D-F

Debridement: Removal of necrotic tissue to promote wound

healing and reduce risk of further infection.

Delayed peak response: The effects of medication take longer

than expected to initiate.

Delirium: Transient brain syndrome presenting as disordered

attention, cognition, psychomotor behavior, and perception.

Delirium tremens (DTs): Symptom of alcohol withdrawal

characterized by hallucinations, delirium, severe agitation,

fever, elevations of blood pressure and heart rate, and possible

cardiac arrhythmias.

Dematiaceous: Darkly pigmented colored spores or fungal hyphae.

Dennie-Morgan line: A line or fold below the lower eyelids;

associated with atopy.

Dermatophyte: Any microscopic fungus that grows on the skin,

scalp, and nails.

Desensitization: The process of giving a medication in a

controlled and gradual manner, which allows the person to

tolerate it temporarily without an allergic reaction.

Desquamation: Peeling or shedding of the epidermis (superficial

layer of the skin) in scales or flakes.

Diabetes insipidus: An uncommon disorder that occurs when

the kidneys pass an abnormally large volume of urine (3–20

quarts/day of urine versus the typical 1–2 quarts/day) that

is dilute and odorless (“insipid”). Unrelated to diabetes

mellitus, although both conditions cause frequent urination

and constant thirst. Individuals with diabetes insipidus have

normal blood glucose levels; however, their kidneys cannot

balance fluid in the body.

Diabetic ketoacidosis: A reversible but life-threatening short-

term complication primarily seen in patients with type 1

diabetes caused by the relative or absolute lack of insulin that

results in marked ketosis and acidosis.

APPENDIX C | GLOSSARY 1579

Dialysate: The physiologic solution used during dialysis to

remove excess fluids and waste products from the blood.

Dialysis: The process of removing fluid and waste products from

the blood across a semi-permeable membrane to maintain fluid,

electrolyte, and acid–base balance in patients with kidney failure.

Diaphoresis: Sweating or profuse perspiration, generally as a

symptom of a disease or an adverse drug effect.

Diarthrodial joint: A freely moveable joint (eg, knee, shoulder).

Contrast with amphiarthrodial joint (a slightly movable joint;

eg, vertebral joint) and synarthrodial joint (an unmovable

joint; eg, fibrous joint).

Dilated cardiomyopathy: Ability of the heart to pump blood is

decreased because the left ventricle is enlarged and weakened.

Diphasic dyskinesia: The motor fluctuations occur while

the plasma levodopa concentrations are rising and when

they are falling. In each dosing interval the patient may

experience improvement, dyskinesia, and improvement (IDI)

or dyskinesia, improvement, dyskinesia (DID).

Direct current cardioversion: The process of administering

a synchronized electrical shock to the chest, the purpose of

which is to simultaneously depolarize all of the myocardial

cells, resulting in restoration of normal sinus rhythm.

Directly observed treatment: Method to increase adherence to

medications when a patient is observed taking the medication

by a health care worker.

Disease-free survival: Period of time from the end of treatment

that the patient survives without signs or symptoms of the disease.

Disease progression: In cancer, at least a 20% increase in the

sum of the longest diameter of target lesions from baseline,

including new lesions discovered during treatment.

Disseminated erythrosquamous papules: Widespread or whole

body red, scaly psoriatic lesions.

Disseminated intravascular coagulation (DIC): A thrombotic

and hemorrhagic disorder marked by uncontrolled systemic

coagulation resulting in thrombosis, which may lead to

generalized bleeding due to the depletion of clotting factors

and increased fibrinolysis.

DNA mismatch repair (dMMR) genes: Genes that control an

intrinsic intracellular mechanism which corrects nucleotide

insertion errors made during DNA replication, by excising

the mismatched base pairs that escaped correction by the

proofreading activities of DNA polymerases and replacing the

mismatched bases with the correct ones.

Door-to-needle time: Time from arrival in hospital to drug

administration in appropriate patients.

Dose density: The total amount of drug given in a fixed unit

of time (usually 1 week), thus is a function of dose and

frequency of administration.

D-test: Double disk diffusion microbiological testing which

indicates the presence or absence of macrolide-induced

resistance to clindamycin.

Ductus arteriosus: Shunt connecting the pulmonary artery to the

aortic arch that allows blood from the right ventricle to bypass

fetal lungs.

Duodenal enterocyte: Cells lining the duodenum, which is the

first of three parts of the small intestine.

Dysarthria: Speech disorder due to weakness or incoordination

of speech muscles; speech is slow, weak, and imprecise.

Dysentery: A number of disorders marked by inflammation of

the intestines, especially of the colon, and attended by pain

in the abdomen, tenesmus, and frequently stools containing

blood and mucus.

