Lippincott Williams & Wilkins’

3rd Edition
 3rd Edition

Helen J. Houser, RN, MSHA, BS, RMA (AMT)

Faculty Medical Assisting
Phoenix College
Phoenix, Arizona

Janet R. Sesser, MS, BS, RMA (AMT), CMA (AAMA)

Director of Academic Operations
Anthem Education Group, Inc
Phoenix, Arizona
Acquisitions Editor: Kelley Squazzo
Product Manager: Paula C. Williams
Marketing Manager: Shauna Kelley
Designer: Teresa Mallon
Compositor: Aptara, Inc.

Copyright © 2012 Lippincott Williams & Wilkins, a Wolters Kluwer business

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please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA
19103, via email at [email protected], or via website at lww.com (products and services).

9 8 7 6 5 4 3 2 1

Library of Congress Cataloging-in-Publication Data

Houser, Helen J., author.

Lippincott Williams & Wilkins’ medical assisting exam review for CMA,
RMA & CMAS certification / Helen J. Houser, Janet R. Sesser. – Third edition.
p. ; cm.
Lippincott Williams and Wilkins’ medical assisting exam review for
CMA, RMA, and CMAS certification
Medical assisting exam review for CMA, RMA & CMAS certification
Includes bibliographical references and index.
ISBN 978-1-60913-368-9 (pbk. : alkaline paper)
1. Medical assistants–Examinations, questions, etc. 2. Physicians’
assistants–Examinations, questions, etc. 3. Medical
assistants–Licenses–United States–Examinations–Study guides.
4. Physicians’ assistants–Licenses–United States–Examinations–Study
guides. I. Sesser, Janet R., author. II. Title. III. Title: Lippincott
Williams and Wilkins’ medical assisting exam review for CMA, RMA, and
CMAS certification. IV. Title: Medical assisting exam review for CMA,
RMA & CMAS certification.
[DNLM: 1. Physician Assistants–Examination Questions. 2. Clinical
Medicine–Examination Questions. 3. Practice Management,
Medical–Examination Questions. W 18.2]
R728.8.H68 2012
610.737076–dc22
2010045361
DISCLAIMER
Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices.
However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from
application of the information in this book and make no warranty, expressed or implied, with respect to the currency,
completeness, or accuracy of the contents of the publication. Application of this information in a particular situation
remains the professional responsibility of the practitioner; the clinical treatments described and recommended may
not be considered absolute and universal recommendations.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in
this text are in accordance with the current recommendations and practice at the time of publication. However, in
view of ongoing research, changes in government regulations, and the constant flow of information relating to drug
therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications
and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a
new or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clear-
ance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the
FDA status of each drug or device planned for use in their clinical practice.
To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to
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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.
To the hardworking medical assistants and administrative medical
specialists in the health care community, and to students and their
instructors who recognize certification as a pursuit of excellence and
professionalism.
 ) * 7 = <  < 0 -  ) = < 0 7 : ;

Helen J. Houser is a registered medical assistant and Janet R. Sesser, a Registered Medical Assistant and
a registered nurse and holds a master of science in health Certified Medical Assistant holds a Master of Science in
care administration. For the past ten years she served as Health Education and Bachelor of Science in Health
the Director of the Medical Assisting Program at Care Management. She is currently the Director of
Phoenix College. Her experience in health care spans Academic Operations, Anthem Education Group, Inc,
over 30 years with various positions involving medical Phoenix, Arizona. Her background includes many years
assisting, including Vice President of Phoenix General working as a practicing medical assistant for various
Hospital, Deer Valley, where she opened and adminis- types of practices and as a cardiopulmonary technician.
tered medical practices in rural areas. She is a national For the past 25 years, she has worked in postsecondary
speaker on such topics as “Immunization Education for education teaching and writing allied health curricula.
Medical Assisting Students” and the recipient of several Sesser is very involved with American Medical Tech-
awards, including the National Institute of Staff and nologists, serving as a member on the AMT Board of
Organizational Development Excellence Award and two Directors. She is a recipient of the Medallion of Merit
Arizona Governor’s Awards for Excellence. Houser lived Award, the highest honor bestowed by AMT to a
on a Navajo reservation for four years and has extensive medical assistant, and a frequent presenter at national
experience working with diverse populations. medical conferences.

^Q
 8 : - .) + -

LWW’s Medical Assisting Exam Review for CMA, RMA, ■ Important review terms with definitions included in
and CMAS Certifications provides a capstone review for each chapter
recent graduates from medical assisting and medical ■ Review and study tips pertinent to each chapter
administrative specialist programs, and working medical ■ Test preparation tips for students for whom English is
assistants and medical administrative specialists who are their second language
preparing to take a national certification exam. Medical ■ Important information for study groups
assisting faculty find the text an invaluable tool to both ■ Explanation of the major national exams
validate learning and integrate topics. The decision to ■ Exam-taking strategies and exam-day preparation
write it grew out of our frustrated attempts to find a ■ Six timed simulated exams: one for each of the three
review book that provided a simple yet effective approach national exams appear in the back of the book, and
to preparing for the national medical assisting and med- one for each of the three national exams is on the
ical administrative specialist exams. Student Resources CD-ROM in the back of the
Yet LWW’s Medical Assisting Exam Review for CMA, book.
RMA, and CMAS Certification is more than a review: You
The following are reviewer comments that attest to the
can use the first three chapters to develop a unique study
effectiveness and practicality of the book’s approach:
plan that is tailored to your individual strengths and
weaknesses. Next, you can implement the plan, study ■ “I think that this is one of the best review texts that I
the material included in the rest of the book, and finally have ever seen - very inclusive.”
test your knowledge and retention with the simulated ■ “This text is excellent and will be recommended to
exams. our students to study for the certification exam.”
The book’s user-friendly design follows a simple out- ■ “The short chapter reviews are very well done and
line format to make the information easy to digest, and effectively organized.”
we have sequenced topics so they build on each other. ■ “The students need a little levity once in a while. The
For example, medical terminology is one of the early cartoons are good. Made me smile.”
chapters because it is necessary to understand anatomy, ■ “Excellent.”
physiology, and additional content areas in subsequent ■ “ Invaluable.”
chapters. ■ “I use a different book in my review class at this time,
Other unique features of LWW’s Medical Assisting but after seeing your text, I will switch.”
Exam Review for CMA, RMA, and CMAS Certification
Our goal is to help you succeed by providing you with
include:
the tools and information you need to ace the national
■ Material that is succinct, focused, pertinent and truly medical assisting exams—and to retain that information
up to date incorporating the national exams’ topics. to ensure a successful career. We have incorporated our
■ New and expanded information on emergency and expertise, creativity, interest in student success, and even
disaster preparedness, the increasing role of the prac- a little humor into this book, and believe we will achieve
tice manager, facility management, the Electronic our goal while helping you achieve yours.
Health Record and more.
■ A pretest with an analysis to help you determine your Helen J. Houser, RN, MSHA, BS, RMA
strong and weak study areas Janet R. Sesser, MS, BS, RMA, CMA
■ A method for creating your own study plan and a cal-
endar to help you track it
■ A design that incorporates Bloom’s Taxonomy for teach-
),,1<176)4:-;7=:+-;
ing with questions answers and rationale on the same
page to avoid flipping back and forth; also, a sturdy Lippincott Williams & Wilkins’ Medical Assisting Exam
bookmark to cover answers Review for CMA, RMA, and CMAS Certification includes
■ 2,000 questions; research shows that probably the best additional resources for instructors that are available on
way to prepare for a specific exam is to practice the book’s companion website at http://thePoint.lww.
answering lots of questions with the content worded com/Houser3e and resources for students that are avail-
differently. able on the CD-ROM packaged with the book and on
■ Practice exams specific to the CMA (AAMA), RMA the book’s companion website at http://thePoint.lww.com/
(AMT) and CMAS (AMT). Houser3e.

^QQ
viii 8ZMNIKM

INSTRUCTOR RESOURCES ■ Electronic flashcards with audio pronunciation

■ Audio Glossary
Approved adopting instructors will be given access to the
following additional resource: In addition, purchasers of the text can access the search-
■ WebCT/Blackboard access
able Full Text On-line by going to the Lippincott Williams
& Wilkins’ Medical Assisting Exam Review for CMA, RMA,
and CMAS Certification website at http://thePoint.lww.
STUDENT RESOURCES com/Houser3e. See the inside front cover of this text for
more details, including the passcode you will need to
■ Interactive Exam Simulator on CD-ROM and online gain access to the website.
with over 2,000 questions simulating the CMA, RMA,
and CMAS national exams
 ) + 3 6 7 ? 4 - , / 5 - 6 < ;

We would like to thank Pamela Rogers, Phoenix College manager and the electronic health record and ellise hay-
2003 Distinguished Teacher of the Year, for providing den, Chief Operating Officer of Adelante Healthcare,
insight and for advising us on the challenges of students Inc., for her emergency preparedness knowledge.
with limited English proficiency. We would also like to We are extremely grateful for the efforts of the excep-
thank Daniel Celaya, Practice Manager Gregory Celaya tional, dedicated reviewers whose thoughts positively
MD, PC, for sharing his expertise in the role of the practice influenced the content of the book.

Q`
 : - > 1 - ? - : ;

Gerry A. Brasin, AS, CMA (AAMA), CPC Anne Gailey, CMA (AAMA)
Coordinator Instructor
Corporate Education Medical Assisting
Premier Education Group Ogeechee Technical College
Springfield, MA Statesboro, GA

Christine Cusano, CMA (AAMA), CPhT, CHI Kari Williams, BS, DC

Senior Regional Director of Education Director
Lincoln Technical Institute Medical Office Technology
Brockton, MA Front Range Community College
Longmont, CO
Donna Domanke-Nuytten
Professor
Health Science Technology
Macomb Community College
Clinton Township, MI

`Q
 + 7 6 < - 6 < ;

About the Authors vi

Preface vii

Acknowledgments ix

Reviewers xi

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Unit 5 -`IU8ZMXIZI\QWV !
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Practice Exam 393

Answers to the Practice Exam 402
Answer Sheet 419
Index 421
 Unit 1
The Starting Point


 The Certification Process
1

You opened this book, so you are probably preparing to tant vary among states, but they all recognize medical
take one of the national medical assisting exams or the assistants who have passed one of the two major
medical administrative specialist exam. Good idea! If you national exams, the American Association of Medical
are a recent graduate of a program, the best time to take Assistants (AAMA) and the American Medical Tech-
the exam is now, while the knowledge is fresh in your nologists (AMT) exams.
mind and your information is up to date. If you are a ■ Expanding administrative responsibilities now warrant
practicing medical assistant, the best time is still now, specialization and validation of knowledge through a
and here’s why: certification process such as the AMT Certified
■ Holding a recognized national certification demon- Medical Administrative Specialist (CMAS).
strates to employers, potential employers (especially if ■ Increasing numbers of medical offices are affiliated
you are moving to another state or changing jobs), with health care organizations accredited by The Joint
patients, and others that you have a standardized body Commission (TJC) (formerly the Joint Commission
of knowledge. This is an important credential that is on Accreditation of Healthcare Organizations
recognized and respected by the public. [JCAHO]), the National Committee on Quality
■ Medical assisting was traditionally guided by local Assurance (NCQA), or other agencies. Staff creden-
informal standards. An increasing number of states tials are always inspected, and national certifications
now regulate the medical assistant role and credentials are looked on favorably.
through legislation. The different training options and ■ Health care is ever-changing. Preparing for a national
criteria required to be considered a valid medical assis- exam is a method to keep up with practice, to review the


4 =VQ\ ■ The Starting Point

latest standards, and to demonstrate your knowledge of g or calling or

by emailing certifi[email protected]
entry-level competencies. writing to:

AAMA Certification Department

6)<176)45-,1+)4);;1;<16/ 20 North Wacker Drive, #1575
-@)5; Chicago, IL 60606
1-800-228-2262
The two major organizations offering nationally rec-
ognized medical assisting examinations are the Ameri- The CMA (AAMA) exam contains 200 multiple choice
can Association of Medical Assistants (AAMA) and the questions with five answer options. Twenty of the ques-
American Medical Technologists (AMT), both of tions are for trial only and do not count toward your
which are respected associations. The question content score. It is not indicated which questions are the trial
of both exams is similar, and both use a multiple choice questions. The questions are in no particular order.
format. The medical assisting certifications issued by Refer to the tables at the end of this chapter for the con-
the AAMA or AMT are equally accepted by employers. tent outline and corresponding study chapters. Exam
The eligibility criteria for each exam differ. Your review questions for Anatomy & Physiology and Medical
choice of which exam to take may be contingent on Terminology are available on the AAMA website.
these criteria.

THE RMA (AMT)

THE CMA (AAMA)
The certification received after passing the AMT Med-
The certification received after passing the AAMA exam ical Assisting exam is called Registered Medical Assistant
is called Certified Medical Assistant (CMA [AAMA]). (RMA, AMT). Those eligible to take the RMA exam are:
Those eligible to take the CMA (AAMA) exam are:

.QO]ZM Insignia of the American Medical Technologists (AMT).

.QO]ZM Insignia of the American Association of Medical Assistants (AAMA).

■ Graduates of (or students scheduled to graduate from)

■ Graduating students or recent graduates of a medical a medical assistant program that holds programmatic
assisting program accredited by the Commission on accreditation by the ABHES or CAAHEP or students
Accreditation of Allied Health Education Programs in a postsecondary school or college that holds institu-
(CAAHEP) or the Accrediting Bureau of Health Edu- tional accreditation by the ABHES or CAAHEP
cation Programs (ABHES) ■ Graduates of (or students scheduled to graduate from)
■ Nonrecent graduates (more than 12 months after grad- a medical assisting program in a postsecondary school
uation) of a CAAHEP or ABHES accredited medical or college that has institutional accreditation by a
assisting program [beginning January 1, 2010, candi- regional accrediting commission or a national accred-
dates will have 60 months from the date of graduation iting organization approved by the U.S. Department
to pass the exam; if a candidate does not pass within this of Education; the program must include a minimum of
time frame, the candidate will not be eligible for the 720 clock-hours (or equivalent) of training in medical
CMA (AAMA) credential] assisting (including a clinical externship)
■ CMAs (AAMA) recertifying their credential by way of ■ Graduates of (or students scheduled to graduate from)
examination a formal medical services training program of the U.S.
Armed Forces
Beginning April 1, 2009, the examination became com- ■ Medical assistants employed in the profession for a
puterized and is available throughout the year at testing minimum of 5 years, no more than 2 years of which
sites. Information on the application, testing locations, may have been as an instructor in the postsecondary
dates, and fees can be found at www.aama-ntl.or
w g or medical assistant program
 +PIX\MZ ■ The Certification Process 5

The exam is offered throughout the year at testing ■ Medical office administrative specialists employed in
sites in two testing formats—a test booklet with answers the profession for a minimum of 5 years
written in pencil on a “bubble” answer sheet or a com-
puter test. Information on the application, testing loca- The exam is offered throughout the year at testing
tions, dates, and fees can be found at www.amt1.com
w or sites in two testing formats—a test booklet with answers
by emailing [email protected] or calling or writing to: written in pencil on a “bubble” answer sheet or a com-
puter test. Information on the application, testing loca-
AMT tions, dates, and fees can be found at www.amt1.com
w or
10700 W. Higgins Road, Suite 150 by emailingg [email protected] or calling or writing to:
Rosemont, IL 60018
1-847-823-5169 AMT
10700 W. Higgins Road, Suite 150
The RMA exam consists of 200 to 210 multiple Rosemont, IL 60018
choice questions with four answer options. If there 1-847-823-5169
are 210 questions, 10 will be trial questions and, as with
the AAMA, they do not count toward your score. You The CMAS exam consists of 200 to 210 multiple
have 2 hours to take the exam. The questions are in no choice questions with four answer options. If there are
particular order. Refer to the tables at the end of this 210 questions, 10 will be trial questions, and as with the
chapter for the content areas and corresponding study CMA (AAMA) and RMA, they do not count toward your
chapters. Exam review questions are located on the score. You have 2 hours to complete the exam. The ques-
AMT website, and for a nominal fee, you may send for tions are in no particular order. Refer to the tables at the
a practice exam. end of this chapter for the content areas and correspon-
ding study chapters. Exam review questions are located
on the AMT website.
NATIONAL MEDICAL ADMINISTRATIVE
A
SPECIALIST EXAM
5)16<)1616/+-:<1.1+)<176
At the time of this writing, the AMT is the only nationally
Once you have received your certification, in order to
recognized organization offering the Medical Administra-
maintain it, you must earn a specific number of continu-
tive Specialist examination. The credential received upon
ing education units (CEUs) each year or in a designated
successful completion is the Certified Medical Adminis-
number of years. The purpose is to stay current in your
trative Specialist (CMAS). Those eligible to take the
field by keeping up to date with changing or new stan-
CMAS exam are:
dards and practices. Generally, one CEU is equivalent to
1 clock-hour. CEUs may be earned in various ways. The
■ Graduating students or graduates of a medical office most common are:
administrative program that holds programmatic
accreditation or is part of a postsecondary school or ■ Attending seminars and conferences approved for
college that holds institutional accreditation by the CEUs by your certifying organization
ABHES ■ Completing online modules of appropriate topics
■ Graduating students or graduates of a medical office approved for CEUs by your certifying organization
administrative program in a postsecondary school or ■ Reading material in journals approved for CEUs by
college that holds institutional accreditation by a your certifying organization and answering related
regional accrediting commission or a national accredit- questions
ing organization approved by the U.S. Department of
■ Listening to audio modules approved for CEUs by
Education; the program must include a minimum of
your certifying organization and completing required
720 clock-hours (or equivalent) of training in medical
exercises or answering related questions
office administration skills (including a practical extern-
ship). The training must include at least: Not only is staying up to date important to maintain
• Medical records management your certification, but you are also responsible for staying
• Health care insurance processing, billing, and current in your field as a legal obligation. You will be held
coding accountable for the standards in place at any given time.
• Office financial responsibilities
• Information processing ;<:)<-/A),>1+-
■ RMAs or equivalent who possess a minimum of 2 years A graduate, who recently took the certification examina-
working as a medical office administrative specialists tion, gives this advice: “Study this book, study the
6 =VQ\ ■ The Starting Point

practice exam at the end, and then study this book ■ Have friends and family test you using your flashcards.
again.” If both the computerized and “bubble” answer ■ Develop rhymes to assist memory (such as, for diabetic
sheet formats are available for the exam you are eligible coma, “hot and dry, sugar high”).
to take, you should decide which option works best for
■ Use alphabetical connections, for example, arteries
you. The simulated computerized exam on the CD-
(begins with an “a”) carry blood away (also begins with
ROM and the simulated written exam with an answer
an “a”).
sheet are located in the back of the book.
■ Incorporate as much repetition as you can.
■ Read the review tip boxes at the beginning of each
STUDYING chapter.
■ Take lots of practice tests, using the tests in this book
This book is designed for simple, efficient study. The
and the practice questions from the AAMA and AMT.
combination of narrative and an outline structure keeps
the information succinct, emphasizes what is most ■ Contact local programs—some offer national exam
likely to be on the exams, and decreases reading time. reviews.
Material is presented in three areas: the body of the ■ Cram only if you are confident of your overall knowl-
text, the review terms, and the questions with associ- edge and need only cursory last-minute review.
ated rationale. This method reinforces previous infor- ■ Consider joining a study group as additional prepara-
mation and provides additional information. Be sure to tion, but not as your only preparation.
study all content areas that are applicable to your exam.
Refer to the tables at the end of this chapter. The mate-
rial may be phrased differently throughout the text to
MULTIPLE CHOICE EXAMS
ensure understanding because it is unlikely that the
wording will appear exactly as it does on the actual The national exams consist of multiple choice questions.
exam. Some questions require critical thinking, but the The AMT exam has four answer choices for each ques-
necessary knowledge to formulate the correct answer is tion; the AAMA exam has five answer choices. The ques-
contained in the book. Use study techniques that have tions have various levels of difficulty. Do not think you
been successful for you in the past, and incorporate will be able to recognize the correct answer without
new strategies, as appropriate. Suggestions include the studying if you do not know the topic. The questions
following: purposefully contain what are called decoys. These are
words that look similar to the correct answer and can
■ Inform your family, friends, employer, and fellow easily confuse you. Studying and preparedness are the
employees that you are preparing for the exam. Ask them only way to pass any exam. Use these strategies for solv-
to support you, and include them in the review process. ing multiple choice questions:
Ask your family to allow you uninterrupted study time;
determine when that time will be and stick to it. ■ Read the question and answer it in your head, and then
■ Read each chapter, and underline or highlight infor- look for the answer you think is correct in the choices,
mation that needs reinforcement. Reread those areas but do not mark it yet.
at different times until you believe you know them. ■ Read the whole question with each of the choices.
Write down information you cannot remember; writ- Some questions have more than one correct answer,
ing helps memorization. but one answer is more correct than the others. Do not
■ Write difficult information in your own words to mark your answer before considering all of the alterna-
assure understanding; ask your employer, a teacher, or tives. That last choice may be better than the first. A
a peer if you need assistance. word that is similar but not correct may appear first
and act as a decoy.
■ Read the important review terms at the end of each
chapter. ■ Watch your time. Do not spend more than 45 seconds
on one question. Come back to it after completing the
■ Develop flashcards by writing the review term on the
questions you know.
front of an index card and the definition on the back.
Again, writing enhances the memorization process. ■ Eliminate choices you know are wrong. The more
choices you eliminate, the better your chance of select-
■ Look for learning moments. These are times outside of
ing the correct one.
your planned study regimen when you can sneak in
some studying, such as during breaks; at lunch; while ■ Watch for “all of the above” answers. If you eliminate
riding as a passenger in a car or bus, using exercise one answer, “all of the above” cannot be correct.
equipment, or walking the dog; or even during televi- ■ Watch for “none of the above.” If one answer is cor-
sion commercials. Be creative! rect, “none of the above” is not the answer.
 +PIX\MZ ■ The Certification Process 7

■ Use caution with questions that contain the word ■ If a question on the exam does not seem to make sense
“except.” The answer you are looking for is the opposite to you, look closely at the verb. It may have another
of the question. If the question says, “You would use meaning different from the one you thought. An exam-
sterile technique in all of the following situations, ple is the word “pose,” commonly meaning to assume a
except,” look for the opposite of when “you would use posture for a picture or artistic purposes (for example,
sterile technique,” such as when taking a blood pressure. “She posed for the picture”). Another meaning, more
Read “except” questions extra carefully and be sure of common in tests, is to present an idea for considera-
what they are asking. tion, such as, “The doctor posed that the patient may
■ Watch for words such as “always,” “never,” “all,” and not be taking his medication according to instructions.”
“none.” If you can think of one exception to a choice, Consider other verb meanings before answering.
then that answer is not correct. ■ Select only one answer—the best answer—for multiple
■ Handle decoys. Some questions lead you to think choice questions. In some countries, you may select
another answer is correct when you are relatively sure several correct answers. In the United States, if you
it is not. Read the whole question with each alternative select more than one answer, it is marked incorrect.
separately. Think about what each question with each ■ Be sure you are familiar with the testing modality you
answer means. Frequently, this helps confirm your select (computer or “bubble” answer sheet).
original answer choice.

What about guessing? The scoring on some multiple

STUDY GROUPS
choice examinations penalizes test takers for guessing by
subtracting additional points for incorrect answers but Study groups generally consist of three to six people
not for blank answers. Neither the AAMA nor the AMT meeting to study or to prepare for a course, test or exam,
subtracts additional points for incorrect answers as or project. A group may be more informal, such as a
opposed to blank answers, so use the strategies outlined group of friends getting together to study on a Saturday
previously, and if you are still not certain, give it your afternoon, or more formal, such as staff members who
best guess. The most effective strategy for multiple work in the same medical complex and who have agreed
choice tests is practice, practice, practice! Practice by try- to meet at designated times and places using an agreed-
ing ALL of the questions in this book. on structure. Study groups have advantages (pros) and
disadvantages (cons).

ENGLISH LANGUAGE LEARNERS

Pros
ELL refers to English Language Learners. If English is
not your primary language, the following are additional ■ Study times and places are designated; people are more
suggestions to assist you in preparing for a national certi- motivated to be prepared if others are relying on them.
fication exam. ■ The work, such as researching or organizing a topic, is
shared.
■ Do not rush into taking the exam; be prepared. ■ One person’s weak area may be another’s strength,
■ Read and follow the previous strategies. which sometimes makes studying easier.
■ Buy or borrow the textbook Test of English as a Foreign ■ You can discuss issues related to the exam, relieve
Language (TOEFL). It offers an effective method to stress, and gain a fresh perspective.
evaluate your English. If you have difficulty with this
text, consider first taking an English or ELL course at
Cons
a community college or other school. Taking a course
may also increase your employment opportunities. ■ Participants must agree on study times and places,
■ English tests called Combined English Language which is sometimes challenging.
Skills Assessments (CELSA) are available at commu- ■ All members may not participate equally, resulting in
nity colleges for non-English speakers to determine more work for some.
their level of English. A national exam will be difficult ■ Everyone does not study at the same pace, leaving
to pass if you score below the high school equivalent some behind and others frustrated with the slowness.
on the CELSA.
■ Conversation and other distracters may interfere with
■ Obtain an ELL medical terminology book and study.
review it.
■ Study with a native English speaker who is motivated Should you organize or join a study group to prepare
and organized (see the next section on study groups). for a national exam? This is a personal decision. If you
8 =VQ\ ■ The Starting Point

are a recent graduate and have a good study group from ■ Organize an overall study plan with topics, assign-
school, stick with it. If you study best alone, perhaps a ments, and a leader for each session. Do this at the first
group is not for you. If several colleagues that you know session. It is sometimes difficult but worth the time.
or work with are planning to take the exam, a study There are many options for putting together a plan.
group could benefit all. The following are tips for work- One method is to plan an overall review of each topic
ing with study groups. or to concentrate on specific topics that most members
of the group find difficult. Anatomy and Physiology is
the most challenging area. The group may decide to
Study Group Advice
concentrate on this and study other topics individually.
■ Know the members and look at their performance in ■ Deal with disrupting or distracting members right
school or at work to determine whether they are com- away; sometimes humor works, for example, “Okay,
mitted and motivated before inviting them to join the time out for you until you stop gossiping and get down
group. to work.”
■ Select a site and time conducive to study—for exam- ■ Leave a study group if it is not working for you; simply
ple, not the home of a friend who has active, small say, “This is not working for me.”
children.
■ Remember, the study group is only one tool; use the
■ Allow only full-time members—coming to only some learning moments, flashcards, and other strategies pre-
sessions should not be permitted because a part-time viously mentioned. After you develop your study plan
member requires time to catch up. An exception would as described in Chapter 3, you will probably need
be if a person only wants to participate for one or two more hours than the group provides, especially to
subjects and the dates and times for those subjects are cover difficult topics.
pre-established.

+76<-6<7=<416-;.7:6)<176)4-@)5;)6,+7::-;876,16/+0)8<-:;

+MZ\QNQML5MLQKIT)[[Q[\IV\x+5)))5)
Work Area Chapter Locations Work Area Chapter Locations
I. General N. (At the time of this writing, Nonapplicable
there are no items for this
A. Medical Terminology Chapters 5, 6, 18, 25
category.)
B. Anatomy & Physiology Chapters 6, 18
O. Maintaining the Office Chapters 4, 16, 26
C. Psychology Chapter 7
P. Office Policies & Procedures Chapter 16
D. Professionalism Chapters 4, 7, 8, 9
Q. Practice Finances Chapter 15
E. Communication Chapters 7, 10, 12
III. Clinical
F. Medicolegal Guidelines & Chapters 4, 11, 13,
R. Principles of Infection Chapters 17, 18,19, 21
Requirements 14, 15
Control
II. Administrative
S. Treatment Area Chapters
G. Data Entry Chapters 9, 13, 14, 15
T. Patient Preparation & Chapters 18, 19
H. Equipment Chapter 9, 16 Assisting the Physician

I. Computer Concepts Chapter 9 U. Patient History Interview Chapters 18

J. Records Management Chapter 11 V. Collecting & Processing Chapter 18, 19, 20,
Specimens; Diagnostic 21, 22
K. Screening & Processing Chapter 12 Testing
Mail
W. Preparing & Administering Chapter 25
L. Scheduling & Monitoring Chapter 10 Medications
Appointments
X. Emergencies Chapter 26
M. Resources & Community Chapters 8, 26
Services Y. First Aid Chapter 26
Z. Nutrition Chapter 24
 +PIX\MZ ■ The Certification Process 9

:MOQ[\MZML5MLQKIT)[[Q[\IV\x:5))5<

Number of Percentage
Work Area Questions of Exam Chapter Locations
I. General Medical Assisting Knowledge 82 41%
A. Anatomy & Physiology Chapters 6, 18
B. Medical Terminology Chapters 5, 6, 18, 25
C. Medical Law Chapters 4, 11, 13, 14, 15
D. Medical Ethics Chapter 4
E. Human Relations Chapters 7, 16
F. Patient Education Chapters 8, 24
II. Administrative Medical Assisting 48 24%
A. Insurance Chapters 13, 14
B. Finance & Bookkeeping Chapter 15
C. Medical Receptionist, Chapters 9, 10, 11, 12
Secretarial, Clerical
III. Clinical Medical Assisting 70 35%
A. Asepsis Chapters 17, 21
B. Sterilization Chapter 17
C. Instruments Chapters 18, 19
D. Vital Signs & Mensurations Chapter 18
E. Physical Examinations Chapter 18
F. Clinical Pharmacology Chapter 25
G. Minor Surgery Chapter 19
H. Therapeutic Modalities Chapter 23
I. Laboratory Procedures Chapter 21
J. Electrocardiography Chapter 20
K. First Aid & Emergency Response Chapter 26
10 =VQ\ ■ The Starting Point

+MZ\QNQML5MLQKIT)LUQVQ[\ZI\Q^M;XMKQITQ[\x+5);)5<

Number of Percentage
Work Area Questions of Exam Chapter Locations
I. Medical Assisting Foundations 26 13%
A. Medical terminology Chapters 5, 6, 18, 25
B. Anatomy & Physiology Chapters 6, 18
C. Legal & Ethical Considerations Chapters 4, 11, 13, 14, 15
D. Professionalism Chapters 4, 7, 8, 9
II. Basic Clinical Medical Assisting 16 8%
A. Basic Health History Interview Chapters 7, 18
B. Basic Charting Chapters 11, 18
C. Vital Signs & Measurements Chapters 5, 6, 18
D. Asepsis in the Medical Office Chapter 17
E. Examination Preparation Chapters 5, 6, 18
F. Medical Office Emergencies Chapter 26
G. Pharmacology Chapters 5, 25
III. Medical Office Clerical Assisting 20 10%
A. Appointment Management & Chapters 7, 10
Scheduling
B. Reception Chapters 7, 10
C. Communication Chapters 7, 10, 12
D. Patient Information & Chapters 8, 26
Community Resources
IV. Medical Records Management 28 14%
A. Systems Chapter 11
B. Procedures Chapter 11
C. Confidentiality Chapters 4, 11
V. Health Care Insurance Processing, 34 17%
Coding, & Billing
A. Insurance Processing Chapter 13
B. Coding Chapter 14
C. Insurance Billing & Finances Chapters 4, 14, 15
VI. Medical Office Financial Management 34 17%
A. Fundamentals of Financial Chapter 15
Management
B. Patient Accounts Chapters 14, 15
C. Banking Chapter 15
D. Payroll Chapter 16

(continued )
 +PIX\MZ ■ The Certification Process 11
VII. Medical Office Information 14 7%
Processing
A. Fundamentals of Computing Chapter 9
B. Medical Office Computing Applications Chapter 9
VIII. Medical Office Management 28 14%
A. Office Communications Chapters 7, 9, 12
B. Business Organization Management Chapters 11, 14, 15, 16
C. Human Resources Chapter 16
D. Safety Chapters 4, 17, 21, 26
E. Supplies & Equipment Chapter 16
F. Physical Office Plant Chapter 16
G. Risk Management & Quality Assurance Chapter 4
 Pretest and Analysis
2

Relax and do not rush when taking the pretest. The pur- relevant for the CMAS (AMT) exam. Answer the pretest
pose is to determine your strengths and weaknesses in questions by circling your answer or writing your
the study subjects, not to produce a score. Do not time answers on a separate sheet of paper. Use the special
yourself. This test is designed to determine basic knowl- bookmark from the back of the book to cover the
edge without intimidation. This also allows you to take answers and work through all the questions without
the pretest in more than one sitting. stopping to see if you are correct.
All questions are relevant for the CMA (AAMA)
and RMA (AMT) exams. Questions 1 through 79 are


 8 : - < - ; <

1. Which of the following positions is used for Answer: *

examination of the abdomen?
Subject: Patient Exams
A. Prone
Refer to Chapter 18
B. Supine
C. Sims’
D. Fowler’s
E. Semi-Fowler’s

2. The two functions of the ear are hearing and: Answer: *

A. movement.
Subject: Anatomy and Physiology
B. equilibrium.
Refer to Chapter 6
C. sound production.
D. maintaining upright position.

3. The two main divisions of the central nervous Answer: +

system are the:
Subject: Anatomy and Physiology
A. cerebrum and cerebellum.
Refer to Chapter 6
B. hypothalamus and medulla.
C. spinal cord and brain.
D. sympathetic and parasympathetic.
E. endocrine and exocrine.

4. The portion of the eye that contains rods and Answer: ,

cones is the:
Subject: Anatomy and Physiology
A. lens.
Refer to Chapter 6
B. sclera.
C. conjunctiva.
D. retina.

5. The term meaning muscular pain is: Answer: +

A. myosin.
Subject: Medical Terminology
B. myoglobin.
Refer to Chapter 5
C. myalgia.
D. myocardium.
E. myomalacia.

6. The reporting mechanism that goes from your Answer: *

direct supervisor to your supervisor’s supervisor is
Subject: Practice Management
called the:
Refer to Chapter 16
A. chain of infection.
B. chain of authority.
C. team administration.
D. administrative management.


 +PIX\MZ ■ Pretest and Analysis 15

7. Pathogens that thrive in oxygen are called: Answer: ,

A. antitoxins. Subject: Microorganisms and Asepsis
B. anaerobes. Refer to Chapter 17
C. spores.
D. aerobes.
E. oxides.

8. The amount of money the medical office owes for Answer: )

supplies and equipment is considered:
Subject: Financial Practices
A. accounts payable.
Refer to Chapter 15
B. assets.
C. accounts receivable.
D. distributions.

9. Balancing a checkbook with the bank statement is Answer: *

called:
Subject: Financial Practices
A. tracking.
Refer to Chapter 15
B. reconciliation.
C. disbursement.
D. justification.
E. endorsement.

10. The hiring process involves all of the following Answer: ,

EXCEPT:
Subject: Practice Management
A. recruiting
Refer to Chapter 16
B. interviewing
C. verifying
D. training

11. The first aid procedure for a suspected Answer: )

fracture includes:
Subject: Emergency Preparedness
A. immobilizing the part.
Refer to Chapter 26
B. applying an elastic bandage.
C. straightening the bones involved.
D. applying heat for pain control.
E. preparing the patient for physical therapy

12. Which condition is characterized by a deficiency in Answer: +

insulin production?
Subject: Anatomy and Physiology
A. Gouty arthritis
Refer to Chapter 6
B. Pancreatic cancer
C. Diabetes mellitus
D. Anemia
E. Gastric reflux disease

13. When deciding whether to purchase or lease a Answer: ,

piece of equipment, the manager would most
Subject: Practice Management
likely decide to lease:
Refer to Chapter 16
A. an expensive piece of equipment.
B. equipment with high utilization.
C. equipment with a short guarantee.
D. equipment that outdates rapidly.
16 =VQ\ ■ The Starting Point

14. The heart is divided into right and left sides by the: Answer: +
A. aorta.
Subject: Anatomy and Physiology
B. atria.
Refer to Chapter 6
C. septum.
D. valves.
E. ventricles.

15. The cardiovascular system includes: Answer: )

A. heart and blood vessels.
Subject: Anatomy and Physiology
B. heart and lungs.
Refer to Chapter 6
C. lungs and capillaries.
D. heart and kidneys.

16. A localized dilation of an artery is a(n): Answer: )

A. aneurysm.
Subject: Anatomy and Physiology
B. embolism.
Refer to Chapter 6
C. infarction.
D. stenosis.
E. thrombus.

17. One type of genetic bleeding disorder is: Answer: +

A. anemia.
Subject: Anatomy and Physiology
B. aneurysm.
Refer to Chapter 6
C. hemophilia.
D. leukemia.

18. The measurement of height or length and Answer: ,

weight is:
Subject: Patient Exams
A. auscultation.
Refer to Chapter 18
B. manipulation.
C. palpation.
D. mensuration.
E. menstruation.

19. Gastrectasia means: Answer: +

A. inflammation of the stomach.
Subject: Medical Terminology
B. ulceration of the stomach.
Refer to Chapter 5
C. stretching of the stomach.
D. surgical repair of the stomach.

20. The muscle that expands and contracts during Answer: ,

respiration, allowing the lungs to fill and empty
Subject: Anatomy and Physiology
air, is the:
Refer to Chapter 6
A. pectoralis.
B. deltoid.
C. gastrocnemius.
D. diaphragm.
E. rectus abdominus.
 +PIX\MZ ■ Pretest and Analysis 17

21. The employee’s performance appraisal should Answer: *

occur at least:
Subject: Practice Management
A. quarterly.
Chapter 16
B. annually.
C. semi-annually.
D. bi-annually.

22. The vocal cords are located in the: Answer: +

A. bronchi.
Subject: Anatomy and Physiology
B. epiglottis.
Refer to Chapter 6
C. larynx.
D. pharynx.
E. trachea.

23. The most effective method of destroying spores is: Answer: ,

A. boiling.
Subject: Microorganisms and Asepsis
B. disinfecting.
Refer to Chapter 17
C. sanitizing.
D. autoclaving.

24. A sphygmomanometer is used to: Answer: ,

A. measure visual acuity.
Subject: Patient Exams
B. listen to heart sounds.
Refer to Chapter 18
C. record electrical activity of the heart.
D. measure blood pressure.
E. auscultate breath sounds.

25. When multiple patients are evaluated and Answer: *

prioritized for treatment, it is called:
Subject: Administrative Technologies
A. screening.
Refer to Chapter 9
B. triage.
C. referral.
D. scheduling.

26. During a job interview, the prospective employer Answer: -

may ask questions about all of the following
Subject: Practice Management
EXCEPT:
Refer to Chapter 16
A. certification.
B. citizenship.
C. job-related weaknesses.
D. reason for leaving previous employment.
E. marital status.

27. The term auscultation means: Answer: ,

A. tapping.
Subject: Patient Exams
B. feeling.
Refer to Chapter 18
C. measuring.
D. listening.
18 =VQ\ ■ The Starting Point

28. The recommended temperature for effective Answer: ,

sterilization in an autoclave is:
Subject: Microorganisms and Asepsis
A. 200°F.
Refer to Chapter 17
B. 212°F.
C. 220°F.
D. 250°F.

29. The organization that established guidelines for Answer: -

occupational exposure to blood is the:
Subject: Microorganisms and Asepsis
A. CDC.
Refer to Chapter 17
B. FDA.
C. HCFA.
D. CMS.
E. OSHA.

30. Which manual identifies procedural codes for Answer: +

submitting insurance claims?
Subject: Medical Coding and Claims
A. PPO
Refer to Chapter 14
B. ICD
C. CPT
D. HMO

31. The “S” in SOAP charting means: Answer: ,

A. symptoms.
Subject: Medical Records
B. signs.
Refer to Chapter 11
C. source.
D. subjective.
E. signature.

32. The pegboard system of accounting generates Answer: ,

which of the following documents?
Subject: Financial Practices
A. Cashier’s check
Refer to Chapter 15
B. Bank statement
C. Collection letter
D. Receipt

33. A business letter in which all lines start flush with Answer: -
the left margin is:
Subject: Correspondence
A. simplified style.
Refer to Chapter 12
B. modified block style.
C. modified indented style.
D. formal.
E. block style.

34. Which of the following acts constitutes Answer: *

negligence?
Subject: Law and Ethics
A. A patient and physician establishing a
Refer to Chapter 4
professional relationship
B. Breach of the physician’s duty of skill or care
C. A patient who has a positive outcome as a
result of treatment
D. Revocation of the physician’s license
 +PIX\MZ ■ Pretest and Analysis 19

35. The Employee’s Withholding Allowance Answer: *

Certificate is the:
Subject: Financial Practices
A. W-2.
Refer to Chapter 15
B. W-4.
C. I-9.
D. FICA.
E. Social Security.

36. A file used as a reminder that something must be Answer: *

taken care of on a certain date is called a:
Subject: Appointment Scheduling
A. matrix.
Refer to Chapter 10
B. tickler.
C. triage.
D. chronologic.

37. A set of principles or values is called: Answer: )

A. ethics.
Subject: Law and Ethics
B. legal rights.
Refer to Chapter 4
C. opinions.
D. standards.

38. An instrument used to test neurologic reflexes Answer: -

is a(n):
Subject: Patient Exams
A. tuning fork.
Refer to Chapter 18
B. audiometer.
C. sphygmomanometer.
D. goniometer.
E. percussion hammer.

39. Slurred speech and one-sided paralysis are Answer: )

symptoms of:
Subject: Emergency Preparedness
A. stroke.
Refer to Chapter 26
B. heart attack.
C. syncope.
D. epistaxis.

40. The abbreviation “mL” means: Answer: +

A. microliter.
Subject: Pharmacology and Medication Administration
B. megaliter.
Refer to Chapter 25
C. milliliter.
D. macroliter.
E. miniliter.

41. Confirming that the message the listener received Answer: ,

is the message you intended to send is called:
Subject: Professional Communication
A. observation.
Refer to Chapter 7
B. listening.
C. empathy.
D. feedback.
20 =VQ\ ■ The Starting Point

42. Insurance that provides protection for wage Answer: ,

earners and pays for medical care resulting from
Subject: Medical Insurance
an occupational accident is:
Refer to Chapter 13
A. disability.
B. CHAMPUS.
C. Medicare.
D. workers’ compensation.
E. Medicaid.

43. The type of appointment scheduling in which Answer: +

several patients are given the same appointment
Subject: Appointment Scheduling
time is called:
Refer to Chapter 10
A. grouping.
B. advance booking.
C. wave scheduling.
D. batching.

44. A drug that relieves nausea and vomiting is Answer: +

classified as an:
Subject: Pharmacology and Medication Administration
A. antispasmodic.
Refer to Chapter 25
B. anticoagulant.
C. antiemetic.
D. analgesic.
E. antidiarrheal.

45. Use of chemicals to clean infectious materials Answer: *

from items or surfaces is called:
Subject: Microorganisms and Asepsis
A. sterilization.
Refer to Chapter 17
B. disinfection.
C. sanitation.
D. cleansing.

46. Myopia is a condition of: Answer: +

A. blindness.
Subject: Anatomy and Physiology
B. farsightedness.
Refer to Chapter 6
C. nearsightedness.
D. loss of peripheral vision.
E. crossed eyes.

47. A fracture that causes the bone to break through Answer: ,

the skin is called:
Subject: Emergency Preparedness
A. greenstick.
Refer to Chapter 26
B. simple.
C. spiral.
D. compound.
 +PIX\MZ ■ Pretest and Analysis 21

48. A document requiring a person to appear in court Answer: )

is a:
Subject: Law and Ethics
A. subpoena.
Refer to Chapter 4
B. deposition.
C. litigation.
D. contract.
E. transcript.

49. The system used for classifying diseases to Answer: +

facilitate collection of health information is:
Subject: Medical Coding and Claims
A. RBRVS.
Refer to Chapter 14
B. CPT-4.
C. ICD-9-CM.
D. HCFA-1500.

50. An example of objective information in a patient Answer: +

chart is the:
Subject: Medical Records
A. patient’s statement of his or her medical
Refer to Chapter 11
history.
B. patient’s statement of the severity of the pain.
C. medical professional’s note of a red, swollen
area.
D. patient’s statement of inability to perform tasks.
E. medical professional’s note that the patient
complains of pain.

51. In communication with patients, an example of an Answer: +

open-ended question would be:
Subject: Professional Communication
A. How much pain medication have you taken?
Refer to Chapter 7
B. During this illness, did you have an elevated
temperature?
C. What brings you to the doctor today?
D. Are you allergic to any medications?

52. The predetermined amount of money paid by the Answer: ,

insured party before the insurance company pays
Subject: Medical Insurance
medical expenses is referred to as:
Refer to Chapter 13
A. capitation.
B. premium.
C. indemnity.
D. deductible.
E. coinsurance.

53. When handling third-party requests for Answer: *

information over the telephone, you should ask
Subject: Administrative Technologies
the caller to:
Refer to Chapter 9
A. contact the physician’s attorney.
B. ask the patient to submit written permission.
C. hang up and not call back.
D. call back to speak with the physician only.
22 =VQ\ ■ The Starting Point

54. To ensure mail delivery the next day, you would Answer: ,
send correspondence via:
Subject: Correspondence
A. first class.
Refer to Chapter 12
B. registered mail.
C. certified mail.
D. express mail.
E. second-class mail.

55. The agency that regulates controlled substances is Answer: )

the:
Subject: Pharmacology and Medication Administration
A. DEA.
Refer to Chapter 25
B. FDA.
C. CDC.
D. OSHA.

56. Orientation of a new staff member would include: Answer: +

A. interview.
Subject: Practice Management
B. performance appraisal.
Refer to Chapter 16
C. review of policies and procedures.
D. sending a W-2 form.
E. checking references.

57. The pulse point located bilaterally in the groin is Answer: +

the:
Subject: Patient Exams
A. apical.
Refer to Chapter 18
B. dorsalis pedis.
C. femoral.
D. popliteal.

58. Following the indexing rules for filing, Answer: ,

which name comes first?
Subject: Medical Records
A. McWilliams
Refer to Chapter 11
B. McCally
C. Mahill
D. MacHall
E. McAllister

59. When a patient authorizes an insurance Answer: )

company to make payment directly to the
Subject: Medical Insurance
physician, it is called:
Refer to Chapter 13
A. assignment of benefits.
B. direct billing.
C. claims submission.
D. reimbursement.

60. A debt incurred but not yet paid is called: Answer: *

A. account balance.
Subject: Financial Practices
B. accounts payable.
Refer to Chapter 15
C. accounts receivable.
D. credit balance.
E. adjustment.
 +PIX\MZ ■ Pretest and Analysis 23

61. An instrument used to examine the eyes is a(n): Answer: ,

A. audiometer.
Subject: Patient Exams
B. otoscope.
Refer to Chapter 18
C. lensometer.
D. ophthalmoscope.

62. The term hematuria means: Answer: -

A. infection in the blood.
Subject: Medical Terminology
B. painful urination.
Refer to Chapter 5
C. protein in the urine.
D. difficult urination.
E. blood in the urine.

63. The Centers for Disease Control and Prevention Answer: ,

recommends universal precautions that include:
Subject: Microorganisms and Asepsis
A. recapping needles when finished using them.
Refer to Chapter 17
B. placing all soiled trash in the waste can.
C. cleaning blood spills with soap and water.
D. wearing personal protective equipment.

64. The signature on the back of a check is the: Answer: *

A. payer.
Subject: Financial Practices
B. endorser.
Refer to Chapter 15
C. disburser.
D. check maker.
E. bank.

65. Which pulse site is most commonly used? Answer: )

A. Radial artery
Subject: Patient Exams
B. Brachial artery
Refer to Chapter 18
C. Apical region
D. Temporal artery

66. In the usual physical examination sequence, which Answer: ,

area of the body does the physician examine first?
Subject: Patient Exams
A. Thorax and lungs
Refer to Chapter 18
B. Genital area
C. Abdomen
D. Head and neck
E. Breasts

67. The attention line of a business letter is located: Answer: +

A. four lines below the date.
Subject: Correspondence
B. three lines below the letterhead.
Refer to Chapter 12
C. two lines below the inside address.
D. two lines below the salutation.
24 =VQ\ ■ The Starting Point

68. When a physician’s license from one state is Answer: +

accepted by another state, it is called:
Subject: Law and Ethics
A. endorsement.
Refer to Chapter 4
B. acceptance.
C. reciprocity.
D. allowance.
E. transfer.

69. A patient with 20/30 vision in both eyes can see Answer: *
with:
Subject: Patient Exams
A. the right eye at 30 feet what the normal eye
Refer to Chapter 18
sees at 20 feet.
B. both eyes at 20 feet what the normal eye
sees at 30 feet.
C. the left eye at 20 feet what the normal eye
sees at 30 feet.
D. both eyes at 30 feet what the normal eye
sees at 20 feet.

70. Which structure is located in the RLQ? Answer: )

A. Appendix
Subject: Anatomy and Physiology
B. Liver
Refer to Chapter 6
C. Spleen
D. Pancreas
E. Gallbladder

71. CMS, formerly HCFA, regulates: Answer: *

A. prescriptions.
Subject: Medical Insurance
B. Medicare insurance.
Refer to Chapter 13
C. banking institutions.
D. clinical laboratories.

72 A patient is placed in Sims’ position to examine Answer: +

the:
Subject: Patient Exams
A. breasts.
Refer to Chapter 18
B. abdomen.
C. rectum.
D. heart.
E. back.

73. The subdivisions of E&M insurance codes include: Answer: *

A. pathology and laboratory codes.
Subject: Medical Claims and Coding
B. diagnostic and treatment services.
Refer to Chapter 14
C. radiology codes.
D. anesthesia codes.

74. Another term for a living will is: Answer: ,

A. patient’s release.
Subject: Law and Ethics
B. implied contract.
Refer to Chapter 4
C. emancipation will.
D. advance directive.
E. power of attorney.
 +PIX\MZ ■ Pretest and Analysis 25

75. A common charting abbreviation used during a Answer: +

complete physical examination is:
Subject: Patient Exams
A. UTI.
Refer to Chapter 18
B. BID.
C. HEENT.
D. NPO.

76. First aid treatment for someone experiencing Answer: )

syncope includes:
Subject: Emergency Preparedness
A. keeping the person sitting with head lowered
Refer to Chapter 26
to the knees.
B. inducing vomiting.
C. giving small amounts of water.
D. maintaining an open airway.
E. using an external defibrillator.

77. A drug classified as an antipyretic would Answer: ,

be used to:
Subject: Pharmacology and Medication Administration
A. lower blood pressure.
Refer to Chapter 25
B. decrease cholesterol.
C. improve breathing.
D. lower fever.

78. Which statement is true about normal values for Answer: +

body temperature?
Subject: Patient Exams
A. A rectal temperature is 2° higher than an oral
Refer to Chapter 18
temperature.
B. An axillary temperature is the most accurate
method of determining temperature.
C. An oral temperature is 1° lower than a rectal
temperature.
D. An oral temperature is the most accurate
method of determining temperature.
E. An axillary temperature is 2° lower than an oral
temperature.

79. Vaccines are an example of which kind of Answer: *

immunity?
Subject: Pharmacology and Medication Administration
A. Natural
Refer to Chapter 25
B. Active
C. Genetic
D. Congenital

80. A substance produced in the body in response to Answer: *

the presence of an antigen is:
Subject: Anatomy and Physiology
A. atelectasis.
Refer to Chapter 6
B. antibody.
C. inflammation.
D. allergen.
E. adrenalin.
26 =VQ\ ■ The Starting Point

81. Which of the following is a fat-soluble vitamin? Answer: )

A. A
Subject: Nutrition
B. B6
Refer to Chapter 24
C. B12
D. C

82. A 12-lead electrocardiogram records: Answer: +

A. four bipolar, four unipolar, and four
Subject: Electrocardiogram
precordial leads.
Refer to Chapter 20
B. six precordial, two unipolar, and four
bipolar leads.
C. three bipolar, three unipolar, and six
precordial leads.
D. two bipolar, four unipolar, and six
precordial leads.
E. six bipolar, three unipolar, and three
precordial leads.

83. A normal male hematocrit reading would be Answer: +

acceptable within:
Subject: Laboratory Procedures
A. 12–18 g/dL.
Refer to Chapter 21
B. 4,500–11,000/mm3.
C. 43%–49%.
D. 300 g/dL.

84. One (1) grain is equivalent to: Answer: +

A. 100 mg.
Subject: Pharmacology and Medication Administration
B. 75 mg.
Refer to Chapter 25
C. 60 mg.
D. 15 mg.
E. 10 mg.

85. Which of the following is a normal specific Answer: *

gravity reading for urine?
Subject: Laboratory Procedures
A. 1.000
Refer to Chapter 21
B. 1.010
C. 1.100
D. 1.115

86. The device used to record cardiac activity of an Answer: -

ambulatory patient over a 24-hour period is a(n):
Subject: Electrocardiogram
A. echocardiograph.
Refer to Chapter 20
B. electrocardiograph.
C. cardiac ultrasound.
D. Doppler.
E. Holter monitor.
 +PIX\MZ ■ Pretest and Analysis 27

87. The treatment method that uses a tank with Answer: ,

equipment that agitates the water for gentle
Subject: Physical Modalities
massage is a(n):
Refer to Chapter 23
A. paraffin bath.
B. infrared radiation.
C. diathermy.
D. whirlpool.

88. When administering a 1-mL or greater Answer: )

amount of medication by injection, all of the
Subject: Pharmacology and Medication Administration
following routes may be used EXCEPT:
Refer to Chapter 25
A. intradermally.
B. subcutaneously.
C. intramuscularly.
D. intrathecally.
E. intravascularly.

89. A radiographic technique that produces a film Answer: +

representing a detailed cross section of tissue
Subject: Medical Imaging
structure is a(n):
Refer to Chapter 22
A. angiogram.
B. barium enema.
C. computerized tomography.
D. myelogram.

90. When requesting a clean-catch urine specimen Answer: +

from a female patient, you should instruct the
Subject: Laboratory Procedures
patient to:
Refer to Chapter 21
A. empty the bladder in the morning and then
collect the second specimen of the day.
B. void most of the urine into the toilet before
collecting the specimen.
C. cleanse each side of the urinary meatus from
front to back.
D. avoid cleansing the urinary meatus to ensure all
artifacts are collected in the urine.
E. increase fluid intake and then collect a late-day
specimen.

91. When performing venipuncture you should Answer: ,

always:
Subject: Laboratory Procedures
A. enter the vein with the bevel of the needle
Refer to Chapter 21
placed downward.
B. enter the vein with the needle at a 45 angle.
C. recap used needles to avoid accidental needle
punctures.
D. remove the tourniquet before removing the
needle from the puncture site.
28 =VQ\ ■ The Starting Point

92. In an electrocardiogram, the standardization Answer: +

mark is:
Subject: Electrocardiogram
A. 1 mm high.
Refer to Chapter 20
B. 5 mm high.
C. 10 mm high.
D. 20 mm high.
E. 25 mm high.

93. A surgical instrument found on a suture Answer: ,

removal tray is a:
Subject: Minor Surgical Procedures
A. scalpel handle.
Refer to Chapter 19
B. towel forceps.
C. needle holder.
D. thumb forceps.

94. Another term for the chest leads on an Answer: ,

electrocardiogram (ECG) is:
Subject: Electrocardiogram
A. bipolar.
Refer to Chapter 20
B. unipolar.
C. augmented.
D. precordial.
E. intercostal.

95. To obtain a capillary blood specimen, you should: Answer: ,

A. squeeze the tip of the patient’s finger.
Subject: Laboratory Procedures
B. collect the first drop of blood.
Refer to Chapter 21
C. use the patient’s index finger.
D. wipe away the first drop of blood.

96. The proper size needle for administering an Answer: +

intradermal injection is:
Subject: Pharmacology and Medication Administration
A. 23 g1''.
Refer to Chapter 25
B. 20 g11/2''.
C. 27 g3/8''.
D. 25 g1''.

97. To obtain an anteroposterior (AP) x-ray view, the Answer: )

patient is positioned with the:
Subject: Medical Imaging
A. anterior aspect of the body facing the x-ray
Refer to Chapter 22
tube.
B. posterior aspect of the body facing the x-ray
tube.
C. left side of the body facing the film.
D. right side of the body facing the film.
E. right side of the body facing the x-ray tube.
 +PIX\MZ ■ Pretest and Analysis 29

98. The best method to deliver deep heat to tissues is Answer: ,

to use:
Subject: Physical Modalities
A. paraffin bath.
Refer to Chapter 23
B. infrared radiation lamp.
C. whirlpool treatment.
D. ultrasound therapy.

99. The muscle used for an intramuscular injection Answer: -

is the:
Subject: Pharmacology and Medication Administration
A. gluteus maximus.
Refer to Chapter 25
B. rectus femoris.
C. triceps.
D. quadriceps.
E. deltoid.

100. When preparing a sterile tray for a minor surgical Answer: )

procedure, remember to:
Subject: Minor Surgical Procedures
A. consider the 1-inch border around the
Refer to Chapter 19
perimeter of the tray nonsterile.
B. place the vial of local anesthetic on the
sterile field.
C. prepare the tray in another location and
carry it to the patient’s location.
D. have a sharps container on the sterile field.

101. A physician orders 125 mg of a drug; the available Answer: +

medication on hand is 500 mg/mL. How many mL
Subject: Pharmacology and Medication Administration
of the drug would you give the patient?
Refer to Chapter 25
A. 0.5 mL
B. 0.4 mL
C. 0.25 mL
D. 0.05 mL
E. 0.04 mL

102. When performing an ECG, you should: Answer: +

A. apply electrodes over bony prominences.
Subject: Electrocardiogram
B. disregard artifacts.
Refer to Chapter 20
C. ensure patient comfort.
D. place lead V1 on the left side of the sternum.

103. When instructing a patient about a low-cholesterol Answer: ,

diet, you should tell the patient to decrease intake
Subject: Patient Education
of which of the following foods?
Refer to Chapter 8
A. Citrus fruit
B. Green vegetables
C. Cereal grains
D. Dairy products
E. Legumes
30 =VQ\ ■ The Starting Point

104. Which of the following is a form of exercise Answer: )

therapy?
Subject: Physical Modalities
A. Range of motion
Refer to Chapter 23
B. Hydrotherapy
C. Ultrasound
D. Massage

105. In an ECG, aVR, aVL, and aVF represent: Answer: *

A. bipolar limb leads.
Subject: Electrocardiogram
B. augmented limb leads.
Refer to Chapter 20
C. precordial leads.
D. standard limb leads.
E. chest leads.

8:-<-;<)6)4A;1; ANALYSIS STEP 1

The pretest analysis helps you determine which topics Go back to each question in the pretest. Put a check
you need to study more or study less and how much mark by the answer if:
study time you need. The analysis has three steps and
takes approximately 15 minutes. This is important time ■ Your answer was incorrect.
to invest. ■ Your answer was correct but you were unsure or you
required more than 45 seconds to decide on an answer.

Table 2-1 ;\]La0W]Z[Ja<WXQKNWZ+5)))5)IVL:5))5<

General Knowledge Administrative Practice Clinical Practice

Law and Ethics Administrative Technologies Microorganisms and Asepsis
Suggested study time ____ hr. n Suggested study time ____ hr. n Suggested study time ____ hr. n
Medical Terminology Appointment Scheduling Patient Exams
Suggested study time ____ hr. n Suggested study time ____ hr. n Suggested study time ____ hr. n
Anatomy and Physiology Medical Records Minor Surgical Procedures
Suggested study time ____ hr. n Suggested study time ____ hr. n Suggested study time ____ hr. n
Professional Communication Correspondence Electrocardiogram
Suggested study time ____ hr. n Suggested study time ____ hr. n Suggested study time ____ hr. n
Patient Education Medical Insurance Laboratory Procedures
Suggested study time ____ hr. n Suggested study time ____ hr. n Suggested study time ____ hr. n
Medical Coding and Claims Medical Imaging
Suggested study time ____ hr. n Suggested study time ____ hr. n
Financial Practices Physical Modalities
Suggested study time ____ hr. n Suggested study time ____ hr. n
Practice Management Nutrition
Suggested study time ____ hr. n Suggested study time ____ hr. n
Pharmacology and Medication Administration
Suggested study time ____ hr. n
Emergency Preparedness
Suggested study time ____ hr. n
 +PIX\MZ ■ Pretest and Analysis 31

Table 2-2 ;\]La0W]Z[Ja<WXQKNWZ+5);)5<

General Knowledge Administrative Practice Clinical Practice

Law and Ethics Administrative Technologies Microorganisms and Asepsis
Suggested study time ____ hr. n Suggested study time ____hr. n Suggested study time ____ hr. n
Medical Terminology Appointment Scheduling Patient Exams
Suggested study time ____ hr. n Suggested study time ____ hr. n Suggested study time ____ hr. n
Anatomy and Physiology Medical Records Pharmacology and Medication
Suggested study time ____ hr. n Suggested study time ____ hr. n Administration
Suggested study time ____ hr. n
Professional Communication Correspondence Emergency Preparedness
Suggested study time ____ hr. n Suggested study time ____ hr. n Suggested study time ____ hr. n
Patient Education Medical Insurance
Suggested study time ____ hr. n Suggested study time ____ hr. n
Medical Coding and Claims
Suggested study time ____ hr. n
Financial Practices
Suggested study time ____ hr. n
Practice Management
Suggested study time ____ hr. n

ANALYSIS STEP 2 Table 2-3 ;\]La0W]Z[;]UUIZa

Each answer on the pretest has a subject that corresponds
to one of the subjects in Table 2-1, for the CMA (AAMA) Pretest suggested study hours
and RMA (AMT) exams, or Table 2-2, for the CMAS. Extra study hours added for 4
(AMT) exam now count the total check marks for each Anatomy and Physiology
subject. Place the total number of check marks for each Timed exam and final prep hours 4
subject in the corresponding box on the appropriate table
for your exam. If you have no check marks for a subject, Total suggested minimum
place a zero in the square. study hours
You may, for example, have three answers checked for
the subject “Law and Ethics.” You would place a 3 in that
box.
ANALYSIS STEP 4
ANALYSIS STEP 3 ■ Now count all the suggested study hours and place the
The higher the number in each box, the more you need total in Table 2-3.
to study that subject. When all the boxes in Table 2-1 or ■ Add all hours in Table 2-3.
Table 2-2 are completed, estimate your needed study
time this way: The pretest analysis is complete. Your results show
you your likely areas of strength and weakness, suggested
■ 0 or 1 in the box suggests reasonable knowledge of the minimum study times for each subject, and a suggested
topic, minimum 1 hour per subject; write “1” on the total review time. Additional time is added in Table 2-3
line “suggested study time __ hr” for Anatomy and Physiology, which has the most con-
■ 2 in the box suggests partial knowledge of the topic, tent, and for the practice exam. Now you are ready to
minimum 2 hours per subject; write “2” on the line move on to make your plan using this information.
“suggested study time __ hr”
■ 3 or higher in the box suggests limited knowledge of
the topic, minimum 3 hours per subject; write “3” on
the line “suggested study time __ hr”
 Making Your Study Plan
3

One of the common characteristics among those who pass modify the calendar based on that date. The following
the exam is that they had a study plan. It is a road map of steps are guidelines only, and you should change them
where you are going and how to get there. Dedication and based on your individual learning needs. Planning is
commitment are essential. They are like fuel for your worth the time!
vehicle—necessary to take you where you want to go. Remove the calendar from the back of the book or use
An 8-week calendar is suggested to give you plenty of a calendar you have. Work the following steps.
time to study. If your exam is already scheduled, you may


34 =VQ\ ■ The Starting Point

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

4 total 1 total 1 total 2 total

.QO]ZM;\MX Fill in the total number of hours per day you will study. Here is an example week.

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

4 total 1 total 1 total 2 total
1 hr (Medical (Communication) Study Group
(Correspondence)
2 hr Terminology) (Anatomy &
(Patient Exam) Physiology )
1 hr
(Medical
Terminology)
.QO]ZM;\MX Assign subjects to each of the days, according to level of difficulty and number of hours available. Here is an
example week.

;<-8 *W`
■ Determine how many hours a week you can devote to ;\IaQVO5W\Q^I\ML
study; be realistic.
■ Refer to Table 2-3 in Chapter 2, which gives your total You’ve probably heard the slogan “Just do it!”
suggested minimum study hours. Adopt this attitude for your exam preparation. Put
all “nonessentials” on hold for 8 weeks and dedi-
■ Use the Study Calendar to assign the study hours for
cate the time to study. Eight weeks go by very
each day.
quickly. If you fall off your schedule, take a deep
■ Refer to Figure 3-1 as an example. breath and jump back on. Let everyone know what
you are doing and ask for their support. If you are
in a study group, help—do not hinder—each other.
;<-8 Keep in mind the reason you chose to take the
■ Refer to Table 2-1 or 2-2, which gives the total num- exam and stay focused.
ber of hours needed per subject. Generally, keeping energized is related to physi-
cal well-being. Commit to eating healthy meals
■ Plug these subjects into the assigned hours on the
and snacks. Try to study in pleasant places. Out-
Study Calendar.
doors is great if weather permits, and distractions
■ Use Figure 3-2 as an example of a study week showing are minimal.
subjects assigned to the study hours. Buy or borrow a little book of inspirational say-
ings and read one daily. Give yourself credit for
milestones: When you complete each subject, you
should feel a sense of accomplishment. When you
complete the study hours for the week, reward
yourself in small ways—buy a treat, watch a
favorite television show, tell others, or plan a fes-
tive event to celebrate the completion of the exam.
“Plan your work—then work your plan.”
 Unit 2
General Knowledge


 Law and Ethics
4

: - > 1 - ?  < 1 8 
Lega
g l and ethical decisions arise in everyy asppect of medical assistingg. Exampl
p es of lega
g l and ethical
practices include ensuring a patient has signed a consent form before releasing information and
billing only for services actually performed.
Examples of illegal or unethical practices are knowingly using an incorrect insurance code,
failing to report a medication error, or discussing patients with friends. Think about legal and
ethical implications that occur in a routine day as you review each chapter.

4)? by the government; a fine or imprisonment can occur.

An example is Medicare fraud.
Law is a set of rules governing conduct and action that 2. Civil—laws that govern crimes or wrongs committed
are enforced by a recognized authority. The purposes of against an individual or property; charges are brought
law are to: forth by the individual or his representative; compen-
sation (usually monetary) is sought.
■ Regulate conduct
■ Punish offenders The practice of medicine is generally regulated by civil
law. Three types of civil law are most frequently involved:
■ Remedy wrongs
■ Benefit society 1. Tort law—laws dealing with accidental or intentional
harm to a person or property resulting from the
The two main areas of law are: wrongdoing of others
2. Contract law—laws dealing with the rights and obli-
1. Criminal—laws that govern crimes or wrongs com- gations of enforceable promises
mitted against society, an individual, or property in 3. Administrative law—laws dealing with requirements
violation of an ordinance; charges are brought forth and standards of governmental agencies


38 =VQ\ ■ General Knowledge

*W` are not covered by the Good Samaritan Act if you are
there as part of your health care position, no matter
<PMt.W]Z,[u where the incident occurs. For instance, if you volunteer
to give immunizations at a school or to provide first aid
The “Four Ds” are used to determine whether a at a sporting event, you are volunteering as a health care
situation is malpractice: professional and are not covered under the act. If you are
1. Duty—the patient/physician relationship was attending a sporting event as a spectator or participant
established and render first aid, you are covered under the Good
2. Dereliction—the professional neglected a Samaritan Act. If money or other forms of compensation
professional obligation to act or acted or gifts are accepted from the victim or the representa-
improperly tive of the victim for administering help, the Good
3. Direct cause—a negative outcome resulted Samaritan Act no longer applies.
directly from the professional’s actions or
failure to act CONTRACT LAW
4. Damages—the patient sustained harm from the
negligent act A contract is an obligation resulting from an agreement
between two or more parties. Five components are
required for a contract to be legal and binding:
1. An offer must be made.
TORT LAW 2. The offer must be accepted.
A tort is a wrongful civil act committed against an indi- 3. An exchange of something of value between the par-
vidual for which compensation is sought. Negligence is ties must occur; this exchange is often referred to as
a common tort and is defined as failure to exercise the consideration.
standard of care that a reasonable, comparably trained 4. All parties must be legally capable of accepting the
person would exercise in similar circumstances. The four terms; this capability is often referred to as capacity.
forms of negligence are: 5. The intent must be legal.
1. Nonfeasance—failure to act when duty is indicated, Contracts may be:
resulting in or causing harm
2. Misfeasance—improper performance of an act, result- ■ Expressed—written or verbal and describing what
ing in or causing harm each contractual party will do
3. Malfeasance—performance of an improper act, ■ Implied—deduced by the actions of the contracting
resulting in or causing harm parties (for example, a patient coming to the physi-
4. Malpractice—failure to act or improper performance cian’s office seeking treatment)
of an act or performance of an improper act by a pro-
fessional (professional negligence); Box 4-1 lists the
“Four Ds,” which help determine whether a situation Consents
is malpractice Consent for medical care is voluntary permission given
A term used in obvious cases of negligence is res ipsa by a competent adult or legal agent of the patient (e.g.,
r meaning “the thing speaks for itself.” Another
loquitur, the parent of a minor child). Consents, as with contracts,
concept is respondeat superior, r which means “let the may be expressed or implied. Except in life-threatening
master answer.” The employer is liable for the actions emergencies, consent must be informed, which requires
and conduct of employees while the employees are the physician or an appropriately trained caregiver to
performing within the scope and job description of their explain the information necessary for the patient to make
position. an educated decision regarding the procedure. The care-
giver should provide the following information:
Good Samaritan Act as Tort Avoidance
■ An explanation of the procedure and the reason for the
The majority of states have a Good Samaritan Act, which procedure
is legislation enacted to encourage off-duty health care ■ The possible risks and side effects
providers to render aid at the scenes of accidents. The
■ Alternative therapies and risks
Good Samaritan Act protects health care personnel from
liability or tort claims. The care given must have been ■ Prognosis with and without the procedure
rendered in good faith and meet the standards of a rea- ■ Any other information that may assist the patient in
sonable and prudent person with similar training. You making an educated decision
 +PIX\MZ ■ Law and Ethics 39

Consentors ■ Equal Employment Opportunity Act (EEOA)—

prohibits employment discrimination because of age,
The following may consent for medical treatment:
color, national origin, race, religion, or sex.
■ Competent adult for self or legal charge (e.g., his or
her minor child)
■ Emancipated minor (state-specific; generally, one The Red Flags Rule (this comes under Administrative Law)
who lives on his or her own and is self-supporting) On August 1, 2009 the Federal Trade Commission
■ Minors serving in the armed forces enacted the Red Flags Rule to combat increasing med-
■ Minors seeking treatment for sexually transmitted dis- ical identity theft which is when a person seeking health-
eases, birth control, or abortion (state-specific) care uses another person’s name or insurance. The law
became effective June 1, 2010 and requires most medical
■ Minor parent with custody of his or her minor child
offices to develop written programs to detect the warning
(Note: In some states, a minor not considered emanci-
signs or red flags of identity theft. The law defines two
pated may consent for the treatment of his or her child but
categories that determine if a business must comply:
may not consent for his or her own medical treatment.)

■ creditors—an entity that regularly defers payment for

Advance Directives services or arranges the extension of credit; examples
Advance directives are special documents signed by the are billing patients after the service is rendered includ-
patient, witnessed, and usually notarized that state the ing fees that are billed after insurance payments are
patient’s wishes for medical decisions should the patient received
become incapable of making the decisions for himself or ■ covered account—a t consumer (patient) account that
herself. Some advance directives are: allows multiple payments or transactions; most patient
records fall in this category.
■ Living will—document stating acceptable and unac- Not adhering to the law may result in financial penalties.
ceptable means to sustain the patient’s life in case of The red flags include:
terminal conditions ■ suspicious documents:
■ Medical (durable) power of attorney—document stating • altered or forged appearance
whom the patient designates to make medical decisions
• photo or description inconsistent with the patient’s
regarding accepting and withholding treatment appearance
■ Designated anatomic donor—documentation or indi-
• inconsistent information provided such as date of
cation on an existing document (the driver’s license in birth, chronic medical condition
some states) expressing the patient’s desire to donate
■ suspicious personal identifying information from other
all or specific anatomic organs
sources such as a social security number different then
what is on file
ADMINISTRATIVE LAW ■ suspicious activities such as mail returned repeatedly
but patient continues to keep appointments and main-
Administrative law refers to regulations established and
tain that address on file
enforced by governmental agencies. Examples include
the U.S. Drug Enforcement Agency (DEA), Food and ■ inconsistency with physical exam and past medical
Drug Administration (FDA), and various state-con- treatment
trolled licensing boards, such as nursing boards and ■ notifications of identity theft from patients or staff
boards of medical examiners. Some of the more common The law requires the implementation of a program that
governmental regulators and regulations that affect the covers:
medical office are: ■ prevention—implementing sound electronic and other
security systems and HIPAA compliance
■ Clinical Laboratory Improvement Amendments ■ detection—training staff and programming electronic
(CLIA)—issues laboratory testing standards for facili- “red flagging” such differences in dates of birth are
ties performing specified tests. automatically identified on the screen
■ Occupational Safety and Health Administration ■ mitigation—assuring medical records of the perpe-
(OSHA)—regulates safety in the workplace. trator and the authentic patient are not commingled
■ Internal Revenue Service (IRS)—regulates federal pay- and knowing where and how to report suspicions or
roll taxes. occurrences
40 =VQ\ ■ General Knowledge

Employment Law ■ Conviction of a felony

Generally, employment law comes under administrative ■ Unprofessional conduct

law because it involves administrative rulings that address ■ Professional or personal incapacity
the rights of employees and employers in the workplace.
Medical offices must follow these laws:
Certification, Registration, and Accreditation
■ Equal Employment Opportunity Commission Health care occupations that do not require a license
(EEOC): Prohibits job discrimination based on race, may be subject to a credential called certification or regis-
color, religion, sex, or national origin. tration. This process is often voluntary, with standards
■ Equal Pay Act: Prohibits sex-based pay discrimina- developed by a national organization that also adminis-
tion for men and women performing the same jobs. ters a national exam. Although governmental agencies
■ Age Discrimination in Employment Act: Prohibits are usually not involved in the process, some states
job discrimination for people age 40 years and older. require certification or registration for many health
care occupations. Examples are medical assisting,
■ Americans with Disabilities Act (ADA): Prohibits
emergency medical technicians (EMTs), paramedics,
discrimination against people with disabilities in
laboratory technicians, and nursing assistants. These
employment, transportation, public accommodation,
are state-specific.
communications, and governmental activities.
Accreditation is another form of credentialing, usually
■ Family Medical Leave Act (FMLA): Allows employ- involving a health care facility or organization. It is vol-
ees up to 12 job-protected weeks of leave without pay untary, with standards developed by a national organi-
for family or medical needs. zation, after a process including site visits and reports
■ Title VII of the Civil Rights Act of 1964: Unwelcome that determine whether the organization meets the
sexual advances, requests for sexual favors, and other ver- standards. Accreditation is not issued by a governmen-
bal or physical conduct of a sexual nature constitutes sex- tal body. The Joint Commission (formerly the Joint
ual harassment when submission to or rejection of this Commission on Accreditation of Healthcare Organiza-
conduct explicitly or implicitly affects an individual’s tions or JCAHO) is one example of an accreditation
employment, unreasonably interferes with an individ- organization.
ual’s work performance or creates an intimidating, hos- Schools and training programs may also become
tile or offensive work environment. (Definition from the accredited, which implies that their graduates have met
U.S. Equal Employment Opportunity Commission.) certain standards. Examples of agencies that accredit
specific health care education schools and programs are:

Licensure ■ Commission on Accreditation of Allied Health Educa-

tion Programs (CAAHEP)
Licensure, the strongest form of professional regula-
tion, is a credential required to practice a profession ■ Accrediting Bureau of Health Education Schools
and issued by an official state agency. This section dis- (ABHES)
cusses the physician’s license to practice medicine,
which is regulated by a state’s Medical Practice Act
and issued by the state’s medical board. The license Scope of Practice
confirms that, after acceptable education and training, In addition to obtaining the appropriate and mandated
the doctor has met minimum standards as defined in licensing or certification, all health care staff is required to
the Medical Practice Act. Medical licensure may be stay within their scope of practice. The scope of practice
obtained through: is the performance of duties and procedures allowed by
law, standards, and educational preparation. As mentioned
■ Examination—successful completion of a written or in Chapter 1, health care personnel are also responsible
oral state examination for staying current in their field as a legal obligation. The
■ Endorsement—acceptance by the state board of a health care professional will be held accountable for the
passing score on a recognized national examination standards in place at any given time.
■ Reciprocity—acceptance by the state board of a valid
medical license from another state
Public Duty and Mandatory Reporting
Renewal of medical licenses is mandatory, and failure States require physicians and other health care personnel
to do so results in suspension or revocation. Other causes to report certain information to provide for the health,
for suspension or revocation are: safety, and welfare of the public.
 +PIX\MZ ■ Law and Ethics 41

■ Birth certificates must be completed and submitted ■ Norm—behavior or conduct that is valued and usually
to the designated local or state agency by the birth expected
attendant. ■ Duties—commitment or obligations to act in a certain
■ Death certificates must be completed by the physician moral manner
in attendance. • Nonmalfeasance—an action that avoids harm
■ Deaths that must be reported to the medical examiner
• Beneficence—an action that creates benefit
include:
• Fidelity—practice of meeting patient’s right to
• Death resulting from violent or criminal activity receive competent care and respect, adherence to
• Death from an undetermined cause laws and agreements
• Death without prior medical care • Veracity—truth
• Death within 24 hours of admission to a health care • Justice—equitable distribution of benefits and bur-
facility dens
■ Each occurrence of specified communicable diseases
such as vaccine-preventable diseases, tuberculosis, and
sexually transmitted diseases must be reported to the CODE OF ETHICS
state or county health department. Each medical facil-
A code of ethics is a statement, usually from a profes-
ity should have a list and reporting forms.
sional group, listing the expected behaviors of its mem-
■ Suspected abuse or criminal acts must be reported to bers. The code may also set standards and disciplinary
specific governmental agencies. These acts include: actions for violations, including censure, suspension,
• Child abuse fines, or expulsion. The following are examples of early
• Elder abuse codes of ethics that relate to health care:
• Spousal abuse/domestic violence (most states) ■ Code of Hammurabi—written 2500 BCE in Babylonia
• Patient abuse ■ Hippocratic Oath—written 400 BCE in Greece by
• Injuries by weapons or assault Hippocrates, a physician
• Injuries sustained in the commission of a crime ■ American Medical Association’s (AMA) Code of
• Suicides or attempted suicides Ethics—first written 1847 in Philadelphia and revised
■ Vaccine administration must be reported to the desig- several times since then to remain current—refer to
nated local or state agency in most states. The required Box 4-2
information includes: ■ American Association of Medical Assistants (AAMA)
• Date Code of Ethics—refer to Box 4-3
• Vaccine, lot number, manufacturer ■ American Medical Technologists’ Standards of
Practice—refer to Box 4-4
• Name, title of person administering the vaccine, and
place administered
• Any adverse reactions (also reportable to VAERS,
the national Vaccine Adverse Events Reporting PATIENT’S BILL OF RIGHTS
System) In 1973, the American Hospital Association was the first
■ Specified medical surveillance, such as phenylketo- to publish the Patient’s Bill of Rights. Several organiza-
nuria (PKU) in newborns, must be reported to the des- tions, including health care insurers and providers, have
ignated local or state agency. followed suit. The bill outlines the courtesies and pre-
rogatives to which the patient is entitled during all health
care episodes and interactions.
-<01+; The following is a condensed version of a typical
Patient’s Bill of Rights.
Ethics are moral principles, values, and duties. The patient has the right to:
Whereas laws are enforceable regulations set forth
by the government, ethics are moral guidelines set ■ receive considerate and respectful care
forth and formally or informally enforced by peers,
■ consult the physician of his choosing
professional organizations, and the community. Exam-
ples of enforcement for breeches in ethics are censor- ■ expect confidentiality and privacy
ship of a writer, suspension from a hospital staff, or ■ receive all information regarding his condition, diag-
simply being left out by peers. nosis, treatment, and prognosis
42 =VQ\ ■ General Knowledge

*W` *W`
)5)8ZQVKQXTM[WN5MLQKIT-\PQK[ 5MLQKIT)[[Q[\QVO+WLMWN-\PQK[
ILWX\ML2]VM
The Code of Ethics of the AAMA shall set forth
I. A physician shall be dedicated to providing principles of ethical and moral conduct as they
competent medical care, with compassion relate to the medical profession and the particular
and respect for human dignity and rights. practice of medical assisting.
II. A physician shall uphold the standards of Members of the AAMA dedicated to the consci-
professionalism, be honest in all professional entious pursuit of their profession, and thus desir-
interactions, and strive to report physicians ing to merit the high regard of the entire medical
deficient in character or competence, or profession and the respect of the general public
engaging in fraud or deception, to appropri- which they serve, do pledge themselves to strive
ate entities. always to:
III. A physician shall respect the law and also A. render service with full respect for the dignity
recognize a responsibility to seek changes in of humanity;
those requirements which are contrary to B. respect confidential information obtained
the best interests of the patient.
through employment unless legally authorized
IV. A physician shall respect the rights of patients, or required by responsible performance of duty
colleagues, and other health professionals, to divulge such information;
and shall safeguard patient confidences and C. uphold the honor and high principles of the
privacy within the constraints of the law. profession and accept its disciplines;
V. A physician shall continue to study, apply, D. seek to continually improve the knowledge and
and advance scientific knowledge, maintain a skills of medical assistants for the benefit of
commitment to medical education, make patients and professional colleagues;
relevant information available to patients, E. participate in additional service activities aimed
colleagues, and the public, obtain consulta- toward improving the health and well-being of
tion, and use the talents of other health the community.
professionals when indicated.
VI. A physician shall, in the provision of appro- Reprinted with permission from the American Associa-
priate patient care, except in emergencies, tion of Medical Assistants.
be free to choose whom to serve, with whom
to associate, and the environment in which
to provide medical care.
VII. A physician shall recognize a responsibility
to participate in activities contributing to BIOETHICS
the improvement of the community and the Bioethics is moral issues dealing with biologic studies,
betterment of public health. research, procedures, policies, and decisions. Some areas
VIII. A physician shall, while caring for a patient, of bioethics are:
regard responsibility to the patient as
paramount. ■ Reproduction—artificial insemination, in vitro fertil-
IX. A physician shall support access to medical ization (IVF), surrogate parenthood, abortion, fetuses
care for all people. for research purposes
■ Genetics—screening, engineering, testing, cloning,
gene therapy
■ Death and dying—euthanasia, do-not-resuscitate (DNR)
orders, brain death, physician-assisted suicide, right
■ receive all necessary information to make an educated to die
decision regarding the course of his care ■ Transplants—source of donations, financial compensa-
■ make his own decision if competent tion for donors, priority of recipients, recipients with
diseases caused by unhealthy lifestyles
■ refuse treatment
■ Resource allocation—cost of health care; funds for
■ participate or not participate in research
research; rationing dependent on age, individual’s
■ receive continuity of care value to society, and other socioeconomic factors; pro-
■ obtain all lawful copies of his medical records longing life
 +PIX\MZ ■ Law and Ethics 43

*W` +76.1,-6<1)41<A018))
)5<;\IVLIZL[WN8ZIK\QKM A cornerstone of medical law and ethics, confidentiality
has long been a standard and expectation in health care.
AMT seeks to encourage, establish, and maintain In 1996, the federal government enacted the Health
the highest standards, traditions and principles of Insurance Portability and Accountability Act (HIPAA). A
the practices which constitute the profession of the portion of the act was concerned with the security of the
Registry. Members of the AMT Registry must rec- electronic medical record (EMR) and electronic submis-
ognize their responsibilities, not only to their sion of claims that contain sensitive information. In addi-
patients, but also to society, to other health care tion, HIPAA outlines what is considered confidential
professionals, and to themselves. The following information:
standards of practice are principles adopted by
the AMT Board of Directors, which define the ■ Names
essence of honorable and ethical behavior for a ■ Geographic subdivisions smaller than a state
health care professional:
■ Dates of birth, admission, discharge, death
1. While engaged in the Arts and Sciences, which ■ Telephone and fax numbers
constitute the practice of their profession,
■ E-mail addresses
AMT professionals shall be dedicated to the
provision of competent service. ■ Social Security numbers
2. The AMT professional shall place the welfare ■ Medical records or account numbers
of the patient above all else. ■ Health plan beneficiary numbers
3. The AMT professional understands the impor-
■ Certificate/license numbers
tance of thoroughness in the performance of
duty, compassion with patients, and the impor- ■ Vehicle or device numbers (for example, a pacemaker
tance of the tasks which may be performed. number)
4. The AMT professional shall always seek to ■ Biometric identifiers
respect the rights of patients and of health ■ Full-face photos
care providers, and shall safeguard patient
■ Any other unique identifying number, characteristic, or
confidences.
5. The AMT professional will strive to increase code
his/her technical knowledge, shall continue to ■ Age older than 89
study, and apply scientific advances in his/her
specialty. Patient information can only be released by written
6. The AMT professional shall respect the law consent of the patient, by subpoena, or in cases of
and will pledge to avoid dishonest, unethical mandatory reporting, as listed previously. All medical
or illegal practices. personnel should be aware of the ordinary daily practices
7. The AMT professional understands that in the medical office that may inadvertently lead to
he/she is not to make or offer a diagnosis or breach of patient confidentiality, including the following
interpretation unless he/she is a duly licensed examples:
physician/dentist or unless asked by the
attending physician/dentist. ■ Computer screens, including personal digital assistants
8. The AMT professional shall protect and value (PDAs), left in sight of unauthorized persons
the judgment of the attending physician or ■ Telephone conversations in earshot of others
dentist, providing this does not conflict with
■ Patient sign-in sheets
the behavior necessary to carry out Standard
Number 2 above. ■ Messages left on a patient’s phone or answering
9. The AMT professional recognizes that any machine with more information than simply to return
personal wrongdoing is his/her responsibility. the call
It is also the professional health care provider’s ■ Information given to callers who are not positively
obligation to report to the proper authorities identified as authorized to receive information
any knowledge of professional abuse. ■ Information given to family members other than the
10. The AMT professional pledges personal legal caretaker
honor and integrity to cooperate in the
■ Unattended fax machines and printers
advancement and expansion, by every lawful
means, of American Medical Technologists. ■ Unshredded patient material in open areas or trash
baskets
44 =VQ\ ■ General Knowledge

■ Patient issues discussed in unsecured areas The Joint Commission and the Occupational Safety and
■ Discussions with patients that can be overheard Health Administration (OSHA) have made safety a major
emphasis in standards and surveys.
■ Appointment lists posted on exam room doors or other
An incident report, sometimes called an occurrence
open areas
report, is a form usually required when an event occurs in
the health care facility that has the potential of resulting
>=46-:)*4-878=4)<176; in harm or loss (lawsuits). The incident report may be
one specific to that facility or one provided by the facil-
Many states have enacted legislation protecting vulnera- ity’s insurance company or attorney. The report contains
ble populations, a group of people who may be physi- the following information:
cally or mentally at risk for harm or exploitation.
Generally, infants and children, the elderly, and the dis- ■ Names and contact information of persons involved in
abled are considered vulnerable populations. The case is the event
being made, in some areas, that all patients should be
■ Date, time, and location of the event
considered vulnerable. To decrease the risk of harm by
convicted predators in certain workplace settings, ■ Brief but complete explanation of the event
including health care, the state and health care employ- ■ Names and contact information of witnesses
ers require employees to be screened and fingerprinted. ■ Any treatment or other actions
The fingerprints are sent to a federal clearinghouse,
■ Name(s) of anyone who was notified
where it is determined whether the person has been con-
victed of a crime. If a criminal record is determined to
Quality improvement (QI), formerly called quality
exist, the person may not be hired.
assurance, is measuring, improving, and remeasuring
patient outcomes based on established criteria or indica-
:1;35)6)/-5-6<;).-<A)6, tors. The emphasis of quality improvement is improved
9=)41<A 158:7>-5-6< outcomes for patients, whereas the emphasis of risk man-
agement is to avoid harm and loss. In some organizations,
As discussed earlier in this chapter, malpractice has the
quality improvement is part of risk management, and in
likelihood of resulting in lawsuits or torts. Other non-
other organizations, quality improvement is a separate
medical areas of a practice, especially those involving
committee. Regardless of the organizational structure, the
safety, may also put the office at risk for lawsuits. These
two are interrelated. For example, an insurance company,
are called risk factors (e.g., patients tripping on an electri-
while reviewing financial losses, discovers that a large per-
cal cord or sustaining injury due to malfunctioning
centage of its asthma patients frequently visit the emer-
equipment). Avoiding malpractice and ensuring safety
gency department (ED), which is expensive. To reduce the
come under an umbrella called risk management,
loss, the insurance company creates a patient education
which is a process to routinely assess, identify, correct,
program for its asthmatic patients and provides the medical
and monitor any potential hazards or risks to prevent
practices with this program. The result is that the asthmatic
harm and loss. The office’s malpractice/liability insur-
patients use the ED less, reducing the company’s financial
ance company can be of assistance in the process and
loss. The outcome for the patient is that his or her asthma
may offer reduced rates for reduced risk. Some common
is better controlled and the quality of life is improved.
examples of risk management in the medical office are:
Some common indicators are patient immunization
rates, percentage of female patients of recommended ages
■ Maintaining a daily temperature chart for refrigerators
receiving mammograms, percentage of diabetic patients
containing biopharmaceuticals
receiving eye exams, and rationale in prescribing specific
■ Requiring and ensuring all employees are current in antibiotics. The outcomes may be disease prevention,
cardiopulmonary resuscitation (CPR) early diagnosis, or more rapid recovery.
■ Reviewing drug expiration dates and removing all
medications due to expire that month
<-:5;
■ Replacing fire extinguishers once a year
■ Ensuring a system is in place to review and report Law and Ethics Review
results of all diagnostic tests The following list reviews the terms discussed in this
■ Using proper containers and techniques for disposal of chapter and provides other important terms that you
biohazardous material may see on the exam.
abandonment withdrawal by a physician from the care
Many other examples are given throughout this book of a patient without reasonable notice or provisions
and can be found in the topics related to the chapters. for another equally or better qualified provider to
 +PIX\MZ ■ Law and Ethics 45

assume care; the physician improperly terminates his fee splitting a fraudulent practice in which a physician
or her contract with the patient receives money from another physician solely for
abuse wrong or improper use referring patients to him or her
advance directives documents signed by the patient fidelity practice of meeting patients’ rights to compe-
and by witnesses stating the patient’s wishes for med- tent care, to respect, and to adherence to laws and
ical care should he or she become incapacitated agreements
Age Discrimination in Employment Act prohibits fraud an act of deceiving or misrepresenting
job discrimination for people age 40 years and older implied consent a patient’s permission in which his or
age of majority age at which a person is considered an her actions indirectly indicate approval
adult; this is state-dependent, but usually is 18 or 21 incident report a form that is usually required when
years old an event occurs in a health care facility that has the
Americans with Disabilities Act (ADA) prohibits potential to result in harm or loss (lawsuits); some-
discrimination against people with disabilities in times called an occurrence report
employment, transportation, public accommodation, informed consent a patient’s permission for a procedure,
communications, and governmental activities given after receiving all the information necessary to
battery touching a person without his or her consent make an educated decision
beneficence actions that create benefit or good invasion of privacy releasing patient information to
bioethics moral issues dealing with biologic studies, unauthorized parties without the consent of the
research, procedures, and decisions patient
breach violation of a trust justice equitable distribution of benefits and burdens
civil law type of law governing crimes or wrongs com- law a set of rules governing conduct and actions;
mitted against an individual or property, with charges enforced by a recognized authority
brought forth by the individual or a representative; libel false or malicious writing against a person’s char-
compensation (usually monetary) is sought acter or reputation
code of ethics a statement, usually from a professional malfeasance performance of an improper act, resulting
group, stating the expected behaviors of its members in or causing harm
competent adult a person who has reached the age of malpractice failure to act, improper performance of
majority and is considered of sound mind and not under that act, or performance of an improper act by a pro-
the influence of drugs or other mind-altering substances fessional, resulting in or causing harm
confidentiality protection of patient information from medical identity theft which is when a person seeking
all but authorized persons healthcare uses another person’s name or insurance
contract an agreement between two or more parties Medical Practice Acts laws established by each state
covered account a patient account that allows multiple to define medical practice, establish educational
payments or transactions requirements for physicians, describe licensing and
criminal law laws that govern crimes or wrongs com- renewal procedures and requirements, determine
mitted against society or an individual or property in conditions for revoking or suspending licenses, and
violation of an ordinance, with charges brought forth prohibit nonqualified individuals with or without a
by the government; fine or imprisonment can occur license from practicing medicine
defamation injury to a person’s character or reputation misfeasance improper performance of an act, resulting
by false or malicious statements in or causing harm
emancipated minor a person who has not reached the negligence commission or omission of an act that
age of majority but is living on his or her own and is resulted in or caused harm
self-supporting; a minor serving in the armed forces non compos mentis not of sound mind
is considered emancipated nonfeasance failure to act when there was a duty to
endorsement a method of licensure through accept- act, resulting in or causing harm
ance of a national examination score nonmalfeasance actions that avoid harm
Equal Employment Opportunity Commission Patient’s Bill of Rights a list of reasonable expectations
(EEOC) prohibits job discrimination based on race, a patient should receive from health care profession-
color, religion, sex, or national origin als regarding treatment as a patient and as an individ-
Equal Pay Act prohibits sex-based pay discrimination ual; the lists are published by formal professional
for men and women performing the same jobs groups and health care institutions
ethics moral principles or values or duties quality improvement (QI) measuring, improving, and
expressed consent verbal or written approval remeasuring patient outcomes based on established
Family Medical Leave Act (FMLA) allows employees criteria or indicators; formerly called quality assurance
up to 12 job-protected weeks of leave without pay quid pro quo “something for something”; a term gener-
for family or medical needs ally used in sexual harassment claims, suggesting that
46 =VQ\ ■ General Knowledge

career-advancing favors (promotions, raises) would standard of care uniform criterion established by an
be exchanged for sexual favors authority to determine quality or measure of health
reciprocity the acceptance by one state of a license that care or that is recognized as acceptable by usage
is issued by another state statute of limitations a legal time limit in which a per-
Red Flags Rule enacted August 1, 2009 by the son may file suit or authorities may file charges for a
Federal Trade Commission to combat medical iden- violation
tity theft subpoena a court order requiring an individual to
registration a process similar to certification in which appear in court on a given date and at a specific time
an individual, after meeting the criteria of an organi- subpoena duces tecum a court order requiring medical
zation (such as passing an exam), is listed on a state records to be brought to the court on or by a certain
or national registry date and time
release of medical records a form signed by a patient Title VII of the Civil Rights Act of 1964 Unwelcome
or his or her legal representative allowing a health sexual advances, requests for sexual favors, and other
care provider to give medical information to a per- verbal or physical conduct of a sexual nature constitutes
son or agency sexual harassment when submission to or rejection of
reportable incidents events or conditions that, by law, this conduct explicitly or implicitly affects an individ-
must be reported to a designated authority ual’s employment, unreasonably interferes with an indi-
res ipsa loquitur “the thing speaks for itself”; used to vidual’s work performance or creates an intimidating,
describe obvious cases of negligence hostile or offensive work environment (definition from
respondeat superior “let the master answer”; the U.S. Equal Employment Opportunity Commission)
employer is responsible for the actions of an tort a wrongful civil act committed against an individ-
employee if the employee followed policy and ual for which compensation is sought
procedure and stayed within the scope of his or her unbundling collecting higher reimbursement by billing
position separately for individual components of a procedure
risk management a process to routinely assess, identify, rather than for the procedure as a whole
correct, and monitor any potential hazards or risks to upcoding an illegal practice of billing more than indi-
prevent harm and loss cated for a procedure by selecting a higher than
scope of practice performance of duties and procedures appropriate code
allowed by law, standards, and educational preparation veracity truth
slander false or malicious verbal statement made against vulnerable populations a group of people who may be
another physically or mentally at risk for harm or exploitation
 +PIX\MZ ■ Law and Ethics

: - > 1 - ?  9 = - ; < 1 7 6 ;

1. Informed consent requires that the: Answer: -

A. patient have a family member present when
Why: E is the definition of informed consent. A family
the consent form is signed.
member or an attorney is not required to be present.
B. medical assistant inform the patient of all
The medical assistant may inform the patient of side
possible side effects of the procedure.
effects, but side effects are only a portion of informed
C. attorney witness the signature.
consent and not enough to make an educated decision.
D. physician treat the patient if it is an emergency.
E. information provided is enough for the Review: Yes ❏ No ❏
patient to make an educated decision.

2. Law refers to the: Answer: )

A. recognized rule of conduct enforced by a legal
Why: A is the definition of law. Charging a fee, the
authority.
Patient’s Bill of Rights, and standards of care are not law.
B. policy used to charge people fees.
C. Patient’s Bill of Rights. Review: Yes ❏ No ❏
D. established standards of care.

3. The law requires a physician to report to the Answer: ,

appropriate authorities:
Why: Elderly abuse is against the law and must be
A. a person who has received a narcotic drug.
reported to the proper authority. Under normal circum-
B. a physician who participates in genetic research.
stances, it is not required to report the activities listed in
C. a physician who conducts an abortion.
A, B, C, or E.
D. a person suspected of elderly abuse.
E. a person with cancer. Review: Yes ❏ No ❏

4. Consent for a person’s own medical treatment may Answer: ,

be given by a:
Why: A person serving in the armed forces, even if a
A. 17-year-old university student whose parents
minor, is legally able to consent to his or her own med-
are paying for school.
ical treatment. In most states, a person 16 or 17 years
B. 16-year-old who has a baby but is not married
old is considered a nonemancipated minor if still
and lives at home.
dependent on parents. Someone taking narcotic medica-
C. 21-year-old who has taken a narcotic pain
tion is not considered competent because of the
medication.
narcotic’s effects.
D. 17-year-old who is in the Navy.
Review: Yes ❏ No ❏

5. A patient’s implied consent usually covers a(n): Answer: *

A. organ donation.
Why: An electrocardiogram is considered a common
B. electrocardiogram.
procedure in a medical practice and is generally under-
C. blood transfusion.
stood to have little risk. Implied consent is sufficient for
D. appendectomy.
such procedures. The other procedures usually require
E. release of medical information.
expressed consent.
Review: Yes ❏ No ❏


48 =VQ\ ■ General Knowledge

6. A tort is: Answer: *

A. a type of criminal law.
Why: A tort is a type of civil law that deals with acciden-
B. a type of civil law.
tal or intentional harm to a person or property resulting
C. exempt from the Good Samaritan Act.
from the wrongdoing of another. It is not criminal law
D. a standard of care.
or exempt from the Good Samaritan Act if malpractice
is committed. A standard of care may be addressed in a
tort but is not a tort itself.
Review: Yes ❏ No ❏

7. Malfeasance is one form of: Answer: +

A. misfeasance.
Why: Malfeasance is performance of an improper act
B. nonfeasance.
that results in or causes harm. Malpractice is failure to act
C. malpractice.
or an improper act that results in or causes harm. Malfea-
D. malnutrition.
sance is a specific type of malpractice. Misfeasance and
E. malformation.
nonfeasance are different from malfeasance but are also
forms of malpractice. Malnutrition and malformation are
medical pathology.
Review: Yes ❏ No ❏

8. A physician may obtain his or her license by any of Answer: ,

the following EXCEPT:
Why: A physician may obtain a license through endorse-
A. endorsement.
ment, examination, or reciprocity. Registration is not a
B. examination.
process for obtaining a license to practice medicine.
C. reciprocity.
D. registration. Review: Yes ❏ No ❏

9. Advance directives include a: Answer: *

A. living memorial.
Why: A medical power of attorney gives a designated
B. medical power of attorney.
person the legal authority to make medical decisions for
C. notarized will.
the patient. This is done by the patient while he or she is
D. driver’s license.
still competent to make his or her own decisions.
E. medical examination.
Review: Yes ❏ No ❏

10. Respondeat superior refers to: Answer: *

A. a subpoena to come to court.
Why: Respondeat superior means “let the master answer”
B. a physician’s responsibility for the actions of
and refers to the physician’s responsibility for the actions
his or her staff.
of his or her staff.
C. “something for something.”
D. “respond to your superiors.” Review: Yes ❏ No ❏

11. The Good Samaritan Act does not cover a health Answer: *
care provider who:
Why: The Good Samaritan Act only covers acts outside
A. renders first aid at the scene of an accident.
of the health care profession. If you volunteer as a
B. volunteers to provide first aid at a charitable
professional, this is considered to be within the formal
“fun run.”
practice of your profession, and the Good Samaritan Act
C. helps a person who has fainted at a sporting
does not apply.
event.
D. provides care to a person having a seizure in a Review: Yes ❏ No ❏
restaurant.
E. provides first aid to a person who has a heart
attack in the health care provider’s home.
 +PIX\MZ ■ Law and Ethics 49

12. A physician who accepts payment from another Answer: )

physician for the referral of a patient is guilty of:
Why: A physician who accepts money from another
A. fee splitting.
physician for referral of a patient is guilty of fee
B. bundling.
splitting. The physician paying for the referral is also
C. battery.
guilty.
D. abandonment.
Review: Yes ❏ No ❏

13. Failure to act in a manner that a prudent and Answer: )

reasonable person would under similar circum-
Why: Negligence is an omission or commission of an act
stances is:
that a prudent and reasonable person would or would
A. negligence.
not do in similar circumstances.
B. implied consent.
C. breach of contract. Review: Yes ❏ No ❏
D. fraud.
E. abuse.

14. The “Four Ds” are used to determine malpractice; Answer: ,

the following are the “Ds” EXCEPT:
Why: A defendant is the person charged with an offense,
A. direct cause.
not an element for determining malpractice. The “Four
B. duty.
Ds” are duty, derelict, direct cause, and damage.
C. derelict.
D. defendant. Review: Yes ❏ No ❏

15. A minor may consent for all of the following Answer: -

EXCEPT:
Why: A minor cannot consent for his or her sterilization.
A. treatment of syphilis.
A minor 12 years of age and older, in most states, may
B. abortion.
consent for treatment of sexually transmitted diseases,
C. birth control.
birth control, and abortion.
D. treatment of gonorrhea.
E. sterilization. Review: Yes ❏ No ❏

16. A communicable disease to be reported to the Answer: +

county health department is:
Why: Rubella, or German measles, is a reportable com-
A. gastroenteritis.
municable disease. Gastroenteritis, infection of the
B. streptococcus.
stomach and small intestine; streptococcus, a bacterial
C. rubella.
infection; and tinnitus, ringing in the ears, are not
D. tinnitus.
required to be reported.
Review: Yes ❏ No ❏

17. Medical examiner cases involve: Answer: )

A. deaths.
Why: Medical examiner cases involve death caused by a
B. births.
criminal act or by violence, death without prior medical
C. communicable diseases.
care, and death from an undetermined cause.
D. professional misconduct.
E. respondeat superior. Review: Yes ❏ No ❏
50 =VQ\ ■ General Knowledge

18. A situation in which the very nature of the injury Answer: ,

implicates malpractice is called:
Why: Res ipsa loquitur means “the thing speaks for itself”
A. slander.
and is used in cases in which the malpractice is obvious.
B. assault.
C. defamation. Review: Yes ❏ No ❏
D. res ipsa loquitur.

19. The strongest mandatory credential regulated Answer: *

by a state to practice a profession is a(n):
Why: Licensure is the strongest mandatory credential.
A. declaration.
The remaining items are voluntary and usually not
B. licensure.
issued by a governmental agency.
C. matriculation.
D. acceptance. Review: Yes ❏ No ❏
E. warranty.

20. Medical assistants may be: Answer: *

A. licensed.
Why: Medical assistants may be certified. They are not
B. certified.
licensed by any state; therefore, reciprocity does not
C. accredited.
apply. Organizations, not individuals, are accredited.
D. reciprocated.
Review: Yes ❏ No ❏

21. Ethics deal with Answer: )

A. morals.
Why: Ethics are morals and values. Respondeat superior
B. respondeat superior.
means the physician is responsible for his or her
C. assault.
employees; assault is an attack or threat to a person; cus-
D. customs.
toms are traditions; religion is the worship of a deity.
E. religion.
Review: Yes ❏ No ❏

22. The Patient’s Bill of Rights includes the right to: Answer: ,
A. choose one’s own housing.
Why: The Patient’s Bill of Rights includes the right to
B. respect from employers.
confidentiality. A, B, C, and E do not address health
C. a fair wage.
care.
D. confidentiality.
E. an education. Review: Yes ❏ No ❏

23. The first medical code of ethics was written by: Answer: ,
A. Hippocrates.
Why: The Code of Hammurabi was written in 2500
B. Socrates.
BCE. Hippocrates, Socrates, and the American Medical
C. the AMA.
Association (AMA) wrote medical codes of ethics later.
D. Hammurabi.
Review: Yes ❏ No ❏

24. Which of the following is considered an ethical Answer: )

issue?
Why: Allocation of resources refers to the distribution of
A. Allocation of resources
funds (money), organs for transplants, needed medical
B. Childbirth
procedures, or other resources, which are ethical issues.
C. Electrical engineering
Childbirth is a medical or natural process; appendectomies
D. Appendectomies
are surgeries. Electrical engineering is a profession. (Long
E. Long waits for patients in physician offices
waits are an inconvenience!)
Review: Yes ❏ No ❏
 +PIX\MZ ■ Law and Ethics 51

25. A medical assistant publicly criticizes a physician’s Answer: )

diagnostic skills. This is an example of:
Why: The definition of slander is a false or malicious
A. slander.
statement against another. Veracity means truth; breach
B. veracity.
of confidentiality refers to releasing protected informa-
C. breach of confidentiality.
tion without consent; malpractice has to do with specific
D. malpractice.
damages to a patient. Battery is touching a person with-
out consent.
Review: Yes ❏ No ❏

26. Which of the following conditions must be Answer: *

reported?
Why: Hepatitis B is a communicable disease that must
A. Hypertension
be reported to the local or state health departments.
B. Hepatitis B
The other choices are medical conditions that do not
C. Hemiplegia
require reporting.
D. Hemorrhage
E. Anemia Review: Yes ❏ No ❏

27. A court order instructing the physician to report to Answer: +

court at a certain time and date is:
Why: A subpoena is a document that mandates a person
A. quid pro quo.
to appear in court at a given time and date. Quid pro quo
B. a contract.
means “something for something,” a favor. A contract is
C. a subpoena.
an agreement between parties; consent is permission to
D. consent.
perform or do something.
Review: Yes ❏ No ❏

28. A living will: Answer: *

A. names the beneficiaries of the estate.
Why: An advance directive is a set of instructions given
B. is an advance directive stating the patient’s
while a person is fully capacitated. One type of advance
decisions for medical care before an
directive is the living will, which states the health care
incapacitating event.
desires of a patient. Advance directives have nothing to do
C. must be drawn up by an attorney.
with the estate or estate taxes and do not have to be drawn
D. is subject to estate taxes.
up by an attorney. No will is needed for selection E.
E. allows a person to give away his or her
belongings while still alive. Review: Yes ❏ No ❏

29. Dr. Smith is no longer willing to take care of Answer: ,

Mr. Watson. If Dr. Smith does not give
Why: When a physician withdraws from the care of a
Mr. Watson proper notification and appropriate
patient without reasonable notice or provision for
time to find a new physician, Dr. Smith is guilty of:
another equally or better qualified provider to assume
A. violation of standard of care.
care, the patient/physician contract is breached and the
B. privacy.
physician is guilty of abandonment.
C. failure to act.
D. abandonment. Review: Yes ❏ No ❏

30. The patient puts out his or her arm to allow the Answer: )
physician to cleanse an abrasion. This type of
Why: Consent is implied by the patient holding out his
consent is:
or her arm. Expressed consent is verbal or written. The
A. implied.
only emergency consent is one that is “life or limb”
B. expressed.
threatening. The terms “positive” and “contracted” do
C. contracted.
not apply to consent.
D. emergency.
E. positive. Review: Yes ❏ No ❏
52 =VQ\ ■ General Knowledge

31. The physician performs an elective surgical Answer: +

procedure without a written consent. The
Why: Battery is touching someone without his or her
physician is guilty of:
consent. There is no indication that bioethics are
A. a bioethic offense.
involved or that the patient’s confidentiality has been
B. breach of confidentiality.
breached. Endorsement is one method for a physician to
C. battery.
obtain a license to practice medicine.
D. endorsement.
Review: Yes ❏ No ❏

32. The purpose of the Good Samaritan Act is to: Answer: +

A. reward health care providers for stopping at
Why: The Good Samaritan Act was designed to encourage
the scene of an accident.
health care workers to stop at the scene of emergencies by
B. ensure physicians know first aid.
protecting them from liability for civil damages.
C. protect health care workers from liability when
rendering emergency care. Review: Yes ❏ No ❏
D. avoid having to pay for first aid.
E. encourage more people to go into health care
professions.

33. Which of the following actions is governed by Answer: -

criminal law?
Why: Purposefully overcharging on a Medicare claim
A. Giving an incorrect medication
is considered fraud and is therefore covered under crim-
B. Discounting
inal law; the other choices are usually considered civil
C. Not reporting suspected measles
offenses if charges are made.
D. Telling a family member the patient’s diagnosis
E. Purposefully overcharging on a Medicare claim Review: Yes ❏ No ❏

34. A patient is treated for a minor gunshot wound Answer: *

that he states was sustained during a hunting
Why: It is the physician’s public duty to report all
accident. The physician is obligated to report this
gunshot wounds.
as part of:
A. implied consent. Review: Yes ❏ No ❏
B. public duty.
C. mandatory counseling.
D. standard of care.
E. respondeat superior.

35. A patient calls to make an appointment and states Answer: ,

the symptoms for the office visit. The scheduler
Why: A person scheduling appointments has not been
says, “That sounds like the flu.” The health care
trained to diagnose. A diagnosis can only be made by a
worker violated the:
physician or mid-level provider such as a physician’s
A. code of ethics.
assistant or nurse practitioner.
B. Patient’s Bill of Rights.
C. Health Insurance Portability and Review: Yes ❏ No ❏
Accountability Act.
D. scope of practice.

36. Mandatory reporting is required in all of the Answer: +

following cases EXCEPT:
Why: Alcohol abuse is not considered reportable,
A. child abuse.
whereas child abuse, death from an unknown cause, and
B. unknown cause of death.
elder abuse must be reported.
C. alcohol abuse.
D. elder abuse. Review: Yes ❏ No ❏
E. communicable disease.
 +PIX\MZ ■ Law and Ethics 53

37. A form of malpractice is nonfeasance, which Answer: )

means:
Why: The definition of nonfeasance is the failure to act
A. failure to act when duty is indicated, resulting
when duty is indicated, resulting in or causing harm. B is
in or causing harm.
misfeasance; C is malfeasance; D and E have nothing to
B. improper performance of an act, resulting in or
do with malpractice.
causing harm.
C. performance of an improper act, resulting in or Review: Yes ❏ No ❏
causing harm.
D. not charging a fee.

38. A physician casts a fracture of the ulna incorrectly. Answer: +

This results in malformation of the arm. The
Why: A tort is accidental or intentional harm to a person
physician could be charged with:
or property resulting from the wrongdoing of another.
A. misadventure.
The other choices do not deal with medical
B. malunion.
wrongdoings.
C. tort.
D. torticollis. Review: Yes ❏ No ❏
E. battery.

39. The medical office must comply with the Answer: -

regulations and standards of:
Why: The Occupational Safety and Health Administra-
A. AFL.
tion (OSHA) is a regulatory governmental agency; its
B. AAMA.
mandates must be followed or legal actions may be
C. GOP.
imposed. The American Federation of Labor (AFL), the
D. AARP.
American Association of Medical Assistants (AAMA),
E. OSHA.
and the Republican Party (GOP) are voluntary special
interest organizations.
Review: Yes ❏ No ❏

40. All of the following are governmental agencies Answer: )

setting standards and regulations that must be
Why: The Joint Commission is the only nongovernmen-
followed by medical offices EXCEPT:
tal voluntary agency in this list. The Drug Enforcement
A. The Joint Commission.
Administration (DEA), Internal Revenue Service (IRS),
B. DEA.
and Food and Drug Administration (FDA) are all
C. IRS.
governmental agencies with regulations affecting the
D. FDA.
medical office.
Review: Yes ❏ No ❏

41. The physician’s office shares a patient’s medical Answer: )

information with an insurance company. The
Why: Providing a patient’s medical information to an
physician’s office did not have the patient’s written
outside party without the patient’s written consent is a
consent. The office is guilty of:
breach of confidentiality.
A. breach of confidentiality.
B. slander. Review: Yes ❏ No ❏
C. abuse.
D. breach of respect.
54 =VQ\ ■ General Knowledge

42. A wheelchair patient could not use the medical Answer: -

office restroom because it was too small for the
Why: The Americans with Disabilities Act (ADA)
wheelchair. This office is in violation of:
mandates that certain workplaces, including medical
A. CLIA.
offices, must provide accommodations for persons with
B. FDA.
special needs. CLIA is the Clinical Laboratory Improve-
C. OSHA.
ment Amendments, FDA is the Food and Drug Admin-
D. CDC.
istration, OSHA is the Occupational Safety and Health
E. ADA.
Administration, and CDC is the Centers for Disease
Control and Prevention.
Review: Yes ❏ No ❏

43. A typical Patient’s Bill of Rights includes the Answer: +

right to:
Why: All Patient’s Bills of Rights include the right to
A. request free treatment.
refuse treatment. A and B are not included in any
B. report patient dissatisfaction with the doctor to
Patient’s Bill of Rights, and D involves tort law.
the medical assistant.
C. refuse treatment. Review: Yes ❏ No ❏
D. sue the doctor for breach of contract.

44. A valid contract must: Answer: *

A. be paid in full at the beginning of the period
Why: One of the five components of a valid contract is
covered.
that all parties must be legally capable of accepting the
B. be entered into by competent parties.
terms or be competent. The other four requirements
C. always be in writing.
are:
D. always cover the patient’s family.
E. always have a witness. ■ an offer must be made,
■ the offer must be accepted,
■ an exchange of value between the parties must occur, and
■ the intent must be legal.

Review: Yes ❏ No ❏

45. The purpose of law is to: Answer: ,

A. legalize cardiopulmonary training.
Why: The purposes of law are to regulate conduct, to
B. provide jobs.
punish offenders, to remedy wrongs, and to benefit
C. benefit special interest groups.
society.
D. remedy wrongs.
Review: Yes ❏ No ❏

46. An expressed contract is: Answer: )

A. written.
Why: The definition of an expressed contract is one that
B. implied.
is written or verbal and describes what each contractual
C. reportable.
party will do. A contract is implied when it is deduced
D. sent via FedEx.
by the parties’ actions. Contracts are generally not
E. illegal.
reportable. How contracts are delivered is the decision
of the consenting parties. An expressed contract is not
illegal.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Law and Ethics 55

47. Written consent for medical care must be: Answer: )

A. voluntary.
Why: Consent for medical care is voluntary permission
B. uninformed.
by the appropriate party. Consent should never be
C. given for all procedures.
uninformed, and written consent is not given for all
D. done on a word processor.
procedures; for noninvasive procedures with low risk,
implied consent is sufficient. Written consent may be in
many forms and can even be handwritten.
Review: Yes ❏ No ❏

48. Examples of ethical cases affected by the law are Answer: )

cases involving:
Why: The right to die is an ethical issue addressed by the
A. the right to die.
law in cases such as assisted suicide or euthanasia.
B. the use of synthetic drugs.
The use of synthetic drugs and endoscopy are common
C. endoscopy.
practices. Licensure is required by states and comes
D. licensure.
under administrative law.
Review: Yes ❏ No ❏

49. Ethical issues are addressed in: Answer: *

A. insurance codes.
Why: Professional codes, dating back to 2500 BCE,
B. professional codes.
address moral behavior and ethics. The other codes
C. billing codes.
listed involve medical office procedures.
D. safety codes.
E. tort law Review: Yes ❏ No ❏

50. In cases of public safety: Answer: )

A. the laws protecting the general population
Why: The laws protecting the public safety take
usually take precedence over an individual’s
precedence. In instances such as contamination and
rights.
quarantine, the rights of patients are secondary to the
B. the AMA is often consulted.
public safety.
C. a person cannot go in public with a
The AMA is not generally consulted in these cases,
communicable disease.
and very few communicable diseases mandate
D. the government must uphold all Patient’s
quarantine. The government is not obligated to uphold
Bills of Rights.
nongovernmental agencies’ Patient’s Bills of Rights.
Review: Yes ❏ No ❏

51. A medical assistant could be held liable for the Answer: +

actions of:
Why: A medical assistant who knowingly withholds
A. a patient.
information involving illegal and, in some cases,
B. the insurance company.
immoral actions of a coworker could be held liable. He
C. a coworker.
or she is not responsible for the actions of the patient,
D. the court.
insurance company, or court.
E. the hospital
Review: Yes ❏ No ❏
56 =VQ\ ■ General Knowledge

52. A patient outcome resulting from the quality Answer: )

improvement process may be preventing:
Why: Preventing illness is directly related to the patient
A. illness.
and quality of care; preventing an increase in insurance
B. an increase in insurance rates.
rates, preventing financial loss, and preventing incident
C. financial loss.
reports are components of risk management.
D. incident reports.
Review: Yes ❏ No ❏

53. All of the following are examples of risk Answer: *

management EXCEPT:
Why: Ensuring the coffee pot is turned off and reporting
A. ensuring the coffee pot is turned off at the end
a frayed wire are intended to prevent fire (loss); checking
of the day.
the emergency cart is intended to provide an
B. giving the patient an injection ordered by the
appropriate standard of care if an emergency occurs
physician.
(prevent harm and loss). However, giving the patient an
C. checking the emergency cart.
injection is part of the prescribed patient’s treatment. It
D. reporting a frayed lamp wire.
is not considered risk management.
E. repairing a tear in the carpet to prevent
tripping. Review: Yes ❏ No ❏

54. The AMA Principles of Medical Ethics require a Answer: ,

physician to:
Why: Article II of the AMA Principles of Medical Ethics
A. belong to the AMA.
states: “A physician shall uphold the standards of profes-
B. treat patients on Medicare.
sionalism, be honest in all professional interactions, and
C. contribute to political action campaigns (PAC).
strive to report physicians deficient in character or com-
D. report other physicians deficient in character or
petence, or engaging in fraud or deception, to appropri-
competence.
ate entities.” The other answers may be implied but do
not specifically deal with ethics.
Review: Yes ❏ No ❏

55. What prohibits job discrimination for race, color, Answer: )

religion, sex, or national origin?
Why: The Equal Employment Opportunity Commission
A. EEOC
is the agency that prohibits job discrimination for race,
B. FMLA
color, religion, sex, or national origin. The FMLA
C. ADA
involves family leave; the ADA prohibits discrimination
D. Equal Pay Act
against people with disabilities; the Equal Pay Act
E. HIPAA
requires equal pay for equal work; and HIPAA involves
confidentiality in health care.
Review: Yes ❏ No ❏

56. Employment law is generally considered: Answer: -

A. criminal law.
Why: Employment law concerns administrative regula-
B. tort law.
tions for the workplace. Criminal law and tort law are
C. bioethics.
not limited to a specific venue. Contract law concerns an
D. contract law.
agreement between two parties, and bioethics are not
E. administrative law.
laws.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Law and Ethics 57

57. The purpose of the Red Flags Rule is to: Answer: +

A. have national holidays off.
Why: The Red Flags Rule was enacted by the Federal
B. watch for Medicare fraud.
Trade Commission August 2009 for the purpose of leg-
C. guard for medical identity theft.
islating certain businesses to implement a program to
D. check references before hiring.
prevent, detect and mitigate medical identity theft.
Review: Yes ❏ No ❏
 Medical Terminology
5

: - > 1 - ?  < 1 8 
Medical terminologgy is a good area for the “learningg moments” strategi
g es described in Chappter 1.
Make flashcards and have people around you ask questions whenever there is an opportunity.
Use the word list in this chapter. Continue to use flashcards as you study other chapters.
Caution: Be careful of terms that sound similar but have different meanings, such as “melanin”
and “melatonin.”

