transcriptionist clinical laboratory scientist medical unit coordinator (unit clerk/ cytogenetic technologist secretary or ward clerk/secretary) cytotechnologist mental health counselor dental assistant mobility specialist dental hygienist music therapist dental laboratory technologist nephrology technician diagnostic medical sonographer nuclear medicine technologist diagnostic molecular scientist nurse, licensed vocational or practical dialysis technician nurse, registered dietetic technician nurse anesthetist dietitian/nutritionist nurse assistant electrocardiography technician nurse midwife electroencephalographic technologist nurse practitioner electroneurodiagnostic technologist nutrition care technologist emergency medical technician occupational therapist fitness therapist occupational therapy assistant genetic counselor operating room technician geriatric home aide ophthalmic dispensing optician NURSE. gerontologist ophthalmic laboratory technician/ Derived from the health and fitness specialist technologist Latin word nutrix, a nurse, from nutrire, to health information administrator optician suckle or nourish, originally health information technician orthoptist described one who suckled histotechnician/histologic technician orthotist/prosthetist or cared for an infant, and home health aide paramedic by extension, now describes one who cares for any sick kinesiotherapy pathologist assistant or helpless person. marriage and family counselor/therapist perfusionist Chapter 3 • Fields of Medical Practice 49 pharmacist recreational therapist pharmacologist rehabilitation counselor pharmacy technician/assistant rehabilitation technologist phlebotomy technician/phlebotomist respiratory therapist physical therapist specialist in blood bank technology physical therapist assistant speech-language pathologist physician assistant speech therapist polysomnographic technologist surgeon assistant psychiatric technician surgical technologist radiation therapy technologist/ therapeutic recreation specialist radiation therapist veterinarian radiologic technologist/radiographer veterinary assistant Summary of Chapter 3 Acronyms/Abbreviations ABMS ............American Board of Medical Specialties D.O. .................Doctor of Osteopathic Medicine ACP .................American College of Physicians ENT.................ear, nose, throat ACS .................American College of Surgeons M.D. ................Doctor of Medicine AOA.................American Osteopathic Association OB/GYN.......obstetrics and gynecology D.C. .................Doctor of Chiropractic Medicine O.D. .................Doctor of Optometry D.D.S. ............Doctor of Dental Surgery Ph.D. ..............Doctor of Psychology D.P.M. ...........Doctor of Podiatric Medicine 50 Medical Terminology: The Language of Health Care PRACTICE EXERCISES For the following words, draw a line or lines to separate prefixes, roots, combining forms, and suffixes. Then define the word according to the meaning of: Pprefix; Rroot; CFcombining form; Ssuffix. EXAMPLE psychiatry _______ / _______ R S psych/iatry R S DEFINITION: mind/treatment 1. oncology _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 2. immunologist _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 3. otolaryngology _____________________ / _____________________ / _____________________ CF CF S DEFINITION: _________________________________________________________________ 4. optometry _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 5. gynecology _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 6. pathology _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 7. orthopedic _____________________ / _____________________ / _____________________ CF R S DEFINITION: _________________________________________________________________ Chapter 3 • Fields of Medical Practice 51 8. urologist _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 9. neurology _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 10. psychologist _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 11. osteopathy _____________________ / _____________________ / _____________________ CF R S DEFINITION: _________________________________________________________________ 12. ophthalmologist _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 13. obstetric _____________________ / _____________________ R S DEFINITION: _________________________________________________________________ 14. anesthesiology _____________________ / _____________________ / _____________________ P CF S DEFINITION: _________________________________________________________________ 15. cardiology _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 16. dermatology _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 17. pediatrics _____________________ / _____________________ R S DEFINITION: _________________________________________________________________ 52 Medical Terminology: The Language of Health Care 18. endocrinologist _____________________ / _____________________ / _____________________ P CF S DEFINITION: _________________________________________________________________ 19. nephrologist _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 20. gastroenterology _____________________ / _____________________ / _____________________ CF CF S DEFINITION: _________________________________________________________________ 21. hematologist _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ Match the following specialists or specialties with the definition: 22. ________ emergency physician a. doctor for adults 23. ________ chiropractor b. treats foot disorders 24. ________ neurosurgeon c. provides emotional counsel 25. ________ physiatrist d. performs dental surgery 26. ________ radiologist e. operates on heart and lungs 27. ________ plastic surgeon f. interprets x-rays 28. ________ rheumatologist g. uses radioactive isotopes 29. ________ thoracic surgeon h. nonsurgical care of brain and spinal cord 30. ________ podiatrist i. treats disease of the mind 31. ________ oral surgeon j. cares for acutely ill 32. ________ psychiatrist k. general practice 33. ________ neurology l. performs brain surgery 34. ________ nuclear medicine m. specialty for treatment of the elderly 35. ________ internist n. performs reconstructive surgical repairs 36. ________ family practice o. treats arthritis Chapter 3 • Fields of Medical Practice 53 37. ________ psychologist p. rehabilitation specialist 38. ________ geriatrics q. manipulates the spine Write the full medical term for the following abbreviations: 39. OB/GYN ___________________________________________________________________ 40. D.D.S. _____________________________________________________________________ 41. ENT_______________________________________________________________________ 42. ABMS _____________________________________________________________________ 43. O.D. ______________________________________________________________________ 44. F.A.C.S. ___________________________________________________________________ 45. ACP _______________________________________________________________________ 46. D.C. _______________________________________________________________________ 47. D.P.M. ____________________________________________________________________ 48. D.O. ______________________________________________________________________ 49–53. From the following list, identify the five specialists who perform surgery: gynecologist cardiologist gastroenterologist neurologist otolaryngologist orthopaedist allergist rheumatologist nephrologist ophthalmologist geneticist endocrinologist internist pediatrician urologist Match the type of school with the degree it grants: 54. ________ dental a. Ph.D. 55. ________ graduate b. O.D. 56. ________ podiatric c. D.D.S. 57. ________ medical d. D.O. 58. ________ chiropractic e. D.P.M. 59. ________ optometric f. D.C. 60. ________ osteopathic g. M.D. Chapter 4 The Medical Record OBJECTIVES After completion of this chapter you will be able to Define basic terms and abbreviations used in documenting a history and physical Explain the concept of problem oriented medical record keeping and common format for documenting SOAP progress notes Identify common hospital records and patient care abbreviations Recognize types of diagnostic imaging modalities Define common terms related to disease Define common pharmacological terms Recognize abbreviations and symbols deemed error prone Define the symbols used in documenting a prescription or physician’s order Record military date and time Follow legal guidelines when making corrections to a medical record entry Explain the terms used in documenting a medical history and physical record Common Records Used in Documenting Care of a Patient To put your knowledge of medical terminology to practical use, you need to see how this language is used in everyday communication about patients. Learning the com- mon abbreviations, symbols, forms, and formats used in recording patient care will help you comprehend medical record documentation. HISTORY AND PHYSICAL CHART. The The record that serves as a cornerstone for patient care is the history and physical. It doc- word originates uments the patient’s medical history and findings from the physical examination. It is from the Latin usually the first document generated when a patient presents for care, most often charta, a kind of paper recorded at the time of a new patient visit (Fig. 4.1), or as part of a consultation (Fig. 4.2). made from papyrus. Charta Subjective information is obtained from the patient and documented in the patient came to mean any leaf or thin sheet of fine paper on history, starting with the chief complaint (the reason for seeking care) along with the his- which graphic illustrations tory of present illness (indicating duration and severity of the complaint) and any other were made. In medicine, the symptoms that the patient is experiencing. Information about the patient’s past medical chart most often refers to history, family history, social history, and occupational history is then noted. The history patient record is complete after documenting the patient’s answers to questions related to the review documentations. of systems, which is intended to uncover any other significant evidence of disease. 54 Chapter 4 • The Medical Record 55 Once subjective data have been recorded, the provider begins a physical examina- tion to obtain objective information, facts that can be seen or detected by testing. Signs, or objective evidence of disease, are documented, and selected diagnostic tests are per- formed or ordered when further evaluation is necessary. The impression, diagnosis, or assessment is made after evaluation of all subjective and objective data, including the results of the physical examination and diagnostic test findings. R/O (rule out) is the abbreviation used to indicate a differential diagno- sis when two or more possible diagnoses are in question. Further tests are then neces- sary to rule out or eliminate these possibilities and verify the final diagnosis. Final notations include the provider’s plan, also called a recommendation or dispo- sition, which outlines strategies designed to remedy the patient’s condition. Further documentation in the form of progress notes is made as care continues. Most often, physicians are required to submit a current history and physical before admitting a patient to the hospital. When the patient is to have surgery, this report is often called a “preoperative” history and physical (see Figure 4.6). Following are common terms and abbreviations used in documenting a history and physical examination. Abbreviation Meaning/Explanation H & P History and Physical documentation of patient history and physical examination findings Hx History record of subjective information regarding the patient’s personal medical history, including past injuries, illnesses, operations, defects, and habits subjective information information obtained from the patient including his or her personal perceptions CC Chief Complaint c/o complains of patient’s description of what brought him or her to the doctor or hospital; it is usually brief and is often documented in the patient’s own words indicated within quotes For example: CC: left lower back pain; patient states, “I feel like I swallowed a stick and it got stuck in my back” HPI (PI) History of Present Illness (Present Illness) amplification of the chief complaint recording details of the duration and severity of the condition (how long the patient has had the complaint and how bad it is) For example: HPI: the patient has had left lower back pain for the past 2 weeks since slipping on a rug and landing on her left side; the pain worsens after sitting upright for any extended period but gradually subsides after lying in a supine position 56 Medical Terminology: The Language of Health Care Abbreviation Meaning/Explanation Sx symptom subjective evidence (from the patient) that indicates an abnormality PMH (PH) Past Medical History (Past History) a record of information about the patient’s past illnesses starting with childhood, including surgical operations, injuries, physical defects, medications, and allergies UCHD usual childhood diseases an abbreviation used to note that the patient had the “usual” or commonly contracted illnesses during childhood (e.g., measles, chickenpox, mumps) NKA no known allergies NKDA no known drug allergies FH Family History state of health of immediate family members A & W alive and well L & W living and well For example: FH: father, age 92, L & W; mother, age 91, died, stroke SH Social History a record of the patient’s recreational interests, hobbies, and use of tobacco and drugs, including alcohol For example: SH: plays tennis twice/wk; tobacco—none; alcohol—drinks 1–2 beers per day OH Occupational History a record of work habits that may involve work- related risks For example: OH: the patient has been employed as a heavy equipment operator for the past 6 years ROS (SR) Review Of Systems (Systems Review) a documentation of the patient’s response to questions organized by a head-to-toe review of the function of all body systems (note: this review allows evaluation of other symptoms that may not have been mentioned) Chapter 4 • The Medical Record 57 Abbreviation Meaning/Explanation objective information facts and observations noted PE (Px) Physical Examination |
documentation of a physical examination of a patient, including notations of positive and negative objective findings HEENT head, eyes, ears, nose, throat NAD no acute distress, no appreciable disease PERRLA pupils equal, round, and reactive to light and accommodation WNL within normal limits Dx Diagnosis IMP Impression A Assessment identification of a disease or condition after evaluation of the patient’s history, symptoms, signs, and results of laboratory tests and diagnostic procedures R/O Rule Out used to indicate a differential diagnosis when one or more diagnoses are suspect; each possible diagnosis is outlined and either verified or eliminated after further testing is performed For example: Diagnosis: R/O pancreatitis R/O gastroenteritis this indicates that either of these two diagnoses is suspected and further testing is required to verify or eliminate one or both possibilities P Plan (also referred to as recommendation or disposition) outline of the treatment plan designed to remedy the patient’s condition, which includes instructions to the patient, orders for medications, diagnostic tests, or therapies 58 Medical Terminology: The Language of Health Care H&P Hx CC HPI c/o UCHD PMH NKDA FH L&W SH OH ROS PE NAD PERRLA A IMP DX P Figure 4.1 History and physical. Chapter 4 • The Medical Record 59 Figure 4.2 History and physical documented as part of a consultation for a patient with an upper respiratory infection. 60 Medical Terminology: The Language of Health Care PROBLEM-ORIENTED MEDICAL RECORD The problem-oriented medical record (POMR) is a method of record keeping intro- duced in the 1960s. It is a highly organized approach that encourages a precise method of documenting the logical thought processes of health care professionals. Data are organized so that information can be accessed readily at a glance, with a focus on the patient’s health problem. The use of POMR and its adaptations has grown in many areas of medicine. The approach is often used in medical schools, hospitals, clinics, and private practices (Fig. 4.3). The central concept is a medical record in which all information is linked to spe- cific problems. The record has four sections: • Database patient’s history, physical examinations, and diagnostic test results; from the database, the problem is identified and a plan is developed to address it • Problem list directory of the patient’s problems; each problem is listed and often assigned a number; problems include 1. a specific diagnosis 2. a sign or symptom 3. an abnormal diagnostic test result 4. any other problem that may influence health or well-being Once identified, each problem is evaluated, and a plan for treating it is written. When a problem is resolved, a notation is made to show its resolution, but the problem remains on the summary list. The original problem list is maintained in the record so that per- sonnel can easily orient themselves to the patient’s prior medical history. • Initial plan the strategy employed to resolve each problem is listed. There are three subdivisions: 1. Diagnostic plan orders are given for specific diagnostic testing to confirm suspicions 2. Therapeutic plan goals for therapy are specified 3. Patient education instructions communicated to the patient are notated Database S Follow-up O Problems Progress A Notes P Plans Orders Patient Therapies education Meds Figure 4.3 Problem-oriented medical record (POMR) diagram. Chapter 4 • The Medical Record 61 • Progress notes documentations of the progress concerning each problem are organized using the SOAP format (Figs. 4.4 and 4.5). S—subjective that which the patient describes O—objective observable information, e.g., test results, blood pressure readings A—assessment patient’s progress and evaluation of the plan’s effectiveness (note: any new problem identified is added to the problem list, and a separate plan for its treatment is recorded) P—plan decision to proceed or alter the plan strategy The SOAP method of documenting a patient’s progress appears to be the most popular adaptation to the entire system, and it is commonly utilized with or without assigning a number to the problem. Subjective WNL Objective Assessment (Impression, Diagnosis) Rule out Plan (Disposition, Recommendation) Figure 4.4 Progress note using SOAP format, representing follow-up visit after history and physical recorded in Figure 4.1. 62 Medical Terminology: The Language of Health Care Figure 4.5 SOAP progress notes following consultation of a patient with an upper respiratory infection (Fig. 4.2). Chapter 4 • The Medical Record 63 HOSPITAL RECORDS The history and physical is usually the first document entered into the patient’s hospi- tal record on admission. Physician’s orders list the directives for care prescribed by the doctor attending the patient. The nurse’s notes and physician’s progress notes chronicle the care throughout the patient’s stay, and ancillary reports note the various procedures and therapies, including diagnostic tests and pathology reports. In a difficult case, a spe- cialist may be called in by the attending physician, and a consultation report is filed. If a surgical remedy is indicated, a narrative operative report is required of the primary surgeon. The anesthesiologist, who is in charge of life support during surgery, must file the anesthesiologist’s report. The final document, which is recorded at the time of dis- charge from the hospital, is the discharge summary. The following are descriptions of common forms used in documenting the care of a hospital patient. history and physical documentation of the patient’s recent medical history and results of a physical examination required before hospital admission (e.g., before admission for surgery) (Fig. 4.6) consent form document signed by the patient or legal guardian giving permission for medical or surgical care informed consent consent of a patient after being informed of the risks and benefits of a procedure and alternatives—often required by law when a reasonable risk is involved (e.g., surgery) physician’s orders a record of all orders directed by the attending physician (Fig. 4.7) diagnostic tests/laboratory records of results of various tests and procedures reports used in evaluating and treating a patient (e.g., laboratory tests, x-rays) (Fig. 4.8) nurse’s notes documentation of patient care by the nursing staff (note: flow sheets and graphs are often used to display recordings of vital signs and other monitored procedures) (Fig. 4.9) physician’s progress notes physician’s daily account of patient’s response to treatment, including results of tests, assessment, and future treatment plans (Fig. 4.10) ancillary reports miscellaneous records of procedures or therapies provided during a patient’s care (e.g., physical therapy, respiratory therapy) consultation report report filed by a specialist asked by the attending physician to evaluate a difficult case; note: a patient may also see another physician in consultation as an outpatient (in a medical office or clinic) 64 Medical Terminology: The Language of Health Care operative report (op report) surgeon’s detailed account of the operation including the method of incision, technique, instruments used, types of sutures, method of closure, and the patient’s responses during the procedure and at the time of transfer to recovery (Fig. 4.11) pathology report report of the findings of a pathologist after the study of tissue (e.g., a biopsy) (Fig. 4.12) anesthesiologist’s report anesthesiologist’s or anesthetist’s report of the details of anesthesia during surgery, including the drugs used, dose and time given, and records indicating monitoring of the patient’s vital status throughout the procedure discharge summary, four terms that describe an outline summary of clinical resume, the patient’s hospital care, including date of clinical summary, admission, diagnosis, course of treatment, final discharge abstract diagnosis, and date of discharge (Fig. 4.13) The sample medical records in Figures 4.6 to 4.13 chronicle the hospital care of Carleen Perron, a 28-year-old woman who was seen in consultation by Dr. Patrick Rod- den, an ENT specialist, who recommended a surgical remedy for the repeated infec- tions she has had over the past 6 months. Chapter 4 • The Medical Record 65 Figure 4.6 Preoperative history and physical. A documentation of a patient’s presurgical history and physical, dic- tated and transcribed for the hospital record before admission. 66 Medical Terminology: The Language of Health Care Figure 4.6 Continued. Chapter 4 • The Medical Record 67 Figure 4.7 Preoperative surgical admitting orders. A form completed by the admitting physician that is forwarded to the hos- pital before the date of surgery. 68 Medical Terminology: The Language of Health Care Figure 4.7 Continued. Physician’s orders. Orders written by the anesthesiologist and surgeon and noted by the nurs- ing staff during the patient’s surgical care. Chapter 4 • The Medical Record 69 Figure 4.7 Continued. 70 Medical Terminology: The Language of Health Care Figure 4.7 Continued. Chapter 4 • The Medical Record 71 Figure 4.8 Diagnostic tests/laboratory reports. Reporting forms with results of blood and urine studies ordered before surgery. 72 Medical Terminology: The Language of Health Care Figure 4.8 Continued. Chapter 4 • The Medical Record 73 Figure 4.9 Nurse’s notes. A recording by the nursing staff of the patient’s progress made during general care and treat- ment. 74 Medical Terminology: The Language of Health Care Figure 4.9 Continued. Vital signs record. A chart recording of the patient’s vital signs documented by the nursing staff. Chapter 4 • The Medical Record 75 Figure 4.10 Physician’s progress notes. Physician’s notations of the patient’s progress throughout care. 76 Medical Terminology: The Language of Health Care Figure 4.11 Operative report. Surgeon’s account of a surgical procedure. Chapter 4 • The Medical Record 77 Figure 4.12 Pathology report. 78 Medical Terminology: The Language of Health Care Figure 4.13 Discharge summary (abstract). Final report documented at the time of discharge that includes the diagnostic record and di- agnosis-related group (DRG)—the number assigned to the individual hospitalization based on the patient’s diagnoses, complications, age, etc.—and that translates to a fixed dollar amount payable from a third-party payer, e.g., Medicare. Chapter 4 • The Medical Record 79 Medical Record Abbreviations Following are common medical record abbreviations used in patient care documenta- tions. They represent the “acceptable” terms used extensively throughout this text. It is important to note that individual medical facilities provide their own list of acceptable terms and abbreviations that may differ from site to site. Memorize the terms and ab- breviations from this list, and plan on adapting them to the variations you encounter in the workplace. ERROR-PRONE ABBREVIATIONS AND SYMBOLS Medical errors caused by illegible entries and misinterpretations of medical ab- breviations and symbols have led health care agencies, such as the Joint Commis- sion on Accreditation of Healthcare Organizations (JCAHO), to require that med- ical facilities publish lists of authorized abbreviations for use by all personnel, including a list of those that are unacceptable. In this text, the abbreviations and symbols that have been identified as error prone are bolded red. Depending on the medical facility, their use may or may not be deemed acceptable; therefore, it is very important to study them, too, so that you can properly interpret their meaning if they have been used in a medical record. Abbreviation Meaning MEDICAL CARE FACILITIES CCU coronary (cardiac) care unit ECU emergency care unit ER emergency room ICU intensive care unit IP inpatient (a registered bed patient) OP outpatient OR operating room PACU postanesthetic care unit PAR postanesthetic recovery post-op/postop postoperative (after surgery) pre-op/preop preoperative (before surgery) RTC return to clinic RTO return to office PATIENT CARE BRP bathroom privileges CP chest pain DC, D/C discharge, discontinue ETOH ethyl alcohol 80 Medical Terminology: The Language of Health Care Abbreviation Meaning L left R right pt patient RRR regular rate and rhythm SOB shortness of breath Tr treatment Tx treatment or traction VS vital signs T temperature P pulse R respiration BP blood pressure Ht height Wt weight WDWN well-developed and well-nourished y.o. year old # number or pound: if before the numeral, it means number (e.g., #2 number two); if after the nu- meral, it means pound (e.g., 150# 150 pounds) female male ° degree or hour ↑ increased ↓ decreased none or negative standing sitting lying Chapter 4 • The Medical Record 81 Common Diagnostic Tests and Procedures Diagnostic tests and procedures are an integral part of patient care. Analyses of urine, stool, and blood specimens are recorded among the earliest efforts to under- stand conditions of disease. The advance of technology has led to the development of a myriad of highly sophisticated laboratory testing, examples of which will be fea- tured in this text as they pertain to a specific body system. The two most common laboratory tests performed as part |
of a general health inquiry or to rule out a par- ticular condition are the complete blood count, or CBC (see Fig. 4.8, Hematology, and Fig. 8.6 in Chapter 8) and urinalysis, or UA (see Fig. 4.8 Continued and Fig. 15.9 in Chapter 15). It is valuable for health care professionals to recognize common diagnostic tests and procedures and the types of technology used to produce them. Diagnostic Imaging Modalities Methods of diagnostic imaging have rapidly expanded in the years since the discovery of x-rays by Wilhelm Roentgen in 1895. Radiation from x-rays, which pass through the body to produce images of the skeleton and other body structures, was found to be ion- izing, a process that changes the electrical charge of atoms with a possible effect on body cells. Overexposure to ionizing radiation can have harmful side effects, e.g., can- cer; however, technological advances have produced images requiring significantly lower doses of radiation to minimize risk. Further advancement has led to the discovery and use of other imaging modalities (techniques) under the umbrella of the medical specialty known as radiology. Com- mon ionizing modalities include radiography (x-ray), computed tomography, and nu- clear medicine. Common nonionizing modalities that present no apparent risk include magnetic resonance imaging and sonography. IONIZING IMAGING Radiography (X-ray) Radiography is a modality using x-rays (ionizing radiation) to provide images of the body’s anatomy to diagnose a condition or impairment. An image is produced when a small amount of radiation is passed through the body to expose a sensitive film. The image is called a radiograph. (Note: -graph is the preferred suffix used in radiology to refer to an x-ray record. It is taken by a radiologic technologist [also known as a radi- ographer] and interpreted or read by a radiologist, a physician specializing in the study of radiology.) (See Figure 4.14.) Computed Tomography or Computed Axial Tomography Computed tomography (CT), also known as computed axial tomography (CAT), is a ra- diologic procedure that uses a machine (called a scanner) to examine a body site by taking a series of cross-sectional (tomographic) x-ray films in a full circle rotation. A computer then calculates and converts the rates of absorption and density of the x-rays into a three-dimensional picture on a screen (Fig. 4.15). Nuclear Medicine Imaging or Radionuclide Organ Imaging This diagnostic imaging technique uses an injected or ingested radioactive isotope, also called a radionuclide (a chemical that has been tagged with radioactive com- pounds that emit gamma rays). A gamma camera detects and produces an image of the 82 Medical Terminology: The Language of Health Care Figure 4.14 The first published x-ray image of the hand and signet ring of Professor Roentgen’s wife. It was produced December 22, 1895. X-ray source moving around a stationary patient Patient X-ray detector moving around the patient A B Figure 4.15 A. Principles of computed tomography (CT). Inset, CT showing multiple open fractures (arrows) of skull. B. CT imaging process. Chapter 4 • The Medical Record 83 Figure 4.16 Nuclear medicine image. A. Gamma camera used to produce image. B. Radionuclide whole-body bone scan. 84 Medical Terminology: The Language of Health Care distribution of the gamma rays in the body. This is useful in determining the size, shape, location, and function of body organs such as the brain, lungs, bones, and heart (Fig. 4.16). NONIONIZING IMAGING Magnetic Resonance Imaging Magnetic resonance imaging (MRI) is a nonionizing imaging technique using mag- netic fields and radiofrequency waves to visualize anatomical structures within the body. A large magnet surrounds the patient as a scanner subjects the body to a radio signal that temporarily alters the alignment of the hydrogen atoms in the patient’s tis- sue. As the radiowave signal is turned off, the atoms realign and the energy produced is absorbed by detectors and interpreted using computers to provide detailed anatom- ical images of the body part. MRI is particularly useful in examining soft tissues, joints, and the brain and spinal cord (Fig. 4.17). Magnetic resonance angiography (MRA) applies MR technology in the study of blood flow (see Diagnostic Tests and Procedures in Chapters 7 and 10). Sonography Sonography (diagnostic ultrasound)[U/S or US] is the use of high-frequency sound waves (ultrasound) to visualize body tissues. Ultrasound waves sent through a scan- ning device, called a transducer, are reflected off structures within the body and ana- lyzed by a computer to produce moving images on a monitor. Sonography is used to examine many parts of the body, including the abdomen, male and female reproduc- tive organs, thyroid and parathyroid glands, and the cardiovascular system (Fig. 4.18). USE OF CONTRAST Some imaging procedures require the internal administration of a contrast medium to enhance the visualization of anatomical structures. There are many different kinds of contrast media, including barium, iodinated compounds, gasses (air, carbon dioxide), and other chemicals known to increase visual clarity. Depending on the medium, it may be injected, swallowed, or introduced through an enema or catheter. Compare Figures 15.5 and 15.8 (x-rays of the urinary tract) in Chapter 15, which show images taken with and without contrast. Chapter 4 • The Medical Record 85 Radiowave detector Radiowave pulses Magnet A Figure 4.17 A. Principles of magnetic resonance imaging (MRI). Patient is positioned within a magnetic field as radiowave sig- nals are conducted through the selected body part. Energy is absorbed by tissues and then released. A computer processes the re- leased energy and formulates the image. Inset, MRI of the knee (lateral view) identifying a torn meniscus. B. MRI unit. 86 Medical Terminology: The Language of Health Care Transducer Skin surface Internal Sound organ waves or fetus Energy in the form of sound waves is reflected off internal organs or, during pregnancy, the fetus and transformed into an image on a A B TV-type monitor. Figure 4.18 A. Principles of sonography. B. Obstetric sonography. Common Medical Record Terms Related to Disease NORMAL. The The following terms related to disease are common in medical records. Learn them as word stems from a foundation on which you will build as your vocabulary expands. the Latin word normalis, referring to that which is made according to a carpenter’s square, from Term Meaning norma, a carpenter’s square; thus, normal refers to acute sharp; having intense, often severe symptoms and a rule or pattern. Abnormal ă-kyūt a short course is out of line, not conforming chronic a condition developing slowly and persisting over to the rule of pattern. kronı̄k time benign mild or noncancerous BENIGN bi-nı̄n VERSUS MALIGNANT. malignant harmful or cancerous These antonyms, stemming mă-lignănt from the Latin words benignus, meaning kind degeneration gradual deterioration of normal cells and body origin, and malignus, dē-jen-er-āshŭn functions meaning bad origin, were first used to refer to degenerative disease any disease in which there is deterioration of conditions that were kind or structure or function of tissue mild as opposed to those diagnosis determination of the presence of a disease based on that were bad or severe. dı̄ -ag-nōsis an evaluation of symptoms, signs, and test findings Galen is credited for using (results) (dia through; gnosis knowing) the terms in reference to tumors. A tumor is etiology cause of a disease (etio cause) considered malignant if ē-tē-olō-jē cancerous and benign if not. exacerbation increase in severity of a disease with aggravation eg-zas-er-bāshŭn of symptoms (ex out; acerbo harsh) remission a period in which symptoms and signs stop or rē-mishŭn abate Chapter 4 • The Medical Record 87 Term Meaning febrile relating to a fever (elevated temperature) FEBRILE. Febrile febrı̄ l is derived from the Latin febris, gross large; visible to the naked eye meaning “I am warm.” In idiopathic a condition occurring without a clearly identified the ancient world, fever was idē-ō-pathik cause (idio one’s own) considered a favorable symptom, and the origin of localized limited to a definite area or part the word is associated with lōkăl-ı̄zd February (the month for cleansing or purifying). systemic relating to the whole body rather than only a part Before the clinical sis-temik thermometer was developed, the method of malaise a feeling of unwellness, often the first indication of estimating fever was to lay mă-lāz illness the hand on the skin. marked significant equivocal vague, questionable ē-kwı̄vō-kl morbidity sick; a state of disease mor-bidi-tē morbidity rate the number of cases of a disease in a given year; the ratio of sick to well individuals in a given population mortality the state of being subject to death mor-tali-tē mortality rate death rate; ratio of total number of deaths to total number in a given population prognosis foreknowledge; prediction of the likely outcome of prog-nōsis a disease based on the general health status of the patient along with knowledge of the usual course of the disease progressive the advance of a condition as signs and symptoms prō-gresiv increase in severity prophylaxis a process or measure that prevents disease prō-fi-laksis (pro before; phylassein to guard) recurrent to occur again; describes a return of symptoms rē-kŭrent and signs after a period of quiescence (rest or inactivity) sequela a disorder or condition after, and usually resulting sē-kwelă from, a previous disease or injury sign a mark; objective evidence of disease that can be seen or verified by an examiner symptom occurrence; subjective evidence of disease that is simptŏm perceived by the patient and often noted in his or her own words syndrome a running together; combination of symptoms and sindrōm signs that give a distinct clinical picture indicating a particular condition or disease, e.g., menopausal syndrome 88 Medical Terminology: The Language of Health Care Term Meaning noncontributory not involved in bringing on the condition or result unremarkable not significant or worthy of noting Pharmaceutical Abbreviations and Symbols Pharmaceutical abbreviations and symbols are frequently used in documenting pa- tient care. They are found throughout the medical record. Efficient medical record keeping and effective communication among health care workers depend on knowl- edge of commonly used pharmaceutical abbreviations and symbols. UNITS OF MEASURE The following are common metric and apothecary units of measurement. Consult your medical dictionary for a complete listing of units of measurement and conversion formulas. Metric System Metric is the most commonly used system of measurement in health care. It is a deci- mal system based on the following units. meter (m) length 39.37 inches liter (L) volume 1.0567 U.S. quarts gram (g or gm) weight 15.432 grains Apothecary System The apothecary system is an outdated method of liquid and weight measure used by the earliest chemists and pharmacists. The liquid measure was based on one drop. The weight measure was based on one grain of wheat. Although the small apothecary measures are rarely used, the larger ones, e.g., fluid ounces, are still common. DRUG. The Middle English Common Abbreviations and Symbols drogge or Abbreviation Meaning drugge is derived from the Old French drogue, all METRIC meaning drug. Earlier origin is uncertain, possibly either cc cubic centimeter (1 cc 1 mL) a Teutonic root meaning dry cm centimeter (2.5 cm 1 inch) or the Persian droa meaning odor because many drugs g or gm gram had a strong odor. Although the ancients listed the use of kg kilogram [1,000 grams (2.2 pounds)] various medicines, the term L liter drug did not appear until the end of the medieval mg milligram [one-thousandth (0.001) of a gram] period. The word druggist did not appear until the ml, mL milliliter [one-thousandth (0.001) of a liter] 16th century. mm millimeter [one-thousandth (0.001) of a meter] cu mm cubic millimeter Chapter 4 • The Medical Record 89 Abbreviation Meaning APOTHECARY fl oz fluid ounce gr grain gt drop (L. gutta drop) gtt drops dr dram (1/8 ounce) oz ounce lb or # pound (16 ounces) qt quart (32 ounces) MEDICATION ADMINISTRATION Prescribed medications can be administered to patients in various ways, depending on the indication for the drug and the status of the patient. The following is an overview of forms of drugs and routes of administration, including abbreviations and symbols. Drug Form Route of Administration SOLID AND SEMISOLID FORMS tablet (tab) oral [per os (p.o.)] by mouth capsule (cap) sublingual (SL) under the tongue buccal in the cheek suppository (suppos) vaginal [per vagina (PV)] inserted in vagina rectal [per rectum (PR)] inserted in rectum LIQUID FORMS fluid inhalation |
inhaled through nose or mouth [e.g., aerosol (spray) or neblizer (device used to produce a fine spray or mist, often in a metered dose)] parenteral by injection (Fig. 4.19) intradermal (ID) within the skin intramuscular (IM) within the muscle intravenous (IV) within the vein subcutaneous (Sub-Q, SC, SQ) under the skin cream, lotion, topical applied to the ointment surface of the skin other delivery transdermal absorption of a drug systems through unbroken skin implant a drug reservoir imbedded in the body to provide continual infusion of a medication (see Chapter 11, Fig. 11.9) 90 Medical Terminology: The Language of Health Care Intramuscular Subcutaneous Muscle Vein Intradermal Intravenous Figure 4.19 Parenteral drug administration. The Prescription Rx. The symbol found at the A prescription is a written direction by a physician for dispensing or administering a beginning of a medication to a patient. It is an order to supply a named patient with a particular drug prescription stands for of a specific strength and quantity along with specific instructions for administration. recipe. The cross on the tail of the Rx incorporates the The prescription is a legal document that must be written in a specific format (Fig. 4.20). astrological sign of Jupiter, which has no connection DRUG NAMES with the word recipe. The sign of Jupiter was placed at The chemical name is assigned to a drug in the laboratory at the time it is invented. It the top of a formula to is the formula for the drug, which is written exactly according to its chemical struc- appease the chief Roman ture. The generic name is the official, nonproprietary name given a drug. The trade or god so that the compound brand is the manufacturer’s name for a drug. For example: might act favorably. The period during the chemical name 1-[[3-(6,7-dihydro-1-methyl-7-oxo-3-propyl-1H-pyra- ascendancy of the planet zolo[4,3-d]pyrimidin-5-yl)-4-ethoxyphenyl]sulfonyl]- Jupiter was considered a favorable time for the 4-methylpiperazine citrate collection of herbs and the generic name sildenafil preparation of medicines. trade or brand Viagra (Pfizer Pharmaceutical Company) Chapter 4 • The Medical Record 91 Figure 4.20 Sample prescription. PRESCRIPTION ABBREVIATIONS Many Latin abbreviations and symbols are commonly used in prescription writing as well as in physicians’ orders. Being familiar with these symbols makes it possible to read a prescription or physician’s order. Historically, prescriptions were written in Latin. The words were abbreviated for convenience. For example, quater in die, Latin for four times a day, is abbreviated q.i.d. The periods were included to indicate the abbreviation of three words; if not carefully documented, however, they can be interpreted with drastic implications. For example, the period in q.d (meaning once a day) can be misinterpreted as q.i.d (four times a day) when handwritten. For the purpose of proper recognition, the periods were included in the abbreviations in this text, but the trend is to discourage their use, especially in writing, because they can be misinterpreted. In practice, you will find variations in- cluding or excluding the periods and the use of uppercase instead of lowercase letters, e.g., QID versus qid. Roman numerals were used exclusively in the early days and are still used today; however, most pharmacy organizations now promote the use of Arabic numerals only. 92 Medical Terminology: The Language of Health Care Error-Prone Abbreviations and Symbols Listed is a sampling of abbreviations and symbols deemed most error prone, including the risk for misin- terpretation and preferred use. Error-Prone Abbreviation Meaning Risk Preferred Use q.d every day mistaken for q.i.d. when spell out “daily” the period after the “q” is sloppily written to look like an “i” q.o.d. every other day mistaken for q.d when the spell out “every other “o” is mistaken for a period day” DC, D/C discharge, when used to mean “dis- spell out “discon- discontinue charge,” mistaken for tinue” or “discontinue” when “discharge” followed by medications prescribed at the time of discharge AS, AD, AU left ear, right ear, mistaken for each other spell out both ears OS, OD, OU left eye, right eye, mistaken for each other spell out both eyes SC or SQ subcutaneous mistaken for SL spell out “subcuta- (sublingual) or “5 every” neously” or use Sub-Q , greater than, mistaken for each other spell out less than Chapter 4 • The Medical Record 93 Common Abbreviations and Symbols DEXTER AND SINISTER. Abbreviation Meaning Latina Dexter is Latin for right, and sinister is Latin for TIME AND FREQUENCY left. The origin of these terms, however, is earlier ā before ante than ancient Rome. Sun a.c. before meals ante cibum worshippers facing the morning sun had the south a.m. before noon ante meridiem on their right hand. The Sanskrit word for south is b.i.d. twice a day bis in die dekkan, allied to dhu, d day shining; thus, the right hand was the south or warm h hour hora shining hand. The left hand h.s. at hour of sleep (bedtime) hora somni was the north or cold hand. Therefore, dexterity or right- noc. night noctis handedness was skill, whereas sinister was p̄ after post ill-omened. Among the p.c. after meals post cibum Romans, sinisteritas (left- handedness) meant p.m. after noon post meridiem awkwardness. p.r.n. as needed pro re nata q every quaque q d every day quaque die q h every hour quaque hora q 2 h every 2 hours q.i.d. four times a day quater in die q.o.d. every other day quaque altera die STAT immediately statim t.i.d. three times a day ter in die wk week yr year MISCELLANEOUS AD right ear auris dextra AS left ear auris sinistra AU both ears aures unitas ad lib. as desired ad libitum amt amount aq water aqua B bilateral C Celsius, centigrade c̄ with cum 94 Medical Terminology: The Language of Health Care Abbreviation Meaning Latina F Fahrenheit m murmur NPO nothing by mouth non per os OD right eye oculus dexter OS left eye oculus sinister OU both eyes oculi unitas per by or through p.o. by mouth per os PR through rectum per rectum PV through vagina per vagina q.n.s. quantity not sufficient q.s. quantity sufficient Rx recipe; prescription Sig: label; instruction to the patient signa s̄ without sine ss̄ one-half semis w.a. while awake times or for [e.g., 6 (six times), 2 d (for 2 days)] > greater than < less than one (modified lowercase Roman numeral i) two (modified lowercase Roman numeral ii) three (modified lowercase Roman numeral iii) four (modified lowercase Roman numeral iv) I, II, III, IV, V, uppercase Roman numerals 1–10 (Note: Arabic numerals are VI, VII, VIII, IX, X preferred) aOriginal Latin given when it is deemed helpful. Chapter 4 • The Medical Record 95 Recording Date and Time The date and time are usually required in entries in a medical record. Always include the month, day of the month, and the year (e.g., 12/25/xx); sometimes eight digits are required (e.g., 01/08/20xx). Often military time is used (Fig. 4.21). Standard Military Standard Military 1:00 a.m. 0100 zero one hundred 1:00 p.m. 1300 thirteen hundred 2:00 a.m. 0200 zero two hundred 2:00 p.m. 1400 fourteen hundred 2:15 a.m. 0215 zero two fifteen 3:00 p.m. 1500 fifteen hundred 3:00 a.m. 0300 zero three hundred 4:00 p.m. 1600 sixteen hundred 4:00 a.m. 0400 zero four hundred 5:00 p.m. 1700 seventeen hundred 4:30 a.m. 0430 zero four thirty 6:00 p.m. 1800 eighteen hundred 5:00 a.m. 0500 zero five hundred 7:00 p.m. 1900 nineteen hundred 6:00 a.m. 0600 zero six hundred 8:00 p.m. 2000 twenty hundred 7:00 a.m. 0700 zero seven hundred 9:00 p.m. 2100 twenty-one hundred 8:00 a.m. 0800 zero eight hundred 10:00 p.m. 2200 twenty-two hundred 9:00 a.m. 0900 zero nine hundred 11:00 p.m. 2300 twenty-three hundred 10:00 a.m. 1000 ten hundred 12:00 a.m. 2400 twenty-four 11:00 a.m. 1100 eleven hundred (midnight) hundred hours 12:00 p.m. 1200 twelve hundred hours (noon) 2400 2300 1300 2200 1400 2100 1500 2000 1600 1900 1700 1800 Figure 4.21 Military and standard time. 96 Medical Terminology: The Language of Health Care Regulations and Legal Considerations Medical record documentations are made by physicians caring for the patient as well as other authorized health care professionals involved with care. State, federal, and private accrediting agencies, e.g., the Joint Commission on Ac- creditation of Healthcare Organizations (JCAHO), provide specific guidelines that reg- ulate how medical records are kept, including proper format for all forms, use of ap- propriate terminology and accepted abbreviations, protocol for personnel having access to records, and responsibilities for documentation. Corrections Sometimes mistakes are made when making an entry in a medical record. Careful clar- ification of the error is essential. If a mistake is made in a handwritten entry, it should be identified by drawing a single line through it, and the correction written in the mar- gin above or immediately after. Include the date, the abbreviation “corr.,” and the ini- tials of the person making the correction. The use of correction fluid, e.g., Wite-Out, is forbidden! The medical record often becomes evidence in medical malpractice cases. Obliter- ations and signs of possible tampering can be construed as trying to withhold infor- mation or covering up negligent wrongdoing. Complete and accurate record keeping is your best defense against any possible legal action (Fig. 4.22). Wrong Right Figure 4.22 Proper correction of a medical record. Chapter 4 • The Medical Record 97 PRACTICE EXERCISES Write the full medical term for the following abbreviations and symbols, and put an asterisk (*) next to those that are error prone: 1. CC ________________________________________________________________________ 2. OH ________________________________________________________________________ 3. PR ________________________________________________________________________ 4. BRP ______________________________________________________________________ 5. PACU _____________________________________________________________________ 6. PH ________________________________________________________________________ 7. D/C _______________________________________________________________________ 8. Sig: _______________________________________________________________________ 9. ER ________________________________________________________________________ 10. ICU _______________________________________________________________________ 11. R/O _______________________________________________________________________ 12. NPO ______________________________________________________________________ 13. L&W ______________________________________________________________________ 14. BP ________________________________________________________________________ 15. AU ________________________________________________________________________ 16. Sx ________________________________________________________________________ 17. VS ________________________________________________________________________ 18. ROS ______________________________________________________________________ 19. pt _________________________________________________________________________ 20. OD _______________________________________________________________________ 21. Sub-Q _____________________________________________________________________ 22. H&P ______________________________________________________________________ 23. Tx ________________________________________________________________________ 24. Dx ________________________________________________________________________ 25. HPI _______________________________________________________________________ 98 Medical Terminology: The Language of Health Care 26. _________________________________________________________________________ 27. ↓ _________________________________________________________________________ Match the following terms with their meanings: 28. ________ febrile a. period in which symptoms stop 29. ________ syndrome b. probable outcome of a disease 30. ________ chronic c. name of a disease based on history, exam, and testing 31. ________ remission d. elevated temperature 32. ________ etiology e. set of symptoms characteristic of a par- ticular disease or condition 33. ________ malignant f. increase in severity with aggravation of symptoms 34. ________ prognosis g. developing slowly over time 35. ________ diagnosis h. limited to a definite area or part 36. ________ exacerbation i. cancerous 37. ________ localized j. the study of the cause of a disease Match the following definitions with their abbreviation or symbol: 38. ________ route of oral medications a. pre-op 39. ________ place for surgery b. prn 40. ________ as desired c.parenteral 41. ________ progress note d. po 42. ________ after surgery e. STAT 43. ________ pound f. ad lib 44. ________ as needed g. post op 45. ________ by injection h. OR 46. ________ before surgery i. SOAP 47. ________ immediately j. # Write the meaning for the following pharmaceutical phrases: 48. VS q h 4 h, then q 2 h ____________________________________________________ 49. po qid pc hs _____________________________________________________________ 50. aspirin (ASA) gr ss _______________________________________________________ Chapter 4 • The Medical Record 99 51. 650 mg po q 4 h prn temp 101° ____________________________________________ 52. suppos PR q noc prn _____________________________________________________ 53. gt OU tid 7 d __________________________________________________________ 54. cap STAT, then q 6 h __________________________________________________ Write the standard pharmaceutical abbreviations for the following: 55. one tablet by mouth three times a day for 7 days ___________________________________________________________________________ 56. one suppository in the vagina at bedtime ___________________________________________________________________________ 57. five milliliters by mouth four times a day ___________________________________________________________________________ 58. one or two by mouth every 3 to 4 hours as needed ___________________________________________________________________________ 59. two drops in left ear every 3 hours ___________________________________________________________________________ 60. one capsule by mouth two times a day, morning and evening ___________________________________________________________________________ 61. two by mouth immediately, then one by mouth every 6 hours ___________________________________________________________________________ 62. thirty milligrams by mouth at bedtime as needed ___________________________________________________________________________ Give the military time for the following: 63. 1:00 a.m. 64. 2:30 p.m. 65. midnight 66. 1:00 p.m. 67. 7:00 p.m. 68. 4:50 a.m. 100 Medical Terminology: The Language of Health Care Match the |
following chart entries with the corresponding health record abbreviations: 69. ________ works as a security officer a. UCHD 70. ________ advised to lower salt intake b. HPI 71. ________ father, age 88, L&W; mother, age 78, died, stroke c. PE 72. ________ quit smoking 2 years ago, drinks alcohol socially d. CC 73. ________ diagnosis: tonsillitis e. OH 74. ________ c/o lower back pain f. SH 75. ________ pain in lower back for 2 weeks, worse at night g. FH 76. ________ no reaction to any previously administered drug h. P 77. ________ had all commonly contracted childhood diseases i. A 78. ________ lungs: clear; heart: regular rate and rhythm j. NKA Give the meaning for the following abbreviations deemed error prone, and list the preferred term for each: Abbreviation Meaning Preferred Term 79. q.d ________________ ___________________ 80. q.o.d. ________________ ___________________ 81. OS ________________ ___________________ 82. AD ________________ ___________________ 83. AU ________________ ___________________ 84. ________________ ___________________ 85. D/C ________________ ___________________ From the following list of diagnostic imaging modalities, circle those that use ion- izing radiation: 86. computed tomography 87. magnetic resonance imaging 88. radiology 89. radionuclide organ imaging 90. sonography Chapter 4 • The Medical Record 101 Match the following imaging modalities with the type of radiation used: 91. ________ computed tomography a. standard x-rays 92. ________ magnetic resonance imaging b. gamma rays 93. ________ radiology c. ultrasound waves 94. ________ radionuclide organ imaging d. radio waves 95. ________ sonography e. 3-D x-rays 102 Medical Terminology: The Language of Health Care MEDICAL RECORD ANALYSES M E D I C A L R E C O R D 4 . 1 Progress Note CC: 37 y.o. c̄ diabetes c / o swelling of the R foot and calf 3d S: There is no Hx of trauma, pain, SOB, or cardiac Sx, smoker 12 yr, ss̄ pkg q d, denies ETOH consumption Meds: parenteral insulin qd, NKDA O: Pt is afebrile, BP 140/84, P 72, R 16, lungs are clear; abdomen is benign s organomegaly; muscle tone and strength are WNL; there is swelling of the R calf but s erythema or tenderness A: Edema of R calf of unknown etiology P: Schedule STAT vascular sonogram of lower extremities; pt is to keep the leg elevated d, then RTC for follow-up and test results on Thursday (or sooner if ↑ edema, SOB, or CP) 1. What is the sex of the patient? 5. How is the patient’s insulin administered? a. male a. orally b. female b. transdermally c. infusion through implant 2. Where was the patient seen? d. by injection a. emergency room b. outpatient office of clinic 6. What is the cause of the patient’s complaint? c. inpatient hospital a. unknown d. not stated b. fever c. shortness of breath 3. What was the condition of the patient’s ab- d. trauma domen? a. shows signs of cancer 7. When should the sonogram be performed? b. internal organs are enlarged a. immediately c. internal organs are not enlarged b. within two days d. muscle tone and strength are weak c. at the time of follow-up d. only if symptoms persist 4. How much does the patient smoke per day? a. one package 8. How long should the patient’s leg be kept b. two packages elevated? c. half a package a. one week d. none; patient quit smoking 12 years ago b. two weeks c. one day d. two days Chapter 4 • The Medical Record 103 M E D I C A L R E C O R D 4 . 2 Postop Meds for Laparotomy 1. Vicodin, tab p.o. q 3 h prn mild pain, or tab p.o. q 3 h prn moderate pain 2. Demerol, 100 mg IM q 3 h prn severe pain 3. Tylenol (acetaminophen) 650 mg p.o. q 4 h prn oral temp ↑ 100.4°F 4. Dalmane (flurazepam) 30 mg p.o. h.s. prn sleep 5. Mylicon (simethicone) 80 mg, tab chewed and swallowed q.i.d. 6. Ducolax (bisacodyl) suppos, PR in a.m. 1. How is the Demerol to be administered? 5. What are the instructions for administering the a. by mouth Vicodin in the case of moderate pain? b. within the vein a. one tablet every three hours c. under the skin b. three tablets every hour d. within the muscle c. two tablets every three hours d. three tablets every three hours 2. What is the Sig: on the Mylicon? a. one every other day 6. How should the Tylenol be administered? b. one twice a day a. one dose every four hours as needed c. one three times a day b. one dose every four hours only if patient has a temperature of 100.4°F or higher d. one four times a day c. one dose every four hours as long as the pa- 3. What is the Sig: on the Ducolax? tient’s temperature does not go over 100.4° a. one suppository in the rectum in the morning d. one dose every hour up to four per day b. one suppository taken orally before noon c. two suppositories before breakfast 7. Laparotomy refers to d. one suppository as needed in the morning a. a puncture of the abdomen b. excision of the stomach 4. When should the Dalmane be administered? c. a puncture of the stomach a. each night d. an incision in the abdomen b. at bedtime c. as needed d. every hour 104 Medical Terminology: The Language of Health Care M E D I C A L R E C O R D 4 . 3 Michael Marsi has had chronic health problems in the past 2 years and has been see- ing Dr. Spaulding, his personal physician, regularly in recent months. Dr. Spaulding uses problem-oriented medical records and writes a new SOAP progress note at each patient visit. Mr. Marsi has come to see Dr. Spaulding today because he feels worse than usual. DIRECTIONS Read Medical Record 4.3 (page 105) for Michael Marsi, and answer the following ques- tions. This record is the progress note for today’s visit, part of Dr. Spaulding’s POMR for Mr. Marsi. Dr. Spaulding handwrote it herself during the patient’s visit. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 4 . 3 Write your answers in the spaces provided. 1. How old is Mr. Marsi? _______________________________________________________ 2. Where was the treatment rendered? ___________________________________________ 3. List the three elements of the patient’s complaint a. __________________________________________________________________________ b. __________________________________________________________________________ c. __________________________________________________________________________ 4. In your own words, not using medical terminology, briefly summarize Mr. Marsi’s history: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 5. Which of the following is not mentioned at all in this history? a. The prescription medication Mr. Marsi takes b. Mr. Marsi’s smoking habit c. Mr. Marsi’s activity level at work d. Mr. Marsi’s consumption of alcohol 6. Dr. Spaulding and Mr. Marsi talked at length about Mr. Marsi’s symptoms and how they’ve changed recently, and then Dr. Spaulding examined him. List three objective findings she noted in this examination. a. __________________________________________________________________________ b. __________________________________________________________________________ c. __________________________________________________________________________ Chapter 4 • The Medical Record 105 Medical Record 4.3 106 Medical Terminology: The Language of Health Care 7. Dr. Spaulding’s assessment is that Mr. Marsi has ______________________________. But she also wants to make sure he does not have ______________________________ ____________________________________________________________________________. 8. Dr. Spaulding’s treatment plan involves four areas. List the specific plan(s) for each of these. Diagnostic tests ordered: _____________________________________________________ ____________________________________________________________________________ Instruct patient to change (and how) these personal habits: _____________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Drug prescribed (and how much and when): __________________________________ ____________________________________________________________________________ Future diagnostic check and/or action to take: _________________________________ ____________________________________________________________________________ 9. When is Dr. Spaulding expecting to see Mr. Marsi again? _______________________ ____________________________________________________________________________ Chapter 5 Integumentary System OBJECTIVES After completion of this chapter you will be able to Define common combining forms used in relation to the integumentary system Describe the basic functions of the integumentary system Define basic anatomical terms related to the integumentary system Identify common symptomatic terms related to the integumentary system Identify common diagnostic terms related to the integumentary system List common diagnostic tests and procedures related to the integumentary system Identify common operative terms referring to the integumentary system Identify common therapeutic terms including drug classifications related to the integumentary system Explain common terms and abbreviations used in documenting medical records involving the integumentary system Combining Forms Combining Form Meaning Example adip/o fat adiposis ad-i-pōsis lip/o lipoma li-pōma steat/o steatoma stē-ā-tōmă derm/o skin hypodermic hı̄pō-dermik dermat/o dermatology der-mă-tolō-jē cutane/o subcutaneous sŭb-kyū-tānē-ŭs erythr/o red erythrodermatitis ĕ-rith-rō-dermā-tı̄tis hidr/o sweat anhidrosis an-hı̄-drōsis 107 108 Medical Terminology: The Language of Health Care Combining Form Meaning Example hist/o tissue histology his-tolō-jē histi/o histiogenic histē-ō-jenik ichthy/o fish ichthyoid ikthē-oyd kerat/o hard keratosis ker-ă-tōsis scler/o scleroderma sklĕr- ō-dermă leuk/o white leukonychia lū-kō-nikē-ă melan/o black melanocyte melă-nō-sı̄t myc/o fungus mycosis mı̄-kōsis onych/o nail onychodystrophy oni-kō-distrō-fē plas/o formation dysplastic dis-plastik purpur/o purple purpuric pŭrpūrik seb/o sebum (oil) seborrhea seb-ō-rēă squam/o scale squamous skwāmūs trich/o hair trichorrhexis trik-ō-reksis xanth/o yellow xanthoma zan-thōmă xer/o dry xerosis zē-rōsis Integumentary System Overview The integumentary system is composed of the skin (also called the integument) and its appendages, including hair, nails, sweat glands, and sebaceous glands. It protects the body from injury or intrusion of microorganisms, helps regulate body tempera- ture, and houses the receptors for the sense of touch, including pain and sensation (Fig. 5.1). The skin is the largest organ in the body. Skin layers are divided into an outer layer called the epidermis, an inner layer called the dermis, and a subcutaneous tissue layer beneath the dermis. Chapter 5 • Integumentary System 109 Squamous cell carcinoma Hair shaft Squamous layer Receptor for (stratum corneum) touch Basal layer Pore (stratum germinativum) Epidermis Dermis Pilomotor muscle Sebaceous gland Subcutaneous tissue Sweat gland Basal cell carcinoma Hair follicle Free nerve ending Adipose tissue Receptor for pressure Venule Arteriole Nerve Normal nevus (mole) (Fig. 1) Malignant melanoma showing asymmetry (Fig. 2) Signs of melanoma Malignant melanoma showing Malignant melanoma showing A Asymmetry: One half does not match the other half border irregularity (Fig. 3) uneven pigmentation (Fig. 4) (Fig. 2). B Border irregularity: The edges are ragged, notched, or blurred (Fig. 3). C Color: The pigmentation is not uniform. Shades of tan, brown, and black are present. Red, white, and blue may add to the mottled appearance (Fig. 4). D Diameter greater than 6 millimeters: Any sudden or continuing increase in size should be of special concern (not shown). Figure 5.1 The skin. 110 Medical Terminology: The Language of Health Care Epidermis The epidermis consists of several layers of stratified squamous (scale-like) epithelium. The two significant layers are the innermost layer, known as the basal layer (stratum germinativum), and the outermost layer, called the squamous layer (stratum corneum). The cells of the basal layer are constantly being produced, moving the older cells up to- ward the surface. As these cells are being pushed up, they flatten, become filled with a hard protein substance called keratin, and soon die. As a result, many layers of tightly packed dead cells accumulate in the outermost squamous layer, where they are sloughed off from the surface of the skin. Melanocytes, which produce the pigment called melanin that gives color to the skin, are found in the basal layer. Dermis The dermis, also called the corium, is the connective tissue layer; it contains blood and lymphatic vessels, nerves and nerve endings, glands, and hair follicles within a network of elastic and collagen fibers. Collagen is a fibrous protein material that is tough and resistant. These fibers give the skin its qualities of toughness and elasticity. Subcutaneous Tissue The subcutaneous layer is below the dermis and is composed of loose connective tis- sue and adipose (fatty) tissue. Anatomical Terms Term Meaning epithelium cells covering external and internal surfaces of the body ep-i-thēlē-ŭm epidermis thin, cellular outer layer of the skin ep-i-dermis squamous cell layer flat, scale-like epithelial cells comprising the outermost skwāmŭs layers of the epidermis basal layer deepest region of the epidermis bāsăl melanocyte a cell found in the basal layer that gives color to the skin melă-nō-sı̄t melanin dark brown to black pigment contained in melanocytes melă-nin dermis dense, fibrous connective tissue layer of the skin (also known as the corium) sebaceous |
glands oil glands in the skin sē-bāshŭs sebum oily substance secreted by the sebaceous glands sēbŭm sudoriferous glands sweat glands (sudor sweat; ferre to bear) sū-dō-rifer-ŭs Chapter 5 • Integumentary System 111 Term Meaning subcutaneous tissue connective and adipose tissue layer just under the dermis sŭb-kyū-tānē-ŭs collagen protein substance found in skin and connective tissue kollă-jen (koila glue; gen producing) hair outgrowth of the skin composed of keratin nail outgrowth of the skin attached to the distal end of each finger and toe, composed of keratin keratin hard protein material found in the epidermis, hair, and nails keră-tin Symptomatic Terms Term Meaning lesion an area of pathologically altered tissue (two types: primary lēzhŭn and secondary) (Fig. 5.2) primary lesions lesions arising from previously normal skin flat, nonpalpable changes in skin color macule (macula) a flat, discolored spot on the skin up to 1 cm across (e.g., a makyūl freckle) (Fig. 5.3A) patch a flat, discolored area on the skin larger than 1 cm (e.g., vitiligo) (Fig. 5.3B) elevated, palpable, solid masses papule a solid mass on the skin up to 0.5 cm in diameter [e.g., a nevus papyūl (mole)] (Fig. 5.3C) plaque a solid mass greater than 1 cm in diameter, limited to the plāk surface of the skin (Fig. 5.3D) nodule a solid mass greater than 1 cm, which extends deeper into nodyūl the epidermis (Fig. 5.3E) tumor a solid mass larger than 1–2 cm (Fig. 5.3F) tumŏr wheal an area of localized skin edema (swelling) (e.g., a hive) hwēl (Fig. 5.3G) elevation formed by fluid within a cavity vesicle little bladder; an elevated, fluid-filled sac (blister) within or vesı̆-kl under the epidermis up to 0.5 cm in diameter (e.g., a fever blister) (Fig. 5.3H) bulla a blister larger than 0.5 cm (e.g., a second-degree burn) bulă (bulla bubble) (Fig. 5.3I) pustule a pus-filled sac (e.g., a pimple) (Fig. 5.3J) pŭschūl 112 Medical Terminology: The Language of Health Care PRIMARY LESIONS Flat discolored, nonpalpable changes in skin color Macule Patch Elevated, palpable solid masses Papule Plaque Nodule Tumor Wheal Elevation formed by fluid in a cavity Vesicle Bulla Pustule SECONDARY LESIONS Loss of skin surface Erosion Ulcer Excoriation Fissure Material on skin surface Scale Crust Keloid VASCULAR LESIONS Cherry angioma Telangiectasia Petechia Ecchymosis Figure 5.2 Types of primary, secondary, and vascular lesions. Term Meaning secondary lesions lesions that result in changes in primary lesions loss of skin surface erosion to gnaw away; loss of superficial epidermis leaving an ēr-ōzhŭn area of moisture but no bleeding (e.g., area of moisture after rupture of a vesicle) (Fig. 5.3K) Chapter 5 • Integumentary System 113 PRIMARY LESIONS A Macule B Patch C Papule D Plaque E Nodule F Tumor G Wheal H Vesicle SECONDARY LESIONS I Bulla J Pustule K Erosion L Ulcer M Excoriation N Fissure O Scale P Crust VASCULAR LESIONS Q Keloid R Cherry angioma S Telangiectasia T Petechia Figure 5.3 Skin lesions. Term Meaning ulcer an open sore on the skin or mucous membrane that can bleed and scar and is sometimes accompanied by infection (e.g., decubitus ulcer) (Fig. 5.3L) excoriation a scratch mark (e.g., from a cat scratch) (Fig. 5.3M) eks-kōrē-āshŭn fissure a linear crack in the skin (Fig. 5.3N) fishŭr 114 Medical Terminology: The Language of Health Care Term Meaning material on skin surface scale a thin flake of exfoliated epidermis (e.g., dandruff) (Fig. 5.3O) crust dried residue of serum (body liquid), pus, or blood on the skin (e.g., in impetigo) (Fig. 5.3P) other secondary lesions cicatrix of the skin a mark left by the healing of a sore or wound showing sikă-triks the replacement of destroyed tissue by fibrous tissue (cicatrix scar) keloid an abnormal overgrowth of scar tissue that is thick and kēloyd irregular (kele tumor) (Fig. 5.3Q) vascular lesions lesions of a blood vessel cherry angioma a small, round, bright-red blood vessel tumor on the chārē an-jē-ōmă skin, often on the trunk of the elderly ((Fig. 5.3R) telangiectasia a tiny, red blood vessel lesion formed by the dilation of a tel-anjē-ek-tāzē-ă group of blood vessels radiating from a central arteriole, spider angioma most commonly seen on the face, neck, or chest spı̄der an-jē-ōmă (telos end) (Fig. 5.3S) purpuric lesions purpura; lesions as a result of hemorrhages into the skin pŭrpū-rik petechia spot; a reddish-brown, minute hemorrhagic spot on the pe-tēkē-ă skin that indicates a bleeding tendency—small purpura (Fig. 5.3T) ecchymosis bruise; a black and blue mark—large purpura (chymo ek-i-mōsis juice) epidermal tumors skin tumors arising from the epidermis nevus a congenital malformation on the skin that can be nēvŭs epidermal or vascular—also called a mole (see Fig. 5.1) dysplastic nevus a mole with precancerous changes dis-plastik nēvŭs verruca an epidermal tumor caused by a papilloma virus—also vĕ-rūkă called a wart (Fig. 5.4) GENERAL SYMPTOMATIC TERMS COMEDO, a alopecia baldness; natural or unnatural deficiency of hair plug of sebum al-ō-pēshē-ă within the opening of a hair follicle, comedo a plug of sebum (oil) within the opening of a hair follicle also known as whitehead or (pl. comedos, (Fig. 5.5) blackhead, is derived from comedones) the Latin word meaning to komē-dō eat up or consume. The material when expressed closed comedo below the skin surface with a white center has a worm-like (whitehead) appearance, and ancient writers thought there was an open comedo open to the skin surface with a black center caused actual worm eating into the (blackhead) by the presence of melanin exposed to air flesh. Chapter 5 • Integumentary System 115 Figure 5.4 Verrucae on a knee. (From Dr. Barankin Figure 5.5 Open and closed comedones. Dermatology Collection.) Term Meaning eruption appearance of a skin lesion ē-rŭpshŭn erythema redness of skin er-i-thēmă pruritus severe itching prū-rı̄tŭs rash a general term for skin eruption, most often associated with communicable disease skin pigmentation skin color due to the presence of melanin depigmentation loss of melanin pigment in the skin hypopigmentation areas of skin lacking color due to deficient amounts of melanin hyperpigmentation darkened areas of skin caused by excessive amounts of melanin suppuration production of purulent matter (pus) sŭpyŭ-rāshŭn urticaria hives; an eruption of wheals on the skin accompanied by erti-kari-a itch (urtica stinging nettle) (see Fig. 5.3G) xeroderma dry skin zērō-dermă Diagnostic Terms Term Meaning acne an inflammation of the sebaceous glands and hair aknē follicles of the skin evidenced by comedones, pustules, or nodules on the skin (acne point) (Fig. 5.6) albinism a hereditary condition characterized by a partial or total albi-nizm lack of melanin pigment (particularly in the eyes, skin, and hair) 116 Medical Terminology: The Language of Health Care Term Meaning burn any injury to body tissue caused by heat, chemicals, electricity, radiation, or gases first-degree burn a burn involving only the epidermis, characterized by erythema (redness) and hyperesthesia (excessive sensation) second-degree burn a burn involving the epidermis and the dermis, characterized by erythema, hyperesthesia, and vesications (blisters) third-degree burn a burn involving all layers of the skin, characterized by the destruction of the epidermis and dermis with damage or destruction of the subcutaneous tissue cellulitis an acute inflammation of subcutaneous tissue resulting from a bacterial invasion through a break in the skin (cellula small storeroom) dermatitis (eczema) an inflammation of the skin characterized by redness, der-mă-tı̄tis pruritus (itching), and various lesions common types: atopic dermatitis a chronic skin inflammation characterized by the (atopic eczema) appearance of inflamed, swollen papules and vesicles that crust and scale, with severe itching and burning; most outbreaks begin in infancy and are marked by exacerbations and remissions that usually clear up before adulthood; occurs in persons with atopy (a genetic hypersensitivity to environmental irritants or allergens) contact dermatitis an inflammation of the skin resulting from contact with a substance to which one is allergic (e.g., chemicals in dyes, preservatives, fragrances, rubber; allergic dermatitis); or one that is a known skin irritant (e.g., acid, solvent; irritant dermatitis) (Fig. 5.7) seborrheic redness of the skin covered by a yellow, oily, itchy scale dermatitis most commonly at the hairline, forehead, and around the nose, ears, or eyelashes and developing at any age; referred to as “cradle cap” in infants Figure 5.6 Acne lesions. Inflammatory papules, Figure 5.7 Contact dermatitis. This eczematous pustules, and closed comedones are present on the dermatitis on the dorsa of the hands was caused by face of a patient diagnosed with acne vulgaris. exposure to lanolin. Chapter 5 • Integumentary System 117 Term Meaning dermatosis any disorder of the skin der-mă-tōsis exanthematous eruption of the skin caused by a viral disease (exanthema viral disease eruption) eg-zan-themă-tŭs rubella reddish; German measles rū-belă rubeola reddish; 14-day measles rū-bēō-lă varicella a tiny spot; chickenpox var-ı̆-selă eczema to boil out; the term is often used interchangeably with ekzĕ-mă dermatitis to denote a skin condition characterized by the appearance of inflamed, swollen papules and vesicles that crust and scale, often with sensations of itching and burning furuncle a boil; a painful nodule formed in the skin by inflammation fyūrŭng-kl originating in a hair follicle—caused by staphylococcosis carbuncle a skin infection consisting of clusters of furuncles (carbo karbŭng-kl small, glowing embers) abscess a localized collection of pus in a cavity formed by the abses inflammation of surrounding tissues that heals when drained or excised (abscessus a going away) gangrene an eating sore; death of tissue associated with a loss of ganggrēn blood supply resulting from trauma or an inflammatory or infectious process such as seen in complications of frostbite, severe burns, and conditions that affect circulation (e.g., diabetes) herpes simplex virus transient viral vesicles (e.g., cold sores, fever blisters) type 1 (HSV-1) that infect the facial area, especially the mouth and nose herpēz (herpes creeping skin disease) herpes simplex virus sexually transmitted ulcer-like lesions of the genital and type 2 (HSV-2) anorectal skin and mucosa; after initial infection, the virus lies dormant in the nerve cell root and may recur at times of stress (see Chapter 17, Fig. 17.9) herpes zoster a viral disease affecting the peripheral nerves characterized herpēz zoster by painful blisters that spread over the skin following the affected nerves; usually unilateral—also known as shingles (zoster girdle) (see Chapter 10, Fig. 10.10) ichthyosis a skin condition caused by a gene defect that results in dry, ik-thē-ōsis thick, scaly skin; ichthyosis vulgaris is the most common of the many types (vulgaris is a Greek word meaning common) impetigo highly contagious, bacterial skin inflammation marked im-pe-tı̄gō by pustules that rupture and become crusted—most often occurs around the mouth and nostrils 118 Medical Terminology: The Language of Health Care Term Meaning keratoses thickened areas of epidermis ker-ă-tōsez actinic keratoses localized thickening of the skin caused by ak-tinik excessive exposure to sunlight; a known solar keratoses precursor to cancer (actinic ray; solar sun) (Fig. 5.8) seborrheic keratoses benign wart-like lesions (seen especially seb-ō-rēik on elderly skin) (Fig. 5.9) lupus a chronic autoimmune disease characterized lūpŭs by inflammation of various parts of the body (lupus wolf) cutaneous lupus limited to the skin; evidenced by a kyū-tānē-ŭs characteristic rash especially on the face, neck, and scalp systemic lupus erythematosus a more severe form of lupus involving the (SLE) skin, joints, and often the vital organs (e.g., sis-temik lūpŭs er-i-themă-tō-sis lungs, kidneys) malignant cutaneous neoplasm skin cancer mă-lignănt kyū-tānē-ŭs nēō-plazm squamous cell carcinoma (SCC) a malignant tumor of squamous epithelium skwāmŭs sel kar-si-nōmă (see Fig. 5.1) basal cell carcinoma (BCC) a malignant tumor of the basal layer of the bāsăl sel kar-si-nōmă epidermis [the most common type of skin cancer (see Fig. 5.1)] malignant melanoma a malignant tumor composed of mă-lignănt melă-nōmă melanocytes—most develop from a pigmented nevus over time (see Signs of Melanoma in Fig. 5.1) Kaposi sarcoma a malignant tumor of the walls of blood kăpō-sē sar-kōmă vessels appearing as painless, dark bluish- purple plaques on the skin; often spreads to lymph nodes and internal organs (Fig. 5.10) onychia inflammation of the fingernail or toenail ō-nikē-ă Figure 5.9 Seborrheic keratoses. A. Lesion with warty, stuck-on appearance. B. Multiple lesions showing various colors and sizes. Figure 5.8 Actinic (solar) keratoses. Chapter 5 • Integumentary System 119 Figure 5.10 Skin lesions associated with Kaposi sarcoma. Term Meaning paronychia inflammation of the nail fold (Fig. 5.11) par-ō-nikē-ă pediculosis infestation with lice that causes itching and pĕ-dikyū-lōsis dermatitis (pediculo louse) (Fig. 5.12) |
pediculosis capitis head lice (capitis head) pĕ-dikyū-lōsis kapi-tis pediculosis pubis lice that generally infect the pubic region, but hair of pĕ-dikyū-lōsis pyūbis the axilla, eyebrows, lashes, beard, or other hairy body surfaces may also be involved—also called crabs (pubis groin) psoriasis an itching; a chronic, recurrent skin disease marked sō-rı̄ă-sis by silver-gray scales covering red patches on the skin that result from overproduction and thickening of skin cells—elbows, knees, genitals, arms, legs, scalp, and nails are common sites of involvement (Fig. 5.13) scabies a contagious disease caused by a parasite (mite) that skābēz invades the skin, causing an intense itch—most often found at articulations between the fingers or toes, elbow, etc. (scabo to scratch) seborrhea a skin condition marked by the hypersecretion of seb-ō-rēă sebum from the sebaceous glands tinea a group of fungal skin diseases identified by the TINEA. Tinea is tinē-ă body part that is affected, including tinea corporis Latin for a grub, (body), commonly called ringworm, and tinea pedis a gnawing (foot), also called athlete’s foot worm; it is used to describe the gnawed or moth-eaten vitiligo a condition caused by the destruction of melanin that appearance of the skin in vit-i-lı̄gō results inthe appearance of white patches on the this condition. skin, commonly the face, hands, legs, and genital areas (see Fig. 5.3B) Figure 5.11 Chronic paronychia. 120 Medical Terminology: The Language of Health Care Pubic louse Head louse Figure 5.13 Psoriasis of the scalp. Figure 5.12 Pediculosis. Diagnostic Tests and Procedures Term Meaning SUTURE. Suture biopsy (Bx) removal of a small piece of tissue for microscopic pathological is derived from bı̄op-sē examination (Fig. 5.14) the Latin sutura, meaning a seam, a sewing excisional Bx removal of an entire lesion together. In surgery, a suture is a thread or other material incisional Bx removal of a selected portion of a lesion used for sewing. Also, to shave Bx a technique using a surgical blade to “shave” tissue from the suture is to sew up or stitch epidermis and upper dermis together. Numbers indicate thickness of the thread (i.e., culture and a technique of isolating and growing colonies of lower numbers denote sensitivity (C&S) microorganisms to identify a pathogen and to determine thicker thread; higher which drugs might be effective in combating the infection numbers denote thinner it has caused thread). frozen section (FS) a surgical method involving cutting a thin piece of tissue from a frozen specimen for immediate pathological examination Figure 5.14 Collection of a biopsy specimen. Chapter 5 • Integumentary System 121 Term Meaning skin tests methods for determining the reaction of the body to a given substance by applying it to, or injecting it into, the skin—commonly seen in treating allergy scratch test the substance is applied to the skin through a scratch patch test the substance is applied topically to the skin on a small piece of blotting paper or wet cloth Operative Terms (Fig. 5.15) Term Meaning chemosurgery a technique for restoring wrinkled, scarred, or blemished kemō-ser-jer-ē skin by application of an acid solution to “peel” away chemical peel the top layers of the skin cryosurgery destruction of tissue by freezing—involves application krı̄-ō-serjer-ē of an extremely cold chemical (e.g., liquid nitrogen) dermabrasion surgical removal of frozen epidermis using wire brushes der-mă-brāzhŭn and emery papers to remove scars, tattoos, and/or wrinkles; aerosol spray is used to freeze the skin debridement removal of dead tissue from a wound or burn site to dā-brēd-mon promote healing and prevent infection curettage to clean; scraping of a wound using a spoon-like cutting kyū-rĕ-tahzh instrument called a curette; this technique is used in debridement electrosurgical use of electric currents to destroy tissue—the type and procedures strength of the current and method of application varies electrocautery use of an instrument heated by electric current (cautery) CAUTERY. A ē-lektrō-cawter-ē to coagulate bleeding areas by burning the tissue (e.g., Greek word to sear a blood vessel) (Fig. 5.16) meaning branding iron refers to the electrodesiccation use of short, high-frequency, electric currents to destroy surgical use of flame or heat ē-lektrō-des-i-kāshŭn tissue by drying—the active electrode makes direct to destroy tissue, control contact with the skin lesion (desicco to dry up) bleeding of wound sites, etc. The ancients used fulguration to lighten; use of long, high-frequency, electric sparks to actual cautery with a ful-gŭ-rāshŭn destroy tissue; the active electrode does not touch the skin metallic instrument heated in incision and incision and drainage of an infected skin lesion (e.g., an a flame and potential drainage (I&D) abscess) cautery with a caustic chemical. laser surgery surgery using a laser in various dermatological lāzer procedures to remove lesions, scars, tattoos, etc. laser an acronym for light amplification by stimulated emission of radiation; an instrument that concentrates high frequencies of light into a small, extremely intense beam that is precise in depth and diameter; it is applied to body tissues to destroy lesions or for dissection (cutting of parts for study) 122 Medical Terminology: The Language of Health Care Jagged tears OPERATIVE REPORT PREOPERATIVE DIAGNOSIS: Complex lacerations of the nose and upper lip due to a dog bite. POSTOPERATIVE DIAGNOSIS: Complex lacerations of the nose and upper lip due to a dog bite. OPERATION: Revision and closure of complex lacerations of the nose and upper lip. Agents used to clean the wound ANESTHESIOLOGIST: H. Vaughn, M.D. INDICATIONS: Anesthetic This 33-year-old female sustained a dog bite to her face while she was handling a dog at a veterinary clinic. Because of the complexity of her injuries, a plastic surgery consultation was requested. PROCEDURE: A type of absorbable Dead tissue The patient’s face was prepped and draped in the usual sterile fashion. A copious amount of dilute Betadine and saline were used to irrigate out all the lacerations. Subcutaneous tissues in the vicinity of the lacerations thread used to removed from were infiltrated with 0.5% Xylocaine with 1:200,000 concentration epinephrine. Attention was directed to the sew up deeper the wound patient’s upper lip. There was a laceration approximately 1.5 cm oriented parallel to the mucocutaneous layers of junction. There was another diagonal laceration measuring approximately 1.0 cm. The devitalized tissues were debrided sharply. The laceration was closed in layers with 5-0 Vicryl sutures and then with 6-0 and 7-0 tissue Prolene on the skin. Attention was directed to the patient’s nose. There are two major lacerations. There is a 2 cm laceration to the left ala. This was a full thickness laceration through the entire alar cartilage into the A type of nose as well as the entire alar rim. First, the devitalized cartilage was debrided sharply. The intranasal Absorbable nonabsorbable incision was closed with 4-0 chromic catgut suture. The alar rim was meticulously reapproximated with a few suture made of tacking sutures to produce perfect anatomic continuity. The remainder of the laceration was closed with 6-0 thread used to and 7-0 Prolene sutures in interrrupted and running fashion. At this time, attention was directed to another sheep or beef sew up surface laceration measuring approximately 2.5 cm located in the right nasal sill area extending to the columella and intestine coated layers of tissue, lip junction. The columella was detached. Again, all devitalized tissues were debrided sharply. Deep with salt to removed after subcutaneous tissues were approximated with 5-0 chromic catgut sutures in such a fashion so as to meticulously reapproximate the columella into its normal anatomic position. The nasal sill was prolong holding healing reapproximated with 6-0 Prolene sutures meticulously reapproximating the detailed anatomy of this area. strength The remainder of the wounds were closed with 6-0 and 7-0 Prolene sutures in a running and interrupted fashion. A few smaller lacerations were closed with Prolene sutures on the bridge of the nose. All the wounds were covered with Neosporin ointment, Adaptic, and appropriate bandages. Brought Oral together again The patient was given intravenous antibiotics; and she will be started on Keflex 250 mg p.o. t.i.d. The patient will be seen in my office in 24 hours for follow-up. antibiotic Topical TR:kf T. Romero, M.D. antibiotic D: 10/19/20xx T: 10/20/20xx OPERATIVE REPORT PT. NAME: SMITH, WILMA ID NO: OPS-167480621 SURGEON: T. ROMERO, M.D. A B C PER TA T-7 C d gjh J K glfk JL hlfk lK jd f jd hfd jd flf g JL SK K JL SK K N O IC ETH Removing suture from sterile Continuous sutures are several stitches Interrupted sutures are groups of package with needle holder from a single length of suture material, individual stitches, each of which knotted at each end is knotted Figure 5.15 Typical documentation of a surgical procedure. Suturing is also depicted. Chapter 5 • Integumentary System 123 Figure 5.16 Electrocautery. A cautery device is used to perform hemostasis during a surgical procedure. Term Meaning Mohs surgery a technique used to excise tumors of the skin by removing mōz fresh tissue layer by layer until a tumor-free plane is reached skin grafting transfer of skin from one body site to another to replace skin lost through burns or injury autograft transfer to a new position in the body of the same person awto-graft (auto self) homograft donor transfer between individuals of the same species such as hōmō-graft human to human (homo same; alloother) allograft alō-graft xenograft a graft transfer from one animal species to one of another zenō-graft species (xeno strange; hetero different) heterograft heter-ō-graft Therapeutic Terms Term Meaning chemotherapy treatment of malignancies, infections, and other diseases with kēmō-ther-ă-pē chemical agents that destroy selected cells or impair their ability to reproduce radiation therapy treatment of neoplastic disease by using ionizing radiation to rādē-āshŭn deter proliferation of malignant cells sclerotherapy use of sclerosing agents in treating diseases (e.g., injection of a sklēr-ō-theră-pē saline solution into a dilated blood vessel tumor in the skin, resulting in hardening of the tissue within and eventual sloughing away of the lesion) ultraviolet therapy use of ultraviolet light to promote healing of a skin lesion (e.g., ŭl-tră-vı̄ō-let an ulcer) COMMON THERAPEUTIC DRUG CLASSIFICATIONS anesthetic a drug that temporarily blocks transmission of nerve an-es-thetik conduction to produce a loss of sensations (e.g., pain) antibiotic a drug that kills or inhibits the growth of microorganisms antē-bı̄-otik 124 Medical Terminology: The Language of Health Care Term Meaning antifungal a drug that kills or prevents the growth of fungi an-tē-fŭngăl antihistamine a drug that blocks the effects of histamine in the body an-tē-histă-mēn histamine a regulating body substance released in excess during allergic histă-mēn reactions causing swelling and inflammation of tissues [e.g., in urticaria (hives), hay fever] anti-inflammatory a drug that reduces inflammation antē-in-flamă- tor-ē antipruritic a drug that relieves itching antē-prū-ritik antiseptic an agent that inhibits the growth of infectious microorgan- isms an-tă-septik Summary of Chapter 5 Acronyms/Abbreviations BCC ....................basal cell carcinoma HSV-2 ...............herpes simplex virus type 2 Bx ........................biopsy I&D.....................incision and drainage C&S ....................culture and sensitivity SCC.....................squamous cell carcinoma FS ........................frozen section SLE.....................systemic lupus erythematosus HSV-1 ...............herpes simplex virus type 1 Chapter 5 • Integumentary System 125 PRACTICE EXERCISES For the following terms, on the lines below the term, write out the indicated word parts: prefixes (P), combining forms (CF), roots (R), and suffixes (S). Then define the word. EXAMPLE hypodermic _______ / _______ / _______ P R S hypo/derm/ic P R S DEFINITION: below or deficient/skin/pertaining to 1. dermatologist __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 2. ichthyoid __________________ / __________________ R S DEFINITION: _________________________________________________________________ 3. onycholysis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 4. histotrophic __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 5. dysplasia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 6. hyperkeratosis __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 126 Medical Terminology: The Language of Health Care 7. leukotrichia __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 8. mycology __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 9. epidermal __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 10. lipoma __________________ / __________________ R S DEFINITION: _________________________________________________________________ 11. subcutaneous __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 12. anhidrosis __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 13. histopathology __________________ / __________________ / __________________ CF CF S DEFINITION: _________________________________________________________________ 14. paronychia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 15. adiposis __________________ / __________________ R S DEFINITION: _________________________________________________________________ 16. squamous __________________ / |
__________________ R S DEFINITION: _________________________________________________________________ Chapter 5 • Integumentary System 127 17. erythrodermatitis __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 18. desquamation __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 19. histotoxic __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 20. melanocyte __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 21. xerosis __________________ / __________________ R S DEFINITION: _________________________________________________________________ 22. purpuric __________________ / __________________ R S DEFINITION: _________________________________________________________________ 23. seborrhea __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 24. xanthoma __________________ / __________________ R S DEFINITION: _________________________________________________________________ 25. asteatosis __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ Complete the medical term by writing the missing part: 26. ________ oma black tumor 27. ________ dermic pertaining to below the skin 128 Medical Terminology: The Language of Health Care 28. ________ angioma bright-red, round blood vessel tumor 29. ________ coriation scratch mark on the skin 30. ________ section type of microscopic study of fresh tissue 31. ________ comedo whitehead 32. anti________ a drug that relieves itching 33. ______________ mycosis condition of fungus of the fingernail or toenail 34. ______________ biopsy removal of an entire lesion for microscopic examination 35. ________ graft transfer of skin to a new position in the body of the same person 36. ____________ therapy method of eliminating a dilated blood vessel tumor of the skin by injection of a hardening solution 37. ____________ pigmentation darkened areas of skin caused by excessive amounts of melanin For each of the following, circle the combining form that corresponds to the meaning given: 38. fat leuk/o steat/o seb/o 39. black necr/o trich/o melan/o 40. fungus seb/o myc/o onych/o 41. nail onych/o trich/o squam/o 42. red xanth/o purpur/o erythr/o 43. hair trich/o histi/o fibr/o 44. dry ichthy/o xer/o xanth/o 45. oil py/o hidr/o seb/o Write the correct medical term for each of the following definitions: 46. death of tissue associated with a loss of blood supply as a result of trauma or inflammatory or infectious process __________________________________________ 47. severe itching ______________________________________________________________ 48. skin infection consisting of a cluster of furuncles _____________________________ 49. baldness ___________________________________________________________________ 50. use of a spoon-like instrument to scrape tissue, such as that used in debridement of a wound ________________________________________________________________ Chapter 5 • Integumentary System 129 51. inflammation of the sebaceous glands and hair follicles of the skin evidenced by comedones, pustules, or nodules on the skin __________________________________ 52. chronic, recurrent skin disease marked by silver-gray scales covering red patches on the skin ________________________________________________________________ 53. acute inflammation of subcutaneous tissue as the result of bacterial invasion through a break in the skin (derived using the Latin word meaning small storeroom) _________________________________________________________________ Match the lay terms with the appropriate medical terms: 54. ________ mole a. pediculosis capitis 55. ________ black and blue mark b. cicatrix 56. ________ blackhead c. seborrheic dermatitis 57. ________ boil d. urticaria 58. ________ crabs e. verruca 59. ________ cradle cap f. nevus 60. ________ head lice g. furuncle 61. ________ hives h. comedo 62. ________ scar i. ecchymosis 63. ________ wart j. pediculosis pubis Using the suffix -derma, name the following conditions of the skin: 64. ____________________ white skin 65. ____________________ yellow skin 66. ____________________ dry skin 67. ____________________ red skin 68. ____________________ hard skin Give the medical terms for the following exanthematous viral diseases: 69. German measles____________________________________________________________ 70. chickenpox_________________________________________________________________ 71. 14-day measles _____________________________________________________________ 130 Medical Terminology: The Language of Health Care Match the following primary lesions with their descriptions: 72. ________ vesicle a. tiny, flat discolored spot on the skin, up to 1 cm diameter 73. ________ pustule b. large, flat discolored area on the skin, larger than 1 cm diameter 74. ________ papule c. solid mass on skin less than 0.5 cm diameter 75. ________ bulla d. solid mass greater than 1 cm that extends into the epidermis 76. ________ nodule e. solid mass greater than 1 cm limited to the skin’s surface 77. ________ wheal f. small blister 78. ________ macule g. area of localized skin edema, such as a hive 79. ________ tumor h. large blister 80. ________ patch i. pus-filled sac 81. ________ plaque j. solid mass larger than 1–2 cm diameter Write the abbreviation used to identify the following terms: 82. biopsy ____________________________________________________________________ 83. incision and drainage ______________________________________________________ 84. basal cell carcinoma ________________________________________________________ 85. herpes virus that causes cold sores ___________________________________________ 86. culture and sensitivity ______________________________________________________ 87. systemic lupus erythematosus _______________________________________________ Match the following terms: 88. ________ scabies a. chemical peel 89. ________ cryosurgery b. purpuric lesion 90. ________ telangiectasia c. eczema 91. ________ tinea d. xenograft 92. ________ heterograft e. intense light 93. ________ actinic keratoses f. desiccation 94. ________ radiation therapy g. spider angioma 95. ________ petechia h. solar keratoses 96. ________ homograft i. allograft Chapter 5 • Integumentary System 131 97. ________ laser j. cancer treatment 98. ________ chemosurgery k. freezing treatment 99. ________ electrosurgery l. mycosis 100. ________ dermatitis m. mites Write the plural forms of the following terms: 101. keratosis _________________________________________________________________ 102. bulla _____________________________________________________________________ 103. nevus ____________________________________________________________________ 104. macula ___________________________________________________________________ 105. ecchymosis _______________________________________________________________ Briefly describe the difference between the following terms: 106. electrodesiccation/fulguration ______________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 107. actinic keratoses/seborrheic keratoses _______________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 108. vitiligo/albinism ___________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 109. cicatrix/keloid _____________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 110. dermatosis/dermatitis______________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 111. incisional biopsy/excisional biopsy __________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 132 Medical Terminology: The Language of Health Care 112. heterograft/allograft _______________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 113. closed comedo/open comedo _______________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 114. cutaneous lupus/systemic lupus erythematosus_______________________________ _______________________________________________________________________________ _______________________________________________________________________________ 115. dysplastic nevus/malignant melanoma_______________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Write in the missing words on the blank lines in the following illustration of the skin. 116–120. Hair shaft 116. layer Receptor for (stratum corneum) touch 117. layer Pore (stratum germinativum) 118. 119. Pilomotor muscle Sebaceous gland 120. tissue Sweat gland Hair follicle Free nerve ending Adipose tissue Receptor for pressure Venule Arteriole Nerve Chapter 5 • Integumentary System 133 For each of the following, circle the correct spelling of the term: 121. cicatrix scicatrix cicatrex 122. pruritis purritis pruritus 123. petechia patechia petecchia 124. veruca verucca verruca 125. eckamosis ecchymosis eckemyosis 126. excission excisison excision 127. soriasis psoreyeasis psoriasis 128. impetigo infantiego impatiego 129. eggszema eczema ecczema 130. debridemant debridement debreedment Give the noun that was used to form the following adjectives: 131. __________ keratotic 132. __________ bullous 133. __________ nodular 134. __________ seborrheic 135. __________ petechial 136. __________ ecchymotic 137. __________ urticarial 138. __________ eczematous 139. __________ macular 140. __________ suppurative 134 Medical Terminology: The Language of Health Care MEDICAL RECORD ANALYSES M E D I C A L R E C O R D 5 . 1 Progress Note S: This is a 30 y.o. presenting with an erythematous and scaly eruption on the face and ears 6 mo. Stress and emotional tensions aggravate the rash. Over-the- counter remedies provide no relief. O: Patchy erythema with greasy, yellowish scaling appears over the nose and along the eyebrows. The external ears are similarly affected. Erythematous papules are scattered across the face, and there is ↑oiliness around the nose. A: Seborrheic dermatitis P: Rx: hydrocortisone cream, ss̄ oz tube Sig: apply to affected areas t.i.d. 1. What is the sex of the patient? 4. How much hydrocortisone cream was pre- a. male scribed? b. female a. one ounce c. not stated b. two ounces c. one-half dram 2. What is the patient’s CC? d. one dram a. stress and emotional tension e. one-half ounce b. appearance of raised, yellow, pus-filled lesions on the skin 5. What is the Sig: on the prescription? c. appearance of red areas on the skin with flak- a. apply to affected areas twice a day ing of the outer layers of the skin b. apply to affected areas three times a day d. appearance of red areas on the skin with open c. apply to affected areas four times a day sores d. apply to affected areas every 2 hours e. appearance of a communicable rash on the e. apply to affected areas every 3 hours face and ear 3. What is the diagnosis? a. inflammation of the sebaceous glands and hair follicles of the skin evidenced by comedones b. fungus of the skin c. inflammation of the skin with excessive secre- tion of sebum from the sebaceous glands d. highly contagious bacterial skin inflammation marked by pustules that rupture and become crusted e. transient, viral cold sores that infect the facial area Chapter 5 • Integumentary System 135 M E D I C A L R E C O R D 5 . 2 After ignoring various skin problems for months, Robert Fuller consulted his doctor in October when he became alarmed by what he saw happening on his right hand. His doctor referred him to Dr. Luong, a dermatologist, who then diagnosed and treated Mr. Fuller. Directions Read Medical Record 5.2 for Robert Fuller (page 136) and answer the following ques- tions. This record is a SOAP progress note dictated by Dr. Luong immediately after the treatment of Mr. Fuller and transcribed the next day by his assistant. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 5 . 2 Write your answers in the spaces provided. 1. Below are medical terms used in this record that you have not yet encountered in this text. Underline each where it appears in the record and define below: vulgaris ___________________________________________________________________ verruciform ________________________________________________________________ 2. In your own words, not using medical terminology, briefly describe Mr. Fuller’s complaint. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. In your own words, not using medical terminology, briefly describe Dr. Luong’s three objective findings. a.___________________________________________________________________________ b.___________________________________________________________________________ c.___________________________________________________________________________ 4. Define the three diagnoses for those three objective findings. a.___________________________________________________________________________ b.___________________________________________________________________________ c.___________________________________________________________________________ 5. Briefly describe the treatments for those three diagnoses: a.___________________________________________________________________________ b.___________________________________________________________________________ c.___________________________________________________________________________ 136 Medical Terminology: The Language of Health Care 6. What did Dr. Luong tell Mr. Fuller might occur in the future? Check all that apply: _____ scarring where the lesions were _____ nausea and possible vomiting from the nitrogen _____ red, freckle-like spots appearing on the right hand _____ possible regrowth of lesions _____ self-desiccating tissue destruction Medical Record 5.2 Chapter 5 • Integumentary System 137 M E D I C A L R E C O R D 5 . 3 About 5 months ago, Patricia Brown saw Dr. Luong, the dermatologist, and was treated for a skin problem. Since she was told then that there was a chance of recur- rence, she has watched that area of her skin carefully. When what looked to her like a small dot appeared in the same area, she called Dr. Luong for another appointment. Directions Read Medical Record 5.3 for Patricia Brown (page 138) and answer the following ques- tions. This record is the progress note dictated by Dr. Luong after treating her and tran- scribed the next day by his assistant. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 5 . 3 Write your answers in the spaces provided. 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record and define below: pigmented __________________________________________________________________ margin _____________________________________________________________________ defect ______________________________________________________________________ 2. In your own words, not using medical terminology, briefly describe what Dr. Lu- ong found in the first visit 5 months ago and the treatment he then gave: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Dr. Malloy analyzed a tissue sample for Dr. Luong 5 months ago and diagnosed the lesion marked C. Translate her diagnosis into lay language: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 4. Before initiating treatment of the recurrent lesion in this visit, Dr. Luong fully ex- plained to Ms. Brown the likely and possible results. What three specific things (in nonmedical language) did she agree to accept as possible risks? a.___________________________________________________________________________ b.___________________________________________________________________________ c.___________________________________________________________________________ 138 Medical Terminology: The Language of Health Care Medical Record 5.3 Chapter 5 • Integumentary System 139 5. Treatment of the recurrent lesion involved several steps. Put the following actions in correct order by numbering them 1 to 5: _____ sample sent to lab _____ suture removal _____ excision of tumor |
and surrounding area _____ patient’s permission given _____ suturing the wound 6. What, briefly, is Dr. Malloy’s role this time? Is this the same as or different from her role in Ms. Brown’s first treatment? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 140 Medical Terminology: The Language of Health Care M E D I C A L R E C O R D 5 . 4 Mary Chen’s physician, Dr. Ogawa, treated her for a skin lesion more than 2 months ago and more recently did a biopsy after that carcinoma apparently recurred. Dr. Ogawa then referred Mary to Dr. Volkman, a dermatologic surgeon. Directions Read Medical Record 5.4 (pages 141–142) for Mary Chen and answer the following questions. This record is the operative report dictated by Dr. Volkman after perform- ing the surgery. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 5 . 4 Write your answers in the spaces provided. 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record and define below: supine ______________________________________________________________________ gentian (crystal) violet _______________________________________________________ hemostasis _________________________________________________________________ flap (full thickness) __________________________________________________________ 2. In your own words, not using medical terminology, briefly describe Ms. Chen’s preoperative diagnosis. ____________________________________________________________________________ Now describe the meaning of the addition to that diagnosis in the postoperative diagnosis. ____________________________________________________________________________ 3. In your own words, describe Dr. Ogawa’s earlier treatment of Ms. Chen’s lesion. ____________________________________________________________________________ ____________________________________________________________________________ 4. The surgery was performed with Ms. Chen in what position? a. lying flat, face down b. lying flat, face up c. lying on her side d. sitting Chapter 5 • Integumentary System 141 Medical Record 5.4 142 Medical Terminology: The Language of Health Care Medical Record 5.4 Continued. Chapter 5 • Integumentary System 143 5. Put the following surgical actions in correct order to describe the surgery by num- bering them 1 to 8: _____ removing the gross tumor _____ stopping the bleeding _____ applying antibiotics _____ outlining clinical margins of the tumor _____ removing first underlying layer _____ evaluating tissues microscopically _____ administering local anesthetic _____ removing second and third layers 6. Translate the surgeon’s phrase “Hemostasis was obtained with electrocautery”: ____________________________________________________________________________ ____________________________________________________________________________ 7. Describe a “frozen section”: __________________________________________________ ____________________________________________________________________________ How many frozen sections were analyzed in this surgery? ______________________ 8. For the other two physicians mentioned, give their specializations and their roles in treating Ms. Chen now and in the future: Dr. O’Connor’s specialization _________________________________________________ role in treatment ____________________________________________________________ Dr. Jensen’s specialization ___________________________________________________ role in treatment ____________________________________________________________ 9. Translate the instructions for the two medications Ms. Chen will be taking postop- eratively: Drug Name Route of Administration Dose Frequency of Dose ____________ ______________________ _________ _________________ ____________ ______________________ _________ _________________ 10. In your own words, not using medical terminology, briefly describe the addi- tional treatment to be considered for Ms. Chen. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Chapter 6 Musculoskeletal System OBJECTIVES After completion of this chapter you will be able to Define common combining forms used in relation to the musculoskeletal system Describe the basic functions of the musculoskeletal system Define the basic anatomical terms referring to the musculoskeletal system Describe the anatomical position List the planes of the body Define positional and directional terms Define the terms related to body movements Define common symptomatic and diagnostic terms related to the musculoskeletal system List common diagnostic tests and procedures related to the musculoskeletal system Identify common operative terms referring to the musculoskeletal system Identify common therapeutic terms including drug classifications related to the muscu- loskeletal system Explain the terms and abbreviations used in documenting medical records involving the musculoskeletal system Combining Forms Combining Form Meaning Example ankyl/o crooked or stiff ankylotic ang-ki-lotik arthr/o joint (articulation) arthritis ar-thrı̄tis articul/o articular ar-tikyū-lăr brachi/o arm brachium brākē-ŭm cervic/o neck cervical servı̆-kal chondr/o cartilage (gristle) chondral kondrăl 144 Chapter 6 • Musculoskeletal System 145 Combining Form Meaning Example cost/o rib intercostal in-ter-kostăl crani/o skull cranial krānē-ăl dactyl/o digit (finger or toe) dactylomegaly DIGIT. The Latin daktil-ō-megă-lē term for finger or toe. Digit in the fasci/o fascia (a band) fasciodesis sense of a number was fas-ē-odĕ-sis derived from the habit of femor/o femur femoral counting on the fingers, femŏ-răl which probably accounts for the decimal system. fibr/o fiber fibrous Digitalis, the heart drug, is fibrŭs an extract of the purple foxglove plant, also known kyph/o humpback kyphosis as ladies fingers. kı̄-fōsis lei/o smooth leiomyoma lı̄o-mı̄-ōmă lord/o bent lordosis lŏr-dōsis lumb/o loin (lower back) lumbar lŭmbar myel/o bone marrow or spinal cord myelitis mı̄-ĕ-lı̄tis my/o muscle myalgia mı̄-aljē-ă myos/o myositis mı̄-ō-sı̄tis muscul/o muscular mŭskyū-lăr oste/o bone osteomyelitis ostē-o-mı̄-ĕ-lı̄tis patell/o knee cap patellar pa-telăr pelv/i hip bone or pelvic cavity pelvimeter pel-vimĕ-ter pelv/o pelvic pelvik radi/o radius radial rādē-ăl rhabd/o rod shaped or striated (skeletal) rhabdomyoma rabdō-mı̄-ōmă sarc/o flesh sarcoma sar-kōmă scoli/o twisted scoliosis skō-lē-ōsis 146 Medical Terminology: The Language of Health Care Combining Form Meaning Example spondyl/o vertebra spondylitis spon-di-lı̄tis vertebr/o vertebral vertĕ-brăl stern/o sternum (breastbone) sternocostal sternō-kostăl ten/o tendon (to stretch) tenodesis tĕ-nodē-sis tend/o tendolysis ten-doli-sis tendin/o tendinitis ten-di-nı̄tis thorac/o chest thoracic thō-rasik ton/o tone or tension myotonia mı̄-ō-tōnē-ă uln/o ulna ulnar ŭlnăr Musculoskeletal System Overview The musculoskeletal system provides support and gives shape to the body. The skele- SKELETON. ton gives structure to the body by providing a framework of bones and cartilage. Also, Skeleton is the bones store calcium and other minerals and produce certain blood cells within the derived from a bone marrow (Figs. 6.1 to 6.4). Greek word meaning “dried The muscles cover the bones where they hinge (articulate) and supply the forces up.” The Greeks used the that make movement possible. They also provide a protective covering for internal or- term in reference to a mummy or dried-up body. gans and produce body heat (Figs. 6.5 and 6.6). They never used the word in the modern meaning of the bony framework of the Anatomical Terms Related to Bones (Figs. 6.1 to 6.4) body. The first recorded use Term Meaning of the modern term in English occurred in 1578. appendicular skeleton bones of shoulder, pelvis, and upper and lower apen-dikyū-lăr extremities ELBOW. Many terms referring to axial skeleton bones of skull, vertebral column, chest, and hyoid the elbow are aksē-ăl bone (U-shaped bone lying at the base of the based on the L-shape tongue); refer to Figure 6.4 for abbreviated formed at the joint. This is identification and numbering of cervical, thoracic, the basis of the “el” of and lumbar vertebrae elbow. It is also the root of the Latin term ulna. An “ell” bone specialized connective tissue composed of was an old measure of osteocytes (bone cells) forming the skeleton length, particularly of cloth, being the amount from the TYPES OF BONE TISSUE elbow (or shoulder) to the compact bone tightly solid, strong bone tissue resistant to fingers, which was a convenient way of rapidly bending measuring lengths. Boga spongy (cancellous) bone mesh-like bone tissue containing marrow and fine was a bending or a bow. spŭnjē kansĕ-lŭs branching canals through which blood vessels run Chapter 6 • Musculoskeletal System 147 Cranium Skull Face Hyoid 1 Clavicle 2 Manubrium 3 Scapula 4 Sternum 5 Ribs 6 7 Xiphoid process 8 Humerus 9 10 Vertebral column 11 Iliac crest 12 Ilium Ischium Ulna Radius Carpals Metacarpals Trochanter Phalanges Pubic bone Femur Sacrum Coccyx Patella Tibia Fibula Tarsals Metatarsals Calcaneus Phalanges Anterior view Posterior view Color key: Appendicular skeleton Axial skeleton Figure 6.1 The skeleton. Term Meaning CLASSIFICATION OF BONES long bones bones of arms and legs short bones bones of wrists and ankles flat bones bones of ribs, shoulder blades, pelvis, and skull irregular bones bones of vertebrae and face sesamoid bones round bones found near joints (e.g., patella) sesă-moyd Anatomy of a long bone Joints of lower limb Hip joint Epiphysis Articular Head cartilage Greater Spongy (cancellous) trochanter bone Neck Epiphyseal disk (plate) Lesser trochanter Red marrow Linea aspera Compact bone Medullary cavity containing marrow Nutrient artery Knee joint Diaphysis Head Neck Yellow marrow Tibial tuberosity Periosteum Interosseous ligament Medial malleolus Lateral malleolus Articular cartilage Ankle joint Talus Epiphysis Calcaneus Anterior view Posterior view Anatomy of joints Lateral view (hip joint) Lateral view (knee joint) Extension Flexion Lateral Patellar condyle ligament Extension Flexion Lateral view (ankle joint) Talus Calcaneus Dorsiflexion Plantarflexion Figure 6.2 Anatomy of bone and joints. 148 Anterior view Frontal bone Parietal bone Supraorbital foramen Greater wing of Lacrimal bone sphenoid bone Ethmoid bone Temporal bone Nasal bones Zygomatic bone Infraorbital foramen Maxilla bone Median nasal septum Mandible Inferior nasal concha Mental foramen THE SKULL: Lateral view Coronal suture Frontal bone Parietal bone Sphenoid bone Lacrimal bone Nasal bone Occipital bone Maxilla Temporal bone Zygomatic bone External auditory Mandible meatus Superior view Lambdoidal suture Occipital bone Sagittal Parietal bone suture Coronal suture Frontal bone Nasal bone Three-dimensional CT reconstruction of a skull showing traumatic injury to facial bones suffered as the result of a motor vehicle accident. Figure 6.3 The skull. 149 150 Medical Terminology: The Language of Health Care THE VERTEBRAE: Lateral view C1 C2 Cervical C3 C4 C1–C7 C5 C6 C7 T1 T2 T3 T4 T5 T6 Thoracic T7 T1–T12 T8 T9 T10 T11 T12 L1 L2 Lumbar L1–L5 L3 L4 L5 Sacrum (5 fused pieces) Coccyx (3–4 fused pieces) Superior view (L2) Magnetic resonance image of portions of the lower vertebrae (lower thoracic, lumbar, sacrum, Spinous process and coccyx) demonstrating normal anatomy. Lamina of vertebral arch Inferior articular process Lateral view Transverse process Spinal cord in neural canal Superior articular facet Pedicle of vertebral arch L3 Vertebral foramen Vertebral body Spinous Lateral view (L2) process L4 Intervertebral Superior articular Superior vertebral notch Transverse disk (disc) process Pedicle process Transverse process Nucleus L5 Spinous process Vertebral pulposus body Laminae Lamina Inferior vertebral notch Inferior articular facet Figure 6.4 The vertebrae. Chapter 6 • Musculoskeletal System 151 Frontalis Galea aponeurotica Temporalis Occipitalis Orbicularis oculi Zygomaticus Sternocleidomastoid Orbicularis oris Trapezius Masseter Deltoid Buccinator Pectoralis major Coracobrachialis Latissimus dorsi Teres minor Serratus Triceps brachii anterior External oblique Teres major Biceps Brachialis under biceps brachii Anconeus Rectus Flexor carpi radialis abdominis Flexor carpi ulnaris Linea Brachioradialis alba Removed Extensor carpi external radialis longus oblique Extensor digitorum Internal Extensor carpi oblique radialis brevis Extensor carpi ulnaris Palmar aponeurosis Transversus Iliotibial band Gluteus abdominis medius Tensor fasciae Iliopsoas Gluteus latae Pectineus maximus Gracilis Adductor longus Sartorius Adductor magnus Vastus lateralis Rectus femoris Peroneus longus Vastus medialis Tibialis anterior Biceps femoris Calcaneus tendon Adductor magnus Soleus Semimembranosus Peroneus longus Semitendinosus Extensor hallucis Peroneus brevis longus Plantaris Gastrocnemius Anterior view Posterior view Figure 6.5 Muscles of the body. 152 Medical Terminology: The Language of Health Care Skeletal muscle tissue Striations Nucleus Muscle fiber Cardiac muscle tissue Striations Muscle fiber Intercalated disk Nucleus Smooth muscle tissue Muscle fiber Nucleus Figure 6.6 Architecture of the three types of muscle. Chapter 6 • Musculoskeletal System 153 Term Meaning PARTS OF A LONG BONE (SEE FIG. 6.2) epiphysis wide ends of a long bone (physis growth) e-pifi-sis diaphysis shaft of a long bone dı̄-afi-sis metaphysis growth zone between epiphysis and diaphysis mĕ-tafi-sis during development of a long bone endosteum membrane lining the medullary cavity of a bone en-dostē-ŭm medullary cavity cavity within the shaft of the long bones filled with medŭ-lār-ē bone marrow bone marrow soft connective tissue within the medullary cavities marō of bones red bone marrow found in cavities of most bones in infants; functions in formation of red blood cells, some white blood cells, and platelets; in adults, red bone marrow is found most often in the flat bones yellow bone marrow gradually replaces red bone marrow in adult bones, functions as storage for fat tissue, and is inactive in formation of blood cells periosteum a fibrous, vascular membrane that covers the bone per-ē-ostē-ŭm articular cartilage a gristle-like substance found on bones where they ar-tikyū-lăr karti-lij articulate Anatomical Terms Related to Joints and Muscles (Figs. 6.2 to 6.7) Term Meaning ANKLE. Ank, a very old Greek articulation a joint; the point where two bones come together root meaning artik-yū-lāshŭn (Fig. 6.7) bend or angle, is the origin of the term for the ankle joint. bursa a fibrous sac between certain tendons and bones It is also associated with bersă that is lined with a synovial membrane that ankyl/o, a |
combining form secretes synovial fluid meaning crooked or bent. disk (disc) a flat, plate-like structure composed of fibrocartilaginous tissue found between the vertebrae to reduce friction (see Fig. 6.4) BURSA. A Latin word for a purse nucleus pulposus the soft, fibrocartilaginous, central portion of was given to the nuklē-ŭs pŭl-pōsŭs intervertebral disk small synovial pouch associated with a joint. The ligament a flexible band of fibrous tissue that connects bone meaning stems from the use ligă-ment to bone (Fig. 6.8) of a purse by the bursar, the man who holds the purse in synovial membrane membrane lining the capsule of a joint order to pay out of it. Most si-nōvē-ăl membrān anatomical terms come from synovial fluid lubricating fluid secreted by the synovial the names of familiar objects si-nōvē-ăl flūid membrane [e.g., patella (dish), acetabulum (bowl)]. 154 Medical Terminology: The Language of Health Care Bursa Joint cavity filled with synovial fluid Patella Extracapsular ligament Joint capsule Intracapsular ligament Fat pad Meniscus Figure 6.7 Lateral view of the knee joint. Term Meaning muscle tissue composed of fibers that can contract, mŭsĕl causing movement of an organ or part of the body (see Figs. 6.5 and 6.6) striated (skeletal) muscle voluntary striated muscle attached to the skeleton striā-ted (skele-tăl) smooth muscle involuntary muscle found in internal organs cardiac muscle muscle of the heart origin of a muscle muscle end attached to the bone that does not move when the muscle contracts Lower end Posterior of femur cruciate ligament Medial condyle Lateral condyle Anterior cruciate Lateral ligament meniscus Medial meniscus Lateral (fibular) Medial (tibial) collateral collateral ligament ligament Fibula Tibia Figure 6.8 Posterior view of the knee and ligaments. Chapter 6 • Musculoskeletal System 155 Term Meaning insertion of a muscle muscle end attached to the bone that moves when the muscle contracts tendon a band of fibrous tissue that connects muscle to tendŏn bone fascia a band or sheet of fibrous connective tissue that FASCIA. Fascia fashē-ă covers, supports, and separates muscle is derived from a Latin word for a band or bandage derived Anatomical Position and Terms of Reference from fascis, a bundle (the bandage that ties up a bundle, especially a band To communicate effectively about the body, health professionals use terms with spe- around a bundle of sticks). cific meanings to refer to body positions, directions, and planes. These terms of refer- Fasces were bundles of ence are based on the body being in anatomical position, in which the person is sticks from which an ax assumed to be standing upright (erect), facing forward, feet pointed forward and projected; they were carried slightly apart, arms at the sides with palms facing forward. The patient is visualized in by Roman officials. In the this pose before applying any other term of reference. 20th century, fasces were With the body in an anatomical position, three different imaginary lines divide the adopted in Italy as a body in half, forming body planes. In addition to the three body planes, positional and political party badge, hence directional terms are used to indicate the location or direction of body parts in respect the term “fascist.” In to each other (Fig. 6.9). anatomy, the sheets of connective tissue that wrap the muscles or other parts Term Meaning are called fascia. Many are named for those who first BODY PLANES described them, such as Camper, Scarpa, Colles. coronal (frontal) plane vertical division of the body into front (anterior) kōrŏ-năl (frŭntăl) and back (posterior) portions sagittal plane vertical division of the body into right and left saji-tăl portions transverse plane horizontal division of the body into upper and trans-vers lower portions TERMS OF POSITION AND DIRECTION anterior (A) (ventral) front of the body an-tērē-ōr (ventrăl) posterior (P) (dorsal) back of the body pos-tērē-ōr (dorsăl) anterior-posterior (AP) from front to back; commonly associated with the direction of an x-ray beam posterior-anterior (PA) from back to front; commonly associated with the direction of an x-ray beam superior (cephalic) situated above another structure, toward the head su-pērē-ōr (se-falik) inferior (caudal) situated below another structure, away from the in-fērē-ōr (kawdăl) head 156 Medical Terminology: The Language of Health Care Body planes Superior (cephalic) Lateral Anterior Posterior (ventral) (dorsal) Medial Inferior (caudal) Sagittal plane Coronal or frontal plane Transverse plane Body cavities Thoracic cavity Cranial Esophagus Dorsal Trachea Pleural cavity Pleura Spinal Thoracic Abdominal Lung Lung Bronchial tubes Ventral Abdomino- pelvic Pelvic Mediastinum Diaphragm Figure 6.9 Body planes and cavities. Chapter 6 • Musculoskeletal System 157 Term Meaning proximal toward the beginning or origin of a structure [e.g., proksi-măl the proximal aspect of the femur (thigh bone) is the area closest to where it attaches to the hip] distal away from the beginning or origin of a structure distăl [e.g., the distal aspect of the femur (thigh bone) is the area at the end of the bone near the knee] medial toward the middle (midline) mēdē-ăl lateral toward the side later-ăl axis line that runs through the center of the body or a aksis body part BODY POSITIONS erect normal standing position ĕ-rĕkt decubitus lying down, especially in bed; i.e., lateral decubitus dē-kyūbi-tŭs is lying on the side (decumbo to lie down) prone lying face down and flat prōn recumbent lying down rē-kŭmbent supine horizontal recumbent; lying flat on the back— sū-pı̄n “on the spine” (Fig. 6.10) BODY MOVEMENTS (FIG. 6.11) flexion bending at the joint so that the angle between the flekshŭn bones is decreased extension straightening at the joint so that the angle between eks-tenshŭn the bones is increased abduction movement away from the body ab-dŭkshŭn adduction movement toward the body ă-dukshŭn rotation circular movement around an axis rō-tāshŭn eversion turning outward, i.e., of a foot ē-verzhŭn inversion turning inward, i.e., of a foot in-verzhŭn Figure 6.10 Supine (horizontal re- cumbent position). Patient lies on back with the legs extended. 158 Medical Terminology: The Language of Health Care Flexion Extension Abduction Adduction Rotation Additional movements of the feet Additional movements of the hands and arm Eversion Inversion Pronation Supination Additional movements of the feet Dorsiflexion Plantar flexion Figure 6.11 Body movements. Term Meaning supination turning upward or forward of the palmar surface sūpi-nāshŭn (palm of the hand) or plantar surface (sole of the foot) pronation turning downward or backward of the palmar prō-nāshŭn surface (palm of the hand) or plantar surface (sole of the foot) dorsiflexion bending of the foot or the toes upward dōr-si-flekshŭn plantar flexion bending of the sole of the foot by curling the toes plantăr toward the ground range of motion (ROM) total motion possible in a joint, described by the terms related to body movements, i.e., ability to flex, extend, abduct, or adduct; measured in degrees goniometer instrument used to measure joint angles (gonio gō-nē-omĕ-ter angle) (Fig. 6.12) Chapter 6 • Musculoskeletal System 159 Figure 6.12 Dorsal placement of goniometer used when measuring digital motion. Symptomatic and Diagnostic Terms Term Meaning SYMPTOMATIC arthralgia joint pain ar-thraljē-ă atrophy shrinking of tissue such as muscle atrō-fē crepitation grating sound made by movement of some joints or krep-i-tāshŭn broken bones crepitus krep-i-tŭs exostosis a projection arising from a bone that develops from eks-os-tōsis cartilage flaccid flabby, relaxed, or having defective or absent muscle flasid tone hypertrophy increase in the size of tissue such as muscle hı̄-pertrō-fē hypotonia reduced muscle tone or tension hı̄pō-tōne-ă myalgia muscle pain mı̄-aljē-ă myodynia mı̄ō-dinē-ă ostealgia bone pain os-tē-aljē-ă osteodynia os-tē-o-dinē-ă rigor or rigidity stiffness; stiff muscle riger or ri-jidi-tē 160 Medical Terminology: The Language of Health Care Term Meaning spasm drawing in; involuntary contraction of muscle spazm spastic uncontrolled contractions of skeletal muscles causing spastik stiff and awkward movements (resembles spasm) tetany tension; prolonged, continuous muscle contraction tetă-nē tremor shaking; rhythmic muscular movement tremer DIAGNOSTIC ankylosis stiff joint condition angki-lōsis arthritis inflammation of the joints characterized by pain, ar-thrı̄tis swelling, redness, warmth, and limitation of motion— there are more than 100 different types of arthritis osteoarthritis (OA) most common form of arthritis that especially affects ostē-ō-ar-thrı̄tis weight-bearing joints (e.g., knee, hip); characterized by the erosion of articular cartilage (Fig. 6.13) degenerative arthritis dē-jener-ă-tiv ar-thrı̄tis degenerative joint disease (DJD) dē-jener-ă-tiv joynt di-zēz Normal hip Hip with mild arthritis Spine Cartilage Shoulder Hip Hip with moderate arthritis Hip with severe arthritis Knee A B Figure 6.13 Osteoarthritis. A. Common sites of osteoarthritis. B. How osteoarthritis affects the hip. Chapter 6 • Musculoskeletal System 161 Term Meaning rheumatoid arthritis (RA) most crippling form of arthritis characterized by a rūmă-toyd ar-thrı̄tis chronic, systemic inflammation most often affecting joints and synovial membranes (especially in the hands and feet) causing ankylosis (stiff joints) and de- formity (Fig. 6.14) gouty arthritis acute attacks of arthritis usually in a single joint GOUT. The term gowtē ar-thrı̄tis (especially the great toe) caused by hyperuricemia for gout stems (an excessive level of uric acid in the blood) from the Latin word meaning a drop. Known to the ancients, the condition was thought to be caused by a liquid secretion that was distilled drop by drop on the diseased part. Cartilage Synovial membrane Bone atrophy Figure 6.14 Joints of the hand affected by rheumatoid arthritis. A. X-ray of normal hand. B. X-ray of hand with rheumatoid arthritis. 162 Medical Terminology: The Language of Health Care Term Meaning bony necrosis dead bone tissue from loss of blood supply such as nĕ-krōsis can occur after a fracture (sequestrum something sequestrum laid aside) sē-kwestrŭm bunion swelling of the joint at the base of the great toe caused bŭnyŭn by inflammation of the bursa bursitis inflammation of a bursa ber-sı̄tis carpal tunnel syndrome condition that results from compression of the karpăl median nerve within the carpal tunnel at the wrist, characterized by pain, numbness, and tingling in the wrist and fingers and weak grip; commonly seen as a result of cumulative trauma of surrounding tendons (Fig. 6.15) chondromalacia softening of cartilage kondrō-mă-lāshē-ă epiphysitis inflammation of epiphyseal regions of the long bone e-pif-i-sı̄tis Figure 6.15 Carpal tunnel con- taining the median nerve and the flexor tendons of the fingers and thumb. Chapter 6 • Musculoskeletal System 163 Term Meaning fracture (Fx) a broken or cracked bone (Fig. 6.16) frakchūr closed fracture a broken bone with no open wound open fracture compound fracture; a broken bone with an open wound simple fracture a nondisplaced fracture involving one fracture line that does not require extensive treatment to repair (e.g., hairline Fx, stress Fx, or crack) complex fracture a displaced fracture that requires manipulation or surgery to repair fracture line line made by broken bone (e.g., oblique, spiral, or transverse) comminuted fracture broken in many little pieces komi-nū-ted greenstick fracture bending and incomplete break of a bone—most often seen in children herniated disk or disc protrusion of a degenerated or fragmented hernē-ā-ted intervertebral disk so that the nucleus pulposus protrudes, causing compression on the nerve root (see Chapter 10, Fig. 10.9) myeloma bone marrow tumor mı̄-ĕ-lōmă myositis inflammation of muscle mı̄-ō-sı̄tis myoma muscle tumor mı̄-ōmă leiomyoma smooth muscle tumor lı̄ō-mı̄-ōmă leiomyosarcoma malignant smooth muscle tumor lı̄ō-mı̄ō-sar-kōmă rhabdomyoma skeletal muscle tumor rabdō-mı̄-omă rhabdomyosarcoma malignant skeletal muscle tumor rabdō-mı̄-ō-sar-kōmă muscular dystrophy a category of genetically transmitted diseases mŭskyū-lăr distrō-fē characterized by progressive atrophy of skeletal muscles (Duchenne’s type is most common) osteoma bone tumor os-tē-ōmă osteosarcoma type of malignant bone tumor ostē-ō-sar-kōmă osteomalacia disease marked by softening of the bone caused ostē-ō-mă-lāshē-ă by calcium and vitamin D deficiency rickets osteomalacia in children (causes bone deformity) rikets 164 Medical Terminology: The Language of Health Care A Comminuted Greenstick Oblique Spiral Transverse B C Figure 6.16 A. Types of common fracture. B. AP radiograph of lower leg demonstrating open fractures of the tibia and fibula (ar- rows). C. Lateral view radiograph demonstrating a closed spiral fracture of the tibia (arrows). (Note: -graph is the preferred suffix used in radiology to refer to an x-ray record.) Chapter 6 • Musculoskeletal System 165 Term Meaning osteomyelitis infection of bone and bone marrow causing ostē-ō-mı̄-ĕ-lı̄tis inflammation osteoporosis condition of decreased bone density and increased ostē-ō-pō-rōsis porosity, causing bones to become brittle and liable to fracture (porosis passage) (Fig. 6.17) spinal curvatures (Fig. 6.18) spı̄năl kyphosis abnormal posterior curvature of the thoracic spine kı̄-fōsis (humpback condition) lordosis abnormal anterior curvature of the lumbar spine lōr-dōsis (sway-back condition) scoliosis abnormal lateral curvature of the spine (S-shaped skō-lē-ōsis curve) (Fig. 6.19) Normal bone Osteoporotic bone Normal |
spine in premenopausal Spine compression and loss woman of height due to osteoporosis in postmenopausal woman Figure 6.17 Osteoporosis. 166 Medical Terminology: The Language of Health Care Normal Kyphosis Lordosis Scoliosis Figure 6.18 Spinal curvatures. Figure 6.19 AP thoracic spine radiograph demonstrating scoliosis. Chapter 6 • Musculoskeletal System 167 L3 Defect L4 Anterior displacement of L5 vertebra Sacral 5 canal L5 S1 S2 S3 Dotted line follows posterior vertebral margins of L5 and the sacrum A B Figure 6.20 Spondylolisthesis. A. Drawing illustrates forward slipping of L5 vertebra. B. X-ray showing displacement. Term Meaning spondylolisthesis forward slipping of a lumbar vertebra (listhesis spondi-lō-lis-thēsis slipping) (Fig 6.20) spondylosis stiff, immobile condition of vertebrae due to joint spon-di-lōsis degeneration sprain injury to a ligament caused by joint trauma but sprān without joint dislocation or fracture subluxation a partial dislocation (luxation dislocation) sŭb-lŭk-sāshŭn (Fig. 6.21) tendinitis inflammation of a tendon ten-di-nı̄tis tendonitis ten-dō-nı̄tis Diagnostic Tests and Procedures Test or Procedure Explanation electromyogram (EMG) a neurodiagnostic graphic record of the ē-lek-trō-mı̄ō-gram electrical activity of muscle at rest and during contraction to diagnose neuromusculoskeletal disorders (e.g., muscular dystrophy); usually performed by a neurologist 168 Medical Terminology: The Language of Health Care Subluxation of jaw in open mouth position Normal jaw position of open mouth Figure 6.21 Subluxation. Test or Procedure Explanation magnetic resonance imaging a nonionizing imaging technique using (MRI) magnetic fields and radiofrequency waves măg-nĕtik rezō-nans imă-jing to visualize anatomical structures—useful in orthopedics to detect joint, tendon, and vertebral disk disorders (see MRI of spine in Fig. 6.4 and MRI of knee in Chapter 4, Fig. 4.17A) nuclear medicine ionizing imaging technique using radioactive nūklē-er isotopes radionuclide organ imaging rādē-ō-nūklı̄d bone scan radionuclide image of bone tissue to detect tumor, malignancy, etc. (see whole-body bone scan in Chapter 4, Fig. 4.16B) X-RAYS. Wilhelm radiography (x-ray) x-ray imaging; an ionizing technique commonly Roentgen rādē-ogră-fē used in orthopedics to visualize the extremities, discovered x-rays in 1895. ribs, back, shoulders, joints, etc. (see Fig. 6.19 and He used the expression rays first radiograph in Chapter 4, Fig. 4.14) for the sake of brevity and named them x-rays to arthrogram an x-ray of a joint taken after injection of a contrast distinguish them from others arthrō-gram medium of the same name. The first diskogram an x-ray of an intervertebral disk after injection of a x-ray image was made of diskō-gram contrast medium Roentgen’s wife’s hand. Chapter 6 • Musculoskeletal System 169 Test or Procedure Explanation dual-energy x-ray an x-ray scan that measures bone mineral density of absorptiometry the spine and extremities to diagnose osteoporosis, (DEXA) determine fracture risk, and monitor treatment; ab-sōrptomĕ-trē classifications of bone mass include normal, osteopenic, or osteoporotic as indicated by a T score (amount of bone mass of the patient compared to that of a normal young adult) computed tomography a specialized x-ray procedure producing a series of (CT) cross-sectional images that are processed by a tō-mogră-fē computer into a 2-dimensional or 3-dimensional computed axial image (see Fig. 6.3) tomography (CAT) sonography ultrasound imaging; a nonionizing technique useful sŏ-nogră-fē in orthopedics to visualize muscles, ligaments, displacements, and dislocations or to guide a therapeutic intervention such as that performed during arthroscopy Operative Terms Term Meaning amputation partial or complete removal of a limb; AKA, am-pyū-tāshŭn above-knee amputation; BKA, below-knee amputation arthrocentesis puncture for aspiration of a joint arthrō-sen-tēsis arthrodesis binding or fusing of joint surfaces ăr-thrō-dēsĭs arthroplasty repair or reconstruction of a joint arthrō-plas-tē arthroscopy procedure using an arthroscope to examine, ar-throskă-pē diagnose, and repair a joint from within (Fig. 6.22) bone grafting transplantation of a piece of bone from one site to another to repair a skeletal defect bursectomy excision of a bursa ber-sektō-mē myoplasty repair of muscle mı̄ō-plas-tē open reduction, internal internal surgical repair of a fracture by bringing fixation (ORIF) of a fracture bones back into alignment and fixing them into place, often utilizing plates, screws, pins, etc. (Fig. 6.23) osteoplasty repair of bone ostē-ō-plas-tē 170 Medical Terminology: The Language of Health Care Tiny incisions, known as portals, are made for insertion Portal for insertion of a of arthroscope and other cannula for flow of saline instruments solution to expand joint space or rinse away blood or debris Operating portal for Insertion of fiberoptic, insertion of specialized camera-equipped arthroscope instruments and motorized provides illumination and equipment used to repair magnified examination of structures and remove joint interior, which is also damaged tissue projected on a video monitor Figure 6.22 Scene of arthroscopic knee surgery with projection of surgeon’s view on a video monitor. Term Meaning osteotomy an incision into bone os-tē-otō-mē spondylosyndesis spinal fusion (see Chapter 10, Fig. 10.24B) spondi-lō-sin-dēsis tenotomy division by incision of a tendon to repair a te-notō-mē deformity caused by shortening of a muscle Chapter 6 • Musculoskeletal System 171 Figure 6.23 An x-ray image taken after open reduction, internal fixation (ORIF) of the right ankle (see Medical Record 6.2). Therapeutic Terms Term Meaning closed reduction, external external manipulation of a fracture to regain fixation of a fracture alignment along with application of an external device to protect and hold the bone in place while healing casting use of a stiff, solid dressing around a limb or other body part to immobilize it during healing (Fig. 6.24) splinting use of a rigid device to immobilize or restrain a broken bone or injured body part; provides less support than a cast, but can be adjusted easier to accommodate for swelling from an injury (Fig. 6.25) traction (Tx) application of a pulling force to a fractured trakshŭn bone or dislocated joint to maintain proper position during healing (Fig. 6.26) closed reduction, external manipulation of a fracture to regain percutaneous fixation of alignment, followed by insertion of one or more a fracture pins through the skin to maintain position—often includes use of an external device called a fixator to keep the fracture immobilized during healing (Fig. 6.27) 172 Medical Terminology: The Language of Health Care Figure 6.24 Applying a short arm cast. Figure 6.25 Finger splint. BRACE. A Latin Term Meaning word from brachia, the orthosis use of an orthopedic appliance to maintain a arms, was originally used as ōr-thōsis bone’s position or provide limb support (e.g., back, a measure of length (the two knee, or wrist brace) (Fig. 6.28) extended arms), or a pair. The meaning was expanded physical therapy (PT) treatment to rehabilitate patients disabled by to the idea of two arms that fizi-kăl theră-pē illness or injury, involving many different connect, support, or modalities (methods), such as exercise, hydrother- strengthen, i.e., to brace. apy, diathermy, and ultrasound Braces in the form of splints were used in ancient Egypt prosthesis an artificial replacement for a diseased or and by most surgeons prosthē-sis missing body part such as a hip, joint, or limb throughout the centuries. (Fig. 6.29) Figure 6.26 Cervical traction. Chapter 6 • Musculoskeletal System 173 Figure 6.27 This radiograph, taken after closed re- Figure 6.28 Examples of orthoses: back, knee, and wrist. duction, percutaneous fixation of an open comminuted distal tibia/fibula fracture, shows placement of an exter- nal fixator to maintain pin placement during the healing process. The injury was the result of a gunshot to the right lower extremity. A B Figure 6.29 A. Prosthetist holding an above-the-knee prosthesis with an array of prostheses on the table in the fore- ground. B. A prosthetic leg makes it possible for an above-the-knee amputee to lead an active life. 174 Medical Terminology: The Language of Health Care COMMON THERAPEUTIC DRUG CLASSIFICATIONS analgesic a drug that relieves pain an-ăl-jēzik narcotic a potent analgesic that has addictive properties nar-kotik anti-inflammatory a drug that reduces inflammation antē-in-flamă-tō-rē antipyretic a drug that relieves fever antē-pı̄-retik nonsteroidal anti-inflammatory a group of drugs with analgesic, anti- drug (NSAID) inflammatory, and antipyretic properties non-stēroy-dăl (e.g., ibuprofen, aspirin) commonly used to treat arthritis Summary of Chapter 6 Acronyms/Abbreviations A .................anterior MRI...........magnetic resonance imaging AKA ..........above-knee amputation NSAID.....nonsteroidal anti-inflammatory drug AP...............anterior-posterior OA .............osteoarthritis BKA ..........below-knee amputation ORIF ........open reduction, internal fixation CAT ...........computed axial tomography P ..................posterior CT...............computed tomography PT ...............physical therapy DEXA ......dual-energy x-ray absorptiometry RA ..............rheumatoid arthritis DJD ..........degenerative joint disease ROM.........range of motion EMG .........electromyogram Tx ..............traction Fx ..............fracture x-ray .........radiography Chapter 6 • Musculoskeletal System 175 PRACTICE EXERCISES For the following terms, on the lines below the term, write out the indicated word parts: prefixes (P), combining forms (CF), roots (R), and suffixes (S). Then define the word. EXAMPLE hypertrophy _______ / _______ / _______ P R S hyper/troph/y P R S DEFINITION: above or excessive/nourishment or development/condition or process of 1. thoracic __________________ / __________________ R S DEFINITION: _________________________________________________________________ 2. myofascial __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 3. arthropathy __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 4. spondylolysis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 5. osteopenia __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 6. achondroplasia __________________ / __________________ / __________________ / __________________ P CF R S DEFINITION: _________________________________________________________________ 7. ostealgia __________________ / __________________ R S DEFINITION: _________________________________________________________________ 176 Medical Terminology: The Language of Health Care 8. polymyositis __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 9. leiomyosarcoma __________________ / __________________ / __________________ / __________________ CF CF R S DEFINITION: _________________________________________________________________ 10. myelocyte __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 11. costovertebral __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 12. musculotendinous __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 13. orthosis __________________ / __________________ R S DEFINITION: _________________________________________________________________ 14. kyphoplasty __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 15. craniectomy __________________ / __________________ R S DEFINITION: _________________________________________________________________ 16. arthrodesis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 17. fibromyalgia __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ Chapter 6 • Musculoskeletal System 177 18. rhabdomyoma __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 19. sternocostal __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 20. intra-articular __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 21. syndactylism __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 22. lumbodynia __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 23. cervicobrachial __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 24. arthroscopy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 25. lordosis __________________ / __________________ R S DEFINITION: _________________________________________________________________ Complete the medical term by writing the missing part: 26. inter __________________ al pertaining to between the ribs 27. __________________ algia joint pain 28. myo __________________ incision in a muscle 29. spondylosyn __________________ binding together of vertebrae 178 Medical Terminology: The Language of Health Care 30. __________________ myoma smooth muscle tumor 31. osteo __________________ softening of bone 32. __________________ listhesis slipping of a vertebra 33. arthro __________________ x-ray of a joint 34. __________________ tomy incision into bone 35. epiphys __________________ inflammation of the ends of the long bones 36. __________________ al pertaining to the neck 37. bony __________________ osis dead bone tissue 38. __________________ oma tumor of cartilage 39. arthro __________________ puncture for aspiration of a joint 40. osteo __________________ repair or reconstruction of bone For each of the following, circle the combining form that corresponds to the meaning given: 41. cartilage crani/o cost/o chondr/o 42. vertebra myel/o spondyl/o lumb/o 43. bone marrow my/o myel/o muscul/o 44. neck thorac/o crani/o cervic/o 45. joint oste/o arthr/o ankyl/o 46. chest thorac/o cervic/o spondyl/o 47. muscle my/o myel/o lei/o 48. rib stern/o chondr/o cost/o Write the correct medical term for each of the following: 49. lateral curvature of the spine ________________________________________________ 50. bone tumor ________________________________________________________________ 51. grating sound made by movement of broken bones ____________________________ 52. synonym for bony necrosis __________________________________________________ 53. plane that divides the body into right and left portions _________________________ 54. application of a pulling force to a fractured or dislocated joint to maintain proper position during healing _____________________________________________________ Chapter 6 • Musculoskeletal System 179 55. arthritis caused by hyperuricemia____________________________________________ 56. a partial dislocation ________________________________________________________ 57. toward the beginning of a structure __________________________________________ 58. osteomalacia in children ____________________________________________________ 59. physician specializing in x-ray technology ____________________________________ Match the following terms related to muscles with their meaning: 60. ________ atrophy a. uncontrolled, stiff, and awkward muscle contractions 61. ________ tremor b. flabby muscle 62. ________ spasm c. involuntary muscle contraction 63. ________ rigidity d. prolonged, continuous muscle contraction |
