english for mt

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INTRODUCTION: English plays a very important role in the Medical Transcription. A successful Medical Transcriptionist is an English language expert. In the Medical Transcription industry, there is no room for misspellings, wrong grammar, wrong punctuations, etc. The MT does not only transcribe doctors’ notes and medical records. The MT is also expected to spot, among others, obvious grammatical errors, and be able to correct them. The MT can do this if, and only if, she has a good base in English. In this module, you will already be introduced to medical terms, used as examples. As it takes some time to develop medical vocabulary, we opted to introduce medical words to you this early. The second reason why medical words are already being introduced this early, is to develop in you the habit of using the dictionaries, the habit of checking and counter-checking. This is very essential in the medical transcription practice. You must understand each and every word in a sentence, in a report. Dictionaries, Medical and English, are some of the reference materials that an MT cannot do without. That is why before you start this module, it is very essential that you already have them. Wordlists are important, however, they do not provide the definitions of words. You will also find exercises in the module. It is very important that you accomplish them, detach them from the module and send them back to us for checking. Your performance in each and every exercise will form part of your grade.


LESSON 1 PARTS OF SPEECH

There are 8 parts of speech: 1. Noun: Name of a person, place, or a thing. Examples: McDonald, New York, needle 2. Pronoun: Words used in place of a noun. Examples: he, she, it 3. Verb: Action words. Examples: run, jump, talk, transcribe 4. Adjective: Words describing a noun. Examples: good, bad, white, black 5. Adverb: Words that modify a verb, an adjective or a phrase. Examples: quickly, more, slowly 6. Conjunctions: Joining words. Examples: and, or, but, yet 7. Interjections: Exclamatory words. Examples: alas!, ah! 8. Prepositions: Words that help make the sentence clear. Examples: on, down, unto THE NOUN A noun is a word used to name a person, animal, place, thing, or abstract concepts. A noun can function in a sentence as a subject, a direct object, an indirect object, a subject complement, an object complement, an appositive, an adjective, or an adverb. Nouns are further classified as follows: Common Nouns: Nouns referring in general to a person, place, or thing. Example: People with illnesses are treated in a hospital. Proper Nouns: Proper nouns are capitalized and include name of a specific person, place or thing, days of the week, month of the year, historical documents, institutions, organizations, religions, their holy texts and their adherents. Example: Dr. Andrews is my primary care physician. Collective Nouns: Collective noun is a noun naming a group of things, animals, or persons. Examples: crowd, mob, army, fleet, family, nation, team Abstract Nouns: An abstract noun is a noun which names anything which you can not perceive through your five physical senses. It is a word used to indicate the quality, action or state of the object. Quality - goodness, kindness, honesty, bravery, wisdom, etc.


Action - laughter, theft, movement, judgment, hatred, etc. State - childhood, youth, death, sickness, poverty, etc. The names of Arts and Sciences (e.g. grammar, music, chemistry, etc. ) are also abstract nouns. Concrete Nouns: A concrete noun is a noun which names anything (or anyone) that you can perceive through your physical senses: touch, sight, taste, hearing or smell. Countable Nouns: A countable noun (or count noun) is a noun with both a singular and a plural form, and it names anything (or anyone) that you can count. Noncountable Nouns: A noncountable noun (or mass noun) is a noun which does not have a plural form, and which refers to something that you could (or would) not usually count. In medical transcription, you will be encountering these nouns: SYMPTOMS Examples: Vomiting, Bleeding, Head-banging, Swelling TIME DURATION Examples:

1) The date of hospital admission is May 7, 200x, and she was discharged on May 9, 2000.

2) This 19-year-old black female was admitted to the hospital on June 14, 199x with a temperature of 102 degrees.

LOCATION Examples:

1) This 20-year-old white female was admitted to the hospital with pain in the left lower quadrant.

2) The left upper extremity was prepped and draped. INSTRUMENTS Examples:

1) Dyonics shaver 2) Acufex tibial guide 3) Gore-Tex prosthesis

PROCEDURES Examples:

1) The patient was taken to the operating room on the same day as admission, at which time she underwent arthroscopy.

2) The patient had a herniorrhaphy and an appendectomy as a teenager. 3) The patient had an ear tube surgery last month.


THE PRONOUN Pronouns can replace a noun or another pronoun. Examples: I, me, my, mine, us, at, they, his, her, they, them, etc. There are several types of pronouns. A Personal Pronoun refers to a specific person or thing and changes its form to indicate person, number, gender, and case. A Subjective Personal Pronoun indicates that the person is acting as the subject of the sentence. Examples: I, you, he, she, it, we, you, they An Objective Personal Pronoun indicates that the pronoun is acting as an object of a verb, compound verb, preposition, or infinitive phrase. Examples: me, you, her, him, it, us, you, and them. A Possessive Pronoun indicates that the pronoun is acting as an indication of possession and defines who owns a particular object. Examples: mine, yours, hers, his, its, ours, and theirs. A Demonstrative Pronoun points to and identifies a noun or a pronoun. The this and these refer to things that are nearby, either in space or in time, while that and those refer to things that are farther away in space or time. An Interrogative Pronoun is used to ask question. Examples: who, whom, which, what, and the compounds formed with the suffix “ever” (whoever, whomever, whichever, whatever). A Relative Pronoun can be used to link one phrase or clause to another phrase or clause. Examples: who, whom, that, which. The compounds whoever, whomever, and whichever are also relative pronouns. You can use the relative pronouns who and whoever to refer to the subject of a clause or sentence, and whom and whomever to refer to the objects of a verb, a verbal or a preposition. An Indefinite Pronoun refers to an unspecified person or thing. An indefinite pronoun depicts the idea of all, any, none, or some. The most common indefinite pronouns are: all, another, any, anybody, anyone, anything, each, everybody, everything, everyone, few, many, nobody, none, one, several, some, somebody, and someone. The Reflexive Pronouns are: myself, yourself, herself, himself, itself, ourselves, yourselves, and themselves. An Intensive Pronoun is a pronoun used to emphasize its antecedent.


THE VERB The verb is perhaps the most important part of the sentence. A verb or compound verb states something about the subject of the sentence. The verb depicts action, events, or states of being. It tells or asserts something about a person or thing. Verb is derived from the Latin word verbum. A Verb normally performs the following tasks: a. It tells you what a person or thing does. Examples:

Harry laughs. The clock strikes. The patient reveals. The doctor operates.

b. It tells you what is done to a person or thing. Examples:

Harry was scolded. The window is broken. The patient had slipped from the staircase.

c. It tells you what a person or thing is. Examples:

The cat is dead. The mitotic rate is high. The tumor is composed of irregular nests, cords, and individual infiltrating cells. Specimen A is received in formalin.

Types of Verb Transitive Verbs: A transitive verb denotes an action, which passes over from the doer or subject to an object. Examples:

The boy kicks the football. He spoke the truth.

Intransitive Verbs: An Intransitive Verb denotes an action which does not pass over to an object, or which expresses a state or being. Examples:

He ran a long distance. The baby sleeps. There is a flaw in this diamond.

Linking Verbs: A linking verb is be in its various forms: is, are, was, were, has, been, might, be, etc. Certain verbs are followed by adjectives, not adverbs, because the subject, not the verb is being described.


Feel, grow, act, look, taste, smell, sound, etc. He says the food tastes bad. not He says the food tastes badly.


THE ADJECTIVE An Adjective is a word used with a noun to describe or point out, the person, animal, place or thing which the noun names, or to tell the number or quantity. TYPES OF ADJECTIVES 1. Adjectives Of Quality: Adjectives of Quality (or Descriptive Adjectives) show the kind or quality of a person or thing. They answer the question “Of what kind?” Examples:

New York is a large city. He is an honest man. The foolish, old crow tried to sing.

2. Adjectives of Quantity: Adjectives of Quantity show how much of a thing is meant. They answer the question “How much?” Examples:

He showed much patience. Take great care of your health. He claimed his half share of the booty.

3. Demonstrative Adjectives: Demonstrative Adjectives point out which person or thing is meant. They answer the question: “Which?” Examples:

This boy is stronger than Harry. Yonder fort once belonged to Shirley.

4. Interrogative Adjectives: “What, which, whose.” These words when used with nouns to ask questions are called Interrogative Adjectives. It will be seen in the following examples that “what” is used in a general sense, while “which” is used in a selective sense.

Which way shall we go? Whose book is this? What did you say?

An Adjective when used along with the noun is said to be used Attributively.

The lazy boy was punished. All open portions of the wound were packed.

When an adjective is used along with the verb and forms a part of the predicate, it is said to be used Predicatively.

The boy is lazy. The axillary vein was intact.


PREPOSITIONS A preposition usually indicates the temporal, spatial, or logical relationship of its object to the rest of the sentence. Examples: on, to, by, about, unto, over, under, etc. A prepositional phrase is made up of the preposition, its object and any associated adjectives or adverbs. A prepositional phrase can function as a noun, an adjective, or an adverb. The most common prepositions are: about, above, across, after, against, along, among, around, at, before, behind, below, beneath, beside, between, beyond, but, by, despite, down, during, except, for, from in, inside, into, like, near, of, off, on, onto, out, outside, over, past, since, through, throughout, till, to, toward, under, underneath, until, up, upon, with, within, and without. KINDS OF PREPOSITIONS: 1. Simple Prepositions: At, by, for, from, in, of, off, on, out, up, through, till, with. 2. Compound Prepositions: About, above, across, along, below, before, amidst, underneath, within, without, beside, beneath, beyond, between, around.