Medical terminology is a significant portion of the ?7:,8):<;

national exams. Questions in other chapters may be
answered by knowing the meaning of the term. Medical A medical term may have three parts—the prefix, the
terminology is comparable to a foreign language. You root, and the suffix. The meaning is found by decipher-
may pick up pieces and phrases just by being around ing the clues.
those who speak it, but you could not expect to pass an 1. Prefix  beginning of the word; it modifies the root
exam in that language without some study. If you are a (not all medical terms have a prefix)
medical assistant or medical administrative specialist Example of a term with no prefix: TONSILLECTOMY
who received on-the-job training, this may apply to you, (removal of tonsils)
especially if you have been working in a specialty practice root: tonsil/o  tonsils
(e.g., obstetrics, where the terminology is basically lim- suffix: -ectomy  removal of
ited to the female reproductive system). Certification 2. Root  meaning or central part of the word; it often
exam questions may require you to select not only the refers to a body part (nearly all medical terms have a
meaning but also the correct spelling of a term. root)

!
60 =VQ\ ■ General Knowledge

*W`
+WUUWV8ZMNQ`M[IVL5MIVQVO
a/n-: absence of endo-: within mono-: one, single
ab-: away from epi-: on, attached to, over multi-: many
ad-: toward ex-: out neo-: new
ante-: before hemi-: half para-: beside
anti-: against hemo-: pertaining to blood per-: through
auto-: self hyper-: high, excessive peri-: around, enclosing
bi-: both, two hypo-: below poly-: many
bio-: life inter-: between post-: after
circum-: around intra-: within pre-: before
con-: with, together iso-: equal primi-: first
contra-: against, opposite mal-: bad retro-: back, behind
dis-: apart, separate mega-: large semi-: half
dys-: painful, difficult meso-: middle sub-: under
ec-: out meta-: beyond super-: excessive
ecto-: outside of micro-: very small supra-: above
en-: in milli-: one thousandth syn-: together, with

3. Suffix  ending of the word; it modifies the root and the material. Take a break, get some fresh air, and, as an
usually refers to a condition, procedure, or action (not unknown philosopher said, “Eat your elephant one bite
all medical terms have a suffix) at a time,” which means that you should take it one step
Example of a term with no suffix: TONSIL (lym- at a time.
phatic tissue in the pharynx)
root: tonsil 5-,1+)4<-:516747/A:->1-?)1,;
Example of a term with a prefix, root, and suffix:
HYPERTHERMIC (abnormally high temperature) The following words and word parts will help with
prefix: hyper-  high, above, super breaking down and building other medical terms and
root: therm/o  related to temperature determining their meaning.
suffix: -ic  condition/state related to the root
Think of an example of a medical term for each of the
BODY PLANES
prefixes (Box 5-1), suffixes (Box 5-2), and roots (Box 5-3).
Medical terminology is difficult and may require more ■ Median or midline plane—a lengthwise plane through
time. Use the Review Tip. Consider adding another the midline running front to back dividing the body
week to your study plan if you are not comfortable with into equal right and left halves

*W`
+WUUWV;]NNQ`M[IVL5MIVQVO
-ad: toward -ism: condition of -philia: abnormal attraction
-al: relating to -itis: inflammation -phobia: abnormal fear
-ectomy: removal of -logist: specialist in -plasia: formation
-emesis: vomiting -logy: study of -plasty: surgical repair
-genic: producing -lysis: destruction of -ptosis: drooping
-genetic: origin- related -megaly: enlargement -rrhage: burst forth
-graph: recording instrument -meter: measurement instrument -rrhea: discharge
-graphy: recording process -oma: tumor -scope: viewing instrument
-iatric: treatment of -osis: condition of -scopy: procedure using a scope
-iatry: field of medicine -pathy: disease -stomy: creating a surgical opening
-ic: relating to -penia: abnormal decrease -tomy: incision into
 +PIX\MZ ■ Medical Terminology 61

*W` ■ Posterior or dorsal—on the back side of the body

■ Proximal—nearer a point of reference, usually the
+WUUWV:WW\[IVL5MIVQVO[
trunk or middle of the body
aden/o: gland glyc/o: sugar, glucose ■ Distal—farther away from a point of reference
arteri/o: artery hepat/o: liver ■ Medial—closer to the midline of the body
arthr/o: joint hist/o: tissue ■ Lateral—toward the side of the body or away from the
audi/o: hearing ir/o: iris midline
blephar/o: eyelid kal/i: potassium
■ Internal or deep—on the inside of the body
bucc/o: cheek lacrim/o: tear
burs/o: bursa lamin/o: lamina ■ External or superficial—on or close to the outside of
calc/i: stone lapar/o: abdomen the body
cardi/o: heart leuk/o: white
cervic/o: neck, neck lip/o: fat
of an organ
LOCATING TERMS
cholecyst/o: myel/o: spinal cord ■ Cephalic or cranial—referring to the head or head end
gallbladder ■ Caudal—referring to the tail or tail end
conjunctiv/o: my/o: muscle
■ Palmar—referring to the front (while standing in
conjunctiva
anatomical position) or palm of the hand
cost/o: rib nephr/o: kidney
crani/o: skull neur/o: nerve ■ Plantar—referring to the sole or bottom of the foot
cutane/o: skin onc/o: tumor
cyan/o: blue opt/o: vision
cyst/o: bladder oste/o: bone
DIAGNOSTIC, SYMPTOMATIC, AND RELATED
cyt/o: cell pector/o: chest SUFFIXES
derm/o: skin pneumon/o: lung ■ -algia—pain
dors/o: back psych/o: mind ■ -cele—hernia, swelling
encephal/o: brain retin/o: retina
fasci/o: fibrous tissue rhin/o: nose ■ -genesis (-gen)—forming, producing
fibr/o: connective synovi/o: lining the joint ■ -gram—record, a writing
tissue ■ -graph—instrument for recording
gastr/o: stomach tend/o: tendon ■ -iasis—abnormal condition
gingiv/o: gum ven/o:- vein
■ -itis—inflammation
■ -malacia—softening
■ Sagittal plane—a lengthwise plane parallel to the mid-
■ -oid—resembling
line running front to back dividing the body or any
part of it into unequal right and left sides or parts ■ -oma—tumor

■ Coronal or frontal plane—a lengthwise plane running ■ -osis—abnormal condition or increase (used primarily
side to side dividing the body into front and back parts with blood cells)
■ Transverse or horizontal plane—a crosswise plane ■ -pathy—disease
dividing the body into upper and lower parts ■ -penia—decrease, deficiency
■ -phagia—eating, swallowing
■ -plegia—paralysis
DIRECTIONAL TERMS
■ -rrhage—bursting forth
Directional terms make it possible to say that something ■ -rrhea—discharge, flow
is above, below, to the left or right of, behind or in front
■ -rrhexis—rupture
of, or nearer or farther from something else.
■ -stasis—standing still
■ Superior—toward the head end or toward the upper ■ -stenosis—narrowing, stricture
part of the body
■ Inferior—farther away from the head or toward the
SURGICAL PROCEDURES
lower part of the body
■ Anterior or ventral—on the front or abdominal side of ■ -centesis—to puncture in order to aspirate
the body ■ -desis—binding or fixation
62 =VQ\ ■ General Knowledge

■ -ectomy—excision, surgical removal of gingivoglossitis inflammation of the gums and tongue

■ -lithotomy—incision for removal of stones gynecopathy any disease of the female reproductive
system
■ -otomy—incision into
hemiplegia paralysis of one half of the body
■ -pexy—suspension or fixation hemostasis to stop or control bleeding
■ -plasty—repair or surgical reconstruction of hepatomegaly enlargement of the liver
■ -scopy—inspection/examination through a hyperplasia excessive formation of cells or tissue
lighted scope hypoglycemia less than normal blood sugar level
hypothermia below normal temperature
■ -stomy—creation of a new opening for drainage
hysterorrhaphy suturing of the uterus
inter- between, in the midst
intracerebral within the main part of the brain
<-:5; intravascular within a vessel
laparotomy incision of the abdominal wall
Medical Terminology Review
leukopenia decreased white cells
(Suggestion: use these terms to make flashcards.) lipectomy excision of fatty tissue
ab- away from, absent litholysis destruction of a stone
abdominocentesis surgical puncture of the abdomen -logy the study of
to remove fluid lymphadenitis inflammation of the lymph
acrocyanosis blue condition of the extremities glands/nodes
adenoma tumor of a gland -lysis destruction, destroy, dissolution
adrenomegaly enlargement of the adrenal gland(s) -malacia softening of tissue
-algesia pain, sensitivity to pain mammoplasty surgical reconstruction of the breast
analgesia take away pain, free from pain meningocele herniation of the meninges
anteroposterior passing from front to rear menostasis suppression of menses
antipyretic against fever; fever reducing metrorrhexis rupture of the uterus
aplasia lack of formation or development; usually refers myc/o fungus or mold
to an organ nasopharyngeal pertaining to nose and throat
arteriosclerosis thickening (hardening) of the necrosis death of tissue or bone
arteries nephrolysis destruction of kidney tissue
arthritis inflammation of the joints nephropathy disease of the kidney
bradycardia slow heart rate (pulse) neuralgia pain in the nerves
cardiomegaly enlargement of the heart neuropathy disease of the nerves
cervicofacial pertaining to the face and neck neurotripsy surgical crushing of a nerve
chiroplasty surgical repair of the hands onychocryptosis an ingrown (hidden) nail, finger
cholecystitis inflammation of the gallbladder or toe
cyanosis bluish condition of the skin onychomycosis condition of fungus of the nails
cystitis bladder inflammation oophorectomy excision of an ovary
cytology study of cells orchidectomy surgical removal of a testicle
cytoscopy microscopic examination of cells osteoarthropathy disease of joints and bones
dacryocystitis inflammation of a tear sac osteocyte bone cell
dactyl/o digit, finger or toe otalgia pain in the ear
dermatosis any skin lesion or eruption -pepsis digestion
dextr/o right peri- around, about
duodenoscopy inspection of the duodenum with a phag/o to ingest or eat
scope phleborrhexis rupture of a vein
dyskinesia difficult or painful movement -phonia voice
dyspepsia indigestion or painful digestion pneum/o air
-emia pertaining to the blood pneumon/o lung
encephal/o pertaining to the brain posteromedial middle of the back, middle of back
encephalitis inflammation of the brain side
endocarditis inflammation of the inside lining of the proctorrhagia hemorrhage from the rectum
heart pyeloplasty surgical repair of the renal pelvis
enteritis inflammation of the small intestine pyogenesis formation of pus
gastrectasia stretching of the stomach retinopathy disease of the retina
gastritis inflammation of the stomach retroperitoneal behind the peritoneum
 +PIX\MZ ■ Medical Terminology 63

rhinorrhea flow or discharge from the nose subpulmonary below the lungs
-rrhagia burst forth, hemorrhage tachycardia increased heart rate (pulse)
-rrhexis rupture of a vessel, organ, or tissue tenodynia painful tendon
splenomegaly enlargement of the spleen thrombectomy surgical removal of a blood clot
-stasis to stop or control transthorax across the chest
sten/o narrowing tympan/o eardrum, drumlike
stomatomycosis condition of fungus in the mouth unilateral on one side
-stomy forming a new opening vas/o vessel or duct
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA), RMA (AMT), and CMAS (AMT) exams.

1. The word root vas/o means: Answer: +

A. vein.
Why: vas/o  vessel or duct
B. artery.
C. vessel. Review: Yes ❏ No ❏
D. capillary.

2. The word root pneumon/o means: Answer: -

A. air.
Why: pneumon/o  lung
B. breathing.
C. bronchus. Review: Yes ❏ No ❏
D. pleura.
E. lung.

3. The suffix -rrhexis means: Answer: ,

A. discharge.
Why: -rrhexis  rupture of a vessel, organ, or tissue
B. pain.
C. flow. Review: Yes ❏ No ❏
D. rupture.

4. The word root myc/o means: Answer: ,

A. muscle.
Why: myc/o  fungus or mold
B. many.
C. middle. Review: Yes ❏ No ❏
D. mold.
E. mucus.

5. The term rhinorrhea means: Answer: +

A. inflammation of the nose.
Why: rhin/o  nose
B. suturing of the nostrils.
-rrhea  flow or discharge
C. discharge from the nose.
D. enlargement of the nose. Review: Yes ❏ No ❏

6. The term hepatomegaly means: Answer: ,

A. dysfunction of the kidneys.
Why: hepat/o  liver
B. underdevelopment of the liver.
-megaly  enlargement
C. increased production of blood cells.
D. enlargement of the liver. Review: Yes ❏ No ❏
E. hemorrhage from the liver.

7. The suffix -lysis refers to: Answer: ,

A. formation.
Why: -lysis  dissolution or destruction
B. hardening.
C. abnormal. Review: Yes ❏ No ❏
D. destruction.


 +PIX\MZ ■ Medical Terminology 65

8. The word root phag/o means: Answer: -

A. grow.
Why: phag/o  to ingest or eat
B. chew.
C. repair. Review: Yes ❏ No ❏
D. narrow.
E. ingest.

9. The term for voice is: Answer: ,

A. phobia.
Why: -phonia, phon/o  voice
B. ptosis.
C. phasia. Review: Yes ❏ No ❏
D. phonia.

10. The term -malacia means: Answer: +

A. accumulation.
Why: -malacia  softening of tissues
B. drooping.
C. softening. Review: Yes ❏ No ❏
D. constriction.
E. hardening.

11. The term neuropathy means: Answer: +

A. inflammation of the nerves.
Why: neur/o  nerves
B. hardening of the nerves.
-pathy  disease, disease process
C. disease of the nerves.
D. surgical removal of nerves. Review: Yes ❏ No ❏

12. The suffix -rrhagia means: Answer: -

A. rupture.
Why: -rrhagia  bursting forth
B. inflammation.
C. painful. Review: Yes ❏ No ❏
D. surgical suturing.
E. burst forth.

13. The term gastritis means: Answer: +

A. disease of the gallbladder.
Why: gastr/o  stomach
B. flow from the duodenum.
-itis  inflammation
C. inflammation of the stomach.
D. rupture of the spleen. Review: Yes ❏ No ❏

14. Inflammation of the joints is known as: Answer: ,

A. tendonitis.
Why: arthr/o  joints
B. bursitis.
-itis  inflammation
C. osteitis.
D. arthritis. Review: Yes ❏ No ❏
E. myositis.

15. The term hypoglycemia means: Answer: *

A. elevated blood sugar level.
Why: hypo-  low, under normal level
B. lower than normal blood sugar level.
glyc/o  sugar, glucose
C. presence of sugar in the blood.
-emia  pertaining to blood
D. elevated sodium level.
Review: Yes ❏ No ❏
66 =VQ\ ■ General Knowledge

16. The term otalgia means: Answer: +

A. discharge from the ear.
Why: ot/o  ear
B. disease of the ear.
-algia  pain
C. pain in the ear.
D. inflammation of the ear. Review: Yes ❏ No ❏
E. opening in the ear.

17. The medical term that means to control bleeding is: Answer: )
A. hemostasis.
Why: hem/o  blood
B. hemophilia.
-stasis  to stop or control
C. hematoma.
D. hemoccult. Review: Yes ❏ No ❏

18. The term enteritis means: Answer: +

A. inflammation of the colon.
Why: enter/o  small intestine
B. disease of the large intestine.
-itis  inflammation
C. inflammation of the small intestine.
D. disease of the esophagus. Review: Yes ❏ No ❏
E. inflammation of the mouth.

19. The term meaning indigestion or painful digestion is: Answer: ,

A. dyspnea.
Why: dys-  painful or difficult
B. dysphagia.
-pepsis  digestion
C. dysplasia.
D. dyspepsia. Review: Yes ❏ No ❏

20. The medical term used to describe any skin lesion Answer: -
or eruption is:
Why: dermat/o  skin
A. dermatomycosis.
-osis  any condition, process
B. dermatoplasty.
C. dermatoid. Review: Yes ❏ No ❏
D. dermatoma.
E. dermatosis.

21. The term meaning bladder inflammation is: Answer: ,

A. cystorrhexis.
Why: cyst/o  bladder or sac
B. cystocele.
-itis  inflammation
C. cystalgia.
D. cystitis. Review: Yes ❏ No ❏

22. The term bradycardia means: Answer: +

A. slow blood pressure.
Why: brady-  slow
B. increased blood flow.
cardi/o  the heart
C. slow heart rate.
-a  pertaining to
D. increased heart rate.
E. slow blood flow. Review: Yes ❏ No ❏
 +PIX\MZ ■ Medical Terminology 67

23. The word part -algesia means: Answer: +

A. against.
Why: -algesia  sensation of pain
B. pertaining to.
C. pain. Review: Yes ❏ No ❏
D. without.

24. The word part dextr/o means: Answer: -

A. sugar.
Why: dextr/o  right or on the right side
B. glucose.
C. left. Review: Yes ❏ No ❏
D. back.
E. right.

25. The word part encephal/o means: Answer: )

A. brain.
Why: encephal/o  inside the head (the brain)
B. head.
C. cerebrum. Review: Yes ❏ No ❏
D. skull.

26. The term osteocyte means: Answer: +

A. compact bone.
Why: oste/o  pertaining to bone
B. spongy bone.
-cyte  cell
C. bone cell.
D. bone cyst. Review: Yes ❏ No ❏
E. bone infection.

27. The word part meaning eardrum is: Answer: ,

A. cochle/o.
Why: tympan/o  a structure that is drumlike
B. salping/o.
C. myring/o. Review: Yes ❏ No ❏
D. tympan/o.

28. The term oophorectomy means: Answer: -

A. formation of an ovum.
Why: oophor/o  pertaining to the ovary
B. repair of an ovary.
-ectomy  surgical removal, excision
C. rupture of the uterus.
D. incision into the uterus. Review: Yes ❏ No ❏
E. excision of an ovary.

29. The term nephropathy means: Answer: ,

A. distention of the bladder.
Why: nephr/o  kidney
B. infection in the kidney.
-pathy  any disease
C. inflammation of a nerve.
D. disease of the kidney. Review: Yes ❏ No ❏

30. The term acrocyanosis means a blue condition Answer: )

of the:
Why: acr/o  extremity
A. extremities.
cyan/o  blue
B. neck.
-osis  any condition
C. face.
D. torso. Review: Yes ❏ No ❏
E. head.
68 =VQ\ ■ General Knowledge

31. The term splenomegaly means: Answer: ,

A. prolapse of the spleen.
Why: splen/o  pertaining to the spleen
B. dysfunction of the spleen.
-megaly  great, enlarged
C. pain in the spleen.
D. enlargement of the spleen. Review: Yes ❏ No ❏

32. The medical term meaning within a vessel is: Answer: +

A. intercellular.
Why: intra-  within
B. interarterial.
vascul/o  vessel
C. intravascular.
-ar  pertaining to
D. intravalvular.
E. intra-articular. Review: Yes ❏ No ❏

33. The term abdominocentesis means: Answer: )

A. surgical puncture of the abdomen.
Why: abdomin/o  pertaining to the abdomen
B. swelling of the abdomen.
-centesis  to puncture
C. dilation of the abdomen.
D. suturing of the abdomen. Review: Yes ❏ No ❏

34. The suffix -stomy means: Answer: ,

A. to cut into.
Why: -stomy  to make a new opening
B. surgical repair.
C. surgical removal. Review: Yes ❏ No ❏
D. to form a new opening.
E. to suture an opening.

35. The term stenosis means: Answer: ,

A. softening.
Why: sten/o  narrow
B. dilation.
-osis  condition
C. spasm.
D. narrowing. Review: Yes ❏ No ❏

36. Cardiomegaly is a term that means: Answer: -

A. rupture of the heart.
Why: cardi/o  heart
B. hardening of the heart tissue.
-megaly  large or enlargement
C. inflammation of the heart.
D. occlusion of heart vessels. Review: Yes ❏ No ❏
E. enlargement of the heart.

37. The term lymphadenitis means: Answer: ,

A. inflammation of lymph fluid.
Why: lymph/o  pertaining to lymph
B. inflammation of adrenal glands.
aden/o  pertaining to a gland
C. infection of the spleen.
-itis  inflammation
D. inflammation of the lymph glands/nodes.
Review: Yes ❏ No ❏

38. A term meaning rupture of the uterus is: Answer: *

A. metrorrhea.
Why: metr/o  related to the uterus
B. metrorrhexis.
-rrhexis  rupture of a body part
C. menorrhagia.
D. meatorrhaphy. Review: Yes ❏ No ❏
E. metritis.
 +PIX\MZ ■ Medical Terminology 69

39. The microscopic examination of cells is called: Answer: )

A. cytoscopy.
Why: cyt/o  cell
B. cystoscope.
-scopy  to study or examine
C. cythemia.
D. cystotomy. Review: Yes ❏ No ❏

40. The prefix meaning between is: Answer: +

A. extra-.
Why: inter-  between, in the midst
B. intra-.
C. inter-. Review: Yes ❏ No ❏
D. supra-.
E. infra-.

41. The term used for surgical removal of a blood Answer: ,

clot is:
Why: thromb/o  clot, blood clot
A. hematectomy.
-ectomy  surgical removal, to excise
B. hemolysis.
C. thrombolysis. Review: Yes ❏ No ❏
D. thrombectomy.

42. The term meaning hemorrhage from an artery is: Answer: *

A. arteriosclerosis.
Why: arteri/o  artery
B. arteriorrhagia.
-rrhagia  hemorrhage, to burst forth
C. arteriorrhaphy.
D. arteriolysis. Review: Yes ❏ No ❏
E. arteriotomy.

43. The term meaning destruction of a stone is: Answer: *

A. lithogenesis.
Why: lith/o  stone, calculus
B. litholysis.
-lysis  destruction
C. lithiasis.
D. lithotomy. Review: Yes ❏ No ❏

44. The term meaning below the lungs is: Answer: )

A. subpulmonary.
Why: sub-  beneath, under
B. infrapulmonary.
pulmon/o  lungs
C. interpulmonary.
-ary  pertaining to
D. interthoracic.
E. intercostal. Review: Yes ❏ No ❏

45. The term cholecystitis means inflammation Answer: )

of the:
Why: chol/e  bile (gall)
A. gallbladder.
cyst/o  bladder, sac
B. liver.
-itis  inflammation
C. adrenal glands.
D. kidneys. Review: Yes ❏ No ❏
70 =VQ\ ■ General Knowledge

46. The term stomatomycosis means a condition of: Answer: )

A. fungus in the mouth.
Why: stomat/o  mouth, opening
B. mucus in the mouth.
myc/o  fungus
C. fungus in the stomach.
-osis  condition
D. mucus in the stomach.
E. inflammation of the mouth. Review: Yes ❏ No ❏

47. The term for inflammation of the gums and Answer: )

tongue is:
Why: gingiv/o  gum tissue
A. gingivoglossitis.
gloss/o  tongue
B. stomatitis.
-itis  inflammation
C. glossopharyngitis.
D. glossostomatitis. Review: Yes ❏ No ❏

48. The term meaning incision of the abdominal wall is: Answer: +
A. abdominocentesis.
Why: lapar/o  abdomen, abdominal wall
B. laparectomy.
-tomy  incision into
C. laparotomy.
D. peritonitis. Review: Yes ❏ No ❏
E. gastrotomy.

49. The term meaning behind the peritoneum is: Answer: *

A. subperitoneal.
Why: retro-  located behind, backward
B. retroperitoneal.
peritone/o  pertaining to the peritoneum
C. subabdominal.
-al  pertaining to
D. intraperitoneal.
Review: Yes ❏ No ❏

50. The term meaning surgical repair of the hands is: Answer: +
A. chiromegaly.
Why: chir/o  pertaining to the hand
B. dactylomegaly.
-plasty  surgical repair, plastic surgery
C. chiroplasty.
D. dactyloplasty. Review: Yes ❏ No ❏
E. dactylitis.

51. A term meaning stretching of the stomach is: Answer: )

A. gastrectasia.
Why: gastr/o  stomach
B. gastralgia.
-ectasia  dilation, stretching
C. gastrorrhagia.
D. gastroplasty. Review: Yes ❏ No ❏

52. The term meaning take away pain, free from pain is: Answer: *
A. algesia.
Why: an-  without
B. analgesia.
-algesia  sensation of pain
C. angina.
D. anesthesia. Review: Yes ❏ No ❏
E. dysplasia.
 +PIX\MZ ■ Medical Terminology 71

53. The term meaning inflammation of the brain is: Answer: +

A. meningitis.
Why: en-  within
B. cephalgesia.
cephal/o  head
C. encephalitis.
-itis  inflammation
D. encephalomeningitis.
Review: Yes ❏ No ❏

54. The word root dactyl/o means: Answer: -

A. ear.
Why: dactyl/o  digit, finger or toe
B. foot.
C. hand. Review: Yes ❏ No ❏
D. eye.
E. finger.

55. The term dyskinesia means: Answer: *

A. painful knee.
Why: dys-  difficult, painful
B. difficult movement.
kinesi/o  movement, motion
C. deformed spine.
-ia  pertaining to
D. curved spine.
Review: Yes ❏ No ❏

56. The term meaning increased heart rate (pulse) is: Answer: )
A. tachycardia.
B. bradycardia. Why: tachy-  rapid, fast
C. hyperpnea. cardi/o  pertaining to the heart
D. hypoxia. -ia  pertaining to
E. arrhythmia Review: Yes ❏ No ❏

57. The term meaning on one side is: Answer: ,

A. medial.
B. bilateral. Why: uni-  one
C. transverse. later/o  side
D. unilateral. -al  pertaining to
Review: Yes ❏ No ❏

58. The term cyanosis means: Answer: +

A. lack of oxygen.
B. swelling of the feet. Why: cyan/o  blue, discoloration
C. bluish condition. -osis  condition of
D. condition of red cells. Review: Yes ❏ No ❏
E. obstructed airway.

59. The term antipyretic means: Answer: +

A. increased temperature.
B. bacteria-reducing. Why: anti-  against
C. fever-reducing. pyret/o  relating to fever
D. decreased pus formation. -ic  pertaining to
Review: Yes ❏ No ❏
72 =VQ\ ■ General Knowledge

60. The suffix meaning the study of is: Answer: +

A. -logist.
Why: -logy  study of, knowledge
B. -graphy.
C. -logy. Review: Yes ❏ No ❏
D. -scopy.
E. -osis.

61. The term cytology means: Answer: ,

A. person who studies cells.
Why: cyt/o  cell
B. study of the bladder.
-logy  study of
C. measuring bladder contents.
D. study of cells. Review: Yes ❏ No ❏

62. The term leukopenia means: Answer: *

A. increased platelets.
Why: leuk/o  white (cells)
B. decreased white cells.
-penia  decrease, lack of
C. enlarged red cells.
D. increased thrombocytes. Review: Yes ❏ No ❏
E. increased white count.

63. The term meaning thickening (hardening) of the Answer: +

arteries is:
Why: arteri/o  artery
A. phlebectasia.
scler/o  thickening, hardening
B. arteriorrhagia.
-osis  condition of
C. arteriosclerosis.
D. phlebotomy. Review: Yes ❏ No ❏

64. The prefix ab- means: Answer: -

A. against.
Why: ab-  away from, absent
B. before.
C. toward. Review: Yes ❏ No ❏
D. uneven.
E. away from.

65. The prefix peri- means: Answer: ,

A. middle.
Why: peri-  around, about
B. side.
C. below. Review: Yes ❏ No ❏
D. around.

66. The term neuralgia means: Answer: +

A. tumor of nerve cells/fibers.
Why: neur/o  nerve, nerve cell
B. surgical removal of nerve fibers.
-algia  pain
C. pain in the nerves.
D. numbness of nerves. Review: Yes ❏ No ❏
E. twitching of nerves.
 +PIX\MZ ■ Medical Terminology 73

67. The term cervicofacial pertains to the: Answer: *

A. neck and arm.
Why: cervic/o  neck, neck of an organ
B. face and neck.
facial  pertaining to the face
C. spine and pelvis.
D. face and scalp. Review: Yes ❏ No ❏

68. A term meaning destruction of kidney tissue is: Answer: -

A. renopathy.
Why: nephr/o  kidney
B. nephropexy.
-lysis  destruction, breakdown
C. nephralgia.
D. pyelitis. Review: Yes ❏ No ❏
E. nephrolysis.

69. The term posteromedial pertains to: Answer: +

A. upper back.
Why: poster/o  back, backside
B. lower back.
medi/o  the middle
C. middle back.
-al  pertaining to
D. toward the back.
Review: Yes ❏ No ❏

70. The term osteoarthropathy means: Answer: ,

A. bone inflammation.
Why: oste/o  bone
B. inflammation of joints.
arthr/o  joint
C. condition of swollen joints.
-pathy  disease process, disease
D. disease of joints and bones.
E. infection of the bones. Review: Yes ❏ No ❏

71. The term orchidectomy means: Answer: )

A. surgical removal of a testicle.
Why: orchid/o  relating to the testicle
B. incision into the scrotum.
-ectomy  surgical removal
C. undescended testicle.
D. excision of the scrotum. Review: Yes ❏ No ❏

72. The term adenoma means: Answer: +

A. benign tumor.
Why: aden/o  gland
B. malignant tumor.
-oma  tumor
C. tumor of a gland.
D. pituitary disease. Review: Yes ❏ No ❏
E. abnormal growth.

73. The term mammoplasty means: Answer: )

A. surgical reconstruction of the breast.
Why: mamm/o  breast
B. excision of breast tumor.
-plasty  plastic surgery, surgical
C. x-ray exam of the breasts.
reconstruction
D. biopsy of breast tissue.
Review: Yes ❏ No ❏
74 =VQ\ ■ General Knowledge

74. The term adrenomegaly means: Answer: +

A. pathology of a gland.
Why: adren/o  adrenal gland(s)
B. destruction of tissue.
-megaly  enlargement
C. enlargement of the adrenal gland(s).
D. condition of the thyroid. Review: Yes ❏ No ❏
E. inflammation of a gland.

75. The term gynecopathy means: Answer: ,

A. study of female reproductive system.
Why: gynec/o  female
B. specialist who studies women’s diseases.
-pathy  any disease process
C. inflammation of female organs.
D. any disease of the female reproductive system. Review: Yes ❏ No ❏

76. A term meaning an ingrown nail is: Answer: ,

A. onychectomy.
Why: onych/o  fingernail or toenail
B. onychalgia.
crypt/o  hidden, concealed (ingrown)
C. onychitis.
-osis  any condition of
D. onychocryptosis.
E. onychorrhea. Review: Yes ❏ No ❏

77. The term meaning excision of fatty tissue is: Answer: +

A. lipolysis.
Why: lip/o  fat, fatty tissue
B. lipoma.
-ectomy  surgical removal, excision
C. lipectomy.
D. lipoidosis. Review: Yes ❏ No ❏

78. The term meaning rupture of a vein is: Answer: ,

A. phleborrhagia.
Why: phleb/o  vein
B. phlebopexy.
-rrhexis  rupture
C. phlebectasia.
D. phleborrhexis. Review: Yes ❏ No ❏
E. phlebitis.

79. The term duodenoscopy means: Answer: *

A. examination of the colon.
Why: duoden/o  duodenum, part of small intestine
B. inspection of the duodenum with a scope.
-scopy  to examine or inspect using an
C. make a new opening into the duodenum.
endoscope
D. incision into the colon.
Review: Yes ❏ No ❏

80. A term meaning a painful tendon is: Answer: +

A. tendonitis.
Why: ten/o  tendon, connects muscle to bone
B. tenotomy.
-dynia  pain
C. tenodynia.
D. tendoplasty. Review: Yes ❏ No ❏
E. tenorrhaphy.
 +PIX\MZ ■ Medical Terminology 75

81. The term dacryocystitis means: Answer: ,

A. excision of a tear sac.
Why: dacry/o  tear (lacrimal)
B. protrusion of a lacrimal sac.
cyst/o  sac, bladder
C. pain in a lacrimal sac.
-itis  inflammation of
D. inflammation of a tear sac.
Review: Yes ❏ No ❏

82. The term intracerebral means: Answer: ,

A. between the spine and brain.
Why: intra-  within
B. within the spinal cord.
cerebr/o  cerebrum, main part of the brain
C. beneath the meninges.
-al  pertaining to
D. within the main part of the brain.
E. between the meninges. Review: Yes ❏ No ❏

83. The term meaning condition of fungus of the nails is: Answer: *
A. dermatomycosis.
Why: onych/o  finger or toe nail
B. onychomycosis.
myc/o  fungus
C. dermatosis.
-osis  any condition
D. onychitis.
Review: Yes ❏ No ❏

84. The term meaning death of tissue or bone is: Answer: )

A. necrosis.
Why: necr/o  death, dead cells or tissue
B. necropsy.
-osis  any condition
C. necrophilia.
D. necrotomy. Review: Yes ❏ No ❏
E. necrectomy.

85. The term meaning passing from front to rear is: Answer: ,
A. anterosuperior.
Why: anter/o  anterior, front, before
B. anteroexternal.
poster/o  back, rear
C. anteroinferior.
D. anteroposterior. Review: Yes ❏ No ❏

86. The term aplasia means: Answer: *

A. decreased plasma.
Why: a-  without, not
B. lack of formation.
-plasia  development, formation
C. difficulty breathing.
D. without pulse. Review: Yes ❏ No ❏
E. painful breathing.

87. The term endocarditis means: Answer: +

A. infection of the heart valves.
Why: endo-  inside, innermost
B. heart attack.
cardi/o  heart
C. inflammation of the inside lining of the heart.
-itis  inflammation of
D. aneurysm within the heart.
Review: Yes ❏ No ❏
76 =VQ\ ■ General Knowledge

88. The term pyeloplasty means: Answer: )

A. surgical repair of the renal pelvis.
Why: pyel/o  pelvis, renal pelvis
B. plastic surgery of the kidney.
-plasty  surgical repair
C. incision into the kidney.
D. excision of the renal pelvis. Review: Yes ❏ No ❏
E. surgical repair of the pelvis.

89. The term meaning below normal temperature is: Answer: +

A. hypoxia.
Why: hypo-  below, sub, less than normal
B. hypotensive.
therm/o  temperature
C. hypothermia.
-ia  pertaining to
D. hypotrophy.
Review: Yes ❏ No ❏

90. The term hysterorrhaphy means: Answer: +

A. rupture of the uterus.
Why: hyster/o  uterus
B. removal of the cervix.
-rrhaphy  suturing, sewing
C. suturing of the uterus.
D. surgical fixation of the cervix. Review: Yes ❏ No ❏
E. incision into the cervix.

91. The term proctorrhagia means Answer: ,

A. rupture of the rectum.
Why: proct/o  rectum and anus
B. fissure of the anus.
-rrhagia  hemorrhage, burst forth
C. inflammation of the rectum.
D. hemorrhage from the rectum. Review: Yes ❏ No ❏

92. The term for disease of the retina is: Answer: -

A. renopathy.
Why: retin/o  retina of the eye
B. retinitis.
-pathy  disease process
C. retinoplasty.
D. renography. Review: Yes ❏ No ❏
E. retinopathy.

93. The term meaning herniation of the meninges is: Answer: +

A. meningomyelocele.
Why: mening/o  meninges
B. myelocele.
-cele  herniation, protrusion
C. meningocele.
D. encephalocele. Review: Yes ❏ No ❏

94. The term meaning suppression of menses is: Answer: ,

A. menstruation.
Why: men/o  menstruation, menses
B. menorrhagia.
-stasis  control, suppress
C. menorrhea.
D. menostasis. Review: Yes ❏ No ❏
E. dysmenorrhea.
 +PIX\MZ ■ Medical Terminology 77

95. The term meaning across the chest is: Answer: +

A. anterolateral.
Why: trans-  across, cross over
B. transverse.
thorax  pertaining to the chest
C. transthorax.
D. anterothoracic. Review: Yes ❏ No ❏

96. The term meaning excessive formation of cells or Answer: *

tissue is:
Why: hyper-  excessive, more than normal
A. hyperphasia.
-plasia  formation
B. hyperplasia.
C. hypertonic. Review: Yes ❏ No ❏
D. hyperopia.
E. hypotonic.

97. The term pyogenesis means: Answer: *

A. growth of cells.
Why: py/o  pus
B. formation of pus.
-genesis  beginning, formation
C. production of bile.
D. origin of a fever. Review: Yes ❏ No ❏

98. The term hemiplegia means: Answer: ,

A. inflammation of the lower legs.
Why: hemi-  half, one half
B. moving one half of the body.
-plegia  pertaining to paralysis
C. paralysis of upper body.
D. paralysis of one half of the body. Review: Yes ❏ No ❏
E. paralysis of one leg.

99. The term nasopharyngeal means pertaining to: Answer: +

A. nose and sinuses.
Why: nas/o  nose
B. mouth and throat.
pharyng/o  pharynx, throat
C. nose and throat.
-al  pertaining to
D. mouth and sinuses.
Review: Yes ❏ No ❏

100. The term neurotripsy means: Answer: *

A. removal of a nerve.
Why: neur/o  nerve, nerve cell
B. surgical crushing of a nerve.
-tripsy  surgically crushing
C. suturing of a nerve.
D. paralysis of a nerve. Review: Yes ❏ No ❏
E. rupture of a nerve.

101. Select the correct spelling of the term: Answer: *

A. hemmorrhoid.
Review: Yes ❏ No ❏
B. hemorrhoid.
C. hemmorhoid.
D. hemorhoid.
E. hemorroid.
78 =VQ\ ■ General Knowledge

102. Scraping of a body cavity is:

A. curretage.
B. currettage. Answer: ,
C. curetage. Review: Yes ❏ No ❏
D. curettage.

103. Inflammation of the tonsils is:

A. tonsillitis.
B. tonsilitis. Answer: )
C. tonsilittis. Review: Yes ❏ No ❏
D. tonssilitis.
E. tonsillittis.
 Anatomy and Physiology
6

: - > 1 - ?  < 1 8 
Anatomyy and Physy iology
gy is the most demandingg chapt
p er but one that pr
p ovides a feelingg of
accomplishment when you have completed it. Study all the figures and tables. The national exams
generally contain at least two questions on each body system. The endocrine system, with the
glands and hormones, tends to be the most difficult. (Remember, during the exam, do not s
pend too much time on any one question.) Schedule your study time by body system.
Limit the number you tackle at each session. Reward yourself when you finish this
chapter!

7>-:>1-? BODY ORDERING

Knowledge of anatomy and physiology is a foundation Living things are arranged from simple to complex.
for many areas of medical assisting and medical Figure 6-1 demonstrates the order of the structures that
administrative specialization. It is used in both admin- make up the human body.
istrative (e.g., insurance billing and coding) and clini-
cal practice (e.g., patient assessment). With a solid ■ Chemicals—atoms and molecules
understanding of the structure and function of body ■ Cells—structural and functional units of life
parts, you will be able to analyze questions and to
■ Tissues—groups of cells with similar structures and
solve problems.
functions (such as connective tissue)
Anatomy—the study of body structure ■ Organ—group of tissues working together to perform
Physiology—the study of body function a function (e.g., kidney)
Pathology—the study of abnormal changes in body ■ Systems—group of organs working together to per-
structure or function, usually caused by disease form a set of related functions

!
80 =VQ\ ■ General Knowledge

Chemicals • Nervous system—nerves and related structures that

Cell receive stimuli and initiate responses
• Sensory system—sensory neurons and special sense
organs that detect the environment and changes
• Endocrine system—glands and related structures that
Tissue produce hormones
• Cardiovascular system—heart and blood vessels that
circulate blood to transport nutrients and remove
waste from tissues

Organ
• Lymphatic system—lymph, lymph nodes, and related
organs that protect against and fight disease
• Respiratory system—lungs and related structures that
transport oxygen (O2) and remove carbon dioxide (CO2)
• Digestive system—mouth, esophagus, stomach, intes-
tines, liver, gallbladder, and pancreas, which ingest
Organ and process food and eliminate solid waste products
system
• Urinary system—kidneys, ureters, bladder, and urethra,
which remove nitrogen-type waste and regulate water
balance
Body as
a whole
• Reproductive system—gonads (ovaries or testes) and
related sex organs and structures that reproduce the
species
■ Body (organism)—group of systems working together
to maintain life

ANATOMIC DESCRIPTORS
The national exams contain several questions related to
the location of specific organs and other anatomic struc-
tures. Directional terms of the body help describe and
locate these structures.

Body Directions and Planes

Figure 6-2 shows the imaginary planes dividing the body:
the frontal (or coronal) plane, the sagittal plane, and the
transverse (or horizontal) plane. The body is in anatomic
position—upright, face forward, and arms down and
slightly away from the sides with palms forward and feet
and legs parallel. Other important descriptors of body
directions are as follows: superior (cranial or cephalic),
anterior (ventral), posterior (dorsal), inferior (caudal),
proximal, distal, medial, and lateral.

Body Cavities
.QO]ZM Body ordering. (Reprinted with permission from Cohen BJ, Wood DL.
Memmler’s The Human Body in Health and Disease. 9th Ed. Philadelphia: The locations of organs are usually described as being in
Lippincott Williams & Wilkins, 2000.) a specific body cavity or space. Directional terms (e.g.,
posterior, anterior, inferior) are used to determine the
position in relation to other organs also found in that
• Integumentary system—skin and related structures cavity. Figure 6-3 illustrates the following body cavities:
that contain and protect
• Skeletal system—bones and related structures that ■ Cranial cavity—contains the brain
support ■ Spinal cavity—contains the spinal cord; runs continu-
• Muscular system—muscles and related structures ously from the brainstem in the cranial cavity to the
that accommodate movement end of the spinal cord
 +PIX\MZ ■ Anatomy and Physiology 81

Superior
(cephalic)

Lateral Anterior Posterior

(ventral) (dorsal)

Medial

Inferior
(caudal)

Sagittal plane Coronal or frontal plane Transverse plane

.QO]ZM Body planes and directions. (Reprinted with permission from Willis MC, CMA-AC. Medical Terminology: A Programmed
Learning Approach to the Language of Health Care. Baltimore: Lippincott Williams & Wilkins, 2002.)

■ Thoracic cavity—contains the heart, lung, and large spleen; it is separated from the thoracic cavity (superior)
blood vessels; it is separated from the abdominal cavity by the diaphragm and from the pelvic cavity (inferior)
by the diaphragm; within the thoracic cavity lies the by an imaginary line across the top of the hip bones
mediastinum, a smaller cavity between the lungs that ■ Pelvic cavity—contains the urinary bladder, rectum,
contains the heart and large blood vessels and internal organs of the male/female reproductive
■ Abdominal cavity—contains the stomach, most of the systems; it is separated from the abdominal cavity
intestines, the kidneys, liver, gallbladder, pancreas, and (superior) by an imaginary line between the hip
bones

Cranial
cavity Abdominal Quadrants and Regions
The abdomen is divided into four quadrants (right upper,
left upper, right lower, and left lower) and nine regions
Spinal (right hypochondriac, epigastric, left hypochondriac,
cavity right lumbar, umbilical, left lumbar, right iliac, hypogas-
(canal) tric, and left iliac), as shown in Figure 6-4. Box 6-1 lists
Thoracic
cavity additional anatomic descriptors used to locate or describe
Dorsal
Diaphragm the location of many body structures.
cavity

BASIC BODY PROCESSES

Ventral Abdominal
cavity cavity For the body to grow, repair itself, and maintain equilib-
Abdominopelvic rium, certain processes must occur. Metabolism, fluid
cavity balance, and homeostasis are basic processes that take
Pelvic place or begin at the cell level.
cavity

Metabolism
Metabolism is energy transformation in living cells.
This transformation occurs in two metabolic processes:
.QO]ZM Body cavities. (Reprinted with permission from Cohen BJ, Wood DL.
■ Anabolism—builds up and repairs cells
Memmler’s The Human Body in Health and Disease. 9th Ed. Philadelphia:
Lippincott Williams & Wilkins, 2000.) ■ Catabolism—breaks down cells
82 =VQ\ ■ General Knowledge

Righ
R
Right
ig
ight
ht Le
Left
e ftt
Epigastricc
E
hypocch
cho
hoonnd
nd iac
dria
driacac hypo
hy
hyp
hypoc
yp
po
poch
poch ho
ond
onndriac
region
Right
ghtt Left rre
egion
eg
ggio
ion
ion reg
reg
regio
regi
gio on
up
ppe
pper
p er upper
upp
up
pper
per
quadrant
adra
adrant
ra
an quadrant
ant
R
Ri
Right Left
Umbilical
lu
umbar
m lumbbar
Ri ht
Right Lefft
Left region
reg
re
egion
g regio
on
on
low
lower
lo
ower
ow
ow
wer lower
lo
ower
wer
quadrant
a d an
adran qu
q
quadra
uadra
dra
ant
Rigght Left
Hyp g ric
Hypogastri
ri
iliac iliac
region
regi
re
egi
eg
gioion re
eggion
gio
io
onn

.QO]ZM Abdominal divisions. ) Quadrants. * Regions. (Reprinted with permission from Cohen BJ, Wood DL. Memmler’s The
Human Body in Health and Disease. 9th Ed. Philadelphia: Lippincott Williams & Wilkins, 2000.)

*W` Fluid Balance

)LLQ\QWVIT)VI\WUQK,M[KZQX\WZ[ Fluid balance is the regulation of the amount and com-
position of the body’s fluids. The two major divisions of
Antebrachial: Brachial: upper arm body fluid are:
forearm Carpal: wrist
Axillary: armpit Cephalic: head ■ Extracellular fluid—body fluid outside the cell
Buccal: cheek Costal: ribs female ■ Intracellular fluid—body fluid inside the cell
Celiac: abdominal cervix
Cervical: neck or Cutaneous: skin The concentration of the fluid affects fluid movement
Cranial: skull Gluteal: buttocks and balance. The three basic solution concentrations are:
Femoral: thigh Lumbar: lower back
Inguinal: groin area ■ Isotonic solution—this has the same concentration as
Mammary: breast Occipital: lower intracellular fluid and moves in and out of the cell at
Ophthalmic: eyes posterior area of the same rate; normal saline (0.9% salt) and 5% dex-
Palmar: palm head trose are examples of manufactured isotonic solutions
Pectoral: chest Otic: ears ■ Hypotonic solution—less concentrated than intracel-
Plantar: sole of foot Patellar: kneecap lular fluid, it results in excess fluid entering the cell and
Sacral: lower spine Pedal: foot may cause the cell to rupture
Umbilical: navel Popliteal: back of knee
■ Hypertonic solution—more concentrated than intra-
Antecubital: area Tarsal: ankle
cellular fluid, it draws fluid away from the cell and
anterior to elbow Vertebral: spine
causes the cell to shrink
 +PIX\MZ ■ Anatomy and Physiology 83

Homeostasis ■ Centriole—rod-shaped material in the cytoplasm that

begins cell division
Homeostasis is the equilibrium or health of the body
as measured by established norms for blood pressure, ■ Cilia (singular cilium)—hairlike processes on the cell
heart rate, temperature, respiratory rate, and other surface that move foreign particles along the cell sur-
indicators. face
■ Flagella (singular flagellum)—whiplike processes on the
cell surface; accommodate cell movement
*7,A+7587;1<176
As previously noted, the body has an ordering of struc-
Cell Division
tures from simple to complex. Each type of structure
(such as cells or tissues) has its own components or pieces, Cell division occurs when one cell splits into two identi-
which are described in this section. cal cells. The process is as follows:

■ Interphase—DNA duplicates and chromosomes double

CELLS ■ Mitosis—also referred to as cell division; comprises four
Cells vary in size, shape, and function, but most cells phases:
contain the same basic components. Some of these com- • Prophase—centrioles move to opposite ends of the
ponents are shown in Figure 6-5. cell, forming two poles; they stretch filaments
between them, resembling longitudes on a globe
■ Cell (plasma) membrane—thin outermost layer of the
cell; regulates what enters and leaves the cell • Metaphase—chromosomes line up along an equator-
type line along centriole filaments
■ Cytoplasm—colloidal substance (protoplasm) found in
the cell; holds other structures in place • Anaphase—duplicated chromosomes separate, and
one of each begins to move toward the opposite cen-
■ Nuclear membrane—thin layer surrounding the nucleus triole or pole
■ Nucleus—located in the center of the cell; controls cell • Telophase—nucleus divides in the center, forming two
activity and contains genetic material (DNA) distinct cells
■ Nucleolus—small structure(s) in nucleus; holds ribonu-
cleic acid (RNA) and ribosomes essential for protein
formation Cellular Movement of Substances
The maintenance of homeostasis and fluid balance and
the process of metabolism require constant movement of
nutrients into the cell and the elimination of waste prod-
ucts from the cell. The movement occurs at the cell or
Genetic material (DNA) plasma membrane. It is semipermeable, meaning it allows
Nucleus passage of some substances but not others. The types of
movement are categorized either as not requiring or
Nuclear membrane requiring cell energy.
Flagellum
Nucleolus ■ Movement without cellular energy
• Diffusion—movement of molecules from area of
higher to lower concentration
• Osmosis—water diffusion (movement from area of
Plasma higher to lower concentration) through a semiper-
Cilia membrane meable membrane
• Filtration—process of pushing water with dissolved
materials through one side of a membrane; an exam-
ple is kidney filtration
Ribosomes
■ Movement with cellular energy
Centriole
• Active transport—movement of molecules from area
Cytoplasm Endoplasmic of lower to higher concentration
reticulum
• Phagocytosis—ingestion and digestion of bacteria
.QO]ZM Basic animal cell with select structures. and other substances by phagocytic cells
84 =VQ\ ■ General Knowledge

TISSUES *7,A;A;<-5;
The body contains different types of tissues found in the The chapter overview describes a system as a group of
diverse organs and systems. The study of tissue is called organs working together to perform a set of related func-
histology. tions. The human body comprises 12 interrelated sys-
tems and is described in detail in this section.
■ Epithelial tissue—forms the outer surface of the body;
lines body cavities and major tubes and passageways
that open to the exterior INTEGUMENTARY
T SYSTEM
• Cells—squamous (flat and irregular), cuboidal Integumentary comes from the Greek word integument,
(square), or columnar (long and narrow) meaning “cover.” The integumentary system is the
• Layers—simple (one layer) or stratified (more than largest system in the body.
one layer)
■ Connective tissue—supports and connects other tis- Functions of the Integumentary System
sues and structures
■ Protects against infection and other “invaders” (e.g.,
• Soft—areolar, adipose radiation)
• Fibrous—tendons, ligaments, capsules, fascia ■ Assists with prevention of dehydration
• Hard—cartilage, bone ■ Controls body temperature
• Liquid—blood, lymph ■ Receives sensory information
■ Muscle tissue—produces movement ■ Eliminates waste products
• Skeletal muscle—moves muscle and bone (voluntary) ■ Produces vitamin D
• Cardiac muscle—forms the heart (involuntary)
• Smooth muscle—forms visceral organs (involuntary) Components of the Integumentary System
■ Nerve tissue—composed of neurons (nerve cells); pro-
vides networks to carry impulses ■ Skin—the largest organ; external covering of the body
(Fig. 6-6)
MEMBRANES • Epidermis—the surface layer of the skin that con-
tains strata (sublayers), melanin (pigment giving the
Membranes are thin sheets of tissue that line and pro- skin its color), and keratin (protein that thickens skin
tect body structures. and makes skin waterproof)
• Dermis—the deeper layer of the skin that contains
Epithelial Membranes nerves, blood vessels, collagen, and other skin
■ Serous membranes—secrete watery fluid
• Parietal membranes—line body cavities
• Visceral membranes—cover internal organs (pleura Sebaceous
and pericardium are examples) (oil) gland
Nerve
■ Mucous membranes—secrete mucus and line tubes or endings
Pore ((opening
g
of sweat gland)
spaces open to the exterior
■ Cutaneous membrane—the skin

Epidermis
Connective Tissue Membranes
■ Synovial membranes—line joint cavities Dermis
(corium)
■ Meninges—surround the brain and spinal cord and are Sudoriferous
(sweat) gland
composed of three layers Subcutaneous
layer
■ Fascia membranes—separate or bind muscles and per-
mit movement of the skin
■ Other connective tissue membranes:
• Pericardium—surrounds heart Hair follicle
.QO]ZM Cross section of skin. (Reprinted with permission from Cohen BJ,
• Periosteum—surrounds bone Wood DL. Memmler’s The Human Body in Health and Disease. 9th Ed.
• Perichondrium—surrounds cartilage Philadelphia: Lippincott Williams & Wilkins, 2000.)
 +PIX\MZ ■ Anatomy and Physiology 85

structures or appendages. Collagen is a fibrous pro- *W`

tein found in the dermis, connective tissues, tendons,
and ligaments. It is sometimes referred to as the +WUUWV;SQV,Q[MI[M[IVL,Q[WZLMZ[
body’s glue, providing strength and flexibility.
Abrasion—scrape
■ Appendages—structures located in the dermis that
Acne—inflammation of sebaceous glands
perform special functions
Albinism—abnormal absence of pigment in skin,
• Sweat glands—coiled tubes located in the dermis hair, and eyes
that produce and transport sweat to help regulate Alopecia—baldness
body temperature and remove waste Avulsion—tearing away from body structure
• Ceruminous glands—structures located in the ear Cyst—a
t sac containing a liquid
that secrete cerumen (earwax) for protection Decubitus—bedsore; ulceration resulting from
pressure and poor circulation
• Sebaceous glands—structures connected to hair fol-
licles located in the dermis that secrete sebum to Dermatitis—inflammation of the skin character-
lubricate skin and hair ized by pruritus (itching), erythema (redness),
and lesions
• Hair—structures composed primarily of dead kera- Eczema—form of dermatitis with a combination
tinized tissue that cover most of body
of vesicles and dry, leathery patches
• Nails—hard, keratinized structures located on tips Eschar—scab
r
of fingers and toes Excoriation—abrasion (scrape) of the epidermis
• Subcutaneous tissue—layer of tissue below the dermis Fissure—furrow, crack, groove, or crevice
composed of adipose and elastic fibers that connects Furuncle—boil
the dermis to muscle surfaces Herpes simplex—cold
x sore or fever blister
Herpes zoster (shingles)—painful vesicles along
peripheral nerve tracts caused by the herpes
Common Diseases and Disorders of the zoster virus, which also causes varicella (chick-
Integumentary System enpox)
■ Burns—tissue damage from exposure to heat, chemi- Impetigo—bacterial infection, usually around the
cals, or electricity mouth and nose, caused by staphylococci or
streptococci; dry to crusty vesicles
• First degree (superficial)—involves the epidermis; Lesion—abnormal change in localized tissue
has a red appearance with minimal or no edema
caused by injury or disease
• Second degree (partial thickness)—involves the Macule—small spot or colored area (such as a
epidermis and part of dermis; has a blistered red freckle)
appearance with edema Nevus (mole)—raised congenital spot on skin
• Third degree (full thickness)—involves epidermis, surface
entire dermis, and often the underlying tissues; has a Papule—pimple
pale white or charred appearance with broken skin Pediculosis—infestation with lice
and edema Psoriasis—chronic inflammatory skin disease char-
■ Carcinoma—skin cancer acterized by scaly red patches on body surface
Pustule—pus- or lymph-filled vesicle
• Basal cell carcinoma—malignant disease of the basal Scleroderma—disease causing thickened, rigid
cell layer of skin
skin
• Squamous cell carcinoma—malignant disease of the Tinea corporis—ringworm; fungal infection
squamous cell layer of skin; more likely to metasta- Tinea pedis—athlete’s foot; fungal infection
size than basal cell Ulcer—open
r lesion on the skin or mucous mem-
• Melanoma—highly malignant nevus (mole) brane
Urticaria—hives
Other common diseases and disorders of the integumen- Verruca—wart
tary system appear in Box 6-2. Vesicle—blisterlike sac on the skin
Vitiligo—skin disease with white milky patches
surrounded by normal pigmentation
SKELETAL SYSTEM Wheal—round, elevated skin lesion with white
The skeletal system is the framework of the body. The center and red periphery
human skeleton is composed of 206 bones, cartilage,
and ligaments.
86 =VQ\ ■ General Knowledge

Functions of the Skeletal System Organization of the Skeletal System

■ Provides frame and strength to the body The major bones are illustrated in Figure 6-7. These bones
■ Produces body movement are divided into the axial segment and the appendicular
segment.
■ Provides protection for organs (e.g., the skull protects
the brain)
■ Serves as storehouse for calcium (Ca) salts Axial Skeleton
■ Produces blood cells in the bone marrow The axial segment of the skeleton consists of the bones
of the skull, spine, and chest.

Components of the Skeletal System ■ Cranium—skull (Fig. 6-8)

■ Bone—hard connective tissue impregnated with a cal- • Frontal—forehead
cium substance (206 bones in the adult skeleton) • Parietal—sides and top
■ Cartilage—firm connective tissue found primarily in
• Temporal—lower sides
joints, thorax walls, larynx, airway passages, and ears
• Mastoid process—lower portion of the temporal bone
■ Ligaments—bands of fibrous connective tissue that
connect the articulating ends of bones to facilitate or • Styloid process—projection inferior to the external ear
limit movement; do not confuse ligaments with • Zygomatic process—upper cheek
tendons, which connect muscle to bone • Occipital—base of the skull, contains the foramen
■ Joints—areas where two or more bones come together magnum (the opening in the skull that connects the
or articulate, such as the knee, shoulder, and neck (see spinal cord to the brain)
Box 6-3, which describes joint movements) • Sphenoid—bat-shaped, lateral eye orbits
• Ethmoid—bony area between the nasal cavity and the
orbits
■ Facial—14 bones form the face (major bones are listed
*W` in Fig. 6-8)
2WQV\5W^MUMV\[ • Nasal—two bones that form the bridge of the nose
• Zygomatic—arch of the cheek
Abduction—moving away from the body midline
(the opposite of adduction) (e.g., spreading the • Mandible—lower jaw
arms) • Maxilla—upper jaw
Adduction—moving toward the body midline (the ■ Vertebral column (spine)—26 vertebrae (bones) that
opposite of abduction) (e.g., bringing the arms cover the spinal cord (Fig. 6-9)
to the sides)
• Cervical vertebrae (7 vertebrae)—neck bones; the
Circumduction—drawing an imaginary circle first is called the atlas (supports the head); the second
with a body structure (e.g., the arms) is called the axis (pivot for the head)
Eversion—turning wrists or ankles outward, away
from the body (the opposite of inversion), such • Thoracic vertebrae (12 vertebrae)—chest; attaches
to the posterior portion of ribs
as turning the foot away from the body
Extension—bringing
n the limbs or phalanges toward • Lumbar vertebrae (5 vertebrae)—small of back;
a straight position (the opposite of flexion), such heavier and larger than other vertebrae
as opening the fingers of a closed hand • Sacrum (1 vertebra)—posterior of bony pelvis locat-
Flexion—bending (the opposite of extension), ed between the two hip bones
such as closing the fingers of the hand
• Coccyx (1 vertebra)—tailbone
Hyperextension—extreme
n or abnormal extension,
■ Thorax—rib cage
usually resulting in injury (e.g., dislocated finger)
Inversion—turning inside out (the opposite of • Ribs—12 pair of bones that make up the thorax; the
eversion), such as turning the heels out so toes bars of the cage
face each other • Sternum—breast bone that, with the ribs, protects the
Plantar flexion—pointing
n toes downward, which heart
flexes the arch of the foot (e.g., en pointe dancing ❍ Manubrium—top of the breast bone that joins
in ballet) with the clavicle and first ribs
Rotation—turning on an axis, such as turning the
❍ Xiphoid process—small tip at the lower end of the
head to indicate “No”
sternum
 +PIX\MZ ■ Anatomy and Physiology 87

Cranium
Skull
Face

Hyoid
1
Clavicle
2 Manubrium
3 Scapula
4 Sternum
5 Ribs
6 Xiphoid process
7
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
.QO]ZM Human skeleton. (Reprinted with permission from Willis MC, CMA-AC. Medical Terminology: A Programmed Learning
Approach to the Language of Health Care. Baltimore: Lippincott Williams & Wilkins, 2002.)

Appendicular Skeleton • Radius—lateral bone of forearm (in anatomic posi-

tion, thumb side)
The appendicular skeleton consists of the bones of the
upper and lower extremities and the girdles attaching • Ulna—medial bone of forearm (in anatomic position)
them to the axial skeleton portion. • Carpals—the four bones that make up the wrist
• Metacarpals—the five bones of the palm of the hand
■ Shoulder girdle
• Phalanges—fingers (three bones each) and thumbs
• Clavicle—collar bone, which joins the sternum at (two bones each)
the anterior and the scapula laterally
■ Pelvic girdle—attaches lower extremities to axial
• Scapula—shoulder blade skeleton
■ Upper extremities—arms, hands, fingers, and thumbs
• Ilium—superior wing-shaped portions of hip
• Humerus—upper arm (largest arm bone) bones
88 =VQ\ ■ General Knowledge

• Ischium—inferior portion of hip bones that supports

Frontal bone Parietal bone weight when sitting
Sphenoid bone
Ethmoid bone
• Pubis—anterior union of the hip bones
■ Lower extremities—legs, feet, and toes
Occipital bone

Nasal bone Temporal bone • Femur—thigh bone; the body’s largest, longest, and
Zygomatic bone
strongest bone
Maxilla • Patella—kneecap
• Tibia—shin bone
Mastoid process
• Fibula—smaller leg bone, lateral to tibia
Mandible
Styloid process
• Tarsals—the seven ankle and foot bones (largest is
the calcaneus, or heel bone)
.QO]ZM The adult skull. (Reprinted with permission from Oatis CA. Kinesiology:
The Mechanics and Pathomechanics of Human Movement. Baltimore: Lippincott • Metatarsals—the five foot bones
Williams & Wilkins, 2003.) • Phalanges—toe bones (three bones each), great toes
(two bones each)

Common Diseases and Disorders of the Skeletal System

■ Congenital or developmental disorders—skeletal
abnormalities resulting from birth defects or occur-
rences during the developmental stages
Atlas
(1st cervical) • Cleft palate—congenital deformity caused by a
malunion of the maxilla, leaving an opening in the
roof of the mouth (palate)
Cervical Axis
vertebrae (2nd cervical) • Spina bifida—congenital deformity caused by malfor-
mation of vertebrae that exposes the spinal column
• Scoliosis—abnormal lateral curvature of the verte-
Transverse bral column
process
Thoracic • Kyphosis (hunchback)—an excessive curvature in
vertebrae Intervertebral the thoracic portion of the vertebral column
disk
• Lordosis (swayback)—excessive curvature in the
lumbar portion of the vertebral column
Note: Know the differences between scoliosis, kyphosis,
and lordosis.
Spinous • Rickets—structural deformities of the bone result-
process ing from lack of vitamin D
■ Arthritis—inflammation of the joints
Foramen for
Lumbar spinal nerve • Osteoarthritis—degenerative joint disease resulting
vertebrae in deformities and chronic pain; usually occurs as
part of the aging process, but excessive joint use
(such as long-distance running) and trauma are also
contributory factors

Sacral • Rheumatoid arthritis—inflammation and overgrowth

Sacrum of synovial membranes and joint tissues characterized
vertebrae
by swelling of joints, usually occurring in young adults
Coccygeal • Gout—inflammation and pain, usually of the great
vertebrae Coccyx toes or thumbs, caused by accumulation of uric acid
crystals; the highest incidence occurs in late-middle-
aged men
.QO]ZM! Adult vertebral column. (Reprinted with permission from Cohen BJ, • Septic arthritis—serious bloodstream bacterial
Wood DL. Memmler’s The Human Body in Health and Disease. 9th Ed. infection attacking the joints; common pathogens
Philadelphia: Lippincott Williams & Wilkins, 2000.) are Streptococcus, Staphylococcus, and tuberculosis
 +PIX\MZ ■ Anatomy and Physiology 89

Closed Open Greenstick Impacted Comminuted Spiral Colles

.QO]ZM Types of fractures.

■ Fractures—a break or rupture in the bone; Figure 6-10 Muscle Traits

illustrates the following types of fractures:
■ Excitability—receive and respond to a stimulus
• Simple—closed fracture with no open wound ■ Contractility—shorten
• Compound—open fracture with an external wound ■ Extensibility—stretch or lengthen
• Greenstick—incomplete break or a bending of the ■ Elasticity—return to original length after shortening
bone, usually in children
or lengthening
• Impacted—broken ends of the bone are forced into
each other
• Comminuted—splintering or crushing of the bone Types of Muscle Tissues
with several fragments
■ Smooth muscle—forms the walls of hollow organs,
• Spiral—fracture caused by a twisting motion blood vessels, and respiratory passages; moves sub-
• Colles—displaced fracture of the distal radius, prox- stances through the systems (involuntary); striated
imal to the wrist
■ Skeletal muscle—attached to bones, moves muscle and
■ Neoplasms—tumors bones (voluntary)
• Malignant—cancerous tumors (e.g., osteosarcoma, ■ Cardiac muscle—forms the wall of heart, creates
osteochondroma) pumping action of the heart (involuntary); striated
• Nonmalignant—benign tumors such as cysts
• Osteomyelitis—inflammation of the bone or mar-
row caused by pathogens Components of the Muscular System
• Osteoporosis—porous, brittle bones resulting from ■ Muscles—tissue made up of contractile fibers that
low levels of calcium salts; common in menopausal effect movement of organs and body parts; Figure 6-11
women illustrates anterior and posterior muscles
■ Tendons—connective tissue that attaches muscle
directly to the periosteum (covering) of the bone
MUSCULAR SYSTEM
■ Aponeurosis—broad sheet that attaches muscle to
The muscular system contains approximately 650 mus- muscle or muscle to select bones, such as the skull
cles that make up the general form of the body.
■ Synapses—neuromuscular junctions transmitting mes-
sages from the nerves that stimulate muscles to act
Functions of the Muscular System
■ Produces body movement through chemical reactions
at cellular level Body Mechanics
■ Maintains body posture and alignment ■ Lever—bone acts as fixed bar moving around a pivot
■ Protects bones and internal organs ■ Fulcrum—joint acts as pivot to the bone
■ Generates heat ■ Force—muscle contracts and pulls bone
 Temporalis

Sternocleidomastoid
Trapezius
Deltoid

Pectoralis major
External
oblique
Biceps brachii

Intercostals

Abdominal
aponeurosis Internal oblique

Rectus abdominis

Sartorius
Adductors
of thigh Vastus lateralis
Rectus Quadriceps
femoris femoris

Gastrocnemius Sternocleidomastoid

Trapezius

Soleus Deltoid

Latissimus
dorsi Triceps brachii

Olecranon
Lumbodorsal
fascia

Gluteus maximus

Hamstring

Gastrocnemius

Achilles tendon

.QO]ZM The muscular system. ) Anterior. * Posterior. (Reprinted with permission from Cohen BJ, Wood DL. Memmler’s The
Human Body in Health and Disease. 9th Ed. Philadelphia: Lippincott Williams & Wilkins, 2000.)

!
 +PIX\MZ ■ Anatomy and Physiology 91

Common Diseases and Disorders of the Muscular System • Dendrites—neuron fibers conducting impulses to
the cell body
■ Muscular dystrophy—progressive weakening of muscles
that leads to paralysis; may be congenital • Axons—neuron fibers conducting impulses away
from the cell body
■ Myasthenia gravis—progressive neuromuscular disease
characterized by great muscle weakness and fatigue that • Myelin sheath—fatty material that covers and pro-
results from poor adenosine triphosphate (ATP) pro- tects neuron fibers; speeds conduction
duction; may be an autoimmune disorder ■ Nerves—bundles of neurons that conduct impulses
■ Tendonitis—inflammation of the tendon and connect to the brain and spinal cord
■ Sprain—overstretching of the ligament ■ Neuroglia—nonconducting cells that support and pro-
tect nervous tissue
■ Strain—overstretching of the tendon
■ Synapses—neuromuscular junctions (gaps) between
■ Atrophy—wasting of muscle, often resulting from
neurons
nonuse
■ Neurotransmitters—chemicals released by the axons
that stimulate the next cell to continue the transmis-
NERVOUS SYSTEM sion of the impulse; the three main neurotransmitters
The nervous system is the coordinating agent of the are acetylcholine, epinephrine, and norepinephrine
body. Similar to a command post and communication ■ Meninges—three layers of connective tissue covering
center, it carries messages to and from points and decides and completely enclosing the brain and spinal cord
on actions and responses. • Dura mater—outer layer, thickest and toughest of the
meninges; from the Latin mater, meaning “mother”
Functions of the Nervous System
• Arachnoid—middle layer, attached to deepest
■ Regulates body functions and processes meninges by weblike fibers with space for movement
■ Communicates stimuli and responses throughout the
of cerebral spinal fluid; from the Latin arachnoid,
body meaning “spider”
■ Generates thoughts, sensations, emotions, and percep- • Pia mater—innermost layer, attached directly to
tions nervous tissue of brain and spinal cord
■ Cerebrospinal fluid (CSF)—clear fluid that flows
Organization of the Nervous System through the brain and spinal cord and into the sub-
arachnoid spaces of the meninges; cushions and sup-
■ Central nervous system (CNS)—brain and spinal cord; ports nervous tissue and transports nutrients and waste
integrates sensory information and responses products from the cells
■ Peripheral nervous system (PNS)—nerves originating ■ Brain—organ acting as the primary center for regulat-
in the brain and spinal cord that extend outside the ing and coordinating body functions and activities
CNS and transmit sensory information and responses (Fig. 6-12); divided into right and left hemispheres
• Somatic nervous system—transmits sensory infor- • Lobes—five areas of the brain located in each hemi-
mation to skeletal muscle; voluntary sphere; each lobe has a corresponding bone that
• Autonomic nervous system—transmits sensory protects it
information to smooth and cardiac muscles (visceral) ❍ Frontal—controls speech and voluntary muscle
and glands; involuntary movement
❍ Sympathetic nervous system—prepares the body
❍ Parietal—contains the sensory area and interprets
for stressful situations (i.e., “fight or flight”) impulses from skin (e.g., pain, heat); also estimates
❍ Parasympathetic nervous system—returns the distance, size, and shapes
body to rest and replenishment of energy ❍ Temporal—interprets sound (auditory sense) and
• Afferent (sensory) division of systems—transmits smell (olfactory sense); also associated with per-
information to the brain sonality, behavior, emotion, and memory
• Efferent (motor) division of systems—transmits ❍ Occipital—interprets sight
information from the brain to organs and other body ❍ Insula—believed to be associated with visceral
structures functions

Components of the Nervous System • Cerebrum—largest part of the brain, divided into
right and left hemispheres by the longitudinal fissure;
■ Neurons—nerve cells, the structural and functional contains auditory, visual, gustatory, and olfactory
units of the nervous system areas and areas of higher mental faculties
92 =VQ\ ■ General Knowledge

Central sulcus Parietal lobe *W`

Frontal lobe
+ZIVQIT6MZ^M[
I. Olfactory nerve—transmits smells from the
nasal mucosa to the brain
II. Optic nerve—transmits vision from the eye
to the brain
III. Oculomotor nerve—facilitates contraction
of many of the eye muscles
IV. Trochlear nerve—innervates eyeball
muscles
V. Trigeminal nerve—composed of three
Occipital
Olfactory bulbs lobe
branches that innervate the face transmitting
sensory (pain, temperature, touch), motor
Temporal lobe Cerebellum (muscles of mastication), and lingual (taste)
Medulla oblongata impulses
VI. AAbducens nerve— innervates the lateral rec-
Spinal cord
tus muscle; responsible for abduction of the
.QO]ZM Surfaces of the brain. (Reprinted with permission from Willis MC, eye (outward movement)
CMA-AC. Medical Terminology: A Programmed Learning Approach to the VII. Facial nerve—controls facial expressions;
Language of Health Care. Baltimore: Lippincott Williams & Wilkins, 2002.) combines with the fibers of the trigeminal
nerve providing the sense of taste to the
anterior two-thirds of the tongue
VIII. A
Auditory nerve—also known as the vestibu-
• Cerebellum (“little brain”)—involved in synergic
control of skeletal muscles and coordination of vol- locochlear or acoustic nerve; transmits
untary muscular movements; connected to the cere- impulses for hearing and equilibrium
brum, brainstem, and spinal cord by the pons IX. Glossopharyngeal nerve—contains sensory
and motor fibers that supply the posterior
• Pons—area where nerves cross, resulting in nerves tongue, pharynx, and parotid gland (largest
located on one side of the brain controlling the
salivary gland); controls swallowing
opposite side of the body; connects the cerebellum
X. Vagus nerve—the longest cranial nerve sup-
with the nervous system
plying organs in the thoracic and abdominal
• Medulla oblongata—portion of the brain connecting cavities; innervates glands that produce
with the spinal cord; contains centers for control of digestive juices and other secretions
heart beat, respiratory rate, and blood pressure XI. Accessory nerve—divides into two branches,
• Midbrain—connects the pons and cerebellum with cranial and spinal; the cranial branch inner-
the cerebrum; functions as relay for certain eye and vates the muscles of the larynx, and the
ear reflexes spinal branch innervates two muscles of the
neck, the sternocleidomastoid and the
• Diencephalon—located between the cerebral hemi-
spheres and the brainstem; contains the thalamus trapezius.
and hypothalamus XII. HHypoglossal
y nerve—transmits impulses to
control the muscles of the tongue
❍ Thalamus—located in diencephalon, serves as
A pneumonic used to remember the 12 pairs
relay for sensory input
of cranial nerves is:
❍ Hypothalamus—located in diencephalon, con- On Old Olympus Tiny Tops A Fin And A
tains nerve cells that assist with maintenance of German Viewed
V A
Amber Hops
water balance, fat and sugar metabolism, secretion
of endocrine glands, and regulation of body tem-
perature ■ Spinal cord—continuous tubelike structure located
• Ventricles—cavities or spaces in the brain and spinal within the spinal vertebrae that extends from the
cord where CSF is formed, filtered, and circulated occipital bone to the coccyx; contains ascending and
■ Cranial nerves (see Box 6-4)—12 pairs of nerves descending nerve tracts that carry transmissions to and
located in the cranium that control sensory, special from the brain
sensory, somatic motor, and visceral motor impulses; ■ Spinal nerves—31 pairs of nerves arising from the
these nerves are identified by Roman numerals spinal cord, with extending branches to the body parts
 +PIX\MZ ■ Anatomy and Physiology 93

■ Ganglia (singular ganglion)—small, raised areas of gray ■ Transient ischemic attack (TIA)—ministrokes; tempo-
matter, located outside the CNS, that contain cells of rary episodes of impaired neurologic function result-
neurons ing from decreased blood flow to the brain

Common Diseases and Disorders of the Nervous System Spinal Cord and Nerves
Brain or Spinal Cord ■ Amyotrophic lateral sclerosis (ALS, Lou Gehrig
disease)—progressive disease of the motor neurons
■ Trauma—injuries as a result of blunt or penetrating
that causes muscle atrophy and weakness
force (e.g., gunshot and knife wounds, motor vehicle
accidents, diving accidents) ■ Herpes zoster—shingles; an infection caused by the
herpes zoster virus (the same virus that causes varicella),
■ Neoplasms—malignant and benign tumors
resulting in blisterlike lesions and pain along the nerve
■ Paralysis—loss of movement and sensation to a body trunks
part or area because of disease or trauma ■ Multiple sclerosis—progressive inflammation and
• Hemiplegia—paralysis of one side of body hardening of the myelin sheath in the nervous system
• Paraplegia—paralysis of the trunk or lower extremities ■ Neuritis—inflammation of the nerve
• Quadriplegia—paralysis of all extremities and usually ■ Poliomyelitis—vaccine-preventable disease that attacks
the trunk the gray matter of the spinal cord; paralysis or partial
paralysis may occur
Brain and Cranial Nerves ■ Sciatica—neuritis and associated pain of the sciatic nerve
and its branches
■ Alzheimer disease—degenerative disorder of the brain
beginning with dementia-like symptoms and progress-
ing to a nonfunctioning of neuron fibers that prevents
SENSORY SYSTEM
communication between cells for ordinary tasks (e.g.,
swallowing) and leads to death; etiology is unknown The sensory system is closely aligned with the nervous
■ Bell palsy—unilateral facial muscle paralysis (drooping system and serves to protect the body by recognizing the
of eye and mouth) resulting from dysfunction of cra- environment and detecting changes. These functions
nial nerve VII allow the nervous system to transmit stimuli, determine
responses, and send reactive messages.
■ Cerebral palsy—loss of mental function or sensation
and control of movement resulting from birth injury
or defect General Senses
■ Cerebrovascular accident (CVA)—stroke; occlusion or General or somatic sensors are located throughout the
hemorrhage of vessel(s) in the brain that results in body.
impairment of mental functions or paralysis
■ Dementia—irrecoverable deterioration of mental ■ Pressure—receptors in skin and internal organs
functions that begins with memory loss and progresses ■ Temperature—receptors in skin and internal organs
to excitability, defective judgment, delusions, and loss
■ Touch—receptors in skin and internal organs
of control of body functions; multiple causes (e.g.,
alcohol abuse, epilepsy, strokes, lesions) ■ Position/orientation—receptors in muscles, tendons,
and joints
■ Encephalitis—inflammation of the brain
■ Pain—receptors in skin, internal organs, muscles, ten-
■ Epilepsy—abnormal electrical activity of the brain that
dons, and joints
results in seizures; multiple causes, such as head trauma,
high fevers, disease processes, poisoning, or overdose
■ Hydrocephalus—accumulation of CSF in the brain Special Senses
caused by an obstruction that results in mounting
The special senses are sight, hearing, smell, and taste.
pressure and destruction of brain tissue
The components of these senses are located in special
■ Narcolepsy—uncontrollable episodes of falling asleep, organs and structures.
also known as sleep epilepsy
■ Parkinson disease—chronic progressive neurologic dis-
Vision (Sight)
ease characterized by fine tremors and muscle weak-
ness and rigidity; etiology believed to be associated Figure 6-13 illustrates the following structures of the eye;
with low dopamine production Box 6-5 lists common diseases and disorders of the eye.
94 =VQ\ ■ General Knowledge

Retina

Choroid
Vitreous chamber

Pupil
Cornea Fovea
Lens capsule centralis
Lens
Ciliary processes
Anterior Optic nerve
chamber Blood supply
Ciliary body and
Posterior ciliary muscle to retina
chamber
Iris .QO]ZM The eye. (Reprinted with permis-
sion from Willis MC, CMA-AC. Medical Termi-
Conjunctiva nology: A Programmed Learning Approach to
Sclera the Language of Health Care. Baltimore:
Optic disk
Lippincott Williams & Wilkins, 2002.)

*W` ■ Eye—organ containing receptors for sight

+WUUWV,Q[MI[M[IVL,Q[WZLMZ[WN\PM-aM • Sclera—white outer coat of eye

❍ Cornea—anterior transparent cover of sclera;
Astigmatism—impaired vision from irregular focuses light rays
curve of cornea; image focuses improperly on • Choroid—middle layer of the eye between sclera
retina; may be mild to severe; usually corrected and retina
with glasses or contact lenses
❍ Iris—colored portion of eye; regulates amount of
Cataract—cloudy
t or opaque lens; usually
light entering eye
corrected by surgery
Conjunctivitis—inflammation of the conjunctiva ❍ Pupil—hole in the middle of the iris

caused by infection or irritation • Retina—innermost layer of the eye; contains pho-

Diabetic retinopathy—damage
y to the retina in toreceptors
diabetic patients resulting from hemorrhage of ❍ Rods—function in dark, recognize shades of gray;
vessels; usually progressive and related to the located throughout the retina
control of the person’s diabetes
❍ Cones—function in light, recognize color; located
Exophthalmia—protrusion of the eyeballs,
throughout the retina
usually resulting from endocrine disorder
Glaucoma—disease causing damage to optic ❍ Optic disc—blind spot, area where the optic nerve

nerve from increased intraocular pressure; often exits the eye

results in blindness if uncontrolled • Chambers
Hyperopia—farsightedness; a condition in which ❍ Anterior—between the lens and cornea; contains
distant objects can be seen more clearly than aqueous humor (clear, watery fluid that maintains
closer objects the slight curve of the cornea)
Macular degeneration—progressive, abnormal
❍ Posterior—between the lens and the retina; con-
growth of blood vessels or other materials in
tains vitreous humor (gelatin-like fluid that main-
retina; usually leads to blindness, although laser
tains shape of eyeball) and some aqueous humor
surgery may slow process
Myopia—condition of nearsightedness; can see • Lens—transparent refractory structure between the
objects close by but not far away iris and vitreous humor
Presbyopia—most common eye condition associ- ■ Accessory structures
ated with aging • Eyebrows and lashes—help protect against foreign
Strabismus—inability of both eyes to simultane- objects entering the eye
ously focus on a subject; known as “lazy eye” or
as being “cross-eyed” • Eyelids—moisturize eyes, also protect against for-
eign objects
 +PIX\MZ ■ Anatomy and Physiology 95

Pinna
Temporal bone
Semicircular canals
• External auditory canal—tubelike opening or mea-
tus from the pinna to the tympanic membrane
Tympanic
y p
membrane ❍ Ceruminous glands—glands in beginning of the
ear canal that produce cerumen (earwax) to pro-
Vestibulocochlear
nerve tect the internal ear structures
❍ Tympanic membrane (eardrum)—boundary
Cochlea
between external and middle ear canals; vibrates to
Malleus Eustachian transmit sound waves to inner ear
Incus ((auditory)
Stapes tube ■ Middle ear—contains three auditory (hearing) ossicles
Ossicles (bones) that amplify sound from the tympanic mem-
External Pharynx
brane and transmit to fluid in inner ear
auditoryy canal
(meatus)
• Malleus (hammer)—first ossicle
.QO]ZM The ear. (Reprinted with permission from Cohen BJ, Wood DL. • Incus (anvil)—second ossicle
Memmler’s The Human Body in Health and Disease. 9th Ed. Philadelphia:
Lippincott Williams & Wilkins, 2000.) • Stapes (stirrup)—third ossicle
■ Eustachian tube—connects the middle ear with the
throat and pharynx; equalizes pressure on the tympanic
membrane
• Lacrimal structures—glands and ducts that secrete
and drain tears ■ Inner ear (labyrinth)—contains vestibule, semicircular
canal, and cochlea, with receptors for hearing and
• Conjunctiva—mucous membrane lining of the eyelid
balance
• Optic nerve—second cranial nerve; carries visual
impulses from the rods and cones to the brain • Vestibule—middle section of the inner ear that
involves balance
• Semicircular canal—curved passageway in the inner
Hearing (Auditory Sense) ear that detects motion and regulates balance
Figure 6-14 illustrates the following structures of the ear; • Cochlea—snail-shaped tube that contains the recep-
Box 6-6 lists common diseases and disorders of the ear. tor for hearing

■ Ear—sense organ for hearing and equilibrium Smell (Olfactory Sense)

■ Outer ear ■ Nasal cavity
• Pinna (auricle)—external ear; directs waves to the • Olfactory epithelium—contains receptors for smell
canal
• Olfactory nerve—first cranial nerve leading from
olfactory center in the temporal lobe of the brain
to olfactory sensors in epithelium
*W`
+WUUWV,Q[MI[M[IVL,Q[WZLMZ[WN\PM-IZ Taste (Gustatory)
■ Tongue
Deafness—partial or complete hearing loss; many
causes, such as trauma, disease, nerve damage
• Glossal papillae—taste receptors, or taste buds,
located on the tongue that sense bitter, sour, sweet,
Ménière’s disease—chronic disturbance in and salty tastes
labyrinth resulting in dizziness, loss of equilib-
rium, and deafness; unknown cause; treatment • Cranial nerves—facial and glossopharyngeal cranial
is palliative (attempting to provide relief for nerves associated with taste
signs and symptoms)
Otitis media—infection of middle ear; most com- ENDOCRINE SYSTEM
mon in infants and toddlers; usually treated
The endocrine system contains glands producing regula-
with antibiotics
tory chemicals or hormones (Fig. 6-15). This system, in
Otosclerosis—partial deafness resulting from
conjunction with the nervous system, regulates and coordi-
bone growth involving the ossicles; may be
nates other body systems. The nervous system communi-
improved by surgery
cates to the endocrine system the need for hormone
Tinnitus—ringing in the ears
adjustments resulting from environmental changes. The
Vertigo—dizziness
hormones are secreted into the bloodstream and carried to
96 =VQ\ ■ General Knowledge

Pineal

Pituitary

Thyroid

Parathyroids

Thymus

Adrenals

Pancreatic
islets

Ovaries

Testes

.QO]ZM Endocrine glands. (Reprinted with permission from Cohen BJ. Medical Terminology. 4th Ed. Philadelphia: Lippincott
Williams & Wilkins, 2003.)

target cells where the reactions occur. The term endocrine ■ Giantism—overproduction of GH that results in
comes from the Greek word endon, meaning “within” abnormally large size
(because the secretions are within the gland). Table 6-1 ■ Acromegaly—overproduction of GH after puberty
summarizes the endocrine glands and their hormones and that results in wide, large face, hands, and feet
functions. Other glands, called exocrine glands, secrete
externally or into ducts. These glands and hormones will
be discussed with the appropriate systems. Thyroid Gland
■ Goiter—enlarged thyroid
Functions of the Endocrine System ■ Hypothyroidism—underactivity of the thyroid
■ Regulates growth, metabolism, reproduction, and • Cretinism—hypothyroidism; decreased secretion of
behavior thyroxine in infants that results in impaired physical
■ Coordinates and stimulates many body functions by and mental development
secreting and sending hormones to specific cells • Myxedema—atrophy of the thyroid in adults that
results in decreased secretion of thyroxine, causing
Common Diseases and Disorders of the Endocrine System forms of physical and mental decline
■ Hyperthyroidism—overactivity of the thyroid
Pineal Gland
• Graves disease—hyperthyroidism; increased secretion
■ Seasonal affective disorder (SAD)—overproduction of of thyroxine characterized by goiter, exophthalmia
melatonin during long periods of darkness (winter), (bulging eyes), weight loss, extreme nervousness, and
resulting in depression rapid metabolism

Anterior Pituitary Gland

Parathyroid Gland
■ Dwarfism—decreased production of growth hormone
(GH) that results in abnormally small size ■ Tetany—spasms resulting from low blood calcium
 +PIX\MZ ■ Anatomy and Physiology 97

Table 6-1 -VLWKZQVM/TIVL[0WZUWVM[IVL;MTMK\. ]VK\QWV[

Gland Hormones and Select Functions

Pineal gland Melatonin—regulates sexual development and sleep/wake cycles
Pituitary gland, “Master gland” Anterior pituitary (adenohypophysis)
Growth hormone (GH)—promotes growth of bone and soft tissue
Thyroid-stimulating hormone (TSH)—stimulates thyroid to produce
thyroid hormones
Adrenocorticotropic hormone (ACTH)—stimulates adrenal cortex to
produce hormones for stress and water/electrolyte balance
Follicle-stimulating hormone (FSH)—stimulates secretion of estrogen and
growth of testes; promotes development of sperm cells
Luteinizing hormone (LH)—causes development of corpus luteum in females
and stimulates secretion of testosterone in males
Prolactin—stimulates female breast development and milk secretion
Posterior pituitary
Vasopressin or antidiuretic hormone (ADH)—increases reabsorption in
kidney and stimulates blood vessels to contract
Oxytocin—increases uterine contractions and causes breast milk secretion
Thyroid gland Thyroid hormone (thyroxine, T4; T3)—increases metabolic rate; necessary for
normal cell growth
Calcitonin—reduces plasma calcium concentrations
Parathyroid gland Parathyroid hormone (PTH)—increases calcium level in blood
Thymus gland Thymosin—stimulates production of T cells, facilitating immunity
Adrenal glands Aldosterone—regulates sodium and potassium levels
Adrenal cortex Cortisol (glucocorticoid)—increases blood glucose and assists in stress
Adrenal medulla Androgens—stimulate development of secondary sex characteristics
Epinephrine—increases heart rate and blood pressure
Norepinephrine—aids neurotransmission
Pancreas Insulin—decreases sugar levels
Glucagon—increases sugar levels
Gonads (sex glands) Ovaries (female) Estrogens—stimulate growth of breasts, uterus, and secondary sex
characteristics
Progesterone—prepares and maintains the uterine lining for pregnancy
Testes (male) Testosterone—stimulates development of sex characteristics and sperm

Adrenal Cortex Gland • Insulin-dependent diabetes mellitus (IDDM)—type

■ Addison disease—hyposecretion of cortisol by the 1 diabetes
adrenal cortex, resulting in muscle atrophy, tissue • Non–insulin-dependent diabetes (NIDDM)—type
weakness, and skin pigmentation 2 diabetes
■ Cushing syndrome—overproduction of cortisol by the
adrenal cortex, resulting in round face, excessive
weight gain, thin skin, and high blood sugar CARDIOVASCULAR SYSTEM
The cardiovascular (or circulatory) system pumps
Pancreas
blood, carrying life-sustaining oxygen and other sub-
■ Diabetes mellitus—most common endocrine disorder; stances throughout the body. The primary components
low production of insulin, resulting in cells retaining sugar are blood, blood vessels, and the heart.
98 =VQ\ ■ General Knowledge

Functions of the Cardiovascular System

■ Transports oxygen, nutrients, and other needed sub-
stances to body tissues Common carotid
Subclavian
■ Assists in removal of body wastes
Aortic arch
■ Regulates acidity (pH) of body fluids
Axillary Intercostals
■ Assists in regulating body temperature
Celiac
Renal
Components of the Cardiovascular System Brachial

Blood Radial
Ulnar Inferior
Blood is the connective tissue containing cells and fluid in mesenteric
Thoracicc
a viscous consistency that circulates in vessels throughout aorta Common
the body. iliac
Superior
mesenteric Internal
■ Plasma—liquid portion of blood (55%) iliac
Femoral
• Albumin—the most abundant plasma protein; main- External
tains osmotic pressure iliac

• Fibrinogen—the smallest amount of plasma protein;

assists in the coagulation (clotting) process
Popliteal
• Globulin—plasma protein used for gamma globulin Anterior tibial
• Serum—clear, liquid portion of blood that remains Posterior tibial
after the blood clots
■ Cellular components of blood (45%)
Dorsalis pedis
• Erythrocytes—red blood cells (RBCs); contain
hemoglobin to carry oxygen; mature cells do not
have a nucleus
.QO]ZM Major arteries. (Reprinted with permission from Cohen BJ, Wood DL.
• Leukocytes—white blood cells (WBCs); fight infec- Memmler’s The Human Body in Health and Disease. 9th Ed. Philadelphia:
tion Lippincott Williams & Wilkins, 2000.)
• Platelets (thrombocytes)—cell fragments; function
in coagulation

Blood Vessels ■ Pericardium—outer fibrous sac that covers and pro-

Blood vessels are the arteries, veins, and capillaries that tects the heart
carry blood throughout the body. ■ Chambers—four heart chambers: two superior and
two inferior
■ Arteries (Fig. 6-16)—blood vessels throughout the • Right atrium (plural atria)—superior chamber that
body that carry oxygenated blood away from the heart receives deoxygenated blood from the systemic vessels
■ Veins (Fig. 6-17)—blood vessels throughout the body • Left atrium—superior chamber that receives oxy-
carrying deoxygenated blood toward the heart; contain genated blood from the pulmonary veins
valves
• Right ventricle—inferior chamber that pumps blood
■ Capillaries—small blood vessels connecting veins and to the lungs
arteries
• Left ventricle—inferior chamber that pumps blood
to the body tissues
Heart
■ Valves—flaplike structures that open and close, allow-
The heart is the body’s pump, a fist-sized muscular organ ing blood to flow through the heart in one direction
composed of three layers and an outer covering. • Atrioventricular valves (AV)—located between the
atria and ventricles; their closing prevents backflow
■ Endocardium—inner layer of blood into the atria
■ Myocardium—middle layer ❍ Tricuspid valve (three flaps)—AV valve located
■ Epicardium—outer layer between the right atrium and ventricle
 +PIX\MZ ■ Anatomy and Physiology 99

Superior vena cava

Aortic
Aortic
rtic
ti
tic
ic ar
a
arch
arch
Jugular Subclavian
Atrial septum
Ao
Ao
orrt
r tta
rta a Pulm
Pul
Pu
P u
ulmon
ulmo
lmona
monary
onary
nary
ary
y
Intercostals Pulmonary arter
arte
art
ar
rtery
r tery
ery
ry
y
veins
Superior
vena cava Axillary
Left atrium
Cephalic
Mitral valve
Inferior
vena cava Brachial Aortic valve
Right atrium
Pulmonary valve

Tricuspid valve Left ventricle

Cephalic Hepatic Ventricular
Renal Right ventricle septum

Lumbar Endocardium
Inferior vena cava
Myocardium
Epicardium
Internal iliac Oxygenated blood
Pericardium
External iliac Deoxygenated blood

.QO]ZM The heart and great vessels. (Reprinted with permission from Willis
Femoral
MC, CMA-AC. Medical Terminology: A Programmed Learning Approach to the
Saphenous Language of Health Care. Baltimore: Lippincott Williams & Wilkins, 2002.)
Popliteal

Tibial
• Vena cava—largest body vein; has inferior and
superior branches
❍ Inferior vena cava—brings deoxygenated blood to
the heart from the lower extremities, pelvis, and
some abdominal organs
.QO]ZM Major veins. (Reprinted with permission from Cohen BJ, Wood DL. ❍ Superior vena cava—brings deoxygenated blood
Memmler’s The Human Body in Health and Disease. 9th Ed. Philadelphia: to the heart from the head, neck, upper limbs, tho-
Lippincott Williams & Wilkins, 2000.)
rax, and some abdominal organs
■ Pulmonary veins (four)—right and left superior and
❍ Mitral valve (bicuspid; two flaps)—AV valve inferior veins bring oxygenated blood from the lungs
located between the left atrium and ventricle to the left atrium of the heart for circulation through-
• Semilunar valves (SL)—located between the ventri- out the body; the only veins that carry oxygenated
cles and the pulmonary artery and aorta; their clos- blood
ing prevents backflow of blood into the ventricles
❍ Aortic valve—located between the left ventricle The Cardiac Cycle
and the aorta
The main function of the cardiovascular system is to cir-
❍ Pulmonary valve—located between the right ven-
culate blood (Fig. 6-19). The major portion of this func-
tricle and the pulmonary artery
tion is accomplished through the pumping of the heart in
■ Great vessels of the heart—Figure 6-18 identifies a rhythmic cycle of contraction and relaxation called the
structures and demonstrates how blood flows through cardiac cycle.
the heart
• Aorta—largest body artery; consists of three parts: ■ Atrial systole (contraction)—the atria contract,
ascending, aortic arch, and descending forcing blood into ventricles through the tricuspid
• Coronary arteries (right and left)—supply blood and mitral valves, which close at the end of the con-
to the myocardium; significant blockage of these traction
arteries results in myocardial infarction (MI; heart ■ Ventricular diastole (relaxation)—the ventricles relax,
attack) filling with blood from the atria
• Pulmonary artery—only artery that carries deoxy- ■ Ventricular systole (contraction)—the ventricles con-
genated blood; transports blood from the heart to tract, forcing blood through the SL valves to the aorta
the lungs to be oxygenated and pulmonary artery
100 =VQ\ ■ General Knowledge

Aorta
Superior and inferior
venae cavae Leaves
General body heart
circulation Aortic
Enters
valve
heart
Right
atrium Left
ventricle

Tricuspid
valve
Bicuspid
(mitral valve)

Right
ventricle
Left
atrium

Pulmonic
valve Returns
to heart
Leaves
heart
Pulmonary
Enters Leaves
Pulmonary veins
lungs lungs
artery

Oxygenated blood
Deoxygenated blood
.QO]ZM! Blood circulation through the body.

■ Atrial diastole (relaxation)—the atria relax, filling with cycle, produce the electrocardiogram, which will be dis-
blood from the vena cava and pulmonary veins cussed in Chapter 20.
■ Cycle repeats beginning with atrial systole
■ Sinoatrial (SA) node—located in the upper wall of the
right atrium, the SA node is the pacemaker of the
Cardiac Conduction heart and initiates a normal heart beat and rate of 60
The heart is stimulated to contract through a series of to 80 beats per minute (sinus rhythm); it causes the
electrical impulses or signals located throughout the atria to contract
heart itself. The impulses are carried or relayed through a ■ AV node—located in the atrial septum at the lower right,
group of structures that make up the conduction system the AV node picks up the impulse or signal from the SA
(Fig. 6-20). These conduction paths, with the cardiac node that causes the atria to contract; if the SA node
 +PIX\MZ ■ Anatomy and Physiology 101

• Pernicious anemia—anemia that results from vita-

min B12 deficiency
Aorta • Sickle cell anemia—chronic inherited disease found
Superior AV bundle in Africans and their descendants, causing the hemo-
vena cava (bundle of His)
globin cell to mutate its shape
■ Leukemia—type of malignancy; rapid and abnormal
development of leukocytes (WBCs) in spleen, bone
marrow, and lymph nodes
Internodal
pathway ■ Hemophilia—genetic bleeding disorder; deficiency of
specific clotting factors that results in abnormal bleed-
ing, especially into the joints, from minor trauma; the
Purkinje causative gene is transmitted from mother to sons
SA node fibers
(pacemaker)

AV node Diseases and Disorders of the Blood Vessels

Inter- ■ Aneurysm—genetic or traumatic weakness of a blood
ventricular vessel wall demonstrated by a “bubble” or outpouch-
septum
ing caused by pressure of blood; an abdominal aortic
aneurysm is called an AAA or triple A
Inferior
vena cava ■ Arteriosclerosis—hardening of the artery and loss of
elasticity resulting from thickening of the vessel wall
Purkinje fibers • Atherosclerosis—most common form of arterioscle-
Left bundle rosis, with irregular fatty deposits on artery wall that
Right bundle
branch branch result in narrowing and occlusion of vessel; may cause
.QO]ZM Cardiac conductive system. (Reprinted with permission from Cohen
MIs, CVAs, gangrene, and other disorders associated
BJ, Wood DL. Memmler’s The Human Body in Health and Disease. 9th Ed. with blood vessel blockage
Philadelphia: Lippincott Williams & Wilkins, 2000.) Note: The difference between atherosclerosis and arte-
riosclerosis is a highly probable exam question.

fails, the AV node may initiate the impulse; the resulting • Coronary artery disease (CAD)—arteriosclerosis or
atherosclerosis-type process of the coronary arteries,
heart rate is slower, at 40 to 60 beats per minute
usually leading to myocardial ischemia (damage to
■ Bundle of His—specialized cells in the ventricular tissue resulting from lack of oxygen caused by an
septum, carrying the impulse from the AV node; occlusion)
should the SA and AV nodes fail, the bundle of His
■ Embolus (plural emboli)—a
i detached thrombus or
may initiate the impulse; the resulting heart rate is 20
other substance that occludes a vessel
to 40 beats per minute
■ Thrombophlebitis—inflammation of a vein with clots
■ Bundle branches—two branches extending from the
bundle of His that carry the impulse down the ventric- ■ Thrombus (plural thrombi)—an
i attached blood clot
ular septum located within the cardiovascular system
■ Purkinje fibers—smaller fibers arising from the bundle
branches that carry the impulse to the ventricular Diseases and Disorders of the Heart
walls, causing them to contract
■ Angina pectoris—severe constricting chest pain result-
ing from lack of blood supply to the heart; associated
Common Diseases and Disorders of the with CAD
Cardiovascular System ■ Arrhythmias—abnormal heart rhythms
Diseases and Disorders of the Blood • Bradycardia—slow heart rate
■ Anemia—abnormally low hemoglobin or RBCs, • Tachycardia—fast heart rate
decreasing oxygen supply to the tissues; anemia has • Flutters—rapid, coordinated heart beats
many causes and types; main symptoms are fatigue and • Fibrillation—rapid, uncoordinated contractions of
weakness the heart (may be atrial or ventricular)
• Aplastic anemia—anemia that results from bone • Heart blocks—interruption of the heart’s electrical
marrow damage decreasing the production of RBCs conduction
102 =VQ\ ■ General Knowledge

■ Congenital heart disease—disorder present at birth ❍ Right lymphatic duct—the smaller lymph duct; it
drains the right side of the body above the
• Patent ductus arteriosis—opening between the aorta
and pulmonary artery in fetal circulation that does diaphragm
not close after birth ■ Lymph nodes—oval-shaped fibrous capsules that filter
and cleanse the lymph as it enters the blood
• Ventricular septal defect—most common congenital
heart problem; a hole in the septum between the two ■ Tonsils—three pairs of masses of lymphoid tissue that
ventricles filter foreign organisms entering the body through the
mouth or nose and assist in the formation of white cells
• Tetralogy of Fallot—presence of four specific con-
genital heart defects • Palatine tonsils—located on each side of the soft
■ Congestive heart failure—venous and pulmonary con- palate, these lymph masses are the ones commonly
gestion and general edema (swelling) resulting from referred to as the “tonsils”
decreased blood circulation • Pharyngeal tonsils—adenoids; located on upper
■ Hypertension—high blood pressure (beginning at pharynx
140/90) • Lingual tonsils—located at back of tongue
■ Myocardial infarction—heart attack; necrosis (death) ■ Spleen—organ located in the upper left hypochon-
of an area in the myocardium resulting from cessation driac region of the abdomen under the diaphragm
of blood supply, usually from coronary thrombosis dome; contains lymph tissue; cleanses blood, destroys
■ Rheumatic heart disease—inflammation and harden- old RBCs, produces RBCs before birth, and reserves
ing of the heart valve(s) resulting from a streptococcal blood in case of emergencies (e.g., hemorrhage)
infection associated with rheumatic fever ■ Thymus—gland, considered part of the endocrine sys-
■ Stenosis of the heart valves (aortic, mitral, tricuspid, or tem, that produces thymosin, which is necessary for
pulmonary)—narrowing of the valve that prevents growth and the function of lymphocytes
normal blood flow
Common Diseases and Disorders of the
LYMPHATIC SYSTEM Lymphatic System
The lymphatic system is sometimes considered part ■ Splenomegaly—enlarged spleen, associated with cer-
of the cardiovascular (circulatory) system. It is similar in tain infectious diseases
that it has a fluid called lymph, which is circulated ■ Lymphoma—benign or malignant tumor of lymph
throughout the body in a network of vessels. The lymph tissue
and lymphatic tissues cleanse and filter, protecting
• Hodgkin’s disease—chronic malignant lymphoma(s)
against and combating disease. with enlarged spleen; treated by chemotherapy and
radiation; generally seen in young men
Functions of the Lymphatic System
• Non-Hodgkin’s lymphoma—widespread malignant
■ Defends against disease disease in lymph tissues; responds poorly to therapy;
■ Assists in developing immunities generally seen in older adults
■ Returns excess interstitial fluid to the blood ■ Acquired immunodeficiency syndrome (AIDS)—
decreased immunity resulting from infection with the
human immunodeficiency virus (HIV); leaves patient
Components of the Lymphatic System
susceptible to opportunistic diseases
■ Lymph—clear fluid resembling blood plasma that con- ■ Mononucleosis (mono)—acute infectious disease
tains some RBCs and WBCs and lymphocytes caused by Epstein-Barr virus, resulting in lymph tissue
■ Lymphocytes—white cells that protect the body involvement, including enlarged spleen; generally seen
against infection and aid in establishing immunity in young adults
■ Lymph vessels—similar to veins, they carry lymph and
contain valves and lymph nodes Overview of Immunity
• Lymph capillaries—microscopic vessels Immunity is the individual’s resistance to specific dis-
• Lymphatic ducts (two)—narrow tubular channels eases or disorders, usually by acquiring the correspon-
carrying lymph to the bloodstream ding antibody to that disease or disorder. Immunity is a
❍ Thoracic duct—the larger lymph duct; it drains function of the lymphatic system. The national exams
the entire body except the right side above the often contain questions concerning active and passive
diaphragm immunity, which are described in Box 6-7.
 +PIX\MZ ■ Anatomy and Physiology 103

*W` *W`
<aXM[WN1UU]VQ\a +WUUWV>IKKQVM8ZM^MV\IJTM,Q[MI[M[
Immunity: resistance or the condition of not being Diphtheria
susceptible to a disease Haemophilus influenzae b
Hepatitis A
Active Immunity Hepatitis B
Long-term immunity—produced
y by the body’s Human papilloma virus
own production of antibodies Influenza (select strains)
Measles
• Natural active immunity—acquired
y from expo- Meningitis (select strains)
sure to disease-causing organisms Mumps
• Artificial active immunity—acquired
y from Pertussis (whooping cough)
immunization with killed or attenuated organisms, Pneumonia (select strains)
toxins, or recombinant DNA Polio
Rotavirus
Passive Immunity Rubella (German measles)
Short-term immunity: produced by introducing Tetanus (lockjaw)
antibodies manufactured outside the body Varicella (chickenpox)
• Natural passive immunity—acquired
y from
maternal antibodies while in the uterus or
breast-feeding to sustain human cells, and giving off carbon dioxide
• Artificial passive immunity—acquired
y from (CO2), which is the waste product of respiration.
immunization with antibodies or globulins of
disease-causing organisms Functions of the Respiratory System
■ Obtains O2 and other gases from the external envi-
ronment
Additional Terms Associated With Immunity
■ Delivers gases to the blood (diffusion)
■ Antigen—a substance (e.g., bacteria/viruses, bacterial/ ■ Removes CO2, a waste product of respiration, from the
viral toxins, foreign blood cells) that causes the forma- cells
tion of antibodies
■ Transports CO2 to the external environment
■ Antibody—a substance produced in the body in
response to the presence of an antigen; antibodies
enhance activities of leukocytes and produce globulins Components of the Respiratory System
protecting the body against further assault from the Respiratory Center
specific antigen
The respiratory center is the bundled nerve cells, located
■ Phagocytosis—ingestion of bacteria and particles by in the medulla oblongata and pons of the brain, control-
phagocytes (a form of leukocyte) ling breathing and responding to changing levels of O2
■ Globulins—the fraction of the blood serum protein and CO2 in the blood.
associated with antibodies; vaccination with globulins
produces passive immunity Upper Respiratory Tract
■ Immunization (vaccination)—protection from com-
municable diseases by administration of living attenu- The upper respiratory tract is the passageway for gases.
ated agents (e.g., measles), killed organisms (e.g., It is composed of the following:
pertussis), inactivated toxins (e.g., tetanus), or recom-
■ Nose—projection on the face that warms and moistens
binant DNA (e.g., hepatitis B); Box 6-8 identifies com-
mon vaccine-preventable diseases air as it enters the body; contains cilia and hair to pre-
vent foreign particles from entering the respiratory
system
RESPIRATORY SYSTEM ■ Pharynx (throat)—passageway from nose to larynx
The respiratory system is a group of body structures ■ Larynx (voice box)—organ between the pharynx and
(Fig. 6-21) responsible for breathing or ventilation. The trachea containing the vocal cords, which vibrate to
process involves taking in oxygen (O2), which is needed produce speech
104 =VQ\ ■ General Knowledge

THE RESPIRATORY SYSTEM ■ Bronchi (singular bronchus)—tubes

s from the trachea
entering the lungs that subdivide into two more
branches in the lungs
• Bronchioles—smaller branches of the bronchi
Nasal cavity • Alveoli (singular alveolus)—air
s sacs at the ends of the
Nasopharynx
Oral cavity bronchioles where the exchange of gases occurs
Oropharynx
Tonsils Nose ■ Lungs (two)—main organ of the respiratory system,
Laryngopharynx located in the thoracic cavity; distributes and exchanges
Epiglottis
pg
gases
E
Esophagus
h
Trachea
Tongue
• Right lung—contains three lobes
Larynx with • Left lung—contains two lobes
vocal cords
• Pleura—lung linings containing pleural fluid to pro-
tect lungs and reduce friction during respiration
Rib Lung
Pleura
Lung ■ Thorax—cavity containing the lungs
Pleural cavity ■ Diaphragm—muscle tissue separating thoracic and
Right main abdominal cavities that contracts and expands during
bronchus
Left main respiration, allowing lungs to fill and empty air
Upper lobe of bronchus
right lung
Upper lobe
Middle lobe of left lung
Additional Respiratory System Terms
Lower lobe ■ Cheyne-Stokes respiration—irregular breathing pat-
Bronchioles tern of slow and shallow, then rapid and deep respira-
Mediastinum Lower lobe
tions, with pauses for 20 to 30 seconds; frequently
Diaphragm
occurs before death
■ Inspiration (inhalation)—bringing air into lungs; the
diaphragm contracts, increasing the size of the tho-
racic cavity and allowing air to enter the lungs
B
Bronchiole
hi l with
ith alveoli
l li
■ Expiration (exhalation)—releasing air from the lungs;
the diaphragm relaxes, decreasing the size of the tho-
racic cavity and pushing air out
Pulmonary
vein
i ■ External respiration—exchange of O2 and CO2 in the
Alveolus lungs and capillaries
■ Internal respiration—exchange of O2 and CO2 between
Lobes
the capillaries and the tissue cells
O2
CO2
■ Pulmonary—referring to the lungs
■ Rales—sometimes referred to as rhonchi; a crackling
Pulmonary
breath sound resulting from increased secretions in the
artery bronchi
■ Stridor—high-pitched breath sounds resembling wind,
.QO]ZM The respiratory system. (Reprinted with permission from Willis MC, caused by partial obstruction of air passages
CMA-AC. Medical Terminology: A Programmed Learning Approach to the ■ Wheeze—squeaking or whistling breath sound, usually
Language of Health Care. Baltimore: Lippincott Williams & Wilkins, 2002.)
caused by narrowed tracheobronchial airways, as in
asthma
■ Epiglottis—flaplike structure that covers the larynx
during swallowing
Common Diseases and Disorders of the
Lower Respiratory Tract Respiratory System
The lower respiratory tract is composed of the following: ■ Asthma—episodic chronic respiratory disorder result-
ing from constricted bronchi, associated with aller-
■ Trachea—tube branching into two bronchi, which lead gens, infection, pollutants, cold air, exercise, or stress;
into the lungs characterized by wheezing and low oxygen levels
 +PIX\MZ ■ Anatomy and Physiology 105

■ Atelectasis—decreased or absence of air in part or in

all of the lung and alveoli resulting from collapse of
these structures
■ Bronchitis—chronic or acute inflammation of the
bronchi Oral cavity

■ Carcinoma (cancer)—malignant tumor of lung or

other areas of respiratory system
Pharynx
■ Chronic obstructive pulmonary disease (COPD)— Trachea
usually progressive respiratory system disorder with
irreversible obstruction of air exchange in the bronchi,
Esophagus
alveoli, and lungs; emphysema is a form of COPD
■ Croup—acute viral infection, usually in infants, char-
acterized by barking cough Stomach
Diaphragm
■ Cystic fibrosis—a genetic disorder that produces
abnormally thick mucous secretions blocking and Liver (cut)
Spleen
Gallbladder
impairing the bronchi, pancreatic and bile ducts, and
intestines Duodenum
Transverse
■ Emphysema—a form of COPD characterized by irre- Common bile duct
colon
versible loss of elasticity in alveoli that impedes respi- Pancreas
Small intestine
ration Ascending colon
■ Legionnaires’ disease—a type of pneumonia caused by Descending
colon
the Legionella pneumophila bacteria Cecum Sigmoid colon
■ Pertussis (whooping cough)—a vaccine-preventable Vermiform appendix

bacterial infection (Bordetella pertussis) s producing a Rectum

Anus
“whoop” coughing sound; may be fatal in infants
.QO]ZM The digestive system. (Reprinted with permission from Cohen BJ,
■ Pharyngitis—sore throat, inflammation of the pharynx
Wood DL. Memmler’s The Human Body in Health and Disease. 9th Ed.
■ Pleurisy—inflammation of the pleura Philadelphia: Lippincott Williams & Wilkins, 2000.)
■ Pneumonia—viral or bacterial infection causing inflam-
mation of the lungs ■ Absorption—the transfer of the products of digestion
■ Pneumothorax—partial or complete collapse of the into the blood and lymph for circulation
lung(s) resulting from air in the pleural cavity ■ Elimination—excretion of the solid waste products of
■ Pulmonary edema—fluid accumulation in the lungs, digestion in the form of feces
often associated with congestive heart failure
■ Tuberculosis—an infectious bacterial disease charac- Components of the Digestive System
terized by tubercles in the tissue; the lung is the most Digestive Tract
common disease site
The digestive tract, or alimentary canal, is the system of
tubelike organs in which digestion occurs; it begins at
DIGESTIVE SYSTEM the mouth and ends at the anus.

The digestive system consists of the digestive tract, or ■ Mouth (oral cavity)—orifice in the lower face where
alimentary canal, and its accessory organs, including food enters the body; chewing (mastication) and mix-
the liver, pancreas, and gallbladder (Fig. 6-22). These ing with saliva occurs, forming a bolus
organs take food and process it into usable energy for the
body’s growth, maintenance, and survival. The nutrients • Salivary glands—three pair of glands located in the
mouth that secrete saliva to moisten food and to
are absorbed and circulated, and the solid waste is
begin the chemical breakdown of carbohydrates
eliminated.
• Teeth—hard dentine structures located in the upper
and lower jaws used for chewing (mastication);
Functions of the Digestive System adults have 32 teeth
■ Digestion—physical and chemical processes changing ■ Pharynx (throat)—this organ is part of the respiratory
food into simple nutrients to be used by the cells for system and also allows masticated food to pass from
energy and building materials the mouth to the esophagus
106 =VQ\ ■ General Knowledge

■ Esophagus—tube from the pharynx to the stomach detoxifies blood, removes bilirubin, manufactures
■ Stomach—J-shaped organ between the esophagus and plasma protein involved in the production of pro-
the duodenum that produces a churning action, mixing thrombin and fibrinogen, and aids metabolism
food with gastric acids and enzymes as part of diges- ■ Pancreas—an endocrine gland located behind the stom-
tion; also stores food ach producing pancreatic juice, which is transported to
■ Small intestine—longest portion of digestive tract; it the duodenum to aid in digestion, and insulin and
digests fats, proteins, and carbohydrates and absorbs glucagon, which regulate carbohydrate metabolism
the nutrient products into the blood ■ Gallbladder—pear-shaped sac located on the inferior
surface of the liver; stores bile to aid in digestion and
• Duodenum—upper portion of the small intestine,
separated from the stomach by the pyloric sphincter fat absorption; bile is carried from the gallbladder to
the duodenum via the common bile duct
• Jejunum—middle portion of the small intestine
• Ileum—lower portion of the small intestine, open-
ing into the cecum
Additional Digestive System Terms
• Villi (singular villus)—tiny
s projections in the small
intestine lining where absorption of nutrients occurs ■ Enzymes—proteins that act as catalysts increasing the
speed of digestion; each enzyme is specific to a certain
■ Large intestine—the final organ of the digestive tract,
type of food and reaction
it connects to the small intestine by the ileum and ends
at the anus; manufactures vitamins K and B; absorbs ■ Hepatic—referring to the liver
fluids and electrolytes; forms, stores, and excretes feces ■ Jaundice—yellowing of skin, white of eyes, and
mucous membranes resulting from increased bilirubin
• Cecum—upper portion of the large intestine; con-
tains the appendix in blood; most common causes are obstruction of bile
flow, liver dysfunction, or excess destruction of RBCs
• Colon—largest portion of large intestine; divided
into four parts ■ Peristalsis—rhythmic contractions that move food
throughout the digestive tract
❍ Ascending colon—portion of colon vertically
positioned along right side of abdominal cavity ■ Rugae—folds in the lining of the stomach and certain
other organs
❍ Transverse colon—portion of colon positioned
horizontally and bridging the ascending and
descending colons
Common Diseases and Disorders of the Digestive System
❍ Descending colon—portion of colon vertically
positioned along the left side of the abdominal ■ Anorexia—diminished appetite and aversion to food
cavity ■ Botulism—serious food poisoning, usually found in
❍ Sigmoid—lower S-shaped portion of colon con- contaminated canned foods, caused by Clostridium bot-
nected to the descending colon and the rectum ulinum bacteria
■ Cancer—malignant disease that may occur in any
• Rectum—the lower portion of the large intestine,
connecting the sigmoid to the anus and containing organ of the digestive system
the reflexes for defecation ■ Cholelithiasis—gallstones
• Anus—the final portion of the digestive tract, where ■ Cirrhosis—end-stage liver disease interfering with
feces are excreted blood flow, resulting in jaundice, portal hypertension,
❍ Internal sphincter—involuntary-control sphincter and function failure
located in the anus ■ Crohn disease—inflammatory bowel disease; chronic
❍ External sphincter—voluntary-control sphincter inflammatory disease of ileum or colon resulting in diar-
located in the anus rhea, pain, weight loss, and sometimes rectal bleeding;
generally affects young female adults
Note: The exams generally contain questions requiring
knowledge of the different portions of the large and small ■ Diverticula (singular diverticulum)—abnormal pouches
intestines. in the walls of an organ, usually found in the colon
■ Diverticulosis—diverticula of the colon
Accessory Digestive Organs ■ Gastroesophageal reflux disease (GERD)—backflow
The organs outside the digestive tract that are involved of stomach acids into the esophagus due to an incom-
in the digestive system functions are: petent esophageal sphincter, resulting in burning and
discomfort; can lead to ulcers
■ Liver—largest gland in the body, located in the upper ■ Giardiasis—infectious diarrhea caused by Giardia lamblia,
right portion of the abdominal cavity; produces bile, which is found in contaminated water
 +PIX\MZ ■ Anatomy and Physiology 107

■ Hemorrhoids—inflammation and dilation of veins in

rectum and anus
■ Hepatitis—acute or chronic inflammation of the liver;
Right kidney Left kidney
there are at least eight types of identified hepatitis (A, B,
C, D, E, F, G, H), with different causes and prognoses Inferior vena
cava
■ Hernia—protrusion of an organ or part of an organ
Abdominal
through the wall normally containing it; the intestine aorta
is the most common organ to herniate Ureters
• Hiatal hernia—protrusion of the stomach into the Urinary
diaphragm bladder

• Incarcerated hernia—protrusion of the intestine that

becomes swollen and obstructed Urethra

• Inguinal hernia—protrusion of the intestine through

the inguinal opening
• Strangulated hernia—constriction of the herniated
organ; may result in gangrene
• Umbilical hernia—protrusion of the intestine .QO]ZM The urinary system. (Reprinted with permission from Willis MC,
through the abdominal wall around the umbilicus CMA-AC. Medical Terminology: A Programmed Learning Approach to the
Language of Health Care. Baltimore: Lippincott Williams & Wilkins, 2002.)
■ Intussusception—one part of the intestine slipping into
another, leading to bowel obstruction and gangrene if
not quickly treated; most common in male infants
■ Thrush—yeast infection of the mouth caused by
reabsorb selected substances, and excrete urine; Figure
Candida albicans
6-24 illustrates the anatomy of the kidney and an
■ Ulcerative colitis—inflammation and ulceration of the enlarged nephron.
mucosa of the colon and rectum
■ Ulcers—lesions of the mucosa of any organ; most ■ Cortex—outer layer
common in the stomach and intestine ■ Medulla—inner layer
• Renal pyramids—triangular wedges in the medulla
URINARY SYSTEM containing nephrons
❍ Nephrons—group of microscopic coiled tubules
Reviewing the muscular, nervous, endocrine, cardiovas- (more than 1 million in each kidney) located in the
cular, respiratory, and other systems demonstrates their renal pyramids that filter blood and form urine;
interdependence on each other. The urinary system is no the main structures are collecting tubules and
different. The main role of the urinary system is to glomeruli (enclosed in Bowman’s capsule) and
remove liquid waste products from the blood and excrete arterioles; the bottom of the paperclip-shaped seg-
them (Fig. 6-23). The urinary system works closely with ment of the nephron is called the loop of Henle
the other systems to carry out these functions; other
❍ Calices (singular calix)—group
i of renal pyramid
functions are listed in the next section with the male
reproductive system. points forming the renal pelvis, where urine col-
lects; also spelled calyces (singular calyx)
x

Functions of the Urinary System

Ureters
■ Excretes nitrogen waste products and excess water and
The ureters are two slim tubes that carry urine from the
salts from the blood in the form of urine
kidneys to the urinary bladder.
■ Assists the liver in detoxification
■ Assists in maintaining pH balance Urinary Bladder
■ Assists in maintaining blood volume
The urinary bladder is a saclike organ behind the sym-
physis pubis that temporarily stores urine.
Components of the Urinary System
Kidneys Urethra
The kidneys are two muscular, bean-shaped organs The urethra is the tube that takes urine from the
located in the back of the abdominal cavity that filtrate, bladder out of the body.
108 =VQ\ ■ General Knowledge

Distal convoluted tubule

Renal cortex Proximal convoluted tubule
Renal medulla Bowman’s capsule
(pyramid) Glomerulus
Papilla of pyramid Afferent
arteriole
Minor calix (calyx)

Major calix (calyx)

Renal artery
Renal vein

Efferent
E Collecting
arteriole tubule

Renal pelvis

Ureter Artery
Vein

Peritubular capillaries
Loop of Henle
Kidney

Nephron

.QO]ZM Longitudinal section of the kidney and enlarged nephron. (Reprinted with permission from Willis MC, CMA-AC. Medical
Terminology: A Programmed Learning Approach to the Language of Health Care. Baltimore: Lippincott Williams & Wilkins, 2002.)

