A

ABCDE checklist of premalignant changes in skin lesions, especially moles; lesion asymmetry; border (profile) irregularity; colour variation; diameter increase; evolution (changes over time) (Figure A1)

Figure A1 Dorsal foot lesion showing ABCDE changes: asymmetry, border/surface irregularity, colour variation, possible satellite lesions, history of a gradual increase in diameter and change of appearance (evolution) over several months. The patient (92-year-old man) would not permit lesion biopsy.

ABCDS interpretation checklist of a plain radiograph: A, bones/joints positions/alignments; B, bone mineralization quality; C, within-joint cartilage space; D, distal proximal image evaluation; S, soft-tissue examination

abciximab see antiplatelet therapy

abduct; abduction movement away from the median line or sagittal plane

abductor muscle drawing a part away from the sagittal plane; therefore abductor action of intrinsic foot muscles is described in relation to the sagittal plane of the foot

abductor digiti minimi first plantar layer intrinsic foot muscle

abductor hallucis first plantar layer intrinsic foot muscle

abductory twist abnormal transverse-plane foot movement in a foot that remains pronated throughout gait or continues to pronate after midstance; the foot undergoes rapid external rotation immediately after heel lift, pivoting about the first metatarsophalangeal joint

ABI see ankle–brachial index

ablation chemical or thermal tissue destruction

ABO classification see blood type

ABPI ankle–brachial pressure index: see ankle–brachial index

abscess pus formation due to a local acute or chronic bacterial infection, with severe acute inflammation, cellulitis, tissue liquefaction, cavity formation and necrosis, and general malaise, pyrexia and lymphadenitis

absorbable suture material suture material broken down by tissue enzymes; loses 30% tensile strength within 14 days; fully absorbed within 90–120 days

absorbents agents that take up fluids, e.g. powders (i.e. starch, talc, kaolin), dressings (i.e. cotton wool, gauze swabs, perforated film dressings) or carrier media (i.e. glycerin)

acantholysis atrophy or detachment of the epidermal stratum spinosum, with intraepidermal blistering

acanthoma epidermal squamous cell hypertrophy, with local tumour formation

acanthosis increase in epidermal stratum spinosum thickness, characteristic of verrucae

acarbose adjunct treatment to oral hypoglycaemic agents in type 2 diabetes mellitus and to prevent postprandial hypoglycaemia in type 1 diabeties; delays carbohydrate digestion and absorption

accessory bones; accessory ossicles inconstant, independent, well-defined corticated bones occurring in 18–30% of normal feet, arising as separate centres of ossification and persisting as separate entities from adjacent constant bone (Table A1)

Table A1 Accessory bones in the foot

accommodative insole simple or casted orthosis made to minimize local plantar trauma

ACE inhibitor see angiotensin-converting enzyme inhibitor

acemetacin; Emflex an indometacin-derived non-steroidal anti-inflammatory drug

acetabular ligament the ligament between the head of the femur and the acetabulum

acetabulum cup-shaped depression formed at the junction of the ischium, ilium and pubis on the external surface of the pelvis into which the head of the femur fits

acetaminophen; N-acetyl-p-aminophenol; paracetamol a non-opioid analgesic with little or no anti-inflammatory action; first-line painkiller of choice; used with care in patients with hepatic or renal impairment, or alcohol dependency, or those taking metoclopramide; overdose causes severe liver damage and death; recommended adult dose: daily maximum of 4 g (i.e. 8 × 500 mg tablets) (see Table P3)

acetic acid constituent of some antimycotic paints

acetoacetic acid ketone body (see ketoacidosis)

acetonuria excretion of abnormal amounts of urinary acetone, characteristic of diabetic ketoacidosis

acetylcholine; ACh neurotransmitter liberated from pre- and postganglionic parasympathetic nerve endings, and from the preganglionic fibres of sympathetic nerve endings