ADVERBS A word that modifies the meaning of a verb, an adjective, or a phrase is called an Adver. Adverbs have a complex grammatical relationship within the sentence or clause as a whole. An adverb can be found in various places within the sentence. An adverb can modify a verb, an adjective, another adverb, a phrase, or a clause. It indicates manner, time, place, cause, or degree and answers questions such as “how, when, where”. You can use a conjunctive adverb to join two clauses together. Some of the most common conjunctive adverbs are: “also, consequently, finally, furthermore, hence, however, incidentally, indeed, instead, likewise, meanwhile, nevertheless, next, nonetheless, otherwise, still, then, therefore, and thus”. A conjunctive adverb is not strong enough to join two independent clauses with the aid of a semicolon. Examples: 1) Bob runs quickly. 2) This is a very sweet mango. 3) Derrick reads quite clearly.


CONJUNCTIONS A Conjunction is a word which join together sentences, and sometimes words. Coordinating Conjunctions (and, but, or, nor, for, so, or yet) are used to join individual words, phrases, and independent clauses. The conjunctions but and for are also used as prepositions. A Subordinating Conjunction introduces a dependent clause and indicates the nature of the relationship among the independent clause(s). The most common subordinating conjunctions are: after, although, as, because, before, how, if, once, since, than, that, though, till, until, when, where, whether, and while. Correlative Conjunctions always appear in pairs – you use them to link equivalent sentence elements. The most common correlative conjunctions are: both….. or, either….. or, neither….. nor, not only….. but also, so… as, and whether….. or. Usually, correlative conjunctions consist of a coordinating conjunction linked to an adjective or adverb. Some words which appear as conjunctions can also appear as prepositions or as adverbs. Examples: 1) God made the country and man made the town. 2) Two and 2 make 4. 3) Our hoard is little, but our hearts are great.


INTERJECTIONS An Interjection is a word used to show or express emotion. Examples: 1) Poor child! She has suffered a great deal. 2) Alas! She is dead.


LESSON 2 SENTENCES

A sentence is a group of words containing a subject and a verb that forms a complete statement and is able to stand alone. SENTENCE VARIATIONS Simple Sentence: A sentence that contains a single subject and verb. It may have multiple adjectives, adverbs, phrases, and appositives. Examples:

The drugs were packed. The ECG was conducted on Thursday. The baby showed signs of Pulmonary Koch disease.

Compound Sentence: A sentence that has as two or more independent (but closely related) clauses, connected by a comma and a conjunction. Examples:

The x-ray was normal, and the gall bladder was well visualized. The specimen was sent to the pathologist for examination; he found nothing suspicious for carcinoma. The patient was admitted to a monitored bed on the cardiac surveillance unit, and initially his amiodarone was increased to 200 mg three times a day. The patient had an uneventful operative procedure, and his postoperative course has been benign. There is no peripheral edema, and electrolytes have improved as noted above. The cutter was positioned at the area of stenosis, and multiple sections were taken in a circumferential manner. A side hole was cut in the composite valve graft, and a tensionless anastomosis was made between the composite valve graft and the aorta.

Complex Sentences: A complex sentence has one independent main clause and one or more dependent subordinate clauses, which together express one complete thought. Examples:

Although it was inflamed, the gall bladder was without stones. The patient was involved in a motorcycle accident five years ago and still complains of headache and pain in the right leg. Similar technique was used for the right graft, and when this was completed the pulmonary artery vent was removed.


I discussed his case with the pediatric nephrology fellow, who suggested a work-up to rule out Bartter syndrome. He was also given Hemoccult cards, which he sent back.

Compound Complex Sentences: A compound complex sentence has two or more independent clauses and one or more dependent clause. Examples:

The posterior pack was removed, and after the wound was copiously irrigated, the procedure was terminated.

The Election Commissioner announced the elections, and although the political parties began to work in full swing, the voters were still unenthusiastic.

The physician may not dictate the outline, and you must be able to recognize each body part in which he or she is discussing, so you can choose the appropriate topic or sub-topic.

If this is elevated we will most likely not pursue this further, as she would not be a surgical candidate for primary hyperparathyroidism; and in addition, we would not undertake an extensive metastatic malignant disease search at this point in time without focal evidence of such process.

The left was wrapped with an Esmarch bandage, and the tourniquet was inflated to 450 mmHg; subsequently, the bandage was removed.

There were no difficulties with this anastomosis, and prior to completing it, the tourniquet was deflated and the last suture placed.

Clipped Sentences: In clipped sentences the subjects, verbs, articles, may be omitted. Physicians often use clipped sentences. They are prevalent and acceptable in surgical reports, laboratory data, review of systems and the physical examination. Examples:

Abdomen benign. Pelvic not done. Rectal negative. Muscle contraction, headaches, chronic. Localized myositis, right side of the neck. Right carotid bruit, asymptomatic.

ANATOMY OF A SENTENCE

• Subject • Predicate • Object • Complement

DEFINITIONS Subject : That part of a sentence about which something is being said. Predicate : That part of a sentence that says something about the subject. Object : When the action is followed onto someone. Complement : Any additional information about the subject, verb or object. The doctor advised the patient to conduct the test.

The doctor – subject.


advised the patient to conduct the test – predicate. advised --- verb. the patient --- object. to conduct the test – complement.

The patient is scheduled for a complete blood count.

The patient --- subject. is scheduled for a complete blood count ---predicate. is scheduled --- verb. for a complete blood count --- object.

My goal is to become a certified medical transcriptionist. My goal --- subject. is to become a certified medical transcriptionist --- predicate. is to become --- verb. certified medical transcriptionist --- object.

Pacemaker wires and mediastinal drainage tubes were inserted.

Pacemaker wires and mediastinal drainage tubes --- subject. were inserted --- predicate/verb.

Exactly one year ago, Janet was promoted.

Janet --- subject. was promoted exactly one year ago --- predicate. was promoted --- verb. exactly one year ago --- complement.

Down the elevator, on a broken wheel chair, struggled my patient.

my patient --- subject. struggled down the elevator on a broken wheel chair --- predicate. struggled --- verb. on a broken wheel chair --- object. Down the elevator --- complement.


CLAUSES A clause is a group of words with a subject and a verb that is a part of a sentence. Example: Everyone who is learning to transcribe should study punctuation. Independent Clause: An Independent clause is a group of words containing a subject and a verb, making complete sense and able to stand alone as a complete sentence. Example: Good English skills are essential for an MT. Dependent Clause: A group of words containing a subject and a verb that depends on some other word or words in the sentence for completeness of meaning. Examples: Many students find transcription easy because they have a flair for it. The gallbladder, although it was inflamed, was without stones. Dependent Essential Clause: The dependant clause that cannot be eliminated Who and Whom - human beings and animals with a name That or Which - inanimate objects or animals without a name. Dependent Nonessential Clause

• The patient, who was referred by her family physician, came to the emergency room.

• The operation, which began at 7 a.m., took 17 hours. PHRASES A phrase is a group of words without a subject and a verb. It begins with an adverb, preposition, or participle. Phrases that tell you more about the noun is called an adjective phrase. ARTICLES Demonstrative Adjectives such as a, an, and the are called Articles. The Articles are of two kinds: Indefinite Articles: ‘A’ or ‘An’ are called the Indefinite Articles because it does not specify a particular person or thing. ‘An’ is used before a word beginning with a vowel sound. ‘A’ is used before words beginning with consonant sounds. Examples:

• a doctor • an umbrella • an heir • an orange • an honest man


Definite Articles: ‘The’ is a Definite Article because it points out some particular person or thing. Example: He saw the doctor. This is a summary of instances when Definite Article ‘the’ may be used. 1) When we speak of a particular person or thing, or one already referred to.

• The book you want is out of print. • I dislike the fellow. • Let us go to the club.

2) When a singular noun is meant to represent a whole class.

• The cow is a useful animal. • The rose is the sweetest of all flowers. • The banyan is a kind of fig tree.

(Do not say, “a kind of a fig tree.” This is a common error.) 3) With names of gulfs, seas, rivers, oceans, group of islands, and mountain-ranges.

• The Persian Gulf. • The Red Sea. • London is on the Thames. • The British Isles.

4) Before the names of certain books. 5) Before Common Nouns which are names of things unique of their kind.

• The sun. • The sky. • The ocean.

6) Before a proper noun only when it is qualified by an adjective or a defining adjectival clause.

• The great Caesar: the immortal Shakespeare. • The Mr. Roy whom you met last night is my uncle.

7) With superlatives.

• The darkest cloud has a silver lining. • This is the best book of elementary chemistry.

8) With ordinals.

• He was the first man to arrive. • The ninth chapter of the book is very interesting.

9) Before musical instruments.

• He can play the flute. 10) Before an adjective when the noun is understood.

• The poor are always with us.


11) Before a noun ( with emphasis ), to give the force of a superlative. • The Verb is the word (= the chief word ) in a sentence.

12) As an adverb with Comparatives.

• The more the merrier. • The more they get, the more they want.

Note: When the Article is used before Proper Nouns, they become Common Nouns Examples:

• This man is a second Newton.(i.e., a philosopher as great as Newton.) • He was the Napoleon of his age. (i.e., the greatest general of his time.)