Additional Urinary System Terms ■ Glomerulonephritis—acute or chronic inflammation

of the kidney glomeruli; symptoms include edema,
■ Dehydration—water deficit
blood and protein in the urine, and possible uremia
■ Dialysis—a form of osmosis removing certain impuri-
■ Hydronephrosis—distention of the renal pelvis result-
ties from the blood (two types: peritoneal dialysis and
ing from obstructed flow of urine
hemodialysis)
■ Hypospadias—congenital disorder in which the male
■ Edema—local or generalized excess retention of tissue
urethra opens on the under side of the penis
fluid
■ Incontinence—inability to retain urine, semen, or feces
■ Glomerular filtration—the movement of fluid and mate-
rials under pressure from the blood through the ■ Nephrolithiasis (renal calculi)—kidney stones
glomerular membrane; the beginning of urine formation ■ Polycystic kidney disease—familial disorder producing
■ Tubular reabsorption—the process that follows cysts in the kidney tubules and leading to kidney
glomerular filtration; the filtered water and other failure
needed materials leave the tubule by diffusion and active ■ Pyelonephritis—inflammation and pyogenic infection
transport to enter tissue fluids of the renal pelvis
■ Urination—voiding or micturition; discharge of urine ■ Renal failure—acute or chronic loss of kidney function
from the bladder through the urethra resulting in buildup of nitrogen waste in the body
■ Urine—fluid waste from the blood secreted by the kid- ■ Uremia—high levels of nitrogen waste in the body
neys; stored in the urinary bladder and excreted from
the urethra
REPRODUCTIVE SYSTEMS
The male and female each has a different reproductive
Common Diseases and Disorders of the Urinary System
system. The male sperm uniting with the female ovum
■ Enuresis—involuntary discharge of urine results in the formation of a new and distinct human.
 +PIX\MZ ■ Anatomy and Physiology 109

The function of reproductive systems is to perpetuate ■ Ejaculatory duct—passage formed by the seminal
the human species. vesicles and vas deferens that allows semen to enter the
urethra
Male Reproductive System ■ Prostate gland—donut-shaped gland around the male
urethra at the bladder neck that secretes alkaline fluid
The male of the human species is characterized by hav- to protect sperm
ing an X and a Y chromosome.
■ Cowper gland—two small glands located at the base of
the penis that secrete lubricant during intercourse
Functions of the Male Reproductive System
■ Penis—external male sex organ that contains the ure-
■ Produces sperm thra; during sexual arousal, it becomes engorged with
■ Deposits sperm into the female reproductive canal blood and firm and erect, allowing entry to the female
vagina where the sperm is ejected (ejaculated)
■ Produces hormones for male sex characteristics
• Glans penis—acorn-shaped head of penis
Components of the Male Reproductive System • Prepuce—foreskin; a fold of skin covering the glans
penis
Figure 6-25 illustrates the components of the male
reproductive system.
Additional Male Reproductive System Terms
■ Scrotum—external pouch suspended from the male ■ Circumcision—surgical removal of foreskin
perineum that contains the testes and epididymis
■ Gamete—male (sperm) or female (ovum) reproductive
■ Testes (testicles)—two glandular organs in the male cell
scrotum that produce sperm, some semen (seminal
■ Genitalia—external sex organs
fluid), and testosterone
■ Spermatozoa—sperm
■ Epididymis—two coiled tubules on the posterior of
the testes that store and carry sperm from the testes to ■ Vasectomy—male sterilization procedure; tying off or
the vas deferens removing part or all of vas deferens
■ Vas deferens (vas)—tubule that carries sperm from epi-
didymis to seminal vesicles Common Diseases and Disorders
■ Seminal vesicles—a pair of accessory glands in the of the Male Reproductive System
male, posterior to the urinary bladder, that secrete
■ Benign prostatic hyperplasia (BPH)—nonmalignant
nutrient fluid for sperm
enlargement of the prostate
■ Cancers of the male reproductive system—malignan-
cies, usually in the testes or prostate
■ Cryptorchidism—failure of testes to descend into the
Rectum scrotum
Ureter
■ Hypospadias—congenital anomaly; the male urethra
Urinary opens on the posterior of the penis
bladder
■ Impotence—inability of the male to achieve erection
or ejaculation
Vas ■ Orchiditis (also spelled orchitis)—inflammation of the
deferens
Pubic symphysis
testes
■ Phimosis—inability to retract the foreskin over the
glans penis because of tightness of the skin
Penis
■ Priapism—abnormal, painful, prolonged penile
erection, usually resulting from spinal cord injury or
Seminal Epididymis disease
vesicle Urethra Glans penis
Prostate
Scrotum
Testis Urethral orifice
Female Reproductive System
.QO]ZM The male reproductive system. (Reprinted with permission from
Stedman’s Medical Dictionary. 27th Ed. Baltimore: Lippincott Williams & Wilkins, The female of the human species is characterized by two
2000.) X chromosomes.
110 =VQ\ ■ General Knowledge

• Mons pubis—soft pad over the symphysis pubis

• Labia majora—two large folds covering the vaginal
Fallopian tube opening, extending from the mons pubis to the per-
ineum
Rectum Ovary
• Labia minora—two small folds of skin inside the
Uterus labia majora
• Clitoris—small nodule of erectile tissue located in
the superior junction of the labia majora; contributes
Urinary
bladder to sexual arousal
Urethra • Bartholin glands—glands at the vaginal opening that
Clitoris provide lubrication during sexual intercourse
• Perineum—area between the vaginal opening and
Labia rectum
majora
■ Breasts—two mammary glands and fatty tissue situated
Cervix Vagina Labia minora over the pectoral muscles that produce milk
.QO]ZM The female reproductive system. (Reprinted with permission from
Stedman’s Medical Dictionary. 27th Ed. Baltimore: Lippincott Williams & Wilkins,
2000.) Additional Female Reproductive System Terms
■ Antepartum—time before delivery
■ Fertilization—impregnation of the female’s ovum (egg)
Functions of the Female Reproductive System with the male’s sperm
■ Produces ova (eggs) for fertilization ■ Fetus—term given to developing baby in the uterus
■ Carries and nurtures developing fetus after the first trimester
■ Gives birth ■ Gestation—period of pregnancy
■ Provides food source for newborn ■ Menarche—first female menses; usually occurs between
9 and 15 years of age
■ Produces hormones for female sex characteristics, repro-
duction, and lactation ■ Menopause—cessation of menses and female repro-
duction as a result of aging or surgical removal of the
ovaries or uterus
Components of the Female Reproductive System
■ Menstrual cycle—an approximately 28-day phase
Figure 6-26 depicts the components of the female repro- beginning with menstruation, followed by the thicken-
ductive system. ing of the endometrium; midcycle, ovulation occurs,
followed by secretion of progesterone by the corpus
■ Ovaries—two female sex glands located in the pelvis luteum to prepare the uterus for a fertilized ovum; if
that form ova (the female egg or germ cell) and secrete pregnancy does not occur, the cycle repeats
estrogen
■ Menstruation (menses)—shedding of the endometrium
■ Uterus—female organ located in pelvic cavity between of the uterus in the form of vaginal bleeding when
the oviducts and the vagina; it houses and nourishes pregnancy does not occur, usually every 28 days
the growing fetus and placenta
■ Neonatal—first 30 days after birth
• Fundus—upper region of the uterus ■ Ovulation—release of an ovum (egg) from the follicle
• Body—large central area of the uterus into the ovarian tube resulting from cyclical hormonal
• Cervix—lower uterine region opening to the vagina function
• Endometrium—lining of the uterus that sloughs off ■ Papanicolaou smear (Pap smear)—test for cervical can-
during menstruation; provides nourishment and cer that involves microscopically examining cervical
protection during pregnancy scrapings
■ Fallopian tubes (oviducts)—canals that pick up ova ■ Parturition—process of delivery; giving birth
released by the ovaries and carry them to the uterus ■ Placenta—oval vascular structure in the uterus during
■ Vagina—part of the birth canal; muscular tube con- pregnancy that supplies nutrients to the fetus
necting the cervix of the uterus to the external female ■ Pregnancy—gestation; period of fetal development in
genitalia the uterus from fertilization to birth, usually lasting
■ Vulva—external female genitalia 40 weeks
 +PIX\MZ ■ Anatomy and Physiology 111

Common Diseases and Disorders of the newborns become infected through the female birth
Female Reproductive System canal
■ Abortion—termination of pregnancy before fetal via- ■ Genital warts—infection caused by human papilloma
bility; may be spontaneous (naturally occurring) or viruses; a potential cause of cervical cancer
medically/surgically induced ■ Gonorrhea—contagious inflammation of the genital
■ Abruptio placentae—premature separation of the mucous membrane of either sex, caused by Neisseria
placenta gonorrhoeae
■ Amenorrhea—absence of menstrual flow ■ HIV—the virus causing AIDS

■ Carcinomas—malignancies of the female reproductive ■ Syphilis—chronic STD resulting in lesions (chancres)

system that most commonly occur in the breasts, that may spread to the bone and other body systems;
ovaries, uterus, and cervix disease may be congenital
■ Eclampsia—toxemia of pregnancy with high blood
pressure, albuminuria, oliguria, seizures, and sometimes TERMS
coma and death
■ Ectopic pregnancy (extrauterine)—implantation of Anatomy and Physiology Review
fertilized ovum outside the uterus, most commonly in The following list reviews the terms discussed in this
the fallopian tubes chapter, as well as other important terms that you
■ Endometriosis—condition caused by abnormal loca- may see on the exam.
tion of endometrium tissue outside the uterus; causes abduction moving away from the body midline (the
pain and, sometimes, cyst formation opposite of adduction) (e.g., spreading the arms)
■ Fibroids—nonmalignant tumors of the uterus abortion termination of pregnancy before viability;
may be spontaneous (naturally occurring) or
■ Menorrhagia—painful menses
medically/surgically induced
■ Miscarriage—spontaneous abortion; natural interrup- abruptio placentae premature separation of the
tion of a pregnancy before the seventh month placenta
■ Pelvic inflammatory disease (PID)—inflammation of the absorption the transfer of the products of digestion
pelvic cavity organs resulting from widespread infection into the blood and lymph for circulation
■ Placenta previa—implantation of the placenta in the acquired immunodeficiency syndrome (AIDS)
lower uterus decreased immunity resulting from infection
with the human immunodeficiency virus (HIV),
■ Premenstrual syndrome (PMS)—irritability, bloating,
leaving victim susceptible to opportunistic
and depression preceding menses
diseases
acromegaly overproduction of the growth hormone
Sexually Transmitted Diseases after puberty, resulting in wide, large face, hands,
and feet
Sexually transmitted diseases (STDs) or infections
active transport movement of molecules from area of
(STIs) affect both males and females. The act of inter-
lower to area of higher concentration
course results in passing and intermingling of body
Addison disease hyposecretion of cortisol by the
secretions between the sexual partners. These secretions
adrenal cortex, resulting in muscle atrophy, tissue
may contain pathogens that are then sexually transmit-
weakness, and skin pigmentation
ted from one person to another. The more sexual part-
adduction moving toward the body midline (the oppo-
ners a person has, the higher the risk of becoming
site of abduction) (e.g., bringing the arms to the
infected.
sides)
adrenal glands endocrine glands located on top of each
■ AIDS—decreased immunity resulting from infection
kidney; refer to Table 6-1 for functions
with HIV; leaves victim susceptible to opportunistic
alveoli (singular alveolus)s air sacs at the ends of the
diseases
bronchioles where the exchange of gases occurs
■ Chlamydia—caused by Chlamydia trachomatis; the most Alzheimer disease degenerative disorder of the brain
prevalent STD; symptoms are frequently undetected beginning with dementia-like symptoms and pro-
and result in female PID; babies born to mothers with gressing to a nonfunctioning of neuron fibers that
chlamydia are at risk for chlamydial pneumonia prevents communication between cells for ordinary
■ Genital herpes—viral infection of the male and female tasks (such as swallowing), which results in death;
genital tracts’ mucous membranes with painful lesions; etiology is unknown
incurable and may lead to cervical cancer in women; amenorrhea absence of menstrual flow
112 =VQ\ ■ General Knowledge

amyotrophic lateral sclerosis (ALS) progressive dis- atherosclerosis the most common form of arterioscle-
ease of the motor neurons, causing muscle atrophy rosis; irregular fatty deposits on arterial wall result in
and weakness; also known as Lou Gehrig disease narrowing and occlusion of vessel; may cause
anabolism phase of metabolism in which cells are built myocardial infarctions, cerebrovascular accidents,
or repaired gangrene, and other disorders associated with blood
anaphase third phase of mitosis; duplicated chromo- vessel blockage
somes separate, and one of each begins to move atrioventricular (AV) node located at the lower right
toward opposite centrioles or poles of the atrial septum, it picks up the impulse or signal
anatomy the study of body structure from the sinoatrial (SA) node that causes atrial con-
anemia abnormally low hemoglobin or red blood cells, traction; if the SA node fails, the AV node may initi-
decreasing oxygen supply to the tissues; many causes ate the impulse; the resulting heart rate is slower, at
and types; the main symptoms are fatigue and 40 to 60 beats per minute
weakness axial skeleton consists of the bones of the skull, spine,
aneurysm congenital or traumatic weakness of the ves- and chest
sel wall demonstrated by a “bubble” or outpouching Bell palsy unilateral facial muscle paralysis (drooping
caused by pressure of blood; an abdominal aortic of eye and mouth) resulting from dysfunction of the
aneurysm is called AAA or triple A seventh cranial nerve
angina pectoris severe constricting chest pain from benign prostatic hyperplasia (BPH) nonmalignant
lack of blood supply to the heart; associated with enlargement of the prostate
coronary artery disease bile a substance produced by the liver and stored in the
anorexia diminished appetite and aversion to food gallbladder that aids in digestion and fat absorption
antepartum time before delivery body organism; a group of systems working together to
anterior in front (ventral) maintain life
antibody a substance produced in the body in response body cavities spaces within the body that house inter-
to the presence of an antigen; antibodies enhance nal organs
activities of leukocytes and produce globulins pro- botulism serious food poisoning, usually found in
tecting the body against further assault from the contaminated canned foods, caused by Clostridium
specific antigen botulinum bacteria
antigen a substance (e.g., bacteria/viruses, bacterial/ brain an organ acting as the primary center for regulat-
viral toxins, foreign blood cells) that causes the ing and coordinating body functions and activities;
formation of antibodies divided into right and left hemispheres
anus the final portion of the digestive tract, where feces bronchi (singular bronchus) s tubes from trachea enter-
are excreted ing the lungs that subdivide into two more branches
aorta the largest body artery; consists of three parts: in the lungs
ascending, aortic arch, and descending bronchioles smaller branches of the bronchi
aponeurosis broad sheet of muscle fibers attaching bronchitis chronic or acute inflammation of the bronchi
muscle to muscle or muscle to select bones, such as bundle branches two branches extending from the
the skull bundle of His in the heart that carry the electrical
appendicular skeleton consists of the bones of the impulse down the ventricular septum
upper and lower extremities and the girdle attaching bundle of His specialized cells in the cardiac ventricular
them to the axial skeleton. septum that carry the electrical impulse from the atri-
arrhythmias abnormal heart rhythms oventricular (AV) node; should the sinoatrial and AV
arteriosclerosis hardening of the arteries and loss of nodes fail, the bundle of His may initiate the impulse;
elasticity resulting from thickening of the vessel wall the resulting heart rate is 20 to 40 beats per minute
arthritis inflammation of the joints cardiovascular system the body system containing the
asthma an episodic chronic respiratory disorder resulting heart and blood vessels to circulate blood, transport
from constricted bronchi; associated with allergens, nutrients, and remove waste from tissues
infection, pollutants, cold air, exercise, or stress; char- carpals four wrist bones
acterized by wheezing and low oxygen levels cartilage firm connective tissue found primarily in joints,
astigmatism impaired vision resulting from irregular thorax walls, larynx, and airway passages and ears
curve of cornea; the image focuses improperly on the catabolism the phase of metabolism in which cells are
retina; may be mild to severe; usually corrected with broken down
glasses or contact lenses cataract a cloudy or opaque lens that impairs sight;
atelectasis a decrease or absence of air in part or all of usually corrected by surgery
the lung and alveoli, resulting in a collapse of these caudal the location near the sacral region of the spinal
structures column
 +PIX\MZ ■ Anatomy and Physiology 113

cecum the upper portion of the large intestine; contains referred to as the body’s glue, providing strength and
the appendix flexibility
cells the structural and functional units of life Colles fracture displaced fracture of the distal radius,
central nervous system (CNS) made up of the brain proximal to the wrist
and spinal cord; integrates sensory information and colon largest portion of large intestine; divides into
responses four parts: ascending colon, transverse colon,
centriole rod-shaped material in the cytoplasm that descending colon, and sigmoid
begins cell division congestive heart failure (CHF) venous and pul-
cerebellum “little brain”; portion of the brain involved monary congestion and general edema (swelling)
in synergic control of skeletal muscles and coordina- resulting from decreased blood circulation
tion of voluntary muscular movements; connected conjunctivitis inflammation of the conjunctiva caused
to the cerebrum, brainstem, and spinal cord by the by infection or irritation
pons coronary artery disease (CAD) arteriosclerosis or ath-
cerebral palsy loss of mental function, sensation, or erosclerosis of the coronary arteries, usually leading
control of movement resulting from birth injury or to myocardial ischemia (damage to tissue)
defect Cowper glands two small glands located at the base of
cerebrospinal fluid (CSF) clear fluid that flows the penis that secrete lubricant during intercourse
through the brain and spinal cord and into the sub- cranial location associated with the head
arachnoid spaces of the meninges; it cushions and cretinism hypothyroidism; decreased secretion of thy-
supports nervous tissue and transports nutrients and roxine in infants resulting in failure of physical and
waste products from the cells mental development
cerebrovascular accident (CVA) stroke; occlusion or Crohn disease inflammatory bowel disease; chronic
hemorrhage of vessel(s) in the brain, resulting in inflammatory disease of ileum or colon resulting in
impairment of mental functions or paralysis or both diarrhea, pain, weight loss, and sometimes rectal
cerebrum the largest part of the brain, divided into bleeding; generally affects young female adults
right and left hemispheres by the longitudinal croup acute viral infection, usually in infants, charac-
fissure; it contains auditory, visual, gustatory, and terized by barking cough
olfactory areas as well as areas of higher mental cryptorchidism failure of testes to descend into the
faculties, and regulates balance scrotum
Cheyne-Stokes respiration an irregular breathing pat- Cushing syndrome overproduction of cortisol by the
tern of slow and shallow, then rapid and deep respi- adrenal cortex, resulting in round face, overweight,
rations with pauses for 20 to 30 seconds; frequently thin skin, and high blood sugar
occurs before death cystic fibrosis a genetic disorder producing abnormally
chlamydia the most prevalent sexually transmitted dis- thick mucous secretions that block and impair the
ease, caused by Chlamydia trachomatis; symptoms are bronchi, pancreatic and bile ducts, and intestines
frequently undetected, resulting in female pelvic cytoplasm colloidal substance (protoplasm) found in
inflammatory disease the cell; holds other structures in place
cholelithiasis gallstones dendrites neuron fibers conducting impulses to the cell
chronic obstructive pulmonary disease (COPD) a body
usually progressive respiratory system disorder with dermis deeper layer of skin containing nerves, blood
irreversible obstruction of air exchange in the bronchi, vessels, and other skin structures or appendages
alveoli, and lungs; emphysema is a form of COPD diabetes mellitus most common endocrine disorder;
cilia hairlike processes that trap and move foreign low production of insulin, resulting in cells retaining
particles sugar; two types: insulin-dependent diabetes mellitus
circumcision surgical removal of foreskin (type 1 diabetes) and non–insulin-dependent diabetes
circumduction drawing an imaginary circle with a mellitus (type 2 diabetes)
body structure (e.g., the arms) diabetic retinopathy damage to the retina in diabetic
cirrhosis end-stage liver disease with interference with patients from hemorrhage of vessels; usually progres-
blood flow, resulting in jaundice, portal hyperten- sive and related to the control of the diabetes
sion, and liver failure dialysis a form of osmosis that removes certain impuri-
clavicle collar bone joining the sternum at the anterior ties from the blood (two types: peritoneal and
and the scapula laterally hemodialysis)
cochlea snail-shaped tube in ear containing receptor diaphragm muscle tissue separating thoracic and
for hearing abdominal cavities that contracts and expands during
collagen a fibrous protein found in the dermis, connec- respiration, allowing lungs to fill and empty air
tive tissues, tendons, and ligaments; it is sometimes diastole relaxation portion of the cardiac cycle
114 =VQ\ ■ General Knowledge

diffusion movement of molecules from area of higher trauma, high fevers, disease processes, poisoning, or
to lower concentration overdose
digestion physical and chemical processes changing erythrocytes red blood cells (RBCs); contain hemoglo-
food into simple nutrients to be utilized by the cells bin to carry oxygen; mature cells do not have a
for energy and building materials and into solid nucleus
waste to be eliminated from the body esophagus tube from the pharynx to the stomach
digestive system body system containing mouth, eustachian tube connects middle ear with throat and
esophagus, stomach, intestines, rectum, liver, gall- pharynx; equalizes pressure on tympanic membrane
bladder, and pancreas; the system ingests and eversion turning wrists or ankles outward, away from
processes food and eliminates solid waste products the body (the opposite of inversion), such as turning
distal away from the origin of a structure the foot away from the body
diverticula (singular diverticulum) abnormal pouches exophthalmia protrusion of the eyeballs, usually result-
in the walls of an organ, usually the colon ing from an endocrine disorder
diverticulosis diverticula of the colon expiration exhalation; letting air out of the lungs; the
dorsal posterior; in back diaphragm relaxes, decreasing the size of the thoracic
duodenum upper portion of small intestine, separated cavity and pushing air out
from the stomach by the pyloric sphincter extension bringing the limbs or phalanges toward a
dwarfism decreased growth hormone, resulting in straight position (the opposite of flexion), such as
abnormally small size opening the fingers of a closed hand
eclampsia toxemia of pregnancy, with high blood pres- extracellular fluid body fluid outside the cell
sure, albuminuria, oliguria, seizures, and sometimes fallopian tubes oviducts; canals leading from the
coma ovaries to the uterus
ectopic pregnancy extrauterine pregnancy; implanta- femur thigh bone; the body’s largest, longest, and
tion of fertilized ovum outside the uterus, most strongest bone
commonly in the ovarian tubes fertilization impregnation of the female ovum (egg)
ejaculatory duct passage formed by the seminal vesi- with the male sperm
cles and vas deferens allowing semen to enter the fetus term given after the first trimester to a develop-
urethra ing baby in the uterus
elimination excretion of the solid waste products of fibroids nonmalignant tumors of the uterus
digestion in the form of feces fibula smaller lower leg bone, lateral to tibia
embolus (plural emboli) a detached thrombus or filtration process of moving fluid containing dissolved
other substance occluding a vessel particles through a membrane; an example is kidney
emphysema a form of chronic obstructive pulmonary filtration
disease that impedes respiration; characterized by flagella whiplike processes on the cell surface; accom-
irreversible loss of elasticity in alveoli modate cell movement
endocardium inner layer of the heart flexion bending (the opposite of extension), such as
endocrine system body system containing glands and closing the fingers of the hand
related structures that produce and secrete hormones fluid balance the regulation of the amount and compo-
endometriosis condition caused by endometrium sition of the body’s fluids
tissue located outside the uterus that causes pain and, frontal plane imaginary line or cut of the body made in
sometimes, cyst formation line with the ears and then down the middle of the
enucleation removal of the eyeball body, resulting in a front and a back portion; also
enuresis involuntary discharge of urine called coronal plane
enzymes proteins that act as catalysts to increase the gallbladder pear-shaped sac located on the inferior sur-
speed of digestion; each enzyme is specific to a face of the liver; stores bile to aid in digestion and fat
certain type of food and reaction absorption
epicardium outer layer of the heart gamete male (sperm) or female (ovum) reproductive cell
epidermis surface layer of skin containing strata and ganglion marked swelling of gray matter, located out-
melanin side the central nervous system, containing cells of
epididymis two coiled tubules on the posterior of the neurons
testes that store and carry sperm from the testes to gastroesophageal reflux disease (GERD) backflow of
the vas deferens stomach acids into the esophagus due to an incom-
epiglottis flaplike structure covering larynx during petent esophageal sphincter, resulting in burning and
swallowing discomfort; can lead to ulcers
epilepsy abnormal electrical activity of the brain result- genital herpes painful and incurable viral infection of the
ing in seizure; there are multiple causes, such as head male or female genital tract’s mucous membrane; may
 +PIX\MZ ■ Anatomy and Physiology 115

lead to cervical cancer in women; newborns become histology study of tissues

infected through contact with the mother’s birth canal homeostasis equilibrium or health of the body as
genitalia external sex organs measured by established norms for blood pressure,
genital warts infection caused by the human papillo- heart rate, temperature, respiration rate, and other
mavirus; believed to be a precursor of female cervical indicators
cancer human immunodeficiency virus (HIV) the virus
gestation period of pregnancy causing acquired immunodeficiency syndrome
giantism overproduction of the growth hormone, human papilloma virus (HPV) the virus associated
resulting in abnormally large size with genital warts and cervical cancer
giardiasis infectious diarrhea caused by Giardia lamblia humerus upper arm bone
in contaminated water hydrocephalus accumulation of cerebrospinal fluid in
glans penis acorn-shaped head of penis the brain caused by an obstruction and resulting in
glaucoma a disease of the eye characterized by mounting pressure and destruction of brain tissue
increased intraocular pressure; causes damage to hydronephrosis distention of the renal pelvis resulting
optic nerve; often results in blindness from obstructed flow of urine
globulins the fraction of the blood serum protein asso- hyperextension extreme or abnormal extension, usual-
ciated with antibodies; vaccination with globulins ly resulting in injury (e.g., dislocated finger)
produces passive immunity hyperopia farsightedness; a condition in which
glomerular filtration the movement of fluid and mate- distant objects can be seen more clearly than closer
rials under pressure from the blood through the kid- objects
ney’s glomerular membrane; the beginning of urine hypertension high blood pressure (beginning at
formation 140/90)
glomerulonephritis acute or chronic inflammation of hyperthyroidism overactivity of the thyroid
the kidney glomeruli; symptoms include edema, hypertonic solution fluid more concentrated than
blood and protein in the urine, and possible uremia intracellular fluid; it draws fluid away from the cell
goiter enlarged thyroid and causes the cell to shrink
gonorrhea contagious inflammation of the genital hypospadias congenital disorder; the male urethra
mucous membrane of either sex, caused by Neisseria opens on the under side of the penis
gonorrhoeae hypothalamus located in the diencephalon, the hypo-
gout inflammation and pain, usually of the great toes or thalamus contains nerve cells assisting in mainte-
thumbs, caused by accumulation of uric acid crystals; nance of water balance, fat and sugar metabolism,
usually occurs in late-middle-aged men secretion of endocrine glands, and regulation of
Graves disease hyperthyroidism; increased secretion of body temperature
thyroxine; characterized by goiter, exophthalmia hypothyroidism underactivity of the thyroid
(bulging eyes), weight loss, extreme nervousness, and hypotonic solution fluid less concentrated than intra-
rapid metabolism cellular fluid; it results in excess fluid entering the
hemodialysis a form of dialysis that removes blood via cell and may cause the cell to rupture
a catheter placed directly into a vein; the blood then ileum lower portion of the small intestine, opening into
circulates through a dialysis machine to remove the cecum
impurities ilium superior wing-shaped portion of hip bones
hemophilia genetic bleeding disorder involving a defi- immunity the individual’s ability to resist specific dis-
ciency of specific clotting factors and resulting in eases or disorders, usually by acquiring the corre-
excessive bleeding, especially into the joints sponding antibody
hemorrhoids inflammation and dilation of veins in immunization vaccination; protection from communi-
rectum and anus cable diseases by administration of living attenuated
hepatic referring to the liver agents (e.g., measles), killed organisms (e.g., pertus-
hepatitis acute or chronic inflammation of the liver; sis), inactivated toxins (e.g., tetanus), or recombinant
there are at least eight types of identified hepatitis DNA (e.g., hepatitis B)
(A, B, C, D, E, F, G, H), with different causes and impotence inability of the male to achieve erection or
prognoses ejaculation
hernia protrusion of an organ or part of an organ incontinence inability to retain urine, semen, or feces
through the wall normally containing it; intestine is incus anvil; second ossicle (bone) of the middle ear
the most common organ to herniate inferior below
herpes zoster shingles; infection caused by the herpes inspiration inhalation; bringing air into lungs;
zoster virus forming blister-type lesions and produc- diaphragm contracts, increasing the size of the tho-
ing pain along the nerve trunks racic cavity and allowing air to enter the lungs
116 =VQ\ ■ General Knowledge

integumentary system the largest system of the body, lordosis swayback; excessive curvature in the lumbar
it contains skin, glands, hair, nails, blood vessels, and portion of the vertebral column
nerves to protect against infection and other lungs two main organs of the respiratory system that
“invaders”; assists with prevention of dehydration; are located in the thoracic cavity; they distribute and
controls body temperature; receives sensory informa- exchange gases
tion; eliminates waste products; and produces vita- lymphatic system body system containing lymph,
min D lymph nodes, and related organs to protect against
intracellular fluid body fluid inside the cell and fight disease
intussusception one part of the intestine slipping into macular degeneration progressive abnormal growth of
another, leading to bowel obstruction and gangrene blood vessels or other structures in the retina, usual-
if not quickly treated; most common in male infants ly leading to blindness
inversion turning inside out (the opposite of eversion), malleus hammer; first ossicle (bone) of the middle ear
such as turning the heels out so toes face each other mandible lower jaw bone
ischium inferior portion of hip bones supporting the maxilla upper jaw bone
body weight when sitting medial toward the middle or center
isotonic solution with the same concentration as intra- mediastinum small cavity within the thoracic cavity that
cellular fluid, moves in and out of the cell at the lies between the lungs and contains the heart and
same rate large blood vessels
jaundice yellow color of skin, white of eyes, and medulla oblongata portion of the brain connecting
mucous membranes resulting from increased biliru- with spinal cord; contains centers for control of
bin in blood; most common causes are obstruction of heart beat, respirations, and blood pressure
bile flow, liver dysfunction, and excess destruction of melanin pigment giving the skin its color
red blood cells membranes thin sheets of tissue that line and protect
joints areas where two or more bones come together or body structures
articulate menarche first female menses; usually occurs between
keratin a protein in the epidermis that thickens and 9 and 15 years of age
waterproofs the skin meninges (singular meninx) three layers of connective
kidneys two muscular, bean-shaped organs located in tissue covering that completely enclose the brain and
the back of the abdominal cavity that filtrate, reab- spinal cord
sorb selected substances, and excrete urine menopause cessation of menses and female reproduc-
kyphosis hunchback; an excessive curvature in the tion from aging or surgical removal of the ovaries
thoracic portion of the vertebral column menorrhagia painful menses
labyrinth inner ear; contains vestibule, semicircular menstrual cycle a phase lasting approximately 28
canal, and cochlea with receptors for hearing and days, beginning with menstruation, followed by the
balance thickening of the endometrium; midcycle, ovulation
large intestine the final organ of the digestive tract; occurs, followed by secretion of progesterone by
connects to the small intestine at the ileum; sections the corpus luteum to prepare the uterus for a fertil-
include cecum, colon, rectum; ends at the anus; ized ovum; if pregnancy does not occur, the cycle
manufactures vitamins K and B; absorbs fluids and repeats
electrolytes; forms, stores, and excretes feces menstruation menses; the shedding of the endometri-
larynx voice box; organ between the pharynx and um of the uterus in the form of vaginal bleeding
trachea containing vocal cords, which vibrate to when pregnancy does not occur, usually in a 28-day
produce speech cycle
lateral away from midline, toward the side metabolism energy transformation in living cells
Legionnaires’ disease a type of pneumonia caused by metacarpals five bones that form the palm of the hand
the Legionella pneumophila bacteria metaphase second phase of mitosis; chromosomes line
leukemia type of malignancy characterized by rapid and up along an equator-type line along centriole
abnormal development of leukocytes (white blood filaments
cells) in spleen, bone marrow, and lymph nodes metatarsals the five foot bones
leukocytes white blood cells (WBCs); fight infection midbrain connects the pons and cerebellum with the
ligaments bands of fibrous connective tissue connecting cerebrum; functions as relay for certain eye and ear
the articulating ends of bones to facilitate or limit reflexes
movement miscarriage spontaneous abortion; a natural interrup-
liver largest gland in the body, located in the upper tion of a pregnancy before the seventh month
right portion of the abdominal cavity; it produces mitosis cell division; comprises four phases: prophase,
bile, detoxifies blood, and aids metabolism metaphase, anaphase, and telophase
 +PIX\MZ ■ Anatomy and Physiology 117

mouth oral cavity; orifice in the lower face where food osteoporosis porous, brittle bones resulting from low
enters the body; chewing (mastication) and mixing levels of calcium salts; common in menopausal
with saliva occurs, forming a bolus women
multiple sclerosis progressive inflammation and hard- osteosarcoma malignant tumor of the bone
ening of the myelin sheath in the nervous system otitis media infection of middle ear; most common in
muscular system body system that contains muscles infants and toddlers; usually treated with antibiotics
and related structures that accommodate movement ovaries two female endocrine sex glands (gonads) that
myocardial infarction (MI) heart attack; necrosis secrete estrogen to stimulate growth of breasts,
(death) of an area in the myocardium resulting from uterus, and secondary sex characteristics and form
cessation of blood supply, usually from coronary ova (the female gametes) and progesterone to pre-
thrombosis pare and maintain uterus in pregnancy; located in
myocardium middle layer of the heart the pelvis
myopia condition of nearsightedness; can see objects ovulation release of an ovum (egg) from the follicle
close by but not far away into the ovarian tube resulting from cyclical hor-
myxedema atrophy of thyroid in adults, resulting in mone function
decreased secretion of thyroxine, causing forms of pancreas an endocrine gland located behind the stomach
physical and mental decline that produces pancreatic juice, which is transported to
narcolepsy uncontrollable episodes of falling asleep; the duodenum to aid in digestion, and insulin and
also known as sleep epilepsy glucagon, which regulate carbohydrate metabolism
neonatal first 30 days after birth Papanicolaou smear (Pap smear) test for cervical can-
nephrolithiasis (renal calculi) kidney stones cer that involves microscopically examining cervical
nephrons group of microscopic coiled tubules (more scrapings
than 1 million in each kidney), located in the renal parasympathetic nervous system portion of the nerv-
pyramids, that filter blood and form urine; main ous system that returns the body to rest and replen-
structures are collecting tubules, glomeruli, and arte- ishes energy
rioles; the bottom of the paperclip-shaped segment parathyroid gland one of four pea-sized glands located
of the nephron is called the loop of Henle on or embedded in the thyroid that secrete parathy-
nervous system body system containing nerves and roid hormone, increasing blood levels of calcium
related structures that receive stimuli and initiate Parkinson disease chronic progressive neurologic
responses disease characterized by fine tremors and muscle
neurotransmitter chemical released by the axons that weakness and rigidity; etiology believed to be
stimulates the next cell to continue the transmission associated with low dopamine production
of an impulse parturition process of delivery; giving birth
nucleolus small structure in the cell nucleus that holds patella kneecap
ribonucleic acid (RNA) and ribosomes essential for patent ductus arteriosus (PDA) opening between the
protein formation aorta and pulmonary artery in fetal circulation that
nucleus located in the center of the cell; controls cell does not close as it should after birth
activity and contains genetic material (DNA) pathology the study of abnormal changes in body
orchiditis (also spelled orchitis)
s inflammation of the structure or function, usually caused by disease
testes pelvic inflammatory disease (PID) inflammation of
organ group of tissues working together to perform a the pelvic cavity organs resulting from widespread
function, such as the kidney infection
osmosis water diffusion (movement from area of higher penis external male sex organ containing the urethra;
to lower concentration) through a semipermeable during sexual arousal, the penis becomes engorged
membrane with blood and firm and erect, allowing entry to the
osmotic pressure the tendency of a higher- female vagina where the sperm is ejected (ejaculated)
concentration solution to draw in water from a peripheral nervous system (PNS) nerves outside the
lower-concentration solution central nervous system originating from the brain
osteoarthritis degenerative joint disease that results in and spinal cord; it transmits sensory information and
deformities and chronic pain; usually occurs as part responses
of the aging process, but excessive use (e.g., in peristalsis rhythmic contractions that move food
marathon runners) and trauma are also contributory throughout the digestive tract
factors peritoneal dialysis a form of dialysis using the peri-
osteochondroma malignancy of the bone and cartilage toneal membrane to filter wastes
osteomyelitis inflammation of the bone or marrow pertussis whooping cough; a vaccine-preventable
caused by pathogens bacterial infection caused by Bordetella pertussis,
118 =VQ\ ■ General Knowledge

producing a “whoop” coughing sound; serious, stretch filaments between them, resembling longi-
sometimes fatal in infants tudes on a globe
phagocytosis ingestion and digestion of bacteria and prostate gland donut-shaped gland around the male
other substances by phagocytic cells urethra at the bladder neck that secretes alkaline
phalanges fingers (three bones each) and thumb (two fluid to protect sperm
bones each); toes (three bones each) and great toes proximal toward the origin of a structure
(two bones each) pubis anterior union of the hip bones
pharyngitis sore throat; inflammation of the pharynx pulmonary edema fluid accumulation in the lungs,
pharynx throat; passageway from nose to larynx often associated with congestive heart failure
phimosis inability to retract the foreskin over the glans Purkinje fibers smaller fibers arising from the bundle
penis because of tightness of the skin branches located in the heart’s conductive system
physiology the study of body function that carry the electrical impulse to the ventricular
pineal gland endocrine gland located in the brain walls, causing them to contract
behind the hypothalamus that secretes melatonin, pyelonephritis inflammation and pyogenic infection of
which regulates the body’s sleep/wake cycles the renal pelvis
pinna auricle; external ear; directs sound waves to the radius lateral bone of forearm (in anatomic position)
canal rales crackling breath sound resulting from increased
pituitary endocrine gland located at the base of the secretions in the bronchi; sometimes referred to as
brain, called “master gland” because of the number rhonchi
of hormones it secretes and functions it serves; Table rectum the lower portion of the large intestine that
6-1 lists its functions contains the reflexes for defecation
placenta oval vascular structure present in the uterus renal failure acute or chronic loss of kidney function
during pregnancy that supplies nutrients to the fetus that results in buildup of nitrogen waste in the body
placenta previa abnormal implantation of the placenta reproductive system body system containing gonads
in the lower uterus (ovaries or testes) and related sex-specific organs and
plantar flexion pointing toes downward, which flexes structures to reproduce the species
the arch of the foot (e.g., en pointe dancing in ballet) respiratory system body system containing nose, phar-
plasma liquid portion of blood (55%) ynx, larynx, trachea, lungs, and related structures
platelets (thrombocytes) cell fragments; function in that transport oxygen and remove carbon dioxide
coagulation rheumatoid arthritis inflammation and overgrowth of
pleura lung linings containing pleural fluid to protect synovial membranes and joint tissues characterized by
lungs and reduce friction during respiration swelling of joints, usually occurring in young adults
pleurisy inflammation of the pleura rotation turning on an axis, such as turning the head to
pneumonia viral or bacterial infection causing inflam- indicate “no”
mation of the lungs rugae folds in the lining of the stomach and some other
pneumothorax partial or complete collapse of the organs
lung(s) resulting from air in the pleural cavity sagittal plane an imaginary line or cut through the
polycystic kidney disease familial disorder producing body, bilaterally separating it into right and left
cysts in the kidney tubules leading to kidney failure halves
pons area where nerves cross, resulting in nerves locat- salivary glands three pairs of glands located in the
ed on one side of the brain controlling the opposite mouth, secreting saliva that moistens food and
side of the body; connects the cerebellum with the begins the chemical breakdown of carbohydrates
nervous system scapula shoulder blade
pregnancy gestation; period of fetal development scoliosis abnormal lateral curvature of the vertebral
in the uterus from fertilization to birth, usually column
40 weeks scrotum external pouch suspended from the male per-
premenstrual syndrome (PMS) irritability, bloating, ineum containing the testes and epididymis
and depression preceding menses seminal vesicles a pair of accessory glands in the male,
prepuce foreskin; a fold of skin on the penis covering posterior to the urinary bladder, that secrete nutrient
the glans fluid for sperm
presbyopia most common eye condition associated serum clear, liquid portion of blood that remains after
with aging the blood clots
priapism abnormal, painful, prolonged penile erection, sigmoid lower S-shaped portion of colon connected to
usually resulting from spinal cord injury or disease the descending colon and the rectum
prophase first stage of mitosis; centrioles move to sinoatrial (SA) node located in the upper wall of the
opposite ends of the cell, forming two poles; they right atrium, it is the pacemaker of the heart and
 +PIX\MZ ■ Anatomy and Physiology 119

initiates a normal heartbeat and rate of 60 to 80 beats tissues group of cells with similar structures and func-
per minute (sinus rhythm); causes atria to contract tions (e.g., renal)
skeletal system body system containing bones and trachea tube branching into two bronchi leading into
related structures to provide structural support the lungs
small intestine longest portion of digestive tract; transient ischemic attack (TIA) ministroke; tempo-
digests fats, proteins, and carbohydrates and absorbs rary episode of impaired neurologic function result-
the nutrient products into the blood; contains three ing from decreased blood flow to the brain
sections: duodenum, jejunum, and ileum transverse plane an imaginary line or cut through the
spermatozoa sperm body horizontally dividing it into superior and infe-
spina bifida congenital deformity exposing the spinal rior sections
column, resulting from malformation of vertebrae tuberculosis an infectious bacterial disease character-
spinal cord continuous tubelike structure located with- ized by tubercles in the tissue; the lung is the most
in the spinal vertebrae extending from the occipital common disease site
bone to the coccyx; it contains cerebrospinal fluid tubular reabsorption the process that follows
and ascending and descending nerve tracts that carry glomerular filtration; the filtered water and other
transmissions to and from the brain needed materials leave the tubule by diffusion and
stapes stirrup; third ossicle (bone) of the middle ear active transport and enter tissue fluids
stomach J-shaped organ between the esophagus and tympanic membrane eardrum; boundary between
the duodenum that produces a churning action that external and middle ear canals; vibrates, transmitting
mixes food with gastric acids and enzymes as part of sound waves to inner ear
digestion; also stores food ulcerative colitis inflammation and ulceration of the
strabismus inability of both eyes to simultaneously mucosa of the colon and rectum
focus on a subject; commonly known as lazy eye or ulcers lesions of the mucosa of any organ; most com-
being cross-eyed mon in the stomach and intestine
strata sublayers ulna medial bone of forearm (in anatomic position)
stridor high-pitched breath sounds resembling wind; uremia high levels of nitrogen waste in the body
caused by a partial obstruction of air passages ureters two slim tubes that carry urine from the
superior above kidneys to the urinary bladder
sympathetic nervous system portion of the nervous urethra tube from the bladder that allows urine to
system preparing the body for stressful situations leave the body
(“fight or flight”) urinary bladder saclike organ behind the symphysis
synapse neuromuscular junction between neurons pubis that temporarily stores urine
syphilis sexually transmitted disease resulting in lesions urinary system body system containing kidneys,
(chancre) that may spread to bone and other systems; ureters, bladder, and urethra that removes nitrogen-
if untreated, it may be terminal type waste and regulates water balance
systole contraction portion of the cardiac cycle urination voiding or micturition; discharge of urine
tarsals the seven ankle and foot bones; the largest is the from the bladder
calcaneus, or heel bone uterus female organ located in pelvic cavity from the
telophase final phase of mitosis; the nucleus divides in oviducts to the vagina; houses and nourishes the
the center, forming two distinct cells growing fetus and placenta
tendons connective tissue attaching muscle directly to vas deferens tubule carrying sperm from epididymis to
the periosteum (covering) of the bone seminal vesicles
testes male endocrine sex glands (gonads) that secrete vasectomy male sterilization procedure; tying off or
testosterone and stimulate the development of male removing part or all of vas deferens
sex characteristics and sperm vena cava largest body vein, with inferior and superior
tetany spasms caused by low blood calcium branches
thalamus located in the diencephalon, serves as relay vertebral column spine; 26 vertebrae (bones that cover
for sensory input the spinal cord)
thorax cavity containing lungs vertigo dizziness
thrombophlebitis inflammation of a vein with clots vestibule middle section of inner ear involving balance
thrombus (plural thrombi) i a blood clot attached to a villi (singular villus)
s tiny projections in the small intes-
vessel wall tine lining where absorption of nutrients occurs
thrush yeast infection of the mouth caused by Candida wheeze squeaking or whistling breath sound, usually
albicans caused by narrowed tracheobronchial airways, as in
tibia shin bone asthma
tinnitus ringing in the ears xiphoid process small tip at the lower end of sternum
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA), RMA (AMT), and CMAS (AMT) exams.

1. The thoracic and abdominal cavities of the body Answer: +

are separated by the:
Why: The diaphragm is a dome-shaped muscle under
A. ribs.
the lungs that flattens during inhalation. This structure
B. stomach.
separates the thoracic cavity, which contain the lungs,
C. diaphragm.
from the abdomen.
D. peritoneum.
Review: Yes ❏ No ❏

2. The main tissue of the outer layer of the skin is: Answer: -
A. connective.
Why: Epithelial tissue covers surfaces, such as skin. It
B. adipose.
also lines cavities and forms glands. Connective tissue
C. mucosal.
supports and forms the framework of body parts.
D. endothelial.
Adipose tissue contains cells that are able to store large
E. epithelial.
amounts of fat. Mucosal tissue lines the tubes and other
spaces that open to the outside of the body, for example,
the lining of the nose.
Review: Yes ❏ No ❏

3. The glands that are saclike in structure and Answer: )

produce oily secretions that lubricate the skin are:
Why: Ceruminous glands are found in the ear canal and
A. sebaceous.
secrete cerumen, or earwax. Mammary glands are found
B. ceruminous.
in the breast and secrete breast milk. Ciliary glands are
C. ciliary.
sweat glands found around the margin of the eyelids.
D. mammary.
Review: Yes ❏ No ❏

4. The portion of skeletal bone that manufactures Answer: *

blood cells is the:
Why: Periosteum is the membrane covering the outside of
A. periosteum.
bones. The diaphysis of a bone is the long, narrow shaft
B. red bone marrow.
of the bone. The epiphysis is the end portion of a bone
C. diaphysis.
where the growth of the bone takes place. Cartilage is a
D. cartilage.
tough, elastic, translucent material that covers the ends of
E. epiphysis.
the long bones. The red bone marrow is found in the
center of bones and manufactures blood cells.
Review: Yes ❏ No ❏

5. The structures that attach muscles to bones are: Answer: +

A. fascia.
Why: Fascia consists of fibrous bands or sheets that sup-
B. ligaments.
port organs and hold them in place. Ligaments are
C. tendons.
structures that connect bone to bone. Cartilage is a
D. cartilage.
tough, elastic, translucent material that covers the ends
of the long bones.
Review: Yes ❏ No ❏


 +PIX\MZ ■ Anatomy and Physiology 121

6. Nerve fibers are insulated and protected by a fatty Answer: )

material called:
Why: Neurons are the functional cells of the nervous
A. myelin.
system, and the axons and dendrites are the neuron
B. dendrites.
fibers that conduct impulses away from and to cell bod-
C. neurons.
ies. A synapse is the contact point from one nerve cell to
D. axons.
another nerve cell.
E. synapses.
Review: Yes ❏ No ❏

7. The function of the lacrimal apparatus is to: Answer: +

A. refract light rays through the eye.
Why: The lens of the eye is important in light refraction.
B. assist in maintaining the shape of the cornea.
Aqueous humor is a watery fluid that fills the eyeball in
C. produce tears to lubricate the eye.
front of the lens and helps maintain the curve of the
D. differentiate black-and-white vision.
cornea. Rods and cones in the retinal layer are responsi-
ble for differentiating between black, white, and color.
Review: Yes ❏ No ❏

8. A bone that is part of the pelvic girdle is the: Answer: +

A. sphenoid.
Why: The sphenoid, ethmoid, and zygomatic are all
B. ethmoid.
bones of the skull. The sphenoid and ethmoid bones are
C. ischium.
part of the cranium, and the zygomatic is the cheekbone.
D. zygomatic.
The sternum is the chest bone.
E. sternum.
Review: Yes ❏ No ❏

9. The cellular components of blood include: Answer: )

A. erythrocytes, leukocytes, and platelets.
Why: Cellular components include cells and cell
B. anticoagulants, antibodies, and electrolytes.
fragments, including erythrocytes, leukocytes, and
C. plasma, serum, and hemoglobin.
platelets. Lipids are fatty acids; anticoagulants found in
D. lipids, amino acids, and albumin.
the blood are clotting factors; electrolytes and amino
acids are chemicals; and albumin is a form of protein.
None of these substances are formed elements like cells.
Review: Yes ❏ No ❏

10. The chambers of the heart are the: Answer: ,

A. septum and valves.
Why: The septum of the heart is a partition dividing the
B. endocardium and epicardium.
heart into two sides. The heart valves direct blood flow
C. apex and septum.
through the heart. Endocardium and epicardium are
D. ventricles and atria.
layers of heart. The apex of the heart refers to the region
E. AV node and SA node.
at the bottom tip of the heart. The SA and AV nodes are
areas involved in the conduction cycle of the heart.
Review: Yes ❏ No ❏

11. An organ located in the left upper quadrant is the: Answer: *

A. thymus.
Why: The thymus is located behind the sternum. The
B. spleen.
liver is in the right upper quadrant, and the appendix is
C. appendix.
in the right lower quadrant.
D. liver.
Review: Yes ❏ No ❏
122 =VQ\ ■ General Knowledge

12. An example of active immunity is: Answer: ,

A. maternal antibodies passed through the uterus
Why: Active immunity is obtained when the individual
to the baby.
actually develops antibodies by having the disease or by
B. immunization with antibodies.
injection of a killed or attenuated organism, forcing the
C. maternal antibodies acquired by the baby from
body to produce antibodies. Passive immunity means
breast milk.
that the antibodies are made outside of the body and are
D. producing antibodies as a result of having a
“passed” on to the person. The mother passing antibod-
disease.
ies through her placenta or breast milk is an example of
E. injection of globulins of disease-causing
this type of immunity.
organisms.
Review: Yes ❏ No ❏

13. The structure in the body also known as the voice Answer: *
box is the:
Why: The pharynx is referred to as the throat. The
A. pharynx.
epiglottis covers the larynx during swallowing to keep
B. larynx.
food and liquids out of the respiratory tract. The trachea
C. epiglottis.
is commonly called the windpipe.
D. trachea.
Review: Yes ❏ No ❏

14. The wavelike movement that propels food through Answer: -

the digestive tract is called:
Why: Diffusion is a process of movement of molecules
A. osmosis.
from a higher concentration to a lower concentration.
B. diffusion.
Metabolism is the combination of chemical processes
C. metabolism.
resulting in growth and bodily functions within a living
D. resorption.
organism. Resorption is the loss of substance or bone.
E. peristalsis.
Osmosis is the movement of materials through a
semipermeable membrane.
Review: Yes ❏ No ❏

15. The process that does not require oxygen for the Answer: *
breakdown of glucose is referred to as being:
Why: Aerobic refers to a process that requires the pres-
A. aerobic.
ence of air or oxygen. The prefix an- at the beginning of
B. anaerobic.
a word means without air or oxygen. Pyrogenic means
C. catabolic.
heat producing, and catabolic refers to the process in
D. pyrogenic.
which substances are metabolized into smaller
substances (i.e., digestion of food).
Review: Yes ❏ No ❏

16. The term that means the body is in a state of Answer: +

equilibrium or balance is:
Why: Homeostasis is a state of equilibrium or health in
A. anabolism.
the body. Metabolism is the body process of transform-
B. catabolism.
ing energy in living cells. Anabolism is the building
C. homeostasis.
phase and catabolism is the breaking down phase of
D. metabolism.
transforming energy. Osmosis is the process of water
E. osmosis.
diffusing through a semipermeable membrane.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Anatomy and Physiology 123

17. The funnel-shaped basin that forms the upper Answer: +

end of the ureter is the:
Why: The glomerulus and Bowman’s capsule are part of
A. glomerulus.
the nephron, the basic unit of the kidney. There are
B. renal cortex.
about 1 million nephrons in each kidney. The renal cor-
C. renal pelvis.
tex is the outer portion of the kidney.
D. Bowman’s capsule.
Review: Yes ❏ No ❏

18. In both males and females, the entire pelvic floor is Answer: -
called the:
Why: The vestibule refers to the area near the vaginal
A. vestibule.
opening, and the fundus is the region in the top of the
B. peritoneum.
uterus, above the fallopian tube openings. The
C. fundus.
peritoneum is a membrane that lines the abdominal cav-
D. pons.
ity. The pons is an area in the brain.
E. perineum.
Review: Yes ❏ No ❏

19. A pregnancy that develops in a location outside the Answer: ,

uterine cavity is referred to as:
Why: The placenta is usually attached to the upper part
A. previa.
of the uterus. Previa refers to the attachment of the pla-
B. miscarriage.
centa near the internal opening of the cervix. Abruptio
C. abruptio.
refers to the premature separation of the placenta
D. ectopic.
from the wall of the uterus. Miscarriage refers to a
termination of pregnancy before the twentieth week of
gestation, usually because of a problem with the concep-
tion or the womb environment.
Review: Yes ❏ No ❏

20. Which of the following body systems includes the Answer: +

thyroid and pituitary glands?
Why: The excretory system refers to the kidneys and
A. Excretory
urinary tract. The integumentary system includes the
B. Integumentary
skin, hair, nails, and sweat and sebaceous glands. The
C. Endocrine
circulatory system refers to the veins and arteries.
D. Circulatory
The nervous system includes the brain and nerves.
E. Nervous
Review: Yes ❏ No ❏

21. The term inguinal pertains to what area or Answer: +

structure of the body?
Why: The umbilicus is also known as the belly button or
A. Intestines
navel. The bladder is the internal organ that serves as a
B. Bladder
reservoir for urine. The intestines are in the abdomen.
C. Groin
The groin or inguinal area is the region where the
D. Umbilicus
abdomen and thighs meet.
Review: Yes ❏ No ❏
124 =VQ\ ■ General Knowledge

22. The measure of acidity or alkalinity of a solution is Answer: +

called:
Why: An acid is a substance that can donate a hydrogen
A. acid.
ion to another substance, and base refers to a substance
B. base.
that can receive a hydrogen ion. A buffer is a substance
C. pH.
that tends to control the hydrogen ion concentration in
D. buffer.
a solution by adding or releasing hydrogen ions.
E. neutral.
Review: Yes ❏ No ❏

23. A term that describes a solution that has the same Answer: +
concentration as cell fluids is:
Why: Osmosis refers to the movement of a pure solvent,
A. hypotonic.
such as water, through a semipermeable membrane to
B. osmosis.
equalize the solution’s concentration. Hypotonic refers
C. isotonic.
to a solution that is less concentrated than the fluids
D. intercellular.
within a cell. Intercellular means between cells. The
prefix iso-means equal or the same.
Review: Yes ❏ No ❏

24. The fibrous bands that support organs to hold Answer: +

them in place are:
Why: Synovia is transparent, thick fluid found in joints.
A. meninges.
Meninges are the coverings of the brain and spinal cord.
B. periosteum.
Periosteum is the covering of bones. Tendons are struc-
C. fascia.
tures that attach muscle to bone.
D. synovia.
E. tendons. Review: Yes ❏ No ❏

25. The membrane that surrounds the heart is the: Answer: ,

A. endocardium.
Why: The prefix peri- means to surround, and the peri-
B. epicardium.
cardium is the membrane or sac that surrounds the
C. mesocardium.
heart. The other choices refer to layers of heart muscle.
D. pericardium.
Review: Yes ❏ No ❏

26. The small tip of cartilage at the lower end of the Answer: ,
sternum is the:
Why: The manubrium is the top part of the sternum.
A. zygomatic process.
The zygomatic process is a bone in the upper cheek, and
B. manubrium.
the ethmoid is a bone between the nasal cavity and
C. styloid process.
orbits of the eye. The styloid process is the bony projec-
D. xiphoid process.
tion behind the ear.
E. ethmoid.
Review: Yes ❏ No ❏

27. A major muscle in the body that assists in raising Answer: ,

the arm away from the body is the:
Why: The extensor carpi muscles are located near the
A. extensor carpi.
wrist in the forearm and assist in flexing and extending
B. biceps femoris.
fingers. The biceps femoris muscle is one of the
C. sartorius.
hamstring muscles and is found in the posterior thigh.
D. deltoid.
The sartorius muscle is located in the leg.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Anatomy and Physiology 125

28. Cells that carry or transmit impulses toward the Answer: )

central nervous system are called:
Why: Motor neurons are also known as efferent neurons
A. afferent neurons.
and carry impulses away from the central nervous
B. efferent neurons.
system. Receptors are sensory nerve endings that
C. motor neurons.
respond to various kinds of stimulation. The meninges
D. receptors.
are the coverings of the brain and spinal cord.
E. meninges.
Review: Yes ❏ No ❏

29. The space(s) in the brain where cerebrospinal fluid Answer: +

is formed is/are the:
Why: The meninges are three layers surrounding the
A. arachnoid.
brain and spinal cord. The arachnoid is one of the
B. meninges.
meningeal layers. The lobes are divisions of the brain.
C. ventricles.
D. lobes. Review: Yes ❏ No ❏

30. Impulses from the receptors for smell are carried Answer: ,
to the brain by the:
Why: Proprioceptors are receptors located in muscles,
A. proprioceptors.
tendons, and joints that relay impulses that aid in judg-
B. glossopharyngeal nerve.
ing position and changes in the locations of body parts
C. vestibulocochlear nerve.
in relation to each other. The glossopharyngeal nerve
D. olfactory nerve.
contains sensory fibers for taste and secretion of saliva.
E. myelin sheath.
The vestibulocochlear nerve carries impulses for hearing
and equilibrium. The myelin sheath is the fatty material
that covers and protects neuron fibers.
Review: Yes ❏ No ❏

31. The hormone that is essential for growth is Answer: +

produced in the:
Why: The parathyroid glands secrete a hormone that
A. parathyroid glands.
regulates exchange of calcium between blood and bones.
B. adrenal glands.
The adrenal glands secrete hormones whose primary
C. pituitary gland.
functions are to increase blood pressure and heart rate
D. thymus gland.
and aid metabolism of carbohydrates, proteins, and fats.
The thymus gland hormone promotes immunity.
Review: Yes ❏ No ❏

32. Which of the following represent layers of the Answer: +

heart?
Why: The atria and ventricles are chambers of the heart.
A. Atria and ventricles
The septum is the dividing wall of the right and left
B. Ventricles and myocardium
sides of the heart.
C. Epicardium and myocardium
D. Endocardium and septum Review: Yes ❏ No ❏
E. Septum and atria

33. The blood vessel that brings blood from the Answer: ,
head, chest, and arms back to the heart is the:
Why: The aorta, pulmonary vein, and carotid artery all
A. aorta.
carry blood away from the heart. The superior vena cava
B. pulmonary vein.
is a vein that carries blood back to the heart from the
C. carotid artery.
upper body.
D. superior vena cava.
Review: Yes ❏ No ❏
126 =VQ\ ■ General Knowledge

34. Which of the following is the proper sequence for Answer: -

the flow of blood in the body?
Why: The sequence of blood flow through the body is
A. Artery S vein S arteriole
from artery to arteriole to capillary, then to venule and
B. Venule S arteriole S capillary
vein. The artery and vein are larger vessels than arterioles
C. Vein S venule S capillary
and venules, and the capillaries are the smallest.
D. Capillary S arteriole S venule
E. Artery S arteriole S capillary Review: Yes ❏ No ❏

35. The condition of inflammation of the lymphatic Answer: +

vessels is called:
Why: Lymphoma refers to a tumor in the lymph tissue.
A. lymphoma.
Splenomegaly means enlargement of the spleen.
B. splenomegaly.
Lymphocytopenia refers to a decrease in the number of
C. lymphangitis.
lymphocytes in the blood.
D. lymphocytopenia.
Review: Yes ❏ No ❏

36. The lymphatic system includes the following Answer: )

organs and tissue EXCEPT:
Why: The hypothalamus is not a part of the lymphatic
A. hypothalamus.
system, but is in the brain. It activates and controls the
B. thymus.
autonomic nervous system and aids in regulating body
C. spleen.
temperature, sleep, and appetite.
D. tonsils.
E. adenoids. Review: Yes ❏ No ❏

37. The process in which white blood cells take in and Answer: *
destroy waste and foreign material is called:
Why: Hemolysis refers to destruction of red blood cells.
A. immunity.
Leukocytosis is an abnormal increase in the number of
B. phagocytosis.
white blood cells. Immunity refers to a condition of
C. hemolysis.
being unaffected by a particular disease.
D. leukocytosis.
Review: Yes ❏ No ❏

38. The structure common to the respiratory and Answer: ,

digestive systems is the:
Why: The larynx is known as the voice box, and the tra-
A. trachea.
chea is known as the windpipe. Both allow airflow in and
B. larynx.
out of the lungs. The esophagus transports food from
C. esophagus.
the pharynx to the stomach. The pharynx transports
D. pharynx.
both food to the digestive system and air to the respira-
E. ileum.
tory system. The ileum is the lower part of the small
intestine.
Review: Yes ❏ No ❏

39. An accumulation of air in the pleural space that Answer: ,

may lead to collapse of the lung is called:
Why: Hemothorax refers to blood in the pleural space,
A. hemothorax.
and pneumothorax is an accumulation of air in the pleu-
B. thoracentesis.
ral space. Thoracentesis is a procedure in which a needle
C. pleurisy.
is inserted into the pleural space below the lung to
D. pneumothorax.
remove fluid. Pleurisy refers to inflammation of the
pleura, the covering or sac around each lung.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Anatomy and Physiology 127

40. The leaf-shaped cartilage that covers the opening Answer: )

of the larynx is the:
Why: The pharynx is also known as the throat. The soft
A. epiglottis.
palate is the tissue that forms the back of the roof of the
B. soft palate.
mouth; the uvula is the soft projection that hangs down
C. uvula.
from this area and is used in speech production. The
D. pharynx.
epiglottis is the cartilage that guards the entrance of the
E. villus.
trachea during swallowing so food will move into the
esophagus, not the larynx and trachea. A villus is one of
many tiny projections in the small intestine lining.
Review: Yes ❏ No ❏

41. Most of the digestive process occurs in the: Answer: +

A. stomach.
Why: The esophagus is a muscular tube that transports
B. large intestine.
food from the pharynx to the stomach. No digestion
C. small intestine.
occurs in the esophagus. In the stomach, food is churned
D. esophagus.
and mixes with digestive juices that begin to liquefy and
break down food. The large intestine reabsorbs water
and eliminates undigested waste. The small intestine
secretes enzymes that digest proteins and carbohydrates.
Digested food is absorbed through the walls of the small
intestine.
Review: Yes ❏ No ❏

42. The lining of the stomach has many folds called: Answer: *
A. diverticula.
Why: Diverticula are the saclike bulges in the intestinal
B. rugae.
wall. Villi are the tiny fingerlike projections in the small
C. villi.
intestine. Mesentery is a fold of peritoneum connecting
D. mesentery.
the jejunum and the ileum with the dorsal wall of the
E. ulcers.
abdomen. Ulcers are lesions of the mucosa of any organ.
Review: Yes ❏ No ❏

43. The first portion of the small intestine is the: Answer: +

A. jejunum.
Why: The pylorus is in the distal region of the stomach
B. ileum.
leading into the small intestine. The small intestine has
C. duodenum.
three portions. The first is the duodenum, the second is
D. pylorus.
the jejunum, and the third is the ileum.
Review: Yes ❏ No ❏

44. An accumulation of excessive fluid in the Answer: +

intercellular spaces is called:
Why: The condition that results from a decrease in the
A. acidosis.
pH of body fluids is called acidosis; an increase in the
B. alkalosis.
pH of body fluids is alkalosis. Effusion refers to the fluid
C. edema.
that escapes into a cavity or space.
D. effusion.
E. osmosis. Review: Yes ❏ No ❏
128 =VQ\ ■ General Knowledge

45. The kidneys are located in the: Answer: )

A. retroperitoneal space.
Why: Both the kidneys and ureters lie behind the
B. renal pelvis.
peritoneum in the retroperitoneal space. The renal
C. dorsal cavity.
pelvis is the funnel-shaped basin that forms the upper
D. hypogastric region.
end of the ureter. The dorsal cavity houses the brain and
spinal cord, and the hypogastric region is the lowest area
in the mid-abdomen.
Review: Yes ❏ No ❏

46. The term hydronephrosis means: Answer: ,

A. inability to retain urine.
Why: Pyelonephritis is the term for inflammation and
B. involuntary discharge of urine.
infection of the renal pelvis. Enuresis is the involuntary
C. inflammation and infection of the renal pelvis.
discharge of urine. Incontinence is the inability to retain
D. distention of the renal pelvis resulting from
urine. Polyuria is excessive urine.
obstructed flow of urine.
E. excessive urine. Review: Yes ❏ No ❏

47. The sex glands of the male and female Answer: +

reproductive system are the:
Why: The sperm and ova are actually the sex cells of
A. sperm and ova.
reproduction. The prostate is a gland that secretes a
B. prostate and uterus.
substance that enhances the motility of the sperm
C. testes and ovaries.
through the reproductive tract. The uterus is the struc-
D. penis and vagina.
ture in which the developing fetus grows to maturity.
The penis and vagina are the structures that provide a
transport system for sperm from the male to the female
for fertilization of an ovum. The vagina is also the birth
canal.
Review: Yes ❏ No ❏

48. The bone that lies between the hip and the knee Answer: *
is the:
Why: The femur is the largest bone in the body and is
A. patella.
also known as the thigh bone. It connects the hip to the
B. femur.
knee. The patella is the kneecap. The pelvis is the bony
C. pelvis.
structure at the lower end of the trunk. The bones of the
D. ilium.
pelvis include the ilium, ischium and pubic bone,
E. tibia.
sacrum, and coccyx. The tibia is the larger bone of the
lower leg below the knee.
Review: Yes ❏ No ❏

49. The largest artery in the body is the: Answer: ,

A. superior vena cava.
Why: The superior and inferior vena cava are both veins.
B. inferior vena cava.
The carotid artery is in the neck and is smaller than the
C. carotid artery.
aorta.
D. abdominal aorta.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Anatomy and Physiology 129

50. The term that refers to absence of menstrual flow Answer: -

in a woman of reproductive age is:
Why: Menses refers to the normal menstrual period
A. menses.
or flow. Dysmenorrhea is painful menstruation, and
B. uremia.
menopause is the term that means the total cessation of
C. dysmenorrhea.
menstruation. Uremia is a condition of high levels of
D. menopause.
nitrogen waste in the body.
E. amenorrhea.
Review: Yes ❏ No ❏

51. The hormone produced by the embryonic cells of Answer: )

the fetus is:
Why: Adrenocorticotropic hormone, known as ACTH,
A. human chorionic gonadotropin hormone.
and follicle-stimulating hormone, known as FSH, are
B. adrenocorticotropic hormone.
hormones produced by the anterior pituitary gland.
C. oxytocin.
Oxytocin is produced by the posterior pituitary.
D. follicle-stimulating hormone.
Review: Yes ❏ No ❏

52. A substance necessary for proper formation of a Answer: ,

blood clot is:
Why: Macrophages are a type of phagocyte that assist in
A. macrophage.
disposing of foreign material in the blood. Lipids are
B. lipid.
fats and cholesterol. Hemoglobin is a protein that con-
C. hemoglobin.
tains iron and allows oxygen to bond to red blood cells
D. thrombin.
for transport through the bloodstream. Albumin is a
E. albumin.
protein found in the blood.
Review: Yes ❏ No ❏

53. The left atrioventricular (AV) valve in the heart is Answer: +

also known as the:
Why: The pulmonary and aortic valves are semilunar
A. pulmonary valve.
valves that are exit valves. AV valves are entrance valves
B. aortic valve.
and include the mitral and tricuspid valve. The tricuspid
C. mitral valve.
valve is on the right, and the mitral valve is on the left.
D. tricuspid valve.
Review: Yes ❏ No ❏

54. The only artery in the body that carries Answer: +

deoxygenated blood is the:
Why: The aorta and coronary arteries both carry
A. superior vena cava.
oxygenated blood to supply the heart and body. The supe-
B. aorta.
rior vena cava and inferior vena cava are veins, not arteries.
C. pulmonary artery.
D. coronary artery. Review: Yes ❏ No ❏
E. interior vena cava.

55. A localized dilation resulting from weakness of a Answer: ,

blood vessel wall is a(n):
Why: An embolus is a foreign object, air, gas, or a piece
A. embolus.
of blood clot circulating in the blood that may become
B. thrombus.
lodged in a blood vessel. A thrombus is a blood clot. A
C. septal defect.
septal defect is an abnormality, usually congenital, in the
D. aneurysm.
wall that divides the heart chambers.
Review: Yes ❏ No ❏
130 =VQ\ ■ General Knowledge

56. An example of a chronic obstructive pulmonary Answer: *

disease is:
Why: Asthma is characterized by recurring episodes of
A. asthma.
wheezing and coughing. Croup is caused by a viral
B. emphysema.
infection, usually in infants. Pleurisy is inflammation of
C. croup.
the pleura. Pertussis is known as whooping cough.
D. pleurisy.
E. pertussis. Review: Yes ❏ No ❏

57. A portion of the large intestine is the: Answer: ,

A. pylorus.
Why: The pylorus is the section of the stomach at the
B. jejunum.
lowest end that connects to the duodenum. The jejunum
C. ileum.
and ileum are parts of the small intestine.
D. sigmoid.
Review: Yes ❏ No ❏

58. A chronic degenerative disease of the liver is: Answer: -

A. Crohn disease.
Why: Crohn disease is a chronic inflammation of the
B. jaundice.
intestine, usually the ileum. Colitis is inflammation of
C. colitis.
the colon, and jaundice is a condition of yellowing of the
D. cholecystitis.
skin resulting from excess bilirubin in the blood caused
E. cirrhosis.
by liver disorders. Cholecystitis is inflammation of the
gallbladder.
Review: Yes ❏ No ❏

59. The tube that permits urine to pass from the Answer: )
bladder to the outside of the body is the:
Why: The ureter is the tube that extends from the
A. urethra.
kidney to the urinary bladder. The renal pelvis is the
B. ureter.
funnel-shaped portion of the kidney where urine collects
C. renal pelvis.
in the kidney. The urinary meatus is not a tube, but
D. urinary meatus.
rather is the external opening of the urethra to the out-
side of the body.
Review: Yes ❏ No ❏

60. The innermost layer of the uterus is the: Answer: +

A. perineum.
Why: The perineum refers to the region between the
B. myometrium.
vagina and rectum. The myometrium is the middle mus-
C. endometrium.
cular layer of the uterus, and the epimetrium is the outer
D. epimetrium.
layer. The cervix is the lower end of the uterus.
E. cervix.
Review: Yes ❏ No ❏

61. The frontal or coronal plane of the body divides Answer: ,

the body into:
Why: The transverse or horizontal plane divides the
A. right and left halves.
body into top and bottom halves. The sagittal plane
B. equal top and bottom halves.
divides the body into right and left sides but not neces-
C. unequal right and left sides.
sarily equal halves. If divided into equal halves, it is
D. front and rear.
called the midsagittal plane.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Anatomy and Physiology 131

62. The membrane attached to internal organs is the: Answer: +

A. mucous membrane.
Why: The internal organs are the viscera, and the mem-
B. cutaneous membrane.
brane surrounding them is the visceral layer. The
C. visceral layer.
mucous membranes line tubes and spaces open to the
D. parietal layer.
outside of the body. The cutaneous membrane is
E. epithelial layer.
commonly known as the skin. The parietal layer is a
serous membrane that is attached to the wall of a cavity
or sac. The epithelial layer is the outer layer of the skin.
Review: Yes ❏ No ❏

63. The term that describes a disorder that breaks Answer: )

down tissues in a body system is:
Why: Infection is an invasion of the body by pathogenic
A. degenerative.
microorganisms. A metabolic disorder refers to a condi-
B. infection.
tion caused by disruption of the reactions involved in
C. metabolic.
cellular metabolism in the body. Neoplastic refers to
D. neoplastic.
cancer or new growth.
Review: Yes ❏ No ❏

64. The study of the cause of any disease or of all Answer: -

factors that may be involved in the development
Why: Physiology is the study of body function; anatomy
of a disease is:
is the study of body structure. Histology is the study of
A. physiology.
tissue. Incidence refers to the range of occurrence of a
B. anatomy.
disease and its tendency to affect certain groups of indi-
C. histology.
viduals more than other groups.
D. incidence.
E. etiology. Review: Yes ❏ No ❏

65. The chronic skin condition characterized by a red, Answer: +

flat area covered with silvery scales is:
Why: A decubitus ulcer, also known as a bedsore, is due
A. decubitus ulcer.
to constant pressure on a part of the body, which impairs
B. urticaria.
blood supply to the area of skin that is pressed between
C. psoriasis.
bone and the patient’s bed. Urticaria, known as hives,
D. shingles.
appears as elevated red patches or wheals. Hives are usu-
ally a result of an allergic reaction. Shingles, caused by
the herpes zoster virus, produces vesicle (blister)-type
lesions.
Review: Yes ❏ No ❏

66. Which of the following is not one of the cranial Answer: -

bones?
Why: The maxilla, the upper jaw bone, is part of the
A. Frontal
skull but is one of the facial bones.
B. Parietal
C. Ethmoid Review: Yes ❏ No ❏
D. Temporal
E. Maxilla
132 =VQ\ ■ General Knowledge

67. The bone that is part of the shoulder girdle and is Answer: )
between the sternum and the scapula is the:
Why: The humerus is the upper arm bone, and the ulna
A. clavicle.
is the smaller medial bone of the forearm. The
B. humerus.
manubrium is the top portion of the sternum.
C. ulna.
D. manubrium. Review: Yes ❏ No ❏

68. The type of muscle responsible for producing Answer: +

peristalsis is:
Why: Cardiac muscle is only found in the heart wall.
A. cardiac.
Skeletal muscle is voluntary muscle attached to bones
B. skeletal.
allowing movement of joints. Smooth muscle is involun-
C. smooth.
tary and is found in the walls of internal organs and pas-
D. voluntary.
sageways such as the intestines, where peristalsis takes
E. diaphragmatic.
place. The term diaphragmatic refers to the
diaphragm.
Review: Yes ❏ No ❏

69. The type of joint motion that allows movement Answer: ,

away from the midline of the body, such as moving
Why: Circumduction is movement in a circular pattern.
the arms straight out to the sides, is:
Flexion is a bending motion decreasing the angle
A. circumduction.
between bones, and extension is a straightening motion
B. flexion.
increasing the angle between bones.
C. extension.
D. abduction. Review: Yes ❏ No ❏

70. The sympathetic system of the autonomic nervous Answer: +

system is responsible for:
Why: The sympathetic system is responsible for
A. constriction of the pupil of the eye.
stimulating the body’s fight-or-flight response (stress).
B. decrease in rate of heart beat.
This response includes dilation of the bronchi. The
C. dilation of bronchi of the lungs.
parasympathetic system returns the body to normal
D. constriction of blood vessels to skeletal
activity by constricting the pupil and the blood vessels
muscles.
and by decreasing the heart rate or slowing the pulse.
E. slowing the pulse.
Review: Yes ❏ No ❏

71. The portion of the brain that aids in the Answer: )

coordination of voluntary muscle action is the:
Why: The thalamus is responsible for relaying sensory
A. cerebellum.
impulses to the cerebral cortex of the brain. The
B. thalamus.
medulla oblongata contains the respiratory center,
C. medulla oblongata.
which controls the muscles of respiration; the cardiac
D. midbrain.
center, which helps regulate the rate and force of the
heartbeat; and the vasomotor center, which regulates the
contraction of smooth muscle in the blood vessel walls.
The midbrain contains a relay center for certain eye and
ear reflexes.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Anatomy and Physiology 133

72. Strabismus is a condition of the eye causing: Answer: ,

A. nearsightedness.
Why: Myopia is nearsightedness, and hyperopia is farsight-
B. farsightedness.
edness. The term for drooping eyelids is blepharoptosis
C. drooping eyelids.
(blephar/o  eyelid, optosis  drooping, falling). The
D. cross-eyed appearance.
sclera is the visible white portion of the eye that can
E. redness of the sclera.
become red from inflammation and irritation.
Review: Yes ❏ No ❏

73. A structure found in the inner ear is the: Answer: ,

A. pinna.
Why: The earlobe is the pinna. The tympanic membrane,
B. tympanic membrane.
or eardrum, separates the external and middle ear. The
C. malleus.
malleus is one of the three small bones of the middle ear.
D. cochlea.
The other bones are the stapes and incus.
Review: Yes ❏ No ❏

74. The clusters of cells called the islets of Langerhans Answer: +

are located in the:
Why: The islets of Langerhans, located in the pancreas,
A. adrenal glands.
secrete insulin, which aids in the transport of glucose
B. anterior pituitary gland.
into cells, decreasing the blood sugar level.
C. pancreas.
D. pituitary gland. Review: Yes ❏ No ❏
E. parathyroid glands.

75. A goiter is associated with abnormal function Answer: )

of the:
Why: A goiter is a swelling in the neck region surround-
A. thyroid gland.
ing the thyroid gland. It is caused by hypertrophy, or
B. parathyroid glands.
chronic enlargement, of the thyroid gland.
C. spleen.
D. pituitary gland. Review: Yes ❏ No ❏

76. The Rh factor in blood is: Answer: )

A. an antigen that affects a person’s blood type.
Why: Rh is a red cell antigen (protein) that contributes
B. responsible for protecting against infection.
to a person’s blood type. A person is Rh-positive if the
C. used to transport oxygen.
antigen is present in the blood and Rh-negative if it is
D. one of the clotting factors.
absent from the blood. This antigen can cause
E. an enzyme that breaks down cholesterol.
incompatibility problems in pregnancies and blood
transfusions.
Review: Yes ❏ No ❏

77. The area of the heart that initiates a heartbeat Answer: *

is the:
Why: The SA node (sinoatrial node) initiates the heart
A. atrioventricular node.
contractions. Impulses travel next to the AV node
B. sinoatrial node.
(atrioventricular node), then to the bundle of His, to the
C. right bundle branches.
right and left bundle branches, and, last, to the Purkinje
D. Purkinje fibers.
fibers.
Review: Yes ❏ No ❏
134 =VQ\ ■ General Knowledge

78. A heart disease that is present at birth is: Answer: +

A. atherosclerosis.
Why: The term congenital means “born with” or “at
B. rheumatic heart disease.
birth.” Atherosclerosis is a degeneration of the inside of
C. congenital heart disease.
the blood vessels that causes a narrowing of the opening
D. angina pectoris.
as the walls become thicker. Angina pectoris is caused by
E. maternal.
inadequate blood flow to the heart muscle and results in
chest pain. Rheumatic heart disease is caused by an attack
of rheumatic fever, usually in childhood. Maternal is a
term meaning “to the mother” or “from the mother.”
Review: Yes ❏ No ❏

79. Which of the following blood vessels is proximal Answer: +

to the heart?
Why: The term proximal means closest to a body part.
A. Iliac artery
The ascending aorta is an extension of the aorta and is
B. Carotid artery
the largest vessel in the body. It is the first blood vessel
C. Ascending aorta
to exit the heart with oxygenated blood. The iliac artery
D. Renal artery
is located in the hip area. The carotid arteries, right and
left, are found in the neck, and the renal artery supplies
blood to the kidneys.
Review: Yes ❏ No ❏

80. Acquired, natural, active immunity is achieved by: Answer: +

A. injection of immune serum.
Why: Injection of any serum or vaccine is an artificial
B. nursing babies with mother’s milk.
means of acquiring immunity. Nursing a baby is a
C. contracting the disease.
method of passing on antibodies from the mother to the
D. injection of a vaccine.
baby, which is passive. If someone comes in contact with
E. immunizing with antibodies of a disease.
a disease and naturally manufactures antibodies, this is
an active method of acquiring immunity.
Review: Yes ❏ No ❏

81. The human immunodeficiency virus is the cause Answer: +

of which disease?
Why: Acquired immunodeficiency syndrome (AIDS) is
A. Hodgkin’s disease
caused by the human immunodeficiency virus (HIV).
B. Leukemia
Hodgkin’s disease, leukemia, and sarcoma are all forms
C. Acquired immunodeficiency syndrome
of malignancy (cancer).
D. Sarcoma
Review: Yes ❏ No ❏

82. Which of the following statements is accurate Answer: +

about the lungs?
Why: The bronchi are larger structures than the
A. The bronchioles branch to form smaller
bronchioles. The right lung has three lobes, and the left
structures called bronchi.
has only two lobes. The most gas exchange takes place
B. The right and left lungs both have three lobes.
in the millions of tiny alveolar sacs. External respiration
C. The sac covering the lungs is the pleural sac.
is the exchange of oxygen and carbon dioxide in the
D. The least amount of gas exchange takes place
lungs. Internal respiration is the exchange of these gases
in the alveoli.
in the capillaries and tissue cells.
E. External respiration is the exchange of oxygen
and carbon dioxide in the lungs. Review: Yes ❏ No ❏
 +PIX\MZ ■ Anatomy and Physiology 135

83. A communicable, infectious disease of the lungs is: Answer: ,

A. emphysema.
Why: Emphysema, chronic obstructive pulmonary
B. chronic obstructive pulmonary disease.
disease (COPD), and asthma are not infectious or com-
C. asthma.
municable. COPD is a condition in which there is an
D. tuberculosis.
obstruction of normal airflow. Air is trapped in the lung
spaces, and there is no proper exchange of oxygen and
carbon dioxide. Emphysema is one type of lung disorder
classified as a COPD. Asthma is a condition that creates
spasms of the involuntary muscles of the bronchial tube
walls and causes labored breathing. Asthma may be
caused by allergens such as dust, pollen, or foods.
Review: Yes ❏ No ❏

84. An example of inflammatory bowel disease is: Answer: +

A. gastritis.
Why: Gastritis is inflammation of the stomach. Pyloric
B. pyloric stenosis.
stenosis is a constriction of the pyloric sphincter, the
C. Crohn disease.
ring of muscle between the stomach and small intestine.
D. Vincent’s disease.
Vincent’s disease is a form of gum disease of the mouth.
E. Hodgkin’s disease.
Hodgkin’s disease is a chronic malignant disease charac-
terized by enlargement of the lymph nodes and spleen.
Review: Yes ❏ No ❏

85. A function of the liver is to: Answer: )

A. detoxify harmful substances, such as alcohol
Why: Insulin is a product of the pancreas. The small
and certain drugs.
intestine is where most nutrients are absorbed into the
B. produce insulin to metabolize glucose.
bloodstream. Hydrochloric acid is produced in the
C. absorb nutrients into the bloodstream.
stomach and is used to start the digestive process.
D. assist in digestion by producing hydrochloric
acid. Review: Yes ❏ No ❏

86. The fluid contained within the body cells is called: Answer: -
A. lymph.
Why: Lymph is the fluid that drains from the tissues into
B. plasma.
the lymphatic system. Plasma is the liquid part of blood,
C. interstitial fluid.
and interstitial fluid is tissue fluid found in the spaces
D. isotonic.
between cells. Isotonic means the same concentration of
E. intracellular fluid.
fluid inside and outside a cell.
Review: Yes ❏ No ❏

87. Two important electrolytes found in the body are: Answer: *

A. zinc and magnesium.
Why: Zinc and magnesium are minerals, protein and
B. sodium and potassium.
carbohydrates are nutrients, and nitrogen and carbon
C. protein and carbohydrates.
dioxide are gases.
D. nitrogen and carbon dioxide.
Review: Yes ❏ No ❏
136 =VQ\ ■ General Knowledge

88. A condition resulting from renal failure and Answer: )

causing high levels of blood urea nitrogen is:
Why: Dehydration is an excessive loss of body fluid.
A. uremia.
Anemia is a condition of decreased amount of hemoglo-
B. anemia.
bin, or red blood cells, in the blood. Edema is an
C. edema.
accumulation of fluid in tissue spaces. Hematuria is a
D. hematuria.
condition of blood in the urine.
E. dehydration.
Review: Yes ❏ No ❏

89. The period of pregnancy is called: Answer: )

A. gestation.
Why: The term menarche refers to the first time a
B. menarche.
female has a menstrual cycle, usually occurring between
C. fertilization.
ages 9 and 15. Fertilization is the impregnation of the
D. ovulation.
female egg with the male sperm; the release of an egg
from the ovary is ovulation.
Review: Yes ❏ No ❏

90. The hormone that causes contraction of uterine Answer: )

muscle during labor is:
Why: Estrogen and progesterone are produced by the
A. oxytocin.
ovaries. Estrogen is important in the growth and devel-
B. progesterone.
opment of sexual organs, and progesterone helps in
C. follicle-stimulating hormone.
development of mammary glands and preparation of the
D. testosterone.
uterus lining for implantation of a fertilized ovum. Folli-
E. estrogen.
cle-stimulating hormone is produced by the anterior
pituitary and stimulates the growth of ovarian follicles.
In the male, it promotes the development of sperm cells
and growth of the testes. Testosterone is male hormone.
Review: Yes ❏ No ❏

91. The region located directly below the umbilical Answer: *

region is the:
Why: The hypogastric region is the region below the
A. right iliac region.
umbilicus (navel), in the middle of the lower abdomen.
B. hypogastric region.
The hypochondriac regions are on the right and left at
C. hypochondriac region.
the base of the ribs. The epigastric region is above the
D. epigastric region.
umbilicus and is located over the stomach area.
Review: Yes ❏ No ❏

92. An example of exocrine glands are: Answer: )

A. sebaceous glands.
Why: The parathyroid, adrenal glands, ovaries, and
B. parathyroid glands.
testes are examples of endocrine glands that secrete their
C. adrenal glands.
hormones directly into the bloodstream and do not
D. ovaries.
require ducts or tubes to transport the hormones.
E. testes.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Anatomy and Physiology 137

93. The order of the vertebral column from top to Answer: ,

bottom is:
Why: The spine starts at the top with the cervical area in
A. cervical, thoracic, sacral, lumbar, coccyx.
the neck region and ends with the coccyx, or the
B. thoracic, lumbar, sacral, coccyx, cervical.
tailbone.
C. coccyx, sacral, lumbar, thoracic, cervical.
D. cervical, thoracic, lumbar, sacral, coccyx. Review: Yes ❏ No ❏

94. The muscle located on the anterior thigh and that Answer: *
functions to extend the leg is the:
Why: Muscles frequently are named for the bone or area
A. tibialis anterior.
located in proximity to the muscle. The tibialis anterior
B. quadriceps femoris.
lies in front, or anterior to, the tibia, the lower leg bone.
C. sternocleidomastoid.
The sternocleidomastoid connects the sternum, the
D. sacrospinalis.
mastoid process, and the clavicle. The sacrospinalis is
E. gluteus maximus.
located in the region of the sacrum, ilium (hip), and
lumbar vertebrae of the spine. The gluteus maximus is
the largest muscle in the posterior hip area.
Review: Yes ❏ No ❏

95. The artery located in the upper arm is the: Answer: )

A. brachial artery.
Why: The brachial artery is located in the upper arm and
B. carotid artery.
subdivides near the elbow to form the radial and ulnar
C. radial artery.
arteries, which lie over the radius and ulna bones of the
D. subclavian artery.
forearm. The carotid arteries are located in the neck.
The subclavian arteries are located in the armpit
(axillary) area.
Review: Yes ❏ No ❏

96. Any foreign substance that enters the body and Answer: *
induces an immune response is a(n):
A. antibody. Why: An immunoglobulin, also known as an antibody, is
B. antigen. a substance produced in response to an antigen. An
C. enzyme. enzyme is a protein produced in the body that causes a
D. immunoglobulin. breakdown of food. A globulin is a protein in the blood
E. globulin. associated with antibodies.
Review: Yes ❏ No ❏

97. The smaller leg bone, lateral to the tibia, is the: Answer: ,
A. femur.
B. tarsal. Why: The femur, the largest bone in the body, is the
C. patella. thigh bone. The patella is the kneecap. Tarsal refers to
D. fibula. any one of the seven ankle bones.
Review: Yes ❏ No ❏
138 =VQ\ ■ General Knowledge

98. The small pouch that is the first part of the large Answer: +
intestine is the:
Why: The jejunum, duodenum, and ileum are parts of
A. pylorus.
the small intestine; the pylorus is the region between the
B. duodenum.
stomach and small intestine.
C. cecum.
D. ileum. Review: Yes ❏ No ❏
E. jejunum.

99. The hormone that regulates the amount of water Answer: )

that is eliminated with urine is:
Why: ADH, antidiuretic hormone, aids in regulating water
A. ADH.
retention or expulsion from the body. ACTH, adrenocor-
B. ACTH.
ticotropic hormone, stimulates the adrenal cortex to pro-
C. FSH.
duce cortical hormones that aid in protecting the body in
D. TSH.
stress and injury. FSH, follicle-stimulating hormone, stim-
ulates the growth and activity of the ovarian follicle. TSH,
thyroid-stimulating hormone, stimulates the thyroid gland
to produce thyroid hormones.
Review: Yes ❏ No ❏

100. An excessive curvature in the thoracic portion of Answer: )

the spinal column, also known as hunchback, is:
Why: Arthritis is inflammation of the joints. Lordosis is
A. kyphosis.
an excessive curvature of the lumbar spine, also known
B. arthritis.
as swayback. Spina bifida is a congenital deformity
C. lordosis.
exposing the spinal column. Spondylitis is inflammation
D. spina bifida.
of the joints of the spine.
E. spondylitis.
Review: Yes ❏ No ❏

101. Diabetic retinopathy is a result of damage to the: Answer: +

A. heart.
Why: Diabetic retinopathy causes damage to the retina
B. lungs.
of the eye from hemorrhage of vessels; it is usually pro-
C. eyes.
gressive and related to the control of the diabetes.
D. brain.
Review: Yes ❏ No ❏

102. Which of the following statements is TRUE? Answer: ,

A. Diabetes mellitus is an uncommon endocrine
Why: Diabetes mellitus results from a low production of
disorder.
insulin. Diabetic persons who are diagnosed with type 1
B. Insulin-dependent diabetes mellitus is known
diabetes require insulin as part of their treatment of this
as type 2 diabetes.
disease. Persons with type 2 diabetes do not require
C. Diabetes mellitus results from an
insulin. Insulin does not assist glucose into the cells but
overproduction of insulin.
promotes the synthesis of carbohydrates.
D. Type 2 diabetes is non–insulin-dependent
diabetes. Review: Yes ❏ No ❏
E. Insulin assists glucose into the cells.

103. Which of the following is a protein found in the Answer: *

epidermis that makes the skin waterproof?
Why: Melanin is a substance that provides pigment for
A. Melanin
the skin. Collagen is a protein found in the dermis that
B. Keratin
provides strength and flexibility. Cilia are hairlike
C. Collagen
processes that trap and move foreign particles.
D. Cilia
Review: Yes ❏ No ❏
 +PIX\MZ ■ Anatomy and Physiology 139

104. What is the most common condition of the eye Answer: -

associated with aging?
Why: Astigmatism is a condition causing impaired vision
A. Astigmatism
from an irregular curve of the cornea. Strabismus is an
B. Strabismus
inability of both eyes to simultaneously focus on a
C. Macular degeneration
subject. Macular degeneration is a progressive,
D. Hyperopia
abnormal growth of blood vessels or other materials in
E. Presbyopia
the retina. Hyperopia is a condition of farsightedness in
which distant objects can be seen more clearly than
closer objects.
Review: Yes ❏ No ❏

105. What structure is at the neck of the bladder and Answer: )

surrounds the urethra?
Why: The epididymis consists of two coiled tubules on
A. Prostate
the posterior of the testes that store and carry sperm.
B. Epididymis
The prepuce is known as the foreskin. The vas deferens
C. Prepuce
is a tubule that carries sperm from the epididymis to the
D. Vas deferens
seminal vesicles.
Review: Yes ❏ No ❏

106. The epigastric anatomical region of the abdomen Answer: ,

is located:
Why: The epigastric anatomical region of the abdomen
A. posterior to the kidneys.
is located below the sternum and above the umbilical
B. inferior to the colon.
region.
C. anterior to the pelvis.
D. distal to the sternum. Review: Yes ❏ No ❏

107. Collagen, a substance found in the dermis, is a/an: Answer: *

A. neurotransmitter.
Why: Collagen is a fibrous protein found in the dermis,
B. fibrous protein.
connective tissues, tendons, and ligaments. It is
C. catecholamine.
sometimes referred to as the body’s glue, providing
D. enzyme.
strength and flexibility.
E. genetic material.
Review: Yes ❏ No ❏

108. Which of the following glands are located on the Answer: +

sides of the vaginal opening and produce mucus?
Why: Bartholin glands are located on the sides of the
A. Prostate
vaginal opening and produce mucus. The prostate and
B. Cowper
Cowper glands are glands associated with the male
C. Bartholin
reproductive system. Endocrine glands have no ducts
D. Endocrine
and secrete hormones directly into the bloodstream.
Review: Yes ❏ No ❏

109. When the foot is moved outward, the joint Answer: +

movement is:
Why: Adduction is moving toward the body or inward;
A. adduction.
circumduction is moving in a circular motion; flexion is
B. circumduction.
bending a body part; and extension is straightening a
C. abduction.
body part.
D. flexion.
E. extension. Review: Yes ❏ No ❏
140 =VQ\ ■ General Knowledge

110. The master gland of the body is the: Answer: *

A. adrenal.
Why: The pituitary gland is an endocrine gland located
B. pituitary.
at the base of the brain. It is called the “master gland”
C. pineal.
because of the number of hormones it secretes and the
D. thyroid.
functions it serves.
Review: Yes ❏ No ❏

111. A fracture of the radius characterized by bending Answer: )

of the bone with the skin left intact is referred
Why: A greenstick fracture is an incomplete break or
to as:
bending of the bone with the skin left intact and unbro-
A. greenstick, closed.
ken. This type of fracture frequently involves the radius
B. greenstick, open.
bone and is common in children.
C. comminuted, closed.
D. comminuted, open. Review: Yes ❏ No ❏
E. Colles, closed.

112. Spermatozoa normally fertilize the female ovum Answer: ,

in the:
Why: Fertilization of the female ovum normally occurs
A. ovary.
in the fallopian tube after the ovum, the egg, has been
B. cervix.
released from the ovary where it is produced. The cervix
C. uterus.
is the neck of the uterus, the structure that houses and
D. fallopian tube.
nourishes the growing fetus and placenta.
Review: Yes ❏ No ❏

113. The glomerulus is a cluster of blood capillaries Answer: -

found in the:
Why: The renal pelvis is a cavity in the kidney where
A. renal pelvis.
urine collects. A calyx is one of the points forming the
B. calyx.
renal pelvis. The loop of Henle is the bottom of the
C. loop of Henle.
paperclip-shaped segment of the nephron.
D. bladder.
E. nephron. Review: Yes ❏ No ❏

114. The disorder characterized by uncontrollable Answer: )

episodes of falling asleep is:
Why: Epilepsy is an abnormal electrical activity of the
A. narcolepsy.
brain resulting in seizure. Bell palsy is a condition of
B. epilepsy.
unilateral facial muscle paralysis. Parkinson disease is a
C. Bell palsy.
chronic progressive neurologic condition characterized
D. Parkinson.
by fine tremors and muscle weakness and rigidity.
Review: Yes ❏ No ❏

115. The regulation of body temperature is controlled Answer: -

by the:
Why: The pancreas produces juices that metabolize
A. pancreas.
sugar, the thalamus serves as relay for sensory input, the
B. thalamus.
pituitary is the master gland, and the medulla oblongata
C. pituitary.
controls heart rate, respiration, and blood pressure.
D. medulla oblongata.
E. hypothalamus. Review: Yes ❏ No ❏
 +PIX\MZ ■ Anatomy and Physiology 141

116. Which of the following substances is NOT a Answer: ,

neurotransmitter?
Why: Acetylcholine, norepinephrine, and epinephrine
A. Acetylcholine
are neurotransmitters. Aldosterone is a hormone that
B. Norepinephrine
regulates sodium and potassium levels.
C. Epinephrine
D. Aldosterone Review: Yes ❏ No ❏

117. Cranial nerve I, the olfactory nerve, is related to Answer: *

the sense of:
Why: The olfactory nerve transmits smells from the
A. sight.
nasal mucosa to the brain. The sense of sight, sound,
B. smell.
taste, and touch are controlled by other cranial nerves.
C. sound.
See Box 6-4.
D. taste.
E. touch. Review: Yes ❏ No ❏

118. A blood cell that carries oxygen and has no nucleus Answer: +
is a/an:
Why: The erythrocyte is a red blood cell that contains
A. leukocyte.
hemoglobin that carries oxygen. The RBC has no
B. platelet.
nucleus. Platelets and thrombocytes are responsible for
C. erythrocyte.
clotting. Leukocytes are white blood cells that do not
D. thrombocyte.
carry oxygen and do have a nucleus.
Review: Yes ❏ No ❏

119. During respiration, exhaled air contains primarily: Answer: +

A. oxygen.
Why: During the respiratory cycle, primarily oxygen is
B. nitrogen.
inhaled, or breathed in, and carbon dioxide is exhaled,
C. carbon dioxide.
or breathed out. Carbon dioxide is the waste product of
D. carbon monoxide.
respiration.
E. nitrous oxide.
Review: Yes ❏ No ❏

120. A condition causing a backflow of stomach acid Answer: )

through an incompetent esophageal sphincter is
Why: GERD stands for gastroesophageal reflux disease.
called:
A. GERD. Review: Yes ❏ No ❏
B. SAD.
C. CVA.
D. IDDM.
 Professional Communication
7

: - > 1 - ?  < 1 8 
Take this time to evaluate your review process and progr
g ess. Is yo
y ur environment comfortable
and conducive to studying? Are you spending the time as you initially planned? Are you staying
focused and motivated (especially after the “killer” A&P chapter)? Is your study group (if you
have one) productive? Are you asking family, friends, and employers for assistance and
encouragement? Revise your plan if necessary, but DO NOT PROCRASTINATE. Remember why
you are taking the exam!.

Communication is the process of forming and transmit- +755=61+)<176/7)4;

ting a message (encoding) to a receiver who interprets
that message (decoding) and, in most cases, transmits a All communication has goals, either conscious or sub-
message back to the original sender, repeating the conscious, that a person must understand to correctly
process (Fig. 7-1). formulate a message. Sometimes there is more than one
Every phase of health care requires communication, goal per message. Some examples of communication
whether it involves patients, their families and friends, goals are to:
physicians, coworkers, other members of the health care ■ Obtain information
team (such as hospital personnel), vendors, attorneys,
■ Provide information
governmental agencies, or other entities.
Many of the serious errors that result in patient ■ Develop trust
harm are associated with faulty communication. Other ■ Demonstrate caring
consequences of miscommunication include malprac- ■ Relieve stress
tice suits, anger, distrust, and stress. Communicating
in a professional, culturally sensitive manner helps
ensure that messages are properly sent and correctly
perceived by the recipient, and that the recipient
;<)/-;7.,->-4785-6<
responds appropriately to the sender. A leading princi- Although there are several theories on what is called
ple of communication in health care is confidentiality. behavioral development, the stages are generally divided
The majority of information in this chapter addresses into specific age groups. There are distinct processes that
communication between the patient and the health normally should occur in each of these stages of develop-
care provider. ment. When communicating with people of various


144 =VQ\ ■ General Knowledge

Transmits message • Letters

• Memorandums
• E-mail
Forms message Interprets message • Books
(encodes) (decodes)
• Reports
Interprets response Forms response • Posters
message (decodes) message (encodes)
• Faxes
• Bulletin boards
■ Nonverbal—communication using body language and
Transmits response message
other nonwritten or nonoral methods

.QO]ZM The communication process.

• Open—receptive, positive appearance (e.g., the
recipient leaning forward to listen)
• Closed—nonreceptive, negative appearance (e.g.,
ages, keep in mind the behavior pertinent to each the recipient standing with frown on face and folded
group. Familiar psychologists, Piaget and Erickson, arms)
described general stages of development, which are listed
• Indicators—signs that imply open or closed commu-
in Table 7-1). nication
❍ Facial expressions, such as a smile or frown

<A8-;7.+755=61+)<176 ❍ Voice tone (e.g., soft or shrill)

❍ Gestures, including sign language (e.g., extending

■ Formal—a style associated with decorum, etiquette,
and a person’s recognized role hand for handshake or shaking a finger at a per-
son, indicating anger or disapproval)
■ Informal—a style associated with an easygoing, open
❍ Body stance and posture, such as standing straight
role and relationship
with arms at side or slouching with arms folded
■ Verbal—word-of-mouth communication; may be for-
mal or informal
• Face-to-face
• Telephone +755=61+)<176*)::1-:;
• Television ■ Noise
• Audio technology (compact discs, tapes) ■ Inadequate listening
■ Written—communication using the printed word; ■ Withdrawal or lack of attention
may be formal or informal ■ Lack of privacy
• Medical records ■ Embarrassment
■ Cultural differences

Table 7-1 /MVMZIT;\IOM[WN,M^MTWXUMV\ • Concepts of health and illness (e.g., only visiting the
physician in the case of illness; not seeking preven-
Stage Focus Issue tive care)
Infant/Toddler Learns through Trust versus • Folk beliefs and practices (e.g., the belief that bury-
comfort mistrust ing the umbilical cord when it falls off will help the
child develop normally)
Preschooler Language Active imagination
acquisition and personifies • Childrearing traditions (e.g., “a fat baby is a healthy
objects baby”)
School Age Begins to process Developing sense • Religion (e.g., Jehovah’s Witnesses prohibit blood
abstract concepts of self-worth transfusions)
Adolescent Role integration Self image • Politeness (e.g., in some Native American cultures,
it is taboo to make eye contact with another person)
Adult Career and family Commitment
relationships • Who speaks for whom (e.g., in some cultures, the
husband speaks for his wife at the health care facility)
 +PIX\MZ ■ Professional Communication 145

• Family ties (e.g., all members of family and extend- ■ Rationalization—justifying thoughts or actions whether
ed family expected to stay with ill person) right or wrong (e.g., spending money on a luxury item
because you’ve had a bad day)
• Death and dying traditions (e.g., required rites,
blessings, or ceremonies) ■ Regression—escaping an unpleasantness by returning
■ Educational differences
to an earlier stage or behavior in life (e.g., a child who
reverts to baby talk when scolded to distract the par-
■ Language barriers ent’s anger)
■ Physical and developmental impairments ■ Repression—dealing with a difficult situation by true
■ Pain or discomfort temporary amnesia (e.g., a witness to a crime who can-
■ Prejudice (holding a negative or positive opinion not remember the crime or who he or she is)
or bias concerning an individual because of his or ■ Sublimation—redirecting unacceptable thoughts or
her affiliation with a specific group; this includes gen- behaviors to acceptable ones (e.g., the alcoholic who
der bias) goes from drinking every night to attending Alcoholics
■ Stereotyping (believing that all members of a culture, Anonymous meetings every night)
subculture, or group are the same) ■ Suppression—purposefully forgetting an unpleasant
■ Emotions situation or avoiding it (e.g., victims of childhood sex-
■ Criticizing, lecturing
ual abuse who do not remember the molestation until,
perhaps, an incident in adulthood triggers the memory)
■ Substance abuse

0-)4<0+):-15841+)<176;
,-.-6;-5-+0)61;5; Every communication within the health care setting has
the potential for affecting a patient’s outcome, physically
People commonly react to injury and illness with anxiety and emotionally, positively or negatively. The relation-
and, often, defensive behavior. Defense mechanisms ship, good or bad, between the patient and the health
are psychological behaviors that protect a person from care provider is predominately the result of their interac-
guilt and shame. Some uses of the mechanisms are con- tions. Other considerations when communicating with
sidered normal. Overuse or exaggerated use may become patients are as follows:
pathologic.
■ Real or unrealistic expectations of patient or health
■ Compensation—overemphasizing certain behaviors to
care providers
accommodate for real or imagined weaknesses (e.g.,
giving a child expensive gifts to make up for not spend- ■ Feelings
ing time with him or her) ■ Challenges
■ Denial—refusal to accept unwanted information or • Obtaining knowledge
unpleasant circumstances (e.g., the parent who will not • Interpreting and understanding each other
consider that his or her child is using drugs despite
very clear indications to the contrary)
• Accurately exchanging information
■ Displacement—transferring negative feelings, some-
• Accepting differences
times hostility, to something or someone unrelated • Making reasonable accommodations
to a negative situation (e.g., being rude to the med-
ical office receptionist because your insurance com- THERAPEUTIC COMMUNICATION
A
pany does not have you listed on the physician’s
roster) The health care team should strive to make every inter-
action with the patient an understanding and caring one.
■ Introjection—identifying and assuming characteris-
The encounter should promote healing or acknowledg-
tics or feelings of another (e.g., the expectant
ment in cases of serious disease or disability and provide
father who has food cravings similar to his pregnant
some level of comfort. Therapeutic communication is:
partner)
■ Projection—placing blame or accusing another for ■ Confidential
actions or feelings committed by the person himself or
■ Respectful
herself (e.g., the patient blaming the health care
provider for continued illness when the patient was ■ Professional (friendly and capable but not too informal)
noncompliant with the care plan) ■ Empathetic (sympathetic but not enabling)
146 =VQ\ ■ General Knowledge

■ Nonjudgmental • Obtain feedback

■ Tolerant and supportive • Encourage questions
■ Accepting ■ Hearing-impaired patients
■ Reassuring • Touch the patient gently on an arm or shoulder to
■ Mindful of the patient’s individuality get his or her attention
■ Honest and open • Address the patient directly
■ Sensitive and tactful • Determine level of hearing loss and what assistive
■ Positive in attitude and body language devices are used by patient
• Increase voice volume, if appropriate, but do not shout
-60)6+16/+755=61+)<176 • Speak distinctly and more slowly, using short sen-
tences with slight pauses
The health care provider should continually strive to
• Eliminate as much background noise as possible
develop and practice better communication techniques.
To promote positive and effective communication, espe- • Offer notepads or other non–hearing communica-
tion devices
cially in the health care setting:
• Use pictures and captioned videos as appropriate
■ Provide a quiet, private, safe, and comfortable envi- • Facilitate return demonstrations as appropriate
ronment
• Obtain feedback
■ Listen carefully with no interruptions
• Encourage questions
■ Provide feedback (paraphrasing, mirroring, repeating,
restating to ensure understanding) Box 7-1 addresses the telecommunication device for the
■ Ask open-ended questions (such as “Tell me about deaf, which allows office personnel to communicate with
your pain”), not questions that can be answered with hearing-impaired patients over the telephone.
yes or no or one word
■ Non–English-speaking or limited English-speaking
■ Seek clarification (who, what, how, how much)
patients
■ Use silence to allow patients to add more information
• Attempt to acquire some knowledge of culture to
■ Demonstrate open body language avoid negative communication (refer to “Cultural dif-
■ Exhibit a confident demeanor ferences” in the section “Communications Barriers”)
■ Focus (stay on important topics) • Provide an interpreter if possible (some insurance
■ Observe boundaries (e.g., remaining at a friendly but companies will arrange or cover the cost; some social
professional distance, not discussing intimate parts of agencies dealing with refugees and immigrants pro-
patient’s life or health care provider’s life that do not vide help)
pertain to the pertinent health care issue; not allowing ❍ Research culture to determine if there are any
rambling; not giving advice) restrictions regarding who may act as an interpreter
(e.g., in some cultures, interpreter must be of the
same sex as patient)
SPECIAL COMMUNICATION
A NEEDS AND STRATEGIES
■ Sight-impaired patients
• Speak in a normal tone of voice *W`
• Describe surroundings and locations of structures <MTMKWUU]VQKI\QWV,M^QKMNWZ\PM,MIN<, ,
• Explain what you are going to do and what you are
doing Many of the larger medical practices maintain a
TDD. This equipment allows the office to call a
• Alert patient before touching him or her hearing-impaired patient and to type a message that
• Explain unusual noises associated with a procedure is electronically transmitted to the receiver’s TDD
• Notify patient of anyone who is entering the room and vice versa. If the office does not have a TDD,
or if you are leaving the room the office’s telephone carrier may be contacted to
• Allow touching of instruments and use models when send a TDD-facilitated message to the patient.
appropriate E-mail is another effective communication technol-
ogy for contacting hearing-impaired patients.
• Facilitate return demonstrations as needed
 +PIX\MZ ■ Professional Communication 147

❍ Determine whether patient is bringing an inter-

preter (children and young adolescents should not
be used)
Self-
❍ Speak directly to the patient even when using an actualization
interpreter needs

• Speak in a normal tone but at a slightly slower pace Esteem and

self-respect needs
• Use simple, short sentences
• Avoid slang or idioms Belongingness and affection
needs
• Observe patient’s body language as questions are
asked and answered
Safety and security needs
• Use visual aids, such as pictures, hand gestures, or
demonstrations
Physiologic needs
• Provide forms, educational materials, and office
signs in various languages, if possible
.QO]ZM Maslow’s hierarchy of human needs. (Reprinted with permission from
• Use dual dictionaries of English and the patient’s Molle EA, Durham LS. Lippincott Williams & Wilkins’ Administrative Medical
language Assisting. Philadelphia: Lippincott Williams & Wilkins, 2004.)

■ Pediatric patients
• Always state the truth • Ensure patient’s comfort and privacy
• Position yourself at the same height as the child • Maintain an unrushed environment
• Use vocabulary appropriate to the child’s develop- • Use feedback strategies often
mental age
• Facilitate staying focused on pertinent topics
• Incorporate dolls, pictures, and other toys to • Include the patient in the conversation even if a
enhance communication or obtain cooperation
caregiver is providing the information
• Allow children to handle safe medical equipment
• Expect child to regress emotionally during illness
• Maintain a calm voice and demeanor, even if the 5);47?s;01-:):+0A
child is “acting out” Abraham Maslow, an American psychiatrist, theorized
■ Adolescent patients that people are motivated by their needs and that those
• Treat the adolescent with respect needs are a progression from basic survival to reaching
one’s pinnacle, or self-actualization. Dr. Maslow ordered
• Avoid being judgmental these needs in a hierarchy and listed them in a pyramid
• Always state the truth formation (Fig. 7-2). Generally, a person cannot progress
• Expect adolescents to demonstrate resentment in ill- from one level to the next until all needs are met in the
ness, especially in chronic illness lower levels.
• Allow privacy from parents during assessment and The implications of Maslow’s hierarchy for health
treatment, if desired by the patient care providers are substantial. Your communication with
the patient will be more effective if you determine where
• Maintain a calm voice and demeanor even if the ado- that person is on Maslow’s hierarchy. For example, a
lescent is “acting out”
patient who does not have the money and other resources
• Do not assume, regardless of the patient’s age, that he (e.g., transportation, child care) to visit a physician when
or she possesses the correct terminology and knowl- he or she is sick will not be motivated to listen to advice
edge related to body functions, especially those relat- regarding preventive health care or nutritional diets that
ed to the reproductive system are more expensive than a current high-fat, high-
• Consider typical teenage preferences and behaviors carbohydrate diet. Effective therapeutic communication
when providing self-care instructions recognizes the stage on the Maslow hierarchy pyramid,
• Obtain feedback provides empathy and understanding, and then strives to
discover a motivating factor within that level. The health
• Encourage questions care provider in this example can explain that if the
■ Geriatric patients patient ignores the treatment plan, the potential for a life-
• Accommodate for hearing, sight, or other impair- threatening illness increases, which may result in leaving
ments his or her children without support.
148 =VQ\ ■ General Knowledge

;<)/-;7.,-)<0)6,,A16/ diplomacy the art of handling people with tact and

genuine concern
Another progression in human life involves the stages of displacement a defense mechanism in which a person
death and dying. Elizabeth Kübler-Ross is credited as transfers negative feelings, sometimes hostility, to
being the first to formally outline these stages. The something or someone unrelated to a negative
patient and the patient’s family and close friends all expe- situation
rience the continuum. Communication is more effective encoding forming and sending a message
when the stage is recognized and appropriate accommo- feedback paraphrasing, mirroring, repeating, or restat-
dations are made. ing to ensure understanding
introjection a defense mechanism in which a person
■ Denial—refusing to accept that death will soon occur identifies and assumes characteristics or feelings of
or has occurred another
■ Anger—lashing out at a deity, family and friends, and Maslow’s hierarchy a progression of a person’s
health care providers needs from basic survival to reaching one’s pinnacle,
■ Bargaining—attempting to gain time through negoti- or self-actualization, identified by Abraham
ating, pleading with a deity, with health care providers Maslow
to do more, and with self nonverbal communication using body language and
■ Depression—withdrawing, feeling low in spirits
other nonwritten or nonoral methods; nonverbal
communication may be formal or informal, open or
■ Acceptance—resigning to the situation, preparing (if closed
time permits), and feeling tranquil prejudice holding a negative or positive opinion or bias
regarding an individual because of his or her affilia-
Sudden death is thought to be more difficult. The tion with a specific group
involved parties do not have the time for a distinct pro- projection a defense mechanism in which a person
gression through the stages and are unprepared; their places blame or accuses another for actions or feel-
reactions are often chaotic. ings committed by himself or herself
rationalization justifying thoughts or actions whether
TERMS right or wrong
regression a defense mechanism in which a person
Communication Review escapes an unpleasantness by returning to an earlier
The following list reviews the terms discussed in this stage or behavior in life
chapter and other important terms that you may see repression a defense mechanism in which a person
on the exam. deals with a difficult situation by true temporary
communication the process of forming and transmit- amnesia
ting a message to a receiver who interprets that mes- stages of death and dying articulated by Elizabeth
sage and, in most cases, transmits a message back to Kübler-Ross, a progression of feelings and behaviors
the original sender, repeating the process that patients, families, and close friends experience
compensation a defense mechanism in which a person when death is imminent or has occurred; these
overemphasizes certain behaviors to accommodate behaviors include denial, anger, bargaining, depres-
for real or imagined weaknesses sion, and acceptance
culture customary beliefs, traits, social forms, and behav- stereotyping believing that all members of a culture,
iors associated with a religious, ethnic, or other group subculture, or group are the same
decoding receiving and interpreting a message sublimation a defense mechanism in which a person
defense mechanisms psychological behaviors that pro- redirects unacceptable thoughts or behaviors to
tect a person from guilt and shame acceptable ones
denial a defense mechanism in which a person refuses suppression a defense mechanism in which a person
to accept unwanted information or unpleasant cir- purposefully forgets an unpleasant situation or avoids
cumstances dealing with it
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA), RMA (AMT), and CMAS (AMT) exams.

1. Which of the following is the best example of Answer: +

nonverbal communication?
Why: Nonverbal communication refers to a way of
A. Clarification
exchanging messages without using words. Body
B. Feedback
language uses types of behavior or gestures and facial
C. Body language
expressions to send a message without saying anything.
D. Messages
Review: Yes ❏ No ❏

2. When a person generalizes the behavior or Answer: *

characteristics of all members of a particular
Why: Bias occurs when personal values or opinions
culture, race, or religion, it is referred to as:
affect the way you treat others. Discriminating is the act
A. empathizing.
of treating certain people unfairly or without respect
B. stereotyping.
because of their cultural, social, or personal values or
C. discriminating.
beliefs. Empathizing means that you emotionally
D. bias.
identify with what another person is feeling or
E. Rationalizing.
experiencing. Rationalizing is the process of explaining
on the basis of reason or logic.
Review: Yes ❏ No ❏

3. Three elements necessary for basic communication Answer: )

include:
Why: The message is the information that is to be
A. message, sender, receiver.
relayed either verbally or nonverbally. There must be
B. message, feedback, body language.
someone sending and someone else receiving the
C. clarification, sender, feedback.
message. Clarification is the process of making a
D. sender, receiver, body language.
message clearer or more understandable to the receiver.
Feedback refers to the responses returned from either
the sender or the receiver about the message.
Review: Yes ❏ No ❏

4. To have proper verbal communication with a Answer: -

patient, you should use:
Why: A monotone voice occurs when a person is speak-
A. a monotone voice so the patient will listen
ing without changing the pitch or key of the voice and is
better.
likely to cause the listener to lose interest in the conver-
B. elaborate medical terminology to impress
sation. Medical terminology is confusing for most
the patient.
laypersons; using such terminology will not lead to a
C. negative body language to get the patient’s
patient understanding your message. Negative body lan-
attention.
guage can make others uncomfortable and may cause
D. sarcastic remarks to get the patient’s attention.
them to ignore, turn away, or walk away from a conver-
E. conversation at the patient’s educational level.
sation. Sarcastic remarks are rude and disrespectful and
should not be part of any professional conversation.
Review: Yes ❏ No ❏

!
150 =VQ\ ■ General Knowledge

5. Communicating with someone who is grieving the Answer: +

loss of a loved one is difficult when the person
Why: Sympathy is sharing someone else’s feeling, espe-
refuses to acknowledge the loss. This type of
cially during a difficult situation, such as the death of a
behavior is referred to as:
loved one. When a person is experiencing the loss of a
A. sympathy.
loved one, he or she is in a period of mourning. Depres-
B. mourning.
sion is a feeling of low spirits and being withdrawn.
C. denial.
Denial is the inability or refusal to accept reality—in this
D. depression.
case, the loss of a loved one.
Review: Yes ❏ No ❏

6. To communicate with a sight-impaired patient, it is Answer: ,

important to:
Why: Always talk to the patient and explain procedures
A. transport the patient in a wheelchair to avoid
before touching or performing any procedures on him
an accident.
or her. If a patient is sight-impaired, it does not
B. use positive body language.
necessarily mean that the person is totally blind. The
C. raise your voice to make your conversation
patient may be capable of walking safely without a
louder.
wheelchair, but transporting the patient does not facili-
D. tell the patient each time before you touch him
tate communication. It may be difficult for the patient to
or her.
see you clearly, so body language is not going to be eas-
E. give directions in writing to ensure
ily seen by the patient. The patient may not be deaf or
understanding.
hard of hearing, so raising your voice is not necessary.
Written instructions are difficult for a sight-impaired
patient to read and will not be an effective method of
communication.
Review: Yes ❏ No ❏

7. To communicate with a hearing-impaired patient, Answer: ,

it would be advisable to:
Why: If a patient is hearing-impaired, it does not neces-
A. not call the patient at home, because of the
sarily mean that he or she is completely deaf. It is appro-
hearing impairment.
priate to call this patient at home to confirm
B. keep at a normal distance from the patient, but
appointments. It is impolite to shout at a patient; there-
talk much louder and shout if necessary to be
fore, it is appropriate to get closer to a hearing-impaired
heard.
patient when having a conversation. It would not be
C. write everything down instead of talking to the
necessary to write everything down, but you may want
patient.
to write down the most important things you want the
D. speak slowly and distinctly to the patient.
patient to remember. The key to communicating with a
hearing-impaired individual is to speak slowly and
clearly.
Review: Yes ❏ No ❏

8. Which of the following is an example of an Answer: ,

open-ended question you would ask a patient?
Why: An open-ended question is one that requires more
A. Did you follow the doctor’s instructions?
than a single-word answer or a yes-or-no answer. This is
B. What time did you take your medication?
a way to get patients to open up and talk or express their
C. Which insurance plan are you covered by?
thoughts. All of the choices require only a single-word
D. Will you tell me about your pain?
answer, except for choice D, which requires the patient
E. What day can you come in for a follow-up
to describe the pain he or she is experiencing.
appointment?
Review: Yes ❏ No ❏
 +PIX\MZ ■ Professional Communication 151

9. When communicating with a difficult, challenging Answer: )

patient, you should:
Why: Diplomacy is the art of handling people with tact
A. exhibit a diplomatic attitude.
and genuine concern. Do not display an attitude of
B. display an attitude of authority.
authority, because this may make a patient or client
C. make sure the patient knows the office is
angry. Patients have rights in the physician’s office, and
correct.
the office may not always be correct. It is not appropri-
D. always ask the patient to put any complaints in
ate to ask any patient to put his or her complaint in writ-
writing.
ing. Suggesting a patient “put it in writing” may be an
invitation to a lawsuit. It is best to discuss concerns as
they surface at the office.
Review: Yes ❏ No ❏

10. Which of the following is an example of behavior Answer: +

that demonstrates open nonverbal
Why: Body language is a form of nonverbal communica-
communication?
tion. Open nonverbal communication is a positive,
A. Frowning eyes and mouth
receptive way of communicating. The recipient usually
B. Folded arms across chest
leans forward to listen and makes direct eye contact with
C. Leaning forward to listen
the person who is sending the message. Closed nonver-
D. Staring at the floor
bal communication is expressed through negative
E. Sighing frequently during conversation
expressions such as frowning, folding arms, not making
direct eye contact, and sighing during the conversation.
These expressions reveal that an individual is not recep-
tive to the communication.
Review: Yes ❏ No ❏

11. When an individual is overemphasizing certain Answer: *

behaviors to accommodate for real or imagined
Why: To regress, or to go backward, is to escape an
weaknesses, he or she is:
unpleasant event or situation and to return to an earlier
A. regressing.
stage or behavior in life. Projecting is placing blame or
B. compensating.
accusing someone else for something you have done.
C. projecting.
Rationalizing means reasoning or justifying one’s
D. rationalizing.
behavior.
Review: Yes ❏ No ❏

12. Maslow’s hierarchy of human needs is based on the Answer: +

concept that:
Why: The physiologic needs are air, food, water, rest,
A. affection is the most important basic need for
and comfort. Without these basic foundational needs
all people.
being met, a person cannot reach any higher levels on
B. a safe environment is placed above all other
Maslow’s hierarchy of human needs. Affection is impor-
needs as the number one requirement of all
tant but not a basic need for all persons. A safe and
persons.
secure environment is only achieved after the basic
C. physiologic needs are the most basic but are
needs are met. Esteem needs are needs to feel self-
necessary for a person to progress any further
worth. Esteem can be self-generated or can come from
toward reaching self-actualization.
others who admire a person.
D. esteem must always come from those around us.
E. security is the most basic and important need. Review: Yes ❏ No ❏
152 =VQ\ ■ General Knowledge

13. When communicating with pediatric patients, you Answer: +

should:
Why: Children are capable of understanding many
A. not allow children to handle safe medical
things, and the truth should always be told to them. If
equipment.
you lie to a child that a procedure will not hurt and then
B. use medical terminology so the child does not
it does, the child may not trust health care workers in
understand the procedure.
the future. It is proper to allow children to handle safe
C. not lie to a child but state the truth.
equipment to help them feel comfortable. You should
D. talk louder and make sure the child
not use language the child does not understand and
understands that you are the adult.
should not display an attitude of being an adult discipli-
narian.
Review: Yes ❏ No ❏

14. The receiving and interpreting of a message is Answer: )

known as:
Why: Feedback is repeating or restating a message to
A. decoding.
ensure understanding. Encoding is the forming and
B. feedback.
sending of a message and does not involve receiving and
C. encoding.
interpreting. Acceptance means to resolve or be
D. acceptance.
resigned to a situation, to accept the outcome. Sending
E. sending.
is the process of carrying or transmitting a message.
Review: Yes ❏ No ❏

15. Psychological behaviors that protect a person from Answer: *

guilt and shame are:
Why: Therapeutic techniques include any activity that
A. therapeutic techniques.
aids in a patient’s recovery. Cultural differences are those
B. defense mechanisms.
traits specific to an ethnic culture or race. A language
C. cultural differences.
barrier is caused when people cannot communicate
D. language barriers.
because they speak different languages.
Review: Yes ❏ No ❏

16. When communicating with a non–English-speaking Answer: ,

patient, it is appropriate to:
Why: You should always take into consideration the cus-
A. ignore the customs or taboos of the patient’s
toms of the patient’s culture so that you do not uninten-
culture.
tionally offend him or her. If an interpreter is available,
B. only communicate with the patient if
this person may be able to better communicate the
accompanied by someone who speaks fluent
information to the patient. The interpreter may be a
English.
family member who is not fluent in English but who
C. raise your voice to increase understanding.
knows enough to relate the messages to the patient. It is
D. use gestures to demonstrate information.
not appropriate to raise your voice just because the
E. use negative body language.
patient does not speak English. Using gestures will help
demonstrate what you are trying to convey to a
non–English-speaking patient. Using negative body lan-
guage is inappropriate and rude.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Professional Communication 153

17. Prejudice is a term that means: Answer: *

A. your personal values are not the same as others.
Why: All people are free to have their own personal val-
B. you hold an opinion or bias concerning an
ues, which may not be the same as those of others, but
individual because of his or her affiliation with
when you hold an opinion or bias concerning an individ-
a specific group.
ual because of his or her affiliation with a specific group
C. you recognize the fear and discomfort that a
of people, this constitutes prejudice, which is also a form
patient is feeling.
of stereotyping. Empathy means that you recognize the
D. you refuse to acknowledge something.
fear and discomfort a patient is feeling; denial is refusing
to acknowledge something.
Review: Yes ❏ No ❏

18. To encourage further comments from a patient, Answer: *

the interviewer can repeat what the patient has said
Why: Summarizing is restating information in a
using open-ended statements that require the
condensed format. Listening is the act of giving
patient to respond. This technique is called:
attention to the person who is talking and understanding
A. summarizing.
what is being said. Focusing is the technique of staying
B. reflecting.
on the same topic or subject during a conversation and
C. listening.
not deviating onto other topics. Encoding is the forming
D. focusing.
and sending of a message.
E. encoding.
Review: Yes ❏ No ❏

19. A patient who is withdrawn, weeping, and isolated Answer: +

from others may be experiencing:
Why: Anger is lashing out at others. Denial is the refusal
A. anger.
to accept a situation, and empathy is feeling the same as
B. denial.
another feels in a situation.
C. depression.
D. empathy. Review: Yes ❏ No ❏

20. Maintaining a professional relationship with the Answer: -

patient means that you should:
Why: It is appropriate to be friendly with patients, but
A. become personally involved with the patient.
you should not become personally or socially involved
B. become socially interactive with the patient.
with patients. Private or personal information about the
C. disclose private, personal information about the
physician should never be disclosed to patients. It is also
physician.
inappropriate to disclose your private phone number or
D. give the patient your private phone number in
address to a patient.
case of emergency.
E. deliver patient care that allows you to continue Review: Yes ❏ No ❏
to provide objective medical care.

21. Proper flow of communication occurs in the Answer: )

following order:
Why: To ensure proper communication, there must first
A. message, response, clarification, feedback.
be a message or information to send. Clarification and
B. response, clarification, feedback, message.
feedback come after the message has been sent. A
C. feedback, message, clarification, response.
response cannot be given to something not yet received.
D. clarification, message, response, feedback.
Review: Yes ❏ No ❏
154 =VQ\ ■ General Knowledge

22. The progression of a person’s needs from basic Answer: +

survival to reaching one’s pinnacle or
Why: A hierarchy is a system of ranking or grading
self-actualization is known as Maslow’s:
things from least to greatest or small to large. Maslow’s
A. rationalization.
hierarchy ranks a person’s needs from basic needs for
B. self-realization.
survival to a rank of fulfillment of oneself or one’s capa-
C. hierarchy.
bilities.
D. mechanism.
E. triangle. Review: Yes ❏ No ❏

23. To avoid breaching confidentiality, you should: Answer: ,

A. use the office intercom to notify another
Why: Patients’ names should not be announced over an
coworker of the name of a caller on the phone.
intercom. Patient information should never be discussed
B. only discuss patient problems during the office
outside the office, such as in a restaurant during lunch.
lunch hour.
At the office, patients should only be discussed in a pri-
C. communicate in writing, not verbally, to
vate area, not in the hallway. Written messages are not
coworkers about patients.
appropriate for all communication in the office. The
D. avoid discussing patient problems in the office
written message is not efficient; paper still needs to be
hallway.
either discarded properly or stored in a confidential
area.
Review: Yes ❏ No ❏

24. Communication techniques that are used when Answer: )

interviewing a patient include:
Why: Reflecting and summarizing are communication
A. reflecting and summarizing.
techniques that allow the interviewer to encourage more
B. language barriers.
conversation from the patient and clarify information
C. stereotyping.
for accuracy. Language barriers exist when the people
D. bargaining and acceptance.
who need to communicate do not speak or understand
E. criticizing.
the same language. Stereotyping is the belief that all
members of a culture or group are the same. Bargaining
and acceptance are stages of dealing with grief. Criticiz-
ing is the act of judging and analyzing to find fault with
something.
Review: Yes ❏ No ❏

25. To set the stage for successful communication, you Answer: *

should:
Why: You should sit at the level of the patient and main-
A. ask closed-ended questions instead of
tain good eye contact during the interview. This creates
open-ended questions because they are less
an atmosphere of focus on the patient. The use of facial
time-consuming and more efficient.
expression and open body language will also add to a
B. sit at the patient’s level, eye to eye, and
positive communication environment. Asking closed-
maintain eye contact with the patient if
ended questions and not encouraging additional
culturally appropriate.
comments will cause the patient to shut down and not
C. avoid using any body language such as
express what is actually going on with his or her health.
appropriate facial expressions.
It may be more difficult for the patient to talk to or dis-
D. discourage any additional comments from the
cuss anything further with the physician.
patient because the physician will question the
patient again during the examination. Review: Yes ❏ No ❏
 +PIX\MZ ■ Professional Communication 155

Answer: -

26. Which of the following is an issue that becomes Why: According to noted behavioral psychologists, the
predominant during the adolescent stage of predominant issue for the adolescent group is self image.
development? Commitment is an adult issue. Mistrust is an infant or
A. Commitment toddler issue. School-age children have issues with
B. Self-worth developing a sense of self-worth, and preschoolers
C. Mistrust develop imagination as a form of communication.
D. Imagination Review: Yes ❏ No ❏
E. Self image
 Patient Education
8

: - > 1 - ?  < 1 8 
Studyy the chappter on communication (Chappter 7)) before yo
y u begi
g n this chapt
p er. The information
supplied in that chapter also applies to patient education and should be integrated with the mate-
rial presented here. Pick a topic pertinent to the medical office where you work or the field in
which you are interested in working and develop a patient education plan. Ask your peers, super-
visors, and physicians to critique it and provide input.