64. ________ spastic e. stiff muscle 65. ________ hypertrophy f. rhythmic muscle movement 66. ________ flaccid g. increase in the size of a muscle 67. ________ tetany h. shrinking of muscle size Briefly describe the difference between the following terms: 68. arthrogram/arthroscopy_____________________________________________________ _______________________________________________________________________________ 69. rhabdomyoma/rhabdomyosarcoma __________________________________________ _______________________________________________________________________________ 70. osteoarthritis/rheumatoid arthritis ___________________________________________ _______________________________________________________________________________ 71. osteomalacia/osteoporosis___________________________________________________ _______________________________________________________________________________ 72. orthosis/prosthesis__________________________________________________________ _______________________________________________________________________________ 73. closed reduction, external fixation of a Fx/open reduction, internal fixation of a Fx _______________________________________________________________________________ 74. ankylosis/spondylosis _______________________________________________________ _______________________________________________________________________________ 180 Medical Terminology: The Language of Health Care 75. leiomyoma/leiomyosarcoma _________________________________________________ _______________________________________________________________________________ 76. lordosis/kyphosis ___________________________________________________________ _______________________________________________________________________________ 77. spondylolisthesis/spondylosyndesis___________________________________________ _______________________________________________________________________________ Match the following positions: 78. ________ erect a. lying down, especially in bed 79. ________ supine b. normal standing 80. ________ decubitus c. face down and flat 81. ________ prone d. horizontal recumbent (“on the spine”) Define the following abbreviations: 82. CT ________________________________________________________________________ 83. PT_________________________________________________________________________ 84. Tx_________________________________________________________________________ 85. ROM ______________________________________________________________________ 86. Fx _________________________________________________________________________ 87. EMG ______________________________________________________________________ For each of the following, circle the correct spelling of the term: 88. spondelosis spandalosis spondylosis 89. scholiosis scoliosis scoleosis 90. arthrodynia arthradynia arthrodenia 91. osteoalgia ostealgia osstealgia 92. sagital saggittal sagittal Chapter 6 • Musculoskeletal System 181 93. flaccid flacid flascid 94. sekquestrum sequestrom sequestrum 95. anklylosis ankylosis anklosis 96. chondral chrondral chondrel 97. dorsaflexion dorsiflexion dorsflexion 98. osteoparosis osteoporosis osteophorosis 99. rabdomyoma rrhabdomyoma rhabdomyoma Write in the missing words on the blank lines in the following illustrations of body planes. 100–107. 105. (cephalic) 102. 104. Lateral (ventral) (dorsal) 100. 106. (caudal) 101. plane 103. Coronal or plane 107. plane 182 Medical Terminology: The Language of Health Care Write in the missing words on the blank lines in the following illustrations of body movements. 108–118. 108. 109. 110. 111. 112. Additional movements of the feet Additional movements of the hands and arms 113. 114. 115. 116. Additional movements of the feet 117. 118. Chapter 6 • Musculoskeletal System 183 Write in the missing anatomical terms on the blank lines in the following illustrations. 119–143. 120. 119. Face Hyoid 1 122. 2 Manubrium 3 123. 4 124. 5 Ribs 6 7 125. 8 126. 9 10 Vertebral column 11 Iliac crest 12 127. 128. 129. 130. 131. 132. 133. 121. Pubic bone 134. 141. 142. 135. 136. 137. 138. 139. 143. 140. Anterior view Posterior view Color key: Appendicular skeleton Axial skeleton 184 Medical Terminology: The Language of Health Care Give the noun that was used to form the following adjectives: 144. orthotic __________________________________________________________________ 145. hypertrophic______________________________________________________________ 146. radial ____________________________________________________________________ 147. kyphotic__________________________________________________________________ 148. bursal ____________________________________________________________________ 149. dystrophic ________________________________________________________________ 150. necrotic __________________________________________________________________ 151. osteoporotic ______________________________________________________________ 152. lordotic___________________________________________________________________ 153. ulnar _____________________________________________________________________ 154. scoliotic __________________________________________________________________ 155. prosthetic ________________________________________________________________ Chapter 6 • Musculloskellettall Systtem 185 MEDICAL RECORD ANALYSES M E D I C A L R E C O R D 6 . 1 History and Physical Examination CC: “attacks” of right knee discomfort and instability HPI: This 19 y/o presents with “attacks” of right knee pain and instability. Three years ago, while playing basketball, he turned sharply and felt his kneecap pop in and out. It was acutely swollen and painful and required manipulation to reduce it. He had a course of PT and did reasonably well for a few months until resuming athletic activ- ities. Since then, he has had recurrent episodes of the knee slipping in and out, all re- lated to twisting and turning while surfing or playing basketball. His primary com- plaint is the episodic discomfort and the inability to trust the knee. He is asymptomatic at this time. PMH: NKDA. Hx of right ankle Fx in 20xx. Meds: none. Operations none. SH: alcohol rarely used. FH: Father, age 49, Mother, age 43, both L&W. ROS: noncontributory PE: The patient is a cooperative male in NAD. VS: T 97.2° F., P 64, R 14, BP 118/66 HEENT: WNL. Neck: supple, no tenderness, full ROM, no adenopathy. Lungs, heart, abdomen: WNL. Back: no tenderness or deformity. Extremities: unremarkable except for involved knee. Knee ROM is 0–45° equally. There is no parapatellar tenderness. Neurologic: Negative. Radiographs show subluxation of the right knee. IMP: RECURRENT RIGHT KNEE PATELLAR INSTABILITY RECOMMENDATION: Patelloplasty is being discussed, and the risks and benefits of the procedure have been explained. The patient will return with his parents for further consultation before deciding whether to proceed with treatment. 1. Which describes the patient’s symptoms at the time of the initial injury? a. severe pain over a short course b. pain that comes and goes c. pain that progressively gets worse d. pain that develops slowly over time e. no pain 2. What treatment was provided 3 years ago? a. puncture for aspiration of a joint b. transplantation of a piece of bone from one site to another c. examination of a joint from within d. physical rehabilitation including exercise e. binding or fusing joint surfaces 186 Medical Terminology: The Language of Health Care 3. Which best describes the patient’s symptoms at the time of this visit? a. severe pain b. moderate pain c. progressive pain d. mild pain e. no pain 4. Describe the orthopedic condition noted in the past history: a. forward slipping of a vertebra b. broken bone c. arthritis d. bone pain e. dislocation 5. What does full ROM indicate? a. swelling b. spasm c. inflammation d. bruising e. mobility 6. What did the radiographs indicate? a. no radiographs were mentioned b. patellar instability c. partial dislocation d. inflammation e. joint stiffness 7. What treatment did the physican recommend? a. surgical reconstruction of the knee cap b. physical therapy c. surgical repair of bone d. excision of the patella e. examination and repair of a joint from within using an endoscope Chapter 6 • Musculoskeletal System 187 M E D I C A L R E C O R D 6 . 2 As Alice Toohey was playing with her young granddaughter, she stepped on a toy dump truck and fell down her porch steps, wrenching her ankle violently. Because of the sharp pain and immediate swelling, Ms. Toohey was taken immediately to the hos- pital. After being seen by the emergency room physician, she was admitted and sched- uled for surgery. Directions Read Medical Record 6.2 for Alice Toohey (page 189) and answer the following questions. This record is the operative report dictated by the surgeon, Dr. Ricardo Rodriguez, immediately after the operation and processed by a medical transcriptionist. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 6 . 2 Write your answers in the spaces provided. 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record and define below: malleolus ___________________________________________________________________ oblique _____________________________________________________________________ sterile_______________________________________________________________________ 2. In your own words, not using medical terminology, briefly describe the preoperative diagnosis for Ms. Toohey. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Put the following operative steps in correct order by numbering them 1 to 10: ____ x-ray of the screws that were too long ____ incision on the outer side of the ankle ____ plate placed onto the fibula ____ sewing the incisions ____ x-ray of satisfactory screw position ____ towel clip positioned ____ removal of medial hematoma ____ removal of lateral hematoma ____ placement of a screw into the lower tibia ____ incision on the inner side of the right ankle 188 Medical Terminology: The Language of Health Care 4. In this operation, the surgeon redid one step after using a diagnostic procedure to check whether that step was as effective as possible. In your own words, explain what Dr. Rodriguez changed and why. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 5. Describe the fracture line. ____________________________________________________________________________ 6. When Dr. Rodriguez examined the ankle after making the first incision, he found a problem he could not and did not repair. In your own words, what had been destroyed in Ms. Toohey’s injury? ____________________________________________________________________________ ____________________________________________________________________________ 7. Which of the following actions did not occur in this operation? a. washing the wound with antibiotic b. taping the fracture line c. drilling holes in the bone d. stapling the skin closed 8. Describe Ms. Toohey’s condition when transferred to PAR after the operation. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Chapter 6 • Musculoskeletal System 189 Medical Record 6.2 190 Medical Terminology: The Language of Health Care M E D I C A L R E C O R D 6 . 3 Jay Dorn, a retired construction worker, has had intermittent back pain for the last 2 months. When he began also having shooting pains in his legs, he went to his doctor at Central Medical Center. After a physical examination, Mr. Dorn underwent a series of back x-rays. Directions Read Medical Record 6.3 for Jay Dorn (page 191) and answer the following questions. This record is the radiographic report dictated by Dr. Mary Volz, the radiographer, af- ter studying Mr. Dorn’s x-rays and later transcribed for the record. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 6 . 3 Write your answers in the spaces provided. 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record and define below: eburnation _________________________________________________________________ lipping _____________________________________________________________________ discogenic __________________________________________________________________ 2. What phrase in the report indicates that more than one x-ray was taken? ____________________________________________________________________________ Does the report state how many x-rays were taken? __________ no __________ yes If yes, how many? ________________________________ 3. In your own words, not using medical terminology, describe the three diagnoses Dr. Volz makes. a.___________________________________________________________________________ b.___________________________________________________________________________ c.___________________________________________________________________________ 4. Not using any abbreviations, explain what test Dr. Volz says may be useful for Mr. Dorn to have next. ____________________________________________________________________________ 5. Which of the following is not mentioned in the report as a finding? a. lateral curvature of the spine b. forward slipping of a vertebra c. immobile condition of the spine d. inflammation of the bone marrow e. inflammation of both hips Chapter 6 • Musculoskeletal System 191 Medical Record 6.3 Chaptter 7 Cardiovascular System OBJECTIVES After completion of this chapter you will be able to Define common combining forms used in relation to the cardiovascular system Identify basic anatomical terms referring to the heart and blood vessels Trace the flow of blood through the heart Define blood pressure and related terms Describe the pathway of electrical conduction in the heart and define related terms Define common symptomatic terms referring to the cardiovascular system Identify common diagnostic terms related to the cardiovascular system List the common diagnostic tests and procedures related to the cardiovascular system Identify common operative terms referring to the cardiovascular system Identify common therapeutic terms including drug classifications related to the cardiovascular system Explain terms and abbreviations used in documenting medical records involving the cardiovascular system Combining Forms Combining Form Meaning Example angi/o vessel angiogram anjē-ō-gram vas/o vasospasm vāsō-spazm vascul/o vascular vasku-lar aort/o aorta aortic ā-ōrtik arteri/o artery arteriosclerosis ar-tērēōskler-ōsis ather/o fatty (lipid) paste atheroma ath-er-ōmaă 192 Chapter 7 • Cardiovascular System 193 Combining Form Meaning Example atri/o atrium atrioventricular atrē-ō-ven-trikyū-lăr cardi/o heart cardiology kar-dē-olō-jē coron/o circle or crown coronary kōro-nār-ē my/o muscle myocardial mı̄-ō-kardē-ăl pector/o chest pectoral pektŏ-ral steth/o stethoscope stethō-skōp sphygm/o pulse sphygmomanometer sfig-mō-mă-nomĕ-ter thrombo clot thrombocyte thrombō-sı̄t ven/o vein venous vēnŭs phleb/o phlebitis flĕ-bı̄tis varic/o swollen, twisted vein varicosis vār-i-kōsis ventricul/o ventricle (belly or pouch) ventricular ven-trikyū-lăr Cardiovascular System Overview The cardiovascular system consists of the heart and blood vessels that transport blood throughout the body. The heart is the muscular organ that pumps blood throughout the body (Fig. 7.1). Its hollow interior has four chambers: the right atrium and left atrium (upper cham- bers) and the right ventricle and left ventricle (lower chambers). A partition, called the septum, divides the heart into right and left portions. The atria are separated by the in- teratrial septum, and the ventricles are separated by the interventricular septum. The valves of the heart open and close with the heartbeat to maintain the one-way flow of blood through the heart. They include the tricuspid valve, the mitral (bicuspid) valve, the pulmonary semilunar valve, and the aortic valve. There are three layers of the heart: endocardium, myocardium, and epicardium. The endocardium is the membrane that |
lines the interior cavities of the heart; the my- ocardium is the thick, muscular layer; and the epicardium is the outer membrane. Sur- rounding and enclosing the heart is a loose, protective sac called the pericardium. Blood transports essential elements within the body. It is circulated throughout the body via arteries, arterioles, capillaries, venules, and veins. (Blood is discussed sepa- rately in Chapter 8.) Blood flow through the heart is as follows. Deoxygenated (depleted of oxygen) blood returning from circulation in the body en- ters the heart through the superior vena cava and inferior vena cava into the right atrium. During atrial contraction, the tricuspid valve opens to allow blood to flow into the right ventricle. Contraction of the ventricle pushes blood through the pulmonary STRUCTURES OF THE HEART (arrows indicate path of blood flow) Superior vena cava Aortic arch Interatrial septum Aorta Pulmonary artery Pulmonary veins Pulmonary veins Left atrium Mitral valve Aortic valve Right atrium Pulmonary semilunar valve Left ventricle Tricuspid valve Interventricular septum Endocardium Right ventricle Myocardium Epicardium Inferior vena cava Pericardium BLOOD CIRCULATION ECHOCARDIOGRAM Normal, two - dimensional, apical four-chamber view Upper extremity Vein Artery Lung Lung Capillaries Lower extremity Figure 7.1 The heart and blood circulation. Chapter 7 • Cardiovascular System 195 semilunar valve into the pulmonary artery. The pulmonary artery carries the blood through two branches going to the lungs and on through the pulmonary circulation (a network of arteries, capillaries, air sacs, and veins in the lung), where it is oxygenated (supplied with oxygen) and gives off carbon dioxide waste. The oxygenated blood re- turns to the heart via the pulmonary veins into the left atrium. With atrial contraction, the mitral valve (also called bicuspid valve) opens to allow blood flow into the left ven- tricle. Contraction of the left ventricle pushes blood through the aortic valve into the aorta. Blood is then carried to all parts of the body through the systemic circulation (ar- teries, arterioles, capillaries, and veins) to provide transport for oxygen and nutrients. Note that the right side of the heart (right heart) handles deoxygenated blood and the left side of the heart (left heart) handles oxygenated blood. The heart is the first organ to receive oxygenated blood via the coronary circula- tion. Branching from the aorta, the right and left coronary arteries divide to distribute blood throughout the entire heart (Fig. 7.2). Anatomical Terms Term Meaning SEPTA AND LAYERS OF THE HEART atrium upper right and left chambers of the heart ātrē-ŭm endocardium membrane lining the cavities of the heart en-dō-kardē-ŭm epicardium membrane forming the outer layer of the heart ep-i-kardē-ŭm interatrial septum partition between right and left atrium in-ter-ā-trē-ăl septŭm interventricular septum partition between right and left ventricle in-ter-ven-trikyū-lăr septŭm myocardium heart muscle mı̄-ō-kardē-ūm pericardium protective sac enclosing the heart composed of two per-i-kardē-ūm layers with fluid between parietal pericardium outer layer (parietal pertaining to wall) pā-rı̄ē-tāl pericardial cavity fluid-filled cavity between the pericardial layers pēr-ı̄-kardē-āl visceral pericardium layer closest to the heart (visceral pertaining to viser-āl organ) MITRAL. Stems ventricle lower right and left chambers of the heart from mitre, the ventri-kāl Latin word referring to a kind of cap or VALVES OF THE HEART AND VEINS headband worn on the head and tied under the heart valves structures within the heart that open and close chin, and used to name the with the heartbeat to regulate the one-way flow of headdress of Christian blood bishops. In medicine, the aortic valve heart valve between the left ventricle and the aorta term mitral is applied to the ā-ōrtik bicuspid valve of the heart because its two parallel mitral or bicuspid valve heart valve between the left atrium and left cusps have a shape similar mı̄trăl or bı̄-kŭspid ventricle (cuspis point) to a bishop’s mitre. ANTERIOR VIEW OF POSTERIOR VIEW OF CORONARY ARTERIES CORONARY ARTERIES Superior vena Arch of aorta Superior vena cava cava Pulmonary trunk Sinoatrial nodal Left coronary artery artery Circumflex branch Right Anterior pulmonary Right interventricular veins coronary artery artery Left marginal artery Diagonal artery Atrioventricular nodal artery Right marginal artery Posterior interventricular artery Anterior interventricular artery PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) Predilation angiogram revealing 99% PTCA procedure showing catheter Post-PTCA angiogram showing stenosis of the right coronary artery (RCA). placement and straddling of the balloon successful dilation. at the occluded site. Catheter and wire placement with balloon inflation. Figure 7.2. Coronary arteries and angiograms illustrating angioplasty. Chapter 7 • Cardiovascular System 197 Term Meaning pulmonary semilunar valve heart valve opening from the right ventricle to the pŭlmō-nār-ē sem-ē-lūnăr pulmonary artery (luna moon) tricuspid valve valve between the right atrium and the right trı̄-kŭspid ventricle valves of the veins valves located at intervals within the lining of veins, especially in the legs, which constrict with muscle action to move the blood returning to the heart BLOOD VESSELS (FIG. 7.3) arteries vessels that carry blood from the heart to the ărtĕr-ēz arterioles (Fig. 7.4) aorta large artery that is the main trunk of the arterial ā-ōrtă system branching from the left ventricle Lungs Artery Vein Heart Valve Veennuulele Lymph node Arrtterriiolle Valve Lymph vessels Lymph capillaries Tissue cells Blood capillaries Deoxygenated blood Oxygenated blood Figure 7.3 Blood and lymph circulation. 198 Medical Terminology: The Language of Health Care ARTERIAL BLOOD CIRCULATION Arteries (carry blood from the heart) Tunica media Carotid artery Arch of aorta Tunica externa Pulmonary artery Brachial Endothelium artery Aorta Tunica Subendothelial layer intima Artery Internal elastic lamina Normal Doppler color flow study of internal carotid artery Femoral artery Abnormal Doppler color flow study showing occlusion of carotid artery Figure 7.4 Arteries. Chapter 7 • Cardiovascular System 199 Term Meaning arterioles small vessels that receive blood from the arteries ăr-tērē-ōlz capillaries tiny vessels that join arterioles and venules CAPILLARY. kapi-lār-ēz A term formed from the Latin venules small vessels that gather blood from the capillaries word capillus, a hair of the venyūlz into the veins head (from caput, meaning veins vessels that carry blood to the heart from the head, and pilus, a hair), vānz venules (Fig. 7.5) hence a very fine tube. Leonardo da Vinci was the CIRCULATION first to make observations on capillary phenomena and systemic circulation circulation of blood throughout the body through spoke of capillary veins. sis-tēmik arteries, arterioles, capillaries, and veins to deliver oxygen and nutrients to body tissues coronary circulation circulation of blood through the coronary blood kōro-nār-ē vessels to deliver oxygen and nutrients to the heart muscle tissue pulmonary circulation circulation of blood from the pulmonary artery pūlmō-nār-ē through the vessels in the lungs and back to the heart via the pulmonary vein, providing for the exchange of gases Blood Pressure Blood pressure is the force exerted by circulating blood on the walls of the arteries, veins, and heart chambers. This pressure is determined by the volume of blood, the space within the arteries and arterioles, and the force of heart contractions (Fig. 7.6). Blood pressure (BP) technique involves measuring pressure within the walls of an artery during the period of contraction of the heart, or systole, and during the period of relaxation of the heart, or diastole. When blood pressure is written, the systolic measurement is recorded first, followed by a slash, then the diastolic measurement (e.g., BP 120/80 means that the systolic reading is 120 and the diastolic reading is 80). Blood Pressure Terms Term Meaning diastole to expand; period in the cardiac cycle when blood dı̄-astō-lē enters the relaxed ventricles from the atria systole to contract; period in the cardiac cycle when the sistō-lē heart is in contraction and blood is ejected through the aorta and pulmonary artery normotension normal blood pressure nōr-mō-tenshŭn hypotension low blood pressure hı̄pō-tenshŭn hypertension high blood pressure hı̄per-tenshŭn 200 Medical Terminology: The Language of Health Care VENOUS CIRCULATION Veins (carry blood to the heart) Tunica Jugular vein externa Subclavian vein Tunica media Superior vena cava Cephalic Endothelium Inferior vein Subendothelial vena cava layer Tunica ternal elastic intima Vein In lamina FEMORAL THROMBUS Artery Vein Femoral vein Thrombus Color flow Doppler showing femoral vein thrombus Figure 7.5 Veins. Chapter 7 • Cardiovascular System 201 Figure 7.6 Blood pressure determination. Cardiac Conduction Movement of blood through the heart is made possible by cardiac conduction. The cardiac cycle is the repeated action of the heart during which an electrical impulse is conducted from the sinoatrial (SA) node (the pacemaker of the heart) to the atrioven- tricular (AV) node, to the bundle of His, to the left and right bundle branches, and to the Purkinje fibers, causing contraction of the heart and circulation of the blood (Fig. 7.7). Initiated by the SA node, each myocardial cell responds to stimulation conducted by electrical impulses, changing from a resting state (polarized) to a state of contrac- tion (depolarized) and then returning to a resting state by recharging (repolarizing); it is then ready again to begin the continuous cycle of contraction and relaxation of the myocardium that pumps blood through the heart. Cardiac Conduction Terms Term Meaning sinoatrial node (SA node) the pacemaker; highly specialized neurological sı̄nō-ātrē-ăl nōd tissue, embedded in the wall of the right atrium, responsible for initiating electrical conduction of the heartbeat, causing the atria to contract and firing conduction of impulses to the AV node atrioventricular node neurological tissue in the center of the heart that (AV node) receives and amplifies the conduction of impulses ātrē-ō-ven-trikyū-lăr from the SA node to the bundle of His bundle of His neurological fibers, extending from the AV node to bŭndl the right and left bundle branches, that fire the impulse from the AV node to the Purkinje fibers 202 Medical Terminology: The Language of Health Care Term Meaning Purkinje fibers (network) fibers in the ventricles that transmit impulses to pŭr-kinjē f ı̄berz the right and left ventricles, causing them to contract polarization resting; resting state of a myocardial cell pōlăr-i-zāshŭn depolarization change of a myocardial cell from a polarized dē-pō-lār-i-zāshŭn (resting) state to a state of contraction (de not; polarization resting) repolarization recharging of the myocardial cell from a contracted rē-pō-lăr-i-zāshŭn state back to a resting state (re again; polarization resting) normal sinus rhythm (NSR) regular rhythm of the heart cycle stimulated by the SA node (average rate of 60 to 100 beats/minute) (see Figs. 7.7 and 7.11) SA node AV node Left bundle Bundle of His Right bundle Purkinje fibers A SA AV node node Bundle of His Purkinje fibers Firing from SA node across atria Firing from AV node to bundle of His, Firing of Purkinje fibers showing (contraction of atria) to AV node down right and left bundle branches contraction of ventricles B Figure 7.7 Cardiac conduction. A. Anatomy. B. Path of conduction. Chapter 7 • Cardiovascular System 203 Symptomatic and Diagnostic Terms Term Meaning SYMPTOMATIC TERMS (FIG. 7.8) arteriosclerosis thickening, loss of elasticity, and calcification ar-tērēōskler-ōsis (hardening) of the arterial walls atherosclerosis buildup of fatty substances within the walls of ather-ō-skler-ōsis arteries atheromatous plaque a swollen area within the lining of an artery caused ath-er-ōmă-tŭs plak by the buildup of fat (lipids) thrombus a stationary blood clot thrombŭs embolus a clot (e.g., air, fat, foreign object) carried in the embō-lŭs bloodstream that obstructs when it lodges (embolus a stopper) stenosis condition of narrowing of a part ste-nō-sis constriction compression of a part kon-strikshŭn occlusion plugging; obstruction or a closing off ŏ-klūzhŭn ischemia to hold back blood; decreased blood flow to tissue is-kēmē-ă caused by constriction or occlusion of a blood vessel A Constriction Atheromatous Thrombus Embolus plaque B Ischemia Infarction Obstruction Occlusion Oxygenated Oxygen-deficient Oxygenated Dead tissue cells tissue cells tissue cells tissue cells Figure 7.8 A. Examples of conditions causing reduction of blood flow. B. Effects of reduction of blood flow. 204 Medical Terminology: The Language of Health Care Term Meaning perfusion deficit a lack of flow through a blood vessel caused by per-fyūzhŭn defi-sit narrowing, occlusion, etc. infarct to stuff; a localized area of necrosis (condition of infarkt tissue death) caused by ischemia as a result of occlusion of a blood vessel angina pectoris chest pain caused by a temporary loss of anji-nā pektō-ris oxygenated blood to heart muscle often caused by narrowing of the coronary arteries (angina to choke) aneurysm a widening; bulging of the wall of the heart, the anyū-rizm aorta, or an artery caused |
by congenital defect or acquired weakness (Fig. 7.9) saccular a sac-like bulge on one side săk-ū-lăr fusiform a spindle-shaped bulge fūzĭ-form dissecting a split or tear of the vessel wall dı̄-sĕkting claudication to limp; pain in a limb (especially the calf) while klaw-di-kāshŭn walking that subsides after rest; it is caused by inadequate blood supply diaphoresis profuse sweating dı̄-ă-fō-rēsis heart murmur an abnormal sound from the heart produced by hart mermer defects in the chambers or valves palpitation subjective experience of pounding, skipping, or pal-pi-tāshŭn racing heartbeats vegetation to grow; an abnormal growth of tissue around a vej-ĕ-tāshŭn valve, generally a result of an infection such as bacterial endocarditis (Fig. 7.10) Common types of aneurysms Saccular Fusiform Dissecting Normal artery Artery with aneurysm Figure 7.9 Types of aneurysms. Chapter 7 • Cardiovascular System 205 Figure 7.10 The mitral valve shows destructive vegetations, which have eroded through the free margins of the valve leaflets in a patient with bacterial endocarditis. DIAGNOSTIC TERMS arrhythmia any of several kinds of irregularity or loss of ă-rithmē-ă rhythm of the heartbeat (Fig. 7.11) dysrhythmia dis-rithmē-ă bradycardia slow heart rate (60 beats/minute) brad-ē-kardē-ă fibrillation chaotic, irregular contractions of the heart, as in fib-ri-lāshŭn atrial or ventricular fibrillation flutter extremely rapid but regular contractions of the flŭter heart, as in atrial or ventricular flutter (typically from 250 to 350 beats/minute) heart block an interference with the normal electrical hart blok conduction of the heart defined by the location of the block (e.g., AV block) premature ventricular a ventricular contraction preceding the normal contraction (PVC) impulse initiated by the SA node (pacemaker) prē-mă-tūr ven-trikyū-lăr kon-trakshūn tachycardia fast heart rate (100 beats/minute) takikardē-ă arteriosclerotic heart a degenerative condition of the arteries disease (ASHD) characterized by thickening of the inner lining, ar-tērē-ō-skler-otik loss of elasticity, and susceptibility to rupture— seen most often in the aged or smokers bacterial endocarditis a bacterial inflammation that affects the bak-tērē-ăl endō-kar-dı̄tis endocardium or the heart valves (see Fig. 7.10) cardiac tamponade compression of the heart produced by the kardē-ak tam-pŏ-nād accumulation of fluid in the pericardial sac as results from pericarditis or trauma, causing rupture of a blood vessel within the heart (tampon a plug) Normal sinus rhythm (NSR) Bradycardia Fibrillation (ventricular) Flutter (atrial) Heart block Premature ventricular contraction (PVC) Tachycardia (sinus) Figure 7.11 Electrocardiogram tracings showing common types of arrhythmia. 206 Chapter 7 • Cardiovascular System 207 Term Meaning cardiomyopathy a general term for disease of the heart muscle kardē-ō-mı̄-opă-thē [e.g., alcoholic cardiomyopathy (damage to the heart muscle caused by excessive consumption of alcohol)] congenital anomaly of malformations of the heart present at birth the heart (anomaly irregularity) kon-jeni-tăl ă-nomă-lē atrial septal defect (ASD) an opening in the septum separating the atria ātrē-ăl septăl dēfekt coarctation of the aorta narrowing of the descending portion of the aorta kō-ark-tāshŭn resulting in a limited flow of blood to the lower part of the body (Fig. 7.12) patent ductus arteriosus an abnormal opening between the pulmonary (PDA) artery and the aorta caused by the failure of the pātĕnt dŭktŭs ăr-tĕr-ē-ōsŭs fetal ductus arteriosus to close after birth (patent open) (Fig. 7.13) tetralogy of Fallot an anomaly that consists of four defects: tet-ral-ō-jē făl-ō pulmonary stenosis, ventricular septal defect, malposition of the aorta, and right ventricular hypertrophy—causes blood to bypass the pulmonary circulation so that deoxygenated blood goes into the systemic circulation, resulting in cyanosis (tetra four) ventricular septal defect an opening in the septum separating the (VSD) ventricles ven-trikyū-lăr septăl dēfekt congestive heart failure failure of the left ventricle to pump an adequate (CHF) amount of blood to meet the demands of the kon-jestiv body, resulting in a “bottleneck” of congestion in left ventricular failure the lungs that may extend to the veins, causing edema in lower portions of the body cor pulmonale a condition of enlargement of the right ventricle kōr pul-mō-nālē as a result of chronic disease within the lungs right ventricular failure that causes congestion within the pulmonary circulation and resistance of blood flow to the lungs (cor heart) Descending aorta Figure 7.12. Coarctation of the aorta. 208 Medical Terminology: The Language of Health Care Arch of aorta Ductus arteriosus Left pulmonary artery Pulmonary trunk Figure 7.13. Patent ductus arteriosus. Term Meaning coronary artery disease (CAD) a condition affecting arteries of the heart that reduces the flow of blood and delivery of oxygen and nutrients to the myocardium—most often caused by atherosclerosis (Fig. 7.14) hypertension (HTN) persistently high blood pressure hı̄per-tenshŭn essential (primary) high blood pressure attributed to no single cause, hypertension but risks include smoking, obesity, increased salt ĕ-senshăl hı̄per-tenshŭn intake, hypercholesterolemia, and hereditary factors secondary hypertension high blood pressure caused by the effects of another disease (e.g., kidney disease) mitral valve prolapse (MVP) protrusion of one or both cusps of the mitral valve mı̄trăl back into the left atrium during ventricular contraction, resulting in incomplete closure and backflow of blood Anterior interventricular artery Plaque buildup in artery wall Figure 7.14 Coronary artery disease. Chapter 7 • Cardiovascular System 209 Term Meaning myocardial infarction (MI) heart attack; death of myocardial tissue (infarction) mı̄-ō-kardē-ăl in-farkshŭn owing to loss of blood flow (ischemia) as a result of an occlusion (plugging) of a coronary artery— usually caused by atherosclerosis; symptoms include pain in the chest or upper body (shoulders, neck, and jaw), shortness of breath, diaphoresis, and nausea (Fig. 7.15) myocarditis inflammation of the myocardium most often mı̄o-kar-dı̄tis caused by viral or bacterial infection pericarditis inflammation of the pericardium peri-kar-dı̄tis phlebitis inflammation of a vein flĕ-bı̄tis rheumatic heart disease damage to heart muscle and heart valves by rū-matik rheumatic fever (a streptococcal infection) thrombophlebitis inflammation of a vein associated with a clot thrombō-flĕ-bı̄tis formation AUSCULTATION. varicose veins abnormally swollen, twisted veins with defective The Latin root vărĭ -kōs valves, most often seen in the legs (Fig. 7.16) means to listen or hear with attention. Listening deep vein thrombosis (DVT) formation of a clot in a deep vein of the body, to the sound of throm-bōsis occurring most often in the femoral and iliac veins the breathing and of the (see Fig 7.5) beating of the heart is an ancient art that was current in Hippocrates’ time. It was Diagnostic Tests and Procedures accomplished by placing the ear directly on the chest Test or Procedure Explanation wall—direct or immediate auscultation. Indirect or auscultation a physical examination method of listening to mediate auscultation has aws-kŭl-tāshŭn sounds within the body with the aid of a been used in modern times stethoscope (e.g., auscultation of the chest for since the invention of the heart and lung sounds) (Fig. 7.17) stethoscope. Figure 7.15 Anterolateral myocardial infarction (darkened area), caused by occlusion of the anterior descending branch of the left coronary artery. 210 Medical Terminology: The Language of Health Care Valve Valve opened closed Valve closed Valve open Valve closed Defective valve in varicose vein causing pooling of blood A B Figure 7.16 Varicose veins. A. Function of valves in the venous system. B. C Contraction of skeletal muscle causes valves to open and close, preventing backflow of blood returning to the heart. C. Photo of patient with varicose veins. Figure 7.17. Auscultating heart sounds. Chapter 7 • Cardiovascular System 211 Test or Procedure Explanation bruit noise; an abnormal heart sound caused by brū-ē turbulence within gallop an abnormal heart sound that mimics the gait of a horse; related to abnormal ventricular contraction electrocardiogram an electrical picture of the heart represented by (ECG or EKG) positive and negative deflections on a graph ē-lek-trō-kardē-ō-gram labeled with the letters P, Q, R, S, and T, corresponding to events of the cardiac cycle (Fig. 7.18) stress electrocardiogram an ECG of the heart recorded during the induction of controlled physical exercise using a treadmill or ergometer (bicycle); useful in detecting conditions such as ischemia and infarction (Fig. 7.19) Holter ambulatory monitor a portable electrocardiograph worn by the patient hōlter ambyū-lă-tōr-ē that monitors electrical activity of the heart over 24 moni-ter hours—useful in detecting periodic abnormalities intracardiac invasive procedure involving placement of electrophysiological catheter-guided electrodes within the heart to study (EPS) evaluate and map the electrical conduction of intr ă-kardē-ak cardiac arrhythmias; intracardiac catheter ablation ē-lektrō-fiz-ē-ō-loji-kăl may be performed at the same time to treat the stŭdē arrhythmia R S-T P segment T U Q S QRS P-R complex interval Q-T interval A B Figure 7.18 A. Electrocardiographic pattern associated with electrical conduction of the heart. B. Resting electrocardiography. 212 Medical Terminology: The Language of Health Care Figure 7.19 Stress electrocardiography. Test or Procedure Explanation intracardiac catheter use of radiofrequency waves sent through a ablation catheter within the heart to treat arrhythmias by intră-kardē-ak kathēter selectively destroying myocardial tissue at sites ab-lāshŭn generating abnormal electrical pathways magnetic resonance magnetic resonance imaging of the heart and angiography (MRA) blood vessels for evaluation of pathology (see rezō-nans an-jē-ogră-fē Chapter 10, Fig. 10.18) nuclear medicine imaging radionuclide organ imaging of the heart after of the heart administration of radioactive isotopes to visualize nūklē-ar medi-sin imă-jing structures and analyze functions myocardial radionuclide a scan of the heart made after an intravenous perfusion scan injection of an isotope (e.g., thallium) that is mı̄-ō-kardē-ăl absorbed by myocardial cells in proportion to rādē-ō-nūklı̄d per-fyūzhŭn blood flow throughout the heart myocardial radionuclide a nuclear scan of the heart taken after the perfusion stress scan induction of controlled physical exercise via treadmill or bicycle or administration of a pharmaceutical agent that produces the effect of exercise stress in patients unable to ambulate positron emission use of nuclear isotopes and computed tomography tomography (PET) scan techniques to produce perfusion (blood flow) of the heart images and study the cellular metabolism of the pozi-tron ē -mishshŭn heart; can be taken at rest or with stress tō-mogră-fē Chapter 7 • Cardiovascular System 213 Test or Procedure Explanation radiology x-ray imaging angiography an x-ray of a blood vessel after injection of contrast an-jē-ogră-fē medium angiogram a record obtained by angiography anjē-ō-gram coronary angiogram an x-ray of the blood vessels of the heart kōro-nār-ē anjē-ō-gram (see Fig. 7.2) arteriogram an x-ray of a particular artery (e.g., coronary ar-tēre-ō-gram arteriogram, renal arteriogram) aortogram an x-ray of the aorta ā-ōrtō-gram venogram an x-ray of a vein vēnō-gram cardiac catheterization introduction of a flexible, narrow tube or catheter kardē-ak kathĕ-ter-ı̄-zāshŭn through a vein or artery into the heart to withdraw samples of blood, measure pressures within the heart chambers or vessels, and inject contrast media for fluoroscopic radiography and cine film (motion picture) imaging of the chambers of the heart and coronary arteries—very often includes interventional procedures such as angioplasty and atherectomy (see endovascular procedures listed under “Operative Terms”) (Fig. 7.20) left heart catheterization an x-ray of the left ventricular cavity and coronary arteries right heart catheterization measurement of oxygen saturation and pressure readings of the right side of the heart ventriculogram an x-ray visualizing the ventricles ven-trikū-lō-gram stroke volume (SV) measurement of the amount of blood ejected from a ventricle in one contraction cardiac output (CO) measurement of the amount of blood ejected from either ventricle of the heart per minute ejection fraction measurement of the volume percentage of left ē-jekshŭn frakshŭn ventricular contents ejected with each contraction sonography sonographic imaging echocardiography (ECHO) recording of sound waves through the heart to ekō-kar-dē-ogr ă-f ē evaluate structure and motion (see Figs. 7.1 and 7.21) stress echocardiogram an echocardiogram of the heart recorded during (stress ECHO) the induction of controlled physical exercise via treadmill or bicycle or administration of a pharmaceutical agent that produces the effect of exercise stress in patients unable to ambulate— useful in detecting conditions such as ischemia and infarction 214 Medical Terminology: The Language of Health Care A Femoral vein Femoral artery Antecubital vein Brachial artery Upper thigh insertion Arm insertion B C Figure 7.20 Cardiac catheterization. A. Possible insertion sites for cardiac catheterization. B. Cardiac catheterization catheters: left, 6 French JL4; middle, 6 French pigtail; right, 6 French JR4.C. Cardiac catheteri- zation laboratory. Chapter 7 • Cardiovascular System 215 Figure 7.21 Echocardiography. Test or Procedure Explanation transesophageal an echocardiographic image of the heart after echocardiogram (TEE) placement of an ultrasonic transducer at the end of trans-ē-sofă-jēăl an endoscope inside the esophagus Doppler sonography an ultrasound technique used to evaluate blood dōplēr sō-nogră-fē flow to determine the presence of a deep vein thrombosis (DVT) or carotid insufficiency, or flow through the heart, chambers, |
valves, etc. (see Figs. 7.4 and 7.5) intravascular sonography ultrasound images made after a sonographic intra-vaskyū-lăr transducer is placed at the tip of a catheter within sŏ-nogră-fē a blood vessel—done to evaluate pathological conditions such as buildup of plaque Operative Terms Term Meaning coronary artery bypass grafting of a portion of a blood vessel retrieved graft (CABG) from another part of the body (such as a length of saphenous vein from the leg or mammary artery from the chest wall) to bypass an occluded coronary artery, restoring circulation to myocardial tissue (Fig. 7.22); the traditional method includes temporary arrest of the heart with circulation (bypass) of the patient’s blood through a heart-lung machine during the procedure—an alternative off-pump approach uses a stabilizer to perform the procedure on the beating heart anastomosis opening; joining of two blood vessels to allow flow ă-nastō-mōsis from one to the other endarterectomy incision and coring of the lining of an artery to end-ar-ter-ektō-mē clear a blockage caused by a clot or atherosclerotic plaque buildup (e.g., carotid endarterectomy) 216 Medical Terminology: The Language of Health Care A Aorta Internal mammary artery graft Saphenous vein grafts B Internal mammary artery graft Blocked artery Chest incision Saphenous vein Bypass graft 1. Bypass incisions 2. Bypass vessels 3. Bypass grafting An incision is made in the chest The long saphenous vein in the Grafting is performed under dividing the sternum to allow leg can be used to make several magnification using extremely access to the heart. bypasses, if needed. The internal fine sutures. Each graft is sewn mammary artery may also be used to the aorta, except for the as a graft. Both are “excess” blood internal mammary artery, which vessels the body does not need. already originates from a branch of the aorta. The other end is sewn to the artery below the blockage. Figure 7.22 Coronary artery bypass graft. A. Common sites for bypass grafts. B. Bypass process. Chapter 7 • Cardiovascular System 217 Term Meaning transmyocardial a laser technique used to open tiny channels in the revascularization (TMR) heart muscle to restore blood flow, thereby relieving angina in patients with advanced coronary artery disease; an option for patients not treatable with angioplasty or coronary artery bypass valve replacement surgery to replace a diseased heart valve with an artificial one types of artificial valves: tissue—most commonly made from animal tissue such as porcine (pig) or bovine (cow) mechanical—made from synthetic material (Fig. 7.23) valvuloplasty repair of a heart valve valvyū-lō-plas-tē endovascular surgery interventional procedures performed endoscopi- cally at the time of cardiac catheterization (Fig. 7.24) angioscopy use of a flexible fiberoptic angioscope accompanied (vascular endoscopy) by an irrigation system, a camera, a video recorder, an-jē-oskō-pē and a monitor that is guided through a specific blood vessel to visually assess a lesion and select the mode of therapy atherectomy excision of atheromatous plaque from within an ăth-er-ektō-mē artery utilizing a device housed in a flexible catheter that selectively cuts away or pulverizes tissue buildup (Fig. 7.24A) Figure 7.23 A. X-ray showing artificial replacement of mitral valve (Starr-Edwards). B. Starr-Edwards Silastic ball mechanical valve. 218 Medical Terminology: The Language of Health Care A Atheromatous Drive cable debris Nose cone (collection chamber) Diamond- Balloon coated burr Cutting blade Cutter Guide wire Guide wire Guide wire Transluminal Rotational catheter Directional catheter extraction catheter B Stent delivered Stent expanded Stent in place Figure 7.24 Examples of devices used in endovascular interventional procedures. A. Atherectomy devices. B. Intravascular stent. Term Meaning percutaneous transluminal a method of treating the narrowing of a coronary coronary angioplasty artery by inserting a specialized catheter with a (PTCA) balloon attachment, then inflating it to dilate and per-kyū-tānē-ŭs open the narrowed portion of the vessel and restore trăns-lūmĭ-năl kōro-nār-ē blood flow to the myocardium (see Fig. 7.2); most anjē-ō-plas-tē often includes placement of a stent intravascular stent implantation of a device used to reinforce the wall intra-vaskyū-lăr of a vessel and ensure its patency (openness)—most often used to treat a stenosis or a dissection (a split or tear in the wall of a vessel) or to reinforce patency of a vessel after angioplasty (see Fig. 7.24B) Therapeutic Terms Term Meaning defibrillation termination of ventricular fibrillation by delivery dē-fibri-lāshŭn of an electrical stimulus to the heart, most commonly by applying electrodes of the defibrillator externally to the chest wall but can be performed internally at the time of open heart surgery or via an implanted device (Fig. 7.25) defibrillator a device that delivers the electrical stimulus in dē-fibri-lāter defibrillation Chapter 7 • Cardiovascular System 219 Figure 7.25 A. External defibrillation. B. Internal defibrillation performed in the operating room. Term Meaning cardioversion termination of tachycardia either by kardē-ō-verzhŭn pharmaceutical means or by delivery of electrical energy implantable cardioverter an implanted, battery-operated device with rate- defibrillator (ICD) sensing leads that monitors cardiac impulses and kardē-ō-verter dē-fibri-lāter initiates an electrical stimulus as needed to stop ventricular fibrillation or tachycardia pacemaker a device used to treat slow heart rates (bradycardia) by electrically stimulating the heart to contract, most often implanted with lead wires and battery circuitry under the skin but can be temporarily placed externally with lead wires inserted into the heart via a vein (Fig. 7.26) thrombolytic therapy dissolution of thrombi using drugs [e.g., throm-bō-litik streptokinase, tissue plasminogen activator (TPA)] COMMON THERAPEUTIC DRUG CLASSIFICATIONS angiotensin-converting a drug that suppresses the conversion of enzyme (ACE) inhibitor angiotensin in the blood by the angiotensin- ănjē-ō-tĕnsin-kŏn-vĕrting converting enzyme; used in the treatment of ĕnzı̄m hypertension antianginal a drug that dilates coronary arteries, restoring antē-anji-năl oxygen to the tissues to relieve the pain of angina pectoris 220 Medical Terminology: The Language of Health Care Small incision Pacemaker Leads Pacemaker Right atrium Right ventricle A small incision is made in the upper The pacemaker leads are then guided A small “pocket” to house the pacemaker chest, below the clavicle, to access through the vein and into the heart. is created just under the skin at the a large vein nearby. After proper placement is determined, incision site. The leads are connected the leads are secured in position. to the pacemaker that is secured in A the “pocket.” Finally, the incision is closed with a few sutures. Figure 7.26 Pacemaker. A. Endocardial pacemaker. B B. Teleradiology/critical care workstation. Chest x-rays on screen show pacemaker placement. Term Meaning antiarrhythmic a drug that counteracts cardiac arrhythmia antē-ă-rithmik anticoagulant a drug that prevents clotting of the blood antē-kō-agyū-lant commonly used in treating thrombophlebitis and myocardial infarction antihypertensive a drug that lowers blood pressure antē-hı̄-per-tensiv beta-adrenergic blocking agents that inhibit responses to sympathetic agents adrenergic nerve activity causing a slowing of bātā ad-rĕ-nerjik bloking electrical conduction and heart rate and a beta blockers lowering of the pressure within the walls of the bātā blokers vessels; used to treat angina pectoris and hypertension Chapter 7 • Cardiovascular System 221 Term Meaning calcium channel blockers agents that inhibit the entry of calcium ions in kalsē-ŭm chanĕl blokers heart muscle cells causing a slowing of the heart rate, lessening the demand for oxygen and nutrients, and relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to prevent or treat angina pectoris, some arrhythmias, and hypertension cardiotonic a drug that increases the force of myocardial kardē-ō-tonik contractions in the heart commonly used to treat congestive heart failure diuretic a drug that increases the secretion of urine dı̄-yū-retik commonly prescribed in treating hypertension hypolipidemic a drug that reduces serum fat and cholesterol hı̄-pō-lipi-dēmik statins agents that lower cholesterol in the blood by inhibiting the effect of HMG-CoA reductase, a liver enzyme responsible for producing cholesterol thrombolytic agents drugs used to dissolve thrombi (blood clots) (e.g., thrombō-litik streptokinase, tissue plasminogen activator [TPA or tPA]) vasoconstrictor a drug that causes narrowing of the blood vessels, vāsō-kon-strikter decreasing blood flow vasodilator a drug that causes dilation of the blood vessels, vāsō-dı̄-lāter increasing blood flow Summary of Chapter 7 Acronyms/Abbreviations ACE ....................angiotensin-converting enzyme MI........................myocardial infarction ASD ....................atrial septal defect MRA ..................magnetic resonance angiography ASHD ...............arteriosclerotic heart disease MVP...................mitral valve prolapse AV .......................atrioventricular NSR ...................normal sinus rhythm BP .......................blood pressure PDA....................patent ductus arteriosus CABG................coronary artery bypass graft PET ....................positron emission tomography CAD....................coronary artery disease PTCA .................percutaneous transluminal coronary CHF ...................congestive heart failure angioplasty CO .......................cardiac output PVC ....................premature ventricular contraction DVT ...................deep vein thrombosis SA ........................sinoatrial ECG, EKG.....electrocardiogram SV........................stroke volume ECHO ...............echocardiography TEE....................transesophageal echocardiogram EPS ....................electrophysiological study TMR ..................transmyocardial revascularization HTN...................hypertension tPA, TPA.........tissue plasminogen activator ICD .....................implantable cardioverter-defibrillator VSD....................ventricular septal defect 222 Medical Terminology: The Language of Health Care PRACTICE EXERCISES For the following terms, on the lines below the term, write out the indicated word parts: prefixes (P), combining forms (CF), roots (R), and suffixes (S). Then define the term. EXAMPLE endocardial _______ / _______ / _______ P R S endo/cardi/al P R S DEFINITION: within/heart/pertaining to 1. angiography __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 2. varicosis __________________ / __________________ R S DEFINITION: _________________________________________________________________ 3. pectoral __________________ / __________________ R S DEFINITION: _________________________________________________________________ 4. vasospasm __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 5. venous __________________ / __________________ R S DEFINITION: _________________________________________________________________ 6. aortocoronary __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 7. thrombophlebitis __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ Chapter 7 • Cardiovascular System 223 8. pericardiocentesis __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 9. vasculopathy __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 10. atherogenesis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 11. stethoscope __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 12. myocardium __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 13. aortoplasty __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 14. venostomy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 15. arteriostenosis __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 16. phlebotomy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 17. cardioaortic __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 224 Medical Terminology: The Language of Health Care 18. ventriculogram __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 19. phlebitis __________________ / __________________ R S DEFINITION: _________________________________________________________________ 20. angioplasty __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 21. endovascular __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 22. cardiotoxic __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 23. arteriogram __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 24. atherectomy __________________ / __________________ R S DEFINITION: _________________________________________________________________ 25. atherothrombosis __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ Fill in the blanks with the appropriate medical terms. 26. __________________ anomalies malformations of the heart present at birth 27. arterio __________________ osis thickening, loss of elasticity, and calcification (hardening) of arterial walls 28. __________________ irregularity or loss of rhythm of the heartbeat 29. cardiomyo __________________ general term for disease of the heart muscle Chapter 7 • Cardiovascular System 225 30. __________________ joining of two blood vessels to allow flow from one to the other 31. ______________________ abnormal heart sound that mimics the gait of a horse 32. __________________ cardiogram a recording of sound waves directed through the heart to evaluate structure and motion 33. cor __________________ a condition of enlargement of the right ventricle as a result of chronic disease within the lungs 34. coronary __________________ an x-ray of the blood vessels of the heart made with the introduction of a catheter and release of a contrast medium 35. __________________ ECG electrocardiogram of the heart recorded during controlled physical exercise 36. intracardiac catheter __________________ treatment of arrhythmia by destroying myocardial tissue at sites generating abnormal electrical pathways For each of the following, circle the combining form that corresponds to the meaning given: 37. chest phleb/o sphygm/o pector/o 38. vein aort/o phleb/o varic/o 39. vessel angi/o arteri/o coron/o 40. heart ven/o coron/o cardi/o 41. fatty paste aor/o ather/o atri/o 42. circle cardi/o coron/o sphygm/o 43. pulse sphygm/o steth/o thromb/o 44. clot atri/o angi/o thromb/o 45. artery arteri/o angi/o aort/o 46. belly or pouch varic/o ventricul/o ven/o 226 Medical Terminology: The Language of Health Care Match the following terms with their meanings: 47. ________ atherosclerosis a. high blood pressure 48. ________ infarct b. bulging of a vessel 49. ________ hypotension c. stationary clot 50. ________ vegetation d. cramp in leg muscle 51. ________ embolus e. normal blood pressure 52. ________ occlusion f. hard, nonelastic condition 53. ________ hypertension g. |
traveling clot that obstructs when it lodges 54. ________ thrombus h. buildup of fat 55. ________ constriction i. growth of tissue 56. ________ normotension j. a plugging 57. ________ angina k. loss of blood flow 58. ________ claudication l. compression 59. ________ ischemia m. cramp in heart muscle 60. ________ arteriosclerosis n. low blood pressure 61. ________ aneurysm o. scar left by necrosis Write the full medical term for the following abbreviations: 62. PVC _______________________________________________________________________ 63. PDA ______________________________________________________________________ 64. ASHD _____________________________________________________________________ 65. ICD _______________________________________________________________________ 66. CHF _______________________________________________________________________ 67. CAD _______________________________________________________________________ 68. HTN_______________________________________________________________________ 69. MVP_______________________________________________________________________ 70. MRA ______________________________________________________________________ 71. VSD _______________________________________________________________________ Write in the missing words on the blank lines in the following illustration of the heart. 72–80. Superior vena cava Aortic arch 72. Atrial Aorta Pulmonary artery Pulmonary veins 76. Left Mitral valve 77. Aortic 73. Right 78. Pulmonary valve 79. Left 74. Tricuspid 80. Ventricular 75. Right Endocardium Inferior vena cava Myocardium Epicardium Oxygenated blood Pericardium Deoxygenated blood Match the following abbreviations with their meanings: 81. ________ ECG a. balloon angioplasty 82. ________ tPA b. magnetic resonance of blood vessels 83. ________ MRA c. a clot in a vein 84. ________ PTCA d. heart bypass surgery 85. ________ MI e. electrical picture of heart 86. ________ DVT f. echocardiogram directed through the esophagus 87. ________ ASD g. left ventricular failure 88. ________ CABG h. thrombolytic drug 89. ________ TEE i. an abnormal opening in the atrial septum 90. ________ CHF j. heart attack 227 228 Medical Terminology: The Language of Health Care For each of the following, circle the correct spelling of the term: 91. ventricel ventrical ventricle 92. aorta aorto aorrta 93. thrombos thrombus thrommbus 94. myocardial mycardial myocardiol 95. hypatension hyptension hypotension 96. diastolie diastoly diastole 97. ischemia ishchemia ishemia 98. oclusion occlusion ocllusion 99. infart enfarct infarct 100. anuerysm aneurysm annurysm 101. atherosclerotic atherosclerrotic atherasclerotic 102. thromboflebitus thromboflebitis thrombophlebitis 103. anngiogram angiogram angeogram 104. defibrillation defibillation defibrilation 105. antarhythmic antiarrhythmic antiarhythmic Write the term that means the opposite of each given term: 106. vasoconstriction __________________________________________________________ 107. coagulant _________________________________________________________________ 108. hypotension ______________________________________________________________ 109. bradycardia _______________________________________________________________ 110. diastole __________________________________________________________________ Chapter 7 • Cardiovascular System 229 MEDICAL RECORD ANALYSES M E D I C A L R E C O R D 7 . 1 Progress Note S: This 54 y.o. was admitted to CCU with onset of acute anterior chest pain radiating to the left shoulder and SOB; pt underwent a CABG 4 six months ago. O: BP 190/110, P 100, R 72, T 38ºC On PE, pt was in moderate to severe distress. An ECG showed sinus tachycardia, and a CXR revealed left ventricular hypertrophy. A: R/O MI P: Order blood enzyme measurement STAT echocardiogram CT scan of chest 1. What is the patient’s CC? 5. What did the electrical picture of the heart reveal? a. severe angina a. extremely rapid but regular contractions of the b. angina developing slowly over time heart c. enlargement of the heart b. slow heart rate d. fast heart rate c. chaotic, irregular contractions of the heart e. slow heart rate d. fast heart rate e. interference with normal electrical conduction 2. Describe the procedure that the patient under- of the heart known as a block went 6 months ago: a. surgery to dilate and open narrowed portions 6. What was the assessment? of coronary arteries a. patient may have had a heart attack b. replacement of occluded arteries with trans- b. patient may be suffering from right heart fail- planted portions of vein ure c. replacement of a diseased heart valve c. patient has congestive heart failure d. coring of the lining of an artery to remove a d. patient may have high blood pressure clot e. patient may have an enlarged heart e. heart transplant 7. What were the objective findings of the chest radi- 3. Where was the patient treated? ograph? a. outpatient medical office a. unknown b. outpatient emergency room b. increase in size of left ventricle c. inpatient intensive care c. vessel disease d. inpatient coronary care d. dead heart muscle e. outpatient cardiology department e. fast heart rate 4. What type of physician is most appropriate to 8. Identify the x-ray imaging procedure ordered in provide initial care and assessment of this pa- the plan: tient? a. sonogram of heart a. emergency room physician b. chest radiography b. internist c. blood pressure c. gerontologist d. computed tomography d. cardiovascular surgeon e. biochemistry panel e. cardiologist 230 Medical Terminology: The Language of Health Care M E D I C A L R E C O R D 7 . 2 Richard Stratten has had serious heart problems for more than 10 years. He has had two operations. During the past 6 months, he has developed increasing pain in the chest and is having more trouble breathing. His cardiologist, Dr. Charles Feingold, has now admitted him to Central Medical Center for further tests. Directions Read Medical Record 7.2 for Richard Stratten (pages 233–236) and answer the follow- ing questions. This record is the history and physical examination dictated by Dr. Feingold after his examination of Mr. Stratten. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 7 . 2 Write your answers in the spaces provided. 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record and define below: obtuse ______________________________________________________________________ dyspnea (dyspneic) __________________________________________________________ hiatal hernia ________________________________________________________________ basilar rales ________________________________________________________________ visceromegaly _______________________________________________________________ clubbing ____________________________________________________________________ 2. In your own words, not using medical terminology, briefly describe why Mr. Stratten has been admitted to the hospital and what test he will be undergoing. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Name the diagnosis that underlies the nature of Mr. Stratten’s heart conditions. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Briefly describe this diagnosis using nonmedical language. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Chapter 7 • Cardiovascular System 231 4. Identify the surgical procedure noted in the history that was initially performed to treat Mr. Stratten’s heart disease. a. dilation of narrow occluded coronary arteries b. replacement of occluded arteries with transplanted portion of vein c. replacement of a diseased heart valve d. coring of the lining of an artery to remove a thrombus e. heart transplant 5. What were the patient’s symptoms 8 years later on May 15, 20xx? __________________________________________________________________________ Using nonmedical language, briefly describe the diagnosis made at that time. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 6. Describe the test that showed changes consistent with the diagnosis. ____________________________________________________________________________ ____________________________________________________________________________ 7. Spell out TPA, and identify the reason why the drug was given to Mr. Stratten. 8. Which of the following were findings of the radiographic tests performed after the May 15 hospitalization? (Mark all that are appropriate.) a. hemorrhage of insertion site of obtuse marginal artery graft b. thromboembolism in the left anterior descending artery c. occluded circumflex artery d. torn sutures of the circumflex artery graft e. stenosis of the left anterior descending artery graft f. total occlusion of the left internal mammary vein graft g. dilated right coronary artery graft 9. List the arteries that were grafted in both bypass operations. ____________________________________________________________________________ ____________________________________________________________________________ 10. Using nonmedical language, list the three symptoms Mr. Stratten is now experiencing. a. ______________________________________________________________________ b. ______________________________________________________________________ c. ______________________________________________________________________ 232 Medical Terminology: The Language of Health Care 11. Mr. Stratten is taking eight different medications. Translate the medication in- struction for these: Drug Name Dosage Frequency of Dose _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ 12. What family members have had a medical history of problems in the same body system? ____________________________________________________________________________ ____________________________________________________________________________ 13. In addition to Mr. Stratten’s heart problems, Dr. Feingold’s physical examination revealed abnormal findings in what other areas? a. head b. abdomen c. extremities d. all of the above e. none of the above 14. What does “probable end-stage cardiomyopathy” mean? What treatment seems possible to Dr. Feingold, even though he had not yet performed the diagnostic tests for which he hospitalized Mr. Stratten? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Chapter 7 • Cardiovascular System 233 Medical Record 7.2 234 Medical Terminology: The Language of Health Care Medical Record 7.2 Continued. Chapter 7 • Cardiovascular System 235 Medical Record 7.2 Continued. 236 Medical Terminology: The Language of Health Care Medical Record 7.2 Continued. Chapter 7 • Cardiovascular System 237 M E D I C A L R E C O R D 7 . 3 William Smith woke in the middle of the night with substernal chest heaviness that ra- diated to both arms. After getting no relief from taking aspirin and antacids, he went to the emergency room and was seen by Dr. Roland Galasso. The chest pain subsided only after administration of intravenous nitroglycerin. Dr. Galasso decided to admit Mr. Smith for further cardiac evaluation and treatment. A cardiac catheterization was performed the next day. Directions Read Medical Record 7.3 for William Smith (pages 239–240) and answer the following questions. This record is a report of the cardiac catheterization performed by Dr. Galasso and transcribed by a cardiology department transcriptionist. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 7 . 3 Write your answers in the spaces provided. 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record: ostium _____________________________________________________________________ hemodynamic _______________________________________________________________ mitral regurgitation _________________________________________________________ focal _______________________________________________________________________ 2. In your own words, not using medical terminology, briefly describe the indications for performing the cardiac catheterization. ____________________________________________________________________________ 3. Put the following actions in correct order by numbering them 1 to 14: _____ pigtail catheter advanced to the left ventricle _____ hemostasis obtained by C-clamp pressure _____ right coronary arteriography performed _____ pigtail catheter exchanged for left coronary artery catheter _____ informed consent signed _____ arterial pressures recorded _____ right groin prepped and draped _____ left coronary arteriography performed _____ right femoral artery entered and Cordis sheath inserted _____ right coronary catheter and femoral artery sheath removed 238 Medical Terminology: The Language of Health Care _____ pigtail catheter inserted through sheath and guided to descending thoracic aorta _____ left coronary catheter exchanged for right coronary catheter _____ left ventriculography performed _____ heparin administered 4. Briefly describe the conclusions of the procedure in nonmedical language: a.___________________________________________________________________________ b.___________________________________________________________________________ 5. From the recommendations, describe the test that will be performed right away. __________________________________________________________________________ 6. Identify the possible complications likely to occur in the future. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Describe the procedure that is recommended should these complications occur. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Chapter 7 • Cardiovascular System 239 Medical Record 7.3 240 Medical Terminology: The Language of Health Care Medical Record 7.3 Continued. Chapter 8 Blood and Lymph Systems OBJECTIVES After completion of this chapter, you will be able to Define common term components used in relation to the blood and lymph systems Describe the basic functions of the blood and lymph systems Define the basic anatomical terms referring to blood and lymph Define common symptomatic and diagnostic terms referring to the blood and lymph systems List common diagnostic tests and procedures related to the blood and lymph systems Identify common operative terms referring to the blood and lymph systems Identify common therapeutic terms including drug classifications related to the blood and lymph systems Explain terms and abbreviations used in documenting medical records involving the blood or lymph systems Combining Forms Combining Form Meaning Example blast/o germ or bud erythroblastemia ĕ-rith´rō-blas-tē´ mē-ă -blast (also a suffix) megaloblast meg´ă-lō-blast chrom/o color chromic krō´ mik chromat/o hemochromatosis hē´ mō-krō-mă-tō´ sis chyl/o juice chylemia kı̄-lē´ mē-ă hem/o blood hemostat hē´ mō-stat hemat/o hematopoiesis hē´ mă-tō-poy-ē´ sis 241 242 Medical Terminology: The Language of Health Care Combining Form Meaning Example immun/o safe immunology im´yū-nol´ō-jē lymph/o clear fluid lymphogenous lim-foj´ĕ-nŭs morph/o form morphologic mōr-fō-loj´ik myel/o bone marrow (also spinal cord) myelogenous mı̄-ĕ-loj´ĕ-nŭs phag/o eat or swallow phagocytosis fag´ō-sı̄-tō´ sis plas/o formation aplastic ā-plas´tik reticul/o a net reticulocyte re-tik´yū-lō-sı̄t splen/o spleen splenomegaly splē-nō-meg´ă-lē thromb/o clot thrombocyte throm´bō-sı̄t thym/o thymus gland thymic thı̄´mik Blood System Overview The blood circulates through the blood vessels to transport oxygen, nutrients, and |
hor- mones to body cells and to carry away wastes. The liquid portion of the blood is called plasma. The cellular components suspended in the plasma are the erythrocytes, leuko- cytes, and platelets. The portion of the plasma that remains after the clotting process is called serum (Fig. 8.1). Anatomical Terms Term Meaning TERMS RELATED TO BLOOD FLUID plasma liquid portion of the blood and lymph plaz´mah containing water, proteins, salts, nutrients, hormones, vitamins, and cellular components (leukocytes, erythrocytes, and platelets) SERUM. Serum serum liquid portion of the blood left after the clotting is Latin for sēr´ŭm process whey, the CELLULAR COMPONENTS OF THE BLOOD watery part of curdled milk, which looks similar to the erythrocyte red blood cell that transports oxygen and carbon watery part of clotted blood. ĕ-rith´rō-sı̄t dioxide within the bloodstream The term was first recorded in English in 1672. hemoglobin protein-iron compound contained in the erythrocyte hē´ mō-glō´ bin that has bonding capabilities for the transport of oxygen and carbon dioxide Unclotted Clotted Red blood cells Plasma Serum Cellular components Platelets White blood cells White blood cells (leukocytes) Granulocytes Neutrophil Basophil Eosinophil White blood cells (leukocytes) Red blood cells Platelets Agranulocytes (erythrocytes) (thrombocytes) Monocyte Lymphocyte Figure 8.1 Components of the blood. 243 244 Medical Terminology: The Language of Health Care Term Meaning leukocyte white blood cell that protects the body from invasion lu´kō-sı̄t of harmful substances granulocytes a group of leukocytes containing granules in their gran´yū-lō-sı̄ts cytoplasm neutrophil a granular leukocyte, named for the neutral stain of nū´ trō-fil its granules, that fights infection by swallowing bacteria (phagocytosis) (neutro neither; phil attraction for) polymorphonuclear another term for neutrophil, named for the many leukocyte (PMN) segments present in its nucleus (poly many; pol-ē-mōr´fō-nū´ klē-ăr morpho form; nucleus kernel) band an immature neutrophil eosinophil a granular leukocyte, named for the rose-color ē-ō-sin´ō-fil stain of its granules, that increases with allergy and some infections [eos dawn-colored (rosy); phil attraction for] basophil a granular leukocyte, named for the dark stain of bā´sō-fil its granules, that brings anticoagulant substances to inflamed tissues (baso base; phil attraction for) agranulocytes a group of leukocytes without granules in their nuclei ă-gran´yū-lō-sı̄ts lymphocyte an agranulocytic leukocyte that is active in the lim´fō-sı̄t process of immunity—there are four categories of lymphocytes: T cells (thymus dependent) B cells (bone marrow derived) NK cells (natural killer) K-type cells monocyte an agranulocytic leukocyte that performs mon´ō-sı̄t phagocytosis to fight infection (mono one) platelets thrombocytes; cell fragments in the blood essential plāt´lets for blood clotting (coagulation) Lymphatic System Overview The lymphatic system is made up of an intricate network of capillaries, vessels, valves, ducts, nodes, and organs. It protects the body by filtering microorganisms and foreign particles from the lymph and supporting the activities of the lympho- cytes in the immune response. It also serves to maintain the body’s internal fluid en- vironment by acting as an intermediary between the blood in the capillaries and tis- sue cells. In addition, it is responsible for carrying fats away from the digestive organs (Fig. 8.2). A B Chapter 8 • Blood and Lymph Systems 245 Upper right quadrant The remainder of Tonsils of body drains to the the body drains right lymphatic duct. to the thoracic duct. Cervical lymph nodes Right lymphatic duct Thymus Axillary lymph gland nodes Thoracic Spleen duct Pancreas Inguinal lymph nodes C Lymphatic Artery vessels Vein Lymph node Heart Valve Venule Arteriole Valve Lymph vessels Lymph capillaries Tissue cells Blood capillaries Figure 8.2 Lymphatic system. A. Lymph structures. B. Lymph drainage. C. Blood and lymph circulation. 245 246 Medical Terminology: The Language of Health Care Anatomical Terms Term Meaning LYMPH ORGANS thymus the primary gland of the lymphatic system, located thı̄´mŭs within the mediastinum; helps maintain the body’s immune response by producing T lymphocytes spleen the organ between the stomach and diaphragm that splēn filters out aging blood cells, removes cellular debris by performing phagocytosis, and provides the envi- ronment for the initiation of immune responses by lymphocytes LYMPH STRUCTURES lymph fluid originating in the organs and tissues of the body limf that is circulated through the lymph vessels lymph capillaries microscopic vessels that draw lymph from the tissues limf kap´i-lār-ēz to the lymph vessels lymph vessels vessels that receive lymph from the lymph capillaries limf ves´ĕlz and circulate it to the lymph nodes lacteals specialized lymph vessels in the small intestine that lak´tē-ălz absorb fat into the bloodstream (lacteus milky) chyle a white or pale yellow substance of the lymph that kı̄l contains fatty substances absorbed by the lacteals lymph nodes many small oval structures that filter the lymph limf nōdz received from the lymph vessels—major locations include the cervical region, axillary region, and inguinal region lymph ducts collecting channels that carry lymph from the lymph limf dŭktz nodes to the veins right lymphatic duct receives lymph from the upper-right part of the body lim-fat´ik dŭkt thoracic duct receives lymph from the left side of the head, neck, thō-ras´ik dŭkt chest, abdomen, left arm, and lower extremities IMMUNITY antigen a substance that, when introduced into the body, an´ti-jen causes the formation of antibodies against it antibody a substance produced by the body that destroys or an´tē-bod-ē inactivates an antigen that has entered the body immunoglobulins (Ig) protein antibodies secreted by B lymphocytes that im´yu-nō-glob´yu-lins protect the body from invasion of foreign pathogens; the five major classes include IgA, IgD, IgE, IgG, and IgM Chapter 8 • Blood and Lymph Systems 247 Term Meaning immunity process of disease protection induced by exposure to an i-myū´ ni-tē antigen active immunity an immunity that protects the body against a future ak´tiv i-myū´ ni-tē infection, as the result of antibodies that develop naturally after contracting an infection or artificially after administration of a vaccine passive immunity an immunity resulting from antibodies that are conveyed pas´iv i-myū´ ni-tē naturally through the placenta to a fetus or artificially by injection of a serum containing antibodies Symptomatic and Diagnostic Terms Term Meaning SYMPTOMATIC Related to Blood microcytosis the presence of small red blood cells (Fig. 8.3) mı̄´krō-sı̄-tō´ sis macrocytosis the presence of large red blood cells (see Fig. 8.4) mak´rō-sı̄-tō´ sis anisocytosis the presence of red blood cells of unequal size (an an- ı̄´sō-sı̄-tō´ sis without; iso equal) (see Fig. 8.4) poikilocytosis the presence of large, irregularly shaped red blood cells poy´ki-lō-sı̄-tō´ sis (poikil/o irregular) (Fig. 8.4) reticulocytosis an increase of immature erythrocytes in the blood re-tik´yū-lō-sı̄-tō´ sis erythropenia an abnormally reduced number of red blood cells ĕ-rith-rō-pē´ nē-ă lymphocytopenia an abnormally reduced number of lymphocytes lim´fō-sı̄-tō-pē´ nē-ă neutropenia a decrease in the number of neutrophils nū´ trō-pē´ nē-ă pancytopenia an abnormally reduced number of all cellular pan´sı̄-tō-pē´ nē-ă components in the blood hemolysis breakdown of the red blood cell membrane hē-mol´i-sis Related to Lymph immunocompromised impaired immunological defenses caused by an im´yū-nō-kom´pro-m ı̄zd immunodeficiency disorder or therapy with immunosuppressive agents immunosuppression impaired ability to provide an immune response im´yū-nō-sŭ-presh´ŭn lymphadenopathy the presence of enlarged (diseased) lymph nodes lim-fad-ĕ-nop´ă-thē 248 Medical Terminology: The Language of Health Care Figure 8.3 A blood smear showing normal erythrocytes (A) compared with a Figure 8.4 Photomicrograph of a blood smear revealing microcytic-hypochromic erythrocytes in a patient with iron de- blood smear from a patient with perni- ficiency anemia (B). cious anemia reveals macrocytosis, anisocytosis, and poikilocytosis. Term Meaning splenomegaly enlargement of the spleen splē-nō-meg´ă-lē DIAGNOSTIC acquired a syndrome caused by the human immunodeficiency immunodeficiency virus (HIV) that renders immune cells ineffective, syndrome (AIDS) permitting opportunistic infections, malignancies, ă-kwı̄rd´ and neurological diseases to develop; it is i-myūn´o-dē-fish´en-sē transmitted sexually or through exposure to sin´drōm contaminated blood anemia a condition in which there is a reduction in the ă-nē´ mē-ă number of red blood cells, the amount of hemoglobin, or the volume of packed red cells in the blood, resulting in a diminished ability of the red blood cells to transport oxygen to the tissues; common types follow: aplastic anemia a normocytic-normochromic ā-plas´tik type of anemia characterized by the failure of bone marrow to produce red blood cells iron deficiency anemia a microcytic-hypochromic type i´ern dē-fish´en-sē of anemia characterized by a lack of iron, affecting production of hemoglobin and characterized by small red blood cells containing low amounts of hemoglobin (see Fig. 8.3) pernicious anemia a macrocytic-normochromic type per-nish´ŭs of anemia characterized by an inadequate supply of vitamin B12, causing red blood cells to become large, varied in shape, and reduced in number (see Fig. 8.4) autoimmune disease any disorder characterized by abnormal function of aw-tō-i-myun´ di-zēz´ the immune system that causes the body to produce antibodies against itself, resulting in tissue destruction or loss of function; rheumatoid arthritis and lupus are examples of autoimmune diseases Chapter 8 • Blood and Lymph Systems 249 Term Meaning erythroblastosis fetalis a disorder that results from the incompatibility of a ĕ-rith´rō-blas-tō´ sis fetus with an Rh-positive blood factor and a mother fē´ tă´ lis who is Rh negative, causing red blood cell destruction in the fetus; necessitates a blood transfusion to save the fetus Rh factor the presence, or lack, of antigens on the surface of red blood cells that may cause a reaction between the blood of the mother and fetus, resulting in fetal anemia Rh positive the presence of antigens Rh negative the absence of antigens hemochromatosis a hereditary disorder that results in an excessive hē´ mō-krō-mă-tō´ sis buildup of iron deposits in the body hemophilia a group of hereditary bleeding disorders in which hē-mō-fil´ē-ă there is a defect in clotting factors necessary for the coagulation of blood leukemia a chronic or acute malignant (cancerous) disease of lū-kē´ mē-ă the blood-forming organs, marked by abnormal leukocytes in the blood and bone marrow; classified according to the types of white cells affected (e.g., myelocytic, lymphocytic) myelodysplasia a disorder within the bone marrow characterized by mı̄´ĕ-lō-dis-plā́ zē-ă the proliferation of abnormal stem cells (cells that give rise to the different types of blood cells); usually develops into a specific type of leukemia lymphoma any neoplastic disorder of lymph tissue, usually lim-fō´ mă malignant, as in Hodgkin disease metastasis the process by which cancer cells are spread by blood mĕ-tas´tă-sis or lymph circulation to distant organs mononucleosis a condition caused by the Epstein-Barr virus mon´ō-nū-klē-ō´ sis characterized by an increase in mononuclear cells (monocytes and lymphocytes) in the blood, along with enlarged lymph nodes (lymphadenopathy), fatigue, and sore throat (pharyngitis) polycythemia an increase in the number of erythrocytes and pol´ē-sı̄-thē´ mē-ă hemoglobin in the blood septicemia a systemic disease caused by the infection of sep-ti-sē´ mē-ă microorganisms and their toxins in the circulating blood thrombocytopenia a bleeding disorder characterized by an abnormal throm´bō-sı̄-tō-pē´ nē-ă decrease in the number of platelets in the blood, which impairs the clotting process 250 Medical Terminology: The Language of Health Care Diagnostic Tests and Procedures Test or Procedure Explanation BLOOD STUDIES blood chemistry a test of the fluid portion of blood to measure the blŭd kem´is-trē presence of a chemical constituent (e.g., glucose, cholesterol) blood chemistry panels specialized batteries of automated blood chemistry tests performed on a single sample of blood; used as a general screen for disease or to target specific organs or conditions (e.g., metabolic panel, lipid panel, arthritis panel) basic metabolic panel battery of tests used as a general screen met-ă-bol´ik for disease: calcium, carbon dioxide (CO2), chloride, creatinine, glucose, potassium, sodium and blood urea nitrogen (BUN) comprehensive metabolic tests in addition to basic metabolic panel panel for expanded screening purposes: albumin, bilirubin, alkaline phosphatase, protein, ALT, and AST (Fig. 8.5) blood culture a test to determine if infection is present in the blŭd kŭl´chŭr bloodstream by isolating a specimen of blood in an environment that encourages the growth of microorganisms; the specimen is observed and the organisms that grow in the culture are identified CD4 cell count a measure of the number of CD4 cells (a subset of T lymphocytes) in the blood; used in monitoring the course of HIV and timing the treatment of AIDS; the normal adult range is 600–1,500 cells complete blood count (CBC) the most common laboratory blood test performed as a screen of general health or for diagnostic purposes; the following is a listing of the component tests included in a CBC (Fig. 8.6) (note: CBC results are usually reported with normal values so |
that the clinician can interpret the results based on the instrumentation used by the laboratory; normal ranges also may vary depending on factors such as the region and climate) white blood count (WBC) a count of the number of white blood cells per cubic millimeter obtained by manual or automated laboratory methods red blood count (RBC) a count of the number of red blood cells per cubic millimeter obtained by manual or automated laboratory methods hemoglobin (HGB or Hgb) a test to determine the blood level of hemoglobin hē´ mō-glō´ bin (expressed in grams) hematocrit (HCT or Hct) a measurement of the percentage of packed hē´ mă-tō-krit red blood cells in a given volume of blood Chapter 8 • Blood and Lymph Systems 251 CENTRAL MEDICAL CENTER 211 Medical Center Drive • Central City, US 90000-1234 • PHONE: (012) 125-6784 • FAX: (012) 125-9999 11/02/20xx 14:27 NAME : TEST, PATIENT LOC: TEST DOB: 02/03/xx AGE: 38Y MR# : TEST-221 SEX: M ACCT# : H111111111 M63561 COLL: 11/02/20xx 13:24 REC: 11/02/20xx 13:25 COMPREHENSIVE METABOLIC PANEL Blood Urea Nitrogen *30 [5–25] mg/dL (BUN) Sodium 139 [135–153] mEq/L Potassium 4.2 [3.5–5.3] mEq/L Chloride 105 [101–111] mEq/L Carbon Dioxide (CO2) 27 [24–31] mmol/L Glucose, Random *148 [70–110] mg/dL Creatinine *1.5 [<1.5] mg/dL SGOT (AST) 18 [10–42] U/L SGPT (ALT) *8 [10–60] U/L Alkaline Phosphatase 58 [42–121] U/L Total Protein 6.5 [6.0–8.0] G/dL Albumin 3.7 [3.5–5.0] G/dL Amylase 33 [<129] U/L Bilirubin, Total 0.7 [<1.5] mg/dL Calcium, Total 9.7 [8.6–10.6] mg/dL TEST, PATIENT TEST-221 END OF REPORT PAGE 1 11/02/20xx 14:27 INTERIM REPORT COMPLETED Figure 8.5 Comprehensive metabolic panel report. Note: Normal ranges are in brackets [ ]. Test or Procedure Explanation blood indices calculations of RBC, HGB, and HCT results to determine in´di-sēz the average size, hemoglobin concentration, and content of red blood cells for classification of anemia mean corpuscular a calculation of the volume of individual cells in cubic (cell) volume (MCV) microns using HCT and RBC results: MCV HCT/RBC kōr-pŭs´kyū-lăr mean corpuscular a calculation of the content in weight of hemoglobin in (cell) hemoglobin the average red blood cell using HGB and RBC results: (MCH) MCH HGB/RBC kōr-pŭs´kyū-lăr hē´ mō-glō´ bin mean corpuscular a calculation of the average hemoglobin (cell) hemoglobin concentration in each red blood cell using HGB and HCT concentration (MCHC) results: MCHC HGB/HCT hē´ mō-glō´ bin kon-sen-trā´shŭn 252 Medical Terminology: The Language of Health Care CENTRAL MEDICAL CENTER 211 Medical Center Drive • Central City, US 90000-1234 • PHONE: (012) 125-6784 • FAX: (012) 125-9999 11/02/20xx 14:27 NAME : TEST, PATIENT LOC: TEST DOB: 2/2/xx AGE: 27Y MR# : TEST-221 SEX: M ACCT# : H111111111 M63558 COLL: 11/2/20xx 13:23 REC: 11/2/20xx 13:24 HEMOGRAM CBC WBC *11.5 [4.5–10.5] K/UL RBC 5.84 [4.6–6.2] M/UL HGB 17.2 [14.0–18.0] G/DL HCT 50.8 [42.0–52.0] % MCV 87 [82–92] FL MCH 29.5 [27–31] PG MCHC 33.9 [32–36] G/DL PLT 202 [150–450] K/UL Auto Lymph % 15 [20–40] % Auto Mono % 2 [1–11] % Auto Neutro % 82 [50–75] % Auto Eos % 1 [0–6] % Auto Baso % 0 [0–2] % Auto Lymph # 1.7 [1.5–4.0] K/UL Auto Mono # 0.2 [0.2–0.9] K/UL Auto Neutro # 9.4 [1.0–7.0] K/UL Auto Eos # 0.1 [0–0.7] K/UL Auto Baso # 0.0 [0–0.2] K/UL TEST, PATIENT TEST-221 END OF R E P ORT PAGE 1 11/02/20xx 14:27 INTERIM REPORT INTERIM REPORT COMPLETE Figure 8.6 Complete blood count (CBC) report. Test or Procedure Explanation differential count a determination of the number of each type of white blood cell (leukocyte) seen on a stained blood smear; each type is counted and reported as a percentage of the total examined Type of Leukocyte Normal Range lymphocytes 25–33% monocytes 3–7% neutrophils 54–75% eosinophils 1–3% basophils 0–1% red cell morphology as part of identifying and counting the WBCs, the mōr-fol´ō-jē condition of the size and shape of the red blood cells in the background of the smeared slide is noted (e.g., anisocytosis, poikilocytosis) platelet count (PLT) a calculation of the number of thrombocytes in the plāt´let blood: normal range 150,000–450,000/cubic millimeters Chapter 8 • Blood and Lymph Systems 253 Test or Procedure Explanation erythrocyte a timed test to measure the rate at which red blood sedimentation rate (ESR) cells settle or fall through a given volume of plasma ĕ-rith´rō-sı̄t sed´i-men-tā´shŭn rāt partial thromboplastin a test to determine coagulation defects such as time (PTT) platelet disorders thromboplastin a substance present in tissues, platelets, and throm-bō-plas´tin leukocytes that is necessary for coagulation prothrombin time (PT) a test to measure the activity of prothrombin in the blood prothrombin a protein substance in the blood that is essential to the prō-throm´bin clotting process venipuncture an incision into or puncture of a vein to withdraw ven-i-pŭnk´chūr blood for testing phlebotomy flĕ-bot´ō-mē BONE AND LYMPH STUDIES bone marrow aspiration a needle aspiration of bone marrow tissue for bōn mar´ō as-pi-rā´shŭn pathological examination (Fig. 8.7) bone marrow biopsy a pathological examination of bone marrow tissue bōn mar´ō bı̄´op-sē lymphangiogram an x-ray image of a lymph node or vessel taken lim-fan´jē-ō-gram after injection of a contrast medium DIAGNOSTIC IMAGING computed tomography full-body x-ray CT images are used to detect (CT) tumors and cancers such as lymphoma positron emission radionuclide scans, especially of the whole body, tomography (PET) are useful in determining the recurrence of cancers or to measure response to therapy; commonly used in evaluating lymphoma Operative Terms Term Meaning bone marrow transplant the transplantation of healthy bone marrow from a bōn mar´ō tranz´plant compatible donor to a diseased recipient to stimulate blood cell production lymphadenectomy the removal of a lymph node lim-fad-ĕ-nek´tō-mē lymphadenotomy an incision into a lymph node lim-fad-ĕ-not´ă-mē lymph node dissection the removal of possible cancer-carrying lymph nodes limf nōd di-sek´shŭn for pathological examination 254 Medical Terminology: The Language of Health Care Figure 8.7 Bone marrow aspiration. Posterior view of the pelvic region showing common site. Term Meaning splenectomy the removal of the spleen splē-nek´tō-mē thymectomy the removal of the thymus gland thı̄-mek´tō-mē Therapeutic Terms Term Meaning blood transfusion the introduction of blood products into the circulation of a recipient whose blood volume is reduced or deficient in some manner autologous blood blood donated by, and stored for, a patient for aw-tol´ŏ-gŭs blud future personal use (e.g., upcoming surgery) homologous blood blood voluntarily donated by any person for hŏ-mol´ō-gŭs blud transfusion to a compatible recipient blood component therapy the transfusion of specific blood components such as packed red blood cells, platelets, and plasma crossmatching a method of matching a donor’s blood to the recipient by mixing a sample in a test tube to determine compatibility chemotherapy the treatment of malignancies, infections, and kem´ō-thēr´ă-pē other diseases with chemical agents that destroy selected cells or impair their ability to reproduce immunotherapy the use of biological agents to prevent or treat im´ū-nō-thār´ă-pē disease by stimulating the body’s own defense mechanisms; as seen in the treatment of AIDS, cancer, and allergy plasmapheresis the removal of plasma from the body with plaz´mă-fĕ -rē´ sis separation and extraction of specific elements (such as platelets) followed by reinfusion (apheresis a withdrawal) Chapter 8 • Blood and Lymph Systems 255 Term Meaning Common Therapeutic Drug Classifications anticoagulant a drug that prevents clotting of the blood an´tē-kō-ag´yū-lant hemostatic a drug that stops the flow of blood within the vessels hē-mō-stat´ik vasoconstrictor a drug that causes a narrowing of blood vessels, vā´sō-kon-strik´ter decreasing blood flow vasodilator a drug that causes dilation of blood vessels, increasing vā´sō-dı̄´lā-ter blood flow Summary of Chapter 8 Acronyms/Abbreviations AIDS........................acquired immunodeficiency Ig................................immunoglobulin syndrome MCH........................mean corpuscular (cell) ALT ..........................alanine aminotransferase (enzyme) hemoglobin AST ..........................aspartate aminotransferase MCHC ....................mean corpuscular (cell) (enzyme) hemoglobin concentration BUN.........................blood urea nitrogen MCV ........................mean corpuscular (cell) volume CBC..........................complete blood count PET ..........................positron emission tomography CO2...........................carbon dioxide PLT ..........................platelet count CT..............................computed tomography PMN ........................polymorphonuclear leukocyte ESR..........................erythrocyte sedimentation rate PT..............................prothrombin time Fe...............................iron (ferrous) PTT ..........................partial thromboplastin time HCT or Hct ........hematocrit RBC .........................red blood cell or count HGB or Hgb......hemoglobin WBC ........................white blood cell or count 256 Medical Terminology: The Language of Health Care PRACTICE EXERCISES For the following terms, on the lines below the term, write out the indicated word parts: prefixes (P), combining forms (CF), roots (R), and suffixes (S). Then define the word. EXAMPLE dyshematopoiesis _______ / _______ / _______ P CF S dys/hemato/poiesis P CF S DEFINITION: painful, difficult, or faulty/blood/formation 1. erythroblastosis __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 2. myelodysplasia __________________ / __________________ / __________________ / __________________ CF P R S DEFINITION: _________________________________________________________________ 3. hemocytometer __________________ / __________________ / __________________ CF CF S DEFINITION: _________________________________________________________________ 4. splenorrhagia __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 5. lymphadenitis __________________ / __________________ / __________________ R R S DEFINITION: _________________________________________________________________ 6. immunotoxic __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 7. reticulocytosis __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ Chapter 8 • Blood and Lymph Systems 257 8. thymopathy __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 9. leukocytic __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 10. lymphangiogram __________________ / __________________ / __________________ R CF S DEFINITION: _________________________________________________________________ 11. splenomegaly __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 12. promyelocyte __________________ / __________________ / __________________ / __________________ P CF R S DEFINITION: _________________________________________________________________ 13. leukocytopenia __________________ / __________________ / __________________ CF CF S DEFINITION: _________________________________________________________________ 14. splenectomy __________________ / __________________ R S DEFINITION: _________________________________________________________________ 15. chylopoiesis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 16. lymphoma __________________ / __________________ R S DEFINITION: _________________________________________________________________ 17. cytomorphology __________________ / __________________ / __________________ CF CF S DEFINITION: _________________________________________________________________ 258 Medical Terminology: The Language of Health Care 18. hemolysis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 19. anemia __________________ / __________________ P S DEFINITION: _________________________________________________________________ 20. metastasis __________________ / __________________ P S DEFINITION: _________________________________________________________________ Complete the medical term by writing the missing part: 21. neutro____________ abnormal reduction of neutrophils 22. _____________ cyte white blood cell 23. hemato______________ formation of blood 24. spleno_______________ enlargement of the spleen 25. ______________ penia an abnormally reduced number of red blood cells 26. ______________ ic pertaining to the thymus gland 27. ____ granulocytes white cells without granules in their nuclei 28. eosino__________ a granular leukocyte named for its attraction to the rose- color stain of its granules 29. ____________ cyte red blood cell 30. _________ cytopenia reduced number of all cellular components in the blood For each of the following, circle the combining form that corresponds to the meaning given: 31. eat or swallow phas/o phag/o plas/o 32. clot thromb/o thym/o lymph/o 33. juice lymph/o hemat/o chyl/o 34. formation plas/o troph/o thromb/o 35. color hem/o chrom/o cyan/o 36. blood erythr/o hem/o lymph/o Chapter 8 • Blood and Lymph Systems 259 37. safe toxic/o reticul/o immun/o 38. germ or bud blast/o gen/o crin/o Fill in the blanks with the appropriate medical terms and abbreviations: 39. The procedure of counting the number of leukocytes in the blood is called a____________ ____________ ____________ and is abbreviated ____________. 40. The blood study that determines the amount of pigment present in RBCs is called a ________________ and is abbreviated ________________. 41. The blood study that determines packed red blood cell volume is called a ____________ and is abbreviated ____________. 42. The classification of WBCs is performed in a ________________ ________________. 43. The calculations provided in blood indices, MCV_________ _______________ _________________, MCH_________ _______________ _________________, and MCHC_________ ______________ _______________ _________________, are used to classify types of _______________________. 44. Venipuncture is also termed _______________________. 45. Hodgkin disease is a malignant type of __________________________. Write the full medical term for the following abbreviations: 46. PT ________________________________________________________________________ 47. ESR ______________________________________________________________________ 48. PTT _______________________________________________________________________ 49. CBC ______________________________________________________________________ 260 Medical Terminology: The Language of Health Care Match the following terms with their meanings: 50. ________ microcytosis a. large red blood cells 51. ________ poikilocytosis b. thrombocyte 52. ________ neutrophil c. WBC with rose-stained granules 53. ________ monocyte d. RBC 54. ________ eosinophil e. agranulocyte active in immunity 55. ________ lymphocyte f. WBC with dark-stained granules 56. ________ basophil g. WBC termed “one cell” 57. ________ platelet h. RBCs of unequal size 58. ________ erythrocyte i. WBC with granules 59. ________ granulocyte j. large, irregular RBCs 60. ________ anisocytosis k. polymorphonuclear WBC 61. ________ macrocytosis l. small red blood cells Write the correct medical term for each of the following: 62. impaired ability to provide an |
immune response ______________________________ 63. test tube method of matching a donor’s blood to the recipient __________________ 64. syndrome caused by HIV ___________________________________________________ 65. condition characterized by an increase in mononuclear cells caused by the Epstein-Barr virus _________________________________________________________ 66. removal of plasma from the body, extraction of specific elements, then reinfusion ___________________________________________________________________________ Chapter 8 • Blood and Lymph Systems 261 Briefly describe the difference between the following terms: 67. plasma/serum ______________________________________________________________ _______________________________________________________________________________ 68. anemia/leukemia ___________________________________________________________ _______________________________________________________________________________ 69. autologous blood/homologous blood _________________________________________ _______________________________________________________________________________ 70. antibody/antigen ___________________________________________________________ _______________________________________________________________________________ 71. vasoconstrictor/vasodilator _________________________________________________ _______________________________________________________________________________ 72. anticoagulant/hemostatic ___________________________________________________ _______________________________________________________________________________ 73. polycythemia/hemochromatosis _____________________________________________ _______________________________________________________________________________ Write in the missing words on the lines in the following illustrations of the components of blood. 74–78. Unclotted Clotted 76. 78. 74. Cellular components 77. 75. 262 Medical Terminology: The Language of Health Care Write in the missing words on the lines in the following illustrations of the lymphatic system. 79–84. THE LYMPHATIC SYSTEM Tonsils 83. Cervical lymph 79. Right duct 80. gland Axillary lymph nodes 81. 84. duct Pancreas Inguinal lymph nodes 82. vessels Chapter 8 • Blood and Lymph Systems 263 For each of the following, circle the correct spelling of the term: 85. hematopoesis hematopoiesis hematoepoisis 86. platelets plattelets plateletts 87. anissocytosis aniscocytosis anisocytosis 88. polkulocytosis poikilocytosis poiekilocytosis 89. hemalysis hemoliesis hemolysis 90. lymphadenpathy lymphadenopathy lymphoadenopathy 91. myelodysplasia mylodysplaszia myelodysphazia 92. thrombocytopnea thrombocytopenia throbocytpenia 93. hematocrit hemacrit hematocrete 94. splenecktomy splenectomy spleenectomy 95. plasmapheresis plazmaphoresis plasmophoresis 96. vasodialator vasodilater vasodilator 97. venipuncture venapuncture venepuncture Give the noun that was used to form the following adjectives: 98. leukemic _________________________________________________________________ 99. immunosuppressive _______________________________________________________ 100. thymic ___________________________________________________________________ 101. hematopoietic ____________________________________________________________ 102. splenic ___________________________________________________________________ 103. septicemic _______________________________________________________________ 104. hemophilic _______________________________________________________________ 105. myelodysplastic __________________________________________________________ 264 Medical Terminology: The Language of Health Care MEDICAL RECORD ANALYSES M E D I C A L R E C O R D 8 . 1 Progress Note CC: fatigue S: This 43 y/o female c/o feeling rundown with lack of energy 1 mo. Pt denies fever, chills, nausea, vomiting, diarrhea, constipation and reports no weight loss. She has had very heavy menstrual periods lasting 5 days since DC of birth control pills 1 year ago. PMH: mononucleosis at age 14, NKDA. FH: father, age 68, died of MI Mother, age 74, has myelodysplasia; sister, age 45, L&W SH: married 8 yr, no children; ETOH—wine with dinner, denies smoking. O: VS: T 98.8ºF, P 81, R 15, BP 136/62. WDWN female in NAD. HEENT-WNL Neck: supple s̄ lymphadenopathy. Lungs: clear. Heart RRR s̄ murmur Abdomen: soft and tender s̄ organomegaly. Extremities: no edema. A: Etiology of fatigue and decreased energy unclear. Possible iron deficiency ane- mia in light of heavy menstrual periods. P: Blood studies to include comprehensive metabolic panel, CBC c̄ differential. RTO in 1 wk for lab results. 1. Which of the following is not mentioned in the b. macrocytic-normochromic type of anemia history? characterized by an inadequate supply of a. type of treatment the patient received for vitamin B12, causing red blood cells to mononucleosis become large, varied in shape, and reduced in number b. patient’s consumption of alcohol c. microcytic-hypochromic type of anemia chrac- c. how long the patient has been married terized by small red blood cells containing low d. health status of the patient’s sister amounts of hemoglobin because of lack of iron in the body 2. Describe the condition of the patient’s mother: d. normocytic-normochromic type of anemia a. she has leukemia characterized by the failure of bone marrow to b. she has a bleeding disorder characterized by an produce red blood cells abnormally decreased number of platelets in the blood 5. Identify the subjective information most signifi- c. she has a hereditary disorder characterized by cantly linked to the assessment: an excessive buildup of iron deposits in the body a. enlarged lymph glands d. she has a disorder within the bone marrow char- b. heavy menstrual periods acterized by a proliferation of abnormal stem c. fatigue cells, which usually develops into leukemia d. the patient quit taking birth control pills 3. Which of the following describes the findings of the physical examination? 6. Of the following tests, which test is part of the a. swollen lymph glands plan? b. normal examination a. test to determine coagulation defects such as platelet disorders c. fast heart rate b. test to diagnose an infection in the blood- d. heart murmur stream, by culturing a specimen of blood 4. What is the possible cause of the patient’s fatigue? c. needle aspiration of bone marrow tissue for a. viral condition characterized by an increase in pathological examination mononuclear cells (monocytes and lympho- d. expanded battery of automated blood chem- cytes) in the blood istry tests used as a general screen for disease Chapter 8 • Blood and Lymph Systems 265 M E D I C A L R E C O R D 8 . 2 Henry Lin went to his personal physician after an extended period of feeling weak and tired, and starting to lose weight. His doctor admitted him to Central Medical Center hospital for additional tests after conducting a physical examination and blood tests. He is now being treated as an outpatient by his internist, Dr. Bradley, and an oncolo- gist, Dr. Ellison, to whom he was referred for consultation and concurrent care. Directions Read Medical Record 8.2 for Mr. Lin (pages 267–268) and answer the following questions. The progress note is the oncology/hematology progress note dictated by Dr. Ellison, the oncologist treating Mr. Lin, at the time of a follow-up visit 2 weeks after Mr. Lin’s hospitalization. The second document is a hematology lab report, submitted before a second follow-up with Dr. Ellison 2 weeks later. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 8 . 2 Write your answers in the spaces provided. 1. Below are medical terms used in the progress note you have not yet encountered in this text. Underline each where it appears in the record and define below: edema ______________________________________________________________________ scaphoid ___________________________________________________________________ anorexia ____________________________________________________________________ 2. In your own words, not using medical terminology, translate Mr. Lin’s diagnosis: ____________________________________________________________________________ 3. Name the diagnostic test that confirmed this diagnosis: ____________________________________________________________________________ 4. Write the medical term for Mr. Lin’s enlarged spleen: ____________________________________________________________________________ 5. Dr. Ellison’s March 31 record includes the results of two CBC component tests from the earlier March 23 lab report, as well as results from the same tests for March 31. The April 15 lab report also contains the CBC component tests. In the spaces below, write the name of the tests and their results at these three times. Do not use abbreviations. Be sure to include units of measure. Result Test March 23 March 31 April 15 ____________________ __________ __________ __________ ____________________ __________ __________ __________ 266 Medical Terminology: The Language of Health Care 6. What are the three elements Dr. Ellison includes in Mr. Lin’s treatment plan? a. ______________________________________________________________________ b. ______________________________________________________________________ c. ______________________________________________________________________ 7. Study the April 15 laboratory report carefully and complete the following table of selected test results. Write the name of the component that is abbreviated and an N if the result for Mr. Lin is within the normal range or an A (abnormal) if the re- sult is outside the normal range. a. WBC b. RBC c. HGB d. HCT e. MCV f. MCH g. MCHC h. PLT i. lymph j. mono k. neutro l. eos m. baso Chapter 8 • Blood and Lymph Systems 267 Medical Record 8.2 268 Medical Terminology: The Language of Health Care CENTRAL MEDICAL CENTER 211 Medical Center Drive • Central City, US 90000-1234 • PHONE: (012) 125-6784 • FAX: (012) 125-9999 04/15/20xx 14:27 NAME : Lin, Henry LOC: TEST DOB: 2/2/xx AGE: 69Y MR# : TEST-226 SEX: M ACCT# : 168946701 M63558 COLL: 04/15/20xx 13:23 REC: 04/15/20xx 13:25 HEMOGRAM CBC WBC 4.1 [4.5–10.5] K/UL RBC 2.93 [4.6–6.2] M/UL HGB 9.1 [14.0–18.0] G/DL HCT 25.3 [42.0–52.0] % MCV 86.2 [82–92] FL MCH 31.1 [27–31] PG MCHC 36.0 [32–36] G/DL PLT 90 [150–450] K/UL Auto Lymph % 8.3 [20–40] % Auto Mono % 32.6 [1–11] % Auto Neutro % 57.8 [50–75] % Auto Eos % 1.0 [0–6] % Auto Baso % 0.3 [0–2] % Auto Lymph # 0.3 [1.5–4.0] K/UL Auto Mono # 1.3 [0.2–0.9] K/UL Auto Neutro # 2.4 [1.0–7.0] K/UL Auto Eos # 0.0 [0–0.7] K/UL Auto Baso # 0.0 [0–0.2] K/UL TEST, PATIENT TEST-221 END OF REPORT PAGE 1 04/15/20xx 14:27 INTERIM REPORT INTERIM REPORT COMPLETE Medical Record 8.2 Continued. Chapter 89 Respiratory System OBJECTIVES After completion of this chapter, you will be able to Define common term components used in relation to the respiratory system Describe the basic functions of the respiratory system Define the basic anatomical terms referring to the respiratory system Define common symptomatic and diagnostic terms referring to the respiratory system List the common diagnostic tests and procedures related to the respiratory system Identify common operative terms referring to the respiratory system Identify common therapeutic terms including drug classifications related to the respiratory system Explain the terms and abbreviations used in documenting medical records involving the respiratory system Combining Forms Combining Form Meaning Example alveol/o alveolus (air sac) alveolar al-vē´ō-lăr bronch/o bronchus (airway) bronchoscope brong´kō-skōp bronchi/o bronchiocele brong´kē-ō-sēl bronchiol/o bronchiole (little airway) bronchiolitis brong-kē-ō-lı̄´tis capn/o carbon dioxide hypercapnia hı̄-per-kap´nē-ă carb/o hypocarbia hı̄-pō-kar´bē-ă laryng/o larynx (voice box) laryngospasm lă-ring´gō-spazm lob/o lobe (a portion) lobectomy lō-bek´tō-mē nas/o nose nasal nā´zăl rhin/o rhinorrhea rı̄-nō-rē´ ă 269 270 Medical Terminology: The Language of Health Care Combining Form Meaning Example or/o mouth oropharyngeal ōr-ō-fă-rin´jē-ăl ox/o oxygen hypoxemia hı̄-pok-sē´mē-ă palat/o palate palatoplasty pal´ă-tō-plas-tē pharyng/o pharynx (throat) pharyngitis far-in-jı̄´tis phren/o diaphragm (also mind) phrenospasm fren´ō-spazm pleur/o pleura pleurisy plūr´i-sē pneum/o air or lung pneumonia nū-mō´nē-ă pneumon/o pneumonectomy nū´mō-nek´tō-mē pulmon/o lung pulmonologist pŭl´mō-nol´ŏ-jist sinus/o sinus (cavity) sinusitis sı̄-nŭ-sı̄´tis spir/o breathing spirometry spı̄-rom´ĕ-trē thorac/o chest thoracotomy thōr-ă-kot´ō-mē pector/o pectoralgia pek-tō-ral´jē-ă steth/o stethoscope steth´ō-skōp tonsill/o tonsil (almond) tonsillitis ton´si-lı̄´tis trache/o trachea (windpipe) trachea trā´kē-ă uvul/o uvula uvulitis yu-vyu-lı̄´tis ADDITIONAL SUFFIX -pnea breathing dyspnea disp-nē´ ă Respiratory System Overview The respiratory system is composed of the organs and structures that function to exchange gases within the body. The exchange of gases, called respiration, occurs when oxygen from the air is inhaled into the lungs and passes into the blood and carbon dioxide diffuses from the blood into the lungs and is exhaled into the air. Respiration is also known as breathing or ventilation. Intake of air is called inspiration or inhalation, and outflow of air is called expiration or exhalation (Fig. 9.1). Chapter 9 • Respiratory System 271 RESPIRATORY SYSTEM Sinuses Frontal Frontal sinus sinus Sphenoid sinus Nasal cavity Ethmoidal Nasopharynx air cells Oral cavity Oropharynx Tonsils Nose Sphenoidal Laryngopharynx sinus Epiglottis Maxillary Esophagus sinus Trachea Tongue Larynx with vocal cords Superior view of larynx Rib Lung Lung Pleura Epiglottis Pleural cavity Vocal Right main cords bronchus Left main open Upper lobe of bronchus right lung Cartilage Upper lobe Middle lobe of left lung Lower lobe Carina Bronchioles Mediastinum Lower lobe Diaphragm Lining of airways Mucus Bronchiole with alveoli Bronchial cilia Bronchial lining cells Mucus-producing Pulmonary cells vein Mucous membranes Alveolus Lobes O2CO2 Pulmonary artery Figure 9.1. Respiratory tract. 272 Medical Terminology: The Language of Health Care Anatomical Terms Term Meaning nose structure that warms, moistens, and filters air as it enters nōz the respiratory tract and that houses the olfactory receptors for the sense of smell sinuses air-filled spaces in the skull that open into the nasal cavity sı̄´nŭs-ĕz palate partition between the oral and nasal cavities; divided into pal´ăt the hard and soft palate pharynx throat; passageway for food to the esophagus and air to far´ingks the larynx nasopharynx part of the pharynx directly behind the nasal passages nā´zō-far-ingks oropharynx central portion of the pharynx between the roof of the ŏr´ō-far-ingks mouth and the upper edge of the epiglottis laryngopharynx lower part of the pharynx just below the oropharynx lă-ring´gō-far-ingks opening into the larynx and the esophagus tonsils oval lymphatic tissues on each side of the pharynx that ton´silz filter air to protect the body from bacterial invasion— also called palatine tonsils adenoid lymphatic tissue on the back of the pharynx behind the ad´ĕ -noyd nose—also called pharyngeal tonsil uvula small projection hanging from the back middle |
edge of yu´vyu-lă the soft palate, named for its grape-like shape (see Chapter 14, Fig. 14.2) larynx voice box; passageway for air moving from pharynx to lar´ingks trachea; contains vocal cords glottis opening between the vocal cords in the larynx glot´is epiglottis lid-like structure that covers the larynx during swallowing ep-i-glot´is to prevent food from entering the airway trachea windpipe; passageway for air from the larynx to the area tră´kē-ă of the carina where it splits into the right and left bronchus bronchial tree branched airways that lead from the trachea to the alveoli brong´kē-ăl right and left two primary airways branching from the area of the carina bronchus into the lungs brong´kŭs bronchioles progressively smaller tubular branches of the airways brong´kē-ōlz alveoli thin-walled microscopic air sacs that exchange gases al-vē´ ō-lı̄ Chapter 9 • Respiratory System 273 Term Meaning lungs two spongy organs, located in the thoracic cavity enclosed LUNG. Lung is lŭngz by the diaphragm and rib cage, responsible for an Anglo-Saxon respiration term derived from lungre, meaning lobes subdivisions of the lung, two on the left and three on the quickly or lightly. The lōbz right connection suggests that the lungs were named for their pleura membranes enclosing the lung (visceral pleura) and lining lightness and ability to float plūr´ă the thoracic cavity (parietal pleura) in water. The lungs were pleural cavity potential space between the visceral and parietal layers of also called “lights.” plūr´ăl kav´i-tē the pleura diaphragm muscular partition that separates the thoracic cavity from dı̄´ă-fram the abdominal cavity and aids in respiration by moving up and down mediastinum partition that separates the thorax into two compartments me´dē -as-tı̄´nŭm (that contain the right and left lungs) and encloses the heart, esophagus, trachea, and thymus gland mucous membranes thin sheets of tissue that line the respiratory passages and myū´kŭs mem´brānz secrete mucus, a viscid (sticky) fluid cilia hair-like processes from the surface of epithelial cells, sil´ē-ă such as those of the bronchi, that provide upward movement of mucus cell secretions parenchyma functional tissues of any organ such as the tissues of the pă-reng´ki-mă bronchioles, alveoli, ducts, and sacs that perform respiration Symptomatic and Diagnostic Terms Term Meaning SYMPTOMATIC Breathing (Fig. 9.2) eupnea normal breathing yūp-nē´ ă bradypnea slow breathing brad-ip-nē´ ă tachypnea fast breathing tak-ip-nē´ ă hypopnea shallow breathing hı̄-pop´nē-ă hyperpnea deep breathing hi-perp-nē´ ă dyspnea difficulty breathing disp-nē´ ă apnea inability to breathe ap´nē-ă 274 Medical Terminology: The Language of Health Care Normal Bradypnea Tachypnea (decreased rate) (increased rate) Inspiration Expiration Time Volume of air Hypopnea Hyperpnea Cheyne-Stokes breathing (shallow depth) (increased depth) Figure 9.2 Examples of breathing patterns. Term Meaning orthopnea ability to breathe only in an upright position ōr-thop-nē´ ă Cheyne-Stokes pattern of breathing characterized by a gradual respiration increase of depth and sometimes rate to a res-pi-rā´ shŭn maximum level, followed by a decrease, resulting in apnea Lung Sounds crackles popping sounds heard on auscultation of the lung krak´ĕlz when air enters diseased airways and alveoli— rales occurs in disorders such as bronchiectasis or rahlz atelectasis wheezes high-pitched, musical sounds heard on hwēz´ez auscultation of the lung as air flows through a rhonchi narrowed airway—occurs in disorders such as rong´kı̄ asthma or emphysema stridor a high-pitched crowing sound that is a sign of str ı̄´dōr obstruction in the upper airway (trachea or larynx) General Symptomatic Terms caseous necrosis degeneration and death of tissue with a cheese- kā´ sē-ŭs nĕ-krō´sis like appearance (characteristic of tuberculosis) dysphonia hoarseness (phon/o voice or sound) dis-fō´nē-ă epistaxis nosebleed (epi upon; stazo to drip) ep´i-stak´sis expectoration coughing up and spitting out of material from the ek-spek-tō-rā´ shŭn lungs sputum material expelled from the lungs by coughing spū´ tŭm hemoptysis coughing up and spitting out blood originating in hē-mop´ti-sis the lungs (ptysis to spit) Chapter 9 • Respiratory System 275 Term Meaning hypercapnia excessive level of carbon dioxide in the blood hı̄-per-kap´nē-ă (capno smoke; carbo coal) hypercarbia hı̄-per-kar´bē-ă hyperventilation excessive movement of air in and out of the lungs hı̄´per-ven-ti-lā´ shŭn causing hypocapnia hypoventilation deficient movement of air in and out of the lungs hı̄´pō-ven-ti-lā´ shŭn causing hypercapnia hypoxemia deficient amount of oxygen in the blood hı̄-pok-sē´mē-ă hypoxia deficient amount of oxygen in tissue cells hı̄-pok´sē-ă obstructive condition blocking the flow of air moving out of lung disorder the lungs (Fig. 9.3C) lŭng dis-ōr´der restrictive lung disorder condition limiting the intake of air into the lungs (see Fig. 9.3B) pulmonary edema fluid filling of the spaces around the alveoli, even- pŭl´mō-nār-ē e-dē´mă tually flooding into the alveoli pulmonary infiltrate density on an x-ray representing solid material pŭl´mō-nār-ē in-fil´trāt within the air spaces of the lungs, usually indicating inflammatory changes (see Fig. 9.7) rhinorrhea thin, watery discharge from the nose r ı̄-nō-rē´ ă Loss of Alveolar elasticity duct Fibrotic tissue Air trapping Alveolus A Normal B Pneumoconiosis Bronchioles and alveolar ducts are Chronic inhalation of dust particles C Emphysema open, allowing air to reach alveoli results in the formation of fibrotic Alveoli lose their elasticity, making it and alveolar capillaries; alveoli and tissue surrounding the alveoli, limiting difficult to push air out of the lungs ducts are elastic, pushing air out of their ability to stretch and restricting and obstructing exhalation of air. the lungs during expiration. the intake of air. Figure 9.3 Comparison of normal alveoli (A) with alveoli in restrictive (B) and obstructive (C) lung disorders. 276 Medical Terminology: The Language of Health Care A B Cross section Cross section Mucus plugs Swelling Constriction Close-up of a bronchiole, showing spasm, edema, and mucus Figure 9.4 Constricted bronchial tubes in asthma. A. Normal. B. Asthma. Term Meaning DIAGNOSTIC asthma panting; obstructive pulmonary disease caused by az´mă a spasm of the bronchial tubes or by swelling of their mucous membrane, characterized by paroxysmal (sudden, periodic) attacks of wheezing, dyspnea, and cough (Fig. 9.4) atelectasis collapse of lung tissue (alveoli) (atele at-ĕ-lek´tă-sis imperfect) bronchiectasis abnormal dilation of the bronchi with brong-kē-ek´tă-sis accumulation of mucus (Fig. 9.5) bronchitis inflammation of the bronchi brong-kı̄´tis bronchogenic carcinoma lung cancer brong-kō-jen´ik kar-si-nō´mă bronchospasm constriction of bronchi caused by spasm of the brong´kō-spazm peribronchial smooth muscle emphysema obstructive pulmonary disease characterized by em-fi-sē´mă overexpansion of the alveoli with air, with destructive changes in their walls resulting in loss of lung elasticity and gas exchange (emphysan to inflate) (see Fig. 9.3C) chronic obstructive permanent, destructive pulmonary disorder that pulmonary disease (COPD) is a combination of chronic bronchitis and kron´ik pŭl´mō-nār-ē di-zēz´ emphysema cystic fibrosis inherited condition of exocrine gland malfunction sis´tik f ı̄-brō´ sis causing secretion of abnormally thick, viscous (sticky) mucus that obstructs passageways within the body, commonly affecting the lungs and digestive tract; mucus that obstructs the airways leads to infection, inflammation, and lung tissue damage laryngitis inflammation of the larynx lar-in-j ı̄ ´ tis Chapter 9 • Respiratory System 277 Normal Bronchiectasis Trachea Bronchi Trapped mucus Figure 9.5. Bronchiectasis. Term Meaning laryngotracheobronchitis inflammation of the upper airways with swelling (LTB) that creates a funnel-shaped elongation of tissue lăr-ing´gō-trā´kē-o-brong-kı̄´tis causing a distinct “seal bark” cough croup krūp laryngospasm spasm of laryngeal muscles causing constriction lă-ring´gō-spazm nasal polyposis presence of numerous polyps in the nose (a polyp nā´zăl pol´i-pō´ sis is a tumor on a stalk) pharyngitis inflammation of the pharynx far-in-j ı̄´tis pleural effusion accumulation of fluid within the pleural cavity plŭr´ăl e-fū´ zhŭn (Fig. 9.6) empyema accumulation of pus in the pleural cavity em-pı̄-ē´mă pyothorax pı̄-ō-thōr´aks hemothorax accumulation of blood in the pleural cavity hē-mō-thōr´aks pleuritis inflammation of the pleura plū-r ı̄´tis pleurisy plūr´i-sē 278 Medical Terminology: The Language of Health Care Normal Pleural effusion Pleural cavity Lung Pleura Pleural cavity Porous membrane Normal space occupied Pleural cavity allows fluid transport by the pleural cavity filling with fluid Figure 9.6 Pleural effusion. Term Meaning pneumoconiosis chronic restrictive pulmonary disease resulting nū´mō-kō-nē- ō´sis from prolonged inhalation of fine dusts such as coal, asbestos (asbestosis), or silicone (silicosis) (conio dust) (see Fig. 9.3B) pneumonia inflammation in the lung caused by infection nū-mō´nē-ă from bacteria, viruses, fungi, or parasites, or resulting from aspiration of chemicals (Fig. 9.7) pneumocystis pneumonia pneumonia caused by the Pneumocystis carinii nū-mō-sis´tis nū-mō´nē-ă organism—a common opportunistic infection seen in those with positive human immunodeficiency virus pneumothorax air in the pleural cavity caused by a puncture of nū-mō-thōr´aks the lung or chest wall (Fig. 9.8) pneumohemothorax air and blood in the pleural cavity nū´mō-hē-mō-thōr´aks pneumonitis inflammation of the lung often caused by nū-mō-nı̄´tis hypersensitivity to chemicals or dusts pulmonary embolism (PE) occlusion in the pulmonary circulation, most pŭl´mō-nār-ē em´bō-lizm often caused by a blood clot (see Figs. 9.11 and 9.15) pulmonary tuberculosis (TB) disease caused by the presence of Mycobacterium pŭl´mō-nār-ē t ū-ber-kyū-lō´ sis tuberculosis in the lungs characterized by the formation of tubercles, inflammation, and necrotizing caseous lesions (caseous necrosis) (Fig. 9.9) sinusitis inflammation of the sinuses sı̄-nŭ-sı̄´tis Chapter 9 • Respiratory System 279 Figure 9.7 Chest x-ray showing pulmonary infiltrates in right upper lobe consistent with lobar pneumonia. Dense ma- terial (inflammatory exudate) absorbs radiation, whereas normal alveoli do not. Term Meaning sleep apnea periods of breathing cessation (10 seconds or slēp ap´nē-ă more) that occur during sleep, often causing snoring tonsillitis acute or chronic inflammation of the tonsils ton´si-lı̄´tis Normal Pneumothorax Air Inspiration Air entering through a wound in the chest causes a collapse of the lung; contents of the thoracic cavity shift to the opposite side, compressing the other lung. Figure 9.8 Simple pneumothorax. 280 Medical Terminology: The Language of Health Care Figure 9.9 Chest x-ray showing presence of tuberculosis in the left upper lobe (arrow). Term Meaning upper respiratory infection infectious disease of the upper respiratory tract (URI) involving the nasal passages, pharynx, and res´pi-ră-tōr-ē in-fek´shŭn bronchi Diagnostic Tests and Procedures Test or Procedure Explanation arterial blood gases (ABGs) analysis of arterial blood to determine the ar-tē´ rē-ăl adequacy of lung function in the exchange of gases pH a measure of blood acidity or alkalinity PaO2 partial pressure of oxygen measuring the amount of oxygen in the blood PaCO2 partial pressure of carbon dioxide measuring the amount of carbon dioxide in the blood endoscopy examination of a body cavity with a flexible en-dos´kŏ-pē endoscope to examine within for diagnostic or treatment purposes bronchoscopy use of a flexible endoscope, called a bronchoscope, brong-kos´kŏ-pē to examine the airways (Fig. 9.10) nasopharyngoscopy use of a flexible endoscope to examine the nasal nā´zō-fa-ring-gos´kŏ-pē passages and the pharynx (throat) to diagnose structural abnormalities such as obstructions, growths, and cancers Chapter 9 • Respiratory System 281 Bronchoscopy team performing procedure Area of carina Bronchoscopic views Carina Left main bronchus Right main bronchus Blood clot Blood clot occluding right main bronchus Mucus plug Mucus plug occluding right main bronchus Foreign body Embedded foreign body Right upper orifice Figure 9.10 Bronchoscopy procedure. 282 Medical Terminology: The Language of Health Care Figure 9.11 Posterior lung scan in a patient with an embolus in the right lung. Ventilation image (A) shows a normal pattern. Absence of blood flow to the right lung is apparent on perfusion scan (B). L, left; R, right. STETHOSCOPE. The Greek word stethos means chest and skopeo Test or Procedure Explanation means to view. The stetho- lung biopsy (Bx) removal of a small piece of lung tissue for scope was invented by René Laënnec in 1816. He is lŭng bı̄´op-sē pathological examination said to have first thought of lung scan two-part nuclear scan of the lungs to detect it when watching children lŭng skan abnormalities of perfusion (blood flow) or playing; some of them ventilation (respiration), commonly called a listening at one end of a V̇/Q̇ (ventilation/perfusion) scan (Fig. 9.11) beam of wood could hear a pin scratching at the other ventilation scan—made as the patient breathes end. He applied this radioactive material into the airways principle to auscultation of the chest, which was then perfusion scan—made after radioactive material is performed by placing the injected into the blood and circulates to the lungs ear directly on the patient’s chest. The first stethoscope magnetic resonance image nonionizing image of the lung to visualize lung was made of wood. (MRI) lesions mag-net´ic rez´ō-nans im´ij polysomnography (PSG) recording of various aspects of sleep (eye and pol´ē-som-nog´ră-fē muscle movements, respiration, brain wave patterns) for diagnosis of sleep disorders (somn/o sleep) (see Chapter 10, Fig. 10.16) physical examination methods auscultation to listen; physical examination method of listening |
