Intern Rulebook

Table of Contents

Table of Contents

• RULES of the game
• I. Game Components
• II. Prepare for Play
• III. Playing the Game
• IV. Admitting Patients
• V. Diagnosing Patients
• VI. Treating Patients
• VII. Consultations
• VIII. Being Paged
• IX. Setbacks
• X. Special Board Spaces
• XI. Ending the Game
• XII. Variations
• XIII. Three Player Version
• XIV. Two Player Version
• Intern's Glossary

RULES of the game

The object of this game is to be the first intern in the hospital to admit, diagnose and treat all of his department's patients with the least expenditure of time. The basic version of Intern is for four players. However, two or three players may play using the special rules on page 11.

I. Game Components

• Rules of Play folder (Intern Manual)
• 16" x 16" Mapboard, representing a large teaching hospital
• 4 Playing Pieces (tokens) representing interns from each of four departments (color-coded to departments on board)
• 2 Dice
• Time Scrip in denominations of 1, 3, 6 and 12 hours (24 each)
• 40 Page Cards
• 16 Patient Cards (4 for each department)
• 32 Diagnosis Cards (Dx Cards) (8 for each department)
• 40 Treatment Cards (Rx Cards) (10 for each department)

II. Prepare for Play

A. Each player chooses a Specialty and takes the appropriate playing piece (Medicine—Yellow, Surgery—Red, Gynecology—Green, Neurology—Blue) and all cards with backs of the corresponding color: four Patient Cards, eight Diagnosis Cards, and ten Treatment Cards.

B. Each player shuffles his Diagnosis Cards and places them face down in his orange Examination Room (right side of ward).

C. Each player shuffles his Treatment Cards and places them face down in his purple Treatment Room (left side of ward).

D. Page Cards are shuffled and placed face down in Central Paging.

E. Time Scrip is sorted into denominations and placed off-board at any convenient location. This is the Time Bank. Each player begins the game with 6 hours of Time Scrip from the Time Bank (one good night's rest).

F. Each player places any two of his four Patient Cards in his ward; these are admitted patients. The remaining two Patient Cards are placed in his Emergency Room (ER).

G. Each player takes his top Dx and Rx cards and places them in front of his ward. This represents his medical school education and, like other Dx and Rx cards obtained throughout game, may be used in management of patients admitted or transferred to his ward.

H. Medicine and Neurology interns place their playing pieces on the Medical entrance. Surgery and Gynecology interns place their playing pieces on the Surgical entrance.

III. Playing the Game

A. Players roll the dice and the highest throw goes first; turns proceed in a clockwise rotation.

B. Each player, in turn, throws the dice and moves his playing piece that number of spaces clockwise through the hospital corridor (marked by heavy black lines on board).

C. If a player rolls DOUBLES, he gets another roll of the dice.

D. Whenever a player passes his entrance (Medical entrance for Medicine and Neurology interns; Surgical entrance for Surgery and Gynecology interns), he receives 6 hours of Time Scrip. In addition, if an intern lands on either entrance, he must pick up a Page Card from Central Paging.

E. A player may admit, transfer, diagnose, treat, and discharge patients only during his own turn, at any time during his own turn.

IV. Admitting Patients

A. An intern must have an empty bed to admit a patient.

B. To admit a patient from his ER, the intern must land on one of Patient Spaces (spaces numbered 1-4 of the same color). He may then remit a number of hours equal to the number of the patient to the Time Bank and move that patient from his ER to one of the three beds in his ward. If an intern does not choose to admit the patient to his ward, or does not have an open bed available, he does nothing instead. He does not get another roll of the dice.

C. If an intern lands on one of his Patient Spaces corresponding to a patient previously admitted, he gets another roll of the dice.

D. The Page Card that says "Admit any patient free" can be used to admit any patient still in an Intern's ER. If the intern does not have any patients still in his ER, does not have an available bed, or does not choose to admit a patient, the card is discarded and no action is taken. No other card is drawn.