The emphasis on patient education in the health care set- 8=:87;-7.8)<1-6<-,=+)<176

ting continues to grow. The Joint Commission and the
■ Maintain and promote health
National Committee for Quality Assurance (NCQA),
both of which accredit health care organizations, have ■ Prevent illness
multiple patient education standards and requirements. ■ Restore health
The result is that more responsibility in this area is placed ■ Cope with impaired function
on the medical practice. Federal and state governments,
health plans, insurance companies, hospitals, physician
offices, other health care agencies, and the public spend <781+;.7:8)<1-6<-,=+)<176
millions of dollars each year publishing patient information
pamphlets, videos, DVDs, and other instructional pieces. The role of the medical assistant or medical administra-
Better-informed patients tend to be more compliant with tive specialist includes educating patients. A few of the
care and more apt to participate in preventive services. many topics encountered in patient education are:
The intended outcome is improved health. Patient edu-
cation frequently contributes to quality improvement in ■ Medication administration
health care outcomes (see Chapter 4). ■ Medical equipment use and care


158 =VQ\ ■ General Knowledge

■ Diet restrictions and modifications ENVIRONMENT CONDUCIVE TO LEARNING

■ Prediagnostic test or procedure instructions
After accounting for the domains of learning and other
■ Postdiagnostic test or procedure instructions factors influencing patient education, the health care
■ Physical exercises provider must also consider the learning environment. A
■ Activity modification person is less likely to assimilate information in a chaotic
environment than in one that is conducive to learning.
■ Preventive health schedules (e.g., immunizations,
Selecting and preparing the environment is part of the
well-woman exams) teaching plan. An environment conducive to learning is:
■ Rehabilitative modalities
■ Other resources, such as indigent food programs ■ Quiet
■ Health warning signs ■ Comfortable
■ Self-exams (e.g., for testicular and breast cancer) ■ Private
■ Health monitoring (e.g., blood pressure readings and ■ Free from interruptions
glucose testing) ■ Trusting
■ Appropriate for any needed equipment or materials

+76;1,-:)<176;.7:8)<1-6<-,=+)<176
TEACHING AIDS AND MODALITIES
Several areas must be considered when developing plans
for patient education. These include the following. The tools and materials selected by the educator to pro-
vide patient instruction are important to the success of
the teaching plan. As an example, you do not want to
DOMAINS OF LEARNING provide only written material to a person who has a low
reading level. Many types of instructional tools and
Domains of learning are the areas of a person’s being
methods are available. They include:
that affect his or her capacity to learn. The educator
should be aware of the person’s domains of learning
■ Pamphlets and other written material
when formulating the teaching plan. The domains are:
■ Braille materials
■ Cognitive (knowledge, comprehension) ■ Hearing devices
■ Affective (values, attitudes, opinions) ■ Videos, compact discs, DVDs, slides, tapes
■ Psychomotor (mental and physical abilities, sensory ■ Oral presentations and discussions
skills) ■ Demonstrations/return demonstrations
■ Anatomic models, dolls

FACTORS INFLUENCING PATIENT EDUCATION ■ Posters and other illustrations

■ Record-keeping logs and journals
In addition to domains of learning, other factors, both
internal and external to the patient, influence the teach- ■ Support groups
ing plan and the likelihood that the patient will comply ■ Referral programs
or not comply with the plan. Some of these factors are: ■ Family participation
■ Feedback
■ Motivation (refer to Maslow’s hierarchy in Chapter 7)
■ Goals
COMMON SOURCES OF MATERIALS AND
■ Adaptation to illness
INFORMATION FOR PATIENT EDUCATION
■ Age
Sources of patient educational materials are plentiful.
■ Developmental age
Some sources will provide material at no cost; other
■ Impairments (e.g., hearing, sight) sources may charge to cover their cost or to make a
■ Pain profit. In some cases, the insurance company will assume
■ Language the cost. Use only credible sources with medically known
and professionally accepted authors, advisors, and
■ Cultural or religious barriers
reviewers. All materials used or proposed should be
■ Socioeconomic barriers approved by the physician or appropriate supervisory
■ Ability of the educator to convey information person in the medical office. Sources include:
 +PIX\MZ ■ Patient Education 159

■ Professional organizations, such as the American Med- 6. Provide a form of written instruction for the patient
ical Association (AMA) to take home (frequently patients sign documents that
■ Government agencies, such as Centers for Disease confirm that they have received and understood infor-
Control and Prevention (CDC) mation).
7. Document the education provided in the patient’s
■ Nonprofit organizations, such as the American Dia-
medical record.
betes Association (ADA)
8. Reevaluate effectiveness using follow-up visits,
■ Commercial publishers of books and videos or DVDs letters, e-mails, or telephone calls per office policy and
■ Internet websites procedure.
■ Computer programs designed to individualize infor-
mation 7<0-:+76;1,-:)<176;
■ Libraries (public, private, and medical)
Some offices compile pertinent standardized informa-
■ Educational and medical supply companies for models, tion in packets that may contain videos, DVDs, calen-
compact discs, and videos (catalogs are usually avail- dars, compact discs, and even bound books. For
able) instance, an obstetrics office may offer information on
■ Insurance and health care companies (these frequently fetal development, diet and exercise during pregnancy,
publish informational materials for members) or what a pregnant woman can expect in each trimester.
Your responsibility may be to discuss with a patient
the information contained in a particular packet and to
-,=+)<176)484)6 elicit and answer any questions that arise. Each patient
should be considered individually, and emphasis
After arming yourself with the tools required for educat-
should be placed on areas of need for that patient. If a
ing a patient, you are ready to begin creating the individ-
patient is overweight, for example, more time should be
ual patient educational plan. The Joint Commission and
spent discussing diet. Accommodations must be made
NCQA standards recommend a multidisciplinary, or
for special-needs patients and those with high-risk
team, approach to developing the plan. Some plans are
pregnancies.
simple, such as explaining to the patient that he or she
The medical record documentation should note
needs to reschedule an appointment, the importance of
whether a prenatal packet was given and explained and
keeping that appointment, and, perhaps, escorting him or
any areas of special emphasis. These entries should
her to the scheduler, who will then arrange the required
include the date, the time, and your signature. Some
appointment. Educating a parent on how to obtain and
medical practices have forms with check-off boxes,
use a small-volume nebulizer requires a more complex
which are signed by you and by the patient. The medical
plan. This process could be multidisciplinary, involving
record, in addition to providing information for the
the insurance company to approve rental or purchase of
patient and members of the health care team, is a legal
equipment and a medical supply company to provide the
document that can protect the health care provider from
equipment. Teaching a patient about diabetes may include
liability if documentation is complete and thorough.
referring the patient to a diabetes educator. Even simple
Accrediting bodies, governmental agencies, and con-
plans tend to be multidisciplinary, involving other mem-
tracted insurance plans also audit medical records to
bers of the health care team. The steps of the plan are:
determine the extent and appropriateness of patient edu-
1. Identify the purpose and topic. cation at the medical practice. Failure to provide ade-
2. Assess the patient’s individual needs and abilities quate patient education might be a reason for not
(domains of learning). obtaining full accreditation or for an insurance company
3. Develop the plan. (Who will do the teaching? What not renewing a contract with a medical office.
will be taught and what materials are needed? Where
will the teaching occur? How will it be done?)
■ Review the plan with the physician or the supervisor TERMS
as appropriate.
Patient Education Review
■ Include appropriate patient support personnel and
medical team members. The following list reviews the terms discussed in this
chapter and other important terms that you may see
4. Implement the plan.
on the exam.
5. Evaluate the patient’s understanding of your plan.
affective relating to a person’s values, attitudes, opin-
■ Use feedback from the patient to evaluate the effec- ions; a domain of learning
tiveness of your teaching. cognitive relating to knowledge and understanding; a
■ Revise or repeat instruction if needed. domain of learning
160 =VQ\ ■ General Knowledge

domains of learning areas of a person’s being that patient educational plan a design (may be multidis-
affect learning; the three domains are as follows: ciplinary) to provide education to a patient on a
cognitive (knowledge, comprehension), affective (val- specific topic that includes identification of the
ues, attitudes, opinions), and psychomotor (mental topic, assessment of the patient’s domains of
and physical abilities, sensory skills) learning, formulation of the actions, implementa-
motivation a circumstance or a tangible item that tion of the actions, and evaluation of the plan’s
drives a person into action effectiveness
multidisciplinary a team approach involving different psychomotor relating to a person’s physical and men-
fields of knowledge and expertise tal capabilities and sensory skills; a domain of
National Commission for Quality Assurance learning
(NCQA) a national accrediting body for health care The Joint Commission (formerly the Joint
organizations Commission on the Accreditation of Healthcare
noncompliant failure or refusal to comply or do some- Organizations or JCAHO) a national accrediting
thing as asked body for health care organizations
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA), RMA (AMT), and CMAS (AMT) exams.

1. The process of acquiring information from a Answer: )

patient to determine health care needs and
Why: Assessment is the gathering or acquiring of infor-
abilities is called:
mation. Evaluation is the process that indicates how well
A. assessment.
a patient is adapting or progressing. Documentation is
B. evaluation.
the writing or recording of a patient’s needs and
C. documentation.
progress and the physician’s evaluation notes. Planning
D. planning.
is the using of this information to fulfill the patient’s
needs.
Review: Yes ❏ No ❏

2. Properly written patient educational materials Answer: ,

should:
Why: Narrative paragraphs are usually not as easy to
A. be narrative paragraphs rather than outlined
read or comprehend as outlined materials. Charts and
information.
diagrams are very valuable in the education process
B. not include charts or diagrams.
because they are visual. Medical terms and phrases usu-
C. include complex medical terms and phrases.
ally confuse the layperson not familiar with medical lan-
D. focus on key points.
guage. Patient information materials should not be
E. be lengthy and use sophisticated words.
lengthy but should only include necessary information.
Presenting information in the simplest way possible will
help ensure the patient understands it.
Review: Yes ❏ No ❏

3. The best way to reinforce verbal instructions for a Answer: *

patient is to:
Why: Before leaving the office, it is best if the patient has
A. explain the directions using pronounced body
written instructions that will act as a reminder. This is
language.
the best way to reinforce what has been discussed with
B. provide the patient with written instructions.
the patient.
C. reassure the patient using constant therapeutic
touch. Review: Yes ❏ No ❏
D. ask the patient to call you in a couple of days to
see if there are any questions.

4. As the best way to document that a patient received Answer: +

written instructions to take home, you should:
Why: Placing a note or entry in a patient’s chart or hav-
A. have the receptionist file a note in the patient’s
ing a patient answer questions does not provide
chart.
documented proof that the patient received educational
B. write an entry in the patient’s chart stating that
materials. If the patient signs a document for the file
the patient received the materials.
verifying receipt of the materials, there is definite docu-
C. have the patient sign a document, to be placed
mentation that the event happened.
in the patient’s chart, verifying receipt of the
materials. Review: Yes ❏ No ❏
D. have the patient answer questions about the
materials to see if he or she read the information.
E. conduct a follow-up phone call to the patient.


162 =VQ\ ■ General Knowledge

5. An environment conducive to learning is Answer: )

characterized by:
Why: An environment that is conducive to learning is
A. privacy.
quiet, free of interruptions, and private. A patient is
B. interruptions.
more likely to concentrate on the information you are
C. noise.
providing in this kind of a place than in one that is noisy
D. chaos.
and full of activity.
Review: Yes ❏ No ❏

6. When evaluating a patient’s progress in a patient Answer: +

educational program, if you discover
Why: Noncompliance means that the patient is refusing
noncompliance, this means that the patient is:
to follow prescribed orders. A compliant patient follows
A. following the instructions exactly as they were
instructions exactly as they were provided. Not all
provided.
patients progress at the same rate, even given the same
B. not progressing as quickly as expected.
treatment plan. Some have quick results, whereas in oth-
C. refusing to follow prescribed orders.
ers, it may take longer to notice change or progress in
D. having a reaction to prescribed medication.
their health. If a patient is having a reaction to a medica-
E. progressing quickly and healing properly.
tion, this implies compliance. Because the drug does not
agree with the patient, this is a case of incompatibility.
Review: Yes ❏ No ❏

7. When developing written patient educational Answer: )

materials, it is most important to consider:
Why: The cognitive level of understanding means the
A. the patient’s cognitive level of understanding.
level at which a person is knowledgeable or
B. the patient’s gender.
comprehends information. It is important to develop
C. incorporating more complex medical
patient educational materials at a basic level the reader
terminology in the information.
can understand. It is not necessarily important to
D. including as many topics as possible in the same
consider the patient’s gender when developing written
written brochure.
patient educational materials. Using complex language
or placing too many diverse topics in one document may
be confusing for the patient.
Review: Yes ❏ No ❏

8. To provide patient education for a patient who is Answer: +

blind, which of the following formats of training
Why: Braille is a form of writing that blind people
materials would be most helpful?
usually can understand. It is a writing system that uses
A. Posters
raised dots to represent each letter of the alphabet. The
B. DVDs
other materials listed are not options for use in training
C. Braille materials
someone who is blind.
D. Pamphlets and brochures
E. Internet websites Review: Yes ❏ No ❏

9. A team approach to patient education that includes Answer: *

different fields of knowledge and expertise is
Why: Multidisciplinary means that people from different
referred to as a(n):
areas of specialty or knowledge are involved together to
A. joint venture.
assist patients in education. The front and back office
B. multidisciplinary plan.
personnel work together with other trained profession-
C. quality assurance.
als to provide the specific information necessary to edu-
D. accommodation.
cate the patient.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Patient Education 163

10. The first step in development of a patient Answer: *

educational program is to:
Why: To design an appropriate patient educational pro-
A. document the educational plan in the patient’s
gram, you must first establish the reason or purpose of
chart.
the educational program. This is the main objective of
B. identify the purpose and topic of the
the education. You cannot gather feedback or document
educational program.
in the patient’s chart unless you first know what the edu-
C. elicit patient feedback for documentation.
cational program is. Evaluating the effectiveness is also
D. evaluate effectiveness of the educational plan.
not possible until the program has been implemented.
E. decide the format for the materials to be
The format for the materials should be selected after the
developed.
purpose has been established.
Review: Yes ❏ No ❏

11. When asked to provide dietary information for a Answer: +

patient, an organization that could provide the
Why: The National Dairy Council is the organization
most valuable materials is the:
that developed a nutritional guide that complements
A. Centers for Disease Control and Prevention.
MyPyramid, the guide to basic nutrition and food group
B. American Academy of Family Physicians.
categories. The other organizations specialize in other
C. National Dairy Council.
areas of health.
D. American Lung Association.
Review: Yes ❏ No ❏

12. Patient educational materials are best implemented Answer: -

when the:
Why: If a patient is simply handed materials or is sent
A. patient is sent packets of materials in the mail.
materials in the mail without any discussion or opportu-
B. physician tells the patient to contact a
nity to ask questions, there is no assurance that the
professional organization to answer questions
patient understands the information. Therefore, it is
about the materials.
best to discuss the materials with the patient and answer
C. patient is given the materials as he or she exits
any questions before the patient leaves the office.
the office.
D. patient’s family is not involved. Review: Yes ❏ No ❏
E. materials are discussed with the patient.

13. A national accrediting body for health care Answer: ,

organizations that has established standards
Why: The NCQA (National Committee for Quality
and requirements for patient education is the:
Assurance) is a national organization that establishes
A. CDC.
standards for practice in health care facilities. Among
B. AMA.
these standards are requirements for informing and edu-
C. FDA.
cating patients on health care issues. The CDC is the
D. NCQA.
Centers for Disease Control and Prevention, the AMA
is the American Medical Association, and the FDA is the
Food and Drug Administration.
Review: Yes ❏ No ❏

14. The cognitive domain of learning refers to: Answer: -

A. attitude.
Why: Cognitive refers to having knowledge or compre-
B. physical abilities.
hending information. Mental and physical abilities and
C. sensory skills.
sensory skills are types of psychomotor learning.
D. attitudes and opinions.
Attitudes and opinions are factors of affective learning.
E. comprehension.
Review: Yes ❏ No ❏
164 =VQ\ ■ General Knowledge

15. The process used to carry out the agreed teaching Answer: +
plan in patient education is called:
Why: Implementation means carrying out or providing
A. assessment.
the means for accomplishing. Assessment, evaluation,
B. evaluation.
and documentation are other processes necessary in the
C. implementation.
patient education process.
D. documentation.
Review: Yes ❏ No ❏

16. The overall purpose of patient education is to: Answer: *

A. meet with patients one-on-one.
Why: Patients who are better informed about their
B. improve patient health.
health are more likely to comply with the physician’s
C. provide excessive information.
treatment plan. This ultimately will help prevent disease
D. involve patients in community activities.
and promote improvement in the patient’s health.
E. comply with accrediting agencies.
Review: Yes ❏ No ❏

17. A patient who needs information about drug Answer: +

addiction could receive education and help from
Why: Substance abuse refers to excessive use of and
an organization that specializes in:
dependency on legal or illegal drugs. This could include
A. prescription medications.
prescription drugs or illegal “street” drugs. Alcohol is
B. preventive health.
also categorized as a substance that is frequently abused.
C. substance abuse.
D. nutrition management. Review: Yes ❏ No ❏

18. If a diabetic patient is reluctant to learn how to Answer: )

give himself or herself insulin injections, the first
Why: You must only perform duties under the direct
thing you should do is:
supervision of the physician and should only inform the
A. notify the patient’s physician for further
physician of the problem with the patient. It is the
assistance.
physician who is responsible for determining what the
B. recommend that the patient see an
next step will be in this patient’s care. The physician may
endocrinologist.
actually refer the patient to another person who special-
C. ask the patient to return to the office only when
izes in this type of problem. You should never go beyond
ready to comply with the instruction.
the level of patient education approved by the physician.
D. refer the patient to a diabetic support group or
a social worker who specializes in diabetes. Review: Yes ❏ No ❏
E. volunteer to give the patient the injections.

19. Of the following, which patient is the least likely to Answer: +

respond to learning objectives?
Why: The word condescending means “regarding
A. A patient who has reached the level of esteem
another as being lower in status or knowledge than
and self-respect on Maslow’s hierarchy of needs
you.” This attitude will discourage the patient from
B. A patient who perceives the information as
working with you. All the other answers are a positive
important to his or her health
indication that the patient will be receptive to the educa-
C. A patient who perceives the health care team as
tion or instruction. It is especially helpful if the medical
condescending
assistant and the patient come from the same cultural
D. A patient who has the same culture and ethnic
and ethnic background. It gives them something in
background that you have
common.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Patient Education 165

20. Of the following, which is the most important for Answer: +

the person who is performing patient education?
Why: Although all of the answers might be helpful, if
A. Producing patient brochures
documentation does not occur, it is as if nothing
B. Using technical words when instructing
happened. Documenting events is the most important
C. Documenting in the patient record whatever
task to properly monitor and evaluate the progress of
teaching is performed
the patient.
D. Learning other languages to facilitate job
performance Review: Yes ❏ No ❏
E. Assuring the patient considers you his or
her friend.

21. One of the factors that helps the most in Answer: +

promoting patient learning is:
Why: The patient’s height, weight, gender (sex), and
A. the height and weight of the patient.
insurance company usually have no effect on the
B. the patient’s gender.
patient’s learning. If the patient has a positive emotional
C. a positive emotional outlook.
outlook, more than likely, he or she will also approach
D. the patient’s insurance company.
the patient education as a positive event.
Review: Yes ❏ No ❏

22. To ensure that a patient follows up with Answer: +

appointments for evaluation of the prescribed
Why: It is always best to provide the patient with some-
plan of treatment, you should:
thing in writing as a reminder. Asking the patient to call
A. assign a project or homework for the patient to
the office or even calling the patient a couple of days in
complete between appointments.
advance is not as effective as handing the patient a writ-
B. ask the patient to call the office to schedule a
ten appointment slip before he or she leaves the office.
follow-up appointment when it is convenient.
Assigning a project or homework is inappropriate,
C. provide the patient with a written appointment
although, depending on the patient education program,
slip with the date and time of his or her next
you may ask the patient to keep a journal of progress to
session.
report on during return visits. It is not appropriate to
D. call the patient a week in advance to confirm
have the physician contact a patient because of a missed
the appointment.
appointment.
E. have the physician contact the patient if the
appointment is missed. Review: Yes ❏ No ❏

23. A way to evaluate the patient’s understanding of Answer: +

educational information is to:
Why: To find out if the patient understands the informa-
A. document in the patient’s medical record that
tion, ask for feedback. Documenting receipt of the
he or she received the materials.
materials does not ensure the patient understands them.
B. design a colorful brochure.
Designing a brochure and assessing the patient’s needs
C. ask for feedback from the patient.
are done before the evaluation process.
D. assess the patient’s individual needs and
abilities. Review: Yes ❏ No ❏
166 =VQ\ ■ General Knowledge

24. When providing patient education, you should: Answer: )

A. encourage questions from the patient.
Why: You should encourage the patient to ask any ques-
B. use only written materials for training.
tions about the educational materials. Using only
C. discuss training materials with the patient in
written materials may not be appropriate for all patients.
the hallway so you do not occupy an exam
You should always discuss training materials in a private
room when the physician needs to use it.
exam room to maintain the patient’s confidentiality.
D. use the same method of training with all
Varying the type of presentation is needed to accommo-
patients.
date different patients. It is important to understand the
E. present the materials at a level much higher
patient’s level of comprehension so the training is mean-
than the patient’s cognitive level.
ingful for the patient.
Review: Yes ❏ No ❏

25. One factor that is a positive contribution to the Answer: +

patient’s learning process is:
Why: A patient who has a good support system from his
A. just keeping quiet and only listening.
or her family will probably take the learning more seri-
B. maintaining noncompliance to directions or
ously and have better progress with his or her health
instructions.
needs. If the patient is quiet and does not ask questions,
C. having family support.
learning may be hindered. Noncompliance means the
D. possessing a know-it-all attitude.
patient does not do what is asked. A know-it-all attitude
may cause the patient not to listen to instructions and
then not know what he or she is to do later.
Review: Yes ❏ No ❏

26. The patient’s mental and physical abilities are Answer: *

referred to as:
Why: Psycho- refers to mind or mental capacity. Motor
A. psychosomatic.
refers to a person’s ability to perform physical functions
B. psychomotor.
such as body movement.
C. psychological.
D. psychosocial. Review: Yes ❏ No ❏
E. psychiatric.

27. The domain of learning that includes values, Answer: ,

attitudes, and opinions is referred to as:
Why: Cognitive refers to knowledge and
A. cognitive.
comprehension. Congenital means born with, and aber-
B. congenital.
rant means wandering from the norm.
C. aberrant.
D. affective. Review: Yes ❏ No ❏
 Unit 3
Administrative Practice


 Administrative Technologies
9

: - > 1 - ?  < 1 8 
Compplete the chapt
p ers on Communication (Chappter 7) and Patient Education (Chappter 8) before
beginning this chapter. Many of the principles discussed in those chapters also apply to adminis-
trative techniques. This chapter lends itself to lunchtime reading and other “learning moments.”
Carry the review book with you and open it when you have a free moment.

Chapter 1 explained that this is a review book, not a text for hospitals, the primary emphasis of this chapter is tele-
primary learning. Many textbooks describe the telephone phone communication between the medical office and the
with its features (e.g., hold and transfer buttons), explain patient. The use of specific skills and guidelines helps
how to place long-distance calls, identify time zones, and ensure that telephone communication is effective.
discuss other operational functions. Although these areas
are necessary for you to know in practice, they have a very
low probability of appearing on the national exams. The TELEPHONE VOICE QUALITIES
telephone information included in this chapter has “exam
■ Enunciation—speak clearly
probability.”
The wired telephone and the cellular telephone are the ■ Pronunciation—say words correctly
most common but not the only methods of electronically ■ Volume—use normal voice level
transmitting messages and information. Advancing com- ■ Speed—use normal rate of conversation
munication technology is found in all aspects of health
■ Inflection—change voice pitch to avoid a monotonous
care. This chapter also covers some of the technologies
tone that implies boredom
found in the medical office, such as computers and facsim-
ile machines. ■ Facial expression—put a “smile” in your voice by having
a pleasant look on your face while speaking even though
the caller cannot see you
■ Courtesy—speak politely, without irritation or impatience
<-4-8076-;
■ Attention—focus on the caller and listen
Despite the increasing use of advanced technology, the
telephone remains the number one technologic method
for patients and health care providers to communicate MEDICAL OFFICE CALLS
with each other. Although the medical office also relies on
the phone for real-time communication with insurance ■ Attempt to answer by the third ring
companies, pharmacies, medical supply companies, and ■ Use standard office greeting

!
170 =VQ\ ■ Administrative Practice

• Greet caller (e.g., “Good morning”). ■ Record message

• Provide name of facility. • Use carbonized message pad, e-mail, or other

methods that allow the message to be forwarded
• State your name. but saved.
• Inquire “How may I help you?”
■ Use standard closing
• Maintain a copy of the message in the patient’s med-
ical record if that is office policy.
• Thank the patient for calling. • Record the caller’s name (confirm spelling), date, time,
• Allow caller to hang up first. reason for call, phone number of caller, and conven-
■ Direct multiple incoming calls ient time to return call.
• Obtain permission of the first caller to be placed on • Inform the caller who will return the call and give an
hold. Explain that you have another incoming call. approximate time the call will be returned.
Allow time for the patient to respond before placing • Initial and forward the message to the appropriate
him or her on hold. person with the patient’s medical record, if needed.
• Ask the second caller to wait; allow time for response ■ Deal with emergencies
before placing him or her on hold.
• Notify the physician immediately.
• Attempt to respond to callers within 30 seconds. • Activate the emergency medical system (EMS/911);
• Provide options if the hold will be longer. if telephone system allows, keep the caller on one
• Thank the caller for waiting. line while you notify 911.
■ Screen calls • Instruct caller to hang up and activate EMS himself
or herself, if the office phone system does not have
• Know who and where to refer patients for appropri- at least two lines.
ate assistance.
• Manage physician’s time by referring necessary calls • Provide EMS or emergency facility with informa-
only and taking messages for other calls. tion, including advance directives and other impor-
tant details.
■ Route calls
• Follow up with the emergency facility.
• Tell caller to whom you are forwarding the call. ■ Manage difficult callers
• Provide the forwarding phone number to which you
are transferring the call in case of disconnection. • Keep your voice at a normal level and remain calm
with angry callers.
• Inform the patient that if the party does not respond,
the patient may leave a voice mail message (if • Determine the problem and notify appropriate staff
available). Suggest the patient include a time when to help the patient.
he or she is available for a return call. • Follow up to ensure the problem was addressed.
■ Know the office policy regarding calls that should be • Ensure that the physician or the administrator is
directed to the physician aware of irate callers or callers with unresolved
problems.
• Forward calls from other physicians, hospital staff,
and patients to whom the physician indicated he • Attempt to obtain identity of threatening callers
or she would like to speak directly (e.g., close and notify the physician or the administrator imme-
colleagues). diately.
• Provide the patient’s medical record (chart or file)
for the physician when transferring a call or leaving
a message if he or she does not have access to the MEDICAL ASSISTING AND MEDICAL
EMR. ADMINISTRATIVE SPECIALIST CALLS
• Assure a patient who insists on speaking only to the All health care providers must stay within the scope of
physician, when the physician is unavailable, that practice for their role. The same principles apply to the
the physician will return the call; if possible, pro- phone to other communication technologies. Remember,
vide a time range during which the call will be only the physician or mid-level provider diagnoses, pro-
returned. vides medical advice, or says anything that may be con-
• Inform callers who will not identify themselves that strued as such. The following are telephone calls that a
you need their name and number to have the physi- non-physician may handle if he or she is the designated
cian return the call. person in that office:
 +PIX\MZ! ■ Administrative Technologies 171

■ Appointments (scheduling, rescheduling, canceling, national exams contained basic questions on the compo-
reminding, recalling) nents of the computer and issues related to facsimiles
■ Patient financial statements, insurance, fees, and service (faxes). The exams will continue to incorporate new tech-
questions nologies.
■ Prescription refills verified by the physician
■ Diagnostic testing and other procedural preparations COMPUTERS
as written
The computer is an electronic device programmed to
■ Satisfactory test results if reviewed and approved by take in, store, retrieve, and process data (Fig. 9-1).
physician following Health Insurance Portability and
Accountability Act (HIPAA) guidelines ■ Hardware—the central processing unit, motherboard,
■ Routine and satisfactory progress reports from patient hard drive, disk drive, keyboard, and monitor of the
if office policy allows computer
■ Reinforcement of patient educational plan • Motherboard—the fiberglass plank of the computer
■ General information regarding office policies, loca- that contains the central processing unit, memory,
tions, or appointment preparation and other circuitry
■ Schedule procedures at other facilities ❍ Central processing unit (CPU)—circuit on a
microchip that processes data; microprocessor
■ Record diagnostic and other procedural results tele-
phoned from health care facilities (within the continu- ❍ Random access memory (RAM)—main memory

ity of care or with patient consent) bank of a computer located on the motherboard;
the more RAM the computer has, the more data
■ Activate answering service
and the faster the data manipulation; memory is
■ Retrieve messages from answering service or voice measured in bytes (e.g., megabytes—one million
mail bytes; gigabytes—one billion bytes)
• Hard drive—a box containing the computer’s pro-
Telephone Confidentiality grams and data files
The HIPAA confidentiality standards, expected in all • Keyboard—a set of typewriter-like keys that plugs
health care activities, also apply to the telephone. into the computer and allows input of data

■ Give information only to authorized persons. (Note:

(
Spouses, friends, parents of adults, or adult children of
patients are not generally authorized unless specifically
approved by the patient in writing.)
■ Verify that you are giving information to an authorized
person (e.g., the patient’s insurance carrier).
■ Ensure telephone conversations are not overheard
or that messages are not seen by unauthorized
persons.
■ Avoid discussing telephone conversations except in
carrying out medical assisting duties with authorized
persons.
■ Avoid leaving information on the patient’s voice mail;
only state the name of the office and the phone num-
ber. Ask the patient to return the call, and leave the
name of the party he or she should request.

7<0-:<-+06747/1+,->1+-;
In addition to the telephone, you may use or come in con-
tact with other technologic devices. It is your responsibility
to keep up with advances. At this book’s press time, the .QO]ZM! Basic components of a computer.
172 =VQ\ ■ Administrative Practice

• Monitor—visual display terminal that allows data to Common File Formats

be seen on a television-like screen
A file format is a mechanism used by the computer to
• Disk drive—a device that allows information to be save and retrieve specific computer information, such as
accessed from a floppy disk or compact disc text or photographs.
■ Accessories
■ DOC—document files (DOCX is a more current ver-
• Mouse—a device that plugs into the computer and sion, but the general recommendation is to save files in
allows the user to control the cursor (pointer) as
DOC for ease of opening from all senders)
viewed on the monitor
■ GIF—Graphics Interchange Format
• Modem—a device connecting the computer to a
telephone line and allowing data to be transmitted ■ JPEG—Joint Photographic Experts Group
over telephone wires ■ RTF—rich text file
■ Software—computer programs that tell the computer ■ PDF—portable data format
what to do
■ Floppy disks—diskettes; magnetic discs that can be Common Computer Networks
inserted in the disk drive; they allow for storage of data A computer network is the ability of two or more com-
outside the computer and for transmission of data into puters to communicate.
and out of the computer
■ Compact disc (CD)—a disc that can be inserted into a ■ LAN (local area network)—a router is used to connect
CD-ROM (compact disc read-only memory) drive and computers, generally of a single organization and all its
read by a laser beam, allowing storage of data, includ- sites
ing audio and visual programs, outside the computer ■ WAN (wide area network)—using telephone systems,
and transmission of the data into and out of the com- coaxial cables, or satellites, connects the computers of
puter (Fig. 9-2) a geographic area; the Internet, which contains the
■ ZIP drive—a drive that allows several megabytes of data World Wide Web (www), is the largest example of a
to be saved to a special disc; can be internal or external WAN
to the computer
■ Digital video disc (DVD)—a high-density optical disc Other Common Computer Terms
the contents of which can be displayed on a computer
■ Blog—a
g type of website, generally maintained by an
or television screen
individual who posts regular commentary or other
■ USB (universal serial bus) drive—small, lightweight, material such as graphics or video
removable data storage device; also called USB
■ Electronic social network—ak group of people inter-
stick, USB key, memory stick, flash drive, or thumbdrive
(Fig. 9-2) connected by the web for the purpose of interacting on
a specific topic or multiple topics of common interest
such as Facebook and Twitter
■ HTML (HyperText Markup Language)—the lan-
guage used to transfer documents on the Internet
■ HTTP (HyperText Transfer Protocol)—how mes-
sages are formatted and sent over the Internet
■ Browser—software
r that locates and displays web pages
on the computer; an example is Internet Explorer
■ Search engine—an extensive program allowing
searches for information and websites by using key
words; examples are Yahoo and Google
■ Spreadsheet—values
t arranged in columns and rows
that may be electronically manipulated using formulas
or other processes
■ URL (Uniform Resource Locator)—identifies the
global address and domain to access web pages
■ Website—a collection of screens with text, images,
videos, or other digital information with a common
.QO]ZM! Compact discs and USB drives domain
 +PIX\MZ! ■ Administrative Technologies 173

■ Word processing—one
g of the most common com-
puter applications used to create, edit, and produce text
documents

Common Computer Uses in the Medical Office

The uses of computers in the medical office continue
to grow. The following are the more common
applications.

■ Appointment and procedure scheduling

■ Patient statements
■ Day sheets
■ Financial ledgers
■ Requisitions
■ Payroll and other personnel functions
■ Reports
■ Correspondence
.QO]ZM! HIPAA standards also apply to computers.
■ Online patient registration
■ Electronic medical records
■ Insurance billing and claims ■ Shred confidential copied materials when no longer
■ Research using the Internet in use
■ Digital imaging
■ Patient educational materials MEDICAL TRANSCRIPTION AND EQUIPMENT
■ Patient reminder and recall notifications
Transcription is basically a written copy of dictated or
■ Staff training recorded information. Although generally done by a per-
■ Inventories son specifically trained in this field, medical transcription
■ Electronically operated patient tests and procedures may be the duty of the medical assistant or the medical
administrative specialist. Common information tran-
■ Website information regarding the practice
scribed for the medical office is:

Computers and Confidentiality ■ Patient history and physicals

■ Admission and discharge notes
The health care standards for confidentiality and release of
patient information also apply to computers (Fig. 9-3). ■ Surgery and other procedural reports
Computer-specific requirements and guidelines have come ■ Consultations
about through standard practice or HIPAA. One of the sig- ■ Correspondence
nificant components of HIPAA is the filing of Medicare
claims through a secure electronic database exchange. To The equipment used includes:
ensure compliance:
■ Transcription machine with earpieces and foot pedals
■ Require authorized persons to use an exclusive “elec-
■ CDs or audiocassettes
tronic signature” or password to view patient records
■ Computer and monitor
■ Change passwords frequently
■ Keyboard
■ Ensure computer screens are not in view of unautho-
rized persons ■ Specific software (e.g., medical terminology spell
check, pharmacology reference)
■ Turn off computers when not in use
■ Install privacy filters on monitors to prevent passersby The important standard for medical transcription is if
from seeing the screen a word or phrase is not clear, NEVER guess. Always go
■ Protect computers from illegal access with appropriate back to the person who dictated the information for clar-
security devices such as firewalls ification. Correct spelling is absolutely necessary.
174 =VQ\ ■ Administrative Practice

Other Common Electronic Devices browser software that locates and displays web pages on
the computer; an example is Internet Explorer
■ Facsimile machine (fax)—an electronic machine
cellular telephones (cell phones) portable wireless
that sends copies of documents over telephone wires
telephones
(fax confidential information only to secured areas; fax
central processing unit (CPU) a circuit on a
cover sheets should include a confidentiality statement)
microchip that processes data; a microprocessor
■ Scanner—software-required device that reads docu- compact disc (CD) a disc that can be inserted into a
ments (text, graphics, photos) and transfers the image CD-ROM drive and read by a laser beam, allowing
to the computer storage of data, including audio and visual programs,
■ Automated routing unit (ARU)—programmable device outside the computer, and transmission of data into
that answers calls and plays prerecorded telephone and out of the computer
messages to prompt a caller to choose options based on compact disc read-only memory (CD-ROM) a
needs; the ARU automatically directs the caller to the computer drive that reads CDs using a laser beam
chosen option; some ARUs are programmed to tele- computer an electronic device that is programmed to
phone patients and leave appointment reminders or take in, store, retrieve, and process data
other messages (these messages should not be left with- diction the style of speaking and enunciating words
out patient consent) digital camera a camera that uses a memory card
■ Electronic mail (e-mail)—a system of communicating instead of film, allowing pictures to be viewed,
electronic messages, images, and sounds via the com- altered, or printed through a computer
puter through a modem and the Internet (e-mails digital video disc (DVD) a high-density optical disc,
should not be sent to patients without their consent) the contents of which can be displayed on a comput-
er or television screen
■ Cellular telephones (cell phones)—portable, wireless
disk drive a device allowing information to be accessed
telephones; their use should be restricted in health
from a floppy disk
care facilities because they may interfere with electrical
electronic mail (e-mail) a system of communicating
medical devices or the noise may impede patient care;
electronic messages, images, and sounds via the com-
medical assistants should not use personal cell phones
puter through the Internet
during working hours
electronic social network a group of people inter-
■ Personal digital assistant (PDA)—a palm-sized, hand- connected by the web for the purpose of interacting
held, wireless computer that may be synchronized with on a specific topic or multiple topics of common
other computers; an example is a Palm Pilot interest
■ Pagers—battery-operated devices that alert a person enunciation speaking clearly
to a message left through a telephone or wireless facsimile machine (fax) an electronic machine that can
source; pagers may also display other information, send copies of documents over telephone wires
such as news bulletins floppy disks diskettes; magnetic discs that can be
■ Digital camera—a camera that uses a memory card inserted in the disk drive; they allow storage of data
instead of film, allowing pictures to be viewed, altered, outside the computer and transmission of data into
or printed through a computer and from the computer
hard drive a box containing the computer’s programs
and data files
TERMS hardware the central processing unit, motherboard,
hard drive, disk drive, keyboard, monitor, and mouse
Administrative Techniques Review
of the computer
The following list reviews the terms discussed in this HTML (HyperText Markup Language) the language
chapter and other important terms that you may see on used to transfer documents on the Internet
the exam. HTTP (HyperText Transfer Protocol) how mes-
automated routing unit (ARU) programmable device sages are formatted and sent over the Internet
that answers calls and plays prerecorded telephone inflection changing voice pitch to avoid a monotonous
messages to prompt a caller to choose options based tone implying boredom
on needs; the ARU automatically directs the caller to keyboard a set of typewriter-like keys that plugs into a
the chosen option; some ARUs are programmed to computer and allows input of data
telephone patients and leave appointment reminders LAN (local area network) uses a router to connect
or other messages computers, generally of a single organization and all
blog a type of website, generally maintained by an its sites
individual who posts regular commentary or other modem a device connecting the computer to a tele-
material such as graphics or video phone line and allowing data to be transmitted
 +PIX\MZ! ■ Administrative Technologies 175

monitor visual display terminal (VDT) that allows data search engine an extensive program allowing searches
to be seen on a television-like screen for information and websites by using key words;
motherboard the fiberglass plank of the computer that examples are Yahoo and Google
contains the central processing unit, memory, and software computer programs that tell the computer
other circuitry what to do related to that topic (e.g., word processing)
mouse a device that plugs into the computer and spreadsheet values arranged in columns and rows that
allows the user to control the cursor viewed on the may be electronically manipulated using formulas or
monitor other processes
pagers battery-operated devices that alert a person to a transcription a written copy of dictated or recorded
message left through a telephone or wireless source; information
pagers may also display other information, such as URL (Uniform Resource Locator) identifies the
news bulletins global address and domain to access web pages
personal digital assistant (PDA) a palm-sized, hand- USB (universal serial bus) drive small, lightweight,
held wireless computer that may be synchronized removable data storage device; also called USB stick,
with other computers; an example is a Palm Pilot USB key, memory stick, flash drive, or thumbdrive
photocopy a duplicate copy of a written document WAN (wide area network) using telephone systems,
pronunciation saying words correctly coaxial cables, or satellites, connects the computers
random access memory (RAM) main memory bank of a geographic area; the largest example of a WAN
of a computer located on the motherboard: the more is the Internet
RAM, the more data and the faster the manipulation; website a collection of screens with text, images, videos,
memory is measured in bytes or other digital information with a common domain
scanner software-required device that reads documents word processing one of the most common computer
(text, graphics, photos) and transfers the image to applications used to create, edit, and produce text
the computer documents
scanning a process of transferring a written document ZIP drive a drive that allows several megabytes of data
or image into an electronic version using computer to be saved to a special disc; can be internal or
hardware called a scanner external to the computer
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA), RMA (AMT), and CMAS (AMT) exams.

1. When assigned to answering the telephone in a Answer: *

physician’s office:
Why: Hanging up on an angry patient will likely exacer-
A. some callers are angry and it is acceptable to
bate the problem. You should try to address the caller’s
hang up.
concern or find someone who can. All calls coming into
B. you should be able to determine which calls are
a physician’s office should be answered promptly and
routine, non-emergent, or emergent situations.
first determined whether they are an emergency. Only
C. it is routine to give family members who call
after it is known that the call is not an emergency should
normal results of laboratory findings.
you place the caller on hold. HIPAA and standards pro-
D. when many phone calls are coming into the
hibit giving out medical information over the telephone
office at one time, it is appropriate to
unless under the direction of the physician and only to
immediately put all calls on hold and then
authorized individuals.
return to each one in the order received.
Review: Yes ❏ No ❏

2. The style of speaking and enunciating words is Answer: )

referred to as:
Why: Diction is the act of articulating words distinctly as
A. diction.
you speak so that you are clearly understood. Pronuncia-
B. pronunciation.
tion is the manner of pronouncing or speaking words
C. expression.
using phonics (speech sounds that make up a language).
D. conversation.
Expression is the use of feeling or character when speak-
E. inflection.
ing to help convey the spoken word. Conversation is an
exchange of words, ideas, or thoughts. Inflection means
to change voice pitch to avoid a monotonous tone.
Review: Yes ❏ No ❏

3. When answering phones during a busy time of day, Answer: *

it is only appropriate to place a caller on hold after
Why: It is appropriate to place a caller on hold only after
you ask the following:
you have asked the caller’s permission to be placed on
A. May I have your phone number so I can call
hold. If it is an emergency, the caller will usually state
you back?
that he or she cannot hold and needs immediate
B. Will you please hold?
attention.
C. Are you a regular patient at this office?
D. We are busy now; will you call back later? Review: Yes ❏ No ❏

4. Which of the following is a phone call that Answer: )

ordinarily does not require the party to speak
Why: You would refer to the prescription information
directly to the physician?
written by the physician in the patient’s medical record
A. A pharmacist calls to verify information written
and communicate the information to the pharmacist. All
on a prescription form.
the other responses would require intervention by the
B. A patient calls complaining of shortness of
physician.
breath, sweating, and heart pounding after
taking new medication. Review: Yes ❏ No ❏
C. A referring physician calls to relate information
of an abnormal electrocardiogram on a patient.
D. A nurse from the local hospital emergency
room calls for orders on a patient just admitted.
E. One of the physician’s family members calls to
talk with the physician about an emergency.


 +PIX\MZ! ■ Administrative Technologies 177

5. The transmission of a hard copy of a written Answer: *

document through a phone line is called a(n):
Why: The facsimile (usually shortened to fax)
x is an elec-
A. electronic mail.
tronic machine that sends written images over telephone
B. facsimile.
wires. Electronic mail is used in conjunction with the
C. photocopy.
Internet via the computer. A photocopy is a duplicate
D. scan.
copy of a written document. Scanning is a process of
transferring a written document or image into an
electronic version using computer hardware called a
scanner.
Review: Yes ❏ No ❏

6. The primary purpose of screening telephone Answer: )

calls is to:
Why: You will screen phone calls to determine which
A. manage the physician’s time by referring only
calls must be forwarded to the physician and which can
necessary calls.
be handled by you.
B. place patients on hold as soon as they contact
the office. Review: Yes ❏ No ❏
C. decrease the number of telemarketing calls to
the office.
D. intercept personal calls.
E. increase the physician’s patient load.

7. The physician has asked you to contact a patient to Answer: +

schedule a return office visit to discuss laboratory
Why: If a patient cannot be reached by phone, it is not
results. The patient is not available when you call.
appropriate to leave a message regarding test results
It is appropriate to:
with anyone other than the patient. Because this is not
A. leave a message with the person answering the
an emergency situation, a letter can be sent to the
phone indicating that the patient should
patient—but you should also try to reach the patient by
contact the office for laboratory results.
telephone later.
B. contact the patient’s workplace to leave a message
for the patient to contact the physician’s office to Review: Yes ❏ No ❏
go over some blood test results.
C. try to reach the patient later but also send a
letter with the information.
D. call the person who is listed as the emergency
contact on the patient’s information sheet.

8. When assigned to work in the reception area of the Answer: *

office, you should attempt to answer all incoming
Why: It is usually impossible to answer all phone calls on
telephone calls:
the first or even second ring. All efforts should be made
A. after assisting all other calls on hold.
to answer calls by the third ring.
B. by the third ring.
C. by the fourth ring. Review: Yes ❏ No ❏
D. by the fifth ring.
E. in between rooming patients.

9. Which of the following is an appropriate standard Answer: +

opening for an incoming call to the physician’s
Why: The first thing a caller should hear is a pleasant
office?
greeting and the name of the facility.
A. Will you please hold?
B. Who’s calling please? Review: Yes ❏ No ❏
C. Good morning, Dr. Smith’s office.
D. 555-2456, may I help you?
178 =VQ\ ■ Administrative Practice

10. When transferring a patient call to the physician, Answer: -

you should:
Why: The physician will want to have the patient’s med-
A. interrupt the physician in an exam room to
ical record available in the event questions arise during
forward the information about the caller.
the conversation that require information from the
B. not forward the call, but ask the caller to call
medical record. It is inappropriate to tell the patient the
back later when the physician is finished with
physician will be upset with the call, and you should not
all patients for the day.
interrupt a physician while in an exam room unless the
C. inform the patient that the physician will be
call is an emergency. Offices typically do not charge
upset if interrupted.
patients for phone calls.
D. inform the patient that there will be an office
visit charge for the call. Review: Yes ❏ No ❏
E. have the patient’s medical record available for
the physician.

11. After a caller has been placed on hold, you should Answer: *
make every attempt to respond to the caller within:
Why: If a caller needs to be placed on hold, it is recom-
A. 10 seconds.
mended that you check back with the caller at least every
B. 30 seconds.
30 seconds. Even if you are still busy with another
C. 1 minute.
patient, at least the caller will be encouraged to continue
D. 5 minutes.
holding.
Review: Yes ❏ No ❏

12. When dealing with a difficult caller, you should: Answer: ,

A. forward the call to the physician.
Why: When a caller is difficult to deal with, it will
B. forward the call to the office manager.
further exacerbate the situation if you also become angry
C. tell the caller you will hang up if he or she
or difficult. Keep your voice at a normal level and
continues to be difficult.
remain calm while you try to determine what the prob-
D. determine the problem and the appropriate
lem is and who can best help the caller.
staff member who can help the caller.
E. put the caller on hold until he or she hangs up. Review: Yes ❏ No ❏

13. When a patient calls with a list of symptoms, Answer: )

including fever, chills, and body aches, that have
Why: A patient with those symptoms may actually have
lasted for the past several days, you should:
the flu, but it is not within your scope of practice or
A. offer the patient an appointment to see the
responsibility to diagnose. The patient should be offered
physician.
an appointment to see the physician to make an
B. tell the patient to stay home in bed and to take
appropriate diagnosis.
aspirin and fluids.
C. inform the patient that there is a lot of flu Review: Yes ❏ No ❏
going around.
D. tell the patient that the physician does not see
patients unless they have been ill for at least a
week and that it is probably a flulike illness that
will pass.
 +PIX\MZ! ■ Administrative Technologies 179

14. When placing calls to patients to confirm Answer: -

appointments, the calls should be made:
Why: All patients should be contacted the day before
A. the morning of the day of the appointments.
their appointment, and the calls should be made from a
B. only to patients who were not given
place where other patients cannot overhear the call.
appointment cards.
Even if patients are given appointment cards, a reminder
C. one week before the appointment.
call is usually made.
D. only to those patients who you know missed
their last appointment. Review: Yes ❏ No ❏
E. in an area where you cannot be overheard by
other patients.

15. An electronic device that takes in, stores, retrieves, Answer: +

and processes data is a:
Why: A disk drive is a device located on the computer
A. disk drive.
that allows information to be accessed from a floppy disk
B. monitor.
or CD-ROM. A monitor is used to visually display the
C. computer.
data, and the compact disk is a device used to store data
D. floppy disk.
outside the computer. The computer is the entire
electronic device that takes in, stores, retrieves, and
processes the data.
Review: Yes ❏ No ❏

16. A computer program that tells the computer what Answer: +

to do is the:
Why: The disk drive is located on the computer and
A. disk drive.
allows information to be accessed from a DVD or CD-
B. modem.
ROM. A modem connects a computer to a telephone
C. software.
line and transmits data via that line. The mouse is the
D. mouse.
device that plugs into the computer and controls the
E. keyboard.
cursor as viewed on the monitor. A keyboard is a set of
typewriter-type keys that allows for input of data.
Review: Yes ❏ No ❏

17. The federal government enacted a standard Answer: *

practice for confidentiality and release of patient
Why: HIPAA stands for Health Insurance Portability
information as it applies to computers. This
and Accountability Act, which is the name of the federal
information is found in the federal register under
guidelines for confidentiality and release of patient
the abbreviation:
information in all forms, including electronically. HCFA
A. HCFA.
is the Health Care Financing Administration; HHS is
B. HIPAA.
the Department of Health and Human Services. HRSA
C. HHS.
is the Health Resources and Services Administration.
D. HRSA.
Review: Yes ❏ No ❏

18. When you are focusing on the conversation of the Answer: *

telephone call and ignoring outside distractions,
Why: To actively listen to a conversation, you must not
you are:
interrupt the speaker and you must ignore what is going
A. expressing yourself.
on around you so that you can concentrate on the
B. actively listening.
conversation.
C. practicing diction.
D. demonstrating time management. Review: Yes ❏ No ❏
E. maintaining confidentiality.
180 =VQ\ ■ Administrative Practice

19. When routing a caller to another person, you Answer: ,

should:
Why: Before forwarding a call, you should inform the
A. forward the call immediately, not wasting time
caller that you are going to forward the call and provide
to talk to the caller.
the phone number or extension in case the call is discon-
B. tell the caller you do not forward calls and
nected. If the person you need to forward the call to is
ask the caller to call back when the person
unavailable, you can give the caller the option of calling
is available.
back or leaving a message, but you would not tell the
C. place the caller on hold for up to 5 minutes
caller that you do not forward calls. You should not place
while you locate the person to whom you need
a caller on hold for more than 30 seconds without check-
to transfer the caller.
ing in to see whether he or she is still willing to hold.
D. provide the phone number or extension to
which you are transferring the caller, in case Review: Yes ❏ No ❏
the call is disconnected.

20. To comply with the HIPAA requirements when Answer: ,

using a computer, you should remember to do the
Why: When not in use, the computer should be turned
following EXCEPT:
off. This will help maintain security of the computer and
A. change passwords frequently.
prevent illegal use or its being viewed by unauthorized
B. protect computers from illegal access with
persons.
appropriate security devices.
C. ensure computer screens are not in view of Review: Yes ❏ No ❏
unauthorized persons.
D. keep the computer on at all times to save time
turning it on.
E. turn off the computer when not in use.

21. Which of the following is a necessary quality for a Answer: ,

good telephone voice?
Why: Proper telephone voice qualities include changing
A. Maintaining a monotonous tone
the pitch to avoid a monotone voice. Use a normal rate
B. Using a rapid rate of conversation
of conversation and actively listen to the caller without
C. Focusing on surrounding activity in the office
allowing the activity around you to interfere with your
while on the phone with a caller
ability to concentrate on the conversation.
D. Speaking clearly and saying words correctly
Review: Yes ❏ No ❏

22. When an unidentified caller insists on speaking Answer: *

with the physician, the medical assistant should:
Why: Explain that the physician is not available to take
A. hang up.
the call but that you will forward the name and number
B. tell the caller that the physician is with a
so that the physician can return the call later. Most peo-
patient and you need a name and a number so
ple will be willing to give their name and number if they
the call can be returned.
know the physician will call them back.
C. put the caller on hold until he or she hangs up.
D. transfer the call immediately to the physician. Review: Yes ❏ No ❏
E. transfer the call to a coworker.
 +PIX\MZ! ■ Administrative Technologies 181

23. The proper way to deal with an emergency call is to: Answer: +
A. ask the caller to hold while you call the local
Why: You would not want to waste time having the
emergency room for instructions.
patient come to the office or contact the physician on
B. ask the caller to come to the office immediately.
call. In a true emergency, the patient should be
C. keep the caller on the line while contacting the
instructed to activate 911/EMS (emergency medical sys-
emergency medical system on another line if
tem), or the physician’s office should contact EMS for
the office has multiple phone lines.
the patient, if possible.
D. give the caller the number of the physician who is
on call when his or her physician is not available. Review: Yes ❏ No ❏

24. Telephone calls that the medical assistant or Answer: *

medical administrative specialist may handle
Why: If the laboratory results were just received from
include the following EXCEPT:
the lab and have not been reviewed and approved for
A. refilling prescriptions verified by the physician.
release by the physician, the medical assistant must not
B. providing a patient with laboratory test results
release the test results.
just received from a lab.
C. scheduling procedures at other medical Review: Yes ❏ No ❏
facilities.
D. answering patient financial statement
questions.
E. confirming the time of an appointment for a
patient.

25. To maintain telephone confidentiality, the medical Answer: )

assistant or medical administrative specialist must:
Why: The medical assistant or medical administrative
A. give information only to authorized persons.
specialist should only give patient information to those
B. discuss telephone conversations anywhere in
who are authorized to receive the information. This
the office.
does not include the patient’s employer or relatives
C. give information to the patient’s employer if he
unless the patient has given permission to release the
or she contacts the office to inquire about the
information. Always discuss information in the office in
patient’s absence from work.
an area where patients or unauthorized persons cannot
D. give information to family members with or
hear the conversation.
without authorization because of their
relationship to the patient. Review: Yes ❏ No ❏

26. Which of the following is not a device used to save Answer: )

computer data?
Why: HTTP (HyperText Transfer Protocol) is how
A. HTTP
messages are formatted and sent over the Internet. All of
B. USB drive
the other devices listed are devices used to save data.
C. DVD
D. ZIP Review: Yes ❏ No ❏
E. CD-ROM
182 =VQ\ ■ Administrative Practice

27. Yahoo is an example of an Internet: Answer: *

A. browser.
Why: A search engine is an extensive program allowing
B. search engine.
searches for information and websites by using key
C. LAN.
words. Yahoo is an example of an Internet search engine.
D. CPU.
A browser is software that locates and displays web
pages on the computer. LAN means local area network;
CPU is a central processing unit; and a scanner is a
device that reads documents (text, graphics, photos) and
transfers the image to the computer.
Review: Yes ❏ No ❏

28. A patient history processed on the computer Answer: ,

would most likely be saved in what type of file?
Why: Word documents such as patient histories are most
A. RTF
frequently saved in document files (DOC). Graphic
B. JPEG
images are saved in GIF format; photographic images
C. GIF
are commonly saved in JPEG files. RTF, rich text file,
D. DOC
can be used to save written documents; however, it is not
E. spreadsheet
commonly used.
Review: Yes ❏ No ❏

Note: This question is an example in which two answers

are correct but one answer is a “better” choice or is
more common. Your clue is the phrase “most likely.”
The exams will contain questions of this nature.

29. Equipment needed for medical transcription is a: Answer: ,

A. copy machine.
Why: Transcription is a written copy of dictated or
B. facsimile machine.
recorded information. A copy machine, facsimile
C. telephone.
machine, or telephone cannot transform oral
D. computer.
information into a written format. The computer is the
E. mouse.
only instrument listed that can do this. This process can
take place without the use of a mouse, although a mouse
may be used minimally. The computer is the BEST
answer.
Review: Yes ❏ No ❏

30. The correct spelling of heavy, uncontrolled Answer: *

bleeding is:
Why: A medical terminology spell check in use while
A. hemmorrhage.
performing medical transcription would indicate that
B. hemorrhage.
choice B (hemorrhage) is the correct spelling.
C. hemmorage.
D. hemorhage. Review: Yes ❏ No ❏
 Appointment Scheduling
10

: - > 1 - ?  < 1 8 
Keepp energgized! This review pr
p ocess, even if it seems gr
g uelingg, is a relativelyy short pe
p riod of time
with an end in sight. Go outside and enjoy a walk or run or just sit on a park bench and clear your
head. Call someone you can count on to be cheerful. Read some jokes or inspirational pieces.
To regain your focus and energy, do something that usually makes you feel good.

The goal of appointment scheduling is to maintain a • Used primarily in urgent care centers
smooth office flow while accommodating the needs of
• Eliminates broken appointments
the medical practice and the patient. The type of sched-
uling used depends on the following: • Limits medical records and procedures preparation
• Prohibits control of number of patients arriving at
■ Nature of practice one time
■ Patient population needs • Needs triage system
■ Doctor’s preferences and habits
■ Clustering (group procedures, categorizing)—similar
■ Available facilities and staff procedures scheduled on predetermined days or in
predetermined time blocks, such as new patient
<A8-;7.;+0-,=416/ exams, sports physicals, and immunizations; they are
designated when the appointment book matrix is
The exam questions will require you to identify the dif- developed
ferent types of scheduling. These types include:
• Increases efficiency and speed for procedures
■ Open hours (tidal wave, open booking)—no appoint- • Theoretically, allows better utilization of equipment
ments needed; first-come, first-served and staff

 
184 =VQ\ ■ Administrative Practice

*W`
+WUXIZQ[WVWN,W]JTM*WWSQVO?I^M5WLQNQML I^MIVL<QUM;XMKQNQK;KPML]TM
Double Booking Wave
9:00 Susan F. Garcia 602-1234 Ref 9:00 Susan F. Garcia 602-1234 Ref
John S. Habib 602-2345 S/R John S. Habib 602-2345 S/R
9:15 Tony McCall 456-3456 CPE Tony McCall 456-3456 CPE
Jane P. Morgan 564-4567 CPE Jane P. Morgan 564-4567 CPE
9:30 Taylor Roberts 324-6789 Inj 10:00 Taylor Roberts 324-6789 Inj
Michael Sanchez 324-7890 NP Michael Sanchez 324-7890 NP
9:45 Joseph Armat 567-1234 Ref Joseph Armat 567-1234 Ref
Selena Green 765-7890 F/U Selena Green 765-7890 F/U
Modified Wave Time-Specific
9:00 Susan F. Garcia 602-1234 Ref 9:00 Susan F. Garcia 602-1234 Ref.
9:15 John S. Habib 602-2345 S/R 9:15 John S. Habib 602-2345 S/R
9:30 Tony McCall 456-3456 CPE 9:30 Tony McCall 456-3456 CPE
9:45 Jane P. Morgan 564-4567 CPE 9:45 2
10:00 Taylor Roberts 324-6789 Inj 10:00 Jane P. Morgan 564-4567 CPE
10:15 Michael Sanchez 324-7890 NP 10:15 2
10:30 Selena Green 765-7890 F/U 10:30 Taylor Roberts 324-6789 Inj

■ Select scheduling (Box 10-1) • Time-specific (streaming)—patient given an

appointment based on length of time needed and on
• Double booking—two or more patients scheduled at available time; this is the most common scheduling
the same time
method
❍ Used by practices with short visits or a high no-
■ Other scheduling considerations
show rate
❍ Increases patient waiting time
• Physician or office delay—keep patients informed of
waiting time; offer opportunity to reschedule or wait
❍ Reduces physician downtime
• Time allotment for visits and procedures—estab-
• Wave—a specific number of patients, usually four, lished criteria indicate the time required for the
scheduled at the beginning of the same hour common procedures and visits in a practice (e.g., a
❍ Reduces physician downtime complete physical exam may be 45 minutes, suture
❍ Allows specific procedures, such as a routine removal may be 15 minutes); new patients are usual-
ECG, to be performed prior to the physician see- ly allotted more time than established patients
ing the patient • Emergencies—office criteria for handling urgent
❍ Intended to start and finish each hour on time medical situations in the office and on the telephone,
including involvement of the emergency medical
❍ Increases waiting for patients seen later in the hour
system and poison control centers
❍ Creates issues of who is seen first if more than one
person arrives at the same time • “Walk-ins”—patients who come to the office without
an appointment expecting to be seen; urgency and
• Modified wave—hour-long blocks broken down to available appointment time should be considered
smaller time increments (usually 10 or 15 minutes
each) and individual patients scheduled within those • Referrals—urgency of referrals should be communi-
cated by the referring physician, and appropriate
increments
medical records, including diagnostic results, should
❍ Intended to start and finish each hour on time be sent to the consulting physician
❍ Decreases patient waiting time compared with wave
• Repeat appointments—schedule patients for a series
scheduling of appointments (e.g., dressing changes, antibiotic
❍ Avoids issues of who should be seen first administration) at the same time on the same day of
 +PIX\MZ ■ Appointment Scheduling 185

the week, if possible; this reduces the incidence of

missed appointments Table 10-1 )XXWQV\UMV\)JJZM^QI\QWV[

• Flexible hours—varied hours on certain days; may Abbreviation Definition

include evenings and weekends
Cons Consultation
• Buffer zone—periods during the day with no appoint- CPE Complete physical exam
ments scheduled to accommodate emergencies and to
allow the physician to catch up if running late F/U Follow-up
• Sales representatives—the norm has become to give Inj Injection
sales representatives, such as with pharmaceutical com-
NP New patient
panies, a designated appointment or to have a specific
day or time of the day set aside for these visits NS No-show
• Other visitors—attorneys, and other nonmedical pro- Ref Referral
fessionals may request to meet with the physician to
S/R Suture removal
function as expert witnesses or perform other consult-
ing-type services; appointments are scheduled to US Ultrasound
accommodate the physician and the practice; these
services are generally billed

-9=185-6<)6,5)<-:1)4; • Fill in physician’s time away from the office, such as

for hospital rounds, out-of-office procedures, or
■ Appointment book—specially designed calendar-type meetings
book used to schedule appointments
• If the cluster method of scheduling is used, mark days
• Remains open and conforms to desk or counter and times that are reserved for special procedures
space size (e.g., if Mondays are reserved for sports physicals, the
• Conforms to Health Insurance Portability and top of the day’s matrix would be marked “sports phys-
Accountability Act (HIPAA) privacy standards; not icals” and times would be blocked in the increments
able to be seen by unauthorized people designated by the practice for each physical)
• Accommodates practice (e.g., it has an adequate ■ Scheduling
number of lines for the number of physicians) • Begin with the first appointment available that has
■ Daily log—separate from the appointment book; a the time required for the specific visit
ledger-type book listing the day’s appointments and • Consider patient and practice needs, such as fasting
used for cross-referencing financial entries, data col- for blood work, preparation for procedures, or who
lection on types and number of procedures, and total does specific procedure
patients seen
• Obtain patient’s full name and telephone number
■ Worksheet—copy of daily patients by list or medical
assistant assignment; used to prepare rooms and
• Note reason for visit, using standard abbreviations
(Table 10-1)
equipment; it is shredded at the end of the day in com-
pliance with HIPAA privacy standards
■ Computer appointment scheduling—software that 8)<1-6<8:-8):)<176
replaces the hard-copy appointment book
At the time the appointment is made:
• Commercial or custom software can be used (it may
also incorporate financial and claims procedures)
■ Verify that the office accepts the patient’s insurance
• Legal, HIPAA, and other standard appointment ■ Inform the patient of any copay and other office finan-
guidelines must be met
cial policies
■ Instruct the patient to bring his or her insurance card
8:7+-,=:- and any necessary insurance forms, medical records,
and immunization records
■ Developing the matrix—preparing the appointment
book or computer to show what times are available and ■ Request that a new patient allow time before an appoint-
unavailable for appointments ment to complete registration material in the office
■ Provide directions to office
• Block off times when appointments are not routinely
scheduled, such as lunch or monthly staff meetings ■ Mail preregistration material if it is office policy to do so
186 =VQ\ ■ Administrative Practice

■ Obtain prior approval from the insurance company if ■ Reminder mailings—cards or computer-generated
required forms mailed to the patient informing him or her
■ Explain any necessary preparations for procedures that an appointment is coming up or to remind the
both verbally and in writing patient to call and schedule an appointment if the
patient is due for a procedure (e.g., annual well-woman
■ Confirm date and time of appointment at the end of
check)
conversation
■ Telephone calls—made by the office the day before the
appointment is scheduled; leave messages only with
8:7+-,=:-;7=<;1,-7.<0-8:)+<1+- prior patient permission (usually obtained during
initial registration)
Depending on the type of practice, it may be necessary to
schedule hospitalizations and procedures to be performed ■ E-mail—sent with patient’s permission
outside of the medical office. The following are guidelines: ■ Recall notices—cards or computer-generated forms
sent to inform the patient that he or she missed a
■ Inpatient scheduling for an illness or procedure that scheduled appointment or that he or she is overdue for
requires a hospital stay: a procedure (e.g., immunizations)
• Ensure insurance requirements, such as prior
authorization, are met
8)<1-6<.47?)6)4A;1;
• Check patient’s availability for expected length of stay
(LOS) Patient flow analysis is a periodic study conducted by the
medical practice to assess the efficiency of scheduling
• Check physician’s availability for procedure and staff and, ideally, resolve identified problems. It gen-
• Know appropriate diagnosis (ICD-9 code) and pro- erally measures the following times:
cedure (CPT code)
• If surgery or procedure, schedule with appropriate ■ Sign in
department within the hospital ■ Scheduled appointment
• Schedule the admission or reservation with the hos- ■ Placement in treatment room
pital Admissions Department (separate from sched-
■ Physician presentation
uling the procedure to assure a bed is available on
the appropriate unit afterward) ■ Discharge

• Provide patient preparation information and materi- The times are then evaluated and compared with estab-
als if appropriate
lished norms and benchmarks. Some insurance compa-
■ Outpatient scheduling for a procedure that does not nies require or recommend a patient flow analysis at
require a hospital stay: intervals or may conduct one as a follow-up to member
• Ensure insurance requirements, such as prior author- complaints or other issues. In addition to participating in
ization, are met the process, the role of the medical assistant and the
• Check patient’s availability medical administrative specialist may be to report the
findings and make recommendations. Changes should
• Check physician’s availability for procedure not be initiated without the approval of the physician or
• Know appropriate diagnosis (ICD-9 code) and pro- practice manager.
cedure (CPT code)
• Schedule with appropriate facility
4-/)41;;=-;
• Provide patient preparation information and materi-
als if appropriate ■ Treat the appointment book and daily log as legal doc-
uments; they may be subpoenaed
■ Maintain HIPAA standards by ensuring confidentiality
)88716<5-6<:-516,-:; with appointment information; if the system is com-
■ Appointment cards—given at the time the appoint- puterized, screens should be protected from view,
ment is established passwords changed frequently, and required firewalls
■ Tickler file—an index system with cards placed in in place if the system is part of a network
chronologic order, usually by week or month; used as ■ Document no-shows and cancellations that are not
reminders for items that need attention in the future, rescheduled in the patient’s medical record and in the
such as immunizations appointment book and log
 +PIX\MZ ■ Appointment Scheduling 187

TERMS patient flow analysis a periodic study conducted by

the medical practice to assess the efficiency of sched-
Appointment Scheduling Review uling and staff and, ideally, resolve identified prob-
The following list reviews the terms discussed in this lems
chapter and other important terms that you may see on recall notice cards or computer-generated forms sent
the exam. to inform the patient that he or she missed a sched-
buffer zone period in the day with no scheduled uled appointment or that he or she is overdue for a
appointments, intended to accommodate emergen- procedure
cies and allow the physician to catch up if running reminder mailings cards or computer-generated forms
late mailed to the patient informing him or her that an
clustering (group procedures, categorizing) similar appointment is coming up or to remind the patient
procedures are scheduled on predetermined days or to call and schedule an appointment if the patient is
in predetermined time blocks due for a procedure
daily scheduling log ledger-type book listing day’s tickler file an index system with cards placed in
appointments; used for cross-referencing financial chronologic order, usually by week or month; used
entries, data collection on types and number of pro- as reminders for items that need attention in the
cedures, and total patients seen future, such as immunizations
double booking scheduling two or more patients at time-specific (streaming) patient is given an appoint-
the same time ment time based both on length of time needed and
length of stay (LOS) the time the patient is in or is on available appointments; this is the most common
expected to be in the hospital scheduling method
modified wave scheduling method that uses hour wave scheduling a specific number of patients, usually
blocks broken down into smaller time increments; four, at the beginning of the same hour
individual patients are scheduled within those incre- worksheet a copy of daily patients by list or by medical
ments assisting assignment, used to prepare rooms and
open hours (tidal wave, open booking) scheduling equipment; it must be shredded at the end of the day
method with no appointments needed; first-come, to ensure compliance with the Health Insurance
first-served Portability and Accountability Act (HIPAA)
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA), RMA (AMT), and CMAS (AMT) exams.

1. When setting up the appointment book by Answer: +

crossing off all times that will not be used for
Why: The matrix is the configuration of the
patient visits, this is known as setting up the:
appointment book after all the unavailable times are
A. schedule.
crossed out. These office times exclude vacations, meet-
B. calendar.
ings, lunch hour, and hospital visits.
C. matrix.
D. time frame. Review: Yes ❏ No ❏

2. Which of the following is a guideline that applies Answer: ,

to using the appointment book?
Why: The appointment book is considered a legal docu-
A. Erase any missed appointments from the book
ment and could be subject to subpoena. Always write or
after it has been documented in the patient’s
print clearly and make any corrections neatly. Missed
chart.
appointments or canceled appointments are not erased
B. Discard all used appointment books.
from the book. Draw a single line through the entry and
C. Always allow 1 hour per day for emergency
note the reason why the appointment was canceled or
appointments.
whether it was rescheduled. Used appointment books
D. Write or print clearly and make corrections
are not discarded but retained according to office policy,
neatly.
usually for the same period as patient records are
E. Leave open one morning and one afternoon
retained. Most offices do not keep time available for
each week for any emergencies.
emergency appointments; if an emergency arises, the
office will try to prioritize the patient into the
physician’s schedule. In the event of a life-threatening
emergency or serious injury, the patient may be referred
to the local emergency room.
Review: Yes ❏ No ❏

3. Of the following situations, which one constitutes Answer: +

a higher level of urgency and should be considered
Why: Of the scenarios listed, none of them appears to be
an emergency appointment?
life-threatening except for someone who is experiencing
A. A patient needing an employment physical so
difficulty breathing. Although all of these scenarios may
that he or she can start a new job the next
seem like emergencies, especially to the patient, the only
morning
true emergency would involve a patient who is having
B. An 8-year-old child who sprained an ankle on
difficulty breathing. The other cases can be handled as
the school playground that morning
immediate status.
C. A 55-year-old man with difficulty breathing
D. A patient who ran out of medication and needs Review: Yes ❏ No ❏
her blood pressure checked so she can refill her
medication


 +PIX\MZ ■ Appointment Scheduling 189

4. The process of double booking in appointment Answer: )

scheduling means that:
Why: Double booking schedules two patients at the
A. two or more patients are scheduled at the same
same time and the patients are seen in the order in
time.
which they arrive at the office. This is used in practices
B. one patient is scheduled but two appointment
in which physician visits are short.
times are used.
C. when two physicians are practicing in the same Review: Yes ❏ No ❏
office, there are two appointment books used.
D. at least four patients are scheduled for the same
time at the beginning of the same hour.
E. four patients are scheduled every 2 hours.

5. If the physician is delayed in arriving at the office Answer: +

for appointments, you should:
Why: When the physician is delayed, the you should
A. immediately reschedule the patients.
keep patients informed of the approximate waiting time
B. cancel the remaining appointments for the day.
and offer to reschedule appointments.
C. offer the waiting patients an opportunity to
reschedule. Review: Yes ❏ No ❏
D. offer to refer the patients to another physician’s
practice.

6. When making an appointment over the telephone Answer: -

for a new patient, it is important to secure the
Why: The patient’s date of birth, place of employment,
following information:
home address, and copay information can be obtained at
A. patient’s place of employment.
the time of the appointment. It is important to know the
B. patient’s date of birth.
patient’s insurance company to ensure that the
C. patient’s copay amount.
physician’s office participates with the provider; if not,
D. patient’s home address.
the patient can be informed of the payment procedures.
E. patient’s insurance provider.
Review: Yes ❏ No ❏

7. When a specific number of patients, usually four, Answer: *

is scheduled at the beginning of the same hour, this
Why: In wave scheduling, the patients are seen in the
is known as:
order in which they arrive at the office. This reduces
A. modified wave scheduling.
physician downtime but may increase waiting time for
B. wave scheduling.
patients, who have to wait their turn if more than one
C. cluster scheduling.
patient arrives at the same time.
D. group scheduling.
Review: Yes ❏ No ❏

8. When setting a series of repeat appointments for a Answer: +

patient, it is best to:
Why: Setting the return appointments at the same time
A. have the patient call back no later than the end
and on the same day of the week will help the patient
of the current week to schedule the return
remember the appointments. It is easier to manage a
appointment.
schedule when there is consistency.
B. offer at least three alternative times for the
return appointment. Review: Yes ❏ No ❏
C. set the appointments at the same time on the
same day of the week to enhance patient
compliance.
D. ask the patient to show up at a convenient time
and you will work him or her into the schedule.
E. vary the appointment times each week.
190 =VQ\ ■ Administrative Practice

9. The most critical aspect of the appointment book Answer: ,

is that:
Why: The appointment book is a legal document and
A. the physician’s personal time out of the office
should be treated as any other legal document with
should not be reflected in the appointment
regard to entries and corrections. It is important to build
book.
a matrix for scheduling that includes any time the physi-
B. when using the wave method of scheduling,
cian will not be in the office. Multiple patients are
always schedule one patient each hour
scheduled per hour when using wave scheduling. The
regardless of the nature of the visit.
lunch break is determined by the practice and may actu-
C. allow at least 1 hour for lunch each day.
ally be shorter or longer than 1 hour.
D. the book is treated as a legal document, because
it may be subpoenaed. Review: Yes ❏ No ❏

10. The most common type of scheduling is: Answer: )

A. time-specific scheduling.
Why: Time-specific scheduling is the method of giving
B. wave scheduling.
each patient an appointment time based on the length of
C. clustering.
time needed and what open time is available. Wave and
D. modified wave.
modified wave scheduling are also used frequently but
E. tidal wave.
are not as common as time-specific scheduling. Cluster-
ing is the process of scheduling similar procedures on
specified days or times. Tidal wave scheduling accommo-
dates patients on a first-come, first-served basis.
Review: Yes ❏ No ❏

11. The abbreviation used in scheduling to designate a Answer: ,

patient who has never been seen in the office
Why: NP means new patient. F/U means follow-up,
before is:
which would be used for a patient who is returning for
A. F/U.
an appointment. CPE means complete physical exam.
B. CPE.
NS is used to designate a patient who is a no-show.
C. NS.
D. NP. Review: Yes ❏ No ❏

12. The reason for documenting a failed appointment Answer: *

in a patient’s file is to:
Why: The physician may need to become involved to let
A. allow for scheduling another patient in that
a patient know that repeatedly missing appointments is
time slot.
disruptive to the office scheduling process. Occasionally,
B. note all missed appointments in the event
a patient’s missing too many appointments may become
further action needs to take place.
of legal importance if the patient does not have a good
C. be able to erase the patient from the
medical outcome.
appointment book.
D. allow the office to not schedule further Review: Yes ❏ No ❏
appointments for that patient.
E. notify the patient’s insurance company.

13. The type of scheduling used in a medical practice Answer: )

primarily depends on the:
Why: The physician always determines the type of sched-
A. physician’s preference.
uling used in the office practice. You may be asked for
B. location of the practice.
input on the decision, but ultimately, the physician makes
C. medical assistant’s preference.
the decision on scheduling preference. The location of
D. size of the examination rooms.
the practice or size of the examination rooms has no
impact on the type of scheduling the physician prefers.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Appointment Scheduling 191

14. Which of the following is the least important Answer: -

concern when scheduling special procedures?
Why: When scheduling a patient for a special procedure,
A. The facilities available in the medical office at
it is necessary to know what facilities are available, how
the time of the appointment
much time the procedure will take, and what equipment
B. The amount of time required for the procedure
is required for the procedure. You should also take into
C. The patient preparation for the procedure
account any special patient preparation, especially if the
D. The equipment required for the procedure
procedure requires fasting.
E. The amount of the insurance copay
Review: Yes ❏ No ❏

15. A patient calls and requests an appointment Answer: ,

immediately. What should be the first question
Why: You should always determine whether the call is an
you ask?
actual emergency or not. After this is determined, you
A. The doctor is booked today. Can you come in
can decide how soon the patient needs to be seen.
tomorrow?
B. Is it more convenient for you to come Review: Yes ❏ No ❏
tomorrow morning or afternoon?
C. When was the last time you were seen in this
office?
D. What are your symptoms and how long have
you had them?

16. When setting a return appointment for a patient, Answer: +

it is best to:
Why: The patient should be offered a time and day and
A. have the patient call back from home after the
see if they would be available to come in then. If that
patient checks his or her calendar.
appointment is not acceptable, you can offer an alterna-
B. have preset appointment cards to distribute to
tive. It is too open to ask the patient to decide when to
patients with a set time and day when time is
come in or to have the patient call the day of the desired
available in the appointment book.
appointment. They are not familiar with your
C. offer the patient a specific time and date.
scheduling procedures and may be indecisive.
D. tell the patient you have only one available time
and day that he or she will have to make work Review: Yes ❏ No ❏
with his or her schedule.
E. have the patient call the morning of the day he
or she can come in for the appointment.

17. Scheduling duties include all the following Answer: ,

EXCEPT:
Why: The physician determines the appointment sched-
A. setting up the matrix of the appointment book.
ule for the office. This includes setting the time of the
B. calling patients to remind them of their
first and last appointments of the day and the break
appointments.
times throughout the day.
C. documenting any missed or rescheduled
appointments in the patient’s record. Review: Yes ❏ No ❏
D. determining the time of day the office will
accept appointments.
192 =VQ\ ■ Administrative Practice

18. When calling a hospital to schedule inpatient Answer: )

surgery, the information not necessary to have
Why: Inpatient surgery is scheduled with the hospital’s
before the call is:
operating room scheduler. All the information listed is
A. patient’s insurance copayment.
important except information about insurance or billing
B. time and day requested by the physician.
because this is not a responsibility of the surgery
C. urgency for the procedure.
department.
D. type of sedation or anesthesia required.
E. the physician’s name. Review: Yes ❏ No ❏

19. A tickler file is a(n): Answer: ,

A. appointment card that is filed in the patient’s
Why: A tickler file may be a simple card file box with
chart.
dividers placed in chronologic order by week or by
B. file used to hold laboratory reports if they
month and containing items that will need attention in
cannot be filed right away.
the future.
C. file of patient names that have missed
appointments. Review: Yes ❏ No ❏
D. filing system used as a reminder of things to
do by a certain date or time.

20. A “walk-in” patient is one who: Answer: +

A. is able to ambulate without assistance.
Why: A “walk-in” is a patient who shows up without an
B. has arrived late for an appointment.
appointment but wants to see the physician. Unless it is
C. arrives at the office without an appointment
an emergency, you should ask the patient to be seated in
but wants to be seen.
the waiting room and check with the physician to see
D. has an emergency.
whether the patient can be seen that day. If not, offer to
E. lives within walking distance of the office.
schedule an appointment for the patient.
Review: Yes ❏ No ❏

21. When a patient needs a return appointment to Answer: *

discuss laboratory or x-ray findings with the
Why: The medical office is responsible for finding out
physician, you should:
when the lab results will be returned to the office so the
A. call the lab and tell them to have the lab results
return appointment can be scheduled accordingly. It is
available by the day of the appointment.
not appropriate to order tests by the next day unless the
B. call the lab to find out when the results will be
physician has made that request. The patient should not
available and make the return visit based on
contact the lab.
that date.
C. ask the patient to contact the lab to determine Review: Yes ❏ No ❏
when the results will be available.
D. tell the lab that the results need to be back to
the office by the next morning.

22. What type of scheduling is typical of an urgent Answer: )

care center?
Why: Tidal wave scheduling means that there are no
A. Tidal wave scheduling
appointments set and patients are seen on a first-come,
B. Wave scheduling
first-served basis. Wave scheduling is a type of scheduling
C. Clustering
in which several patients, usually four, are scheduled at the
D. Double booking
beginning of the same clock hour. Grouping and cluster-
E. Group scheduling
ing are the same types of scheduling, in which patients
having similar procedures are scheduled to come in on
specified days or at specific times. Double booking means
that two or more patients are scheduled at the same time.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Appointment Scheduling 193

23. Types of patient appointment reminders used by Answer: ,

offices include the following EXCEPT:
Why: A facsimile, also called a fax, allows the medical
A. postcards.
office to send and receive printed material over a phone
B. appointment cards.
line. These machines are very popular in businesses but
C. telephone calls.
may not be found in homes. The fax machine is not used
D. facsimile.
as a method to send appointment reminders.
Review: Yes ❏ No ❏

24. If the physician requests that the patient return for a Answer: ,
fasting blood glucose and follow-up appointment,
Why: This patient is having a fasting blood test
the best time of day to schedule this appointment
performed, which requires the patient to have eaten
would be:
nothing for several hours before the exam. By
A. the first appointment after the lunch break.
scheduling it as the first morning appointment, the
B. at the end of the day.
patient can come to the office and have the blood drawn
C. the last morning appointment before the lunch
before eating breakfast.
break.
D. the first appointment in the morning. Review: Yes ❏ No ❏
E. any time 1 hour after the patient has eaten.

25. When a group of patients needs immunizations, Answer: *

the best type of scheduling for this is:
Why: Clustering is a type of scheduling used when simi-
A. tidal wave.
lar procedures are scheduled on specified days or at spe-
B. clustering.
cific times. Tidal wave scheduling allows patients to walk
C. modified wave.
in at any time to be seen. This type of scheduling is typi-
D. double booking.
cally used in urgent care facilities. Modified wave sched-
uling is when hour-long blocks are broken down to
smaller time increments (usually 10 or 15 minutes each)
and individual patients are scheduled within those incre-
ments. Double booking means that two or more patients
are scheduled at the same time.
Review: Yes ❏ No ❏

26. When conducting a patient flow analysis, it is Answer: ,

determined that patients wait in the treatment
Why: The role of the medical assistant or medical
room for approximately 15 minutes prior to the
administrative specialist participating in the patient flow
physician presenting. As a result, you would:
analysis is to report the findings. Recommendations may
A. Schedule patients 15 minutes later
also be made, but it is up to the physician or practice
B. Schedule less patients in each hour
manager to make changes and approve what should be
C. Report the findings to the insurance company
sent to the insurance company.
D. Report the findings to the physician
E. Direct the physician to spend less time with Review: Yes ❏ No ❏
each patient

27. When scheduling an outpatient procedure, it is Answer: )

important to know all the following EXCEPT the:
Why: A patient will not be staying in the hospital follow-
A. LOS
ing an outpatient procedure; therefore, the length of
B. Procedure
stay (LOS) is not necessary. All other information is
C. Diagnosis
required.
D. Date
Review: Yes ❏ No ❏
194 =VQ\ ■ Administrative Practice

28. The primary purpose of a patient flow analysis Answer: +

is to:
Why: The primary purpose of a patient flow analysis is
A. Identify patients who are late for appointments
to determine the efficiency of the practice. The other
B. Demonstrate to insurance companies that the
answer choices may result, but these would only be inci-
office does a good job
dental to the primary reason for initially conducting the
C. Determine the efficiency of the practice
analysis.
D. Fire ineffective staff
E. Encourage the physician to see more patients Review: Yes ❏ No ❏

29. When scheduling an inpatient procedure, the Answer: *

reason for scheduling the admission separate from
Why: A time for a surgery, for example, may be
the actual procedure is to:
scheduled in the operating room, but that does not
A. Provide billing information
guarantee that a hospital bed will be available for the
B. Reserve a hospital bed
patient afterward. The Admissions Department is the
C. Assure the patient has meals ordered
only area that takes the reservations for the actual hospi-
D. Notify the insurance company
tal bed. The department where the procedure is done is
only aware of patients for that department, not for all
admissions throughout the facility.
Review: Yes ❏ No ❏

30. Electronic appointment scheduling is: Answer: -

A. Only for practices with multiple sites
Why: Whether appointment scheduling is manual or
B. Less personal than a manual system
electronic, both HIPAA and governmental requirements
C. Difficult to learn
must be met. Electronic scheduling may be used in sin-
D. Unlikely to require a subpoena
gle-site practices as well as multiple-site practices. It is
E. Held to HIPAA standards
not impersonal because it requires a staff member to
conduct the appointment process, and it is generally not
more difficult to learn than a manual system. As
mentioned earlier, the same requirements are enforced
for manual or electronic systems.
Review: Yes ❏ No ❏
 Medical Records
11

: - > 1 - ?  < 1 8 
Conggratulations! Believe it or not,, yo
y u are nearlyy at the halfwayy po
p int of the review chappters. The
road to completion becomes easier from here. Don’t give up your goal to become a nationally cer-
tified health professional. Be sure to complete Chapter 4, “Law and Ethics,” before beginning this
one—some material involving medical records is also covered in that chapter.

The term medical record is used synonymously with ■ Retrieve—recover the medical record from the
patient chart or chart; it contains all information related to secured storage as needed and document when and
a patient’s medical care. The Medical Records chapter is where the record was taken
divided into three sections:
■ Transfer—send the record to another health care
provider when the proper consent for release of
■ Medical records management
medical records is obtained (send copies only, not
■ The individual medical record originals)
■ Documentation guidelines
■ Protect—ensure the medical record is in a secured area
and kept intact and that all computer safeguards are in
5-,1+)4:-+7:,;5)6)/-5-6< place for the electronic health record.

The medical assistant and medical administrative special- ■ Audit—examine medical record files to ensure accu-
ist are usually responsible for management of the office’s racy, completeness, and sequence of the documents;
medical records. This responsibility involves several may be an internal file audit performed by the office
functions: staff or an external file audit performed by professional
auditors of an organization or agency who are not
■ Assemble—place all the forms used by the specific employees of the practice
practice in the patient record in the prescribed order
■ Retain—keep the medical record in a secured area
■ File—place active medical records in the secured stor- for the prescribed length of time (this is state-
age area in the order prescribed by the filing system specific); the term conditioning is sometimes used
used by that facility to describe preparation of the chart for retention:
■ Maintain—ensure all documentation is in the medical secure all loose documents, and examine the
record in the proper order and that the record is in a record for completeness and correct filing order of
secured area documents

!
196 =VQ\ ■ Administrative Practice

■ Purge—remove medical records that are beyond the • Labels—alphabetic or numeric color or other cod-
time period of the statute of limitations ing containing section names, such as progress notes
or alerts
■ Destroy—shred or otherwise destroy the medical
record, ensuring no identifying factors are recogniza- • Outguides—folders inserted on the file shelf when a
ble, when the prescribed statute of limitations is medical record file is in use; designates who took it,
reached; maintain a file indicating when the record was when, and where (may be computerized instead of
destroyed hard-copy folder)
• Long-term hard-copy storage (inactive and closed)
In addition to the functions associated with medical ❍ Boxed; maintained onsite
records, you must know information about the organiza- ❍ Boxed; maintained offsite
tion and handling of medical records.
■ Filing systems
■ Types of files • Alphabetic—charts filed by the units of the patient’s
name: letter by letter beginning with the patient’s
• Active—patient seen within 2 to 5 years (dependent
on practice type) last name (Table 11-1)
❍ Unit 1—last name, letter by letter
• Inactive—patient not seen within past 2 to 5 years
(dependent on practice type) ❍ Unit 2—first name, letter by letter

• Closed—patient not expected to return to practice, ❍ Unit 3—middle initial or middle name, letter by
such as if the patient is deceased, has moved, or has letter
reached age limit in pediatrics ❍ Unit 4—prefixes and suffixes (e.g., Dr., Mrs., Jr.,

■ File equipment and storage Sr., I, II, III): numbers appear first (e.g., I, II, III);
Jr. follows numbers and comes before Sr.
• Shelving units (active files)
❍ Open or closed shelving units • Numeric—each patient is assigned a medical record
number through manual or computerized means;
❍ Vertical or lateral units through a manual or computerized system, numbers
❍ Stationary or moveable units are cross-referenced with the alphabetic file, some-
❍ Locked units or units locked in self-contained times referred to as a master file
area ❍ Consecutive numeric order—patients are assigned
numbers in the order of their first visit to the prac-
• Electronic health records, or EHR (active, inactive,
and closed files)—complex Health Insurance tice; charts are filed in this order; used by small
Portability and Accountability Act (HIPAA) security practices
issues; firewalls should be in place if located on a ❍ Terminal digit order—patients are assigned a six-
network or electronically transferred digit number; to file the charts, the numbers are
❍ Combination electronic and hard-copy records divided into three groups of two digits each and
read from right to left
❍ Total electronic records

❍ Floppy disk, CD-ROM

• Color coding—system filed in coordination with
numbers or alphabet
❍ Microfiche (for closed or inactive records)
❍ Each letter or group of letters in the alphabet is
❍ Scanned file designated a specific color, which makes the letters
• CMS (Centers for Medicare and Medicaid easier to locate
Services) has established a goal that by the ❍ Each group of numbers in terminal digit filing is
year 2014, health care providers will have designated a color
converted all paper, hard-copy records to elec-
❍ In group practices, patients of the individual physi-
tronic health records. This is based on published
cians may be designated a color in addition to the
information available at the time this text was
alphabetic or numeric system
printed.
• Alphanumeric—system using a combination of
■ Medical record hard-copy supplies numbers and letters
• File folders—top or side identification areas with ❍ Initial filing done alphabetically by first letter
method to secure loose file forms of last name or subject; then numbers are
• Guides—dividers assigned
 +PIX\MZ ■ Medical Records 197

Table 11-1 )TXPIJM\QK.QTQVOJa=VQ\[

Unit 1 Unit 2 Unit 3 Unit 4

Example of Patient Name (Last Name) (First Name) (Middle Name) (Title)
Using units John E. Smith Smith John E.
John William Jones Jones John William
Two-word last names Susan B. Saint Nicolas Saintnicolas Susan B.
Period in last name Harry F. St. James Saintjames Harry F.
(ignore period
and spell
out name)
Hyphens or apostrophes Jose Garcia-Lopez Garcialopez Jose Peter
(considered a single unit) Jesse Peter O’Hara Ohara Jesse
Using titles Dr. Jose Garcia-Lopez Garcialopez Jose Dr.
Mary T. El (Mrs. John) El Mary T. Mrs. John
Jr. and Sr. Joseph C. Tan, Jr. Tan Joseph C. Jr.
(Jr. filed before Sr.) Joseph C. Tan, Sr. Tan Joseph C. Sr.
Birth order (filed in Tomas Jacob Love, I Love Tomas Jacob I
chronologic order) Tomas Jacob Love, II Love Tomas Jacob II
Tomas Jacob Love, III Love Tomas Jacob III
Jr., Sr., and numbers Roberto De Rosa, III Derosa Roberto III
(numbers first in Roberto De Rosa, IV Derosa Roberto IV
chronologic order, Roberto De Rosa, Jr. Derosa Roberto Jr.
Jr. next, Sr. last) Roberto De Rosa, Sr. Derosa Roberto Sr.
Businesses A-One Medical Supply Aone Medical Supply
and associations The McMay Insurance Mcmay Insurance Group The
Group

❍ Seldom used for medical records; more frequently <0-16,1>1,=)45-,1+)4:-+7:,

used for other office files
■ Medical records retention (hard copy or electronic)—
The individual medical record is all the information
the length of time a medical record should be retained related to a patient’s medical care. This information may
be in the form of paper (e.g., progress notes or letters),
• Guidelines from federal/state statute of limitations; medical imaging (such as x-rays, ultrasounds), tapes (e.g.,
retention for adults is usually 7 to 10 years audio, visual), disks, electronic printouts (e.g., electro-
• Retention for minors is the age of majority plus the cardiogram tracings, fetal monitoring strips), photo-
statute of limitations (7 to 10 years) graphs, and any other materials that tell the “story” of
• Guidelines may also be issued by insurance compa- the patient’s medical journey. The medical record mate-
nies and accrediting and legal organizations rial is the property of the health care provider. The
information in the medical record is the property of the
• Functional storage and retrieval systems required patient.
■ Medical records destruction
• After completion of statute of limitations and rec-
ommended guidelines ■ Uses

• Total eradication (shredding, burning, deleting); safe • Facilitates good medical care through continuity
shredding and disposal of documents may be done • Provides legal protection for the health care
by an outside company specializing in those services provider and the patient
• saved notation of destruction and date • Functions as a quality of care monitor
198 =VQ\ ■ Administrative Practice

*W` • Patient noncompliance with his or her care plan

-`IUXTMWN5MLQKIT:MKWZL[.WZU • Questionable medical records
WZ;KZMMV;MY]MVKQVO ❍ Delayed filing of tests or notes
❍ Incomplete information
Medical Record Sequence of Forms ❍ Illegible entries
1. Patient information/insurance ❍ Improperly corrected entries
2. Consent for assignment of benefits
❍ Missing information
3. Problem list
4. Medical, social, and family histories ❍ Lost record

5. Progress notes
6. Immunization record
7. Medication/prescription ,7+=5-6<)<176/=1,-416-;
8. Diagnostic reports Documentation, also referred to as charting, makes up
9. Consultation/referral reports the medical record. A caveat, referred to as the “golden
10. Medical records rule,” is: If it is not documented, it was not done.
11. Correspondence, telephone notes
12. Termination summary ■ “Cs” of charting (a list of terms beginning with the
letter “C” to help with proper documentation)
• Client’s words (use quotation marks or “patient
• Facilitates research states . . .”)
• Provides resource for education • Clear
■ Determination of record organization and sequence • Complete
(Box 11-1)
• Concise
• Type of practice • Chronologic or reverse chronologic order
• Physician preference • Confidential
• Frequency of access ■ Documentation inclusions
■ Potentials for legal and ethical dilemmas
• Name of the patient, additional identifier (e.g., med-
• Confidentiality breach (see “Confidentiality” in ical record number), and date on each page, front and
Chapter 4) back
• Improper release of information (Box 11-2) • Dated entry for each visit and procedure
• Withdrawal from care; discharge of patient • Health care provider signature or initials and title
• Broken appointments for all entries
• Dated entry for no-shows, cancellations, or phone
calls
*W` • Dated entry for failure to follow treatment plan
:MTMI[MWN5MLQKIT:MKWZL[ • Dated entry for prescription refills
• Notations or copies of forms for outpatient and hos-
A release of medical records to insurance compa- pital visits
nies, other recognized reimbursement agencies,
• Dated entry with explanation for termination of care
and health care providers within the same health
care network is generally included in a general con- • Documentation of reported results and follow-up
for all tests and procedures
sent form and is obtained at the first office visit.
Release of medical records to other health care • Acceptable error correction method (Box 11-3)
providers, attorneys, or others requires a Release of ■ Charting methods
Medical Information form signed by the patient or
• Source-oriented medical record (SOMR)—this file
the patient’s legal representative, such as a court- is divided into sections by guides, such as a section
appointed guardian. for progress notes or diagnostic reports; may be used
Lawful mandatory reporting situations or sub- in conjunction with other charting methods
poenas do not require consent forms (refer to
Chapter 4). • Problem-oriented medical record (POMR)—the
patient’s problems are numbered and listed on a
 +PIX\MZ ■ Medical Records 199

*W` TERMS
8IXMZ:MKWZL-ZZWZ+WZZMK\QWV Medical Records Review
The following list reviews the terms discussed in this
Draw a single line through the error with black ink
chapter and other important terms that you may see on
and write “error” or “err.” above. Never white out
the exam.
or completely eliminate the error. Correct the
active medical record the chart of a patient seen with-
error above the entry if it involves only a few words
in 2 to 5 years (dependent on practice type)
or below the entry if the error is longer. Record the
audit examine medical record files to ensure accuracy,
date and time and sign or initial the entry with your
completeness, and sequence of the documents
health care provider title.
chart the patient’s medical record
closed medical record the chart of a patient not
Example:
expected to return to the practice, such as a patient
09/10/20XX 0900 urine specimen collected. Mary who is deceased or has moved
Smith, MA conditioning preparation of the chart for retention:
sputum/M.S., MA secure all loose documents, and examine the chart
for completion and correct filing order of documents
electronic health record (EHR) patient health infor-
mation maintained in an electronic format, comput-
erized record
form (problem list) that is placed in the front of the Health Insurance Portability and Accountability
chart; each visit or treatment is associated with a Act (HIPAA) originally enacted in 1996, contains
problem number (for example, if asthma is the pri- requirements for patient confidentiality
mary problem it, is listed as #1 and documented as inactive medical record the chart of a patient not
#1 throughout the chart); may be used in conjunc- seen at the specific medical office within the past 2
tion with other charting methods. In addition to to 5 years (dependent on practice type)
the problem list, POMR usually contains the fol- medical record all patient information related to the
lowing: medical care; may be in the form of paper, medical
❍ Database—patient profile and demographics; imaging, tapes, disks, electronic printouts, photo-
baseline and assessment information including graphs, and any other material telling the “story” of
chief complaint (cc) and test results the patient’s medical history
❍ Treatment plan—course of procedures, medica- medical records management processes of assembling,
tions, and other instructions for the patient’s care filing, maintaining, retrieving, transferring, protect-
ing, retaining, and destroying medical records
❍ Progress notes—continuing narrative of the
outguides folders inserted on file shelf when file is in
patient’s improvement or lack of improvement
use; they designate who took it, when, and where it is
• SOAP documentation—format for documenting (may be computerized instead of hard-copy folder)
each visit using subjective information, objective problem-oriented medical record (POMR) the
information, an assessment, and a plan, in that order; patient’s problems are numbered and listed on a
may be used in conjunction with other charting form (problem list) placed in front of chart; each
methods visit or treatment is associated with the number of
❍ S  subjective data (symptoms the patient states the corresponding problem (e.g., if asthma is #1, it is
that cannot be seen, heard, or measured, such as a documented as #1 throughout chart)
headache) reverse chronologic order format with the most recent
❍ O  objective data (measurable and observable documentation filed on top of the past documentation
signs, such as swelling) SOAP documentation format for documenting each
medical visit using subjective information, objective
❍ A  assessment (exam and impressions)
information, an assessment, and a plan, in that order
❍ P  plan (design for tests, treatments, education, source-oriented medical record (SOMR) the patient
follow-up) file is divided into sections by guides, such as a sec-
• Reverse chronologic order—format with the most tion for progress notes or diagnostic reports
recent records filed on top: visits in 2010 would be terminal digit order a system of filing medical records
closer to the front of the chart than visits in 2009; that assigns each patient a six-digit number; to file
may be used in conjunction with other charting the charts, the numbers are divided into three groups
methods of two digits each and read from right to left
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA), RMA (AMT), and CMAS (AMT) exams.

1. When adding medical records to a patient’s Answer: +

chart, you should:
Why: Whenever a new document or record is generated
A. file all materials in the front of the chart
for a patient’s medical record, the physician must review
regardless of the type of record it is.
the record before it is filed in the chart for storage. If
B. photocopy all records and retain in a separate
there is abnormal medical information, the physician
file.
will want to act on the information to ensure proper
C. ensure that the physician has initialed all
medical care for the patient.
reports before they are inserted into the chart.
D. sign all documents with the medical assistant Review: Yes ❏ No ❏
title and file in the patient’s chart.

2. The most common method of documentation for a Answer: +

patient medical record is:
Why: The abbreviation SOAP stands for subjective,
A. POMR.
objective, assessment, plan. This is the most common
B. SOMR.
method of documenting used by physicians. POMR
C. SOAP.
(problem-oriented medical records) and SOMR (source-
D. SOB.
oriented medical records) are methods used in organiz-
E. DOB.
ing the patient’s chart either by the patient’s problem
categories or by sources of information, respectively.
SOB stands for shortness of breath and is associated
with a condition a patient has, not a documentation
method. DOB stands for date of birth, which is a chart-
ing abbreviation.
Review: Yes ❏ No ❏

3. When filing numerically using the terminal digit Answer: *

filing method, what is the proper sequence for
Why: Terminal digit filing divides the medical record
filing these four numbers: 381249, 831140,
numbers into three units of two—for instance, the num-
105449, 943550?
ber 381249 is divided into 38 12 49. The last units of the
A. 381249, 831140, 943650, 105449
above numbers are 49, 40, 49, and 50, which are filed in
B. 831140, 381249, 105449, 943650
the order 40, 49, 50. Because there are two numbers
C. 943650, 381249, 105449, 831140
ending in 49, the next unit determines the order of the
D. 105449, 381249, 831140, 943650
numbers. Because 12 comes before 54, 381249 comes
before 105449.
Review: Yes ❏ No ❏


 +PIX\MZ ■ Medical Records 201

4. Which of the following is a true statement Answer: -

regarding guidelines for alphabetic filing?
Why: Alphabetic filing guidelines dictate that Junior is
A. When two male family members have the
filed before Senior. These guidelines also state that the
suffixes Junior and Senior, Senior is filed
name Saint James becomes one word and is filed in the S
before Junior.
section under Saint. The John Smith names are the
B. The chart for a patient with the last name of
same except for the middle name; Will is filed before
Saint James would be filed in the J (James)
William. A name starting with Mc is filed in alphabetic
section of the files.
order, after Mac.
C. The name McMurray is filed before MacIntosh.
D. John William Smith is filed before John Review: Yes ❏ No ❏
Will Smith.
E. When a last name has a hyphen, it is filed as if
the hyphen were not there.

5. When a paper medical record is in use, a folder Answer: ,

inserted on the shelf in place of the medical record
Why: A closed or inactive file indicates the status of the
file is a(n):
file, and a file label is affixed to a file to indicate its
A. closed file.
name. An outguide is a folder inserted on a file shelf to
B. inactive file.
replace a medical record file that is in use. The outguide
C. file label.
folder designates who took the medical file, when it was
D. outguide.
removed, and where it is.
Review: Yes ❏ No ❏

6. One of the “Cs” of charting includes: Answer: )

A. clear.
Why: The six “Cs” of charting include client’s words,
B. closed.
clear, complete, concise, chronologic, and confidential-
C. computerized.
ity. These are essential guidelines of documentation.
D. complex.
E. conditional. Review: Yes ❏ No ❏

7. The “P” in the SOAP method of charting includes: Answer: ,

A. measurable signs.
Why: The “P” stands for the plan and includes the plan
B. physician’s exam.
for the patient’s tests, treatment, and follow-up. Measur-
C. symptoms the patient states.
able signs are objective (“O”), the physician’s exam is
D. plan for tests and treatments.
assessment (“A”), and symptoms the patient states are
subjective data (“S”).
Review: Yes ❏ No ❏
202 =VQ\ ■ Administrative Practice

8. If filing using reverse chronologic order, which of Answer: *

the following is in the correct sequence?
Why: Reverse chronologic order means that the most
A. Laboratory test results from June 2007 would
recent records are filed in front of or on top of the past
be in front of those from December 2010.
record. The only example of this is item B. All the other
B. Office visit entries from June 2010 would be in
examples would place the older reports or events first.
front of visits from December 2008.
C. X-ray exam reports from November 15, 2009, Review: Yes ❏ No ❏
would be in front of those from December 30
of the same year.
D. A surgical report from an operation in 2001
would be in front of a report of a procedure
performed in 2009.
E. A physician’s referral report from May 15,
2009, would be in front of a report from the
same physician dated May 30, 2009.

9. The proper procedure to correct an error in a Answer: )

patient’s chart is to:
Why: A correction should always be dated and signed by
A. date and sign the correction.
the person making the correction. Corrections should
B. white out the error before writing in the
not be covered with white out or lined out with red ink.
correction.
If it is only a word or two to correct, the correction is
C. draw a single line through the error with red ink.
written above the error after the error is crossed out
D. always start a new line in the chart for
with a single line in black ink.
corrections.
Review: Yes ❏ No ❏

10. A system of filing made of combinations of Answer: -

numbers and letters is:
Why: Alphanumeric filing uses letters (“alpha”) and
A. direct filing.
numbers (“numeric”) for filing.
B. numeric filing.
C. subject filing. Review: Yes ❏ No ❏
D. demographic filing.
E. alphanumeric filing.

11. Of the following patient names, which would come Answer: *

first in alphabetic filing?
Why: Alphabetic filing requires that each letter be con-
A. Fisher, Bill
sidered as a unit. All these names start with the same
B. Fischer, William
first three letters, F I S. The next letter determines
C. Fishar, Bob
which name comes first in filing. C comes before H H, so
D. Fishare, Bill
the name Fischer is first in filing.
Review: Yes ❏ No ❏

12. The “golden rule” in documentation is the Answer: +

following. Why: All of the answers are part of proper
A. Always sign your complete name and title. documentation, but the “golden rule” of documentation
B. Always document in ink. is: If it is not documented, it was not done.
C. If it is not documented, it was not done.
D. Always date and time all entries. Review: Yes ❏ No ❏
E. The physician must initial all chart entries.
 +PIX\MZ ■ Medical Records 203

13. Determining the organization of the medical Answer: *

record and sequence of filing is dependent on the
Why: The location of the medical practice has no bear-
following factors EXCEPT:
ing on how medical records will be organized or filed.
A. type of practice.
The other factors listed will determine the best way to
B. location of practice.
manage the patients’ medical records.
C. physician preference.
D. frequency of access. Review: Yes ❏ No ❏

14. The database component of problem-oriented Answer: ,

medical records (POMR) includes what
Why: POMR has four components, including database,
information?
problem list, treatment plan, and progress notes. The
A. Patient’s past medical problems
problem list includes past medical problems, but the
B. Treatment plan for the patient
database includes chief complaint, present illness,
C. Progress notes
patient profile, review of systems, physical examination,
D. Patient’s present illness
and laboratory reports.
E. Laboratory findings from 5 years ago
Review: Yes ❏ No ❏

15. The term used to describe the legal length of time Answer: )
regarding storage of medical and business records is:
Why: The statute of limitations may vary from state to
A. statute of limitations.
state. It is the legal time limit you must retain medical
B. release of medical records.
and business records before they can be destroyed. Most
C. microfiche.
states require a minimum of 7 years from the date of the
D. closed records.
last entry. Many practices store records permanently
because of the possibility of a malpractice suit.
Review: Yes ❏ No ❏

16. The method of filing used when documentation is Answer: +

placed in order based on the date of occurrence is:
Why: The word chronologic means “arranged in the order
A. demographic grouping.
of occurrence.” Most charting requires the most recent
B. statistical numbering.
reports or records to be placed in front of or on top of
C. chronologic order.
older information.
D. consecutive numeric order.
E. alphabetic filing. Review: Yes ❏ No ❏

17. An important rule for releasing medical records is: Answer: ,

A. Release the original medical record when the
Why: A practice never releases the original medical
patient asks for it.
record, only a copy. It is required that the patient sign a
B. There is no need to obtain the patient’s
form to release medical records. A verbal consent is not
signature on an Authorization for Release of
official authorization. Information, no matter how lim-
Medical Record form as long as the patient has
ited, is never given over the telephone to anyone but the
given verbal authorization.
patient.
C. Limit the amount of medical information you
release over the telephone when you are not Review: Yes ❏ No ❏
talking directly to the patient.
D. Release a copy of the medical record, not the
original.
204 =VQ\ ■ Administrative Practice

18. If a patient is not expected to return to the practice Answer: +

because he or she has moved away, the patient’s
Why: An inactive file would be for a patient who has not
record would be classified as:
been seen within the past 2 to 5 years. An active file is
A. inactive.
used for a patient who has been seen within the past 2 to
B. active.
5 years. The number of years is established by each
C. closed.
practice, with 2 to 5 being the most common range. A
D. transferred.
closed file is used for a patient who will not be expected
E. released.
back to the practice. This would include deceased
patients and patients who have moved away. A
transferred file has been sent to another practice; it is
released when the file has been approved for transfer to
another health care provider.
Review: Yes ❏ No ❏

19. The pages of the medical record contained within Answer: *

the patient’s file are the property of the:
Why: The health care provider, the physician, owns the
A. patient.
medical record. The patient can request the information
B. physician.
contained within the record, but the actual record
C. insurance carrier.
belongs to the physician.
D. spouse or guardian.
Review: Yes ❏ No ❏

20. Indexing rules for alphabetic filing include the Answer: -

following EXCEPT:
Why: A hyphenated name is treated as one unit (i.e.,
A. File records according to last name, first name,
Jane Fisher-Smith is filed as Fisher-Smith, Jane, not as
and middle initial.
Smith, Jane Fisher).
B. File abbreviated names as if they were spelled
out. Review: Yes ❏ No ❏
C. Disregard apostrophes.
D. Junior is filed before Senior.
E. Treat hyphenated names as two units.

21. A backup file to a computer medical record is Answer: +

called the:
Why: A disk of a computer record, can be used as a
A. file folder.
backup to the electronic system. A file folder is the
B. outguide.
holder of the medical records. An outguide is used to
C. disk.
temporarily replace a medical file while it is in use. An
D. electronic copy.
electronic copy refers to the computerized version of the
record.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Medical Records 205

22. The process of gathering all chart items together Answer: )

and preparing them for filing by removing loose
Why: Conditioning is the process of making sure the
pieces of tape or paper clips and replacing them
chart records are presentable for filing. It is inappropri-
with staples is known as:
ate to file records that have paper clips, because they
A. conditioning.
become too bulky and take up file space. Sorting the
B. sorting.
files into groups makes it easier to file records. They can
C. destroying.
be sorted alphabetically or numerically first and then
D. indexing.
placed in the appropriate space on the file shelf.
E. retrieving.
Destroying is the process of shredding the medical
record to permanently remove it from storage. Indexing
is the process of separating business records from the
patient’s medical records. Retrieving is the process of
recovering the medical record from the secured storage
location.
Review: Yes ❏ No ❏

23. The federal government policy that sets standards Answer: +

for electronic transmission of medical information
Why: HIPAA, the Health Insurance Portability and
is included in the act adopted in 1996 called:
Accountability Act, was passed by the federal
A. OSHA.
government and mandates that health care providers
B. CLIA.
adopt policies in their medical practice that regulate the
C. HIPAA.
electronic transmission of patients’ medical information.
D. CDC.
In addition, the act sets standards on the disclosure and
release of medical records. OSHA stands for
Occupational Safety and Health Administration. CLIA
stands for Clinical Laboratory Improvement
Amendments. CDC stands for the Centers for Disease
Control and Prevention.
Review: Yes ❏ No ❏

24. To avoid legal and ethical issues, patients’ medical Answer: ,

records should be properly maintained, which
Why: The patient’s medical record should always docu-
includes all of the following EXCEPT:
ment missed appointments and noncompliance with the
A. entry of any broken or missed appointments.
physician’s treatment plan, in case of a malpractice suit
B. letter sent to patient to notify of withdrawal of
brought against the physician for questionable patient
care.
care. When a physician notifies a patient of withdrawal
C. notation of patient’s noncompliance with
of care, a copy of the letter sent to the patient is
the treatment plan.
included in the medical record. The medical assistant or
D. delay in filing test results.
medical administrative specialist should always ensure
E. initialing of all corrections made in a
timely filing of reports and lab results. There is a chance
medical chart.
these records will be lost if not filed promptly. When
making corrections to a chart, draw a single line through
the error, write the correct information above the error,
and initial the entry.
Review: Yes ❏ No ❏
206 =VQ\ ■ Administrative Practice

25. When using the SOAP method of charting, which Answer: +

of the following belongs to the O section?
Why: The “O” stands for “objective data.” Objective
A. Patient’s complaint of headache
data include things that are measurable and observable.
B. Order for an electrocardiogram
A patient’s blood pressure is a measurable, objective
C. Blood pressure reading
sign. The patient’s complaint of headache is subjective
D. Physician’s request to have patient return for
data—something that cannot be seen or observed. The
follow-up appointment
physician’s request for an electrocardiogram and follow-
up appointment are all part of the plan for the patient.
Review: Yes ❏ No ❏

26. SOMR refers to: Answer: -

A. subjective objective medical record.
Why: The SOMR, source-oriented medical record, is a
B. safe objective medical radiology.
type of filing within the medical record that sorts the
C. State Office of Medical Records.
information by sections such as progress notes, diagnos-
D. Secure Office for Medical Records.
tic reports, and correspondence.
E. source-oriented medical record.
Review: Yes ❏ No ❏

27. When a medical record or patient file is audited, it is: Answer: *

A. purged.
Why: When a file is examined for completeness, for
B. examined.
accuracy, and to ensure the documents are in the proper
C. destroyed.
order, it is being audited. Purging, destroying, and
D. shredded
shredding are methods of cleaning out old files and
appropriately discarding medical records that no longer
need to be retained or maintained.
Review: Yes ❏ No ❏
 Correspondence
12

: - > 1 - ?  < 1 8 
Become familiar with the various corresppondence formats and materials discussed in this
chapter. Look for examples in your workplace, among your own business mail, or in other
available sources.

Written communication in the medical office takes many address (if appropriate), usually at the top of the page;
forms. E-mail, patient instructions, faxes, and various white, gray, or buff paper is most common
computer applications have been discussed in previous ■ Following pages—plain quality bond stationery that
chapters. This chapter concentrates on written corre- matches the letterhead
spondence involving mail and transcription. The topics
are generally prescriptive, which means they follow a ■ Envelopes—no. 10 is the size most commonly used
custom or rule. because it fits 81/2''  11'' paper folded in thirds;
The majority of letters generated in the medical should be made of quality bond paper that matches the
office follow a template, or form, which is recom- letterhead used for letters; lower-quality envelopes
mended by the physician’s attorney, insurance carrier, with clear windows may be used for patient statements
or professional organization. The purpose is to pro- that are folded to exhibit patient’s address through the
tect the doctor from medicolegal risk. The few window
original letters are usually those dictated by the physi- ■ Resources—medical offices have various books and
cian and sent to other physicians regarding patient other sources, including the Internet, to ensure that
findings or treatment. The medical assistant or med- the grammar, spelling, and format for correspondence
ical administrative specialist must know the correct are correct. Some helpful resources are:
format, materials, and process for outgoing and
incoming mail. • Desk dictionary
• Medical dictionary/encyclopedia (the exams usually
have questions on misspelled words; see Box 12-1)
• Writing style books
5)<-:1)4; • Physicians’ Desk Reference (PDR)
■ Letterhead—quality bond stationery used for the first • Other medical reference books
page of correspondence; contains the name of physi- • Date stamp—used to imprint date received on all
cian or group, address, telephone number, and e-mail incoming mail


208 =VQ\ ■ Administrative Practice

*W` • Complimentary closing—two lines below the last sen-

tence of the letter body; if the closing contains more
.ZMY]MV\Ta5Q[[XMTTML?WZL[ than one word, only the first word is capitalized

abscess ischium • Keyed signature—usually four lines below the com-

plimentary closing; use titles before or after name,
aneurysm larynx
not both (e.g., Dr. James Jones or James Jones,
arrhythmia ophthalmology
M.D., not Dr. James Jones, M.D.)
cirrhosis pharynx
curettage pneumonia • Reference initials—two lines below keyed signature;
hemorrhage rheumatic the initials of the individual signing the letter in
hemorrhoids roentgenology uppercase letters followed by a colon and the initials
humerus sphygmomanometer of the individual processing the letter in lowercase
ileum Staphylococcus letters
ilium tonsillitis • Enclosures—two lines below the reference initials;
ischemia indicates that other items are included with the let-
ter; may simply state “enclosures,” or it may be
followed by a colon and the titles of the enclosed
document(s)
4-<<-:; • Copies—“cc:” or “Cc:” (computer software often
■ Styles automatically capitalizes the first “C”) literally
means carbon copy, but is still used to indicate that a
• Full block—all lines begin at left margin; this is the copy of the document is being sent to the person
most common style
whose name follows the “cc:”; this notation is listed
• Modified block—subject and complimentary closing one or two lines below the reference initials; when
and signature begin at the middle of the paper; other more than one person is copied, the names are listed
lines begin at left margin in alphabetic order
• Semiblock (indented modified block)—subject and • Envelope addresses
complimentary closing and signature begin in the
❍ Start address 14 lines down from top of envelope
center, and the first line of each paragraph is
and 4 inches from left edge when using a no. 10
indented five spaces; all other lines begin at the left
envelope
margin
❍ Do not use punctuation except when using
• Simplified—the greeting and complimentary closing expanded zip codes
are omitted; all lines begin at the left margin
❍ Use all uppercase letters
■ Components
• Margins—the blank space or border around the
text on a business letter; the standard margin is
1 inch 5)14
• Date—keyed 15 lines from top of page or 2 to 4 lines ■ Classifications—different types of mailings require dif-
below letterhead; key in full date: January 1, 2010, ferent postage and handling costs. Generally, the speed-
not 01/01/2010 ier the delivery is, the more expensive the postage. The
• Inside addresses—the sender’s address is located on following classifications are in order according to the
the letterhead; the recipient’s address referred to as cost (most expensive to least expensive) and the speed of
the inside address, is keyed at the left margin; abbre- delivery
viations in addresses should not be used except for ®
• Express Mail —delivery guaranteed the following day
the state TM
• Registered Mail —first-class mail insured for a
• Salutation (greeting)—keyed at the left margin, two named value
lines below the recipient’s address, followed by a TMM
colon • Certified Mail —first-class mail with a verification
from the postal service that it arrived at the designat-
• Subject (optional)—topic of letter, keyed two lines ed address; the sender, for an additional fee, may
below salutation, usually at the left margin; some- request a signature for the correspondence indicating
times begins with “RE:” (“regarding”) who received it; the sender has the option to use the
• Letter body—begins two lines below the salutation United States Postal Service’s (USPS) “NetPost”
or the subject line; the position of the paragraph Internet service or to take the correspondence to the
beginning depends on the style of the letter post office
 +PIX\MZ ■ Correspondence 209
®
• First-Class Mail —postage generally used for office • Subject—the topic of the memo; two lines below
correspondence, including patient statements; “From” line
weight must be 13 ounces or less • Message—begins three lines below “Subject” line
®
• Priority Mail —first-class mail handling for items ■ Distribution
70 pounds or less; usually takes 2 to 3 days to arrive
• Hard copy sent to individual staff members
• Standard MailTM (bulk)—postage used for maga-
zines, periodicals, newspapers, catalogs, and flyers; • Hard copy posted in office
requires a minimum of 200 pieces; formerly called • Electronic mail
second- and third-class mail
■ Mail payment methods
• Stamps TRANSCRIPTION
• Postage meter—purchased or leased printing Transcription is the conversion of the dictated word of
machines or services that print postage directly onto the health care provider to a word-processed form. Let-
mail pieces or labels; postage-metered envelopes do ters and patients’ medical histories and treatments are
not need to be canceled and therefore save time; meter the most common transcribed documents in the medical
date is automatically or manually changed daily; office. Transcribed documents involving the patient
postage meter services may be purchased online become part of the patient’s medical record. The rules of
■ Incoming mail procedure confidentiality apply, including when these documents
may be mailed to other entities.
• Stamp items with date received The transcriber should always check with the health
• Staple or paperclip original envelope to incoming care provider if in doubt about any portion of the docu-
mail piece ment; never guess. The format used is based on the type
• Stamp payment checks with endorsement of document and the facility preference. Accurate tran-
• Ensure all envelopes are empty before disposing of scription requires the following:
them
■ Equipment
• Sort according to type
• Check clinical mail for urgency • Transcriber with digital counter, foot pedal, and ear-
phones
• Distribute mail to appropriate staff
• Word processing tools
• Carry out any assigned functions related to the mail, ■ Resources
such as posting payments
• Medical dictionary/spell checker
• Drug reference book/software
7<0-:+7::-;876,-6+- • Diagnostic and procedural code sources
Two other types of correspondence important to medical • Grammar book/checker
offices are memorandums and transcription. Questions A significant amount of transcription is being replaced
on these topics may be on the national exam. by the electronic medical record.

MEMORANDUMS TERMS
Interoffice correspondence is usually in the form of a Correspondence Review
memorandum (plural is memorandums or memoranda), or
memo. The following list reviews the terms discussed in this
chapter and other important terms that you may see on
■ Components the exam.
Certified Mail first-class mail with a verification from
• Date—the day the memo is written; placed 13 lines the postal service that the mail arrived at the desig-
from top of the page, with a 1-inch side margin; left
nated address; the sender, for an additional fee, may
justified
request a receiver sign for the correspondence; the
• To—the parties to whom the memo is directed; two sender has the option to use the United States Postal
lines below “Date” line Office website or to take the correspondence to the
• From—the name of the party sending the memo; post office
two lines below “To” line Express Mail next-day delivery service
210 =VQ\ ■ Administrative Practice

full block style of letter writing with all lines beginning Priority Mail faster delivery than first-class mail; usual-
at left margin; most common letter style ly takes 2 to 3 days
letterhead quality bond stationery used for the first page Registered Mail first-class mail insured for a named
of correspondence; contains, usually at the top of the value
page, the name of the physician or group, address, semiblock (indented modified block) style of letter
telephone number, and e-mail address (if appropriate); writing with the subject, complimentary closing, and
white, gray, or buff paper is most common signature beginning at the center; the first line of
memorandum (plural memorandums or memoranda) a each paragraph is indented five spaces; all other lines
memo; interoffice correspondence consisting of date, begin at left margin
to, from, subject, and a message; may be hard copy or simplified style of letter writing with the greeting and
e-mail complimentary closing omitted; all lines begin at left
modified block style of letter writing in which the sub- margin
ject, complimentary closing, and signature begin in Standard Mail (bulk) postage used for magazines,
the middle of the paper; all other lines begin at left periodicals, newspapers, catalogs, and flyers; requires
margin a minimum of 200 pieces; formerly called second-
postage meter purchased or leased printing machines and third-class mail
or services that print postage directly onto mail transcription the conversion of the dictated word of
pieces or labels the health care provider into a word-processed form
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA), RMA (AMT), and CMAS (AMT) exams.

1. The most formal and professional style of letter Answer: +

format is:
Why: The full block letter is written so that all the left
A. memorandum.
margins are indented at 1 inch. This style has the most
B. semiblock.
professional look.
C. full block.
D. indented block. Review: Yes ❏ No ❏

2. The standard business envelope is a: Answer: +

A. no. 7.
B. no. 9. Why: A no. 10 envelope is used for standard 81/2”  11”
C. no. 10. paper folded into thirds.
D. no. 12. Review: Yes ❏ No ❏
E. no. 8.

3. The punctuation mark following the salutation of Answer: ,

a professional business letter is a:
Why: The salutation is the opening of the letter, which is
A. period.
followed by a colon in a professional letter.
B. hyphen.
C. semicolon. Review: Yes ❏ No ❏
D. colon.

4. The standard margin used for a business letter is: Answer: *

A. 1/2 inch.
Why: One inch is used as the standard margin for all
B. 1 inch.
sides of a letter. The letter appears standardized and
C. 11/2 inches.
professional.
D. 2 inches.
E. 21/2 inches. Review: Yes ❏ No ❏

5. The component of a letter that indicates the Answer: )

purpose of the correspondence is the:
Why: The subject line introduces the main topic of the let-
A. subject line.
ter and begins with the abbreviation “RE” (short for
B. enclosure.
“regarding”) followed by a colon. The word “enclosure” is
C. letterhead.
placed below the reference initials, indicating that there
D. salutation.
are other documents included with the letter. Letterhead
is stationery with the sender’s name and address at the top
of the page. The salutation is the greeting of the letter.
Review: Yes ❏ No ❏

6. Which of the following is true regarding the date Answer: -

on a business letter?
Why: The date the letter is written should be placed two
A. The date includes the month and year only.
lines below the letterhead.
B. The date is not necessary on a business letter.
C. It is proper to abbreviate the date to save space. Review: Yes ❏ No ❏
D. The date is placed on the same line as the
inside address on the right of the paper.
E. The date is placed two lines below the
letterhead.


