A-C

2,3-Diphosphoglycerate: A compound in red blood cells that

affects oxygen binding to and release from hemoglobin.

Ablation: Destruction of part or all of an organ or structure.

Abscess: Purulent collection of fluid separated from surrounding

tissue by a wall consisting of inflammatory cells and adjacent

organs.

Acanthosis nigricans: Increased thickness and hyperpigmentation

of the outer cell layers of the skin; typically observed at areas

of flexure.

Acaricide: A chemical that kills mites and ticks.

Acetylcholine: Neurotransmitter at synapses in the ganglia of the

visceral motor system and a variety of sites within the central

nervous system.

Achalasia: Disorder in which the esophageal sphincter is impaired,

preventing normal swallowing and often causing reflux of

contents and a feeling that something is caught in the throat.

Achlorhydria: Absence of free hydrochloric acid in the stomach.

Acinar cells: Cells in the pancreas responsible for the synthesis,

secretion, and storage of certain digestive enzymes.

Action potential: A rapid change in the polarity of the voltage

of a cell membrane from negative to positive and back to

negative; a wave of electrical discharge that travels across a cell

membrane.

Acute coronary syndromes: Ischemic chest discomfort at rest

most often accompanied by ST-segment elevation, ST-segment

depression, or T-wave inversion on the 12-lead electrocardiogram;

caused by plaque rupture and partial or complete occlusion of

the coronary artery by thrombus. Acute coronary syndromes

include myocardial infarction and unstable angina.

Acute respiratory distress syndrome: Diffuse inflammatory

condition of the lung resulting in damage of alveoli, surfactant

production, innate immune system response, and dysregulation

of hemostasis in the pulmonary tract.

Addiction: A primary, chronic, neurobiologic disease, with

genetic, psychosocial, and environmental factors influencing its

development and manifestations. Characterized by behaviors

such as impaired control over substance use, compulsive use,

continued use despite harm, and craving.

Adenoma: A non-malignant tumor of the epithelial tissue that is

characterized by glandular structures.

Adenomatous polyposis coli: A gene associated with familial

adenomatous polyposis, an inherited disorder characterized

by the development of myriad polyps in the colon, often

occurring in adolescents and young adults ages 15 to 25.

Adjuvant chemotherapy: Treatment given after primary surgical

treatment and designed to eliminate any remaining cancer cells

that are undetectable, with the goal of improving survival.

Appendix C: Glossary

Adrenalectomy: Surgical removal of an adrenal gland.

Adverse drug reaction: Any unexpected, unintended, undesired,

or excessive response to a medication that requires discontinu-

ing the medication; requires changing the medication; requires

modifying the dose (except for minor dosage adjustments);

necessitates admission to the hospital; prolongs stay in a health

care facility; necessitates supportive treatment; significantly

complicates diagnosis; negatively affects prognosis; or results

in temporary or permanent harm, disability, or death.

Aeroallergen: Airborne substance that causes an allergic response.

Afterload: The force against which a ventricle contracts that

is contributed to by the vascular resistance, especially of

the arteries, and by the physical characteristics (mass and

viscosity) of the blood.

Ageism: Discrimination against aged persons.

Air embolus: An obstruction in a small blood vessel caused by air

that is introduced into a blood vessel and carried through the

circulation until it lodges in a smaller vessel.

Akathisia: Motor or subjective feelings of restlessness, often

characterized by the urge to move limbs and inability to sit still.

Akinesia: Lack of movement.

Allodynia: Pain that results from a stimulus that does not

normally cause pain.

Allogeneic: A transplant taking cells from one person and

donating them to another.

Allogeneic hematopoietic stem cell transplant (HSCT): A

procedure in which a patient receives hematopoietic stem cells

from a genetically similar donor.

Allograft: Tissue or organ transplanted from a donor of the

Allograft survival: After the transplant procedure, when the

Allorecognition: Recognition of the foreign antigens present on

Alopecia: Hair loss.

