Medical Assisting Review: Passing The

CMA, RMA, and CCMA Exam 7th

Edition Jahangir Moini
Visit to download the full and correct content document:
https://ebookmass.com/product/medical-assisting-review-passing-the-cma-rma-and-c
cma-exam-7th-edition-jahangir-moini/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Medical Assisting Review: Passing the CMA, RMA, and

CCMA Exams Jahangir Moini

https://ebookmass.com/product/medical-assisting-review-passing-
the-cma-rma-and-ccma-exams-jahangir-moini/

Mosbyu2019s Dental Assisting Exam Review E Book (Review

Questions and Answers for Dental Assisting) 3rd
Edition, (Ebook PDF)

https://ebookmass.com/product/mosbys-dental-assisting-exam-
review-e-book-review-questions-and-answers-for-dental-
assisting-3rd-edition-ebook-pdf/

Elsevier’s Veterinary Assisting Exam Review 1st Edition

Margi Sirois

https://ebookmass.com/product/elseviers-veterinary-assisting-
exam-review-1st-edition-margi-sirois/

Functional And Clinical Neuroanatomy. A Guide For

Health Care Professionals Jahangir Moini

https://ebookmass.com/product/functional-and-clinical-
neuroanatomy-a-guide-for-health-care-professionals-jahangir-
moini/
Medical Assisting-Administrative and Clinical
Procedures, 7e (Jan 6, 2020)_(1259608549)_(McGraw Hill)
7th Edition Booth

https://ebookmass.com/product/medical-assisting-administrative-
and-clinical-procedures-7e-jan-6-2020_1259608549_mcgraw-hill-7th-
edition-booth/

Lippincott Williams & Wilkins’ Clinical Medical

Assisting 5th Edition, (Ebook PDF)

https://ebookmass.com/product/lippincott-williams-wilkins-
clinical-medical-assisting-5th-edition-ebook-pdf/

CISSP Exam Certification Companion: 1000+ Practice

Questions and Expert Strategies for Passing the CISSP
Exam Mohamed Aly Bouke

https://ebookmass.com/product/cissp-exam-certification-
companion-1000-practice-questions-and-expert-strategies-for-
passing-the-cissp-exam-mohamed-aly-bouke/

The PA Rotation Exam Review First Edition

https://ebookmass.com/product/the-pa-rotation-exam-review-first-
edition/

CISSP Exam Certification Companion: 1000+ Practice

Questions and Expert Strategies for Passing the CISSP
Exam (Certification Study Companion Series) 1st Edition
Bouke
https://ebookmass.com/product/cissp-exam-certification-
companion-1000-practice-questions-and-expert-strategies-for-
passing-the-cissp-exam-certification-study-companion-series-1st-
 MEDICAL ASSISTING

REVIEW
Passing the CMA, RMA, CCMA, and NCMA Exams
SeventhEdition

Jahangir Moini, M.D., M.P.H.

Former Professor and Director of Allied Health Sciences including the
Medical Assisting Program, Everest University, Melbourne, Florida; and
Retired Professor of Science and Health, Eastern Florida State College,
Palm Bay, Florida

ISTUDY
 Final PDF to printer

MEDICAL ASSISTING REVIEW

Published by McGraw Hill LLC, 1325 Avenue of the Americas, New York, NY 10121. Copyright © 2022
by McGraw Hill LLC. All rights reserved. Printed in the United States of America. No part of this
publication may be reproduced or distributed in any form or by any means, or stored in a database or
retrieval system, without the prior written consent of McGraw Hill LLC, including, but not limited to, in
any network or other electronic storage or transmission, or broadcast for distance learning.

Some ancillaries, including electronic and print components, may not be available to customers outside
the United States.

This book is printed on acid-free paper.

1 2 3 4 5 6 7 8 9 LOV 26 25 24 23 22 21

ISBN 978-1-260-59793-6
MHID 1-260-59793-8

Cover Image: ra2studio/Shutterstock

All credits appearing on page or at the end of the book are considered to be an extension of the
copyright page.

The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a
website does not indicate an endorsement by the authors or McGraw Hill LLC, and McGraw Hill LLC
does not guarantee the accuracy of the information presented at these sites.

mheducation.com/highered

ISTUDY moi97938_fm_ise.indd ii 10/16/20 11:49 AM

 ABOUT THE AUTHOR

Dr. Moini was assistant professor at Tehran University School of Medicine for nine years, teaching medical and allied health stu-
dents. The author was a professor and former director (for 24 years) of allied health programs at Everest University. Dr. Moini rees-
tablished the Medical Assisting Program in 1990 at Everest University’s Melbourne campus. He also established several other new
allied health programs for Everest University. He is now a retired professor of science and health at Eastern Florida State College.
Dr. Moini was a physician liaison for the Florida Society of Medical Assistants 2000–2008. He has been a marketing strategy
team member of the National AAMA and president of the Brevard County chapter of the AAMA. He is the author of 43 published
textbooks since 1999. His book entitled “Anatomy & Physiology for Health Professionals” has been translated into Japanese and
South Korean, and released in those countries.

Dedication
To the memory of my Mother,
and
To my wonderful wife, 
Hengameh, my two daughters, 
Mahkameh and Morvarid, 
and also to my precious granddaughters, 
Laila Jade and Anabelle Jasmine Mabry.

ISTUDY
 BRIEF TABLE OF CONTENTS

Preface ix
SECTION 1 General Medical Assisting Knowledge 1
Chapter 1 The Profession of Medical Assisting 2
Chapter 2 Medical Terminology 12
Chapter 3 Anatomy and Physiology 42
Chapter 4 Pathophysiology 75
Chapter 5 Microbiology 92
Chapter 6 General Psychology 104
Chapter 7 Nutrition and Health Promotion 114
Chapter 8 Medical Law and Ethics 126
SECTION 2 Administrative Medical Assisting Knowledge 160
Chapter 9 Reception, Correspondence, Mail, Telephone Techniques, and Supplies 161
Chapter 10 Appointments, Scheduling, Medical Records, Filing, Policies, and Procedures 180
Chapter 11 Communication in the Medical Office 192
Chapter 12 Keyboarding and Computer Applications 202
Chapter 13 Financial Management 212
Chapter 14 Medical Insurance 233
Chapter 15 Medical Coding 249
SECTION 3 Clinical Medical Assisting Knowledge 284
Chapter 16 Blood-Borne Pathogens and Principles of Asepsis 285
Chapter 17 Preparing the Patient 296
Chapter 18 Vital Signs and Measurement 316
Chapter 19 Pharmacology 326
Chapter 20 Administration of Medication 352
Chapter 21 Electrocardiography 370
Chapter 22 Diagnostic Imaging 381
Chapter 23 Promoting Healing After an Injury 391
Chapter 24 Medical Emergencies and First Aid 403
Chapter 25 Clinical Laboratory 421
PRACTICE EXAMS 471
Practice Exam 1 - CMA 472
Practice Exam 2 - RMA 485
Practice Exam 3 - CCMA 496
Practice Exam 4 - NCMA 504
ANSWER KEYS TO END OF CHAPTER QUESTIONS 514
ANSWER KEY TO TEST YOUR KNOWLEDGE 522
ANSWER KEY TO PRACTICE EXAM 524
INDEX 527

iv
ISTUDY
 TABLE OF CONTENTS

Preface ix 3.9 Sensory System 57

3.10 Cardiovascular System 59
3.11 Respiratory System 64
Section 1 General Medical Assisting
Knowledge 1 3.12 Digestive System 65

Chapter 1 – The Profession of Medical 3.13 Endocrine System 67

Assisting 2 3.14 Urinary System 68
1.1 The Profession of Medical Assisting 3 3.15 Reproductive System 70
1.2 Membership in a Medical Assisting Chapter 3 Review 73
Association 4 Chapter 4 – Pathophysiology 75
1.3 Medical Assisting Credentials 4 4.1 Mechanisms of Disease 76
1.4 CMA and RMA Exam Topics 5 4.2 Immunology 76
1.5 Certified Clinical Medical  4.3 Hereditary and Congenital Diseases 
Assistant (CCMA) Examination 6 and Conditions 77
1.6 National Certified Medical  4.4 Neoplasia 78
Assistant (NCMA) Examination 6
4.5 Common Infectious Diseases 80
1.7 Externships 6
4.6 Major Diseases and Disorders 80
1.8 Preparing for Employment 7
Chapter 4 Review 90
Chapter 1 Review 9
Chapter 5 – Microbiology 92
Chapter 2 – Medical Terminology 12
5.1 Microorganisms 93
2.1 Word Building 13
5.2 Microbial Growth 96
2.2 Spelling 17
5.3 Microbes and the Human Body 96
2.3 Common Medical Abbreviations 18
Chapter 5 Review 102
2.4 Medical Terminology in Practice 21
Chapter 6 – General Psychology 104
2.5 Unacceptable Abbreviations 38
6.1 Basic Principles 105
Chapter 2 Review 40
6.2 Motivation and Emotion 105
Chapter 3 – Anatomy and Physiology 42
6.3 Personality 105
3.1 Levels of Organization 43
6.4 Humanistic Theory of Personality 106
3.2 Cell Structure 44
6.5 Behavioral/Learning Theory of Personality 107
3.3 Chemistry 45
6.6 Psychological Disorders 108
3.4 Tissues of the Body 46
6.7 Aging and Dying 109
3.5 Division Planes and Body Cavities 47
6.8 Grief 110
3.6 Integumentary System 48
6.9 Promoting Health and Wellness 110
3.7 Musculoskeletal System 49
6.10 Substance Abuse 110
3.8 Nervous System 54
Chapter 6 Review 111

ISTUDY
 Chapter 7 – Nutrition and Health Promotion 114 11.2 The Communication Cycle 193
7.1 Nutrition 115 11.3 Types of Communication 194
7.2 Water 115 11.4 Improving Your Communication Skills 194
7.3 Carbohydrates 115 11.5 Communicating in Special Circumstances 196
7.4 Lipids 115 11.6 Communicating with 
7.5 Protein 116 Coworkers and Superiors 198
7.6 Vitamins 116 11.7 Managing Stress and Preventing Burnout 198
7.7 Minerals 118 11.8 The Policy and Procedures Manual 198
7.8 Nutrition and Diet Needs 119 Chapter 11 Review 200
7.9 Food-Related Diseases 122 Chapter 12 – Keyboarding and Computer
Chapter 7 Review 123 Applications 202
Chapter 8 – Medical Law and Ethics 126 12.1 The Computer Revolution 203

8.1 Law 127 12.2 Types of Computers 203

8.2 The Law and Medicine 129 12.3 Computer Systems 203

8.3 Ethics 135 12.4 Using Computer Software 206

8.4 Death and Dying 137 12.5 Security in the Computerized Office 208
Chapter 8 Review 138 12.6 Computer System Care and Maintenance 208
Section 1 CMA Review 141 12.7 Computers of the Future 209
Section 1 RMA Review 144 Chapter 12 Review 210
Section 1 CCMA Review 146 Chapter 13 – Financial Management 212
Section 1 NCMA Review 148 13.1 Purchasing 213
Section 1 Test Your Knowledge – General 151 13.2 Accounting 215
13.3 Banking for the Medical Office 219
Section 2 Administrative Medical 13.4 Billing and Collections 222
Assisting Knowledge 160
13.5 Accounts Payable 224
Chapter 9 – Reception, Correspondence, Chapter 13 Review 231
Mail, Telephone Techniques,
and Supplies 161 Chapter 14 – Medical Insurance 233
9.1 Reception 162 14.1 Medical Insurance Terminology 234

9.2 Managing Correspondence and Mail 162 14.2 Types of Health Insurance 235
9.3 Telephone Techniques 173 14.3 Types of Health Plans 236
9.4 Supplies and Equipment in the  14.4 Determination of Benefits 240
Medical Office 175 14.5 Claims Processing 240
9.5 Travel Arrangements 176 Chapter 14 Review 246
9.6 Patient Education 176 Chapter 15 – Medical Coding 249
Chapter 9 Review 177 15.1 Data and Billing Basics 250
Chapter 10 – Appointments, Scheduling, 15.2 Basic Coding 251
Medical Records, Filing, Policies,
15.3 Diagnosis Codes: The ICD-10-CM 251
and Procedures 180
15.4 Procedure Codes 255
10.1 Appointments and Schedules 181
15.5 Comparison of ICD-9-CM 
10.2 Medical Records and Filing 184
and ICD-10-CM 257
10.3 Policies and Procedures 188
15.6 HCPCS 257
Chapter 10 Review 189
15.7 Avoiding Fraud 257
Chapter 11 – Communication in the
Medical Office 192 Chapter 15 Review 260

11.1 Communicating with Patients  Section 2 CMA REVIEW 263

and Families 193 Section 2 RMA REVIEW 266

vi TA BL E OF C ON T E N T S
ISTUDY
 Section 2 CCMA REVIEW 269 20.2 Measuring Medication 
Section 2 NCMA REVIEW 272 and Dosage Calculations 354
Section 2 Test Your Knowledge –  20.3 Methods of Administering Medications 357
Administrative 275 20.4 Setting Up Medications 362
20.5 Vaccinations 362
Section 3 Clinical Medical Chapter 20 Review 367
Assisting Knowledge 284
Chapter 21 – Electrocardiography 370
Chapter 16 – Blood-Borne Pathogens and
Principles of Asepsis 285 21.1 The Electrical System of the Heart 371

16.1 Blood-Borne Pathogens 286 21.2 The Electrocardiograph 372

16.2 Medical and Surgical Asepsis 288 21.3 Other Tests 376

16.3 OSHA Requirements 290 21.4 Other Heart Conditions 

and Procedures 377
Chapter 16 Review 293
Chapter 21 Review 378
Chapter 17 – Preparing the Patient 296
Chapter 22 – Diagnostic Imaging 381
17.1 Patient Rights, Responsibilities, 
and Privacy 298 22.1 Terminology 382

17.2 Medical Interview 298 22.2 Types of Diagnostic Imaging 383

17.3 Physical Examination 299 22.3 Therapeutic Uses of Radiation 385

17.4 Minor Surgery 308 22.4 Medical Assistant’s Role 385
Chapter 17 Review 313 22.5 Safety and Storage 387
Chapter 18 – Vital Signs and Measurement 316 Chapter 22 Review 388
18.1 Vital Signs 317 Chapter 23 – Promoting Healing
After an Injury 391
18.2 Body Measurements 322
23.1 Terminology 392
Chapter 18 Review 324
23.2 Patient Assessment 393
Chapter 19 – Pharmacology 326
23.3 Treatment 393
19.1 General Pharmacology Terms and 
Concepts 327 23.4 Mobility-Assisting Devices 396
19.2 Drugs and Their Effects 330 Chapter 23 Review 400
19.3 Drug Administration 337 Chapter 24 – Medical Emergencies
19.4 Antibiotics 337 and First Aid 403
24.1 Emergencies 404
19.5 Pharmacology of the Integumentary
System 340 24.2 Handling Emergencies 404
19.6 Pharmacology of the Musculoskeletal  24.3 Injuries Caused by Extreme 
System 340 Temperatures 405
19.7 Pharmacology of the Nervous System 340 24.4 Burns 407
19.8 Pharmacology of the Cardiovascular  24.5 Wounds 408
System 345 24.6 Bites and Stings 410
19.9 Pharmacology of the Respiratory System 346 24.7 Orthopedic Injuries 411
19.10 Pharmacology of the Digestive System 346
24.8 Head and Related Injuries 411
19.11 Pharmacology of the Endocrine System 348
24.9 Diabetic Emergencies 411
19.12 Pharmacology of the Sensory System 348
24.10 Cardiovascular Emergencies 412
19.13 Pharmacology of the Urinary System 348
24.11 Respiratory Emergencies 416
19.14 Pharmacology of the Reproductive 
24.12 Digestive Emergencies 416
System 349
Chapter 19 Review 350 24.13 Reproductive System Emergencies 416

Chapter 20 – Administration of 24.14 Poisoning 417

Medication 352 24.15 Bioterrorism 417
20.1 Drug Classifications 354 Chapter 24 Review 418

