0
Q
Pt
A
Patient
1
Q
prn
A
As needed
2
Q
PO
A
Per Os (by mouth)
3
Q
PERRL
A
Pupils are equal, round, and reactive to light
4
Q
PE
A
Pulmonary embolism Or Physical exam
5
Q
PCP
A
Primary care physician
6
Q
___ P
A
Post, after
7
Q
OD
A
Overdose
8
Q
O2 sat
A
Oxygen saturation (Sa02)
9
Q
N/V/D
A
Nausea/Vomiting/ Diarrhea
10
Q
UTI
A
Urinary tract infection
11
Q
UTD
A
Up to date
12
Q
US
A
Ultrasound
13
Q
URI
A
Upper respiratory infection
14
Q
UA
A
Urinalysis
15
Q
Tx
A
Treatment
16
Q
TM
A
Tympanic membrane
17
Q
TID
A
3 times a day
18
Q
TIA
A
Transient Ischemic Attack
19
Q
Sx
A
Symptoms
20
Q
S/P
A
Status post
21
Q
SOB
A
Shortness of breath
22
Q
___ S
A
Without
23
Q
R/O
A
Rule out
24
Rx
Prescription
25
RUQ
Right Upper Quadrant
26
RUE
Right Upper Extremity
27
ROS
Review of system
28
ROM
Range of Motion
29
RLQ
Right Lower Quadrant
30
Abx
Antibiotics
31
Hematuria
Large amounts of blood in the urine
32
Hemoptysis
Coughing up large amounts of blood
33
Hemorrhage
Excessive of profuse bleeding
34
Hepatomegaly
Enlarged liver
35
Hypertension
High blood pressure
36
Hypotension
Low blood pressure
37
Hypoxia
Low oxygen saturation of the body. Not enough oxygen in the blood
38
Infarct
Area of dead tissue after a lack of blood supply
39
Inferior
Lower on the body, farther from the head
40
Ischemia
Lack of blood supply
41
Superior
Higher on the body, nearer the head
42
Supine
Body position lying face up
43
Syncope
"Passing out" Loss of consciousness "Fainting"
44
Ecchymosis
A bruise
45
Edema
Swelling
46
Emesis
Vomiting
47
Epistaxis
Nose bleed
48
Erythema/ Erythematous
Redness/red
49
Grossly
Obviously A lot Wholly
50
Hematemesis
Very large amounts of blood in the vomit
51
Pallor
Pale skin
52
Pulmonary Embolism
Blocking of pulmonary artery due to a blood clot
53
Posterior/Dorsal
Rear or backside of the body
54
Proximal
Nearer to the trunk of the body
55
Purulent
Pus-like
56
Rales
Crackles; wet crackling noise in lungs
57
Rhinorrhea
Clear nasal discharge "Runny nose"
58
Rhonchi
Rattling noise of mucous in the lungs
59
Sepsis
Dangerous infection of the blood
60
STEMI
ST elevation MI Real-time ongoing death of heart tissue due to ischemia
61
Deep Vein Thrombosis (DVT)
A blood clot in a deep vein, most often an extremity.
