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MEDICAL ASSISTING
REVIEW
Passing the CMA, RMA, CCMA, and NCMA Exams
SeventhEdition
Jahangir Moini, M.D., M.P.H.

Former Professor and Director of Allied Health Sciences including the
Medical Assisting Program, Everest University, Melbourne, Florida; and
Retired Professor of Science and Health, Eastern Florida State College,
Palm Bay, Florida
ISTUDY
Final PDF to printer
MEDICAL ASSISTING REVIEW
Published by McGraw Hill LLC, 1325 Avenue of the Americas, New York, NY 10121. Copyright © 2022
by McGraw Hill LLC. All rights reserved. Printed in the United States of America. No part of this
publication may be reproduced or distributed in any form or by any means, or stored in a database or
retrieval system, without the prior written consent of McGraw Hill LLC, including, but not limited to, in
any network or other electronic storage or transmission, or broadcast for distance learning.
Some ancillaries, including electronic and print components, may not be available to customers outside
the United States.
This book is printed on acid-free paper.
1 2 3 4 5 6 7 8 9 LOV 26 25 24 23 22 21
ISBN 978-1-260-59793-6
MHID 1-260-59793-8
Cover Image: ra2studio/Shutterstock
All credits appearing on page or at the end of the book are considered to be an extension of the
copyright page.
The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a
website does not indicate an endorsement by the authors or McGraw Hill LLC, and McGraw Hill LLC
does not guarantee the accuracy of the information presented at these sites.
mheducation.com/highered
ISTUDY moi97938_fm_ise.indd ii 10/16/20 11:49 AM

ABOUT THE AUTHOR
Dr. Moini was assistant professor at Tehran University School of Medicine for nine years, teaching medical and allied health stu-
dents. The author was a professor and former director (for 24 years) of allied health programs at Everest University. Dr. Moini rees-
tablished the Medical Assisting Program in 1990 at Everest University’s Melbourne campus. He also established several other new
allied health programs for Everest University. He is now a retired professor of science and health at Eastern Florida State College.
Dr. Moini was a physician liaison for the Florida Society of Medical Assistants 2000–2008. He has been a marketing strategy
team member of the National AAMA and president of the Brevard County chapter of the AAMA. He is the author of 43 published
textbooks since 1999. His book entitled “Anatomy & Physiology for Health Professionals” has been translated into Japanese and
South Korean, and released in those countries.
Dedication
To the memory of my Mother,
and
To my wonderful wife,
Hengameh, my two daughters,
Mahkameh and Morvarid,
and also to my precious granddaughters,
Laila Jade and Anabelle Jasmine Mabry.
ISTUDY
BRIEF TABLE OF CONTENTS
Preface ix
SECTION 1 General Medical Assisting Knowledge 1
Chapter 1 The Profession of Medical Assisting 2
Chapter 2 Medical Terminology 12
Chapter 3 Anatomy and Physiology 42
Chapter 4 Pathophysiology 75
Chapter 5 Microbiology 92
Chapter 6 General Psychology 104
Chapter 7 Nutrition and Health Promotion 114
Chapter 8 Medical Law and Ethics 126
SECTION 2 Administrative Medical Assisting Knowledge 160
Chapter 9 Reception, Correspondence, Mail, Telephone Techniques, and Supplies 161
Chapter 10 Appointments, Scheduling, Medical Records, Filing, Policies, and Procedures 180
Chapter 11 Communication in the Medical Office 192
Chapter 12 Keyboarding and Computer Applications 202
Chapter 13 Financial Management 212
Chapter 14 Medical Insurance 233
Chapter 15 Medical Coding 249
SECTION 3 Clinical Medical Assisting Knowledge 284
Chapter 16 Blood-Borne Pathogens and Principles of Asepsis 285
Chapter 17 Preparing the Patient 296
Chapter 18 Vital Signs and Measurement 316
Chapter 19 Pharmacology 326
Chapter 20 Administration of Medication 352
Chapter 21 Electrocardiography 370
Chapter 22 Diagnostic Imaging 381
Chapter 23 Promoting Healing After an Injury 391
Chapter 24 Medical Emergencies and First Aid 403
Chapter 25 Clinical Laboratory 421
PRACTICE EXAMS 471
Practice Exam 1 - CMA 472
Practice Exam 2 - RMA 485
Practice Exam 3 - CCMA 496
Practice Exam 4 - NCMA 504
ANSWER KEYS TO END OF CHAPTER QUESTIONS 514
ANSWER KEY TO TEST YOUR KNOWLEDGE 522
ANSWER KEY TO PRACTICE EXAM 524
INDEX 527
iv
ISTUDY
TABLE OF CONTENTS
Preface ix 3.9 Sensory System 57

3.10 Cardiovascular System 59
3.11 Respiratory System 64
Section 1 General Medical Assisting
Knowledge 1 3.12 Digestive System 65
Chapter 1 – The Profession of Medical 3.13 Endocrine System 67

Assisting 2 3.14 Urinary System 68
1.1 The Profession of Medical Assisting 3 3.15 Reproductive System 70
1.2 Membership in a Medical Assisting Chapter 3 Review 73
Association 4 Chapter 4 – Pathophysiology 75
1.3 Medical Assisting Credentials 4 4.1 Mechanisms of Disease 76
1.4 CMA and RMA Exam Topics 5 4.2 Immunology 76
1.5 Certified Clinical Medical 4.3 Hereditary and Congenital Diseases
Assistant (CCMA) Examination 6 and Conditions 77
1.6 National Certified Medical 4.4 Neoplasia 78
Assistant (NCMA) Examination 6
4.5 Common Infectious Diseases 80
1.7 Externships 6
4.6 Major Diseases and Disorders 80
1.8 Preparing for Employment 7
Chapter 4 Review 90
Chapter 1 Review 9
Chapter 5 – Microbiology 92
Chapter 2 – Medical Terminology 12
5.1 Microorganisms 93
2.1 Word Building 13
5.2 Microbial Growth 96
2.2 Spelling 17
5.3 Microbes and the Human Body 96
2.3 Common Medical Abbreviations 18
Chapter 5 Review 102
2.4 Medical Terminology in Practice 21
Chapter 6 – General Psychology 104
2.5 Unacceptable Abbreviations 38
6.1 Basic Principles 105
Chapter 2 Review 40
6.2 Motivation and Emotion 105
Chapter 3 – Anatomy and Physiology 42
6.3 Personality 105
3.1 Levels of Organization 43
6.4 Humanistic Theory of Personality 106
3.2 Cell Structure 44
6.5 Behavioral/Learning Theory of Personality 107
3.3 Chemistry 45
6.6 Psychological Disorders 108
3.4 Tissues of the Body 46
6.7 Aging and Dying 109
3.5 Division Planes and Body Cavities 47
6.8 Grief 110
3.6 Integumentary System 48
6.9 Promoting Health and Wellness 110
3.7 Musculoskeletal System 49
6.10 Substance Abuse 110
3.8 Nervous System 54
ISTUDY
Chapter 7 – Nutrition and Health Promotion 114 11.2 The Communication Cycle 193
7.1 Nutrition 115 11.3 Types of Communication 194
7.2 Water 115 11.4 Improving Your Communication Skills 194
7.3 Carbohydrates 115 11.5 Communicating in Special Circumstances 196
7.4 Lipids 115 11.6 Communicating with
7.5 Protein 116 Coworkers and Superiors 198
7.6 Vitamins 116 11.7 Managing Stress and Preventing Burnout 198
7.7 Minerals 118 11.8 The Policy and Procedures Manual 198
7.8 Nutrition and Diet Needs 119 Chapter 11 Review 200
7.9 Food-Related Diseases 122 Chapter 12 – Keyboarding and Computer
Chapter 7 Review 123 Applications 202
Chapter 8 – Medical Law and Ethics 126 12.1 The Computer Revolution 203
8.1 Law 127 12.2 Types of Computers 203
8.2 The Law and Medicine 129 12.3 Computer Systems 203
8.3 Ethics 135 12.4 Using Computer Software 206

8.4 Death and Dying 137 12.5 Security in the Computerized Office 208
Chapter 8 Review 138 12.6 Computer System Care and Maintenance 208
Section 1 CMA Review 141 12.7 Computers of the Future 209
Section 1 RMA Review 144 Chapter 12 Review 210
Section 1 CCMA Review 146 Chapter 13 – Financial Management 212
Section 1 NCMA Review 148 13.1 Purchasing 213
Section 1 Test Your Knowledge – General 151 13.2 Accounting 215
13.3 Banking for the Medical Office 219
Section 2 Administrative Medical 13.4 Billing and Collections 222
Assisting Knowledge 160
13.5 Accounts Payable 224
Chapter 9 – Reception, Correspondence, Chapter 13 Review 231
Mail, Telephone Techniques,
and Supplies 161 Chapter 14 – Medical Insurance 233
9.1 Reception 162 14.1 Medical Insurance Terminology 234
9.2 Managing Correspondence and Mail 162 14.2 Types of Health Insurance 235
9.3 Telephone Techniques 173 14.3 Types of Health Plans 236
9.4 Supplies and Equipment in the 14.4 Determination of Benefits 240
Medical Office 175 14.5 Claims Processing 240
9.5 Travel Arrangements 176 Chapter 14 Review 246
9.6 Patient Education 176 Chapter 15 – Medical Coding 249
Chapter 9 Review 177 15.1 Data and Billing Basics 250
Chapter 10 – Appointments, Scheduling, 15.2 Basic Coding 251
Medical Records, Filing, Policies,
15.3 Diagnosis Codes: The ICD-10-CM 251
and Procedures 180
15.4 Procedure Codes 255
10.1 Appointments and Schedules 181
15.5 Comparison of ICD-9-CM
10.2 Medical Records and Filing 184
and ICD-10-CM 257
10.3 Policies and Procedures 188
15.6 HCPCS 257
15.7 Avoiding Fraud 257
Chapter 11 – Communication in the
Medical Office 192 Chapter 15 Review 260
11.1 Communicating with Patients Section 2 CMA REVIEW 263

and Families 193 Section 2 RMA REVIEW 266
vi TA BL E OF C ON T E N T S
ISTUDY
Section 2 CCMA REVIEW 269 20.2 Measuring Medication
Section 2 NCMA REVIEW 272 and Dosage Calculations 354
Section 2 Test Your Knowledge – 20.3 Methods of Administering Medications 357
Administrative 275 20.4 Setting Up Medications 362
20.5 Vaccinations 362
Section 3 Clinical Medical Chapter 20 Review 367
Assisting Knowledge 284
Chapter 21 – Electrocardiography 370
Chapter 16 – Blood-Borne Pathogens and
Principles of Asepsis 285 21.1 The Electrical System of the Heart 371
16.1 Blood-Borne Pathogens 286 21.2 The Electrocardiograph 372
16.2 Medical and Surgical Asepsis 288 21.3 Other Tests 376
16.3 OSHA Requirements 290 21.4 Other Heart Conditions

and Procedures 377
Chapter 17 – Preparing the Patient 296
Chapter 22 – Diagnostic Imaging 381
17.1 Patient Rights, Responsibilities,
and Privacy 298 22.1 Terminology 382
17.2 Medical Interview 298 22.2 Types of Diagnostic Imaging 383
17.3 Physical Examination 299 22.3 Therapeutic Uses of Radiation 385

17.4 Minor Surgery 308 22.4 Medical Assistant’s Role 385
Chapter 17 Review 313 22.5 Safety and Storage 387
Chapter 18 – Vital Signs and Measurement 316 Chapter 22 Review 388
18.1 Vital Signs 317 Chapter 23 – Promoting Healing
After an Injury 391
18.2 Body Measurements 322
23.1 Terminology 392
23.2 Patient Assessment 393
Chapter 19 – Pharmacology 326
23.3 Treatment 393
19.1 General Pharmacology Terms and
Concepts 327 23.4 Mobility-Assisting Devices 396
19.2 Drugs and Their Effects 330 Chapter 23 Review 400
19.3 Drug Administration 337 Chapter 24 – Medical Emergencies
19.4 Antibiotics 337 and First Aid 403
24.1 Emergencies 404
19.5 Pharmacology of the Integumentary
System 340 24.2 Handling Emergencies 404
19.6 Pharmacology of the Musculoskeletal 24.3 Injuries Caused by Extreme
System 340 Temperatures 405
19.7 Pharmacology of the Nervous System 340 24.4 Burns 407
19.8 Pharmacology of the Cardiovascular 24.5 Wounds 408
System 345 24.6 Bites and Stings 410
19.9 Pharmacology of the Respiratory System 346 24.7 Orthopedic Injuries 411
19.10 Pharmacology of the Digestive System 346
24.8 Head and Related Injuries 411
19.11 Pharmacology of the Endocrine System 348
24.9 Diabetic Emergencies 411
19.12 Pharmacology of the Sensory System 348
24.10 Cardiovascular Emergencies 412
19.13 Pharmacology of the Urinary System 348
24.11 Respiratory Emergencies 416
19.14 Pharmacology of the Reproductive
24.12 Digestive Emergencies 416
System 349
Chapter 19 Review 350 24.13 Reproductive System Emergencies 416
Chapter 20 – Administration of 24.14 Poisoning 417

Medication 352 24.15 Bioterrorism 417
20.1 Drug Classifications 354 Chapter 24 Review 418
ISTUDY
Chapter 25 – Clinical Laboratory 421 Practice Exams 471
25.1 Collecting and Testing Blood 423 Practice Exam 1 - CMA 472
25.2 Collecting and Testing Urine 437 Practice Exam 2 - RMA 485
25.3 Medical Microbiology 443 Practice Exam 3 - CCMA 496
Chapter 25 Review 448 Practice Exam 4 - NCMA 504
Section 3 CMA Review 450 Answer Keys to End of Chapter Questions 514
Section 3 RMA Review 453
Answer Key to Test Your Knowledge 522
Section 3 CCMA Review 456
Section 3 NCMA Review 459 Answer Key To Practice Exam 524
Section 3 Test Your Knowledge – Clinical 462 Index 527
v i i i TA BL E OF C ON T E N T S
ISTUDY
Rev. Confirming Pages
PREFACE
Catching your success has never been easier, with the sixth edition of Medical Assisting Review: Passing the CMA, RMA, CCMA, and
NCMA Exams. Confidently master the competencies you need for certification with a user-friendly approach and various practice
exams.
Organization • At the end of each section, there is a new Test Your

