Legacy Manual With Medical Phrasing

EL Material with Medical Context Based Examples
Page
Sl No Topics Number
1 Chapter: 1 - Nouns 7
2 Chapter: 2 - Articles 15
3 Chapter: 3 - Prepositions 36
4 Chapter: 4 - Verbs and Verb Tenses 41
5 Chapter: 5 - Tense 50
6 Chapter: 6 - Passive Construction 54
7 Chapter: 7 - Pronouns 64
8 Chapter: 8 - Adjectives 70
9 Chapter: 9 - Adverbs 75
10 Chapter: 10 - Conjunctions 81
11 Chapter: 11 - Sentence Structure 84
12 Chapter: 12 - Subject and Verb Agreement 112
13 Chapter: 13 - Punctuation 120
14 Chapter: 14 - Capitalization 132
15 Chapter: 15 - Language Differences 173
1
INTRODUCTION TO ENGLISH GRAMMAR
For most of you, it has probably been a long time since you were in school;
therefore, this is a review of very basic grammar that you may need,
particularly as they apply to medical transcription.
The basic foundation of the English language lies in the use of the parts of
speech. To master the English language, one must first learn the parts of
speech.
There are 8 parts of speech in English: Nouns, Prepositions, Verbs,

Pronouns, Adjectives, Adverbs, Conjunctions, and Interjections.
To remember them, think of IVAN CAPP.
I - Interjection
V - Verb
A - Adjectives
N - Noun
C - Conjunction
A - Adverb
P - Pronouns
P - Preposition
These 8 parts of speech are the building blocks of communication.
When you talk, write, or read, only by the correct use of these parts of speech
will the words or sentences make sense.
Some words function as different parts of speech in different sentences.
To determine the part of speech of a word, you must first decide its
function in the sentence.
NOUNS
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DEFINITION: A noun is the name of a person, place, thing,
idea, concept, feeling, or quality.
Every sentence either contains a noun or is about a

noun.
TYPES OF NOUNS: There are two main types of nouns.
1. Proper noun is a specific name or a name in particular, and it always

begins with a capital letter.
Examples: Dr. John, Apollo Hospital, Delhi, Indian, Benadryl
2. Common noun is a name given in common.
Examples: doctors, room, darkness, itching, sensation, childhood
The patient came to the clinic today.

He denies any swelling of his joints.
I asked for his details.
Another classification of nouns: COUNTABLE and NON-COUNTABLE

NOUNS NOUNS
Countable Nouns are nouns that can be counted.

They have both singular and plural forms.
Examples: finger, lips, arteries, piece, specimen, city, solution
Non-Countable Nouns are nouns that cannot be counted.

They have no plural form. They are considered to be singular in usage.
They cannot be preceded by articles (a/an).
Examples: milk, honesty, water, news, vomiting, weather, curd
NOTE: Some nouns like advice, information, furniture, luggage, work,
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bread, traffic, weather, news are considered to be countable by
Indians but are treated as non-countable by Americans.
Avoid using them wrongly with a/an in the plural form.
Examples: Give me some information about yourself.

[NOT] Give me an information about yourself.
Some nouns can be either count or non-count depending on how

they are used in a sentence.
Examples: Experience is the best teacher. [NC]

We had many exciting experiences in college. [C]
Number: Nouns and pronouns both have numbers, meaning that they can
be either singular or plural.
Singular means one.
Plural means more than one.
Not all nouns have both singular and plural, but many do.
singular plural
doctor doctors
child children
person people/persons
louse lice
bacterium bacteria
diagnosis diagnoses
fungus fungi
toe toes
rash rashes
crutch crutches
sclera sclerae
disease diseases
count counts
treatment treatments
symptom symptoms
conjunctiva conjunctivae
allergy allergies
emergency emergencies
cavity cavities
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biopsy biopsies
effect effects
mass masses
infection infections
dosage dosages
COMMON PLURAL ENDINGS
(i) Ending in „s‟
Examples: friends, signs, pets, physicians, ratios, years
(ii) Ending in „es‟
Examples: knives, echoes, diagnoses, shelves, branches
(iii) Ending in „ies‟
Examples: cities, babies, commodities, stories, memories
(iv) Ending in „ae‟
Examples: larvae, algae, formulae, vertebrae
(v) Ending in „i‟
Examples: nuclei, fungi, cocci, bronchi
(vi) Ending in „a‟
Examples: bacteria, criteria, phenomena, ganglia
NOTE: There are many irregular plural forms.
Examples: teeth, lice, children, mice, women, men
SOME EXCEPTIONS
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Some nouns LOOK plural but are singular in usage.
Examples: mumps, anemia, measles, ascites, herpes, physics
Physics is very boring.

Mumps is a painful disease.
Some nouns are ALWAYS plural in usage.
Examples: scissors, shorts, jeans, forceps, tights, adnexa, genitalia
My pants are torn.

The left adnexa were removed along with the uterus.
Some nouns can be used either as singular or plural.
Examples: The Japanese are very hardworking people.

Japanese is my favorite language.
COMMON NOUN ENDINGS
Following is a list of some common noun endings. This in no way covers all
types of nouns, but it will help you in identifying nouns.
-ness: illness, gloominess, hardness sadness
-ity: scarcity prosperity humidity ability
-ssion: mission impression admission obsession
-sion: tension fusion vision incision
-tion: lotion operation education infection
-ment: ointment management treatment comment
-hood: childhood neighborhood
-ing:
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GERUND: An „-ing‟ ending word that functions as a Noun.
It is formed by adding „-ing‟ to the verb form, and therefore is confused most
often to be a verb.
Examples: I am tired of reminding you.

Swimming is an excellent exercise to tone your body.
The itching will reduce over a period of time.
NOTE: Thus „-ing‟ can also be another ending for a noun. One must be
careful while picking such nouns.
The chapter on Verbs will provide a better understanding of Gerunds.
Nouns in Medical Phrasing Context
1. Incorrect: The patient complains of rhinorrhea, which onset 3 days

ago.
Correct: The patient complains of rhinorrhea, which started/began 3
days ago.
Explanation: onset is a noun and can never be used as a verb.
2. Incorrect: The patient presents for a follow up visit.

Correct: The patient presents for a follow-up visit.
Explanation: Follow-up is a noun and follow up is a verb.
3. Correct: The patient will follow up with Dr. Smith tomorrow. ( used as
a verb)
4. Complaints Vs. Complains
Explanation: Complain is a verb and complaint is a noun
5. Incorrect: He complaints of left leg pain.

Correct: He complains of left leg pain.
More on phrasing based nouns:
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The patient is a/an xx-year-old female presenting with:
Singular Plural Nouns
A cough coughs
A cold Colds
A rash A rashes
A bruise Bruises
A lesion Lesions
A fever Fevers
A subjective fever Subjective fevers
A sweat Sweats
A sore throat Sore throats
A taste Tastes
A bad taste ( An abnormal taste) Bad tastes (we use abnormal
tastes)
When add any (use plural nouns)
A mammogram
A wart Warts
A dermatologist Dermatologists (Skin)
A medication Medications
A muscle relaxant muscle relaxants
A topical cream
A lump
A surgery Surgeries
A flu shot
A pneumonia vaccination
A vaccination vaccinations
A headache headaches
Uncountable Nouns
nausea, Pain, Water, Sugar, News, Information, furniture, milk, ankle
edema, food,
Common Nouns Proper Nouns

university Memorial University of
Newfoundland, Canada
park Ramna Park
Hospital, clinic Cleveland Hospital, Clinic
Augmedix
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ibuprofen Advil, Motrin
Paracetamol or acetaminophen Tylenol
Omeprazole Seclo
Voltaren
** The patient denies a cough or coughs. / a cold or colds/ a rash or

rashes/ a bruise or bruises/ a lesion or lesions/ a fever or fevers etc.
** The patient denies any coughs, colds, rashes, bruises, or lesions.
*** Pap Smear ( P is always capitalized)
1. Incorrect: In August 15th, she did pap smear.
Correct: On August 15th, she had a Pap smear done. / She had a Pap
smear on August 15th.
Usage of denies (nor):

The patient denies any fevers, headaches, or nausea.
He denies any chest pain, shortness of breath, or coughs.
Usage of Any:
** When we use “any”, it usually follows by a plural noun
(depending on countable or uncountable noun)
Examples: : any medications, any fevers, headaches, rashes, coughs,
Any pain (uncountable noun)
Using “any”
He denies any palpitations.
She denies any chest pressure.
She denies any anxiety or panic attacks.
He denies any suicidal or homicidal thoughts.
He denies any pain.
She denies any bowel or bladder abnormalities.
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She reports headaches but denies taking any medications to treat them.
GRAMMAR STUDY
Exercise I
Pick the nouns and indicate whether the noun is a common noun (use „C‟) or
proper noun (use „P‟).
1. We went to Graywood Park and got an idea when we saw the birds in the
pond.
2. Using a piece of wood, we saw that Robert could actually lift the men
sitting on the benches next to us.
3. The ability to talk is a very powerful advantage.
4. The principal gave Mike a new folder because he constantly loses his
stuff.
5. A colony of ants climbed onto our picnic table!
Exercise II
Pick the nouns and indicate whether the noun is singular (use „S‟) or plural (use
„P‟).
1. The muffins were in the oven.
2. Because we live at Hawaii, all we see is water, sand, and waves.
3. Communication is very important to all people.
4. Mary is filled with happiness today because justice has been served by
the judge.
5. My folder fell out of my briefcase and landed somewhere.
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Exercise III
Pick the nouns and indicate whether the noun is a countable noun (use „C‟) or a
non-countable noun (use „NC‟).
1. This restaurant serves the best Thai food in the city.
2. Let's play some music.
3. The office has its own stationery.
4. It's hard to discover the truth about this particular case.
5. For such large women, the Klandutzy sisters move across the dance floor
with astonishing grace.
6. It took great courage for Farrody to admit embezzling funds from the bank.
7. Can you give me some advice about finding work in Portland?
8. Most men in my family don't wear jewelry.
9. The soldiers stole all the equipment.
10. We need money to buy new furniture for our bedroom.
ARTICLES
"To be or to be." That's how one of the most famous sentences in the English language
began several years ago in a new edition of Shakespeare's "Hamlet." Six professional
proofreaders failed to catch the mistake, which received national publicity and gave the
publishing company a red face.
DEFINITION: Articles are words that precede and modify nouns.
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TYPES OF ARTICLES
„A‟, „An‟, „The‟ are the three articles.
Sometimes, these words will indicate whether we are referring to the

noun in specific (e.g., the intestines are infected) or in general (e.g.,
give him a pain killer).
„The‟ is called the Definite article. „A‟ and „An‟ are the Indefinite
articles.
„The‟ precedes a specific or previously mentioned noun. It can be used with

singular and plural countable nouns, as well as non-countable nouns.
„a‟ vs. „an‟
„A‟ and „An‟ are used when you are taking about something in the general or
singular context. They can be used only with singular countable nouns.
The choice between „a‟ or „an‟ depends on the initial sound of the
next word.
„a‟ is used before consonant sounds, and „an‟ is used before vowel
sounds.
Examples: a person a transcriptionist a CMT a toy

an exam an hour an MRI an accident
NOTE: The chapter on Phonetics will provide a better understanding

on the usage of the articles: „a‟ and „an.‟
First and subsequent references.
When we first refer to something in the written text, we often use an

indefinite article to modify it.
Example: A newspaper has an obligation to seek and tell the

truth.
In a subsequent reference to this newspaper, however, we will use the

definite article.
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Example: There are situations, however, when the newspaper must
determine whether the public's safety is jeopardized by
knowing the truth.
Zero articles: Several kinds of nouns never use articles. We do not use
articles with the names of languages, sports, and academic subjects.
Examples: He was learning Chinese.

[But when the word Chinese refers to the people, the definite
article might come into play: "The Chinese are hoping to get
the next Olympics."]
She plays badminton and basketball.
She's taking economics and math.
NOTE: Non-countable nouns and sometimes plural countable

nouns are also used without articles.
Examples: We like wine with our dinner.

We adore Arabian music.
We use roses for many purposes.
idiomatic We'll go by train. (as opposed to "We'll

expressions take the train.)
using be and go He must be in school.
with seasons In spring, we like to clean the house.
with institutions He's in church/college/jail/class.

Breakfast was delicious.
with meals
He's preparing dinner by himself.
with diseases He's dying of pneumonia.
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Appendicitis nearly killed him.
She has cancer.
We traveled mostly by night.
with time of day
We'll be there around midnight.
Common countable nouns are used without articles in certain special

situations
WHEN TO USE: A LITTLE/LITTLE and A FEW/FEW
There is an important difference between "little" and "few."
Little is used with non-countable nouns and "few" is used with

countable nouns.
Examples: Tasha has a little experience in management.

[Although Tasha is no great expert, she does have
some experience.]
Tasha has little experience in management.
[She doesn't have enough experience.]
Charlie owns a few books on Latin American literature

[He has some books, not a lot of books.]
Charlie owns few books on Latin American literature.
[He doesn't have enough for our purpose.]
CAUTION!!
Even after you learn all the principles required to

use these articles, you will find an abundance of
situations where choosing the correct article or
choosing whether to use one or not will prove
difficult.
Icy highways are dangerous.
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The icy highways are dangerous.
Both are correct.
Articles in Medical Phrasing Context

Article usage: the, a, an
● The
○ She reports going to the gym.
○ He was advised to contact the office.
● A
○ She reports a non-productive cough.
○ The patient is a xx-year-old female presenting for a follow-up.
○
● An
○ The patient is a xx-year-old female presenting for an annual
physical.
Articles usage with nouns:
The patient
The doctor
A xx-year-old male/female
A xx-year-old male/female
An appointment
A follow-up appointment
A follow-up visit
A follow-up
A cough
coughs
A cold
Colds
A rash
A rashes
A bruise
Bruises
A lesion
Lesions
A fever
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A subjective fever
Fevers
Subjective fevers
A sweat
Sweats
A sore throat
Sore throats
A taste
A bad taste ( An abnormal taste)
Tastes
Bad tastes (we use abnormal tastes)
A mammogram
An MRI
A CAT Scan
A CBC
An STD test
An eye exam
A wart
Warts
A Pap smear (capitalized P)
A dermatologist
A Dermatologist
Dermatologists (Skin)
A medication
Medications
The antibiotic (previously prescribed)
An antibiotic
Antibiotics
A muscle relaxant
muscle relaxants
A topical cream
A lump
A surgery
Surgeries
A flu shot
A pneumonia vaccination
A vaccination
vaccinations
A refill
A headache
headaches
Pain (no article)
a low-fat diet
a note
a work excuse note
a sick note
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a non-smoker
a smoker
GRAMMAR STUDY
Exercise I
Make sentences using the following expressions with and without „the.‟
(a) flowers
(b) water
(c) clothes
Exercise II
Fill in the blanks with „A‟ or „An‟ or „The‟ where necessary.
Soccer or football, as it is called by ____ rest of ____ world outside ____
United States, is surely ____ most popular sport in ____ world. Every
four years, ____ world championship of soccer, ____ World Cup, is
watched by billions all over the world.
It is ____ genuine world championship involving teams from many
countries (as many as 172) and played in venues all over ____ globe.
But although ____ soccer has become ____ important sport in ____
American sports scene, it will never make inroads into ____ hearts and
markets of ____ American sports ____ way that ____ cricket, tennis,
football, basketball, hockey, baseball, and even golf have done. There
are many reasons for this. Anyone who has attended ____ live football
game knows how commercial time-outs slow ____ game, and

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sometimes, at its most exciting moments, disrupt ____ flow of events.
No one raises ____ objection; however, without ____ television, football
knows that it simply wouldn't remain in ____ homes and hearts of
____ Americans. Also, without those advertising dollars, ____ teams
couldn't afford ____ sky-high salaries of their high-priced superstars.
Exercise III
Fill in the blanks with „A‟ or „An‟ or „The‟ where necessary.
This is _____ 80-year-old female, who is _____ Italian, with multiple

treatments and multiple relapses for _____ chronic leukemia. She
used to work as _____ executive for _____ leading multinational
company. She is _____ good historian. I have recommended
_____ MRI. She has been put on _____ pain-relieving medication
for some time now, which has not been helping her. She did come
in with _____ UTI problem last month, which has now resolved.
Plan is to continue with _____ radiation therapy course at
_____ present time. If _____ pain gets worse, we will recommend
_____ increase in _____ medication dosage. She was asked to
consult Dr. Stevenson at _____ Cancer Research Center for
_____ comprehensive blood work. We will recommend further
changes in _____ treatment plan after that.
PHONETICS
DEFINITION: Phonetics is the systematic study of speech sounds.
Why Phonetics?
There are major differences between the American and Indian
pronunciation, which could cause a lot of errors while transcribing.
If the listener does not hear a word properly, he/she will replace the actual
word with a word that sounds similar. Once a major word in a sentence is
incorrect, the remaining words will also follow suit.
With phonetics, we try to minimize such errors.
18
CLASSIFICATION
Languages
Phonetic Non-Phonetic
Phonetic languages have one-to-one correspondence between the spelling

and the pronunciation.
Examples: Kannada, Hindi, etc.
Non-phonetic languages have no one-to-one correspondence between the

spelling and the pronunciation.
Examples: English, French, etc.
AIR STREAMS
Breathing In Breathing Out
Pulmonary Pulmonary
Ingressive Egressive
Air Stream Air stream
We use the pulmonary egressive air stream while speaking English.
When we speak, we make use of the following systems.
INTERNAL ORGANS OF SPEECH
Respiratory Phonatory Articulatory
Lungs Larynx Nose

Muscle of the Chest Vocal Cords Lips
Trachea/Wind Pipe Glottis Teeth
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Roof of the mouth
Tongue
Articulators are organs that help to make sound meaningful. There are 2
kinds of articulators: Active and Passive.
Sounds in American English
Total numbers of speech sounds in American English is 41.
Vowels Consonants
Sounds Sounds
17 24
Classification of consonant sounds
Consonant sounds are classified based on
● Position of the vocal cords (POVC) - voiced(V)/voiceless(VL).

● Where the obstruction takes place - place of articulation (POA).
● How the obstruction takes place - manner of articulation(MOA).
Position of the Vocal Cords
VOCAL CORDS
OPEN CLOSED
20
NO VIBRATION VIBRATION
VOICELESS VOICED
SOUNDS SOUNDS
/s/, /p/, /k/ /z/, /b/, /g/
VOICELESS SOUNDS are sounds that are produced when the vocal
cords are in an open position, thus causing no vibration.
VOICED SOUNDS are sounds that are produced when the vocal cords
are in a closed position, thus causing vibration.
All vowel sounds are voiced sounds.

Some consonant sounds are voiced while others are voiceless.
Place of Articulation (POA)
We classify consonant sounds based on where the obstruction of air

takes place in the oral cavity. There are 9 different places of articulation.
Bilabial /p/ /b/ /m/ /w/

Labiodental /f/ /v/
Dental / / /ð/
Alveolar /t/ /d/ /s/ /z/ /1/ /n/
Post-alveolar /r/
Palato-alveolar / / / // // /
Palatal /j/
Velar /k/ /g/ /ŋ/
Glottal /h/
Manner of Articulation (MOA)
The 6 manners of articulation refer to the ways in which the obstruction

of air takes place in the oral cavity.
Plosive There is complete closure and sudden release of air.

/p/ /b/ /t/ /d/ /k/ /g/
Affricate There is complete closure and slow release of air.

21
/ // /
Fricative There is incomplete closure and air is released with a

hiss or friction.
/f/ /v/ /θ/ /ð/ /s/ /z/ / / / / /h/
Nasal Complete oral closure and air is released through the

nose.
/m/ /n/ /ŋ/
Lateral The air is obstructed by the tongue along the roof of

the mouth, and air escapes by the sides of the
tongue.
/1/
Approximant (Semi-vowels) There is little or no obstruction to

the passage of air.
/w/ /r/ /j/
Three-Term Label
All consonant sounds are uniquely identified using a three-term label
which includes position of the cords, place of articulation, and manner of
articulation.
The order is important: POVC B POA B MOA
Examples: /p/ voiceless, bilabial, plosive

/ / voiceless, palato-alveolar, affricate
TABLE OF CONSONANTS
PLACE OF ARTICULATION
Bilabial Labio- Dental Alveolar Post- Palato- Palatal Velar Glottal

dental alveolar alveolar
VL V VL V VL V VL V VL V VL V VL V VL V VL V
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Plosives p
M
A
N
N
Affricates
E
R
Fricatives θ
O
F
Nasals
A
R
T
I Lateral 1
C
U
L Approximant
A Or
T
Semi-Vowels
I
O
N
VOWEL SOUNDS
17
12 Pure Vowel Sounds 5 Diphthongs
7 short vowel sounds 5 long vowel sounds
Pure Vowels Sounds
1. / æ/ as in apple, larynx, back
23
2. /Λ/ as in but, cut, blood
3. // is called a schwa or a weak vowel
as in around, about, hospital
4. /г / as in father, supper, color
5. /e/ as in eggs, head, examine
6. /I/ as in fit, women, live
7. /U/ as in foot, put, could
8. /a:/ as in calm, arm, heart

9. / / as in birds, shirt, learn
10. /i:/ as in feet, seat, leave
11. /u:/ as in loot, food, few
12. // as in orange, awful, August
Diphthongs
1. /eI/ as in game, shame, patient
2. /aI/ as in my, cry, deny
3. / I/ as in boy, annoy, turmoil
4. /o / as in go, bowl, flow
5. /a / as in couch, mouth, now
SOUND POSITIONS
CONSONANT INITIAL MEDIAL FINAL

SOUNDS
1. /p/ people topmost cheap

person capable slip
2. /b/ burn labor cub

boy rubber sob
3. /t/ town fatal but

take butter fit
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4. /d/ dog middle third
dear admit mad
5. /k/ catch baker back

keep equal talk
6. /g/ goat figure rug

grape begin vague
7. / / cheese richer catch

cheap nature inch
8. / / jest danger ridge

jar soldier sponge
9. /f/ first defend laugh

final affair loaf
10. /v/ vast ever behave

vain silver groove
11. /θ/ think author breath

thirst lethal path
12. / / though within with

there leather soothe
13. /s/ seal essay pass

city pencil famous
14. /z/ zest easy has

zinc bosom does
15. / / shop fissure wish

shirt mission cash
16. / / - confusion rouge

- usual beige
17. /m/ middle fumble rhythm

mud lemon seem
18. /n/ kneel inside down

nail dinner pen
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19. /ŋ/ - singer bang
- longing wrong
20. /1/ lead milk apple

light else fill
21. /w/ water one -

when equal -
22. /r/ river carry car

red borrow tar
23. /j/ yet Tuesday -

urinary beauty -
24. /h/ hot behave -

head perhaps -
SPELLING OPTIONS
CONSONANT SPELLING SOUND

SOUNDS OPTIONS POSITIONS
/p/ p pot, capable, tap

pp happy
/b/ b bill, table, club

bb rubber
/t/ t toy, Peter, receipt

tt battle
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/d/ d door, tender, mad
dd waddle
/k/ k kid, joking, park

c come, macaroni, sac
cc soccer
ch chronic, chemistry
ck suck
lk bulk
q quick, equal
/g/ g goat, gas, glucose

gh ghost
// ch chest, cheese
tr ventricle, treatment
// g general, gel
j jaw, joints
dr drug
/f/ f fall, face

ff suffer, staff
ph physics
gh cough
/v/ v very, vein
/θ/ th thick, thunder, thumb
// th this, feather, there
/s/ s sick
ps psychology
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c cyst
sc science
/z/ z zoo
s cesarean
x Xylocaine
// sh shoe
su sugar
ss issue
si mansion
ti dementia
ci suspicion
ce ocean
se nauseous
ch champagne
sch schwa
x flexion
// su measure
ge rouge
si fusion
/m/ m mouth, thumb

mm stammer
/n/ n noun, begin

nn thinner, nanny
pn pneumonia
kn know, knife
gn sign
wn lawn
/ŋ/ ng tongue, lung
/1/ l lab, color

ll illness
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/w/ w water
wh white
v java
o one
u equal
/r/ r risk, refer

rr arrival, worry
/j/ y young, yet

u urinary, pure
ew few, new
eu Europe
j marijuana
ll tortiya
/h/ h head, behold
MINIMAL PAIRS
Minimal pairs are a pair of those consonant sounds that have two
similarities and one difference in classification (3-Term Labels). These are
sounds that are confused for one another. There are 98 minimal pairs. The
table of consonants is used to derive them.
Examples: /p/- /b/ /t/ /k/

/j/- /w/ /r/
CONFUSING SOUNDS
Confusing sounds are those sounds that are not minimal pairs but yet are
confused for one another. Some of them are given below.
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/w/ - /v/ - Wine /vine
/t/ - // - Treated /cheated
/δ/ - /h/ - This pain / his pain
/1/ - /r/ - Less / rest
COMMONLY CONFUSED WORDS AND PHRASES
Transcribed Dictated
1. Paxil Taxol
2. Navacor Mevacor
3. Coded Coated
4. Very Fairly
5. Bigger Weaker
6. His finding This finding
7. Was found Was phoned
8. With lots of With loss of
9. Serious sight problem Serious height problem
10. Pack cream Tac cream
Some DIFFERENCES in the American pronunciation
Rule 1: /t/ becomes an almost /d/ when unstressed and between 2

vowel sounds.
Examples: photo, attic, dirty, bottle, Seattle, what is it?
Rule 2: „nt‟ rule: /t/ is not pronounced if it comes after the

/n/ sound provided there is no stress on /t/.
Examples: winter, enteritis, international, seventy
„tn‟ rule: /t/is held when it is unstressed and comes
before the /n/ sound.
Examples: kitten, mutton, curtain, certain
Rule 3: a) /nju:/ is pronounced as /nu:/

Examples: nuclear, news, neuralgia, enumeration
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b) /dju:/ is pronounced as /du:/
Examples: induce, medulla, during, conducive
c) /tju:/ is pronounced as /tu:/
Examples: Tuesday, attitude, tubal, tumor
Rule 4: a) In some „i1e‟ ending words, the pronunciation in the

end changes from /aIl/ to /I1/.
Examples: sterile, mobile, fertile, virile
b) In some „tory‟ ending words, the „tory‟ is dragged as in
respiratory (/respItourI/).
Examples: respiratory, laboratory, preparatory
c) In the prefixes (anti-, multi-, and semi-), the pronunciation
changes (/æntaI/or / ænaI/, / mл1taI/, /semaI/).
Examples: antibiotic, semiautomatic, multilobed
Rule 5: Americans pronounce „r‟ in all positions. (Indians do not

pronounce the „r‟ in the end of a word or before a consonant.)
Examples: factor, percussion, murmur, heart, cardiac
EXERCISES
1. From the consonant chart, derive the 98 minimal pairs.

