University of the Philippines

Roxas Ave, Diliman, Quezon City, Metro Manila

College of Medicine

UNIVERSITY OF THE PHILIPPINES

COLLEGE OF MEDICINE

MEDICINE I (PHYSICAL DIAGNOSIS)

Tricia L. Tuazon

A.Y

2019-2025

| College of Medicine
 University of the Philippines
Roxas Ave, Diliman, Quezon City, Metro Manila
College of Medicine

BASIC NURISNG TERMINOLOGY ABBREVIATIONS &

SYSTEMATIC STUDY OF BODY SYSTEMS

 The following list contains some of the most common abbreviations found in
medical records. Please note that in medical terminology, the capitalization of
letters bears significance as to the meaning of certain terms, and is often used to
distinguish terms with similar acronyms.

- BASIC NURISNG TERMINOLOGY

ABBREVIATIONS

@—at
am—morning
A & P—anatomy and physiology
AMA—against medical advice
ab—abortion
amal—amalgam
abd—abdominal
amb—ambulate, walk
ABG—arterial blood gas
AMI—acute myocardial infarction
a.c.—before meals
amt—amount
ac & cl—acetest and clinitest
ANS—automatic nervous system
ACLS—advanced cardiac life support
ant—anterior
AD—right ear
AOx3—alert and oriented to person, time, and
place
ADL—activities of daily living
Ap—apical
ad lib—as desired
AP—apical pulse
adm—admission
approx—approximately
afeb—afebrile, no fever
aq—aqueous
AFB—acid-fast bacillus
ARDS—acute respiratory distress syndrome
AKA—above the knee
AS—left ear
alb—albumin
ASA—aspirin
alt dieb—alternate days (every other day)

16
|College of Medicine
 University of the Philippines
Roxas Ave, Diliman, Quezon City, Metro Manila
College of Medicine

asap (ASAP)—as soon as possible bx—biopsy

as tol—as tolerated c—with

ATD—admission, transfer, discharge C & S—culture and sensitivity

AU—both ears c-spine—cervical spine

Ax—axillary CA—cancer

BE—barium enema CAD—coronary artery disease

bid—twice a day cal—calorie

bil, bilateral—both sides CAT—computerized axial tomography

BK—below knee cath—catheter

BKA—below the knee amputation CBC—complete blood count

bl—blood cc—cubic centimeters

bl wk—blood work CC—chief complaint

BLS—basic life support CCU—coronary care unit, critical care unit

BM—bowel movement CHD—coronary heart disease

BOW—bag of waters CHF—congestive heart failure

B/P—blood pressure CHO—carbohydrate

bpm—beats per minute chol—cholesterol

BR—bed rest circ—circumcision

BRP—bathroom privileges cl liq—clear liquid

BS—breath sounds CNS—central nervous sysyem

BSI—body substance isolation c/o—complains of

BSO—bilateral salpingo-oophorectomy COPD—chronic obstructive pulmonary disease

BUN—blood, urea, nitrogen levels CPK—creatine phosphokinase

BVM—bag-valve-mask CPR—cardiopulmonary resuscitation

17
|College of Medicine
 University of the Philippines
Roxas Ave, Diliman, Quezon City, Metro Manila
College of Medicine