62
Dyspnea
Problems with breathing
63
Dysuria
Painful urination
64
Laceration
Splitting of the skin due to trauma A cut due to something sharp
65
Lateral
Farther from the midline A line that can be traced from the nose to the belly button
66
Medial
Nearer to the midline
67
Melena
Black tarry stool
68
Myocardial Infarction (MI)
Death of cardiac muscle due to ischemia
69
Myalgia
Muscular pain "Muscle aches"
70
Oriented \*3
Oriented to person, place, and time
71
Benign
Normal, of no danger to health
72
Bradycardia
Slow heart rate ( heart rate less than 60 bpm)
73
Cardiomegaly
Enlarged heart
74
Cholecystitis
Inflammation of the cholecyst (gallbladder)
75
Chronic
Long-standing Constant Opposite of acute
76
COPD
Chronic Obstructive Pulmonary Disease (Lung disease commonly seen in smokers)
77
Coronary Artery
The artery that supplies the heart tissue with blood
78
Cerebrovascular Accident (CVA)
"Stroke" Lack of blood supply to the brain causing brain damage
79
Diaphoresis
Sweating
80
Distal
Farther from the trunk of the body
81
GI
Gastrointestinal
82
G/P/Ab
Gravida/Para/Abortion G: # of pregnancies P: #of delivered pregnancies Ab: # of abortions
83
GSW
Gun Shot Wound
84
GU
Genitourinary
85
HA
Headache
86
FHx
Family history
87
EtOH
Alcohol
88
Abrasion
Scrape of the skin due to something abrasive
89
Acute
New Usually of rapid onset Of concern Opposite of chronic
90
Anterior
Located towards the front of the body
91
C/O
Complains of
92
C-Spine
Cervical spine(neck)
93
DKA
Diabetic Ketoacidosis
94
DM
Diabetes Mellitus
95
DNR
Do not resuscitate
96
DOE
Dyspnea on exertion
97
DVT
Deep vein thrombosis
98
Dx
Diagnosis
99
Dz
Disease
100
Fx
Fracture
101
Vertigo
Condition of dizziness "room spinning"
102
Transient Ischemic Attack TIA
Minor stroke Neurological function is regained quickly with time
103
Tachypnea
Increased breathing rate
104
Tachycardia
Fast heart rate ( greater than 100bpm)
105
CAD
Coronary Artery Disease "Heart disease"
106
CT or CAT
Computerized Tomography Or Computerized Assisted Tomography
107
CHF
Congestive Heart Failure
108
COPD
Chronic Obstructive Pulmonary Disease
109
CP
Chest pain
110
CPR
Cardiopulmonary Resuscitation
111
C-section
Caesarean section
112
CSF
Cerebrospinal fluid
113
CVA
Cerebrovascular Accident Or Costovertebral Angle
114
CXR
Chest X-Ray
115
AMA
Against medical advice
116
AMS
Altered mental status
117
ASA
Acetylsalicylic Acid (Aspirin)
118
BID
Twice daily
119
Bilat LE
Bilateral lower extremities
120
BM
Bowel movement
121
BP
Blood pressure
122
\_\_\_ C
With
123
CA
Cancer Or carcinoma
124
CABG
Coronary Artery Bypass Graft "Open heart surgery"
125
\_\_\_ A
Before
126
AAA
Abdominal Aortic Aneurysm
127
A Fib
Atrial Fibrillation
128
Abd
Abdominal/ abdomen
129
LLQ
Lower left quadrant
130
LLE
Lower left extremity
131
JVD
Jugular Vein Distension
132
IVDA
IV Drug Abuse
133
WNL
Within normal limits
134
qh
Every hour
135
qd
Every day
136
PTA
Prior to arrival
137
Wheezing
High pitched sound heard in the lungs with asthmatics or lung disease
138
EKG/ECG
Electrocardiogram
139
HEENT
Head Ears Eyes Nose Throat
140
HPI
History of Present Illness
141
Hx
History
142
IDDM
Insulin Dependent Diabetes Mellitus
143
I&D
Incision and drainage
144
H&P
History of present illness& physical exam
145
H&H
Hemoglobin and hematocrit
146
Fx
Fracture
147
LUQ
Left upper quadrant
148
LUE
Left upper extremity
149
LP
Lumbar puncture
150
LOC
Loss of consciousness
151
LNMP
Last normal menstrual period
152
RLE
Right lower extremity
153
QID
Four times a day