ISTUDY
 Chapter 25 – Clinical Laboratory 421 Practice Exams 471
25.1 Collecting and Testing Blood 423 Practice Exam 1 - CMA 472
25.2 Collecting and Testing Urine 437 Practice Exam 2 - RMA 485
25.3 Medical Microbiology 443 Practice Exam 3 - CCMA 496
Chapter 25 Review 448 Practice Exam 4 - NCMA 504
Section 3 CMA Review 450 Answer Keys to End of Chapter Questions 514
Section 3 RMA Review 453
Answer Key to Test Your Knowledge 522
Section 3 CCMA Review 456
Section 3 NCMA Review 459 Answer Key To Practice Exam 524

Section 3 Test Your Knowledge – Clinical 462 Index 527

v i i i TA BL E OF C ON T E N T S
ISTUDY

PREFACE
Catching your success has never been easier, with the sixth edition of Medical Assisting Review: Passing the CMA, RMA, CCMA, and
NCMA Exams. Confidently master the competencies you need for certification with a user-friendly approach and various practice
exams.
Organization
Medical Assisting Review is divided into three sections,
similar to how the certification exams are divided: General
Medical Assisting Knowledge (Chapters 1–8); Ad​ministra-
tive Medical Assisting Knowledge (Chapters 9–15); and
Clinical Medical Assisting Knowledge (Chapters 16–25). Each
chapter opens with Learning Outcomes to set the stage for the
content to come. That list is followed by a table listing the
relevant CMA, RMA, CCMA, and NCMA Medical Assisting
Competencies for that chapter. Throughout the chapters, you
will find At A Glance tables that summarize key information for
quick review. At the beginning and end of most chapters, there
are also Strategies for Success boxes, which contain tips on study
skills and test-taking skills. Each chapter then closes with the
Chapter Review—10 multiple-choice questions written in the style
of CMA, RMA, CCMA, and NCMA exam questions.
New to the Seventh Edition
OVERVIEW
A number of enhancements have been made with the sixth edi-
tion to enrich the user’s experience with the product:
• The Chapter Reviews, at the end of each chapter, have
additional questions so that they now have 25 questions
each instead of 10.
• This edition has many new figures that did not appear
previously.
ISTUDY moi21793_fm_i-xvi.indd ix
Rev. Confirming Pages
• At the end of each section, there is a new Test Your
Knowledge feature that contains 100 multiple choice
questions. The Answer Key for each of these is at the
end of the book.
• There are four exams included at the back of the book.
The existing exams have all been updated to reflect new
material in the chapters, and all of the exams have gone
through an accuracy review.
CHAPTER HIGHLIGHTS
Definitions have been expanded and added in every chapter in
direct response to market feedback:
• Chapter 4: Information has been added about Zika virus
disease and Ebola virus disease.
• Chapter 11: The rules or guidelines that determine the
daily working of an office have been removed from the
section entitled “The Policy and Procedures Manual.”
• Chapter 12: A new section has been added that is called
“Cell Phones and the Internet.”
• Chapter 13: A “W-9” form has been added.
• Chapter 15: A new introduction to medical coding has
been added, and there has been a large amount of updat-
ing and revisions in this chapter.
• Chapter 19: Drug information has been completely
updated.
11/22/21 12:46 PM
 • Chapter 20: Immunization schedules have been
updated. Information on the Coronavirus (COVID-19)
has been added.
• Chapter 23: This chapter has been retitled as “Promoting
Healing After an Injury”; it was previously called
“Physical Therapy.”
For a detailed transition guide between the sixth and seventh
editions for all chapters of Medical Assisting Review, visit the
Instructor Resources in Connect.
Medical Assisting Review Preparation in the Digital World:
Supplementary Materials for the Instructor and Student
Instructor Resources
You can rely on the following materials to help you and your
students work through the material in this book. All of the
resources in the following table are available through the
Instructor Resources on the Library tab in Connect.

Supplement Features
Instructor’s Manual Each chapter has:
• Learning Outcomes and Lecture Outline
• Overview of PowerPoint Presentations
• Teaching Strategies
• Answer Keys for End-of-Chapter Questions and two Practice Exams from the back of the book
• List of Additional Resources
PowerPoint Presentations • Key Concepts
Electronic Test Bank • TestGen (computerized)
(Two Practice Exams) • Word version
• These two exams are also available in the Library tab of Connect. Both of them, along with 12
additional exams, are available within Connect.
• Questions are tagged with learning outcomes, level of difficulty, level of Bloom’s taxonomy,
feedback, and ABHES and CAAHEP competencies.
Tools to Plan Course • Transition Guide, by chapter, from Moini, 6e, to Moini, 7e
• Correlations of the chapters to the major accrediting bodies (previously included in the book),
as well as correlations by learning outcomes to ABHES and CAAHEP
• Sample Syllabi
• Asset Map—a recap of the key instructor resources, as well as information on the content avail-
able through Connect

A few things to note:
• All student content is now available to be assigned
through Connect.
• Instructors can share the answer keys and test bank
exams available through the Instructor Resources at
their discretion.
Need help? Contact McGraw-Hill’s Customer Experience
Group (CXG). Visit the CXG website at www.mhhe.com/
support. Browse our FAQs (frequently asked questions) and
product documentation and/or contact a CXG representative.
CXG is available Sunday–Friday.
Practice Medical Office
Practice Medical Office is a 3-D immersive game that features 12
engaging and challenging modules representing the functional
areas of a medical practice: Administrative Check In, Clinical,
and Administrative Check Out. As the players progress through
each module, they will face realistic situations and learning
events, which will test their mastery of critical job-readiness
skills and competencies such as professionalism, soft skills,
office procedures, application of medical knowledge, and appli-
cation of privacy and liability regulation. An ideal way to engage,
excite, and prepare students to be successful on the job, Practice
Medical Office is available for use on tablets and computers.
It is perfect for the capstone Medical Assisting Examination
Preparation course, and Externship course, or may be used
throughout the Medical Assisting program. PMO is accessible
through a widget in Connect. For a demo of Practice Medical
Office, please go to http://www.mhpractice.com/products/
Practice_Medical_Office and click on “Play the Demo.”
Best-in-Class Digital Support
Based on feedback from our users, McGraw-Hill Education has
developed Digital Success Programs that will provide you and
your students the help you need, at the moment you need it.
• One-to-One Training: Get ready to drive classroom
results with our Digital Success Team—ready to provide
in-person, remote, or on-demand training as needed.
• Peer Support and Training: No one understands your
needs like your peers. Get easy access to knowledgeable

x PR E FAC E
ISTUDY
 digital users by joining our Connect Community, or Get started today. Learn more about McGraw-Hill Education’s
speak directly with one of our digital faculty consultants. Digital Success Programs by contacting your local sales
• Online Training Tools: Get immediate anytime, any- representative.
where access to modular tutorials on key features
through our Connect Success Academy at www.mhhe
.com/support.

Remote Proctoring & Browser-Locking Capabilities

New remote proctoring and browser-locking capabilities, hosted by Proctorio within Connect, provide control of the assessment envi-
ronment by enabling security options and verifying the identity of the student.
Seamlessly integrated within Connect, these services allow instructors to control students’ assessment experience by restricting
browser activity, recording students’ activity, and verifying students are doing their own work.
Instant and detailed reporting gives instructors an at-a-glance view of potential academic integrity concerns, thereby avoiding per-
sonal bias and supporting evidence-based claims.

ISTUDY
 Instructors: Student Success Starts with You
Tools to enhance your unique voice
Want to build your own course? No problem. Prefer to use our
turnkey, prebuilt course? Easy. Want to make changes throughout the
65%
Less Time
semester? Sure. And you’ll save time with Connect’s auto-grading too.
Grading

Study made personal

Incorporate adaptive study resources like
SmartBook® 2.0 into your course and help your
students be better prepared in less time. Learn
more about the powerful personalized learning
experience available in SmartBook 2.0 at
www.mheducation.com/highered/connect/smartbook

Laptop: McGraw Hill; Woman/dog: George Doyle/Getty Images

Affordable solutions, Solutions for

added value your challenges
Make technology work for you with A product isn’t a solution. Real
LMS integration for single sign-on access, solutions are affordable, reliable,
mobile access to the digital textbook, and come with training and
and reports to quickly show you how ongoing support when you need
each of your students is doing. And with it and how you want it. Visit www.
our Inclusive Access program you can supportateverystep.com for videos
provide all these tools at a discount to and resources both you and your
your students. Ask your McGraw Hill students can use throughout the
representative for more information. semester.

Padlock: Jobalou/Getty Images Checkmark: Jobalou/Getty Images

ISTUDY
 Students: Get Learning that Fits You
Effective tools for efficient studying
Connect is designed to make you more productive with simple, flexible, intuitive tools that maximize your
study time and meet your individual learning needs. Get learning that works for you with Connect.

Study anytime, anywhere “I really liked this

Download the free ReadAnywhere app and access your app—it made it easy
online eBook or SmartBook 2.0 assignments when it’s to study when you
convenient, even if you’re offline. And since the app don't have your text-
automatically syncs with your eBook and SmartBook 2.0
assignments in Connect, all of your work is available book in front of you.”
every time you open it. Find out more at
www.mheducation.com/readanywhere - Jordan Cunningham,
Eastern Washington University

Everything you need in one place

Your Connect course has everything you need—whether reading on your
digital eBook or completing assignments for class, Connect makes it
easy to get your work done.

Calendar: owattaphotos/Getty Images

Learning for everyone

McGraw Hill works directly with Accessibility Services
Departments and faculty to meet the learning needs
of all students. Please contact your Accessibility
Services Office and ask them to email
accessibility@mheducation.com, or visit
www.mheducation.com/about/accessibility
for more information.
Top: Jenner Images/Getty Images, Left: Hero Images/Getty Images, Right: Hero Images/Getty Images

ISTUDY
 ACKNOWLEDGMENTS

Suggestions have been received from faculty and students throughout the country. This is vital feedback that is relied on for product
development. Each person who has offered comments and suggestions has our thanks. The efforts of many people are needed to
develop and improve a product. Among these people are the reviewers and consultants who point out areas of concern, cite areas of
strength, and make recommendations for change. In this regard, the following instructors provided feedback that was enormously
helpful in preparing the manuscript.

PREVIOUS EDITION REVIEWERS Cheryl Kolar, AS in HS, RMA, LPN

Cecil College
Many instructors have attended focus groups or reviewed the
Sarah Kuzera, BS, AAS, CMA (AAMA)
manuscript while it was in development, providing valuable feed- Bryan Career College
back that has directly impacted the last six editions.
Angela LeuVoy, AAMA, CCMA, CMA, CMRS
Elizabeth Cason, CPC, CDC, CMA Fortis College
Centura College
Lynnae Lockett, RMA, CMRS, RN
Cheryl Kolar, AS in HS, RMA, LPN Bryant and Stratton College
Cecil College
Marta Lopez, MD, LM, CPM, RMA, BMO
Sarah Kuzera, BS, AAS, CMA (AAMA) Miami Dade College
Bryan University Carrie A. Mack, AS, CMA (AAMA)
Melissa Rub, CMA (AAMA) Branford Hall Career Institute
Rasmussen College Lori Mikell, RMA, AHI
Jodi Wyrick, MBA, BBA, CMA (AAMA) Ridley-Lowell Business and Technical Institute
Bryant and Stratton University Nanci Milbrath, AAS, CMA (AAMA)
Ramona Atiles Pine Technical College
New Life Business Institute Shauna Phillips, CCMA, CPT, CET, CMT
William Butler, RMA, MHA Fortis College
ECPI University Dale Schwartz, RMA
Elizabeth Cason, CPC, CDC, CMA Sanford-Brown Institute
Centura College Lisa Smith, CMA (AAMA), LXMO
Amanda Davis-Smith, NCMA, AHI, CPC Minnesota School of Business
Jefferson Community College Kasey Waychoff, CMA, CPT
Jessica DeLuca Centura College
College of Westchester Jodi Wyrick, MBA, BBA, CMA (AAMA)
Kathy Gaeng, AOS in Bus Mgmt, MA, RMA, Red Cross Bryant and Stratton College
Instructor, Proctor-NCCT, Burdick Cert. Deborah Zenzal, RN, BSN, MS, CPC, CCS-P, RMA
Vatterott College Penn Foster College
Henry Gomez
ASA College SURVEY RESPONDENTS
Gabriel Holder Multiple instructors participated in surveys to help guide the
Berkeley College early development of the product.
Karlene Jaggan, NRAHA, PN, BIT Doris Allen, LPN
Centura College Wichita Technical Institute

xiv
ISTUDY
 Rev. Confirming Pages

Annette S. Baer, CMA (AAMA) TECHNICAL EDITING/ACCURACY PANEL

Johnicka Byrd, CMA (AAMA), AS
Virginia College A panel of instructors completed a technical edit and review of
Monica Cox, CMA, BA in HRM, MHA the content in the book page proofs to verify its accuracy.
Virginia College Annette S. Baer, CMA (AAMA)
Todd Farney, BS, DC Shauna Phillips, CCMA, CPT, CET, CMT
Wichita Technical Institute Fortis College

Kathy Gaeng, AOS in Bus Mgmt, MA, RMA, Red Cross Melissa M. Rub, BA, CMA (AAMA)
Instructor, Proctor-NCCT, Burdick Cert. Rasmussen College
Vatterott College Deborah Wuethrick, MBA/HR, AMT, CPT, CMAA, NHA,
Cindy Gordon, MBA, CMA (AAMA) BLS, AHA
Baker College Computer Systems Institute
Gary L. Hayes, MD
ECPI University
Pamela Hurst, CMA/AC (AAMA), AS
Ridley-Lowell Business and Technical Institute
SYMPOSIA
Christina Ivey, NRCMA, BSHS/M
Centura College An enthusiastic group of trusted faculty members active in this
course area attended symposia to provide crucial feedback.
Karlene Jaggan, NRAHA, PN, BIT
Centura College Sandra Brightwell, RHIA
Hunter Jones, PhD RN Central Arizona College
Virginia College Linda Buchanan-Anderson, RN, BSN, RMA (AMT)
Angela LeuVoy, AAMA, CCMA, CMA, CMRS Central Arizona College
Fortis College William Travis Butler, RMA, MHA
G. Martinez, BS (HSO), MS (HA), Cert. Medical Billing ECPI University
Wichita Technical Institute Mohammed Y. Chowdhury, MBBS, MPH, CCA (AHIMA),
M. McGuire, RN CBCS (NHA), CAHI (AMT)
Wichita Technical Institute Lincoln Technical Institute
Lori Mikell, RMA, AHI Kristy Comeaux, CMA, CPT, EKG
Ridley-Lowell Business and Technical Institute Delta College
Mariela Nale, CMA, RPT Amanda Davis-Smith, NCMA, AHI, CPC
Centura College Jefferson Community and Technical College
Sherry Nemconsky, CMA
Marylou de Roma-Ragaza, BSN, MSN, RN
Ridley-Lowell Business and Technical Institute
Lincoln Educational Services
Shauna Phillips, CCMA, CPT, CET, CMT
Kathy Gaeng, RMA, CAHI
Fortis College
Vatterott College
Sharmalan Sathiyaseelan, MD, RMA
Karlene Jaggan, PN, NRCAHA, BIT
Sanford-Brown Institute
Centura College
Lucy Schultz, BBA, NCICS
Dorsey Schools Jennifer B. Kubetin, CEHR
Branford Hall Career Institute
Dale Schwartz, RMA
Sanford-Brown Institute Cheryl A. Kuck, BS, CMA (AAMA)
Rhodes State College
LaShawn Smalls, DC
Virginia College Lynnae Lockett, RN, RMA, MSN
Bryant & Stratton College
Amy Voytek
Westmoreland College Marta Lopez, MD, LM, CPM, RMA, BMO
Miami Dade College – Medical Campus
Kasey Waychoff, CMA, CPT
Centura College Carrie A. Mack, CMA (AAMA)
Branford Hall Career Institute
Andrea Weymouth, CMA, NCCT, RMA
Ridley-Lowell Business and Technical Institute Nanci Milbrath, AAS, CMA (AAMA)
Pine Technical College
Deborah Wuethrick, MBA/HR, AMT, CPT, CMAA, NHA,
BLS, AHA Corina Miranda, CMPC-I, CPC
Computer Systems Institute Kaplan College
Deborah Zenzal, RN, BSN, MS, CPC, CCS-P, RMA Angela M. B. Oliva, BS, CMRS
Penn Foster College Heald College and Boston Reed College