CPT—chest physical therapy DW—distilled water

CS—central supply D5W 5%—dextrose in water

CSF—cerebrospinal fluid Dx—diagnosis

CT—computer tomography EBL—estimated blood loss

CVA—cerebrovascular accident (stroke) ECG—electrocardiogram

CVU—cardiovascular unit ED—emergency department

cx—cervix or complaint of EEG—electroencephalogram

CXR—chest X ray EENT—eyes, ears, nose, throat

cysto—cystography EKG—electrocardiogram

d/c—discontinue EMG—electromyogram

D & C—dilation and curettage EOA—esophageal obturator airway

DAT—diet as tolerated ESR—erythrocyte sedimentation rate

DC—discontinue or discharge est—estimated

del—delivery ER—emergency room

Del. Rm.—delivery room ET—endotracheal

diff—differential ETA—estimated time of arrival

DNA—deoxyribonucleic acid etiol—etiology

DNR—do not resuscitate ETOH—ethyl alcohol, intoxicated

DOA—dead on arrival exam—examination

DOB—date of birth exp—exploratory

DPT—diphtheria, pertussis, tetanus ext—external, extract, extraction

DRG—diagnosis-related grouping FBOA—foreign body obstructed airway

D/S—dextrose in saline FBS—fasting blood sugar

DT’s—delirium tremens FBW—fasting blood work

18
|College of Medicine
 University of the Philippines
Roxas Ave, Diliman, Quezon City, Metro Manila
College of Medicine

FF (F. Fl)—force fluids HR—heart rate

FH—family history hs—hour of sleep, bedtime

FHS—fetal heart sounds ht—height

FHT—fetal heart tone Hx—history

FIFO—first in, first out hypo—hypodermic injection

FSH—follicle-stimulating hormone hyst—hysterectomy

ft—foot IBS—irritable bowel syndrome

FUO—fever of undetermined origin I & D—incision and drainage

Fx—fracture I & O—intake and output

GB—gallbladder ICP—intracranial pressure

GI—gastrointestinal ICU—intensive care unit

GU—genitourinary IM—intramuscular

GTT—glucose tolerance test (pancreas test) ing—inguinal

gtt(s)—drop(s) inj—injection

gyn—gynecology IPPB—intermittent positive pressure breathing

H & H—hemoglobin and hematocrit irrig—irrigation

HCG—human chorionic gonadotrophin IS—intercostal space

hct—hematocrit isol—isolation

HDL—high-density lipoprotein IT—inhalation therapy

hgb—hemoglobin IUD—intrauterine device

HOB—head of bed IV—intravenous

hr (h)—hour IVF—in vitro fertilization

HIV—human immunodeficiency virus IVP—intravenous pyelogram

H&P—history and physical K+—potassium

19
|College of Medicine
 University of the Philippines
Roxas Ave, Diliman, Quezon City, Metro Manila
College of Medicine

KCl—potassuim chloride min—minute

KUB—kidney, ureter, bladder MN—midnight

L—lumbar MOM—milk of magnesia

L & D—labor and delivery MRI—magnetic resonance imagery

lac—laceration MS—morphine sulfate, multiple sclerosis

lab—laboratory MVA—motor vehicle accident

lap—laparotomy NVD—nausea, vomiting, diarrhea

lat—lateral Na+—sodium

LD—lethal dose NaCl—sodium chloride

LDH—lactic dehydrogenase N/C—nasal cannula

LDL—low-density lipoprotein no—complaints

liq—liquid neg—negative

LLQ, LLL—left lower quadrant (abdomen), lobe neuro—neurology

(lung)
NG—nasogastric
LMP—last menstrual period
NGT—nasogastric tube
LOC—level of consciousness
nitro—nitroglycerine
LP—lumbar puncture
NKA—no known allergies
lt—left
noc (t)—night
LUQ, LUL—left upper quadrant (abdomen),
lobe (lung) NPO—nothing by mouth

MA—mental age NS—normal saline

MAST—medical antishock trousers nsg—nursing

MCI—mass casualty incident NSR—normal sinus rhythm

meds—medications NVS—neurological vital signs

MI—myocardial infarction O—oxygen

MICU—mobile intensive care unit

20
|College of Medicine
 University of the Philippines
Roxas Ave, Diliman, Quezon City, Metro Manila
College of Medicine