aws-kŭl-tā´ shŭn to the sounds within the body with the aid of a stethoscope, such as auscultation of the chest for heart and lung sounds percussion physical examination method of tapping over the per-kŭsh´ŭn body to elicit vibrations and sounds to estimate the size, border, or fluid content of a cavity such as the chest pulmonary function testing direct and indirect measurements of lung volumes (PFT) and capacities pŭl´mō-nār-ē fŭngk´shŭn spirometry portion of pulmonary function testing that is a di- spı̄-rom´ĕ-trē rect measurement of lung volume and capacity (Fig. 9.12) Chapter 9 • Respiratory System 283 A B Bell Recorder FPO of Modern spirometer Air Lungs Breathing by the test subject causes the piston-like bell to rise and fall, H O Pen 2 moving the pen on the recording drum. Figure 9.12 A. Principle of spirometry. B. Modern spirometry. Test or Procedure Explanation tidal volume (TV or VT) amount of air exhaled after a normal inspiration tı̄´dăl vol´yŭm vital capacity (VC) amount of air exhaled after a maximal inspiration vı̄t´ăl kă-pas´i-tē peak flow (PF) measure of the fastest flow of exhaled air after a peak expiratory flow maximal inspiration (Fig. 9.13) rate (PEFR) ek-spı̄´ră-tō-rē flō rāt Figure 9.13. Routine peak flow monitoring by asthmatic adoles- cent female is performed to predict signs of an oncoming attack. 284 Medical Terminology: The Language of Health Care A B Figure 9.14 Pulse oximetry. A. Placement of a sensor on the patient’s finger. B. Oxygen saturation reading on a portable monitor. Test or Procedure Explanation pulse oximetry noninvasive method of estimating the percentage pŭls ok-sim´ĕ-trē of oxygen saturation in the blood using an oximeter with a specialized probe attached to the skin at a site of arterial pulsation, commonly the finger; used to monitor hypoxemia (Fig. 9.14) radiology x-ray imaging rā-dē-ol´ō-jē chest x-ray (CXR) x-ray image of the chest to visualize the lungs computed tomography (CT) computed x-ray imaging of the head is used to tō-mog´ră-fē visualize the structures of the nose and sinuses; CT of the thorax is used to detect lesions in the lung pulmonary angiography x-ray of the blood vessels of the lungs after pŭl´mō-nār-ē an-jē-og´ră-fē injection of contrast material (Fig. 9.15) Figure 9.15 Pulmonary angiogram: embolus obstructing pul- monary circulation (arrow). Chapter 9 • Respiratory System 285 Operative Terms Term Meaning adenoidectomy excision of the adenoids ad´ĕ-noy-dek´tō-mē lobectomy removal of a lobe of a lung lō-bek´tō-mē nasal polypectomy removal of a nasal polyp nā´zăl pol-i-pek´tō-mē pneumonectomy removal of an entire lung nū´mō-nek´tō-mē thoracentesis puncture for aspiration of the chest (Fig. 9.16) thōr´ă-sen-tē´ sis thoracoplasty repair of the chest involving fixation of the ribs thōr´ă-kō-plas-tē thoracoscopy endoscopic examination of the pleural cavity thōr-ă-kos´kŏ-pē using a thoracoscope thoracostomy creation of an opening in the chest usually for thōr-ă-kos´tō-mē insertion of a tube (see Fig. 9.16) thoracotomy incision into the chest thōr-ă-kot´ō-mē tonsillectomy excision of the palatine tonsils ton´si-lek´tō-mē tonsillectomy and adenoidectomy excision of the tonsils and adenoids (T & A) ad´ĕ-noy-dek´tō-mē tracheostomy creation of an opening in the trachea, most trā´kē-os´tō-mē often to insert a tube (Fig. 9.17) tracheotomy incision into the trachea (see Fig. 9.17) trā´kē-ot´ō-mē Thoracentesis Thoracostomy Surgical puncture with a needle Surgical puncture into the into the pleural space for pleural space and insertion of drainage of the pleural cavity thoracostomy tube for drainage of the pleural cavity Pleural effusion Figure 9.16 Common treatments of pleural effusion. 286 Medical Terminology: The Language of Health Care Tracheotomy Tracheostomy Incision of the trachea for exploration, Incision of the trachea and insertion Sagittal view, with tracheostomy for removal of a foreign body, or for of a tube to facilitate passage of air tube in place obtaining a biopsy specimen or removal of secretions Incision Placement of tracheostomy tube Tracheostomy tube Figure 9.17 Operative procedures related to the trachea. Therapeutic Terms Term Meaning cardiopulmonary resuscitation (CPR) method of artificial respiration and closed- kar´dē-ō-pŭl´mo-nār-ē rē-sŭs´i-tā´ shŭn chest massage used to restore breathing and cardiac output after cardiac arrest continuous positive airway pressure device that pumps a constant pressurized (CPAP) flow of air through the nasal passages, commonly used during sleep to prevent airway closure in sleep apnea (Fig. 9.18) endotracheal intubation passage of a tube into the trachea via the en´dō-trā´kē-ăl in-tū-bā´ shŭn nose or mouth to open the airway for delivering gas mixtures to the lungs (e.g., oxygen, anesthetics, or air) incentive spirometry common postoperative breathing therapy in-sen´tiv spı̄-rom´ĕ-trē using a specially designed spirometer to encourage the patient to inhale and repeatedly sustain an inspiratory volume to exercise the lungs and prevent pulmonary complications (Fig. 9.19) mechanical ventilation mechanical method performed by a mĕ-kan´i-kăl ven-ti-lā´ shŭn respiratory therapist to provide assisted breathing using a ventilator (Fig. 9.20) Figure 9.18 Patient wearing a CPAP mask. Figure 9.19 Incentive spirometer. Neonate Pediatric Adult Figure 9.20 Mechanical ventilation. 288 Medical Terminology: The Language of Health Care Term Meaning COMMON THERAPEUTIC DRUG CLASSIFICATIONS antibiotic drug that kills or inhibits the growth of microorganisms an´tē-b ı̄-ot´ik anticoagulant drug that dissolves, or prevents the formation of, thrombi an´tē-kō-ag´yū-lant or emboli in the blood vessels (e.g., heparin) antihistamine drug that neutralizes or inhibits the effects of histamine an-tē-his´tă-mēn histamine compound in the body that is released by injured cells in his´tă-mēn allergic reactions, inflammation, etc., causing constriction of bronchial smooth muscle, dilation of blood vessels, etc. bronchodilator drug that dilates the muscular walls of the bronchi brong-kō-dı̄-lā´ ter expectorant drug that breaks up mucus and promotes coughing ek-spek´tō-rănt Summary of Chapter 9 Acronyms/Abbreviations ABGs .............arterial blood gases PaO2 ..............partial pressure of oxygen Bx ....................biopsy PE ...................pulmonary embolism COPD............chronic obstructive pulmonary disease PEFR ............peak expiratory flow rate CPAP.............continuous positive airway pressure PF ....................peak flow CPR................cardiopulmonary resuscitation PFT ................pulmonary function testing CT....................computed tomography pH ...................potential of hydrogen CXR ...............chest x-ray PSG ................polysomnography HIV ................human immunodeficiency virus T & A ............tonsillectomy and adenoidectomy LTB ................laryngotracheobronchitis TB ...................tuberculosis MRI................magnetic resonance image TV or VT.....tidal volume O2 ....................oxygen URI.................upper respiratory infection PaCO2 ..........partial pressure of carbon dioxide VC ...................vital capacity Chapter 9 • Respiratory System 289 PRACTICE EXERCISES For the following terms, on the lines below the term, write out the indicated word parts: prefixes (P), combining forms (CF), roots (R), and suffixes (S). Then define the word. EXAMPLE intranasal ______/ ____________/ __________ P R S intra/nas/al P R S DEFINITION: within/nose/pertaining to 1. pulmonology __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 2. thoracocentesis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 3. nasosinusitis __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 4. hypoxemia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 5. pleuritis __________________ / __________________ R S DEFINITION: _________________________________________________________________ 6. hypercarbia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 290 Medical Terminology: The Language of Health Care 7. alveolar __________________ / __________________ R S DEFINITION: _________________________________________________________________ 8. tracheotomy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 9. oronasal __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 10. rhinorrhea __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 11. thoracostomy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 12. tonsillectomy __________________ / __________________ R S DEFINITION: _________________________________________________________________ 13. tracheobronchitis __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 14. bronchospasm __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 15. laryngostenosis __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 16. spirogram __________________ / __________________ CF S DEFINITION: _________________________________________________________________ Chapter 9 • Respiratory System 291 17. lobectomy __________________ / __________________ R S DEFINITION: _________________________________________________________________ 18. peripleural __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 19. stethoscope __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 20. pneumonic __________________ / __________________ R S DEFINITION: _________________________________________________________________ 21. nasopharyngoscopy __________________ / __________________ / __________________ CF CF S DEFINITION: _________________________________________________________________ 22. bronchiolectasis __________________ / __________________ R S DEFINITION: _________________________________________________________________ 23. phrenoptosis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 24. pectoral __________________ / __________________ R S DEFINITION: _________________________________________________________________ 25. uvulopalatopharyngoplasty __________________ /__________________ / __________________ / __________________ CF CF CF S DEFINITION: _________________________________________________________________ Complete the medical term by writing the missing part: 26. ______________coni______________ lung condition caused by prolonged dust inhalation 292 Medical Terminology: The Language of Health Care 27. bronchi______________ dilation of bronchus 28. ______________plasty surgical repair of the chest 29. ______________itis inflammation of the lung 30. ______________metry process of measuring breathing 31. ______________ventilation deficient movement of air in and out of the lungs 32. ______________pnea normal breathing 33. ______________pnea slow breathing 34. ______________pnea difficulty breathing 35. ______________pnea inability to breathe except in an upright position 36. ______________pnea inability to breathe 37. ______________pnea fast breathing For each of the following, circle the meaning that corresponds to the combining form given: 38. nose ren/o rhin/o nos/o 39. air or lung aden/o pneum/o thorac/o 40. throat thorac/o laryng/o pharyng/o 41. chest thorac/o pneum/o lapar/o 42. voice box laryng/o trache/o pharyng/o 43. breathing aer/o spir/o crin/o 44. diaphragm phren/o pleur/o pneumon/o 45. mouth ox/o or/o spir/o Write the correct medical term for each of the following: 46. air in the pleural space _______________________________________________________ 47. pus in the pleural space _______________________________________________________ 48. blood in the pleural space _______________________________________________________ 49. listening to sounds within the body _______________________________________________________ Chapter 9 • Respiratory System 293 50. endoscope used to examine the airways _______________________________________________________ 51. coughing up and spitting out material from the lungs _______________________________________________________ 52. inflammation of the pleura _______________________________________________________ 53. to elicit sounds or vibrations by tapping _______________________________________________________ 54. puncture for aspiration of the chest _______________________________________________________ 55. hoarseness _______________________________________________________ 56. inflammation of the voice box _______________________________________________________ 57. deficient amount of oxygen in tissue cells _______________________________________________________ 58. disease characterized by overexpansion of the alveoli with air _______________________________________________________ 59. nosebleed _______________________________________________________ 60. cancer originating in the bronchus _______________________________________________________ 61. inherited condition of exocrine gland malfunction that causes mucus to obstruct the airways _______________________________________________________ 62. collapse of lung tissue _______________________________________________________ 63. material expelled from the lungs by coughing _______________________________________________________ 64. high-pitched crowing sound that is a sign of obstruction in the upper airway _______________________________________________________ 65. blood clot in the lungs _______________________________________________________ 66. surgical creation of an opening in the trachea _______________________________________________________ 67. disease characterized by paroxysmal wheezing, dyspnea, and cough _______________________________________________________ 68. excessive movement of air in and out of the lungs _______________________________________________________ 294 Medical Terminology: The Language of Health Care 69. common lung infection seen in those with positive HIV _______________________________________________________ 70. disorder that is a combination of emphysema and chronic bronchitis _______________________________________________________ Write the full medical term for the following abbreviations: 71. PEFR ______________________________________________________________ 72. VC _________________________________________________________________ 73. TB _________________________________________________________________ 74. CPR ________________________________________________________________ 75. COPD ______________________________________________________________ 76. PaCO2 ______________________________________________________________ 77. URI _______________________________________________________________ 78. VT ________________________________________________________________ 79. PFT _______________________________________________________________ 80. PSG _______________________________________________________________ 81. CPAP ______________________________________________________________ Match the following: 82. ________ crackles a. naso 83. ________ wheezes b. hyperventilation 84. ________ pleurisy c. LTB 85. ________ pneumoconiosis d. thoraco 86. ________ empyema e. CPAP 87. ________ hemothorax f. asbestosis 88. ________ stetho g. pleuritis 89. ________ sleep apnea h. rhonchi 90. ________ hypocapnia i. pyothorax 91. ________ rhino j. hypoventilation 92. ________ hypercapnia k. rales 93. ________ croup l. thoracentesis Chapter 9 • Respiratory System 295 Write the standard abbreviations for the following: 94. chest x-ray ____________________ 95. analysis of blood to determine the adequacy of lung function in exchange of gases ______________________ 96. surgical removal of the tonsils and adenoids ______________________________ Write in the missing words on the blank lines in the following illustration of the respiratory tract. 97–104. Sinuses 102. Frontal Frontal sinus Sphenoid sinus Nasal cavity Ethmoidal 97. Naso air cells Oral cavity Oropharynx Tonsils Nose Sphenoidal Laryngopharynx sinus Epiglottis Maxillary Esophagus sinus 98. Tongue 103. with vocal cords Rib Lung Lung 99. Pleural cavity 104. Left main Right main bronchus 100. Upper of right lung Upper lobe Middle lobe of left lung Lower lobe Bronchioles Mediastinum Lower lobe 101. 296 Medical Terminology: The Language of Health Care For each of the following, circle the correct spelling of the term: 105. auskucation auscultation ascultation 106. tackypnea tachypenia tachypnea 107. eupnea eupenia eupneia 108. plurisy plurisey pleurisy 109. hemathorax hemothorax hematothorex 110. stethoscope stethescope stethascope 111. epitaxes epistaxes epistaxis 112. ronchi rhonchi rhonkhi 113. hemoptysis hemaptysis hemoptsis 114. rhinorhea rhinorrhea rinorhea 115. imphasema emphysema emphasema 116. atelectasis atalexisis attelexis 117. bronkodielater bronchodialator bronchodilator Give the noun that was used to form the following adjectives: 118. orthopneic ______________________________________________________________ 119. pleural __________________________________________________________________ 120. hypoxic _________________________________________________________________ 121. dyspneic ________________________________________________________________ 122. pharyngeal ______________________________________________________________ 123. apneic __________________________________________________________________ 124. tracheal _________________________________________________________________ 125. asthmatic _______________________________________________________________ Chapter |
9 • Respiratory System 297 MEDICAL RECORD ANALYSES M E D I C A L R E C O R D 9 . 1 S: This is a 26 y.o. c/o a nonproductive cough, dyspnea, and fever 2 d; pt does not smoke and has otherwise been in good health. O: T 101ºF, BP 100/64, R 25, 104 Tachypnea is accompanied by mild cyanosis, and inspiratory crackles are noted upon auscultation. WBC 31,000, Hct 37%, platelet count 109,000. CXR shows diffuse infiltrates at the bases of both lungs. An ABG taken while the patient was breathing room air showed a pH of 7.54, PaCo2, of 20, PaO2 of 74, sputum specimen contains 3 WBC but no bacteria. A: Pneumonia of unknown etiology P: IV erythromycin STAT admit to ICU deliver O2 by face mask and monitor for hypoxemia 1. What is the patient’s chief complaint? b. inflammation of the bronchi a. afebrile with a dry cough and difficulty breathing c. inflammation of the pleura b. febrile with a dry cough and difficulty breathing d. inflammation of the lungs due to sensitivity to c. cannot breathe, fever, and coughing up dust or chemicals material from the lungs e. inflammation of the lungs of unknown cause d. hoarse throat, dry cough, and fever e. febrile, coughing up sputum, and breathing fast 5. What is an ABG? a. analysis of blood to determine the adequacy of 2. What are the findings upon PE? lung function in the exchange of gases a. slow breathing, blue skin, and rhonchi heard in b. meausurement of lung volume and capacity the lungs as the patient exhales c. measure of the flow of air during inspiration b. fast breathing, blue skin, and musical sounds d. scan to detect breathing abnormalities heard in the lungs as the patient inhales e. image of the lungs used to visualize lung c. slow breathing, blue skin, and rales heard in lesions the lungs as the patient holds her breath d. fast heart, blue skin, and rales heard in the 6. Describe the condition for which the patient was lungs as the patient inhales monitored while undergoing oxygen therapy: e. fast breathing, blue skin, and popping sounds a. blockage of airflow out of the lungs heard in the lungs as the patient inhales b. excessive movement of air in and out of the lungs 3. What did the chest x-ray show? c. deficient amount of oxygen in the blood a. tuberculosis d. deficient amount of oxygen in the tissue cells b. asthma e. excessive level of carbon dioxide in the blood c. density representing solid material usually indicating inflammation 7. What is the Sig: on the erythromycin? d. fluid filling of spaces around the lungs a. not mentioned e. lung cancer b. inject into a vein immediately 4. What is the impression? c. take four immediately a. dilation of the bronchi with an accumulation of d. insert into the vagina immediately mucus e. inject into a muscle immediately 298 Medical Terminology: The Language of Health Care M E D I C A L R E C O R D 9 . 2 Angelica Torrance, a retired painter who for years has boasted to friends that she has the good health of a 30-year-old, suffered a broken ankle when she slipped off a foot- stool in her basement. The surgical repair of her fracture at Central Medical Center was routine, but soon after surgery Ms. Torrance developed other problems, and a pul- monologist was eventually called in for a consultation. Directions Read Medical Record 9.2 for Ms. Torrance (pages 300–302) and answer the following questions. This record is the history and physical examination report from Dr. Carl Brownley, the pulmonologist who consulted with Ms. Torrance’s doctors after she de- veloped breathing problems. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 9 . 2 Write your answers in the spaces provided. 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record and define below: morphine _________________________________________________________________ heparin ___________________________________________________________________ obese ____________________________________________________________________ 2. In your own words, not using medical terminology, describe what surgery Ms. Torrance had for her broken ankle: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 3. Describe in your own words the four symptoms that Ms. Torrance developed postsurgically: a. _____________________________________________________________________ b. _____________________________________________________________________ c. _____________________________________________________________________ d. _____________________________________________________________________ 4. Before Ms. Torrance’s acute “sense of suffocating,” she was being treated with what three pharmacological treatments? a. _____________________________________________________________________ b. _____________________________________________________________________ c. _____________________________________________________________________ 5. Immediately after her reported “sense of suffocating,” she was given what two treatments? a. _____________________________________________________________________ b. _____________________________________________________________________ Chapter 9 • Respiratory System 299 6. Put the following events that occurred in the hospital in correct order by numbering them 1 to 8: _____ postoperative pulmonary symptoms _____ transport to intensive care _____ sense of suffocation _____ episode of tachycardia _____ nuclear lung scan showing high probability of embolus _____ evaluation for complications in the lungs _____ open reduction, internal fixation _____ intravenous drugs first administered 7. In your own words, not using medical terminology, describe the two diagnostic imaging studies performed the morning of 10/24: a. _____________________________________________________________________ b. _____________________________________________________________________ 8. Name and describe the test that was performed to monitor Ms. Torrance’s heparin therapy: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 9. Translate into lay language Dr. Brownley’s first four assessments from the examination: a. _____________________________________________________________________ b. _____________________________________________________________________ c. _____________________________________________________________________ d. _____________________________________________________________________ 10. Dr. Brownley’s recommendations include requests for certain tests to be run (or run again) and certain other actions to be taken while Ms. Torrance stays in the hospital. Without using abbreviations, list the tests to be performed and the actions to be taken: Tests: a. _____________________________________________________________________ b. _____________________________________________________________________ c. _____________________________________________________________________ d. _____________________________________________________________________ e. _____________________________________________________________________ f. _____________________________________________________________________ Actions: g. _____________________________________________________________________ h. _____________________________________________________________________ 300 Medical Terminology: The Language of Health Care Medical Record 9.2 Chapter 9 • Respiratory System 301 Medical Record 9.2 Continued. 302 Medical Terminology: The Language of Health Care Medical Record 9.2 Continued. Chapter 9 • Respiratory System 303 M E D I C A L R E C O R D 9 . 3 Richard Puma, a heavy smoker until recently, had been treated for pneumonia in the last month. Even though his condition had deteriorated in the last few days, he refused to be hospitalized. Today, May 18, having much trouble breathing, he came to Central Medical Center and was seen by Dr. Theresa Cunningham. Directions Read Medical Record 9.3 for Richard Puma (pages 306–309) and answer the following questions. This record includes the history, physical examination, and discharge sum- mary dictated by Dr. Cunningham and transcribed the next day. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 9 . 3 Write your answers in the spaces provided. 1. Below are medical terms used in these records you have not yet encountered in this text. Underline each where it appears in the record and define below: hepatosplenomegaly ________________________________________________________ precordial ________________________________________________________________ fulminant _________________________________________________________________ respiratory acidosis _________________________________________________________ cardiac arrest _____________________________________________________________ 2. In your own words, not using medical terminology, describe Mr. Puma’s chief complaint to Dr. Cunningham: _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 3. Following are various elements from the history of Mr. Puma’s present illness. Put them in correct chronological order by numbering them 1 to 7, starting with the event that occurred first: ___ productive cough with some show of blood ___ seen at the Bradford Emergiclinic ___ progressively worsening with marked SOB ___ diagnosis of pneumonia ___ refusal to be hospitalized ___ administration of Cipro began ___ administration of Cipro started a second time 304 Medical Terminology: The Language of Health Care 4. In your own words, not using medical terminology, describe how Mr. Puma looked in general at the time of examination: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 5. Although examination of the abdomen produced no negative findings, Dr. Cun- ningham’s auscultation of the lungs and heart was more significant. In your own words, what were her findings? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 6. Dr. Cunningham concluded her examination with a diagnosis and treatment plan. Although the cause of Mr. Puma’s condition is unclear, the diagnosis state- ment itself is definite. Describe it in your own words: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 7. In the history and physical examination, Dr. Cunningham’s treatment plan called for what immediate action? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 8. As noted in the discharge summary, Dr. Anderson was next to see Mr. Puma. In your own words, describe Dr. Anderson’s specialty: ________________________________________________________________________ 9. What diagnostic test was first to be performed on admission to the CCU? ________________________________________________________________________ 10. During the CCU examination, what happened to Mr. Puma? ________________________________________________________________________ How did Dr. Anderson respond? ________________________________________________________________________ Chapter 9 • Respiratory System 305 11. Put Dr. Cunningham’s final three diagnoses in your own words (do not include history or treatment information): a. _____________________________________________________________________ b. _____________________________________________________________________ c. _____________________________________________________________________ 306 Medical Terminology: The Language of Health Care The patient is a 62-year-old white male with a history of pneumonia diagnosed four weeks ago. He appeared to have a favorable response to a two-week course of Cipro; however, after being off the medication for two days, symptoms including hemoptysis and yellow sputum returned. He was restarted on half a dose of the antibiotic for five more days with some improvement. This was finished 11/2 weeks ago. Over the past 10 days, he has become progressively worse with a marked increase in shortness of breath and orthopnea. Two days ago, he was seen at the Bradford Emergiclinic because of the progressive nature of his shortness of breath. At that time, hospitalization was recommended, but the patient refused. 20xx Medical Record 9.3 Chapter 9 • Respiratory System 307 Medical Record 9.3 Continued. 308 Medical Terminology: The Language of Health Care Medical Record 9.3 Continued. Chapter 9 • Respiratory System 309 Medical Record 9.3 Continued. Chapter 10 Nervous System OBJECTIVES After completion of this chapter you will be able to Define common term components used in relation to the nervous system and psychiatry Describe the basic functions of the nervous system Define the basic anatomical terms referring to the nervous system Define common symptomatic and diagnostic terms related to the nervous system Define common diagnostic terms related to the nervous system List common diagnostic tests and procedures related to the nervous system Define common operative terms related to the nervous system Define common therapeutic terms including drug classifications related to the nervous system Define common symptomatic terms related to psychiatry Define common diagnostic terms related to psychiatry Define common therapeutic terms related to psychiatry Explain common terms and abbreviations used in documenting medical records involving the nervous system or field of psychiatry Combining Forms Combining Form Meaning Example arthr/o articulation dysarthria cerebell/o cerebellum (little brain) cerebellar ser-e-belar cerebr/o cerebrum (largest part of brain) cerebrospinal serĕ-brō-spı̄-năl crani/o skull cranium krānē-ŭm encephal/o entire brain encephalography en-sef-ă-logră-fĕ esthesi/o sensation hyperesthesia hı̄per-es-thēzē-ă gangli/o ganglion (knot) ganglioneuroma gangglē-ō-nū-rōmă 310 Chapter 10 • Nervous System 311 Combining Form Meaning Example gli/o glue glial glı̄ăl gnos/o knowing gnosia nōsēă hypn/o sleep hypnosis hip-nōsis somn/i somnipathy som-nipă-thē somn/o polysomnography polē-som-nogră-fē kinesi/o movement kinesiology ki-nē-sē-olō-jē lex/o word or phrase dyslexia dis-leksē-ă mening/o meninges (membrane) meningocele mĕ-ninggō-sēl meningi/o meningitis men-in-jı̄tis myel/o spinal cord or bone marrow myeloma mı̄-ĕ-lōmă narc/o stupor, sleep narcotic nar-kotik neur/o nerve neuralgia nū-raljē-ă phas/o speech dysphasia dis-fāzē-ă phob/o exaggerated fear or sensitivity phobia fōbē-ă phor/o carry or bear euphoria yu-fōrē-ă phren/o mind schizophrenia skiz-ō-frēnē-ă psych/o psychotic sı̄-kotik thym/o dysthymia dis-thı̄mē-ă schiz/o split schizoid skizoyd somat/o body psychosomatic sı̄kō-sō-matik spin/o spine (thorn) spinal spı̄năl spondyl/o vertebra spondylosyndesis spondi-lō-sin-dēsis vertebr/o vertebral verte-brăl 312 Medical Terminology: The Language of Health Care Combining Form Meaning Example stere/o three dimensional or solid stereotaxic sterē-ō-taksik tax/o order or coordination ataxic ă-taksik thalam/o thalamus (a room) thalamotomy thal-ă-motō-mē ton/o tone or tension tonic tonik top/o place topesthesia topes-thē-zē-ă ventricul/o ventricle (belly or pouch) ventriculostomy ven-trik-yū-lostō-mē ADDITIONAL PREFIX cata- down catatonic kat-ă-tonik ADDITIONAL SUFFIXES -asthenia weakness neurasthenia nūr-as-thēnē-ă -lepsy seizure narcolepsy narkō-lep-sē -mania condition of abnormal necromania impulse toward nek-rō-mānē-ă -paresis slight paralysis hemiparesis hemē-pa-rēsis -plegia paralysis paraplegia par-ă-plējē-ă Nervous System Overview The nervous system is an intricate communication network of structures that activates and controls |
all functions of the body and receives all input from the environment. There are two major classes of cells that make up the nervous system: the neuron, the basic structure, and the neuroglia, the supporting cells (Fig. 10.1). Each neuron is made up of a soma (the body of the neuron), dendrites (the afferent branches of the soma), and an axon (the efferent branch of the soma), which are linked via terminals called synapses. At the synapse, chemicals known as neurotransmitters are released to effect changes that inhibit or excite cells. They function within the vast complex of impulse-carrying fibers called nerves. A ganglion is a collection of somas in the peripheral nervous system, and a nucleus is a collection of somas in the central nervous system. Four types of neuroglia perform essential functions in the nervous system: ependy- mal cells make the cerebrospinal fluid that circulates in and around the brain and spinal cord. The star-shaped astrocytes have the responsibility of passing nutrients from blood to neurons. Myelin, the lipid that surrounds nerve fibers and helps to con- duct neuronal impulses, is produced by the oligodendroglia. The small, branching microglia perform phagocytosis. The nervous system has three divisions: (a) central nervous system, (b) peripheral nervous system, and (c) autonomic nervous system. Chapter 10 • Nervous System 313 NEURON Soma Myelin sheath Dendrites Axon Synaptic terminals GLIAL CELLS Ependymal cells Oligodendrocytes Astrocytes Microglial cells (line brain ventricles) (wrap axons: myelination) (support capillaries) (engulf invading microorganisms and dead tissues) Axons Neurons (nerve fibers) Capillaries Figure 10.1 Basic components of the nervous system. Anatomical Terms Term Meaning central nervous system (CNS) brain and spinal cord brain portion of the central nervous system contained within the cranium cerebrum largest portion of the brain; it is divided into sĕr-ēbrum right and left halves known as cerebral hemispheres that are connected by a bridge of nerve fibers called the corpus callosum; lobes of the cerebrum are named after the skull bones they underlie (Fig. 10.2) frontal lobe anterior section of each cerebral hemisphere frŭntăl lōb responsible for voluntary muscle movement and personality parietal lobe portion posterior to the frontal lobe, responsible pă-rı̄ĕ-tăl lōb for sensations such as pain, temperature, and touch 314 Medical Terminology: The Language of Health Care A B Central sulcus Parietal lobe Motor area Somatosensory Speech area, Frontal lobe Expression Taste Body awareness Occipital Olfactory bulbs lobe Vision Temporal lobe Cerebellum Auditory Medulla oblongata Spinal cord Speech reception Figure 10.2 A. Lobes of the brain. B. Localized functions of the cerebrum. Term Meaning temporal lobe portion that lies below the frontal lobe, responsible tempŏ-răl lōb for hearing, taste, and smell occipital lobe portion posterior to the parietal and temporal ok-sipi-tăl lōb lobes, responsible for vision cerebral cortex outer layer of the cerebrum consisting of gray serĕ-brăl kōrteks matter, responsible for higher mental functions (cortex bark) thalamus (diencephalon) two gray matter nuclei deep within the brain, thală-mŭs dı̄-en-sefă-lon responsible for relaying sensory information to the cortex gyri ring or circle; convolutions (mounds) of the jı̄rı̄ cerebral hemispheres sulci ditch; shallow grooves that separate gyri sŭlsı̄ fissures splitting crack; deep grooves in the brain fishŭrz cerebellum portion of the brain located below the occipital ser-ĕ-belŭm lobes of the cerebrum, responsible for control and coordination of skeletal muscles (Fig. 10.3) brainstem region of the brain that serves as a relay between brānstem the cerebrum, cerebellum, and spinal cord, responsible for breathing, heart rate, and body temperature; there are three levels: mesencephalon (midbrain), pons, and medulla oblongata ventricles series of interconnected cavities within the ventri-klz cerebral hemispheres and brainstem filled with cerebrospinal fluid (Fig. 10.4) Chapter 10 • Nervous System 315 THE BRAIN Corpus callosum Meninges Thalamus Pineal body Frontal sinus Hypothalamus Pituitary gland Sphenoid sinus Pons Medulla oblongata Cerebellum Spinal cord Midsagittal view of brain Cranium Venous sinus Dura mater Meninges Arachnoid Pia mater Subdural space Subarachnoid space Cerebrum Magnetic resonance imaging (MRI) of normal brain, midsagittal view Figure 10.3 Midsagittal view of the brain. 316 Medical Terminology: The Language of Health Care Lateral ventricles B Posterior horns of lateral ventricles A Magnetic resonance image, horizontal view A Interventricular foramen Third ventricle Inferior horn of lateral ventricle Cerebral aqueduct Fourth ventricle Magnetic resonance image, coronal view B Figure 10.4 Ventricles of the brain. Term Meaning cerebrospinal fluid (CSF) plasma-like clear fluid circulating in and around serĕ-brō-spı̄-năl flūid the brain and spinal cord spinal cord column of nervous tissue from the brainstem spı̄năl kōrd through the vertebrae, responsible for nerve conduction to and from the brain and the body meninges three membranes that cover the brain and mĕ-ninjēz spinal cord, consisting of the dura mater, pia mater, and arachnoid peripheral nervous system nerves that branch from the central nervous (PNS) system, including nerves of the brain (cranial nerves) and spinal cord (spinal nerves) (Fig. 10.5) cranial nerves 12 pairs of nerves arising from the brain krānē-ăl nervz Chapter 10 • Nervous System 317 THE PERIPHERAL NERVOUS SYSTEM Dorsal primary ramus Cervical Ventral primary ramus nerves Musculocutaneous nerve Median nerve Thoracic Radial nerve nerves Filum terminale Ulnar nerve Cauda Lumbar equina Deep branch of nerves radial nerve Sacral nerves Superficial branch of radial nerve Coccygeal nerve Femoral nerve Obturator nerve Saphenous nerve Sciatic nerve Common peroneal Common peroneal nerve nerve Tibial nerve Superficial peroneal nerve Superficial peroneal nerve Deep peroneal Deep peroneal nerve nerve Medial plantar Lateral plantar nerve nerve Anterior view Posterior view Figure 10.5 Peripheral nervous system. Term Meaning spinal nerves 31 pairs of nerves arising from the spinal cord sensory nerves nerves that conduct impulses from body parts sensŏ-rē nervz and carry sensory information to the brain—also called afferent nerves (ad toward; ferre carry) motor nerves nerves that conduct motor impulses from the brain to muscles and glands; also called efferent nerves (e out; ferre carry) 318 Medical Terminology: The Language of Health Care Term Meaning autonomic nervous system nerves that carry involuntary impulses to smooth (ANS) muscle, cardiac muscle, and various glands hypothalamus control center for the autonomic nervous system hı̄pō-thală-mŭs located below the thalamus (diencephalon) sympathetic nervous division of the ANS concerned primarily with system preparing the body in stressful or emergency sim-pă-thetik situations parasympathetic nervous division of the ANS that is most active in ordinary system conditions; it counterbalances the effects of the par-ă-sim-pă-thetik sympathetic system by restoring the body to a restful state after a stressful experience Symptomatic and Diagnostic Terms Term Meaning SYMPTOMATIC aphasia condition without speech; impairment due to ă-fāzē-ă localized brain injury that affects understanding, retrieving, and formulating meaningful and sequential elements of language dysarthria condition of difficult articulation; group of related dis-arthrē-ă speech impairments that may affect the speed, range, direction, strength, and timing of motor movement as a result of paralysis, weakness, or incoordination of speech muscles (arthr/o articulation) dysphasia difficulty speaking dis-fāzē-ă COMA. Coma is derived from a coma general term referring to levels of decreased Greek word kō mă consciousness with varying responsiveness; a meaning a deep sleep, a common method of assessment is the Glasgow coma state of unconsciousness scale (Fig. 10.6) from which one cannot be roused. In Greek mythology, delirium state of mental confusion due to disturbances in Comus was the guardian of dē-lirē-ŭm cerebral function—there are many causes, including banquets who indulged in fever, shock, or drug overdose (deliro to draw the nightly orgies that resulted in furrow awry in plowing, i.e., to go off the rails) a state of profound insensibility caused by a dementia impairment of intellectual function characterized by drunken stupor. The dē-menshē-ă memory loss, disorientation, and confusion ingestion of a toxin such as (dementio to be mad) alcohol is only one of many causes of coma. The words motor deficit loss or impairment of muscle function comic and comical share mō ter defi-sit the same origin with coma. sensory deficit loss or impairment of sensation sensŏ -rē defi-sit Chapter 10 • Nervous System 319 Glasgow Coma Scale A.M. P.M. A.M. Assessment Reaction Score 8 10 12 2 4 6 8 10 12 2 4 6 8 Eye Opening Spontaneously 4 X X X X X X Response To speech 3 X X To pain 2 X X X No response 1 Motor Response Obeys verbal command 6 X X X X X X Localizes pain 5 X X Flexion withdrawal 4 X X Flexion 3 X Extension 2 No response 1 Verbal Response Oriented x3 5 X X X X X X Conversation confused 4 X X Inappropriate speech 3 X Incomprehensible sounds 2 X X No response 1 Figure 10.6 Glasgow Coma Scale scoring for a child. A score of 3 to 8 denotes severe trauma; a score of 9 to 12 denotes moderate trauma; and a score of 13 to 15 denotes slight trauma. Notice the gradual improvement from coma in this example. Term Meaning neuralgia pain along the course of a nerve nū-raljē-ă paralysis temporary or permanent loss of motor control flaccid paralysis defective (flabby) or absent muscle control caused by flassid pă-rali-sis a nerve lesion spastic paralysis stiff and awkward muscle control caused by a central spastik pă-rali-sis nervous system disorder hemiparesis partial paralysis of the right or left half of the body hem-ē-pa-rēsis sciatica pain that follows the pathway of the sciatic nerve sı̄-ati-kă caused by compression or trauma of the nerve or its roots seizure sudden, transient disturbances in brain function sēzher resulting from abnormal firing of nerve impulses (may or may not be associated with convulsion) convulsion to pull together; type of seizure that causes a series of kon-vŭlshŭn sudden, involuntary contractions of muscles syncope fainting sinkŏ -pē tactile stimulation evoking a response by touching taktil 320 Medical Terminology: The Language of Health Care Term Meaning hyperesthesia increased sensitivity to stimulation such as touch or hı̄per-es-thēzē-ă pain paresthesia abnormal sensation of numbness and tingling par-es-thēzē-ă without objective cause DIAGNOSTIC agnosia any of many types of loss of neurological function ag-nōsē-ă associated with interpretation of sensory information astereognosis inability to judge the form of an object by touch ă-stērē-og-nōsis (e.g., a coin from a key) atopognosis inability to locate a sensation properly, such as to ă-top-og-nōsis locate a point touched on the body Alzheimer disease disease of structural changes in the brain resulting in an irreversible deterioration that progresses from forgetfulness and disorientation to loss of all intellectual functions, total disability, and death (see Fig. 10.19) amyotrophic lateral a condition of progressive deterioration of sclerosis (ALS) motor nerve cells resulting in total loss of voluntary ā-mı̄-ō-trōfik muscle control; symptoms advance from muscle weakness in the arms, legs, muscles of speech, swallowing, and breathing to total paralysis and death—also known as Lou Gehrig disease cerebral palsy (CP) condition of motor dysfunction caused by damage to serĕ-brăl pawlzē the cerebrum during development or injury at birth, characterized by partial paralysis and lack of muscle coordination (palsy paralysis) cerebrovascular disease disorder resulting from a change within one or more blood vessels of the brain cerebral arteriosclerosis hardening of the arteries of the brain ar-tērē-ō-skler-ōsis cerebral atherosclerosis condition of lipid (fat) buildup within the blood ather-ō-skler-ōsis vessels of the brain (ather/o fatty [lipid] paste) cerebral aneurysm dilation of a blood vessel in the brain anyū-rizm (aneurysm dilation or widening) cerebral thrombosis presence of a stationary clot in a blood vessel of throm-bōsis the brain cerebral embolism obstruction of a blood vessel in the brain by an embō-lizm embolus transported through the circulation cerebrovascular damage to the brain caused by cerebrovascular accident (CVA) disease (e.g., occlusion of a blood vessel by an stroke embolus or thrombus or intracranial hemorrhage after rupture of an aneurysm) (Fig. 10.7) transient ischemic brief episode of loss of blood flow to the brain attack (TIA) usually caused by a partial occlusion that results in tranzē-ĕnt is-kēmik temporary neurological deficit (impairment)—often precedes a CVA (Fig. 10.8) Chapter 10 • Nervous System 321 Cerebral thrombosis Cerebral embolism Intracranial hemorrhage (thrombotic stroke) (embolic stroke) (hemorrhagic stroke) Thrombus Moving embolus gradually builds, creates damage blocking artery where it lodges Rupture or bleed of an artery Figure 10.7 Cerebrovascular accident. Frontal view Circle of Willis view from underneath the brain Anterior communicating artery Circle Anterior Middle of Willis cerebral artery cerebral artery Basilar artery Internal External carotid artery carotid Posterior artery communicating Posterior Internal artery cerebral artery carotid artery Carotid Superior |
Basilar artery sinus cerebellar artery Vertebral artery Common carotid artery Innominate Subclavian artery Aorta Figure 10.8 Sites of transient ischemic attack: carotid and vertebrobasilar circulation. 322 Medical Terminology: The Language of Health Care Term Meaning CAROTID. carotid TIA ischemia of the anterior circulation of the brain Carotid stems ka-rotid from the Greek word meaning to stupefy or vertebrobasilar TIA ischemia of the posterior circulation of the brain throttle. The ancients used vertĕ-brō-basi-lăr the term to describe the encephalitis inflammation of the brain arteries in the neck because they believed that when they en-sef-ă-lı̄tis were pressed hard, one epilepsy disorder affecting the central nervous system became sleepy. epi-lepsē characterized by recurrent seizures EPILEPSY. tonic-clonic stiffening-jerking; a major motor seizure involving all Epilepsy comes tonik-klonik muscle groups—previously termed grand mal (big from a Greek bad) seizure word for seizure. Aristotle absence seizure involving a brief loss of consciousness used the word to mean a absens without motor involvement—previously termed petit convulsive seizure, a condition that came to be mal (little bad) seizure called epilepsy. It was partial seizure involving only limited areas of the brain with regarded in ancient times as localized symptoms an infliction from the gods, hence the Roman term, glioma tumor of glial cells graded by degree of malignancy morbus sacer (sacred glı̄-ōmă disease). Many other terms were applied to epilepsy, herniated disk protrusion of a degenerated or fragmented such as “disease of hernē-ā-ted intervertebral disk so that the nucleus pulposus Hercules” because sufferers protrudes, causing compression on the nerve root seemed to have superhuman (Fig. 10.9) strength. herpes zoster viral disease affecting the peripheral nerves, herpēz zoster characterized by painful blisters that spread over the skin following the affected nerves, usually unilaterally—also known as shingles (Fig. 10.10) Huntington disease (HD) hereditary disease of the central nervous system Huntington chorea characterized by bizarre involuntary body kōr-ēă movements and progressive dementia (choros dance) Herniated disk Spinal Herniated disk cord presses on spinal Vertebra nerve, causing pain Spinal nerve Disk Disk Vertebra Superior view of vertebra Sagittal view of spine Figure 10.9 Herniated disk. Chapter 10 • Nervous System 323 Herpes affecting spine Figure 10.10 Herpes zoster: typical eruption site. Term Meaning hydrocephalus abnormal accumulation of cerebrospinal fluid in the hı̄-drō-sefă-lŭs ventricles of the brain as a result of developmental hydrocephaly anomalies, infection, injury, or tumor (Fig. 10.11; also see Fig. 10.13) meningioma benign tumor of the coverings of the brain mĕ-ninjē-ōmă (meninges) meningitis inflammation of the meninges men-in-jı̄tis migraine headache paroxysmal attacks of mostly unilateral headache mı̄grān often accompanied by disordered vision, nausea, and/or vomiting, lasting hours or days and caused by dilation of arteries multiple sclerosis (MS) disease of the central nervous system characterized sklĕ-rōsis by the demyelination (deterioration of the myelin sheath) of nerve fibers, with episodes of neurological dysfunction (exacerbation) followed by recovery (remission) (Fig. 10.12) myasthenia gravis autoimmune disorder that affects the neuromuscular mı̄-as-thēnē-ă gravăs junction, causing a progressive decrease in muscle strength with activity and a return of strength after a period of rest myelitis inflammation of the spinal cord mı̄-ĕ-lı̄tis 324 Medical Terminology: The Language of Health Care Figure 10.11 Sonogram of fetus with Figure 10.12 Magnetic resonance image of the brain. hydrocephalus. Arrows, plaque formation in a patient with multiple sclerosis. Term Meaning narcolepsy sleep disorder characterized by a sudden, narkō-lep-sē uncontrollable need to sleep, attacks of paralysis (cataplexy), and dreams intruding while awake (hypnagogic hallucinations) Parkinson disease condition of slowly progressive degeneration of an area of the brainstem (substantia nigra) resulting in a decrease of dopamine (a chemical neurotransmitter that is necessary for proper movement); characterized by tremor, rigidity of muscles, and slow movements (bradykinesia), usually occurring later in life plegia paralysis plējē-ă hemiplegia paralysis on one side of the body hem-ē-plējē-ă paraplegia paralysis from the waist down par-ă-plējē-ă quadriplegia paralysis of all four limbs kwahdri-plējē-ă poliomyelitis inflammation of the gray matter of the spinal cord polē-ō-miĕ-lı̄tis caused by a virus, often resulting in spinal and muscle deformity and paralysis (polio gray) Chapter 10 • Nervous System 325 Figure 10.13 Spina bifida with myelomeningo- cele. The infant also has hydrocephaly. Term Meaning polyneuritis inflammation involving two or more nerves, often polē-nū-rı̄tis owing to a nutritional deficiency such as lack of thiamine reflex sympathetic condition of abnormal function of the sympathetic dystrophy (RSD) nervous system in response to pain perception, rēfleks sim-pă-thetik usually as the result of an injury to an extremity; distrō-fē symptoms include persistent burning pain, tissue edema, joint tenderness, changes in skin color and temperature, and abnormal sweating at the pain site—decreased mobility caused by pain can lead to muscle atrophy and loss of motor function sleep apnea periods of breathing cessation that occur during apnē-ă sleep, often causing snoring spina bifida congenital defect in the spinal column characterized spı̄nă bifă-dă by the absence of vertebral arches, often resulting in pouching of spinal membranes or tissue (Fig. 10.13) Diagnostic Tests and Procedures Test or Procedure Explanation electrodiagnostic procedures ē-lektrō-dı̄-ag-nōstik electroencephalogram record of the minute electrical impulses of the brain (EEG) used to identify neurological conditions that affect ē-lektrō-en-sefă-lō-gram brain function and level of consciousness (Fig. 10.14) evoked potentials record of minute electrical potentials (waves) that ē-vokt pō-tenshăls are extracted from ongoing EEG activity to diagnose auditory, visual, and sensory pathway disorders—also used to monitor the neurological function of patients during surgery (Fig. 10.15) 326 Medical Terminology: The Language of Health Care Electroencephalography (EEG) FP1 FP2 FZ F4 F7 F8 F3 C3 C4 (T3)T7 CZ T8 (T4) A1 A2 P3 PZ P4 (T5)P7 P8 (T6) 01 02 Position of electrodes Normal EEG wave forms shown on left and computer compilation of frequency bands (delta, theta, alpha, and beta) mapped on right Figure 10.14 Electroencephalography. SOMNUS. Somnus is a Test or Procedure Explanation Latin word for nerve conduction electrical shock of peripheral nerves to record time sleep that was derived from velocity (NCV) of conduction; used to diagnose various peripheral ancient mythology. Somnus nerv kon-dŭkshŭn nervous system diseases was the poetical god of sleep, the son of Nox polysomnography (PSG) recording of various aspects of sleep (e.g., eye and (night), who lived with his polē-som-nogră-fē muscle movements, respiration, EEG patterns) to brother Thanatos (death) in diagnose sleep disorders (Fig. 10.16) a palace at the western end of the world. Figure 10.15 Use of evoked potentials to monitor neurological function during surgery. Chapter 10 • Nervous System 327 Figure 10.16 Polysomnography. Figure 10.17 Magnetic resonance imaging unit. Test or Procedure Explanation lumbar puncture (LP) introduction of a specialized needle into the spine lŭmbar pŭnkchūr in the lumbar region for diagnostic or therapeutic purpose, such as to obtain cerebrospinal fluid for testing; also called spinal tap magnetic resonance nonionizing imaging technique using magnetic imaging (MRI) fields and radiofrequency waves to visualize mag-netic rezō-nans anatomical structures (especially soft tissue), such imă-jing as the tissues of the brain and spinal cord (Fig. 10.17; also see Figs. 10.3, 10.4, and 10.12) magnetic resonance use of magnetic resonance in imaging of the blood angiography (MRA) vessels—useful in detecting pathological conditions mag-netic rezō-nans such as atherosclerosis and thrombosis an-jē-ogră-fē intracranial MRA magnetic resonance image of the head to visualize intră-krānē-ăl the vessels of the circle of Willis (common site of cerebral aneurysm, stenosis, or occlusion) (Fig. 10.18A) extracranial MRA magnetic resonance image of the neck to visualize ekstră-krānē-ăl the carotid artery (Fig. 10.18B) nuclear medicine imaging radionuclide organ imaging SPECT brain scan scan combining nuclear medicine and computed (single photon emission tomography technology to produce images of the computed tomography) brain after administration of radioactive isotopes 328 Medical Terminology: The Language of Health Care A B Figure 10.18 A. Contrast-enhanced intracranial magnetic resonance angiography showing circulation of the circle of Willis. B. Contrast-enhanced extracranial magnetic resonance angiography showing carotid circulation. Test or Procedure Explanation positron emission technique combining nuclear medicine and tomography (PET) computed tomography technology to produce pozi-tron ē-mishŭn images of brain anatomy and corresponding tō-mogră-fē physiology—used to study stroke, Alzheimer disease, epilepsy, metabolic brain disorders, chemistry of nerve transmissions in the brain, etc.; it provides greater accuracy than SPECT but is used less often because of cost and limited availability of the radioisotopes (Fig. 10.19) Warm colors (red and yellow) indicate a higher rate of metabolism and brain activity in the normal brain when compared with the brain of the Alzheimer’s patient Area of scan PET scan of healthy brain PET scan of Alzheimer brain Figure 10.19 Positron emission tomography (PET) scans. Chapter 10 • Nervous System 329 A B Figure 10.20 Reflex testing. A. Normal plantar reflex. B. Babinski sign. Test or Procedure Explanation radiography x-ray imaging rādē-ogră-fē cerebral angiogram x-ray of blood vessels in the brain after intracarotid serĕ-brăl anjē-ō-gram injection of contrast medium computed tomography computed tomographic x-ray images of the head (of the head) used to visualize abnormalities within (e.g., brain tumors, malformations) myelogram x-ray of the spinal cord made after intraspinal injection of contrast medium reflex testing test performed to observe the body’s response to a stimulus (Fig. 10.20A) deep tendon involuntary muscle contraction after percussion at a reflexes (DTR) tendon (e.g., patella, Achilles) indicating function; positive findings are noted when there is either no reflex response or an exaggerated response to stimulus; numbers are often used to record responses: no response 1 diminished response 2 normal response 3 more brisk than average response 4 hyperactive response Babinski sign or reflex pathological response to stimulation of the plantar surface of the foot; a positive sign is indicated when the toes dorsiflex (curl upward) (Fig. 10.20B) transcranial sonogram image made by sending ultrasound beams through trans-krānē-ăl the skull to assess blood flow in intracranial vessels—used in diagnosis and management of stroke and head trauma (Fig. 10.21) 330 Medical Terminology: The Language of Health Care Figure 10.21 Transcranial sonography procedure. Operative Terms Term Meaning craniectomy excision of part of the skull to approach the brain krānē-ektō-mē craniotomy incision into the skull to approach the brain krā-nē-otō-mē diskectomy (discectomy) removal of a herniated disk often done dis-ektō-mē percutaneously (Fig. 10.22) laminectomy excision of one or more laminae of the vertebrae to lami-nektō-mē approach the spinal cord vertebral lamina flattened posterior portion of the vertebral arch (see Chapter 6, Figure 6.4) Vertebral disk Vertebral disk nucleus Spinal endoscope Disk herniation pushing on spinal nerve root Vertebra Spinal cord Spinal nerve Figure 10.22 Diskectomy (discectomy). Chapter 10 • Nervous System 331 A B Intervertebral disk Removal of disk (fusion of vertebrae) Spinal cord Figure 10.24 Spondylosyndesis. A. Spinal column. B. Spinal fusion. Figure 10.23 Microscope designed for neurological surgery. Term Meaning microsurgery utilization of a microscope to dissect minute mı̄-krō-serjer-ē structures during surgery (Fig. 10.23) neuroendovascular surgery diagnosis and treatment of disorders within nūrō-en-do-vaskyu-lăr cerebral blood vessels performed in a specialized serjer-ē angiographic laboratory by interventional neuroradiologists; common procedures include: • cerebral angioplasty and stent to restore blood flow through narrowed vessels such as the carotid artery, middle cerebral, and vertebrobasilar arteries • embolization (plugging) of intracranial aneurysms and other malformations neuroplasty surgical repair of a nerve nūrō-plas-tē spondylosyndesis spinal fusion (Fig. 10.24) spondi-lō-sin-dēsis 332 Medical Terminology: The Language of Health Care Therapeutic Terms Term Meaning chemotherapy treatment of malignancies, infections, and other kemō-thāră-pē diseases with chemical agents that destroy selected cells or impair their ability to reproduce radiation therapy treatment of neoplastic disease using ionizing rādē-āshŭn thāră-pē radiation to impede proliferation of malignant cells (Fig. 10.25) stereotactic (stereotaxic) radiation treatment to inactivate malignant lesions radiosurgery involving the focus of multiple, precise external sterē-ō-taktik radiation beams on a target with the aid of a (sterē-ō-taksik) stereotactic frame and imaging such as CT, MRI, or rādē-ō-serjer-ē angiography; used to treat inoperable brain tumors and other lesions stereotactic (stereotaxic) mechanical device used to localize a point in space frame targeting a precise site (Fig. 10.26) thrombolytic therapy dissolution of thrombi using drugs [e.g., tissue throm-bō-litik plasminogen activator (tPA)] used to treat acute ischemic stroke COMMON THERAPEUTIC DRUG CLASSIFICATIONS analgesic agent that relieves pain an-ăl-jēzik anticoagulant drug that prevents clotting of the blood; commonly antē-kō-agyū-lant used to prevent heart attack and ischemic stroke Figure 10.26 Stereotactic frame. Figure 10.25 Radiation therapy: linear accelerator. Chapter 10 • Nervous System 333 Term Meaning anticonvulsant agent that prevents or lessens convulsion antē-kon-vŭlsant hypnotic agent that induces sleep hip-notik sedative agent that has a calming effect sedă-tiv Psychiatric Terms Term Meaning SYMPTOMATIC TERMS affect emotional feeling or mood affekt flat |
affect significantly dulled emotional tone or outward reaction apathy lack of interest or display of emotion apă-thē catatonia state of unresponsiveness to one’s outside kat-ă-tōnē-ă environment, usually including muscle rigidity, staring, and inability to communicate delusion persistent belief that has no basis in reality dē-loozhŭn grandiose delusion person’s false belief that he or she possesses great wealth, intelligence, or power persecutory delusion person’s false belief that someone is plotting against him or her with intent to harm dysphoria restless, dissatisfied mood dis-fōrē-ă euphoria exaggerated, unfounded feeling of well-being yu-fōrē-ă hallucination false perception of the senses for which there is no ha-loosi-nāshŭn reality, most commonly hearing or seeing things (alucinor to wander in mind) ideation formation of thoughts or ideas [e.g., suicidal ı̄ -dē-āshŭn ideation (thoughts of suicide)] mania state of abnormal elation and increased activity mānē-ă neurosis psychological condition in which anxiety is noo-rōsis prominent psychosis mental condition characterized by distortion of sı̄-kōsis reality, resulting in the inability to communicate or function within one’s environment thought disorder thought that lacks clear processing or logical direction 334 Medical Terminology: The Language of Health Care Psychiatric Diagnostic Terms Term Meaning MOOD DISORDERS major depression disorder causing periodic disturbances in mood that major depressive illness affect concentration, sleep, activity, appetite, and clinical depression social behavior; characterized by feelings of major affective disorder worthlessness, fatigue, and loss of interest unipolar disorder dysthymia milder affective disorder characterized by a chronic dis-thı̄mē-ă depression persisting for at least 2 years manic depression affective disorder characterized by mood swings of bipolar disorder (BD) mania and depression (extreme up and down states) seasonal affective disorder affective disorder marked by episodes of depression (SAD) that most often occur during the fall and winter and remit in the spring ANXIETY DISORDERS generalized anxiety most common anxiety disorder, characterized by disorder (GAD) chronic, excessive, and uncontrollable worry about everyday problems that affects the ability to relax or concentrate but does not usually interfere with social interactions or employment; physical symptoms include muscle tension, trembling, twitching, fatigue, headaches, nausea, and insomnia—symptoms must exist for at least 6 months before a diagnosis can be made panic disorder (PD) disorder of sudden, recurrent attacks of intense feelings including physical symptoms that mimic a heart attack such as rapid heart rate, chest pain, shortness of breath, chills, sweating, and dizziness, with a general sense of loss of control or feeling that death is imminent; often progresses to agoraphobia Chapter 10 • Nervous System 335 Term Meaning phobia exaggerated fear of a specific object or fōbē-ă circumstance that causes anxiety and panic; named for the object or circumstance, such as agoraphobia (marketplace), claustrophobia (confinement), or acrophobia (high places) posttraumatic stress condition resulting from an extremely traumatic disorder (PTSD) experience, injury, or illness that leaves the sufferer with persistent thoughts and memories of the ordeal; may occur after a war, violent personal assault, physical or sexual abuse, serious accident, natural disaster, etc.; symptoms include feelings of fear, detachment, exaggerated startle response, restlessness, nightmares, and avoidance of anything or anyone who triggers the painful recollections obsessive-compulsive anxiety disorder featuring unwanted, senseless disorder (OCD) obsessions accompanied by repeated compulsions, which can interfere with all aspects of a person’s daily life (e.g., the thought that a door is not locked, with repetitive checking to make sure that it is locked; thoughts that one’s body has been contaminated, with repetitive washing) hypochondriasis preoccupation with thoughts of disease and concern hı̄pō-kon-drı̄ă-sis that one is suffering from a serious condition that persists despite medical reassurance to the contrary DISORDERS USUALLY DIAGNOSED IN CHILDHOOD autism developmental disability commonly appearing awtizm during the first 3 years of life, resulting from a neurological disorder affecting brain function, evidenced by difficulties with verbal and nonverbal communication, and an inability to relate to anything beyond oneself (auto self) in social interactions; individuals with autism often exhibit body movements such as rocking, repetitive hand movements, and commonly become preoccupied with observing parts of small objects or moving parts or performing meaningless rituals dyslexia developmental disability characterized by a dis-leksē-ă difficulty understanding written or spoken words, sentences, or paragraphs, affecting reading, spelling, and self-expression attention-deficit/ dysfunction characterized by consistent hyperactivity disorder hyperactivity, distractibility, and lack of control (ADHD) over impulses, which interferes with the ability to function normally at school, home, or work; specific criteria must be met before a diagnosis is made mental retardation condition of subaverage intelligence characterized by an IQ of 70 or below, resulting in the inability to adapt to normal social activities 336 Medical Terminology: The Language of Health Care Term Meaning EATING DISORDERS anorexia nervosa severe disturbance in eating behavior caused by an-ō-reksē-ă nervōs-ă abnormal perceptions about one’s body weight, evidenced by an overwhelming fear of becoming fat that results in a refusal to eat and body weight well below normal bulimia nervosa eating disorder characterized by binge eating boo-limē-ă followed by efforts to limit digestion through induced vomiting, use of laxatives, or excessive exercise SUBSTANCE ABUSE DISORDERS substance abuse disorders mental disorders resulting from abuse of substances such as drugs, alcohol, or other toxins causing personal and social dysfunction; identified by the abused substance, such as alcohol abuse, amphetamine abuse, opioid (narcotic) abuse, or polysubstance abuse PSYCHOTIC DISORDERS schizophrenia disease of brain chemistry causing a distorted skizō-frēnē-ă cognitive and emotional perception of one’s environment characterized by a broad range of “positive” and “negative” symptoms positive symptoms include distortions of normal function (behaviors that are absent in normal people, e.g., disorganized thought, delusions, hallucinations, catatonic behavior) negative symptoms (normal reactions missing in persons with schizophrenia) including flat affect, apathy, and withdrawal from reality types: disorganized featuring disorganized speech, behavior, and flat or inappropriate affect catatonic featuring catatonia paranoid featuring delusions, most often persecutory or pară-noyd grandiose types schizoaffective disorder concurrent with major depression or manic skizō-ă-fektiv depression Psychiatric Therapeutic Terms Term Meaning electroconvulsive electrical shock applied to the brain to induce therapy (ECT) convulsions; used to treat severely depressed ē-lektrō-kon-vŭlsiv patients light therapy use of specialized illuminating light boxes and visors to treat seasonal affective disorder Chapter 10 • Nervous System 337 Term Meaning psychotherapy treatment of psychiatric disorders using verbal and sı̄kō-thāră-pē nonverbal interaction with patients, individually or in a group, employing specific actions and techniques behavioral therapy treatment to decrease or stop unwanted behavior bē-hāvver-ăl thāră-pē cognitive therapy treatment to change unwanted patterns of thinking kogni-tiv COMMON THERAPEUTIC DRUG CLASSIFICATIONS psychotropic drugs medications used to treat mental illnesses sı̄kō-trōpik (trop/o a turning) antianxiety agents drugs used to reduce anxiety antē-ang-zı̄ĕ-tē anxiolytic agents angzē-ō-litik antidepressant agent that counteracts depression antē-dē-presănt neuroleptic agents drugs used to treat psychosis, especially noor-ō-leptik schizophrenia Summary of Chapter 10 Acronyms/Abbreviations ADHD ......attention-deficit/hyperactivity disorder MRI ...........magnetic resonance imaging ALS ............amyotrophic lateral sclerosis MS ..............multiple sclerosis ANS ...........autonomic nervous system NCV...........nerve conduction velocity BD ..............bipolar disorder OCD...........obsessive-compulsive disorder CNS ...........central nervous system PD...............panic disorder CP ...............cerebral palsy PET............positron emission tomography CSF ............cerebrospinal fluid PNS ...........peripheral nervous system CVA ...........cerebrovascular accident PSG............polysomnography DTR...........deep tendon reflexes PTSD ........posttraumatic stress disorder ECT ...........electroconvulsive therapy RSD ...........reflex sympathetic dystrophy EEG...........electroencephalogram SAD ...........seasonal affective disorder GAD...........generalized anxiety disorder SPECT .....single photon emission computed HD..............Huntington disease tomography LP ...............lumbar puncture TIA .............transient ischemic attack MRA..........magnetic resonance angiography 338 Medical Terminology: The Language of Health Care PRACTICE EXERCISES For the following terms, on the lines below the term, write out the indicated word parts: prefixes (P), combining forms (CF), roots (R), and suffixes (S). Then define the word. EXAMPLE anencephaly _______ / _______ / _______ P R S an/encephal/y P R S DEFINITION: without/entire brain/condition or process of 1. ganglioma __________________ / __________________ R S DEFINITION: _________________________________________________________________ 2. atopognosia __________________ / __________________ / __________________ / __________________ P CF R S DEFINITION: _________________________________________________________________ 3. catatonic __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 4. dystaxia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 5. bradykinesia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 6. meningocele __________________ / __________________ CF S DEFINITION: _________________________________________________________________ Chapter 10 • Nervous System 339 7. dysthymia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 8. polysomnogram __________________ / __________________ / __________________ P CF S DEFINITION: _________________________________________________________________ 9. spondylosyndesis __________________ / __________________ / __________________ CF P S DEFINITION: _________________________________________________________________ 10. hemiplegia __________________ / __________________ P S DEFINITION: _________________________________________________________________ 11. craniotomy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 12. thalamic __________________ / __________________ R S DEFINITION: _________________________________________________________________ 13. neuroglial __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 14. dyslexia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 15. somnipathy __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 16. hydrocephalic __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 340 Medical Terminology: The Language of Health Care 17. dysarthria __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 18. acrophobia __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 19. hypnotic __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 20. euphoria __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 21. parasomnia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 22. narcolepsy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 23. stereotaxy __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 24. hemiparesis __________________ / __________________ P S DEFINITION: _________________________________________________________________ 25. neurasthenia __________________ / __________________ R S DEFINITION: _________________________________________________________________ 26. myelopathy __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ Chapter 10 • Nervous System 341 27. intracranial __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 28. aphasia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 29. schizophrenia __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 30. cerebrospinal __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ Complete the medical term by writing the missing part: 31. electro___________________ gram record of electrical brain impulses 32. ___________________ syndesis spinal fusion 33. crani_____________ excision of part of the skull 34. cerebral _______________ sclerosis fat buildup in blood vessels of the brain 35. hyper______________________ increased sensations 36. dys_________________ condition of difficulty speaking 37. __________ algesia loss of sense of pain 38. a_________________ gnosis inability to judge the form of an object by touch (e.g., to tell a coin from a key) For each of the following, circle the combining form that corresponds to the meaning given: 39. brain encephal/o crani/o neur/o 40. movement esthesi/o kinesi/o somat/o 41. speech lex/o gnos/o phor/o 42. body somn/o somat/o phren/o 43. spinal cord vertebr/o spondyl/o myel/o 342 Medical Terminology: The Language of Health Care 44. mind cerebr/o thym/o thalm/o 45. sensation esthesi/o neur/o kinesi/o 46. place top/o tax/o phor/o 47. sleep somat/o hypn/o esthesi/o 48. knowing phren/o phas/o gnos/o Write the correct medical term for each of the following: 49. inflammation of the meninges _______________________________________________ 50. excision of a herniated disk__________________________________________________ 51. slowly progressive degeneration of nerves in the brain characterized by tremor, rigidity of muscles, and slow movements _____________________________________ 52. pathological response to stimulation of the plantar surface of the foot indicated by dorsiflexion of the toes ___________________________________________________ 53. numbness and tingling ______________________________________________________ 54. state of unconsciousness ____________________________________________________ 55. congenital defect of the spinal column resulting in pouching of spinal membranes _______________________________________________________________ Match the following neurological terms with their abbreviations: 56. ________ amyotrophic lateral sclerosis a. PSG 57. ________ herpes zoster b. tonic-clonic 58. ________ spinal tap c. CVA 59. ________ faint d. Alzheimer disease 60. ________ grand mal e. Lou Gehrig disease 61. ________ petit mal f. flaccid 62. ________ cerebral thrombus g. absence 63. ________ flabby h. clot 64. ________ stroke i. LP 65. ________ dementia j. shingles 66. ________ sleep study k. syncope Chapter 10 • Nervous System 343 Write the full medical term for the following abbreviations: 67. CT ________________________________________________________________________ 68. MRI _______________________________________________________________________ 69. PET _______________________________________________________________________ 70. MS ________________________________________________________________________ 71. CNS _______________________________________________________________________ 72. CP ________________________________________________________________________ 73. TIA________________________________________________________________________ 74. EEG_______________________________________________________________________ 75. DTR _______________________________________________________________________ 76. CSF _______________________________________________________________________ 77. MRA ______________________________________________________________________ 78. CVA _______________________________________________________________________ 344 Medical Terminology: The Language of Health Care Write in the missing words on the blank lines in the following illustration of brain anatomy. 79–86. 82. Corpus Meninges 83. Pineal body Frontal sinus Hypothalamus Pituitary gland Sphenoid sinus 79. Medulla oblongata 80. 81. cord Midsagittal view of brain 84. Venous sinus Dura mater 85. Arachnoid Pia mater Subdural space Subarachnoid space 86. Chapter 10 • Nervous System 345 Match |
the following psychiatric terms with their meanings: 87. ________ hallucination a. exaggerated, unfounded feeling of well-being 88. ________ persecutory delusion b. dull emotional tone or outward reaction 89. ________ catatonia c. false belief that one is very wealthy, intelligent, or powerful 90. ________ apathy d. false belief that one is being plotted against 91. ________ euphoria e. state of abnormal elation and increased activity 92. ________ mania f. lack of interest or display of emotion 93. ________ flat affect g. thoughts that lack clear process or logical direction 94. ________ dysphoria h. state of unresponsiveness in- cluding muscle rigidity, staring, and inability to communicate 95. ________ thought disorder i. restless, dissatisfied mood 96. ________ grandiose delusion j. hearing or seeing things Write the full medical term for the following abbreviations: 97. GAD______________________________________________________________________ 98. ADHD ____________________________________________________________________ 99. OCD _____________________________________________________________________ 100. ECT ______________________________________________________________________ 101. PD _______________________________________________________________________ 102. BD _______________________________________________________________________ 103. PTSD_____________________________________________________________________ Match the following psychiatric diagnoses: 104. ________ unipolar disorder a. hypochondriasis 105. ________ anxiety disorder b. anorexia nervosa 106. ________ bipolar disorder c. clinical depression 107. ________ psychosis d. dysthymia 108. ________ disorder identified in childhood e. schizophrenia 109. ________ eating disorder f. manic depression 110. ________ mild depression g. autism 346 Medical Terminology: The Language of Health Care Match the following psychiatric conditions with therapeutic terms: 111. ________ anxiety a. behavioral therapy 112. ________ schizophrenia b. light therapy 113. ________ seasonal affective disorder c. anxiolytic agent 114. ________ major affective disorder d. electroconvulsive therapy 115. ________ bulimia e. neuroleptic agent For each of the following, circle the correct spelling of the term: 116. Alsheimer Alzheimer Alshiemer 117. skitzoprenia skizophrenia schizophrenia 118. polysomnography polysonography polysolemography 119. parenoia paranoia paranoyea 120. atopagnosis atopegnosis atopognosis 121. demensha dementia dimentia 122. epilapsey epilepsey epilepsy 123. catonia catatonia catetonia 124. delushion dilusion delusion 125. hellucination hallucination hallucinashun 126. poliomyalitis poliomyelitis poleiomyalitis Give the noun that was used to form the following adjectives: 127. epileptic __________________________________________________________________ 128. euphoric__________________________________________________________________ 129. delusional ________________________________________________________________ 130. syncopal__________________________________________________________________ 131. autistic ___________________________________________________________________ 132. psychotic _________________________________________________________________ 133. cerebral __________________________________________________________________ 134. dysphasic _________________________________________________________________ 135. paranoid__________________________________________________________________ Chapter 10 • Nervous System 347 MEDICAL RECORD ANALYSES M E D I C A L R E C O R D 1 0 . 1 Progress Note OP H&P Neurological Services CC: numbness and tingling in feet and hands HPI: This 44 y.o. right-handed female c/o numbness in her feet for the past two weeks with “pockets” of numbness in the abdomen. Her legs feel heavy and numb. Her hands started tingling a week ago and she is feeling very nervous. She has had similar episodes over the past 3 years, lasting about a week at a time, often after stressful events, or during hot weather. PMH: Operations: none. No serious illnesses/accidents FH: Father, age 71, L&W; Mother, age 66, is bipolar; Her only sibling, a sister, age 28, has cerebral palsy. SH: Denies smoking or use of street drugs, but drinks socially OH: certified public accountant. Marital Status: single ROS: noncontributory. VS: T 98.2° F., P 82, R 16, BP 110/68, Ht 52, Wt 138# PE: HEENT: WNL. Neck: negative. Heart/Lungs: normal. Cranial nerves intact. Reflexes: DTR’s are increased, greater on the left than the right without spasticity. Toes upgoing bilaterally. There is numbness to tactile pin stimulation over both extremities. She has no finger-to-nose ataxia. Her gait is steady. A: R/O MS P: Schedule MRI of the brain with and without gaolinium (contrast) RTO for re- port and further evaluation 1 wk 1. Which medical term best describes the patient’s 3. Describe the sister’s condition: symptoms: a. disorder affecting the central nervous system a. hyperesthesia characterized by seizures b. paresthesia b. hereditary disease of the central nervous c. ataxia system characterized by bizarre involuntary body movements and progressive dementia d. hemiparesis c. abnormal accumulation of cerebrospinal fluid e. neuralgia in the ventricles of the brain as a result of developmental abnormality 2. What is noted in the history about the patient’s mother? d. condition of motor dysfunction caused by dam- age to the cerebrum during development or a. she is alive and well injury at birth b. she suffers from depression e. slowly progressive degeneration of nerves in the c. she has mood swings of mania and depression brain characterized by tremor, rigidity, and d. she suffers from generalized anxiety slow movements e. she is a hypochondriac 348 Medical Terminology: The Language of Health Care 4. Which medical term describes the positive finding 6. Describe the test noted in the plan: of the “toes upgoing” bilaterally? a. x-ray a. Babinski sign b. nuclear image b. neuralgia c. ultrasound scan c. hemiparesis d. tomographic radiograph d. spastic paralysis e. scan produced by magnetic fields and radiofre- e. flaccid paralysis quency waves 5. What is the doctor’s impression? a. the patient has multiple sclerosis b. the patient does not have multiple sclerosis c. the patient may have multiple sclerosis d. the patient may have hardening of the arteries in the brain e. the patient does not have hardening of the arteries in the brain Chapter 10 • Nervous System 349 M E D I C A L R E C O R D 1 0 . 2 Mary Clarke came into the living room where her father, Bob Clarke, had been watch- ing television and found him slumped back in his chair, apparently asleep. When she could not wake him, she realized he was unconscious and called 911. The ambulance rushed him to the Central Medical Center emergency room, where he was seen by Dr. Gregory Kincaid. Directions Read Medical Record 10.2 for Mr. Clarke (pages 351–353) and answer the following questions. This record is the history and physical examination report dictated by Dr. Kincaid after his examination and initial treatment of Mr. Clarke. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 1 0 . 2 Write your answers in the spaces provided. 1. Below are medical terms used in this record you have not encountered in this text so far. Underline each where it appears in the record and define below: abrasion ____________________________________________________________________ foci of atrophy_______________________________________________________________ ambulate____________________________________________________________________ cataract _____________________________________________________________________ 2. In your own words, not using medical terminology, briefly describe Mr. Clarke’s condition from the time he was found at home: ____________________________________________________________________________ Describe his condition after he arrived at the ER: ____________________________________________________________________________ 3. Which of the following was not an emergency treatment provided for Mr. Clarke? a. administration of Valium b. assessment of respiratory rate c. CPR d. assistance with breathing 4. Define “postictal”: ____________________________________________________________ 5. Mr. Clarke has a past medical history of several different illnesses. On the follow- ing list, check all health problems Mr. Clarke has experienced: _____ skin bruising _____ heart attacks _____ excessive thyroid secretion 350 Medical Terminology: The Language of Health Care _____ COPD _____ skin scrapes _____ headaches _____ nausea and vomiting _____ atrial fibrillation _____ pulmonary embolus 6. From the list of medications Mr. Clarke is taking, one includes an abbreviation that has been deemed error prone. Identify the abbreviation, potential problem, and preferred wording. Abbreviation Potential Problem Preferred Wording ____________ _________________ _________________ 7. In your own words, describe the surgery Mr. Clarke had in the past: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 8. In lay language, what nervous system disorder did a family member experience? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 9. Dr. Kincaid’s diagnosis identifies three possible conditions that may have led to Mr. Clarke’s seizure. Put each in your own words: a.___________________________________________________________________________ b.___________________________________________________________________________ c.___________________________________________________________________________ 10. What three actions will now occur in the ICU? a.___________________________________________________________________________ b.___________________________________________________________________________ c.___________________________________________________________________________ Chapter 10 • Nervous System 351 Medical Record 10.2 352 Medical Terminology: The Language of Health Care Medical Record 10.2 Continued. Chapter 10 • Nervous System 353 Medical Record 10.2 Continued. 354 Medical Terminology: The Language of Health Care M E D I C A L R E C O R D 1 0 . 3 Anne Cross had been fairly healthy until she had a stroke about 2 months ago. She was treated by Dr. Paul Jiang, her personal physician, at that time and was discharged from the hospital on medication. At the request of Ms. Cross, Dr. Jiang called for a consul- tation from a neurologist, Dr. Melvin Classen. Directions Read Medical Record 10.3 for Ms. Cross (pages 356–357) and answer the following questions. This record is a consultation report written by Dr. Classen as a letter back to Ms. Cross’s physician, Dr. Jiang, after his consultation. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 1 0 . 3 Write your answers in the spaces provided. 1. Below are medical terms used in this record you have not yet encountered. Under- line each where it appears in the record and define below: homonymous hemianopsia ___________________________________________________ finger-nose test ______________________________________________________________ apraxia _____________________________________________________________________ clonus ______________________________________________________________________ 2. In your own words, not using medical terminology, briefly describe Ms. Cross’s symptoms in April before she was admitted to the hospital: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Write the missing parts in this table summarizing the diagnostic tests performed in April: Test Definition of Test Findings CT _________________________ ______________________ _________________ sound waves through heart ______________________ carotid ultrasound _________________________ ______________________ _________________ _________________________ slowed electrical pulses on right side 4. What family member had a problem perhaps similar to Ms. Cross’s? ____________________________________________________________________________ Chapter 10 • Nervous System 355 5. For each of the following medications given to Ms. Cross, translate the dosage instructions: Persantine __________________________________________________________________ aspirin ______________________________________________________________________ Proventil ____________________________________________________________________ Procardia ___________________________________________________________________ 6. Dr. Classen recommends two diagnostic studies. Describe both in your own words: a.___________________________________________________________________________ b.___________________________________________________________________________ In one sentence, describe Dr. Classen’s rationale for recommending the combina- tion of these two tests: ____________________________________________________________________________ ____________________________________________________________________________ 7. Name the preventive surgical procedure Dr. Classen suggests that may be appro- priate if changes are found in the carotid blood vessels: ____________________________________________________________________________ Describe that procedure in your own words: ____________________________________________________________________________ ____________________________________________________________________________ 356 Medical Terminology: The Language of Health Care Medical Record 10.3 Chapter 10 • Nervous System 357 Medical Record 10.3 Continued. Chapter 11 Endocrine System OBJECTIVES After completion of this chapter you will be able to Define common term components used in relation to the endocrine system Describe the basic functions of the endocrine system Define the basic anatomical terms referring to the endocrine system Define common symptomatic and diagnostic terms referring to the endocrine system List the common diagnostic tests and procedures related to the endocrine system Identify common operative terms referring to the endocrine system Identify common therapeutic terms including drug classifications related to the endocrine system Explain the terms and abbreviations used in documenting medical records involving the endocrine system Combining Forms Combining Form Meaning Example aden/o gland adenoma ad-ĕ-nōmă adren/o adrenal gland adrenotrophic ă-drē-nō-trōfik adrenal/o adrenalopathy ă-drē-nă-lopă-thē andr/o male androgenous an-drojĕ-nŭs crin/o to secrete endocrine endō-krin dips/o thirst polydipsia pol-ē-dipsē-ă gluc/o sugar glucogenic glū-kō-jenik glucos/o glucose glookōs glyc/o hyperglycemia hiper-glı̄ -sēmē-ă glycos/o glycosuria glı̄ -kō-sūrē-ă 358 Chapter 11 • Endocrine System 359 Combining Form Meaning Example THYMUS. Derived from the hormon/o hormone (an urging on) hormonal Greek word for hōr-mōnăl an offer or sacrifice, the thyme plant was burnt on ket/o ketone bodies ketogenic altars because of its sweet kē-tō-jenik smell. The term was applied keton/o ketonuria to the thymus gland because of its likeness to a bunch of kē-tō-nūrē-ă thyme. pancreat/o pancreas pancreatitis THYROID. pankrē-ă-tı̄ tis Thyroid is from a thym/o thymus gland thymoma Greek word thı̄ -mōmă referring to a large oblong shield carried by soldiers. It thyr/o thyroid gland (shield) thyrotoxic had a deep notch at the top thı̄ -rō-toksik for the chin. The thyroid gland and the thyroid thyroid/o thyroiditis cartilage in the neck were thı̄ -roy-dı̄tis named for this shield because of their similar appearance. Endocrine System Overview The endocrine system is a network of ductless glands and other structures that affect the function of targeted organs by the secreting hormones. Figure 11.1 shows the loca- tions of the endocrine glands. The hormones secreted by these glands and their func- tions are described under “Anatomical Terms” and in Figure 11.2. Anatomical Terms Gland or Hormone Location or Function adrenal glands located next to each kidney, the adrenal cortex ă-drēnăl secretes steroid hormones and the adrenal suprarenal |
glands medulla secretes epinephrine and norepinephrine sūpră-rēnăl steroid hormones regulate carbohydrate metabolism and salt and stēroyd water balance; some effect on sexual glucocorticoids characteristics glū-kō-kōrti-koydz mineral corticosteroids miner-ăl kōrti-kō-stēroydz androgens andrō-jenz epinephrine affect sympathetic nervous system in stress epi-nefrin response norepinephrine nōrep-i-nefrin ovaries located one on each side of the uterus in the ōvă-rēz female pelvis, functioning to secrete estrogen and progesterone 360 Medical Terminology: The Language of Health Care Pineal body (Hypothalamus–CNS controller of endocrine system) Pituitary gland Parathyroid glands Thyroid gland Thymus gland (Trachea) (Heart) (Lungs) Adrenal glands Islets of Langerhans of the pancreas Ovaries in (Kidneys) female (Uterus) (Labels in parentheses indicate Testes organs shown for orientation only. These are not endocrine system organs.) Figure 11.1 Endocrine system. Chapter 11 • Endocrine System 361 Endocrine gland Secretions Function * Anterior pituitary Thyroid-stimulating hormone (TSH) Stimulates secretion from thyroid gland (adenohypophysis) Adrenocorticotropic hormone (ACTH) Stimulates secretion from adrenal cortex Follicle-stimulating hormone (FSH) Initiates growth of ovarian follicle; stimulates secretion of estrogen in females and sperm production in males Luteinizing hormone (LH) Causes ovulation; stimulates secretion of progesterone by corpus luteum; causes secretion of testosterone in testes Melanocyte-stimulating hormone (MSH) Affects skin pigmentation Growth hormone (GH) Influences growth Prolactin (lactogenic hormone) Stimulates breast development and milk production during pregnancy * Posterior pituitary Antidiuretic hormone (ADH) Influences the absorption of water by (neurohypophysis) kidney tubules Oxytocin Influences uterine contraction Pineal body Melatonin Exact function unknown, affects onset of puberty Serotonin Serves as a precursor to melatonin Thyroid gland Triiodothyronine (T3), thyroxine (T4) Regulate metabolism Calcitonin Regulates calcium and phosphorus metabolism Parathyroid glands Parathyroid hormone (PTH) Regulates calcium and phosphorus metabolism Pancreas Insulin, glucagon Regulates carbohydrate/sugar metabolism (islets of Langerhans) Thymus gland Thymosin Regulates immune response Adrenal glands Steroid hormones: Regulate carbohydrate metabolism and salt (suprarenal glands) glucocorticoids, mineral corticosteroids, and water balance; some effect on sexual androgens characteristics Epinephrine, norepinephrine Affect sympathetic nervous system in stress response Ovaries Estrogen, progesterone Responsible for the development of female secondary sex characteristics and for the regulation of reproduction Testes Testosterone Affects masculinization and reproduction * Release of hormones in pituitary is controlled by hypothalamus Figure 11.2 Functions of the endocrine glands. 362 Medical Terminology: The Language of Health Care Gland or Hormone Location or Function estrogen responsible for the development of female estrō-jen secondary sex characteristics and the regulation progesterone of reproduction prō-jester-ōn pancreas located behind the stomach in front of the first (islets of Langerhans) and second lumbar vertebrae, functioning to pankrē-as secrete insulin and glucagon insulin regulate carbohydrate/sugar metabolism insŭ-lin glucagon glūkă-gon parathyroid glands located on the posterior aspect of the thyroid par-ă-thı̄ royd gland in the neck, functioning to secrete parathyroid hormone (PTH) parathyroid regulates calcium and phosphorus metabolism hormone (PTH) pineal gland located in the center of the brain, functioning to pinē-ăl secrete melatonin and serotonin melatonin exact function unknown; affects onset of puberty mel-ă-tōnin serotonin a neurotransmitter that serves as the precursor to melatonin pituitary gland located at the base of the brain, the anterior pi-tūi-tār-ē pituitary secretes thyroid-stimulating hormone, hypophysis adrenocorticotropic hormone, follicle-stimulating hı̄ -pofi-sis hormone, luteinizing hormone, melanocyte- stimulating hormone, growth hormone, and prolactin; the posterior pituitary releases antidiuretic hormone and oxytocin anterior pituitary (adenohypophysis) adĕ-nō-hı̄ -pofi-sis thyroid-stimulating stimulates secretion from thyroid gland hormone (TSH) adrenocorticotropic stimulates secretion from adrenal cortex hormone (ACTH) ă-drēnō-kōrti-kō-trōfik follicle-stimulating initiates growth of ovarian follicle; stimulates hormone (FSH) secretion of estrogen in females and sperm foli-kl production in males luteinizing hormone (LH) causes ovulation; stimulates secretion of lūtē-ı̄ -nı̄z-ing progesterone by corpus luteum; causes secretion of testosterone in testes Chapter 11 • Endocrine System 363 Gland or Hormone Location or Function melanocyte-stimulating affects skin pigmentation hormone (MSH) melă-nō-sı̄ t growth hormone (GH) influences growth prolactin stimulates breast development and milk (lactogenic hormone) production during pregnancy prō-laktin posterior pituitary (neurohypophysis) nūrō-hı̄ -pofi-sis antidiuretic influences the absorption of water by kidney hormone (ADH) tubules antē-dı̄ -yū-retik oxytocin influences uterine contraction ok-sē-tōsin testes located one on each side within the scrotum in testēz the male, functioning to secrete testosterone testosterone affects masculinization and reproduction tes-tostĕ-rōn thymus gland located in the mediastinal cavity anterior to and thı̄ mŭs above the heart, functioning to secrete thymosin thymosin regulates immune response thı̄ mō-sin thyroid gland located in front of the neck, functioning to secrete triiodothyronine (T3), thyroxine (T4), and calcitonin triiodothyronine (T3) known as the thyroid hormones; regulate trı̄ -ı̄ ō-dō-thı̄ rō-nēn metabolism thyroxine (T4) thı̄ -roksēn calcitonin regulates calcium and phosphorus metabolism kal-si-tōnin Symptomatic and Diagnostic Terms Term Meaning SYMPTOMATIC exophthalmos protrusion of one or both eyeballs, often because ek-sof-thalmos of thyroid dysfunction or a tumor behind the exophthalmus eyeball (see Fig. 11.6B) 364 Medical Terminology: The Language of Health Care Term Meaning glucosuria glucose (sugar) in the urine glū-kō-sūrē-ă glycosuria glı̄ -kō-sūrē-ă hirsutism shaggy; an excessive growth of hair especially in hersū-tizm unusual places (e.g., a woman with a beard) hypercalcemia an abnormally high level of calcium in the blood hı̄ per-kal-sēmē-ă hypocalcemia an abnormally low level of calcium in the blood hipō-kal-sēmē-ă hyperglycemia high blood sugar hı̄ per-glı̄ -sēmē-ă hypoglycemia low blood sugar hı̄ pō-glı̄ -sēmē-ă hyperkalemia an abnormally high level of potassium in the blood hı̄ per-kă-lēmē-ă (kalium potassium) hypokalemia deficient level of potassium in the blood hı̄ pō-ka-lēmē-ă hypernatremia excessive level of sodium ions in the blood hı̄ per-nă-trēmē-ă (natro sodium) hyponatremia low level of sodium ions in the blood hı̄ pō-nă-trēmē-ă hypersecretion abnormally increased secretion hı̄ per-se-krēshŭn hyposecretion decreased secretion hı̄ pō-se-krēshŭn ketosis presence of an abnormal amount of ketone bodies kē-tōsis (acetone, beta-hydroxybutyric acid, and ketoacidosis acetoacetic acid) in the blood and urine indicating kē-tō-as-i-dōsis an abnormal utilization of carbohydrates as seen diabetic ketoacidosis (DKA) in uncontrolled diabetes and starvation (keto alter) metabolism all chemical processes in the body that result in mĕ-tabō-lizm growth, generation of energy, elimination of waste, and other body functions polydipsia excessive thirst pol-ē-dipsē-ă polyuria excessive urination pol-ē-yūrē-ă Chapter 11 • Endocrine System 365 Term Meaning DIAGNOSTIC Adrenal Glands Cushing syndrome collection of signs and symptoms caused by an excessive level of cortisol hormone from any cause, such as a result of excessive production by the adrenal gland (often caused by a tumor), or more commonly as a side effect of treatment with glucocorticoid (steroid) hormones such as prednisone for asthma, rheumatoid arthritis, lupus or other inflammatory diseases; symptoms include upper body obesity, facial puffiness (moon-shaped appearance), hyperglycemia, weakness, thin and easily bruised skin with stria (stretch marks), hypertension, and osteoporosis (Fig. 11.3) adrenal virilism excessive output of the adrenal secretion of ă-drēnăl viri-lizm androgen (male sex hormone) in adult women owing to tumor or hyperplasia; evidenced by amenorrhea (absence of menstruation), acne, hirsutism, and deepening of the voice (virilis masculine) Pancreas (pankrē-as) diabetes mellitus (DM) metabolic disorder caused by an abnormal di-ă-bētēz meli-tŭs utilization of insulin secreted by the pancreas; evidenced by hyperglycemia and glucosuria (diabetes passing through; mellitus sugar) insulin hormone secreted by the beta cells of the islets of insŭ-lin Langerhans of the pancreas responsible for regulating the metabolism of glucose (insulin island) type 1 diabetes mellitus diabetes in which there is no beta cell production of insulin—the patient is dependent on insulin for survival Figure 11.3 Cushing syndrome. 366 Medical Terminology: The Language of Health Care Term Meaning type 2 diabetes mellitus diabetes in which the body produces insulin, but not enough, or there is insulin resistance (a defective use of the insulin that is produced)— the patient usually is not dependent on insulin for survival hyperinsulinism condition resulting from an excessive amount of hı̄ per-insū-lin-izm insulin in the blood that draws sugar out of the bloodstream, resulting in hypoglycemia, fainting, and convulsions; often caused by an overdose of insulin or by a tumor of the pancreas pancreatitis inflammation of the pancreas pankrē-ă-tı̄ tis Parathyroid Glands (par-ă-thı̄ royd) hyperparathyroidism hypersecretion of the parathyroid glands, usually hı̄ per-par-ă-thı̄ royd-izm caused by a tumor hypoparathyroidism hyposecretion of the parathyroid glands hipō-par-ă-thı̄ royd-izm Pituitary Gland considered the master gland because it secretes (Hypophysis) hormones that regulate the function of other glands, such as the thyroid gland, adrenal glands, ovaries, and testicles acromegaly disease characterized by enlarged features, ak-rō-megă-lē especially the face and hands, caused by hypersecretion of the pituitary hormone after puberty, when normal bone growth has stopped; most often caused by a pituitary tumor (Fig. 11.4) Figure 11.4 Enlarged hands and facial features in a pa- tient with acromegaly. Figure 11.5 Normal male (extreme right) and three types of dwarfism. (1) On the extreme left is a child who has failed to grow because of the congenital absence of the thyroid gland (cretinism). (2) The next two dwarfs have normal proportions but are half normal size (pituitary dwarfism). The next two dwarfs on the right show disproportionately short extremities but normal-size trunk and head (disproportionate dwarfism). Chapter 11 • Endocrine System 367 Term Meaning diabetes insipidus condition of abnormal increase in urine output di-ă-bētēz in-sipid-ŭs most commonly caused by inadequate secretion of pituitary antidiuretic hormone (vasopressin); symptoms include polyuria and polydipsia; urine appears colorless due to the inability of the kidneys to concentrate urine (insipid without taste) pituitary dwarfism condition of congenital hyposecretion of growth dwōrfizm hormone slowing growth and causing a short yet proportionate stature (not affecting intelligence)— often treated during childhood with growth hormone (Fig. 11.5) [note: there are many other forms of dwarfism, a condition of being markedly undersized; disproportionate types (short limb or short trunk) are most often caused by gene defects (see Fig. 11.5)] pituitary gigantism condition of hypersecretion of growth hormone jı̄ gan-tizm during childhood bone development that leads to an abnormal overgrowth of bone, especially of the long bones; most often caused by a pituitary tumor Thyroid Gland goiter enlargement of the thyroid gland caused by goyter thyroid dysfunction, tumor, lack of iodine in the diet, or inflammation (goiter throat) (Fig. 11.6A) hyperthyroidism condition of hypersecretion of the thyroid gland hı̄ -per-thı̄ royd-izm characterized by exophthalmia, tachycardia, goiter, and tumor (see Fig. 11.6 and Fig. 11.7A) Graves disease grāvz di-zēz thyrotoxicosis thı̄ rō-tok-si-kōsis Figure 11.6 Hyperthyroidism. A. Patient with goiter. B. Patient with exophthalmos. 368 Medical Terminology: The Language of Health Care A B Fine, silky hair with hair loss Perspiration Dry, brittle hair with hair loss Decreased perspiration Exophthalmos Edema of face and eyelids Bradycardia Diffuse toxic goiter Tachycardia Thick, heavy tongue with slow speech and coarse voice Weight gain Skin: warm, moist, velvety Weight loss Skin: pale, cold, dry, scaling, doughy feeling Increased appetite Amenorrhea Lethargic, poor memory, slow, expressionless Restless, nervous, insomnia, and irritable Fine tremor Brisk deep tendon reflexes Menorrhagia Figure 11.7 A. Hyperthyroidism. B. Hypothyroidism. Term Meaning hypothyroidism condition of hyposecretion of the thyroid gland hı̄ pō-thı̄ royd-izm causing low thyroid levels in the blood that result in sluggishness, slow pulse, and often obesity (Fig. 11.7B) myxedema advanced hypothyroidism in adults characterized mik-se-dēmă by sluggishness, slow pulse, puffiness in the hands and face, and dry skin (myx mucous) cretinism condition of congenital hypothyroidism in children krētin-izm that results in a lack of mental development and dwarfed physical stature; the thyroid gland is either congenitally absent or imperfectly developed (see Fig. 11.5) Chapter 11 • Endocrine System 369 Diagnostic Tests and Procedures Test or Procedure Explanation LABORATORY TESTING blood sugar (BS) measurement of the level of sugar (glucose) in the blood glucose blood fasting blood sugar (FBS) measurement of blood sugar level after a fast of 12 hours postprandial blood measurement of blood sugar level after a meal, sugar (PPBS) commonly after 2 hours glucose tolerance test (GTT) measurement of the body’s ability to metabolize carbohydrates by administering a prescribed amount of glucose after a fasting period, then measuring blood and urine for glucose levels every hour thereafter—usually for 4 to 6 hours glycohemoglobin molecule (fraction) in hemoglobin that rises in glı̄ -kō-hē-mō-glōbin the blood as a result of an increased level of blood sugar; it is a common blood test used in diagnosing and treating diabetes, also known as glycosylated hemoglobin (HbA1c) electrolytes measurement of the level of specific ions ē-lektro-lı̄ tz (sodium, potassium, CO2, and chloride) in the blood; electrolyte balance is essential for normal metabolism thyroid function study measurement of thyroid hormone levels in blood plasma to determine efficiency of glandular secretions, including T3, T4, and TSH urine sugar and ketone chemical tests to determine the presence of |
sugar studies or ketone bodies in the urine; used as a screen for kētōn diabetes (note: to void means to urinate) IMAGING PROCEDURES computed tomography (CT) CT of the head is used to obtain a transverse view of the pituitary gland magnetic resonance imaging nonionizing images of magnetic resonance are (MRI) useful in identifying abnormalities of pituitary, pancreas, adrenal, and thyroid glands sonography sonographic images are used to identify endocrine pathology, such as with thyroid ultrasound thyroid uptake and image nuclear image involving scan of the thyroid to visualize the radioactive accumulation of previously ingested isotopes to detect thyroid nodules or tumors (Fig. 11.8) 370 Medical Terminology: The Language of Health Care Figure 11.8 Thyroid uptake and image detecting presence of multiple nodules (ar- rows). Operative Terms Term Meaning adrenalectomy excision of adrenal gland ă-drē-năl-ektō-mē hypophysectomy excision of pituitary gland hı̄ pof-i-sektō-mē pancreatectomy excision of pancreas pankrē-ă-tektō-mē parathyroidectomy excision of parathyroid gland pară-thı̄ -roy-dektō-mē thymectomy excision of thymus gland thı̄ -mektō-mē thyroidectomy excision of thyroid gland thı̄ -roy-dektō-mē Therapeutic Terms Term Meaning continuous subcutaneous use of an insulin-delivery device worn on the body insulin infusion (CSII) (usually the abdomen) that subcutaneously infuses insulin pump therapy doses of insulin programmed according to the individual needs of the diabetic patient (Fig. 11.9) radioiodine therapy use of radioactive iodine to treat disease, such as rādē-ō-ı̄ ō-din to eradicate thyroid tumor cells Chapter 11 • Endocrine System 371 Figure 11.9 Abdominal placement of insulin pump (continuous subcutaneous insulin infusion). Term Meaning COMMON THERAPEUTIC DRUG CLASSIFICATIONS antihypoglycemic drug that raises blood glucose antē-hı̄ pō-glı̄ -sēmik antithyroid drug agent that blocks the production of thyroid hormones; used to treat hyperthyroidism hormone replacement drug that replaces a hormone deficiency hōrmōn (e.g., estrogen, testosterone, thyroid) hypoglycemic drug that lowers blood glucose (e.g., insulin) antihyperglycemic hı̄ pō-glı̄ -sēmik antē-hı̄ per-glı̄ -sēmik Summary of Chapter 11 Acronyms/Abbreviations ACTH . . . . .adrenocorticotropic hormone GH . . . . . . . .growth hormone ADH . . . . . .antidiuretic hormone GTT . . . . . . .glucose tolerance test BS . . . . . . . . .blood sugar LH . . . . . . . .luteinizing hormone CO2 . . . . . . .carbon dioxide MRI . . . . . . .magnetic resonance imaging CSII . . . . . . .continuous subcutaneous insulin MSH . . . . . .melanocyte-stimulating hormone infusion PPBS . . . . .postprandial blood sugar CT . . . . . . . . .computed tomography PTH . . . . . . .parathyroid hormone DKA . . . . . . .diabetic ketoacidosis T3 . . . . . . . . .triiodothyronine DM . . . . . . . .diabetes mellitus T4 . . . . . . . . .thyroxine FBS . . . . . . .fasting blood sugar TSH . . . . . . .thyroid-stimulating hormone FSH . . . . . . .follicle-stimulating hormone 372 Medical Terminology: The Language of Health Care PRACTICE EXERCISES For the following terms, on the lines below the term, write out the indicated word parts: prefixes (P), combining forms (CF), roots (R), and suffixes (S). Then define the word. EXAMPLE parathyroid _______ / _______ / _______ P R S para/thyr/oid P R S DEFINITION: alongside of/thyroid gland/resembling 1. adenitis __________________ / __________________ R S DEFINITION: _________________________________________________________________ 2. euglycemia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 3. thyrotoxicosis __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 4. polydipsia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 5. hormonal __________________ / __________________ R S DEFINITION: _________________________________________________________________ 6. ketosis __________________ / __________________ R S DEFINITION: _________________________________________________________________ 7. polyuria __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ Chapter 11 • Endocrine System 373 8. endocrine __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 9. thyroptosis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 10. thymoma __________________ / __________________ R S DEFINITION: _________________________________________________________________ 11. acromegaly __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 12. android __________________ / __________________ R S DEFINITION: _________________________________________________________________ 13. adrenotrophic __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 14. pancreatogenic __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 15. glycosuria __________________ / __________________ / __________________ R R S DEFINITION: _________________________________________________________________ 16. dipsogenic __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 374 Medical Terminology: The Language of Health Care Complete the medical term by writing the missing part: 17. _______________secretion abnormally increased secretion 18. _______________glycemia low blood sugar 19. _______________ syndrome condition resulting from hypersecretion of the adrenal cortex causing obesity, hyperglycemia, and weakness 20. _______________secretion decreased secretion 21. _______________glycemia high blood sugar 22. _______________graphy ultrasound imaging For each of the following, circle the meaning that corresponds to the combining form given: 23. adren/o male extremity adrenal gland 24. thyr/o nourishment shield chest 25. crin/o blue cell secrete 26. gluc/o stomach sugar pancreas 27. dips/o thirst ketones secrete 28. thym/o shield hormone thymus gland 29. hormon/o development urging on ketones 30. aden/o male extremity gland Write the correct medical term for each of the following: 31. another name for Graves disease ____________________________________________ 32. protrusion of one or both eyeballs ___________________________________________ 33. disease characterized by enlarged features caused by hypersecretion of the pituitary hormone after puberty ______________________________________________ 34. enlargement of the thyroid gland ____________________________________________ 35. condition of congenital hyposecretion of growth hormone _____________________ 36. nuclear image of the thyroid ________________________________________________ Chapter 11 • Endocrine System 375 Match the following: 37. ________ cretinism a. gigantism 38. ________ polydipsia b. inadequate antidiuretic hormone 39. ________ hyperthyroidism c. excessive sodium 40. ________ pituitary gland d. depends on insulin 41. ________ thyromegaly e. congenital hypothyroidism 42. ________ myxedema f. hypophysis 43. ________ hypokalemia g. not usually insulin dependent 44. ________ type 2 diabetes h. excessive thirst 45. ________ pituitary hypersecretion i. goiter 46. ________ adrenal virilism j. low potassium 47. ________ hypernatremia k. advanced adult hypothyroidism 48. ________ type 1 diabetes l. thyrotoxicosis 49. ________ diabetes insipidus m. hirsutism Write the full medical term for the following abbreviations: 50. BS ________________________________________________________________________ 51. HRT ______________________________________________________________________ 52. FBS _______________________________________________________________________ 53. DM _______________________________________________________________________ 54. PPBS _____________________________________________________________________ 55. GTT ______________________________________________________________________ 56. DKA ______________________________________________________________________ 376 Medical Terminology: The Language of Health Care Write in the missing words on the blank lines in the following illustration of the endocrine glands. 57–62. THE ENDOCRINE SYSTEM Pineal body (Hypothalamus–CNS controller of endocrine system) 60. gland 57. thyroid glands 61. gland 58. gland (Trachea) (Heart) 59. glands (Lungs) 62. Islets of Langerhans of the Ovaries in (Kidneys) female (Uterus) (Labels in parentheses indicate Testes organs shown for orientation only. These are not endocrine system organs.) Chapter 11 • Endocrine System 377 For each of the following, circle the correct spelling of the term: 63. hirsutism hirsuitism hirsitism 64. exopthalmos exopthamamos exophthalmos 65. myexedema myxedema myxadema 66. goiter goyter goitir 67. androgenius androgenous andreogenous 68. virillism virilism viralism 69. epinephrine epinefrine epineprine 70. hypoglicemic hypoglicemic hypoglycemic Give the noun that was used to form the following adjectives: 71. _______ acromegalic 72. _______ exophthalmic 73. _______ metabolic 74. _______ diabetic 75. _______ hypoglycemic 378 Medical Terminology: The Language of Health Care MEDICAL RECORD ANALYSES M E D I C A L R E C O R D 1 1 . 1 S: This is a 27 y.o. c̄ a known Hx of diabetes seen in the ER with nausea and vom- iting for the past three hours. She has skipped two doses of her insulin because BS levels monitored at home have been low. She is now experiencing a cephalalgia similar to what she has had in the past before coma. O: T 35.5º C, P 90, R 20, BP 126/68 Lab blood studies: sodium 130, potassium 4.1, CO2 9, chloride 102, glucose 296 A: Diabetic ketoacidosis P: Admit to ICU: give 10 units insulin IV; measure BS 1º p̄ insulin given, then q 4 h; check urine for sugar and ketosis q void; repeat electrolytes in a.m. 1. What is the CC? 5. Why were the blood electrolyte studies performed? a. nausea, vomiting, and headache a. to examine the electrical impulses of the brain b. nausea, vomiting, and dizziness b. to measure the level of ions in the blood in c. nausea, vomiting, and high blood pressure evaluation of metabolism d. nausea, vomiting, and ringing in the ears c. to measure hormone levels and determine glandular efficiency e. nausea, vomiting, and unconsciousness d. to visualize the accumulation of radioactive 2. What is the diagnosis? isotopes to eliminate the presence of tumor a. hyperglycemia e. to measure the level of glucose in the blood b. hypoglycemia 6. How should the insulin be administered? c. type 1 DM with presence of ketone bodies in a. within the skin the blood b. absorption through unbroken skin d. type 2 DM without the presence of ketone bodies in the blood c. within the muscle e. combination of hyperglycemia and glucosuria d. within the vein e. under the skin 3. As an inpatient, where was treatment provided? 7. How often should the blood glucose be measured? a. neuropsychiatric facility a. one hour after insulin administration, then b. coronary care facility every four hours c. emergency room b. once each morning d. recovery room c. each time the patient urinates e. critical care facility d. one hour before insulin administration, then four times a day 4. Which of the following are electrolytes? 1. sodium e. one hour before insulin administration, then 2. potassium 3. chloride 4. glucose every four hours thereafter a. only 1, 2, and 3 are correct b. only 1 and 3 are correct c. only 2 and 4 are correct d. only 4 is correct e. all are correct Chapter 11 • Endocrine System 379 M E D I C A L R E C O R D 1 1 . 2 Tara Nguyen had a long history of hyperthyroidism that was managed by pharmaco- logical treatment for more than 5 years. She was often unhappy with how she felt, how- ever, and decided on her own to stop taking the drug. Two months ago, the symptoms of hyperthyroidism recurred, and she sought medical attention. Directions Read Medical Record 11.2 for Ms. Nguyen (page 380) and answer the following ques- tions. This record is the report by Dr. Rincon, who analyzed Ms. Nguyen’s thyroid uptake and imaging study. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 1 1 . 2 Write your answers in the spaces provided. 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record and define below: propylthiouracil (PTU) _______________________________________________________ uptake ______________________________________________________________________ baseline (nonmedical term) ___________________________________________________ 2. In your own words, not using medical terminology, briefly describe what seems to have been missing in Ms. Nguyen’s past medical management: ____________________________________________________________________________ ____________________________________________________________________________ 3. In nonmedical terms, explain how the sodium iodide was administered: ____________________________________________________________________________ 4. In your own words, not using medical terminology, briefly describe Dr. Rincon’s diagnosis: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 5. What additional test did Dr. Rincon order on his own authority? a. thyroid function study b. fasting blood sugar c. thyroid MRI d. thyroid ultrasound 6. Which of the following tests is recommended to be performed in 6 months? a. thyroid function study b. fasting blood sugar c. thyroid MRI d. thyroid ultrasound 380 Medical Terminology: The Language of Health Care Medical Record 11.2 Chapter 11 • Endocrine System 381 M E D I C A L R E C O R D 1 1 . 3 Jane Dano, an 11-year-old girl, started experiencing a constant thirst accompanied by frequent urination. Gradually, she lost weight. At the suggestion of Dr. Freeman, her family doctor, she was admitted to Central Medical Center for tests. Shortly after ad- mission, her care was referred to Dr. Gallegos. Directions Read Medical Record 11.3 regarding Jane Dano (pages 383–385) and answer the fol- lowing questions. These records represent the physician’s orders from Dr. Gallegos, who assumed the care of Jane at the time of her admission, and his clinical summary dictated at the time of her |
discharge. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 1 1 . 3 Write your answers in the spaces provided. 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the records and define below: void ________________________________________________________________________ urinalysis ___________________________________________________________________ nocturia ____________________________________________________________________ dietitian_____________________________________________________________________ Kussmaul respiration ________________________________________________________ 2. In your own words, not using medical terminology, briefly describe Jane’s condi- tion as identified by the admitting and final diagnosis: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Dr. Gallegos requested that the unit nurses take Jane’s blood pressure every ___ hours. 4. Explain in lay language Dr. Gallegos’ instructions to the nurses for Jane’s fluid intake: ____________________________________________________________________________ ____________________________________________________________________________ 5. Every nurse helping care for Jane needs to know to check her urine for acetone and sugar at what times? ____________________________________________________________________________ 382 Medical Terminology: The Language of Health Care 6. Part of Jane’s care involves teaching her and others how to manage her diabetes when she returns home after discharge. The nurses and dietician provided this education to which of the following people (check all that apply): _____ Jane’s stepmother _____ Jane’s father _____ Jane’s teachers _____ Jane’s older brother _____ a neighbor _____ Dr. Gallegos _____ the twins 7. Explain in lay language the two symptoms Jane had for 2 months before being admitted: ___________________________________________________________________________ What two additional symptoms occurred in the last 3 weeks? ___________________________________________________________________________ ___________________________________________________________________________ 8. At the time of discharge, Jane weighed: a. 40 lb b. 148 lb c. 89 lb d. 148 kg 9. Which of the following diagnostic tests will Jane and her family be performing at home? a. blood glucose monitoring b. vital signs c. body weight d. insulin injections 10. If you were Jane’s parent, what guidance would you give about how active she can be at school? (Put in terms an 11-year-old can understand.) ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Chapter 11 • Endocrine System 383 Medical Record 11.3 384 Medical Terminology: The Language of Health Care Medical Record 11.3 Continued. Chapter 11 • Endocrine System 385 Medical Record 11.3 Continued. Chapter 12 Eye OBJECTIVES After completion of this chapter you will be able to Define the common term components used in relation to the eye Locate and name the major structures of the eye and list their functions Define common symptomatic and diagnostic terms referring to the eye List the common diagnostic tests and procedures related to the eye Identify common operative terms referring to the eye Identify common therapeutic terms including drug classifications related to the eye Explain the terms and abbreviations used in documenting medical records involving the eye Combining Forms Combining Form Meaning Example aque/o water aqueous akwē-ŭs blephar/o eyelid blepharospasm blefă-rō-spazm conjunctiv/o conjunctiva (to join together) conjunctival kon-jŭnk-tı̄ văl corne/o cornea corneal kōrnē-ăl kerat/o keratoplasty keră-tō-plas-tē cycl/o ciliary body (circle) cycloplegia sı̄ -klō-plējē-ă ir/o iris (colored circle) iritis irid/o ı̄ -rı̄ tis iridectomy iri-dektō-mē lacrim/o tear lacrimal lakri-măl dacry/o dacryocyst dakrē-ō-sist 386 Chapter 12 • Eye 387 Combining Form Meaning Example ocul/o eye ocular okyū-lăr ophthalm/o ophthalmology of-thal-molō-jē opt/o optometry op-tomĕ-trē phac/o lens (lentil) phacolysis fă-koli-sis phak/o phakoma fa-kōmă phot/o light photophobia fō-tō-fōbē-ă presby/o old age presbyopia prez-bē-ōpē-ă retin/o retina retinopathy ret-i-nopă-thē scler/o sclera (hard) scleritis sklĕ-rı̄ tis vitre/o glassy vitreous vitrē-ŭs ADDITIONAL SUFFIX -opia condition of vision hyperopia hı̄ -per-ōpē-ă Eye Overview The eye is the organ of sight that through pairing provides three-dimensional vision (Fig. 12.1). Each eye is located in a bony orbit (cavity) of the skull and is covered by the protective fold of the eyelid. The sclera, the white of the eye, and the cornea, the transparent anterior coating, are part of the outer fibrous tunic (layer) that refracts (bends) light that enters the eye. The choroid, a vascular layer located just beneath the sclera, contains blood vessels that nourish the outer portion of the retina. The iris contains blood vessels, pigment cells, and muscle fibers. Muscles of the iris regulate the amount of light that enters through the central opening known as the pupil. Melanin, the pigment present in the epithelial cells that cover the iris, gives color to the eyes. The ciliary body is a ring of muscle located behind the peripheral iris that controls the power of the lens. The elas- tic, transparent lens, located behind the pupil, focuses light rays on the retina in the in- ner, posterior part of the eye. Aqueous humor, produced by the surface epithelium of the ciliary body, provides nutrition to the avascular lens and cornea. Vitreous is the jelly-like material that occupies the space between the lens and retina. The retina is the nerve tissue layer that contains cells for visual reception. The vi- sual receptor neurons of the retina are the rods and cones. Rods are responsible for vi- sion in dim light, and cones are responsible for vision in bright light. The macula lutea is the central region of the retina. It has a yellowish color caused by its pigment. At the center of the macula, a tiny, pinpoint depression known as the fovea centralis is the site of sharpest, central vision. The optic disk is the area in the retina where nerve fibers form the optic nerve for transmission to the optic tracts in the brain. 388 Medical Terminology: The Language of Health Care Eyelid (palpebra) Canal of Schlemm Retina Meibomian glands Choroid Glands of Vitreous chamber Zeis Lashes Pupil Cornea Fovea Lens capsule centralis Lens Ciliary processes Anterior Optic nerve chamber Ciliary body and Blood supply Posterior ciliary muscle to retina chamber Iris Conjunctiva Sclera Optic disk Figure 12.1 Anatomy of the eye (sagittal view). The conjunctiva provides a lining for the eye and eyelid. The lacrimal gland, located in the orbit above each eye, secretes tears that lubricate and protect the eye. Tears con- stantly flow across the eye and downward to the lacrimal ducts, to the lacrimal sac, and then into the nasolacrimal duct that drains into the nose. The meibomian glands are sebaceous glands located within the rim of the eyelid that secrete sebum to keep the lids from sticking together, and the glands of Zeis are sebaceous glands surrounding the hair follicles of the eyelashes. Anatomical Terms Term Meaning anterior chamber fluid-filled space between the cornea and iris aqueous humor watery liquid secreted at the ciliary body that fills akwē-ŭs hyūmer the anterior and posterior chambers of the eye and provides nourishment for the cornea, iris, and lens (humor fluid) canal of Schlemm duct in the anterior chamber that carries filtered aqueous humor to the veins and bloodstream choroid vascular layer beneath the sclera that provides kōroyd nourishment to the outer portion of the retina ciliary body ring of muscle behind the peripheral iris that silē-ar-ē controls the power of the lens ciliary muscle smooth muscle portion of the ciliary body, which contracts to assist in near-vision capability ciliary processes epithelial tissue folds on the inner surface of the ciliary body that secrete aqueous humor conjunctiva joining together; mucous membrane that lines the kon-jŭnk-tı̄ vă eyelids and outer surface of the eyeball Chapter 12 • Eye 389 Term Meaning cornea transparent, anterior part of the eyeball covering kōrnē-ă the iris, pupil, and anterior chamber that functions to refract (bend) light to focus a visual image eyelid (palpebra) movable protective fold that opens and closes, pal-pēbră covering the eye fovea centralis pinpoint depression in the center of the macula fōvē-ă sen-trālis lutea that is the site of sharpest vision (fovea pit) fundus (base) interior surface of the eyeball including the retina, fŭndŭs optic disk, macula, and posterior pole (curvature at the back of the eye) glands of Zeis oil glands surrounding the eyelashes meibomian glands oil glands located along the rim of the eyelids mı̄ -bōmē-an iris colored circle; colored part of the eye located ı̄ ris behind the cornea that contracts and dilates to regulate light passing through the pupil lacrimal gland gland located in the upper outer region above the lakri-măl eyeball that secretes tears (Fig. 12.2) lacrimal ducts tubes that carry tears to the lacrimal sac lacrimal sac structure that collects tears before emptying into the nasolacrimal duct lens transparent structure behind the pupil that bends and focuses light rays on the retina lens capsule capsule that encloses the lens macula lutea (macula) central region of the retina responsible for central makyū-lă vision; yellow pigment provides its color (lutea yellow) (see Fig. 12.13B) Puncta Lacrimal ducts Lacrimal gland Lacrimal sac Meibomian glands Nasolacrimal duct Figure 12.2 Lacrimal apparatus. 390 Medical Terminology: The Language of Health Care Term Meaning nasolacrimal duct passageway for tears from the lacrimal sac into the nā-zō-lakri-măl nose optic disk exit site of retinal nerve fibers, as well as the optik entrance point for retinal arteries and the exit point for retinal veins (see Fig. 12.13B) optic nerve nerve responsible for carrying impulses for the sense of sight from the retina to the brain posterior chamber space between the back of the iris and the front of the vitreous filled with aqueous fluid PUPIL. The Latin pupil black circular opening in the center of the iris word, pupilla, pyūpı̄ l through which light passes as it enters the eye the pupil of the eye, is derived from pupa, retina innermost layer that perceives and transmits light meaning a doll or little girl. reti-nă to the optic nerve (see Fig. 12.13B) The name is said to have been given to the pupil of cones cone-shaped cells within the retina that are color the eye because a tiny sensitive and respond to bright light image of the beholder may be seen reflected in it. rods rod-shaped cells within the retina that respond to dim light sclera tough, fibrous, white outer coat extending from sklēră the cornea to the optic nerve trabecular meshwork mesh-like structure in the anterior chamber that tră-bekyū-lăr filters the aqueous humor as it flows into the canal of Schlemm vitreous jelly-like mass filling the inner chamber between vitrē-ŭs the lens and retina that gives bulk to the eye Symptomatic and Diagnostic Terms Term Meaning SYMPTOMATIC asthenopia eyestrain (asthenia weak condition) as-thĕ-nōpē-ă blepharospasm involuntary contraction of the muscles blefă-rō-spazm surrounding the eye, causing uncontrolled blinking and lid squeezing diplopia double vision di-plōpē-ă exophthalmos abnormal protrusion of one or both eyeballs ek-sof-thalmos exophthalmus lacrimation secretion of tears lak-ri-māshŭn nystagmus involuntary, rapid oscillating movement of the nis-tagmŭs eyeball (nystagmos a nodding) photophobia extreme sensitivity to, and discomfort from, light fō-tō-fōbē-ă Chapter 12 • Eye 391 Term Meaning scotoma blind spot in vision (skotos darkness) skō-tōmă DIAGNOSTIC refractive errors defects in the bending of light as it enters the eye, rē-fraktiv causing an improper focus on the retina astigmatism distorted vision caused by an oblong or cylindrical ă-stigmă-tizm curvature of the lens or cornea that prevents light rays from coming to a single focus on the retina (stigma point) hyperopia farsightedness; difficulty seeing close objects when hı̄ -per-ōpē-ă light rays extend beyond the proper focus on the retina (Fig. 12.3A and B) myopia nearsightedness; difficulty seeing distant objects mı̄ -ōpē-ă when light rays fall short of the proper focus on the retina (Fig. 12.3A and C) presbyopia impaired vision owing to old-age loss of prez-bē-ōpē-ă accommodation accommodation ability of the eye to adjust focus on near objects ă-komŏ-dāshŭn amblyopia decreased vision in early life due to a functional am-blē-ōpē-ă defect that can occur as a result of strabismus, refractive errors (when one eye is more near- sighted, farsighted, or astigmatic than the other), or trauma; usually occurs in one eye, also known as lazy eye (ambly/o dim) aphakia absence of the lens, usually after cataract ă-fākē-ă extraction blepharitis inflammation of the eyelid blefă-rı̄ tis blepharochalasis baggy eyelid; overabundance and loss of elasticity blefă-rō-kală-sis of skin on the upper eyelid, causing a fold of skin dermatochalasis to hang down over the edge of the eyelid when the dermă-tō-kală-sis eyes are open (chalasis a slackening) blepharoptosis drooping of the eyelid usually caused by paralysis blefă-roptō-sis ptosis Normal vision Hyperopia Myopia A B C Figure 12.3 A. Proper focus of light rays on the retina. B. Light rays extend beyond proper focus in hyperopia. C. Light rays fall short of proper |
focus in myopia. 392 Medical Terminology: The Language of Health Care Term Meaning chalazion chronic nodular inflammation of a meibomian ka-lāzē-on (shă-lāzē-on) gland, usually the result of a blocked duct; commonly presents as a swelling on the upper or lower eyelid (chalaza hailstone) (Fig. 12.4) CATARACT. This cataract opaque clouding of the lens causing decreased Greek word meaning kată-rakt vision (Figs. 12.5 and 12.6B) waterfall, or something that conjunctivitis pinkeye; inflammation of the conjunctiva rushes down to form an kon-jŭnk-ti-vı̄ tis obstruction, like a portcullis, was probably related to the dacryoadenitis inflammation of the lacrimal gland obstruction of vision that is dakrē-ō-ad-ĕ-nı̄ tis symptomatic of a cataract. It was an ancient belief that dacryocystitis inflammation of the tear sac (cyst/o sac) the interference with vision dakrē-ōsis-tı̄ tis occurred between the lens diabetic retinopathy disease of the retina in diabetics characterized by and the iris (like a veil). dı̄ -ă-betik ret-i-nopă-thē capillary leakage, bleeding, and new vessel formation (neovascularization), leading to scarring and loss of vision (Figs. 12.6C and 12.13C) ectropion outward turning of the rim of the eyelid (trop/o ek-trōpē-on turning) (Fig. 12.7A) entropion inward turning of the rim of the eyelid (Fig. 12.7B) en-trōpē-on epiphora abnormal overflow of tears caused by blockage of ē-pifō-ră the lacrimal duct (epi upon; phor/o to carry or bear) glaucoma group of diseases of the eye characterized by glaw-kōmă increased intraocular pressure that results in damage to the optic nerve, producing defects in vision (Fig. 12.6D) hordeolum sty; an acute infection of a sebaceous gland of the hōr-dēō-lŭm eyelid (hordeum barley) (Fig. 12.8) iritis inflammation of the iris ı̄ -rı̄ tis keratitis inflammation of the cornea ker-ă-tı̄ tis Figure 12.4 Chalazion. Chapter 12 • Eye 393 Normal focus of light rays on the retina Light rays diffused by a cataract Iris Retina Clouded lens (cataract) Cornea Pupil A Clear lens (normal) Normal daytime vision Simulation of daytime cataract vision B1 B2 Normal nighttime vision Simulation of nighttime cataract vision Figure 12.5 Cataract. A. Normal light focus compared with light focus interference caused by a cataract. B. Simu- lation of cataract vision. 394 Medical Terminology: The Language of Health Care A Normal vision B Cataract (hazy vision) C Diabetic retinopathy (retinal damage leads to blind spots) D Glaucoma (loss of peripheral vision) E Macular degeneration (loss of central vision) Figure 12.6 Simulations of vision loss. Term Meaning macular degeneration breakdown or thinning of the tissues in the makyū-lăr dē-jen-er-āshŭn macula, resulting in partial or complete loss of central vision (see Fig. 12.6E) pseudophakia eye in which the natural lens is replaced with an sū-dō-fakē-ă artificial lens implant (pseudo false) pterygium fibrous growth of conjunctival tissue that extends tĕ-rijēŭm onto the cornea (Fig. 12.9) retinal detachment separation of the retina from the underlying ret-i-nal epithelium, disrupting vision and resulting in blindness if not repaired surgically (Fig. 12.13D) retinitis inflammation of the retina ret-i-nı̄ tis Chapter 12 • Eye 395 A B Figure 12.7 Eyelid abnormalities. A. Severe bilateral lower lid ectropion. B. Lower lid entropion causing the lashes to rub on the cornea. Term Meaning strabismus crossed eyes; a condition of eye misalignment STRABISMUS. stra-bizmŭs caused by intraocular muscle imbalance Strabo, a (strabismus a squinting; hetero other) geographer and (Fig. 12.10) prominent figure in Alexandria during the heterotropia Roman period, suffered from heter-ō-trōpē-ă a peculiar and noticeable squint. Any man with the esotropia right or left eye deviates inward toward the nose same type of squint was es-ō-trōpē-ă (eso inward; tropo turning) called Strabo, which led to exotropia right or left eye deviates outward away from the the word strabismus. ek-sō-trōpē-ă nose (exo out; tropo turning) scleritis inflammation of the sclera sklĕ-rı̄ tis trichiasis misdirected eyelashes that rub on the conjunctiva trı̄ -kı̄ ă-sis or cornea Figure 12.8 Upper lid hordeolum. Figure 12.9 Pterygium caused by ultraviolet exposure and drying. 396 Medical Terminology: The Language of Health Care Esotropia Exotropia Figure 12.10 Strabismus. Diagnostic Tests and Procedures Test or Procedure Explanation distance visual acuity measure of the ability to see the details and shape of identifiable objects from a specified distance (usually 20 feet), typically using a Snellen chart (Fig. 12.11) fluorescein angiography visualization and photography of retinal and flūr-esē-in an-jē-ogră-fē choroidal vessels made as fluorescein dye, which is injected into a vein, circulates through the eye (Fig. 12.12) ophthalmoscopy use of an ophthalmoscope to view the interior of of-thal-moskō-pē the eye (Fig. 12.13) refraction measurement of refractive errors using a rē-frak´shŭn phoropter to determine best corrected vision and prescription for eye glasses or contact lenses phoropter instrument that holds corrective lenses in front fŏ-rop´ter of the eye to determine optical correction Figure 12.11 Snellen eye chart for testing distance visual acuity. Chapter 12 • Eye 397 A B Figure 12.12 Fluorescein angiography photo- graphs. A. Right eye before injection of fluorescein. B. Maximal levels of fluorescein circulating through the retinal blood vessels 30 seconds after injection. C C. Elimination after 5 minutes. Macula Optic disk Vein Artery D Figure 12.13 A. Doctor performing ophthalmoscopy using an ophthalmoscope. B. Normal retina. C. Aneurysms seen in diabetic retinopathy. D. Retinal detachment. 398 Medical Terminology: The Language of Health Care Figure 12.14 Slit-lamp biomicroscope. Test or Procedure Explanation slit-lamp biomicroscopy use of a tabletop microscope to examine the biō-mi-kroskŏ-pē eye, especially the cornea, lens, fluids, and membranes (Fig. 12.14) sonography use of high-frequency sound waves to detect sŏ-nogră-fē pathology within the eye such as foreign bodies or a detached retina tonometry use of a tonometer to measure intraocular tō-nomĕ-trē pressure, which is elevated in glaucoma (Fig. 12.15) Operative Terms Term Meaning blepharoplasty surgical repair of an eyelid blefă-ro-plast-tē cataract extraction excision of a cloudy lens from the eye kată-rakt ek-strakshŭn cryoretinopexy use of intense cold to seal a hole or tear in the krı̄ -ō-reti-nō-pek-se retina; used to treat retinal detachment cryopexy dacryocystectomy excision of a lacrimal sac dakrē-ō-sis-tektō-mē Chapter 12 • Eye 399 Figure 12.15. Tonometer/tonometry. Term Meaning enucleation excision of an eyeball ē-nū-klē-āshŭn iridectomy excision of a portion of iris tissue iri-dektō-mē iridotomy incision into the iris (usually with a laser) to allow ir-i-dotō-mē for drainage of aqueous humor from the posterior to anterior chamber; used to treat a type of glaucoma keratoplasty corneal transplant; replacement of a diseased or keră-tō-plas-tē scarred cornea with a healthy one from a matched donor laser surgery use of a laser to make incisions or destroy tissues (e.g., to create fluid passages, to obliterate tumors or aneurysms) (Fig. 12.16) laser-assisted in situ technique using the excimer laser to reshape the keratomileusis (LASIK) surface of the cornea to correct refractive errors in sı̄ tū keră-tō-mil-oosis such as myopia, hyperopia, and astigmatism (smileusis carving) 400 Medical Terminology: The Language of Health Care Figure 12.16. Simulation of laser application. Term Meaning intraocular lens (IOL) implantation of an artificial lens to replace a implant defective natural lens (e.g., after cataract intră-okyū-lăr extraction) (Fig. 12.17) phacoemulsification use of ultrasound to shatter and break up a fakō-ē-mŭl-si-fi-kāshŭn cataract with aspiration and removal scleral buckling surgery to treat retinal detachment by placing a sklĕrăl bŭkling band of silicone around the sclera to cinch it to- ward the middle of the eye and relieve pull on the retina—often combined with other techniques to seal retinal tears such as cryoretinopexy trabeculectomy removal of a portion of the trabecular meshwork tră-bekyū-lektō-mē to increase the flow of aqueous humor from the eye; used in treatment of acute glaucoma or glaucoma not treatable with medication Chapter 12 • Eye 401 Figure 12.17. Size comparison of an intraocular lens to a dime. Therapeutic Terms Term Meaning contact lens small plastic curved disk with optical correction that fits over the cornea; used to correct refractive errors eye instillation introduction of a medicated solution in the eye eye irrigation washing of the eye with water or other fluid (e.g., saline) 402 Medical Terminology: The Language of Health Care COMMON THERAPEUTIC DRUG CLASSIFICATIONS antibiotic ophthalmic solution antimicrobial agent in solution, used to treat antē-bı̄ -otik of-thalmik bacterial infections (e.g., conjunctivitis, corneal ulcers) cycloplegic agent that paralyzes the ciliary muscle and powers sı̄ -klō-plējik of accommodation; commonly used in pediatric eye examinations mydriatic (dilation of pupil) agent that causes dilation of the pupil (e.g., for mi-drē-atik certain eye examinations) miotic agent that causes the pupil to contract (mio less) mı̄ -otik Summary of Chapter 12 Acronyms/Abbreviations IOL ..............intraocular lens LASIK .......laser-assisted in situ keratomileusis Chapter 12 • Eye 403 PRACTICE EXERCISES For the following terms, on the lines below the term, write out the indicated word parts: prefixes (P), combining forms (CF), roots (R), and suffixes (S). Then define the word. EXAMPLE epikeratophakia _______ / _______ / _______ / _______ P CF R S epi/kerato/phak/ia P CF R S DEFINITION: upon/cornea/lens/condition of 1. blepharoptosis _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 2. iridotomy _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 3. ophthalmology _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 4. vitrectomy _____________________ / _____________________ R S DEFINITION: _________________________________________________________________ 5. dacryolithiasis _____________________ / _____________________ / _____________________ CF R S DEFINITION: _________________________________________________________________ 6. lacrimal _____________________ / _____________________ R S DEFINITION: _________________________________________________________________ 404 Medical Terminology: The Language of Health Care 7. photophobia _____________________ / _____________________ / _____________________ CF R S DEFINITION: _________________________________________________________________ 8. keratoplasty _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 9. aqueous _____________________ / _____________________ R S DEFINITION: _________________________________________________________________ 10. iritis _____________________ / _____________________ R S DEFINITION: _________________________________________________________________ 11. corneal _____________________ / _____________________ R S DEFINITION: _________________________________________________________________ 12. phacolysis _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 13. retinopathy _____________________ / _____________________ / _____________________ CF R S DEFINITION: _________________________________________________________________ 14. ocular _____________________ / _____________________ R S DEFINITION: _________________________________________________________________ 15. conjunctivitis _____________________ / _____________________ R S DEFINITION: _________________________________________________________________ Chapter 12 • Eye 405 16. presbyopia _____________________ / _____________________ R S DEFINITION: _________________________________________________________________ 17. optometry _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 18. aphakia _____________________ / _____________________ / _____________________ P R S DEFINITION: _________________________________________________________________ 19. hyperopia _____________________ / _____________________ P S DEFINITION: _________________________________________________________________ 20. scleromalacia _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ Complete the following medical term by writing the missing part: 21. _______________phakia absence of the lens of the eye 22. _______________ophthalmos protrusion of the eyeball 23. ____________________chalasis baggy eyelids 24. _______________ buckling surgical placement of a band of silicone around the sclera to cinch it toward the middle of the eye 25. blepharo___________ involuntary contraction of the muscles surrounding the eye For each of the following, circle the combining form that corresponds to the meaning given: 26. eye or/o opt/o ot/o 27. old age presby/o scler/o phas/o 28. glassy aque/o vitre/o hydr/o 29. light phon/o phot/o opt/o 406 Medical Terminology: The Language of Health Care 30. hard or sclera corne/o vitre/o scler/o 31. lens (lentil) phac/o scler/o conjunctiv/o 32. colored circle chrom/o irid/o corne/o 33. tear dacry/o hydr/o aque/o 34. eyelid ocul/o ophthalm/o blephar/o 35. water aque/o hidr/o vitre/o Write the correct medical term for each of the following: 36. pinkeye ___________________________________________________________________ 37. inflammation of the eyelid __________________________________________________ 38. eyestrain __________________________________________________________________ 39. an agent that causes dilation of the pupil _____________________________________ 40. a sty; acute infection of a meibomian gland of the eyelid ______________________ 41. clouding of the lens causing decreased vision _________________________________ 42. breakdown or thinning of the tissues in the macula, resulting in partial or com- plete loss of central vision __________________________________________________ Match the surgical procedures with diagnoses: 43. ________ keratoplasty a. myopia 44. ________ phacoemulsification b. retinal detachment 45. ________ LASIK c. cataract 46. ________ trabeculectomy d. dermatochalasis 47. ________ blepharoplasty e. scarred cornea 48. ________ cryoretinopexy f. acute glaucoma Briefly define the following medical terms: 49. entropion _________________________________________________________________ 50. tonometer _________________________________________________________________ 51. ectropion _________________________________________________________________ 52. nystagmus ________________________________________________________________ Chapter 12 • Eye 407 Match the following: 53. ________ myopia a. old-age loss of accommodation 54. ________ strabismus b. lazy eye 55. ________ presbyopia c. pink eye 56. ________ astigmatism d. double vision 57. ________ hyperopia e. distorted vision 58. ________ amblyopia f. nearsightedness 59. ________ scotoma g. sty 60. ________ diplopia h. crossed eyes 61. ________ conjunctivitis i. farsightedness 62. ________ hordeolum j. blind spot in vision Write in the missing words on the blank lines in the following illustration of the eye’s anatomy. 63–70. 63. (palpebra) Canal of Schlemm 69. Meibomian glands Choroid Glands of 67. Zeis chamber Lashes Pupil 64. Fovea Lens capsule |
