BSBMED301B: Assignment 1
What you have to do
Using the learning resource provided answer the following questions:

Question 1
Using your knowledge of word components, give the correct medical term for each of the definitions below.
Definition Medical Term
1. rectal hernia Rectocele
2. excision of the stomach Gastrectomy
3. inflammation of the kidney Nephritis
4. enlargement of the liver Hepatomegaly
5. incision to remove a stone Lithotomy
6. fixation of the intestine Enteropexy
7. artificial opening in the colon Colostomy
8. incision into the abdomen Laparotomy
9. absence of one or both testes Anarchism
10. rupture of the uterus Hysterorrhexis
11. excision of the prostate gland Prostatectomy
12. visual examination of the vagina Colposcopy
13. surgical repair of a testicle Orchiopexy
14. discharge of milk Galactorrhea
15. difficult labour or delivery Dystocia
16. suture of the tongue Glossorrhaphy
17. surgical puncture of the abdomen Abdominocentesis
18. pus in the urine Pyuria
19. pertaining to above the kidney Suprarenal
20. narrowing of the urethra Urethral Stricture

Question 2
Give the meaning of each of the abbreviations below.

Abbreviation Medical Meaning
1. LUQ Left upper quadrant
2. GI Gastrointestinal
3. OGD Oesophago-gastro duedenoscopy
4. CVS Chorionic villus sampling
5. STD Sexually transmitted disease
6. IUD Intrauterine device
7. TURP Transurethral resection of the prostate
8. DRE Digital rectal exam
9. UTI Urinary Tract Infection
10. C&S Culture and sensitivity

Question 3
Using your learning resources, give a brief definition of each of the following medical terms.

Medical Term Definition
1. chronic Describing a disease of long duration involving very slow changes.

2. sign An indication of a particular disorder that is detected by a physician while examining a patient but is not apparent to the patient.

3. syphilis A sexually transmitted disease caused by the bacterium Treponema Pallidum, resulting in the formation of lesions throughout the body.

4. benign prostatic hypertrophy Non-cancerous enlargement or growth of the prostate gland.

5. cirrhosis A chronic disease in which the liver slowly deteriorates, with scar tissue replacing healthy liver tissue and partially blocking the flow of blood through the liver.

6. hemodialysis A technique of removing waste materials or poisons from the blood using the principle of dialysis.

7. blood urea nitrogen BUN is a test that reveals important information about how well your kidneys and liver are working. A BUN test measures the amount of urea nitrogen that's in your blood.

8. pancreatitis Inflammation of the pancreas.

9. mastectomy Surgical removal of a breast.

10. CIN Cervical intraepithelial neoplasia -Cellular changes in the cervix of the uterus preceding the invasive stages of cervical cancer.

Question 4

Match the positional and directional terms given below with the correct definitions.
Extension Rotation Flexion
Adduction Supination Abduction
Pronation Dorsiflexion Plantar Flexion
Inversion

Definition Positional/Directional Term
1. movement away from the midline Abduction
2. turning the palm down Pronation
3. turning the palm up Supination
4. straightening out a limb Extension
5. bending the sole of the foot downward Plantar flexion
6. circular movement around an axis Rotation
7. bending a limb Flexion
8. movement toward the midline Adduction
9. backward (upward) bending of the foot Dorsiflexion
10. turning inward Inversion

Case study 1: Female Reproductive System
Susan Smith
Susan Smith has seen her gynaecologist, Dr. Stanley Cunningham, yearly for a routine examination and Papanicolaou (Pap) smear. Every year the results have been normal. Susan is generally a healthy active woman. This year, however, Dr Cunningham’s examination and Pap smear found a problem. When the test results were in, Susan returned for additional testing.