acetylsalicylic acid aspirin

Achilles paratendinitis see Achilles tendinitis

Achilles tendinitis; Achilles paratendinitis Achilles tendon (tendo Achilles: TA) overuse syndrome; presenting in acute (<2 weeks’ duration), subacute (3–6 weeks’ duration) or chronic (>6 weeks’ duration) forms; treated by RICE(P) and immobilization; postacute-phase remobilization includes a heel raise (to reduce tendon traction), biomechanical assessment and orthoses as necessary to control identified foot/limb anomalies (e.g. true or functional rearfoot varus, forefoot varus, forefoot valgus, plantarflexed first ray, limb-length discrepancy); it predisposes to total or partial tendon rupture (see Achilles tendon rupture)

Achilles tendon; tendo Achilles; TA large posterior lower-leg tendon arising from the inferior margins of superior posterior muscle group and inserting into the middle one-third of the posterior aspect of the calcaneum; superficial fibres extend distally into the plantar heel area to blend with superficial plantar fascia fibres; TA dysfunction is associated with poor rearfoot function and posterior/plantar heel pain

Achilles tendon rotation see compromise of tibialis posterior (PTM) function

Achilles tendon rupture; TAR loss of TA continuity due to trauma or as the endpoint of untreated Achilles tendinitis, presenting as an acute, chronic or acute on chronic condition

achillorrhaphy surgical repair of the Achilles tendon

achillotomy percutaneous partial division of the Achilles tendon, to allow tendon lengthening by applied traction (forced dorsiflexion of the ankle), to increase ankle joint mobility, prolong heel contact during stance and decrease forefoot loading

achondroplasia autosomal-dominant congenital chondrodystrophy characterized by restricted limb growth but normal head and trunk size

acids compounds yielding hydrogen ions (H⁺) in polar solvents (e.g. water), of pH<7

acid-fast bacteria that retain acidic microbiological stains

acidosis pathophysical disorder characterized by hydrogen (H⁺) ion increase or base (OH⁻) loss, so that the tissue pH can no longer be maintained at 7.4

acitretin vitamin A derivative used in the treatment of severe, resistant psoriasis, Darier’s disease (keratosis follicularis) and ichthyosis

acne inflammatory, follicular, papular and pustular skin eruption with inflammation and infection of the sebaceous glands

acne vulgaris face, neck, upper back and chest acne occurring primarily during puberty and adolescence, but associated in young adult women with polycystic ovary syndrome

acquired non-congenital

acquired fibrokeratosis; garlic clove fibroma; Koenen’s tumour; acral fibromatosis small, flesh-coloured, garlic clove-shaped benign tumours arising from nail eponychial areas which may cause a local nail plate distortion; strongly associated with tuberose sclerosis (epiloia)

acquired immunity see immunity, acquired

acquired immunodeficiency syndrome see AIDS

acquired keratoderma hyperkeratotic skin lesions associated with the menopause (keratoderma climactericum), internal malignancy (acrokeratosis paraneoplastica/Bazex syndrome) or hypothyroidism

acquired melanocytic naevus benign junctional naevus of palmar and plantar skin; more common in black skin

acral of limb extremities

acral lentiginous melanoma aggressive (malignant) melanoma more common in black than white races, presenting as a flat pigmented lesion that gradually increases in size and becomes nodular

acrocephalopolysyndactyly see syndrome, Carpenter’s

acrocephalosyndactyly single-gene mutation causing craniosynostosis (premature fusion of skull bones), midface underdevelopment, variable degrees of learning difficulties and gross syndactyly or webbing of the fingers and toes (see syndrome, Apert’s; syndrome, Apert–Crouzon)

acrocyanosis benign circulatory persistently cold, cyanotic and sweaty hands (and to a lesser extent the feet) in cool temperatures (less marked in warmer conditions), commoner in young women; normal pulses; no trophic skin changes; mild presentations resemble chilblains

