CHAPTER 4
Grammar
This module of the A2 test assesses communication skills. Grammar, punctuation, and spelling represent the building blocks of written communication. If English is not your first language, you can benefit from a review of these skills. Even if English is your first language, you may still wish to skim this chapter to get a sense of the key skills covered on the A2 test and to make sure that your skills are adequate.
SUBJECT-VERB AGREEMENT
Nouns and pronouns may be singular, referring to one person, place, thing, or idea. They may be plural, referring to more than one person, place, thing, or idea. In standard English, verbs agree with subjects in number. Singular subjects require singular verbs, and plural subjects require plural verbs.
• My supervisor reviews my work with me weekly. (singular)
• My supervisors review my work with me weekly. (plural)
• Everyone enjoys his lectures on surgical innovations. (singular)
• We enjoy his lectures on surgical innovations. (plural)
Do not become confused by words that come between a subject and verb.
• Recording songs with my friends is often hilarious. (singular)
• The tracks of the truck still show in the muddy ground. (plural)
In the case of multiple subjects, the verb depends on the conjunction used. Use a plural verb with subjects joined with and.
• Catherine and she work together on Mondays. (plural)
When subjects are joined with or, either/or, nor, or neither/nor, the verb should agree with the nearest subject.
• Neither the residents nor Catherine works on weekends. (singular)
The pronouns I and you take a plural verb, even when you is singular.
• I never believe a word in that so-called journal.
• You read far too many pseudo-scientific articles.
Certain indefinite pronouns may cause trouble. Be sure that you know which pronouns are singular and which are plural. A few may be either, depending upon context.
Indefinite Pronouns
• Everybody is going to the party. (singular)
• Several are going to the party. (plural)
PRONOUNS
Pronouns take the place of nouns in a sentence. They have gender, and they also have case.
Pronoun Case
Personal pronouns come in three cases. They may be subjects, objects, or possessive words. (See Table 4.1.) In addition, the pronoun who is a subject pronoun. The pronoun whom is an object pronoun.
Table 4.1 Pronoun Cases
Use subject pronouns as sentence subjects or after a linking verb.
• He and I always read to the patients in the children’s ward.
• The best volunteers in the hospital are they.
• Who worked the most hours in the month of August?
Use object pronouns as direct objects, indirect objects, or the objects of prepositions.
• The event celebrated him and us. (direct object)
• The director presented me with a plaque. (indirect object)
• To whom was that speech delivered? (object of a preposition)
Person pronouns my, your, his, her, its, our, and their come before a noun. The other possessive pronouns stand alone.
• That is my lab coat.
• That lab coat is mine.
Notice that no possessive pronoun takes an apostrophe!
Pronoun-Antecedent Agreement
The antecedent of a pronoun is the noun or pronoun it replaces or renames. Pronouns must agree with their antecedents in number and gender.
• Victoria presented her results in a seminar on Friday.
• He asked Darla to remind him about the lecture.
• Everyone should try to control his or her temper.
Antecedents joined by and require a plural pronoun.
• Song Lee and Jasper scowled because they disagreed.
Singular antecedents joined by or, either/or, nor, or neither/nor require a singular pronoun.
• Neither Vito nor Ralph remembered his notebook.
MISPLACED MODIFIERS
To make meaning clear, modifying phrases and clauses should appear as close as possible to the words they modify. Sometimes that requires moving words around. Sometimes it requires a rewrite.
• Wrong: At the age of two, my father taught me how to box. (Who was two years old? It’s not clear.)
• Right: When I was two, my father taught me how to box.
• Wrong: The house belongs to my uncle that has a cupola. (Who or what has a cupola? It’s not clear.)
• Right: The house that has a cupola belongs to my uncle.
SENTENCES
A sentence states a complete idea and is composed of at least one subject and one verb. Communicating in complete sentences is rare in these days of instant messaging and texts, but it remains a critical part of formal writing.