Ambulatory esophageal reflux monitoring: A telemetry capsule

Amenorrhea: The absence or discontinuation of regular

Ampulla of Vater: Dilation of the duodenal wall at the opening

same species but different genetic makeup; recipient’s immune

system must be suppressed to prevent rejection of the graft.

transplanted organ continues to have some degree of function,

from excellent to poor.

the transplanted organ or the donor’s antigen presenting cells.

containing a tiny camera is swallowed, or a transnasal catheter

is inserted to determine how often reflux is occurring as

well as the incidence of abnormal esophageal acid exposure.

The telemetry capsule provides about 48 hours of data, whereas

the transnasal catheter provides about 24 hours of data.

menstrual periods. Abnormal cessation or absence of menses.

of the fused pancreatic and common bile ducts.Amylin: A 37-amino acid polypeptide hormone that is secreted

from the β-cells of the pancreas in response to nutrients.

Mechanisms of action include slowing gastric emptying,

suppressing postmeal glucagon secretion, and suppressing

appetite.

Amyloid: Any of a group of chemically diverse proteins that are

composed of linear non-branching aggregated fibrils.

Anaerobic: Living in the absence of oxygen.

Anaphylactic/anaphylaxis: Immediate, severe, potentially fatal

hypersensitivity reaction induced by an antigen.

Anaphylactoid: An anaphylactic-like reaction, similar in signs

and symptoms but not mediated by IgE. The drug causing this

reaction produces direct release of inflammatory mediators by

a pharmacological effect.

Anastomosis: The connection of two hollow organs to restore

continuity after resection. A surgical connection made between

two blood vessels.

Androgen deprivation therapy: Agents such as LHRH agonists,

GnRH antagonist, and antiandrogens that are used to suppress

testosterone levels to that consistent with medical castration

(testosterone levels < 50 ng/mL).

Anergy: A reduction or lack of an immune response to a specific

antigen.

Aneurysm: A blood-filled bulge which forms in the wall of a

weakened blood vessel; if ruptured, may result in bleeding,

shock, and/or other negative health outcome including mortality.

Angioedema: Swelling similar to urticaria (hives), but the

swelling occurs beneath the skin instead of on the surface.

It is characterized by deep swelling around the eyes and lips

and sometimes of the hands and feet. If it proceeds rapidly,

it can lead to airway obstruction and suffocation, and should

therefore be treated as a medical emergency.

Angiogenesis: The formation of new blood vessels. Increased

blood flow to deliver nutrients is required for tumor growth.

Angiography: Examination of the blood vessels using x-rays after

injection of a radiopaque substance.

Anosmia: Loss of smell.

Anovulatory cycle: A menstrual cycle where ovaries fail to

produce, mature, or release egg.

Anterior circulation: Blood supply to the anterior section of the

brain supplied by the internal carotid arteries, anterior cerebral

artery, and middle cerebral artery.

Anterograde amnesia: Inability to create new memories or recall

the recent past.

Anticitrullinated protein antibodies: Autoantibodies directed

against cyclic citrullinated peptide, a circular peptide (a ring of

amino acids) containing the amino acid citrulline.

Anticoagulant: Any substance that inhibits, suppresses, or delays

the formation of blood clots. These substances occur naturally

and regulate the clotting cascade. Several anticoagulants have

been identified in a variety of animal tissues and have been

commercially developed for medicinal use.

Antiprotease: A substance that inhibits the enzymatic activity of

a protease.

Aortic dissection: A serious condition in which there is a tear in

the wall of the aorta.

Aortic stenosis: A condition in which the aortic valve becomes

thickened or calcified leading to a narrowing of the aortic valve

opening and restriction of blood flow from the left ventricle.

Aphakic: The absence of a lens in the eye.

Aphasia: Impairment of language affecting the ability to speak

and to understand speech.

Aphthous ulcer: A small superficial area of ulceration within the

gastrointestinal mucosa, typically found in the oral cavity.

Aplasia cutis: Congenital absence of skin, commonly affecting

the scalp.

Apoptosis: Programmed cell death as signaled by the nuclei in

normally functioning cells when age or state of cell health and

condition dictates. A genetically directed process of cell self-

destruction or programed cell death.

Arcuate scotoma: An arc-shaped area of blindness in the field

of vision.

Arteriovenous malformation: A tangle of blood vessels, usually

in the brain, that results in abnormal connections between

arteries and veins; if ruptured, may result in hemorrhage.