Dysesthesia: An unpleasant abnormal sensation.1580 APPENDICES

Dyskinesia: Abnormal involuntary movements (dystonia, chorea,

End-stage liver disease: Liver failure that is usually accompanied

and akathisia).

by complications such as ascites or hepatic encephalopathy.

Dyslipidemia: Elevation of the total cholesterol, low density

Enthesitis: Inflammation of the sites where tendons, ligaments,

lipoprotein cholesterol or triglyceride concentrations, or a

or fascia attach to bone.

decrease in high density lipoprotein cholesterol concentration

Enuresis: Involuntary discharge of urine.

in the blood.

Eosinophilic asthma: Sub-phenotype of asthma with elevated

Dysmenorrhea: Crampy pelvic pain occurring with or just prior

tissue and sputum eosinophils, thickening of the basement

to menses. “Primary” dysmenorrhea implies pain in the setting

membrane zone, and corticosteroid responsiveness. Criteria

of normal pelvic anatomy, while “secondary” dysmenorrhea is

that have been used for medications to treat eosinophilic

secondary to underlying pelvic pathology.

asthma include blood eosinophil count ≥ 150 cells/µL (0.150 ×

Dyspareunia: Pain during or after sexual intercourse.

109/L) or > 300 cells/µL (0.3 × 109/L) (400 cells/µL [0.4 × 109/L]

Dyspepsia: Upper abdominal symptoms that may include pain

for reslizumab) in the past year, sputum eosinophil count ≥ 3%

or discomfort, bloating, feeling of fullness despite little food

(0.03), and exhaled nitric oxide concentration ≥ 50 ppb.

intake, unusual fullness after meals, nausea, loss of appetite,

Epilepsy: A neurological disorder characterized by recurring

heartburn, regurgitation of food or acid, and belching.

motor, sensory, or psychic malfunction with or without loss of

Dysphagia: Painful or difficult swallowing, accompanied by a

consciousness or convulsive seizures.

sensation of food being stuck in passage.

Epistaxis: Nasal hemorrhage with blood drainage through the

Dysphonia: Impairment of the voice or difficulty speaking.

nostrils; a nosebleed.

Dyspnea: Difficult or labored breathing.

Erosive esophagitis: A severe form of gastroesophageal reflux

Dystonia: A type of dyskinesia. The movement is slow and

disease (GERD) in which the mucous membrane lining the

twisting. It may be associated with painful muscle contractions

esophagus is inflamed with areas of erosion resulting from

or spasms.

abnormal reflux of gastric acid.

Ebstein anomaly: Congenital heart defect in which the opening

Erythema nodosum: Inflammation of the fat cells under the skin

of the tricuspid valve is displaced towards the apex of the right

resulting in termer red nodules or lumps.

ventricle.

Erythematous: Flushing of the skin caused by dilation of capillaries.

Eburnation: A condition in which bone or cartilage becomes

Erythema is often a sign of inflammation and infection.

hardened and denser.

Erythrodermic psoriasis: Generalized erythema covering

Ecchymosis: Passage of blood from ruptured blood vessels into

nearly the entire body surface area. Fever and malaise are

subcutaneous tissue causing purple discoloration of the skin.

common and, while quite rare, can be severe and even fatal;

Eclampsia: Seizures associated with high blood pressure.

it is usually associated with a worsening of other forms of

Ectopic pregnancy: Presence of a fertilized ovum outside of the

psoriasis.

uterine cavity.

Erythropoiesis stimulating agents: Agents developed by recom-

Effector cells: Cells that become active in response to initiation

of the immune response.

Ejection fraction: The fraction of the volume present at the end

of diastole that is pushed into the aorta during systole.

Electroconvulsive therapy: Administration of electric current

to the brain through electrodes placed on the head to induce

seizure activity in the brain; used in the treatment of certain

mental disorders.

Electroencephalography: The recording of brain waves via

electrodes placed on the scalp or cortex.

Embolism: The sudden blockage of a vessel caused by a blood

clot or foreign material which has been brought to the site by

the flow of blood.

Embolization: The process by which a blood clot or foreign

material dislodges from its site of origin, flows in the blood,

and blocks a distant vessel.

Empiric: A strategy or treatment administered without definitive

evidence of the cause, ie, often at the onset of symptoms or

radiological findings.

Endometritis: Inflammation of the endometrium.

Endophthalmitis: Inflammation of intraocular fluid (vitreous

and aqueous), usually due to infection.

Endoscopy: Visual inspection of the inside of hollow organs

with an endoscope, mainly for diagnostic purposes; refers to

procedures such as gastroscopy, duodenoscopy, colonoscopy,

and sigmoidoscopy.

Endothelial cell: A single layer of cells surrounding the lumen

of arteries.