Knowledge feature that contains 100 multiple choice
Medical Assisting Review is divided into three sections, questions. The Answer Key for each of these is at the
similar to how the certification exams are divided: General end of the book.
Medical Assisting Knowledge (Chapters 1–8); Administra- • There are four exams included at the back of the book.
tive Medical Assisting Knowledge (Chapters 9–15); and The existing exams have all been updated to reflect new
Clinical Medical Assisting Knowledge (Chapters 16–25). Each material in the chapters, and all of the exams have gone
chapter opens with Learning Outcomes to set the stage for the through an accuracy review.
content to come. That list is followed by a table listing the
relevant CMA, RMA, CCMA, and NCMA Medical Assisting
Competencies for that chapter. Throughout the chapters, you
CHAPTER HIGHLIGHTS
will find At A Glance tables that summarize key information for Definitions have been expanded and added in every chapter in
quick review. At the beginning and end of most chapters, there direct response to market feedback:
are also Strategies for Success boxes, which contain tips on study
• Chapter 4: Information has been added about Zika virus
skills and test-taking skills. Each chapter then closes with the
disease and Ebola virus disease.
Chapter Review—10 multiple-choice questions written in the style
of CMA, RMA, CCMA, and NCMA exam questions. • Chapter 11: The rules or guidelines that determine the
daily working of an office have been removed from the
section entitled “The Policy and Procedures Manual.”
New to the Seventh Edition • Chapter 12: A new section has been added that is called
“Cell Phones and the Internet.”
OVERVIEW
• Chapter 13: A “W-9” form has been added.
A number of enhancements have been made with the sixth edi- • Chapter 15: A new introduction to medical coding has
tion to enrich the user’s experience with the product: been added, and there has been a large amount of updat-
• The Chapter Reviews, at the end of each chapter, have ing and revisions in this chapter.
additional questions so that they now have 25 questions • Chapter 19: Drug information has been completely
each instead of 10. updated.
• This edition has many new figures that did not appear
previously.
ISTUDY moi21793_fm_i-xvi.indd ix 11/22/21 12:46 PM

• Chapter 20: Immunization schedules have been Medical Assisting Review Preparation in the Digital World:
updated. Information on the Coronavirus (COVID-19) Supplementary Materials for the Instructor and Student
has been added.
Instructor Resources
• Chapter 23: This chapter has been retitled as “Promoting You can rely on the following materials to help you and your
Healing After an Injury”; it was previously called students work through the material in this book. All of the
“Physical Therapy.” resources in the following table are available through the
For a detailed transition guide between the sixth and seventh Instructor Resources on the Library tab in Connect.
editions for all chapters of Medical Assisting Review, visit the
Instructor Resources in Connect.
Supplement Features
Instructor’s Manual Each chapter has:
• Learning Outcomes and Lecture Outline
• Overview of PowerPoint Presentations
• Teaching Strategies
• Answer Keys for End-of-Chapter Questions and two Practice Exams from the back of the book
• List of Additional Resources
PowerPoint Presentations • Key Concepts
Electronic Test Bank • TestGen (computerized)
(Two Practice Exams) • Word version
• These two exams are also available in the Library tab of Connect. Both of them, along with 12
additional exams, are available within Connect.
• Questions are tagged with learning outcomes, level of difficulty, level of Bloom’s taxonomy,
feedback, and ABHES and CAAHEP competencies.
Tools to Plan Course • Transition Guide, by chapter, from Moini, 6e, to Moini, 7e
• Correlations of the chapters to the major accrediting bodies (previously included in the book),
as well as correlations by learning outcomes to ABHES and CAAHEP
• Sample Syllabi
• Asset Map—a recap of the key instructor resources, as well as information on the content avail-
able through Connect
A few things to note: office procedures, application of medical knowledge, and appli-
• All student content is now available to be assigned cation of privacy and liability regulation. An ideal way to engage,
through Connect. excite, and prepare students to be successful on the job, Practice
• Instructors can share the answer keys and test bank Medical Office is available for use on tablets and computers.
exams available through the Instructor Resources at It is perfect for the capstone Medical Assisting Examination
their discretion. Preparation course, and Externship course, or may be used
throughout the Medical Assisting program. PMO is accessible
Need help? Contact McGraw-Hill’s Customer Experience
through a widget in Connect. For a demo of Practice Medical
Group (CXG). Visit the CXG website at www.mhhe.com/
Office, please go to http://www.mhpractice.com/products/
support. Browse our FAQs (frequently asked questions) and
Practice_Medical_Office and click on “Play the Demo.”
product documentation and/or contact a CXG representative.
CXG is available Sunday–Friday.
Best-in-Class Digital Support
Practice Medical Office Based on feedback from our users, McGraw-Hill Education has
Practice Medical Office is a 3-D immersive game that features 12 developed Digital Success Programs that will provide you and
engaging and challenging modules representing the functional your students the help you need, at the moment you need it.
areas of a medical practice: Administrative Check In, Clinical, • One-to-One Training: Get ready to drive classroom
and Administrative Check Out. As the players progress through results with our Digital Success Team—ready to provide
each module, they will face realistic situations and learning in-person, remote, or on-demand training as needed.
events, which will test their mastery of critical job-readiness • Peer Support and Training: No one understands your
skills and competencies such as professionalism, soft skills, needs like your peers. Get easy access to knowledgeable
x PR E FAC E
ISTUDY
digital users by joining our Connect Community, or Get started today. Learn more about McGraw-Hill Education’s
speak directly with one of our digital faculty consultants. Digital Success Programs by contacting your local sales
• Online Training Tools: Get immediate anytime, any- representative.
where access to modular tutorials on key features
through our Connect Success Academy at www.mhhe
.com/support.
Remote Proctoring & Browser-Locking Capabilities
New remote proctoring and browser-locking capabilities, hosted by Proctorio within Connect, provide control of the assessment envi-
ronment by enabling security options and verifying the identity of the student.
Seamlessly integrated within Connect, these services allow instructors to control students’ assessment experience by restricting
browser activity, recording students’ activity, and verifying students are doing their own work.
Instant and detailed reporting gives instructors an at-a-glance view of potential academic integrity concerns, thereby avoiding per-
sonal bias and supporting evidence-based claims.
ISTUDY
Instructors: Student Success Starts with You
Tools to enhance your unique voice
Want to build your own course? No problem. Prefer to use our
turnkey, prebuilt course? Easy. Want to make changes throughout the
65%
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semester? Sure. And you’ll save time with Connect’s auto-grading too.
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ISTUDY
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ISTUDY
ACKNOWLEDGMENTS
Suggestions have been received from faculty and students throughout the country. This is vital feedback that is relied on for product
development. Each person who has offered comments and suggestions has our thanks. The efforts of many people are needed to
develop and improve a product. Among these people are the reviewers and consultants who point out areas of concern, cite areas of
strength, and make recommendations for change. In this regard, the following instructors provided feedback that was enormously
helpful in preparing the manuscript.
PREVIOUS EDITION REVIEWERS Cheryl Kolar, AS in HS, RMA, LPN

Cecil College
Many instructors have attended focus groups or reviewed the
Sarah Kuzera, BS, AAS, CMA (AAMA)
manuscript while it was in development, providing valuable feed- Bryan Career College
back that has directly impacted the last six editions.
Angela LeuVoy, AAMA, CCMA, CMA, CMRS
Elizabeth Cason, CPC, CDC, CMA Fortis College
Centura College
Lynnae Lockett, RMA, CMRS, RN
Cheryl Kolar, AS in HS, RMA, LPN Bryant and Stratton College
Cecil College
Marta Lopez, MD, LM, CPM, RMA, BMO
Sarah Kuzera, BS, AAS, CMA (AAMA) Miami Dade College
Bryan University Carrie A. Mack, AS, CMA (AAMA)
Melissa Rub, CMA (AAMA) Branford Hall Career Institute
Rasmussen College Lori Mikell, RMA, AHI
Jodi Wyrick, MBA, BBA, CMA (AAMA) Ridley-Lowell Business and Technical Institute
Bryant and Stratton University Nanci Milbrath, AAS, CMA (AAMA)
Ramona Atiles Pine Technical College
New Life Business Institute Shauna Phillips, CCMA, CPT, CET, CMT
William Butler, RMA, MHA Fortis College
ECPI University Dale Schwartz, RMA
Elizabeth Cason, CPC, CDC, CMA Sanford-Brown Institute
Centura College Lisa Smith, CMA (AAMA), LXMO
Amanda Davis-Smith, NCMA, AHI, CPC Minnesota School of Business
Jefferson Community College Kasey Waychoff, CMA, CPT
Jessica DeLuca Centura College
College of Westchester Jodi Wyrick, MBA, BBA, CMA (AAMA)
Kathy Gaeng, AOS in Bus Mgmt, MA, RMA, Red Cross Bryant and Stratton College
Instructor, Proctor-NCCT, Burdick Cert. Deborah Zenzal, RN, BSN, MS, CPC, CCS-P, RMA
Vatterott College Penn Foster College
Henry Gomez
ASA College SURVEY RESPONDENTS
Gabriel Holder Multiple instructors participated in surveys to help guide the
Berkeley College early development of the product.
Karlene Jaggan, NRAHA, PN, BIT Doris Allen, LPN
Centura College Wichita Technical Institute
xiv
ISTUDY
Rev. Confirming Pages
Annette S. Baer, CMA (AAMA) TECHNICAL EDITING/ACCURACY PANEL

Johnicka Byrd, CMA (AAMA), AS
Virginia College A panel of instructors completed a technical edit and review of
Monica Cox, CMA, BA in HRM, MHA the content in the book page proofs to verify its accuracy.
Virginia College Annette S. Baer, CMA (AAMA)
Todd Farney, BS, DC Shauna Phillips, CCMA, CPT, CET, CMT
Wichita Technical Institute Fortis College
Kathy Gaeng, AOS in Bus Mgmt, MA, RMA, Red Cross Melissa M. Rub, BA, CMA (AAMA)
Instructor, Proctor-NCCT, Burdick Cert. Rasmussen College
Vatterott College Deborah Wuethrick, MBA/HR, AMT, CPT, CMAA, NHA,
Cindy Gordon, MBA, CMA (AAMA) BLS, AHA
Baker College Computer Systems Institute
Gary L. Hayes, MD
ECPI University
Pamela Hurst, CMA/AC (AAMA), AS
Ridley-Lowell Business and Technical Institute
SYMPOSIA
Christina Ivey, NRCMA, BSHS/M
Centura College An enthusiastic group of trusted faculty members active in this
course area attended symposia to provide crucial feedback.
Karlene Jaggan, NRAHA, PN, BIT
Centura College Sandra Brightwell, RHIA
Hunter Jones, PhD RN Central Arizona College
Virginia College Linda Buchanan-Anderson, RN, BSN, RMA (AMT)
Angela LeuVoy, AAMA, CCMA, CMA, CMRS Central Arizona College
Fortis College William Travis Butler, RMA, MHA
G. Martinez, BS (HSO), MS (HA), Cert. Medical Billing ECPI University
Wichita Technical Institute Mohammed Y. Chowdhury, MBBS, MPH, CCA (AHIMA),
M. McGuire, RN CBCS (NHA), CAHI (AMT)
Wichita Technical Institute Lincoln Technical Institute
Lori Mikell, RMA, AHI Kristy Comeaux, CMA, CPT, EKG
Ridley-Lowell Business and Technical Institute Delta College
Mariela Nale, CMA, RPT Amanda Davis-Smith, NCMA, AHI, CPC
Centura College Jefferson Community and Technical College
Sherry Nemconsky, CMA
Marylou de Roma-Ragaza, BSN, MSN, RN
Ridley-Lowell Business and Technical Institute
Lincoln Educational Services
Shauna Phillips, CCMA, CPT, CET, CMT
Kathy Gaeng, RMA, CAHI
Fortis College
Vatterott College
Sharmalan Sathiyaseelan, MD, RMA
Karlene Jaggan, PN, NRCAHA, BIT
Sanford-Brown Institute
Centura College
Lucy Schultz, BBA, NCICS
Dorsey Schools Jennifer B. Kubetin, CEHR
Branford Hall Career Institute
Dale Schwartz, RMA
Sanford-Brown Institute Cheryl A. Kuck, BS, CMA (AAMA)
Rhodes State College
LaShawn Smalls, DC
Virginia College Lynnae Lockett, RN, RMA, MSN
Bryant & Stratton College
Amy Voytek
Westmoreland College Marta Lopez, MD, LM, CPM, RMA, BMO
Miami Dade College – Medical Campus
Kasey Waychoff, CMA, CPT
Centura College Carrie A. Mack, CMA (AAMA)
Branford Hall Career Institute
Andrea Weymouth, CMA, NCCT, RMA
Ridley-Lowell Business and Technical Institute Nanci Milbrath, AAS, CMA (AAMA)
Pine Technical College
Deborah Wuethrick, MBA/HR, AMT, CPT, CMAA, NHA,
BLS, AHA Corina Miranda, CMPC-I, CPC
Computer Systems Institute Kaplan College
Deborah Zenzal, RN, BSN, MS, CPC, CCS-P, RMA Angela M. B. Oliva, BS, CMRS
Penn Foster College Heald College and Boston Reed College
ISTUDY moi21793_fm_i-xvi.indd xv 06/30/21 01:56 PM