V. Diagnosing Patients

A. After a patient has been admitted, a diagnosis must be made by obtaining a Dx Card which pertains to his symptoms.

B. A Dx Card is obtained by landing on an orange diagnostic space (Chemistry, Radiology, Pathology). This entitles the intern to take the top Dx Card from his Examining Room in exchange for one hour of time rendered to the Time Bank. (See Rules X.C. and E.)

C. For each patient there are two relevant Dx Cards:

1.) One Dx Card leads to a diagnosis appropriate to the intern's own department (contains only one color triangle at top).

2.) The other Dx Card leads to a diagnosis of a problem more properly managed by another intern's department and entitles the intern to TRANSFER that patient to the other department (contains two different color triangles at top—the one on the right being the department the patient can be transferred to).

D. If a player has both cards for a patient, he can use either one during any turn.

E. A player may not use the TRANSFER Card to diagnose the patient himself. A player may not use the TRANSFER Card and then use another Dx Card to diagnose the patient himself. An intern may not use or TRANSFER Card once he has diagnosed the patient himself.

F. To establish a diagnosis, the appropriate Dx Card is obtained and placed on top of the Patient Card in the ward.

G. To TRANSFER a patient, the appropriate Dx Card is obtained and placed on top of the Patient Card and both cards are given to the receiving intern.

H. Dx Cards may be kept hidden from other players.

I. Dx Cards that apply to a patient already diagnosed, transferred, or expired are discarded when drawn. No action is taken and no other card may be drawn. If a player has both relevant Dx Cards for the same patient, once he plays one, he must discard the other.

VI. Treating Patients

A. After the patient has been admitted and diagnosed (or transferred), he must be correctly treated.

B. To treat a patient, the intern must obtain the Rx Card corresponding to the Dx Card already obtained.

C. An Rx Card is obtained by landing on a purple treatment space (Pharmacy, Dressing Room, Operating Room). This entitles the intern to take the top Rx Card from his Treatment Room in exchange for one hour of Time Scrip rendered to the Time Bank. (See Rules X.D. and E.)

D. To effect a treatment, the correct Rx Card is placed on the Patient Card and the Rx Card and all three are removed and kept for later scoring. The patient is thereby considered discharged.

E. Rx Cards may be kept hidden from other players.

F. Rx Cards that apply to a patient already discharged or transferred are discarded when drawn. No action is taken and no other card may be drawn.

VII. Consultations

A. If a player lands on any Patient Space within another intern's department, he is obliged to render CONSULTATION to that department.

B. The player must pay the intern of that department an amount of Time Scrip depending on the condition of the patient whose space he occupies:

1.) If the patient has been admitted—the number of hours indicated on the space.

2.) If the patient has been diagnosed or transferred—two times the number.

3.) If the patient has been discharged or not admitted—nothing.

C. CONSULTATION is rendered to each intern who has participated in the care of the patient. The intern who admitted and transferred the patient and the intern who the patient was transferred to both receive an amount equal to the patient's number. EXCEPTION: If a patient has been transferred, the receiving intern does not have to render CONSULTATION to the transferring intern.

D. If a player lands on a square where he would have to render CONSULTATION but the intern to whom the CONSULTATION would be rendered does not claim such CONSULTATION before the next player rolls the dice, the CONSULTATION is forfeit.

VIII. Being Paged

A. If an intern lands on a Page Space (beeper and intercom) or either hospital entrance, he is obliged to pick up the top Page Card and respond without delay, following the directions on the card.

B. After a Page Card is used, it is placed in a discard pile next to the unused Page Cards. When all Page Cards have been used (all are in the discard pile), the cards are reshuffled.

C. Page Cards are picked one at a time and acted upon one at a time. When an intern is required to pick more than one Page Card, he must act upon and resolve the first card before picking the second card.

D. If a card instructs an intern to advance to a space, he may collect hours if he passes his entrance. However, if the card instructs an intern to go back to a space, he may not collect hours if he passes his entrance. In either case, the action that would normally take place on the space he moves to is ignored.