Endovascular: Procedures involving insertion of a catheter

containing medications or instruments into a blood vessel for

the treatment of vascular disease.

binant DNA technology that have the same biological activity

as endogenous erythropoietin to stimulate erythropoiesis (red

blood cell production) in the bone marrow.

Erythropoietin: A hormone primarily produced by the progenitor

cells of the kidney that stimulates red blood cell production in

the bone marrow. Lack of this hormone leads to anemia.

Esophageal manometry: Measurement of pressures and muscle

contractions in the esophagus.

Esophageal stricture: Narrowing of the esophageal lumen

resulting chronic inflammation and formation of scar tissue.

Esophageal varices: Dilated blood vessels in the esophagus.

Essential fatty acid deficiency: Deficiency of linoleic acid,

linolenic acid, and/or arachidonic acid, characterized by hair

loss, thinning of skin, and skin desquamation. Long-chain

fatty acids include trienes (containing three double-bonds

[eg, 5,8,11-eicosatrienoic acid [or Mead acid], trienoic acids])

and tetraenes (containing four double-bonds [eg, arachidonic

acid]). Biochemical evidence of essential fatty acid deficiency

includes a triene:tetraene greater than 0.2 and low linoleic or

arachidonic acid plasma concentrations.

Exanthem: Eruption of the skin.

Excess body weight: Calculated as the difference between actual

and ideal body weight.

Exfoliative dermatitis: Severe inflammation and peeling of the

entire skin surface due to a reaction to certain drugs.

Exploratory laparotomy: Surgical incision into the abdominal

cavity, performed to examine the abdominal organs and cavity

in search of an abnormality and diagnosis.

External beam radiotherapy (EBRT): An external source of

radiation is pointed at a particular part of the body.

Extraabdominal: Outside of the abdominal cavity

Extraction ratio: Fraction of the drug entering the liver in the

Focal seizures: Seizures that start in a small area of the brain.

blood which is irreversibly removed.

They may stay localized or spread to involve larger areas or the

Extrapyramidal symptoms (EPS): Adverse drug effects of

entire brain.

medications such as phenothiazines. EPS include dystonia

Forced expiratory volume in the first second (FEV1): The

(involuntary muscle contractions), tardive dyskinesia

volume of air that a patient can forcibly exhale in the first

(repetitive, involuntary movements), and akathisia (motor

second of forced exhalation after taking a maximal breath.

restlessness or anxiety).

Forced vital capacity: The maximum volume of air that can be

Extravasation: Movement of fluid from inside a blood vessel into

forcibly exhaled after taking a maximal breath.

the surrounding tissues.

Fraction of exhaled nitric oxide (FeNO): A noninvasive test that,

Facultative: An optional biological condition, not required for

when elevated, is an indicator of inflammation in the airways

growth or survival.

and likely responsiveness to inhaled corticosteroids.

Felty syndrome: An extra-articular manifestation of rheumatoid

Fragility fracture: A fracture resulting from a fall from standing

arthritis associated with splenomegaly and neutropenia.

height or less amount of trauma.

Ferritin: A protein in the body that binds to iron; most of the iron

Frailty: Excess demand imposed upon reduced capacity; a

stored in the body is bound to ferritin.

common biological syndrome in the elderly.

Festination: Walking with short, rapid, shuffling steps.

Frank-Starling mechanism: Increase in stroke volume in

Fibrin: An insoluble protein that is one of the principal ingredients

response to an increase in volume of blood filling the heart (ie,

of a blood clot. Fibrin strands bind to one another to form a

end diastolic volume) when all other factors remain constant.

fibrin mesh. The fibrin mesh often traps platelets and other

Freezing: A sudden but temporary inability to move.

blood cells.

Fremitus: Vibrations through the chest wall that may be detected

Fibrinolysis: A normal ongoing process that dissolves fibrin and

through touch (tactile) or heard (vocal) through a stethoscope

results in the removal of small blood clots; hydrolysis of fibrin.

with certain spoken words (eg, “ninety-nine”).

Fibroadenoma: A benign neoplasm which commonly occurs in

French scale: Scale used to measure external diameter of a feeding

breast tissue and is derived from glandular epithelium.

tube.

Fibrosis: Development of fibrous connective tissue in response

Fructooligosaccharide: Soluble fiber that is fermented by colonic

to injury or damage.

bacteria to short-chain fatty acids (SCFAs).

Fluorescence in situ hybridization (FISH): A laboratory

Fistula: Abnormal connection between two internal organs (eg,

Fistulogram: X-ray photograph (or radiograph) taken after

Flexural psoriasis: Flexural psoriasis is characterized by lesions

Flight of ideas: A nearly continuous flow of rapid speech

Floppy iris syndrome: A syndrome of pupillary constriction,

Flow cytometry: A method of measuring the number of cells in

chromosomes on the slide, they light up when viewed under a

Foam cell: Lipid-laden white blood cell.