2. List some commonly confused words using minimal pairs or confusing
sounds.
PREPOSITIONS
Have fun reading the following passage.
You can sit before the desk (or in front of the desk). The professor
can sit on the desk (when he's being informal) or behind the desk with
his feet under the desk or beneath the desk. He can stand beside the
desk (meaning next to the desk), before the desk, between the desk and
you, or even on the desk. If he's clumsy, he can bump into the desk or
try to walk through the desk (and stuff would fall off the desk). Passing
his hands over the desk or resting his elbows upon the desk, he often
looks across the desks and speaks of the desk as if there were nothing
else like the desk. Because he thinks of nothing except the desk,
sometimes you wonder about the desk, what's in the desk, what he paid
for the desk, and if he could live without the desk. You can walk
toward[s] the desk, to the desk, around the desk, by the desk, or
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even past the desk while he sits at the desk or leans against the desk.
All of this happens during the class, before the class, until the class
finishes, throughout the class, or after the class.
Those words in bold are all prepositions.
DEFINITION: A preposition is a word used to show a connection between

a noun or a pronoun to some other word in the sentence.
Below is a list of the most common prepositions.
about around to* beneath during inside on
above before of beside except into onto
across behind for over under among below
by from off through with besides after
without between in towards until outside up to
since toward till within out underneath at
against along up beyond amid down past
unto throughout
* 'to' can function as either a preposition or an infinitive marker.
Some prepositions are made up of multiple words. These are called

compound prepositions.
according to in addition to in spite of

along with in front of instead of
because of in place of on account of
aside from due to next to
NOTE: The only way English language learners can begin to master
the intricacies of preposition usage is through practice and paying
close attention to speech and the written word.
Keeping a good dictionary close at hand (to hand?) is an important first step.
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SOME COMMON PREPOSITION USAGES
Prepositions of Time: at, on, and in

We use at to designate specific times.
We use on to designate days and dates.
We use in for nonspecific times during a day, a month, a season, or a year.
Examples: The train is due at 12:15 p.m.

My brother is coming on Monday.
We're having a party on the Fourth of July.
She likes to jog in the morning.
It's too cold in winter to run outside.
He started the job in 1971.
He's going to quit in August.
Prepositions of Place: at, on, and in

We use at for specific addresses.
We use on to designate names of streets, avenues, etc.
We use in for the names of land/areas (towns, counties, states, countries,
and continents.)
Examples: Tina lives at 55 Boretz Road in Durham.

Her house is on Boretz Road.
She lives in Durham.
Durham is in Windham County.
Windham County is in Connecticut.
Prepositions of Location: at, on, and in
Prepositions of Location: in, at, and on and when not used.

IN AT ON NO PREPOSITION
(the) bed* class* the bed* downstairs
the bedroom home the ceiling downtown
the car [the] library* the floor inside
(the) class* [the] office the horse outside
the library* school* the plane upstairs
school* work the train uptown
* You may sometimes use different prepositions for these.
Prepositions of Movement: to and toward[s]
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We use “to” in order to express movement toward[s] a place. “Toward” and
“towards” are also helpful prepositions to express movement. These are simply
variant spellings of the same word; use whichever sounds better to you.
Examples: They were driving to the mall together.

She's going to the dentist's office this morning.
We're moving toward[s] the light.
This is a big step toward[s] the project's completion.
NOTE: With the words home, downtown, uptown, inside, outside,

downstairs, upstairs, we use no preposition.
Examples: Grandma went upstairs.

Grandpa went home.
They both went outside.
Prepositions of Time: for and since
We use for when we measure time or duration (seconds, minutes, hours, days,
months, years).
We use since with a specific date or time.
Examples: He held his breath for seven minutes.

She's lived there for several years.
He's worked here since 1970.
She's been sitting in the waiting room since two-thirty.
PREPOSITIONAL PHRASE
Example: Ms. Sheila is in the clinic to see the doctor and has been
waiting for him.
A preposition is always accompanied by a Noun/Pronoun which is referred to

as the object] of the preposition.
The preposition, its object, including the optional words in between

(modifiers of the object), all together form the prepositional phrase.
PREPOSITION + (modifiers) + OBJECT = PREPOSITIONAL PHRASE
Examples: A good remedy for a cold is a cup of Nestles hot coca.

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The man was placed in the intensive care unit overnight.
NOTE: It is important to remember that a prepositional phrase

will never contain a verb or the subject.
If a pronoun is the object of the preposition, use the object form of the
pronoun.
Example: I gave a brief about him. (Not „he‟ but „him‟)
PHRASAL VERBS
Some verbs contain prepositions. They are considered part of the verb, not as
prepositions. Such as get up, break through, sit up, work out, flare up, sit down,
take out, etc.
Examples: The doctor will follow up with this patient next week.
Never give up hope.
PREPOSITION VERSUS ADVERB
Some words (e.g., down, before, in, behind, on, outside, inside, over) can be
used either as prepositions or adverbs.
Remember that prepositions have objects while adverbs do not.
Examples: The patient looked around the emergency room.

(„around‟ is a preposition with „room‟ as its object)
The patient walked around.

(„around‟ is an adverb modifying the verb „walked‟)
PREPOSITION (“to”) VERSUS THE INFINITIVE (“to”)
Do not confuse an infinitive with the preposition „to.‟ Remember that an
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infinitive will have a verb following „to‟ whereas the preposition „to‟ will
be followed by a noun or a pronoun or a modifier.
Examples:
Infinitive: She has to take her tablets.
Preposition: He gave them to her.
Prepositions in Medical Phrasing Context

On vs. in vs. at
● On - Specific dates (including the date, month and/or year) or surface

complaints (think about it physically)
○ He complains of a rash on his left leg.
○ She has a bruise on her left arm.
○ She reports undergoing a biopsy on 12/13/2018.
○ His pain began on Wednesday.
● In - Less specific dates (not using the date) or internal complaints

○ She tends to get rashes in summer.
○ She was seen by his cardiologist in March.
○ He notes having sharp pain in his abdomen.
○ His last colonoscopy was in 2010.
● At - Locations or times
○ Her BP was elevated at the start of the visit, but it has decreased
since then.
○ He has pain at the base of his heel.
○ She had a mammogram at North Medical.
○ Her surgery will take place at 2:30 PM.
From vs. since vs. over vs. for
● From
○ The patient's medication dose was decreased from 10 mg to 5 mg.
○ She will discontinue the medication from Tuesday.
○ She was advised to abstain from taking all types of contraceptive
pills.
○ I will review the labs from her last ER visit.
● For
36
○ She complains of right knee pain for the past 3 days.
○ He reports he has been seeing a pulmonologist for his asthma.
○ He notes his headache lasted for 2 hours before resolving on its
own.
○ He states he has had the rash for 2 weeks.
○ He notes receiving acupuncture therapy for 2 months previously
with benefit.
● Since
○ She has been following up with her OB-GYN since 2002.
○ Patient reports/has been reporting nausea since Monday.
○ She took ibuprofen for her knee pain which has since resolved.
○ He reports several syncopal episodes since 12/03/2018.
○ She has been using her albuterol inhaler regularly since the last
visit.
○ She is willing to change her medication since her previous one was
not resolving her symptoms.
○ She has been suffering from depression since she was 23.
● Over
○ She notes her symptoms have progressively worsened over the last
4 months.
○ She states she fell over and landed on her right hand.
○ He notes having 3 knee injections over the course of 2 months.
Frequently used Prepositions in medical phrasing context:
1. self-medicating with
2. evaluated by
3. involved in
4. has never been to physical therapy.
5. attributes her pain to prolonged standing and walking.
6. reports nasal congestion after recent contact with others
7. an appointment set up with Dr. D
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8. due to the severity of the pain.
9. complains of
10. denies any SOB on exertion
11. reports changes in her speech/ feelings/
12. He has been compliant with metformin.
13. a medication refill for metformin
14. in the past 7 years
15. requests a referral to a neurologist.
16. She is on a healthy diet
17. He has been working on his diet and exercise.
18. She had her angiogram and angioplasty carried out 10 years ago.
19. The patient is a xx-year-old male with a history of chronic back
pain
20. back pain resulting from a bike accident
21. was last seen 3 months ago (not before)
22. He has been on Lexapro 300 mg (on+medicine name. ex: on Napa)
23. Her A1c levels are elevated at 6.5%.
24. history of GERD.
25. the recent TSH level was elevated at 52 from 48 on 9/16/15.
26. He lost 10 lbs in six months and is dissatisfied with this.
(satisfied/ dissatisfied with)
27. with/without benefit (not benefits)
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28. His symptoms have gradually progressed over the past three
years.
29. His blood pressure is within normal limits today
30. has an appointment with his surgeon.
31. The patient is a 00-year-old female who presents for..
32. suffering from situational depression
33. reports leg swelling, which lasted for a few days.
34. The patient is an xx-year-old male presenting today for a follow-
up on/of prostate cancer/ diabetes.
35. The patient is an xx-year-old male who presents for a follow-up
on/of prostate cancer/ diabetes.
36. She was advised to rest/ advised to exercise/ advised to
discontinue/quit smoking.
37. side effects of Chantix (side effects of+medicine name)
38. is referred to physical therapy
39. The patient agreed to go forward with the treatment.
40. during the visit/ during the procedure
Grammar Study
Exercise I
Fill in the blanks with prepositions. Choose from the clue list.
1. My best friend, John, is named ______ his great-grandfather.

(to, after, about)
2. Grandpa stayed up ______ two in the morning.

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(since, for, until)
3. My parents have been married ______ forty-nine years.

(since, for, until)
4. He usually travels to Philadelphia ______ train.

(on, by, with)
5. You frequently see this kind of violence ______ television.

(with, in, on)
6. I told Mom we'd be home ______ an hour or so.

(to, in, at)
7. I was visiting my best friend ______ the hospital.

(from, at, in)
8. The professor ______ South Africa amazed the American students with
her stories.
(of, in, from)
9. I'll see you ______ home when I get there.

(in, by, at)
10. It's been snowing ______ Christmas morning.

(since, for, until)
Exercise II
Fill in the blanks with suitable prepositions.
"The Shaw shank Redemption" is one _____ the few films this year to refrain
_____ insulting the viewers. The film leaves the viewer _____ a warmhearted
feeling. This film is considered the dark horse _____ the Best Picture Oscar.
This is an extraordinary movie _____ hope, friendship, and suffering _____
life. The film is carefully constructed and shot _____ an even pace.
Freeman Red is the anchor who keeps us _____ sinking _____ a sea _____
emotion.
Exercise III
Correct the following sentences by adding, removing, or changing

the prepositions.
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1. Our ship leaves August 15.
2. I could of dance all night.
3. Where did you get this from?
4. You can't just walk in the house without knocking.
5. He will be back the tenth.
VERBS and VERB TENSES
DEFINITION: A verb is a word or phrase which indicates the action,

condition, or state of being of the subject.
Every sentence contains a verb.
TYPES OF VERBS: There are three main types of verbs.
1. Some verbs indicate what the subject does. These are called action
verbs.
Examples: Dr. Hutchins operates only on Mondays.

Poor personal hygiene causes some diseases.
Her heart beats 100 times per minute.
2. Some verbs indicate what happens to the subject or what the

subject is. These verbs are called linking verbs because they link
the subject to words that rename or describe it.
The most common linking verbs are all the forms of the verb „to
be‟ and some other verbs like seem, become, remain, feel, looks,
smell, sounds, taste, etc., which indicate state of being or condition.
Examples: His heart beat is 100 beats per minute.

The abrasions appear self-inflicted.
The patient was a good historian.
Note: Some verbs double as both linking and action verbs. You must
look at how they are used in the sentence.
A linking verb is often referred to as an equal sign(=).

An action verb always denotes an action.
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Examples:
action verb
The patient smelled smoke before seeing the fire.
linking verb (=)

The rose smells sweet.
3. Sometimes action verbs use helping words that convey

additional information. These words are called helping verbs, and
they always precede the main verb.
A main verb together with its helping verb(s) is called a verb

phrase/verb string.
Examples: The patient was operated on Thursday.

Some diseases are caused by poor personal
hygiene.
The patient had broken his leg while
waterskiing.
The following words may be used as HELPING VERBS within verb strings.
Forms of Forms of
Forms of to be Modals
„to do‟ „to have‟
am, is, are, was, can, will, shall, could,

do, does, did have, has, had were, be, being, would, should, may,
been, might, must, ought to
will be, shall be,
has been, had
been, have been
The most common helping verbs are forms of „to be‟ and „to have.‟
Forms of the verb „to be‟: am, is, are, was, were,
will be, shall be, has been,
had been, have been
Forms of the verb „to have‟: have, had, has
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Another common group of helping verbs is called as MODALS,
such as can, could, may, might, must, ought to, shall,
should, will, would.
TENSES
Tense is the property of a verb that indicates time.
In English, there are 3 Main Tenses: Present, Past, and Future.
Each main tense is classified into 4 Sub Tenses.
a) Simple: Indicating unchanging or repeated action.

b) Continuous: Indicating ongoing action.
c) Perfect: Indicating completed action.
d) Perfect Continuous: Indicating ongoing action that will be
completed at some definite time.
The table below illustrates the usage of the verb „talk‟ in the different
tenses using the first person, second person, and third person as the
pronoun subjects.
PERSON I PERSON II PERSON III PERSON

>
TIME singular plural Singular plural Singular Plural
\/
S Pr T -------------------------talk-------------------------- -----------talks--------- ----------talk-----------
Pr C T am are -----are talking----- -------is talking--------- -----are talking--------
talking
Pr C T have + past participle (have talked) -------has talked------- ------have talked-----
Pr P C T have been + present participle has been talking have been talking
(have been talking)
S Ps T ----------------------------------------------------talked--------------------------------------------------------
Ps C T was were ----were talking----- ------was talking------- ------were talking---
talking
Ps P T ---------------------------------had + past participle (had talked)----------------------------------------
Ps P C T -------------------------had been + present participle (had been talking)----------------------------
NOTE: ‘will/shall’ can be used as the helping verb for future tense
43
SFT --------------------------------------will + root verb (will talk)-----------------------------------------------
FCT ---------------------------will be + present participle (will be talking)----------------------------------
FPT ---------------------------will have + past participle (will have talked)---------------------------------
FPCT ---------------------will have been + present participle (will have been talking)-------------------
NOTE: It is only in the Simple Present Tense that the root verb changes form. In all other forms of present,
past, and future tenses, the root verb remains the same, only the helping verb, changes.
SIMPLE FORMS
Simple Present Tense

The simple present tense expresses an unchanging, repeated/ recurring
action or situation. It can also represent a fact/ widespread truth.
Examples
Every year during winter, the patient gets this kind of an infection.
She smokes a pack of cigarette a week.
He works as a mechanic.
The sun rises in the east and sets in the west.
Simple Past Tense

The simple past tense expresses an action or situation that started
and finished in the past.
Examples
I examined the patient thoroughly.
He wrote a letter to his mother explaining his problem.
The doctor suggested chemotherapy.
Simple Future Tense

The simple future tense expresses an action or situation that will
occur in the future.
The helping verbs will/shall can be used.
Examples
She will see me on Monday again.
The parents will contact our office if the need arises.
NOTE: The future tense can also be expressed using am, is, are,
44
along with „going to.‟
Example: The doctor is going to inform his parents about his

condition.
CONTINUOUS FORMS
Present Continuous Tense

The present continuous tense describes an ongoing action at the present
time.
Examples
The physicians are monitoring his condition.
The doctor is examining the patient.
The patient is doing well today.
Past Continuous Tense

The past continuous tense describes a continuous action in the past.
Examples
The patient was cooking when the accident occurred.
She was recovering well after the operation.
They were not listening to her.
Future Continuous Tense

The future continuous tense describes a continuous action that will take
place in the future.
Examples
The patient will be seeing me again in a week‟s time.
I will be presenting all the facts to them.
PERFECT FORMS
Present Perfect Tense

45
The present perfect tense describes an action that began in the past and
continues in the present, or an action that happened at an indefinite time in
the past.
Examples
She has traveled widely over the past 2 years.
The doctors have suggested therapy.
The patient has shown some improvement.
Past Perfect Tense

The past perfect tense describes an action that took place in the past before
another past action, or an action that got completed at a definite time in the
past.
Example: By the time he was brought to the hospital, the patient‟s

condition had worsened considerably.
Future Perfect Tense

The future perfect tense describes an action that will occur in the future
before some other action.
Example: By the time the ambulance arrives, the patient will have
died due to blood loss.
PERFECT CONTINUOUS FORMS
Present Perfect Continuous Tense

The present perfect continuous tense describes an action that began in the
past, continues in the present, and may continue into the future.
Example: The patient has been considering a transfer to Texas.
Past Perfect Continuous Tense

The past perfect continuous tense describes a continuous action that took
place in the past before some other past action.
Example: Before he was referred to me, the patient had been consulting
Dr. Fuller.
46
Future Perfect Continuous Tense
The future perfect continuous tense describes a continuous action that will
occur before some specified time in the future.
Example: By the end of this year, I will have been participating in

her care for more than 3 years.
TENSE AGREEMENT
Finally, you need to be sure that all verbs in a document agree in tense.
Dictators, as you may have surmised by now, are not always consistent in
what they say. For example, in a physical examination, you need to watch
that the dictator does not switch from past tense to present tense and back
again.
Example
HEENT examination is unremarkable. Neck was supple. Chest is

clear to auscultation and percussion. There are no rales, rhonchi, or
wheezes. The heart has a regular rate and rhythm with no
murmur. The extremities were without clubbing, cyanosis, or
edema.
You will notice that in the above paragraph verb tense jumps back and
forth between present and past. It really does not (in most cases) matter
which tense you utilize when typing such dictation.
However, you need to be consistent in using whichever one you decide is
most appropriate.
PARTICIPLES
A participle is a word formed by

1) verb + (-ing) (present participle)
or
2) verb + (–ed or –en) (past participle)
NOTE: There are also some irregular forms of the past participle
which may not follow these endings.
Examples
47
Verb Present participle Past participle
give giving given
walk walking walked
examine examining examined
go going gone (irregular verb)
send sending sent (irregular verb)
hit hitting hit (irregular verb)
NOTE: A verb‟s past participle is sometimes the same as its past

tense. To ensure that you are using the participle and
not the past tense, remember that the past participle is
the form that follows the helping verbs: have, has, or had.
Participles can be used as nouns/verbs/adjectives. Participles used as

verbs cannot stand alone; they must be a part of a verb phrase and follow a
form of the helping verb „to be‟ or „to have‟.
Present participles used as nouns are called Gerunds.
Examples
Examining the patient proved to be quite difficult.
Reduce your weight by exercising.
Convincing his wife is of utmost importance.
Boiling water is the safest way of cleaning it.
Participles used as part of a verb phrase (must follow any form of the verb
„to be‟ or „to have‟).
Examples
The doctor is examining the patient.
The patient has been speaking to his family.
The nurse will be sterilizing the instruments.
CONTRACTIONS
Many helping verbs can shrink into shorter forms called contractions.
Example: I'm (I am) looking forward to this evening with my boss. After
supper we'll (we will) watch the game.
Here are some common contractions.
Auxiliary Short form Example of Contraction
48
Am 'm I am = I'm
Are 're you are = you're
is or has 's Tom is = Tom's
Have 've they have = they've
Had or would 'd we would = we'd
will or shall 'll he will = he'll
Tenses in medical phrasing context:
Simple Present Tense

1. Simple Present Tense: Describing what is happening during the visit.
Complains of:
The patient complains of rhinorrhea.
Reports:
The patient reports headaches, which have been intermittent for a long time.
Presents with:
The patient is a xx-year-old male who presents with a cough, body aches, and
increased sweating for the past week.
Notes:
He has knee pain but notes that it is not very bothersome.
States:
She states she has been working excessively recently.
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2. Simple Present Tense: Documenting a fact.
He has a longstanding history of GERD.
She has an appointment with her gynecologist this afternoon.
3. Simple Present Tense: Documenting a routine.
She drinks 1 cup of coffee daily.

She regularly checks her blood pressure at home.
Simple Past Tense

1. Simple Past Tense: Documenting something that happened before the
patient‟s visit to the doctor.
Had surgery:
The patient had surgery 3 months ago.
Saw a specialist:
He saw his dentist in October.
Tried:
He tried a spray without significant improvement.
The patient tried physical therapy last month.
Took a medicine:
The patient took Tylenol last night.
The patient took metformin this morning.
2. Simple Past Tense: Describing test results.