LESSON 3 SUBJECT-VERB AGREEMENT

Making the subject and verb of a sentence agree is of crucial importance in the English language. One of the most glaring grammatical errors is to have a subject and verb which do not agree. Every verb must agree with its subject in number. A singular subject must always have a singular verb. A plural subject must always have a plural verb. RULE 1: A Verb agrees in number with the subject Examples: The nurse will give you the injection now. Nurse --- subject. therefore will --- singular subject. Singular:

The patient presents to the emergency room. The patient’s private physician recommends this treatment.

Plural:

The patients present to the emergency room. The patient’s private physicians recommend this treatment.

(Notice that these examples follow the ‘s‘ rule in verbs.) Exception to the Rule: The forms of the verb ‘to be’ are an exception to the ‘s’ Rule. Singular Plural Present Tense: is are Past tense: was were RULE 2: The Verb must agree with the subject even when the two are not in proximity. Examples:

• The findings on tomography were normal. findings --- plural subject were normal --- plural form (inspite of “on tomography ” appearing in between, the verb will be in the plural form.

• No malignant cells, however, are seen.


RULE 3: When a compound subject “or” is present, make the verb agree in number with the closest noun. Examples: No definite adenopathy or masses were felt.

The compound is or There are two nouns: adenopathy and masses. The verb will be in the plural form because the noun closest to the verb is masses.

High fever or excessive uterine cramps were the probable symptoms. No masses or adenopathy was seen. RULE 4: If a compound subject is joined by “and”, a plural verb is used even if the word closest to the verb is singular. Examples: The patient’s gait and station were normal.

The subject has two nouns. Although station is in the singular the verb form used is plural.

The boy and the girl were asked to take the dictation. RULE 5: Usage of the verb depends whether the collective noun is singular or plural. Examples: The group is meeting frequently throughout its stay. The groups of patients were meeting frequently throughout their stay. In the first sentence, the collective noun group is in the singular, so the verb is in the singular. In the second sentence the collective noun is in the plural, so the verb is in the plural.


ACTIVE AND PASSIVE VOICE RULE 1: The verb indicates the subject is doing something in active voice. RULE 2: In passive voice, the form of the verb shows that something is done to the person denoted by the subject. RULE 3: Voice is that form of the verb which shows whether what is denoted by the subject does something or has something done to it. RULE 4: When the verb is changed from the active voice to the passive voice, the object of the Transitive Verb in the active voice becomes the subject of the verb in the passive voice. RULE 5: Only transitive verbs can be used in passive voice. RULE 6: Students must know when to use the active voice and the passive voice. RULE 7: The active voice is used when the agent ( i.e. the doer of the action ) is to be made prominent. RULE 8: The passive voice is used when the person or thing acted upon is to be made prominent. RULE 9: The passive voice is therefore generally preferred when the active form would involve the use of an infinite or vague pronoun or noun. RULE 10: The “by” phrase cannot be avoided where the agent has some importance and is necessary to complete the sense. GRAMMAR RULES RULE 1: Make sure that the verb and noun match in number. Examples:

There were 15 members present. Sections of the cervical tissue show mild dysplasia. The Language Of Medicine, stacked with three other terminology texts, is sitting on my table.

Collective Nouns often cause problems:

This group of diagnoses is proposed. Then, 2 cc was injected. Review of systems was negative.

RULE 2: Use proper parts of speech. Examples: The patient was found lying on the floor.


Give this to whoever sees the patient. The Tumor Board agreed that it would meet on the first Friday. She neither smokes nor drinks. RULE 3: Use proper words. Examples:

There was no recurrence of his tumor. It’s the worst possible diagnosis. He should have been admitted immediately. It looked as if he would begin the procedure unassisted. The patient was seen yesterday and was doing well.

RULE 4: Use nouns and adjectives correctly. Examples:

He was scheduled for replacement of his aortic valve. She had a vesical fistula to her vagina.

RULE 5: Use proper singular or plural nouns. Example:

The conjunctivae were bilaterally inflamed. RULE 6: Position the modifiers correctly. Example:

The patient had a hysterectomy leaving one tube and ovary in Jacksonville. (incorrect)

The patient had a hysterectomy in Jacksonville, leaving one tube and ovary. (correct)

RULE 7: Use the proper tense. Past tense is used in the past history portion of a report and in the discharge summaries to discuss an expired patient. Present tense is used in the current illness or disease and in the history and physical. Example:

The patient has had left sciatica for the past two years; this is now exacerbated. IN A NUTSHELL SENTENCES: A sentence is a group of words containing a subject and a verb that forms a complete statement and is able to stand alone. In other words a sentence is grammatically independent and complete.


Capitalize the first letter of each sentence (including clipped sentences or sentence fragments.) Do not begin a sentence with a word that must never be capitalized; instead, edit lightly or recast the sentence

Dictated: pH was 7.18 Transcribed: The pH was 7.18

CLIPPED SENTENCE: Complete sentences are the grammatically correct form, but physicians often dictate clipped sentences, omitting subjects verbs, articles, as the case may be. The dictator may prefer that these clipped sentences be transcribed as dictated rather than edited to complete sentences. Dictated clipped sentences are acceptable when they achieve directness and succinctness without loss of clarity. Examples: Abdomen benign. Pelvic not done. Rectal negative. Clipped sentences are particularly prevalent and acceptable in surgical reports, laboratory data, review of systems, and the physical examination, even when complete sentences are used in the remaining sections of the report. Such a mix is acceptable. When the dictator’s style is to dictate in clipped sentences (throughout the report or in certain sections), it is not necessary to expand dictated clipped sentences into complete sentences unless that is the dictator’s preference. When an occasional clipped sentence appears within a report (or within a section of a report), it may be expanded into a complete sentence in order to make the report (or section) consistent, provided the change is not too extensive. Likewise, when an occasional complete sentence appears amidst clipped sentences, it may be clipped for consistency. SIMPLE SENTENCE: A simple sentence has a single subject and a predicate (each can be singular or plural) expressing a single complete thought. It may also include multiple adjectives, adverbs, phrases, and appositives. End each sentence with the appropriate ending punctuation (period, question mark, exclamation point.) Examples:

The patient was placed on the operating table. The cat sat on the wall. The patient came in for his annual checkup.

COMPOUND SENTENCE: A compound sentence has two or more independent (but closely related) clauses, each of which could stand alone as a simple sentence; it may be joined by a comma, a conjunction (e.g. and, but), or by a semicolon. Examples:

The appendix was inflamed, and he was brought to surgery in the morning. The specimen was sent to the pathologist for examination; he found nothing

suspicious for carcinoma.

I understand that you will complete the history and physical for the admission, and I will order the preoperative evaluation.


Good English skills are essential to our secretary; she will study hard to ensure her success.

Conjunctive adverbs (consequently, however, moreover, nevertheless, otherwise, therefore, thus) are used between independent clauses. Precede them with a semicolon and follow them with a comma. Examples:

The patient remained febrile; nevertheless, he left the hospital against medical advice.

The pathologist found nothing suspicious for carcinoma on gross examination;

however, frozen section demonstrated fibrocystic disease. COMPLEX SENTENCE: A complex sentence has one independent (main) clause and one or more dependent (subordinate) clauses, which together express one complete thought. Example:

The patient was involved in a motorcycle accident five years ago and still complains of headache and pain in the right leg.

COMPOUND-COMPLEX SENTENCE: A compound-complex sentence has two or more independent clauses and one or more dependent clauses. Example:

The posterior pack was removed, and after the wound was copiously irrigated, the procedure was terminated.

VERB: The first step in acquiring sentence sense is learning to recognize verbs. A verb is a word or a group of words that expresses action or otherwise helps to make a statement. Examples:

The patient needs a complete blood count. The patient is scheduled for a complete blood count. The patient had a complete blood count Will you advise the patient to have a complete blood count?

TRANSITIVE VERBS: Verbs which show action and which pass their action along to objects and which answer the question “what” or “whom” after the verbs. Examples: eat, repaired, prefers, needs, gave, found, bought, sold, judged, made etc.. LINKING VERB: The most common linking verb is be in various forms: is, are, was, were, has, been, might, be etc. Other common linking verbs include appear, become, seem, and in some contexts such verbs as feel, grow, act, look, taste, smell and sound. Such verbs are followed by adjectives, not adverbs, because the subject, not the verb is being described. Examples:

He says the food tastes bad. not He says the food tastes badly.


AGREEMENT OF SUBJECT AND VERB: A verb agrees in number with its subject (a noun or pronoun.) A singular subject must be matched with a singular verb, a plural subject with a plural verb. Examples:

The abdomen is soft and nontender. The lungs are clear.

The verb must agree with its subject even when the two are not in proximity. Be extra careful when another noun intervenes. Example: The findings on tomography were normal Take care to accurately identify the subject; inaccurate identification can lead to errors in the number of the verb. Example: He is one of those patients who demand constant reassurance. (The subject of demand is who, referring to patients, not to he.) Subject-verb agreement errors occur frequently in medical dictation, and it is the medical transcriptionist’s responsibility to correct such errors. The first steps in assuring subject-verb agreement are to analyze the sentence, identify the subject of the sentence, and decide if the subject is singular or plural, then check to see if the verb agrees with the subject in number. If dictated: The edema in both legs have not yet responded to diuretics. Transcribed: The edema in both legs has not yet responded to diuretics. Note: The word legs is part of the prepositional phrase intervening between the subject (edema) and the verb. When a compound subject joined by or is present, make the verb agree in number with the closest noun. Examples:

No definite adenopathy or masses were felt. No definite masses or adenopathy was felt.