ISTUDY moi21793_fm_i-xvi.indd xv 06/30/21 01:56 PM

 Debra J. Paul, BA, CMA-AAMA
Ivy Tech Community College
Denise Pruitt, EdD
Middlesex Community College
Wendy Schmerse, CMRS
Charter College
LaShawn D. Sullivan, BSHIM, CPC
Medtech
Gina F. Umstetter
Bachelor in Computer Management, MSIT (ABT)
Instructor, Delta College of Arts & Technology
Lisa Wright, CMA (AAMA), MT, SH
Bristol Community College
Deborah Ann Zenzal, RN BSN MS CCS-P CPC RMA
Penn Foster
SPECIAL THANKS TO THE
INSTRUCTORS WHO HELPED WITH
THE DEVELOPMENT OF CONNECT AND
LEARNSMART. THESE INCLUDE:
Belinda Beeman, M.Ed, CMA (AAMA), PBT (ASCP)
Eastern New Mexico University-Roswell
Kendra Barker, AA, BS
Pinnacle Career Institute
William Travis Butler, RMA, MHA
ECPI University
Susan Cousins, RN, CPC, M.Ed., MBA
Daymar College-Online
Carol Dew, MA-T, CMA-AC (AAMA)
Baker College
Amy Ensign, CMA (AAMA), RMA (AMT)
Baker College
Patti Finney, CMA
Ridley Lowell Business and Technical Institute
Cheryl Kolar, AS in HS, RMA, LPN
Cecil College
Cheryl A. Kuck, BS, CMA (AAMA)
Rhodes State College
Sarah Kuzera, BS, AAS, CMA (AAMA)
Bryan Career College
Marta Lopez, MD, LM, CPM, RMA, BMO
Miami Dade College–Medical Campus
Carrie A. Mack, CMA (AAMA)
Branford Hall Career Institute
x v i AC K NOW L E D G M E N T S
ISTUDY
Stephanie McGahee, CMA (AAMA)
Augusta Technical College
Nanci Milbrath, AAS, CMA (AAMA)
Pine Technical College
Lori Mikell, RMA, AHI
Ridley-Lowell Business and Technical Institute
Sherry Nemconsky, CMA
Ridley-Lowell Business and Technical Institute
Debra J. Paul, BA, CMA-AAMA
Ivy Tech Community College
Denise Pruitt, Ed.D.
Middlesex Community College; Fisher College
Kristy Royea, MBA, CMA (AAMA)
Mildred Elley College
Dale Schwartz, RMA
Sanford-Brown Institute
Lisa Smith, CMA (AAMA), LXMO
Minnesota School of Business
Sharon L. Vaughan, RN, BSN, RMA (AMT)
Georgia Northwestern Technical College
Kasey Waychoff, CMA, CPT
Centura College
Sten Wiedmeier RMA, BS
Bryan University
ACKNOWLEDGMENTS FROM
THE AUTHOR
Sincere thanks go to the following McGraw Hill staff for their
considerable efforts, invaluable assistance, and vital guidance
during the development of this book:
Chad Grall, Managing Director for Health Professions;
William Lawrensen, Executive Brand Manager; Harper
Christopher, Executive Marketing Manager; Christine “Chipper”
Scheid, Senior Product Developer; Katie Ward, Digital Product
Analyst.
I would also like to thank Danielle Mbadu for her work on
revising the Instructor’s Manual and PowerPoint presentation,
and Tammy Vannatter for her work on revising and updating the
Connect materials.
Additionally, I would like to express my appreciation to
McGraw Hill for providing the artwork that helped illustrate this
book. Lastly, I would like to thank Greg Vadimsky, Assistant to
the Author, for his help. I would also like to acknowledge the
reviewers listed for their time and efforts in aiding me and con-
tributing to this book.
 GENERAL MEDICAL SECTION 1
ASSISTING
KNOWLEDGE

SECTION OUTLINE

Chapter 1 – The Profession of Medical Assisting

Chapter 2 – Medical Terminology
Chapter 3 – Anatomy and Physiology
Chapter 4 – Pathophysiology
Chapter 5 – Microbiology
Chapter 6 – General Psychology
Chapter 7 – Nutrition and Health Promotion
Chapter 8 – Medical Law and Ethics

ISTUDY
 CHAPTER 1

THE PROFESSION OF
MEDICAL ASSISTING
LEARNING OUTCOMES

1.1 Describe the administrative, clinical, and 1.5 Explain the requirements for obtaining
­specialized duties of a medical assistant. and maintaining the CCMA credential.
1.2 List the benefits of a medical assisting program. 1.6 Describe the subject areas covered by the NCMA
1.3 Identify the different types of credentials exam.
available to medical assistants through 1.7 Describe the purpose and benefits of the extern
examination. experience.
1.4 List the three areas of knowledge included 1.8 Describe the personal attributes of a ­professional
in the CMA and RMA exams. medical assistant.

MEDICAL ASSISTING COMPETENCIES

COMPETENCY CMA RMA CCMA NCMA

General/Legal/Professional
Respond to and initiate written communications
by using correct grammar, spelling, and formatting
techniques X X X X
Recognize and respond to verbal and nonverbal
­c ommunications by being attentive and adapting com-
munication to the recipient’s level of understanding X X X X
Be aware of and perform within legal and ethical
boundaries X X X X
Demonstrate knowledge of and monitor current federal
and state health-care legislation and regulations; main-
tain licenses and accreditation X X X X
Exercise efficient time management X X X X
Project a positive attitude X X X

ISTUDY
 MEDICAL ASSISTING COMPETENCIES (cont.)

General/Legal/Professional
Be a “team player” X X X
Exhibit initiative X X X
Adapt to change X X X
Project a responsible attitude X X X
Be courteous and diplomatic X X X
Conduct work within scope of education, training, 
and ability X X X X
Be impartial and show empathy when dealing with
patients X X X
Understand allied health professions and credentialing X X X

1.1 The Profession of Medical
Assisting
Medical assisting is one of the most versatile health-care profes-
sions. Men and women can be equally successful as medical
assistants. They are able to work in a variety of administrative
and clinical positions within health care. According to the U.S.
Department of Labor’s Occupational Outlook Handbook, medi-
cal assisting is one of the 10 fastest growing occupations.
The Duties of a Medical Assistant
Medical assistants are skilled health-care professionals who
work primarily in ambulatory settings such as medical offices
and clinics. The duties a medical assistant may perform include
administrative and clinical duties.
Administrative duties: Administrative medical assisting duties
include the following:
• Greeting patients
• Handling correspondence
• Scheduling appointments
• Answering telephones
• Communicating with patients, families, and coworkers
• Creating and maintaining patient medical records
• Handling billing, bookkeeping, and insurance claim
form processing
• Performing medical transcription
• Arranging for hospital admissions and testing
procedures
• Organizing and managing office supplies
• Explaining treatment procedures to patients
• Educating patients
• Coding for specific procedures and tests when filling out
lab requests
• Collecting payments and speaking with patients about
collection policies
Clinical duties: Medical assistants’ clinical duties vary accord-
ing to state law. They may include the following:
• Maintaining asepsis and controlling infection
• Preparing the examination and treatment areas
• Interviewing patients and documenting patients’ vital
signs and medical histories
• Preparing patients for examinations and explaining treat-
ment procedures
• Assisting the physician during examinations
• Disposing of contaminated supplies
• Performing diagnostic tests, such as electrocardiograms
(ECGs)
• Giving injections (where allowed by law)
• Performing first aid and cardiopulmonary resuscitation
(CPR)
• Preparing and administering medications as directed
by the physician, and following state laws for invasive
procedures
• Removing sutures or changing wound dressings
• Sterilizing medical instruments
• Assisting patients from diverse cultural backgrounds, as
well as patients with hearing or vision impairments or
physical or mental disabilities
• Educating patients
Medical assistants’ clinical duties may also include process-
ing various laboratory tests. Medical assistants may prepare the

