Medical Specialists and Case Reports

CHAPTER OBJECTIVES

• To describe the training process of physicians

• To identify medical specialists and describe their specialties

• To identify combining forms used in terms that describe specialists

• To decipher medical terminology as written in case reports

Introduction

This chapter reviews many of the terms you have learned in previous chapters and adds others related to medical specialists. In the following section, the training of physicians is described and specialists are listed with their specialties. Next, on page 175, useful combining forms are presented with terminology to increase your medical vocabulary. Finally, short case reports beginning on page 180 illustrate the use of the medical language in context. As you read these reports, I guarantee that you will be impressed with your ability to understand medical terminology!

Medical Specialists

Doctors complete 4 years of medical school and then pass national medical board examinations to receive an MD degree (MD stands for Latin Medicinae Doctor, “teacher [doctor] of medicine”). They may then begin postgraduate training, which lasts at least 3 years and in some cases longer. This postgraduate training is known as residency training. Examples of residency programs are

Anesthesiology	Administration of agents capable of bringing about a loss of sensation
Dermatology	Diagnosis and treatment of skin disorders
Emergency medicine	Care of patients that requires sudden and immediate action
Family practice	Primary care of all members of the family on a continuing basis
Internal medicine	Diagnosis and treatment of usually complex, nonsurgical disorders in adults
Ophthalmology	Diagnosis and treatment of eye disorders
Pathology	Diagnosis of the cause and nature of disease
Pediatrics	Diagnosis and treatment of children’s disorders
Psychiatry	Diagnosis and treatment of disorders of the mind
Radiology	Diagnosis using x-ray studies including ultrasound and magnetic resonance imaging (MRI)
Surgery	Treatment by manual (SURG- means hand) or operative methods

Examinations are administered after the completion of each residency program to certify the doctor’s competency in that specialty area.

A physician may then choose to specialize further by doing fellowship training. Fellowship programs (lasting 2 to 5 years) train doctors in clinical (patient care) and research (laboratory) skills. For example, an internist (specialist in internal medicine) may choose fellowship training in internal medicine specialties such as neurology, nephrology, endocrinology, and oncology. A surgeon interested in further specialization may do fellowship training in thoracic surgery, neurosurgery, or plastic surgery. On completion of training and examinations, the doctor is then recognized as a specialist in that area of medical practice.

Medical specialists and an explanation of their specialties are listed below:

MEDICAL SPECIALIST	AREA OF PRACTICE
allergist	Treatment of hypersensitivity reactions
anesthesiologist	Administration of agents to prevent pain and unpleasant awareness during surgical and other procedures
cardiologist	Treatment of heart disease
cardiovascular surgeon	Surgery on the heart and blood vessels
colorectal surgeon	Surgery on the colon and rectum
dermatologist	Treatment of skin disorders
emergency practitioner	Immediate evaluation and treatment of acute injury and illness in a hospital setting
endocrinologist	Treatment of endocrine gland disorders
family practitioner	Primary care and treatment for families on a continuing basis
gastroenterologist	Treatment of stomach and intestinal disorders
geriatrician	Treatment of diseases of old age
gynecologist	Surgery and treatment for diseases of the female reproductive system
hematologist	Treatment of blood disorders
hospitalist	General medical care of hospitalized patients
infectious disease specialist	Treatment of diseases caused by microorganisms (bacteria, viruses, fungi, others)
internist	Comprehensive care for adults in an offce or a hospital setting
nephrologist	Treatment of kidney diseases
neurologist	Treatment of nerve disorders
neurosurgeon	Surgery on the brain, spinal cord, and nerves
obstetrician	Treatment of pregnant women; delivery of babies
oncologist	Diagnosis and medical treatment of malignant and benign tumors
ophthalmologist	Surgical and medical treatment of eye disorders
orthopedist	Surgical treatment of bone, muscle, and joint conditions
otolaryngologist	Surgical treatment of ear, nose, and throat disorders
pathologist	Diagnosis of disease by analysis of cells
pediatrician	Treatment of diseases of children
physiatrist	Treatment to restore function after illness; physical medicine and rehabilitation specialist
psychiatrist	Treatment of mental disorders
pulmonologist	Treatment of lung diseases
radiologist	Examination of x-ray images to determine a diagnosis; interpretation of ultrasound, MRI, and nuclear medicine studies
radiation oncologist	Treatment of disease with high-energy radiation
rheumatologist	Treatment of systemic diseases affecting joints and muscles
thoracic surgeon	Surgery on chest organs
urologist	Surgery on the urinary tract and for treatment of male reproductive disorders

To help you identify medical specialists and what they do, select from the list of medical specialists to match the test or procedure described. Answers are found on page 201.