Arthrocentesis: Puncture and aspiration of a joint. Certain drugs

can be injected into the joint space for a local effect.

Articular: Related to the joints of the body.

Ascites: Accumulation of fluid within the peritoneal cavity.

Asterixis: Involuntary jerking movements, especially in the

hands, best demonstrated by having the patient extend their

arms in front of them, flex the hands upward, where a

subsequent “flapping” can be seen; occurs primarily with

various metabolic and toxic encephalopathic conditions, such

as hepatic encephalopathy.

Astringent: A substance that causes tissues to constrict, resulting

in a drying effect of the skin.

Atelectasis: Decreased or absent air in a partial or entire lung,

with resulting loss of lung volume.

Atherosclerosis: Accumulation of lipids, inflammatory cells, and

cellular debris in the subendothelial space of the arterial wall.

Atherosclerotic cardiovascular disease: Disease in which plaque

builds up in vessels.

Atresia: Congenital absence of a normal opening or normally

patent lumen.

Atrophic urethritis: Thinning and inflammation of the vaginal

walls secondary to decline in estrogen, experienced by almost

50% of postmenopausal women.

Attenuated: Loss of intensity or virulence.

Aura: Visual, but sometimes sensory, motor, or verbal disturbance,

usually occurring before a migraine or seizure.

Auspitz sign: Pinpoint bleeding that occurs when a psoriasis

scale or lesion is peeled off of the skin.

Autologous: A transplant using one’s own stem cells.

Autologous hematopoietic stem cell transplant (HSCT): A

procedure in which hematopoietic stem cells are removed,

stored, and then infused into the same patient.

Autoreceptor: Transmitter receptors on or near presynaptic

terminals which are sensitive to the transmitter(s) released by

the terminal itself.

Avolition: Inability to initiate and persist in goal-directed activities.

Azoospermic: Having no living spermatozoa in the semen, or

failure of spermatogenesis.

Bacteremia: Presence of bacteria in the blood.

Barium enema: A diagnostic test using an x-ray to view the lower

gastrointestinal tract (colon and rectum) after rectal administration

of barium sulfate, a chalky liquid contrast medium.

Barrett esophagus: A change of the normal squamous epithelium

of the distal esophagus to a metaplastic, columnar-lined

epithelium, usually caused by prolonged exposure of the

esophageal mucosa to gastric acid. The condition is associated

with an increased risk of developing esophageal cancer.

Basal ganglia: Cluster of nerve cells deep in the brain that

coordinate normal movementBence–Jones proteins: Light chained immunoglobulins found

in the urine.

β-Hydroxybutyric acid: A ketone body that is elevated in ketosis,

is synthesized in the liver from acetyl-CoA, and can be used as

an energy source by the brain when blood glucose is low.

β-Lactam allergy: Allergy to the β-lactam family, namely

penicillins and cephalosporins, but may also include

carbapenems.

β2 microglobulin: A low molecular weight protein that may be

elevated in multiple myeloma.

Bilateral salpingo-oophorectomy: Surgical removal of both

ovaries and fallopian tubes.

Bile acids: The organic acids in bile. Bile is the yellowish-brown

or green fluid secreted by the liver and discharged into the

duodenum where it aids in the emulsification of fats, increases

peristalsis, and retards putrefaction.

Biliary sludge: A deposit of tiny stones or crystals made up of

cholesterol, calcium bilirubinate, and other calcium salts. The

cholesterol and calcium bilirubinate crystals in biliary sludge

can lead to gallstone formation.

Biopsy: The removal of cells or tissue for examination.

Bladder hypotonicity: Low elastic tension of the bladder.

Blast: An immature cell.

Blastospores: An asexual reproductive sphore formed by

budding, often seen with yeast.

Blood urea nitrogen (BUN): A waste product in the blood

produced from the breakdown of dietary proteins. The kidneys

filter blood to remove urea and maintain homeostasis; a

decline in kidney function results in an increase in BUN.

Body mass index: A calculation utilized to correct weight

changes for height and is a direct calculation regardless of

gender. It is the result of the weight in kilograms divided by

the height in meters squared. If nonmetric measurements are

used, it is the result of the weight in pounds multiplied by

703 and then that quantity divided by the product of height

in inches squared.