212 =VQ\ ■ Administrative Practice

7. Certified Mail is also considered or classified as: Answer: )

A. First-Class Mail.
Why: Certified Mail is sent first class, and the sender can
B. Second-Class Mail.
request verification that the mail piece was delivered to
C. Third-Class Mail.
the recipient. Second-Class Mail was used to send items
D. Express Mail.
such as magazines, and Third-Class Mail was the same
as bulk mail and was typically used to send promotional
materials. (These types of mail are now called Standard
Mail.) Express Mail is sent with a guarantee of next-day
delivery.
Review: Yes ❏ No ❏

8. The mail classification used to send most medical Answer: ,

office mail is:
Why: First-Class Mail is used for most office correspon-
A. Priority Mail.
dence, including letters and postcards. Priority Mail and
B. Second-Class Mail.
Express Mail expedite the delivery. Second-Class Mail is
C. Express Mail.
now called Standard Mail, and it is primarily used for
D. First-Class Mail.
printed matter, newsletters, bulletins, and catalogs.
E. Standard Mail.
Review: Yes ❏ No ❏

9. The style of letter in which all the lines begin at Answer: )

the left margin except the subject and
Why: The modified block is a style of letter that is less
complimentary closing is:
formal. The subject, complimentary closing, and signa-
A. modified block.
ture lines begin at the center of the page, with all other
B. semiblock.
lines beginning at the left margin.
C. simplified.
D. full block. Review: Yes ❏ No ❏

10. The proper style of writing the date in a Answer: +

professional letter is:
Why: The proper date in a professional letter should be
A. 2010
written out fully. The month is not abbreviated, and
B. Jan. 1, 2010
four digits are used for the year.
C. January 1, 2010
D. January 1, ‘10 Review: Yes ❏ No ❏
E. January 01, ‘10

11. How many lines below the salutation should the Answer: *
body of the letter start?
Why: Two lines is the standard amount of space between
A. 1
the salutation and the body of the letter. This amount of
B. 2
space allows the salutation to be set apart from the body.
C. 3
D. 4 Review: Yes ❏ No ❏

12. An example of a properly keyed signature is: Answer: +

A. Dr. James Jones, M.D.
Why: It is not appropriate to use both the title “Dr.” and
B. Dr. Jones, M.D.
the initials “M.D.” in the same title. You may use either
C. James Jones, M.D.
one, but not both. The first name and the last name of
D. Doctor Jones, M.D.
the person signing the letter should be spelled out
E. J. Jones, M.D.
completely.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Correspondence 213

13. The classification of mail that guarantees delivery Answer: ,

the following day is:
Why: Express Mail will ensure that the delivery will
A. First-Class Mail.
arrive the next day. This service is more expensive than
B. Certified Mail.
other types of mail classes, but offices rely on Express
C. Registered Mail.
Mail for sending records and office correspondence that
D. Express Mail.
must arrive by the next day. Certified Mail and
Registered Mail are used when the sender wants to have
confirmation of delivery or have the mail delivered to a
specific person. First-Class Mail is the most common
type of delivery used for letters but has no guarantee of
what day the mail will be delivered. Typically it will take
2 to 3 days for most first-class mail to reach its
destination.
Review: Yes ❏ No ❏

14. At the bottom of a professional letter, the reference Answer: *

initials represent:
Why: The initials for both the individual signing the let-
A. the individual processing the letter, in
ter and the person who processed the letter are
uppercase letters.
indicated. The uppercase initials belong to the individ-
B. the individual signing the letter, in uppercase
ual signing the letter; the lowercase initials belong to the
letters.
person who processed the letter.
C. the individual signing the letter, in lowercase
letters. Review: Yes ❏ No ❏
D. only the individual processing the letter.
E. the individual receiving the letter.

15. The abbreviation “cc:” or “Cc:,” when used at the Answer: *

end of a professional letter, means:
Why: The abbreviation “cc:” means carbon copy. With
A. there is an enclosure in the envelope with the
computer processing, the abbreviation “cc:” is also
letter.
proper and means correspondence copy. This is used to
B. the letter was sent to another person.
indicate that a duplicate or copy of the letter has been
C. the physician requested a copy of the letter.
sent. The abbreviation is placed at the bottom left mar-
D. there is a copy of another letter enclosed with
gin of the letter. The name of the person follows the
this letter.
abbreviation (e.g., cc: James Jones, M.D.).
Review: Yes ❏ No ❏

16. When mail arrives at the office, the first step in Answer: -
processing the mail is to:
Why: Before anything else is done with the mail, the
A. record all insurance payments.
mail is opened and stamped with the current date. This
B. distribute the mail to the appropriate staff
records the date it was received by the office in case
members.
there is a question in the future about the arrival date of
C. review it with the physician.
materials. After that, the medical assistant or medical
D. dispose of advertisements.
administrative specialist can sort the mail and determine
E. date stamp each item of mail.
distribution of the remaining mail.
Review: Yes ❏ No ❏
214 =VQ\ ■ Administrative Practice

17. The process of converting the dictated word of the Answer: +

health care provider to a word-processed form is:
Why: Transcription is the process of converting the
A. dictation.
health care provider’s dictated words to a word-
B. recording.
processed form.
C. transcription.
D. documentation. Review: Yes ❏ No ❏

18. The style of letter in which the first sentence of Answer: +

each paragraph is indented five spaces is:
Why: The semiblock style is similar to the modified
A. full block.
block except the first sentence of each paragraph is
B. modified block.
indented five spaces. This style is less formal than the
C. semiblock.
full block but more formal than a simplified letter. All of
D. simplified.
these types of letters use the block format.
E. block.
Review: Yes ❏ No ❏

19. When a professional letter requires more than one Answer: ,

page, the pages following the first page:
Why: A professional letter is processed on quality bond
A. are printed on embossed letterhead the same as
stationery with the first page containing the physician’s
the first page.
name, address, and telephone number. All pages follow-
B. are not numbered.
ing the first page should contain the name of the person
C. do not include the date of the letter.
to whom the letter is addressed, the date of the letter,
D. are the same paper as the first page with no
and the page number.
letterhead printing.
Review: Yes ❏ No ❏

20. The inside address of a professional letter is the: Answer: -

A. address of the sending group practice.
Why: The inside address is the address of the person or
B. recipient’s address written with abbreviations
company to whom the letter is being sent. It should not
to save space.
contain any abbreviations.
C. physician’s home address printed at the left
margin. Review: Yes ❏ No ❏
D. physician’s office address.
E. recipient’s address written without abbreviations.

21. If there are materials included in the envelope with Answer: +

the letter, this should be noted:
Why: If there are materials to be mailed with the letter,
A. below the inside address.
it should be noted by using the abbreviation “Enc.” or
B. within the body of the letter only.
the word “Enclosures” followed by the name of the doc-
C. two lines below the reference initials.
ument or the number if there is more than one.
D. four lines below the complimentary closing.
Review: Yes ❏ No ❏

22. The classification of mail used for at least 200 Answer: +

pieces of promotional information is:
Why: Standard Mail is also known as bulk mail. This is a
A. Certified Mail.
classification used to mail promotional pieces such as
B. Second-Class Mail.
flyers or brochures. There must be a minimum of 200
C. Standard Mail.
pieces to qualify for this class of mail.
D. Registered Mail.
E. Priority Mail. Review: Yes ❏ No ❏
 +PIX\MZ ■ Correspondence 215

23. A postage meter is a: Answer: +

A. device used to weigh letters or packages.
Why: A postage meter is a postage-printing machine or
B. scale to determine the classification of mail for
system used in the home or office. Meters print postage
letters.
directly onto mail pieces or onto an approved label that
C. machine that prints postage onto mail pieces
you affix to your mail piece.
or onto an approved label.
D. machine used to scan zip codes. Review: Yes ❏ No ❏

24. The keyed signature is typed: Answer: )

A. four lines below the complimentary closing.
Why: The keyed signature is the typed full name of the
B. two lines before the return address.
person signing the letter. It is placed four lines below the
C. two lines after the reference line.
complimentary closing to allow space for the handwrit-
D. four lines below the salutation.
ten signature.
E. six lines below the salutation.
Review: Yes ❏ No ❏

25. The letterhead on stationery should include the Answer: +

following EXCEPT the:
Why: The physician’s personal information should not
A. physician’s name.
appear on professional business stationery used for office
B. office address and office telephone number.
correspondence. The physician’s home telephone num-
C. physician’s home telephone number.
ber is private and usually unlisted.
D. medical group’s name.
Review: Yes ❏ No ❏
 Medical Insurance
13

: - > 1 - ?  < 1 8 
As you read this chapt
p er, write anyy definition or insurance typ
ype that reqquires further review on an
index card or piece of paper (definition on the front, answer on the back); writing the information
helps reinforce it. Go over the cards whenever you have a “learning moment” or at a set study
time. This is a good exercise for study groups.

The intent of medical insurance is to provide financial +75576<A8-;7.5-,1+)4

protection for costs associated with sickness or injury. 16;=:)6+-84)6;
Because of the complex American social and health sys-
tems, the types of medical insurance and payers are var- An insurance company (carrier), whether private or gov-
ied and dependent on eligibility criteria. ernmental, may offer all common plan types or a hybrid
Health care is one of the few services paid for by a of multiple types. The medical assistant and medical
party other than the one receiving the actual service. The administrative specialist must know not only the insur-
insurance company or responsible governmental agency ance company but also the plan covering the patient.
or private entity is known as the third-party payer—the
r Each plan has different costs and benefits to the patient
party that pays the second party (doctor, hospital, phar- and different payments to the health care provider.
macy, etc.) for the medical bills of the first party (patient
or insured individual). The term third-party administrator ■ Health maintenance organization (HMO)—an associ-
is sometimes used. ation that provides all care to the insured person for a
This chapter is organized differently from previous fixed fee, usually paid for by the insured or employer
chapters. The types and sources of insurance are through a monthly premium; a copayment may or may
described with information that has “exam probability.” not be required
The “Terms” section contains the remaining materials ■ Indemnity—plan through which the insured person
and definitions for medical insurance. Do not skip it. selects his or her own health care providers; an established


218 =VQ\ ■ Administrative Practice

amount or percentage of care costs is paid by the insur- A and Medicare Part B; allows participant to
ance plan on a fee-for-service basis; usually has deductibles choose a Medicare Advantage plan, which is HMO-
and limits type coverage
■ Preferred provider organization (PPO)—a list of physi- ❍ Part D—optional benefit; covers approved phar-
cians, hospitals, and other health care services approved maceuticals
by the insurance plan to provide these services at a dis- • Advanced Beneficiary Notice of Noncoverage
counted rate (ABN)—notification to the beneficiary (person
■ Major medical—type of insurance that does not cover insured by Medicare) of their potential liability for
primary care, but covers costs associated with signifi- payment of services under certain conditions that are
cant illness or injury (e.g., hospitalization, surgeries); not covered or approved for payment by Medicare;
premiums are lower than full-coverage insurance i.e., frequency of coverage such as a maximum num-
ber of glucose tests that will be approved for pay-
ment within a specific time frame
;7=:+-;7.5-,1+)416;=:)6+- ■ Medigap—also called Medicare Supplement Insurance;
■ Commercial—for-profit
l companies that provide health commercial medical insurance intended to cover
insurance for a fee to individuals or groups; Blue Cross Medicare deductible, coinsurance, and other uncovered
and Blue Shield is perhaps the most widely known items
• Eligibility ■ Medicaid—federal insurance program established in
❍ Individual plan—coverage provided for a person 1965 under the Social Security Act (Title 19) and
and eligible dependents when premiums are made administered by the Centers for Medicare and Medic-
and designated criteria are met aid Services (CMS), formerly called HCFA; eligibility,
benefits, and name differ from state to state (e.g., in
❍ Group plan—generally associated with employ-
California, it is called MediCal); provides health cov-
ment; coverage provided for employee and usually
erage for the categorically needy
dependents; premiums may be paid by employer
or shared with the employee • Eligibility—low-income (calculated as a percentage
of poverty level, which differs from state to state)
• Benefits—dependent on plan selection, premiums, families and individuals who are citizens or, in some
and eligibility criteria
cases, select refugees and immigrants
■ Medicare—federal insurance program established in
1965 under the Social Security Act (Title 18) and • Benefits—minimum benefits are mandated by the
federal government, and other benefits are defined
administered by the Centers for Medicare and Med-
by the states; minimum medically necessary benefits
icaid Services (CMS), formerly called HCFA; prima-
include:
rily designed for eligible citizens age 65 years and
older ❍ Primary care

❍ Early, periodic screening, diagnosis, and treatment

• Eligibility
(EPSDT) for children
❍ Persons and spouses of persons age 65 years or
older who are eligible for Social Security benefits ❍ Hospitalizations

❍ Retired railroad workers ❍ Outpatient services

❍ Persons receiving Social Security benefits ❍ Family planning

❍ Persons with end-stage kidney disease who have ❍ Skilled nursing facilities (SNFs)

contributed to Social Security ❍ Medi/Medi—persons eligible for both Medicare

and Medicaid (dual eligibility); Medicaid is always
• Benefits
the payer of last resort
❍ Part A—benefit is automatic when eligibility and
deductible are met; covers hospital inpatient costs, ■ TRICARE—formerly CHAMPUS; offers three
hospice, limited nursing facility stays, and home health care benefits plans sponsored by the federal
health government, primarily for spouses and dependents of
service men and women
❍ Part B—optional benefit; requires premiums,
deductibles, and coinsurance; covers physician costs, • TRICARE Standard—program under TRICARE that
outpatient services, durable medical equipment, automatically enrolls all eligible beneficiaries
and medical supplies • TRICARE Prime—PPO-type TRICARE option
❍ Part C—formerly called Medicare  Choice, now with an annual deductible
referred to as Medicare Advantage; requires par- • TRICARE Extra—HMO-type TRICARE option
ticipants to be covered under both Medicare Part with an annual deductible and copays
 +PIX\MZ ■ Medical Insurance 219

• Eligibility *W`
❍ Spouses and dependents of active military personnel
*ZMISQVO,W_V:MTI\Q^M>IT]M:MQUJ]Z[MUMV\
❍ Military retirees, spouses, and dependents

❍ Spouses and dependents of deceased active or RBRVS  the system for reimbursement
retired military personnel RVS  the list of procedures with the (relative)
❍ Former spouses of active or retired military per-
value for each
sonnel who meet requirements RVU  the component that is multiplied by a
factor to determine the (relative) value ($)
❍ Spouses, former spouses, and dependents of court-
martialed active-duty service personnel
❍ Spouses, former spouses, and dependents of
retirement-eligible military personnel who lost
eligibility as a result of child or spousal abuse +755765-<07,;7.,-<-:51616/
❍ Other select individuals 16;=:)6+-8)A5-6<
• Benefits ■ Fee schedule—list of a physician’s customary charges;
❍ Hospitalization may incorporate insurance plan–specific discounts
❍ Maternity care ■ Resource-based relative value system or scale
❍ Inpatient and outpatient treatment for mental (RBRVS)—a method used to establish physician fees for
illness specific medical services by assigning worth to a relative
value unit (RVU) (Box 13-1)
❍ Physician services

❍ Diagnostic testing
• RVU—a component (e.g., time) that is multiplied by
a monetary conversion factor to establish physician
❍ Emergency services, including ambulances payment; it includes the physician’s:
❍ Family planning ❍ Service
❍ Durable medical equipment ❍ Overhead
❍ Home health care ❍ Cost of malpractice insurance
■ CHAMPVA (Civilian Health and Medical Program of
• Relative value studies (RVS)—relative values listed
the Veterans Administration)—a service benefit pro- by health care procedure codes; allow comparison of
gram with no premiums for select family members of reimbursement for different codes
specific veterans
■ Usual, customary, and reasonable (UCR)—a method
• Eligibility used by insurance carriers to establish provider pay-
❍ Spouses and dependents of military personnel ments based on a fee compendium of other like
with permanent, total, service-related disability providers
❍ Spouses and dependents of military personnel who • Prevailing fee—the usual, customary, and reasonable
died from a service-related disability fees of like providers in the same geographic area
• Benefits—the same as TRICARE Standard • Copayment—a portion of the cost to the provider
■ Workers’ compensation—medical
n and disability insur- (usually a flat fee) owed by the insured at the time of
ance that covers employees in the event of a work- service; may also be called coinsurance; routine waiv-
related injury, illness, or death ing of copayment by the medical office is against
federal guidelines for Medicare and Medicaid
• Eligibility
■ Capitation—payment made to a provider based on a
❍ Federal coverage—federal employees, coal miners,
fixed amount per enrollee assigned to that provider
and maritime workers
regardless of services provided
❍ State coverage—all workers not covered by federal
■ Diagnostic-related groups (DRG)—a classification of
statutes
diagnoses used to determine hospital payment for
• Benefits Medicare inpatients; this method does not take into
❍ Medical treatment related to disability, including account length of stay (LOS)
prostheses ■ Preauthorization/Precertification—under
— some health
❍ Temporary disability payments plans, individuals are required to receive advance
❍ Permanent disability payments authorization from the insurance provider for particu-
lar medical services; usually required for referral to a
❍ Death benefits to survivors
physician specialist
220 =VQ\ ■ Administrative Practice

-4-+<:761+0-)4<0+):-+4)15; diagnostic-related groups (DRG) a classification of

diagnoses used to determine hospital payment for
■ Claims are transmitted electronically from the provider’s Medicare inpatients
computer to the Medicare contractor’s computer exclusion conditions or circumstances that are not
■ When submitting electronic claims, the provider must covered under the insurance plan
use a computer with software that meets electronic fil- explanation of benefits (EOB) a claim summary indi-
ing requirements and national standards established cating what services were covered, what was not
under Health Insurance Portability and Accountability covered, and why; also referred to as remittance advice
Act (HIPAA) fee-for-service a payment made to the health care
■ Claims are reviewed by the Medicare contractor for provider for each service rendered
accuracy of submission, and the entire batch of submit- fee schedule a list of a physician’s customary charges;
ted claims may be denied and returned for correction may incorporate insurance plan–specific discounts
even if one claim is found with an area of noncompli- health maintenance organization (HMO) an associa-
ance with submission standards tion that provides all care to the insured person for a
fixed fee, usually paid for by the insured or employer
through a monthly premium; a copayment may or
may not be required
TERMS indemnity a plan through which the insured person
selects his or her own health care providers; an
Medical Insurance Review established amount or percentage of care cost is paid
The following list reviews the terms discussed in this by the insurance plan on a fee-for-service basis;
chapter and other important terms that you may see on usually has deductibles and limits
the exam. major medical a type of insurance that does not cover
Advanced Beneficiary Notice of Noncoverage primary care but covers costs associated with signifi-
(ABN) notification to the beneficiary (insured by cant illness or injury, such as hospitalization or sur-
Medicare) of their potential liability for payment geries; premiums are lower than full-coverage
of services under certain conditions that are not insurance
covered or approved for payment by Medicare Medicaid provides health coverage for the categorically
assignment of benefits authorization for the insurance needy; a federal insurance program established in
company to send insurance payments directly to the 1965 under the Social Security Act (Title 19) and
health care provider; also, an agreement with administered by the Centers for Medicare and
Medicare that the provider will accept the Medicaid Services (CMS), formerly called HCFA;
remittance as full payment eligibility, benefits, and name differ from state to
beneficiary a person eligible to receive insurance benefits state (e.g., in California, it is called Medi-Cal)
birthday rule a method used to determine the primary Medicare primarily for people older than age 65 and
insurance carrier when children are covered under others eligible for Social Security; federal insurance
both parents’ insurance plans; the parent whose program established in 1965 under the Social
birthday falls earliest in the calendar year becomes Security Act (Title 18) and administered by the
the primary carrier Centers for Medicare and Medicaid Services (CMS),
capitation a health care insurance payment made to a formerly called HCFA
provider based on a fixed amount per enrollee assigned point of service facility where the health care service
to that provider, regardless of services provided took place (e.g., physician’s office, emergency depart-
carrier insurance company that provides the policy and ment)
benefits preauthorization process of obtaining approval for a
coinsurance a percentage or an established dollar service through the individual’s insurance company
amount of costs contractually assumed by the by establishing that it is a medical necessity
insured party precertification process of determining whether a
copayment a portion of the cost to the provider owed service is covered under the insured person’s plan
by the insured at the time of service; may be referred predetermination a process of ascertaining the amount
to as coinsurance the insurance carrier will pay for a specific service
deductible an established dollar amount of actual costs preexisting condition a diagnosed and treated health
of medical services that must be paid by the insured condition that the patient had before obtaining
party before the insurance carrier will cover costs; insurance
usually applies every year preferred provider organization (PPO) a plan allow-
dependent a person covered under the primary ing the insured person to select physicians, hospitals,
insured’s policy and other health care services from an approved list
 +PIX\MZ ■ Medical Insurance 221

issued by the insurance plan to provide care at a dis- Temporary Assistance to Needy Families (TANF)
counted rate formerly known as Assistance to Families with
premium a dollar amount the insured person pays for Dependent Children (AFDC); the federal welfare
insurance coverage program
prevailing fee the usual, customary, and reasonable fees third-party payer the entity (usually the insurance
of like providers in the same geographic area company) that pays the second party (doctor, hospi-
primary care provider (PCP) physician contracted tal, pharmacy, etc.) for the medical bills of the first
through a specific insurance plan to provide or to party (patient or insured individual); also referred to
coordinate the care of all patients assigned through as the third-party administrator
the insurance carrier TRICARE formerly CHAMPUS; health care benefit
quality improvement organization (QIO) formerly plans provided by the federal government, primarily
called a peer review organization (PRO); group of for spouses and dependents of service men and women
professionals that monitor health care treatments, usual, customary, and reasonable (UCR) a method
length of hospital stays (LOS), outcomes, and other used by insurance carriers to establish provider pay-
indicators for appropriateness and improvement ments based on a compendium of other like provider
opportunities fees
relative value studies (RVS) relative values listed by utilization review a process of reviewing and monitor-
health care procedure codes; allows comparison of ing a provider’s usage of health care resources for
reimbursement for different codes appropriateness and comparison with peers
relative value unit (RVU) the component (e.g., time) waiting period the time an individual is required to
that is multiplied by a monetary conversion factor to wait before being eligible for insurance benefits
establish physician payment for the resource-based waiver a special policy provision that forgoes a stipula-
relative value system or scale tion or requirement
resource-based relative value system/scale (RBRVS) workers’ compensation medical and disability insur-
a system that calculates physician reimbursement for ance to cover employees in the event of a work-
services using relative value units (RVUs) related injury, illness, or death
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA), RMA (AMT), and CMAS (AMT) exams.

1. When a patient gives written authorization for Answer: +

reimbursement to the physician for billed charges,
Why: Assignment of benefits is necessary if the physician
this is called:
agrees to wait for payment from the insurance company
A. coordination of benefits.
for billed charges.
B. capitation.
C. assignment of benefits. Review: Yes ❏ No ❏
D. copayment.

2. Coordination of benefits means: Answer: *

A. the patient pays a specific amount of money for
Why: Some patients have more than one benefit or
medical services before the insurance pays.
insurance plan. Usually there is a primary carrier, and
B. one insurance plan will work with other insurance
the other becomes the secondary. The primary carrier
plans to determine how much each plan pays.
determines an amount it will pay on a claim, and the
C. there is a flat fee paid for each service.
secondary carrier will then determine the amount of the
D. there is a deductible required by the patient
remaining balance that it will pay.
before payment from the insurance is made.
E. each insurance company will pay an equal Review: Yes ❏ No ❏
amount of the patient’s bill.

3. The person who is covered by a benefits plan is Answer: ,

the:
Why: The insured is the person who is covered by the
A. employee.
insurance benefits. This person could be an employee,
B. carrier.
but this would have to involve an employer-sponsored
C. administrator.
benefits plan. An administrator and a carrier are persons
D. insured.
involved directly with the insurance provider.
Review: Yes ❏ No ❏

4. A person’s spouse or child who is covered under Answer: -

the benefits plan is called the:
Why: The dependent is related to the group member,
A. group member.
the primary person covered, either as a family member
B. coinsured.
or as an employee.
C. primary carrier.
D. carrier. Review: Yes ❏ No ❏
E. dependent.

5. The amount that will be paid by the insurance Answer: ,

plan for each procedure or service is based on the:
Why: A fee schedule is a list of a physician’s customary
A. coinsurance.
charges, which may incorporate insurance plan–specific
B. capitation.
discounts. Coinsurance refers to the portion the patient is
C. deductible.
responsible for after the benefit plan pays a percentage of
D. fee schedule.
the eligible benefits and the member pays the deductible.
Capitation is a system of payment used by managed care
plans and refers to a fixed, per capita amount for each
patient enrolled over a stated period. The deductible is
the amount the insured must pay each calendar year
before the plan begins to pay benefits.
Review: Yes ❏ No ❏


 +PIX\MZ ■ Medical Insurance 223

6. A government-sponsored program that provides Answer: ,

health benefits to low-income or indigent
Why: Medicare, CHAMPUS, and CHAMPVA are all
persons is:
government-sponsored insurance programs, but only
A. CHAMPUS.
Medicaid determines eligibility based on income. States
B. CHAMPVA.
typically use the same criteria as their state welfare assis-
C. Medicare.
tance programs. Blue Cross and Blue Shield is an inde-
D. Medicaid.
pendent health insurer.
E. Blue Cross and Blue Shield
Review: Yes ❏ No ❏

7. Expenses resulting from work-related illness or Answer: +

injury are usually covered by:
Why: Employees in every state are covered by a workers’
A. Medicare.
compensation program administered by the state.
B. HMOs.
Medicare is a federal insurance program, primarily for
C. workers’ compensation.
people older than 65. An HMO is an association that
D. employee’s health insurance.
provides all care to the insured person for a fixed fee.
Employee’s health insurance refers to an insurance pro-
gram that an employee may voluntarily enroll in but
that does not usually cover illness or injury determined
to be work-related.
Review: Yes ❏ No ❏

8. The statement issued to the provider and the Answer: ,

patient that lists the details of a payment that has
Why: The explanation of benefits (EOB) tells how the
been made by the insurance plan is the:
payment was made, including the deductible and
A. fee schedule.
coinsurance information. The EOB statement may show
B. coordination of benefits.
several claims that have processed during a particular
C. assignment of benefits.
period. A fee schedule is a list of a physician’s customary
D. explanation of benefits.
charges. Coordination of benefits occurs when a person
E. deductible.
has insurance coverage from more than one company.
The primary carrier will work with other insurance
plans to determine how much each plan pays.
Assignment of benefits occurs when a patient gives writ-
ten authorization for reimbursement to the physician for
billed charges. The deductible is an established dollar
amount of actual costs of medical services that must be
paid by the insured party before the insurance carrier
will cover costs.
Review: Yes ❏ No ❏

9. If a patient is diagnosed with a disease before the Answer: )

effective date of the insurance plan, it is a(n):
Why: A preexisting condition is any illness or disease
A. preexisting condition.
that was diagnosed before the effective date of the insur-
B. crossover claim.
ance plan. A typical illness that may be considered
C. exclusion.
preexisting is cancer.
D. capitation.
Review: Yes ❏ No ❏
224 =VQ\ ■ Administrative Practice

10. The amount of eligible charges each patient must Answer: -

pay each calendar year before the plan begins to
Why: It is the patient’s responsibility to pay the
pay benefits is called:
deductible amount before the insurance benefits will pay
A. coinsurance.
a percentage of the allowable charges. Most deductible
B. exclusion.
amounts are between $1500 and $2500 per patient per
C. eligibility.
year.
D. capitation.
E. deductible. Review: Yes ❏ No ❏

11. Medicare is a federal health insurance program for: Answer: ,

A. anyone over 62 years of age.
Why: Medicare is available to any individual who is 65
B. disabled workers who are at least 65 years of
years of age or older who is retired and on Social Secu-
age.
rity or who retired from a railroad or civil service. Blind
C. blind individuals who are at least 50 years of
and disabled individuals receiving Social Security bene-
age.
fits have no age restrictions.
D. individuals 65 years of age or older who are
retired and on Social Security. Review: Yes ❏ No ❏

12. Medicare Part A provides coverage for: Answer: +

A. clinical laboratory services.
Why: Medicare Part A primarily covers the cost of inpa-
B. physician’s office services.
tient hospitalization for the hospital room and board,
C. hospitalization.
general nursing, and hospital services and supplies. All
D. physician’s hospital services.
of the physician’s charges are covered under Part B.
E. outpatient referral fee for a specialist.
Review: Yes ❏ No ❏

13. The process of determining whether a service or Answer: *

procedure is covered by the insurance provider is
Why: Contacting the insurance carrier for
called:
precertification determines whether the patient’s insur-
A. coordination of benefits.
ance company will pay for a specific service or
B. precertification.
procedure. The patient may still be responsible for a
C. capitation.
portion of the charges after the insurance plan has paid a
D. assignment of benefits.
percentage of the charges. If the carrier does not precer-
tify the service or procedure, the patient may be respon-
sible for all the charges.
Review: Yes ❏ No ❏

14. The medical bills of spouses and children of Answer: -

veterans with total, permanent, service-connected
Why: The Civilian Health and Medical Program of the
disabilities are covered under:
Veterans Administration (CHAMPVA) is a federal gov-
A. Blue Cross.
ernment–sponsored insurance that covers veterans’
B. HMO.
spouses and children. Blue Cross and Blue Shield is a
C. workers’ compensation.
private insurance company; an HMO is a type of insur-
D. HCFA.
ance plan. Workers’ compensation covers a patient who
E. CHAMPVA.
has a work-related illness or injury. HCFA is the Health
Care Finance Administration (now called the Centers
for Medicare and Medicaid Services, or CMS).
Review: Yes ❏ No ❏
 +PIX\MZ ■ Medical Insurance 225

15. The process of making a payment to a provider Answer: +

based on a fixed amount per enrollee assigned to
Why: Capitation is the process of paying a provider
that provider regardless of services provided is:
based on an established amount per person enrolled in
A. exclusion.
the plan regardless of services rendered.
B. deductible.
C. capitation. Review: Yes ❏ No ❏
D. predetermination.

16. A group of physicians who review cases for Answer: +

appropriateness of hospitalizations and discharges
Why: Physicians and specialists review cases from hospi-
is called:
talizations to determine whether the patient’s care was
A. relative value studies.
provided in the most cost-effective setting. Many inpa-
B. preferred provider organization.
tient procedures are performed on an outpatient basis to
C. quality improvement organization.
save the patient excessive charges from an inpatient stay.
D. third-party payer.
The quality improvement organization (QIO), formerly
E. state medical board.
referred to as the peer review organization (PRO), eval-
uates cases to ensure the procedures are necessary and
cost-effective.
Review: Yes ❏ No ❏

17. A health maintenance organization is best Answer: )

described as:
Why: An HMO (health maintenance organization) com-
A. a group of physicians who have a contract to
prises physicians who work under contract to provide
provide services to participating patients for a
services to the subscribers of the plan. The plan is set up
predetermined fee.
on a contracted fee-for-service basis, also known as
B. independently practicing physicians providing
capitation.
services to patients covered under all types of
insurance. Review: Yes ❏ No ❏
C. a group of physicians who are partners in the
same corporation.
D. a group of physicians who specialize in
wellness.

18. A database or list of charges for each procedure Answer: *

indicating the charge of the majority of physicians
Why: UCR (usual, customary, and reasonable) refers to
in a geographic area is referred to as:
the typical charges for services for physicians. Charges
A. utilization review.
that exceed the UCR limit are considered unreasonable
B. usual, customary, and reasonable.
and are not eligible for reimbursement.
C. coordination of benefits.
D. explanation of benefits. Review: Yes ❏ No ❏
E. capitation.

19. Medicare Part B does not cover: Answer: +

A. physician office visits.
Why: Part A of Medicare covers hospital charges and
B. diagnostic laboratory services.
services except for the physician charges that are
C. hospitalization.
covered under Part B.
D. outpatient x-rays.
Review: Yes ❏ No ❏
226 =VQ\ ■ Administrative Practice

20. Health benefits policies are purchased by an Answer: )

individual by paying the:
Why: A premium is an annual amount charged by the
A. premium.
insurance plan to enroll an individual for the health ben-
B. deductible.
efits of the policy. When an employee subscribes to
C. copayment.
health insurance through his or her workplace, a portion
D. coinsurance.
of the premium may be taken directly from each
E. exclusion.
paycheck.
Review: Yes ❏ No ❏

21. A primary care physician, or PCP, is: Answer: ,

A. only authorized to accept assignment of
Why: A PCP may be a general practitioner, pediatrician,
benefits.
family practitioner, or general internist who refers
B. a specialist who accepts referral patients.
patients to see specialists for services as needed.
C. not authorized to accept Medicare patients.
D. a general practitioner who oversees patients in Review: Yes ❏ No ❏
an HMO or PPO.

Answer: *
22. A condition or circumstance for which the health
insurance policy will not provide benefits is a(n): Why: An exclusion is any condition or circumstance that
A. benefit. is not covered by the insurance plan. For example, some
B. exclusion. insurance plans do not cover cosmetic surgical
C. review. procedures.
D. waiting period. Review: Yes ❏ No ❏
E. capitation.

23. Insurance coverage that provides a specific Answer: *

monthly or weekly income when an individual
Why: Disability income insurance provides temporary or
becomes unable to work because of an illness or
permanent income during a period when an individual
injury is:
cannot work because of illness or injury. This is not to
A. workers’ compensation insurance.
be confused with workers’ compensation insurance,
B. disability income insurance.
which provides coverage of medical costs incurred from
C. TRICARE insurance.
work-related injuries or illness. TRICARE is an
D. major medical insurance.
insurance plan for spouses and dependents of service
men and women provided by the federal government.
Major medical insurance covers the costs associated with
significant illness or injury, but it does not provide
income for an individual if he or she is unable to work.
Review: Yes ❏ No ❏

24. The amount of money owed by the insured to the Answer: -

provider at the time of service is called:
Why: A copayment may also be called coinsurance. It
A. capitation.
refers to the amount of money that the patient is
B. exclusion.
responsible to pay to the provider at the time of service.
C. fee-for-service.
It is usually a fixed dollar amount per visit.
D. indemnity.
E. copayment. Review: Yes ❏ No ❏
 +PIX\MZ ■ Medical Insurance 227

25. When a dependent child is covered by the benefit Answer: ,

plans of both parents, determination of the
Why: The birthday rule is based on which parent’s birth-
primary carrier is based on the:
day falls earliest in the calendar year. The insurance plan
A. coordination of benefits.
carried by that parent becomes the primary carrier.
B. coinsurance.
C. assignment of benefits. Review: Yes ❏ No ❏
D. birthday rule.

26. In order to be eligible for Medicare Part C, the Answer: +

participant must be enrolled in
Why: Medicare Part C requires participants to be
A. Medicare Part B and Medicare Part D.
covered under both Medicare Part A and Medicare Part
B. an HMO plan.
B. Medicare Part C allows the participant to choose a
C. Medicare Part A and Medicare Part B.
Medicare Advantage plan, which is HMO-type
D. Medicaid.
coverage. Enrollment in an HMO is not a criterion for
E. Medigap.
eligibility for Medicare Part C. Medigap is a supplement
to Medicare insurance that assists with the payment of
coinsurance, copayments, or deductibles.

27. The Medicare part specifically designed to provide Answer: ,

pharmaceutical coverage is:
Why: Part A primarily covers hospitalization, Part B pri-
A. Part A.
marily covers outpatient care, Part C is HMO-type cov-
B. Part B.
erage, and Part D is designed to provide pharmaceutical
C. Part C.
coverage.
D. Part D.
Review: Yes ❏ No ❏

28. A hospital payment system that categorizes Answer: -

patients by diagnosis and treatment is referred
Why: Diagnosis-related groups (DRGs) are established
to as:
by a comparison of patients with medically related diag-
A. ICD.
noses or treatments.
B. CPT.
C. UCR. Review: Yes ❏ No ❏
D. HCPCS.
E. DRG.

29. UCR provider payments are based on: Answer: )

A. what the majority of physicians in a specific
Why: Usual, customary, and reasonable charges (UCR)
geographic area charge for procedures.
are based on what the average or majority of physicians
B. state laws where the physician practices
in a specific region would charge for the same or similar
medicine.
procedure. Any amount that exceeds the UCR rate may
C. the maximum amount paid by other insurance
be considered ineligible for payment.
companies for similar procedures.
D. recommendations of the federal government. Review: Yes ❏ No ❏
228 =VQ\ ■ Administrative Practice

30. When a Medicare patient is told that he or she may Answer: +

be responsible for payment of services not covered
Why: ABN is an advanced beneficiary notice that is the
by Medicare, the physician’s office should inform
formal notification to the patient that certain services
the patient and have the patient sign a form called
may not be covered by Medicare. EOB is an explanation
a/an:
of benefits that were covered for services. HMO is a
A. EOB.
type of insurance plan, and DRG is a classification of
B. HMO.
diagnoses used to determine hospital payment for
C. ABN.
Medicare inpatients.
D. DRG.
E. CPT. Review: Yes ❏ No ❏
 Medical Coding and Claims
14

: - > 1 - ?  < 1 8 
If you are not comfortable with codingg, while reviewingg this chapt
p er, use the current International
Classification of Diseases, coding book, a Current Procedural Terminology (CPT) coding book, and
a Health Care Procedural Coding System (HCPCS) manual that includes Level II codes. This will
simplify definitions and explanations. Further explanation of these manuals and their contents is
included in this chapter.

Medical coding is a process that assigns numeric and 8:7+-,=:)4+7,16/

alphabetic identifiers to illnesses and injuries, medical
procedures and services, drugs, and equipment. The The systems used for coding health care professional
two major coding systems are diagnosis coding and services, supplies, pharmaceuticals, equipment, and
procedural coding. It is important that the diagnosis other materials are referred to as procedural coding. These
and the procedure be compatible. For example, a systems provide uniform methods for collecting data and
woman should have a pregnancy diagnosis to have a determining payment. The American Medical Associa-
cesarean section surgical procedure. The insurance tion (AMA) developed the Current Procedural Termi-
claim is the submission of these medical codes and nology (CPT) coding system, and the federal Health
other information for reimbursement to the health care Care Finance Administration (HCFA) developed two
provider. additional levels. The CPT codes are included in the
The organization of this chapter is similar to Chapter 13. HCFA coding system and are considered Level I. Each
The types of coding are described with information level is described in more detail later in the chapter but is
that has “exam probability.” The “Terms” section con- listed below to provide an overview.
tains the remaining information and definitions. Do not ■ Health Care Procedural Coding System (HCPCS
skip it. [pronounced “hicpics”])—a method developed by the

!
230 =VQ\ ■ Administrative Practice

*W` *W`
-`IUXTMWN+8<+WLQVO8ZWKM[[ -`IUXTM[WN+8<+WLQVO5WLQNQMZ
NWZ1VKQ[QWVIVL,ZIQVIOMWN
I0MUI\WUIWN\PM;SQV A cholecystectomy was performed by one physician,
and postoperative management was performed by
Follow the steps using a CPT code book. another.
1. Go to “skin” in index; read down to “incision Example 1
and drainage,” which gives you a range of codes
or individual codes (e.g., 10040–10180). The physician performing the surgery would use
2. Turn to the section with the codes suggested the following:
from the index, which will be under the CPT code: 47600-54
“Surgery” section; “Integumentary System.” (47600 for the cholecystectomy and -54 as the
3. Read the suggested codes until you find the one modifier indicating the physician performed
that matches your procedure. the surgery only)
4. Read and follow any notes and cross-references
(in this case, there are none). Example 2
5. Select the most descriptive and complete code, The physician providing postoperative care would
which in this case is 10140. use the following:
CPT code: 47600-55
(47600 for the cholecystectomy and -55 as the
Health Care Finance Administration (now the Centers modifier indicating the physician is providing
for Medicare and Medicaid Services, or CMS) for cod- postoperative care only)
ing procedures and other services delivered to Medicare
patients. There are three levels:
■ General steps for CPT coding (Box 14-1):
• Level I—consists of codes for procedures and pro-
fessional services; the codes are the same as the CPT 1. Identify the procedure or service to be coded.
codes 2. Locate the term(s) in the CPT index.
3. Review term, subterms, and code numbers for
• Level II—consists of codes for services not covered
in the CPT codes: supplies, drugs, and other reim- descriptions that specifically match all the compo-
bursable equipment and materials nents of the procedure to be coded.
4. Locate codes in the body of the manual as directed
• Level III—consists of codes for regionally approved by the index; do not code directly from the index.
Medicare/Medicaid procedures or new procedures
5. Read and follow any notes and cross-references.
that have not been assigned a permanent CPT code
6. Select the most descriptive and complete code.
7. Select a modifier when applicable.
CPT CODING ■ Modifier—an addition to the initial CPT code that
identifies certain circumstances (Box 14-2)
CPT coding was first published by the AMA in 1966.
Each procedure code contains five numeric digits. The • Common modifiers—identified by the initial CPT
code followed by a dash and two numbers
manual is updated annually and organized into six sections
representing the major clinical areas, each with a range of ❍ -24: unrelated E&M service

five-digit numbers. The actual numbers may change, but ❍ -50: bilateral procedure
the range is reserved for that section, whether or not all ❍ -54: surgical care only
the numbers are in use.
❍ -55: postoperative care only

■ Sections ❍ -56: preoperative care only

❍ -80: assistant surgeon

• Evaluation and management (E&M)—99200 to
99499 • Common HCPCS modifiers also used in CPT coding
• Anesthesia—00100 to 01999 ❍ -E1—upper left eyelid

• Surgery—10000 to 69999 ❍ -E2—lower left eyelid

• Radiology—70000 to 79999 ❍ -E3—upper right eyelid

• Pathology and laboratory—80000 to 89999 ❍ -E4—lower right eyelid

• Medicine—90000 to 99199 ❍ -FA—left thumb

 +PIX\MZ ■ Medical Coding and Claims 231

*W` • Components—E&M codes usually involve five

components: three major and two contributory
-`IUXTMWN+WLQVONWZ6M_ (Table 14-1)
IVL-[\IJTQ[PML8I\QMV\[
❍ Examination (major)
Coding for office or other outpatient visit of patient, ❍ Problem severity (major)
which requires: ❍ Medical decision making (MDR) (major)

• A problem-focused history, ❍ Coordination of care and counseling (contribu-

• A problem-focused examination, and tory)
• Straightforward medical decision making. ❍ Time (contributory)
• Use CPT code 99201 for a new patient.
• Use CPT code 99211 for an established patient.
• Levels of care—each of the five components involves
levels of care ranging from minimal to high
❍ Problem focused (PF)—minimal; only involves
affected body area or one organ system
-F1 to -F4—left fingers, digits 2 through 5
❍
❍ Expanded problem focused—low; involves an
❍ -F5—right thumb
affected body area or one organ system and symp-
❍ -F6 to -F9—right fingers, digits 2 through 5 toms related to other body areas
❍ -TA—left great toe ❍ Detailed—moderate; involves the affected body
❍ -T1 to -T4—left toes, digits 2 through 5 area or areas and related body system(s)
❍ -T5—right great toe ❍ Comprehensive—moderate to high or high;

❍ -T6 to -T9—right toes, digits 2 through 5

involves multiple systems or complex involvement
of one organ system
• E&M section—the E&M section is unique; it covers
services (e.g., counseling) rather than, in most cases,
actual procedures, and requires specific components HCPCS LEVEL II CODES
based on assessment and judgment; E&M codes also
specify whether the patient is “new” or “established” HCPCS Level II provides coding for services not covered
(Box 14-3) in the CPT codes: supplies, pharmaceuticals, ambulance
services, and other reimbursable equipment and materials.
• Common E&M terms The codes begin with a letter (A–V), followed by four
❍ New patient—a person who has not received care numeric digits. A question concerning Level II codes is
from the physician or another physician of the usually found on the exams; know the beginning letters
same specialty in the same group practice within of the main sections.
3 years
❍ Established patient—a person who has received ■ Selected HCPCS Level II sections
care from the physician or another physician of • A0000–A0999—transportation and ambulance
the same specialty in the same group practice services
within 3 years
• A4000–A8999—medical supplies
❍ Concurrent care—similar services provided to the
same patient on the same day by more than one • E0100–E9999—durable medical equipment
physician • J0000–J8999—drugs administered other than oral
❍ Critical care (definition used for coding profes-
Do not confuse HCPCS Level II codes with four-
sional services)—intensive care in acute life-
letter ICD-9 E codes for external injuries. It is important
threatening conditions requiring constant bedside
to differentiate services and materials from the diagnosis
attention by the physician
before selecting the code.
❍ Counseling (definition used for coding profes-
sional services)—discussion with patient or family
concerning diagnosis, recommendations, risks, ben- HCPCS LEVEL III CODES
efits, prognosis, options, and necessary condition- HCPCS Level III provides codes for regionally approved
related education Medicare/Medicaid procedures or new procedures that
❍ Consultation—services rendered by a physician have not yet been assigned a regular CPT code. Examples
whose opinion or advice is requested by another might be a procedure such as a bone marrow transplant
physician or agency in the evaluation or treatment for a new use that is covered by Medicaid in one state but
of a patient’s illness or suspected problem not in another, or an experimental drug that is covered in
232 =VQ\ ■ Administrative Practice

Table 14-1 +WUXWVMV\[IVL4M^MT[WNIV-^IT]I\QWVIVL5IVIOMUMV\7NNQKM>Q[Q\

Components
Coordination
Medical Decision Problem of Care and
History Examination Making (MDR) Severity Counseling Time
Level 1 Problem Problem Straightforward Minor Consistent with 10 min.
(minimal) focused focused the nature of
the problem and
the patient’s or
family’s needs
Level 2 (low) Expanded Expanded Straightforward Low to Consistent with 20 min.
problem problem moderate the nature of
focused focused the problem
and the patient’s
or family’s needs
Level 3 Detailed Detailed Low complexity Moderate Consistent with 30 min.
(moderate) the nature of
the problem
and the patient’s
or family’s needs
Level 4 Comprehensive Comprehensive Moderate Moderate to Consistent with 45 min.
(moderate complexity high the nature of
to high) the problem
and the patient’s
or family’s needs
Level 5 (high) Comprehensive Comprehensive High complexity Moderate Consistent with 60 min.
to high the nature of the
problem and the
patient’s or
family’s needs

limited circumstances until it is approved by the Food • Support medical research

and Drug Administration. The Level III HCPCS code
• Evaluate utilization of health care resources
begins with a letter (W–Z), followed by four numeric
digits. • Profile physicians’ services and charges
■ ICD-9

,1)/67;<1++7,16/ • Volumes for physician offices

❍Volume 1—tabular (numeric) listing of diseases
In 1979, the International Classification of Diseases,
Ninth Revision, Clinical Modifications (ICD-9-CM) ❍ Volume 2—alphabetic listing of diseases

became the primary system for coding diseases and • Coding digits
injuries in the United States. It is published by the U.S. ❍ Three to five numeric digits are used for each code
Department of Health and Human Services and based (three digits alone are uncommon)
on the World Health Organization’s ICD-9. The ICD-
❍ A decimal is placed after the third digit
9-CM and the ICD-9 are considered the same, and gen-
erally, the acronyms are used interchangeably. ICD-9 ❍ Each digit provides more specific description of

will be used throughout this text to represent the classifi- the disease or condition (Table 14-2)
cation of diagnoses used in the United States. ❍Fifth digit: identified at the beginning of the
The ICD-9 has multiple uses. three-digit category for the disease entity (e.g.,
diabetes) or at the beginning of a four-digit sub-
■ Purpose category (a further descriptor of the disease entity)
• Track disease processes ❍ If listed, the fifth digit is not optional

• Classify causes of morbidity and mortality • Special ICD-9 codes

 +PIX\MZ ■ Medical Coding and Claims 233

codes will allow you to identify the correct one without

Table 14-2 -`IUXTMWN,M[KZQX\WZ[_Q\P needing to be familiar with the actual digits. Box 14-4
.Q^M,QOQ\1+,!+WLM[ assists you in this process.
Code Description
250 Diabetes mellitus
16<-:6)<176)4+4);;1.1+)<1767.
250.1 Diabetes mellitus with ketoacidosis ,1;-);-;<-6<0:->1;176+4161+)4
250.13 Diabetes mellitus with ketoacidosis 57,1.1+)<176;1+,+5
type 1 uncontrolled In 1993, the World Health Organization published the
International Classification of Diseases, Tenth Revision
(ICD-10), which, at the time of this writing, is not in com-
plete use in the United States. It is scheduled for full
E codes—supplementary classification of ICD-9
❍
implementation October 1, 2013, and will replace the
coding that denotes the external cause of an injury
ICD-9-CM, the diagnosis-based system used in both
or poisoning rather than a disease; explains the
physician offices and hospitals. The ICD-9 Procedural
mechanism of injury
Coding System (PCS) is currently used in hospitals only
❍ V codes—ICD-9 coding identifying health care and will be replaced by the ICD-10-PCS. The CPT sys-
encounters for reasons other than illness tem will continue to be used in physicians’ offices for cod-
• ICD tables ing procedures. Documents and other materials may refer
❍ Drugs and chemicals (use E codes) to the ICD-9 as I-9 and the ICD-10 as I-10. Another term
is the General Equivalency Mapping (GEM), which is a
❍ Neoplasms
crosswalk between the ICD-9 and the ICD-10. The CMS
❍ Hypertension reports that the change from the ICD-9-CM is a result of
■ General steps for ICD coding the obsolescence of a system that is inconsistent with cur-
1. Locate the term in the alphabetic index. rent medical practice. The CMS website lists the follow-
2. Refer to the notes under the main heading. ing advantages of the ICD-10:
3. Read the terms in parentheses.
4. Note indented subterms. ■ Improved ability to measure health services
5. Proceed to tabular index and instructional terms. ■ Increased sensitivity with grouping and reimburse-
6. Assign code. ment methods
The exams contain critical thinking questions that ■ Enhanced ability for public health surveillance
require you to differentiate among CPT, HCPCS Level II, ■ Decreased need for supporting documentation with
and ICD-9 codes. Knowing how to recognize the types of claims

*W`
+IVAW]:MKWOVQbM\PM,QNNMZMVKMQV+WLM['
Procedural Codes
CPT or HCPCS Level 1 Five numeric digits (e.g., 99202); codes for professional services
HCPCS Level II Letter A–V and four numeric digits (e.g., J3105); codes for nonprofessional
services or materials
HCPCS Level III Letter W–Z and four numeric digits (e.g., Z5602) (fictional); codes for regional
use or temporary code for new procedures

Diagnostic Codes
ICD-9 Three to five numeric digits with a decimal after the third (e.g., 569.82); codes
that identify the patient’s diagnosis
ICD-9 E codes Letter E and three to four numeric digits with a decimal after the third digit
(e.g., E919.3); further describes the diagnostic code by reporting the external
cause of an injury rather than a disease
ICD-9 V codes Letter V and two to four numeric digits with a decimal after the second digit
(e.g., V59.2); identifies health care encounters for reasons other than illness
234 =VQ\ ■ Administrative Practice

Table 14-3 -`IUXTMWN1+,_Q\P1+,!+WUXIZQ[WV

Number of
ICD-10 Codes Example of Number of
General Description for General ICD-10 Code and ICD-9 Codes Example of ICD-9 Code
of Code Description Specific Description for Description and Specific Description
Mechanical complication 156 T82.310 1 996.1
of other vascular Breakdown (mechanical) Mechanical complication
device, implant, of aortic (bifurcation) of other vascular
and graft graft (replacement) device, implant, and graft

■ Provides codes for comparing mortality and morbidity • Digital fax—processed by computer and faxed to the
data insurance company, where it is read by an optical
■ Provides better data for: coder and transmitted into the claims system
■ CMS 1500 abbreviations: use only capital letters with
• Measuring patient care
no punctuation
• Designing payment systems
• Processing claims • SSN—Social Security number
• Making clinical decisions • EIN—employer identification number
• Identifying fraud and abuse • PIN—provider identification number
• Conducting research • NPI—national provider identifier
■ Dirty claims—claims held or rejected by the insurance
• ICD-10-CM: diagnostic coding system developed carrier because of problems or errors such as the
for use in the United States by the CDC; consists of
following:
three to seven alphanumeric digits (Table 14-3):
❍ Digit 1: alphabetic
• Incorrect data
❍ Digit 2: numeric
• Missing data
❍ Digits 3–7: alphabetic or numeric
• Diagnosis not supporting the procedure
• Coding errors
• Patient ineligible for services
+4)15; • Claim to wrong carrier
A claim is a bill sent to the insurance carrier for payment • Coding or dates not compatible with documentation
of professional services. The universal health care insur- ■ Common fraudulent claim terms
ance form is called the CMS 1500. (Note:
( This has a high • Unbundling—using several CPT codes to identify
probability to be an exam question!) It was originally procedures normally covered by a single code
designed by HCFA, now called CMS, and is used for
• Upcoding—deliberately using an incorrect code to
group and individual claims. In 1990, the form was bill at a higher rate
printed in red to accommodate optical scanning.
The Health Insurance Portability and Accountability • Phantom billing—billing for services or supplies not
provided
Act (HIPAA) regulations regarding confidentiality must
be upheld with insurance claims as with all medical docu- • Ping-ponging—unnecessary or excessive referrals of
ments. Extensive firewalls and other safeguards are required patients to other providers and back to primary
for electronic claims submission. office
• Yo-yoing—scheduling the patient for unnecessary
■ Claims submission types follow-up visits
• Paper—processed by computer; hard copy sent to • Gang visits—billing for individual visits when not all
the insurance carrier through the mail (this method the patients present during the visit received servic-
is becoming obsolete) es (e.g., visiting a nursing home and not providing
• Electronic—processed by computer and sent to the services for all patients who are billed)
insurance carrier through an electronic data • Split billing—billing for several visits when services
exchange, the Internet, telephone wires, or a disk were performed on one visit
 +PIX\MZ ■ Medical Coding and Claims 235

■ Other fraudulent claim practices claim a bill sent to the insurance carrier for payment
related to patient care
• Falsifying medical records to justify higher payment
clean claim completed insurance claim form submitted
• Omitting relevant information, especially additional to a carrier without deficiencies or errors
diagnoses
CMS 1500 universal health insurance claim form used in
• Altering dates of service the physician’s office, originally designed by the Health
• Altering the diagnosis Care Financing Administration (now called the
■ Appeals for disputed claims Centers for Medicare and Medicaid Services, or CMS)
comorbidity a condition that exists along with the con-
• Process specific to the insurance carrier dition for which the patient is receiving treatment
• Five levels of CMS appeals and may increase patient’s length of stay (LOS) if
❍ Predetermination hospitalized
❍ Reconsideration concurrent care similar services provided to the same
patient on the same day by a different physician
❍ Administrative Judge
consultation services rendered by a physician whose
❍ Appeals Review Board opinion or advice is requested by another physician
❍ Federal Court Review or agency in the evaluation or treatment of a
patient’s illness or suspected problem
counseling discussion with patient or family concern-
018)))6,+7>-:-,-6<1<1-; ing diagnosis, recommendations, risks, benefits,
prognosis, options, and necessary condition-related
A covered entity is a medical office that performs any of education; definition used for the coding of profes-
the following procedures electronically: sional services
critical care intensive care in acute life-threatening
■ Files claims or managed care encounter forms
conditions requiring constant bedside attention by
■ Checks claims status the physician; definition used for the coding of pro-
■ Checks eligibility fessional services
■ Checks certifications or authorizations Current Procedural Terminology (CPT) coding sys-
tem first published by the American Medical
■ Receives payment and remittance advice
Association in 1966; a manual, updated annually, that
■ Provides coordination of benefits contains the codes for procedures and services per-
formed by doctors and other select medical personnel
A medical office is also considered a covered entity if dirty claim a claim held or rejected by the insurance
any of the above procedures is conducted by a contracted carrier due to problems or errors
service on the office’s behalf. HIPAA requires covered E code a supplementary classification of ICD-9 coding
entities to maintain confidentiality (see Chapter 9). that denotes the external cause of an injury rather than
a disease; explains the mechanism of injury; includes
drug events such as poisonings and adverse effects
TERMS eponym the name of a disease or procedure derived
from the name of a place or person
Medical Coding and Claims Review
established patient a person who has received care
The following list reviews the terms discussed in this from the physician or another physician of the same
chapter and other important terms that you may see on specialty in the same group practice within 3 years
the exam. etiology the cause of disease
abuse an unreasonable and generally unacceptable fraud intentional and unlawful deception for gain that
departure from precedent and custom with one results in harm to another person or organization
person taking advantage of another person or set of gang visits billing for individual visits when not all the
circumstances; abuse may or may not be unlawful patients present during the visit received services
adverse effect a pathologic reaction to a drug that General Equivalency Mapping (GEM) a crosswalk
occurs when appropriate doses are given between the ICD-9 and the ICD-10
appeal a resort to a higher authority for a decision Health Care Procedural Coding System (HCPCS
benign tumor a nonmalignant lesion that is not inva- [pronounced “hicpics”]) a method developed by
sive or metastatic the Health Care Finance Administration for coding
chief complaint a patient’s statement describing symp- procedures and other services delivered to Medicare
toms and conditions that are the reason for seeking patients
health care services in situ neoplasm confined to the site of origin
236 =VQ\ ■ Administrative Practice

International Classification of Diseases, Ninth phantom billing billing for services or supplies not
Revision, Clinical Modifications (ICD-9 or provided
ICD-9-CM) a coding system published by the U.S. ping-ponging unnecessary or excessive referrals of
Department of Health and Human Services to patients to other providers and back to primary
classify diseases and injuries office
International Classification of Diseases, Tenth point of service (POS) facility where the health care
Revision, Clinical Modifications (ICD-10-CM) service took place (e.g., physician’s office, emergency
diagnostic coding system developed for use in the department)
United States by the CDC; consists of three to seven primary diagnosis the symptoms, conditions, and ini-
alphanumeric digits tial impressions diagnosed as the cause for the
International Classification of Diseases, Tenth patient seeking health care services
Revision, Procedural Coding System (ICD-10- principal diagnosis the definitive diagnosis, obtained
PCS) procedural coding system developed for use in generally through hospitalization
the United States by the CDC; consists of seven split billing billing for several visits when services were
alphanumeric digits performed during one visit
late effect a residual condition occurring after the superbill also called an encounter form; a charge form
acute phase is over custom-designed for the specific medical practice;
malignant tumor a neoplasm with invasive and lists the ICD-9 and CPT codes common to the serv-
metastatic properties ices of that practice
new patient a person who has not received care from the unbundling using several CPT codes to identify proce-
physician or another physician of the same specialty in dures normally covered by a single code
the same group practice within 3 or more years upcoding deliberately using an incorrect code to bill at
Not Elsewhere Classified (NEC) a term used in a higher rate
ICD-9 coding when information is not available to V codes ICD-9 codes identifying health care visits for
code the term in a more specific category reasons other than illness
Not Otherwise Specified (NOS) a term used in ICD- yo-yoing scheduling the patient for unnecessary
9 coding for unspecified diagnosis follow-up visits
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA), RMA (AMT), and CMAS (AMT) exams.

1. The abbreviation for the manual first published by Answer: *

the American Medical Association containing the
Why: The Current Procedural Terminology manual is
codes for procedures and services performed by
used to determine the proper insurance codes to use
doctors and medical personnel is:
when filing insurance claims for procedures and services.
A. ICD.
B. CPT. Review: Yes ❏ No ❏
C. HCPCS.
D. DRG.

2. The coding term used for the level of care that Answer: -
involves multiple systems or complex involvement
Why: Problem focused refers to minimal care involving
of one organ system is:
a specific body area or one organ system. Expanded
A. problem focused.
problem focused refers to the same level of care as prob-
B. expanded problem focused.
lem focused with the addition of symptoms related to
C. detailed.
other body areas. Detailed level of care involves the
D. minimal.
affected body area(s) and related body system(s).
E. comprehensive.
Review: Yes ❏ No ❏

3. When a health professional has a discussion with a Answer: ,

patient and his or her family concerning diagnosis,
Why: Counseling involves meeting with a patient or the
recommendations, risks, benefits, prognosis, and
family members to discuss the patient’s condition and
options, the specific coding component used is
prognosis, treatment, and concerns surrounding the
under the heading:
treatment. This gives the patient or family member an
A. consultation.
opportunity to ask questions about the information pro-
B. critical care.
vided by the health care practitioner.
C. concurrent care.
D. counseling. Review: Yes ❏ No ❏

4. A pediatric patient comes into the office for otitis Answer: ,

media. The physician also administers a routine
Why: D is the correct answer because it includes an
childhood vaccination. What diagnostic codes
ICD-9 code, consisting of a three-digit number
would be used in this situation?
followed by a decimal and another digit, and a V code,
A. 99201 and 99212
an ICD-9 code that identifies health care reasons other
B. 86850 and E 858.1
than disease (immunization). The numbers in A are five-
C. 041.5 and J 5678
digit CPT codes; those in B are a CPT code and an ICD
D. 382.9 and V 03.81
code related to external injuries (preceded by the letter E).
E. 99201 and V 71.5
C consists of an ICD code and a HCPCS Level III code
(as recognized by the letter J and four digits); E is a
combination of a CPT code and a V code.
Review: Yes ❏ No ❏


238 =VQ\ ■ Administrative Practice

5. When a claim is deliberately coded incorrectly to Answer: +

increase the payment, it is referred to as:
Why: When a CPT code is manipulated to increase the
A. superbilling.
amount of reimbursement, it is known as upcoding.
B. customary coding.
This is an unethical practice.
C. upcoding.
D. bundling. Review: Yes ❏ No ❏

6. ICD-9-CM codes that identify health care Answer: -

encounters for reasons other than illness or injury
Why: V codes are used to identify reasons other than ill-
are known as:
ness or injury and to identify patients whose injury or
A. E codes.
illness is influenced by special circumstances or
B. F codes.
problems.
C. CPT codes.
D. T codes. Review: Yes ❏ No ❏
E. V codes.

7. The coding system published by the U.S. Answer: +

Department of Health and Human Services used to
Why: The International Classification of Diseases,
categorize diseases and injuries is the:
Ninth Revision, Clinical Modification manual (ICD-9-
A. Physician’s Desk Reference.
CM) is a numeric code system for diagnoses of diseases
B. Current Procedural Terminology.
and injuries.
C. International Classification of Diseases.
D. Relative Value Study. Review: Yes ❏ No ❏

8. CMS developed codes for use when specific services, Answer: *

materials, drugs, and procedures are not listed in the
Why: HCPCS, the CMS Common Procedure Coding
CPT code book. These are known as:
System, was developed to accommodate coding areas
A. RVU.
not already specified in the CPT code book. These serv-
B. HCPCS.
ices, materials, drugs, and procedures are provided to
C. DRG.
Medicare patients.
D. E codes.
E. E&M codes. Review: Yes ❏ No ❏

9. The largest of the six major sections of the CPT Answer: ,

manual, which contains codes from 10000 to
Why: The six sections of the CPT manual are as follows:
69999, is:
Evaluation and Management, 99200 to 99499; Anesthe-
A. medicine.
sia, 00100 to 01999; Surgery, 10000 to 69999;
B. anesthesia.
Radiology, 70000 to 79999; Pathology and Laboratory,
C. radiology.
80000 to 89999; and Medicine, 90701 to 99199.
D. surgery.
Review: Yes ❏ No ❏

10. When a physician requests the services of another Answer: *

physician whose opinion or advice assists in the
Why: A consultation is the process of seeking the advice
evaluation or treatment of a patient’s illness or
or opinion of another physician or specialist to aid in the
suspected problem, the code section used is titled:
diagnosis or evaluation of a patient’s disease or
A. critical care.
condition.
B. consultation.
C. counseling. Review: Yes ❏ No ❏
D. concurrent care.
E. comorbidity.
 +PIX\MZ ■ Medical Coding and Claims 239

11. Of the following, which is not one of the purposes Answer: +

of diagnostic coding?
Why: Diagnostic coding helps establish statistics and
A. To track disease processes
demographic information about diseases and illness.
B. To support medical research
Diagnostic coding is not a mechanism to increase a
C. To provide increased revenue for the physician
physician’s income.
or medical practice
D. To classify the causes of morbidity and mortality Review: Yes ❏ No ❏

12. When a patient has received an external injury, Answer: ,

which type of code is used to explain the mechanism
Why: E codes are supplemental codes that are used to
of the injury?
code external injuries rather than diseases.
A. V code
B. CPT code Review: Yes ❏ No ❏
C. UCR code
D. E code
E. NOS

13. Which CPT code identifies a sigmoidoscopy? Answer: +

A. 531.03
Why: Answer C is correct because it is the only five-
B. 453.30
digit number that is characteristic of a CPT code.
C. 45330
D. 685 Review: Yes ❏ No ❏

14. The CPT code used for a cholecystectomy, along Answer: -

with the modifier indicating that the physician
Why: Answer E is a CPT code indicating a procedure
provided only preoperative care, is which of the
and includes a dash and a two-digit modifier that identi-
following?
fies a specific circumstance. A and B are CPT codes
A. 47600
without modifiers. C is a HCPCS Level II code, recog-
B. 99201
nized by the letter J followed by four digits. D is a CPT
C. J3105
code with an attached ICD code, which is never done.
D. 47600-V59.2
E. 47600-56 Review: Yes ❏ No ❏

15. The components used to determine the level of Answer: ,

E&M code applicable include the following
Why: The E&M, or Evaluation and Management, codes
EXCEPT the:
require assessment of the visit and judgment of the
A. comprehensive depth of the patient history.
provider as to the depth of the visit, complexity of the
B. problem severity.
illness, and amount of time involved in treatment of the
C. amount of time spent with the patient.
patient.
D. number of procedures ordered for the patient.
Review: Yes ❏ No ❏

16. The Health Care Finance Administration is now Answer: +

named:
Why: The Health Care Finance Administration (HCFA)
A. Centers for Disease Control and Prevention.
has been renamed the Centers for Medicare and Medic-
B. Department of Health and Human Services.
aid Services, or CMS. This is the federal government
C. Centers for Medicare and Medicaid Services.
agency that oversees the regulations and policies for
D. National Institutes of Health.
Medicare and Medicaid.
E. American Medical Association.
Review: Yes ❏ No ❏
240 =VQ\ ■ Administrative Practice

17. The patient’s statement describing symptoms and Answer: ,

conditions that are the reason for seeking health
Why: The chief complaint is the primary reason that
care services is the:
brings the patient to the health care provider for
A. adverse effect.
treatment. The insurance company requires this
B. primary concern.
information to appear on the claim form.
C. objective finding.
D. chief complaint. Review: Yes ❏ No ❏

18. When a patient has a condition that coexists with Answer: *

his or her primary condition and complicates the
Why: Comorbidity occurs when the patient experiences
treatment and management of the primary
a complication in the treatment plan resulting from a
condition, it is referred to as:
condition other than the primary condition. This may
A. late effect.
actually lengthen a hospital stay.
B. comorbidity.
C. etiology. Review: Yes ❏ No ❏
D. critical care.
E. concurrent care.

19. Etiology is a term meaning: Answer: +

A. residual condition.
Why: Etiology is the study of all factors that may be
B. metastatic disease.
involved in the development of a disease.
C. cause of the disease.
D. prognosis of a disease. Review: Yes ❏ No ❏

20. The coding abbreviation NOS means: Answer: )

A. Not Otherwise Specified.
Why: NOS means “Not Otherwise Specified,” a term
B. No Objective Signs.
used in the ICD-9-CM coding system to indicate an
C. Nonspecific Objective Symptoms.
unspecified diagnosis.
D. Non Organic Syndrome.
E. Not Otherwise Classified. Review: Yes ❏ No ❏

21. When coding, the term describing a cancer that has Answer: +
not invaded neighboring tissues is:
Why: In situ refers to a neoplasm or new growth (tumor)
A. metastatic.
that is confined to the site of origin and has not spread
B. carcinoma.
or metastasized.
C. in situ.
D. benign. Review: Yes ❏ No ❏

22. The coding abbreviation NEC is used: Answer: )

A. if information is unavailable for more specific
Why: NEC means “Not Elsewhere Classifiable.” This
coding.
term is used in ICD-9-CM coding when information
B. to describe external injuries.
necessary to code the disease or injury in a more specific
C. to abbreviate normal causes for the disease.
category is not available.
D. when the patient is newly established.
E. if the patient has extensive injuries. Review: Yes ❏ No ❏
 +PIX\MZ ■ Medical Coding and Claims 241

23. The reference manual used to code a Answer: +

cholecystectomy is:
Why: The CPT manual is the Current Procedural Termi-
A. PDR.
nology book that contains procedures, including surgeries.
B. ICD.
A cholecystectomy is the surgical removal of the gallblad-
C. CPT.
der. If disease of the gallbladder—cholecystitis or
D. HCFA.
cholelithiasis—needs to be coded, the ICD manual is used.
Review: Yes ❏ No ❏

24. If a patient’s current injury is a fracture of the left Answer: -

ankle but he or she then experiences a malunion of
Why: A late effect is a problem that occurs after the orig-
this fracture, this is referred to as a(n):
inal problem. A malunion of a fracture means the
A. principal diagnosis.
fracture did not heal properly.
B. secondary complaint.
C. adverse effect. Review: Yes ❏ No ❏
D. concurrent care.
E. late effect.

25. A claim that is submitted to the carrier without Answer: ,

deficiencies or errors is called a:
Why: A clean claim means that the completed insurance
A. common claim.
claim form contains all the necessary information with-
B. customary claim.
out deficiencies so it can be processed and paid
C. managed claim.
promptly.
D. clean claim.
Review: Yes ❏ No ❏

26. A physician charging an unreasonable amount for a Answer: *

procedure is most likely an example of:
Why: Abuse is an unreasonable and generally unaccept-
A. fraud.
able departure from precedent and custom, with one
B. abuse.
person taking advantage of another person. Fraud is
C. upcoding.
intentional deceit resulting in harm and unlawful.
D. phantom billing.
Upcoding is selecting a higher level of care than actually
E. unbundling.
provided. Phantom billing is charging for services that
were not rendered. Unbundling is billing separately for
services that should have been billed under one code for
the sole purpose of making more money.
Review: Yes ❏ No ❏

27. Phantom billing is an example of: Answer: )

A. fraud.
Why: Phantom billing is charging for services that were
B. abuse.
not provided and is an unlawful intentional deceit.
C. upcoding.
D. unbundling. Review: Yes ❏ No ❏

28. All ICD-10-CM codes contain: Answer: ,

A three to five numeric digits.
Why: ICD-10-CM codes contain three to seven
B. three to five alphanumeric digits.
alphanumerical digits because that is how the coding
C. three to seven numeric digits.
system is designed.
D. three to seven alphanumeric digits.
E. seven alphanumeric digits. Review: Yes ❏ No ❏
242 =VQ\ ■ Administrative Practice

29. The final appeal for a denied CMS claim is Answer: ,

determined by the:
Why: The Attorney General and the Supreme Court do
A. Attorney General.
not become involved in Medicare/Medicaid claims. The
B. Supreme Court.
fourth level of appeal is with an Administrative Judge,
C. Administrative Judge.
and the final level of appeal is the Federal Court Review.
D. Federal Court Review.
Review: Yes ❏ No ❏

30. The ICD-10 is scheduled for full implementation Answer: -

in the United States on:
Why: October 1, 2013 is the date designated by the fed-
A. January 1, 2012.
eral government to provide organizations with enough
B. April 15, 2012.
time for implementation. October 1 is also the
C. January 1, 2013.
beginning of the federal fiscal year.
D. April 15, 2013.
E. October 1, 2013. Review: Yes ❏ No ❏
 Financial Practices
15

: - > 1 - ?  < 1 8 
You’ve worked hard and made it this far. Good work! An unknown author said, “You can be on the
right track but you can still get hit if you just sit there.” So keep going!

Chapters 13 and 14 described how physician fees are ■ Accounting functions

established and reimbursement is obtained through • Entries—recording of each transaction
insurance companies using claims and coding. This
chapter concentrates on the day-to-day financial prac- • Postings—transferring information from the journal
(day sheet) to the accounts receivable ledger or to
tices in the medical office.
the individual patients’ ledgers
• Adjustments—changes made to the amount
of money owed for reasons other than additional
)++7=6<; services or payments, such as fee discounts or
refunds
Accounts are records of financial transactions and the
resulting balances during a fiscal period, usually Janu- • Billings—records of charges sent to the patient in the
ary 1st through December 31st. The medical office form of statements to indicate balance due and to
primarily deals with two types of accounts: accounts request payment; most practices bill on a monthly
receivable, which is the money owed to the practice cycle
(e.g., patient bills), and accounts payable, which is the • Balancing—ensuring accuracy in totals by compar-
money the practice owes (e.g., rent, utilities, medical ing them with preestablished criteria (e.g., in
supplies, payroll). The following accounting functions accounts receivable, the total of balances from indi-
apply to both accounts receivable and accounts vidual patient statements must equal the total of
payable. accounts receivable recorded in the journal)


244 =VQ\ ■ Administrative Practice

■ Accounts receivable • Collections—efforts to obtain money owed to a

• Components medical office
❍ Day sheet—a daily record of the services ren- ❍ Office efforts can include payment by cash, check,
dered, charges made, and payments received; may or charge at time of service; payment plans with or
be a manual or a computerized system without interest; payment through billing, by
❍ Journal—a chronologic collection of the day
billing all patients on the same day each month or
sheets with running totals for a specific period by cycling patients for billing on different days of
the month based on preestablished criteria, such
❍ Accounts receivable ledger—a listing by individual
as billing those whose names begin with certain
patient names of all monies owed to the practice letters on the same day; and telephone calls and
❍ Patient ledger—a patient statement or itemized letters for aging bills
statement that is an individual form of each ❍ Collection agency—an outside company, inde-
patient’s accounts receivable activities; often used pendent of the medical practice, that is contracted
as the patient bill by the medical practice to attempt to obtain pay-
❍ Charge slip—a form given to the patient to indi- ment of delinquent bills after internal efforts have
cate the charges for the service(s); may be a copy failed; a medical practice should not make fur-
of the superbill or the patient ledger ther efforts to collect a bill after the account is
❍ Receipt—a numbered form given to the patient turned over to the collection agency; collection
indicating the payments he or she made that day agencies are usually paid 50% of the amount col-
❍ Pegboard system—a system of layered forms that
lected
allows all transactions to be completed at one time ❍ Small claims court—a less formal court setting
(Fig. 15-1); composed of day sheet, patient ledger, that allows the parties to represent themselves in
charge slips, receipts, and day sheet–sized board civil disputes involving small amounts; the amount
with pegs to hold forms in place is designated by the court and is generally less
than $5,000
• Age of accounts receivable—the period between
when the service is rendered and the bill is paid, usu- ❍ Bankruptcy—if a patient declares bankruptcy, the
ally in 30-day intervals; computerized financial pro- medical office must attempt to collect unpaid bills
grams will process statements calculating the through the court-appointed representative
amount of money that is owed on the account for 30, ❍ Deaths—unpaid bills of deceased patients should
60, 90, or 120 days since the date of service; also be collected through the patient’s estate
known as aging analysis ■ Accounts payable
• Monthly trial balance—a list and total of all the debit • Purchase order—a document sent to a vendor via
and credit accounts for the medical practice; usually mail, fax, or the Internet to purchase supplies and
a two-column chart with debt listed in one column equipment for the medical office
and credit listed in the other column; a monthly trial
balance ensures that debits equal credits • Invoice—a bill sent from the vendor stating what
was purchased and the charges
• Materials—items received from the vendor should
be verified with the invoice or packing list and pur-
chase order
• Bill—statements sent to the medical office request-
ing payment for materials or services
• Payment—money remitted by the medical office for
materials or services
• Petty cash—a small sum of money (usually less than
$200), kept separate from the cash drawer, used for
incidental expenses (e.g., postage due)

*)6316/
■ Checks
• Payee—the person to whom the check is written; the
.QO]ZM Pegboard system. person receiving the money
 +PIX\MZ ■ Financial Practices 245

• Payer—the person or organization giving the money *W`

to the payee
-`IUXTMWN5IQV+WUXWVMV\[WN+PMKSQVO
• Acceptable checks—cashier’s check, traveler’s check, )KKW]V\:MKWVKQTQI\QWV
certified check, personal check with proper identifi-
cation, money order
Unacceptable checks—third-party checks (except 1. Beginning balance $25,000.00
•
from the patient’s insurance company), payroll 2. Total deposits 45,000.00
checks, personal checks without identification if 3. Total checks cleared –35,000.00
unfamiliar with the person and his or her financial 4. Total checks outstanding –10,000.00
history with the medical practice 5. Charges 00.00
Ending balance $25,000.00
• Voided check—a check written by the practice but
not used because of error or other reason; write To determine the ending balance, add lines 1 and 2,
VOID across the front and keep with canceled and then subtract lines 3, 4, and 5 from the total of
checks in the proper numeric sequence lines 1 and 2.
• Lost or stolen check—the bank should be notified
immediately and a notation made in the checkbook as needed until the maximum amount has been
• Endorsement—signing the back of a check as the reached
payee for the amount represented on the front of the
check
❍ Blank endorsement—only the signature of the
+75576<)@-;
payee on the back of the check (can be easily The federal and state governments require medical
cashed by anyone) offices to pay specific taxes. The most common and
❍ Restrictive endorsement—signature of the payee “exam probable” taxes follow.
with instructions, such as “for deposit only”
■ Federal income tax—a specified percentage of income
• Nonsufficient funds (NSF)—indicates that the withheld based on total amount earned
checking account on which the check is written does
not hold enough money to honor the amount of the • W-2 form—a federal tax form prepared for each
check; medical offices usually add a charge to the office employee containing all income and deduc-
balance to cover the associated bank charges tions for the previous calendar year
■ Deposits—checks and cash paid to the medical office • W-4 form—a federal tax form for each employee
and placed in a checking account at the bank; usually that contains the number of tax exemptions he or she
deposits are made daily claims
• Deposit slip—a form completed with the deposit ■ Federal Insurance and Contribution Act (FICA)—a
listing all checks and cash and the total amount percentage of income withheld for Social Security and
deposited; contains account number and other iden- Medicare
tifying information ■ Federal Unemployment Tax Act (FUTA)—a percent-
• Check register (checkbook)—a book or computer age of each employee’s income paid by employer for an
program maintained by the office listing in chrono- unemployment fund
logic order all checks written, deposits made, and an
ongoing balance; used to reconcile bank statement
■ Bank statements—reports sent by the bank listing the 16+75-
monthly account activities, including checks written The amount of money a medical practice earns is the
and cashed, deposits, bank charges, and balances income (accounts receivable). The practice also incurs
■ Reconciliation (balancing or trial balancing)—process expenses such as wages, taxes, supplies, equipment, and
of verifying that the information on the bank state- utilities (accounts payable). Certain additional deductions
ment tallies with the information in the check register (e.g., bad debts) are allowed in addition to expenses.
(Box 15-1) These are deducted from the total income.
■ Line of Credit—a financial agreement between a
bank or financial institution and a borrower estab- ■ Gross income—total amount of earned income for the
lishing the maximum amount of money the borrower medical practice before deductions
can obtain through a loan; the total amount of the ■ Net income—amount of earned income for the med-
funds may be borrowed at one time or in increments ical practice after deductions (Box 15-2)
246 =VQ\ ■ Administrative Practice

*W` debit value subtracted from or owed by an account

endorsement signing the back of a check as the payee
-`IUXTMWN/ZW[[IVL6M\1VKWUM,QNNMZMVKM for the amount represented on the front of the check
entry the recording of each transaction on the appro-
Gross income $250,000 priate forms or components
Deductions & expenses –75,000 gross income the total amount of income for the med-
Net income $175,000 ical practice before deductions
income the amount of money a medical practice earns
invoice a bill sent from a vendor stating what was pur-
TERMS chased and what the charges are
journal a chronologic collection of day sheets with run-
Financial Practices Review
ning totals for a specific period
The following list reviews the terms discussed in this liability obligation; debt of the individual or business
chapter and other important terms that you may see on line of credit a financial agreement between a bank or
the exam. financial institution and a borrower establishing the
accounts records of financial transactions and the maximum amount of money the borrower can obtain
resulting balances during a fiscal period, usually through a loan
January 1st through December 31st monthly trial balance a list and total of all the debit
accounts payable the money the practice owes (e.g., and credit accounts for the medical practice
rent, utilities, medical supplies, payroll) net income the amount of income for the medical
accounts receivable the money owed to the practice, practice after deductions
such as patient bills patient ledger a patient statement that is an individual
accounts receivable ledger listing by individual form of each patient’s accounts receivable activities;
patient name of all monies owed to the practice often used as the patient bill
adjustments changes to the amount of money owed for payee the person to whom the check is written; the
reasons other than additional services or payments person receiving the money
(e.g., fee discounts, refunds) payer the person or organization giving the money to
age of accounts receivable (aging analysis) the period the payee
between when the service is rendered and the bill is pegboard system a system of layered day sheets,
paid, usually in 30-day intervals; computerized finan- patient ledgers, charge slips, and receipts; allows all
cial programs will process statements calculating the entries to be made with one transaction
amount of money that is owed on the account for 30, petty cash a small sum of money (usually less than
60, 90, or 120 days since the date of service $200), separate from the cash drawer, used for inci-
asset anything of value owned by an individual or busi- dental expenses
ness posting transferring information from the journal (day
balancing ensuring accuracy in totals by comparing sheet) to the accounts receivable ledger or to the
them with preestablished criteria; in accounts receiv- individual patients’ ledgers
able, the total of balances from individual patient purchase order a document sent to a vendor via mail,
statements must equal the total of accounts receiv- fax, or the Internet to purchase supplies and equip-
able recorded in the journal ment for the medical office
blank endorsement only the signature of the payee reconciliation the process of verifying that the infor-
appears on the back of the check mation on the bank statement agrees with the infor-
credit value added to an account, usually in the form of mation in the check register
payment for a debt owed to that party restrictive endorsement signature of the payee with
currency official paper money of a country instructions (e.g., “for deposit only”)
day sheet a daily record of the services rendered, superbill (encounter form) a provided form that has
charges made, and payments received; may be a all the necessary information to file an insurance
manual or computerized system claim related to that office visit
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA), RMA (AMT), and CMAS (AMT) exams.

1. The patient’s bill or statement is also referred to as Answer: +

the patient’s:
Why: A patient’s ledger is an individual form containing
A. receipt.
each patient’s accounts receivable activities.
B. charge slip.
C. ledger. Review: Yes ❏ No ❏
D. posting.

2. The listing by individual patient names of all monies Answer: -

owed to the practice is the:
Why: Accounts receivable refers to the money owed to
A. receipt.
the practice by patients. These amounts are recorded in
B. charge slip.
a ledger called the accounts receivable ledger.
C. day sheet.
D. accounts payable roster. Review: Yes ❏ No ❏
E. accounts receivable ledger.

3. A check written from an account that does not have Answer: *

enough money for the amount of the check is
Why: When there is not enough money in an account to
called a(n):
cover the amount of a check, the bank account has non-
A. voided check.
sufficient funds (NSF) to cover the check.
B. NSF check.
C. blank check. Review: Yes ❏ No ❏
D. third-party check.

4. The Federal Insurance and Contribution Act was Answer: +

created to sponsor:
Why: The Federal Insurance and Contribution Act
A. unemployment.
(FICA) requires deduction from an employee’s pay to
B. life insurance.
cover the cost of sponsoring Social Security and
C. Social Security and Medicare.
Medicare.
D. workers’ compensation.
E. Medicare. Review: Yes ❏ No ❏

5. The process of verifying that the information on the Answer: +

bank statement agrees with the information in the
Why: Reconciliation is the process of making things
check register is:
right. The balance in the checkbook should equal the
A. registering.
balance on the bank statement after adjustments have
B. accounting.
been made for outstanding checks and deposits.
C. reconciling.
D. examining. Review: Yes ❏ No ❏


248 =VQ\ ■ Administrative Practice

6. When a discount or refund is applied to an account, Answer: *

this is referred to as a(n):
Why: When a medical practice applies a discount or
A. charge.
refunds money to an account, it is making an adjustment
B. adjustment.
to the total amount owed by the client. Another example
C. payable.
is when a client pays his or her balance in full and then
D. receivable.
the medical practice receives an insurance payment to
E. withholding.
cover some or all of the visit; the patient should be
refunded the overpayment.
Review: Yes ❏ No ❏

7. Activities that an office can do to assist in the Answer: +

collection of money owed the practice include:
Why: Patients should be asked at the time of service
A. allowing patients to pay for services when they
what method of payment they want to use to pay for the
get paid.
services. This allows the office to establish that it is nec-
B. requiring all patients to pay cash when services
essary to pay for services at the time they are rendered.
are rendered and not providing any payment
If a patient is unable to pay in full, billing for the balance
plans.
should be done on a monthly basis.
C. asking patients at the time of service if they want
to pay for the services by cash, check, or charge. Review: Yes ❏ No ❏
D. sending billing notices to patients on a quarterly
basis.

8. When a patient declares bankruptcy, the medical Answer: ,

office must:
Why: After bankruptcy has been declared, the office is
A. turn over the patient’s balance owed to a
not allowed to contact the patient directly but must
collection agency.
attempt to collect any debt through the court-appointed
B. write off the balance of the account.
representative.
C. sue the patient for the balance owed on the
account. Review: Yes ❏ No ❏
D. collect unpaid bills through the court-appointed
representative.
E. set up a loan repayment plan with interest.

9. The form enclosed with merchandise ordered from Answer: *

a vendor that states the contents of the package and
Why: The invoice usually accompanies the merchandise
the amount owed is a(n):
and includes the total amount due on the order. A ledger
A. ledger.
is a list of the accounts receivable activities for a patient
B. invoice.
or a company. A purchase order is a document sent to a
C. purchase order.
vendor to purchase supplies and equipment for the med-
D. receipt.
ical office. A receipt is given as proof of payment.
Review: Yes ❏ No ❏

10. If a check is written but not used, what is written Answer: )

across the front of the check?
Why: The word “void” means useless or invalid. A
A. Void
voided check should be filed with the canceled checks
B. Nonsufficient funds
for tracking purposes.
C. Do not use
D. Error Review: Yes ❏ No ❏
E. Reconcile
 +PIX\MZ ■ Financial Practices 249

11. The amount of money earned before taxes or Answer: ,

deductions are taken out is called:
Why: The gross income refers to the entire amount of
A. net income.
money earned by an employee or the amount of income
B. total income.
in a business before expenses, deductions, or taxes have
C. prior earnings.
been subtracted.
D. gross income.
Review: Yes ❏ No ❏

12. The cash kept on hand in a business practice used Answer: *

for incidental purchases is called:
Why: “Petty” refers to a small amount. Petty cash is usu-
A. purchase order.
ally around $200 cash and is used to purchase items that
B. petty cash.
are needed on a daily basis that are paid for right away.
C. ancillary money.
Postage stamps, coffee supplies, office supplies, and so
D. spending money.
on are often bought with petty cash.
E. currency.
Review: Yes ❏ No ❏

13. The money owed by the physician for items such as Answer: ,
rent, utilities, and payroll is referred to as:
Why: Accounts payable refers to the amount of money
A. financial responsibility.
the physician or business owner needs to pay out for
B. accounts receivable.
expenses of the business.
C. business expenses.
D. accounts payable. Review: Yes ❏ No ❏

14. To balance a checkbook, you must have: Answer: +

A. a copy of all the bills paid in the month to
Why: The bank sends a monthly statement that lists all
verify all checks written.
deposits made, checks written and cashed, bank charges
B. paycheck stubs to prove deposits made.
and fees, and the beginning and ending balance on the
C. the monthly bank statement.
account for the month. This statement is used to
D. a copy of all endorsed checks.
compare with the check register to balance it.
E. day sheets.
Review: Yes ❏ No ❏

15. The signature of the payee of a check with Answer: +

instructions stating “for deposit only” is an example
Why: A check that has a signature and “for deposit only”
of a(n):
on the reverse side indicates that it can only be
A. blank endorsement.
deposited into the account of the payee, making it a
B. unlimited endorsement.
restrictive endorsement. If the payee signs the check
C. restrictive endorsement.
without writing any restrictions, it can be cashed by any-
D. registered endorsement.
one if lost or stolen.
Review: Yes ❏ No ❏

16. The monitoring of unpaid accounts to determine Answer: -

how overdue the accounts are is called:
Why: Aging of accounts is a way to monitor the ability of
A. posting.
offices to collect money on unpaid accounts. Usually the
B. calendar tracking.
practice will measure in 30-day intervals up to 120 days.
C. collections.
D. overdue auditing. Review: Yes ❏ No ❏
E. aging accounts.
250 =VQ\ ■ Administrative Practice

17. The most common schedule of billing patients is: Answer: *

A. weekly.
Why: Monthly billing is the most accepted method of
B. monthly.
billing because it is highly effective in collection of
C. bimonthly.
unpaid debts. Most people pay bills based on monthly
D. quarterly.
income and, if budgeted properly, will schedule
payments on owed accounts monthly.
Review: Yes ❏ No ❏

18. When the medical assistant is given the task of Answer: ,

trying to collect payment on an account, it is
Why: It is improper collections activity to contact some-
appropriate practice to first:
one before 8:00 AM or after 9:00 PM. It is also
A. contact the client’s employer.
inappropriate to visit patients at their homes or to con-
B. contact the client at home before 8:00 AM.
tact a client’s employer. Threatening calls are a form of
C. leave a message on the client’s answering
harassment and intimidation and should not be made.
machine about possible lawsuits or small claims
Initially, the office should try to collect the money
court activity if he or she does not call you back.
through written correspondence. This method also pro-
D. contact the client about the overdue bill through
vides a paper trail for tracking if further collection
a mailed letter or notice attached to his or her bill.
methods need to be tried.
E. visit the patient at his or her home to discuss a
payment plan. Review: Yes ❏ No ❏

19. When a charge is made to an account, it is called Answer: +

a(n):
Why: A debit is a charge to an account and represents
A. posting.
what is owed. Posting is the process of transferring
B. credit.
information from a day sheet to an accounts receivable
C. debit.
ledger or to an individual patient’s ledger. A credit is the
D. adjustment.
same as a payment, or applying money to an account to
lower the balance owed. An adjustment is a change made
to the amount of money owed for reasons other than
additional services or payments.
Review: Yes ❏ No ❏

20. A preprinted form that has the basic office charges Answer: ,
listed and space for the patient’s current charges is
Why: A superbill is usually a three-copy form that has all
an example of a(n):
the necessary information for the patient to use in filing
A. ledger.
an insurance claim. It states the coding for the office visit
B. journal.
with diagnosis and the amount charged for the services
C. day sheet.
during the visit. Most superbills also have a place to put
D. superbill.
information about the patient’s return or follow-up visit.
E. invoice.
Review: Yes ❏ No ❏

21. An example of a debit adjustment is: Answer: +

A. applying a professional discount to the account.
Why: A debit adjustment increases or adds to the
B. posting the payment made from the patient’s
patient’s account balance. When a patient’s check is not
insurance company.
honored by the bank because there are not enough
C. return of a nonsufficient fund check from a
funds in the account to cover the amount, the office will
patient’s bank.
apply the amount of the check back to the account. The
D. removing a charge from a patient’s account that
payment is eliminated, and the patient owes the amount
was placed there by mistake.
of the check plus an additional fee.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Financial Practices 251

22. When a check is received in the office, the medical Answer: *

assistant should first:
Why: Checks received in the office should be
A. place the check in a cash lockbox.
immediately endorsed “for deposit only” so no one
B. endorse the check in writing or with a rubber
would be able to cash the checks if the checks were lost
stamp reading “for deposit only.”
or stolen.
C. contact the bank to verify the funds are in the
account. Review: Yes ❏ No ❏
D. enter the receipt of the check in the patient’s
medical chart.
E. process a receipt to send to the patient.

23. To reconcile a checking account, you must: Answer: )

A. ensure that the information on the bank
Why: The purpose of reconciling a checking account is
statement agrees with the information in the
to ensure that the information contained on the bank
check register.
statement agrees with the information in the check reg-
B. add to the checkbook balance any monthly fees
ister. Steps in reconciling that account include subtract-
or bank charges that are listed on the bank
ing monthly fees or charges from the checkbook
statement.
balance, subtracting outstanding checks from the bank
C. add any outstanding checks to the bank
statement balance, and adding the amount of interest
statement balance.
earned to the checkbook balance.
D. add to the bank statement the amount of interest
earned on the account that month. Review: Yes ❏ No ❏

24. The amount of money an employee is paid after Answer: ,

taxes are withheld is called:
Why: The gross income is the amount of money earned
A. gross income.
before tax withholding. The wage is the amount of
B. tax withholding.
money earned by the employee, usually based on an
C. wage.
hourly rate. Net income is known as “take home” pay
D. net income.
after all the taxes and other deductions have been
E. deduction.
subtracted from the gross amount. A deduction is any
amount of money taken out of the total income. Deduc-
tions may include state and federal taxes and insurance
premiums.
Review: Yes ❏ No ❏

25. At the end of each calendar year, the employer is Answer: *

required to provide a statement to each employee of
Why: The W-4 form is the Employee’s Withholding
the year’s total gross income and the taxes withheld.
Allowance Certificate. The employee completes this
This form is the:
form when employed and specifies the amount of deduc-
A. W-4.
tions claimed for tax purposes. A W-2 form is issued to
B. W-2.
the employee at the end of each year to show the
C. FICA.
amount of money the employee earned during the year.
D. FUTA.
It is required as proof of income when filing income tax.
The Federal Insurance and Contribution Act (FICA)
was developed to sponsor Social Security and Medicare.
The Federal Unemployment Tax Act (FUTA) requires
employers to pay a percentage of each employee’s
income to sponsor an unemployment fund.
Review: Yes ❏ No ❏
252 =VQ\ ■ Administrative Practice

26. If a medical practice periodically had unexpected Answer: -

expenses and needed a loan, the practice owner
Why: A line of credit is an established amount of money
could apply for:
that a bank will loan a borrower. It can be used all at
A. additional petty cash.
one time or in increments as needed. Petty cash is a
B. a withholding allowance.
small amount of cash kept on hand in the office for
C. an endorsement.
small purchases. Withholding allowance refers to
D. reconciliation.
money held out of earnings for tax purposes. Endorse-
E. a line of credit.
ment is the act of signing the back of a check as the
payee for the amount represented on the front of the
check. Reconciliation is the process of verifying that the
information on the bank statement agrees with the
information in the check register.
Review: Yes ❏ No ❏

27. A chart or table that includes a list and total of all Answer: ,
the debit and credit accounts for a medical practice
Why: A monthly trial balance is a chart of all the debits
is a/an:
and credits for the practice and is used to ensure that the
A. check register.
practice debits equal the credits. A check register is a log
B. pegboard daysheet.
of all the activity of the checking account. A pegboard
C. aging analysis.
daysheet lists patient charges and payments made in a
D. monthly trial balance.
single day for the practice. Aging analysis is the process
of determining the period between when the service is
rendered and the bill is paid, usually in 30-day intervals.
Review: Yes ❏ No ❏
 Practice Management
16

: - > 1 - ?  < 1 8
Dependingg on the size of the practice, many manage g ment functions may be delegag ted to other
departments and positions. An example is human resources. Questions involving these areas are
incorporated into the role of practice management. Do not be confused if the manager where you
work or completed your externship performs more or less of the functions that are included in this
chapter. Also, do not be confused if the person in charge of your medical office has a different title
such as practice or office administrator or executive or director. For the purposes of the national
exams, the terms practice management and medical office management are used. If your
medical office manager is not aware that you are preparing to take the national exam, this may
be an opportunity to tell him or her and ask for any encouragement or advice that he or she may
have.

Today’s medical offices may be owned by a physician or laboratory, billing, and so on. In multispecialty organi-
corporation where the physician is not an owner but a zations, clinical supervisors may be designated by
contracted employee. One person is in charge of over- specialty, such as pediatrics, internal medicine, and
seeing the day-to-day operations, the medical office cardiology.
manager. Depending on the size of the practice,
other supervisory personnel may report to the practice
manager. Each supervisor would then have staff
reporting directly to him or her. Additional supervi-
7:/)61B)<176
sory staff titles include clinical team leader or supervi- Every medical office has an organizational model that
sor or manager; administrative team leader or may or may not be represented by a formal organiza-
supervisor or manager; and supervisors or managers tional chart. The chart shows the supervisory structure
of various departments such as human resources, and reporting relationships between different functions


254 =VQ\ ■ Administrative Practice

board of directors is ultimately responsible but is not

Physician
involved in the daily operations of the company.
The organizational charts reflect the chain of com-
mand, which demonstrates how each position is
Practice
accountable to those directly superior and how the
Manager
authority passes from one link in the chain to the next, or
from the top to the bottom. Today’s businesses, including
Medical Other Clinical Business medical offices, operate using a chain of command. It is
Assistant Staff Staff important for employees to understand the chain of
.QO]ZM Organizational chart of physician-owned medical practice. command and stay within it. Questions regarding the
chain of command may be on the exam.

and positions—who is responsible for whom and what.

In most states, the medical assistant is under the direct 5)6)/-5-6<;<A4-;
supervision of the physician and/or midlevel providers, Managers tend to direct or lead using a specific manage-
such as the physician assistant or nurse practitioner, for ment or leadership style. Many names are associated
direct patient care activities. The practice manager is with the styles, but four are most common. A manager
usually responsible for interviewing, hiring, firing, evalu- usually gravitates to one style but may use a combination
ating, assuring training, and credentialing medical assis- of the styles depending on the situation and group of
tants, which are all considered administrative functions employees:
and not direct patient care functions. Figure 16-1 is a
simplified organizational chart of a physician-owned ■ Autocratic—the manager makes all the decisions
practice. A physician-owned medical practice often has (autocratic directive); appropriate when rapid deci-
the legal designation of a professional corporation (PC). sions must be made; an autocratic manager may make
Figure 16-2 shows a simplified organizational chart of decisions but allows staff some autonomy in carrying
a corporate-owned medical facility. The company may be out the work (autocratic permissive)
for profit or nonprofit. Again, the practice manager is in
■ Democratic (participatory or teamwork)—staff
charge of the day-to-day operations, with the exception
takes part in the decision making; democratic man-
of the direct patient care functions of the medical assis-
agers may monitor staff closely (directive) or not (per-
tants, the physicians, and the midlevel providers who are
missive); should not be used when there is not enough
accountable to the medical director. The dotted lines
time to get appropriate employee input; this style
between the practice manager and the medical director
helps employees grow and develop
indicate equality in rank and collaboration between the
roles. The dotted line from the practice manager to the ■ Bureaucratic—the manager “goes by the book”; fol-
other physicians indicates collaboration. For example, lows procedures exactly and generally does not like
the practice manager may ensure the physicians are making complex decisions; best for training situations
properly credentialed. The medical director has the and working with precise tasks
majority of the responsibilities for the physicians such as ■ Laissez-faire—the manager provides very little lead-
schedules and evaluations. The president, practice man- ership and gives employees lots of leeway; employees
ager, medical director, and other physicians and staff are may feel insecure and lack confidence in the manager;
employees of the company and paid by the company. A this style works best in creative fields

CEO Board of
or Directors
President

Medical Practice
Director Manager

Physicians Medical Other Clinical Business

PAs Assistant Staff Staff
NPs

.QO]ZM Organizational chart of corporate-owned medical practice.

 +PIX\MZ ■ Practice Management 255

+755=61+)<176 often excellent problem-solving techniques. The role

of the manager is also to assure that all communica-
Chapter 7 discusses general communication techniques tion is appropriate, respectful, timely, and Health
and communication with patients, persons with special Insurance Portability and Accountability Act (HIPAA)
needs, and coworkers. The practice management position compliant. Many offices have policies and procedures
requires excellent verbal and written communication and related to communication, especially electronic com-
interpersonal skills. Some of the routine individuals and munication.
groups with whom the practice manager communicates
on a regular basis are:

■ Staff
STAFF COMMUNICATION
A
■ Patients The following are communication modalities often used
with staff.
■ Physicians (within the practice and in other practices)
■ Hospitals ■ Staff meetings
■ Insurers
• Agenda—the list of meeting topics and the order in
■ Vendors which they will be addressed (Fig. 16-3)
■ Employers • Minutes—the meeting record, including the date
■ Contractors and time, who was present and absent, what was dis-
cussed, and who was responsible for any actions
■ Governmental agencies
■ In-service—facilitating and communicating educa-
■ Other regulatory and professional agencies
tion and training conducted in the facility
■ Educational facilities
■ E-mail—a large number of offices have e-mail for each
■ Bankers employee or group of employees
■ Attorneys ■ Newsletters—provide information on what is going on
■ Community organizations in the practice, new policies and procedures or
requirements, accomplishments and awards, and inter-
Communicating with each individual and group nal and community events; also often highlight staff
requires knowledge of the business or situation and members or departments

Valley Health Care: Staff Lounge

Staff Meeting Agenda
November 1, 20XX
12:00 to 1:30 p.m.
Lunch provided

Introductions Dan Martinez

Staff News All
Quality Assurance Report Susan Kuchara
Policy and Procedure Update Dan Martinez
EHR Committee Report Vrushti Patel
Report from AHIMA Conference Shondeen Roberts
Old Business:
■ Extending office hours Dan Martinez
■ Upcoming flu shot clinic Susan Kuchara
New Business:
■ Holiday party Dan Martinez
Other
Adjournment
Next meeting December 2, 20XX 12:00 to 1:30 p.m.

.QO]ZM Staff meeting agenda.

256 =VQ\ ■ Administrative Practice

■ Bulletin boards—usually located in the staff lounge; include such items as salaries with potential raises,
should not contain any confidential or sensitive infor- rent, utilities, supplies, equipment rental and purchase,
mation because janitorial staff and others outside of technology costs, insurance and business fees, taxes,
the practice may have access contracted services such as janitorial support, and oth-
■ Communication books—becoming replaced with elec- ers. The manager reviews the commercial health care
tronic communication; a notebook or binder with insurance and governmental agency patient care con-
information the manager wants to inform the staff tracts and other sources of income such as sports phys-
about is kept in a central location; employees may be icals. He or she estimates the number of patients from
required to initial each entry to assure it was read each entity and then calculates the anticipated reim-
bursement or payments. This is the projected revenue.
■ Open door policy—a y practice giving staff the free-
Sometimes the manager must renegotiate the contract
dom to come talk with the manager any time that the
if costs have risen. If revenues are lower than expected
office door is opened
and the expenses are higher, the manager makes the
■ Suggestion box—staff submit ideas in a box with a decisions on what to cut back on, such as supplies and
name or anonymously salaries, to balance the budget.

4-/)4)6,*=;16-;;.=6+<176; SCHEDULING AND TRAVEL

Another role of the practice manger is to assure compli- Ensuring that adequate staff are on duty at all times for
ancy with legal requirements and the standard for med- the business to function properly is an additional aspect
ical and business practices. This responsibility involves of the practice manager’s role. Scheduling is a job that
many systems and processes. Some of the more common may be relegated to a supervisor or other person depend-
ones are assuring that: ing on the size of the practice but is monitored by the
manager. Often physicians and other staff, such as med-
■ Policy and procedure manuals are developed, main- ical assistants, travel for educational purposes with
tained, reviewed, and updated (usually annually) expenses covered by the practice. Planning for staffing
■ Physicians and midlevel providers are properly licensed the office when personnel are gone may be necessary. In
addition to staffing, the following are some travel-related
■ Physician and midlevel provider Drug Enforcement
responsibilities:
Administration (DEA) forms are up-to-date
■ Medical assistants, phlebotomists, coders, and other per- ■ Travel and lodging accommodations; may be done
sonnel are properly trained and certified or credentialed through a travel agent; online websites are common;
according to federal, state, and professional standards food may be paid for on a per diem basis, which means
■ Required licenses to operate the facility, such as local a certain money amount is designated either daily or
business licenses, are up-to-date per meal
■ Centers for Medicare and Medicaid Services (CMS) ■ Itinerary preparation, which is the schedule of travel
and accrediting approvals are in place and up-to-date and events, with arrival and departure times and other
■ Insurance requirements such as malpractice and liabil- specifics such as contact numbers
ity contracts are up-to-date and reflect current values ■ Speaker accommodations for physicians or other staff
■ Contracts with health insurance companies, laborato- presenting at conferences or other events, which may
ries, attorneys, and other services necessary to conduct include arranging for media, creating biographies and
business are in place presentation material such as PowerPoint presenta-
tions, and copying and shipping handout materials
■ Required reporting to authorities, such as communica-
ble diseases, is in compliance

OTHER BUSINESS FUNCTIONS

BUDGET AND OVERALL FINANCES The contemporary medical office relies on technology
for communication, appointment scheduling, coding,
A budget is created annually and reviewed at least billing, diagnostic test ordering and reporting, prescrip-
monthly. The budget is the predicted expenses and tion refills, and the electronic health record. These areas
revenues to operate over a given period of time. First, require highly specialized skills to install and maintain.
the manager must know the total expenses, which The office manager:
 +PIX\MZ ■ Practice Management 257

■ Evaluates and purchases the systems that fit the needs ■ Recruiting staff
and budget of the practice ■ Verifying qualifications and credentials
■ Facilitates the installation and staff training ■ Interviewing (Box 16-1)
■ Oversees the ongoing operations ■ Hiring
■ Terminating the employee following a process (unless
Other managerial functions include assuring mailing and the offense is very serious, and then termination may
shipping services, inventory and supply purchase, and be immediate):
appropriate market and public relation strategies such as
websites, brochures, and community events. • First offense: brings undesirable behavior to the
attention of the staff member
• Second offense: gives verbal or written warning
0=5)6:-;7=:+-; • Third offense: gives written warning if verbal warn-
ing was previously given
Human resources (HR), personnel services, or people
• Fourth offense: terminates the employee
services refers to how employees are managed by the
business and deals with the following.
■ Performing staff evaluations and an improvement
process as necessary:
■ Writing job descriptions, which should contain:
• Discusses the need for improvement with employee
• Name of organization
• Writes an improvement plan/contract with the
• Name of position employee
• Grade, if appropriate • Provides additional training as needed
• Summary of position • Follows progress at scheduled intervals
• Job responsibilities • Terminates employee if improvement plan/contract
• Requirements and qualifications not met
• Title of supervisor ■ Orienting new staff

*W`
1V\MZ^QM_QVO<WXQK[\W)^WQL
The U.S. Equal Employment Opportunity Commission (EEOC) prohibits discrimination in hiring. The follow-
ing topics should be avoided when interviewing a job applicant to assure the applicant’s rights are not violated.

RACE BIRTHPLACE

SEX NATIONAL ORIGIN

(may ask for proof that the applicant has
authorization to work in the United States)

COLOR MARITAL/FAMILY STATUS

(do not ask if the applicant has children)

DISABILITY AGE
(may ask if the applicant has anything that may (may ask for proof that applicant is over 18 years
prevent him or her from fulfilling the job of age if appearance justifies it and necessary
requirements) for position)

RELIGION IF THE APPLICANT HAS OR HAS HAD

EEOC MATTERS
258 =VQ\ ■ Administrative Practice

■ Managing payroll and benefits including following efficient workplace the practice manager facilitates the
workers’ compensation cases of office employees following.
■ Setting policies involving personnel issues such as an
employee grievance process ■ Utilization of space

■ Maintaining staff records such as performance evalua- ■ Payment of mortgage or rental, utilities, etc.
tions, trainings, and employee health ■ Selection and purchase or lease of capital equipment
■ Assuring compliance with federal, state, and local such as copy machines and telephone systems
income taxes and other regulations related to ■ Establishment of contracts and oversight of janitorial,
personnel biohazardous waste disposal, and other services
■ Mediating appropriate issues between staff members ■ Required maintenance of elevators and heating, air
conditioning, and other equipment; pavement of park-
Once again, depending on the size of the organization, ing lot; replacement of light bulbs
all of these responsibilities may fall on the practice man- ■ Replacement of worn furniture, carpeting, etc.
ager. Larger organizations have a separate department
■ Compliance with Americans with Disabilities Act (ADA)
with its own director, manager, supervisor, or coordina-
requirements
tor. This person generally reports to the practice man-
ager. Some offices contract out many HR services such as ■ Availability of adequate supplies and materials
payroll. ■ Emergency repairs such as clogged drains
■ Security
■ Landscape maintenance
0-)4<0)6,;).-<A ■ Plans for future needs
Regulations from the Occupational Safety and Health
These elements interface with other legal, business, and
Act (OSHA) and state and local authorities regarding a
health and safety responsibilities. The practice manager
safe work environment must be followed. The practice
must have the capability of “wearing many hats,” which
manager assures compliance by:
requires the ability to prioritize and perform more than
one task at a time. This referred to as multitasking or
■ Developing policies and procedures (P&P), which are
being multifocal.
then incorporated in a safety manual
■ Establishing systems to accommodate P&P, for exam-
ple, establishing a contract with a biohazardous waste TERMS
company that includes containers, a schedule, and
removal Practice Management Review
■ Educating and training staff in the P&Ps The following list reviews the terms discussed in this
■ Making supplies and equipment available such as per- chapter and other important terms that you may see on
sonal protective equipment the exam.
agenda the list of meeting topics and the order in
■ Monitoring observance of the P&P
which they will be addressed
autocratic management style the manager makes all
Health and safety also incorporate emergency prepared-
the decisions (directive); appropriate when rapid
ness plans with directions for office evacuation and
decisions must be made; an autocratic manager may
posted information. Risk management and quality
make decisions but allows staff some autonomy in
improvement are also the role of the practice manager
carrying out the work (permissive)
and are discussed in Chapter 4, Law and Ethics.
budget the predicted expenses and revenues to operate
over a given period of time
chain of command demonstrates how each rank is
accountable to those directly superior and how the
<0-80A;1+)4.)+141<A authority passes from one link in the chain to the
The physical facility or plant is the building or buildings, next, or from the top to the bottom; reporting
offices, parking structures, furniture, and mechanical hierarchy
systems (elevators, electrical, heating, cooling, plumbing, democratic (participatory or teamwork) manage-
etc.) that make up the medical practice. To promote an ment style staff takes part in the decision making;
 +PIX\MZ ■ Practice Management 259

democratic managers may monitor staff closely supervisor; generally, physician assistants and nurse
(directive) or not (permissive); should not be used practitioners
when there is not enough time to get appropriate minutes the meeting record; contains the date and
employee input; this style helps employees grow and time, who was present and absent, what was dis-
develop cussed, and who is responsible for any actions
in-service education and training conducted in the open door policy a practice giving staff the freedom to
facility come talk any time the manager’s office door is
itinerary the schedule of travel and events, with arrival opened
and departure times and other specifics such as con- organizational chart a model showing the supervisory
tact numbers structure and reporting relationships between differ-
midlevel providers examine, diagnose, and provide ent functions and positions; who is responsible for
some treatments that must be signed off by a whom and what
 : - > 1 - ?  9 = - ; < 1 7 6 ;
All questions are relevant for the CMA (AAMA), RMA (AMT), and CMAS (AMT) exam.

1. The model that shows the chain of command is Answer: ,

called the:
Why: An organizational chart contains the formal super-
A. practice management.
visory structure and reporting relationships between dif-
B. staff assignments.
ferent functions and positions of the management and
C. practice ownership.
staff. This is referred to as the chain of command.
D. organizational chart.
E. corporate plan. Review: Yes ❏ No ❏

2. The hiring and firing role of the practice manager Answer: +

comes under the category of:
Why: Human resources is a common term involving
A. health and safety.
services directly related to the people or staff in the
B. communications.
organization. Hiring and firing are directly related to
C. human resources.
staff. Health and safety, communications, and quality
D. quality improvement.
improvement involve patients and other entities outside
of the organization.
Review: Yes ❏ No ❏

3. If a medical practice has a health and safety violation, Answer: -

the organization involved would be:
Why: Workplace health and safety is under the Occupa-
A. CDC.
tional Safety and Health Administration. The CDC is
B. MSDS.
involved with public health, and the CMS is involved
C. CMS.
with Medicare and Medicaid health insurance. P&P
D. P&P.
refers to policies and procedures and is not an
E. OSHA.
organization.
Review: Yes ❏ No ❏

4. The topics discussed at a staff meeting are reported Answer: )

in the:
Why: The agenda is the schedule of topics to be
A. minutes.
addressed at a meeting. The chain of command refers to
B. agenda.
the reporting structure of the business, and the itinerary
C. chain of command.
refers to travel details.
D. itinerary.
Review: Yes ❏ No ❏

5. Management of the physical plant involves: Answer: )

A. leasing the facility.
Why: The physical plant, also referred to as the physical
B. selecting the EHR system.
facility, makes up the building and the systems,
C. complying with OSHA.
equipment, and supplies that are directly involved in the
D. managing payroll.
functioning of the building, whether it associated with a
E. mailing and shipping.
medical practice or another business such as an
attorney’s practice.
Review: Yes ❏ No ❏


 +PIX\MZ ■ Practice Management 261

6. The topics to be discussed at a staff meeting are Answer: )

included in the:
Why: The minutes are the topics of a meeting that
A. agenda.
already took place. The chain of command refers to the
B. minutes.
reporting structure of the business, and the itinerary
C. chain of command.
refers to travel details.
D. itinerary.
Review: Yes ❏ No ❏

7. Through which of the following is the manager Answer: +

most likely to discover a problem?
Why: Risk management is a process to routinely assess,
A. Policies and procedures
identify, correct, and monitor any potential problems to
B. Organizational chart
prevent harm and loss.
C. Risk management
D. Physical plant Review: Yes ❏ No ❏
E. Human resources

8. The office manager role includes all of the following Answer: ,

EXCEPT:
Why: Unless a person is providing direct care, he or she
A. developing policy and procedure manuals.
would not be documenting in the medical portion of the
B. verifying licenses and other credentials.
patient’s record. If the practice manager functions in a
C. negotiating contracts.
different role, such as a medical assistant, this is not part
D. documenting in the medical record.
of the manager’s role.
Review: Yes ❏ No ❏

9. The schedule of travel and events is called the: Answer: -

A. minutes.
Why: The minutes are the topics of the meeting that
B. agenda.
already took place. The chain of command refers to the
C. chain of command.
reporting structure of the business, and the agenda
D. in-service.
refers to the topics of the upcoming meeting. In-service
E. itinerary.
refers to training activities offered in the organizations.
Review: Yes ❏ No ❏

10. The physical plant must comply with: Answer: )

A. ADA.
Why: The physical plant refers to the building, parking
B. HIPAA.
area, hallways, elevators, and so on. All of these
C. CMS.
structures are expected to meet the specifications of the
D. MSDS.
Americans with Disabilities Act (ADA), which requires
adequate access to people with special needs.
Review: Yes ❏ No ❏

11. If a manager does not include others in the decision Answer: *

making or how the decision should be implemented,
Why: Rationale needed. Diplomatic is handling
this management style is referred to as:
situations with tact; democratic is allowing others to
A. diplomatic.
participate in decision making; bureaucratic is very
B. autocratic.
structured and “goes by the book”; laissez-faire is an
C. democratic.
easy going leadership style permitting lots of leeway to
D. bureaucratic.
employees
E. laissez-faire.
Review: Yes ❏ No ❏
262 =VQ\ ■ Administrative Practice

12. Training conducted in the workplace is referred Answer: +

to as:
Why: A staff meeting is a get together of all members of
A. staff meetings.
the practice to discuss various topics with a planned
B. seminars.
agenda. A seminar is an educational program attended
C. in-service.
outside of the office and usually conducted by a profes-
D. supervision.
sional organization. Supervision is what the person
above you on the chain of command does.
Review: Yes ❏ No ❏

13. All of the following are common methods used by Answer: -

the practice manager to communicate with staff
Why: The practice manager would not normally send a
EXCEPT:
staff member a certified letter unless he or she was
A. bulletin boards.
unable to reach the person using the common methods.
B. e-mails.
Certified mail is used to reach patients with important
C. communication books.
information that may require documentation that it was
D. newsletters.
received.
E. certified letters.
Review: Yes ❏ No ❏

14. When dealing with supplies, the role of the practice Answer: )
manager would most likely be to:
Why: Ordering, receiving, and putting away supplies are
A. assure they were ordered.
usually the duties of the medical assistant or medical
B. order the supplies.
administrative specialist. The manager’s role is to assure
C. put them away.
that the functions are taking place.
D. receive the supplies when they arrive.
Review: Yes ❏ No ❏

15. A job description usually contains all of the following Answer: *

elements EXCEPT:
Why: The job description usually includes the title of
A. summary of the position.
the supervisor, such as director, but does not include the
B. name of the supervisor.
person’s actual name. The names of supervisors may
C. responsibilities.
change, but the organization’s job descriptions are usu-
D. qualifications.
ally in place for a long period of time.
E. organization.
Review: Yes ❏ No ❏

16. The major purpose for monitoring a budget is to: Answer: +

A. determine who is spending too much money.
Why: A budget is done to estimate what the annual
B. ascertain if Medicare is paying on time.
expenses will be and what the revenues will be. If the
C. assure the revenue is meeting the expenses.
revenue does not cover the expenses, adjustments in the
D. decide how much money is left for raises.
budget must be made.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Practice Management 263

17. An example of a typical job requirement to work in a Answer: )

medical office is:
Why: Working in a medical office usually requires
A. ability to lift 25 lbs.
lifting, whether it may be in assisting a patient or dealing
B. proof of citizenship in the United States.
with supplies and equipment. It is not acceptable to
C. being unmarried.
require or ask about citizenship (may ask for documen-
D. age between 18 and 40 years.
tation regarding working in this country legally which
E. 20/20 vision.
may be done on a work visa), marital status, age (unless
person looks under 18 years old), and unreasonable
physical requirements such as 20/20 vision.
Review: Yes ❏ No ❏

18. A question that you would not ask during an Answer: ,

interview would be whether the applicant:
Why: Whether the person has a certification or went to
A. is certified in his or her field.
college could very well be a job requirement or
B. has a college degree.
preference. If the office is open on Sundays or may hold
C. is able to work on Sundays.
special events on Sundays, such as immunization clinics
D. has a religious affiliation.
prior to the beginning of school, then asking the appli-
cant if he or she is able to work on Sundays is appropri-
ate. It is never appropriate to ask about an applicant’s
religious affiliation.
Review: Yes ❏ No ❏

19. When an employee entered incorrect information Answer: +

into a medical record that resulted in an incorrect
Why: If it is the employee’s first offense, the manager
payment, the manager would most likely:
would probably give a verbal warning. If it had
A. have the employee apologize to the patient.
happened in the past, the employee may be given a writ-
B. terminate the employee.
ten warning and/or additional training.
C. provide a verbal warning.
D. not give the employee a raise. Review: Yes ❏ No ❏
E. dock the employee’s pay.

20. When an employee is under a performance Answer: *

improvement plan, the manager will probably meet
Why: Part of the improvement plan should be to sched-
with the employee:
ule regular periods to follow up on the employee’s
A. at the employee’s annual evaluation.
progress. The exception is if the contract states that the
B. on a predetermined schedule.
next time the behavior occurs the employee is
C. when the manager has time.
terminated.
D. at staff meetings.
Review: Yes ❏ No ❏

21. When dealing with HIPAA compliance, the manager Answer: *

would most likely use what type of management
Why: HIPAA compliance is extremely important and
style?
P&Ps should be followed without exception. This is an
A. Democratic
example when a bureaucratic style should be used
B. Bureaucratic
regardless of the manager’s principal leadership style.
C. Laissez-faire
D. Diplomatic Review: Yes ❏ No ❏
264 =VQ\ ■ Administrative Practice

22. A role of the practice manager related to service Answer: +

vendors is to:
Why: The role of the office manager is to get the best
A. make appointments for them with the physician.
service for the best price. Appointments with the physi-
B. provide patients with the vendors’ brochures.
cian are usually made by the person scheduling appoint-
C. negotiate contracts for their services.
ments. Patients who require vendor services may be
D. request that they supply lunch for staff meetings.
given contact information not marketing information.
E. treat them as if they are staff members.
Vendors will sometimes provide staff lunch if an in-
service is involved, but this is sometimes frowned upon
as conflict of interest. While vendors should be treated
with respect, they are not on the same day-to-day status
as staff members.
Review: Yes ❏ No ❏

23. If an incident occurs in the medical office that Answer: +

results in a legal action, the manager is expected to: Why: The manager is expected to discuss the incident
A. keep it a secret. with the appropriated parties involved and keep it to
B. place the information in the staff newsletter. himself or herself. It should not be discussed in the staff
C. maintain records of the occurrence. newsletter because a newsletter is not confidential. The
D. go to court. manager is not usually the person to go to court if it
becomes necessary, but the manager is expected to keep
accurate records on the incident and save medical
records that may be involved.
Review: Yes ❏ No ❏

24. When preparing the budget, the office manager Answer: +

would include all the following EXCEPT:
Why: Most of the budget is created on predicted costs
A. predicted increased costs of supplies.
based on estimates and inflation. Generally, these
B. estimated tax payments.
estimates are higher than the previous year for
C. rumored increases in Medicare payments
payments. Rumored increases in any payments or
D. inflation-adjusted equipment purchases.
revenue are not a reasonable approach to budgeting,
especially since most insurance plans, including
Medicare, continually attempt to negotiate lower
payments to physicians.
Review: Yes ❏ No ❏

25. A function of managing the physical facility may Answer: *

be to:
Why: Landscaping maintenance is a function of the
A. purchase pharmaceuticals.
physical facility. Purchasing pharmaceuticals, upgrading
B. contract for landscaping maintenance.
the electronic health record, and replacing the ECG
C. upgrade the electronic health record system.
machine are related to direct patient care services. Pay-
D. replace the electrocardiogram (ECG) machine.
roll is a human resources function.
E. evaluate a new payroll service.
Review: Yes ❏ No ❏
 Unit 4
Clinical Practice


 Microorganisms and Asepsis
17

: - > 1 - ?  < 1 8
This chapt
p er beggins the review of clinical toppics. Aseps
p is is a cornerstone of safe,, healthyy practices
in the medical office and in personal life. To reinforce these principles, look for applications at
work and at home as each topic is addressed.

51+:77:/)61;5; ❍Rod (bacilli; singular bacillus; Latin, meaning

“little staff ”)—examples are Bacillus anthracis
Microorganisms, or microbes or germs, are living (cause of anthrax), Mycobacterium tuberculosis
organisms that are too small to see with the naked eye. (cause of tuberculosis), Bacillus tetanus (cause of
These organisms surround us and are part of every living tetanus)
process. Some of these microbes cause disease, and oth-
❍ Spiral (spirilla or spirochete; singular spirillum;
ers cause disease only under certain circumstances; for
example, Escherichia coli ((E. colii), which is found normally Latin, meaning “spiral”); corkscrew-shaped; an
in the intestinal tract, may cause sepsis if introduced into example is Helicobacter pylori (one cause of chronic
the bloodstream. gastritis)
❍ Spores—encapsulated (shell or capsule) bacteria in
an inactive or resting state; in the medical office,
spores are killed only by autoclaving
COMMON PATHOGENS • Types defined by air need
Common pathogens are prevalent microorganisms that ❍ Aerobic—bacteria that require oxygen for
cause disease. survival
❍ Anaerobic—bacteria that live without oxygen
■ Bloodborne pathogen—any type of pathogen that lives
in and is transmitted through blood • Virus—extremely small microbes that pass through
most filters; examples of viral diseases include
• Bacteria (singular bacterium)—one-celled microor- measles, mumps, rubella, herpes, hepatitis B, and
ganisms; may be found singularly or in chains influenza
❍ Types defined by principal shapes
• Fungus (plural fungi )—microbes that grow on other
❍ Spherical (cocci; singular coccus; Latin, meaning organisms, causing diseases such as tinea (ring-
“berry”)—examples are streptococci, staphylococci, worm), candidiasis (thrush), histoplasmosis, or coc-
pneumococci cidioidomycosis


268 =VQ\ ■ Clinical Practice

• Protozoa—simplest form of animal pathogen; para- 5. Susceptible host—person with no previous immunity
sites; examples of diseases caused by protozoa are or with weakened immunity resulting from illness,
malaria, giardiasis, and trichomonas (one cause of injury, or poor nutrition, or if the pathogen is too
vaginitis) virulent (strong) for a normal immune system to
resist

PORTALS OF ENTRY LOCALIZED VERSUS GENERALIZED

Portals of entry are the ways microorganisms enter the INFECTIONS
body.
■ Localized—infection confined to one area of the body
(e.g., a pustule)
■ Respiratory system—nose, mouth (air)
■ Generalized or systemic—infection spread throughout
■ Gastrointestinal system—mouth, rectum (food and
the body (e.g., septicemia)
water)
■ Integumentary system—any break in the skin
■ Eyes and ears BIOCHEMICAL AGENTS TO
■ Vascular system—through blood supply COMBAT PATHOGENS
■ Antibiotics—substances ingested, injected, or applied
to a living being that have the power to inhibit the
CHAIN OF INFECTION growth of or to destroy bacteria
■ Chemotherapy—ingestion, injection, or application of
The chain of infection illustrates the elements neces-
chemical agents in treating disease
sary for disease to spread (Fig. 17-1).
■ Immunizations—biological or chemical agents that
1. Reservoir host—initial carrier of the microbe; may be
create immunity to specific diseases when ingested
a person, an animal, an insect
or injected (see Box 6-7, “Types of Immunity,” and
2. Means of exit—method of leaving the reservoir host
Box 6-8, “Common Vaccine-Preventable Diseases” in
(e.g., sneezing, coughing, feces, blood)
Chapter 6)
3. Means of transmission—method of moving from
the exit of the reservoir host to the entrance of the
susceptible host, such as air, contaminated materials
called fomites (such as food or water), or soiled );-8;1;
hands Asepsis is the absence or the control of microorgan-
4. Means of entrance—see “Portals of Entry” isms. Many of the U.S. Occupational Safety and
Health Administration (OSHA) guidelines and man-
dates address asepsis.

