MEDICAL TRANSCRIPTION LAB & DIAGNOSTIC TERMS:
Section A - Common Laboratory Terms: WBC , hemoglobin , hematocrit , platelet count , segs , lymphs, eos, monos, bands, basos, retic count.
MCV, MCH, RDW
ESR , PT , INR , PTT .
sodium , potassium , chloride , CO2 , BUN , creatinine , glucose , albumin , magnesium, calcium .
ammonia
alkaline phosphatase , AST , ALT, bilirubin (direct or total).
albumin, protein
amylase, lipase
creatine kinase, CK-MB , MB% , troponin less than 0.3, digoxin level .
ABG , pH , pCO2 , pO2 , bicarb , oxygen saturation on room air.
BNP level
BUN and creatinine
complement C3, complement C4
C-reactive protein or CRP
D-dimer, ESR, GGT
HDL, LDL, triglycerides, cholesterol
IgA, IgG, IgM, IgE
serum iron, TIBC
LDH
CD4, CD8
PSA
TSH, T3, T4, free T3 and free T4
anion gap, base excess
Urinalysis essentially within normal limits. specific gravity, wbc's, rbc's, blood, ketones, protein, nitrites, leukocytes, bacteria, squamous epithelial cells, etc. UA by clean catch midstream. Urine beta hCG.
cerebrospinal fluid (CSF) - albumin, cell count, chloride, glucose, IgG, pressure, protein
fecal white blood cell, ova and parasites (O&P), Clostridium difficile toxin (CDT) assay
HIV serology
protein electrophoresis
rapid strep, Monospot, Chem-7, influenza antigen
rheumatoid titers
(x) sets of cardiac enzymes (where x = 2, 3, 5, etc)
stool for culture and ova/parasite Lab Section Transcribed Examples
Chest x-ray Terms:
chest x-ray reveals: (one of the following below): cardiomegaly
congestive heart failure elevated hemidiaphragms emphysema hilar fullness hyperexpanded lungs increased reticular markings infiltrates infrahilar mass patchy infiltrate pleural effusion pneumonia pulmonary congestion reversible ischemia scarring Electrocardiogram Terms in Diagnostic Data Section:
12-lead EKG - leads I, II, III, V1, V2, V3, V4, V5, V6, aVF, aVL, aVR, etc.
atrial fibrillation beats per minute left axis deviation nonspecific ST-T wave changes normal sinus rhythm Still More Lab Section Examples Common types of scans in medical reports: carotid Doppler scan
CT/CAT scan DEXA bone scan GI bleeding scan HIDA scan MRI scan MUGA scan myocardial perfusion scan PET scan SPECT scan V/Q scan (or ventilation/perfusion scan) venous duplex scan Other Diagnostic Terms:
Holter monitor
portable chest x-ray KUB More Studies or Tests:
24-hour pH study
24-hour urine study
48-hour Bravo pH study
adenosine isotope study
arterial flow study
barium enema study
barium study
bedside swallow study
blood volume study
bone marrow study
brain flow study
CDT study
color flow study
cystogram study
cystometric study
DNA PCR study
Endocapsule study
EP study
esophageal manometry study
esophageal motility study
gastric emptying study
Gastrografin study
HIDA CCK study
HIPA study
intrathecal pump dye study
leak point pressure study
M2A capsule study
mapping study
multigated acquisition study
Myoview study
nerve conduction study
nuclear medicine study
overnight oxygen saturation study
peak flow study
perfusion imaging study
pneumogram study
PSG study
radionuclide shunt study
reflux study
right retrograde ureteropyelogram study
sleep study
small bowel study
STA-MCA bypass study
stool study
stress nuclear study
symptom index study
tagged red cell study
tilt-table study
transesophageal echo with bubble study
transthoracic echocardiogram with bubble study
urodynamic study
video swallow study
visual field study
voiding pressure study |