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Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHIEF COMPLAINT: , Left breast cancer.,HISTORY:, The patient is a 57-year-old female, who I initially saw in the office on 12/27/07, as a referral from the Tomball Breast Center. On 12/21/07, the patient underwent image-guided needle core biopsy of a 1.5 cm lesion at the 7 o'clock position of the left breast (inferomedial). The biopsy returned showing infiltrating ductal carcinoma high histologic grade. The patient stated that she had recently felt and her physician had felt a palpable mass in that area prior to her breast imaging. She prior to that area, denied any complaints. She had no nipple discharge. No trauma history. She has had been on no estrogen supplementation. She has had no other personal history of breast cancer. Her family history is positive for her mother having breast cancer at age 48. The patient has had no children and no pregnancies. She denies any change in the right breast. Subsequent to the office visit and tissue diagnosis of breast cancer, she has had medical oncology consultation with Dr. X and radiation oncology consultation with Dr. Y. I have discussed the case with Dr. X and Dr. Y, who are both in agreement with proceeding with surgery prior to adjuvant therapy. The patient's metastatic workup has otherwise been negative with MRI scan and CT scanning. The MRI scan showed some close involvement possibly involving the left pectoralis muscle, although thought to also possibly represent biopsy artifact. CT scan of the neck, chest, and abdomen is negative for metastatic disease.,PAST MEDICAL HISTORY:, Previous surgery is history of benign breast biopsy in 1972, laparotomy in 1981, 1982, and 1984, right oophorectomy in 1984, and ganglion cyst removal of the hand in 1987.,MEDICATIONS:, She is currently on omeprazole for reflux and indigestion.,ALLERGIES:, SHE HAS NO KNOWN DRUG ALLERGIES.,REVIEW OF SYSTEMS:, Negative for any recent febrile illnesses, chest pains or shortness of breath. Positive for restless leg syndrome. Negative for any unexplained weight loss and no change in bowel or bladder habits.,FAMILY HISTORY:, Positive for breast cancer in her mother and also mesothelioma from possible asbestosis or asbestos exposure.,SOCIAL HISTORY: ,The patient works as a school teacher and teaching high school.,PHYSICAL EXAMINATION,GENERAL: The patient is a white female, alert and oriented x 3, appears her stated age of 57.,HEENT: Head is atraumatic and normocephalic. Sclerae are anicteric.,NECK: Supple.,CHEST: Clear.,HEART: Regular rate and rhythm.,BREASTS: Exam reveals an approximately 1.5 cm relatively mobile focal palpable mass in the inferomedial left breast at the 7 o'clock position, which clinically is not fixed to the underlying pectoralis muscle. There are no nipple retractions. No skin dimpling. There is some, at the time of the office visit, ecchymosis from recent biopsy. There is no axillary adenopathy. The remainder of the left breast is without abnormality. The right breast is without abnormality. The axillary areas are negative for adenopathy bilaterally.,ABDOMEN: Soft, nontender without masses. No gross organomegaly. No CVA or flank tenderness.,EXTREMITIES: Grossly neurovascularly intact.,IMPRESSION: , The patient is a 57-year-old female with invasive ductal carcinoma of the left breast, T1c, Nx, M0 left breast carcinoma.,RECOMMENDATIONS: , I have discussed with the patient in detail about the diagnosis of breast cancer and the surgical options, and medical oncologist has discussed with her issues about adjuvant or neoadjuvant chemotherapy. We have decided to recommend to the patient breast conservation surgery with left breast lumpectomy with preoperative sentinel lymph node injection and mapping and left axillary dissection. The possibility of further surgery requiring wider lumpectomy or even completion mastectomy was explained to the patient. The procedure and risks of the surgery were explained to include, but not limited to extra bleeding, infection, unsightly scar formation, the possibility of local recurrence, the possibility of left upper extremity lymphedema was explained. Local numbness, paresthesias or chronic pain was explained. The patient was given an educational brochure and several brochures about the diagnosis and treatment of breast cancers. She was certainly encouraged to obtain further surgical medical opinions prior to proceeding. I believe the patient has given full informed consent and desires to proceed with the above. | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PROCEDURE: , Urgent cardiac catheterization with coronary angiogram.,PROCEDURE IN DETAIL: , The patient was brought urgently to the cardiac cath lab from the emergency room with the patient being intubated with an abnormal EKG and a cardiac arrest. The right groin was prepped and draped in usual manner. Under 2% lidocaine anesthesia, the right femoral artery was entered. A 6-French sheath was placed. The patient was already on anticoagulation. Selective coronary angiograms were then performed using a left and a 3DRC catheter. The catheters were reviewed. The catheters were then removed and an Angio-Seal was placed. There was some hematoma at the cath site.,RESULTS,1. The left main was free of disease.,2. The left anterior descending and its branches were free of disease.,3. The circumflex was free of disease.,4. The right coronary artery was free of disease. There was no gradient across the aortic valve.,IMPRESSION: , Normal coronary angiogram., | Cardiovascular / Pulmonary |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | EXAM: , MRI of the brain without contrast.,HISTORY: , Daily headaches for 6 months in a 57-year-old.,TECHNIQUE: ,Noncontrast axial and sagittal images were acquired through the brain in varying degrees of fat and water weighting.,FINDINGS: , The brain is normal in signal intensity and morphology for age. There are no extraaxial fluid collections. There is no hydrocephalus/midline shift. Posterior fossa, 7th and 8th nerve complexes and intraorbital contents are within normal limits. The normal vascular flow volumes are maintained. The paranasal sinuses are clear.,Diffusion images demonstrate no area of abnormally restricted diffusion that suggests acute infarct.,IMPRESSION: , Normal MRI brain. Specifically, no findings to explain the patient's headaches are identified. | Radiology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | EXAM:, Nuclear medicine tumor localization, whole body.,HISTORY: , Status post subtotal thyroidectomy for thyroid carcinoma, histology not provided.,FINDINGS: , Following the oral administration of 4.3 mCi Iodine-131, whole body planar images were obtained in the anterior and posterior projections at 24, 48, and 72 hours.,There is increased uptake in the left upper quadrant, which persists throughout the examination. There is a focus of increased activity in the right lower quadrant, which becomes readily apparent at 72 hours. Physiologic uptake in the liver, spleen, and transverse colon is noted. Physiologic urinary bladder uptake is also appreciated. There is low-grade uptake in the oropharyngeal region.,IMPRESSION: ,Iodine-avid foci in the right lower quadrant and left upper quadrant medially suspicious for distant metastasis. Anatomical evaluation, i.e., CT is advised to determine if there are corresponding mesenteric lesions. Ultimately (provided that the original pathology of the thyroid tumor with iodine-avid) PET scanning may be necessary. No evidence of iodine added locoregional metastasis. | Radiology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | HISTORY OF PRESENT ILLNESS: , She is a 28-year-old G1 at approximately 8 plus weeks presented after intractable nausea and vomiting with blood-tinged vomit starting approximately worse over the past couple of days. This is patient's fourth trip to the emergency room and second trip for admission.,PAST MEDICAL HISTORY: , Nonsignificant.,PAST SURGICAL HISTORY: , None.,SOCIAL HISTORY: , No alcohol, drugs, or tobacco.,PAST OBSTETRICAL HISTORY: ,This is her first pregnancy.,PAST GYNECOLOGICAL HISTORY: , Not pertinent.,While in the emergency room, the patient was found to have slight low sodium, potassium slightly elevated and her ALT of 93, AST of 35, total bilirubin is 1.2. Her urine was 3+ ketones, 2+ protein, and 1+ esterase, and rbc too numerous to count with moderate amount of bacteria. H and H stable at 14.1 and 48.7. She was then admitted after giving some Phenergan and Zofran IV. As started on IV, given hydration as well as given a dose of Rocephin to treat bladder infection. She was admitted overnight, nausea and vomiting resolved to only one episode of vomiting after receiving Maalox, tolerated fluids as well as p.o. food. Followup chemistry was obtained for AST, ALT and we will plan for discharge if lab variables resolve.,ASSESSMENT AND PLAN:,1. This is a 28-year-old G1 at approximately 8 to 9 weeks gestation with one hyperemesis gravidarum admit for IV hydration and followup.,2. Slightly elevated ALT, questionable, likely due to the nausea and vomiting. We will recheck for followup. | General Medicine |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: , Left inguinal hernia.,POSTOPERATIVE DIAGNOSIS:, Left indirect inguinal hernia.,PROCEDURE PERFORMED:, Repair of left inguinal hernia indirect.,ANESTHESIA: , Spinal with local.,COMPLICATIONS:, None.,DISPOSITION,: The patient tolerated the procedure well, was transferred to recovery in stable condition.,SPECIMEN: , Hernia sac.,BRIEF HISTORY: , The patient is a 60-year-old female that presented to Dr. X's office with complaints of a bulge in the left groin. The patient states that she noticed there this bulge and pain for approximately six days prior to arrival. Upon examination in the office, the patient was found to have a left inguinal hernia consistent with tear, which was scheduled as an outpatient surgery.,INTRAOPERATIVE FINDINGS: , The patient was found to have a left indirect inguinal hernia.,PROCEDURE: , After informed consent was obtained, risks and benefits of the procedure were explained to the patient. The patient was brought to the operating suite. After spinal anesthesia and sedation given, the patient was prepped and draped in normal sterile fashion. In the area of the left inguinal region just superior to the left inguinal ligament tract, the skin was anesthetized with 0.25% Marcaine. Next, a skin incision was made with a #10 blade scalpel. Using Bovie electrocautery, dissection was carried down to Scarpa's fascia until the external oblique was noted. Along the side of the external oblique in the direction of the external ring, incision was made on both sides of the external oblique and then grasped with a hemostat. Next, the hernia and hernia sac was circumferentially grasped and elevated along with the round ligament. Attention was next made to ligating the hernia sac at its base for removal. The hernia sac was opened prior grasping with hemostats. It was a sliding indirect hernia. The bowel contents were returned to abdomen using a #0 Vicryl stick tie pursestring suture at its base. The hernia sac was ligated and then cut above with the Metzenbaum scissors returning it to the abdomen. This was then sutured at the apex of the repair down to the conjoint tendon. Next, attention was made to completely removing the round ligament hernia sac which was again ligated at its base with an #0 Vicryl suture and removed as specimen. Attention was next made to reapproximate it at floor with a modified ______ repair. Using a #2-0 Ethibond suture in simple interrupted fashion, the conjoint tendon was approximated to the ilioinguinal ligament capturing a little bit of the floor of the transversalis fascia. Once this was done, the external oblique was closed over, reapproximated again with a #2-0 Ethibond suture catching each hump in between each repair from the prior floor repair. This was done in simple interrupted fashion as well. Next Scarpa's fascia was reapproximated with #3-0 Vicryl suture. The skin was closed with running subcuticular #4-0 undyed Vicryl suture. Steri-Strips and sterile dressings were applied. The patient tolerated the procedure very well and he was transferred to Recovery in stable condition. The patient had an abnormal chest x-ray in preop and is going for a CT of the chest in Recovery. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | SUBJECTIVE:, This is a 62-year-old female who comes for dietary consultation for carbohydrate counting for type I diabetes. The patient reports that she was hospitalized over the weekend for DKA. She indicates that her blood sugar on Friday night was 187 at bedtime and that when she woke up in the morning her blood sugar was 477. She gave herself, in smaller increments, a total of 70 extra units of her Humalog. Ten of those units were injectable; the others were in the forms of pump. Her blood sugar was over 600 when she went to the hospital later that day. She is here at this consultation complaining of not feeling well still because she has a cold. She realizes that this is likely because her immune system was so minimized in the hospital.,OBJECTIVE:, Current insulin doses on her insulin pump are boluses set at 5 units at breakfast, 6 units at lunch and 11 units at supper. Her basal rates have not been changed since her last visit with Charla Yassine and totaled 30.5 units per 24 hours. A diet history was obtained. I instructed the patient on carbohydrate counting at 1 unit of insulin for every 10 g carbohydrate ratio was recommended. A correction dose of approximately 1 unit of insulin to bring the blood sugars down 30 mg/dl was also recommended. The Lilly guide for meal planning was provided and reviewed. Additional carbohydrate counting book was provided.,ASSESSMENT:, The patient was taught an insulin-to-carbohydrate ratio of 1 unit to 10 g of carbohydrates as recommended at the previous visit two years ago, which she does not recall. It is based on the 500 rule which suggests this ratio. We did identify carbohydrate sources in the food supply, recognizing 15-g equivalents. We also identified the need to dose her insulin at the time that she is eating her carbohydrate sources. She does seem to have a pattern of fixing blood sugars later in the day after they are elevated. We discussed the other option of trying to eat a consistent amount of carbohydrates at meals from day to day and taking a consistent amount of insulin at those meals. With this in mind, she was recommended to follow with three servings or 45 g of carbohydrate at breakfast, three servings or 45 g of carbohydrate at lunch and four servings or 60 g of carbohydrate at dinner. Joanne Araiza joined our consultation briefly to discuss whether her pump was working appropriately. The patient was given an 800 number for the pump to contact should there be any question about its failure to deliver insulin appropriately.,PLAN:, Recommend the patient use 1 unit of insulin for every 10-g carbohydrate load consumed. Recommend the patient either use this as a carbohydrate counting tool or work harder at keeping carbohydrate content consistent at meals from day to day. This was a one-hour consultation. Provided my name and number should additional needs arise. | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | TITLE OF OPERATION:,1. Diagnostic arthroscopy exam under anesthesia, left shoulder.,2. Debridement of chondral injury, left shoulder.,3. Debridement, superior glenoid, left shoulder.,4. Arthrotomy.,5. Bankart lesion repair.,6. Capsular shift, left shoulder (Mitek suture anchors; absorbable anchors with nonabsorbable sutures).,INDICATION FOR SURGERY: , The patient was seen multiple times preoperatively and found to have chronic instability of her shoulder. Risks and benefits of the procedure had been discussed in length including but not exclusive of infection, nerve or artery damage, stiffness, loss of range of motion, incomplete relief of pain, continued instability, recurrent instability, medical complications, surgical complications, and anesthesia complications. The patient understood and wishes to proceed.,PREOP DIAGNOSIS: , Anterior instability, left shoulder.,POSTOP DIAGNOSES:,1. Anterior instability, left shoulder.,2. Grade 4 chondromalacia, 10% humeral head, chondral defect 1 cm squared, left shoulder.,3. Type 1 superior labrum anterior and posterior lesion, left shoulder.,4. Anteroinferior glenoid erosions 10% bony surface, left shoulder.,5. Bankart lesion, left shoulder.,PROCEDURE: , The patient was placed in a supine position and both shoulders examined systematically. She had full range of motion with no joint adhesions. She had equal range of motion bilaterally. She had Hawkins 2 anteriorly and posteriorly in both shoulders with a grade 1 sulcus sign in both shoulders. This was the same when the arm was in neutral or in external rotation. The patient was then turned to right lateral decubitus position, axillary roll was placed, and beanbag was inflated. Peroneal nerve was well protected. All bony prominences were well protected.,The left upper extremity was then prepped and draped in the usual sterile fashion. The patient was given antibiotics well before the start of the procedure to decrease the risk of infection. The arm was placed in a arm holder with 10 pounds of traction. A posterior portal was created in the usual manner by isolating gently with the spinal needle, it was insufflated with 30 cubic centimeters of saline. A small incision was made after infiltrating the skin with Marcaine and epinephrine. The scope was introduced into the shoulder with no difficulty. It was then examined systematically. The patient did have diffuse synovitis throughout her shoulder. Her posterior humeral head showed an enlarged bold spot with some other areas of chondromalacia on the posterior head. She also had an area 1 cm in diameter, which was on more central portion of the head and more inferiorly which appeared to be more of an impaction-type injury. This had some portions of fibrillated and loose cartilage, hanging from the edges. These were later debrided, but the dissection was proximally 10 to 15% of the humeral surface.,The biceps tendon appeared to be normal. The supraspinatus, infraspinatus tendons were normal. The inferior pouch was normal with no capsular tearing and no HAGL lesions. The posteroinferior labrum was normal as well as the posterosuperior labrum. There was some fraying in the posterosuperior labrum, which was later debrided. It was found essentially to be a type 1 lesion anteriorly and superiorly. The anterosuperior labrum appeared to be detached, which appeared to be more consistent with a sublabral hole. The middle glenohumeral ligament was present as an entire sheath, but attach to the labrum. The labrum did appeared to be detached from the anterior glenoid from the 11 o'clock position all the way down to the 6 o'clock position. The biceps anchor itself was later probed and found to be stable and normal. The subscapularis tendon was normal. The anterior band of the glenohumeral ligament was present, but it was clearly avulsed off the glenoid. There was some suggestion of anteroinferior bony erosions, which was later substantiated when the shoulder was opened. The patient was missing about 10 to 15% of her anteroinferior glenoid rim. The patient had a positive drive-through sign.,The arm was then moved to lateral and placed through range of motion. There was contact of the rotator cuff to the superior glenoid in flexion at 115 degrees, maximum flexion was 150 degrees. The arm abducted and externally rotated. There was contact to the rotator cuff with posterosuperior labrum. This occurred with the arm position of 90 degrees with abduction at 55 degrees of external rotation. It should be noted that the maximum abduction is 150 degrees and with the arm abducted 90 degrees, maximum external rotation was 95 degrees. The patient did have a positive relocation maneuver. The posterior labrum did appear to tilt-off, but did not appear to peel off.,The arm was then placed back in the arm holder. Anterior portal was created with Wissinger rod. A blue cannula was inserted into the shoulder without difficulty. Shaver was introduced in the labrum. Also the area of chondromalacia as mentioned above was debrided. The labrum was found to be stable with only a type 1 SLAP lesion, and there was no evidence as there was really a type 2 SLAP lesion. The instruments were then removed along with excess fluid. The posterior portals were closed with single 4-0 nylon suture. The anterior portal was left open. The patient was then placed in a supine position, and the extremity was reprepped and draped in anticipation of performing open capsular shift.,The patient's anterior incision made just lateral to the coracoid in the skin line. Mediolateral skin flaps were developed, and cephalic vein was identified and protected throughout the case. The interval was developed down the clavipectoral fascia. The conjoined tendon was retracted medially and the deltoid laterally. The patient's subscapularis was intact, and the subscapularis split was then made between the upper one half and lower one half in line with muscle fibers. The capsule could easily be detached from the muscle, and the interval developed very easily. A retractor was placed inferiorly to protect the axillary nerve. Then Gelpi retractor was used to hold the subscapularis split open.,Next, an arthrotomy was made down at the 9 o'clock position. The labrum was identified and found to be attached all the way down to 6 o'clock position. The inferior flap was then created in a usual manner and tied with a 0 Vicryl suture. The patient's glenoid rim did have some erosion as mentioned above with some bone loss and flattening. This was debrided with the soft tissue. Three Mitek suture anchors were then placed into the glenoid rim right at the margin of articular cartilage to the scapular neck. These were absorbable anchors with nonabsorbable sutures. They had excellent fixation once they had been placed.,Next, the capsular shift and Bankart repair were performed in the usual manner with the number 2 Ti-Cron sutures as an outside in and then inside out technique. This brought the capsule right up to the edge of the glenoid rim. With the arm in internal rotation and posterior pressure on the head, the capsule was then secured to the rim with no difficulty under direct visualization. The capsule did come right up into the joint as expected with this type of repair. The superior flap was then closed, the inferior flap over the superior anchor. The interval between two flaps was closed with multiple number 2 Ti-Cron sutures. Once this has been completed, there was no tension on the repair with the arm to side until 10 degrees of external rotation was reached. The arm abducted 90 degrees. There was tension on the repair until 20 degrees of external rotation reached.,The wound was thoroughly irrigated throughout with antibiotic-impregnated irrigation. The subscapularis split was closed with interrupted 0 Vicryl sutures. The deep subcutaneous tissues were closed with interrupted 0 Vicryl sutures. The superficial subcutaneous tissues were closed with number 2-0 Vicryl sutures. The skin was closed with 4-0 subcuticular Prolene, reinforced with Steri-Strips. A sterile bandage was applied along with a cold therapy device and a shoulder immobilizer. The patient was sent to the recovery room in stable and satisfactory condition. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | REASON FOR CONSULTATION: , ICU management.,HISTORY OF PRESENT ILLNESS: , The patient is a 43-year-old gentleman who presented from an outside hospital with complaints of right upper quadrant pain in the abdomen, which revealed possible portal vein and superior mesenteric vein thrombus leading to mesenteric ischemia. The patient was transferred to the ABCD Hospital where he had a weeklong course with progressive improvement in his status after aggressive care including intubation, fluid resuscitation, and watchful waiting. The patient clinically improved; however, his white count remained elevated with the intermittent fevers prompting a CT scan. Repeat CT scan showed a loculated area of ischemic bowel with perforation in the left upper abdomen. The patient was taken emergently to the operating room last night by the General Surgery Service where proximal half of the jejunum was noted to be liquified with 3 perforations. This section of small bowel was resected, and a wound VAC placed for damage control. Plan was to return the patient to the Operating Room tomorrow for further exploration and possible re-anastomosis of the bowel. The patient is currently intubated, sedated, and on pressors for septic shock and in the down ICU.,PAST MEDICAL HISTORY:, Prior to coming into the hospital for this current episode, the patient had hypertension, diabetes, and GERD.,PAST SURGICAL HISTORY:, Included a cardiac cath with no interventions taken.,HOME MEDICATIONS:, Include Lantus insulin as well as oral hypoglycemics.,CURRENT MEDS:, Include Levophed, Ativan, fentanyl drips, cefepime, Flagyl, fluconazole, and vancomycin. Nexium, Synthroid, hydrocortisone, and Angiomax, which is currently on hold.,REVIEW OF SYSTEMS:, Unable to be obtained secondary to the patient's intubated and sedated status.,ALLERGIES: , None.,FAMILY HISTORY:, Includes diabetes on his father side of the family. No other information is provided.,SOCIAL HISTORY:, Includes tobacco use as well as alcohol use.,PHYSICAL EXAMINATION:,GENERAL: The patient is currently intubated and sedated on Levophed drip.,VITAL SIGNS: Temperature is 100.6, systolic is 110/60 with MAP of 80, and heart rate is 120, sinus rhythm.,NEUROLOGIC: Neurologically, he is sedated, on Ativan with fentanyl drip as well. He does arouse with suctioning, but is unable to open his eyes to commands.,HEAD AND NECK EXAMINATION: His pupils are equal, round, reactive, and constricted. He has no scleral icterus. His mucous membranes are pink, but dry. He has an EG tube, which is currently 24-cm at the lip. He has a left-sided subclavian vein catheter, triple lumen.,NECK: His neck is without masses or lymphadenopathy or JVD.,CHEST: Chest has diminished breath sounds bilaterally.,ABDOMEN: Abdomen is soft, but distended with a wound VAC in place. Groins demonstrate a left-sided femoral outline.,EXTREMITIES: His bilateral upper extremities are edematous as well as his bilateral lower extremities; however, his right is more than it is in the left. His toes are cool, and pulses are not palpable.,LABORATORY EXAMINATION: , Laboratory examination reveals an ABG of 7.34, CO2 of 30, O2 of 108, base excess of -8, bicarb of 16.1, sodium of 144, potassium of 6.5, chloride of 122, CO2 18, BUN 43, creatinine 2.0, glucose 172, calcium 6.6, phosphorus 1.1, mag 1.8, albumin is 1.6, cortisone level random is 22. After stimulation with cosyntropin, they were still 22 and then 21 at 30 and 60 minutes respectively. LFTs are all normal. Amylase and lipase are normal. Triglycerides are 73, INR is 2.2, PTT is 48.3, white count 20.7, hemoglobin 9.6, and platelets of 211. UA was done, which also shows a specific gravity of 1.047, 1+ protein, trace glucose, large amount of blood, and many bacteria. Chest x-rays performed and show the tip of the EG tube at level of the carina with some right upper lobe congestion, but otherwise clear costophrenic angles. Tip of the left subclavian vein catheter is appropriate, and there is no pneumothorax noted.,ASSESSMENT AND PLAN:, This is a 43-year-old gentleman who is acutely ill, in critical condition with mesenteric ischemia secondary to visceral venous occlusion. He is status post small bowel resection. We plan to go back to operating room tomorrow for further debridement and possible closure. Neurologically, the patient initially had question of encephalopathy while in the hospital secondary to slow awakening after previous intubation; however, he did clear eventually, and was able to follow commands. I did not suspect any sort of pathologic abnormality of his neurologic status as he has further CT scan of his brain, which was normal. Currently, we will keep him sedated and on fentanyl drip to ease pain and facilitate ventilation on the respirator. We will form daily sedation holidays to assess his neurologic status and avoid over sedating with Ativan.,1. Cardiovascular. The patient currently is in septic shock requiring vasopressors maintained on MAP greater than 70. We will continue to try to wean the vasopressin after continued volume loading, also place SvO2 catheter to assess his oxygen delivery and consumption given his state of shock. Currently, his rhythm is of sinus tachycardia, I do not suspect AFib or any other arrhythmia at this time. If he does not improve as expected with volume resuscitation and with resolution of his sepsis, we will obtain an echocardiogram to assess his cardiac function. Once he is off the vasopressors, we will try low-dose beta blockade as tolerated to reduce his rate.,2. Pulmonology. Currently, the patient is on full vent support with a rate of 20, tidal volume of 550, pressure support of 10, PEEP of 6, and FiO2 of 60. We will wean his FiO2 as tolerated to keep his saturation greater than 90% and wean his PEEP as tolerated to reduce preload compromise. We will keep the head of bed elevated and start chlorhexidine as swish and swallow for VAP prevention.,3. Gastrointestinal. The patient has known mesenteric venous occlusion secondary to the thrombus formation at the portal vein as well as the SMV. He is status post immediate resection of jejunum leaving a blind proximal jejunum and blind distal jejunum. We will maintain NG tube as he has a blind stump there, and we will preclude any further administration of any meds through this NG tube. I will keep him on GI prophylaxis as he is intubated. We will currently hold his TPN as he is undergoing a large amount of volume changes as well as he is undergoing electrolyte changes. He will have a long-term TPN after this acute episode. His LFTs are all normal currently. Once he is postop tomorrow, we will restart the Angiomax for his venous occlusion.,4. Renal. The patient currently is in the acute renal insufficiency with anuria and an increase in his creatinine as well as his potassium. His critical hyperkalemia which is requiring dosing of dextrose insulin, bicarb, and calcium; we will recheck his potassium levels after this cocktail. He currently is started to make more urine since being volume resuscitated with Hespan as well as bicarb drip. Hopefully given his increased urine output, he will start to eliminate some potassium and will not need dialysis. We will re-consult Nephrology at this time.,5. Endocrine. The patient has adrenal insufficiency based on lack of stem to cosyntropin. We will start hydrocortisone 50 q.6h.,6. Infectious Disease. Currently, the patient is on broad-spectrum antibiotic prophylaxis imperially. Given his bowel ischemia, we will continue these, and appreciate ID service's input.,7. Hematology. Hematologically, the patient has a hypercoagulable syndrome, also had HIT secondary to his heparin administration. We will restart the Angiomax once he is back from the OR tomorrow. Currently, his INR is 2.2. Therefore, he should be covered at the moment. Appreciate the Hematology's input in this matter.,Please note the total critical care time spent at the bedside excluding central line placement was 1 hour. | Emergency Room Reports |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | HISTORY: , Neurologic consultation was requested to assess and assist with her seizure medication. The patient is a 3-year 3 months old girl with refractory epilepsy. She had been previously followed by XYZ, but has been under the care of the UCSF epilepsy program and recently by Dr. Y. I reviewed her pertinent previous neurology evaluations at CHCC and also interviewed mom.,The patient had seizure breakthrough in August 2007, which requires inpatient admission, Thanksgiving and then after that time had seizures every other day, up-to-date early December. She remained seizure-free until 12/25/2007 when she had a breakthrough seizure at home treated with Diastat. She presented to our ER today with prolonged convulsive seizure despite receiving 20 mg of Diastat at home. Mom documented 103 temperature at home. In the ER, this was 101 to 102 degrees Fahrenheit. I reviewed the ER notes. At 0754 hours, she was having intermittent generalized tonic-clonic seizures despite receiving a total of 1.5 mg of lorazepam x5. UCSF fellow was contacted. She was given additional fosphenytoin and had a total dose of 15 mg/kg administered. Vital weight was 27. Seizures apparently had stopped. The valproic acid level obtained at 0835 hours was 79. According to mom, her last dose was at 6 p.m. and she did not receive her morning dose. Other labs slightly showed leukocytosis with white blood cell count 21,000 and normal CMP.,Previous workup here showed an EEG on 2005, which showed a left posterior focus. MRI on June 2007 and January 2005 were within normal limits. Mom describes the following seizure types:,1. Eye blinking with unresponsiveness.,2. Staring off to one side.,3. Focal motor activity in one arm and recently generalized tonic seizure.,She also said that she was supposed to see Dr. Y this Friday, but had postponed it to some subsequent time when results of genetic testing would be available. She was being to physicians' care as Dr. Z had previously being following her last UCSF.,She had failed most of the first and second line anti-epileptic drugs. These include Keppra, Lamictal, Trileptal, phenytoin and phenobarbital. These are elicited to allergies, but she has not had any true allergic reactions to these. Actually, it has resulted in an allergic reaction resulting in rash and hypotension.,She also had been treated with Clobazam. Her best control is with her current regimen of valproic acid and Tranxene. Other attempts to taper Topamax, but this resulted increased seizures. She also has oligohidrosis during this summertime.,CURRENT MEDICATIONS: , Include Diastat 20 mg; Topamax 25 mg b.i.d., which is 3.3 per kilo per day; Tranxene 15 mg b.i.d.; Depakote 125 mg t.i.d., which is 25 per kilo per day.,PHYSICAL EXAMINATION:,VITAL SIGNS: Weight 15 kg.,GENERAL: The patient was awake, she appeared sedated and postictal.,NECK: Supple.,NEUROLOGICAL: She had a few brief myoclonic jerks of her legs during drowsiness, but otherwise no overt