Reservoir host

PURPOSES OF ASEPSIS
■ Protect patient/public
Susceptible host ■ Protect health care worker
■ Prevent infectious disease from starting
Means of exit ■ Stop infectious disease from spreading

TYPES OF ASEPSIS
Means of entrance ■ Medical asepsis (clean technique)—techniques and
procedures to reduce number of microorganisms in an
Means of transmission
environment and decrease opportunities for further
spread
■ Surgical asepsis (sterile technique)—techniques and
.QO]ZM Chain of infection.
procedures to eliminate all microorganisms in an envi-
ronment
 +PIX\MZ ■ Microorganisms and Asepsis 269

COMMON METHODS OF ASEPSIS (the looser the wrap, the shorter the time
required)
■ Medical handwashing
❍ Sterilization bags or pouches, disposable paper
1. Remove jewelry (wedding and engagement rings wraps, or surgical towels are used for autoclaving
usually remain) surgical instruments, including those that will be
2. Use hand- or foot-controlled faucet placed on sterile fields; usually, double wrapping is
3. Wash hands and wrists for 2 to 3 minutes required when using disposable paper wraps or
4. Use brush and cuticle stick on nails surgical towels
5. Hold hands in downward position while rinsing
❍ Packages must be dry before removing them from
6. Dry hands with paper or clean cloth towel
7. Turn off hand faucets with paper or clean cloth the autoclave
towel ❍ Procedure:
8. Lotion may be applied 1. Place cleaned and dried instruments in center of wrap
(hinged instruments in open position) with steriliza-
■ Surgical handwashing tion indicator tape
1. Remove all jewelry 2. Position opened wrap on a flat surface in a diamond
2. Use foot- or knee-controlled faucet shape with a point toward you
3. Wash hands, wrists, and forearms for 10 minutes 3. Fold the corner closest to you over the instrument
with brush (first surgical scrub of day) 4. Fold the first side corner toward the center, com-
4. Use cuticle stick on nails pletely covering the instrument; fold extra material
5. Hold hands in upward position while rinsing back to form a tab; repeat with the second side corner
6. Dry with sterile towel 5. Fold the last corner toward the center and around
7. Do not apply lotion the packet, ensuring the instrument is completely
8. Keep hands upright and do not touch anything until covered
sterile gloves are applied 6. Fasten the packet with sterilization-sensitive tape

■ Antiseptics—bacteriostatic chemical cleaning ■ Standard or universal precautions

agents used on skin to remove and to inhibit the • Treat all blood and bodily fluids as contaminated
growth of bacteria; these agents do not destroy all • Protect the patient from you (especially when patient’s
pathogens immune system is compromised)
■ Disinfectants—bacteriostatic chemical agents used to • Protect yourself from the patient
clean and to decrease the pathogens on inanimate
objects (e.g., surgical instruments, countertops); these
■ Personal protective equipment (PPE)
agents do not destroy all pathogens
■ Sterilization—process of destroying all living organisms • Gloves (nonsterile used for majority of patient pro-
cedures; sterile used only for procedures requiring
• Gas—used for wheelchairs, beds, and other large sterile aseptic technique, e.g., surgery)
equipment; very toxic
• Goggles or eye shields
• Dry heat—used for instruments that corrode easily;
requires at least 1 hour at 320F • Masks
• Chemical (cold sterilization)—used for heat-sensitive • Gowns
equipment such as fiberoptic endoscopes; equip- • Aprons
ment is soaked in closed containers with strong
agents (e.g., glutaraldehyde); specific time recom- ■ Other safety materials and actions
mendations are determined by the manufacturer of
the chemical agent • Safety plan and policies and procedures
• Material Safety Data Sheets (MSDS) and labels for
• Steam heat (autoclave)—the most common method all hazardous agents
of sterilization used in the medical office; the
steam is under pressure to achieve higher tempera- • Employee training
tures • Sharps (needles, scalpels, glass vials, etc.) containers
❍ Water temperature must be 212F • Other biohazard receptacles for non-sharp material
❍ Steam temperature must be 250F to 254F
contaminated with body fluids
❍ Time required is between 20 and 40 minutes, • Eyewash stations
depending on how tightly items are wrapped • Showers
270 =VQ\ ■ Clinical Practice

TERMS health care–acquired infection (HAI) infection a

patient acquires when in a health care facility, typi-
Microorganisms and Asepsis Review cally a hospital setting; also known as nosocomial
The following list reviews the terms discussed in this infection
chapter and other important terms that you may see on medical asepsis (clean technique) techniques and
the exam. procedures that reduce the number of microorgan-
antibiotic a substance ingested, injected, or applied to a isms in an environment and decrease opportunities
living being that has the power to inhibit the growth for further spread
of or to destroy bacteria microorganisms microbes or germs; living organisms
antiseptic a chemical cleaning agent used on the skin that are too small to see with the naked eye
to remove or to inhibit the growth of bacteria mycology the study of fungi
asepsis the absence of or the control of microorganisms OSHA (Occupational Safety and Health
bacteria (singular bacterium) one-celled microorgan- Administration) a federal agency that develops and
isms; may be found singularly or in chains monitors guidelines and mandates that address
bacteriocide an agent or a process that kills bacteria health and safety in the workplace
bacteriology the study of bacteria parasite an organism that lives at the expense of another
bacteriostasis the process of inhibiting or controlling organism
bacterial growth parasitology study of worms, protozoa, and other
bloodborne pathogen any type of disease-causing parasites
organism that lives in and is transmitted through blood pathogens microorganisms that cause disease
chain of infection elements necessary for disease to portals of entry routes by which microorganisms enter
spread: reservoir, host, portal of exit, means of trans- the body
mission, portal of entry, susceptible host spores encapsulated bacteria in an inactive or resting
disinfectant a bacteriostatic chemical agent used to state
clean and to decrease the number of pathogens on sterilization process of destroying all living organisms
inanimate objects (such as surgical instruments, surgical asepsis (sterile technique) techniques and
countertops); does not sterilize procedures intended to eliminate all microorganisms
fomite contaminated food or drink and contaminated in an environment
objects such as soiled hands; provide avenue for indi- virology study of virus
rect transmission of microbes
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA) and RMA (AMT) exams. Questions 1 through 17 are relevant for the
CMAS (AMT) exam.

1. The specific name used for any type of pathogen Answer: +

that lives in and is transmitted through blood is:
Why: A bloodborne pathogen is a microorganism that
A. anaerobic bacteria.
lives in and is transmitted through blood.
B. parasitic amoeba.
C. bloodborne pathogen. Review: Yes ❏ No ❏
D. aerobic pathogen.

2. The chain of infection requires the microorganism Answer: *

to find a means of exit from the host. These means
Why: Ingestion is the process of taking food or water
of exit include the following EXCEPT:
into the body. This is a means by which a
A. sneezing.
microorganism can enter the body but is not a means of
B. ingestion.
exit.
C. coughing.
D. blood. Review: Yes ❏ No ❏
E. feces.

3. An example of a viral disease is: Answer: ,

A. ringworm.
Why: Ringworm and candidiasis are examples of condi-
B. candidiasis.
tions caused by fungus. Malaria is caused by protozoal
C. malaria.
parasites.
D. measles.
Review: Yes ❏ No ❏

4. A bacteria that lives without oxygen is: Answer: -

A. aerobic.
B. aseptic. Why: An anaerobe is a microorganism that can live and
C. anemic. grow in the absence of oxygen. The term anaerobic
D. anoxic. describes this type of bacteria. Aerobic means requiring
E. anaerobic. oxygen for life and growth. Anoxic is a term used to
describe the absence of oxygen in arterial blood. Anemic
describes a condition in which the number of red blood
cells or hemoglobin of the blood is below the normal
level. Aseptic describes the absence or control of
microorganisms.
Review: Yes ❏ No ❏

5. The major reason for using proper aseptic Answer: ,

procedures is to:
Why: Aseptic technique is practiced to protect patients,
A. follow office policies.
the public, and health care workers from the
B. destroy all bacteria on surfaces.
transmission of disease-causing microorganisms. Asepsis
C. control the patient’s immune system.
is a condition in which living pathogenic organisms are
D. protect patients and health care workers.
absent: the environment is sterile.
Review: Yes ❏ No ❏


272 =VQ\ ■ Clinical Practice

6. The process that destroys all living organisms is: Answer: +

A. handwashing.
Why: Autoclaving is the only process listed that ensures
B. sanitizing.
that all bacteria are destroyed and the items autoclaved
C. autoclaving.
are sterile.
D. cleansing.
E. disinfecting. Review: Yes ❏ No ❏

7. Personal protective equipment includes the Answer: )

following EXCEPT:
Why: Personal protective equipment (PPE) includes any
A. needles.
device or garment that protects the individual from con-
B. gowns.
tact with blood and body fluid that may contain
C. gloves.
bloodborne pathogens.
D. masks.
Review: Yes ❏ No ❏

8. Ringworm is an example of a: Answer: *

A. bacteria. Why: Fungus is a simple parasitic plant. Ringworm is a
B. fungus. type of fungal skin disease that forms a red, ringlike
C. protozoa. lesion on the skin.
D. virus.
E. parasite. Review: Yes ❏ No ❏

9. The organization that develops and monitors Answer: ,

guidelines and mandates health and safety practices
Why: The Occupational Safety and Health Administra-
in the workplace is:
tion (OSHA) is a federal agency that has developed poli-
A. AMA.
cies for the workplace that include guidelines for health
B. CDC.
care workers to prevent the transmission of bloodborne
C. FDA.
pathogens.
D. OSHA.
Review: Yes ❏ No ❏

10. A chemical agent used to clean countertops to Answer: *

decrease the number of disease-causing organisms
Why: A disinfectant is used to clean surfaces to free
is a(n):
them of pathogenic organisms. Antibiotics, antiseptics,
A. antibiotic.
and germicidal soaps are used on or in the body, not on
B. disinfectant.
inanimate objects. A sterile solution is any product that
C. antiseptic.
is free of microorganisms.
D. sterile solution.
E. germicidal soap. Review: Yes ❏ No ❏

11. Characteristics of a susceptible host include the Answer: +

following EXCEPT:
Why: A susceptible host is a person who is more vulner-
A. lack of hygiene.
able to a disease or disorder. Chronic illness, injury to
B. poor nutrition.
the body, poor nutrition, and a lack of good hygiene
C. intact immune system.
contribute to the environment for microorganisms to
D. chronic illness.
cause infection or disease. A person with an intact
E. injury to the body.
immune system is more likely to be able to resist infec-
tions caused by pathogens.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Microorganisms and Asepsis 273

12. One difference between a localized and a generalized Answer: )

infection is that a:
Why: A localized infection is confined to one area or
A. localized infection is contained within a
part of the body, whereas a generalized infection has
specific area.
spread to many areas of the body or may be systemic.
B. generalized infection has spread to one specific
area of the body. Review: Yes ❏ No ❏
C. localized infection is the same as a systemic
infection.
D. generalized infection is caused by nonspecific
microorganisms.

13. The most important guideline stated in the universal Answer: *

precautions is to:
Why: All patients’ blood and bodily fluids are considered
A. always wear gloves even if there is no risk for
contaminated, even if they are not. This practice will
contact with bloodborne pathogens.
ensure you always use universal precautions with all
B. treat all blood and bodily fluids as contaminated.
patients, not just those suspected of having a bloodborne
C. label specimens from patients who are suspected
pathogen. It is not necessary to use gloves when
of having a bloodborne pathogen such as HIV.
performing procedures that will not put you at risk for
D. conserve supplies by reusing gloves but changing
contact with blood or body fluids. This includes most
them when visibly soiled with blood.
noninvasive procedures. Never reuse gloves on different
patients.
Review: Yes ❏ No ❏

14. When a patient acquires an infection while in a Answer: +

medical facility, it is referred to as a: Why: A health care–acquired infection is an infection
A. bacterial infection. separate from the patient’s original condition that is
B. causative infection. acquired while the patient is being treated in a hospital
C. health care–acquired infection. or health care facility.
D. pathogenic infection.
Review: Yes ❏ No ❏

15. The chain of infection does not include: Answer: ,

A. susceptible host.
Why: Asepsis is the absence or the control of
B. means of transmission.
microorganisms. The use of aseptic technique inhibits
C. reservoir.
the spread of disease.
D. asepsis.
Review: Yes ❏ No ❏

16. Which of the following is a chemical cleaning agent Answer: *

used on the skin to remove bacteria?
Why: A disinfectant is a chemical agent used to clean
A. Disinfectant
inanimate objects. An immunization is a biological or
B. Antiseptic
chemical agent that creates immunity to specific
C. Immunization
diseases. Immunizations are ingested or injected. Cold
D. Cold sterilization solution
sterilization solution is used to soak instruments before
E. Sterile water
autoclaving. Sterile water is not a chemical cleaning
agent.
Review: Yes ❏ No ❏
274 =VQ\ ■ Clinical Practice

17. Hepatitis B and rubella are examples of diseases Answer: -

caused by:
Why: Viruses are the smallest form of microorganisms
A. yeasts.
and are not susceptible to antibiotics. They are difficult
B. fungi.
to treat.
C. bacteria.
D. protozoa. Review: Yes ❏ No ❏
E. viruses.

18. Steps to follow for proper autoclaving include: Answer: )

A. keeping hinged instruments in an open position.
Why: Instruments should be dry before they are
B. wrapping instruments while they are wet.
wrapped for autoclaving. It is not necessary to wear
C. wearing sterile gloves to wrap autoclave packs
sterile gloves to process wraps for autoclaving. After
for processing.
autoclaving, packs need to be dry before being placed
D. storing autoclaved packs while they are damp.
in storage.
Review: Yes ❏ No ❏

19. Which of the following are bacteria normally found Answer: +

in the intestinal tract but that cause infection if
Why: Escherichia coli is abbreviated to E. coli. It is a
introduced into the urinary tract or bloodstream?
bacterium found in the intestinal tract and usually causes
A. Clostridium tetani
no problem except when it invades other body systems.
B. Bacillus anthracis
Clostridium tetani causes tetanus, Bacillus anthracis causes
C. Escherichia coli
anthrax, and Treponema pallidum causes syphilis.
D. Treponema pallidum
E. Coccidioidomycosis Review: Yes ❏ No ❏

20. The process that kills spore-producing bacteria is: Answer: ,

A. handwashing.
Why: Autoclaving is the same as sterilizing. It is the use
B. chemical soaking.
of steam under pressure. The autoclave is used at an
C. disinfecting.
average temperature of 250F for an average time of
D. autoclaving.
30 minutes. This process is used to ensure that spores
will be killed.
Review: Yes ❏ No ❏

21. Which of the following is not part of proper surgical Answer: +

handwashing technique?
Why: When performing a surgical handwash, hands
A. Remove jewelry.
should be held upward while rinsing so the water does
B. Dry hands with sterile towel.
not carry bacteria from the unscrubbed portion of the
C. Hold hands in a downward position while
upper arm to the scrubbed portion of the arms and
rinsing.
hands.
D. Use foot- or knee-controlled faucet.
E. Use a cuticle stick on nails. Review: Yes ❏ No ❏

22. The unique characteristic of spore-forming bacteria Answer: ,

is that they:
Why: Spore-forming bacteria are able to form a capsule
A. are easily destroyed with the use of chemical
or shell around themselves that is resistant to most
cleaners.
means of asepsis, such as heat or chemicals. Autoclaving
B. are only found in cocci shapes or formation.
or sterilizing is the only method known to kill spores.
C. account for most of the known viruses.
D. are able to form a resistant capsule around Review: Yes ❏ No ❏
themselves.
 +PIX\MZ ■ Microorganisms and Asepsis 275

23. Objects that provide an avenue for indirect Answer: ,

transmission of microbes are called:
Why: Spores are bacteria that are able to form a capsule
A. spores.
or shell around them that is resistant to most means of
B. pathogens.
asepsis, such as heat or chemicals. Pathogens include any
C. PPE.
disease causing microorganisms. PPE is personal protec-
D. fomites.
tive equipment used for protection during procedures
where there is a chance of contact with pathogens.
Review: Yes ❏ No ❏

24. A type of protozoa that causes vaginitis is: Answer: +

A. Candida.
Why: Candida is an example of yeast, tinea is ringworm,
B. staphylococci.
and staphylococci are bacteria. Trichomonas are protozoa,
C. Trichomonas.
single-celled parasites.
D. tinea.
Review: Yes ❏ No ❏

25. The temperature setting and timing for proper Answer: +

autoclaving is:
Why: Most autoclave loads are processed at 250F for
A. 175F for 10 minutes.
30 minutes. The timing or temperature may vary
B. 212F for 15 minutes.
slightly because of the tightness of the wrap.
C. 250F for 30 minutes.
D. 275F for 45 minutes. Review: Yes ❏ No ❏
E. 300F for 30 minutes.

26. Which of the following is an example of spherical Answer: )

or round bacteria?
Why: Round or spherical-shaped bacteria are called cocci.
A. Staphylococci
Under the microscope, staphylococci appear as clusters
B. Tetanus
or groups of round bacteria. Tetanus bacteria, E. coli, and
C. E. coli
Shigella are rod shaped.
D. Shigella
Review: Yes ❏ No ❏
 Patient Exams
18

: - > 1 - ?  < 1 8
The national exams often reqquire you to identifyy instruments and equ
q ippment from a pi
p cture.
Practice recognizing various instruments and their medical uses. Also, study the body positions
described in this chapter, since they usually are incorporated in the exams.

The medical assistant, from the moment of contact, determined by asking an open-ended question such as
observes the patient for baseline behaviors, changes, “What brings you here today?”
and signs and symptoms. This first observation begins ■ Symptoms—subjective descriptions of altered health
the patient exam, and observations continue through- indicators (e.g., nausea, headache); complaints that
out the patient visit. Specific medical record forms are cannot be seen or measured
used to record the information. The medical assistant
should note the data from previous visits as a compari- ■ Medical-related histories—accounts of past health
son to the newly obtained information. Appropriate status or practices and exposures that affect health
asepsis should be followed throughout procedures status
(refer to Chapter 17). • Family history—medical history of the patient’s
close biological relatives (e.g., grandparents, parents,
siblings)

8)<1-6<16<-:>1-? • Patient medical history—the patient’s past health

status; usually conducted by a review of body
The interview process discussed in this chapter incorpo- systems
rates the knowledge, techniques, and skills from previ-
ous chapters—including medical terminology, anatomy • Social and environmental history—the patient’s past
and current personal habits and exposures that influ-
and physiology, communication, law and ethics, patient
ence health
education, medical records, and microorganisms and
asepsis. Professionalism and confidentiality are expected • Screen for abuse and domestic violence—a history-
standards. type questionnaire recommended by many profes-
sional organizations and mandated in some jurisdic-
■ Chief complaint—a summary of the patient’s words tions to assist in determining the presence of abuse
explaining why he or she is seeking health care; best in the patient’s life


278 =VQ\ ■ Clinical Practice

+75576);;-;;5-6< norm is 60 to 100 beats per minute (bpm) in a regular

5-);=:-5-6<; rhythm, usually the same rate and rhythm as the heart;
the infant norm is 100 to 160 bpm; and the norm of
Obtaining assessment measurements is also known as children to age 10 is 70 to 120 bpm
anthropometry. Anthropometry comprises signs, func-
tions, and capacities that can be objectively determined • Anatomic sites—the pulse may be taken using any
by the senses (e.g., sight, hearing, smell, touch) or by artery lying over bone; the most common follow in
specific equipment and tests. Medical asepsis is main- the order of frequency of use
tained in preparing, performing, and following all com- ❍ Radial—pulse located on the thumb side of the
mon assessment functions. wrist; most common site used for adults
❍ Brachial—pulse located medially on both arms
anterior to the elbow; most common site used for
VITAL SIGNS children
Vital signs are measurements of body temperature, ❍ Apical—pulse located at the fifth intercostal space
pulse rate, respirations (TPR), and blood pressure midclavicular; common site used for infants;
(BP). requires a stethoscope
❍ Dorsalis pedis—pulse located medially on the top
■ Body temperature—measured by a thermometer using of both feet, often used to assess circulation to the
one of two scales, degrees Fahrenheit (F) or degrees extremities
Celsius (C), also referred to as centigrade; the normal
❍ Carotid—pulse located on both sides of the neck,
range for infants, children, and adults is the same, but
lateral to the trachea
infants and small children are more sensitive to exter-
nal temperature changes ❍ Femoral—pulse located bilaterally in groin

❍ Popliteal—pulse located posterior to both knees,

• Common anatomic locations to obtain temperature
also used to assess circulation to the extremities
❍ Oral (temperature taken in the mouth) adult norm
is 98.6F or 37C ❍ Temporal—pulse located bilaterally over temporal
bone
❍ Rectal (temperature taken in the rectum) norm is
1 degree higher than oral; adult norm is 99.6F or • Methods to obtain pulse
37.5C ❍ Manual—light compression of the artery with

❍ Axillary (temperature taken in the armpit) norm is index and middle finger; count beats for 30 or 60
1 degree lower than oral; adult norm is 97.6F or seconds, multiplying beats by 2 if 30-second count
36.4C is used
❍ Aural, otic, or tympanic (temperature taken in the ❍ Doppler—ultrasonic device used to locate, audibly

ear) norm is the same as oral; adult norm is 98.6F transmit, and sometimes record pulse
or 37C ❍ Electronic sphygmomanometer—device used to
measure pulse and blood pressure simultaneously
• Thermometer—instrument used to measure tem-
perature using a blood pressure cuff
❍ Mercury—a glass thermometer with a mercury ■ Respiration—measurement of the number of respira-
column. No longer used due to mercury danger tory cycles per minute, usually done by observation; a
respiratory cycle consists of inspiration and expira-
❍ Electronic—a thermometer with a power source
tion; the adult norm is 12 to 20 respiratory cycles per
used for all sites (special type is used for the
minute in a regular rhythm; the younger the infant or
ear); displays the temperature digitally; converts
child, the more rapid the normal respiratory rate;
from F to C or vice versa by flipping a
0- to 1-year norm is 20 to 40; 2- to 6-year norm is
small switch; stylus is covered by a disposable
20 to 30
sheath
■ BP—measurement of the force of blood on the artery
❍ Tympanic—electronic thermometer resembling an
walls during contraction (systole) and relaxation (dias-
otoscope that is used in the ear
tole) of the heart; recorded as a fraction with systole as
❍ Disposable—one-time-use plastic thermometer the numerator and diastole as the denominator; the
strips, dots, or probes used on the skin or orally; adult norm is 120/80; BPs are not commonly taken in
considered least reliable children younger than 4 years; the most accurate posi-
■ Pulse—“beat” caused by expansion and relaxation of tion for taking a blood pressure is placing the arm at
the artery wall, expressed in beats per minute; the adult the level of the heart
 +PIX\MZ ■ Patient Exams 279

• Korotkoff sounds—sounds heard through the Comparisons of Height and Weight

stethoscope during the measurement of blood pres-
Using the height and weight in formulas and charts pro-
sure; there are five phases:
vides the practitioner with an approximation of the
1. Phase I—faint tapping sounds heard as the cuff patient’s size related to normal standards. These meth-
deflates (systole) ods are used to determine the patient’s health risk for
2. Phase II—soft swishing sounds various diseases and conditions.
3. Phase III—rhythmic, sharp, distinct tapping sounds
4. Phase IV—soft tapping sounds that become ■ Body mass index—a
x health risk assessment tool for
faint adults and children to estimate the percentage of body
5. Phase V—disappearance of sound (diastole) fat by using a formula based on the individual’s height
and weight; calculations are found online.
• Pulse pressure—the difference between the systolic
and diastolic pressures; the adult norm is 40; the • Normal range  18.5 to 24.9
difference should be approximately one third of • Underweight  18.5
systole
• Overweight  25 to 29.9
• Orthostatic pressure—blood pressure taken in all • Obese  30 and above
three positions (supine, sitting, and standing) at least
1 to 2 minutes apart ■ Pediatric growth chart—supplied
t by the Centers for
Disease Control and Prevention (CDC); the form is
• Sphygmomanometer—the instrument used to meas- specific to the current age and sex of the child and con-
ure BP; composed of a cuff for the arm, thigh,
tains the height, weight, and head circumference; the
wrist, or finger, and a measurement device; the cor-
individual’s measurements are compared by percentile
rect size and cuff fit influence the accuracy of the
to an established reference group (Fig. 18-1)
readings
❍ Mercury sphygmomanometer—no longer in use
because of mercury danger Vision
❍ Aneroid sphygmomanometer—a blood pressure
Visual acuity is the measurement of how well a person can
cuff with a numeric gauge to measure readings; see at specified distances; the Snellen chart method is
stethoscope required used with various letters of the alphabet for adults; the E
❍ Electronic sphygmomanometer—blood pressure chart is commonly used for preschoolers. The right eye
cuff with an electronic device to measure and the left eye are measured individually, and then both
blood pressure and pulse readings; no stethoscope eyes are measured together. The adult norm is 20/20: the
required numerator indicates the distance the chart is placed from
• Stethoscope—the instrument’s diaphragm or bell is the patient, usually 20 feet; the denominator indicates the
placed at the artery to be used to hear the sounds distance at which people with normal acuity could read the
that compose the BP last line read by the patient—for example, 20/30 vision
indicates that the patient sees at 20 feet what someone with
normal vision sees at 30 feet (Fig. 18-2 and Fig. 18-3).
OTHER MEASUREMENTS
■ Ishihara color vision test—used
t to determine color
Height vision deficiencies (color blindness); consists of a series
Height or length is commonly measured by a rod attached of pages or plates with imbedded numbers of various
to a weight scale or fixed bar on a wall; a measuring tape is colors; depending on the degree of the deficiency, the
used for measuring the length of neonates and also the person would not see the number or would see it in a
head circumference. Measurements are recorded in feet different color
(ft) and inches (in), or centimeters (cm); conversion is ■ Tonometer—an
r instrument used to measure the
2.5 cm per inch. intraocular pressure of the eye to diagnose glaucoma;
the procedure is called tonometry
■ Ophthalmoscopy (funduscopy) exam—an examina-
Weight tion of the interior eye with an instrument that reflects
Weight is commonly measured in the medical office light through the pupil to determine the health of the
using a balance beam or an electronic scale. Measure- interior of the eye; the abbreviation PERRLA is used
ments are recorded in pounds (lb) or kilograms (kg); con- to document the normal finding of “pupils equal round
version is 2.2 lb per kg. and reactive to light and accommodation”
280 =VQ\ ■ Clinical Practice

.QO]ZM  Centers for Disease Control and Prevention (CDC) growth chart for U.S. males, birth to 36 months of age (from the CDC).
 +PIX\MZ ■ Patient Exams 281

E
F P
1

2 1
T O Z 3
2
L P E D 4
P E C F D 5 3
E D F C Z P 6
4
F E L O P Z D 7
D E F P O T E C 8 5
L E F O D P C T 9
6
F D P L T C E O 10 7
P E Z O L C F T D
11 8
.QO]ZM  Snellen eye chart for those who know the alphabet (from Wikipedia). .QO]ZM  Snellen “E” eye chart for preschoolers (from Wikipedia).

All measurements of hearing should be preceded by a ■ Audiometry—a hearing test using an audiometer with
visual exam of the auditory canal and eardrum using an earphones that measures the patient’s response to
otoscope. Hearing measurements may be gross or highly tones; it is recorded in decibels (db) and frequencies
defined. ■ Impedance audiometry—a hearing test using an
audiometer and an ear probe that measures tympanic
■ Startle—gross measurement used with neonates; a membrane and ossicle mobility
loud noise such as a clap will be initiated; the expected
■ Tympanometry—a test that uses a tympanometer (air
result is that the infant will react with a jerk or a cry
pressure) to measure tympanic membrane mobility
■ Whisper—gross measurement; the health care
provider will whisper to the patient and the patient
repeats what is said; each ear is done separately Common Respiratory Tests
■ Tuning fork—gross measurement; instrument is acti- Part of the physical exam is to determine how well the
vated by striking it with a hand and is then placed on lungs are functioning. The practitioner performs an ini-
top of the patient’s head, beside each ear, and on each tial evaluation by listening for normal breath sounds with
side of the patient’s mastoid bone; determines hearing a stethoscope. Other common respiratory tests are per-
and conduction formed by the medical assistant.
282 =VQ\ ■ Clinical Practice

■ Pulse oximetry—a
y test using a pulse oximeter on the *W` 
patient’s digit to measure the percentage of oxygen
(O2) in the blood; this is a common test done with vital +WUUWV;]XXTQM[IVL<WWT[NWZ
signs when visiting the medical office :W]\QVM8I\QMV\-`IU
■ Pulmonary function test (PFT)—used to diagnose
4  4 gauze Slide and fixative or
and measure the severity of lung problems by evaluat-
(nonsterile) Thin Prep–type con-
ing how well the lungs work: the amount of air the
Exam gloves tainer and applicator
lungs can hold and how quickly the lungs move air in
(nonsterile) (pelvic exam)
and out; measurements also include the efficiency of
Laryngeal mirror Sphygmomanometer
oxygenating the blood and removing carbon dioxide
Lubricant Stethoscope
• Spirometry—the
y most common lung function test; (pelvic and rectal Tape measure
measures how much and how quickly air is moved in exams) Thermometer
and out of the lungs by breathing into a mouthpiece Nasal speculum Tissues
attached to a recording device (spirometer); a graph Ophthalmoscope Tongue depressor
with the results (spirogram) is produced Otoscope Tuning fork
• Peak flow meter—a r handheld device used to meas- Penlight Vaginal speculum
ure the peak expiratory flow rate (PEFR) to monitor Percussion hammer (pelvic exam)
asthmatics; the ranges are established by the practi-
tioner; height may be used as a factor.

80A;1+)4-@)58:-8):)<176
The type of examination scheduled for the health care • Knee-chest position—patient rests on knees with
provider to perform determines how the medical assis- chest and arms on table and arms flexed over the
tant prepares the patient and the supplies and tools used. head; commonly used for rectal and sigmoidoscopic
Ensure privacy is maintained, requesting that the patient exams
undress to facilitate access to the body areas that will be
examined; provide gowns and draping accordingly. Con- • Fowler’s—patient lies face up on table with upper
body elevated to a 45 to 90 angle; commonly used
sideration for the patient’s comfort includes room tem-
for patients short of breath and for head and neck
perature, lighting, sound, and physical position while
exams
waiting and during the exam.
• Semi-Fowler’s—the Fowler’s position at a 45 angle
■ Common supplies and instruments—the medical assis- is sometimes referred to as semi-Fowler’s
tant is responsible for ensuring all supplies and equip- ■ Examination techniques
ment are readily available for the physical exam; Box • Observation—visual review of the body, inspecting
18-1 lists common supplies and tools for a routine for symmetry, abnormalities, and skin color and con-
patient exam; Figure 18-4 illustrates some of those tools ditions
■ Patient positions (Fig. 18-5)
• Palpation—use of fingertips and hands to feel for
• Supine—patient lies on back with arms to the sides; sizes and positions of specific organs, masses, and
commonly used for abdominal exams other abnormalities; texture and firmness; skin tem-
perature and moisture; and flexibility of joints
• Dorsal recumbent—patient lies on back with knees
bent and feet flat on the exam table; commonly used • Percussion—process of determining density of spe-
to check progress of labor cific internal structures by the sound (e.g., dull, hol-
low) produced by external tapping, usually with fin-
• Lithotomy—patient lies on back with buttocks on
edge of exam table, legs elevated and resting in stir- gers or with a percussion hammer for testing neuro-
rups; commonly used for pelvic exams logic reflexes

• Sims’—patient lies on left side with left leg slightly • Auscultation—use of an instrument, usually a stetho-
flexed and left arm behind body as comfortable; scope, to listen to internal body sounds for abnor-
right leg is flexed toward chest and right arm is over malities
the chest; commonly used for rectal exams • Manipulation—passive movement of body joints to
determine the extent of movement
• Prone—patient lies on stomach; commonly used for
exam of posterior and administration of intramuscu- • Mensuration—measurement of height or length and
lar injections on adults weight
 +PIX\MZ ■ Patient Exams 283

A Sphygmomanometers

B Tuning forks C Nasal specula

D Ophthalmoscope and otoscope E Laryngeal F Vaginal specula

mirror

.QO]ZM  Select tools for routine physical exam (Sklar Instruments, West Chester, PA).

TERMS auscultation use of an instrument, usually a stethoscope,

to listen to internal body sounds for abnormalities
Patient Exams Review body mass index (BMI) a health risk assessment tool
The following list reviews the terms discussed in this for adults and children to estimate the percentage of
chapter and other important terms that you may see on body fat by using a formula based on the individual’s
the exam. height and weight
anthropometry obtaining assessment measurements; chief complaint a summary of the patient’s words
comprises signs, functions, and capacities that can be explaining why he or she is seeking health care
objectively determined by the senses (e.g., sight, Doppler an ultrasonic device used to locate, audibly
hearing, smell) or by specific equipment or tests transmit, and sometimes record pulses
audiometry a hearing test using an audiometer with impedance audiometry a hearing test using an
earphones that measures the patient’s response to audiometer and an ear probe that measures tympanic
tones; it is recorded in decibels (db) and frequencies membrane and ossicle mobility
284 =VQ\ ■ Clinical Practice

.QO]ZM  Patient positions for exams and procedures. (Reprinted with permission from Hosley JB, Jones SA, Molle-Matthews EA.
Lippincott’s Textbook for Medical Assistants. Philadelphia: Lippincott-Raven Publishers, 1997.)

Ishihara color vision test used to determine color mensuration measurement of height or length and
vision deficiencies (color blindness); consists of a weight
series of pages or plates with imbedded numbers of observation visual review of the body, inspecting for
various colors; depending on the degree of the defi- symmetry, abnormalities, and skin color and conditions
ciency, the person would not see the number or ophthalmoscope (funduscope) an instrument that
would see it in a different color reflects light throughout the pupil to determine the
Korotkoff sounds sounds heard through the stetho- health of the interior of the eye
scope during the measurement of blood pressure; orthostatic pressure comparative blood pressures
there are five phases taken in the supine, sitting, and standing positions
manipulation passive movement of body joints to otoscope an instrument to examine the auditory canal
determine the extent of movement and eardrum
 +PIX\MZ ■ Patient Exams 285

palpation use of fingertips and hands to feel for sizes sphygmomanometer instrument used to measure
and positions of specific organs, masses, or other blood pressure; the instrument is composed of a cuff
abnormalities; texture and firmness; skin temperature for the arm, thigh, wrist, or finger and a measure-
and moisture; and flexibility of joints ment device
peak flow meter a handheld device used to measure spirometry the most common lung function test;
the peak expiratory flow rate (PEFR) to monitor measures how much and how quickly air is moved in
asthmatics and out of the lungs by breathing into a mouthpiece
percussion process of determining density of specific attached to a recording device (spirometer); a graph
internal structures by the sound produced by exter- with the results (spirogram) is produced
nal tapping, usually with fingers or with a percussion symptoms subjective descriptions of altered health
hammer for testing neurologic reflexes indicators (e.g., nausea, headache); complaints that
PERRLA pupils equal, round, reactive to light and cannot be seen or measured
accommodation; abbreviation used to describe the tonometry a test using an instrument (tonometer) to
normal pupil of the eye measure the intraocular pressure of the eye to diag-
pulmonary function test (PFT) used to diagnose and nose glaucoma
measure the severity of lung problems by evaluating tuning fork used for gross measurement for hearing
how well the lungs work: the amount of air the lungs and sound conduction; the instrument is activated by
can hold and how quickly the lungs move air in and striking it with the hand and is then placed on top of
out; measurements also include the efficiency of oxy- a patient’s head, beside each ear, and on each side of
genating the blood and removing carbon dioxide the patient’s mastoid bone
pulse oximetry a test using a pulse oximeter to meas- tympanometry a test that uses a tympanometer, which
ure the percentage of oxygen in the blood uses air pressure to measure tympanic membrane
Snellen chart poster with letters in rows of graduated mobility
sizes used to measure how well a person can see at vital signs measurements of body temperature, pulse
specified distances rate, respirations (TPR) and blood pressure (BP)
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA), RMA (AMT), and CMAS (AMT) exams.

1. The main reason why an ill patient is seeking Answer: +

medical care is referred to as the:
Why: When a patient seeks medical care, the medical
A. assessment.
assistant should summarize the patient’s words explain-
B. symptoms.
ing why the patient has come to see the doctor. The
C. chief complaint.
abbreviation of “chief complaint” is CC. Assessment
D. observation.
means to evaluate or measure. Symptoms are subjective
health indicators such as nausea and headache. Observa-
tion is a visual inspection of the body.
Review: Yes ❏ No ❏

2. What is the normal adult pulse range in beats per Answer: *

minute?
Why: The normal adult pulse should be between 60 and
A. 50–120
100 beats per minute and should have a regular rhythm.
B. 60–100
C. 70–130 Review: Yes ❏ No ❏
D. 80–140
E. 90–140

3. The pulse point located behind the knee is the: Answer: ,

A. femoral.
Why: The popliteal pulse, located behind the knee, is
B. dorsalis pedis.
used to assess circulation to the extremities. The tempo-
C. temporal.
ral pulse is located on the side of the head above the eye,
D. popliteal.
the dorsalis pedis on the top of the foot, and the femoral
in the groin.
Review: Yes ❏ No ❏

4. The instrument used to measure the blood pressure Answer: +

is a(n):
Why: The medical terminology root sphygm means
A. pulse oximeter.
“pulse,” and meter means “an instrument for
B. Doppler.
measuring.” A pulse oximeter measures the amount of
C. sphygmomanometer.
oxygen in the blood. A Doppler is an ultrasonic device
D. tympanometer.
used to locate and audibly transmit a pulse. A
E. audiometer.
tympanometer uses air pressure to measure tympanic
membrane mobility. An audiometer measures the
patient’s hearing based on his or her response to tones.
Review: Yes ❏ No ❏

5. The instrument used in the physical exam to Answer: +

determine hearing and conduction is a:
Why: A tuning fork is a metal device that vibrates and
A. reflex hammer.
produces a humming sound. It is used to determine
B. stethoscope.
whether a patient can hear. After striking the tuning
C. tuning fork.
fork, it is placed on the patient’s head or mastoid bone to
D. speculum.
examine conductive and sensorineural hearing loss.
Review: Yes ❏ No ❏

 
 +PIX\MZ ■ Patient Exams 287

6. The formula used to change pounds to kilograms is: Answer: -

A. 22 lb  1 kg
Why: Remember, it takes approximately twice the num-
B. 2.2 kg  1 lb
ber of pounds to equal a kilogram.
C. 100 lb  1 kg
D. 1 lb  100 kg Review: Yes ❏ No ❏
E. 2.2 lb  1 kg

7. The examination technique used to listen to internal Answer: ,

body sounds is:
Why: Auscultation is performed with the use of a stetho-
A. palpation.
scope. The physician can listen to the sounds made as
B. percussion.
air moves in and out of the lungs. Bowel sounds are also
C. mensuration.
heard when the stethoscope is placed over the abdomen.
D. auscultation.
Review: Yes ❏ No ❏

8. Which of the following items is not considered Answer: +

necessary for a routine patient exam?
Why: Nonsterile exam gloves are used during a routine
A. Ophthalmoscope
patient exam. Sterile gloves are only used when
B. Percussion hammer
performing a procedure that requires sterile aseptic
C. Sterile gloves
technique.
D. Tongue depressor
E. Otoscope Review: Yes ❏ No ❏

9. A Snellen chart is used to: Answer: *

A. record a child’s growth.
Why: The Snellen chart is a poster with rows of letters
B. measure a patient’s vision.
in graduated sizes and is used to measure vision at
C. determine normal values in spirometry.
specific distances. A person with 20/20 vision can see the
D. monitor vital signs.
letters at 20 feet away from the chart the same as a per-
son with normal vision can at 20 feet.
Review: Yes ❏ No ❏

10. The average adult respiration rate is: Answer: +

A. 20 to 24 per minute.
Why: Respiration ranges vary by age. Infants have a res-
B. 10 to 12 per minute.
piration rate of at least 20 per minute or greater,
C. 12 to 20 per minute.
children’s respiratory rate is 18 to 20 per minute, and the
D. 25 to 30 per minute.
average adult breathes in and out (one respiration) 14 to
E. 30 to 35 per minute.
20 times a minute.
Review: Yes ❏ No ❏

11. The patient exam position used for a patient who is Answer: ,
having difficulty breathing is:
Why: In Fowler’s position, the patient lies face up on the
A. dorsal recumbent.
exam table with the upper body elevated at a 45 to 90
B. lithotomy.
angle.
C. prone.
D. Fowler’s. Review: Yes ❏ No ❏
288 =VQ\ ■ Clinical Practice

12. The pulse point located on the thumb side of the Answer: ,
wrist is the:
Why: The radial pulse is palpated at the wrist on the
A. apical.
thumb side over the radial bone—the bone in the lower
B. brachial.
arm on the lateral side.
C. carotid.
D. radial. Review: Yes ❏ No ❏
E. popliteal.

13. The systolic pressure is described as: Answer: *

A. soft tapping sounds that become faint, or
Why: The Korotkoff sounds are those sounds heard
phase IV.
through the stethoscope during the measurement of
B. faint tapping sounds heard as the cuff deflates,
blood pressure. There are five phases; phase I is the
or phase I.
determination of the systolic pressure. This is the sound
C. rhythmic, sharp, distinct tapping sounds, or
made when arterial blood starts flowing back through
phase III.
the blood vessels as the cuff is deflated.
D. a soft swishing sound, or phase II.
Review: Yes ❏ No ❏

14. A percussion hammer is used for which kind of Answer: *

examination?
Why: A percussion hammer is used to test neurologic
A. Orthopaedic
reflexes. Neurologic refers to the nerves. If a patient has
B. Neurologic
diminished reflexes, this may indicate some nerve
C. Gynecologic
involvement. Orthopaedic refers to the skeletal and
D. Urologic
muscular system. Otologic refers to the ear.
E. Otologic
Gynecologic refers to women, and urologic refers to the
urinary system.
Review: Yes ❏ No ❏

15. The instrument used to visualize the ear canal and Answer: )
tympanic membrane is the:
Why: The root oto refers to the ear. A scope is an instru-
A. otoscope.
ment used to examine a body part. Sometimes a scope
B. audiometer.
has a light source attached. An otoscope is a lighted
C. nasoscope.
instrument used to look into the ear canal and examine
D. ophthalmoscope.
the eardrum (tympanic membrane). An audiometer is
used to measure hearing (audio means hearing or sound).
A nasoscope is an instrument used to examine the nose,
and an ophthalmoscope is used to examine the eyes.
Review: Yes ❏ No ❏

16. The exam method used to check for conjunctivitis Answer: ,

(pinkeye) is:
Why: Conjunctivitis, or pinkeye, is an inflammation of
A. auscultation.
the conjunctiva of the eye. The physician visually
B. palpation.
inspects the eyes for the signs of infection and
C. percussion.
inflammation.
D. inspection.
E. mensuration. Review: Yes ❏ No ❏
 +PIX\MZ ■ Patient Exams 289

17. The exam method used when a physician is Answer: +

determining a patient’s range of motion is:
Why: Manipulation is the passive movement of the joints
A. auscultation.
of the body to determine the extent of movement. Men-
B. palpation.
suration refers to the measurement of height, weight,
C. manipulation.
and length. Auscultation is the act of listening to
D. mensuration.
internal body sounds, usually using a stethoscope. Palpa-
tion is using the fingertips and hands to feel for sizes and
positions of specific organs, masses, and abnormalities.
Review: Yes ❏ No ❏

18. An oral temperature registers 99.4F, which equates Answer: *

to a(n):
Why: The temperature reading taken rectally is 1 degree
A. rectal reading of 101.4F.
higher than oral. An axillary temperature, under the
B. axillary reading of 98.4F.
arm, is 1 degree lower, and a temperature taken in the
C. otic reading of 100.4F.
ear is the same as an oral temperature.
D. rectal reading of 99.4F.
E. axillary reading of 99.4F. Review: Yes ❏ No ❏

19. If the blood pressure is 130/90, the pulse pressure is: Answer: )
A. 40
Why: The pulse pressure is the difference between the
B. 60
systolic and diastolic readings. Therefore, 130 minus 90
C. 90
equals 40.
D. 130
Review: Yes ❏ No ❏

20. What position would be used to examine the back Answer: -

or spine?
Why: In the prone position, the patient is lying face
A. Fowler’s
down on the exam table. Supine is face up, and dorsal
B. Supine
recumbent is face up with knees bent and feet flat on the
C. Knee-chest
table. The knee-chest position requires the patient to
D. Dorsal recumbent
kneel on the table and lower the chest to the table. The
E. Prone
knee-chest position is used to perform rectal exams.
Review: Yes ❏ No ❏

21. Which of the following pulse sites requires a Answer: +

stethoscope to take the pulse?
Why: The apical pulse is located at the fifth intercostal
A. Brachial
space midclavicular. A stethoscope is placed on the chest
B. Carotid
at this location to listen to the pulse.
C. Apical
D. Femoral Review: Yes ❏ No ❏

22. When performing a physical exam, the abbreviation Answer: ,

PERRLA is used to describe what part(s) of the
Why: PERRLA means pupils equal, round, and reactive
body?
to light and accommodation. This abbreviation is used
A. Abdomen
to describe normal pupils in the eye.
B. Nose and sinuses
C. Ears Review: Yes ❏ No ❏
D. Eyes
E. Heart
290 =VQ\ ■ Clinical Practice

23. Which of the following instruments and supplies is Answer: +

not included for a pelvic exam?
Why: It is not necessary to include sterile gloves with a
A. Lubricant
pelvic exam tray setup; only regular nonsterile exam
B. Cytology slide
gloves are used.
C. Sterile gloves
D. Vaginal speculum Review: Yes ❏ No ❏

24. When measuring the blood pressure, the medical Answer: *

assistant will normally place the stethoscope over
Why: The term brachial means “relating to the arm.”
which artery?
The brachial artery is located on the inner aspect of the
A. Apical
anterior of the arm, and the pulse is felt at the elbow
B. Brachial
region.
C. Carotid
D. Radial Review: Yes ❏ No ❏
E. Aorta

25. Blood pressure readings taken 1 to 2 minutes apart Answer: +

in the supine, sitting, and then standing position,
Why: The term orthostatic refers to “erect posture or
are the:
position.” A patient’s blood pressure can fluctuate when
A. pulse pressure.
changing positions from lying down to standing up.
B. metastatic pressure.
C. orthostatic pressure. Review: Yes ❏ No ❏
D. orthopaedic pressure.
 Minor Surgical Procedures
19

: - > 1 - ?  < 1 8
Chappter 17,, “Microorga
g nisms and Aseppsis,,” has direct app
pplication to surggical procedures—be sure
you understand those concepts before reviewing this chapter. Minor surgery is another area of
the national exams that contains questions requiring identification, care, and usage of surgical
instruments.

Most states define and regulate types of surgery that are • Examine sterile items for signs of break in packaging
considered appropriate for the medical office. Medical or presence of moisture (discard item if either is
malpractice insurance carriers also play a role. Refer to noted)
Chapter 4, “Law and Ethics,” for issues concerning
licensure, scope of practice, patient rights, informed con-
• Open the sterile package(s)
❍ Open the top flap first; open away from you to
sent, malpractice, and confidentiality. As in all areas of
medical assisting, patient education is an important com- avoid reaching over sterile field
ponent (see Chapter 8). ❍ Open the right and left flaps to the sides
General anesthesia is not usually administered for ❍ Open the last flap toward you
surgery in the medical office and is not covered in this
book.
• Allow only sterile items to come into contact with
other sterile items
• Keep all sterile items and hands above the waists of
the surgical team
8:-8):)<176
• Maintain a border of 1 inch between nonsterile and
Surgical asepsis must be maintained throughout the sterile areas
preparation and performance of surgical procedures. • Do not turn your back to a sterile field or leave it
unattended
■ Sterile field—a pathogen-free area containing sterile
instruments, solutions, sponges, and other items that • Do not lean or reach over sterile field
will come in direct contact with another sterile item or • Do not pass contaminated or nonsterile items over a
the surgical field; this includes the hands and anterior sterile field
neck to waist of the surgical team • Pour liquids such as sterile saline or an antiseptic
into a sterile waterproof container on the sterile field
• Ensure sterile indicators and dates on instruments
and solutions are intact and current before opening • Do not touch the container with the nonsterile
and placing on a sterile field bottle

!
292 =VQ\ ■ Clinical Practice

• Do not drip or spill liquid on the sterile field chemical sterilization. Safety (e.g., the use of sharps con-
tainers and other biohazard receptacles) was also addressed
• Do not talk, cough, or sneeze over a sterile field in Chapter 17.
■ Surgical handwashing (scrub)—remove all jewelry;
use foot- or knee-controlled faucet; wash hands,
wrists, and forearms for 10 minutes (first surgical COMMON INSTRUMENTS (FIG. 19-1)
scrub of day); hold hands in upward position while ■ Curette—sharp or smooth spoon-shaped instrument
rinsing; use brush and cuticle stick on nails; do not used to scrape tissue or other substances from a body
apply lotion; dry with sterile towel; apply sterile orifice or organ; the most common types are ear and
gloves uterine
■ Personal protective equipment (PPE) for surgery ■ Dilator—solid instrument used to stretch or widen the
• Gloves—sterile opening to an anatomic structure
■ Forceps—a two-handled instrument used to grasp,
• Goggles or eye shields—nonsterile
move, or crimp tissue; may be with or without
• Masks—nonsterile “teeth”
• Gowns—sterile
• Splinter forceps—fine-pointed, tweezer-like forceps
• Aprons—sterile if worn over surgical gown without teeth used to remove splinters and other for-
eign objects
■ Surgical site preparation
• Hair removal—shave or cut hair at surgical site only • Thumb forceps—smooth (without teeth) forceps;
with physician order (usually in procedure file); use the general-use forceps
only disposable blades; sterile instruments should be • Adson forceps—tweezer-like forceps, with or with-
covered during hair removal; all loose hair should be out teeth, with a smaller tip for smaller areas
removed before application of antiseptic • Bayonet forceps—tweezer-like forceps shaped
• Skin cleansing—using an antiseptic cleansing solu- like a bayonet used for packing in areas (e.g., the
tion (check for patient allergies) such as Betadine® nostrils)
or Hibiclens®, cleanse the surgical site using a cir- • Ring (sponge) forceps—long, two-handled forceps
cular motion from the point of the incision outward; with open ovals on the ends to grasp tissue, hold
use a clean sponge to repeat sponges, or transfer sterile instruments
• “Painting” and draping—after performing the previ- • Hemostat—sometimes referred to as a forceps;
ous steps, a sterile member of the surgical team will straight or curved instrument used to compress or
use a sterile sponge stick and sterile sponges to apply, crimp capillaries and other blood vessels to stop
or “paint,” an antiseptic solution on the surgical site, bleeding; also referred to as a clamp or a crile; types
using circular motions beginning with the incision are
site and working outward (one sponge per layer of ❍ Kelly hemostat—a medium-size hemostat; may be
antiseptic); fenestrated drapes (a drape with a hole or curved or straight
opening) or sterile towels, held in place by sterile
❍ Mosquito hemostat—a small hemostat used for
towel clips, are applied, as well as any other drapes
(sterile coverings) required by the size of the sterile pediatric, plastic, or microsurgery; may be curved
field or straight
■ Needle holder—a two-handled instrument that clasps
• When local anesthetic is required on a sterile field, a suture needle, allowing the physician to push and
the physician will hold the sterile syringe with sterile
gloved hands; the medical assistant shows the physi- pull the needle with suture material through various
cian the label on the vial and holds the vial upside anatomic structures
down for the physician to draw out the required ■ Probe—a straight instrument with ends of various
amount of medication shapes, used primarily to explore ducts, canals, and other
anatomic structures
■ Retractors—instruments of various shapes used to
hold back tissue and organs to facilitate exposure to
16;<:=5-6<)<176
the operative site
All instruments or parts of instruments that enter the ster- ■ Scalpels—knives of various blade shapes and sizes,
ile field must be sterile. Chapter 17 covered the two com- used to make surgical incisions; the blade is always dis-
mon procedures for sterilization: autoclaving and cold or posable; the knife handle may or may not be disposable
 +PIX\MZ! ■ Minor Surgical Procedures 293

A Hemostats B Tenaculum C Needle holder D Ring (sponge) forceps E Splinter forceps

F Surgical scissors G Suture removal scissors H Bandage scissors I Towel clip

J Retractors (rake) K Probe L Sounds M Curettes N Bayonet forceps

.QO]ZM! Common surgical instruments (Sklar Instruments, West Chester, PA).

294 =VQ\ ■ Clinical Practice

■ Scissors—two-bladed instrument used to cut tissue Other Common Instrumentation With Power Sources
and materials during surgical procedures
■ Electrosurgery—a method of dissection and cauteriza-
• Surgical/operating scissors—scissors used during tion using an electric current directed to a specific
surgery to cut and dissect tissue; may be curved or anatomic area to cut, destroy, or coagulate; the power
straight, blunt or sharp (e.g., Mayo scissors) source is initiated and controlled through a boxlike
• Suture scissors—scissors used to cut suture material; unit that transmits to a hand piece with sterile remov-
straight-bladed suture scissors are used in suturing; able tips that come in direct contact with the surgical
suture scissors with a hook on the end of one side are site; the patient must be grounded and safety precau-
used to remove sutures tions enforced
• Bandage scissors—angled scissors with a blunt ■ Cryosurgery—a method of destroying tissue by freez-
knobbed end to insert under dressings to remove ing (cryogenics) using liquid nitrogen applied from a
them without injuring tissue tank with a gauge and removable hand pieces (e.g., for
■ Sound—a straight or curved instrument used to removal of cervical lesions), or other cryomaterials
explore body cavities for measurement of depth and requiring simple spray canisters (e.g., for removal of
presence of masses or foreign bodies skin lesions)
■ Tenaculum—a long, two-handled instrument with ■ Laser surgery—a method using high concentrations of
pointed ends used to grasp tissue during surgery; a cer- electromagnetic radiation in narrow beams for surgical
vical tenaculum is commonly used in well-woman and diagnostic applications (e.g., coagulation of retinal
exams hemorrhage); uses vary and are dependent on the color
spectrum; common terms associated with laser surgery
■ Towel clamps (clips)—small instruments of various
are argon, continuous wave, pulsed wave, excimer, krypton,
shapes used to keep sterile towels used as drapes in
KTP, YAG, and Q-switched; goggles should be worn and
place during surgery
special training provided before assisting in laser surgery

COMMON SURGICAL TRAY INSTRUMENTS

Each office maintains a file of all instruments, supplies, +47;=:-5)<-:1)4;
and equipment needed for each surgical procedure. The
following are select surgical trays and their instruments. The type of material used for closure is dependent on
■ General minor surgery tray used for procedures such several factors. Is the closure on an internal anatomic
as removal of lesions—towel clips (four), scalpel and structure or on the skin? What are the depth, thick-
blade, curved and straight hemostats (two each), surgi- ness, and length of the closure site? What are the heal-
cal scissors, thumb forceps, forceps with teeth, suture ing capacity factors of the patient (e.g., nutritional
scissors, needle holder (retractors and other instru- status, diabetes, recent history of steroid administra-
ments may be added as needed), specified type of sur- tion, smoking)?
gical sponge; sutures and sizes may be on the file card ■ Suture—derived from Latin, meaning “a sewing”;
or requested by the physician during the procedure threadlike materials (ligature) and needle used to close
a wound; the needle and ligature used in the medical
■ Suture tray—towel clips (four), curved hemostat, for-
office are usually mechanically attached (swaged) by
ceps with teeth, thumb forceps, suture scissors, needle
the manufacturer
holder, sterile 4  4 gauze; sutures identified by the
physician and added to the setup ■ Ligature

■ Suture or staple removal tray—suture scissors or staple • Absorbable—material that dissolves in the body
remover, thumb forceps, sterile 4  4 gauze (e.g., catgut); used for internal suturing
• Nonabsorbable—material that does not dissolve
(e.g., silk, nylon and other synthetics, wires); gener-
ENDOSCOPE ally for external use, although some wires may be
used internally; most nonabsorbable sutures are
An endoscope is a special instrument used to examine removed after healing takes place
the interior of canals and hollow viscus; the specific
design and name is dependent on the organ (e.g., gastro- • Size—determined by the thickness of the diame-
ter; the range is approximately from 7, the largest,
scope, bronchoscope). The instrument usually contains
to 11-0, the smallest (Box 19-1)
fiberoptic technology that allows lighting, video trans-
mission, and other technologic procedures; biopsies and ■ Needle
select surgical procedures may be performed through the • Cutting—needle with sharp, flat edge used on tough
endoscope, eliminating or minimizing a surgical incision. tissue (e.g., skin)
 +PIX\MZ! ■ Minor Surgical Procedures 295

*W`!
:IVOMWN+WUUWV;]\]ZM5I\MZQIT;QbM[
Larger to smaller

7 6 5 4 3 2 1 0 1-0 2-0 3-0 4-0 5-0 6-0 7-0 8-0 9-0 10-0 11-0

Large Small

• Noncutting—needle with sharp, smooth, rounded ■ Laceration—a jagged traumatic cut resulting in irregu-
edge used on finer tissue, such as peritoneum lar wound edges
• Curved—the shape of the needle; may have cutting ■ Puncture—a hole in the skin made by a sharp pointed
or noncutting edge; needle holder used object
• Straight (Keith)—the shape of the needle; may have ■ Healing—physiologic process of wound closure; there
cutting or noncutting edge; no needle holder required are two predominant types
• Size—determined by the size of the ligature to be • First intention (primary)—wound edges are approx-
used; physician will ask for ligature size on a cutting imated and healing process occurs in all layers (e.g.,
or noncutting, curved or straight needle incision, laceration)
■ Staples—metal clips used to approximate skin edges • Secondary intention (granulation)—wound edges do
during healing or occlude internal structures; materials not approximate and healing begins at wound bot-
vary per use (e.g., stainless steel used on skin, silver used tom, forming granular projections on the wound
for neurosurgery); external staples must be removed surface (e.g., a wound from a drain)
with a staple remover ■ Dressings—defined as sterile coverings placed over a
■ Steri-Strips—adhesive strips of material used in minor wound but often used synonymously with bandaging;
lacerations or as a follow-up to sutures to hold wound types of dressing include gauze, occlusives (e.g., Vase-
edges together during healing line gauze), nonstick (e.g., Telfa), nonopaque (e.g.,
■ Glue—bonding material used externally to approxi- BioDerm), and commercial gauze impregnated with
mate skin edges or internally to affix structures; often medication (e.g., NuGauze); dressings should be
used in neurologic or orthopaedic surgeries applied using sterile technique
■ Bandages—sterile or nonsterile materials that splint or
protect injured tissue (e.g., Kerlix, Ace bandages, tri-
?7=6,; angular slings, tube gauze [frequently used on digits]),
maintain pressure over an area (such as abdominal
Wounds are traumas to body tissues caused by physical pads, Coban), and hold sterile dressings in place (e.g.,
means. The trauma may be unintentional, such as a fall, Montgomery straps, rolled gauze)
or intentional, such as surgery. The type of wound deter-
mines the treatment and the potential for healing. Surgi-
cal wounds are considered clean wounds because they are
initiated under sterile conditions. Dirty wounds are TERMS
those sustained under contaminated conditions (e.g., a
knife wound while preparing a meal). Minor Surgical Procedures Review
■ Abrasion—outer layers of skin scraped off, resulting in
The following list reviews the terms discussed in this
a small amount of sanguineous or serosanguineous
chapter and other important terms that you may see on
drainage, such as a “skinned” knee
the exam.
■ Contusion—bleeding below unbroken skin caused by abrasion outer layers of skin scraped off, resulting in a
blunt trauma; a bruise small amount of sanguineous or serosanguineous
■ Incision—a smooth cut as in surgery or as made with a drainage, such as a “skinned” knee
razor; the amount of bleeding depends on the location contusion bleeding below unbroken skin caused by
and depth blunt trauma; a bruise
296 =VQ\ ■ Clinical Practice

cryosurgery a method of destroying tissue by freezing laser surgery a method using high concentrations of
(cryogenics) using liquid nitrogen applied from a electromagnetic radiation in narrow beams for surgi-
tank with a gauge and removable hand pieces, or cal and diagnostic applications
other cryomaterials requiring simple spray needle holder a two-handled instrument that clasps a
canisters needle, allowing the physician to push and pull the
curettes sharp or smooth spoon-shaped instruments needle with suture material through various anatom-
used to scrape tissue or other substances from a ic structures
body orifice or organ; most common are ear and probe a straight instrument with ends of various
uterine shapes; used primarily to explore patency of ducts,
dilators solid instruments used to stretch or widen the canals, and other anatomic structures
opening to an anatomic structure (e.g., uterine, ure- puncture a hole in the skin made by a sharp pointed
thral sounds) object
electrosurgery a method of dissection or cauterization retractors instruments of various shapes used to hold
using an electric current directed to a specific back tissue and organs to facilitate exposure to the
anatomic area to cut, destroy, or coagulate operative site
endoscope special instrument used to examine the scalpels knives with various blade shapes and sizes,
interior of canals and hollow viscus; design and name used to make surgical incisions
is dependent on the organ; it usually contains sound a straight or curved instrument used to explore
fiberoptic technology allowing lighting, video trans- body cavities for measurement of depth and presence
mission, and other technologic procedures of masses or foreign bodies
forceps a two-handled instrument used to grasp, move, suture scissors scissors used to cut suture material;
or crimp tissue straight-bladed suture scissors are used to suture;
hemostat sometimes referred to as a forceps; straight or suture scissors with a hook on the end of one side
curved instrument used to compress capillaries and are used to remove sutures
other blood vessels to stop bleeding; also referred to tenaculum a long, two-handled instrument with point-
as a clamp or a crile ed ends used to grasp tissue during surgery; a cervical
incision a smooth cut as in surgery or as made with a tenaculum is commonly used in well-woman exams
razor towel clamps (clips) small instruments of various
laceration a jagged traumatic cut resulting in irregular shapes used to keep sterile towels used as drapes in
wound edges place during surgery
 : - > 1 - ?  9 = - ; < 1 7 6 ;
All questions are relevant for the CMA (AAMA) and RMA (AMT) exams.

1. An instrument used to grasp tissue is a: Answer: ,

A. probe.
Why: There are many types of forceps, such as splinter
B. curette.
forceps, thumb forceps, Adson forceps, and sponge for-
C. dilator.
ceps. These are used to grasp tissue or supplies.
D. forceps.
Review: Yes ❏ No ❏

2. The instrument used to remove stitches is: Answer: +

A. operating scissors.
Why: Sutures and stitches are the same. Suture scissors
B. Kelly hemostat.
have a hook on the end of one of the blades. This hook
C. suture scissors.
is slipped under the stitch/suture, and the stitch is cut
D. Mayo scissors.
for removal.
E. needle holder.
Review: Yes ❏ No ❏

3. A procedure that uses liquid nitrogen to freeze and Answer: ,

destroy tissue is:
Why: The root cryo means “cold.” Liquid nitrogen pro-
A. electrosurgery.
duces a freezing effect that destroys tissue. This method
B. laser surgery.
is frequently used to destroy cervical lesions.
C. endoscopic surgery.
D. cryosurgery. Review: Yes ❏ No ❏

4. Which of the following statements is true regarding Answer: +

the sizing of suture, or ligature?
Why: Suture is available in different sizes or gauges.
A. 2-0 suture is finer than 6-0 suture.
When the size ends in a zero, suture sizes become
B. 3 suture is thicker than 6 suture.
smaller as the number gets larger. A 2-0 suture is thicker
C. 4-0 suture is finer than 2-0 suture.
than a 10-0 suture. The opposite is true when the suture
D. 5-0 suture is finer than 6-0 suture.
size is a whole number. The higher the whole number,
E. 4 suture is finer than 2 suture.
the larger or thicker the suture. For example, size 7
suture is thicker than size 2.
Review: Yes ❏ No ❏

5. Which of the following sutures does not require Answer: )

removal from the body?
Why: Catgut suture is an absorbable suture made from
A. Catgut
the intestines of sheep or cattle. It is readily broken
B. Silk
down by the body and usually does not require removal.
C. Nylon
D. Cotton Review: Yes ❏ No ❏

6. The type of wound caused by scraping off the Answer: *

outer layers of skin is a(n):
Why: An example of an abrasion is a skinned knee, in
A. incision.
which the top layers of skin are scraped off.
B. abrasion.
C. contusion. Review: Yes ❏ No ❏
D. laceration.
E. bruise.

!
298 =VQ\ ■ Clinical Practice

7. Which of the following instruments is used to scrape Answer: ,

foreign substance from an ear?
Why: A curette is a sharp or smooth, spoon-shaped
A. Dilator
instrument used to scrape tissue or other substances
B. Hemostat
from a body orifice or organ. A dilator is a solid
C. Retractor
instrument used to stretch or widen the opening to an
D. Curette
anatomic structure. A hemostat is used to compress or
crimp capillaries and other blood vessels to stop
bleeding. A retractor is used to hold and separate tissue.
Review: Yes ❏ No ❏

8. The type of bandage material that is not intended to Answer: *

apply pressure but to hold a dressing in place on the
Why: Rolled gauze is available in different widths from
forearm is:
1 inch to 6 inches and in various lengths. It is used to
A. elastic bandage.
wrap around a body part such as an arm or a leg. Elastic
B. rolled gauze.
bandage is made from a stretchy material and is used to
C. triangular bandage.
apply pressure. Triangular bandages are used to make a
D. tubular gauze.
sling for the arm. Tubular gauze is used to bandage toes
E. 4  4 gauze.
and fingers. Gauze squares are used to cover wounds
and are available in 1-inch to 4-inch squares.
Review: Yes ❏ No ❏

9. A type of wound caused by a blunt trauma to the Answer: +

body that results in bleeding below unbroken skin
Why: A contusion causes a bruise. A bruise forms from
is a(n):
bleeding beneath the skin. The skin is not broken, but
A. puncture.
the injury is visible through the surface of the skin.
B. laceration.
C. contusion. Review: Yes ❏ No ❏
D. abrasion.

10. Items that are placed on the sterile field of a biopsy Answer: +
surgical tray setup include the following EXCEPT:
Why: Bandage scissors are used to cut through and
A. scalpel.
remove bandages and have a blunt end so they do not
B. needle holder.
injure the patient during use. They are not included on
C. bandage scissors.
the tray for a biopsy.
D. hemostat.
E. curette. Review: Yes ❏ No ❏

11. The type of material preferred to bandage Answer: *

a digit is:
Why: Tube gauze is gauze manufactured into a tube
A. 4  4 gauze.
shape. It stretches and conforms to body parts such as
B. tube gauze.
fingers and toes (digits).
C. Ace bandage.
D. 2  2 gauze. Review: Yes ❏ No ❏
 +PIX\MZ! ■ Minor Surgical Procedures 299

12. Which of the following statements is true regarding Answer: -

the sterile tray setup?
Why: Bandage materials are not placed on the sterile
A. All bandage materials are added to the sterile
field. Only those items that are sterile are on the tray.
tray for easy access after the procedure.
For example, adhesive and surgical tape are not sterile.
B. You should pour solutions into the basin on the
When pouring solutions from a bottle, pour the liquid
sterile tray holding the bottle label down so you
from the container with the label face up, so that if
can see the liquid in the container.
liquid drips down the bottle, the label will not be
C. Surgical handwashing is not required.
destroyed or damaged. Before setting up a sterile tray, it
D. You should reach over the sterile field, not
is essential to perform a surgical handwash. You should
around it, to access something on the other side
never reach over a sterile tray.
of the tray.
E. A 1-inch border around the sterile field is Review: Yes ❏ No ❏
considered contaminated.

13. A fenestrated sterile drape: Answer: *

A. is used to cover the sterile tray after it is set up to
Why: The word fenestra is a Latin term for “window” or
protect it from becoming contaminated.
“opening.” This sterile drape is approximately 18  24
B. has an opening in the middle and is placed over
inches and has a 2-inch square opening in the middle.
the area of the patient where a surgical incision
The drape is placed over the patient, with the opening
will be made.
over the area where the surgical procedure will be
C. is a type of bandaging material used to cover a
performed.
large area of the body.
D. is a sterile drape impregnated with an anesthetic Review: Yes ❏ No ❏
medication.

14. To ensure package sterility, the medical assistant Answer: +

should:
Why: You should not use a sterile package if it is wet or
A. use a torn sterile package only if the tear is small.
damp or has become damaged. Packs sterilized in-house
B. use sterile packages up to 30 days after the
expire 30 days from the preparation date. The outside of
expiration date to conserve the need to
the sterile package is not considered sterile, only the
re-autoclave.
contents within the pack. Therefore, sterile gloves are
C. use only dry, undamaged sterile packages.
not required to transport the pack. It is not necessary to
D. only transport sterile packages with sterile
perform a surgical handwash before wrapping packs.
gloves.
E. perform a surgical handwash before wrapping Review: Yes ❏ No ❏
packs for sterilization.

15. Electrosurgery is used to: Answer: +

A. retract tissues.
Why: Electrosurgery is a method of cauterization using
B. dilate openings in the body.
an electric current to dissect or coagulate tissue. Surgical
C. dissect and coagulate tissue.
instruments are used to retract or to hold back
D. freeze tissue.
structures of the body during surgery. Dilation is the
process of making an opening larger. Cryosurgery is the
method used to freeze tissue.
Review: Yes ❏ No ❏
300 =VQ\ ■ Clinical Practice

16. The first step performed to set up a sterile field is to: Answer: +
A. open the sterile package.
Why: Handwashing is performed before any procedure.
B. pour solutions that will be used during the
When setting up a sterile field, a surgical handwashing is
procedure.
performed for 10 minutes.
C. wash your hands.
D. don sterile gloves. Review: Yes ❏ No ❏
E. prepare the local anesthetic in a syringe and
place it on the sterile field.

17. After a surgical procedure, the guidelines for Answer: )

discarding materials include:
Why: All items that are disposable and considered sharp
A. placing all sharps in a biohazard sharps container.
are discarded in the biohazard sharps container. This
B. placing only visibly soiled materials in a
includes suture materials with needles attached, syringes
biohazard sharps container.
and needles, and scalpel blades. All other materials
C. discarding all paper materials in the trash can.
soiled with body fluids should be placed in a biohazard
D. pouring unused solutions back into their proper
container, but not in one specifically designed for
containers.
sharps. Red trash bags are most commonly used for
these items.
Review: Yes ❏ No ❏

18. An instrument used to explore anatomic structures Answer: -

is a:
Why: A probe is a straight instrument with various
A. hemostat.
shaped ends that are usually blunt, used primarily to
B. curette.
explore the patency of ducts, canals, and other anatomic
C. forceps.
structures.
D. dilator.
E. probe. Review: Yes ❏ No ❏

19. Instruments used to hold back tissue and organs are: Answer: +
A. thumb forceps.
Why: Retractors may be plain or toothed and may be
B. Kelly forceps.
sharp or blunt. They are designed to be either held by
C. retractors.
an assistant or screwed open to be self-retaining.
D. curettes.
Review: Yes ❏ No ❏

20. A common antiseptic solution used to prep the Answer: )

surgical site is:
Why: Formaldehyde is not intended for use on the skin.
A. Betadine®.
Alcohol is used for surface cleansing of the skin for
B. alcohol.
minor invasive procedures and to wipe items such as
C. hydrogen peroxide.
stethoscopes. Hydrogen peroxide does not have the
D. formaldehyde.
antiseptic qualities necessary for prepping the skin
E. sterile saline.
before surgery. Sterile saline is a salt solution that is free
from all microorganisms.
Review: Yes ❏ No ❏
 +PIX\MZ! ■ Minor Surgical Procedures 301

21. A jagged traumatic cut resulting in irregular wound Answer: *

edges is a(n):
Why: A contusion does not break the skin but bleeding
A. contusion.
occurs beneath the skin, resulting in a visible bruise. An
B. laceration.
incision is a smooth cut, as made with a razor or a
C. incision.
scalpel. An abrasion is a wound caused from scraping
D. abrasion.
away the top layers of skin.
Review: Yes ❏ No ❏

22. An instrument used to examine the interior of canals Answer: -

or of hollow organs is a(n):
Why: An endoscope is an illuminated optic instrument
A. retractor.
used for visualizing the interior of a body cavity or of an
B. catheter.
organ. Scopes include a gastroscope, which is used to
C. dilator.
examine the stomach; a bronchoscope, which is used to
D. curette.
examine the bronchi of the lungs; and a sigmoidoscope,
E. endoscope.
which is used to examine the sigmoid colon.
Review: Yes ❏ No ❏

23. The procedure for delivering local anesthetic to the Answer: ,

sterile field is to:
Why: The vial of medication is not sterile and should
A. fill the syringe with the proper amount of
not be placed on the sterile field. Using sterile
solution before the procedure and place it on the
technique, a syringe is placed on the sterile field. The
sterile field.
physician holds the syringe and directs the needle into
B. place the vial of solution on the sterile field so
the rubber stopper of the vial and withdraws the
the physician can have access to it.
required amount of solution. The medical assistant must
C. remove the syringe from the sterile field, fill the
remember to wipe the top of the vial with alcohol before
syringe with the amount of solution required,
offering the vial to the physician. Also, it is usually
and return the syringe to the sterile field for the
required that the medical assistant either show the
physician to use.
physician the vial label or read the label out loud before
D. while the physician holds the syringe with sterile
using the solution to ensure the solution is the correct
gloved hands, the medical assistant holds the vial
one.
of solution for the physician, and the physician
draws out the required amount of solution. Review: Yes ❏ No ❏

24. The bandage material preferred when pressure is Answer: *

required over the injured area is:
Why: The elastic (Ace) bandage is form-fitting and used
A. 4  4 gauze.
as a pressure bandage. It is important to check the
B. elastic bandage.
patient’s extremities for proper blood return into toes
C. roller gauze.
and fingers. If the bandage is too tight, it can restrict
D. triangular bandage.
blood flow to the body part.
E. Telfa pad.
Review: Yes ❏ No ❏

25. A wrapped, autoclaved, sterile package is opened on Answer: +

the Mayo stand by opening the top flap of the
Why: The top flap is opened away from you so that as
wrapper:
the other flaps are opened you will not have to reach
A. toward the right side of the table.
over the sterile contents of the package. After the top
B. toward the left side of the table.
flap is open, the right and left flaps are opened to the
C. away from you.
sides. The last flap, closest to you, is opened by lifting it
D. toward you.
toward you.
Review: Yes ❏ No ❏
 The Electrocardiogram
20

: - > 1 - ?  < 1 8
Refer to Chapt
p er 6, “Anatomyy and Phyysiologgy,
y ” and review the cardiovascular syystem, includingg
the functions, components, cardiac cycle, and cardiac conduction. Exam questions may involve
identifying a cardiac rhythm or PQRST waves from a picture of an electrocardiogram strip or
identifying cardiac leads.

The electrocardiogram (ECG or EKG) is the graphic the cardiac cycle, which results in the heart pumping blood
representation of the electrical activity that passes through throughout the body (see Chapter 6, Figs. 6-19 and 6-20).
the heart. It is monitored at the skin surface with sensors
called electrodes that produce specific leads or views of ■ Cardiac polarity—electrical status of cardiac muscle
the heart, which is a three-dimensional organ. The ECG cells; an attempt to maintain electronegativity (ability to
is a painless and noninvasive tool used to collect baseline attract electrons) inside these cells to ensure an appro-
information (e.g., during a routine physical exam) and to priate distribution of ions (e.g., potassium, sodium,
diagnose and monitor various heart diseases such as chloride, calcium)
myocardial infarctions and other ischemia, heart blocks
• Polarization—resting cardiac muscle cells
and other conduction defects, benign and life-threatening
arrhythmias, and the effects of cardiac drugs. • Depolarization—charged and contracting cardiac
muscle cells
• Repolarization—recovering cardiac muscle cells;
7>-:>1-? returning to equilibrium
The electrical activity of the heart begins at the cellular ■ Cardiac cycle—the pumping of the heart in a rhyth-
level. It then follows the conductive pathway bringing about mic cycle of contraction and relaxation (the sound


304 =VQ\ ■ Clinical Practice

through a stethoscope is often described as “lub • QT interval—the QRST waves representing a full
dub”) cardiac electrical cycle
• Normally 60 to 100 cycles or beats per minute (nor- • ST segment—a slight upward line connecting the
mal adult heart rate) QRS waves to the T wave and representing the time
• Phases of atrial and ventricle contractions (systole) between contraction of the ventricles and relaxation
and relaxation (diastole) or recovery
❍ Atrial systole—contraction of atria, forcing blood ■ Types of ECGs
into ventricles through tricuspid and mitral valves • Single-lead ECG—information recorded from one
❍ Ventricle diastole—relaxation of ventricles, allow- view of the heart; a lead is a specific view of the
ing them to fill with blood from atria heart, which is a three-dimensional organ; usually,
❍ Ventricle systole—contraction of the ventricles,
lead II is selected
forcing blood through the aortic and pulmonic • 12-lead (multichannel) ECG—information record-
valves to the aorta and pulmonary artery ed from 10 electrodes, representing 12 views of the
❍ Atrial diastole—relaxation of atria, allowing them
heart from 12 different angles
to fill with blood from the vena cava and pulmonary • Telemetry—single-lead or 12-lead ECGs transmitted
veins via radio, electronic, or telephone waves to another
■ ECG complex—a full cardiac electrical cycle (one heart- site for monitoring or interpretation
beat) represented by PQRST waves (and sometimes U • Interpretive ECG—a computerized ECG machine
wave) working together as a complex (Fig. 20-1) that is programmed to analyze data and produce a
printed interpretation with the graph
• P wave—an upward curve representing atrial con-
traction; used to measure the atrial rate
• Q wave—a downward deflection after the P wave
-4-+<:7,-;84)+-5-6<)6,4-),;
• R wave—a large upward spike after the Q wave
• S wave—a downward deflection after the R wave The terms “electrodes” and “leads” are sometimes used
synonymously. This is not correct. An electrode is the sen-
• T wave—an upward curve after the S wave, repre- sor attached to the ECG machine that adheres to the
senting the repolarization and resting of the ventricles
skin. A lead is the view of the heart produced by a stan-
• U wave—a small upward curve sometimes following dard combination of electrode placements. The 12-lead
the T wave, representing slow repolarization or return ECG is produced using 10 electrodes (Fig. 20-2). The
to resting correct placement of these electrodes influences the
• QRS complex—the QRS waves representing con- quality and accuracy of the rhythm strip. The right leg
traction of the ventricles (RL) is the grounding electrode and not used as part of
• PR interval—the P wave and the line connecting it any lead. Electrodes should never be placed over a bony
to the QRS complex, representing the time the elec- prominence or clothing.
trical impulse travels from the sinoatrial (SA) node
to the atrioventricular (AV) node
PLACEMENT OF ELECTRODES (10 SENSORS)
■ Chest electrodes (6)
5 mm
0.2 sec • V1—fourth intercostal space at right margin of ster-
R num
5 mm

P-R S-T • V2—fourth intercostal space at left margin of sternum

seg seg
e
T • V3—midway between V2 and V4
P
• V4—fifth intercostal space at left midclavicular line
0.5 mV

• V5—placed midway between V4 and V6

P-R S-T U
interval
nterva
Q
S
interval
terv
• V6—fifth intercostal space at the left midaxillary line
QRS
■ Limb electrodes (4)
int. Q-T
interval
nterval • RA—right arm
• LA—left arm
.QO]ZM Normal cardiac electrical cycle. (Reprinted with permission from
Pillitteri A. Maternal and Child Nursing. 4th Ed. Philadelphia: Lippincott Williams • RL—right leg (ground)
& Wilkins, 2003.) • LL—left leg
 +PIX\MZ ■ The Electrocardiogram 305

• Unipolar (augmented voltage) limb leads

❍ aVR (RA electrode)
Midclavicular line ❍ aVL (LA electrode)
Anterior axillary line
Midaxillary line ❍aVF (LL electrode)
■ Chest (precordial) leads (6)—all chest leads are unipo-
Horizontal
lar and equate to the six chest electrodes
plane of V4–V6
• V1
RA
A LA
A • V2
• V3
V1 V2 V3 V4 V5 V6
• V4
• V5
• V6
The national certification examinations frequently ask
questions about identification of ECG leads.

ECG PAPER
RL ECG paper is standardized paper designed for ECG
LL
L
machines. It has a combination of small and large blocks
to measure the cardiac electrical activity demonstrated
on the graph.

■ Horizontal line—time
■ Vertical line—voltage or amplitude
.QO]ZM Twelve-lead electrocardiogram electrode placement. (Reprinted
with permission from Hosley JB, Molle-Matthews E. Lippincott’s Pocket Guide to ■ Small block—1 mm  1 mm, representing 0.1 milli-
Medical Assisting. Philadelphia: Lippincott Williams & Wilkins, 1999.) volt (mV) on the vertical axis and representing 0.04
second on the horizontal axis
■ Large block—5 mm  5 mm, representing 0.5 mV on
ECG LEADS (12 VIEWS OF THE HEART) the vertical axis and representing 0.20 second on the
horizontal axis; five large horizontal blocks repre-
■ Limb leads (6)
sent1 second
• Bipolar limb leads—record cardiac electrical activity ■ Vertical slashes above the graph—mark 3-second inter-
between two electrodes
vals (15 large blocks); used to calculate heart rate
❍ Lead I—heart view between LA and RA electrodes
■ Paper speed—25 mm/sec is the usual speed for adults;
❍ Lead II—heart view between LL and RA electrodes 50 mm/sec is usual speed for children
❍ Lead III—heart view between LL and LA electrodes ■ Calibration—10-mm (two large blocks) vertical mark
❍ Lead I, lead II, and lead III with RL (ground) form is the normal standard; it is sometimes referred to as
Einthoven triangle (Fig. 20-3) the standardization mark; the calibration is changed to

I II III

– + – –

.QO]ZM Einthoven triangle representing views of + +

the heart in leads I, II, and III.
306 =VQ\ ■ Clinical Practice

*W`
-+/4MIL5IZSQVO+WLM[
Limb leads: Bipolar Limb leads: Unipolar Chest leads
(Dot  •) (Dash  —) (Dash  — / Dot  •)
Lead I • aVR — V1 — •
Lead II • • aVL — — V2 — • •
Lead III • • • aVF — — — V3 — • • •
V4 — • • • •
V5 — • • • • •
V6 — • • • • • •

5 mm (one-half standard) in situations where the R interval of complexes that may be compared to a previ-
wave is too large and the ECG machine amplitude ous ECG. Criteria for NSR are as follows (Box 20-2):
must be decreased to allow the tracing to fit on the
paper ■ Regular rhythm—same number of spaces between all
■ Marking codes—symbols of dots and dashes repre- R waves
senting the leads on an ECG tracing (Box 20-1); most ■ Heart rate—normal adult heart rate is 60 to 100 beats
model machines identify the leads by placing I, II, III, per minute
aVR, aVL, aVF, V1, V2, V3, V4, V5, or V6 in the por- • Calculation method 1—count number of large blocks
tion of the graph representing that lead between two R waves and divide into 300 (e.g., five
large blocks between two R waves  300/5  60 beats
per minute)
• Calculation method 2—count number of R waves
STYLUS between 6-second marks (30 large blocks) and multi-
A stylus is a heated penlike instrument of the ECG ply by 10 (e.g., 6 R waves in 6 seconds  6  10  60
machine that receives impulses via electrodes and moves beats per minute)
on ECG paper, recording the electrical activity of the ■ P waves—P waves present before each QRS complex
heart. ■ Normal PR interval—0.12 to 0.20 second (three to five
small blocks)
■ Normal-shaped QRS complex—0.06- to 0.10-second
duration (1.5 to 2.5 small blocks)
67:5)4 ;16=;:0A<056;:
Normal sinus rhythm (NSR) is a standard cardiac cycle
+):,1)+)::0A<051);
that begins in the SA node. The role of the medical assis-
tant is not to interpret an ECG. The expectation is that Cardiac arrhythmias or dysrhythmias are irregular heart
the medical assistant can differentiate normal sinus activities resulting in loss of a regular rhythm. If all the
rhythm from abnormal cardiac rhythms and notify the criteria for normal sinus rhythm, as stated previously, are
physician of irregularities. The physician may order a not met, the beat is considered abnormal. Figure 20-4
rhythm strip, a long tracing of lead II, as opposed to a illustrates a normal sinus rhythm and some examples of
complete ECG. The purpose is to evaluate a longer arrhythmias.

*W`
<MUXTI\MNWZ1LMV\QNaQVO6WZUIT;QV][:Pa \PU
Rhythm Rate P wave present Normal PR interval Normal-shaped QRS interval
(0.12–0.20 sec) (0.06–0.10 sec)
 +PIX\MZ ■ The Electrocardiogram 307

A Normal sinus rhythm

B Premature ventricular contractions (PVCs)

C Ventricle tachycardia

D Atrial fibrillation
.QO]ZM Select electrocardiogram strips. (Reprinted with permission from Smeltzer SC, Bare BG. Textbook of Medical-Surgical Nursing. 9th Ed.
Philadelphia: Lippincott Williams & Wilkins, 2000.)
308 =VQ\ ■ Clinical Practice

■ Bradycardia—a heart rate slower than 60 beats per ):<1.)+<;

minute
Artifacts are interruptions or disturbances in the ECG
■ Tachycardia—a heart rate faster than 100 beats per strip resulting from activity outside the heart. Figure 20-5
minute demonstrates examples of some of the following artifacts.
■ Asystole—absence of a heart rate, no complexes; flat
line; cardiac arrest ■ Somatic tremors or movement—involuntary or volun-
■ Ectopic beat—a beat originating outside the SA node, tary muscle or other movement by the patient
the pacemaker of the heart ■ Alternating current (AC) interference—caused by other
■ Bigeminy—every other beat is ectopic and/or premature sources of electricity in the room, such as other equip-
■ Ventricular arrhythmias—irregularities in the ventric- ment including some cell phones, crossed wires,
ular activity improper grounding
■ Wandering baseline—movement of the stylus from the
• Premature ventricular contraction (PVC)—a con- center of the ECG paper in a “roaming” or “wander-
traction of the ventricles occurring early; may
ing” manner; causes may be electrodes that are too
be life threatening, depending on the ratio of
loose or too tight, corroded or dirty electrodes, oil or
PVCs to normal ventricular contractions; report to
lotion on the patient’s skin
physician
■ Interrupted baseline—a break between complexes,
• Ventricular tachycardia—ventricular rate of more usually resulting from a wire becoming disconnected
than 100 to 150 beats per minute, a wide QRS
from an electrode or a broken wire
complex; considered a life-threatening arrhythmia
and should be reported to the physician immedi- ■ Heat or pressure—imprint on the ECG paper caused
ately by a hot or sluggish stylus

• Ventricular flutter—ventricular rate of 150 to 300

beats per minute; considered a life-threatening
arrhythmia and should be reported to the physician
7<0-:+75576+):,1)+<-;<;
immediately
■ Holter monitor—a portable ECG device worn by a
• Ventricular fibrillation—uncoordinated, ineffective patient for 24 hours; monitors heart activity during
ventricular contractions, “quivering of the heart”;
displayed on the ECG as coarse or fine trembles normal activities of daily living and requires a patient
with no identifiable waves or complexes; considered to keep a diary of activities to help physician with
a life-threatening arrhythmia and should be report- diagnosis; electrodes are placed in the following loca-
ed to the physician immediately tions:

■ Atrial arrhythmias—irregularities in the atrial activity • Fourth intercostal space, right sternal margin
• Premature atrial contraction (PAC)—a contraction • Right clavicle, lateral to sternal notch
of the atria occurring early • Left clavicle, lateral to sternal notch
• Atrial tachycardia—also called AT; atrial rate of 150 • Fifth intercostal space, left axillary line
to 250 beats per minute; P waves are often unidenti- • Lower right chest wall
fiable or hidden in previous T wave ■ Stress test—ECG recordings taken while the patient
• Paroxysmal atrial tachycardia (PAT)—atrial tachy- exercises using a treadmill, stationary bicycle, or stair
cardia that starts, and often stops, suddenly climber; monitors the response of the heart to increased
demand
• Atrial flutter—atrial rate of 250 to 350 beats per
minute; “saw tooth” pattern on ECG; the ventricular ■ Echocardiogram—sound waves transmitted through
rate is dependent on the number of nonconducted the heart producing a picture on a screen; used to
beats test the heart for structural or functional abnormali-
ties
• Atrial fibrillation—atrial rate of 350 to 500 beats per
minute; P waves not distinct because of rapid rate; R ■ Angiogram—an x-ray visualization with contrast mate-
to R waves are usually irregular; often with a rapid rial injected into a blood vessel to determine the pres-
ventricular rate ence of structural or functional abnormalities
■ Cardiac catheterization—insertion of a catheter into a
major blood vessel to visualize the heart’s activity, to
Use Box 20-2 and Figure 20-4 to practice identifying measure pressures, and to identify abnormalities, espe-
normal sinus rhythm versus an arrhythmia. cially blockages
 +PIX\MZ ■ The Electrocardiogram 309

WANDERING BASELINE

SOMATIC MUSCLE TREMOR

AC INTERFERENCE

.QO]ZM Electrocardiogram artifacts. (Reprinted with permission from Hosley JB, Jones SA, Molle-Matthews EA. Lippincott’s Textbook for Medical Assistants.
Philadelphia: Lippincott-Raven Publishers, 1997.)

TERMS R to R waves usually irregular, often with a rapid

ventricular rate
Electrocardiogram Review atrial flutter atrial rate of 250 to 350 beats per
The following list reviews the terms discussed in this minute; a “saw tooth” pattern on ECG; the
chapter and other important terms you may see on the ventricular rate is dependent on the number of
exam. nonconducted beats
arrhythmia irregular heart activity resulting in loss of a atrial tachycardia (AT) atrial rate of 150 to 250 beats
rhythm per minute; P waves are often unidentifiable or hid-
artifacts interruptions or disturbances in the ECG strip den in previous T wave
resulting from activity outside the heart bigeminy every other beat is ectopic or premature
asystole absence of a heart rate, no complexes; repre- bradycardia a heart rate slower than 60 beats per
sented by a flat line; cardiac arrest minute
atrial fibrillation atrial rate of 350 to 500 beats per depolarization charged and contracting cardiac muscle
minute; P waves not distinct because of rapid rate; cells; systole
310 =VQ\ ■ Clinical Practice

ECG complex a full cardiac electrical cycle (one heart- premature atrial contraction (PAC) a contraction of
beat) represented by the PQRST (and sometimes U) the atria occurring early
waves premature ventricular contraction (PVC) a contrac-
echocardiogram reflected sound waves used to test the tion of the ventricles occurring early; may be life
heart for structural or functional abnormalities threatening, depending on the ratio of PVCs to nor-
ectopic beat a beat originating outside the sinoatrial mal ventricular contractions
(SA) node, the pacemaker of the heart repolarization recovering cardiac muscle cells; diastole;
Einthoven triangle the views of the heart from the returning to equilibrium
placement of lead I, lead II, and lead III, which form sinoatrial (SA) node pacemaker of the heart
a triangular shape stress test ECG recordings taken while the patient exer-
electrocardiogram (ECG or EKG) the graphic rep- cises on a treadmill, stationary bicycle, or stair climber
resentation of the heart’s electrical activity moni- stylus a heated penlike instrument of the ECG
tored at the skin surface with sensors called elec- machine that receives impulses via electrodes and
trodes moves on ECG paper, recording the electrical activi-
electrodes skin sensors used to capture or monitor ty of the heart
electrical activity of various organs (e.g., the heart, tachycardia a heart rate faster than 100 beats per
the brain) minute
Holter monitor a portable ECG device worn by a ventricular fibrillation uncoordinated and ineffective
patient for 24 hours; heart activity is monitored dur- ventricular contractions, “quivering of the heart”;
ing normal activities of daily living displayed on the ECG as coarse or fine trembles
lead a standard combination of electrode placements with no identifiable waves or complexes; considered
that designates a specific view of the heart a life-threatening arrhythmia
normal sinus rhythm (NSR) a standard cardiac cycle ventricular flutter ventricular rate of 150 to 300 beats
that begins in the SA node per minute; considered a life-threatening arrhythmia
paroxysmal atrial tachycardia (PAT) atrial tachycardia ventricular tachycardia ventricular rate of more than
that starts, and often stops, suddenly 100 to 150 beats per minute, wide QRS complex;
polarization resting cardiac muscle cells considered a life-threatening arrhythmia
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA) and RMA (AMT) exams.

1. The measurements of the smallest blocks on Answer: ,

standard ECG graph paper are:
Why: The small blocks are 1 mm by 1 mm, and the large
A. 1 mm wide by 5 mm high.
blocks are 5 mm by 5 mm.
B. 1 cm high by 1 cm wide.
C. 5 mm wide by 1 mm high. Review: Yes ❏ No ❏
D. 1 mm wide by 1 mm high.

2. Lead I of the ECG tracing is the heart view Answer: )

between the:
Why: Leads I, II, and III are the standard limb leads;
A. right arm (RA) and the left arm (LA).
they are also known as bipolar leads. Lead I is
B. right arm (RA) and the left leg (LL).
designated as the first lead, starting at the top of the
C. left arm (LA) and the left leg (LL).
body with both arms.
D. right leg (RL) and the left leg (LL).
E. left arm (LA) and the right leg (RL). Review: Yes ❏ No ❏

3. In a standard ECG, lead V3 is located: Answer: +

A. at the midaxillary line at the horizontal level of
Why: After the location of V2 and V4 have been
position V4 and position V5.
determined, V3 is located on an imaginary line midway
B. at the fifth intercostal space and left
between V2 and V4.
midclavicular line.
C. midway between position V2 and position V4. Review: Yes ❏ No ❏
D. at the fourth intercostal space at the right
margin of the sternum.

4. Proper preparation of the patient includes the Answer: *

following EXCEPT:
Why: Electrodes or sensors should be placed over fleshy,
A. nylon hose should be removed to expose the
muscular parts of the upper arms and lower legs.
area of the legs where the sensors will be placed.
Conduction will be impaired if placed on bony
B. place the electrodes or sensors over bony
prominences.
prominences of the arms and legs where the
electrical activity is more easily conducted. Review: Yes ❏ No ❏
C. position the power cord away from the patient to
lessen the chance of artifacts in the ECG tracing.
D. make the patient comfortable and reassure
patient that the procedure is not painful and
that there is no transfer of electricity.
E. place the ground sensor on the right leg.

5. The height of a normal standardization mark on an Answer: *

ECG tracing is:
Why: A normal standardization mark that marks the accu-
A. 5 mm.
racy of the ECG machine should be 10 mm high. The
B. 10 mm.
mark should have a square top. Most ECG machines auto-
C. 20 mm.
matically place a standardization mark at the beginning of
D. 25 mm.
the tracing. To manually insert a standardization mark,
you need to push the Standard button on the machine.
Review: Yes ❏ No ❏


312 =VQ\ ■ Clinical Practice

6. AC interference is an artifact in an ECG tracing Answer: +

that means:
Why: There may be electrical machines, computers, or
A. the patient is having a muscle tremor.
other devices causing interference with the function of
B. there is a loose electrode connection.
the ECG machine. It may be necessary to unplug other
C. there is electrical interference in the room.
appliances or equipment in the room, or the patient may
D. the electrodes are too tight on the patient.
need to be moved to another room to properly complete
E. the patient may be cold and shivering.
the ECG.
Review: Yes ❏ No ❏

7. The cardiac testing procedure that requires the Answer: ,

patient to keep a diary of daily activities is a(n):
Why: The Holter monitor is a small, portable ECG
A. cardiac stress test.
device that a patient wears while continuing with daily
B. echocardiogram.
activities. Usually a 24-hour period is adequate to record
C. 12-lead electrocardiogram.
and monitor the heart’s activity. The patient maintains a
D. Holter monitor.
written diary or log of activities and events during this
time. The physician can determine if there is any corre-
lation between abnormal heart function and the daily
activity that took place during that period.
Review: Yes ❏ No ❏

8. The ECG grounding lead is the lead attached Answer: +

to the:
Why: The grounding lead helps to reduce alternating
A. right arm.
current (AC) interference. It keeps the average voltage
B. left arm.
of the patient the same as the instrument.
C. right leg.
D. chest, midway between V2 and V4. Review: Yes ❏ No ❏
E. left leg.

9. The ECG tracing is printed on graph paper at a Answer: )

standard speed for an adult of:
Why: Each block on the ECG graph paper represents
A. 25 mm/sec.
1 mm. When an ECG tracing is moving at a standard
B. 50 mm/sec.
speed, the paper is advancing at 25 millimeters (25 small
C. 10 cm/sec.
squares) each second.
D. 20 cm/sec.
Review: Yes ❏ No ❏

10. Lead II of the ECG tracing records the electrical Answer: *

activity through the heart from the:
Why: The standard limb leads—lead I, lead II, and lead
A. right arm to left arm.
III—form an imaginary triangle when lines connect the
B. right arm to left leg.
reference points. Lead I is the top horizontal line of the
C. right leg to left leg.
triangle, the left side of the triangle is lead II, and the
D. right arm to right leg.
right side of the triangle is lead III.
E. left arm to left leg.
Review: Yes ❏ No ❏
 +PIX\MZ ■ The Electrocardiogram 313

11. During the electrical heart cycle, repolarization Answer: )

refers to the:
Why: During the heart cycle, cardiac cells are exchang-
A recovering phase.
ing positive and negative charges within the cell
B. discharging phase.
membranes. During repolarization, negative ions are
C. resting phase.
transferred to the inside of the cell, and the positive ions
D. contracting phase.
return to the outside. Repolarization is a recovery time
for the cells and is a necessary process for another heart-
beat to take place.
Review: Yes ❏ No ❏

12. The chest lead V1 is located at which intercostal Answer: )

space?
Why: V1 is located at the fourth intercostal space at the
A. Fourth
right margin of the sternum.
B. Fifth
C. Between fourth and fifth Review: Yes ❏ No ❏
D. Sixth
E. Third

13. The image traced on the ECG paper is made by a: Answer: +

A. pen filled with an ink cartridge.
Why: The ECG paper is coated with a finish that is heat
B. needle scratching the image on the paper.
sensitive. The stylus is heated and melts away the
C. heated stylus tip that melts the coating of the
coating, exposing the dark paper underneath. The trac-
paper.
ing can be thick or blurry because of an overheated sty-
D. felt pen.
lus. The temperature of the stylus needs to be adjusted
to ensure a good, clear tracing.
Review: Yes ❏ No ❏

14. The purpose of adjusting the normal standard to Answer: +

one-half standard is to:
Why: When the ECG machine setting is changed from
A. conserve paper.
the normal 10-mm-high standard mark to one-half stan-
B. enlarge the height of the patient’s ECG tracing.
dard, 5 mm high, it decreases the size of the patient’s
C. decrease the size of the patient’s ECG tracing.
ECG tracing. This is necessary when the tracing is so
D. eliminate artifacts in the tracing.
large it goes off the paper. The physician cannot
E. ensure proper lead placement.
properly measure the complex unless the entire complex
is on the paper.
Review: Yes ❏ No ❏

15. When a patient has trouble relaxing or cannot Answer: )

remain still for the ECG, the artifact that may
Why: A somatic muscle tremor appears as a static line in
occur is:
between the complexes on the ECG paper. To avoid this
A. somatic muscle tremor.
artifact, make sure the patient is comfortable and not
B. wandering baseline.
cold. Pillows may be placed under the knees to help the
C. AC interference.
patient relax.
D. electrode interference.
Review: Yes ❏ No ❏
314 =VQ\ ■ Clinical Practice

16. The type of cardiac procedure that requires the use Answer: *
of a treadmill is:
Why: A cardiac stress test is a procedure that measures
A. echocardiography.
the body’s response to increased demands made on the
B. cardiac stress test.
heart muscle. The patient walks on a treadmill while the
C. cardiac angiography.
ECG tracing is recorded. Some cardiac abnormalities
D. 12-lead ECG.
may be exhibited on exertion rather than at rest.
E. Holter monitoring.
Review: Yes ❏ No ❏

17. The medical assistant should gather all the Answer: *

appropriate patient data before the ECG procedure
Why: It is not important to know when the patient had
EXCEPT:
his or her first ECG procedure. However, it may be
A. patient’s height and weight.
important to know when the patient had his or her last
B. date of the patient’s first ECG procedure.
ECG. Some patients have had many electrocardiograms
C. patient’s current medications.
performed. If the patient had a prior ECG with the
D. time and date of the recording.
same physician, the record will be in the patient’s file,
and the physician can do a comparison.
Review: Yes ❏ No ❏

18. The leads aVR, aVL, and aVF are the: Answer: -
A. standard leads.
Why: Augmented voltage leads provide additional infor-
B. bipolar leads.
mation about the electrical activity of the heart. They
C. limb leads.
use the electrical midpoint of the three limb sensors as
D. chest leads.
the negative pole, and each limb sensor is considered the
E. augmented voltage leads.
positive pole. Lead aVR, augmented voltage right, uses a
midpoint between the left leg and left arm as the
negative pole and the right arm as the positive pole.
Lead aVL uses a midpoint between the left leg and right
arm as the negative pole and the left arm as the positive
pole. Lead aVF uses a midpoint between the right arm
and left arm as the negative pole and the left leg as the
positive pole.
Review: Yes ❏ No ❏

19. The QRS complex of the ECG tracing represents: Answer: +

A. atrial depolarization.
Why: The QRS complex represents the contraction of
B. atrial repolarization.
the ventricles as positive ions enter the cells and
C. ventricular depolarization.
negative ions leave them. Depolarization is the electrical
D. ventricular repolarization.
activity that causes the heart to contract.
Review: Yes ❏ No ❏

20. The ECG marking code that represents lead V1 is: Answer: ,
A. one dot.
Why: All the chest leads, V1 through V6, are identified
B. one dash.
as a dash followed by the number of dots that
C. two dots.
corresponds with the number of the lead.
D. one dash and one dot.
E. one dash and two dots. Review: Yes ❏ No ❏
 +PIX\MZ ■ The Electrocardiogram 315

21. A long strip of QRS complexes of a certain lead Answer: +

used to define certain cardiac arrhythmias is a(n):
Why: A rhythm strip is run to give the physician a trac-
A. monitor strip.
ing longer than the typical lead length. This allows the
B. stress strip.
physician to determine whether the patient has an
C. rhythm strip.
abnormality that only shows up occasionally and not
D. artifact strip.
with each beat.
Review: Yes ❏ No ❏

22. If the electrodes are too loose on the patient, what Answer: )
artifact might you find on the ECG tracing?
Why: A wandering baseline appears as a tracing that
A. Wandering baseline
wanders back and forth from the bottom to the top of
B. Somatic tremor
the paper. The normal baseline should stay within the
C. AC interference
middle of the paper. Check all electrodes for proper
D. Electrical interference
connection. If electrodes are too loose, the baseline may
E. Muscle tremor
wander on the tracing paper.
Review: Yes ❏ No ❏

23. The purpose of setting the ECG paper speed at Answer: )

50 mm/sec is to:
Why: When a patient has a rapid heartbeat, the faster
A. help record rapid heartbeats.
speed allows the complexes to space farther apart on the
B. increase the size of the complex on the paper.
paper. It is easier to determine the quality of the
C. help record slow heartbeats.
complexes when they are not plotted close together.
D. decrease the size of the complex on the paper.
Rapid heartbeats are normal for infants and young
children.
Review: Yes ❏ No ❏

24. The P wave represents the: Answer: ,

A. last waveform of the ECG complex.
B. activity of the ventricles. Why: The P wave is the first waveform of the ECG
C. resting phase of the heart muscle. complex and represents the electrical activity that
D. atrial depolarization. spreads from the SA node through the atria, causing
E. ventricle repolarization. atrial contraction. During this time, the cells are
depolarizing.
Review: Yes ❏ No ❏

25. What should the medical assistant tell a patient if Answer: +

the patient asks if he or she will feel any discomfort
Why: Reassure the patient that the ECG machine does
from the ECG procedure?
not send out any electricity and that it does not hurt to
A. If you feel any shocks or electrical tingling,
have the procedure performed. The medical assistant
please let me know.
should ask the patient if there is anything that would
B. Don’t worry, we do lots of these exams every day.
make him or her more comfortable during the exam,
C. The ECG procedure does not hurt and does
especially if the patient has a problem that could cause
not send electricity through you.
discomfort when lying down. Pillows used as support for
D. The electrodes are cold and may feel too tight,
the arms or legs could help relax the patient.
but we need to get a good connection.
Review: Yes ❏ No ❏
 Laboratory Procedures
21

: - > 1 - ?  < 1 8 
Review Chaptp er 17,, “Microorgganisms and Aseps
p is,”
, which contains information that is needed for
laboratory procedures. Understand the concepts in that chapter before beginning this chapter. Be
able to recognize the laboratory norms and other information contained in the tables, boxes,
and review terms.

Laboratory procedures, whether for diagnosis or treat- laboratory tests for glucose, cholesterol, calcium, globu-
ment, are an integral part of health care provided in the lin, blood urea nitrogen (BUN), chloride, sodium,
medical office. The medical assistant plays a major role potassium, bilirubin, and triglycerides
and is often the one to obtain, prepare, and process the ■ Cytology—analysis of cells to determine abnormali-
laboratory specimen. The integrity of the specimen and ties; examples include Pap smears and chromosomal
adherence to the processing procedure can determine studies
the correctness of the test results, the accuracy of
■ Hematology—study of blood and blood-forming tissue;
the patient’s diagnosis, and even the efficacy of the
analysis of blood to determine abnormalities; examples
treatment.
include tests for hemoglobin, hematocrit, prothrombin
time, erythrocyte sedimentation rate, platelet count, and
differential white blood cell count (diff) (Table 21-1 lists
4)*7:)<7:A,1>1;176; common blood tests and their normal ranges)
■ Histology—microscopic study of cells, tissues, and
Laboratory procedures are divided into areas or divi-
organs in association with their functions; examples of
sions of expertise. The divisions are named according to
tests include biopsy and tissue analysis
the types of tissues or organisms to be studied and
require different equipment, reagents, and staff training. ■ Immunology (serology and blood banking)—study of
Although many of the laboratory procedures are not immunity, sensitivity, and induced sensitivity; the
performed in the medical office, the specimens are col- presence of antibodies/antigens and pathology; exam-
lected there and general knowledge of divisions is ples include tests for Rh typing, ABO blood typing,
needed. Rh antibody titer, rapid plasma reagent (RPR),
mononucleosis, human immunodeficiency virus, and
■ Clinical chemistry—analysis that identifies and meas- pregnancy
ures chemical components in blood, urine, spinal fluid, ■ Microbiology—study of microorganisms; in the labora-
tissue, and other body fluids; common examples include tory, this division usually determines the presence and


318 =VQ\ ■ Clinical Practice

Table 21-1 +WUUWV*TWWL<M[\["6WZUIT:IVOM[ Table 21-2 +WUXWVMV\[WN:MIOMV\;\ZQX

=ZQVITa[Q[IVL6WZUIT:M[]T\[
Test Adult Normal Range
Test Norm
Bleeding time 2–7 minutes
pH 4.5–8
Blood urea nitrogen (BUN) 10–20 mg/dL
Protein Negative
Chloride 98–110 mEq/L
Glucose Negative
Cholesterol: total 140–200 mg/dL
Ketone Negative
High-density lipoprotein 30–90 mg/dL
Bilirubin Negative
Low-density lipoprotein 30–100 mg/dL
Blood Negative
Creatinine 0.6–1.3 mg/dL
Leukocytes Negative
Erythrocyte sedimentation (Results are age- and method-
rate dependent) Nitrites Negative
(ESR, sed rate) Male: 0–20 mm/hr
Female: 0–30 mm/hr Urobilinogen 2.0 mg/dL

Glucose (fasting blood 70–110 mg/dL Specific gravity 1.020–1.030

sugar, FBS) Color Pale-dark yellow
Hematocrit (HCT Male: 39%–49% packed RBCs Clarity Clear
or “crit”) Female: 35%–45% packed
RBCs Odor Distinct

Hemoglobin (Hb, Hgb) Male: 13.2–17.3 g/dL

Female: 11.7–16.0 g/dL
Platelets 150–400  103 cells/L
Potassium 3.5–5.0 mEq/L
+4161+)44)*7:)<7:A158:7>-5-6<
)5-6,5-6<;
Prostate-specific 0–6.5 ng/mL (age-specific
antigen (PSA) ranges) Enacted in 1988 by Congress, the Clinical Laboratory
Improvement Amendments (CLIA) placed all laborato-
Red blood cells (RBCs) Male: 4.3–5.7  103 cells/L
ries involved with testing human laboratory specimens
Female: 3.8–5.1  103 cells/L
under the regulation of the Health Care Finance Admin-
Rheumatoid factor (RF)  30 U/mL istration (now called the Centers for Medicare and Med-
Sodium 135–148 mEq/L icaid Services) and the Centers for Disease Control and
Prevention (CDC). The standards developed were
Triglycerides Male: 40–163 mg/dL divided into three areas: personnel, testing, and quality
Female: 35–128 mg/dL assurance.
White blood cells (WBCs) 4.5–11.0  103 cells/L The CDC also identifies and publishes a list of CLIA-
L  mm (sometimes used to measure WBCs).
3 waived laboratory tests. These are tests generally permit-
ted in a medical office without the stringent standards
associated with non–CLIA-waived tests performed in
laboratories. The list of waived tests also includes the
identity of microorganisms found in specimens; exam- names of approved commercial products for conducting
ples are tests for tuberculosis, meningitis, and diphtheria these tests. The medical assistant may perform the
CLIA-waived tests for the following:
■ Parasitology—study of human parasites and ova (eggs);
examples include tests for hookworm, scabies, pinworms,
tapeworms, toxoplasmosis, malaria, and amebiasis ■ Blood ketone
■ Urinalysis—physical, chemical, and microscopic analy- ■ High-density lipoprotein cholesterol
sis of urine; examples include tests for color, clarity, ■ Infectious mononucleosis antibodies (mono)
specific gravity (physical), pH, glucose, ketones, nitrites ■ Streptococcus, group A (rapid strep)
(chemical), red blood cells (RBCs), white blood cells
■ Urine hCG by visual color comparison (pregnancy test)
(WBCs), crystals (microscopic), and human chorionic
gonadotropin (hCG) for pregnancy; Table 21-2 lists ■ Blood glucose monitoring devices
normal ranges for urinalysis ■ Hemoglobin—copper sulfate, nonautomated
 +PIX\MZ ■ Laboratory Procedures 319

■ Hemoglobin by single analyte instruments *W`

■ Microhematocrit, spun
>MVW][*TWWL+WTTMK\QWV:MUQVLMZ[
■ Urine dipstick or tablet analytes
• Bilirubin • Ask the patient about latex and tape allergies.
• Glucose • The antecubital fossa is the preferred site for
blood draw.
• Hemoglobin
• The vein of choice is the median cubital.
• Ketone • The tourniquet should be placed 3 to 4 inches
• Leukocytes above the point of puncture.
• Nitrite • The tourniquet should not be left on for more
than 1 minute.
• pH • Cleanse the site using a circular pattern begin-
• Protein ning at the point of puncture and moving to the
• Specific gravity outside.
• Allow the antiseptic to dry before inserting
• Urobilinogen
safety needle.
■ Ovulation test by visual color comparison
• Always anchor the vein.
■ Fecal occult blood • Safety needle attached to the tube collection
■ Erythrocyte sedimentation rate, nonautomated holder (use a butterfly only for difficult draws).
• Release the tourniquet when filling the last tube.
■ Helicobacter pylori antibodies
• Gently invert the collection tubes 8 to 10 times
to mix tube additives.
• Using a sterile dressing, apply direct pressure to
+75576;8-+15-6;+744-+<-, the site.
16<0-5-,1+)47..1+- • Do not tape until bleeding has stopped.

Although only CLIA-waived tests are performed in the

medical office, many specimens are collected there and
sent to reference laboratories for processing. Correct
• Collection tubes—glass and plastic; Box 21-2 lists
the order of collection for glass and for plastic tubes
specimen collection is vital to test results and is often the
❍ Yellow top—used to collect serum for bacterio-
responsibility of the medical assistant.
logic tests; does not contain an additive
■ Biopsies—removing tissue from patients for microscopic
examination to determine cancer or other abnormalities;
may be done surgically or with endoscopes, biopsy
punches, or other instruments
■ Phlebotomy—incision or needle puncture into a vein
to draw blood (see Box 21-1); during insertion, the
bevel of the needle should be face up at a 15 to 30
angle
Plasma
• Blood components (see Fig. 21-1) (55%)
❍ Plasma—relatively clear yellow liquid portion of
blood; composes 55% of whole blood; upper layer
in specimen tube Buffy coat
(WBCs and
❍ Buffy coat—light grayish liquid portion of blood platelets)
containing WBCs; composes 1% of whole blood; (1%)
middle layer in specimen tube Red blood
❍ Red blood cells (RBCs)—dark red opaque portion cells (44%)
of blood containing RBCs; composes 44% of whole
blood; bottom layer of specimen tube
❍ Serum—liquid portion of blood after clotting fac- .QO]ZM Centrifuged blood specimen. (Reprinted with permission from
tors are removed; composition includes portions McCall RE, Tankersly CM. Phlebotomy Essentials. 3rd Ed. Philadelphia: Lippincott
of plasma and buffy coat Williams & Williams, 2003.)
320 =VQ\ ■ Clinical Practice

*W` lumbar puncture performed by a physician or mid-

level provider
7ZLMZWN,ZI_\W)^WQL
■ Cervical scrapings/brushings—specimens obtained dur-
+ZW[[+WV\IUQVI\QWVWN)LLQ\Q^M[ ing a pelvic exam; used to test for cancer of the cervix
and other diseases
Order of Draw Using Plastic or Glass Tubes
■ Sputum—secretions from the respiratory system
1. Yellow-top tubes requiring sterility (for blood obtained by deep coughing; used to culture for pres-
cultures) ence of tuberculosis (Mycobacterium
( tuberculosiss) and
2. Light blue top other disease-causing microorganisms
3. Red or speckled top
■ Stool—fecal specimen used to test for ova and parasites,
4. Green top
pathologic bacteria, and occult blood (e.g., Hemoccult),
5. Lavender top
which may indicate cancer
6. Gray top
■ Throat swabbing (with sterile cotton applicator)—
specimen collected for culture and sensitivity (C&S) to
detect disease-causing microorganisms in the throat and
❍ Red top—used to collect serum for chemistry and to test for the appropriate antibiotic to combat them
serology; a “clot tube”; does not contain an additive ■ Urethral brushings—specimen collected with a fine
❍ Speckled top (red and black)—used to collect brushlike applicator inserted in the urethra; used to
serum for chemistry and serology; different from test for sexually transmitted infections
red top in that it contains a gel that separates ■ Urine
serum and RBCs during centrifugation • Random sample—urine specimen collected at any
❍ Lavender top—used to collect plasma for hema- time
tology testing; contains an anticoagulant • Clean-catch sample—urine specimen collected after
❍ Blue top—used to collect plasma for coagulation cleaning the urinary meatus; the patient then begins
studies; contains anticoagulant sodium citrate to void, stops, collects a portion of urine in the pro-
❍ Green top—used to collect plasma for urgent chem- vided container, and finishes voiding in the toilet;
istry studies; contains anticoagulant referred to as a “midstream” urine; used for tests to
determine the presence of bacteria in the urine
❍ Gray top—used to collect blood for glucose and
alcohol testing; contains anticoagulant • 24-hour sample—all urine voided in a 24-hour period
is collected directly into a specified container; used to
• Capillary puncture—dermal puncture of finger, ear- determine the presence of substances released only
lobe, or heel (in infants) to obtain a blood specimen;
sporadically and to measure the amount of urinary
examples include tests for blood glucose and hemo-
output
globin; also used for mandated neonatal specimen
collection • First voided sample—urine collected in the morning
after a night’s sleep; used to obtain more concentrat-
❍ Capillary puncture for phenylketonuria (PKU)—
ed substances for pregnancy testing and microscop-
capillary specimen from the infant’s heel used to
ic exams
detect phenylalanine; required by law in the United
States • Catheterized sample—urine collected by insertion
of a sterile tube into the urinary bladder; used to
❍ Capillary puncture for thyroid hormones—capillary
measure the amount of residual urine in the bladder
specimen from infant’s heel used to detect hypothy-
or to obtain a sterile urinary specimen for culturing
roidism; required by law in the United States
• Postprandial—urine collected after patient has con-
• Capillary puncture technique sumed a meal
❍ Avoid squeezing tip of finger
■ Wound swabbings (with sterile applicator)—drainage
❍ May “milk” hand and finger from wounds; used to culture for pathogens
❍ Discard first drop of blood

❍ Avoid scraping collection tube over puncture

❍ Avoid air bubbles or spaces in the collection area 8:-8):)<176.7:;8-+15-6-@)516)<176

of the tube ■ Smear—using a swab-type applicator, a small amount
■ Cerebral spinal fluid—clear, colorless fluid that covers of the specimen is applied to a glass slide and allowed
the spinal cord and brain, obtained for testing by a to dry
 +PIX\MZ ■ Laboratory Procedures 321

■ Wet mount—a drop of normal saline (0.9% sodium

chloride) is placed on a slide that has been smeared with
the specimen; a cover slide is placed on top, and the
specimen is ready for examination with a microscope
■ Potassium hydroxide (KOH) mount—primarily used
to identify fungal infections; the specimen is prepared
as a wet mount, substituting KOH for the saline; the
specimen is allowed to sit at room temperature until
examination under the microscope
■ Stains—a smear of the specimen is prepared; when
dry, the slide is heated and a stain material applied;
specific bacteria hold certain color stains, allowing
identification
• Purple stain—identifies gram-positive bacteria
• Red stain—identifies gram-negative bacteria
• Acid-fast—certain bacteria are not susceptible to
color staining; these bacteria are called acid-fast (e.g.,
Mycobacterium tuberculosis)
s
■ Sensitivity—testing to determine a pathogen’s suscep-
tibility to specific antibiotics
■ Culture—the process of growing pathogens from spec-
imens inoculated into a culture media and maintained
at a designated temperature; the purpose is to identify
.QO]ZM Basic parts of the microscope.
the microorganisms contained in the specimen
• Common culture media—substances used to pro-
mote growth of bacteria by providing a nutrition mentioned. The main portions of the microscope are
source; may be a liquid or gel-like state described below and illustrated in Figure 21-2.
❍ Transport media—usually a tube structure with a
substance used to keep the bacteria alive until they ■ Ocular lens(es)—eyepiece(s)
can be plated on an appropriate culture media; ■ Frame—structure that supports the scope
specific tubes may be used for specific specimens
• Base—bottom portion of the frame that holds entire
❍ Petri dish—a round plastic dish that contains agar, a structure
gelatin-like culture material made from algae, and
has a cover to minimize contamination of the speci- • Arm—extension of the frame that holds upper por-
tion of the scope
men with environmental bacteria the covered petri
dish should be placed in the incubator upside down ■ Head—portion of the frame below the eyepiece(s)
❍ Plating—process of inoculating agar with the ■ Stage—platform that holds the slide during observa-
specimen swab and sometimes with a sterile inoc- tion
ulating loop ■ Condenser—lens beneath the stage that focuses light
on the slide; it may be raised or lowered
■ Light source—located on base; provides light to the
<0-51+:7;+78-
condenser
The microscope (scope) is an instrument used to mag- ■ Diaphragm—controls the amount of light on the con-
nify very small objects, usually objects not visible to the denser
naked eye. Anton van Leeuwenhoek (17th century) is
■ Nosepiece—portion below the head that holds the
attributed with being the first to use an instrument with
objective lenses
lenses to visualize “germs.” Many different types and
strengths of microscopes are used in clinical and research ■ Objective lenses—lenses below the nosepiece marked
laboratories. The most common one found in the med- with specified magnifications; these are summarized in
ical office is the binocular, or two-eyepiece, scope. It is Table 21-3
used to identify microorganisms placed on slides from • Low power—magnification 10; used for initial
various body specimens using the processes previously focus
322 =VQ\ ■ Clinical Practice

culture the process of growing pathogens from speci-

Table 21-3 7JRMK\Q^M4MV[5IOVQNQKI\QWV mens inoculated into a culture medium and main-
Total Lens tained at a designated temperature; the purpose is
Ocular Lens Lens Magnification Magnification to identify the microorganisms contained in the
specimen
Low power 10  10 100
cytology analysis of cells to determine abnormalities
High-power dry 10  40 400 evacuated tube (ET) a tube, sealed to maintain the
vacuum, that is used for obtaining blood specimens;
Oil immersion 10  100 1000
it may have additives, depending on the type of
blood specimen to be obtained
fibrinogen a protein in blood plasma that assists
clotting
hematocrit percentage of red blood cells in the total
• High-power dry—magnification 40; used to locate
and focus on the specimen blood volume
hematology study of blood and blood-forming tissue;
• Oil immersion—magnification 100; used with oil analysis of blood to determine abnormalities
to perform differential count of blood smear
hemoglobin oxygen-carrying portion of red blood cells
■ Coarse adjustment—outside knob used with low-power histology microscopic study of cells, tissues, and organs
objective lens in association with their functions
■ Fine adjustment—inside knob used with both high- human chorionic gonadotropin (hCG) hormone
power and oil-immersion objective lenses present in blood and urine during pregnancy; urine
or blood tests are used to determine pregnancy by
the presence of hCG
immunohematology specialized immunology dealing
TERMS with blood, the presence of antibodies/antigens, and
pathology
Laboratory Procedures Review immunology study of immunity, sensitivity, and
The following list reviews the terms discussed in this chap- induced sensitivity; the presence of antibodies/anti-
ter and other important terms you may see on the exam. gens and pathology
anticoagulant substance that prevents blood from incubation maintaining a controlled environment to
clotting promote growth of microbial or tissue cultures
biopsy removing tissue from patients for microscopic lancet a sharp, sterile, disposable instrument used to
examination to determine the presence of cancer or puncture skin for collecting capillary blood
other abnormalities; may be done surgically or with microbiology study of microorganisms; in the labora-
endoscopes, biopsy punches, or other instruments tory, this division usually determines the presence
calibration a measurement compared with a standard; a and the identity of microorganisms found in speci-
method for testing the accuracy of equipment; a mens; examples include tests for tuberculosis, menin-
quality assurance procedure gitis, and diphtheria
capillary puncture dermal puncture of finger, earlobe, microscope (scope) an instrument used to magnify
or heel in infants to obtain a blood specimen very small objects usually not visible to the naked eye
centrifuge laboratory instrument that spins at high parasitology study of human parasites and ova (eggs)
speeds, separating particles in specimens such as phenylketonuria (PKU) a disease resulting in mental
blood and urine retardation caused by a deficiency in the metabolic
clinical chemistry analysis to identify and to measure process; tested for by using a capillary specimen
chemical components in blood, urine, spinal fluid, from an infant’s heel, a test required by law in the
tissue, and other body fluids United States
complete blood count (CBC) panel of blood tests phlebotomy incision or needle puncture into a vein to
that includes hematocrit, hemoglobin, red blood draw blood
cells, white blood cells, and differential white blood plasma relatively clear yellow liquid portion of blood;
cells (diff) composes 55% of whole blood; upper layer in speci-
control a specimen with known values that serves as a men tube
check of test accuracy plating process of inoculating agar with a specimen
crossmatching laboratory testing process to determine swab and sometimes a sterile inoculating loop
compatibility of blood donated by one person with point of care testing (POCT) laboratory testing per-
the blood of a potential recipient formed at the location where the patient is receiving
 +PIX\MZ ■ Laboratory Procedures 323

his or her health care (usually the medical office) sensitivity testing to determine a pathogen’s suscepti-
using small, rapid instruments and methods; these bility to specific antibiotics
tests are Clinical Laboratory Improvement serum liquid portion of the blood that remains after
Amendments (CLIA) waived clotting factors are removed
qualitative analysis the identification of a type of universal donor a person who has O-negative blood,
pathogen by its appearance in the specimen which is theoretically able to be transfused into a
quantitative analysis the method used to determine person with another blood type in an emergency
the number of bacteria present in a specimen situation
reagent a substance that, when added to a solution urinalysis the physical, chemical, and microscopic
of another substance, participates in a chemical analysis of urine
reaction; it may be used to identify or to quantify the urinometer a sealed glass float placed in approximately
presence of another substance 15 mL of urine and that measures specific gravity
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA), RMA (AMT) exam.