acrokeratosis paraneoplastica see syndrome, Bazex

acromegaly slowly progressive enlargement of glabellar ridges, nose, tongue, hands and feet over several years, due to excess growth hormone production; many acromegalics develop diabetes

acropachy see clubbing of the digits

acrosclerosis progressive digital sclerosis characteristic of severe Raynaud’s

ACTH adrenocorticotrophic hormone: see hormone, adrenocorticotrophic

actinic dermatitis see dermatitis, actinic

actinomycetoma; Madura foot Actinomycetoma, Nocardia and Streptomyces fungal infections, presenting as chronic inflammation and gross oedema of the foot; prevalent in Africa and India

actinomycin antibiotic agents isolated from Actinomyces species (Streptomyces) active against Gram-positive bacteria and fungi

action potential all-or-nothing response made by an excitable cell in response to a stimulus

activated charcoal charcoal, treated to increase its adsorptive properties, incorporated into wound dressings and insoles to absorb odours

active movement movement initiated and sustained by the individual (see passive movement)

actomyosin system of actin filaments and myosin particles forming muscle fibres that interact causing muscle contraction (see muscle contraction)

acupuncture therapeutic stimulation of specific meridians or channels by the application of fine needles to acupuncture points

acute arterial occlusion limb-threatening leg ischaemia due to arterial occlusion

acute compartment syndrome (ACS) see syndrome, acute compartment

acute dermatitis see dermatitis, acute

acute idiopathic polyneuritis see syndrome, Guillain–Barré

acute inflammation heat (calor), redness (rubor), swelling (tumor), pain (dolor) and loss of function, mediated by the release of inflammatory mediators in response to actual or threatened tissue trauma; inflammation initiates healing and restoration of the status quo

acute insulin deficiency see insulin

acute paronychia see paronychia

ad- movement toward

adactylous without fingers or toes

adalimumab cytokine inhibitor used to treat recalcitrant moderate or severe rheumatoid disease, psoriasis and ankylosing spondylitis, sometimes in conjunction with methotrexate

adaptation reducing responsiveness of cell surface receptors to repeated constant stimuli

add-on posts preformed corrective posts, as 2°, 3° or 4° angled wedges added to standardized orthoses

adduct movement toward sagittal plane, i.e. toward the midline of the body

adductor muscle drawing a part towards the sagittal plane; therefore adductor action of intrinsic foot muscles is described in relation to the sagittal plane of the foot

adductor brevis medial thigh muscle

adductor canal deep furrow on medial thigh between vastus medialis anteriorly and adductors magnus and longus posteriorly and overlain by sartorius; contains femoral vessels, saphenous nerve and nerve to vastus medialis

adductor hallucis intrinsic plantar muscle, within the fourth layer

origin two heads: oblique head (from sheath of peroneus longus tendon and bases of second, third and fourth metatarsals) and transverse head (from deep transverse metatarsal ligament and plantar ligaments of the capsules of the second, third, fourth and fifth metatarso-phalangeal joints)

insertion both insert into lateral head of flexor hallucis muscle

nerve supply deep branch of lateral plantar nerve

action oblique head adducts and flexes first metatarsophalangeal joint; transverse head accents transverse metatarsal arch; contraction of adductor hallucis tends to abduct the hallux in foot with metatarsus primus varus or incipient hallux abductovalgus

adductor longus medial thigh muscle

origin inferior ramus of pubis, and tuberosity and ramus of ischium

insertion into the linear aspera, medial supracondylar line and adductor tubercle of the femur

nerve supply anterior branch of obturator nerve

action with adductors longus and brevis and pectineus it adducts, extends and medially rotates the hip joint, stabilizing the hip, and preventing lateral hip tilt when standing on one leg

adductor magnus medial thigh muscle

origin from ischiopubic ramus and lower part of ischial tuberosity

insertion into posterior femur, from gluteal tuberosity to adductor tubercle; insertion is perforated (the adductor opening) allowing passage of femoral vessels