CHAPTER 1 /
ISTUDY
 patient for the test, collect the sample, complete the test, report
the results to the physician, and report information about the
test from the physician to the patient. It must be noted that med-
ical assistants are not qualified to make any diagnoses. Specific
laboratory duties may include:
• Performing tests, such as a urine pregnancy test, in the
physician’s office laboratory (POL)
• Performing Clinical Laboratory Improvements Act
(CLIA)-waived tests that have a low risk of an erroneous
result, which include urinalysis and blood chemistry
• Collecting, preparing, and transmitting laboratory
specimens, including blood, body fluids, cultures, tissue
samples, and urine specimens
• Teaching specimen collection to patients
• Arranging laboratory services
• Meeting safety standards and fire protection mandates
• Performing as an Occupational Safety and Health
Administration (OSHA) compliance officer
Specialization
Medical assistants may choose to specialize in a specific field
of health care, in either an administrative or clinical area. For
example, ophthalmic medical assistants help ophthalmologists
(physicians who provide eye care) by administering diagnostic
tests, measuring and recording vision, testing the functioning of
a patient’s eyes and eye muscles, and performing other duties.
Additional training may be required for a medical assistant to
specialize in certain areas.
Administrative specialty areas include the following:
• Multiskilled health-care professional
• Medical office administrator
• Dental office administrator
• Medical transcriptionist
• Medical record technologist
• Coding, billing, and insurance specialist
Clinical specialty areas include the following:
• Histologic technician
• Surgical technologist
• Physical therapy assistant
• CPR instructor
• Medical laboratory assistant
• Phlebotomist
1.2 Membership in a Medical
Assisting Association
Certification and Registration
Certification or registration is not required to practice as a med-
ical assistant in most states. However, for instance, as of July
4 S E C T IO N 1 / General Medical Assisting Knowledge
ISTUDY
2013, the state of Washington now requires certification. Source:
https://apps.leg.wa.gov/rcw/default.aspx?cite=18.360&full=true. You
may practice with a high school diploma or the equivalent.
However, you will have more career options if you graduate from
an accredited school and become certified or registered.
A solid medical assisting program provides the following:
• Facilities and equipment that are up to date
• Job placement services
• A cooperative education program and opportunities for
continuing education
1.3 Medical Assisting Credentials
Professional associations set high standards for quality and per-
formance in a profession. They define the tasks and functions
of an occupation. They also provide members with the opportu-
nity to communicate and network with one another.
State and Federal Regulations
Certain provisions of the Occupational Safety and Health Act
(OSHA) and the Clinical Laboratory Improvements Act of
1988 (CLIA ’88) are making mandatory credentialing for medi-
cal assistants a logical step in the hiring process. Currently,
OSHA and CLIA ’88 do not require that medical assistants be
credentialed. However, various components of these statutes
and their regulations can be met by demonstrating that medical
assistants in a clinical setting are certified.
One of the CLIA regulatory categories based on their poten-
tial risk to public health is waived tests. Waived tests are “labo-
ratory examination and procedures that have been approved by
the Food and Drug Administration (FDA) for home use or that,
as determined by the secretary, are simple laboratory examina-
tions and procedures that have an insignificant risk of an erro-
neous result.”
CMA Certification
The Certified Medical Assistant (CMA) credential is awarded
by the Certifying Board of the American Association of Medical
Assistants (AAMA). The AAMA works to raise the standards
of medical assisting to a more professional level.
The AAMA’s address is 20 N. Wacker Drive, Suite 1575,
Chicago, IL 60606. Phone: 1-312-899-1500 or 1-800-228-2262.
Fax: 1-312-899-1259. E-mail: certification@aama-ntl.org. Their
website address is www.aama-ntl.org.
The AAMA Role Delineation Study: In 1996 the AAMA formed
a committee. Its goal was to revise and update the standards
used for accrediting medical assisting programs. Accreditation
is defined as a process in which recognition is granted to an
education program. The committee’s findings were published
in 1997 under the title of the “AAMA Role Delineation Study:
Occupational Analysis of the Medical Assisting Profession.”
Included was a new Role Delineation Chart that outlined the
areas of competence entry-level medical assistants must ­master.
The Role Delineation Chart was further updated in 2003. The
AAMA’s certification examination evaluates the mastery of
 medical assisting competencies on the basis of the 2003 Role
Delineation Study. To take this exam, you must have gradu-
ated from a postsecondary accredited program. The National
Board of Medical Examiners (NBME) also provides techni-
cal assistance in developing the tests. Its website address is
www.nbme.org.
The areas of competence listed in the AAMA Role
Delineation Study must be mastered by all students enrolled in
accredited medical assisting programs. Each of the three areas
of competence—administrative, clinical, and general (or trans-
disciplinary)—contains a list of statements that describe the
medical assistant’s role.
According to the AAMA, the Role Delineation Chart may
be used to:
• Describe the field of medical assisting to other health-
care professionals
• Identify entry-level competency areas for medical
assistants
• Help practitioners assess their own current competence
in the field
• Aid in the development of continuing education programs
• Prepare appropriate materials for home study
Recertification for the CMA is required every five years.
The medical assistant may choose to recertify by taking the
examination again, or by obtaining 60 continuing education
units (CEUs) over this five-year period.
RMA Certification
The Registered Medical Assistant (RMA) credential is awarded
by the American Medical Technologists (AMT), an organi-
zation founded in 1939. AMT is accredited by the National
Commission for Certifying Agencies (NCCA) and a member of
the Institute for Credentialing Excellence.
The AMT’s address is 10700 West Higgins Road, Suite 150,
Rosemont, IL 60018. Phone: 1-847-823-5169. Fax: 1-847-823-
0458. E-mail: mail@americanmedtech.org. The AMT’s website
address is www.americanmedtech.org.
Professional support for RMAs: The AMT offers many benefits
for RMAs. These include:
• Insurance programs, including liability, health, and life
• Membership in the AMT Institute for Education
• State chapter activities
• Annual meeting and educational seminars
Recertification for the RMA is required every three years.
Also, 30 hours of continuing education credits are required
every year to maintain certification.
The American Registry of Medical Assistants
(ARMA)
Medical assistants who become certified by passing a national
certification examination (for example, the CMA or RMA) and
medics in military service may apply for membership with the
American Registry of Medical Assistants (ARMA).
ISTUDY
ARMA is a national registry established in 1950 that certi-
fies medical assistants who have provided the necessary docu-
mentation to be a qualified medical assistant.
ARMA grants qualified members the credential of RMA for
clinical medical assistants and RMA-A for administrative medical
assistants. The ARMA’s website address is http://arma-cert.org.
1.4 CMA and RMA Exam Topics
The CMA and RMA qualifying examinations are rigorous.
Participation in an accredited program, however, will help you
learn what you need to know. The examinations cover several
distinct areas of knowledge. These include:
• Administrative knowledge, including scheduling appoint-
ments, managing mail and office correspondence, medical
records management, collections, insurance processing, and
HIPAA (Health Insurance Portability and Accountability Act)
• Clinical knowledge, including examination room tech-
niques; pharmacology—the preparation, calculation, and
administration of medications; first aid and emergency
care; performing ECGs; specimen collection and labora-
tory testing
• General medical knowledge, including terminology,
anatomy and physiology, behavioral science, and medi-
cal law and ethics
The CMA exam is computer based and features 200 multiple-
choice questions that have “one best answer” from five different
answer choices. There are 180 questions that are scored, and
20 that are pretest questions that are not scored. They are for-
matted as incomplete statements or questions, and the answer
choices either complete the statement or answer the question.
After July 15, 2021, the AAMA will change the number and
percent of questions by category as follows:
Clinical competency: 106 (59%), including Clinical Workflow:
Patient Intake and Discharge, Safety and Infection Control,
Procedures/Examinations, and Pharmacology
General: 9 (21%) including Legal and Ethical Issues, and
Communication
Administrative: 6 (20%) including Billing, Coding, and
Insurance; and Schedule Appoints and Health Information
Management
For complete information, go to: CMA (AAMA)
Certification Exam Content Outline located at: http://www
.aama-ntl.org.
Each person taking the test must achieve a passing score on
every section in order to become certified. An unofficial “pass”
or “fail” is given immediately after the test, but final confirma-
tion is mailed within 12 weeks.
The RMA exam is either computer based or can be taken
using pencil and paper. It features 210 multiple-choice questions
that have “one best answer” from four different answer choices.
Candidates have 2.5 hours to complete the exam. It requires
recall of facts, understanding of medical illustrations, solving
of problems, and interpretation of information from case stud-
ies. The computerized version of the exam offers an immediate
CHAPTER 1 /
 pass/fail score. If the pencil-and-paper version is taken, results
will arrive by mail within eight weeks. A score of 70 or above
is required to pass the exam. Candidates who fail the exam will
be given detailed information about areas in which their knowl-
edge was weakest. Anyone retaking the exam must complete
the entire examination in full. Like the CMA exam, the RMA
covers three areas: general, administrative, and clinical medical
assisting knowledge.
1.5 Certified Clinical Medical Assistant
(CCMA) Examination
This credential is awarded by the National Healthcareer
Association (NHA). The CCMA exam is offered in a written
form or by computer via its website. It consists of 150 ques-
tions plus 20 pretest questions covering several distinct areas
of knowledge. These areas emphasize clinical knowledge,
including general assisting, ECG, phlebotomy, and basic lab
skills. Also included is preparation of patients, such as taking
a medical history, vital signs, physical examination, and patient
positioning; biological hazards; emergency first aid; infection
control; understanding the structure of a prescription; anatomy
and physiology; law and ethics; pharmacology; specimen han-
dling; quality control; use of microscopes; and various labo-
ratory procedures. CCMAs also need 10 hours of continuing
education every two years in order to keep their certification.
Recertification for the CCMA is required every two years.
The NHA’s address is 1161 Overbrook Road, Leawood,
KS 66211. Phone: 1-800-499-9092 or 1-913-661-5592. Fax:
1-913-661-6291. E-mail: info@nhanow.com. The website address
is http://nhanow.com.
1.6 National Certified Medical Assistant
(NCMA) Examination
The NCMA exam is offered by the National Center for
Competency Testing (NCCT), a for-profit agency. To take
the NCMA exam, candidates must have completed either an
AT A GLANCE Medical Assistant Certification Exams
Organization Credential
American Association of Medical CMA (5 years)
Assistants (AAMA)
American Medical RMA (3 years)
Technologists (AMT)
National Healthcareer Association CCMA (2 years)
(NHA)
National Center for Competency NCMA (1 year)
Testing (NCCT)
Table 1-1
6 S E C T IO N 1 / General Medical Assisting Knowledge
ISTUDY
approved medical assistant training program or at least two
years of on-the-job training that was supervised by a physician.
Unlike the other medical assisting exams, the NCMA creden-
tial must be renewed every year, and 14 continuing education
credits must be earned in order for renewal to be approved. The
exam is offered in both computerized and paper forms. It con-
sists of 165 questions, which includes 15 that are not graded.
Three hours are allowed to take the exam. The NCMA exam
covers a variety of subject areas, which include pharmacol-
ogy, medical procedures, patient care, phlebotomy, diagnostic
tests, electrocardiogram, general office procedures, medical
office general management, financial management, and law
and ethics.
The NCCT’s address is 7007 College Blvd., Suite 385,
Overland Park, KS 66211. Phone: 1-800-875-4404. Fax: 1-913-
498-1243. The website address is http://www.ncctinc.com.
Table 1-1 summarizes the various certification examinations
and their related information.
The National Association for Health Professionals (NAHP)
(http://www.nahpusa.com) offers various credentials for
health-care professionals. These include the Medical Assistant,
Administrative Health Assistant, Coding Specialist, Dental
Assistant, EKG Technician, Patient Care Technician, Pharmacy
Technician, Phlebotomy Technician, and Surgical Technician
credentials.
1.7 Externships
An externship offers work experience while you complete a
medical assisting program. You will practice skills learned in
the classroom in an actual medical office environment. A medi-
cal assisting extern must be able to accept constructive criti-
cism, be flexible, and also be willing to learn. In an externship,
you may be exposed to some procedures that are not performed
exactly as you were taught in the classroom or clinical labora-
tory. Learn as much as possible while on an externship. It is
unprofessional to argue with an externship preceptor. Ask your
externship preceptor to explain any differences in techniques
from what you learned while you were in the classroom.
Fees Notes
$125 for recent graduates  Not-for-profit. Annual fees $25–$40
and members, $250 for for students, up to $107 for
others ­others, all based on state.
$120 Not-for-profit. Annual fees $50.
$149 For-profit.
$90 for recent graduates;  For-profit.
$135 for others
 1.8 Preparing for Employment
Career Services will assist you with your resume, interviewing
skills, and learning about positions in your field. It is important
to include certification awarded in relation to a position on your
resume.
New employee: An initial performance evaluation should be
given 90 days after employment.
Personal Attributes
Medical assistants can be more effective and productive if they
have the personal qualifications of professionalism, empathy,
flexibility, self-motivation, integrity and honesty, and account-
ability. A neat and professional appearance is also essential.
Professionalism: A medical assistant should demonstrate cour-
tesy, conscientiousness, and a generally businesslike manner
at all times. It is essential for medical assistants to act profes-
sionally with patients, doctors, and coworkers. Present a neat
appearance and show courtesy and respect for peers and
instructors.
Professionalism is also displayed in your attitude. The medi-
cal assistant is a skilled professional on whom many people,
including coworkers and patients, depend. Your attitude can
make or break your career. A professional always projects a
positive, caring attitude. The medical assistant should avoid
using terms of endearment with patients and remain strictly
professional.
Empathy: Empathy is the ability to put yourself in someone
else’s situation—to identify with and understand another per-
son’s feelings. Patients who are sick, frustrated, or frightened
appreciate empathetic medical personnel. It is always advisable
for the medical assistant to ask patients if they need any assis-
tance, including disabled patients.
Flexibility: An attitude of flexibility will allow you to adapt to
and handle situations with professionalism. For example, when
a physician’s schedule changes to include evening and weekend
hours, the staff also may be asked to change their schedules.
Therefore, you must be flexible and meet the employer’s needs.
Self-motivation: You must be self-motivated and offer assistance
with work that needs to be done, even if it is not your assigned
job. For example, if a coworker is on sick leave or vacation,
offer to pitch in and work extra time to keep the office running
smoothly.
Integrity and honesty: Medical assistants with integrity hold
themselves to high standards. Integrity may be characterized
by honesty, dependability, and reliability. The most important
elements in providing superior customer service to patients are
integrity and honesty. If you make an error, be honest about it.
In order to have integrity, you must be dependable and reliable.
Accountability: Legal, mental, or moral responsibility. In medi-
cine, it refers to the responsibility for moral and legal require-
ments of patient care.
Neat appearance: Medical facilities expect externs and their
staff to appear as medical professionals. Most require a uni-
form that consists of a scrub top and bottom and a lab jacket.
Your name tag or badge should always be worn and visible to
patients. Visible tattoos must be covered. Your hair should be
ISTUDY
a natural color and pulled back from your face and off the col-
lar. Perfumes and colognes should be avoided because patients
with respiratory conditions or allergies may not be able to
tolerate them.
Dependability: This is shown by arriving to work on time,
reporting absences ahead of time, generally avoiding absentee-
ism, following orders, making notes of completed tasks, and
preparing materials needed for work.
Initiative: Demonstrating the ability to initiate work, action,
and decisions.
Credibility: The quality of being believable and worthy of trust.
Attitude: A positive, upbeat demeanor toward work and
individuals.
Test-Taking Preparation
It is important to understand all of the content that the exami-
nation you choose to take will include. You must create a study
schedule and follow it closely. Waiting until the last minute is
never a good idea, and may even cause you to fail. Each of these
exams is difficult and requires sufficient study in order to pass.
It is suggested that you take as many practice exams as pos-
sible prior to taking either the CMA, RMA, CCMA, or NCMA
exam. When taking a practice exam, make sure to read all of
the answer key content, including the rationales for each cor-
rect answer, and each incorrect answer. This will greatly help
you to understand the material more deeply, and is a great way
to study. The various organizations that offer these certifica-
tion exams also provide guides and study materials to help you
prepare. There are also exam study groups, handbooks, and
other materials available via the Internet. Another important
suggestion is to practice doing mathematic calculations without
the use of a calculator or scratch paper, both of which are not
allowed when you take an actual exam.
On the day of the exam, make sure you are well rested, wear-
ing comfortable clothing, wearing a watch if you have one, and
have eaten enough so that you do not get hungry during the
exam. It is not suggested that you study right up until you leave
to take the exam, since it is important to allow yourself a little
“buffer time.” Then, you will be more prepared to absorb the
questions, and take in and process information. Arrive early,
and make sure you bring whatever materials are required to
enter the examination area. Do not bring anything else that will
not be allowed into that area. Once inside, remember not to talk
to anyone else taking the exam. Never leave the examination
area without the permission of the test administrator. Be ready
to get started, and remember that with all of your preparations,
you should do very well.
The most important thing to remember when taking one of
these exams is to read each question carefully, paying attention
to detail. Questions that contain the words “except” or “not”
can be tricky if you read them too quickly. Before you look at
the answer choices, see if you have the answer already in mind.
This way, the answer choices will not influence your selection,
and you are less likely to choose incorrectly. Usually, one or
more of the answer choices can be easily eliminated. Another
tip is to cross off each of these in order to focus on the other
remaining choices more effectively. Methods of “marking”
CHAPTER 1 /
 various questions vary between computerized versions of the
exams, but paper exams are obviously easy to mark up.
Do not spend too much time on each question; instead, cir-
cle those that seem more difficult and come back to them. Pace
yourself as you move through the various sections of the test.
Do not simply go straight through the questions and attempt to
answer each of them while not paying attention to the time that
you are spending on each.
Make sure you respond to each question. No points will be
subtracted for incorrect answers—you are only graded on the
amount that you answer correctly. For the more difficult ques-
tions, eliminate as many answer choices as possible prior to
8 S E C T IO N 1 / General Medical Assisting Knowledge
ISTUDY
making your selection. For paper exams, make sure you mon-
itor your answer sheet carefully so that you are filling in the
correct area for each question. If you must erase or change an
answer, make sure you do it clearly so that your intended answer
is obvious. At the end of an exam, or a section of an exam, if you
still have extra time, go back over your answers to double check
for any errors.
Give your eyes a break during your exam by looking away
from the computer monitor or the test paper briefly, every
10–15 minutes. Excessive concentration while focusing on them
can cause eye strain, resulting in a headache.
 CHAPTER 1 REVIEW

Instructions: 6. Which of the following terms describes behaving cour-

Answer the following questions. teously, conscientiously, and in a generally businesslike
manner?
1. Accreditation may be defined as A. self-motivation
A. a contract that specifies an agreement. B. professionalism
B. permission to engage in a profession. C. job description
C. permission to be licensed. D. ethics
D. an assessment of an individual’s performance. E. morals
E. a process in which recognition is granted to an
­education program. 7. Which of the following constitutes unprofessional behavior
when interacting with an externship preceptor?
2. Which of the following organizations offers the Registered A. accepting criticism
Medical Assistant credential? B. arguing
A. AMA C. being flexible
B. AAMA D. listening to instructions
C. AMT E. having references
D. CDC
E. NBME 8. Which of the following is the correct website address for
the National Board of Medical Examiners?
3. The CMA and RMA examinations cover all of the follow- A. www.nbme.org
ing distinct areas of knowledge except B. www.nbme.gov
A. calculations for preparing medications. C. www.nbm.com
B. HIPAA. D. www.meboard.com
C. criminal justice. E. www.medexam.com
D. medical records.
E. behavioral science. 9. Which of the following is not an example of a medical assis-
tant’s clinical duties?
4. Which of the following professional attributes indicates the A. preparing patients for examinations
ability to identify with someone else’s situation? B. interviewing patients and documenting their vital
A. empathy signs
B. professionalism C. performing diagnostic tests
C. self-motivation D. explaining treatment procedures to patients
D. integrity E. diagnosing communicable diseases
E. flexibility
10. A patient with a physical disability comes to the office. The
5. After you become a certified clinical medical assistant, most appropriate response by the medical assistant is to
how often is recertification required? A. express sympathy regarding the disability.
A. every year B. tell your supervisor.
B. every two years C. ask the patient whether assistance is needed.
C. every three years D. ask the patient how the disability occurred.
D. every five years E. assume that the patient needs assistance and begin
E. every seven years giving aid.

CHAPTER 1 /
ISTUDY
 11 All of the following provide a certification examination for 17. How many multiple-choice questions are given to certify as
medical assistants, except an RMA?
A. NHA. A. 110
B. NCCT. B. 150
C. AMT. C. 180
D. NAHP. D. 210
E. AAMA. E. 280

12. Which of the following terms refers to the responsibility 18. Which of the following is not a clinical specialty for
for moral and legal requirements of patient care? ­medical assistants?
A. empathy A. CPR instructor
B. professionalism B. phlebotomist
C. accountability C. patient educator
D. flexibility D. histologic technician
E. honesty E. surgical technologist

13. The CCMA exam consists of how many questions? 19. Which of the following organizations formed a committee
A. 90 to revise and update standards used for accrediting medi-
B. 120 cal assistant programs?
C. 150 A. HIPAA
D. 180 B. AAMA
E. 210 C. AMT
D. OSHA
14. For obtaining recertification for the CMA, how many con- E. NAHP
tinuing education units (CEUs) over a five-year period are
required? 20. How many years are the CCMA credential good for?
A. 20 A. one
B. 30 B. two
C. 40 C. three
D. 50 D. four
E. 60 E. five

15. Which of the following is the correct website address for 21. Which of the following is the fee for membership in the
the AMT? AAMA?
A. www.medboard.com A. $90
B. www.nbm.com B. $110
C. www.medexam.com C. $115
D. www.americanmedtech.org D. $120
E. www.americannatioanassoc.gov E. $125

16. Which of the following is the most important element in 22. During an examination, excessive concentration on the
providing superior customer service to patients? computer monitor causes eye strain, resulting in which of
A. integrity and honesty the following?
B. flexibility A. headache
C. empathy B. neck pain
D. accountability C. strabismus
E. attitude D. sleepiness
E. hunger

10 S E C T IO N 1 / General Medical Assisting Knowledge

ISTUDY
 23. Which of the following organizations is for-profit? 25. What is the fee for CCMAs to take the medical assistant
A. WHO certification exam?
B. NHA A. $120
C. AAMA B. $125
D. AMT C. $149
E. CDC D. $155
E. $90
24. Which of the following is the website address for the
American Registry of Medical Assistants?
A. www.nbme.org
B. http://medscape.com
C. http://medexam.com
D. http://arma-cert.org
E. http://www.ncctinc.com

CHAPTER 1 /
ISTUDY
 CHAPTER 2

MEDICAL
TERMINOLOGY
LEARNING OUTCOMES

2.1 Identify and define common roots, suffixes, and 2.4 Define medical terms used in relation to ­diseases
prefixes. and body systems.
2.2 Demonstrate proper spelling of common medical 2.5 Describe unacceptable abbreviations as ­outlined
terms in singular, plural, and ­possessive forms. by the Joint Commission.
2.3 Identify abbreviations commonly used in medical
practice.

MEDICAL ASSISTING COMPETENCIES

COMPETENCY CMA RMA CCMA NCMA

General/Legal/Professional
Use appropriate medical terminology X X X X

ISTUDY
 STRATEGIES FOR SUCCESS
Study Skills
Organize and manage!
Organize your notes after class. Doing so will not only help you review material but also make it easier to understand your
notes when you go back to them to study for an exam. Organizing your notes right away will also give you plenty of time
to ask your instructor to clarify something you didn’t understand.

2.1 Word Building
Root: The main part of a word that gives the word its central
meaning. The root is the basic foundation of a word.
Prefix: A structure at the beginning of a word that modifies the
meaning of the root. Not all medical words have a prefix. For a
list of common prefixes, see Table 2-1.
Suffix: A word ending that modifies the meaning of the root. Not
all words have a suffix. For a list of common suffixes, see Table 2-2.
Combining vowels: When a medical term is formed from many
different word parts, these parts are often joined by a vowel.
This vowel is usually an o and occasionally an i. The vowel o is
the most common combining vowel. The combining vowel is
used to ease pronunciation.