1. The process of removing tissue from a patient for Answer: +

microscopic examination is called:
Why: The process of removing tissue from the body for
A. cytology.
examination is called a biopsy. Cytology and histology
B. microbiology.
are both a process of analysis or examination of cells.
C. biopsy.
Microbiology is the study of all microscopic
D. histology.
organisms.
Review: Yes ❏ No ❏

2. The following blood collection tubes contain an Answer: -

anticoagulant EXCEPT:
Why: A red-stoppered collection tube is used to collect
A. blue.
serum for chemistry and serology tests. The tube does
B. lavender.
not contain any additive, enabling the blood to form a
C. gray.
clot and the serum to be separated from the clot or
D. green.
clotted cells.
E. red.
Review: Yes ❏ No ❏

3. A urine specimen that is collected at any time of the Answer: *

day is referred to as:
Why: Random means at any time. Clean catch is a
A. clean catch.
method of collection of urine in which the patient
B. random.
cleans the area of the urinary meatus and collects the
C. 24-hour.
urine in midstream. A 24-hour urine is a collection of all
D. postprandial.
urine in a 24-hour period. Postprandial means after a
meal.
Review: Yes ❏ No ❏

4. The clear liquid portion of blood that composes Answer: *

55% of whole blood is:
Why: Serum is the fluid portion of blood that remains
A. serum.
after coagulation. It contains no fibrinogen, a plasma
B. plasma.
protein essential to the blood clotting process.
C. hemoglobin.
Hemoglobin is a protein-iron compound found in the
D. fibrinogen.
blood; it carries oxygen to the cells from the lungs and
E. thrombin.
carries carbon dioxide away from the cells to the lungs.
Fibrinogen, a globulin, and thrombin, an enzyme, are
products found in the blood that are required for proper
clotting.
Review: Yes ❏ No ❏


 +PIX\MZ ■ Laboratory Procedures 325

5. Appropriate locations for collecting capillary blood Answer: +

include the following EXCEPT:
Why: The antecubital space, in the inner surface of the
A. fingertip.
bend of the elbow, is where the veins are located that are
B. earlobe.
used for phlebotomy. Capillary punctures are not
C. antecubital space.
performed here.
D. heel.
Review: Yes ❏ No ❏

6. When multiple tubes of blood are to be drawn, Answer: *

which is drawn first?
Why: Any time a sterile specimen is required, such as
A. Tubes with anticoagulant additive
blood cultures, special care is taken not to contaminate
B. Blood culture tubes or any test requiring a
the specimen—therefore, these specimens are drawn
sterile specimen
first. After that, tubes containing no additive are drawn
C. Tubes with no additive
and then tubes with additive. This order of draw
D. Tubes containing heparin
prevents contamination of tubes with the additives.
E. Tubes containing sodium citrate
Review: Yes ❏ No ❏

7. The specimen used to perform a culture test for the

Answer: )
presence of tuberculosis is:
A. sputum. Why: Tuberculosis typically infects the lungs. Sputum is
B. capillary blood. the material coughed up from the lungs. A culture of
C. venous blood. this material will grow the acid-fast bacillus
D. swab from throat. Mycobacterium tuberculosis.
Review: Yes ❏ No ❏

8. A blood test used to indicate the level of kidney Answer: +

function is:
Why: Blood urea nitrogen (BUN) is a measurement of
A. sedimentation rate.
the amount of nitrogenous substance present in the
B. complete blood count.
blood as urea. Urea is a major end product of protein
C. blood urea nitrogen.
and amino acid metabolism. The kidneys are responsible
D. human chorionic gonadotropin.
for excreting this product. If the levels are elevated, it
E. hematocrit.
may indicate kidney failure. A sedimentation rate is used
to monitor the course of inflammation in rheumatoid
arthritis. A complete blood count (CBC) will provide
information about the formed white and red cells in the
body, both quantity and quality. Human chorionic
gonadotropin is a hormone present in blood or urine
during pregnancy. This test is used to determine
pregnancy. A hematocrit is a blood test that determines
the percentage of packed cells in a volume of blood.
Review: Yes ❏ No ❏

9. The solution used to identify fungal infections is: Answer: ,

A. 0.9% sodium chloride.
Why: Potassium hydroxide (KOH) is mixed with skin
B. sodium citrate.
scrapings and the mixture is placed on a microscope
C. PSA.
slide for analysis. Sodium chloride 0.9% is the solution
D. KOH.
used for a wet mount. Sodium citrate is an additive in a
blue-top evacuated tube used for coagulation studies.
PSA is an abbreviation for prostate-specific antigen,
which is used in the detection of cancer of the prostate.
Review: Yes ❏ No ❏
326 =VQ\ ■ Clinical Practice

10. A urine test that compares the weight of urine with Answer: +
that of distilled water is:
Why: Distilled water is used as a measure of density
A. sedimentation rate.
against other liquids such as urine. Distilled water with a
B. clarity.
specific gravity of 1.000 is compared with urine, which
C. specific gravity.
has particles dissolved in it. The normal specific gravity
D. pH.
of urine is 1.005 to 1.030.
E. ketone analysis.
Review: Yes ❏ No ❏

11. Which of the following is proper technique when Answer: )

performing venipuncture?
Why: The bevel of the needle should always be face up
A. The bevel of the needle is face up, and the
when performing venipuncture. If it is face down during
insertion angle is 15 to 30.
insertion, the bevel may lodge against the back wall of
B. The bevel of the needle is face down, and the
the vein and no blood would be obtained. Insertion
insertion angle is 30.
should be at a slight angle, no greater than 30.
C. The bevel of the needle is face up, and the
insertion angle is 45 to 60. Review: Yes ❏ No ❏
D. The placement of the bevel is not critical, but
the insertion angle should be at least 45.

12. Proper sites for a capillary puncture include the Answer: +

following EXCEPT:
Why: The index finger tends to be more calloused and
A. tip of ring finger.
may not provide proper blood flow from a lancet punc-
B. heel of infant.
ture.
C. tip of index finger.
D. earlobe. Review: Yes ❏ No ❏
E. tip of middle finger.

13. The normal range of urine pH is: Answer: *

A. 3.0–5.0
Why: On the pH scale, 7.0 represents a neutral reading.
B. 5.0–8.0
Readings lower than 7.0 are acidic and higher than 7.0
C. 5.0–10.0
are basic. The normal range of urine is from slightly
D. 8.0–10.0
acid to slightly basic.
Review: Yes ❏ No ❏

14. Which of the following is a normal adult WBC Answer: *

count?
Why: The normal range for a white blood cell count is
A. 1,000 cells/mm3
4.5–11.0  103 cells/mm3. This means there are 4,500
B. 7,000 cells/mm3
to 11,000 white blood cells in a cubic millimeter. A
C. 20,000 cells/mm3
white blood cell count range is also reported as
D. 50,000 cells/mm3
4.5–11.0  103 cells/L.
Review: Yes ❏ No ❏

15. A urine pregnancy test measures: Answer: +

A. RPR.
Why: hCG is the human chorionic gonadotropin
B. VDRL.
hormone present in blood and urine during pregnancy.
C. hCG.
D. HDL. Review: Yes ❏ No ❏
 +PIX\MZ ■ Laboratory Procedures 327

16. Which of the following is an incorrect technique to Answer: *

use when performing phlebotomy?
Why: It is not required that you wear sterile gloves for
A. Check the expiration dates printed on vacuum
routine venipuncture; however, clean gloves must be
collection tubes to make sure they are not
used with each patient.
expired.
B. Put on sterile gloves to ensure use of universal Review: Yes ❏ No ❏
standard precautions.
C. Apply the tourniquet snugly, but not too tightly.
D. After the puncture site is determined and
cleansed, do not touch the site.
E. Release the tourniquet before removing the
needle from the patient’s vein.

17. The color of the stopper of the vacuum collection Answer: ,

tube used to collect plasma for coagulation
Why: The yellow-, red-, and red-and-black-top tubes do
studies is:
not contain any anticoagulant additive. Blood collected
A. yellow.
in these tubes will clot and cannot be used for clotting
B. red.
or coagulation blood tests.
C. red and black.
D. blue Review: Yes ❏ No ❏

18. The term used to describe cloudy urine is: Answer: -

A. pale.
Why: Pale, straw, and amber are used to describe the
B. straw.
color of urine; transparent is the term to describe clear
C. transparent.
urine. Turbid or cloudy urine indicates the presence of
D. amber.
some particles in the urine, such as chemicals, blood
E. turbid.
cells, bacteria, or mucus.
Review: Yes ❏ No ❏

19. Which department of the laboratory performs Answer: ,

hemoglobin and hematocrit tests?
Why: Cytology is the department that analyzes cells to
A. Cytology
determine abnormalities. Immunology is the study of
B. Bacteriology
immunity and antibodies/antigens. Bacteriology is the
C. Immunology
study of bacteria, culture, and sensitivity. Hematology
D. Hematology
includes the study of the blood for any abnormalities of
the blood-forming tissue and the quality of the blood
cells.
Review: Yes ❏ No ❏
328 =VQ\ ■ Clinical Practice

20. Which of the following is part of proper capillary Answer: -

blood collection technique?
Why: When using a microhematocrit collection tube,
A. Use the index finger as the preferred site for
the test will be inaccurate if there are air pockets in the
capillary puncture.
tube. Proper technique requires that the index finger
B. Squeeze the tip of the finger for at least
not be used but that the ring or middle finger be used
30 seconds before a puncture of the skin.
instead. You should not scrape the skin during the
C. Scrape the tip of the collection tube over the tip
collection process, because this encourages platelet acti-
of the finger to get every drop of blood in the
vation, which can cause the blood to clot and alter the
tube.
test results. To encourage blood flow, make sure the site
D. After performing the skin puncture, use the first
chosen is warm. Gently massage from the base to the
drop of blood that comes to the surface of the
top of the site but do not squeeze the finger. Squeezing
skin.
or milking the site will dilute the specimen with tissue
E. When collecting blood, avoid air bubbles in the
fluid. Always wipe away the first drop of blood before
microhematocrit collection tube.
starting to collect the specimen. The first drop of blood
contains a higher concentration of tissue fluid, which
may alter the test results.
Review: Yes ❏ No ❏

21. A hematocrit reading of 40 means that: Answer: )

A. 40% of the total blood volume consists of RBCs.
Why: A hematocrit is the percentage of red blood cells
B. 60% of the total blood volume consists of RBCs.
contained in whole blood. A reading of 40 means that of
C. 40% of the total blood volume is plasma.
100% total blood volume, 40% is red blood cells and
D. 60% of the total blood volume is WBCs.
60% is plasma, WBCs, and platelets.
Review: Yes ❏ No ❏

22. When whole blood is allowed to clot, the clear Answer: +

portion visible after centrifugation is the:
Why: Serum is the clear liquid portion of the blood that
A. plasma.
contains no blood cells, platelets, or fibrinogen. Plasma
B. buffy coat.
is the clear portion of blood that still contains clotting
C. serum.
agents. The buffy coat is the light grayish liquid portion
D. hemoglobin.
of blood containing WBCs; it composes 1% of whole
E. fibrinogen.
blood and is the middle layer in the specimen tube.
Hemoglobin is the oxygen-carrying portion of RBCs.
The platelets and fibrinogen are clotting agents that
form the clot.
Review: Yes ❏ No ❏

23. Which of the following would be considered a Answer: +

normal finding for urine?
Why: The color of normal urine is yellow and is typically
A. Protein—positive, 4
described as straw-colored. The protein content in urine
B. Clarity—cloudy
should be negative. A positive reading could indicate a
C. Color—straw
kidney disorder. The clarity or characteristic of urine
D. Specific gravity—1.055
should be clear, not cloudy or turbid. The specific grav-
ity of urine is 1.003 to 1.035. The higher the reading,
the more dense the urine is because of dissolved
particles in the urine. These could be blood cells, chem-
icals, or bacteria.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Laboratory Procedures 329

24. Parasitology includes the study of: Answer: )

A. worms.
Why: Parasitology is the study of human parasites
B. fungi.
(worms and scabies) and ova (eggs).
C. cells.
D. bacteria. Review: Yes ❏ No ❏
E. antibodies.

25. Which of the following represents an error in Answer: *

performing venipuncture?
Why: If a blood specimen is vigorously shaken, the blood
A. Using the proper size needle to avoid hemolysis
cells will rupture (hemolyze) and release hemoglobin
of the specimen
into the plasma. This can result in erroneous readings.
B. Vigorously shaking the anticoagulated blood
Blood drawn in anticoagulant tubes should be well
specimens to completely mix the anticoagulant
mixed by gently tilting the tube back and forth several
with the blood
times.
C. Labeling the tube with the date, time of draw,
patient’s name, and your initials Review: Yes ❏ No ❏
D. Allowing the venipuncture site to completely
dry before insertion of the needle
 Medical Imaging
22

: - > 1 - ?  < 1 8 
You reached Medical Imaggingg Chappter 22!
So keep on going—you’re almost through.
Stay on the review path—don’t go astray
’Cause certification is not far away!

Radiology is the study and use of radioactive substances patient for the test, including providing preparatory edu-
to visualize an internal structure. The image of the struc- cation (e.g., fasting, bowel cleansing, ingesting specific
ture is produced on film and called a radiograph, x-ray, or substances). Positioning the patient may also be the role
roentgenogram (all synonymous terms). This process was, of the medical assistant. ((Note: Endoscopic procedures
for many years, the only noninvasive method to penetrate are generally not performed in the medical imaging
solid objects and obtain “pictures,” most commonly of department even though they may be considered diag-
bones and dense organs. The department providing the nostic imaging.) Some endoscopic exams are used in tan-
service was called Radiology. Today, different power dem with or as a replacement for radiologic exams. For
sources and technologies are used and different images example, the colonoscopy may be done in place of the
can be produced. Radiation is also used as a treatment, lower gastrointestinal (GI) series. This eliminates patient
such as in cancer therapy. Therefore, the Radiology exposure to radiation.
Department has been replaced by the Medical Imaging
Department.
+75576<A8-;7.5-,1+)415)/16/
Many states require separate certifications to perform
any form of medical imaging. The role of the medical ■ Radiography—may be used for diagnostic purposes (e.g.,
assistant and medical administrative specialist, in these to determine a fracture) or therapeutic purposes (e.g., as a
states, is not to perform the procedure but to prepare the treatment for cancer)


332 =VQ\ ■ Clinical Practice

• Angiography—radiographic visualization of blood ■ Scintigraphy (scintiphotography)—photographic images

vessels and blood flow by injecting radiopaque mate- using a gamma camera to record the distribution of a
rial through a subcutaneous catheter radioactive agent; used to identify cancer metastasis
• Arthrography—radiographic visualization of a joint ■ Ultrasonography (ultrasound)—use of high-frequency
by injection of contrast media ultrasonic waves to produce an image and identify and
measure deep body structures and abnormalities
• Barium enema (lower GI series)—rectal administra-
tion of barium to radiographically visualize the
lower portion of the gastrointestinal system 8)<1-6<87;1<17616/.7::),1747/A
• Barium swallow (upper GI series)—oral administra- The physician usually orders an x-ray based on the view(s)
tion of barium to radiographically visualize the upper he or she wants, such as “CXR AP and lateral,” which
portion of the gastrointestinal system means a chest x-ray with anteroposterior and lateral views.
• Bone x-ray—flat plates including anteroposterior and The medical assistant and the medical administrative spe-
lateral; when ordering an x-ray of a bone or bones of a cialist must know the meaning of the positions to properly
body part that is bilateral, such as a foot, the provider order the tests and, in some instances, set up the patient to
frequently wants an x-ray of the same bone(s) of the obtain the correct film. Production of a radiograph
opposite side as a comparison. requires the x-ray beam to go from the machine through
the patient’s body part(s) to the x-ray plate or cassette that
• Chest x-ray (CXR)—flat plates (x-rays) of the chest; contains the film. Standardized body views or positions are
includes anteroposterior (AP) and lateral view
used to perform the x-ray. The views are named for the
• Cholangiography—radiographic visualization of the direction of the beam through the body part (Fig. 22-1).
bile ducts by injection of contrast media
• Cholecystography—radiographic visualization of ■ Anteroposterior view (AP)—x-ray beam directed from
the gallbladder structure and function the front to the back of the body or body part
• Computed tomography (CT)—radiographic visuali- ■ Posteroanterior view (PA)—x-ray beam directed from
zation of body structures in thin cross sections or the back to the front of the body or body part
layers; much more precise than traditional x-ray ■ Lateral view (lat)—x-ray beam directed from one side of
• Intravenous pyelography (IVP)—radiographic visu- the body to the other; view is named after the side
alization of the kidney, ureters, and bladder by injec- closest to the cassette. Caution: This distinction,
tion of contrast media through a vein compared to the AP and PA views, can be confusing.
• Kidney, ureter, and bladder (KUB)—flat plate (x-ray) • Right lateral view (RL)—x-ray beam directed from
of the abdomen the left side of the body to the right
• Mammography—radiographic examination of breasts • Left lateral view (LL)—x-ray beam directed from
(usually female) with specialized x-ray equipment the right side of the body to the left
• Myelography—radiographic visualization of the spinal • Oblique view—x-ray beam directed at an angle
cord and nerve roots by injection of contrast media through the body or body part; view is named after
into the subarachnoid space body position closest to the cassette, such as the
• Retrograde pyelography—radiographic visualization right anterior oblique
of the KUB by administration of contrast media
through a urinary catheter :),1)<176;).-<A
■ Magnetic resonance imaging (MRI)—film visualiza- Radiation is the energy source for producing many of the
tion of internal structures, including soft tissue, by images described previously. Specific safety measures
using a magnetic field in combination with radiation must be taken to protect the patient, staff, and others in
■ Nuclear medicine—area of medicine using radioiso- the area of the machine. Some of these measures, such as
topes to diagnose and treat specific pathology; used in monitoring the dosimeters and scheduling maintenance,
some cancer therapies may be the responsibility of the medical assistant or
■ Positron emission tomography (PET)—process of medical administrative specialist.
producing color images by injecting radioisotopes that
combine with particles in the body; used to assess ■ Proper construction of the room(s) in which the
physiology and metabolic activity, not just structures machines are housed (e.g., lead-lined walls)
■ Radiation therapy—using radiation to treat diseases, typ- ■ Proper care, inspection, and maintenance of machine(s)
ically cancer, by shrinking the tumor; may be performed ■ Personal dosimeter worn by all staff present during x-
in medical imaging department or outpatient facility rays; dosimeters are monitored for absorption of radiation
 +PIX\MZ ■ Medical Imaging 333
Anteroposterior (AP) view Posteroanterior (PA) view

Right lateral (RL) view Left lateral (LL) view

Left posterior oblique view Right posterior oblique view

Left anterior oblique view Right anterior oblique view

.QO]ZM Standard positions for specific x-ray views. (Reprinted with permission from Hosley JB, Jones SA, Molle-Matthews EA.
Lippincott’s Textbook for Medical Assistants. Philadelphia: Lippincott-Raven Publishers, 1997.)

■ Lead aprons, gloves, and so on, made available for staff ■ Radioactive materials are disposed of in suitably manu-
when the staff is not behind protective shield during factured and identified containers
x-ray procedures
■ Female patients should be asked whether they are
pregnant; if so, physician should be notified before +755768)<1-6<8:-8):)<176
the x-ray
Most medical imaging requires patient preparation. The
■ Lead shields are used to cover patients’ reproductive education required for the patient to prepare for the spe-
organs and other organs not involved in exam cific test is generally performed by the medical assistant
■ X-ray rooms are properly identified and have a red or certified medical administrative specialist. Regardless
light displayed outside the room when tests are in of the procedure, always ask the patient if he or she is aller-
progress gic to anything and check the medical record. Be alert for
334 =VQ\ ■ Clinical Practice

iodine and shellfish allergies if contrast materials are to • Instruct patient to not wear metal hair clips or eye
be used. Some procedures (e.g., angiogram) may be done makeup for procedure
under emergency conditions, and the usual preparation ■ Ultrasound
is waived. Common preparations for scheduled tests fol-
low. • Instruct the patient if a full bladder is required for
specific ultrasound (e.g., obstetrical ultrasound); pro-
■ Angiography vide water

• Instruct patient to consume nothing by mouth • Describe the type of transducer and gel to be used
(NPO) for 8 hours before procedure
• Determine whether the patient is on any blood- TERMS
thinning medication, including aspirin; report to
physician if the patient is on such medication Medical Imaging Review
■ Barium enema The following list reviews the terms discussed in this chap-
• Instruct the patient to ingest only clear liquids the ter and other important terms you may see on the exam.
day before the test angiography radiographic visualization of blood vessels
and blood flow by injecting radiopaque material
• Instruct NPO usually 8 hours before the procedure through a subcutaneous catheter
• Explain bowel cleansing per facility criteria arthrography radiographic visualization of a joint by
• Instruct the patient to increase fluids after the exam injection of contrast media
and report if there is no bowel movement within barium enema (lower GI series) rectal administration
24 hours after the test of barium to radiographically visualize the lower
■ Barium swallow portion of the gastrointestinal system
barium swallow (upper GI series) oral administration
• Instruct patient to have a light evening meal and NPO of barium to radiographically visualize the upper
usually 8 hours before the procedure
portion of the gastrointestinal system
• Instruct the patient to increase fluids after the test; a cholangiography radiographic visualization of the bile
laxative is usually recommended ducts using contrast media
■ Cholangiogram cholecystography radiographic visualization of the
• Instruct patient to have a fat-free evening meal prior gallbladder structure and function
to the exam computed tomography (CT) radiographic visualiza-
tion of body structures in thin cross sections or layers
• Instruct the patient to take color contrast tablets dosimeter badge-like meter worn by radiology person-
2 hours after the evening meal
nel to measure the individual’s x-ray exposure
• Instruct patient NPO after meal and tablets intravenous pyelography (IVP) radiographic visuali-
• Bowel cleansing may be ordered per facility criteria zation of the kidney, ureters, and bladder by injec-
■ CT tion of contrast media through a vein
kidney, ureter, and bladder (KUB) flat plate (x-ray) of
• Explain that contrast media will be ingested just prior the abdomen
to procedure
magnetic resonance imaging (MRI) film visualization
• Describe whirling sound and motion of machine of internal structures, including soft tissue, by using
■ IVP a magnetic field with radiation
• Instruct the patient to ingest only clear liquids the mammography radiographic examination of breasts
day before the procedure (usually female) with specialized x-ray equipment
myelography radiographic visualization of the spinal
• Instruct NPO usually 8 hours before the procedure cord and nerve roots by injection of contrast media
• Explain bowel cleansing per facility criteria into the subarachnoid space
■ Mammography nuclear medicine area of medicine using radioisotopes
• Instruct patient not to apply lotion, deodorant, or to diagnose and treat specific pathology; used in
powder from the neck to the waist some cancer therapies
oscilloscope screen that displays the visual pattern or
• Instruct the patient to avoid caffeine 1 week before picture of an ultrasound
the test, if this is a facility criterion
positron emission tomography (PET) process of
■ MRI producing color images by injecting radioisotopes
• Check for internal metal prostheses or other internal that combine with particles in the body; used to
metals (e.g., pacemaker, clips) assess physiology and metabolic activity
 +PIX\MZ ■ Medical Imaging 335

rad unit of absorbed dose of radiation roentgen international unit measuring radiation dose
radiology the study and use of radioactive substances to in the air
visualize an internal structure scintigraphy (scintiphotography) photographic
radiolucent a substance or structure that x-rays will images using a gamma camera to record the distribu-
penetrate tion of a radioactive agent; used to identify cancer
radiopaque substance or structure that is not penetrat- metastasis
ed by x-rays ultrasonography (ultrasound) use of high-frequency
retrograde pyelography radiographic visualization of ultrasonic waves to produce an image and
the kidney, ureters, and bladder by administration of identify and measure deep body structures and
contrast media through a urinary catheter abnormalities
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA), RMA (AMT) and CMAS (AMT) exams.

1. An x-ray study of the urinary system that shows the Answer: *

kidneys, ureters, and bladder following injection of
Why: An angiogram is a radiographic record of vessels
a contrast medium is a(n):
using contrast medium; a cholangiogram is specifically
A. angiogram.
a radiographic record of the bile ducts obtained by
B. intravenous pyelogram.
cholangiography. A cholecystogram is a radiographic
C. cholangiogram.
record of gallbladder structure and function.
D. cholecystogram.
Review: Yes ❏ No ❏

2. The procedure known as diagnostic medical Answer: -

sonography is called:
Why: Diagnostic medical sonography uses high-
A. fluoroscopy.
frequency sound waves (ultrasound) to create images.
B. tomography.
Fluoroscopy is the examination of the tissues and deep
C. angiography.
structures of the body by x-ray using a fluoroscope.
D. CT scan.
Tomography is an x-ray technique that produces a film
E. ultrasound.
representing a detailed cross section of tissue. CT scan
refers to computed tomography. Angiography is
radiographic visualization of blood vessels.
Review: Yes ❏ No ❏

3. The exam used to visualize the lower portion of the Answer: ,

gastrointestinal system after administration of a
Why: A colonoscopy is an exam of the colon with the use
radiopaque contrast medium is:
of a scope. IVP (intravenous pyelogram) is performed to
A. colonoscopy.
visualize the kidneys, ureters, and bladder. A
B. intravenous pyelogram.
cholangiogram is performed to visualize the bile ducts
C. cholangiogram.
using contrast media.
D. barium enema.
Review: Yes ❏ No ❏

4. The position used in x-ray imaging when the x-ray Answer: *

beam is directed from the front to the back of the
Why: The anteroposterior (AP) view describes the posi-
body part or body is:
tion of the x-ray beam as it passes from the front to the
A. oblique.
back of the body or body part. The oblique view
B. anteroposterior.
describes the position in which the x-ray beam is
C. posteroanterior.
directed at an angle through the body or body part. The
D. lateral.
posteroanterior (PA) view is the opposite of the AP view:
E. anterolateral.
the beam passes from the back to the front of the body
or body part. The lateral view occurs when the x-ray
beam is directed from one side of the body to the other.
Anterolateral is not an x-ray imaging position.
Review: Yes ❏ No ❏


 +PIX\MZ ■ Medical Imaging 337

5. The term oblique used in x-ray imaging means a Answer: )

view of the body or body part from:
Why: Oblique means any variation from the perpendicu-
A. a slanting direction.
lar or the horizontal, usually on a slant. The body is
B. the side.
slightly tilted, and the x-ray beam enters on an angle.
C. the top to bottom.
D. a perpendicular or horizontal direction. Review: Yes ❏ No ❏

6. The main quality of a contrast medium used in Answer: *

x-ray examinations is that it is:
Why: The term radiopaque describes a substance
A. radiolucent.
through which an x-ray beam will not pass. Bones are
B. radiopaque.
relatively radiopaque and show up as white areas on
C. high-frequency sound waves.
exposed x-ray film. A contrast medium such as barium is
D. high-energy radiation.
also radiopaque and is used to visualize and outline
E. nonallergenic.
internal structures that would otherwise allow x-rays to
pass through and therefore be invisible. Contrast media
may contain iodine, which can cause an allergic response
in some patients.
Review: Yes ❏ No ❏

7. The radiographic examination of the breasts is: Answer: *

A. ultrasonography.
Why: Mammography is the radiographic examination of
B. mammography.
the soft tissues of the breast to allow identification of
C. myelography.
various benign and malignant (cancerous) processes.
D. angiography.
Review: Yes ❏ No ❏

8. The practice of radiation protection includes Answer: +

wearing a:
Why: A dosimeter is a device that monitors an individual
A. transducer.
to see how much radiation he or she has been exposed to
B. collimator.
over time.
C. dosimeter.
D. face mask. Review: Yes ❏ No ❏
E. pair of eye goggles.

9. The radiographic visualization of a joint by Answer: ,

injection of contrast media is a(n):
Why: An arthrogram is used to visualize a joint. The
A. intravenous pyelogram.
root arthro means “joint.” IVP (intravenous pyelogram)
B. angiogram.
is an exam of the kidneys, ureters, and bladder after
C. cholangiogram.
injection of contrast media through the vein. An
D. arthrogram.
angiogram is a visualization of blood vessels; a
cholangiogram is visualization of bile ducts.
Review: Yes ❏ No ❏
338 =VQ\ ■ Clinical Practice

10. It is important to instruct a patient to do this Answer: +

before having an upper GI series performed.
Why: Although patients may be asked to avoid some
A. Avoid all medication at least 12 hours before
medication, most medication should be taken as sched-
the exam
uled. It is not necessary for a patient to use a cleansing
B. Use a cleansing enema 2 to 3 hours before the
enema before an upper GI series. This exam only visual-
procedure
izes the digestive tract through the duodenum. Patients
C. Have a light or liquid meal early in the evening
will be asked to avoid a heavy meal the night before an
and then nothing to eat or drink after midnight.
exam and then not to eat or drink anything for at least
D. Eat a light meal 2 hours before the exam
8 hours before the exam. Usually it is recommended that
E. Avoid using laxatives
the meal be very light or liquid.
Review: Yes ❏ No ❏

11. When positioning a patient for a left lateral view, Answer: *

the patient is positioned so that the:
Why: A left lateral view means that the x-ray beam is
A. right side of the body is closest to the film.
directed from the right side of the body to the left. This
B. left side of the body is closest to the film.
means the body is positioned with the left side closest to
C. patient is lying down on the x-ray table with the
the x-ray film.
left side closest to the x-ray beam.
D. patient is lying down on the x-ray table with the Review: Yes ❏ No ❏
right side at a 45 angle to the x-ray cassette.

12. Angiography is radiography of the: Answer: -

A. kidneys.
Why: Angio is a root word that refers to vessels or,
B. heart.
specifically, blood vessels.
C. spinal cord.
D. gallbladder. Review: Yes ❏ No ❏
E. blood vessels.

13. The x-ray examination of the urinary system is a: Answer: *

A. GI series.
Why: The abbreviation KUB means kidneys, ureters,
B. KUB.
and bladder. This is a flat-plate x-ray of the abdomen to
C. MRI.
determine the location and size of the structures. A GI
D. CXR.
series includes x-rays of the upper and lower
gastrointestinal tract. MRI is the abbreviation for mag-
netic resonance imaging. CXR means chest x-ray.
Review: Yes ❏ No ❏

14. A barium enema would be scheduled before an Answer: *

upper GI study because the:
Why: Proper scheduling of x-ray exams is a responsibil-
A. upper GI is completed faster than the barium
ity of the medical assistant. If a barium swallow (upper
enema.
GI series) is performed first, the patient must wait until
B. barium from the upper GI may take days to
all the barium has been eliminated before the
clear the patient’s system before the barium
preparation for a barium enema can begin. This could
enema can be performed.
take days. The lower GI barium enema requires that
C. upper GI may show a diagnostic problem sooner
only the large intestine be filled with contrast barium.
than the barium enema.
This can be eliminated from the body and not interfere
D. patient may have an allergy to barium and the
with the upper GI series.
reaction will not be as significant when
performing the barium enema first. Review: Yes ❏ No ❏
E. upper GI series takes longer to perform.
 +PIX\MZ ■ Medical Imaging 339

15. If a patient is instructed to be NPO for 8 hours prior Answer: ,

to an x-ray exam, it means that the patient should:
Why: NPO means nothing by mouth (orally). Most x-ray
A. not eat 8 hours before the exam.
exams require that the patient be NPO for at least 8 hours
B. ingest only clear liquids before the exam.
before the exam. The patient should be instructed that
C. avoid food but continue to drink fluids as
this means liquids also. Occasionally the patient is
needed.
allowed to take necessary medication.
D. not eat or drink anything 8 hours before the
exam. Review: Yes ❏ No ❏

16. When a patient is positioned for a chest x-ray and Answer: -

the patient is facing the x-ray film, this position is
Why: Posteroanterior position means that the patient’s
known as:
back or posterior side is closest to the x-ray beam and
A. posterior oblique.
the anterior or front of the body is facing or closest to
B. anteroposterior.
the x-ray film.
C. lateral.
D. decubitus. Review: Yes ❏ No ❏
E. posteroanterior.

17. The radiographic visualization of the spinal cord by Answer: *

injection of a contrast medium is a(n):
Why: A myelogram is an x-ray taken after injection of
A. intravenous pyelogram.
a radiopaque medium into the subarachnoid space to
B. myelogram.
demonstrate any spinal cord or spinal nerve root defor-
C. cystogram.
mity. An intravenous pyelogram x-rays the kidneys, ureters,
D. arteriogram.
and bladder; a cystogram is an x-ray of a sac or bladder;
and an arteriogram is an x-ray to visualize the arteries.
Review: Yes ❏ No ❏

18. Which of the following is used to produce an MRI? Answer: )

A. Magnetic field in combination with radiation
Why: MRI means magnetic resonance imaging. It is a
B. Injection of radioisotopes
form of medical imaging that uses a magnetic field as its
C. High-frequency ultrasonic waves
source of energy. Radiation is the energy source for pro-
D. Radioactive chemicals
ducing images on x-ray film.
E. Multiple radioactive iodines
Review: Yes ❏ No ❏

19. Radiation safety principles include the following Answer: )

EXCEPT:
Why: A dosimeter is a device worn by those working in
A. placing a dosimeter on the patient.
and around the x-ray area, not by the patient. This
B. maintaining x-ray machines in a lead-lined
device measures the amount of accumulated x-rays to
room.
which the person is exposed while working in an area
C. determining whether a female patient is
where x-rays are taken. A patient is not exposed to addi-
pregnant.
tional x-rays, only those required for the exam.
D. repeating x-rays until the views are absolutely
clear. Review: Yes ❏ No ❏

20. Before injection of contrast materials, it is important Answer: +

to determine whether the patient has:
Why: Patients who are allergic to iodine or shellfish will
A. eaten a fat-free meal the night before the exam.
usually have a serious or life-threatening allergic
B. fasted for 8 hours.
reaction to the contrast medium.
C. any allergies.
D. had previous x-rays. Review: Yes ❏ No ❏
E. ingested any liquids.
340 =VQ\ ■ Clinical Practice

21. Patient instructions after an exam using barium Answer: +

include the following EXCEPT:
Why: There is no need for the patient to remain NPO
A. increase intake of water and fluids.
after the exam. NPO means nothing by mouth.
B. report if no bowel movement within 24 hours of
the exam. Review: Yes ❏ No ❏
C. remain NPO for 2 hours.
D. resume a normal diet.

22. The term radiolucent means that x-rays: Answer: *

A. cannot penetrate the material and it will show
Why: Radiolucent means that x-rays will pass through
as a light or white object on an x-ray film.
the materials because they are not dense and do not
B. will pass through the material and produce a
absorb the radiation; therefore, the materials show dark
dark image on the x-ray film.
on the x-ray film. An example is air in the colon. The air
C. of higher doses are required to produce an
will not absorb x-rays and will not show except as a black
image on the x-ray film.
image on the film.
D. will penetrate the material and will show as a
white image on the x-ray film. Review: Yes ❏ No ❏
E. will penetrate bony tissue and produce a dark
image on the x-ray film.

23. The purpose of a cholangiogram is to: Answer: ,

A. visualize the size of a tumor.
Why: A cholangiogram is a radiographic procedure that
B. assess the location and size of the kidneys.
uses contrast media to visualize the bile ducts of the gall-
C. view movement of barium through the digestive
bladder.
tract.
D. visualize the bile ducts. Review: Yes ❏ No ❏

24. X-ray films are reviewed and interpreted by a: Answer: +

A. radiologic technologist.
Why: A radiologist is a medical doctor who is
B. registered nurse.
responsible for interpreting the findings on the x-ray
C. radiologist.
films. A radiologic technologist, also called a
D. radiographer.
radiographer, is a person who is trained to take x-ray
E. mammographer.
films. This person is not licensed or authorized to inter-
pret the films, although most are able to see and identify
problem areas on films. A registered nurse is a licensed
nurse trained to assess patients’ needs and provide clini-
cal care. Nurses are not licensed or trained to perform
x-rays. A mammographer is a person trained to perform
mammography, that is, imaging of the breasts.
Review: Yes ❏ No ❏

25. The abbreviation used to order an x-ray to evaluate Answer: +

the lungs is:
Why: CXR is the abbreviation for chest x-ray. The x-ray
A. PA.
includes an anteroposterior (AP) and lateral view of the
B. lat.
chest without use of any contrast medium.
C. CXR.
D. AP. Review: Yes ❏ No ❏
 Physical Modalities
23

: - > 1 - ?  < 1 8 
Your medical practice mayy not pr
p ovide services for phyysical modalities or fittingg of ambulation
devices; however, it is important that the medical assistant recognize improper fitting and use
when patients present with crutches, walkers, or canes. Information may be obtained from
durable medical equipment vendors or retailers.

Physical modalities are noninvasive therapeutic agents, 57*141<A<-;<16/

procedures, and preventive measures used in the fol-
lowing: ■ Goniometry—measurement of degrees of joint motion
using a goniometer
■ Physical medicine (physiatry)—diagnosis and treatment ■ Range of motion (ROM) test—exam requiring the
of disease and disability using physical means, such as patient to perform various joint motions to determine
diathermy the extent of movement (see Chapter 6, Box 6-3, “Joint
■ Rehabilitative medicine—restores and improves function Movements”); may be active or passive
impaired by disease or injury ■ Strength tests—exams requiring the patient to perform
■ Sports medicine—prevents and treats injuries and impai- select muscle or muscle group actions to determine the
rments that are sports related strength of function
■ Preventive health—applies techniques and uses ■ Activities of daily living (ADL) tests—exams that deter-
devices to prevent injury and impairment (e.g., body mine the patient’s ability to perform common tasks
mechanics) (e.g., opening doors, brushing hair)


342 =VQ\ ■ Clinical Practice

<0-:)81-; constriction); it is used in the initial treatment of an

injury.
THERMOTHERAPY
Thermotherapy uses heat to reduce swelling and to ■ Dry cold—cold therapy without moisture
decrease pain by dilating blood vessels (vasodilation), • Ice pack—waterproof bag filled with ice; air should
increasing circulation to the affected area; it is not used be removed and bag covered with fabric before plac-
in the initial phase of injury treatment. ing on skin; monitor to prevent skin damage
• Chemical ice bag—pack filled with a chemical com-
■ Dry heat—heat without moisture pound that produces cold when activated (usually by
• Heating pads—electrically or microwave-heated applying pressure); follow same precautions as with
packs for thermotherapy use; should always be cov- ice pack
ered with fabric before placing on skin; check cords ■ Moist cold—cold therapy using moisture
for safety and frequently monitor temperature to
avoid burns • Cold soaks—water or water with antiseptic or other
solution is cooled with ice and affected area is sub-
• Chemical hot packs—heating pads filled with a merged for a given period
chemical compound that produce heat when activat-
ed (usually by applying pressure); follow same pre- • Cold compresses—fabric is wet with cold water or
antiseptic or other solution and placed on affected
cautions as for heating pads
area
• Infrared—heat produced by wavelengths in various
lamp-like structures; position a safe distance from
skin and monitor frequently to avoid burns HYDROTHERAPY
• Ultraviolet—sunlamps used to treat specific condi- Hydrotherapy uses hot- or cold-water regimens for
tions (e.g., psoriasis, newborn jaundice); patient’s
therapy.
eyes should be covered and length of exposure timed
and monitored to avoid burns
■ Whirlpool—a bath or other container in which water
■ Moist heat—heat with moisture sources is continually circulated to provide massage and heat
• Hot soaks—water or water with antiseptic or other therapy
solution is warmed between 100F and 105F; affected ■ Hot-to-cold plunges—the affected area is alternately
area requiring treatment is submerged for a specific plunged between hot and cold baths to contract and
period dilate vessels
• Hot compresses—fabric is wet with water or anti-
septic or other solutions and placed on affected area;
plastic-type wrap may be used to cover compress and EXERCISES
conserve heat
Exercise is an action to strengthen, develop, or maintain
■ Paraffin—hand or foot is immersed in melted wax with muscle.
additive such as mineral oil; plastic bags or “mittens”
are worn after wax is applied to retain heat; when cool, ■ Active exercise—an action to strengthen, develop, or
the wax is peeled off; used for relief of arthritis pain maintain muscle that is performed directly by the
■ Diathermy—deep heat therapy using a mechanical patient
energy source
• Isometric exercises—exercises that contract oppos-
• Ultrasound—heat therapy using high-frequency ing muscles without the muscles shortening
sound waves; a special gel substance is placed on the
• Resistance exercise—exercises performed with count-
head of the ultrasound attachment to improve con- er pressure applied to increase the effectiveness and
ductivity determine improvement
• Microwave—heat therapy using electromagnetic • Water exercises—exercises performed in water
radiation for tissues; should not be used with mois-
■ Passive exercise—exercises performed on the patient
ture or on patients with pacemakers
by another person or by a mechanical device
• Electrical stimulation—electrical device used to
stimulate muscles or nerves
CRYOTHERAPY
• Passive motion device—a mechanical apparatus
Cryotherapy uses cold to prevent swelling and to placed on a patient to passively exercise the affected
reduce pain by causing blood vessels to constrict (vaso- area; frequently used on knees after surgery; speed
 +PIX\MZ ■ Physical Modalities 343

and flexion may be increased or decreased according between the axilla and the axillary support on
to the patient’s pain tolerance crutches; adjust crutch height to accommodate;
adjust handgrips to 30 of elbow flexion
• Massage—rubbing, stroking, kneading, and tapping
tissue with hands or devices to alleviate pain and im- • Common gaits—crutches placed on ground 4 inch-
prove function es to 6 inches lateral and 2 inches in front of feet
❍ Swing-to gait—patient moves both crutches for-
ward simultaneously, plants them, and lifts body to
crutches; repeat steps
RANGE OF MOTION
❍ Swing-through gait—patient moves both crutches
Range of motion (ROM) can be passive or active; the forward simultaneously, plants them, and lifts
patient or caregiver exercises joints by performing stan- body past crutches; repeat steps
dard joint motions such as flexion and rotation to main-
❍ Two-point gait—the patient moves one crutch
tain or improve the extent of movement.
forward and the opposite foot at the same time,
followed by the other crutch and other foot
❍ Three-point gait (most commonly taught in med-
OTHER COMMON PHYSICAL THERAPIES ical office)—for weight bearing on one leg; patient
■ Manipulation—maneuvers to realign affected area; freq- moves both crutches and affected leg forward
uently used on joint dislocations or spinal injuries simultaneously and follows with unaffected leg;
repeat steps
■ Immobilization—prevention of movement, usually of
joint or bone, through the use of splints, casts, and ❍ Four-point gait—the patient moves right crutch for-

other devices to reduce pain and allow healing to occur ward, followed by the left crutch, and then the left
leg forward parallel to the left crutch, followed by
■ Traction—application of a slow pulling force; com-
the right leg forward parallel to the right crutch;
monly used to realign fractured bones
repeat steps
• Caution—shoes should be flat and nonskid; avoid
throw rugs, wet areas, and other hazards; to avoid
COMMON ASSISTIVE DEVICES axilla nerve damage, support weight using hand-
grips, not crutch underarm pads
■ Cane—a rod-type device used for minimal standing or
walking support as a result of weakness on one side or ■ Gait or transfer belt—a wide woven belt used to assist
balance problems; the handle may be candy cane shaped in lifting or steadying the patient during ambulation or
or straight and perpendicular to the rod transfer (e.g., car or wheelchair)

• Types—single-pronged, tripod, or four-pronged • Placement—buckled over patient’s clothes around

(quad); the length may be adjustable or nonadjustable waist at mid-abdominal area; allow room for two fin-
gers to fit between the waist and the belt
• Fit—the patient’s elbow should be at a 30 angle
when standing to obtain proper cane length • Caution—the belt should not be used if patient
has no use of lower extremities; check for abdominal,
• Gait—cane is held on patient’s strongest side, tip
back, or rib conditions and ostomy or feeding devices
4 inches to 6 inches lateral to the foot, tip flat on the
ground; cane moves forward approximately 12 inches ■ Walker—waist-high assistive walking device with four
followed by the affected limb, which stops at the cane; legs, used when a cane is not enough support; may be
the stronger limb moves forward to the cane, and steps folded when not in use
are repeated • Types—standard (fixed) with rubber-tipped legs; or
can roll on wheels
• Caution—stronger limb is first going up stairs,
weaker limb first going down • Fit—client’s elbows flexed at 30 angle; hand rests
■ Crutches—assistive walking devices, used singly or as a should be approximately at top of patient’s femur
pair, which transfer weight bearing to upper extremities • Gait—patient steps into the walker and grasps hand-
grips, moves walker forward 6 inches to 12 inches then
• Common types—standard or axillary crutches usually
used for temporary conditions; Lofstrand or forearm moves one foot at a time back into walker; repeat steps
crutches usually used for long-term disability • Caution—walkers should not be used on stairs or
narrow passages
• Fit—measure with the shoes patient will be
wearing; patient standing; normally crutch tips are ■ Wheelchair—a mobile chair with adjustable or nonad-
placed 4 inches to 6 inches lateral to each foot and 2 justable footrests and brakes, used when a patient can-
inches in front of feet; allow 2 to 3 finger widths not ambulate
344 =VQ\ ■ Clinical Practice

• Types—nonmechanical or mechanical, standard size cryotherapy (cold) causes blood vessels to constrict,
or custom fitted to patient preventing swelling and reducing pain; used in the
initial treatment of an injury
• Caution—always lock brakes when patient is getting diathermy deep heat therapy using a mechanical ener-
into or out of chair; do not allow patient to place arms
around your neck gy source
ergonomics adaptation of the environment and use of
techniques and equipment to prevent injury
hydrotherapy hot- or cold-water regimens used for
*7,A5-+0)61+;
therapy
Body mechanics is defined as the efficient use of the isometric exercise a type of exercise that contracts
body to prevent injury to the health care provider or opposing muscles without the muscles shortening
patient. The general guidelines follow. passive exercise exercises performed on the patient by
another person or a mechanical device
■ Keep the back straight physical medicine (physiatry) deals with the diagnosis
■ Keep abdominal muscles tight and treatment of disease and disability using physical
means, such as diathermy
■ Bend from knees, not back
range of motion (ROM) passive or active; the patient
■ Maintain a broad base with one foot slightly forward or caregiver exercises joints by performing standard
■ Use the feet, not the body, to pivot joint motions (e.g., flexion and rotation) to maintain
■ Carry heavy objects close to your body or improve the movement
rehabilitative medicine deals with restoring or
■ Synchronize lifting, such as “on three—one, two, three”
improving function impaired by disease or injury
■ Know your limits resistance exercise exercises performed with counter
pressure applied to increase the effectiveness and to
determine improvement
TERMS thermotherapy (heat) reduces swelling and decreases
Physical Modalities Review pain by improving circulation; it is not used in acute
phase of injury
The following list reviews the terms discussed in this ultrasound heat therapy using high-frequency sound
chapter and other important terms you may see on the waves; a special gel substance is placed on the head of
exam. the ultrasound attachment to improve conductivity
activities of daily living (ADL) common acts per- ultraviolet heat lamps to treat specific conditions (e.g.,
formed during a person’s normal day psoriasis, newborn jaundice)
body mechanics the efficient use of the body to pre- whirlpool bath or other container in which water is con-
vent injury to the health care provider or patient tinually circulated to provide massage and heat therapy
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA) and RMA (AMT) exams.

1. Heat applied to a large part of the body will cause: Answer: *

A. vasoconstriction.
Why: Cold application causes the blood vessels to
B. vasodilation.
constrict, or become smaller, thus increasing blood pres-
C. decreased blood flow to the body part.
sure in the area and decreasing blood flow to the body
D. increased blood pressure to the area.
part or area. Heat application has the opposite effect on
the area.
Review: Yes ❏ No ❏

2. Infrared therapy uses heat produced by: Answer: -

A. electricity.
Why: Infrared therapy is treatment by exposure to vari-
B. water.
ous wavelengths of infrared radiation. Infrared
C. chemicals.
treatment relieves pain and stimulates circulation of
D. sound waves.
blood.
E. wavelengths.
Review: Yes ❏ No ❏

3. Cryotherapy is a form of treatment that uses: Answer: *

A. sound waves and microwaves.
Why: The root cryo refers to the use of cold or freezing.
B. ice packs and cold packs.
Cryotherapy is a form of treatment that utilizes different
C. paraffin wax.
forms of cold such as chemical ice bags, cold soaks, and
D. hot compresses and hot water.
ice packs.
Review: Yes ❏ No ❏

4. Which of the following is necessary to do when Answer: +

measuring crutches so they fit properly?
Why: There should be some space between the
A. The patient should be fitted without shoes on,
underarm and the top of the crutch to make sure the
barefooted.
patient’s underarm does not rub on the crutch. Two to
B. With the patient standing normally, the crutch
three finger widths, or approximately 2 inches is
tips should be touching the sides of the shoes.
adequate. The patient should have shoes on, and the
C. There should be a gap of 2 to 3 finger widths
crutch tips should be placed at least 4 inches to 6 inches
between the underarm and the top of the crutch.
from the shoes. The elbows should be flexed slightly
D. When the hands are resting on the handgrips,
when the hands are on the handgrips. The handgrips are
the elbows should be straight, not flexed.
positioned slightly above the hip but not at the waist.
E. The handgrips on the crutches should be at the
same height as the patient’s waist. Review: Yes ❏ No ❏

5. A device used to measure the extent of joint Answer: ,

movement is a(n):
Why: A goniometer is used to perform goniometry, the
A. diathermy machine.
measurement of degrees of joint motion. Diathermy is
B. passive motion machine.
the use of shortwaves to heat the body tissues. A passive
C. electrical stimulation device.
motion machine is a device that moves a body part without
D. goniometer.
the patient assisting. Electrical stimulation is the use of
intermittent electrical stimuli to cause muscles to contract.
Review: Yes ❏ No ❏

346 =VQ\ ■ Clinical Practice

6. The realignment of a dislocated finger is an example Answer: *

of which kind of therapy?
Why: Manipulation is the use of the hands in therapy
A. Immobilization
to reduce a dislocation or move a body part into
B. Manipulation
alignment. Immobilization of a body part does not allow
C. Traction
movement. An example is placing a splint or cast on the
D. Resistance exercise
body part. Traction is a method of applying force on a
E. Passive exercise
body part to pull or stretch the body part. Resistance
exercise is the act of exercising while applying opposite
force—for example, using weights while exercising.
Passive exercise requires another person to perform the
movement for the patient. The patient does not move
the body part.
Review: Yes ❏ No ❏

7. When the tips of both crutches and one leg are Answer: )
advancing at the same time, it is referred to as a:
Why: A three-point gait refers to two crutch tips and one
A. three-point gait.
foot touching the ground at the same time.
B. two-point gait.
C. swing-to gait. Review: Yes ❏ No ❏
D. swing-through gait.

8. The type of exercise used when the patient is unable Answer: -

to move the affected body part without help is:
Why: In passive exercise, someone or something moves
A. range of motion.
the body part without patient assistance. Passive exercise
B. active exercise.
is frequently used after surgery to increase flexion and
C. isometric exercise.
extension in joints.
D. resistant exercise.
E. passive exercise. Review: Yes ❏ No ❏

9. Kneading and tapping tissue with the hands is a Answer: ,

form of:
Why: Massage is a type of passive treatment used to alle-
A. manipulation.
viate pain and improve function of body parts. Massage
B. traction.
includes rubbing, stroking, kneading, and tapping tissue
C. range of motion.
with the hands or with devices.
D. massage.
Review: Yes ❏ No ❏

10. When instructing a patient on the use of a cane, you Answer: +

should tell him or her to:
Why: Proper technique when using a cane includes
A. use the cane only when using stairs.
using the cane on the stronger side. The cane will
B. use the cane on his or her weaker side.
provide support on the strong side when moving the
C. go up steps with the stronger limb first.
weak side. The patient then has a smoother gait and
D. go down steps with the cane first.
does not have the tendency to limp. When going up
E. adjust the cane low enough so that the arm is
steps, the stronger side goes first; going down steps, the
straight when walking.
weaker limb goes first. When using the cane, the arm is
slightly bent.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Physical Modalities 347

11. Good body mechanics include the following Answer: )

guidelines except:
Why: When lifting, the feet should be slightly apart with
A. when lifting, maintain a narrow base with feet
one foot forward. This provides a broad base to support
together.
the weight of the load.
B. carry heavy objects close to your body.
C. bend from the knees, not the back. Review: Yes ❏ No ❏
D. use feet to pivot, not the body.

12. The area of medicine that deals with restoring or Answer: +

improving function impaired by disease is:
Why: Rehabilitative medicine deals with restoration of
A. preventive health.
an individual or a part of the body to normal or near
B. ergonomics.
normal function after a disabling disease or injury.
C. rehabilitative medicine.
D. thermotherapy. Review: Yes ❏ No ❏
E. disability management.

13. Cold therapy is frequently applied to: Answer: ,

A. increase blood flow to the affected part.
Why: Cold has the effect of decreasing pain by numbing
B. promote healing by increasing circulation.
the nerve pathways. Cold therapy decreases circulation
C. increase nerve sensitivity.
(blood flow), thus decreasing swelling.
D. decrease swelling.
Review: Yes ❏ No ❏

14. The use of a whirlpool is an example of: Answer: +

A. diathermy.
Why: The root word hydro means “water.” A whirlpool is
B. cryotherapy.
a tank in which warm water is circulated to provide mas-
C. hydrotherapy.
sage and heat therapy.
D. thermotherapy.
E. ultrasound therapy. Review: Yes ❏ No ❏

15. An example of a deep heating agent is: Answer: )

A. diathermy.
Why: Deep heating agents produce heat through
B. hydrocollator pack.
energy that will penetrate the tissues as deep as 30 to
C. infrared lamp.
50 millimeters. Superficial heating agents affect tissues
D. paraffin bath.
approximately 10 millimeters beneath the skin’s surface.
Hydrocollator packs (hot packs), infrared lamps, and
paraffin baths are all considered superficial heating agents.
Review: Yes ❏ No ❏

16. To evaluate the extent of movement of a patient’s Answer: *

knee, the following exam would be performed:
Why: Range of motion testing is performed to
A. isometric exercise.
determine the extent of movement of various joints. The
B. range of motion.
patient is evaluated to see how many degrees of flexion
C. manipulation.
and extension the joint will perform. Isometric exercises
D. gait evaluation.
are exercises that contract opposing muscles without the
E. body mechanics.
muscles shortening. Manipulation involves maneuvers
to realign affected areas such as joint dislocations or
spinal injuries. Gait evaluation is the evaluation of the
manner of walking. Body mechanics is defined as the
efficient use of the body to prevent injury.
Review: Yes ❏ No ❏
348 =VQ\ ■ Clinical Practice

17. The preferred method used in the initial treatment Answer: ,

of an injury is:
Why: Cold therapy is initially used after an injury to pre-
A. hot compresses.
vent swelling and reduce pain. There is decreased blood
B. paraffin.
flow to the affected part, limiting the initial edema in the
C. hydrotherapy.
area.
D. ice pack.
E. ultrasound. Review: Yes ❏ No ❏

18. The type of gait in which the patient advances the Answer: *
left foot and right crutch and then the right foot
Why: A two-point gait means there are two “points” on
and left crutch is a:
the ground at the same time. One crutch and the oppo-
A. swing-through gait.
site foot are on the ground at the same time, followed by
B. two-point gait.
the other crutch and foot. This is used for a patient who
C. three-point gait.
is partially weight bearing and can place some weight on
D. four-point gait.
both sides of his or her body.
Review: Yes ❏ No ❏

19. Exercises performed by the patient without Answer: )

assistance are:
Why: Active exercise refers to those movements the
A. active exercises.
patient is able to perform without assistance. Passive
B. passive exercises.
exercise requires another person to move the body part.
C. range of motion exercises.
Range of motion and water exercises both can be
D. water exercises.
performed passively.
Review: Yes ❏ No ❏

20. The common acts performed during a person’s Answer: *

normal day are referred to as:
Why: ADL, activities of daily living, are the common
A. body mechanics.
tasks that a person performs each day, such as brushing
B. activities of daily living.
hair and opening doors. Body mechanics refers to the
C. ergonomics.
efficient use of the body while performing activities, and
D. isometric exercises.
ergonomics is the adaptation of the environment and
E. passive exercises.
use of techniques and equipment to prevent injury—for
example, equipment designed for better posture when
sitting in a desk chair. Isometric and passive exercises
are used in rehabilitative therapy.
Review: Yes ❏ No ❏

21. A therapeutic method used to treat jaundice in Answer: ,

newborns is:
Why: Ultraviolet is light beyond the range of human
A. ultrasound.
vision. It occurs naturally in sunlight and burns or tans
B. infrared.
the skin. Ultraviolet lamps are also used to treat psoriasis
C. diathermy.
and other skin conditions.
D. ultraviolet.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Physical Modalities 349

22. Physiatry deals with: Answer: +

A. prevention and treatment of sports injuries.
Why: Physiatry, or physical medicine, deals with the
B. prevention of injury and impairment.
diagnosis and treatment of disease and disability using
C. diagnosis and treatment of disease and disability
physical means, including such therapies as diathermy.
using physical means.
D. restoring and improving function through Review: Yes ❏ No ❏
rehabilitation.
E. diagnosis and treatment of mental disorders.

23. Which of the following therapeutic methods Answer: *

uses melted wax?
Why: Paraffin is a type of wax that is melted to create a
A. Chemical hot packs
liquid. The affected body part—usually a hand, a foot,
B. Paraffin bath
or a joint—is submerged in the wax, or the wax is
C. Diathermy
painted on the body part. The wax hardens, and the heat
D. Cryotherapy
of the wax penetrates the skin and provides a soothing
effect to the painful area. It is frequently used to treat
arthritic joint pain and stiffness.
Review: Yes ❏ No ❏

24. A method of physical therapy used to realign Answer: -

fractured bones is:
Why: Traction is the application of a slow pulling force
A. electrical stimulation.
on a body part and is commonly used to realign
B. massage.
fractured bones.
C. passive exercise.
D. infrared heat. Review: Yes ❏ No ❏
E. traction.

25. The purpose of heat therapy includes the following Answer: *

EXCEPT:
Why: Heat causes an increase in blood flow to an area of
A. relieve muscle spasm.
the body, causing muscles to relax, and relieves pain.
B. decrease bleeding or hemorrhage.
Cold therapy is indicated for decreasing blood flow and
C. relieve pain.
to control hemorrhage.
D. increase blood flow to the body part.
Review: Yes ❏ No ❏
 24
Nutrition

: - > 1 - ?  < 1 8
Increasingg empphasis is placed on nutrition in treatingg disease and maintainingg wellness. The
certification exams always include questions on therapeutic diets, as well as vitamins and their
functions in the body.

Nutrition is the process of taking food into the body and ENERGY NUTRIENTS
using it.
Energy nutrients produce energy/calories when metabo-
lized. Table 24-1 lists calorie distribution for energy
nutrients.
;<-8;7.6=<:1<176
1. Ingestion—taking in of nutrients; eating and drinking ■ Carbohydrates—sugars and starches, the body’s
2. Digestion—physical and chemical changing of nutri- primary energy source; they produce 4 calories per
ents in the body to allow absorption gram
3. Absorption—transferring of digested nutrients from
■ Proteins—nutrients with amino acids (building blocks);
the gastrointestinal system to the blood circulation
build and heal body tissue; they produce 4 calories per
4. Metabolism—synthesizing of nutrients from the blood-
gram
stream, producing energy
• Complete—protein nutrient that contains all nine
essential amino acids
• Incomplete—protein nutrient that does not contain
6=<:1-6<; all nine essential amino acids
Nutrients are components of food necessary for the ■ Fats (lipids)—greasy material in nutrients; transport
body to perform physiologic functions. fat-soluble vitamins, insulate the body from the cold,


352 =VQ\ ■ Clinical Practice

❍ Low-density lipoprotein, or LDL (bad choles-

Table 24-1 +ITWZQM,Q[\ZQJ]\QWV terol)—waxy material that clogs blood vessels,
Nutrient Calories per Gram causing cardiovascular disease

Carbohydrate 4 • Triglycerides—component molecule of fat found in

fatty foods; a combination of fatty acids and glycerol;
Protein 4 high levels clog blood vessels, causing cardiovascular
Fat 9 disease

NONENERGY NUTRIENTS
■ Fiber—nondigestible but edible portion of plants; nec-
and provide fatty acids; they produce 9 calories per essary for the gastrointestinal elimination function
gram ■ Vitamins—organic substances found naturally in foods;
• Saturated fats—primarily found in meat, butter, and needed in small amounts for metabolism and preven-
egg yolks; usually solid at room temperature; increase tion of certain diseases ((Note: The certification exams
blood cholesterol ask questions about which vitamins are water-soluble
• Unsaturated fats—primarily found in vegetable and and which are fat-soluble.)
olive oils; usually liquid at room temperature; help • Vitamin B1 (thiamin)—water-soluble vitamin prima-
decrease blood cholesterol rily found in whole grains and beans necessary for
• Cholesterol—found in animal foods and manufac- carbohydrate metabolism
tured by the body; not a true fat or lipid but a • Vitamin B2 (riboflavin)—water-soluble vitamin pri-
lipoprotein; necessary for vitamin D and acid bile marily found in animal products and broccoli; nec-
production essary for protein metabolism
❍ High-density lipoprotein, or HDL (good choles-
• Vitamin B6—water-soluble vitamin primarily found
terol)—works to stabilize LDL by transporting in brewer’s yeast, whole grains, and nuts; aids in reg-
select amounts of it to the liver for elimination ulation of central nervous system

Table 24-2 5IRWZ5QVMZIT[

Mineral Major Food Source Purpose

Calcium (Ca) Dairy products, salmon Bone and tooth development,
nerve impulse transmission;
disorders include osteoporosis
and rickets
Chloride (Cl) Table salt, meats Acid-base balance; disorders
include decreases in mental
capacities
Magnesium (Mg) Green vegetables, whole grains Enzyme activity, metabolism,
heartbeat regulation; deficiencies
include metabolic disorders
Phosphorus (P) Dairy products, meats, fish, nuts Bone and tooth development,
acid-base balance, protein and
glucose metabolism; disorders
include anemia, abnormal
growth, bone loss
Potassium (K) Oranges, dried fruits Protein metabolism, acid-base
balance correction, nerve
impulse transmission, heartbeat
regulation; disorders include
hyperkalemia and hypokalemia
Sodium (Na) Table salt, processed food Fluid balance maintenance;
disorders include hypertension
 +PIX\MZ ■ Nutrition 353

Table 24-3 <ZIKM5QVMZIT[

Mineral Major Food Source Purpose

Copper (Cu) Organ meats, whole grains, nuts Hemoglobin formation, iron
absorption, enzyme function
Fluoride (Fl) Fish, some water supplies Tooth decay resistance; disorders
from overuse include tooth
mottling
Iodine (I) Saltwater fish and crustaceans, Metabolism regulation, element
iodized table salt of thyroid hormone; disorders
include goiter
Iron (Fe) Organ meats, dark green Hemoglobin element, oxygen
leafy vegetables transport; disorders include
anemia
Zinc (Zn) Organ meats, other foods Enzyme element, wound
high in protein healing, growth; disorders
include dwarfism

• Vitamin B12 (cyanocobalamin)—water-soluble vita- ,1-<):A/=1,-416-;

min primarily found in animal products and soy-
The United States Department of Agriculture (USDA)
beans; promotes red blood cell (RBC) formation; a
developed guidelines to assist the general population in
deficiency causes pernicious anemia
making healthy food choices. Prior to 2005, these guide-
• Vitamin C (ascorbic acid)—water-soluble vitamin pri- lines were displayed in a food pyramid that divided foods
marily found in citrus fruits and tomatoes; promotes into groups. The group with the most recommended
stress resistance, wound healing, and oral health servings per day was on the bottom, and the group with
• Vitamin A—fat-soluble vitamin primarily found in the fewest recommended servings per day was on the
milk and yellow vegetables; promotes good eyesight top, forming the pyramid shape. The new version was
and protects skin from infection; a deficiency causes introduced in 2005 when the Dietary Guidelines Advi-
night blindness sory Committee met and the latest in 2010. The major
• Vitamin D—fat-soluble vitamin primarily found in change is that the estimated energy requirement
sunlight and dairy products; strengthens bone devel- (EER) is more specific and based on gender, age, height,
opment; a deficiency causes rickets weight, and activity level. EERs decrease with age, and
children have separate recommendations. The food
• Vitamin E—fat-soluble vitamin primarily found in groups in the new pyramid are displayed in a vertical
green leafy vegetables, nuts, and whole grains; pro-
presentation rather than horizontal (Fig. 24-1).
tects RBCs; a deficiency causes anemia
• Vitamin K—fat-soluble vitamin primarily found in
green leafy vegetables and tomatoes; promotes
blood clotting
■ Minerals—elements usually found in the earth’s crust,
the human body, and some foods; necessary to carry
out bodily functions
• Major minerals—essential elements needed by the
body in larger amounts: calcium (Ca), chloride
(Cl), magnesium (Mg), phosphorus (P), potassium
(K), sodium (Na); Table 24-2 lists the major miner-
als, their sources, and their purposes
• Trace minerals—essential elements needed by the
body in very small amounts: copper, fluoride, iodine,
iron, zinc; Table 24-3 lists the trace minerals, their
sources, and their purposes .QO]ZM My Pyramid.
354 =VQ\ ■ Clinical Practice

GENERAL USDA RECOMMENDATIONS

A ■ Low (restricted) sodium

■ Eat a variety of foods from each food group • Used in hypertension, congestive heart failure, and
other diseases that increase the body’s normal fluid
■ Combine healthy eating with physical activity load
■ Choose a diet low in saturated fat and cholesterol
• Educate patient to read sodium contents in food
■ Eat plenty of grain products, fruit, and vegetables ingredient labels
■ Note sodium content in food products and use in ■ Low cholesterol (low fat)
moderation
• Used in patients with high cholesterol, increased
■ Use alcoholic beverages in moderation triglycerides, and cardiovascular disease
• Limitation of fat calories to less than 20% of total
daily caloric intake
FOOD GROUPS IN ORDER OF LARGEST
■ Low purine
TO SMALLEST
1. Grains
• Used in patients who have gout or the inability to
metabolize uric acid
2. Vegetables
3. Milk • Limitation of purine-rich foods such as organ meats,
4. Fruits red meat, asparagus, salmon, halibut
5. Meats and beans ■ Food intolerance
6. Oils • gluten free—avoid this protein contained in wheat,
oats, barley and rye

COMMON THERAPEUTIC (SPECIAL) DIETS • lactose free—avoid or limit dairy products

■ Pregnancy/lactating diet
-<061++76;1,-:)<176;
• Calorie intake as recommended by health care
provider The demographics of the United States continue to
• Calcium, iron, vitamin C, and folic acid intake should change as diverse populations grow. Certain diseases
increase prominent in specific races or cultures (e.g., hyperten-
sion in African Americans and diabetes in certain Native
• Weight gain as recommended by health care provider American tribes) are often controlled by diet. It is impor-
■ Clear liquid tant for the patient educator to determine the dietary
• Used in introducing foods back into diet (e.g., after habits of the involved ethnic group. Every attempt
illness or surgery and in preparation for specific pro- should be made to maintain the foods of the specific cul-
cedures such as a colonoscopy) ture with, perhaps, different methods of preparation—
• Rule of thumb: clear liquids are those you can see for example, baking instead of frying. The educator, who
through, such as apple juice, tea, clear broth, or non- often is the medical assistant, must know the prescribed
caffeinated sodas therapeutic diet and understand the fundamentals of
nutrients. All health care workers are obligated to stay
■ Soft
current as standards and guidelines change.
• Normal foods in mashed or pureed form
• Accommodation for patients with difficulty chewing
■ Bland TERMS
• Nonirritating foods (e.g., most dairy products, hot Nutrition Review
cereals, mashed potatoes, grits)
The following list reviews the terms discussed in this chap-
• Used in gastrointestinal tract disorders, such as var- ter and other important terms you may see on the exam.
ious ulcer forms, ulcerative colitis, or gastritis absorption the transfer of digested nutrients from the
■ Diabetic gastrointestinal system to the blood circulation
calorie unit of energy that produces heat
• Goal is to prevent abnormal fluctuations in insulin
and blood glucose levels carbohydrates sugars and starches; the body’s primary
energy source
• Simple sugars should be limited digestion physical and chemical changing of nutrients
• Intake of complex carbohydrates, protein, and in the body to allow absorption
unsaturated fats should increase estimated energy requirement (EER) approximation
• Calorie intake is tailored per patient of needed daily calories
 +PIX\MZ ■ Nutrition 355

fats (lipids) greasy material in nutrients; transport fat- nutrition the process of taking food into the body and
soluble vitamins, insulate the body from the cold, using it
and provide fatty acids obese 20% overweight for sex, height, and type of frame
fiber nondigestible but edible portion of plants; proteins nutrients comprising amino acids (building
necessary for the gastrointestinal elimination blocks); build and heal body tissue
function triglycerides component molecule of fat found in fatty
ingestion taking in of nutrients; eating and drinking foods; a combination of fatty acids and glycerol; high
metabolism synthesizing of nutrients from the blood- levels clog blood vessels, causing cardiovascular disease
stream, producing energy vitamins organic substances found naturally in foods
nutrients components of food necessary for the body and needed in small amounts for metabolism and
to perform physiologic functions prevention of certain diseases
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA), RMA (AMT), and CMAS (AMT) exams.

1. The process of taking nutrients into the body is Answer: *

called:
Why: Ingestion is the process of introducing food and
A. digestion.
drink into the stomach. Digestion, absorption, and
B. ingestion.
metabolism are part of the digestive process after the
C. absorption.
food enters the body.
D. metabolism.
Review: Yes ❏ No ❏

2. The cholesterol considered to be the “good” type is: Answer: *

A. triglycerides.
Why: High-density lipoproteins are considered the good
B. high-density lipoprotein.
cholesterol because they actually carry back to the liver
C. low-density lipoprotein.
cholesterol that has been deposited on arterial walls.
D. saturated fat.
Increased deposits on arterial walls can lead to blockage
E. unsaturated fat.
of arteries and result in a higher risk of heart disease or
heart attack.
Review: Yes ❏ No ❏

3. The nutrient that primarily builds and heals body Answer: +

tissue is:
Why: Protein is a nutrient comprising amino acids, the
A. carbohydrate.
building blocks of the body. The amino acids help build
B. fat.
up tissue and promote healing of damaged tissue.
C. protein.
D. triglyceride. Review: Yes ❏ No ❏

4. The vitamin that promotes red blood cell Answer: -

production is:
Why: Vitamin B12 is used to treat red blood cell deficien-
A. vitamin A.
cies such as pernicious anemia. It promotes the produc-
B. vitamin C.
tion of red blood cells. Vitamin B12 is found in organ
C. vitamin D.
meats and dairy products.
D. vitamin K.
E. vitamin B12. Review: Yes ❏ No ❏

5. The organization that developed guidelines to Answer: *

assist people in making healthy food choices is the:
Why: The United States Department of Agriculture
A. FDA.
(USDA) developed the food pyramid that emphasizes
B. USDA.
food from the major food groups: (1) grains, (2) vegeta-
C. CDC.
bles, (3) fruits, (4) milk, (5) meat and beans, and (6) oils.
D. AMA.
The FDA is the Food and Drug Administration, the
CDC is the Centers for Disease Control and
Prevention, and the AMA is the American Medical
Association.
Review: Yes ❏ No ❏


 +PIX\MZ ■ Nutrition 357

6. A clear liquid diet includes the following EXCEPT: Answer: +

A. chicken broth.
Why: Clear liquid means you can see through the liquid.
B. tea.
Milk is not considered a clear liquid. A clear liquid diet
C. milk.
is recommended for patients recovering from diarrhea
D. apple juice.
or surgery.
E. water.
Review: Yes ❏ No ❏

7. Metabolism is the process of: Answer: ,

A. taking food into the body.
Why: Metabolism is the process by which nutrients are
B. physically changing nutrients to allow
distributed into the blood and are used for growth and
absorption.
energy production.
C. chemically changing nutrients in the body.
D. using nutrients from the bloodstream to Review: Yes ❏ No ❏
produce energy.

8. The fat-soluble vitamin that promotes blood Answer: -

clotting is:
Why: Vitamins A, D, E, and K are all fat-soluble
A. vitamin A.
vitamins, which means that they are stored in the body
B. vitamin D.
and can have a cumulative effect. Vitamin K has a chief
C. vitamin E.
function of production of prothrombin in the body.
D. vitamin C.
Prothrombin is one of the clotting factors.
E. vitamin K.
Review: Yes ❏ No ❏

9. A person on a low-cholesterol diet should avoid Answer: *

which of the following food groups?
Why: Cholesterol is found in animal products. This
A. Fruits
includes chicken and fish, although these tend to be
B. Meats
lower in cholesterol than red meat. The human liver
C. Vegetables
also naturally produces cholesterol. An increase in cho-
D. Grains
lesterol is associated with an increased risk for heart dis-
ease and atherosclerosis (cholesterol plaque in the blood
vessels).
Review: Yes ❏ No ❏

10. The mineral responsible for proper bone and Answer: +

tooth development is:
Why: Calcium is primarily found in milk and milk prod-
A. iron.
ucts. It is also found in dark green leafy vegetables and
B. sodium.
promotes the formation of teeth and bones.
C. calcium.
D. potassium. Review: Yes ❏ No ❏
E. zinc.

11. Which of the following nutrients has the highest Answer: *

amount of calories per gram?
Why: Carbohydrates and proteins have 4 calories per
A. Carbohydrate
gram of food. Fat contains 9 calories per gram. Fiber is
B. Fat
a nondigestible nutrient but one necessary for
C. Protein
gastrointestinal elimination.
D. Fiber
Review: Yes ❏ No ❏
358 =VQ\ ■ Clinical Practice

12. A patient diagnosed with hypertension will Answer: )

usually benefit from a diet low in:
Why: Sodium is found in table salt and processed food.
A. sodium.
Sodium is responsible for maintaining fluid balance, so a
B. calcium.
diet low in sodium may help lower blood pressure by
C. iodine.
decreasing the amount of fluid retained by the body.
D. iron.
E. protein. Review: Yes ❏ No ❏

13. Which of the following diets is recommended for a Answer: +

patient diagnosed with gout?
Why: Gout is a condition associated with the inability to
A. Low salt
metabolize uric acid. If there is an excess of uric acid in
B. Low carbohydrate
the body, it is converted to sodium urate crystals that
C. Low purine
deposit in the joints. A common joint affected by the
D. Low fiber
pain of gout is the great toe. Purine-rich foods are
primarily organ meats such as liver and kidney.
Review: Yes ❏ No ❏

14. The substance necessary for hemoglobin to Answer: ,

transport oxygen in the blood is:
Why: Iron is found in organ meats and dark green leafy
A. zinc.
vegetables and is responsible for increasing the ability of
B. iodine.
the red blood cells to transport oxygen by providing
C. potassium.
hemoglobin. Iron injections are administered to help
D. iron.
treat disorders including iron-deficiency anemia.
E. calcium.
Review: Yes ❏ No ❏

15. The process by which nutrients leave the Answer: +

gastrointestinal system and enter the
Why: Ingestion is the process of taking nutrients into the
bloodstream is:
body. Digestion is the process of breaking down the
A. ingestion.
nutrients for absorption into the bloodstream. Metabo-
B. digestion.
lism is the synthesizing of nutrients from the
C. absorption.
bloodstream, producing energy.
D. metabolism.
Review: Yes ❏ No ❏

16. An example of a saturated fat is: Answer: )

A. butter.
Why: Saturated fat is a type of fat that is found in a solid
B. olive oil.
state when at room temperature and is responsible for
C. egg whites.
increasing blood cholesterol. Unsaturated fats are
D. walnuts.
usually liquid at room temperature and are helpful in
E. salmon.
decreasing blood cholesterol. Olive oil is an example of
an unsaturated fat. Egg whites are not fats but rather are
proteins. Walnuts and salmon are proteins that contain
unsaturated fat.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Nutrition 359

17. A patient diagnosed with hypokalemia should Answer: *

increase the intake of:
Why: Hypokalemia is a condition in which an
A. copper.
inadequate amount of potassium is found in the
B. potassium.
bloodstream. The treatment includes increasing the
C. fluoride.
intake of potassium through certain foods or
D. calcium.
medication. Foods rich in potassium include fruits, espe-
cially bananas and citrus fruits.
Review: Yes ❏ No ❏

18. The mineral iodine is an essential substance for the Answer: +

proper function of which one of the following
Why: The thyroid gland requires adequate amounts of
organs?
iodine to function properly. A decrease in the function
A. Kidneys
of the thyroid gland may result in development of a goi-
B. Adrenal glands
ter, an enlargement of the thyroid gland.
C. Thyroid gland
D. Liver Review: Yes ❏ No ❏

19. Night blindness can be caused by a deficiency of: Answer: )

A. vitamin A.
Why: Vitamin A is a fat-soluble vitamin that promotes
B. vitamin B.
good eyesight and may cause night blindness when defi-
C. vitamin C.
cient in the body. Vitamin A is found in milk and yellow
D. vitamin D.
vegetables.
Review: Yes ❏ No ❏

20. The diet recommended for the treatment of Answer: ,

ulcers is:
Why: A bland diet includes foods that are nonirritating,
A. low sodium.
including dairy products, mashed potatoes, and hot
B. soft.
cereals.
C. clear liquid.
D. bland. Review: Yes ❏ No ❏
E. low cholesterol.

21. A clear liquid diet is indicated for which of the Answer: +

following?
Why: A patient with diarrhea should initially limit intake
A. A patient with an ulcer
to clear liquids and then gradually add foods back into
B. A patient with difficulty chewing
the diet. A patient with an ulcer will usually benefit from
C. A patient with diarrhea
a diet that is bland and nonirritating. A patient with dif-
D. A patient who is limiting calories for weight loss
ficulty chewing can usually eat soft foods but does not
require only liquids. A patient who is limiting calories
for weight loss should still eat balanced meals from all of
the food groups; there is no indication for a clear liquid
diet.
Review: Yes ❏ No ❏
360 =VQ\ ■ Clinical Practice

22. A low-fat diet would be recommended to treat: Answer: *

A. hypertension.
Why: The gallbladder is where bile is stored. Bile is nec-
B. gallbladder disease.
essary to break up fat particles that can be absorbed
C. thyroid disease.
through the intestinal walls into the body. Patients with
D. gout.
gallbladder disease will want to limit the intake of fat to
E. diabetes.
decrease the need for bile. Most gallbladder disease is
caused by obstruction of the bile ducts resulting from
gallstones.
Review: Yes ❏ No ❏

23. Ascorbic acid is also known as vitamin: Answer: +

A. A.
Why: Ascorbic acid, also known as vitamin C, is a water-
B. B.
soluble vitamin present in citrus fruits, tomatoes, and
C. C.
green leafy vegetables. Vitamin C is essential for
D. D.
fighting bacterial infections and preventing scurvy.
Scurvy is characterized by weakness, anemia, edema, soft
bleeding gums with ulceration, and loosening of the
teeth.
Review: Yes ❏ No ❏

24. Which of the following may be prevented with Answer: -

proper amounts of vitamin D in the diet?
Why: Rickets is a condition characterized by weak bones.
A. Diabetes
The disease usually is seen in infancy and childhood.
B. Hemorrhage
The bones do not form properly because they are soft
C. Blindness
and pliable. Deformities may include bowlegs and
D. Heart disease
knock-knees.
E. Rickets
Review: Yes ❏ No ❏

25. Persons who need to limit their intake of iodine in Answer: *

the body will want to avoid:
Why: Seafood, especially shellfish, is very high in iodine
A. Milk
content. Some people are highly allergic to iodine and
B. Seafood
should avoid foods with iodine. Injected contrast media
C. Bananas
should also be avoided because of the high
D. Eggs
concentration of iodine.
Review: Yes ❏ No ❏
 Pharmacology and Medication
25
Administration

: - > 1 - ?  < 1 8
The national exams contain medication dosage g calculation problems. Know how to multipl p y and
divide fractions and decimals. Practice solving problems without a calculator since you are not permit-
ted to use one during the exam. The examiners usually provide scrap paper to work out the problem
before listing the answer on the exam form. Practice problems follow the review terms in this chapter.

Pharmacology is the study of drugs. Two federal agencies ■ Diagnosis—determine the presence of a specific dis-
regulate drugs and drug administration. The Food and ease by the body’s reaction to specific drugs, such as
Drug Administration (FDA) controls the drugs that are Tensilon to aid in the diagnosis of myasthenia gravis
acceptable for use in the United States; the Drug ■ Restoration—remove the cause of the disease or disor-
Enforcement Agency (DEA) controls who may adminis- der (e.g., an antibiotic)
ter and use specific drugs. Both agencies hold enforcement
■ Replacement—substitute chemical agents normally
powers, which may include imprisonment, fines, and revo-
found in the body, such as hormone replacement ther-
cation or suspension of professional licenses. Drugs are
apy (HRT)
placed in five schedules for regulation and control, as
described in Table 25-1. Visit RxList (www.rxlist.com) for a ■ Prevention—block or weaken certain diseases (e.g.,
list of the 200 most current commonly used drugs. immunizations for vaccine-preventable diseases); see
Box 6-7, “Types of Immunity,” and Box 6-8, “Com-
mon Vaccine-Preventable Diseases,” in Chapter 6
),5161;<:)<176
MEDICAL DRUG USES COMMON DRUG TYPES
■ Treatment—relieves symptoms of a disease or disorder Drugs are named and grouped for their uses—for exam-
(e.g., ibuprofen for fever and pain) ple, antiemetics are used to combat emesis (vomiting).


362 =VQ\ ■ Clinical Practice

Table 25-1 ,Z]O;KPML]TM[

Schedule Use Example

I Illegal or restricted to research; dispensed with special Heroin, marijuana
permits; high potential for abuse
II Medical use with precautions and limitations; dispensed Cocaine, morphine, Demerol,
with written prescription; high potential for abuse oxycodone, Ritalin
III Medical use with precautions and limitations; dispensed Barbiturates, small doses of codeine
with written prescription; moderate potential for abuse in combination with other drugs
(e.g., Tylenol with codeine)
IV Medical use with precautions and limitations; dispensed Valium
with written or oral prescription; low potential for abuse
V Medical use with purchase over the counter; very low Benadryl, Robitussin
potential for abuse

Table 25-2 lists common drug types and their trade ■ Otic—placed in ear via drops
names and uses. ■ Parenteral—non-oral, usually refers to injected medica-
tion: IM, IV, subcutaneous, intradermal
COMMON DRUG ROUTES ■ Rectal—placed in patient’s rectum via suppository
■ Buccal—placed between gum and cheek via tablet, gel, ■ Subcutaneous (Sub-Q or subQ; S.C. or S.Q. no longer
or spray used, per The Joint Commission)—injected in fatty
tissue under the skin at a 45 angle via 23- to 25-gauge
■ Inhalation—inhaled into respiratory system via sprays,
needle (1/2–5/8 inches long); aspirate before injection to
mists, masks (oxygen is considered a drug)
ensure that the needle is not in a blood vessel
■ Intradermal (ID)—injected into dermal layer of skin at
15 angle via fine (25–27) gauge short needle, produc- • Used for allergic extracts administered with tuber-
culin needle and syringe to avoid entering muscle,
ing a small wheal; forearm site is most common, as
and for insulin administration
with a tuberculin skin test
■ Intramuscular (IM)—injected into muscle at 90 angle • Common subcutaneous sites
via an 18- to 23-gauge long needle (1–3 inches); aspi- ❍ Upper arms

rate before injection to ensure that the needle is not in ❍ Upper thighs
a blood vessel ❍ Upper medial back
• Common IM sites ❍ Abdominal external obliques
❍ Deltoids (upper arms) ■ Sublingual—placed under the tongue via tablets or
❍ Gluteus medius (the ventrogluteal area of this gels
muscle is now recommended over the dorsog- ■ Topical—placed on skin or mucous membranes via
luteal area) ointments, creams, liquids, or sprays for direct treat-
❍ Vastus lateralis (thighs) ment of skin or membranes
• Z-track—used for specific IM medications that irri- ■ Transdermal—placed on skin via medicated patch for
tate subcutaneous tissue (e.g., Imferon and medication to absorb through skin and enter blood-
Kenalog); the skin at the injection site is pulled to stream
one side before injection; the medication is adminis- ■ Urethral—placed into urethra and bladder via a ure-
tered and skin released; prevents medication from thral catheter
seeping into subcutaneous layers
■ Vaginal—placed into vagina via applicator of cream or
■ Intravenous (IV)—injected into vein via 18- to 21- via douche
gauge needle (1–11/2 inches)
■ Ophthalmic—placed into eye via ointment or drops Note: Implantable medication devices and eye-curing
■ Oral—placed in the mouth and swallowed via tablet, lens devices are also available; national exam question
capsule, liquid, gel (most common medication route) probability is extremely low for these routes.
 +PIX\MZ ■ Pharmacology and Medication Administration 363

Table 25-2 +WUUWV,Z]O<aXM[

Drug Type Common Use Example

Analgesic Lessens or relieves pain Ibuprofen (Motrin)
Acetaminophen (Tylenol)
Anesthetic (local) “Deadens” an area to sensation, including pain Lidocaine (Xylocaine)
Antacid Neutralizes acid in gastrointestinal tract Tums, Mylanta
Antibiotic Eradicates or inhibits the growth of specific microbes Penicillin, Augmentin
Anticoagulant Prevents or decreases clotting Heparin, Coumadin
Anticonvulsant Prevents seizures Dilantin, Tegretol
Antidepressant Inhibits or decreases depression Prozac, Cymbalta
Antidiarrheal Inhibits or decreases diarrhea Lomotil, Kaopectate
Antiemetic Inhibits or decreases nausea Compazine, Dramamine
Antihistamine Inhibits or decreases symptoms of allergies Benadryl, Claritin
Antihypertensive Inhibits or controls high blood pressure Aldomet, Lopressor
Anti-inflammatory Inhibits or decreases inflammation

■ Steroidal Decadron
■ Nonsteroidal Ibuprofen
anti-inflammatory
drug
g (NSAID)
Antipyretic Decreases fever Acetaminophen, ibuprofen
Antitussive Inhibits or decreases cough Codeine, Dimetapp
Bronchodilator Dilates the bronchi Albuterol
Decongestant Decreases nasal congestion Neo-Synephrine
Diuretic Decreases body fluid by increasing urination Lasix, Diuril
Immunization Protects from specific communicable diseases Hepatitis B, varicella,and polio vaccines

SYRINGES SEVEN “RIGHTS” OF DRUG ADMINISTRATION

Syringes are plastic or glass tube-like carriers used with These procedures must be carried out each time a drug is
an attached needle to administer substances into the administered to avoid medication errors:
body via injection.
■ Right patient—check the name on the physician’s
■ Insulin—small syringe with short, fine needle attached
order and the medical record; ask the patient first and
to administer insulin; measurements are in units (U) is
last name
another Joint Commision; 100 units  1 mL; syringes
are supplied with 100-unit (most common), 80-unit, or ■ Right drug—check the drug label three times: when
40-unit capacities taking the drug container out (check drug expira-
■ Tuberculin—small syringe with short, fine needle tion date at the same time), after placing the med-
attached to administer Mantoux tuberculin skin test ication in the dispenser (e.g., syringe, medication
intradermally; measurements are in tenths of a mil- cup), and before returning the drug container to
limeter (0.1 mL) with a 1-mL capacity; usual amount is storage
0.1 mL of purified protein derivative (PPD); test ■ Right route—check the route the physician ordered
results should be read in 48 to 72 hours with the route you prepared (e.g., oral versus
■ Cartridges—individual-dose glass tubes with needles injectable)
that screw onto or slide into a dispenser designed for ■ Right dose—check the dose on the physician’s order
that cartridge with the dose prepared
364 =VQ\ ■ Clinical Practice

■ Right technique—ensure that the correct method is

used throughout the procedure including positioning Table 25-3 +WUUWV+WV^MZ[QWV[
the patient and aseptic technique Component Equivalent
■ Right time—check when the medication is to be given
1 gram (G, Gm, g, gm) 1000 milligrams (mg)
(e.g., now, with meals) 5 grains (gr)
■ Right documentation—record the procedure in the
1 gr 60 mg
patient’s medical record on completion, noting date,
time, drug, dose, route, site (if injectable, topical, or 1 kilogram (kg) 2.2 pounds (lb)
transdermal), results/tolerance, patient education, 1,000 Gm
medical assistant signature, and title 1 milliliter (mL, ml) 15 drops (15 gtt)
1 cubic centimeter

SAFETY 1 teaspoon (tsp) 5 mL

60 gtt
When administering medication, safety and Occupa-
tional Safety and Health Administration (OSHA) guide-
lines apply:
■ Body surface area—used to calculate pediatric medica-
tion doses; complicated formula rarely used in medical
■ Prevent accidental needlesticks by using safety lock
office.
needles
■ Discard needles and syringes immediately into biohaz-
ard containers 8:-;+18<176;
■ Wear appropriate personal protective equipment (PPE) Prescriptions are written directions for therapeutic
agents; the most common involve medications. Licensed
physicians, licensed nurse practitioners with prescribing
,7;)/-+)4+=4)<176; privileges, or properly credentialed physicians’ assistants
are the only persons authorized to write prescriptions.
The majority of medical facilities maintain conversion
They provide a legal document, informing the pharma-
charts to simplify medication dosage calculations when
cist of the order to be filled. The medical assistant with a
one unit (such as grams) must be changed to another
physician’s order may administer drugs but may never
unit (such as milligrams). In other instances, the
prescribe drugs. The medical assistant and administra-
amount of a medication ordered may be more or less
tive medical specialist may call a prescription into a phar-
than the medication on hand. The medical assistant is
macy as written by one of the above legal entities. This is
expected to determine the correct dosage. Table 25-3
not considered prescribing.
contains the most common conversions used in dosage
Dispensing is defined as preparing and distributing
calculations.
medication. Only pharmacists, physicians, and properly
credentialed nurse practitioners and physicians’ assistants
METHODS may dispense drugs. The medical assistant and adminis-
trative medical specialist may not dispense drugs but may
■ Formula with like units—used when medication give a patient prepackaged drugs (e.g., samples as ordered
ordered is more than or less than the medication on by the physician). This is not considered dispensing.
hand (units are the same—for example, both mil-
ligrams). Box 25-1 shows the steps involved in calcu-
lating a dosage for like units.
PRESCRIPTION INFORMATION
■ Conversion ratio—used when the units of medication Box 25-4 lists common abbreviations used on prescrip-
on hand are different from the units ordered (e.g., mil- tions.
ligrams are ordered, but the medication on hand is in
grams). The conversion is done first, then the formula ■ Physician name, address, phone number
for the dosage. Box 25-2 shows the steps involved in ■ Date of prescription
calculating a dosage for unlike units. ■ Patient name, address, and phone number
■ Body weight—used in instances in which medication ■ Drug, dose, and form
dosage is more closely calculated for the individual
■ Number of doses to be dispensed
patient (e.g., pediatrics); pounds are converted to kilo-
grams. Box 25-3 shows the steps involved in calculat- ■ Patient instructions
ing a dosage based on body weight. ■ Number of refills
 +PIX\MZ ■ Pharmacology and Medication Administration 365

*W`
,W[IOM+ITK]TI\QWV?Q\P4QSM=VQ\[
Problem 1: The physician ordered 800 mg ibuprofen po to be given now; the office stocks ibuprofen in 200 mg
per tablet. How many tablets will you give?
Dose ordered Quantity
Formula: × = Amount desired
Dose on hand 1
(where “quantity” is the amount and form that contains the dose on hand)
Step 1: Set up formula.
800 mg 1tablet
× = number of tablets desired
200 mg 1

Step 2: Multiply 800  1 and 200  1.

800
= 4 tablets
200

Answer: 4 tablets of 200 mg each are to be given.

Problem 2: The physician ordered 250 mg amoxicillin po to be given now; the office stocks amoxicillin 500 mg
per tsp. How many teaspoons will you give?
Use the same formula as above:
250 mg 1tsp 1
× = /2 or 0.5tsp to be given
500 mg 1

■ Physician signature ■ Nutritional supplement

■ DEA number ■ Rapid access to vein
■ Intolerance to medications via other routes
MEDICAL ASSISTANT RESPONSIBILITY TO AVOID
DRUG ABUSE
■ Security of prescription pads COMPLICATIONS
■ Protection of signature stamps and physician’s DEA ■ Infiltration—the solution enters the tissue around the
number vein
■ Extravasation—leakage of fluid from the vein into the
8-:180-:)416<:)>-67=;<0-:)8A surrounding tissue
Similar to radiography, involvement with IV therapy
may or may not be in the medical assistant’s scope of
practice dependent on the state rules and regulations, the
community standards, the medical assistant’s training, Table 25-4 ;MTMK\QVO+WUUWV1><]JQVOJa,ZQX+IXIKQ\a
and the medical practice’s insurance carrier. The previ-
ous material in this chapter related to medication admin- Tubing Drops Use
istration also pertains to IV therapy. The following are Macrodrip 15 drops/mL Standard adult
IV-related topics that may appear on the national exam. infusion rates
Table 25-4 lists common IV tubing by drip capacity.
Microdrip (minidrip) 60 drops/mL Restricted or
precise fluid
INDICATIONS delivery (e.g.,
■ Rapid medication distribution and absorption certain medications
or pediatrics)
■ Fluid volume replacement or maintenance
366 =VQ\ ■ Clinical Practice

*W`
,W[IOM+ITK]TI\QWV?Q\P=VTQSM=VQ\[
Problem: The physician ordered 0.4 Gm of ibuprofen po now; the office stocks ibuprofen 200 mg per tablet.
How many tablets will you give?
Step 1: Because the units of the available dosage (mg) differ from the units of the ordered dosage (Gm), they
must be converted. Grams are converted to milligrams using the following ratio:
1,000 mg : 1 Gm
or
1,000 mg  1 Gm
Step 2: Set up the proportion to find the dosage using the above ratio, x (the unknown, in milligrams), and 0.4
Gm, which is the dose ordered:
1,000 mg : 1 Gm  x mg : 0.4 Gm
or
1,000 mg : 1 Gm :: x mg : 0.4 Gm

((Hint: Use like units for the first and third numbers and the second and fourth numbers.)
Step 3: The product of the first and fourth numbers equals the product of the second and third numbers: 400 mg
 x mg.
Step 4: Use the formula in Box 25-1:
Dose ordered Quantity
Formula: × = Amount desired
Dose on hand 1
400 mg tablet
× = 2 tablets
200 mg 1

Answer: 2 tablets of 200 mg each are to be given.

■ Infection—an illness caused by a microorganism; char- ■ System(s) fluid overload—a result of too rapid or too
acterized by localized redness, swelling, and pain, much infusion of a solution
fever, and other systemic symptoms ■ Hematoma—discoloration and swelling in the tissue
due to blood leaking from the vein
■ Venous spasm—contraction of vein
*W` ■ Thrombus—blood clot
,W[IOM+ITK]TI\QWV?Q\P*WLa?MQOP\ ■ Thrombophlebitis—inflammation of the blood vessel
■ Embolism—traveling clot, usually blood
Problem: The physician ordered 15 mg Tylenol
■ Air embolism—bolus of air, usually through IV tubing
per kilogram (kg) of body weight. You weighed the
child, who is 8 kg. How many milligrams of ■ Nerve, tendon, ligament, or limb damage from initial
Tylenol will you give? venipuncture, infiltration, or infection
■ Damaged IV catheter, which may cause harm at the
Formula: Dose ordered  Weight
side or break off and travel to vital organs
in kg  Dose to be given
Set up formula.
15 mg  8 kg  120 mg EXTREMITIES TO AVOID
Answer: 120 mg Tylenol is to be given. ■ Legs
■ Side of a radical mastectomy
 +PIX\MZ ■ Pharmacology and Medication Administration 367

*W`
+WUUWV8ZM[KZQX\QWV)JJZM^QI\QWV[IVL1V[\Z]K\QWV[
Time
Once per day bid: twice per day tid: three times per day qid: four times per day
(“od” no longer used,
per The Joint
Commission)
q: every Every day qh: every hour q (2, 3, 4, etc.) h: every
(“qd” no longer used, (2, 3, 4, etc.) hours
per The Joint
Commission)

Select Administration Sites

Right ear Left ear Both ears Right eye
(“AD” no longer used, (“AS” no longer used, (“AU” no longer used, (“OD” no longer used,
per The Joint per The Joint per The Joint per The Joint
Commission) Commission) Commission) Commission)
Left eye Both eyes po: by mouth top: topically
(“OS” no longer used, (“OU” no longer used,
per The Joint per The Joint
Commission) Commission)
Note: The Joint Commission eliminated a number of common abbreviations that resulted in medication errors.

■ Side of cerebrovascular accident (CVA) or other paral- extravasation the leakage of fluid from the vein into
ysis the surrounding tissue
■ Partial amputations, scars, or other deformities Food and Drug Administration (FDA) federal
■ Shunts or grafts
agency that controls the drugs that are acceptable
for use in the United States
Note: All OSHA and CDC guidelines for safety, asepsis, infiltration IV solution enters the tissue around the
and biohazards in previous chapters apply to IV therapy. vein
Review the sections “Fluid Balance” and “Cellular intramuscular (IM) injected into muscle at 90 angle
Movement of Substances” in Chapter 6. via 18- to 23-gauge long needle
macrodrop a type of IV tubing that delivers approxi-
mately 15 drops of solution per milliliter
microdrop a type of IV tubing that delivers approxi-
TERMS mately 60 drops of solution per milliliter
parenteral substances administered by intramuscular,
Pharmacology and Medication Administration Review
intradermal, intravenous, or subcutaneous routes
The following list reviews the terms discussed in this patient-controlled analgesia (PCA) an electronic
chapter as well as other important terms that you may infusion device that allows the patient to self-admin-
see on the exam. ister IV pain medication through an open IV line
dispensing preparing and distributing medication pharmacology the study of drugs
Drug Enforcement Agency (DEA) federal agency that piggybacked IV infusion a secondary IV line coupled
controls who may administer and use specific drugs to the primary infusion line through an injection
electronic infusion device (EID) an electronic mech- port; the piggyback infusion solution must be hung
anism that regulates the amount and flow rate of above the primary infusion solution in order to run;
intravenous solutions IV antibiotics are often administered in this manner
368 =VQ\ ■ Clinical Practice

prescriptions written directions for therapeutic agents; 2. The physician orders 750 mg Tagamet liquid; 1,500
the most common involve medications mg/tsp is on hand. How many teaspoons will you
Rx most commonly found on prescription forms, give? __________
meaning treatment or recipe 3. The physician ordered 75 mg of Seconal; 50
subcutaneous injected in fatty tissue under the skin at mg/mL is on hand. How many milliliters will you
a 45 angle give? __________
syringes plastic or glass tube-like carriers used with an
4. The physician ordered 1,500 mg Duricef; 1 g/tablet
attached needle to administer substances into the
is on hand. How many tablets will you give?
body via injection
___________
topical placed on skin or mucous membranes via oint-
ments, creams, liquids, or sprays for direct treatment 5. The physician orders 15 mg morphine sulfate; 1
to skin or membranes gr/mL is on hand. How many milliliters will you
transdermal drug route in which medication is placed give? __________
on skin via a patch for medication to absorb through 6. The physician ordered 10 units of regular insulin;
skin and enter bloodstream 100 units/mL is on hand. How many millimeters
venoscope an illumination device used to assist in will you give? __________
locating veins for venipuncture or IV therapy; the 7. The physician ordered 5 mg Coumadin; 5 mg/tablet
device directs cool light into subcutaneous tissue, is on hand. How many tablets will you give?
which highlights the presence of a vein by causing it __________
to appear as a dark line
8. The physician ordered 20 mg Tylenol/kg of body
Z-track a method of intramuscular (IM) medication
weight; on hand is 80 mg/tablet. The child weighs
administration used for specific IM medications that
12 kg. How many tablets will you give? __________
irritate subcutaneous tissue (e.g., Imferon, Kenalog);
the skin is pulled to one side of the injection site 9. The physician ordered 20 mg Tylenol/kg of body
before the injection; the medication is administered, weight; on hand is 80 mg/tablet. The child weighs
and the skin is released; prevents medication from 44 lb. How many tablets will you give? __________
seeping into subcutaneous layers 10. The physician ordered 3,000 units of heparin; 5,000
units/mL is on hand. How many milliliters will you
8:7*4-5; give? ___________
MEDICATION DOSAGE CALCULATION
1. The physician orders 40 mg Depo-Medrol; 80 Answers: (1) 0.5 mL, (2) 0.5 tsp, (3) 1.5 mL, (4) 1.5 tab,
mg/mL is on hand. How many milliliters will you (5) 0.25 mL, (6) 0.1 mL, (7) 1 tab, (8) 3 tab, (9) 5 tab,
give? __________ (10) 0.6 mL
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA) and RMA (AMT) exams. Questions 1 through 15 are relevant for the
CMAS (AMT) exam.

1. The agency that controls who may administer Answer: +

and use specific drugs is the:
Why: The Drug Enforcement Agency (DEA) is a federal
A. FDA.
branch of the Justice Department. Their responsibilities
B. CDC.
include overseeing the prescribing, refilling, and storing
C. DEA.
of controlled substances in the medical office. The FDA
D. PDR.
is the Food and Drug Administration, the CDC is the
Centers for Disease Control and Prevention, and the
PDR is the Physician’s Desk Reference.
Review: Yes ❏ No ❏

2. Which of the following is not included in the Answer: *

“rights” of drug administration?
Why: The “rights” of drug administration are the proce-
A. Right drug
dures to be carried out each time a drug is administered
B. Right physician
to a patient to avoid medication errors. The “rights”
C. Right patient
include the right patient, drug, route, dose, technique,
D. Right route
time, and documentation.
E. Right time
Review: Yes ❏ No ❏

3. Drugs that can be purchased over the counter Answer: ,

are classified as schedule:
Why: Drugs are placed in five schedules for regulation
A. I.
and control. Schedule I drugs are illegal or restricted to
B. II.
research. Schedule II and III drugs must be used with
C. IV.
precautions and limitations and are dispensed with a
D. V.
written prescription. Schedule II drugs have a high
potential for abuse, and Schedule III drugs have a mod-
erate potential for abuse. Schedule IV drugs are
dispensed with written or oral prescription and have a
low potential for abuse.
Review: Yes ❏ No ❏

4. Parenteral administration of medication generally Answer: *

means that the medication is:
Why: Parenteral is a term used to describe the adminis-
A. administered through a suppository.
tration of medication by injection so the medication
B. injected.
does not pass through the gastrointestinal tract. This
C. in liquid form to swallow.
method includes intramuscular, subcutaneous, and intra-
D. dissolved in and absorbed through the
venous routes.
mouth
E. placed under the tongue Review: Yes ❏ No ❏

!
370 =VQ\ ■ Clinical Practice

5. To convert grams to milligrams: Answer: ,

A. divide by 100.
Why: Grams is a single unit of measure; milli is the pre-
B. divide by 1,000.
fix used for 1,000; 1,000 mg  1 g.
C. multiply by 100.
D. multiply by 1,000. Review: Yes ❏ No ❏

6. Information found on a prescription includes the Answer: +

following EXCEPT:
Why: The patient’s birth date is not included on a
A. patient instructions.
prescription. Most prescription forms are preprinted
B. number of doses to be dispensed.
with the physician’s name, address, phone number, and
C. patient’s date of birth.
DEA number. The physician completes the prescription
D. patient’s name and address.
with the prescription date, drug requested, dose, drug
E. number of refills.
form, and number of refills. There is also a space for the
patient’s name and address.
Review: Yes ❏ No ❏

7. Which of the following is an appropriate task for Answer: )

a medical assistant or administrative medical
Why: A medical assistant or administrative medical spe-
specialist?
cialist may call in a prescription for a drug that a physi-
A. Call a drug renewal to a pharmacy
cian has ordered for a patient. Only a physician can
B. Prescribe drugs
prescribe and authorize the reorder or refill of drugs.
C. Authorize reorder of drugs
Dispensing drugs is only permitted by licensed pharma-
D. Dispense drugs
cists, physicians, or other credentialed medical
personnel.
Review: Yes ❏ No ❏

8. The prescription directions “ii gtt q4h” mean: Answer: ,

A. one drop every hour.
Why: The abbreviation gtt means “drops.” The Roman
B. one drop every four hours.
numeral ii means “two.” “Every four hours” is abbrevi-
C. two drops every hour.
ated q4h.
D. two drops every four hours.
E. four drops every four hours. Review: Yes ❏ No ❏

9. Which of the following classifications of Answer: +

medication is used to control high blood pressure?
Why: The prefix anti means “to work against.”
A. Antipyretic
Hypertension is the medical term for elevated or high
B. Antiemetic
blood pressure. Antipyretics are used to decrease fever,
C. Antihypertensive
antiemetics to decrease nausea, and antihistamines to
D. Antihistamine
decrease symptoms of allergies.
Review: Yes ❏ No ❏

10. Of the following drugs, which one can be dispensed Answer: ,

only with a written prescription?
Why: Morphine is classified as a Schedule II drug. Drugs
A. Valium
in this category require a written prescription and are
B. Robitussin
ordered with precautions and limitations. They have a
C. Tylenol
high potential for abuse
D. Morphine
E. Benadryl Review: Yes ❏ No ❏
 +PIX\MZ ■ Pharmacology and Medication Administration 371

11. The method of administration of medication Answer: +

under the tongue is:
Why: Sublingual means “beneath the tongue.”
A. topical.
Nitroglycerin, used to treat angina, is an example of a
B. sublingual.
medication administered sublingually. It is dissolved
C. parenteral.
beneath the tongue and absorbed through the mucous
D. subcutaneous.
membranes.
Review: Yes ❏ No ❏

12. The physician orders 300 mg of medication tid  10 Answer: )

days. The medication is available in 150-mg
Why: The patient will need to take two capsules three
capsules. How many capsules will the patient
times a day for 10 days. The total is 60 capsules for the
need to complete the course of therapy?
entire course of therapy. The abbreviation tid means
A. 60
three times per day. To receive 300 mg of the
B. 45
medication with each dose, the patient will have to take
C. 30
two 150-mg capsules for each dose.
D. 20
E. 10 Review: Yes ❏ No ❏

13. The agency that controls the drugs that are Answer: +
acceptable for safe use and sale in the
Why: The Food and Drug Administration (FDA)
United States is the:
reviews drug applications and petitions for food
A. DEA.
additives and removes unsafe drugs from the sales mar-
B. AMA.
ket. The FDA also oversees the proper labeling of food,
C. FDA.
drugs, and cosmetics.
D. CDC.
Review: Yes ❏ No ❏

14. The equivalent of 5 cubic centimeters is: Answer: *

A. 5 milligrams.
Why: The measurement of 1 cubic centimeter is the
B. 5 milliliters.
same as 1 milliliter. One cubic centimeter is a square
C. 5 centimeters.
cube 1 centimeter long by 1 centimeter wide by
D. 5 drops.
1 centimeter high. One milliliter of fluid will equally fill
E. 5 grams.
1 cubic centimeter of space; therefore, 5 cubic centime-
ters equals 5 milliliters.
Review: Yes ❏ No ❏

15. The physician orders 2.5 mg of Compazine, IM. Answer: +

Available is Compazine 5 mg/mL provided in a
Why: That the medication is provided in a 10-mL multi-
10-mL multidose vial. How many milliliters will
dose vial is not important when performing the calcula-
you give the patient?
tion. This information states the total number of
A. 0.1 mL
milliliters in the container. If there are 5 milligrams of
B. 0.25 mL
Compazine in 1 milliliter, then to give 2.5 mg, which is
C. 0.5 mL
one-half of 5 mg, give one-half milliliter, or 0.5 mL.
D. 1.0 mL
Review: Yes ❏ No ❏
372 =VQ\ ■ Clinical Practice

16. The classification of drugs that prevent or Answer: -

decrease clotting is:
Why: Anticoagulants are used to prevent the formation
A. antiemetic.
of blood clots. Antiemetics are used to inhibit nausea.
B. antipyretic.
Antipyretics are used to decrease fever. Antineoplastics
C. antineoplastic.
are indicated to slow the rate of tumor growth and delay
D. antitussive.
metastasis (cancer). Antitussives are used to control
E. anticoagulant.
coughing.
Review: Yes ❏ No ❏

17. The proper angle of the needle to the skin when Answer: ,
administering an intramuscular injection is:
Why: The needle should be at a 90 angle to ensure that
A. 30.
the beveled tip of the needle is placed within the muscle.
B. 45.
If a lesser angle is used, the medication may be deposited
C. 60.
within the subcutaneous or fatty layer of tissue.
D. 90.
Review: Yes ❏ No ❏

18. The muscle used for injection in the thigh is the: Answer: +
A. gluteus maximus.
Why: The vastus lateralis is the large (vastus) s muscle on
B. gluteus medius.
the side (lateralis, lateral) of the thigh. This is the
C. vastus lateralis.
preferred site for injections for infants.
D. rectus abdominis.
E. rectus femoris. Review: Yes ❏ No ❏

19. Which of the following is proper technique when Answer: ,

administering a tuberculin skin test?
Why: Massaging or covering the site may cause the med-
A. Massage the injection site to lessen the pain
ication to be pressed into the tissues or out of the wheal,
of the procedure.
and the results, if any, will be unreliable. Aspiration is
B. Place a bandage over the injection site.
not required for an intradermal injection.
C. After inserting the needle beneath the skin,
aspirate to ensure the needle is not in a blood Review: Yes ❏ No ❏
vessel.
D. Leave the injection site uncovered.

20. The physician orders ampicillin 0.5 Gm. Available Answer: -

is ampicillin 250 mg/mL. How many milliliters
Why: The first step to calculate the dose is to convert
will you give the patient?
grams to milligrams. 0.5 Gm (grams) is equal to 500 mg
A. 0.25 mL
(1 gram equals 1,000 milligrams). The dose ordered is
B. 0.5 mL
500 mg, and available is 250 mg in each milliliter. Two
C. 1 mL
(2) milliliters of this medication contains 500 mg.
D. 1.5 mL
E. 2 mL Review: Yes ❏ No ❏

21. A subcutaneous injection is injected into: Answer: +

A. muscle tissue.
Why: The subcutaneous tissue lies beneath the skin or
B. dermal tissue.
dermis. It is the fatty layer. Medications injected in this
C. fatty tissue.
tissue are absorbed slower than those given by the intra-
D. epidermal tissue.
muscular method.
Review: Yes ❏ No ❏
 +PIX\MZ ■ Pharmacology and Medication Administration 373

22. A solution administered through the ID method is: Answer: ,

A. Keflex.
Why: ID is the abbreviation for intradermal. This is the
B. penicillin.
injection method of placing a minute amount of solution
C. hepatitis B vaccine.
just beneath the surface of the skin, within the dermis.
D. tuberculin solution.
Tuberculin solution is used to perform tuberculosis skin
E. Imferon.
testing.
Review: Yes ❏ No ❏

23. Imferon, an iron preparation, is administered by Answer: *

which method?
Why: Z-track is an intramuscular method of injection.
A. Subcutaneous
Iron is a medication that will cause irritation and discol-
B. Z-track
oration if deposited in the subcutaneous tissue. The Z-
C. Intravenous
track method requires that the skin be pulled to one side
D. Sublingual
before injection. After the injection is given, the skin is
released, and there is no trailing or seeping of
medication into the tissues.
Review: Yes ❏ No ❏

24. A subcutaneous injection is given using which Answer: ,

technique?
Why: The subcutaneous injection is administered into
A. 90 angle, 21-gauge needle
the fatty tissue. To avoid entering the muscle, a 45
B. 15 angle, 25-gauge needle
angle is required. Solutions used for subcutaneous
C. 60 angle, 21-gauge needle
method are aqueous (watery), so they can be injected
D. 45 angle, 25-gauge needle
into the fatty tissue and absorbed slowly.
E. 30 223-gauge needle
Review: Yes ❏ No ❏

25. The reason for aspirating before injecting a Answer: +

medication is to ensure that the:
Why: Aspiration is the process of pulling back on the
A. patient receives all the medication.
syringe plunger to ensure the needle is not positioned in
B. injection will be deposited in the muscular tissue.
a blood vessel. If blood appears in the syringe, the injec-
C. needle is not in a blood vessel.
tion is discontinued and a new syringe is prepared. If the
D. injection will be less painful.
medication is injected into a blood vessel, the patient
could have a serious adverse reaction to the medication.
Review: Yes ❏ No ❏
 Emergency Preparedness
26

: - > 1 - ?  < 1 8 
After yo
y u compplete the chapt p er, check yo
y ur cardioppulmonaryy resuscitation (CPR)) certification card
and ensure it is current. If not, sign up for a course and bring a friend or relative. CPR is a separate
certification, and the national exams contain only general questions.

The focus of this chapter is not to teach general first touching him or her, even though it is in the context of
aid but to discuss emergency preparedness and provide providing first aid. A medical emergency is the occur-
an overview of recognizing and dealing with emergen- rence of a sudden injury or illness that requires immediate
cies that may occur within the medical office or the medical intervention. First aid is the immediate care ren-
community. Please note that the AAMA often refers to dered in an emergency until definitive or advanced care is
“emergency preparedness” as “protective practices.” available if needed. Being prepared is a major component
Emergency preparedness or protective practices may in effectively dealing with emergencies that arise in the
be divided into three categories: medical office. The medical office generally has guidelines,
policies, and procedures for office emergencies and docu-
■ The individual (patient, staff member, visitor) mentation. These should be reviewed and revised on a reg-
■ The medical office (emergency within the office such ular basis and followed when needed. Many of the
as fire or chemical exposure) elements of preparedness come under the roles of the med-
■ The community (natural disaster, act of terrorism, ical assistant and medical administrative specialist.
horrific event such as a school fire)
ACTIVATION OF EMERGENCY MEDICAL
<0-16,1>1,=)4 SYSTEM (EMS)
Before proceeding, review the section on the Good Samar- ■ Dial 911 (in most areas)
itan Act in Chapter 4, which discusses an individual’s liabil- ■ Know the correct number if there is no 911 system in
ity in emergency situations. No matter the location or the the area (e.g., the emergency number for some rural
emergency, always ask the victim’s permission before areas may be the police or fire department)


376 =VQ\ ■ Clinical Practice

■ Know if an alternative to 911, such as 311, is available ■ Cold packs

for less urgent situations ■ Emergency childbirth delivery pack (for offices that
■ Have readily available the numbers for poison control practice obstetrics) with gloves, blankets, two Kelly
center, suicide hotlines, abuse shelters, emergency food clamps, cord clamp, scissors, nasal suction bulb, and
banks, and other services that may be used in an emer- plastic bag or container for placenta
gency
■ Know the capacity of the office telephone system
(e.g., can you keep a patient on the line and activate :-+7/61B16/-5-:/-6+1-;
EMS?)
A four-pronged approach is used in recognizing medical
■ Know when your physicians and other medical staff
emergencies and determining their seriousness. The first
are onsite
is the ability to determine an emergency exists; the sec-
ond is to be sure the health care responder or others are
not in danger. Health care personnel will then perform
MEDICAL ASSISTANT AND MEDICAL primary and secondary assessments.
ADMINISTRATIVE SPECIALIST ROLES
IN EMERGENCIES
SIGNS OF EMERGENCIES
■ Recognizing emergencies and responding
■ Respiratory distress
■ Monitoring emergency supplies, equipment, and
drug readiness (includes expiration dates on drugs ■ Unconsciousness
and sterile packs; functioning of battery-operated ■ Hemorrhage
equipment) ■ Chest pain
■ Knowing the location of emergency supplies ■ Wounds or penetrating objects
■ Restocking equipment after each use ■ Bone protrusions or deformities
■ Maintaining up-to-date emergency phone numbers ■ Skin burns
■ Keeping CPR and other first aid skills current ■ High or low body temperatures
■ Providing personal protection for self, patient, and other ■ Severe pain
involved individuals
■ Abnormal skin color
■ Documenting the event and the first aid rendered
■ Abnormal behavior
■ Observing the environment for possible risks, such
as frayed wiring or loose carpeting (risk manage-
ment)
SCENE MANAGEMENT
The guidelines here apply to the medical office in addi-
COMMON EMERGENCY EQUIPMENT AND SUPPLIES tion to other sites.
IN THE MEDICAL OFFICE
■ Ensure dangers do not exist for responder (e.g., wet
■ Oxygen with nasal cannulas and various sizes of oxy-
floor, “hot” wire)
gen masks
■ Remove hazard if this does not pose a danger to the
■ Various sizes of blood pressure cuffs
responder
■ Code cart containing cardiac monitor and defibrilla-
■ Remove others in the vicinity of danger if appropriate
tor, emergency drugs, intravenous (IV) solutions with
tubing and IV cannulas, tourniquets and tapes, band- ■ Assign tasks; for example, have someone activate EMS
age scissors, pen light, Ambu bag, airways, and intuba- while you are rendering first aid
tion equipment per physician’s preferences and
training
■ Automatic external defibrillator (AED) PRIMARY ASSESSMENT AND TREATMENT
■ Personal protective equipment (PPE) (refer to Chap- PRIORITIES (ABCS)
ter 17) ■ A—airway: check open airway using head-tilt/chin-lift
■ Materials for wound care: antiseptic solution, sterile method or jaw thrust (for suspected neck injuries) if
dressings needed
 +PIX\MZ ■ Emergency Preparedness 377

■ B—breathing: ensure patient is breathing by looking

for chest movement
■ C—circulation: ensure patient has a pulse

SECONDARY ASSESSMENT, IF INDICATED

■ Vital signs (pulse, respirations, blood pressure, tem-
perature)
■ Skin (color, temperature, degree of moisture)
■ Head-to-toe observation and palpation for pain,
abnormalities, and bleeding (usually done by physi-
cian, midlevel provider, or EMS personnel)
■ Level of consciousness

+75576-5-:/-6+1-;
Common emergencies are listed, along with the first
aid treatment generally administered by the medical .QO]ZM Rule of nines. (Reprinted with permission from Hosley JB, Jones SA,
assistant. Molle-Matthews EA. Lippincott’s Textbook for Medical Assistants. Philadelphia:
Lippincott-Raven Publishers, 1997.)

BURNS
Burns are tissue damage caused by exposure to heat, • Check ABCs
chemicals, or electricity. The extent of burns is esti- • Use sterile gloves and other PPE if indicated
mated using the rule of nines, in which each body part • Cover affected areas with sterile dressings soaked in
is considered 9% of the body: the affected parts are sterile saline
added to determine the percentage of body burned
• Observe for shock
(Fig. 26-1).

■ First degree (superficial)—involves epidermis; red

appearance with minimal or no edema (such as sun- SHOCK
burn)
Shock is a life-threatening condition related to inade-
• Immerse in cool water or provide cool water com- quate oxygen supply. It is often characterized by heavy
presses blood loss; lowered blood pressure; weak, increased pulse;
• Avoid ointments or other greasy substances cool, clammy skin; increased respiratory rate; anxiety; and
(e.g., butter, which is a home remedy for some agitation. The most common types of shock are:
cultures)
■ Second degree (partial thickness)—involves epidermis ■ Hypovolemic—shock resulting from hemorrhage (exces-
and part of dermis; blistered red appearance with sive bleeding)
edema • Use PPE
• Immerse in cool (not cold) water or provide cool • Cover wound with sterile dressing (if possible) and
(not cold) compresses apply direct pressure
• Avoid ointments or other greasy substances • Elevate bleeding area
• May apply dry, sterile dressing • Keep head lower than body (except in cases of head
■ Third degree (full thickness)—involves epidermis, wounds)
entire dermis, and often underlying tissues; pale • Apply pressure to nearest pressure point (review
white or charred appearance with broken skin and Fig. 6-16, “Major arteries,” in Chapter 6) between
edema bleeding and heart if bleeding does not stop
• Activate EMS • Keep patient warm
378 =VQ\ ■ Clinical Practice

■ Anaphylactic (anaphylaxis)—shock caused by a severe MYOCARDIAL INFARCTION

allergic reaction that results in respiratory distress and,
in some instances, cardiac arrest Myocardial infarction (MI, heart attack) is necrosis of the
cardiac muscle caused by blockage in the coronary artery.
• Activate EMS It is characterized by chest, left arm, or jaw pain; sweat-
• Check ABCs ing; rapid respirations; and often nausea and vomiting.
• Remove allergen if possible
■ Activate EMS
• Keep patient warm
■ Septic—shock caused by an overwhelming infection ■ Check ABCs if needed
affecting major body systems ■ Position code cart and AED

• Activate EMS ■ Initiate cardiac monitor

• Check ABCs ■ Take vital signs

■ Cardiogenic—shock caused by impaired cardiac func- ■ Keep patient calm
tion; first aid is the same as for septic shock ■ Prepare to assist with administration of oxygen with
■ Neurogenic—shock caused by trauma or other insult physician’s order
(e.g., toxin) to the nervous system
• Activate EMS
• Check ABCs CEREBROVASCULAR ACCIDENT
• Immobilize head for spinal injury A cerebrovascular accident (CVA, stroke) is the occlu-
• Keep patient warm sion of a blood vessel or vessels in the brain or hemor-
rhage in the brain characterized by one or more of the
• Prepare to assist with administration of antitoxin if following symptoms: weakness, paralysis of one or more
known and available
areas, dysphasia or aphasia, and confusion.
■ Insulin (see “Diabetic Emergencies”)
■ Activate EMS
DIABETIC EMERGENCIES ■ Check ABCs, if needed
Box 26-1 contains a mnemonic to help differentiate ■ Take vital signs
between insulin shock and diabetic coma. ■ Keep patient calm

■ Insulin shock—severe hypoglycemia in diabetic patients, ■ Prepare to assist with administration of oxygen with
characterized by rapid heart rate; cold, clammy skin; physician’s order
and confusion
• Administer sugar (e.g., Insta-Glucose, a glucose gel
rapidly absorbed through oral mucosa) RESPIRATORY EMERGENCIES
• Keep patient quiet and at rest Respiratory emergencies involve the impairment or
■ Diabetic coma—severe hyperglycemia in diabetic absence of breathing.
patients, characterized by rapid respirations; warm,
dry skin; thirst; “fruity” breath (sometimes mistaken ■ Respiratory arrest—total absence of breathing
for alcohol); and confusion • Activate EMS
• Activate EMS • Check ABCs
• Prepare to bring the insulin and appropriate needle • Head-tilt/chin-lift maneuver
and syringe or administer insulin with the physician’s
order if within the scope of practice in your state • Support breathing by health care provider “breath-
ing” for victim (CPR guidelines) or using an Ambu
bag
*W` • Prepare for cardiac arrest (have code cart, emer-
5VMUWVQK\W0MTX,QNNMZMV\QI\M*M\_MMV gency drugs, and cardiac monitor ready; begin chest
,QIJM\QK+WUIIVL1V[]TQV;PWKS compressions if pulse/heartbeat stops)
■ Asthma—inflammatory lung disease characterized by
Hot and dry; sugar high (diabetic coma) difficulty breathing caused by airway obstruction
Cold and clammy; needs some candy (insulin shock) • Check ABCs
• Maintain sitting position if conscious
 +PIX\MZ ■ Emergency Preparedness 379

• Keep patient calm ■ Assist the patient in lying down or sitting with head to
knees
• Assist patient with his or her inhaler if available
■ Loosen tight clothing
• Prepare to initiate small-volume nebulizer with
physician order ■ Use ammonia capsule at least 6 inches from nose and
avoiding eyes (office policy permitting)
• Monitor oxygen saturation by using a pulse oximeter
■ Place cool cloth on forehead
■ Hyperventilation—increased ventilation leading to
decreased carbon dioxide, dizziness, and possible
unconsciousness; usually stress induced
COMMON INJURIES
• Keep patient calm
■ Wounds
• Seal paper bag over patient’s mouth and nose
• Assist patient with taking slow, deep breaths into • Contusion (bruise)—a closed wound usually caused
paper bag by blunt trauma
❍ Apply ice pack or cold compress
■ Choking—laryngospasms, usually caused by obstruc-
tion of the airway with a foreign object, such as food ❍ Observe for increased swelling

• Allow patient to cough • Abrasion—an open wound resulting from scraping

off of skin layer(s) by trauma; may or may not pro-
• Use Heimlich maneuver if coughing, speaking, or duce bleeding
breathing ceases
❍ Cleanse with soap and water or antiseptic
❍ Standing—get behind victim; rescuer’s arms come
around to below victim’s xiphoid process; rescuer ❍ Apply sterile dressing if needed
makes fist with dominant hand and administers ❍ Determine patient’s tetanus immunization status
inward and upward thrusts until foreign object is
expelled
• Avulsion—an open wound caused by forceful tearing
away of skin from bony structure by trauma, some-
❍ Lying—if patient loses consciousness, lower him times leaving a skin flap and causing excessive bleeding
or her to floor, check mouth for foreign objects ❍ Replace skin flap if present
and, if seen, sweep objects out with fingers; res-
❍ Treat the same as an abrasion
cuer kneels beside patient, places closed dominant
hand below xiphoid process, and administers • Laceration—a jagged cut into the body tissue
inward and upward abdominal thrusts until for- ❍ Treat the same as an abrasion
eign object is expelled ❍ May require sutures or Steri-Strips

• Puncture—an open wound caused by an object

piercing the skin (first aid for bites and stings is the
SEIZURES same as punctures and abrasions)
A seizure, or convulsion, is an abnormal generalized series ❍ Treat the same as an abrasion
of involuntary muscle contraction and relaxation. There
are many causes, including brain injury or high fever. • Puncture with fixed penetrating object
❍ Activate EMS

■ Activate EMS ❍ Leave object imbedded

■ Lower patient to floor ❍ Stabilize object to prevent movement

■ Protect from injury by furniture or other obstacles • Traumatic amputation—the removal of a body part
■ Loosen tight clothing by traumatic event
■ Log roll patient if he or she is vomiting ❍ Treat the same as an avulsion

■ Avoid restricting patient or putting anything in patient’s ❍ Wrap amputated part in sterile moist dressing and

mouth transport with patient (do not place on ice)

■ Assist with breathing if necessary when seizure is over ■ Fracture—broken bones; see Figure 6-10, “Types of
fractures,” in Chapter 6
• Open fracture—broken bone that protrudes through
SYNCOPE skin
❍ Immobilize with a splint
Syncope, also called fainting or swooning, is transient
unconsciousness, usually caused by a sudden decrease in ❍ Cover wound with sterile dressing

blood pressure or oxygen. ❍ Arrange transport to hospital

380 =VQ\ ■ Clinical Practice

• Closed fracture—broken bone without an open H1N1 influenza in 2009 was an example. Common
wound Occupational Safety and Health Administration (OSHA)
❍ Immobilize with a splint
and state-specific emergency preparedness guidelines
recommend that facilities have:
❍ Apply ice pack or cold compress
❍ Elevate; sling may be used to elevate and support
■ An exposure control plan that describes personnel
hand and lower arm; tie knot off to the side of the protective equipment (PPE) and other safety engi-
neck, avoiding spine neering devices and processes; it provides instructions
of what an employee should do if an exposure occurs.
The plan should be reviewed annually and contain:
POISONINGS
• Definitions such as biohazardous waste
A poisoning is the injection, respiration, or ingestion of
a toxic substance (may be natural or chemical). • Responsibilities
• Availability of recommended immunizations
■ Remove substance or victim from area of substance • Availability and disposal mechanisms of PPE and safety
while protecting rescuer (PPE) engineering devices
■ Check ABCs • Procedures to follow for prevention and exposures
■ Call poison control center for specific instructions • Training guidelines
■ Do not induce vomiting or administer ipecac unless • Record keeping and reporting
instructed to do so ■ Adequate PPE and safety engineering devices
■ Contract for disposal of biohazardous material
EXTREME TEMPERATURE EMERGENCIES ■ Material Safety Data Sheets (MSDS)
■ Hyperthermia—abnormally high body temperature ■ Common safety features
(e.g., heat exhaustion and heat stroke [most serious]) • Fire extinguishers; serviced annually; standard
• Remove from heat source acronym for use
❍ P—pull the pin
• Check ABCs and activate EMS for heat stroke
❍ A
A—aim the nozzle at the base of the fire
• Cool body with wet cloths
❍ S—squeeze the trigger while keeping the extin-
• Slowly administer cool liquids if patient is alert
guisher upright
■ Hypothermia—abnormally low body temperature
❍ S—sweep the area using the nozzle and covering
• Check ABCs the fire with the extinguisher material
• Activate EMS
• Proper labeling for safety equipment such as bio-
• Remove any wet clothing hazardous waste material and eyewash stations (see
• Warm with blankets Fig. 26-2)
• Slowly administer warm liquids if patient is alert (no • Evacuation plan
alcoholic beverages) ❍ Establish and post evacuation routes
■ Frostbite—freezing of body parts; usually affects fin- ❍ Keep hallways and stairways unobstructed at all
gers, toes, ears, and nose times
• Gently wrap affected part in warm material, such as ❍ Move those closest to danger first
a blanket
❍ Initiate alarm
• Do not submerge in water or other liquid or rub ❍ Move those requiring the most assistance last
• Transport to hospital unless in immediate danger
❍ Establish area to store mobility assistive devices

<0-5-,1+)47..1+- such as wheelchairs

❍ Establish the chain of command; specifically who
Risk management in Chapter 4 is also a part of medical
is in charge
office safety such as observing for frayed electrical cords.
In addition to common hazards, the medical office is at ❍ Avoid delaying to “grab” valuables

risk for emergencies and safety hazards encompassing ❍ Designate responsibility for moving or shutting
more than a single person such as fire or chemical or down flammable substances such as oxygen unless
infectious disease exposures (refer to Chapter 17). The it places the person in danger
 +PIX\MZ ■ Emergency Preparedness 381

+A
E
D Biohazard
material
Automatic Electronic Emergency Emergency Fire Biohazard
Defibrilator Eye Wash Shower Extinguisher Material

.QO]ZM Examples of standard safety signs and symbols.