centralis 65. Ciliary processes Anterior 70. chamber 68. Ciliary body and nerve Posterior chamber muscle Blood supply Iris to retina Conjunctiva 66. Optic disk For each of the following, circle the correct spelling of the term: 71. asthenopia assthinopia asthinopia 72. terigium pterygium pteregium 408 Medical Terminology: The Language of Health Care 73. horadeolum hordeolum hordeaolum 74. nistagmis nystagmis nystagmus 75. chalazion shalazion calazion 76. mydriatic midriatic myadriatic 77. skotoma scotoma schotoma 78. epiphora epifora epifhora 79. dakryeocyst dacryocyst dacreyocyst 80. opthalmoscope ofthalmoscope ophthalmoscope Give the noun that was used to form the following adjectives: 81. conjunctival _______________ 82. myopic _______________ 83. scleral _______________ 84. macular _______________ 85. exophthalmic _______________ Chapter 12 • Eye 409 MEDICAL RECORD ANALYSES M E D I C A L R E C O R D 1 2 . 1 S: This 51 y/o c/o a growth in the corner of her right eye that is dry and irritated. She has had the feeling that there was “something in the eye” for about four months before actually noticing the growth three weeks ago. She wears contacts to correct farsightedness, but has recently switched to eyeglasses because of the discomfort. She is active physically and loves tennis and water sports, but does not frequently wear sunglasses. O: Inspection of the right eye reveals an inflamed, raised, whitish, triangular wedge of fibrovascular tissue, whose base lies within the interpalpebral conjunctiva and whose apex encroaches the cornea. A photo documentation is made and in- cluded in the chart. A: INFLAMED PTERYGIUM, RIGHT EYE P: 1) The patient is advised that the pterygium is not dangerous, but further growth could interfere with vision and warrant surgical excision. She was counseled on the importance of wearing UV blocking sunglasses and advised to avoid smoky or dusty areas as much as possible. 2) RX: fluorometholone, 0.1% suspension, 1 gt q 4h OD during the day for in- flammation; OTC artificial tears solution, prn dryness/irritation 3) RTO in 3 months for slit lamp evaluation, or sooner if symptoms persist. 1. Describe the refractive error noted in the subjec- c. use of a tabletop microscope to examine the tive information: eye, especially the cornea a. eyestrain d. implantation of an artificial lens b. inflammation of the cornea e. use of a tonometer to measure intraocular c. difficulty seeing distant objects pressure d. difficulty seeing close objects 4. How should the fluorometholone be adminis- e. blind spot in vision tered? a. one drop every 4 hours 2. Which action on the part of the patient likely contributed to the condition? b. four drops in the eye every morning a. wearing contact lenses c. one drop every day for 4 days b. removing contact lenses d. as needed during the day c. playing tennis e. one drop every other day for 4 days d. not routinely wearing sunglasses 5. When should the patient instill the artificial e. strenuous physical activity tears? a. every day 3. Which ophthalmological procedure is included in the plan? b. every night a. use of a laser to reshape the surface of the c. during the day cornea d. only as needed b. use of an ophthalmoscope to view the interior e. when feeling the need to cry of the eye 410 Medical Terminology: The Language of Health Care 6. What caused the pterygium? 7. What was the patient told about the pterygium? a. misdirected eyelashes that rub on the conjunc- a. it is cancerous tiva or cornea b. it is not cancerous b. intraocular muscle imbalance c. it must be removed c. separation of the retina from the underlying d. both a and c epithelium d. abnormal overflow of tears e. ultraviolet exposure and drying Chapter 12 • Eye 411 M E D I C A L R E C O R D 1 2 . 2 Not long ago, Cassandre Aquero had cataract surgery for her left eye, and she is now losing vision in her right eye because of another cataract. She is consulting an oph- thalmologist, Dr. Oanh Tran, about surgery on the right eye. Directions Read Medical Record 12.2 for Ms. Aquero (pages 413–414) and answer the following questions. This record is the history and physical examination written by Dr. Tran in planning for Ms. Aquero’s surgery. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 1 2 . 2 Write your answers in the spaces provided. 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record and define below: appendectomy ______________________________________________________________ irides ______________________________________________________________________ 2. In your own words, briefly describe Ms. Aquero’s current complaint and diagnosis noted under “History of Present Illness”: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Describe in lay language the two medical conditions Ms. Aquero has in addition to her current problem and past surgeries: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 4. Which of the following findings on physical examination is related to her general medical condition in addition to her eye problems? a. rales on auscultation b. disoriented consciousness c. BP 180/100 d. weight 135 lb 412 Medical Terminology: The Language of Health Care 5. The planned operation involves several risks that the patient has accepted in the hopes of regaining good eyesight. Which of the following was not mentioned by Dr. Tran as a risk? a. hypertensive crisis b. retinal detachment c. edema of the macula d. bleeding 6. The preoperative nursing staff will ensure that Ms. Aquero receives five medica- tions before surgery. Translate the instructions for these: a. __________________________________________________________________________ b. __________________________________________________________________________ c. __________________________________________________________________________ d. __________________________________________________________________________ e. __________________________________________________________________________ 7. In your own words, not using medical terminology, briefly describe what will oc- cur in the surgery: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Chapter 12 • Eye 413 Medical Record 12.2 414 Medical Terminology: The Language of Health Care Medical Record 12.2 Continued. Chapter 13 Ear OBJECTIVES After completion of this chapter you will be able to Define the common term components used in relation to the ear Locate and name the major structures of the ear and list their functions Define common symptomatic and diagnostic terms referring to the ear List the common diagnostic tests and procedures related to the ear Identify common operative terms referring to the ear Identify common therapeutic terms including drug classifications related to the ear Explain the terms and abbreviations used in documenting medical records involving the ear Combining Forms Combining Form Meaning Example acous/o hearing acoustic ă-kŭstik audi/o audiometry aw-dē-omĕ-trē aer/o air or gas aerotitis ār-ō-tı̄ tis aur/i ear auricle awri-kl ot/o otology ō-tolŏ-jē cerumin/o wax ceruminosis se-rū-mi-nōsis salping/o eustachian tube or uterine tube salpingoscope sal-pinggō-skōp tympan/o eardrum tympanic tim-panik myring/o myringotomy mir-ing-gotō-mē ADDITIONAL SUFFIX -acusis hearing condition presbyacusis prezbē-ă-kūsis 415 416 Medical Terminology: The Language of Health Care TYMPANUM. Overview of the Ear Tympanum is the Latin word for The sense of hearing occurs through the mechanical action of the ear and its three tambourine or kettledrum, percussion instruments that divisions: outer ear, middle ear, and inner ear (Fig. 13.1). are struck or beaten. Use of Sounds are gathered by the projections of the external ear called the pinna, or the term for eardrum was auricle, and then dispersed through the external auditory meatus (canal) to the tym- first introduced in 1255 and panum, or eardrum, of the middle ear. Glands located throughout the external canal was adopted by the famous secrete a protective, waxy substance called cerumen. anatomist, Gabrielle The tympanum transmits sound vibrations through the auditory ossicles— Fallopius, because of the malleus, incus, and stapes—to the oval window. Vibrations are increased as they are likeness of the eardrum to a distributed from the tympanum to the malleus, incus, and stapes. When the stapes, tambourine. held by a ligament called the oval window, vibrates, it stimulates the motion of the au- OSSICLE. ditory fluids in the inner ear. Ossicle means a Within the middle ear, the eustachian tube or auditory tube provides a passageway little bone; it is a to the throat, allowing air to pass to and from the outside of the body. This process is diminutive of the Latin important for maintaining equal air pressure. ossiculum, meaning bone. Located within the temporal bone of the skull, the inner ear receives sound vibra- Specifically, ossicle means one of the small bones in the tions passed from the oval window to the cochlea, the outer structure of the inner ear, middle ear. The first authentic which is part of the intricate intercommunicating tubes and chambers known as the records indicate that the labyrinth. Vibrations are passed through perilymph, a fluid within an area of the malleus and the incus were cochlea called the scala vestibuli, to the cochlear duct, which is filled with a fluid called the first two to be discovered endolymph. Finally, the vibrations are passed through the organ of Corti, where hairs in 1514. The stapes was along its lining stimulate surrounding nerve fibers, generating impulses that then discovered around 1546. travel to the brain for processing of hearing. THE EAR Auricle Malleus Ossicles (bones Incus of middle ear) Stapes Cochlea Facial nerve Vestibulocochlear nerve Oval window Round window Tympanic cavity Tympanic membrane External auditory Endolymph canal Eustachian tube Perilymph Utricle (auditory tube) Saccule Pharynx Osseous labyrinth Cochlear duct Perilymph Cochlea Membranous labyrinth Semicircular canals Ampulla Oval window Labyrinth and Cochlea Vestibule Organ of Corti Figure 13.1. Anatomy of the ear. Chapter 13 • Ear 417 In addition to hearing, the labyrinth is responsible for the equilibrium within the body. Within the labyrinth, the semicircular canals are connected to the cochlea by a cavity called the vestibule. Within the vestibule are structures known as the utricle and saccule. Hair cells and surrounding nerve fibers within the canals that connect with the utricle respond to and are moved by endolymph to stimulate nerve conduction when changes in movement occur. Anatomical Terms Term Meaning external ear pinna auricle (little ear); projected part of the external pină ear (pinna feather) external auditory meatus external passage for sounds collected from the (canal) pinna to the tympanum (meat/o opening) cerumen waxy substance secreted by glands located sĕ-rūmen throughout the external canal middle ear tympanic membrane (TM) eardrum; drum-like structure that receives sound tim-panik membrān collected in the external auditory meatus (canal) and amplifies it through the middle ear (see Fig. 13.3B) malleus hammer; first of the three auditory ossicles of malē-ŭs the middle ear incus anvil; middle of the three auditory ossicles of the ingkŭs middle ear stapes stirrup; last of the three auditory ossicles of the stāpēz middle ear eustachian tube tube connecting the middle ear to the pharynx yū-stāshŭn (throat) auditory tube mastoid process projection of the temporal bone located behind mastoyd the ear containing air cells that connect to the middle ear (masto breast) oval window membrane that covers the opening between the middle ear and inner ear inner ear structures and liquids that relay sound waves to the auditory nerve fibers on a path to the brain for interpretation of sound labyrinth maze; inner ear consisting of bony and labi-rinth membranous labyrinths cochlea coiled tubular structure of the inner ear that koklē-ă contains the organ of Corti (cochlea snail) perilymph fluid that fills the bony labyrinth of the ear peri-limf endolymph fluid within the cochlear duct of the inner ear endō-limf (labyrinth) 418 Medical Terminology: The Language of Health Care Term Meaning organ of Corti organ located in the cochlea that contains receptors (hair cells) that receive vibrations and generate nerve impulses for hearing vestibule middle part of the inner ear in front of the vesti-būl semicircular canals and behind the cochlea that contains the utricle and saccule utricle larger of two sacs within the membranous ūtri-kl labyrinth of the vestibule in the inner ear (uter leather bag) saccule smaller of two sacs within the membranous sakyūl labyrinth of the vestibule in the inner ear (sacculus small bag) semicircular canals three canals within the inner ear that contain semē-sirkyū-lăr kă-nalz specialized receptor cells that generate nerve impulses with body movement Symptomatic and Diagnostic Terms Term Meaning SYMPTOMATIC otalgia earache ō-taljē-ă otodynia ō-tō-dinē-ă otorrhagia bleeding from the ear ō-tō-rājē-ă otorrhea purulent drainage from the ear ō-tō-rēă |
tinnitus a jingling; ringing or buzzing in the ear ti-nı̄tŭs vertigo a turning round; dizziness verti-gō DIAGNOSTIC External Ear otitis externa inflammation of the external auditory meatus ō-tı̄tis eks-ternă (canal) (Fig. 13.2B) cerumen impaction excessive buildup of wax in the ear sĕ-rūmen im-pakshŭn Middle Ear myringitis inflammation of the eardrum mir-in-jı̄ tis tympanitis tim-pă-nı̄ tis Chapter 13 • Ear 419 A B Figure 13.2. A. Otoscopic examination of the external auditory meatus (canal). B. Otitis externa. Term Meaning otitis media inflammation of the middle ear (Fig. 13.3C) ō-tı̄ tis mēdē-ă aerotitis media inflammation of the middle ear from changes in ār-ō-t ı̄ tis mēdē-ă atmospheric pressure; often occurs in frequent air travel otosclerosis hardening of the bony tissue in the ear ōtō-sklē-rōsis mastoiditis inflammation of the mastoid process; most commonly mas-toy-dı̄ tis seen as a result of the spread of inflammation and infection in otitis media eustachian obstruction blockage of the eustachian tube usually as a result of yū-stāshŭn ob-strŭkshŭn infection, as in otitis media Inner Ear acoustic neuroma benign tumor on the auditory nerve (8th cranial ă-kŭstik noo-romă nerve) that causes vertigo, tinnitus, and hearing loss aplasia condition of absence or malformation of inner ear ă-plāzē-ă structures during embryonic development, resulting in hearing loss labyrinthitis inflammation of the labyrinth labı̆ -rin-thı̄ tis Ménière disease disorder of the inner ear due to an excessive buildup mĕn-yerz of endolymphatic fluid causing episodes of vertigo, tinnitus, nausea, vomiting, and hearing loss; one or both ears can be affected, and attacks vary in frequency and intensity 420 Medical Terminology: The Language of Health Care Figure 13.3. A. Doctor performing pneumatic otoscopy. B. Normal tympanic membrane. C. Otitis media. Term Meaning General deafness general term for partial or complete hearing loss defnes conductive hearing loss hearing impairment caused by interference with kon-dŭktiv sound or vibratory energy in the external canal, middle ear, or ossicles sensorineural hearing loss hearing impairment caused by lesions or dysfunction sensōr-i-nūrăl of the cochlea or auditory nerve mixed hearing loss combination of sensorineural and conductive hearing loss presbyacusis hearing impairment in old age prezbē-ă-kūsis presbycusis prez-bē-kūsis Chapter 13 • Ear 421 Diagnostic Tests and Procedures Test or Procedure Explanation audiometry process of measuring hearing (Fig. 13.4) aw-dē-omĕ-trē audiometer instrument to measure hearing aw-dē-omĕ-ter audiogram record of hearing measurement awdē-ō-gram audiologist person who specializes in the study of hearing aw-dē-olō-jist impairments auditory acuity physical assessment of hearing; useful in testing differentiating between conductive and awdi-tōr-ē ă-kyūi-tē sensorineural hearing loss (Fig. 13.5) tuning fork two-pronged, fork-like instrument that vibrates when struck: used to test for hearing, especially bone conduction Figure 13.4. Audiometry: hearing screening. 422 Medical Terminology: The Language of Health Care Bone conduction Air conduction A B Figure 13.5. Tuning fork testing. A. Weber test. B. Rinne test. Test or Procedure Explanation brainstem auditory evoked electrodiagnostic testing using computerized potentials (BAEP) equipment to measure involuntary responses to sound within the auditory nervous system— commonly used to assess hearing in newborns (Fig. 13.6) otoscopy use of an otoscope to examine the external auditory ō-toskŏ -pē meatus (canal) and tympanic membrane (Figs. 13.2A and Fig. 13.7) Figure 13.6. Brainstem auditory evoked potentials (BAEP) testing of a newborn. Chapter 13 • Ear 423 Test or Procedure Explanation pneumatic otoscopy otoscopic observation of the tympanic membrane as noo-matik ō-toskŏ-pē air is released into the external auditory meatus (canal); immobility indicates the presence of middle ear effusion (fluid buildup) as occurs as a result of otitis media (see Fig. 13.3A) tympanometry measurement of the compliance and mobility timpă-nomĕ-trē (conductibility) of the tympanic membrane and ossicles of the middle ear by monitoring the response after exposure to external airflow pressures Operative Terms Term Meaning microsurgery surgery with the use of a microscope; used in mı̄ -krō-serjer-ē procedures involving delicate tissue such as the ear myringotomy incision into the eardrum, most often for insertion mir-ing-gotŏ-mē of a small metal or plastic tube [e.g., polyethylene tympanostomy (PE) tube], to keep the meatus (canal) open, timpăn-ostō-mē avoiding fluid buildup (effusion) as that which occurs as a result of otitis media (Fig. 13.8) otoplasty surgical repair of the external ear ōtō-plas-tē stapedectomy excision of the stapes to correct otosclerosis stā-pĕ-dektō-mē tympanoplasty vein graft of a scarred tympanic membrane to timpă-nō-plas-tē improve sound conduction Figure 13.8. View through otoscope shows Figure 13.7. Otoscope. placement of tympanostomy tube. 424 Medical Terminology: The Language of Health Care Therapeutic Terms Term Meaning auditory prosthesis any internal or external device that improves or prosthē-sis substitutes for natural hearing hearing aid external amplifying device designed to improve hearing by more effective collection of sound into the ear cochlear implant electronic device implanted in the cochlea that provides koklē-ă r sound perception to patients with severe or profound sensorineural (nerve) hearing loss in both ears (Fig. 13.9) ear lavage irrigation of the external ear canal, commonly lă -vahzh done to remove excessive buildup of cerumen ear instillation introduction of a medicated solution into the in-sti-lāshŭn external canal COMMON THERAPEUTIC DRUG CLASSIFICATIONS antibiotic drug that inhibits the growth of or destroys antē-bı̄ -otik microorganisms; used to treat diseases caused by bacteria (e.g., otitis media) antihistamine drug that blocks the effects of histamine an-tē-histă-mēn histamine regulating body substance released in excess during histă -mēn allergic reactions that cause swelling and inflammation of tissues; seen in hay fever, urticaria (hives), etc. anti-inflammatory drug that reduces inflammation antē-in-flamă-tō-rē decongestant drug that reduces congestion and swelling of dē-kon-jestant membranes, such as those of the nose and eustachian tube after infection Chapter 13 • Ear 425 Figure 13.9. A and B. Operation of a cochlear im- plant. (1) Directional microphone. (2) Sound is carried from the microphone by a cord to the speech processor worn on the belt or pocket. (3) The speech processor fil- ters, analyzes, and digitizes the sound into coded signals and sends it (4) to the transmitting coil (5). The coil sends the coded signals as FM radio signals to the cochlear im- plant inserted under the skin. The cochlear implant (6) de- livers the electrical energy to the array of electrodes sur- gically inserted into the cochlea (7). The electrodes stimulate the remaining auditory nerve fibers (8), and sound information is sent to the brain for interpretation. Summary of Chapter 13 Acronyms/Abbreviations BAEP .......brainstem auditory evoked potentials TM .............tympanic membrane PE...............polyethylene 426 Medical Terminology: The Language of Health Care PRACTICE EXERCISES For the following terms, on the lines below the term, write out the indicated word parts: prefixes (P), combining forms (CF), roots (R), and suffixes (S). Then define the word. EXAMPLE macrotia _______ / _______ / _______ P R S macr/ot/ia P R S DEFINITION: large or long/ear/condition of 1. acoustic _____________________ / _____________________ R S DEFINITION: _________________________________________________________________ 2. otorrhea _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 3. myringoplasty _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 4. aerotitis _____________________ / _____________________ / _____________________ R R S DEFINITION: _________________________________________________________________ 5. ototoxic _____________________ / _____________________ / _____________________ CF R S DEFINITION: _________________________________________________________________ 6. ceruminolysis _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 7. salpingoscope _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ Chapter 13 • Ear 427 8. hyperacusis _____________________ / _____________________ P S DEFINITION: _________________________________________________________________ 9. audiometry _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 10. tympanocentesis _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 11. otodynia _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 12. auricle _____________________ / _____________________ R S DEFINITION: _________________________________________________________________ 13. myringotomy _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ 14. ceruminosis _____________________ / _____________________ R S DEFINITION: _________________________________________________________________ 15. audiology _____________________ / _____________________ CF S DEFINITION: _________________________________________________________________ Complete the medical term by writing the missing part: 16. oto_____________________osis condition of hardening of the bony tissue of the ear 17. _____________________scope instrument used to view the ear canal and tympanum 18. _____________________ disease disorder of the inner ear due to an excessive buildup of endolymphatic fluid 19. _____________________neuroma tumor of the auditory nerve affecting hearing 428 Medical Terminology: The Language of Health Care For each of the following, circle the combining form that corresponds to the meaning given: 20. eardrum salping/o ot/o myring/o 21. hearing ot/o audi/o angi/o 22. wax cerumin/o crin/o scler/o 23. eustachian tube tympan/o myring/o salping/o 24. ear rhin/o ot/o or/o 25. air acr/o aur/i aer/o Match the following: 26. ________ conductive hearing loss a. presbyacusis 27. ________ one who studies hearing impairments b. aplasia 28. ________ bleeding from the ear c. otalgia 29. ________ partial or complete hearing loss d. cochlear implant 30. ________ sensorineural hearing loss e. otorrhea 31. ________ hearing impairment of old age f. nerve conduction 32. ________ discharge from the ear g. otorrhagia 33. ________ auditory prosthetic h. deafness 34. ________ earache i. audiologist 35. ________ absence of inner ear structures j. bone conduction Write the correct medical term for each of the following: 36. ___________________________________ inflammation of labyrinth 37. ___________________________________ dizziness 38. ___________________________________ ringing in the ear 39. ___________________________________ excision of stapes to correct otosclerosis 40. ___________________________________ excessive buildup of earwax 41. ___________________________________ the study of hearing 42. The introduction of a medicated solution into the external canal is called ear instillation. Irrigation of the external ear canal is called ear ______________. Chapter 13 • Ear 429 Write in the missing words on the blank lines in the following illustration of the ear. 43–50. 43. 46. Ossicles (bones 47. of middle ear) 48. 49. Facial nerve Vestibulocochlear nerve Oval window Round window Tympanic cavity 50. membrane External auditory canal 44. tube (auditory tube) 45. For each of the following, circle the correct spelling of the term: 51. aerotitus aerotitis airotitis 52. cerumen ceramen ceruman 53. myrimogotomy mirongotomy myringotomy 54. presbyecusis presbyacusis presbeacusis 55. vertigo vertago verttigo 56. antihestamine antihistamine antehistamine 57. tinnitis tinitus tinnitus 58. stapedectomy stapesectomy stapedecktomy 59. defness deafnass deafness 60. eustation eustachian euhstation 430 Medical Terminology: The Language of Health Care MEDICAL RECORD ANALYSES M E D I C A L R E C O R D 1 3 . 1 Progress Note S: This 21 y.o white male c/o a clogged R ear c̄ increasing tinnitus. He has had a slight pharyngitis and nasal congestion 7 d. O: On PE there was moist infectious debris in the R ear that was suctioned clear. The R tympanum was dull and thickened. The L external ear was clear and the tympanic membrane intact. A: Otitis media R ear P: (1) Keep ears dry; (2) Rx Pen VK 250 mg #24 ·T q.i.d. p.c. and h.s.; (3) RTO in 10 d for followup (f/u) 1. Summarize the subjective information: a. patient complains of clogged, ringing ears; sore throat; and stuffy nose b. patient has a clogged right ear, sore throat, stuffy nose, and dizziness c. patient’s right eardrum is thick and dull and clogged with infectious matter, causing dizziness d. patient complains of a sore throat, stuffy nose, and a clogged right ear that is buzzing e. patient has a sore throat, stuffy nose, and purulent drainage from the right ear 2. What was the assessment? a. clogged right ear, sore throat, and stuffy nose b. inflammation of the right middle ear c. inflammation of the right external ear canal d. blockage of the eustachian tube e. inflammation of the right eardrum 3. When should the patient take the prescribed medication? a. twice in 24 hours b. before meals c. at bedtime d. four times a day e. every 4 hours 4. Which is true of the plan? a. patient should return to the office immediately if a fever develops b. patient is given ear drops and advised not to get the ears wet for 10 days c. doctor wants to examine the patient again in 10 days d. patient is given an antibiotic and advised to increase fluid intake e. if not better in 10 days, the patient will be referred to an otolaryngologist Chapter 13 • Ear 431 M E D I C A L R E C O R D 1 3 . 2 Hank Ball, a preschooler, has had recurrent ear infections for 1 year that his doctor has not been able to treat successfully with antibiotics and other drugs. His preschool teacher also identified nasal speech patterns that his doctor later confirmed were related to his medical problems. After Hank saw several doctors who recommended surgery, his parents have admitted him to Central Medical |
Center. Directions Read Medical Record 13.2 for Hank Ball (pages 434–436) and answer the following questions. These records are the history and physical examination before surgery and the subsequent operative report, both dictated by Dr. Baird, the surgeon. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 1 3 . 2 Write your answers in the spaces provided. 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record and define below: hepatosplenomegaly ________________________________________________________ turbinates __________________________________________________________________ extubation _________________________________________________________________ 2. In the left column, list the patient’s medical problems noted in the HPI; in the right column, write the diagnosis that pertains to each. Medical Problem Diagnosis a. ______________________________ ______________________________ ______________________________ ______________________________ b. ______________________________ ______________________________ ______________________________ ______________________________ 3. In your own words, explain how Hank’s social history is related to his medical history: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 4. Under the “Review of Systems,” were any additional medical symptoms or problems identified? If so, list below. ____________________________________________________________________________ ____________________________________________________________________________ 432 Medical Terminology: The Language of Health Care 5. What does it mean that at the time of the examination Hank was afebrile? ____________________________________________________________________________ 6. Carefully read the physical examination. Mark the body areas/systems in which Dr. Baird found any abnormalities: __________ general __________ HEENT __________ chest __________ back __________ rectal/genitalia __________ extremities 7. List the surgical procedures identified under “Plan,” and briefly describe them in your own words, not using medical terminology: a. __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ b. __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ c. __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 8. In your own words, not using medical terminology, briefly describe oral intubation. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Chapter 13 • Ear 433 9. Put the following operative actions in correct order by numbering them 1 to 11: __________ removal of adenoids __________ incision in right eardrum __________ PE tube placement in right tympanum __________ repositioning in Rose’s position __________ incision in left eardrum __________ aspiration of right middle ear __________ extubation __________ removal of wax in right ear __________ nasopharynx examination __________ polyethylene tube placement in left tympanum __________ intubation 10. In your own words, not using medical terminology, briefly describe the condition of Hank’s adenoids before adenoidectomy: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 434 Medical Terminology: The Language of Health Care Medical Record 13.2 Chapter 13 • Ear 435 Medical Record 13.2 Continued. 436 Medical Terminology: The Language of Health Care Medical Record 13.2 Continued. Chapter 14 Gastrointestinal System OBJECTIVES After completion of this chapter you will be able to Define common term components used in relation to the gastrointestinal system Describe the basic functions of the gastrointestinal system Define the basic anatomical terms referring to the gastrointestinal system and accessory organs Identify the anatomical and clinical divisions of the abdomen Define common symptomatic and diagnostic terms referring to the gastrointestinal system List the common diagnostic tests and procedures related to the gastrointestinal system Identify common operative terms referring to the gastrointestinal system Identify common therapeutic terms including drug classifications related to the gastrointestinal system Explain the terms and abbreviations used in documenting medical records involving the gastrointestinal system Combining Forms Combining Form Meaning Example abdomin/o abdomen abdominocentesis ab-domi-nō-sen-tēsis celi/o celiac sēlē-ak lapar/o laparoscopy lap-ă-roskŏ-pē an/o anus anal ānăl appendic/o appendix appendical ă-pendi-kăl bil/i bile biligenic bil-i-jenik chol/e cholelithiasis kōlē-li-thı̄ă-sis 437 438 Medical Terminology: The Language of Health Care Combining Form Meaning Example bucc/o cheek buccal bŭkăl cheil/o lip cheiloplasty kı̄lō-plas-tē col/o colon colitis kō-lı̄tis colon/o colonoscopy kō-lon-oskŏ-pē cyst/o bladder or sac cholecystectomy kōlē-sis-tektō-mē dent/i teeth dental dentăl doch/o duct choledochotomy kō-led-ō-kotō-mē duoden/o duodenum duodenal dūō-dēnăl enter/o small intestine enterocele enter-ō-sēl esophag/o esophagus esophageal ē-sofă-jēăl gastr/o stomach gastritis gas-trı̄tis gingiv/o gum gingivitis jin-ji-vı̄tis gloss/o tongue glossitis glo-sı̄tis lingu/o lingual linggwăl hepat/o liver hepatomegaly hepă-tō-megă-lē hepatic/o hepaticotomy he-pat-i-kotō-mē herni/o hernia herniorrhaphy hernē-ōră-fē ile/o ileum ileostomy ilē-ostō-mē inguin/o groin inguinal inggwi-năl jejun/o jejunum (empty) jejunitis je-jū-nı̄tis lith/o stone lithiasis li-thı̄ă-sis Chapter 14 • Gastrointestinal System 439 Combining Form Meaning Example or/o mouth oral orăl stomat/o stomatosis stō-mă-tōsis pancreat/o pancreas pancreatitis pankrē-ă-tı̄tis peritone/o peritoneum peritoneoscopy peri-tō-nē-oskŏ-pē phag/o eat or swallow aphagia ă-fājē-ă proct/o anus and rectum proctologic prok-tō-lojik pylor/o pylorus (gatekeeper) pyloric pı̄-lōrik rect/o rectum rectal rektăl sial/o saliva sialolithiasis sı̄ă-lō-li-thı̄ă-sis sigmoid/o sigmoid colon (resembles s) sigmoidoscopy sigmoy-doskŏ-pē steat/o fat steatolysis stē-ă-toli-sis ADDITIONAL SUFFIX -emesis vomiting hematemesis hē-mă-temĕ-sis Gastrointestinal System Overview The gastrointestinal (GI) system processes and transports nutrients and various wastes. The organs form a tube or tract, known as the alimentary canal, extending from the mouth to the anus. The alimentary canal is composed of the mouth, pharynx, esophagus, stomach, and intestines (Fig. 14.1). The gastrointestinal system has three functions: digestion, absorption, and excre- tion. Digestion is the process by which food is broken down by chewing and swallow- ing and is then mixed with digestive juices in the stomach to convert some of the food into absorbable molecules. Absorption is the passage of digested food molecules through the walls of the intestines into the bloodstream to be carried to the body cells. Excretion is the elimination of materials that are not absorbed (waste products) by transporting them outside the body. The accessory organs that aid in the digestion and absorption of food are the teeth, salivary glands, liver, gallbladder, and pancreas. Stomach Cardiac sphincter Esophagus Liver Fundus Gallbladder Tongue Small Esophagus intestine (duodenum, Lesser curvature Body jejunum, Lesser omentum ileum) Stomach Pancreas Duodenum Pyloric sphincter Pylorus Rugae Greater Greater omentum curvature Duodenum, gallbladder, pancreas, and liver Large intestine Rectum Anus Liver Gallbladder Hepatic duct Cystic duct Common bile duct Duodenum Duodenal papilla Pancreas Pancreatic duct Sphincter (of Oddi) Large intestine Duodenal ampulla Transverse colon Descending colon Ascending colon Ileocecal valve Ileum Cecum Appendix Sigmoid colon Rectum Anal canal Anus Figure 14.1 Gastrointestinal system. Chapter 14 • Gastrointestinal System 441 Anterior view Gums Incisors Soft palate Canine Premolars Uvula Palatoglossal arch Molars Palatine tonsil Dorsum of tongue Premolars Canine Incisors Figure 14.2 Oral cavity. Anatomical Terms Term Meaning oral cavity cavity that receives food for digestion (Fig. 14.2) mouth salivary glands three pairs of exocrine glands in the mouth that secrete saliva: sali-vār-ē parotid, submandibular (submaxillary), and sublingual cheeks lateral walls of the mouth lips fleshy structures surrounding the mouth palate structure that forms the roof of the mouth; it is divided into palăt the hard and soft palate uvula small projection hanging from the back middle edge of the yūvyū-lă soft palate tongue muscular structure of the floor of the mouth covered by mucous membrane and held down by a band-like membrane known as the frenulum gums tissue covering the processes of the jaws teeth hard bony projections in the jaws that serve to masticate (chew) food 442 Medical Terminology: The Language of Health Care Term Meaning pharynx throat; passageway for food traveling to the esophagus faringks and air traveling to the larynx esophagus muscular tube that moves food from the pharynx to ē-sofă-gŭs the stomach stomach sac-like organ that chemically mixes and prepares food stŭmŭk received from the esophagus cardiac sphincter opening from the esophagus to the stomach kardē-ak sfingkter (sphincter band) pyloric sphincter opening of the stomach into the duodenum pı̄-lōrik sfingkter small intestine tubular structure that digests food received from the DUODENUM. The Latin word in-testin stomach for 12 is the duodenum first portion of the small intestine origin of the name for the dū-ō-dēnŭm first part of the small intestine because the length of the jejunum second portion of the small intestine structure was estimated to jĕ-jūnŭm be 12 fingerbreadths. ileum third portion of the small intestine JEJUNUM. The ilē-ŭm Latin word large intestine larger tubular structure that receives the liquid waste meaning empty products of digestion, reabsorbs water and minerals, or hungry was used for the and forms and stores feces for defecation portion of the small intestine that follows the duodenum cecum first part of the large intestine because the ancients noted sekŭm it was always empty after death. vermiform appendix worm-like projection of lymphatic tissue hanging off vermi-fōrm ă-pendiks the cecum with no digestive function—may serve to resist infection (vermi worm) colon portions of the large intestine extending from the kōlon cecum to the rectum; identified by direction or shape ascending colon portion that extends upward from the cecum as-sending transverse colon portion that extends across from the ascending colon trans-vers descending colon portion that extends down from the transverse colon dē-sending sigmoid colon portion (resembling an s) that terminates at the rectum sigmoyd rectum distal (end) portion of the large intestine rektŭm rectal ampulla dilated portion of the rectum just above the anal canal rektăl am-pūllă anus opening of the rectum to the outside of the body ānŭs feces refuse; solid waste formed in the large intestine fēsēz Chapter 14 • Gastrointestinal System 443 Term Meaning defecation evacuation of feces from the rectum def-ĕ-kāshŭn peritoneum membrane surrounding the entire abdominal cavity peri-tō-neŭm consisting of the parietal layer (lining the abdominal wall) and visceral layer (covering each organ in the abdomen) peritoneal cavity space between the parietal and visceral peritoneum per-i-tō-nēăl omentum a covering; an extension of the peritoneum attached to the ō-mentŭm stomach and connecting it with other abdominal organs liver organ in the upper right quadrant that produces bile, which is secreted into the duodenum during digestion PANCREAS. The Greek word for gallbladder receptacle that stores and concentrates the bile produced sweetbread is gawlblad-er in the liver formed by the combination of -creas, meaning flesh, pancreas gland that secretes pancreatic juice into the duodenum, and pan-, meaning all. The pankrē-as where it mixes with bile to digest food organ was so named biliary ducts ducts that convey bile, including hepatic, cystic, and because of its meaty or bilē-ār-ē common bile ducts fleshy character. Aristotle used the term. Anatomical and Clinical Divisions of the Abdomen Anatomical and clinical divisions of the abdomen provide specific or general reference for descriptive purposes. There are nine specific anatomical divisions and four general clinical divisions (Figs. 14.3–14.5). All references are based on the patient’s right or left. Right Left hypochondriac hypochondriac region region Epigastric region Umbilical region Right lumbar Left lumbar region region Hypogastric region Right inguinal Left inguinal region region Figure 14.3 Anatomical divisions of the abdomen. 444 Medical Terminology: The Language of Health Care Right upper Left upper quadrant (RUQ) quadrant (LUQ) Right lower Left lower quadrant (RLQ) quadrant (LLQ) Figure 14.4 Clinical divisions of the abdomen. HYPOCHONDRIAC. This Greek word meaning below the Anatomical Divisions cartilage was used to refer to regions below the cartilages of Region Location the ribs. In these hypochondriac regions, hypochondriac regions upper lateral regions beneath the ribs various sensations of a hı̄-pō-kondrē-ak distressing nature were epigastric region upper middle region below the sternum sometimes experienced without apparent organic ep-i-gastrik disease. People with such lumbar regions middle lateral regions complaints were called lŭmbar hypochondriacs. Today, hypochondria refers to one who has an abnormal concern for one’s health with the false Right upper quadrant pain Left upper quadrant pain belief that he or she is suffering Gallbladder and Gastritis from disease. biliary tract Pancreatitis Cholecystitis Splenomegaly Hepatitis Renal pain Peptic ulcer Myocardial ischemia Renal pain Pneumonia Pneumonia Right lower quadrant pain Left lower quadrant pain Appendicitis Diverticulitis Intestinal obstruction Intestinal obstruction Diverticulitis Ectopic pregnancy Ectopic pregnancy Ovarian cyst Ovarian cyst Salpingitis Salpingitis Endometriosis Endometriosis Ureteral calculi Ureteral calculi Renal pain Renal pain Figure 14.5 Common sites of abdominal pain characteristic of various conditions. Chapter 14 • Gastrointestinal System 445 Region Location umbilical region region of the navel ŭm-bili-kăl inguinal regions lower lateral groin regions inggwi-năl hypogastric region region below the navel hı̄-pō-gastrik Symptomatic and Diagnostic Terms Term Meaning SYMPTOMATIC anorexia loss of appetite (orexia appetite) an-ō-reksē-ă aphagia inability to swallow ă-fājē-ă ASCITES. A Greek word for ascites accumulation of fluid in the peritoneal cavity (ascos bag) pouch or sac ă-sı̄tēz (Fig. 14.6) referring to the appearance buccal in the cheek of the abdomen with the bŭkăl collection of fluid in the peritoneal cavity. Figure 14.6 Side view of a patient showing massive ascites and distention of abdomen. 446 Medical Terminology: The Language of Health Care Term Meaning constipation infrequent or incomplete bowel movements kon-sti-pāshŭn characterized by hardened, dry stool that is difficult to pass (constipo to press together) diarrhea frequent loose |
or liquid stools dı̄-ă-rēă dyspepsia indigestion (peptein to digest) dis-pepsē-ă dysphagia difficulty in swallowing dis-fājē-ă eructation belch ē-rūk-tāshŭn flatulence gas in the stomach or intestines (flatus a blowing) flatyū-lens halitosis bad breath (halitus breath) hal-i-tōsis hematochezia red blood in the stool (chezo defecate) ICTERUS. Icterus hēmă-tō-kēzē-ă is a Greek word hematemesis vomiting blood for jaundice hē-mă-temĕ-sis meaning yellow bird. The yellow color associated with hepatomegaly enlargement of the liver the condition was thought hepă-tō-megă-lē similar to the color of this bird. It was said that if a hyperbilirubinemia excessive level of bilirubin (bile pigment) in the blood person suffering from hı̄per-bili-rū-bi-nēmē-ă jaundice looks at the bird, the bird dies and the patient icterus yellow discoloration of the skin, sclera (white of the recovers. ikter-ŭs eye), and other tissues caused by excessive bilirubin jaundice in the blood (jaundice yellow) (Fig. 14.7) NAUSEA. jawndis Nausea is melena dark-colored, tarry stool caused by old blood derived from a me-lēnă Greek word for ship referring to “ship sickness.” nausea sick in the stomach Hippocrates used the term nawzē-ă for seasickness; later, it became generally applied steatorrhea feces containing fat to the sick and uneasy steă-tō-rēă feeling that precedes vomiting. Figure 14.7 The yellow color of jaundice (icterus) is easily seen in the sclera of this patient and also in the skin as contrasted with the examiner’s hand. Chapter 14 • Gastrointestinal System 447 Term Meaning sublingual under the tongue sŭb-linggwăl hypoglossal hı̄-pō-glosăl DIAGNOSTIC stomatitis inflammation of the mouth stō-mă-tı̄tis sialoadenitis inflammation of a salivary gland siă-lō-ad-ĕ-nı̄tis parotitis (parotiditis) inflammation of the parotid gland; also par-ō-tı̄tis called mumps cheilitis inflammation of the lip kı̄-lı̄tis glossitis inflammation of the tongue glo-sı̄tis ankyloglossia tongue-tie; a defect of the tongue angki-lō-glosē-ă characterized by a short, thick frenulum (ankyl/o crooked or stiff) gingivitis inflammation of the gums jin-ji-vı̄tis esophageal varices swollen, twisted veins in the esophagus ē-sofă-jēăl especially susceptible to ulceration and hemorrhage (see Fig. 14.15) esophagitis inflammation of the esophagus ē-sof-ă-jı̄tis gastritis inflammation of the stomach gas-trı̄tis (see Fig. 14.15) gastroesophageal reflux disease (GERD) backflow of stomach contents into the gastrō-ē-sofă-jēăl rēflŭks di-zēz esophagus, often as a result of abnormal function of the lower esophageal sphincter; causes burning pain in the esophagus pyloric stenosis narrowed condition of the pylorus pı̄-lōrik ste-nōsis peptic ulcer disease (PUD) a sore on the mucous membrane of the peptik ŭlser di-zēz stomach, duodenum, or any other part of the gastrointestinal system exposed to gastric juices; commonly caused by infection with Helicobacter pylori bacteria (pept/o to digest) (Fig. 14.8) gastric ulcer ulcer located in the stomach gastrik duodenal ulcer ulcer located in the duodenum dūō-dēnăl 448 Medical Terminology: The Language of Health Care Excessive amounts of acid and pepsin are released into the stomach Gastric juices (acidic) Ulcer Duodenal Gastric Excess secretions ulcer ulcer overwhelm resistance of stomach lining and eventually break it down, forming an ulceration Figure 14.8 Peptic ulcer disease. Term Meaning gastroenteritis inflammation of the stomach and small intestine gastrō-en-ter-ı̄tis enteritis inflammation of the small intestine en-ter-ı̄tis ileitis inflammation of the lower portion of the small intestine il-ē-ı̄tis colitis inflammation of the colon (large intestine) kō-lı̄tis ulcerative colitis chronic inflammation of the colon along with ulcerations ŭlser-ă-tiv diverticulum a by-way; an abnormal side pocket in the gastrointestinal dı̄-ver-tikyū-lŭm tract usually related to a lack of dietary fiber diverticulosis presence of diverticula in the gastrointestinal tract, dı̄ver-tik-yū-lōsis especially in the bowel (Fig. 14.9; also see Fig. 14.15) diverticulitis inflammation of diverticula dı̄ver-tik-yū-lı̄tis dysentery inflammation of the intestine characterized by frequent, disen-tār-ē bloody stools, most often caused by bacteria or protozoa (e.g., amebic dysentery) Chapter 14 • Gastrointestinal System 449 Opening of diverticulum Diverticula Large intestine Figure 14.9 Diverticulosis. Term Meaning appendicitis inflammation of the appendix ă-pen-di-sı̄tis hernia protrusion of a part from its normal location hernē-ă hiatal hernia protrusion of part of the stomach upward through the hı̄-ātăl hiatal opening in the diaphragm (Fig. 14.10) inguinal hernia protrusion of a loop of the intestine through layers of the inggwi-năl abdominal wall in the inguinal region (see Fig. 14.10) incarcerated hernia hernia that is swollen and fixed within a sac, causing in-karser-ā-ted an obstruction strangulated hernia hernia that is constricted, cut off from circulation, and stranggyū-lā-ted likely to become gangrenous umbilical hernia protrusion of the intestine through a weakness in the ŭm-bili-kăl abdominal wall around the umbilicus (navel) intussusception prolapse of one part of the intestine into the lumen of the intŭs-sŭ-sepshŭn adjoining part (intus within; suscipiens to take up) (Fig. 14.11) volvulus twisting of the bowel on itself, causing obstruction volvū-lŭs (volvo to roll) (Fig. 14.12) polyposis multiple polyps in the intestine and rectum with a high poli-pōsis malignancy potential (see Fig. 14.15) polyp tumor on a stalk polip proctitis inflammation of the rectum and anus prok-tı̄tis anal fistula abnormal tube-like passageway from the anus that may ānăl fistyū-lă connect with the rectum (fistula pipe) (Fig. 14.13) 450 Medical Terminology: The Language of Health Care Hiatal hernia Herniation of the stomach through Diaphragm the hiatal opening Diaphragm Stomach Inguinal hernia Direct inguinal hernia Figure 14.10 Common hernias. Cross section of intussusception of small intestine Small Large intestine intestine Figure 14.11 Intussusception. Chapter 14 • Gastrointestinal System 451 Large intestine Small intestine Twisted portion of small intestine Small intestine is twisted upon itself Figure 14.12 Volvulus. Term Meaning hemorrhoid swollen, twisted vein (varicosity) in the anal region hemŏ -royd (haimorrhois a vein likely to bleed) peritonitis inflammation of the peritoneum peri-tō -nı̄tis hepatitis inflammation of the liver hep-ă-tı̄tis hepatitis A infectious inflammation of the liver caused by the hepatitis A virus (HAV), usually transmitted orally through fecal contamination of food or water hepatitis B infectious inflammation of the liver caused by the hepatitis B virus (HBV) that is transmitted sexually or by exposure to contaminated blood or body fluids hepatitis C inflammation of the liver caused by the hepatitis C virus (HCV) transmitted by exposure to infected blood (rarely contracted sexually) CIRRHOSIS. A cirrhosis chronic disease characterized by degeneration of liver tissue, most Greek word sir-rō sis often caused by alcoholism or a nutritional deficiency referring to a (cirrho yellow) yellow condition, cirrhosis was first applied to the cholangitis inflammation of the bile ducts fibrosis of the liver in kō -lan-jı̄tis alcoholics because the cholecystitis inflammation of the gallbladder granular deposits in the organ looked yellow. kō lē-sis-tı̄tis Opening Anal fistula Anus Anal fistula Figure 14.13 Anal fistula. 452 Medical Terminology: The Language of Health Care Term Meaning cholelithiasis presence of stones in the gallbladder or bile kō lē-li-thı̄ă-sis ducts (Fig. 14.14; also see Fig. 14.21B) choledocholithiasis presence of stones in the common bile duct kō -ledō -kō -lith-ı̄ă-sis (see Figs. 14.14 and 14.15) pancreatitis inflammation of the pancreas pankrē-ă-tı̄tis Diagnostic Tests and Procedures Test or Procedure Explanation endoscopy examination within a body cavity with a en-doskŏ -pē flexible endoscope for diagnosis or treatment; used in the gastrointestinal tract to detect abnormalities and perform procedures such as biopsies, excision of lesions, dilations of narrowed areas, and removal of swallowed objects (Fig. 14.15) esophagoscopy examination of the esophagus with an ē-sof-ă-goskŏ -pē esophagoscope gastroscopy examination of the stomach with a gas-troskŏ -pē gastroscope upper gastrointestinal endoscopy examination of the lining of the esophagus, gastrō -in-testin-ăl stomach, and duodenum with a flexible endoscope; also known as esophagogastroduodenoscopy (EGD) or panendoscopy (see Fig. 14.15) endoscopic retrograde endoscopic procedure including x-ray cholangiopancreatography (ERCP) fluoroscopy to examine the ducts of the en-doskŏpik retrō -grād liver, gallbladder, and pancreas (biliary kō -lanjē-ō -pan-krē-ă-togră-fē ducts) Intrahepatic Liver Stomach Common hepatic duct Gallbladder Cystic duct Common bile duct Ampulla Pancreas Figure 14.14 Sites of gallstones. The endoscope, an instrument for viewing and photographing Fiberoptics in the endoscope conduct bright, cool internal cavities of the body, is used for evaluating pathological light along a curved path, allowing illumination of conditions and performing minimally invasive corrective procedures. tissues and structures within the body. A color video Endoscope camera converts the optical images into electrical signals, which are displayed on a monitor. The pictures below were taken endoscopically. Tongue Esophageal Esophagus varices Stomach Duodenum Gastritis Gallbladder and common bile duct Jejunum Common bile duct stone extraction Gastrointestinal tract can be thought of as a long tube, folded to fit in the body; unfolded, it reveals its parts in a clear sequence. Ileum Diverticulosis Cecum and appendix Colon polypectomy Colon For endoscopic views of the lower portions of the digestive system, colon, and rectum, an endoscope is inserted through the anus. Rectum Anus Figure 14.15 Endoscopy of gastrointestinal system. Small intestine not drawn to scale; average length in adult is about 20 feet 454 Medical Terminology: The Language of Health Care Test or Procedure Explanation laparoscopy examination of the abdominal cavity with a lap-ă-roskŏ -pē laparoscope—often including interventional surgical procedures (Fig. 14.16) peritoneoscopy examination of the peritoneal cavity with a peri-tō -nē-oskŏ -pē peritoneoscope; often performed to examine the liver and obtain a biopsy specimen capsule endoscopy examination of the small intestine made by a tiny kapsool video camera placed in a capsule and swallowed; images are transmitted to a waist-belt recorder and downloaded onto a computer for assessment of possible abnormalities; traditional endoscopy cannot completely access the small intestine because of its length and complexity colonoscopy examination of the colon using a flexible colonoscope kō -lon-oskŏ -pē (see Fig. 14.15) sigmoidoscopy examination of the sigmoid colon with a rigid or sigmoy-doskŏ -pē flexible sigmoidoscope proctoscopy examination of the rectum and anus with a prok-toskŏ -pē proctoscope DIAGNOSTIC IMAGING magnetic resonance nonionizing imaging technique for visualizing the image of the abdomen abdominal cavity to identify disease or deformity in the gastrointestinal tract nuclear medicine radionuclide organ imaging liver scan scan of the liver made after injection of radioactive tracers into the bloodstream; used to detect tumors and functional abnormalities Laparoscope Liver Laparoscopic sleeve Gallbladder Uterus Spleen Bladder Stomach Large intestine Small intestine Fallopian tube Spleen Ovary Kidney Large Diaphragm Adrenal intestine Appendix gland Figure 14.16 Laparoscopy. Chapter 14 • Gastrointestinal System 455 Figure 14.17 Plain radiograph (without contrast) showing two impacted for- eign bodies in a child, aged 2 1/2 years. This child has ingested a safety pin and an ornamental pin. Endoscopic removal was required. Test or Procedure Explanation radiography x-ray imaging (Fig. 14.17) rādē-ogră-fē upper GI series x-ray of the esophagus, stomach, and duodenum after the patient has swallowed a contrast medium (barium is most commonly used) (Fig. 14.18) barium swallow x-ray of the esophagus only; often used to locate barē-ŭm swallowed objects fluoroscopy x-ray using a fluorescent screen to visualize structures flūr-oskŏ -pe in motion (such as during a barium swallow) small bowel series x-ray exam of the small intestine—generally done in conjunction with an upper GI series lower GI series x-ray of the colon after administration of an enema barium enema containing a contrast medium (Fig. 14.19) enĕ-mă cholangiogram x-ray of the bile ducts; often performed during surgery kō-lanjē-ō-gram cholecystogram x-ray of the gallbladder taken after oral ingestion of iodine kō -lē-sistō -gram 456 Medical Terminology: The Language of Health Care Figure 14.19 Barium enema radiograph of the colon showing a ruptured diverticulum. Its elongated appearance is similar to that of a deflated balloon. Figure 14.18 Upper gastrointestinal radiograph showing a hiatal hernia. Test or Procedure Explanation computed tomography cross-sectional x-ray of the abdomen used to identify (CT) of abdomen a condition or anomaly within the gastrointestinal tō -mogră-fē tract (e.g., tumor, injury) (Fig. 14.20) CT colonography computed tomographic image of the colon performed as an alternative to traditional invasive colonoscopy; also known as virtual colonoscopy sonography ultrasound imaging sŏ -nogră-fē abdominal sonogram ultrasound image of the abdomen to detect disease sonō -gram or deformity in organs and vascular structures (e.g., liver, pancreas, gallbladder, spleen, aorta) (Fig. 14.21) endoscopic sonography endoscopic procedure using a sonographic endō-skŏpik transducer within an endoscope to examine a body cavity and make sonographic images of structures and tissues Chapter 14 • Gastrointestinal System 457 Figure 14.20 A. CT scan of a patient involved in a motor vehicle accident demonstrates a jagged laceration (arrows) extending from the posterior to inferior vena cava (V ) through the right lobe of the liver (L). S, spleen. B. CT scanner. Test or Procedure Explanation LABORATORY STUDIES biopsy (Bx) removal of tissue for microscopic pathological bı̄op-sē examination endoscopic biopsy removal of a specimen for biopsy during |
an endoscopic procedure (e.g., colonoscopy) excisional biopsy removal of an entire lesion for examination ek-sizhŭn-ăl 458 Medical Terminology: The Language of Health Care A Figure 14.21 A. Abdominal sonography procedure. B. Abdominal sonogram of two stones present in the gallbladder (arrows). Test or Procedure Explanation incisional biopsy removal of a portion of a lesion for examination in-sizhŭn-ăl needle biopsy percutaneous removal of a core specimen of tissue using a special hollow needle (e.g., liver biopsy) (Fig. 14.22) stool culture and isolation of a stool specimen in a culture medium sensitivity (C&S) to identify disease-causing organisms; if present, the drugs to which they are sensitive are listed stool occult blood study chemical test of a stool specimen to detect the presence of blood; positive findings indicate bleeding in the gastrointestinal tract Lung 6th rib Diaphragm Liver 7th rib Figure 14.22 Liver biopsy procedure. Chapter 14 • Gastrointestinal System 459 Operative Terms Term Meaning bariatric surgery treatment of morbid obesity by surgery to the stomach bar-ē-atrik and/or intestines; procedures include restrictive techniques that limit the size of the stomach and malabsorptive techniques that limit the absorption of food (baros weight; iatric pertains to treatment) cheiloplasty repair of the lip kı̄lō -plas-tē glossectomy excision of all or part of the tongue glo-sektō-mē glossorrhaphy suture of the tongue glo-sōră-fē esophagoplasty repair of the esophagus ē-sofă-gō-plas-tē gastrectomy partial or complete removal of the stomach gas-trektō-mē gastric resection partial removal and repair of the stomach gastrik rē-sekshŭn abdominocentesis puncture of the abdomen for aspiration of fluid ab-domi-nō-sen-tēsis (e.g., fluid accumulated in ascites) paracentesis pară-sen-tēsis laparotomy incision into the abdomen lapă-rotō-mē laparoscopic surgery abdominal surgery using a laparoscope lapă-rō-skōpik herniorrhaphy repair of a hernia hernō-ōră-fē hernioplasty hernē-ō-plas-tē colostomy creation of an opening in the colon through the kō-lostō-mē abdominal wall to create an abdominal anus allowing stool to bypass a diseased portion of the colon; performed to treat ulcerative colitis, cancer, or obstructions (Fig. 14.23) anastomosis union of two hollow vessels; used in bowel surgery ă-nastō-mōsis ileostomy surgical creation of an opening on the abdomen to which ilē-ostō-mē the end of the ileum is attached, providing a passageway for ileal discharges; performed after removal of the colon (e.g., to treat chronic inflammatory bowel diseases such as ulcerative colitis) 460 Medical Terminology: The Language of Health Care 1. Ascending colostomy 2. Transverse colostomy 3. Descending colostomy 4. Sigmoid colostomy Figure 14.23 Common colostomy sites. Term Meaning appendectomy excision of a diseased appendix ap-pen-dektō -mē incidental appendectomy removal of the appendix during abdominal surgery for another procedure (e.g., a hysterectomy) polypectomy excision of polyps pol-i-pektō -mē proctoplasty repair of the anus and rectum proktō -plas-tē anal fistulectomy excision of an anal fistula fis-tyū-lektō -mē hemorrhoidectomy excision of hemorrhoids hemō -roy-dektō -mē hepatic lobectomy excision of a lobe of the liver he-patik lō -bektō -mē cholecystectomy excision of the gallbladder kō lē-sis-tektō -mē laparoscopic cholecystectomy excision of the gallbladder through a lapă-rō -skŏpik laparoscope cholelithotomy incision for removal of gallstones kō le-li-thotō -mē choledocholithotomy incision of the common bile duct for kō -ledō -kō -li-thotō -mē extraction of gallstones cholelithotripsy crushing of gallstones kō -lē-lithō -trip-sē pancreatectomy excision of the pancreas pankrē-ă-tektō -mē Chapter 14 • Gastrointestinal System 461 Therapeutic Terms Term Meaning gastric lavage oral insertion of a tube into the stomach for gastrik lă-vahzh examination and treatment [e.g., to remove blood clots from the stomach and monitor bleeding (lavage to wash)] nasogastric (NG) intubation insertion of a tube through the nose into the nā-zō -gastrik in-tū-bāshŭn stomach for various purposes (e.g., to obtain a gastric fluid specimen for analysis) COMMON THERAPEUTIC DRUG CLASSIFICATIONS antacid drug that neutralizes stomach acid ant-asid antiemetic drug that prevents or stops vomiting antē-ĕ-metik antispasmodic drug that decreases motility in the gastrointestinal antē-spaz-modik tract to arrest spasm or diarrhea cathartic drug that causes movement of the bowels; also kă-thartik called a laxative Summary of Chapter 14 Acronyms/Abbreviations Bx .....................biopsy HBV ................hepatitis B virus C&S.................culture and sensitivity HCV ................hepatitis C virus CT .....................computed tomography LLQ .................left lower quadrant EGD ................esophagogastroduodenoscopy LUQ.................left upper quadrant ERCP .............endoscopic retrograde MRI .................magnetic resonance imaging cholangiopancreatography NG....................nasogastric GERD ............gastroesophageal reflux disease PUD.................peptic ulcer disease GI......................gastrointestinal RLQ.................right lower quadrant HAV ................hepatitis A virus RUQ ................right upper quadrant 462 Medical Terminology: The Language of Health Care PRACTICE EXERCISES For the following terms, on the lines below the term, write out the indicated word parts: prefixes (P), combining forms (CF), roots (R), and suffixes (S). Then define the word. EXAMPLE sublingual ______/ ____________/ __________ P R S sub/lingu/al P R S DEFINITION: below or under/tongue/pertaining to 1. transabdominal __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 2. gastroenterostomy __________________ / __________________ / __________________ CF CF S DEFINITION: _________________________________________________________________ 3. sialolithotomy __________________ / __________________ / __________________ CF CF S DEFINITION: _________________________________________________________________ 4. glossorrhaphy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 5. hematemesis __________________ / __________________ R S DEFINITION: _________________________________________________________________ 6. cheilostomatoplasty ___________________ / __________________ / __________________ CF CF S DEFINITION: _________________________________________________________________ Chapter 14 • Gastrointestinal System 463 7. appendicitis __________________ / __________________ R S DEFINITION: _________________________________________________________________ 8. celiotomy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 9. cholangiogram ___________________ / __________________ / __________________ R CF S DEFINITION: _________________________________________________________________ 10. colonoscopy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 11. anorectal ___________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 12. enterocolitis ___________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 13. orolingual ___________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 14. proctosigmoidoscopy ____________________ / __________________ / __________________ CF CF S DEFINITION: _________________________________________________________________ 15. laparoscope __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 16. dysphagia ____________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 464 Medical Technology: The Language of Health Care 17. pancreatoduodenostomy ____________________ / __________________ / __________________ CF CF S DEFINITION: _________________________________________________________________ 18. hernioplasty __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 19. biliary __________________ / __________________ R S DEFINITION: _________________________________________________________________ 20. gastroesophageal ___________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 21. choledochotomy ___________________ / __________________ / __________________ CF CF S DEFINITION: _________________________________________________________________ 22. steatorrhea __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 23. dentalgia __________________ / __________________ R S DEFINITION: _________________________________________________________________ 24. pylorospasm __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 25. hepatotoxic ___________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 26. ileojejunitis ___________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ Chapter 14 • Gastrointestinal System 465 27. peritoneocentesis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 28. buccogingival ___________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 29. cholecystectomy ___________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 30. perirectal ___________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ Complete the medical term by writing the missing part or word: 31. hemi ____________________ ectomy removal of half of the colon 32. ____________________ itis inflammation of the appendix 33. ____________________ rrhaphy suture of the lip 34. cholelitho ____________________ incision for removal of gallstones 35. ____________________ plasty surgical repair of the mouth 36. chol ____________________ gram x-ray of bile ducts (vessels) 37. ____________________ bilirubin ____________________ excessive level of bilirubin in the blood 38. gastric ____________________ partial removal and repair of the stomach 39. diverticulo ____________________ the presence of diverticula For each of the following, circle the combining form that corresponds to the meaning given: 40. abdomen gastr/o lapar/o stomat/o 41. tongue gloss/o proct/o gingiv/o 42. small intestine col/o appendic/o enter/o 43. teeth dent/i chol/e lingu/o 466 Medical Terminology: The Language of Health Care 44. stomach lapar/o stomat/o gastr/o 45. cheek bucc/o or/o proct/o 46. bile col/o celi/o chol/e 47. mouth gastr/o stomat/o lapar/o 48. liver hepat/o nephr/o ren/o 49. eat phas/o phag/o gloss/o 50. stone scler/o steat/o lith/o 51. rectum an/o proct/o col/o Write the correct medical term for each of the following: 52. inflammation of the stomach ________________________________________________ 53. loss of appetite _____________________________________________________________ 54. inability to swallow _________________________________________________________ 55. in the cheek ________________________________________________________________ 56. gas in the stomach or intestines ______________________________________________ 57. rupture or protrusion of a part from its normal location _______________________ 58. black tarry stool ____________________________________________________________ 59. belch ______________________________________________________________________ 60. instrument used to examine the rectum _______________________________________ 61. inflammation of the large intestine ___________________________________________ 62. portion of upper GI series x-ray used to examine the esophagus only ___________ 63. accumulation of fluid in the peritoneal cavity _________________________________ 64. inflammation of the gallbladder ______________________________________________ 65. feces containing fat _________________________________________________________ 66. presence of inflamed abnormal side pockets in gastrointestinal tract ____________ 67. peptic ulcer located in the stomach ___________________________________________ 68. enlargement of the liver _____________________________________________________ 69. tongue-tie condition ________________________________________________________ Chapter 14 • Gastrointestinal System 467 Name the anatomical divisions of the abdomen: 70. lower lateral groin regions ___________________________________________________ 71. upper lateral regions beneath the ribs ________________________________________ 72. upper middle region below the sternum ______________________________________ 73. region below the navel ______________________________________________________ 74. middle lateral regions _______________________________________________________ 75. region of the navel __________________________________________________________ Name the clinical divisions of the abdomen: 76. _____________________________________________________________ 77. _____________________________________________________________ 78. _____________________________________________________________ 79. _____________________________________________________________ Match the following terms: 80. ________ cathartic a. cholelithotripsy 81. ________ herniorrhaphy b. barium swallow 82. ________ appendicitis c. bariatric surgery 83. ________ lower GI series d. appendectomy 84. ________ icterus e. colostomy 85. ________ peptic ulcer disease f. hernioplasty 86. ________ abdominocentesis g. H. pylori bacterial infection 87. ________ parotitis h. barium enema 88. ________ sublingual i. mumps 89. ________ upper GI series j. paracentesis 90. ________ ulcerative colitis k. jaundice 91. ________ cholelithiasis l. hypoglossal 92. ________ morbid obesity m. laxative 468 Medical Terminology: The Language of Health Care An endoscope is an instrument used to examine within the body. Name the specific type of endoscope used to examine the following body parts: 93. abdomen _________________________________________________________________ 94. anus _____________________________________________________________________ 95. stomach _________________________________________________________________ 96. colon ____________________________________________________________________ 97. peritoneal cavity __________________________________________________________ 98. esophagus ________________________________________________________________ 99. Which type of hernia is swollen and fixed within a sac, causing obstruction? ____________________________________________________________ 100. Which type of biopsy involves the removal of an entire growth? _______________ Write the full medical term for the following abbreviations: 101. NG tube __________________________________________________________________ 102. ERCP ____________________________________________________________________ 103. GERD ____________________________________________________________________ 104. LUQ ______________________________________________________________________ 105. GI ________________________________________________________________________ 106. MRI ______________________________________________________________________ 107. EGD ______________________________________________________________________ Chapter 14 • Gastrointestinal System 469 Write in the term components related to each of the gastrointestinal organs on the blank lines provided in the following illustration. 108–115. 108. 109. 112. 110. Esophagus (duodenum, jejunum, ileum) 113. Pancreas 111. 114. 115. For each of the following, circle the correct spelling of the term: 116. anorexia annorexia anorrexia 117. asites ascitis ascites 118. hematochesia hemochezia hematochezia 119. icterus ickterus icteris 120. ankleoglossia ankyloglosia ankyloglossia 121. volvulis volvulus volvolus 122. cirhosis cirrhosus cirrhosis 123. glossectomy glozectomy glosectomy 124. hernniorhaphy herniorraphy herniorrhaphy 125. hemorroidectomy hemroidectomy hemorrhoidectomy 470 Medical Terminology: The Language of Health Care 126. anteacid anacid antacid 127. antiemetic antemetic antaemetic 128. cathartik cathartic catarthic 129. melena melenna melana Give the noun that was used to form the following adjectives: 130. fecal _______________ 131. icteric _______________ 132. ileal _______________ 133. endoscopic _______________ 134. hemorrhoidal _______________ 135. pancreatic _______________ Chapter 14 • Gastrointestinal System 471 MEDICAL RECORD ANALYSES M E D I C A L R E C O R D 1 4 . 1 S: This is a 36 y.o. with a complaint of abdominal pain. He describes having lifted a 75# beam yesterday at work. He noticed a sharp pain in his navel but continued to work. The pain intensified as the day went on and persisted through last night and today. He claims his navel now bulges forward. He denies fever, chills, dys- phagia, anorexia, or vomiting. PMH: No hospitalizations or surgeries Meds: none Allergies: NKDA O: T 97.5ºF, P 87, R18, BP 128/86 WDWN male in moderate distress secondary to abdominal pain. Upon palpation, the abdomen is soft with spasm of the muscles in the periumbilical region, and there is an obvious bulge in the umbilicus. The omentum is also palapable. There is no hepatosplenomegaly. A: Incarcerated umbilical hernia P: Admit for STAT umbilical hernia repair 1. Summarize the subjective information: 5. Which of the following best describes the diagno- a. pain in stomach sis? b. pain in abdomen a. portion of the bowel has protruded through the abdominal wall and has been cut off from cir- c. pain in the groin area culation d. generalized abdominal pain with chills and b. prolapse of one part of the |
intestine into the lu- fever men of the adjoining part e. stomach pain and has difficulty swallowing c. portion of the intestine has protruded through a weakness in the abdominal wall around the 2. What kind of an appetite does the patient have? navel and is swollen and fixed in a sac a. normal d. portion of the bowel has twisted on itself caus- b. increased ing obstruction c. decreased e. inflammation of the stomach and small intes- tine 3. What is the condition of the patient’s liver? a. not stated 6. Which of the following medical terms describes b. enlarged the planned surgery? c. not enlarged a. laparotomy d. inflamed b. gastroenterostomy e. ruptured c. hernioplasty d. ileostomy 4. What were the objective findings? e. abdominocentesis a. involuntary contraction of the muscles around the navel b. pouching of the muscles under the navel c. contraction of abdominal muscles and enlarge- ment of the spleen d. protrusion of the navel and enlargement of the liver e. pouching of the stomach and omentum 472 Medical Terminology: The Language of Health Care M E D I C A L R E C O R D 1 4 . 2 Mr. Antonio Villata undergoes a comprehensive physical examination each year as part of a wellness program promoted by his employer. This year, after a routine sigmoidoscopic exam revealed a polyp in his intestine, he was referred to Dr. Blain, a gastroenterologist at Central Medical Center, for evaluation. Directions Read Medical Record 14.2 for Antonio Villata (page 475) and answer the following questions. This record is a procedure report dictated by Dr. Blain after his evaluation and treatment of Mr. Villata in the endoscopy suite at Central Medical Center. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 1 4 . 2 Write your answers in the spaces provided. 1. Below are medical terms used in the progress note you have not yet encountered in this text. Underline each where it appears in the record and define below: cannulated __________________________________________________________________ pediculated _________________________________________________________________ verge _______________________________________________________________________ snare _______________________________________________________________________ 2. Describe the screening procedure performed by Dr. Kolima prior to Mr. Villata’s referral to Dr. Blain: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. In your own words, not using medical terminology, briefly describe the procedure performed by Dr. Blain and the indications for which the patient was referred: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 4. The procedure was performed with Mr. Villata in what position? a. lying flat, face down b. lying flat, face up c. lying on his side d. sitting Chapter 14 • Gastrointestinal System 473 5. Put the following actions in order by numbering them 1 to 12: _____ location of the cecum was confirmed by internal and external landmarks _____ video colonoscope was inserted in the rectum and advanced carefully to the cecum _____ hemorrhoids were noted _____ terminal ileum was then cannulated _____ scope was straightened, air was aspirated, and scope was withdrawn _____ scattered diverticula were noted in the sigmoid colon _____ lining of the colon was thoroughly inspected _____ polyp was removed using a snare and submitted to pathology lab for biopsy _____ pediculated 4 mm polyp was seen in the sigmoid colon _____ scope was brought back to the rectum and retroflexed _____ patient was placed in the left lateral decubitus position _____ scope was brought back to the cecum and then gradually withdrawn 6. Translate the statement noting that “a pediculated 4-mm polyp was seen in the sigmoid colon”: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 7. How many inches from the anal verge was the polyp? ______________ 8. Write the sentence that describes the polypectomy that was performed: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 9. Name and describe the condition for which a high-fiber diet was indicated in the Plan: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 474 Medical Terminology: The Language of Health Care 10. Describe the third condition Dr. Blain listed in his assessment of Mr. Villata. Include the degree of severity and any treatment planned: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 11. In your own words, describe the recommendations outlined in the Plan that will be made depending on the results of the biopsy: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Chapter 14 • Gastrointestinal System 475 CENTRAL MEDICAL CENTER ENDOSCOPY LABORATORY REPORT PATIENT: Villata, Antonio DATE: 4/29/20xx PROCEDURE PERFORMED: COLONOSCOPY WITH BIOPSY INDICATIONS: This is a 54-year-old white male referred to me for evaluation of a polyp found during a screening sigmoidoscopy by Dr. Kolima. A complete colonoscopy is being done to remove the polyp and rule out other concurrent lesions. CONSENT: The procedure and its risks including bleeding, infection, perforation, and sedative reaction have been explained to the patient, and informed consent was obtained. INSTRUMENT USED: Olympus video colonoscope. MEDICATIONS GIVEN: Demerol 50 mg and Versed 3 mg in divided doses. The patient had stable vital signs. A Fleets Phospho-Soda prep provided good visualization. PROCEDURE: The patient was placed in the left lateral decubitus position. After adequate sedation, a rectal examination was performed. No masses were felt. The video colonoscope was inserted in the rectum and advanced carefully to the cecum. The location of the cecum was confirmed by internal and external landmarks, and photographic documentation was obtained. The terminal ileum was then cannulated. This was normal to about 2 cm. The scope was brought back to the cecum and then gradually withdrawn. The lining of the colon was thoroughly inspected. There were scattered diverticula noted in the sigmoid colon. A pediculated 4 mm polyp was seen in the sigmoid colon at 30 cm from the anal verge. This was removed using a snare and submitted to pathology lab for biopsy. The scope was brought back to the rectum and retroflexed. Minimal hemorrhoids were noted. The scope was straightened, air was aspirated, and the scope was withdrawn. The patient tolerated the procedure well. IMPRESSION: 1. POLYP ON SIGMOID COLON AT 30 CM. 2. SIGMOID DIVERTICULAR DISEASE. 3. HEMORRHOIDS. PLAN: 1. A high-fiber diet is indicated. 2. Await pathology results. If adenomatous, a full colonoscopy is indicated in 3 years. If hyperplastic or normal, a colonoscopy is indicated in 10 years. _________________________________ Roger Blain, M.D. RB:mw D : 4/29/xx T: 5/1/xx cc: R. Kolima, M.D. Medical Record 14.2 476 Mediicall Terrmiinollogy:: The LLanguage off Healltth Carre M E D I C A L R E C O R D 1 4 . 3 At age 77, Kathleen Hillman has been in fairly good health. But 1 week ago, she devel- oped what she called “stomach problems” that led to frequent vomiting. She refused to seek medical help at first, until her daughter coaxed her into calling her family practi- tioner, Dr. Shigeda. Once she learned how serious Ms. Hillman’s problem had become, Dr. Shigeda urged her to go to the emergency room immediately. Directions Read Medical Record 14.3 for Kathleen Hillman (pages 479–481) and answer the fol- lowing questions. This record is the consultation report dictated by Dr. Flagstone after he examined her in the emergency room at Central Medical Center. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 1 4 . 3 Write your answers in the spaces provided. l. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record and define below: rebound tenderness _________________________________________________________ abdominal guarding _________________________________________________________ dehydration ________________________________________________________________ stasis dermatitis _____________________________________________________________ intractable _________________________________________________________________ 2. What was Ms. Hillman’s complaint that led her to call Dr. Shigeda, who then sent her to the emergency room at Central Medical Center? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. From the list of medications Ms. Hillman is taking, one includes an abbreviation that has been deemed error prone. Identify the abbreviation, potential problem, and preferred wording. Abbreviation Potential Problem Preferred Wording ____________ _________________ _________________ 4. According to Dr. Flagstone’s initial impression, which factor in Ms. Hillman’s present history might be a cause of her gastrointestinal symptoms? a. her drinking b. stress from living with her daughter c. her allergies d. her arthritis medications Chapter 14 • Gastrointestinal System 477 5. Describe the two previous operations Ms. Hillman has had involving the musculoskeletal system: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 6. Using nonmedical language, explain what Ms. Hillman does not remember exactly about her gastrointestinal history two decades ago: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 7. Check all of the findings below that Dr. Flagstone noted in the physical examination of Ms. Hillman: _____ dehydration _____ pulse 98 _____ icterus in the whites of the eyes _____ chronic stasis dermatitis _____ varicose veins _____ irregular heart rate _____ vaginal infection _____ possible atrial fibrillation _____ parotitis _____ yellowing of the skin _____ multiple ecchymoses _____ clear lungs 8. Does Ms. Hillman have blood in her stool? Write the phrase from the medical record that indicates this: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 478 Medical Terminology: The Language of Health Care 9. In your own words, explain the initial diagnoses, including the possibilities to eliminate: a. _________________________________________________________________________ b. _________________________________________________________________________ c. _________________________________________________________________________ 10. Dr. Flagstone’s plan calls for administering medications, checking tests, and performing a procedure. Fill in the details below: Administered to Ms. Hillman a. ______________________________________________________________________ b. ______________________________________________________________________ c. ______________________________________________________________________ Check Ms. Hillman’s d. ______________________________________________________________________ e. ______________________________________________________________________ f. ______________________________________________________________________ Perform g. ______________________________________________________________________ 11. In your own words, describe stool culture and sensitivity: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Chapter 14 • Gastrointestinal System 479 Medical Record 14.3 480 Medical Terminology: The Language of Health Care Medical Record 14.3 Continued. Chapter 14 • Gastrointestinal System 481 Medical Record 14.3 Continued. Chapter 15 Urinary System OBJECTIVES After completion of this chapter you will be able to Define common term components used in relation to the urinary system Describe the basic functions of the urinary system Define the basic anatomical terms referring to the urinary system Define common symptomatic and diagnostic terms referring to the urinary system List the common diagnostic tests and procedures related to the urinary system Define common operative terms referring to the male reproductive system Identify common therapeutic terms including drug classifications related to the urinary system Explain terms and abbreviations used in documenting medical records involving the urinary system Combining Forms Combining Form Meaning Example albumin/o protein albuminoid al-byūmin-oyd bacteri/o bacteria bacterium bak-tērē-ŭm cyst/o bladder or sac cystoscope sistō-skōp vesic/o vesicotomy vesi-kotō-mē dips/o thirst polydipsia pol-ē-dipsē-ă glomerul/o glomerulus (little ball) glomerular glō-māryū-lăr gluc/o sugar glucogenic gloo-kō-jenik glucos/o glucose glūkōs glyc/o glycolysis glı̄-koli-sis 482 Chapter 15 • Urinary System 483 Combining Form Meaning Example ket/o ketone bodies ketosis kē-tōsis keton/o ketonuria kē-tō-nūrē-ă lith/o stone lithiasis li-thı̄ă-sis meat/o meatus (opening) meatal mē-ātăl nephr/o kidney nephrosis ne-frōsis ren/o renal rēnăl pub/o pubic bone (lower front suprapubic portion of hip bone) soo-pră-pyubik (see Figs. 6.1 and 15.1) pyel/o renal pelvis (basin) pyelonephrosis pı̄ĕ-lō-ne-frōsis py/o pus pyonephritis pı̄ĕ-lō-ne-frı̄tis ureter/o ureter ureterolithiasis yū-rēter-ō-li-thı̄ă-sis urethr/o urethra urethrodynia yū-rē-thrō-dinē-ă ur/o urine urologist yū-rolō-jist urinary urin/o yūri-nār-ē Urinary System Overview The urinary system includes the organs and structures involved in the secretion and elimination of urine: kidneys, ureters, urinary bladder, and urethra (Fig. 15.1). The principal organs of the urinary system, the kidneys, are located on each side of the lum- bar region. They filter the blood and secrete water and nitrogenous wastes (e.g., urea, creatinine) in the form of urine. The functional unit of the kidney is called the nephron. Each nephron consists of a glomerulus, the little ball-shaped cluster of capillaries at the top; Bowman’s capsule, the top part that encloses the nephron; and a renal tubule, the stem portion of the nephron. Approximately one million nephrons make up the cortex, the outer part of each kidney. They gather waste substances by filtering the blood that enters the kid- ney through the renal artery at the hilum, the prominent indented portion. In the medulla, the inner portion of the kidney, the calyces collect urine from the tubules of the nephrons and drain their contents into the renal pelvis, the basin-like portion of the ureter within the kidney. 484 Medical Terminology: The Language of Health Care Right kidney Left kidney Inferior vena cava Abdominal aorta Ureters Urinary bladder Urethra Pubic bone Figure 15.1 Urinary system. The ureters, usually one for each kidney, are tubes that carry the urine from the kidney to the urinary bladder, where it |
is held until being expelled during urination (micturition). The urethra is the single canal that carries urine from the bladder to the outside of the body. The urethral meatus is the opening in the urethra to the outside of the body. In addition to excreting waste products such as urea and creatinine, the kidneys play an essential life-sustaining role by regulating the levels of critical elements such as water, sodium, and potassium. Anatomical Terms Term Meaning kidneys two structures located on each side of the lumbar region that kidnēz filter blood and secrete impurities, forming urine (Fig. 15.2) cortex outer part of the kidney (cortex bark) kōrteks hilum indented opening in the kidney where vessels enter and hı̄lŭm leave medulla inner part of the kidney me-dūlă calyces (calices) system of ducts carrying urine from the nephrons to the kali-sēz renal pelvis (kalyx cup of a flower) nephron microscopic functional units of the kidney, comprised of nefron kidney cells and capillaries, each capable of forming urine (see Fig. 15.2) glomerulus little ball-shaped cluster of capillaries located at the top of glō-māryū-lŭs each nephron Bowman’s capsule top part of the nephron that encloses the glomerulus bō-mĕnz kapsūl Chapter 15 • Urinary System 485 Distal convoluted tubule Renal cortex Proximal convoluted tubule Renal medulla Bowman’s capsule (pyramid) Glomerulus Papilla of pyramid Afferent arteriole Minor calyx (calix) Major calyx (calix) Renal artery Renal vein Efferent Collecting arteriole tubule Renal pelvis Ureter Artery Vein Peritubular capillaries Loop of Henle Kidney Nephron Figure 15.2 Kidney and nephron. Term Meaning renal tubule stem portion of the nephron rēnăl tūbyūl ureter tube that carries urine from the kidney to the bladder ū-rēter renal pelvis basin-like portion of the ureter within the kidney rēnăl pelvis ureteropelvic junction point of connection between the renal pelvis and ureter yūrēter-ō-pelvik urinary bladder sac that holds the urine yūri-nār-ē urethra single canal that carries urine to the outside of the body yū-rēthră urethral meatus opening in the urethra to the outside of the body mē-ātŭs urine fluid produced by the kidneys containing water and yūrin waste products urea waste product formed in the liver, filtered out of the yū-rēă blood by the kidneys, and excreted in urine creatinine waste product of muscle metabolism filtered out of the krē-ati-nēn blood by the kidneys and excreted in urine 486 Medical Terminology: The Language of Health Care Symptomatic and Diagnostic Terms Term Meaning SYMPTOMATIC albuminuria presence of albumin in the urine; occurs in renal al-byū-mi-nūrē-ă disease or in normal urine after heavy exercise proteinuria prō-tē-nūrē-ă anuria absence of urine formation an-yūrē-ă bacteriuria presence of bacteria in the urine bak-tēr-ē-ūrē-ă dysuria painful urination dis-yūrē-ă enuresis to void urine; involuntary discharge of urine, most en-yū-rēsis often refers to a lack of bladder control nocturnal enuresis bed wetting during sleep nok-ternăl hematuria presence of blood in the urine (Fig. 15.3) hē-mă-tūrē-ă glucosuria glucose (sugar) in the urine gloo-kōs-yurē-ă INCONTINENCE. incontinence involuntary discharge of urine or feces The Latin word in-konti-nens continent means to hold in, and the prefix in- stress urinary involuntary discharge of urine at the time of cough, means not. In Shakespeare’s incontinence (SUI) sneeze, and/or strained exercise time, incontinently was used to mean immediately. Today, ketonuria presence of ketone bodies in the urine incontinence specifically kē-tō-nūrē-ă refers to the inability to ketone bodies acetone, beta-hydroxybutyric acid, and acetoacetic prevent the discharge of kētōn acid are products of metabolism that appear in the excretions, especially urine ketone compounds urine as a result of an abnormal utilization of or feces. carbohydrates; seen in uncontrolled diabetes and starvation Figure 15.3 Hematuria. Microscopic urine showing a large number of red blood cells. One lone white blood cell is present in the center of the field. Chapter 15 • Urinary System 487 Term Meaning nocturia urination at night nok-tūrē-ă oliguria scanty production of urine ol-i-gūrē-ă polyuria condition of excessive urination pol-ē-yūrē-ă pyuria presence of white cells in the urine, usually indicating pı̄-yūrē-ă infection (Fig. 15.4) urinary retention retention of urine owing to the inability to void (urinate) yūri-nār-ē rē-tenshŭn naturally because of spasm, obstruction, etc. DIAGNOSTIC adult polycystic kidney inherited condition of multiple cysts that gradually disease (APKD) form in the kidney, causing destruction of normal tissue that leads to renal failure—diagnosed in adults presenting with hypertension, kidney enlargement, and recurrent urinary tract infections glomerulonephritis form of nephritis involving the glomerulus glō-māryū-lō-nef-r ı̄tis hydronephrosis dilation and pooling of urine in the renal pelvis and hı̄drō-ne-frōsis calyces of one or both kidneys caused by an obstruction in the outflow of urine (Fig. 15.5) nephritis inflammation of the kidney ne-frı̄tis pyelonephritis inflammation of the renal pelvis pı̄ĕ-lō-ne-frı̄tis Figure 15.4 Pyuria. Microscopic urine showing the presence of white blood cells (arrows). Figure 15.5 Collection of contrast media in the kidney displays an extraordinary amount of material, which indi- cates right-sided hydronephrosis caused by obstruction in the ureter. 488 Medical Terminology: The Language of Health Care Inferior vena cava Renal calculi (stones) Right kidney Stone blocking right ureter Right ureter Migrating pain Urethra Stone blocking urethra Figure 15.6 Kidney stone formation. Term Meaning nephrosis degenerative disease of the renal tubules ne-frōsis nephrolithiasis presence of renal stone or stones caused by mineral buildup nefrō-li-thı̄ă-sis in the kidneys—most commonly as a result of hyperuricuria (excessive amount of uric acid in the urine) or hypercalci- uria (excessive amount of calcium in the urine) (Fig. 15.6) cystitis inflammation of the bladder sistı̄tis urethritis inflammation of the urethra yū-rē-thrı̄tis urethrocystitis inflammation of the urethra and bladder yū-rēthrō-sis-tı̄tis urethral stenosis narrowed condition of the urethra yū-rēthrăl ste-nōsis urinary tract invasion of pathogenic organisms (commonly bacteria) in infection (UTI) the structures of the urinary tract, especially the urethra and bladder; symptoms include dysuria, urinary frequency, and malaise uremia excess of urea and other nitrogenous waste in the blood as yū-rēmē-ă a result of kidney failure azotemia az-ō-tēmē-ă Diagnostic Tests and Procedures Test or Procedure Explanation cystometrogram record that measures urinary volume, bladder pressure, and sis-tō-metrō-gram capacity to evaluate urinary dysfunction such as incontinence Chapter 15 • Urinary System 489 Bladder Calculi (stones) Urethra Cystoscope Figure 15.7. Cystoscopy. Test or Procedure Explanation cystoscopy examination of the bladder using a rigid or sis-toskŏ-pē flexible cystoscope (Fig. 15.7) kidney biopsy (Bx) removal of kidney tissue for pathological renal biopsy examination radiography x-ray studies commonly used in urology rādē-ogră-fē intravenous pyelogram (IVP) x-rays of the urinary tract taken after iodine is intră-vēnŭs pı̄el-ō-gram injected into the bloodstream and as the contrast intravenous urogram passes through the kidney, revealing obstruction, evidence of trauma, etc. (see Fig. 15.5) kidney, ureter, bladder (KUB) abdominal x-ray of kidney, ureter, and bladder typically used as a scout film before doing an IVP (Fig. 15.8) scout film plain x-ray taken to detect any obvious pathology before further imaging (e.g., a KUB before an IVP) renal angiogram (arteriogram) x-ray of the renal artery made after injecting anjē-ō-gram contrast material into a catheter in the artery retrograde pyelogram (RP) x-ray of the upper urinary tract taken after retrō-grād contrast medium is injected up to the kidney by way of a small catheter passed through a cystoscope—done to detect the presence of stones or obstruction voiding (urinating) x-ray of the bladder and urethra taken during cystourethrogram urination (VCU or VCUG) sis-tō-yū-rēthrō-gram abdominal sonogram ultrasound image of the urinary tract including sonō-gram the kidney, ureters, and bladder 490 Medical Terminology: The Language of Health Care Figure 15.8 KUB showing kidney stones in ureters and bladder (arrows). LABORATORY TESTING Test or Procedure Explanation urinalysis (UA) physical, chemical, and microscopic examination of yū-ri-nali-sis urine (Fig. 15.9) specific gravity (SpGr) measure of the kidney’s ability to concentrate or dilute urine pH measure of the acidity or alkalinity of urine glucose (sugar) chemical test used to detect sugar in the urine, used glūkōs most often to screen for diabetes albumin (alb) chemical test used to detect albumin in the urine al-byūmin protein ketones chemical test used to detect ketone bodies in the urine; if positive, fats are being utilized by the body instead of carbohydrates, which occurs in starvation or an unstable diabetic state Chapter 15 • Urinary System 491 Figure 15.9 Sample urinalysis report. 492 Medical Terminology: The Language of Health Care Test or Procedure Explanation occult blood, urine chemical test used to detect hidden blood in the urine resulting from red blood cell hemolysis— indicates bleeding in the kidneys (occult hidden) bilirubin chemical test used to detect bilirubin in the urine— bil-i-rūbin seen in gallbladder and liver disease urobilinogen chemical test used to detect bile pigment in the yūr-ō-bı̄-linō-jen urine—increased amounts seen in gallbladder and liver disease nitrite chemical test used to detect bacteria in the urine nı̄trı̄t microscopic findings microscopic identification of abnormal constituents mı̄-krō-skopik in the urine (e.g., red blood cells, white blood cells, casts) as reported per high- or low-power field (hpf or lpf) (see Figs. 15.3 and 15.4) urine culture and isolation of a urine specimen in a culture medium sensitivity (C&S) that propagates the growth of microorganisms; organisms that grow in the culture are identified, and drugs to which they are sensitive are listed blood urea nitrogen (BUN) blood test to determine the level of urea in the yū-rēănı̄trō-jen blood—a high BUN indicates the kidney’s inability to excrete urea creatinine, serum test to determine the level of creatinine in the krē-ati-nēn sērŭm blood—useful in assessing kidney function creatinine, urine test to determine the level of creatinine in the urine creatinine clearance testing measurements of the level of creatinine in the blood and a 24-hour urine specimen to determine the rate that creatinine is “cleared” from the blood by the kidneys Operative Terms Term Meaning urologic endoscopic use of specialized endoscopes (e.g., resectoscope) surgery within the urinary tract to perform various surgical yū-rō-lojik-ăl procedures, such as resection of a tumor, repair of an obstruction, stone retrieval, or placement of a stent (Fig. 15.10) resectoscope urologic endoscope sent through the urethra to rē-sektō-skōp resect (cut and remove) lesions of the bladder, urethra, or prostate intracorporeal lithotripsy method of destroying stones within the urinary intră-kōr-pōrē-ăl tract using electrical energy discharges transmitted lithō-trip-sē to a probe within a flexible endoscope—most com- monly used to pulverize bladder stones (Fig. 15.11) nephrotomy incision into the kidney ne-frotō-mē Chapter 15 • Urinary System 493 Figure 15.10 Stone basket used in kidney stone retrieval. Term Meaning nephrorrhaphy suture of an injured kidney nef-rōră-fē nephrolithotomy incision into the kidney for the removal of stones nefrō-li-thotō-mē nephrectomy excision of a kidney ne-frektō-mē pyeloplasty surgical reconstruction of the renal pelvis pı̄e-lō-plas-tē stent placement use of a device to hold open vessels or tubes (e.g., an obstructed ureter) (Fig. 15.12) kidney transplantation transfer of a kidney from the body of one person renal transplantation (donor) to another (recipient) (Fig. 15.13) urinary diversion creation of a temporary or permanent diversion of the urinary tract to provide a new passage through which urine exits the body—used to treat defects or disease such as bladder cancer Figure 15.11 Simulation of the pulverizing of stones performed by intracorporeal lithotripsy. 494 Medical Terminology: The Language of Health Care Before After Ureteral Stent in obstruction place Figure 15.12 Placement of a double-J stent to relieve ureteral obstruction. Term Meaning common types of urinary diversion: noncontinent ileal removal of a portion of the ileum to use as a conduit conduit to which the ureters are attached at one non-konti-nent ilē-ăl end; the other end is brought through an opening kondū-it (stoma) created in the abdomen—urine drains continually into an external appliance (bag) (Fig 15.14) continent urostomy internal reservoir (pouch) constructed from a konti-nent yūr-ostō-mē segment of intestine that diverts urine through an opening (stoma) that is brought through the abdominal wall; a valve is created internally to prevent leakage, and the patient empties the pouch by catheterization orthotopic bladder bladder constructed from portions of intestine (neobladder) connected to the urethra, allowing “natural” voiding *Continent refers to the ability to hold or retain urine. Noncontinent indicates that urine cannot be held and drains continually. Right Left suprarenal suprarenal glands glands Site of diseased Left kidney right kidney Donor’s kidney External Internal iliac vein iliac artery Ureter Bladder Figure 15.13 Common site for donor kidney transplantation. Chapter 15 • Urinary System 495 Figure 15.14 Urostomy: ileal conduit. Therapeutic Terms Term Meaning extracorporeal shock procedure using ultrasound to penetrate the body wave lithotripsy (ESWL) from outside and bombard and disintegrate |
a ekstră-kōr-pōrē-ăl stone within—most commonly used to treat lithō-trip-sē urinary stones above the bladder (Fig. 15.15) kidney dialysis methods of filtering impurities from the blood to dı̄-ali-sis replace the function of one or both kidneys due to renal failure hemodialysis method to remove impurities by pumping the hē-mō-dı̄-ali-sis patient’s blood through a dialyzer, the specialized filter of the artificial kidney machine (hemodialyzer) Dual-imaging system Computer display X-ray overhead Dual-imaging system X-ray film cassette Ultrasound system Shock-wave–generating system Figure 15.15 Shock wave system for extracorporeal lithotripsy of kidney stones. 496 Medical Terminology: The Language of Health Care Term Meaning peritoneal dialysis method of removing impurities using the per-i-tō-nēăl peritoneum as the filter; catheter insertion in the peritoneal cavity is required to deliver cleansing fluid (dialysate) that is washed in and out in cycles Kegel exercises specific exercises that strengthen the muscles of the pelvic floor to maintain proper organ placement and retain urine urinary catheterization methods of placing a tube into the bladder to drain or collect urine common types: straight catheter inserted through the urethra into the bladder to relieve urinary retention or collect a sterile specimen of urine for testing—removed immediately after the procedure Foley catheter indwelling catheter inserted through the urethra into the bladder; includes a collection system that allows urine to be drained into a bag—can remain in place for an extended time suprapubic catheter indwelling catheter inserted directly into the bladder through an abdominal incision above the pubic bone; includes a collection system that allows urine to be drained into a bag—used in patients requiring long-term catheterization COMMON THERAPEUTIC DRUG CLASSIFICATIONS analgesic drug that relieves pain an-ăl-jēzik antibiotic drug that kills or inhibits the growth of antē-bı̄-otik microorganisms antispasmodic drug that relieves spasm antē-spaz-modik diuretic drug that increases the secretion of urine dı̄-yū-retik Summary of Chapter 15 Acronyms/Abbreviations alb ..............................albumin KUB ...........................kidney, ureter, bladder APKD ........................adult polycystic kidney disease RP ................................retrograde pyelogram BUN ...........................blood urea nitrogen SpGr ..........................specific gravity Bx ................................biopsy SUI ..............................stress urinary incontinence C&S ............................urine culture and sensitivity UA................................urinalysis ESWL........................extracorporeal shock wave UTI..............................urinary tract infection lithotripsy VCU, VCUG .........voiding cystourethrogram IVP ..............................intravenous pyelogram Chapter 15 • Urinary System 497 PRACTICE EXERCISES For the following terms, on the lines below the term, write out the indicated word parts: prefixes (P), combining forms (CF), roots (R), and suffixes (S). Then define the word. example pericystitis _______ / _______ / _______ P R S peri/cyst/itis P R S DEFINITION: around/bladder or sac/inflammation 1. vesicoureteric __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 2. bacteriosis __________________ / __________________ R S DEFINITION: _________________________________________________________________ 3. transurethral __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 4. urogram __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 5. urethrocystitis __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 6. nephroptosis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 7. polydipsia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 498 Medical Terminology: The Language of Health Care 8. glomerulosclerosis __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 9. pyonephritis __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 10. urology __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 11. ureterovesicostomy __________________ / __________________ / __________________ CF CF S DEFINITION: _________________________________________________________________ 12. glycorrhea __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 13. meatotomy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 14. pyelonephrosis __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 15. cystoscopy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 16. suprarenal __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 17. nephrolithiasis __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ Chapter 15 • Urinary System 499 18. ureterocele __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 19. albuminous __________________ / __________________ R S DEFINITION: _________________________________________________________________ 20. pyelography __________________ / __________________ CF S DEFINITION: _________________________________________________________________ Using nephr/o, the Greek combining form meaning kidney, identify the medical term for the following: 21. ____________________________ inflammation of the kidney 22. ____________________________ degenerative condition of the kidney 23. ____________________________ incision in the kidney 24. ____________________________ suture of a kidney 25. ____________________________ removal of the kidney 26. ____________________________ incision into the kidney for the removal of stones Complete the following: 27. urethral ________________osis a narrowed condition of the urethra 28. extracorporeal shock wave _________________________ procedure for disintegration of kidney stones 29. _____________________ catheter indwelling catheter inserted in the bladder through an abdominal incision above the pubic bone 30. _________________________scope specialized endoscope to remove lesions from the bladder, prostate gland, and urethra 31. _________________________ exercises strengthen muscles of the pelvic floor to maintain proper organ placement and retain urine 32. _________________________blood hidden blood 33. _________________________ a record that measures urinary volume, bladder pressure, and capacity 34. peritoneal _________________ method of replacing the function of the kidneys to removing impurities from the blood using the peritoneum as a filter 35. ____________ film plain x-ray taken to detect obvious pathology before further imaging 500 Medical Terminology: The Language of Health Care Identify the medical term for the following: 36. __________________________ inflammation of the bladder 37. __________________________ involuntary discharge of urine or feces 38. __________________________ involuntary discharge of urine 39. __________________________ bed wetting during sleep 40. __________________________ dilation and pooling of urine in the kidney caused by obstruction of outflow of urine 41. __________________________ inherited condition of multiple cysts that gradually form in the kidney in adult life Using the suffix -uria, name the following conditions of urine: 42. __________________________ urinating at night 43. __________________________ scanty urination 44. __________________________ painful urination 45. __________________________ presence of ketone bodies in the urine 46. __________________________ presence of blood in the urine 47. __________________________ presence of pus (white cells/infection) in the urine Match the following: 48. ________ sugar a. cyst/o 49. ________ proteinuria b. bacteriuria 50. ________ uremia c. renal Bx 51. ________ ren/o d. albuminuria 52. ________ vesic/o e. neobladder 53. ________ diuretic f. Foley 54. ________ kidney biopsy g. glyc/o 55. ________ nitrite h. nephr/o 56. ________ catheter i. azotemia 57. ________ urinary diversion j. urobilinogen 58. ________ bile pigment k. urination Chapter 15 • Urinary System 501 Define the following abbreviations: 59. alb ________________________________________________________________________ 60. IVP________________________________________________________________________ 61. ESWL _____________________________________________________________________ 62. UTI________________________________________________________________________ 63. SUI________________________________________________________________________ 64. BUN_______________________________________________________________________ For each of the following, circle the combining form that corresponds to the meaning given: 65. urine hydr/o ur/o ren/o 66. thirst dips/o crin/o hidr/o 67. pus pyel/o py/o albumin/o 68. bladder cyt/o vesic/o nephr/o 69. protein albumin/o lip/o bacteri/o 70. kidney hepat/o cyst/o nephr/o 71. opening or/o meat/o orth/o 72. basin meat/o vesic/o pyel/o 73. stone scler/o lip/o lith/o 502 Medical Terminology: The Language of Health Care Write in the missing words on the blank lines in the following illustration of the urinary anatomy. 74–78. 78. 74. Inferior vena cava Abdominal aorta 75. 76. Urinary 77. For each of the following, circle the correct spelling of the term: 79. cystascope cystoskope cystoscope 80. pyleogram pyelogram pielogram 81. oliguria oleguria oligouria 82. hydronefrosis hidronephrosis hydronephrosis 83. azootemia azothemia azotemia 84. urinalysis urinelysis uranalysis 85. glowmerular glomerular glomarular 86. nefrectomy nephrecktomy nephrectomy 87. diuretic dyuretic diuretik 88. hemadialysis hemodialysis hemidialysis 89. cathetersation catheterization cathterization Give the noun that was used to form the following adjectives: 90. urinary ___________________ 91. glomerular ___________________ 92. meatal ___________________ Chapter 15 • Urinary System 503 93. uremic ___________________ 94. urethral ___________________ 95. nephrotic ___________________ Write the abbreviation for the following terms: 96. urinalysis ________________________ 97. urine culture and sensitivity _______________ 98. retrograde pyelogram ______________ 99. x-ray of kidneys, ureters, and bladder ____________ 100. voiding cystourethrogram __________________ 504 Medical Terminology: The Language of Health Care MEDICAL RECORD ANALYSES M E D I C A L R E C O R D 1 5 . 1 S: This 70 y.o. female has had polyuria, nocturia, and dysuria 2-3 days. She had a similar infection 6 months ago and was treated with Macrobid, 50 mg, qid 3d. She has occasional stress incontinence with hard sneezing. O: The patient is afebrile. UA shows a trace of leukocytes and blood A: R/O recurrent UTI P: C&S Cipro 500 mg tab po bid pending culture pt instructed to ↑ fluid intake and call for culture results in 48 h 1. What is the patient’s CC? 4. Which medical terms describe the UA findings? a. the presence of red and white blood cells in a. pyuria and hematuria her urine b. dysuria and enuresis b. a urinary tract infection c. bacteriuria and hematuria c. pain when she urinates with the need to go d. bacteriuria and nocturia often, even at night d. urinary tract infection 5. To what does C&S refer? a. a condition of urinary stress 2. What were the objective findings? b. the isolation of microorganisms in the urine a. culture showed leukocytes and blood in the c. inflammation of the bladder urine d. physical, chemical, and microscopic study of b. urinalysis indicated red and white blood cells urine present in urine c. bladder infection 6. How should the Cipro be administered? d. return of bladder infection a. two, by mouth every day b. one, by mouth two times a day 3. What was the doctor’s impression? c. one, by mouth three times a day a. there were leukocytes and blood in the patient’s urine d. one, by mouth four times a day b. the patient has pain when she urinates with 7. Was the patient’s temperature elevated? the need to go often, even at night a. yes c. the pain has a bladder infection b. no d. the patient may have another bladder infection c. nothing is stated about the patient’s temperature Chapter 15 • Urinary System 505 M E D I C A L R E C O R D 1 5 . 2 Charles Mercier had urination problems and abdominal pain when he saw his doctor, who referred him to Central Medical Center for a possible kidney infection. Dr. Zlatkin performed surgery, and Mr. Mercier was soon doing fine and was discharged. As planned, he later returned for surgical removal of a device that had been temporarily placed during the first surgery. Directions Read Medical Record 15.2 for Mr. Mercier (pages 507–508) and answer the following questions. The first record is the discharge summary from the first surgery, dictated by Dr. Zlatkin. The second record is the operative report for Mr. Mercier’s return surgery 6 weeks later, also dictated by Dr. Zlatkin. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 1 5 . 2 Write your answers in the spaces provided. 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record and define below: stent (double J) ______________________________________________________________ drain (Jackson-Pratt)_________________________________________________________ lithotomy position ___________________________________________________________ ureteral catheter _____________________________________________________________ patency _____________________________________________________________________ 2. In your own words, not using medical terminology, briefly describe the history of Mr. Mercier’s medical problems identified in the “Discharge Summary”: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. Put the following events reported in the “Discharge Summary” in chronological or- der by numbering them from 1 to 5: _____ removal of drain _____ reconstruction of renal pelvis _____ difficulty with micturition _____ urine test for microorganisms _____ insertion of stent 506 Medical Terminology: The Language of Health Care 4. While at home after the operation, Mr. Mercier is instructed to do two things and not to do three things. List them below: Mr. Mercier should __________________________________________________________ ____________________________________________________________________________ Mr. Mercier should not_______________________________________________________ ____________________________________________________________________________ 5. When Mr. Mercier returned 6 weeks later for follow-up surgery, describe in your own words the preoperative diagnosis: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 6. During the second surgery, an endoscopic procedure and two different x-ray pro- cedures were used to visualize internal structures. List and define each procedure and describe the findings: Procedure Definition Finding _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ 7. The first surgery included insertion of a specialized device that was then removed in the second surgery. What was this device, and what function did it perform dur- ing the time between the two surgeries? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 8. In the second surgery, did Mr. Mercier experience any |
complications? Write the sentence that supports your answer: ____________________________________________________________________________ ____________________________________________________________________________ Chapter 15 • Urinary System 507 Medical Record 15.2 508 Medical Terminology: The Language of Health Care Medical Record 15.2 Continued. Chapter 156 Male Reproductive System OBJECTIVES After completion of this chapter you will be able to Define common term components used in relation to the male reproductive system Describe the basic functions of the male reproductive system Define the basic anatomical terms referring to the male reproductive system Define common symptomatic and diagnostic terms referring to the male reproductive system List the common diagnostic tests and procedures related to the male reproductive system Define common operative terms referring to the male reproductive system Identify common therapeutic terms including drug classifications related to the male reproductive system Explain terms and abbreviations used in documenting medical records involving the male reproductive system Combining Forms Combining Form Meaning Example balan/o glans penis balanoplasty balan-ō-plas-tē epididym/o epididymis epididymitis ep-i-did-i-mı̄tis orch/o testis or testicle orchitis ORCHIO. ōr-kı̄tis Orchio is a Greek root for orchi/o orchiopexy testicle, so named for the ōrkē-ō-peksē resemblance of the gland to orchid/o orchidectomy the root of the orchid plant. At one time, orchid root was ōr-ki-dektō-mē used to treat diseases of the test/o testicle testicle. testĭ-kl perine/o perineum perineal peri-nēăl 509 510 Medical Terminology: The Language of Health Care Combining Form Meaning Example prostat/o prostate prostatodynia prostă-tō-dinē-ă sperm/o sperm (seed) oligospermia ol-i-gō-spermē-ă spermatic spermat/o sper-matik vas/o vessel vasorrhaphy vas-ōră-fē Male Reproductive System Overview The male reproductive system includes the scrotum, testes, epididymides, vas deferens, seminal vesicles, prostate gland, bulbourethral glands, urethra, and penis (Fig. 16.1). These parts produce and maintain sperm, the male reproductive cells, and introduce them into the female reproductive tract for the purpose of fertilizing the female ovum. The male reproductive organs also secrete certain hormones necessary for the main- tenance of secondary sexual characteristics in the male. TESTICLE. Anatomical Terms Testicle is from Term Meaning the Latin testis, a word that also meant a scrotum a bag; skin-covered pouch in the groin that is divided into witness or one who testifies. skrōtŭm two sacs, each containing a testis and an epididymis The presence of the testicles was evidence of virility, and testis (testicle) one of the two male reproductive glands, located in the it is said that under Roman testis scrotum, that produces sperm and the male hormone law, no man could witness testosterone in court unless his testicles were present. An oath was sperm male gamete or sex cell produced in the testes that unites taken with a hand on the spermatozoon with the ovum in the female to produce offspring testicles. The testicles are spermă-tō-zōon also associated with the epididymis coiled duct on top and at the side of the testis that stores swearing of oaths in the Old Testament of the Bible. ep-i-didi-mis sperm before emission penis erectile tissue covered with skin that contains the urethra pēnis for urination and ducts for the secretion of seminal fluid PENIS. Penis is a (semen) Latin word for tail. The name is glans penis bulging structure at the distal end of the penis (glans also derived from pendere, glanz acorn) meaning to hang down. The Romans had a great many prepuce foreskin; loose casing covering the glans penis—removed terms for the male organ— prēpūs by circumcision e.g., cauda (tail), clava (club), gladius (sword), radix vas deferens duct that carries sperm from the epididymis to the (root), ramus (branch), and vas defer-ens ejaculatory duct (vas vessel; deferens carrying away) vomer (plough). Penis was seminal vesicle one of two sac-like structures lying behind the bladder and adopted as the anatomical semi-năl connected to the vas deferens on each side—secretes an term, and it has been used alkaline substance into the semen to enable the sperm to in English since the 17th century. live longer Chapter 16 • Male Reproductive System 511 THE MALE REPRODUCTIVE SYSTEM Sagittal view Urinary bladder Ampulla Frontal view Seminal vesicle Symphysis pubis Vas deferens Ejaculatory duct Prostate gland Corpus cavernosum Urethra Bladder Penis Glans penis Prepuce Seminal vesicles Urethral meatus Prostate gland Testis Vas deferens Scrotum Urethra Anus Bulbourethral gland Perineum Vas deferens Epididymis A typical sperm (magnified drawing) Acrosome Nucleus Tail Midpiece Head Figure 16.1 Male reproductive system. Term Meaning semen mixture of the secretions of the testes, seminal vesicles, sēmen prostate, and bulbourethral glands discharged from the male urethra during orgasm (semen seed) ejaculatory duct duct formed by the union of the vas deferens with the duct ē-jakyū-lă-tōr-ē of the seminal vesicle; its fluid is carried into the urethra 512 Medical Terminology: The Language of Health Care Term Meaning prostate gland trilobular gland that encircles the urethra just below prostāt the bladder—secretes an alkaline fluid into the semen bulbourethral glands pair of glands below the prostate with ducts opening (Cowper glands) into the urethra—adds a viscid (sticky) fluid to the bŭlbō-yū-rēthrăl semen perineum external region between the scrotum and anus in a peri-nēŭm male and between the vulva and anus in a female spermatic cord cord containing the vas deferens, arteries, veins, sper-matik kōrd lymph vessels, and nerves that extends from the internal inguinal ring through the inguinal canal to each testicle Symptomatic and Diagnostic Terms Term Meaning SYMPTOMATIC aspermia inability to secrete or ejaculate sperm ā-spermē-ă azoospermia semen without living spermatozoa, a sign of ā-zō-ō-spermē-ă infertility in the male (zoo life) oligospermia scanty production and expulsion of sperm ol-i-gō-spermē-ă mucopurulent discharge drainage of mucus and pus myū-kō-pūrū-lent DIAGNOSTIC anorchism absence of one or both testes an-ōrkizm balanitis inflammation of glans penis bal-ă-nı̄tis cryptorchism undescended testicle; failure of a testis to descend krip-tōrkizm into the scrotal sac during fetal development; it most often remains lodged in the abdomen or inguinal canal, requiring surgical repair (crypt to hide) (Fig. 16.2) epididymitis inflammation of the epididymis ep-i-did-i-mı̄tis hydrocele hernia of fluid in the testis or tubes leading from the hı̄drō-sēl testis (Fig. 16.3B) hypospadias congenital opening of the male urethra on the hı̄pō-spādē-ăs undersurface of the penis (spadias to draw away) (Fig. 16.4) 1 Deep 2 inguinal ring 3 Inguinal 4 canal Figure 16.2 Cryptorchism. Four de- Normal Superficial grees of incomplete descent of the testis. 1. descent inguinal In the abdominal cavity close to the deep in- ring guinal ring. 2. In the inguinal canal. 3. At the superficial inguinal ring. 4. In the upper part of the scrotum. A B Spermatic artery Hydrocele Vein Vas deferens Epididymis Tunica vaginalis C D Spermatocele Varicocele Figure 16.3 A. Normal testes and appendages. B. Hydrocele. C. Spermato- cele. D. Varicocele. 514 Medical Terminology: The Language of Health Care Term Meaning erectile dysfunction (ED) failure to initiate or maintain an erection until ejaculation because of physical or psychological dysfunction; formerly termed impotence (im not; potis able) Peyronie disease disorder characterized by a buildup of hardened pā-rōnē fibrous tissue in the corpus cavernosum causing pain and a defective curvature of the penis, especially during erection (Fig. 16.5) phimosis narrowed condition of the prepuce (foreskin) f ı̄-mōsis resulting in its inability to be drawn over the glans penis, often leading to infection—commonly requires circumcision (phimo means muzzle) (Fig. 16.6) benign prostatic enlargement of the prostate gland; frequently hyperplasia/hypertrophy seen in older men, causing urinary obstruction (BPH) (Fig. 16.7) bē-nı̄n pros-tatik hı̄-pĕr-plāzē-ă/hı̄-pertrō-fē prostate cancer malignancy of the prostate gland prostatitis inflammation of the prostate pros-tă-tı̄tis spermatocele painless, benign cystic mass containing sperm spermă-tō-sēl lying above and posterior to the testicle, but separate from it (see Fig. 16.3C) Fibrous cord Transverse section Balanic hypospadias Penile hypospadias Figure 16.4 Hypospadias. Figure 16.5 Peyronie disease. Chapter 16 • Male Reproductive System 515 Figure 16.6 Phimosis. Term Meaning testicular cancer malignant tumor in one or both testicles commonly tes-tikyŭ-lăr developing from the germ cells that produce sperm— classified in two groups according to growth potential seminoma most common type of testicular tumor, composed of sem-i-nōmă immature germ cells—highly treatable with early detection nonseminomas testicular tumors arising from more mature germ cells that have a tendency to be more aggressive than seminomas; often develop earlier in life (includes choriocarcinoma, embryonal carcinoma, teratoma, and yolk sac tumors) varicocele enlarged, swollen, herniated veins near the testis vari-kō-sēl (varico twisted vein) (Fig. 16.3D) Bladder wall distention caused by urethral narrowing and pressure Bladder Prostatic enlargement Prostate compresses the urethra, Urethra making urination difficult A B Figure 16.7 A. Normal prostate. B. Hypertrophic prostate. 516 Medical Terminology: The Language of Health Care Term Meaning SEXUALLY TRANSMITTED DISEASE (STD) Major Bacterial STDs bak-tērē-ăl chlamydia most common sexually transmitted bacterial kla-midē-ă infection in North America; often occurs with no symptoms and is treated only after it has spread GONORRHEA. gonorrhea contagious inflammation of the genital mucous Derived from the gon-ō-rēă membranes caused by invasion of the gonococcus, Greek root Neisseria gonorrhoeae (gono seed; rrhea discharge) gono, meaning offspring or seed, and the suffix -rrhea, syphilis infectious disease caused by a spirochete transmitted meaning flow or discharge, sifi-lis by direct intimate contact that may involve any organ the word literally means flow or tissue over time; usually manifested first on the skin of semen. It was once with the appearance of small, painless red papules that thought that the urethral erode and form bloodless ulcers called chancres (Fig. discharge characteristic of 16.8) the infection was a leakage of semen. Although the Major Viral STDs reasoning is wrong, v ı̄răl attempts to change the term failed because its usage hepatitis B virus (HBV) virus that causes inflammation of the liver as a result was too firmly established. hep-ă-t ı̄tis of transmission through any body fluid, including vaginal secretions, semen, and blood herpes simplex virus type 2 virus that causes ulcer-like lesions of the genital and (HSV-2) anorectal skin and mucosa; after initial infection, herpēz the virus lies dormant in the nerve cell root and may recur at times of stress (see Fig. 17.9) Figure 16.8 Syphilitic chancre. Chapter 16 • Male Reproductive System 517 Term Meaning human immunodeficiency virus virus that causes acquired (HIV) immunodeficiency syndrome (AIDS), which imyū-nō-dē-fishen-sē permits various opportunistic infections, malignancies, and neurological diseases; contracted through exposure to contaminated blood or body fluid (e.g., semen, vaginal secretions) human papilloma virus (HPV) virus transmitted by direct sexual contact pap-i-lōmă that causes an infection that condyloma acuminatum can occur on the skin or mucous kon-di-lōmah ă-kyūmı̆-nātŭm membranes of the genitals; on the skin, the pl. condylomata acuminata lesions appear as cauliflower-like warts, and kon-di-lōmahtă ă-kyūmı̆-nahtă on the mucous membranes, they have a flat appearance (also known as venereal or genital warts) (see Fig. 17.10) Diagnostic Tests and Procedures Test or Procedure Explanation biopsy (Bx) tissue sampling used to identify neoplasia biopsy of the prostate needle biopsy of the prostate often performed using ultrasound guidance (see Fig. 16.10) testicular biopsy biopsy of a testicle tes-tikyū-lăr digital rectal exam (DRE) insertion of a finger into the male rectum to palpate the rectum and prostate (Fig. 16.9) Figure 16.9 Digital rectal examination. 518 Medical Terminology: The Language of Health Care Test or Procedure Explanation prostate-specific antigen (PSA) test blood test used to screen for prostate cancer; anti-jen an elevated level of the antigen indicates the possible presence of tumor urethrogram x-ray of the urethra and prostate yū-rēthrō-gram semen analysis study of semen, including a sperm count, sēmen with observation of morphology (form) and motility; usually performed to rule out male infertility endorectal (transrectal) sonogram scan of the prostate made after introducing of the prostate an ultrasonic transducer into the rectum— endō-rektăl trans-rektăl also used to guide needle biopsy (Fig. 16.10) Operative Terms Term Meaning circumcision removal of the foreskin (prepuce), exposing the ser-kŭm-sizhŭn glans penis epididymectomy removal of an epididymis epi-did-i-mektō-mē orchiectomy removal of a testicle ōr-kē-ektō-mē orchidectomy ōr-ki-dektō-mē Prostate Rectum Biopsy needle Probe Figure 16.10 Ultrasound and biopsy (inset) of prostate. Chapter 16 • Male Reproductive System 519 Resectoscope Prostate gland Figure 16.11 Transurethral resection of prostate (TURP). Term Meaning orchioplasty repair of a testicle ōrkē-ō-plas-tē orchiopexy fixation of an undescended testis in the scrotum ōrkē-ō-peksē prostatectomy excision of the prostate gland pros-tă-tektō-mē transurethral resection of removal of prostatic gland tissue through the the prostate (TURP) urethra using a resectoscope, a specialized trans-yū-rēthrăl re-sekshŭn urological endoscope—common treatment for benign prostatic hyperplasia/hypertrophy (BPH) (Fig. 16.11) Vas deferens Scrotum Testes A B C D Locating the vas deferens An incision |
is made over The vas deferens is The vas deferens is the vas deferens withdrawn through the returned, and the incision, a section is scrotum incision is removed, and the ends closed with sutures. are tied. Figure 16.12 Vasectomy. 520 Medical Terminology: The Language of Health Care Term Meaning vasectomy removal of a segment of the vas deferens to va-sektō-mē produce sterility in the male (Fig. 16.12) vasovasostomy restoration of the function of the vas deferens to vāsō-vă-sostō-mē regain fertility after vasectomy Therapeutic Terms Term Meaning chemotherapy treatment of malignancies, infections, and other dis kemō-thār-ă-pē eases with chemical agents that destroy selected cells or impair their ability to reproduce cancer immunotherapy treatment of cancer by stimulating the patient’s own imū-nō-thār-ă-pē immune response by transfer of immune components such as antibodies or T cells from an outside source to kill cancer cells radiation therapy treatment of neoplastic disease by using radiation to rādē-āshŭn deter the proliferation of malignant cells brachytherapy radiation technique involving internal implantation of radioactive isotopes, such as radioactive seeds to treat prostate cancer (brachy, meaning short distance, refers to localized application) hormone replacement use of a hormone to remedy a deficiency or regulate therapy (HRT) production (e.g., testosterone) penile prosthesis implantation of a device designed to provide an pēnı̄l prosthē-sis erection of the penis—used to treat physical impotence penile self-injection intracavernosal injection therapy causing an erection—used in treatment of erectile dysfunction Summary of Chapter 16 Acronyms/Abbreviations BPH ..........benign prostatic hyperplasia/hypertrophy HPV ..........human papilloma virus Bx ...............biopsy HRT ..........hormone replacement therapy DRE ..........digital rectal exam HSV-2 ......herpes simplex virus type 2 ED ..............erectile dysfunction PSA............prostate-specific antigen HBV ..........hepatitis B virus STD ...........sexually transmitted disease HIV............human immunodeficiency virus TURP .......transurethral resection of the prostate Chapter 16 • Male Reproductive System 521 PRACTICE EXERCISES For the following terms, on the lines below the term, write out the indicated word parts: prefixes (P), combining forms (CF), roots (R), and suffixes (S). Then define the word. EXAMPLE synorchism _______ / _______ / _______ P R S syn/orch/ism P R S DEFINITION: together/testis or testicle/condition of 1. oligospermia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 2. perineoplasty __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 3. testalgia __________________ / __________________ R S DEFINITION: _________________________________________________________________ 4. balanic __________________ / __________________ R S DEFINITION: _________________________________________________________________ 5. prostatomegaly __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 6. orchidectomy __________________ / __________________ R S DEFINITION: _________________________________________________________________ 522 Medical Terminology: The Language of Health Care 7. anorchism __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 8. vasectomy __________________ / __________________ R S DEFINITION: _________________________________________________________________ 9. aspermia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 10. cystoprostatectomy __________________ / __________________ / __________________ CF R S DEFINITION: _________________________________________________________________ 11. balanitis __________________ / __________________ R S DEFINITION: _________________________________________________________________ 12. orchioplasty __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 13. spermatocele __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 14. epididymotomy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 15. vasovasostomy __________________ / __________________ / __________________ CF CF S DEFINITION: _________________________________________________________________ Chapter 16 • Male Reproductive System 523 Identify the medical term for the following: 16. ____________________________ absence of a testicle 17. ____________________________ inflammation of the glans penis 18. ____________________________ enlarged, herniated veins near the testicle 19. ____________________________ specialized endoscope used to approach the prostate when performing a TURP 20. ____________________________ enlargement of the prostate 21. ____________________________ removal of a portion of the vas deferens to pro- duce male sterility 22. ____________________________ disorder that causes a buildup of hardened fibrous tissue in the corpus cavernosa in the penis Match the following: 23. ________ fertility restoration a. prostatectomy 24. ________ phimosis b. seminoma 25. ________ BPH c. STD 26. ________ cryptorchism d. ED 27. ________ testicular cancer e. orchiopexy 28. ________ penile self-injection f. TURP 29. ________ prostate cancer g. circumcision 30. ________ condyloma acuminata h. vasovasostomy Complete the following: 31. _____________________ orchism undescended testicle 32. _____________________ sonogram of prostate ultrasound scan of the prostate made after introduction of a transducer into the rectum 33. _______________________ cele fluid hernia in the testis 34. _______________________ spadias condition of congenital opening of the male urethra on the undersurface of the penis 35. _______________________ _______________________ exam insertion of a finger into the male rectum to palpate the rectum and prostate 36. _______________________ therapy radiation technique involving implantation of radioactive “seeds” 524 Medical Terminology: The Language of Health Care Match the following terms related to sperm: 37. ________ semen analysis a. semen without living sperm 38. ________ oligospermia b. inability to secrete sperm 39. ________ azoospermia c. sperm morphology 40. ________ aspermia d. scanty production of sperm Write the term for the following abbreviations: 41. PSA _______________________________________________________________________ 42. Bx_________________________________________________________________________ 43. TURP______________________________________________________________________ 44. DRE_______________________________________________________________________ 45. ED ________________________________________________________________________ For each of the following, circle the combining form that corresponds to the meaning given: 46. testis prostat/o epididym/o orchi/o 47. perineum peritone/o perine/o prostat/o 48. sperm test/o orchi/o spermat/o 49. vessel aden/o angin/o vas/o 50. glans penis prostat/o orchid/o balan/o 51. epididymis sperm/o vas/o epididym/o Chapter 16 • Male Reproductive System 525 Write in the missing words on the blank lines in the following illustration of the male anatomy. 52–59. Sagittal view 56. Urinary Ampulla Seminal vesicle Symphysis pubis 52. Corpus cavernosum Ejaculatory duct 57. 53. gland Penis 54. Anus Prepuce Bulbourethral gland Urethral meatus 58. 55. Vas deferens Scrotum 59. For each of the following, circle the correct spelling of the term: 60. epididymis epididymus epedidimis 61. oligspermia oligospermia oligispermia 62. azospermia asospermia azoospermia 63. anorchesm anorchism anorschizm 64. balanitis balanitus balantis 65. creptorchism criptorchism cryptorchism 66. hypospadias hypospadeas hypespadias 67. clamidyia chlamidya chlamydia 68. syphilis syphillis syphyllis 69. fimosis phimosis phymosis 526 Medical Terminology: The Language of Health Care Give the noun that was used to form the following adjectives: 70. prostatic ____________________ 71. epididymal __________________ 72. perineal _____________________ 73. penile _______________________ 74. gonorrheal __________________ 75. testicular ____________________ Chapter 16 • Male Reproductive System 527 MEDICAL RECORD ANALYSES M E D I C A L R E C O R D 1 6 . 1 Chart Note S: Twelve days ago this 34 y.o. male had a flu-like syndrome that lasted about 2–3 hours. For the past two days, he has felt lousy again and is experiencing left testicular pain and swelling s̄ avoiding Sx Allergies: none PH: negative Habits: smoking—no alcohol—occasional beer ROS: otherwise negative O: Slightly small testes bilaterally; tender L epididymis; normal circumcised penis UA: WNL A: L epididymitis P: Rx: Maxaquin 400 mg #16 Sig: STAT, then q.d. 14 d; return in two weeks for follow-up 1. What was the patient’s diagnosis? 4. Did the patient have any trouble urinating? a. testicular pain and swelling a. yes b. inflammation of the testicle b. no c. swollen veins near the testis 5. What was the condition of the right testicle? d. inflammation of the coiled duct that stores sperm a. inflamed e. fluid hernia in a testicle b. enlarged c. small 2. What was the condition of the patient’s penis? d. normal a. small but normal e. had been excised b. prepuce had been excised c. inflamed 6. What was the result of the urinalysis? d. swollen and tender a. not stated e. not stated b. normal c. not performed because the patient could not 3. What was the Sig: on the prescription? void a. two every other day for fourteen days d. hematuria b. two immediately, then one a day for fourteen e. glucosuria days c. one immediately, then one a day for fourteen days d. one as needed every day for fourteen days e. two a day for fourteen days 528 Medical Terminology: The Language of Health Care M E D I C A L R E C O R D 1 6 . 2 Larry Phelps, age 31, has been happily married to his wife Nancy for almost 5 years. They have two children. The second child caused some health problems for Nancy, and her obstetrician recommended that they have no more children because of the risk to her health. After trying different forms of birth control, Nancy and Larry decided that he would have a vasectomy. His doctor referred him to Dr. Jerard Derrick in the urology department at Central Medical Group. Directions Read Medical Record 16.2 for Larry Phelps (pages 530–531) and answer the following questions. This record is a series of three chart notes written by Dr. Derrick after first meeting with Mr. Phelps to schedule surgery, after the surgery and discharge, and after seeing Mr. Phelps in a follow-up 10 days later. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 1 6 . 2 Write your answers in the spaces provided. 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record and define below: sterility ____________________________________________________________________ infiltrated __________________________________________________________________ resect ______________________________________________________________________ ejaculation _________________________________________________________________ induration __________________________________________________________________ 2. The medical record suggests that Mr. Phelps signed which of these before surgery? a. last will and testament b. consent form c. application to sperm bank d. none of the above 3. In your own words, not using medical terminology, briefly summarize the proce- dure Dr. Derrick performed: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 4. Complications of the surgery included the following: a. sterility b. fever c. nausea and vomiting d. bleeding e. all of the above f. none of the above Chapter 16 • Male Reproductive System 529 5. Translate the instruction for the immediate postoperative medication (how much, how often): __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 6. Mark any of the following that were symptoms Mr. Phelps reported to Dr. Derrick on his follow-up visit 10 days after surgery: a. fever b. bleeding c. pain in the scrotum d. impotence e. suture loosening 7. Dr. Derrick carefully examined Mr. Phelps in the follow-up visit and noted the fol- lowing objective findings (mark all that are appropriate): a. minor bruising in the scrotum b. small area of hard tissue at left vasectomy site c. bleeding at left vasectomy site d. pain at left vasectomy site e. very sore elevated mass at right vasectomy site f. bleeding at right vasectomy site g. pain at right vasectomy site h. hard tissue areas along upper scrotum i. black and blue penis 8. In your own words, define the diagnosis Dr. Derrick made in the follow-up visit: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 9. Translate Dr. Derrick’s medication instructions after the follow-up visit: Medication Amount How Often ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ 530 Medical Terminology: The Language of Health Care Medical Record 16.2 Chapter 16 • Male Reproductive System 531 Medical Record 16.2 Continued 532 Medical Terminology: The Language of Health Care M E D I C A L R E C O R D 1 6 . 3 James Easley was having some difficulty urinating fully and was feeling gradually increasing pain in the perineal area. He went to see his personal physician, who after a digital rectal examination referred him to Dr. Lentz, a urologist at Central Medical Center. Directions Read Medical Record 16.3 for James Easley (page 534) and answer the following ques- tions. This record is the ultrasound report dictated by Dr. Lentz after his session with Mr. Easley in the ultrasound suite at Central Medical Center. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 1 6 . 3 Write your answers in the spaces provided: 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record and define below: needle biopsy ______________________________________________________________ MHz _____________________________________________________________________ bifocal ____________________________________________________________________ 2. In your own words, not using medical terminology, briefly describe the ultrasound procedure Mr. Easley underwent: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 3. In your own words, describe the position Mr. Easley was put in for the ultrasound: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 4. Mark any of the following that are abnormal findings in Dr. Lentz’s report: a. enlarged prostate gland b. hemorrhage c. hypoechoic lesion d. obstructed urethra e. prostatic calculi f. multiplanar rectum Chapter 16 • Male Reproductive System 533 5. Because |