OB—obstetrics PE—physical exam, pulmonary embolism

OD—right eye, overdose PEDS—pediatrics

oint—ointment per—by or through

OOB—out of bed PERL(A)—pupils equal and reactive to light

(and accommodation)
OPD—outpatient department
PET—positron emission tomography
OR—operating room
PH—past history
ord—orderly
pH—hydrogen ion concentration
ORTH—orthopedics
PID—pelvic inflammatory disease
ortho—correct, right (bones)
PKU—phenylketonuria
os—mouth
pm—between noon and midnight
OS—left eye
PNS—peripheral nervous system
OT—occupational therapy
po—by mouth
OU—both eyes
post (pos)—posterior
oz—ounce
postop, PostOp—–postoperative
p—after
pp (p.p.)—postprandial (after eating)
P—pulse
pO2—partial pressure of oxygen
P & A—percussion and auscultation
PPD—purified protein derivative (TB test)
PAC—premature atrial contraction
preop, PreOp—before surgery
palp—palpation
prn—as needed, whenever necessary
PAR—post-anesthesia room
pro time—prothrombin time
PAT—paroxysmal atrial tachycardia
pt—patient, pint
pc—after meals
PT—physical therapy
pCO2—partial pressure of carbon dioxide
PTT—partial prothrombaplastin time
PDR—physician’s desk reference
PVC—premature ventricular contraction

21
|College of Medicine
 University of the Philippines
Roxas Ave, Diliman, Quezon City, Metro Manila
College of Medicine

Px—physical exam, prognosis RUQ, RLL—right upper quadrant, lobe

q—every rt—right

qd—every day RV—residual volume

qh—every hour Rx—take (prescription)

q2h, q3h, ...—every two hours, every three s—without

hours, ...
S & S—signs and symptoms
qhs—every night at bedtime
ss—1/2
qid—four times a day
Sats—oxygen/blood saturation level
qns—quantity not sufficient
SA—sinoatrial
qod—every other day
SB—small bowel
qs—quantity sufficient
sc—subcutaneous
r (R)—rectal
SGOT—serum glutamic oxaloacetic
R (resp)—respirations, rectal transaminase

RAIU—radioactive iodine uptake study SGPT—serum glutamic pyruvic transaminase

RBC—red blood cell/count SIDS—sudden infant death syndrome

reg—regular Sig:—label/write

Rh—rhesus SL—sublingual

RK—radial keratomy SMAC—sequential multiple analysis computer

RL—ringer’s lactate SOB—shortness of breath

RLQ, RLL—right lower quadrant (abdomen), spec—specimen

lobe (lung)
sp. gr.—specific gravity
RML—right middle lobe (lung)
SQ, sub q—subcutaneous
RO—reality orientation
SSE—soap suds enema
R/O—rule out
stat—immediately
ROM—range of motion
STD—sexually transmitted disease
R.R.—recovery room

22
|College of Medicine
 University of the Philippines
Roxas Ave, Diliman, Quezon City, Metro Manila
College of Medicine