A Match the medical specialists with the procedures and tests that they perform. Write the name of the specialist on the line provided.

allergist

anesthesiologist

cardiologist

cardiovascular surgeon

PROCEDURE/TEST	MEDICAL SPECIALIST
1. Esophagoscopy and colonoscopy	____________________
2. Blood cell counts; bone marrow biopsy	____________________
3. Ultrasound examination of the heart; angioplasty	____________________
4. Skin testing to determine sensitivity to antigens	____________________
5. Serum (blood) level of hormones	____________________
6. Vision tests; retinoscopy	____________________
7. Coronary artery bypass grafting (CABG)	____________________
8. Catheter and IV line insertion for sedation during surgery	____________________
9. Pap smear (microscopic examination of cells from the cervix and organs); hysterectomy	____________________

B Select from the list of medical specialists to match the test or procedure described.

PROCEDURE/TEST	MEDICAL SPECIALIST
1. Nephrectomy; cystectomy; prostatectomy	____________________
2. Personality and mental function tests	____________________
3. Use of high-energy beams (photon and proton) to kill tumor cells	____________________
4. Fixation of bone fracture; arthroscopic surgery	____________________
5. Breathing function (spirometry) tests	____________________
6. Microscopic examination of biopsy samples; autopsies	____________________
7. CT scan; MRI; ultrasound examination	____________________
8. Kidney function tests; dialysis	____________________
9. Spinal and cranial nerve refex tests	____________________

COMBINING FORMS AND VOCABULARY

The combining forms listed below should be familiar because they are found in the list of terms describing medical specialists. A medical term is included to illustrate the use of the combining form. Write the meaning of the medical term in the space provided. You can always check your answers with the Mini-Dictionary: Glossary of Medical Terms beginning on page 341.

COMBINING FORM	MEANING	MEDICAL TERM	MEANING
cardi/o	heart	cardiomegaly ____________________
col/o	colon (large intestine)	colitis ____________________
dermat/o	skin	dermatitis ____________________
endocrin/o	endocrine glands	endocrinology ____________________

Ulcerative colitis and Crohn disease

Both of these conditions are types of inflammatory bowel disease (IBD), with similar signs and symptoms, such as abdominal pain, diarrhea, and bleeding from the rectum. While ulcerative colitis is confined to the colon, Crohn’s commonly affects the last part of the small intestine and may involve other areas of the gastrointestinal tract. Lesions can be identified, but causes of both types of IBD are unknown. See the In Person feature on page 192.

enter/o	intestines	enteritis ____________________
esthesi/o	sensation	anesthesiology ____________________
gastr/o	stomach	gastroscopy ____________________
ger/o	old age	geriatrics ____________________
gynec/o	woman, female	gynecology ____________________
hemat/o	blood	hematoma ____________________
iatr/o	treatment	iatrogenic ____________________
		IATR/O means treatment by a physician or with medicines. An iatrogenic illness is produced (-GENIC) adversely and unexpectedly by a treatment.
laryng/o	voice box	laryngeal ____________________
lymph/o	lymph	lymphadenopathy ____________________
		Lymph “glands” are actually lymph nodes, located all over the body but especially in axillary (armpit), inguinal (groin), cervical (neck), and mediastinal (area between the lungs) regions. Lymphadenopathy often refers to the presence of malignant cells in lymph nodes.
nephr/o	kidney	nephrostomy ____________________
		A catheter (tube) is inserted into the kidney for drainage of fluid.
neur/o	nerve	neuralgia ____________________
nos/o	disease	nosocomial ____________________
		A nosocomial infection is acquired during hospitalization (COMI/O means to care for).
obstetr/o	midwife	obstetric ____________________

odont/o	tooth	orthodontist ____________________
		ORTH/O means straight.
onc/o	tumor	oncogenic ____________________
		Oncogenic viruses give rise to tumors.
ophthalm/o	eye	ophthalmologist ____________________
opt/o	eye	optometrist ____________________
		An optometrist examines (METR/O means to measure) eyes and prescribes corrective lenses but cannot treat eye diseases.
optic/o	eye	optician ____________________
		Opticians grind lenses and fit glasses, and may treat eye diseases.
orth/o	straight	orthopedist ____________________
		PED/O comes from paidos, the Greek word for “child.” In the past, orthopedists were concerned with straightening bone deformities in children. Today, they treat bone, muscle, and joint disorders in adults as well.
ot/o	ear	otitis ____________________
path/o	disease	pathology ____________________
ped/o	child	pediatrics ____________________
psych/o	mind	psychosis ____________________
pulmon/o	lung	pulmonary ____________________

Dental specialists

The following are other specialists in dental medicine:

Dental Specialist	Area of Expertise
periodontist	Gums (PERI- means surrounding)
endodontist	Root canal therapy (the root canal is the inner part of a tooth containing blood vessels and nerves)
pedodontist	Children (PED/O means child)
prosthodontist	Replacement of missing teeth with artifcial appliances (PROSTH/O = artificial replacement)

radi/o	x-rays	radiotherapy ____________________
		Radiotherapy is also called radiation therapy. See Figure 5-1.
rect/o	rectum	rectocele ____________________
		-CELE means a hernia or protrusion. The walls of the rectum weaken and bulge forward toward the vagina. See Figure 5-2.
rheumat/o	flow, fluid	rheumatology
		Joints can fill with fluid when diseased—hence, RHEUMAT/O indicates a problem with a swollen joint. Rheumatoid arthritis is a chronic inflammatory disease of joints and connective tissues that leads to deformation of joints. See Figures 5-3 and 5-4.

Rheumatoid arthritis and osteoarthritis

Rheumatoid arthritis first appears when patients (often women) are young, and it has an autoimmune component (antibodies are found that destroy joint tissue). Osteoarthritis most often appears in older patients (both men and women) and is marked by degenerative changes that cause destruction of the joint space. Knee and hip replacements may be helpful treatments for patients with osteoarthritis.

rhin/o	nose	rhinorrhea ____________________
thorac/o	chest	thoracotomy ____________________
ur/o	urinary tract	urology ____________________
vascul/o	blood vessels	vasculitis ____________________

Case Reports

Here are short case reports related to medical specialties. Many of the terms will be familiar to you; others are explained in the Mini-Dictionary: Glossary of Medical Terms (beginning on page 341). For every case report, write the meaning of the boldface terms in the spaces provided.

CASE 1 Cardiology

Mr. Rose was admitted to the cardiac care unit (CCU) with angina and a history of hypertension.

A coronary angiogram (Figure 5-5, A) showed spasm of the right coronary artery (closed arrow), causing acute myocardial ischemia. The electrocardiogram (ECG) showed ventricular arrhythmias as well.

Figure 5-5 **A, Coronary angiogram** showing spasm of the right coronary artery *(arrow).* B, Angiogram showing reversal of the spasm *(arrow).* (A and B, *From Zipes DP, et al:* Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, *ed 7, Philadelphia, 2005, Saunders.*)

Nitroglycerin was administered, and within minutes, the angiogram showed reversal of the spasm (Figure 5-5, B). The ECG recorded reversal of the life-threatening arrhythmias as well. To prevent further ischemia and myocardial infarction, Mr. Rose’s treatment will include antiarrhythmic, diuretic, and anticoagulant drugs. In the future, he may need an additional procedure to place a stent in his coronary artery to keep it open.

acute myocardial ischemia _________________________________________

angina ______________________________________________

antiarrhythmic ___________________________________________

anticoagulant _____________________________________________

coronary angiogram ______________________________

diuretic ___________________________________________

hypertension ____________________________________________________

myocardial infarction _______________________________________________

nitroglycerin ________________________________________

spasm _____________________________________________

stent _________________________________________________

ventricular arrhythmias ____________________________________________________

CASE 2 Gynecology

Ms. Sessions has had dysmenorrhea and menorrhagia for several months. She is also anemic. Because of the presence of a large fibroid, as seen on a pelvic ultrasound image (sonogram) (see Figure 5-6, A), a hysterectomy was recommended. After it was removed, the uterus was opened to reveal multiple fibroids (leiomyomas) bulging into the uterine cavity and displaying a firm, white appearance. See Figure 5-6, B.

anemic _______________________________________________

dysmenorrhea ____________________________________________

fibroids _____________________________________________

hysterectomy _______________________________

leiomyomas ________________________________________

menorrhagia ___________________________________

sonogram __________________________

ultrasound _________________________

CASE 3 Oncology

John Smith, a 26-year-old law student, was admitted to the hospital after experiencing several months of fatigue, low-grade fevers, chest pain, and night sweats. A chest MRI scan (see Figure 5-7) revealed large mediastinal masses, as shown by arrows. Needle biopsy confirmed a diagnosis of Hodgkin disease. There was no evidence of lymphadenopathy or hepatic involvement. Treatment included chemotherapy followed by radiotherapy to the chest. Mr. Smith’s prognosis is good.

chemotherapy __________________________________

diagnosis __________________________________

fatigue __________________________________

hepatic __________________________________

Hodgkin disease __________________________________

lymphadenopathy __________________________________

mediastinal __________________________________

MRI __________________________________

needle biopsy __________________________________

prognosis __________________________________

radiotherapy __________________________________

CASE 4 Urology

Scott Jones has a history of lower back pain, associated with hematuria and dysuria. An abdominal x-ray film (Figure 5-8, A) shows a renal calculus (black arrow) in the right upper quadrant. His doctor tells him that renal calculi should be suspected any time a calcification is seen within the renal outline or along the expected course of the ureter (dotted lines).