Debra J. Paul, BA, CMA-AAMA Stephanie McGahee, CMA (AAMA)
Ivy Tech Community College Augusta Technical College
Denise Pruitt, EdD Nanci Milbrath, AAS, CMA (AAMA)
Middlesex Community College Pine Technical College
Wendy Schmerse, CMRS Lori Mikell, RMA, AHI
Charter College Ridley-Lowell Business and Technical Institute
LaShawn D. Sullivan, BSHIM, CPC Sherry Nemconsky, CMA
Medtech Ridley-Lowell Business and Technical Institute
Gina F. Umstetter Debra J. Paul, BA, CMA-AAMA
Bachelor in Computer Management, MSIT (ABT) Ivy Tech Community College
Instructor, Delta College of Arts & Technology Denise Pruitt, Ed.D.
Lisa Wright, CMA (AAMA), MT, SH Middlesex Community College; Fisher College
Bristol Community College Kristy Royea, MBA, CMA (AAMA)
Deborah Ann Zenzal, RN BSN MS CCS-P CPC RMA Mildred Elley College
Penn Foster Dale Schwartz, RMA
Sanford-Brown Institute
SPECIAL THANKS TO THE Lisa Smith, CMA (AAMA), LXMO
INSTRUCTORS WHO HELPED WITH Minnesota School of Business
THE DEVELOPMENT OF CONNECT AND Sharon L. Vaughan, RN, BSN, RMA (AMT)
LEARNSMART. THESE INCLUDE: Georgia Northwestern Technical College
Kasey Waychoff, CMA, CPT
Belinda Beeman, M.Ed, CMA (AAMA), PBT (ASCP)
Centura College
Eastern New Mexico University-Roswell
Sten Wiedmeier RMA, BS
Kendra Barker, AA, BS
Bryan University
Pinnacle Career Institute
William Travis Butler, RMA, MHA
ECPI University ACKNOWLEDGMENTS FROM
Susan Cousins, RN, CPC, M.Ed., MBA THE AUTHOR
Daymar College-Online Sincere thanks go to the following McGraw Hill staff for their
Carol Dew, MA-T, CMA-AC (AAMA) considerable efforts, invaluable assistance, and vital guidance
Baker College during the development of this book:
Amy Ensign, CMA (AAMA), RMA (AMT) Chad Grall, Managing Director for Health Professions;
Baker College William Lawrensen, Executive Brand Manager; Harper
Patti Finney, CMA Christopher, Executive Marketing Manager; Christine “Chipper”
Ridley Lowell Business and Technical Institute Scheid, Senior Product Developer; Katie Ward, Digital Product
Analyst.
Cheryl Kolar, AS in HS, RMA, LPN
Cecil College I would also like to thank Danielle Mbadu for her work on
revising the Instructor’s Manual and PowerPoint presentation,
Cheryl A. Kuck, BS, CMA (AAMA)
and Tammy Vannatter for her work on revising and updating the
Rhodes State College
Connect materials.
Sarah Kuzera, BS, AAS, CMA (AAMA) Additionally, I would like to express my appreciation to
Bryan Career College McGraw Hill for providing the artwork that helped illustrate this
Marta Lopez, MD, LM, CPM, RMA, BMO book. Lastly, I would like to thank Greg Vadimsky, Assistant to
Miami Dade College–Medical Campus the Author, for his help. I would also like to acknowledge the
Carrie A. Mack, CMA (AAMA) reviewers listed for their time and efforts in aiding me and con-
Branford Hall Career Institute tributing to this book.
x v i AC K NOW L E D G M E N T S
ISTUDY
GENERAL MEDICAL SECTION 1
ASSISTING
KNOWLEDGE
SECTION OUTLINE
Chapter 1 – The Profession of Medical Assisting

Chapter 2 – Medical Terminology
Chapter 3 – Anatomy and Physiology
Chapter 4 – Pathophysiology
Chapter 5 – Microbiology
Chapter 6 – General Psychology
Chapter 7 – Nutrition and Health Promotion
Chapter 8 – Medical Law and Ethics
ISTUDY
CHAPTER 1
THE PROFESSION OF
MEDICAL ASSISTING
LEARNING OUTCOMES
1.1 Describe the administrative, clinical, and 1.5 Explain the requirements for obtaining
specialized duties of a medical assistant. and maintaining the CCMA credential.
1.2 List the benefits of a medical assisting program. 1.6 Describe the subject areas covered by the NCMA
1.3 Identify the different types of credentials exam.
available to medical assistants through 1.7 Describe the purpose and benefits of the extern
examination. experience.
1.4 List the three areas of knowledge included 1.8 Describe the personal attributes of a professional
in the CMA and RMA exams. medical assistant.
MEDICAL ASSISTING COMPETENCIES
COMPETENCY CMA RMA CCMA NCMA
General/Legal/Professional
Respond to and initiate written communications
by using correct grammar, spelling, and formatting
techniques X X X X
Recognize and respond to verbal and nonverbal
c ommunications by being attentive and adapting com-
munication to the recipient’s level of understanding X X X X
Be aware of and perform within legal and ethical
boundaries X X X X
Demonstrate knowledge of and monitor current federal
and state health-care legislation and regulations; main-
tain licenses and accreditation X X X X
Exercise efficient time management X X X X
Project a positive attitude X X X
ISTUDY
MEDICAL ASSISTING COMPETENCIES (cont.)
Be a “team player” X X X
Exhibit initiative X X X
Adapt to change X X X
Project a responsible attitude X X X
Be courteous and diplomatic X X X
Conduct work within scope of education, training,
and ability X X X X
Be impartial and show empathy when dealing with
patients X X X
Understand allied health professions and credentialing X X X
1.1 The Profession of Medical • Coding for specific procedures and tests when filling out
lab requests
Assisting • Collecting payments and speaking with patients about
Medical assisting is one of the most versatile health-care profes- collection policies
sions. Men and women can be equally successful as medical
assistants. They are able to work in a variety of administrative Clinical duties: Medical assistants’ clinical duties vary accord-
and clinical positions within health care. According to the U.S. ing to state law. They may include the following:
Department of Labor’s Occupational Outlook Handbook, medi- • Maintaining asepsis and controlling infection
cal assisting is one of the 10 fastest growing occupations.
• Preparing the examination and treatment areas
• Interviewing patients and documenting patients’ vital
The Duties of a Medical Assistant signs and medical histories
Medical assistants are skilled health-care professionals who • Preparing patients for examinations and explaining treat-
work primarily in ambulatory settings such as medical offices ment procedures
and clinics. The duties a medical assistant may perform include
• Assisting the physician during examinations
administrative and clinical duties.
Administrative duties: Administrative medical assisting duties • Disposing of contaminated supplies
include the following: • Performing diagnostic tests, such as electrocardiograms
(ECGs)
• Greeting patients
• Giving injections (where allowed by law)
• Handling correspondence
• Performing first aid and cardiopulmonary resuscitation
• Scheduling appointments
(CPR)
• Answering telephones
• Preparing and administering medications as directed
• Communicating with patients, families, and coworkers by the physician, and following state laws for invasive
• Creating and maintaining patient medical records procedures
• Handling billing, bookkeeping, and insurance claim • Removing sutures or changing wound dressings
form processing • Sterilizing medical instruments
• Performing medical transcription • Assisting patients from diverse cultural backgrounds, as
• Arranging for hospital admissions and testing well as patients with hearing or vision impairments or
procedures physical or mental disabilities
• Organizing and managing office supplies • Educating patients
• Explaining treatment procedures to patients Medical assistants’ clinical duties may also include process-
• Educating patients ing various laboratory tests. Medical assistants may prepare the
CHAPTER 1 /
ISTUDY
patient for the test, collect the sample, complete the test, report 2013, the state of Washington now requires certification. Source:
the results to the physician, and report information about the https://apps.leg.wa.gov/rcw/default.aspx?cite=18.360&full=true. You
test from the physician to the patient. It must be noted that med- may practice with a high school diploma or the equivalent.
ical assistants are not qualified to make any diagnoses. Specific However, you will have more career options if you graduate from
laboratory duties may include: an accredited school and become certified or registered.
A solid medical assisting program provides the following:
• Performing tests, such as a urine pregnancy test, in the
physician’s office laboratory (POL) • Facilities and equipment that are up to date
• Performing Clinical Laboratory Improvements Act • Job placement services
(CLIA)-waived tests that have a low risk of an erroneous • A cooperative education program and opportunities for
result, which include urinalysis and blood chemistry continuing education
• Collecting, preparing, and transmitting laboratory
specimens, including blood, body fluids, cultures, tissue
samples, and urine specimens
1.3 Medical Assisting Credentials
• Teaching specimen collection to patients Professional associations set high standards for quality and per-
formance in a profession. They define the tasks and functions
• Arranging laboratory services
of an occupation. They also provide members with the opportu-
• Meeting safety standards and fire protection mandates nity to communicate and network with one another.
• Performing as an Occupational Safety and Health
Administration (OSHA) compliance officer State and Federal Regulations
Certain provisions of the Occupational Safety and Health Act
(OSHA) and the Clinical Laboratory Improvements Act of
Specialization
1988 (CLIA ’88) are making mandatory credentialing for medi-
Medical assistants may choose to specialize in a specific field cal assistants a logical step in the hiring process. Currently,
of health care, in either an administrative or clinical area. For OSHA and CLIA ’88 do not require that medical assistants be
example, ophthalmic medical assistants help ophthalmologists credentialed. However, various components of these statutes
(physicians who provide eye care) by administering diagnostic and their regulations can be met by demonstrating that medical
tests, measuring and recording vision, testing the functioning of assistants in a clinical setting are certified.
a patient’s eyes and eye muscles, and performing other duties. One of the CLIA regulatory categories based on their poten-
Additional training may be required for a medical assistant to tial risk to public health is waived tests. Waived tests are “labo-
specialize in certain areas. ratory examination and procedures that have been approved by
Administrative specialty areas include the following: the Food and Drug Administration (FDA) for home use or that,
• Multiskilled health-care professional as determined by the secretary, are simple laboratory examina-
tions and procedures that have an insignificant risk of an erro-
• Medical office administrator
neous result.”
• Dental office administrator
• Medical transcriptionist
CMA Certification
• Medical record technologist
The Certified Medical Assistant (CMA) credential is awarded
• Coding, billing, and insurance specialist by the Certifying Board of the American Association of Medical
Assistants (AAMA). The AAMA works to raise the standards
Clinical specialty areas include the following:
of medical assisting to a more professional level.
• Histologic technician The AAMA’s address is 20 N. Wacker Drive, Suite 1575,
• Surgical technologist Chicago, IL 60606. Phone: 1-312-899-1500 or 1-800-228-2262.
Fax: 1-312-899-1259. E-mail: certification@aama-ntl.org. Their
• Physical therapy assistant
website address is www.aama-ntl.org.
• CPR instructor
The AAMA Role Delineation Study: In 1996 the AAMA formed
• Medical laboratory assistant
a committee. Its goal was to revise and update the standards
• Phlebotomist used for accrediting medical assisting programs. Accreditation
is defined as a process in which recognition is granted to an
education program. The committee’s findings were published
1.2 Membership in a Medical in 1997 under the title of the “AAMA Role Delineation Study:
Assisting Association Occupational Analysis of the Medical Assisting Profession.”
Included was a new Role Delineation Chart that outlined the
Certification and Registration areas of competence entry-level medical assistants must master.
Certification or registration is not required to practice as a med- The Role Delineation Chart was further updated in 2003. The
ical assistant in most states. However, for instance, as of July AAMA’s certification examination evaluates the mastery of
4 S E C T IO N 1 / General Medical Assisting Knowledge