AT A GLANCE Common General Prefixes

Prefix Meaning Example Definition

a- Without Aphonia Inability to produce sound
ab- From, away from Abduct To move away from the midline of the body
ad-, ac-, af-, ag-, al-,  Toward, increasing Adduct To move toward the midline of the body
ap-, ar-, as-, at-
alb- White Albinism Whiteness of skin, hair, and eyes caused by the
absence of pigment
ambi- Both Ambidextrous Able to use both hands effectively
ana- Up, upward Anaphylactic Characterized by an exaggerated reaction 
to an antigen or toxin
ante- Before Antepartum Before childbirth
anti- Against Antibiotic Acting against microorganisms
auto- Self Autodermic Of the patient’s own skin 
(said of skin grafts)
bi- Two, both Bilateral Pertaining to both sides
bio- Life Biology Study of life
broncho- Bronchus, bronchi Bronchorrhaphy Suturing a wound of the bronchus
circum- Around Circumcision Removal of the skin around the tip of the
penis
con-, col-, com-, cor- Together, with Congenital Accompanying birth, present at birth
contra- Against Contraceptive Preventing conception
de- Away from, down, not Decalcify To decrease or remove calcium
dia- Through Diagnosis Knowledge through testing
dis- Apart, separate Dislocation Removal of any part of the body from its
­normal position

Table 2-1, continued

CHA
ISTUDY
 AT A GLANCE Common General Prefixes

Prefix Meaning Example Definition

dys- Bad, difficult, painful, poor Dysuria Painful urination
ec- Out, away Ectopic Pertaining to something outside its normal
location
ecto- Outside Ectoplasm Outermost layer of cell protoplasm
en-, em- In Endemic Occurring continuously in a population
Empyema Pus in a body cavity
endo- Within Endoscope Instrument to examine something from within
epi- Upon, over Epidermal Upon the skin
eu- Good Eupnea Normal, good breathing
ex-, e- Out, away Exhale To breathe out
Emanation Something given off
hemi- Half Hemicardia Half of the heart
hyper- Excessive, beyond Hyperlipemia Condition of excessive fat in the blood
hypo- Below, under Hypoglycemia Low blood sugar
in-, il-, im-, ir- Not Impotence Inability to achieve erection
infra- Below, under, beneath Inframammary Below the breast
inter- Between Intercellular Between cells
intra- Within Intravenous Within a vein
iso- Equal Isometric Of equal dimension
juxta- Near, beside Juxtaarticular Near a joint
mal- Bad Malaise Discomfort
mega-, megal- / o Large Megacephaly Abnormal enlargement of the head
mes- / o Middle Mesoderm Middle layer of the skin
meta- Beyond, after Metastasis Spread of disease from one part of the body 
to another
micro- Small Microscope Instrument used to view small organisms
milli- One-thousandth Milliliter One-thousandth of a liter
mono- One, single Mononuclear Having only one nucleus
multi- Many Multidisciplinary Pertaining to many areas of study
neo- New, recent Neonatal Pertaining to the period after birth
non- Not Noninvasive Not invading the body through any organ,
­cavity, or skin (said of a diagnostic or
­therapeutic technique)
para- Near, beside, beyond, opposite, Paramedic Person who provides emergency medical 
abnormal care (alongside other medical personnel)
per- Through Percutaneous Through the skin

Table 2-1, continued

14 S E C T IO N 1 / General Medical Assisting Knowledge

ISTUDY
 AT A GLANCE Common General Prefixes

Prefix Meaning Example Definition

peri- Around, surrounding Perianal Around the anus
poly- Many Polyarthritis Inflammation of many joints
post- After Postmortem; After death; After taking medications
Postprandial

pre- Before Premature Before maturation

primi- First Primiparous Having given birth for the first time
re- Again, back Reactivate To make active again
retro- Back, backward, behind Retrograde Going backward
rube- Red Rubella Viral disease characterized by red rashes,
among other things
sacro- Sacrum Sacroiliac Pertaining to the sacrum and iliac bones
sarco- Flesh Sarcoma A malignant tumor arising from 
connective tissues
semi- Half Semiconscious Half conscious
sub- Under, below Sublingual Under the tongue
super- Above, excessive Superficial Near or above the surface
supra- Above, over Suprapubic Above the pubic area
syn-, sym- Together Symbiosis Mutual interdependence
tri- Three Triceps Muscle with three heads
ultra- Beyond, excessive Ultrasound Sound with a very high frequency, used to
obtain medical images
uni- One Unicellular One-celled

Table 2-1, concluded

AT A GLANCE Common General Suffixes

Suffix Meaning Example Definition

-ac Pertaining to Cardiac Pertaining to the heart
-ad Toward Cephalad Toward the head
-al Pertaining to Thermal Pertaining to the production of heat
-ar Pertaining to Articular Pertaining to a joint
-desis Binding Arthrodesis Surgical binding or fusing of a joint
-e Noun marker Dermatome Instrument used to cut the skin
-ectomy Excision, removal Hysterectomy Removal of the entire uterus
-emesis Vomit Hyperemesis Excessive vomiting

Table 2-2, continued

CHA
ISTUDY
 AT A GLANCE Common General Suffixes

Suffix Meaning Example Definition

-form Resembling, like Vermiform Shaped like a worm
-genic Beginning, originating, producing Toxigenic Producing toxins
-gram Record Electrocardiogram Record of the variations in electrical
­potential caused by the heart muscle
-graph Instrument for recording Electrocardiograph Instrument for making electrocardiograms
-graphy Process of recording Electrocystography Process of recording the changes of electric
potential in the urinary bladder
-iasis Condition, formation Lithiasis Formation or presence of stones
-iatric Pertaining to medical treatment Pediatric Pertaining to the treatment of children
-iatry Study or field of medicine Psychiatry Study of the human psyche
-ic Pertaining to Thoracic Pertaining to the thorax
-ical Pertaining to Neurological Pertaining to nerves
-ism Condition Cryptorchidism Condition of undescended testes
-ist Specialist Otorhinolaryngologist Physician who specializes in the ear, nose,
and larynx
-itis Inflammation Appendicitis Inflammation of the appendix
-logist Specialist in the study of Microbiologist Biologist who specializes in the study of
microorganisms
-logy Study of Microbiology Study of microorganisms
-lysis Destruction, breaking down Hemolysis Breaking down of blood
-megaly Enlargement Cardiomegaly Enlargement of the heart
-meter Instrument used to measure Scoliosometer Instrument for measuring the curves 
of the spine
-oma Tumor Carcinoma Cancerous, malignant tumor
-ory Pertaining to Auditory Pertaining to hearing
-osis Condition, disease Leukocytosis Condition of increased leukocytes in the blood
-pathy Disease Hemopathy Disease of the blood
-penia Deficiency Leukocytopenia Decrease in the number of white blood cells
-pexy Surgical fixation Orchiopexy Surgical fixation of an undescended testicle
within the scrotum
-phagia Swallowing Dysphagia Difficulty swallowing
-philia Attraction Necrophilia Attraction to dead bodies
-phobia Abnormal fear Photophobia Fear of light
-plasia Development Dysplasia Faulty formation
-plasty Molding, surgical repair Rhinoplasty Surgical repair of the nose
-plegia Paralysis Paraplegia Paralysis of the lower extremities
-pnea Breathing Hypopnea Shallow breathing

Table 2-2, continued

16 S E C T IO N 1 / General Medical Assisting Knowledge

ISTUDY
 AT A GLANCE Common General Suffixes

Suffix Meaning Example Definition

-ptosis Drooping, prolapse, falling Mastoptosis Drooping of the breast
-ptysis Spitting Hemoptysis Spitting up blood
-rrhage, -rrhagia Excessive flow, discharge Hemorrhage Bursting forth of blood
-rrhea Discharge, flow Amenorrhea Absence of menstrual flow
-rrhexis Rupture Cardiorrhexis Rupture of the heart
-scope Instrument used to view Oscilloscope Instrument that displays visual representa-
tion of electrical variations
-scopy Process of viewing with a scope Opthalmoscopy Process of examining the interior of the eye
by using an opthalmoscope
-stasis Stoppage, balance, control Hemostasis A stopping of the flow of blood
-stomy Surgical creation of a new Colostomy Creation of an opening between the colon
opening and the surface of the body
-tomy Incision, cutting Phlebotomy Incision into a vein

Table 2-2, concluded

Guidelines for using combining vowels include the following: • Osseous • Predictable
• When a root and a suffix beginning with a vowel are con- • Pamphlet • Principle
nected, a combining vowel is usually not used. • Pruritus • Sizable
• Connecting a word root and a suffix that starts with a • Parenteral • Specimen
consonant usually requires a connecting vowel.
• Parietal • Surgeon
• When two roots are connected, a combining vowel is
• Perineum • Tranquility
most often used even if vowels are present at the junction.
• Most common prefixes can be connected to other word • Perseverance • Vaccine
parts without a combining vowel. • Precede • Vacuum
To correct a misspelled word in a patient’s chart, you must
2.2 Spelling draw a single line through the word.
Plural forms: Here are some general rules. Remember, there are
Spelling: Some commonly misspelled words are:
almost always exceptions.
• Abscess • Conscious
• Add an s or es to most singular nouns to make them plural.
• Accessible • Defibrillator
• When a medical term in the singular form ends in is,
• Aerobic • Desiccation drop the is and add es to make it plural (metastasis/
• Agglutinate • Dissect metastases).
• Analyses • Epididymis • When the term ends in um or on, drop the um or on and
• Analysis • Fissure add a (atrium/atria, ganglion/ganglia).
• Aneurysm • Glaucoma • When the term ends in us, drop the us and add i (bron-
chus/bronchi). Exceptions to this rule mainly involve
• Asepsis • Hemorrhoid
certain words of Latin origin (corpus/corpora, genus/
• Asthma • Homeostasis genera, sinus/sinuses, virus/viruses).
• Auxiliary • Humerus • When the term ends in ma, add ta (stoma/stomata).
• Benign • Hyperglycemia
• When the term otherwise ends in a, drop the a and add
• Capillary • Hypoglycemia ae (vertebra/vertebrae).
• Chancre • Irrelevant
Possessive forms: For singular nouns and plural nouns that do
• Changeable • Ischium not end in s, add an apostrophe and an s. For plural nouns that
• Clavicle • Occlusion end in s, just add an apostrophe but no additional s.

CHA
ISTUDY
 2.3 Common Medical Abbreviations Pharmaceutical Abbreviations
Metric system: A system of measurement based on the decimal
Abbreviations: The most common abbreviations used in asso-
system. Its units include the meter, gram, and liter. It is the most
ciation with medical care facilities are presented in Table 2-3.
commonly used system of measurement in health care. For a
The most common medical record abbreviations are listed in
list of common abbreviations used in the metric system, see
Table 2-4, abbreviations associated with the metric system are
Table 2-5.
listed in Table 2-5, and common prescription abbreviations are
Conversion factors for the metric system: The meter (m),
listed in Table 2-6. Tables of relevant abbreviations are also
used for length, equals approximately 39.37 inches; the liter
included for each body system.

AT A GLANCE Medical Care Facility Abbreviations

Abbreviation Meaning Abbreviation Meaning

CCU Coronary care unit OR Operating room
ED Emergency department PAR Postanesthetic recovery
ER Emergency room postop Postoperative
ICU Intensive care unit preop Preoperative
IP Inpatient RTC Return to clinic
OP Outpatient RTO Return to office
OPD Outpatient department

Table 2-3

AT A GLANCE Medical Record Abbreviations

Abbreviation Meaning Abbreviation Meaning

AIDS Acquired immunodeficiency syndrome GYN Gynecology
a.m.a. Against medical advice H&P History and physical
BP Blood pressure HEENT Head, ears, eyes, nose, throat
bpm Beats per minute HIV Human immunodeficiency virus
C Celsius, centigrade Ht Height
CBC Complete blood count Hx History
C.C. Chief complaint I&D Incision and drainage
CNS Central nervous system inj Injection
c/o Complains of IV Intravenous
CP Chest pain L Left
CPE Complete physical examination L&W Living and well
CV Cardiovascular lab Laboratory studies
D&C Dilation and curettage MM Mucous membrane
Dx Diagnosis N&V Nausea and vomiting
ECG/EKG Electrocardiogram NP New patient, Nurse practitioner
ED, ER Emergency room P Pulse

Table 2-4, continued

18 S E C T ION 1 / General Medical Assisting Knowledge

ISTUDY
 AT A GLANCE Medical Record Abbreviations

Abbreviation Meaning Abbreviation Meaning

F Fahrenheit Pap Pap smear
FH Family history PE Physical examination
Fl/fl Fluid pH Hydrogen concentration (acidity/
alkalinity)
GBS Gallbladder series PI Present illness
GI Gastrointestinal PMH Past medical history
GU Genitourinary PMS Premenstrual syndrome
PNS Peripheral nervous system stat Immediately
pt Patient STD Sexually transmitted disease
PT Physical therapy surg Surgery
Px Physical examination T Temperature
R Right TPR Temperature, pulse, respirations
re✔ Recheck Tx Treatment
ref Referral UCHD Usual childhood diseases
R/O Rule out US Ultrasound
ROS/SR Review of systems/systems review VS Vital signs
Rx Prescription WDWN Well-developed and well-nourished
subq. Subcutaneously WNL Within normal limits
sig Sigmoidoscopy Wt Weight
SOB Shortness of breath y.o. Year old
S/R Suture removal

Table 2-4, concluded

AT A GLANCE Common Abbreviations Used in the Metric System

Abbreviation Meaning Abbreviation Meaning

cm Centimeter (2.5 cm = 1 inch) deca- × 10
km Kilometer hect- × 100
mL Milliliter (1 mL = 1 cc) kilo- × 1,000
mm Millimeter deci- ÷ 10
g, gm Gram centi- ÷ 100
kg Kilogram (1 kg = 1,000 gm = 2.2 pounds) milli- ÷ 1,000
L or l Liter = 1,000 mL (1 gallon =  micro- ÷ 1,000,000
4 quarts = 8 pints = 3.785 L; 
1 pint = 473.16 mL)

Table 2-5

CHA
ISTUDY
 AT A GLANCE Common Abbreviations Used in Prescriptions

Abbreviation Meaning Abbreviation Meaning

a Before PR Through the rectum
a.c. Before meals p.r.n., PRN As needed
ad lib. As desired PV, vag. Through the vagina
AM, a.m. Morning q Every
amt Amount qh Every hour
aq Water q2h Every 2 hours
b.i.d., BID Twice a day q.i.d., QID Four times a day
buc Buccal qm Every month
​¯
c​ With q.o.d., QOD Every other day
cap Capsule ® Right, registered trademark
d Day Rx Prescription, take
Fl. Fluid ​¯s ​ Without
h, hr Hour sub-Q, subcu Subcutaneous
*
h.s. At bedtime, at the hour of sleep Sig: Instruction to patient
ID Intradermal soln. Solution
IM Intramuscular sp. Spirits
IV Intravenous ​¯
ss ​ One half
noc., n. Night stat Immediately
NPO Nothing by mouth supp., suppos Suppository
oint., ung. Ointment syr. Syrup
​¯
p​ After T Topical
p.c. After meals tab Tablet
per By, through t.i.d., TID Three times a day
PM, p.m. After noon x Times, for
p.o., PO By mouth

Table 2-6
*Though this abbreviation is on the JCAHO’s Do Not Use List, it is still in common usage.

