HTHS 1101 Weber State Medical Terminology Exam 1 review (1,2,3)

History of present illness

The story of the patient's problem

Review of systems

Description of individual body systems in order to discover any symptoms not directly related to the main problem

hepat/o

liver

hemat/o

blood

my/o

muscle

gen/o

creation, cause

myc/o

fungus

necr/o

death

path/o

suffering, disease

troph/o

nourishment, development

xer/o

dry

-ia

condition

-ism

condition

-iatrics

medical science

-iatrist

specialist in the medicine of

-ist

specialist

-logist

specialist in the study of

-logy

study of

-algia

pain

-dynia

pain

-emia

blood condition

-iasis

presence of

-itis

inflammation

-lysis

loosen, break down

-oid

resembling

-oma

tumor

-osis

condition

-pathy

disease

-penia

deficiency

-rrhexis

rupture

-spasm

involuntary contraction

-centesis

puncture

-graph

instrument used to produce a record

-graphy

process of recording

-meter

instrument used to measure

-scopy

process of looking

-desis

binding, fixation

-ectomy

removal

-plasty

reconstruction

-rrhaphy

suture

-stomy

creation of an opening

-tomy

incision

anti-

against

de-

down, away from

ante-

before

pro-

before, on behalf of

re-

again

ab-

away

ad-

toward

e-

out

ec-

out

ecto-

outside

exo-

outside

en-

in, inside

epi-

upon

hyper-

over

con-

with, together

sym-

with, together

dys-

bad

Past medical history

Other significant past illnesses, like high blood pressure, asthma, or diabetes

Family history

Any significant illnesses that run in the patient's family

Clinic note

Documents a visit

Consult note

Provides an expert opinion on a more challenging problem

Emergency department note

Documents an emergency department visit

Admission summary

Documents the admission of a patient to the hospital

Discharge summary

Describes when and why the patient was admitted; documents a longer stay

Operative report

Documents a surgery in detail

Daily hospital note/progress note

Documents daily hospital visit

Radiology report

Explains reason for image, how image was performed, what was seen on image, radiologist's assessment; sometimes a recommendation

Pathology report

Provides reasons for test, what was seen on the test, and an assessment

Prescription

Provides directions for a medication

acute

it just started recently or is a sharp, severe symptom

chronic

it has been going on for a while now

exacerbation

it is getting worse

abrupt

all of a sudden

febrile

to have a fever

afebrile

to not have a fever

malaise

not feeling well

progressive

more and more each day

symptom

something a patient feels

noncontributory

not related to this specific problem

lethargic

a decrease in level of consciousness; in a medical record, this is generally an indication that the patient is really sick

genetic/hereditary

it runs in the family

alert

able to answer questions; responsive; interactive

oriented

being aware of who he or she is, where he or she is, and the current time; a patient who is aware of all three is "oriented X 3"

marked

it really stands out

unremarkable

another way of saying normal

auscultation

to listen

percussion

to hit something and listen to the resulting sound or feel for the resulting vibration; drums are a percussion instrument

palpation

to feel

impression

another way of saying assessment

diagnosis

what the health care professional thinks the patient has

differential diagnosis

a list of conditions the patient may have based on the symptoms exhibited and the results of the exam

benign

safe

malignant

dangerous; a problem

degeneration

to be getting worse

etiology

the cause

remission

to get better or improve; most often used when discussing cancer; remission does not mean cure

idiopathic

no known specific cause; it just happens

localized

stays in a certain part of the body