ISTUDY
medical assisting competencies on the basis of the 2003 Role ARMA is a national registry established in 1950 that certi-
Delineation Study. To take this exam, you must have gradu- fies medical assistants who have provided the necessary docu-
ated from a postsecondary accredited program. The National mentation to be a qualified medical assistant.
Board of Medical Examiners (NBME) also provides techni- ARMA grants qualified members the credential of RMA for
cal assistance in developing the tests. Its website address is clinical medical assistants and RMA-A for administrative medical
www.nbme.org. assistants. The ARMA’s website address is http://arma-cert.org.
The areas of competence listed in the AAMA Role
Delineation Study must be mastered by all students enrolled in
accredited medical assisting programs. Each of the three areas 1.4 CMA and RMA Exam Topics
of competence—administrative, clinical, and general (or trans-
The CMA and RMA qualifying examinations are rigorous.
disciplinary)—contains a list of statements that describe the
Participation in an accredited program, however, will help you
medical assistant’s role.
learn what you need to know. The examinations cover several
According to the AAMA, the Role Delineation Chart may
distinct areas of knowledge. These include:
be used to:
• Describe the field of medical assisting to other health- • Administrative knowledge, including scheduling appoint-
care professionals ments, managing mail and office correspondence, medical
records management, collections, insurance processing, and
• Identify entry-level competency areas for medical
HIPAA (Health Insurance Portability and Accountability Act)
assistants
• Help practitioners assess their own current competence • Clinical knowledge, including examination room tech-
in the field niques; pharmacology—the preparation, calculation, and
administration of medications; first aid and emergency
• Aid in the development of continuing education programs
care; performing ECGs; specimen collection and labora-
• Prepare appropriate materials for home study tory testing
Recertification for the CMA is required every five years. • General medical knowledge, including terminology,
The medical assistant may choose to recertify by taking the anatomy and physiology, behavioral science, and medi-
examination again, or by obtaining 60 continuing education cal law and ethics
units (CEUs) over this five-year period.
The CMA exam is computer based and features 200 multiple-
RMA Certification choice questions that have “one best answer” from five different
The Registered Medical Assistant (RMA) credential is awarded answer choices. There are 180 questions that are scored, and
by the American Medical Technologists (AMT), an organi- 20 that are pretest questions that are not scored. They are for-
zation founded in 1939. AMT is accredited by the National matted as incomplete statements or questions, and the answer
Commission for Certifying Agencies (NCCA) and a member of choices either complete the statement or answer the question.
the Institute for Credentialing Excellence. After July 15, 2021, the AAMA will change the number and
The AMT’s address is 10700 West Higgins Road, Suite 150, percent of questions by category as follows:
Rosemont, IL 60018. Phone: 1-847-823-5169. Fax: 1-847-823- Clinical competency: 106 (59%), including Clinical Workflow:
0458. E-mail: mail@americanmedtech.org. The AMT’s website Patient Intake and Discharge, Safety and Infection Control,
address is www.americanmedtech.org. Procedures/Examinations, and Pharmacology
General: 9 (21%) including Legal and Ethical Issues, and
Professional support for RMAs: The AMT offers many benefits Communication
for RMAs. These include: Administrative: 6 (20%) including Billing, Coding, and
• Insurance programs, including liability, health, and life Insurance; and Schedule Appoints and Health Information
Management
• Membership in the AMT Institute for Education
For complete information, go to: CMA (AAMA)
• State chapter activities Certification Exam Content Outline located at: http://www
• Annual meeting and educational seminars .aama-ntl.org.
Each person taking the test must achieve a passing score on
Recertification for the RMA is required every three years.
every section in order to become certified. An unofficial “pass”
Also, 30 hours of continuing education credits are required
or “fail” is given immediately after the test, but final confirma-
every year to maintain certification.
tion is mailed within 12 weeks.
The RMA exam is either computer based or can be taken
The American Registry of Medical Assistants using pencil and paper. It features 210 multiple-choice questions
(ARMA) that have “one best answer” from four different answer choices.
Medical assistants who become certified by passing a national Candidates have 2.5 hours to complete the exam. It requires
certification examination (for example, the CMA or RMA) and recall of facts, understanding of medical illustrations, solving
medics in military service may apply for membership with the of problems, and interpretation of information from case stud-
American Registry of Medical Assistants (ARMA). ies. The computerized version of the exam offers an immediate
CHAPTER 1 /
ISTUDY
pass/fail score. If the pencil-and-paper version is taken, results approved medical assistant training program or at least two
will arrive by mail within eight weeks. A score of 70 or above years of on-the-job training that was supervised by a physician.
is required to pass the exam. Candidates who fail the exam will Unlike the other medical assisting exams, the NCMA creden-
be given detailed information about areas in which their knowl- tial must be renewed every year, and 14 continuing education
edge was weakest. Anyone retaking the exam must complete credits must be earned in order for renewal to be approved. The
the entire examination in full. Like the CMA exam, the RMA exam is offered in both computerized and paper forms. It con-
covers three areas: general, administrative, and clinical medical sists of 165 questions, which includes 15 that are not graded.
assisting knowledge. Three hours are allowed to take the exam. The NCMA exam
covers a variety of subject areas, which include pharmacol-
ogy, medical procedures, patient care, phlebotomy, diagnostic
1.5 Certified Clinical Medical Assistant tests, electrocardiogram, general office procedures, medical
(CCMA) Examination office general management, financial management, and law
and ethics.
This credential is awarded by the National Healthcareer
The NCCT’s address is 7007 College Blvd., Suite 385,
Association (NHA). The CCMA exam is offered in a written
Overland Park, KS 66211. Phone: 1-800-875-4404. Fax: 1-913-
form or by computer via its website. It consists of 150 ques-
498-1243. The website address is http://www.ncctinc.com.
tions plus 20 pretest questions covering several distinct areas
Table 1-1 summarizes the various certification examinations
of knowledge. These areas emphasize clinical knowledge,
and their related information.
including general assisting, ECG, phlebotomy, and basic lab
The National Association for Health Professionals (NAHP)
skills. Also included is preparation of patients, such as taking
(http://www.nahpusa.com) offers various credentials for
a medical history, vital signs, physical examination, and patient
health-care professionals. These include the Medical Assistant,
positioning; biological hazards; emergency first aid; infection
Administrative Health Assistant, Coding Specialist, Dental
control; understanding the structure of a prescription; anatomy
Assistant, EKG Technician, Patient Care Technician, Pharmacy
and physiology; law and ethics; pharmacology; specimen han-
Technician, Phlebotomy Technician, and Surgical Technician
dling; quality control; use of microscopes; and various labo-
credentials.
ratory procedures. CCMAs also need 10 hours of continuing
education every two years in order to keep their certification.
Recertification for the CCMA is required every two years. 1.7 Externships
The NHA’s address is 1161 Overbrook Road, Leawood,
An externship offers work experience while you complete a
KS 66211. Phone: 1-800-499-9092 or 1-913-661-5592. Fax:
medical assisting program. You will practice skills learned in
1-913-661-6291. E-mail: info@nhanow.com. The website address
the classroom in an actual medical office environment. A medi-
is http://nhanow.com.
cal assisting extern must be able to accept constructive criti-
cism, be flexible, and also be willing to learn. In an externship,
1.6 National Certified Medical Assistant you may be exposed to some procedures that are not performed
exactly as you were taught in the classroom or clinical labora-
(NCMA) Examination tory. Learn as much as possible while on an externship. It is
The NCMA exam is offered by the National Center for unprofessional to argue with an externship preceptor. Ask your
Competency Testing (NCCT), a for-profit agency. To take externship preceptor to explain any differences in techniques
the NCMA exam, candidates must have completed either an from what you learned while you were in the classroom.
AT A GLANCE Medical Assistant Certification Exams
Organization Credential Fees Notes

American Association of Medical CMA (5 years) $125 for recent graduates Not-for-profit. Annual fees $25–$40
Assistants (AAMA) and members, $250 for for students, up to $107 for
others others, all based on state.
American Medical RMA (3 years) $120 Not-for-profit. Annual fees $50.
Technologists (AMT)
National Healthcareer Association CCMA (2 years) $149 For-profit.

(NHA)
National Center for Competency NCMA (1 year) $90 for recent graduates; For-profit.
Testing (NCCT) $135 for others
Table 1-1

ISTUDY
1.8 Preparing for Employment a natural color and pulled back from your face and off the col-
lar. Perfumes and colognes should be avoided because patients
Career Services will assist you with your resume, interviewing with respiratory conditions or allergies may not be able to
skills, and learning about positions in your field. It is important tolerate them.
to include certification awarded in relation to a position on your Dependability: This is shown by arriving to work on time,
resume. reporting absences ahead of time, generally avoiding absentee-
New employee: An initial performance evaluation should be ism, following orders, making notes of completed tasks, and
given 90 days after employment. preparing materials needed for work.
Initiative: Demonstrating the ability to initiate work, action,
Personal Attributes and decisions.
Medical assistants can be more effective and productive if they Credibility: The quality of being believable and worthy of trust.
have the personal qualifications of professionalism, empathy, Attitude: A positive, upbeat demeanor toward work and
flexibility, self-motivation, integrity and honesty, and account- individuals.
ability. A neat and professional appearance is also essential.
Professionalism: A medical assistant should demonstrate cour- Test-Taking Preparation
tesy, conscientiousness, and a generally businesslike manner It is important to understand all of the content that the exami-
at all times. It is essential for medical assistants to act profes- nation you choose to take will include. You must create a study
sionally with patients, doctors, and coworkers. Present a neat schedule and follow it closely. Waiting until the last minute is
appearance and show courtesy and respect for peers and never a good idea, and may even cause you to fail. Each of these
instructors. exams is difficult and requires sufficient study in order to pass.
Professionalism is also displayed in your attitude. The medi- It is suggested that you take as many practice exams as pos-
cal assistant is a skilled professional on whom many people, sible prior to taking either the CMA, RMA, CCMA, or NCMA
including coworkers and patients, depend. Your attitude can exam. When taking a practice exam, make sure to read all of
make or break your career. A professional always projects a the answer key content, including the rationales for each cor-
positive, caring attitude. The medical assistant should avoid rect answer, and each incorrect answer. This will greatly help
using terms of endearment with patients and remain strictly you to understand the material more deeply, and is a great way
professional. to study. The various organizations that offer these certifica-
Empathy: Empathy is the ability to put yourself in someone tion exams also provide guides and study materials to help you
else’s situation—to identify with and understand another per- prepare. There are also exam study groups, handbooks, and
son’s feelings. Patients who are sick, frustrated, or frightened other materials available via the Internet. Another important
appreciate empathetic medical personnel. It is always advisable suggestion is to practice doing mathematic calculations without
for the medical assistant to ask patients if they need any assis- the use of a calculator or scratch paper, both of which are not
tance, including disabled patients. allowed when you take an actual exam.
Flexibility: An attitude of flexibility will allow you to adapt to On the day of the exam, make sure you are well rested, wear-
and handle situations with professionalism. For example, when ing comfortable clothing, wearing a watch if you have one, and
a physician’s schedule changes to include evening and weekend have eaten enough so that you do not get hungry during the
hours, the staff also may be asked to change their schedules. exam. It is not suggested that you study right up until you leave
Therefore, you must be flexible and meet the employer’s needs. to take the exam, since it is important to allow yourself a little
Self-motivation: You must be self-motivated and offer assistance “buffer time.” Then, you will be more prepared to absorb the
with work that needs to be done, even if it is not your assigned questions, and take in and process information. Arrive early,
job. For example, if a coworker is on sick leave or vacation, and make sure you bring whatever materials are required to
offer to pitch in and work extra time to keep the office running enter the examination area. Do not bring anything else that will
smoothly. not be allowed into that area. Once inside, remember not to talk
Integrity and honesty: Medical assistants with integrity hold to anyone else taking the exam. Never leave the examination
themselves to high standards. Integrity may be characterized area without the permission of the test administrator. Be ready
by honesty, dependability, and reliability. The most important to get started, and remember that with all of your preparations,
elements in providing superior customer service to patients are you should do very well.
integrity and honesty. If you make an error, be honest about it. The most important thing to remember when taking one of
In order to have integrity, you must be dependable and reliable. these exams is to read each question carefully, paying attention
Accountability: Legal, mental, or moral responsibility. In medi- to detail. Questions that contain the words “except” or “not”
cine, it refers to the responsibility for moral and legal require- can be tricky if you read them too quickly. Before you look at
ments of patient care. the answer choices, see if you have the answer already in mind.
Neat appearance: Medical facilities expect externs and their This way, the answer choices will not influence your selection,
staff to appear as medical professionals. Most require a uni- and you are less likely to choose incorrectly. Usually, one or
form that consists of a scrub top and bottom and a lab jacket. more of the answer choices can be easily eliminated. Another
Your name tag or badge should always be worn and visible to tip is to cross off each of these in order to focus on the other
patients. Visible tattoos must be covered. Your hair should be remaining choices more effectively. Methods of “marking”
CHAPTER 1 /
ISTUDY
various questions vary between computerized versions of the making your selection. For paper exams, make sure you mon-
exams, but paper exams are obviously easy to mark up. itor your answer sheet carefully so that you are filling in the
Do not spend too much time on each question; instead, cir- correct area for each question. If you must erase or change an
cle those that seem more difficult and come back to them. Pace answer, make sure you do it clearly so that your intended answer
yourself as you move through the various sections of the test. is obvious. At the end of an exam, or a section of an exam, if you
Do not simply go straight through the questions and attempt to still have extra time, go back over your answers to double check
answer each of them while not paying attention to the time that for any errors.
you are spending on each. Give your eyes a break during your exam by looking away
Make sure you respond to each question. No points will be from the computer monitor or the test paper briefly, every
subtracted for incorrect answers—you are only graded on the 10–15 minutes. Excessive concentration while focusing on them
amount that you answer correctly. For the more difficult ques- can cause eye strain, resulting in a headache.
tions, eliminate as many answer choices as possible prior to

ISTUDY
CHAPTER 1 REVIEW
Instructions: 6. Which of the following terms describes behaving cour-

Answer the following questions. teously, conscientiously, and in a generally businesslike
manner?
1. Accreditation may be defined as A. self-motivation
A. a contract that specifies an agreement. B. professionalism
B. permission to engage in a profession. C. job description
C. permission to be licensed. D. ethics
D. an assessment of an individual’s performance. E. morals
E. a process in which recognition is granted to an
education program. 7. Which of the following constitutes unprofessional behavior
when interacting with an externship preceptor?
2. Which of the following organizations offers the Registered A. accepting criticism
Medical Assistant credential? B. arguing
A. AMA C. being flexible
B. AAMA D. listening to instructions
C. AMT E. having references
D. CDC
E. NBME 8. Which of the following is the correct website address for
the National Board of Medical Examiners?
3. The CMA and RMA examinations cover all of the follow- A. www.nbme.org
ing distinct areas of knowledge except B. www.nbme.gov
A. calculations for preparing medications. C. www.nbm.com
B. HIPAA. D. www.meboard.com
C. criminal justice. E. www.medexam.com
D. medical records.
E. behavioral science. 9. Which of the following is not an example of a medical assis-
tant’s clinical duties?
4. Which of the following professional attributes indicates the A. preparing patients for examinations
ability to identify with someone else’s situation? B. interviewing patients and documenting their vital
A. empathy signs
B. professionalism C. performing diagnostic tests
C. self-motivation D. explaining treatment procedures to patients
D. integrity E. diagnosing communicable diseases
E. flexibility
10. A patient with a physical disability comes to the office. The
5. After you become a certified clinical medical assistant, most appropriate response by the medical assistant is to
how often is recertification required? A. express sympathy regarding the disability.
A. every year B. tell your supervisor.
B. every two years C. ask the patient whether assistance is needed.
C. every three years D. ask the patient how the disability occurred.
D. every five years E. assume that the patient needs assistance and begin
E. every seven years giving aid.
CHAPTER 1 /
ISTUDY
11 All of the following provide a certification examination for 17. How many multiple-choice questions are given to certify as
medical assistants, except an RMA?
A. NHA. A. 110
B. NCCT. B. 150
C. AMT. C. 180
D. NAHP. D. 210
E. AAMA. E. 280
12. Which of the following terms refers to the responsibility 18. Which of the following is not a clinical specialty for
for moral and legal requirements of patient care? medical assistants?
A. empathy A. CPR instructor
B. professionalism B. phlebotomist
C. accountability C. patient educator
D. flexibility D. histologic technician
E. honesty E. surgical technologist
13. The CCMA exam consists of how many questions? 19. Which of the following organizations formed a committee
A. 90 to revise and update standards used for accrediting medi-
B. 120 cal assistant programs?
C. 150 A. HIPAA
D. 180 B. AAMA
E. 210 C. AMT
D. OSHA
14. For obtaining recertification for the CMA, how many con- E. NAHP
tinuing education units (CEUs) over a five-year period are
required? 20. How many years are the CCMA credential good for?
A. 20 A. one
B. 30 B. two
C. 40 C. three
D. 50 D. four
E. 60 E. five
15. Which of the following is the correct website address for 21. Which of the following is the fee for membership in the
the AMT? AAMA?
A. www.medboard.com A. $90
B. www.nbm.com B. $110
C. www.medexam.com C. $115
D. www.americanmedtech.org D. $120
E. www.americannatioanassoc.gov E. $125
16. Which of the following is the most important element in 22. During an examination, excessive concentration on the
providing superior customer service to patients? computer monitor causes eye strain, resulting in which of
A. integrity and honesty the following?
B. flexibility A. headache
C. empathy B. neck pain
D. accountability C. strabismus
E. attitude D. sleepiness
E. hunger