(L or l), used for volume, equals approximately 1.056 U.S. (i = 1, ii = 2, iv = 4, v = 5, vi = 6, ix = 9, x = 10, xi = 11,
quarts; and the gram (g or gm), used for weight, equals approxi- xx = 20, xl = 40, l = 50, lx = 60, xc = 90, c = 100, cx = 110,
mately 0.035 ounce. cc = 200, d = 500, m = 1,000, mm = 2,000, etc.). A bar writ-
Apothecaries’ system: An old system of measurement in which ten above a numeral multiplies its value by 1,000:
the weight measure is based on one grain of wheat and the liq-
uid measure is based on one drop of water. The apothecaries’ ¯ = 5,000, ​​ c ​​
(​​ v ​​ ¯ = 100,000, ​​ ¯
m ​​= 1,000,000, ​​ ¯
ss ​​= ​½, etc.)
system measures weight by grains (gr), scruples (scr), drams
Conversion factors for the apothecaries’ system: There are
(dr), ounces (oz), and pounds (lb). It uses minims (min), flu-
approximately 60 milligrams to a grain, and 15 grains to a gram.
idrams (fl dr), fluid ounces (fl oz), pints (pt), quarts (qt), and
grains × 60 = milligrams
gallons (gal) to measure volume. In the apothecary system,
grains ÷ 15 = grams
dosage quantities are written in lowercase Roman numerals

20 S E C T ION 1 / General Medical Assisting Knowledge

ISTUDY
 2.4 Medical Terminology in Practice
Common Terms Related to Disease
AT A GLANCE Common Terms Related to Disease

Term Meaning
Benign Noncancerous
Convalescent The period of recovery after an illness, injury, or surgery
Declining Gradually deteriorating, weakening, or wasting
Degeneration Change of tissue to a less functionally active form
Etiology Cause of a disease
Incubation period The time between exposure to an infectious organism and the onset of symptoms of illness
Malaise Not feeling well (the first indication of illness)
Malignant Cancerous
Prodromal Pertaining to early symptoms that may mark the onset of a disease
Prognosis Prediction about the outcome of a disease
Prophylaxis Protection against disease
Remission Cessation of signs and symptoms

Table 2-7

Integumentary System
AT A GLANCE Integumentary System—Common Combining Forms

Combining Form Meaning Example Definition

adip / o Fat Adipose tissue Layer of fat beneath the skin
albin / o White Albinism Condition caused by the lack of melanin
­pigment in the skin, hair, and eyes
cry / o Cold Cryosurgery Surgery that uses liquid nitrogen to freeze
tissue
cutane / o Skin Subcutaneous Beneath the skin
dermat / o Skin Dermatitis Inflammation of the skin
erythr / o Red Erythrodermatitis Inflammation of the skin marked by redness
and scaling
hidr / o Sweat Hidradenitis Inflammation of a sweat gland
hist / o Tissue Histology Study of tissues
kerat / o Hard skin, horny  Keratosis Lesion formed from an overgrowth of the
tissue, keratin horny layer of skin
leuk / o White Leukoplakia Raised, white patches on the mouth or vulva
lip / o Fat Lipoma Common benign tumor of the fatty tissue
onych / o Nail Onycholysis Separation of the nail from its bed

Table 2-8, continued

CHA
ISTUDY
 AT A GLANCE Integumentary System—Common Combining Forms

Combining Form Meaning Example Definition

pachy / o Thick Pachyonychia Abnormal thickness of fingernails 
or toenails
seb / o Sebum (oil) Seborrhea Excessive secretion of sebum
squam / o Scale Squamous Scale-like
trich / o Hair Trichopathy Any disease of the hair
xanth / o Yellow Xanthoma Yellow deposit of fatty material in the skin
xer / o Dry Xerosis Abnormal dryness of the eye, 
skin, and mouth

Table 2-8, concluded

AT A GLANCE Integumentary System—Suffixes

Suffix Meaning Example Definition

-malacia Softening Onychomalacia Softening of the nails
-phagia Eating, swallowing Dysphagia Difficulty swallowing, painful swallowing

Table 2-9

AT A GLANCE Integumentary System—Abbreviations

Abbreviation Meaning
Bx Biopsy
Derm Dermatology
SC, sub-Q, SQ, subcu, subq Subcutaneous

Table 2-10

Musculoskeletal System

AT A GLANCE Musculoskeletal System—Common Combining Forms

Combining Form Meaning Example Definition

ankyl / o Stiff Ankylosis Complete loss of movement in a joint
arthr / o Joint Arthralgia Pain in the joint
bucc / o Cheek Buccinator Cheek muscle
burs / o Bursa Bursolith Stone in a bursa
calc / o Calcium Hypercalcemia Excessive amount of calcium in the blood
carp / o Wrist Carpal Pertaining to the wrist
cervic / o Neck Cervical Pertaining to the neck

Table 2-11, continued

22 S E C T ION 1 / General Medical Assisting Knowledge

ISTUDY
 AT A GLANCE Musculoskeletal System—Common Combining Forms

Combining Form Meaning Example Definition

chondr / o Cartilage Osteachondroma Benign bone tumor
cost / o Rib Intercostal Between the ribs
crani / o Cranium (skull) Cranial Pertaining to the skull
dors / o Back Dorsal Pertaining to the back
fasci / o Band of fibrous tissue Fasciotomy Operation to relieve pressure on the muscles
by making an incision into the fascia
fibr / o Fiber Fibroma Benign tumor of the connective tissues
kyph / o Hump Kyphosis Excessive curvature of the spine,
“humpback”
lamin / o Lamina Laminectomy Surgical removal of the lamina
lei / o Smooth muscle Leiomyoma Benign tumor of smooth muscle
lord / o Curve Lordosis Inward curvature of the spine, “swayback”
my / o Muscle Myalgia Muscle pain
myos / o Muscle Myositis Inflammation of muscle tissue
oste / o Bone Osteoporosis Condition in which bones become porous
and fragile
pector / o Chest Pectoral Pertaining to the chest
rhabd / o Striated, skeletal muscle Rhabdomyolysis Destruction of muscle tissue accompanied
by the release of myoglobin
spondyl / o Vertebra Spondylitis Inflammation of the joints between the
­vertebrae in the spine
synov / i Synovia Synovial membrane Membrane lining the capsule of a joint
ten / o, tend / o, tendin / o Tendon Tendinitis Inflammation of the tendons

Table 2-11, concluded

AT A GLANCE Musculoskeletal System—Suffixes

Suffix Meaning Example Definition

-asthenia Weakness Myasthenia gravis Disorder of neuromuscular transmission
marked by weakness
-clasia Breaking Arthroclasia Artificial breaking of adhesions of an anky-
losed joint
-desis Binding Arthrodesis Surgical binding or fusing of a joint
-physis Growth Metaphysis The growing portion of a long bone
-schisis Splitting Rachischisis Failure of vertebral arches and neural tube
to fuse
-trophy Development Hypertrophy Excessive development

Table 2-12

CHA
ISTUDY
 AT A GLANCE Musculoskeletal System—Abbreviations

Abbreviation Meaning
C1, C2, . . . C7 Individual cervical vertebrae (first through seventh)
Ca Calcium
CTS Carpal tunnel syndrome
EMG Electromyography
fx Fracture
L1, L2, . . . L5 Individual lumbar vertebrae (first through fifth)
ortho Orthopedics
ROM Range of motion
SLE Systemic lupus erythematosus
T1, T2, . . . T12 Individual thoracic vertebrae (first through twelfth)

Table 2-13

AT A GLANCE Actions of Muscles

Motion Meaning
Abduction Movement away from the midline

Adduction Movement toward the midline

Circumduction Movement in a circular motion

Depression Act of lowering a body part from a joint

Dorsiflexion Act of pointing the foot upward

Elevation Act of raising a body part from a joint

Eversion Act of turning outward

Extension Increase in the angle of a joint

Flexion Decrease in the angle of a joint

Hyperextension Increase in the angle of a joint beyond what is normal

Inversion Act of turning inward

Plantar flexion Act of pointing the foot downward

Pronation Act of turning downward or inward

Protraction Movement of a body part anteriorly

Retraction Movement of a body part posteriorly

Rotation Act or process of turning on an axis

Supination Act of turning upward or outward

Table 2-14

24 S E C T IO N 1 / General Medical Assisting Knowledge

ISTUDY
 Nervous System

AT A GLANCE Nervous System—Common Combining Forms

Combining Form Meaning Example Definition

cerebell / o Cerebellum Cerebellar Pertaining to the cerebellum
cerebr / o Cerebrum Cerebral cortex Outer layer of the cerebrum
dur / o Dura mater Subdural hematoma Bleeding between the dural and
­arachnoidal membranes
encephal / o Brain Encephalitis Inflammation of the brain
mening / o Membrane Meningomyelocele Protrusion of the spinal cord through a
defect in the vertebral column
myel / o Spinal cord, bone marrow Myelogram Radiographic study of the spinal
­subarachnoid space
neur / o Nerve Neuralgia Pain in a nerve
poli / o Gray matter Poliodystrophy Wasting of gray matter
psych / o Mind Psychosomatic Pertaining to the influence of the mind 
on the body

Table 2-15

AT A GLANCE Nervous System—Prefixes

Prefix Meaning Example Definition

hemi- Half Hemihypesthesia Diminished sensation in one side of the body
tetra- Four Tetraparesis Weakness of all four extremities

Table 2-16

AT A GLANCE Nervous System—Suffixes

Suffix Meaning Example Definition

-algesia Excessive sensitivity to pain Analgesia Without a sense of pain
-algia Pain Neuralgia Nerve pain
-esthesia Feeling sensation Anesthesia Loss of sensation
-kinesia Movement Bradykinesia Decrease in spontaneity and movement
-kinesis Movement Hyperkinesis Excessive muscular activity
-lepsy Seizure Epilepsy Chronic brain disorder, often
c­haracterized by seizures
-paresis Slight paralysis Hemiparesis Weakness on one side of the body
-phasia Speech Aphasia Impairment of language ability
-plegia Paralysis Hemiplegia Paralysis of one side of the body
-praxia Action Apraxia Impairment of purposeful movement

Table 2-17

CHA
ISTUDY
 AT A GLANCE Nervous System—Abbreviations

Abbreviation Meaning
ALS Amyotrophic lateral sclerosis
CAT Computed axial tomography
CNS Central nervous system
CP Cerebral palsy
CSF Cerebrospinal fluid
CT Computed tomography
CVA Cerebrovascular accident (stroke)
EEG Electroencephalogram
LP Lumbar puncture
MRI Magnetic resonance imaging
MS Multiple sclerosis
TIA Transient ischemic attack

Table 2-18
Cardiovascular System

AT A GLANCE Cardiovascular System—Common Combining Forms

Combining Form Meaning Example Definition

angi / o Vessel Angiogram X-ray image of a blood vessel
aort / o Aorta Aortic stenosis Narrowing of the aorta
arter / i Artery Arteriectomy Surgical removal of a portion of an artery
arter / o, arteri / o Artery Arteriosclerosis Thickening of arterial walls
atri / o Atrium Atrial Pertaining to an atrium
bas / o Base Basophil Cell with granules that stain specifically with 
basic (alkaline) dyes
cardi / o Heart Cardiomegaly Enlargement of the heart
coagul / o Clotting Anticoagulant Drug that prevents clotting of the blood
coron / o Crown, circle Coronary arteries Blood vessels encircling the heart
cyt / o Cell Cytology Study of cells
hem / o, hem / a, hemat / o Blood Hemorrhage Abnormal discharge of blood
Hematology Study of blood
is / o Same, equal Anisocytosis Abnormality of red blood cells that are of 
unequal size
kary / o Nucleus Eukaryote Cell that contains membrane-bound nucleus 
with chromosomes
lymph / o Lymph Lymphadenitis Inflammation of the lymph nodes

Table 2-19, continued

26 S E C T IO N 1 / General Medical Assisting Knowledge

ISTUDY
 AT A GLANCE Cardiovascular System—Common Combining Forms

Combining Form Meaning Example Definition

phleb / o Vein Phlebotomy Incision in vein to draw blood
plasm / o Plasma Plasmapheresis Removal of plasma from the body, separation
and extraction of specific elements, and
reinfusion
thromb / o Clot Thrombolysis Dissolving of a clot
valv / o, valvul / o Valve Valvoplasty Surgical reconstruction of a cardiac valve
vas / o Vessel Vasoconstriction Narrowing of the blood vessels
ven / o Vein Venous Pertaining to a vein

Table 2-19, concluded

AT A GLANCE Cardiovascular System—Suffixes

Suffix Meaning Example Definition

-apharesis Removal Plasmapheresis Removal of plasma from the blood with a centrifuge
-blast Immature stage, Myoblast Immature muscle cell
germ, bud
-clast Breakdown Osteoclast Bone breakdown
-crit Separation Hematocrit Percentage of volume of a blood sample 
that is composed of cells
-cytosis Abnormal condi- Poikilocytosis Presence of large, irregularly shaped 
tion of cells blood cells
-globin Protein Hemoglobin Protein of red blood cells

Table 2-20

AT A GLANCE Cardiovascular System—Abbreviations

Abbreviation Meaning
AED Automatic external defibrillator
AF Atrial fibrillation
AS Aortic stenosis
ASD Atrial septal defect
BP Blood pressure
CAD Coronary artery disease
CHD Coronary heart disease
CHF Congestive heart failure
ECG, EKG Electrocardiogram
ECHO Echocardiography

Table 2-21, continued

CHA
ISTUDY
 AT A GLANCE Cardiovascular System—Abbreviations

Abbreviation Meaning
HTN Hypertension
MI Myocardial infarction (heart attack)
MVP Mitral valve prolapse
PDA Patent ductus arteriosus
PVC Premature ventricular contraction
VT Ventricular tachycardia

Table 2-21, concluded

Respiratory System

AT A GLANCE Respiratory System—Common Combining Forms

Combining Form Meaning Example Definition

adenoid / o Adenoid Adenoidectomy Operation to remove adenoid growths
alveol / o Air sac Alveolar Pertaining to a small cell or cavity
bronch / i, bronch / o Bronchus Bronchitis Inflammation of the mucous membrane 
of the bronchial tubes
capn / o Carbon dioxide Hypercapnia Excessive carbon dioxide in the blood
coni / o Dust Pneumoconiosis Pulmonary disease caused by prolonged
inhalation of fine dust
cyan / o Blue Cyanosis Bluish discoloration of the skin caused by a
deficiency of oxygen in the blood
laryng / o Larynx Laryngitis Inflammation of the mucous membrane in
the larynx
lob / o Lobe of the lung Lobectomy Excision of a lobe
nas / o Nose Paranasal sinuses Accessory sinuses in the bones of the face
that open into the nasal cavities
ox / o, ox / i Oxygen Hypoxia Deficiency of oxygen in tissue cells
phon / o Voice, Sound Dysphonia Hoarseness, difficulty speaking
phren / o Diaphragm Phrenohepatic Pertaining to the diaphragm and liver
pneum / o, pneum / a, pneumat / o Lung, air Pneumatosis Abnormal presence of air or other gas
pneum / o, pneumon / o Lung Pneumonia Inflammation of the lung parenchyma
pulmon / o Lung Pulmonary Pertaining to the lungs
rhin / o Nose Rhinorrhea A watery discharge from the nose
spir / o Breathing Spirometer Gasometer used to measure respiration
tonsill / o Tonsil Tonsillectomy Removal of the tonsil