nerve supply anterosuperior part of the muscle is subserved by posterior branch of obturator nerve; inferior part is subserved by tibial branch of sciatic nerve

action with adductors longus and brevis and pectineus it adducts, extends and medially rotates the hip joint, stabilizing the hip and preventing lateral hip tilt when standing on one leg

adductovarus deformity positional first-ray anomaly; adduction of the first toe at the first metatarsophalangeal joint toward the midline of the body; associated with metatarsus adductus

adductus foot; atavistic foot foot with marked metatarsus primus varus and adduction of the lesser metatarsals (see Figure F3)

aden-; adeno- of a gland

adenitis inflammation of a lymph node or gland

adenosine nucleotide administered intravenously as part of advanced life support, to reverse paroxysmal supraventricular tachycardia

adenosine triphosphate; ATP; adenosine diphosphate; ADP intracellular biochemicals; ATP releases energy (to fuel intracellular reactions) when hydrolysed by enzymic action into ADP; ADP is later reconverted to ATP by energy-dependent enzymic reactions

ADH; antidiuretic hormone see hormone, antidiuretic

adhesive clinical padding semicompressed felt, urethane foams or fleece cut to specific shapes and affixed to the foot or an insole to realign and correct mobile deformity, deflect pressure from shoes or an adjacent toe, cushion, reduce shear and tensile stresses, or substitute for lost or atrophied tissues

adhesive plaster see Strapping

adhesive tendinopathy fibrosis of Achilles tendon paratendon with characteristic painful posterior muscle spasm on movement

adipose tissue loose areloar tissue containing high volumes of fat cells

adjuvant analgesics range of membrane-stabilizing drugs used to enhance analgesia and increase pain tolerance when conventional analgesics (paracetamol, codeine, tramadol, morphine) are non-effective; antidepressants (e.g. amitriptyline), anticonvulsants (e.g. gabapentin, carbamazepine), antiarrhythmics (e.g. lidocaine, mexiletine), N-methyl-d-aspartic acid (NMDA) antagonists (e.g. ketamine), centrally acting antihypertensives (e.g. clonidine)

adnexa skin appendages, e.g. hair, sweat glands, hair follicles

ADP see adenosine triphosphate; ATP; adenosine diphosphate; ADP

adrenal gland endocrine gland located at upper pole of each the kidney

adrenaline hormone produced by medulla of the adrenal gland; see epinephrine

adrenaline receptors cell membrane receptors reactive to adrenaline (Table A2)

Table A2 Effects of stimulation of alpha, beta and dopamine receptors

adrenergic (1) autonomic nerve cells/fibres (e.g. postganglionic sympathetic nerve endings) using adrenaline as their neurotransmitter

adrenergic (2) drugs that mimic sympathetic nervous system activity

adrenergic receptors tissue receptors that react to sympathomimetic drugs, e.g. adrenaline

adrenocorticoid hormones glucocorticoid, mineralocorticoid (aldosterone) and sex hormones (testosterone and oestrogen) secreted by the adrenal cortex under the influence of pituitary adrenocorticotrophic hormone

adrenocorticotrophin; adrenocorticotrophic hormone see hormone, adrenocorticotrophic

adrenolytic agents antagonistic to adrenaline (epinephrine), noradrenaline (norepinephrine) and other sympathomimetic agents

adsorbent a substance that allows gas, liquid or solids in suspension to attach to its surface without itself undergoing a chemical change

advanced glycation endproducts; AGEs formation of endproducts of non-enzymatic protein lipoproteins and nucleic acid glycosylation; exaggerated in old age, but accelerated in poorly controlled diabetes mellitus; AGEs accumulate in structural proteins (of ligaments, blood vessel walls, etc.) to compromise the microcirculation, especially within skin, vasa vasorum and vasa nervosum, contributing to the secondary complications of long-term diabetes, i.e. loss of joint mobility, neuropathy and ischaemia (see glycosylated haemoglobin; glycosylation)

advanced life support; ALS system of emergency life support and training extending beyond basic ABC (airway, breathing, circulation), including administration of emergency drugs and other life-saving measures

adventitious formed after birth

adverse drug reactions; ADRs un-intended and harmful effect of drug therapy, neither intended nor expected in normal therapeutic use (Table A3)