ISTUDY
23. Which of the following organizations is for-profit? 25. What is the fee for CCMAs to take the medical assistant
A. WHO certification exam?
B. NHA A. $120
C. AAMA B. $125
D. AMT C. $149
E. CDC D. $155
E. $90
24. Which of the following is the website address for the
American Registry of Medical Assistants?
A. www.nbme.org
B. http://medscape.com
C. http://medexam.com
D. http://arma-cert.org
E. http://www.ncctinc.com
CHAPTER 1 /
ISTUDY
CHAPTER 2
MEDICAL
TERMINOLOGY
LEARNING OUTCOMES
2.1 Identify and define common roots, suffixes, and 2.4 Define medical terms used in relation to diseases
prefixes. and body systems.
2.2 Demonstrate proper spelling of common medical 2.5 Describe unacceptable abbreviations as outlined
terms in singular, plural, and possessive forms. by the Joint Commission.
2.3 Identify abbreviations commonly used in medical
practice.
MEDICAL ASSISTING COMPETENCIES
COMPETENCY CMA RMA CCMA NCMA
Use appropriate medical terminology X X X X
ISTUDY
STRATEGIES FOR SUCCESS
Study Skills
Organize and manage!
Organize your notes after class. Doing so will not only help you review material but also make it easier to understand your
notes when you go back to them to study for an exam. Organizing your notes right away will also give you plenty of time
to ask your instructor to clarify something you didn’t understand.
2.1 Word Building Suffix: A word ending that modifies the meaning of the root. Not
all words have a suffix. For a list of common suffixes, see Table 2-2.
Root: The main part of a word that gives the word its central Combining vowels: When a medical term is formed from many
meaning. The root is the basic foundation of a word. different word parts, these parts are often joined by a vowel.
Prefix: A structure at the beginning of a word that modifies the This vowel is usually an o and occasionally an i. The vowel o is
meaning of the root. Not all medical words have a prefix. For a the most common combining vowel. The combining vowel is
list of common prefixes, see Table 2-1. used to ease pronunciation.
AT A GLANCE Common General Prefixes
Prefix Meaning Example Definition

a- Without Aphonia Inability to produce sound
ab- From, away from Abduct To move away from the midline of the body
ad-, ac-, af-, ag-, al-, Toward, increasing Adduct To move toward the midline of the body
ap-, ar-, as-, at-
alb- White Albinism Whiteness of skin, hair, and eyes caused by the
absence of pigment
ambi- Both Ambidextrous Able to use both hands effectively
ana- Up, upward Anaphylactic Characterized by an exaggerated reaction
to an antigen or toxin
ante- Before Antepartum Before childbirth
anti- Against Antibiotic Acting against microorganisms
auto- Self Autodermic Of the patient’s own skin
(said of skin grafts)
bi- Two, both Bilateral Pertaining to both sides
bio- Life Biology Study of life
broncho- Bronchus, bronchi Bronchorrhaphy Suturing a wound of the bronchus
circum- Around Circumcision Removal of the skin around the tip of the
penis
con-, col-, com-, cor- Together, with Congenital Accompanying birth, present at birth
contra- Against Contraceptive Preventing conception
de- Away from, down, not Decalcify To decrease or remove calcium
dia- Through Diagnosis Knowledge through testing
dis- Apart, separate Dislocation Removal of any part of the body from its
normal position
Table 2-1, continued
CHA
ISTUDY

dys- Bad, difficult, painful, poor Dysuria Painful urination
ec- Out, away Ectopic Pertaining to something outside its normal
location
ecto- Outside Ectoplasm Outermost layer of cell protoplasm
en-, em- In Endemic Occurring continuously in a population
Empyema Pus in a body cavity
endo- Within Endoscope Instrument to examine something from within
epi- Upon, over Epidermal Upon the skin
eu- Good Eupnea Normal, good breathing
ex-, e- Out, away Exhale To breathe out
Emanation Something given off
hemi- Half Hemicardia Half of the heart
hyper- Excessive, beyond Hyperlipemia Condition of excessive fat in the blood
hypo- Below, under Hypoglycemia Low blood sugar
in-, il-, im-, ir- Not Impotence Inability to achieve erection
infra- Below, under, beneath Inframammary Below the breast
inter- Between Intercellular Between cells
intra- Within Intravenous Within a vein
iso- Equal Isometric Of equal dimension
juxta- Near, beside Juxtaarticular Near a joint
mal- Bad Malaise Discomfort
mega-, megal- / o Large Megacephaly Abnormal enlargement of the head
mes- / o Middle Mesoderm Middle layer of the skin
meta- Beyond, after Metastasis Spread of disease from one part of the body
to another
micro- Small Microscope Instrument used to view small organisms
milli- One-thousandth Milliliter One-thousandth of a liter
mono- One, single Mononuclear Having only one nucleus
multi- Many Multidisciplinary Pertaining to many areas of study
neo- New, recent Neonatal Pertaining to the period after birth
non- Not Noninvasive Not invading the body through any organ,
cavity, or skin (said of a diagnostic or
therapeutic technique)
para- Near, beside, beyond, opposite, Paramedic Person who provides emergency medical
abnormal care (alongside other medical personnel)
per- Through Percutaneous Through the skin

ISTUDY

peri- Around, surrounding Perianal Around the anus
poly- Many Polyarthritis Inflammation of many joints
post- After Postmortem; After death; After taking medications
Postprandial
pre- Before Premature Before maturation

primi- First Primiparous Having given birth for the first time
re- Again, back Reactivate To make active again
retro- Back, backward, behind Retrograde Going backward
rube- Red Rubella Viral disease characterized by red rashes,
among other things
sacro- Sacrum Sacroiliac Pertaining to the sacrum and iliac bones
sarco- Flesh Sarcoma A malignant tumor arising from
connective tissues
semi- Half Semiconscious Half conscious
sub- Under, below Sublingual Under the tongue
super- Above, excessive Superficial Near or above the surface
supra- Above, over Suprapubic Above the pubic area
syn-, sym- Together Symbiosis Mutual interdependence
tri- Three Triceps Muscle with three heads
ultra- Beyond, excessive Ultrasound Sound with a very high frequency, used to
obtain medical images
uni- One Unicellular One-celled
Table 2-1, concluded
AT A GLANCE Common General Suffixes
Suffix Meaning Example Definition

-ac Pertaining to Cardiac Pertaining to the heart
-ad Toward Cephalad Toward the head
-al Pertaining to Thermal Pertaining to the production of heat
-ar Pertaining to Articular Pertaining to a joint
-desis Binding Arthrodesis Surgical binding or fusing of a joint
-e Noun marker Dermatome Instrument used to cut the skin
-ectomy Excision, removal Hysterectomy Removal of the entire uterus
-emesis Vomit Hyperemesis Excessive vomiting
CHA
ISTUDY

-form Resembling, like Vermiform Shaped like a worm
-genic Beginning, originating, producing Toxigenic Producing toxins
-gram Record Electrocardiogram Record of the variations in electrical
potential caused by the heart muscle
-graph Instrument for recording Electrocardiograph Instrument for making electrocardiograms
-graphy Process of recording Electrocystography Process of recording the changes of electric
potential in the urinary bladder
-iasis Condition, formation Lithiasis Formation or presence of stones
-iatric Pertaining to medical treatment Pediatric Pertaining to the treatment of children
-iatry Study or field of medicine Psychiatry Study of the human psyche
-ic Pertaining to Thoracic Pertaining to the thorax
-ical Pertaining to Neurological Pertaining to nerves
-ism Condition Cryptorchidism Condition of undescended testes
-ist Specialist Otorhinolaryngologist Physician who specializes in the ear, nose,
and larynx
-itis Inflammation Appendicitis Inflammation of the appendix
-logist Specialist in the study of Microbiologist Biologist who specializes in the study of
microorganisms
-logy Study of Microbiology Study of microorganisms
-lysis Destruction, breaking down Hemolysis Breaking down of blood
-megaly Enlargement Cardiomegaly Enlargement of the heart
-meter Instrument used to measure Scoliosometer Instrument for measuring the curves
of the spine
-oma Tumor Carcinoma Cancerous, malignant tumor
-ory Pertaining to Auditory Pertaining to hearing
-osis Condition, disease Leukocytosis Condition of increased leukocytes in the blood
-pathy Disease Hemopathy Disease of the blood
-penia Deficiency Leukocytopenia Decrease in the number of white blood cells
-pexy Surgical fixation Orchiopexy Surgical fixation of an undescended testicle
within the scrotum
-phagia Swallowing Dysphagia Difficulty swallowing
-philia Attraction Necrophilia Attraction to dead bodies
-phobia Abnormal fear Photophobia Fear of light
-plasia Development Dysplasia Faulty formation
-plasty Molding, surgical repair Rhinoplasty Surgical repair of the nose
-plegia Paralysis Paraplegia Paralysis of the lower extremities
-pnea Breathing Hypopnea Shallow breathing

ISTUDY

-ptosis Drooping, prolapse, falling Mastoptosis Drooping of the breast
-ptysis Spitting Hemoptysis Spitting up blood
-rrhage, -rrhagia Excessive flow, discharge Hemorrhage Bursting forth of blood
-rrhea Discharge, flow Amenorrhea Absence of menstrual flow
-rrhexis Rupture Cardiorrhexis Rupture of the heart
-scope Instrument used to view Oscilloscope Instrument that displays visual representa-
tion of electrical variations
-scopy Process of viewing with a scope Opthalmoscopy Process of examining the interior of the eye
by using an opthalmoscope
-stasis Stoppage, balance, control Hemostasis A stopping of the flow of blood
-stomy Surgical creation of a new Colostomy Creation of an opening between the colon
opening and the surface of the body
-tomy Incision, cutting Phlebotomy Incision into a vein
Guidelines for using combining vowels include the following: • Osseous • Predictable
• When a root and a suffix beginning with a vowel are con- • Pamphlet • Principle
nected, a combining vowel is usually not used. • Pruritus • Sizable
• Connecting a word root and a suffix that starts with a • Parenteral • Specimen
consonant usually requires a connecting vowel.
• Parietal • Surgeon
• When two roots are connected, a combining vowel is
• Perineum • Tranquility
most often used even if vowels are present at the junction.
• Most common prefixes can be connected to other word • Perseverance • Vaccine
parts without a combining vowel. • Precede • Vacuum
To correct a misspelled word in a patient’s chart, you must
2.2 Spelling draw a single line through the word.
Plural forms: Here are some general rules. Remember, there are
Spelling: Some commonly misspelled words are:
almost always exceptions.
• Abscess • Conscious
• Add an s or es to most singular nouns to make them plural.
• Accessible • Defibrillator
• When a medical term in the singular form ends in is,
• Aerobic • Desiccation drop the is and add es to make it plural (metastasis/
• Agglutinate • Dissect metastases).
• Analyses • Epididymis • When the term ends in um or on, drop the um or on and
• Analysis • Fissure add a (atrium/atria, ganglion/ganglia).
• Aneurysm • Glaucoma • When the term ends in us, drop the us and add i (bron-
chus/bronchi). Exceptions to this rule mainly involve
• Asepsis • Hemorrhoid
certain words of Latin origin (corpus/corpora, genus/
• Asthma • Homeostasis genera, sinus/sinuses, virus/viruses).
• Auxiliary • Humerus • When the term ends in ma, add ta (stoma/stomata).
• Benign • Hyperglycemia
• When the term otherwise ends in a, drop the a and add
• Capillary • Hypoglycemia ae (vertebra/vertebrae).
• Chancre • Irrelevant
Possessive forms: For singular nouns and plural nouns that do
• Changeable • Ischium not end in s, add an apostrophe and an s. For plural nouns that
• Clavicle • Occlusion end in s, just add an apostrophe but no additional s.
CHA
ISTUDY
2.3 Common Medical Abbreviations Pharmaceutical Abbreviations
Metric system: A system of measurement based on the decimal
Abbreviations: The most common abbreviations used in asso-
system. Its units include the meter, gram, and liter. It is the most
ciation with medical care facilities are presented in Table 2-3.
commonly used system of measurement in health care. For a
The most common medical record abbreviations are listed in
list of common abbreviations used in the metric system, see
Table 2-4, abbreviations associated with the metric system are
Table 2-5.
listed in Table 2-5, and common prescription abbreviations are
Conversion factors for the metric system: The meter (m),
listed in Table 2-6. Tables of relevant abbreviations are also
used for length, equals approximately 39.37 inches; the liter
included for each body system.
AT A GLANCE Medical Care Facility Abbreviations
Abbreviation Meaning Abbreviation Meaning

CCU Coronary care unit OR Operating room
ED Emergency department PAR Postanesthetic recovery
ER Emergency room postop Postoperative
ICU Intensive care unit preop Preoperative
IP Inpatient RTC Return to clinic
OP Outpatient RTO Return to office
OPD Outpatient department
Table 2-3
AT A GLANCE Medical Record Abbreviations

AIDS Acquired immunodeficiency syndrome GYN Gynecology
a.m.a. Against medical advice H&P History and physical
BP Blood pressure HEENT Head, ears, eyes, nose, throat
bpm Beats per minute HIV Human immunodeficiency virus
C Celsius, centigrade Ht Height
CBC Complete blood count Hx History
C.C. Chief complaint I&D Incision and drainage
CNS Central nervous system inj Injection
c/o Complains of IV Intravenous
CP Chest pain L Left
CPE Complete physical examination L&W Living and well
CV Cardiovascular lab Laboratory studies
D&C Dilation and curettage MM Mucous membrane
Dx Diagnosis N&V Nausea and vomiting
ECG/EKG Electrocardiogram NP New patient, Nurse practitioner
ED, ER Emergency room P Pulse
18 S E C T ION 1 / General Medical Assisting Knowledge