Bouchard nodes: Hard, bony enlargement of the proximal

interphalangeal (middle) joint of a finger or toe.

Boutonniere deformity: Joint deformity associated with

rheumatoid arthritis that presents as flexion of the proximal

interphalangeal joints with hyperextension of the distal

interphalangeal joints.

Brachial plexus: Collection of nerves that arises from the spine

at the base of the neck from nerves that supply parts of the

shoulder, arm, forearm, and hand.

Brachytherapy: A form of radiotherapy where a sealed radiation

source is placed inside or next to the area requiring treatment.

Bradycardia: Slower than normal heart rate.

Bronchiectasis: Chronic dilation of bronchi or bronchioles as a

result of inflammatory disease or obstruction associated with

heavy sputum.

Bullectomy: Surgical removal of one or more bullae (air spaces

in the lung measuring more than one centimeter in diameter

in the distended state).

Burst suppression: Electroencephalography pattern characterized

by electrical brain activity alternating with periods of no activity.

Calcitonin: A hormone produced by the parafollicular cells of the

thyroid gland; involved in helping to regulate levels of calcium

and phosphate in the blood.

Calculi: An abnormal concretion (or stone) usually found in

hollow organs or their passages (eg, kidney stone).

Capillary leak: Loss of intravascular volume into the interstitial

space within the body.

APPENDIX C | GLOSSARY 1577

Carcinogenesis: Production or origin of cancer.

Carcinoma: A malignant growth that arises from epithelium,

found in skin or the lining of body organs. Carcinomas tend

to infiltrate into adjacent tissue and spread to distant organs.

Carcinomatosis: Condition of having widespread dissemination

of carcinoma (cancer) in the body.

Cardiac cachexia: Physical wasting with loss of weight and

muscle mass caused by cardiac disease; a wasting syndrome

that causes weakness and a loss of weight, fat, and muscle.

Cardiac index: Cardiac output normalized for body surface area

(cardiac index = cardiac output/body surface area).

Cardiac output: The volume of blood ejected from the left side of

the heart per unit of time:

Cardiac output (L/min) = Stroke volume (L) × heart rate (1/min)

Cardiac remodeling: Genome expression resulting in molecular,

cellular and interstitial changes and manifested clinically as

changes in size, shape, and function of the heart resulting from

cardiac load or injury.

Cardiomyopathy: Diseases of the heart muscle in which the

heart muscle becomes enlarged, thick, or rigid.

Carotid bruit: Abnormal sound heard when auscultating a

carotid artery caused by turbulent blood flow, usually due to

the presence of atherosclerotic plaques.

Carotids: The two main arteries in the neck.

Castration resistant prostate cancer: Prostate cancer that

continues to progress despite suppression of typical hormonal

growth signals (ie, despite androgen deprivation that achieves

castration levels of testosterone).

Cataplexy: A sudden loss of muscle control with retention of clear

consciousness that follows a strong emotional stimulus (eg, elation,

surprise, or anger) and is a characteristic symptom of narcolepsy.

Catheterization: Insertion of a tubular medical device into canals,

vessels, passageways, or body cavities to permit injection or

withdrawal of fluids or to keep a passage open.

Causalgia: Persistent burning pain, allodynia, and hyperpathia

following a traumatic nerve lesion.

Cavitary lesions: Gas or fluid filled areas of the lung in the center

of a nodule observed through radiographic investigation.

CD4 and CD8: Protein markers predominantly found on the

surface of T cells.

Cell-mediated immunity: An immune response that involves

activation of phagocytes, antigen-specific cytotoxic T-lymphocytes,

and the release of various cytokines in response to an antigen.

Can be independent of antibody action.

Central pain: Pain that results from a lesion or dysfunction in the

central nervous system.

Cervicitis: Inflammation of the cervix.

Chemokines: Any of a group of cytokines produced by various

cells that stimulate chemotaxis in white blood cells.

Chemoprevention: Clinical application of pharmacologic agents

to reduce the risk of developing certain malignancies. Use of

drugs, vitamins, or other agents to reduce the risk of or delay

the development or recurrence of cancer.