Table A3 Types of adverse drug reaction

aerobe oxygen-dependent organism

aerobic exercise physical exercises that enhance cardiovascular fitness

aerosol pressurized therapeutic agent forming a fine powder on release

aesthesio- sensation or perception

aesthesiometer device used to determine sensory threshold status (see monofilament; neuraesthesiometer; see Table M13)

aetiology cause of disease

afferent impulses nerve impulses conducted along sensory nerve fibres, from peripheral tissues towards the spinal cord and/or brain

AFS see ambulatory foot surgery

agar plate medium on which micro-organisms are cultured, and their sensitivity to antibiotics tested

age of consent adults (i.e. 18 years of age in UK, 21 years in other countries, e.g. USA) can give informed consent to a procedure or intervention (see consent); patients aged 16–18 years are considered able to give consent even though they have not reached their age of majority; consent in patients of <16 years of age is normally given by the parent or carer, in consultation with the patient

age spots see lentigo

agglutination clumping of cells or particles suspended within a medium

agglutinin an antibody that causes clumping of bacteria or other cells

aglet metal tag protecting the end of a shoe lace

agonist (1) prime mover, i.e. a muscle that generates sufficient force on contraction to overcome the resistance of its antagonist, so that resultant movement reflects concentric agonist contraction (see antagonist)

agonist (2) a drug that combines with cellular receptors to initiate drug reactions (see antagonist)

agranulocyte a non-granular leukocyte

agranulocytosis pronounced leukopenia (especially circulating polymorpho- nuclear leukocytes), e.g. due to chemotherapy or radiotherapy

AIDS; acquired immunodeficiency syndrome see syndrome, acquired immunodeficiency

ainhum; spontaneous dactylolysis a painful, constrictive, circumferential, fibrous band at the base of the fifth toe, with progressive ischaemia of the toe and eventual autoamputation of the digit

airborne transmission transmission of infection due to inhalation of clinical dust or deposition of aerosol fluids (e.g. infected skin squames, nail dust, fungal spores, blood, tissue fluid, lesion exudates and pus)

Aircast boot removable lower-limb bi-valve walking cast that allows ambulation whilst maintaining the foot in a non-weight-bearing condition

airway device used to maintain free passage or prevent obstruction of air through the respiratory tract

airway management maintenance of an open airway in a collapsed patient (head back, neck extended, lower jaw pulled forward) to allow air to enter the lungs (see basic life support)

akaryocyte non-nucleated cell, e.g. erythrocyte

Akin procedure excision of a medial wedge of bone from the hallux proximal phalanx to correct hallux phalangeus valgus, or to realign the hallux proximal phalanx with the head of the first metatarsal (and reduce the hallux valgus angle) see Fig S1

ALARA principle the principle governing exposure to ionizing radiation; exposure must always be ‘as low as is reasonably achievable’ to confirm the diagnosis

Albers–Schönberg disease see disease, Albers–Schönberg

albinism congenital inherited absence of pigmentation in skin, hair and eyes due to melanocyte dysfunction or deficiency