Run-ons
A run-on sentence typically consists of two or more sentences that lack internal punctuation. A comma splice is two or more sentences connected only by a comma. You may correct run-on sentences by breaking the sentences into correctly punctuated parts. You may often correct comma splices by replacing the comma with a semicolon or by adding a conjunction (and, but, or or).
• Run-on sentence: When I finished my shift I returned to the apartment it was as cold as an icebox the heat had switched off.
• Correct: When I finished my shift, I returned to the apartment. It was as cold as an icebox; the heat had switched off.
• Comma splice: I called up the landlord, I had to leave a message, he was not at home.
• Correct: I called up the landlord, but I had to leave a message; he was not at home.
Fragments
Fragments are parts of sentences written as sentences. They may be prepositional phrases, items in a series, dependent clauses, or simply subjects without predicates or predicates without subjects. They may require revised punctuation, or they may need additional words to complete them.
• Fragment: Trying to understand how anyone could like kale.
• Correct: I am trying to understand how anyone could like kale.
• Fragment: Our busy but productive day at the library.
• Correct: Our busy but productive day at the library meant that we finished our report early.
Organization
Sentences are made up of the eight parts of speech, as shown in Table 4.2.
Table 4.2 Parts of Speech
Syntax is the way in which we organize words, phrases, and clauses to form sentences. Most sentences in English conform to an SVO word order: The subject precedes the verb, which precedes the object, as in this example:
• 
In a compound sentence, two such independent clauses are joined using a semicolon or a comma plus a conjunction.
• The anesthesiologist replaced his gloves, and he discarded the old ones.
A complex sentence contains a dependent clause—a group of words, containing a subject and verb, that does not express a complete thought—attached to an independent clause.
• The anesthesiologist replaced his gloves because they were torn.
Finally, a compound-complex sentence contains more than one independent clause plus at least one dependent clause.
• The anesthesiologist replaced his gloves because they were torn, and he discarded the old ones.
In a sentence that is in active voice, the subject is clearly performing the action of the sentence.
• The receptionist called my name.
In a sentence that is in passive voice, the object of the action becomes the subject of the sentence.
• My name was called by the receptionist.
Active voice is usually clearer and more concise than passive voice.
Occasionally, changing passive voice to active voice requires the addition of a subject, as in this example:
• Passive: Her purse was stolen.
• Active: Someone stole her purse.
End Punctuation
Every sentence ends with a punctuation mark. The mark used depends upon the type of sentence. (See Table 4.3.)
Table 4.3 Sentences and End Punctuation
Test Yourself
1. Revise this run-on sentence to make it correct.
I’m not sure how to get there luckily my car has GPS.
2. Revise this passive voice sentence to make it active.
Our choices were marked on our ballots.
3. What part of speech is the underlined word?
After we visited the museum, we stopped for lunch.
A. Adjective
B. Adverb
C. Conjunction
D. Preposition
4. Which sentence is grammatically correct?
A. The sandwiches she made were eaten by us.
B. We ate the sandwiches she made.
C. She made the sandwiches of which we ate.
D. She made the sandwiches we ate them.
5. What punctuation is needed in the following sentence to make it correct?
Could you please inform the doctor of our grave concerns
A. Period
B. Comma
C. Question mark
D. Exclamation point
Answers
1. I’m not sure how to get there. Luckily, my car has GPS. OR I’m not sure how to get there; luckily, my car has GPS.
2. We marked our choices on our ballots. This is an example of a passive sentence that requires an added subject.
3. D. For is a preposition that relates what we did (stopped) to why we did it (lunch).
4. B. Choice A is passive voice, and choices C and D are ungrammatical.
5. C. Although this is similar to a command, it is framed in the form of a question.
COMMAS
Commas are not only the most common punctuation mark outside of the period, but they are also the most frequently misused. The rules are simple, but there are a lot of them.
In a Series
Use commas to separate items in a series. If you use the Oxford comma rule, the number of commas will equal the number of items minus one.
• I purchased a planner, note cards, and a stapler.
• The students gossiped, chatted, texted, and laughed.
• That is a well-stocked, economical, convenient store.
In Direct Address
Use a comma or commas to set off words used in direct address.