of the results of the ultrasound, Dr. Lentz decided to perform an additional diagnostic procedure while Mr. Easley was in the ultrasound suite. In your own words, describe that procedure: __________________________________________________________________________ __________________________________________________________________________ 6. Explain why Dr. Lentz’s report does not include a plan or recommendations for further actions: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 7. When and for how long should Mr. Easley take the Noroxin? __________________________________________________________________________ _________________________________________________________________________ 534 Medical Terminology: The Language of Health Care Medical Record 16.3 Chapter 17 Female Reproductive System OBJECTIVES After completion of this chapter you will be able to Define common term components used in relation to the female reproductive system Describe the basic functions of the female reproductive system Define the basic anatomical terms referring to the female reproductive system Define common gynecological symptomatic and diagnostic terms List the common gynecological diagnostic tests and procedures Define common gynecological operative and therapeutic terms Define common obstetrical symptomatic and diagnostic terms List the common obstetrical diagnostic tests and procedures Define common obstetrical operative and therapeutic terms Explain terms and abbreviations used in documenting medical records involving the female reproductive system Combining Forms Combining Form Meaning Example cervic/o neck or cervix cervical servı̆ -kal colp/o vagina (sheath) colposcope kolpō-skōp vagin/o vaginal vaji-năl episi/o vulva (covering) episiotomy e-piz-ē-otō-mē vulv/o vulvar vŭlvăr gynec/o woman gynecology gı̄ -nĕ-kolō-jē hyster/o uterus hysteroscopy his-ter-oskŏ-pē metr/o metrorrhagia mē-trō-rājē-ă uter/o uterus ūter-ŭs 535 536 Medical Terminology: The Language of Health Care Combining Form Meaning Example lact/o milk lactogenic lak-tō-jenik mast/o breast mastodynia mas-tō-dinē-ă mamm/o mammogram mamō-gram men/o menstruation menopause menō-pawz obstetr/o midwife obstetric ob-stetrik oophor/o ovary oophoritis ō-of-ōr-ı̄ tis ovari/o ovarian ō-varē-an ov/i egg ovigenesis ō-vi-jenĕ-sis ov/o ovum ōvŭm pelv/i pelvic cavity pelvimetry pel-vimĕ-trē salping/o uterine (fallopian) tube salpingitis sal-pin-jı̄ tis toc/o labor or birth dystocia dis-tōsē-ă ADDITIONAL SUFFIX -arche beginning menarche me-narkē Female Reproductive System Overview The female reproductive system consists of the uterus, ovaries, uterine (fallopian) tubes, vagina, and vulva (Fig. 17.1). These structures are responsible for producing and main- taining female ova and providing a place for the implantation and nurturing of the fer- tilized ovum until birth. Treatment of the female reproductive system involves two medical specialties: gynecology and obstetrics. Anatomical Terms Term Meaning uterus womb; pear-shaped organ in the pelvic cavity in ūter-ŭs which the embryo develops fundus upper portion of the uterus above the entry to the fŭndŭs uterine tubes Chapter 17 • Female Reproductive System 537 Sagittal view Mons pubis Fallopian tube (uterine tube) Clitoris Ovary Labium major Fimbriae Labium minor Urethral opening Uterus Vaginal opening Round ligament (introitus) with Cervix hymen Urinary bladder Perineum Symphysis pubis Anus Urethra Clitoris Vagina Labium minor Labium major Uterus: Frontal view Rectum The right side shows a cutaway Anus view; the left side shows an external view. Fallopian tube Fundus (uterine tube) Fimbriae Follicle Ovary Developing eggs Broad ligament Ovary Ovarian ligament Body of uterus Endometrium Round ligament Myometrium Cervix Cervical os Corpus luteum Vagina Mature graafian follicle Ovulation (ovum released) Figure 17.1 Female reproductive system. Term Meaning endometrium lining of the uterus that is shed approximately endō-mētrē-ŭm every 28–30 days in the nonpregnant female during menstruation (see Table 17.1 on page 538) myometrium muscular wall of the uterus FALLOPIUS. mı̄ ō-mētrē-ŭm Gabriele uterine or fallopian tubes tubes extending from each side of the uterus Fallopius, a yūter-in fa-lōpē-an toward the ovary that provide a passage for ova to 16th-century Italian the uterus anatomist, made many important observations, adnexa uterine tubes and ovaries (uterine appendages) especially concerning the ad-neksă female reproductive organs. His classical descriptions right uterine appendage right tube and ovary resulted in his name being left uterine appendage left tube and ovary associated with the uterine ovary one of two glands located on each side of the pelvic tubes. He compared the abdominal end of each tube ōvă-rē cavity that produce ova and female sex hormones to a trumpet. 538 Medical Terminology: The Language of Health Care Table 17.1 Menstrual Cycle The menarche is the time in puberty when the female menstrual cycle begins and continues in a 28–30-day cycle throughout reproductive life, except at times of pregnancy, until menopause (generally occurring between 45 and 55 years of age). Hormones secreted by the anterior pituitary gland control the four stages of the menstrual cycle: Menstrual stage (period) Days 1–5 Shedding of unused endometrial tissue in a bloody discharge Follicular stage Days 6–13 Secretion of follicle-stimulating hormone (FSH), initiating growth of an ovum in the graafian follicle, and release of estrogen by the maturing follicle, causing thickening and revitalization of the endometrial lining Ovulatory stage Days 14–16 Secretion of luteinizing hormone causes the follicle to rupture and release the mature ovum into the uterine tube; the ruptured follicle, remaining in the ovary, transforms into the corpus luteum, which then secretes progesterone and estrogen to further nourish the endometrium. Premenstrual stage Days 17–28 If conception does not take place, the corpus luteum stops secreting progesterone and estrogen, thinning of the endometrial lining occurs, and tissue breakdown culminates in menstruation. Term Meaning cervix neck of the uterus serviks cervical os opening of the cervix to the uterus servı̆ -kăl os vagina tubular passageway from the cervix to the outside of the vă-jı̄ nă body vulva external genitalia of the female vŭlvă labia folds of tissue on either side of the vaginal opening lābē-ă known as the labia majora and labia minora clitoris female erectile tissue situated in the anterior portion of klitō-ris the vulva hymen fold of mucous membrane that encircles the entrance hı̄ men to the vagina introitus entrance to the vagina in-trōi-tŭs Bartholin glands two glands located on either side of the vaginal opening that secrete a lubricant during intercourse perineum region between the vulva and anus peri-nēŭm Chapter 17 • Female Reproductive System 539 Breast anatomy Rib Intercostal muscles Chest muscles Skin Adipose tissue Alveolar glands Areola Nipple Lactiferous duct Figure 17.2 Breast. Term Meaning mammary glands two glands of the female breasts capable of producing milk MAMMA. mamă-rē (Fig. 17.2) Mamma is Latin for breast; the mammary papilla nipple word is said to come from pă-pilă the cry of the infant for areola dark pigmented area around the nipple “mama,” which is a sound ă-rēō-lă common to most languages and is the root for mother in embryo developing organism from fertilization to the end of the many. The word “breast” is embrē-ō eighth week (Fig. 17.3) derived from the German word for “bursting forth” or fetus developing organism from the ninth week to birth (Fig. 17.4) “budding.” fētŭs placenta vascular organ that develops in the uterine wall during plă-sentă pregnancy that provides nourishment for the fetus (placenta cake) Sperm and ovum A B Figure 17.3 A. Sperm and ovum. B. Two-dimensional sonogram of 8-week embryo. 540 Medical Terminology: The Language of Health Care Placenta Uterus Amniotic fluid Fetus Amnion A B Figure 17.4 A. Fetus in utero. B. Three-dimensional sonogram of fetus “waking up.” Term Meaning amnion innermost of the membranes surrounding the embryo amnē-on in the uterus filled with amniotic fluid amniotic fluid fluid within the amnion that surrounds and protects the fetus meconium intestinal discharges of the fetus that form the first stools in mē-kōnē-ŭm the newborn Gynecological Symptomatic Terms gı̄ nĕ-kō-loji-kăl Term Meaning amenorrhea absence of menstruation ă-men-ō-reă anovulation absence of ovulation an-ov-yū-lāshŭn dysmenorrhea painful menstruation dis-men-ōr-ēă dyspareunia painful intercourse (coitus) (dys painful; dis-pa-rūnē-ă para alongside of; eunia a lying) leukorrhea abnormal white or yellow vaginal discharge lū-kō-rēă menorrhagia excessive bleeding at the time of menstruation (menses) men-ō-rājē-ă metrorrhagia bleeding from the uterus at any time other than normal mē-trō-rājē-ă menstruation oligomenorrhea scanty menstrual period oli-gō-men-ō-rēă oligo-ovulation irregular ovulation oli-gō-ovyū-lāshŭn Chapter 17 • Female Reproductive System 541 Gynecological Diagnostic Terms Term Meaning cervicitis inflammation of the cervix ser-vi-sı̄ tis congenital anomalies birth defects causing the abnormal development (irregularities) of a female organ or structure (e.g., double uterus, kon-jeni-tăl ă-nomă-lēz absent vagina) dermoid cyst congenital tumor composed of displaced embryonic dermoyd sist tissue (teeth, bone, cartilage, and hair) more commonly found in an ovary; it is usually benign displacement of uterus displacement of the uterus from its normal position (Fig. 17.5) anteflexion abnormal forward bending of the uterus an-tē-flekshŭn (ante before; flexus bend) retroflexion abnormal backward bending of the uterus re-trō-flekshŭn retroversion backward turn of the whole uterus—also called re-trō-verzhŭn tipped uterus Anteflexion Retroflexion The three degrees of retroversion 1st degree 2nd degree Normal 3rd degree Figure 17.5 Displacements of the uterus. 542 Medical Terminology: The Language of Health Care Term Meaning endometriosis condition characterized by migration of portions endō-mē-trē-ōsis of endometrial tissue outside the uterine cavity endometritis inflammation of the endometrium endō-mē-trı̄ tis fibroid benign tumor in the uterus composed of smooth fı̄ broyd muscle and fibrous connective tissue (Fig. 17.6) fibromyoma fı̄ brō-mı̄ -ōmă leiomyoma lı̄ ō-mı̄ -ōmă fistula abnormal passage such as from one hollow fistyū-lă organ to another (fistula pipe) (Fig. 17.7) rectovaginal fistula abnormal opening between the vagina and rek-tō-vaji-năl rectum vesicovaginal fistula abnormal opening between the bladder and ves-i-kō-vaji-năl vagina cervical neoplasia abnormal development of cervical tissue cells cervical intraepithelial potentially cancerous abnormality of epithelial neoplasia (CIN) tissue of the cervix, graded according to the intră-ep-i-thēlē-ăl extent of abnormal cell formation: nē-ō-plāzē-ă CIN 1 mild dysplasia cervical dysplasia CIN 2 moderate dysplasia dis-plāzē-ă CIN 3 severe dysplasia (see Fig. 17.13B) Fallopian tube Fibroids connected to the uterine wall with stalks Ovary Serosa Fibroid extending from the uterine wall into the uterine cavity (submucosal) Intramural fibroid Fibroids inside the Cervix uterine wall (subserosal) Vagina Figure 17.6 Fibroids. Chapter 17 • Female Reproductive System 543 Rectovaginal fistula Vesicovaginal fistula Vagina Fistula Vagina Fistula Urinary Rectum bladder Figure 17.7 Fistulas. Term Meaning carcinoma in situ (CIS) malignant cell changes of the cervix of the cervix that are localized without any spread to adjacent kar-si-nōmă in sı̄ tū structures menopause cessation of menstrual periods owing to a lack of menō-pawz ovarian hormones oophoritis inflammation of one or both ovaries ō-of-ōr-ı̄ tis parovarian cyst cyst of the fallopian tube par-ō-varē-an pelvic adhesions scarring of tissue within the pelvic cavity as a pelvik ad-hēzhŭnz result of endometriosis, infection, or injury pelvic inflammatory inflammation of organs in the pelvic cavity usually disease (PID) including the fallopian tubes, ovaries, and endometrium—most often caused by bacteria pelvic floor relaxation relaxation of supportive ligaments of the pelvic organs (Fig. 17.8) cystocele pouching of the bladder into the vagina sistō-sēl rectocele pouching of the rectum into the vagina rektō-sēl enterocele pouching sac of peritoneum between the vagina enter-ō-sēl and rectum urethrocele pouching of the urethra into the vagina yū-rēthrō-sēl prolapse descent of the uterus down the vaginal canal prō-laps salpingitis inflammation of a fallopian tube sal-pin-jı̄ tis 544 Medical Terminology: The Language of Health Care Normal view of bladder Bladder with cystocele Rectocele Bladder falls or Rectum bulges descends from into wall of the normal position vagina Enterocele Urethrocele Prolapse Small intestine Urethra sags and Uterus descends bulges between eventually bulges from normal rectum and vagina into the vaginal wall position into vagina Figure 17.8 Pelvic floor relaxation. SEXUALLY TRANSMITTED DISEASES (STDs) Term Meaning Major Bacterial STDs chlamydia most common sexually transmitted bacterial kla-midē-ă infection in North America; often occurs with no symptoms and is treated only after it has spread, such as to cause pelvic inflammatory disease gonorrhea contagious inflammation of the genital mucous gon-ō-rēă membranes caused by invasion of the gonococcus, Neisseria gonorrhoeae (gono seed; rrhea discharge) syphilis infectious disease caused by a spirochete sifi-lis transmitted by direct intimate contact that may involve any organ or tissue over time; usually manifested first on the skin with the appearance of small, painless red papules that erode and form bloodless ulcers called chancres Major Viral STDs hepatitis B virus (HBV) virus that causes an inflammation of the liver as a hep-ă-tı̄ tis result of transmission through any body fluid, including vaginal secretions, semen, and blood herpes simplex virus virus that causes ulcer-like lesions of the genital type 2 (HSV-2) and anorectal skin and mucosa; after initial herpēz infection, the virus lies dormant in the nerve cell root and may recur at times of stress (Fig. 17.9) Chapter 17 • Female Reproductive System 545 Figure 17.9 Herpes simplex virus type 2. Term Meaning human immunodeficiency virus that causes acquired immunodeficiency virus (HIV) syndrome (AIDS), permitting various imyū-nō-dē-fishen-sē opportunistic infections, malignancies, and neurological |
diseases—contracted through exposure to contaminated blood or body fluid (e.g., semen, vaginal secretions) human papilloma virus virus transmitted by direct sexual contact (HPV) that causes an infection that can occur on the pap-i-lōmă skin or mucous membranes of the genitals; condyloma acuminatum on the skin, the lesions appear as cauliflower- kon-di-lōmah ă-kyūmı̆ -nātŭm like warts, and on the mucous membranes, pl. condylomata acuminata they have a flat appearance (also known as kon-di-lōmahtă ă-kyūmı̆ -nahtă venereal or genital warts) (Fig. 17.10) Figure 17.10 Condylomata acuminata (genital warts) caused by HPV. 546 Medical Terminology: The Language of Health Care Term Meaning vaginitis inflammation of the vagina with redness, swelling, and vaj-i-nı̄tis irritation—often caused by a specific organism, such as Candida (yeast) or Trichomonas (sexually transmitted parasite) atrophic vaginitis thinning of the vagina and loss of moisture owing to ă-trofik depletion of estrogen, which causes inflammation of tissue vaginosis infection of the vagina with little or no inflammation vaji-nō-sis characterized by a milk-like discharge and an unpleasant odor—also known as nonspecific vaginitis BREASTS adenocarcinoma of the malignant tumor of glandular breast tissue breast adĕ-nō-kar-si-nōmă amastia absence of a breast ă-mastē-ă fibrocystic breasts benign condition of the breasts consisting of fı̆ -brō-sistik fibrous and cystic changes that render the tissue more dense—patient feels painful lumps that fluctuate in size during the menstrual cycle gynecomastia development of mammary glands in the male, gı̄ nĕ-kō-mastē-ă caused by altered hormone levels (Fig. 17.11) Figure 17.11 This 15-year-old boy presented with a 3-year history of gradual, bilateral breast enlargement known as gynecomastia. He was otherwise healthy and showed normal pubertal development. The cause in his case was idiopathic, but most are related to hormone imbalance as seen in tumors of the pituitary or adrenal glands. For cosmetic reasons and because of functional impairment (breast pain with running), he underwent breast reduction mammoplasty. Chapter 17 • Female Reproductive System 547 Term Meaning hypermastia abnormally large breasts hı̄ -per-mastē-ă macromastia mak-rō-mastē-ă hypomastia unusually small breasts hı̄ po-mastē-ă micromastia mı̄ kro-mastē-ă mastitis inflammation of the breast—most common in mas-tı̄ tis women when breast-feeding polymastia presence of more than two breasts pol-ē-mastē-ă polythelia presence of more than one nipple on a breast pol-ē-thēlē-ă supernumerary nipples sū-per-nūmer-ār-ē Gynecological Diagnostic Tests and Procedures Test or Procedure Explanation biopsy (Bx) removal of tissue for microscopic pathological bı̄ op-sē examination (Fig. 17.12) aspiration Bx needle draw of tissue or fluid from a cavity for as-pi-rāshŭn cytological examination—also called needle biopsy endoscopic Bx removal of a specimen for biopsy during an endō-skōpik endoscopic procedure (e.g., colposcopy) excisional Bx removal of an entire lesion for microscopic ek-sizhŭn-ăl examination incisional Bx removal of a piece of suspicious tissue for in-sizhŭn-ăl microscopic examination (e.g., cervical or endometrial biopsy) needle Bx removal of a core specimen of tissue using a special hollow needle stereotactic breast Bx use of x-ray or ultrasound imaging, a specialized stereotactic frame, and a computer to calculate, sterē-ō-taktik precisely locate, and direct a needle into a breast lesion for the removal of a core specimen for biopsy sentinel node breast Bx biopsy of the sentinel node (the first lymph node to sentinl nōd receive lymphatic drainage from a tumor) in a breast with early cancer to determine metastases and, if no malignancy is found, avoid the extensive removal of axillary nodes that causes lymphedema (swelling under the arms); includes radionuclide imaging to locate the sentinel node (sentinel refers to guarding a point of entry) 548 Medical Terminology: The Language of Health Care Incisional Excisional biopsy biopsy Aspiration biopsy Endometrial biopsy Suction curette Figure 17.12 Biopsy. Test or Procedure Explanation colposcopy examination of the vagina and cervix using a kol-poskŏ-pē colposcope, a specialized microscope used to examine the vagina and cervix, often with a camera attachment for photographs—used to document findings and follow-up treatments (Fig. 17.13) hysteroscopy use of a hysteroscope to examine the intrauterine his-ter-oskŏ-pē cavity for the assessment of abnormalities (e.g., polyps, fibroids, anomalies) (Fig. 17.14) magnetic resonance use of nonionizing images to detect gynecological imaging (MRI) conditions (e.g., anomalies of the pelvis or soft rezō-nans tissues of the breast) or stage tumors arising from the endometrium or cervix Papanicolaou smear (Pap) study of cells collected from the cervix to screen pa-pĕ-nēkĕ-low for cancer and other abnormalities Chapter 17 • Female Reproductive System 549 A Cervical colposcopy Normal cervix High-grade lesions (low magnification) High-grade lesions (high magnification) B Figure 17.13 A. Colposcopy. B. Photographs taken during cervical colposcopy. Biopsy of the high-grade lesions revealed CIN 3 (severe dysplasia). Hysteroscopic visualization of a fibroid in the uterus Figure 17.14 Hysteroscopy. 550 Medical Terminology: The Language of Health Care Test or Procedure Explanation radiography x-ray imaging rādē-ogră-fē hysterosalpingogram x-ray of the fallopian tubes after injection of a hister-ō-sal-ping-ō-gram contrast medium through the cervix—used to determine tubal patency mammogram low-dose x-ray of breast tissue done to detect mamō-gram neoplasms (Fig. 17.15) pelvic sonography ultrasound imaging of the female pelvis sŏ-nogră-fē (Fig. 17.16) endovaginal sonogram ultrasound image of the uterus, tubes, and ovaries endō-vaji-năl made after introduction of an ultrasonic transducer transvaginal sonogram within the vagina to detect conditions such as trans-vaji-năl sonō-gram ectopic pregnancy or missed abortion hysterosonogram transvaginal sonographic image made as sterile (saline infusion sonogram) saline is injected into the uterus; used to assess uterine pathology or determine tubal patency; also known as sonohysterogram transabdominal sonogram ultrasound image of the lower abdomen including trans-ab-domi-năl the bladder, uterus, tubes, and ovaries to detect conditions such as cysts and tumors Figure 17.15 A. Mammography procedure. B. Mammogram of a patient with an implant. Arrows, pectoralis muscle anterior to the implant. Chapter 17 • Female Reproductive System 551 A Endovaginal probe B Figure 17.16 Pelvic sonography. A. Transabdominal imaging procedure. Inset, simple ovarian cyst. B. Transvaginal imaging procedure. Inset, twin pregnancies. Gynecological Operative Terms Term Meaning adhesiolysis breaking down or severing of pelvic adhesions ad-hēzē-ōli-sis adhesiotomy ad-hē-sē-ot-ōmē cervical conization removal of a cone-shaped portion of the cervix servı̆ -kal kō-nı̄ -zāshŭn 552 Medical Terminology: The Language of Health Care Vaginal speculum Vagina Uterus Cryoprobe Insertion of speculum and introduction of Placement of cryosurgical probe Ice crystals seen immediately after cryoprobe into the vagina at treatment site freezing treatment A B C Figure 17.17 Cryosurgical procedure: cryoconization of the cervix. Term Meaning colporrhaphy suture to repair the vagina kol-pōră-fē anterior repair repair of a cystocele posterior repair repair of a rectocele A&P repair anterior and posterior repair of a cystocele and rectocele cryosurgery method of destroying tissue by freezing—used for krı̄ -ō-serjer-ē treating dysplasia and early cancers (Fig. 17.17) Speculum Vagina Forceps Uterus Speculum Needle Cul-de-sac Figure 17.18 Culdocentesis. Chapter 17 • Female Reproductive System 553 A curette (a spoon-shaped cutting Curetting (scraping) the instrument) is inserted after dilating endometrium the cervix. Figure 17.19 Dilation and curettage. Term Meaning culdocentesis aspiration of fluid from the cul-de-sac (cavity that kŭl-dō-sen-tēsis lies between the rectum and posterior wall of the uterus)—used for diagnosing ectopic pregnancy and pelvic inflammatory disease (Fig. 17.18) dilation and curettage (D&C) dilation of the cervix and scraping of the dı̄-lāshŭn kyū-rĕ-tahzh endometrium to control bleeding, obtain tissue for biopsy, or remove polyps or products of concep- tion (Fig. 17.19) hysterectomy removal of the uterus HYSTERIA. his-ter-ektō-mē Hysteria is a Greek word abdominal hysterectomy removal of the uterus through an incision in the meaning a uterine abdomen condition. Ancient Greeks vaginal hysterectomy removal of the uterus through the vagina believed that nervous symptoms were due to the total hysterectomy removal of the uterus and cervix uterus and therefore were experienced only by laparoscopy inspection of the abdominal or pelvic cavity with women. Plato described the lap-ă-roskŏ-pē a laparoscope, an endoscope used to examine the uterus as an animal abdominal and pelvic regions endowed with spontaneous sensation and emotion that laparoscopic surgery surgical procedures within the abdominal or was lodged in a woman, pelvic region using a laparoscope ardently desiring to produce laser surgery use of a laser to destroy lesions or dissect or cut children. If the uterus lāzer tissue—used frequently in gynecology remained sterile long after puberty, it became ill- loop electrosurgical excision use of electrosurgical or radio waves transformed tempered and caused a procedure (LEEP) through a loop-configured electrosurgical device general disturbance in the large loop excision of the to treat precancerous lesions by simultaneous body until it became transformation zone excisional biopsy and treatment of affected tissue pregnant. The common (LLETZ) (e.g., cervical dysplasia, human papilloma virus prescription for the hysterical lesions); note that the transformation zone is the female in those days was marriage and childbirth! area of the cervix where neoplasia (abnormal cell formation) is most likely to arise (Fig. 17.20) 554 Medical Terminology: The Language of Health Care Loop electrode Transformation zone Cervix A B C Figure 17.20 Loop electrosurgical excision procedure (LEEP) or large loop excision of the transformation zone (LLETZ). A. Electrode approach. B. Removal of the transformation zone. C. Excision site (region between the endocervix and ectocervix). Term Meaning myomectomy excision of fibroid tumors mı̄ -ō-mektō-mē oophorectomy excision of an ovary ō-of-ōr-ektō-mē ovarian cystectomy excision of an ovarian cyst ō-varē-an sis-tektō-mē salpingectomy excision of a uterine tube sal-pin-jektō-mē bilateral salpingo-oophorectomy excision of both uterine tubes and bı̄ -later-ăl sal-pinggō-ō-of-ō-rektō-mē ovaries salpingotomy incision into a fallopian tube—often sal-pin-gottō-mē performed to remove an ectopic pregnancy (Fig. 17.21) salpingostomy creation of an opening in the fallopian sal-ping-gostō-mē tube to open a blockage tubal ligation sterilization of a woman by cutting and lı̄ -gāshŭn tying (ligating) the uterine tubes Unruptured ectopic tubal pregnancy Surgical incision of uterine tube for Suture of incision site removal of products of conception Figure 17.21 Salpingotomy. Chapter 17 • Female Reproductive System 555 Term Meaning BREASTS lumpectomy excision of a breast tumor without removing lŭm-pektō-mē any other tissue or lymph nodes; most often followed by radiation and/or chemotherapy if cancerous mastectomy removal of a breast (Fig. 17.22) mas-tektō-mē simple mastectomy removal of an entire breast with underlying muscle and axillary lymph nodes left intact radical mastectomy removal of an entire breast, underlying chest muscles, and axillary lymph nodes modified radical mastectomy removal of an entire breast and axillary lymph nodes (Fig. 17.23A) Brachial nodes Axillary nodes Pectoralis major Subclavian nodes muscle Pectoralis major muscle Pectoralis minor muscle (under Internal mammary pectoralis major nodes muscle) A Mammary gland B Long thoracic nerve Subscapular nodes Anterior pectoral nodes Anatomy Simple Mastectomy The breast, the underlying muscles, and the lymph nodes Only the breast is removed. The underlying muscle and are the structures involved in breast cancer surgery. The lymph associated lymph nodes are not removed. nodes, which act as barriers against bacteria or tumor cells, are useful in staging breast cancer. Stump of pectoralis Brachial nodes major muscle Axillary nodes Axillary artery Subclavian nodes Stump of pectoralis minor muscle Axillary artery Cut edge of pectoralis major muscle Internal mammary nodes Intercostal muscle Rib Pathways to opposite breast C Long thoracic nerve D Long thoracic nerve Radical Mastectomy Modified Radical Mastectomy The breast, pectoralis muscles, and contents of the The breast and lymph nodes of the axilla are removed. axilla (including lymph nodes and adipose tissue) are removed. Occasionally, the pectoralis minor muscle is transected or removed to approach the lymph nodes. Figure 17.22 A. Anatomy of the breast. B–D. Mastectomy alternatives. 556 Medical Terminology: The Language of Health Care Figure 17.23 Augmentation mammoplasty. A. Left modified radical mastectomy in a 53-year-old woman (3 months postoperation). B. Same patient 10 months after augmentation mammoplasty. Term Meaning mammoplasty surgical reconstruction of a breast mamō-plas-tē augmentation mammoplasty reconstruction to enlarge the breast, often by insertion of an implant (see Fig. 17.23A and B) reduction mammoplasty reconstruction to remove excessive breast tissue (Fig. 17.24) mastopexy elevation of pendulous breast tissue mastō-pek-sē (see Fig. 17.24B) Therapeutic Terms Term Meaning chemotherapy treatment of malignancies, infections, and kemō-thār-ă-pē other diseases with chemical agents that destroy selected cells or impair their ability to reproduce radiation therapy treatment of neoplastic disease by using radiation, usually from a cobalt source, to deter the proliferation of malignant cells hormone replacement use of a hormone (e.g., estrogen, progesterone) therapy (HRT) to replace a deficiency or regulate production Chapter 17 • Female Reproductive System 557 Figure 17.24 Mammoplasty and mastopexy. A. Micromastia of one breast and macromastia of the opposite breast in a 22-year-old patient. B. Same patient 15 months postreduction mammoplasty and mastopexy. Term Meaning hormonal contraceptives hormones used to prevent conception |
by suppressing ovulation oral contraceptive birth control pill pill (OCP) contraceptive injection injection of a hormone such as Depo-Provera into the body contraceptive implant insertion of a contraceptive capsule under the skin that provides a continual infusion over an extended time barrier contraceptives products that provide a physical barrier that prevents conception (e.g., condoms, diaphragms) intrauterine device (IUD) contraceptive device inserted into the intră-yūter-in uterus that prevents implantation of the fertilized egg spermicidals creams, jellies, lotions, or foams containing sper-mi-sı̄ dălz agents that kill sperm (cido to kill) uterine fibroid catheter-guided injection of embolic agents embolization (UFE) into the arteries supplying blood to fibroid tumors, blocking circulation and causing shrinkage; minimally invasive procedure performed by a vascular and interventional radiologist in a angiographic laboratory 558 Medical Terminology: The Language of Health Care Obstetrical (OB) Symptomatic and Diagnostic Terms ob-stetri-kal Term Meaning SYMPTOMATIC gravida pregnant woman gravi-dă [Note: In an obstetrical history, gravida, or G, followed by a numeral indicates the number of pregnancies (Fig. 17.25).] nulligravida having never been pregnant nŭl-i-gravi-dă primigravida first pregnancy prı̄ -mi-gravi-dă para to bear; a woman who has produced one or more viable pară (live outside the uterus) offspring [Note: In an obstetrical history, para, or P, followed by a numeral indicates the number of times a pregnancy has resulted in a single or multiple birth (see Fig. 17.25).] nullipara woman who has not borne a child (nulli none; nŭl-i-pară para to bear) primipara first delivery (primi first; para to bear) pri-mipă-ră multipara woman who has given birth to two or more children mŭl-tipă-ră (multi many; para to bear) cervical effacement progressive obliteration of the endocervical canal during ĕ-fāsment delivery estimated date of expected date for delivery of the baby—normally 280 days confinement (EDC) or 40 weeks from conception kon-fı̄nment estimated date of delivery (EDD) meconium staining presence of meconium in amniotic fluid mē-kōnē-ŭm ruptured membranes rupture of the amniotic sac, usually at the onset of labor rŭpchūrd macrosomia large-bodied baby commonly seen in diabetic pregnancies mak-rō-sōmē-ă (macro large; soma body) polyhydramnios excessive amniotic fluid polē-hı̄ -dramnē-os DIAGNOSTIC abortion (AB) expulsion of the product of conception before the fetus ă-bōrshŭn can be viable (live outside the uterus) spontaneous miscarriage; expulsion of products of conception abortion (SAB) occurring naturally spon-tānē-ŭs Chapter 17 • Female Reproductive System 559 The following abbreviations are used in recording an obstetrical history. GPA terms: G gravida number of pregnancies P para number of viable birth experiences (may include multiple births) AB abortus abortions SAB spontaneous abortion TAB therapeutic abortion Arabic numerals are placed after each abbreviation to indicate the number of pregnancies, viable births, or abortions. Example: Obstetric history: G2, P1, AB1 or gravida 2, para 1, abortus 1. [The patient has been pregnant twice, had one birth experience that resulted in the delivery of at least one viable offspring, and had one abortion.] TPAL terms: T term infants P premature infants A abortions L living children Example: Obstetric history: 5 term infants, 0 premature infants, 0 abortions, 5 living children or Obstetric history: 5-0-0-5. [The patient has delivered five term infants, no premature infants, no abortions and has five living children.] Occasionally, combined GPA and TPAL abbreviations are used. For example: Obstetrical history: gravida 3, 4-0-0-4 [The patient has been pregnant three times, had four term infants, no premature infants, no abortions, and has 4 living children. (Numbers indicate one twin birth.)] Figure 17.25 Obstetrical history abbreviations. Term Meaning habitual abortion spontaneous abortion occurring in three or more consecutive pregnancies incomplete abortion incomplete expulsion of products of conception missed abortion death of a fetus or embryo within the uterus that is not naturally expelled after death threatened abortion bleeding with threat of miscarriage 560 Medical Terminology: The Language of Health Care Term Meaning cephalopelvic conditions preventing normal delivery through the disproportion (CPD) birth canal—either the baby’s head is too large or sefă-lō-pelvik the birth canal is too small ECLAMPSIA. eclampsia true toxemia of pregnancy characterized by high Eclampsia is a ek-lampsē-ă blood pressure, albuminuria, edema of the legs and Greek word feet, severe headaches, dizziness, convulsions, and meaning to flash out or coma shine forth suddenly, first used in the 18th century for preeclampsia toxemia of pregnancy characterized by high blood any sudden convulsion. prē-ē-klampsē-ă pressure, albuminuria, edema of the legs and feet, Today, it particularly refers pregnancy-induced and puffiness of the face, without convulsion or to toxemia of pregnancy. hypertension (PIH) coma ectopic pregnancy implantation of the fertilized egg outside the uterine ek-topik cavity, often in the tube, ovary, or (rarely) the abdominal cavity (Fig. 17.26) erythroblastosis fetalis disorder that results from the incompatibility of a ĕ-rithrō-blas-tōsis fētālis fetus with an Rh-positive blood factor and a mother who is Rh negative, causing red blood cell destruction in the fetus—necessitates a blood transfusion to save the fetus Rh factor presence, or lack, of antigens on the surface of red blood cells that may cause a reaction between the blood of the mother and fetus, resulting in fetal anemia (which causes erythroblastosis fetalis) Rh positive presence of antigens Rh negative absence of antigens Tubal (isthmic) Abdominal Interstitial Tubal (ampullar) Infundibular (ostial) Ovarian Figure 17.26 Ectopic pregnancy: sites of extrauterine implantation. Chapter 17 • Female Reproductive System 561 Term Meaning hyperemesis gravidarum severe nausea and vomiting in pregnancy that can hı̄ -per-emĕ-sis grav-i-dārŭm cause severe dehydration in the mother and fetus (emesis vomit) meconium aspiration fetal aspiration of amniotic fluid containing mē-kōnē-ŭm as-pi-rāshŭn meconium placenta previa displaced attachment of the placenta in the lower plă-sentă prēvē-ă region of the uterine cavity (Fig. 17.27) abruptio placentae premature detachment of a normally situated ab-rŭpshē-ō pla-sentē placenta Obstetrical Diagnostic Tests and Procedures Test or Procedure Explanation chorionic villus sampling of placental tissue for microscopic and sampling (CVS) chemical examination to detect fetal kō-rē-onik vilus abnormalities (Fig. 17.28A) amniocentesis aspiration of a small amount of amniotic fluid for amnē-ō-sen-tēsis analysis of possible fetal abnormalities (Fig. 17.28B) fetal monitoring use of an electronic device for simultaneous recording of fetal heart rate and uterine contractions pelvimetry obstetrical measurement of the pelvis to evaluate pel-vimĕ-trē proper conditions for vaginal delivery pregnancy test test performed on urine or blood to detect the presence of human chorionic gonadotropin hormone (secreted by the placenta) that indicates pregnancy Marginal placenta previa Partial placenta previa Total placenta previa Figure 17.27 Placenta previa. 562 Medical Terminology: The Language of Health Care Ultrasound guidance Wall of uterus Chorionic villi Chorionic villi sampled Placenta Cells are grown in a Petri dish, A harvested for chromosomes, and stained for analysis Ultrasound guidance Placenta Amniotic fluid aspirated Wall of uterus Cells extracted from the fluid B are grown in a Petri dish, harvested for chromosomes, and stained for analysis Figure 17.28 A. Chorionic villus sampling (9–11 weeks). B. Amniocentesis (15–18 weeks). Term Meaning endovaginal sonogram ultrasound image of the uterus, tubes, and ovaries transvaginal sonogram made after introduction of an ultrasonic transducer within the vagina—useful in detecting pathology (e.g., ectopic pregnancy, missed abortion) (see Fig. 17.16) obstetrical sonogram ultrasound image of the pregnant uterus to determine fetal development (see Figs. 17.3B, 17.4B, and 17.16B) Chapter 17 • Female Reproductive System 563 Obstetrical Operative and Therapeutic Terms Term Meaning OPERATIVE cesarean section (C-section) surgical delivery of a baby by making an incision CESAREAN se-zārē-ăn through the abdomen and into the uterus SECTION. The fetus is removed episiotomy incision of the perineum to facilitate delivery from the uterus through an e-piz-ē-otō -mē incision in the abdomen. THERAPEUTIC The procedure was first used to save the baby when the amnioinfusion introduction of a solution into the amniotic sac— mother had died. Julius amnē-ō-in-fyūzhŭn most commonly an isotonic solution used to Caesar is said to have been relieve fetal distress born in this manner. therapeutic abortion (TAB) abortion induced by mechanical means or by drugs for medical consideration version manual method reversing the position of the fetus, usually done to facilitate delivery external version abdominal manipulation internal version intravaginal manipulation COMMON THERAPEUTIC DRUG CLASSIFICATIONS abortifacient drug that causes abortion (e.g., RU-486) ă-bōr-ti-fāshent oxytocin hormone secreted by the pituitary gland that ok-sē-tōsin causes myometrial contraction—used for induction of labor Rh immune globulin immunizing agent given to an Rh-negative mother globyū-lin within 72 hours after delivering an Rh-positive baby to suppress the Rh immune response tocolytic agent drug used to stop labor contractions tō-kō-litik Summary of Chapter 17 Acronyms/Abbreviations AB........................abortion IUD .....................intrauterine device Bx ........................biopsy LEEP .................loop electrosurgical excision CIS ......................carcinoma in situ procedure CIN .....................cervical intraepithelial neoplasia LLETZ ..............large loop excision of the transforma- CPD ....................cephalopelvic disproportion tion zone C-section ........cesarean section MRI ....................magnetic resonance imaging CVS ....................chorionic villus sampling OB .......................obstetrics D&C ...................dilation and curettage OCP ....................oral contraceptive pill EDC....................estimated date of confinement Pap......................Papanicolaou smear EDD ...................estimated date of delivery PID......................pelvic inflammatory disease GYN ...................gynecology PIH .....................pregnancy-induced hypertension HIV.....................human immunodeficiency virus SAB ....................spontaneous abortion HPV....................human papilloma virus STD ....................sexually transmitted disease HRT ...................hormone replacement therapy TAB ....................therapeutic abortion HSV-2 ...............herpes simplex virus type 2 UFE ....................uterine fibroid embolization 564 Medical Terminology: The Language of Health Care PRACTICE EXERCISES For the following terms, on the lines below the term, write out the indicated word parts: prefixes (P), combining forms (CF), roots (R), and suffixes (S). Then define the word. EXAMPLE ectocervical _______ / _______ / _______ P R S ecto/cervic/al P R S DEFINITION: outside/cervix or neck/pertaining to 1. vulvitis __________________ / __________________ R S DEFINITION: _________________________________________________________________ 2. polymastia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 3. ovoid __________________ / __________________ R S DEFINITION: _________________________________________________________________ 4. tocolysis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 5. salpingotomy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 6. mammoplasty __________________ / __________________ CF S DEFINITION: _________________________________________________________________ Chapter 17 • Female Reproductive System 565 7. transvaginal __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 8. hysterorrhexis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 9. colposcopy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 10. mammography __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 11. metrorrhagia __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 12. ovariocentesis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 13. menarche __________________ / __________________ R S DEFINITION: _________________________________________________________________ 14. oophorectomy __________________ / __________________ R S DEFINITION: _________________________________________________________________ 15. oligomenorrhea __________________ / __________________ / __________________ P CF S DEFINITION: _________________________________________________________________ 16. dystocia __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 566 Medical Terminology: The Language of Health Care 17. gynecologist __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 18. pelvimeter __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 19. episiotomy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 20. colporrhaphy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 21. hysterospasm __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 22. lactorrhea __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 23. ovigenesis __________________ / __________________ CF S DEFINITION: _________________________________________________________________ 24. endocervical __________________ / __________________ / __________________ P R S DEFINITION: _________________________________________________________________ 25. uterotomy __________________ / __________________ CF S DEFINITION: _________________________________________________________________ Complete the following: 26. ____________________ pause cessation of menstruation 27. ____________________ menorrhea painful menstruation Chapter 17 • Female Reproductive System 567 28. ____________________ menorrhea absence of menstruation 29. ____________________ menorrhea scanty menstruation 30. ____________________ rrhagia excessive bleeding at time of menstruation 31. ____________________ rrhagia bleeding from the uterus at any time other than the normal period 32. ____________________ mastia development of mammary glands in male 33. ____________________ mastia absence of a breast 34. ____________________ mastia unusually small breasts—a common surgical remedy is ____________________ mammoplasty 35. ____________________ mastia unusually large breasts—a common surgical remedy is ____________________ mammoplasty 36. masto____________________ surgical fixation of a pendulous breast 37. ____________________ ectomy removal of a breast 38. ____________________ ectomy removal of a breast lump For each of the following, circle the combining form that corresponds to the meaning given: 39. birth or labor tox/o toc/o troph/o 40. vagina uter/o metr/o colp/o 41. uterine tube vagin/o oophor/o salping/o 42. menstruation men/o mamm/o mast/o 43. cervix colp/o cervic/o salping/o 44. egg oophor/o ov/i ovari/o 45. vulva episi/o vagin/o metr/o 46. uterus vagin/o metr/o oophor/o 47. milk lact/o leuk/o lip/o 48. ovary ov/o oophor/o salping/o 49. breast men/o metr/o mast/o 50. woman gen/o gynec/o hyster/o 568 Medical Terminology: The Language of Health Care Match the following: 51. ________ removal of a uterine tube a. PID and an ovary 52. ________ white vaginal discharge b. |
chlamydia 53. ________ condition when the baby’s head c. colporrhaphy is too big for the birth canal 54. ________ presence of more than d. LEEP one nipple on a breast 55. ________ implantation of a fertilized e. CPD egg outside the uterus 56. ________ most common bacterial f. leukorrhea STD in North America 57. ________ excisional biopsy g. polythelia 58. ________ painful intercourse h. ectopic pregnancy 59. ________ surgical repair of a cystocele i. salpingo-oophorectomy 60. ________ inflammation of entire j. dyspareunia female pelvic cavity Give the medical term for the following: 61. condition of benign lumps in the breast that fluctuate in size during the menstrual cycle ____________________________________________________________ 62. abnormal opening between the bladder and vagina ___________________________ 63. cutting and tying the uterine tubes ___________________________________________ 64. having more than two breasts ______________________________________________ 65. bacterial STD caused by a spirochete ________________________________________ 66. study of cervical cells to screen for cancer ____________________________________ 67. condition of migration of endometrial tissue _________________________________ 68. abnormal opening between the rectum and vagina ____________________________ 69. surgical remedy for a rectocele ______________________________________________ Define the following abbreviations: 70. IUD _________________________________________________________ 71. HPV _________________________________________________________ 72. CVS _________________________________________________________ Chapter 17 • Female Reproductive System 569 73. D&C _________________________________________________________ 74. HBV _________________________________________________________ 75. EDC _________________________________________________________ 76. HSV _________________________________________________________ 77. STD _________________________________________________________ 78. TAB _________________________________________________________ 79. HRT ________________________________________________________ Identify terms related to abortion: 80. ________________________________ a naturally occurring miscarriage 81. ________________________________ a miscarriage occurring in three or more consecutive pregnancies 82. ________________________________ fetal expulsion with parts of the placenta remaining with bleeding 83. ________________________________ fetal death within the uterus 84. ________________________________ abortion induced by mechanical means or by drugs 85. ________________________________ bleeding with the threat of miscarriage Match the following: 86. ________ retroflexion a. forward bend of uterus 87. ________ condylomata b. toxemia of pregnancy 88. ________ para 2 c. backward bend of uterus 89. ________ prolapse d. a pregnant woman 90. ________ cystocele e. cancer 91. ________ gravida f. genital warts 92. ________ rectocele g. woman who has given birth twice 93. ________ eclampsia h. first delivery 94. ________ CIN 2 i. protrusion of the rectum into the vagina 95. ________ primipara j. descent of the uterus from its normal position 96. ________ anteflexion k. cervical dysplasia 97. ________ CIS l. pouching of the bladder into the vagina 570 Medical Terminology: The Language of Health Care Write in the missing words on the blank lines in the following illustration of the female reproductive anatomy. 98–105. Uterus: Frontal view The right side shows a cutaway view; the left side shows an external view. 100. Fallopian tube Fundus ( tube) Fimbriae Follicle 105. Broad ligament 101. Ovarian ligament 102. Body of Round ligament 98. 103. Cervical os 104. Corpus luteum 99. Mature graafian follicle Ovulation (ovum released) For each of the following, circle the correct spelling of the term: 106. gonoorhea gonorrhea ghonarhea 107. dyspareunia dyspariunia dysparunia 108. tokolytic toecolytic tocolytic 109. polithelia polythelia polytelia 110. meterorrhagia metrorrhagia metrorhagia 111. dialation dyelayshun dilation 112. salpingottomy salpingotomy salpigotomy 113. nulligravida nuligravida nulligraveda 114. meconeium meconium meconeum 115. macrosomia macrosomnia macrasomia 116. cureitage curettage curetage 117. eclampshea eklampsia eclampsia 118. amenorrhea amennorhea amenorhea 119. abortifacient abortafacient abortofacent Chapter 17 • Female Reproductive System 571 Give the noun that was used to form the following adjectives: 120. chlamydial __________________ 121. areolar ______________________ 122. syphilitic ____________________ 123. cervical _____________________ 124. dysplastic ___________________ 125. endometrial _________________ 572 Medical Terminology: The Language of Health Care MEDICAL RECORD ANALYSES M E D I C A L R E C O R D 1 7 . 1 GYN Chart Note S: This 44 y.o. female, gravida 2, para 2, c/o extremely heavy periods for the past several years that have been getting worse for the past 2 months and have been accompanied by moderately severe cramps. Pap smears have been normal. She has no bladder or bowel complaints. O: On pelvic exam, the uterus is found to be retroverted and irregularly enlarged with several large fibroids palpable. There are no adnexal masses. A: Leiomyomata uteri with secondary menorrhagia P: Schedule vaginal hysterectomy; donate 1 pint of blood for autologous transfusion, if necessary 1. What is the patient’s OB history? 4. What was the condition of the patient’s uterine a. never been pregnant tubes? b. been pregnant only once a. not stated c. had two miscarriages b. normal d. has been pregnant four times c. inflamed e. has had two live births d. enlarged e. had been previously removed 2. Identify the patient’s most significant symptom: a. amenorrhea 5. What was the Dx? b. dyspareunia a. congenital tumor composed of displaced embryonic tissue c. leukorrhea b. cyst of the uterine tube d. menorrhagia c. inflammation of the organs of the pelvic cavity e. metrorrhagia d. smooth muscle tumors in the uterus 3. Which of the following was one of the objective e. ovarian tumors findings? a. tipped uterus 6. What surgical procedure is planned? b. forward-bending uterus a. incision into uterine tube to remove the cyst c. backward-bending uterus b. excision of uterus d. presence of several ovarian tumors c. excision of ovaries e. migration of portions of endometrial tissue d. dilation of cervix and scraping of endometrium e. excision of tubes and ovaries Chapter 17 • Female Reproductive System 573 M E D I C A L R E C O R D 1 7 . 2 Jane Foley has seen her gynecologist, Dr. Phyllis Widetick, yearly for a routine ex- amination and Pap smear. Every year, the results have been normal. Jane is gener- ally a healthy, active woman. This year, however, Dr. Widetick’s examination and Pap smear found a problem. When the test results were in, Jane returned for addi- tional testing. Directions Read Medical Record 17.2 for Ms. Foley (pages 575–576) and answer the following questions. This record is the history and physical report dictated by Dr. Widetick after her examination. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 1 7 . 2 Write your answers in the spaces provided. 1. In your own words, not using medical terminology, briefly describe the patient’s chief complaint: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 2. In your own words, not using medical terminology, briefly describe what a Pap smear is: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 3. Explain the result of Ms. Foley’s Pap smear: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 4. Because of this result, Dr. Widetick used colposcopy for further testing. Translate into nonmedical language what she discovered with this diagnostic procedure: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 574 Medical Terminology: The Language of Health Care 5. What was the positive finding from the biopsy? Define this in your own words: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 6. Ms. Foley underwent all the following procedures. Put these in correct sequence by numbering them 1 to 6 in the order they were performed: _____ follow-up examination _____ visualization with colposcope _____ ultrasound _____ Pap smear _____ routine physical examination _____ Bx 7. The sonogram definitely showed what finding? __________________________________________________________________________ What were the possible findings? __________________________________________________________________________ __________________________________________________________________________ 8. In nonmedical language, define the two previous surgeries Ms. Foley has had: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 9. How many children has Ms. Foley had? _________________________________________ 10. Mark any of the following abnormal findings from the present physical examination: a. enlarged uterus b. gross reflexes c. eroded cervix d. hypertension e. enlarged thyroid f. mobile right ovarian cyst 11. Define Dr. Widetick’s final diagnosis, and explain what she will do next to treat Ms. Foley: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Chapter 17 • Female Reproductive System 575 Medical Record 17.2 576 Medical Terminology: The Language of Health Care Medical Record 17.2 Continued Chapter 17 • Female Reproductive System 577 M E D I C A L R E C O R D 1 7 . 3 Kathleen Montegrande is pregnant with her first child. She has regularly seen her ob- stetrician, Dr. Linda Fenton, throughout the pregnancy. The pregnancy has gone well so far, although the fetus is in a breech presentation. She has come for a routine ob- stetrical examination by Dr. Fenton, which confirms the breech presentation. She then reports to Central Medical Center when labor begins. Directions Read Medical Record 17.3 for Ms. Montegrande (pages 579–581) and answer the fol- lowing questions. The first record is the history and physical examination report dic- tated by Dr. Fenton after Ms. Montegrande’s last routine examination and before de- livery. The second record is the discharge summary dictated from Central Medical Center by Dr. Fenton after Ms. Montegrande had her baby. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 1 7 . 3 Write your answers in the spaces provided: 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record and define below: Apgar score ________________________________________________________________ rubella vaccination _________________________________________________________ 2. In your own words, not using medical terminology, briefly describe a breech presentation: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 3. Which two tests that Dr. Fenton performed confirmed the breech presentation? a. sonography b. cesarean c. amniocentesis d. Bx e. pelvic examination f. colposcopy g. Pap smear 4. Mark any possible negative findings included in PMH: a. rheumatic fever b. closed cervix c. heart murmur d. mitral valve prolapse 5. Where did the autologous blood come from? __________________________________________________________________________ 578 Medical Terminology: The Language of Health Care 6. Explain what is important about the possibility of Ms. Montegrande’s baby being Rh positive: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 7. In your own words, explain what “80% effaced” means: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 8. What is the main reason for Dr. Fenton’s plan to perform a primary cesarean section? __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 9. What two occurrences brought Ms. Montegrande to the Central Medical Center on March 6? __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 10. In your own words, describe the surgery Ms. Montegrande underwent: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 11. What kind of suture did Dr. Fenton use to close the incision? __________________________________________________________________________ 12. Two other doctors were present in the surgical suite with Dr. Fenton: Dr. Nelson was there to help care for (whom?) ________________________________ Dr. O’Brien was there to help care for (whom?) _______________________________ 13. Mark any of the following surgical complications that occurred: a. uterine hemorrhage b. postop fever c. cervical erosion d. all of the above e. none of the above Chapter 17 • Female Reproductive System 579 Medical Record 17.3 580 Medical Terminology: The Language of Health Care Medical Record 17.3 Continued Chapter 17 • Female Reproductive System 581 Medical Record 17.3 Continued 582 Medical Terminology: The Language of Health Care M E D I C A L R E C O R D 1 7 . 4 Carla Woodward has been healthy all her life but is bothered by the unbalanced shape of her breasts. Finally, at age 23, she has chosen to see Dr. Karen McNeil, a plastic sur- geon recommended by her personal physician. Directions Read Medical Record 17.4 for Ms. Woodward (page 584) and answer the following questions. This record is the consultation report dictated by Dr. McNeil after meeting with and examining Ms. Woodward. Q U E S T I O N S A B O U T M E D I C A L R E C O R D 1 7 . 4 Write your answers in the spaces provided: 1. Below are medical terms used in this record you have not yet encountered in this text. Underline each where it appears in the record and define below: saline-filled ________________________________________________________________ silicone walled _____________________________________________________________ 2. In your own words, not using medical terminology, describe Ms. Woodward’s chief complaint: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 3. Summarize the two past surgeries Ms. Woodward has had. For each, identify the primary body system involved: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 4. Ms. Woodward told Dr. McNeil that she has never had a mammogram, a diagnos- tic procedure used primarily for what purpose? __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Chapter 17 • Female Reproductive System 583 5. Dr. McNeil’s physical examination focuses on Ms. Woodward’s breasts. Describe the findings related to the breasts (first give the medical term for the finding, then define it): Medical Finding Definition Left breast ________________________ ___________________________________ ___________________________________ ___________________________________ Right breast _______________________ ___________________________________ ___________________________________ ___________________________________ 6. In your |
own words, not using medical language, describe the surgery Dr. McNeil has proposed to Ms. Woodward: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 584 Medical Terminology: The Language of Health Care Medical Record 17.4 APPENDIX A Glossary of Prefixes, Suffixes, and Combining Forms Term Component to English balan/o ..................glans penis coron/o..................circle or crown a- ..........................without bi-..........................two or both cost/o ....................rib ab- ........................away from bil/i ........................bile crani/o ..................skull abdomin/o ............abdomen -blast ....................germ or bud crin/o ....................to secrete -ac ........................pertaining to blast/o ..................germ or bud cutane/o ................skin acous/o..................hearing blephar/o ..............eyelid cyan/o ..................blue acr/o ......................extremity or brachi/o ................arm cyst/o ....................bladder or sac topmost brady- ..................slow cyt/o ......................cell -acusis ..................hearing condition bronch/o ..............bronchus (airway) dacry/o ..................tear ad- ........................to, toward, or near bronchi/o ..............bronchus (airway) dactyl/o ................digit (finger or aden/o ..................gland bronchiol/o ..........bronchiole (little toe) adip/o....................fat airway) de- ........................from, down, or not adren/o..................adrenal gland bucc/o ..................cheek dent/i ....................teeth aer/o ......................air or gas capn/o ..................carbon dioxide derm/o ..................skin -al ..........................pertaining to carb/o....................carbon dioxide dermat/o ..............skin albumin/o ............protein carcin/o ................cancer -desis ....................binding -algia ....................pain cardi/o ..................heart dextr/o ..................right, or on the allo- ......................other cata- ......................down right side alveol/o..................alveolus (air sac) -cele........................pouching or hernia dia- ........................across or through ambi- ....................both celi/o ....................abdomen diaphor/o ..............profuse sweat an- ........................without -centesis ................puncture for dips/o ....................thirst ana- ......................up, apart aspiration dis- ........................separate from or an/o ......................anus cephal/o ................head apart andr/o ..................male cerebell/o ..............cerebellum (little doch/o ..................duct angi/o ....................vessel brain) duoden/o ..............duodenum ankyl/o ..................crooked or stiff cerebr/o ................cerebrum (largest -dynia....................pain ante- ......................before part of brain) dys- ......................painful, difficult, anti- ......................against or opposed cerumin/o ............wax or faulty to cervic/o ................neck or cervix -e ..........................noun marker aort/o ....................aorta cheil/o ..................lip e- ..........................out or away appendic/o ............appendix chir/o ....................hand -eal ........................pertaining to aque/o ..................water chol/e ....................bile ec- ........................out or away -ar..........................pertaining to chondr/o ..............cartilage (gristle) -ectasis ..................expansion or -arche....................beginning chrom/o ................color dilation arteri/o ..................artery chromat/o ............color ecto- ......................outside arthr/o ..................joint, articulation chyl/o ....................juice -ectomy ................excision (removal) articul/o ................joint circum- ................around -emesis..................vomiting -ary........................pertaining to cis/o ......................cut -emia ....................blood condition -ase........................enzyme col/o ......................colon en- ........................within -asthenia ..............weakness colon/o ..................colon encephal/o ............entire brain ather/o ..................fatty paste colp/o ....................vagina (sheath) endo- ....................within -ation ....................process con- ......................together or with enter/o ..................small intestine atri/o ....................atrium conjunctiv/o..........conjunctiva (to epi- ........................upon audi/o....................hearing join together) epididym/o............epididymis aur/i ......................ear contra- ..................against or opposed episi/o ..................vulva (covering) auto-......................self to erythr/o ................red bacteri/o................bacteria corne/o..................cornea esophag/o..............esophagus 585 586 Medical Terminology: The Language of Health Care esthesi/o................sensation infra- ....................below or under meta- ....................beyond, after, or eu- ........................good or normal inguin/o ................groin change ex- ........................out or away inter- ....................between -meter ..................instrument for exo- ......................outside intra- ....................within measuring extra- ....................outside ir/o ........................iris (colored metr/o ..................uterus fasci/o ..................fascia (a band) circle) -metry ..................process of femor/o ................femur irid/o ....................iris (colored measuring fibr/o ....................fiber circle) micro- ..................small gangli/o ................ganglion (knot) -ism ......................condition of mono- ..................one gastr/o ..................stomach iso- ........................equal, like morph/o ................form -gen ......................origin or -ist ........................one who multi- ....................many production specializes in muscul/o ..............muscle -genesis ................origin or -itis ........................inflammation my/o ......................muscle production -ium ......................structure or tissue myc/o ....................fungus gen/o ....................origin or jejun/o ..................jejunum (empty) myel/o ..................bone marrow or production kerat/o ..................hard or cornea spinal cord ger/o ......................old age ket/o ......................ketone bodies myos/o ..................muscle gingiv/o ................gums keton/o..................ketone bodies myring/o ..............eardrum gli/o ......................glue kinesi/o ................movement narc/o....................stupor, sleep glomerul/o ............glomerulus (little kyph/o ..................humpback nas/o ....................nose ball) lacrim/o ................tear nat/i ......................birth gloss/o ..................tongue lact/o ....................milk necr/o....................death glott/o....................opening lapar/o ..................abdomen neo- ......................new gluc/o ....................sugar laryng/o ................larynx (voice box) nephr/o ................kidney glyc/o ....................sugar lei/o ......................smooth neur/o ..................nerve glycos/o ................sugar -lepsy ....................seizure obstetr/o................midwife gnos/o ..................knowing leuc/o ....................white ocul/o ....................eye -gram ....................record leuk/o ....................white -oid........................resembling -graph ..................instrument for lex/o ......................word or phrase -ole ........................small recording lingu/o ..................tongue olig/o ....................few or deficient -graphy ................process of lip/o ......................fat -oma......................tumor recording lith/o......................stone or calculus onych/o ................nail gynec/o..................woman lob/o ......................lobe (a portion) oophor/o ..............ovary hem/o....................blood -logist ....................one who ophthalm/o ..........eye hemat/o ................blood specialized in -opia......................condition of vision hemi- ....................half the study or opt/o......................eye hepat/o..................liver treatment of or/o........................mouth hepatic/o ..............liver -logy ......................study of orch/o....................testis (testicle) herni/o ..................hernia lord/o ....................bent orchi/o ..................testis (testicle) hetero- ..................different lumb/o ..................loin (lower back) orchid/o ................testis (testicle) hidr/o ....................sweat lymph/o ................clear fluid orth/o ....................straight, normal, hist/o ....................tissue -lysis......................breaking down or or correct histi/o ....................tissue dissolution -osis ......................condition or homo- ..................same macro- ..................large or long increase hormon/o..............hormone (an -malacia ................softening oste/o ....................bone urging on) mamm/o ..............breast ot/o........................ear hydr/o ..................water -mania ..................abnormal impulse -ous ......................pertaining to hyper-....................above or excessive (attraction) ov/i ........................egg hypn/o ..................sleep toward ov/o ......................egg hypo- ....................below or deficient mast/o ..................breast ovari/o ..................ovary hyster/o ................uterus meat/o ..................opening ox/o ......................oxygen -ia ..........................condition of mega- ....................large pachy- ..................thick -iasis......................formation of or megal/o ................large palat/o ..................palate presence of -megaly ................enlargement pan- ......................all iatr/o ....................treatment melan/o ................black pancreat/o ............pancreas -iatrics ..................treatment men/o....................menstruation para-......................alongside of or -iatry ....................treatment mening/o ..............meninges abnormal -ic ..........................pertaining to (membrane) -paresis ................slight paralysis -icle ......................small meningi/o ............meninges patell/o ..................knee cap ile/o ......................ileum (membrane) path/o....................disease immun/o ..............safe meso- ....................middle pector/o ................chest Appendix A • Glossary of Prefixes, Suffixes, and Combining Forms 587 ped/o ....................child or foot ren/o......................kidney tachy- ....................fast pelv/i, pelv/o ........hip bone reticul/o ................a net tax/o ......................order or -penia....................abnormal retin/o ..................retina coordination reduction retro- ....................backward or ten/o ......................tendon (to stretch) per-........................through behind tend/o....................tendon (to stretch) peri- ......................around rhabd/o ................rod shaped or tendin/o ................tendon (to stretch) perine/o ................perineum striated test/o ....................testis (testicle) peritone/o ............peritoneum (skeletal) thalam/o................thalamus (a room) -pexy ....................suspension or rhin/o ....................nose therm/o ................heat fixation -rrhage ..................to burst forth thorac/o ................chest phac/o ..................lens (lentil) -rrhagia ................to burst forth thromb/o ..............clot phag/o ..................eat or swallow -rrhaphy................suture thym/o ..................thymus gland phak/o ..................lens (lentil) -rrhea ....................discharge thyr/o, thyroid/o ..thyroid gland pharyng/o ............pharynx (throat) -rrhexis ................rupture (shield) phas/o ..................speech salping/o ..............uterine (fallopian) -tic ........................pertaining to -phil ......................attraction for tube; also toc/o ......................labor or birth -philia ..................attraction for eustachian tube tom/o ....................to cut phleb/o..................vein sarc/o ....................flesh -tomy ....................incision phob/o ..................exaggerated fear schiz/o ..................split, division ton/o......................tone or tension or sensitivity scler/o ..................hard or sclera tonsill/o ................tonsil (almond) phon/o ..................voice or sound scoli/o....................twisted top/o......................place phor/o ..................to carry or bear -scope....................instrument for tox/o ......................poison phot/o....................light examination toxic/o ..................poison phren/o ................diaphragm (also -scopy....................examination trache/o ................trachea mind) seb/o......................sebum (oil) (windpipe) physi/o ..................physical, nature semi- ....................half trans- ....................across or through plas/o ....................formation sial/o ....................saliva tri- ........................three -plasia ..................formation sigmoid/o..............sigmoid colon trich/o ..................hair -plasty ..................surgical repair or sinistr/o ................left, or on the left -tripsy....................crushing reconstruction side troph/o ..................nourishment or -plegia ..................paralysis sinus/o ..................hollow (cavity) development pleur/o ..................pleura somat/o ................body tympan/o ..............eardrum -pnea ....................breathing somn/i ..................sleep -ula, -ule................small pneum/o................air or lung somn/o ..................sleep uln/o......................ulna (a bone of the pneumon/o ..........air or lung son/o ....................sound forearm) pod/o ....................foot -spasm ..................involuntary ultra- ....................beyond or -poiesis..................formation contraction excessive poly- ......................many sperm/o ................sperm (seed) uni-........................one post- ......................after or behind spermat/o..............sperm (seed) ur/o ......................urine pre-........................before sphygm/o ..............pulse ureter/o ................ureter presby/o ................old age spin/o ....................spine (thorn) urethr/o ................urethra pro- ......................before spir/o ....................breathing urin/o ....................urine proct/o ..................anus and rectum splen/o ..................spleen uter/o ....................uterus prostat/o ..............prostate spondyl/o ..............vertebra vagin/o ..................vagina (sheath) psych/o..................mind squam/o ................scale varic/o ..................swollen or twisted -ptosis ..................falling or -stasis ....................stop or stand vein downward steat/o ..................fat vas/o......................vessel displacement sten/o ....................narrow vascul/o ................vessel pulmon/o ..............lung stere/o ..................three-dimensional ven/o ....................vein purpur/o ..............purple or solid ventricul/o ............ventricle (belly or py/o ......................pus stern/o ..................sternum pouch) pyel/o ....................basin (breastbone) vertebr/o ..............vertebra pylor/o ..................pylorus steth/o ..................chest vesic/o ..................bladder or sac (gatekeeper) stomat/o................mouth vesicul/o................bladder or sac quadri- ..................four -stomy ..................creation of an vitre/o....................glassy radi/o ....................radius (a bone of opening vulv/o ....................vulva (covering) the forearm); sub- ......................below or under xanth/o..................yellow radiation (espe- super-....................above or excessive xeno- ....................strange cially x-ray) supra-....................above or excessive xer/o ......................dry re-..........................again or back sym- ......................together or with -y ..........................condition or rect/o ....................rectum syn- ......................together or with process of 588 Medical Terminology: The Language of Health Care English to Term Component bone ......................oste/o disease ..................path/o abdomen ..............abdomin/o, celi/o, bone marrow........myel/o dissolution............-lysis lapar/o both ......................ambi-, bi- division ................schiz/o abnormal ..............para- brain ....................cerebr/o (largest down ....................cata-, de- abnormal part), downward impulse encephal/o displacement ....-ptosis (attraction) (entire brain) dry ........................xer/o toward ..............-mania breaking down ....-lysis duct ......................doch/o abnormal breast ....................mamm/o, mast/o duodenum ............duoden/o reduction ..........-penia breathing ..............-pnea, spir/o ear ........................aur/i, ot/o above ....................hyper-, super-, bronchus ..............bronch/o, eardrum................myring/o, supra- bronchi/o tympan/o across....................dia-, trans- bud........................-blast, blast/o eat, swallow..........phag/o adrenal gland ......adren/o, adrenal/o burst forth ............-rrhage, -rrhagia egg ........................ov/i, ov/o after ......................meta-, post- calculus ................lith/o enlargement ........-megaly again ....................re- cancer ..................carcin/o enzyme ................-ase against ..................anti-, contra- carbon dioxide ....capn/o, carb/o epididymis............epididym/o air..........................aer/o, pneum/o, carry......................phor/o equal ....................iso- pneumon/o cartilage................chondr/o esophagus ............esophag/o air sac ..................alveol/o cavity (sinus) ........atri/o, sin/o eustachian tube....salping/o airway ..................bronch/o, cell ........................cyt/o examination ........-scopy bronchi/o cerebellum............cerebell/o excessive ..............hyper-, super-, all ..........................pan- cerebrum ..............cerebr/o supra-, ultra- alongside of ..........para- cervix ....................cervic/o excision alveolus ................alveol/o change ..................meta- (removal) ..........-ectomy anus ......................an/o cheek ....................bucc/o expansion or anus and rectum ..proct/o chest......................pectoro, steth/o, dilation..............-ectasis aorta......................aort/o thorac/o extremity ..............acr/o apart ....................ana-, dis- child ......................ped/o eye ........................ocul/o, appendix ..............appendic/o circle ....................coron/o ophthalm/o, arm ......................brachi/o clear fluid ............lymph/o opt/o around ..................circum-, peri- clot ........................thromb/o eyelid ....................blephar/o artery ....................arteri/o colon ....................col/o, colon/o falling....................-ptosis articulation ..........arthr/o colon, sigmoid......sigmoid/o fallopian tube ......salping/o atrium ..................atri/o color......................chrom/o, fascia ....................fasci/o attraction for ........-phil, -philia chromat/o fast ........................tachy- away......................e-, ec-, ex- colored circle........ir/o, irid/o fat..........................adip/o, away from ............ab- condition ..............-osis lip/o, steat/o back ......................re- condition of ..........-ia, -ism, ium, -y fatty paste ............ather/o, backward ..............retro- contraction, faulty ....................dys- bacteria ................bacteri/o involuntary ......-spasm fear, exaggerated..phob/o basin ....................pyel/o coordination ........tax/o femur ....................femor/o bear ......................phor/o cornea ..................corne/o, kerat/o few ........................olig/o before....................ante-, pre-, pro- correct ..................ortho- fiber ......................fibr/o beginning..............-arche creation of an fixation ................-pexy behind ..................post-, retro- opening ............-stomy flesh ......................sarc/o below ....................hypo-, infra-, sub- crooked ................ankyl/o foot........................ped/o, pod/o bent ......................lord/o crown....................coron/o form ......................morph/o between ................inter- crushing................-tripsy formation..............plas/o, -plasia, beyond ..................meta-, ultra- cut ........................cis/o, tom/o -poiesis bile ........................bil/i, chol/e death ....................necr/o formation of ........-iasis bile duct................choledoch/o deficient................hypo-, olig/o four ......................quadri- binding ................-desis development ........troph/o from ......................de- birth ......................nat/i, toc/o diaphragm ............phren/o fungus ..................myc/o black ....................melan/o different ................hetero- ganglion................gangli/o bladder..................cyst/o, vesic/o, difficult ................dys- gas ........................aer/o vesicul/o digit (finger germ or bud..........-blast, blast/o blood ....................hem/o, hemat/o or toe)................dactyl/o gland ....................aden/o blood condition....-emia dilation or glans penis............balan/o blue ......................cyan/o expansion..........-ectasis glassy ....................vitre/o body ......................somat/o discharge ..............-rrhea glomerulus............glomerul/o Appendix A • Glossary of Prefixes, Suffixes, and Combining Forms 589 glue ......................gli/o milk ......................lact/o process..................-ation good ......................eu- mind ....................phren/o, psych/o, process of ............-y groin ....................inguin/o thym/o production............-gen, gen/o, gums ....................gingiv/o mouth ..................or/o, stomat/o -genesis hair ......................trich/o movement ............kinesi/o prostate ................prostat/o half........................hemi-, semi- muscle ..................muscul/o, my/o, protein ..................albumin/o hand......................chir/o myos/o pulse ....................sphygm/o hard ......................kerat/o, scler/o nail ........................onych/o puncture for head ......................cephal/o narrow ..................sten/o aspiration..........-centesis hearing..................acous/o, audi/o nature ..................physi/o purple ..................purpur/o hearing near ......................ad- pus ........................py/o condition ..........-acusis neck ......................cervic/o pylorus..................pylor/o heart......................cardio/o nerve ....................neur/o radius....................radi/o heat ......................therm/o net ........................reticul/o record ..................-gram hernia ..................-cele, herni/o new ......................neo- recording, hip bone................pelv/i, pelv/o normal ..................eu-, ortho- process of..........-graphy hormone ..............hormon/o nose ......................nas/o, rhin/o rectum ..................rect/o humpback ............kyph/o not ........................de- red ........................erythr/o ileum ....................ile/o nourishment ........troph/o resembling............-oid incision ................-tomy oil ..........................seb/o reticulum..............reticul/o increase ................-osis old age ..................ger/o, geront/o, retina ....................retin/o inflammation ......-itis presby/o rib ........................cost/o instrument for one ........................mono-, uni- right, or on the examination......-scope one who right side ..........dextr/o instrument for specializes in ....-ist rod shaped............rhabd/o measuring ........-meter one who rupture..................-rrhexis instrument for specializes in sac ........................cyst/o, vesic/o, recording ..........-graph the study or vesicul/o jejunum (empty) ..jejun/o treatment of ......-logist safe........................immun/o joint ......................arthr/o, articul/o opening ................glott/o, meat/o saliva ....................sial/o juice ......................chyl/o opening, scale ......................squam/o ketone bodies ......ket/o, keton/o creation of ........-stomy sclera ....................scler/o kidney ..................nephr/o, ren/o opposed to ............anti-, contra- sebum ..................seb/o kneecap ................patell/o order ....................tax/o secrete ..................crin/o knowing................gnos/o origin ....................-gen, -genesis, seizure ..................-lepsy labor......................toc/o gen/o self ........................auto- large ......................macro-, mega-, other ....................allo- sensation ..............esthesi/o megal/o out ........................e-, ec-, ex- sensitivity, larynx....................laryng/o outside ..................ecto-, exo-, extra- exaggerated ......phob/o left, or on the ovary ....................oophor/o, ovari/o separate from ......dis- left side..............sinistr/o oxygen ..................ox/o sheath ..................vagin/o lens........................phac/o, phak/o pain ......................-algia, -dynia sigmoid colon ......sigmoid/o light ......................phot/o painful ..................dys- sinus......................sinus/o like ........................iso- palate ....................palat/o skeletal..................rhabd/o lip ..........................cheil/o pancreas ..............pancreat/o skin ......................cutane/o, derm/o, liver ......................hepat/o, hepatic/o paralysis................-plegia dermat/o lobe ......................lob/o paralysis, slight ....-paresis skull ......................crani/o loin (lower back) ..lumb/o perineum ..............perine/o sleep......................hypn/o, narc/o, long ......................macro- peritoneum ..........peritone/o somn/i, somn/o lung ......................pneum/o, pertaining to ........-ac, -al, -ar, -ary, slow ......................brady- pneumon/o, -eal, -ic, -ous, small ....................-icle, micro-, -ole, pulmon/o -tic -ula, -ule male ......................andr/o pharynx ................pharyng/o small intestine......enter/o many ....................multi-, poly- phrase ..................lex/o smooth..................lei/o measuring, physical ................physi/o softening ..............-malacia instrument for ..-meter place......................top/o sound ....................phon/o, son/o measuring, pleura....................pleur/o specializes, process of..........-metry poison ..................tox/o, toxic/o one who ............-ist meninges ..............mening/o, portion..................lob/o speech ..................phas/o meningi/o pouching ..............-cele sperm....................sperm/o, menstruation........men/o presence of ..........-iasis spermat/o 590 Medical Terminology: The Language of Health Care spinal cord............myel/o thalamus ..............thalam/o urethra..................urethr/o spine ....................spin/o thick......................pachy- urine ....................ur/o, urin/o spleen....................splen/o thirst ....................dips/o uterine tube ..........salping/o split ......................schiz/o three......................tri- uterus....................hyster/o, metr/o, sternum ................stern/o three- uter/o stiff........................ankyl/o dimensional vagina ..................colp/o, vagin/o stomach ................gastr/o or solid ..............stere/o vein |
......................phleb/o, ven/o stone ....................lith/o throat ....................pharyng/o vein, swollen or stop or stand ........-stasis through ................dia-, per-, trans- twisted ..............varic/o straight ................orth/o thymus gland........thym/o ventricle ................ventricul/o strange ..................xeno- thyroid gland........thyr/o, thyroid/o vertebra ................vertebr/o, striated..................rhabd/o tissue ....................hist/o, -ium spondyl/o structure ..............-ium to or toward..........ad- vessel ....................angi/o, vas/o, study of ................-logy together ................con-, sym-, syn- vascul/o study of, tone ......................ton/o vision, one who tongue ..................gloss/o, lingu/o condition of ......-opia specializes in ....-logist tonsil ....................tonsill/o voice......................phon/o stupor ..................narc/o topmost ................acr/o voice box ..............laryng/o sugar ....................gluc/o, glyc/o, trachea..................trache/o vomiting ..............-emesis glycos/o treatment..............iatr/o, -iatrics, vulva ....................episi/o, vulv/o surgical repair or -iatry water ....................aque/o, hydr/o reconstruction ..-plasty treatment, wax........................cerumin/o suspension............-pexy one who weakness ..............-asthenia suture....................-rrhaphy specializes in ....-logist white ....................leuc/o, leuk/o swallow ................phag/o trop/o ....................to turn windpipe ..............trache/o sweat ....................hidr/o tumor....................-oma with ......................con-, sym-, syn- sweat, profuse ......diaphor/o turn ......................trop/o within ..................en-, endo-, intra- tear........................dacry/o, lacrim/o twisted ..................scoli/o without ................a-, an- teeth ......................dent/i two ........................bi- woman..................gynec/o tendon ..................ten/o, tend/o, ulna ......................uln/o word......................lex/o tendin/o under ....................infra-, sub- yellow....................xanth/o tension ..................ton/o up ..........................ana- testis (testicle) ......orch/o, orchi/o, upon......................epi- orchid/o, test/o ureter ....................ureter/o APPENDIX B Abbreviations and Symbols Abbreviations deemed error prone are printed in red. ā . . . . . . . . . . . . . . before AST . . . . . . . . . . aspartate aminotrans- c/o . . . . . . . . . . . . complains of A . . . . . . . . . . . . . anterior; assessment ferase (enzyme) COPD . . . . . . . . chronic obstructive A&P . . . . . . . . . . auscultation and AU. . . . . . . . . . . . both ears pulmonary disease percussion AV. . . . . . . . . . . . atrioventricular CP . . . . . . . . . . . . chest pain; cerebral A&W . . . . . . . . . alive and well B . . . . . . . . . . . . . bilateral palsy AB. . . . . . . . . . . . abortion BAEP. . . . . . . . . brainstem auditory CPAP . . . . . . . . . continuous positive ABG . . . . . . . . . . arterial blood gas evoked potentials airway pressure a.c. . . . . . . . . . . . before meals BCC . . . . . . . . . . basal cell carcinoma CPD . . . . . . . . . . cephalopelvic ACE . . . . . . . . . . angiotensin-converting BD . . . . . . . . . . . bipolar disorder disproportion enzyme b.i.d.. . . . . . . . . . twice a day CPR . . . . . . . . . . cardiopulmonary ACP . . . . . . . . . . American College of BKA . . . . . . . . . . below-knee resuscitation Physicians amputation CSF . . . . . . . . . . cerebrospinal fluid ACS . . . . . . . . . . American College of BM . . . . . . . . . . . black male; bowel C-section . . . . . cesarean section Surgeons movement CSII . . . . . . . . . . continuous ACTH . . . . . . . . adrenocorticotrophic BP . . . . . . . . . . . . blood pressure subcutaneous hormone BPH . . . . . . . . . . benign prostatic insulin infusion AD. . . . . . . . . . . . right ear hyperplasia/ CT . . . . . . . . . . . . computed tomography ADH. . . . . . . . . . antidiuretic hormone hypertrophy cu mm . . . . . . . cubic millimeter ADHD . . . . . . . . attention-deficit/ BRP . . . . . . . . . . bathroom privileges CVA . . . . . . . . . . cerebrovascular hyperactivity BS . . . . . . . . . . . . blood sugar accident disorder BUN. . . . . . . . . . blood urea nitrogen CVS . . . . . . . . . . chorionic villus ad lib. . . . . . . . . as desired Bx . . . . . . . . . . . . biopsy sampling AIDS . . . . . . . . . acquired immuno- c̄ . . . . . . . . . . . . . . with CXR . . . . . . . . . . chest x-ray deficiency syndrome C . . . . . . . . . . . . . Celsius; centigrade d. . . . . . . . . . . . . . day AKA . . . . . . . . . . above-knee C&S . . . . . . . . . . culture and sensitivity D&C. . . . . . . . . . dilation and curettage amputation CABG . . . . . . . . coronary artery bypass DC. . . . . . . . . . . . Doctor of Chiropractic alb. . . . . . . . . . . . albumin graft Medicine ALS . . . . . . . . . . amyotrophic lateral CAD . . . . . . . . . . coronary artery DC, D/C . . . . . discharge; discontinue sclerosis disease DDS . . . . . . . . . . Doctor of Dental ALT . . . . . . . . . . alanine aminotrans- cap . . . . . . . . . . . capsule Surgery ferase (enzyme) CAT . . . . . . . . . . computed axial DEXA . . . . . . . . dual-energy x-ray a.m. . . . . . . . . . . morning tomography absorptiometry AMBS . . . . . . . . American Board of CBC . . . . . . . . . . complete blood count DJD . . . . . . . . . . degenerative joint Medical Specialties cc . . . . . . . . . . . . cubic centimeter disease amt. . . . . . . . . . . amount CC. . . . . . . . . . . . chief complaint; car- DKA . . . . . . . . . . diabetic ketoacidosis ANS . . . . . . . . . . autonomic nervous diac catheterization DM . . . . . . . . . . . diabetes mellitus system CCU . . . . . . . . . . coronary (cardiac) DO . . . . . . . . . . . Doctor of Osteopathic AOA . . . . . . . . . . American Osteopathic care unit; critical Medicine Association care unit DPM . . . . . . . . . Doctor of Podiatric AP . . . . . . . . . . . . anterior posterior CHF . . . . . . . . . . congestive heart failure Medicine APKD . . . . . . . . adult polycystic kidney CIN. . . . . . . . . . . cervical intraepithelial dr. . . . . . . . . . . . . dram disease neoplasia DRE . . . . . . . . . . digital rectal aq . . . . . . . . . . . . water CIS . . . . . . . . . . . carcinoma in situ examination AS . . . . . . . . . . . left ear cm. . . . . . . . . . . . centimeter DTR . . . . . . . . . . deep tendon reflex ASD . . . . . . . . . . atrial septal defect CNS . . . . . . . . . . central nervous system DVT . . . . . . . . . . deep vein thrombosis ASHD . . . . . . . . arteriosclerotic heart CO. . . . . . . . . . . . cardiac output Dx . . . . . . . . . . . . diagnosis disease CO2. . . . . . . . . . . carbon dioxide ECG . . . . . . . . . . electrocardiogram 591 592 Medical Terminology: The Language of Health Care ECHO . . . . . . . . echocardiogram HCV. . . . . . . . . . hepatitis C virus MD . . . . . . . . . . . muscular dystrophy; ECT . . . . . . . . . . electroconvulsive HD . . . . . . . . . . . Huntington disease Medical Doctor therapy HEENT . . . . . . head, eyes, ears, nose, mg. . . . . . . . . . . . milligram ECU . . . . . . . . . . emergency care unit throat MI . . . . . . . . . . . . myocardial infarction ED . . . . . . . . . . . erectile dysfunction HGB or Hgb . hemoglobin ml, mL . . . . . . . milliliter EDC . . . . . . . . . . estimated date of HIV . . . . . . . . . . human immuno- mm. . . . . . . . . . . millimeter confinement deficiency virus MRA . . . . . . . . . magnetic resonance EDD. . . . . . . . . . estimated date of HPI. . . . . . . . . . . history of present angiography delivery illness MRI . . . . . . . . . . magnetic resonance EEG . . . . . . . . . . electroencephalogram HPV . . . . . . . . . . human papilloma imaging EGD. . . . . . . . . . esophagogastro- virus MS . . . . . . . . . . . multiple sclerosis; duodenoscopy HRT . . . . . . . . . . hormone replacement musculoskeletal EIA . . . . . . . . . . . enzyme immunoassay therapy MSH . . . . . . . . . melanocyte- EKG. . . . . . . . . . electrocardiogram h.s.. . . . . . . . . . . bedtime (hour of stimulating EMG . . . . . . . . . electromyogram sleep); half strength hormone ENT . . . . . . . . . . ear, nose, throat HSV-1 . . . . . . . . herpes simplex virus MVP. . . . . . . . . . mitral valve prolapse EPS . . . . . . . . . . electrophysiological type 1 NCV . . . . . . . . . . nerve conduction study HSV-2 . . . . . . . . herpes simplex virus velocity ER. . . . . . . . . . . . emergency room type 2 NG . . . . . . . . . . . nasogastric ERCP . . . . . . . . endoscopic retrograde Ht . . . . . . . . . . . . height NKA. . . . . . . . . . no known |
allergy cholangio- HTN. . . . . . . . . . hypertension NKDA . . . . . . . . no known drug allergy pancreatography Hx . . . . . . . . . . . . history noc. . . . . . . . . . . night ESR . . . . . . . . . . erythrocyte I&D . . . . . . . . . . incision and drainage NPO . . . . . . . . . . nothing by mouth sedimentation rate ICD. . . . . . . . . . . implantable NSAID . . . . . . . nonsteroidal anti- ESWL . . . . . . . . extracorporeal shock cardioverter inflammatory drug wave lithotripsy defibrillator NSR . . . . . . . . . . normal sinus rhythm ETOH ICU. . . . . . . . . . . intensive care unit O . . . . . . . . . . . . . objective . . . . . . . . ethyl alcohol F ID . . . . . . . . . . . . intradermal O2 . . . . . . . . . . . . oxygen . . . . . . . . . . . . . Fahrenheit FACP . . . . . . . . . Fellow of the Ig . . . . . . . . . . . . . immunoglobulins OA. . . . . . . . . . . . osteoarthritis American College of IM . . . . . . . . . . . . intramuscular OB . . . . . . . . . . . obstetrics IMP . . . . . . . . . . impression OB/GYN. . . . . . obstetrics and Physicians FACS IOL. . . . . . . . . . . intraocular lens gynecology . . . . . . . . . Fellow of the American College of implant OCD . . . . . . . . . . obsessive-compulsive IP. . . . . . . . . . . . . inpatient disorder Surgeons IUD. . . . . . . . . . . intrauterine device OCP . . . . . . . . . . oral contraceptive pill FBS . . . . . . . . . . fasting blood sugar IV . . . . . . . . . . . . intravenous OD . . . . . . . . . . . right eye; Doctor of Fe . . . . . . . . . . . . iron (ferrous) IVP . . . . . . . . . . . intravenous pyelogram Optometry FH. . . . . . . . . . . . family history kg . . . . . . . . . . . . kilogram OH . . . . . . . . . . . occupational history fl oz . . . . . . . . . . fluid ounce KUB. . . . . . . . . . kidney, ureter, bladder OP. . . . . . . . . . . . outpatient FS . . . . . . . . . . . . frozen section L . . . . . . . . . . . . . left; liter OR . . . . . . . . . . . operating room FSH . . . . . . . . . . follicle-stimulating L&W . . . . . . . . . living and well ORIF . . . . . . . . . open reduction, hormone LASIK. . . . . . . . laser-assisted in situ internal fixation Fx . . . . . . . . . . . . fracture keratomileusis OS. . . . . . . . . . . . left eye g. . . . . . . . . . . . . . gram lb . . . . . . . . . . . . . pound OU . . . . . . . . . . . both eyes GAD . . . . . . . . . . generalized anxiety LEEP. . . . . . . . . loop electrosurgical oz . . . . . . . . . . . . ounce disorder excision procedure p̄. . . . . . . . . . . . . . after GERD . . . . . . . . gastroesophageal LH . . . . . . . . . . . luteinizing hormone P . . . . . . . . . . . . . plan; posterior; pulse reflux disease LLETZ . . . . . . . large loop excision of PA . . . . . . . . . . . . posterior anterior GH . . . . . . . . . . . growth hormone transformation zone PaCO2 . . . . . . . . arterial partial GI . . . . . . . . . . . . gastrointestinal LLQ . . . . . . . . . . left lower quadrant pressure of gm. . . . . . . . . . . . gram LP . . . . . . . . . . . . lumbar puncture carbon dioxide gr. . . . . . . . . . . . . grain LTB . . . . . . . . . . laryngotracheo- PACU. . . . . . . . . postanesthetic care gt . . . . . . . . . . . . . drop bronchitis unit gtt . . . . . . . . . . . . drops LUQ . . . . . . . . . . left upper quadrant PaO2 . . . . . . . . . arterial partial GTT . . . . . . . . . . glucose tolerance test m. . . . . . . . . . . . . meter pressure of oxygen GYN. . . . . . . . . . gynecology m . . . . . . . . . . . . murmur PAP . . . . . . . . . . Papanicolaou test h. . . . . . . . . . . . . . hour MCH . . . . . . . . . mean corpuscular (smear) H&H . . . . . . . . . hemoglobin and (cell) hemoglobin PAR . . . . . . . . . . postanesthetic hematocrit MCHC. . . . . . . . mean corpuscular recovery H&P. . . . . . . . . . history and physical (cell) hemoglobin p.c. . . . . . . . . . . . after meals HAV . . . . . . . . . . hepatitis A virus concentration PD. . . . . . . . . . . . panic disorder HBV. . . . . . . . . . hepatitis B virus MCV . . . . . . . . . mean corpuscular PDA . . . . . . . . . . patent ductus HCT or Hct . . hematocrit (cell) volume arteriosus Appendix B • Abbreviations and Symbols 593 PE . . . . . . . . . . . . physical examination; q.s. . . . . . . . . . . . quantity sufficient TIA . . . . . . . . . . . transient ischemic pulmonary qt . . . . . . . . . . . . . quart attack embolism; R . . . . . . . . . . . . . right; respiration t.i.d. . . . . . . . . . . three times a day polyethylene RA. . . . . . . . . . . . rheumatoid arthritis TM . . . . . . . . . . . tympanic membrane PEFR. . . . . . . . . peak expiratory flow RBC . . . . . . . . . . red blood cell; red TMR . . . . . . . . . transmyocardial rate blood count revascularization per . . . . . . . . . . . by RIA. . . . . . . . . . . radioimmunoassay tPA, TPA . . . . . tissue plasminogen PERRLA . . . . . pupils equal, round, RLQ . . . . . . . . . . right lower quadrant activator and reactive to light R/O. . . . . . . . . . . rule out TPR . . . . . . . . . . temperature, pulse, and accommodation ROM . . . . . . . . . range of motion respiration PET . . . . . . . . . . positron emission ROS . . . . . . . . . . review of symptoms Tr . . . . . . . . . . . . treatment tomography RP. . . . . . . . . . . . retrograde pyelogram TSH . . . . . . . . . . thyroid-stimulating PF . . . . . . . . . . . . peak flow RRR. . . . . . . . . . regular rate and hormone PFT. . . . . . . . . . . pulmonary function rhythm TURP . . . . . . . . transurethral resection testing RSD . . . . . . . . . . reflex sympathetic of the prostate pH. . . . . . . . . . . . potential of hydrogen dystrophy TV . . . . . . . . . . . . tidal volume PH. . . . . . . . . . . . past history RTC Tx . . . . . . . . . . . . treatment; traction . . . . . . . . . . return to clinic Ph.D. . . . . . . . . . Doctor of Philosophy UA. . . . . . . . . . . . urinalysis RTO . . . . . . . . . . return to office PI. . . . . . . . . . . . . present illness UCHD . . . . . . . . usual childhood RUQ. . . . . . . . . . right upper quadrant PID . . . . . . . . . . . pelvic inflammatory diseases Rx . . . . . . . . . . . . recipe; take thou disease UFE . . . . . . . . . . uterine fibroid s̄ . . . . . . . . . . . . . . without PIH. . . . . . . . . . . pregnancy-induced embolization S . . . . . . . . . . . . . subjective hypertension URI. . . . . . . . . . . upper respiratory SA . . . . . . . . . . . . sinoatrial PLT . . . . . . . . . . platelet (count) infection SAB . . . . . . . . . . spontaneous abortion p.m. . . . . . . . . . . afternoon UTI . . . . . . . . . . . urinary tract infection SAD . . . . . . . . . . seasonal affective PMH . . . . . . . . . past medical history VC. . . . |
. . . . . . . . vital capacity disorder PMN . . . . . . . . . polymorphonuclear VCU, VCUG . . voiding SC . . . . . . . . . . . . subcutaneous leukocyte cystourethrogram SCC . . . . . . . . . . squamous cell PNS . . . . . . . . . . peripheral nervous VS . . . . . . . . . . . . vital signs carcinoma system VSD . . . . . . . . . . ventricular septal SH. . . . . . . . . . . . social history p.o. defect . . . . . . . . . . . by mouth Sig: . . . . . . . . . . . instruction to patient post op VT . . . . . . . . . . . . tidal volume . . . . . . . after operation SLE . . . . . . . . . . systemic lupus PPBS . . . . . . . . . postprandial blood w.a.. . . . . . . . . . . while awake erythematosus sugar WBC . . . . . . . . . white blood cell; white PR SOB . . . . . . . . . . shortness of breath . . . . . . . . . . . . per rectum blood count pre-op, preop before operation SPECT . . . . . . . single photon WDWN. . . . . . . well developed and p.r.n. emission computed . . . . . . . . . as needed well nourished PSA tomography wk . . . . . . . . . . . . week . . . . . . . . . . prostate-specific antigen SpGr . . . . . . . . . specific gravity WNL . . . . . . . . . within normal limits PSG SQ. . . . . . . . . . . . subcutaneous Wt . . . . . . . . . . . . weight . . . . . . . . . . polysomnography x-ray. . . . . . . . . . radiography pt . . . . . . . . . . . . . patient SR. . . . . . . . . . . . systems review PT . . . . . . . . . . . . physical therapy; ss . . . . . . . . . . . . . one-half y.o. . . . . . . . . . . . year old prothrombin time STAT . . . . . . . . . immediately yr . . . . . . . . . . . . . year PTCA . . . . . . . . . percutaneous STD . . . . . . . . . . sexually transmitted . . . . . . . . . . . . . female transluminal disease . . . . . . . . . . . . . male #. . . . . . . . . . . . . . number or pound coronary angioplasty Sub-Q . . . . . . . . subcutaneous PTH . . . . . . . . . . parathyroid hormone SUI . . . . . . . . . . . stress urinary ° . . . . . . . . . . . . . . degree or hour ↑. . . . . . . . . . . . . . increased; above PTSD. . . . . . . . . posttraumatic stress incontinence disorder suppos . . . . . . . suppository ↓. . . . . . . . . . . . . . decreased; below PTT . . . . . . . . . . partial thromboplastin SV . . . . . . . . . . . . stroke volume . . . . . . . . . . . . none or negative time Sx . . . . . . . . . . . . symptom . . . . . . . . . . . . . standing PUD . . . . . . . . . . peptic ulcer disease T . . . . . . . . . . . . . temperature . . . . . . . . . . . . sitting PV . . . . . . . . . . . . per vagina T3 . . . . . . . . . . . . triiodothyronine . . . . . . . . . . lying PVC . . . . . . . . . . premature ventricular T4 . . . . . . . . . . . . thyroxine . . . . . . . . . . . . . times or for contraction T&A . . . . . . . . . . tonsillectomy and . . . . . . . . . . . . . greater than Px . . . . . . . . . . . . physical examination adenoidectomy . . . . . . . . . . . . . less than q. . . . . . . . . . . . . . every tab . . . . . . . . . . . tablet . . . . . . . . . . . . one q2h . . . . . . . . . . . every 2 hours TAB . . . . . . . . . . therapeutic abortion . . . . . . . . . . . . two qd . . . . . . . . . . . . every day TB. . . . . . . . . . . . tuberculosis qh . . . . . . . . . . . . every hour TEDS. . . . . . . . . thromboembolic . . . . . . . . . . . three q.i.d.. . . . . . . . . . four times a day disease stockings . . . . . . . . . . . four q.n.s. . . . . . . . . . quantity not sufficient TEE . . . . . . . . . . transesophageal I, II, III, IV, V, VI, VII, VIII, IX, X q.o.d.. . . . . . . . . every other day echocardiogram uppercase Roman numerals 1–10 APPENDIX C Commonly Prescribed Drugs The following alphabetical list of commonly prescribed drugs (trade and generic) is based on listings of prescriptions dispensed in the United States in 2003. The classifi- cation and major therapeutic uses for each are also provided. Trade name drugs begin with a capital letter; their generic names accompany them in parentheses. All generic names are set in lowercase. Name Classification Major Therapeutic Uses Accupril angiotensin-converting hypertension, congestive (quinapril hydrochloride) enzyme (ACE) inhibitor heart failure (CHF) Accutane (isotretinoin) retinoid acne acetaminophen and codeine analgesic/antipyretic and moderate to severe pain, opiate (narcotic) fever combination Aciphex (rabeprazole) proton pump inhibitor (PPI) peptic ulcer disease (PUD), (gastric acid secretion gastroesophageal reflux inhibitor) disease (GERD) Actonel (risedronate) bisphosphonate (bone osteoporosis, Paget disease resorption inhibitor) Actos (pioglitazone) oral antidiabetic type 2 diabetes mellitus Adderall XR amphetamine attention-deficit/ (amphetamine mixed salts) hyperactivity disorder (ADHD) Advair Diskus adrenergic agonist asthma (salmeterol/fluticasone) (bronchodilator) and glucocorticoid (anti-inflammatory) albuterol adrenergic agonist asthma, bronchitis (bronchodilator) Allegra (fexofenadine) antihistamine allergy Allegra D (fexofenadine/ antihistamine and allergy with nasal pseudoephedrine) decongestant combination congestion allopurinol xanthine oxidase inhibitor gout Alphagan P (brimonidine) 2-adrenergic agonist glaucoma ophthalmic solution (antihypertensive) alprazolam benzodiazepine (anxiolytic, anxiety sedative, hypnotic) 594 Appendix C • Commonly Prescribed Drugs 595 Name Classification Major Therapeutic Uses Altace (ramipril) angiotensin-converting hypertension, congestive enzyme (ACE) inhibitor heart failure (CHF) Amaryl (glimepiride) oral antidiabetic type 2 diabetes mellitus Ambien (zolpidem) hypnotic insomnia amitriptyline antidepressant depression amoxicillin penicillin (antibiotic) bacterial infections amoxicillin/clavulanate penicillin (antibiotic) and bacterial infections -lactamase inhibitor combination Apri (desogestrel/ oral contraceptive birth control ethinyl estradiol) Aricept (donepezil) acetylcholinesterase Alzheimer disease inhibitor Atacand (candesartan) angiotensin receptor hypertension blocker (antihypertensive) atenolol cardioselective blocker/ hypertension, angina 1-adrenergic antagonist pectoris, cardiac (antihypertensive, arrhythmias antiarrhythmic, antianginal) Atrovent (ipratropium) anticholinergic chronic obstructive (bronchodilator) pulmonary disease (COPD) Augmentin (amoxicillin/ penicillin (antibiotic) and bacterial infections clavulanate) -lactamase inhibitor combination Avalide (irbesartan/ angiotensin receptor hypertension hydrochlorothiazide) blocker (antihypertensive) and diuretic combination Avandia (rosiglitazone) oral antidiabetic type 2 diabetes mellitus Avapro (irbesartan) angiotensin receptor blocker hypertension (antihypertensive) Avelox (moxifloxacin) fluoroquinolone (antibiotic) bacterial infections Aviane (levonorgestrel/ oral contraceptive birth control ethinyl estradiol) Bactrim (trimethoprim/ antibacterial and sulfonamide bacterial infections sulfamethoxazole) (antibiotic) combination Bactroban (mupirocin) topical antibiotic bacterial skin infections Bextra (valdecoxib) cox-2 inhibitor (nonsteroidal pain, inflammation, fever, anti-inflammatory drug arthritis [NSAID]) Biaxin (clarithromycin) macrolide (antibiotic) bacterial infections carisoprodol skeletal muscle relaxant skeletal muscle spasms and spasticity Cartia XT (diltiazem) calcium channel blocker hypertension, angina pectoris, cardiac arrhythmias 596 Medical Terminology: The Language of Health Care Name Classification Major Therapeutic Uses Cefzil (cefprozil) cephalosporin (antibiotic) bacterial infections Celebrex (celecoxib) cox-2 inhibitor (nonsteroidal pain, inflammation, fever, anti-inflammatory drug arthritis [NSAID]) Celexa (citalopram) selective serotonin reuptake depression inhibitor (SSRI) (antidepressant) cephalexin cephalosporin (antibiotic) bacterial infections Cipro (ciprofloxacin) fluoroquinolone (antibiotic) bacterial infections ciprofloxacin fluoroquinolone (antibiotic) bacterial infections clonazepam benzodiazepine (sedative/ epilepsy, seizures, anxiety hypnotic, anticonvulsant, (panic disorder) anxiolytic) clonidine 2-adrenergic agonist hypertension (antihypertensive) clotrimazole and topical antifungal and anti- fungal infections, some betamethasone inflammatory combination parasites Combivent (ipratropium/ anticholinergic and asthma, chronic bronchitis, albuterol) inhalation adrenergic agonist combi- emphysema aerosol nation (bronchodilators) Concerta (methylphenidate) central nervous system attention-deficit/ extended release stimulant hyperactivity disorder (ADHD) Coreg (carvedilol) cardioselective blocker/ hypertension, congestive 1-adrenergic antagonist heart failure (CHF) (antihypertensive, antiarrhythmic, antianginal) Coumadin (warfarin sodium) anticoagulant thromboembolic disorders Cozaar (losartan) angiotensin receptor blocker hypertension (antihypertensive) cyclobenzaprine skeletal muscle relaxant skeletal muscle spasms and spasticity Depakote (divalproex) anticonvulsant epilepsy, migraine prophylaxis, bipolar mania Detrol LA (tolterodine) anticholinergic overactive bladder diazepam benzodiazepine (sedative/ anxiety, skeletal muscle hypnotic, anticonvulsant, spasm, epilepsy, seizures anxiolytic) Diflucan (fluconazole) antifungal fungal infections Digitek (digoxin) cardiac glycoside congestive heart failure (CHF), cardiac tachyarrhythmias Dilantin (phenytoin) hydantoin (anticonvulsant) epilepsy, seizures diltiazem hydrochloride calcium channel blocker hypertension, angina pectoris, cardiac arrhythmias Appendix C • Commonly Prescribed Drugs 597 Name Classification Major Therapeutic Uses Diovan (valsartan) angiotensin receptor blocker hypertension (antihypertensive) Diovan HCT (valsartan/ angiotensin receptor blocker hypertension hydrochlorothiazide) and diuretic combination (antihypertensive) Ditropan XL (oxybutynin) anticholinergic (urinary overactive bladder antispasmodic) doxycycline tetracycline (antibiotic) bacterial, rickettsial, and chlamydial infections Duragesic (fentanyl) analgesic, opiate (narcotic) pain, sedation Effexor XR (venlafaxine) antidepressant depression Elidel (pimecrolimus) immunosuppressant agent atopic dermatitis topical cream enalapril angiotensin-converting hypertension, congestive enzyme (ACE) inhibitor heart failure (CHF) Endocet (oxycodone/ opiate (narcotic) and moderate to severe pain acetaminophen) nonsteroidal anti- inflammatory (NSAID) (analgesic/antipyretic) combination Evista (raloxifene) selective estrogen receptor prevention and treatment of modulator (SERM) osteoporosis Flomax (tamsulosin) 1-adrenergic antagonist benign prostatic (antihypertensive, hypertrophy (BPH) vasodilator) Flonase (fluticasone) glucocorticoid (anti- allergic rhinitis nasal spray inflammatory, immunosuppressant) Flovent (fluticasone) glucocorticoid (anti- asthma control oral inhalation inflammatory, immunosuppressant) fluoxetine selective serotonin reuptake depression inhibitor (SSRI) (antidepressant) folic acid vitamin nutritional supplement Fosamax (alendronate) bisphosphonate (bone osteoporosis, Paget disease resorption inhibitor) furosemide diuretic hypertension, edema associated with congestive heart failure (CHF) or renal disease gemfibrozil antihyperlipidemic hypertriglyceridemia, hyperlipidemia Glucophage XR (metformin) oral antidiabetic type 2 diabetes mellitus Glucotrol XL (glipizide) oral antidiabetic type 2 diabetes mellitus Glucovance (glyburide/ oral antidiabetic type 2 diabetes mellitus metformin) (combination product) 598 Medical Terminology: The Language of Health Care Name Classification Major Therapeutic Uses glyburide oral antidiabetic type 2 diabetes mellitus Humalog (insulin lispro) insulin; antidiabetic type 1 and 2 diabetes mellitus Humulin (insulin insulin; antidiabetic type 1 and 2 diabetes preparation) mellitus hydrochlorothiazide diuretic hypertension, edema associated with congestive heart failure (CHF) or renal disease hydrocodone and opiate (narcotic) and moderate to severe pain acetaminophen nonsteroidal anti- inflammatory drug (NSAID) (analgesic/ antipyretic) |
combination Hyzaar (losartan/ angiotensin receptor blocker hypertension hydrochlorothiazide) and diuretic combination (antihypertensive) ibuprofen analgesic; nonsteroidal anti- pain, inflammation, fever inflammatory drug (NSAID) Imitrex (sumatriptan triptan (antimigraine agent) migraine headache succinate) Inderal LA (propranolol) blocker (antihypertensive, hypertension, angina antiarrhythmic, antianginal) pectoris, cardiac arrhythmias, migraine headache prophylaxis isosorbide mononitrate coronary vasodilator angina pectoris (antianginal) Kariva (desogestrel/ oral contraceptive birth control ethinyl estradiol) Klor-Con (potassium potassium salt; electrolyte potassium deficiency chloride) supplement Lanoxin (digoxin) cardiac glycoside congestive heart failure (CHF), cardiac tachyarrhythmias Lantus (insulin glargine) insulin; antidiabetic type 1 and 2 diabetes mellitus Lescol XL (fluvastatin) HMG-CoA reductase hyperlipidemia, inhibitor (statin) hypercholesterolemia Levaquin (levofloxacin) fluoroquinolone (antibiotic) bacterial infections Levothroid (levothyroxine) thyroid hormone hypothyroidism Levoxyl (levothyroxine thyroid hormone hypothyroidism sodium) Lexapro (escitalopram) selective serotonin reuptake depression inhibitor (SSRI) (antidepressant) Lipitor (atorvastatin) HMG-CoA reductase hyperlipidemia, inhibitor (statin) hypercholesterolemia Appendix C • Commonly Prescribed Drugs 599 Name Classification Major Therapeutic Uses lisinopril angiotensin-converting hypertension enzyme (ACE) inhibitor lorazepam benzodiazepine (sedative/ anxiety, preop sedation, hypnotic, anticonvulsant, epilepsy, seizures anxiolytic) Lotensin (benazepril) angiotensin-converting hypertension enzyme (ACE) inhibitor Lotrel (amlodipine/ calcium channel blocker and hypertension benazepril) angiotensin-converting enzyme (ACE) inhibitor combination Low-Ogestrel (norgestrel/ oral contraceptive birth control ethinyl estradiol) Macrobid (nitrofurantoin) antibiotic bacterial infections of urinary tract meclizine anticholinergic motion sickness, vertigo metformin oral antidiabetic type 2 diabetes mellitus methylprednisolone glucocorticoid (anti- inflammation, inflammatory, immunological disorders, immunosuppressant) allergies metoprolol cardioselective blocker hypertension, angina (1-adrenergic antagonist) pectoris Miacalcin (calcitonin) hormone osteoporosis, Paget disease Microgestin Fe oral contraceptive birth control (norethindrone ethinyl estradiol) MiraLax (polyethylene glycol) laxative constipation Mobic (meloxicam) nonsteroidal anti- osteoarthritis inflammatory drug (NSAID) Monopril (fosinopril) angiotensin-converting hypertension enzyme (ACE) inhibitor naproxen analgesic, nonsteroidal pain, fever, arthritis anti-inflammatory drug (NSAID) Nasacort (triamcinolone) glucocorticoid allergic rhinitis AQ topical nasal spray (anti-inflammatory, immunosuppressant) Nasonex (mometasone) glucocorticoid (anti- allergic rhinitis topical nasal spray inflammatory, immunosuppressant) Necon (ethinyl estradiol/ oral contraceptive birth control norethindrone) Neurontin (gabapentin) anticonvulsant postherpetic neuralgia, epilepsy (partial seizures) Nexium (esomeprazole) proton pump inhibitor (PPI) peptic ulcer disease (PUD), (gastric acid secretion gastroesophageal reflux inhibitor) disease (GERD) 600 Medical Terminology: The Language of Health Care Name Classification Major Therapeutic Uses Niaspan (niacin) vitamin dyslipidemia nifedipine calcium channel blocker hypertension, angina pectoris NitroQuick (nitroglycerin) antianginal coronary vasodilator Norvasc (amlodipine) calcium channel blocker hypertension, angina pectoris omeprazole proton pump inhibitor (PPI) peptic ulcer disease (PUD), (gastric acid gastroesophageal reflux secretion inhibitor) disease (GERD) Omnicef (cefdinir) cephalosporin (antibiotic) bacterial infections Ortho Evra contraceptive patch birth control (norelgestromin/ ethinyl estradiol) Ortho Novum oral contraceptive birth control (norethindrone/ ethyl estradiol) Ortho Tri-Cyclen oral contraceptive birth control (norgestimate/ ethyl estradiol) oxycodone and opiate (narcotic) and moderate to severe pain acetaminophen nonsteroidal anti- inflammatory drug (NSAID) (analgesic/ antipyretic) combination OxyContin (oxycodone) opiate (narcotic) analgesic moderate to severe pain Patanol (olopatadine) ophthalmic antihistamine allergic conjunctivitis Paxil (paroxetine) selective serotonin reuptake depression inhibitor (SSRI) (antidepressant) Penicillin VK (penicillin penicillin (antibiotic) bacterial infections V potassium) Percocet (oxycodone and opiate (narcotic) and moderate to severe pain acetaminophen) nonsteroidal anti- inflammatory drug (NSAID) (analgesic/ antipyretic) combination phenobarbital barbiturate (sedative/ insomnia, epilepsy, seizures, hypnotic, anticonvulsant, anxiety anxiolytic) phenytoin hydantoin (anticonvulsant) epilepsy, seizures Plavix (clopidogrel) antiplatelet agent reduction in stroke or myo- cardial infarction risk by excessive clot prevention Plendil (felodipine) calcium channel blocker hypertension, angina pectoris potassium chloride potassium salt; electrolyte potassium deficiency supplement Pravachol (pravastatin) HMG-CoA reductase hyperlipidemia, inhibitor (statin) hypercholesterolemia Appendix C • Commonly Prescribed Drugs 601 Name Classification Major Therapeutic Uses prednisone glucocorticoid (anti- inflammation, inflammatory, immunological disorders, immunosuppressant) allergy Premarin (conjugated estrogen derivative hormone replacement estrogens) Prempro (estrogen/ estrogen/progestin hormone replacement medroxyprogesterone) Prevacid (lansoprazole) proton pump inhibitor (PPI) peptic ulcer disease (PUD), (gastric acid secretion gastroesophageal reflux inhibitor) disease (GERD) Prilosec (omeprazole) proton pump inhibitor (PPI) peptic ulcer disease (PUD), (gastric acid secretion gastroesophageal reflux inhibitor) disease (GERD) promethazine antihistamine; sedative and allergy; motion sickness, antiemetic nausea promethazine and codeine antihistamine and opiate cold and cough (narcotic) antitussive combination propoxyphene and opiate (narcotic) analgesic mild to moderate pain acetaminophen and nonsteroidal anti- inflammatory drug (NSAID) (analgesic/antipyretic) combination propranolol blocker (antihypertensive, hypertension, angina antiarrhythmic, pectoris, cardiac antianginal) arrhythmias, migraine headache prophylaxis Proscar (finasteride) 5-reductase inhibitor benign prostatic hyperplasia (BPH) Protonix (pantoprazole) proton pump inhibitor (PPI) peptic ulcer disease (PUD), (gastric acid secretion gastroesophageal reflux inhibitor) disease (GERD) Pulmicort (budesonide) glucocorticoid (anti- asthma inhalant inflammatory, immunosuppressant) ranitidine hydrochloride H2 receptor antagonist peptic ulcer disease (PUD), gastroesophageal reflux disease (GERD) Remeron (mirtazapine) atypical antidepressant depression Rhinocort Aqua (budesonide) glucocorticoid (anti- allergic rhinitis nasal spray inflammatory, immunosuppressant) Risperdal (risperidone) atypical antipsychotic psychoses (e.g., (neuroleptic) schizophrenia) Roxicet (oxycodone and opiate (narcotic) and moderate to severe pain acetaminophen) nonsteroidal anti- inflammatory drug (NSAID) (analgesic/ antipyretic) combination 602 Medical Terminology: The Language of Health Care Name Classification Major Therapeutic Uses Seroquel (quetiapine) atypical antipsychotic psychoses (e.g. (neuroleptic) schizophrenia) Singulair (montelukast) leukotriene receptor asthma antagonist Skelaxin (metaxalone) skeletal muscle relaxant skeletal muscle spasms and spasticity spironolactone potassium sparing diuretic hypertension, edema Strattera (atomoxetine) selective norepinephrine attention-deficit/ reuptake inhibitor (SNRI) hyperactivity disorder (ADHD) Synthroid (levothyroxine) thyroid product hypothyroidism temazepam benzodiazepine (hypnotic) insomnia terazosin 1-adrenergic antagonist hypertension, benign (antihypertensive, prostatic hypertrophy vasodilator) timolol blocker (antihypertensive, hypertension, angina antiarrhythmic, pectoris, cardiac antianginal) arrhythmias, glaucoma (ophthalmic solution) TobraDex (tobramycin antibiotic and corticosteroid external ocular bacterial and dexamethasone) combination infections ophthalmic solution Topamax (topiramate) anticonvulsant epilepsy (partial seizures) Toprol-XL (metoprolol) cardioselective blocker hypertension, angina (1-adrenergic antagonist) pectoris, congestive heart failure (CHF) trazodone atypical antidepressant depression triamcinolone glucocorticoid (anti- inflammation, inflammatory, immunological disorders, immunosuppressant) allergy triamterene and diuretic combination hypertension, edema in hydrochlorothiazide congestive heart failure (HCTZ) (CHF) Tricor (fenofibrate) fibric acid derivative hyperlipidemia, hypertriglyceridemia, hypercholesterolemia trimethoprim/ antibacterial and bacterial infections sulfamethoxazole sulfonamide (antibiotic) (TMP-SMX or combination co-trimoxazole) Trimox (amoxicillin) penicillin (antibiotic) bacterial infections Trivora-28 (levonorgestrel/ oral contraceptive birth control ethinyl estradiol) Tussionex (hydrocodone narcotic antitussive and cough and cold and chlorpheniramine) antihistamine combination Appendix C • Commonly Prescribed Drugs 603 Name Classification Major Therapeutic Uses Ultracet (tramadol/ opioid analgesic and pain acetaminophen) nonsteroidal anti- inflammatory drug (NSAID) (analgesic/ antipyretic) combination Valtrex (valacyclovir) antiviral herpes viruses verapamil calcium channel blocker hypertension, cardiac arrhythmias, angina pectoris Viagra (sildenafil) phosphodiesterase (type 5) erectile dysfunction (ED) enzyme inhibitor Vioxx (rofecoxib) cox-2 inhibitor (nonsteroidal pain, inflammation, fever, anti-inflammatory drug arthritis [NSAID]) warfarin anticoagulant thromboembolic disorders Wellbutrin SR (bupropion) atypical antidepressant depression Xalatan (latanoprost) prostaglandin glaucoma ophthalmic solution Yasmin 28 (drospirenone/ oral contraceptive birth control ethinyl estradiol) Zetia (ezetimibe) cholesterol absorption hypercholesterolemia inhibitor Zithromax (azithromycin macrolide (antibiotic) bacterial infections dihydrate) Zocor (simvastatin) HMG-CoA reductase hyperlipidemia, inhibitor (statin) hypercholesterolemia Zoloft (sertraline) selective serotonin reuptake depression inhibitor (SSRI) (antidepressant) Zyprexa (olanzapine) atypical antipsychotic psychoses (e.g., (neuroleptic) schizophrenia) Zyrtec (cetirizine) antihistamine allergy References Quick Look Drug Book. Baltimore: Lippincott Williams & Wilkins, 2004. Copyright ©2004 by Lexi-Comp, Inc. RxList Top 200 Drugs of 2003, www.rxlist.com/top200.htm. Stedman’s Medical Dictionary for the Health Professions and Nursing, 5th ed. Baltimore: Lippincott Williams & Wilkins, Appendix: Commonly Prescribed Drugs and Their Applica- tions, 2005. APPENDIX D Answers to Practice Exercises CHAPTER 1 (PP. 7–8) 1. personal commitment 7. stress reduction and mental stamina 2. Answers will vary. 8. see it, say it, write it. 3. a. Act immediately to focus on goals. 9. Preparation and the use of flash cards provide visual, b. Don’t try to take on too much at once. kinesthetic, and auditory reinforcement of the senses c. Divide materials into smaller, more manageable helpful in memorization. Flash cards are portable and portions. can be carried at all times. d. Celebrate progress along the way, and look 10. When you annotate text material, you make notes in forward to future benefits for learning (note: class the margin as you read. This includes drawing lines to discussion will bring out other good ideas). separate component parts of key terms and writing 4. It promotes positive thinking and self-confidence that out their meanings. lead to success. 11. a. Draw pictures of word components. 5. Answers will vary. b. Listen to audiotapes/pronunciations on 6. a. Find a comfortable place to study, and organize CD-ROM. your study area. c. Make up songs or rhymes. b. Listen to enjoyable music while studying. d. Find a person or group to study with. c. Replace negative self-talk with “can do” affirmatives. d. Think positively, and visualize yourself as a suc- cessful learner. CHAPTER 2 (PP. 30–37) 1. pan / cyto / penia 8. tachy / card / ia P CF S P R S DEFINITION: all / cell / abnormal reduction DEFINITION: fast / heart / condition of 2. leuk / emia 9. pyo / poiesis R S CF S DEFINITION: white / blood condition DEFINITION: pus / formation 3. tox / oid 10. aden / itis R S R S DEFINITION: poison / resembling DEFINITION: gland / inflammation 4. meso / morph / ic 11. macro / cephal / ous P R S P R S DEFINITION: middle / form / pertaining to DEFINITION: large or long / head / pertaining to 5. acro / dynia 12. para / centesis CF S P S DEFINITION: extremity / pain DEFINITION: alongside of / puncture for aspiration 6. meta / stasis 13. micro / lith / iasis P S P R S DEFINITION: beyond, after, or change / stop or stand DEFINITION: small / stone / formation or presence of 7. ultra / sono / graphy 14. ortho /ped / ic P CF S CF R S DEFINITION: beyond or excessive / sound / process of DEFINITION: straight, normal, or correct / foot / recording pertaining to 604 Appendix D • Answers to Practice Exercises 605 15. angio / megaly 41. b. pro CF S 42. d. circum DEFINITION: vessel / enlargement 43. c. hemi 16. psych / iatry 44. f. ab- R S 45. g. inter- DEFINITION: mind / treatment 46. h. para- 17. carcino /genesis 47. b. peri- CF S 48. a. retro- DEFINITION: cancer / origin or production 49. j. intra- 18. nephro / logist 50. c. anti- CF S 51. i. an- DEFINITION: kidney / one who specializes in the study 52. d. ecto- or treatment of 53. e. dia- 19. rhino / sten / osis 54. many CF R S 55. below or deficient DEFINITION: nose / narrow / condition or increase 56. few or deficient 20. hypo / hydr / ation 57. one P R S 58. all DEFINITION: below or deficient / water / process 59. beyond or excessive 21. aero / gastr / algia 60. two or both CF R S 61. four DEFINITION: air or gas / stomach / pain 62. half 22. fibr / oma 63. below or under R S 64. above or excessive DEFINITION: fiber / tumor 65. c. ante- 23. necro / philia 66. d. post- CF S 67. e. tachy- DEFINITION: death / attraction for 68. a. brady- 24. scler / osis 69. b. re- R S 70. d. without DEFINITION: hard / condition or increase 71. b. foot 25. hemo / lysis 72. d. mouth CF S 73. d. new DEFINITION: blood / breaking down or dissolution 74. a. surgical repair 26. acro / phob / ia 75. e. process CF R S 76. c. crushing DEFINITION: topmost (or extremity) / exaggerated 77. c. expansion fear or sensitivity / condition of 78. c. right 27. cyto / meter 79. f. melan/o CF S 80. a. tri- DEFINITION: cell / instrument for measuring 81. j. erythr/o 28. cyano / tic 82. g. quadri- CF S 83. b. leuk/o DEFINITION: blue / pertaining to 84. e. uni- 29. extra / vascul / ar 85. c. cyan/o P R S 86. k. bi- DEFINITION: outside / vessel / pertaining to 87. i. oligo- 30. hyper / troph / y 88. d. dextr/o P R S 89. h. sinistr/o DEFINITION: above or excessive / nourishment or 90. c. -gram development / condition or process of 91. c. -osis 31. c. supra 92. c. -ectomy 32. d. re 93. b. -ar 33. c. pre 94. d. -rrhexis 34. b. de 95. c. -ula 35. e. trans 96. a. -ism 36. c. super 97. nephritis 37. b. infra 98. nephrolysis 38. a. exo 99. nephrotomy 39. b. dys 100. nephrogenous 40. b. ab 101. nephropexy 606 Medical Terminology: The Language of Health Care 102. nephrostomy 112. ovaries, ova 103. nephrectomy 113. metastases 104. nephrolithiasis 114. verrucae 105. nephroma 115. condyloma 106. nephrocele 116. index 107. nephrorrhaphy 117. thrombi 108. nephroptosis 118. c. nephrorrhaphy 109. d. colostomy 119. a. abdominoscopy 110. a. vasorrhaphy 120. b. pericardium |
111. c. abdominocentesis CHAPTER 3 (PP. 50–53) 1. onco / logy 15. cardio / logy CF S CF S DEFINITION: tumor / study of DEFINITION: heart / study of 2. immuno / logist 16. dermato / logy CF S CF S DEFINITION: safe / one who specializes in the study DEFINITION: skin / study of or treatment of 17. ped / iatrics 3. oto / laryngo / logy R S CF CF S DEFINITION: child / treatment DEFINITION: ear / voice box / study of 18. endo / crino / logist 4. opto / metry P CF S CF S DEFINITION: within / to secrete / one who specializes DEFINITION: eye / process of measuring in the study or treatment of 5. gyneco / logy 19. nephro / logist CF S CF S DEFINITION: woman / study of DEFINITION: kidney / one who specializes in the study 6. patho / logy or treatment of CF S 20. gastro / entero / logy DEFINITION: disease / study of CF CF S 7. ortho / ped / ic DEFINITION: stomach / small intestine / study of CF R S 21. hemato / logist DEFINITION: straight, normal, or correct / foot / CF S pertaining to DEFINITION: blood / one who specializes in the study 8. uro / logist or treatment of CF S 22. j DEFINITION: urine / one who specializes in the study 23. q or treatment of 24. l 9. neuro / logy 25. p CF S 26. f DEFINITION: nerve / study of 27. n 10. psycho / logist 28. o CF S 29. e DEFINITION: mind / one who specializes in the study 30. b or treatment of 31. d 11. osteo / path / y 32. i CF R S 33. h DEFINITION: bone / disease / condition or process of 34. g 12. ophthalmo / logist 35. a CF S 36. k DEFINITION: eye / one who specializes in the study or 37. c treatment of 38. m 13. obstetr / ic 39. obstetrics and gynecology R S 40. Doctor of Dental Surgery DEFINITION: midwife / pertaining to 41. ears, nose, and throat 14. an / esthesio / logy 42. American Board of Medical Specialties P CF S 43. Doctor of Optometry DEFINITION: without / sensation / study of 44. Fellow of the American College of Surgeons Appendix D • Answers to Practice Exercises 607 45. American College of Physicians 54. c 46. Doctor of Chiropractic Medicine 55. a 47. Doctor of Podiatric Medicine 56. e 48. Doctor of Osteopathic Medicine 57. g 49–53. 58. f gynecologist 59. b ophthalmologist 60. d otolaryngologist orthopaedist urologist CHAPTER 4 (PP. 97–101) 1. chief complaint 50. two and one-half grains of aspirin 2. occupational history 51. 650 milligrams by mouth every 4 hours as needed for 3. per rectum temperature more than 101° 4. bathroom privileges 52. one suppository through the rectum every night as 5. postanesthetic recovery unit needed 6. past history 53. one drop in both eyes 3 times a day for 7 days 7. *discontinue or discharge 54. two capsules immediately, then one every 6 hours 8. instructions to patient 55. tab po tid 7 d or tab po tid 7 d 9. emergency room 56. suppos PV hs or suppos PV hs 10. intensive care unit 11. rule out 57. 5 mL po qid 12. nothing by mouth 58. or po q 3–4 h prn 13. living and well 59. gtt AS q 3 h or gtt AS q 3 h 14. blood pressure 60. cap po bid am and pm or cap po bid am and pm 15. *both ears 61. po STAT, then q 6 h 16. symptom 62. 30 mg po hs prn 17. vital signs 63. 0100 hours 18. review of systems 64. 1430 hours 19. patient 65. 2400 hours 20. *right eye 66. 1300 hours 21. subcutaneous 67. 1900 hours 22. history and physical 68. 0450 hours 23. treatment or traction 69. e 24. diagnosis 70. h 25. history of present illness 71. g 26. female 72. f 27. decreased 73. i 28. d 74. d 29. e 75. b 30. g 76. j 31. a 77. a 32. j 78. c 33. i 79. every day, daily 34. b 80. every other day, every other day 35. c 81. left eye, left eye 36. f 82. right ear, right ear 37. h 83. both ears, both ears 38. d 84. greater than, greater than 39. h 85. discharge or discontinue, discharge or discontinue 40. f 86. yes 41. i 87. no 42. g 88. yes 43. j 89. yes 44. b 90. no 45. c 91. e 46. a 92. d 47. e 93. a 48. vital signs every hour for 4 hours, then every 2 hours 94. b 49. one by mouth, 4 times a day, after meals and at bed- 95. c time 608 Medical Terminology: The Language of Health Care CHAPTER 5 (PP. 125–133) 1. dermato / logist 20. melano / cyt / e CF S CF R S DEFINITION: skin / one who specializes in the study DEFINITION: black / cell / noun marker or treatment of 21. xer / osis 2. ichthy / oid R S R S DEFINITION: dry / condition or increase DEFINITION: fish / resembling 22. purpur / ic 3. onycho / lysis R S CF S DEFINITION: purple / pertaining to DEFINITION: nail / breakdown or dissolution 23. sebo / rrhea 4. histo / troph / ic CF S CF R S DEFINITION: sebum (oil) / discharge DEFINITION: tissue / nourishment of development / 24. xanth / oma pertaining to R S 5. dys / plas / ia DEFINITION: yellow / tumor P R S 25. a / steat / osis DEFINITION: painful, difficult, or faulty / formation / P R S condition of DEFINITION: without / fat / condition or increase 6. hyper / kerat / osis 26. melanoma P R S 27. hypodermic DEFINITION: above or excessive / hard / condition 28. cherry angioma or increase 29. excoriation 7. leuko / trich / ia 30. frozen section CF R S 31. closed comedo DEFINITION: white / hair / condition of 32. antipruritic 8. myco / logy 33. onychomycosis CF S 34. excisional biopsy DEFINITION: fungus / study of 35. autograft 9. epi / derm / al 36. sclerotherapy P R S 37. hyperpigmentation DEFINITION: upon / skin / pertaining to 38. steat/o 10. lip / oma 39. melan/o R S 40. myc/o DEFINITION: fat / tumor 41. onych/o 11. sub / cutane / ous 42. erythr/o P R S 43. trich/o DEFINITION: below or under / skin / pertaining to 44. xer/o 12. an / hidr / osis 45. seb/o P R S 46. gangrene DEFINITION: without / sweat / condition or increase 47. pruritus 13. histo / patho / logy 48. carbuncle CF CF S 49. alopecia DEFINITION: tissue / disease / study of 50. curettage 14. par / onych / ia 51. acne P R S 52. psoriasis DEFINITION: alongside of / nail / condition of 53. cellulitis 15. adip / osis 54. f R S 55. i DEFINITION: fat / condition or increase 56. h 16. squam / ous 57. g R S 58. j DEFINITION: scale / pertaining to 59. c 17. erythro / dermat / itis 60. a CF R S 61. d DEFINITION: red / skin / inflammation 62. b 18. de / squam / ation 63. e P R S 64. leukoderma DEFINITION: from, down, or not / scale / process 65. xanthoderma 19. histo / tox / ic 66. xeroderma CF R S 67. erythroderma DEFINITION: tissue / poison / pertaining to 68. scleroderma Appendix D • Answers to Practice Exercises 609 69. rubella 109. cicatrix—scar; mark left by the healing of a sore or 70. varicella wound showing the replacement of destroyed tissue 71. rubeola by fibrous tissue; keloid—an abnormal overgrowth 72. f of scar tissue that is thick and irregular 73. i 110. dermatosis—any disorder of the skin; dermatitis— 74. c inflammation of the skin 75. h 111. incisional biopsy—removal of a selected portion 76. d of a lesion for microscopic pathological analysis; 77. g excisional biopsy—removal of an entire lesion for 78. a analysis 79. j 112. heterograft—graft transfer from one animal species 80. b to one of another species; allograft—donor transfer 81. e between individuals of the same species such as 82. Bx human to human 83. I&D 113. closed comedo—below the skin surface with a 84. BCC white center; open comedo—open to the skin 85. HSV-1 surface with a black center caused by the presence of 86. C&S melanin exposed to air 87. SLE 114. cutaneous lupus—lupus limited to the skin; 88. m evidenced by a characteristic rash especially on 89. k the face, neck, and scalp; systemic lupus 90. g erythematosus—more severe form of lupus 91. l involving the skin, joints, and often vital organs 92. d 115. dysplastic nevus—mole with precancerous changes; 93. h malignant melanoma—cancerous tumor composed 94. j of melanocytes; most develop from a pigmented 95. b nevus over time 96. i 116. squamous layer (stratum corneum) 97. e 117. basal layer (stratum germinativum) 98. a 118. epidermis 99. f 119. dermis 100. c 120. subcutaneous tissue 101. keratoses 121. cicatrix 102. bullae 122. pruritus 103. nevi 123. petechia 104. maculae 124. verruca 105. ecchymoses 125. ecchymosis 106. electrodesiccation—use of short, high-frequency, 126. excision electric currents to destroy tissue by drying; the 127. psoriasis active electrode makes direct contact with the skin 128. impetigo lesion; fulguration—use of long, high-frequency, 129. eczema electric sparks to destroy tissue; the active electrode 130. debridement does not touch the skin 131. keratosis 107. actinic keratoses—localized thickening of the skin 132. bulla caused by excessive exposure to sunlight; seborrheic 133. nodule keratoses—benign, wart-like lesions seen especially 134. seborrhea on elderly skin 135. petechia 108. vitiligo—condition caused by the destruction of 136. ecchymosis melanin that results in the appearance of white 137. urticaria patches on the skin; albinism—a hereditary 138. eczema condition characterized by a partial or total lack 139. macula (macule) of melanin pigment 140. suppuration CHAPTER 6 (PP. 175–184) 1. thorac / ic 3. arthro / path / y R S CF R S DEFINITION: chest / pertaining to DEFINITION: joint / disease / condition or process of 2. myo / fasci / al 4. spondylo / lysis CF R S CF S DEFINITION: muscle / fascia (a band) / pertaining to DEFINITION: vertebra / breaking down or dissolution 610 Medical Terminology: The Language of Health Care 5. osteo / penia 24. arthro / scopy CF S CF S DEFINITION: bone / abnormal reduction DEFINITION: joint / process of examination 6. a / chondro / plas / ia 25. lord / osis P CF R S R S DEFINITION: without / cartilage / formation / condition of DEFINITION: bent / condition or increase 7. oste / algia 26. intercostal R S 27. arthralgia DEFINITION: bone / pain 28. myotomy 8. poly / myos / itis 29. spondylosyndesis P R S 30. leiomyoma DEFINITION: many / muscle / inflammation 31. osteomalacia 9. leio / myo / sarc / oma 32. spondylolisthesis CF CF R S 33. arthrogram or arthrograph DEFINITION: smooth / muscle / flesh / tumor 34. osteotomy 10. myelo / cyt / e 35. epiphysitis CF R S 36. cervical DEFINITION: bone marrow or spinal cord / cell / 37. bony necrosis noun marker 38. chondroma 11. costo / vertebr / al 39. arthrocentesis CF R S 40. osteoplasty DEFINITION: rib / vertebra / pertaining to 41. chondr/o 12. musculo / tendin / ous 42. spondyl/o CF R S 43. myel/o DEFINITION: muscle / tendon / pertaining to 44. cervic/o 13. orth / osis 45. arthr/o R S 46. thorac/o DEFINITION: straight, normal, or correct / condition 47. my/o or increase 48. cost/o 14. kypho / plasty 49. scoliosis CF S 50. osteoma DEFINITION: humpback / surgical repair or 51. crepitation or crepitus reconstruction 52. sequestrum 15. crani / ectomy 53. sagittal R S 54. traction DEFINITION: skull / excision (removal) 55. gout or gouty arthritis 16. arthr / desis 56. subluxation CF S 57. proximal DEFINITION: joint / binding 58. rickets 17. fibro / my / algia 59. radiologist CF R |
S 60. h DEFINITION: fiber / muscle / pain 61. f 18. rhabdo / my / oma 62. c CF R S 63. e DEFINITION: rod-shaped or striated (skeletal) / 64. a muscle / tumor 65. g 19. sterno / cost / al 66. b CF R S 67. d DEFINITION: sternum (breastbone) / rib / pertaining to 68. arthrogram—x-ray of a joint; arthroscopy— 20. intra / articul / ar procedure using an arthroscope to examine, P R S diagnose, and repair a joint from within DEFINITION: within / joint / pertaining to 69. rhabdomyoma—skeletal (striated) muscle tumor; 21. syn / dactyl / ism rhabdomyosarcoma—malignant skeletal muscle P R S tumor DEFINITION: together or with / digit (finger or toe) / 70. osteoarthritis—most common form of arthritis condition of that especially affects weight-bearing joints 22. lumbo / dynia characterized by the erosion of articular CF S cartilage; rheumatoid arthritis—most DEFINITION: loin (lower back) / pain crippling form of arthritis characterized by a 23. cervico / brachi / al chronic, systemic inflammation affecting joints CF R S and synovial membranes causing ankylosis and DEFINITION: neck / arm / pertaining to deformity Appendix D • Answers to Practice Exercises 611 71. osteomalacia—disease marked by softening of the 104. posterior bone; osteoporosis—condition of decreased bone 105. superior density and increased porosity 106. inferior 72. orthosis—use of an orthopedic appliance to 107. transverse maintain a bone’s position or provide limb support; 108. flexion prosthesis—an artificial replacement for a diseased 109. extension or missing body part such as a hip, joint, or limb 110. abduction 73. closed reduction, external fixation of a Fx— 111. adduction external manipulation of a fracture to regain 112. rotation alignment along with application of an external 113. eversion device to protect and hold the bone in place while 114. inversion healing; open reduction internal fixation of a 115. pronation Fx—internal surgical repair of a fracture by bringing 116. supination bones back into alignment and fixing them into 117. dorsiflexion place, often utilizing plates, screws, and pins 118. plantar flexion 74. ankylosis—stiff joint condition; spondylosis—stiff, 119. skull immobile condition of vertebrae 120. cranium 75. leiomyoma—smooth muscle tumor; 121. phalanges leiomyosarcoma—malignant smooth muscle tumor 122. clavicle 76. lordosis—abnormal anterior curvature of the 123. scapula lumbar spine (sway-back condition); kyphosis— 124. sternum abnormal posterior curvature of the thoracic spine 125. xiphoid process (humpback condition) 126. humerus 77. spondylolisthesis—diagnostic term describing a 127. ilium forward slipping of a lumbar vertebra; 128. ischium spondylosyndesis—operative (surgical) term for 129. ulna spinal fusion 130. radius 78. b 131. carpals 79. d 132. metacarpals 80. a 133. trochanter 81. c 134. femur 82. computed tomography 135. patella 83. physical therapy 136. tibia 84. traction 137. fibula 85. range of motion 138. tarsals 86. fracture 139. metatarsals 87. electromyogram 140. phalanges 88. spondylosis 141. sacrum 89. scoliosis 142. coccyx 90. arthrodynia 143. calcaneus 91. ostealgia 144. orthosis 92. sagittal 145. hypertrophy 93. flaccid 146. radius 94. sequestrum 147. kyphosis 95. ankylosis 148. bursa 96. chondral 149. dystrophy 97. dorsiflexion 150. necrosis 98. osteoporosis 151. osteoporosis 99. rhabdomyoma 152. lordosis 100. medial 153. ulna 101. sagittal 154. scoliosis 102. anterior 155. prosthesis 103. frontal CHAPTER 7 (PP. 222–228) 1. angio / graphy 3. pector / al CF S R S DEFINITION: vessel / process of recording DEFINITION: chest / pertaining to 2. varic / osis 4. vaso / spasm R S CF S DEFINITION: swollen, twisted vein / condition or DEFINITION: vessel / involuntary contraction increase 612 Medical Terminology: The Language of Health Care 5. ven / ous 25. athero / thromb / osis R S CF R S DEFINITION: vein / pertaining to DEFINITION: fatty (lipid) paste / clot / condition or 6. aorto / coron / ary increase CF R S 26. congenital anomalies DEFINITION: aorta / circle or crown / pertaining to 27. arteriosclerosis 7. thrombo / phleb / itis 28. arrhythmia or dysrhythmia CF R S 29. cardiomyopathy DEFINITION: clot / vein / inflammation 30. anastomosis 8. peri / cardio / centesis 31. gallop P CF S 32. echocardiogram DEFINITION: around / heart / puncture for aspiration 33. cor pulmonale 9. vasculo / path / y 34. coronary angiogram CF R S 35. stress ECG DEFINITION: vessel / disease / condition or process of 36. intracardiac catheter ablation 10. athero / genesis 37. pector/o CF S 38. phleb/o DEFINITION: fatty (lipid) paste / origin or production 39. angi/o 11. stetho / scope 40. cardi/o CF S 41. ather/o DEFINITION: chest / instrument for examination 42. coron/o 12. myo / card / ium 43. sphygm/o CF R S 44. thromb/o DEFINITION: muscle / heart / structure or tissue 45. arteri/o 13. aorto / plasty 46. ventricul/o CF S 47. h DEFINITION: aorta / surgical repair or 48. o reconstruction 49. n 14. veno / stomy 50. i CF S 51. g DEFINITION: vein / creation of an opening 52. j 15. arterio / sten / osis 53. a CF R S 54. c DEFINITION: artery / narrow / condition or increase 55. l 16. phlebo / tomy 56. e CF S 57. m DEFINITION: vein / incision 58. d 17. cardio / aort / ic 59. k CF R S 60. f DEFINITION: heart / aorta / pertaining to 61. b 18. ventriculo / gram 62. premature ventricular contraction CF S 63. patent ductus arteriosus DEFINITION: ventricle / record 64. arteriosclerotic heart disease 19. phleb / itis 65. implantable cardioverter-defibrillator R S 66. congestive heart failure DEFINITION: vein / inflammation 67. coronary artery disease 20. angio / plasty 68. hypertension CF S 69. mitral valve prolapse DEFINITION: vessel / surgical repair or 70. magnetic resonance angiography reconstruction 71. ventricular septal defect 21. endo / vascul / ar 72. atrial septum P R S 73. right atrium DEFINITION: within / vessel / pertaining to 74. tricuspid valve 22. cardio / tox / ic 75. right ventricle CF R S 76. left atrium DEFINITION: heart / poison / pertaining to 77. aortic valve 23. arterio / gram 78. pulmonary semilunar valve CF S 79. left ventricle DEFINITION: artery / record 80. ventricular septum 24. ather / ectomy 81. e R S 82. h DEFINITION: fatty (lipid) paste / excision removal 83. b Appendix D • Answers to Practice Exercises 613 84. a 98. occlusion 85. j 99. infarct 86. c 100. aneurysm 87. i 101. atherosclerotic 88. d 102. thrombophlebitis 89. f 103. angiogram 90. g 104. defibrillation 91. ventricle 105. antiarrhythmic 92. aorta 106. vasodilation 93. thrombus 107. anticoagulant 94. myocardial 108. hypertension 95. hypotension 109. tachycardia 96. diastole 110. systole 97. ischemia CHAPTER 8 (PP. 256–263) 1. erythro / blast / osis 14. splen / ectomy CF R S R S DEFINITION: red / germ or bud / condition or increase DEFINITION: spleen / excision (removal) 2. myelo / dys / plas / ia 15. chylo / poiesis CF P R S CF S DEFINITION: bone marrow / faulty (bad, difficult) / DEFINITION: juice / formation formation / condition of 16. lymph / oma 3. hemo / cyto / meter R S CF CF S DEFINITION: clear fluid / tumor DEFINITION: blood / cell / instrument for measuring 17. cyto / morpho / logy 4. spleno / rrhagia CF CF S CF S DEFINITION: cell / form / study of DEFINITION: spleen / to burst forth 18. hemo / lysis 5. lymph / aden / itis CF S R R S DEFINITION: blood / breaking down or dissolution DEFINITION: clear fluid / gland / inflammation 19. an / emia 6. immuno / tox / ic P S CF R S DEFINITION: without / blood condition DEFINITION: safe / poison / pertaining to 20. meta / stasis 7. reticulo / cyt / osis P S CF R S DEFINITION: beyond, after, or change / stop or stand DEFINITION: a net / cell / condition or increase 21. neutropenia 8. thymo / path / y 22. leukocyte CF R S 23. hematopoiesis DEFINITION: thymus gland / disease / condition 24. splenomegaly or process of 25. erythropenia, erythrocytopenia 9. leuko / cyt / ic 26. thymic CF R S 27. agranulocytes DEFINITION: white / cell / pertaining to 28. eosinophil 10. lymph / angio / gram 29. erythrocyte R CF S 30. pancytopenia DEFINITION: clear fluid / vessel / record 31. phag/o 11. spleno / megaly 32. thromb/o CF S 33. chyl/o DEFINITION: spleen / enlargement 34. plas/o 12. pro / myelo / cyt / e 35. chrom/o P CF R S 36. hem/o DEFINITION: before / bone marrow / cell / noun 37. immun/o marker 38. blast/o 13. leuko / cyto / penia 39. white blood count, WBC CF CF S 40. hemoglobin, HGB or Hgb DEFINITION: white / cell / abnormal 41. hematocrit, HCT or Hct reduction 42. differential count 614 Medical Terminology: The Language of Health Care 43. mean corpuscular (cell) volume, mean corpuscular 71. vasoconstrictor—drug that causes a narrowing of (cell) hemoglobin, mean corpuscular (cell) blood vessels, decreasing blood flow; vasodilator— hemoglobin concentration, anemia drug that causes dilation of blood vessels, increasing 44. phlebotomy blood flow 45. lymphoma 72. anticoagulant—drug that prevents clotting of the 46. prothrombin time blood; hemostatic—drug that stops the flow of 47. erythrocyte sedimentation rate blood within the vessels 48. partial thromboplastin time 73. polycythemia—increase in the number of 49. complete blood count erythrocytes and hemoglobin in the blood; 50. l hemochromatosis—hereditary disorder that 51. j results in an excessive buildup of iron deposits in 52. k the body 53. g 74. plasma 54. c 75. leukocytes 55. e 76. erythrocytes 56. f 77. thrombocytes 57. b 78. serum 58. d 79. right lymphatic duct 59. i 80. thymus gland 60. h 81. thoracic duct 61. a 82. lymphatic vessels 62. immunosuppression 83. cervical lymph nodes 63. cross matching 84. spleen 64. acquired immunodeficiency syndrome (AIDS) 85. hematopoiesis 65. mononucleosis 86. platelets 66. plasmapheresis 87. anisocytosis 67. plasma—liquid portion of the blood and lymph 88. poikilocytosis containing water, proteins, salts, nutrients, hormones, 89. hemolysis vitamins, and cellular components; serum—liquid 90. lymphadenopathy portion of the blood left after the clotting process 91. myelodysplasia 68. anemia—condition affecting red blood cells that 92. thrombocytopenia results in their diminished ability to transport 93. hematocrit oxygen to the tissues; leukemia—cancer of the blood- 94. splenectomy forming organs marked by abnormal white blood 95. plasmapheresis cells in the blood and bone marrow 96. vasodilator 69. autologous blood—blood donated by a person and 97. venipuncture stored for his or her future use; homologous 98. leukemia blood—blood voluntarily donated by any person for 99. immunosuppression transfusion 100. thymus 70. antibody—substance produced by the body that 101. hematopoiesis destroys or inactivates an antigen that has entered 102. spleen the body; antigen—a substance that, when 103. septicemia introduced into the body, causes the formation of 104. hemophilia antibodies against it 105. myelodysplasia CHAPTER 9 (PP. 289–296) 1. pulmono / logy 5. pleur / itis CF S R S DEFINITION: lung / study of DEFINITION: pleura / inflammation 2. thoraco / centesis 6. hyper / carb / ia CF S P R S DEFINITION: chest / puncture for aspiration DEFINITION: above or excessive / carbon dioxide / 3. naso / sinus / itis condition of CF R S 7. alveol / ar DEFINITION: nose / sinus / inflammation R S 4. hyp / ox / emia DEFINITION: alveolus (air sac) / pertaining to P R S 8. tracheo / tomy DEFINITION: below or deficient / oxygen / blood CF S condition DEFINITION: trachea / incision Appendix D • Answers to Practice Exercises 615 9. oro / nas / al 29. pneumonitis CF R S 30. spirometry DEFINITION: mouth / nose / pertaining to 31. hypoventilation 10. rhino / rrhea 32. eupnea CF S 33. bradypnea DEFINITION: nose / discharge 34. dyspnea 11. thoraco / stomy 35. orthopnea CF S 36. apnea DEFINITION: chest / creation of an opening 37. tachypnea 12. tonsill / ectomy 38. rhin/o R S 39. pneum/o DEFINITION: tonsil / excision (removal) 40. pharyng/o 13. tracheo / bronch / itis 41. thorac/o CF R S 42. laryng/o DEFINITION: trachea (windpipe) / bronchus 43. spir/o (airway) / inflammation 44. phren/o 14. broncho / spasm 45. or/o CF S 46. pneumothorax DEFINITION: bronchus (airway) / involuntary 47. empyema, pyothorax contraction 48. hemothorax 15. laryngo / sten / osis 49. auscultation |