ISTUDY
AT A GLANCE Medical Record Abbreviations

F Fahrenheit Pap Pap smear
FH Family history PE Physical examination
Fl/fl Fluid pH Hydrogen concentration (acidity/
alkalinity)
GBS Gallbladder series PI Present illness
GI Gastrointestinal PMH Past medical history
GU Genitourinary PMS Premenstrual syndrome
PNS Peripheral nervous system stat Immediately
pt Patient STD Sexually transmitted disease
PT Physical therapy surg Surgery
Px Physical examination T Temperature
R Right TPR Temperature, pulse, respirations
re✔ Recheck Tx Treatment
ref Referral UCHD Usual childhood diseases
R/O Rule out US Ultrasound
ROS/SR Review of systems/systems review VS Vital signs
Rx Prescription WDWN Well-developed and well-nourished
subq. Subcutaneously WNL Within normal limits
sig Sigmoidoscopy Wt Weight
SOB Shortness of breath y.o. Year old
S/R Suture removal
AT A GLANCE Common Abbreviations Used in the Metric System

cm Centimeter (2.5 cm = 1 inch) deca- × 10
km Kilometer hect- × 100
mL Milliliter (1 mL = 1 cc) kilo- × 1,000
mm Millimeter deci- ÷ 10
g, gm Gram centi- ÷ 100
kg Kilogram (1 kg = 1,000 gm = 2.2 pounds) milli- ÷ 1,000
L or l Liter = 1,000 mL (1 gallon = micro- ÷ 1,000,000
4 quarts = 8 pints = 3.785 L;
1 pint = 473.16 mL)
Table 2-5
CHA
ISTUDY
AT A GLANCE Common Abbreviations Used in Prescriptions

a Before PR Through the rectum
a.c. Before meals p.r.n., PRN As needed
ad lib. As desired PV, vag. Through the vagina
AM, a.m. Morning q Every
amt Amount qh Every hour
aq Water q2h Every 2 hours
b.i.d., BID Twice a day q.i.d., QID Four times a day
buc Buccal qm Every month
¯
c With q.o.d., QOD Every other day
cap Capsule ® Right, registered trademark
d Day Rx Prescription, take
Fl. Fluid ¯s Without
h, hr Hour sub-Q, subcu Subcutaneous
*
h.s. At bedtime, at the hour of sleep Sig: Instruction to patient
ID Intradermal soln. Solution
IM Intramuscular sp. Spirits
IV Intravenous ¯
ss One half
noc., n. Night stat Immediately
NPO Nothing by mouth supp., suppos Suppository
oint., ung. Ointment syr. Syrup
¯
p After T Topical
p.c. After meals tab Tablet
per By, through t.i.d., TID Three times a day
PM, p.m. After noon x Times, for
p.o., PO By mouth
Table 2-6
*Though this abbreviation is on the JCAHO’s Do Not Use List, it is still in common usage.
(L or l), used for volume, equals approximately 1.056 U.S. (i = 1, ii = 2, iv = 4, v = 5, vi = 6, ix = 9, x = 10, xi = 11,
quarts; and the gram (g or gm), used for weight, equals approxi- xx = 20, xl = 40, l = 50, lx = 60, xc = 90, c = 100, cx = 110,
mately 0.035 ounce. cc = 200, d = 500, m = 1,000, mm = 2,000, etc.). A bar writ-
Apothecaries’ system: An old system of measurement in which ten above a numeral multiplies its value by 1,000:
the weight measure is based on one grain of wheat and the liq-
uid measure is based on one drop of water. The apothecaries’ ¯ = 5,000,  c 
( v  ¯ = 100,000,  ¯
m = 1,000,000,  ¯
ss = ½, etc.)
system measures weight by grains (gr), scruples (scr), drams
Conversion factors for the apothecaries’ system: There are
(dr), ounces (oz), and pounds (lb). It uses minims (min), flu-
approximately 60 milligrams to a grain, and 15 grains to a gram.
idrams (fl dr), fluid ounces (fl oz), pints (pt), quarts (qt), and
grains × 60 = milligrams
gallons (gal) to measure volume. In the apothecary system,
grains ÷ 15 = grams
dosage quantities are written in lowercase Roman numerals

ISTUDY
2.4 Medical Terminology in Practice
Common Terms Related to Disease
AT A GLANCE Common Terms Related to Disease
Term Meaning
Benign Noncancerous
Convalescent The period of recovery after an illness, injury, or surgery
Declining Gradually deteriorating, weakening, or wasting
Degeneration Change of tissue to a less functionally active form
Etiology Cause of a disease
Incubation period The time between exposure to an infectious organism and the onset of symptoms of illness
Malaise Not feeling well (the first indication of illness)
Malignant Cancerous
Prodromal Pertaining to early symptoms that may mark the onset of a disease
Prognosis Prediction about the outcome of a disease
Prophylaxis Protection against disease
Remission Cessation of signs and symptoms
Table 2-7
Integumentary System
AT A GLANCE Integumentary System—Common Combining Forms
Combining Form Meaning Example Definition

adip / o Fat Adipose tissue Layer of fat beneath the skin
albin / o White Albinism Condition caused by the lack of melanin
pigment in the skin, hair, and eyes
cry / o Cold Cryosurgery Surgery that uses liquid nitrogen to freeze
tissue
cutane / o Skin Subcutaneous Beneath the skin
dermat / o Skin Dermatitis Inflammation of the skin
erythr / o Red Erythrodermatitis Inflammation of the skin marked by redness
and scaling
hidr / o Sweat Hidradenitis Inflammation of a sweat gland
hist / o Tissue Histology Study of tissues
kerat / o Hard skin, horny Keratosis Lesion formed from an overgrowth of the
tissue, keratin horny layer of skin
leuk / o White Leukoplakia Raised, white patches on the mouth or vulva
lip / o Fat Lipoma Common benign tumor of the fatty tissue
onych / o Nail Onycholysis Separation of the nail from its bed
CHA
ISTUDY
AT A GLANCE Integumentary System—Common Combining Forms

pachy / o Thick Pachyonychia Abnormal thickness of fingernails
or toenails
seb / o Sebum (oil) Seborrhea Excessive secretion of sebum
squam / o Scale Squamous Scale-like
trich / o Hair Trichopathy Any disease of the hair
xanth / o Yellow Xanthoma Yellow deposit of fatty material in the skin
xer / o Dry Xerosis Abnormal dryness of the eye,
skin, and mouth
AT A GLANCE Integumentary System—Suffixes

-malacia Softening Onychomalacia Softening of the nails
-phagia Eating, swallowing Dysphagia Difficulty swallowing, painful swallowing
Table 2-9
AT A GLANCE Integumentary System—Abbreviations
Abbreviation Meaning
Bx Biopsy
Derm Dermatology
SC, sub-Q, SQ, subcu, subq Subcutaneous
Table 2-10
Musculoskeletal System
AT A GLANCE Musculoskeletal System—Common Combining Forms

ankyl / o Stiff Ankylosis Complete loss of movement in a joint
arthr / o Joint Arthralgia Pain in the joint
bucc / o Cheek Buccinator Cheek muscle
burs / o Bursa Bursolith Stone in a bursa
calc / o Calcium Hypercalcemia Excessive amount of calcium in the blood
carp / o Wrist Carpal Pertaining to the wrist
cervic / o Neck Cervical Pertaining to the neck

ISTUDY
AT A GLANCE Musculoskeletal System—Common Combining Forms

chondr / o Cartilage Osteachondroma Benign bone tumor
cost / o Rib Intercostal Between the ribs
crani / o Cranium (skull) Cranial Pertaining to the skull
dors / o Back Dorsal Pertaining to the back
fasci / o Band of fibrous tissue Fasciotomy Operation to relieve pressure on the muscles
by making an incision into the fascia
fibr / o Fiber Fibroma Benign tumor of the connective tissues
kyph / o Hump Kyphosis Excessive curvature of the spine,
“humpback”
lamin / o Lamina Laminectomy Surgical removal of the lamina
lei / o Smooth muscle Leiomyoma Benign tumor of smooth muscle
lord / o Curve Lordosis Inward curvature of the spine, “swayback”
my / o Muscle Myalgia Muscle pain
myos / o Muscle Myositis Inflammation of muscle tissue
oste / o Bone Osteoporosis Condition in which bones become porous
and fragile
pector / o Chest Pectoral Pertaining to the chest
rhabd / o Striated, skeletal muscle Rhabdomyolysis Destruction of muscle tissue accompanied
by the release of myoglobin
spondyl / o Vertebra Spondylitis Inflammation of the joints between the
vertebrae in the spine
synov / i Synovia Synovial membrane Membrane lining the capsule of a joint
ten / o, tend / o, tendin / o Tendon Tendinitis Inflammation of the tendons
AT A GLANCE Musculoskeletal System—Suffixes