Grove Medical Centre
HISTORY
PATIENT SMITH, Susan
DATE TO BE ADMITTED MAY 9, 2009
CHIEF COMPLAINT Right ovarian cyst
HISTORY OF PRESENT
ILLNESS This is a 34-year-old Caucasian female who had a routine examination on April 21, 2009, at which time the examination revealed the right ovary to be approximately two to three times normal size. Otherwise, all was normal. The Pap smear revealed atypical cells of undetermined significance. The patient returned for a colposcopy, and this revealed what appeared to be squamous epithelial lesions CIN I-II. Biopsies were performed which revealed chronic cervicitis and no evidence of CIN. The patient was placed on Lo-Ovral for two cycles and then was rechecked. The right ovary continued to enlarge and got to the point where it was approximately 4 x 5 cm, floating anteriorly in the pelvis, and was fairly firm to palpation. A pelvic ultrasound confirmed the clinical findings. Superior to the right adnexa was a 4 x 5 cm mass, possibly with haemorrhage into either a paraovarian cyst or a dermoid cyst. The patient is to be admitted now for an exploratory laparotomy.
PAST MEDICAL HISTORY The patient had the usual childhood diseases and has had good health as an adult.
Previous Surgery The patient had a hymenotomy and dilatation and curettage in 2006.
Menstrual History Menstrual cycle is 28 days, averaging a three to six day flow.
Obstetrical History The patient is a Gravida 0.
FAMILY HISTORY Heart disease in the family. Father died of lung cancer. Mother L/W.
REVIEW OF SYSTEMS Non-contributory.

S. Cunningham MD Physical examination
GENERAL The patient is a well-developed, well-nourished Caucasian female in no acute distress.
VITAL SIGNS Height: 170 cm Weight: 61 kg Blood Pressure: 110/82. Normal. The trachea is in the midline. The thyroid is not enlarged.
CHEST Lungs: Clear to percussion and auscultation. Heart: Regular sinus rhythm with no murmur. Breasts: Normal to palpation.
ABDOMEN Soft and flat. No scars or masses.
PELVIC The outlet and vagina are normal. The cervix is moderately eroded. The uterus is normal size and anterior. The left adnexa is negative. The right adnexa has a firm, irregular cystic ovary that is anterior and approximately 5 × 5 cm. This is mobile and non-tender.
EXTREMITIES Normal. Reflexes are grossly intact.
DIAGNOSIS Right ovarian cyst.
PLAN The patient is to be admitted for exploratory laparotomy and ovarian cystectomy.

S. Cunningham, MD

Questions
Answer the following questions. Use your learning material to help you with your answers. Write your answers in the spaces provided.
1 State the patient’s diagnosis and give a brief definition of this diagnosis. Right ovarian cyst. The right adnexa has a firm, irregular cystic ovary that is anterior and approximately 5x5cm. this is mobile and tender. An ovarian cyst is a fluid-filled or semi-solid sac located on or in the ovary.
2 Define the term ‘Pap Smear’. Papanicolaou (pap) smear is a screening tool used to identify early changes in cervical cells that may lead to cancer. The cells are collected from the cervix and placed (smeared) onto a slide which is sent for laboratory examination.
3 What is the result of Ms. Smith’s Pap smear? Is further investigation necessary? The pap smear revealed atypical cells of undetermined significance. This is the most common abnormal finding in a pap test. It may be a sign of infection with certain types of human papillomavirus (HPV). It may also be a sign of benign growth. More testing such as a HPV test maybe needed.
4 Dr. Cunningham performed a colposcopy. Describe this procedure and give Ms. Smith’s results. A colposcopy is a diagnostic procedure that allows for visual examination of the cervix (and vagina) using a colposcope. Ms. Smith’s colposcopy revealed what appeared to be squamous epithelial lesions CIN I-II. Biopsies were performed which revealed chronic cervicitis and no evidence of CIN.
5 What was the positive finding from the biopsy? (Positive in a medical context refers to anything identified or diagnosed.) The biopsies revealed chronic cervicitis and no evidence of CIN.
6 Ms. Smith underwent all the following procedures. Put these in correct sequence by numbering them 1 to 6 in the order they were performed.
5 follow-up examination
3 visualisation with colposcope
6 ultrasound
2 Pap smear
1 routine physical examination
4 Bx

7 The ultrasound revealed a mass that was felt to be a cyst of which type? Either a paraovarian cyst or a dermoid cyst.
8 List and define the two surgeries Ms. Smith has had previous to her current condition. Hymenotomy – is a surgical removal or opening of the hymen. Dilation & curettage – is a procedure to remove tissue from inside your uterus. 9 How many children has Ms. Smith had? Ms. Smith has no children.
10 Mark any of the following abnormal findings from the present physical examination. enlarged uterus gross reflexes
✔ eroded cervix hypertension enlarged thyroid
✔ mobile right ovarian cyst
11 Ms. Smith is to be admitted to hospital. What surgery is planned for this admission? Ms. Smith is to be admitted for exploratory laparotomy and ovarian cystectomy.