Examination revealed the prostate to be normal in size and benign in
consistency.
Total cholesterol increased since 6/18/15.
The patient tested positive for HIV.
3. Simple Past Tense: Describing the treatment plan

The doctor advised bed rest for 2 weeks.
The doctor recommended daily stretching.
The doctor referred the patient to Dr. Smith.
The doctor provided a pamphlet on smoking cessation.
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Present Perfect Tense
1. Present perfect tense: Documenting symptoms
Has worsened:
Her headaches have worsened over the last week.
Has localized:
The pain has localized to his right knee.
Has spread:
The rash has spread to her lower back.
Has increased:
The pain has increased from 5/10 to 8/10.
VOICES
In addition to tenses, another property of verbs is Voice.
Passive and Active Voices.
Verbs are said to be either active or passive in voice.
Example: The hospital committee approved the new policy. (AV)

The new policy was approved by the hospital committee. (PV)
In the active voice, the subject and verb relationship is straightforward: the
subject is the do-er or be-er, and the verb moves the sentence along.
In the passive voice, the subject of the sentence is neither a do-er or a be-er
but is acted upon by something.
Passive Voice Rules for all Tenses

Present Simple Tense (Passive Voice)
Auxiliary verb in passive voice: am/is/are
Active Voice: Passive Voice:
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1. He sings a song. 1. A song is sung by him.
2. He does not sing a song. Does 2. A song is not sung by him. Is a
he sing a song? song sung by him?
Present Continuous Tense (Passive Voice)
Auxiliary verb in passive voice: am being/is being/are being
1. I am writing a letter 1. A letter is being written by me.
2. I am not writing a letter. 2. A letter is not being written by me.
3. Am I writing a letter? 3. Is a letter being written by me?
Present Perfect Tense (Passive Voice)
Auxiliary verb in passive voice: has been/have been
1. She has finished the work 1. The work has been finished by her.
2. She has not finished her work. 2. Her work has not been finished by
3. Has she finished her work? her.
3. Has her work been finished by her?
Past Simple Tense (Passive Voice)
Auxiliary verb in passive voice: was/were
1. I killed a snake A snake was killed by me.
2. I did not kill a snake. A snake was not killed by me.
3. Did I kill a snake? Was a snake killed by me?
Past Continuous Tense (Passive Voice)
Auxiliary verb in passive voice: was being/were being
He was driving a car. A car was being driven by him.
He was not driving a car. A car was not being driven by him.
Was he driving a car? Was a car being driven by him?
Past Perfect Tense (Passive Voice)
Auxiliary verb in passive voice: had been
They had completed the The assignment had been completed by
assignment. them.
They had not completed the The assignment had not
assignment. been completed by them.
Had they completed the Had the assignment been completed by
assignment? them?
Future Simple Tense (Passive Voice)

Auxiliary verb in passive voice: will be
52
She will buy a car. A car will be bought by her.
She will not buy a car. A car will not be bought by her.
Will she buy a car? Will a car be bought by her?
Future Perfect Tense (Passive Voice)
Auxiliary verb in passive voice: will have been
You will have started the job. The job will have been started by you.
You will have not started the The job will not have been started by
job. you.
Will you have started the Will the job have been started by
job? you?
Note: The following tenses cannot be changed into passive voice.
1. Present perfect continuous tense

2. Past perfect continuous tense
3. Future continuous tense
4. Future perfect continuous tense
Passive Voice in Medical Phrasing Context

In medical phrasing, the mostly used tense for passive construction in simple
past, which we call simple past passive voice.
This is an example of when you use the simple past passive voice. In both
cases, we don‟t care or don‟t know who did the action (diagnosing and
evaluating).
1. Simple Past Passive Voice: Documenting actions that happened in the past
when the subject doing the action is unimportant or unknown.
Ex: The patient was diagnosed with sleep apnea.

Ex: The patient was evaluated for diabetes.
Medical Phrasing Examples in Simple Past Passive Voice:
1. She was evaluated by a cardiologist in the past.

2. She was made aware that diabetes predisposes a person to neuropathy.
3. He was last seen 3 months ago and was started on Benicar 10 mg.
4. A repeat colonoscopy was recommended in 10 years.
5. Her recent TSH level was elevated at 52 from 48 on 9/16/15.
6. The dose was increased due to no benefit noticed with the lower dose.
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7. His total cholesterol was elevated with his labs done one week ago.
8. Mrs. B was diagnosed with breast cancer.
9. She was evaluated for sleep apnea a while ago, which was negative.
10. She was advised to rest.
11. The patient was advised to exercise.
12. The patient was advised to discontinue smoking.
13. He was provided a work excuse note for two weeks.
14. The patient was provided a referral to a counselor.
15. The patient was diagnosed with an enlarged prostate.
Grammar Study
Exercise I
Describe the picture given below. Understand the usage of verbs.
54
Exercise II
In the space provided, write the proper form of the irregular verb given.
John _________ (to fly) to Vancouver in September. He _________
(to choose) to fly United Airlines, which had _________ (to run) ads
all that summer. His grandchildren had _________ (to grow) up
there, and he hadn't _________ (to see) them in years. He hadn't
_________ (to write) to them or _________ (to speak) on the phone
with them either. At the Vancouver airport, he _________ (to drag)
his suitcase to a rental car and _________ (to drive) to their home to
surprise them. He _________ (to take) his time _________ (to walk)
up the driveway, and then he _________ (to ring) the doorbell.
Exercise III
Choose the correct form of the helping verb in each blank.
The athlete _____ (is, are) getting ready. She _____ (is, had) prepared
for this moment all her life. She _____ (was, has) thinking of beating
her opponents. Suddenly, the crowd _____ (was, were) yelling. The
race _____ (is, had) started without her. But she _____ (was, were)
running too. The race _____ (was, had) ended in a flash. Someone
_____ (was, were) hugging her. Friends _____ (was, were) lifting her
onto their shoulders. She _____ (had, was) won the race. She _____
(has, had) run without realizing it. The winner _____ (was, were)
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grinning from ear to ear. The crowd _____ (was, were) cheering
enthusiastically. The trophy will _____ (have, has) been given by
tonight. She _____ (is, has, had) been waiting for this moment for a
long time.
Exercise IV
Underline the verb[s] in the following sentences.
1. We were trying to investigate the problem.
2. I can wait.
3. Go home as soon as the anesthetic has worn off.
4. They will go to the mountains.
5. Policemen were patrolling the area.
6. You will certainly be punished severely.
7. They had been ingesting large amounts of chemicals in an attempt to be

part of the group.
8. I will have finished the backlog by Monday.
9. The workers have always been protesting against the bill.
10. The expenses were not paid by the company.
Exercise V
Rewrite the following sentences in all the 12 tenses.
1. The doctor examines the patient.

2. The patient goes to work
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Exercise VI
Rewrite the sentences in passive voice.
Example: Peter writes a letter.

A letter is written by Peter.
1. They built a house.
2. Our uncle takes Susan to hospital.
3. We have cleaned the car.
4. They speak English.
5. The policemen help the children.
6. A robber broke the window of the shop.
7. My mother sends me to the butcher.
8. Peter will look after my little brother.
Exercise VII
Correct the following paragraph by making all verbs agree in tense.
PHYSICAL EXAMINATION: The patient is an alert, well-developed, well-

nourished white male, appearing in no acute distress. His head, eyes,
ears, nose and throat exam is unremarkable. His neck is supple. Lungs
were clear throughout with no rales, rhonchi, or wheezing. The breasts
appeared normal. Heart reveals a regular rate and rhythm with a
systolic murmur. The extremities were normal, without clubbing,
cyanosis, or edema. Neurological exam is intact.
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PRONOUNS
DEFINITION: A pronoun is a word used instead of a noun to avoid

repetition of that noun in the sentence.
The noun to which a pronoun refers or which it replaces is

known as its antecedent.
Examples
The train was late, the train had been delayed. (Sounds horrid ?)
With a pronoun.
The train was late, it had been delayed. (Much better !)
The trains were late, the trains had been delayed. (Sounds horrid ?)
With a pronoun.
The trains were late, they had been delayed. (Much better !)
TYPES OF PRONOUNS
1. Personal pronouns: I, me, you, he, him, she, her, it, we,
us, they, them.
Personal Pronoun - Subject I You he/she/it we they

Personal Pronoun - Object me you him/her/it us them
Personal pronouns refer to specific person[s] or thing[s]. They are the

most commonly used pronouns.
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Example: Dr. Braderick and I agree that this patient will have to see us
again after the surgery.
2. Possessive pronouns: my, your, his, her, our,

their, mine, yours, his, hers, its, ours,
theirs.
Possessive pronouns show ownership/belonging/possessiveness.
Examples: His encephalitis is an extremely virulent type.

That record is hers.
NOTE: There are 2 forms of the possessive case: possessive

adjectives and possessive pronouns. In the first
example „his‟ is a possessive adjective and in the
second example „hers‟ is possessive pronoun.
Possessive
my Your his/her/its our their
Adjectives
Possessive
mine Yours his/hers/its ours theirs
Pronouns
CAUTION!
Possessive Pronoun Contraction of - it is/it has
its it's
(no apostrophe) (with apostrophe)
3. Demonstrative pronouns: this, that, these, those, such.
Demonstrative pronouns identify/point out specific people or

objects.
Examples: This is the procedure outlined by Dr. Brown in his

recommendation.
That is the reason I have decided to take this
course.
4. Intensive and Reflexive pronouns: myself, ourselves,

yourself, yourselves, himself,
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herself, themselves, itself.
Intensive pronouns are used to strengthen the subject of the verb.

Reflexive pronouns are used when the subject and the object of the verb
are the same.
Examples: I myself could not diagnose the patient‟s problem.

She kept telling herself that the pain would go away.
himself,
Reflexive
myself ourselves yourself/yourselves herself, themselves
Pronouns
itself
5. Relative pronouns: who, which, that, whose, whom, what,

where.
Relative pronouns connect nouns or pronouns to groups of words.

They are used to introduce dependent clauses which you will learn later.
Examples: This is a 21-year-old female who has a history of

lower abdominal pain.
He is whom I would recommend.
This is the person whose arm was amputated.
The nurse will tell you what you need to know.
This is where she lives.
6. Indefinite pronouns:
Indefinite pronouns do not refer to specific nouns. They represent an

indefinite entity, not mentioning who or what they are, and are thus
called indefinite pronouns.
Examples: Does anybody know where she is?

Both of the patient‟s kidneys went into kidney failure.
Neither of them could be revived.
Some tests are necessary.
Indefinite pronouns are either singular, plural, or take the number of

their antecedent. Thus, there are 3 types of indefinite pronouns.
List of Indefinite Pronouns.
DEPENDENT
SINGULAR PLURAL ON
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ANTECEDENT
Another Anybody Anything Both All
Anyone Each Either Few Any
Every Everybody Everyone Many More
Everything One No one Others Most
Nothing Nobody Neither Several None
Many a/an Much Somebody Some
Someone Something
7. Interrogative pronouns: who, which, what, whom, where.
Interrogative pronouns introduce questions.
Examples: Which course do you propose that we undertake for the care
of this patient?
What is that?
Who will help me?
Pronoun Usage
To understand the usage of certain pronouns (personal, demonstrative,

relative, indefinite) in sentences, we need to understand if they are used
as subjects or objects.
SUBJECT PRONOUNS: Subject pronouns are pronouns which replace

the subject in a sentence.
The most commonly used subject pronouns are the personal pronouns,
although many other pronouns such as relative, indefinite,
demonstrative, and indefinite can also be used as subjects (I, you, he,
she, it, they, we, who, which, that, those, etc.)
NOTE: In a sentence, the subject can be either a noun or a

pronoun. If it is a pronoun, it must be a subject pronoun.
Examples: The patient and I have agreed on her treatment.

(„I‟ is part of the compound subject „the patient and I‟
which is the subject of the verb „have agreed‟).
They have an understanding about the amount of

help that she requires from him.
(„They‟ is the subject of the verb „have‟; „she‟ is the
subject of the verb „requires‟).
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That is the patient who complained of pain in his low
back.
(„That‟ is the subject of the verb „is‟; „who‟ is the
subject of the verb „complained‟).
HINT
If a pronoun is a part of a compound subject, break the sentence into
two parts to help determine the correct pronoun.
Example: Dr. Dryer and (him/he) believe that the patient is out
of danger.
Break the sentence down

Dr. Dryer believes that the patient is out of danger.
He believes that the patient is out of danger. (CORRECT)
Him believes that the patient is out of danger. (INCORRECT)
Answer: Dr. Dryer and he believe that the patient is out of danger.
OBJECT PRONOUNS: Object pronouns are pronouns which are

used as objects(direct/indirect) of the verb or as objects of the
preposition which was done earlier in the chapter on Prepositions.
Examples: I questioned him about this matter.

(„Him‟ is the direct object of the verb „questioned.‟)
Mr. Troy has given me directions to the detoxification
center.
(The direct object of the verb „have given‟ is directions.
The indirect object is the pronoun „me.‟)
He has recommended this treatment to them.
(„Them‟ is the object of the preposition „to.‟)
Special Case: „Who‟ versus „Whom‟
Using „‟who‟ and „whom‟ can be difficult. Please remember that „who‟ is
the subject form and „whom‟ is the object form.
HINT: If you are uncertain about which pronoun to use,

substitute a personal pronoun (she/ her, he/ him,
they/them) to help determine the correct function.
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Example: I don‟t know ________ he wanted. (who/whom)
HINT: He wanted __________. (she/her)
„Her‟ is the correct form of answer. Since it is the object form, „whom‟ is
the correct choice (since it is also the object form).
Example: This is the patient ________ complains of abdominal discomfort.
HINT: ______ complains of abdominal discomfort. (he/him)
„He‟ is the correct form of answer. Since it is the subject form, „who‟ is
the correct choice (since it is also the subject form).
Pronouns in Medical Phrasing Context
Pronoun agreement is very important in medical phrasing. Below are few

common and most important examples:
1. The patient is a xx-year-old male with a history of chronic back pain who
presents with low back pain.
2. The patient is a xx-year-old male who presents with a cough, body aches,
and increased sweating for the past week.
3. The patient is a 48-year-old male who presents with constant lower back
pain.
4. The patient is a xx-year-old male who presents with left ankle pain radiating
to the back.
5. The patient is a 00-year-old female who presents for an evaluation following

a motor vehicle accident that occurred two days ago.
6. He reports nasal congestion after recent contact with others who are
experiencing cold-like symptoms.
7. She also reports leg swelling, which(referred to “leg swelling) lasted for a few
days and resolved on its own/ spontaneously.
8. She is suffering from situational depression precipitated by several crises in

her life.
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9. Mrs. B was diagnosed with breast cancer. The first phase of her treatment
included a mastectomy to remove her left breast and the tumor. Following the
surgery, her doctors recommended chemotherapy.
10. She attributes her pain to prolonged standing and walking.
11. She tends to cough when her throat starts itching.
12. She had her angiogram and angioplasty done/performed/carried out 10

years ago.
13. She regularly checks her blood pressure at home.
14. She reports slight improvement with regards to her back pain.
15. She ran out of her medication 2 days ago, which(referred to medication)
was last filled in December.
16. She has been recording her blood sugar values at various times
throughout the day.
17. She states her blood sugar is usually around 100, though she is concerned
as she has had occasional values as high as 300. Her blood sugar value has
never reached 400.
18. He has an appointment with his oral surgeon this afternoon.
19. He reports no issues with neither his medication regimen nor his
treatment./ He denies any issues with his medication regimen or the
treatment.
20. He has been working on his diet and exercise.
Grammar Study
Exercise I
Fill in the blanks with suitable pronouns.
1. You're too young to go out by __________.

2. He told __________ to do it, but we forgot.
3. His new machine is driving __________ crazy.
4. Switzerland is famous for __________ watches.
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5. They plan to move to __________ new house soon.
6. Give it to him, not to __________.
7. __________ have done our share.
8. There's no secret between you and __________.
9. __________ should do your work.
10.__________ hasn't sold her car yet.
Exercise II
Use who/whom appropriately.
1. ___________ is your closest friend?

2. ____________ do you bank with?
3. ____________ do you think will win the award?
4. Clare knows ____________ the winner is already.
5. ____________ was that in the clown costume?
6. Kathy was not sure ____________ she was voting for.
7. He is the man ____________ was employed here.
8. She is the woman ____________ we employed last year.
9. ____________ do you think will do the work best?
10.He is the man ____________ we think you mentioned.
Exercise III
Choose the correct pronoun to fill in the blanks.
Others __________ (who/whom/which) have taken Nyquil claim __________

(which/that/this) __________ (its/it‟s/their/theirs) symptoms disappear
rapidly. We will let __________ (they/them) decide whether __________ (we/
they) want to keep __________ (he/him) here or transfer __________
(she/her/him) to Extended Care Facility.
MODIFIERS
DEFINITION: Modifiers describe or give extra information.
Based on what they modify, modifiers are classified into 2 types.
ADJECTIVES and ADVERBS
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ADJECTIVES
DEFINITION: An adjective is a word which modifies a noun or a

pronoun.
Adjectives generally answer the following questions

What kind?
What color?
What size?
Which one?
How many?
or
How much?
Examples: Robert wears rubber gloves at work.

There is a big scar on his cheek.
She reports 2 episodes of dizziness.
He showed little patience and was very restless.
He takes a fair amount of pain medications.
NOTE: In the above examples, the adjectives modify either a

noun or a pronoun.
PLACEMENT OF ADJECTIVES
Most adjectives are found preceding the noun they modify. A noun may
have one or more adjectives which modify it.
Examples: Linda‟s request for bypass surgery was turned down.

(“Linda‟s” modifies request and „bypass‟ modifies surgery)
This unhealthy, obese female came in for her first exam.

(„unhealthy‟ and „obese‟ modify female and „her‟ and „first‟
modify exam]
Adjectives may also immediately follow linking verbs.
Example: The patient seems lethargic and unresponsive.

(„seems‟ is a linking verb, „lethargic‟ and „unresponsive‟
modify patient)
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NOTE: Adjectives can also be found immediately after the noun
they modify and even separated from the said noun by a verb
Example: The rash, red and bumpy, has spread.
TYPES OF ADJECITVES
1. Nouns as adjectives.
Some nouns may function as adjectives modifying other nouns in a
sentence. In such cases, the noun is considered as an adjective.
Example: The patient came into the emergency room with chest
pain.
(„emergency‟ modifies „room‟ and „chest‟ modifies „pain‟)
More Examples:
operation theater cigarette smoke
sleep apnea syndrome foot injury
ozone treatment hospital administrator
NOTE: Possessive nouns always act as adjectives.
Examples: The patient‟s cancer has spread extensively.

(„patient‟s modifies „cancer‟)
Tom‟s mother is with him today.
[“Tom‟s” modifies „mother‟]
2. Articles as adjectives.
Articles are a special category of adjectives.
The articles, „a‟ and „an,‟ are indefinite articles which introduce a
singular noun in general. The article „the‟ is a definite article
which recalls a noun that had been previously introduced or
speaks of a specific noun.
Examples: The tick was removed under sterile conditions with

tweezers.
She lives in a retirement community with her husband
who is an invalid.
3. Participles (-ing, -en, ed ending words) as adjectives:
Examples: The examining physician was Dr. Roberts.

The terrified patient did not speak.
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The patient was being treated for a broken leg.
Convincing arguments are hard to come by.
4. Demonstrative Adjectives, Indefinite Adjectives, Interrogative

Adjectives, and Possessive Adjectives.
All possessive, but some demonstrative, indefinite, and
interrogative pronouns may function as adjectives.
Demonstrative: This exercise is difficult.

I‟m feeling quite ill these days.
That drug has been banned.
Those medications were very helpful.
Possessive: His foot was injured,

Their pets were all neutered.
Its claws had been clipped.
Her clothes were covered with dried blood.
NOTE: Do not use apostrophes with possessive pronouns.
CORRECT: its
INCORRECT: it‟s (“it‟s” is a contraction of „it is‟ or „it has‟)
Indefinite:
Any food causes him abdominal discomfort.
Many bottles were found in the rear of his vehicle.
More medications have been prescribed.
All injections and IVs are recorded in the register.
Interrogative: Whose letters are these?

Which way should I go?
What approach should I adopt?
5. Pure adjectives.
These are words which are always adjectives.
They can never function as any other part of speech.
Some common adjectival endings/suffixes are:
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-al: physical, typical, unusual
-ar: lunar, circular, ulnar
-ic: tragic, lethargic, barbaric, allergic
-ive: imperative, responsive, negative
-able: predictable, livable, recognizable
-ous: cautious, previous, obvious
-ful: wonderful, resourceful, beautiful
NOTE: The above are simply some common endings. They do

not even begin to cover the broad spectrum of adjectives in
the English language. It is much more important to learn to
recognize these words by function rather than by form or
spelling.
Adjectives in Medical Phrasing Context
1. The patient is an xx-year-old male presenting today for a follow-up

on/of/prostate cancer. ( Never write “Black” as a race)
2. The patient reports burning pain in her right leg.
3. He describes the pain as "dull and aching."
4. His abdominal pain has been gradually worsening since last month.
5. The patient is a poor historian.
6. The patient will have an appointment set up with Dr. D for surgical
consultation.
7. She underwent a nasal surgery previously but reports no other surgical

history.
8. The patient reports that the pain is worse today.
9. He complains of weakness in his legs, worse on the left.
10. His blood pressure is within normal limits today.
11. She reports poor sleep quality.
12. He denies loud snoring or depression.
13. She reports neuropathy in her left arm.
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14. The patient is referred to physical therapy twice-weekly.
15. She has had frequent UTIs when she was young.
16. The patient reports stabbing pain in his lower back.
17. He notes having sharp pain in his abdomen.
18. His last colonoscopy was in 2010.
19. The patient has had a severe headache.
20. The patient reports a healthy lifestyle including a daily exercise.
ADVERBS
DEFINITION: An adverb is a word which describes or modifies

a verb or an adjective or another adverb.
Adverbs generally answer the following questions

When?
Where?
Why?
How?/ In what manner?
How often?
How much? / To what extent or degree?
Examples:
Adverbs modifying verbs: Chemotherapy has fairly improved

her condition.
He can climb stairs slowly.
Adverbs modifying adjectives: The patient is quite ill today.

This is very irregular for this
patient.
Adverbs modifying adverbs: He is improving extremely slowly.

The child is urinating very
frequently.
70
TYPES OF ADVERBS
1. Adverbs of Time.
Examples: The patient comes daily for radiation therapy.

I hurt my knee yesterday.
Now, we shall begin with the seminar.
Scott has been already informed.
He denies any fever or pain today.
She had the surgery 2 years ago.
I will see you soon.
Lately, there has been less complaints.
He says he can never bend his back.
She comes early everyday.
2. Adverbs of Frequency.
Examples: He has taken this medication twice.

I have met him once before.
The child often complains to his mother.
He called me again to confirm the diagnosis.
His father always finds fault in him.
He needs to urinate frequently.
3. Adverbs of Place.
Examples: I will wait here till he returns.

They were asked to sit outside.
There is no evidence of anemia.
4. Adverbs of Manner.
Examples: The child slept soundly yesterday.

The patient is doing well today.
He can read the chart clearly.
5. Conjunctive Adverbs.
These are adverbs functioning as conjunctions.
Examples: She has shown improvement; therefore, we will

discontinue the current medications.
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However, there is some pain on the left side.
PLACEMENT OF ADVERBS
Adverbs may be found anywhere in a sentence. They have no fixed

places unlike adjectives.
Examples
Slowly, the patient took his first steps after surgery.

(„slowly‟ occurs at the beginning of the sentence and modifies the verb
„took‟)
Massive hemorrhages usually are encountered in acute gastric

erosions.
(„usually‟ occurs before the verb phrase „are encountered‟ which it
modifies)
The shape of the phospholipid molecule is roughly that of a

clothespin.
(„roughly‟ occurs after the verb „is‟ which it modifies)
Massive hemorrhage are often complicated by the clinical picture

of hemorrhage shock.
(„often‟ falls between the two words of the verb phrase „are
complicated‟ which it modifies)
She comes here for here physical therapy regularly.

(„regularly‟ occurs at the end of the sentence and modifies the verb
„comes‟).
He suffered an extremely painful laceration on his tongue.

(„extremely‟ occurs before the adjective „painful‟ which it modifies).
She recovered quite quickly.

(„quite‟ occurs before the adverb „quickly‟ which it modifies).
Common adverb ending: -ly
Examples: quickly, slowly, loudly, carefully, finally, etc.
NOTE: The above is only a common ending for an adverb. It does

not cover the broad spectrum of adverbs in the English
language which includes adverbs without „–ly‟ ending (very, quite,
72
rather, etc.). It is much more important to learn to recognize these
words by function rather than by form or spelling.
-ly ending is not a guarantee that the word is an adverb.

The words ugly, lovely, friendly, lonely, etc., are adjectives not
adverbs.
ADVERBS VERSUS ADJECTIVES
Adverbs and adjectives are often confused for one another. Many adverbs are
formed adding -ly to the adjective.
Remember that the difference lies in what they modify.

Adverbs can modify adjectives, but adjectives cannot modify adverbs.
DEGREES OF COMPARISON
Modifiers can express different degrees of modifications. There are 3 degrees of

comparison: positive, comparative, and superlative.
The comparative is used for comparing 2 persons/things. The superlative is
used for comparing 3 or more. Notice the word THAN frequently accompanies
the comparative, and the word THE precedes the superlative.
The suffixes –er and –est suffice to form most comparatives and superlatives
although –ier and –iest is used for „y‟ endings (happy, happier, happiest);
otherwise, more and most is used for 2 or more syllables.
Positive Comparative Superlative

Rich Richer Richest
Lovely Lovelier Loveliest
Beautiful More beautiful Most beautiful
Certain adjectives have irregular forms in the comparative and superlative

degrees.
Irregular Comparative and Superlative Forms

Good Better Best
Bad Worse Worst
Little Less Least
73
Like adjectives, adverbs can also have comparative and superlative forms to
show degree.
Example: Walk faster if you want to keep up with me.
We can use more and most, less and least to show degree with adverbs.
Examples: She worked less confidently after her accident.