-asthenia Weakness Myasthenia gravis Disorder of neuromuscular transmission
marked by weakness
-clasia Breaking Arthroclasia Artificial breaking of adhesions of an anky-
losed joint
-desis Binding Arthrodesis Surgical binding or fusing of a joint
-physis Growth Metaphysis The growing portion of a long bone
-schisis Splitting Rachischisis Failure of vertebral arches and neural tube
to fuse
-trophy Development Hypertrophy Excessive development
Table 2-12
CHA
ISTUDY
Another random document with
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Lydia was much too tactful to point out that it was still ten minutes
before her bedtime, understanding perfectly that the indiscreetness
of Mr. Monteagle Almond’s conversation was responsible for her
accelerated departure.
She had learnt that she was really going to school, and she was
happy.
Aunt Beryl gradually became reconciled to the loss of her pupil, and
presently began to show signs of pride in Lydia’s advancement.
Once or twice Lydia heard her talking to Mrs. Jackson in the rapid
undertones always adopted by Aunt Beryl and Aunt Evelyn with their
friends.
“Quite a backward child, when she came to us last year. Between
ourselves, my sister-in-law never took much trouble.... I was quite
against sending her to Miss Glover’s at first—you know, I thought
she’d be so behind in everything. So she was, too, but the way that
child has picked up! You really wouldn’t believe it—I’m sure half the
sums in her book I couldn’t do myself. Never was good at figures.”
Lydia was very proud of her faculty for arithmetic. She thought very
little of being first in her class for English composition, and none of
the other girls thought much of it either, but they all envied her when
the weekly announcement came, as it frequently did:
“Problem No. 15. No one got that right except Lydia Raymond. Stand
up, Lydia Raymond, and show the class the working of No. 15 on the
black-board. ‘If a train left Glasgow at 8.45 a.m. on Wednesday,
travelling at the rate of 60 miles an hour——’”
Lydia enjoyed those problems, worked by herself on the black-board
in full view of half-a-dozen befogged, pencil-chewing seniors.
But for her French, Lydia would have found herself more highly
placed than she was in the school.
Monday and Thursday afternoons.
O horrible verbs, O hateful Première Année de Grammaire, and
thrice-hateful genders!
Why should a table be feminine and an arm-chair masculine?
Lydia hated her French, and continued to say “Esker le feneter de la
salong ay ouvere?” in a lamentable voice and an unalterably British
accent. Very few of Miss Glover’s girls were “good at French.” Only
three had any acquaintance with German, and of these one was
Dutch.
Many of them could play the piano correctly, and even brilliantly,
some of them could copy free-hand drawings or plaster casts, but
hardly one could write a letter without making mistakes in spelling,
punctuation, and English. All, unconsciously enough, were more or
less defective in the correct pronunciation of English.
Since brains, in Great Britain, are for the most part the prerogative of
the middle classes, it follows that their possessors enjoy a certain
prestige among their compeers which would, on those same
grounds, be denied them in more exalted circles.
Lydia found that her schoolfellows were proud of her cleverness, and
disposed to seek her friendship.
She easily assumed leadership amongst the group of girls of her
own age who were also day boarders at Miss Glover’s.
“Do help me with this beastly sum, Lydia. I’m sure you can do it.”
Lydia always acceded very graciously to such frequent requests,
partly because she loved to show her own superior attainments, and
partly because of a very definite conviction, which she had never yet
put into words, that it was always worth while to show oneself
agreeable. In consequence of this complacence, she was seldom at
a loss for companionship in play-time. There was always someone to
walk about with, arms round one another’s waists after the
immemorial schoolgirl practice, heads close together under black or
scarlet tam o’ shanter, for a better exchange of confidences.
Then Lydia put into practice Grandpapa’s Golden Rule: Always let
the other people talk about themselves.
“I say, Lydia, I’ll tell you a secret. Mind, now, you’re not to say a word
to anyone, because I promised not to tell ... but I know I can trust
you?”
An interrogative turn to that last sentence.
“Yes, truly you can, Ethel. Tell me.”
“Well, promise you won’t tell. Not even if you’re asked?”
“Cross my heart——” in the glib, accustomed formula.
“Well, then, Daisy Butcher and May Holt have had a row. You know
what frightful friends they’ve been ever since the beginning of the
term? Well, it’s all over, and they’ve quarrelled. Only don’t ever say I
said so because Edith told me, and I said I wouldn’t say because it
was May Holt herself who told her, and she made her promise not to
say. I wouldn’t say a word myself, only I really thought you ought to
know, sitting next to May in class and everything. I say, do you like
May Holt?”
Lydia, who thought May Holt common and stupid, was for a moment
tempted to say so. Then, innate caution and a distrust of her
companion’s garrulity restrained her.
“She’s all right,” she said vaguely. “I thought you were rather friends
with her?”
“Not now,” said Ethel hastily. “If the quarrel comes out and there’s
any taking sides, I shall be on Daisy’s side. I think May Holt’s been
awfully mean. I simply can’t bear mean ways. I’m like that, you
know.”
Thus Ethel’s confidences, similar to scores of others, all ending in an
exposition of the speaker’s view of her own personal traits of
character.
Storms raged in teacups, confidences were violated, the identical
Ethel who had sworn Lydia to secrecy on the May and Daisy quarrel,
found herself taxed with various indiscreet utterances and sent to
Coventry.
“Well, it was Edith who told me, and she said May Holt was a liar,
what’s more,” sobbed Ethel, in counter-accusation that availed her
nothing, although it raised fresh and terrible issues between herself
and Edith, and again between Edith and May Holt, and all May Holt’s
partisans.
Lydia listened to it all, and thought how clever she had been to keep
clear of all this trouble.
It was a thing always to be remembered—the unwisdom of uttering
opinions that would probably be repeated to their object—never,
never to say anything that could not be safely repeated without
making for one an enemy.
Lydia silently added this conviction to her increasing store of worldly
wisdom.
So she welcomed the confidences of the other girls, most of whom
seemed quite unable to prevent themselves from talking, and she
was at the same time very careful never to render herself unpopular
by mischief-making or by carrying backwards and forwards any of
their indiscreet utterances.
“You can always trust Lydia,” said one or two of the girls.
And once she heard one of them exclaim:
“I’ve never heard Lydia Raymond say an unkind word about
anybody.”
It sounded very sweet and charitable, but Lydia, with a sense of
humour not unlike her grandfather’s, had a little grim, private laugh
at the irony of it.
Several of her schoolfellows asked her to tea, or to an occasional
picnic in the summer, but Lydia very often regretfully said that her
aunt did not like her to go out much, and declined the invitations,
without ever referring them to Aunt Beryl at all.
She had a fastidious idea that she did not want to be reputed “great
friends” with the children of the more superior tradespeople, or even
with the two youthful social lights of the establishment, the daughters
of a rich local dentist.
Instinct, and certain recollections of her mother, led her to seek the
friendship of a quiet little girl, actually a boarder, whose home was in
the west of England, and of whom Lydia only knew that her father
was a clergyman, and that she had nice manners and somehow
spoke differently from the others. Her name was Nathalie Palmer.
Nathalie did not make so many confidences as did the other girls,
and when she did talk to Lydia it was of Devonshire and of her own
home, not of the people at school.
This Lydia observed, instinctively approved, and inwardly made note
of for future imitation.
As Nathalie knew no one outside the school, she was naturally
unable to ask Lydia to come home with her, but just before the
midsummer break-up her father came to visit her.
He stayed for two days at the Seaview Hotel, and Nathalie took
Lydia to luncheon there.
Mr. Palmer looked old to be the father of fourteen-year-old Nathalie,
and had a slow, clerical manner of speech that rather overawed
Lydia.
She had never had a meal at any hotel since the days with her
mother and father in London, that seemed now so immeasurably
remote, and she felt rather nervous. Politely answering Mr. Palmer’s
kind inquiries as to her place in class, her favourite games and
lessons, she was all the time anxiously casting surreptitious glances
at Nathalie to see how she helped herself to the strange and
numerous dishes proffered by the waiter.
Aunt Beryl was very particular about “table-manners,” but at
Regency Terrace there was never any such bewildering profusion of
knives and forks to perplex one.
Once Lydia embarked upon the butter-dish, offered by Mr. Palmer,
with her own small knife, and then, leaving it in the butter-dish, found
only a very large knife left beside her plate with which to spread it.
Shame and disaster threatened.
Lydia looked up, and her distressed gaze met that of a waiter. To her
own effable surprise, she made a movement of her head that
brought him deferentially to her elbow with the required implement.
Simplicity itself!
Lydia inwardly decided that one need never be frightened, in the
most unaccustomed surroundings, if only one kept one’s head and
never betrayed any sense of insecurity.
Next day she had the gratification of being shyly told by Nathalie:
“Father said what a pretty face you had, Lydia, and what nice
manners. He was so glad I’d got such a nice friend, and he said I
might ask you whether one day your aunt would let you come and
stay with us during the holidays.”
IV
When Lydia was fifteen, expectant of Honours in her examinations,
highly placed in the school, and with a secret hope that the following
term might see her Head of the School—and that, moreover, at an
unprecedently early age—unexpected disaster overtook her.
The three placid years at Regency Terrace had been so little marked
by any changes that she had forgotten that old sense of the
insecurity and impermanence of life, bred of early days with her
mother, and it came as a shock to her that anything should interfere
seriously with her schemes.
Quite unexpectedly she fell ill.
“I don’t like that cough of yours, Lydia.”
“It’s only a cold, auntie.”
“It doesn’t seem to get any better. Let me see, how long have you
had it now?”
Lydia pretended to think that Aunt Beryl was only talking to herself,
and bent lower over her books. She always worked at her
preparation in the evenings after supper now.
It was damp, chilly weather, and her cough grew worse, although
she stifled it as far as possible, and said nothing about the pains in
her back and sides.
Aunt Beryl brought her a bottle of cough mixture recommended by
Mrs. Jackson, and Lydia put it on the mantlepiece in her bedroom,
and carefully dusted the bottle every day, and sometimes poured
away a little of the contents.
But one morning, one important morning when there was a French
lesson which it was essential that Lydia, with whom French still
remained the weakest of links in an otherwise well-forged chain,
should attend, she found herself quite unable to go downstairs to
breakfast.
Her head swam, her eyes and mouth were burning, and her legs
unaccountably trembled beneath her.
“No such thing as can’t,” muttered Lydia fiercely, repeating
Grandpapa’s favourite axiom.
The pain in her side had increased without warning, and suddenly
gave her an unendurable stab every time that she tried to move.
“Oh!”
Lydia sank back on the bed, and found herself crying hoarsely from
pain and dismay. Surely even Grandpapa would admit the necessity
for saying “can’t” at last.
But Lydia did not see Grandpapa for some time after that morning.
She lay in bed with a fire in the room, sometimes suffering a great
deal of pain, and sometimes in a sort of strange, jumbled dream,
when the pattern of the wall paper turned into mysterious columns of
figures that would never add up, and French Irregular Verbs danced
across the ceiling.
Aunt Beryl nursed her all day and sat up with her at nights very
often, and Dr. Young came to see her every day.
Once he said to her:
“You’re a very good patient. I don’t know what we should have done
with you if you hadn’t been a good, reasonable girl, and done
everything you were told.”
Lydia was pleased.
“Am I very ill?” she asked.
“Oh, you’ve turned the corner nicely now,” said Dr. Young cheerfully.
“But pneumonia’s no joke, and you’ll have to be careful for a long
while yet.”
“Shan’t I be able to go up for the examination?”
“Let me see—that’s about a month off. We shall have to see about
that.”
Dr. Young’s daughter was at Miss Glover’s school, too, and he knew
all about the terrible importance of the examination. Nevertheless, he
gave Lydia no permission to resume her studies.
“Don’t worry, dear, there’s plenty of time before you, and now I’ve got
some nice fruit jelly for you,” said Aunt Beryl, and Lydia always
thanked her very gratefully and lay back against the pillow, trying all
the time to recapitulate the French verbs and the list of Exceptions to
Rules that she had been learning when she first fell ill.
Except for anxiety about the examination, convalescence was
agreeable.
Uncle George came up to see her one day, and brought her some
grapes, and explained to her why it was that the great pieces of ice
in her glass of barley-water did not cause it to overflow, quite in the
old Mr. Barlow manner, and once Nathalie Palmer came by invitation
and had tea with her upstairs, and told her how sorry all the girls had
been about her illness.
“And you’ll miss the exam,” moaned Nathalie, “and it seems such a
shame. I know you’d have done splendidly.”
“What have you been having in class?” asked Lydia.
“Almost all recapitulation. The only really new thing that we’re doing
is Henry V. for literature.”
That evening Lydia made Gertrude, the servant, bring her the
volume of Shakespeare from the drawing-room.
Her brain felt quite clear now, and her eyes no longer hurt her when
she tried to read.
Next day she was allowed to go downstairs for tea.
Aunt Beryl, who looked very tired and sallow, helped her to dress,
and Uncle George came upstairs to fetch her, and they both
supported her very carefully down the stairs and into the drawing-
room, where a fire had been lit, and a special tea laid on a little table
beside the arm-chair.
Grandpapa, with Shamrock prancing unrestainedly at his feet, and
the parrot, brought up from the dining-room, hanging upside down in
his cage on the centre-table, were all waiting to welcome her.
“Very glad to see you down, me dear,” said Grandpapa, shaking
hands with her formally. “A nasty time you’ve had, a very nasty time,
I’m afraid.”
“She’s been such a good girl, Grandpapa,” said Aunt Beryl, raising
her voice as though by a great effort. “Dr. Young says she’s the best
patient he’s ever had.”
“Did you have to swallow a great deal of physic, Lyddie? Ah, a very
disagreeable thing, physic,” said Grandpapa, who was ordered a
certain draught daily, which he was only too apt to pour away into the
nearest receptacle in the face of all Aunt Beryl’s protests.
“Mr. Almond asked after you on Wednesday, Lydia. He has been
quite concerned over your illness,” Uncle George told her.
Lydia sat back in the arm-chair, her long plaits falling over either
shoulder, and could not help feeling that all this attention was rather
agreeable.
Aunt Beryl’s friend, Mrs. Jackson, “stepped in,” to ask how she felt,
and to borrow a paper pattern for a blouse, and said she had also
heard from Dr. Young and other sources what a good patient Lydia
had been.
“And so hard on you, poor child, missing your examinations and all.”
“Perhaps Dr. Young will let me go,” said Lydia wistfully: “It’s only four
days, and not till next week.”
Mrs. Jackson shook her head doubtfully.
“The Town Hall is well warmed, with those pipes and all, but I don’t
know. Perhaps if you could go in a closed cab, well wrapped up....
But you’ve missed such a lot of study, haven’t you?”
“I know,” said Lydia dejectedly.
They were all very kind to her, and seemed to realize the great
disappointment of failing after all, or even of putting off the
examination for another year, when one would be nearly sixteen, and
no longer the youngest candidate of all.
Mrs. Jackson refused tea, and hurried away with her paper pattern,
Shamrock flying to the head of the stairs after her, and breaking into
a storm of howls, as though in protest at her departure. Aunt Beryl
hastened distressfully after him.
“Hark at that!” said she unnecessarily.
Grandpapa put on his deafest expression.
“This is very trying for you, Lydia,” said Uncle George pointedly. “It
seems to go through and through one’s head.”
Did Grandpapa actually throw a glance of concern at the invalid?
She could hardly believe her eyes, and felt more than ever how
pleasant it was to be the centre of attention.
And then Aunt Beryl came in again, dropped into a chair near the
door, oddly out of breath, and quietly fainted away.
Gertrude had been sent for Dr. Young before they could bring her
back to consciousness again, and when he did arrive, he and Uncle
George almost carried Aunt Beryl up to her room.
“Thoroughly overdone,” said Dr. Young. “Miss Raymond has been so
very unsparing of herself during her niece’s illness—one of those
unselfish people, you know, who never think anything about
themselves. I am ashamed of myself for not seeing how near she
was to a break-down.”
Decidedly Aunt Beryl was the heroine of the hour.
Lydia was ashamed of herself for the resentment that this turning of
the tables awoke in her.
She went to her own room, unescorted, when the commotion had
subsided, and her supper was brought up to her by Gertrude nearly
an hour late.
“How is Aunt Beryl now?” she asked.
“Gone to sleep, miss. She is wore out, after sitting up at night, and
then the nursing during the day, and seeing to the house and the old
gentleman, all just the same as usual—and no wonder.”
No wonder, indeed! Everyone said the same.
During the two days that Aunt Beryl, by the doctor’s orders,
remained upstairs, the household in Regency Terrace had time to
realize what, in fact, was the case—that never before had Miss
Raymond been absent from her post for more than a few hours at a
time.
When Mr. Monteagle Almond came in on Wednesday evening, full of
inquiries and congratulations for Lydia, he was hardly allowed time to
formulate them.
“It’s my poor sister we are anxious about,” said Uncle George, just
as though Lydia had never been ill at all.
“Quite knocked up with nursing,” said Grandpapa, shaking his head.
“I’ve never known Beryl take to her bed before, and we miss her
sadly downstairs.”
Mr. Monteagle Almond was deeply concerned.
“Dear me, dear me. This is very distressing news. I had no idea of
this. Miss Raymond never complains.”
“That’s it,” agreed Uncle George gloomily. “One somehow never
thought of her overdoing it.”
“Unselfish,” said Mr. Almond, adding thoughtfully: “Well, well, well,
selfish people have the best of it in this world, there’s no doubt.”
The little bank clerk was generalizing, according to his fashion, but
Lydia felt angry and uncomfortable, as though the reference might
have application to herself.
Aunt Beryl certainly looked much as usual when she reappeared
downstairs, but it was very evident that two days without her had
thoroughly awakened both Grandpapa and Uncle George to a new
sense of her importance.
“We must try and spare your aunt as much as possible,” Uncle
George said gravely to Lydia. “I’m afraid that we’ve all been allowing
her to do far too much for us.”
Lydia found it curiously disagreeable to see the focus of general
interest thus shifted. Unconsciously, she had occupied the centre
place in the little group in Regency Terrace ever since her arrival
there, as the twelve-year-old orphan, in her pathetic black frock.
Without consciously posing, she had certainly, as the eager student
at Miss Glover’s bringing back prizes and commendations, been the
most striking personality of that small world, and she had known that
her elders discussed her cleverness, her steady industry, even her
increasing prettiness, as topics of paramount interest.
Lydia, in other words, was complacently aware of being the heroine
of that story, which is the aspect worn by life to the imaginative. Now
it appeared that this rôle had been summarily usurped by Aunt Beryl.
Lydia’s sense of drama was far too keen for her to undervalue the
possibilities of the aspect presented by her aunt. It was pathetic to
have toiled, without appreciation, all these years, to have nursed
one’s niece devotedly day and night, and then to faint away
helplessly without a word of complaint. But the more Lydia realized
how pathetic it was, the more annoyed she became.
Her own convalescence was a very rapid one, partly owing to her
determination to get to the Town Hall for the examination. Both
Grandpapa and Uncle George, with the masculine inability to
entertain more than one anxiety at a time, appeared to have
forgotten that she had ever been ill, and Dr. Young himself, when
applied to, only said:
“Well, well, if you’ve really set your mind on it—the weather’s nice
and warm. But you must wrap up well and keep out of draughts. We
don’t want a relapse, mind. Miss Raymond can’t do any more
nursing, you know. She ought to be nursed herself.”
Lydia would cheerfully have nursed Aunt Beryl, if only to retain her
own sense of self-importance, but well did she know that her aunt
would give her no such opportunity. Really, unselfish people could be
very trying.
She went to the Town Hall, and was greatly restored by the
enthusiastic greetings of her fellow-candidates.
“Oh, Lydia, how plucky of you to try, after all! Don’t you feel fearfully
behindhand? Fancy, if you do get through! It’ll be even more
splendid than if you hadn’t been ill, and had no disadvantage of
missing such a lot.”
Lydia had a shrewd suspicion that she had not missed nearly so
much as they all thought. Nathalie had said that most of the work
done in class during her absence had been recapitulation, and
recapitulation, to Lydia’s sound memory and habits of accuracy
inculcated by Uncle George, had never been more than a pleasant
form of making assurance doubly sure.
For the last two days she had been studying frantically, and had
made Nathalie go through Henry V. with her, and mark the passages
to be learnt by heart.
Fortune favoured her in causing the English Literature paper to be
set for the last day of the examination.
When that last day came Lydia felt tolerably certain that she had
thoroughly overtaxed her barely-restored strength, and would shortly
suffer for it with some severity, but her examination-papers had been
a series of inward triumphs.
French had certainly presented its usual stumbling-blocks, but Lydia
reasonably told herself that she would probably have experienced at
least equivalent difficulties, had she attended every class, and where
mechanical rote-learning could avail her, she knew that she was
safe. Moreover, the algebra and arithmetic papers, over which most
of the candidates were groaning, she could view with peculiar
complacency.
“How did you get on?” several of the girls asked her eagerly.
“Not too badly, I hope,” said Lydia guardedly.
It would be far more of a triumph, if she did succeed, for her success
to come as a surprise to everyone. They could hardly expect it, after
such an absence from class as hers had been.
Even the governess in charge of the group of girls said to her kindly:
“You mustn’t be disappointed if you don’t get through this time, dear.
Miss Glover knows you’ve worked very well, and that it’s only illness
that’s thrown you back.”
Lydia returned to Regency Terrace thoroughly exhausted.
“I’m sure you’ve done your best, dear, and if it isn’t this time, it’ll be
next,” said Aunt Beryl philosophically. “Now go straight upstairs and
have a good rest.”
Lydia went, and was not at all displeased to find that her head was
throbbing and her face colourless.
The following day the doctor saw her, and shook his head at her.
“Better give her a change of air, Miss Raymond. If you won’t go away
yourself, it will, anyway, set you rather more free not to have Miss
Lydia on your mind.”
Lydia felt that the advice might have been worded in a manner more
flattering to herself, but she was pleased at the idea of a change.
She had not been away since her first arrival as an inmate of
Grandpapa’s household. Aunt Beryl’s theory was that one went away
to the sea, not from it. If one happened to live by the sea, there was
no need to go away at all. Only Uncle George, taking his fortnightly
holiday in the summer, departed on a walking or bicycling tour with
some bachelor friend of his own.
“You’ll enjoy staying with your Aunt Evelyn,” said Aunt Beryl. “The
girls must be nearly grown up now, I declare. How time flies! Beatrice
must be all of eighteen, and Olive sixteen, and I suppose Bob is
somewhere between the two of them. How long is it since you’ve
seen them, Lydia?”
“Not since I was quite little—about ten, I think.”
“It’ll be nice for you to make friends with the girls. I’ve often wished
you had a sister.”
Lydia did not echo the wish when she had seen the Senthoven
family circle.
“There’s no nonsense about us,” might have been taken for their
motto, or even their war-cry.
On the evening of Lydia’s arrival she was mysteriously taken
possession of by Olive, her youngest cousin, under pretext of
unpacking.
“I say, Lydia.”
“Yes?”
“Yes?” mimicked Olive, with a screwed-up mouth and mincing
pronunciation, in derisive mockery of Lydia’s low, clear enunciation,
which was in part natural, and in part learnt from Nathalie Palmer.
“I declare you’re afraid of the sound of your own voice. You ought to
hear us! My word! we’ll make you open your eyes—and ears too—
before we’ve done with you. You should just hear the ragging that
goes on whenever Bob’s at home. Look here, this is what I want to
know.”
This time Lydia only looked interrogation. She despised Olive too
thoroughly to care whether she laughed at her way of speaking or
not, but she thought that the sooner Olive satisfied her curiosity and
went away the better.
“Do you like fun?” said Miss Senthoven, bringing her prominent
brown eyes and head of untidy, flopping hair close to Lydia’s face in
her extreme eagerness for a reply.
Lydia, when she had recovered from her surprise at the form of the
inquiry, assented, since assent was obviously expected of her, but
she had grave doubts as to whether her own definition of “fun” would
coincide with that of the Senthovens.
It did not.
“Fun” was synonymous with noise, and the most brilliant repartee
known to any Senthoven was Bob’s favourite form of squashing such
“nonsense” as a comment on the blueness of the sky: “Well, you
didn’t expect to see it red, did you?”
Bob, a hobble-de-hoy of seventeen, short and thick-set, was his
mother’s idol. But there was “no nonsense” allowed from poor Aunt
Evelyn by her terrible daughters.
“The mater’s so mushy,” they shouted disgustedly, when she made
excuse, on the morning after Lydia’s arrival, for Bob’s very tardy
appearance.
Lydia looked round the breakfast-table. She was quite well again
now, and breakfast upstairs would have been unheard of. Beatrice
was a still larger, taller, more athletic, and, if possible, noisier edition
of Olive. She had just left school, and her dark hair, very thick and
heavy, was piled into untidy heaps at the back of her head.
“No nonsense about my hair, I can tell you. Half the time I don’t even
look in the glass to see how I’ve done it,” Beatrice would declare
proudly.
The girls wore flannel shirts, with collars and ties, and short skirts
that invariably contrived to be rather longer at the back than they
were in the front.
They strenuously refused to make any change of toilette in the
evenings, only substituting heelless strapped black shoes for their
large and sturdy boots, over their thick-ribbed stockings.
Those evenings were the noisiest that Lydia had ever known.
Only Uncle Robert, small, and sallow, and spectacled, was silent.
He sat at the foot of the table, said a brief, muttered grace, and
dispensed the soup.
“I say, what tommy-rot it is your not playing hockey, Lydie. Bee and I
have got a match on to-morrow afternoon.”
“Can’t I come and watch you play?”
“I suppose so. I don’t care if you do, I’m sure,” Olive hastily
repudiated the mere suggestion of such a dangerous approach to
“nonsense” as was implied by a possible interest in another’s
movements.
“I say, I do believe Bob gets later every blessed day. A nice row
there’d be if we came in late for every meal!”
“Too bally hungry to do that!”
“Your brother doesn’t get much fresh air. You must remember he’s in
an office all day, and has two stuffy train journeys, poor boy,” said
Bob’s mother unwisely.
“Ow! poor ’ickle sing, then—mammy’s own baby-boy!” yelled
Beatrice derisively.
“Mater!” said Olive, “how can you be so sloppy?”
Lydia looked round her, amazed. No one seemed to think, however,
that Beatrice and Olive were behaving otherwise than well and
dutiful.
“Beef, Lydia?”
“Yes, please, Uncle Robert.”
Lydia saw Beatrice wink at Olive, and Olive stuff a corner of her
Japanese paper napkin into her mouth, as though to prevent an
explosion of laughter. She only perceived that the jest lay in the
manner of her own reply, when to the same inquiry her cousins
successively answered, very loudly and curtly.
“Ra-ther!”
After the beef Aunt Evelyn helped the pudding. There were two
dishes in front of her, one containing the remaining half of the pink
mould that had figured on the dinner-table in the middle of the day,
and the other the cold remnants of the previous night’s tart.
And Lydia, invited to make her choice, replied very clearly and rather
defiantly:
“I should like some tart, if you please, Aunt Evelyn.”
Bob, who had made his entry with the second course, roared with
laughter, and, reaching across his sister Beatrice, banged Lydia
heavily on the back.
“That’s right, Lady Clara Vere de Vere. You stick to it!”
Lydia, who hated being touched, jumped in her place, but she had
the wit to guess that the surest way of making her cousins pursue
any particular course of action would be to show that she disliked it,
in which case they would instantly look upon her as “fair game.” She
did not in the least mind the series of witticisms, lasting the length of
her visit, designed to emphasize what the Senthovens considered
the affectations of her speech.
“Just the weeniest little tiny bit, if you will be so awf’ly kind, please.
Thank you so awf’ly much.”
Thus Beatrice, humorously.
And Bob:
“Well, perhaps—if you were to press me to a jelly——”
Lydia was not in the least amused at these sallies, but she laughed
at them cheerfully enough. She felt immeasurably superior to the
Senthovens, and had every intention of proving that superiority to
them before the end of her stay.
At first blush, this did not appear to be any too easy. There was no
doubt that the Senthovens, the girls especially, were efficient in their
own line of action.
Beatrice was a renowned hockey captain; Olive had silver trophies
from both the Golf Club and the Swimming Club, and both had won
Junior Championships at lawn-tennis.
“Are you a good walker, old girl?” Beatrice one day inquired of Lydia.
This last term of endearment was a sign of the highest goodwill, and
if employed too frequently would almost certainly lead to the
accusation of sloppiness.
“Oh, yes,” said Lydia, thinking of the school crocodile wending its
decorous way the length of the Parade.
“Good. Olive’s an awful rotter at walking. You and I can do some
tramps together. Are you game for a six o’clock start to-morrow
morning?”
Lydia laughed, really supposing the suggestion to be humorously
intended.
“What are you cackling about? You’re such an extraordinary kid; you
always seem to laugh with your mouth shut. I suppose they taught
you that at this precious school of yours, where you don’t even play
hockey. Well, what about to-morrow? We can take some sort of
fodder with us, but I’ve got to be back at the Common at ten sharp
for a hockey practice.”
Lydia was obliged to resign her pretensions. She hadn’t understood
quite what Beatrice meant by a “good walker.”
“Anything up to twenty-five miles is my mark,” said Beatrice
complacently.
She and Olive were both good-humouredly contemptuous of Lydia’s
incapabilities, and Bob was even ready to show her how to serve at
tennis, and how to throw a ball straight. Lydia was willing to be
taught, and was sufficiently conscious that her tennis was improving
rapidly, to submit to a good deal of shouting and slangy, good-
humoured abuse.
She did not like it, but was philosophically aware that her stay at
Wimbledon was drawing to a close, and that she would reap the
benefit of improved tennis for ever afterwards.
“I suppose, being a duffer at games, that you’re a regular Smart
Aleck at lessons, aren’t you?” Olive amiably asked her.
An assent would certainly be regarded as “bucking,” but, on the
other hand, Lydia had no mind to let her claims to distinction be
passed over.
“I’ve just been in for an examination,” she said boldly. “I might hear
the result any day now.”
“Get on! I thought you’d been ill.”

