Lab and Diagnostic Terms/Words For Medical Transcriptionists

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

Section B – Diagnostic Terms:

chest x-ray reveals: (one of the following below):

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

atrial fibrillation

beats per minute

left axis deviation

nonspecific ST-T wave changes

normal sinus rhythm

Common types of scans in medical reports:

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

portable chest x-ray

KUB

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