That was the most skillfully done operation I've seen in
years.
Adverbs in Medical Phrasing Context
1. The patient notes she gets up at 6:00 AM every day.
2. She drinks 1 cup of coffee daily.
3. She exercises regularly and has a healthy diet.
4. She exercises regularly by running and using the elliptical at the gym.
5. She regularly checks her blood pressure at home and reports it ranges
between 142-160 systolic.
6. She initially experienced a poor appetite and weight loss on citalopram, but
she is now eating regularly and reports a healthy diet.
7. His symptoms initially improved after starting Augmentin but have since
worsened.
8. He was previously using inhalers for his asthma without significant benefit.
9. His abdominal pain has been gradually worsening since last month.
10. She states her blood sugar is usually around 100, though she is concerned
as she has had occasional values as high as 300.
11. Her blood pressure has been fluctuating recently.
12. He has not been attending any physical therapy sessions lately.
13. He is not currently taking any medications but is interested in starting

one.
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14. He states it has been worsening over the last month, and he needs to rest
periodically when he walks.
15. He did not seek medical attention for those symptoms, and they
disappeared spontaneously.
16. The patient is referred to physical therapy twice-weekly.
17. The benefits and risks of the procedure were thoroughly explained to the
patient.
18. He takes Wellbutrin 150 mg twice per day for depression.
19. Her blood sugar value has never reached 400.
20. The patient has never been to physical therapy.
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Grammar Study
Exercise I
Fill in the words in brackets as an adjective or adverb like in the example.
Example: Peter works ____________ (slow).

Answer: Peter works slowly.
1. He __________ (quick) reads the book.
2. Mandy is a __________ (pretty) girl.
3. The class is __________ (terrible) loud today.
4. Max is a __________ (good) singer.
5. You can __________ (easy) open this tin.
6. It's a __________ (terrible) day today.
7. She sings the song __________ (melodious).
8. He is a __________ (careful) driver.
9. He drives the car __________ (careful).
10. The dog barks __________ (loud).
11. She has a ___________ (loud) voice.
12. He is a __________ (quick) worker.
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Exercise II
Spot the error. Make corrections if necessary.
1. He has been referred for consideration of addition radiation therapy.
2. The patient improved rapid after diuresis.
3. She has a 3-month history of left face paresthesias.
4. There is a focus area in the right hip.
5. The patient is a blacky 56-year-old male.
6. The lung sounds gradual improved.
7. She developed crampy abdomen pain with vomiting and anorexia.
8. There was a history of mildly asthma, recurring urine tract infections,

and hypertension.
9. She did well postoperative until the morning of admission.
10. He can usual walk and exercise daily and is quite vigour.
11. The patient played normal on the morning of admission.
12. The patient was advised to return to the clinic immediate for any
redness or swelling.
13. The postoperative symptoms were normal.
14. Pain and swelling progressed rapid.
15. There is a minimum amount of nose tenderness, which is not clinical

significant.
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CONJUNCTIONS
DEFINITION: A conjunction is a word that joins words or group of words.
TYPES OF CONJUNCTIONS
There are 3 types of conjunctions.
1. Coordinating Conjunctions join words or phrases or clauses of equal

importance.
HINT:The coordinating conjunctions (for, and, nor, but, or, yet, so) can
be easily remembered using the acronym FAN BOYS.
Examples: The patient complains of nausea and vomiting.

The patient denies any nausea or vomiting.
He is a diabetic, but he does not exercise.
Charlie became addicted to drugs, so he was put in a
rehab center.
2. Subordinating Conjunctions join dependent clauses to the rest of the

sentence.
Some Common Subordinating

Conjunctions
after if though
although if only that
as in order that till
as if now that unless
as long as once until
as though rather than when
because since whenever
before so that where
even if than whereas
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even though how wherever
who, whom For while
NOTE: Relative pronouns always act as subordinating

conjunctions. Some preposition look-alikes may also act
as subordinating conjunctions.
Examples: This is the patient who was admitted for abdominal cramps.
A spinal tap was done on the patient since the doctor last
examined him.
After the patient was prepped and draped, he was
wheeled into the OT.
NOTE: Sometimes subordinating conjunctions join two clauses,

but come at the beginning of the first clause, not
between the two clauses.
Example: If the patient does not recover soon, we will have to

start a new course of medicine.
3. Correlative Conjunctions are pairs of conjunctions used to join parts of

a sentence of equal rank.
Here is a brief list of common correlative conjunctions.
both . . . and neither . . . nor

not only . . . but (also) whether . . . or
not . . . but as . . . as
either . . . or
Examples: Not only were the pupils equal and round, but they were
also reactive to light and accommodation
Neither the child nor the parents were able to explain

the symptoms clearly to me.
4. Conjunctive Adverbs
Conjunctive adverbs are not true conjunctions, but these adverbs often
function as conjunctions in joining two independent clauses. They serve
as transitional devices between one main thought and another.
Some Common Conjunctive Adverbs:
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consequently, furthermore, however, moreover, nevertheless,
nonetheless, otherwise, subsequently, therefore, accordingly,
instead, hence
Conjunctions in Medical Phrasing Context
FANBOYS: The mostly used coordinating conjunctions in medical phrasing

among the FANBOYS (for, annd, nor, but, or, yet, so) are and, but, or, & for.
Examples:
1. He has not received a flu vaccine and declines at this time.
2. He was last seen 3 months ago and was started on Benicar 10 mg.
3. He also saw his dentist in October and finished a course of antibiotics for an
incidental tooth infection.
4. He has been on Lexapro 300 mg a day and reports no issues with this
increase in dosage.
5. She exercises regularly and follows a healthy diet.
6. He is following a low-sodium diet and is avoiding cheese.
7. He states it has been worsening over the last month, and he needs to rest
periodically when he walks.
8. He did not seek medical attention for those symptoms, and they disappeared
spontaneously.
9. He has seen a chiropractor in the past, but he has not been back for this
pain.
history.
11. His symptoms initially improved after starting Augmentin but have since
worsened.
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12. She initially experienced a poor appetite and weight loss on citalopram, but
she is now eating regularly and reports a healthy diet.
13. He has knee pain but notes that it is not very bothersome.
14. He denies any chest pain, shortness of breath, or coughs.
15. She denies any alcohol, tobacco, or recreational drug use.
16. She does have a family history of hypertension but not of heart attacks or
strokes.
17. The patient denies pain or dyspnea on exertion.
18. He also reports the pain is aggravated by walking, moving, or/and lying
down.
19. She must have been very hungry, for she ate everything immediately.
20. He‟s overweight, for he eats too many cakes and biscuits.
Subordinating Conjunctions: The most commonly used subordinating

conjunctions in medical phrasing are after, when, while,
1. The pain began after the patient had a fall.
2. He reports nasal congestion after recent contact with others who are
experiencing cold-like symptoms.
3. The patient also reports that she sustained a finger laceration 1 week ago
while cutting apples.
4. He reports palpitations last night while watching TV.
5. She has had frequent UTIs when she was young.
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SENTENCE STRUCTURE
Sentences are made up of various groups of words. Different types of
groups have different names.
A phrase is a group of words that does not contain a subject or a verb

and cannot stand independently (or which is incomplete).
There are prepositional phrases, infinitive phrases, participle phrases,

and many other phrases.
Examples: The accident occurred near the river.

Mr. Jones was eager to obtain his license.
Reading the copy, I fell asleep.
Filled with emotions, she began to cry.
But the main building blocks of a sentence are clauses.
A clause is a group of words that contains a minimum of one subject and

one verb. Sometimes a clause will also contain phrases.
There are two types of clauses.
1. Independent Clause: A clause is independent if it can stand

alone.
2. Dependent Clause: It is dependent if it depends on an

independent clause.
Dependent clauses are always
introduced by a subordinating
conjunction.
Examples for Independent and Dependent Clauses.
Independent Clause: Dr. Ambrose has been notified.

(Subject: Dr Ambrose
Verb: has been notified
It can stand alone.)
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Independent Clause: He will see the patient at noon.
(Subject: He
Verb: will see
It can stand alone.]
Example: He attempted to irrigate the ear although it had

caused him acute pain.
Independent Clause: He attempted to irrigate the ear.

(Subject: He
Verb: attempted
It can stand alone.]
Dependent Clause: although it had caused him acute pain.

(Subject: it
Verb: had caused
Subordinating Conjunction: although
It cannot stand alone.]
Sentence Structure in Medical Phrasing

Context
Things to remember:
In medical context, the sentences sometimes can be both complete or

incomplete (will lack a proper subject to be a complete sentence) with the main
sentence which is always a complete sentence. In that case we need to be very
careful with the usage of commas. If the second part of the sentence is a
complete sentence then a comma is a must to use before the conjunction. If the
other part of the sentence is incomplete then we are not using any comma.
Examples:
1. He did not seek medical attention for those symptoms, and they
disappeared spontaneously.
2. He has seen a chiropractor in the past, but he has not been back for this
pain.
3. He has not received a flu vaccine and declines at this time. (no comma)

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history. (no comma)
Grammar Study
Exercise I
Fill in the blanks with the appropriate conjunctions.
1. John was cold, _____ he put on a coat.

2. Maria tried to read a novel in French, _____ was too difficult.
3. To get from Vancouver to Victoria, you can fly, _____ you can ride the
ferry.
4. I bought a bottle of wine, _____ we drank it together.
5. The waiter was not very nice, _____ the food was delicious.
6. I went to buy a Rolling Stones CD, _____ the shop didn't have it.
7. Anna needed some money, _____ she took a part-time job.
8. Julie has a guitar, _____ she plays it really well.
10. The concert was cancelled, _____ we went to a nightclub instead.
11. I took my umbrella _____ it was raining.
12. Some apples are red _____ others are green.
13. _____ my sister ______ my brother play the piano.
14. Tonight's program is _____ Mozart _____ Beethoven.
15. _____ the orchestra ______ the chorus was able to overcome the
terrible acoustics in the church.
Exercise II
Fill in the blanks with the appropriate conjunctions given below.
because and but although or

while after even if so
_____ we have lived in Atlanta, we have never been to any exhibit at

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the High Museum. _____ I was waiting in line for the Matisse Exhibit,
I ate my lunch. _____ the line was long and the wait over two hours,
I was very tired. _____ you have already bought your ticket, you
will still need to wait in line. I love Matisse's works _____ he uses
colors so brilliantly.
We have tickets for the symphony _____ the opera. The orchestra
rehearses on Tuesday, _____ the chorus rehearses on Wednesday.
Have you seen _____ heard the opera by Scott Joplin? I wanted to sit
in the front of the balcony, _____ I ordered my tickets early. Does Sue
raise money for the symphony, _____ does she usher at all concerts?
We are going out to eat ______ the show gets over.
Exercise III
Use appropriate conjunctions to join the clauses.
1. He arrived late. We delayed the surgery.

2. John has an uncle. He works for Manhattan Builders.
3. She was given anesthetic. We began surgery.
4. You do not continue your medications. You will not recover from this
illness.
5. In the box is an instrument. I have not seen it.
HOMONYMS
Homonyms are words that are similar in pronunciation but different in

meaning and spelling.
Sometimes these are called “phonetic pairs.”
A few examples are
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hare and hair
weak and week
to, too, and two
where and were
If one of these words was dictated, knowing its meaning would help you
decide how to spell it.
SOME ENGLISH TROUBLESOME TWOSOMES
loose/lose
loose (adjective) “not tight”

lose (verb) “to misplace” / “to not win”
Examples: The patient complained of loose stools.

The patient began to lose weight.
The bolts on the car door are loose.
If we invest poorly, we might lose our money.
complement/ compliment / complimentary
complement (noun) “to add to, complete, or reinforce something”

complement (verb) “to complete”
compliment (noun) “to flatter with a remark / expression of
admiration”
compliment (verb) “to flatter”
complimentary “free”
Examples: The baby had a full complement of fingers and toes.

The printed book complements the online tutorial.
Camille‟s yellow dress complemented her blonde hair.
They complimented her on her hair.
The author paid Carol a compliment.
Peanuts are complimentary on many airplane flights.
cite / sight / site
cite (verb) “to acknowledge”

sight (noun) “ability to see” / “something that is seen”
sight (verb) “to glimpse”
site (noun) “location”
site (verb) “to place/identify”:
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Examples: When you quote someone in a paper, be sure you cite
the source.
Wearing an 8-feet feathered head-dress, he was a
magnificent sight.
In Memphis last week, Elvis was sighted in the
supermarket.
The archeological site exposed several layers of human
occupation.
I sited the deer tracks in the forest.
coarse / course
coarse (adjective) “rough”

course (noun) “path” / ”plan”/ “unit of study”
Examples: The texture of the fabric is coarse.

This is a writing course.
lay / lie
lay (verb + object) “to put or place something”

Its main forms are lay, laid, laid.
lie (verb + no object) “to assume or be in a reclining position” /
“to be situated”
Its main forms are lie, lay, lain.
Examples: He lay the book on the table.

He went to his bedroom to lie down.
We could lay the tablecloth in the sun.
I lie awake at night.
The town lies east of the border.
on to / onto
on to [verb] “to proceed”

onto [preposition] “on”
Examples: The group went on to finish first.

He has improved on to have a surgery.
He climbed onto the bed to get onto the top
its / it‟s
its [the possessive form of the pronouns „it‟]

it‟s [contraction for „it is‟ or „it has‟]
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Examples: That plant is losing its leaves.
It‟s likely to die if you do not water it.
explicit / implicit
explicit “stated outright”

implicit “implied, unstated”
Examples: I left explicit instructions.

We had an implicit understanding.
conscience / conscious
conscience [noun] “a sense of right and wrong”

conscious [adjective] “aware” / “awake”
Examples: Though I was barely conscious, my conscience nagged

me.
He says his conscience is clean.
The child was conscious in the ER.
He reads my stories only because he has a guilty
conscience.
He is not conscious of how others react to him.
affect / effect
affect (noun) “manner/behavior”

affect (verb) “to influence”
effect (noun) “consequence/result”
effect (verb) “to bring about” / “to cause”
Examples: The drug did not affect (v) his driving; in fact, it
seemed to have no effect (n) at all.
The patient‟s affect is appropriate.
Technology affects people in different ways.
It has both positive and negative effects on job performance.

Skiing effects a sense of exhilaration.
already / all ready
already “previously”
all ready “every one is ready”
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Example: We were all ready to go to the movie, but it had already
started.
farther / further
farther “additional distance”

further “additional time, amount, or other abstract matters”
Examples: How much farther is it to the beach?

I do not want to discuss this any further.
elicit / illicit
elicit (verb) “to bring out or call forth”

illicit (adjective) “unlawful”
Examples: The crime elicited an outcry against illicit drugs.

The doctor could not elicit any more information from
the patient.
It is illicit to give out information about a patient
without his written permission.
The physician tried to elicit the facts about the patient‟s
condition.
stationary/ stationery
stationary (adjective) “still/not moving”

stationery (noun) “writing paper”
Examples: The patient‟s condition was stationary.

Please purchase some stationery at the store.
When the wind died, the sailboat was stationary.
The captain took out his stationery and wrote a letter
to his family.
advice / advise
advice (noun) “counsel/recommendation”

advise (verb) “to counsel/to notify”
Examples: The advice that Dr. Brad gave was excellent.

Dr. Brad will advise her to have surgery.
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principal / principle
principal [adjective; noun) “chief/main/leader”

principle [noun) “rule”
Examples: The patient‟s principal complaint was pain.

It is my principle not to borrow any money.
any more / anymore [Both are used in negative constructions.)
any more [any modifying more] “no more”

anymore [adverb] “now/no longer”
Examples: We do not want to buy any more property.

We do not live here anymore.
than / then
than [conjunction) “used of comparison”

then [adjective) “at that time”
Examples: A word processor is faster than an electric typewriter.

Proofread your work; then you can vouch for its
accuracy.
their / there
their [adjective) “of, belonging to, made, or done by them”

there [adverb) “at/in that place”
Examples: There are several laboratory tests to be performed.

Their opinion is the same as mine.
altogether / all together
altogether [adverb) “entirely”

all together [pronoun + noun] “everybody is included ”
Example: It‟s not altogether true that our family spends

vacations all together.
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continual / continuous
continual [adjective; adverb] “constantly recurring”

continuous [adjective] “unceasing”
Examples: Most television shows are continually interrupted by

commercials.
Cable television often shows movies continuously without
commercials.
may be/maybe
may be [verb] “possibly can” / “can exist”

maybe [adverb] “perhaps”
Examples: The patient may be asked to repeat the tests.

He can maybe take a second opinion on the diagnosis.
HINT: “maybe” can be removed from the sentence, but “may be”
cannot without the structure or meaning being changed.
anybody / any body, anyone / any one
anybody [indefinite pronouns] “any person”

anyone [indefinite pronouns] “any person”
any body [a noun modified by any] “any member/unit of a
group”
any one [a pronoun or adjective modified by any] “any
member/unit of a group”
Examples: Can anyone help with this problem?

How can anybody communicate with any body of the central
government?
I have more work than any one person can handle.
Did anyone come?
everybody / every body, everyone / every one,

everyday / every day
everybody / everyone [indefinite pronouns] “all”

every body / every one [indefinite pronouns] “each individual”
everyday [adjective] “used daily/common”
every day [a noun modified by every] “each day”
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Examples: Everybody [everyone) knows that Tom steals.
The commissioner has stocked every body of fresh water in
the state with fish, and now every one of our rivers is a
potential trout stream.
Every one of the athletes was tested for steroid use.
Everyone participated in the talent show.
Everyday problems tend to arise every day.
somebody / some body, someone / some one
somebody / someone [indefinite pronouns] “some person”

some body [a noun modified by some] “some member/unit of a
group”
some one [a noun or adjective modified by some] “some
member/unit of a group”
Examples: Somebody ought to invent a shampoo that will give hair

some body.
Someone told James he should pick some one plan and stick
with it.
someday / some day, sometime / some time / sometimes
someday [adverb] “express future time indefinitely”

some day [adjective + noun] “a particular day”
some time [(adjective + noun) “span of time”
sometime [adverb) “at an indefinite/unspecified time in the future”
sometimes (adverb) “now and then/occasionally”
Examples: We will succeed someday. Someday we will.

We should do that some day.
Choose some day (not someday) that is not so busy.
We have some time before the test begins.
Why do not you come sometime?
I still see my old friend Josie sometimes.
I need some time to make the payments.
PHRASAL VERBS are verbs containing prepositions which act more as a

verb and not as a preposition. Some of them can also act as a Noun/Adjective.
Verb + preposition
follow up knock over break down
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watch out break up hold on
flare up carry on work out
wake up work up give up
break through slow down sit up
As two words = Verb
As One word = Noun / Adjective
One word or two?

Not up to you
Not up to me
What do the books say?
When you don’t get it right, someone has to pay
Don’t let it be you
Just stop and check, one word or two.
FOLLOW UP/FOLLOWUP
Follow up as a noun
He was asked to come for a followup.
| | |
prep article noun
Follow up as a verb
She should follow up regularly.
| |
H.verb M.verb
Follow up as an adjective
This is the patient‟s followup visit.
| |
adjective noun
MORE EXAMPLES: She will follow up with her family physician.

Follow up with me in 2 weeks
He was instructed to follow up in 2 weeks
Followup diabetes: blood sugar level under
control.
Here is here for followup depression.
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BREAK UP/ BREAKUP
EXAMPLES: She cannot bring herself to break up her relationship

with that boy.
I cannot break up my association with them.
After her breakup, she attempted suicide.
FLARE UP/ FLARE-UP
EXAMPLES: His parents flare up every time he talks about

marrying his girlfriend.
The flare-up caused a lot of damage.
There was a flare-up yesterday.
WORK UP/ WORKUP
EXAMPLES: The workup has to be done regularly for significant

results.
They need to work up if they want to find a solution to
this problem.
WORK OUT/ WORKOUT
EXAMPLES: To cut down your weight, I would recommend a

workout.
We might be able to work out some solution.
BREAK DOWN/ BREAKDOWN
EXAMPLES: They have been asked to break down the syllabus.

He believes her breakdown is because of the divorce.
Exercise I
Choose the correct homonym.
1. He will (advice, advise) anyone on their medical problems.

2. Please (lay, lie) the paper down on the examination table.
3. The medical assistant intended the remark as a (compliment,
complement).
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4. (Whose, who‟s) dictionary is this on my desk?
5. (Your, you‟re) office is (too, two) far from the hospital.
6. The old medical building was (razed, raised) to make room for a new
hospital.
7. With a great (serge, surge) the patient leaped (fourth, forth).
8. Tell the patient to (sight, cite) an example for you.
9. Ms. Drake had one (course, course) of radiation treatment following her
left mastectomy.
10. Our stock of office (stationary, stationery) is almost exhausted.
11. The patient‟s rhinoplasty had a tremendous (affect, effect) on her social
relationship.
12. The (affect, effect) of the new surgical procedure gave hope to millions of
people.
13. The patient would prefer to come at 8 a.m. if an appointment is available
(than, then).
14. Developing x-ray films is much faster (than, then) it was ten years ago.
15. The medical assistant quickly sorted the (correspondence,
correspondents) for filing.
16. The surgery on Mr. Salazar lasted nine hours, and Dr. Cho performed
another surgery on Mrs. Baker without a (brake, break).
17. The (principle, principal) reason for the trip was to search for a new
hospital.
18. The physician gave the medical assistant instructions to (accept, except)
the subpoena when it was served.
Exercise II
Two words or one word.
1. (Follow up/ Followup) with her family physician is advised.
2. She will (follow up/ followup) with her family physician.
3. The doctor postponed her (follow up/ followup) for another 2 weeks.
4. He advised the patient to (follow up/ followup) regularly.
5. He (may be/ maybe) at risk for evolving neurologic deficits.
6. If I (may be/ maybe) of any further assistance, please do not hesitate to

contact me.
7. We will probably treat him again with (may be/ maybe) some Augmentin.
8. I am afraid that this (may be/ maybe) necrobiosis diabeticorum.

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9. The 4 hospital visits cost $ 5 (altogether/ all together).
10. We should learn how to operate the new word processors

(altogether / all together).
11. At this hospital, (anyone/ any one) is entitled to incentive pay when
doing medical transcription.
12. Is there (anyway/ any way) you can have the history and physical typed
by 2 p.m.?
13. (Although/ all though) it‟s Friday, we still have to put in some overtime.
14. Is there (alright/ all right) to turn the discharge summary in a day late?
15. The cholecystectomy is planned for (someday/ some day) in January.
16. She knows that (someday/ some day) she will be given a raise.
17. The medical records and medical transcription supervisors are finally
(already/ all ready) to announce the new incentive policy.
18. The radiology report was (already/ all ready) filed in the medical record
when the physician asked for it.
19. Dr. Gordon should be able to see you (anytime/ any time) in February.
20. The emergency room services are open for your use (anytime/ any time).
21. He has certain clothes for (everyday/ every day) wear and surgical
gowns for work.
22. For (sometime/ some time) now, he has been dictating his medical
reports a day late.
23. The consultation reports were sent (sometime/ some time) last week.
24. Her senior medical typists don‟t get (anymore/ any more) pay rises.
25. Is there (anything/ any thing) Dr. Avery can get you for your headache?
26. It took her (awhile/ a while) to understand what the patient was
complaining about.
27. A horizontal osteotomy was (affected/ effected).
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28. On general examination of the abdominal cavity, (they‟re/their/there)
was no abnormality found.
29. (They‟re/their/there) bringing in the accident case to the emergency

room.
30. The tubes were traced out to the fimbriae to doubly identify (they‟re/
their/ there) anatomy.
WHAT ARE THESE?
Homonyms: Words that are similar in pronunciation but different

in meaning and spelling. Also known as homophones
or phonetic pairs.
Example: plain/plane
Antonyms: Word that means the opposite of another word.