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MEDICAL ASSISTING REVIEW

This book is printed on acid-free paper.

Cover Image: ra2studio/Shutterstock

ISTUDY moi97938_fm_ise.indd ii 10/16/20 11:49 AM

Preface ix 3.9 Sensory System 57

Chapter 1 – The Profession of Medical 3.13 Endocrine System 67

8.1 Law 127 12.2 Types of Computers 203

8.3 Ethics 135 12.4 Using Computer Software 206

11.1 Communicating with Patients  Section 2 CMA REVIEW 263

16.1 Blood-Borne Pathogens 286 21.2 The Electrocardiograph 372

16.3 OSHA Requirements 290 21.4 Other Heart Conditions 

17.2 Medical Interview 298 22.2 Types of Diagnostic Imaging 383

17.3 Physical Examination 299 22.3 Therapeutic Uses of Radiation 385

Chapter 20 – Administration of 24.14 Poisoning 417

Section 3 Test Your Knowledge – Clinical 462 Index 527

Organization • At the end of each section, there is a new Test Your

ISTUDY moi21793_fm_i-xvi.indd ix 11/22/21 12:46 PM

Remote Proctoring & Browser-Locking Capabilities

Study made personal

Laptop: McGraw Hill; Woman/dog: George Doyle/Getty Images

Affordable solutions, Solutions for

Padlock: Jobalou/Getty Images Checkmark: Jobalou/Getty Images

Study anytime, anywhere “I really liked this

Everything you need in one place

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Learning for everyone

PREVIOUS EDITION REVIEWERS Cheryl Kolar, AS in HS, RMA, LPN

Annette S. Baer, CMA (AAMA) TECHNICAL EDITING/ACCURACY PANEL

ISTUDY moi21793_fm_i-xvi.indd xv 06/30/21 01:56 PM

Chapter 1 – The Profession of Medical Assisting

MEDICAL ASSISTING COMPETENCIES

COMPETENCY CMA RMA CCMA NCMA

4 S E C T IO N 1 / General Medical Assisting Knowledge

AT A GLANCE Medical Assistant Certification Exams

Organization Credential Fees Notes

National Healthcareer Association CCMA (2 years) $149 For-profit.

6 S E C T IO N 1 / General Medical Assisting Knowledge

8 S E C T IO N 1 / General Medical Assisting Knowledge

Instructions: 6. Which of the following terms describes behaving cour-

10 S E C T IO N 1 / General Medical Assisting Knowledge

MEDICAL ASSISTING COMPETENCIES

COMPETENCY CMA RMA CCMA NCMA

AT A GLANCE Common General Prefixes

Prefix Meaning Example Definition

Table 2-1, continued

Prefix Meaning Example Definition

ISTUDY moi97938_fm_ise.indd ii 10/16/20 11:49 AM

11.1 Communicating with Patients Section 2 CMA REVIEW 263

16.3 OSHA Requirements 290 21.4 Other Heart Conditions

Section 3 Test Your Knowledge – Clinical 462 Index 527

ISTUDY moi21793_fm_i-xvi.indd ix 11/22/21 12:46 PM

ISTUDY moi21793_fm_i-xvi.indd xv 06/30/21 01:56 PM