E. SPECIAL PAGE CARDS: (Cards numbered as below.)

1. Complication Page Cards (four)—If an intern draws a Complication Page Card, he immediately gives the card to the specified intern who is obliged to admit the patient to his ward if he has an open bed. If the receiving intern does not have an available bed, the card is discarded and no action is taken. No other card is drawn. A Complication Patient, once admitted, functions as a diagnosed patient and must be treated and discharged. The Page Card is the (Complication) Patient Card.

2. Wild Turkey Card (one)—This card serves as a patient with complaints referrable to each of the four departments: dizziness, weakness, low back pain and dyspareunia. Since there is nothing objective found on physical examination or in-hospital studies, definitive diagnosis and therapy is not possible. If an intern draws the Wild Turkey, he is obliged to admit the patient if he has an open bed in his ward. If the intern does not have a free bed, the card is discarded and no action is taken. No other card is drawn. The Wild Turkey remains in the intern's ward until another intern lands on the Intercom Space, On-Call Room, Beeper Space or the Cafeteria Space, in which case that intern is then obliged to take the Turkey in transfer to his ward. However, if the potential receiving intern does not have an open bed, the transfer cannot be made. A player cannot end the game if he has the Wild Turkey in his ward. The Page Card is the (Wild Turkey) Patient Card.

3. Patient Re-Transfer (one)—The intern does not have to re-transfer a patient, but he may do so if he desires. If the intern has more than one transfer patient, he may choose which one to transfer. If the intern has no transfer patients, the card is held for possible future use.

4. Get Out of ICU Free (one)—The intern rolls the dice and moves that number of spaces out of the ICU. This card may be held for possible future use. (See Rule IX.A.)

5. Chronic Disposition Card (one)—This card functions like a Complication Card. If an intern draws this card he must immediately admit this patient to his ward if he has an open bed. If the intern does not have an available bed, the card is discarded and no action is taken. No other card is drawn. A Chronic Disposition patient, once admitted, functions as a diagnosed patient and must be treated and discharged. The Page Card is the (Chronic Disposition) Patient Card.

IX. Setbacks

A. If a player rolls three consecutive DOUBLES, he goes directly to the Intensive Care Unit (ICU)—Medicine and Neurology interns go to the Medical Intensive Care Unit (MICU), Surgery and Gynecology interns go to the Surgical Intensive Care Unit (SICU). His turn is over and he may not collect hours even if he passes his entrance on the way.

The player must remain in the ICU for three turns unless, on his next turn: 1) he can throw DOUBLES (in which case he immediately moves that number of spaces), 2) he has the "Get out of Intensive Care Unit Free" Card (in which case the intern rolls the dice and moves that number of spaces out of the ICU), or 3) he remits 6 hours of Time Scrip to the Time Bank (in which case he rolls the dice and moves that number of spaces). Players exit the ICU by the #3 patient space.

After three turns in the ICU, if an intern has not gotten out, he must remit the 6 hours of Time Scrip on the fourth turn and move normally. If he does not have the 6 hours of Time Scrip, he must stay in the ICU and MOONLIGHT until he has the 6 hours to remit (in which case he then pays it to the Time Bank and moves normally). While MOONLIGHTING, he can still throw the dice each turn and if he throws DOUBLES, he can move normally without remitting any Time Scrip earned MOONLIGHTING.

B. If a player rolls SKULL'S EYES (double ones), his most advanced patient expires and is removed to the hospital morgue (out of the game). The intern receives no credit for this patient. The most advanced patient is (in order): 1) a patient who has been diagnosed, 2) a patient who has been admitted, or 3) the patient with the highest number (1, 2, 3, or 4). Discharged, transferred or complication patients can never die. The Wild Turkey can only die if he is the intern's only remaining patient, including patients in the ER not yet admitted.

C. If a player cannot meet his obligations (does not have enough Time Scrip), he must MOONLIGHT and thereby forfeit subsequent turns. If he owes time to the hospital, he goes directly to his own ER and may not collect hours if he passes his entrance on the way. If he owes time to another intern, he goes directly to that player's ER and may not collect hours if he passes his entrance on the way.

When forced to MOONLIGHT, an intern earns 3 hours of Time Scrip for each turn forfeited. He must remain till he has fulfilled all his obligations, but must leave on the turn after this is accomplished. He exits the ER by the #4 patient space.