If a compound subject is joined by and, a plural verb is used even if the word closest to the verb is singular. Examples:

The patient’s gait and station were normal. Hemoglobin and hematocrit were 14 and 40 respectively.

NOTE: "amount of"—takes a singular verb. Examples:

A minimal amount of bleeding was present. The amount of adhesions was minimal

"average of"—takes a plural verb if preceded by an, singular if preceded by the. Examples:

An average of 10 tests were done on each patient.


The average of the results was 48.3%. "either…..or, neither….nor" Correlative conjunctions. With an either…or, neither…nor construction, match the number of the verb with the number of the nearest subject. Examples:

Neither the sister nor the brother exhibits similar symptoms. Neither the sisters nor the brothers exhibit similar symptoms. Neither the brothers nor the sister exhibits similar symptoms

COLLECTIVE NOUNS: Represents a collection of persons or things regarded as a unit. Usage determines whether the collective noun is singular or plural. It is singular and takes a singular verb when the total group it represents is emphasized. It is plural and takes a plural verb when the individuals making up the group are emphasized. EXAMPLES OF COLLECTIVE NOUNS

• board (of directors) • class • committee • couple • group • majority • number • pair • set • staff • team

Examples:

The group is meeting frequently throughout its stay The group of patients were female. (each was female) A number of adhesions were present. (individual adhesions were present, not a

collective adhesion) The number of adhesions was minimal. The couple were injured in a plane crash. but The couple has an appointment with the geneticist.

Treat units of measure as singular. Examples: Twenty milliequivalents of KCL was given. The second step in acquiring sentence sense is learning to recognize the subject of verbs. That part of a sentence about which something is being said. This part is properly called the complete subject, but within the complete subject, there is always a word or group of words that is principal word within the complete subject and is called the simple subject. The subject is usually a noun or pronoun. Notice the subject written in italics in the following sentences.

The patient needs a complete blood count. The patient is scheduled for a complete blood count.


The patient had a complete blood count. He had a complete blood count

The first three examples are nouns, and the fourth example is a pronoun. A word used in place of a noun is called a pronoun. Pick out the noun subject of the following sentence. My goal is to become a certified medical transcriptionist. If you picked the noun goal, you are correct. Now look at this sentence and identify the subject and then the verb. Exactly one year ago, Janet was promoted. If you selected Janet as the subject and was promoted as the verb, you are correct. Because the subject may appear at almost any point in a sentence, it is usually easiest to locate if you pick out the verb first. We can also express a sentence as follows: Exactly one year ago, she was promoted In this case, the pronoun she is used in place of the noun. Select the subject of the following sentence: Down the elevator, on a broken wheelchair, struggled my patient. Good for you if you selected patient from this convoluted grouping! Did you remember to find the verb first (struggled) and then ask yourself “who struggled”? CLAUSE: Step three is recognizing the independent clause or main clause in a sentence and the dependent clause when there is one. A clause is a group of words with a subject and a verb and that is part of a sentence. Example: Everyone who is learning to transcribe should study punctuations. Notice that in the above example, there are two sets of clauses. The one in italics is dependent. It contains a subject and a verb like the remainder of the sentence, but it depends on the balance of the sentence to make sense. (Everyone should study punctuations is the main clause.) Pick out the subject in this sentence:

Routine laboratory studies that we carried out on admission disclosed a white count of 19,200.

If you selected studies or the complete subject, routine laboratory studies, as the subject, you are correct. The verb is disclosed. The dependent clause is "that we carried out on admission".


INDEPENDENT CLAUSE: A group of words containing a subject and a verb, making complete sense and able to stand alone as a complete sentence. Examples:

Good English Skills are essential for an MT. There was a small area of fibrotic scarring involving the right uterosacral ligament.

Note: In the second example, "There" is the subject, and "was" is the verb. Pick out the two independent clauses from this compound sentence: The patient had a complete blood count and we asked him to wait for the results. HINT: Remember to look for the verb first (had in the first clause and asked in the second.) Good if you selected, "The patient had a complete blood count" as the first independent clause, and "we asked him to wait for the results as the second". Notice that each of these clauses can stand alone and that neither depends on the other to express a complete thought. DEPENDENT CLAUSE: A group of words containing a subject and a verb that depends on some other word or words in the sentence for completeness of meaning. Examples:

Many students find transcription easy because they have a flair for it. The gallbladder, although it was inflamed, was without stones. He is a patient who must have general anesthesia because he does not respond

normally to routine dental care NOTE: In the first example, "Many students find transcription easy" is the independent clause, and "because they have a flair for it" is the dependent clause. Notice how the dependent clause depends on the other words for completeness of meaning. Select the dependent clause in the following sentence: She had a complete blood count because she was scheduled for surgery tomorrow. The clause "because she was scheduled for surgery tomorrow" is the dependent or subordinate clause, because it is dependent on the first part of the sentence for it to be complete. It cannot stand alone as an independent clause can.


LESSON 4 PUNCTUATIONS

COMMA Commas are used to indicate a break in thought, to set off material, and to introduce a new but connected thought. Sometimes commas must be used, sometimes it must not be used, and sometimes their use is optional. The trend is toward avoiding overuse. Use commas when the rules require them and when they enhance clarity, improve readability, or diminish confusion or misunderstanding. RULES INDEPENDENT CLAUSE: Also known as the main clause. It can stand alone as a sentence. Use a comma to separate independent clauses joined by a conjunction (and, but, for, or, yet, or so). The comma is optional if the main clauses are short and their meanings will not be confused. Examples:

The patient came into the emergency room, and he was attended to immediately.

The platysma was then divided in the direction of its fibers, and blunt dissection was performed so that the prevertebral space was entered.

DEPENDENT CLAUSE: One that is subordinate to, or depends on the independent clause; also known as a subordinate clause. It has a subject and a verb, but it cannot stand alone; hence its name. It may be introduced by such terms as who, whom, that, which, when, after, although, before, if, whether. Example: Paul Otis, who had a coronary last year, came in for an examination today DEPENDENT ESSENTIAL CLAUSE: Dependent clause that cannot be eliminated without changing the meaning of the sentence; also known as restrictive clause. Use who or whom to introduce an essential clause referring to a human being or to an animal with a name. Use that or which to introduce an essential clause referring to an inanimate object or to an animal without a name. Do not use commas to set off dependent essential clauses.

The patient came in to the emergency room, and she was treated for tachycardia that had resisted conversion in her physician’s office.

She had two large wounds that were bleeding profusely and several small bleeders

I want to examine all of the children who have been prepped. Medical staff members who do not attend the meeting will lose their

consulting privileges. DEPENDENT NONESSENTIAL CLAUSE: Dependent clause that can be eliminated without changing the meaning of the sentence; also known as restrictive clause. Use commas to set off nonessential subordinate clauses. Use who or whom to introduce a nonessential clause referring to a human being or an animal with a name. Use which to introduce a nonessential clause referring to an inanimate object or to an animal without a name.


Examples: The patient, who was referred by her family physician, came in to the emergency

room. The patient’s parents, who had been summoned from Europe, were consulted

about his past history. The operation, which began at 7 a.m., took 17 hours.

(In order to know whether a clause is essential or nonessential is to mentally cover that part of the sentence and see if the rest of the sentence conveys the same meaning on its own.) ADJECTIVES: Use commas to separate two or more adjective(s) and nouns. Do not place a comma between the last adjective and modified noun. Examples:

Physical examination reveals a pleasant, cooperative, elderly female in no acute distress.

The abdomen is soft, nontender, and supple If two or more words independently modify the same noun, separate them with a comma if a mental “and” can be placed between them or the order in which they are used can be reversed. Examples:

She is a beautiful, intelligent woman. This 54-year-old Caucasian female was referred to my office for evaluation. (no

comma) She did not have audible paroxysmal tachycardia. (no comma) He is an efficient medical transcriptionist.

Use commas to set off an adjective or adjectival phrase directly following the noun it modifies. Examples:

Diagnosis: Fracture, left tibia. He has degenerative arthritis, left knee, with increasing inability to cope.

APPOSITIVES: A noun or pronoun that closely follows another noun to restate, rename, explain, or clarify it. It may be essential or nonessential. Do not use commas to set off essential appositives (those essential to the meaning of the sentence.) Example:

His brother Walter was tested as a potential bone marrow donor. (No comma since it is essential to know which brother as he might have had more than one).

NONESSENTIAL APPOSITIVE: Use comma before and after nonessential appositives (those not essential to the meaning of the sentence.) Example:

Dr. Johnson, the pathologist, deserves the credit for that diagnosis. CONJUNCTION: Use a comma to separate independent clauses joined by a conjunction (and, but, for, or, nor, or so.) Examples:

The patient came into the emergency room, but he was in a stable condition.


A consultation was obtained, and liver function studies were done. He was seen in the emergency room, but he was not admitted.