Chemoreceptor trigger zone: Located in the area postrema of

the fourth ventricle of the brain. It is exposed to cerebrospinal

fluid and blood and is easily stimulated by circulating toxins to

induce nausea and vomiting.

Chemosis: Edema of the bulbar conjunctiva.

Cheyne–Stokes respiration: Pattern of breathing with gradual

increase in depth (and sometimes in rate) to a maximum,

followed by a decrease resulting in apnea; the cycles ordinarily

are 30 seconds to 2 minutes in duration, with 5 to 30 seconds

of apnea.1578 APPENDICES

Chimeric: An individual, organ, or substance composed of

substances with different genetic origins.

Chloasma: Melasma characterized by irregularly shaped brown

patches on the face and other areas of the skin, often seen during

pregnancy or associated with the use of oral contraceptives.

Chlorpromazine equivalents: Approximate dose equivalent of

a first-generation antipsychotic to 100 mg of chlorpromazine

(relative potency).

Cholecystitis: Inflammation of the gallbladder.

Cholelithiasis: Formation of stones in the gallbladder (gallstones).

Cholestasis: Reduced or lack of flow of bile, or obstruction of

bile flow.

Cholesteatoma: A mass of keratinized epithelial cells and

cholesterol resembling a tumor that forms in the middle ear

or mastoid region.

Chorea: A type of dyskinesia with rhythmic dance-like movement.

Chronotropic: An effect that influences the rate of rhythmic

movements (eg, heart rate).

Chvostek sign: Elicited by tapping on the proximal distribution

of the facial nerve (adjacent to the ear). This will produce a

brief spasm of the upper lip, eye, nose, or face in hypocalcemic

patients.

Chylothorax: The presence of lymphatic fluid (chyle) in the

pleural cavity.

Circadian rhythm: 24-hour cycles of behavior and physiology that

are generated by endogenous biological clocks (pacemakers).

Cirrhosis: Hepatic fibrosis and regenerative nodules that have

destroyed the architecture of the liver, scarring the liver tissues.

Progressive scarring of the liver resulting in non-functional

hepatocytes.

Clonal expansion: An immunologic response in which

lymphocytes stimulated by antigen proliferate and amplify the

population of relevant cells.

Closed comedo: A plugged hair follicle of sebum, keratinocytes,

and bacteria that remains beneath the surface of the skin. Also

referred to as a “whitehead.”

Clotting cascade: A series of enzymatic reactions by clotting

factors leading to the formation of a blood clot. The clotting

cascade is initiated by several thrombogenic substances. Each

reaction in the cascade is triggered by the preceding one and

the effect is amplified by positive feedback loops.

Clotting factor: Plasma proteins found in the blood that are

essential to the formation of blood clots. Clotting factors

circulate in inactive forms but are activated by their predecessor

in the clotting cascade or a thrombogenic substance. Each

clotting factor is designated by a Roman numeral (eg, factor

VII) and by the letter “a” when activated (eg, factor VIIa).

Clubbing: Proliferation of soft tissues, especially in the nail bed,

which results in thickening and widening of finger and toe

extremities.

Coalescence: Fusion of smaller lipid emulsion particles forming

larger particles, resulting in destabilization of the emulsion.

Cocoon immunization: Vaccine strategy to protect an infant

from disease by vaccinating those with expected close contact.

Cognitive deficit: An impairment in the mental process that

affects the way a person interacts with their environment.

Collateral damage: Bacterial resistance to an antimicrobial that

occurs when the antimicrobial is being used to treat a separate

bacterial infection.

Colonocyte: Cell lining the colonic surface.

Colonoscopy: Visual examination of the colon using a lighted,

lens-equipped, flexible tube (colonoscope) inserted into the

rectum.

Colony-forming units: The number of microorganisms that

form colonies when cultured and is indicative of the number

of viable microorganisms in a sample.

Comedolytic: An agent that is able to break up or destroy a comedo.

Comorbidities: Multiple disease states occurring concurrently

in one patient.

Complete response: In cancer, disappearance of all targeted lesions.

Complex regimen: Taking medications 3 or more times per day,

or 12 or more doses per day.