X. Special Board Spaces

A. CAFETERIA—If an intern lands on the Cafeteria Space he is obliged to spend one hour in Time Scrip (eating) or answer one Page (by TV monitor).

B. ON-CALL—If an intern lands on the On-Call Space he is obliged to spend three hours in Time Scrip (sleeping) or answer two Pages (by telephone).

C. DIAGNOSTIC AREAS—If an intern lands on any one of the three Diagnostic Spaces (colored orange—Chemistry, Radiology, and Pathology), he may remit one hour of Time Scrip to the Time Bank and draw one Dx Card from his department's Examining Room.

D. THERAPEUTIC AREAS—If an intern lands on any one of the three Therapeutic Spaces (colored purple—Pharmacy, Operating Room, and Dressing Room), he may remit one hour of Time Scrip to the Time Bank and draw one Rx Card from his department's Treatment Room.

E. DIAGNOSTIC & THERAPEUTIC AREAS—If an intern lands on one of the two Diagnostic & Therapeutic Spaces (colored orange and purple—Attending Rounds and Library), he may remit two hours of Time Scrip to the Time Bank and draw one Dx Card from his department's Examining Room and one Rx Card from his department's Treatment Room. Alternatively, he may remit just one hour and draw just one card.

XI. Ending the Game

A. A player may end the game when he has no patients left in either his ward or his ER.

B. At the conclusion of play, each intern adds up his score and the winner is the player with the highest score.

C. Points are awarded as follows:

• Total number of hours in Time Scrip accrued
• Patients discharged—three times the patient's number
• Patients transferred by you—two times the patient's number
• Patients transferred to you and discharged—the patient's number
• Complication patients discharged—four points
• Patient expired—minus ten points.
• Untreated complication patients—minus four points.
• Untreated patients (including transfers)—minus the patient's number
• Undiagnosed patients—minus two times the patient's number
• Patient remaining in the ER—minus three times the patient's number
• Wild Turkey in the ward—minus sixteen points
• = Total Number of Points

D. ACADEMIC ADVANCEMENT—Rendered as follows:

• 101 or more Points—Direct Faculty Appointment
• 76-100 Points—Chief Resident
• 51-75 Points—Senior Assistant Resident
• 31-50 Points—Junior Assistant Resident
• 21-30 Points—Repeat Internship
• 11-20 Points—Go Back to Medical School (do not collect hours on the way)
• 1-10 Points—Brush up on Premedical Studies
• 0 or less Points—Have you considered a career in the Humanities?

XII. Variations

After extensive play, players may wish to add one or more of the following rules to add variety to the game.

A. DIRTY TRICKS—

1. If a player lands on a space occupied by one or more other interns, he may employ one of the following dirty tricks:

   a. If the space is the Intercom Space, On-Call Room, Beeper Space, or Cafeteria Space, he may make the other intern (or one of the other interns) take one Page Card instead of taking one himself.

   b. If the space is a Dx Space, he may make the other intern (or one of the other interns) return one of his Dx Cards (the other intern's choice of which card to be returned) instead of taking one himself.

   c. If the space is a Rx Space, he may make the other intern (or one of the other interns) return one of his Rx Cards (the other intern's choice of which card to be returned) instead of taking one himself.

   d. If the space is a Dx/Rx Space, he may make the other intern (or one of the other interns) return one card (his choice as to whether the card is a Dx or Rx Card, but the other intern's choice as to the exact card of the chosen type) instead of taking one or two cards himself.

   e. If the space is any other space (except the ones mentioned in a-d above), the intern may send the other intern (or one of the other interns) to the ICU, or send the other intern six spaces backwards or forwards (in either case though, the other intern does not collect hours if he passes his entrance and the action that would normally take place on the space he moves to is ignored).