• Dr. Martinez, have you met our visiting lecturer?
• The new technique, Joe, is something you should master.
Between Independent Clauses
Use a comma to separate independent clauses joined by a conjunction in a compound sentence.
• That book was not in the library, but I found it online.
• We can work in the lab today, or we can enjoy the sunshine.
• This topic is especially difficult, and the test is next week.
After Words, Phrases, and Clauses
Use a comma after an introductory word, participial phrase, long or combined prepositional phrase, or adverb clause.
• No, I’m afraid that she cannot attend the event on Tuesday.
• Consumed by work, she will be in the office all day.
• At this time of year, the agency is especially busy.
• Until she completes the inventory, she will be unavailable.
With Nonessential Elements
Use commas to set off nonessential clauses, nonessential participial phrases, interrupting elements, or parenthetical asides.
• My friend Ellen, who comes from Chicago, is visiting.
• Ellen, hoping to find a new job, is sleeping on my couch.
• Her sister, my best friend from childhood, works overseas.
• Generally speaking, Ellen is proving to be a good guest.
SEMICOLONS AND COLONS
Some writers go out of their way to avoid semicolons, but this punctuation mark can be very useful. Writers rarely use colons, but when they do, they should use them correctly.
Semicolons
Use a semicolon to separate independent clauses in a compound sentence when the clauses are not joined by conjunctions.
• Kyra wandered all over the city; its history delighted her.
Use a semicolon to join independent clauses joined by transition words such as for example, nevertheless, or therefore. (Use a comma after the transition word.)
• She had never been abroad; nevertheless, she felt at ease.
Use a semicolon between items in a series when the items contain commas.
• On her tour were visitors from San Jose, California; Reno, Nevada; and Salt Lake City, Utah.
Colons
Use a colon to clarify items in a list or a formal statement or quote.
• You should take the following courses this year: one anatomy class, one psychology class, and a chemistry lab.
• My adviser had this to say: “Organic chemistry makes or breaks students.”
Use a colon between the hour and minute in time, between chapter and verse in Bible passages, and after the salutation in a business letter.
• 3:15
• Proverbs 17:22
• Dear Doctor Jessup:
APOSTROPHES
Apostrophes are small but mighty. They make the difference between well and we’ll, or between kings and king’s. Apostrophes are used to represent missing letters, and they are used in possessive forms of nouns.
With Possessives
A possessive noun shows ownership. Use an apostrophe plus s to form the possessive case of a singular noun.
• Is that Myra’s backpack?
• She took my father’s advice.
Use only an apostrophe to form the possessive case of a plural noun that ends in s.
• We followed the Smiths’ car to town.
• Jack bought five dollars’ worth of gas.
Use an apostrophe plus s to form the possessive case of a plural noun that does not end in s.
• The children’s trip to the zoo went well.
• They admired the deer’s various antlers.
Use an apostrophe plus s to form the possessive case of indefinite pronouns (but never of personal pronouns).
• Correct: Everyone’s reports are finished.
• Incorrect: Has the professor read your’s yet? (Use yours.)
With Contractions
A contraction is a shortened form of a word or group of words. Use an apostrophe to show where letters have been left out.
Some Examples of Contractions
TROUBLESOME WORD PAIRS
Certain words are frequently confused. If you can keep the meanings and spellings of the following pairs separate, your writing will benefit. Some of the pairs are homophones, meaning that they sound alike but mean different things. Others are just close in appearance and cause readers and writers difficulty. (See Table 4.4.)
Table 4.4 Troublesome Word Pairs
SPELLING RULES
Spelling is mostly a matter of memorization. However, as difficult as English is, and as many exceptions as there are to every rule, there are some spelling rules worth remembering. Table 4.5 shows a few.
Table 4.5 A Few Spelling Rules
Nouns with -ance and -ence endings are tricky enough that it’s worth memorizing a chart of both.
In addition, there are scores of spelling demons that everyone seems to misspell. A few that you might need to use in your medical career appear below.
Health-Related Spelling Demons