Albright’s disease see disease, Albright’s, Polyostotic fibrous dysplasia

albumin globular protein widely distributed throughout tissues; the principal plasma buffer protein

albuminuria see proteinuria

alcohol; ethanol; spirit ethyl alcohol (CH₃CH₂OH) used as a clinical solvent, medicament carrier (e.g. Betadine in spirit) and rapid-acting surface disinfectant

aldosterone adrenal mineralocorticoid hormone; causes retention of sodium (Na⁺) and excretion of unwanted potassium (K⁺) and hydrogen (H⁺) ions via urine

aldosterone antagonists see diuretics

aldosteronism excess aldosterone in blood, causing excess retention of Na⁺ and excess loss of K⁺ and H⁺ via the urine

algesiometer instrument to give an objective value to levels of pain experienced

alginate dressings hydrophilic wound dressings that absorb large volumes of wound exudate and maintain a moist wound interface without tissue maceration; indicated for highly exuding wounds (see Table D10)

algometer algesiometer

algorithm written set of structured and focused questions, the answers to which form a protocol for management of specific health care problems

alkali strongly basic substance yielding hydroxide (OH⁻) ions in solution, e.g. potassium hydroxide (KOH); sodium hydroxide (NaOH)

alkaline phosphatase an enzyme marker of bone formation; levels are raised in active Paget’s disease

alkalosis pathophysical disorder characterized by hydrogen (H⁺) ion loss or base (OH⁻) excess, so that the tissue pH can no longer be maintained at 7.4

‘all or nothing’ response nerve response to a stimulus; once threshold is reached, the action potential occurs; the action potential is always of the same magnitude

Allen’s test see test, Allen’s

allergen surface protein residues (e.g. on pollens, latex) that trigger an allergic response (e.g. hayfever, asthma, eczema, dermatitis, anaphylactoid reactions) in susceptible and hypersensitive individuals

allergic contact dermatitis; contact dermatitis acute inflammatory response provoked by contact with a trigger allergen, e.g. latex, non-hypo-allergenic adhesives, chemicals used in leather tanning

allergic reactions acute inflammatory skin hypersensitivity reaction (redness, tissue oedema, pruritus) induced by the histamine released from local mast cells in response to allergen contact in susceptible individuals (Table A4)

Table A4 Classification of types of hypersensitivity reactions

allergy acquired or induced hypersensitivity; after an initial non-reactive exposure to an allergen, the individual shows a hypersensitivity reaction at all subsequent exposures; re-exposure to the specific allergen evokes a predictable reaction within minutes or hours; acquired hypersensitivity to certain drugs and biological products may predict anaphylaxis at a subsequent exposure

allergy testing challenge by potentially allergenic substances (applied in varying dilutions to the skin of the back or the forearm) to determine specific hypersensitivity

allodynia pain induced by non-noxious stimuli; characteristic of painful neuropathy and complex regional pain syndrome (see syndrome, complex regional pain)

allograft tissue graft from a donor with a very similar/identical tissue type to the graft recipient

allopurinol drug used for long-term treatment of gout, in a daily dose proportional to disease severity (mild presentation: 100–200 mg; moderate to severe presentation: 300–600 mg; severe presentation: 700–900 mg); it is not indicated for asymptomatic hyperuricaemia

allylamine a group of fungicidal drugs which disrupt fungal cell wall formation, by inhibiting squalene epioxase activity (see terbinafine)

alopecia baldness; permanent or temporary hair loss

alpha-adrenoceptor-blocking drugs; alpha-blockers vasodilator and marked antihypertensive agents that block postsynaptic alpha-receptors (see phenoxybenzamine hydrochloride)

alpha fetoprotein (α-FP) maternal blood factor; important indicator of fetal neural tube defects

alpha-receptors adrenaline receptors (Table A2)

alternative therapies therapies (e.g. acupuncture, reflexology, aromatherapy, reiki massage, homeopathic remedies) found to be beneficial by some patients with chronic disease, the full therapeutic benefits or modes of action of which have not been fully evaluated in double-blind placebo-controlled clinical trials

aluminium acetate solution see Burow’s solution

aluminium chloride; Anhydrol Forte 20% aluminium chloride in alcohol, a strongly astringent agent used topically to treat hyperhidrosis

alveoli terminal dilatations of terminal branches of bronchioles; the site of gaseous exchange (oxygen in, carbon dioxide out)