2. Dirty Tricks are always voluntarily employed. An intern may choose not to use them.

3. If the other intern does not have a card to lose (in cases b-d above), a dirty trick may not be employed.

4. A player who is about to be a victim of a dirty trick may bargain with the player who is employing the dirty trick against him.

   a. He may offer any amount of hours in Time Scrip which he has or any one or more of the following Page Cards (or a combination of the two): "Get Out Of ICU Free" or "Emergency Treatment" (if being used).

   b. Bargaining may also be in the form of a verbal agreement such as not to employ dirty tricks against each other for the remainder of the game. Of course, agreements of this sort may be broken at any time.

   c. Rx Cards, Dx Cards, and Page Cards other than those listed above may not be traded or used in bargaining.

B. OPTIONAL MOVEMENT—

Players roll the dice normally. However, players may now choose to move a number of spaces equal to either one of the dice or the total of the dice.

This rule will shorten the average time it takes to play the game.

C. ADMITTING PATIENTS—

If an intern lands on one of his Patient Spaces corresponding to a patient previously admitted, he may admit any other patient still in his ER instead. If he does not have a bed available, chooses not to admit a patient, or does not have any patient left in his ER, he gets another roll of the dice. If he does admit a patient, he does not get the extra roll of the dice.

D. OPTIONAL PREPARE FOR PLAY—

1. Each player receives 12 hours of Time Scrip at the beginning of the game (instead of the normal 6).

2. Each player may admit one or two of his patients to his ward to begin the game. Any of his four patients may be selected. The intern must remit to the Time Bank a number of hours two times the patient's number for each patient he admits. An intern may choose not to admit any patients and begin the game with his ward empty instead.

E. OPTIONAL SCORING—

1. The player who ends the game is automatically declared the winner. Points do not have to be counted.

   OR

2. The player who ends the game receives 24 hours of Time Scrip (one good day's rest) as a bonus for being the first intern to clear his ward of patients. Points are counted normally.

3. A player who is about to be a victim of a dirty trick may bargain with the player who is employing the dirty trick against him.

   a. He may offer any amount of hours in Time Scrip which he has or any one or more of the following Page Cards (or a combination of the two): "Get Out Of ICU Free" or "Emergency Treatment" (if being used).

   b. Bargaining may also be in the form of a verbal agreement such as not to employ dirty tricks against each other for the remainder of the game. Of course, agreements of this sort may be broken at any time.

   c. Rx Cards, Dx Cards, and Page Cards other than those listed above may not be traded or used in bargaining.

   d. If there are several players on a space, players may wish to offer the player who is about to employ a dirty trick a better deal than the other players so they will not be the victim.

XIII. Three Player Version

A. The three players are the Medicine, Surgery, and Gynecology interns.

B. When a player lands on a Patient Space of the non-playing intern's department (Neurology), he does not have to render CONSULTATION.

C. Patients transferred to non-playing intern's department are considered discharged five turns after transfer.

D. Remove the following cards from the game:

1.) Page Cards: "Additional lab data revises diagnosis. Transfer patient back to ward of origin." (Page card number 3). "Patient suffers acute left cerebrovascular accident. Transfer to Neurology." (Page card number 1-A)

2.) Medicine Department—Treatment Cards: Coma, Cystitis

3.) Surgery Department—Treatment Cards: Headache, Dementia

4.) Gynecology Department—Treatment Cards: Depression, Ascites

E. The Medical intern may not transfer his ASCITES patient. However, either Dx Card may be used to diagnose the patient in the intern's own ward.

F. The Gynecology intern may not transfer his CYSTITIS patient. However, either Dx Card may be used to diagnose the patient in the intern's own ward.

G. All other rules are the same as the basic four-player version.

XIV. Two Player Version

A. The two players are the Medicine and Surgery interns.

B. When a player lands on a Patient Space of a non-playing intern's department (Gynecology and Neurology), he does not have to render CONSULTATION.