Example: benign-malignant
Eponyms: The person after whom something is believed to

be named; a name (as of a drug or a disease) based on
or derived from an eponym.
Example: Alzheimer disease
Synonyms: Words that have the same meaning but different

spellings and pronunciations.
Example: chop [hack]
Heteronyms: Words that have the same spelling as another but a different
meaning and a different pronunciation.
Example: minute “time”
minute “microscopically small”
FINDING THE SUBJECT
Every sentence must contain a subject and a verb and must express a
complete thought. You must be able to recognize the subject and the verb
no matter where they occur in a sentence.
DEFINITION: The subject of a sentence can be a noun or pronoun
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indicating who or what the sentence is about.
HINT: A simple way to find a subject is to ask who or what the

sentence is about. It helps to remember that the subject of a
sentence is always a noun or pronoun.
By referring to the sentences below, you can easily find the subjects as
follows.
1. The subject can tell us who or what does the action stated
by the verb.
Example: The patient drank an unknown amount of Safeway

brand bleach.
2. The subject can indicate who or what is affected by the action

stated by the verb.
Example: Four Dermalon sutures were placed under

sterile technique.
3. The subject can indicate who or what about which something is

stated.
Example: He is a well-developed male in no acute distress.
The subjects indicated above are the simple subjects (patient, suture, he).
The simple subject is the main noun or pronoun.
A complete subject is the simple subject and its modifiers. In the above
examples the complete subjects are „the patient,‟ „four Dermalon sutures.‟
Compound subjects are two or more subjects joined by „and.‟ Example: Her
son and grandson agree about her excessive eating.
Sentence structure: Note that in all of the above sentences, the sentence
begins with the subject and then the verb follows. This is the most common
form of a sentence.
Some sentences are not in the usual subject-verb order; these are called
inverted sentences, and the subject comes after a verb.
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The common inverted sentences are
1. Those sentences that begin with „here‟ or „there.‟ The subject of the
sentence will never be „here‟ or „there.‟
Example: Here is a guide to the medical services available.

(„guide‟ = subject, „is‟ = verb)
2. Questions are usually inverted with the subject coming after the verb
or even between the parts of a verb phrase.
Examples: When is the best time to take this medicine?

(„time‟ = subject, „is‟ = verb)
Are you following up on this patient?

(„you‟ = subject, „are following up‟ = verb)
3. Although prepositional phrases may contain nouns and/or

pronouns, the subject of the sentence will never be found in
a prepositional phrase.
Example: One of the doctors needs to sign your discharge

forms.
(„one‟ = subject, „doctors‟ = object of the preposition)
Grammar Study
Exercise I
Identify the subject[s] and the verb[s] in the following sentences.
1. The patient has taken two Benedryl tablets.
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2. Physical examination reveals a healthy 30-year-old female.
3. I anesthetized the wound using 1% lidocaine.
4. The procedure was done under neurosurgical observation.
5. X-rays of the right shoulder show calcification.
6. Since then, the child has been using an Ace bandage.
7. To buy a home in the suburbs is her ambition.
8. The child is crying and complaining of acute pain.
9. The patient and Dr. Robbins have decided to delay treatment.
10.Toprol and Pepcid are his present medications.
Exercise II
Identify the subject[s] in the following sentences.
1. The trunk reveals no abrasions.

2. The patient was apparently playing golf when he got hurt.
3. She agreed to the procedure and cooperated quietly.
4. The surviving spouse and her sister were given the details of the patient‟s
death.
5. He has no neck pain or headaches.
6. Urinalysis showed greater than 30 white cells.
7. Myocardial infarction and unstable angina may be the cause.
8. She was depressed and presented to the ER around midnight.
9. The patient denies any history of myocardial infarction, but his wife
claims that he does have a history of angina.
10. The resection and suture was done under anesthesia.
SUBJECT & VERB AGREEMENT
Making the subject and verb of a sentence agree is of crucial importance.

One of the most glaring grammatical errors is to have a subject and a verb which
do not agree.
As a transcriptionist, it will be important for you to have a very good
understanding of this principle, since this is one of the most common errors
that dictators make.
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There are several rules governing proper agreement. These will enable you to
recognize dictation errors and correct them.
FUNDAMENTAL RULE: The verb must agree with subject in

number and person.
AGREEMENT IN NUMBER: Every verb must agree with subject in number.

A singular subject must always take a singular
verb and a plural subject must always take a
plural verb.
THE NUMBER OF SUBJECT & VERB
When we speak of numbers, we are referring to „how many.‟
There are only two ways that number can be expressed grammatically.
Singular = One
Plural = More than One
NOTE: Only nouns and pronouns have number.
FINDING THE SUBJECT [who/what the sentence is about]
Singular subject: A singular subject is a subject in the singular form. It

may be a noun [some countable nouns or a non-
countable noun] or a pronoun.
Examples: The patient presents to the emergency room.

The diagnosis is quite serious.
The news was a shock to him.
He returns for a followup visit.
Plural subject: A plural subject is a subject in the plural form.
Examples: Multiple diagnoses are listed on his chart.

Many medications have serious side effects.
They return every two to three days.
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CHOOSING THE VERB
Singular verb: A singular verb is simply the verb form that agrees with a
singular subject.
HINT: They often end in the letter „s.‟
Examples: The patient‟s private physician recommends this treatment.

She hurts herself when she is angry.
The medication helps him most of the time.
He falls asleep very easily.
Plural verb: The plural verb is simply the form of the verb that agrees with
a plural subject.
HINT: They do not end in the letter „s.‟
Examples: The patient‟s private physicians recommend this treatment.

They give free medical care.
The counts fall rapidly.
NOTE: Only in the present tense do regular verbs have number.

In all other tenses, the verbs remain the same for both singular and
plural subjects. (Exception: forms of the verb „to be.‟)
THE „s‟ RULE
In the present tense, singular verbs usually end in „s.‟
Examples: Singular Plural

complains complain
walks walk
recommends recommend
Exception to this Rule: The forms of the verbs „to be‟ are an exception
to the „s‟ rule.
Singular Plural
Present Tense: is are
Past Tense: was were
(This irregular verb has number even in its past tense, meaning it must agree
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with the number of its subject in present as well as past tense.)
THE PERSON OF SUBJECT & VERB
The person of a subject can be determined as given below.
First Person: The person who is speaking. (I/we)

Second Person: The person spoken to (you)
Third Person: The person or thing about which one is speaking.
[he, she, it, they, and all other nouns and pronouns]
All the three persons have a singular and a plural form. In the following chart,
the different forms of verbs that agree with the person of the noun or pronoun
are listed.
NOTE: This is only for verbs in the present tense. In any other tense,
the person of the subject does not affect the form of the verb
except for the irregular verb „to be‟.
First Person Second Person Third Person

Noun Verb Noun Verb Noun Verb
Singular I am You are He is
have have She has
present present It presents
Plural We are You (all) are They are
have have have
present present present
NOTE: The forms of the verbs „to have‟ and „to present‟ are considered as
regular verbs, and the forms of the verb „to be‟ as our irregular verb.
From the above chart, you will notice that the irregular verb „to be‟ changes in
both the first person singular and the third person singular forms.
Regular verbs change only in their third person, singular form.
HINT
1. These are the forms of the irregular verb „to be.‟
Present Tense: I am We are You are He/She/It is They are

Past Tense: I was We were You were He/She/it was They were
2. Regular verbs remain in their „plural‟ form or without the „s‟ ending for all
103
persons except third person singular where they take on the „s‟ ending.
Examples
„to sit‟: I sit, we sit, you sit, he/she/it sits, they sit
„to sleep‟: I sleep, we sleep, you sleep, he/she/it sleeps, they sleep
MORE RULES ON SUBJECT & VERB AGREEMENT
The basic rule of subject and verb agreement is fairly simple. But there
are certain sentences which are constructed in such a way that it is
difficult to determine what the subject is and whether it is singular or
plural. These are sentences that require more than the simple basic rule
to determine agreement of the subject and verb, and the rules governing
them make up the remainder of this section.
The following rules should help you to navigate through most of these difficult
sentences.
RULE 1 Compound subject: A compound subject is 2 or more words

combined to form the subject of a sentence.
a) Subjects joined by „and‟ take a plural verb.
Examples: The patient and her mother are in the waiting room.
[The compound subject „patient and mother‟ requires the
plural verb „are.‟]
The lower abdominal discomfort and the gastric

abnormality are probably due to her eating disorder.
[The compound subject „discomfort and abnormality‟
requires the plural verb „are.‟]
The driver and the passenger agree that the accident was
not their fault.
[The compound subject „driver and passenger‟ requires the
plural verb „ agree.‟ ]
NOTE
There is an exception to this rule, but it is very uncommon in medical
reports.
104
When the parts of a compound subject are together considered as a unit,
or when all the parts refer to the same person or thing, a singular verb is
required.
Examples: My friend and companion is John Walters.

[The compound subject „friend and companion‟ refers
to one individual, John Walters. Therefore, the
singular verb „is‟ is used.]
Rest and relaxation is the only treatment for your problem.

[The compound subject „rest and relaxation‟ refers to
the single element „treatment‟ and requires a single
verb „is‟.]
b) When subjects are joined by „OR‟ or „NOR,‟ the verb agrees with the
NEAREST or CLOSEST subject.
Examples: Either the wife or the children have to sign the consent form.
[The subject „children‟ is closer to the verb hence the plural verb
„have.‟]
No medication or treatment has an effect on this tumor.

[The subject „treatment‟ is closer to the verb hence the singular
verb „has.‟]
Neither blood transfusions nor sexual contact is the reason

for this infection.
[The subject „contact‟ is closer to the verb hence the singular verb
„is.‟]
c) When a singular indefinite pronoun precedes a compound subject, a

singular verb must be used.
Examples: Each medication and treatment is to be approved by

Dr. Glenner.
[The compound subject „medication and treatment‟
is preceded by the indefinite pronoun „each‟ and thus
requires the singular verb „is.‟ ]
Every patient and physician has a discussion on the

course of treatment.
[The compound subject „patient and physician‟ is
preceded by the indefinite pronoun „every‟ and thus
105
requires the singular verb „has.‟]
NOTE
There is an exception to this rule, but it is very uncommon in medical
reports.
Compound subjects which are followed by the indefinite pronoun „each‟
agree with a plural verb.
Example: Medication and treatment each are to be approved

by Dr. Mu.
[The compound subject „medication and treatment‟ is followed by
the indefinite pronoun „each‟ and requires a plural verb „are.‟]
RULE 2 A Collective Noun (as subject) takes a singular verb when

the collection is thought of as one whole or a single unit; a
plural verb when the individuals of the collection are
considered.
Examples: The hospital staff has a meeting today.

The hospital staff have received their pay slips today.
RULE 3 Some nouns (as subjects) look plural in form but are
singular in meaning.
Examples: Pediatrics is a very interesting branch in medicine.

The news was shocking.
RULE 4 Some nouns (as subjects) are always considered to be plural.
Examples: The adnexa are unremarkable.

His trousers were torn in the scuffle.
NOTE: Non-countable nouns (as subjects) are generally taken to be in

the singular form.
Examples: The vomiting has decreased.

Food is essential for the overall development of the body.
RULE 5 Subjects of Quantity or Number depend on the
106
antecedent.
Subjects that indicate quantity or number take a singular verb if their

antecedent is a singular unit or a plural verb if their antecedent is a plural
unit.
This includes
a) fractions
b) percentages
c) phrases like a minority/majority of, a part of, a percentage of, a portion
of.
Examples: One third of the new medicines were returned.

(The subject „one third‟ refers to the antecedent „medicines‟ which
is plural and agrees with the plural verb „were.‟)
A percentage of this patient‟s medical bills are to be submitted to

her insurance company.
(The subject „percentage‟ refers to the antecedent „bills‟ which is
plural and agrees with the plural verb „are.‟)
A large portion of the patient‟s body weight is fat.

(The subject „portion‟ refers to the antecedent „weight‟ which is
singular and agrees with the singular verb „is.‟)
RULE 6 The phrase „a number‟ is considered to be plural, and the

phrase „the number‟ is considered to be singular.
Examples: A number of the patients are afflicted by these symptoms.

(The subject „number‟ is always plural and agrees with the plural
verb „are.‟)
The number of the patients with this affliction has

increased.
(The subject „the number‟ is always singular and agrees with
the singular verb „has increased.‟)
RULE 7 Subjects that specify numerical values of distance, measurement,

time, money, weight, volume, or any other amount take
singular verbs.
Examples: Two tablets is the maximum daily allowance for this

medication.
(The subject „two tablets‟ refers to „allowance‟ which is
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singular. Therefore, we use the singular verb „is.‟)
Three weeks is the duration for these symptoms.

(The subject „three weeks‟ refers to „duration‟ which is
100 mg is the recommended dosage.

(The subject „100 mg‟ refers to „dosage‟ which is
RULE 8 Title names (as subjects) are considered to be singular.
Examples: AAMT Book of Style is the reference book for all transcriptionists.
Mary Jones Community Hospital is an excellent hospital.
RULE 9 Distinguishing the subject from the other nouns and

pronouns in the sentence.
Sometimes in a sentence, one might mistake other words in a sentence for the
subject. This can be avoided by following these rules.
a) Object[s] of a preposition cannot be subjects.
Examples: The x-rays of the facial bone show a slight hairline

fracture of the jawbone.
The history of this patient‟s problems is very intriguing.
NOTE: Do not look for subjects in a prepositional phrase.
b) Words NOT joined by a Coordinating Conjunction.
Nouns and pronouns that appear to be joined with the subject but
are not connected to the subject by a coordinating conjunction or a
correlative conjunction, must not be confused as being either the
subject or a part of the subject.
PUNCTUATION RULE: When a word or words are joined to the subject

by anything other than a coordinating conjunction, it must be set off
by commas.
NOTE: Do not look for subjects in the set off portion.
108
Some of the common phrases that you will come across are: as well as,
along with, in addition to, accompanied by, etc. Usually, a preposition is
part of the connecting term.
Examples: The surgeons, accompanied by the anesthesiologist,

get ready for the surgery.
[The word „anesthesiologist‟ is connected to the
subject „surgeons‟ by the phrase „accompanied by.‟
As this is not a coordinating conjunction nor a
correlative conjunction, „anesthesiologist‟ is not a part
of the subject, and the entire phrase is set off with
commas. So the subject is only „surgeons‟ which agrees with
the plural verb „get.‟]
The x-ray, as well as the MRI, was negative for

any signs of a foreign body.
[The verb „was‟ agrees with the singular subject
„x-ray.‟ The term „as well as‟ joins the word „MRI‟
to the subject „x-ray.‟ As this is neither a
coordinating conjunction nor a correlative
conjunction, „MRI‟ is not a part of the subject.]
The patient, along with her husband, comes in for a

routine followup visit.
[The verb „comes‟ agrees with the singular subject
„patient.‟ The term „along with‟ joins the word
„husband‟ to the subject „patient.‟ As this is neither a
coordinating conjunction nor a correlative conjunction,
„husband‟ is not a part of the subject.]
c) Inverted Sentences
Some sentences are not in the usual order of the subject followed by the
verb; these are called inverted sentences.
There are various types of inverted sentences, and each type will have a
slightly different structure.
1. Sentences beginning with prepositional phrase[s] followed by the

verb.
When a prepositional phrase is followed by the verb instead of the

109
subject, the sentence is inverted and the subject will be found later in
the sentence.
Example: In the patient‟s records was found the history of this

disorder.
[The subject „history‟ comes after the verb phrase „was
found.‟ Notice that the verb agrees with „history‟ in number.
Be careful not to mistake „records/disorder‟ as the subject
because they are the objects of the prepositional phrases in
the sentence.)
Within the eyes lies the truth of the soul.

[The subject „truth‟ comes after the verb „lies.‟ Notice
that the verb agrees with „truth‟ in number. Be careful
not to mistake „eyes‟ as the subject because it is the
object of the prepositional phrase.]
2. Sentences that start with the words „HERE‟ or „THERE.‟
„Here‟ and „There‟ are adverbs of place. They can never be the subject of
a sentence; therefore, you must locate the subject elsewhere in the
sentence, determine whether it is singular or plural, and then make the
verb agree accordingly.
Examples: There are multiple abrasions across the patient‟s face

and neck.
[The subject „abrasions‟ comes after the verb „are.‟
These are both plural in number.]
Here are the results of her CAT scan.

[The subject „results‟ comes after the verb „are.‟]
NOTE: This is one rule that is important to know as a transcriptionist. It

is also more difficult because you are typing as you are listening, and a
dictator will often dictate sentences such as these incorrectly. You may
need to listen ahead a bit to find out what the subject is, and be sure
that it agrees with the verb the dictator gives.
3. Interrogative sentences.
These are often inverted. They are easily recognized as they are
110
usually introduced by an interrogative pronoun.
Examples: What is his name?

[The subject „name‟ follows the verb „is.‟]
When are we leaving?

[The subject „we‟ actually comes between the words of
the verb phrase „are‟ leaving.‟ This is still considered
an inverted sentence.]
Subject and Verb Agreement in Medical Phrasing

Context
Subject and verb agreement in medical phrasing is a little tricky sometimes.
However, the below examples will help to go through the common errors and to
avoid them.
1. Incorrect: She complains of lesions on her right arm which has been
present for 2 weeks.
Correct: She complains of lesions on her right arm which have been present
for 2 weeks.
2. Incorrect: If his anti-hypertensive medications does not work, we will think

about switching them.
Correct: If his anti-hypertensive medications do not work, we will think about
switching them.
3. Incorrect: The patient request a refill.

Correct: The patient requests a refill.
4. Incorrect: Her symptoms is improving.

Correct: Her symptoms are improving.
5. Incorrect: He complains of anxiety and nervousness, which is affecting his

work occasionally.
Correct: He complains of anxiety and nervousness, which are affecting his
work occasionally.
6. Incorrect: He have a history of diabetes and taking metformin once a day.

Correct: He has a history of diabetes and taking metformin once a day.
111
7. Incorrect: The patient use eye drops.
Correct: The patient uses eye drops.
8. Incorrect: He has had several suicide attempt over the past 10 years.
Correct: He has had several suicide attempts over the past 10 years.
9. Incorrect: He reports nasal congestion after recent contact with others

who is experiencing cold-like symptoms.
Correct:He reports nasal congestion after recent contact with others who
are experiencing cold-like symptoms.
10. Incorrect: His vaccinations is up to date.

Correct: His vaccinations are up to date.
11. Incorrect: She was made aware that diabetes predispose a person to
neuropathy.
Correct: She was made aware that diabetes predisposes a person to
neuropathy.
12. Incorrect: The patient also reports that she has been taking care of her
children who has been presenting similar symptoms at home.
Correct: The patient also reports that she has been taking care of her children
who have been presenting similar symptoms at home.
13. Incorrect: Patient states her children has similar symptoms.

Correct: Patient states her children have similar symptoms.
14. Incorrect: His symptoms initially improved after starting Augmentin but
has since worsened.
Correct: His symptoms initially improved after starting Augmentin but have
since worsened.
15. Incorrect: She regularly check her blood pressure at home.

Correct: She regularly checks her blood pressure at home.
16. Incorrect: The patient is a xx-year-old male who present with a cough.
Correct: The patient is a xx-year-old male who presents with a cough.
17. Incorrect: A repeat colonoscopy were recommended in 10 years.

Correct: A repeat colonoscopy was recommended in 10 years.
18. Incorrect: She exercise regularly and have a healthy diet.

Correct: She exercises regularly and has a healthy diet.
19. Incorrect: He is accompanied by his home caretaker who provide

112
additional history.
Correct: He is accompanied by his home caretaker who provides additional
history.
20. Incorrect: His chest pain appear to be pleuritic in nature.

Correct: His chest pain appears to be pleuritic in nature.
RULES ON PRONOUN AGREEMENT
FUNDAMENTAL RULE: Pronouns must agree in person, number, and

gender with their antecedents.
An antecedent is the noun/pronoun that a pronoun refers to or which the

pronoun replaces.
I A pronoun must agree in person and with its antecedent.
There are 3 persons for pronouns.
First Person: The person who is speaking.

Second Person: The person to whom one is speaking.
Third Person: The person or thing about whom one is speaking.
Use the correct pronoun to refer to the antecedent.
First Person: I, me, mine, we, us, ours, our

Second Person: you, your, yours
Third person: he, him, his, she, her, hers, it its, they, their,
theirs
Examples: When a patient comes in with this type of gynecological

problem, she should give her history to the consulting
physician immediately.
[The antecedent „patient‟ is in the third person; therefore, we
must use the third person pronouns „she‟ and „her‟ to refer to
it.
Anybody who donates blood must ensure that he/she

is HIV negative.
[The antecedent „anybody‟ is in the third person; therefore we
113
must use the third person pronoun „he‟ or „she.‟]
NOTE: Gender agreement takes place only in third person

singular.
II A pronoun must agree in number with its antecedent.
i) Indefinite Pronouns
Indefinite pronouns are either singular, plural, or take the number of

their antecedent. You must remember the number of each individual
pronoun in order to ensure verb agreement.
Following is a list of the most common indefinite pronouns and their

number. Refer to this when determining subject-verb agreement.
Singular Plural Dependent

On
Antecedent
Another many a/an both all

Anybody much few any
Anything nobody many more
Anyone neither others most
Each no one several none
Either nothing some
Every other
Everybody somebody
Everyone someone
Everything something
One
NOTE: In the column titled „Dependent on Antecedent,‟ remember that

you must determine the antecedent of the subject pronoun before
deciding on its number.
When singular indefinite pronouns are used as antecedents, the

personal pronouns that refer to them must be singular.
Examples: Each of the patient was asked to give his past medical
records.
114
[The singular pronoun „his‟ refers to the singular indefinite
pronoun „each.‟]
Anybody can get his/her records from the medical records

department.
[The singular pronoun „his/her‟ refers to the singular
indefinite pronoun „anybody.‟]
When the plural indefinite pronouns are used as antecedents, the

personal pronouns that refer to them must be plural.
Examples: Many of the patients claim that their diets are not adequate.
[The plural pronoun „their‟ refers to the plural indefinite
pronoun „many.‟]
Few of the patients show recurrence of their symptoms

during a followup visit.
[The plural pronoun „their‟ refers to the plural indefinite pronoun „few.‟]
When the antecedent dependent indefinite pronouns are used as

antecedents, the personal pronouns that refer to them will be
singular or plural depending on their respective antecedent.
Examples: None of the medications have shown their side effects.

[„Their‟ refers to „none‟ which is plural because its
antecedent is „medications.‟]
Some of the money was not used for its intended purpose.
[„Its‟ refers to „some‟ which is singular because its
antecedent is „money.‟]
More Examples on Subject-Verb agreement involving pronouns.
Each of the patient‟s allergies has been discovered by one of these

attacks.
(Singular subject „each‟ agrees with the singular verb „has.‟)
Both of these symptoms are due to HIV infection.

(Plural subject „both‟ agrees with the plural verb „are.‟)
115
More of this fluid is to be tested for antibodies.
(Subject „more‟ refers to the antecedent „fluid‟ which is
singular and agrees with the singular verb „is.‟)
Some of the tests do not agree with this theory.

(Subject „some‟ refers to the antecedent „tests‟ which is plural
and agrees with the plural verb „do agree.‟)
ii) Demonstrative pronouns used as adjectives must agree in number

with the noun they modify.
Singular Plural
This These
That Those
Examples: This type of disease is very rare in North America.

[„Type‟ is singular; therefore, we use the singular
adjective „this.‟]
These diseases are very rare in North America.

[„Diseases‟ is plural. Therefore, we use the plural adjective
pronoun „these.‟]
iii) Relative Pronouns
The relative pronouns „who,‟ „which,‟ and „that‟ take the

number of their antecedents. You must determine the number of their
antecedent and then choose the correct number of the verb to agree with
the antecedent.)
Examples: This medication which is to be discontinued must be

noted as an allergy for this patient.
(Subject „which‟ refers to the singular antecedent
„medication‟ and agrees with the singular verb
„is.‟)
These treatments which are working effectively

should be administered biweekly.
(Subject „which‟ refers to the plural antecedent
„treatments‟ and agrees with the plural verb „are
working.‟)
116
Grammar Study
Exercise I
Choose the correct form of the verb to fill in the blanks.
1. Pain, blurring of vision, and sensitivity to bright light ____________

noted yesterday morning.
(a) was (b) were
2. The information contained in the genes and carried by means of the DNA
molecule _____________ from generation to generation.
(a) passes (b) pass
3. The study of anatomy and the study of physiology ____________ into one
course of study.
(a) combines (b) combine
4. _______________ your father and mother at home?

(a) is (b) are
5. The medication or the continued smoking ______________ to be

responsible for her symptoms.
(a) seem (b) seems
6. Each of you_________ to give the details by tomorrow.

(a) has (b) have
7. There ___________ to be numerous lesions across her chest and abdomen.

(a) appears (b) appear
8. On every Monday and Thursday ____________ hospital inspection.

(a) is (b) are
9. Here _____________ all of the samples that you requested.

(a) is (b) are
10. Few of the patients who undergo this surgery ___________ any
recurrence of kidney failure.
(a) shows (b) show
11. Under the patient‟s nails ____________ to be a rash of an unusual nature.