Alzheimer’s disease see disease, Alzheimer’s

ambulatory foot surgery; AFS foot surgery predominantly carried out under local anaesthesia as a day-stay case

amelanotic melanoma neoplastic skin lesion not characterized by an increase in local skin pigmentation, and thus difficult to diagnose; characteristic of one-third of skin melanomas

American College of Rheumatology (ACR) guidelines system of diagnosis of rheumatological disease (Table A5)

Table A5 American College of Rheumatology diagnostic criteria of rheumatoid disease

American shoe size system see shoe sizes

amethocaine see tetracaine

amiloride see diuretics

amino acids ‘building blocks’ of globular and structural body proteins; essential amino acids cannot be synthesized within the body and must be supplied within the diet; non-essential amino acids can be synthesized by the body

aminoglycosides antibiotic agents active against some Gram-positive and many Gram-negative microorganisms, including Pseudomonas and Mycobacterium

aminosalicylates see sulfasalazine

amiodarone drug used to maintain normal heart rhythm after reversion of atrial fibrillation; side-effects include altered thyroid function, vision impairment (especially during night driving) and skin photosensitivity

amitriptyline tricyclic antidepressant drug used as an adjuvant analgesic for chronic pain states

amlodipine calcium channel-blocking agent with similar actions to nifedipine (see Table H17)

amnesia long-term memory disturbance, with total or partial inability to recall past experiences; characteristic of Alzheimer’s disease (see disease, Alzheimer’s)

amniocentesis analysis of a sample of amniotic fluid to determine the genetic status of the fetus

amorolfine; Loceryl antifungal agent presented as a nail lacquer for daily topical application for 6 weeks at the early stage of white superficial onychomycosis or where only one or two nails are infected, or used topically in conjunction with systemic antifungal medication in cases with widespread mycotic nail infection

amorphous hydrogels hydrophilic polymer paste wound dressings, used to rehydrate escharotic tissue and as a carrier medium for topical drugs, e.g. metronidazole (see Table D10)

amoxicillin penicillin antibiotic of similar action to ampicillin; usually administered as 250 mg by mouth every 8 hours (125 mg every 8 hours for a child) for soft-tissue infections

amphotericin B a nephrotoxic antibiotic used in the treatment of systemic thrush, some types of onychomycosis and leishmaniasis

ampicillin penicillin antibiotic effective against some Gram-positive and Gram-negative organisms but ineffective against penicillinase-secreting bacteria; as almost all staphylococci are resistant to ampicillin, it is not the drug of choice for ‘blind’ treatment of infection

ampoule hermetically sealed glass or plastic unit containing a sterile medicinal solution (e.g. local anaesthetic or adrenaline)

amputation surgical removal of part of a limb at a level determined by the tissue viability and healing potential of the created stump, and biomechanical function of the postamputation prosthesis; 50% of all lower-limb amputations in the UK occur as a complication of diabetes mellitus

amyelinated non-myelinated or unmyelinated

amyl nitrate vasodilatory drug (as sublingual tablets or spray) for treatment of angina pectoris

amyloid a group of chemically diverse proteins formed as pathological extracellular deposits in the walls of blood vessels; characteristic of amyloidosis

amyloidosis disease of unknown cause, characterized by the deposition of extracellular amyloid and resultant tissue dysfunction, e.g. reduced renal or lung function

amyotonia see myotonia

amyotrophic lateral sclerosis; ALS form of motor neurone disease characterized by progressive spastic limb paralysis due to corticospinal tracts deterioration, showing both upper and lower motor neurone lesion effects (see Table U4)

anabolism energy-dependent process of assimilation of nutritive material and its conversion into living tissue (opposite: catabolism)

anaemia condition characterized by reduced numbers of red blood cells (erythrocytes) per mm³ of blood, reduced haemoglobin, packed red blood cell volume and reduced blood oxygenation, so that patients with anaemia are characteristically pale and feel constantly tired; examples include:

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