SUBORDINATE CONJUCTIONS like where, while, since, after, yet, so, are preceded by a comma Example:

He was in great pain, yet refused treatment. DO NOT USE A COMMA BEFORE A COORDINATING CONJUNCTION THAT IS FOLLOWED BY A SECOND VERB WITHOUT A NEW SUBJECT Examples:

The patient tolerated the procedure well and left the department in stable condition.

The gallbladder was inflamed but was without stones. CONJUNCTIVE ADVERBS connect two independent clauses together. They include consequently, finally, furthermore, however, moreover, nevertheless, similarly, subsequently, then, therefore, and thus. Precede a conjunctive adverb by a semicolon and follow it by a comma. Examples:

He was admitted through the emergency room; consequently, he was taken to surgery.

She reported feeling better; however, her fever still spiked in the evenings. CREDENTIALS AND PROFESSIONALS: Use commas to set off professional credentials when they follow the person’s name. Examples:

William Walters, MD Stella Olson, CMT, AAMT Director

DATES: When the month, day, and year are given in sequence, set off the year by commas. Do not use ordinals. Example:

She was admitted on December 14, 1993, and discharged on January 4, 1994. DO NOT USE COMMAS WHEN THE MONTH AND YEAR ARE GIVEN WITHOUT THE DAY, OR WHEN THE MILITARY DATE SEQUENCE (DAY, MONTH, YEAR) IS USED. Examples:

She was admitted in December 1993 and discharged in January 1994. She was admitted on 14 December 1993 and discharged on 4 January 1994.

MULTIPLE DEGREES: Use the order preferred by the individual named, separating the degrees by comma. In general, omit academic degrees below the master’s level. If an individual has a doctoral degree, omit degrees at master’s level or below, unless the master’s degree represents a relevant but different or specialized field. Examples:

David Byron, PhD not David Byron, MS, PhD Stella Jones, MD, MSW


Include specialized professional certifications if pertinent, (CMT, RN, PA). Separate multiple degrees (and/or professional credentials) by commas. Examples:

Micheal Mergenere, RPh, PhD Susan Pierce, CMT, ART

When an individual holds two doctorates, use either or both according to the individual’s preference. Example: Wanda Williams, MD, PhD NUMBERS: Drop the comma in numbers of 4 digits.

1234 123,455

Use a comma to separate groups of 3 numerals in numbers of 5 digits or more, but omit the commas if decimals are used.

Platelet count was 354,000. White count was 7100. 12345.67

Use a comma to separate adjacent unrelated numerals if neither can be readily expressed in words and the sentence cannot be readily reworded. Example:

In March 1991, 1038 patients were seen in the emergency room. LAB DATA AND VALUES: Do not use commas to separate a lab value from the test it describes. When multiple lab results are given, separate related tests by commas, unrelated tests by periods. (If uncertain, use periods). Examples:

White count 5.9, hemoglobin 14.7, hematocrit 43.1. Urine specific gravity 1.006, pH 6, negative dipstick.

LATIN ABBREVIATIONS: Latin abbreviations are commonly used in English. Place a comma before and after the abbreviations. Examples:

She is fluent in several languages, e.g., French, Italian, Spanish. He continues to play football, basketball, tennis etc., despite his knee injury. She continued to be uncooperative, i.e., she refused all treatment He has numerous pets, viz., 8 dogs, 14 cats, 15 rabbits, 2 goats, and 3 llamas

PARENTHESIS: Do not precede a parenthesis mark by a comma. If a comma is required following the parenthetical information, it must be placed after the closing parenthesis mark. Example:

The patient is improving (despite her repeated insistence that she is dying), and we plan to discharge her to an extended care facility next week.


PARENTHETICAL EXPRESSIONS: Expressions that interrupt the flow of the sentence are set off by commas. Example:

A great deal of swelling was present, more on the left than on the right. Ultimately this cleared, however, and azotemia too was reversed

PHRASES: A phrase is a group of words without a subject and a verb. It usually begins with an adverb, preposition or participle. Use a comma before and/or after a phrase when the sentence could be misread without it, but do not use commas if they change the intended meaning. The comma following a short opening adverbial phrase may be omitted. Use the comma for longer introductory phrases or when its absence may cause confusion. Examples:

Presently she is without pain. During hospitalization, she will have a CAT scan. Because of vomiting, an NG tube was put in place.

INTRODUCTORY PREPOSITIONAL PHRASE: An introductory prepositional phrase is always correct with a comma. Introductory expressions in which the subject and the verb are understood, are clauses not phrases, and should always be followed by a comma. Examples:

After surgery, he was taken to the recovery room. If so, he will return sooner. (If so is understood to mean if that is so.)

DO NOT USE A COMMA BEFORE OR AFTER OTHER PREPOSITIONAL PHRASES UNLESS IT IS NEEDED FOR CLARITY. Examples:

The patient will return to my office for continuing pain. The exam revealed a young, white male with multiple injuries.

DO NOT USE COMMAS TO SET OFF ESSENTIAL PARTICIPIAL PHRASES. USE COMMAS TO SET OFF NONESSENTIAL PARTICIPIAL PHRASES. Examples:

Examination revealed 2 wounds bleeding profusely and several small bleeders. The incision, running from the umbilicus to the symphysis pubis, was closed in

layers. The patient was admitted screaming with pain.

QUOTES: Always place the comma following a quotation inside the closing quotation marks. Example:

The patient stated that “the itching is driving me crazy,” and she scratched her arms throughout our meeting.

SENTENCES: When there are only 2 subjects, do not separate them by a punctuation. When there are more than 2 subjects, use series punctuation. Examples:

Pacemaker wires and mediastinal drainage tubes were inserted. (no comma)


The aryepiglottic folds, arytenoids, and the postcricoid spaces were normal

When there are only 2 predicates, do not separate them by a punctuation. Example:

He continued to improve and was discharged home on the second postoperative day.

COMPOUND: A compound sentence has two or more independent (but closely related) clauses, each of which could stand alone as a simple sentence. It may be joined by a comma and a conjunction (and, but) or by a semicolon. Separate coordinate independent clauses joined by a coordinating conjunction (and, but, nor), by a comma, or by a semicolon if one of the clauses already contains punctuation and the semicolon will enhance clarity Example: A sector iridotomy was done, and Zolyse was instilled. When coordinate independent clauses are very short and closely related, they may be joined without a comma or semicolon. Example:

The x-rays were normal and the gallbladder was well visualized. Use semicolons to separate coordinate independent clauses that are not joined by a coordinating conjunction. Example:

The specimen was sent to the pathologist for examination; he found nothing suspicious for carcinoma.

COMPLEX: Use a comma after a subordinate clause that precedes the main clause. Example:

Although it was inflamed, the gallbladder was without stones. DO NOT USE A COMMA IF THE SENTENCE FOLLOWS THE NATURAL ORDER. Example:

The gallbladder was without stones although it was inflamed. SERIES: Use a comma to separate a series of 3 or more items. AAMT’s practice is to use the final comma. Examples:

Ears, nose, and throat are normal. No dysphagia, hoarseness, or enlargement of the thyroid gland.

STATE, COUNTY, CITY: Follow city or town name by a comma. Examples:

Modesto, California Venice, Italy

Place a comma before and after the state name preceded by a city or county name or a country name preceded by state or city name.


Examples: The patient returned from a business trip to Paris, France, the week prior to

admission The patient moved to Dallas, Texas, 15 years ago.

ADDRESSES: Use commas to separate the parts of an address in narrative form. Do not place a comma before the ZIP code. Example:

The patient’s address is 139 Goddard Street, Modesto, CA 95355

Always use figures (even number 1) to refer to house numbers. Do not use commas. Examples:

1 Eight Avenue 1408 41st Street 101st Street 1408 Albany Avenue No. or # may be used before an apartment, suite, or number. Example:

1408 Albany Avenue, Apt. #148 Place a comma before and after the state name preceded by a city or county name, or a country name preceded by a state or city name. Examples:

The patient moved to Dallas, Texas, 15 years ago. The patient returned from a business trip to Paris, France, the week prior to

admission. In addresses, place a comma after the city name but not after the state name. Examples:

Worcester County, Massachusetts. Modesto, California

TITLES: Lowercase titles are set off from a name by commas. Examples:

The 1994 AAMT secretary, Bonnie Monico, read the minutes. Robert Reich, secretary of labor, is interested in the impact of electronic

monitoring on employees. DO NOT USE A COMMA OR OTHER PUNCTUATION MARKS BETWEEN UNITS OF THE SAME DIMENSION. Examples:

The infant weighed 5 pounds 3 ounces. He is 5 feet 4 inches tall.

This is not the end of the chapter on commas !! Please do not think this is all you need to know, learning does not end here. Everyday we learn new rules. When in doubt, research.


THE PERIOD (.) Periods are most commonly used to mark closure. They may also be used as a mark of separation. RULES 1. Place a period with the following: a. Single capitalized words and single letter abbreviations Example:

Mr. Dr. Inc. Ltd. Joseph P. Myers E. coli b. Lower case Latin abbreviation. Example:

a.m. p.m. e.g. t.i.d. p.o. q.4h. c. Place a period at the end of a declarative sentence Example:

The patient’s past medical history is unremarkable. Separate values of unrelated tests by periods. (refer to chapter on Commas). If a sentence terminates with an abbreviation that ends with a period, do not add another period at the end of a sentence. Example:

He takes Valium 5 mg q.a.m.

f. Always place the period inside quotation marks. g. Amount over $1 use the dollar sign preceding the dollar amount, and separate dollars and cents by a decimal point. Do not use a decimal point if cents are not included. h. The name of the genus when it is abbreviated and used with the species. Example:

E. coli, M. tuberculosis, E. histolytica

i. To separate a decimal fraction from whole numbers. Example:

His temperature was 98.4 F. j. Use a period after each initial within a name. Do not use periods when initials replace a complete name. Examples:

Harry S. Truman. John F. Kennedy but JFK

k. Usage of a comma before and a period after is optional, but use both or neither. Do not use all capitals (JR, SR).