(a) appears (b) appear
117
12. In a typical spinal motor neuron, a number of processes ___________ out
from the cell body.
(a) extends (b) extend
13. The number of neurons ___________ considerably in different parts of the

nervous system.
(a) differ (b) differs
14. Most of the antibiotics _________ been administered at this time.

(a) has (b) have
15. Several of the patient‟s laboratory results ______________ above normal

for a woman of her size and age.
(a) was (b) were
16. Another of the patient‟s arteries _________ become blocked.

(a) has (b) have
17. The patient and her mother each _________ concerned about the after
effects.
(a) was (b) were
18. Many an anesthetic _____________ been used in this procedure,

but this one seems to be the most effective.
(a) has (b) have
19. He denies any fever, rashes, or joint swelling although he has

irritation on his left leg that ______________ been bothering him.
(a) has (b) have
20. There does not appear to be any CVA tenderness that

______________ causing her discomfort.
(a) is (b) are
21. Much of what we know about this patient ____________ based on what he
told us about his past.
(a) was (b) were
22. The patient, along with his mother, _________ here for a followup visit.
(a) is (b) are
23. Three fourths of anesthetic ___________ administered during surgery.

(a) was (b) were
118
Exercise II
Make corrections where necessary.
1. There has been several objections to the new policy.
2. She is allergic to penicillin and Demerol and it is allergic to bee stings as

well.
3. Nowadays five hundred rupees are a meager salary.
4. Either my sister or my nephews are coming.
5. A stoic patient plays down his troubles while a hypochondriac

exaggerates it.
6. My parents finds fault with everything I do.
7. No blood test or x-ray are necessary at this time.
8. Not one of you have done his work properly.
9. All of the medicine is paid for by the company.
10. With treatments, there were improvement.
11. Pappilloma, as well as angioma, fibroma, chondroma, and osteoma

are rarely seen.
12. Mathematics frighten most children.
13. General Motors will probably recall most of their four-wheel drive
vehicles.
14. At the foot of the mountain were two enormous vineyards.
15. HEENT examination, not cardiac examination, include a complete

review of the head, eyes, ears, nose, throat, mouth and teeth.
16. All of the IV fluid were been used.
17. Half of the tests is positive.
18. One of the test is negative.
119
PUNCTUATION RULES
NOTE: For all punctuations follow the general guidelines and account-
specific instructions. Always consult appropriate references in case of
doubt.
RULES ON THE USE OF PERIODS
1. At the end of a declarative sentence [or a statement] or a mild

command or an instruction or an indirect question.
Review of systems is negative.

The patient has no known drug allergies.
Maintain current medications.
Increase fluid intake.
Follow up in 2 weeks.
Direct Question: What is your name? [Direct questions end with „?‟]
Indirect Question: He asked my name.
The patient asked if she could drive.

I will question the patient about this on her next visit.
I questioned the husband about this.
2. At the end of each entry in a LIST (vertical/horizontal) display.
IMPRESSION/PLAN
1. Type 2 diabetes.
2. Angina.
3. Osteoarthritis.
4. Atrial Fibrillation.
5. Status post laminectomy.
NOTE: For a horizontal (run-on) list. Use a period at the end of each
entry if the entries begin with capitals/uppercased letter.
RECOMMENDATIONS: Supplemental potassium. Telemetry. We will
follow up in 2 weeks.
3. To end a quotation, place the period within close quotes.
The patient said, “I cannot sit for long.”

The child states that she feels “woozy.”
120
4. Latin Abbreviations.
[Most Latin Abbreviations are lowercased.]
e.g. for example

etc. etcetera/and so forth.
i.e. that is
et al. and others/other people.
viz. namely/that is
5. Drug-related Latin abbreviations.
q.i.d. t.i.d. q. 6h. p.r.n. b.i.d. p.o.
NOTE: If the sentence ends with a period of an abbreviation, do not

follow it with another period. Do not use 2 periods, one for the
abbreviation and one to end the sentence; instead, one period will
do for both.
PLAN
Apply Lidex 0.05% ointment to this area p.r.n.
Paxil 40 mg p.o. q.a.m.
6. If a parenthesis ends a sentence, place the period after the

parenthetical statement/after the closing parenthesis.
Victor is allergic to penicillin (he also mentions erythromycin).
7. Separate unrelated data/test results.

(Unrelated by period/semicolon, related by comma)
LABORATORY DATA: Cholesterol 173, triglycerides 143, and LDL 111.

Potassium 3.4, BUN 19, and creatinine 1. Urinalysis with pH of 7.0.
8. As a decimal point.
Period can also serve as a decimal point to separate fractions from the
whole numbers.
Temperature 98.6/100.2 degrees

Drug dosages 3.5 mg
Measurements 1.5 cm
121
Concentration 0.5%
Money $245.50 (to separate dollar & cent)
Urine specific gravity is always transcribed as a 4-digit number as a

single numeral followed by a period/decimal point, i.e., place the period
after „1‟ or the first digit from your left.
1.025 [Most often the doctor will not dictate the decimal
point. You might hear it as “ten twenty five.” You are
required to transcribe it accordingly.]
9. Abbreviated Courtesy/Professional Titles.

(Mr. Mrs. Ms. Dr. Jr. Sr.)
I saw the patient Ms. Lewis and her husband Mr. Thompson in
the office today.
Dr. Ramirez referred him to orthopedics.
NOTE: Usage of comma before and a period after the junior/senior

abbreviations is optional. Use both or neither.
Terry Presley Jr [or] Terry Presley, Jr.
10. Initials within a name when abbreviated takes a period but not
when the initials replace a complete name.
James D. Watt JFK
11. Acronyms, Abbreviated Professional Degree Credentials,

Academic Degree Abbreviations do not take periods.
AIDS SOAP MBBS MD CMT RN
12. Chemical Symbols, units of measurements, ordinal numbers, and

US 2-letter state abbreviations do not take periods.
Na O2 K mg cm g
2nd 7th 3rd
NY AR IA
122
RULES ON THE USE OF COMMAS
Commas are used

a) to indicate a break in thought
b) when they enhance clarity
c) to improve readability
d) diminish confusion/misunderstanding
e) to set off material, non-essential information
Sometimes they must be used; sometimes must not be used; and sometimes it
is optional.
Avoid their overuse.
1. Use a comma after introductory elements like phrases, adverbs.

Phrases like prepositional phrases or infinitive phrases or participle
phrases can introduce the sentence.
NOTE: If there is only one introductory phrase, you can place a comma
after that phrase, but if there are multiple or a series or a combination of
introductory phrases, you can place the comma after the last phrase.
After much discussion, he agreed to do a biopsy.

On examination, the tube is in place.
Over the top of the crossway, she struck this vehicle.
On auscultation of the chest, excellent air movement in the lungs.
To do an MRI, the patient was taken to the radiology department.

To get a second opinion and to remove all doubts, Dr. Brown was
consulted.
Observing her, I could not make a diagnosis.

Keeping the patient‟s condition in mind, I decided to put her on
Paxil.
NOTE: No comma used when the introductory phrase] is followed by

a verb.
In the chart note are all his details.

On the back of his neck is a laceration.
To find time to see this patient will be difficult.
123
Adverbs introducing independent clauses are also optionally set off.
Unfortunately, we could not save the patient.

Additionally, he received IV nitroglycerin
Frankly, I don't believe the patient is telling the truth.
Incidentally on arrival, Dr. Thomas was in the ER.
He insists that it is not a mosquito bite, but apparently, his wife
disagrees.
We have talked about this in detail, and today, she has agreed to go
ahead with surgery.
Tomorrow we plan to do an MRI.
2. Separate a dependent clause from an independent clause by a

comma not vice versa.
When she is on her feet, she has pain in her left foot.
After she finished dinner, she began experiencing abdominal discomfort.
We will make no changes because she is currently doing well.
If she shows improvement, we will discharge her.
NOTE: A subordinating conjunction always introduces a dependent

clause.
3. Use a comma to separate independent clauses joined by a

coordinating conjunction [one among FANBOYS].
NOTE: The comma is optional if the clauses are very short.
The patient continues to have cough, and she is concerned.

His sputum has cleared, but his cough is not improving.
She has no shortness of breath and is able to climb stairs with ease.
He sings and she dances.
DO NOT use a comma before a coordinating conjunction

linking only 2 words, phrases, or not joining independent clauses.
124
4. To separate elements of a series (more than 2 elements).
She was advised rest, liquid diet, elevation, and Tylenol p.r.n.
He denies any neck pain, chest pain, or upper extremity pain.
The patient is sitting up, watching television, eating well, and seems
significantly improved.
NOT if all entries are joined by „and/or‟.

She was advised rest and liquid diet and elevation and Tylenol
p.r.n.
He denies any neck pain or chest pain or upper extremity pain.
NOTE: It is uncommon for a series to be dictated in this manner;

however, if dictated, you should be aware of how to punctuate them.
5. To separate two or more adjectives preceding a noun not joined by

„and‟ but where it can be inserted.
Exam reveals a pleasant, alert female in no acute distress.

[We can say pleasant and alert.]
Exam reveals a pleasant, alert, slender European female in no acute

distress.
[We can say pleasant and alert female, alert and slender female, but not
slender and European female. No comma between slender and
European.]
A partial pelvic exam was done.

[We cannot say partial and pelvic.]
The patient is a quite well-developed, well-nourished, young girl in no

acute distress.
[We cannot say quite and well-developed, but we can say well-developed
and well-nourished, well-nourished and young.]
6. Set off Appositives.
Appositives are words or a group of words that directly follow the

noun and describe or rename the noun. These are usually non-
essential and are thus set off.
The surgeons, Dr. Jones and Dr. Smith, report that the procedure was a
success.
125
The patient, young and alert, comes in for a follow-up.
The patient, who is a hairdresser, comes to the ER.
NOTE: Essential clauses are not set off.
Anyone who has a visitor‟s pass can meet the patient.

[“who has a visitor‟s pass” is an essential clause because if we remove
this clause, the meaning of the sentence changes. So we do not set it
off.]
7. Set off Conjunctive Adverbs.
Some of the common conjunctive adverbs used are

consequently, furthermore, however, moreover, nevertheless,
nonetheless, otherwise, subsequently, therefore, accordingly.
a. If a conjunctive adverb joins two independent clauses, set it off

with a semicolon and a comma.
I need to do some tests; therefore, I have admitted the

patient.
She is going ahead with arthroplasty; however, I discussed it with

her again.
b. When the above condition is not satisfied, set it off with two
commas.
He was, however, mildly injured.

The patient, nevertheless, has shown signs of recovery.
c. If a conjunctive adverb begins/introduces a sentence, follow it with

a comma.
However, I suspect his symptoms will get worse.
d. If a conjunctive adverb ends a sentence, set if off with a comma

and a period.
There are no side effects, however.
126
8. For a complete date separate the day from the year with a comma
and also after the year if the sentence continues, else a comma after
the day and a period after the year if the complete date ends the
sentence.
NOT for incomplete dates.
The biopsy was performed on April 31, 2003, at Fairy Hospital.

The biopsy was performed on April 31, 2003.
The biopsy was performed on April 2003 at Fairy Hospital.
9. If required place comma before close quotes.
The doctor said, “You are doing fine,” and he was asked to leave.
The patient said he feels “queasy,” but she had no other complaints.
“I am not well,” said the patient.
10. If required place the comma only after the closing parenthesis.
The patient will come tomorrow (results awaited), and we will

decide on the course of treatment.
DO NOT precede an opening or closing parenthesis by a comma.
11. Use commas to set off interrupting elements, as well as contrasting

elements.
Interrupting elements are expressions/phrases that interrupt the
flow of the sentence and are considered to be non-essential.
Some of the common interrupting elements are
as a matter of fact on the other hand after all

at any rate if necessary on the contrary
in my opinion for instance by the way
in fact of course indeed
and other such terms.
The patient, in my opinion, does not need surgery.

Her grafts remained viable throughout this episode and, in fact, looked
very good.
127
The patient was, indeed, much improved on this regimen.
His LFTs, incidentally, were normal at the time of discharge.
She will, I am quite sure, readmit herself upon return from her vacation.
Contrasting elements are most often introduced by „NOT‟ or „BUT NOT‟ or

„NEVER.‟
Such occurrences are rare; however, you should be aware of the
punctuation required.
He was taking Alupent and occasionally prednisone, not Ventolin.

The patient states that he fell injuring his right hip, not his arm.
The patient was instructed to take Benadryl for his congestion only while
at home, never while driving.
He was symptomatic last week, but not now.
12. Academic degrees & professional credentials are set off by

commas.
Ruth Cammery, MD, DO, leading orthopedic surgeon, is here for a

seminar.
13. Set off city, state, and country names. When 2 or more land
areas are mentioned, the larger one should also be set off.
The patient returns from a trip to Paris, France, and does not feel good
after that.
He has lived in San Jose for the past 20 years.
He I has lived in San Jose, California, for the past 20 years.
14. After a farewell in a letter.
Sincerely yours,
Faithfully yours,
15. Transcribing a number greater than 4 digits and not a decimal

number.
Place commas after digits indicating thousands, i.e., group in 3‟s from
the right.
1,523,124,321 821,340
128
DO NOT punctuate a decimal number. US Postal codes are also not
punctuated.
5678 12456.6 FL 31025
16. Related data/lab tests/results are separated by commas.
LABORATORY DATA: WBC of 18.2 with 94 segs, 80 lymphs, 64 monos.

Specific gravity 1.025, no casts.
17. In addresses between the city name and 2-letter state code.
Mr. Ferguson
16 Lavelle Lane
New city, FL 12314
Following are the approved abbreviations for each state.
Alabama AL Louisiana LA Ohio OH

Alaska AK Maine ME Oklahoma OK
Arizona AZ Maryland MD Oregon OR
Arkansas AR Massachusetts MA Pennsylvania PA
California CA Michigan MI Rhode Island RI
Colorado CO Minnesota MN South Carolina SC
Connecticut CT Mississippi MS South Dakota SD
Delaware DE Missouri MO Tennesse TN
Florida FL Montana MT Texas TX
Georgia GA Nebraska NE Utah UT
Hawaii HI Nevada NV Vermont VT
Idaho ID New York NY Virginia VA
Illinois IL New Mexico NM Washington DC
Indiana IN New Jersey NJ Washington WA
Iowa IA New Hampshire NM WestVirginia WV
Kansas KS North Carolina NC Wisconsin WI
Kentucky KY North Dakota ND Wyoming WY
18. Latin Abbreviations or their English equivalents are set off

when they occur in a sentence as they interrupt the sentence.
e.g. for example
i.e. that is
etc. and so forth (etcetera)
etal. and other
viz. that is/namely
129
She does not wish to leave her apartment, i.e., go outdoors.
The normal temperatures, for example, are not indicative of a bacterial

infection.
19. Subordinate Subjects may be set off optionally.
Words attached to the subject by phrases given below are called

subordinate subjects. They may be optionally set off, as they are not
considered as the subject or part of the subject.
Some common phrases that are used to connect the subject to

subordinate subjects are
along with as well as accompanied by

together with in addition to including
aside from followed by escorted by
The patient, along with his parents, is in the consultation room.
The doctors, as well as the interns, were in the OT.
The patient, not his wife, was examined.
20. DO NOT use a comma to separate units of the same

measurement.
He is 5 feet 6 inches tall.
The test was done 1year 8 months ago.
130
RULES ON THE USE OF CAPITALIZATION
1. Every sentence must begin with capital letter.
The patient has extreme halitosis.

This is 21-year-old drug abuser.
2. Capitalize proper nouns.
a) Names of persons, institutions, buildings, organizations, firms,

government bodies.
Jack Smith is the duty doctor.

He was admitted to St. James Hospital.
She works in Empire State Building.
b) Sociocultural names.
These may be names of languages, political, religious, races, ethnic
groups, or nationalities.
She speaks Tagalog.

This is an African male.
She is a active member of the Republican party.
This is a 40-year-old Hispanic female.
NOT color designations of a race.
This is a 25-year-old pleasant white female.
c) Geographical names.
Middle East Pacific Coast Rocky Mountains
NOT geographical names with special meanings.

We used plaster of paris to make a mould.
We ate french fries for lunch.
d) Capitalize directions referring to a specific region or part of a

proper noun.
She is from the North East.

This is a South American female.
131
e) Capitalize calendar items like days of the week, months, as
well as names of holidays, special events, or celebrations.
She will return on Monday.

We have postponed the surgery to December after she returns
from visiting her relatives for Thanksgiving.
NOT names of seasons unless part of a proper noun.

This condition is not common in winter.
In our college, we have a Spring Fest every year.
f) A places in a hospital which is part of a proper noun.

In medical reports, you need to capitalize specific places in the
hospital which are obviously proper names.
The patient was treated at County Hospital Emergency Service.
NOT rooms, units, wards or departments.

The patient was brought to the emergency room.
She was referred to the surgery department for further studies.
g) Capitalize brand names/trade names.
She has a habit of drinking Pepsi during her breaks.
For drugs or medications look up appropriate dictionaries or

references. If the generic name of a drug is dictated, it is not
capitalized, but if it is a brand name, then it is capitalized.
Therefore, check appropriate references to be sure.
He was asked to take Tylenol if symptoms persist.

Take a paracetamol if symptoms persist.
h) Capitalize eponyms.
Eponyms are derivatives of personal names. Plural or adjectival
forms are not capitalized.
He suffers from Parkinson disease.

Mrs. Neils was diagnosed with Alzhiemer‟s. She had a cesarean
section.
i) Capitalize book titles.

I find Medical Typing and Transcribing by Diehl and Fordney
an extremely useful book.
All transcriptionists swear by The AAMT Book of Style.
132
3. Capitalize the first letter of the word beginning a direct quotation.
The doctor said, “You may have to come again.”
NOT for incomplete quotes.

The patient states that his finger was “flopped over.”
Do not capitalize the first letter of a parenthetical entry within a

sentence.
We suggested the use of antibiotic therapy (on an outpatient

basis) for suspected early cellulites.
4. Capitalize the pronoun „I‟ anywhere in the sentence.
This is what I would recommend for her at the present time.
5. Capitalize all letters of acronyms, professional degree abbreviations,

academic degree abbreviations, as well as official title abbreviations.
AIDS CABG BRAT SIDS UNICEF

CMT RN MBBS MB CEO
NOTE: Most abbreviations are not capitalized. Use appropriate

references.
Discharged with doxycycline 100 mg b.i.d. x3.
We need to check the wbc count again.
I suggested some relaxation activities, e.g., walking, listening to
music, or gardening.
A 1-cm laceration in the suboccipital region.
6. Headings and Subheadings.
Headings and subheadings of medical reports are usually capitalized so

that the reader can quickly identify pertinent sections by scanning the
report. Capitalize the first letter of the word following a heading or a
subheading.
DIAGNOSIS: Acute supraventricular tachycardia.
[or]
DIAGNOSIS
Acute supraventricular tachycardia.
PHYSICAL EXAMINATION
Vital Signs: Temperature 98 degrees.
Neck: Supple.
133
7. Capitalize genus name and their abbreviated forms, but not
the plural or adjectival forms.
His blood work grew Proteus mirabilis after 48 hours.

This can be caused by Staph aureus.
He had a proteus group infection.
The specimen shows no streptococci.
NOT species names.

Stool samples taken confirm the presence of Escherichia faccalis.
DO NOT CAPITALIZE
1. Most disease names are not capitalized, however, some are.

This patient has been diagnosed with epilepsy.
We need to talk to her family about her past medical history as the
patient suffers from Down‟s syndrome.
2. Some suture names, operating instrument names may be capitalized

or may not be. Check appropriate references.
We used Dacron sutures.
The 2-0 silk sutures were used.
A Jackson-Pratt drain was used.
3. Do not capitalize chemical names, or Greek letter expansions.

The level of potassium had decreased.
We recommend the use of beta blockers for this condition.
4. Names of medical specialties, official or professional credentials

following a name.
Dr. Toledo, the pediatrician, will examine the child today.
Kristen Doug, management consultant, was admitted last night.
NOTE: If the official or professional credential/title precedes a name, it

is capitalized.
Surgeon Debb Jones makes her rounds around noon.
The MRI study done on Bishop Arbuckle revealed no abnormalities.
We have to contact Chief Executive Officer Hilary Jones for
permission.
5. Do not capitalize the words “score,” “grade,” “class,” or “vitamin.”
134
RULES ON THE USE OF COLON
A colon can be thought of as “an equal to” sign: it tells the reader that what
follows it is equivalent to what precedes it. The primary function of colon
is to introduce what follows a list, series, enumeration, an example, or
sometimes a quotation (instead of a comma).
1. A colon is used to express ratio of numbers.
Xylocaine 1:200,000
2. A colon is also used in time expressions between the hour and the
minute, but not for military time.
We fixed the appointment for 11:30 a.m.

We fixed the appointment for 1325 hours.
We fixed the appointment for 3 o‟clock.
3. A colon is used in equator readings.
Sclerotomy drainage was done at the 8:30 position.
4. A colon is used after a heading or a subheading when continuing

on the same line.
HISTORY: The patient is a 55-year-old female.
Some of the other headings are given below.
HISTORY OF PRESENT ILLNESS:
PHYSICAL EXAMINATION:
PAST MEDICAL HISTORY:
LABORATORY DATA:
HOSPITAL COURSE:
NOTE: Do not use a colon if not continuing on the same line, instead
moving on to the line down.
HISTORY
The patient is a 55-year-old female.
135
5. Use a colon to introduce a list/series of items within a sentence.
NOTE: Here the doctor will dictate the colon as punctuation.
The cell is made up of a number of highly specialized units: nucleus,

mitochondria, endoplasmic reticulum, Golgi complex, and lysomes.
NOTE: Do not use a colon to introduce words that fit properly into the
grammatical structure of the sentence without the colon, for example, after
verb, after a preposition, or after „because.‟
Wrong: The patient is using: Tylenol, Advil, and bacitracin.
The patient is on: Tylenol, Advil, and bacitracin.
The patient came here last night because: he had severe

nausea and vomiting
6. After a salutation in a letter.
Dear Sir:
Dear Dr. Ammerman:
136
RULES ON THE USE OF SEMICOLON
A semicolon is used where a comma is inadequate and a period is too

final.
1. Use a semicolon before a conjunctive adverb when it links two

independent clauses.
The patient is very dehydrated; therefore, she was immediately put on IV

glucose.
The cat attack could be a possible rabies exposure; consequently, the

patient will be given a rabies vaccination.
There are basilar changes; however, these are felt to be fibrotic.
2. When multiple lab data/results/tests are given, unrelated tests must

be separated by periods or semicolons.
His blood test results showed white count5.9, hemoglobin 14.6, hematocrit
43.1; urine test results showed urine specific gravity 1.006, pH6, with a
negative dipstick and negative microscopic exam.
3. If required always place the semicolon outside the close quotation marks.
The patient clearly stated “no allergies”; however, his medical record states he is
allergic to penicillin.
4. Use a semicolon to separate two independent clauses that do not have

a coordinating conjunction linking them together into a single sentence.
This happens very rarely. Separating the two clauses with a period would
be better.
The patient is mentally ill; this is because of her paranoia.
She failed to keep her appointment; she was ill that day.
137
RULES ON THE USE OF QUOTATION MARKS
1. Complete Quotations (Direct Speech) and Incomplete Quotations.
Use quotation marks around the exact words of the speaker

whether complete or incomplete. Only if the quoted matter is
complete the first letter is capitalized, not otherwise.
She said, “My back is in excruciating pain.”

She said she feels “woozy” but does not understand why.
NOTE: To introduce direct speech follow “she said” or similar

attributions with a comma (colon is also acceptable sometimes)
when they precede a quoted matter.
2. If required always place a period and comma before the close

quotation marks, and the semicolon outside close quotes.
The patient complained, “I have heaviness in my shoulders.”

His wife states, “He does not exercise,” and she also
complained about his diet.
She said, “I would like to leave now”; however, she cannot
ambulate.
3. Place the question mark outside the closing quotation mark if the
quoted matter is not a question but is placed within an interrogative
sentence.
Do you think he said, “You‟ll be hearing from my attorney”?
Place the question mark before the closing quotation marks if

the matter being quoted is in the form of a question.
The patient asked, “Must I return for followup that soon?”
The question mark replaces the comma that normally

precedes the ending quotation mark which is followed by “he
said” or similar attributions.
“When am I supposed to stop this medication?” the patient asked.
138
RULES ON THE USE OF APOSTROPHES
The apostrophe is used to form the possessive in many instances, to

form the plural of numbers, specific words, and letters, and also for
contractions or short forms.
1. Use the apostrophe to form the possessive case of nouns and pronouns
in the following instances.
a. To form the possessive case of singular or plural common nouns

that do not end in “s”, proper nouns not ending in “s”, and
indefinite pronouns, add “apostrophe + s” (‘s).
The liver‟s cells secrete bile into the bile duct.