CF R S 50. bronchoscope DEFINITION: larynx (voice box) / narrow / condition 51. expectoration or increase 52. pleurisy, pleuritis 16. spiro / gram 53. percussion CF S 54. thoracentesis, thoracocentesis DEFINITION: breathing / record 55. dysphonia 17. lob / ectomy 56. laryngitis R S 57. hypoxia DEFINITION: lobe (a portion) / excision (removal) 58. emphysema 18. peri / pleur / al 59. epistaxis P R S 60. bronchogenic carcinoma DEFINITION: around / pleura / pertaining to 61. cystic fibrosis 19. stetho / scope 62. atelectasis CF S 63. sputum DEFINITION: chest / instrument for examination 64. stridor 20. pneumon / ic 65. pulmonary embolism R S 66. tracheostomy DEFINITION: air or lung / pertaining to 67. asthma 21. naso / pharyngo / scopy 68. hyperventilation CF CF S 69. pneumocystis pneumonia DEFINITION: nose / pharynx (throat) / process of 70. chronic obstructive pulmonary disease (COPD) examination 71. peak expiratory flow rate 22. bronchiol / ectasis 72. vital capacity R S 73. tuberculosis DEFINITION: bronchiole (little airway) / expansion 74. cardiopulmonary resuscitation or dilation 75. chronic obstructive pulmonary disease 23. phreno / ptosis 76. partial pressure of carbon dioxide CF S 77. upper respiratory infection DEFINITION: diaphragm / falling or downward 78. tidal volume displacement 79. pulmonary function testing 24. pector / al 80. polysomnography R S 81. continuous positive airway pressure DEFINITION: chest / pertaining to 82. k 25. uvulo / palato / pharyngo / plasty 83. h CF CF CF S 84. g DEFINITION: uvula (grape) / palate / throat / surgical 85. f repair or reconstruction 86. i 26. pneumoconiosis 87. l 27. bronchiectasis 88. d 28. thoracoplasty 89. e 616 Medical Terminology: The Language of Health Care 90. b 108. pleurisy 91. a 109. hemothorax 92. j 110. stethoscope 93. c 111. epistaxis 94. CXR 112. rhonchi 95. ABGs 113. hemoptysis 96. T&A 114. rhinorrhea 97. nasopharynx 115. emphysema 98. trachea 116. atelectasis 99. pleura 117. bronchodilator 100. upper lobe of lung 118. orthopnea 101. diaphragm 119. pleura 102. frontal sinus 120. hypoxia 103. larynx with vocal cords 121. dyspnea 104. left main bronchus 122. pharynx 105. auscultation 123. apnea 106. tachypnea 124. trachea 107. eupnea 125. asthma CHAPTER 10 (PP. 338–346) 1. gangli / oma 13. neuro / gli / al R S CF R S DEFINITION: ganglion (knot) / tumor DEFINITION: nerve / glue / pertaining to 2. a / topo / gnos / ia 14. dys / lex / ia P CF R S P R S DEFINITION: without / place / knowing / condition of DEFINITION: painful, difficult, or faulty / word or phrase / 3. cata / ton / ic condition of P R S 15. somni / path / y DEFINITION: down / tone or tension / pertaining to CF R S 4. dys / tax / ia DEFINITION: sleep / disease / condition or process of P R S 16. hydro / cephal / ic DEFINITION: painful, difficult, or faulty / order or CF R S coordination / condition of DEFINITION: water / head / pertaining to 5. brady / kines / ia 17. dys / arthr / ia P R S P R S DEFINITION: slow / movement / condition of DEFINITION: difficult, painful, or faulty / articulation / 6. meningo / cele condition of CF S 18. acro / phob / ia DEFINITION: meninges (membrane) / pouching or CF R S hernia DEFINITION: topmost / exaggerated fear / condition of 7. dys / thym / ia 19. hypno / tic P R S CF S DEFINITION: painful, difficult, or faulty / mind / DEFINITION: sleep / pertaining to condition of 20. eu / phor / ia 8. poly / somno / gram P R S P CF S DEFINITION: good or normal / carry or bear / condition DEFINITION: many / sleep / record of 9. spondylo / syn / desis 21. para / somn / ia CF P S P R S DEFINITION: vertebra / together or with / DEFINITION: abnormal / sleep / condition of binding 22. narco / lepsy 10. hemi / plegia CF S P S DEFINITION: stupor (sleep) / seizure DEFINITION: half / paralysis 23. stereo / tax / y 11. cranio / tomy CF R S CF S DEFINITION: three-dimensional or solid / order or co- DEFINITION: skull / incision ordination / condition or process of 12. thalam / ic 24. hemi / paresis R S P S DEFINITION: thalamus (a room) / pertaining to DEFINITION: half / slight paralysis Appendix D • Answers to Practice Exercises 617 25. neur / asthenia 74. electroencephalogram R S 75. deep tendon reflexes DEFINITION: nerve / weakness 76. cerebrospinal fluid 26. myelo / path / y 77. magnetic resonance angiography CF R S 78. cerebrovascular accident DEFINITION: spinal cord / disease / condition or 79. pons process of 80. cerebellum 27. intra / crani / al 81. spinal P R S 82. callosum DEFINITION: within / skull / pertaining to 83. thalamus 28. a / phas / ia 84. cranium P R S 85. meninges DEFINITION: without / speech / condition of 86. cerebrum 29. schizo / phren / ia 87. j CF R S 88. d DEFINITION: split / mind / condition of 89. h 30. cerebro / spin / al 90. f CF R S 91. a DEFINITION: cerebrum / spine / pertaining to 92. e 31. electroencephalogram 93. b 32. spondylosyndesis 94. i 33. craniectomy 95. g 34. cerebral atherosclerosis 96. c 35. hyperesthesia 97. generalized anxiety disorder 36. dysphasia 98. attention-deficit/hyperactivity disorder 37. analgesia 99. obsessive-compulsive disorder 38. astereognosis 100. electroconvulsive therapy 39. encephal/o 101. panic disorder 40. kinesi/o 102. bipolar disorder 41. lex/o 103. posttraumatic stress disorder 42. somat/o 104. c 43. myel/o 105. a 44. thym/o 106. f 45. esthesi/o 107. e 46. top/o 108. g 47. hypn/o 109. b 48. gnos/o 110. d 49. meningitis 111. c 50. diskectomy (discectomy) 112. e 51. Parkinson disease 113. b 52. Babinski sign 114. d 53. paresthesia 115. a 54. coma 116. Alzheimer 55. spina bifida 117. schizophrenia 56. e 118. polysomnography 57. j 119. paranoia 58. i 120. atopognosis 59. k 121. dementia 60. b 122. epilepsy 61. g 123. catatonia 62. h 124. delusion 63. f 125. hallucination 64. c 126. poliomyelitis 65. d 127. epilepsy 66. a 128. euphoria 67. computed tomography 129. delusion 68. magnetic resonance image or imaging 130. syncope 69. positron emission tomography 131. autism 70. multiple sclerosis 132. psychosis 71. central nervous system 133. cerebrum 72. cerebral palsy 134. dysphasia 73. transient ischemic attack 135. paranoia 618 Medical Terminology: The Language of Health Care CHAPTER 11 (PP. 372–377) 1. aden / itis 20. hyposecretion R S 21. hyperglycemia DEFINITION: gland / inflammation 22. sonography or ultrasonography 2. eu / glyc / emia 23. adrenal gland P R S 24. shield DEFINITION: good or normal / sugar / blood condition 25. secrete 3. thyro / toxic / osis 26. sugar CF R S 27. thirst DEFINITION: thyroid gland (shield) / poison / condition 28. thymus gland or increase 29. urging on 4. poly / dips / ia 30. gland P R S 31. hyperthyroidism or thyrotoxicosis DEFINITION: many / thirst / condition of 32. exophthalmos or exophthalmus 5. hormon / al 33. acromegaly R S 34. goiter DEFINITION: hormone (an urging on) / pertaining to 35. pituitary dwarfism 6. ket / osis 36. thyroid uptake and image R S 37. e DEFINITION: ketone bodies / condition or increase 38. h 7. poly / ur / ia 39. l P R S 40. f DEFINITION: many / urine / condition of 41. i 8. endo / crin / e 42. k P R S 43. j DEFINITION: within / to secrete / noun marker 44. g 9. thyro / ptosis 45. a CF S 46. m DEFINITION: thyroid gland (shield) / falling or 47. c downward displacement 48. d 10. thym / oma 49. b R S 50. blood sugar DEFINITION: thymus gland / tumor 51. hormone replacement therapy 11. acro / megaly 52. fasting blood sugar CF S 53. diabetes mellitus DEFINITION: extremity / enlargement 54. postprandial blood sugar 12. andr / oid 55. glucose tolerance test R S 56. diabetic ketoacidosis DEFINITION: male / resembling 57. para 13. adreno / troph / ic 58. thymus CF R S 59. adrenal DEFINITION: adrenal gland / nourishment or 60. pituitary development / pertaining to 61. thyroid 14. pancreato / gen / ic 62. pancreas CF R S 63. hirsutism DEFINITION: pancreas / origin or production / 64. exophthalmos pertaining to 65. myxedema 15. glycos / ur / ia 66. goiter R R S 67. androgenous DEFINITION: sugar / urine / condition of 68. virilism 16. dipso / gen / ic 69. epinephrine CF R S 70. hypoglycemic DEFINITION: thirst / origin or production / 71. acromegaly pertaining to 72. exophthalmos 17. hypersecretion 73. metabolism 18. hypoglycemia 74. diabetes 19. Cushing syndrome 75. hypoglycemia Appendix D • Answers to Practice Exercises 619 CHAPTER 12 (PP. 403–408) 1. blepharo / ptosis 20. sclero / malacia CF S CF S DEFINITION: eyelid / falling or downward DEFINITION: sclera / softening displacement 21. aphakia 2. irido / tomy 22. exophthalmos CF S 23. blepharochalasis or dermatochalasis DEFINITION: iris / incision 24. scleral buckling 3. ophthalmo / logy 25. blepharospasm CF S 26. opt/o DEFINITION: eye / study of 27. presby/o 4. vitr / ectomy 28. vitre/o R S 29. phot/o DEFINITION: glassy / excision (removal) 30. scler/o 5. dacryo / lith / iasis 31. phac/o CF R S 32. irid/o DEFINITION: tear / stone / formation or presence of 33. dacry/o 6. lacrim / al 34. blephar/o R S 35. aque/o DEFINITION: tear / pertaining to 36. conjunctivitis 7. photo / phob / ia 37. blepharitis CF R S 38. asthenopia DEFINITION: light / sensitivity / condition of 39. mydriatic 8. kerato / plasty 40. hordeolum CF S 41. cataract DEFINITION: cornea / surgical repair or reconstruction 42. macular degeneration 9. aque / ous 43. e R S 44. c DEFINITION: water / pertaining to 45. a 10. ir / itis 46. f R S 47. d DEFINITION: iris / inflammation 48. b 11. corne / al 49. inward turning of the rim of the eyelid R S 50. instrument to measure intraocular pressure DEFINITION: cornea / pertaining to 51. outward turning of the rim of the eyelid 12. phaco / lysis 52. involuntary, rapid oscillating movement of the eyeball CF S 53. f DEFINITION: lens (lentil) / breaking down or dissolution 54. h 13. retino / path / y 55. a CF R S 56. e DEFINITION: retina / disease / condition or process of 57. i 14. ocul / ar 58. b R S 59. j DEFINITION: eye / pertaining to 60. d 15. conjunctiv / itis 61. c R S 62. g DEFINITION: conjunctiva (to join together) / 63. eyelid inflammation 64. cornea 16. presby / opia 65. lens R S 66. sclera DEFINITION: old age / condition of vision 67. vitreous 17. opto / metry 68. ciliary CF S 69. retina DEFINITION: eye / process of measuring 70. optic 18. a / phak / ia 71. asthenopia P R S 72. pterygium DEFINITION: without / lens (lentil) / condition or 73. hordeolum process of 74. nystagmus 19. hyper / opia 75. chalazion P S 76. mydriatic DEFINITION: above or excessive / condition of vision 77. scotoma 620 Medical Terminology: The Language of Health Care 78. epiphora 82. myopia 79. dacryocyst 83. sclera 80. ophthalmoscope 84. macula 81. conjunctiva 85. exophthalmos or exophthalmus CHAPTER 13 (PP. 426–429) 1. acous / tic 16. otosclerosis R S 17. otoscope DEFINITION: hearing / pertaining to 18. Ménière disease 2. oto / rrhea 19. acoustic neuroma CF S 20. myring/o DEFINITION: ear / discharge 21. audi/o 3. myringo / plasty 22. cerumin/o CF S 23. salping/o DEFINITION: eardrum / surgical repair or 24. ot/o reconstruction 25. aer/o 4. aer / ot / itis 26. j R R S 27. i DEFINITION: air or gas / ear/inflammation 28. g 5. oto / tox / ic 29. h CF R S 30. f DEFINITION: ear / poison / pertaining to 31. a 6. cerumino / lysis 32. e CF S 33. d DEFINITION: wax / breaking down or dissolution 34. |
c 7. salpingo / scope 35. b CF S 36. labyrinthitis DEFINITION: eustachian tube / instrument for 37. vertigo examination 38. tinnitus 8. hyper / acusis 39. stapedectomy P S 40. cerumen impaction DEFINITION: above or excessive / hearing condition 41. audiology 9. audio / metry 42. lavage CF S 43. auricle DEFINITION: hearing / process of measuring 44. eustachian 10. tympano / centesis 45. pharynx CF S 46. malleus DEFINITION: eardrum / puncture for aspiration 47. incus 11. oto / dynia 48. stapes CF S 49. cochlea DEFINITION: ear / pain 50. tympanic 12. aur / icle 51. aerotitis R S 52. cerumen DEFINITION: ear / small 53. myringotomy 13. myringo / tomy 54. presbyacusis CF S 55. vertigo DEFINITION: eardrum / incision 56. antihistamine 14. cerumin / osis 57. tinnitus R S 58. stapedectomy DEFINITION: wax / condition or increase 59. deafness 15. audio / logy 60. eustachian CF S DEFINITION: hearing / study of Appendix D • Answers to Practice Exercises 621 CHAPTER 14 (PP. 462–470) 1. trans / abdomin / al 19. bili / ary P R S R S DEFINITION: across or through / abdomen / DEFINITION: bile / pertaining to pertaining to 20. gastro / esophag / eal 2. gastro / entero / stomy CF R S CF CF S DEFINITION: stomach / esophagus / pertaining to DEFINITION: stomach / small intestine / creation of 21. chole / docho / tomy an opening CF CF S 3. sialo / litho / tomy DEFINITION: bile / duct / incision CF CF S 22. steato / rrhea DEFINITION: saliva / stone / incision CF S 4. glosso / rrhaphy DEFINITION: fat / discharge CF S 23. dent / algia DEFINITION: tongue / suture R S 5. hemat / emesis DEFINITION: teeth / pain R S 24. pyloro / spasm DEFINITION: blood / vomiting CF S 6. cheilo / stomato / plasty DEFINITION: pylorus (gatekeeper) / involuntary CF CF S contraction DEFINITION: lip / mouth / surgical repair or 25. hepato / tox / ic reconstruction CF R S 7. appendic / itis DEFINITION: liver / poison / pertaining to R S 26. ileo / jejun / itis DEFINITION: appendix / inflammation CF R S 8. celio / tomy DEFINITION: ileum / jejunum / inflammation CF S 27. peritoneo / centesis DEFINITION: abdomen / incision CF S 9. chol / angio / gram DEFINITION: peritoneum / puncture for aspiration R CF S 28. bucco / gingiv / al DEFINITION: bile / vessel / record CF R S 10. colono / scopy DEFINITION: cheek / gum / pertaining to CF S 29. chole / cyst / ectomy DEFINITION: colon / process of examination CF R S 11. ano / rect / al DEFINITION: bile / bladder or sac / excision (removal) CF R S 30. peri / rect / al DEFINITION: anus / rectum / pertaining to P R S 12. entero / col / itis DEFINITION: around / rectum / pertaining to CF R S 31. hemicolectomy DEFINITION: small intestine / colon / inflammation 32. appendicitis 13. oro / lingu / al 33. cheilorrhaphy CF R S 34. cholelithotomy DEFINITION: mouth / tongue / pertaining to 35. stomatoplasty 14. procto / sigmoido / scopy 36. cholangiogram CF CF S 37. hyperbilirubinemia DEFINITION: anus and rectum / sigmoid colon / 38. gastric resection process of examination 39. diverticulosis 15. laparo / scope 40. lapar/o CF S 41. gloss/o DEFINITION: abdomen / instrument for examination 42. enter/o 16. dys / phag / ia 43. dent/i P R S 44. gastr/o DEFINITION: painful, difficulty, or faulty / eat or 45. bucc/o swallow / condition of 46. chol/e 17. pancreato / duodeno / stomy 47. stomat/o CF CF S 48. hepat/o DEFINITION: pancreas / duodenum / creation of an 49. phag/o opening 50. lith/o 18. hernio / plasty 51. proct/o CF S 52. gastritis DEFINITION: hernia / surgical repair or reconstruction 53. anorexia 622 Medical Terminology: The Language of Health Care 54. aphagia 95. gastroscope 55. buccal 96. colonoscope 56. flatulence 97. peritoneoscope 57. hernia 98. esophagoscope 58. melena 99. incarcerated hernia 59. eructation 100. excisional biopsy 60. proctoscope or rectoscope 101. nasogastric tube 61. colitis 102. endoscopic retrograde cholangiopancreatography 62. barium swallow 103. gastroesophageal reflux disease 63. ascites 104. left upper quadrant 64. cholecystitis 105. gastrointestinal 65. steatorrhea 106. magnetic resonance imaging 66. diverticulitis 107. esophagogastroduodenoscopy 67. gastric ulcer 108. hepat/o or hepatic/o 68. hepatomegaly 109. cholecyst 69. ankyloglossia 110. enter/o 70. inguinal regions 111. col/o or colon/o 71. hypochondriac regions 112. gloss/o or lingu/o 72. epigastric region 113. gastr/o 73. hypogastric region 114. proct/o or rect/o 74. lumbar regions 115. an/o 75. umbilical region 116. anorexia 76. right upper quadrant 117. ascites 77. right lower quadrant 118. hematochezia 78. left upper quadrant 119. icterus 79. left lower quadrant 120. ankyloglossia 80. m 121. volvulus 81. f 122. cirrhosis 82. d 123. glossectomy 83. h 124. herniorrhaphy 84. k 125. hemorrhoidectomy 85. g 126. antacid 86. j 127. antiemetic 87. i 128. cathartic 88. l 129. melena 89. b 130. feces 90. e 131. icterus 91. a 132. ileum 92. c 133. endoscopy, endoscope 93. laparoscope 134. hemorrhoid 94. anoscope or proctoscope 135. pancreas CHAPTER 15 (PP. 497–503) 1. vesico / ureter / ic 6. nephro / ptosis CF R S CF S DEFINITION: bladder / ureter / pertaining to DEFINITION: kidney / falling or downward 2. bacteri / osis displacement R S 7. poly / dips / ia DEFINITION: bacteria / condition or increase P R S 3. trans / urethr / al DEFINITION: many / thirst / condition of P R S 8. glomerulo / scler / osis DEFINITION: across or through / urethra / pertaining to CF R S 4. uro / gram DEFINITION: glomerulus (little ball) / hard / condition CF S or increase DEFINITION: urine / record 9. pyo / nephr / itis 5. urethro / cyst / itis CF R S CF R S DEFINITION: pus / kidney / inflammation DEFINITION: urethra / bladder / inflammation Appendix D • Answers to Practice Exercises 623 10. uro / logy 44. dysuria CF S 45. ketonuria DEFINITION: urine / study of 46. hematuria 11. uretero / vesico / stomy 47. pyuria CF CF S 48. g DEFINITION: ureter / bladder / creation of an opening 49. d 12. glyco / rrhea 50. i CF S 51. h DEFINITION: sugar / discharge 52. a 13. meato / tomy 53. k CF S 54. c DEFINITION: meatus (opening) / incision 55. b 14. pyelo / nephr / osis 56. f CF R S 57. e DEFINITION: renal pelvis (basin) / kidney / condition 58. j or increase 59. albumin 15. cysto / scopy 60. intravenous pyelogram CF S 61. extracorporeal shock wave lithotripsy DEFINITION: bladder / process of examination 62. urinary tract infection 16. supra / ren / al 63. stress urinary incontinence P R S 64. blood urea nitrogen DEFINITION: above / kidney / pertaining to 65. ur/o 17. nephro / lith / iasis 66. dips/o CF R S 67. py/o DEFINITION: kidney / stone / formation or presence of 68. vesic/o 18. uretero / cele 69. albumin/o CF S 70. nephr/o DEFINITION: ureter / pouching or hernia 71. meat/o 19. albumin / ous 72. pyel/o R S 73. lith/o DEFINITION: protein / pertaining to 74. right kidney 20. pyelo / graphy 75. ureters CF S 76. urinary bladder DEFINITION: renal pelvis (basin) / process of recording 77. urethra 21. nephritis 78. left kidney 22. nephrosis 79. cystoscope 23. nephrotomy 80. pyelogram 24. nephrorrhaphy 81. oliguria 25. nephrectomy 82. hydronephrosis 26. nephrolithotomy 83. azotemia 27. urethral stenosis 84. urinalysis 28. extracorporeal shock wave lithotripsy 85. glomerular 29. suprapubic catheter 86. nephrectomy 30. resectoscope 87. diuretic 31. Kegel exercises 88. hemodialysis 32. occult blood 89. catheterization 33. cystometrogram 90. urine 34. peritoneal dialysis 91. glomerulus 35. scout film 92. meatus 36. cystitis 93. uremia 37. incontinence 94. urethra 38. enuresis 95. nephrosis 39. nocturnal enuresis 96. UA 40. hydronephrosis 97. C&S 41. adult polycystic kidney disease 98. RP 42. nocturia 99. KUB 43. oliguria 100. VCU or VCUG 624 Medical Terminology: The Language of Health Care CHAPTER 16 (PP. 521–526) 1. oligo / sperm / ia 23. h P R S 24. g DEFINITION: few or deficient / sperm / condition of 25. f 2. perineo / plasty 26. e CF S 27. b DEFINITION: perineum / surgical repair or reconstruction 28. d 3. test / algia 29. a R S 30. c DEFINITION: testis or testicle / pain 31. cryptorchism 4. balan / ic 32. endorectal or transrectal sonogram of prostate R S 33. hydrocele DEFINITION: glans penis / pertaining to 34. hypospadias 5. prostato / megaly 35. digital rectal exam CF S 36. brachytherapy DEFINITION: prostate / enlargement 37. c 6. orchid / ectomy 38. d R S 39. a DEFINITION: testis or testicle / excision (removal) 40. b 7. an / orch / ism 41. prostate-specific antigen P R S 42. biopsy DEFINITION: without / testis or testicle / condition of 43. transurethral resection of the prostate 8. vas / ectomy 44. digital rectal examination R S 45. erectile dysfunction DEFINITION: vessel / excision (removal) 46. orchi/o 9. a / sperm / ia 47. perine/o P R S 48. spermat/o DEFINITION: without / sperm (seed) / condition of 49. vas/o 10. cysto / prostat / ectomy 50. balan/o CF R S 51. epididym/o DEFINITION: bladder / prostate / excision (removal) 52. vas deferens 11. balan / itis 53. urethra R S 54. glans penis DEFINITION: glans penis / inflammation 55. testis 12. orchio / plasty 56. urinary bladder CF S 57. prostate gland DEFINITION: testis or testicle / surgical repair or recon- 58. perineum struction 59. epididymis 13. spermato / cele 60. epididymis CF S 61. oligospermia DEFINITION: sperm (seed) / pouching or hernia 62. azoospermia 14. epididymo / tomy 63. anorchism CF S 64. balanitis DEFINITION: epididymis / incision 65. cryptorchism 15. vaso / vaso / stomy 66. hypospadias CF CF S 67. chlamydia DEFINITION: vessel / vessel / creation of an opening 68. syphilis 16. anorchism 69. phimosis 17. balanitis 70. prostate 18. varicocele 71. epididymis 19. resectoscope 72. perineum 20. benign prostatic hyperplasia or hypertrophy 73. penis 21. vasectomy 74. gonorrhea 22. Peyronie disease 75. testicle or testis Appendix D • Answers to Practice Exercises 625 CHAPTER 17 (PP. 564–571) 1. vulv / itis 20. colpo / rrhaphy R S CF S DEFINITION: vulva (covering) / inflammation DEFINITION: vagina (sheath) / suture 2. poly / mast / ia 21. hystero / spasm P R S CF S DEFINITION: many / breast / condition of DEFINITION: uterus / involuntary contraction 3. ov / oid 22. lacto / rrhea R S CF S DEFINITION: egg / resembling DEFINITION: milk / discharge 4. toco / lysis 23. ovi / genesis CF S CF S DEFINITION: birth or labor / breaking down or dissolu- DEFINITION: egg / origin or production tion 24. endo / cervic / al 5. salpingo / tomy P R S CF S DEFINITION: within / cervix / pertaining to DEFINITION: uterine (fallopian) tube / incision 25. utero / tomy 6. mammo / plasty CF S CF S DEFINITION: uterus / incision DEFINITION: breast / surgical repair or reconstruction 26. menopause 7. trans / vagin / al 27. dysmenorrhea P R S 28. amenorrhea DEFINITION: across or through / vagina (sheath) / 29. oligomenorrhea pertaining to 30. menorrhagia 8. hystero / rrhexis 31. metrorrhagia CF S 32. gynecomastia DEFINITION: uterus / rupture 33. amastia 9. colpo / scopy 34. hypomastia or micromastia; augmentation CF S mammoplasty DEFINITION: vagina (sheath) / process of examination 35. hypermastia or macromastia; reduction 10. mammo / graphy mammoplasty CF S 36. mastopexy DEFINITION: breast / process of recording 37. mastectomy 11. metro / rrhagia 38. lumpectomy CF S 39. toc/o DEFINITION: uterus / to burst forth 40. colp/o 12. ovario / centesis 41. salping/o CF S 42. men/o DEFINITION: ovary / puncture for aspiration 43. cervic/o 13. men / arche 44. ov/i R S 45. episi/o DEFINITION: menstruation / beginning 46. metr/o 14. oophor / ectomy 47. lact/o R S 48. oophor/o DEFINITION: ovary / excision (removal) 49. mast/o 15. oligo / meno / rrhea 50. gynec/o P CF S 51. i DEFINITION: few or deficient |
/ menstruation / discharge 52. f 16. dys / toc / ia 53. e P R S 54. g DEFINITION: painful, difficult, or faulty / labor or birth 55. h / condition of 56. b 17. gyneco / logist 57. d CF S 58. j DEFINITION: woman / one who specializes in the study 59. c or treatment of 60. a 18. pelvi / meter 61. fibrocystic breasts CF S 62. vesicovaginal fistula DEFINITION: pelvic cavity / instrument to measure 63. tubal ligation 19. episio / tomy 64. polymastia CF S 65. syphilis DEFINITION: vulva (covering) / incision 66. Papanicolaou (Pap) smear 626 Medical Terminology: The Language of Health Care 67. endometriosis 97. e 68. rectovaginal fistula 98. cervix 69. colporrhaphy—posterior repair 99. vagina 70. intrauterine device 100. uterine 71. human papilloma virus 101. ovary 72. chorionic villus sampling 102. uterus 73. dilation and curettage 103. endometrium 74. hepatitis B virus 104. myometrium 75. estimated date of confinement 105. developing eggs (ova) 76. herpes simplex virus 106. gonorrhea 77. sexually transmitted disease 107. dyspareunia 78. therapeutic abortion 108. tocolytic 79. hormone replacement therapy 109. polythelia 80. spontaneous abortion 110. metrorrhagia 81. habitual abortion 111. dilation 82. incomplete abortion 112. salpingotomy 83. missed abortion 113. nulligravida 84. therapeutic abortion 114. meconium 85. threatened abortion 115. macrosomia 86. c 116. curettage 87. f 117. eclampsia 88. g 118. amenorrhea 89. j 119. abortifacient 90. l 120. chlamydia 91. d 121. areola 92. i 122. syphilis 93. b 123. cervix 94. k 124. dysplasia 95. h 125. endometrium 96. a Figure Credits Figure 1.1 Redrawn from Bliss EC. Getting Things Done. New Figure 5.11 Courtesy of L. J. Underwood and R. D. York: Bantam, 1976:67. Underwood, Mission Viejo, CA. Figure 3.1 From Sheldon H. Boyd’s Introduction to the Study Figure 5.13 From Goodheart HP. Goodheart’s Photoguide of of Disease, 11th ed. Philadelphia: Lea & Febiger, 1992:35. Common Skin Disorders, 2nd ed. Philadelphia: Lippincott Figure 3.2 From Hotel Dieu Museum, Beaune, France. Williams & Wilkins, 2003. Figure 3.3 From Tate Gallery, London, United Kingdom/Art Figure 5.14 Courtesy of Ellman International, Hewlett, NY. Resource, NY. Randolph Waldman, MD, photographer. Figure 3.4 Thomas Eakins’ The Agnew Clinic. From University Figure 5.16 From Goodheart HP. Goodheart’s Photoguide of of Pennsylvania School of Medicine, Philadelphia, PA. Common Skin Disorders, 2nd ed. Philadelphia: Lippincott Unnumbered Figure in Chapter 4. Courtesy of Welch Allyn, Williams & Wilkins, 2003. Inc., Skaneateles Falls, NY. Figure 6.3 CT of skull. Courtesy of West Coast Radiology Figure 4.14 Courtesy of Deutsches Roentgen-Museum, Center, Santa Ana, CA. Remscheid-Lennep, Germany. Figure 6.4 From Haines DE. Neuroanatomy: An Atlas of Figure 4.15 B. Courtesy of Toshiba Medical Systems. Structures, Sections, and Systems, 6th ed. Baltimore: Figure 4.16 Courtesy of ADAC Laboratories, a Philips Medical Lippincott Williams & Wilkins, 2004. Systems Company, Bothell, WA. Figure 6.8 From Cipriano J. Photographic Manual of Regional Figure 4.17 B. Courtesy of Philips Medical Systems, Bothell, Orthopaedic and Neurological Tests, 2nd ed. Baltimore: WA. Inset. Courtesy of Mission Regional Imaging, Mission Lippincott Williams & Wilkins, 1991. Viejo, CA. Figure 6.10 LifeART image copyright ©2005. Lippincott Figure 4.18 B. Courtesy of Acuson Corporation, a Siemens Williams & Wilkins. All rights reserved. Company. Figure 6.12 From Malone TR (Ed). Hand and Wrist Injuries Figure 5.1 Squamous cell carcinomas and basal cell and Treatment. Baltimore: Williams & Wilkins, 1989:5. carcinomas. Reprinted with permission of Skin Cancer Figure 6.14 X-rays. From Harris JH Jr, Harris WH, Novelline Foundation, New York, NY. Signs of melanoma (Figures 1–4). RA. The Radiology of Emergency Medicine, 3rd ed. Baltimore: Courtesy of American Cancer Society, Atlanta, GA. Williams & Wilkins, 1993:440, 467. Figure 5.3 A–L and N–Q. Petechia. Courtesy of American Figure 6.15 Courtesy of Neil O. Hardy, Westpoint, CT. Academy of Dermatology, Schaumburg, IL. Figure 6.16 B and C. Courtesy of Orange Coast College Figure 5.3 M. From Goodheart HP. Goodheart’s Photoguide of Radiologic Technology Program. Common Skin Disorders, 2nd ed. Philadelphia: Lippincott Figure 6.17 A and B. Courtesy of Neil O. Hardy, Westpoint, Williams & Wilkins, 2003. CT. Figure 5.4 From Dr. Barankin Dermatology Collection, Figure 6.19 Courtesy of Orange Coast College Radiologic Stedman’s Medical Dictionary, 27th ed. Baltimore: Lippincott Technology Program. Williams & Wilkins, 2000. Figure 6.20 From Moore KL, Dalley AF II. Clinical Oriented Figure 5.5 From Goodheart HP. Goodheart’s Photoguide of Anatomy, 4th ed. Baltimore: Lippincott Williams & Wilkins, Common Skin Disorders, 2nd ed. Philadelphia: Lippincott 1999. Williams & Wilkins, 2003. Figure 6.22 Photo courtesy of Lumenis. Figure 5.6 From Goodheart HP. Goodheart’s Photoguide of Figure 6.24 Photo courtesy of 3M Health Care. Common Skin Disorders, 2nd ed. Philadelphia: Lippincott Figure 6.25 From Bucholz RW, Heckman JD. Rockwood & Williams & Wilkins, 2003. Green’s Fractures in Adults, 5th ed. Lippincott Williams & Figure 5.7 From Goodheart HP. Goodheart’s Photoguide of Wilkins, 2001. Common Skin Disorders, 2nd ed. Philadelphia: Lippincott Figure 6.26 Photo courtesy of Camp Healthcare. Williams & Wilkins, 2003. Figure 6.27 Courtesy of Smith & Nephew Systems, Inc., Figure 5.8 Sauer GC: Manual of Skin Diseases, 5th ed. Memphis, TN. Philadelphia: JB Lippincott, 1985. Figure 6.28 Photo courtesy of Camp Healthcare. Figure 5.9 From Goodheart HP. A Photoguide of Common Figure 6.29 Courtesy of RGP Prosthetic Research Center, San Skin Disorders: Diagnosis and Management (0.683.30357.4). Diego, CA. Philadelphia: Williams & Wilkins, 1999:268 (Figure 21-17). Figure 7.6 Courtesy of Welch Allen, Skaneateles Falls, NY. Figure 5.10 From Roche Lexikon Medizin, 3rd ed. Munich, Figure 7.10 From Rubin E, Farber JL. Pathology, 3rd ed. Germany: Urban & Schwarzenburg, 1993:877. Philadelphia: Lippincott Williams & Wilkins, 1999. 627 628 Medical Terminology: The Language of Health Care Figure 7.16 Photo from Sheldon H. Boyd’s Introduction to the Figure 10.21 Photo courtesy of Nicolet Vascular, Inc. Study of Disease, 11th ed. Philadelphia: Lea & Febiger, 1992:90. Figure 10.23 Courtesy of Carl Zeiss, Inc. Figure 7.17 From Pillitteri A. Maternal and Child Nursing, 4th Figure 10.25 Courtesy of Varian Medical Systems, Palo Alto, CA. ed. Philadelphia: Lippincott Williams & Wilkins, 2003. Figure 10.26 Courtesy of Radionics, Burlington, MA. Figure 7.18 B. Photo courtesy of Quinton Cardiology, Inc. Figure 11.3 From Weber J, Kelly J. Lippincott’s Learning Figure 7.19 Photo courtesy of Quinton Cardiology, Inc. System: Health Assessment in Nursing. Philadelphia: Figure 7.20 B. Courtesy of Mallinckrodt Medical, St. Louis, Lippincott Williams & Wilkins, 1997:188. MO. C. Courtesy of GE Healthcare. Figure 11.4 From Weber J, Kelly J. Lippincott’s Learning Figure 7.21 Courtesy of Acuson Corporation, Mt. View, CA. System: Health Assessment in Nursing. Philadelphia: Figure 7.23 A. From Sheldon H. Boyd’s Introduction to the Lippincott Williams & Wilkins, 1997:188. Study of Disease, 11th ed. Philadelphia: Lea & Febiger, 1992. Figure 11.5 From Sheldon H. Boyd’s Introduction to the Study B. Courtesy of Edwards Lifesciences. of Disease, 11th ed. Philadelphia: Lea & Febiger, 1992:640. Figure 7.25 Courtesy of Hewlett-Packard, McMinniville, OR. Figure 11.6 From Weber J, Kelly J. Lippincott’s Learning Figure 7.26 A. Redrawn from About Your Pacemaker. Sylmar, System: Health Assessment in Nursing. Philadelphia: CA: Siemens Pacesetter, p. 18. B. Courtesy of Philips Medical Lippincott Williams & Wilkins, 1997:188. Systems, Shelton, CT. Figure 11.8 Courtesy of Felix Wang, MD, University of Figure 8.1 Components of the Blood. White blood cells and red California Irvine. blood cells. From Lee GR, et al. Wintrobe’s Clinical Figure 11.9 Photo courtesy of Medtronic MiniMed. Hematology, 9th ed. Philadelphia: Lea & Febiger, 1993. Figure 12.4 From Tasman W, Jaeger E. The Wills Eye Hospital Platelets. Courtesy of Mosby’s Medical Nursing and Allied Atlas of Clinical Ophthalmology, 2nd ed. Philadelphia: Health Dictionary, 4th ed. St. Louis: Mosby-Year Book, Lippincott Williams & Wilkins, 2001. 1994:1230. Figure 12.7 From Tasman W, Jaeger E. The Wills Eye Hospital Figure 8.3 From Lee GR, et al. Wintrobe’s Clinical Atlas of Clinical Ophthalmology, 2nd ed. Philadelphia: Hematology, 10th ed. Philadelphia: Lippincott Williams & Lippincott Williams & Wilkins, 2001. Wilkins, 1999:910, 911 (Fig 30.4A). Figure 12.8 Courtesy of Ellman International, Hewlett, NY. Figure 8.4 From Lee GR, et al. Wintrobe’s Clinical Robert Baran, MD, photographer. Hematology, 9th ed. Philadelphia: Lea & Febiger, 1993;1:758. Figure 12.9 From Roche Lexikon Medizin, 3rd ed. Munich, Figure 8.7 LifeART image copyright ©2005. Lippincott Germany: Urban & Schwarzenburg, 1993. Williams & Wilkins. All rights reserved. Figure 12.11 From Stedman’s Medical Dictionary, 25th ed. Figure 9.7 Sheldon H. Boyd’s Introduction to the Study of Baltimore: Williams & Wilkins, 1990:1578. Disease, 11th ed. Philadelphia: Lea & Febiger, 1992:340. Figure 12.13 B–D. Courtesy of Welch Allen, Skaneateles Falls, Figure 9.9 Sheldon H. Boyd’s Introduction to the Study of NY. Disease, 11th ed. Philadelphia: Lea & Febiger, 1992:344. Figure 12.14 Courtesy of Nikon, Inc., Melville, NY. Figure 9.10 Photo courtesy of Temple University Health Figure 12.15 Courtesy of Keeler Instruments, Inc., Broomall, PA. Sciences Center, Philadelphia, PA. Figure 12.16 Courtesy of Lumenis. Figure 9.11 Courtesy of Felix Wang, MD, University of Figure 12.17 Courtesy of Jackie Moody, Irvine, CA. California Irvine. Figure 13.2 Courtesy of Welch Allyn, Inc., Skaneateles Falls, Figure 9.12 B. Courtesy of SensorMedics, Yorba Linda, CA. NY. Figure 9.13 Courtesy of Respironics, Inc., Murrysville, PA. Figure 13.3 Courtesy of Welch Allyn, Inc., Skaneateles Falls, Figure 9.14 Courtesy of Nellcor Incorporated, Pleasanton, CA. NY. Figure 9.15 Courtesy of Felix Wang, MD, University of Figure 13.4 Courtesy of Welch Allyn, Inc., Skaneateles Falls, California Irvine. NY. Figure 9.18 Courtesy of Respironics, Inc., Murrysville, PA. Figure 13.6 Courtesy of BioLogic Systems Corporation. Figure 9.19 Photo courtesy of DHD HEALTHCARE. Figure 13.7 Courtesy of Welch Allyn, Inc., Skaneateles Falls, Figure 9.20 Courtesy of Siemens Medical Systems, Inc., NY. Danvers, MA. Figure 13.8 Courtesy of Welch Allyn, Inc., Skaneateles Falls, Figure 10.3 MRI. From Haines DL. Neuroanatomy: An Atlas of NY. Structures, Sections, and Systems, 4th ed. Baltimore: Williams Figure 13.9 Photograph provided by Cochlear Corporation, & Wilkins, 1995:29. Englewood, CO. Figure 10.4 MRIs from Haines DL. Neuroanatomy: An Atlas of Figure 14.2 From Anatomical Chart Company. Structures, Sections, and Systems, 4th ed. Baltimore: Williams Figure 14.6 From Lindsay KL, Reynolds TB, Hoefs JC, & Wilkins, 1995:131, 237. Sanmarco ME. Ascites. West J Med 1981;134:415. Figure 10.6 From Pillitteri A. Maternal and Child Nursing, 4th Figure 14.7 From Bickley LS, Szilagyi P. Bates’ Guide to ed. Philadelphia: Lippincott Williams & Wilkins, 2003. Physical Examination and History Taking, 8th ed. Figure 10.11 From Cyber 3D Ultrasound Society, and GE Philadelphia: Lippincott Williams & Wilkins, 2003. Medical Systems, author Dr. Saied Tohamy, Egypt. Figure 14.15 Redrawn from poster created by Reed & Figure 10.12 Courtesy of Mission Regional Imaging, Mission Carnrick, Kenilworth, NJ. Endoscope and fiberoptics. Courtesy Viejo, CA. of Olympus America, Inc., Lake Success, NY. Photographs. Figure 10.13 From Pillitteri A. Child Health Nursing: Care of Courtesy of Mission Hospital Regional Medical Center, the Child and Family. Philadelphia: Lippincott Williams and Mission Viejo, CA. Wilkins, 1999:532 (Figure 18-13). Figure 14.17 From Ratcliff KM. Esophageal foreign bodies. Figure 10.15 Photo courtesy of Cadwell Laboratories, Inc. Am Fam Physician 1991;44:827. Figure 10.16 Courtesy of SensorMedics. Figure 14.20 A. From Brant WE, Helms CA. Fundamentals of Figure 10.17 Courtesy of General Electric Medical Systems, Diagnostic Radiology. Baltimore: Williams & Wilkins, 1994. Milwaukee, WI. B. Courtesy of Philips Medical Systems, Shelton, CT. Figure 10.18 Images courtesy of Philips Medical Systems. Figure 14.21 A. Courtesy of Acuson Corporation, a Siemens Figure 10.19 PET scans courtesy of Newport Diagnostic Company. B. Courtesy of Mission Regional Imaging, Mission Center, Newport Beach, CA. Viejo, CA. Figure Credits 629 Figure 14.22 From Smeltzer SC, Bare BG. Textbook of Figure 17.3 A. Courtesy of Lucinda Veeck, New York, NY. Medical-Surgical Nursing, 9th ed. Philadelphia: Lippincott B. Courtesy of Acuson Corporation, a Siemens Company. Williams & Wilkins, 2000. Figure 17.4 From Cyber 3D Ultrasound Society, and GE Figure 15.3 From McClatchey KD, et al. Clinical Laboratory Medical Systems, author Dr. Saied Tohamy, Egypt. Medicine, 2nd ed. Baltimore: Lippincott Williams & Wilkins, Figure 17.9 Mjolsness D. Gynecologic diagnosis: Primary 2001:538 (Figure 28.20). herpes lesions. Patient Care 1990;Apr 30:85 (Figure 6). Figure 15.4 From McClatchey KD, et al. Clinical Laboratory Figure 17.10 From Micha JP. Genital warts: Treatable warning Medicine, 2nd ed. Baltimore: Lippincott Williams & Wilkins, of cancer. Female Patient 1984; 9:31; Belle Mead, NJ: Excerpta 2001:539 (Figure 28.23). Medica. Figure 15.5 From Sheldon H. Boyd’s Introduction to the Study Figure 17.11 Courtesy of William B. Wadlington, MD, of Disease, 11th ed. Philadelphia: Lea & Febiger, 1992:436. Nashville, TN. Figure 17.13 B. Photographs courtesy of Cabbott |
Figure 15.8 Courtesy of Mission Regional Imaging, Mission Medical/Cryomedics, Langhorne, PA. Viejo, CA. Figure 17.15 A. Courtesy of General Electric Medical Systems, Figure 15.10 Courtesy of Circon Corporation, Santa Barbara, Milwaukee, WI. B. From Brant WE, Helms CA. Fundamentals CA. of Diagnostic Radiology. Baltimore: Williams & Wilkins, Figure 15.11 Courtesy of Circon Corporation, Santa Barbara, 1994:548. CA. Figure 17.16 Insets. Courtesy of Siemens Medical Systems, Figure 16.3 From Rubin E, Farber JL. Pathology, 3rd ed. Inc., Danvers, MA. Philadelphia: Lippincott Williams & Wilkins, 1999. Figure 17.23 Georgiade GS, et al. Textbook of Plastic, Figure 16.6 From Weber J, Kelley J. Health Assessment in Maxillofacial and Reconstructive Surgery, 2nd ed. Baltimore: Nursing, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, Williams & Wilkins, 1992:853, 863. 2003. Figure 17.24 Georgiade GS, et al. Textbook of Plastic, Figure 16.8 Courtesy of L. J. Underwood and R. D. Maxillofacial and Reconstructive Surgery, 2nd ed. Baltimore: Underwood, Mission Viejo, CA. Williams & Wilkins, 1992:795. Index Numbers in italics denote figures. A Accutane, 594 Agnosia, 320 Abbreviations/acronyms, 592–593 ACE (angiotensin-converting enzyme) AIDS (acquired immunodeficiency blood and lymph system, 255 inhibitors, 219 syndrome), 248, 545 cardiovascular system, 221 Acetaminophen/codeine, 594 Albinism, 115 ear, 425 Aciphex, 594 Albuminuria, 486, 490 endocrine system, 371 Acne, 115, 116 Albuterol, 594 error-prone, 79–80, 92 Acoustic neuroma, 419 Alcoholic cardiomyopathy, 207 eye, 402 Acquired immunodeficiency syndrome Alimentary canal, 439, 440 female reproductive system, 563 (AIDS), 248, 545 Allegra, 594 for history and physical, 55–57 Acromegaly, 366 Allegra D, 594 hospital, 79–80 Acronyms/abbreviations (see Allergy and immunology, 44 integumentary system, 124 Abbreviations/acronyms) Allografts, 123 male reproductive system, 520 ACTH (adrenocorticotropic hormone), Allopurinol, 594 medical record, 79–80 361, 362 Alopecia (baldness), 114 medical specialties, 49 Actinic keratoses, 118, 118 Alphagan P, 594 musculoskeletal system, 174 Actonel, 594 Alprazolam, 594 nervous system, 337 Actos, 594 ALS (amyotrophic lateral sclerosis, Lou pharmaceutical, 88–90 Acuity Gehrig disease), 320, 328 prescription auditory, 421, 422 Altace, 595 common, 91, 91, 93–94 visual, 396 Alveoli, 271, 273 error-prone, 92, 93–94 Adderall XR, 594 normal vs. obstructed, 275 respiratory system, 288 Adduction, 148, 157 Alzheimer disease, 320, 328 urinary system, 496 Adenocarcinoma, of breast, 546 Amaryl, 595 Abdomen Adenohypophysis (anterior pituitary Amastia, 546 anatomical divisions, 443–444 gland), 360, 361, 362 Ambien, 595 clinical divisions, 444–445 Adenoidectomy, 285 Amblyopia, 391 Abdominal hysterectomy, 553 Adenoids, 272 Amenorrhea, 540 Abdominal sonography, 456, 458 ADH (antidiuretic hormone, vasopressin), American College of Physicians (ACP), Abdominocentesis, 459 361, 363 42–43 Abduction, 148, 157 ADHD (attention deficit/hyperactivity American College of Surgeons (ACS), ABGs (arterial blood gases), 280 disorder), 335 42–43 Ablation, intracardiac catheter, 212 Adhesiolysis, 551 American Osteopathic Association ABMS (American Board of Medical Adhesions, pelvic, 543 (AOA), 43 Specialties), 42–43 Adhesiotomy, 551 Amitriptyline, 595 Abortifacient, 563 Adjective endings, 28 Amniocentesis, 561, 562 Abortion, 558–559 Adnexa, uterine, 537 Amnion, 540 habitual, 559 Adrenalectomy, 370 Amniotic fluid, 540 Abruptio placentae, 561 Adrenal (suprarenal) glands, 359, 360, Amoxicillin, 595 Abscess, skin, 117 361, 365 Amoxicillin/clavulanate, 595 Absence seizures, 322 Adrenocorticotropic hormone (ACTH), Ampulla, rectal, 440, 442 Absorption, 439 361, 362 Amputation, 169 Abstract, discharge (see Discharge Adult polycystic kidney disease Amyotrophic lateral sclerosis (ALS, Lou summaries) (APKD), 487 Gehrig disease), 320, 328 Accent, primary, 18 Advair Diskus, 594 Anal fistula, 449, 451 Accommodation, visual, 391 Affect, 333 Anal fistulectomy, 460 Accupril, 594 flat, 333 Analgesics, 174, 333, 496 631 632 Medical Terminology: The Language of Health Care Anastomosis, 215, 459 Anticoagulants, 220, 255, 288, 333 Articular cartilage, 153 Anatomical positions and points of Anticonvulsants, 334 Articulation, 153, 154, 318 reference, 155–158 Antidiuretic hormone (ADH, Ascending colon, 440, 442 Anatomical terms vasopressin), 361, 363 Ascites, 445, 445 blood and lymph systems Antiemetic, 461 ASD (atrial septal defect), 207 blood, 242–244 Antifungal, 124 ASHD (arteriosclerotic heart disease), 205 lymph, 246–247 Antigens, 246 Aspermia, 512 cardiovascular system, 195, 196, 197, Antihistamines, 124, 288, 424 Aspiration biopsy, 547, 548 197, 198, 199 Antihyperglycemic drugs, 371 Assessment, 57 ear, 417–418 Antihypertensives, 220 Astereognosis, 320 female reproductive system, 536–540 Antihypoglycemic drugs, 371 Asthenopia, 390 gastrointestinal system, 441–443 Anti-inflammatories, 124, 174, 424 Asthma, 276, 276 integumentary system, 110–111 Antipruritics, 124 Astigmatism, 391 male reproductive system, 510–512 Antipyretics, 174 Astrocytes, 312, 313 musculoskeletal system Antiseptics, 124 Atacand, 595 bones, 146–148 Antispasmodics, 461, 496 Atelectasis, 276 joints and muscles, 153–155 Antithyroid drugs, 371 Atenolol, 595 nervous system, 313–318 Anuria, 486 Atherectomy, 217, 218 respiratory system, 272–273 Anus, 440, 442 Atheromatous plaque, 203, 203 Ancillary reports, 63 Anxiety disorders, 334–335 Atherosclerosis, 203 Androgens, 359, 361 Anxiolytic agents, 337 Athlete’s foot (tinea pedis), 119 Anemia, 248 AOA (American Osteopathic Atopic dermatitis (eczema), 116, 117 Anesthesia, 44 Association), 43 Atopognosis, 320 Anesthesiologist’s reports, 64 Aorta, 197, 198 Atrial septal defect (ASD), 207 Anesthesiology, 44 arch of, 198 Atrioventricular node (AV node), 201, 202 Anesthetic, 123 coarctation of, 207, 207 Atrium (atria), of heart, 193, 194, 195 Aneurysm, 204, 204 Aortic valve, 195, 196 Atrophic vaginitis, 546 cerebral, 320 Aortogram, 213 Atrophy, 159 Angina pectoris, 204 Apathy, 333 Atrovent, 595 Angiogram/angiography, 213 Aphakia, 391 Attention deficit/hyperactivity disorder cerebral, 329 Aphasia, 318 (ADHD), 335 fluorescein, 396, 397 APKD (adult polycystic kidney Attitude, 2 magnetic resonance (MRA), 212, disease), 487 Audiogram, 421 327, 328 Aplasia, of inner ear, 419 Audiologist, 421 pulmonary, 81, 84, 169, 284, 284 Aplastic anemia, 248 Audiometer, 421 renal, 489 Apnea, 273 Audiometry, 421, 421 Angioma Appendectomy, 460 Auditory acuity, 421, 422 cherry, 113, 114 Appendicitis, 449 Auditory meatus (canal), external, 417 spider, 113, 114 Appendicular skeleton, 146 Auditory ossicles, 416, 417 Angioplasty, percutaneous transluminal Appendix, vermiform, 440, 442 Auditory prosthesis, 424 coronary (PTCA), 196, 218 Apri, 595 Auditory sense, 2 Angioscopy, 217 Aqueous humor, 387, 388 Auditory tube, 416, 417 Angiotensin-converting enzyme (ACE) Arch of aorta, 198 Augmentation mammoplasty, 556 inhibitors, 219 (see also individual Areola, 539 Augmentin, 595 drugs) Aricept, 595 Auricle (pinna), 416, 417 Anisocytosis, 247 Arrhythmia (dysrhythmia), 205, 206 Auscultation, 209, 210, 282 Ankle, 153 Arterial blood gases (ABGs), 280 Autism, 335 Ankyloglossia (tongue-tie), 447 Arteries, 197, 198 Autografts, 123 Ankylosis, 160 coronary, 196 Autoimmune disease, 248 Annotation, as learning tool, 4–5 pulmonary, 195 Autologous blood, 254 Anorchism, 512 renal, 483, 485 Autonomic nervous system (ANS), 318 Anorexia nervosa, 336 Arteriogram, 213 Avalide, 595 Anovulation, 540 renal (renal angiogram), 489 Avandia, 595 ANS (autonomic nervous system), 318 Arterioles, 199 Avapro, 595 Antacid, 461 Arteriosclerosis, 203 Avelox, 595 Anteflexion, of uterus, 541, 541 Arteriosclerotic heart disease (ASHD), 205 Aviane, 595 Anterior chamber, of eye, 388 Arthralgia, 159 AV node, 201, 202 Anterior (ventral) direction, 155 Arthritis, 160–161 Axial skeleton, 146 Anterior pituitary gland (adeno- degenerative, 160 Axis (axes), 157 hypophysis), 360, 361, 362 degenerative joint disease (DJD), 160 Azoospermia, 512 Anterior-posterior (AP), 155 gouty, 161 Azotemia, 488 Antianginal agents, 219 osteo- (OA), 160 Antianxiety agents, 337 rheumatoid (RA), 161, 161 B Antiarrhythmics, 220 Arthrocentesis, 169 Babinski sign (Babinski reflex), 329, 329 Antibiotic ophthalmic solution, 402 Arthrodesis, 169 Bacterial endocarditis, 204, 205 Antibiotics, 123, 288, 424, 496 (see also Arthrogram, 168 Bacteriuria, 486 individual drugs) Arthroplasty, 169 Bactrim, 595 Antibodies, 246 Arthroscopy, 169, 170 Bactroban, 595 Index 633 BAEP (brainstem auditory evoked lymph, 246–247 Bronchial tree, 271, 272 potentials), 422 combining forms, 241–242 Bronchiectasis, 276, 277 Balanitis, 512 diagnostic terms, 248–249 Bronchioles, 271, 272 Baldness (alopecia), 114 diagnostic tests and procedures, Bronchitis, 276 Band neutrophils, 244 250–253 Bronchodilators, 288 Bariatric surgery, 459 drug classifications, 255 Bronchogenic carcinoma, 276 Barium enema (lower GI series), 455, 456 operative terms, 253–254 Bronchoscopy, 280, 281 Barium swallow (upper GI series), 455 overview Bronchus (bronchi), 271, 272 Barrier contraceptives, 557 blood system, 242–244 Bruit, 211 Bartholin glands, 537, 538 lymphatic system, 244–245 Buccal administration, 89 Basal cell carcinoma, of skin, 118 practice exercises, 256–263 Bulbourethral (Cowper’s) glands, 511, 512 Basic metabolic panel, 250 symptomatic terms, 247–248 Bulimia nervosa, 336 Basic term components, 9, 9–37 (see also Blood chemistry, 250 Bullae, skin, 111, 112, 113 Term components) Blood chemistry panels, 250 BUN (blood urea nitrogen), 492 Basophils, 243, 244 Blood component therapy, 254 Bundle of His, 201, 202 Behavioral therapy, 337 Blood culture, 250 Bunions, 162 Belching (eructation), 446 Blood flow, through heart, 193, 194, 195 Burns, 115–116 Benign prostatic hyperplasia/hypertrophy Blood flow reduction, 203–204, 203 Bursa (bursae), 153, 154 (BPH), 514, 517 Blood indices, 251 Bursectomy, 169 Benign vs. malignant, as terms, 86 Blood pressure, 199, 201, 201 Bx (see Biopsy) Beta-adrenergic blocking agents (beta Blood studies, 250–253 blockers), 220 Blood sugar/blood glucose testing, 369 Bextra, 595 Blood transfusion, 254 C Biaxin, 595 Blood urea nitrogen (BUN), 492 CABG (coronary artery bypass graft), Bicuspid (mitral) valve, 195, 196 Blood vessels, 197, 198, 199 215, 216 Biliary ducts, 440, 443 Board certified, 42 CAD (coronary artery disease), 208 Bilirubin, 492 Body cavities, 156 Caduceus, 43, 43 Biopsy (Bx), 457 Body movements, 157–158, 158 Calcitonin, 361, 363 bone marrow, 253 Body planes, 155, 156 Calcium channel blockers, 221 breast, 547, 548 Body positions, 155, 157 Calyces (calices), 483, 485 endoscopic, 457 Boils, 117 Canal of Schlemm, 388 excisional, 457 Bone grafting, 169 Cancellous bone, 146 gynecological procedures, 547, 548, 548 Bone marrow, 153 Cancer, 86 (see also Carcinoma) incisional, 458 Bone marrow aspiration, 253, 254 cervical, 543 kidney (renal), 489 Bone marrow biopsy, 253 prostate, 514 liver, 458, 458 Bone marrow transplant, 253 signs of melanoma, 109 lung, 282 Bones skin, 109, 118 needle, 458 classification, 147 as term, 23 prostate, 517 compact, 146 testicular, 515 skin, 120, 120 flat, 147 Candida vaginitis, 546 testicular, 517 irregular, 147 Capillaries types, 547–548 long, 153 blood, 199 Bipolar disorder (manic depression), 334 sesamoid, 147 lymph, 246 Birth control (oral contraceptive) pill, 557 short, 147 Capsule Blackheads (comedos), 114, 115 spongy (cancellous), 146 Bowman’s, 483, 484, 485 Bladder inflammation (cystitis), 488 tissue types, 146 joint, 154 Blepharitis, 391 Bony necrosis, 162 lens, 389 Blepharochalasis, 391 Bowman’s capsule, 483, 484, 485 Capsule endoscopy, 454 Blepharoplasty, 397 Braces, splint, 172 Carbuncles, 117 Blepharoptosis, 391 Brachial artery, 198 Carcinoma Blepharospasm, 390 Bradycardia, 205, 206 bronchogenic, 276 Blood Bradypnea, 273, 274 of skin autologous, 254 Brain, 313–316 (see also Cerebral and basal cell, 118 cellular components, 242–244, 248 Cerebro- entries) squamous cell, 118 fluid-related terms, 242 Brainstem, 314, 315 Carcinoma in situ, cervical, 543 homologous, 254 Brainstem auditory (BAEP) evoked Cardiac catheterization, 213, 214, in stool (melena, hematochezia), potentials, 422, 422 239–240 446, 458 Breasts (mammary glands), 539, 539 Cardiac conduction, 201, 202 symptomatic terms, 247 adenocarcinoma of, 546 Cardiac muscle, 152, 154 in urine (hematuria), 486, 492 biopsy, 547–548, 548 Cardiac output (CO), 213 vomiting (hematemesis), 446 diagnostic terms, 546–547 Cardiac sphincter, 440, 442 Blood and lymph system, therapeutic fibrocystic, 546 Cardiac tamponade, 205 terms, 254–255 operative terms, 555–556 Cardiology, 44 Blood and lymph systems, 241–268 (see Breathing (respiration), 271, 272 (see also Cardiomyopathy, 207 also Blood entries; Lymph entries) Respiratory system) Cardiopulmonary resuscitation (CPR), 286 abbreviations/acronyms, 255 mechanical ventilation, 286, 287 Cardiotonics, 221 anatomical terms symptomatic terms of, 273–275 Cardiovascular system, 192–240 blood, 242–244 Breve, 18 abbreviations/acronyms, 221 634 Medical Terminology: The Language of Health Care Cardiovascular system (continued) Cerebrovascular accident (CVA, stroke), Circulation anatomical terms, 195, 196, 197, 320, 321 arterial, 198 198, 199 Cerebrovascular disease, 320 coronary, 199 blood pressure, 199, 201 Cerebrum, 313, 314 of heart, 193, 194, 195 cardiac conduction, 201, 202 Cerumen, 416 pulmonary, 195, 199 combining forms, 192–193 Cerumen impaction, 418 systemic, 195, 199 diagnostic terms, 205–209 Cervical carcinoma in situ, 543 venous, 200 diagnostic tests and procedures, Cervical conization, 551 Circumcision, 518 209–215 Cervical dysplasia, 542 Cirrhosis, 451 drug classifications, 219–221 Cervical effacement, 558 Claudication, 204 medical record analyses, 229–240 Cervical intraepithelial neoplasia (CIN), Clinical psychologist, 48 operative terms, 215–218 542–543, 549 Clinical resume, 64 overview, 193, 194, 195 Cervical neoplasia, 542–543, 549 Clinical summary, 64 practice exercises, 222–228 Cervical os, 537, 538 Clitoris, 537, 538 symptomatic terms, 203–204 Cervicitis, 541 Clonazepam, 596 therapeutic terms, 218–221 Cervix, 537, 538 Clonidine, 596 Cardioversion, 219 Cesarean section (C-section), 563 Closed fracture, 163 Carisoprodol, 595 Chalazion, 392, 392 Closed reduction Carotid arteries, 198 Chambers external fixation, 171 Carotid TIA, 321, 322 anterior of eye, 388 percutaneous fixation, 171, 173 Carpal tunnel syndrome, 162, 162 of heart, 193, 194 Clotrimazole/betamethasone, 596 Cartia XT, 595 posterior of eye, 390 CNS (central nervous system), 313–316 Cartilage, articular, 153 Chancre, syphilitic, 516 CO (cardiac output), 213 Caseous necrosis, 274 Chart, 54 Coarctation of aorta, 207 Casting, of fracture, 171, 172 Chart notes, 136–139 Cochlear implant, 424, 425 CAT (see Computed tomography) Cheeks, 440, 441 Cognitive therapy, 337 Cataract, 392, 393, |
394 Cheilitis, 447 Colitis, 448 Cataract extraction, 397 Cheiloplasty, 459 ulcerative, 448 Catatonia, 333 Chemical drug name, 90 Colon, 440, 442 Catatonic schizophrenia, 336 Chemical peel, 121 Colon and rectal surgery, 44 Cathartics, 461 Chemosurgery, 121 Colonoscopy, 453, 454 Colostomy, 459, 460 Catheter ablation, intracardiac, 212 Chemotherapy, 123, 254, 332, 556 Colporrhaphy, 551–552 Catheters, common types, 496 Cherry angioma, 113, 114 Colposcopy, 548, 549 Caudal (inferior) direction, 155 Chest x-ray (CXR), 284, 284 Coma, 318, 319 Cautery, 121 Cheyne-Stokes respiration, 274, 274 Combining, forms, 10 Cavity (cavities) CHF (congestive heart failure), 207 Combining forms, 23–25 body, 156 Chief complaint, 55 blood and lymph systems, 241–242 medullary, 153 Childhood psychiatric disorders, 335 cardiovascular system, 192–193 oral, 441 Chiropractic medicine, 47 ear, 415–436 pericardial, 195 Chiropractor, 47 endocrine system, 358–359 peritoneal, 440, 443 Chlamydia, 516, 544 eye, 386–387 pleural, 271, 273 Cholangiogram, 455 gastrointestinal system, 436–439 thoracic, 156 Cholangiopancreatography, endoscopic glossary, 585–590 CBC (complete blood count), 250 retrograde (ERCP), 452 integumentary system, 107–108 CD4 cell count, 250 Cholangitis, 451 male reproductive system, 509–510 Cecum, 440, 442 Cholecystectomy, 460 for medical specialties, 38–40 Cefzil, 596 Cholecystitis, 451 musculoskeletal system, 144–146 Celebrex, 596 Cholecystogram, 455 nervous system, 310–312 Cells Choledocholithiasis, 452 respiratory system, 269–270 ependymal, 312, 313 Choledocholithotomy, 460 urinary system, 482–483 glial, 313 Cholelithiasis (gallstones), 452 Combining vowels, 10, 11–12 Cellular blood components, 242–244 Cholelithotomy, 460 Combivent, 596 Cellulitis, 116 Cholelithotripsy, 460 Comedos, 114, 115 Central nervous system (CNS), 313–316 Chondromalacia, 162 Comminuted fracture, 163, 164 Cephalexin, 596 Chorionic villus sampling (CVS), 561, 562 Commitment, 1 Cephalic (superior) direction, 155 Choroid, 387, 388 Compact bone, 146 Cephalic vein, 200 Chronic obstructive pulmonary disease Complete blood count (CBC), 250, 252 Cephalopelvic disproportion, 560 (COPD), 276 Complex fracture, 163 Cerebellum, 314, 315 Chyle, 246 Components, basic term, 9–37 (see also Cerebral aneurysm, 320 Cicatrix of skin, 114 Term components) Cerebral angiography, 329 Cilia, 271, 273 Comprehensive metabolic panel, Cerebral arteriosclerosis, 320 Ciliary body, 387, 388 250, 251 Cerebral atherosclerosis, 320 Ciliary muscle, 388 Computed tomography (CT, CAT Cerebral cortex, 314 Ciliary processes, 388 [computed axial tomography]), 81, Cerebral hemispheres, 313, 314 CIN (cervical intraepithelial neoplasia), 82, 84, 169, 253, 284 Cerebral palsy, 320 542–543, 549 of abdomen, 456, 457 Cerebral thrombosis, 320 Cipro, 596 of head, 329, 369 Cerebrospinal fluid (CSF), 312, 316 Ciprofloxacin, 596 single photon emission (SPECT), 327 Index 635 Concerta, 596 Cryoretinopexy, 397 Dermis, 109, 110 Conductive hearing loss, 420 Cryosurgery, 121, 552, 552 Dermoid cyst, 541 Condylomata acuminata (genital warts), Cryptorchism, 512, 513 Descending colon, 440, 442 517, 545, 545 C & S (see Culture and sensitivity) Detrol LA, 596 Cones, visual, 390 C-section (cesarean section), 563 DEXA (dual-energy x-ray absorp- Confinement, estimated date of (EDC), CSF (cerebrospinal fluid), 312, 316 tiometry), 169 558 CT (see Computed tomography) Dexter, as term, 93 Congenital anomalies, female repro- Culdocentesis, 552, 552 Diabetes insipidus, 367 ductive system, 541 Culture, blood, 250 Diabetes mellitus (DM), 365 Congenital anomalies of heart, 207 Culture and sensitivity (C & S), 120 type 1, 365 Congestive heart failure (CHF), 207 stool, 458 type 2, 366 Conization, cervical, 551 urine, 492 Diabetic ketoacidosis (DKA), 364 Conjunctiva, 388 Curettage, 121 Diabetic retinopathy, 392, 394 Conjunctivitis (pinkeye), 392 Cushing syndrome, 365, 365 Diagnostic imaging (see Imaging Consent form, 63 Cutaneous lupus, 118 modalities) Constipation, 446 CVA (cerebrovascular accident, stroke), Diagnostic suffixes, 26–27 Constriction, 203, 203 320, 321 Diagnostic terms Consultation reports, 59, 63, 300–302, CVS (chorionic villus sampling), 561, 562 blood and lymph system, 248–249 356–357, 479–481 Cyclobenzaprine, 596 cardiovascular system, 205–209 Contact dermatitis, 116, 116 Cycloplegic, 402 ear, 418–420 Contact lens, 401 Cystectomy, ovarian, 554 endocrine system, 368 Continuous positive airway pressure Cystic fibrosis, 276 eye, 391–396 (CPAP), 286, 287 Cystitis (bladder inflammation), 488 female reproductive system Continuous subcutaneous (CSII) insulin Cystocele, 543, 544 gynecological, 541–547 infusion, 370, 371 Cystometrogram, 488 obstetrical, 558–561 Contraceptive implants, 557 Cystoscopy, 488, 488 gastrointestinal system, 447–452 Contraceptives, 557 Cysts integumentary system, 115–120 Contrast medium, 84 dermoid, 541 male reproductive system, 512–517 Convulsions, 319 parovarian, 543 nervous system, 320–325 COPD (chronic obstructive pulmonary pancreas, 365–366 disease), 276 D parathyroid glands, 366 Coreg, 596 Dacryoadenitis, 392 pituitary gland, 366 Cornea, 388, 389 Dacryocystectomy, 397 psychiatric, 334–337 Coronal (frontal) plane, 155, 156 Dacryocystitis, 392 thyroid gland, 367–368 Coronary angiogram, 213 Database, of medical record, 60 urinary system, 487–488 Coronary arteries, 196 Date and time recording, 95, 95 Diagnostic tests and procedures, 63, 81, Coronary artery bypass graft (CABG), D & C (dilation and curettage), 553, 553 82, 83, 84, 85, 86 215, 216 D.C. (Doctor of Chiropractic blood and lymph system, 250–253 Coronary artery disease (CAD), 208 Medicine), 47 cardiovascular system, 209–215 Coronary circulation, 199 D.D.S. (Doctor of Dental Surgery), 47 ear, 421–423 Cor pulmonale, 207 Deafness, 420 eye, 396–397 Corpus callosum, 313, 314 Debridement, 121 female reproductive system Correction, of medical record, 96, 96 Decongestants, 424 gynecological, 547–551 Cortex, cerebral, 314 Decubitus position, 157 obstetrical, 561–563 Corti, organ of, 416, 417 Deep tendon reflexes (DTR), 329 gastrointestinal system, 452–458 Corticosteroids, mineral, 359, 361 Deep vein thrombosis (DVT), 200, 209 integumentary system, 120–121 Coumadin, 596 Defecation, 443 male reproductive system, 517 Cowper’s (bulbourethral) glands, 511, 512 Defibrillation, 218, 219 musculoskeletal system, 167–169 Cozaar, 596 Defibrillator, 218 nervous system, 326–329 CPAP (continuous positive airway implantable cardioverter (ICD), 219 respiratory system, 280–284 pressure), 286, 287 Degenerative arthritis, 160 Dialysis CPR (cardiopulmonary resuscita- Degenerative joint disease (DJD), 160 hemo-, 495 tion), 286 Delirium, 318 kidney (renal), 495–496 Crabs (pediculosis pubis), 119, 120 Delivery, estimated date of (EDC), 558 peritoneal, 496 Crackles, 274 Delusions, 333 Diaphoresis, 204 Cranial nerves, 316, 317 Dementia, 318 Diaphragm, 271, 273 Craniectomy, 330 Dendrites, 312, 313 Diaphysis, 147, 153 Craniotomy, 330 Depakote, 596 Diarrhea, 446 Creatinine, 485, 492 Depigmentation, 115 Diastole, 199 Creatinine clearance testing, 492 Depolarization, 202 Diazepam, 596 Crepitation, 159 Depression, 334 Diencephalon (thalamus), 314 Crepitus, 159 Dermabrasion, 121 Differential blood count, 252 Cretinism, 366, 368 Dermatitis Differential diagnosis, 57 Crossed eyes (strabismus), 395 atopic (eczema), 116, 117 Diflucan, 596 Crossmatching, 254 contact, 116 Digestion, 439 Croup, 277 seborrheic, 116 Digitalis, 145 Crusts, skin, 113, 114 Dermatology, 44 Digital rectal exam (DRE), 517, 517 Cryopexy, 397 Dermatosis, 116 Digitek, 596 636 Medical Terminology: The Language of Health Care Digits, 145 Drug forms, 89 Effexor XR, 597 Dilantin, 596 Drug names, 90 Ejection fraction, 213 Dilation and curettage (D & C), 553, 553 Drugs Elbow, 146 Diltiazem hydrochloride, 596 commonly prescribed, 594–603 Electrocardiogram (ECG, EKG), 206, 211, Diminutive endings, 28 routes of administration, 89–90 211, 212 Diovan, 597 as term, 88 Electrocautery, 121, 123 Diovan HCT, 597 Dual-energy x-ray absorptiometry Electroconvulsive therapy (ECT), 336 Diplopia, 390 (DEXA), 169 Electrodesiccation, 121 Directional terms, 155–157 Duchenne muscular dystrophy, 163 Electroencephalogram (EEG), 326–329, Discharge, mucopurulent, 512 Ducts 326 Discharge summaries, 64, 78, 308, biliary, 440, 443 Electrolytes, 369 384–385, 507, 581 lacrimal, 388, 389 Electromyogram (EMG), 167 Disease-related terms, medical record, lymph, 246 Elidel, 597 86–88 nasolacrimal, 390 Embolization, uterine fibroid, 557 Disk (disc) thoracic, 246 Embolus (emboli), 203, 203 herniated, 163 Duodenal ulcer, 447, 448 Embryo, 539 intervertebral, 150, 153 Duragesic, 597 Emergency medicine, 44 herniated, 322 DVT (deep vein thrombosis), 200, 209 EMG (electromyogram), 167 optic, 387, 388, 390 Dwarfism, pituitary, 366 Emphysema, 275, 276 Diskectomy (discectomy), 330, 330 Dysarthria, 318 Empyema, 277 Diskogram, 168 Dysentery, 448, 449 Enalapril, 597 Disposition (treatment plan), 57 Dyslexia, 335 Encephalitis, 322 Dissecting aneurysm, 204 Dysmenorrhea, 540 Endarterectomy, 215 Distal aspect, 157 Dyspareunia, 540 Endocarditis, 204, 205 Ditropan XL, 597 Dyspepsia, 446 Endocardium, 195 Diuretics, 221, 496 Dysphagia, 446 Endocet, 597 Diverticulitis, 448, 449 Dysphasia, 318 Endocrine pancreas (islets of Diverticulosis, 448, 449 Dysphonia, 274 Langerhans), 362 Diverticulum (diverticula), 448, 449 Dysphoria, 333 Endocrine system, 358–385 DKA (diabetic ketoacidosis), 364 Dysplasia, cervical, 542 abbreviations/acronyms, 371 D.O. (Doctor of Osteopathic Medicine), Dysplastic nevus, 114 anatomical terms, 359–363 41–42 Dyspnea, 273 combining forms, 358–359 Doctor of Chiropractic Medicine Dysrhythmia (arrhythmia), 205, 206 diagnostic terms, 365–368 (D.C.), 47 Dysthymia, 334 diagnostic tests and procedures, 369, Doctor of Dental Surgery (D.D.S.), 47 Dysuria, 486 Doctor of Medicine (M.D.), 41 370 Doctor of Optometry (O.D.), 47 drug classifications, 371 Doctor of Osteopathic Medicine (D.O.), E medical record analyses, 378–385 41–42 Ear, 415–436 operative terms, 370 Doctor of Podiatric Medicine abbreviations/acronyms, 425 overview, 359, 360, 361 (D.P.M.), 47 anatomical terms, 417–418 practice exercises, 372–377 Doctor of Psychology (Ph.D.), 48 combining forms, 415 symptomatic terms, 363–364 Documentation (see Medical record; diagnostic terms, 418–420 therapeutic terms, 370–371 Medical record analyses) diagnostic tests and procedures, Endocrinology, 44 Doppler imaging, femoral vein 421–423 Endolymph, 416, 418 thrombus, 200 drug classifications, 424 Endometriosis, 542 Doppler sonography, 215 (see also medical record analyses, 430–436 Endometritis, 542 Sonography) operative terms, 423 Endometrium, 537 carotid arteries, 198 overview, 416–417 Endorectal (transrectal) sonogram, of Dorsal (posterior) direction, 155 practice exercises, 426–429 prostate, 518 Dorsiflexion, 158 symptomatic terms, 418 Endoscopic biopsy, 457, 547 Double rr’s, 29 therapeutic terms, 424 Endoscopic retrograde cholangiopancre- Doxycycline, 597 Ear instillation, 424 atography (ERCP), 452 D.P.M. (Doctor of Podiatric Medicine), 47 Ear lavage, 424 Endoscopic sonography, 456 DRE (digital rectal exam), 517 Eating disorders, 336 Endoscopy, 280, 285, 452, 453 Drug classifications, 123–124 Ecchymosis (bruising), 114 capsule, 454 blood and lymph system, 255 ECG (EKG), 206, 211, 211, 212 laboratory reports, 475 cardiovascular system, 219–221 Echocardiography (ECHO), 213, 215 Endosteum, 153 ear, 424 Eclampsia, 560 Endothelium endocrine system, 371 ECT (electroconvulsive therapy), 336 blood vessel, 198 eye, 402 Ectopic pregnancy, 560, 560 venous, 200 female reproductive system Ectropion, 392, 395 Endotracheal intubation, 296 gynecological, 567 Eczema (atopic dermatitis), 116, 117 Endovaginal sonogram (ultrasound), 550, obstetrical, 563 EDC (estimated date of confinement), 558 551, 562 gastrointestinal system, 461 EDD (estimated date of delivery), 558 Endovascular surgery, 217, 218 musculoskeletal system, 174 Edema, pulmonary, 275 Enema, barium (lower GI series), psychiatric, 337 EEG (electroencephalogram), 326–329, 455, 456 respiratory system, 288 326 Enteritis, 448 urinary system, 496 Effacement, cervical, 558 Enterocele, 543, 544 Index 637 ENT physician, 46 Expectorants, 288 Femoral artery, 198 Entropion, 392, 396 Expectoration, 274 Femoral vein, 200 Enucleation, 399 Expiration (exhalation), 270, 271 Femoral vein thrombus, 200 Enuresis, 486 Extension, 148, 157 Fetal monitoring, 561 Eosinophils, 243, 244 External auditory meatus (canal), 417 Fetus, 539, 540 Ependymal cells, 312, 313 Extracorporeal shock wave lithotripsy Fibrillation, 205, 206 Epicardium, 195 (ESWL), 495 Fibrocystic breast disease, 546 Epidermis, 109, 110 Extracranial MRA, 327, 328 Fibroids, uterine, 542 Epididymectomy, 518 Eye, 386–414 Fibromyoma, 542, 542 Epididymis, 510, 511 abbreviations/acronyms, 402 Fissures Epididymitis, 512 anatomical terms, 388–390 of brain, 314 Epigastric region, 444 combining forms, 386–387 skin, 113, 113 Epilepsy, 322 (see also Seizures) diagnostic terms, 391–396 Fistula Epinephrine, 359, 361 diagnostic tests and procedures, anal, 449, 453 Epiphora, 392 396–398 vaginal, 542, 543 Epiphysis, 147, 153 drug classifications, 402 Fistulectomy, anal, 460 Epiphysitis, 162 medical record analyses, 409–414 Fitness, 2 Episiotomy, 563 operative terms, 398–400 Flaccid (term), 159 Epistaxis, 274 overview, 387–388 Flaccid paralysis, 319 Epithelium, 110 practice exercises, 403–408 Flash cards, 3–4, 3, 4, 5 EPS (electrophysiological study), 211 symptomatic terms, 390–391 Flat affect, 333 Epstein-Barr virus, 249 therapeutic terms, 401–402 Flat bones, 147 ERCP (endoscopic retrograde Eye instillation, 401 Flatulence, 446 cholangiopancreatography), 452 Eye irrigation, 401 Flexion, 148, 157 Erectile dysfunction (impotence), 514 Eyelid (palpebra), 388, 389 plantar, 158 Erect position, 157 Eyelid abnormalities, 395 Flomax, 597 Erosions, skin, 112, 113 Flonase, 597 Error-prone abbreviations (see under F Flovent, 597 Abbreviations/acronyms) F.A.C.P. (Fellow of American College of Fluid administration, 89 Eructation (belching), 446 Physicians), 42 Fluoroscopy, 455 Eruption, of skin lesion, 115 F.A.C.S. (Fellow of American College of Fluoxetine, 597 Erythema, 115 Surgeons), 42 Flutter, 205, 206 Erythroblastosis fetalis, 249, 560 Fainting (syncope), 319 Foley catheter, 496 Erythrocytes (red blood cells, RBCs), Fallopian (uterine) tubes, 537 Folic acid, 597 242, 248 Fallopius, Gabriele, 537 Follicle-stimulating hormone (FSH), Erythrocyte sedimentation rate (ESR), 253 Family history, 56 361, 362 Erythropenia, 247 Family practice, 44 Fosamax, 597 Esophageal varices, 447, 453 Fascia, 155 Esophagitis, 447 Fasting blood sugar (FBS), 369 Fovea centralis, 388, 389 Esophagoplasty, 459 Fatty paste, 588 Fracture (Fx), 163 Esophagostomy, 452 Feces, 442 open reduction, internal fixation Esophagus, 440, 442 Female reproductive system, 535–584 (ORIF), 169, 171 Esotropia, 395 abbreviations/acronyms, 563 types of common, 164 ESR (erythrocyte sedimentation anatomical terms, 536–540 Fracture line, 163 rate), 253 combining forms, 535–536 Frequency abbreviations, 93 Essential hypertension, 208 diagnostic terms Frontal lobe, 313, 314 Estimated date gynecological, 541–547 Frontal (coronal) plane, 155, 156 of confinement (EDC), 558 obstetrical, 558–562 Frozen section (FS), 120 |
of delivery (EDD), 558 diagnostic tests and procedures FSH (follicle-stimulating hormone), Estrogen, 361, 362 gynecological, 547–551 361, 362 ESWL (extracorporeal shock wave obstetrical, 561–563 Fulguration, 121 lithotripsy), 495 drug classifications Fundus of eyeball, 388, 389 Etymology, 9 gynecological, 567 Furosemide, 597 Euphoria, 333 obstetrical, 563 Furuncles, 117 Eupnea, 273, 274 medical record analyses, 572–584 Fusiform aneurysm, 204 Eustachian obstruction, 419 operative terms Eustachian tube, 416, 417 gynecological, 551–556 G Eversion, 148, 157 obstetrical, 563 Gabapentin, 599 Evista, 597 overview, 536, 537 GAD (generalized anxiety disorder), 334 Evoked potentials, 326–329 practice exercises, 564–571 Gamma camera, 81, 83, 84 Excisional biopsy, 457, 547, 548 sexually transmitted diseases (STDs), Gallstones (cholelithiasis), 452, 452 Excoriation, skin, 113, 113 544–546 Gangrene, 117 Excretion, 439 symptomatic terms Gastric lavage, 461 Exhalation (expiration), 270, 271 gynecological, 540 Gastric resection, 459 Exocrine pancreas, 440, 443 obstetrical, 558 Gastric ulcer, 447, 448 Exophthalmos, 363, 367, 390 therapeutic terms Gastritis, 447, 453 Exostosis, 159 gynecological, 556–557 Gastroenteritis, 448 Exotropia, 395 obstetrical, 563 Gastroenterology, 45 638 Medical Terminology: The Language of Health Care Gastroesophageal reflux disease Glucovance, 597 Hemoglobin A1c, 369 (GERD), 447 Glyburide, 598 Hemolysis, 247 Gastrointestinal system, 436–481 Glycohemoglobin, 369 Hemophilia, 249 abbreviations/acronyms, 461 Glycosuria, 364, 486 Hemoptysis, 274 abdominal divisions, 443–445 Glycosylated hemoglobin, 369 Hemorrhoid, 451 anatomical terms, 441–443 Goiter, 367 Hemostatics, 255 combining forms, 437–439 Goniometer, 158, 159 Hemothorax, 277 diagnostic terms, 447–452 Gonorrhea, 516, 544 Hepatitis, 451 diagnostic tests and procedures, Gout, 161 Hepatitis B virus (HBV), 516, 544 452–458 Gouty arthritis, 161 Hepatomegaly, 446 drug classifications, 461 Grandiose delusions, 333 Hernia, 449, 450 medical record analyses, 471–481 Grand mal seizures, 322 Herniated intervertebral disk, 163, 322, operative terms, 459–460 Granulocytes, 243, 244 322 overview, 439–441 Graves disease, 367 Hernioplasty, 459 practice exercises, 462–470 Gravida, 558, 559 Herniorrhaphy, 459 symptomatic terms, 445–447 Greenstick fracture, 163, 164 Herpes simplex virus (HSV), 117 therapeutic terms, 461 Growth hormone (GH), 361, 363 Herpes simplex virus type 2 (HSV-2), 516, Gastroscopy, 452 GTT (glucose tolerance test), 369 544, 545 Gemfibrozil, 597 Gums (gingivae), 440, 441 Herpes zoster (shingles), 117, 322, 323 Generalized anxiety disorder (GAD), 334 Gustatory sense, 2 Heterografts, 123 General prefixes, 22 Gynecological terms (see also Female Heterotropia, 395 General suffixes, 27–28 reproductive system) HGB/Hgb (hemoglobin), 250 General surgery, 47 diagnostic, 541–547 Hiatal hernia, 449, 450 Generic drug name, 90 diagnostic tests and procedures, Hilum, of kidney, 483, 485 Genetics, medical, 45 547–551 Hippocrates, 40, 40 Genital warts (venereal warts, operative, 551–556 Hippocratic Oath, 40 condylomata acuminata), 517, 545 symptomatic, 540 Hirsutism, 364 GERD (gastroesophageal reflux therapeutic, 556–557 Histamine, 124, 288, 424 disease), 447 Gynecology, 46, 536 (see also Female History Geriatric medicine, 45 reproductive system) cardiovascular, 233–234 Gigantism, pituitary, 366 Gynecomastia, 546, 546 consultation, 59, 300 Gingivitis, 447 Gyrus (gyri), 314 ear, 434 GI system (see Gastrointestinal system) Gland(s) (see also Endocrine system) H family, 56 gynecological, 575 adrenal (suprarenal), 359, 360, 361 Habitual abortion, 559 hospital records of, 63, 65–66 Bartholin, 537, 538 Halitosis, 446 of medicine, 40 bulbourethral (Cowper’s), 511, 512 Hallucinations, 333 lacrimal, 389 HBV (hepatitis B virus), 516, 544 nervous system, 351–352 mammary (breasts), 539, 546–547 HCT/Hct (hematocrit), 250 obstetrical, 579 meibomian, 388, 389 Headache, migraine, 323 occupational, 56 parathyroid, 360, 361 Health care professions, 48–49 past medical, 56 pituitary, 360, 361 Hearing aid, 424 preoperative, 65–66 prostate, 512 Hearing loss of present illness, 55 salivary, 440, 441 conductive, 420 respiratory, 306, 307 sebaceous, 109, 110 mixed, 420 social, 56 sudoriferous, 109, 110 sensorineural, 420 History and physical, 54–58, 58, 59, 63, thymus, 246, 359, 360, 361 Heart, 193, 194 (see also Cardiovascular 65–66 thyroid, 359, 360, 361 system) cardiovascular, 235–236 of Zeis, 388, 389 circulation of, 193, 194, 195 ear, 434–435 Glans penis, 510, 511 congenital anomalies of, 207 eye, 414–415 Glasgow Coma Scale, 318, 319 septa and layers, 193, 194, 195 gynecological, 575–576 Glaucoma, 392, 394 Heart block, 205, 206 medical record analyses, 185–186 Glial cells, 313 Heart failure, congestive (CHF), 207 obstetric, 579–580 Glioma, 322 Heart murmur, 204 preoperative, 65–66 Glomerulonephritis, 487 Heart valve replacement, 217, 217 HIV (human immunodeficiency virus), Glomerulus (glomeruli), 484, 485 Heart valves, 195, 196, 197 248, 517, 545 Glossary, of prefixes, suffixes, and com- Hematemesis, 446 Hives (urticaria), 115 bining forms, 585–590 Hematochezia, 446, 492 Holter ambulatory monitor, 211 Glossectomy, 459 Hematocrit (HCT, Hct), 250 Homografts, 123 Glossitis, 447 Hematology, 45 Homologous blood, 254 Glossorrhaphy, 459 Hematology lab report, 268 Hordeolum (sty), 392, 395 Glucagon, 361, 362 Hematuria, 486, 486, 492 Hormonal contraceptives, 557 Glucocorticoids, 359, 361 Hemiparesis, 319 Hormone, 359, 361 Glucophage XR, 597 Hemiplegia, 324 Hormone replacement therapy (HRT), Glucose, in urine, 490 Hemispheres, cerebral, 313, 314 371, 556 Glucose tolerance test (GTT), 369 Hemochromatosis, 249 Hospital abbreviations, 79–80 Glucosuria, 364 Hemodialysis, 495 Hospitals, 41, 41 Glucotrol XL, 597 Hemoglobin (HGB, Hgb), 250 HPV (human papilloma virus), 517, 545 Index 639 HRT (hormone replacement Hypothyroidism, 368, 368 Integumentary system, 107–143 therapy), 556 Hypotonia, 159 anatomical terms, 110–111 HSV-2 (herpes simplex type 2), 544, 545 Hypoventilation, 275 combining forms, 107–108 HSV (herpes simplex virus), 516 Hysterectomy, 553 diagnostic terms, 115–120 Humalog, 598 Hysteria, 553 diagnostic tests and procedures, Human immunodeficiency virus (HIV), Hysterosalpingogram, 550 120–121 248, 517, 545 Hysteroscopy, 548, 549 operative terms, 121–123 Human papilloma virus (HPV), 517, 545 Hysterosonogram, 550, 551 overview, 108, 110 Humulin, 598 Hyzaar, 598 symptomatic terms, 111–115 Huntington chorea, 322 therapeutic terms, 123–124 Huntington disease, 322 I Interatrial septum, 193, 194, 195 Hydrocele, 512, 513 Ibuprofen, 598 Internal medicine, 44–45 Hydrocephalus, 323, 324, 325 ICD (implantable cardioverter Interventricular septum, 193, 194, 195 Hydrocephaly, 323, 324, 325 defibrillator), 219 Intervertebral disk (disc), 150, 153 Hydrochlorothiazide, 598 Ichthyosis, 117 herniated, 163, 322 Hydrocodone/acetaminophen, 598 Icterus (jaundice), 446 Intestines, 440, 442 Hydronephrosis, 487, 487 Ideation, 333 Intracardiac catheter ablation, 212 Hymen, 537, 538 Ig (immunoglobulin), 246 Intracardiac electrophysiological study Hyperbilirubinemia, 446 Ileal conduit, 494, 495 (EPS), 211 Hypercalcemia, 364 Ileitis, 448 Intracorporeal lithotripsy, 492, 493 Hypercapnia, 275 Ileostomy, 459 Intracranial MRA, 327, 328 Hypercarbia, 275 Imaging modalities, 81, 82, 83, 84, 85, 86 Intradermal administration, 89, 90 Hyperemesis gravidarum, 561 (see also specific modalities) Intramuscular administration (IM), 89, 90 Hyperesthesia, 320 bone and lymph systems, 253 Intraocular lens implant (IOL), 400, 401 Hyperglycemia, 364 contrast medium in, 84 Intrauterine device (IUD), 557 Hyperinsulinism, 366 endocrine system, 369, 370 Intravascular sonography, 215 Hyperkalemia, 364 gastrointestinal tract, 454–457 Intravascular stent, 218 Hypermastia, 547 ionizing, 81, 82, 83, 84 Intravenous administration (IV), 89, 90 Hypernatremia, 364 musculoskeletal system, 167–169 Intravenous pyelogram (IVP), 489 Hyperopia, 391, 391 nonionizing, 84, 85, 86 Intravenous urogram, kidney, urine, Hyperparathyroidism, 366 Imitrex, 598 bladder (KUB), 489, 490 Hyperpigmentation, 115 Immunity, 246–247 Introitus, vaginal, 537, 538 Hyperplasia active, 247 Intussusception, 449, 450 benign prostatic (BPH), 514, 517 passive, 247 Inversion, 148, 157 as term, 159 Immunocompromise, 247 Ionizing imaging modalities, 81, 82, Hyperpnea, 273, 274 Immunoglobulins (Ig), 246 83, 84 Hypersecretion, 364 Immunology, 44 Iridectomy, 399 Hypertension (high blood pressure), Immunosuppression, 247 Iridotomy, 399 199, 208 Impetigo, 117 Iris, 388, 389 pregnancy-induced (PIH), 560 Implantable cardioverter defibrillator Iritis, 392 Hyperthyroidism, 367, 367, 368 (ICD), 219 Iron deficiency anemia, 248, 248 Hypertrophy Implant administration, 89 Irregular bones, 147 benign prostatic (BPH), 514, 515 Impotence (erectile dysfunction), 514 Ischemia, 203, 203 as term, 159 Incarcerated hernia, 449 Islets of Langerhans (endocrine Hyperventilation, 275 Incentive spirometry, 286, 287 pancreas), 360, 361, 362 Hypnotics, 334 Incisional biopsy, 458, 547–548 Isosorbide mononitrate, 598 Hypocalcemia, 364 Incision and drainage (I & D), 121 Itching (pruritus), 115 Hypochondriac, 444 Incomplete abortion, 559 IUD (intrauterine device), 557 Hypochondriac regions, 444 Incontinence, 486 IVP (intravenous pyelogram), 489 Hypochondriasis, 335 Incus, 416, 417 Hypogastric region, 445 Infarct, 203, 204 J Hypoglossal, 447 Inferior (caudal) direction, 155 Jaundice (icterus), 446, 446 Hypoglycemia, 364 Inferior vena cava, 200 Joint capsule, 154 Hypoglycemic antihyperglycemic Information Joint disease, degenerative (DJD), 160 drugs, 371 objective, 57 Joints, Hypokalemia, 364 subjective, 55–56 anatomy of, 147 Hypolipidemics, 221 Informed consent, 63 knee, 154 Hypomastia, 547 Inguinal hernia, 449, 450 of lower limb, 147 Hyponatremia, 364 Inguinal region, 445 Jugular vein, 200 Hypoparathyroidism, 366 Inhalation, administration by, 89 Junction, ureteropelvic, 485 Hypophysectomy, 370 Inhalation (inspiration), 270, 271 Hypophysis (pituitary gland), 362 Initial plan, 60 K Hypopigmentation, 115 Insertion, of muscle, 154, 155 Kaposi sarcoma, 118, 119 Hypopnea, 273, 274 Inspiration (inhalation), 270, 271 Kariva, 598 Hyposecretion, 364 Insulin, 361, 362, 365 Kegel exercises, 496 Hypospadias, 512, 514 Insulin infusion, continuous subcuta- Keloid, 113, 114 Hypotension, 199 neous (CSII), 370, 371 Keratitis, 392 Hypothalamus, 318 Insulin pump, 370, 371 Keratoplasty, 399 640 Medical Terminology: The Language of Health Care Keratoses, 118, 118 flash cards, 3–4, 3, 4, 5 Lymph, 246 actinic, 118, 118 mnemonics, 5–6, 5 symptomatic terms, 247–248 seborrheic, 118, 118 senses, 2–3 Lymphadenectomy, 253 solar, 118, 118 study tips, 6 Lymphadenopathy, 247 Ketone bodies, 486 LEEP (loop electrosurgical excision Lymphadenotomy, 253 Ketone compounds, 486 procedure), 553, 554 Lymphatic system (see also Blood and Ketones, 490 Left ventricular failure (congestive heart Lymph system) Ketonuria, 486 failure), 207 overview Ketosis, 364 Legal considerations, for medical immunity, 246 Kidney, 483, 484, 485 record, 96 lymph organs, 245, 246 Kidney (renal) biopsy, 489 Leiomyoma, 163, 542 lymph structures, 245, 246 Kidney (renal) transplantation, 493, 494 Leiomyosarcoma, 163 Lymph capillaries, 246 Kidney stones (calculi) Lens capsule, 389 Lymph ducts (lymphatic ducts), 246 (nephrolithiasis), 488, 488 Lescol XL, 598 Lymph node dissection, 253 Kidney, urine, bladder (KUB) intravenous Lesions, skin, 111–112 Lymph nodes, 246 urogram, 489, 490 Leukemia, 249 Lymphocytes, 243, 244 Kinesthetic sense, 2 Leukocytes (white blood cells, WBCs), Lymphocytopenia, 247 Klor-Con, 598 243, 244 Lymphoma, 249 Knee joint, 154 Leukorrhea, 540 Lymph vessels, 246 KUB (kidney, urine, bladder urogram), Levaquin, 598 489, 490 Levothroid, 598 M Kyphosis, 165, 166 Levoxyl, 598 Macrobid, 599 Lexapro, 598 Macrocytosis, 247 L LH (luteinizing hormone), 361, 362 Macromastia, 547 Labia, 537, 538 Lice (pediculosis capitis), 119, 120 Macron, 18 Laboratory reports, 63, 71–72 Ligaments, 153, 154 Macrosomia, 558 endoscopy, 475 Ligation, tubal, 554 Macula lutea, 387, 388, 389 Laboratory testing, urinary system, Light therapy, 336 Macular degeneration, 394, 394 490–492 Lines, fracture, 163 Macules, 111, 112, 113 Labyrinth, 416, 418 Lipitor, 598 Magnetic resonance angiography (MRA), Labyrinthitis, 419 Lips, 440, 441 212, 327, 328 Lacrimal ducts, 388, 389, 389 Liquid drug forms, 89 Magnetic resonance imaging (MRI), 84, Lacrimal glands, 389, 389 Lisinopril, 599 85, 167, 253, 282, 327, 327, 369, Lacrimal sac, 388, 389, 389 Lithotripsy 454, 549 Lacrimation, 390 extracorporeal shock wave (ESWL), 495 Major affective disorder, 334 Lacteals, 246 intracorporeal, 492, 493 Male reproductive system, 509–534 Lactogenic hormone (prolactin), Liver, 440, 443 abbreviations/acronyms, 520 361, 363 Liver biopsy, 458, 458 Lamina, vertebral, 330 Liver scan, 454 anatomical terms, 510–512 Laminectomy, 330 LLETZ (large loop excision of transfor- combining forms, 509–510 Langerhans, islets of (endocrine mation zone), 553 diagnostic terms, 512–517 pancreas), 360, 361, 362 Lobectomy, 285 diagnostic tests and procedures, Lanoxin, 598 Lobes 517–518 Lantus, 598 frontal, of brain, 313, 314, 314 medical record analyses, 527–535 Laparoscopic cholecystectomy, 460 of lung, 271, 273 operative terms, 518–520 Laparoscopic surgery, 459, 553 occipital, 314, 314 overview, 510, 511 Laparoscopy, 454, 454 parietal, of brain, 313, 314 practice exercises, 521–526 Laparotomy, 459 temporal, 314 sexually transmitted diseases (STDs), Large intestine, 440, 442 Long bones, 147, 148, 153 516–517 Large loop excision, of transformation Loop electrosurgical excision procedure symptomatic terms, 512 zone (LLETZ), 553 (LEEP), 553, 554 therapeutic terms, 520 Laryngitis, 276 Lorazepam, 599 Malignant melanoma, 118 Laryngopharynx, 271, 272 Lordosis, 165, 166 Malleus, 416, 417 Laryngospasm, 277 Lotensin, 599 Mammary glands (breasts), 539, 546–547 Laryngotracheobronchitis, 277 Lotrel, 599 fibrocystic disease of, 546 Laser-assisted in situ keratomileusis Lou Gehrig disease (ALS, amyotrophic operative terms, 555–556 (LASIK), 399 lateral sclerosis), 320, 328 Mammary papilla (nipple), 539 Lasers, 121 Lower GI series (barium enema), 455, 456 supernumerary, 547 Laser surgery, 121, 553 Low-Ogestrel, 599 Mammogram, 550, 550 of eye, 399, 400 Lumbar puncture (spinal tap), 328 Mammoplasty, 556, 556 Lateral aspect, 157 Lumbar region, 444 Mania, 333 Lavage Lumpectomy, 555 Manic depression (bipolar disorder), 334 ear, 424 Lungs, 271, 273 Marrow, bone, 153 gastric, 461 Lung sounds, 274 Mastectomy, 555, 555 Learning, personal aspects of Lupus, cutaneous, 118 Mastitis, 547 successful, 1–2 Lupus erythematosus, systemic Mastoiditis, 419 Learning tools, 2–6 (SLE), 118 Mastoid process, 417 annotation, 4–5 Luteinizing hormone (LH), 361, 362 Mastopexy, 556, 557 Index 641 MCHC (mean corpuscular [cell] hemoglo- Melanocyte-stimulating hormone (MSH), Mucous membranes, respiratory tract, bin concentration), 251 361, 363 271, 273 |
MCV (mean corpuscular volume), 251 Melanoma Multipara, 558 M.D. (Doctor of Medicine), 41 malignant, 118 Multiple sclerosis (MS), 323, 324 Mean corpuscular volume (MCV), 251 signs of, 109 Muscle, 151, 152, 154 Measurement, prefixes of, 21–22 Melatonin, 361, 362 cardiac, 152, 154 Mechanical ventilation (breathing), Melena, 446 ciliary, 388 286, 287 Membranes insertion of, 154, 155 Meclizine, 599 mucous, respiratory tract, 271, 273 origin of, 152, 154 Meconium, 540 ruptured uterine, 558 skeletal, 152 Meconium aspiration, 561 synovial, 153, 154 smooth, 152, 154 Meconium staining, 558 tympanic, 417, 420 striated (skeletal), 152, 154 Medial aspect, 157 Ménière disease, 419 Muscular dystrophy, 163 Medical genetics, 45 Meninges, 316 Musculoskeletal system, 144–191 Medical record (see also Medical record Meningioma, 323 anatomical positions and points of analysis and subtopics) Meningitis, 323 reference, 155–158 correction of, 96, 96 Meniscus (kneecap), 154 body planes, 155, 156 date and time recording, 95, 95 Menopause, 543 anatomical terms disease-related terms, 86–88 Menorrhagia, 540 for bones, 146–148 history and physical, 54–58, 58, 59 Menstrual cycle, 538 joints and muscles, 153–155 hospital, 63–79 (see also Hospital Mental retardation, 335 combining forms, 144–146 records) Metabolic panel diagnostic terms, 160–167 medication administration, 89–90 basic, 250 diagnostic tests and procedures, pharmaceutical comprehensive, 250, 251 167–169 abbreviations/acronyms and symbols, Metabolism, 364 drug classifications, 174 88–90 Metaphysis, 153 operative terms, 169–170 prescriptions, 90–94, 91 Metastasis, 249 overview, 146–152, 154 problem-oriented, 60–63, 60 Metformin, 599 symptomatic terms, 159–160 regulations and legal considerations, 96 Methylprednisolone, 599 therapeutic terms, 171–174 Medical record analyses Metoprolol, 599 Myalgia, 159 blood and lymph system, 264–268 Metrorrhagia, 540 Myasthenia gravis, 323 MI (myocardial infarction, heart attack), Mydriatic, 402 cardiovascular system, 229–240 209, 209 Myelin, 312, 313 chart notes, 136–139 Miacalcin, 599 Myelitis, 323 ear, 430–436 Microcytosis, 247 Myelodysplasia, 249 endocrine system, 378–385 Microgestin Fe, 599 Myelogram, 329 eye, 408–414 Micromastia, 547 Myeloma, 163 gastrointestinal tract, 471–481 Microsurgery, 331, 423 Myelomeningocele, 325 history and physical examination, Migraine headache, 323 Myocardial infarction (MI, heart attack), 185–186 Military time, 95, 95 209, 209 integumentary system, 134–143 Mineral corticosteroids, 359, 361 Myocardial radionuclide perfusion male reproductive system, 527–535 Miotic, 402 scan, 212 musculoskeletal system, 185–191 MiraLax, 599 Myocardial radionuclide perfusion stress nervous system and psychiatric Miscarriage (spontaneous abortion), 558 scan, 212 disorders, 347–357 Missed abortion, 559 Myocarditis, 209 operative reports, 140–143, 187–189 Mitral (bicuspid) valve, 195, 196 Myocardium, 195 postop meds for laparotomy, 103 Mitral valve prolapse, 208 Myodynia, 159 progress notes, 61, 61–62, 75, 102, 229, Mixed hearing loss, 420 Myomas, 163 264, 267, 430, 530–531, 572 Mnemonics, 5–6 Myomectomy, 554 respiratory system, 297–309 Mobic, 599 Myometrium, 537 SOAP notes, 105–106 Modified radical mastectomy, 555–556 Myopia, 391, 391 urinary system, 504–508 Mohs surgery, 123 Myoplasty, 169 x-ray report, 190–191 Monitoring, fetal, 561 Myositis, 163 Medical specialties, 38–53 Monocytes, 243, 244 Myringitis, 418 American Board of Medical Specialties Mononucleosis, 249 Myringotomy, 423 (ABMS), 42–43 Monopril, 599 Myxedema, 368 combining forms, 38–40 Mood disorders, 334 internal medicine, 45–46 Motor deficit, 318 N physicians, 40–42 Motor nerves, 317 Naproxen, 599 scope of practice, 44–47 Mouth, 440, 441 Narcolepsy, 324 Medication (see also Drugs) MRA (magnetic resonance angiography), Narcotics, 174 administration, 89–90 212, 327, 328 Nasacort, 599 medical record analyses, 103 MRI (magnetic resonance imaging), 84, Nasal polypectomy, 285 Medicine (science), historical aspects, 40 85, 167, 253, 282, 369, 454, 549 Nasal polyposis, 277 Medulla, of kidney (renal medulla), MS (multiple sclerosis), 323, 324 Nasogastric (NG) intubation, 461 483, 485 MSH (melanocyte-stimulating hormone), Nasolacrimal duct, 390 Medullary cavity, 153 361, 363 Nasonex, 599 Meibomian glands, 388, 389 Mucopurulent discharge, 512 Nasopharyngoscopy, 280 642 Medical Terminology: The Language of Health Care Nasopharynx, 271, 272 Nipple (mammary papilla), 539 Omentum, 440, 443 Nausea, 446 supernumerary, 547 Omeprazole, 600 NCV (nerve conduction velocity), 327 NitroQuick, 600 Omnicef, 600 Necon, 599 Nocturia, 487 Oncology, 45 Needle (aspiration) biopsy, 458, 547, 548 Nocturnal enuresis, 486 Onychia, 118 Negation, prefixes of, 20 Nodes Oophorectomy, 554 Neisseria gonorrhoeae, 516, 544 atrioventricular (AV node), 201, 202 Oophoritis, 543 Neoplasia, cervical, 542–543, 549 lymph, 246 Open fracture, 163, 164 Neoplasms (see also Cancer; Tumors) sinoatrial (SA node), 201, 202 Open reduction, internal fixation (ORIF), malignant cutaneous, 118 Nodules, skin, 111, 112, 113 169, 171 Nephrectomy, 493 Noncontinent ileal conduit, 494, 495 Operative reports, 64, 76, 140–143, 142, Nephritis, 487 Nonionizing imaging modalities, 84, 85 187–189, 189, 436, 508 Nephrolithiasis (kidney stones), 488 Nonseminomas, 515 Operative suffixes, 27 Nephrolithotomy, 493 Nonsteroidal anti-inflammatory drugs Operative terms Nephrology, 45 (NSAIDs), 174 blood and lymph system, 253–254 Nephrons, 483, 484, 485 Norepinephrine, 359, 361 breasts (mammary glands), 555–556 Nephrorrhaphy, 493 Normal, as term, 86 cardiovascular system, 215–218 Nephrosis, 488 Normal sinus rhythm (NSR), 202 ear, 423 Nephrotomy, 492 Normotension, 199 endocrine system, 370 Nerve conduction velocity (NCV), 327 Norvasc, 600 eye, 397–400 Nerves Nose, 271, 272 female reproductive system cranial, 316, 317 (see also Nervous Notes gynecological, 551–556 system) chart, 527, 572 obstetrical, 563 motor, 317 nurse’s, 63, 73–74 gastrointestinal system, 459–460 optic, 387, 388 physician’s progress, 63, 75 male reproductive system, 518–520 sensory, 317 progress, 61–62, 75, 102, 229, 264, 267, musculoskeletal system, 169–170, 171 spinal, 317 430, 530–531, 572 urinary system, 492–495 Nervous system, 310–357 SOAP format for, 61–62 Ophthalmic solution, antibiotic, 402 abbreviations/acronyms, 337 NSAIDs (nonsteroidal anti-inflammatory Ophthalmology, 46 anatomical terms, 313–318 drugs), 174 Ophthalmoscopy, 396, 397 autonomic (ANS), 318 Nuclear medicine (see Radionuclide Optic disk (disc), 387, 388, 390 central (CNS), 313–316 imaging) Optic nerve, 387, 388 combining forms, 310–312 Nucleus pulposus, 150, 153 Optometrist, 47 diagnostic terms, 320–325 Nulligravida, 558, 559 Oral cavity, 441, 441 diagnostic tests and procedures, Nullipara, 558 Oral contraceptive pill (birth control 325–329, 330 Nurse, 48 pill), 557 drug classifications, 333 Nurse’s notes, 63, 73–74 Orchidectomy, 518 medical record analyses, 347–357 Nystagmus, 390 Orchiectomy, 518 operative terms, 330–331 Orchiopexy, 519 overview, 312, 313 O Orchioplasty, 519 parasympathetic, 318 Oblique fracture, 164 Orders, physician’s, 63, 67–70, 383 peripheral (PNS), 316–318 Obsessive-compulsive disorder Organ of Corti, 416, 417 practice exercises, 338–346 (OCD), 335 Oropharynx, 271, 272 psychiatric terms, 333–337 Obstetrical sonogram (ultrasound), 562 Ortho Evra, 600 sympathetic, 318 Obstetrical terms (see also Female Ortho Novum, 600 symptomatic terms, 318–320 reproductive system) Orthopedic surgery, 46 therapeutic terms, 332, 333 diagnostic, 558–561 Orthosis, 172, 173 Neuralgia, 319 diagnostic tests and procedures, Orthotopic bladder (neobladder), Neuroendovascular surgery, 331 561–563 494–495 Neuroglia, 312, 313 drug classifications, 563 Ortho Tri-Cyclen, 600 Neurohypophysis (posterior pituitary symptomatic, 558, 559 Os, cervical, 537, 538 gland), 360, 361, 363 therapeutic, 563 Ossicles, auditory, 416, 417 Neuroleptic agents, 337 Obstetrics, 536 Ostealgia, 159 Neurological surgery, 45 Obstetrics and Gynecology (OB/GYN), 45 Osteoarthritis (OA), 160, 160 Neurology, 45 Obstructive lung disorder, 275 Osteodynia, 159 Neuroma, acoustic, 419 Occipital lobe, 314 Osteoma, 163 Neurons, 312, 313 Occlusion, 203, 203 Osteomalacia, 163 Neurontin, 599 Occult blood, in urine, 492 Osteomyelitis, 165 Neuroplasty, 331 Occupational history, 56 Osteoplasty, 169 Neurosis, 333 OCD (obsessive-compulsive Osteoporosis, 165, 165 Neurotransmitters, 312 disorder), 335 Osteosarcoma, 163 Neutropenia, 247 O.D. (Doctor of Optometry), 47 Osteotomy, 170 Neutrophils, 243, 244 Olfactory sense, 2 Otalgia, 418 Nevus (nevi), 114 Oligodendroglia, 312, 313 Otitis externa, 418, 419 dysplastic, 114 Oligomenorrhea, 540 Otitis media, 419, 420 Nexium, 599 Oligo-ovulation, 540 Otodynia, 418 Niaspan, 600 Oligospermia, 512 Otolaryngology, 46 Nifedipine, 600 Oliguria, 487 Otoplasty, 423 Index 643 Otorrhagia, 418 Pediatrics, 46 obstetrical, 580 Otorrhea, 418 Pediculosis capitis (head lice), 119, 120 preoperative, 66 Otosclerosis, 419 Pediculosis pubis (crabs), 119, 120 pulmonary, 301–302 Otoscopy, 422–423, 423 PEFR (peak expiratory flow rate), 283 respiratory, 282, 306, 307, 309 pneumatic, 420 Pelvic adhesions, 543 Physical medicine, 46 pneumonic, 423 Pelvic floor relaxation, 543, 544 Physical therapy (PT), 172 Oval window, 416, 417 Pelvic inflammatory disease (PID), 543 Physicians, 40–42 Ovarian cystectomy, 554 Pelvic sonography, 550, 551 Doctor of Medicine (M.D.), 41 Ovaries, 359, 360, 361, 537 Pelvimetry, 561 Doctor of Osteopathic Medicine (D.O.), Oxycodone/acetaminophen, 600 Pelvis, renal, 483, 485 41–42 OxyContin, 600 Penicillin VK, 600 specialty fields and scope of practice, Oxytocin, 361, 363, 563 Penis, 510, 511 44–47 Peptic ulcer disease (PUD), 447, 448 Physician’s orders, 63, 67–70, 383 P Percocet, 600 Physician’s progress notes, 63, 75 Pacemaker, 219, 220 Percutaneous transluminal coronary an- PID (pelvic inflammatory disease), 543 PaCO2, 280 gioplasty (PTCA), 196, 218 Pigmentation, skin, 115 Palate, 271, 272, 440, 441 Perfusion deficit, 204 Pineal body, 360, 361 Palpebra (eyelid), 388, 389 Pericardial cavity, 195 Pineal gland, 362 Palpitation, 204 Pericarditis, 209 Pinna (auricle), 416, 417 Palsy, cerebral, 320 Pericardium, 195 Pituitary dwarfism, 366 Pancreas Perilymph, 416, 418 Pituitary gigantism, 367 diagnostic terms, 365–366 Perineum Pituitary gland, 360, 361 endocrine (islets of Langerhans), 360, female, 537, 538 anterior (adenohypophysis), 360, 361, 362 male, 511, 512 361, 362 exocrine, 440, 443 Periosteum, 153 diagnostic terms, 366 Pancreatectomy, 370, 460 Peripheral nervous system (PNS), posterior (neurohypophysis), 360, Pancreatitis, 366, 452 316–318, 317 361, 363 Pancytopenia, 247 Peritoneal cavity, 440, 443 Placenta, 539, 540 Panic disorder, 334 Peritoneal dialysis, 496 Placenta previa, 561, 561 PaO2, 280 Peritoneoscopy, 454 Plan Papanicolaou (Pap) smear, 548 Peritoneum, 440, 443 initial, 60 Papilla, mammary (nipple), 539, 547 Peritonitis, 451 treatment, 57 Papules, 111, 112, 113 Pernicious anemia, 248, 248 Planes of body, 155, 156 Para, 558 PERRLA, 57 Plantar flexion, 158 Paracentesis, 459 Persecutory delusions, 333 Plasma, 242 Paralysis, 319, 324 Personal commitment, 1 Plasmapheresis, 254 Paranoid schizophrenia, 336 PET (positron emission tomography), Plastic surgery, 46 Paraplegia, 324 328, 328 Platelet count (PLT), 252 Parasympathetic nervous system, 318 of heart, 212 Platelets, 243, 244 Parathyroidectomy, 370 Petechia(e), 113, 114 Plavix, 600 Parathyroid glands, 360, 361, 362 Petit mal seizures, 322 Plegia, 324 diagnostic terms, 366 Peyronie disease, 514, 514 Plendil, 600 Parathyroid hormone (PTH), 361, 362 PF (peak flow), 283 Pleura, 271, 273 Parenchyma, 273 PFT (pulmonary function testing), Pleural cavity, 271, 273 Parenteral administration, 89, 90 282, 283 Pleural effusion, 277, 278 Paresthesia, 320 pH, 280, 490 Pleurisy, 277 Parietal lobe, 313, 314 Phacoemulsification, 400 Pleuritis, 277 Parietal pericardium, 195 Pharmaceutical abbreviations and Plural and singular forms, 19 Parkinson disease, 324 symbols, 88–90 PMN (polymorphonuclear leukocyte), Paronychia, 119, 119 Pharyngitis, 277 243, 244 Parotitis (parotiditis), 447 Pharynx, 271, 272, 440, 442 Pneumatic otoscopy, 420 Parovarian cyst, 543 Phenobarbital, 600 Pneumoconiosis, 275, 278 Partial seizures, 322 Phenytoin, 600 Pneumocystis carinii, 278 Partial thromboplastin time (PTT), 253 Phimosis, 514, 515 Pneumocystis pneumonia, 278, 279 Patanol, 600 Phlebitis, 209 Pneumohemothorax, 278 Patches, skin, 111, 112, 113 Phlebotomy, 253 Pneumonectomy, 285 Patch test, 121 Phobia, 335 Pneumonic otoscopy, 423 Patella, 154 Phonetic system, 18 Pneumonitis, 278 Patent ductus arteriosus (PDA), 207, 208 Phoropter, 396 Pneumothorax, 278, 279 Pathology, 46 Photophobia, 390 PNS (peripheral nervous system), Pathology reports, 64, 77 Physiatry, rehabilitation, 46 316–318, 317 Paxil, 600 Physical examination, 57 (see also History Podiatry, 47 PBH (benign prostatic hyperplasia/ and physical) Poikilocytosis, 247 hypertrophy), 514, 517 cardiovascular, 235–236 Polarization, 202 PDA (patent ductus arteriosus), 207, 208 ear, 435 Poliomyelitis, 324 PE (pulmonary embolism), 278, 282, 284 eye, 414–415 Polycystic kidney disease, adult Peak expiratory flow rate (PEFR), 283 gynecological, 575–576, 576 (APKD), 487 Peak flow (PF), 283 nervous system, 352–353 Polycythemia, 249 644 Medical Terminology: The Language of Health Care Polydipsia, 364 Preoperative physician’s orders, 67–70 Psychotic disorders, 336 Polyhydramnios, 558 Prepuce, 510, 511 Psychotropic agents, 337 Polymastia, 547 Presbyacusis, 420 PT (prothrombin time), 253 Polymorphonuclear (PMN) leukocytes, Presbycusis, 420 PTCA (percutaneous transluminal coro- 243, 244 Presbyopia, 391 nary angioplasty), 196, 218 Polyneuritis, 325 Prescriptions, 90–94, 91 Pterygium, 394, 395 Polypectomy, 460 Prevacid, 601 PTH (parathyroid hormone), 361, 362 Polyposis, 449, 453 Preventive medicine, 46 Ptosis, 391 Polyps, 277, 449, 453 Prilosec, 601 PTSD (posttraumatic stress disorder), 335 Polysomnography (PSG), 282, 326, 327, Primary accent, 18 PTT (partial thromboplastin time), 253 327 Prime time, 1–2 PUD (peptic ulcer disease), 447, 448 Polythelia, 547 Primigravida, 558, 559 Pulmicort, 601 Polyuria, 364, 487 Primipara, 558 Pulmonary angiography, 81, 84, 169, Positional terms, 155–157 Problem list, 60 284, 284 Position/direction, prefixes of, 20–21 Problem-oriented medical record Pulmonary artery, 195, 198 Positron emission tomography (PET), (POMR), 60–63, 60 Pulmonary circulation, 195, 199 328, 328 Processes Pulmonary consultation report, 300–302 of heart, 212 ciliary, 388 Pulmonary edema, 275 Posterior chamber, of eye, 390 mastoid, 417 Pulmonary embolism (PE), 278, 282, 284 Posterior (dorsal) direction, 155 Procrastination, 2 Pulmonary function testing (PFT), Posterior pituitary gland (neurohypoph- Proctitis, 449, 453 282, 283 ysis), 360, 361, 363 Proctoplasty, 460 Pulmonary infiltrate, 275 Postprandial blood sugar (PPBS), 369 Progesterone, 361 Pulmonary semilunar valve, 197 Posttraumatic stress disorder (PTSD), 335 Progress notes, 229, 264, 267, 347–348, Pulmonary |
tuberculosis (TB), 278, 280 Potassium chloride, 600 430, 530–531, 572 Pulse oximetry, 284, 284 PPBS (postprandial blood sugar), 369 physician’s, 63, 75 Pupil, of eye, 387, 388, 390 Practice exercises SOAP format for, 61–62 Purkinje fibers, 202, 202 answers to, 604–626 Prolactin (lactogenic hormone), 361, 363 Purpuric lesions, 113, 114 basic term components, 30–37 Promethazine, 601 Pus (suppuration), 115 blood and lymph system, 256–263 Promethazine/codeine, 601 Pustules, 111, 112, 113 cardiovascular system, 222–228 Pronation, 158 PVC (premature ventricular contraction), ear, 426–429 Prone position, 157 205, 206 endocrine system, 372–377 Pronunciation, 17–18 Pyelogram, retrograde (RP), 489 eye, 403–408 phonetic system, 18 Pyelonephritis, 487 female reproductive system, 564–571 Propoxyphene/acetaminophen, 601 Pyeloplasty, 493 fields of medical practice, 50–53 Propranolol, 601 Pyloric sphincter, 440, 442 gastrointestinal tract, 462–470 Proscar, 601 Pyloric stenosis, 447 getting started, 7–8 Prostate Pyothorax, 277 integumentary system, 125–133 endorectal (transrectal) sonogram Pyuria, 487, 487 male reproductive system, 521–526 of, 518 medical record, 97–101 transurethral resection of (TURP), 519 Q musculoskeletal system, 175–184 Prostate biopsy, 517 Quadriplegia, 324 nervous system and psychiatric terms, Prostate cancer, 514 Quantity, prefixes of, 21–22 338–346 Prostatectomy, 519 respiratory system, 289–296 Prostate gland, 512 R urinary system, 497–503 Prostate-specific antigen (PSA) test, 518 Radiation therapy, 123, 332, 332, 556 Pravachol, 600 Prostatitis, 514 Radical mastectomy, 555 Prednisone, 601 Prosthesis modified, 555–556 Preeclampsia, 560 auditory, 424 Radiography (x-rays), 47, 81, 82 (see also Prefixes limb, 172, 173 X-rays and specific modalities) common, 20–22 Proteinuria, 486 Radioiodine therapy, 370 defined, 10 Prothrombin, 253 Radionuclide imaging (nuclear medicine), general, 22 Prothrombin time (PT), 253 45, 81, 83, 84, 168, 282, 454 glossary, 585–590 Protonix, 601 of heart, 212 of negation, 20 Proximal aspect, 157 SPECT brain scan, 327 of position/direction, 20–21 Pruritus (itching), 115 thyroid uptake, 369, 370, 380 of quantity or measurement, 21–22 PSA (prostate-specific antigen) test, 518 Radiosurgery, stereotactic of time, 22 Pseudophakia, 394 (stereotaxic), 332 Pregnancy (see also Obstetrical entries) PSG (polysomnography), 326, 327 Rales, 274 ectopic, 560 Psoriasis, 119, 120 Range of motion (ROM), 158 Pregnancy-induced hypertension Psychiatric terms, 333–337 Ranitidine hydrochloride, 601 (PIH), 560 drug classifications, 337 Rashes, 115 Pregnancy test, 561 symptomatic, 333 RBC (red blood count), 250 Premarin, 601 therapeutic, 336–337 RBCs (red blood cells, erythrocytes), Premature ventricular contraction (PVC), Psychiatry, 46 242, 248 205, 206 Psychologist, 48 Recommendation (treatment plan), 57 Prempro, 601 Psychosis, 333 Rectal ampulla, 440, 442 Preoperative history and physical, 65–66 Psychotherapy, 337 Rectal exam, digital (DRE), 517 Index 645 Rectocele, 543, 544 Retrograde pyelogram (RP), 489 Semen analysis, 518 Rectovaginal fistula, 542, 543 Retroversion, of uterus (tipped Semicircular canals, 418 Rectum, 440, 442 uterus), 541 Seminoma testicular cancer, 515 Recumbent position, 157 Review of systems (ROS), 56 Sensorineural hearing loss, 420 Red blood cells (RBCs, erythrocytes), Rhabdomyoma, 163 Sensory deficit, 318 242, 248 Rhabdomyosarcoma, 163 Sensory nerves, 317 Red blood count (RBC), 250 Rheumatic heart disease, 209 Sentinel node breast biopsy, 547 Red cell morphology, 252 Rheumatology, 45 Septicemia, 249 Reduction, of fractures, 171, 171 Rh factor, 249, 560 Septum (septa) Reduction mammoplasty, 556 Rh immune globulin, 563 interatrial, 193, 194, 195 Reflex sympathetic dystrophy (RSD), 325 Rhinocort Aqua, 601 interventricular, 193, 194, 195 Reflex testing, 329, 329 Rhinorrhea, 275 Sequestrum, 162 Reflux, gastrointestinal (GERD), 447 Rh positive/negative, 249 Seroquel, 602 Refraction, 396 Rickets, 163 Serotonin, 361, 362 of light, 387 Right ventricular failure (cor Serum, of blood, 242 Refractive errors, 391 pulmonale), 207 Sesamoid bones, 147 Regulations, for medical record, 96 Rigor/rigidity, 159 Sexually transmitted diseases (STDs), 451 Rehabilitation physiatry, 46 Ringworm (tinea corporis), 119 female reproductive system, 544–546 Relaxation, 2 Rinne test, 422 male reproductive system, 516–517 Remeron, 601 Risperdal, 601 Shingles (herpes zoster), 117, 322, 323 Renal angiogram, 489 Rod of Aesculapius (caduceus), 43, 43 Short bones, 147 Renal artery, 483, 485 Rods, 390 Sialoadenitis, 447 Renal (kidney) biopsy, 489 ROM (range of motion), 158 Sigmoid colon, 440, 442 Renal (kidney) dialysis, 495 Root, of term, 10 Sign, Babinski (Babinski reflex), 329 Renal medulla, 483, 485 Rotation, 148, 157 Simple fracture, 163 Renal pelvis, 483, 485 Routes of administration, 89–90 Simple mastectomy, 555 Renal transplantation, 493, 494 Roxicet, 601 Single photon emission computed tomog- Renal tubules, 483, 485 RSD (reflex sympathetic dystrophy), 325 raphy (SPECT), 327 Repolarization, 202 Rubella, 117 Singulair, 602 Reports Rubeola, 117 Singular and plural forms, 19 ancillary, 63 Rule out (R/O), 57 Sinister, as term, 93 anesthesiologist’s, 64 Rupture, of uterine membranes, 558 Sinoatrial node (SA node), 201, 202 consultation, 584 Rx symbol, 94 Sinuses, 271, 272 consultation, 63, 300–302, 479–481 Sinusitis, 278 endoscopy laboratory, 475 S Skelaxin, 602 laboratory, 63, 71–72 Sac, lacrimal, 389 Skeletal muscle, 151, 152, 154 operative, 64, 76, 142, 189, 436, 508 Saccular aneurysm, 204 Skeleton, 146, 147 (see also Bone[s]) pathology, 64, 77 Saccule, 418 appendicular, 146 urinalysis, 491 SAD (seasonal affective disorder), 334 axial, 146 Reproductive system Sagittal plane, 155, 156 Skin (see also Integumentary system) female, 535–584 (see also Female Salivary glands, 440, 441 Skin cancer, 109 reproductive system) Salpingectomy, 554, 554 Skin grafting, 123 male, 509–534 (see also Male reproduc- Salpingitis, 543 Skin pigmentation, 115 tive system) Salpingostomy, 554 Skin plaque, 111, 112, 113 Resectoscope, 492 Salpingotomy, 554 Skull (cranium), 149 Respiration (breathing), 271, 272 Scabies, 119 SLE (systemic lupus erythematosus), 118 Cheyne-Stokes, 274 Scala vestibuli, 416, 418 Sleep apnea, 279, 286, 325 Respiratory system, 270–309 Scales, skin, 113, 114 Slit-lamp biomicroscopy, 398, 398 abbreviations/acronyms, 288 Schizoaffective disorder, 336 Small bowel series, 455 anatomical terms, 272–273 Schizophrenia, 336 Small intestine, 440, 442 combining forms, 269–270 Schlemm, canal of, 388 Smooth muscle, 152, 154 diagnostic terms, 276–280 Sciatica, 319 Snellen chart, 396 diagnostic tests and procedures, Sclera, of eye, 387, 388, 390 SOAP notes, 61–62, 229, 264, 267, 430, 280–284 Scleral buckling, 400 530–531, 572 drug classifications, 288 Scleritis, 395 medical record analyses, 105–106, medical record analyses, 297–309 Sclerotherapy, 123 132–136 overview, 270–272 Scoliosis, 165, 166 Social history, 56 practice exercises, 289–296 Scotoma, 391 Solar keratoses, 118, 118 symptomatic terms, 273–276 Scout film, 489 Solid/semisolid drug forms, 89 Restrictive lung disorder, 275 Scratch test, 121 Solutions, antibiotic ophthalmic, 402 Resuscitation, cardiopulmonary Seasonal affective disorder (SAD), 334 Soma, of neuron, 312, 313 (CPR), 286 Sebaceous glands, 109, 110 Sonogram Reticulocytosis, 247 Seborrhea, 119 endorectal (transrectal) of prostate, 518 Retina, 387, 388, 390 Seborrheic dermatitis, 116 prostatic, 534 Retinal detachment, 394, 397 Seborrheic keratoses, 118, 118 Sonogram (ultrasound), 84, 86 Retinitis, 394 Secondary hypertension, 208 abdominal, 489 Retinopathy, diabetic, 392, 394 Sedatives, 334 endovaginal, 562 Retroflexion, of uterus, 541, 541 Seizures, 319, 322 obstetrical, 562 646 Medical Terminology: The Language of Health Care Sonogram (ultrasound), (continued) Strattera, 602 musculoskeletal system, 159–160 pelvic, 550, 551 Stress echocardiogram (stress Symptoms (Sx), 56 transcranial, 329, 330 ECHO), 213 Synapses, 312, 313 transvaginal, 562 Stress electrocardiogram, 211, 212 Syncope (fainting), 319 Sonography Stress urinary incontinence (SUS), 486 Synovial fluid, 153 Doppler, 215 Striated (skeletal) muscle, 151, 152, 154 Synovial membranes, 153 intravascular, 215 Stridor, 274 Synthroid, 602 Sonography (ultrasound), 84, 86, 169 Stroke (cerebrovascular accident, CVA), Syphilis, 516, 544 abdominal, 456, 458 320, 321 Syphilitic chancre, 516 cardiac, 213, 215 Stroke volume (SV), 213 Systemic circulation, 199 endocrine system, 369 Sty (hordeolum), 392, 394 Systemic lupus erythematosus endoscopic, 456 Subclavian vein, 200 (SLE), 118 of eye, 397 Subcutaneous administration (Sub-Q), Systems review (SR), 56 Spasm, 160 89, 90 Systole, 199 Spastic paralysis, 319 Subcutaneous tissue, 109, 110, 111 Spastic/spasticity, 160 Subjective information, 55–56 T Specialty boards, 42–43 Sublingual administration, 89, 447 T3 (triiodothyronine), 361, 363 Specific gravity (SpGr), of urine, 490 Subluxation, 167, 168 T4 (thyroxine), 361, 363 SPECT (single photon emission Substance abuse disorders, 336 Tachycardia, 205, 206 computed tomography), 327 Sudoriferous glands, 109, 110 Tachypnea, 273, 274 Spelling, 16–17 Suffixes Tactile stimulation, 319 Sperm (spermatozoon), 510, 511 common, 25–29t TEE (transesophageal Spermatic cord, 511, 512 defined, 10 echocardiogram), 215 Spermatocele, 514 diagnostic, 26–27 Teeth, 440, 441 Spermicidals, 557 with double rr’s, 29 Telangiectasia, 114 Sphincter general, 27–28 Temazepam, 602 cardiac, 440, 442 glossary, 585–590 Temporal lobe, 314 pyloric, 440, 442 operative, 27 Tendinitis (tendonitis), 167 Spider angioma, 113, 114 symptomatic, 26 Tendons, 155 Spina bifida, 325, 325 Sulcus (sulci), 314 Tenotomy, 170 Spinal cord, 316 Superior-anterior (SA), 155 Terazosin, 602 Spinal curvatures, 165, 166 Superior (cephalic) direction, 155 Term components, 9, 9–37 Spinal nerves, 317 Superior vena cava, 200 additional roots, 10 Spinal tap (lumbar puncture), 328 Supernumerary nipples, 547 analysis of, 9–11 Spiral fracture, 164 Supination, 158 combining forms, 23–25 Spirometry, 282, 283 Supine position, 157, 157 combining vowels/combining forms, 10 incentive, 286, 287 Suppositories, 89 forming words from, 14–16 Spironolactone, 602 Suppuration (pus), 115 prefixes, 10, 20–22 Spleen, 246 Suprapubic catheter, 496 quick review, 11 Splenectomy, 254 Suprarenal (adrenal) glands, 359, root and suffix, 10 Splenomegaly, 248 360, 361 rules for using, 11–12 Splinting, of fracture, 171, 172 Surgeon’s operative reports, 76, 142, 189 structure analysis, 13–14 Spondylolisthesis, 167, 167 Surgery, 47 (see also Operative terms and suffixes, 25–29t Spondylosis, 167 specific procedures) in term formation, 14–16 Spondylosyndesis, 170, 331, 331 neuroendovascular, 331 Term formation, 14–16 Spontaneous abortion (miscarriage), 558 thoracic, 47 Terms Sprain, 167 Surgical suffixes, 27 acceptable formations, 17 Sputum, 274 SUS (stress urinary incontinence), 486 blood pressure, 199, 201 Squamous cell carcinoma (SCC), of Suture, 122 common prefixes, 20–22 skin, 118 definitions, 120 forming from components, 14–16 Staff of Mercury (caduceus), 43, 43 SV (stroke volume), 213 pronunciation, 17–18 Stapedectomy, 423 Symbols, 592–593 (see also Abbreviations) singular and plural forms, 19 Stapes, 416, 417 pharmaceutical, 88–90 spelling, 16–17 Statins, 221 Rx, 94 Testicular biopsy, 517 Steatorrhea, 446 Sympathetic nervous system, 318 Testis (testicle), 360, 361, 510, 511 Stents, 218, 493, 494 Symptomatic suffixes, 26 Testosterone, 361 Stereotactic breast biopsy, 547 Symptomatic terms Tests and procedures, diagnostic (see Stereotactic (stereotaxic) frame, 332, 332 blood and lymph systems, 247–248 Diagnostic tests and procedures) Stereotactic (stereotaxic) radio- cardiovascular system, 203–204 Tetany, 160 surgery, 332 ear, 418 Tetralogy of Fallot, 207 Steroid hormones, 359, 361 endocrine system, 363–364 Thalamus (diencephalon), 314 Stethoscope, 282 eye, 390–391 Therapeutic terms Stomach, 440, 442 female reproductive system blood and lymph system, 254–255 Stomatitis, 447 gynecological, 540 cardiovascular system, 218–221 Stool culture and sensitivity, 458 obstetrical, 558, 559 ear, 424 Stool occult blood study, 458 gastrointestinal system, 445–447 endocrine system, 370–371 Strabismus (crossed eyes), 395, 396 integumentary system, 111–115 eye, 401–402 Strangulated hernia, 449 male reproductive system, 512 female reproductive system Index 647 gynecological, 556–557 TPA (tissue plasminogen activator, tPA), Tympanometry, 423 obstetrical, 563 221, 332 Tympanoplasty, 423 gastrointestinal system, 461 Trabecular meshwork, 390 Tympanostomy, 423 integumentary system, 123–124 Trabeculectomy, 400 Tympanum, 416 psychiatric, 336–337 Trachea (windpipe), 271, 272 urinary system, 495–496 Tracheostomy, 285, 286 U Thoracentesis, 285, 285 Tracheotomy, 285, 286 UFE (uterine fibroid embolization), 557 Thoracic cavity, 156 Traction (Tx), on fracture, 171, 172 Ulcerative colitis, 448 Thoracic duct, 246 Trade (brand) drug name, 90 Ulcers Thoracic surgery, 47 Transabdominal sonogram, 550, 551 duodenal, 447, 448 Thoracoplasty, 285 Transcranial sonogram, 329, 330 gastric, 447, 448 Thoracoscopy, 285 Transdermal administration, 89 peptic, 447, 448 Thoracostomy, 285, 285 Transesophageal echocardiogram skin, 113 Thoracotomy, 285 (TEE), 215 Ultracet, 603 Thought disorder, 333 Transformation zone, large loop excision Ultrasound (see Sonogram) Threatened abortion, 559 of (LLETZ), 553 Ultrasound (sonogram), 169 Thrombocytopenia, 249 Transient ischemic attack (TIA), 320, 321, endocrine system, 369 Thrombolytic therapy, 219, 221, 332 322 of eye, 397 Thrombophlebitis, 209 Transmyocardial revascularization Ultraviolet (UV) therapy, 123 Thromboplastin, 253 (TMR), 217 Umbilical hernia, 449 Thrombus, 203, 203 Transplantation Umbilical region, 445 Thymectomy, 254, 370 bone marrow, 253 Unipolar disorder, 334 Thymosin, 361, 363 kidney (renal), 493, 494 Upper gastrointestinal endoscopy, Thymus gland, 246, 359, 360, 361, 363 Transrectal (endorectal) sonogram, of 452, 453 Thyroidectomy, 370 prostate, 518 Upper GI series, 455, 456 Thyroid function study, 369 Transurethral resection, of prostate Upper respiratory infection (URI), 280 Thyroid gland, 359, 360, 361, 363, 367–368 (TURP), 519 Urea, 485 Thyroid-stimulating hormone (TSH), Transvaginal sonogram (ultrasound), 562 Uremia, 488 361, 362 Transverse colon, 440, 442 Ureteropelvic junction, 485 Thyroid uptake and imaging study, 369, Transverse fracture, 164 Ureters, 484, 485 370, 370, 380 Transverse plane, 155, 156 Urethra, 484 Thyrotoxicosis, 367, 368 Trazodone, 602 Urethral meatus (canal), 485 Thyroxine (T4), 361, 363 Treatment plan, 57 Urethral stenosis, 488 TIA (transient ischemic attack), 320, 321, Tremor, 160 Urethritis, 488 322 Triamcinolone, 602 Urethrocele, 543, 544 Tidal volume (TV, VT), 283 Triamterene/hydrochlorothiazide Urethrocystitis, 488 Time (HCTZ), 602 Urethrogram, 518 abbreviations for, 93 Trichiasis, 395 URI (upper respiratory infection), 280 prefixes of, 22 Trichomonas vaginitis, 546 |
Urinalysis (UA), 490, 491 Time and date recording, 95, 95 Tricuspid valve, 196, 197 Urinalysis report, 491 Time management, 1–2 Triiodothyronine (T3), 361, 363 Urinary bladder, 484, 485 Timolol, 602 Trimethoprim/sulfamethoxazole, 602 inflammation of (cystitis), 488 Tinea, 119 Trimox, 602 Urinary catheterization, 496 Tinnitus, 418 Trivora-28, 602 Urinary diversion, 493–494 Tipped uterus (uterine retroversion), 541 TSH (thyroid-stimulating hormone), Urinary retention, 487 Tissue, subcutaneous, 109, 111, 118 361, 362 Urinary stones (calculi), 495 Tissue plasminogen activator (tPA, TPA), Tubal ligation, 554 Urinary system, 482–508 221, 332 Tubes abbreviations/acronyms, 496 TMR (transmyocardial auditory, 416, 417 anatomical terms, 484–485 revascularization), 217 eustachian, 416, 417 combining forms, 482–483 TobraDex, 602 uterine (fallopian), 537 diagnostic terms, 487–488 Tocolytic agents, 563 Tubules, renal, 483, 485 diagnostic tests and procedures, Tomography (see also Computed Tumors 488–494 tomography [CT]) epidermal, 114 (see also Neoplasia and drug classifications, 496 positron emission (PET), 212, 328 specific types) medical record analyses, 504–508 Tongue, 440, 441 fibroid, 542 operative terms, 492–495 Tongue-tie (ankyloglossia), 447 skin, 111, 112, 113 overview, 483–485 Tonic-clonic epilepsy, 322 Tunic, of eye, 387, 388 practice exercises, 497–503 Tonometry/tonometer, 399, 399 Tunica externa, 198, 200 symptomatic terms, 486–487 Tonsillectomy, 285 Tunica intima, 198, 200 therapeutic terms, 495–496 Tonsillectomy and adenectomy, 285 Tunica media, 198, 200 Urinary tract infection (UTI), 488 Tonsillitis, 279 Tuning fork tests, 421, 422 Urination, 484 Tonsils, 271, 272 TURP (transurethral resection of Urine, 483, 485 Topamax, 602 prostate), 519 microscopic findings in, 492, 496, 497 Topical administration, 89 Tussionex, 602 Urine culture and sensitivity (C & S), 492, Toprol-XL, 602 TV (tidal volume), 283 496, 497 Total hysterectomy, 553 Tympanic membrane, 417, 420 Urine sugar and ketone studies, 369 Toxemia of pregnancy (eclampsia), 560 Tympanitis, 418 Urobilinogen, 492 648 Medical Terminology: The Language of Health Care Urologic endoscopic surgery, 492, 493 Venereal warts (condylomata acuminata), Voiding cystourethrogram (VCU, Urology, 47 517, 545 VCUG), 489 Urostomy, continent/noncontinent, 494 Venipuncture, 253 Volvulus, 449, 451 Urticaria (hives), 115 Venogram, 213 Vowels, combining, 10, 11–12 Usual childhood diseases (UCHD), 56 Venous circulation, 200 VSD (ventricular septal defect), 207 Uterine adnexa, 537 Ventilation (breathing) (see also Respira- VT, 283 Uterine fibroid embolization (UFE), 557 tory system) Vulva, 537, 538 Uterine fibroids, 542 mechanical, 286, 287 Uterine fundus, 536–537 normal, 271, 272 W Uterine prolapse, 543 Ventral (anterior) direction, 155 Warfarin, 603 Uterine (fallopian) tubes, 537 Ventricles Warts, genital (venereal warts, Uterus, 536–537 of brain, 314, 316 condylomata acuminata), 517, 545 displacement of, 541 of heart, 193, 194, 195 Warts (verrucae), 114, 115 UTI (urinary tract infection), 488 Ventricular failure WBC (white blood count), 250 Utricle, 418 left (congestive heart failure), 207 Weber test, 422 Uvula, 272, 440, 441 right (cor pulmonale), 207 Wellbutrin SR, 603 Ventricular septal defect (VSD), 207 Wheals, skin, 111, 112, 113 V Ventriculogram, 213 Wheezes, 274 Vagina, 537, 538 Venules, 199 White blood count (WBC), 250 Vaginal fistula, 542 Verapamil, 603 Windpipe (trachea), 271, 272 Vaginal hysterectomy, 553 Vermiform appendix, 440, 442 Word structure analysis, 13–14 Vaginal introitus, 537, 538 Verruca (wart), 114, 115 Vaginitis, 546 Vertebrae, 150 X atrophic, 546 Vertebral lamina, 330 Xalatan, 603 Vaginosis, 546 Valtrex, 603 Vertebrobasilar TIA, 321, 322 Xenografts, 123 Vertigo, 418 X-ray report analyses, 190–191 Valves, heart, 193, 194, 195, 196, 197 Valvuloplasty, 217 Vesicles X-rays, 81, 82 Varicella (chickenpox), 117 seminal, 510, 511 cardiovascular, 213, 214 skin, 111, 112, 113 chest (CXR), 284, 284 Varices, esophageal, 447, 453 Varicocele, 513, 515 Vesicovaginal fistula, 542, 543 gastrointestinal tract, 455, 455, 456 Vessels gynecological/pelvic, 550 Varicose veins, 209, 210 Vascular lesions, of skin, 113, 114 blood, 197, 197, 198, 199 musculoskeletal system, 168–169 Vas deferens, 510, 511 lymph, 246 nervous system, 329 Vasectomy, 519, 520 Vestibule, of ear, 418 Vasoconstrictors, 221, 255 Viagra, 603 Y Vasodilators, 221, 255 Viral diseases Yasmin 28, 603 Vasopressin (antidiuretic hormone, sexually transmitted, 516–517, 544–545 ADH), 363 of skin, 117 Z Vasovasostomy, 520 Visceral pericardium, 195 Zeis, glands of, 388, 389 VC (vital capacity), 283 Visual acuity, 396 Zetia, 603 VCU, VCUG (voiding Visual sense, 2 Zithromax, 603 cystourethrogram), 489 Vital capacity (VC), 283 Zocor, 603 Vegetations, valvular, 204, 205 Vital signs record, 74 Zoloft, 603 Veins, 199, 200 Vitiligo, 119 Zyprexa, 603 Vena cava, 200 Vitreous, 390 Zyrtec, 603 Medical Terminology: The Language of Health Care Second Edition Marjorie Canfield Willis QUICK STUDY REFERENCE Term Basics Term Component to English a- without cardi/o heart -emia blood condition Most medical terms have three ab- away from cata- down en- within basic components: root, suffix, abdomin/o abdomen -cele pouching or hernia encephal/o entire brain and prefix. -ac pertaining to celi/o abdomen endo- within The root is the foundation or acous/o hearing -centesis puncture for aspiration enter/o small intestine subject of the term. All medical acr/o extremity or topmost cephal/o head epi- upon terms have one or more roots. -acusis hearing condition cerebell/o cerebellum (little brain) epididym/o epididymis ad- to, toward, or near cerebr/o cerebrum (largest part of episi/o vulva (covering) The suffix is the term ending that aden/o gland brain) erythr/o red modifies and gives essential meaning adip/o fat cerumin/o wax esophag/o esophagus to the root. All terms have a suffix. adren/o adrenal gland cervic/o neck or cervix esthesi/o sensation The prefix is a term beginning aer/o air or gas cheil/o lip eu- good or normal used only when needed to further -al pertaining to chir/o hand ex- out or away modify the root or roots. Not all albumin/o protein chol/e bile exo- outside medical terms have a prefix. -algia pain chondr/o cartilage (gristle) extra- outside A combining vowel (usually o or i) allo- other chrom/o color fasci/o fascia (a band) connects a root to another root or to a alveol/o alveolus (air sac) chromat/o color femor/o femur suffix (term ending). A combining ambi- both chyl/o juice fibr/o fiber vowel is not used if the suffix begins an- without circum- around gangli/o ganglion (knot) with a vowel, but is retained when ana- up, apart cis/o cut gastr/o stomach the suffix begins with a consonant. an/o anus col/o colon -gen origin or production andr/o male colon/o colon gen/o origin or production A combining form is a root plus angi/o vessel colp/o vagina (sheath) ger/o old age a combining vowel. Remembering ankyl/o rooked or stiff con- together or with -genesis origin or production combining forms makes it easy to ante- before conjunctiv/o conjunctiva (to join together) gingiv/o gums form and spell medical terms. anti- against or opposed to contra- against or opposed to gli/o glue Most medical terms can be defined aort/o aorta corne/o cornea glomerul/o glomerulus (little ball) by determining the meaning of the appendic/o appendix coron/o circle or crown gloss/o tongue suffix first, then the prefix (if aque/o water cost/o rib glott/o opening present), then the root or roots. -ar pertaining to crani/o skull gluc/o sugar Consult a good medical dictionary -arche beginning crin/o to secrete glyc/o sugar for the meaning of terms that are arteri/o artery cutane/o skin glycos/o sugar exceptions to this general rule. arthr/o joint, articulation cyan/o blue gnos/o knowing articul/o joint cyst/o bladder or sac -gram record -ary pertaining to cyt/o cell -graph instrument for recording Rules for Forming and -ase enzyme dacry/o tear -graphy process of recording Spelling Medical Terms -asthenia weakness dactyl/o digit (finger or toe) gynec/o woman 1 A combining vowel is used to ather/o fatty paste de- from, down, or not hem/o blood join root to root as well as root to -ation process dent/i teeth hemat/o blood any suffix beginning with a consonant, atri/o atrium derm/o skin hemi- half e.g., electr/o/cardi/o/gram. audi/o hearing dermat/o skin hepat/o, hepatic/o liver aur/i ear -desis binding herni/o hernia 2 A combining vowel is not used auto- self dextr/o right, or on the right side hetero- different before a suffix that begins with a bacteri/o bacteria dia- across or through hidr/o sweat vowel, e.g., vas/ectomy. balan/o glans penis diaphor/o profuse sweat hist/o tissue 3 If the root ends in a vowel and bi- two or both dips/o thirst histi/o tissue the suffix begins with the same vowel, bil/i bile dis- separate from or apart homo- same drop the final vowel from the root -blast germ or bud doch/o duct hormon/o hormone (an urging on) and do not use a combining vowel, blast/o germ or bud duoden/o duodenum hydr/o water e.g., card/itis. blephar/o eyelid -dynia pain hyper- above or excessive brachi/o arm dys- painful, difficult, or faulty hypn/o sleep 4 Most often, a combining vowel brady- slow -e noun marker hypo- below or deficient is inserted between two roots even bronch/o bronchus (airway) e- out or away hyster/o uterus when the second root begins with a vowel, e.g., cardi/o/esophageal. bronchi/o bronchus (airway) -eal pertaining to -ia condition of bronchiol/o bronchiole (little airway) ec- out or away -iasis formation of or presence of 5 Occasionally, when a prefix ends bucc/o cheek -ectasis expansion or dilation iatr/o treatment in a vowel and the root begins with capn/o carbon dioxide ecto- outside -iatrics treatment a vowel, the final vowel is dropped carb/o carbon dioxide -ectomy excision (removal) -iatry treatment from the prefix, e.g., par/enter/al. carcin/o cancer -emesis vomiting -ic pertaining to Term Component to English -icle small myos/o muscle -plasty surgical repair or reconstruction -stasis stop or stand ile/o ileum myring/o eardrum -plegia paralysis steat/o fat immun/o safe narc/o stupor, sleep pleur/o pleura sten/o narrow infra- below or under nas/o nose -pnea breathing stere/o three dimensional or solid inguin/o groin nat/i birth pneum/o air or lung stern/o sternum (breastbone) inter- between necr/o death pneumon/o air or lung steth/o chest intra- within neo- new pod/o foot stomat/o mouth ir/o iris (colored circle) nephr/o kidney -poiesis formation -stomy creation of an opening irid/o iris (colored circle) neur/o nerve poly- many sub- below or under -ism condition of obstetr/o midwife post- after or behind super- above or excessive iso- equal, like ocul/o eye pre- before supra- above or excessive -ist one who specializes in -oid resembling presby/o old age sym- together or with -itis inflammation -ole small pro- before syn- together or with -ium structure or tissue olig/o few or deficient proct/o anus and rectum tachy- fast jejun/o jejunum (empty) -oma tumor prostat/o prostate tax/o order or coordination kerat/o hard or cornea onych/o nail psych/o mind ten/o tendon (to stretch) ket/o ketone bodies oophor/o ovary -ptosis falling or downward tend/o tendon (to stretch) keton/o ketone bodies ophthalm/o eye displacement tendin/o tendon (to stretch) kinesi/o movement -opia condition of vision pulmon/o lung test/o testis (testicle) kyph/o humped opt/o eye purpur/o purple thalam/o thalamus (a room) lacrim/o tear orch/o testis (testicle) py/o pus therm/o heat lact/o milk orchi/o testis (testicle) pyel/o basin thorac/o chest lapar/o abdomen orchid/o testis (testicle) pylor/o pylorus (gatekeeper) thromb/o clot laryng/o larynx (voice box) or/o mouth quadri- four thym/o mind, thymus gland lei/o smooth orth/o straight, normal, or correct radi/o radius (a bone of the forearm); thyr/o, thyroid/o thyroid gland -lepsy seizure -osis condition or increase radiation (especially x-ray) (shield) leuc/o white oste/o bone re- again or back -tic pertaining to leuk/o white ot/o ear rect/o rectum toc/o labor or birth lex/o word or phrase -ous pertaining to ren/o kidney tom/o to cut lingu/o tongue ovari/o ovary reticul/o a net -tomy incision lip/o fat ov/i egg retin/o retina ton/o tone or tension lith/o stone or calculus ov/o egg retro- backward or behind tonsill/o tonsil (almond) lob/o lobe (a portion) ox/o oxygen rhabd/o rod shaped or top/o place -logist one who specialized in the pachy- thick striated (skeletal) tox/o poison study or treatment of palat/o palate rhin/o nose toxic/o poison -logy study of pan- all -rrhage to burst forth trache/o trachea (windpipe) lord/o bent pancreat/o pancreas -rrhagia to burst forth trans- across or through lumb/o loin (lower back) para- alongside of or abnormal -rrhaphy suture tri- three lymph/o clear fluid -paresis slight paralysis -rrhea discharge trich/o hair -lysis breaking down or dissolution patell/o knee cap -rrhexis rupture -tripsy crushing macro- large or long path/o disease salping/o uterine (fallopian) tube; troph/o nourishment or development -malacia softening pector/o chest also eustachian tube tympan/o eardrum mamm/o breast ped/o child or foot sarc/o flesh -ula, -ule small -mania abnormal impulse (attraction) pelv/i, pelv/o hip bone schiz/o split, division uln/o ulna (a bone of the forearm) toward -penia abnormal reduction scler/o hard or sclera ultra- beyond or excessive mast/o breast per- through scoli/o twisted uni- one meat/o opening peri- around -scope instrument for examination ur/o urine mega- large perine/o perineum -scopy |
Contributors Numbers in parentheses indicate the page numbers on which the authors' contributions begin. C.A.Anderson (129) Merck Research Laboratories, Merck & Company, Inc., West Point, Pennsylvania 19486 Raj K. Batra (533) Division of Pulmonary and Critical Care Medicine, Veterans Administration Greater Los Angeles Health Care System, and University of California, Los Angeles, School of Medicine and Jonsson Comprehensive Center, Los Angeles, California 90073 Steven R. Bauer (615) Division of Cellular and Gene Therapies, CBER Food and Drug Administration, Rockville, Maryland 20852 A. J. Bett (129) Merck Research Laboratories, Merck & Company, Inc., West Point, Pennsylvania 19486 Gerald W. Both (447) Molecular Science, CSIRO, North Ryde, Nev^ South Wales 1670, AustraHa A. Bout (129) Crucell NV, 2301 CA Leiden, The Netherlands K. Brouv^er (129) Crucell NV, 2301 CA Leiden, The Netherlands C. Chartier^ (105) Department of Genetic Therapy, Transgene, 67082 Stras bourg Cedex, France Tandra R. Chaudhuri {6SS) University of Alabama at Birmingham, Birming ham, Alabama 35294 L. Chen (129) Merck Research Laboratories, Merck & Company, Inc., West Point, Pennsylvania 19486 ^ Present address: Children's Hospital, Boston, Massachusetts xxiii X X I V Contributors Paula R. Clemens (429) Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania E. Degryse^ (105) Department of Genetic Therapy, Transgene, 67082 Stras bourg Cedex, France Joanne T. Douglas (205) Division of Human Gene Therapy, Departments of Medicine, Pathology, and Surgery, and the Gene Therapy Center, University of Alabama at Birmingham, Birmingham, Alabama 35294 Jared D. Evans (39) Department of Molecular Genetics and Microbiology, State University of New York, School of Medicine, Stony Brook, New York 11794 S. M. Galloway (129) Merck Research Laboratories, Merck &c Company, Inc., West Point, Pennsylvania 19486 Thomas A. Gardner (247) Urology Research Laboratory, Indiana University Medical Center, Indianapohs, Indiana 46202 Frank L. Graham (71) Departments of Biology, Pathology, and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada L8S 4K1 Patrick Hearing (39) Department of Molecular Genetics and Microbiology, State University of New York, School of Medicine, Stony Brook, New York 11794 Daniel R. Henderson (287) Calydon, Incorporated, Sunnyvale, California 94089 R. B. Hill (129) Merck Research Laboratories, Merck & Company, Inc., West Point, Pennsylvania 19486 Hui-Chen Hsu (409) Department of Medicine, Division of Clinical Immunol ogy and Rheumatology, University of Alabama at Birmingham, Birming ham, Alabama 35294 Chinghai H. Kao (247) Urology Research Laboratory, Indiana University Medical Center, Indianapolis, Indiana 46202 D. Kaslow (129) Merck Research Laboratories, Merck &c Company, Inc., West Point, Pennsylvania 19486 David Kirn (329) Program for Viral and Genetic Therapy of Cancer, Imperial Cancer Research Fund, Hammersmith Hospital, Imperial College School of Medicine, London, W12 ONN, United Kingdom Stefan Kochanek (429) Center for Molecular Medicine, University of Cologne, D-50931 Cologne, Germany Jay K. KoUs {595) Department of Medicine and Pediatrics, Louisanna State University, Health Sciences Center, New Orleans, Louisianna 70112 Victor Krasnykh (205) Division of Human Gene Therapy, Departments of Medicine, Pathology, and Surgery, and the Gene Therapy Center, Uni versity of Alabama at Birmingham, and VectorLogics, Inc., Birmingham, Alabama 35294 R. Lardenoije (129) Crucell NV, 2301 CA Leiden, The Netherlands ^ Present address: Laboratoire Microbiologie, Pernod-Ricard, Creteil Cedex, France. Contributors X X V J. Lebron (129) Merck Research Laboratories, Merck & Company, Inc., West Point, Pennsylvania 19486 B. J. Ledwith (129) Merck Research Laboratories, Merck &c Company, Inc., West Point, Pennsylvania 19486 J. Lew îs (129) Merck Research Laboratories, Merck & Company, Inc., West Point, Pennsylvania 19486 Erik Lubberts (595) University Medical Center St. Radboud, Nijmegen Cen ter for Molecular Life Science, 6500 HB Nijmegen, The Netherlands M. Lusky (105) Department of Genetic Therapy, Transgene, 67082 Stras bourg Cedex, France S. V. Machotka (129) Merck Research Laboratories, Merck & Company, Inc., West Point, Pennsylvania 19486 S. Manam (129) Merck Research Laboratories, Merck & Company, Inc., West Point, Pennsylvania 19486 D. Martinez (129) Merck Research Laboratories, Merck & Company, Inc., West Point, Pennsylvania 19486 M. Mehtali^ (105) Department of Genetic Therapy, Transgene, 67082 Stras bourg Cedex, France John D. Mountz (409) Department of Medicine, Division of Clinical Immunol ogy and Rheumatology, University of Alabama at Birmingham, and Birmingham Veterans Administration Medical Center, Birmingham, Alabama 35294 Stephen J. Murphy (481) Molecular Medicine Program, Mayo Clinic and Foundation, Rochester, Minnesota 55905 Glen R. Nemerov^ (19) Department of Immunology, The Scripps Research Institute, La JoUa, California 92037 Philip Ng"̂ (71) Department of Biology, McMaster University, Hamilton, Ontario, Canada L8S 4K1 W. W. Nichols (129) Merck Research Laboratories, Merck & Company, Inc., West Point, Pennsylvania 19486 Catherine O'Riordan (375) Genzyme Corporation, Framingham, Massa chusetts 01701 Raymond John Pickles (565) Cystic Fibrosis/Pulmonary Research and Treat ment Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599 Anne M. Pilaro (615) Division of Clinical Trial Design and Analysis, CBER Food and Drug Administration, Rockville, Maryland 20852 Sudhanshu P. Raikwar (247) Urology Research Laboratory, Indiana Univer sity Medical Center, Indianapolis, Indiana 46202 ^ Present address: Deltagen, Illkirch, France. "^Present address: Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030. X X V I Contributors C. Russo (129) Merck Research Laboratories, Merck &: Company, Inc., West Point, Pennsylvania 19486 Carl Scandella (167) Carl Scandella Consulting, Bellevue, Washington Gudrun Schiedner (429) Center for Molecular Medicine, University of Cologne, D-50931 Cologne, Germany Paul Shabram (167) Canji Inc., San Diego, California 92121 Thomas P. Shanley (349) Divisions of Pulmonary Biology and Critical Care Medicine, Children's Hospital Medical Center, Cincinnati, Ohio 45229 Sherven Sharma (533) Division of Pulmonary and Critical Care Medicine, Veterans Administration Greater Los Angeles Health Care System, and Wadsworth Pulmonary Immunology Laboratory, University of Califor nia, Los Angeles, Los Angeles, California 90073 Phoebe L. Stewart (1) Department of Molecular and Medical Pharmacology, Crump Institute for Molecular Imaging, University of California, Los Angeles, School of Medicine, Los Angeles, California 90095 Bruce C. Trapnell (349) Divisions of Pulmonary Biology and Critical Care Medicine, Children's Hospital Medical Center, Cincinnati, Ohio 45229 D. Valerio (129) Crucell NV, 2301 CA Leiden, The Netherlands M. van der Kaaden (129) Crucell NV, 2301 CA Leiden, The Netherlands Gary Vellekamp (167) Shering-Plough Research Institute, Kenilworth, New Jersey Richard G. Vile (481) Molecular Medicine Program, Mayo Clinic and Foun dation, Rochester, Minnesota 55905 R. Vogels (129) Crucell NV, 2301 CA Leiden, The Netherlands Christoph Volpers (429) Center for Molecular Medicine, University of Cologne, D-50931 Cologne, Germany Karen D. Weiss (615) Division of Clinical Trial Design and Analysis, CBER Food and Drug Administration, Rockville, Maryland 20852 Lily Wu (533) Departments of Urology and Pediatrics, University of Cal ifornia, Los Angeles, School of Medicine and Jonsson Comprehensive Center, Los Angeles, California 90073 De-Chao Yu (287) Cell Genesys, Incorporated, Foster City, California 94404 Huang-Ge Zhang (409) Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, and Birmingham Veterans Administration Medical Center, Birmingham, Alabama 35294 Kurt R. Zinn (655) University of Alabama at Birmingham, Birmingham, Alabama 35294 D. Zuidgeest (129) Crucell NV, 2301 CA Leiden, The Netherlands Freface The number of human gene therapy cHnical trials employing adenoviral vectors is expanding at an unprecedented rate. This increased use of adenoviral vectors has both fueled, and has in turn been fueled by, a parallel explosion in our knov^ledge of the biology of adenoviruses and their vectors. Moreover, there have been concomitant advances in associated technologies. It is therefore timely to reviev^ both basic and applied aspects of adenoviruses and adenoviral vectors in a single, comprehensive, multi-author volume. The first few chapters focus on basic virology—the structure of aden oviruses and the biology of adenoviral infection and replication. Advances in our understanding of the parental virus have facilitated the rational design of adenoviral vectors for gene therapy. The construction, propagation, and purifi cation of adenoviral vectors have benefited from a number of technological advances, as discussed in the next series of chapters. In addition to the underlying biological features that favor their use for gene therapy, it is recognized that adenoviral vectors have suffered from a number of limitations. These limitations, together w îth strategies by which they might be overcome, are considered. Thus, separate contributions discuss approaches to target adenoviral vectors to specific cell types, as well as strategies to circumvent the host immune response. Replication-competent adenoviruses, which are increasingly being used as oncolytic agents for the treatment of cancer, are described. Other vectorological advances covered in this section include high capacity adenoviral vectors, xenogenic adenoviral vectors, and xxvii XXVIII Preface hybrid adenoviral vectors, which combine the advantages of adenoviral vectors with beneficial features derived from other vector systems. The next group of contributors describes the use of adenoviral vectors in animal models of human disease — cancer, genetic disease, and acquired diseases. These chapters discuss the lessons that have been learned from these model systems and their implications for the employment of adenoviral vectors in humans. Specific approval from the regulatory bodies must be obtained prior to the implementation of human trials, as detailed in the following chapter. Finally, the recognition of the need for noninvasive methods to monitor adenovirus-mediated gene transfer in human patients has predicated the development of novel imaging technologies. In the aggregate, we have provided herein a comprehensive overview of adenoviral technology, both classical and novel. This update should provide an entree into the field for the neophyte as well as a reference source for the practitioner. David T. Curiel Joanne T. Douglas C H A P T E R Adenovirus Structure Phoebe L. Stewart Department of Molecular and Medical Pharmacology Crump Institute for Molecular Imaging University of California, Los Angeles School of Medicine Los Angeles, California I. introduction The world got its first look at the icosahedral symmetry of adenovirus (Ad) in 1959 with published electron micrographs of negatively stained Ad5 [1]. In this classic work, Home et al. were able to resolve the basic subunits and thus determine that the adenovirus capsid is composed of 252 subunits, 12 of which have five neighbors (pentons) and 240 of which have six neighbors (hexons). A few years later, Valentine and Pereira [2] published a striking electron micrograph of a single Ad5 particle, revealing the long protruding fibers that are characteristic of adenovirus. In analogy to what was known at the time about the role of phage tails, the authors correctly deduced that the adenovirus fiber might be involved in adsorption to the host cell surface. Since then electron microscopy has continued to play a role in our understanding of the structure of adenovirus and its interaction with av integrins [3, 4]. In recent years X-ray crystallography has contributed atomic structures for the capsid proteins hexon [5, 6], fiber knob [7-9], and shaft [10], the fiber knob complexed with a receptor domain[ll], and the virally encoded protease [12]. Our growing knowledge of adenovirus structure has already contributed to the field of vector design [13]. For example, initial attempts at modifying the C-terminal end of the fiber protein gave suboptimal results for gene delivery [14], while subsequent efforts utilizing knowledge of the fiber knob structure produced vectors with enhanced performance [15, 16]. Strategies for improving adenoviral vectors by making genetic modifications to capsid proteins and by designing hybrid vectors are discussed in later chapters. An understanding of adenovirus structure will be essential for these endeavors. ADENOVIRAL VECTORS FOR GENE THERAPY | Copyright 2002, Elsevier Science (USA). All rights reserved. Phoebe L. Stewart II. Molecular Composition The approximately 50 known human adenovirus serotypes are classified into six subgroups, A-F, and all share a similar structure and genomic organi zation [17]. Adenovirus is an nonenveloped virus of ~150 MDa, composed of multiple copies of 11 different structural proteins, 7 of which form the icosa- hedral capsid (II, III, Ilia, IV, VI, VIII, IX) and 4 of which are packaged with the linear double-stranded DNA in the core of the particle (V, VII, mu, and terminal protein). For clarification of the nomenclature, note that most of the Ad polypeptides were named based on their position on a polyacrylamide gel. The highest molecular mass protein band turned out to be a complex of com ponents, and consequently there is no polypeptide I in adenovirus. Also note that polypeptide Ilia was not originally resolved as a separate band; however, it is a distinct structural protein. In addition to the capsid and core components, approximately 10 copies of the adenovirus protease are incorporated into each virion [18]. For many icosahedral viruses, determination of a crystal structure has resolved outstanding molecular composition |
issues. In the case of adenovirus, there is as yet no atomic structure for the intact virion. In 1985, a prelimi nary X-ray crystallographic density map of the Ad2 hexon showed that the capsomer was a trimer of polypeptide II with a triangular top and a pseu- dohexagonal base [19]. Together with the early electron microscopy of the intact virion [1], the crystallographically observed hexon symmetry fixed the copy number of polypeptide II at 720 in the Ad virion. The stoichiometry of eight other structural proteins (III, Ilia, IV, V, VI, VII, VIII, and IX) was inferred by careful sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analyses of radiolabeled virions ([^^S] methionine) using hexon as the standard [20]. After adenovirus protease cleavage sites were found in the sequences of polypeptides Ilia, VI, and VIII [18], changing the number of methionines in the mature proteins, their predicted copy numbers were revised [21]. The molecular stoichiometry indicated that there is symmetry mismatch in the Ad penton [20]. Symmetry mismatches are not unheard of in icosahedral viruses. One example is SV40, which has pentamers of VPl at sites of both local fivefold and sixfold symmetry in the crystal structure [22]. The conformationally flexible C-termini of VPl are able to adapt to the position of the pentamer within the SV40 capsid. In the case of adenovirus, three copies of polypeptide IV form the fiber and five copies of polypeptide III form the penton base. The fiber and penton base together compose the penton, which sits at the fivefold symmetry axes of the icosahedral capsid. Microheterogeneity in the Ad penton base has been offered as an explanation for the symmetry mismatch [20]. 1. Adenovirus Structure More recently a reversed-phase high-performance Hquid chromato graphic (RP-HPLC) assay was developed in order to more fully characterize the Ad5 proteome [23]. N-terminal protein sequencing and matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectroscopy were used to identify each component protein contributing at least 2% to the total protein mass of the virus. Peaks for the fiber protein, which contributes only 1.8% of the total protein mass, as well as the terminal protein and the protease, were not identified. The mass of the remaining structural proteins was determined to within ± 0 . 1 % . Their copy numbers were estimated using hexon as the standard and with the exception of the copy number for the core polypeptide VII, which was significantly reduced, the new copy numbers are in good agreement with the SDS-PAGE numbers [20, 21]. The precise mass measurements confirmed the proteolytic processing of polypeptides Ilia, VI, VII, VIII, and mu and interestingly cleaved precursor products of all but polypeptide Ilia were found to be present in the purified Ad5 virions. III. Structure of the Intact Virion In 1991 the first structure of an intact Ad particle was determined by cryo- electron microscopy (cryo-EM) and three-dimensional image reconstruction methods [24]. The technique of cryo-EM was developed in the mid-1980s by Dubochet and colleagues [25] for imaging viruses and other macromolecular assemblies in a native-like, frozen-hydrated state. Since then it has proven to be a powerful approach for studying icosahedral viruses and it has been applied to numerous members of over 20 different viral families [26]. The method involves placing a droplet of concentrated virus on an EM grid layered with a holey carbon film (carbon with holes 1-10 ixm in diameter), blotting with a piece of filter paper to leave a thin (~1000 A) layer of water and sample stretched across the holes of the grid, and then plunge freezing into a cryogen such as ethane slush chilled by liquid nitrogen. This rapid freezing causes formation of vitreous (amorphous) ice rather than crystalline ice. Formation of normal crystalline (hexagonal) ice would be harmful to the biological sample because of its expansion relative to liquid water. After cryo-freezing the sample grids are maintained at liquid nitrogen temperature to preserve the vitreous state. Transmission electron micrographs are collected using a low dose of electrons to avoid significant radiation damage to the frozen, unstained sample. The real power of the technique lies in the fact that many particle images can be computationally combined to generate a three-dimensional density map [26-28]. In the early 35-A-resolution reconstruction of Ad2, the features of the icosahedral protein capsid were clear and its dimensions without the fiber were measured as 914, 884, and 870 A along the five-, two-, and threefold symmetry Phoebe L. Stev^art axes, respectively [24]. The reconstruction showed the trimeric shape of the hexon, the pentameric shape of the penton base, and a short portion (^^88 A) of the fiber shaft. The full-length fiber, ~300 A long including the knob at the distal end, was occasionally visible in cryo-electron micrographs. Comparison of these particle images with projections of modeled full-length fibers indicated that the knobs were not positioned as would be expected if the fibers were straight. This suggested that the Ad fibers in the intact Ad2 particle are bent or flexible. Electron micrographs of negatively stained Ad2 fibers show a bend close to the N-terminal end, which binds the penton base [29]. A pseudo repeat of 15 residues was noted in the central section of the Ad2 fiber sequence [30] and later analysis of the fiber sequences from a variety of Ad serotypes revealed a range of 6-23 pseudorepeats in the shaft [31]. A long, nonconsensus repeat at motif 3 was proposed to induce a bend in the shaft of many Ad serotypes [31]. The idea that the fiber is bent for many Ad serotypes is consistent with both negative-stain electron micrographs [29] and the fact that only a short rigid portion of the Ad2 fiber shaft was reconstructed [24]. A more recent cryo-EM reconstruction of Ad2 [3] is shown in Fig. 1 (see color insert) with modeled full-length fibers. Reconstructions have now been pubHshed of Ad2 at 17-A resolution [32], Ad5 [33], Adl2 [3], Ad2 complexed with a Fab fragment from a monoclonal antibody directed against the integrin-binding region of the penton base [34], both Ad2 and Adl2 complexed with a soluble form of avp5 integrin, the internalization receptor for many Ad serotypes [3], and a fiberless Ad5 vector [33]. The capsids of these Ad serotypes appear quite similar, with only subtle differences observed in the size and flexibility of the surface protrusions of the hexon and penton base [3]. IV. Structure of the Capsid Components A. Hexon, Polypeptide II Crystal structures have been published for hexon of serotype Ad2 [5] and Ad5 [6], two members of subgroup C. The sequences of these hexons (967 amino acids for Ad2, 951 for Ad5) are closely related with 86% amino acid identity. Both structures show that the monomer has two eight-stranded P-barrels at the base and long loops that intertwine in the trimer to form a triangularly shaped top (Fig. 2). The high degree of interlocking observed between the monomers might explain why an adenovirus-encoded 100-kDa protein is required for trimer assembly [35]. In the trimer the six ^-barrels, two from each monomer, form a ring with pseudohexagonal symmetry that allows for close packing with six neighboring capsomers in the icosahedral capsid. Regions of the electron density for the Ad2 hexon, refined to 2.9-A resolution. 1. Adenovirus Structure Figure 2 The crystallographic structure of the Ad5 hexon trimer [6] with one monomer shown in block (PDB ID: 1RUX [90]). (A) A side view showing the two p-borrels near the bottom of the block monomer. Note that there are several gaps in the atomic model at the top of the molecule. (B) A top view revealing the pseudohexagonal shape of the bottom of the trimer. This figure was generated with the program MOLSCRIPT [91 ]. were unclear and gaps were left in the atomic model. During refinement of the Ad5 hexon to 2.5-A resolution, significant changes were made in the atomic model involving reassignment of greater than 25% of the sequence. In light of this result and the high homology between the two hexons, it has been suggested that the Ad2 atomic model should be revised [6], The most significant change was a shift of the first 130 amino acids leaving a gap of just four residues at the N-terminus of the Ad5 structure vs an N-terminal gap of 43 residues in the initial Ad2 model. Phoebe L. Ste>vart Revision of the hexon structure has cleared up several mysteries in the lit erature. First, a comprehensive comparison of hexon sequences from serotypes in all six human subgroups as v^ell as bovine and mouse serotypes found seven hypervariable regions [36]. Alignment vv̂ ith the Ad2 hexon structure indicated that five regions w êre in exposed loops as expected, v^hile tw ô regions w êre buried. The Ad5 hexon structure nov^ show ŝ all seven hypervariable loops exposed on the top of the molecule [6]. Second, trypsin cleavage sites v^ere identified at Arg-142 and Arg-165 in Ad2 [37] and these are nov\̂ located in the exposed top of the hexon molecule [6]. Similarly a pH-dependent cleavage site for the proteolytic enzyme dispase w âs found somew^here betw^een residues 135 and 150 of the Ad2 hexon [38]. In the original Ad2 hexon structure this stretch w âs buried and far from the top of the molecule. In the Ad5 hexon structure this region is likely exposed on the molecule, although it is in an unmodeled region of the structure [6]. The Ad5 structure places a previously buried highly acidic stretch of residues, 133-161 for Ad2, at the top of the molecule and accessible to solvent [6]. The acidic region is also found in the Ad5 hexon sequence, but not in those of Ad9, Adl2, or Ad37. In the Ad8 hexon sequence there is a longer, slightly basic insertion at this position [36]. It has been suggested that the acidic stretch may create an electrostatic repulsion betw^een the exterior of the Ad2 or Ad5 virion and acidic cell surface proteins [39]. Others have proposed that perhaps the acidic region plays a role in tissue tropism for the subgroup C viruses [40]. B. Penton Base, Polypeptide III In the absence of a crystal structure for the penton base, structural information on this protein comes mainly from cryo-EM reconstructions of the dodecahedron formed by Ad3 pentons [41] and intact Ad virions of various serotypes [3, 32-34]. Alignment of the know^n penton base sequences from subgroups A, B, C, and E shoves high homology throughout the protein except for a central variable length region that contains the nearly alw^ays conserved Arg-Gly-Asp (RGD) sequence, residues 340-342 for Ad2 [4,42]. The Ad2 and Ad5 penton bases (571 residues each) have among the longest variable RGD regions [4,43,44]. The RGD sequence, utilized for interaction w îth cellular av integrins [4,45], is lacking from the enteric Ad40 and Ad41 serotypes of subgroup F [46]. Presumably these tv^o serotypes don't interact with av integrins during viral cell entry. Site-directed mutagenesis of the Ad2 penton base has indicated particular residues that are important for various functions including pentamerization and stable fiber-penton base interaction [47]. While recombinantly expressed Ad2 penton base is knov^n to self-assemble into homo-pentamers, tw ô mutations in the N-terminal portion of penton base, R254E and W119 H, and several 1. Adenovirus Structure in the C-terminal region, W439 H, Y553F, and K556E, reduce or abolish pentamerization. Several mutations, C432S, W439 H, RRR(547-549)EQQ, and K556E, completely abolish the association of fiber with penton base. Other mutations throughout the penton base (W119 H, Wl 65 H, R245E, R340E, and W406H) reduce the penton base interaction with fiber. Screening with a filamentous phage-display library indicated that the Ad2 penton base sequence RLSNLLG, residues 254-260, is important for fiber binding [48]. One of these residues, R245E, was also identified by mutagenesis, but clearly residues throughout the penton base play a role in fiber association. Electron micrographs of negatively stained penton base, fiber, and the penton complex indicate that the isolated fiber is '^40 A longer than the fiber that extends from the penton base [29]. It is not clear whether or not the N-terminal end of the fiber inserts into a central cavity of the penton base or merely attaches to the outer surface. Cryo-EM reconstructions of the Ad3 penton dodecahedron both with and without the fiber reveal a subtle shift of the RGD protrusions outward by ^^15 |