❍Designate a pre-established assembly place agreements are updated at specified intervals. Generally,
❍Designate who leaves last and assures the facility is a medical office emergency preparedness committee
empty is appointed. The committee develops and implements
an emergency preparedness plan that, at a minimum,
❍ Establish a means of accounting for all staff,
includes:
patients, and visitors
❍ Do not return until instructed by the appropriate ■ Designation of roles such as triage officer, area coordi-
emergency services personnel nators, recorders, and runners
❍ Conduct evacuation drills (frequency of drills may ■ Designation of medical office areas such as triage,
be required by local authorities; for example, some holding, and treatment
cities require evacuation in high rise buildings
■ Readiness of emergency supplies such as PPE, dress-
quarterly)
ings, splints, cots, and blankets; these should be stored
• Clearly marked and lighted exits and used only for disasters, not for general operation,
and checked on a regular basis
■ Preassembled “to go box” with pens, pads, tape, clips,
<0-+755=61<A vests or large name tags identifying staff roles, and
Health care providers often feel a responsibility to the emergency charts with specially designed emergency
community in times of disaster; the “community” may be forms (to date, these forms are hardcopy, not elec-
local, national or global. Many accrediting bodies such as tronic, and move with the patient)
The Joint Commission require emergency preparedness. ■ Staff training and drills (usually semi-annually and
This section addresses considerations for response to a coordinated by the local emergency preparedness
local disaster. The medical assistant and medical admin- agency or hospital)
istrative assistant may be involved in community emer- ■ Response call list for staff if a disaster occurs after
gency preparedness on two fronts: within the medical hours
facility and directly within the community emergency
■ Ancillary services and needs such as rapidly accessing
preparedness system.
more doses of tetanus toxoid, nearby child care for vic-
tims and staff, transport to a facility for higher level of
THE MEDICAL FACILITY RESPONSE care if needed
■ Plan evaluation mechanism
The medical facility may agree to take incoming “walk-
ing wounded” persons who have been triaged at a disas-
ter command center, have minor injuries, and are
capable of walking. This is dependent on the size and the
INDIVIDUAL COMMITMENT
affiliation of the facility such as a community health cen- Health care providers, including medical assistants and
ter or medical office adjacent to a hospital. It requires medical administrative specialists, may volunteer, as indi-
previous coordination and agreements with the local viduals, with the local emergency preparedness authority
emergency preparedness authorities and the hospital or or affiliates such as the local department of health
other facilities that provide a higher level of care. These to respond to a disaster or emergency. An example is
382 =VQ\ ■ Clinical Practice

pandemic flu requiring rapid mass immunization. For contusion (bruise) closed wound usually caused by
the individual volunteer this usually involves: blunt trauma
epistaxis nosebleed
■ Completing an application exposure control plan plan that describes personnel
■ Verification of credentials and requirements (may protective equipment (PPE) and other safety engi-
include specific immunizations and fingerprinting or neering devices and processes; it provides instructions
other clearance for working with vulnerable popula- of what an employee should do if an exposure occurs
tions) first aid the immediate care rendered in a medical emer-
gency until definitive or advanced care is available
■ Training (may be conducted online)
hemorrhage excessive bleeding that may result in
hypovolemic shock
This community involvement is not covered by the
hyperglycemia abnormally high blood glucose level
Good Samaritan Act. The volunteer should check with
hyperthermia abnormally high body temperature (e.g.,
the sponsoring agency to assure inclusion in their liabil-
heat exhaustion and heat stroke [most serious])
ity coverage.
hypoglycemia abnormally low blood glucose level
hypothermia abnormally low body temperature
laceration straight or jagged cut into the body tissue
TERMS medical emergency the occurrence of a sudden
injury or illness that requires immediate medical
Emergency Preparedness Review
intervention
The following list reviews the terms discussed in this PASS pull, aim, squeeze, sweep; acronym for using a
chapter and other important terms that you may see on fire extinguisher
the exam. poisoning the injection, respiration, or ingestion of a
ABCs (airway, breathing, circulation) primary assess- toxic substance (may be natural or chemical)
ment in emergencies to determine whether the rule of nines formula used to determine extent of the
patient’s airway is open, breathing is occurring, and body burned; each body part is considered 9% of the
blood is appropriately circulating body; the affected parts are added to determine the
abrasion open wound resulting in scraping off of skin percentage of body burned
layer(s) by trauma; may or may not produce bleeding seizure convulsion generalized series of involuntary
anaphylaxis shock caused by a severe allergic reaction muscle contractions
that results in respiratory distress and, in some shock life-threatening condition related to inadequate
instances, cardiac arrest oxygen supply and often characterized by heavy
avulsion open wound caused by forceful tearing away blood loss; lowered blood pressure; weak, increased
of skin from bony structure by trauma, sometimes pulse; cool, clammy skin; increased respiratory rate;
leaving a skin flap and causing excessive bleeding anxiety; and agitation
burns tissue damage from exposure to heat, chemicals, syncope transient unconsciousness, usually caused by a
or electricity sudden decrease in blood pressure or oxygen; also
cardiopulmonary resuscitation (CPR) a standardized called fainting or swooning
approach to providing first aid in a situation in which walking wounded persons in a disaster who have been
the victim is not breathing and the heart may have triaged at a command center of the community dis-
stopped beating aster, have minor injuries, and are capable of walking.
 : - > 1 - ?  9 = - ; < 1 7 6 ;

All questions are relevant for the CMA (AAMA), RMA (AMT), and CMAS (AMT) exam.

1. The type of shock caused by severe allergic Answer: ,

reaction is:
Why: Anaphylactic shock is an immediate type of
A. traumatic.
allergic reaction resulting from hypersensitivity to an
B. septic.
antigen. Substances may include drugs, vaccines, certain
C. cardiogenic.
foods, serum and allergen extracts, insect venom, or
D. anaphylactic.
chemical products such as latex.
Review: Yes ❏ No ❏

2. The type of soft tissue injury that is a closed wound Answer: +

occurring from blunt trauma to the body is a(n):
Why: Abrasions, avulsions, lacerations, and punctures
A. abrasion.
are all types of open wounds. A contusion is a closed
B. avulsion.
wound that appears as a bruise on the skin. Blood
C. contusion.
collects under the skin and causes the discoloration.
D. laceration.
E. puncture. Review: Yes ❏ No ❏

3. The type of fracture that is common in children and Answer: *

is a partial or incomplete break in the bone is:
Why: A greenstick fracture is named because the bone
A. comminuted.
breaks like a green branch, only bending and causing a
B. greenstick.
few of the fibers to separate. It is not an open or
C. open.
compound fracture. A spiral fracture is caused by the
D. spiral.
twisting of a bone.
Review: Yes ❏ No ❏

4. To control bleeding or hemorrhage, you should Answer: *

initially:
Why: Application of direct pressure over the wound will
A. place ice over the wound.
stop hemorrhage in most cases. Use a tourniquet as a
B. apply direct pressure.
last resort if direct pressure does not stop the bleeding
C. apply a tourniquet above the injury.
or if the wound is too large to apply direct pressure. If
D. immobilize the body part.
possible, the body part that is bleeding should be
E. place the bleeding body part lower than the
elevated higher than the victim’s heart.
victim’s heart.
Review: Yes ❏ No ❏

5. The ABCs of CPR include management of: Answer: )

A. airway, breathing, circulation.
Why: The ABCs of CPR include an assessment of the
B. assessment, breathing, compressions.
major systems of the body that can result in life-
C. alertness, bleeding, circulation.
threatening situations. First, check the airway to make
D. airway, bleeding, circulation.
sure it is open and unobstructed. Second, if the airway is
open, ensure that the victim is breathing. Third, deter-
mine that the victim’s heart is pumping and proper
circulation is taking place in the body. This is important
to deliver oxygen to the vital body organs.
Review: Yes ❏ No ❏

 
384 =VQ\ ■ Clinical Practice

6. The medical term used to describe a victim who has Answer: -

fainted is:
Why: Syncope is usually caused by a sudden fall in blood
A. epistaxis.
pressure or loss of oxygen to the brain resulting in loss
B. shock.
of consciousness.
C. anaphylaxis.
D. febrile. Review: Yes ❏ No ❏
E. syncope.

7. A stroke is also known as: Answer: *

A. CVD.
Why: The abbreviation CVA means cerebrovascular
B. CVA.
accident; this occurs when there is damage in the blood
C. CHF.
vessels in the brain blocking circulation to that part of
D. COPD.
the brain. Blockage can be caused by a thrombus (blood
clot) or embolus (any other abnormal particle). CVD
means cardiovascular disease, CHF means congestive
heart failure, and COPD means chronic obstructive pul-
monary disease.
Review: Yes ❏ No ❏

8. Another term for a heart attack is: Answer: +

A. cardiovascular disease.
Why: Myocardial infarction means the myocardium, or
B. coronary artery disease.
heart muscle, has experienced damage because of
C. myocardial infarction.
blocked arteries. The blockage is usually the result of
D. congestive heart failure.
plaque buildup in the vessels.
E. cardiogenic shock.
Review: Yes ❏ No ❏

9. The treatment of third-degree burns includes: Answer: ,

A. immersing body part in cold water.
Why: Third-degree burns are the most invasive type of
B. applying an ice pack to the affected part.
burn, involving the epidermis, the entire dermis, and
C. removing any blisters that form.
sometimes subcutaneous tissue, muscle, and bone.
D. covering the victim and notifying EMS.
Treatment includes covering the victim with a blanket to
conserve warmth and transporting for further treatment,
including management of shock.
Review: Yes ❏ No ❏

10. Treatment of a victim experiencing convulsions Answer: -

includes the following EXCEPT:
Why: Nothing should be placed in the victim’s mouth
A. placing the victim on the floor.
during seizure activity. The object may break teeth or
B. providing privacy to the victim.
obstruct the airway.
C. clearing nearby objects.
D. not restraining the victim. Review: Yes ❏ No ❏
E. placing an airway in the mouth.

11. In some cases of poisoning, it is necessary to induce Answer: *

vomiting. The agent used is:
Why: Syrup of ipecac is used to induce vomiting when
A. iodine.
the victim has ingested a poison that is noncorrosive. It is
B. ipecac.
used because of the emetic (vomit-inducing) effect it has.
C. adrenalin.
D. epinephrine. Review: Yes ❏ No ❏
 +PIX\MZ ■ Emergency Preparedness 385

12. The type of shock caused from bacterial infection is: Answer: ,
A. anaphylactic.
Why: Sepsis is a condition of something being dirty or
B. cardiogenic.
unclean. Septic shock is caused from bacteria invading
C. psychogenic.
the body and causing a systemic infection, which leads
D. septic.
to septicemia, or blood poisoning. The patient will ulti-
E. hypovolemic.
mately go into shock.
Review: Yes ❏ No ❏

13. A victim experiencing a body temperature below Answer: )

95F is:
Why: Hypothermia is an abnormally low body tempera-
A. hypothermic.
ture. The external environment can lead to
B. hyperthermic.
hypothermia. Treatment of hypothermia is internal
C. febrile.
warming of the body.
D. hypovolemic.
Review: Yes ❏ No ❏

14. Which of the following is a sign or symptom of Answer: ,

shock?
Why: Signs of shock include cool, clammy skin, low
A. Warm skin
blood pressure, increased respiratory rate, and rapid
B. Slow pulse
pulse. The skin is pale and may appear cyanotic (a blue
C. High blood pressure
or purplish coloration) because of decreased oxygen of
D. Pale skin
the blood.
E. Slow respiration
Review: Yes ❏ No ❏

15. Characteristics of a first-degree burn include: Answer: +

A. blistered skin.
Why: First-degree burns are the least serious type of
B. charred skin.
burn. Sunburn is an example of a first-degree burn. The
C. reddened skin.
skin is only reddened, with no blisters or broken skin.
D. edema of the skin.
Review: Yes ❏ No ❏

16. The type of soft tissue injury that causes a jagged Answer: -
wound that bleeds is a(n):
Why: A laceration results from tearing of tissues partly
A. abrasion.
or completely. Lacerations are frequently caused by bro-
B. contusion.
ken glass or metal objects.
C. puncture.
D. hematoma. Review: Yes ❏ No ❏
E. laceration.

17. Diabetic coma is caused by: Answer: +

A. overproduction of insulin.
Why: Diabetic coma results from a lack of insulin caus-
B. low blood glucose level.
ing high blood glucose levels, which results in severe
C. lack of insulin.
acidosis. A patient with low blood glucose could be in
D. normal glucose with high insulin level.
insulin shock, which is the opposite of diabetic coma.
Review: Yes ❏ No ❏
386 =VQ\ ■ Clinical Practice

18. To control bleeding from a laceration of the Answer: ,

palm of the hand, direct pressure should be placed
Why: To control bleeding, direct pressure should be
over the:
placed over the artery closest to the injury and between
A. subclavian artery.
the injury and the heart.
B. brachial artery.
C. medial artery. Review: Yes ❏ No ❏
D. radial artery.
E. cephalic artery.

19. To transport a victim with a compound fracture, it Answer: )

is important to:
Why: A compound fracture is a break in the bone with
A. apply a splint to the limb without repositioning
the bone protruding through broken skin. This type of
the limb.
fracture is to be managed without realigning, reposition-
B. straighten the limb and apply a splint.
ing, or moving the fractured bone. Apply a splint to the
C. wrap the extremity with an elastic bandage.
limb in the position of the fracture and seek medical
D. place the fractured bone in alignment and apply
care.
an elastic bandage.
Review: Yes ❏ No ❏

20. When applying a triangular sling to support an Answer: -

injured arm, it is important to do all the following
Why: A triangular sling is used in first aid to immobilize
EXCEPT:
an injured limb. If used to support an injured arm, the
A. tie the sling at the neck off to the side of the
sling must be applied so the hand is slightly elevated to
spine to avoid nerve injury.
encourage good circulation and avoid accumulation of
B. elevate the hand slightly to promote better
fluid in the extremity. If the hand is lower than the heart,
circulation in the hand.
edema can develop in the limb and cause further injury
C. instruct the patient how to reapply the sling if
or pain.
removed.
D. secure the sling at the elbow to better support Review: Yes ❏ No ❏
the injured limb.
E. position the hand lower than the level of the
heart to avoid accumulation of fluid in the
extremity.

21. First aid treatment for a puncture wound with a Answer: )

fixed penetrating object includes the following
Why: It is important not to remove the imbedded object
EXCEPT:
but to leave it, stabilize it, and transport the victim to an
A. removing the object if it is still imbedded in the
emergency medical facility for treatment. If the object is
body.
removed, further damage may occur to surrounding tis-
B. activating EMS.
sue. Hemorrhage may also be initiated if the object is
C. applying a sterile dressing around the puncture
removed and a blood vessel is opened.
site.
D. keeping the victim calm. Review: Yes ❏ No ❏

22. The type of wound that results from scraping off Answer: ,
layer(s) of skin is a(n):
Why: An abrasion is described as a rubbing away of a
A. bruise.
surface. An example is a skinned knee.
B. laceration.
C. avulsion. Review: Yes ❏ No ❏
D. abrasion.
E. contusion.
 +PIX\MZ ■ Emergency Preparedness 387

23. The emergency treatment for a conscious patient Answer: *

with hypoglycemia is to:
Why: If the patient is conscious, you can give sugar by
A. monitor the patient and eventually he or she will
mouth, but you should always contact the physician or
recover after the body has produced more
EMS for instructions for treatment. If a victim is uncon-
insulin.
scious, you will never give anything by mouth. If insulin
B. give the patient some form of sugar by mouth
is injected into a patient with a low blood sugar level
after you have notified and received instructions
(hypoglycemia), the blood sugar level will drop even
from the physician or EMS.
lower. If it is necessary to transport the patient, use the
C. give an insulin injection immediately.
closest emergency medical facility available, because the
D. immediately transport the victim to his or her
victim’s medical provider may be too far away.
own physician’s office for treatment.
Review: Yes ❏ No ❏

24. Which of the following is a fracture of the radius Answer: +

bone at the wrist?
Why: A compound fracture occurs when the bone is bro-
A. Compound
ken and punctures through the skin. A closed fracture is
B. Closed
a fracture of the bone without puncture of the skin. A
C. Colles
greenstick is a partial or incomplete fracture of a bone,
D. Greenstick
and a spiral fracture is caused from twisting of a bone.
E. Spiral
All of these fractures are not specific to a certain bone of
the body, but a Colles fracture always involves the radial
bone at the wrist.
Review: Yes ❏ No ❏

25. It is necessary to perform the Heimlich maneuver if: Answer: +

A. the victim is coughing.
Why: The Heimlich maneuver is performed to dislodge
B. the victim says he or she is choking.
an object that is obstructing the airway. It is performed
C. the victim is conscious but cannot speak or
when a person is conscious but cannot speak or cough. If
cough.
he or she can speak or cough, there is an airway or at
D. the victim becomes unconscious.
least a partial airway open and the object may dislodge
by itself with enough coughing. The universal sign for
choking is a person who is unable to talk or cough and is
clutching his or her throat.
Review: Yes ❏ No ❏

26. The acronym PASS for using a fire extinguisher Answer: +

means:
Why: Pull the pin, aim the extinguisher, squeeze the
A. point, assess, squeeze, and squirt.
trigger, and sweep the fire is the process for using a fire
B. pin, aim, squirt and, sweep.
extinguisher that is correct and has become a standard
C. pull, aim, squeeze, and sweep.
through common usage.
D. point, assess, squeeze, and sweep.
E. pull, assert, squirt, and stop. Review: Yes ❏ No ❏

27. Fire extinguishers should be serviced: Answer: ,

A. monthly.
Why: Annually is the recommendation from the
B. quarterly.
National Fire Protection Association unless in a “severe
C. semi-annually.
environment” such as a chemistry laboratory.
D. annually.
Review: Yes ❏ No ❏
388 =VQ\ ■ Clinical Practice

28. Exposure control plan guidelines are Answer: *

recommended by:
Why: OSHA is the Occupational Safety and Health
A. MSDS.
Administration under which safety in the workplace
B. OSHA.
falls. MSDS are material safety data sheets and provide
C. EEOC.
information related to chemicals; EEOC is the Equal
D. ADA.
Employment Opportunity Commission and addresses
E. HIPAA.
discrimination in the workplace; the Americans with
Disabilities Act (ADA) addresses equal accommodations
for people with special needs and the Healthcare Insur-
ance Portability and Accountability Act (HIPAA)
involves confidentiality in health care.
Review: Yes ❏ No ❏

29. An element of evacuation of a facility is to: Answer: )

A. evacuate those closest to danger first.
Why: To prevent the most harm you would evacuate
B. take valuables with you.
those closest to the danger first. You should not take
C. avoid using wheelchairs or other mobility
anything with you, and you would want to use mobility
devices.
devices to assist with the evacuation of persons with
D. return as often as possible to assist.
mobility limitations. You should not return to a facility
that is in the process of evacuation. You place yourself
and emergency responders in danger.
Review: Yes ❏ No ❏

30. An exposure control plan would include: Answer: -

A. fire extinguisher servicing.
Why: The exposure control plan describes personnel
B. the evacuation route.
protective equipment (PPE) and other safety engineering
C. first aid for closed fractures.
devices and processes. Recommended immunizations
D. storage of mobility devices.
will protect an employee from specific bloodborne
E. recommended immunizations.
diseases and are included in the OSHA guidelines. Fire
extinguisher servicing, mobility device storage, and an
evacuation route are safety issues that do not fall under
exposure control. First aid is not part of an exposure plan
with the exception of how employees should protect
themselves and others from the spread of pathogens.
Review: Yes ❏ No ❏
 Unit 5
Exam Preparation

 !
 Certification Exam Day Advice
27
Here are a few simple strategies to help relieve the stress ■ Eat a meal or snack that contains protein 30 to 60 min-
of exam day and increase your preparedness. Read them utes before the exam.
before taking the practice exam.

■ Do not cram or study the night before.

),>1+-.7:<)316/<0--@)5
■ Do what works for you to get a good night’s rest.
■ Read the exam instructions carefully; if you are taking
■ Know the exact location of the exam site, including the
the computerized version, know how to get back to
room (do not guess; consider a trip to the site before
answer questions you have not completed. DO NOT
exam day).
forget to submit the exam at the end.
■ Know the parking situation.
■ Guess if you do not know an answer. Neither the
■ Know the intensity of the traffic for the route and for AAMA nor the AMT penalizes for guessing.
the time of day of the exam and allow plenty of time to
■ Review the strategies for solving multiple choice ques-
get there.
tions found in Chapter 1.
■ Place your exam acceptance letter or permit, photo
identification, and other instructions where you will Best wishes and remember the words of Sara Hender-
not forget them. son, a writer and outpost manager in the Australian
■ Wear layered clothes; exam rooms may be cold or hot outback: “All the strength you need to achieve anything is
regardless of the outside temperature. within you!”

!
 Practice Exam 393
8 : ) + < 1 + -  - @ ) 5

This timed exam is your opportunity to take a practice 2. Use the answer sheet provided. You may photocopy
exam within a specific period. This will help determine the sheet so you can retake the exam.
your readiness to sit for the actual exam. Follow these 3. Do not look at the answer key until you have
instructions carefully and then proceed with the exam. completed the exam; then compare your answers with
the answer key.
1. There are 100 questions and you have 1 hour to com- 4. Choose a quiet, comfortable place to take the exam.
plete the practice exam. Set a timer or have someone Make sure others are aware that you are taking the
time the exam for you. Be honest and stop the exam practice exam so they will not interrupt you.
when the hour is completed. Unanswered questions
are counted as wrong answers.

!
394 Practice Exam

8:)+<1+--@)5x+5)))5) 7. A patient is noncompliant if he or she:

A. follows the instructions exactly as they were
1. Pathogens that thrive in the absence of oxygen are provided.
called: B. does not progress as quickly as expected to the
A. antitoxins. treatment plan.
B. anaerobes. C. refuses to follow prescribed orders.
C. spores. D. has a reaction to prescribed medication.
D. aerobes. E. asks his or her family to participate in
E. deoxygenators. the plan.
2. A communicable disease that does not have to be 8. A telephone call that the medical assistant can
reported to the county health department is: handle is:
A. tuberculosis. A. authorizing a prescription refill in the absence
B. streptococcus. of the physician.
C. rubella. B. advising a patient who is complaining of chest
D. syphilis. pain after taking new medication.
E. rabies. C. taking results from a referring physician
about a patient’s abnormal electrocardiogram
3. The term esophagogastritis means inflammation results.
of the: D. a hospital admitting clerk with the room
A. larynx and pharynx. number for a newly admitted patient.
B. stomach and small intestine. E. ordering exams for a hospitalized patient.
C. small intestine and stomach.
D. esophagus and stomach. 9. If a certain number of patients are scheduled to
E. esophagus and small intestine. come in for an appointment at the beginning of the
same clock hour, this is:
4. The structure in the body that lays over the larynx A. modified wave scheduling.
like a lid and prevents food from entering the B. wave scheduling.
trachea is the: C. block scheduling.
A. pharynx. D. group scheduling.
B. uvula. E. tidal wave scheduling.
C. epiglottis.
D. glottis. 10. When alphabetically filing, which of the following
E. esophagus. is last?
A. John A. Hall
5. Proper interaction with pediatric patients includes B. John A. Hale
the following EXCEPT: C. John A. Haley
A. allowing them to handle safe medical D. John A. Halee
equipment to see that it will not harm them. E. John A. Halley
B. using words the child will understand to
describe the procedure. 11. The salutation of a letter is placed:
C. telling a child that a procedure will not hurt at A. two lines below the inside address.
all. B. two lines below the signature line.
D. talking in the same tone and volume as you C. before the inside address.
would use with an adult. D. after the complimentary closing.
E. positioning yourself at the same level when E. before the date of the letter.
speaking to the child.
12. Medical expenses resulting from a back injury
6. A urine test that compares the weight of urine to while at work are submitted to:
that of distilled water is: A. Medicare.
A. specific gravity. B. HMO.
B. clarity. C. Workers’ compensation.
C. sedimentation rate. D. employee’s health insurance.
D. pH. E. Blue Cross/Blue Shield.
E. ketone analysis.
 Practice Exam 395
13. A ledger is also used as the patient’s: 20. The vacuum tube used to collect blood so the
A. receipt. blood will clot in the tube is:
B. charge slip. A. red.
C. statement. B. lavender.
D. posting. C. gray.
E. claim. D. green.
E. blue.
14. The book containing procedure and service codes
performed by doctors and medical personnel 21. An intravenous pyelogram is used to examine the:
is the: A. liver and gallbladder.
A. International Classification of Diseases. B. stomach and large intestine.
B. Current Procedural Terminology. C. kidneys and bladder.
C. Physician’s Desk Reference. D. colon and ileum.
D. Insurance Payment Manual. E. kidneys and pelvis.
E. AMA Journal.
22. Passive exercise means that the patient:
15. Ringworm is an example of a disease caused by: A. does not move the body part without
A. bacteria. assistance.
B. fungus. B. can move the joints freely.
C. virus. C. has full range of motion.
D. parasite. D. cannot move the joints freely.
E. yeast. E. uses weights when exercising.

16. The faint tapping sounds heard as the blood pres- 23. When nutrients are initially taken into the body, it
sure cuff initially deflates are recorded as the: is called:
A. pulse pressure. A. digestion.
B. diastolic pressure. B. ingestion.
C. rhythm pressure. C. absorption.
D. systolic pressure. D. metabolism.
E. apical pressure. E. salivation.

17. A forceps is an instrument used to: 24. The muscle used for an injection located in the
A. grasp tissue. thigh is the:
B. retract tissue. A. gluteus medius.
C. cut tissue. B. gluteus maximus.
D. suture tissue. C. rectus femoris.
E. clamp a blood vessel. D. vastus lateralis.
E. gastrocnemius.
18. The ECG lead that measures the difference in
electrical potential between the right arm and left 25. Emergency treatment for third-degree burns is:
arm is: A. immersing the body part in cold water.
A. lead II. B. applying an ice pack to the affected part.
B. lead I. C. removing any blisters that form.
C. aVR. D. covering the victim and notifying EMS.
D. aVF. E. applying an antibiotic ointment.
E. V6.
26. A patient’s implied consent usually covers:
19. Medicare Part B does not cover: A. organ donation.
A. doctor’s office visits. B. biopsy.
B. diagnostic laboratory services. C. blood transfusion.
C. hospital charges. D. appendectomy.
D. x-rays in an outpatient facility. E. electrocardiogram.
E. durable medical equipment.
396 Practice Exam

27. The medical term that means “within a vessel” is: 33. An outguide used in filing is a:
A. intercellular. A. file that is no longer in use.
B. interarterial. B. file of a patient who is not a patient in the office
C. intravascular. any longer.
D. intravalvular. C. guide to alphabetizing file.
E. intervascular. D. folder inserted in the file to hold the place of a
file in use.
28. An organ located in the left upper quadrant is the: E. tickler to remind the staff of something missing
A. thymus. from that file.
B. spleen.
C. appendix. 34. The inside address of a professional letter includes
D. liver. the:
E. gallbladder. A. address of the sending physician.
B. recipient’s address written with abbreviation to
29. Which of the following is an example of nonverbal save space.
communication? C. physician’s residence address printed at the left
A. Clarification margin.
B. Feedback D. recipient’s address written without
C. Body language abbreviations.
D. Messages E. recipient’s insurance company address.
E. E-mail
35. The person covered by a benefits plan is the:
30. A patient who is sight impaired would benefit from A. administrator.
patient educational training materials that are B. carrier.
produced as: C. employee.
A. Braille materials. D. insured.
B. videotapes. E. payer.
C. posters.
D. pamphlets. 36. The listing of charges for a medical practice
E. brochures. is the:
A. coding chart.
31. When the medical assistant is dealing with a B. customary charges.
difficult caller on the phone, he or she should C. value scale.
first: D. value unit.
A. ask the physician to handle the call. E. fee schedule.
B. forward the call to the office manager.
C. tell the caller you will hang up if he or she 37. The withholding from an employee’s paycheck for
continues to be difficult. Social Security and Medicare is required under
D. determine the problem and the appropriate which law?
staff that can help. A. FICA
E. alert another staff member to witness B. FCC
the call. C. HCFA
D. IRA
32. The abbreviation used in an appointment book to E. FUTA
indicate a patient is coming in to see the physician
about a medical problem already treated is: 38. A yeast infection that causes vaginitis is:
A. F/U. A. Candida.
B. CPX. B. staphylococci.
C. NP. C. Trichomonas.
D. BE. D. tinea.
E. NS. E. scabies.
 Practice Exam 397
39. A respiration rate that falls within the average adult 46. Diathermy is an example of an agent that incorpo-
range is: rates the use of:
A. 10 per minute. A. paraffin wax.
B. 20 per minute. B. cold water.
C. 25 per minute. C. ultraviolet light.
D. 30 per minute. D. deep heat.
E. below 10 per minute. E. hot water.

40. Proper technique to ensure package sterility 47. Which of the following conditions would benefit
includes using: from a low-purine diet?
A. a sterile package with only a small tear. A. Gout
B. sterile packages up to 30 days after the expira- B. Obesity
tion date. C. High blood pressure
C. a dry, undamaged sterile package. D. Constipation
D. sterile gloves to transport sterile packages. E. Coronary artery disease
E. a sterile pack still damp from the autoclave.
48. Antihypertensive medications are associated with
41. AC interference in an ECG tracing means: the treatment of:
A. the patient is having a muscle tremor. A. fever.
B. there is a loose electrode connection. B. vomiting.
C. there is electrical interference in the room. C. high blood pressure.
D. the electrodes are too tight on the patient. D. allergies.
E. the power to the machine is off. E. gout.

42. The clear liquid portion of whole blood is: 49. A laceration appears as a:
A. serum. A. scrape on the skin.
B. thrombin. B. bruise.
C. hemoglobin. C. jagged cut.
D. fibrinogen. D. swelling on the skin.
E. plasma. E. hematoma.

43. To convert milligrams to grams: 50. Res ipsa loquitur is a Latin term that means which of
A. divide by 100. the following?
B. divide by 1,000. A. Let the buyer beware.
C. multiply by 100. B. The thing speaks for itself.
D. multiply by 1,000. C. The employer is responsible for the
E. subtract the numerator from the denominator. employee.
D. The patient is always first.
44. Diabetic coma is due to: E. The physician is responsible.
A. overproduction of insulin.
B. low blood glucose level. 51. The medical term meaning “inflammation of the
C. lack of insulin. bone” is:
D. normal glucose with high insulin level. A. arthritis.
E. increased metabolism of glucose. B. bursitis.
C. chondritis.
45. An arthrogram is the radiographic visualization of: D. osteitis.
A. a joint. E. tendonitis.
B. a blood vessel.
C. the gallbladder.
D. the spinal column.
E. an artery.
398 Practice Exam

52. The superior vena cava is the: 58. Coordination of benefits means:
A. vein that carries blood from the lower A. the amount of money paid by the patient for
extremities to the aorta. medical services before the insurance pays.
B. artery that carries blood between the heart and B. one insurance plan will work with other
lungs. insurance plans to determine how much each
C. vein that carries blood between the heart and plan pays.
lungs. C. there is a flat fee paid for each service.
D. artery that carries blood from the aorta to the D. there is a deductible required by the patient
kidneys. before payment from the insurance is made.
E. vein that carries blood from the upper body E. each insurance company will pay an equal
back to the heart. amount of the patient’s bill.

53. Basic communication requires a message and: 59. ICD-9 codes that identify medical problems for
A. sender and receiver. reasons other than illness or injury are known as:
B. feedback and body language. A. E codes.
C. clarification and feedback. B. M codes.
D. receiver and body language. C. CPT codes.
E. a decoder. D. V codes.
E. neoplasms.
54. The term facsimile refers to:
A. fax. 60. When a bank uses the term NSF, it means that:
B. photocopy. A. the check is voided and not to be used.
C. e-mail. B. the account is a newly opened account.
D. voice mail. C. there is not enough money to cover the amount
E. Internet. of the check.
D. the bank will issue a cashier’s check in the
55. A matrix is a(n): amount of the check.
A. form of billing. E. the bank must wait 1 week before depositing
B. appointment book schedule with blocked out the check.
periods of time.
C. form used for insurance filing. 61. The proper time and temperature for sterilizing
D. timed laboratory test. instruments is:
E. document used for patient A. 30 minutes at 150F.
billing. B. 45 minutes at 250F.
C. 60 minutes at 150F.
56. The most common method used to chart the D. 30 minutes at 250F.
patient’s medical record is: E. 20 minutes at 150F.
A. CPT.
B. SOMR. 62. The Fowler’s position is used for:
C. SOAP. A. female pelvic exam.
D. HCFA. B. exam of the abdomen.
E. ICD. C. patient with difficulty breathing.
D. sigmoidoscopy.
57. The salutation of a letter is the: E. exam of the spine.
A. closing.
B. reference line. 63. The abbreviation OU is no longer in use. Instead of
C. enclosure. using OU, which of the following should be
D. greeting. written?
E. purpose for writing. A. Both eyes
B. Right ear
C. Both ears
D. Left eye
E. Optical unit
 Practice Exam 399
64. Which of the following is the finer or smaller 71. The first action to control bleeding or hemorrhage
suture? is to:
A. 2-0 A. place ice over the wound.
B. 4-0 B. apply direct pressure.
C. 0-0 C. apply a tourniquet above the injury.
D. 10-0 D. immobilize the body part.
E. 1-0 E. elevate the head.

65. The V1 ECG lead is located: 72. The term enteritis means inflammation
A. between the fourth and fifth intercostal space. of the:
B. over the left nipple. A. colon.
C. between the second and third intercostal space. B. small intestine.
D. at the fourth intercostal space to the right of C. stomach.
the sternum. D. esophagus.
E. at the fourth intercostal space to the left of the E. gallbladder.
sternum.
73. An example of active immunity is:
66. Which of the following is a proper site for a A. maternal antibodies passed through the uterus
capillary puncture? to the baby.
A. Tip of ring finger B. immunization with antibodies.
B. Heel of an adult C. maternal antibodies acquired by the baby from
C. Tip of index finger breast milk.
D. Tip of little finger D. producing antibodies as a result of having a
E. Earlobe of an infant disease.
E. avoiding an infected person.
67. The abbreviation used to indicate that a patient
should be fasting for an exam is: 74. When a person refuses to acknowledge the loss of a
A. NPO. loved one, this type of behavior is:
B. AC. A. sympathy.
C. PC. B. mourning.
D. NOS. C. denial.
E. CBC. D. depression.
E. withdrawal.
68. KUB is an x-ray examination of the:
A. heart and lungs. 75. The computer device that displays the written data
B. spinal column. is the:
C. liver and gallbladder. A. disk drive.
D. abdomen. B. monitor.
E. urinary system. C. hard drive.
D. floppy disk.
69. Cold applied to part of the body causes the effect of: E. software.
A. vasoconstriction.
B. vasodilation. 76. When the doctor is late and not yet at the office,
C. increased blood flow to the body part. the medical assistant should:
D. increased blood pressure to the area. A. offer waiting patients an opportunity to
E. muscle rigor. reschedule.
B. cancel all remaining appointments for
70. A patient with arteriosclerosis would benefit from the day.
which of the following diets? C. reschedule all the patients for another day.
A. Low salt D. offer to refer the patients to another physician’s
B. Low carbohydrate practice.
C. Low protein E. close the office and notify the answering
D. Low cholesterol service.
E. High protein
400 Practice Exam

77. The “O” in the SOAP method of charting includes 84. The ECG grounding lead is attached
the: to the:
A. blood pressure reading. A. RA.
B. opinion of a family member. B. LA.
C. symptoms the patient states. C. RL.
D. prior complaints from the patient. D. LL.
E. patient’s demographics. E. AV.

78. To retain insurance coverage, the individual must 85. A urine specimen that is collected after eating is
pay the cost of the insurance, which is the: called:
A. premium. A. clean catch.
B. copayment. B. random.
C. coinsurance. C. voided.
D. deductible. D. postprandial.
E. reimbursement. E. timed.

79. CPT is an abbreviation of the reference manual 86. A myelogram is an x-ray examination of the:
used for: A. spinal cord.
A. ordering laboratory tests. B. brain.
B. billing insurance companies for procedures. C. muscles.
C. reporting diseases to the CDC. D. heart.
D. selecting the fees for each exam. E. abdomen.
E. providing the diagnosis on a claim.
87. A physician orders amoxicillin 1 Gm to be divided
80. The best way to ensure that patients pay for into 4 equal doses. Available is amoxicillin
services is to: 250 mg/5 mL. How many milliliters will the
A. ask patients where they would like the bill patient receive for each dose?
mailed. A. 0.5 mL
B. give a copy of the bill to patients when they B. 1 mL
leave the office. C. 5 mL
C. confirm the name of the patient’s insurance D. 10 mL
company. E. 2 mL
D. accept checks only, not credit cards.
E. ask for payment of services at the time of the 88. Anaphylaxis refers to a:
office visit. A. nose bleed.
B. type of shock.
81. Acquired immunodeficiency syndrome is caused by: C. hemorrhage disorder.
A. yeast. D. congenital disorder.
B. fungi. E. heart attack.
C. bacteria.
D. a virus. 89. Dyspepsia refers to:
E. a parasite. A. difficulty speaking.
B. difficult digestion.
82. The pulse point located on the top of the foot is the: C. difficulty breathing.
A. femoral. D. abnormal pain.
B. dorsalis pedis. E. difficulty swallowing.
C. temporal.
D. popliteal. 90. The perineum is the:
E. ulnar. A. lining of the abdomen.
B. covering of the spinal cord.
83. An instrument required on a suture tray is a: C. floor of the pelvis.
A. dilator. D. outside lining of the lungs.
B. scalpel. E. lining of the heart.
C. retractor.
D. needle holder.
E. stapler remover.
 Practice Exam 401
91. Respondeat superior refers to: 96. The classification of drugs used to relieve pain is:
A. a subpoena. A. antidepressant.
B. a physician’s responsibility for the actions of his B. analgesic.
staff. C. antibiotic.
C. something for something, a favor for a favor. D. antidote.
D. responding to your superiors. E. antihypertensive.
E. the thing speaks for itself.
97. The device used to check vision is a(n):
92. The proper angle of the needle to the skin when A. otoscope.
administering a subcutaneous injection is: B. ophthalmoscope.
A. 10. C. Snellen chart.
B. 15. D. tuning fork.
C. 45. E. flashlight.
D. 75.
E. 90. 98. A wound that results from scraping the skin is a(n):
A. laceration.
93. Which of the following is not considered for use B. avulsion.
on the skin for cleansing? C. contusion.
A. Acetone D. evisceration.
B. Povidone-iodine E. abrasion.
C. Betadine
D. Alcohol 99. When several tubes of blood are to be drawn,
E. Hibiclens which is drawn first?
A. Anticoagulant tubes
94. Which of the following instruments is used to B. Blood culture tubes
evaluate lung capacity? C. Tubes with no additive
A. Audiometer D. Heparinized tubes
B. Goniometer E. EDTA tubes
C. Sphygmomanometer
D. Spirometer 100. The parenteral method of administration of
E. Doppler medication means that the drug is:
A. rubbed on the skin.
95. The process by which nutrients transfer from the B. inserted rectally.
gastrointestinal system into the blood is referred C. swallowed.
to as: D. dissolved in the mouth.
A. ingestion. E. injected.
B. digestion.
C. absorption.
D. metabolism.
E. mastication.
 )6;?-:;<78:)+<1+--@)5x+5)))5)

1. B 26. E 51. D 76. A

2. B 27. C 52. E 77. A

3. D 28. B 53. A 78. A

4. C 29. C 54. A 79. B

5. C 30. A 55. B 80. E

6. A 31. D 56. C 81. D

7. C 32. A 57. D 82. B

8. D 33. D 58. B 83. D

9. B 34. D 59. D 84. C

10. E 35. D 60. C 85. D

11. A 36. E 61. D 86. A

12. C 37. A 62. C 87. C

13. C 38. A 63. A 88. B

14. B 39. B 64. D 89. B

15. B 40. C 65. D 90. C

16. D 41. C 66. A 91. B

17. A 42. E 67. A 92. C

18. B 43. B 68. E 93. A

19. C 44. C 69. A 94. D

20. A 45. A 70. D 95. C

21. C 46. D 71. B 96. B

22. A 47. A 72. B 97. C

23. B 48. C 73. D 98. E

24. D 49. C 74. C 99. B

25. D 50. B 75. B 100. E


 Practice Exam 403

8:)+<1+--@)5x:5))5< 8. A telephone call that the medical assistant can

handle is:
1. Pathogens that thrive in the absence of oxygen are A. authorizing a prescription refill in the absence
called: of the physician.
A. antitoxins. B. advising a patient who is complaining of chest
B. anaerobes. pain after taking new medication.
C. spores. C. taking results from a referring physician
D. aerobes. about a patient’s abnormal electrocardiogram
results.
2. A communicable disease that does not have to be D. a hospital admitting clerk with the room
reported to the county health department is: number for a newly admitted patient.
A. tuberculosis.
B. streptococcus. 9. If a certain number of patients are scheduled to
C. rubella. come in for an appointment at the beginning of the
D. syphilis. same clock hour, this is:
A. modified wave scheduling.
3. The term esophagogastritis means inflammation B. wave scheduling.
of the: C. block scheduling.
A. larynx and pharynx. D. group scheduling.
B. stomach and small intestine.
C. small intestine and stomach. 10. When alphabetically filing, which of the following
D. esophagus and stomach. is last?
A. John A. Hall
4. The structure in the body that lays over the larynx B. John A. Hale
like a lid and prevents food from entering the C. John A. Halley
trachea is the: D. John A. Halee
A. pharynx.
B. uvula. 11. The salutation of a letter is placed:
C. epiglottis. A. two lines below the inside address.
D. glottis. B. two lines below the signature line.
C. before the inside address.
5. Proper interaction with pediatric patients includes D. after the complimentary closing.
the following EXCEPT:
A. allowing them to handle safe medical 12. Medical expenses resulting from a back injury
equipment to see that it will not harm them. while at work are submitted to:
B. using words the child will understand to A. Medicare.
describe the procedure. B. HMO.
C. telling a child that a procedure will not hurt C. Workers’ compensation.
at all. D. employee’s health insurance.
D. talking in the same tone and volume as you
would use with an adult. 13. A ledger is also used as the patient’s:
A. receipt.
6. A urine test that compares the weight of urine to B. charge slip.
that of distilled water is: C. statement.
A. specific gravity. D. posting.
B. clarity.
C. sedimentation rate. 14. The book containing procedure and service codes
D. pH. performed by doctors and medical personnel is the:
A. International Classification of Diseases.
7. A patient is noncompliant if he or she: B. Current Procedural Terminology.
A. follows the instructions exactly as they were C. Physician’s Desk Reference.
provided. D. Insurance Payment Manual.
B. does not progress as quickly as expected to the
treatment plan.
C. refuses to follow prescribed orders.
D. has a reaction to prescribed medication.
404 Practice Exam

15. Ringworm is an example of a disease caused by: 23. When nutrients are initially taken into the body, it
A. bacteria. is called:
B. fungus. A. digestion.
C. virus. B. ingestion.
D. parasite. C. absorption.
D. metabolism.
16. The faint tapping sounds heard as the blood
pressure cuff initially deflates are recorded as the: 24. The muscle used for an injection located in the
A. pulse pressure. thigh is the:
B. diastolic pressure. A. gluteus medius.
C. rhythm pressure. B. gluteus maximus.
D. systolic pressure. C. rectus femoris.
D. vastus lateralis.
17. A forceps is an instrument used to:
A. grasp tissue. 25. Emergency treatment for third-degree burns is:
B. retract tissue. A. immersing the body part in cold water.
C. cut tissue. B. applying an ice pack to the affected part.
D. suture tissue. C. removing any blisters that form.
D. covering the victim and notifying EMS.
18. The ECG lead that measures the difference in
electrical potential between the right arm and left 26. A patient’s implied consent usually covers:
arm is: A. organ donation.
A. lead II. B. electrocardiogram.
B. lead I. C. blood transfusion.
C. aVR. D. appendectomy.
D. aVF.
27. The medical term that means “within a vessel” is:
19. Medicare Part B does not cover: A. intercellular.
A. doctor’s office visits. B. interarterial.
B. diagnostic laboratory services. C. intravascular.
C. hospital charges. D. intravalvular.
D. x-rays in an outpatient facility.
28. An organ located in the left upper quadrant is the:
20. The vacuum tube used to collect blood so the A. thymus.
blood will clot in the tube is: B. spleen.
A. red. C. appendix.
B. lavender. D. liver.
C. gray.
D. green. 29. Which of the following is an example of nonverbal
communication?
21. An intravenous pyelogram is used to examine the: A. Clarification
A. liver and gallbladder. B. Feedback
B. stomach and large intestine. C. Body language
C. kidneys and bladder. D. Messages
D. colon and ileum.
30. A patient who is sight impaired would benefit from
22. Passive exercise means that the patient: patient educational training materials that are
A. does not move the body part without assistance. produced as:
B. can move the joints freely. A. Braille materials.
C. has full range of motion. B. videotapes.
D. cannot move the joints freely. C. posters.
D. pamphlets.
 Practice Exam 405
31. When the medical assistant is dealing with a 38. A yeast infection that causes vaginitis is:
difficult caller on the phone, he or she should first: A. Candida.
A. ask the physician to handle the call. B. staphylococci.
B. forward the call to the office manager. C. Trichomonas.
C. tell the caller you will hang up if he or she D. tinea.
continues to be difficult.
D. determine the problem and the appropriate 39. A respiration rate that falls within the average adult
staff that can help. range is:
A. 10 per minute.
32. The abbreviation used in an appointment book to B. 20 per minute.
indicate a patient is coming in to see the physician C. 25 per minute.
about a medical problem already treated is: D. 30 per minute.
A. F/U.
B. CPX. 40. Proper technique to ensure package sterility
C. NP. includes using:
D. BE. A. a sterile package with only a small tear.
B. sterile packages up to 30 days after the expira-
33. An outguide used in filing is a: tion date.
A. file that is no longer in use. C. a dry, undamaged sterile package.
B. file of a patient that is not a patient in the office D. sterile gloves to transport sterile packages.
any longer.
C. guide to alphabetizing file. 41. AC interference in an ECG tracing means:
D. folder inserted in the file to hold the place of a A. the patient is having a muscle tremor.
file in use. B. there is a loose electrode connection.
C. there is electrical interference in the room.
34. The inside address of a professional letter includes D. the electrodes are too tight on the patient.
the:
A. address of the sending physician. 42. The clear liquid portion of whole blood is:
B. recipient’s address written with abbreviation to A. serum.
save space. B. thrombin.
C. physician’s residence address printed at the left C. hemoglobin.
margin. D. plasma.
D. recipient’s address written without
abbreviations. 43. To convert milligrams to grams:
A. divide by 100.
35. The person covered by a benefits plan is the: B. divide by 1,000.
A. administrator. C. multiply by 100.
B. carrier. D. multiply by 1,000.
C. employee.
D. insured. 44. Diabetic coma is due to:
A. overproduction of insulin.
36. The listing of charges for a medical practice is the: B. low blood glucose level.
A. fee schedule. C. lack of insulin.
B. customary charges. D. normal glucose with high insulin level.
C. value scale.
D. value unit. 45. An arthrogram is the radiographic visualization of:
A. a joint.
37. The withholding from an employee’s paycheck for B. a blood vessel.
Social Security and Medicare is required under C. the gallbladder.
which law? D. the spinal column.
A. FICA
B. FCC
C. HCFA
D. IRA
406 Practice Exam

46. Diathermy is an example of an agent that incorpo- 54. The term facsimile refers to:
rates the use of: A. fax.
A. paraffin wax. B. photocopy.
B. cold water. C. e-mail.
C. ultraviolet light. D. voice mail.
D. deep heat.
55. A matrix is a(n):
47. Which of the following conditions would benefit A. form of billing.
from a low-purine diet? B. appointment book schedule with blocked out
A. Gout periods of time.
B. Obesity C. form used for insurance filing.
C. High blood pressure D. timed laboratory test.
D. Constipation
56. The most common method used to chart the
48. Antihypertensive medications are associated with patient’s medical record is:
the treatment of: A. CPT.
A. fever. B. SOMR.
B. vomiting. C. SOAP.
C. high blood pressure. D. HCFA.
D. allergies.
57. The salutation of a letter is the:
49. A laceration appears as a:
A. closing.
A. scrape on the skin.
B. reference line.
B. bruise.
C. enclosure.
C. jagged cut.
D. greeting.
D. swelling on the skin.

50. Res ipsa loquitur is a Latin term that means which of 58. Coordination of benefits means:
the following? A. the amount of money paid by the patient
A. Let the buyer beware. for medical services before the insurance
B. The thing speaks for itself. pays.
C. The employer is responsible for the employee. B. one insurance plan will work with other
D. The patient is always first. insurance plans to determine how much each
plan pays.
51. The medical term meaning “inflammation of the C. each insurance company will pay an equal
bone” is: amount of the patient’s bill.
A. arthritis. D. there is a deductible required by the patient
B. bursitis. before payment from the insurance is
C. chondritis. made.
D. osteitis.
59. ICD-9 codes that identify medical problems
52. The superior vena cava is the: for reasons other than illness or injury are
A. vein that carries blood from the lower extremi- known as:
ties to the aorta. A. E codes.
B. artery that carries blood between the heart and B. M codes.
lungs. C. CPT codes.
C. vein that carries blood from the upper body D. V codes.
back to the heart.
D. vein that carries blood between the heart and 60. When a bank uses the term NSF, it means that:
lungs. A. the check is voided and not to be used.
B. the account is a newly opened account.
53. Basic communication requires a message and: C. there is not enough money to cover the amount
A. sender and receiver. of the check.
B. feedback and body language. D. the bank will issue a cashier’s check in the
C. clarification and feedback. amount of the check.
D. receiver and body language.
 Practice Exam 407
61. The proper time and temperature for sterilizing 69. Cold applied to part of the body causes the effect of:
instruments is: A. vasoconstriction.
A. 30 minutes at 150F. B. vasodilation.
B. 45 minutes at 250F. C. increased blood flow to the body part.
C. 60 minutes at 150F. D. increased blood pressure to the area.
D. 30 minutes at 250F.
70. A patient with arteriosclerosis would benefit from
62. The Fowler’s position is used for: which of the following diets?
A. female pelvic exam. A. Low salt
B. exam of the abdomen. B. Low carbohydrate
C. patient with difficulty breathing. C. Low protein
D. sigmoidoscopy. D. Low cholesterol

63. The abbreviation OU is no longer in use. Instead 71. The first action to control bleeding or hemorrhage
of using OU, which of the following should be is to:
written? A. place ice over the wound.
A. Both eyes B. apply direct pressure.
B. Right ear C. apply a tourniquet above the injury.
C. Both ears D. immobilize the body part.
D. Left eye
72. The term enteritis means inflammation of the:
64. Which of the following is the finer or smaller A. colon.
suture? B. small intestine.
A. 2-0 C. stomach.
B. 4-0 D. esophagus.
C. 0-0
D. 10-0 73. An example of active immunity is:
A. maternal antibodies passed through the uterus
65. The V1 ECG lead is located: to the baby.
A. between the fourth and fifth intercostal space. B. immunization with antibodies.
B. at the fourth intercostal space to the left of the C. maternal antibodies acquired by the baby from
sternum. breast milk.
C. between the second and third intercostal space. D. producing antibodies as a result of having a disease.
D. at the fourth intercostal space to the right of
the sternum. 74. When a person refuses to acknowledge the loss of a
loved one, this type of behavior is:
66. Which of the following is a proper site for a A. sympathy.
capillary puncture? B. mourning.
A. Tip of ring finger C. denial.
B. Heel of an adult D. depression.
C. Tip of index finger
D. Tip of little finger 75. The computer device that displays the written data
is the:
67. The abbreviation used to indicate that a patient A. disk drive.
should be fasting for an exam is: B. monitor.
A. NPO. C. hard drive.
B. AC. D. floppy disk.
C. PC.
D. NOS. 76. When the doctor is late and not yet at the office,
the medical assistant should:
68. KUB is an x-ray examination of the: A. offer waiting patients an opportunity to
A. urinary system. reschedule.
B. spinal column. B. cancel all remaining appointments for the day.
C. liver and gallbladder. C. reschedule all the patients for another day.
D. abdomen. D. offer to refer the patients to another physician’s
practice.
408 Practice Exam

77. The “O” in the SOAP method of charting includes 85. A urine specimen that is collected after eating is
the: called:
A. blood pressure reading. A. clean catch.
B. opinion of a family member. B. random.
C. symptoms the patient states. C. voided.
D. prior complaints from the patient. D. postprandial.

78. To retain insurance coverage, the individual must 86. A myelogram is an x-ray examination of the:
pay the cost of the insurance, which is the: A. spinal cord.
A. premium. B. brain.
B. copayment. C. muscles.
C. coinsurance. D. heart.
D. deductible.
87. A physician orders amoxicillin 1 Gm to be divided
79. CPT is an abbreviation of the reference manual into 4 equal doses. Available is amoxicillin 250 mg/
used for: 5 mL. How many milliliters will the patient receive
A. ordering laboratory tests. for each dose?
B. billing insurance companies for procedures. A. 0.5 mL
C. reporting diseases to the CDC. B. 1 mL
D. selecting the fees for each exam. C. 5 mL
D. 10 mL
80. The best way to ensure that patients pay for
services is to: 88. Anaphylaxis refers to a:
A. ask patients where they would like the bill A. nose bleed.
mailed. B. type of shock.
B. ask for payment of services at the time of the C. hemorrhage disorder.
office visit. D. congenital disorder.
C. confirm the name of the patient’s insurance
company. 89. Dyspepsia refers to:
D. accept checks only, not credit cards. A. difficulty speaking.
B. difficult digestion.
81. Acquired immunodeficiency syndrome is caused by: C. difficulty breathing.
A. yeast. D. abnormal pain.
B. fungi.
C. bacteria. 90. The perineum is the:
D. a virus. A. lining of the abdomen.
B. covering of the spinal cord.
82. The pulse point located on the top of the foot is the: C. floor of the pelvis.
A. femoral. D. outside lining of the lungs.
B. dorsalis pedis.
C. temporal. 91. Respondeat superior refers to:
D. popliteal. A. a subpoena.
B. a physician’s responsibility for the actions of his
83. An instrument required on a suture tray is a: staff.
A. dilator. C. something for something, a favor for a favor.
B. scalpel. D. responding to your superiors.
C. retractor.
D. needle holder. 92. The proper angle of the needle to the skin when
administering a subcutaneous injection is:
84. The ECG grounding lead is attached to the: A. 10.
A. RA. B. 15.
B. LA. C. 45.
C. RL. D. 75.
D. LL.
 Practice Exam 409
93. Which of the following is not considered for use 97. The device used to check vision is a(n):
on the skin for cleansing? A. otoscope.
A. Acetone B. ophthalmoscope.
B. Povidone-iodine C. Snellen chart.
C. Betadine D. tuning fork.
D. Alcohol
98. A wound that results from scraping the skin is a(n):
94. Which of the following instruments is used to A. laceration.
evaluate lung capacity? B. avulsion.
A. Audiometer C. contusion.
B. Goniometer D. abrasion.
C. Sphygmomanometer
D. Spirometer 99. When several tubes of blood are to be drawn,
which is drawn first?
95. The process by which nutrients transfer from the A. Anticoagulant tubes
gastrointestinal system into the blood is referred to B. Blood culture tubes
as: C. Tubes with no additive
A. ingestion. D. Heparinized tubes
B. digestion.
C. absorption. 100. The parenteral method of administration of
D. metabolism. medication means that the drug is:
A. rubbed on the skin.
96. The classification of drugs used to relieve pain is: B. inserted rectally.
A. antidepressant. C. swallowed.
B. analgesic. D. injected.
C. antibiotic.
D. antidote.
 )6;?-:;<78:)+<1+--@)5x:5))5<

1. B 26. B 51. D 76. A

2. B 27. C 52. C 77. A

3. D 28. B 53. A 78. A

4. C 29. C 54. A 79. B

5. C 30. A 55. B 80. B

6. A 31. D 56. C 81. D

7. C 32. A 57. D 82. B

8. D 33. D 58. B 83. D

9. B 34. D 59. D 84. C

10. C 35. D 60. C 85. D

11. A 36. A 61. D 86. A

12. C 37. A 62. C 87. C

13. C 38. A 63. A 88. B

14. B 39. B 64. D 89. B

15. B 40. C 65. D 90. C

16. D 41. C 66. A 91. B

17. A 42. D 67. A 92. C

18. B 43. B 68. A 93. A

19. C 44. C 69. A 94. D

20. A 45. A 70. D 95. C

21. C 46. D 71. B 96. B

22. A 47. A 72. B 97. C

23. B 48. C 73. D 98. D

24. D 49. C 74. C 99. B

25. D 50. B 75. B 100. D


 Practice Exam 411

8:)+<1+--@)5x+5);)5< 8. A telephone call that the medical assistant can

handle is:
1. Pathogens that thrive in the absence of oxygen are A. authorizing a prescription refill in the absence
called: of the physician.
A. antitoxins. B. advising a patient who is complaining of chest
B. anaerobes. pain after taking new medication.
C. spores. C. taking results from a referring physician about
D. aerobes. a patient’s abnormal electrocardiogram results.
D. a hospital admitting clerk with the room
2. A communicable disease that does not have to be number for a newly admitted patient.
reported to the county health department is:
A. tuberculosis. 9. If a certain number of patients are scheduled to
B. streptococcus. come in for an appointment at the beginning of the
C. rubella. same clock hour, this is:
D. syphilis. A. modified wave scheduling.
B. wave scheduling.
3. The term esophagogastritis means inflammation C. block scheduling.
of the: D. group scheduling.
A. larynx and pharynx.
B. stomach and small intestine. 10. When alphabetically filing, which of the following
C. small intestine and stomach. is last?
D. esophagus and stomach. A. John A. Hall
B. John A. Hale
4. The structure in the body that lays over the larynx C. John A. Halley
like a lid and prevents food from entering the D. John A. Halee
trachea is the:
A. pharynx. 11. The salutation of a letter is placed:
B. uvula. A. two lines below the inside address.
C. epiglottis. B. two lines below the signature line.
D. glottis. C. before the inside address.
D. after the complimentary closing.
5. Proper interaction with pediatric patients includes
the following EXCEPT: 12. Medical expenses resulting from a back injury
A. allowing them to handle safe medical while at work are submitted to:
equipment to see that it will not harm them. A. Medicare.
B. using words the child will understand to B. HMO.
describe the procedure. C Workers’ compensation.
C. telling a child that a procedure will not hurt at D. employee’s health insurance.
all.
D. talking in the same tone and volume as you 13. A ledger is also used as the patient’s:
would use with an adult. A. receipt.
B. charge slip.
6. A urine test that compares the weight of urine to C. statement.
that of distilled water is: D. posting.
A. specific gravity.
B. clarity. 14. The book containing procedure and service codes
C. sedimentation rate. performed by doctors and medical personnel is the:
D. pH. A. International Classification of Diseases.
B. Current Procedural Terminology.
7. A patient is noncompliant if he or she: C. Physician’s Desk Reference.
A. follows the instructions exactly as they were D. Insurance Payment Manual.
provided.
B. does not progress as quickly as expected to the
treatment plan.
C. refuses to follow prescribed orders.
D. has a reaction to prescribed medication.
412 Practice Exam

15. Ringworm is an example of a disease caused by: 24. The term that demonstrates how each rank is
A. bacteria. accountable to those directly superior is called:
B. fungus. A. the agenda.
C. virus. B. autocratic management style.
D. parasite. C. participatory management.
D. the chain of command.
16. The faint tapping sounds heard as the blood
pressure cuff initially deflates are recorded as the: 25. Emergency treatment for third-degree burns is:
A. pulse pressure. A. immersing the body part in cold water.
B. diastolic pressure. B. applying an ice pack to the affected part.
C. rhythm pressure. C. removing any blisters that form.
D. systolic pressure. D. covering the victim and notifying EMS.

17. A forceps is an instrument used to: 26. A patient’s implied consent usually covers:
A. grasp tissue. A. organ donation.
B. retract tissue. B. electrocardiogram.
C. cut tissue. C. blood transfusion.
D. suture tissue. D. appendectomy.

18. An evacuation plan requires: 27. The medical term that means “within a vessel” is:
A. keeping hallways unobstructed at all times. A. intercellular.
B. maintaining MSDS. B. interarterial.
C. using a fire extinguisher. C. intravascular.
D. returning to the building to help others. D. intravalvular.

19. Medicare Part B does not cover: 28. An organ located in the left upper quadrant is the:
A. doctor’s office visits. A. thymus.
B. diagnostic laboratory services. B. spleen.
C. hospital charges. C. appendix.
D. x-rays in an outpatient facility. D. liver.
20. PASS is an acronym for: 29. Which of the following is an example of nonverbal
A. using a fire extinguisher. communication?
B. keeping hallways unobstructed at all times. A. Clarification
C. maintaining MSDS. B. Feedback
D. returning to the building during an evacuation C. Body language
to help others. D. Messages
21. An intravenous pyelogram is used to examine the:
30. A patient who is sight impaired would benefit from
A. liver and gallbladder.
patient educational training materials that are
B. stomach and large intestine.
produced as:
C. kidneys and bladder.
A. Braille materials.
D. colon and ileum.
B. videotapes.
22. Passive exercise means that the patient: C. posters.
A. does not move the body part without D. pamphlets.
assistance.
B. can move the joints freely. 31. When the medical assistant is dealing with a
C. has full range of motion. difficult caller on the phone, he or she should first:
D. cannot move the joints freely. A. ask the physician to handle the call.
B. forward the call to the office manager.
23. When nutrients are initially taken into the body, it C. tell the caller you will hang up if he or she
is called: continues to be difficult.
A. digestion. D. determine the problem and the appropriate
B. ingestion. staff that can help.
C. absorption.
D. metabolism.
 Practice Exam 413
32. The abbreviation used in an appointment book to 39. A respiration rate that falls within the average adult
indicate a patient is coming in to see the physician range is:
about a medical problem already treated is: A. 10 per minute.
A. F/U. B. 20 per minute.
B. CPX. C. 25 per minute.
C. NP. D. 30 per minute.
D. BE.
40. A plan that describes personnel protective
33. An outguide used in filing is a: equipment (PPE) and other safety engineering
A. file that is no longer in use. devices and processes and provides instructions of
B. file of a patient that is not a patient in the office what an employee should do if a related incident
any longer. occurs is called:
C. guide to alphabetizing file. A. risk management.
D. folder inserted in the file to hold the place of a B. quality assurance.
file in use. C. exposure control.
D. aseptic technique.
34. The inside address of a professional letter includes
the: 41. The schedule of travel and events with arrival and
A. address of the sending physician. departure times and other specifics such as contact
B. recipient’s address written with abbreviation to numbers is called a(n):
save space. A. agenda.
C. physician’s residence address printed at the left B. budget.
margin. C. itinerary.
D. recipient’s address written without D. conference.
abbreviations.
42. The first aid for frostbite is to:
35. The person covered by a benefits plan is the: A. vigorously rub the affected body part.
A. administrator. B. immerse the affected body part in water.
B. carrier. C. gently wrap the affected body part in warm
C. employee. material.
D. insured. D. instruct the person to move around to increase
circulation.
36. The listing of charges for a medical practice is the:
A. fee schedule. 43. Facilities management includes all the following
B. customary charges. EXCEPT:
C. value scale. A. hiring and firing disposable waste contractors.
D. value unit. B. negotiating contracts with insurance
companies.
37. The withholding from an employee’s paycheck for C. maintaining carpeting, elevators, and other
Social Security and Medicare is required under structures.
which law? D. complying with the Americans with Disabilities
A. FICA Act.
B. FCC
C. HCFA 44. Diabetic coma is due to:
D. IRA A. overproduction of insulin.
B. low blood glucose level.
38. A yeast infection that causes vaginitis is: C. lack of insulin.
A. Candida. D. normal glucose with high insulin level.
B. staphylococci.
C. Trichomonas. 45. An arthrogram is the radiographic visualization of:
D. tinea. A. a joint.
B. a blood vessel.
C. the gallbladder.
D. the spinal column.
414 Practice Exam

46. Diathermy is an example of an agent that incorpo- 53. Basic communication requires a message and:
rates the use of: A. sender and receiver.
A. paraffin wax. B. feedback and body language.
B. cold water. C. clarification and feedback.
C. ultraviolet light. D. receiver and body language.
D. deep heat.
54. The term facsimile refers to:
47. Which of the following conditions would benefit A. fax.
from a low-purine diet? B. photocopy.
A. Gout C. e-mail.
B. Obesity D. voice mail.
C. High blood pressure
D. Constipation 55. A matrix is a(n):
A. form of billing.
48. Antihypertensive medications are associated with B. appointment book schedule with blocked out
the treatment of: periods of time.
A. fever. C. form used for insurance filing.
B. vomiting. D. timed laboratory test.
C. high blood pressure.
D. allergies. 56. The most common method used to chart the
patient’s medical record is:
49. A laceration appears as a: A. CPT.
A. scrape on the skin. B. SOMR.
B. bruise. C. SOAP.
C. jagged cut. D. HCFA.
D. swelling on the skin.
57. The salutation of a letter is the:
50. Res ipsa loquitur is a Latin term that means which of A. closing.
the following? B. reference line.
A. Let the buyer beware. C. enclosure.
B. The thing speaks for itself. D. greeting.
C. The employer is responsible for the employee.
D. The patient is always first. 58. Coordination of benefits means:
A. the amount of money paid by the patient for
51. The medical term meaning “inflammation of the medical services before the insurance pays.
bone” is: B. one insurance plan will work with other insur-
A. arthritis. ance plans to determine how much each plan
B. bursitis. pays.
C. chondritis. C. each insurance company will pay an equal
D. osteitis. amount of the patient’s bill.
D. there is a deductible required by the patient
52. The superior vena cava is the: before payment from the insurance is made.
A. vein that carries blood from the lower extremi-
ties to the aorta. 59. ICD-9 codes that identify medical problems for
B. artery that carries blood between the heart and reasons other than illness or injury are known as:
lungs. A. E codes.
C. vein that carries blood from the upper body B. M codes.
back to the heart. C. CPT codes.
D. vein that carries blood between the heart and D. V codes.
lungs.
 Practice Exam 415
60. When a bank uses the term NSF, it means that: 68. KUB is an x-ray examination of the:
A. the check is voided and not to be used. A. urinary system.
B. the account is a newly opened account. B. spinal column.
C. there is not enough money to cover the amount C. liver and gallbladder.
of the check. D. abdomen.
D. the bank will issue a cashier’s check in the
amount of the check. 69. Another term for participatory management is:
A. democratic management.
61. Supplies that are stored and maintained for emer- B. autocratic management.
gencies in the medical office are: C. laissez faire management.
A. available for daily use. D. bureaucratic management.
B. used and replaced on a routine basis.
C. often kept off site to better utilize space. 70. A patient with arteriosclerosis would benefit from
D. unintended for routine use. which of the following diets?
A. Low salt
62. The Fowler’s position is used for: B. Low carbohydrate
A. female pelvic exam. C. Low protein
B. exam of the abdomen. D. Low cholesterol
C. patient with difficulty breathing.
D. sigmoidoscopy. 71. The first action to control bleeding or hemorrhage
is to:
63. The abbreviation OU is no longer in use. Instead A. place ice over the wound.
of using OU, which of the following should be B. apply direct pressure.
written? C. apply a tourniquet above the injury.
A. Both eyes D. immobilize the body part.
B. Right ear
C. Both ears 72. The term enteritis means inflammation of the:
D. Left eye A. colon.
B. small intestine.
64. A fire extinguisher should be serviced at least: C. stomach.
A. daily. D. esophagus.
B. monthly.
C. every 6 months. 73. An example of active immunity is:
D. annually. A. maternal antibodies passed through the uterus
to the baby.
65. The role of the practice manager generally B. immunization with antibodies.
includes all the following EXCEPT: C. maternal antibodies acquired by the baby from
A. negotiating insurance contracts. breast milk.
B. evaluating personnel. D. producing antibodies as a result of having a
C. reviewing policies and procedures. disease.
D. developing treatment protocols.
74. When the person refuses to acknowledge the loss
66. An exposure control plan should be reviewed at of a loved one, the type of behavior is:
least: A. sympathy.
A. annually. B. mourning.
B. monthly. C. denial.
C. every 6 months. D. depression.
D. quarterly.
75. The computer device that displays the written data
67. The abbreviation used to indicate that a patient is the:
should be fasting for an exam is: A. disk drive.
A. NPO. B. monitor.
B. AC. C. hard drive.
C. PC. D. floppy disk.
D. NOS.
416 Practice Exam

76. When the doctor is late and not yet at the office, 83. Ensuring a system is in place to review and report
the medical assistant should: results of all diagnostic tests is an example of:
A. offer waiting patients an opportunity to A. exposure control.
reschedule. B. incident reporting.
B. cancel all remaining appointments for the day. C. facility management.
C. reschedule all the patients for another day. D. risk management.
D. offer to refer the patients to another physician’s
practice. 84. Another term for an occurrence report is a(n):
A. subpoena.
77. The “O” in the SOAP method of charting includes B. civil suit.
the: C. torte.
A. blood pressure reading. D. incident report.
B. opinion of a family member.
C. symptoms the patient states. 85. When the physician improperly terminates his or
D. prior complaints from the patient. her contract with the patient, this is called:
A. patient abandonment.
78. To retain insurance coverage, the individual must B. breach of confidentiality.
pay the cost of the insurance, which is the: C. noncompliance.
A. premium. D. reciprocity.
B. copayment.
C. coinsurance. 86. A myelogram is an x-ray examination of the:
D. deductible. A. spinal cord.
B. brain.
79. CPT is an abbreviation of the reference manual C. muscles.
used for: D. heart.
A. ordering laboratory tests.
B. billing insurance companies for procedures. 87. The term used when an outside entity examines
C. reporting diseases to the CDC. the practice’s medical records to ensure accuracy,
D. selecting the fees for each exam. completeness, and sequence of the documents is:
A. medical records management.
80. The best way to ensure that patients pay for B. accreditation.
services is to: C. audit.
A. ask patients where they would like the bill D. aging analysis.
mailed.
B. ask for payment of services at the time of the 88. Anaphylaxis refers to a:
office visit. A. nose bleed.
C. confirm the name of the patient’s insurance B. type of shock.
company. C. hemorrhage disorder.
D. accept checks only, not credit cards. D. congenital disorder.

81. Acquired immunodeficiency syndrome is caused by: 89. Dyspepsia refers to:
A. yeast. A. difficulty speaking.
B. fungi. B. difficult digestion.
C. bacteria. C. difficulty breathing.
D. a virus. D. abnormal pain.

82. The pulse point located on the top of the foot is the: 90. The perineum is the:
A. femoral. A. lining of the abdomen.
B. dorsalis pedis. B. covering of the spinal cord.
C. temporal. C. floor of the pelvis.
D. popliteal. D. outside lining of the lungs.
 Practice Exam 417
91. Respondeat superior refers to: 96. The classification of drugs used to relieve pain is:
A. a subpoena. A. antidepressant.
B. a physician’s responsibility for the actions of his B. analgesic.
staff. C. antibiotic.
C. something for something, a favor for a favor. D. antidote.
D. responding to your superiors.
97. The device used to check vision is a(n):
92. Management of the electronic health record does A. otoscope.
not require: B. ophthalmoscope.
A. archiving. C. Snellen chart.
B. retrieving. D. tuning fork.
C. conditioning.
D. security. 98. A wound that results from scraping the skin is a(n):
A. laceration.
93. The medical record provides all the following B. avulsion.
EXCEPT a: C. contusion.
A. resource for public education. D. abrasion.
B. legal document.
C. tool for quality monitoring. 99. In the medical office, the electronic medical record
D. method for continuity of care. will decrease the need for:
A. security.
94. The telecommunications device for the deaf is B. transcription.
what type of communication? C. a release of information form.
A. Closed D. staff.
B. Body language
C. Verbal 100. Retention of medical records for minors is
D. Nonverbal generally:
A. 7–10 years.
95. The process by which nutrients transfer from the B. 7–10 years after reaching 18 years old.
gastrointestinal system into the blood is referred to C. 7–10 years after becoming an emancipated
as: minor.
A. ingestion. D. 7–10 years after the age of majority.
B. digestion.
C. absorption.
D. metabolism.
)6;?-:;<78:)+<1+--@)5x+5);)5<

1. B 26. B 51. D 76. A

2. B 27. C 52. C 77. A

3. D 28. B 53. A 78. A

4. C 29. C 54. A 79. B

5. C 30. A 55. B 80. B

6. A 31. D 56. C 81. D

7. C 32. A 57. D 82. B

8. D 33. D 58. B 83. D

9. B 34. D 59. D 84. D

10. C 35. D 60. C 85. A

11. A 36. A 61. D 86. A

12. C 37. A 62. C 87. C

13. C 38. A 63. A 88. B

14. B 39. B 64. D 89. B

15. B 40. C 65. D 90. C

16. D 41. C 66. A 91. B

17. A 42. C 67. A 92. C

18. A 43. B 68. A 93. A

19. C 44. C 69. A 94. C

20. A 45. A 70. D 95. C

21. C 46. D 71. B 96. B

22. A 47. A 72. B 97. C

23. C 48. C 73. D 98. D

24. D 49. C 74. C 99. B

25. D 50. B 75. B 100. D


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C ❍
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E

22. ❍
A ❍
B ❍
C ❍
D ❍
E 47. ❍
A ❍
B ❍
C ❍
D ❍
E 72. ❍
A ❍
B ❍
C ❍
D ❍
E 97. ❍
A ❍
B ❍
C ❍
D ❍
E

23. ❍
A ❍
B ❍
C ❍
D ❍
E 48. ❍
A ❍
B ❍
C ❍
D ❍
E 73. ❍
A ❍
B ❍
C ❍
D ❍
E 98. ❍
A ❍
B ❍
C ❍
D ❍
E

24. ❍
A ❍
B ❍
C ❍
D ❍
E 49. ❍
A ❍
B ❍
C ❍
D ❍
E 74. ❍
A ❍
B ❍
C ❍
D ❍
E 99. ❍
A ❍
B ❍
C ❍
D ❍
E

25. ❍
A ❍
B ❍
C ❍
D ❍
E 50. ❍
A ❍
B ❍
C ❍
D ❍
E 75. ❍
A ❍
B ❍
C ❍
D ❍
E 100 . ❍
A ❍
B ❍
C ❍
D ❍
E

!
 1 6 , - @

Note: Page numbers followed by b, f and t indicate boxed text, figures and tables respectively

A American Diabetes Association. See ADA PPE, 269

American Medical Association. See AMA standard or universal precautions,
AAMA (American Association of Medical American Medical Technologists. See AMT 269
Assistants), 3, 4, 6, 42b Americans with Disabilities Act. See ADA sterilization, 269
ab-, 62 AMT (American Medical Technologists), surgical handwashing, 269
Abdominal cavity, 81, 81f 1 3, 4, 6 purposes of, 268
ABHES (Accrediting Bureau of Health AMT Standards of Practice, 43b review questions for, 271–275
Education Programs), 4, 40 Amyotrophic lateral sclerosis. See ALS review terms for, 270
ABN (Advanced Beneficiary Notice of Anabolism, 81 types of
Noncoverage), 218 Anaphase, 83 medical, 268
Abrasion, 295 Anaphylactic shock, 378 surgical, 269
Acceptance, 148 Anatomic descriptors, 82b Asthma, 104, 378–379
Accessories, for computer, 172 abdominal quadrants and regions, 81, 82f2 Asystole, 308
Accessory digestive organs, 106 body directions and planes, 80, 81f
1 AT (atrial tachycardia), 308
Accounts, 243–244 Anemia, 101 Atrial arrhythmias, 308
functions, 243 Aneroid sphygmomanometer, 279 Atrial diastole (relaxation), 100
payable, 244 Aneurysm, 101 Atrial fibrillation, 308
receivable, 244 Anger, 148 Atrial flutter, 308
Accreditation, 40 Angina pectoris, 101 Atrial systole (contraction), 99
Accrediting Bureau of Health Education Angiogram, 308 Atrial tachycardia. See AT
Schools. See ABHES Angiography, 332, 334 Atrophy, 91
Acquired immunodeficiency syndrome. Anterior pituitary gland, 96 Attention, 169
See AIDS Anthropometry, 278 Audiometry, 281
Acromegaly, 96 Antibody, 103 Auscultation, 282
Active files, 196 Antigen, 103 Autocratic manager, 254
Active transport, 83 Antiseptics, 269 Automated routing unit. See ARU
Activities of daily living. See ADL Aponeurosis, 89 Axial skeleton
ADA (American Diabetes Association), 159 Appendages, 85 cranium, 86, 88f 8
ADA (Americans with Disabilities Act), 40 Appendicular skeleton, 87–88 facial, 86, 88f
8
Addison’s disease, 97 lower extremities, 88 thorax, 86
ADL (activities of daily living), 341 pelvic girdle, 87 vertebral column, 86, 88f 8
Administration shoulder girdle, 87
drug routes, 362 upper extremities, 87
drug schedules, 362t Appointment book, 185 B
drug types, 361–362, 363t Appointment cards, 186 Bandages, 295
medical drug uses, 361 Appointment scheduling, 183 Bank statements, 245
safety relating to, 364 appointment reminders, 186 Banking, 244–245
seven rights of drug administration, equipment and materials, 185 bank statements, 245
363–364 legal issues, 186 checks, 244–245
syringes relating to, 363 patient flow analysis, 186 deposits, 245
Administrative law, 37, 39 patient preparation, 185–186 Line of Credit, 245
Adolescent procedure, 185 reconciliation, 245
development stage, 144t procedures outside of practice, 186 Bankruptcy, 244
patients, 147 review questions for, 188–194 Bargaining, 148
Adult, development stage, 144t review terms for, 187 Barium enema, 332, 334
Advance directives, 39 types of, 183–185, 184b Barium swallow, 332, 334
Advanced Beneficiary Notice of Arrhythmias, 101 Basal cell carcinoma, 85
Noncoverage. See ABN Arteries, 98, 98f
8 Bell’s palsy, 93
Affective domain, 158 Arteriosclerosis, 101 Bigeminy, 308
Age Discrimination in Employment Act, 40 Arthritis, 88–89 Binocular, 321
Aging analysis, 244 Arthrography, 332, 334 Bioethics, 42
AIDS (acquired immunodeficiency Artifacts, 308, 309f9 Biopsies, 319, 322
syndrome), 102 ARU (automated routing unit), 174 Blog, 172
-algesia, 62 Asepsis, 267 Blood, 98, 101. See also Venous blood
ALS (amyotrophic lateral sclerosis), 93 common methods of collection reminders
Alzheimer’s disease, 93 antiseptics, 269 Blood circulation, 100f0
AMA (American Medical Association), 41, 159 disinfectants, 269 Blood components, 319
principles of medical ethics, 42b medical handwashing, 269 Blood tests, 318t
American Association of Medical Assistants. other safety materials and actions, Blood vessels, 98, 98f,
8 99f,
9 101
See AAMA 269 Bloodborne pathogen, 267–268


422 Index

Body Cardiac conduction, 100–101, 101f 1 Ceruminous glands, 85

basic processes of Cardiac cycle, 99–100, 99f 9f 303–304 CEUs (continuing education units), 5
fluid balance, 82 Cardiac muscle, 84 Chain of infection, 268, 268f 8
homeostasis, 83 Cardiac polarity, 303 CHAMPUS. See TRICARE
metabolism, 81 Cardiac tests, 308 CHAMPVA (Civilian Health and Medical
cavities of Cardiogenic shock, 378 Program of the Veterans
abdominal, 81, 81f 1 Cardiopulmonary resuscitation (CPR), 44 Administration), 219
cranial, 80, 81f
1 Cardiovascular system, 80, 97 Charge slip, 244
pelvic, 81, 81f
1 cardiac conduction of, 100–101, 101f 1 Checks, 244–245
spinal, 80, 81f
1 cardiac cycle of, 99–100, 99f 9 Chest (precordial) leads, 305
thoracic, 81, 81f1 common diseases and disorders Chest electrodes, 304
composition of in blood, 101 Chest x-ray. See CXR
cells, 83, 83f
3 in blood vessels, 101 Choking, 379
membranes, 84 in heart, 101–102 Cholangiography, 332, 334
tissues, 84 components of Cholecystography, 332, 334
planes of blood, 98 Chronic obstructive pulmonary disease.
coronal or frontal plane, 61, 81f1 blood vessels, 98, 98f8f 99
9f See COPD
median or midline, 60, 81f 1 heart, 98–99, 99f9 Chronic progressive neurologic disease, 93
sagittal, 61, 81f
1 functions of, 98 Cilia, 83
transverse or horizontal, 61, 81f1 Cartilage, 86 Civil laws, 37
systems of Catabolism, 81 Civil Rights Act of 1964, 40
cardiovacular, 80, 97–102, 98f,8 99f,
9 CD (compact disc), 172, 172f 2 Claims submission types, 234
100f,
0 101f1 CDC (Centers for Disease Control and CLIA (Clinical Laboratory Improvement
digestive, 80, 105–107, 105f 5 Prevention), 159, 318 Amendments), 39, 318
endocrine, 80, 95–97, 96f,6 97t CDC growth chart, 280f 0 CLIA-waived tests, 318, 319
integumentary, 80, 84–85, 84f 4 Cell division Clinical chemistry, 317, 322
lymphatic, 80, 102–103 interphase, 83 Clinical Laboratory Improvement
muscular, 80, 89–91, 90f
0 mitosis, 83 Amendments. See CLIA
nervous, 91–93, 92f 2 Cell membrane, 83 Closed files, 196
reproductive, 80, 108–111, 109f, 9 Cells, 83, 83f
3 Closure materials, 294–295
110f
0 Cellular components of blood, 98 Clustering, 183
respiratory, 80, 103–105, 104f 4 Cellular energy, 83 CMA (AAMA), 4, 8, 30t
sensory, 80, 93–95, 94f,
4 95f 5 Cellular movement, of substances CMAS (AMT), 31t
skeletal, 80, 85–89, 87f,
7 88f,8 89f9 with cellular energy, 83 CMAS (Certified Medical Administrative
urinary, 80, 107–108, 108f 8 without cellular energy, 83 Specialist), 5, 10–11
Body mass index, 279 Cellular telephones, 174 CMS (Centers for Medicare and Medicaid
Body ordering, 79–80, 80f 0 CELSA (Combined English Language Skills Services), 196, 318
Body temperature, 278 Assessments), 7 CMS 1500, 234
Bone, 86 Centers for Disease Control and Prevention CNS (Central nervous system), 91
Bone x-ray, 332 growth chart. See CDC growth Code of ethics, 41, 42b
BP (blood pressure), 278–279 chart Cognitive domain, 158
Bradycardia, 308 Centers for Disease Control and Prevention. Collection agency, 244
Brain, 91–92, 92f2 See CDC Combat pathogens, biochemical agents to,
Browser, 172 Centers for Medicare and Medicaid 268
Budget and overall finances, 256 Services. See CMS Combined English Language Skills
Buffer zone, 185 Central nervous system. See CNS Assessments. See CELSA
Bureaucratic manager, 254 Central processing unit. See CPU Commercial insurance, 218
Burns, 85 Centriole, 83 Commission on Accreditation of Allied
rule of nines, 377, 377f7 Cerebral palsy, 93 Health Education Programs.
Cerebrospinal fluid. See CSF See CAAHEP
Cerebrovascular accident. See CVA Common assistive devices, 343–344
C Certification, 40 Communication, 255. See also Telephone
CAAHEP (Commission on Accreditation of Certification exam day advice, 391 techniques and other technologies
Allied Health Education Certification process, 3 barriers, 144–145
Programs), 4, 40 maintaining, 5 death and dying stages relating to, 148
CAD (coronary artery disease), 101 national medical assisting exams defense mechanisms relating to, 145
Cane, 343 CMA (AAMA), 4 enhancement of, 146–147
Capillaries, 98 national medical administrative goals of, 143
Capillary puncture specialist exam, 5 health care implications relating to,
for phenylketonuria, 320 RMA (AMT), 4–5 145–146
for thyroid hormones, 320 strategies, 5 Maslow’s ’ hierarchy relating to, 147, 147
7f
techniques, 320 ELL, 7 process of, 143, 144f4
Capitation, 219 multiple choice exams, 6–7 review questions for, 149–155
Carbohydrates, 351 study groups, 7–8 review terms for, 148
Carcinoma, of skin, 85 studying, 6 special needs and strategies for, 146–147
Cardiac arrhythmias, 306–308 Certified Medical Administrative Specialist. staff, 255–256
Cardiac catheterization, 308 See CMAS stages of development, 143–144, 144t
 Index 423
TDD, 146b Cranial cavity, 80, 81f
1 Direct multiple incoming calls, 170
therapeutic, 145–146 Cranial nerves, 92, 92b Dirty claims, 234
types of, 144 Cranium, 86, 88f8 Disinfectants, 269
Community Creditors, 39 Disk drive, 172
individual commitment, 381–382 Cretinism, 96 Dispensing, 364
medical facility response, 381 Criminal laws, 31 Displacement, 145
Compact disc. See CD Crutches, 343 Disposable thermometer, 278
Compensation, 145 Cryosurgery, 294 Document files, 172
Computed tomography. See CT CSF (Cerebrospinal fluid), 91 Domains, of learning, 158
Computer appointment scheduling, 185 CT (computed tomography), 332, 334 Double booking, 184, 184b
Computers Curette, 292 Draping, 292
components of, 171f 1 Cushing’s syndrome, 97 Dressings, 295
accessories, 172 Cutaneous membrane, 84 DRG (diagnostic-related groups), 219
hardware, 171–172 CVA (cerebrovascular accident), 93, 378 Drug Enforcement Agency. See DEA
and confidentiality, 173 CXR (chest x-ray), 332 Drug routes, 362
file formats for, 172 Cytology, 317, 322 Drug schedules, 362t
HIPAA relating to, 171, 173f3 Cytoplasm, 83 Drug types, 361–362, 363t
in medical office, common applications, Duty, 32b, 41
173 DVD (digital video disc), 172
networks, 172 D Dwarfism, 96
other common terms, 172–173 Daily log, 185
as technologic devices, 171–173 Damages, 32b E
Conducive environment, for patient Day sheet, 244 Ear, 95, 95f
5
education, 158 DEA (Drug Enforcement Agency), 39, 361 common diseases and disorders of, 95b
Confidentiality, 43–44 Deaf, telecommunication device for, 146 ECG (electrocardiogram), 303
communication in health care, 143 Death and dying, 42 artifacts, 308, 309f
9
computers and, 173 stages of, communication relating to, 148 cardiac arrhythmias, 306–308
telephones relating to, 171 Decoding, 143 cardiac tests, 308
Congenital heart disease, 102 Defense mechanisms, communication complex, 304
Congenital or developmental disorders, 88 relating to, 145 electrodes, placement, and leads, 304–306
Congestive heart failure, 102 Dementia, 93 normal sinus rhythm (NSR), 306
Connective tissue, 84 Democratic manager, 254 overview, 303–304
Connective tissue membranes, 84 Denial, 145, 148 review questions, 311–315
Consentors, 39 Deposits, 245 review terms for, 309–310
Consents, 38 Depression, 148 stylus, 306
expressed, 38 Dereliction, 32b types of, 304
implied, 38 Dermis, 84 ECG leads, 305
informed, 38 Diabetes mellitus, 97 ECG paper, 305
for medical treatment, 39 Diabetic coma, 378 Echocardiogram, 308
Continuing education units. See CEUs Diabetic emergencies, 378, 378b Ectopic beat, 308
Contract law, 37, 38–39 diabetic coma, 378 ED (emergency department), 44
Contusion, 295 insulin shock, 378 Edema, 108
Convulsion. See Seizure Diagnostic medical coding, 232 Educational plan, for patient education, 159
COPD (chronic obstructive pulmonary ICD-9, 232–233 EEOA (Equal Employment Opportunity
disease), 104 ICD coding, general steps for, 233 Act), 39
Coronal plane, 61, 81f1 purpose, 232 EEOC (Equal Employment Opportunity
Coronary artery disease. See CAD Diagnostic-related groups. See DRG Commission)
Corporate-owned medical practice, Dialysis, 108 EER (estimated energy requirement), 353
organizational chart of, 254f
4 Dietary guidelines, 353 Ejaculatory duct, 109
Correspondence, 207 food groups in order of largest to Electrocardiogram. See ECG
letters, 208 smallest, 354 Electrodes, placement of, 304
mail, 208–209 therapeutic diets, 354 Electronic medical record. See EMR
materials, 207 USDA recommendations, 354 Electronic social network, 172
memorandums, 209 Difficult callers, managing, 170 Electronic sphygmomanometer, 279
review questions, 211–215 Diffusion, 83 Electronic thermometer, 278
review terms for, 209 Digestive system, 80, 105, 105f
5 Electrosurgery, 294
transcription, 209 common diseases and disorders of, ELL (English Language Learners), 7
Courtesy, 169 106–107 E-mail, 146b, 174
Covered account, 39 components of Emancipated minor, 39
Covered entity, 235 accessory digestive organs, 106 Emergencies, 184
Cowper’s gland, 109 digestive tract, 105–106 deal with, 170
CPT coding, 229, 230–231 functions of, 105 Emergency department. See ED
general steps for, 230 terms for, 106 Emergency medical system. See EMS
HCPCS Level II sections, 231 Digital camera, 174 Emergency preparedness
modifier, 230–231 Digital video disc. See DVD common
sections, 230 Dilator, 292 burns, 377, 377f7
CPU (central processing unit), 171 Direct cause, 32b CVA, 378
424 Index

Emergency preparedness (Continued) d Ethnic considerations, nutrition relating to, Food and Drug Administration. See FDA
diabetic emergencies, 378, 378b 354 Forceps, 292
extreme temperature, 380 Eustachian tube, 95 Formal communication, 144
injuries, 379–380 Exercise, 342–343 “Four Ds”, 38b
MI, 378 Exposure control plan, 380 Fractures, 89, 89f
9f 379–380
poisoning, 380 Extracellular fluid, 82 Frontal plane, 61
respiratory, 378–379 Extreme temperature emergencies, 380 Frostbite, 380
seizures, 379 Extremity avoidance, peripheral intravenous FUTA (Federal Unemployment Tax Act),
shock, 377–378 therapy relating to, 366–367 245
syncope, 379 Eye, 94, 94f
4
community common diseases and disorders of, 94b G
individual commitment, 381–382
F Gait or transfer belt, 343
medical facility response, 381
Ganglia, 93
EMS, 376 Facial, 86, 88f
8
Gastroesophageal reflux disease. See GERD
equipment and supplies relating to, 376 expression, 169
Genetics, 42
medical assistant and medical Facsimile machine (fax), 174
GERD (gastroesophageal reflux disease),
administrative roles in, 376 Fainting. See Syncope
106
medical office, 380–381, 381f 1 Family Medical Leave Act. See FMLA
Geriatric patients, 147
recognition of Fascia membranes, 84
Gestures, 144
primary assessment and treatment Fats, 351–352
Giantism, 96
priorities, 377 Fax. See Facsimile machine
GIF (Graphics Interchange Format), 172
scene management, 376 FDA (Food and Drug Administration), 39,
Globulins, 103
secondary assessment, if indicated, 361
Glomerular filtration, 108
377 Federal income tax, 245
Glomerulonephritis, 108
signs of, 376 Federal Insurance and Contribution Act.
Glue, 295
review questions for, 383–388 See FICA
Goiter, 96
review terms for, 382 Federal Unemployment Tax Act. See FUTA
Goniometry, 341
-emia, 62 Feedback, 146
Good Samaritan Act, 38, 381
Employment Law, 40 Female reproductive systems. See
Graphics Interchange Format. See GIF
EMR (electronic medical record), 43 Reproductive systems
Graves’ disease, 96
EMS (emergency medical system), 376 Fiber, 352
Gross income, 245
Encephalitis, 93 FICA (Federal Insurance and Contribution
Encoding, 143 Act), 245
Endocardium, 98 File formats, for computer, 172 H
Endocrine system, 80, 95–96 Filing systems, 196 Hair, 85
common diseases and disorders Filtration, 83 removal, 292
in anterior pituitary gland, 96 Financial practices, 243 Handwashing
in pancreas, 97 accounts, 243–244 medical, 269
in parathyroid gland, 96 functions, 243 surgical, 269
in pineal gland, 96 payable, 244 Hard drive, 171
in thyroid gland, 96 receivable, 244 Hardware, 171–172
functions of, 96 banking, 244–245 HCFA (Health Care Finance
glands of, 96–97, 96f6 bank statements, 245 Administration). See CMS
hormones, and select functions, checks, 244–245 HCPCS Level II codes, 231
97t deposits, 245 HCPCS Level II sections, 231
Endoscope, 294 Line of Credit, 245 HCPCS Level III codes, 231–232
Energy nutrients, 351–352, 352t reconciliation, 245 HDL (High-density lipoprotein), 352
English Language Learners. See ELL common taxes, 245 Healing, 295
Enunciation, 169 federal income tax, 245 Health and safety, 257
Enuresis, 108 Federal Insurance and Contribution Health Insurance Portability and
Environment conducive, to learning, 158 Act (FICA), 245 Accountability Act. See HIPAA
Epicardium, 98 Federal Unemployment Tax Act Health maintenance organization. See HMO
Epidermis, 84 (FUTA), 245 Hearing (auditory sense), 95, 95f
5
Epididymis, 109 income, 245 Hearing-impaired patients, 146
Epilepsy, 93 gross income, 245 Heart, 98–99, 99f,
9 101–102. See also Cardio
Epithelial membranes, 84 net income, 245 vascular system
Epithelial tissue, 84 review questions, 247–252 chambers of, 98
Equal Employment Opportunity Act. review terms for, 246 endocardium, 98
See EEOA First aid, 375 epicardium, 98
Equal Employment Opportunity Flagella, 83 great vessels of, 99
Commission. See EEOC Flash drive/thumbdrive. See USB (universal myocardium, 98
Equal Pay Act, 40 serial bus) drive pericardium, 98
Equipment Flexible hours, 185 pulmonary veins, 99
and supplies, in medical office, 376 Floppy disks, 172 valves, 98–99
Escherichia coli, 267 Fluid balance, 82 Height, 279
Estimated energy requirement. See EER FMLA (Family Medical Leave Act), 40 Hematology, 317, 322
Ethics, 41 Fomites, 268, 270 Hemophilia, 101
 Index 425
Herpes zoster, 93 Injuries, 379 Laceration, 295
High-density lipoprotein. See HDL fracture, 378–379 Laissez-faire manager, 254
HIPAA (Health Insurance Portability and wounds, 379 LAN (local area network), 172
Accountability Act), 43–44, 234 Inner ear, 95 Laryngeal mirror, 283f 3
and covered entities, 235 Inpatient scheduling, 186 Laser surgery, 294
telephone techniques and other Instrumentation, 292 Law, 37
technologies, 171, 173f
3 common instruments, 292–294 administrative, 37, 39
Histology, 84, 317, 322 common surgical tray instruments, 294 certification, registration, and
HMO (health maintenance organization), endoscope, 294 accreditation, 40
217 Insulin-dependent diabetes mellitus. See civil, 37
Hodgkin’s disease, 102 IDDM contract, 37, 38–39
Holter monitor, 308 Insulin shock, 378 criminal, 31
Homeostasis, 83 Integumentary system, 80 employment, 40
Horizontal plane, 61 common diseases and disorders of the, Good Samaritan Act, 38
Hormone replacement therapy. See HRT 85b purposes of, 37
HRT (hormone replacement therapy), 361 burns, 85 tort, 37, 38
HTML (Hyper Text Markup Language), carcinoma, 85 LDL (Low-density lipoprotein), 352
172 components of Lead, 304
HTTP (Hyper Text Transfer Protocol), 172 appendages, 85 Learning, domains of, 158
Human resources, 256–257 skin, 84–85 Ledger, 244
Human skeleton, 87f7 functions of, 84 Legal and business functions, 256
Hydrocephalus, 93 Internal Revenue Service. See IRS budget and overall finances, 256
Hydronephrosis, 108 Interphase, 83 scheduling and travel, 256
Hydrotherapy, 342 Interpretive ECG, 304 Letters, 208
Hyper Text Markup Language. See HTML Interview process, 277 Leukemia, 101
Hyper Text Transfer Protocol. See HTTP Intracellular fluid, 82 Licensure, 40
Hypertension, 102 Intravenous pyelography. See IVP Ligaments, 86
Hyperthermia, 380 Introjection, 145 Ligature, 295
Hyperthyroidism, 96 IRS (Internal Revenue Service), 39 Limb electrodes, 304
Hypertonic solution, 82 Ishihara color vision test, 279 Limb leads, 305
Hyperventilation, 379 Isotonic solution, 82 Line of Credit, 245
Hypospadias, 108 IVP (intravenous pyelography) Localized versus generalized infections
Hypothermia, 380 -logy, 62
Hypothyroidism, 96 Low-density lipoprotein. See LDL
J
Hypotonic solution, 82 Lower extremities, 88
Hypovolemic shock, 377 JCAHO (Joint Commission on Lower respiratory tract, 104
Accreditation of Healthcare Lymphatic system, 80, 102
Organizations), 3, 40, 157 common diseases and disorders of, 102
I Joint Commission on the Accreditation of components of, 102
ICD-9 (International Classification of Healthcare Organizations. See functions of, 102
Diseases, Ninth Revision, Clinical JCAHO immunity relating to, 102–103, 103b
Modifications), 232–233 JPEG (Joint Photographic Experts Group), Lymphoma, 102
ICD-10-CM (International Classification of 172 -lysis, 62
Diseases, Tenth Revision, Clinical Joints, 86, 86b
Modifications), 233–234 The Joint Commission. See TJC M
ICD coding, general steps for, 233 Journal, 244 Magnetic resonance imaging. See MRI
IDDM (insulin-dependent diabetes Mail, 208–209
mellitus), 97 K Major medical insurance, 218
Incontinence, 108 Keyboard, 171 -malacia, 62
Immobilization, 343 Kidney, ureter, and bladder. See KUB Male reproductive systems. See Reproductive
Immunity, 102 Kidneys, 107, 108f
8 systems
types of, 103b Korotkoff sounds, 279 Malfeasance, 38
Immunization (vaccination), 103 KUB (kidney, ureter, and bladder), 332, 334 Malpractice, 38
Immunology, 317 Kübler-Ross, Elizabeth, 148 Mammography, 332, 334
Impedance audiometry, 281 Management styles, 254
Inactive files, 196 Mandatory reporting, 40–41
Incident report, 44 L Manipulation, 282, 343
Incision, 295 Laboratory procedures Maslow, Abraham, 147
Income, 245 CLIA, 318–319 Maslow’s hierarchy, 147, 147f
7
gross income, 245 divisions of, 317, 318t Material Safety Data Sheets. See MSDS
net income, 245 microscope, 321–322, 321f 1f 322t Materials, 207
Indemnity, 217–218 reviews questions for, 324–329 and information, for patient education,
Individual commitment, 381–382 reviews terms for, 322–323 158–159
Individual medical record, 197–198 specimen examination, preparation for, Median plane, 60
Infant/toddler, development stage, 144t 320–321 Medicaid, 218
Inflection, 169 specimens collected in medical office, Medical administrative roles in emergencies,
Informal communication, 144 319–320, 319b, 319f9f 320b 376
426 Index

Medical asepsis, 268 retention, 197 common surgical tray instruments,

Medical assistant review questions, 200–206 294
role in emergencies, 376 review terms for, 199 endoscope, 294
Medical assistant responsibility, to avoid Medical terminology, 59 preparation, 291–292
drug abuse, 365 review aids for review questions, 297–301
Medical assisting and administrative body planes, 60–61 review terms for, 296
specialist calls, 170 diagnostic, symptomatic, and related wounds, 295
Medical coding and claims, 229 suffixes, 61 Misfeasance, 38
claims, 234–235 directional terms, 61 Mitosis, 83
diagnostic coding, 232 locating terms, 61 Mobility testing, 341
ICD-9, 232–233 prefixes, 60b Modalities
ICD coding, general steps for, 233 roots, 61b physical. See Physical modalities
purpose, 232 suffixes, 60b and teaching aids, for patient education,
HIPAA and covered entities, 235 surgical procedures, 61–62 158
ICD-10-CM, 233–234 terms, 62–63 Modem, 172
procedural coding, 229 word parts, 59–60 Modified wave scheduling, 184,
CPT coding, 230–231 Medical transcription and equipment, 184b
HCPCS Level II codes, 231 173–174 Monitor, 172
HCPCS Level III codes, 231–232 Medicare, 218 Mononucleosis, 102
review questions, 222–228 Medicare Supplement Insurance. Monthly trial balance, 244
review terms for, 220–221 See Medigap Motherboard, 171
Medical drug uses, 361 Medication dosage calculations, 364, 364t, Mouse, 172
Medical facility response, 381 365b, 366b, 368 MRI (magnetic resonance imaging), 332,
Medical handwashing, 269 Medigap, 218 334
Medical imaging Melanoma, 85 MSDS (Material Safety Data Sheets),
patient preparation, 333–334 Membranes 269
radiation safety, 332–333 in body composition, 84 Mucous membranes, 84
radiology, patient positioning for, 332, 333f
3 connective tissue, 84 Multidisciplinary approach, to patient
review terms for, 334–335 cutaneous, 84 education, 159
reviews questions for, 336–340 epithelial, 84 Multiple choice exams, 6–7
types of, 331–332 fascia, 84 Multiple sclerosis, 93
Medical insurance, 217 mucous, 84 Muscle tissue, 84
common types of, 217 parietal, 84 types of, 89
HMO, 217 pericardium, 84 Muscle traits, 89
indemnity, 217–218 perichondrium, 84 Muscles, 89
major medical, 218 periosteum, 84 Muscular dystrophy, 91
PPO, 218 serous, 84 Muscular system, 80, 89
electronic health care claims, 220 synovial, 84 body mechanics of, 89
payment methods for, 219 visceral, 84 common diseases and disorders of
RBRVS, 219 Memorandums, 209 atrophy, 91
capitation, 219 Memory stick. See USB (universal serial bus) muscular dystrophy, 91
DRG, 219 drive myasthenia gravis, 91
fee schedule, 219 Meninges, 84, 91 sprain, 91
preauthorization/precertification, 219 Mensuration, 282 strain, 91
UCR, 219 Mercury sphygmomanometer, 279 tendonitis, 91
review questions, 222–228 Mercury thermometer, 278 components of, 90f 0
review terms for, 220–221 Metabolism, 81 aponeurosis, 89
sources of, 218–219 Metaphase, 83 muscles, 89
CHAMPVA, 219 MI (Myocardial infarction), 102, 378 synapses, 89
commercial, 218 Microbiology, 317, 322 tendons, 89
Medicaid, 218 Microorganisms functions of, 89
Medicare, 218 chain of infection, 268, 268f
8 Myasthenia gravis, 91
Medigap, 218 combat pathogens, biochemical agents Myc/o, 62
TRICARE, 218–219 to, 268 Myelography, y 332, 334
workers’ compensation, 219 common pathogens, 267–268 Myocardial infarction. See MI
Medical office, 380–381, 381f 1 localized versus generalized infections, Myocardium, 98
computers in, 173 268 Myxedema, 96
Medical office calls, 169–170 portals of entry, 268
Medical Practice Act, 40 Microscope, 321–322, 321f 1f 322t N
Medical records, 195 Middle ear, 95 Nails, 85
destruction, 197 Midline plane, 60 Narcolepsy, 93
documentation guidelines for, Midstream urine, 320 Nasal cavity, 95
198–199 Minerals, 353 Nasal specula, 283f
3
hard-copy supplies, 196 Minor surgical procedures, 291 National Committee on Quality Assurance.
individual, 197–198 closure materials, 294–295 See NCQA
management of, 195–197 instrumentation, 292 National medical assisting exams
release of, 198b common instruments, 292–294 CMA (AAMA), 4
 Index 427
national medical administrative specialist O -pepsis, 62
exam, 5 Peri-, 62
Occupational Safety and Health
RMA (AMT), 4–5 Percussion, 282
Administration. See OSHA
NCQA (National Committee on Quality Pericardium, 98
Occurrence report, 44
Assurance), 4, 157 Peripheral intravenous therapy, 365
Open/closed communication, 144
Needle, 295 complications, 365–366
Open hours scheduling, 183
Needle holder, 294 extremity avoidance relating to, 366–367
Ophthalmoscope, 283f 3
Negligence, 38 indications, 365
Ophthalmoscopy (funduscopy) exam, 279
Neoplasms, 89, 93 Peripheral nervous system. See PNS
Organizational model, 253–254
Nephrolithiasis, 108 PERRLA (pupils equal, round, reactive to
Orthostatic pressure, 279
Nerve tissue, 84 light and accommodation), 279
OSHA (Occupational Safety and Health
Nerves, 91 Personal digital assistant. See PDA
Administration), 39, 44, 268
Nervous system, 80, 91 Personal protective equipment. See PPE
Osmosis, 83
common diseases and disorders of PPE (personal protective equipment),
Otoscope, 283f
3
in brain and cranial nerves, 93 269
Outer ear, 95
in brain or spinal cord, 93 PET (positron emission tomography), 332
Outpatient scheduling, 186
in spinal cord and nerves, 93 PFT (pulmonary function test), 282
components of Phag/o, 62
brain, 91–92, 92f
2 P Phagocytosis, 83
cranial nerves, 92, 92b PAC (premature atrial contraction), 308 Pharmacology and medication
CSF, 91 Pagers, 174 administration
ganglia, 93 Painting, 292 common drug routes, 362
meninges, 91 Palpation, 282 common drug types, 361–362, 363t
nerves, 91 Pancreas, 97 dosage calculations, 364, 364t, 365b,
neuroglia, 91 Paralysis, 93 366b, 368
neurons, 91 Parathyroid gland, 96 medical drug uses, 361
neurotransmitters, 91 Parietal membranes, 84 peripheral intravenous therapy, 365–367
spinal cord, 92 Parkinson’s disease, 93 prescriptions, 364–365, 367b
spinal nerves, 92–93 PAT (paroxysmal atrial tachycardia), 308 review questions for, 369–373
synapses, 91 Patient education review terms for, 367–368
functions of, 91 considerations for safety, 364
organization of conducive environment, 158 seven rights of drug administration,
CNS, 91 domains of learning, 158 363–364
PNS, 91 internal and external factors, 158 syringes, 363
Net income, 245 materials and information, 158–159 Phenylketonuria. See PKU
Networks, computer, 172 teaching aids and modalities, 158 Phlebotomy, 319, 322
Neuritis, 93 educational plan for, 159 -phonia, 62
Neurogenic shock, 378 multidisciplinary approach to, 159 Physical facility, 257
Neuroglia, 91 other considerations, 159 Physical medicine, 341
Neurons, 91 plan, 159 Physical modalities
Neurotransmitters, 91 purpose of, 157 body mechanics, 344
NIDDM (non-insulin-dependent diabetes), review questions for, 161–166 mobility testing, 341
97 review terms for, 159–160 review questions for, 345–349
Nonenergy nutrients, 352–353, 353t topics for, 157–158 review terms for, 344
Non–English-speaking/limited English- Patient exams, 277 therapies, 342–344
speaking patients, 146–147 common assessment measurements, 278 Physician/office delay, 184
Nonfeasance, 38 height, 279 Physician-owned medical practice,
Non-Hodgkin’s lymphoma, 102 vision, 279–281 organizational chart of, 254f
4
Non-insulin-dependent diabetes. See vital signs, 278–279 Pineal gland, 96
NIDDM weight, 279 PKU (phenylketonuria), 41
Nonverbal communication, 144 interview, 277 Plasma, 98
Normal sinus rhythm. See NSR physical exam preparation, 282 PNS (peripheral nervous system), 91
NSR (normal sinus rhythm), 306 review questions, 286–290 Poisoning, 380
Nuclear medicine, 332, 334 review terms for, 283–285 Poliomyelitis, 93
Nuclear membrane, 83 Patient ledger, 244 Polycystic kidney disease, 108
Nucleolus, 83 Patient’s Bill of Rights, 41 POMR (problem-oriented medical record),
Nucleus, 83 Payee, 244 198–199
Nutrients Payer, 245 Portable data format (PDF), 172
energy, 351–352, 352t PDA (personal digital assistant), 174 Portals of entry, 268
nonenergy, 352–353, 353t Peak flow meter, 282 Positron emission tomography. See PET
Nutrition Pediatric growth chart, 279 PPE (personal protective equipment), 292,
dietary guidelines, 353–354 Pediatric patients, 147 380
ethnic considerations, 354 Pegboard system, 244 PPO (preferred provider organization), 218
nutrients, 351–353, 352t, 353t Pegboard system, 244f 4 Practice exam, 393–418
review questions for, 356–360 Pelvic cavity, 81, 81f
1 Practice management, 253
review terms for, 354–355 Pelvic girdle, 87 communication, 255
steps of, 351 Penis, 109 staff, 255–256
428 Index

Practice management (Continued) d RBRVS (resource-based relative value Scanner, 174

health and safety, 257 system/scale), 219 Scene management of emergencies, in
human resources, 256–257 Recall notices, 186 medical office, 376
legal and business functions, 256 Reconciliation, 245 Scheduling and travel, 256
budget and overall finances, 256 Record message, 170 School Age, development stage, 144t
scheduling and travel, 256 Red Flags Rule, 39 Sciatica, 93
management styles, 254 Referrals, 184 Scintography (scintiphotography), 332
organization, 253–254 Registration, 40 Scissors, 294
physical facility, 257 Regression, 145 Scope of practice, 40
review questions, 260–264 Rehabilitative medicine, 341 Scrotum, 109
review terms for, 258–259 Reminder mailings, 186 Screen calls, 170
Preferred provider organization. Renal failure, 108 Search engine, 172
See PPO Repeat appointments, 184 Seasonal affective disorder. See SAD
Prejudice, 145 Repression, 145 Sebaceous glands, 85
Premature atrial contraction. See PAC Reproduction, 42 Secondary assessment, if indicated, for
Preschooler, development stage, 144t Reproductive systems, 80, 108 medical emergencies, 377
Prescriptions, 364–365, 367b female, 110f0 Seizures, 379
abbreviations used for, 364, 367b common diseases and disorders of, Select scheduling, 184
medical assistant responsibility to avoid 111 Seminal vesicles, 109
drug abuse, 365 components of, 110 Sensory system, 80
Pretest, 13–30 functions of, 110 general senses of, 93
analysis, 30–31 terms for, 110 special senses of
Preventive health, 341 male, 109f
9 hearing (auditory sense), 95, 95f
5
Primary assessment and treatment priorities, common diseases and disorders of, smell (olfactory sense), 95
of emergencies, 377 108 taste (gustatory), 95
Probe, 294 components of, 108 vision (sight), 93–94, 94f
4
Problem-oriented medical record. functions of, 108 Septic shock, 378
See POMR terms for, 108 Serous membranes, 84
Procedural medical coding, 229 Res ipsa loquitur, 38 Seven rights of drug administration,
CPT coding, 230–231 Resource allocation, 42 363–364
HCPCS Level II codes, 231 Resource-based relative value system/scale. Sexually transmitted diseases. See STDs
HCPCS Level III codes, 231–232 See RBRVS Shock
Professional communication. See Respiration, 278 anaphylactic, 378
Communication Respiratory arrest, 378 cardiogenic, 378
Projection, 145 Respiratory center, 103 hypovolemic, 377
Pronunciation, 169 Respiratory emergencies, 378–379 insulin, 378
Prophase, 83 Respiratory system, 80, 103, 104f 4 neurogenic, 378
Prostate gland, 109 common diseases and disorders of, septic, 378
Protective practices. See Emergency 104–105 Shoulder girdle, 87
preparedness components of Sight-impaired patients, 146
Proteins, 351 lower respiratory tract, 104 Signs of emergencies, in medical office, 376
Psychomotor domain, 158 respiratory center, 103 Single-lead ECG, 304
Public duty, 40–41 upper respiratory tract, 103–104 Skeletal muscle, 84
Pulmonary function test. See PFT functions of, 103 Skeletal system, 80, 85
Pulmonary veins, 99 Respondeat superior, 38 common diseases and disorders of
Pulse, 278 Retractors, 294 arthritis, 88–89
Pulse oximetry, 282 Retrograde pyelography, 332, 335 congenital or developmental disor-
Pulse pressure, 279 Rheumatic heart disease, 102 ders, 88
Puncture, 295 Rich text file (RTF), 172 fractures, 89, 89f
9
Pupils equal, round, reactive to light and Risk factors, 44 neoplasms, 89
accommodation. See PERRLA Risk management, 44 components of
Pyelonephritis, 108 RMA (AMT), 4–5, 9, 30t bone, 86
Roentgenogram, 331 cartilage, 86
Q ROM (Range of motion), 341, 343 joints, 86
Route calls, 170 ligaments, 86
QI (quality improvement), 44
-rrhagia, 63 functions of, 86
Quality assurance, 44
-rrhexis, 63 organization of, 87f7
Quality improvement. See QI
Rule of nines, 377, 377f7 appendicular skeleton, 87–88
axial skeleton, 86, 88f
8
R Skin, 84–85, 84f4
Radiation safety, 332–333 S Skin cleansing, 292
Radiation therapy, 332 SAD (Seasonal affective disorder), 96 Small claims court, 244
Radiograph, 331 Safety, 44 Smell (olfactory sense), 95
Radiology, 331 medication relating to, 364 Smooth muscle, 84
RAM (random access memory), 171 Sagittal plane, 61, 81f
1 Snellen chart method, 279
Range of motion. See ROM Sales representatives scheduling, 185 Snellen eye chart, 281f 1
Rationalization, 145 Scalpels, 294 SOAP documentation, 199
 Index 429
Software, 172 Telecommunication device for deaf. Tongue, 95
SOMR (source-oriented medical record), See TDD Tonometer, 279
198 Telemetry, 304 Tonsils, 102
Sound, 294 Telephone calls, 186 Tort law, 37, 38
Source-oriented medical record. See SOMR Telephone techniques and other Towel clamps (clips), 294
Special needs and strategies, for technologies Traction, 343
communication, 146–147 review questions for, 176–182 Transcription, 209
Speed, 169 review terms for, 174–175 and equipment, medical, 173–174
Sphygmomanometer, 279, 283f 3 technologic devices Transient ischemic attack. See TIA
Spinal cavity, 80, 81f
1 ARU, 174 Transplants, 42
Spinal cord, 92 cellular telephones, 174 Transverse plane, 61, 81f
1
Spinal nerves, 92–93 computers, 171–173. See also Trauma, 93
Spirometry, 282 Computers TRICARE, 218–219
Splenomegaly, 102 digital camera, 174 Tubular reabsorption, 108
Sports medicine, 341 E-mail, 174 Tuning fork, 281, 283f
3
Sprain, 91 fax, 174 12-lead (multichannel) ECG, 304, 305f
5
Spreadsheet, 172 medical transcription and equipment, Two-eyepiece, 321
Squamous cell carcinoma, 85 173–174 Tympanic thermometer, 278
Staff communication, 255–256 pagers, 174 Tympanometry, 281
Staff meeting agenda, 255f5 PDA, 174
Stages of death and dying, 148 scanner, 174 U
Standardization mark, 305 telephones, 169
UCR (usual, customary, and reasonable),
Staples, 295 confidentiality relating to, 171
219
Startle, 281 medical assisting and administrative
Ultrasonography, 332
-stasis, 63 specialist calls relating to, 170
Uniform Resource Locator. See URL
STDs (sexually transmitted diseases), 111 medical office calls relating to,
United States Department of Agriculture.
Sten/o, 63 169–170
See USDA
Stenosis of heart valves, 102 voice qualities relating to, 169
Upper extremities, 87
Stereotyping, 145 Telophase, 83
Upper respiratory tract, 103–104
Steri-Strips, 295 Tenaculum, 294
Uremia, 108
Sterile field, 291 Tendonitis, 91
Ureters, 107
Sterilization, 269 Tendons, 89
Urethra, 107
Stethoscope, 279 Test of English as a Foreign Language. See
Urinary bladder, 107
-stomy, 63 TOEFL
Urinary system, 80, 107, 107f7
Strain, 91 Testes, 109
common diseases and disorders of, 108
Strength tests, 341 Tetany, 96
components of
Stress test, 308 Therapeutic communication, 145–146
kidneys, 107, 108f
8
Study groups, 7–8 Therapies
ureters, 107
Studying, 6 common assistive devices, 343–344
urethra, 107
Stylus, 306 exercise, 342–343
urinary bladder, 107
Subcutaneous tissue, 85 hydrotherapy, 342
functions of, 107
Sublimation, 145 immobilization, 343
terms for, 108
Subpoena, 43 manipulation, 343
Urination, 108
Suppression, 145 ROM, 343
Urine, 108
Surgical asepsis, 268 thermotherapy, 342
URL (Uniform Resource Locator), 172
Surgical handwashing, 269, 292 traction, 343
USB (universal serial bus) drive, 172, 172f
2
Suspected abuse, 41 Thermometer, 278
USDA (United States Department of
Suspicious documents, 39 Thermotherapy, 342
Agriculture), 353
Suture, 294 Third-party payer, 217
Usual, customary, and reasonable. See UCR
Sweat glands, 85 Thoracic cavity, 81, 81f1
Swooning. See Syncope Thorax, 86
Synapses, 89, 91 Thyroid gland, 96 V
Syncope, 379 TIA (transient ischemic attack), 93 Vaccine administration, 41
Synovial membranes, 84 Tickler file, 186 Vaccine-preventable diseases, 103b
Syringes, 363 Time allotment for visits and procedures, Vaginal specula, 283f
3
184 Valves, of heart, 98–99
T Time-specific scheduling, 184, 184b Vas deferens, 109
Tachycardia Tissues. See also Connective tissue Vas/o, 63
Taste (gustatory), 95 membranes Veins, 98, 99f
9
Taxes, common, 245 of body composition, 84 Venous blood collection reminders,
federal income tax, 245 connective, 84 319b
FICA, 245 epithelial, 84 Ventricular arrhythmias, 308
FUTA, 245 muscle, 84 Ventricular diastole (relaxation), 99
TDD (telecommunication device for deaf), nerve, 84 Ventricular systole (contraction), 99
146b TJC (The Joint Commission), 3 Verbal communication, 144
Teaching aids and modalities, for patient TOEFL (Test of English as a Foreign Vertebral column, 86, 88f8
education, 158 Language), 7 Visceral membranes, 84
430 Index

Vision (sight), 93–94, 94f,

4 279–281 W Workers’ compensation, 219
Vital signs, 278–279 Worksheet, 185
Walker, 343
body temperature, 278 Wounds, 295, 379
“Walk-ins”, 184
BP, 278–279 Written communication, 144, 207
Walking wounded, 381
pulse, 278
WAN (wide area network), 172
respiration, 278 X
Wave scheduling, 184, 184b
Vitamins, 352–353
Website, 172 X-ray, 331
Voice qualities, telephones relating to,
Weight, 279
169
Wheelchair, 343–344 Z
Volume, 169
Whisper, 281
Vulnerable populations, 44 ZIP drive, 172
Word processing, 173