Example: John F. Kennedy Jr or John F. Kennedy, Jr.

2. The following are not punctuated a. Metric and English units of measurements. Examples:

wpm mph ft oz sq in mg ml cm km b. Certification, registration, license abbreviations Examples:

CMA-A CMT RN RRA ART LPN c. Acronyms Examples:

CARE HOPE AIDS UCLA

d. Abbreviations typed in capital letter. Examples:

UCLA PKU ICU CBC COPD e. Scientific abbreviations typed in a combination of capital and lowercase letters Examples:

Rx Dx Hb pH IgG mEq f. Abbreviations that are brief forms of words. Examples:

exam phenobarb sed rate flu Pap smear. g. If the amount is less than $1. Example:

50 cents SEMICOLON (;) Semicolons are sometimes used instead of periods in cases where sentences are grammatically independent but the meaning is closely connected. Semicolons are not as common as periods or commas. Examples:

Some people work best in the mornings; others do better in the evenings. It is a fine idea; let us hope that it is going to work.

SEMICOLONS

• help preserve the continuity of the subject • help the reader to grasp the relationship between one clause and the

next. • Indicate a relationship that is too close for a period and too remote for

commas.


• Serve to separate clauses that describe different aspects of the same subject

In general, use a semicolon to mark a separation when a comma is inadequate and a period is too final. RULES 1. Use a semicolon instead of a comma when the second clause is closely linked to the first without a conjunction. Examples:

He had numerous complaints; several were inconsistent with one another. Too often, the tablets are allowed to become stale and inert from storage; they

should be fresh. You have requested our cooperation; we have complied.

2. Use a semicolon to separate closely related independent clauses when they are not connected by conjunction (and, but, for, nor, yet, so.) Alternatively, the independent clauses may be written as separate sentences, but keep in mind that the semicolon demonstrates a relationship or link between the independent clauses that the period does not. Examples:

The patient had a radical mastectomy for malignancy of the breast; the nodes were negative. (preferred)

or The patient had a radical mastectomy for malignancy of the breast. The nodes

were negative. (acceptable) 3. Use a semicolon before a conjunction connecting independent clauses if one or more of the clauses contain complicated internal punctuations. Examples:

The left inguinal region was prepped and draped in the usual fashion; and with 2% lidocaine for local anesthesia, a radiopaque #4 French catheter was introduced into the left common femoral artery, employing the Seldinger technique.

Use a semicolon to separate closely related independent clauses when the second begins with a transitional word or phrase such as also, besides, however, in fact, instead, moreover, namely, nevertheless, rather, similarly, therefore, then, or thus. Alternatively, the independent clauses may be written as separate sentences, but again, keep in mind that the semicolon shows a link or relationship between the clauses that the period does not. Examples:

The patient had a radical mastectomy for a malignancy of the breast; however, the nodes were negative. (preferred)

or The patient had a radical mastectomy for a malignancy of the breast. However,

the nodes were negative. (acceptable) I attempted a labor induction with Pitocin, and contractions occurred; however,

the patient failed to develop an effective labor pattern.


Items in a series: Use a semicolon to separate items in a series if one or more items in the series include other internal punctuation. This usage is frequently seen in list of medications and dosages, as well as in list of lab results. Example:

The patient received Cerubidine 120 mg daily x3 on February 26, 27, and 28; he received Cystosar 200 mg IV over 12 hours x14 doses beginning February 26; and thioguanine 80 mg in the morning and 120 mg in the evening x14 doses, for a total dose of 200 mg a day, starting February 26.

His lab results showed white count 5.9, hemoglobin 14.6, hematocrit 43.1, PT 11.2, PTT 31.4; and urine specific gravity 1.006, pH 6, with negative dipstick and negative microscopic exam.

Among those present at the Utilization Committee Meeting were Dr. Frank Byron, chief-of-staff; Mrs. Joan Armath, administrator; Ms. Nancy Speeth, medical records technician; and Mr. Ralph Johnson, director of nurses.

You may use the sports facilities on condition that your subscription is paid regularly; that you arrange for all necessary cleaning to be carried out; that you undertake to make good any damage.

COLON Colons(:) The primary function of a colon as a punctuation mark is to introduce what follows: a list, series, or enumeration; sometimes a quotation (in place of a comma.)

She said: “I have never gotten along with my mother, and I no longer try.” or

She said, “I have never gotten along with my mother, and I no longer try.” Do not use a colon to introduce words that fit properly into the grammatical structure of the sentence without the colon, for e.g., after a verb, between a preposition and its object, or after because. Example:

The patient is using Theo-Dur, prednisone, and Bronkometer. The patient is on Theo-Dur, prednisone, and Bronkometer. He came to the emergency room because he was experiencing fever and chills

of several hours’ duration. Capitalize the word following the colon if it is normally capitalized or if it follows a heading or subheading. Examples:

The patient is on the following medications: Theo-Dur, prednisone, Bronkometer. ABDOMEN: Benign.

A colon may be used instead of a semicolon to separate main clauses when the second one explains or expands upon the first.

He had numerous complaints; several were inconsistent with one another. or

He had numerous complaints: several are inconsistent with one another.


Colons are also used with Explanations Example:

We decided not to go on holiday: we had too little money. Lists Example:

The main points are as follows: (1) Y, (2) Y, (3) Y, We need three kinds of support: economic, moral and political.

A colon can introduce a subdivision of a subject - for instance, in a title or heading. Punctuation: Colon Colons are more often followed by capital letters. A colon is usually placed after the opening salutations (Dear…) in a business letter. Example:

Dear Mr. Callan: Use a colon to introduce a list (as follows, such as, namely, the following) Example:

His symptoms include all of the following: Dyspnea on exertion, fatigue, and productive cough.

Past History: Usual childhood diseases; no sequelae Allergy: Patient denies any drug or food sensitivity Re: Mrs. Blanche Mitchell Reference: # 306-A Subject: Stress Test Vital Signs: Temperature: 101. Pulse: 58. BP: 130/90. Respirations: 18.

DO NOT USE A COLON BETWEEN A VERB AND LIST THAT FOLLOWS. Examples:

His symptoms include exertion, fatigue, and productive cough Place a colon between the hours and minutes indicating the time in figures. Example:

Her appointment is for 10:30 a.m. The colon and double zeroes are not used with the even time of day, (10 a.m.) Use a colon to express a ratio or mathematical expression showing the relationship of one part to another. Example:

1:10 was instilled

HYPHEN (-) Hyphens as word connectors or joiners may be permanent or temporary. Do not space before or after a hyphen. Exception: Single-space after a suspending hyphen (one used to connect a series of compound modifiers with the same base term). Example:

We used 3- and 4-inch bandages.


RULES Use a hyphen when two or more words have the force of a single modifier before a noun. Examples:

figure-of-eight sutures Self-addressed envelope End-to-end anastomoses Self-inflicted knife wound Well-known speaker Ill-defined tumor mass Large-for-date fetus Up-to-date reference book

Use a suspending hyphen in a series of compound modifiers. Example:

There were small- and large-sized cysts scattered throughout the parenchyma. Hyphenate compound numbers 21 to 99 when they are written (spelled) out. Example:

Fifty-five medical transcriptionists attended the meeting last night. Use a hyphen when there is a prefix before a proper noun. Examples:

Anti-American pseudo-Christian. The estimated date of confinement is mid-May.

Use a hyphen after the prefixes "ex", "self" and after other prefixes to avoid an awkward combination of letters, such as two or more identical vowels in a sequence, and when it will assist in reading and pronunciation. Examples:

salpingo-oopherectomy, self-inflicted, re-x-rayed (but x-rayed again preferred), co-workers, re-emphasize

Use a hyphen after a prefix when the unhyphenated word would convey a different meaning Example:

re-treat, re-creation, and re-cover PREFIXES Do not use a hyphen with the prefixes, bi-, tri-, uni-, co-, contra-, counter-, de-, extra-, infra-, intra-, mid-, mini-, multi-,micro-, pseudo-, sub-, super-, supra-, ultra-, out-, over-, ante-, anti-, semi-, un-, non-, pre-, post-, pro-, trans-, and re-, unless there are identical letters in a sequence. Examples:

Preoperative, postoperative, antenatal, antecubital, antithesis, bitemporal, cooperate, contraindication, counterproductive, defibrillate, extraterrestrial, infraumbilical, interpersonal, intracranial, microscope, midline, nontender, overenthusiastic, preoperative, profile, pseudocele, reimburse, semicircular, sublingual, superficial, supramammary, transvaginal, trivalent, ultraviolet, unencumbered, underwear.