A when the fiber is present, but no open hole in the fiberless complex [41]. A similar observation was made for an Ad5 vector both with and without the fiber [33]. These results indicate a subtle conformational change of the penton base during fiber binding and possible expansion of the penton base to allow insertion of the N-terminal end of the fiber. Numerous Ad serotypes are known to utilize the RGD residues for infection via interaction with cell surface av integrins [4,45]. The position of RGD on the penton base has been determined by a cryo-EM reconstruction of Ad2 complexed with Fab fragments of the DAV-1 monoclonal antibody [34]. Curiously, Fab fragments of DAV-1 are capable of neutralizing Ad2 infection, but the biologically relevant DAV-1 IgG molecules are not. MALDI mass spectroscopy identified the DAV-1 binding site as containing a linear epitope of nine residues including RGD [34]. The cryo-EM structure of the Ad2/DAV-1 complex localized the RGD residues to the top of five 22-A protrusions on the penton base. The observation of weak density at the top of the protrusions in the control uncomplexed Ad2 reconstruction, as well as the diffuse nature of the bound Fab density, indicated that the RGD residues are in a highly mobile surface loop [34]. Perhaps the mobility of the RGD loops, as well as their relatively close spacing around the central protruding fiber (Fig. 3, see color insert), contributes to the ability of the virus to evade antibody neutralization at this exposed receptor binding site [34]. The combined steric hindrance of the fiber and a few bulky IgG molecules bound to flexible epitopes effectively shields the remaining RGD sites from saturation by IgG, while the less bulky Fab fragments can bind to all five protrusions. Prior to complexing adenovirus with a soluble form of avp5 integrin, a comparison between the known penton base sequences indicated that Ad 12 has the conserved RGD residues within a much shorter variable region than 8 Phoebe L Stewart Ad2 [3]. Cryo-EM reconstructions of both Ad2 and Ad 12 complexed with avp5 revealed better defined integrin density in the Ad 12 reconstruction, sug gestive of a less mobile RGD loop for Adl2. A careful analysis of the penton base density in the control Ad2 and Ad 12 reconstructions also supported this idea w îth a smaller region of weak, diffuse density over the Ad 12 protrusions than the Ad2 protrusions (Fig. 4, see color insert). The spacing of the RGD protrusions on the penton base is thought to be important for the clustering of integrin molecules, thus triggering signaling events required for virus inter nalization [3]. Notably a monomeric RGD peptide (50-mer) derived from the penton base is unable to activate p72 Syk kinase or promote adhesion of B lymphoblastoid cells, two demonstrated functions of the pentameric penton base [49]. Structural support for the importance of the RGD spacing comes from the crystal structure of foot-and-mouth disease virus, which also utilizes av integrins for cell entry [50, 51]. The RGD loops of both the Ad penton base and foot-and-mouth disease virus have the same spacing, 60 A, around the fivefold symmetry axes despite these two viruses being structurally and evolutionarily unrelated [3]. C. Fiber, Polypeptide IV All human Ad serotypes have 12 fibers, one protruding from each penton base at the vertices of the icosahedral capsid. The length of the fiber protein varies from 320 to 587 residues and the sequence can be broken down into three segments: an N-terminal tail, a central shaft of variable length, and the C-terminal domain, which forms the distal knob of the fiber [31]. Biopanning of a phage-library peptide library has shown that the conserved N-terminal motif (FNPVYP, residues 11-16 in Ad2) interacts with the penton base [48]. The knob of most, but not all, serotypes [52] has a high affinity for the cellular receptor known as Coxsackie and adenovirus receptor (CAR) [53, 54]. Although a single fiber gene is the norm, Ad40 and Ad41 have two fiber genes of different length[31,55]. Perhaps the expression of two different fibers enables the virus to interact with a wider array of cell receptors as the knobs are quite different [55] and only one fiber type binds CAR [11]. Although there are two fiber genes in Ad40 and Ad41, only one fiber is found per penton. Notably, avian adenoviruses have two fibers per penton and they may have evolved distinct cell-entry strategies [56-58]. The first atomic resolution information for the fiber was a crystal structure of the Ad5 knob domain (residues 386-581 of the intact fiber protein) [7, 8]. The structure revealed a trimer with an eight-stranded antiparallel p-sandwich in each monomer (Fig. 5). More recently, crystal structures have been published of the Ad2 knob [9], and the Ad 12 knob both alone and complexed with the Dl domain of CAR [11]. The main differences between the knob structures are found in the N-terminal region and the loops. The Adl2 knob/CAR-Dl 1 . Adenov i rus Structure Figure 5 The crystallographic structure of the Ad2 fiber knob and a portion of the fiber shaft [10] (PDB ID: IQIU [90]). The trimeric molecule is shown with one monomer in black and two in gray. (A) A side view oriented to show the eight-stranded p sandwich in the knob domain of the black monomer and four repeats of the triple p-spiral fold in the shaft. (B) A top view looking along the molecular threefold axis in the direction of the virus. This figure was generated with the program MOLSCRIPT[91]. complex reveals that the CAR binding site is on the side of the knob and involves primarily the AB-loop [11]. Two models, both high in ^-strand content, were predicted for the fiber shaft [30, 59] before a crystal structure was published for a portion of the Ad2 shaft in 1999 [10]. The structure shows a novel triple ^-spiral motif (Fig. 5) that is different from either model in that the P-strands lie more along the fiber axis. The hydrogen bonding pattern observed in the structure suggests that 1 0 Phoebe L. Stewart the basic repeating structural motif should be redefined. Also a linker region was observed between the shaft and the knob, indicating that Ad2 has only 21 repeats, as opposed to 22 suggested by the earlier sequence analysis [30]. As noted in section III, fiber shafts of various serotypes appear by both negative stain electron microscopy [29] and cryo-EM [24] to be bent near the N-terminus, presumably in the region of the third fiber shaft repeat [31]. Some of the fibers with short shafts may, however, be relatively straight. The cryo- EM reconstruction of the Ad3 penton dodecahedron showed the full-length straight fiber including the knob extending 136 A from the penton base [41]. D. Polypeptide Ilia Polypeptide Ilia plays an important role in the assembly of adenovirus, as a temperature-sensitive mutation in polypeptide Ilia produces only empty capsids [60]. The full-length polypeptide Ilia, prior to proteolytic cleavage, is 585 residues for Ad2 [43]. A protease cleavage site was predicted after residue 570 [18] and the MALDI-TOF mass spectroscopic analysis of Ad5 confirms that this cleavage does occur [23]. According to both the SDS-PAGE analysis [20, 21] and the RP-HPLC analysis [23] there are approximately 60 copies of polypeptide Ilia in one adenovirus virion. The position of polypeptide Ilia within the capsid has been tentatively assigned in a cryo-EM difference map [61]. The difference map was generated by positioning 240 copies of the crystallographic Ad2 hexon [5] within the cryo-EM reconstruction of Ad2 [24] and then subtracting the hexon density. The hexon positions in the calculated capsid, published in [21], were optimized for their agreement with the cryo-EM reconstruction rather than for optimum contacts between hexons and as such represent only a crude pseudoatomic model for the hexon portion of the capsid. Approximately 65% of the density assigned to polypeptide Ilia was observed on the external surface of the capsid and the other 35% on the inner surface [21,61]. Contradictory biochemical information indicated that polypeptide Ilia is exposed on both the inner and outer capsid surfaces and thus it had been suggested that this protein might span the capsid [62]. The external density assigned to polypeptide Ilia is clearly visible without difference mapping in the recent 17-A resolution of Ad2 [32] (Fig. 6, see color insert). Two elongated density regions are observed along each of the 30 edges of the icosahedral capsid. E. Polypeptide VI The full-length precursor form of the Ad2 polypeptide VI has 250 residues [63], but 33 residues are cleaved by the protease from the N-terminus and 11 residues from the C-terminus [18, 23], Interestingly the cleaved C- terminal peptide functions as a cofactor for the protease [64, 65]. Analysis of 1. Adenovirus Structure 1 1 the Ad2 cryo-EM difference map led to an assignment for polypeptide VI on the inner capsid surface [61]. Trimeric density regions were observed spanning the bottoms of the five hexons around each penton, often called the peripentonal hexons on the basis of their location in the capsid. The assigned positions are indicated on the outer surface of the 17 A Ad2 reconstruction [32] (Fig. 7, see color insert). In order to account for ^360 copies of polypeptide VI in the virion [20, 21, 23], each trimeric density region w âs suggested to be a trimer of dimers [61]. In other v^ords, six copies of polypeptide VI might form each observed trimeric density region. Five trimeric regions found in one vertex w^ould contain 30 copies of polypeptide VI, and all 12 vertices w^ould have a total of 360 copies. The observed volume of one trimeric region is too lov^ to account for six copies of polypeptide VI, but a large portion of the protein may be loosely ordered and interacting w îth the viral core. It has been know^n for some time that polypeptide VI can bind nonspecifically to DNA [66] and thus the proposed location on the inner capsid surface seems logical. F. Polypeptide VIII The sequence of polypeptide VIII in both Ad2 [67, 68] and Ad5 [44] indicates an uncleaved precursor molecule of 227 amino acid residues. Protease cleavage sites are predicted for molecules of both serotypes follow^ing Gly- 111, v^hich implies a much smaller mature protein [18]. MALDI-TOF mass spectroscopy confirms this cleavage site for Ad5 and also indicates a second cleavage site after Ala-15 7, as the fragment from Gly-158 through the C- terminus is found in the virion [23]. Polypeptide VIII is present in roughly 127 copies per virion [20, 21], but little is knov^n about its structure or its position v^ithin the virion other than the general observation that it is associated v^ith hexons [69]. G. Polypeptide IX Polypeptide IX is thought to help stabilize adenovirus as mutant virions lacking this protein are less stable than vŝ ild type [70]. In Ad2, polypeptide IX is 140 residues [71] and it is not cleaved by the viral protease. This capsid component can be isolated from both intact virions and from the viral dissociation product known as the group-of-nine hexons [69]. Scanning transmission electron microscopy (STEM) analysis of the group-of-nine hexons indicated that there are 12 copies of polypeptide IX arranged as four trimers within this capsid fragment [72]. The Ad2 cryo-EM difference map confirmed this arrangement and showed that polypeptide IX is on the outer surface of the capsid [61]. The locations of the polypeptide IX trimers are indicated on the 17-A resolution Ad2 cryo-EM reconstruction [32] (Fig. 8, see color insert). The copy number for polypeptide IX has been measured as approximately 1 2 Phoebe L Stewart 240 [20, 21, 23] and this is consistent with four trimers in each of the 20 triangular facets of the icosahedral capsid. V. Core Structure The first cryo-EM reconstruction of Ad2 showed that the DNA/protein core does not follow icosahedral symmetry throughout, although the outer sur face of the core does interact with the capsid and may be partially ordered [24]. There is presently no atomic structure known for any of the core proteins (V, VII, mu, and terminal protein). Ad2 was the first serotype to be completely sequenced and its DNA genome has 35,937 base pairs [43]. The two 5̂ ends of the DNA genome are covalently linked to the terminal protein [73] |
via Ser-562 [74]. Terminal protein (488 residues in Ad2) is the proteolytically cleaved form of the preterminal protein (653 amino acids in Ad2) [74-76]. It has been proposed that the terminal protein-DNA complex, present in the mature virion, serves as a template for early transcription and the first round of DNA replication, while the preterminal protein-DNA complex formed after DNA replication serves only for subsequent rounds of DNA replication [77]. In the Ad core the terminal protein-DNA complex is associated with ^^160 copies of polypeptide V [20, 23], ^633 copies of polypeptide VII [23], and -^104 copies of late L2 mu, also known as polypeptide X [78]. Little is known about polypeptide V (369 amino acids in Ad2) [79]other than the fact that it is moderately basic [69]. The polypeptide VII precursor (198 amino acids in Ad2) [44]and mu precursor (79 amino acids in Ad2) [80]are both cleaved by the viral protease. Of the three core proteins that are noncovalently linked to the viral DNA, polypeptide VII is most tightly bound [81] and it is sometimes referred to as the major core protein since it contributes the most protein mass to the core. VI . Adenovirus Protease The adenovirus protease plays a role in maturation of the virus, cleaving six virion precursors (Ilia, VI, VII, VIII, mu, and terminal protein) [18]. Analysis of the temperature-sensitive mutant virion, ts 1 [82], indicates that the protease also plays a role during Ad cell entry [83, 84]. The observation that the cleavage products of polypeptides VI, VII, VIII, and mu are present in the mature Ad5 virion [23] is consistent with the idea that the adenovirus protease is incorporated inside of the viral capsid and that peptide cleavage takes place either on the inner surface of the capsid or in the core of the virion [18]. The cleaved C-terminal tail of polypeptide VI serves as a cofactor for the protease [64, 65] increasing its catalytic rate constant (^cat) by 300- fold [85]. It has also been reported that viral DNA is a cofactor [64, 85] 1. Adenovirus Structure 1 3 Figure 9 The crystallographic structure of the Ad2 protease (gray) with its 11 -amino-acid cofac- tor (black), a proteolytic cleavage product of polypeptide VI [12] (PDB ID: 1AVP[90]). Note that the cofactor extends a p-sheet in the enzyme. This figure was generated with the program MOLSCRIPT[91]. although this is disputed in the Uterature. Other studies suggest that DNA may not be necessary for catalysis, but rather might enhance the interaction of protease and substrates in vivo [86]. Either way, the apoenzyme is relatively inactive and thus the cofactor(s) may help to control the activity of the enzyme so that the virion proteins are cleaved at the appropriate time during the viral life cycle. A crystal structure has been determined for the protease of Ad2 (204 amino acids) complexed vv̂ ith its 11-amino-acid cofactor (Fig. 9) [12]. The structure reveals that the peptide cofactor becomes the sixth p-strand in a P-sheet and forms a disulfide bond and numerous hydrogen bonds with the protease. The hydrophobic pockets observed in the structure help to explain the known consensus sequences for cleavage, which are (M,L,I)XGX/G or (M,L,I)XGG/X where X is any residues and "/" indicates the cleavage site [87, 88]. The active site contains a Cys-His-Glu triplet and an oxyanion hole similar to papain and the Ad protease probably has a similar catalytic mechanism to papain. However, the fold as well as the order of the catalytic residues in the sequence is different in the two enzymes. The Ad protease is considered to be the first member of a fifth group of cysteine proteases [12]. VII. Summary Adenovirus is a complex human virus whose structure still holds many mysteries. The synthesis of results from a diverse array of experimental tech niques has led to our current level of understanding. MALDI-TOF mass spectroscopy [23] has confirmed the predicted protease cleavage sites [18] of 1 4 Phoebe L. Stewart several structural proteins. The use of phage-display libraries has pinpointed the residues involved in the interaction betv^een penton base and fiber [48], w^hich w âs first observed by negative stain electron microscopy [2]. X-ray crys tallography [6] and sequence analysis [36] together reveal the hypervariable regions of hexon at the top of the molecule w^here the most variation is toler ated. The early biochemical characterization of the component molecules [69] was advantageous for interpreting the first cryo-EM reconstruction [24] and difference map [61]. Identification of the CAR receptor [53, 54] and the crys tal structure of a fiber knob complexed with one domain of CAR [11] have advanced our understanding of cell attachment. The finding that av integrins are utilized as internalization receptors by many serotypes [89] led to the observations by cryo-EM that the penton base ROD protrusions are located appropriately to both evade antibody neutralization [34] and facilitate receptor clustering [3]. Clearly the more we learn about adenovirus structure, assembly, and cell entry, the better our position will be for designing the adenoviral vectors of the future. Acknowledgments Hundreds of people have contributed to our understanding of adenovirus structure over the past 40+ years and I acknowledge their efforts even though they may not all be cited in this chapter. I gratefully thank Dr. Charles Chiu, a talented and productive former member of my laboratory; Dr. Glen Nemerow, a supportive collaborator; and John Ho and Moin Vera for their assistance with figure preparation. References 1. Home, R. W., Brenner, S., Waterson, A. P., and Wildy, P. (1959). The icosahedral form of adenovirus./. Mo/. 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N., Weissig, H., Shindyalov, I. N., and Bourne, P. E. (2000). The Protein Data Bank. Nucleic Acids Res. 28, 235-242. 91. KrauHs, P. J. (1991). MOLSCRIPT: A program to produce both detailed and schematic plots of protein structures. / . Appl. Crystallogr. 24, 946-950. C H A P T E R Biology of Adenovirus Cell Entry Glen R. Nemerow^ Department of Immunology The Scripps Research Institute Lo Jolla, California I. PathvNfay of Adenovirus Cell Entry Adenoviruses cause a significant number of acute respiratory, gastroin testinal, and ocular infections in man. While these infections are usually self-limiting they can result in significant morbidity and in immunocompro mised individuals are capable of causing fatal disseminated infections [1]. Among the ^^50 different adenovirus (Ad) serotypes, representing six different subgroups (A-F) [2, 3], the majority of information on the molecular basis of host cell interactions is derived from studies on the closely related types 2 and 5 (subgroup C) [4]. It is, therefore, not surprising that replication-defective forms of Ad5 are currently being used for most in vitro and in vivo gene delivery applications [5, 6]. Despite some reported successes, adenovirus-mediated gene delivery remains hampered due in large part to the host immune response to viral proteins [7, 8]. Increased knowledge of Ad structure [9, 10] and host cell interactions [11] may allov^ redesigning of viral vectors in order to avoid some of the major problems in this area. Ad types 2/5 bind to cells via their fiber protein [12], which recognizes a 46-kDa cell receptor known as CAR (Coxsackie and adenovirus receptor) [13, 14]. However, this high-affinity receptor interaction is unable to promote efficient virus uptake into the host cell. Instead, secondary interactions of the virus penton base protein with avp3 or avP5 integrins facilitates virus internalization [15] (Fig. 1). Adenovirus particles enter cells via ~120 nM clathrin-coated pits and vesicles [16]. Hela cells expressing a mutant form of dynamin; a large GTPase associated with endosome formation, fail to support efficient virus uptake or infection, indicating that clathrin/receptor-mediated endocytosis is the primary pathway of Ad2/5 infection of host cells [17]. Adenovirus internalization also requires the participation of cell signaling ADENOVIRAL VECTORS FOR GENE THERAPY 1 O Copyright 2002, Elsevier Science (USA). All rights reserved. 20 Glen R. Nemerow Actin Reorganization Adenovirus Internalization Figure 1 Schematic diagram of adenovirus cell entry events. Virus attachment is mediated by fiber protein (black) association with CAR. Subsequent interaction of the penton base (light gray) v/ith av integrins (dark gray) promotes Ad internalization. Integrin-mediated Ad internalization also requires the participation of several signaling molecules (c-Src, p i 30CAS, PI 3K, and Rho GTPAses) that mediate actin polymerization. molecules including phosphatidylinositol 3-OH kinase [18], a lipid kinase that regulates a number of important host cell functions. These signaling proteins form a complex that promotes the polymerization of cortical actin filaments needed to efficiently internalize virus particles [16, 19]. Similar processes are used for cell invasion by a number of pathogenic bacteria [20, 21]. While the role of actin in virus or bacteria cell entry has not been clearly defined, polymerized actin filaments may serve as a |
scaffold to prolong the half-life of signaling complexes or they may provide the mechanical force necessary for the formation of endocytic vacuoles [22-24]. 2. Biology of Adenovirus Cell Entry 2 1 An important step of Ad entry postinternalization involves disruption of the early endosome allov^ing escape of virions into the cytoplasm prior to degradation by lysosomal proteases [25-27]. As is the case for many nonen- veloped viruses, the precise mechanisms involved in Ad-mediated endosome penetration remain poorly defined. The majority of studies indicate that expo sure of the virus to mildly acidic conditions (~pH 6.0) are sufficient to initiate the loss of key virus coat proteins as w êll as activate the viral encoded cysteine protease. Hov^ever, there is not complete agreement on the requirement for a proton gradient in the early endosome to initiate its disruption [28]. Follow^ing endosome disruption, adenovirus particles are rapidly (30-60 min) translo cated from the cytoplasm to the nucleus. Transmission electron micrographs obtained by several investigators have show^n that viral capsids are docked at the nuclear pore complex [29, 30]. Current information indicates that virus association w îth microtubules [31] may play a key role in nuclear transport. Biochemical analyses have indicated that the majority of the viral capsid remains in the cytoplasm during transport of the viral genome into the nucleus [32]. This latter process appears to require the major host cell factors involved in nuclear import, the heat-shock p70 protein (Hsp70) and perhaps other cellular factors [33]. Viral gene expression and/or viral replication takes place once nuclear transport has occurred and ultimately results in the generation of transgene products in the case of viral vectors or in progeny virions in the case of w^ild-type particles. As is the case w îth many human pathogens, important questions remain to be answ^ered regarding the precise mechanisms involved in each step of adenovirus cell entry. II. Cell Receptors Involved in Attachment A. CAR Studies carried out by Lonberg-Holm et aL [34] first demonstrated that adenovirus and Coxsackie B viruses share the same receptor. A function- blocking monoclonal antibody was subsequently raised against the adenovirus receptor [35]; however, it was only recently that this antibody was used to identify the attachment receptor, CAR [13]. A murine homolog (MCAR) of human CAR (HCAR) is also capable of serving as an Ad attachment receptor [14]. The mechanisms by which CAR expression is regulated in different cell types as well its role in normal host cell functions have not yet been determined. The gene encoding HCAR was recently localized to the short arm of chromosome 21 [36], a finding that may provide further clues to the function and/or regulation of this receptor. The extracellular domain of CAR contains two Ig-like domains but only the most N-terminal domain is necessary for virus interaction [37]. HCAR is anchored in the cell membrane 2 2 Glen R. Nemerow by a single transmembrane domain followed by a relatively long cytoplasmic tail. Previous studies have indicated that only the extracellular domain of CAR is required for adenovirus-mediated gene delivery since recombinant forms of CAR lacking the cytoplasmic tail are fully capable of supporting virus infection [38]. These studies indicate that signaling events are probably not involved in CAR-mediated virus attachment. Several lines of evidence indicate that CAR is a major determinant of Ad infection in vivo. For example, CAR expression is particularly high in cardiac tissue [14] and this correlates with efficient Ad-transgene delivery to the heart in vivo [39, 40]. In contrast, CAR expression is low or absent in primary human fibroblast [41] as well as most hematopoietic cells [42, 43] and these cell types are also difficult to infect with Ad5-based vectors. CAR expression is also limited to the basolateral surface of ciliated airway epithelial cells [44] and this has hampered efficient Ad-mediated gene delivery to the apical surface of these cells [45, 46]. Other investigators have reported that certain cell culturing conditions may also alter CAR expression and, thereby, influence Ad-mediated gene delivery [47]. The recent generation of transgenic mice expressing high levels of HCAR on peripheral blood lymphocytes has allowed efficient transduction of these cells by Ad5 vectors [48]. Ad binding to CAR is mediated by a high-affinity interaction with the fiber knob domain {K^ ~ 1 nM). There are approximately 30-50,000 CAR molecules per epithefial cell depending upon the tissue type [15]. Recent high-resolution structure studies and mutagenesis experiments have shed con siderable light on the molecular basis for fiber-CAR association. Bewley and coworkers have solved the crystal structure of the Ad 12 fiber knob domain in a complex with the first Ig-domain of CAR [49]. The cocrystal structure revealed that CAR interacts with the lateral surface of the fiber knob rather than on top of the fiber as had been predicted in earlier structure studies of the Ad5 fiber [50]. The CAR binding sites, which are composed of multiple regions on extended loop structures, are situated at the interface between individual fiber monomers. As many as three CAR molecules could bind to each fiber knob domain; however, this has not been formally demonstrated. Roelvink and colleagues reported that highly conserved amino acid residues located in the AB loop of the fiber knob domain of adenovirus types are involved in CAR binding as well as in the cocrystal contacts [49]. In contrast, divergent sequences are present in the same region of Ad types (i.e., subgroup B) which do not use CAR [51, 52]. They also showed that site-specific mutations in the AB loop significantly reduced virus binding and infection. The identification of the precise regions in the fiber involved in CAR association has provided an opportunity to generate novel Ad vectors in which the CAR binding sites have been deleted and new receptor binding epitopes inserted (i.e. HI loop). Roelvink et al. have demonstrated the feasibility of this approach by redirecting an Ad5 vector containing a CAR-binding mutation to 2. Biology of Adenovirus Cell Entry 2 3 a novel host cell molecule [52]. Thus, the development of new Ad vectors vî ith increased host cell specificity may be on the horizon. B. Other Adenovirus Receptors Although CAR represents the major host cell receptor for Ad binding and infection, recent studies have suggested that other host cell molecules may also serve as attachment receptors. The a2 domain of MHC class I molecules has been reported to serve as a receptor for Ad5 particles based on competi tion experiments with phage-display peptides [53]. At the present time, these findings have yet to be confirmed by other investigators and thus it remains uncertain as to whether MHC class 1 molecules are specific Ad receptors. Recently Dechecchi et al. provided data suggesting that heparin sulfate pro teoglycans (HSPGs) may also promote cell attachment of subgroup C (Ad2/5) but not subgroup B (Ad3) virus particles [54]. These findings suggest that HSPG may work in concert with CAR to facilitate high-affinity subgroup C virus binding to cells. These investigators also suggested that heparin sulfate proteoglycan interactions may occur via a site(s) located in the fiber shaft rather in the knob domain. Belin and Boulanger have also analyzed host cell proteins capable of interacting with virus particles by cross-linked Ad2 to Hela cells. They showed that cross-hnked virus was bound to three major host cell proteins with molecular weights of 130, 60, and 44 kDa \SS\ They concluded that the 130-kDa protein was a pi integrin subunit; however, they did not identify the lower molecular weight proteins. Based on its apparent mobility on SDS gels, the 44-kDa protein likely is CAR. Ad types belonging to subgroup B that lack the conserved CAR binding residues noted above are very likely to use alternative cell receptors; however, these molecules have yet to be fully characterized. For example, serotypes 3 and 7 have been shown to bind to cells in a CAR-independent manner since the fiber proteins from these types fail to compete Ad5 fiber binding to cells \SG\. While the receptor for subgroup B adenoviruses have not been identified, a partial characterization of a candidate receptor has been reported \S1\, Additional investigations have indicated that Ad serotypes belonging to other subgroups may also use distinct cell receptors for virus attachment. Using virus protein blot assays, Roelvink et a\, demonstrated that Ad serotypes belonging to subgroups A, C, D, E, and F were capable of binding to CAR [51]; however, these investigators did not establish that different virus types were actually capable of associating with CAR on intact cells. This distinction may be important given the fact that there are structural differences in the fiber proteins of different Ad serotypes. For example, adenoviruses from subgroup B and D fibers have relatively short and inflexible fiber shaft domains. These structural features could restrict interaction with CAR on the lateral surface 2 4 Glen R. Nemerow of a short-shafted fiber. In support of this, Shayakhmetov and Lieber found that truncated Ad5 fiber molecules have reduced binding capacity [58]. Huang et al. previously showed that Ad37 (a subgroup D serotype) contains a short- shafted fiber protein displaying the conserved CAR binding residues in its AB loop, but fails to efficiently infect CAR-expressing epithelial cells. Instead, a critical lysine residue at position 240 in the CD loop of the Ad37 fiber knob, mediates association with a cell receptor, expressed on conjunctiva epithelial cells [59]. Arnberg and coworkers also reported that Ad37 does not use CAR but instead recognize sialic acid residues present on one or more unidentified cell membrane proteins [60]. In recent studies, Wu et aL discovered that a 60-kDa protein expressed on diverse cell types is recognized by Ad37 particles and that this association is dependent upon sialic acid [61]. These authors also found that a 50-kDa membrane protein that is preferentially expressed on conjunctiva and supports Ad37 binding in a sialic acid-independent manner. They concluded that the 50-kDa putative receptor represents a portal of entry for pathogenic strains of adenovirus that are associated with severe ocular infections. Further biochemical and molecular biological studies are needed to identify different Ad receptors and determine their precise role in tissue tropism and disease. Despite the fact that alternative Ad receptors have yet to be identified, new viral vectors with altered cell tropism have been generated. For example, several investigators have replaced (pseudotyped) the fiber protein in a first- generation Ad5 vector with an Ad3 or Ad7 fiber [56, 62-64]. The Ad3 pseudotyped vectors were shown to improve gene delivery to several different cell types. Thus, human lymphocytes which are very poorly transduced by Ad5 vectors supported substantially higher levels of infection with vectors equipped with the Ad3 fiber [64], presumably because of higher level of expression of the Ad3 receptor on these cells compared to CAR. Chillon et al also showed that an Ad5 vector pseudotyped with an Adl7 (subgroup D) fiber showed enhanced gene delivery to neuronal cells [65] while vectors retargeted with an Ad35 fiber improve gene delivery to stem cells [66]. It is likely that as new Ad receptors are identified, further knowledge of their tissue expression and structure should lead to improved modifications of standard El A - Ad5 vectors in order to increase host cell specificity. III. Adenovirus Internalization Receptors A. Role of av Integrins as Coreceptors In studies conducted over 40 years ago, Pereira [67] and Everitt et al. [68] described a soluble toxic factor produced during adenovirus infection that caused cell rounding. This toxic factor was later identified as the penton base 2. Biology of Adenovirus Cell Entry 2 5 protein [69]. Wickham et al. subsequently demonstrated that the penton base protein was not actually toxic, although it was capable of inducing epithelial cell detachment from plastic tissue culture surfaces. Cell detachment is due to the presence of an integrin-binding motif (RGD) in the penton base [70] that is able to compete for vitronectin, an extracellular matrix protein. In further studies, Wickham showed that penton base association with the vitronectin binding integrins av^S and avP5 promotes adenovirus internalization rather than virus attachment [15]. While the overall contribution of av integrins in adenovirus infection in vivo has not been firmly established, several lines of evidence suggest that integrins play a significant role. The penton base proteins of most adenoviruses representing different subgroups contain a conserved RGD motif and these viruses also use av integrins for |
infection [71, 72]. Interestingly, adenoviruses belonging to subgroup F (types 40, 41) lack an RGD motif and show delayed uptake into cells [73]. Bai et al. also showed that mutations in the penton base RGD motif reduce the kinetics of Ad2 infection in vitro [74]. Huang et al. demonstrated that human B lymphocytes lack av integrins and are not susceptible to infection with Ad5 vectors [43]. In contrast, transformation of B cells with Epstein-Barr virus upregulates av integrin expression and allows infection with Ad5-based vectors. Von Seggern et al. has produced a fiberless adenovirus vector that fails to bind to CAR [7S]. These particles are significantly less infectious that wildtype Ad particles; however, they can infect human monocytic cells in an integrin-dependent manner. Recently, mice genetically deficient (knockouts) in cell integrins have been generated that may allow further investigation of the role of av integrins in adenovirus infection in vivo. Bader and coworkers described the generation of mice genetically deficient in the av integrin subunit which, therefore, lack both avP3 and avp5 [7G\. Unfortunately, the majority of these animals die early during development, thus precluding analyses of adenovirus infection. Huang et al. have reported the generation of p5-integrin-deficient mice and fortunately these animals do not show enhanced developmental lethality [77]. Interestingly, P5-deficient mice did not show decreased susceptibility to adenovirus infection suggesting that expression of this coreceptor is not an absolute requirement for virus infection. However, compensatory cell entry pathways mediated by integrin avP3 or perhaps other as yet unidentified receptors may confound interpretations of these findings. While the precise contribution of integrins to adenovirus infection in vivo remains to be determined, knowledge of integrin interactions has allowed further modification of Ad vectors to take advantage of the integrin/coreceptor pathway to improve gene delivery. For example, Vigne and coworkers showed that a recombinant adenovirus containing RGD motifs inserted into the hexon protein could infect vascular smooth muscle cells in CAR independent manner [78]. Wickham and colleagues have also replaced the penton base RGD motif 2 6 Glen R. Nemerov^ with a pi-integin binding motif (LDV) [79] and suggested that this might be advantageous for expanding the cell tropism of modified Ad vectors since this receptor is broadly distributed on most cell types. B. Structural Features of Penton Base-av Integrin Association A monoclonal antibody (DAV-1) was used to localize the integrin bind ing sites on the penton base protein using cryoelectron microscopy and image reconstruction [80]. This antibody recognizes the Ad2 penton base RGD motif as well as several flanking residues (IRGDTFATR). In more recent studies, Mathias et al. have produced a soluble form of avp5 integrin containing the entire ectodomain of the receptor [81]. This recombinant protein retained ligand-binding activity and was subsequently used to examine the complex of Ad particle and soluble avP5 by cryo-EM [82] (Fig. 2, see color insert). The inte grin ectodomain consists of an N-terminal globular (proximal) region, which is attached to slender stalk-like segments that are intertwined in the cryo-EM images. Approximately four to five soluble integrin molecules were capable of binding to each penton base protein as assessed by surface plasmon resonance analyses (BIAcore), consistent with density measurements obtained in the cryo- EM studies. The integrins form a ring-like structure above the virus surface. Each integrin molecule binds at an approximately 45° angle relative to the fiber shaft, a feature that may allow multimeric receptor association. A small cleft at the base of the integrin proximal domain, which interacts with the 20 A RGD protrusion, could also be visualized (Fig. 3, see color insert). The five RGD protrusions on the penton base are spaced approximately 60 A apart. It is inter esting to note that foot-and-mouth disease virus (FMDV), a nonenveloped RNA virus that also uses integrins for infection, has a similar geometrical arrange ment of its RGD motifs [83]. This observation suggests that the precise display of RGD sites on a nanoscale level plays a key role in promoting integrin cluster ing at the cell surface. In support of this concept, Stupack et al, demonstrated that the multimeric penton base protein but not a monomeric RGD peptide could stimulate B cell signaling and cell adhesion [84]. Maheshawri et al. have also shown that conjugation of RGD peptides on a synthetic substrate with an average spacing of 50 A allows efficient integrin-mediated cell motility [85]. Integrin clustering is intimately associated with signaling processes and actin rearrangement required for efficient virus entry (discussed below). C. Signaling Events Associated with Adenovirus Internalization Association of cell integrins such as avp3 with the extracellular matrix induces the formation of focal adhesion complexes. These integrin complexes contain a number of cytoskeletal associated proteins that recognize specific amino acid sequences located in P integrin cytoplasmic domains as well 2. Biology of Adenovirus Cell Entry 2 7 as tyrosine and mitogen-activated kinases, lipid kinases, and various other adapter molecules [S6, 87]. Integrin-mediated signaling events play a crucial role in several important cell processes including cell motility, tumor cell metastasis, wound healing, and cell grov^th and differentiation [88, 89]. Integrin-mediated signaling events also facilitate host cell invasion by a number of pathogenic bacteria [90] as w êll as other viruses [91]. A general feature observed in integrin signaling is the rearrangement of actin filaments underlying the plasma membrane. Recent studies have indicated that actin assembly may play a significant role in receptor-mediated endocytosis in mammalian cells [22]. Filamentous actin could provide additional mechanical force necessary for endosome formation [24] or it may serve as a platform to stabilize the half-life of signaling complexes needed to induce receptor internalization [92]. Cytochalasin D, an agent that disrupts the actin cytoskeleton also inhibits adenovirus entry and infection [16]. Li and colleagues therefore investigated whether specific signaling events leading to actin reorganization were also involved in adenovirus internalization [19]. They found that adenovirus inter action with cells altered the cell membrane shape, induced polymerized cortical actin filaments as well as activated phosphatidylinositol-3-OH kinase (PI3K). PIP3, a major product of PI3K, acts as a second messenger in many differ ent cell signaling processes, including those regulating cytoskeletal function [93] and bacterial cell invasion [94]. Li et al. found that activation of PI3K was also required for efficient Ad internalization but not virus attachment [18]. PI3K is also capable of activating Rab5, a GTPase associated with early endosome formation. Overexpression of a dominant negative Rab5 in host cells significantly inhibits adenovirus endocytosis and infection [95]. Several lines of evidence suggest that it is the penton base interaction with integrin coreceptors that initiates the key signaling events for virus entry and infection. First, recombinant penton base but not fiber protein is capable of activating PI3K [18]. Second, fiberless adenovirus particles induce similar levels of cell signaling as wild-type fiber-containing virions [96], Finally, Bergelson et al. have shown that mutant forms of CAR that lack a normal transmembrane anchor and cytoplasmic domain support normal levels of adenovirus-mediated gene delivery [38]. In addition to PI3K, the Rho family of small GTPases including Racl, CDC42 and RhoA also are involved in adenovirus cell entry. These small GTPases are tightly regulated molecular switches that control changes in cell shape as well as actin reorganization [97] via interaction with additional downstream effector molecules such as WASP and PAKl [98]. Expression of dominant-negative forms of Rac or CDC42 reduce virus entry and infection [19]. Recently, Li et al. found that pl30CAS is also required for efficient adenovirus entry [96]. This large adapter molecule provides an important functional link between the tyrosine kinase c-SRC [99] and the p85 catalytic 2 8 Glen R. Nemerow subunit of PI3K [96]. The downstream effect molecules downstream of PI3K and CAS have yet to be fully characterized. It is interesting to note that other signaling molecules may become activated upon adenovirus interaction with host cells; however, they may not actually contribute to virus entry. For example, pl25FAK (focal adhesion kinase) becomes tyrosine phosphorylated during adenovirus entry [19], but cells expressing dominant negative forms of FAK exhibit normal levels of Ad uptake [19]. Moreover, mouse embryonic fibroblasts genetically deficient in FAK support very similar levels of Ad infection as expressing cells. Bruder et al. [100] also reported that MAP kinases are activated during Ad infection, whereas inhibitors of ERK1/ERK2 MAP kinases have little if any effect on virus entry [18]. Despite recent progress, the precise mechanisms by which signaling processes regulate virus entry have not been elucidated. Impediments to further advances include the difficulty of studying complex signaling events in live (unfixed) cells. Moreover, signaling processes may vary among different cell types and thus the overall role of a given signaling pathway may differ in different cell types. Finally, the involvement of a specific signaling molecule may be difficult to assess if related molecules (functional homologs) perform similar functions. While further research is needed to fully characterize Ad cell entry mechanisms, the identification of specific signaling molecules involved in adenovirus cell entry may allow improvements in Ad-mediated gene delivery to cells which lack CAR and/or av integrins. For example, ligation of certain growth factor receptors (i.e., epithelial growth factor (EGF)) or cytokines (i.e., tumor necrosis factor alpha (TNFa)) results in activation of remarkably similar signaling pathways as those induced by integrin clustering [101-103]. Li et al. recently investigated whether activation of growth factor receptors could circumvent the need for av integrins/CAR in adenovirus-mediated gene delivery [104]. They generated a bifunctional antibody that recognizes the penton base RGD motif (DAV-1) as well as one of several different cytokine or growth factor receptors. Ad vectors complexed with these bifunctional molecules significantly increased PI3K activation in host cells and improved gene delivery to human melanoma cells that lack avp3 and av^5 integrins. The bifunctional antibody also increased gene delivery by a fiberless adenovirus vector. In addition to having a direct role in adenovirus cell entry, signaling events may also contribute to host immune responses to viral vectors. For example, Bruder and Kovesdi previously reported that adenovirus infection triggers expression of interleukin-8 [100], a response that may enhance the inflammatory reactions associated with in vivo delivery of viral vectors for gene therapy. Zsengeller and coworkers also reported that adenovirus internaliza tion into macrophages involves PI3K-mediated signaling and this is associated with the production of inflammatory cytokines in vivo [105]. Further studies 2. Biology of Adenovirus Cell Entty 2 9 are therefore needed to determine the extent to which the signaUng events ehcited during cell entry influence host immune responses to the virus. These processes are likely to have an impact on vector toxicity as w êll as the duration of transgene expression. IV. Virus-Mediated Endosome Disruption and Uncoating In contrast to enveloped viruses, much less is known about how nonen- veloped viruses traverse cell membranes during the infectious process. Early electron microscopic studies by Chardonnet and Dales [29] and subsequently by Patterson et al. [16] showed that Ad5 particles are rapidly internalized into clathrin-coated vesicles and shortly thereafter are found free in the cytoplasm. The ability of endocytosed Ad particles to escape the early endosome prior to degradation in lysosomes is a key feature of Ad-mediated gene delivery. Although the precise details of adenovirus-mediated endosome penetration remains a mystery; prior studies have provided a few clues that may ultimately lead to further advances in our understanding of Ad entry. A. Role of Penton Base and av Integrins Seth and coworkers first showed that adenovirus interaction with cells alters membrane permeability [25] and that this depends upon association of the penton base with av integrins [15, 26, 106, 107]. Ad-mediated membrane permeabilization occurs at a pH that is very similar to the environment of the early endosome (pH 6.1) [27, 108-110]. The exact nature of the membrane lesion has not yet been revealed; however, it does not appear to be the result of ion channel formation. Further studies indicated that of all the major Ad capsid proteins, the penton base plays a key role in facilitating membrane per meabilization. Interestingly, the penton base of different adenovirus serotypes exhibit different levels of membrane permeabilizing activity. For example, type 3 but not type 2/5 penton base is capable of forming a dodecahedron [111] and Ad3 dodecahedra also directly transduce cDNA into host cells [111], whereas Ad2 penton base monomers do not [107]. Wickham etal. previously demonstrated that although integrins avp3 and avp5 both support adenovirus |
internalization, av^5 plays a preferential role in membrane permeabilization and infection [15]. Wang et aL subsequently showed that the cytoplasmic tail of the p5 integrin subunit regulates Ad escape from early endosomes [30]. In these studies, they identified multiple TVD motifs, present in the p5 cytoplasmic tail but not in other integrin subunits, that promote membrane permeabilization. These findings suggest that other as 3 0 Glen R. Nemerow yet unidentified host cell molecules may interact with p5 integrin cytoplasmic tail to promote virus penetration. B. Role of the Adenovirus Cysteine Protease The Ad2 penton base, either in its native form or presented in a multivalent form on latex particles, is unable to directly mediate membrane per- meabilization [15], This suggests that other virus/host cell factors are required for efficient virus penetration. Hannan et al. first described a temperature- sensitive Ad particle, designated ^sl, w^hich failed to cleave five precursor viral proteins at the nonpermissive temperature as w êll as lacked infectivity and uncoating activities associated with wild-type virions [112]. tsl particles can bind and enter host cells but remain trapped inside cell vesicles and eventu ally undergo lysosomal degradation. Cotton and Weber subsequently showed that tsl particles fail to incorporate the adenovirus-encoded 23K cysteine pro tease which is normally present in approximately 10 copies per virion particle and as a consequence, fail to mediate efficient gene delivery of membrane permeabilization [113]. Further biochemical studies by Greber et al. showed that tsl virions also lack the ability to cleave the capsid-stabilizing protein VI [114], a molecule associated with virus uncoating and endosome escape. Interestingly, these investigators reported that interaction of Ad particles with cell integrins was required for activation of the cysteine protease based on competition studies with RGD peptides. While these and other studies have provided some clues as to the events associated with virus penetration and uncoating, further studies are needed to determine the precise mechanisms underlying these events. V. Beyond the Endosome: Trafficking of Viral Capsids and Import of Viral DNA into the Nucleus A. Intracytoplasmic Transport of Viral Capsids An important step in adenovirus ceil entry is the transport of viral capsids to the nucleus following their escape from the early endosome. Early electron microscopic studies by Chardonnet and Dales had suggested that adenovirus particles associate with microtubules during nuclear transport [29]. Unfortunately, it was difficult to discern from these early investigations whether Ad particles were nonspecifically associated with these structure elements during sample preparation. Several investigators have therefore sought to test the validity of these early findings. Using fluorescence-tagged viruses, Greber and colleagues found that adenovirus particles fail to traffic to the 2. Biology of Adenovirus Cell Entry 3 1 nucleus in nocodazole-treated cells, consistent with a role for microtubules [31]. Furthermore, overexpression of p50/dynamitin, a molecule which is known to regulate microtubule motor (dynein)-mediated transport, altered adenovirus movement [31]. Thus, as is the case for some other large DNA viruses, [115] adenovirus appears to use the microtubule apparatus to achieve vectorial movement through the host cell. Matthews and Russell also reported that a cellular protein, p32, may also participate in vectorial transport of Ad capsids [116]. B. Docking at the Nuclear Pore and Translocation of Viral DNA Since adenovirus replicates in the nucleus, it must deliver its genome into this cellular compartment to complete the infectious cycle. Consistent with this concept, electron microscopic studies have revealed partially uncoated adenovirus capsids docked at nuclear pore complexes of infected cells within 1-2 h postinfection. The relatively limited size of the nuclear pore complex, approximately 25 nM in diameter, also indicates that Ad capsids (approx. 90 nM) do not directly enter into the nucleus. Moreover, proteins of greater than 20-40 kDa cannot passively diffuse through the nuclear pore complex and thus the classical nuclear import machinery must then be used to facilitate translocation of the viral genome and associated proteins through pore com plexes. Previous studies have indicated that after exposure of viral particles to low pH, the hexon protein is the major capsid protein that docks at the nuclear pore complex [33]. Using a permeabilized cell system, Saphire et al. showed that purified nuclear transport factors such as importin-a and -P, as well as heat shock 70 (hsp70), are required to facilitate nuclear import of purified hexon proteins but these factors cannot promote import of adenovirus DNA [33]. These findings indicated that other as yet unidentified cellular factors may also be required for DNA translocation. One major question that remains to be addressed is whether nuclear import of the Ad genome requires a protein chaperone(s). In this regard, Greber and coworkers previously showed that protein VII, a protein that is associated with the viral DNA inside the capsid also enters the nucleus along with the viral DNA [114]. In contrast, the vast majority of the hexon outer coat protein remains in the cytoplasm [32]. Further studies are needed to directly demonstrate a role for protein VII or other molecules in facilitating DNA import. VI . Conclusions Adenovirus cell entry requires interactions of multiple host cell receptors with distinct virus capsid proteins. Adenovirus associations with different 3 2 Glen R. Nemerov^ receptors influences cell tropism and undoubtedly plays an important role in determining the efficiency of Ad-mediated gene delivery in vivo. The Ad capsid structure is particularly well designed to mediate multiple receptor events. The elongated and flexible fiber protein of most Ad serotypes mediates high-affinity binding with a receptor (CAR) that is broadly distributed on different host cells. Further studies are needed to determine how the structure of the fiber shaft influences receptor usage and to uncover other host cell receptors that can serve as receptors for different Ad types. The Ad penton base displays five RGD integrin binding motifs and the precise geometrical arrangement of these motifs Ukely facilitates integrin clustering and subsequent signaling events. In particular, integrin coreceptors induce activation of P13K and Rho GTPases that promote virus entry and endosome penetration. Events occurring subsequent to internalization including endosome disruption remain obscure. Other host cell molecules interacting with integrin avp5 may play a key role in this process. Finally, adenovirus may provide important clues as to the mechanisms by which nucleic acids are transported into the nucleus. Increased knowledge of virus structure and host cell interactions has led to reengineering of first-generation Ad vectors to improve tissue targeting, and this may improve transgene expression as well as reduce vector toxicity. 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Introduction Since their discovery, adenoviruses have served the scientific community as a pov\^erful tool for research of important virological as v^ell as cellular events. Adenoviruses w êre first isolated as a result of researchers pursuing the causative agent of the common cold. Rowe and colleagues, in 1953, observed cytopathic effect in primary cell cultures derived from human adenoids [1]. The follov^ing year, the same effect w âs seen in cells exposed to respiratory secretions by Hilleman and Werner, v^ho w êre trying to uncover the cause of acute respiratory disease in Army recruits [2]. It w âs later shov^n that adenoviruses, so named after its source of origin, w êre not the etiologic agent of the common cold, since they cause practically no respiratory morbidity among the general population. Hov^ever, adenovirus (Ad) has been show^n to cause severe respiratory distress in immunocompromised individuals [3]. Ad infection can also result in epidemic conjunctivitis [4] as v^ell as a number of other syndromes, including gastroenteritis [5]. These infections are usually resolved quickly, resulting in lifelong immunity to the virus. The adenovirus family is a large one, containing members that can infect a wide range of animals, including monkeys, livestock, mice, and birds as w êll as humans. All of these viruses consist of a naked icosahedral protein shell (70-100 nm in diameter) that encapsidates a linear, double-stranded DNA molecule. The exact dimension of the virion particle and size of the Ad genome can differ quite greatly betv^een adenoviruses that infect different species. Less than 10 years after their initial discovery, it v^as seen that adenovirus serotype 12 (Adl2) could cause malignant tumors in infected nev\rborn ham sters [6]. This seminal finding by Trentin and colleagues v^as the first evidence ADENOVIRAL VECTORS FOR GENE THERAPY J Q Copyright 2002, Elsevier Science (USA). All rights reserved. 4 0 Evans and Hearing that a human virus could induce cellular transformation. The fact that the transformation occurred in vivo and produced disease made the finding even more profound. Hov\^ever, to date, there has been no significant evidence that w^ould implicate adenovirus in oncogenesis in human beings. Trentin's discov ery thrust adenovirus into the forefront of model systems in the study of cancer as well as basic cellular processes. Adenovirus proved a worthy experimental system due to the ability to grow the virus to high titers in vitro as well as infect a wide variety of cell types. The relative safety and ease with which adenovirus and its genome can be manipulated also make Ad an attractive tool to study basic virology as well as cellular responses to viral infection. Discoveries in adenovirus research has provided a greater understanding of viral and cellular gene expression, DNA replication, cell cycle control, and cellular transformation. A notable example of the impact that the study of adenovirus has had on the scientific field is the discovery of mRNA splicing. It was shown that adenovirus produces a number of mRNAs from a single large transcript [7]. The analysis of the structure of mRNAs by Sharp and colleagues effectively revealed the existence of introns. The existence of splicing sites was then observed. From this finding, it was possible to dissect cellular mRNAs to show the presence of introns and the function of splicing in eukaryotes. II. Classification The family to which adenoviruses belong, Adenoviridiae, is divided into two genera: Mastadenovirus and Aviadenovirus. The Mastadenovirus genus contains viruses that infect a wide range of mammalian species, including human, simian, bovine, ovine, equine, porcine, and opposum. The Aviaden ovirus group infects only bird species (i.e., chicken and turkey). The viruses are classified into six subgroups based on two different criteria: percentage of guanine-cytosine in the DNA molecule and the ability to agglutinate red blood cells [8]. Within these groups are the serotypes of adenovirus. To date, human adenoviruses have been further subdivided into >50 specific types, primarily on the basis of neutralization assays. Type-specific neutralization occurs by antibodies binding the virion capsid hexon protein and, to a much lesser extent, the capsid fiber and penton proteins. IIL Genome Organization The human Ad genome is present as a linear double-stranded DNA molecule approximately 35-36 kbp in length. The genome is contained within the capsid in a highly condensed form, associated with viral proteins V and 3 . Adenov i rus Replication 4 1 VII. These proteins organize the DNA into a nucleosome-hke structure known as the core. The core is tethered to the capsid through the interaction of protein V with protein VI, a protein associated with internal facets of the capsid. The Ad rephcation origins are present in the first 50 base pairs of the '^lOO-bp inverted terminal repeats (ITRs) located at each end of the viral genome. The inverted nature of the ITRs plays a functional role in viral DNA replication (discussed below). A terminal protein is covalently attached to each 5̂ terminus of the viral genome. This protein, along with the Ad DNA polymerase. Ad single-strand DNA binding protein, and cellular factors, are essential for viral DNA replication. A ds-acting packaging sequence is located at one end of Ad genome, conventionally called the left end, which directs the polar encapsidation of the viral DNA into the capsid. The Ad chromosome contains one immediate-early region (ElA), four early transcription units (ElB, E2, E3, and E4), two "delayed" early units (IX and IVa2), and one late unit (major late) that produces five families of mRNAs (LI to L5) (Fig. 1). All of the viral transcription units utilize cellular RNA polymerase II for their transcription. Ad-encoded regulatory proteins participate in the specificity of the transcription program. The viral genome also contains at least one gene that codes for VA RNA (some Ad serotypes have two) which is transcribed by RNA polymerase III. The schematic representation of the genome (Fig. 1) is conventionally drawn with the ElA transcription unit at the left end, adjacent to the packaging sequences (\|;). The transcription units of the Ad genome are transcribed from both strands of the chromosome: ElA, ElB, pIX, the major late transcription unit, VA RNA, and E3 are transcribed using the rightward reading strand and E4, E2, and IVa2 are transcribed using the leftward reading strand. The Ad genome is an excellent example of the need for viruses to efficiently use limited genetic space and information to produce the maximum number of proteins necessary for virus propagation. In the case of adenovirus, the host cell's RNA producing/processing machinery is manipulated to the advantage of the virus. It would appear that the viral genome is organized in IX ^ L ^^^ ^^ . 19 " -S. L4 ,̂ L5., ^ l > l > MLP ' ^ IM^ I ~ I I I I I I I l ~ 0 10 20 30 40 50 60 70 80 90 . < H E2b E2a E4 IVa2 Figure 1 Schematic representation of the human adenovirus genome. Black arrows depict imme diate-early, early, and delayed-early genes and hatched arrows depict the late genes. The inverted terminal repeats are labeled ITR and the packaging sequence is denoted as \};. MLP corresponds to the major late promoter. 4 2 Evans and Hearing its current fashion as a result of evolution determining the most functionally prudent structure and order. It would also seem obvious that evolution has selected for particular grouping of RNAs, since the majority of Ad transcription units produce proteins with related functions. The grouping of related proteins within the same transcription unit might indicate that replication of the virus requires a logical, stepwise progression of gene expression in order to usurp control of the cellular machinery to direct the efficient production of virus. IV. Virus Infection The primary targets of adenovirus infection are the terminally differenti ated epithelial cells of the upper respiratory tract, gut, and eye. However, it has been shown that adenovirus can infect almost any cell type. Adenovirus entry into a cell is discussed in detail in chapter 2 of this volume. Briefly, adenovirus binds to a cell via a cell surface receptor known as CAR (Coxsackie and adenovirus receptor) through interaction of CAR with the fiber protein [9]. The penton base portion of the fiber structure contains an ROD amino acid sequence that binds integrins on the cell surface. The integrins act as corecep- tors for viral entry. Integrins are not essential for attachment of the virus to the cell, but are necessary for gaining access to the interior of the cell [10]. Virus infection can be blocked by the presence of excess RGD peptides. Recently, it was shown that at least one adenovirus serotype, Ad37, can utilize sialic acid to enter cells [11]. Both CAR and sialic acid are expressed on most, if not all, cell types, which may explain the ability of adenovirus to infect |
a wide variety of cells. Once bound to its receptor, adenovirus is internalized via receptor mediated endocytosis in clathrin coated pits. The adenovirus can be visualized in endosomes shortly after infection. The low pH of the endosome facilitates release of the Ad particles that move to the nucleus, apparently via microtubule transport. During transport, the viral capsid is partially degraded, allowing the genome to be inserted into the nucleus through the nuclear pore complexes. Inside the nucleus, the genome positions itself adjacent to particular nuclear organelles through attachment of the terminal protein to the nuclear matrix. This attachment is believed to position the genome in a manner that makes it available for early gene expression and viral DNA replication. V. Early Gene Expression Once the viral genome has entered the nucleus, Ad early gene expression is directed toward achieving three main objectives. First, the host cell must be stimulated to enter S phase of the cell cycle to provide the correct intracellular 3. Adenovirus Replication 4 3 environment for viral replication. Second, the infected cell must be protected from the anti-viral host response to virus infection both from v^ithin the cell and due to the extracellular immune response. Third, viral gene products are produced to be used in concert v^ith cellular proteins to carry out the viral DNA replication program. VI. Early Region l A ( E I A ) Adenovirus encodes over 25 individual early gene products. The early genes are expressed in a temporal and coordinated manner. The first early region expressed after Ad infection is the immediate-early transcription unit ElA since it requires only cellular proteins for its expression. The ElA gene products in turn activate transcription from the other early promoter regions. The ElA gene is composed of tw ô exons and several ElA polypeptides are produced follow^ing alternative splicing of a primary RNA transcript (Fig. 2). The most abundant of the ElA proteins early after infection are referred to as the ElA 12S (243 amino acids) and 13S (289 amino acids) gene products based on the mRNAs that encode them. The ElA 12S and 13S proteins act as major regulators of early viral transcription as well as important modulators of host cell gene expression and proliferation (review^ed in [12-14]. The ElA 12S and 13S proteins share tv^o conserved regions within the 5' exon referred to as CRl and CR2. The two proteins differ only in a 46-residue internal exon segment present in the 13S protein. This region, referred to as conserved region 3 (CR3), is important for the transcriptional transactivation properties of the ElA 13S protein. Both proteins are localized to the nucleus due to a carboxy-terminal Rb/p107/p 130 p400 PCAF TBR ATF, pSOO/CBP Srb CtBP E1A13S [ •jdsIH RsS^HSslSifr^ 1 PRQaa 1 40 80 121 140 185 186 289 E1A12S [ •riSH MSHg-—— 1 ?43aa 1 139 Transformation Apoptosis, Txl repression Txl transactivation Suppression transformation Figure 2 Functional map of El A proteins. The coding sequences of the 12S and 13S El A proteins are shown with conserved regions depicted (CRl, CR2, and CR3). Binding sites for cellular proteins are indicated by bars along with E lA functional activities. 4 4 Evans and Hearing nuclear localization sequence (NLS). The ElA gene products exert their effects by interactions with numerous cellular proteins, most of which are involved in transcriptional regulation [12, 14]. The ElA products interact with a number of important cellular proteins (Fig. 2), including: (1) the retinoblastoma tumor suppressor, pRb, and related family members p l07 and pl30 via CRl and CR2; (2) transcriptional coactivators p300 and CBP via CRl and amino terminal sequences; (3) a number of transcription factors such as TATA- binding protein (TBP), members of the ATF family (e.g., ATF-2, Spl, and c-Jun), and the Srb/mediator complex via CR3 and CtBP via the C-terminus. Rb family members repress the activity of the E2F family of transcription factors, among numerous binding partners (reviewed in [13]). p300/CBP have histone acetyl transferase (HAT) activity and play a role in chromatin remod eling (reviewed in [15]). The ElA 13S product is the major transcriptional activator of viral early gene expression and mediates its function principally through the CR3 domain that acts as a powerful modulator of other proteins involved in transcription [12, 14]. The ElA 13S protein may increase tran scription through stabilization of the transcription factor complex TFIID (via interaction with TBP) at viral and cellular promoter regions. ElA also may increase transcription through stimulation of specific transcription factors. For example, ElA binding to ATF-2 may result in a conformational change result ing in transcriptional activation (reviewed in [16]). Finally, ElA binds to CtBP, a transcriptional corepressor; CtBP binding correlates with ElA suppression of transformation [17]. The most well characterized instance of ElA activation of gene expression involves the E2F family of transcription factors. The E2F family of proteins was initially discovered through studies of Ad E2 promoter regulation [18]. The Ad E2 early promoter contains binding sites for both ATF and E2F transcription factors. E2F transcription factors play a major role in the expression of cellular genes important for the regulation of cell cycle progression [13]. E2Fs exist in the cell as heterodimers containing one of six identified E2F proteins with one of two DP molecules. E2Fs both positively and negatively regulate gene expression. As repressors, E2Fs are bound to DNA at specific sites in complexes with members of the Rb tumor suppressor family (pRb, p l07, pl30). Rb family members interact with histone deacetylase complexes (HDACs), which repress the activity of promoter regions via deacetylation of histones and other promoter-bound transcription factors [19, 20]. Specific members of the Rb family bind to different E2F complexes, determined by the member of the E2F present. E2F binding to Rb members involves the large binding pocket domain of Rb family members which is also the target for ElA protein binding. In uninfected cells, E2F is negatively regulated by binding to Rb family members. Rb family binding to E2Fs is controlled through phosphorylation by cyclin-dependent kinases (cdks) [13]. The hyperphosphorylation of Rb family proteins by Cdks in Gl phase of the cell cycle results in dissociation of Rb from 3. Adenovirus Replication 4 5 the E2F complexes, and derepression of E2F responsive genes. The activation of E2F complexes results in the promotion of Gl and S phase progression. El A acts to subvert the tight control of E2F by binding directly to Rb proteins and sequestering them, freeing E2F heterodimers to activate viral and cellular gene expression [13]. E2Fs activate transcription by the recruitment of HATs to promoter regions [21, 22]. Both the ElA 12S and 13S products direct the release of Rbs from E2Fs, and both ElA proteins are capable of stimulating Ad E2a transcription [12, 14]. As stated, the primary targets of adenoviruses are terminally differentiated epithelial cells. As such, these cells are generally quiescent v^ith low metabolic activity. It is for these reasons that the virus must pressure the infected cell into S phase of the cell cycle in order to augment viral macromolecular synthesis. The interaction of ElA v^ith p300/CBP or Rb family proteins is sufficient to stimulate cellular DNA synthesis (reviev^ed in [23]). It appears that the increase in DNA synthesis may be due, in part, to the activation of E2F transcription through ElA-Rb interactions. The ability of ElA to foster unscheduled DNA synthesis also contributes to its oncogenic potential. Almost all adenoviruses are capable of transforming cells in culture and this ability is primarily attributed to ElA. The regions of ElA responsible for transformation and its oncogenic potential are involved in the binding of p300 and Rb family of tumor suppressor proteins. It appears as though ElA's ability to induce S phase is directly responsible for its ability to cause transformation [23]. ElA also plays a role in the induction of apoptosis in infected cells (reviev^ed in [24, 25]). It has been shown that ElA causes an increase in the level of the tumor suppressor p53. The rise in p53 levels is a result of the stabilization of this usually labile protein by ElA. The presence of p53 is a major obstacle to efficient lytic infection by adenovirus. One function of p53 is to protect the genomic integrity of the cell. Unscheduled DNA synthesis, such as adenovirus DNA production, causes activation of p53. Activated p53 induces gene expression by binding specific promoter sequences, which activates genes that are involved in a number of cellular processes. The presence of p53 can affect cells in primarily two ways [24, 25]. First, p53 can induce Gl arrest, thus inhibiting progression of the cell cycle. This arrest can be facilitated by the transactivation of a gene encoding an inhibitor of Cdks, termed p21^^P~i/^^P-i, which prevents the phosphorylation of Rb family members. p53 also can induce cell death by apoptosis. It does so by inducing the activation of degradative enzymes, caspases, which generate the classic apoptotic pathway. This proteolytic cascade results in a characteristic apoptotic phenotype of shrinkage and rounding of the cell due to breakdown of the cytoskeleton, cleavage of cellular DNA and condensation of the chromatin, cytoplasmic vacuolization and membrane blebbing, and in the final stages, fragmentation of the cell membrane into vesicles or apoptotic bodies that can be taken up by neighboring cells. The activation of p53 and induction 4 6 Evans and Hearing of cellular apoptosis at this stage of infection would be quite deleterious to the virus replication program. Therefore, adenovirus has evolved several mechanisms to decrease or inhibit p53 activity (discussed below). Recently, El A has been shown to suppress p53 transactivation [26]. El A causes the activation of pi9^^^, which leads to the upregulation and stabilization of p53 [27]. El A represses p53 transcriptional activation through the binding and sequestration of p300/CBP, coactivators required for p53-dependent gene expression [28]. VII. Early Region IB(EIB) The second El gene expressed is early region IB that leads to the production of two major species of mRNAs. One mRNA codes for a 19-kDa polypeptide (ElB 19K) and the other codes for a 55-kDa protein (ElB 55K). The two proteins are encoded by alternative reading frames and share no sequence homology. The major roles of these proteins in Ad infection are to inhibit apoptosis and further modify the intracellular environment in order to make the cell more hospitable to viral protein production and viral DNA replication [24, 25]. Viruses with mutations in either or both ElB proteins are significantly reduced in virus yield due to cell death by apoptosis prior to the completion of the replicative cycle. The ElB 55K protein is essential for a variety of important functions in the viral life cycle. One important function is inhibition of the p53 tumor suppressor and inhibition of the induction of p53-dependent apoptosis [24, 25]. The ElB 55K protein binds to the acidic transactivation domain of p53, thus inhibiting p53-induced transcription [29]. However, the binding of ElB 55K to p53 alone cannot inhibit p53 functions. It is theorized that ElB 55K directs repression of promoters when held in a complex with p53 due to strong transcriptional repression by ElB 55K [30]. By doing so, ElB 55K inhibits the activation of p53-responsive promoter regions and blocks cycle arrest and apoptosis programs before they get underway. It is not clear if the ElB 55K protein itself is a transcriptional repressor or it recruits a repressor to the p53-bound complex on DNA. ElB 55K acts in a complex with another early protein, E4 ORE6, which leads to the proteasome-dependent degradation of p53, further decreasing p53 effects on the infected cell [31]. ElB 55K also plays a very important role in producing a cellular environment conducive to viral protein production. A complex containing the ElB 55K protein and the E4 ORF6 product contributes to host cell protein synthesis shutoff by selectively stabiUzing and transporting viral mRNAs from the nucleus to the cytoplasm while inhibiting the transport of host cell mRNAs. This topic will be discussed further in the section on early region 4 (E4). 3. Adenovirus Replication 4 7 The ElB 19K protein is also involved in the inhibition of apoptotis. ElB 19K acts to block apoptotic pathv^ays that do not rely on p53, such as the TNF and Fas ligand cell death pathv^ays [24, 25]. ElB 19K is a functional homolog of a cellular |
suppressor of apoptosis, Bcl-2. Homodimers of a pro- apoptotic protein, such as Bax, result in the activation of caspases, leading to cell death. Bcl-2 heterodimerizes v^ith Bax and inhibits its function, preventing the induction of apoptosis. The dimerization occurs through interaction of specific binding regions, Bcl-2 homology or BH domains. ElB 19K acts in the same manner as Bcl-2 by binding Bax and other apoptosis inducers. ElB 19K shares sequence similarity w îth Bcl-2 in tw ô BH domains present in ElB 19K that are necessary to bind Bax. The binding of Bax by ElB 19K leads to inhibition of apoptosis [24, 25]. ElB 19K also plays a role in inhibition of TNF-induced apopto sis by blocking the oligomerization of death-inducing complexes involving FADD [32]. FADD is a protein that is activated by binding Fas via death domains, thus its name (Fas-associated death domain). The exact function of ElB 19K in FADD regulation is not w êll understood. VIII. Early Region 2 (E2) The E2 transcription unit encodes the viral proteins involved in aden ovirus DNA replication: Ad DNA polymerase (Ad Pol), preterminal protein (pTP), and DNA binding protein (DBF). The E2 transcription unit is tran scribed from the E2 early promoter (E2A at genome coordinate l(i)^ v\̂ hich is activated by El A at early times after infection, and the E2 late promoter (E2B at genome coordinate 72), w^hich is activated at intermediate times after infection through an unknow^n mechanism. DBF is expressed by the E2A region (Fig. 1), v^hich shares common RNA leader sequences near genome coordinates IS and 68 v^ith mRNAs for pTP and Ad Pol. Ad Pol and pTP are encoded by the E2B region of the viral genome (Fig. 1) and their mRNAs share a common exon at genome coordinate 39. These short exons are spliced to the main body of the open reading frames (ORFs) for pTP and Ad Pol at genome coordinates 28.9 and 24.1, respectively. The E2 early promoter was shov\̂ n to possess four ds-acting elements that upregulated transcription of the gene: a TBP binding site, two E2F binding sites, and an ATE binding site (reviewed in [33]). The efficient transcription of the E2 early promoter is dependent on the ElAs via Rb binding and E2F derepression and by transactivation via TBP and ATEs. The binding of E2F/DP heterodimers to the E2 early promoter is stabilized by a product of the E4 transcription unit, E4-ORF6/7 (discussed below). The mechanism by which the E2 late promoter is delayed or transactivated is not known. DBF is a nuclear phosphoprotein of apparent molecular weight of 72 kDa that is produced in large quantities in an infected cell. The protein is from 4 8 Evans and Hearing 473 to 529 amino acids in length, according to Ad serotype, and is expressed throughout the infectious cycle. DBP is involved in a number of functions including viral DNA replication, early and late gene expression, host range, transformation, virion assembly, and possibly DNA recombination (reviewed in [34-36]. The N-terminal portion of DBP is highly phosphorylated and contains the NLS. The C-terminal domain is not phosphorylated, but it binds to DNA and is involved in viral DNA replication. DBP binds cooperatively to single-stranded DNA with high affinity and acts to protect the DNA from nuclease digestion. DBP possesses a helix- destabilizing property that is required for unwinding double-stranded DNA in an ATP-independent manner during the elongation phase of viral DNA replication by strand displacement [37]. DBP enhances renaturation of dis placed complementary strands [38]. DBP is also responsible for enhancement of the initiation of DNA replication by facilitating formation of the initiation complex pTP-dCMP as well as increasing NF-I/CTF binding to its recognition site in the auxiliary origin (see below). Finally, DBP increases the processivity of Ad Pol [39]. The pTP protein exists as a stable heterodimer with Ad-Pol and is critical for the initiation of viral DNA replication [34-36]. Ad-Pol catalyzes the covalent linkage of dCMP to serine 580 of pTP. The pTP-dCMP complex functions as the protein primer for Ad DNA synthesis. In adenovirus-infected cells, pTP in a 1:1 stoichiometric ratio with Ad Pol; both of these proteins are expressed at significantly lower levels than DBP. During the initiation of viral DNA replication, pTP binds to the core origin sequences in a phosphorylation- dependent manner. At late times in infection, the 80-kDa pTP is processed to the 55-kDa TP via cleavage by the virus-encoded protease [40]. The 55-kDa TP protein is covalently linked at the 5̂ ends of the genome in the mature virion. The processing of pTP-DNA to TP-DNA is not required for viral DNA replication or virion assembly, but it is necessary for full infectivity of mature virus particles. The presence of pTP or TP at the 5̂ termini may protect the viral genome from exonuclease digestion. Also, covalent attachment of pTP/TP to the genome has been shown to facilitate unwinding of the DNA duplex at the origin of replication. pTP (and TP) is responsible for the attachment of the adenovirus genome to the nuclear matrix [41, 42]. The interaction of pTP and a protein complex that directs pyrimidine biosynthesis known as CAD (carbamyl phosphate synthetase, aspartate transcarbamylase, and dihydroorotase) at active sites of viral DNA replication might suggest that the area in which the genome is deposited is predetermined due to the presence of proteins necessary for DNA synthesis [43]. Ad Pol is a 140-kDa phosphoprotein that is responsible for both the initiation and elongation steps of adenovirus DNA replication (reviewed in [34-36]). Ad Pol is localized to the nucleus via its association with pTP. Ad Pol is a member of a family of proteins known as the alpha DNA polymerases 3. Adenovirus Replication 4 9 and possesses five of the six regions conserved among other members. However, the regions necessary for Ad Pol activity are distributed over the entire length of the molecule and are not limited to the five regions of homology with the other DNA polymerases [44]. Ad Pol possesses an intrinsic 3̂ -^ 5' proofreading exonuclease activity as well as two potential zinc finger motifs important for its DNA binding and viral DNA replication initiation functions. Along with forming a stable heterodimer with pTP that is crucial for viral DNA replication, Ad Pol physically interacts with NF-I/CTF (a cellular factor involved in Ad replication, see below), and this interaction directs the Ad Pol-pTP complex to the origin of replication. Ad Pol is phosphorylated on serine residues, with serine 67 being the major site of phosphorylation. Phosphorylation appears to be important for Ad Pol to initiate replication [45]. The molecular and physical mechanism of Ad replication and the roles of viral and cellular proteins described in this section will be discussed below in the section on viral DNA replication. IX. Early Region 3 (E3) In order to conduct and successfully complete the infectious cycle, ade noviruses have evolved a number of mechanisms to evade the host antiviral defense array. Many of the proteins responsible for counteraction of the host immune response are encoded within the E3 region. The primary host defense against Ad infection is to eliminate the infected cell. The E3 region encodes multiple proteins that function to inhibit multiple pathways of cell death induced by the host innate and cellular immune responses to the infected cell (Fig. 3) (reviewed in [46, 47]). The E3 transcription unit is an early region located at genome position 76-86 whose transcription is induced by the El A 13S protein. The E3 promoter has a TATA box as well as upstream binding sites for the ATF, API, NFl transcription factors as well as NFKB [46]. It is believed that adenovirus-specific cytotoxic T lymphocytes (CTLs) are the major mechanism by which adenovirus-infected cells are eliminated. E3 encodes at least four proteins that are capable of inhibiting CTL killing [46, 47]. For CTL to destroy a virus-infected cell, the T-cell receptor must first recognize viral peptides presented on the cell surface in association with major histocompatibility complex (MHC) class I antigens. Adenovirus encodes a protein, E3 gpl9K, which prevents the transport of MHC I to the cell surface. E3 gpl9K is a membrane glycoprotein that localizes to the endoplasmic reticulum (ER), where it forms a complex with newly synthesized class I antigens, thus preventing their transport to the cell surface. When this protein is expressed, CTL killing of Ad-infected cells is greatly reduced. E3 gpl9K, and subsequently MHC I, are retained in the ER by an ER-retention signal 5 0 Evans and Hearing 3.6K 10.4K 14.7K \;^^m<;^ V/////////A 6.7K 7.5K 12.5K gp19K 11.6K 14.5K II 1 1 1 1 1 1 II V//////////////A kWWN 1 1 1 1 1 1 nt. 1000 2000 3000 gp19K: Integral membrane protein, inhibits kill by CTLs (blocks MHCI presentation) 10.4K (RIDa) and 14.5K (RIDp): Integral membrane protein, together form the RID complex to block FasL and TNF mediated apoptosis by degrading Fas and internalizing TNFR1 14.7K: Inhibits FasL and TNF-mediated apoptosis 11.6K (aka ADP): Integral membrane protein, promotes host cell death and virus release 12.5K, 6.7K and 3.6K: Functions unknown Figure 3 Schematic of the E3 transcription unit. The different proteins encoded by the E3 region are indicated by bars. The functions ascribed to different E3 proteins are listed below the diagram. (KKXX) found at the extreme C-terminus of E3 gpl9K [48]. E3 gpl9K binds to all MHC class I antigens, but with different affinities to which a hierarchy can be assigned [46, 47]. The E3 region also produces proteins that inhibit defenses involving ligand-receptor interactions and activation of cell death pathways [46, 47]. On the surface of most cells, receptors containing death domains (DDs) are expressed. Once CTL are activated, they kill via three main pathways. The primary mechanism of cell killing involves perforin and granzymes that act in concert: perforin forms holes in the target cell and granzymes are then introduced into the cytoplasm of the target cell. One of these enzymes, granzyme B, activates caspases to induce apoptosis. The second pathway involves the receptor Fas expressed on the surface of the infected target cell. The third pathway is mediated through the tumor necrosis factor (TNF) receptor type 1 (TNFRl). The ligands to these receptors are found on the surface of activated CTL: Fas ligand (FasL) and TNF, respectively. The interaction of ligand with receptor triggers a series of protein-protein interactions in the target cell that results in the induction of apoptosis (reviewed in [49]). Upon binding of FasL to Fas, the latter trimerizes and then binds a protein named FADD. This binding is facilitated though the "death domain" (DD), present in both Fas and FADD. FADD also has a "death effector domain" (DED) through which it associates with procaspase 8, thus causing autocleavage and activation of caspase 8. Activated caspase 8 cleaves and activates downstream caspases — a cascade that results in apoptosis. TNF binding to TNFR follows a similar pathway except TNFR binds the DD of TRADD (TNF-receptor-associated death domain) which then binds FADD 3. Adenovirus Replication 5 1 and caspase 8 as well as another DD-containing protein named RIP [50]. RIP is a serine/threonine kinase whose exact function is unclear. E3 RID (for receptor internalization and degradation) is an integral membrane protein composed of two E3 products RIDa (E3 10.4K) and RIDp (E3 14.5K). The RID complex localizes to the plasma membrane, Golgi apparatus, and ER. RID inhibits apoptosis through the TNERl and Fas pathways [51, 52]. Expression of RID leads to the clearance of Fas from the cell surface, which results in degradation in lysosomes. RID-mediated elimination of TNFRl is less efficient, and it is not known if TNFRl is degraded in lysosomes. RID also stimulates internalization of certain other receptors whose activation may result in a less direct inflammatory response. Once RID has deposited the receptor in the lysosome for destruction, RID is recycled back to the cell surface to repeat the internalization process. E3 14.7K also inhibits apoptosis induced by the cytokine activation of receptors. Its effects on TNF pathway is more dramatic than on Fas [53, 54]. Unlike many of the other E3 proteins, E3 14.7K is not associated with a membrane structure, but is present in the cytosol and nucleus. E3 14.7K acts by binding proteins involved in the apoptotic pathway. One protein is FIP-3, which also binds |
RIP, a component of TNF-induced activation of NFKB [55]. NFKB activation appears to inhibit apoptosis; FIP3 may activate an apoptotic pathway in conjunction with inhibition of NFKB transactivation. Therefore, the binding of E3 14.7K to FIP-3 allows NFKB to induce transcription of genes that defend against the TNF signal. Also, the presence of NFKB sites in the E3 promoter may lead to the increased expression of E3 proteins [56]. It has also been reported that E3 14.7K may bind caspase 8 directly to inhibit the caspase/protease cascade. Both RID and E3 14.7K prevent TNF-induced release of arachidonic acid (AA). Cytosolic phospholipase Ai (cPLA2) is activated by TNF signaling which causes it to translocate to membranes and cleave phospholipids, producing AA. RID inhibits the translocation of cPLA2 to membranes. This action occurs prior to RID clearing TNFR from the cell surface [54]. The mechanism of E3 14.7K inhibition of AA release is not known. Both RID and E3 14.7K are required to inhibit inflammation and pathology in infected mouse lung. These Ad-encoded E3 proteins inhibit two of the three mechanisms utilized by CTL for cell killing. If Ad also inhibits perforin/granzyme lysis of cells is presently unknown. The E3 11.6K protein, also known as the adenovirus death protein (ADP), is an integral membrane protein localized to the Golgi and ER that is modified with complex oligosaccharides at a single N-linked site. This protein promotes cell death very late in the infectious cycle in order to release mature virions into the surrounding environment. Cells infected with an Ad mutant that does not express the E3 11.6K protein remain viable much longer than cells infected with wild-type adenovirus [57]. This action may seem contradictory to the functions of the other E3 proteins, but E3 11.6K is not produced in significant 52 Evans and Hearing amounts until very late stages of infection when virions accumulate aw^aiting release [58]. X. Early Region 4 (E4) Whether they are early or late, a common theme among the transcription units of adenovirus is that they encode multiple proteins of related functions. How^ever, early region 4 (E4) is the only transcription unit that produces proteins of relatively disparate functions. E4 encodes at least seven proteins according to analysis of ORFs and spliced mRNAs. The gene products exhibit a wide range of activities (Fig. 4). Proteins expressed from the E4 region have been shown to be important for viral DNA replication, viral mRNA transport and splicing, shutoff of host cell protein synthesis, and regulation of apoptosis. Viruses lacking the entire E4 region are extremely compromised for growth, decreased >5 logs in virus growth compared to wild-type Ad [59, 60]. Several of the proteins produced by E4 appear to be cytotoxic to cells. The E4 products cytotoxicity may influence the virus life cycle as well as the decision to include them in gene therapy vectors. The E4 region is transcribed in response to induction by El A. The E4 promoter is regulated to a certain extent by ATE sites, but expression depends more on two sites that bind a transcription factor termed E4E [12]. If El A is not present, the E4 transcription unit is still expressed, but to a much lower extent. The E4 ORFl 14.3-kDa protein is relatively uncharacterized. The E4 ORFl proteins of a number of Ad serotypes are capable of transforming 2 1 vy/////y////////////^^^^^^ ^mmmzzzzzzz 3000 2000 1000 1nt. ORF 1: Transformation, mammary tumors, binds PDZ proteins ORF 2: Function unknown ORF 3: Redundant with 0RF6, virus growth, disrupts PODS, persistence of transgene expression \n vivo ORF 4: Stimulates PP2A, induces apoptosis ORF 6: Redundant with ORF3, host cell shutoff, virus growth ORF 6/7: E2F induction Figure 4 Schematic of the E4 transcription unit. The different proteins encoded by the E4 region are indicated by bars. The functions ascribed to different E4 proteins are listed below the diagram. 3. Adenovirus Replication 5 3 primary rat cells in culture. In addition, the E4 ORFl protein of Ad9 induces mammary carcinomas in rats, independent of El A [61]. The E4 ORFl protein binds to a number of cellular proteins that possess a motif referred to as the PDZ domain, including the cellular dig tumor suppressor protein, and the binding of E4 ORFl to PDZ-containing proteins appears to mediate the oncogenic nature of this viral gene product [62]. The exact role that E4 ORFl plays in the viral replication cycle is currently being analyzed. Nothing is known about the role of the E4 ORF2 14.6-kDa protein in viral replication. This is also true of the E4 ORF3/4 7.1-kDa protein that is the product of a spliced mRNA that fuses the amino terminus of E4 ORF3 to the carboxy terminus of E4 ORF4. The E4 ORF3 11- to 14-kDa protein is expressed early in infection. E4 ORF3 is very tightly associated w îth the nuclear matrix. E4 ORF3 has been shown to have redundant function(s) with another E4 protein, E4 ORF6, with respect to virus growth and splicing of viral mRNAs [59, 60, 63]. A profound defect in Ad growth is observed with mutants that lack all of E4 coding sequences. However, if either E4 ORF3 or E4 ORF6 is expressed with an otherwise E4-deleted virus, growth capacity is restored to within 10-fold of wild type. Further, individual mutation of either the E4 ORF3 or E4 ORF6 proteins has only a modest impact on viral growth, whereas mutation of both protein reading frames results in a significant reduction in virus yield. Thus, either the E4 ORF3 or E4 ORF6 proteins are sufficient to confer the majority of E4 function in an Ad lytic infection in cultured cells. The E4 ORF3 and E4 ORF6 proteins both bind to the ElB 55K product, although to different ends. E4 ORF6 enhances the inhibition of p53 by ElB 55K, whereas E4 ORF3 transiently relieves the repression of p53 by ElB 55K [31, 64, 65]. Yet another function that E4 ORF3 has been proposed to have in common with E4 ORF6 is the ability to bind and inhibit the activity of DNA-protein kinase (DNA- PK), thus resulting in an inhibition of double strand break repair (DSBR) mechanism [66]. Ad DNA replication is likely to induce cellular DSBR. The binding of E4 ORF3 or E4 ORF6 proteins to DNA-PK appears to inhibit DSBR and block the formation of viral DNA concatamers that occurs in the absence of E4 expression. The formation of Ad DNA concatamers would block viral DNA replication and packaging of the genome into the capsid. E4 ORF3 has been shown to localize with discrete nuclear structures known as PODs, PML oncogenic domains, or NDlOs [67]. PODs exist as multiprotein complexes that exhibit a discreet, punctate appearance in the nucleus of an uninfected cell. E4 ORF3 is necessary and sufficient to cause redistribution of these protein complexes into long, track-like structures. PODs have been implicated in a number of cellular processes ranging from transcriptional regulation to the regulation of apoptosis (reviewed in [68]). PODs have also been shown to react to stresses such as heat shock and heavy metals as well as interferon, suggesting a role in cellular defense mechanisms. 5 4 Evans and Hearing A number of DNA viruses express proteins that function to disrupt PODs, i.e., herpesviruses, cytomegalovirus, and papillomavirus [69]. The exact function of PODs is still unknown, as is the purpose for POD reorganization by E4 ORF3, although it has been linked to adenovirus replication [67], E4 ORF3 is also capable of binding a number of other proteins, some of v^hich are involved in transcriptional regulation such as p300 and CBP (Evans and Hearing, unpublished results). Despite considerable research, the exact function(s) of E4 ORF3 in the viral replication cycle is still unclear. E4 ORF4 is a 14-kDa protein that plays a role in several different processes during Ad infection. First, E4 ORF4 binds to the Ba subunit of the serine/threonine phosphatase PP2A [70]. By binding this subunit, the trimeric form of PP2A is activated to dephosphorylate targets such as mitogen-activated protein (MAP) kinases that are important in signal transduction pathways. Increased PP2A activity leads to decreased phosphorylation and inactivation of certain transcription factors, such as E4F, through direct interaction or through the inactivation of MAP kinases. E4 ORF4 expression also results in decreased ElA phosphorylation at MAP kinase consensus sites that are important for E4 transactivation [71]. Through decreasing the activity of ElA and E4F, E4 ORF4 regulates the expression of the E4 region itself through its interaction with PP2A, perhaps to reduce the amount of potentially toxic E4 products [72]. Second, E4 ORF4 plays a role in the regulation of mRNA splicing. Third, much attention has been paid recently to the ability of E4 ORF4 to induce p53-independent apoptosis. The binding to and regulation of PP2A by E4 ORF4 is essential for the induction of cell death. E4 ORF4-dependent apoptosis also requires modulation of Src-family kinases [73]. E4 ORF6/7 is a 17-kDa protein produced from a spliced mRNA that encodes the amino terminus of E4 ORF6 linked to the unique E4-ORF7 sequence. E4 ORF6/7 molecules form stable homodimers that contribute to viral DNA synthesis by enhancing the production of E2 products. E4 ORF6/7 binds free E2F and induces cooperative and stable binding of E2F/DP heterodimers to inverted E2F binding sites in the Ad E2 early promoter [74]. Recently, it was shown that E4 ORF6/7 induces expression from the cellular E2F-1 promoter and is able to functionally compensate for ElA in adenovirus infection [75, 76]. The E4 ORF6 34-kDa protein provides a number of functions that are important in Ad infection. As stated above, E4 ORF6 has been shown to be redundant with E4 ORF3 for a number of roles in the Ad replication cycle. However, E4 ORF6 has a set of unique functions that have led to it being stud ied more intensively than its counterpart. E4 ORF6 binds to and inhibits p53, providing adenovirus yet another defense for p53 effects within the cell [64]. E4 ORF6 enhances ElA-dependent cellular transformation, possibly through the inhibition of p53 [77]. E4 ORF6 also directly binds ElB 55K, and this complex leads to the proteasome-dependent degradation of p53, counteracting 3. Adenovirus Replication 5 5 the induction of p53 stability provided by El A [31]. The E4 ORF6-E1B 55K complex is also important in the replication cycle of adenovirus. These proteins lead to host protein synthesis shutoff by selectively transporting viral mRNAs from the nucleus to the cytoplasm and inhibiting the transport of host mRNAs. E4 ORF6 possesses three targeting signals with its amino acid sequence: an arginine/lysine-rich NLS in its amino terminus, a nuclear export signal in its central region w^here it also binds p53, and a nuclear retention signal (NRS) tov^ard its carboxy terminus. The association of E4 ORF6 causes the relocal- ization of ElB 55K from the perinuclear region to the interior of the nucleus via the NLS and NRS [78]. ElB 55K was also shown to have a shuttling capability independent of its binding to E4 ORF6 [79]. ElB 55K is capable of binding mRNAs in a sequence-independent manner [80]. ElB 55K also has been shown to bind a cellular protein that binds to RNA [81]. The localization of the ElB 55K-E4 ORF6 complex to the viral transcription centers in the nucleus ensures that primarily only adenovirus late mRNA transcripts are bound and selectively transported from the nucleus. The NES of E4 ORF6 mediates the transport the RNA-protein complex out of the nucleus to the cytoplasm for translation. Early gene expression sets the stage for the replication of the viral genome. The accumulation of the replication proteins encoded in the E2 region is necessary to provide the machinery capable of carrying out viral DNA replication while a variety of early proteins attempt to stimulate the cell into S phase or negate the defense systems of the host. If the virus is successful in these pursuits, the virus will replicate very efficiently. XI . Viral DNA Replication Replication of the adenovirus DNA genome has been intensively studied over the past two decades. An in vitro Ad replication system was the first example of a mammalian cell-free DNA replication system which led to a number of discoveries on the mechanics of DNA replication, on the function of nucleoprotein complexes, and on the intricacies of virus-host interactions [34, 36, 82]. |
Ad DNA replication is the result of an organized interplay between viral proteins, cellular factors, and viral template DNA at distinct sites within the nucleus termed replication factories. DNA synthesis requires three viral proteins (Ad Pol, pTP, and DBP) encoded by the E2 region. Ad replication is significantly stimulated by three cellular proteins (NFI/CTF, NFII, and NFIII/Oct-1) [34, 36, 82]. These cellular factors increase replication initiation up to 200-fold. Ad replication is initiated by a protein priming event, followed by a "jumping back" mechanism, and completion by strand elongation to termination (Fig. 5). The defined origin of Ad DNA replication is located within the first 50 bp of the ITR (Fig. 5A). The terminal 18 bp of the viral genome contains 56 Evans and Hearing AdITR Oct-1 pTP/Ad-Pol TP NF-I Oct-1 NF-I t -^^ I. core on B. Preinitiation complex ^ +dCTP Origin unwinding pTP-dCMP formation NF-I dissociates pTP-CAT formation m Jumping back Oct-1 dissociates Dissociation of pTP/Ad-Pol Elongation ^GTK^^^ Figure 5 Mcdel of adenovirus DNA replication. See text for details. the minimal replication origin (core origin) with an essential triplet repeat at the molecular ends (5^-CATCAT in Ad2/5). Although this region contains the core origin, alone it can support only very limited levels of replication initiation. Immediately adjacent to the core origin is an auxiliary region that contains binding sites for NFI/CTF and NFIII/Oct-1. Binding of these cellular factors to the Ad ITR increases the efficiency vŝ ith w^hich initiation and elongation are undertaken. Nuclear factor I (NFI), a cellular transcription factor also known as CTF, was purified from HeLa cells as a protein that could enhance Ad DNA replication in vitro [34, 36, 82]. NFI/CTF binds as a dimer to the auxiliary origin of replication. This binding is enhanced by DBF, probably via changes in the DNA structure. NFI/CTF interacts with the Ad Pol-pTP complex and recruits this complex to the core origin [83]. The position of the NFI/CTF site 3. Adenovirus Replication 5 7 with relation to the core origin is critical and suggests the spatial distance is necessary for NFI/CTF to position Ad Pol-pTP correctly at the terminus of the genome. The interaction of NFI/CTF with Ad Pol-pTP leads to increased stability of the Ad Pol-pTP complex at the origin, thus increasing stimulation of initiation up to 60-fold. Oct-1, originally identified in adenovirus replication as NFIII, is an extremely well studied transcription factor, which binds to the octamer element present in a variety of promoter and enhancer regions [34, 36, 82]. The only portion of Oct-1 that is required for stimulation of Ad DNA replication is the DNA-binding POU domain [84]. The POU domain is a bipartite sequence of two conserved subdomains separated by a nonconserved or variable linker region. The presence of both subdomains is required for high-affinity DNA binding. In the adenovirus origin, the Oct-1 POU domain binds to a recognition site next to the NFI/CTF site in the auxiliary region and stimulates initiation six- to eightfold, depending on the Ad Pol-pTP concentration. The POU domain contacts the pTP protein in the Ad Pol-pTP complex, whereas NFI/CTF contacts Ad Pol, suggesting a cooperative effect of these proteins to enhance the binding of the initiation complex to the origin. Also, as with NFI/CTF, the spatial relation of the Oct-1 binding site to the core origin is important for stimulation of DNA replication. In order for efficient replication of the entire genome, a third cellular factor is required. NFII is necessary if replication is to proceed beyond 30% of the genome. This protein is a type I DNA topoisomerase and is required for elongation in vitro [85]. The reason for the need for topoisomerase function in vitro is currently unknown. Interestingly, both type I and II topoisomerase activities are required for effective Ad replication in vivo [86]. Inhibition of type I topoisomerase activity leads to an immediate block of all adenovirus replication, while inhibition of type II topoisomerase activity blocks replication after completion of the first round of synthesis. The model of the dynamics of adenovirus DNA replication involves the cooperative efforts of a number of proteins during initiation, jumping back, and elongation (Fig. 5B) [34, 36, 82]. These events need to be carefully orchestrated and organized, in order to be carried out in an efficient manner. Preceding the initiation event, the preinitiation complex composed of Ad Pol-pTP, DBP, NFI/CTF, and Oct-1 is formed at the origin. The assembly of this complex can occur in the absence of nucleotides. Binding of NFI/CTF to its site in the auxiliary origin region is facilitated by DBP [87]. Specific interactions of NFI/CTF and Oct-1 in the auxiliary region recruit and stabilize the interaction of the Ad Pol-pTP complex with the core origin [88]. The binding of the Ad Pol-pTP complex to the core origin is further enhanced by the TP linked to the genome. The phosphorylation state of Ad Pol and pTP is likely to influence the interactions of these proteins with DNA and with other proteins. After recruitment of the Ad Pol-pTP complex to the origin, DNA replication 5 8 Evans and Hearing initiates with the covalent coupUng of the first dCTP to pTP, resuhing in the formation of a pTP-dCMP complex necessary for the protein priming function. The initiation reaction is stimulated by DBP. It is also believed that DBP may be responsible for the unwinding of the origin. After the unwinding, the Ad Pol-pTP complex then forms a pTP- trinucleotide intermediate, pTP-CAT, by Ad Pol using the complementary sequence 3^-GTA located at nucleotides 4 - 6 from the genomic terminus. The presence of nucleotides in the complex causes the dissociation of NFI/CTF from its binding site. This trinucleotide-protein complex then jumps back from positions 4 - 6 by base pairing with template strand nucleotides 1-3 [89]. Following the jumping back event. Ad Pol dissociates from pTP linked to the end of the viral genome and elongation ensues. As Ad Pol replicates the viral DNA, it displaces the Oct-1 from its binding site. Ad Pol carries out DNA replication by displacing the nontemplate strand, with DBP assisting in the unwinding of downstream duplex DNA [37]. DBP also coats the single- stranded DNA resulting from elongation in order to protect it from nuclease digestion. The single-stranded DNA is then available to act as a template for a new round of pTP-primed initiation. However, in order for the Ad Pol-pTP to recognize and bind DNA, the template must be double-stranded. A double- stranded DNA template may be achieved by the annealing of the left and right ITRs on one DNA strand to one another to form a loop or panhandle structure, the end of which looks like the end of an intact genome and contains covalently attached TP. Alternatively, two single-stranded DNA molecules could anneal to form duplex DNA. The pTP attached to the 5̂ end of newly synthesized may protect the genome from nuclease digestion as well as assist in loading of an initiation complex in subsequent rounds of replication. The adenovirus E4 region produces several proteins that are required for efficient DNA replication in cell culture. As described above, the E4 ORF3 and E4 ORF6 proteins display redundant functions in Ad infection. A virus that lacks both of these two proteins is severely delayed in the onset of viral DNA replication, whereas viruses that express either one of these E4 gene products exhibit only a modest delay in the onset of DNA replication [59, 60]. Since neither of these proteins is required for DNA replication in vitro, they probably play a regulatory role in the process rather than have a direct effect in DNA synthesis. The exact nature of their participation in viral DNA replication is still unclear. Another E4 product that affects viral DNA replication is E4 ORF4. E4 ORF4 was shown to have an inhibitory effect on viral DNA replication in the absence of the E4 ORF3 and E4 ORF6 proteins [90]. E4 ORF4 may downregulate DNA synthesis through its interaction with PP2A. Dephosphorylation of ElA may affect the accumulation of E2 products, which would then decrease viral DNA synthesis. Also, PP2a activated by E4 ORF4 may dephosphorylate the viral phosphoproteins involved in DNA replication. 3. Adenovirus Replication 5 9 XII . VA RNA Genes Adenovirus encodes one or two VA (virus-associated) RNAs, depending on serotype, of about 160 nucleotides that are transcribed by host cell RNA polymerase III. VA-RNAj targets the protein kinase named PKR (reviewed in [91]). PKR is activated by the presence of low levels of double-stranded RNA, a likely product from symmetrical transcription of the Ad genome. Upon activation, PKR phosphorylates and inactivates eukaryotic initiation factor 2 alpha (eIF-2a), thus inhibiting protein synthesis in general. VA RNA is produced in large quantities in Ad-infected cells. PKR binds to the significant secondary structure found in VA-RNAj, and the high level of VA-RNAj interferes with PKR activation. This allows for the maintenance of efficient translation in Ad-infected cells [91]. XIII. Late Gene Expression and Virus Assembly Efficient late gene expression commences with the onset of Ad DNA replication. Late transcripts are initiated from the major late promoter (MLP) located at 16 map units (Fig. 1) [92]. Activation of the major late promoter appears to be mediated by both ds-acting changes in the viral genome as well as trans-acting factors. Both cellular and viral trans-acting components have been identified that bind sequences within the major late promoter. Cellular transcription factors TBP/TF-IID, USF/MLTF, and CAT box factor interact with ds-acting elements upstream of the major late promoter initiation site and are important activators of MLP expression [93]. Activation of the MLP also is specified by protein binding sites located downstream from the transcriptional start site [94]. The trans-acting components binding these sites are not fully characterized, but constitute multiprotein complexes containing the virally encoded IVa2 protein [95]. Through a mechanism(s) that is not understood, the Ad replication process significantly stimulates the activity of the MLP. The primary transcript from the major late promoter extends to the right end of the viral genome and is ~30,000 nucleotides (nt) in length. This primary transcript is polyadenylated at one of five sites and undergoes multiple splicing events to generate five families of late mRNAs (LI to L5; Fig. 1) [92]. At least 18 distinct late mRNAs are produced by alternative polyadenylation and splicing of the primary major late transcript. The 5̂ ends of all Ad late mRNAs contain an ~200-nt leader sequence referred to as the tripartite leader (due to the joining of three short exons in the primary late transcript). The tripartite leader sequence directs efficient translation of Ad late mRNAs independent of the host cell initiation factor eIF4F [96, 97]. eIF4F 60 Evans a n d H e a r i n g is a protein complex composed of phosphorylated cap-binding protein eIF4E, eIF4E kinase Mnkl , eIF4A, poly(A)-binding protein, and eIF4 G. Adenovirus infection blocks cellular translation by displacing Mnkl from eIF4F, thereby blocking phosphorylation of eIF4E 198]. The Ad-encoded lOOK late protein binds to eIF4 G in the same region bound by Mnkl and displaces Mnkl from the eIF4F complex. This results in the shut off of translation of host mRNAs and Ad mRNAs that lack the tripartite leader sequence. The translation of Ad late mRNAs that carry the tripartite leader sequence continues, effectively shutting down host mRNA translation w^hile permitting viral late mRNA translation. The mechanism by v^hich translation of Ad late mRNAs continues despite inactivation of eIF4F is not fully understood. Ad late mRNAs encode proteins that are part of the Ad capsid structure (discussed in Chapter 1 of this volume), that are involved in the virus assembly process, or that play other regulatory roles during the late phase of virus infection. Adenovirus DNA packaging into virus particles occurs in a polar manner from left to right and relies on a ds-acting packaging domain located betw^een approximately nt 200 and 380 nt (Fig. 6) (review^ed in [99]). It is thought that as-acting packaging sequences and trans-acting protein components act in conjunction to mediate DNA packaging, similar to a number of bacteriophages like lambda or^29. The formation of Ad particles proceeds through an A. packaging A repeats E1A ITR A1 TTTG GGCGTAAC CG 1 2 3 4 5 6 7 A2 TTTG GCCATTTT 1 1 1 CG 03 194 380 499 |
E1A enhancer A5 TTTG TCTAGGGC CG A6 TTTG ACCGTTTA CG B. 5'-TTTG NQ C G - 3 ' Al A2 A3 GGATGTTGTAGTAA|ffni^GCGTAA(^C^GTAAG|ATTTG|GCCATT^^ 230 250 270 290 310 A4 A5 A6 A7 AATA/{ffff^GTTACTCATAGCGCGTAAl|ATTTG[TCTAGGGa(P^ 330 350 370 Figure 6 Schematic of the adenovirus DNA packaging domain. (A) A schematic diagram of the left end of the adenovirus genome including the inverted terminal repeat (ITR), the packaging/enhancer region (nts. 194 to 380), and the El A 5' flanking region. The packaging repeats (A l through A7) are represented by arrows. The El A transcriptional start site is indicated by an arrow at nt 499. (B) The nucleotide sequence of the Ad5 packaging domain is shown. Numbers at the top correspond to nucleotides relative to the left end terminus. A repeats 1 through 7 are encircled. (C) The A repeat consensus sequence is shown. 3. Adenovirus Replication 6 1 ordered series of assembly events. The first virus assembly intermediate is the light particle that appears to be equivalent to a bacteriophage prohead. Light intermediate particles contain all of the major capsid proteins, lack viral DNA, and contain additional proteins that exit the particle during maturation and that may act as scaffolding proteins. Light particles mature to heavy intermediate particles upon the packaging of viral DNA and associated core proteins. As the final maturation step, activation of the virus-encoded and packaged protease results in numerous protein cleavages within the virus particle that result in maturation into the infectious virus [100]. These proteolytic cleavages are absolutely essential for the formation of highly infectious Ad particles. Further, Ad protease plays an important role in the infection process for proper release of the viral core particle from endosomes foUov^ing initial infection (reviewed in Chapter 2 of this volume). The Ad5 packaging domain is depicted in Fig. 6. The Ad5 packaging domain consists of at least seven redundant, although not functionally equiva lent, elements termed A repeats 1 through 7 [101, 102]. The functionally most important A repeats (Al, A2, A5, and A6) share a bipartite consensus motif S^-TTTGNgCG-S', which is conserved among different Ad serotypes [103]. There are spacing constraints between the two conserved parts of the bipartite consensus motif rather than between different A repeats. Multimerized copies of individual packaging repeats can restore viability to a mutant virus lacking a packaging domain. The Ad5 packaging domain displays considerable flexi bility in its position and orientation, but it must be located within ~600 bp of a genomic terminus [104]. Very little is known about the identity of trans-acting packaging com ponents involved in the packaging process. The packaging repeats very likely are binding sites for a trans-acting factor(s) that directs the packaging process. Several cellular DNA binding activities including OCT-1, COUP-TFl, and an unknown activity termed P complex interact with the TTTG half site of the packaging consensus sequence [105]. The functional significance of the binding of these cellular factors is presently under evaluation (Erturk and Hearing, unpublished results). The Ad IVa2 protein interacts with sequences that overlap the CO half of the Ad5 packaging repeat consensus [106]. It is not known if IVa2 is involved in Ad packaging, but the Ad IVa2 protein forms a protein complex with an Ad late gene product, LI 52/55K, that has a clear link to the Ad assembly process [107]. LI 52/55K mutants produce empty Ad particles or particles that are only partly packaged [108, 109]. It is easy to imagine that viral and cellular proteins form a multiprotein complex on Ad packaging signals that direct the encapsidation of the viral genome into virions. The identity and specificity of Ad packaging elements has been used to engineer Ad helper viruses whose packaging may be suppressed and to optimize yields of gutted Ad vectors. These approaches are reviewed in Chapter 15 of this volume. 6 2 Evans and Hearing XIV. Vector Design The ability of adenoviruses to infect a wide range of cell types as well as the ease with which their genomes can be manipulated has made Ad extremely attractive as a gene therapy vector. In order to obtain viral vectors for gene therapy, the viral genome carrying the transgene must be replicated and packaged to relatively high titers. Therefore, the replication events described in this chapter must be carried out to fruition in order for progeny virus to be produced, whether it is through traditional or alternative means. The first generation of Ad vectors lacked functional El and E3 regions, thus making them replication deficient due to the absence of ElA expres sion and greatly reduced transactivation of other early genes including the E2 region. These viruses were propagated in cell lines that provided El pro teins in trans allowing for efficient replication. The lack of E3 expression did not affect virus production in culture. These viruses were very effective in introducing a transgene to cells in culture and in the animal. However, the first-generation viruses elicited a significant host immune response including innate, cell-mediated, and humoral responses, preventing prolonged therapy and efficient reintroduction of the viral vector (reviewed in [110, 111]). Also, the production of these El-deficient viruses in complementing cell lines often resulted in El-positive, replication-competent adenovirus (RCA) due to recom bination with endogenous viral DNA sequences present in the complementing cell line. The contamination of gene therapy vector stocks with essentially wild-type adenovirus is unacceptable due to the outcome of lytic virus infec tion. Production of first generation vectors in complementing cell lines with integrated; nonoverlapping sequences will reduce the instances of recombinant RCAs in virus stocks. It is believed that a low level of expression of Ad proteins using first generation Ad vectors resulted in an immune response to viral infection. This may in part reflect low levels of replication of the viral genome despite the lack of El gene products. Second-generation Ad vectors were developed with additional deletions in genes involved in the replication cycle [110, 111]. The development of El-complementing cells lines that express additional Ad gene products from early region 2 or early region 4 greatly facilitated the development of the second generation Ad vectors. The inclusion of the E2 region proteins required for Ad DNA replication (Ad Pol, DBP, and pTP) in a gene therapy virus was primarily for ease of propagation of the virus due to the lack of complementing cell lines. Recently, several cell lines were described that constitutively or inducibly produce one or more of the E2 proteins, allowing for vectors lacking these sequences [112-114]. Similar lines were developed that express E4 gene products [115]. The removal of the E2 or E4 genes would provide more genetic space for the insertion of larger transgene sequences as well as allow the production of Ad vectors with greatly 3. Adenovirus Replication 6 3 reduced replication potential. The net effect of second-generation Ad vectors was the development of vectors with greater safety and significantly reduced host inflammatory responses and CTL responses to infected cells. However, the deletion of additional Ad gene products may not be without consequence to the utility of the vector in vivo. For example, the presence of the E4 ORF3 gene in Ad vectors that utilize the CMV promoter has been found to significantly contribute to sustained transgene expression both in vitro and in vivo [116, 117]. Thus, Ad vectors that express certain early gene products may be most useful under certain circumstances. An intriguing new approach in the development of adenovirus vectors is the design of oncolytic vectors that replicate in selected cells or types of cells (reviewed in [111]). This approach involves conditionally replicating viruses that undergo lytic infection in tumor cells. An example of conditionally replicating viruses is ONYX-015 [118]. This virus has been shown to replicate more efficiently in cells lacking p53. ONYX-015 is deleted for ElB 55K and it cannot replicate well in p53-positive cells, but is capable of productive infection in cells lacking active p53, such as tumor cells. The ONYX virus is discussed in great detail in Chapter 11 of this volume. Other conditionally replicative cells could be produced with El genes under the control of cell specific promoters, which are discussed in Chapters 9 and 10 of this volume. Other approaches to attack and eliminate p53 mutant cell refractory to other treatments could include vectors possessing E4 ORF4 or the E3 ADP proteins, which induce cell death independent of p53 status. The strategies mentioned above all result in the death of a target cell, such as a tumor cell, which would generally benefit from an inflammatory response and CTL infiltrate. This response would result in clearance of virus- infected cells. However, an immune response would not be beneficial while attempting to treat other diseases, such as metabolic disorders, that may require more than one treatment or prolonged presence of the viral genome. One approach that may delay or evade the immune system would be to include genes from the Ad E3 region that are involved in evasion of host immune responses during viral infection [119]. Additionally or alternatively, other viral or cellular immunomodulatory genes may be incorporated into Ad vectors toward the same goal. These types of approaches are discussed in Chapter 14 of this volume. XV. Conclusion The life cycle of adenovirus represents a complex series of events that must occur in a temporally and stoichiometrically appropriate fashion in order for efficient production of progeny virus. The virus must usurp control of the cellular machinery while controlling the expression and functions of its own 6 4 Evans and Hearing proteins. 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C H A P T E R Adenoviral Vector Construction I: Mammalian Systems Philip Ng'-^ and Frank L Graham'̂ ^^^ Departments of *Biology, "^Pathology, and "^Molecular Medicine McMaster University Hamilton, Ontario, Canada I. Introduction Adenoviruses (Ads) are excellent gene transfer vectors and are extensively used for high level expression of transgene products in cultured cells, as potential recombinant viral vaccines and for gene therapy. Ads are particularly v^ell suited for these applications because their genome is relatively easy to manipulated, they grow to high titers, they are stable and easy to purify, and they can transduce many cell types from numerous mammalian species including both dividing and nondividing cells in vitro and in vivo [1-4]. A. Adenovirus Biology The adenovirion is a nonenveloped icosohedral capsid containing a linear double-stranded DNA genome of ~30 -40 kb. Of the ~50 serotypes of human Ad, the most extensively characterized are serotypes 2 (Ad2) and 5 (Ad5) of subgroup C (review^ed in [5]). The 36-kb genomes of Ad2 and Ad5 are flanked by inverted terminal repeats (ITRs) which are the only sequences required in cis for viral DNA replication. A c/s-acting packaging signal, required for encapsidation of the genome, is located near the left ITR (relative to the conventional map of Ad). The Ad genome can be roughly divided into tv^o sets of genes (Fig. 1): the early region genes. El A, ElB, E2, E3, and E4, are expressed before DNA replication and the late region genes, LI to L5 are expressed to ^ Present address: Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas. ADENOVIRAL VECTORS FOR GENE THERAPY J | Copyright 2002, Elsevier Science (USA). All rights reserved. 72 Ng and Graham Late Transcription ^ 1 2 3 X y z [ t EIAEIB 1 E3 ' feVA, ^ _ •'^- ^ N 0 10 20 30 40 50 60 70 80 90 100 1 1 1 I - 1 1 1 1 1 1— 1 » _ i 1 1 1 — 1 1 1 1—1 l^a^ m\'' ^ ^ V _ . V E2 Figure 1 Transcription map of human adenovirus serotype 5. The 100 map unit (~36 kb) genome is divided into four early region transcription units, El - E 4 , and five families of late mRNA, LI -15, which are alternative splice products of a common late transcript expressed from the major late promoter (MPL) located at 16 |x. Four smaller transcripts, pIX, IVa, and VA RNAs I and II, are also produced. Not shown are the 103-bp inverted terminal repeats located at the termini of the genome involved in viral DNA replication and the packaging signal located from nucleotides 190 to 380 at the left end of the genome involved in encapsidation. high levels after initiation of DNA replication. The ElA transcription unit encodes two major ElA proteins that are involved in transcriptional regulation of the virus and stimulation of the host cell to enter an S phase-like state and is the first early region to be expressed during viral infection. The two major ElB proteins are necessary for blocking host mRNA transport, stimulating viral mRNA transport and blocking ElA-induced apoptosis. The E2 region encodes proteins required for viral DNA replication and can be divided into two subregions; E2a encodes the 72-kDa DNA-binding protein and E2b encodes the viral DNA polymerase and terminal protein precursor (pTP). The E3 region, which is dispensable for virus growth in cell culture, encodes at least seven proteins, most of which are involved in host immune evasion. The E4 region encodes at least six proteins, some functioning to facilitate DNA replication, enhance late gene expression and decrease host protein synthesis. The late region genes are expressed from a common major late promoter (MLP) and are generated by alternative splicing of a single transcript. Most of the late mRNAs encode virion structural proteins. In addition to the early and late region genes, four other small transcripts are also produced. The 4. Adenoviral Vector Construction I: Mammalian Systems 7 3 gene encoding protein IX (pIX) is colinear with ElB but utilizes a different promoter and is expressed at an intermediate time, as is the pIVal gene. Other late transcripts include the RNA polymerase III transcribed VA RNA I and II. Virus infection is initiated through the Ad fiber protein binding to specific primary receptors on the cell surface [6, 7] followed by a secondary interaction between the virion penton base and ayPs and ayps integrins [8]. The efficiency with which Ad binds and enters the cell is directly related to the level of primary and secondary receptors present on the cell surface [9, 10]. Penton-integrin interaction triggers Ad internalization by endocytosis where it escapes from the early endosome into the cytosol prior to lysosome formation [11,12]. The virion is sequentially disassembled during translocation along the microtubule network toward the nucleus where the viral DNA is released into the nucleus [13] where viral DNA replication, beginning 6 to 8 h postinfection, and assembly of progeny virions occur. The entire life cycle takes about 24-36 h, generating |
about 10"̂ virions per infected cell. Ads have never been implicated as a cause of malignant disease in their natural host and, in immunocompetent humans, they generally cause only relatively mild, self-limiting illness. The reader is referred to an excellent review by Shenk [5] for a more comprehensive discussion of adenoviruses. B. Adenovirus Vectors Typically, Ads are converted into mammalian gene transfer vectors by replacing the El region with the foreign DNA of interest. This serves two important purposes. First, since the packaging constraint of Ad is 105% of wild type [14], deletion of El increases the cloning capacity to ~5 kb. Second, it renders the vectors replication-deficient, which is important with respect to safety for human gene therapy and other applications. These replication- deficient vectors must be propagated in El-complementing cell lines such as 293 [15]. The E3 region can also be deleted from the vector since it is not required for virus propagation in culture. The combination of El and E3 deletions results in a cloning capacity of ~8 kb, a size that is more than adequate for most expression cassettes. C. Early Methods of Constructing Recombinant Adenoviruses All methods for manipulating Ad genomes for construction of vectors rely on the observation that purified viral DNA is infectious [16]. Early methods for generating recombinant Ad involved direct manipulation of viral DNA extracted from virions. These methods included in vivo homologous recombination between viral DNAs cotransfected into cells [17] and in vitro ligation of viral DNAs cleaved by restriction enzymes [18, 19]. However, a major limitation of these methods was that precisely defined alterations 74 Ng and Graham ^ i^ Viral DNA Xbal Xbal I Cleave DNAs with Xba 11 Ligate in vitro and transfect 293 cells ^f Recombinant virus ^ lA Viral DNA Xbal Cleave with Xba I and cotransfect / 293 cells with shuttle plasmid Homologous recombination X ^^ Recombinant virus Figure 2 Early methods for constructing recombinant Ad vectors. In the method depicted in (A), shuttle plasmids bearing the modified left end of the Ad genome and purified viral DNA are cleaved with a restriction enzyme. The recombinant Ad genome is generated by direct in vitro ligation between the shuttle plasmid and the viral DNA and infectious recombinant viruses are generated by transfecting the ligation product into 293 cells. In the method depicted in (B), shuttle plasmids bearing the modified left end of the Ad genome and purified viral DNA are cotransfected into 293 cells. Recombinant viruses are generated as a result of in vivo homologous recombination between their overlapping region of homology. To minimize production of nonrecombinant parent virus, the viral DNA is cleaved with a restriction enzyme at the left end prior to cotransfection. Thick gray lines represent cloned Ad DNA, thick black lines represent Ad viral DNA, thin black lines represent bacterial plasmid sequences and small arrows represent ITR. \\f, packaging signal. could not be introduced into the genome owing to the difficuhy inherent in manipulating the large linear viral DNA. In 1981, Stow [20] devised a method to overcome this limitation, at least for modifications of the left end of the genome, that employed in vitro ligation between a cloned subgenomic Ad fragment and viral DNA (Fig. 2A). In this study, the left end Hpal E fragment (0 to 4.5 mu) bearing the ElA region of Ad2 was inserted into pBR322, thus 4. Adenoviral Vector Construction I: Mammalian Systems 7 5 permitting the plasmid-borne El A sequences to be easily modified. The plasmid and Ad5 viral DNA (from variant dl309 which has a unique Xbal site [21]) w êre cleaved with Xbal at 3.7 mu and ligated in vitro. Recombinant Ads bearing the modified ElA region were generated by transfecting the ligation product into 293 cells. The significance of this method lay in the ability to reconstruct an infectious viral genome by using a cloned Ad subgenomic fragment as one of the substrates, thus allowing modifications engineered into the cloned sequence to be readily introduced into the viral genome. However, despite this advance, the approach was limited because few unique restriction enzyme sites were available due to the relatively large size of the Ad genome. A method that overcame these limitations was developed by Kapoor and Chinnadurai [22], who demonstrated that recombinant Ads could be generated by in vivo homologous recombination between a cloned Ad subgenomic fragment and viral DNAs (Fig. 2B). As in the method developed by Stow [20], a shuttle plasmid bearing a left end subgenomic Ad fragment was first constructed to permit easy modification of El sequences. The shuttle plasmid along with viral DNA were cotransfected into 293 cells and in vivo homologous recombination between their overlapping sequences resulted in the generation of recombinant Ad bearing the modified El . While this method does not rely on ligation of two restriction enzyme sites, the viral DNA is still cleaved prior to cotransfection to reduce the background of nonrecombinant parental virus. Currently, the unique Xbal site at 3.7 mu in Ad5 variant dl309 and the unique Clal site at 2.5 mu in wt Ad5 are the most useful for manipulation of the left end. While both of these early methods have proven useful, a major limitation is the requirement for viral DNA as a substrate for vector construction. Purification of viral DNA is time consuming and laborious and its use leads to a background of parental nonrecombinant viruses resulting in the need to screen a large number of viruses to isolate the desired recombinant. This can prove especially problematic when the parental virus has a growth advantage over the recombinant vector. Considering the importance and utility of Ad vectors as a tool for mammalian gene transfer, development of improved systems for their efficient and reliable construction was clearly imperative. II. The Two-Plasmid Rescue System One of the first methods that was developed to overcome the limitations of the earlier approaches was the two-plasmid rescue system (Fig. 3A). In this method, recombinant Ad vectors are generated by in vivo homologous recombination between two noninfectious plasmids cotransfected into 293 cells. Since its development, the two-plasmid rescue method has been widely used due to its simplicity. Other methods of constructing Ad vectors have 7 6 Ng and Graham Shuttle plasmid/ Foreign DN homologous recombination ! J3 lA Foreign DNA ™ AEl Adenovirus vector ITR Shuttle plasmid ^• ' • ' 'S^ t^o .^ ign ^^A , lox? Cre-mediated recombination ITR , J ry ITR , _ V̂ LacZ J_^ =t3 AEl /o;cP Adenovirus vector Figure 3 Construction of Ad vectors by (A) in vivo homologous recombination following cotrons- fection of 293 cells with a shuttle plasmid and an Ad genomic plasmid and (B) Cre-mediated site-specific recombination following cotransfection of 293Cre4 cells with a shuttle plasmid bearing a lox P site and pBHGloxAEl ,3. Ad sequences are represented by thick black lines, bacterial plasmid sequences are represented by thin black lines and the position and orientation of the loxP site is represented by a white triangle. Only the relevant portions of the shuttle plasmids are shown. also been developed; however, discussion of these is beyond the scope of this chapter. The reader is encouraged to consult the other chapters in this book for further details regarding these other methods. The remainder of this section w îll focus on the development of the tw^o-plasmid rescue method and the recent improvements that have been made to increase the method's efficiency and expand its versatility. The final section provides detailed protocols for 4. Adenoviral Vector Construction I: Mammalian Systems 7 7 the construction, using the two plasmid rescue method, and propagation of recombinant Ad vectors. A. Development of the Two-Plasmid Rescue System In developing the tw^o-plasmid rescue method, advantage w âs taken of observations made in early studies of Ad. One such observation was made in 1983 by Berkner and Sharp [23], who demonstrated that infectious recombinant Ads could be generated by cotransfecting 293 cells with cloned, noninfectious subgenomic Ad fragments. In this study, subgenomic fragments of Ad were cloned into the EcoRI site of pBR322. Infectious recombinant virus could be generated following cotransfection of 293 cells with these plasmids as a result of in vivo homologous recombination between their overlapping Ad sequences. Generation of infectious virus by this method was dependent on releasing the Ad ITR from at least one of the plasmids by EcoRI cleavage. The significance of this study lies in using only noninfectious plasmids, instead of viral DNA, as the substrates for vector construction, thus avoiding the need to isolate viral DNA and the problem of contaminating nonrecombinant virus. Another key finding, made in 1983 by Ruben et al. [24], was the discovery that up to 10% of Ad viral DNA molecules become circularized following infection of mammalian cells. This permitted cloning of the entire Ad genome as an infectious bacterial plasmid. One such Ad genomic plasmid, pFG140, consisted of a circularized dl309 Ad genome [21] with a 2.2-kb insert in the Xbal site at 3.7 mu containing the ampicillin resistance marker and a bacterial origin of DNA replication [25]. This Ad genomic plasmid could be stably propagated in Escherichia coli and was capable of generating infectious virus following transfection into mammalian cells at efficiencies comparable to purified virion DNA. In 1987, Ghosh-Choudhury et al. [26] observed that an Ad genomic plas mid of wild-type size but, unlike pFG140, bearing a deletion of the Ad protein IX gene was noninfectious. Based on this observation, they hypothesized that pIX was essential for the packaging of full-length Ad genomes. According to this hypothesis, reintroduction of the pIX gene into the noninfectious Ad genomic plasmid should restore its infectivity. To test this, 293 cells were cotransfected with the noninfectious pIX-deleted Ad genomic plasmid and a plasmid bearing the left end of the Ad genome including the pIX gene. Infectious viruses, all bearing the pIX gene, were generated as a result of in vivo homologous recombination between the two cotransfected plasmids thus demonstrating that pIX is essential for packaging full-length genomes. Based on the early studies of Ad described above, McGrory et aL [27] developed the first two-plasmid rescue system designed specifically for con structing recombinant, replication-defective Ad vectors in which the El region was substituted with a foreign transgene as depicted in Fig. 3A. To accomplish 7 8 Ng and Graham this the infectious Ad genomic plasmid pFG140 was modified by replacing the 2.2-kb insert with a 4.4-kb segment to generate the 40-kb plasmid pJM17. The resulting genome exceeded the packaging constraint of Ad and was nonin fectious but could replicate following transfection into 293 cells. To generate infectious recombinant Ads bearing foreign DNA of up to 5.4 kb in place of the El region, 293 cells were cotransfected with pJM17 and a shuttle plasmid bearing the left end of the Ad genome with the desired El region substitution. Since, in principle, neither plasmid was infectious only the desired recombinant El substituted vector should be generated as a result of in vivo homologous recombination between the overlapping Ad sequences in the shuttle plasmid and pJM17. While this system proved to be useful and highly successful, it was observed that pJM17 was not absolutely noninfectious, being able to generate infectious virus, albeit at low frequencies, following single transfection into 293 cells. It was discovered that the restoration of infectivity of pJM17 was due to deletions of the bacterial plasmid sequences following transfection into 293 cells resulting in size reduction to within the packaging constraints of Ad. The two plasmid rescue method was refined in 1994 by Bett et al. [28]. In this iteration of the system, an improved Ad genomic plasmid, pBHGlO, was constructed to address the shortcoming of pJM17 and to introduce additional flexibility into the system. The plasmid pBHGlO contains essentially the entire Ad5 genome joined at the ITRs with two modifications. The first modification is a deletion from 0.5 to 3.7 mu, which removes the El A region as well as the packaging signal required for encapsidation of the adenoviral genome thus rendering the plasmid noninfectious. The second modification was removal of -^2.7 kb from the nonessential E3 region, from 78.3 to 85.8 mu, and introduction of a Fad restriction enzyme site. A series of shuttle plasmids were also developed to be used in conjunction with pBHGlO. These shuttle plasmids contained the |