154
q2h
Every 2 hours
155
qhs
At every bedtime
156
NTG
Nitroglycerin
157
NSR
Normal sinus rhythm
158
NSAID
Non-Steroidal anti-inflammatory Drug
159
Nml/ nl
Normal
160
NKDA
No known drug abuse
161
NIDDM
Non insulin dependent diabetes Mellitus
162
NAD
No acute disease Or No acute distress
163
N/a
Not applicable
164
MVA/MVC
Motor vehicle accident Or motor vehicle collision
165
MI
Myocardial infarction
166
IUP
Intrauterine pregnancy
167
MCA
Motorcycle accident
168
As needed
prn
169
Patient
Pt
170
Per Os (by mouth)
PO
171
Pupils are equal, round, and reactive to light
PERRL
172
Pulmonary embolism Or Physical exam
PE
173
Primary care physician
PCP
174
Post, after
\_\_\_ P
175
Overdose
OD
176
Oxygen saturation (Sa02)
O2 sat
177
Nausea/Vomiting/ Diarrhea
N/V/D
178
Urinary tract infection
UTI
179
Up to date
UTD
180
Ultrasound
US
181
Upper respiratory infection
URI
182
Urinalysis
UA
183
Treatment
Tx
184
Tympanic membrane
TM
185
3 times a day
TID
186
Transient Ischemic Attack
TIA
187
Symptoms
Sx
188
Status post
S/P
189
Shortness of breath
SOB
190
Without
\_\_\_ S
191
Rule out
R/O
192
Prescription
Rx
193
Right Upper Quadrant
RUQ
194
Right Upper Extremity
RUE
195
Review of system
ROS
196
Range of Motion
ROM
197
Right Lower Quadrant
RLQ
198
Antibiotics
Abx
199
Large amounts of blood in the urine
Hematuria
200
Coughing up large amounts of blood
Hemoptysis
201
Excessive of profuse bleeding
Hemorrhage
202
Enlarged liver
Hepatomegaly
203
High blood pressure
Hypertension
204
Low blood pressure
Hypotension
205
Low oxygen saturation of the body. Not enough oxygen in the blood
Hypoxia
206
Area of dead tissue after a lack of blood supply
Infarct
207
Lower on the body, farther from the head
Inferior
208
Lack of blood supply
Ischemia
209
Higher on the body, nearer the head
Superior
210
Body position lying face up
Supine
211
"Passing out" Loss of consciousness "Fainting"
Syncope
212
A bruise
Ecchymosis
213
Swelling
Edema
214
Vomiting
Emesis
215
Nose bleed
Epistaxis
216
Redness/red
Erythema/ Erythematous
217
Obviously A lot Wholly
Grossly
218
Very large amounts of blood in the vomit
Hematemesis
219
Pale skin
Pallor
220
Blocking of pulmonary artery due to a blood clot
Pulmonary Embolism
221
Rear or backside of the body
Posterior/Dorsal
222
Nearer to the trunk of the body
Proximal
223
Pus-like
Purulent
224
Crackles; wet crackling noise in lungs
Rales
225
Clear nasal discharge "Runny nose"
Rhinorrhea
226
Rattling noise of mucous in the lungs
Rhonchi
227
Dangerous infection of the blood
Sepsis
228
ST elevation MI Real-time ongoing death of heart tissue due to ischemia
STEMI
229
A blood clot in a deep vein, most often an extremity.
Deep Vein Thrombosis (DVT)
230
Problems with breathing
Dyspnea
231
Painful urination
Dysuria
232
Splitting of the skin due to trauma A cut due to something sharp
Laceration
233
Farther from the midline A line that can be traced from the nose to the belly button
Lateral
234
Nearer to the midline
Medial
235
Black tarry stool
Melena
236
Death of cardiac muscle due to ischemia
Myocardial Infarction (MI)
237
Muscular pain "Muscle aches"
Myalgia
238
Oriented to person, place, and time
Oriented \*3
239
Normal, of no danger to health
Benign
240
Slow heart rate ( heart rate less than 60 bpm)
Bradycardia
241
Enlarged heart
Cardiomegaly
242
Inflammation of the cholecyst (gallbladder)
Cholecystitis
243
Long-standing Constant Opposite of acute
Chronic
244
Chronic Obstructive Pulmonary Disease (Lung disease commonly seen in smokers)
COPD
245