The cocci‟s presence will be revealed in a culture.
Mary‟s religious affiliation is Amish.
The patient considered everyone‟s opinion before reaching a final
decision.
b. If a proper noun (name) already ends in „s‟ in its singular form,

adding an „s‟ would make the pronunciation difficult, it is best to
use just the apostrophe (‘).
Dr. Moses‟ opinion is that the patient suffers from sickle cell
anemia.
c. To form the possessive case of a singular or plural noun ending in

„s‟, add apostrophe only (‘).
The boss‟ secretary instructed her to phone 911 for an ambulance.

She was instructed to follow up with me in two weeks‟ time.
NOTE: Do not add an apostrophe to a noun ending in „s‟ when it is used

as a descriptive term instead of a possessive.
Veterans Administration Hospital

She was referred to the Senior Citizens Home.
139
2. When a compound term or name or phrase combination is used in a
sentence, use the following rules.
a. To form the possessive of hyphenated compound terms, add

(„apostrophe+s‟) at the end of the term.
Her son-in-law‟s opinion is of no importance to her.

The physician-in chief‟s office is located in the west wing.
b. To form the plural of such terms, add „s‟ to the main noun in the
term.
Her sons-in-law‟s opinions conflict with each other.
c. Phrase or name combinations: Show possession only after the

final word in the phrase or name. To indicate joint possession,
only the last word takes possessive form but for individual
possession, all individual words take the possessive form
The medical representative urged the doctor to buy Drake and Drake‟s
Pharmaceutical Annual.
Dr. Bob and Dr. Jack‟s opinion concurred.
Dr. Bob‟s and Dr. Jack‟s opinion differed.
NOTE: Do not use an apostrophe to from the possessive case

in the following instances.
a. Do not use an apostrophe with the possessive forms of

personal pronouns.
its, ours, yours, his hers, theirs, whose
b. Do not use an apostrophe when forming the possessive of

eponymic terms. Refer appropriate references.
The patient shows symptoms of progressive Alzheimer disease.

This is characteristic of Down syndrome.
140
3. To form plurals, use the following rules.
a. Add „s‟ without an apostrophe for capitalized abbreviations.
MRIs RBCs TMs
b. Use „apostrophe + s‟ to from the plural of lowercase

abbreviations.
rbc‟s wbc‟s
c. To form the plural of brief forms, add „s‟ without an

apostrophe.
exams polys segs Paps
d. Add „s‟ or „es‟ without an apostrophe to form the plural for

names, including eponyms.
Babinskis were outgoing.

The Joneses would like a referral to see an orthopedist in the
Connecticut area.
e. Use „apostrophe +s‟ to form the plurals of letters, symbols, and

single digit numerals.
6‟s and 7‟s

Any ?‟s should be directed to the teacher.
Watch your p‟s and q‟s.
f. Add only an „s‟ to form the plural of multiple digit numerals

and years.
70s 500s 1950s
NOTE: When using possessive adjectives, use „apostrophe +s‟ („s)

or add an apostrophe only („), whichever is appropriate. Do not
confuse the possessive adjective form with the compound
modifier form, which takes a hyphen.
one month‟s history or a one-month history

three days‟ time but three-day time period
141
4. Contracted forms.
Use an apostrophe to show where letters have been omitted.
Contractions are usually expanded in reports.
do not - don't
it is - it's
you are - you're
they are - they're
cannot - can't
were not - weren't
are not - aren't
The most common mistake in written English usage is the misuse of

contractions and possessive pronouns. Listed below are the most
commonly mistaken contractions/pronouns.
it's - shortened form of "it is / it has"

It's his turn. (it is his turn)
its - possessive form of the pronoun "it"

Put it back in its place. (place is possessed by it)
you're - shortened form of "you are"

If you're going (if you are going)
your - possessive form of the pronoun "you"

Let's go to your house. (house possessed by you)
they're - shortened form of "they are"

They're right behind you. (they are right behind
you)
their - possessive form of "they"

It's in their car. (car possessed by them)
who‟s - shortened form of "who is / who has"

The child, who is a girl, is crying.
whose - possessive form of the pronoun "who"

Whose house is this?
RULES ON THE USE OF HYPENS
142
There are various ways in which a hyphen is used in sentences. The most common and
probably most confusing is the compound modifier. We will first go through each of the
rules using hyphens with compound modifiers.
Compound Modifiers
A compound modifier is a group of words which together act as a single modifier
(usually as an adjective). A compound modifier means that the word is acting as a
single description. This is important because you must not confuse two separate
adjectives as a compound modifier.
Example: fast–moving train
(fast-moving is a compound modifier because it expresses one

description about the train.)
Combination of different parts of speech.

The rules for hyphenating compound modifiers are based on the parts of speech of
each of the words in the compound modifier. Each of the rules that follow indicates
how to hyphenate the different combinations of parts of speech.
To determine the part of speech of each of the words in a compound modifier, you
must look at the form, not the function.
Example: The patient is suffering from heart disease.
Form: If we look at the word „heart,‟ we must label it as a noun as it is the

name of a part of the body.
Function: If we look at the function of the word „heart,‟ we must label it as

an adjective as it is modifying the noun „disease.‟
So, in this chapter, we will label the words in the compound modifier by form.
Example: The patient was on a fast–moving train.
„Fast‟ is an adjective.
„Moving‟ is a participle.
To punctuate this compound modifier, we must refer to the rule for
adjective-participle compound modifiers.
Following are the compound modifier rules for hyphens.

143
1. Adjective-Adjective compound modifier that precedes/follows what it
modifies.
She has yellow-brown stains in her urine.

The child‟s eyes are blue-green.
2. Adjective-Noun compound modifier that precedes the noun it

modifies.
third-floor apartment
Her apartment is on the third floor.
3. Adjective-Participle compound modifier, whether it precedes or

follows what it modifies.
The patient is pale-appearing.

This is a pale-appearing patient.
The patient is a friendly-looking foreigner.
4. Adverb(well)-Participle compound modifier that precedes the noun it

modifies. This rule is applicable only to the “well” words.
There is a well-defined area of tenderness.

The area of tenderness is well defined.
NOTE: Do not use a hyphen to join an adverb ending/not ending in

„ly‟ to a participle or adjective to form a compound modifier.
He was with quickly paced steps.

The area is slightly swollen.
5. Noun-Adjective compound modifier when it precedes the noun it is

modifying.
The specimen tested positive for antibiotic-resistant yeast
6. Noun-Participle compound modifier when it precedes the noun it

144
modifies.
This patient has diet-centered obesity
7. Noun-Noun compound modifier when it precedes the noun it modifies.
The parent-child bond is very crucial during the early years of childhood.
8. Use a hyphen to join most compound adjectives that contain a preposition.
The patient has pain on left-to-right movement of the arm.

The hospital has a state-of-the-art facility.
These medications are available over-the-counter.
MISCELLANEOUS COMBINATIONS
The following compound modifier rules deal with other types of

combinations. For these modifiers you are not necessarily identifying the part of
speech.
9. Use a hyphen in most „high‟ and „low‟ compound adjectives.
low-grade fever high-fiber diet
10. Use a hyphen to join a number-word compound modifier when it

precedes the noun it modifies.
There is a 10-day waiting period to see this doctor.

A 2-cm incision was made.
This is a 42-year-old Hispanic male.
There appears to be a ¾-inch laceration.
He has a 50-pack-year smoking history.
[NO Hyphen]
This female is 20 years old.

She came 5 weeks ago.
Miscellaneous Usage
145
Sometimes hyphens are used between two words that are not a
compound modifier. Following are the rules for this usage.
1. Use a hyphen to join two or more eponymic names used as multiple

word modifiers of syndrome or virus names, signs or phenomena,
operations, instruments, or procedures. Do not hyphenate if the
eponymic name refers to a single person. Use appropriate references to
differentiate.
Epstein-Barr virus Cheyne-Stokes respiration

Bloodwell-Brown forceps Castellani-Low sign
Arias-Stella phenomenon Achard-Thiers syndrome
Blalock-Hanlon operation
INDEX
Barr- Canadian anatomist Jamestown Canyon- name of

a place
Bender- American psychiatrist Leede- American physician
Braun- German surgeon Marcus Gunn- British
Bray- An American ophthalmologist
oncologist Robin- French anatomist
Brenn- American researcher Roser- German surgeon
Brown- American microbiologist Rumpel- German physician
Coxsackie- place in New York Soto Hall- American physician
Epstein- American physician Swan- American cardiologist
Foster Kennedy- American neurologist Van Slyke- American
biochemist.
Ganz- American cardiologist Virchow- German pathologist
Gestalt- theory in psychology Wever- American psychologist
Graham Little- English physician
2. Use the „digit hyphen zero‟ style to express suture sizes.
3-0 nylon 5-0 Vicryl
NOTE: Refer AAMT for further information regarding the transcription of

suture sizes.
3. Use a hyphen to express the space between two vertebrae (the

146
intervertebral space) not for the vertebra number.
Intervertebral space: L4-L5 T1-T4
Vertebra number: S4 L1 T8 C5
4. Use a hyphen when a fraction is spelled out and as an adjective.
One-half bottle of blood was administered.

One half of the intestine was ruptured.
5. Numbers
1-20: Do not use a hyphen when number two to twenty are

spelled out.
five nineteen
21-99: Use hyphen in compound numbers from twenty-one to

ninety-nine when they are spelled out.
fifty-seven ninety-three
100 and above: Use hyphen only in the part of the number
that expresses the digits below 100.
One hundred ninety-three

Two thousand hundred fifty-seven
6. Ratio of words, use „to‟ or a hyphen.
NOTE: Check appropriate references.
The leukocyte-erythrocyte ratio is normal.
7. Some suffixes are joined directly to the root word they refer to, others
are joined by a hyphen, and still others remain separated by character
space.
Sometimes, use a hyphen to avoid triple consonants or vowels.
ileo-ascending colostomy
Suffixes “like” or “type” is usually hyphenated.

147
The tumor is shell-like in structure.
8. General prefix rule is not to use a hyphen to join most prefixes.
antecubital semicircular counterproductive bilateral

antibiotic preoperative postoperative recheck
nontender cooperate multilobed midfoot
EXCEPTIONS TO THE PREFIX RULE
a. Use a hyphen with “ex-” and self-“ and “all-“
He is the ex-husband of the patient.

She was allergic to a self-injected medication.
The patient will have to pay all-inclusive fees.
b. Use a hyphen to join a prefix to a proper noun, capitalized

words, numbers, and abbreviations.
Further evaluation will be done post-Lyme titer.

All her pre-1994 admissions have been for diabetes-related
problems.
A clinical examination reveals non-Hodgkin lymphoma.
She was given this information pre-EKG.
I think she is a non-North American patient.
c. Use a hyphen after a prefix if it would have another meaning

without the hyphen.
re-lease (lease again) or release (set free)

re-sign (sign again) or resign (give up)
d. Use a hyphen following a prefix to avoid an awkward

combination of letters or confusion and when it will assist in
reading and pronunciation.
re-x-rayed (but x-rayed again is preferred)

co-occur, co-owner, co-opt (EXCP: cooperate, coordinate)
re-emphasize (EXCP: reexamine never hyphenated)
non-insulin-dependent diabetes
DO NOT USE A HYPHEN

148
1. Do not use a hyphen with most disease entity compound modifiers,
even when they precede the noun they modify.
left lobe pneumonia jugular venous distension
2. Do not use a hyphen to join foreign expressions like “in vivo” or “in
vitro” or “in situ” or “status post.” The exception being cul-de-sac.
in vivo incubation in vitro fertilization
The patient is here for followup status post hysterectomy.
3. It is acceptable to use a hyphen between the limits of a range if the

following five conditions are met:
a. The phrases “from----to-----” or “from----through----” or “between-

---and” are NOT used.
b. Decimals and/or commas do not appear in the numeric values.
c. Neither value contains four or more digits.
d. Neither value is a negative.
e. Neither value is accompanied by a symbol.
When all conditions are not met, use „to‟ in place of a hyphen. „To‟ may be used
even if the five conditions are met.
NOTE: For all punctuations follow the general guidelines. Consult

appropriate medical and English dictionaries for additional guidance.
Refer to AAMT for additional clarifications and further guidance. Always
consult appropriate references.
149
COMPREHENSION
Model Passage
"John F. Kennedy's Inaugural Address in 1961”
We observe today not a victory of party but a celebration of freedom

symbolizing an end as well as a beginning, signifying renewal as well as
change, for I have sworn before you and Almighty God the same solemn oath
our forbears prescribed nearly a century and three-quarters ago.
The world is very different now, for man holds in his mortal hands the power to
abolish all forms of human poverty and all forms of human life. And yet the
same revolutionary beliefs for which our forbears fought are still at issue
around the globe. The belief that the rights of man comes not from the
generosity of the State but from the hand of God. We dare not forget today that
we are the heirs of that first revolution. Let the word go forth from this time
and place to friend and foe alike that the torch has been passed to a new
generation of Americans born in this century, tempered by war, disciplined by
a hard and bitter peace, proud of our ancient heritage and unwilling to witness
or permit the slow undoing of those human rights to which this nation has
always been committed, and to which we are committed today at home and
around the world.
Let every nation know whether it wishes us well or ill that we shall pay any
price, bear any burden, meet any hardship, support any friend, oppose any foe,
to assure the survival and the success of liberty. This much we pledge and
more.
So, my fellow Americans ask not what your country can do for you ask what
you can do for your country. My fellow citizens of the world ask not what
America will do for you, but what together we can do for the Freedom of Man.
Finally, whether you are citizens of America or citizens of the world ask of us
here the same high standards of strength and sacrifice which we ask of you.
With a good conscience our only sure reward, with history the final judge of our
deeds, let us go forth to lead the land we love, asking His blessing and His
help, but knowing that here on earth God's work must truly be our own.
150
Comprehension Questions (Choose your answer)
1. President Kennedy said the people were celebrating ________

a) a party
b) freedom
c) the victory of the democratic party
2. President Kennedy has promised God and __________ that he will continue to
renew The United States.
a) Congress
b) the American people
c) Jacqueline Kennedy
3. How is the world different today (in 1961)?

a) we can party
b) we can travel quickly
c) we can get rid of hunger and each other
4. Who supplies the rights of man?

a) the State
b) God
c) Man
5. What should Americans not forget?

a) to vote for Kennedy
b) to pay taxes
c) what their ancestors created
6. What should friends and foes know?

a) that the United States is powerful
b) that the new generation of Americans are responsible for their government
c) that the United States is governed by liberals
7. What is Kennedy's promise to the world?

a) to support liberty
b) to provide money to developing countries
c) to visit each country at least once
8. What should Americans ask of America?

a) how much their taxes will be
b) what they can do for The United States
c) what the government will do for them
151
9. What should citizens of the world ask of America?
a) How America can help them
b) If America plans to invade their country
c) What they can do for the freedom of mankind
10. Who is responsible for what happens on the planet Earth?

a) God
b) Destiny
c) Man
ANSWERS
1. President Kennedy said the people were celebrating ________

b) freedom
2. President Kennedy has promised God and __________ that he will continue to
renew The United States.
b) the American people
3. How is the world different today (in 1961)?

c) we can get rid of hunger and each other
4. Who supplies the rights of man?

b) God
5. What should Americans not forget?

c) what their ancestors created
6. What should friends and foes know?

b) that the new generation of Americans are responsible for their
government
7. What is Kennedy's promise to the world?

a) to support liberty
8. What should Americans ask of America?

b) what they can do for The United States
9. What should citizens of the world ask of America?

c) What they can do for the freedom of mankind
10. Who is responsible for what happens on the planet Earth?

c) Man
152
PARAGRAPH WRITING
Four Writing Steps
1. Write the topic, supporting sentences, and closing sentence.

2. Write clear and simple sentences to express your meaning.
3. Focus on the main idea of your paragraph.
4. Use the dictionary to help you find additional words to express your ideas.
Grammar and Spelling
1. Check your spelling.

2. Check your grammar.
3. Read your essay again.
4. Make sure each sentence has a subject.
5. See if your subjects and verbs agree with each other.
6. Check the verb tenses of each sentence.
7. Make sure that each sentence makes sense.
Style and Organization
1. Make sure your paragraph has a topic sentence.

2. Make sure your supporting sentences focus on the main idea.
3. Make sure you have a closing sentence.
4. Check that all your sentences focus on the main idea.
5. See if your paragraph is interesting.
What is the editing stage?
The editing stage is when you check your paragraph for mistakes and correct
them.
153
EFFECTIVE WRITING
The following sentences are rewritten to make them more effective.
It is necessary that you not be uninformed about this case.

You must be informed about this case.
There is ample evidence which indicates that the attorneys for the defense did
not provide inadequate counseling to their client.
Ample evidence shows that the defense attorneys provided adequate
counseling to their client.
Speaking and to listen well are important elements of communication.
Speaking and listening well are important elements of communication.
OR To speak and to listen well are important communication elements.
To win is the obvious goal, but playing fair is important too.
Winning is the obvious goal, but playing fair is important too. OR
To win is the obvious goal, but to play fair is important too.
They were charged with assault, robbery, and forging checks.
They were charged with assault, robbery, and check forgery.
I remember his generosity and that he was considerate.
I remember his generosity and consideration.
She worked quickly and in an efficient manner.
She worked quickly and efficiently.
When working with power tools, eyes should be protected.
When working with power tools, protect your eyes. OR
Protect your eyes when you use power tools.
When changing a diaper, a baby should be on his or her back.
When changing a diaper, lay a baby down on his or her back. OR
Lay a baby down on his or her back when changing a diaper.
I have some letters the mail carrier delivered in my purse.
The mail carrier delivered some letters that I have in my purse.
We have tuna casserole I made in the refrigerator.
In the refrigerator, we have tuna casserole that I made.
Mollie came over while I was playing the piano with a piece of pound cake.
While I was playing the piano, Mollie came over with a piece of pound
cake.
While asleep, the flea bit the dog.
The flea bit the sleeping dog.
I tried calling to tell you about that TV show five times.
I called five times to tell you about that TV show.
Although very spicy, Dana managed to finish the enchilada.
Dana managed to finish the enchilada although it was very spicy.
154
PROOF READING
Make sure that...
you've expressed your ideas clearly;

your papers are well-written, well-organized, and a pleasure to read;
there are no errors in your grammar, punctuation or spelling.
We'd like to show you what do while editing

Below on the left is the original version of the paper, while on the right is the
edited version.
Impeticos Ltd. is what we've chosen to call Impeticos Ltd. is the name we've
a 'turn-key solutions' company. chosen for our 'turn-key solutions'
company.
Whatever your requirements are, as a Whether you‟re a large corporation or

large corporation or a new entrepreneur, a new entrepreneur, Impeticos Ltd
we provide all the tools and information can provide all the tools and
you need to stay on top of things. information you need to succeed in
your business.
Among services offered you will find: Our services

Tailormade internet and webdesign
solutions, starting-up packages for newly We offer:
founded entrepreneurs including market Tailor-made Internet and web design
research, advertisement creation etc., solutions,
translation services for companies Start-up packages for new
considering to expand to foreign markets, entrepreneurs, including market
creating contact between our customers research, advertising projects and
and various experts within business life, marketing plans, etc.,
general information retrieval in all fields Translation services for companies
of industry and business. considering expanding into foreign
markets,
Contacts with a wide range of
business experts,
General information retrieval in all
fields of industry and business.
As we say: "whatever you are in need of As we say: "Whatever your business,

finding we most likely can provide it". we will do our utmost to meet your
needs".
As a new service we've entered the ISP Also, we have recently entered the ISP
business to so we now have our own business and we now have our own
servers and can offer 'hosting only servers, so we can offer our clients
packages'. 'hosting-only packages'.
We hope it will be a pleasure for you doing We know that you will enjoy doing
business with Impeticos. We support business with Impeticos, because we
155
ethical and responsible business as well on support ethical and responsible
the internet as beyond and are always business on the Internet and beyond.
ready to listen to your opinion as a Providing fast, friendly, professional
customer. Friendly, professional and fast service is just one of our goals. Our
service are but some of our objectives and clients are very important to us; we
it is our goal continuously to strive value your opinions, and we will
towards making each single part of dealing continue to strive to make your every
with our business as nice an experience as single business interaction with us as
possible. enjoyable as possible.
Lately we have realized a strong need to In response to strong international

extend our opening hours. Thus, we have demand, we have decided to extend
taken the consequence and can now offer our business hours, and now offer
you our services 24/7 no matter from 24/7 services no matter where in the
where in the world you contact us. You world you are calling from. Just
therefore needn't worry anymore about contact us whenever it suits you, and
checking opening hours etc. Just contact we will get back to you almost
us whenever it fits you and your schedule immediately.
and we will swiftly respond.
We welcome you to Impeticos Ltd. and So, welcome to Impeticos Ltd.