Case study 2: Digestive system
Cathryn Lee
At age 72 Cathryn Lee has been in fairly good health. However, one week ago she developed what she called ‘stomach problems’ that led to frequent vomiting. She refused to seek medical help at first, until her daughter coaxed her into calling her family practitioner, Dr. Brown who urged her to go to Accident & Emergency immediately.

Grove Medical Centre
Accident & Emergency Report
REASON FOR This 72-year-old female presented herself to the
ATTENDANCE emergency room with a one-week history of rather severe nausea and vomiting and also diarrhoea and epigastric pain; she was sent by Dr Brown, her family practitioner. The most troubling symptom for her is the vomiting and nausea because she vomits everything she drinks and eats. The epigastric pains are tolerable. The diarrhoea also has somewhat improved. The patient’s bowel movements usually are normal without history of black or bloody stools. Her appetite has been down markedly, and she has lost at least 1 to 2 kg in the last several days. Her urination is normal. She is a social drinker and has a past history of tobacco usage – quit 30 years ago.
MEDICATIONS: Prednisone, 10 mg, 1 q.i.d.; Naprosyn, 250 mg, 1 q noc: Voltaren 1 q d; penicillamine t.i.d.; and Mylanta and Tylenol p.r.n.
ALLERGIES: Demerol, which gives severe confusion lasting for days.
PAST MEDICAL HISTORY/ The patient has reading glasses. There is no history of
REVIEW OF SYSTEMS cephalalgia, diplopia, or tinnitus. There is no history of diabetes or other endocrine disorders.
Cardiopulmonary There is no history of emphysema, hypertension, haemoptysis, dyspnoea, angina, or heart murmurs.
Gastrointestinal The patient had peptic ulcer disease about 15 years ago, non-bleeding, and does not remember whether it was gastric or duodenal. It was healed by diet and antacids. There has been no recurrence since. There is no history of gallbladder disease, hepatitis, pancreatitis, or colitis. However, years ago, she was told she had diverticulosis.
Genitourinary She is Gravida II Para II. Her last menstrual period was some 20 years ago. There is no history of dysuria, haematuria, or nephrolithiasis.
Musculoskeletal The patient has had severe rheumatoid arthritis for about 18 years and has been in treatment with Dr. Carter. The disease is relatively well controlled with the above-mentioned medications. She had a right hip replacement in 2004 and a left knee arthroscopy.
Neuromuscular There is no history of loss of consciousness or seizure disorder.
PSYCHIATRIC REVIEW Negative.
FAMILY HISTORY Parents died of natural causes. One sister and two brothers alive – one brother with prostate CA, sister has RA also.
SOCIAL HISTORY The patient is a widow. She lives with her daughter.