left 15.8 mu of the Ad5 genome including the left end ITR and the packaging signal but with a 3181-bp deletion in El from 0.9 to 9.8 mu into which a polylinker was introduced for transgene insertion. This version of the two-plasmid rescue system offered several improvements over the original system of McGrory et al, [27]. First, the combination of the El region deletion in the shuttle plasmid and the E3 region deletion in the Ad genomic plasmid increased the cloning capacity of the recombinant vector, permitting rescue of up to '^ 8 kb of foreign DNA. Second, recombinant vectors bearing foreign DNA insertions in the E3 region could be easily constructed by utilizing the unique Fad site in the Ad genomic plasmid. To simplify cloning into the large pBHG plasmids, insertion of foreign DNA into the Fad site is facilitated by using the kanamycin resistant pABS series of small shuttle plasmids (www.microbix.com). The pABS plasmids bear two Fad sites which flank a polylinker and the kanamycin resistance gene. The kanamycin resistance gene is flanked by Swal sites. The foreign DNA is first inserted into the polylinker of the pABS plasmid. The Fad fragment bearing 4. Adenoviral Vector Construction I: Mammalian Systems 7 9 the foreign DNA and the kanamycin resistant gene is then cloned into the Pad site of the pBHG plasmid. Following transformation of E. coli, positive clones bearing the E3 insertion are easily identified by their resistance to both ampicillin and kanamycin. Finally, the kanamycin resistance gene is collapsed out of the pBHG plasmid by Swal digestion and religation, leaving behind the foreign DNA in the E3 region. Thus, by using this system, a total of ~8 kb of foreign sequence could be easily rescued into the El and/or E3 regions of the recombinant vector. Third, the deletion of the packaging signal rendered pBHGlO absolutely noninfectious and, thus, all progeny virus generated following cotransfection were the desired recombinant. This version of the two-plasmid rescue system has become very popular for construction of El replacement vectors due to its versatility and simplicity; one need only clone the foreign DNA into the small shuttle plasmid and cotransfect it along with pBHGlO into 293 cells to generated recombinant vectors. However, one limitation of the two plasmid rescue method, especially for those not experienced in adenovirology, was the low efficiency of vector rescue if cells or transfection parameters were suboptimal. B. Refinements to the Two-Plasm id Rescue Method In 1999, Ng et al, [29] hypothesized that the low efficiency of vector res cue was due, in part, to the inefficiency of in vivo homologous recombination. Consistent with this hypothesis was the observation that the plaque-forming efficiency of the infectious Ad genomic plasmid pFG140 was ~100-fold higher than that achieved by a typical cotransfection for vector rescue. To address this limitation the two-plasmid rescue system was modified to make use of high efficiency site-specific recombination catalyzed by bacteriophage PI recombi- nase Cre instead of homologous recombination (Fig. 3B). To accomplish this, a loxP site was inserted into pBHGlO, 5' of the pIX gene and into the shuttle plasmid, y of the foreign transgene. Thus, vector rescue could be achieved by high efficiency Cre-mediated recombination between the two modified plas- mids following their cotransfection into 293 cells expressing Cre recombinase (293Cre4 [30]). Ng et al. [29] demonstrated that the efficiency of vector rescue by Cre-mediated recombination was ~30-fold higher than by homologous recombination. Further improvements were subsequently introduced when Ng et al. [31] demonstrated that replacement of the single ITR in the shuttle plasmid with a head to head ITR junction resulted in a 14-fold increase in the efficiency of homologous recombination mediated vector rescue. Combining Cre-mediated recombination and shuttle plasmids bearing an ITR junction increased the efficiency of vector rescue by ~ 100-fold over the earlier methods of McGrory et al. [27] and Bett et al. [28]. A number of nonmutually exclusive explanations were postulated to account for the effect of ITR junctions on vector rescue 8 0 Ng and Graham efficiency (Fig. 4). Based on the fact that ITR junctions serve as an efficient origin of viral DNA rephcation [25] in contrast to a single ITR linked to plasmid DNA and that the ITRs are the only ds-acting Ad sequences required for viral DNA replication, it w âs postulated that shuttle plasmids bearing an ITR junction, in contrast to shuttle plasmids having only a single ITR, were capable of virus-mediated DNA replication foUov^ing cotransfection of 293 cells with the Ad genomic plasmid which would supply all the trans-acting factors required for viral DNA replication. Thus, the increased vector rescue efficiency may reflect an increase in the substrate pool for recombination. In addition, since Ad DNA replicates as a linear molecule (reviewed in [32]), it is also possible that linearization of the shuttle plasmid by ITR junction-mediated DNA replication may produce a preferred substrate for recombination in contrast to shuttle plasmids bearing a single ITR which remains circular. Also, generation of an infectious genome may be more complex following recombination between a circular and a linear DNA molecule (single ITR shuttle plasmid and replicating Ad genomic plasmid) (Fig. 4A) than between two linear DNA molecules (replicating shuttle and Ad genomic plasmid) (Fig. 4B). In the former case (Fig. 4A), recombination would first result in integration of the circular substrate into the linear substrate. This intermediate is not packagable owing to its size [14] and the distance between the packaging signal and the genome terminus [33]. An infectious packagable genome could be generated from this intermediate by a second step following DNA replication in which the internal ITR is utilized as an origin of replication through the formation of a panhandle structure and repair, a process that is known to occur [34] but which might be less efficient than utilization of the terminal ITRs. In contrast, in the latter case (Fig. 4B), a packagable, infectious genome is generated immediately following recombination between two linear substrates. To further expand the versatility of this method, the system was modified to permit high-efficiency Cre-mediated vector rescue to be achieved using the ubiquitous 293 cells (or any other El-complementing cell line) thus abrogating the need for Cre-expressing cell lines which are not as widely available as the parental 293 cell line. To accomplish this, a Cre expression cassette was inserted into a region of the Ad genomic plasmid which would not contribute to the final recombinant vector genome but permitted transient Cre expression following cotransfection. The vector rescue efficiency following cotransfection of 293 cells using this Ad genomic plasmid was found to be nearly as high as with 293Cre4 cells [31]. One limitation of Cre-mediated vector rescue is that it would be unsuit able for constructing vectors bearing loxP sites elsewhere in the genome designed, for example, to regulate transgene expression [35-37] or to inhibit vector packagability [38] since it would lead to undesired Cre-mediated vector rearrangements. This was addressed by modifying the two plasmid rescue ^ o fl VH _0 3 O a o 3 oo •§7 T>S cCiDi o I <: a>_o S 1 t .E CL - " o E C5D -Q.< to D + -̂^̂ II % o %. % II •t=.2 ^o _1g D5Q. -a I.S O _jc < ? o a n I D L . E o o ^ ^ 1̂ > - D ^ _g) CO D E •T3 t o 0 'c E k ^ U E %, •% S "D "D cD ^ "D CO O Q - 'E«o D ^ Q_ o 41 £ 'E 3 o .0) c 81 8 2 Ng and Graham method to utilize the yeast FLP-mediated site-specific recombination sys tem [39]. With loxP sites in the Ad genomic and shuttle plasmids replaced with frt sites and the Cre-expression cassette replaced with a FLP-expression cassette in the Ad genomic plasmid the efficiency of FLP-mediated vector rescue was comparable to that mediated by Cre. The choice of either Cre- or FLP- mediated recombination further expanded the versatility of the two plasmid rescue method by permitting high-efficiency vector rescue in cases where one of the recombinases is unsuitable or undesirable for vector construction. C. The Ad Genomic Plasmid A variety of Ad genomic plasmids are available for construction of vectors by site-specific recombination (Fig. 5). The plasmids pBFIGloxESCre and pBHGfrtE3FLP bear a wild-type E3 region and are used to generate vectors by Cre-mediated and FLP-mediated recombination, respectively. Owing to the size constraints of Ad [19], the maximum foreign DNA insert that can be rescued into an El-deleted vector with a wild-type E3 region is ^ 5 kb. The plasmids pBHGloxAE3(Xl)Cre and pBHGfrtAE3(Xl)FLP have a 1864-bp deletion in the E3 region and thus permit foreign sequences up to ~7.2 kb to be rescued into vectors, whereas the plasmids pBHGloxAEl,3Cre and pBHGfrtAEl,3FLP have a 2653-bp deletion in the E3 region and permit rescue of up to ~ 8 . While these latter two plasmids offer maximum cloning capacity, vectors bearing this larger E3 deletion may grow slightly slower and result in lower yields ('^2-fold) than vectors bearing the wild-type E3 or smaller E3 deletion (F. L. Graham; unpublished results). As with the earlier pBHGlO based methods, the unique Pad sites in pBHGfrtAEl,3FLP, pBHGfrtAEl,3FLP, pBHGloxAE3(Xl)Cre, and pBHGfrtAE3(Xl)FLP permit insertion of foreign sequences into the E3 deletion for rescue into virus if desired. The choice of these Ad genomic plasmids is dictated by the size of the foreign sequence to be rescued, whether a wild-type or a deleted E3 region is desired and which site-specific recombination system is preferred/necessitated. D. The Shuttle Plasmid A variety of shuttle plasmids are available for insertion and rescue of foreign sequences into Ad vectors by Cre or FLP-mediated recombination (Fig. 6). The shuttle plasmids pDC311 and pDC312 are designed for rescue of expression cassettes into El by Cre-mediated recombination and pDCSll and pDC512 for rescue by FLP-mediated recombination. The shuttle plas mids pDC315, pDC316, pDC515, and pDC516 carry promoters and poly(A) sequences and are designed for insertion of coding sequences. PDC315 and pDC316 use Cre-mediated recombination and pDC515 and pDC516 use FLP- mediated recombination. The polycloning site in these plasmids is flanked by 4. Adenoviral Vector Construction I: Mammalian Systems 83 ITRs Cre ITRs AE3 Cre AE3 (-1864 bp) AiA (-1864 bp) Pad AEl Pad loxF ITRs AE3 Cre AE3 (-2653 bp) (-2653 bp) Pad Pad Figure 5 Ad genomic plasmids used for vector rescue by in vivo site-specific recombination. The plasmids pBHGloxE3Cre, pBHGloxAE3(Xl)Cre, and pBHGloxAEl,3Cre are used to rescue vectors by Cre-mediated recombination bearing a wildtype E3 region, a 1864 bp deletion or a 2653 bp deletion of E3, respectively. Analogous plasmids pBHGfrtE3FLP, pBHGfrtAE3(Xl )FLP and pBHGfrtAEl,3FLP are used to rescue vectors by FLP-mediated recombination. The unique Pad restriction enzyme site in pBHGloxAEl,3Cre, pBHGloxAE3(Xl)Cre, pBHGfrtAE3(Xl)FLP, and pBHGfrtAEl ,3FLP permit insertion of foreign sequences into the E3 deletion. Ad and bacterial plasmid sequences are represented by thick and thin lines, respectively, and loxP or frt sites are represented by ">". 84 Ng and Graham ITRs ITRs polylinker MCMV y promoter loxP polylinker amp SV40 polyA amp loxP ITRs ITRs polylinker y SV40 polyA amp EcoRI Xbal StuI Nhel ^ ,,, Hindlll Ecll36II ACCI Bglll Sad pDCBll 5'TCTAGAGAATTCAGGCCTGCTAGCAGATCTAAGCTTGAGCTCGTCGAC 3 ' EcoRI Nhel Hindlll Ecll36II ^ccl Xbal StuI Bglll Sad BamHI pDC511 5' TCTAGAGAATTCAGGCCTGCTAGCAGATCTAAGCTTGAGCTCGTCGACGGATCC 3>' Sail Acd Ecll36II Hjn^iii E Xbal Sad Bglll Nhel coRI pDC312 StuI BamHI pDC512 5 TCTAGAGTCGACGAGCTCAAGCTTAGATCTGCTAGCAGGCCTGAATTCGGATCC Sail EcoRI Nhel BamHI Acd pDC315 pDC515 5' GAATTCAAGCTGCTAGCAAGGATCCAGCTTGTCGAC 3' Smal Xmal ^ ,̂ ^ Hindlll EC1136II ^^fj EcoRI Bglll Sad pDC316 pDC516 5' GAATTCCCCGGGAGATCTAAGCTTGAGCTCGTCGAC 3' Figure 6 Shuttle plasmids and their polylinker sequences used for vector rescue by /n vivo site-specific recombination. The shuttle plasmids pDC311 (3276 bp), pDC312 (3288 bp), pDC315 (3913 bp), and pDC316 (3913 bp) are used to rescue vectors by Cre-mediated recombination. The shuttle plasmids pDC511 (3277 bp), pDC512 (3277 bp), pDC515 (3957 bp), and pDC516 (3957 bp) are used to rescue vectors by FLP-mediated recombination. The plasmids pDC311, pDC312, pDC511, and pDC512 are used for insertion of expression cassettes (inserts with a pro moter/enhancer and polyadenylation signal as well as coding sequence). The plasmids pDC315, pDC316, pDC515, and pDC516 bear a polylinker flanked by the murine cytomegalovirus immedi ate-early promoter/enhancer and SV40 polyadenylation signal and are used for insertion of coding sequences (e.g., cDNAs). 4. |
Adenoviral Vector Construction I: Mammalian Systems 8 5 a murine cytomegalovirus (MCMV) immediate-early promoter and the SV40 polyadenylation signal for high level transgene expression in most cell types. The choice of shuttle plasmid is dictated by v^hether expression from a strong viral promoter is desired, by the orientation of the polylinker and by the site- specific recombination system desired for vector rescue. It has been observed that higher expression levels are obtained when the transcription orientation of the transgene is in the same direction as El and that the MCMV immediate early promoter is stronger in most cell lines than its more commonly used human counterpart [40]. III. Protocols for the Two-Plosmid Rescue System The remainder of this chapter provides detailed protocols for each of the steps involved in the rescue and propagation of recombinant Ad vectors. A flow chart of these steps is presented in Fig. 7. Briefly, 293 cells are cotransfected with the Ad genomic plasmid and the shuttle plasmid. The recombinant vector is generated by in vivo site-specific recombination between the two plasmids and forms a plaque in the cell monolayer. The plaques are isolated, the virus expanded, and the vector DNA is extracted for confirmation by restriction enzyme digestion. The vector is plaque purified by titration and a high titer stock is generated which is then purified by CsCl banding and characterized with respect to concentration, DNA structure, level of RCA contamination and transgene expression. It is recommended that all the steps outlined in Fig. 7 be followed. However, since all infectious viruses generated after cotransfection are the desired recombinant [29, 31, 39], vector production can be expedited if necessary by following one or more shortcuts indicated in Fig. 7 and described in section III.I. A. Preparation of Plasmid DNA The foreign DNA is inserted into an appropriate shuttle plasmid and transformed into £. coli by conventional molecular biology techniques. This section describes the preparation of high-quality plasmid DNA for cotransfec tion. MATERIALS 1. Plasmid DNA: All plasmids described in this chapter and their sequences can be obtained from Microbix Biosystems Inc. (www.microbix.com). 2. Sterile LB broth (Lennox) (Difco) and LB-agar plates supplemented with 50 |xg/mL ampicillin. Optional: Sterile Super Broth; LB broth 86 Ng and Graham Clone foreign DNA into shuttle plasmid Rescue and isolate Ad vector (section IIIC) Analyze Ad vectors and prepare vector lysate (section HID) Plaque purify Adv ector by titration (section HIE) Analyze Ad vector and prepare vector lysate (section HID) Prepare high titer vector stocks (section IIIF) Purify Ad vector by CsCl banding (section IIIG) Characterize Ad vector (section IIIH) Figure 7 Overview of the steps involved in rescue, propagation, purification, and characterization of Ad vectors. The recommended steps are indicated by thick arrows. Acceptable alternatives to expedite vector production are indicated by thin arrows (see section III.I). 4. Adenoviral Vector Construction I: Mammalian Systems 8 7 supplemented with 22 g/mL peptone, 15 g/mL yeast extract, 1 g/mL D-glucose, 0.005 N NaOH, and 50 |JLg/mL ampicillin. 3. Solution I: 10 mM EDTA, pH 8.0, 50 mM glucose, 25 mM Tris, pH 8.0, prepared from sterile stock solutions. 4. Solution 11:1% SDS, 0.2 N NaOH, freshly prepared. 5. Solution III: 3 M potassium acetate, 11.5% glacial acetic acid, auto clave sterilized. 6. Isopropanol. 7. TE: 10 mM Tris, pH 8.0, 1 mM EDTA, pH 8.0, autoclave sterilized. 8. Pronase stock solution: 20 mg/mL pronase in 10 mM Tris, pH 7,5-^ preincubate at 56° C for 15 min, followed by 37°C for 1 h. Aliquot and store at —20°C. 9. Pronase-SDS solution: 0.5 mg/mL pronase (above) in 0.5% SDS, 10 mM Tris, pH 7.4, 10 mM EDTA pH 8.0. 10. CsCl (biotechnology grade). 11. 10 mg/mL ethidium bromide. METHOD 1. Inoculate 5 mL of LB supplemented with 50 |xg/mL ampicillin with bacteria bearing the desired plasmid in the morning. Incubate culture at 37°C with shaking. For the large Ad genomic plasmid, bacterial cultures should be started from well-isolated colonies picked from a bacterial plate less than 1 week old. 2. Inoculate 500 mL of LB supplemented with 50 |xg/mL ampicillin with the above culture in the late afternoon. Incubate overnight at 37°C with shaking. Optional: For higher yields of plasmid DNA use richer medium such as Super Broth. 3. Transfer culture to a centrifuge bottle and pellet bacteria by spinning at 6000 g for 10 min at 4°C. Resuspend bacterial pellet in 40 mL of cold solution I so that no cell clumps are visible. 4. Add 80 mL of freshly prepared solution II, mix thoroughly but gently by swirling to produce a relatively clear, viscous lysate. 5. Add 40 mL of cold solution III, mix thoroughly but gently by swirling and incubate for 20 min on ice. The viscosity should be greatly reduced and a white precipitate should form. 6. Add 10 mL of dHiO and centrifuge at 4°C for 10 min at 6000 g. 7. Collect the supernatant by filtering it through two to three layers of cheesecloth into a centrifuge bottle. 8. Add 100 mL (0.6 vol) of isopropanol, mix well, and incubate for 30 min at room temperature to precipitate plasmid DNA, centrifuging at 4°C for 10 min at 6000 g to pellet plasmid DNA. 9. Discard the supernatant and air dry the pellets for 15 min. Wipe inside the rim with a clean Kim Wipe to remove all residual isopropanol. 8 8 Ng and Graham 10. Dissolve plasmid DNA pellet in 5 mL TE and transfer to a 50-mL conical tube. 11. Add 2 mL pronase-SDS solution. Mix well and incubate for 30 min at 37°C. 12. Add 8.6 g CsCl, mix to dissolve completely, and incubate on ice for 30 min. 13. Centrifuge at 3000 g for 30 min at 5°C. Slowly collect the supernatant using a 10 cc syringe and 16-gauge needle, avoiding as much of the pellicle as possible. 14. Transfer to a VTi65 ultracentrifuge tube. Add 25 |xL of 10 mg/mL ethidium bromide and fill the tube with light parafin oil. 15. Seal the tube and mix by inversion. Centrifuge in a Beckman VTi 65.1 rotor at 55,000 rpm for 10-14 h at 14°C. 16. Remove tube and support it with a stand. The supercoiled plasmid DNA band should be the thick red band in the gradient. Puncture the top of the tube to allow entry of air and collect the plasmid DNA through the side of the tube with a 3 cc syringe and 18-gauge needle by puncturing the side of tube just below the band. Except when recovering plasmid DNA bands, keep the tubes in the dark or covered with foil to avoid unnecessary exposure to fluorescent or UV light. 17. Transfer plasmid DNA to a 15-mL polypropylene tube containing 5-mL isopropanol which has been saturated with CsCl in TE. Mix immediately to extract the ethidium bromide into the solvent layer. Allow the phases to separate and discard the ethidium bromide-solvent (pink) layer. Repeat extraction until the solvent layer is colorless. 18. Add TE to bring the volume up to 4 mL, add 8 mL cold 95% ethanol, and mix by inversion to precipitate the DNA. 19. Spin at 3000 g in a table-top centrifuge at room temperature for 15 min to pellet DNA. Wash pellet twice with 5 mL 70% ethanol. 20. Remove as much of the 70% ethanol as possible, allow the pellet to dry, and resuspend with an appropriate volume of TE. Ideally, the concentration should be 1 to 2 |Jig/|xL. 21. Determine the plasmid DNA concentration by OD260 and digest a sample with appropriate diagnostic restriction enzymes and confirm the structure by agarose gel electrophoresis. B. Cell Culture Low-passage 293 cells are maintained in 150-mm dishes and are split 1 to 2 or 1 to 3 when they reach confluency (every 2 to 3 days). Generally, a ~90% confluent 150-mm dish of 293 cells is split into 10 60-mm dishes for use the next day for cotransfections. Never allow the cells to become overconfluent or to be seeded too thinly. Change the medium regularly between splits (twice weekly 4. Adenoviral Vector Construction I: Mammalian Systems 8 9 if they are not growing rapidly enough to permit spUtting every 2 - 4 days). A sufficient number of ampoules of the cells should be frozen and stored in liquid N2 to permit initiation of new cultures when the passage number of the lab stocks has reached 40-45 passages or when the cells are no longer behaving well under agar overlays (see sections III.C and III.E). Higher passage or poorly adherent cells which are unsuitable for cotransfections or titrations may still be adequate for virus propagation. 293N3S are suspension-adapted 293 cells and can be used for large-scale vector production instead of 293 cells due to greater ease of handling. MATERIALS 1. Low-passage 293 and 293N3S cells (Microbix Biosystems Inc.). 2. Complete medium: MEM (Gibco BRL 61100) containing 10% fetal bovine serum (FBS) (heat inactivated), 100 units/mL penicillin/strepto mycin, 2 mM L-glutamine, and 2.5 |xg/mL fungizone. 3. Joklik's modified-MEM (Gibco BRL 22300) supplemented with 10% horse serum (heat inactivated). 4. Citric saline: 135 mM KCl, 15 mM sodium citrate, autoclave steril ized. 5. Spinner flasks (Bellco). Prewarm all cell culture reagents to 37°C prior to use. METHOD 1. Remove medium from 150-mm dish of 293 cells and rinse monolayer twice with 5 mL citric saline. 2. Remove citric saline from step 1, add 0.5 mL citric saline, and leave the dish at room temperature until cells start to round up and detach from the dish (no more than 15 min). 3. Tap the side of the dishes to detach all cells. 4. Resuspend cells with complete medium and distribute into new dishes. 293N3S cells are grown at 37°C in spinner flasks in Joklik's modified MEM supplemented with 10% horse serum (heat inactivated) and should be diluted 1 to 2 or 1 to 3 when the density reaches 5 x 1 0 ^ cells/mL. C. Cotransfection Under optimal conditions, large numbers of plaques are typically gener ated by cotransfecting a single 60-mm dish of 293 cells with 2 |jig of the shuttle plasmid and 2 |JLg of the Ad genomic plasmid by site-specific recombination (Table I). However, many factors can influence the efficiency of vector rescue including the quality of the DNA, the efficiency of transfection and especially the state of the 293 cells. Another important consideration is that the plaques 90 Ng and Graham Table 1 Vector Rescue Efficiency by in Vivo Site -Specific Recombination" Shuttle plasmid Ad genomic: plasmid Average plaques/60-mm dish pCA35loxAITR pBHGloxAEl,3Cre 43 pBHGloxAE3(Xl)Cre 63 pBHGloxE3Cre 48 pCA35frtAlTR pBHGfrtAEl,3FLP 41 pBHGfrtAE3(Xl)FLP 27 pBHGfrtE3FLP 25 pFG140^ 103 ^60-mm Dishes of 293 cells were cotransfected with 2 |jLg of each plasmid and plaques were counted 10 days postcotransfection. ^60-mm Dishes of 293 cells were transfected with 0.5 \xg of pFG140 and plaques were counted 10 days postcotransfection. be well isolated. Thus, it is recommended that a range of DNA amounts be cotransfected to ensure that plaques are obtained and that they are well iso lated. The infectious Ad genomic plasmid pFG140 [18] provides a control for transfection efficiency and under optimal conditions should yield up to ~100 plaques per 0.5 |jLg. The following is a protocol in which four 60-mm dishes of 293 cells are cotransfected with 0.5, 2, and 5 |jLg of each plasmid (Fig. 8). MATERIALS 1. Monolayers of low passage 293 cells at ^^80 to 90% confluency in 60-mm dishes. 2. Hepes-buffered saline (HBS): 21 mM Hepes, 137 mM NaCl, 5 mM KCl, 0.7 mM Na2HP04, 5.5 mM glucose, pH 7.1 (adjusted with NaOH), filter sterilized. Store at 4°C in small aliquots in tightly sealed plastic conical tubes. 3. Salmon sperm DNA (2 |jig/|JLL in TE). 4. 2.5 M CaCli, filter sterilized. 5. Complete medium (see section III.B) 6. 2x Maintenance medium: 2x MEM (Gibco BRL 61100) sup plement with 10% horse serum (heat inactivated), 200 units/mL penicillin/streptomycin, 4 mM L-glutamine, 5 |xg/mL fungizone, and 0.2% yeast extract. 7. 1 % Agarose solution, autoclave sterilized. Store at room temperature and melt in a microwave oven prior to use. 8. Ad genomic plasmid DNA (see section II.C). 9. Shuttle plasmid DNA with the desired foreign sequence inserted (see section II.D). 4. Adenoviral Vector Construction I: Mammalian Systems 91 8 ml HBS + 40 |il salmon sperm |
DNA, vortex for 1 min V i ; T 2ml 2ml 2ml 1ml 66 A 99 "B" u u u u Shuttle 20 | ig plasmid 8 | ig 2|^g Ad genomic 20 | ig l |^g plasmid 8l ig 2 | l g (pFG140) 2.5 M CaCl^ 100 III 100 III 100 III 50 III 0.5 ml/60 mm dish i i i I Figure 8 Standard protocol for Ad vector rescue by in vivo site-specific recombination. 10. Phosphate-buffered sahne (PBS): 137 mM NaCl, 8.2 mM Na2HP04, 1.5 mM KH2PO4, 2.7 mM KCl, autoclave sterihzed. 11. PBS++: PBS supplemented with 0.68 mM sterile MgCli and 0.5 mM sterile CaCli. 12. Glycerol, autoclave sterilized. 9 2 Ng and Graham METHOD 1. Label four 60-mm dishes "A", four dishes "B", four dishes "C", and two dishes "D". Seed these dishes with 293 cells to reach ~ 8 0 % confluency in 1 to 2 days for cotransfection. 2. In the late afternoon, 1 hour prior to cotransfection, replace the medium from the 60-mm dishes of 293 cells with 5 mL of freshly prepared complete medium without washing. 3. Meanwhile combine in a 15 mL conical tube 8 mL of HBS and 40 |JLL of salmon sperm DNA and vortex at maximum setting for 1 min. 4. Add 2 mL of the above solution to each of three polystyrene tube labeled "A", "B", and "C 'and 1 mL to a fourth polystyrene tube labeled "D". 5. Add 2 |xg of shuttle plasmid DNA and 2 |xg of Ad genomic plasmid DNA to tube "A" (this will result in 0.5 |xg of each plasmid per dish). Add 8 |jLg of shuttle plasmid DNA and 8 |JLg of Ad genomic plasmid DNA to tube "B" (2 |xg of each plasmid per dish). Add 20 |xg of shuttle plasmid DNA and 20 |xg of Ad genomic plasmid DNA to tube " C " (5 |jLg of plasmid per dish). Add 1 |xg of pFG140 DNA to tube "D". Gently mix each tube thoroughly. 6. To tubes ' 'A", "B", and " C " add 100 |JLL of 2.5 M CaCli dropwise with gentle mixing. To tube " C " add 50 |xL of 2.5 M CaCli dropwise with gentle mixing. Incubate the tubes at room temperature for 30 min. The solutions should become slightly cloudy. 7. Add 0.5 mL of the contents in tube "A"dropwise to the monolayer in each of the dishes labeled "A" without removing the medium. Repeat for tubes "B", "C", and "D". Distribute the precipitate evenly by rocking the dishes and return to the incubator. 8. The following morning, melt 1% agarose solution in a microwave oven and allow it to equilibrate to 45°C. Equilibrate 2x maintenance medium to 37°C. Prepare overlay solution by combining 7S mL of melted 1 % agarose and 75 mL of 2 x maintenance medium. 9. Remove the medium from each of the cotransfected dishes and add 10 mL of overlay solution prepared in step 8. Perform this step quickly to prevent the overlay solution from prematurely solidifying but gently to prevent disturbing the monolayer. 10. Allow the overlay to solidify at room temperature (10 to 15 min) and then return the dishes to the incubator. Plaques should begin to appear in 5 days and will continue to appear until about 12 to 14 days post-cotransfection. 11. Ten days post-cotransfection, pick well isolated plaques from the monolayer by punching out agar plugs with a sterile cotton plugged Pasteur pipet attached to a rubber bulb. It is recommended that 4. Adenoviral Vector Construction I: Mammalian Systems 9 3 plaques be isolated at about 10 days post-cotransfection to ensure that those chosen are well isolated with no plaques overlapping. 12. Transfer the agar plugs into 0.5 mL PBS"̂ + supplemented with glycerol to 10% in a suitable vial. Vortex briefly and store at —70°C. D. Analysis of Recombinant Vectors and Preparation of Working Vector Stocks Once plaques have been isolated, the viruses are expanded for extraction of vector DNA for analysis and to yield a working vector stock. MATERIALS 1. 90% Confluent 60-mm dishes of 293 cells. 2. TE (see section II.A). 3. Complete medium (see section II.A). 4. Maintenance medium: MEM (Gibco BRL 61100) containing 5% horse serum (HS) (heat inactivated), 100 units/mL penicillin/strepto mycin, 2 mM L-glutamine, and 2.5 |jLg/mL fungizone. 5. PBS++ (see section II.C). 6. Pronase-SDS solution (see section II.A). METHOD 1. Seed 60-mm dishes of 293 cells (one per plaque) to reach ^^90% confluency on the day of use. 2. Thaw virus plaque picks and vortex briefly. Remove medium from the 60-mm dishes of 293 cells and add 250 |xL of the plaque pick. Adsorb for 1 h in the incubator rocking the dishes every 10 to 15 min. 3. Following adsorption, add 5 mL of maintenance medium and return dishes to incubator until complete cytopathic effect (CPE) is observed (>90% cells rounded up and detached from dish, usually 4 to 5 days postinfection). It is important that the DNA be extracted following complete CPE so that vector DNA bands are clearly visible above the background of cellular DNA. If complete CPE is not reached by 5 days postinfection (most likely due to low multiplicity) then scrape the monolayer into the medium and transfer the cell suspension into a suitable vial and supplement with glycerol to 10%. Freeze (—70°C)-thaw the cell suspension and infect 60-mm dishes of 90% confluent 293 cells with 0.2 to 0.4 mL as described above. Complete CPE should be observed within 5 days and the vector DNA can be extracted. 4. Once complete CPE is reached, the dishes are processed as follows: Scrape the cells into the medium and transfer 1.5 mL of the cell suspension into an eppendorff tube for vector DNA extraction (see 9 4 Ng and Graham step 5). Transfer the remainder of the cell suspension into a suitable vial, supplement with glycerol to 10% and store at — 70°C. This lysate should contain a significant amount of virus ('^lO^ pfu/mL) and can be used for plaque purification of the vector (section III.E) or can be used in preliminary experiments or for further vector expansion (section III.F). 5. To extract vector DNA, pellet cells by spinning at 3000 rpm in a microcentrifuge for 5 min. 6. Discard supernatant, resuspend the cell pellet in 0.2 mL pronase-SDS solution and incubate tubes at 37°C overnight. 7. Add 0.2 mL dHiO and 1 mL 95% ethanol and mixing by inversion until the DNA precipitate is formed. 8. Pellet DNA by spinning in a microcentrifuge (maximum speed for 2 min) and wash pellet twice with 70% ethanol. Let the pellet dry and resuspend in an appropriate volume of TE (~35 JJLL). Dissolve DNA by heating at 65°C with occasional vortexing. 9. Digest 5 to 10 (JLL of the DNA with an appropriate restriction enzyme. Analyze the DNA structure by agarose gel electrophoresis to verify that the DNA structure of the recombinant virus is correct. If the infection of 293 cells has been complete, viral DNA bands should be readily visible superimposed on a smear of cellular DNA. Once the DNA structure of the vector has been verified the virus can be plaque purified (section IILE). E. Titration of Adenovirus The procedure outlined below is used to plaque purify recombinant vectors as well as to determine the concentration of vector stocks. To accurately determine vector concentration, titrations should be performed in duplicate. MATERIALS 1. 80 to 90% Confluent 60-mm dishes of 293 cells. 2. PBS++ (see section III.C). 3. 1% Agarose solution (see section III.C). 4. 2x Maintenance medium (see section III.C). 5. Glycerol, autoclave sterifized. METHOD 1. Seed 60-mm dishes of 293 cells to reach ^80 to 90% confluency in 1 to 2 days for titration. 2. Prepare serial dilutions of the recombinant virus in PBS"̂ + (10~^ to 10~^ for samples prepared in section III.D and 10~^ to 10~^^ for samples prepared in sections III.F and III.G). 4. Adenoviral Vector Construction I: Mammalian Systems 9 5 3. Remove the medium from the 60-mm dishes of 293 cells and infect with 0.2 mL of the diluted samples. Return dishes to the incubator and adsorb for 1 h, rocking the dishes every 10 to 15 min. 4. During the adsorption period, melt 1% agarose solution in a micro- v^ave oven and equilibrate to 45°C. Equilibrate 2x maintenance medium to 37°C. 5. Follov^ing 1 h adsorption, combine equal volumes of melted agarose solution w îth 2 x maintenance medium, mix well, and gently overlay dishes with 10 mL. Perform this step quickly to prevent the overlay solution from solidifying prematurely but gently to prevent disturbing the monolayer. 6. Allow overlay to solidify for 10 to 15 min at room temperature and then return dishes to the incubator. 7. Plaques should start to appear about 4 days postinfection and should be counted 10 to 12 days postinfection. For isolation of recombi nant virus by plaque purification well isolated plaques should be picked according to steps 11 and 12 of section III.C around 10 days postinfection. The plaque purified vectors are expanded according to section III.D and used as inoculum for the preparation of high-titer viral stocks (section III.F). 8. Determine the vector concentration in plaque forming units per ml (pfu/mL) as follows: titer = (number of plaques)(dilution factor)/(infection volume) Calculate the titer from dishes bearing approximately 20 to 80 plaques. The number of plaques should vary in direct proportion to the dilu tion factor; otherwise, repeat the titration making sure that the samples are thoroughly mixed when setting up the serial dilutions. F. Preparation of High-Titer Viral Stocks (Crude Lysate) Since most of the virus remains associated with the infected cells until very late in infection (i.e., until the cells lyse), high-titer stocks can be easily prepared by concentrating infected 293 cells. The following protocol describes the production of high titer virus preparations using either monolayers of 293 cells or suspension cultures of 293N3S cells. 293N3S cells are preferable for the production of very large amounts of high-titer viral stocks due to the greater ease of handling suspension cultures. The following describes protocols for the preparation of crude lysates of high-titer vector stocks that are suitable for most experiments. Prior to the preparation of high-titer stocks, confirm that enough inoculum is available and if not, prepare an intermediate-scale virus stock by infecting two to three 150-mm dishes of 293 cells. 9 6 Ng and Graham 1. Preparation of High-Titer Viral Stocks (Crude Lysate) from Ceils in Monolayer MATERIALS 1. PBS++ (see section III.C). 2. Glycerol, autoclave sterilized. 3. 150-mm dishes of 80 to 90% confluent 293 cells. 4. Maintenance medium (see section III.D). METHOD 1. Seed 150-mm dishes with 293 cells to be 80-90% confluent at time of infection. The number of dishes is dictated by the amount of vector desired. 2. Dilute vector sample prepared in section III.E, step 7 1:8 v^ith PBS++. 3. Remove medium from the 293 cells and add 1 mL of the diluted vector sample prepared in step 2 to each 150-mm dish of cells (moi of 1-lOpfu/cell). 4. Adsorb for 1 h in the incubator, rocking the dishes every 10 to 15 min. FoUow îng adsorption, add 25 mL maintaince medium and return dishes to the incubator. Examine daily for signs of CPE. 5. When CPE is nearly complete (most cells rounded but not yet detached) harvest by scraping the cells into the medium and centrifuging the cell suspension at 800g for 15 min. 6. Discard the supernatant and resuspend the cell pellet in 2 mL PBS^"^ supplemented w îth glycerol to 10% for each 150-mm dish infected. Freeze (—70°C) and thaw^ the crude virus stock prior to characteriza tion of the vector (section IILH). Store aliquots at —70°C. 2. Preparation of High-Titer Viral Stocks (Crude Lysate) from Cells in Suspension MATERIALS 1. 293N3S cells (Microbix Biosystems Inc.). 2. Joklik's modified MEM supplemented v^ith 10% horse serum (heat inactivated) (see section III.B). 3. Spinner flasks (Bellco) 4. 1% Sodium citrate. 5. Carnoy's fixative: add 25 mL glacial acetic acid to 75 mL methanol. 6. Orcein solution: add 1 g orcein dye to 25 mL glacial acetic acid plus 25 mL dHiO; filter through Whatman No. 1 paper. 4. Adenoviral Vector Construction 1: Mammalian Systems 9 7 |
METHOD 1. Grow 293N3S cells to a density of 2 - 4 x 10^ cells/mL in 4 L complete Joklik's modified MEM supplemented with 10% HS. Centrifuge cell suspension at 750g for 20 min and save half of the conditioned medium. Resuspend the cell pellet in 0.1 vol fresh medium, and transfer to a sterile 500-mL bottle containing a sterile stir bar. 2. Add virus at an MOI of 1-20 pfu/cell and stir gently at 37°C. After 1 h, return the cells to the 4-L spinner flask and bring to the original volume using 50% conditioned medium and 50% fresh medium. Continue stirring at 37°C. 3. Monitor infection daily by inclusion body staining as follows: (a) Remove 5 mL from the infected spinner culture. Spin for 10 min at 750g and resuspend the cell pellet in 0.5 mL of 1% sodium citrate. (b) Incubate at room temperature for 10 min and then add 0.5 mL Carnoy's fixative and fix for 10 min at room temperature. (c) Add 2 mL Carnoy's fixative and spin 10 min at 750g. Discard supernatant and resuspend the pellet in a few drops of Carnoy's fixative. Add one drop of fixed cells to a slide and air dry for about 10 min Add one drop orcein solution and a coverslip and examine using a microscope. Inclusion bodies appear as densely staining nuclear structures resulting from accumulation of large amounts of virus and viral products at late times postinfection. Include a negative control in initial tests. 4. When inclusion bodies are visible in 80-90% of the cells (~3 days depending on the input MOI), harvest by centrifugation at 75Og for 20 min in sterile 1-L bottles. Combine pellets in a small volume of medium, and spin again. 5. Discard supernatant and resuspend pellet in 20 ml PBS'*"+ supplemented with 10% glycerol. Freeze (—70°C)-thaw and then aliquot and store at — 70°C and characterize vector as described in section III.H. G. Purification of Adenovirus by CsCi Banding Many experimental studies can be performed using virus in the form of crude infected cell lysates prepared as described in sections III.E and III.F. However, for some experiments, particularly for animal work, it is desirable to use purified virus. The following protocol describes a method for purifying vectors obtained from 4-L of infected 293N3S cells or 30 x 150-mm dishes of 293 cells by CsCl banding. 9 8 Ng and Graham MATERIALS 1. 10 and 100 mM Tris, pH 8.0, autoclave sterilized. 2. 5% Sodium deoxycholate, filter sterilized. 3. 2 M MgCl2, autoclave sterilized. 4. DNAase I (100 mg bovine pancreatic deoxyribosenuclease I in 10 mL of 20 mM Tris, pH 7.4, 50 mM NaCl, 1 mM dithiothreitol, 0.1 mg/mL bovine serum albumin, 50% glycerol, aliquoted and stored at -20°C). 5. CsCl solutions: Density (g/cc) CsCl (g) 10 mM Tris, pH 8.0 (g) 1.5 90.8 109.2 1.35 70.4 129.6 1.25 54.0 146.0 Dissolve CsCl into 10 mM Tris, pH 8.0, solution in the amounts indicated above to achieve the desired density solution and filter sterilize. Weigh 1.00 mL to confirm density. 6. Glycerol, autoclave sterilized. 7. Beckman SW41 and SW50 rotor and ultraclear tubes. 8. Slide-A-Lyzer dialysis cassettes (Pierce). METHOD 1. Prepare crude cell lysate from infected cells as follows: (a) For 30 x 150-mm dishes as prepared in section IILE.l: when complete CPE is evident, scrape the cells into the medium, transfer the cell suspension to a centrifuge bottle, and spin for 10 min at 750g, Resuspend the cell pellet in 15 ml 0.1 M Tris-Cl, pH 8.0. Sample can be stored at — 70°C. (b) For 4-L spinner cultures prepared in section in.E.2: when inclu sion bodies are visible in 80-90% of the cells, harvest cells by centrifugation at 750g for 20 min in sterile bottles. Resuspend pellet in 15 mL 0.1 M Tris, pH 8.0. Samples can be store at —70°C. 2. Thaw sample and add 1.5 mL 5% Na deoxycholate for each 15 mL of cell lysate. Mix well and incubate at room temperature for 30 min. This results in a highly viscous suspension. 3. Add 150 |iL 2 M MgCli and 75 |xL DNAase I solution to each 15 mL of cell lysate, mix well, and incubate at 37°C for 60 min, mixing every 10 min. The viscosity should be greatly reduced. 4. Spin at SOOOg for 15 min at 5°C in the Beckman table-top centrifuge. 5. Meanwhile, prepare CsCl step gradients (one SW41 ultraclear tube for each 5 mL of sample): Add 0.5 mL of 1.5 g/cc solution to each tube. Gently overlay with 3.0 mL of 1.35 g/cc solution. Gently overlay this with 3.0 mL of 1.25 g/cc solution. 4. Adenoviral Vector Construction I: Mammalian Systems 9 9 6. Apply 5 mL of supernatant from step 4 to the top of each gradient. If necessary, top off tubes with 0.1 M Tris, pH 8. 7. Spin at 35,000 rpm in an SW41 rotor at 10°C, for 1 h. 8. Collect virus band (should be at 1.25 d/1.35 d interface) with a needle and syringe by piercing the side of the tube. The volume collected is unimportant at this stage so try to recover as much of the virus band as possible. If more than one tube was used, pool virus bands into a single SW50.1 ultraclear tube. 9. Top off tubes with 1.35 g/cc CsCl solution if necessary and centrifuge in a SW50.1 rotor at 35,000 rpm, 4°C, for 16-20 h. (Alternatively, the pooled virus can be centrifuged in the SW41 rotor at 35,000 rpm, 10°C, 16-24 h.) 10. To collect the virus band, puncture the side of the tube just below the virus band with a needle and syringe. Collect the virus band in the smallest volume possible and transfer to a Slide-A-Lyzer dialysis cassette. Dialyze at 4°C against three changes of 500 mL 10 mM Tris, pH 8.0, for at least 24 h total. 11. After dialysis, transfer the virus to a suitable vial and add sterile glycerol to a final concentration of 10%. Store the purified virus in small aliquots at — 70°C. H. Characterization of Adenoviral Vector Preparations Before the recombinant vector is used for experimentation the concen tration should be determined, the DNA structure should be confirmed and expression of the transgene should be ascertained. MATERIALS 1. All materials Usted in section III.E. 2. TE (see section III.A). 3. lOmMTris , pH8.0 4. 10% SDS 5. Pronase-SDS solution (see section III.A). 6. 3 M Sodium acetate, pH 5.2, autoclave sterilized. 7. 95 and 70% Ethanol. METHOD The concentration in pfu/ml is determined by titration on 293 cells as describe in section III.E. The concentration of virus particles, based on DNA content at OD26O can also be determine spectrophotometrically as follows: 1. Dilute (usually 20-fold) purified virus with TE supplemented with SDS to 0 .1%. Set up blank the same except add virus storage buffer 1 0 0 *Ng and Graham (10 mM Tris, pH 8.0, supplemented with glycerol to 10%) instead of virus. 2. Incubate for 10 min at 56°C. 3. Vortex sample briefly. 4. Determine OD260- 5. Calculate the number of particles/mL, based on the extinction coeffi cient of wildtype Ad as determined by Maizel et al, [41] as follows: (OD26o)(dilutionfactor)(l.l x 10^^). The DNA structure of the recombinant vector should be confirmed following large-scale preparation. Virion DNA can be extracted from CsCl banded virus for analysis as follows: 1. An appropriate volume (~25 |JLL depending on the concentration of the virus) of the purified virus is added to pronase-SDS solution to a final volume of 0.4 mL and incubated overnight at 37°C to lyse the virions and digest virion proteins. 2. Virion DNA is precipitated by adding 1/10 vol 3 M sodium acetate, pH 5.2, and 2.5 vol 95% ethanol and incubating at —20°C for 15 to 30 min. 3. Spin in microcentrifuge for 10 to 15 min at maximum speed. 4. Discard supernatant and wash DNA pellet twice with 70% ethanol. 5. Dry DNA pellet and resuspend in an appropriate volume of TE. For crude preparations, viral DNA can be extracted following infection of 293 cells as described in section III.D. A sample of the vector DNA is digested with the appropriate diagnostic restriction enzyme(s) and the structure of the DNA is analyzed by agarose gel electrophoresis. 293 cells contain nts 1-4344 bp of Ad5 DNA [42] with consequent homology flanking the expression cassette of generation vectors. Therefore, the possibility exists that homologous recombination between the Ad vector and the Ad sequences present in 293 cells may result in the formation of E1+ replication-competent Ad (RCA). The frequency with which Ad vectors recombine with Ad sequences in 293 cells is unknown but in general E1+ RCA replicate faster than El~ vectors. Consequently the proportion of RCA increases with prolonged propagation of the vectors in 293 cells. RCA can act as a "helper" virus resulting in the mobilization of the replication-deficient El-substituted vector in coinfected cells as well as cause tissue damage and pathogenicity. To minimize RCA contamination, vectors should not be serially propagated indefinitely. It is recommended that large-scale vector prepara tions be initiated from a stock prepared immediately after plaque purification (section III.E). If the original plaque purified stock is exhausted, plaque purifi cation can be repeated. The presence and level of RCA contamination in vector stocks should be determined, especially if the vector is to be used for extensive 4. Adenoviral Vector Construction I: Mammalian Systems 1 0 1 experimentation. A number of different approaches has been developed for the detection of RCA, including Southern blot hybridization [43], quantitative PCR [43] and biological assays [44]. I. Alternative Procedures to Expedite Vector Production It is recommended that the steps outlined in Fig. 7 and detailed in the preceding sections be followed as they are well proven. However, since only the correct recombinant vector should be generated following cotransfection [29, 31, 39], several alternative procedures are acceptable to expedite vector production (Fig. 7). 1. Once the vector has been rescued following cotransfection (section III.C), it can be immediately titrated for plaque purification and the DNA structure can be checked afterward. 2. While plaque purification is strongly recommended (section III.E), especially if large quantities of the vector are to be generated for extensive experimentation, this step is not absolutely essential since all infectious virus generated should be the desired recombinant. Optionally, therefore, high-titer stocks can be generated directly from the plaques isolated following cotransfection. 3. As mentioned in section III.F, vector purification by CsCl banding, while recommended, may not be necessary for many experiments. 4. It is strongly recommended that the recombinant vector be isolated from individual plaques following cotransfection using the method described in section III.C. However, vector production can be expe dited by omitting steps 8 through 12 in section III.C. In this case, following overnight cotransfection, remove the medium from the monolayers and add 5 mL of maintenance medium. If complete CPE is observed within 7 days post-cotransfection, then proceed from step 4 in section III.D. If complete CPE is not observed by 7 days post-cotransfection see section III.D, step 3. Acknovsfledgments This work was supported by grants from the National Institutes of Health, the Canadian Institutes of Health Research (CIHR), the National Cancer Institute of Canada (NCIC), and by Merck Research Laboratories. P.N. was supported by a CIHR Postdoctoral Fellowship. References 1. Berkner, K. L. (1988). Development of adenovirus vectors for expression of heterologous genes. Biotechniques 6, 616-629. 1 0 2 Ng and Graham 2. Graham, F. L., and Prevec, L. (1992). Adenovirus-based expression vectors and recombinant vaccines. In "Vaccines: New Approaches to Immunological Problems" (R. W. Ellis, Ed.), pp. 363-389. Butterv^orth-Heinemann, Boston, MA. 3. Hitt, M., Addison, C. L., and Graham, F. L. (1997). Human adenovirus vectors for gene transfer into mammaHan cells. Adv. Pharmacol. 40, 137-206. 4. Hitt, M. M., Parks, R. J., and Graham, F. L. (1999). Structure and genetic organization of adenovirus vectors. In "The Development of Human Gene Therapy" (T. Friedman, Ed.), pp. 61-86. Cold Spring Harbor Laboratory Press, Cold Spring Harbor, NY. 5. Shenk, T. (1996). Adenoviridae: The viruses and their replication. In "Fields Viology" (B. N. Fields, D. M. Knipe, and P. M. Hov^ely, Eds.), pp. 2111-2148. Lipponcott-Raven, Philadelphia, PA. 6. Bergelson, J. M., Cunningham, J. A., Droguett, G., et al. (1997). Isolation of |
a common receptor for Coxsackie B viruses and adenoviruses 2 and 5. Science 275, 1320-1323. 7. Hong, S. S., Karayan, L., Tournier, J., Curiel, D. T., and Boulanger, P. A. (1997), Adenovirus type 5 fiber knob binds to MHC class I alpha2 domain at the surface of human epitheHal and B lymphoblastoid cells. EmboJ. 16, 2294-2306. 8. Wickham, T. J., Mathias, P., Cheresh, D. A., and Nemerow, G. R. (1993). Integrins alpha v beta 3 and alpha v beta 5 promote adenovirus internalization but not virus attachment. Cell 73,309-319. 9. Wickham, T. J., Segal, D. M., Roelvink, P. W., et al. (1996). Targeted adenovirus gene transfer to endothelial and smooth muscle cells by using bispecific antibodies. / . Virol. 70, 6831-6838. 10. Goldman, M., Su, Q., and Wilson, J. M. (1996). Gradient of RGD-dependent entry of adenoviral vector in nasal and intrapulmonary epithelia: Implications for gene therapy of cystic fibrosis. Gene Ther. 3, 811-818. 11. Mellman, I. (1992). The importance of being acidic: The role of acidification in intracellular membrane traffic./. Exp. Biol. 172, 39-45 . 12. Leopold, P. L., Ferris, B., Grinberg, I., Worgall, S., Hackett, N. R., and Crystal, R. G. (1998). Fluorescent virions: Dynamic tracking of the pathway of adenoviral gene transfer vectors in living cells. Hum. Gene Ther. 9, 367-378. 13. Greber, U. F., Willetts, M., Webster, P., and Helenius, A. (1993). Stepwise dismantling of adenovirus 2 during entry into cells. Cell 75, 477-486. 14. Bett, A. J., Prevec, L., and Graham, F. L. (1993). Packaging capacity and stability of human adenovirus type 5 vectors./. Virol. 67^ 5911-5921. 15. Graham, F. L., Smiley, J., Russell, W. C , and Nairn, R. (1977). Characteristics of a human cell line transformed by DNA from human adenovirus 5. / . Gen. Viol. 36, 59-72. 16. Graham, F. L., and van der Eb, A. J. (1973). A new technique for the assay of infectivity of human adenovirus 5 DNA. Virology 52, 456-467. 17. Chinnadurai, G., Chinnadurai, S., and Brusca, J. (1979). Physical mapping of a large plaque mutation of adenovirus type 2. / . Virol. 32, 623-628. 18. Carlock, L. R., and Jones, N. C. (1981). Transformation-defective mutant of adenovirus type 5 containing a single altered Ela mRNA species. / . Virol. 40, 657-664. 19. Solnick, D. (1981). An adenovirus mutant defective in splicing RNA from early region lA. Nature 291, 50H-510. 20. Stow, N. D. (1981). Cloning of a DNA fragment from the left-hand terminus of the adenovirus type 2 genome and its use in site-directed mutagenesis./. Viol. 37, 171-180. 21. Jones, N., and Shenk, T. (1979). Isolation of adenovirus type 5 host range deletion mutants defective for transformation of rat embryo cells. Cell 17, 683-689. 22. Kapoor, Q. S., and Chinnadurai, G. (1981). Method for introducing site-specific mutations into adenovirus 2 genome: Construction of a small deletion mutant in VA-RNAj gene. Proc. Natl. Acad. Sci. USA 78, 2184-2188. 4. Adenoviral Vector Construction I: Mammalian Systems 1 0 3 23. Berkner, K. L., and Sharp, P. A. (1983). Generation of adenovirus by transfection of plasmids. Nucleic Acids Res. 11, 6003-6020. 24. Ruben, M., Bacchetti, S., and Graham, F. L. (1983). Covalently closed circles of adenovirus 5 DNA. Nature 301, 172-174. 25. Graham, F. L. (1984). Covalently closed circles of human adenovirus DNA are infectious. £MBO 7.3 ,2917-2922. 26. Ghosh-Choudhury, G., Haj-Ahmad, Y., and Graham, F. L. (1987). Protein IX, a minor component of the human adenovirus capsid, is essential for the packaging of full length genomes. EMBO J. 6, 1733-1739. 27. McGrory, W. J., Bautista, D. S., and Graham, F. L. (1988). A simple technique for the rescue of early region I mutations into infectious human adenovirus type 5. Virology 163, 614-617. 28. Bett, A. J., Haddara, W., Prevec, L., and Graham, F. L. (1994). An efficient and flexible system for construction of adenovirus vectors with insertions or deletions in early regions 1 and 3. Proc. Natl. Acad. Sci. USA 91, 8802-8806. 29. Ng, P., Parks, R. J., Cummings, D. T., Evelegh, C. M., Sankar, U., and Graham F. L. (1999) A high efficiency Cre//oxP based system for construction of adenoviral vectors. Hum. Gene Ther. 10, 2667-2672. 30. Chen, L., Anton, M. ., and Graham, F. L. (1996). Production and characterization of human 293 cell lines expressing the site-specific recombinase Cre. Somatic Cell Mol. Genet. 22, 477-488. 31. Ng, P., Parks, R. J., Cummings, D. T., Evelegh, C. M., and Graham, F. L. (2000) An enhanced system for construction of adenoviral vectors by the tv̂ ô plasmid rescue method. Hum. Gene Ther. 11, 693-699. 32. Van Der Vliet, P. C. (1995). Adenovirus DNA replication. Curr. Top. Microbiol. Immunol. 2, 1-27. 33. Hearing, P., Samulski, R. J., Wishart, W. L., and Shenk, T. (1987). Identification of a repeated sequence element required for efficient encapsidation of the adenovirus type 5 chromosome. / . V/ro/. 61,2555-2558. 34. Haj-Ahmad, Y., and Graham, F. L. (1986). Characterization of an adenovirus type 5 mutant carrying embedded inverted terminal repeats. Virology 153, 22-34. 35. Anton, M., and Graham, F. L. (1995). Site-specific recombination mediated by an adenovirus vector expressing the Cre recombinase protein: A molecular switch for control of gene expression. / . Virol 69, 4600-4606. 36. Bilbao, G., Zhang, H., Contreras, J. L., Zhou, T., Feng, M., Saito, I., Mountz, J. D., and Curiel, D. T. (1999). Construction of a recombinant adenovirus vector encoding Fas ligand with a Cre//oxP inducible system. Transplantation Proc. 31, 792-793. 37. Fujino, M., Li, X. -K., Okuyama, T., Funeshima, N., Tamura, A., Enosawa, S., Kita, Y., Amano, T., Yamada, M., Amemiya, H., and Suzuki, S. (1999). On/off switching Fas-ligand gene expression in liver by Cre//oxP adenovirus vector system. Transplantation Proc. 31, 753-754. 38. Parks, R. J., Chen, L., Anton M., Sankar, U., Rudnicki, M. A., and Graham, F. L. (1996). A helper-dependent adenovirus vector system: Removal of helper virus by Cre-mediated excision of the viral packaging signal. Proc. Natl. Acad. Sci. USA 93, 13,565-13,570. 39. Ng, P., Cummings, D. T, Evelegh, C. M., and Graham, F. L. (2000) The yeast recombinase flp functions effectively in human cells for construction of adenovirus vectors. Biotechniques 29, 524-528. 40. Addison, C. L., Hitt, M., Kunsken, D., and Graham, F. L. (1997). Comparison of the human versus murine cytomegalovirus immediate early gene promoters for transgene expression by adenoviral vectors./. Gen. Virol. 78, 1653-1661. 41 . Maizel, J. V., White, D., and Scharff. M. D. (1968). The polypeptides of adenovirus. I. Evidence of multiple protein components in the virion and a comparison of types 2, 7a, and 12. y/ro/og)/36, 115-125. 1 0 4 Ng and Graham 42. Louis, N., Evelegh, C , and Graham, F. L. (1997). Cloning and sequencing of the cellular/viral junction from the human adenovirus type 5 transformed 293 cell line. Virology 233,423-429. 43. Lochmuller, H., Jani, A., Haurd, J. Prescott, S., Simoneau, M., Massie, B., Karpati, G., and Acsadi, G. (1994). Emergence of early region 1-containing replication-competent adenovirus in stocks of replication-defective adenovirus recombinants (AE1+AE3) during multiple passages in 293 cells. Hum. Gene Ther. 5, 1485-1491. 44. Hehir, K. M., Armentano, D., Cardoza, L. M., Choquette, T. L., Berthelette, P. B., White, G. A., Couture, L. A., Everton, M. B., Keegan, J., Martin, J. M., Pratt, D. A., Smith, M. P., Smith, A. E., and Wadsv^orth, S. C. (1996). Molecular characterization of replication- competent variants of adenovirus vectors and genomic modifications to prevent their occurrence./. Virol. 70, 8459-8467. C H A P T E R Adenoviral Vector Construction II: Bacterial Systems M. Lusky,̂ E. Degryse,^ M. Mehtali,^ and C. Chartier^ Department of Genetic Therapy Transgene Strasbourg Cedex, France I. Introduction The use of adenovirus (Ad) as a vector for in vitro and in vivo gene delivery is expanding rapidly. Besides the use of Ad for gene therapy, it is a highly efficient tool to study in vitro and in vivo gene expression in cell types or tissues not easily transduced by other methods. Other purposes include the use of Ad for the production of high levels of recombinant, potentially therapeutic, proteins and for in vivo vaccination [1-6]. In fact, pioneering the applications of Ad as a gene expression vector were studies which demonstrated that high levels of expression of the SV40 large T antigen in Ad vectors could be achieved. This has become an important source for the biochemical analysis of SV40 T antigen [7, 8]. The ability of Ad vectors to efficiently transduce a variety of cell types and many different target organs in vivo, independent of active cell division, is considered an advantage over other vectors. Furthermore, high titers of virus and high levels of transgene expression can easily be obtained [3]. Extensive genetic and molecular analyses of adenovirus have resulted in a detailed knowledge of the viral life cycle and the function of the majority of viral proteins, further stimulating the use and modifications of Ad vectors [9, 10; Chapters 1 and 2, this volume]. The genome of the most commonly used human adenovirus (group C, serotype 5) consists of a linear 36-kb double- stranded DNA molecule. Transcription of the viral genome occurs on both ^ Corresponding author. ^ Present address: Laboratoire Microbiologie, Pernod-Ricard, Creteil Cedex, France. ^ Present address: Deltagen, Illkirch, France. ^ Present address: Children's Hospital, Boston, Massachusetts. ADENOVIRAL VECTORS FOR GENE THERAPY 1 Q C Copyright 2002, Elsevier Science (USA). All rights reserved. 1 0 6 Lusky ef al. strands and viral gene expression is coordinated through a precisely temporally regulated splicing program of almost all the transcripts. Early transcription units (El, E2, E3, E4) are differentiated from late ones, depending on the expression pattern relative to the onset of viral DNA synthesis [9, 10]. The overlapping location of viral genes on the viral genome limits the molecular manipulations for vector constructions to the El , E2, E3, and E4 regions. The earliest, first-generation Ad vectors have the El region deleted (El°), rendering such vectors replication-deficient. In addition, in most AdEl° vectors the viral E3 region is also deleted, as the E3 functions are not required for the viral life cycle in vitro [9, 10]. In most cases a heterologous expression cassette w îth a transgene is inserted in place of the El region. Such AdEl° and AdEl°E3° vectors can be propagated to high yields in permissive El-complementation cell lines, such as 293 cells [11] or PER.C6 cells [12; Chapter 6, this volume]. The latter prevent the occurrence of replication-competent adenovirus by recombination, allow^ing the production of safe, clinical-grade batches of Ad vectors. Hov^ever, the high level of tissue toxicity and inflammation associated with first generation Ad vectors have stimulated further manipulation of the viral genome, resulting in vectors w îth simultaneous deletions of several regulatory regions, AdEl°E3°E2A° or AdEl°E3°E4° [13-25]. Importantly, AdErE3°E4-modified vectors, carrying the E4 ORF3 or E40RF3 + ORF4 functions w êre able to allow persistent transgene expression in vivo, in selected animal models, in the absence of vector-induced toxicity and inflammation [14, 21, 26]. This renders these types of vectors, with a cloning capacity of approximately 11 kb, attractive for certain, such as liver-selective, gene therapy applications [27]. In this context, various studies have shown that high-capacity or gutless vectors, devoid of all viral genes [28, 29], also combine long-term transgene expression with reduced toxicity [30, 31]. The generation of gutless vectors will be described in Chapter 15. This overview summarizes the recent development of novel technologies, which efficiently permit the rapid construction and generation of single or multiply deleted Ad in Escherichia coli. The construction of Ad in £. coli by various recombination techniques, emphasizing homologous recombination, will be summarized and compared to direct in vitro cloning technologies by ligation. II. Generation of Ad: Traditional Approaches Initially Ad El° vectors were generated in eukaryotic cells, such as in 293 cells using two approaches: (i) the in vitro ligation method [32-35] and (ii) the homologous recombination method in 293 cells [36-39]. The in vitro ligation method uses whole viral DNA, cut at a unique site downstream from the viral El region, and ligated directly to a DNA fragment containing the viral left end 5. Adenoviral Vector Construction II: Bacterial Systems 1 0 7 joined to a transgene; the ligation product is used to transfect 293 cells. This method is hampered by the large size of the Ad genome which limits the number of useful restriction sites available for in |
vitro ligation and contamination with wild-type virus. Efficient and improved in vitro ligation techniques for the construction of vectors in bacterial systems have been reported [40-42] and will be described below. Alternatively, cotransfection into the complementation cells of the viral genome and plasmid molecules can generate the Ad by homologous recombi nation in vivo. These methods frequently generate a background of parental virus and repeated screening of many plaques is often required to isolate pure recombinant vectors. However, the development of counterselective methods against the parental wild type vector [43-46] has facilitated the screening for the recombinant virus. The homologous recombination method described by Bett et aL [36] uses two plasmids with overlapping sequences of homology that recombine in vivo. The first plasmid carries the entire Ad genome with a deletion of the DNA packaging signal and the El A region. The second plasmid contains the left inverted terminal repeat (ITR), packaging signal, transgene and overlapping sequence with the first plasmid. Both plasmids are cotransfected into 293 cells and pure Ad is then isolated by plaque purification. The major limitation of this approach remains the low frequency of the recombination event and the potential instability of the large plasmid due to the presence of a head-to-head ITR junction [47]. However, due to a variety of novel and improved techniques, highly efficient methods are now available to generate Ad in mammalian systems, reviewed in Chapter 4. Another method is based on the manipulation of the entire viral genome as an infectious yeast artificial chromosome (YAC) [48]. Targeted modifica tions of the viral genome are introduced by homologous recombination in yeast cells and infectious virions are generated after transfection of the ade novirus genome, excised from the YAC vector. Although clearly pioneering the subsequent studies of viral vector construction in bacterial systems, the YAC system requires the use of an additional host (yeast) and DNA yields are relatively low. III. Generation of Ad: Bacterial Systems Recently, several novel methods based on bacterial systems have been developed for the generation of Ad. Three basic methods have evolved to enable the manipulation of the full-length adenoviral genome as a stable plasmid and facilitate the efficient construction of precisely tailored and infectious Ad in £. coli. These methods are based on: (i) homologous recombination, (ii) direct ligation, and (iii) cosmid technology. All three methods offer major advantages over traditional approaches: (i) Manipulation of the viral genome at any point 10 8 Lusky ef a/. is possible, (ii) Recombinant viral DNA is purified from individual bacterial clones and therefore generates homogenous virus preparations, obviating the need for tedious plaque screening and purification, (iii) Importantly, and in contrast to the traditional in vivo approaches, these methods entirely separate viral vector construction from virus production. The first step is performed in bacteria and the second step takes place in the mammalian complementation cell line. Therefore, each step can be carefully controlled and optimized. Trouble shooting is facilitated; for example, failure of producing a virus cannot be associated with the inability to generate the desired genome. The recombination and direct ligation methods are described below. IV. Homologous Recombination in E. coli The use of classical molecular biology techniques for the manipulation of the Ad genome is limited by its large size. Homologous recombination presents an alternative way to engineer DNA. In yeast, homologous recombination is particularly flexible and recombination between linear DNA fragments flanked by short-homology arms and endogenous recipients such as the yeast genome or YACs or a gapped plasmid [49, 50] is routinely used. The concept was also applied in £. coli by the cloning of short DNA fragments [51] and of PCR products [52] into gapped plasmids as targets. We mentioned above the work of Ketner et al. [48], who reported in 1994 the cloning and further manipulation of the Ad genome as an infectious YAC clone, taking advantage of the very efficient Saccharomyces cerevisiae recombination machinery. The availability of specific mutant bacterial strains allowed us and others to transfer this technology into E. coli and to bring the adenovirus genome manipulation back to the level of standard molecular biology. Recombination is an essential process involved in the repair of DNA lesions, such as double-stranded breaks (DSBs) and the restart of replication forks that failed to progress to completion. The E. coli recombination machin ery includes at least 25 different proteins among which the RecBCD enzyme and the RecA protein are major components of the initiation and pairing steps [53]. In wild-type cells, the RecBCD enzyme binds to the end of a dsDNA substrate and initiates unwinding. RecBCD degrades the 3^-terminated strand during unwinding until it reaches a chi site. The chi sequence is a recombination hotspot which modifies the enzymatic activities of RecBCD enzyme [54]. The nuclease activity of RecBCD is attenuated and RecA is loaded on the 3̂ end of ssDNA, allowing the essential steps of pairing and strand exchange. The RecBCD nuclease activity is also responsible for the degradation of foreign DNA that does not contain any chi site. This last property explains why, in contrast to yeast, most bacteria do not recombine transformed DNA readily and are not widely used for plasmid manipulation by homologous recombi nation [55], However, some bacterial strains where the RecBCD enzyme is 5. Adenoviral Vector Construction II: Bacterial Systems 1 0 9 inactivated have been show^n to be recombination-proficient. They harbor an additional suppressor (sbcA or sbcB) mutation that activates an ahernative recombination pathway [56]. The genotype (endA, sbcBC, recBC, galK, met, thi-1, bioT, hsdR, stf) of the BJ5183 bacterial strain [57] used in most of the studies discussed belov^ is RecBC sbcBC and contains in addition an activated RecF pathway. This pathway has been shown to direct nonconservative recom bination which is defined as a homologous recombination event generating one duplex molecule out of two duplex DNA molecules [58]. Subsequently, taking advantage of such recombination-proficient £. coli strains [59], several systems have been developed to manipulate the Ad genome by homologous recombination. The different systems applying homologous recombination for Ad con struction can be put into two groups depending whether the targeted vector is transfected as a linear DNA fragment or as a circle. In the first case, the recombinant plasmid is rescued by recombination between two linear DNA fragments (the donor fragment and the linearized vector). In this approach the only selection necessary is the recircularization of the plasmid. The first application of this technology for Ad construction was described by Chartier et al. [60], demonstrating (i) stable cloning of the entire viral genome into a bacterial plasmid and (ii) the use of such infectious bacterial plasmids to further introduce alterations into the viral genome. Subsequently, the basic protocol was extended and modified by others [61]. A second approach where the plasmid to be modified is transformed as a circle allows more flexibility but requires the development of complex selection systems. Such approaches have been reported and will be discussed [62, 63]. V. Homologous Recombination \N\\\\ Linear Ad Vector Genome Plasmids The work by Chartier et al. [60] showed that stable maintenance of plas mids containing the entire Ad viral genome is achieved through the separation of the viral ITRs by the bacterial plasmid backbone, confirming the observa tions made earlier by Hanahan and Gluzman [64]. This was accomplished by the insertion of the left and right end of the Ad genome in their normal orien tation into a colEI-derived bacterial plasmid ppolyll [65]., using conventional cloning techniques. Such a plasmid linearized between the two Ad ends served as a vector to eventually incorporate the entire Ad viral genome. Cotransfection of the linearized vector DNA and linear Ad5 genomic DNA into the £. coli strain BJ5183 generated a stable circular plasmid containing the full-length Ad5 genome through homologous recombination within the end fragments of Ad5 (Fig. 1). Engineering unique restriction sites such as Pad (noncutting within the Ad5 viral genome) immediately adjacent to the viral ITRs enabled 110 Lusky ef a/. the precise release of a fully infectious viral genome (Fig. 1). In contrast, the closed circular plasmid was unable to generate any infectious virus, confirming that at least one viral ITR extremity has to be in a free configuration to efficiently initiate the replication machinery of Ad [33, 64]. Various single-step replacement strategies exploiting the E. coli homolo gous recombination machinery w êre subsequently designed in our laboratory to selectively modify various genetic regions in Ad5. The principle for these manipulations is simple: the viral region to be modified is first subcloned into a bacterial shuttle plasmid containing sequences of the Ad genome to be targeted. The desired alterations, such as deletions, point mutations, or insertions of transgene-containing expression cassettes, are performed in this shuttle plasmid using standard molecular biology techniques. Subsequently, a restriction fragment containing the modified DNA segment and leaving suffi cient sequences of Ad homology on either side of the modification is prepared. Homologous recombination in E.co/i with linear Ad vectors Cotransform recBC sbcBC BJ5183: -^ homologous recombination transform recA E.coli (DH5a) -^ clonal viral genome construction iiL Production of virus particles in mammalian cells >k Pad digestion, release of the viral genome ^ transfection of permissive mammalian cells ^i homogenous population of Ad5 virus Figure 1 Cloning of infectious full-lengtfi Ad5 genome in E. coli by homologous recombina tion [60]. The vector plasmid pTG3601 contains 935 and 853 bp from the left and right ends of Ad5. Cotransfection of Bglll - linearized pTG3601 with linear Ad5 DNA results in recombinants containing the full-length Ad5 genome. 5. Adenoviral Vector Construction II: Bacterial Systems 111 purified, and cotransfected into BJ5183 along with the plasmid DNA con taining the full length Ad genome to be modified. The Ad genome plasmid is linearized in the targeted region. After recombination occurred between the donor fragment and the linearized Ad plasmid, the expected recombinant is simply rescued by plating bacteria in the presence of the appropriate antibiotic. The circularization of the plasmid is the only selection pressure applied. A detailed example for the targeting of the El region is illustrated in Fig. 2. Unique restriction sites available for the targeting of alterations into various regions of the Ad genome (Fig. 3) are Clal (El), Sg/"!, BamHl (E2), Sr/"!, and Spel (E3). In cases where the double strand break is located outside the targeted region, the percentage of rescue of the expected modification decreases with increasing distance of the linearization site with respect to the targeted region [60, 66]. In order to improve this and to very efficiently modify the E4 Ad5: targeting of the E1 region 1. cloning transgene into transfer plasmid -* homologous recombination (BJ5183) with Clal - linearized pAd5 2. clonal isolation of recombinants (DH5a) 3. virus production : 293, PER.C6 cells Pad Pad recombination Pad MCS Ad5 H+1+- Ad5 Transfer plasmids Pad MCS Ad5 II CMVpH+H+-[pAlf~ Ad5 Figure 2 Targeting of the Ad5 El region by homologous recombination with linear vectors. Representative examples of transfer plasmids are schematically shown. The transfer plasmid is linearized or the expression cassette flanked with sequences of homology is excised. They are then cotransfected with the C/d-l inearized Ad5 genome vector plasmid. Upon homologous recombination in E. coli BJ5183 a recombinant viral genome plasmid is generated with the El region deleted and replaced by the foreign expression cassette. 112 Lusky ef o/. L3 L4 L5 L2- E1A E1B L1. E3 L-ITR pIX MLP R-ITR 3' D= Ad 5 5' n= =n 3' IVa2 E2A (DBP) E4 E2B (pTP, POL) • Release of the viral aenome Pad Clal Swal • linearization • • homoloaous recombination: • E 1 : Clal •E2: Sgfl •E3: l-Scel • L5 / E4: BstBI Figure 3 Schematic representation of the Ad5 genome and map of the basic Ad5 genome plasmid pTGl 5152 used as a standard vector in our laboratory for the construction of Ad vectors. The extent of the deletions in the El and the E3 regions is indicated.. With the exception of these deletions the entire sequence of Ad5 is contained in this plasmid. The viral genome can be released from the plasmid backbone by Swa\ or Pod digestions, located immediately adjacent to the left and right inverted terminal repeats (L-ITR, R-ITR). Unique restriction sites to target the E l , E2, E3 L5/E4 region are indicated. The Clo\ site |
is resistant to Dam methylation. To facilitate efficient homologous recombination in the E3 region, the recognition site for the homing endonuclease l-Scel [68] v/as introduced at the deletion point in E3. The 6s/BI site, located exactly between the L5 and E4 transcription units enables the generation of recombinants in both regions. region or introduce mutations into the fiber gene of Ad, we have introduced a Bst^l site just between the poly(A) sites of the fiber gene (L5) and the E4 region [21, 67]. In addition, a recognition site for the homing endonuclease I- Scel [68] was introduced directly at the deletion point in E3 (Fig. 3) to improve the efficiency of targeting the E3 region. The single Clal restriction site in the El region (GATCGATC) is Dam methylation-sensitive. The dam gene of Escherichia coli encodes a DNA methyltransferase that methylates adenine in -GATC-sequences in double-stranded DNA [69]. Thus, the replacement of this Dam-methylation-sensitive Clal site with a methylation-resistant Clal site (T/AATCGATT/A) represented another improvement of the procedure, alleviating the need for a cumbersome step of growing the Ad plasmids in 5. Adenoviral Vector Construction II: Bacterial Systems 113 a dani~ bacterial strain. Multiple transfer plasmids are now available in our laboratory to routinely target the viral El , E2A, E3, L5, and E4 regions using the strategic sites indicated above. Thus, wt have successfully introduced numerous alterations, deletions, as v^ell as insertions of transgenes into the viral El , E2A, E3, E4, and fiber regions [20, 21, 27, 60, 67-^ R. Rooke, unpubfished observations]. The application of homologous recombination to modify the E4 region is illustrated in Fig. 4. Due to the availability of nev^ endonucleases, such as intron-encoded homing endonucleases [70], the generation of further multiply altered Ad viral genomes can be envisioned, by insertion of such endonucleases at further strategic sites in the Ad vector genome. Our experimental evidence suggests that a minimum of ^^50 bp of complete homology on either side is required for significant recombina tion efficiency, consistent v^ith Watt et al. [71]. There is an exponential increase in the frequency of recombination when the length of homol ogous DNA is increased to about 100 bp. Beyond this value, there is an apparent linear increase with longer DNA segments of homology [71; Ad5: targeting of the E4 region E4 modifications AdSErES" E4 wt Ad5ErE3° E4 - modified E1° n= l:0RF4: I lORFS: I l:ORF6;7l |QRF3;,€Ji Figure 4 Targeting of the E4 region. E4 modifications are introduced in the appropriate transfer plasmid by standard cloning procedures. The vector genome plasmid (such as pTG15152) is linearized at the BsfBI site. Co-transfection into E. coli BJ5183 and homologous recombination introduces the E4 modifications indicated in place of E4. 1 1 4 Lusky ef al. M. Lusky and D. Dreyer, unpublished observations]. If the length of homol ogous DNA segments is too large (1 kb and beyond), double recombination events may result in the parental vector backbone, thus diminishing the yield of true recombinants (M. Lusky and D. Dreyer, unpublished observa tions). The ratios of vector DNA (Ad5 plasmid, linearized) to transfer DNA and the absolute amounts also influence the efficiency of transformation as w êll as the frequency of homologous recombination in BJ1583. Our own experimental evidence suggests that a molar ratio of vector to transfer DNA of about 1:10 appears optimal. In addition, ŵ e routinely use about 3 to 10 ng of vector DNA to achieve optimal transformation and recombination efficiencies. This is consistent w îth the notion that the size of the Ad5 genome constitutes a limiting factor and increasing amounts of Ad vector DNA inhibit the transformation intoE. CO//BJ5183 [60]. One draw^back of the method described above is that tvv̂ o transformation steps in E. colt are required prior to the use of high quality, infectious plasmid DNA for transfection into the appropriate mammalian complementation cells. This is due to the fact that the yield and quality of large plasmids, such as Ad plasmids, in the E. coli strain BJ5183 are low .̂ The nonconservative recombination mechanism exploited for the manipulation of the Ad plasmids is responsible for this feature. During plasmid amplification in a RecBC sbcBC bacterial strain, nonconservative recombination occurs betw^een a replicating circle and another circle. The end of the generated rolling circle undergoes further recombination v^ith circles. This results in the accumulation of linear plasmid multimers and decreases the yield in circular plasmid DNA [58, 72]. Thus, for extensive characterization of a new^ recombinant clone, candidate plasmid DNAs derived upon homologous recombination in BJ5183 are trans formed into the recA~ E. coli strain DH5a [73] in our laboratory. In this strain large plasmids are stable and the yield and quality of plasmid DNA is high. Furthermore, due to the availability of state-of-the-art plasmid preparation kits, this second step becomes routine w^ork, taking one extra day's w^orth of work. Once the new recombinant viral genome is fully characterized, the viral DNA is transfected upon release with Pad into the appropriate human complementation cells. Since production of recombinant virus is clonal there is no need for plaque purification. With simple El-deleted or El replacement vectors complete CPE is usually obtained within 5 to 7 days after transfection into either 293 [11] or PER.C6 cells [12]. Since the screening and molecular analysis have already been carried out in the prokaryotic host, the eukaryotic cells merely serve to amplify the clonal recombinant. This leads to an enormous gain in time. 5. Adenoviral Vector Construction II: Bacterial Systems 1 1 5 Taken together, the basic procedure developed by Chartier et al. [60] allows the rapid cloning and manipulation of full-length infectious Ad genomes in bacterial plasmids. The method combines the powerful genetic engineer ing techniques available in £. colt and the ability of this microorganism to recombine homologous sequences at high frequency. The advantages of this technology are multiple and evident: (i) all cloning and, more importantly, all recombination steps are carried out in E. coli, thus a high degree of control is possible at each step during the procedure, (ii) the frequency of bacterial colonies containing the plasmids with the modified Ad genome is very high (up to 90% efficiency), (iii) any genetic region of the viral genome can be specifically modified or deleted, including the introduction of point mutations, if appropriate restriction sites are available, (iv) plasmids containing full-length and modified Ad genomes can be introduced into appro priate bacterial strains for production of large amounts of infectious viral DNA, and (v) transfection of released recombinant Ad viral DNA into the appropriate complementation cell lines generates homogenous pure virus particles without the time-consuming need for plaque screening and purifi cation. The method also has been successfully applied to the assembly and further modification of a variety of animal adenoviruses into infectious plas mids [74-78]. A direct modification of the technique developed by Chartier et al. [60] uses oligonucleotide site-directed cleavage of DNA and homologous recom bination for the production of recombinant Ad vectors [61]. This procedure, schematically illustrated in Fig. 5, allows the introduction of modifications into the viral genome at virtually any predetermined sequence. Toward this goal, the authors describe the use of torsionally stressed supercoiled Ad plasmid DNA which will allow the stable strand displacement of a targeted sequence by hybridization with a complementary oligonucleotide. The hybridization induces the formation of a stable D-loop structure. The single-stranded DNA displaced in such D-loops is specifically cleaved by a single strand-specific nuclease, such as SI nuclease (Fig. 5). This results in the linearization of the Ad plasmid at the targeted site and therefore provides a perfect template for homologous recombination. The recombination reaction is then performed as described above. The utility of this method was demonstrated by using an oligonucleotide complementary to the E3 transcription unit of Ad5 to incor porate the simian virus 40 (SV40) origin of replication into the E3 region by homologous recombination. The resulting cloning efficiency was about 60%, probably reflecting the relative inefficiency of the vector linearization. The clear advantage of this procedure is the complete independence of unique restriction sites in the vector backbone, thus enabling modification virtually anywhere in the vector genome. 116 Lusky ef a / . D - loop technique \ ^ ^ 0.2MNaC D- loop/S1 linear DNA Supercoiled DNA • primer Homologous recombination homologous Recombinant recombination plasmid BJ5183 Figure 5 Schematic representation of the D-loop technique [61 ]. Linearization of the supercoiled target vector backbone is induced by oligonucleotide-mediated D-loop formation followed by SI nuclease digestion at the target site. D-loop / SI -linearized DNA serves as a vector for subsequent homologous recombination events. VI . Homologous Recombination vsfith Circular Ad Vector Genome Plasmids Another way to circumvent the need for single cutting sites is obviously to use a circular instead of a linear template for the homologous recombination. However, in that case the selection process will necessarily involve a step of counterselection against the parental Ad plasmid, rendering the selection process more complex than the simple recircularization to be selected for in the systems described above. Two different approaches where the viral backbone is used as a supercoiled circular plasmid have been described [62, 63] The method by Crouzet et al. [62] for the clonal production of £. coli- derived Ad genomes (EDRAG) exploits the observation that incP-derived plasmids, but not colEl-derived plasmids, such as pBR322- or pUC-derivatives, replicate and are stably maintained in E. colt polA mutant hosts [79]. As a starting point, an incP plasmid [80, 81] with a tetracycline resistant marker, carrying the extremities of Ad5 was used as a vector to incorporate the entire Ad5 genome to generate a full-length Ad5 genomic infectious plasmid. Sub sequently, any modification can be introduced in this incP-derived full-length viral genome plasmid by homologous recombination events between the incP- Ad5 replicon and a colEl shuttle plasmid. The colEl shuttle plasmid, carrying 5. Adenoviral Vector Construction II: Bacterial Systems 117 a kanamycin resistance marker and a conditional suicide gene (the sacB gene of Bacillus subtilis [82]) is engineered by standard cloning techniques containing the specified modification flanked by appropriate homology sequences to the Ad genome. The colEl-derived shuttle plasmid is transformed into the polA host carrying the incP/Ad5 plasmid. Cointegrates are selected by growing the polA host in the presence of both antibiotics. Resolution, leading to loss of the colEl replicon from the recombinant Ad plasmid, of this cointegrate is subse quently selected by growth of the cells in sucrose activating the B. subtilis sacB gene as suicide gene, leading to the concomitant loss of the sacB conditional suicide marker. Consecutive rounds of this two step recombination procedure allow the introduction of multiple independent modifications within the virus genome, with no requirement for an intermediate virus. The potential of this procedure was demonstrated by the recovery of various E1°E3°E4° vectors. The second system [63] using circular viral genome plasmids as target for the homologous recombination is designed only to replace the viral El region with heterologous transgene expression cassettes (see Fig. 6). The vector backbones (pAdEasy) lack Ad nt 1-3533 and are further deleted of the E4 and/or E3 regions. The various shuttle vectors designed (pShuttle) contain a polylinker or a prepared expression cassette surrounded by adenoviral sequences ("arms"), allowing homologous recombination with the pAdEasy Homologous recombination inE. co//with circular Ad vectors transgene . right arm ^ * t \ "̂ '̂ homologous recombination (BJ5183) Pmel "̂ " " ' " shuttle vector left pAdEasy ^L-LTR / / arm Ad backbc^ne Pacr Pad Pad left arm Clonal isolation in E.coli recA Pad - release • virus production (e.g. 293 cells) L-LTR transgene ĵght arm Ad backbone left arm R-LTR Figure 6 Homologous recombination in E. co// BJ5183 with circular target vectors [63]. The gene of interest is cloned into a shuttle vector. The resulting plasmid is linearized by Pmel and cotransfected into E. coli BJ5183 with the circular Ad backbone plasmid pAdEasy. Selection of recombinant Ad plasmids in the presence of Kanamycin allows the counterselection of the pAdEasy parental backbone. 1 1 8 Lusky ef al. system. The left arm contains Ad nt 34,931 to 35,935 (3^ end of Ad) joined to the plasmid backbone and joined to Ad nt 1-480 (5^ ITR, ori and packaging sequence). The right arm consists of Ad nt 3534-5790 joined to the expression cassette. Pad sites |
are engineered immediately adjacent to the ITRs to facilitate the generation of infectious recombinant Ad genomes. Importantly, the shuttle plasmid backbone contains a kanamycin resistance gene for the selection of recombinants in £. colt. Upon linearization of the shuttle plasmid at a single restriction site between the "arms," the DNA is cotransfected with the supercoiled pAdEasy vector into E. colt BJ5183 (Fig. 6). Recombination occurs between the homologous arms, the pAdEasy plasmid backbone that harbors an ampicillir resistance gene is replaced by the pShuttle plasmid backbone that presents the kanonyan resistance gene and the expression cassette is introduced in the El deletion. Recombinant viral genomes are selected in the presence of kanamycin allowing efficient counterselection of the parental, circular pAdEasy vector. Contamination of the reaction with some uncut shuttle DNA can easily be distinguished from the recombinant DNA due to the size differences. Similar to the approach described by Chartier et al, [60], the new recombinant viral plasmid then needs to be transferred into a recA~ strain, such as DHIOB [73] for greater yields of DNA. Using this approach, a cloning efficiency of about 70% was reported. Upon release of the recombinant viral genome from the bacterial plasmid backbone, virus is produced in the appropriate human complementation cell lines as described above. In some of the vectors described by He et al. [63] the green fluorescent protein reporter gene is cointroduced with the expression cassette into the recombinant virus, facilitating the tracing at each step of the viral production. The system as outlined [63] is specifically designed to efficiently and easily introduce heterologous expression cassettes in place of the viral El region. Since this approach relies on the replacement of the plasmid backbone in between the two Ad ITRs for the selection of the recombinants, only viral regions located at the extremities of the genome (El region, E4 region) can easily be targeted. The targeting of any other region requires additional procedures to promote the loss of the prokaryotic selection marker from the viral genome as illustrated in the system described by Crouzet etal. [62]. VII. Ad Vector Construction by Tronsposon-Medioted Recombination Recently a transposon-mediated recombination system has been devel oped which involves the generation of Ad by Tn7-mediated, site-specific transposition in E. colt [83]. The development of this system requires two plasmid components: (i) a low-copy-number, full-length, circular adenoviral plasmid (admid [83]) with a P-galactosidase marker replacing the El region 5. Adenoviral Vector Construction 11: Bacterial Systems 1 1 9 and containing the Tn7 attachment site (lacZatfTn?) and (ii) an admid trans fer vector with a mini-Tn7 containing an expression cassette with the gene of interest. Tn7-mediated transposition of the expression cassette into the lacZattTn? site disrupts the lacZ coding region, resuhing in a P-gal- phe- notype of the newly generated admid. The authors describe a transposition frequency averaging 25%. After clonal isolation of the new recombinants, the Ad genome is released from the admid backbone and transduced into 293 cells for amplification and production. Described to carry out replacements in the El region, the admid system could also be adapted to alter other or additional viral regions. VIII. Ad Vector Construction by in Vitro Ligation The notion of separation of the molecular construction of the rAd vector from the virus production is also guiding the direct cloning procedures described below. Efficient and improved in vitro ligation techniques have recently been described [40-42]. Due to the paucity of unique restriction sites within the adenoviral genome, direct ligation of a transgene expression cassette into the viral vector backbone is facilitated by the use of intron- encoded endonucleases. The technique basically involves two cloning steps in £. coli followed by the transduction of the linear recombinant viral DNA into the permissive mammalian cell-complementation system (see Fig. 7). Intron-encoded endonucleases are enzymes that are encoded within group I introns [70]. An unusually long homing sequence ranging from 15 to 39 bp renders these endonucleases rare cutting and ideal to use for cloning sites in adenoviral backbones. Two groups have described the use of intron-encoded endonucleases, such as l-Ceul [84] and PI-Sc^I [85] for the direct substitution of the viral El region by a reporter gene. Mizuguchi and Kay [40] have generated four basic viral backbones, pAdHMl-4 in a bacterial plasmid; all viral backbones are El° with or without an E3 deletion and the viral DNA is flanked by Pad and Clal sites (pAdHMl, 2) or by Pad sites at both ends (pAdHM3, 4). In each backbone three unique cleavage sites are introduced in to the El-deleted region: l-Ceul, Swal, Vl-Scel. A basic shuttle plasmid (pHM3) contains a multiple cloning site flanked by l-Ceul and Vl-Scel sites, respectively. The expression cassette of interest can be inserted in any site of the multiple cloning site. After cloning, the cassette-containing insert is excised from the shuttle plasmid using the intron-encoded endonucleases. The restricted fragment is then directly cloned into the vector backbone, which is linearized by l-Ceul and Fl-Scel. This scheme permits a directed cloning by ligation of the expression cassette into the viral backbone and lowers the background of parental viral vector (null vector) due to different ends created 120 Lusky ef o/. Ad5 vector construction: in vitro ligation Pad Pad Pl-Scel in vitro ligation ; transform E.coii recA ; Pad release, virus produdion in 293 cells transgene —m — L-ITR E3^ R-ITR Figure 7 Construction of Ad by ligation in vitro [40-42]. A detailed description is found in the text. by the two different intron-encoded endonucleases. Restriction of the ligation product with Swal further diminishes the background of the parental null vector in the cases where the ligation products do not contain a Swal site. The restricted ligation product is then directly transformed into E. coli DH5a. With this method the authors report a 90% cloning efficiency for recombinant viral genomes with the correct restriction pattern. The recombinant viral genome can subsequently be released from the plasmid backbone by Pad or Fad plus Clal digestion followed by the generation of a homogenous Ad population upon transfection into 293 cells. The simplicity of the system is clearly emphasized by the careful choice of unique and strategic restriction sites. The authors have recently added new vector backbones including ElE3E4-deleted vectors as well as modified shuttle vectors to increase the variety of vector construction [41]. The p Advantage system described by Souza and Armentano [42] follows the same logic. Their basic viral El° backbone (pAdyantage) is based on Ad 2 (serotype 2) and contains an l-Ceul site in the region of the El deletion, the ITRs of the viral genome are flanked by Sna^l sites (Sna^l does not 5. Adenoviral Vector Construction II: Bacterial Systems 1 2 1 cleave within the Ad2 viral genome). A shuttle plasmid containing a poly linker flanked by l-Ceul sites is used to introduce the gene expression cassette of interest. The ligation of the l-Ceul restricted expression cassette into the 1-Ceul linearized vector is reported v^ith an ~ 5 0 % cloning efficiency. The authors describing the in vitro ligation approach (Fig. 7) indicate that under optimal conditions the timing from start (cloning of the gene of interest into the shuttle vector) to finish (isolation of plaques, or passage 1 lysate) generally does not exceed 3 weeks. Taken together, the improved, direct in vitro ligation method is simple, straightforward, and appears very efficient, although restricted to the replacement of the El region [42] and to the El and E4 region [40, 41] in its current state. Although it will not allow more precise modification of the Ad genome, the system is clearly amenable to further developments and improvements. For example, additional introduction of noncutting endonucleases, such as intron-encoded or other nonconventional nucleases, into the viral E3 and E4 regions will enable the generation of Ad vectors containing multiple inserts. IX. Conclusion In summary, the concept of the separation of the steps of Ad genome construction in prokaryotic cells and virus amplification in eukaryotic cells has led to the exploitation of powerful methods, including homologous recom bination, direct ligation and transposition technologies to clonally derive Ad constructs in E. coli. The advent of these technologies has enabled the con struction and generation of numerous modified Ad vectors carrying many different transgenes. In addition, our understanding of the in vivo biology of these vectors has been advanced tremendously through the ease of introducing viral genome modifications and studying their effects. The methods in use are simple, highly efficient, and can generate Ad within a very short time period (Fig. 8). The choice of which method to use will depend on the vector region to be targeted and the type of modification to be introduced. Homologous recom bination methods using linear vectors can target virtually any region in the Ad5 backbone and allow precise modification of the Ad genome sequence such as small deletions and point mutations. Homologous recombination methods with circular vectors and the in vitro ligation technique, although very efficient, are currently set up to target the ends of the viral genome (e.g.. El , E4 region) It is clear that these techniques will be further optimized, as research develops, and could be adapted for the generation of other viral vector systems. Many applications of these methods can be envisioned, including the use of custom tailored Ad for the in vivo production of recombinant therapeutic proteins or the generation of custom-made libraries in Ad vectors to enable the high-throughput screening and applied functional analysis of many genes in the context of functional genomics projects. P CL, t o ^ o -a ^4 ^ ' ^ J ^ _y sXtjp e oj 2 sXBp 6 0 U ^ o 9 O C .5 "̂ g-5 w ^ i • .S g - • p - 2 I § § . « O CO ^^ a o CT- _Q U C D. E U 0 >s _yV. ^ V̂ J O (D s/Cep e oj 2 SXBP 5 OJ £ sA^p 6 01Z, _g c E ^ .S o a> > u "Oc o D _Q C si I ̂ _̂ L J L J 0) O SABP £ OJ 2 sAcp 6 oj /. sXipijoTFl 00 O 0) - a iZ E 122 5. Adenoviral Vector Construction II: Bacterial Systems 1 2 3 Acknowledgments We thank various members of our laboratory, particularly Dr. A. Winter for helpful suggestions. The technical assistance of D. Dreyer and M. Gantzer is gratefully acknowledged. References 1. Berkner, K. L. (1988). 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J. Belt/ L Chen/ M. van der Kaaden,^ S. M. Gal loway/ R. B. Hi l l / S. V. Machotka/ C. A. Anderson,"^ J. Lev^is,'' D. MartineZ/'' J. Lebron,'' C. Russo/ D. Valerio,^ and A. Bout^ *Merck Research Laboratories Merck & Company, Inc. West Point/ Pennsylvania +Crucell NV Leiden, The Netherlands I. Introduction A. Scope of the Chapter The goal of gene therapy is the introduction of genes into human somatic cells for therapeutic purposes. The success of gene therapy is therefore dependent on the efficiency by which a therapeutic gene can be transferred to the patient's target tissues. In many cases, viruses are exploited for gene transfer purposes and in particular gene transfer vectors derived from adenoviruses (adenoviral vectors) are often used to achieve this (for reviev^ see [1]). The reason for this is that adenoviral vectors: • efficiently transfer genes to many different cell types; • can be propagated on well-defined production systems to high yields; and • are very stable, which makes purification and long-term storage possi ble, thereby making pharmaceutical production feasible. ADENOVIRAL VECTORS FOR GENE THERAPY | 2 9 Copyright 2002, Elsevier Science (USA). All rights reserved. 1 3 0 Nichols ef aL This contribution will focus on the production systems for clinical lots of adenoviral vectors. Particular attention v îll be paid to the generation and use of complementation cell lines that carry the El genes. Particular emphasis will be on the PER.C6 cell line, which was developed to prevent generation of replication-competent adenovirus (RCA) during propagation of El-deleted adenoviral vectors. In addition, safety issues with respect to the use of the cell line for making clinical grade material will be addressed. B. Adenoviruses Human adenovirus was isolated for the first time in 1953 from cultured adenoidal tissue [2, 3]. Since then, 51 different serotypes have been isolated from various tissues and excretions of humans, of which serotypes 42-51 were obtained from immunocompromised individuals [4-6]. A serotype is defined on the basis of its immunological distinctiveness as judged by quantitative neutralization with animal antisera (horse, rabbit). If neutralization shows a certain degree of cross-reaction between two viruses, distinctiveness of serotype is assumed if (i) the hemagglutinins are unrelated, as shown by lack of cross-reaction on hemagglutination-inhibition, or (ii) substantial biophysical/ biochemical differences in DNA exist [7]. Human adenoviruses are subdivided into six different groups (A-F), which are based mainly on differences in hemagglutination, restriction enzyme analysis, and DNA homology [8]. The adenoviruses were found to be associ ated with different disease patterns (see, e.g., [9, 10]). In addition to the human adenoviruses, some 40 different serotypes have been isolated from various animal species [11]. All adenoviruses possess a DNA molecule that is surrounded by a capsid consisting essentially of hexon, penton-base, and fiber proteins. The virion has an icosahedral symmetry and, depending on the serotype, a diameter of 60-90 nm. The well characterized adenovirus serotypes 2 and 5 have a linear double-stranded DNA genome of approximately 36,000 base pairs (Fig. 1). Other adenoviruses have genome sizes ranging from 30 to 38 kb. The genome contains, at both its ends, identical inverted terminal repeats (ITRs) of approximately 90-140 base pairs with the exact length depending on the serotype. The viral origins of replication are within the ITRs exactly at the genome ends. Sequences required for encapsidation (^) of the viral genome are located in a region of approximately 400 bp downstream of the left ITR. The structure of the adenoviral genome is described on the basis of the adenovirus genes expressed following infection of human cells, which are called early (E) and late (L), according to whether transcription of these regions takes place prior to or after onset of DNA replication. 6. Propagation of Adenoviral Vectors 1 3 1 "¥ E1 pIX L1-L3 ITR IVa2 E2B Figure 1 Map of the adenovirus genome. The 36-kb (for adenovirus type 5) double-stranded DNA molecule is usually divided into 100 map units (mu). The early (E) and late (L) regions are indicated on the map. The ITR sequences (inverted terminal repeats) are identical, inverted, terminal repeats of approximately 100 bp, depending on the serotype, which are required for replication. ^ is a stretch of sequences involved in packaging of the viral DNA into particles. El comprises the El A and ElB region, both encoding two proteins, which are described in detail in section I.C. E2A encodes the DNA binding protein, E2B the precursor terminal protein and DNA polymerase. E3 encodes a number of proteins that are predominantly involved in modulating the host's immune response against adenoviral infected cells. E4 proteins (six in total) are involved in modulation of gene expression and viral replication, mainly through interactions with the host cell. IVa2 (transcriptional activator of major late promoter) and pIX (essential for assembly of the virion) are intermediate proteins. LI -15 encode the late proteins, which are mainly capsid proteins, including penton (L2), hexon (L3), hexon-assembly (L4), and fiber (L5) protein. Infection of a target cell starts by interaction of the fiber with a receptor on the surface of the cell. Many, but not all [12], adenoviruses use the Coxsackie- adenovirus receptor (CAR) for this [13,14], which is present on the cell surface. Integrins act as secondary receptors by binding to the viral penton-base protein. Subsequently, the virus is internalized by receptor-mediated endocytosis. The adenoviruses escape from the endocytic vesicles (or receptosomes) by virtue of a change in the configuration of the virion surface due to the low pH in these vesicles. As a consequence, the virus particles are released in the cytoplasm of the cell, where they are further degraded [15], with the DNA ending up in the nucleus, where a complex with histone proteins is formed, which may attach to the nuclear matrix for replication [16]. The adenovirus DNA is usually not integrated into the host cell chromo somal DNA but remains episomal (extrachromosomal) unless transformation or tumorigenesis has occurred. C. Adenovirus Replication As indicated before, a productive adenovirus infection is divided into two distinct phases: the early and the late phases. In the early phase, the so-called early genes (El, E2, E3, and E4) of adenovirus are expressed to prepare the host cell for virus replication. During the late phase, actual viral DNA replication and production of viral structural proteins takes place, leading to the formation of new viral particles. Adenovirus replication requires both host-cell and viral proteins (see [8,16] for reviews). The cellular proteins needed for replication are nuclear factors I, II, and III [16], which are involved in initiation of viral DNA replication and elongation, as well as in increasing the efficiency of replication. 1 3 2 Nichols ef o/. Adenovirus DNA replication starts with expression of the "immedi ate-early" El genes. The El region comprises two different transcription units, ElA and ElB. The main functions of the ElA gene products are (i) to induce quiescent cells to enter the cell cycle and resume cellular DNA syn thesis and (ii) to transcriptionally activate the ElB gene and the other early regions (E2, E3, E4). The ElA region encodes two major RNA products, 12S and 13S, which are generated by one transcription unit and which differ in size due to alternative spHcing. The RNAs encode acidic proteins of 243 and 289 amino acids, respectively (for adenovirus 5). These are phosphorylated proteins, present in the nucleus of the cells. In addition, during lytic infection mRNAs of 9S, lOS, and IIS are produced, but these proteins were found to be not essential for adenoviral replication [17, 18]. The function of these proteins has not yet been resolved. The ElB region codes for one 22S mRNA, which is translated into two proteins, with molecular weights (for adenovirus 5) of 21 and 55 kDa. ElB proteins assist ElA in redirecting the cellular functions to allow viral replication. The ElB 55-kDa protein forms a complex with the E4 open reading frame 6 (ORF6) 34-kDa protein, which is localized in the nucleus [19, 20]. Its main function is to inhibit the synthesis of host proteins and to facilitate the expression of viral genes. In addition, it also blocks the p53 tumor-suppressor protein, thereby inhibiting apoptosis [21]. The ElB 21-kDa protein is important for quenching the cytotoxic effects to the target cells induced by ElA proteins. It has anti-apoptotic functions similar to the human Bcl-2 protein, which is important for preventing premature death of the host cell before the virus life cycle has been completed [22]. Mutant viruses incapable of expressing the ElB 21-kDa gene-product exhibit a shortened infection cycle that is accompanied by excessive degradation of host cell chromosomal DNA (J^g-phenotype) and an enhanced cytopathic effect (cyt- phenotype) [23]. The E2 region encodes three different proteins that function in viral DNA replication: an Ad-specific DNA polymerase, the precursor terminal protein (pTP), and the DNA-binding protein [16]. The DNA-binding protein, which is encoded by the E2A gene, binds to single-stranded DNA and is involved in unwinding duplex DNA. It might also be involved in the regulation of transcription. The precursor of the terminal protein (pTP) and the DNA polymerase, which are present as a heterodimer, are encoded by the E2B region. The pTP is attached to the adenoviral DNA and is cleaved by the viral protease late in infection. It has a function in protection of the DNA from nucleolytic breakdown and in attaching the adenoviral DNA to the nuclear matrix, which may localize the viral genome to areas of the nucleus in which high concentrations of replication and transcription factors are present. The polymerase is involved in the synthesis of |
new DNA strands. 6. Propagation of Adenoviral Vectors 1 3 3 None of the E3 products are required for virus replication. They do, however, play an important role in virus multiplication in vivo, since they pro tect virus-infected cells from being eradicated by the host's immune response (review^ed in [9]). Several differentially spliced mRNAs are synthesized from the E4 region during infection and six different polypeptides have been iden tified in infected cells [24]. These proteins are involved in modulation of gene expression and viral replication, mainly through interactions w îth the host cell. The E4 ORF3 and E4 ORF6-encoded proteins are involved in post- transcriptional processes that increase viral late protein synthesis. They do so by facilitating the cytoplasmic accumulation of the mRNAs encoding these proteins and by expansion of the pool of late RNAs in the nucleus, most likely by influencing splicing. In addition, the E4 ORF6-encoded protein forms a complex v^ith the ElB 55-kDa protein that selectively increases the rate of export of viral late mRNAs from the nucleus. The complex is located in so-called viral inclusion bodies, the region w^here viral DNA replication, viral late gene transcription, and RNA processing occur [25]. The E4 ORF6 protein, either alone or in a complex w îth the ElB 55-kDa protein, binds the cellular protein p53, thereby blocking its potential to activate the transcription of tumor-suppressing genes [26, 27]. E4 ORFl sequences are related to dUTPase enzymes. It has been hypoth esized that this gene has a role in stimulating quiescent cells [24]. The E4 ORF4 protein binds to protein phosphatase 2A, v^hich results in hypophosphorylation of some proteins, including the adenovirus El proteins. This perhaps limits cytotoxic effects of El A and may lead to a more productive infection. It is also in line w îth the observation that E4 ORF4 mutants are more effective than w^ild-type viruses in killing nonpermissive rodent cells [28]. E4 ORF4 also induces apoptosis in transformed cells like 293 cells [29]. The E4 ORF6/7 modulates the activity of the cellular transcription factor E2F, w^hich may subsequently activate cellular genes v^hich are important for the S phase [30]. The functions of E4 ORFl, ORF2, and ORF3/4 during lytic infection are less clear and are dispensable for grow^th of the virus in laboratory cell lines. After onset of DNA replication, expression of the late genes L2-L5, w^hich are all under the control of one promoter, is sw^itched on. These genes encode the structural components of the virus particles, including L2 the penton, L3 the hexon, L4 the hexon assembly, and L5 the fiber protein. These proteins form the new virus particles into which the adenoviral DNA becomes entrapped. Depending on the serotype, 10,000-100,000 progeny adenovirus particles can be generated in a single cell. The adenoviral replication causes lysis of the cells. 1 3 4 Nichols ef al. II. Cells Expressing El of Adenovirus A. Transformation of Cells by El of Adenovirus In the previous section of this chapter, the function of adenoviral gene products in the repUcation of adenovirus w âs described. There is extensive influence of adenoviral proteins on a large number of cellular functions. In the absence of lytic viral replication, adenoviral genes may have a profound effect on cellular functions, the most striking being transformation by the adenoviral El A and ElB proteins. Clearly, these proteins interfere v^ith the regulatory mechanism of cellular proliferation. Human adenoviruses have a narrow^ host range for productive infections, and can only be propagated in cells of human, chimpanzee [31], pig [32], and cotton rats [33]. In rodent cells, e.g., from rat (w îth the exception of the cotton rat), hamster, or mouse, they bring about an abortive infection, which occasionally leads to transformation [34]. In the transformed cells the adenoviral DNA is integrated into the genome and at least the genes of the viral El region are expressed (review^ed in [35]). The viruses that w êre used for such studies w êre mainly adenovirus serotypes 2, 5, and 12. The various Ad serotypes differ in their ability to induce tumors upon inoculation into newborn hamsters; for example, Ad type 5 (Ad5) is nononcogenic [36], whereas Adl2 is highly oncogenic [34]. However, all Ad serotypes or their DNA can transform rodent cells [37, 38]. Ad5El- transformed cells can form tumors only in immunodeficient mice and rats, whereas Adl2El-transformed cells are oncogenic both in immunodeficient and in immunocompetent animals [39], which correlates with the ability of Adl2El to repress expression of MHC class I genes [40]. In culture, both rodent cells, e.g., from rat, mouse, or hamster, and human cells can be transformed by Ad DNA, although human cells, including fibroblasts and epithelial cells, are relatively refractory to transformation. Ade novirus DNA transformed human cell lines have been made from cultures of human embryonic kidney [41, 42], human embryonic retina [43-46], human embryonic lung [44], and recently, human amniocytes [47]. As described before, the El region consists of two transcriptional units, ElA and ElB. For complete morphological transformation, both regions are needed, but the ElA region by itself can immortalize rodent cells [48] and occasionally human cells [43], albeit with very low efficiency. Expression of ElA usually results in induction of programmed cell death (apoptosis), which can be prevented by coexpression of ElB [49]. The ElA associates with a number of cellular proteins, including the tumor suppressor gene product pRb, as well as pl07, pl30, cyclins A and E, cyclin-dependent kinase 2 (cdk2), and p300 (reviewed in [50-52]). Most of these proteins are involved in cell- cycle control, and, with the exception of p300, regulate the activity of the 6. Propagation of Adenoviral Vectors 1 3 5 transcription factor E2F [51]. The El A proteins do not exert their activity in initiation of transcription by direct, sequence-specific binding to DNA, but rather do so by binding to cellular transcription factors. The ElB 55-kDa [19] and 21-kDa [53] proteins cooperate independently with El A in transformation, and are required to inhibit the apoptotic response initiated by ElA. The 55-kDa ElB protein inhibits apoptosis by blocking the function of the p53 tumor-suppressor protein, which mediates ElA-induced apoptosis [21]. The 21-kDa ElB protein inhibits apoptosis in a way similar to the cellular Bcl-2 protein [22]. B. El -Expressing Cell Lines for Adenoviral Vector Production Most adenoviral vectors currently used in gene therapy have a deletion in the El region, where novel genetic information can be introduced [54]. The El deletion renders the recombinant virus replication-defective, which is a prerequisite for most of the clinical applications. In order to be able to produce El-deleted recombinant adenoviral vectors, complementing cell lines have to be used that express the El proteins of adenovirus. One of the main challenges here is to express sufficient levels of the El protein to achieve this. However, adenovirus El proteins, and in particular ElA proteins, are very toxic to cells. ElA has a profound effect on the transcription of many cellular genes, which leads to alteration of the morphology and growth of the cells and may lead to apoptosis. A few examples have been reported in literature, where cells have been immortalized (but not transformed) with ElA only. This has been described both for rodent [48] and for human cells [43]. It is not known whether cells that express ElA only are able to complement adenoviral vectors that are deleted for both ElA and ElB. Attempts have also been made to express El proteins in established cell lines such as A549. Growth of established cells is not dependent on El expression and the toxicity of El proteins made it difficult to isolate clones that show stable expression of the El proteins, although a few papers report encouraging results [46, 55, 56]. To the best of our knowledge, there is limited use of such cells and therefore this chapter will deal mainly with the group of El-expressing cells that use the transforming capacity of the adenoviral El genes. Typical examples are the cell lines derived from human embryonic kidney (HEK) [41, 42], human embryonic retina (HER) [43-46], and human amniocytes [47]. The advantage of using El for immortalization is that such cells are dependent on El expression for growth, and therefore the levels of El expression are remarkably constant over time. The vast majority of cell lines that were made by immortalization and transformation of primary cells, were made to study immortalization and transformation and were not made for propagation of El-deleted adenoviral 1 3 6 Nichols ef al. vectors. The only documented cell lines based on the El immortalization principle, which were made specifically for use in gene therapy are the PER.C6 cell line [46] and the amniocyte-derived cell line [47]. These cell lines have been tailor-made for the manufacture of clinical lots of adenoviral vectors, with special attention to avoiding generation of RCA (see below). In addition, proper documentation and adequate safety testing are pivotal to ensure manufacture of safe batches of adenoviral vectors. As PER.C6 is the only cell line currently used for making clinical lots of adenoviral vectors, a description of the generation of PER.C6 is given below. Also, the performance of the cell line in production of recombinant adenovirus as well as results of safety and genetic testing are provided. III. PERX6 Prevents RCA during Vector Production A. RCA The majority of preparations of El-deleted adenoviral vectors have been produced on 293 cells. This cell line was generated in Leiden in the group of Prof. Van der Eb, by transfection of El sequences of adenovirus type 5 into primary human embryonic kidney cells [41]. The aim of this experiment was to study the transforming potential of adenoviral El sequences, and the DNA used for it was sheared adenoviral DNA [41]. Precise mapping of the adenoviral sequences present in this cell line indicated that the cell line had integrated bases 1-4137 of the adenoviral DNA [57]. Adenoviral vectors carry a deletion in the El region that runs from approximately nt 400 to nt 3500 of the adenoviral genome. This means that there is a substantial sequence overlap between the El sequences present in the cell line and the adenoviral vector DNA (see Fig. 2). This sequence overlap may result in homologous recombination between the sequences. Due to a double crossover, the El region present in the cellular chromosome may end up into the El-deleted adenoviral vector [58] (Fig. 2). The resulting virus is El-positive and therefore capable of replicating independently in cells that do not contain El sequences in the chromosome. Several reports have described the occurrence of RCA in adenoviral vector batches produced on 293 cells [46, 55^ 58-60]. RCA in clinical preps is unwanted, both from the manufacturing and the safety points of view. Its appearance in batches is a chance process and is therefore unpre dictable and difficult to control. This is a significant problem for GMP manufacturing, in particular if large-scale batches have to be prepared. It is also unwanted from a safety point of view, as upon coinfection of a cell RCA causes the El-deleted adenoviral vector to replicate in an 6. Propagation of Adenoviral Vectors 1 3 7 293 Vector RCA [] [ Figure 2 Mechanism of generation of RCA in 293 cells. Adenoviral vectors contain sequences tfiat overlap with sequences present in the genome of 293 cells, indicated by the crossing lines. Due to the sequence homology, crossover events can occur, which lead to exchange of DNA. El sequences replace the transgene in the adenoviral vectors, resulting in El-containing adenoviruses that are replication-competent. uncontrollable way. It causes shedding of the vector [61]. In addition, RCA has been shown to cause inflammatory responses [59, 62]. Therefore, RCA generation during production of El-deleted adenoviral vectors has to be circumvented. B. PER.C6: Absence of Sequence Overlap Eliminates RCA Generation The strategy to prevent RCA occurrence was to eliminate sequence overlap between the El sequences present in the cellular genome and the adenoviral vector [46]. A potential hurdle to do this is the way the ElB and pIX gene are regulated. Both ElB and pIX use the same poly(A) sequences [63]. Furthermore, the pIX gene is not expressed upon transfection in cultured cells [64], but can be expressed only if present in an adenoviral genome. Therefore, an RCA-free packaging system should consist of two components: (i) an adenoviral vector that is |
deleted for ElA and ElB, but contains the pIX expression cassette and (ii) a cell hne that expresses ElA and ElB and is devoid of pIX sequences. 1. El Construct Used for Making PER.C6 To create the novel cell line, the aim was to use only a minimal number of human adenovirus-type-5-derived sequences, i.e., the El protein coding sequences only, to prevent sequence overlap with El-deleted Ad. The El promoter and poly(A) sequences were therefore obtained from nonadenovirus 138 Nichols ef a/. sources. The El promoter was replaced by the human phosphoglycerate kinase (PGK) promoter (see below), which is a known housekeeping promoter [65] and the poly(A) sequences were isolated from hepatitis B virus [66, 67], The construct pIG.ElA.ElB contains, in addition to the ElA and ElB coding regions, sequences upstream of the ElA gene, including ElA enhancer elements and the cap sequence. Untranslated ElA sequences were also retained in the construct. These elements were included since earlier studies indicated that this results in efficient expression of the ElA gene [68]. A map of the construct, designated as pIG.ElA.ElB, is presented in Fig. 3. Despite removal of the splice site at position 3509 of the adenoviral genome [63], which is highly conserved, and truncation of the ElB transcript, high expression levels of both ElB 21 kDa and ElB 55 kDa were obtained [46]. In fact, the expression of the ElB proteins was even higher than in 293 and 911 cells, whereas equal expression levels of ElA were observed [46]. To prevent sequence overlap with El present in PER.C6 cells, adenoviral vectors were constructed that carry a deletion of the complete El region. These vectors were shown to propagate efficiently in PER.C6 cells (see below) and were found to express the pIX gene [46]. 2. Generation of PER.C6 The primary cells selected for making a new El-complementing cell line were human embryonic retinoblasts (HER). The choice for retinoblasts [43] was based on the observation that Adl2 could transform hamster retinal cells in vitro [69] and induce retinoblastomas following intraocular injection into newborn baboons [70]. It has been described that these cells can be immortalized relatively easily by El of human Ad5 [43, 44, 71] and Adl2 [72]. In addition, the 911 cells, which are derived from HER cells, are very efficient in production of recombinant adenoviral vectors and easy to use [71], thus providing a second argument for the use of primary HER cells as the source of primary cells to make a novel cell line. Primary HER cells have a limited life span. Such cells can be cultured for only a few passages, after which the cells senesce. Transfection of HER cells with El constructs results in immortalization and transformation of the cells, reflected by focus formation in the cultures. This is easily recognized by both macroscopic and microscopic examination of the cultures. Such foci '̂î UK ^Pf P^- ''"- "' " , ^ j ' ^ , ,i,^;;fvi^,;^.'.^..-„: • p{'^). Figure 3 The El construct used to generate PER.C6. The pIG.ElA.ElB construct contains aden ovirus type 5 sequences 4 5 9 - 3 5 1 0 . E l A expression is driven by the human PGK promoter. ElB transcription is terminated by hepatitis B virus-derived poly(A) sequences. 6. Propagation of Adenoviral Vectors 1 3 9 can be isolated and cultured further. Therefore, the pIG.ElA.ElB construct was transfected into primary HER cells, and PER.C6 cells were isolated as described in detail before [46]. After propagation of the cells to passage number 29, a research master cell bank was laid down, which was extensively characterized and tested for safety, including sterility testings (see below). Immortalization of primary cells with El sequences of adenovirus guar antees (i) a stable expression of El proteins, as the cells need El expression for growth, and (ii) that no external selection marker is needed to distinguish El expressing from nonexpressing cells. Human adenovirus serotype 5 was taken as the donor for El sequences. C. Frequency of RCA Occurrence In order to test whether PER.C6 cells are able to propagate adenoviral vectors without concomitant generation of RCA, El-deleted adenoviral vectors were propagated on 293 cells and on PER.C6 cells. The adenoviral vectors used did not have any sequence overlap with El sequences in PER.C6. The batches of vector were analyzed for the presence of RCA, using cell culture based assays, as described before [46, 58]. The results (summarized in Table I) clearly indicate that adenoviral vectors when propagated on 293 cells, get contaminated with RCA. On the other hand, the data provided in Table I clearly demonstrate that PER.C6 cells support RCA-free propagation of El deleted adenoviral vectors, even if large-scale batches (produced on 1-3E10 Table I Frequency of RCA Occurrence in 293 Cells and in PER.C6 Cells Helper cell No. of No. of cells per No. of RCA productions production positive batches 2.5E9 lU 2.5E10 lU 293 22 1E8-3E9 13/22 ND PER.C6 8 1E8-3E9 0/8 0/2 PER.C6 3 1E10-3E10 ND 0/3 Note. Batches of El deleted adenoviral vectors, propagated on either 293 and PER.C6 cells, were tested for the presence of RCA at a level of sensitivity of either 1 RCA in 2.5E9 infectious units (lU) or 1 RCA in 2.5E10 lU of El deleted adenoviral vector. The number of batches that were produced on either cell line, as well as the number of cells used for the production, are indicated as well. 1 4 0 Nichols ef al. PER.C6 cells) were tested for RCA in a very sensitive assay (1 RCA/2.5E10 infectious units). In a separate experiment, an El- and E3-deleted Ad5 vector w âs derived and propagated in PER.C6 cells. A master virus seed (MVS), prepared from passage 12, w âs used to generate 8 virus-production lots (passage 13). The unprocessed virus harvest (vector-infected suspension culture) of the MVS and the virus-production lots w êre tested for RCA. In brief, test articles were frozen and thawed and then assayed by inoculation onto the human- lung-carcinoma (A549, ATCC CCL 185) cell line for approximately 1-2 h at 37°C, after which the inoculum was removed and the culture was refed with medium. Cultures were passaged three times to amplify any putative RCA present, with incubation times ranging from 4 to 7 days for the early passages and 2 to 5 days for the final passage. The cultures were exam ined for cytopathic effects at each passage. The virus-production scale was approximately 20 L and a 60 mL volume (diluted to 600 mL to avoid toxicity and interference with detection of RCA) was tested for RCA for each lot. The testing volume was selected on the basis of a worst-case calculation to ensure the testing of at least three dose equivalents of virus. Earlier virus- production studies suggested that the freeze-thaw extract would contain at least 5 X 10^ particles/mL (or 10^^ particles/20 mL). Thus, at least 3 x 10^^ Ad5 particles (three dose equivalents) would be tested. Assuming a random (Poisson) distribution of RCA, if there were an average of one RCA per 1 X 10^^ particles (20 mL), one would predict the probability of not detecting it by testing only 1 x 10^^ particles to be = e~^ or 0.3679 (36.79% chance). By testing 3 x 10^^ particles (60 mL), the (binomial) probability of not detecting 1 RCA/1 X 10^1 particles is reduced to = ^'^ or 0.04979 (4.98% chance). Mathematically, this is equivalent to three independent tests of 20 mL each (60 mL total). No RCA was detected in the MVS or in any of eight virus-production lots assayed. Using the ratio of particle/TCID50 determined for purified virus (15.6 particles/infectious units), the virus-production lots were estimated to have an average of 1.9 x 10^^ particles/mL. It was estimated that the mean probability of not detecting at least one RCA in a dose of 10^^ particles of virus-production lots was 0.000887%. Besides having directly tested the infected cell suspension of the MVS for RCA, the repeated inability to detect RCA in the various clinical batches bodes well for the RCA-free nature of the MVS. For the clinical production runs, 1 mL of MVS is used to inoculate each of 100 roller bottles (RBs). This means a total of 800 mL of MVS have been used for these "clinical lots." Following the same calculation scheme as above, if there were one RCA per 20 mL of the MVS, there would be ^"^^^ or 0.00674 probability (0.674% chance) of not transmitting an RCA when preparing a single clinical batch. Moreover, cumulatively across the eight clinical production runs, there would be only (e'^^'^f or a 4.25 x 10-^^ probability (4.25 x 10"^^%) chance of not 6. Propagation of Adenoviral Vectors 1 4 1 transmitting RCA in the preparation of eight lots. In conclusion, the 60-mL freeze-thaw sample used for RCA testing provided adequate assurance for the detection of RCA in virus-production lots, at a level of one RCA for a 10^^ dose. How^ever, for testing of future Ad5 vector lots, we plan to use a clarified lysate. In this case, the probability estimated for detection of RCA w îll be based on more direct measurement of virus concentration. In summary, eliminating overlap betw^een El sequences in the cell and the El-deleted adenoviral vector eliminates RCA. IV. Production of Adenoviral Vectors A. Vector Stability When constructing El-deleted adenoviral vectors, a number of choices must be made regarding the structure of the vector backbone and the com position of the transgene. One must determine if the size of the El deletion v îll be adequate to accommodate the size of the transgene or if additional deletions, such as in the E3 region, w îll be needed. One must also decide on the placement of the transgene w^ithin the genome (El vs E3) and the orientation of the transgene (El parallel vs El antiparallel). Finally one must decide on the composition of the transgene in terms of the transcrip tional regulation elements that are utilized (promoter and polyadenylation signals). All of these parameters make constructing adenoviral vectors that express the transgene to the desired level, are genetically stable and propagate well enough to allows high-level production, a somew^hat empirical process. The net genome size of the vector, the deletions used, transgene orientation, the composition of the transgene and the transgene product itself can all affect the growAth and productivity of the vector. The degree to which vector and transgene structure can effect genomic stability and productivity is illustrated by our experience with Ad5 vector 1 (Fig. 4). Vector 1 contains an El deletion into which the transgene was introduced in the El antiparallel orientation. The transgene is composed of our gene of interest flanked by the immediate-early gene promoter and intron A from the human cytomegalovirus, and the bovine growth hormone polyadenylation signal sequence. In addition to the deletion of the El region, the vector has an E3 deletion [73]. When the genetic stability of vector 1 was assessed after serial passage in PER.C6 it was found to be unstable. Restriction analysis of purified viral DNA recovered from passages 12 to 19 indicated that the virus population contained genetic variants (Fig. 5). Over this passage series, the proportion and number of variants appeared to increase. An analysis of the novel restriction fragments and close to 1000 individually recovered, circularized viral genomes, indicated that two genetic mechanisms could account for all of the observed 142 Nichols ef o/. Vectorl Hindlll Hindlll HindlllHindlll Hindlll Hindlll Hindlll Hindlll ITR4^BGH Gene Intron A HCMV pA Promoter Figure 4 Genetic structure of Ad5 vector 1. MW P12 P13 P14 P15 P16 P17 P18 P19 pV1 7.0 i 6.0 i' 9tiK^ ^i-i ^ ^ ^ H i^K ||g|gt ̂ H S B J B iw%^S ̂ M ̂ E fli B H Figure 5 Genetic structure of serially passaged vector 1. Viral DNA was purified from passages 12 to 19 of vector 1 digested with H/ndlll and end-labeled with [P^^]-dATP. The end-labeled restriction fragments were then size-fractionated by gel electrophoresis and detected by autoradiography. pVl , the plasmid used to derive Vector 1 is shown for comparison. The position in the vector 1 genome to which the restriction fragments correspond is indicated on the right. The reduction and upward shift in the 6.6-kb transgene-containing restriction fragment (uppermost double arrow) is due to amplification of |
the 107-bp sequence in the packaging region. Novel bands seen at approximately 4.8 and 3.2 kb (arrowheads) are due to deletions in the transgene in association with amplification in the packaging region. 6. Propagation of Adenoviral Vectors 1 4 3 RFLPs: (i) deletions of the transgene expression cassette, particularly in the region of the hCMV promotor and intron A, and, in two instances, deletion of only adenovirus sequence; and (ii) amplification (two to four repeats) of a 107-bp sequence in the region containing the viral packaging elements. No rearrangements or insertions in the E3 region were detected. The genetic analysis of vector 1 has led to the development of highly stable vectors that can be easily propagated in PER.C6 cells, suggesting that the genetic instability can be overcome by vector design and is not necessarily related to the use of PER.C6 cells. B. The Production Process To make El-deleted adenoviral vectors for human gene therapy, a scaleable process suitable for commercial manufacturing under GMP condi tions was developed. One of the key factors in the development of cell-culture- based production processes is the culture system. In particular, if scaling of the process is needed, culture of the cells in a bioreactor is highly desired. For robust and scaleable systems, suspension growth of the required cell line is extremely advantageous. PER.C6 cells can be cultured both as adherent cells and in suspension culture. For suspension growth, specific well-defined serum-free media have been developed (e.g., ExCell 525; JRH Biosciences). These media do not contain any protein that is derived from human or animal tissues or specimens. This results not only in many fewer contaminants to be removed during downstream processing but also a favorable safety profile with respect to pathogens which might be introduced by animal/human-derived components. The serum-free culture medium (SF-medium) supports the growth of PER.C6 cells to densities of 1.5-2.5 x 1^ cells/mL in routine T-flask and roller bottle cultures. In perfused bioreactor systems, cell densities up to 1^ cell/mL are easily obtained. An overview of the process of production of El-deleted recombinant adenoviruses is presented in Fig. 6 and is summarized below. After thawing a vial of PER.C6, expansion in a T-flask containing SF- medium is done, followed by transfer of the suspension culture to roller bottles. Then these roller bottles are cultured until sufficient cells are generated to inoculate a bioreactor. In the standard batch-wise production process (e.g., in 2- or 20-L bioreactor) half of the bioreactor working volume is inoculated at 0.5 X 10^ cells/mL. Then PER.C6 is grown in 2 days to 2 x 10^ cells/mL and diluted once to 1 x 10^ cells/mL by adding the same volume of fresh medium. Then the seed virus is added and temperature is lowered from 37° to 35°C, followed by harvest after 3 days by pelleting. The latter is necessary if the purification process consists of ultracentrifugation with CsCl density gradients. After these 3 days, the virus particles become suspended utilizing 144 Nichols ef al. ,iR £^ n U ftraf iltration Capture DOOQO S E C I E X DDODO Final Product Figure 6 Overview of the process of production of El-deleted recombinant adenovirus. The process is described in section 4B of this chapter. cell lysis. The batch process is very robust but not economical since only low cell densities can be obtained due to the rapid consumption of nutrients from the medium. When high cell densities are required a perfusion system can be used. Nutrients are replaced and metabolites removed by perfusion of fresh medium. A suitable perfusion system can be obtained with hollow fiber modules. These modules are operated externally on the bioreactor and can therefore easily be replaced when malfunction occurs. Hollow-fiber technology also has the opportunity for virus retention, easy scale-up, and its potential application as a first step in the virus isolation. To take full advantage of high-density cultures the virus replication should last longer than 3 days to enable the utilization of all cells present because a repeated infection can occur with newly released particles from lysed cells. A typical example of a 20-L bioreactor run is presented in Fig. 7. Because a large part of the total produced virus will be in suspension, the volume of such a culture is too large to enable purification by ultracentrifugation. Hollow-fiber ultrafiltration and chromatography are methods of choice for virus isolation and purification. With these systems directly connected to the bioreactor, thereby ensuring a closed system, all virus can be isolated from the culture medium. After capture of the virus, the bulk product can be further purified utilizing ion exchange chromatography and/or size exclusion chromatography systems. The obtained product is of high purity and infectivity. Final formulation can be done by ultrafiltration, bringing the product to the final concentration in the required buffer. 6. Propagation of Adenoviral Vectors 145 10 + 8 o t 6 1̂ "̂ S 1,5 a > • t 2 144 192 336 time (hours) Figure 7 Example of production of El -deleted adenoviral vectors in PER.C6 in a 20-L bioreactor. PER.C6 cells are seeded at a density of 0.5E6 cells/mL, in ExCell525 culture medium. Perfusion is started 48 h later, at a rate of 1 bioreactor volume/24 h. The glucose concentration remains constant during perfusion. Under these conditions, cell densities of 1 x 10^ cells/ml are obtained. C. Yields of Adenoviral Vectors The yields of virus obtained after propagation in PER.C6 cells in 20-L sus pension cultures ranges from 0.6 x 10^^ to 1.1 x 10^^ vp/mL culture medium with an average yield of 0.8 x 10^^ vp/mL {n = S), The cell density during infection was approximately 3 x 10^ cells/mL. The calculated virus yield per cell is therefore 0.2 x 10^-0.4 x 10^ vp/cell. As the cultures are inoculated at a multiplicity of infection of 40 vp/cell, an amplification factor of 500 was achieved. The loss during isolation and purification can be held to 70-80%. This figure was consistently obtained in multiple runs for three different adenoviral vectors. Similar yields of El-deleted adenoviral vectors obtained on PER.C6 have been obtained by others [74]. D. Scale of Adenoviral Vector Production The estimated scale of the required bioreactor and cell-line stability is calculated as follows. The cell density used for virus production in perfusion mode is 3-6 x 10^ cell/mL. Therefore, assuming at least 20,000 virus particles per cell yield, the overall expected yield in the crude bioreactor harvest is 2 x 10"̂ vp/cell X 5 X 10^ cell/mL = 1 x 10^^ vp/mL. Further, after optimization. 1 4 6 Nichols ef al. maximum expected loss of virus particles after downstream processing (DSP) by column chromatography is 75%, Therefore, from a 20-L perfusion bioreactor 1 X 10^^ vp/mL X 0.25 (recovery) x 10"̂ mL = 5 x 10̂ "̂ vp can be obtained. This gives 5 x 10̂ "̂ vp/1 x 10^^ vp/dose = 50,000 doses (assuming 1 x 10^^ vp/dose). When during product development 40% of the batch is retained for QC and archiving purposes 3000 patients can receive 50,000 x 0.6/3000 = 10 doses each. Therefore, using the currently developed technology, this 20-L bioreactor is sufficient for the generation of material for the first clinical studies. However, to be able to do process development on a larger scale, needed for full commercial production, a larger vessel is required. Full production scale is expected to be about five times larger, and therefore a 100-L bioreactor is expected to be the maximum volume required for application with single doses up to 10^^ vp. To propagate the cells from a working cell bank ampoule, containing 5^ cells, to a 5E6 cell/mL culture in a 100-L bioreactor would take 17 cell doubhngs. So a reliable production process would require a cell line which is at least stable over 20 cell doublings. PER.C6 was shown to be stable with respect to El expression for at least 98 cell doublings. V. Safety Considerations of PER.C6 A. QC Testing of PER.C6 Cells for Use in the Manufacture of Biologicals and Vaccines The safety of vaccines and biologicals manufactured in continuous cell lines of animal or human origin is of paramount importance and must be ensured by the manufacturer through a program of quality control (QC) testing applied to the product before release for human administration. This QC testing is intended to (i) ensure the identity of the product, (ii) ensure the safety and sterility of the product by demonstrating the absence of adventitious microbial agents, and (iii) ensure the safety and sterility of the product by demonstrating the absence of adventitious viral agents. The program for QC testing applied to a biological product, formalized as a release protocol^ is developed as a responsibility of a Department of BioAnalytical Development. The release protocol is developed through an evaluation and integration of (i) relevant compendial literature and precedents, (ii) the origin of the cell line used for production and its development as a master cell bank, (iii) the sourcing and quality control testing of raw materials of animal origin used in manufacture, and (iv) the method of good manufacturing practice (cGMP) manufacture of the bulk and intermediate and final product considering, among other things, the quality of environment in which bioprocessing is conducted, the method of manufacture, in particular the isolation of the culture system from operators, and the consistency of preparation. 6. Propagation of Adenoviral Vectors 1 4 7 The release protocol prescribes the QC testing to be applied not only to final product but, importantly, master cell banks, master virus seeds, and other bioprocess inputs, raw materials of animal origin, and intermediate bulk products developed during dov^nstream processing, purification and formulation. The release protocol specifies testing methods and volumes to be tested relying upon bacterial broth and agar cultures, embryonated eggs, small animals, and in vitro cell culture in a variety of primary and continuous cell lines of mammalian or human origin. These methods are well known to be sensitive to the detection of a variety of bacterial and viral agents and applied in concert provide a comprehensive and sensitive analytical approach upon which to ensure product safety. More recently, with the development of exquisitely sensitive polymerase chain reaction (PCR) methods for the detection of agents which are refractory to animal or cell culture, these classical propagation methods are commonly supplemented with agent-specific testing, using PCR and polymerase-enhanced reverse transcriptase (PERT) assays. The general methods of testing to ensure product safety are presented in illustrated form in Fig. 8. 1. QC Testing for the Release of PER.C6 Master Cell Bank The development of PER.C6 research master cell bank (rMCB) A068-016 to support manufacture of biologies has been previously described. The release protocol to ensure the (i) identity, (ii) sterility, and (iii) viral safety of the rMCB is presented in Table II. The QC testing was conducted by contract at Inveresk Research (Tranent, Scotland) and at MicroSafe (Leiden, The Netherlands). Table 11 Release Protocol for Crucell rMCB A068-0T6 Test Method Identity Isoenzyme analysis Sterility Broth and agar for cultivation of bacteria, fungi, mycoplasma In vitro indicator cells for detection of mycoplasma using Hoechst stain Viral safety In vivo eggs Eggs (allantoic and yolk sac) In vitro cell culture MRC-5, HeLa, Vero, bovine cells Agent-specific testing HBV, HCV, EBV, HHV6, HIV-1, HIV-2, using PCR HTLV-1, HTLV-2, AAV, B19, SV40 Agent-specific testing PERT, S+L-,XC testing for retroviruses 148 Nichols et aL Method Criteria for Evaluation g ^ L::D Turbidity, Sterility Colony Formation Inoculation of Broth and Agar Culture and Cell Cytoplasmic Fluoresence Cultures with Observation of 14-21 days ^ 5> Viability Gross morphology In Vivo Testing in Eggs Hemagluttination Injection of Eggs by Amniotic, Allantoic or Yolk Sac Routes with Obserx'ationfor 7-14 days In Vivo Testing in Animals Viability Fitness Injection of Adult or Suckling mice, Guinea pigs or Evidence of Disease Rabbits by IM, IP, or SC Routes with Observation for 7-60 days In Vitro Testing in Cell Culture Evidence of Cytopathology Hemadsorption Inoculation of Primary or Continuous Cell Lines of Hemagluttination Human, Primate or Animal Origin with Observation for 14-28 days Evidence of Gene Testing for Specific Virus Agents Specific Product Use of Sequence Specific Primers for PCR Evidence of Enzymatic Amplification or PERT, or TEM Activity ofRT Figure 8 Testing methods for the demonstration of product safety. 6. Propagation of Adenoviral Vectors |