Use a hyphen following a single letter joined to a word forming a coined word. Examples:

x-ray, T-cell count, U-bag, C-section Place a hyphen between compound nouns and compound surnames. Example:

A Davis-Crowe mouth gas was used. Use hyphens to assist in pronunciation. Example:

co-workers, re-study COMPOUND MODIFIERS A compound modifier is 2 or more words that act as a unit modifying a noun or pronoun. The use of hyphens varies depending on the type of compound modifier. Some compound modifiers are so commonly used together that they are automatically read as a unit and do not need to be joined with hyphens. Examples:

deep tendon reflexes jugular venous distension left lower quadrant low back pain normal sinus rhythm right upper quadrant central nervous system atrial septal defect

Do not use hyphens in compound modifiers that are clear without them. Example:

Dark brown lesion. ADJECTIVE ENDING IN "LY" Use hyphen in a compound modifier beginning with an adjective ending in "ly". (This requires distinguishing between adjectives ending in "ly" and adverbs ending in ly; compound modifiers containing an adverb ending in "ly" do not take a hyphen). Examples:

Scholarly-looking patient. Squirrelly-faced stuffed animal. but Quickly paced steps.

ADJECTIVE-NOUN COMPOUND Use a hyphen in an adjective-noun compound that precedes and modifies another noun. Example:

Second-floor office. but The office is on the second floor.


ADJECTIVE WITH PREPOSITION Use hyphens in most compound adjectives that contain a preposition Examples:

Figure-of-eight Finger-to-nose

ADJECTIVE WITH PARTICIPLE Use a hyphen to join an adjective to a participle, whether the compound precedes or follows the noun. Examples:

Good-natured, soft-spoken patient. The patient is good-natured and soft-spoken.

ADVERB WITH PARTICIPLE OR ADJECTIVE Use a hyphen to form a compound modifier made up of an adverb coupled with a participle or adjective when they precede the noun they modify but not when they follow it. Examples:

Well-developed and well-nourished male but

The patient was well developed and well nourished. Fast-acting medication but The medication was fast acting. ADVERB ENDING IN "LY" Do not use a hyphen in a compound modifier to link an adverb ending in "ly" with a participle or adjective. Examples:

Recently complete workup Moderately acute pain

ADVERB WITH "VERY" Drop the hyphen in a compound modifier with a participle or adjective when it is preceded by the adverb very. Example:

Very well developed patient. DISEASE-ENTITY MODIFIERS Do not use hyphens with most disease-entity modifiers even when they precede the noun. Examples:

cervical disk disease oat cell carcinoma pelvic inflammatory disease sickle cell disease urinary tract infection

but insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus.


EPONYMS Use a hyphen to join 2 or more eponymic names used as multiple-word modifiers of operations, procedures, instruments, etc…Do not use a hyphen if the eponymic name refers to a single person. Use appropriate references to differentiate. Examples:

Osgood-Schlatter disease Chevalier Jackson forceps

EQUAL, COMPLEMENTARY, OR CONTRASTING ADJECTIVES Use a hyphen to join 2 adjectives that are equal, complementary or contrasting. Examples:

anterior-posterior infarction Physician-patient confidentiality issue His eyes are blue-green.

FOREIGN EXPRESSIONS Do not hyphenate foreign expressions used in compound adjectives even when they precede the noun they modify (unless they are always hyphenated). Examples:

in vitro experiments carcinoma in situ cul-de-sac (always hyphenated). ex officio member

HIGH AND LOW Use a hyphen in most high and low compound adjectives. Examples:

high-density mass low-frequency waves

NOUN WITH PARTICIPLE Use a hyphen to join a noun and a participle to form a compound modifier preceding a noun. Examples:

bone-biting forceps Pus-aspirating methods Mucus-coated throat (the throat was coated with mucus not mucous) Callus-forming lesion (the lesion was forming callus, not callous).

NUMERAL WITH WORDS Use a hyphen when numbers are used with words as a compound modifier preceding a noun. Examples:

5-cm incision 3-week history

SERIES OF HYPHENATED COMPOUND MODIFIERS Use a suspending hyphen after each incomplete modifier when there is a series of hyphenated compound modifiers with a common last word that is expressed only after


the final modifier in the series. If one or more of the incomplete modifiers is not hyphenated, repeat the base with each, hyphenating or not, as appropriate. Examples:

10- to 12-year history Full- and split-thickness grafts Preoperative and postoperative diagnoses (not pre- and postoperative diagnosis)

TO CLARIFY OR AVOID CONFUSION Use a hyphen to clarify meaning and to avoid confusion, absurdity, or ambiguity in compound modifiers. Example:

large-bowel obstruction (obstruction of the large bowel, not a large obstruction of the bowel)

COMPOUND MODIFIERS FORMED FROM COMPOUND MODIFIERS Use a hyphen to join hyphenated compound modifiers or a hyphenated compound modifier with a one-word modifier Example:

Non-insulin-dependent diabetes (from insulin-dependent diabetes) COMPOUND WORDS Hyphens are always used in some compound words, never in others. Examples:

father-in-law cul-de-sac vice president chief of staff attorney at law

Use a hyphen to join two nouns that are equal, complementary, or contrasting Examples:

blood-brain barrier secretary-treasurer

Use a hyphen in compound verbs unless one of the terms is a preposition. Examples:

single-space but follow up

Sometimes hyphenated compound words become so well established that the hyphen is dropped and the words are joined together without a hyphen. When such a word can be used as either a noun, adjective, or verb, the noun and adjective forms are joined without a hyphen, but the verb form remains two separate words if one of them is a preposition Examples:

Noun, adjective verb Checkup check up Followup follow up Workup work up


Followthrough follow through

Use a hyphen with all compound nouns containing ex- when ex- means former and precedes a noun that can stand on its own. Examples:

ex-president ex-student

Some terms with a single letter or symbol followed by a word are hyphenated, others are not. Some terms may be unhyphenated in their noun form but hyphenated in their adjective form. Check appropriate references for guidance Examples:

B-complex vitamins T cell T-cell abnormality T wave T-wave abnormality x-rays x-ray results C-section

When a Greek letter is part of the name, use a hyphen after the symbol but not after the spelled-out form. Example:

β-carotene but beta carotene FRACTIONS Hyphenate fractions when written without the whole number Examples:

one-fourth empty two-thirds full

RANGE Use numerals. It is acceptable to use a hyphen between the limits of a range if the following 5 conditions are met.

1. The phrases “from to,” “from through,” “between and” are not used. 2. Decimals and/or commas do not appear in the numeric values. 3. Neither value contains 4 or more digits. 4. Neither value is a negative 5. Neither value is accompanied by a symbol.

When all 5 conditions are not met, use "to" in place of a hyphen. (To may be used, of course, even if the conditions are met.)

8-12 wbc or 8 to 12 wbc but $4 to $5 million 25 to +48 Weight fluctuated between 120 and 130 pounds Platelet counts: 120,000 to 160,000


DO NOT USE A COLON BETWEEN THE LIMITS OF A RANGE. COLONS ARE USED TO EXPRESS RATIOS, NOT RANGES STATUS POST Do not italize. Do not hyphenate. Do not join post to the word or phrase following it. Examples:

Status post hysterectomy SUFFIXES Some suffixes are joined directly to the root word they refer to, others are joined by a hyphen, and still others remain separated by character space. General guidelines follow. Join most suffixes directly to the root word (without a hyphen). Including –fold, -hood, -less, -wise. Examples:

likelihood Likewise Nevertheless Threefold

Sometimes, use a hyphen to avoid triple consonants or vowels. Examples:

shell-like ileo-ascending colostomy

SPACING WITH PUNCTUATIONS NO SPACE WITH THE FOLLOWING 1. Following a period within an abbreviation 2. Following a period used as a decimal point 3. Between quotation marks and the quoted material 4. Before or after a hyphen 5. Before or after a slash 6. Between parentheses and the enclosed material 7. Between any word and the punctuation following it 8. Between the number and the colon in diluted solution 9. On either side of a colon when expressing the time of day 10. After the closing parenthesis if another mark of punctuation follows SINGLE SPACE AFTER 1. A comma 2. A semicolon 3. A period following an initial or at the end of a sentence 4 A period at the end of an abbreviation. 5. The closing parenthesis 6. After a period, question mark, or exclamation point at the end of a sentence


TWO SPACES (OR SINGLE SPACE) 1. A quotation mark at the end of a sentence 2. A colon (except when used within the time of a day or when expressing a diluted solution) 3. A colon used as a punctuation mark. 4. A closing quotation mark. SPELLINGS RULES: 1. -able and -ible words usually end in -able when - the root is a complete word. Adapt - adaptable, change - changeable 2. Words usually end in -ible when—the root is not a complete word. Examples:

Audible, edible, possible—the root is a complete word that has -ive or -ion in one of its forms.