C. Patients transferred to non-playing intern's departments are considered discharged five turns after transfer.

D. Remove the following cards from the game:

1.) Page Cards: "Additional lab data revises diagnosis. Transfer patient back to ward of origin." (Page card number 3) "Patient develops postmenopausal bleeding. Dx: endometrial cancer. Transfer to Gynecology." (Page card number 1-C) "Patient suffers acute left cerebrovascular accident. Transfer to Neurology." (Page card number 1-A)

2.) Medicine Department Cards—Treatment Cards: Coma, Gonorrhea, Cystitis

3.) Surgery Department Cards—Treatment Cards: Headache, Dementia, Amenorrhea

E. All other rules are the same as the basic four-player version.

Intern's Glossary

ADNEXAL MASS (ad-NEX-al): mass of the tubes or ovaries.

ALZHEIMER'S DISEASE (ALTS-hi-merz): pre-senile dementia.

AMENORRHEA (A-men-o-RE-ah): absence of menstruation.

ANTICONVULSANT (ant-i-con-VUL-sant): a drug that prevents seizures.

ANGINA PECTORIS (AN-ji-nah PECT-tor-is): a type of chest pain due to coronary artery disease.

AORTIC ANEURYSM (a-OR-tic AN-ur-iz-im): widening of the body's main artery due to weakness in its wall.

APPENDICITIS (a-pend-i-SIT-is): inflammation of the appendix.

ARTHRALGIA (arth-RAL-jah): pain in a joint.

ASCITES (as-SIT-ez): collection of fluid in the abdominal cavity.

BABINSKI SIGN (ba-BIN-ske): abnormal reflex brought out by stroking the sole, and indicative of central nervous system disease.

BLOOD UREA NITROGEN (BUN) (...u-RE-ah): indicator of kidney function, a chemical test.

CARCINOMA (car-si-NO-mah): cancer.

CARDIOVERSION (CAR-di-o-ver-shun): restoration of heart rhythm by means of electrical countershock.

CEREBRAL VEIN THROMBOSIS (ce-RE-bral van throm-BO-sis): clotting of a major vessel carrying blood from the brain.

CEREBROVASCULAR ACCIDENT (stroke) (CE-re-bro-vas-cu-lar...): rupture or blockage of any artery carrying blood to the brain.

CHRONIC PYELONEPHRITIS (...pi-lo-nef-RI-tis): longstanding, recurrent infection of the kidneys.

COMA: state of profound unconsciousness.

COMPUTED TOMOGRAPHY (CT) (to-MO-gra-fe): computer assisted X-ray technique that produces a cross-sectional image of the body.

CULDOCENTESIS (cul-do-sen-TEZ-is): aspiration of fluid from the cul-de-sac by needle puncture of the posterior vaginal wall.

CUTDOWN: surgical exposure of a blood vessel.

CYSTITIS (cist-I-tis): inflammation of the bladder.

DELIRIUM TREMENS (DT's) (de-LER-E-um TRE-menz): agitated state with sweating, tremor, restlessness and hallucinations due to alcohol withdrawal.

DEMENETIA (de-MEN-te-ah): general deterioration in mentation.

DIABETES MELLITUS (...mel-LIT-us): hereditary metabolic disorder caused by insufficient production of insulin with subsequent elevation of blood and urine sugar, weakness, thirst, and increased frequency of urination.

DIURETIC (di-u-RET-ic): a drug which increases urination.

DYSPAREUNIA (dis-pa-RU-ne-ah): painful sexual intercourse.

ECTOPIC PREGNANCY (ec-TOP-ic...): abnormal implantation of an ovum outside the uterine cavity.

EDROPHONIUM TEST (ed-ro-FO-ne-um...): pharmacologic test for the diagnosis of myasthenia gravis.

ELECTROENCEPHALOGRAPHY (EEG) (e-lec-tro-en-cef-al-OG-raf-e): recording of the electrical activity of the brain.

ENDOMETRIAL CARCINOMA (end-o-ME-tre-al): neoplasm derived from the membrane lining the uterus.

ESSENTIAL HYPERTENSION (hi-per-TEN-shun): elevation of the arterial blood pressure without known cause.

GALEN, CLAUDIUS (GA-len): Greek physician and experimental physiologist (130-201 AD) who practiced medicine in Rome, and wrote and theorized on many medical subjects. His teachings have been accepted as dogma for fourteen centuries.

GLYCOSURIA (gli-co-SU-re-a): presence of glucose in the urine.