hope that you will use this opportunity to We hope that you will use this
view our website opportunity to check out the rest of
our web site.
This version shows the editing marks.
Impeticos Ltd. is the name what we've chosen for our to call a 'turn-key
solutions' company.
Whether you‟re a large corporation or a new entrepreneur, Indiocracy Ltd
Whatever your requirements are, as a large corporation or a new entrepreneur,
can we provide all the tools and information you need to succeed in your
business. stay on top of things.
Our services Among services offered you will find:
We offer:
Ttailor-made Internet and web-design solutions,
Sstarting-up packages for newly founded entrepreneurs, including market
research, advertising projects and marketing plans, ement creation etc.,
Ttranslation services for companies considering expanding into to expand to
foreign markets,
creating Contacts with between our customers and a wide range of business
various experts within business life,
Ggeneral information retrieval in all fields of industry and business.
As we say:"Wwhatever your business, are in need of finding we most likely can

provide itwill do our utmost to meet your needs".
Also, we recently as a new service we've entered the ISP business to so and we
now have our own servers, so we and can offer our clients 'hosting-only
156
packages'.
We know hope that you will enjoy doing business with Impeticos, because we it
will be a pleasure for you doing business with Impeticos. support ethical and
responsible business on the Internet and beyond. We support ethical and
responsible business as well on the internet as beyond and are always ready to
listen to your opinion as a customer. Friendly, fast, professional service is just
one of our goals. Our clients are very important to us, we value your opinions,
and we will continue strive to make your every single business interaction with
us as enjoyable as possible. Friendly, professional and fast service are but
some of our objectives and it is our goal continuously to strive towards making
each single part of dealing with our business as nice an experience as possible.
In response to strong international demand, we have decided to Lately we have
realized a strong need to extend our business opening hours, .Thus, we have
taken the concequence and can now offer you our 24/7 services, 24/7 no
matter from where in the world you are calling from. You therefore needen't
worry anymore about checking opening hours etc. Just contact us whenever it
fits suits you and your schedule, and we will get back to you almost
immediately. swiftly respond.
So, We welcome you to Impeticos Ltd and .
SOME DIFFICULT ENGLISH WORDS
157
A
abrasion: An abraded area of the skin; scrape, no bleeding.
abundant: Plentiful.
abuse: Use improperly; misuse; maltreat; insult verbally.
accessory: A person contributing to the commission of an offense.
accommodation: Lodgings; adjustment, adaptation; convenient arrangement.
accumulate: To gather or pile up, little by little.
achievement: The result gained by effort.
acknowledgment: Recognition or favorable notice of an achievement.
acquire: To get as one‟s own.
acute: Characterized by sharpness or severity.
additional: Also.
adolescent: Between childhood and adulthood..
adult: A human being above the age of 12.
advice: (Noun) Recommendation regarding a course of conduct.
advise: (Verb) To counsel.
afebrile: Not marked by fever.
affect: (Verb) To change / influence. To produce an effect upon.
(Noun) Outward appearance of an inner emotion (flat affect).
aftereffect: An effect after an interval.
alcohol: A drink like whiskey or beer.
alimony: Money payable to a divorced or separated spouse.
all right: O.K.
allege: To assert without proof.
allegedly: Questionably true.
allergen: A substance that induces allergy.
allude: To refer to.
altercation: A noisy, angry dispute.
alternate: Occurring or succeeding by turns.
although: Even though.
ambulate: To walk.
among: Surrounded by; included in or in the category of; between.
amputation: To remove by cutting.
apartment: A set of rooms used as a dwelling.
apparent: Obvious; seeming.
appetite: Desire (especially for food); inclination.
appointment: An arrangement for a meeting.
appreciate: To value and treasure.
approximation: The state of being close or near.
arguing: Disputing.
argument: A quarrel or disagreement.
arousable: Can be stimulated.
aver: To declare or affirm solemnly and formally as true.
ashen: Deadly pale, resembling ashes.
assault: A violent physical or verbal attack.
158
assessment: To determine the rate or amount.
assistance: The act of helping.
asymptomatic: Presenting no symptoms.
attorney: A legal agent or advocate.
attribute: To regard as a quality of a person or thing.
atypical: Irregular or unusual.
auditory: Related to hearing.
augment: To increase.
available: Ready for immediate use.
auscultate: To listen with a stethoscope.
B
believe: To accept as true.
belligerent: Quarrelsome, a person with a fighting attitude.
beneficial: Useful.
benefit(t)ed: To have been advantageous.
benign: Showing kindness and gentleness; mild, not malignant.
bizarre: Odd or eccentric in style.
bleary: Dim-sighted, blurred
boggy: Wet and spongy.
brake: To stop or slow down.
breech: Short trousers fastened below the knee; birth in which
buttocks emerge first.
bulky: Large, unwieldy.
bump: A protuberance on a surface.
bypass: To avoid; main road round town or its center.
C
cachexia: A person who is thin and hungry-looking.
canceling: Removing, revoking, discontinuing.
cancellation: The act of removing or revoking.
category: A division, a classification.
Caucasian: Of the white race.
challenge: To dare or defy.
chronic: Marked by long duration but not necessarily acute.
cigarette: A slender roll of tobacco in paper to be smoked.
cite: To quote.
cleanse: To rid of impurities by washing.
clot: A round, viscous lump.
clutch: To hold on tightly.
coarse: Harsh, rough, and unrefined.
collision: An act of clashing.
coming: Arriving.
commitment: An engagement to assume an obligation at a future date.
comparative: One that compares to another on an equal footing, rival.
comparison: Examining two or more items to note similarities or
159
differences.
complain: (Verb) To express disagreement.
complaint: (Noun) The expression of disagreement.
compliant: Willing to carry out the orders or wishes of another without
protest.
compresses: A folded cloth to press against a body part for relief.
concern: To care and be interested in someone or something.
condominium: Individual ownership in a multiunit structure.
confused: To be perplexed and mixed up.
conjunction: Occurring together.
conscientious: An upright person who has scruples.
conscious: Awake and aware.
consciousness: The quality or state of being aware.
consistent: Marked by regularity.
constitutional: Of or in line with the constitution; inherent; walk taken as
exercise.
controversial: (Adjective) A discussion marked by opposing views.
controversy: Something that might provoke a quarrel or fight.
copious: Present in large quantity, plentiful, abundant.
cord: A long, slender material of thread or yarn.
coroner: A public officer to deal with the cause of death.
counter: A level surface such as a table where transactions are
conducted.
cramping: A sharp, abdominal pain.
cranky: Fussy and angry when opposed.
crisis: A situation where one is pained or distressed; decisive
moment.
crouch: To stand, squat, etc., with legs bent close to the body.
crutches: A support to help the disabled in walking.
currently: Occurring at the present time.
D
dander: Anger, temper.
debilitated: Weakened, enfeebled.
defervesce: The subsidence of a fever.
define: To identify the meaning.
definitely: Certainly.
definition: A statement expressing the meaning.
deformity: An imperfection or blemish.
delinquent: An offender; guilty of misdeed.
deny: To declare untrue or non-existent; repudiate.
department: A division or section.
describe: To represent to give an account of in words.
description: Discourse intended to give a mental image.
detrimental: Harmful or damaging.
device: Thing made or adapted for particular purpose; scheme.
160
diagnosis: The act of identifying a disease from its symptoms.
diet: The kind and amount of food and drink prescribed .
difficulty: The quality or state of being troublesome.
defer: Postpone; to yield or make concession.
differ: Be unlike.
discreet: Tactful, prudent, cautious in speech and action.
disabled: A person who is incapacitated by injury or wounds.
disastrous: Causing suffering and disaster.
discharged: Released, let go; ejected, emitted.
discomfort: Mental or physical uneasiness or annoyance.
discrete: Separate, distinct.
disheveled: Marked by disorder or disarray.
disoriented: To cause to lose sense of time, place, and identity.
disposition: Natural tendency; temperament; arrangement.
disruption: Disorder; interruption of continuity.
distended: Expanded; swollen by pressure from within.
distraught: Agitated with doubt or mental conflict.
distress: Pain or suffering affecting the body or mind.
diverse: Different.
document: A writing conveying information.
dominant: Prevailing over all others.
dovetail: To fit skillfully to form a whole.
drain: To exhaust physically or emotionally.
dramatic: Striking in appearance or effect.
drip: To let fall in drops.
drool: Dribble saliva .
droop: To hang or incline downwards.
drowsy: Ready to fall asleep.
dump truck: An automotive truck for the transportation of bulk material.
E
echo: The repetition of sound caused by reflection of sound waves.
effect: (Verb) To cause / to accomplish / to do.
(Noun) The result; outcome.
elevate: To lift up or raise.
elicit: To call for or draw out information.
eliminate: To remove or cast out.
emanate: To come out or emit from a source.
endorse: To approve openly.
enlargement: The act or instance of enlarging.
environment: Surroundings; circumstances affecting person‟s life.
episode: An incident.
eruption: The act of breaking out.
etiology: Study of causation or of causes of disease.
evaluation: The act of determining or estimating the value of.
events: Occurrences.
161
evidence: An outward indication that furnishes truth.
exacerbation: To make more violent or severe.
exaggerate: To overstate beyond the bounds of truth.
excellent: Very good, first class.
except: To leave out or to exclude.
exception: The act of excepting, exclusion.
excruciating: Causing great pain or anguish, extreme.
exertion: A laborious effort where one exerts oneself a great deal.
existence: Fact or manner of existing..
exogenous: Introduced or produced outside the system.
experience: A direct observation of events based on knowledge.
explanation: The act or process or making something clear or
understandable.
exposure: To be made known.
F
facade: The front of a building, also a false appearance.
facilitate: To make easier and to bring about.
facility: Opportunity or equipment for doing something.
family: A group of individuals living under one roof; group of similar
things, people, etc.
fascinate: To hold spellbound by a power.
faucet: Tap.
febrile: Feverish.
February: The second month of the year.
festoon: To decorate or adorn.
fiery: Burning or blazing.
financial: Relating to finance.
fingerbreadth: The breadth of a finger.
flaccid: Lacking firmness.
fluid: Substance, especially gas or liquid, capable of flowing freely.
flushed: Feverish redness or temperature; cause to glow or blush;
cleanse by flow of water.
forty: The number 40.
fracture: To break a bone.
frail: Physically weak and fragile.
frequent: Occurring very often.
frown: To disapprove by facial expression.
frozen: Become rigid from cold.
fulfill: To carry out; satisfy.
furnace: An enclosed structure in which heat is produced.
G
gait: Manner of walking.
gargle: To put water into the mouth and agitate it with air from the
lungs.
162
gauge: To measure precisely the size and dimension
gaze: An intent look.
general: Applicable to the majority of individuals.
girth: Size, dimension.
globose: Globular.
government: The act or process of direction or control.
greasy: Oily in appearance.
grip: To seize or hold firmly.
grit: Firmness in mind with extraordinary courage.
gross: Overfed; bloated; coarse, indecent; flagrant; total, not net;
very obvious.
gruel: A thin porridge.
gulp: To swallow hurriedly and greedily.
gurney: A wheeled cot or stretcher.
gym: Outdoor play equipment.
H
hallucination A perception of objects with no reality
height: Measurement from base to top; high point; extreme example.
hesitant: To be undecided.
hindrance: Obstruction.
hollow: An unfilled space or hole.
homicidal: A quality where one has the tendency to kill another person.
hospitalization: The process of being in the hospital as a patient.
hygiene: Conditions of cleanliness.
I
ideation: The forming of ideas.
illicit: Unlawful; forbidden.
immunization: A process to make a person immune.
impairment: The process in which something is damaged or worsened.
inasmuch: In view of the fact that.
incarcerated: Confined; imprisoned.
incidentally: Not intentionally, by the way.
increment: Amount of increase; added amount.
indigent: Poor and impoverished.
indigestion: Inability or difficulty digesting something.
indispensable: Absolutely necessary, essential.
infant: A child in the first period of life.
infirmary: A place where sick people are cared for.
inflamed: To make more heated; to intensify.
inflammation: An injury that is marked by redness, heat, and pain.
inflict: Impose.
information: What is told; knowledge; news.
initiate: To begin.
injure: To harm or pain someone.
163
inoculate: To infuse or inject a microorganism into.
insecure: Not confident or secure.
insight: The power of seeing into a situation; to discern.
insistence: To be firm on something demanded.
insofar: To such extent or degree.
instruction: Order, direction (as to how thing works, etc.); teaching.
insurance: Coverage by contract whereby one party undertakes to
indemnify or guarantee another against loss by a specified
contingency.
interfered: To interpose in such a way so as to hinder or impede
someone.
intermittent: Coming and going at intervals; occasional.
interpreted: Explained or told the meaning of.
intervention: To come in between.
iridescent: A lustrous rainbow-like display of colors.
ironical: Sarcastic.
irresistible: Impossible not to like.
irrigation: To refresh by watering; to moisten (wound, etc.) with
constant flow of liquid.
ivy: An ornamental climbing shrub.
J
Jacuzzi: A recreational whirlpool bath.
jagged: Having a sharply uneven edge or surface.
jargon: Words used by particular group or profession.
jerk: Sharp sudden pull, twist, etc.; spasmodic muscle
twitch; (slang) stupid person
jittery: To be nervous.
jovial: Good humored.
judgment: Critical faculty, discernment, good sense; opinion;
sentence of court of law.
juvenile: Youthful; of or for young people; immature.
K
kill: To deprive of life.
L
laceration: A torn or ragged wound.
lady: A woman of refinement and gentle manners.
lancinate: To pierce or stab.
lawn mower: A machine for cutting grass.
led: Past tense of lead.
legal: One that conforms to the rules of law.
license: Permission to act; also driver‟s license.
likelihood: Probability.
liquid: A fluid form.
164
loose: Not tight fitting.
lose: To miss from one‟s possession.
loser: Person who regularly fails.
M
maceration: A process where something is softened and wetted by
liquid.
maintenance: The process of keeping in good condition; amount paid
to support life.
male: Boys and men.
malignant: Tending to deteriorate, for e.g., a malignant tumor.
mall: A public area designed as a pedestrian walk; a
shopping area.
malodor: An offensive odor.
manual: A handbook.
marked: Noticeable.
marriage: A union of man and woman.
medicolegal: Relating to both medicine and law.
medic: One engaged in medical work or study.
midline: A median line.
mild: Gentle in nature and behavior.
minimal: The least possible.
misspelt: Spelled incorrectly.
moderate: Avoiding extremes of behavior.
moreover: Besides.
mottled: A surface having colored spots or blotches.
mow: To cut grass.
muscular: Having well-developed musculature.
N
narcissism: Being in love with one‟s self.
narrate: To comment in detail.
nausea: Inclination to vomit.
necessary: Required; compulsory.
nevertheless: In spite of.
ninety: The number 90.
nontender: Not tender.
normoactive: Normal and active.
notify: To inform.
nursing home: A home where the sick are cared for.
O
obese: Fat.
oblivious: Not being aware.
165
observation: A process where one is inspected or taken note of.
obtund: To reduce or dull the edge or violence of.
obturator: One that closes.
obvious: Easily discovered or seen; evident.
occasion: A happening or incident.
occasional: Taking place at infrequent intervals.
occupation: Profession or employment; pastime.
occur: To happen or to come into existence.
occurred: Something that has just happened.
occurrence: The act of happening.
odor: Smell.
opinion: A view or judgment.
opportunity: A good chance for progress.
oriented: Directed towards the interests of a particular group.
ostracize: To exclude from society, refuse to associate with.
otherwise: In different circumstances.
outpatient: A person who is not hospitalized, but visits the
hospital.
P
palpate: To examine by touch.
paramedic: Specially trained medical technicians providing a wide
range of emergency services during transportation to a
hospital.
parole: Temporary or permanent release of prisoner before end
on promise of good behavior.
particular: A specific detail of information or news.
pearly: Resembling pearls.
peer: An equal.
perception: A mental image or concept.
perform: To carry out.
perfuse: To cause to spread; to diffuse.
permissible: That which may be allowed.
persistent: Continues to exist or do something in spite of
obstacles.
personal: Relating to a person‟s private life.
persuade: To urge or move by argument.
pill: A medicine in a small rounded mass to be swallowed
whole.
pinprick: A small puncture made by a pin or as if by a pin.
pint: A measurement.
pleasant: Having pleasing manners and appearance.
polysubstance: Different substances.
poop: To become exhausted.
possession: Ownership.
poultice: A soft (usually hot) medicated dressing applied to sore
166
or inflamed part of the body.
practical: Showing in practice; not theoretical or ideal.
practice: To do or perform often.
precede: Come or go before in time, order, importance, etc.
precipitating: Exacerbating.
preclude: Rule out in advance.
preferable: Something which is liked better than something else.
prejudice: An adverse opinion or leaning.
premises: A tract of land along with the buildings on it.
prepare: To make ready before hand for some purpose.
prescription: A doctor‟s slip for a medication.
prevalent: Generally existing or occurring.
previous: The one before.
principal: Chief, first in importance; the head of an institution.
principle: Fundamental truth or law; personal code of conduct.
printer: A machine that prints.
prior: Earlier in time or order.
privilege: A benefit or advantage.
probably: Without much doubt.
procedure: An established way of doing things.
proceed: To go on in an orderly, regular way.
profanity: Blasphemy; swear word.
profession: A vocation or employment.
professor: A teacher at a college.
profuse: In great abundance.
progressive: A process marked by advancing further or higher.
prolonged: To lengthen or continue in time or range.
prominent: Important and noticeable.
propped up: Supported.
proprioception: The reception of stimuli produced within the organism.
prosthesis: An artificial device to replace a missing body part.
publicity: An act to attract public interest.
puncture A hole or perforation.
pungent: Having sharp or strong taste or smell; biting, caustic.
pursue: To seek or chase.
Q
queasy: Nauseated; ill at ease.
query: To ask questions.
questionable: Something which is doubted or challenged.
questionnaire: A set of questions for obtaining useful information.
quiescent: Causing no trouble or symptoms.
quiet: Silent.
quit: Give up, let go; cease, stop; leave or depart from.
quite: To a considerable extent.
167
R
raccoon: A small nocturnal mammal with dark eyes.
ramp: A sloping way.
rapid: Fast, quick.
realm: In the person‟s sphere or domain.
ream: A quantity of paper.
rear: (Verb) To raise or help grow up.
rear: (Noun) The backside.
reassure: To restore to confidence.
receive: To acquire.
receiving: Acquiring.
recommendation: An act of commending.
recurrent: Happening again and again.
referral: The act of classifying in a general category or group.
referring: Classifying in a general category or group.
regimen: A systematic plan design to improve and maintain the
health of a patient.
relief: Lightening of something painful or distressing.
repetition: The act or instance of being repeated.
repletion: The condition of being filled up.
rescue: To free from danger or evil.
resistant: The quality of opposing.
respond: To say something in return as an answer.
response: A reaction.
restrain: To prevent from doing.
retraction: The process of withdrawing.
reveal: To uncover and to open up to view.
review: To view or see again.
rhythm: Recurrent alternation of strong and weak elements in
sound.
rigid: Stiff and inflexible.
risk factors: Factors that would cause injury.
roller blade: A type of roller skate.
roster: A list of personnel.
rototiller: A landscaping implement to lift and turn over soil.
rotund: Rounded.
roulette: A type of gambling game.
rouse: To awaken.
ruddy: Reddish; healthily red.
S
saturation: A condition when something is filled completely.
scar: A mark left by an injury.
schedule: A written document about a plan; timetable.
scratch: To scrape or rub to reduce itching.
scrub: To clean with hard rubbing.
168
secondary: Of second rank or value.
segment: A separate piece or fragment.
seize: To take possession of.
seldom: Rarely, infrequently.
sensation: Awareness (as of heat or pain).
separate: Keep apart, detach.
separation: The act or process of keeping apart.
series: A number of things or events of the same class.
sever: To cut.
severe: Strict in discipline; extreme.
shear: To remove by cutting with something sharp.
sibling: One of two or more individuals having a common
parent.
sieve: A device to sift smaller particles of a mixture.
sight (to view): Something that is seen.
significant: Having meaning and importance.
sign: Indication of quality, state, etc.; mark, symbol.
similar: Being alike and having characteristics in common.
sincerity: The quality of being honest.
site: The location, usually of a building.
sitz bath: A tub in which one bathes in a sitting position.
sledge: A strong heavy sled.
sliver: A splinter or a long slender piece cut off.
slur: To run words, sounds into one another.
snowstorm: A storm of snow with wind.
sober: Serious; not drunk.
soccer: A game like football.
social: A person who is in pleasant companionship with
friends.
somnolent: Drowsy and sleepy.
sordid: Wretched and filthy.
spasm: An involuntary muscular contraction
spontaneous Natural, not contrived.
sports: Physical activities.
sprain: To injure by sudden twist.
stab: A wound produced by a weapon.
stable: Steady and firm.
stagger: To walk unsteadily.
status post: After the event.
steady: Direct and firm in movement.
steak: A thick slice of meat( especially beef) or fish, usually
grilled or fried.
sterile: Barren, unproductive; free from micro-organisms.
stiff: Rigid.
stimulus: Something that incites to activity.
stocky: Sturdy and thick in build.
169
strain: Bodily injury from excessive effort.
streaking: A mark of a different color.
strength: The quality or state of having great physical power.
stretcher: A device for carrying an injured person.
stuck: Adhered to a surface.
studying: To read in detail with the intention of learning.
subpoena: A writ commanding a person to appear in court.
subsequent: Following in time, order, or place.
subtle: Not obvious.
succeed: To come after or follow another in position.
succession: The order in which one succeeds to property.
succumb: To yield to another.
suing: Taking legal proceedings in court.
suite: A group of rooms occupied as a unit.
superficial: Lacking depth.
supple: Able to perform bending movements with ease; pliant;
flexible.
V
vibrant: Pulsating with life and activity.
vigorous: Full of active physical and mental strength.
villain: The person who does evil.
visible: Something which can be seen.
visiting: Invited to attend an institution for a limited time.
visual: Appealing to the eyes.
vomitus: The material discharged by vomiting.
W
wane: To lessen in intensity.
wax: To increase in intensity.
wean: To accustom a child to food other than mother‟s milk.
weird: Strange.
well-oriented: A person adjusted to time and place.
whatsoever: Whatever.
wheelchair: A chair in which a handicapped person sits.
whirlpool: Water moving rapidly in a circle, as eddying
whole: Entire.
withdrawal: The process of removing.
woozy: Hazy and unclear.
worsen: To make worse.
wound: An injury to the body.
wrestling: A sport where two people fight.
wrinkle: A crease on the skin usually because of age
Y
yearn: To long for.
170
yell: To shout.
Z
zombie: A person who is lifeless; dull or apathetic person.
SOME POINTS TO NOTE:
1. Learn the meanings of these words.
2. Master their spellings.

(Note: All the words are spelled the American way.)
3. Get used to hearing these words as these are repeatedly used in

medical transcription.
4. Even though a word may have a meaning which you think may be unfit in
the sentence. If you still hear the same word, you must look it up. It may have
a different meaning.
5. Be familiar with these words from the beginning as you must be able to
distinguish English words from medical words. Initially, this is a major
problem that trainees face.
Language Difference in Medical Phrasing Context

Complaint Vs. Complain
● The patient is presenting with a complaint of a headache.

● The patient complains of rhinorrhea
With benefit vs. with benefits
● Primarily only going to use with benefit

○ She reports taking ibuprofen with benefit.
○ He notes using hot and cold compresses with benefit.
○ She has been taking OTC Zantac with benefit.
Effect vs. affect
● Effect (used as a noun)
171
○ She reports that she experienced side effects after taking her
anxiety medication this morning.
○
● Affect (used as a verb)
○ PE
Psych: Flat mood and affect.
○ She states her pain affects her work.
Introductory comma, Oxford comma
● Introductory comma
○ Today, he comes in for a follow-up on his hypertension..
○ At that time, her HbA1c was 6.5.
● If his symptoms do not resolve in 3 days, he will contact the office.
● Oxford Comma
○ She denies chest pain, shortness of breath, or palpitations.
○ He complains of a productive cough, rhinorrhea, and nasal
congestion.
Follow up vs. follow-up
● The patient will follow up in 3 months.

● The patient is a xx-year-old female presenting for a follow-up on her
diabetes.
● Follow up in 1 year or sooner if needed.
● Advised to follow up if symptoms persist or worsen.
● The patient is a xx-year-old male presenting for a hypertension follow-up.
● The patient was seen last week for an ER follow-up.
Using "of"
● Incorrect - She reports of...

● Correct - She complains of…
Sometimes Vs. Sometime Vs. Some time
● The patient mentions that she feels dizzy sometimes.

● The patient took some time to remember the history.
● The patient goes for a morning walk and spends some time at the lake for
refreshment.
172
● The patient stays awake for sometime at night.
Reminders:
Dates: In the US, it is normally month/date/year
Symbols: (2 by 3 = 2x3) (6 over 10= 6/10)
173

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EL Material with Medical Context Based Examples

There are 8 parts of speech in English: Nouns, Prepositions, Verbs,

To remember them, think of IVAN CAPP.

These 8 parts of speech are the building blocks of communication.

Some words function as different parts of speech in different sentences.

function in the sentence.

Every sentence either contains a noun or is about a

TYPES OF NOUNS: There are two main types of nouns.

1. Proper noun is a specific name or a name in particular, and it always

Examples: Dr. John, Apollo Hospital, Delhi, Indian, Benadryl

2. Common noun is a name given in common.

Examples: doctors, room, darkness, itching, sensation, childhood

The patient came to the clinic today.

Another classification of nouns: COUNTABLE and NON-COUNTABLE

Countable Nouns are nouns that can be counted.

Examples: finger, lips, arteries, piece, specimen, city, solution

Non-Countable Nouns are nouns that cannot be counted.

Examples: milk, honesty, water, news, vomiting, weather, curd

NOTE: Some nouns like advice, information, furniture, luggage, work,

Examples: Give me some information about yourself.

Some nouns can be either count or non-count depending on how

Examples: Experience is the best teacher. [NC]

Singular means one.

Plural means more than one.

COMMON PLURAL ENDINGS

(i) Ending in „s‟

Examples: friends, signs, pets, physicians, ratios, years

(ii) Ending in „es‟

Examples: knives, echoes, diagnoses, shelves, branches

(iii) Ending in „ies‟

Examples: cities, babies, commodities, stories, memories

(iv) Ending in „ae‟

Examples: larvae, algae, formulae, vertebrae

(v) Ending in „i‟

Examples: nuclei, fungi, cocci, bronchi

(vi) Ending in „a‟

Examples: bacteria, criteria, phenomena, ganglia

NOTE: There are many irregular plural forms.

Examples: teeth, lice, children, mice, women, men

Examples: mumps, anemia, measles, ascites, herpes, physics

Physics is very boring.

Some nouns are ALWAYS plural in usage.

Examples: scissors, shorts, jeans, forceps, tights, adnexa, genitalia

My pants are torn.

Some nouns can be used either as singular or plural.

Examples: The Japanese are very hardworking people.

COMMON NOUN ENDINGS

-ness: illness, gloominess, hardness sadness

-ity: scarcity prosperity humidity ability

-ssion: mission impression admission obsession

-sion: tension fusion vision incision

-tion: lotion operation education infection

-ment: ointment management treatment comment

-hood: childhood neighborhood

Examples: I am tired of reminding you.

The chapter on Verbs will provide a better understanding of Gerunds.

Nouns in Medical Phrasing Context

1. Incorrect: The patient complains of rhinorrhea, which onset 3 days

Explanation: onset is a noun and can never be used as a verb.

Soccer or football, as it is called by rest of world outside

four years, world championship of soccer, World Cup, is

No one raises objection; however, without television, football

Americans. Also, without those advertising dollars, teams

This is _ 80-year-old female, who is _ Italian, with multiple