Table 2-22

28 S E C T ION 1 / General Medical Assisting Knowledge

ISTUDY
Another random document with
no related content on Scribd:
me hours to go over a five-foot bookshelf with a dust-rag. And to-
night was no exception. Particularly fascinating were the books of
the New Captain on esoteric philosophy. There was no getting away
from them; here was the “foreign religion” he and Mattie had
embraced and the “books to prove it by.”
There was nothing modern. One great tome was Madame
Blavatsky’s “Isis Unveiled,” Eastern theosophy set forth in defiant
terms to a skeptical audience of 1875. Luckily, I had read it before, or
I should have been reading it yet. I was already informed as to the
writings on the Temple of Karnac that were identical with those on
the walls of a ruin in Yucatan, proving that the religious rites of Asia
and America were the same in the days before the Pyramids, when
Atlantis was a continent in the middle of the ocean and the British
Isles were under the sea. I wished that the New Captain had heard a
certain lecture that I had recently heard delivered by a savant, who
claimed that the secret of how to cut a canal from the Mediterranean
to the Indian Ocean was well understood by the Magi of the Orient
and that it was only due to international politics that it had never
been attempted. Because, forsooth, it would incidentally cause the
Sahara to be partially inundated and to “bloom like a rose,” but that
the redistribution of the waters of the world would engulf all of
England. Poor England! As if she, like myself, did not have enough
trouble with what was in her house, without being swamped by what
was under it! However, this erudite lecturer had just been released
from a sanitarium, we learned afterward, and to it he was shortly
returned, the Mecca of most of those who follow worlds too far.
Blavatsky’s story of the ball of fire which turned itself into a cat and
frisked around the room, before floating up the chimney, was
marked. It could have happened in this very room. There was a
white sheet of paper pinned to the wall opposite me, with a round
black disk on it, that might have been there when she wished to go
into a trance. I felt that if I looked at it long enough I might see
means by which Mattie aided concentration a ball of fire turning into
a cat. I wondered what they would have thought of Hudson’s
drummer, who, although locked up in a cell, played upon his drum
which was left behind in his lodging-house to keep awake the
enemies who had thrown him into jail? Or of Conan Doyle’s
poltergeists who threw pebbles at the man seeking shelter in a
bomb-cellar? But they had manifestations of their own, no doubt, and
perhaps I should come across some record of them, although they
had worked out their philosophy before the days when one could
simply seize a pencil and write upon a roll of wall-paper facts
dictated by one’s “control.”
Mattie and the New Captain had had no opportunity to be influenced
by the great mass of post-war spiritualistic literature. The fragments
from which they formed their code were bits of gold for which they
had to wash many cold streams of Calvinistic thought. They must
have gloated over each discovery like misers. I could see them
sitting here in this room on a winter evening, the shutters closed, the
lean fire crackling, the two heads bent beneath the oil-lamp,
exclaiming over some nugget of wisdom which would corroborate
their own experiences. Those were the times when “old Mis’ Hawes”
must have called and bellowed and pounded on the floor without
getting Mattie to answer any summons to the front bedroom on the
other side of the house.
Mattie and the New Captain may not have known anything about
photographing fairies, or the S. P. R., or the S. P. C. A., for that
matter, but cats they knew. I had found the saucers of seven of them
in the kitchen and strings on all the chairs, as if Mattie had
sometimes tied them up. There was a book on the shelves about a
cat: “The World of Wonders, or Divers Developments Showing the
Thorough Triumph of Animal Magnetism in New England, Illustrated
by the Power of Prevision in Matilda Fox,” published in Boston in
1838. It was enlivened with pen-and-ink drawings showing Mrs.
Matilda Fox being hypnotized by a feather, with the cat in her lap,
which, according to the text, licked her neck until it sent her spirit
soaring from her body in aërial journeys to distant lands. As far as I
had time to read I could not ascertain whether the author was in
earnest or whether he was trying to ridicule animal magnetism, but I
could not help wondering if the book had not had some influence on
the legacy in favor of a home for cats, which had defrauded Mattie. If
any one could be put in a trance by the manipulation of the tongue of
a cat, perhaps she had not been entirely altruistic in her harboring of
the creatures. Certainly, the one who had rushed wildly out of the
house as we came in was glad to make its escape. Where were the
rest of the cats that belonged to the saucers? Catching fish on the
beach in the moonlight, possibly, and hypnotizing sand-pipers.
The books that told of cataleptic sleep were all well worn. The New
Captain lived in the days when the subject of a wandering mesmerist
would allow himself to be stretched out in a village drugstore window,
remaining inert between two chairs for days at a time, while the
curious glued their eyes to the glass and tried to stay there long
enough to see him move or catch a confederate sneaking in to feed
him. But this sleep was only the imperfect imitation of the
somnambulance which the East Indians had practised for centuries.
Theirs was true life-in-death, when the heart ceased to beat and the
body grew cold, and yet, to a disciple of the occult, there was a way
of reviving it. The theory of vampires rose from this phenomenon,
and that of catalepsy, for if a tomb were opened and the corpse
found without decay it was easy enough to ascribe the wilting of a
child, in the meantime, to the thirst of the absent spirit for blood to
satisfy its coffined body. More persons would have lived for longer
periods if, instead of making sure of death by driving a stake through
the possessed one’s heart, they had made sure of life by breathing
into his mouth and unwinding the tight shroud. The ancient Orientals
understood this. The holy fakirs permitted themselves to be buried
and dug up again, to the glory of God, only making sure beforehand
that their bodies were not interred in ground infested with white ants.
But the New Captain had the Puritan’s respect for life and death. He
dreaded that he would come to life again in an iron-bound box, or he
would not have despised undertakers or written into the will which
we had seen at the Winkle-Man’s the clause about Mattie spending a
week beside his body. He must have thought it was only due to her
that he had been called back before from the first of the seven
planes, and that his celestial passport was spurious unless she
signed it. Poor Mattie! No one had sat beside her after her tired spirit
had freed itself.
I picked up another book.
French, this time. It was called “Les Secrets du Petit Albert,” and
dealt with necromancy of the eighteenth century. There was also a
French book on astrology, illustrated with crude drawings of the
sacred signs of the zodiac and diagrams of potent numbers. Another
one, “Le Dragon Rouge, ou L’Art de Commander les Esprits
Célestes,” was not more than three by four inches, and half an inch
thick. Its brittle yellow pages were bound in worn calfskin, and gave
explicit directions how to conjure up the devil and how to send him
back to his own kingdom when one had done with him. My scant
school French could barely master the archaic forms, but I gave
Mattie full credit for being able to read all the volumes stored on her
top shelf. Her ancestry was traditionally French, according to the
judge’s story, for she had been picked up from a ship just off
Quebec, and the grooves of her mind would run easily to the mother-
tongue. A recluse will master a foreign language for the mental
exercise it affords. Perhaps in some other nook of the house I should
find her French grammar, but here, indeed, were books that some
one must have been able to read,—a significant part of their highly
specialized library.
I began reading aloud from “Le Dragon Rouge”:
“Je te conjure, O Esprit! Deparoitre dans la minute par la force du
grand Adonay, par Eloim, par Ariel, par Jehovam, par Agla, Tagla,
Mathon, Oarios, Almouzin, Arios, Menbrot, Varios, Pithona, Magots,
Silphae, Cabost, Salamandre, Tabots, Gnomus Terrae, Coelis,
Godens, Aqua, Gingua, Janua, Etituamus, Zariatnatmik, A. E. A. J.
A. T. M. O. A. A. M. V. P. M. S. C. T. G. T. C. G. A. J. E. Z.”
[“I conjure thee, O Spirit, to appear instantly through the will of the
great Adonay”—etc.]
The little magic book then went on to say that if this were repeated
twice, Lucifer would appear immediately. I thought perhaps it would
be just as well to discontinue reading.
Had they actually attempted materialization up here in this very room
in the old house on the tip end of the cape? There was nothing
against it. If it were possible anywhere to conjure up the shades of
the dead, or the devils themselves, this was as apt a place as any—
a hamlet at the tip of a barren cape that extended into the ocean a
hundred and forty miles, a house separated from that hamlet by its
bad repute, as well as its location, a room cut off from the rest of the
house, and two people in it who had no contact with realities, to
whom each was the other’s world and this world not all. If any one
was able to cut through the opaque cloud of dogma surrounding
metaphysical subjects to a glimpse of realities beyond, I believed
that Mattie had done so. And then, I realized that I had come by a
circuitous path of my own to the very same conclusion that all the
townspeople had long since come to—that Mattie was clairvoyant.
Would that help her now? Did she know where her spirit would dwell
more accurately than those who were orthodox? Could she return
the more easily from Stygian shores? Or was that power of prevision
only a mortal faculty that passed with her passing and that, while it
was able to call up others from the further world, could not bring
back itself?
There was a story of an old nurse of mine that I wished I had
forgotten—how she was once governess in a house where a strange
foreign gentleman had intercourse with spirits; how he used to talk to
them as he walked about the rooms—and was happy in their
friendship and sullen when they would not appear.
“That was all right for him,” she used to say; “but after he left, the
spirits that he had called up to amuse him still hung around. That
they did, and I could never get rid of them. Try as I would,—paint,
paper, or insect-powder,—every dark night when I was alone one or
the other of them would brush up against me and stay just where I
could never quite see it until dawn.”
It was a dark night and I was alone. I sincerely hoped that whatever
had been conjured up by Mattie would not brush past me. At any
rate, I had no mind to sleep upstairs again in that little gabled room. I
did not argue with myself about the headboard; it was too late at
night for that. I opened up a folding sofa in the room that I was in,
where the New Captain must have slept many times, and lay down.
The sound of the full tide on the rising, answering the questioning of
the Five Pines trees, made a lullaby.
It was with a shock and the feeling that I had been asleep a long
time that I woke up, hearing some one coming down the stairs. The
little kitchen-stairs, it must be, that pitched down from the upper
room like a ladder, for the main stairs were too far away for me to
have heard any footfall on them. And this was not the clumping step
of a full-sized man. This was the stealthy, soundless tread of a body
without weight. But still it was unmistakable.
I sat up in chilled terror, gathering the bed-clothes around me with
that involuntary gesture known to all women surprised in their sleep,
and waited for whoever it was to come through the kitchen into my
room.
But no one entered my room.
At the foot of the stairs some one tried a door, rattled a latch, and
went back up again. For a brave second I thought I would leap out of
bed and run and push the bolt on the kitchen door, but before I
managed to start I heard the footsteps coming down upon me. This
time they would keep on, I thought; but again slowly, laboriously,
they went back up, and every time they lost themselves upstairs it
seemed as if I heard the weight of a person thrown against a door.
Or did it go through the door and then throw its weight against it? I
strained to listen. Then the steps would come down again. The
inside door of the eaves closet upstairs was locked. I had left it the
way I had found it, but the steps seemed not to be within that secret
room to-night, but without, as if last night a presence had been
struggling to get through the closet into my room and now was trying
to get back. Tortured, restless footsteps going up and down the
stairs, up and down, up and down.
Every time they reached the bottom and tried the kitchen door, I
swooned with terror. When they rattled the latch and went back up
again I clutched my knees and did not breathe till they returned.
At cockcrow they ceased of their own volition, and, my will released,
my body fell exhausted.
 CHAPTER X
THE CAT OR THE CAPTAIN

WHEN I awoke the sun was shining in the windows on both sides of
the study where I had gone to bed, the neighbor’s chickens were
clucking through my back-yard, and the boats on the bay were
putting up their sails. The past night seemed unreal.
The door at the foot of the kitchen companionway was not only wide
open, but fastened back with a brick. I had forgotten that. Then how
could I have heard some one trying the latch? And upstairs the little
room was just as I had left it, not a thing disturbed. No one could
have thrown himself against the small eaves-closet door from this
side, because the bed was still in front of it, and no one could have
been shut in on the other side and at the same time be pacing up
and down steps. I went into the upper hall and looked at the big main
stairs. Had any one been climbing them? But if any one had, I should
have hardly been able to hear him, away off in the wing behind the
kitchen. Perhaps I could persuade the judge to come to the house
and practise going up and down the flight of stairs, while I listened
from the study.
I had been reading too much last night in the old vellum-bound
books of occult sciences. Without understanding the manner of
doing so, I had evidently hypnotized myself into the condition in
which the thing that I thought probable seemed to be true. I had
made up my mind that Mattie was a clairvoyant and could
materialize spirits and that those spirits might still linger in the house;
thereupon I myself had materialized one, unconsciously. The first
night I had half-expected to hear or see something uncanny, and it
had followed that I had. These manifestations were due to the
influence upon me of what I had heard about the House of the Five
Pines, and to nothing else. Jasper had not known all the harrowing
stories that were in circulation, and so he had not seen the moving
headboard. If he had been with me on the second night he doubtless
would not have heard footsteps. It was all perfectly simple when you
understand psychology; that was it, to keep a firm hold on yourself,
not to be carried away by imaginings.
And then I defended myself that any one left alone in a big house
like that would be hearing things at night and that I was no more
weak-minded than the rest.
After breakfast I began again upon the settling.
One of the features of the House of the Five Pines was that
everything in it was included in the sale. Perhaps because there
were no heirs, or because Judge Bell, as the trustee, was not
grasping; perhaps, and most probable of all, because the
townspeople had such a dread of it that they would take nothing from
it. The family linen still was packed away in the big sea-chest—
homespun sheets and thin yellow blankets, pillow-cases with
crocheted lace. The family china remained in the cupboard behind
the front hall—firestone pitchers and teapots, in pink and faded
purple, luster bowls, and white plates as heavy as dumb bells, each
with a gold leaf in the center; and in a corner cupboard in the dining-
room was almost a full set of willow-ware, with all the lids unbroken
on the little rice-cups. The big mahogany bureaus, and there were at
least two in each room, four drawers below and three little ones
above, contained the clothing of two generations of Haweses. This
meant more in the Old Captain’s family than the usual sixty years; it
meant a hundred, for two more generations could easily have been
born in the old homestead if “Mis’ Hawes” had not been so set
against the New Captain’s marriage. Her brass-handled high-boy
held calico dresses and muslin underwear, yellow and stiff with
starch, that Mattie had neither disposed of nor used. Upstairs there
was apparel that must have dated back past the era of the New
Captain into that of his father, Jeremiah. In Mattie’s room was less
than in the others. She had found herself at the end of her life with
barely a change of linen.
In the study two doors at either side of the finely carved mantel
opened into closets. One was filled with shelves on which were
papers and magazines that had been stored for twenty years. The
other was filled with the out-of-door clothes of the New Captain—a
worn cardigan jacket, and a thick blue coat with brass buttons, two
felt hats, and a yellow oilskin. A red shawl hung on a hook at the end
of the closet. I took it down to see if there were moths in it, then
dropped it and backed away. The hook that I had lifted the shawl
from was an old iron latch. The whole end of the closet was a wall-
paper covered door.
I was afraid. The flat sealed door might open on the latch, or it might
not. It might be fastened on the other side. I could not tell. But I did
not want to know what was on the other side. I did not want to stay
here any longer.
I fled out to the sunlight and around to the back of the house. There
was nothing visible; I had known that all the time. The wall-paper
covered door inside must lead either up or down. Down, there was
nothing but space beneath the house, the “under,” filled with rubbish.
Up—?
I remembered the footsteps of the night before and knew now why
the kitchen door and the little one in the upper room had looked so
unmolested. Those steps that I had heard had been traveling not the
kitchen companionway nor the main front stairway, but secret stairs
built in this wall behind the chimney, connecting with the room
above. That was where the restless spirit had been promenading,
just as it had been the first night, and that was where it still must be.
I could not wait for Jasper to return from New York to solve this
mystery. Neither did I dare to face it alone nor put it off longer. I
would go and get Judge Bell, and together we would hurry back and
find out who or what was living in my house.
But the Judge was not at home. Dropping down on his front porch I
thought of what Ruth had said to me last summer, that the first three
times you attempted to call on any one that person was always out!
Well, I could wait. I was in no rush to return to the House of the Five
Pines. I could stay here all day, if necessary.
At noon Judge Bell’s Portuguese cook came out and looked me
over.
“The judge he won’t be back,” she volunteered.
“Why not?”
She only smirked without replying.
“Why not? Doesn’t he come for lunch?”
She stuck her second finger in the roof of her mouth and looked
away.
“Not always, he don’t. Not to-day, anyhow.”
“Where is he?” I intended to follow him to his lair, wherever it was,
but Isabella seemed to think I was prying.
“I ain’t to say where he went,” she answered, twisting one bare foot
over the other. “He says if anybody asts me I don’ know.”
“And don’t you?” I could not resist.
But she only stuck her finger further into her mouth until I was afraid
that she would choke. I saw that I was tempting her to be unfaithful
to a trust, and dropped the matter. The judge must have gone off
down the cape to a séance, leaving orders with Isabella to uphold
the majesty of the law.
My next stop was the Sailor’s Rest.
I hoped to find Alf there. He would not be so stanch an ally as the
judge in this emergency, because he believed in ghosts himself and
could scarcely be convincing in his reassurances. But he might be
persuaded to break open those doors for me, and I would repay him
by promising to look over all the antique correspondence tucked
away in the pigeonholes of the desk for stamps. There might well be
some rare ones left at the House of the Five Pines. I opened the
office door carefully this time, remembering not to raise a draft that
would blow his collection away.
Behind the ledger sat a strange girl in a georgette waist, dressed to
take tickets at a motion-picture window, who informed me firmly that
“Mr. Alfred had gone to Boston.”
To Boston! It was then that I realized how dear Alf was to me.
I turned sadly into the dining-room and tried to eat the beef-hash.
One could follow the developments of the hotel’s cuisine by lunching
there daily. First the roast and then the stew, then the hash, and then
the soup—just like home. And fresh clams every day,—unless they
were the same clams! After lunch I loitered around the lobby for an
hour, trying to pick out some one among the strangers who came in
and out at infrequent intervals who would be likely to go back to the
House of the Five Pines with me willingly, as a matter of course,
without asking too many pertinent questions. I planned what I would
say and what the man thus addressed would answer.
I would say, “There is a door at my house that is locked on the
further side of a secret closet behind the bed that I want to open, and
another one downstairs, in—” How absurd! If it were only one door it
might not sound so preposterous.
I might begin: “My husband is in New York, and I want you to come
up to my house and open a door of a secret room—” No, that was
worse yet. To a beginning like that a man would only say, “Indeed?”
and walk off; or he might reply, “Thanks awfully!”
There was no use in accosting any one. They all looked as if they
would turn and run. If only some summer people were here—
adventurous artists, or intrepid college boys, or those Herculean
chauffeurs that haunt the soda-fountains while their grande dames
take a siesta! But there was no one.
Finally I remembered the Winkle-Man, and hurried up there.
I was surprised to find outside that the wind had turned, the sun had
gone, and a storm was coming up—a “hurricane,” as they call it on
the cape. A fisherman knocked into me, hurrying down to the beach
to drag his dory up beyond the rising. Outside of the point, where the
lighthouse stood, one could see a procession of ships coming in, a
whole line of them. I counted seven sweeping up the tip of the cape,
like toys drawn by children along the nursery floor. They seemed to
ride the sand rather than the sea, their sails appearing above that
treacherous neck which lay between them and me. Their barometers
must have registered this storm hours ago, for they were converging
from all the far-off fishing-banks. The bay was black. Near shore the
sailors were stripping their canvas, letting out their anchors, or tying
up to the wharves. There was a bustle and a stir in the harbor like
the confusion of a house whose occupants run wildly into one
another while they slam the windows. I ought to go up to the House
of the Five Pines and shut mine.
The tide was far out. Beyond the half-mile of yellow beach it beat a
frothy, impatient tattoo upon the water-line. When it came in it would
sweep up with a rush, covering the green seaweed and the little rills
with white-capped waves, pounding far up against the breakwaters,
setting the ships rocking and straining at their ropes, carrying away
everything that it could pry loose. Now it was waiting, getting ready,
lashing itself into a fury of anticipation. There was a feeling of
suspense to the air itself, cold in an under-stratum that came across
the sea, hot above where it hung over the torpid land. It seemed as if
you could feel the wind on your face, but not a leaf stirred. People
were hastening into their homes, even as the boats were scurrying
into the harbor. No one wanted to be abroad when the storm struck.
The Winkle-Man’s loft was deserted. I saw him far out upon the flats,
still picking up his winkles with his pronged fork, hurrying to get all he
could before the tide covered them, knowing with the accuracy of an
alarm-clock when that would be. Should I wait for him? He might not
come back, for he did not live in this shack and where his home was
I did not know. I stood wondering what to do, when suddenly down
the street came a horse and wagon, the boy beating the beast to
make it go even faster, although it was galloping up and down in the
shafts and the stones were rattling out of the road. The dust flew into
my face when they flashed by. Then, as quickly, the whole fantastic
equipage stopped.
“Whoa!” yelled the boy. You could hear him up and down the street.
He jumped over the back of the seat and threw something—a great
box, as nearly as I could make out—into the road, and then, turning
the wagon on two wheels, came careening back again, still beating
the horse as he went past me, standing up and lashing it with the
whip, cursing like a sailor, and vanishing in his own cloud.
All this to get back before it rained?
I looked down the street to where the box lay in the middle of the
road, and then I saw that he had dropped it in front of my house. It
was my box he had delivered, and his hurry had not been entirely
because of the storm. I suppose I might expect to have all my
packages dropped in the road by fleeing rogues too craven to go
near the dwelling.
Vexed with him for being such a fool, knowing I could not leave my
belongings there in the street through a hurricane that might develop
into a three days’ storm, yet still having no one to help me, I ran up
the path as the first drops came down on my head and, getting an
old wheelbarrow out of the yard, hoisted the heavy thing into it and
pushed it up to the door. It was a box of books, packed in my
husband’s sketchy manner, with openings between the boards on
top through which newspapers showed. Not the sort of covering to
withstand a northwest storm! And it was very heavy. A bitter gust
drove a flying handful of straw up the street and whirled it round and
round in the yard till it caught in the tops of the pine-trees like a
crow’s-nest. They bent and swayed and squeaked under the high
wind. A sheet of solid rain swept across the bay like a curtain just as
I succeeded in shoving the box of books over the threshold and shut
the door behind me.
Something had come in with me. It eyed me from under the stove.
There was the skinny cat that had bounded out of the house with our
arrival and had never been seen since! Tired with my futile trip,
overwrought with the approaching storm, angry over my struggles
with the box, I leaped upon the creature as if it was the cause of all
my troubles.
“Get out! You can’t stay here! I don’t want you! Scat!”
But the cat thought otherwise.
It leaped past my clutch, scampering through the kitchen and on into
the study beyond. I followed fast. The room was half-dark with the
storm that beat around it; the rain made a cannonade upon the roof
and blinded the windows with a steady downpour. The whole house
shook. The five pine-trees outside bent beneath the onslaught as if
they would snap and crash down upon me. I knew that the old
shingles must be leaking, but first of all I must get that cat, I must put
that horrible beast out!
As if it knew my thoughts it jumped upon the mantel and raised its
back at me. Its eyes were green in its small head and its tail waved
high above it. It did not seem to be a cat at all, but the reincarnation
of some sinister spirit, tantalizing and defiant, aloof, and at the same
time inexorable. I was so excited that I picked up the poker and
would have struck it dead. But it dodged and leaped away—into the
coat-closet, and I after it. I made a lunge with the poker, missed the
cat, and struck the latch of the forbidden door. It flew open. The cat
sprang—and disappeared. I followed. As I found myself climbing
steep steps hand over hand in a black hole, I had time to think, like a
drowning man, that anyway I had the poker, and if it was the captain
hiding up there, he must be an old man and I could knock him down.
I did not want to be locked in the house in a hurricane with a black
cat and God knows what. I wanted to find out.
What I found was more of a shock than what I was ready to meet.
 CHAPTER XI
THE THIRD NIGHT