GONORRHEA (gon-o-RE-ah): localized inflammation of the genital tract due to infection by the sexually transmissible Neisseria gonorrhea.

HALSTED, WILLIAM: American surgeon (1852-1922) who helped establish the foundations of modern surgery, and introduced the use of rubber gloves, block anesthesia, and residency training (Johns Hopkins).

HARVEY, WILLIAM: English physician/anatomist (1578-1657) who first discovered the circulation of the blood.

HEMIANOPSIA (hem-e-an-op-se-a): loss of vision in one half of the visual field.

HEMIPARESIS (hem-e-PAR-i-sis): paralysis of one half of the body.

HEPATITIS: inflammation of the liver, usually as a result of viral infection.

HERNIORRHAPHY (hern-e-OR-a-fe): surgical repair of a hernia.

HIPPOCRATES (hip-POC-cra-tez): Greek physician (460-361 BC) recognized as the "Father of Medicine" for freeing medicine from superstition and placing it on a scientific foundation; raised ethical standards. The Hippocratic Oath, derived from his Collections, is taken by every graduating physician today.

HYPOREFLEXIA (hi-po-re-FLEX-e-a): decreased deep tendon reflexes.

HYPOTHERMIA (hi-po-THERM-e-a): subnormal body temperature.

HYSTERECTOMY (his-ter-EC-to-me): surgical removal of the uterus.

INCARCERATED HERNIA (in-CAR-cer-a-ted...): protrusion of a loop of intestine through a weakening in the abdominal wall with subsequent obstruction to the movement of feces.

INTRAVENOUS PYELOGRAPHY (IVP) (in-tra-VE-nus pi-LOG-ra-fe): radiography of the urinary system following IV administration of a dye excreted in urine.

LAENNEC'S CIRRHOSIS (la-NEX si-RO-sis): degeneration, scarring and disorganization of liver tissue often associated with chronic alcoholism.

LAPAROTOMY (lap-a-ROT-o-me): incision through the abdominal wall for surgical exploration of the peritoneum.

MANIC-DEPRESSIVE PSYCHOSIS (...si-ko-sis): familial, organic psychiatric disorder characterized by exaggerated mood swings from increased psychomotor activity to severe depression.

MARFAN'S SYNDROME (MAR-fanz): hereditary condition characterized by tall stature, long slender fingers, and insufficiency of the aortic valve.

McBURNEY'S POINT: the point in the right lower quadrant (RLQ) of the abdomen where the tenderness of acute appendicitis is localized.

MEDIASTINUM (ME-de-as-TI-num): median dividing wall of thorax.

MEIG'S SYNDROME (mags sin-drom): fibromyoma (benign fibrous neoplasm) of the ovary with associated serous accumulation in the abdominal and thoracic cavities.

MIGRAINE (MI-gran): headache caused by vasoconstriction and subsequent dilatation of cranial vessels.

MITCHELL, SILAS WEIR: American physician (1829-1914) who was the founder and most eminent specialist in American Neurology. His contributions include the use of tendon reflexes, and studies on nerve injuries and reflex paralysis.

MULTIPLE MYELOMA (...mi-e-lo-mah): malignant neoplasm of bone marrow with abnormal proliferation of plasma cells and excess production of abnormal immunoglobulin proteins in serum and urine.

MYASTHENIA GRAVIS (mi-as-THEN-e-a GRAV-is): progressive autoimmune disease of the neuromuscular junction causing weakness worsened by fatigue.

MYELOGRAPHY (mi-el-OG-ra-fe): radiographic study of the spinal column following injection of a radiopaque substance into the spinal subarachnoid space.

MYOCARDIAL INFARCTION (mi-o-CAR-de-al in-FARK-shun) (heart attack): localized damage to heart muscle caused by obstruction of one or more coronary arteries.

NEOPLASM (NE-o-plas-im): new growth, i.e., tumor.

OLSER, SIR WILLIAM: American physician (1849-1919) who was an educator, a master of bedside physical diagnosis, and the author of "Principles and Practice of Medicine." Creator of the upper resident staff system (Johns Hopkins).