3. -ant/-ance and -ent/ence -- when the suffix is preceded by c having the sound of k, or by g having a hard sound, use -ant, -ance, or –ancy. Examples:

significant, arrogant, applicant, elegance 4. When c has the sound of s, or g the sound of j, use -ent, -ence, or –ency. Examples:

Indigent, innocent, reticent, diligent 5. ei and ie ie: chief, belief, relief, hygiene

ei: receive, conceive, weigh, neighbor, vein 6. Doubling the consonant: Double the final consonant of a one-syllable word before adding a suffix beginning with a vowel, if the final consonant is preceded by a single vowel. Plot plotted, begin beginning, refer referring- before the plural ending -es, the final consonant remains single. Examples: Bus-es, gas-es 7. If the final consonant is preceded by another consonant or by two vowels, do not double the final consonant. React reacting, brief briefing, look looked, laud laudable WORDS COMMONLY MISUSED advise: to recommend (verb). advice: recommendation (noun). affect: to influence; feeling or emotion effect: to accomplish; result or

consequence

appraise: to estimate the nature or quality of

apprise: to give notice to, to inform compose: to make up comprise: to include or consist of


complement: something that completes or balances

compliment: praise desert: arid region; to leave or abandon dessert: final course of a meal emigrate: to leave the country immigrate: to enter and settle in a

country heroin: illegal narcotic heroine: principal female character profuse: abundant, in great amount perfuse: to diffuse, to pass through aid: help aide: assistant accept: to take except: to exclude all ready: completely ready already: previously altar: platform in a church alter: to change born: given birth borne: carried, supported brake: to slow and stop break: to fracture, damage breach: a break breech: the buttocks callous: unfeeling callus: hardened skin complain: complaint: discreet: circumspect discrete: separate

disk: vertebrae disc: phonograph its: belonging to it it’s: it is loose: not tight or bound lose: to experience loss navel: of the navy naval: umbilicus perspective: view, vision prospective: future precede: to go before proceed: to continue prescribe: to recommend proscribe: to prohibit principal: chief, main principle: rule prostate: gland prostrate: lying flat quiet: still quite: very shear: to clip sheer: transparent starring: resembling a star; having the

lead role staring: gazing fixedly stationary: fixed stationery: paper supplies than: as in “greater than.” then: at that time who’s: who is whose: belonging to whom your: belonging to you you’re: you are


QUOTATION MARKS (“ ”) 1. Use quotation marks to enclose the exact words of a speaker. Example:

The patient said, “I have not been feeling well lately.”

2. Use quotation marks to single out words or phrases for special attention. Example:

I can see no reason for “temper tantrums.”

3. Use quotation marks to mark off slang, coined or humorous words. Example:

See if you can schedule a few “well” patients for a change.

4. In quotations, placed the semicolon outside the quotation marks. Example:

The patient clearly stated “no allergies”; yet, his medical record states he is allergic to penicillin.

5. Always place the comma following a quotation inside the closing quotation marks. Example:

The patient stated that the “the itching is driving me crazy,” and she scratched her arms throughout our meeting.

6. Always place periods inside quotation marks. Example:

The consultant’s report reads “The patient is a 21-year-old male referred to me by Dr. Wilson.”

SLASH OR VIRGULE (/) 1. Use a slash in writing certain technical terms. The slash sometimes substitutes for the words, ‘to’, ‘over’. Examples:

She has 20/20 vision. His blood pressure is 120/80. grade ¼ murmur

2. Use a slash to write fractions Example: 2/3. Use a slash to separate numerals representing the month, day, year in tables and figures. Do not use hyphens instead of virgules Examples:

Admission: 4/4/94 but The patient was seen on April 4, 1994. not The patient was seen on 4-4-94.


PER To express per with a virgule there must at least one specific numeric quantity, and the element immediately on each side of the virgule must be either a specific numeric quantity or a unit of measurement. Do not use a virgule if the unit of measure does not have an acceptable abbreviated form, when a prepositional phrase intervenes between the elements between per, or in nontechnical phrases. Examples:

sed rate: 52 mm/h 120 beats per minute not 120 beats/min

She takes 5 mg of Valium per day . not 5 mg of Valium/day. She weighs in three days per week. not she weighs in 3 d/w.

Do not use more than one virgule per expression. Examples:

4 ml/kg per minute not 4 ml/kg/min

THE APOSTROPHE (‘) Apostrophes have many uses, the most common being to show possession, to form some plurals, and to denote omitted letters or numbers in contractions. Knowing when not to use apostrophes is as important as knowing when to use them. Medical transcription rules for apostrophes generally reflect those of common usage RULES: 1. Use an apostrophe to show singular or plural possession of nouns, relative pronouns, and abbreviations. Examples:

SINGULAR POSSESSIVE: The typist’s responsibility Dr. Farnsworth’s office The waitress’ table James Rose’s appointment

2. PLURALS: Use the general rules to form plurals unless the dictionary provides the plural form. In general, do not use apostrophes but there are exceptions. Examples:

WBCs not WBC’S EEGs not EEG’s PVCs not PVC’s


BRIEF FORMS: Add “s” without an apostrophe Examples:

exams, segs, polys 3. NAMES: Add “s’ (or es ) without an apostrophe to form the plural. Examples:

The Joneses were referred by … 4. NUMBERS (including years) Add “s” without an apostrophe. Exception: With single numerals add ’s. Examples:

500s She is in her 20s 6’s and 7’s

5. UNITS OF MEASURE, ABBREVIATED: The singular and plurals forms are the same. Do not add apostrophe or “s.” Examples:

5 mg, 8 cc

6. POSSESSION: There are general and specialized rules for showing possession, as well as exceptions to these rules. Some of these rules and exceptions follow. Plural nouns ending in “s” are formed by adding an apostrophe after the “s.” Examples:

Typists’ responsibility (more than one.) The Jonesses’ medical records. The employees’ records.

Nouns not ending with “s.” Examples:

patient’s Children’s Jane’s

HYPHENATED NOUNS: My brother-in-law’s book. PRONOUNS:

Nobody’s fault. Anyone’s guess

UNDERSTOOD NOUN:

The stethoscope is Dr. Green’s I consulted Dorland’s

POSSESSION INVOLVING TWO PERSONS:

Dr. Pate and Dr. Frank’s office (one office.) Dr. Pate’s and Dr. Frank’s offices (two offices.) Dr. Thomas’ associate’s diagnosis.


Abbreviation: Proofreading is the CMT’s responsibility. 7. EXPRESSIONS OF TIME, DISTANCE, AND VALUE: Use an apostrophe in possessive expressions of time, distance, and value. Examples:

He should be able to return to work in a month’s time. His cast will come off in two months’ time. I want the patient to feel that she got her money’s worth.

8. PERSONAL PRONOUNS: Personal pronouns such as ‘its’, ‘hers’, ‘yours’, ‘his’, ‘hers’, ‘theirs’, ‘ours’, or ‘whose’ do not require an apostrophe. Examples:

The next appointment is hers. The dog injured its foot. My conclusion Your referral Its course

9. COMPOUND PLURALS CONTAINING A POSSESSIVE: Keep the existing possessive term singular and make the second noun possessive, as well Example:

driver’s licenses’ renewal dates

10. EPONYMS: Do not use possessive form with eponymic terms. Examples:

Apgar score Babinski sign Down syndrome Gram stain Hodgkin disease

11. NOUNS AS DESCRIPTIVE TERMS: Do not add an apostrophe to a noun ending in “s” when it is used as a descriptive term instead of a possessive. Examples:

educators conference business leaders meeting Veterans Administration Doctors Hospital


LESSON 5 BASIC PLURAL RULES FOR ENGLISH AND MEDICAL WORDS

RULES: 1. Adding ‘s’ to the singular usually forms the plural. Examples:

myleogram myleograms disease diseases bronochoscope bronchoscopes

2. When a noun ends in ‘s’, ‘x’, ‘ch’, ‘sh’, ‘z’, add ‘es’ to the singular Examples:

Singular Plural stress stresses fax faxes patch patches crutch crutches dish dishes waltz waltzes

3. When a noun ends in ‘y’ preceded by a consonant change the ‘y’ to ‘i’ and add ‘es’ Examples:

mamoplasty mamoplasties artery arteries

4. When a noun ends in ‘y’ preceded by a vowel add an ‘s’ to the singular word Example:

attorney attorneys 5. When a noun ends in ‘o’ and is preceded by a consonant, in most cases ‘es’ is added to the singular Example:

tomato tomatoes

6. Most nouns that end in ‘f’ or ‘fe’ are made plural by changing the ‘f’ or ‘fe’ to ‘ves’ Examples:

scarf scarves life lives calf calves knife knives

7. Compound words are made plural on the main word when there is one. When there is not a main word, the plural is formed at the end. Examples:

hangers on, mothers-in- law, surgeons, fingerbreadths, follow-ups The following are some of the rules for making medical terms plural. 1. When a word ends in “um,” change the “um” to “a.”


Example: Labium becomes labia

2. When a word ends in “a” form the plural by adding an “e.” Example:

Vertebra becomes vertebrae.

3. When a word ends in “us” change the “us” to “i.” Example:

Coccus becomes cocci

4. When a word ends in “is” change the “is” to “es.” Examples:

urinalysis becomes urinalyses. diagnosis becomes diagnoses

5. When a word ends in “ax” or “ix” change the “x” to “c” and add “es.” Examples:

thorax becomes thoraces

6. When a word ends in “ex” or “ix” change the “ex” or “ix” to “ices.” Examples:

appendix becomes appendices

7. When a word ends in “nx” change the “x” to “g” and add “es.” Examples:

phalanx becomes phalanges EXCEPTIONS

Femur becomes femora epididymis becomes epididymides iris becomes irides foramen becomes foramina adenoma becomes adenomata

SPECIAL PLURAL FORMS: Some words change form in the plural.

Singular Plural child children woman women

WORDS THAT ARE ALWAYS SINGULAR

ascites herpes lues

WORDS THAT ARE ALWAYS PLURAL

adnexa genitalia

english for mt

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