THIS was a child’s room; there were playthings on the floor.

The rain fell heavily on the low roof, blanketing the skylight and
making the loft so dark that for a few seconds I could not see.
A sound came from a far corner. High-strung with terror, I thought it
was some witless creature who had been concealed up here for
many years, waiting for death to unburden it from a life that could
never grow old.
It moved—and I saw it was the cat.
Again I could have killed it, but instead I sank down on the floor and
began to laugh and cry.
“Come here, Cat! I won’t hurt you. We’re all mad together.”
But the cat mistrusted me. She slunk away, and for a while watched
me very carefully, until, deciding that I had lost interest in her, she sat
up and licked her tail. I wondered if this was her regular abode and if
it was she whom I had heard walking above me at night, and, if so,
how she managed an entrance when the doors were closed.
Perhaps she was feline by day and by night was psychic. But she
was not a confidential cat. Something fell coldly on my hand. I looked
up. The skylight was leaking.
I could distinguish the furniture in the loft now. I saw a wash-bowl on
a little stand, and put it under the loose-paned glass in the roof
beneath which a pool was spreading. There was a low bureau in the
room and a short turned bed, painted green, with a quilt thrown over
one end, two little hand-made chairs, and one of those solid wooden
rocking-horses, awesomely brave in the dusk. An open sea-chest
held picture-books and paints and bent lead soldiers, and strewn
upon the floor were quahaug-shells and a string of buoys. The room
appeared as if its owner had just stepped out, and once more I took
a cautious look around, behind me and in all the corners. Running
my hand over the quilt I found that the dust of years was thick upon
it. This attic had not been lived in recently. Its disturbed face was
only the kind of confusion that is left after some one has died whose
belongings are too precious to touch.
I opened one of the drawers of the cherry bureau and discovered
that it was full of the clothes of a little boy, of a period so long ago
that I could not fathom the mystery of who he might have been.
Tears came to my eyes as I unfolded the little ruffled shirts made by
hand out of faded anchor-printed calico, and picked up the knitted
stockings. This had been a real child; there were real holes in the
stockings.

My theory that it was the captain who was living up here was
exploded. Like a percussion-cap under a railroad train it had gone off
when I blundered into the room. Nothing remained of it now but a
wan smile and a sensation of relief. I only regretted that I had not
broken open both doors behind my bed after the first night and rid
my mind of the obsession at once. I walked across the room to the
door at the far end and found it was not locked after all, only that the
rusty latch was stuck. Forcing it up, I found myself, as I had
expected, in the eaves closet, where the little door ahead of me led
into Mattie’s room. I would have to go down the other way and move
the bed in order to open it, but I felt assured that no one had been
before me and escaped by retreating through here. I peered up and
down the black length of the closet, whose floor was the adjacent
edge of the roof of the old part of the house. Obviously no one was
concealed. But from the rain that filtered in and the shaking of the
attic beneath the storm, I felt that drafts alone might have caused the
bending of the wall. Wind was sure to be playing tag at midnight in
this space between two partitions, and a neurasthenic imagination
could supply the rest.
I only wished that I had all those miserable hours back that I had
wasted during the day, wrestling with the mystery. The best theory
that I had evolved was that the New Captain had not died at all, but
that Mattie, watching him during that legendary week, had managed
to raise him out of his cataleptic sleep, and, although the
townspeople thought he had been buried, she had kept his life a
secret for the last five years. She could easily have hidden him in
this unknown room. That would explain why she was so loath to
show the house to any one. It would also explain why she refused to
move out and why, in the end, she committed suicide rather than do
so. Not daring to abandon him and have him discovered by the next
occupant, an event which would end by their both being incarcerated
in the same poor-house, she had done away with herself. The
significance of this move would have been that Mattie was no longer
dependent on the New Captain nor enchained to him by the spirit, as
she was always reported to have been. Loving him, she would never
have deserted him. But thinking of him in the rôle of a cataleptic old
man, resuscitated after his second death, it was plausible to suppose
that he would be so loathsome as to have worn out all her emotions,
even faithfulness. He must have been no more than a crazy man,
shut up in that loft, and love, though as strong as Mattie’s had been,
cannot live forever on mere remembrance. So, according to my
solution, she had at last forsaken him, after having provisioned him
beforehand, as for a siege. It had been only the short length of a
month after her drowning that we had moved in, and during that time
no one else had been near the place. After my arrival, perhaps as
before, he had lain quiet all day. By night he had prowled around
trying to get out.
It was a grand theory—while it lasted. I did not analyse the flaws in it,
now I had given it up. Another night did that!
However, so many things had been solved by my heroic journey into
the unknown and the unknowable, and I was so interested in them,
that I forgot the rest. Here was the crux of the building of the
captain’s wing, the reason for not hiring workmen in the town, and
why Mattie alone had helped to carry lumber and worked until she
fell exhausted from her own roof. Without dwelling on the secret
room that had become a nursery, considering that room in its original
aspect as part of the passageway between Mattie’s room and the
New Captain’s, here was cause enough for not wanting any outside
help. Mrs. Dove had been wrong in her conclusion that because he
had employed no village carpenters they had afterward boycotted
him. He would never have given them the opportunity. Also, the
architectural idiosyncrasies of that room were her excuse for not
showing the house when the judge had tried to sell it. A person who
would buy it as I had, without going inside the door, was an
exception. There were not many whose need was so urgent; most
house-shoppers would have poked behind her bed and pried into all
the closets before the deal was closed.
Mattie had managed to keep this room hidden all her life. Alf, at the
Sailor’s Rest, had told me squarely that there was no attic, and he
knew as much as any one else in the town about the House of the
Five Pines. Old Mis’ Hawes had died without knowing that after
Mattie had plumped up her pillows and thrust the brass warming-pan
into her bed, and taken her candle and gone upstairs, she was able
to come down again and spend the evening with the New Captain. I
would keep the secret, too, partly out of loyalty to Mattie, who had
bequeathed it to me, and partly because it would be a lark to have it
known only to my dear one. I could hear Jasper’s exclamation of
pleased surprise when, some night after he had tucked me in, I
appeared again through his study-closet. It would be a game for
winter evenings.
I let myself down the steep steps behind the chimney and, going
through the study and the kitchen, came up into Mattie’s room.
Shoving the bed away from the little door in the eaves closet, I
opened it and walked straight back into the attic-chamber. That was
the way of it—a complete loop through the house!
Mattie’s room was to be mine for no other reason than its mysterious
means of egress. If I had any servants or any visiting relatives, I
would put them in the two big bedrooms on the other side of the
upper hall and turn the hall bedroom into a bath-room. But if I ever
had any babies, if we ever had, I knew where I would put them.
There was a room next mine waiting for some child to play with the
wall-eyed rocking-horse and sleep in the little turned bed. Dormer-
windows could be cut on both sides and running water be brought
up, and such a nursery would bloom beneath the old roof that the art
magazines would send up representatives to take pictures of it. I
could hardly restrain my impatience to begin to make it ready,
although as yet there was no need for it. For the first time since we
moved into the house I was happy and contented.
I was in the mood to write Jasper a long and intimate letter, telling
him of my hopes for our life up here and how the House of the Five
Pines was all ready for us. Of my hallucinations about the attic I said,
“Nothing was locked in the room but my own fears.”
The tide had turned, and from my window at the big desk in the
lower room I watched the lines of foaming spray licking up the
beach. There was no longer any horizon between sea and sky. All
was one blur of moving gray water, picked out with breaking white-
caps and roaring as it fought to engulf the land. I thought, as I often
had before: suppose the tide does not pause at the crest and retreat
into the ocean, but keeps on creeping up and over, over the bank
and over the road, over the hedge and over the house. However, as
always, it halted in its race, pawed upon the stone breakwater, and I
knew that by morning it would have slunk out again, and that
children would be wading where waves had been, and Caleb Snow
would be picking up winkles. Living was like that; the tide of our
passions turns. The New Captain had built this double room for the
great storm that had swept through his life, bearing away the
barricades of his traditions; but its force was spent now, and the
skeleton laid as bare as a fish-bone on the sandy flats where
strangers walked.
As I sat at the desk I smelled coffee cooking. The impression was so
strong that I went into the kitchen and walked over to the stove to
shove back the coffee-pot that I fancied had been left there since
morning. The fire must have caught on a smoldering coal and the
grounds were boiling up. But the coffee-pot was not on the stove. I
found it still on the shelf, and the coffee was safe in the can. The
odor must have come from out-of-doors.
I was too tired to figure the matter out, and ended by making some
for myself, and going to bed. This was my third night at the House of
the Five Pines, and I retired peacefully, in confidence, without any
disturbing inhibitions. Everything had been solved.
I had shut the door in the secret stairs in the study-closet and
fastened it with a piece of wire. In Mattie’s room I dropped down on
the bed where I had shoved it across the floor that afternoon.
Afterward I rose and pushed the bureau in front of the little door. I do
not know what subconscious motive impelled this, but a woman who
is living alone in a house with nine known rooms, none of which are
in their right places, and three stairs, front, back, and secret, ought to
be forgiven for locking up what she can.
Rain fell in wearied gusts; the worst was over. The wind, still high,
blew dense clouds across the face of the moon and carried them on
again over the sea, so that the waste was momentarily illumined.
Whenever the veils of mist were torn aside the oval mirror in its
frame above my bureau reflected the moonlight. I watched it for a
long time on my way to sleep.
At exactly twelve o’clock I found myself sitting up in bed.
There was moonlight in the room, that fell in quivering patches on
the bed-quilt and lightened up the dark walls, throwing into relief all
the five white doors. But there was also another light, on the ceiling,
that moved steadily up and down. Forcing my hypnotized glance
away from it, I turned to the haunted door and the bureau that I had
placed in front of it, and saw with sickening understanding that the
mirror above it was swaying on its hinges, swinging back and forth.
This caused the moonlight reflected from the water to dance like a
sun-spot. The glass turned as if it were being pushed and could not
keep its balance. I crawled over to it and put my hand out to steady
it, and the whole thing turned.
As I drew back, the pressure on the other side of the wall withdrew. I
could hear footsteps receding until they fell away down what I now
knew was the stairway at the other end of the secret room. I had
heard them the night before and I was sure. Whatever was in there
had given up trying to get out at this side and was going back to try