STH—somatotropic hormone TUR—transurethral resection

SVD—spontaneous vaginal delivery TV—tidal volume

SVN—small volume nebulizer TVH—total vaginal hysterectomy

SVT—supraventricular tachycardia TX—traction

Sx—symptoms UA—urinalysis

T—temperature, thoracic umb—umbilicus

T & A—tonsillectomy and adenoidectomy unc.—unconscious

tab—tablet ung—ointment

tachy—–tachycardic unk—unknown

TAH—total abdominal hysterectomy ur—urine

TB—tuberculosis URC—usual, reasonable, customary

TCDB—turn, cough, deep breath URI—upper respiratory infection

temp (T)—temperature US—ultrasonic

TH—thyroid hormone UTI—urinary tract infection

TIA—transient ischemic attack V fib—ventricular fibrillation

tid—three times a day V tach—ventricular tachycardia

TMJ—temporomandibular joint vag—vaginal

tol—tolerated VC—vital capacity

TPN—total parenteral nutrition VD—venereal disease

TPR—temperature, pulse, respirations vit—vitamin

tr—tincture vo—verbal order

trach—tracheotomy, tracheostomy vol—volume

TSH—thyroid-stimulating hormone V/S—vital signs

TT—tetanus toxiod WA—while awake

23
|College of Medicine
 University of the Philippines
Roxas Ave, Diliman, Quezon City, Metro Manila
College of Medicine
WBC—white blood cell/count
w/c—wheelchair
WNL—within normal limits
wt—weight
y/o—year(s) old
- ORGAN SYSTEMS
Human Body Organ Systems
The organ systems of the human body all
have specific functions. The VA uses the
categories of major organ systems to classify
disability claims. Here, we will break down
how the different organ systems match up
with the VA’s disability systems.
How Organ Systems Are Connected to
VA Disability Ratings?
Our bodies are made up of 11 basic organ
systems that manage all the essential body
functions. These systems, while
interdependent, can become out of tune.
When one is not functioning properly, the
others will attempt to correct the problem.
All the systems will work together to try to
create what is known as homeostasis or a
state of balance within the body.
The 11 organ systems include the
integumentary system, skeletal system,
muscular system, lymphatic system,
respiratory system, digestive system,
nervous system, endocrine system,
cardiovascular system, urinary system, and
reproductive systems.
The VA defines 14 disability systems, which
are similar to the body systems. However,
the disability systems are separated
differently for rating purposes. These
|College of Medicine
systems are listed with the medical listing
and are identified independently when
necessary.
These 14 systems are the Musculoskeletal
system; Organs of Special Sense (optical);
Auditory; Infectious Diseases, Immune
Disorders, and Nutritional Deficiencies;
Respiratory system; Cardiovascular system;
Digestive system; Genitourinary System;
Hemic and Lymphatic system; Skin;
Endocrine system; Neurological conditions;
Mental Disorders, and Dental and Oral
conditions.
For Individual Unemployability ratings; if
you are rated with more than one disability
within one body system, your rating will
increase towards unemployability. For this
reason, we have outlined the VA defined
body systems and have included a link to our
VA Unemployability Calculator so you can
see if your ratings make you eligible for
Individual Unemployment.
Below is a description of the basic functions
of each system as well as some of the
diseases and disorders associated with each
system. These lists are not complete and do
not take the place of medical advice.
Integumentary System (Skin, Hair, Nails)
The integumentary system is the largest
organ of the body, equaling 15-20% of our
total body mass. It acts as a barrier to
physical, chemical, and biological agents.
The skin prevents water loss and regulates
body temperature. It transmits the senses of
touch, pain, and pleasure and maintains body
temperature by secreting sweat. The hair
lubricates the scalp, which secretes
pheromones and cools or warms our heads.
The nails protect our fingers, which are a
24
 University of the Philippines
Roxas Ave, Diliman, Quezon City, Metro Manila
College of Medicine
major tool used for protecting ourselves and
providing ourselves with food, shelter, and
sensations. The skin leaves us most
vulnerable when it is compromised by open
wounds, allowing infectious agents into the
body.
The VA notes diseases and disorders
associated with the skin to include acne, and
chloracne; dermatitis/eczema; hives; lupus;
psoriasis and other autoimmune disorders;
diseases affecting keratin, pores and hair;
cancer and tumors of the skin such as
melanomas and basal cell carcinoma.
Musculoskeletal System
Skeletal System