OOPHORECTOMY (o-OF-or-EK-to-me): surgical removal of the ovaries.

PAPILLEDEMA (pa-pil-e-DE-mah): swelling of the optic nerve visible on eye exam, often associated with brain swelling.

PALMAR ERYTHEMA (...er-i-THE-mah): redness of the palms of the hand, often seen in liver disease.

PARATHYROID ADENOMA (par-a-THI-roid a-de-NO-mah): benign neoplasm of the parathyroid gland resulting in increased secretion of parathormone and increased serum calcium.

PARATHYROIDECTOMY (par-a-THI-roid-ECT-o-me): surgical removal of the parathyroids.

PEDAL EDEMA: swelling of the ankles.

PELVIC INFLAMMATORY DISEASE (PID): infection of the female genital tract and peritoneum.

PITUITARY ADENOMA (pi-TU-i-ta-re ad-e-NO-mah): benign neoplasm of the pituitary gland causing visual and endocrine abnormalities.

PLASMACYTE (PLAS-ma-sit): bone marrow cell which synthesizes antibodies.

PLEURAL EFFUSION (PLU-ral ef-FU-shun): fluid accumulation within the serous membrane enveloping the lungs and lining the walls of the thoracic cavity.

POLYCYSTIC DISEASE OF THE OVARIES (Stein-Levinthal Syndrome) (pol-e-sis-tic): female ovarian disorder resulting in masculinization and infertility.

POSTPARTUM (post PART-um): following obstetrical delivery.

PREECLAMPSIA (pre-ek-LAMP-se-a): disorder of pregnant or postpartum women characterized by hypertension, edema and proteinuria; can lead to seizures.

PROTEINURIA (pro-ten-UR-e-a): presence of protein in the urine.

PUTAMENAL HEMORRHAGE (pu-TAM-in-al...): hypertensive stroke due to rupture of a small blood vessel in the putamen deep within the brain.

REPETITIVE NERVE STIMULATION: electrophysiologic test for myasthenia gravis.

SALPINGOTOMY (sal-pin-GOT-o-me): surgical removal of the Fallopian tubes.

S4 GALLOP: extra heart sound often associated with heart strain.

SEIZURE DISORDER (epilepsy, convulsions): focal or generalized body stiffness and shaking with loss of consciousness due to sudden discharge of cerebral neurons.

SELLA TURCICA (...TUR-si-kah): saddle-like prominence at the base of the skull which houses the pituitary.

SIMS, JAMES: American physician (1813-1833) who was the first specialist in the treatment of diseases peculiar to women. Founder of American gynecology. Contributions include introduction of the speculum, vesicovaginal fistula repair, and establishment of the first state hospital exclusively for women.

SPIDER ANGIOMA (...an-ji-o-mah): a small swelling on the surface of the skin due to dilatation of blood vessels commonly seen in hepatic disease.

SYDENHAM, SIR THOMAS: English physician (1624-1689) who was the greatest representative of practical medicine of his time. Bedside clinician known as the "English Hippocrates", his Collected Works are still applicable today.

SYRINGOMYELIA (si-ring-o-mi-EL-e-ah): degenerative disorder of the central portion of the spinal cord characterized by segmental loss of pain and temperature appreciation and muscular atrophy in the extremities.

THORACENTESIS (tho-ra-sen-TEZ-is): removal by needle aspiration of abnormal fluid accumulated within the thorax.

TRANSUDATE (TRANS-u-dat): fluid accumulated in a body cavity by filtration through a membrane.

THYMECTOMY (thim-EC-to-me): surgical removal of the thymus gland.

TRANSPHENOIDAL HYPOPHYSECTOMY (trans-fen-OY-dal): surgical removal of the pituitary approached nasally through the sphenoid bone.

URINE CHORIONIC GONADOTROPHIN (UCG) (...kor-e-ON-ic go-NAD-o-tro-fin): pregnancy test performed on urine.

VENIPUNCTURE (VEN-e-punct-ur): withdrawal of venous blood by needle for diagnostic examination.