The artery that supplies the heart tissue with blood
Coronary Artery
246
"Stroke" Lack of blood supply to the brain causing brain damage
Cerebrovascular Accident (CVA)
247
Sweating
Diaphoresis
248
Farther from the trunk of the body
Distal
249
Gastrointestinal
GI
250
Gravida/Para/Abortion G: # of pregnancies P: #of delivered pregnancies Ab: # of abortions
G/P/Ab
251
Gun Shot Wound
GSW
252
Genitourinary
GU
253
Headache
HA
254
Family history
FHx
255
Alcohol
EtOH
256
Scrape of the skin due to something abrasive
Abrasion
257
New Usually of rapid onset Of concern Opposite of chronic
Acute
258
Located towards the front of the body
Anterior
259
Complains of
C/O
260
Cervical spine(neck)
C-Spine
261
Diabetic Ketoacidosis
DKA
262
Diabetes Mellitus
DM
263
Do not resuscitate
DNR
264
Dyspnea on exertion
DOE
265
Deep vein thrombosis
DVT
266
Diagnosis
Dx
267
Disease
Dz
268
Fracture
Fx
269
Condition of dizziness "room spinning"
Vertigo
270
Minor stroke Neurological function is regained quickly with time
Transient Ischemic Attack TIA
271
Increased breathing rate
Tachypnea
272
Fast heart rate ( greater than 100bpm)
Tachycardia
273
Coronary Artery Disease "Heart disease"
CAD
274
Computerized Tomography Or Computerized Assisted Tomography
CT or CAT
275
Congestive Heart Failure
CHF
276
Chronic Obstructive Pulmonary Disease
COPD
277
Chest pain
CP
278
Cardiopulmonary Resuscitation
CPR
279
Caesarean section
C-section
280
Cerebrospinal fluid
CSF
281
Cerebrovascular Accident Or Costovertebral Angle
CVA
282
Chest X-Ray
CXR
283
Against medical advice
AMA
284
Altered mental status
AMS
285
Acetylsalicylic Acid (Aspirin)
ASA
286
Twice daily
BID
287
Bilateral lower extremities
Bilat LE
288
Bowel movement
BM
289
Blood pressure
BP
290
With
\_\_\_ C
291
Cancer Or carcinoma
CA
292
Coronary Artery Bypass Graft "Open heart surgery"
CABG
293
Before
\_\_\_ A
294
Abdominal Aortic Aneurysm
AAA
295
Atrial Fibrillation
A Fib
296
Abdominal/ abdomen
Abd
297
Lower left quadrant
LLQ
298
Lower left extremity
LLE
299
Jugular Vein Distension
JVD
300
IV Drug Abuse
IVDA
301
Within normal limits
WNL
302
Every hour
qh
303
Every day
qd
304
Prior to arrival
PTA
305
High pitched sound heard in the lungs with asthmatics or lung disease
Wheezing
306
Electrocardiogram
EKG/ECG
307
Head Ears Eyes Nose Throat
HEENT
308
History of Present Illness
HPI
309
History
Hx
310
Insulin Dependent Diabetes Mellitus
IDDM
311
Incision and drainage
I&D
312
History of present illness& physical exam
H&P
313
Hemoglobin and hematocrit
H&H
314
Fracture
Fx
315
Left upper quadrant
LUQ
316
Left upper extremity
LUE
317
Lumbar puncture
LP
318
Loss of consciousness
LOC
319
Last normal menstrual period
LNMP
320
Right lower extremity
RLE
321
Four times a day
QID
322
Every 2 hours
q2h
323
At every bedtime
qhs
324
Nitroglycerin
NTG
325
Normal sinus rhythm
NSR
326
Non-Steroidal anti-inflammatory Drug
NSAID
327
Normal
Nml/ nl
328
No known drug abuse
NKDA
329
Non insulin dependent diabetes Mellitus
NIDDM
330
No acute disease Or No acute distress
NAD
331
Not applicable
N/a
331
Not applicable
N/a
332
Motor vehicle accident Or motor vehicle collision
MVA/MVC
332
Motor vehicle accident Or motor vehicle collision
MVA/MVC
333
Myocardial infarction
MI
333
Myocardial infarction
MI
334
Intrauterine pregnancy
IUP
334
Intrauterine pregnancy
IUP
335
Motorcycle accident
MCA
335
Motorcycle accident
MCA
SCRIBE TRAINING
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Decks in class (5)
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