(Bones, Joints)
The skeletal system supports and protects the
body’s internal organs. The ribs protect the
abdominal organs, which are both vulnerable
to injury and dangerous to our well being
when injured. The skull protects our brain
which controls all functions of our bodies
and minds. The skeleton provides the
framework and shape to our bodies. It also
connects to our major muscles to allow
movement. Bones store minerals such as
calcium and create blood cells in the soft
bone tissue called marrow. Bones can break
easily without enough calcium and are
subject to such diseases as arthritis; cancers;
scoliosis; osteoporosis, gout; bursitis;
fractures and breaks; and amputations.
Muscular system
(Cardiac, Smooth, and Skeletal Muscles)
Cardiac muscles are found in the heart and
power the actions that maintain blood flow
through our body;
|College of Medicine
Smooth, or involuntary muscles are found in
the heart and organs, they surround the
internal organs and are responsible for their
movement such as moving food through the
digestive tract; and
Skeletal, or voluntary muscles, are
responsible for carrying out the actions and
movements caused by messages sent from
our brains through our nervous system.
Skeletal muscles are also responsible for
maintaining posture and producing heat.
When muscles lack appropriate levels of
oxygen they can cramp and tear, creating
pain. When not used they can atrophy and
become useless. Diseases and disorders of
the muscular system include muscular
dystrophy; fibromyalgia; tendinitis; multiple
sclerosis; and muscle strain or sprains;
hernias.
Lymphatic System
(Red Bone Marrow, Thymus, Lymphatic
Vessels, Thoracic Duct, Spleen, Lymph
Nodes)
This system transports clean fluids in our
body back to the blood and drains excess
fluids and debris from the tissues and cells of
the body. It also houses the white blood cells
(lymphocytes) involved in protecting our
bodies from infection. Diseases and
disorders specific to the lymphatic system
include anemias; leukemia; tuberculosis of
the lymph nodes; Hodgkin’s disease; and
other blood disorders.
Respiratory System
(Nasal Cavity, Pharynx, Larynx, Trachea,
Bronchus, Lung)
This system maintains our breathing. It
supplies the body with oxygen for cellular
respiration by collecting oxygen in the lungs
25
 University of the Philippines
Roxas Ave, Diliman, Quezon City, Metro Manila
College of Medicine
and disposes of carbon dioxide by breathing
out the waste product. It also provides our
functions of speech and smell. Diseases and
disorders of the respiratory system include
allergies; rhinitis and sinusitis; laryngitis;
COPD; pleurisy; bronchitis; emphysema;
asthma; sarcoidosis; fibrosis; asbestosis;
pulmonary vascular diseases; fungal or
bacterial infections of the lungs; sleep apnea;
tuberculosis of the respiratory system; and
lung, throat, and other respiratory cancers.
Digestive system
(Oral Cavity, Esophagus, Liver, Stomach,
Small Intestine, Large Intestine, Rectum,
Anus)
Beginning with our mouths, this system is
responsible for the breaking down and
absorption of nutrients and the elimination of
the waste not utilized by the body. It is
responsible for identifying which minerals,
vitamins, and other essentials from the foods
we eat can be absorbed and utilized or stored
by the body and which are to be disposed of,
and carrying out those functions. Diseases
and disorders of the digestive system include
diverticulitis; gastritis; pancreatitis;
cholecystitis; cirrhosis; hepatitis; liver
cancer; irritable bowel or colon syndromes;
Crone’s disease; and hemorrhoids.
Nervous System
(Brain, Spinal Cord, Nerves)
This system is actually made up of two
distinct parts; the central nervous system
(CNS) and the peripheral nervous system.
The central nervous system is made up of the
brain and spinal cord, and the peripheral
nervous system is made up of all the nerves
that lead into and out of the CNS to other
parts of the body. The entire nervous system
controls all of the other systems of the body,
|College of Medicine
such as digestion and cardiac rhythm, and
responds to internal and external changes,
such as activating muscles and breathing. It
also transmits information to the brain, such
as pain and external sensations.
Diseases and disorders of the nervous system
include paralysis; Parkinson’s Disease;
palsy, embolisms; thrombosis;
arteriosclerosis; polio; myelitis; ALS;
meningitis; Multiple Sclerosis; muscular
tics; Huntington’s Disease; cancers of the
brain, spinal cord or nerves; epilepsy, seizure
disorders; narcolepsy; migraine headaches;
peripheral neuropathy; and traumatic brain