PHYSICAL EXAMINATION
GENERAL: The patient appeared to be in moderate to severe distress, appearing pale with dehydration.
Ms Hillman (cont.)
Blood pressure Blood pressure, lying: 100/70. Blood pressure, sitting: 90/65. Temperature: 37ºC. Pulse: 80; went to 100 on sitting up. Respirations: 12.
Eyes Pupils equal, round, reactive to light and accommodation. No scleral icterus. Fundi benign. Ears, nose, throat and mouth were unremarkable. No lymphadenopathy. No thyromegaly.
Chest Chest, costovertebral angle and back were non-tender.
Lungs Clear to percussion and auscultation.
Heart There was an irregular rate, possibly atrial fibrillation, with a II/VI systolic ejection-type murmur mostly along the left sternal border.
Abdomen Soft. There was moderate epigastric tenderness. There was no hepatosplenomegaly, no guarding, no rebound tenderness, no masses, no ascites, no abdominal bruits.
Rectal examination Good sphincter tone. Light brown, semiformed stool in the rectal ampulla which was occult blood negative.
Extremities No oedema. No varicose veins. Good peripheral pulse. No clubbing. There were, however, brownish changes of chronic stasis dermatitis.
Skin The skin showed 10-15% dehydration without jaundice. There were multiple ecchymoses secondary to the patient’s prednisone.
PROVISIONAL DIAGNOSIS
1 Severe nausea and vomiting, intractable, with dehydration, probably secondary to medication-induced gastritis or possible recurrent peptic ulcer disease. 2 Pancreatitis secondary to prednisone or penicillamine. 3 Viral gastroenteritis.
SECONDARY DIAGNOSIS
1 History of longstanding, advanced rheumatoid arthritis with left knee surgery and right hip replacement. 2 History of diverticulosis and previous peptic ulcer disease.
PLAN The patient will be admitted at least for a 23-hour hold and is then to be re-evaluated and will receive fluid volume replacement and potassium replacement; she will have her electrolytes checked, as well as her blood count, and will also be placed on Zantac intravenously. She will then have a gastroscopy in the morning. Her stools will also be checked, if they are still loose, for further occult blood, ova and parasites, and a possible culture and sensitivity. G. Montgomery MD

Questions
Answer the following questions. Use your learning resources to help you with your answers. Write your answers in the spaces provided.
1 Provide a brief definition for the following medical terms used in this report. rebound tenderness Pain or tenderness that occurs upon sudden release of pressure, especially abdominal pressure. abdominal guarding Tensing of the abdominal wall muscle to guard inflamed organs within the abdomen from the pain of pressure upon them. dehydration Body doesn’t have as much water and fluids as it should rheumatoid arthritis A chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet and ankles intractable Hard to control or deal with.
2 What was Mrs. Lee’s complaint that led her to call Dr Brown, who then sent her to Accident & Emergency? Nausea and vomiting and also diarrhoea and epigastric pain. 3 According to Dr. Montgomery’s initial impression, which factor in Mrs. Lee’s present history might be a cause of her gastrointestinal symptoms? her drinking stress from living with her daughter her allergies
✔ her arthritis medications
4 Identify the two previous operations Mrs. Lee has had involving the musculoskeletal system:

Right hip replacement and left knee arthroscopy.
5 Explain what Mrs. Lee does not remember about her gastrointestinal history. Mrs. Lee had peptic ulcer disease about 15 years ago; she doesn’t remember whether it was gastric or duodenal.
6 Tick all of the findings below that Dr. Montgomery noted in the physical examination of Mrs. Lee.
✔ dehydration pulse 37
✔ clear lungs
✔ chronic stasis dermatitis varicose veins icterus in the whites of eyes vaginal infection
✔ possible atrial fibrillation parotitis yellowing of skin
✔ multiple ecchymoses
✔ irregular heart rate
7 Does Mrs. Lee have blood in her stool? Write the phrase from the report that indicates this.

No. Light brown, semi formed stool in the rectal ampulla which was occult blood negative.

8 Explain Mrs. Lee’s initial diagnoses.
(a) Severe nausea and vomiting, intractable with dehydration, probably secondary to medication-induced gastritis or possible recurrent peptic ulcer disease.
(b) Pancreatitis secondary to prednisone or penicillamine.
(c) Viral gastroenteritis.

9 Dr. Montgomery’s plan calls for administering medications, checking tests, and performing a procedure. Fill in the details below.
Administered to Mrs. Lee:
(a) Fluid volume replacement
(b) Potassium replacement
(c) Zantac intravenously
Check the following:
(d) Electrolytes
(e) Blood count
(f) Stools
10 What procedure is planned for Mrs. Lee? Gastroscopy.

11 Define the laboratory procedure ‘stool culture and sensitivity’. Stool culture and sensitivity is a test of the stool that looks for pathogenic bacteria in the gastrointestinal tract. This test is used to identify what bacterium is causing the infection.