Computed tomography: Radiography in which a three-dimensional

image of a body structure is constructed by computer from a

series of plane cross-sectional images made along an axis.

Concreteness: Inability to think in abstract terms. It may be a

primary developmental defect or secondary to organic mental

disorder or schizophrenia.

Congenital adrenal hyperplasia: A rare inherited condition

resulting from a deficiency in cortisol and aldosterone

synthesis with resulting excess androgen production. The

clinical presentation depends on the variant of the condition

but typically manifests as abnormalities in sexual development

and/or adrenal insufficiency.

Conidia: Non-motile spores produced by fungi.

Conjunctival injection: Erythema of the conjunctiva.

Conjunctivitis: Inflammation of the conjunctiva.

Conjunctivitis medicamentosa: A drug-induced form of

allergic conjunctivitis resulting from overuse of topical ocular

vasoconstrictors.

Consolidation: Treatment that is given after cancer has disappeared

following the initial therapy. Consolidation therapy is used to

kill any cancer cells that may be left in the body.

Contiguous: Spread of infection via direct invasion of adjacent

structures.

Continuous positive airway pressure (CPAP): A technique of

assisting breathing by maintaining the air pressure in the lungs

and air passages constant and above atmospheric pressure

throughout the breathing cycle.

Cor pulmonale: Right-sided heart failure caused by lung disease.

Corneal arcus: Accumulation of lipid on the cornea.

Coronary artery bypass graft surgery: Surgical intervention

to improve coronary blood flow by removing a vein from

the leg and attaching one end to the aorta and the other end

to the coronary artery distal to the atherosclerotic plaque.

Alternatively, an artery from the inside of the chest wall may

be used to bypass the coronary occlusion.

Cosyntropin: A synthetic version of adrenocorticotropic

hormone.

Counterirritant: A substance that elicits a superficial inflammatory

response with the objective of reducing inflammation in

deeper, adjacent structures.

C-peptide: A peptide which is made when proinsulin is split into

insulin and C-peptide. They split before proinsulin is released

from endocytic vesicles within the pancreas, one C-peptide

for each insulin molecule. C-peptide is the abbreviation for

“connecting peptide.” It is used to determine if a patient has

type 1 or type 2 diabetes mellitus.

Creaming: Aggregation of lipid emulsion particles that then

migrate to the surface of the emulsion can be reversed with

mild agitation.

Creatinine: A waste product in the blood produced from the

breakdown of protein by-products generated by muscle in the

body or ingested in the diet. The kidneys filter blood to remove

creatinine and maintain homeostasis; a decline in kidney

function results in an increase in creatinine.Crepitus: A grating sound or sensation typically produced by

friction between bone-on-cartilage or bone-on-bone contact.

It is also a crackling chest sound that is heard in pneumonia.

Cross-allergenicity: Sensitivity to one drug with activity to a

different drug with a similar chemical structure.

Crypt abscess: Neutrophilic infiltration of the intestinal glands

(crypts of Lieberkühn); a characteristic finding in patients with

ulcerative colitis.

Cutis laxa: Hypereflacidity of the skin with loss of elasticity.

Cyanosis: A dark blue or purple discoloration of the skin and

mucous membranes due to deficient oxygenation of the blood.

Cyclooxygenase: An enzyme that catalyzes the conversion

of arachidonic acid to prostaglandins and consists of two

isoforms, generally abbreviated COX-1 and COX-2.

Cystitis: Inflammation of urinary bladder.

Cystocele: Herniation of the urinary bladder into the vagina.

Herniation is abnormal protrusion of an organ through a

defect or natural opening.

Cytokines: Regulatory proteins, such as interleukins and

lymphokines, are released by cells of the immune system and act as

intercellular mediators in the generation of an immune response.

Soluble glycoproteins released by the immune system which act

through specific receptors to regulate immune responses.

Cytomegalovirus (CMV) disease: This is the term used when

patients who are already infected with CMV present with the

classically associated symptoms that resemble a viral infection

and may include fever, malaise, arthralgias, and others.

Cytomegalovirus (CMV) infection: This is the term used when

a patient has anti-CMV antibodies in the blood, when CMV

antigens are detected in infected cells, or when the virus is

isolated from a culture.