injury.
Endocrine System
(Pineal Gland, Pituitary Gland, Thyroid
Gland, Thymus, Adrenal Gland, Pancreas,
Ovary, Testis)
The glands of the endocrine system secrete
chemicals called hormones that regulate
most of the processes in our bodies such as
growth, reproduction, metabolism, and even
the control of the amount of glucose in our
blood. Diseases and disorders of the
endocrine system include Type 1 & Type 2
Diabetes, hypoglycemia, Addison’s disease;
Cushing’s syndrome; hyper/hypothyroidism,
thyroid cancer; and other active cancers of
the endocrine glands.
Cardiovascular (Circulatory) System
(Heart, Blood Vessels)
The heart, made of cardiac muscle, pumps
blood and blood vessels such as arteries and
veins, transport the blood to every part of our
body providing organs and muscles with
nourishment. The blood carries oxygen,
carbon dioxide, nutrients, waste and more
throughout the body. Diseases and disorders
26
 University of the Philippines
Roxas Ave, Diliman, Quezon City, Metro Manila
College of Medicine
associated with the cardiovascular system
include myocardial infarction; coronary
bypass surgery; arrhythmias; valve
replacements; pacemakers; transplants; heart
diseases (ischemic; hypertensive;
arteriosclerotic); hypertension; aneurysms;
fistulas; arteriosclerosis; anaphylaxis shock;
varicose veins; cold weather injuries; and
sarcomas of the blood vessels.
Urinary system
(Kidney, Ureter, Urinary Bladder, Urethra)
This system is responsible for eliminating
waste products of metabolism and other
materials from the body that are of no use.
The system is also responsible for
maintaining the balanced fluid volume in our
bodies by regulating the amount of water
that is excreted, maintaining the
concentrations of electrolytes, and normal
pH levels of the blood. Diseases and
disorders of the urinary system include
nephrosis, bladder cancer, urethritis,
bedwetting (enuresis), urinary and kidney
stones and infections, renal failure,
incontinence, blood in the urine, and
interstitial cystitis.
Reproductive Systems
MALE (prostate gland, penis, testis,
scrotum, ductus deferens)
FEMALE (Mammary glands, ovary, uterus,
vagina, fallopian tube)
VA Equivalent for rating – Female
Reproductive System
(Male reproductive system is under
genitourinary system)
The reproductive system mainly functions to
create human life. Ovaries produce female
|College of Medicine
sex hormones and eggs. Eggs are fertilized
in the fallopian tube by sperm then travel to
the uterus, which provides the site for
growth. The mammary glands produce milk
for the newborn. Diseases and disorders
associated with the female reproductive
systems include breast cancer, removal of
breast or lumpectomy; hysterectomy;
pregnancy complications; endometriosis;
ovarian or cervical cancers; and diseases or
injuries of the vulva, vagina, cervix, uterus,
fallopian tubes, or ovaries.
ADDITONAL SYSTEMS
Organs of Special Sense (eyes)
Diseases and disorders include any
disturbances of field of vision; blurry vision;
scotoma; muscle dysfunctions; intraocular
hemorrhage; detachment of the retina;
retinopathy; conjunctivitis; corneal
conditions and transplants; aphakia; cataract;
glaucoma; optic neuropathy; tear production
issues; loss of eyelids, eyebrows, or lashes;
tuberculosis of the eye, and cancers of the
eye.
Impairment of Auditory Acuity (ears)
Diseases and disorders include hearing loss;
tinnitus; chronic earaches; balance disorders;
and cancers of the ear.
Mental Disorders (psychological issues)
Mental disorders have changed throughout
the years so if your ratings are older than
2014; they may be listed as a different
disorder or be rated by different criteria. Ask
your attorney or VSO to look at your ratings
and see if you are in need of an increased
rating based on the changes in the rating
system. Diseases and disorders under mental
disorders include social impairments;
anxiety; PTSD; obsessive-compulsive
27
 University of the Philippines
Roxas Ave, Diliman, Quezon City, Metro Manila
College of Medicine

disorders; panic attacks; adjustment disorder;

bipolar disorder; somatic disorders;
depressive disorders; schizophrenia;
schizoaffective disorder; delusional
disorders; neuro-cognitive disorders;
phobias; and eating disorders.

Infectious Diseases, Immune Disorders;

and Nutritional Deficiencies

This includes the diseases and disorders such

as cholera; leprosy; malaria; trench fever;
plague, rheumatic fever; typhoid fever; lyme
disease; HIV; syphilis; lupus; non-
respiratory tuberculosis; and chronic fatigue
syndrome.

---END OF THE CHAPTER---

28
|College of Medicine