seizure, no seizure activity nor involuntary movements were observed.,She was able to follow commands such as when I request that she gave mom a kiss. She acknowledged her doll. Left fundus is sharp. She resisted the rest of the exam. There was no obvious lateralized findings.,ASSESSMENT:, Status epilepticus resolved. Triggered by a febrile illness, possibly viral. Refractory remote symptomatic partial epilepsy.,IMPRESSION: , I discussed the maximizing Depakote to mom and she concurred. I recommend increasing her maintenance dose to one in the morning, one in the day, and two at bedtime. For today, she did give an IV Depacon 250 mg and the above dosage can be continued IV until she is taking p.o. Dr. X agreed with the changes and orders were written for this. She can continue her current doses of Topamax and Tranxene. This can be given by NG if needed. Topamax can be potentially increased to 25 mg in the morning and 50 mg at night. I will be available as needed during the rest of her hospitalization. Mom will call contact Dr. Y an update him about the recent changes. | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: , Colovesical fistula.,POSTOPERATIVE DIAGNOSES:,1. Colovesical fistula.,2. Intraperitoneal abscess.,PROCEDURE PERFORMED:,1. Exploratory laparotomy.,2. Low anterior colon resection.,3. Flexible colonoscopy.,4. Transverse loop colostomy and JP placement.,ANESTHESIA: , General.,HISTORY: ,This 74-year-old female who had a recent hip fracture and the patient was in rehab when she started having some stool coming out of the urethra. The patient had retrograde cystogram, which revealed colovesical fistula. Recommendation for a surgery was made. The patient was explained the risks and benefits as well as the two sons and the daughter. They understood that the patient can even die from this procedure. All the three procedures were explained, without a colostomy, with Hartmann's colostomy, and with a transverse loop colostomy, and out of the three procedures, the patient's requested to have the loop colostomy and stated that the Hartmann's colostomy leaving the anastomosis with the risk of leaking.,PROCEDURE DETAILS: , The patient was taken to the operating room, prepped and draped in the sterile fashion and was given general anesthetic. An incision was performed in the midline below the umbilicus to the pubis with a #10 blade Bard Parker. Electrocautery was used for hemostasis down to the fascia. The fascia was grasped with Ochsner's and then immediately the peritoneum was entered and the incision was carried cephalad and caudad with electrocautery.,Once within the peritoneum, adhesiolysis was performed to separate the small bowel from the attachment of the anterior abdominal wall. At this point, immediately a small bowel was retracted cephalad. The patient was taken to a slightly Trendelenburg position and the descending colon was seen. The white line of Toldt was opened all the way down to the area of inflammation. At this point, meticulous dissection was carried to separate the small bowel from the attachment to the abscess. When the small bowel was completely freed of abscess, bulk of the bladder was seen anteriorly to the uterus. The abscess was cultured and sent it back to Bacteriology Department and immediately the opening into the bladder was visualized. At this point, the entire sigmoid colon was separated posteriorly as well as laterally and it was all the way down to sigmoid down to the rectum. At this point, decision to place a moist towel and retract old intestine superiorly as well as to place first self-retaining retractor in the abdominal cavity with a bladder blade was placed. Immediately, a GIA was fired right across the descending colon and sigmoid colon junction and then with peons within the mesentery were placed all the way down to the rectosigmoid junction where a TA-55 balloon Roticulator was fired. The specimen was cut with #10 blade Bard-Parker and sent it to Pathology. Immediately copious amount of irrigation was used and the staple line in the descending colon was brought with Allis. A pursestring device was fired. The staple line was cut. The dilators were used using #25 and #29, then _________ #29 EEA was placed and the suture was tied. At this point, attention was directed down to the rectal stump where dilators #25 and #29 were passed from the anus into the rectum and then the #29 Ethicon GIA was introduced. The spike came posteriorly through the staple line to avoid the inflammatory process anteriorly that was present in the area of the cul-de-sac as well as the uterine was present in this patient. ,Immediately, the EEA was connected with a mushroom. It was tied, fired, and a Doyen was placed above the anastomosis approximately four inches. Fluid was placed within the _________ and immediately a colonoscope was introduced from the patient's anus insufflating air. No air was seen evolving from the staple line. All fluid was removed and pictures of the staple line were taken. The scope was removed at this point. The case was passed to Dr. X for repair of the vesicle fistula. Dr. X did repair down the perforation of the bladder that was communicating with an abscess secondary to the perforated diverticulitis and the colon. After this was performed, copious amount of irrigation was used again. More lysis of adhesions were performed and decision to make a loop transverse colostomy was made to protect the anastomosis in a phase of a severe inflammatory process in the pelvis in the infected area. The incision was performed in the right upper quadrant.,This incision was performed with cutting in the cautery, down into the fascia splitting the muscle and then the Penrose was passed under transverse colon, and was grasped on pulling the transverse colon at the level of the skin. The wire was passed under the transverse colon. It was left in place. Moderate irrigation was used in the peritoneal cavity and in the right lower quadrant, a JP was placed in the pelvis posteriorly to the abscess cavity that was down on the pelvis. At this point, immediately, yellow fluid was removed from the peritoneal cavity and the abdomen was closed with cephalad to caudad and caudad to cephalad with a loop PDS suture and then tied. Electrocautery for hemostasis and the subcutaneous tissue. Copious amount of irrigation was used. The skin was approximated with staples. At this point, immediately, the wound was covered with a moist towel and decision to mature the loop colostomy was made. The colostomy was opened longitudinally and then matured with interrupted #3-0 Vicryl suture through the skin edge. One it was completely matured, immediately the index finger was probed proximally and distally and both loops were completely opened. As previously mentioned, the Penrose was removed and the Bard was secured with a #3-0 nylon suture. The JP was secured with #3-0 nylon suture as well. At this point, dressings were applied. The patient tolerated the procedure well. The stent from the left ureter was removed and the Foley was left in place. The patient did tolerate the procedure well and will be followed up during the hospitalization. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | REASON FOR CONSULTATION: , Lightheaded, dizziness, and palpitation.,HISTORY OF PRESENT ILLNESS: , The patient is a 50-year-old female who came to the Emergency Room. This morning, the patient experienced symptoms of lightheaded, dizziness, felt like passing out; however, there was no actual syncope. During the episode, the patient describes symptoms of palpitation and fluttering of chest. She relates the heart was racing. By the time when she came into the Emergency Room, her EKG revealed normal sinus rhythm. No evidence of arrhythmia. The patient had some cardiac workup in the past, results are as mentioned below. Denies any specific chest pain. Activities fairly stable. She is actively employed. No other cardiac risk factor in terms of alcohol consumption or recreational drug use, caffeinated drink use or over-the-counter medication usage.,CORONARY RISK FACTORS: , No history of hypertension or diabetes mellitus. Nonsmoker. Cholesterol normal. No history of established coronary artery disease and family history noncontributory.,FAMILY HISTORY: , Nonsignificant.,SURGICAL HISTORY: , Tubal ligation.,MEDICATIONS: , On pain medications, ibuprofen.,ALLERGIES:, SULFA.,PERSONAL HISTORY: , She is a nonsmoker. Does not consume alcohol. No history of recreational drug use.,PAST MEDICAL HISTORY: , History of chest pain in the past. Had workup done including nuclear myocardial perfusion scan, which was reportedly abnormal. Subsequently, the patient underwent cardiac catheterization in 11/07, which was also normal. An echocardiogram at that time was also normal. At this time, presentation with lightheaded, dizziness, and palpitation.,REVIEW OF SYSTEMS:,CONSTITUTIONAL: No history of fever, rigors, or chills.,HEENT: No history of cataract, blurry vision, or glaucoma.,CARDIOVASCULAR: As above.,RESPIRATORY: Shortness of breath. No pneumonia or valley fever.,GASTROINTESTINAL: No epigastric discomfort, hematemesis or melena.,UROLOGICAL: No frequency or urgency.,MUSCULOSKELETAL: Nonsignificant.,NEUROLOGICAL: No TIA. No CVA. No seizure disorder.,ENDOCRINE/HEMATOLOGIC: Nonsignificant.,PHYSICAL EXAMINATION:,VITAL SIGNS: Pulse of 69, blood pressure 127/75, afebrile, and respiratory rate 16 per minute.,HEENT: Atraumatic and normocephalic.,NECK: Neck veins flat. No carotid bruits. No thyromegaly. No lympyhadenopathy.,LUNGS: Air entry bilaterally fair.,HEART: PMI normal. S1 and S2 regular.,ABDOMEN: Soft and nontender. Bowel sounds present.,EXTREMITIES: No edema. Pulses palpable. No clubbing or cyanosis.,CNS: Benign.,PSYCHOLOGICAL: Normal.,MUSCULOSKELETAL: Nonsignificant.,EKG: , Normal sinus rhythm, incomplete right bundle-branch block.,LABORATORY DATA:, H&H stable. BUN and creatinine within normal limits. Cardiac enzyme profile negative. Chest x-ray unremarkable.,IMPRESSION:,1. Lightheaded, dizziness in a 50-year-old female. No documented arrhythmia with the symptoms of palpitation.,2. Normal cardiac structure by echocardiogram a year and half ago.,3. Normal cardiac catheterization in 11/07.,4. Negative workup so far for acute cardiac event in terms of EKG, cardiac enzyme profile. | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHRONIC SNORING,Chronic snoring in children can be associated with obstructive sleep apnea or upper airway resistant syndrome. Both conditions may lead to sleep fragmentation and/or intermittent oxygen desaturation, both of which have significant health implications including poor sleep quality and stress on the cardiovascular system. Symptoms like daytime somnolence, fatigue, hyperactivity, behavior difficulty (i.e., ADHD) and decreased school performance have been reported with these conditions. In addition, the most severe cases may be associated with right ventricular hypertrophy, pulmonary and/or systemic hypertension and even cor pulmonale.,In this patient, the risks for a sleep-disordered breathing include obesity and the tonsillar hypertrophy. It is therefore indicated and medically necessary to perform a polysomnogram for further evaluation. A two week sleep diary will be given to the parents to fill out daily before the polysomnogram is performed. | General Medicine |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHIEF COMPLAINT: ,Severe tonsillitis, palatal cellulitis, and inability to swallow.,HISTORY OF PRESENT ILLNESS: , This patient started having sore throat approximately one week ago; however, yesterday it became much worse. He was unable to swallow. He complained to his parent. He was taken to Med Care and did not get any better, and therefore presented this morning to ER, where seen and evaluated by Dr. X and concerned as whether he had an abscess either pharyngeal, palatal, or peritonsillar. He was noted to have extreme tonsillitis with kissing tonsils, marked exudates especially right side and right palatal cellulitis. A CT scan at ER did not show abscess. He has not had airway compromise, but he has had difficulty swallowing. He may have had a low-grade fever, but nothing marked at home. His records from Hospital are reviewed as well as the pediatric notes by Dr. X. He did have some equivalent leukocytosis. He had a negative monospot and negative strep screen.,PAST MEDICAL HISTORY: ,The patient takes no medications, has had no illnesses or surgeries and he is generally in good health other than being significantly overweight. He is a sophomore at High School.,FAMILY HISTORY: ,Noncontributory to this illness.,SURGERIES: , None.,HABITS: , Nonsmoker, nondrinker. Denies illicit drug use.,REVIEW OF SYSTEMS:,ENT: The patient other than having dysphagia, the patient denies other associated ENT symptomatology.,GU: Denies dysuria.,Orthopedic: Denies joint pain, difficulty walking, etc.,Neuro: Denies headache, blurry vision, etc.,Eyes: Says vision is intact.,Lungs: Denies shortness of breath, cough, etc.,Skin: He states he has a rash, which occurred from penicillin that he was given IM yesterday at Covington Med Care. Mildly itchy. Mother has penicillin allergy.,Endocrine: The patient denies any weight loss, weight gain, skin changes, fatigue, etc, essentially no symptoms of hyper or hypothyroidism.,Physical Exam:,General: This is a morbidly obese white male adolescent, in no acute disease, alert and oriented x 4. Voice is normal. He is handling his secretions. There is no stridor.,Vital Signs: See vital signs in nurses notes.,Ears: TM and EACs are normal. External, normal.,Nose: Opening clear. External nose is normal.,Mouth: Has bilateral marked exudates, tonsillitis, right greater than left. Uvula is midline. Tonsils are touching. There is some redness of the right palatal area, but is not consistent with peritonsillar abscess. Tongue is normal. Dentition intact. No mucosal lesions other than as noted.,Neck: No thyromegaly, masses, or adenopathy except for some small minimally enlarged high jugular nodes.,Chest: Clear to auscultation.,Heart: No murmurs, rubs, or gallops.,Abdomen: Obese. Complete exam deferred.,Skin: Visualized skin dry and intact, except for rash on his inner thighs and upper legs, which is red maculopapular and consistent with possible allergic reaction.,Neuro: Cranial nerves II through XII are intact. Eyes, pupils are equal, round, and reactive to light and accommodation, full range.,IMPRESSION: , Marked exudative tonsillitis, non-strep, non-mono, probably mixed anaerobic infection. No significant prior history of tonsillitis. Possible rash to PENICILLIN.,RECOMMENDATIONS: , I concur with IV clindamycin and IV Solu-Medrol as per Dr. X. I anticipate this patient may need several days of IV antibiotics and then be able to switch over to oral. I do not insist that this patient will need surgical intervention since there is no evidence of abscess. This one episode of severe tonsillitis does not mean the patient needs tonsillectomy, but if he continues to have significant tonsil problems after this he should be referred for ENT evaluation as an outpatient. The patient's parents in the room had expressed good understanding, have a chance to ask questions. At this time, I will see the patient back on an as needed basis. | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | HISTORY OF PRESENT ILLNESS: , The patient returns for followup evaluation 21 months after undergoing prostate fossa irradiation for recurrent Gleason 8 adenocarcinoma. His urinary function had been stable until 2 days ago. Over the past couple of days he has been waking every 1 to 1-1/2 hours and has had associated abdominal cramping, as well as a bit of sore throat (his wife has had a cold for about 2 weeks). His libido remains intact (but he has not been sexually functional), but his erections have been dysfunctional. The bowel function is stable with occasional irritative hemorrhoidal symptoms. He has had no hematochezia. The PSA has been slowly rising in recent months. This month it reached 1.2.,PAIN ASSESSMENT: , Abdominal cramping in the past 2 days. No more than 1 to 2 of 10 in intensity.,PERFORMANCE STATUS: , Karnofsky score 100. He continues to work full-time.,NUTRITIONAL STATUS: , Appetite has been depressed over the past couple of days, and he has lost about 5 pounds. (Per him, mostly this week.),PSYCHIATRIC: , Some stress regarding upcoming IRS audits of clients.,REVIEW OF SYSTEMS: , Otherwise noncontributory.,MEDICATIONS,1. NyQuil.,2. Timolol eye drops.,3. Aspirin.,4. Advil.,5. Zinc.,PHYSICAL EXAMINATION,GENERAL: Pleasant, well-developed, gentleman in no acute distress. Weight is 197 pounds.,HEENT: Sclerae and conjunctivae are clear. Extraocular movement are intact. Hearing is grossly intact. The oral cavity is without thrush. There is minor pharyngitis.,LYMPH NODES: No palpable lymphadenopathy.,SKELETAL: No focal skeletal tenderness.,LUNGS: Clear to auscultation bilaterally.,CARDIOVASCULAR: Regular rate and rhythm.,ABDOMEN: Soft, nontender without palpable mass or organomegaly.,DIGITAL RECTAL EXAMINATION: There are external hemorrhoids. The prostate fossa is flat without suspicious nodularity. There is no blood on the examining glove.,EXTREMITIES: Without clubbing, cyanosis, or edema.,NEUROLOGIC: Without focal deficit.,IMPRESSION:, Concerning slow ongoing rise in PSA.,PLAN: , Discussed significance of this in detail with the patient. He understands the probability that there may be residual cancer although the location is unknown. For now there is no good evidence that early management affects the ultimate prognosis. Accordingly, he is comfortable with careful monitoring, and I have asked him to return here in 3 months with an updated PSA. I also suggested that he reestablish contact with Dr. X at his convenience. | SOAP / Chart / Progress Notes |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | REASON FOR VISIT: , I have been asked to see this 63-year-old man with a dilated cardiomyopathy by Dr. X at ABCD Hospital. He presents with a chief complaint of heart failure.,HISTORY OF PRESENT ILLNESS: , In retrospect, he has had symptoms for the past year of heart failure. He feels in general "OK," but is stressed and fatigued. He works hard running 3 companies. He has noted shortness of breath with exertion and occasional shortness of breath at rest. There has been some PND, but he sleeps on 1 pillow. He has no edema now, but has had some mild leg swelling in the past. There has never been any angina and he denies any palpitations, syncope or near syncope. When he takes his pulse, he notes some irregularity. He follows no special diet. He gets no regular exercise, although he has recently started walking for half an hour a day. Over the course of the past year, these symptoms have been slowly getting worse. He gained about 20 pounds over the past year.,There is no prior history of either heart failure or other heart problems.,His past medical history is remarkable for a right inguinal hernia repair done in 1982. He had trauma to his right thumb. There is no history of high blood pressure, diabetes mellitus or heart murmur.,On social history, he lives in San Salvador with his wife. He has a lot of stress in his life. He does not smoke, but does drink. He has high school education.,On family history, mother is alive at age 89. Father died at 72 of heart attack. He has 2 brothers and 1 sister all of whom are healthy, although the oldest suffered a myocardial infarction. He has 3 healthy girls and 9 healthy grandchildren.,A complete review of systems was performed and is negative aside from what is mentioned in the history of present illness.,MEDICATIONS: , Aspirin 81 mg daily and chlordiazepoxide and clidinium - combination pill at 5 mg/2.5 mg 1 tablet daily for stress.,ALLERGIES: , Denied.,MAJOR FINDINGS:, On my comprehensive cardiovascular examination, he is 5 feet 8 inches and weighs 231 pounds. His blood pressure is 120/70 in each arm seated. His pulse is 80 beats per minute and regular. He is breathing 1two times per minute and that is unlabored. Eyelids are normal. Pupils are round and reactive to light. Conjunctivae are clear and sclerae are anicteric. There is no oral thrush or central cyanosis. Neck is supple and symmetrical without adenopathy or thyromegaly. Jugular venous pressure is normal. Carotids are brisk without bruits. Lungs are clear to auscultation and percussion. The precordium is quiet. The rhythm is regular. The first and second heart sounds are normal. He does have a fourth heart sound and a soft systolic murmur. The precordial impulse is enlarged. Abdomen is soft without hepatosplenomegaly or masses. He has no clubbing, cyanosis or peripheral edema. Distal pulses are normal throughout both arms and both legs. On neurologic examination, his mentation is normal. His mood and affect are normal. He is oriented to person, place, and time.,DATA: , His EKG shows sinus rhythm with left ventricular hypertrophy.,A metabolic stress test shows that he was able to exercise for 5 minutes and 20 seconds to 90% of his maximum predicted heart rate. His peak oxygen consumption was 19.7 mL/kg/min, which is consistent with mild cardiopulmonary disease.,Laboratory data shows his TSH to be 1.33. His glucose is 97 and creatinine 0.9. Potassium is 4.3. He is not anemic. Urinalysis was normal.,I reviewed his echocardiogram personally. This shows a dilated cardiomyopathy with EF of 15%. The left ventricular diastolic dimension is 6.8 cm. There are no significant valvular abnormalities.,He had a stress thallium. His heart rate response to stress was appropriate. The thallium images showed no scintigraphic evidence of stress-induced myocardial ischemia at 91% of his maximum age predicted heart rate. There is a fixed small sized mild-to-moderate intensity perfusion defect in the distal inferior wall and apex, which may be an old infarct, but certainly does not account for the degree of cardiomyopathy. We got his post-stress EF to be 33% and the left ventricular cavity appeared to be enlarged. The total calcium score will put him in the 56 percentile for subjects of the same age, gender, and race/ethnicity.,ASSESSMENTS: , This appears to be a newly diagnosed dilated cardiomyopathy, the etiology of which is uncertain.,PROBLEMS DIAGNOSES: ,1. Dilated cardiomyopathy.,2. Dyslipidemia.,PROCEDURES AND IMMUNIZATIONS: , None today.,PLANS: , I started him on an ACE inhibitor, lisinopril 2.5 mg daily, and a beta-blocker, carvedilol 3.125 mg twice daily. The dose of these drugs should be up-titrated every 2 weeks to a target dose of lisinopril of 20 mg daily and carvedilol 25 mg twice daily. In addition, he could benefit from a loop diuretic such as furosemide. I did not start this as he is planning to go back home to San Salvador tomorrow. I will leave that up to his local physicians to up-titrate the medications and get him started on some furosemide.,In terms of the dilated cardiomyopathy, there is not much further that needs to be done, except for family screening. All of his siblings and his children should have an EKG and an echocardiogram to make sure they have not developed the same thing. There is a strong genetic component of this.,I will see him again in 3 to 6 months, whenever he can make it back here. He does not need a defibrillator right now and my plan would be to get him on the right doses of the right medications and then recheck an echocardiogram 3 months later. If his LV function has not improved, he does have New York Heart Association Class II symptoms and so he would benefit from a prophylactic ICD.,Thank you for asking me to participate in his care.,MEDICATION CHANGES:, See the above. | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: , Achilles tendon rupture, left lower extremity.,POSTOPERATIVE DIAGNOSIS: , Achilles tendon rupture, left lower extremity.,PROCEDURE PERFORMED:, Primary repair left Achilles tendon.,ANESTHESIA: , General.,COMPLICATIONS: , None.,ESTIMATED BLOOD LOSS: , Minimal.,TOTAL TOURNIQUET TIME: ,40 minutes at 325 mmHg.,POSITION:, Prone.,HISTORY OF PRESENT ILLNESS: ,The patient is a 26-year-old African-American male who states that he was stepping off a hilo at work when he felt a sudden pop in the posterior aspect of his left leg. The patient was placed in posterior splint and followed up at ABC orthopedics for further care.,PROCEDURE:, After all potential complications, risks, as well as anticipated benefits of the above-named procedure were discussed at length with the patient, informed consent was obtained. The operative extremity was then confirmed with the patient, the operative surgeon, Department Of Anesthesia, and nursing staff. While in this hospital, the Department Of Anesthesia administered general anesthetic to the patient. The patient was then transferred to the operative table and placed in the prone position. All bony prominences were well padded at this time.,A nonsterile tourniquet was placed on the left upper thigh of the patient, but not inflated at this time. Left lower extremity was sterilely prepped and draped in the usual sterile fashion. Once this was done, the left lower extremity was elevated and exsanguinated using an Esmarch and the tourniquet was inflated to 325 mmHg and kept up for a total of 40 minutes. After all bony and soft tissue land marks were identified, a 6 cm longitudinal incision was made paramedial to the Achilles tendon from its insertion proximal. Careful dissection was then taken down to the level of the peritenon. Once this was reached, full thickness flaps were performed medially and laterally. Next, retractor was placed. All neurovascular structures were protected. A longitudinal incision was then made in the peritenon and opened up exposing the tendon. There was noted to be complete rupture of the tendon approximately 4 cm proximal to the insertion point. The plantar tendon was noted to be intact. The tendon was debrided at this time of hematoma as well as frayed tendon. Wound was copiously irrigated and dried. Most of the ankle appeared that there was sufficient tendon links in order to do a primary repair. Next #0 PDS on a taper needle was selected and a Krackow stitch was then performed. Two sutures were then used and tied individually ________ from the tendon. The tendon came together very well and with a tight connection. Next, a #2-0 Vicryl suture was then used to close the peritenon over the Achilles tendon. The wound was once again copiously irrigated and dried. A #2-0 Vicryl sutures were then used to close the skin and subcutaneous fashion followed by #4-0 suture in the subcuticular closure on the skin. Steri-Strips were then placed over the wound and the sterile dressing was applied consisting of 4x4s, Kerlix roll, sterile Kerlix and a short length fiberglass cast in a plantar position. At this time, the Department of anesthesia reversed the anesthetic. The patient was transferred back to hospital gurney to the Postanesthesia Care Unit. The patient tolerated the procedure well. There were no complications. | Orthopedic |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | VITAL SIGNS:, Blood pressure *, pulse *, respirations *, temperature *.,GENERAL APPEARANCE: , Alert and in no apparent distress, calm, cooperative, and communicative.,HEENT:, Eyes: EOMI. PERRLA. Sclerae nonicteric. No lesions lids, lashes, brows, or conjunctivae noted. Funduscopic examination unremarkable. No papilledema, glaucoma, or cataracts. Ears: Normal set and shape with normal hearing and normal TMs. Nose and Sinus: Unremarkable. Mouth, Tongue, Teeth, and Throat: Negative except for dental work.,NECK: , Supple and pain free without carotid bruit, JVD, or significant cervical adenopathy. Trachea is midline without stridor, shift, or subcutaneous emphysema. Thyroid is palpable, nontender, not enlarged, and free of nodularity.,CHEST: , Lungs bilaterally clear to auscultation and percussion.,HEART: , S1 and S2. Regular rate and rhythm without murmur, heave, click, lift, thrill, rub, or gallop. PMI is nondisplaced. Chest wall is unremarkable to inspection and palpation. No axillary or supraclavicular adenopathy detected.,BREASTS: , Normal male breast tissue.,ABDOMEN:, No hepatosplenomegaly, mass, tenderness, rebound, rigidity, or guarding. No widening of the aortic impulse and intraabdominal bruit on auscultation.,EXTERNAL GENITALIA: , Normal for age. Normal penis with bilaterally descended testes that are normal in size, shape, and contour, and without evidence of hernia or hydrocele.,RECTAL:, Negative to 7 cm by gloved digital palpation with Hemoccult-negative stool and normal-sized prostate that is free of nodularity or tenderness. No rectal masses palpated.,EXTREMITIES: , Good distal pulse and perfusion without evidence of edema, cyanosis, clubbing, or deep venous thrombosis. Nails of the hands and feet, and creases of the palms and soles are unremarkable. Good active and passive range of motion of all major joints.,BACK: , Normal to inspection and percussion. Negative for spinous process tenderness or CVA tenderness. Negative straight-leg raising, Kernig, and Brudzinski signs.,NEUROLOGIC: , Nonfocal for cranial and peripheral nervous systems, strength, sensation, and cerebellar function. Affect is normal. Speech is clear and fluent. Thought process is lucid and rational. Gait and station are unremarkable.,SKIN: ,Unremarkable for any premalignant or malignant condition with normal changes for age. | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PROCEDURE: , Left heart catheterization, coronary angiography, left ventriculography.,COMPLICATIONS: , None.,PROCEDURE DETAIL: , The right femoral area was draped and prepped in the usual fashion after Xylocaine infiltration. A 6-French arterial sheath was placed in the usual fashion. Left and right coronary angiograms were then performed in various projections after heparin was given 2000 units intraaortic. The right coronary artery was difficult to cannulate because of its high anterior takeoff. This was nondominant. Several catheters were used. Ultimately, an AL1 diagnostic catheter was used. A pigtail catheter was advanced across the aortic valve. Left ventriculogram was then done in the RAO view using 30 mL of contrast. Pullback gradient was obtained across the aortic valve. Femoral angiogram was performed through the sheath which was above the bifurcation, was removed with a Perclose device with good results. There were no complications. He tolerated this procedure well and returned to his room in good condition.,FINDINGS,1. Right coronary artery: This has an unusual high anterior takeoff. The vessel is nondominant, has diffuse mild-to-moderate disease.,2. Left main trunk: A 30% to 40% distal narrowing is present.,3. Left anterior descending: Just at the ostium of the vessel and up to and including the bifurcation of the first large diagonal branch, there is 80 to 90% narrowing. The diagonal is a large vessel about 3 mm in size.,4. Circumflex: Dominant vessel, 50% narrowing at the origin of the obtuse marginal. After this, there is 40% narrowing in the AV trunk. The small posterior lateral branch has diffuse mild disease and then the vessel gives rise to a fairly large posterior ventricular branch, which has 70% ostial narrowing, and then after this the posterior descending has 80% narrowing at its origin.,5. Left ventriculogram: Normal volume in diastole and systole. Normal systolic function is present. There is no mitral insufficiency or left ventricular outflow obstruction.,DIAGNOSES,1. Severe complex left anterior descending and distal circumflex disease with borderline, probably moderate narrowing of a large obtuse marginal branch. Dominant circumflex system. Severe disease of the posterior descending. Mild left main trunk disease.,2. Normal left ventricular systolic function.,Given the complex anatomy of the predominant problem which is the left anterior descending; given its ostial stenosis and involvement of the bifurcation of the diagonal, would recommend coronary bypass surgery. The patient also has severe disease of the circumflex which is dominant. This anatomy is not appropriate for percutaneous intervention. The case will be reviewed with a cardiac surgeon. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHIEF COMPLAINT:, Recurrent dizziness x1 month.,HISTORY OF PRESENT ILLNESS:, This is a 77-year-old African-American female with multiple medical problems including CHF (O2 dependent), atrial fibrillation, diabetes mellitus, hypothyroidism, possible stroke, multiple joint disease including gout, arthritis, both rheumatoid and DJD, who presents with a complaint of one month of dizziness. She reports a rotational sensation upon arising from the bed or chair that lasts for several minutes and requires her to sit back down and stay in one place. She gets similar symptoms when she rolls over in bed. She is not able to describe what direction she feels like she is spinning. At times, she also feels as though she is going to pass out. These sensations stop if she just sits in one place or lies down for several minutes. She does note that it is worse when she turns to the right and when she turns to the left. She also complains that she gets similar sensations when she looks up. She denies any recent fever, chills, earache, diplopia, dysarthria, dysphagia, other change in vision, or recent new headaches. She also notes occasional tinnitus to her right ear.,PAST MEDICAL HISTORY:,1. CHF (uses portable oxygen).,2. Atrial fibrillation.,3. Gout.,4. Arthritis (DJD/rheumatoid).,5. Diabetes mellitus.,6. Hypothyroidism.,7. Hypertension.,8. GERD.,9. Possible stroke treated in 2003 at University of Maryland with acute onset of presyncopal sensations, sharp pains in the left side of her head and right-sided hemiparesis and numbness.,FAMILY HISTORY: , Noncontributory.,SOCIAL HISTORY: , She is married. She does not smoke, use alcohol or use illicit drugs.,MEDICATIONS: , Please see medication sheet in the chart. It includes potassium, Pravachol, Prevacid, Synthroid, Diovan, Amaryl, Vitamin B12, Coreg, Coumadin, furosemide, Actos, aspirin, colchicine, Cipro, Percocet, Ultram (has held the latter two medications for the past two weeks due to concerns of exacerbating dizziness).,REVIEW OF SYSTEMS:, Please see note in chart essentially entirely positive including cardiovascular problems of shortness of breath, PND and palpitations, chronic lack of energy, weight gain, the dizziness for which she presented. Tinnitus in the right ear. Diabetes and hypothyroidism. Chronic nausea. Chronic severe musculoskeletal pains to all extremities as well as to chest and abdomen and back. Right-sided numbness as well as complaints of bilateral lower extremity numbness and difficulty walking. She says her mood is sad and may be depressed and she is also extremely anxious. She has chronic shortness of breath and coughs easily when has to breathe deeply. She also endorses poor sleep.,PHYSICAL EXAMINATION:,VITAL SIGNS: Sitting BP 112/84 with a pulse of 84, standing after two minutes 130/90 with a pulse of 66. Respiratory rate is 20. Weight is 257 pounds. Pain scale is 7.,GENERAL: This is a somewhat anxious elderly African-American female who tends to amplify findings on examination. It is a difficult examination due to the fact that no matter where the patient was touched she would wince in pain and withdraw. She is obese.,HEENT: She is normocephalic and atraumatic. Conjunctivae and sclerae are clear. Tympanic membranes were visualized bilaterally. There is tenderness to palpation of any sinus region. There are no palpable cervical nodes.,NECK: Supple although she complains of pain when rotating her neck.,CHEST: Clear to auscultation bilaterally.,HEART: Heart sounds are distant. There are no carotid bruits.,EXTREMITIES: She has 1-2+ pitting edema to the mid shins bilaterally.,NEUROLOGIC EXAMINATION:,MENTAL STATUS: She is alert and oriented x3. Her speech is fluent; however, she is extremely tangential. She is unable to give a cogent medical history including details of hospitalization one month ago when she was admitted for a gout attack and urinary tract infection and underwent several days of rehabilitation.,CRANIAL NERVES: Cranial nerves are intact throughout; specifically there is no nystagmus, her gaze is conjugate, there is no diplopia, visual fields are full to confrontation, pupils are equal, round and reactive to light and accommodation, extraocular movements are intact, facial sensation and expression are symmetric, vestibuloocular reflexes are intact, hearing is intact to finger rub bilaterally, palate rises symmetrically, normal cough, shoulder shrug is symmetric which shows easy breakaway give, and tongue protrudes in the midline.,MOTOR: This is a limited exam due to easy breakaway gait and pain that appears exaggerated to movement of any extremity. There is suggestion of some mild right-sided paresis; however, the degree was inconsistent and her phasic strength is estimated at 4-4+ throughout. Her tone is normal throughout.,SENSORY: She appears to have diffuse light tough and pinprick and temperature to the right arm and proximal leg. She also reports that she is numb in both feet; however, sensation testing of light tough, pinprick and vibration was intact.,COORDINATION: There is no obvious dysmetria.,GAIT: She uses a walker to stand up, and several near falls when asked to stand unassisted and can only ambulate with a walker. There are some mild right lower extremity circumduction present.,REFLEXES: Biceps 1, triceps trace, brachioradialis 1, patella and ankle absent. Toes are equivocal.,OTHER: Barany maneuver was attempted; however, when the patient was placed supine she immediately began screaming, "Oh my back, oh my back", and was unable to complete the maneuver. Brief inspection of her eyes failed to show any nystagmus at that time.,IMPRESSION AND PLAN:, This is a 77-year-old African-American female with multiple medical problems who presents with episodic positionally related dizziness of unclear etiology. Most certainly there is significant exaggeration of the underlying problem and her neurological examination is compounded by much functional overlay, limiting the interpretation of my findings. I suspect this is just a mild benign positional vertigo, although I cannot rule out vertebrobasilar compromise. I agree with symptomatic treatment with Antivert.,We will schedule her for CT of head, CT angiogram to evaluate for possible brain stroke and vertebrobasilar insufficiency. In addition, we will attempt to get further objective data by ENG testing. I will see the patient again after these tests are completed and she has a trial of the Antivert. | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CC: ,Low Back Pain (LBP) with associated BLE weakness.,HX:, This 75y/o RHM presented with a 10 day h/o progressively worsening LBP. The LBP started on 12/3/95; began radiating down the RLE, on 12/6/95; then down the LLE, on 12/9/95. By 12/10/95, he found it difficult to walk. On 12/11/95, he drove himself to his local physician, but no diagnosis was rendered. He was given some NSAID and drove home. By the time he got home he had great difficulty walking due to LBP and weakness in BLE, but managed to feed his pets and himself. On 12/12/95 he went to see a local orthopedist, but on the way to his car he crumpled to the ground due to BLE weakness and LBP pain. He also had had BLE numbness since 12/11/95. He was evaluated locally and an L-S-Spine CT scan and L-S Spine X-rays were "negative." He was then referred to UIHC.,MEDS: ,SLNTC, Coumadin 4mg qd, Propranolol, Procardia XL, Altace, Zaroxolyn.,PMH: ,1) MI 11/9/78, 2) Cholecystectomy, 3) TURP for BPH 1980's, 4) HTN, 5) Amaurosis Fugax, OD, 8/95 (Mayo Clinic evaluation--TEE (-), but Carotid Doppler (+) but "non-surgical" so placed on Coumadin).,FHX:, Father died age 59 of valvular heart disease. Mother died of DM. Brother had CABG 8/95.,SHX:, retired school teacher. 0.5-1.0 pack cigarettes per day for 60 years.,EXAM:, BP130.56, HR68, RR16, Afebrile.,MS: A&O to person, place, time. Speech fluent without dysarthria. Lucid. Appeared uncomfortable.,CN: Unremarkable.,MOTOR: 5/5 strength in BUE. Lower extremity strength: Hip flexors & extensors 4-/4-, Hip abductors 3+/3+, Hip adductors 5/5, Knee flexors & extensors 4/4-, Ankle flexion 4-/4-, Tibialis Anterior 2/2-, Peronei 3-/3-. Mild atrophy in 4 extremities. Questionable fasciculations in BLE. Spasms illicited on striking quadriceps with reflex hammer (? percussion myotonia). No rigidity and essential normal muscle tone on passive motion.,SENSORY: Decreased vibratory sense in stocking distribution from toes to knees in BLE (worse on right). No sensory level. PP/LT/TEMP testing unremarkable.,COORD: Normal FNF-RAM. Slowed HKS due to weakness.,Station: No pronator drift. Romberg testing not done.,Gait: Unable to stand.,Reflexes: 2/2 BUE. 1/trace patellae, 0/0 Achilles. Plantar responses were flexor, bilaterally. Abdominal reflex was present in all four quadrants. Anal reflex was illicited from all four quadrants. No jaw jerk or palmomental reflexes illicited.,Rectal: normal rectal tone, guaiac negative stool.,GEN EXAM: Bilateral Carotid Bruits, No lymphadenopathy, right inguinal hernia, rhonchi and inspiratory wheeze in both lung fields.,COURSE: ,WBC 11.6, Hgb 13.4, Hct 38%, Plt 295. ESR 40 (normal 0-14), CRP 1.4 (normal <0.4), INR 1.5, PTT 35 (normal), Creatinine 2.1, CK 346. EKG normal. The differential diagnosis included Amyotrophy, Polymyositis, Epidural hematoma, Disc Herniation and Guillain-Barre syndrome. An MRI of the lumbar spine was obtained, 12/13/95. This revealed an L3-4 disc herniation extending inferiorly and behind the L4 vertebral body. This disc was located more on the right than on the left , compromised the right neural foramen, and narrowed the spinal canal. The patient underwent a L3-4 laminectomy and diskectomy and subsequently improved. He was never seen in follow-up at UIHC. | Neurology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSES: , History of compartment syndrome, right lower extremity, status post 4 compartments fasciotomy, to do incision for compartment fasciotomy.,POSTOPERATIVE DIAGNOSES: , History of compartment syndrome, right lower extremity, status post 4 compartments fasciotomy, to do incision for compartment fasciotomy.,OPERATIONS:,1. Wound debridement x2, including skin, subcutaneous, and muscle.,2. Insertion of tissue expander to the medial wound.,3. Insertion of tissue expander to the lateral wound.,COMPLICATIONS: , None.,TOURNIQUET: , None.,ANESTHESIA: ,General.,INDICATIONS: , This patient developed a compartment syndrome. She underwent 4 compartment fasciotomy with dual incision on medial and lateral aspect of the right lower leg. She was doing very well and was obviously improving.,The swelling was reduced. A compartment pressure had obviously improved based on examination. She was therefore indicated for placement of tissue expander for ventral wound closure. The risks of procedure as well as alternatives of this procedure were discussed at length with the patient and he understood them well. Risks and benefits were all discussed, risk of bleeding, infection, damage to blood vessels, damage to nerve roots, need for further surgery, chronic pain with range of motion, risk of continued discomfort, risk of need for further reconstructive procedures, risk of blood clots, pulmonary embolism, myocardial infarction, and risk of death were discussed. She understood them well. All questions were answered, and she signed the consent for the procedure as described.,DESCRIPTION OF THE PROCEDURE:, The patient was placed on the operating table and general anesthesia was achieved. The medial wound was noted to be approximately 10.5 cm in length x 4 cm. The lateral wound was noted in approximately 14 cm in length x 5 x 5 cm in width. Both wounds were then thoroughly debrided. The debridement of both wounds included skin and subcutaneous tissue and nonviable muscle portion. This involve very small portion of muscle as well as skin edge and the subcutaneous tissue did require debridement on both sides. At this point adequate debridement was performed and healthy tissue did appear to be present. Initially on the medial wound I did place the DermaClose RC continuous external tissue expander. On the medial wound the 5 skin anchors were placed on each side of the wound and separated appropriately. I then did place the line loop from the tension controller in a lace like manner through the skin anchors and the tension controller was attached to the middle anchor. I then did place adequate tension on the sutures. Continued tension will be noted after engaging the tension controller. At this point I performed the similar procedure to the lateral wound. The skin anchors were placed separately and appropriately on either side of the skin margin. The line loop from the tension controller was placed in lace like manner through the skin anchors. The tension controller was then attached to the mid anchor and appropriate tension was applied.,It must be noted I did undermine the skin edges both sides of flap from both incision site prior to placement of the skin anchor and adequate mobilization was obtained. Adequate tension was placed in this region. A non thick dressing was then applied to the open-wound region and sterile dressing was then applied. No complications were encountered throughout the procedure and the patient tolerated the procedure well. The patient was taken to recovery room in stable condition. | Orthopedic |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PROCEDURE: , Right sacral alar notch and sacroiliac joint/posterior rami radiofrequency thermocoagulation.,ANESTHESIA: ,Local sedation.,VITAL SIGNS: , See nurse's notes.,COMPLICATIONS: , None.,DETAILS OF PROCEDURE: , INT was placed. The patient was in the operating room in the prone position. The back prepped with Betadine. The patient was given sedation and monitored. Under fluoroscopy, the right sacral alar notch was identified. After placement of a 20-gauge, 10 cm SMK needle into the notch, a positive sensory, negative motor stimulation was obtained. Following negative aspiration, 5 cc of 0.5% of Marcaine and 20 mg of Depo-Medrol were injected. Coagulation was then carried out at 90oC for 90 seconds. The SMK needle was then moved to the mid-inferior third of the right sacroiliac joint. Again the steps dictated above were repeated.,The above was repeated for the posterior primary ramus branch right at S2 and S3 by stimulating along the superior lateral wall of the foramen; then followed by steroid injected and coagulation as above.,There were no complications. The patient was returned to outpatient recovery in stable condition. | Pain Management |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | EXTERNAL EXAMINATION - SUMMARY,The body is presented in a black body bag. At the time of examination, the body is clothed in a long-sleeved red cotton thermal shirt, khaki twill cargo pants, and one black shoe.,The body is that of a normally developed, well nourished Caucasian female measuring 63 inches in length, weighing 114 pounds, and appearing generally consistent with the stated age of thirty-five years. The body is cold and unembalmed with declining rigor. Pronounced unblanching lividity is present on the posterior of the body in the regions of the feet; the upper thighs, particularly on the right side; the lower back, particularly on the right side; the right arm; and the neck.,The scalp is covered by long (16 inches) brown hair. The body hair is female and average. The skull is symmetric and evidences extensive trauma in the occipital region. The eyes are open and the irises are blue. Pupils are asymmetrically dilated. The teeth are natural and well maintained. The anterior chest is of normal contour and is intact. The breasts are female and contain no palpable masses. The abdomen is flat and the pelvis is intact. The external genitalia are female and unremarkable. The back is symmetrical and intact. The upper and lower extremities are symmetric, normally developed and intact. The hands and nails are clean and evidence no injury.,There are no residual scars, markings or tattoos.,INTERNAL EXAMINATION - SUMMARY,CENTRAL NERVOUS SYSTEM: ,The brain weighs 1,303 grams and is within normal limits. ,SKELETAL SYSTEM:, Subdural hematoma and comminuted fractures of the occipital bone are observed. Numerous bone fragments from the fractures penetrated the brain tissue. ,RESPIRATORY SYSTEM--THROAT STRUCTURES: ,The oral cavity shows no lesions. The mucosa is intact and there are no injuries to the lips, teeth or gums. There is no obstruction of the airway. The mucosa of the epiglottis, glottis, piriform sinuses, trachea and major bronchi are anatomic. No injuries are seen and there are no mucosal lesions. The lungs weigh: right, 355 grams; left 362 grams. The lungs are unremarkable. ,CARDIOVASCULAR SYSTEM:, The heart weighs 253 grams, and has a normal size and configuration. No evidence of atherosclerosis is present. ,GASTROINTESTINAL SYSTEM: ,The mucosa and wall of the esophagus are intact and gray-pink, without lesions or injuries. The gastric mucosa is intact and pink without injury. Approximately 125 ml of partially digested semisolid food is found in the stomach. The mucosa of the duodenum, jejunum, ileum, colon and rectum are intact. ,URINARY SYSTEM:, The kidneys weigh: left, 115 grams; right, 113 grams. The kidneys are anatomic in size, shape and location and are without lesions. ,FEMALE GENITAL SYSTEM: ,The structures are within normal limits. Examination of the pelvic area indicates the victim had not given birth and was not pregnant at the time of death. Vaginal fluid samples are removed for analysis. ,DESCRIPTION OF INJURIES - SUMMARY,Blunt force traumatic injury with multiple cranial fractures resulting in craniocerebral injury. Wound measures approximately 4 inches high x 5 1/2 inches wide. Subdural hematoma and comminuted fractures of the occipital bone are observed. Numerous bone fragments from the fractures penetrated the brain tissue. Depths of penetration range from 1/2-inch to 3 inches. Injury appears to have resulted from a single blow administered to the posterior of the head, delivered at an approximate 90º angle to the occipital bone.,LABORATORY DATA,CEREBROSPINAL FLUID CULTURE AND SENSITIVITY:,Gram stain: Unremarkable,Culture: No growth after 72 hours,CEREBROSPINAL FLUID BACTERIAL ANTIGENS:,Hemophilus influenza B: Negative,Streptococcus pneumoniae: Negative,N. Meningitidis: Negative,Neiserria meningitidis B/E. Coli K1: Negative ,PRELIMINARY TOXICOLOGICAL RESULTS:,BLOOD - ETHANOL - NEG ,BLOOD - CANNABINOIDS-ETS - INC,BLOOD - COCAINE-ETS - INC,BLOOD - OPIATES-ETS - INC,BLOOD - AMPHETAMINE-ETS - INC,BLOOD - BARBITURATE -ETS - INC,BLOOD - BENZODIAZEPINE-ETS - INC,BLOOD - METHADONE-ETS - INC,BLOOD - PCP-ETS - INC,BLOOD - CARBON MONOXIDE - NEG,Urine Drugs: Initial test results inconclusive. Further tests pending. ,EVIDENCE COLLECTED,1. Samples of Blood (type O+), Urine, Bile, and Tissue (heart, lung, brain, kidney, liver, spleen). ,2. Thirteen autopsy photographs. ,3. Two postmortem x-rays. ,Clothing transferred to ABC Lab for further analysis. | Autopsy |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | HISTORY:, Reason for ICU followup today is acute anemia secondary to upper GI bleeding with melena with dropping hemoglobin from 11 to 8, status post transfusion of 2 units PRBCs with EGD performed earlier today by Dr. X of Gastroenterology confirming diagnosis of ulcerative esophagitis, also for continuing chronic obstructive pulmonary disease exacerbation with productive cough, infection and shortness of breath. Please see dictated ICU transfer note yesterday detailing the need for emergent transfer transfusion and EGD in this patient. Over the last 24 hours, the patient has received 2 units of packed red blood cells and his hematocrit and hemoglobin have returned to their baseline of approximately 11 appropriate for hemoglobin value. He also underwent EGD earlier today with Dr. X. I have discussed the case with him at length earlier this afternoon and the patient had symptoms of ulcerative esophagitis with no active bleeding. Dr. X recommended to increase the doses of his proton pump inhibitor and to avoid NSAIDs in the future. The patient today complains that he is still having issues with shortness of breath and wheezing and productive cough, now producing yellow-brown sputum with increasing frequency, but he has had no further episodes of melena since transfer to the ICU. He is also complaining of some laryngitis and some pharyngitis, but is denying any abdominal complaints, nausea, or diarrhea.,PHYSICAL EXAMINATION,VITAL SIGNS: Blood pressure is 100/54, heart rate 80 and temperature 98.8. Is and Os negative fluid balance of 1.4 liters in the last 24 hours.,GENERAL: This is a somnolent 68-year-old male, who arouses to voice, wakes up, seems to have good appetite, has continuing cough. Pallor is improved.,EYES: Conjunctivae are now pink.,ENT: Oropharynx is clear.,CARDIOVASCULAR: Reveals distant heart tones with regular rate and rhythm.,LUNGS: Have coarse breath sounds with wheezes, rhonchi, and soft crackles in the bases.,ABDOMEN: Soft and nontender with no organomegaly appreciated.,EXTREMITIES: Showed no clubbing, cyanosis or edema. Capillary refill time is now normal in the fingertips.,NEUROLOGICAL: Cranial nerves II through XII are grossly intact with no focal neurological deficits.,LABORATORY DATA:, Laboratories drawn at 1449 today, WBC 10, hemoglobin and hematocrit 11.5 and 33.1, and platelets 288,000. This is up from 8.6 and 24.7. Platelets are stable. Sodium is 134, potassium 4.0, chloride 101, bicarb 26, BUN 19, creatinine 1.0, glucose 73, calcium 8.4, INR 0.96, iron 13%, saturations 4%, TIBC 312, TSH 0.74, CEA elevated at 8.6, ferritin 27.5 and occult blood positive. EGD, final results pending per Dr. X's note and conversation with me earlier, ulcerative esophagitis without signs of active bleeding at this time.,IMPRESSION/PLAN,1. Melena secondary to ulcerative esophagitis. We will continue to monitor the patient overnight to ensure there is no further bleeding. If there are no further episodes of melena and hemoglobin is stable or unchanged in the morning, the patient will be transferred back to medical floor for continuing treatment of his chronic obstructive pulmonary disease exacerbation.,2. Chronic obstructive pulmonary disease exacerbation. The patient is doing well, taking PO. We will continue him on his oral Omnicef and azithromycin and continuing breathing treatments. We will add guaifenesin and N-acetyl-cysteine in a hope to mobilize some of his secretions. This does appear to be improving. His white count is normalized and I am hopeful we can discharge him on oral antibiotics within the next 24 to 48 hours if there are no further complications.,3. Elevated CEA. The patient will need colonoscopy on an outpatient basis. He has refused this today. We would like to encourage him to do so. Of note, the patient when he came in was on bloodless protocol, but with urging did accept the transfusion. Similarly, I am hoping that with proper counseling, the patient will consent to further examination with colonoscopy given his guaiac-positive status, elevated CEA and risk factors.,4. Anemia, normochromic normocytic with low total iron binding capacity. This appears to be anemia of chronic disease. However, this is likely some iron deficiency superimposed on top of this given his recent bleeding, with consider iron, vitamin C, folate and B12 supplementation and discharge given his history of alcoholic malnutrition and recent gastrointestinal bleeding. Total critical care time spent today discussing the case with Dr. X, examining the patient, reviewing laboratory trends, adjusting medications and counseling the patient in excess is 35 minutes. | Gastroenterology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS:, Chronic abdominal pain and heme positive stool.,POSTOPERATIVE DIAGNOSES:,1. Antral gastritis.,2. Duodenal polyp.,PROCEDURE PERFORMED:, Esophagogastroduodenoscopy with photos and antral biopsy.,ANESTHESIA: , Demerol and Versed.,DESCRIPTION OF PROCEDURE: , Consent was obtained after all risks and benefits were described. The patient was brought back into the Endoscopy Suite. The aforementioned anesthesia was given. Once the patient was properly anesthetized, bite block was placed in the patient's mouth. Then, the patient was given the aforementioned anesthesia. Once he was properly anesthetized, the endoscope was placed in the patient's mouth that was brought down to the cricopharyngeus muscle into the esophagus and from the esophagus to his stomach. The air was insufflated down. The scope was passed down to the level of the antrum where there was some evidence of gastritis seen. The scope was passed into the duodenum and then duodenal sweep where there was a polyp seen. The scope was pulled back into the stomach in order to flex upon itself and straightened out. Biopsies were taken for CLO and histology of the antrum. The scope was pulled back. The junction was visualized. No other masses or lesions were seen. The scope was removed. The patient tolerated the procedure well. We will recommend the patient be on some type of a H2 blocker. Further recommendations to follow. | Gastroenterology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | REASON FOR CONSULTATION: , Management of end-stage renal disease (ESRD), the patient on chronic hemodialysis, being admitted for chest pain.,HISTORY OF PRESENT ILLNESS:, This is a 66-year-old Native American gentleman, a patient of Dr. X, my associate, who has a past medical history of coronary artery disease, status post stent placement, admitted with chest pressure around 4 o'clock last night. He took some nitroglycerin tablets at home with no relief. He came to the ER. He is going to have a coronary angiogram done today by Dr. Y. I have seen this patient first time in the morning, approximately around the 4 o'clock. This is a late entry dictation. Presently lying in bed, but he feels fine. Denies any chest pain, shortness of breath, nausea, vomiting, abdominal pain, diarrhea. Denies hematuria, dysuria, or bright red blood per rectum.,PAST MEDICAL HISTORY:,1. Coronary artery disease, status post stent placement two years ago.,2. Diabetes mellitus for the last 12 years.,3. Hypertension.,4. End-stage renal disease.,5. History of TIA in the past.,PAST SURGICAL HISTORY:,1. As mentioned above.,2. Cholecystectomy.,3. Appendectomy.,4. Right IJ PermaCath placement.,5. AV fistula graft in the right wrist.,PERSONAL AND SOCIAL HISTORY:, He smoked 2 to 3 packets per day for at least last 10 years. He quit smoking roughly about 20 years ago. Occasional alcohol use.,FAMILY HISTORY: , Noncontributory.,ALLERGIES: ,No known drug allergies.,MEDICATIONS AT HOME: , Metoprolol, Plavix, Rocaltrol, Lasix, Norvasc, Zocor, hydralazine, calcium carbonate, and loratadine.,PHYSICAL EXAMINATION,GENERAL: He is alert, seems to be in no apparent distress.,VITAL SIGNS: Temperature 98.2, pulse 61, respiratory 20, and blood pressure 139/63.,HEENT: Atraumatic and normocephalic.,NECK: No JVD, no thyromegaly, supra and infraclavicular lymphadenopathy.,LUNGS: Clear to auscultation. Air entry bilateral equal.,HEART: S1 and S2. No pericardial rub.,ABDOMEN: Soft and nontender. Normal bowel sounds.,EXTREMITIES: No edema.,NEUROLOGIC: The patient is alert without focal deficit.,LABORATORY DATA:, Laboratory data shows hemoglobin 13, hematocrit 38.4, sodium 130, potassium 4.2, chloride 96.5, carbonate 30, BUN 26, creatinine 6.03, and glucose 162.,IMPRESSION:,1. End-stage renal disease, plan for dialysis today.,2. Diabetes mellitus.,3. Chest pain for coronary angiogram today.,4. Hypertension, blood pressure stable.,PLAN: , Currently follow the patient. Dr. Z is going to assume the care. | Nephrology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | REASON FOR REFERRAL:, The patient is a 58-year-old African-American right-handed female with 16 years of education who was referred for a neuropsychological evaluation by Dr. X. She is presenting for a second opinion following a recent neuropsychological evaluation that was ordered by her former place of employment that suggested that she was in the "early stages of a likely dementia" and was thereafter terminated from her position as a psychiatric nurse. A comprehensive evaluation was requested to assess current cognitive functioning and assist with diagnostic decisions and treatment planning. Note that this evaluation was undertaken as a clinical exam and intended for the purposes of aiding with treatment planning. The patient was fully informed about the nature of this evaluation and intended use of the results.,RELEVANT BACKGROUND INFORMATION: ,Historical information was obtained from a review of available medical records and clinical interview with the patient. A summary of pertinent information is presented below. Please refer to the patient's medical chart for a more complete history.,HISTORY OF PRESENTING PROBLEM:, The patient reported that she had worked as a nurse supervisor for Hospital Center for four years. She was dismissed from this position in September 2009, although she said that she is still under active status technically, but is not able to work. She continues to receive some compensation through FMLA hours. She said that she was told that she had three options, to resign, to apply for disability retirement, and she had 90 days to complete the process of disability retirement after which her employers would file for charges in order for her to be dismissed from State Services. She said that these 90 days are up around the end of November. She said the reason for her dismissal was performance complaints. She said that they began "as soon as she arrived and that these were initially related to problems with her taking too much sick time off secondary to diabetes and fibromyalgia management and at one point she needed to obtain a doctor's note for any days off. She said that her paperwork was often late and that she received discipline for not disciplining her staff frequently enough for tardiness or missed workdays. She described it as a very chaotic and hectic work environment in which she was often putting in extra time. She said that since September 2008 she only took two sick days and was never late to work, but that she continued to receive a lot of negative feedback.,In July of this year, she reportedly received a letter from personnel indicating that she was being referred to a state medical doctor because she was unable to perform her job duties and due to excessive sick time. Following a brief evaluation with this doctor whose records we do not have, she was sent to a neuropsychologist, Dr. Y, Ph.D. He completed a Comprehensive Independent Medical Evaluation on 08/14/2009. She said that on 08/27/2009, she returned to see the original doctor who told her that based on that evaluation she was not able to work anymore. Please note that we do not have copies of any of her work-related correspondence. The patient never received a copy of the neuropsychological evaluation because she was told that it was "too derogatory." A copy of that evaluation was provided directly to this examiner for the purpose of this evaluation. To summarize, the results indicated "diagnostically, The patient presents cognitive deficits involving visual working memory, executive functioning, and motor functioning along with low average intellectual functioning that is significantly below her memory functioning and below expectation based on her occupational and academic history. This suggests that her intellectual functioning has declined." It concluded that "results overall suggest early stages of a likely dementia or possibly the effects of diabetes, although her deficits are greater than expected for diabetes-related executive functioning problems and peripheral neuropathy… The patient' deficits within the current test battery suggest that she would not be able to safely and effectively perform the duties of a nurse supervisor without help handling documentary demands and some supervision of her visual processing. The prognosis for improvement is not good, although she might try stimulant medication if compatible with her other. Following her dismissal, The patient presented to her primary physician, Henry Fein, M.D., who referred her to Dr. X for a second opinion regarding her cognitive deficits. His neurological examination on 09/23/2009 was unremarkable. The patient scored 20/30 on the Mini-Mental Status Exam missing one out of three words on recall, but was able to do so with prompting. A repeat neurocognitive testing was suggested in order to assess for subtle deficits in memory and concentration that were not appreciated on this gross cognitive measure.,IMAGING STUDIES: , MRI of the brain on 09/14/2009 was unremarkable with no evidence of acute intracranial abnormality or abnormal enhancing lesions. Note that the MRI was done with and without gadolinium contrast.,CURRENT FUNCTIONING: ,The patient reported that she had experienced some difficulty completing paperwork on time due primarily to the chaoticness of the work environment and the excessive amount of responsibility that was placed upon her. When asked about changes in cognitive functioning, she denied noticing any decline in problem solving, language, or nonverbal skills. She also denied any problems with attention and concentration or forgetfulness or memory problems. She continues to independently perform all activities of daily living. She is in charge of the household finances, has had no problems paying bills on time, has had no difficulties with driving or accidents, denied any missed appointments and said that no one has provided feedback to her that they have noticed any changes in her cognitive functioning. She reported that if her children had noticed anything they definitely would have brought it to her attention. She said that she does not currently have a lawyer and does not intend to return to her previous physician. She said she has not yet proceeded with the application for disability retirement because she was told that her doctors would have to fill out that paperwork, but they have not claimed that she is disabled and so she is waiting for the doctors at her former workplace to initiate the application. Other current symptoms include excessive fatigue. She reported that she was diagnosed with chronic fatigue syndrome in 1991, but generally symptoms are under better control now, but she still has difficulty secondary to fibromyalgia. She also reported having fallen approximately five times within the past year. She said that this typically occurs when she is climbing up steps and is usually related to her right foot "like dragging." Dr. X's physical examination revealed no appreciable focal peripheral deficits on motor or sensory testing and notes that perhaps these falls are associated with some stiffness and pain of her right hip and knee, which are chronic symptoms from her fibromyalgia and osteoarthritis. She said that she occasionally bumps into objects, but denied noticing it happening one on any particular part of her body. Muscle pain secondary to fibromyalgia reportedly occurs in her neck and shoulders down both arms and in her left hip.,OTHER MEDICAL HISTORY: , The patient reported that her birth and development were normal. She denied any significant medical conditions during childhood. As mentioned, she now has a history of fibromyalgia. She also experiences some restriction in the range of motion with her right arm. MRI of the C-spine 04/02/2009 showed a hemangioma versus degenerative changes at C7 vertebral body and bulging annulus with small central disc protrusion at C6-C7. MRI of the right shoulder on 06/04/2009 showed small partial tear of the distal infraspinatus tendon and prominent tendinopathy of the distal supraspinatus tendon. As mentioned, she was diagnosed with chronic fatigue syndrome in 1991. She thought that this may actually represent early symptoms of fibromyalgia and said that symptoms are currently under control. She also has diabetes, high blood pressure, osteoarthritis, tension headaches, GERD, carpal tunnel disease, cholecystectomy in 1976, and ectopic pregnancy in 1974. Her previous neuropsychological evaluation referred to an outpatient left neck cystectomy in 2007. She has some difficulty falling asleep, but currently typically obtains approximately seven to eight hours of sleep per night. She did report some sleep disruption secondary to unusual dreams and thought that she talked to herself and could sometimes hear herself talking in her sleep.,CURRENT MEDICATIONS:, NovoLog, insulin pump, metformin, metoprolol, amlodipine, Topamax, Lortab, tramadol, amitriptyline, calcium plus vitamin D, fluoxetine, pantoprazole, Naprosyn, fluticasone propionate, and vitamin C.,SUBSTANCE USE: , The patient reported that she rarely drinks alcohol and she denied smoking or using illicit drugs. She drinks two to four cups of coffee per day.,SOCIAL HISTORY: ,The patient was born and raised in North Carolina. She was the sixth of nine siblings. Her father was a chef. He completed third grade and died at 60 due to complications of diabetes. Her mother is 93 years old. Her last job was as a janitor. She completed fourth grade. She reported that she has no cognitive problems at this time. Family medical history is significant for diabetes, heart disease, hypertension, thyroid problems, sarcoidosis, and possible multiple sclerosis and depression. The patient completed a Bachelor of Science in Nursing through State University in 1979. She denied any history of problems in school such as learning disabilities, attentional problems, difficulty learning to read, failed grades, special help in school or behavioral problems. She was married for two years. Her ex-husband died in 1980 from acute pancreatitis secondary to alcohol abuse. She has two children ages 43 and 30. Her son whose age is 30 lives nearby and is in consistent contact with her and she is also in frequent contact and has a close relationship with her daughter who lives in New York. In school, the patient reported obtaining primarily A's and B's. She said that her strongest subject was math while her worst was spelling, although she reported that her grades were still quite good in spelling. The patient worked for Hospital Center for four years. Prior to that, she worked for an outpatient mental health center for 2-1/2 years. She was reportedly either terminated or laid off and was unsure of the reason for that. Prior to that, she worked for Walter P. Carter Center reportedly for 21 years. She has also worked as an OB nurse in the past. She reported that other than the two instances reported above, she had never been terminated or fired from a job. In her spare time, the patient enjoys reading, participating in women's groups doing puzzles, playing computer games.,PSYCHIATRIC HISTORY: , The patient reported that she sought psychotherapy on and off between 1991 and 1997 secondary to her chronic fatigue. She was also taking Prozac during that time. She then began taking Prozac again when she started working at secondary to stress with the work situation. She reported a chronic history of mild sadness or depression, which was relatively stable. When asked about her current psychological experience, she said that she was somewhat sad, but not dwelling on things. She denied any history of suicidal ideation or homicidal ideation.,TASKS ADMINISTERED:,Clinical Interview,Adult History Questionnaire,Wechsler Test of Adult Reading (WTAR),Mini Mental Status Exam (MMSE),Cognistat Neurobehavioral Cognitive Status Examination,Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Form XX),Mattis Dementia Rating Scale, 2nd Edition (DRS-2),Neuropsychological Assessment Battery (NAB),Wechsler Adult Intelligence Scale, Third Edition (WAIS-III),Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV),Wechsler Abbreviated Scale of Intelligence (WASI),Test of Variables of Attention (TOVA),Auditory Consonant Trigrams (ACT),Paced Auditory Serial Addition Test (PASAT),Ruff 2 & 7 Selective Attention Test,Symbol Digit Modalities Test (SDMT),Multilingual Aphasia Examination, Second Edition (MAE-II), Token Test, Sentence Repetition, Visual Naming, Controlled Oral Word Association, Spelling Test, Aural Comprehension, Reading Comprehension,Boston Naming Test, Second Edition (BNT-2),Animal Naming Test | Neurology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS:, Acute left subdural hematoma.,POSTOPERATIVE DIAGNOSIS:, Acute left subdural hematoma.,PROCEDURE:, Left frontal temporal craniotomy for evacuation of acute subdural hematoma.,DESCRIPTION OF PROCEDURE: , This is a 76-year-old man who has a history of acute leukemia. He is currently in the phase of his therapy where he has developed a profound thrombocytopenia and white cell deficiency. He presents after a fall in the hospital in which he apparently struck his head and now has a progressive neurologic deterioration consistent with an intracerebral injury. His CT imaging reveals an acute left subdural hematoma, which is hemispheric.,The patient was brought to the operating room, placed under satisfactory general endotracheal anesthesia. He had previously been intubated and taken to the Intensive Care Unit and now is brought for emergency craniotomy. The images were brought up on the electronic imaging and confirmed that this was a left-sided condition. He was fixed in a three-point headrest. His scalp was shaved and prepared with Betadine, iodine and alcohol. We made a small curved incision over the temporal, parietal, frontal region. The scalp was reflected. A single bur hole was made at the frontoparietal junction and then a 4x6cm bur hole was created. After completing the bur hole flap, the dura was opened and a gelatinous mass of subdural was peeled away from the brain. The brain actually looked relatively relaxed; and after removal of the hematoma, the brain sort of slowly came back up. We investigated the subdural space forward and backward as we could and yet careful not to disrupt any venous bleeding as we close to the midline. After we felt that we had an adequate decompression, the dura was reapproximated and we filled the subdural space with saline. We placed a small drain in the extra dural space and then replaced the bone flap and secured this with the bone plates. The scalp was reapproximated, and the patient was awakened and taken to the CT scanner for a postoperative scan to ensure that there was no new hemorrhage or any other intracerebral pathology that warranted treatment. Given that this actual skin looked good with apparent removal of about 80% of the subdural we elected to take patient to the Intensive Care Unit for further management.,I was present for the entire procedure and supervised this. I confirmed prior to closing the skin that we had correct sponge and needle counts and the only foreign body was the drain. | Neurology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CT HEAD WITHOUT CONTRAST AND CT CERVICAL SPINE WITHOUT CONTRAST,REASON FOR EXAM: , Motor vehicle collision.,CT HEAD WITHOUT CONTRAST,TECHNIQUE:, Noncontrast axial CT images of the head were obtained.,FINDINGS: , There is no acute intracranial hemorrhage, mass effect, midline shift, or extra-axial fluid collection. The ventricles and cortical sulci are normal in shape and configuration. The gray/white matter junctions are well preserved. There is no calvarial fracture. The visualized paranasal sinuses and mastoid air cells are clear.,IMPRESSION: , Negative for acute intracranial disease.,CT CERVICAL SPINE,TECHNIQUE: ,Noncontrast axial CT images of the cervical spine were obtained. Sagittal and coronal images were obtained.,FINDINGS:, Straightening of the normal cervical lordosis is compatible with patient position versus muscle spasms. No fracture or subluxation is seen. Anterior and posterior osteophyte formation is seen at C5-C6. No abnormal anterior cervical soft tissue swelling is seen. No spinal compression is noted. The atlanto-dens interval is normal. There is a large retention cyst versus polyp within the right maxillary sinus.,IMPRESSION:,1. Straightening of the normal cervical lordosis compatible with patient positioning versus muscle spasms.,2. Degenerative disk and joint disease at C5-C6.,3. Retention cyst versus polyp of the right maxillary sinus. | Neurology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHIEF COMPLAINT: , Right knee. ,HISTORY OF THE PRESENT ILLNESS: , The patient presents today for follow up of osteoarthritis Grade IV of the bilateral knees and flexion contracture, doing great. Physical therapy is helping. The subjective pain is on the bilateral knees right worse than left.,Pain: Localized to the bilateral knees right worse than left.,Quality: There is no swelling, no redness, or warmth. The pain is described as aching occasionally. There is no burning. ,Duration: Months.,Associated symptoms: Includes stiffness and weakness. There is no sleep loss and no instability. ,Hip Pain: None. ,Back pain: None. ,Radicular type pain: None. ,Modifying factors: Includes weight bearing pain and pain with ambulation. There is no sitting, and no night pain. There is no pain with weather change.,VISCOSUPPLEMENTATION IN PAST:, No Synvisc.,VAS PAIN SCORE: , 10 bilaterally.,WOMAC SCORE: , 8,A-1 WOMAC SCORE: , 0,See the enclosed WOMAC osteoarthritis index, which accompanies the patient's chart, for complete details of the patient's limitations to activities of daily living. ,REVIEW OF SYSTEMS:, No change.,Constitutional: Good appetite and energy. No fever. No general complaints.,HEENT: No headaches, no difficulty swallowing, no change in vision, no change in hearing.,CV - RESP: No shortness of breath at rest or with exertion. No paroxysmal nocturnal dyspnea, orthopnea, and without significant cough, hemoptysis, or sputum. No chest pain on exertion.,GI: | Orthopedic |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS:, Right inguinal hernia.,POSTOPERATIVE DIAGNOSIS: , Right inguinal hernia.,ANESTHESIA: , General.,PROCEDURE: ,Right inguinal hernia repair.,INDICATIONS: , The patient is a 4-year-old boy with a right inguinal bulge, which comes and goes with Valsalva standing and some increased physical activity. He had an inguinal hernia on physical exam in the Pediatric Surgery Clinic and is here now for elective repair. We met with his parents and explained the surgical technique, risks, and talked to them about trying to perform a diagnostic laparoscopic look at the contralateral side to rule out an occult hernia. All their questions have been answered and they agreed with the plan.,OPERATIVE FINDINGS: ,The patient had a well developed, but rather thin walled hernia sac on the right. The thinness of hernia sac made it difficult to safely cannulate through the sac for the laparoscopy. Therefore, high ligation was performed, and we aborted the plan for laparoscopic view of the left side.,DESCRIPTION OF PROCEDURE: , The patient came to operating room and had an uneventful induction of general anesthesia. Surgical time-out was conducted while we were preparing and draping his abdomen with chlorhexidine based prep solution. During our time-out, we reiterated the patient's name, medical record number, weight, allergies status, and planned operative procedure. I then infiltrated 0.25% Marcaine with dilute epinephrine in the soft tissues around the inguinal crease in the right lower abdomen chosen for hernia incision. An additional aliquot of Marcaine was injected deep to the external oblique fascia performing the ilioinguinal and iliohypogastric nerve block. A curvilinear incision was made with a scalpel and a combination of electrocautery and some blunt dissection and scissor dissection was used to clear the tissue layers through Scarpa fascia and expose the external oblique. After the oblique layers were opened, the cord structure were identified and elevated. The hernia sac was carefully separated from the spermatic cord structures and control of the sac was obtained. Dissection of the hernia sac back to the peritoneal reflection at the level of deep inguinal ring was performed. I attempted to gently pass a 3-mm trocar through the hernia sac, but it was rather difficult and I became fearful that the sac would be torn in proximal control and mass ligation would be less effective. I aborted the laparoscopic approach and performed a high ligation using transfixing and a simple mass ligature of 3-0 Vicryl. The excess sac was trimmed and the spermatic cord structures were replaced. The external oblique fascia and Scarpa layers were closed with interrupted 3-0 Vicryl and skin was closed with subcuticular 5-0 Monocryl and Steri-Strips. The patient tolerated the operation well. Blood loss was less than 5 mL. The hernia sac was submitted for specimen, and he was then taken to the recovery room in good condition. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: , Metastatic papillary cancer, left neck.,POSTOPERATIVE DIAGNOSIS: , Metastatic papillary cancer, left neck.,OPERATION PERFORMED: , Left neck dissection.,ANESTHESIA: ,General endotracheal.,INDICATIONS: , The patient is a very nice gentleman, who has had thyroid cancer, papillary cell type, removed with a total thyroidectomy and then subsequently recurrent disease was removed with a paratracheal dissection. He now has evidence of lesion in the left mid neck and the left superior neck on ultrasound, which are suspicious for recurrent cancer. Left neck dissection is indicated.,DESCRIPTION OF OPERATION: , The patient was placed on the operating room table in the supine position. After adequate general endotracheal anesthesia was administered, the table was then turned. A shoulder roll placed under the shoulders and the face was placed in an extended fashion. The left neck, chest, and face were prepped with Betadine and draped in a sterile fashion. A hockey stick skin incision was performed, extending a previous incision line superiorly towards the mastoid cortex through skin, subcutaneous tissue and platysma with Bovie electrocautery on cut mode. Subplatysmal superior and inferior flaps were raised. The dissection was left lateral neck dissection encompassing zones 1, 2A, 2B, 3, and the superior portion of 4. The sternocleidomastoid muscle was unwrapped at its fascial attachment and this was taken back posterior to the XI cranial nerve into the superior posterior most triangle of the neck. This was carried forward off of the deep rooted muscles including the splenius capitis and anterior and middle scalenes taken medially off of these muscles including the fascia of the muscles, stripped from the carotid artery, the X cranial nerve, the internal jugular vein and then carried anteriorly to the lateral most extent of the dissection previously done by Dr. X in the paratracheal region. The submandibular gland was removed as well. The X, XI, and XII cranial nerves were preserved. The internal jugular vein and carotid artery were preserved as well. Copious irrigation of the wound bed showed no identifiable bleeding at the termination of the procedure. There were two obviously positive nodes in this neck dissection. One was left medial neck just lateral to the previous tracheal dissection and one was in the mid region of zone 2. A #10 flat fluted Blake drain was placed through a separate stab incision and it was secured to the skin with a 2-0 silk ligature. The wound was closed in layers using a 3-0 Vicryl in a buried knot interrupted fashion for the subcutaneous tissue and the skin was closed with staples. A fluff and Kling pressure dressing was then applied. The patient was extubated in the operating room, brought to the recovery room in satisfactory condition. There were no intraoperative complications. | ENT - Otolaryngology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS (ES):, Rectovaginal fistula.,POSTOPERATIVE DIAGNOSIS (ES):, Rectovaginal fistula.,PROCEDURE:, CPT code 57307 - Closure of rectovaginal fistula, transperineal approach.,MATERIAL FORWARDED TO THE LABORATORY FOR EXAMINATION:, Includes fistula tract.,ESTIMATED BLOOD LOSS:, 25 mL.,INDICATIONS:, The patient is a 27-year-old morbidly obese gravida three, para one, who was seen in consultation from Dr. M's office, in the office of Chattanooga GYN Oncology on 01/12/06 regarding an obstetrically related rectovaginal fistula, dating from 1998. She had an episioproctotomy associated with the birth of her seven pound son in 1998 and immediately noted the spontaneous loss of gas and stool. She had her fistula repaired by Dr. R in 2000 and did well for approximately one year, without complaint, when she again noted the spontaneous loss of stool and gas from her vagina. She has partial control if her stools are formed, but she has no control of her gas. She is a type 2 diabetic, with poorly controlled blood sugars at times, however, her diabetes has been fairly well controlled of late.,FINDINGS AT THE TIME OF SURGERY:, She had a 1 cm fistulous tract, approximately 4 cm proximal to the vaginal introitus. This communicated directly with the low rectal vault. She had good rectal sphincter tone and a very thin perineal body. The fistulous tract was excised completely and intact. The underlying rectal mucosa was closed with chromic and the perineal body was reinforced and reconstructed. At the completion of the procedure, the repair is watertight, there were no other defects.,DESCRIPTION OF THE OPERATION:, The patient was taken to the operating room where she underwent general endotracheal anesthesia. She was then placed in the lithotomy position using candy-cane stirrups. The vulva and vagina were prepped and the patient was draped. A lacrimal duct probe was used to define the fistulous tract and a transperineal incision was made. The rectovaginal septum was developed and with an index finger in the rectum, the rectovaginal septum was easily defined. The fistulous tract was isolated and using the lacrimal duct probe, it was completely isolated. Using electrocautery dissection on the pure cut mode, the rectal mucosa was entered in a circumferential fashion as was the vaginal mucosa. This allowed for removal of the fistulous tract intact, with both epithelial layers preserved. The perineum and rectum were irrigated vigorously and then the rectal mucosa was reapproximated with a running stitch of number 4-0 chromic. The rectal vault was distended with saline and the repair was watertight. The defect was irrigated, suctioned, inspected and found to be free of clot, blood or debris. The perineal body was reconstructed with reapproximation of the levator muscles, using a series of interrupted horizontal mattress stitches of number 2-0 Vicryl. This allowed for excellent restoration of the perineal body. After this was accomplished, the defect was once again irrigated, suctioned, inspected, and found to be free of clot, blood or debris. The vaginal defect was closed with a running locking stitch of number 2-0 Vicryl and the perineal incision was closed with a subcuticular stitch of number 2-0 Vicryl. The patient was awakened and taken to the recovery room in stable condition, after having tolerated the procedure well. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHIEF COMPLAINT:, Jaw pain this morning.,BRIEF HISTORY OF PRESENT ILLNESS:, This is a very nice 53-year-old white male with no previous history of heart disease, was admitted to rule out MI and coronary artery disease. The patient has history of hypercholesterolemia, presently on Lipitor 20 mg a day and hyperthyroidism, on Synthroid 0.088 mg per day. Also, history of chronic diverticulitis with recent bouts. The patient has been doing well, seen in my office at the end of December for complete physical examination. I had ordered a stress test for him, then delayed due to a family illness. However, denies any chest pain or chest tightness with exertion. The patient was doing well. He was watching television yesterday afternoon or p.m. and fell asleep holding his head in his left hand. He awoke and noticed pain in the jaw and neck area, on both sides, but no shortness of breath, diaphoresis, nausea, or chest pain. He is able to go to sleep, woke up this morning with same discomfort, decided to call our office, talked to our triage nurse, who instructed to come to the emergency room for possibility of just having a cardiac event. The patient's pain resolved. He was given nitroglycerin in the emergency room drawing his blood pressure 67/32. Blood pressure quickly came back to normal with the patient's reverse Trendelenburg.,FAMILY HISTORY: , Strongly positive for heart disease in his father. He had a bypass at age 60. Both parents are alive. Both have dementia. His father has history of coronary artery disease and multiple vascular strokes. He is in his 80s. His mother is 80, also with dementia. The patient does not smoke or drink.,PAST MEDICAL HISTORY:, Remarkable for tonsillectomies.,MEDICATIONS:, Synthroid and Lipitor.,ALLERGIES:, PENICILLIN AND BIAXIN.,REVIEW OF SYSTEMS:, Noncontributory.,PHYSICAL EXAMINATION:,VITAL SIGNS: The patient's blood pressure is 113/74, pulse rate is 72, respiratory rate is 18. He is afebrile.,GENERAL: He is well-developed, well-nourished white male, in no acute distress.,HEENT: Pupils equal, round, and reactive to light and accommodation. Extraocular movements were intact. Throat was clear.,NECK: Supple. There is no organomegaly or thyromegaly. Carotids are +2 without bruits.,CHEST: Lungs are clear to auscultation and percussion.,CV: Without any murmurs or gallops.,ABDOMEN: Soft. There is no hepatosplenomegaly. Bowel sounds are active. No tenderness.,EXTREMITIES: No cyanosis, clubbing, or edema. Peripheral pulses 2+.,NEUROLOGICAL: Intact. Motor exam is 5/5.,LABORATORY STUDIES:, EKG is within normal limits, good sinus rhythm. His axis is somewhat leftward. CBC and BMP were normal and cardiac enzymes were negative x1.,IMPRESSION:,1. Jaw pain, sounds musculoskeletal. We will rule out angina equivalent.,2. Hypercholesterolemia.,3. Hypothyroidism.,PLAN: , Lipitor and thyroid have been ordered. His chest pain unit protocol for the stress thallium that will be done in the morning. If test is negative, we will discharge home. If positive, we will consult Cardiology. The patient requests Dr. ABC. | General Medicine |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: , Bilateral degenerative arthritis of the knees.,POSTOPERATIVE DIAGNOSIS: , Bilateral degenerative arthritis of the knees.,PROCEDURE PERFORMED: , Right total knee arthroplasty done in conjunction with a left total knee arthroplasty, which will be dictated separately.,ANESTHESIA: , General.,COMPLICATIONS: ,None.,ESTIMATED BLOOD LOSS: , Bilateral procedure was 400 cc.,TOTAL TOURNIQUET TIME: ,75 minutes.,COMPONENTS: , Include the Zimmer NexGen complete knee solution system, which include a size F right cruciate retaining femoral component, a size #8 peg tibial component precoat, a All-Poly standard size 38, 9.5 mm thickness patellar component, and a prolonged highly cross-linked polyethylene NexGen cruciate retaining tibial articular surface size blue 12 mm height.,HISTORY OF PRESENT ILLNESS: , The patient is a 69-year-old male who presented to the office complaining of bilateral knee pain for a couple of years. The patient complained of clicking noises and stiffness, which affected his daily activities of living.,PROCEDURE: , After all potential complications, risks as well as anticipated benefits of the above-named procedure was discussed at length, the patient's informed consent was obtained.,Operative extremities were then confirmed with the operating surgeons as well as the nursing staff, Department of Anesthesia, and the patient. The patient was then transferred to preoperative area to operative suite #2 and placed on the operating room table in supine position. All bony prominences were well padded at this time. At this time, Department of Anesthesia administered general anesthetic to the patient. The patient was allowed in DVT study and the right extremity was in the Esmarch study as well as the left. The nonsterile tourniquet was then applied to the right upper thigh of the patient, but not inflated at this time. The right lower extremity was sterilely prepped and draped in the usual sterile fashion. The right upper extremity was then elevated and exsanguinated using an Esmarch and the tourniquet was inflated using 325 mmHg. The patient was a consideration for a unicompartmental knee replacement. So, after all bony and soft tissue landmarks were identified, a limited midline longitudinal incision was made directly over the patella. A sharp dissection was then taken down to the level of the fascia in line with the patella as well as the quadriceps tendon. Next, a medial parapatellar arthrotomy was performed using the #10 blade scalpel. Upon viewing of the articular surfaces, there was significant ware in the trochlear groove as well as the medial femoral condyle and it was elected to proceed with total knee replacement. At this time, the skin incisions as well as the deep incisions were extended proximally and distally in a midline fashion. Total incision now measured approximately 25 cm. Retractors were placed. Next, attention was directed to establishing medial and lateral flaps of the proximal tibia. Reciprocating osteal elevator was used to establish soft tissue plane and then an electrocautery was then used to subperiosteal strip medially and laterally on the proximal tibia. At this time, the patella was then everted. The knee was flexed up to 90 degrees. Next, using the large drill bit, the femoral canal was then opened in appropriate position. The intramedullary sizing guide was then placed and the knee was sized to a size F. At this time, the three degrees external rotation holes were then drilled after carefully assessing the epicondylar access as well as the white sideline. The guide was then removed. The intramedullary guide was then placed with nails holding the guide in three degrees of external rotation. Next, the anterior femoral resection guide was then placed and clamped into place using a pointed _________________ was then used to confirm that there would no notching performed. Next, soft tissue retractors were placed and an oscillating saw was used to make the anterior femoral cut. Upon checking, it was noted to be flat with no oscillations. The anterior guide was then removed and the distal femoral resection guide was placed in five degrees of valgus. It was secured in place using nails. The intramedullary guide was then removed and the standard distal femoral cut was then made using oscillating saw.,This was then removed and the size F distal finishing femoral guide was then placed on the femur in proper position. Bony and soft tissue landmarks were confirmed and the resection guide was then held in place using nail as well as spring screws. Again, the collateral ligament retractors were then placed and the oscillating saw was used to make each of the anterior and posterior as well as each chamfer cut. A reciprocating saw was then used to cut the trochlear cut and the peg holes were drilled as well. The distal finishing guide was then removed and osteotome was then used to remove all resected bone. The oscillating saw was then used to complete the femoral notch cut. Upon viewing, there appeared to be proper amount of bony resection and all bone was removed completely. There was no posterior osteophytes noted and no fragments to the posterior aspect. Next, attention was directed towards the tibia. The external tibial guide was reflected. This was placed on the anterior tibia and held in place using nails after confirming the proper varus and valgus position. The resection guide was then checked and appeared to be sufficient amount of resection in both medial and lateral condyles of the tibia. Next, collateral ligament retractors were placed as well as McGill retractors for the PCL. Oscillating saw was then used to make the proximal tibial cut. Osteotome was used to remove this excess resected bone. The laminar spreader was then used to check the flexion and extension. The gaps appeared to be equal. The external guide was then removed and trial components were placed to a size F femoral component and a 12 mm tibial component on a size 8 tray. The knee was taken through range of motion and had very good flexion as well as full extension. There appeared to be good varus and valgus stability as well. Next, attention was directed towards the patella. There noted to be a sufficient ware and it was selected to replace the patella. It was sized with caliper, pre-cut and noted to be 26 mm depth. The sizing guide was then used and a size 51 resection guide selected. A 51 mm reamer was then placed and sufficient amount of patella was then removed. The calcar was then used to check again and there was noted to be 15 mm remaining. The 38 mm patella guide was then placed on the patella. It was noted to be in proper size and the three drill holes for the pegs were used. A trial component was then placed. The knee was taken through range of motion. There was noted to be some subluxation lateral to the patellar component and a lateral release was performed. After this, the component appeared to be tracking very well. There remained a good range of motion in the knee and extension as well as flexion. At this time, an AP x-ray of the knee was taken with the trial components in place. Upon viewing this x-ray, it appeared that the tibial cut was in neutral, all components in proper positioning. The knee was then copiously irrigated and dried. The knee was then flexed ___________ placed, and the peg drill guide was placed on the tibia in proper position, held in place with nails.,The four peg holes were then drilled. The knee again was copiously irrigated and suction dried. The final components were then selected again consisting of size F femoral components. A peg size 8 tibial component, a 12 mm height articular surface, size blue, and a 38 mm 9.5 mm thickness All-Poly patella. Polymethyl methacrylate was then prepared at this time. The proximal tibia was dried and the cement was then pressed into place. The cement was then placed on the backside of the tibial component and the tibial component was then impacted into proper positioning. Next, the proximal femur was cleaned and dried. Polymethyl methacrylate was placed on the resected portions of the femur as well as the backside of the femoral components. This was then impacted in place as well. At this time, all excess cement was removed from both the tibial and femoral components. A size 12 mm trial tibial articular surface was then put in place. The knee was reduced and held in loading position throughout the remaining drying position of the cement. Next, the resected patella was cleaned and dried. The cement was placed on the patella as well as the backside of the patellar component. The component was then put in proper positioning and held in place with a clamp. All excess polymethyl methacrylate was removed from this area as well. This was held until the cement had hardened sufficiently. Next, the knee was examined. All excess cement was then removed. The knee was taken through range of motion with sufficient range of motion as well as stability. The final 12 mm height polyethylene tibial component was then put into place and snapped down in proper position. Again range of motion was noted to be sufficient. The knee was copiously irrigated and suction dried once again. A drain was then placed within the knee. The wound was then closed first using #1 Ethibond to close the arthrotomy oversewn with a #1 Vicryl. The knee was again copiously irrigated and dried. The skin was closed using #2-0 Vicryl in subcuticular fashion followed by staples on the skin. The ConstaVac was then _______ to the drain. Sterile dressing was applied consisting of Adaptic, 4x4, ABDs, Kerlix, and a 6-inch Dupre roll from foot to thigh. Department of Anesthesia then reversed the anesthetic. The patient was transferred back to the hospital gurney to Postanesthesia Care Unit. The patient tolerated the procedure well and there were no complications. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSES: , Angina with severe claudication, coronary artery disease, hypertension, dyslipidemia, heavy tobacco abuse, and PAD.,POSTOPERATIVE DIAGNOSES: , Angina with severe claudication, coronary artery disease, hypertension, dyslipidemia, heavy tobacco abuse, and PAD. Significant coronary artery disease, very severe PAD.,PROCEDURES PERFORMED:,1. Right common femoral artery cannulation.,2. Conscious sedation using IV Versed and IV fentanyl.,3. Retrograde bilateral coronary angiography.,4. Abdominal aortogram with pelvic runoff.,5. Left external iliac angiogram with runoff to the patient's left foot.,6. Left external iliac angiogram with runoff to the patient's right leg.,7. Right common femoral artery angiogram runoff to the patient's right leg.,PROCEDURE IN DETAIL:, The patient was taken to the cardiac catheterization laboratory after having a valid consent. He was prepped and draped in the usual sterile fashion.,After local infiltration with 2% Xylocaine, the right common femoral artery was entered percutaneously and a 4-French sheath was placed over the artery. The arterial sheath was flushed throughout the procedure.,Conscious sedation was obtained using IV Versed and IV fentanyl.,With the help of a Wholey wire, a 4-French 4-curve Judkins right coronary artery catheter was advanced into the ascending aorta. The wire was removed, the catheter was flushed. The catheter was engaged in the left main. Injections were performed at the left main in different views. The catheter was then exchanged for an RCA catheter, 4-French 4-curve which was advanced into the ascending aorta with the help of a J-wire. The wire was removed, the catheter was flushed. The catheter was engaged in the RCA. Injections were performed at the RCA in different views.,The catheter was then exchanged for a 5-French Omniflush catheter, which was advanced into the abdominal aorta with the help of a regular J-wire. The wire was removed. The catheter was flushed. Abdominal aortogram was then performed with runoff to the patient's pelvis.,The Omniflush catheter was then retracted into the aortic bifurcation. Through the Omniflush catheter, a Glidewire was then advanced distally into the left SFA. The Omniflush was then removed. Through the wire, a Royal Flush catheter was then advanced into the left external iliac. The wire was removed. Left external iliac angiogram was performed with runoff to the patient's left foot _______ was then performed. The catheter was then retracted into the left common iliac. Angiograms were performed of the left common iliac with runoff to the patient's left groin. The catheter was then positioned at the level of the right common iliac. Angiogram of the right common iliac with runoff to the patient's right leg was then performed. The catheter was then removed with the help of a J-wire. The J-wire was left in the abdominal aorta. Hand injection was performed of the right common femoral artery in 2 locations with runoff to the patient's right leg.,The wire was then removed. The arterial sheath was then removed after being flushed. Hemostasis was obtained using hand compression.,The patient tolerated the procedure well and had no complications. At the end of the procedure, palpable right common femoral pulses were noted as well as 1+ right PT pulse.,Hemodynamic Findings:, Aortic pressure 140/70.,ANGIOGRAPHIC FINDINGS: , Left main with calcification 25% to 40% lesion.,The left main is very short.,LAD with calcification 25% to 40% proximal lesion.,D1 has 25% lesion. No in-stent restenosis was noted in D1.,D2 and D3 are very small with luminal irregularities.,Circumflex artery was diseased throughout the vessel. The circumflex artery has an ostium of 60% to 75% lesion distally and the circumflex has a 75% lesion.,OM1 has 25% to 40% lesion. These OMs are small with luminal irregularities.,RCA has 25% to 50% lesion, distally, the RCA has luminal irregularities.,Left ventriculography was not done.,ABDOMINAL AORTOGRAM:, Right renal artery with luminal irregularities. Left renal artery with luminal irregularities. The abdominal aorta has 25% lesion.,Right common iliac has a 25% to 50% lesion as well as a distal 75% lesion.,The right external iliac has a proximal 75% lesion.,The distal part of the right external iliac as well as the right common femoral appears to be occlusive by the 5-French sheath.,The right SFA was visualized, although not very well.,Left common iliac with 25% to 50% lesion. Left external iliac with 25% to 40% lesion. Left common femoral with 25% to 40% lesion. Left SFA with 25% lesion. Left popliteal with wall luminal irregularities.,Three-vessel runoff is noted at the level of the left knee and at the level of the left ankle.,Conclusions: Severe coronary artery disease. Very severe peripheral arterial disease.,PLAN: , Because of the anatomic distribution of the coronary artery disease, for now we will continue medical treatment for CAD. We will proceed with revascularization of the right external iliac as well as right common femoral. Discontinue tobacco. | Cardiovascular / Pulmonary |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS:, Airway stenosis with self-expanding metallic stent complication.,POSTOPERATIVE DIAGNOSIS:, Airway stenosis with self-expanding metallic stent complication.,PROCEDURES:,1. Rigid bronchoscopy with removal of foreign body, prolonged procedure taking two hours to remove the stent piecemeal in a very difficult and trying situation.,2. Excision of granulation tissue tumor.,3. Bronchial dilation with a balloon bronchoplasty, right main bronchus.,4. Argon plasma coagulation to control bleeding in the trachea.,5. Placement of a tracheal and bilateral bronchial stents with a silicon wire stent.,ENDOSCOPIC FINDINGS:,1. Normal true vocal cords.,2. Proximal trachea with high-grade occlusion blocking approximately 90% of the trachea due to granulation tissue tumor and break down of metallic stent.,3. Multiple stent fractures in the mid portion of the trachea with granulation tissue.,4. High-grade obstruction of the right main bronchus by stent and granulation tissue.,5. Left main bronchus was covered by the distal portion of the stent and was only being ventilated through the struts of the stent.,6. All in all a high-grade terrible airway obstruction with involvement of the carina, left and right main stem bronchus, mid, distal, and proximal trachea.,TECHNIQUE IN DETAIL: , After informed consent was obtained from the patient, he was brought into the operating field. A rapid sequence induction was done. He was intubated with a rigid scope. Jet ventilation technique was carried out using a rigid and flexible scope. A thorough airway inspection was carried out with findings as described above.,Dr. D was present in the operating room and we conferred on operative strategy and agreed that the best of strategy would be to first dilate the right main bronchus, cauterize it to control bleeding and then piecemeal removed the stent from distal to proximal. This is the technique that was carried out in a painstaking fashion removing bits of the stent piecemeal with finally getting all of the visible stent out of the airway. It should be noted that Dr. Donovan and I felt that two of the metallic stents were probably in place but we cannot be sure because of the terrible anatomy and the fact that the stent pieces were coming out twisted metal in fragments. Nevertheless, all the visible stent was removed, and the airway was much better after with the dilation of balloon and the rigid scope. We took measurements and decided to place stents in the trachea, left and right main bronchus using a Dumon Y-stent. It was measured 18 mm in tracheal diameter and 14 mm in bronchial diameter. The right main stem stent was 2.25 cm in length, the left main stem stent was 3 cm in length and the tracheal portion was 9 cm in length. After it was placed, excellent placement was achieved with the proximal end of the stent 3 cm below the true vocal cords. The patient tolerated the procedure well and was brought to the recovery room extubated. | Cardiovascular / Pulmonary |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS:, Empyema.,POSTOPERATIVE DIAGNOSIS: , Empyema.,PROCEDURE PERFORMED:,1. Right thoracotomy, total decortication.,2. Intraoperative bronchoscopy.,ANESTHESIA: , General.,COMPLICATIONS: , None.,ESTIMATED BLOOD LOSS:, 300 cc.,FLUIDS: , 2600 cc IV crystalloid.,URINE: , 300 cc intraoperatively.,INDICATIONS FOR PROCEDURE: ,The patient is a 46-year-old Caucasian male who was admitted to ABCD Hospital since 08/14/03 with acute diagnosis of right pleural effusion. A thoracostomy tube was placed at the bedside with only partial resolution of the pleural effusion. On CT scan evaluation, there is evidence of an entrapped right lower lobe with loculations. Decision was made to proceed with surgical intervention for a complete decortication and the patient understands the need for surgery and signed the preoperative informed consent.,OPERATIVE PROCEDURE: , The patient was taken to the operative suite and placed in the supine position under general anesthesia per Anesthesia Department. Intraoperative bronchoscopy was performed by Dr. Y and evaluation of carina, left upper and lower lobes with segmental evidence of diffuse mucous, thick secretions which were thoroughly lavaged with sterile saline lavage. Samples were obtained from both the left and the right subbronchiole segments for Gram stain cultures and ASP evaluation. The right bronchus lower, middle, and upper were also examined and subsegmental bronchiole areas were thoroughly examined with no evidence of masses, lesions, or suspicious extrinsic compressions on the bronchi. At this point, all mucous secretions were thoroughly irrigated and aspirated until the airways were clear. Bronchoscope was then removed. Vital signs remained stable throughout this portion of the procedure. The patient was re-intubated by Anesthesia with a double lumen endotracheal tube. At this point, the patient was repositioned in the left lateral decubitus position with protection of all pressure points and the table was extended in customary fashion. At this point, the right chest was prepped and draped in the usual sterile fashion. The chest tube was removed before prepping the patient and the prior thoracostomy site was cleansed thoroughly with Betadine. The first port was placed through this incision intrathoracically. A bronchoscope was placed for inspection of the intrathoracic cavity. Pictures were taken. There is extensive fibrinous exudate noted under parietal and visceral pleura, encompassing the lung surface, diaphragm, and the posterolateral aspect of the right thorax. At this point, a second port site anteriorly was placed under direct visualization. With the aid of the thoracoscopic view, a Yankauer resection device was placed in the thorax and blunt decortication was performed and aspiration of reminder of the pleural fluid. Due to the gelatinous nature of the fibrinous exudate, there were areas of right upper lobe that adhered to the chest wall and the middle and lower lobes appeared entrapped. Due to the extensive nature of the disease, decision was made to open the chest in a formal right thoracotomy fashion. Incision was made. The subcutaneous tissues were then electrocauterized down to the level of the latissimus dorsi, which was separated with electrocautery down to the anterior 6th rib space. The chest cavity was entered with the right lung deflated per Anesthesia at our request. Once the intrathoracic cavity was accessed, a thorough decortication was performed in meticulous systematic fashion starting with the right upper lobe, middle, and the right lower lobe. With the expansion of the lung and reduction of the pleural surface fibrinous extubate, warm irrigation was used and the lungs allowed to re-expand. There was no evidence of gross leakage or bleeding at the conclusion of surgery.,Full lung re-expansion was noted upon re-inflation of the lung. Two #32 French thoracostomy tubes were placed, one anteriorly straight and one posteriorly on the diaphragmatic sulcus. The chest tubes were secured in place with #0-silk sutures and placed on Pneumovac suction. Next, the ribs were reapproximated with five interrupted CTX sutures and latissimus dorsi was then reapproximated with a running #2-0 Vicryl suture. Next, subcutaneous skin was closed sequentially with a cosmetic layered subcutaneous closure. Steri-Strips were applied along with sterile occlusive dressings. The patient was awakened from anesthesia without difficulty and extubated in the operating room. The chest tubes were maintained on Pleur-Evac suction for full re-expansion of the lung. The patient was transported to the recovery with vital signs stable. Stat portable chest x-ray is pending. The patient will be admitted to the Intensive Care Unit for close monitoring overnight. | Cardiovascular / Pulmonary |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: , Chronic renal failure.,POSTOPERATIVE DIAGNOSIS: ,Chronic renal failure.,PROCEDURE PERFORMED:, Insertion of left femoral circle-C catheter.,ANESTHESIA: , 1% lidocaine.,ESTIMATED BLOOD LOSS:, Minimal.,COMPLICATIONS: , None.,HISTORY: , The patient is a 36-year-old African-American male presented to ABCD General Hospital on 08/30/2003 for evaluation of elevated temperature. He was discovered to have a MRSA bacteremia with elevated fever and had tenderness at the anterior chest wall where his Perm-A-Cath was situated. He did require a short-term of Levophed for hypotension. He is felt to have an infected dialysis catheter, which was removed. He was planned to undergo replacement of his Perm-A-Cath, dialysis catheter, however, this was not possible. He will still require a dialysis and will require at least a temporary dialysis catheter until which time a long-term indwelling catheter can be established for dialysis. He was explained the risks, benefits, and complications of the procedure previously. He gave us informed consent to proceed.,OPERATIVE PROCEDURE: , The patient was placed in the supine position. The left inguinal region was shaved. His left groin was then prepped and draped in normal sterile fashion with Betadine solution. Utilizing 1% lidocaine, the skin and subcutaneous tissue were anesthetized with 1% lidocaine. Under direct aspiration technique, the left femoral vein was cannulated. Next, utilizing an #18 gauge Cook needle, the left femoral vein was cannulated. Sutures were removed, nonpulsatile flow was observed and a Seldinger guidewire was inserted within the catheter. The needle was then removed. Utilizing #11 blade scalpel, a small skin incision was made adjacent to the catheter. Utilizing a #10 French dilator, the skin, subcutaneous tissue, and left femoral vein were dilated over the Seldinger guidewire. Dilator was removed and a preflushed circle-C 8 inch catheter was inserted over the Seldinger guidewire. The guidewire was retracted out from the blue distal port and grasped. The catheter was then placed in the left femoral vessel _______. This catheter was then fixed to the skin with #3-0 silk suture. A mesenteric dressing was then placed over the catheter site. The patient tolerated the procedure well. He was turned to the upright position without difficulty. He will undergo dialysis today per Nephrology. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: , Squamous cell carcinoma on the right hand, incompletely excised.,POSTOPERATIVE DIAGNOSIS: , Squamous cell carcinoma on the right hand, incompletely excised.,NAME OF OPERATION: , Re-excision of squamous cell carcinoma site, right hand.,ANESTHESIA:, Local with monitored anesthesia care.,INDICATIONS:, Patient, 72, status post excision of squamous cell carcinoma on the dorsum of the right hand at the base of the thumb. The deep margin was positive. Other margins were clear. He was brought back for re-excision.,PROCEDURE:, The patient was brought to the operating room and placed in the supine position. He was given intravenous sedation. The right hand was prepped and draped in the usual sterile fashion. Three cubic centimeters of 1% Xylocaine mixed 50/50 with 0.5% Marcaine with epinephrine was instilled with local anesthetic around the site of the excision, and the site of the cancer was re-excised with an elliptical incision down to the extensor tendon sheath. The tissue was passed off the field as a specimen.,The wound was irrigated with warm normal saline. Hemostasis was assured with the electrocautery. The wound was closed with running 3-0 nylon without complication. The patient tolerated the procedure well and was taken to the recovery room in stable condition after a sterile dressing was applied. | Hematology - Oncology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: ,Oropharyngeal foreign body.,POSTOPERATIVE DIAGNOSES:,1. Foreign body, left vallecula at the base of the tongue.,2. Airway is patent and stable.,PROCEDURE PERFORMED: , Flexible nasal laryngoscopy.,ANESTHESIA:, ______ with viscous lidocaine nasal spray.,INDICATIONS: , The patient is a 39-year-old Caucasian male who presented to ABCD General Hospital Emergency Department with acute onset of odynophagia and globus sensation. The patient stated his symptoms began around mid night after returning home _________ ingesting some chicken. The patient felt that he had ingested a chicken bone, tried to dislodge this with fluids and other solid foods as well as sticking his finger down his throat without success. The patient subsequently was seen in the Emergency Department where it was discovered that the patient had a left vallecular foreign body. Department of Otolaryngology was asked to consult for further evaluation and treatment of this foreign body.,PROCEDURE: , After verbal informed consent was obtained, the patient was placed in the upright position. The fiberoptic nasal laryngoscope was inserted in the patient's right naris and then the left naris. There was visualized some bilateral caudal spurring of the septum. The turbinates were within normal limits. There was some posterior nasoseptal deviation to the left. The nasal laryngoscope was then inserted back into the right naris and it was advanced along the floor of the nasal cavity. The nasal mucous membranes were pink and moist. There was no evidence of mass, ulceration, lesion, or obstruction.,The scope was further advanced to the level of the nasopharynx where the eustachian tubes were visualized bilaterally. There was evidence of some mild erythema in the right fossa Rosenmüller. There was no evidence of mass lesion or ulceration in this area, however. The eustachian tubes were patent without obstruction. The scope was further advanced to the level of the oropharynx where the base of the tongue, vallecula, and epiglottis were visualized. There was evidence of a 1.5 cm left vallecular white foreign body. The rest of the oropharynx was without abnormality. The epiglottis was within normal limits and was noted to be omega in shape. There was no edema or erythema to the epiglottis. The scope was then further advanced to the level of the hypopharynx to the level of the true vocal cords. There was no evidence of erythema or edema of the posterior commissure, arytenoid cartilage, or superior surface of the vocal cords. The laryngeal surface of the epiglottis was within normal limits. There was no evidence of mass lesion or nodularity of the vocal cords. The patient was asked to Valsalva and the piriform sinuses were observed without evidence of foreign body or mass lesion. The patient did have complete glottic closure upon phonation and the airway was patent and stable throughout the exam. The glottic aperture was completely patent with inspiration. The anterior commissure, epiglottic folds, false vocal cords, and piriform sinuses were all within normal limits. The scope was then removed without difficulty. The patient tolerated the procedure well and remained in stable condition.,FINDINGS:,1. A 1.5 cm white foreign body consistent with a chicken bone at the left vallecular region. There is no evidence of supraglottic or piriform sinuses foreign body.,2. Mild erythema of the right nasopharynx in the region of the fossa Rosenmüller. No mass is appreciated at this time.,PLAN:, The patient is to go to the operating room for direct laryngoscopy/microscopic suspension direct laryngoscopy for removal of foreign body under anesthesia this a.m. Airway precautions were instituted. The patient currently remained in stable condition. | ENT - Otolaryngology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | REASON FOR EXAMINATION: , Cardiac arrhythmia.,INTERPRETATION: , No significant pericardial effusion was identified.,The aortic root dimensions are within normal limits. The four cardiac chambers dimensions are within normal limits. No discrete regional wall motion abnormalities are identified. The left ventricular systolic function is preserved with an estimated ejection fraction of 60%. The left ventricular wall thickness is within normal limits.,The aortic valve is trileaflet with adequate excursion of the leaflets. The mitral valve and tricuspid valve motion is unremarkable. The pulmonic valve is not well visualized.,Color flow and conventional Doppler interrogation of cardiac valvular structures revealed mild mitral regurgitation and mild tricuspid regurgitation with an RV systolic pressure calculated to be 28 mmHg. Doppler interrogation of the mitral in-flow pattern is within normal limits for age.,IMPRESSION:,1. Preserved left ventricular systolic function.,2. Mild mitral regurgitation.,3. Mild tricuspid regurgitation. | Cardiovascular / Pulmonary |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | REASON FOR REFERRAL:, Chest pain, possible syncopal spells.,She is a very pleasant 31-year-old mother of two children with ADD.,She was doing okay until January of 2009 when she had a partial hysterectomy. Since then she just says "things have changed". She just does not want to go out anymore and just does not feel the same. Also, at the same time, she is having a lot of household stressors with both of her children having ADD and ODD and she feels she does not get enough support from her husband. Her 11-year-old is having a lot of trouble at school and she often has to go there to take care of problems.,In this setting, she has been having multiple cardiovascular complaints including chest pains, which feel "like cramps" and sometimes like a dull ache, which will last all day long. She is also tender in the left breast area and gets numbness in her left hand. She has also had three spells of "falling", she is not really clear on whether these are syncopal, but they sound like they could be as she sees spots before her eyes. Twice it happened, when getting up quickly at night and another time in the grocery store. She suffered no trauma. She has no remote history of syncope. Her weight has not changed in the past year.,MEDICATIONS: , Naprosyn, which she takes up to six a day.,ALLERGIES:, Sulfa.,SOCIAL HISTORY: , She does not smoke or drink. She is married with two children.,REVIEW OF SYSTEMS:, Otherwise unremarkable.,PEX:, BP: 130/70 without orthostatic changes. PR: 72. WT: 206 pounds. She is a healthy young woman. No JVD. No carotid bruit. No thyromegaly. Cardiac: Regular rate and rhythm. There is no significant murmur, gallop, or rub. Chest: Mildly tender in the upper pectoral areas bilaterally (breast exam was not performed). Lungs: Clear. Abdomen: Soft. Moderately overweight. Extremities: No edema and good distal pulses.,EKG: , Normal sinus rhythm, normal EKG.,ECHOCARDIOGRAM (FOR SYNCOPE): , Essentially normal study.,IMPRESSION:,1. Syncopal spells - These do sound, in fact, to be syncopal. I suspect it is simple orthostasis/vasovagal, as her EKG and echocardiogram looks good. I have asked her to drink plenty of fluids and to not to get up suddenly at night. I think this should take care of the problem. I would not recommend further workup unless these spells continue, at which time I would recommend a tilt-table study.,2. Chest pains - Atypical for cardiac etiology, undoubtedly due to musculoskeletal factors from her emotional stressors. The Naprosyn is not helping that much, I gave her a prescription for Flexeril and instructed her in its use (not to drive after taking it).,RECOMMENDATIONS:,1. Reassurance that her cardiac checkup looks excellent, which it does.,2. Drink plenty of fluids and arise slowly from bed.,3. Flexeril 10 mg q 6 p.r.n.,4. I have asked her to return should the syncopal spells continue. | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | DISCHARGE DATE: MM/DD/YYYY,HISTORY OF PRESENT ILLNESS: Mr. ABC is a 60-year-old white male veteran with multiple comorbidities, who has a history of bladder cancer diagnosed approximately two years ago by the VA Hospital. He underwent a resection there. He was to be admitted to the Day Hospital for cystectomy. He was seen in Urology Clinic and Radiology Clinic on MM/DD/YYYY.,HOSPITAL COURSE: Mr. ABC presented to the Day Hospital in anticipation for Urology surgery. On evaluation, EKG, echocardiogram was abnormal, a Cardiology consult was obtained. A cardiac adenosine stress MRI was then proceeded, same was positive for inducible ischemia, mild-to-moderate inferolateral subendocardial infarction with peri-infarct ischemia. In addition, inducible ischemia seen in the inferior lateral septum. Mr. ABC underwent a left heart catheterization, which revealed two vessel coronary artery disease. The RCA, proximal was 95% stenosed and the distal 80% stenosed. The mid LAD was 85% stenosed and the distal LAD was 85% stenosed. There was four Multi-Link Vision bare metal stents placed to decrease all four lesions to 0%. Following intervention, Mr. ABC was admitted to 7 Ardmore Tower under Cardiology Service under the direction of Dr. XYZ. Mr. ABC had a noncomplicated post-intervention hospital course. He was stable for discharge home on MM/DD/YYYY with instructions to take Plavix daily for one month and Urology is aware of the same.,DISCHARGE EXAM:,VITAL SIGNS: Temperature 97.4, heart rate 68, respirations 18, blood pressure 133/70.,HEART: Regular rate and rhythm.,LUNGS: Clear to auscultation.,ABDOMEN: Obese, soft, nontender. Lower abdomen tender when touched due to bladder cancer.,RIGHT GROIN: Dry and intact, no bruit, no ecchymosis, no hematoma. Distal pulses are intact.,DISCHARGE LABS: CBC: White count 5.4, hemoglobin 10.3, hematocrit 30, platelet count 132, hemoglobin A1c 9.1. BMP: Sodium 142, potassium 4.4, BUN 13, creatinine 1.1, glucose 211. Lipid profile: Cholesterol 157, triglycerides 146, HDL 22, LDL 106.,PROCEDURES:,1. On MM/DD/YYYY, cardiac MRI adenosine stress.,2. On MM/DD/YYYY, left heart catheterization, coronary angiogram, left ventriculogram, coronary angioplasty with four Multi-Link Vision bare metal stents, two placed to the LAD in two placed to the RCA.,DISCHARGE INSTRUCTIONS: Mr. ABC is discharged home. He should follow a low-fat, low-salt, low-cholesterol, and heart healthy diabetic diet. He should follow post-coronary artery intervention restrictions. He should not lift greater than 10 pounds for seven days. He should not drive for two days. He should not immerse in water for two weeks. Groin site care reviewed with patient prior to being discharged home. He should check groin for bleeding, edema, and signs of infection. Mr. ABC is to see his primary care physician within one to two weeks, return to Dr. XYZ's clinic in four to six weeks, appointment card to be mailed him. He is to follow up with Urology in their clinic on MM/DD/YYYY at 10 o'clock and then to scheduled CT scan at that time.,DISCHARGE DIAGNOSES:,1. Coronary artery disease status post percutaneous coronary artery intervention to the right coronary artery and to the LAD.,2. Bladder cancer.,3. Diabetes.,4. Dyslipidemia.,5. Hypertension.,6. Carotid artery stenosis, status post right carotid endarterectomy in 2004.,7. Multiple resections of the bladder tumor.,8. Distant history of appendectomy.,9. Distant history of ankle surgery. | Discharge Summary |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: , Epigastric hernia.,POSTOPERATIVE DIAGNOSIS: , Epigastric hernia.,OPERATIONS:, Epigastric herniorrhaphy.,ANESTHESIA: , General inhalation.,PROCEDURE: , Following attainment of satisfactory anesthesia, the patient's abdomen was prepped with Hibiclens and draped sterilely. The hernia mass had been marked preoperatively. This area was anesthetized with a mixture of Marcaine and Xylocaine. A transverse incision was made over the hernia and dissection carried down to the entrapped fat. Sharp dissection was carried around the fat down to the fascial edge. The preperitoneal fat could not be reduced; therefore, it is trimmed away and the small fascial defect then closed with interrupted 0-Ethibond sutures. The fascial edges were injected with the local anesthetic mixture. Subcutaneous tissues were then closed with interrupted 4-0 Vicryl and skin edges closed with running subcuticular 4-0 Vicryl. Steri-Strips and a sterile dressing were applied to complete the closure. The patient was then awakened and taken to the PACU in satisfactory condition.,ESTIMATED BLOOD LOSS: , 10 mL.,SPONGE AND NEEDLE COUNT: , Reported as correct.,COMPLICATIONS: , None. | Gastroenterology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PROCEDURE: , Gastroscopy.,PREOPERATIVE DIAGNOSIS: , Gastroesophageal reflux disease.,POSTOPERATIVE DIAGNOSIS:, Barrett esophagus.,MEDICATIONS: , MAC.,PROCEDURE: , The Olympus gastroscope was introduced into the oropharynx and passed carefully through the esophagus, stomach, and duodenum to the transverse duodenum. The preparation was excellent and all surfaces were well seen. The hypopharynx appeared normal. The esophagus had a normal contour and normal mucosa throughout its distance, but at the distal end, there was a moderate-sized hiatal hernia noted. The GE junction was seen at 40 cm and the hiatus was noted at 44 cm from the incisors. Above the GE junction, there were three fingers of columnar epithelium extending cephalad, to a distance of about 2 cm. This appears to be consistent with Barrett esophagus. Multiple biopsies were taken from numerous areas in this region. There was no active ulceration or inflammation and no stricture. The hiatal hernia sac had normal mucosa except for one small erosion at the hiatus. The gastric body had normal mucosa throughout. Numerous small fundic gland polyps were noted, measuring 3 to 5 mm in size with an entirely benign appearance. Biopsies were taken from the antrum to rule out Helicobacter pylori. A retroflex view of the cardia and fundus confirmed the small hiatal hernia and demonstrated no additional lesions. The scope was passed through the pylorus, which was patent and normal. The mucosa throughout the duodenum in the first, second, and third portions was entirely normal. The scope was withdrawn and the patient was sent to the recovery room. He tolerated the procedure well.,FINAL DIAGNOSES:,1. A short-segment Barrett esophagus.,2. Hiatal hernia.,3. Incidental fundic gland polyps in the gastric body.,4. Otherwise, normal upper endoscopy to the transverse duodenum.,RECOMMENDATIONS:,1. Follow up biopsy report.,2. Continue PPI therapy.,3. Follow up with Dr. X as needed.,4. Surveillance endoscopy for Barrett in 3 years (if pathology confirms this diagnosis). | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSES:, Prior history of anemia, abdominal bloating.,POSTOPERATIVE DIAGNOSIS:, External hemorrhoids, otherwise unremarkable colonoscopy.,PREMEDICATIONS:, Versed 5 mg, Demerol 50 mg IV.,REPORT OF PROCEDURE:, Digital rectal exam revealed external hemorrhoids. The colonoscope was inserted into the rectal ampulla and advanced to the cecum. The position of the scope within the cecum was verified by identification of the appendiceal orifice. The cecum, the ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, and rectum were normal. The scope was retroflexed in the rectum and no abnormality was seen. So the scope was straightened, withdrawn, and the procedure terminated.,ENDOSCOPIC IMPRESSION:,1. Normal colonoscopy.,2. External hemorrhoids. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PROCEDURE PERFORMED:, Laparoscopic cholecystectomy with attempted intraoperative cholangiogram.,PROCEDURE: , After informed consent was obtained, the patient was brought to the operating room and placed supine on the operating room table. General endotracheal anesthesia was induced without incident. The patient was prepped and draped in the usual sterile manner.,A 2 cm infraumbilical midline incision was made. The fascia was then cleared of subcutaneous tissue using a tonsil clamp. A 1-2 cm incision was then made in the fascia, gaining entry into the abdominal cavity without incident. Two sutures of 0 Vicryl were then placed superiorly and inferiorly in the fascia, and then tied to the special 12 mm Hasson trocar fitted with a funnel-shaped adapter in order to occlude the fascial opening. Pneumoperitoneum was then established using carbon dioxide insufflation to a steady pressure of 16 mmHg.,The remaining trocars were then placed into the abdomen under direct vision of the 30 degree laparoscope taking care to make the incisions along Langer's lines, spreading the subcutaneous tissues with a tonsil clamp, and confirming the entry site by depressing the abdominal wall prior to insertion of the trocar. A total of 3 other trocars were placed. The first was a 10/11 mm trocar in the upper midline position. The second was a 5 mm trocar placed in the anterior axillary line approximately 3 cm above the anterior superior iliac spine. The third was a 5 mm trocar placed to bisect the distance between the second and upper midline trocars. All of the trocars were placed without difficulty.,The patient was then placed in reverse Trendelenburg position and was rotated slightly to the left. The gallbladder was then grasped through the second and third trocars and retracted cephalad toward the right shoulder. A laparoscopic dissector was then placed through the upper midline cannula, fitted with a reducer, and the structures within the triangle of Calot were meticulously dissected free.,A laparoscopic clip applier was introduced through the upper midline cannula and used to doubly ligate the cystic duct close to the gallbladder. The gallbladder was then grasped through the upper midline cannula and a fine-tipped scissors introduced through the third cannula and used to make a small ductotomy in the cystic duct near the clips. Several attempts at passing the cholangiocatheter into the ductotomy were made. Despite numerous attempts at several angles, the cholangiocatheter could not be inserted into the cystic duct. After several such attempts, and due to the fact that the anatomy was clear, we aborted any further attempts at cholangiography. The distal cystic duct was doubly clipped. The duct was divided between the clips. The clips were carefully placed to avoid occluding the juncture with the common bile duct. The port sites were injected with 0.5% Marcaine.,The cystic artery was found medially and slightly posteriorly to the cystic duct. It was carefully dissected free from its surrounding tissues. A laparoscopic clip applier was introduced through the upper midline cannula and used to doubly ligate the cystic artery proximally and distally. The artery was divided between the clips. The port sites were injected with 0.5% Marcaine.,After the cystic duct and artery were transected, the gallbladder was dissected from the liver bed using Bovie electrocautery. Prior to complete dissection of the gallbladder from the liver, the peritoneal cavity was copiously irrigated with saline and the operative field was examined for persistent blood or bile leaks of which there were none.,After the complete detachment of the gallbladder from the liver, the video laparoscope was removed and placed through the upper 10/11 mm cannula. The neck of the gallbladder was grasped with a large penetrating forceps placed through the umbilical 12 mm Hasson cannula. As the gallbladder was pulled through the umbilical fascial defect, the entire sheath and forceps were removed from the abdomen. The neck of the gallbladder was then secured with a Kocher clamp, and the gallbladder was removed from the abdomen.,Following gallbladder removal, the remaining carbon dioxide was expelled from the abdomen.,Both midline fascial defects were then approximated using 0 Vicryl suture. All skin incisions were approximated with 4-0 Vicryl in a subcuticular fashion. The skin was prepped with benzoin, and Steri-Strips were applied. Dressings were applied. All surgical counts were reported as correct.,Having tolerated the procedure well, the patient was subsequently extubated and taken to the recovery room in good and stable condition. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | ADMISSION DIAGNOSES: , Hyperglycemia, cholelithiasis, obstructive sleep apnea, diabetes mellitus, and hypertension.,DISCHARGE DIAGNOSES: , Hyperglycemia, cholelithiasis, obstructive sleep apnea, diabetes mellitus, hypertension, and cholecystitis.,PROCEDURE: , Laparoscopic cholecystectomy.,SERVICE: , Surgery.,HISTORY OF PRESENT ILLNESS:, Ms. ABC is a 57-year-old woman. She suffers from morbid obesity. She also has diabetes and obstructive sleep apnea. She was evaluated in the Bariatric Surgical Center for placement of a band. During her workup, she was noted to have evidence of cholelithiasis. It was felt that the patient would benefit from removal of her gallbladder prior to having band placement secondary to her diabetes and the risk of infection of the band. The patient was scheduled to undergo her procedure on 12/31/09; however, at blood glucose check, the patient was noted to be hyperglycemic, her sugar was 438. She was admitted to the hospital for treatment of her hyperglycemia.,HOSPITAL COURSE: , Ms. ABC was admitted to the hospital. She was seen by Dr. A. He put her on an insulin drip. Her sugars slowly did come down to normal down to between 115 and 134. On the next day, she was then taken to the operating room, where she underwent her laparoscopic cholecystectomy. She was noted to be a difficult intubation for the procedure. There were some indications of chronic cholecystitis, a little bit of edema, mild edema and adhesions of omentum around the gallbladder. She underwent the procedure. She tolerated without difficulty. She was recovered in the Postoperative Care Unit and then returned to the floor. Her blood sugar postprocedure was noted to be 233. She was started back on a sliding scale insulin. She continued to do well and was felt to be stable for discharge following the procedure.,DISCHARGE INSTRUCTIONS: ,To return to the Medifast diet. To continue with her blood glucose. She needs to follow up with Dr. B, and she will see me next week on Friday. We will determine if we will proceed with her lap band at that time. She may shower. She needs to keep her wounds clean and dry. No heavy lifting. No driving on narcotic pain medicines. She needs to continue with her CPAP machine and continue to monitor her sugars. | Discharge Summary |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | EXAM:,MRI LEFT SHOULDER,CLINICAL:,This is a 69-year-old male with pain in the shoulder. Evaluate for rotator cuff tear.,FINDINGS:,Examination was performed on 9/1/05.,There is marked supraspinatus tendinosis and extensive tearing of the substance of the tendon and articular surface, extending into the myotendinous junction as well. There is still a small rim of tendon along the bursal surface, although there may be a small tear at the level of the rotator interval. There is no retracted tendon or muscular atrophy (series #6 images #6-17).,Normal infraspinatus tendon.,There is subscapularis tendinosis with fraying and partial tearing of the superior most fibers extending to the level of the rotator interval (series #9 images #8-13; series #3 images #8-14). There is no complete tear, gap or fiber retraction and there is no muscular atrophy.,There is tendinosis and superficial tearing of the long biceps tendon within the bicipital groove, and there is high grade (near complete) partial tearing of the intracapsular portion of the tendon. The biceps anchor is intact. There are degenerative changes in the greater tuberosity of the humerus but there is no fracture or subluxation.,There is degeneration of the superior labrum and there is a small nondisplaced tear in the posterior superior labrum at the one to two o’clock position (series #6 images #12-14; series #3 images #8-10; series #9 images #5-8). There is a small sublabral foramen at the eleven o’clock position (series #9 image #6). There is no osseous Bankart lesion.,Normal superior, middle and inferior glenohumeral ligaments.,There is hypertrophic osteoarthropathy of the acromioclavicular joint with narrowing of the subacromial space and flattening of the superior surface of the supraspinatus musculotendinous junction, which in the appropriate clinical setting is an MRI manifestation of an impinging lesion (series #8 images #3-12).,Normal coracoacromial, coracohumeral and coracoclavicular ligaments. There is minimal fluid within the glenohumeral joint. There is no atrophy of the deltoid muscle.,IMPRESSION:, There is extensive supraspinatus tendinosis and partial tearing as described. There is no retracted tendon or muscular atrophy, but there may be a small tear along the anterior edge of the tendon at the level of the rotator interval, and this associated partial tearing of the superior most fibers of the subscapularis tendon. There is also a high-grade partial tear of the long biceps tendon as it courses under the transverse humeral ligament. There is no evidence of a complete tear or retracted tendon. Small nondisplaced posterior superior labral tear. Outlet narrowing from the acromioclavicular joint, which in the appropriate clinical setting is an MRI manifestation of an impinging lesion. | Orthopedic |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | INDICATIONS FOR PROCEDURE:, The patient has presented with crushing-type substernal chest pain, even in the face of a normal nuclear medicine study. She is here for catheterization.,APPROACH:, Right common femoral artery.,ANESTHESIA:, IV sedation per cardiac catheterization protocol. Local sedation with 1% Xylocaine.,COMPLICATIONS:, None.,ESTIMATED BLOOD LOSS:, Less than 10 mL.,ESTIMATED CONTRAST:, Less than 150 mL.,PROCEDURES PERFORMED:, Left heart catheterization, left ventriculogram, selective coronary arteriography, aortic arch angiogram, right iliofemoral angiogram, #6 French Angio-Seal placement.,OPERATIVE TECHNIQUE:, The patient was brought to the cardiac catheterization lab in the usual fasting state. She was placed supine on the cardiac catheterization table and the right groin was prepped and draped in the usual sterile fashion. One percent Xylocaine was infiltrated into the right femoral vessels. Next, a #6 French sheath was then placed in the right common femoral artery by the modified Seldinger technique.,SELECTIVE CORONARY ARTERIOGRAPHY:, Next, right and left Judkins diagnostic catheters were advanced through their respective ostia and injected in multiple views.,LEFT VENTRICULOGRAM:, Next, a pigtail catheter was advanced across the aortic valve and left ventricular pressure recorded. Next, an LV-gram was then performed with a hand injection of 50 mL of contrast. Next, pull-back pressure was measured across the aortic valve.,AORTA ARCH ANGIOGRAM:, Next, aortic arch angiogram was then performed with injection of 50 mL of contrast at a rate of 20 mL/second to maximum pressure of 750 PSI performed in the 40-degree LAO view.,Next, right iliofemoral angiogram was performed in the 20-degree RAO view. Next Angio-Seal was applied successfully.,The patient left the cath lab without problems or issues.,DIAGNOSES:, Left ventricular end-diastolic pressure was 18 mmHg. There was no gradient across the aortic valve. The central aortic pressure was 160 mmHg.,LEFT VENTRICULOGRAM:, The left ventriculogram demonstrated normal LV systolic function with estimated ejection fraction greater than 50%.,AORTIC ARCH ANGIOGRAM: ,The aortic arch angiogram demonstrated normal aortic arch. No aortic regurgitation was seen.,SELECTIVE CORONARY ARTERIOGRAPHY:, The right coronary artery is large and dominant.,The left main is patent.,The left anterior descending is patent.,The left circumflex is patent.,IMPRESSION:, This study demonstrates normal coronary arteries in the presence of normal left ventricular systolic function. In addition, the aortic root is normal. | Cardiovascular / Pulmonary |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | SUBJECTIVE:, The patient is a 68-year-old white female who presents for complete physical, Pap and breast exam. Her last Pap smear was 05/02/2002. Her only complaint is that she has had some occasional episodes of some midchest pain that seems to go to her back, usually occurs at rest. Has awakened her at night on occasion and only last about 15 to 20 minutes. Denies nausea, vomiting, diaphoresis or shortness of breath with it. This has not happened in almost two months. She had a normal EKG one year ago. Otherwise, has been doing quite well. Did quite well with her foot surgery with Dr. Clayton.,PAST MEDICAL HISTORY:, Reactive airway disease; rheumatoid arthritis, recent surgery on her hands and feet; gravida 4, para 5, with one set of twins, all vaginal deliveries; iron deficiency anemia; osteoporosis; and hypothyroidism.,MEDICATIONS:, Methotrexate 2.5 mg five weekly, Fosamax 70 mg weekly, folic acid daily, amitriptyline 15 mg daily, Synthroid 0.088 mg daily, calcium two in the morning and two at noon, multivitamin daily, baby aspirin daily and Colace one to three b.i.d.,ALLERGIES:, None.,SOCIAL HISTORY:, She is married. Denies tobacco, alcohol and drug use. She is not employed outside the home.,FAMILY HISTORY: , Unremarkable.,REVIEW OF SYSTEMS:, HEENT, pulmonary, cardiovascular, GI, GU, musculoskeletal, neurologic, dermatologic, constitutional and psychiatric are all negative except for HPI.,OBJECTIVE:,Vital Signs: Weight 146. Blood pressure 100/64. Pulse 80. Respirations 16. Temperature 97.7.,General: She is a well-developed, well-nourished white female in no acute distress.,HEENT: Grossly within normal limits.,Neck: Supple. No lymphadenopathy. No thyromegaly.,Chest: Clear to auscultation bilaterally.,Cardiovascular: Regular rate and rhythm.,Abdomen: Positive bowel sounds, soft and nontender. No hepatosplenomegaly.,Breasts: No nipple discharge. No lumps or masses palpated. No dimpling of the skin. No axillary lymph nodes palpated. Self-breast exam discussed and encouraged.,Pelvic: Normal female genitalia. Atrophic vaginal mucosa. No cervical lesions. No cervical motion tenderness. No adnexal tenderness or masses palpated.,Rectal: Normal sphincter tone. No stool present in the vault. No rectal masses palpated.,Extremities: No cyanosis, clubbing or edema. She does have obvious rheumatoid arthritis of her hands.,Neurologic: Grossly intact.,ASSESSMENT/PLAN:,1. Chest pain. The patient will evaluate when it happens next; what she has been eating, what activities she has been performing. She had normal ECG one year ago. In fact this does not sound cardiac in nature. We will not do further cardiac workup at this time. Did discuss with her she may be having some GI reflux type symptoms.,2. Hypothyroidism. We will recheck TSH to make sure she is on the right amount of medication at this time, making adjustments as needed.,3. Rheumatoid arthritis. Continue her methotrexate as prescribed by Dr. Mortensen, and follow up with Dr. XYZ as needed.,4. Osteoporosis. It is time for her to have a repeat DEXA at this time and that will be scheduled.,5. Health care maintenance, Pap smear was obtained today. The patient will be scheduled for mammogram. | Obstetrics / Gynecology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | INDICATIONS: , An 82-year-old man entering the cardiac rehabilitation program 6 weeks after a porcine aortic valve replacement and single-vessel coronary bypass graft procedure. The patient has had a complicated postoperative course with rapid atrial fibrillation, pleural effusions, anemia and thrombocytopenia. He is currently stabilized and improving in strength. He is living in Nantucket with his daughter Debra Anderson while he recuperates and completes the cardiac rehabilitation program. He has a few other significant medical problems.,MEDICATIONS:,1. Toprol-XL 25 mg daily.,2. Simvastatin 80 mg daily.,3. Aspirin 81 mg daily.,4. Synthroid 0.5 mg daily.,5. Warfarin 1.5 mg daily.,PHYSICAL EXAMINATION: , The patient appears pale and fragile. He is comfortable at rest. His resting heart rate is 80. His resting blood pressure is 112/70. His conjunctivae are pale. His lungs have decreased breath sounds throughout and dullness at the bases bilaterally. Heart exam reveals a distant S1 and S2. There is a short 2/6 systolic ejection murmur. The extremities are normal without clubbing, cyanosis or edema.,The resting echocardiogram showed a sinus rhythm at 70 beats per minute. There is poor R wave progression across the pericardium and Q waves inferiorly.,DESCRIPTION: ,The patient exercised according to the modified Bruce protocol stopping at 3 minutes and 20 seconds with fatigue and shortness of breath. He did not experience chest pain with exercise. He did achieve a maximal heart rate of 100, which is 72% of his maximal predicted heart rate. His maximal blood pressure was 190/70 resulting in a double product of 19,000 and achieving 2.3 METS. As noted, the resting electrocardiogram had inferior Q waves and poor R wave progression. There were no significant ST segment changes with exercise. There were only rare ventricular premature beats with exercise.,CONCLUSION:,1. Poor exercise capacity 6 weeks following an aortic valve replacement and single-vessel bypass procedure.,2. No chest pain with exercise.,3. No significant ECG changes with exercise.,4. The patient is considered stable to enter our cardiac rehabilitation program. I recommend the patient have a complete blood count, basic metabolic profile, and TSH obtained prior to entering the rehab program. | Cardiovascular / Pulmonary |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | HISTORY OF PRESENT ILLNESS:, The patient is a 67-year-old white female with a history of uterine papillary serous carcinoma who is status post 6 cycles of carboplatin and Taxol, is here today for followup. Her last cycle of chemotherapy was finished on 01/18/08, and she complains about some numbness in her right upper extremity. This has not gotten worse recently and there is no numbness in her toes. She denies any tingling or burning.,REVIEW OF SYSTEMS: , Negative for any fever, chills, nausea, vomiting, headache, chest pain, shortness of breath, abdominal pain, constipation, diarrhea, melena, hematochezia or dysuria. The patient is concerned about her blood pressure being up a little bit and also a mole that she had noticed for the past few months in her head.,PHYSICAL EXAMINATION:,VITAL SIGNS: Temperature 35.6, blood pressure 143/83, pulse 65, respirations 18, and weight 66.5 kg. GENERAL: She is a middle-aged white female, not in any distress. HEENT: No lymphadenopathy or mucositis. CARDIOVASCULAR: Regular rate and rhythm. LUNGS: Clear to auscultation bilaterally. EXTREMITIES: No cyanosis, clubbing or edema. NEUROLOGICAL: No focal deficits noted. PELVIC: Normal-appearing external genitalia. Vaginal vault with no masses or bleeding.,LABORATORY DATA: , None today.,RADIOLOGIC DATA: , CT of the chest, abdomen, and pelvis from 01/28/08 revealed status post total abdominal hysterectomy/bilateral salpingo-oophorectomy with an unremarkable vaginal cuff. No local or distant metastasis. Right probably chronic gonadal vein thrombosis.,ASSESSMENT: , This is a 67-year-old white female with history of uterine papillary serous carcinoma, status post total abdominal hysterectomy and bilateral salpingo-oophorectomy and 6 cycles of carboplatin and Taxol chemotherapy. She is doing well with no evidence of disease clinically or radiologically.,PLAN:,1. Plan to follow her every 3 months and CT scans every 6 months for the first 2 years.,2. The patient was advised to contact the primary physician for repeat blood pressure check and get started on antihypertensives if it is persistently elevated.,3. The patient was told that the mole that she is mentioning in her head is no longer palpable and just to observe it for now.,4. The patient was advised about doing Kegel exercises for urinary incontinence, and we will address this issue again during next clinic visit if it is persistent., | SOAP / Chart / Progress Notes |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | SUBJECTIVE:, The patient comes back to see me today. She is a pleasant 73-year-old Caucasian female who had seen Dr. XYZ with low back pain, lumbar degenerative disc disease, lumbar spondylosis, facet and sacroiliac joint syndrome, lumbar spinal stenosis primarily bilateral recess, intermittent lower extremity radiculopathy, DJD of both knees, bilateral pes anserinus bursitis, and chronic pain syndrome. Dr. XYZ had performed right and left facet and sacroiliac joint injections, subsequent right L3 to S1 medial branch blocks and radiofrequency ablation on the right from L3 to S1. She was subsequently seen with some mid back pain and she had right T8-T9 and T9-T10 facet injections on 10/28/2004. She was last seen on 04/08/2005 with recurrent pain in her low back on the right. Dr. XYZ repeated her radiofrequency ablation on the right side from L3-S1 on 05/04/2005.,The patient comes back to see me today. She states that the radiofrequency ablation has helped her significantly there, but she still has one spot in her low back that seems to be hurting her on the right, and seems to be pointing to her right sacroiliac joint. She is also complaining of pain in both knees. She says that 20 years ago she had a cortisone shot in her knees, which helped her significantly. She has not had any x-rays for quite some time. She is taking some Lortab 7.5 mg tablets, up to four daily, which help her with her pain symptoms. She is also taking Celebrex through Dr. S’ office.,PAST MEDICAL HISTORY:, Essentially unchanged from my visit of 04/08/2005.,PHYSICAL EXAMINATION:,General: Reveals a pleasant Caucasian female.,Vital Signs: Height is 5 feet 5 inches. Weight is 183 pounds. She is afebrile.,HEENT: Benign.,Neck: Shows functional range of movements with a negative Spurling's.,Musculoskeletal: Examination shows degenerative joint disease of both knees, with medial and lateral joint line tenderness, with tenderness at both pes anserine bursa. Straight leg raises are negative bilaterally. Posterior tibials are palpable bilaterally.,Skin and Lymphatics: Examination of the skin does not reveal any additional scars, rashes, cafe au lait spots or ulcers. No significant lymphadenopathy noted.,Spine: Examination shows decreased lumbar lordosis with tenderness that seems to be in her right sacroiliac joint. She has no other major tenderness. Spinal movements are limited but functional.,Neurological: She is alert and oriented with appropriate mood and affect. She has normal tone and coordination. Reflexes are 2+ and symmetrical. Sensation is intact to pinprick.,FUNCTIONAL EXAMINATION:, Gait has a normal stance and swing phase with no antalgic component to it.,IMPRESSION:,1. Low back syndrome with lumbar degenerative disc disease, lumbar spinal stenosis, and facet joint syndrome on the right L4-5 and L5-S1.,2. Improved, spinal right L3-S1 radiofrequency ablation.,3. Right sacroiliac joint sprain/strain, symptomatic.,4. Left lumbar facet joint syndrome, stable.,6. Right thoracic facet joint syndrome, stable.,7. Lumbar spinal stenosis, primarily lateral recess with intermittent lower extremity radiculopathy, stable.,8. Degenerative disc disease of both knees, symptomatic.,9. Pes anserinus bursitis, bilaterally symptomatic.,10. Chronic pain syndrome.,RECOMMENDATIONS:, Dr. XYZ and I discussed with the patient her pathology. She has some symptoms in her low back on the right side at the sacroiliac joint. Dr. XYZ will plan having her come in and injecting her right sacroiliac joint under fluoroscopy. She is also having pain in both knees. We will plan on x-rays of both knees, AP and lateral, and plan on seeing her back on Monday or Friday for possible intraarticular and/or pes anserine bursa injections bilaterally. I explained the rationale for each of these injections, possible complications and she wishes to proceed. In the interim, she can continue on Lortab and Celebrex. We will plan for the follow up following these interventions, sooner if needed. She voiced understanding and agreement. Physical exam findings, history of present illness, and recommendations were performed with and in agreement with Dr. Goel's findings. | Orthopedic |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS:, Acute cholecystitis.,POSTOPERATIVE DIAGNOSIS:, Acute gangrenous cholecystitis with cholelithiasis.,OPERATION PERFORMED: , Laparoscopic cholecystectomy with cholangiogram.,FINDINGS: ,The patient had essentially a dead gallbladder with stones and positive wide bile/pus coming from the gallbladder.,COMPLICATIONS: ,None.,EBL: , Scant.,SPECIMEN REMOVED: , Gallbladder with stones.,DESCRIPTION OF PROCEDURE: ,The patient was prepped and draped in the usual sterile fashion under general anesthesia. A curvilinear incision was made below the umbilicus. Through this incision, the camera port was able to be placed into the peritoneal cavity under direct visualization. Once this complete, insufflation was begun. Once insufflation was adequate, additional ports were placed in the epigastrium as well as right upper quadrant. Once all four ports were placed, the right upper quadrant was then explored. The patient had significant adhesions of omentum and colon to the liver, the gallbladder constituting definitely an acute cholecystitis. This was taken down using Bovie cautery to free up visualization of the gallbladder. The gallbladder was very thick and edematous and had frank necrosis of most of the anterior gallbladder wall. Adhesions were further taken down between the omentum, the colon, and the gallbladder slowly starting superiorly and working inferiorly towards the cystic duct area. Once the adhesions were fully removed, the cholangiogram was done which did not show any evidence of any common bile duct dilatation or obstruction. At this point, due to the patient's gallbladder being very necrotic, it was deemed that the patient should have a drain placed. The cystic duct and cystic artery were serially clipped and transected. The gallbladder was removed from the gallbladder fossa removing the entire gallbladder. Adequate hemostasis with Bovie cautery was achieved. The gallbladder was then placed into a bag and removed from the peritoneal cavity through the camera port. A JP drain was then run through the anterior port and out of one of the trochar sites and secured to the skin using 3-0 nylon suture. Next, the right upper quadrant was copiously irrigated out using the suction irrigator. Once this was complete, the additional ports were able to be removed. The fascial opening at the umbilicus was reinforced by closing it using a 0 Vicryl suture in a figure-of-8 fashion. All skin incisions were injected using Marcaine 1/4 percent plain. The skin was reapproximated further using 4-0 Monocryl sutures in a subcuticular technique. The patient tolerated the procedure well and was able to be transferred to the recovery room in stable condition. | Gastroenterology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CC:, Progressive lower extremity weakness.,HX: ,This 54 y/o RHF presented on 7/3/93 with a 2 month history of lower extremity weakness. She was admitted to a local hospital on 5/3/93 for a 3 day h/o of progressive BLE weakness associated with incontinence and BLE numbness. There was little symptom of upper extremity weakness at that time, according to the patient. Her evaluation was notable for a bilateral L1 sensory level and 4/4 strength in BLE. A T-L-S Spine MRI revealed a T4-6 lipomatosis with anterior displacement of the cord without cord compression. CSF analysis yielded: opening pressure of 14cm H20, protein 88, glucose 78, 3 lymphocytes and 160 RBC, no oligoclonal bands or elevated IgG index, and negative cytology. Bone marrow biopsy was negative. B12, Folate, and Ferritin levels were normal. CRP 5.2 (elevated). ANA was positive at 1:5,120 in speckled pattern. Her hospital course was complicated by deep venous thrombosis, which recurred after heparin was stopped to do the bone marrow biopsy. She was subsequently placed on Coumadin. EMG/NCV testing revealed " lumbosacral polyradiculopathy with axonal degeneration and nerve conduction block." She was diagnosed with atypical Guillain-Barre vs. polyradiculopathy and received a single course of Decadron; and no plasmapheresis or IV IgG. She was discharged home o 6/8/93.,She subsequently did not improve and after awaking from a nap on her couch the day of presentation, 7/3/93, she found she was paralyzed from the waist down. There was associated mild upper lumbar back pain without radiation. She had had no bowel movement or urination since that time. She had no recent trauma, fever, chills, changes in vision, dysphagia or upper extremity deficit.,MEDS:, Coumadin 7.5mg qd, Zoloft 50mg qd, Lithium 300mg bid.,PMH:, 1) Bi-polar Affective Disorder, dx 1979 2) C-section.,FHX:, Unremarkable.,SHX:, Denied Tobacco/ETOH/illicit drug use.,EXAM: ,BP118/64, HR103, RR18, Afebrile.,MS: ,A&O to person, place, time. Speech fluent without dysarthria. Lucid thought processes.,CN: ,Unremarkable.,MOTOR:, 5/5 strength in BUE. Plegic in BLE. Flaccid muscle tone.,SENSORY:, L1 sensory level (bilaterally) to PP and TEMP, without sacral sparing. Proprioception was lost in both feet.,CORD: ,Normal in BUE.,Reflexes were 2+/2+ in BUE. They were not elicited in BLE. Plantar responses were equivocal, bilaterally.,RECTAL: ,Poor rectal tone. stool guaiac negative. She had no perirectal sensation.,COURSE:, CRP 8.8 and ESR 76. FVC 2.17L. WBC 1.5 (150 bands, 555 neutrophils, 440 lymphocytes and 330 monocytes), Hct 33%, Hgb 11.0, Plt 220K, MCV 88, GS normal except for slightly low total protein (8.0). LFT were normal. Creatinine 1.0. PT and PTT were normal. ABCG 7.46/25/79/96% O2Sat. UA notable for 1+ proteinuria. EKG normal.,MRI L-spine, 7/3/93, revealed an area of abnormally increased T2 signal extending from T12 through L5. This area causes anterior displacement of the spinal cord and nerve roots. The cauda equina are pushed up against the posterior L1 vertebral body. There bilaterally pulmonary effusions. There is also abnormally increased T2 signal in the center of the spinal cord extending from the mid thoracic level through the conus. In addition, the Fila Terminale appear thickened. There is increased signal in the T3 vertebral body suggestion a hemangioma. The findings were felt consistent with a large epidural lipoma displacing the spinal cord anteriorly. there also appeared spinal cord swelling and increased signal within the spinal cord which suggests an intramedullary process.,CSF analysis revealed: protein 1,342, glucose 43, RBC 4,900, WBC 9. C3 and C$ complement levels were 94 and 18 respectively (normal) Anticardiolipin antibodies were negative. Serum Beta-2 microglobulin was elevated at 2.4 and 3.7 in the CSF and Serum, respectively. It was felt the patient had either a transverse myelitis associated with SLE vs. partial cord infarction related to lupus vasculopathy or hypercoagulable state. She was place on IV Decadron. Rheumatology felt that a diagnosis of SLE was likely. Pulmonary effusion analysis was consistent with an exudate. She was treated with plasma exchange and place on Cytoxan.,On 7/22/93 she developed fever with associated proptosis and sudden loss of vision, OD. MRI Brain, 7/22/93, revealed a 5mm thick area of intermediate signal adjacent to the posterior aspect of the right globe, possibly representing hematoma. Ophthalmology felt she had a central retinal vein occlusion; and it was surgically decompressed.,She was placed on prednisone on 8/11/93 and Cytoxan was started on 8/16/93. She developed a headache with meningismus on 8/20/93. CSF analysis revealed: protein 1,002, glucose2, WBC 8,925 (majority were neutrophils). Sinus CT scan negative. She was placed on IV Antibiotics for presumed bacterial meningitis. Cultures were subsequently negative. She spontaneously recovered. 8/25/93, cisternal tap CSF analysis revealed: protein 126, glucose 35, WBC 144 (neutrophils), RBC 95, Cultures negative, cytology negative. MRI Brain scan revealed diffuse leptomeningeal enhancement in both brain and spinal canal.,DSDNA negative. She developed leukopenia in 9/93, and she was switched from Cytoxan to Imuran. Her LFT's rose and the Imuran was stopped and she was placed back on prednisone.,She went on to have numerous deep venous thrombosis while on Coumadin. This required numerous hospital admissions for heparinization. Anticardiolipin antibodies and Protein C and S testing was negative. | Orthopedic |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHIEF COMPLAINT:, Neck and lower back pain.,VEHICULAR TRAUMA HISTORY:, Date of incident: 1/15/2001. The patient was the driver of a small sports utility vehicle and was wearing a seatbelt. The patient’s vehicle was proceeding through an intersection and was struck by another vehicle from the left side and forced off the road into a utility pole. The other vehicle had reportedly been driven by a drunk driver and ran a traffic signal. Estimated impact speed was 80 m.p.h. The driver of the other vehicle was reportedly cited by police. The patient was transiently unconscious and came to the scene. There was immediate onset of headaches, neck and lower back pain. The patient was able to exit the vehicle and was subsequently transported by Rescue Squad to St. Thomas Memorial Hospital, evaluated in the emergency room and released.,NECK AND LOWER BACK PAIN HISTORY:, The patient relates the persistence of pain since the motor vehicle accident. Symptoms began immediately following the MVA. Because of persistent symptoms, the patient subsequently sought chiropractic treatment. Neck pain is described as severe. Neck pain remains localized and is non-radiating. There are no associated paresthesias. Back pain originates in the lumbar region and radiates down both lower extremities. Back pain is characterized as worse than the neck pain. There are no associated paresthesias. | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PROCEDURE: , Esophagogastroduodenoscopy with biopsy and colonoscopy with biopsy.,INDICATIONS FOR PROCEDURE: , A 17-year-old with history of 40-pound weight loss, abdominal pain, status post appendectomy with recurrent abscess formation and drainage. Currently, he has a fistula from his anterior abdominal wall out. It does not appear to connect to the gastrointestinal tract, but merely connect from the ventral surface of the rectus muscles out the abdominal wall. CT scans show thickened terminal ileum, which suggest that we are dealing with Crohn's disease. Endoscopy is being done to evaluate for Crohn's disease.,MEDICATIONS: ,General anesthesia.,INSTRUMENT:, Olympus GIF-160 and PCF-160.,COMPLICATIONS: , None.,ESTIMATED BLOOD LOSS:, Less than 5 mL.,FINDINGS: , With the patient in the supine position, intubated under general anesthesia. The endoscope was inserted without difficulty into the hypopharynx. The scope was advanced down the esophagus, which had normal mucosal coloration and vascular pattern. Lower esophageal sphincter was located at 40 cm from the central incisors. It appeared normal and appeared to function normally. The endoscope was advanced into the stomach, which was distended with excess air. Rugal folds were flattened completely. There were multiple superficial erosions scattered throughout the fundus, body, and antral portions consistent with Crohn's involvement of the stomach. The endoscope was advanced through normal-appearing pyloric valve into the first, second, and third portion of the duodenum, which had normal mucosal coloration and fold pattern. Biopsies were obtained x2 in the second portion of the duodenum, antrum, body, and distal esophagus at 37 cm from the central incisors for histology. Two additional biopsies were obtained in the antrum for CLO testing. Excess air was evacuated from the stomach. The scope was removed from the patient who tolerated that part of the procedure well.,The patient was turned and scope was changed for colonoscopy. Prior to colonoscopy, it was noted that there was a perianal fistula at 7 o'clock. The colonoscope was then inserted into the anal verge. The colonic clean out was excellent. The scope was advanced without difficulty to the cecum. The cecal area had multiple ulcers with exudate. The ileocecal valve was markedly distorted. Biopsies were obtained x2 in the cecal area and then the scope was withdrawn through the ascending, transverse, descending, sigmoid, and rectum. The colonic mucosa in these areas was well seen and there were a few scattered aphthous ulcers in the ascending and descending colon. Biopsies were obtained in the cecum at 65 cm, transverse colon 50 cm, rectosigmoid 20 cm, and rectum at 5 cm. No fistulas were noted in the colon. Excess air was evacuated from the colon. The scope was removed. The patient tolerated the procedure well and was taken to recovery in satisfactory condition.,IMPRESSION: , Normal esophagus and duodenum. There were multiple superficial erosions or aphthous ulcers in the stomach along with a very few scattered aphthous ulcers in the colon with marked cecal involvement with large ulcers and a very irregular ileocecal valve. All these findings are consistent with Crohn's disease.,PLAN: ,Begin prednisone 30 mg p.o. daily. Await PPD results and chest x-ray results, as well as cocci serology results. If these are normal, then we would recommend Remicade 5 mg/kg IV infusion. We would start Modulon 50 mL/h for 20 hours to reverse the malnutrition state of this boy. Check CMP and phosphate every Monday, Wednesday, and Friday for receding syndrome noted by following potassium and phosphate. We will discuss with Dr. X possibly repeating the CT fistulogram if the findings on the previous ones are inconclusive as far as the noting whether we can rule in or out an enterocutaneous fistula. He will need an upper GI to rule out small intestinal strictures and involvement of the small intestine that cannot be seen with upper and lower endoscopy. If he has no stricture formation in the small bowel, we would then recommend a video endoscopy capsule to further evaluate any mucosal lesions consistent with Crohn's in the small intestine that we cannot visualize with endoscopy. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS:, Phimosis.,POSTOPERATIVE DIAGNOSES:, Phimosis.,OPERATIONS:, Circumcision.,ANESTHESIA: , LMA.,EBL:, Minimal.,FLUIDS: , Crystalloid.,BRIEF HISTORY: , This is a 3-year-old male, who was referred to us from Dr. X's office with phimosis. The patient had spraying of urine and ballooning of the foreskin with voiding. The urine seemed to have collected underneath the foreskin and then would slowly drip out. Options such as dorsal slit, circumcision, watchful waiting by gently pulling the foreskin back were discussed. Risk of anesthesia, bleeding, infection, pain, scarring, and expected complications were discussed. The patient's family understood all the complications and wanted to proceed with the procedure. Consent was obtained using interpreter.,DESCRIPTION OF PROCEDURE: ,The patient was brought to the OR and anesthesia was applied. The patient was placed in supine position. The patient was prepped and draped in usual sterile fashion. All the penile adhesions were released prior to the prepping. The extra foreskin was marked off, 1 x 3 Gamco clamp was used. Hemostasis was obtained after removing the extra foreskin using the Gamco clamp.,Using 5-0 Monocryl, 4 quadrant stitches were placed and horizontal mattress suturing was done. There was excellent hemostasis. Dermabond was applied. The patient was brought to recovery at the end of the procedure in stable condition. | Urology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | EXAM: , Lumbar spine CT without contrast.,HISTORY: , Back pain after a fall.,TECHNIQUE:, Noncontrast axial images were acquired through the lumbar spine. Coronal and sagittal reconstruction views were also obtained.,FINDINGS: , There is no evidence for acute fracture or subluxation. There is no spondylolysis or spondylolisthesis. The central canal and neuroforamen are grossly patent at all levels. There are no abnormal paraspinal masses. There is no wedge/compression deformity. There is intervertebral disk space narrowing to a mild degree at L2-3 and L4-5.,Soft tissue windows demonstrate atherosclerotic calcification of the abdominal aorta, which is not dilated. There was incompletely visualized probable simple left renal cyst, exophytic at the lower pole.,IMPRESSION:,1. No evidence for acute fracture or subluxation.,2. Mild degenerative changes.,3. Probable left simple renal cyst., | Neurology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: ,Gallstone pancreatitis.,POSTOPERATIVE DIAGNOSIS: , Gallstone pancreatitis.,PROCEDURE PERFORMED: , Laparoscopic cholecystectomy.,ANESTHESIA: , General endotracheal and local injectable Marcaine.,ESTIMATED BLOOD LOSS: , Minimal.,SPECIMEN: , Gallbladder.,COMPLICATIONS: ,None.,OPERATIVE FINDINGS: , Video laparoscopy revealed dense omental adhesions surrounding the gallbladder circumferentially. These dense adhesions were associated with chronic inflammatory edematous changes. The cystic duct was easily identifiable and seen entering into the gallbladder and clipped two proximally and one distally. The cystic artery was an anomalous branch that was anterior to the cystic duct and was identified, clipped with two clips proximally and one distally. The remainder of the evaluation of the abdomen revealed no evidence of nodularity or masses in the liver. There was no evidence of adhesions from the abdominal wall to the liver. The remainder of the abdomen was unremarkable.,BRIEF HISTORY: ,This is a 17-year-old African-American female who presented to ABCD General Hospital on 08/20/2003 with complaints of intractable right upper quadrant abdominal pain. She had been asked to follow up and scheduled for surgery previously. Her pain had now been intractable associated with anorexia. She was noted on physical examination to be afebrile; however, she was having severe right upper quadrant pain with examination as well as a Murphy's sign and voluntary guarding with examination. Her transaminases were markedly elevated. She also developed pancreatitis secondary to gallstones. Her common bile duct was dilated to 1 cm with no evidence of wall thickening, but evidence of cholelithiasis. She was seen by the gastroenterologist and underwent a sphincterotomy with balloon extraction of gallstones secondary to choledocholithiasis. Following this, she was scheduled for operative laparoscopic cholecystectomy. Her parents were explained the risks, benefits, and complications of the procedure. She gave us informed consent to proceed with surgery.,OPERATIVE PROCEDURE: ,The patient brought to the operative suite and placed in the supine position. Preoperatively, the patient received IV antibiotics of Ancef, sequential compression devices and subcutaneous heparin. The abdomen was prepped and draped in the normal sterile fashion with Betadine solution. Utilizing a #15 blade scalpel, a transverse infraumbilical incision was created. Utilizing a Veress needle with anterior traction on the anterior abdominal wall with a towel clamp, the Veress needle was inserted without difficulty. Hanging water drop test was performed with notable air aspiration through the Veress needle and the saline passed through the Veress needle without difficulty. The abdomen was then insufflated to 15 mmHg with carbon-dioxide. Once the abdomen was sufficiently insufflated, a #10 mm bladed trocar was inserted into the abdomen without difficulty. Video laparoscope was inserted and the above notable findings were identified in the operative findings. The patient to proceed with laparoscopic cholecystectomy was decided and a subxiphoid port was placed. A #15 bladed scalpel was used to make a transverse incision in the subxiphoid region within the midline. The trocar was then inserted into the abdomen under direct visualization with the video laparoscope and seen to go to the right of falciform ligament. Next, two 5 mm trocars were inserted under direct visualization, one in the midclavicular and one in the anterior midaxillary line. These were inserted without difficulty. The liver edge was lifted and revealed a markedly edematous gallbladder with severe omental adhesions encapsulating the gallbladder. Utilizing Endoshears scissor, a plane was created circumferentially to the dome of the gallbladder to allow assistance and dissection of these dense adhesions. Next, the omental adhesions adjacent to the infundibulum were taken down and allowed to expose the cystic duct. A small vessel was seen anterior to the cystic duct and this was clipped two proximally and one distally and noted to be an anomalous arterial branch. This was transected with Endoshears scissor and visualized the pulsatile branch with two clips securely in place. Next, the cystic duct was carefully dissected with Maryland dissectors and was visualized clearly both anterior and posteriorly. Endoclips were placed two proximally and one distally and then the cystic duct was transected with Endoshears scissor.,Once the clips were noted to be in place, utilizing electrocautery another Dorsey dissector was used to carefully dissect the gallbladder off the liver bed wall. The gallbladder was removed and the bleeding from the gallbladder wall was easily controlled with electrocautery. The abdomen was then irrigated with copious amounts of normal saline. The gallbladder was grasped with a gallbladder grasper and removed from the subxiphoid port. There was noted to be gallstones within the gallbladder. Once the abdomen was re-insufflated after removing the gallbladder and copious irrigation was performed, all ports were then removed under direct visualization with no evidence of bleeding from the anterior abdominal wall. Utilizing #0 Vicryl suture, a figure-of-eight was placed to the subxiphoid and infraumbilical fascia and this was approximated without difficulty. The subxiphoid port was irrigated with copious amounts of normal saline prior to closure of the fascia. A #4-0 Vicryl suture was used to approximate all incisions. The incisions were then injected with local injectable 0.25% Marcaine. All ports were then cleaned dry. Steri-Strips were placed across and sterile pressure dressings were placed on top of this. The patient tolerated the entire procedure well. She was transferred to the Postanesthesia Care Unit in stable condition. She will be followed closely in the postoperative course in General Medical Floor. | Gastroenterology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHIEF COMPLAINT:, The patient is a 49-year-old Caucasian male transported to the emergency room by his wife, complaining of shortness of breath.,HISTORY OF PRESENT ILLNESS:, The patient is known by the nursing staff here to have a long history of chronic obstructive pulmonary disease and emphysema. He has made multiple visits in the past. Today, the patient presents himself in severe respiratory distress. His wife states that since his recent admission of three weeks ago for treatment of pneumonia, he has not seemed to be able to recuperate, and has persistent complaints of shortness of breath.,Today, his symptoms worsened and she brought him to the emergency room. To the best of her knowledge, there has been no fever. He has persistent chronic cough, as always. More complete history cannot be taken because of the patient’s acute respiratory decompensation.,PAST MEDICAL HISTORY:, Hypertension and emphysema.,MEDICATIONS:, Lotensin and some water pill as well as, presumably, an Atrovent inhaler.,ALLERGIES:, None are known.,HABITS:, The patient is unable to cooperate with the history.,SOCIAL HISTORY:, The patient lives in the local area with his wife.,REVIEW OF BODY SYSTEMS:, Unable, secondary to the patient’s condition.,PHYSICAL EXAMINATION:,VITAL SIGNS: Temperature 96 degrees, axillary. Pulse 128. Respirations 48. Blood pressure 156/100. Initial oxygen saturations on room air are 80.,GENERAL: Reveals a very anxious, haggard and exhausted-appearing male, tripoding, with labored breathing.,HEENT: Head is normocephalic and atraumatic.,NECK: The neck is supple without obvious jugular venous distention.,LUNGS: Auscultation of the chest reveals very distant and faint breath sounds, bilaterally, without obvious rales.,HEART: Cardiac examination reveals sinus tachycardia, without pronounced murmur.,ABDOMEN: Soft to palpation.,Extremities: Without edema.,DIAGNOSTIC DATA:, White blood count 25.5, hemoglobin 14, hematocrit 42.4, 89 polys, 1 band, 4 lymphocytes. Chemistry panel within normal limits, with the exception of sodium of 124, chloride 81, CO2 44, BUN 6, creatinine 0.7, glucose 182, albumin 3.3 and globulin 4.1. Troponin is 0.11. Urinalysis reveals yellow clear urine. Specific gravity greater than 1.030 with 2+ ketones, 1+ blood and 3+ protein. No white cells and 0-2 red cells.,Chest x-ray suboptimal in quality, but without obvious infiltrates, consolidation or pneumothorax.,CRITICAL CARE NOTE:, Critical care one hour.,Shortly after the patient’s initial assessment, the patient apparently began to complain of chest pain and appeared to the nurse to have mounting exhaustion and respiratory distress. Although O2 had been placed, elevating his oxygen saturations to the mid to upper 90s, he continued to complain of symptoms, as noted above. He became progressively more rapidly obtunded. The patient did receive one gram of magnesium sulfate shortly after his arrival, and the BiPAP apparatus was being readied for his use. However, the patient, at this point, became unresponsive, unable to answer questions, and preparations were begun for intubation. The BiPAP apparatus was briefly placed while supplies and medications were assembled for intubation. It was noted that even with the BiPAP apparatus, in the duration of time which was required for transfer of oxygen tubing to the BiPAP mask, the patient’s O2 saturations rapidly dropped to the upper 60 range.,All preparations for intubation having been undertaken, Succinylcholine was ordered, but was apparently unavailable in the department. As the patient was quite obtunded, and while the Dacuronium was being sought, an initial trial of intubation was carried out using a straight blade and a cupped 7.9 endotracheal tube. However, the patient had enough residual muscle tension to make this impractical and further efforts were held pending administration of Dacuronium 10 mg. After approximately two minutes, another attempt at intubation was successful. The cords were noted to be covered with purulent exudates at the time of intubation.,The endotracheal tube, having been placed atraumatically, the patient was initially then nebulated on 100% oxygen, and his O2 saturations rapidly rose to the 90-100% range.,Chest x-ray demonstrated proper placement of the tube. The patient was given 1 mg of Versed, with decrease of his pulse from the 140-180 range to the 120 range, with satisfactory maintenance of his blood pressure.,Because of a complaint of chest pain, which I myself did not hear, during the patient’s initial triage elevation, a trial of Tridil was begun. As the patient’s pressures held in the slightly elevated range, it was possible to push this to 30 mcg per minute. However, after administration of the Dacuronium and Versed, the patient’s blood pressure fell somewhat, and this medication was discontinued when the systolic pressure briefly reached 98.,Because of concern regarding pneumonia or sepsis, the patient received one gram of Rocephin intravenously shortly after the intubation. A nasogastric and Foley were placed, and an arterial blood gas was drawn by respiratory therapy. Dr. X was contacted at this point regarding further orders as the patient was transferred to the Intensive Care Unit to be placed on the ventilator there. The doctor’s call was transferred to the Intensive Care Unit so he could leave appropriate orders for the patient in addition to my initial orders, which included Albuterol or Atrovent q. 2h. and Levaquin 500 mg IV, as well as Solu-Medrol.,Critical care note terminates at this time.,EMERGENCY DEPARTMENT COURSE:, See the critical care note.,MEDICAL DECISION MAKING (DIFFERENTIAL DIAGNOSIS):, This patient has an acute severe decompensation with respiratory failure. Given the patient’s white count and recent history of pneumonia, the possibility of recurrence of pneumonia is certainly there. Similarly, it would be difficult to rule out sepsis. Myocardial infarction cannot be excluded.,COORDINATION OF CARE:, Dr. X was contacted from the emergency room and asked to assume the patient’s care in the Intensive Care Unit.,FINAL DIAGNOSIS:, Respiratory failure secondary to severe chronic obstructive pulmonary disease.,DISCHARGE INSTRUCTIONS:, The patient is to be transferred to the Intensive Care Unit for further management. | Emergency Room Reports |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | EXAM:, Mammographic screening FFDM,HISTORY: , 40-year-old female who is on oral contraceptive pills. She has no present symptomatic complaints. No prior history of breast surgery nor family history of breast CA.,TECHNIQUE: , Standard CC and MLO views of the breasts.,COMPARISON: , This is the patient's baseline study.,FINDINGS: , The breasts are composed of moderately to significantly dense fibroglandular tissue. The overlying skin is unremarkable.,There are a tiny cluster of calcifications in the right breast, near the central position associated with 11:30 on a clock.,There are benign-appearing calcifications in both breasts as well as unremarkable axillary lymph nodes.,There are no spiculated masses or architectural distortion.,IMPRESSION:, Tiny cluster of calcifications at the 11:30 position of the right breast. Recommend additional views; spot magnification in the MLO and CC views of the right breast.,BIRADS Classification 0 - Incomplete,MAMMOGRAPHY INFORMATION:,1. A certain percentage of cancers, probably 10% to 15%, will not be identified by mammography.,2. Lack of radiographic evidence of malignancy should not delay a biopsy if a clinically suspicious mass is present.,3. These images were obtained with FDA-approved digital mammography equipment, and iCAD Second Look Software Version 7.2 was utilized. | Radiology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS:, Obstructive sleep apnea.,POSTOPERATIVE DIAGNOSIS: ,Obstructive sleep apnea.,PROCEDURE PERFORMED:,1. Tonsillectomy.,2. Uvulopalatopharyngoplasty.,ANESTHESIA:, General endotracheal tube.,BLOOD LOSS: , Approximately 50 cc.,INDICATIONS: , The patient is a 41-year-old gentleman with a history of obstructive sleep apnea who has been using CPAP, however, he was not tolerating used of the machine and requested a surgical procedure for correction of his apnea.,PROCEDURE: , After all risks, benefits, and alternatives have been discussed with the patient, informed consent was obtained. The patient was brought to the operative suite where he was placed in supine position and general endotracheal tube intubation was delivered by the Department of Anesthesia. The patient was rotated 90 degrees away and a shoulder roll was placed and a McIvor mouthgag was inserted into the oral cavity. Correct inspection and palpation did not reveal evidence of a bifid uvula or submucosal clots. Attention was directed first to the right tonsil in which a curved Allis forceps was applied to the superior pole. The needle-tip Bovie cautery was used to incise the mucosa of the anterior tonsillar pillar. Once the tonsillar pillar was identified and the superior pole was released, the curved forceps with a straight Allis forceps and the dissection was carried down inferiorly, dissecting the tonsil free from all fascial attachments. Once the tonsil was delivered from the oral cavity, hemostasis was obtained within the tonsillar fossa utilizing suction cautery.,Attention was then directed over to the left tonsil in which a similar procedure was performed. Once all bleeding was controlled, the mucosa of both the hard and soft palate was anesthetized with a mixture of 1% lidocaine and 1:50000 epinephrine solution. Now attention was directed to the posterior pillars. A hemostat was used to clamp the posterior pillar, which was then taken down with Metzenbaum scissors. The posterior pillar was then approximated to the anterior pillar with the use of #3-0 PDS suture so as to create a box shaped soft palate. Now, the uvula was reflected onto the soft palate and #12 blade scalpel was used to incise the mucosa of the soft palate extending down onto the uvula. The mucosa was dissected off with the use of Potts scissors. Now the uvula was reflected onto the soft palate and sutured down in place with use of #3-0 PDS suture approximated with deep muscle layers. Now the mucosa of the soft palate and the uvula were approximated with interrupted #3-0 PDS sutures. Finally, #4-0 Vicryl sutures were placed intermittently between the PDS to further secure the uvula, which had been reflected onto the soft palate. A final #3-0 PDS suture was used to further approximate the anterior and posterior tonsil pillars. Final inspection did not reveal any further bleeding. The mouth was then irrigated with saline and suctioned. At this point, the procedure was complete. He was awakened and taken to recovery room in stable condition. He will be admitted as an observation patient to the Telemetry Floor for routine postoperative management. Of note, IV Decadron was administered during the procedure. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | EXAM:,MRI LEFT SHOULDER,CLINICAL:,This is a 26 year old with a history of instability. Examination was preformed on 12/20/2005.,FINDINGS:,There is supraspinatus tendinosis without a full-thickness tear, gap or fiber retraction and there is no muscular atrophy (series #105 images #4-6).,Normal infraspinatus and subscapularis tendons.,Normal long biceps tendon within the bicipital groove. There is medial subluxation of the tendon under the transverse humeral ligament, and there is tendinosis of the intracapsular portion of the tendon with partial tearing, but there is no complete tear or discontinuity. Biceps anchor is intact (series #105 images #4-7; series #102 images #10-22).,There is a very large Hill-Sachs fracture, involving almost the entire posterior half of the humeral head (series #102 images #13-19). This is associated with a large inferior bony Bankart lesion that measures approximately 15 x 18mm in AP and craniocaudal dimension with impaction and fragmentation (series #104 images #10-14; series #102 images #18-28). There is medial and inferior displacement of the fragment. There are multiple interarticular bodies, some of which may be osteochondromatous and some may be osseous measuring up to 8mm in diameter. (These are too numerous to count.) There is marked stretching, attenuation and areas of thickening of the inferior and middle glenohumeral ligaments, compatible with a chronic tear with scarring but there is no discontinuity or demonstrated HAGL lesion (series #105 images #5-10).,Normal superior glenohumeral ligament.,There is no SLAP tear.,Normal acromioclavicular joint without narrowing of the subacromial space.,Normal coracoacromial, coracohumeral and coracoclavicular ligaments.,There is fluid in the glenohumeral joint and biceps tendon sheath.,IMPRESSION:,There is a very large Hill-Sachs fracture involving most of the posterior half of the humeral head with an associated large and inferior and medial displaced osseous Bankart lesion.,There are multiple intraarticular bodies, and there is a partial tear of the inferior and middle glenohumeral ligaments.,There is medial subluxation of the long biceps tendon under the transverse humeral ligament with partial tearing of the intracapsular portion., | Orthopedic |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHIEF COMPLAINT:, Left foot pain.,HISTORY:, XYZ is a basketball player for University of Houston who sustained an injury the day prior. They were traveling. He came down on another player's foot sustaining what he describes as an inversion injury. Swelling and pain onset immediately. He was taped but was able to continue playing He was examined by John Houston, the trainer, and had tenderness around the navicular so was asked to come over and see me for evaluation. He has been in a walking boot. He has been taped firmly. Pain with weightbearing activities. He is limping a bit. No significant foot injuries in the past. Most of his pain is located around the dorsal aspect of the hindfoot and midfoot. ,PHYSICAL EXAM:, He does have some swelling from the hindfoot out toward the midfoot. His arch is maintained. His motion at the ankle and subtalar joints is preserved. Forefoot motion is intact. He has pain with adduction and abduction across the hindfoot. Most of this discomfort is laterally. His motor strength is grossly intact. His sensation is intact, and his pulses are palpable and strong. His ankle is not tender. He has minimal to no tenderness over the ATFL. He has no medial tenderness along the deltoid or the medial malleolus. His anterior drawer is solid. His external rotation stress is not painful at the ankle. His tarsometatarsal joints, specifically 1, 2 and 3, are nontender. His maximal tenderness is located laterally along the calcaneocuboid joint and along the anterior process of the calcaneus. Some tenderness over the dorsolateral side of the talonavicular joint as well. The medial talonavicular joint is not tender.,RADIOGRAPHS:, Those done of his foot weightbearing show some changes over the dorsal aspect of the navicular that appear chronic. I don't see a definite fracture. The tarsometarsal joints are anatomically aligned. Radiographs of his ankle again show changes along the dorsal talonavicular joint but no other fractures identified. Review of an MR scan of the ankle dated 12/01/05 shows what looks like some changes along the lateral side of the calcaneocuboid joint with disruption of the lateral ligament and capsular area. Also some changes along the dorsal talonavicular joint. I don't see any significant marrow edema or definitive fracture line. ,IMPRESSION:, Left Chopart joint sprain.,PLAN:, I have spoken to XYZ about this. Continue with ice and boot for weightbearing activities. We will start him on a functional rehab program and progress him back to activities when his symptoms allow. He is clear on the prolonged duration of recovery for these hindfoot type injuries. | Chiropractic |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CLINICAL INDICATIONS: , MRSA bacteremia, rule out endocarditis. The patient has aortic stenosis.,DESCRIPTION OF PROCEDURE: , The transesophageal echocardiogram was performed after getting verbal and a written consent signed. Then a multiplane TEE probe was introduced into the upper esophagus, mid esophagus, lower esophagus, and stomach and multiple views were obtained. There were no complications. The patient's throat was numbed with Cetacaine spray and IV sedation was achieved with Versed and fentanyl.,FINDINGS:,1. Aortic valve is thick and calcified, a severely restricted end opening and there is 0.6 x 8 mm vegetation attached to the right coronary cusp. The peak velocity across the aortic valve was 4.6 m/sec and mean gradient was 53 mmHg and peak gradient 84 mmHg with calculated aortic valve area of 0.6 sq cm by planimetry.,2. Mitral valve is calcified and thick. No vegetation seen. There is mild-to-moderate MR present. There is mild AI present also.,3. Tricuspid valve and pulmonary valve are structurally normal.,4. There is a mild TR present.,5. There is no clot seen in the left atrial appendage. The velocity in the left atrial appendage was 0.6 m/sec.,6. Intraatrial septum was intact. There is no clot or mass seen.,7. Normal LV and RV systolic function.,8. There is thick raised calcified plaque seen in the thoracic aorta and arch.,SUMMARY:,1. There is a 0.6 x 0.8 cm vegetation present in the aortic valve with severe aortic stenosis. Calculated aortic valve area was 0.6 sq. cm.,2. Normal LV systolic function., | Radiology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSES: ,1. Fractured and retained lumbar subarachnoid spinal catheter.,2. Pseudotumor cerebri (benign intracranial hypertension).,PROCEDURES: ,1. L1 laminotomy.,2. Microdissection.,3. Retrieval of foreign body (retained lumbar spinal catheter).,4. Attempted insertion of new external lumbar drain.,5. Fluoroscopy.,ANESTHESIA: , General.,HISTORY: ,The patient had a lumbar subarachnoid drain placed yesterday. All went well with the surgery. The catheter stopped draining and on pulling back the catheter, it fractured and CT scan showed that the remaining fragment is deep to the lamina. The patient continues to have right eye blindness and headaches, presumably from the pseudotumor cerebri.,DESCRIPTION OF PROCEDURE: ,After induction of general anesthesia, the patient was placed prone on the operating room table resting on chest rolls. Her face was resting in a pink foam headrest. Extreme care was taken positioning her because she weighs 92 kg. There was a lot of extra padding for her limbs and her limbs were positioned comfortably. The arms were not hyperextended. Great care was taken with positioning of the head and making sure there was no pressure on her eyes especially since she already has visual disturbance. A Foley catheter was in place. She received IV Cipro 400 mg because she is allergic to most antibiotics.,Fluoroscopy was used to locate the lower end of the fractured catheter and the skin was marked. It was also marked where we would try to insert the new catheter at the L4 or L3 interspinous space.,The patient was then prepped and draped in a sterile manner.,A 7-cm incision was made over the L1 lamina. The incision was carried down through the fascia all the way down to the spinous processes. A self-retaining McCullough retractor was placed. The laminae were quite deep. The microscope was brought in and using the Midas Rex drill with the AM-8 bit and removing some of the spinous process of L1-L2 with double-action rongeurs, the laminotomy was then done using the drill and great care was taken and using a 2-mm rongeur, the last layer of lamina was removed exposing the epidural fat and dura. The opening in the bone was 1.5 x 1.5 cm.,Occasionally, bipolar cautery was used for bleeding of epidural veins, but this cautery was kept to a minimum.,Under high magnification, the dura was opened with an 11 blade and microscissors. At first, there was a linear incision vertically to the left of midline, and I then needed to make a horizontal incision more towards the right. The upper aspect of the cauda equina was visualized and perhaps the lower end of the conus. Microdissection under high magnification did not expose the catheter. The fluoroscope was brought in 2 more times including getting a lateral view and the fluoroscope appeared to show that the catheter should be in this location.,I persisted with intensive microdissection and finally we could see the catheter deep to the nerves and I was able to pull it out with the microforceps.,The wound was irrigated with bacitracin irrigation.,At this point, I then attempted lumbar puncture by making a small incision with an 11 blade in the L4 interspinous space and then later in the L3 interspinous space and attempted to puncture the dural sac with the Tuohy needle. Dr. Y also tried. Despite using the fluoroscope and our best attempts, we were not able to convincingly puncture the lumbar subarachnoid space and so the attempted placement of the new lumbar catheter had to be abandoned. It will be done at a later date.,I felt it was unsafe to place a new catheter at this existing laminotomy site because it was very high up near the conus. The potential for complications involving her spinal cord was greater and we have already had a complication of the catheter now and I just did not think it was safe to put in this location.,Under high magnification, the dura was closed with #6-0 PDS interrupted sutures.,After the dura was closed, a piece of Gelfoam was placed over the dura. The paraspinous muscles were closed with 0 Vicryl interrupted sutures. The subcutaneous fascia was also closed with 0 Vicryl interrupted suture. The subcutaneous layer was closed with #2-0 Vicryl interrupted suture and the skin with #4-0 Vicryl Rapide. The 4-0 Vicryl Rapide sutures were also used at the lumbar puncture sites to close the skin.,The patient was then turned carefully on to her bed after sterile dressings were applied and then taken to the recovery room. The patient tolerated procedure well. No complications. Sponge and needle counts correct. Blood loss minimal, none replaced. This procedure took 5 hours. This case was also extremely difficult due to patient's size and the difficulty of locating the catheter deep to the cauda equina. | Neurosurgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: ,Cataract, right eye.,POSTOPERATIVE DIAGNOSIS: , Cataract, right eye.,PROCEDURE: , Cataract extraction with phacoemulsification and posterior chamber intraocular lens implantation. ME 30, AC 25.0 diopter lens was used.,COMPLICATIONS: ,None.,ANESTHESIA: , Local 2%, peribulbar lidocaine.,PROCEDURE NOTE: ,Right eye was prepped and draped in the normal sterile fashion. Lid speculum placed in his right eye. Paracentesis made supratemporally. Viscoat injected into the anterior chamber. A 2.8 mm metal keratome blade was then used to fashion a clear corneal beveled incision temporally. This was followed by circular capsulorrhexis and hydrodissection of the nucleus would be assessed. Nuclear material removed via phacoemulsification. Residual cortex removed via irrigation and aspiration. The posterior capsule was clear and intact. Capsular bag was then filled with Provisc solution. The wound was enlarged to 3.5 mm with the keratoma. The lens was folded in place into the capsular bag. Residual Provisc was irrigated from the eye. The wound was secured with one 10-0 nylon suture. The lid speculum was removed. One drop of 5% povidone-iodine prep was placed into the eye as well as a drop of Vigamox and TobraDex ointment. He had a patch placed on it. The patient was transported to the recovery room in stable condition. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: , Pilonidal cyst with abscess formation.,POSTOPERATIVE DIAGNOSIS:, Pilonidal cyst with abscess formation.,OPERATION: , Excision of infected pilonidal cyst.,PROCEDURE: , After obtaining informed consent, the patient underwent a spinal anesthetic and was placed in the prone position in the operating room. A time-out process was followed. Antibiotics were given and then the patient was prepped and draped in the usual fashion. It appeared to me that the abscess had drained somewhat during the night, as it was much smaller than I was anticipating. An elliptical excision of all infected tissues down to the coccyx was performed. Hemostasis was achieved with a cautery. The wound was irrigated with normal saline and it was packed open with iodoform gauze and an absorptive dressing.,The patient was sent to recovery room in satisfactory condition. Estimated blood loss was minimal. The patient tolerated the procedure well. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PROCEDURES PERFORMED:, Colonoscopy.,INDICATIONS:, Renewed symptoms likely consistent with active flare of Inflammatory Bowel Disease, not responsive to conventional therapy including sulfasalazine, cortisone, local therapy.,PROCEDURE: , Informed consent was obtained prior to the procedure with special attention to benefits, risks, alternatives. Risks explained as bleeding, infection, bowel perforation, aspiration pneumonia, or reaction to the medications. Vital signs were monitored by blood pressure, heart rate, and oxygen saturation. Supplemental O2 given. Specifics discussed. Preprocedure physical exam performed. Stable vital signs. Lungs clear. Cardiac exam showed regular rhythm. Abdomen soft. Her past history, her past workup, her past visitation with me for Inflammatory Bowel Disease, well responsive to sulfasalazine reviewed. She currently has a flare and is not responding, therefore, likely may require steroid taper. At the same token, her symptoms are mild. She has rectal bleeding, essentially only some rusty stools. There is not significant diarrhea, just some lower stools. No significant pain. Therefore, it is possible that we are just dealing with a hemorrhoidal bleed, therefore, colonoscopy now needed. Past history reviewed. Specifics of workup, need for followup, and similar discussed. All questions answered.,A normal digital rectal examination was performed. The PCF-160 AL was inserted into the anus and advanced to the cecum without difficulty, as identified by the ileocecal valve, cecal stump, and appendical orifice. All mucosal aspects thoroughly inspected, including a retroflexed examination. Withdrawal time was greater than six minutes. Unfortunately, the terminal ileum could not be intubated despite multiple attempts.,Findings were those of a normal cecum, right colon, transverse colon, descending colon. A small cecal polyp was noted, this was biopsy-removed, placed in bottle #1. Random biopsies from the cecum obtained, bottle #2; random biopsies from the transverse colon obtained, as well as descending colon obtained, bottle #3. There was an area of inflammation in the proximal sigmoid colon, which was biopsied, placed in bottle #4. There was an area of relative sparing, with normal sigmoid lining, placed in bottle #5, randomly biopsied, and then inflammation again in the distal sigmoid colon and rectum biopsied, bottle #6, suggesting that we may be dealing with Crohn disease, given the relative sparing of the sigmoid colon and junk lesion. Retroflexed showed hemorrhoidal disease. Scope was then withdrawn, patient left in good condition. ,IMPRESSION:, Active flare of Inflammatory Bowel Disease, question of Crohn disease.,PLAN: , I will have the patient follow up with me, will follow up on histology, follow up on the polyps. She will be put on a steroid taper and make an appointment and hopefully steroids alone will do the job. If not, she may be started on immune suppressive medication, such as azathioprine, or similar. All of this has been reviewed with the patient. All questions answered. | Gastroenterology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | TITLE OF OPERATION:,1. Repair of total anomalous pulmonary venous connection.,2. Ligation of patent ductus arteriosus.,3. Repair secundum type atrial septal defect (autologous pericardial patch).,4. Subtotal thymectomy.,5. Insertion of peritoneal dialysis catheter.,INDICATION FOR SURGERY: , This neonatal was diagnosed postnatally with total anomalous pulmonary venous connection. Following initial stabilization, she was transferred to the Hospital for complete correction.,PREOP DIAGNOSIS: ,1. Total anomalous pulmonary venous connection.,2. Atrial septal defect.,3. Patent ductus arteriosus.,4. Operative weight less than 4 kilograms (3.2 kilograms).,COMPLICATIONS: , None.,CROSS-CLAMP TIME: , 63 minutes.,CARDIOPULMONARY BYPASS TIME MONITOR:, 35 minutes, profound hypothermic circulatory arrest time (4 plus 19) equals 23 minutes. Low flow perfusion 32 minutes.,FINDINGS:, Horizontal pulmonary venous confluence with right upper and middle with two veins entering the confluence on the right and multiple entry sites for left-sided veins. Large patulous anastomosis between posterior aspect of the left atrium and anterior aspect of the pulmonary venous confluence. Nonobstructed ascending vein ligated. Patent ductus arteriosus diminutive left atrium with posterior atrial septal defect with deficient inferior margin. At completion of the procedure, right ventricular pressure approximating one-half of systemic, normal sinus rhythm, good biventricular function by visual inspection.,PROCEDURE: , After the informed consent, the patient was brought to the operating room and placed on the operating room table in supine position. Upon induction of general endotracheal anesthesia and placement of indwelling arterial and venous monitoring lines. The patient was prepped and draped in the usual sterile fashion from chin to groins. A median sternotomy incision was performed. Dissection was carried through the deeper planes until the sternum was scored and divided with an oscillating saw. A subtotal thymectomy was performed. Systemic heparinization was achieved and the pericardium was entered and fashioned until cradle. A small portion of the anterior pericardium was procured and fixed in glutaraldehyde for patch closure of segment of the atrial septal defect during the procedure. Pursestrings were deployed on the ascending aorta on the right. Atrial appendage. The aorta was then cannulated with an 8-French aorta cannula and the right atrium with an 18-French Polystan right-angle cannula. With an ACT greater than 400, greater pulmonary bypass was commenced with excellent cardiac decompression and the patent ductus arteriosus was ligated with a 2-0 silk tie. Systemic cooling was started and the head was packed and iced and systemic steroids were administered. During cooling, traction suture was placed in the apex of the left ventricle. After 25 minutes of cooling, the aorta was cross-clamped and the heart arrested by administration of 30 cubic centimeter/kilogram of cold-blood cardioplegia delivered directly within the aortic root following the aorta cross-clamping. Following successful cardioplegic arrest, a period of low flow perfusion was started and a 10-French catheter was inserted into the right atrial appendage substituting the 18-French Polystan venous cannula. The heart was then rotated to the right side and the venous confluence was exposed. It was incised and enlarged and a corresponding incision in the dorsal and posterior aspect of the left atrium was performed. The two openings were then anastomosed in an end-to-side fashion with several interlocking sutures to avoid pursestring effect with a running 7-0 PDS suture. Following completion of the anastomosis, the heart was returned into the chest and the patient's blood volume was drained into the reservoir. A right atriotomy was then performed during the period of circulatory arrest. The atrial septal defect was very difficult to expose, but it was sealed with an autologous pericardial patch was secured in place with a running 6-0 Prolene suture. The usual deairing maneuvers were carried out and lining was administered and the right atriotomy was closed in two layers with a running 6-0 Prolene sutures. The venous cannula was reinserted. Cardiopulmonary bypass restarted and the aorta cross-clamp was released. The patient returned to normal sinus rhythm spontaneously and started regaining satisfactory hemodynamics which, following a prolonged period of rewarming, allow for us to wean her from cardiopulmonary bypass successfully and moderate inotropic support and sinus rhythm. Modified ultrafiltration was carried out and two sets of atrial and ventricular pacing wires were placed as well as the peritoneal dialysis catheter and two 15-French Blake drains. Venous decannulation was followed by aortic decannulation and administration of protamine sulfate. All cannulation sites were oversewn with 6-0 Prolene sutures and the anastomotic sites noticed to be hemostatic. With good hemodynamics and hemostasis, the sternum was then smeared with vancomycin, placing closure with stainless steel wires. The subcutaneous tissues were closed in layers with the reabsorbable monofilament sutures. Sponge and needle counts were correct times 2 at the end of the procedure. The patient was transferred in very stable condition to the pediatric intensive care unit .,I was the surgical attending present in the operating room and in charge of the surgical procedure throughout the entire length of the case. Given the magnitude of the operation, the unavailability of an appropriate level, cardiac surgical resident, Mrs. X (attending pediatric cardiac surgery at the Hospital) participated during the cross-clamp time of the procedure in quality of first assistant. | Pediatrics - Neonatal |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: ,Left breast mass with abnormal mammogram.,POSTOPERATIVE DIAGNOSIS:, Left breast mass with abnormal mammogram.,PROCEDURE PERFORMED:, Needle-localized excisional biopsy of the left breast.,ANESTHESIA:, Local with sedation.,COMPLICATIONS: , None.,SPECIMEN: , Breast mass.,DISPOSITION: , The patient tolerated the procedure well and was transferred to recovery in stable condition.,INTRAOPERATIVE FINDINGS: , The patient had a nonpalpable left breast mass, which was excised and sent to Radiology with confirmation that the mass is in the specimen.,BRIEF HISTORY:, The patient is a 62-year-old female who presented to Dr. X's office with an abnormal mammogram showing a suspicious area on the left breast with microcalcifications and a nonpalpable mass. So the patient was scheduled for a needle-localized left breast biopsy.,PROCEDURE:, After informed consent, the risks and benefits of the procedure were explained to the patient. The patient was brought to the operating suite. After IV sedation was given, the patient was prepped and draped in normal sterile fashion. Next, a curvilinear incision was made.,After anesthetizing the skin with 0.25% Marcaine and 1% lidocaine mixture, an incision was made with a #10 blade scalpel. The lesion with needle was then grasped with an Allis clamp. Using #10 blade scalpel, the specimen was colonized out and sent to Radiology for confirmation. Next, hemostasis was obtained using electrobovie cautery. The skin was then closed with #4-0 Monocryl suture in running subcuticular fashion. Steri-Strips and sterile dressings were applied. The patient tolerated the procedure well and was sent to Recovery in stable condition. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSES: ,1. Herniated nucleus pulposus, C5-C6, greater than C6-C7 and C4-C5 with left radiculopathy.,2. Cervical stenosis with cord compression, C5-C6 (723.0).,POSTOPERATIVE DIAGNOSES: ,1. Herniated nucleus pulposus, C5-C6, greater than C6-C7 and C4-C5 with left radiculopathy.,2. Cervical stenosis with cord compression, C5-C6 (723.0), with surgical findings confirmed.,PROCEDURES: ,1. Anterior cervical discectomy at C4-C5, C5-C6, and C6-C7 for neural decompression (63075, 63076, 63076).,2. Anterior interbody fusion at C4-C5, C5-C6, and C6-C7 (22554, 22585, 22585) utilizing Bengal cages times three (22851).,3. Anterior instrumentation for stabilization by Slim-LOC plate C4, C5, C6, and C7 (22846); with intraoperative x-ray times two.,ANESTHESIA:, General.,SERVICE: , Neurosurgery.,OPERATION: , The patient was brought into the operating room, placed in a supine position where general anesthesia was administered. Then the anterior aspect of the neck was prepped and draped in a routine sterile fashion. A linear skin incision was made in the skin fold line from just to the right of the midline to the leading edge of the right sternocleidomastoid muscle and taken sharply to platysma, which was dissected in a subplatysmal manner, and then the prevertebral space was encountered and prominent anterior osteophytes were well visualized once longus colli muscle was cauterized along its mesial border, and self-retaining retractors were placed to reveal the anterior osteophytic spaces. Large osteophytes were excised with a rongeur at C4-5, C5-C6, and C6-C7 revealing a collapsed disc space and a #11 blade was utilized to create an annulotomy at all three interspaces with discectomies being performed with straight disc forceps removing grossly degenerated and very degenerated discs at C4-C5, then at C5-C6, then at C6-C7 sending specimen for permanent section to Pathology in a routine and separate manner. Residual disc fragments were drilled away as drilling extended into normal cortical and cancellous elements in order to perform a wide decompression all the way posteriorly to the spinal canal itself finally revealing a ligament, which was removed in a similar piecemeal fashion with 1 and 2-mm micro Kerrison rongeurs also utilizing these instruments to remove prominent osteophytes, widely laterally bilaterally at each interspace with one at C4-C5, more right-sided. The most prominent osteophyte and compression was at C5-C6 followed by C6-C7 and C4-C5 with a complete decompression of the spinal canal allowing the dura to finally bulge into the interspace at all three levels, once the ligaments were proximally removed as well and similarly a sign of a decompressed status. The nerve roots themselves were inspected with a double ball dissector and found to be equally decompressed. The wound was irrigated with antibiotic solution and hemostasis was well achieved with pledgets of Gelfoam subsequently irrigated away. Appropriate size Bengal cages were filled with the patient's own bone elements and countersunk into position, filled along with fusion putty, and once these were quite tightly applied and checked, further stability was added by the placement of a Slim-LOC plate of appropriate size with appropriate size screws, and a post placement x-ray showed well-aligned elements.,The wound was irrigated with antibiotic solution again and inspected, and hemostasis was completely achieved and finally the wound was closed in a routine closure by approximation of the platysma with interrupted 3-0 Vicryl, and the skin with a subcuticular stitch of 4-0 Vicryl, and this was sterilely dressed, and incorporated a Penrose drain, which was carried from the prevertebral space externally to the skin wound and safety pin for security in a routine fashion. At the conclusion of the case, all instruments, needle, and sponge counts were accurate and correct, and there were no intraoperative complications of any type. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSES:,1. Intrauterine pregnancy at 38 weeks.,2. Malpresentation.,POSTOPERATIVE DIAGNOSES:,1. Intrauterine pregnancy at 38 weeks.,2. Malpresentation.,3. Delivery of a viable male neonate.,PROCEDURE PERFORMED: , Primary low transverse cervical cesarean section.,ANESTHESIA: , Spinal with Astramorph.,ESTIMATED BLOOD LOSS: , 300 cc.,URINE OUTPUT:, 80 cc of clear urine.,FLUIDS: , 2000 cc of crystalloids.,COMPLICATIONS: , None.,FINDINGS: , A viable male neonate in the left occiput transverse position with Apgars of 9 and 9 at 1 and 5 minutes respectively, weighing 3030 g. No nuchal cord. No meconium. Normal uterus, fallopian tubes, and ovaries.,INDICATIONS: , This patient is a 21-year-old gravida 3, para 1-0-1-1 Caucasian female who presented to Labor and Delivery in labor. Her cervix did make some cervical chains. She did progress to 75% and -2, however, there was a raised lobular area palpated on the fetal head. However, on exam unable to delineate the facial structures, but definite fetal malpresentation. The fetal heart tones did start and it continued to have variable decelerations with contractions overall are reassuring. The contraction pattern was inadequate. It was discussed with the patient's family that in light of the physical exam and with the fetal malpresentation that a cesarean section will be recommended. All the questions were answered.,PROCEDURE IN DETAIL: , After informed consent was obtained in layman's terms, the patient was taken back to the operating suite and placed in the dorsal lithotomy position with a leftward tilt. Prior to this, the spinal anesthesia was administered. The patient was then prepped and draped. A Pfannenstiel skin incision was made with the first scalpel and carried through to the underlying layer of fascia with the second scalpel. The fascia was then incised in the midline and extended laterally using Mayo scissors. The superior aspect of the rectus fascia was then grasped with Ochsners, tented up and the underlying layer of rectus muscle was dissected up bluntly as well as with Mayo scissors. The superior portion and inferior portion of the rectus fascia was identified, tented up and the underlying layer of rectus muscle was dissected up bluntly as well as with Mayo scissors. The rectus muscle was then separated in the midline. The peritoneum was then identified, tented up with hemostats and entered sharply with Metzenbaum scissors. The peritoneum was then gently stretched. The vesicouterine peritoneum was then identified, tented up with an Allis and the bladder flap was created bluntly as well as using Metzenbaum scissors. The uterus was entered with the second scalpel and large transverse incision. This was then extended in upward and lateral fashion bluntly. The infant was then delivered atraumatically. The nose and mouth were suctioned. The cord was then clamped and cut. The infant was handed off to the awaiting pediatrician. The placenta was then manually extracted. The uterus was exteriorized and cleared of all clots and debris. The uterine incision was then repaired using #0 chromic in a running fashion marking a U stitch. A second layer of the same suture was used in an imbricating fashion to obtain excellent hemostasis. The uterus was then returned to the anatomical position. The abdomen and the gutters were cleared of all clots. Again, the incision was found to be hemostatic. The rectus muscle was then reapproximated with #2-0 Vicryl in a single interrupted stitch. The rectus fascia was then repaired with #0 Vicryl in a running fashion locking the first stitch and first last stitch in a lateral to medial fashion. This was palpated and the patient was found to be without defect and intact. The skin was then closed with staples. The patient tolerated the procedure well. Sponge, lap, and needle counts were correct x2. She will be followed up as an inpatient with Dr. X. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | HISTORY: ,I had the pleasure of meeting and evaluating the patient today, referred for evaluation of tracheostomy tube placement and treatment recommendations. As you are well aware, he is a pleasant 64-year-old gentleman who unfortunately is suffering from end-stage COPD, who required tracheostomy tube placement about three months ago when being treated for acute exacerbation of COPD and having difficulty coming off ventilatory support. He now resides in an extended care facility with a capped tracheostomy tube, and he unfortunately states he has had not had to use the tracheostomy tube since his discharge and admission to the extended care facility. He requires constant oxygen administration and has been having no problems with shortness of breath, worsening, requiring opening the tracheostomy tube site. He states there has been some tenderness associated with the tracheostomy tube and difficulty with swallowing and he wishes to have it removed. Apparently there is no history of any airway issues while sleeping or need for uncapping the tube and essentially the tube has just remained present for months capped in his neck. No history of any previous tracheostomy tube insertion.,PAST MEDICAL HISTORY: , COPD, history of hypercarbic hypoxemia, history of coronary artery disease, history of previous myocardial infarction, and history of liver cirrhosis secondary to alcohol use.,PAST SURGICAL HISTORY: ,Tonsillectomy, adenoidectomy, cholecystectomy, appendectomy, hernia repair, and tracheostomy.,FAMILY HISTORY: ,Strong for heart disease, coronary artery disease, hypertension, diabetes mellitus, and cerebrovascular accident.,CURRENT MEDICATIONS:, Prevacid, folic acid, aspirin, morphine sulfate, Pulmicort, Risperdal, Colace, clonazepam, Lotrisone, Roxanol, Ambien, Zolpidem tartrate, simethicone, Robitussin, and prednisone.,ALLERGIES: , Nitroglycerin.,SOCIAL HISTORY: , The patient has a 25-year-smoking history, which I believe is quite heavy and he has a significant alcohol use in the past.,PHYSICAL EXAMINATION: ,VITAL SIGNS: Age 64, blood pressure is 110/78, pulse 96, and temperature is 98.6.,GENERAL: The patient was examined in his wheelchair, resting comfortably, in no acute distress.,HEAD: Normocephalic. No masses or lesions noted.,FACE: No facial tenderness or asymmetry noted.,EYES: Pupils are equal, round and reactive to light and accommodation bilaterally. Extraocular movements are intact bilaterally.,EARS: The tympanic membranes are intact bilaterally with a good light reflex. The external auditory canals are clear with no lesions or masses noted. Weber and Rinne tests are within normal limits.,NOSE: The nasal cavities are patent bilaterally. The nasal septum is midline. There are no nasal discharges. No masses or lesions noted.,THROAT: The oral mucosa appears healthy. Dental hygiene is maintained well. No oropharyngeal masses or lesions noted. No postnasal drip noted.,NECK: The patient has a stable-appearing tracheostomy tube site and the stoma appears to be without signs of infection. The previous incision was vertical in nature and there is no hypertrophic scar formation. No adenopathy noted. No stridor noted.,NEUROLOGIC: Cranial nerve VII intact bilaterally. No signs of tremor.,LUNGS: Diminished breath sounds in all four quadrants. No wheezes noted.,HEART: Regular rate and rhythm.,PROCEDURE: , Limited bronchoscopy and then fiberoptic laryngoscopy.,IMPRESSION: ,1. End-stage chronic obstructive pulmonary disease with a history of respiratory failure requiring mechanical ventilatory support with tracheostomy tube placement.,2. Difficulty tolerating tracheostomy tubes secondary to swallow discomfort and neck irritation with no further need for tracheostomy tube over the past few months with the patient tolerating capped tracheostomy tube 24 hours a day.,3. History of coronary artery disease.,4. History of myocardial infarction.,5. History of cirrhosis of liver.,RECOMMENDATIONS: , I discussed with the patient in detail after fiberoptic laryngoscopy and limited bronchoscopy was performed in the office whether or not to pull out the tracheostomy tube. His vocal cords moved well, and I do not see any signs of granuloma or airway obstruction either in the supraglottic or subglottic region, and I felt he would tolerate the tube being removed with close monitoring by nursing at his extended care facility. I did impress the fact that I believe he probably will have other events requiring airway support, which could include intubation, and if the intubation is prolonged a tracheostomy may be needed. Creation of a long-term tracheostoma may be beneficial whereas the patient would not need such a long tracheostomy tube, and I informed the patient there are other options other than the tube he has at the present time. The patient still wished to have the tube removed and he is aware he may need to have it replaced or he may have trouble with the area healing or scarring or he could end up having an emergent airway situation with the tube gone, but wishes to have it removed, and I did remove it today. Dressing was applied and we will see him back next week to make sure everything is healing properly. | Cardiovascular / Pulmonary |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PROCEDURE: ,This tracing was obtained utilizing silver chloride biopotential electrodes placed at the medial and lateral canthi at both eyes and on the superior and inferior orbital margins of the left eye along a vertical line drawn through the middle of the pupil in the neutral forward gaze. Simultaneous recordings were made in both eyes in the horizontal direction and the left eye in the vertical directions. Caloric irrigations were performed using a closed loop irrigation system at 30 degrees and 44 degrees C into either ear.,FINDINGS: , Gaze testing did not reveal any evidence of nystagmus. Saccadic movements did not reveal any evidence of dysmetria or overshoot. Sinusoidal tracking was performed well for the patient's age. Optokinetic nystagmus testing was performed poorly due to the patient's difficulty in following the commands. Therefore adequate OKNs were not achieved. The Dix-Hallpike maneuver in the head handing left position resulted in moderate intensity left beating nystagmus, which was converted to a right beating nystagmus when she sat up again. The patient complained of severe dizziness in this position. There was no clear-cut decremental response with repetition. In the head hanging left position, no significant nystagmus was identified. Positional testing in the supine, head hanging, head right, head left, right lateral decubitus, and left lateral decubitus positions did not reveal any evidence of nystagmus.,Caloric stimulation revealed a calculated unilateral weakness of 7.0% on the right (normal <20%) and left beating directional preponderance of 6.0% (normal <20-30%).,IMPRESSION: , Abnormal electronystagmogram demonstrating prominent nystagmus on position testing in the head hanging right position. No other significant nystagmus was noted. There was no evidence of clear-cut caloric stimulation abnormality. This study would be most consistent with a right vestibular dysfunction. | Ophthalmology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: , Colon polyps.,POSTOPERATIVE DIAGNOSES:,1. Universal diverticulosis.,2. Nonsurgical internal hemorrhoids.,PROCEDURE PERFORMED:, Total colonoscopy with photos.,ANESTHESIA:, Demerol 100 mg IV with Versed 3 mg IV.,SPECIMENS: , None.,ESTIMATED BLOOD LOSS: , Minimal.,INDICATIONS FOR PROCEDURE: ,The patient is a 62-year-old white male who presents to the office with a history of colon polyps and need for recheck.,PROCEDURE:, Informed consent was obtained. All risks and benefits of the procedure were explained and all questions were answered. The patient was brought back to the Endoscopy Suite where he was connected to cardiopulmonary monitoring. Demerol 100 mg IV and Versed 3 mg IV was given in a titrated fashion until appropriate anesthesia was obtained. Upon appropriate anesthesia, a digital rectal exam was performed, which showed no masses. The colonoscope was then placed into the anus and the air was insufflated. The scope was then advanced under direct vision into the rectum, rectosigmoid colon, descending colon, transverse colon, ascending colon until it reached the cecum. Upon entering the sigmoid colon and throughout the rest of the colon, there was noted diverticulosis. After reaching the cecum, the scope was fully withdrawn visualizing all walls again noting universal diverticulosis.,Upon reaching the rectum, the scope was then retroflexed upon itself and there was noted to be nonsurgical internal hemorrhoids. The scope was then subsequently removed. The patient tolerated the procedure well and there were no complications. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PROCEDURES,1. Arthroscopic rotator cuff repair.,2. Arthroscopic subacromial decompression.,3. Arthroscopic extensive debridement, superior labrum anterior and posterior tear.,PROCEDURE IN DETAIL: , After written consent was obtained from the patient, the patient was brought back into the operating room and identified. The patient was placed on the operating room table in supine position and given general anesthetic. Once the patient was under general anesthetic, a careful examination of the shoulder was performed. It revealed no patholigamentous laxity. The patient was then carefully positioned into a beach-chair position. We maintained the natural alignment of the head, neck, and thorax at all times. The shoulder and upper extremity was then prepped and draped in the usual sterile fashion.,Once we fully prepped and draped, we then began the surgery. We injected the glenohumeral joint with sterile saline with a spinal needle. This consisted of 60 cc of fluid. We then made a posterior incision for our portal, 2 cm inferior and 2 cm medial to the posterolateral angle of the acromion. Through this incision, a blunt trocar and cannula were placed in the glenohumeral joint. Through the cannula, a camera was placed; and the shoulder was insufflated with sterile saline through a preoperative feed. We then carefully examined the glenohumeral joint.,We found the articular surface to be in good condition. There was a superior labral tear (SLAP). This was extensively debrided using a shaver through an anterior portal. We also found a full thickness rotator cuff tear. We then drained the glenohumeral joint. We redirected our camera into the subacromial space. An anterolateral portal was made, both superior and inferior.,We then proceeded to perform a subacromial decompression using high-speed shaver. The bursa was extensively debrided. We then abraded the bone over the footprint of where the rotator cuff is usually attached. The corkscrew anchors were used to perform a rotator cuff repair. Pictures were taken.,Through a separate incision, an indwelling pain catheter was then placed. It was carefully positioned. Pictures were taken. We then drained the joint. All instruments were removed. The patient did receive IV antibiotic preoperatively. All portals were closed using 4-0 nylon sutures.,Xeroform, 4 x 4s, and OpSite were applied over the pain pump. ABD, tape, and a sling were also applied. A Cryo/Cuff was also placed over the shoulder. The patient was taken out of the beach-chair position maintaining the neutral alignment of the head, neck, and thorax. The patient was extubated and brought to the recovery room in stable condition. I then went out and spoke with the family, going over the case, postoperative instructions, and followup care. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | HISTORY: , The patient is a 19-year-old boy with a membranous pulmonary atresia, underwent initial repair 12/04/1987 consisting of pulmonary valvotomy and placement of 4 mm Gore-Tex shunt between the ascending aorta and pulmonary artery with a snare. This was complicated by shunt thrombosis __________ utilizing a 10-mm balloon. Resulting in significant hypoxic brain injury where he has been left with static encephalopathy and cerebral palsy. On 04/07/1988, he underwent heart catheterization and balloon pulmonary valvuloplasty utilizing a 10-mm balloon. He has been followed conservatively since that time. A recent echocardiogram demonstrated possibly a significant right ventricle outflow tract obstruction with tricuspid valve regurgitation velocity predicting a right ventricular systolic pressure in excess of 180 mmHg. Right coronary artery to pulmonary artery fistula was also appreciated. The patient underwent cardiac catheterization to assess hemodynamics associated with his current state of repair.,PROCEDURE:, The patient was placed under general endotracheal anesthesia breathing on 30% oxygen throughout the case. Cardiac catheterization was performed as outlined in the attached continuation sheets. Vascular entry was by percutaneous technique, and the patient was heparinized. Monitoring during the procedure included continuous surface ECG, continuous pulse oximetry, and cycled cuff blood pressures, in addition to intravascular pressures.,Using a 7-French sheath, a 6-French wedge catheter was inserted. The right femoral vein advanced through the right heart structures out to the branch pulmonary arteries. This catheter was then exchanged over wire for a 5-French marker pigtail catheter, which was directed into the main pulmonary artery.,Using a 5-French sheath, a 5-French pigtail catheter was inserted in the right femoral artery and advanced retrograde to the descending aorta, ascending aorta, and left ventricle. This catheter was then exchanged for a Judkins right coronary catheter for selective cannulation of the right coronary artery.,Flows were calculated by the Fick technique using a measured assumed oxygen consumption and contents derived from Radiometer Hemoximeter saturations and hemoglobin capacity.,Cineangiograms were obtained with injection of the main pulmonary artery and right coronary artery.,After angiography, two normal-appearing renal collecting systems were visualized. The catheters and sheaths were removed and topical pressure applied for hemostasis. The patient was returned to the recovery room in satisfactory condition. There were no complications.,DISCUSSION:, Oxygen consumption was assumed to be normal. Mixed venous saturation was normal with no evidence of intracardiac shunt. Left-sided heart was fully saturated. Phasic right atrial pressures were normal with an A-wave similar to the normal right ventricular end-diastolic pressure. Right ventricular systolic pressure was mildly elevated at 45% systemic level. There was a 25 mmHg peak systolic gradient across the outflow tract to the main branch pulmonary arteries. Phasic branch pulmonary artery pressures were normal. Right-to-left pulmonary artery capillary wedge pressures were normal with an A-wave similar to the normal left ventricular end-diastolic pressure of 12 mmHg. Left ventricular systolic pressure was systemic with no outflow obstruction to the ascending aorta. Phasic ascending and descending pressures were similar and normal. The calculated systemic and pulmonary flows were equal and normal. Vascular resistances were normal. Angiogram with contrast injection in the main pulmonary artery showed catheter induced pulmonary insufficiency. The right ventricle appeared mildly hypoplastic with a good contractility and mild tricuspid valve regurgitation. There is dynamic narrowing of the infundibulum with hypoplastic pulmonary annulus. The pulmonary valve appeared to be thin and moved well. The median branch pulmonary arteries were of good size with normal distal arborization. Angiogram with contrast injection in the right coronary artery showed a non-dominant coronary with a small fistula arising from the proximal right coronary artery coursing over the infundibulum and entering the left facing sinus of the main pulmonary artery.,INITIAL DIAGNOSES:,1. Membranous pulmonary atresia.,2. Atrial septal defect.,3. Right coronary artery to pulmonary artery fistula.,SURGERIES (INTERVENTIONS): ,1. Pulmonary valvotomy surgical.,2. Aortopulmonary artery central shunt.,3. Balloon pulmonary valvuloplasty.,CURRENT DIAGNOSES: ,1. Pulmonary valve stenosis supplemented to hypoplastic pulmonary annulus.,2. Mild right ventricle outflow tract obstruction due to supple pulmonic narrowing.,3. Small right coronary artery to main pulmonary fistula.,4. Static encephalopathy.,5. Cerebral palsy.,MANAGEMENT: , The case to be discussed with combined Cardiology/Cardiothoracic Surgery case conference. Given the mild degree of outflow tract obstruction in this sedentary patient, aggressive intervention is not indicated. Conservative outpatient management is to be recommended. Further patient care will be directed by Dr. X. | Cardiovascular / Pulmonary |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: , Penoscrotal abscess.,POSTOPERATIVE DIAGNOSIS:, Penoscrotal abscess.,OPERATION: , Incision and drainage of the penoscrotal abscess, packing, penile biopsy, cystoscopy, and urethral dilation.,BRIEF HISTORY: , The patient is a 75-year-old male presented with penoscrotal abscess. Options such as watchful waiting, drainage, and antibiotics were discussed. Risks of anesthesia, bleeding, infection, pain, MI, DVT, PE, completely the infection turning into necrotizing fascitis, Fournier's gangrene were discussed. The patient already had significant phimotic changes and disfigurement of the penis. For further debridement the patient was told that his penis is not going to be viable, he may need a total or partial penectomy now or in the future. Risks of decreased penile sensation, pain, Foley, other unexpected issues were discussed. The patient understood all the complications and wanted to proceed with the procedure.,DETAIL OF THE OPERATION: ,The patient was brought to the OR. The patient was placed in dorsal lithotomy position. The patient was prepped and draped in the usual fashion. Pictures were taken prior to starting the procedure for documentation. The patient had an open sore on the right side of the penis measuring about 1 cm in size with pouring pus out using blunt dissection. The penile area was opened up distally to allow the pus to come out. The dissection around the proximal scrotum was done to make sure there are no other pus pockets. The corporal body was intact, but the distal part of the corpora was completely eroded and had a fungating mass, which was biopsied and sent for permanent pathology analysis.,Urethra was identified at the distal tip, which was dilated and using 23-French cystoscope cystoscopy was done, which showed some urethral narrowing in the distal part of the urethra. The rest of the bladder appeared normal. The prostatic urethra was slightly enlarged. There are no stones or tumors inside the bladder. There were moderate trabeculations inside the bladder. Otherwise, the bladder and the urethra appeared normal. There was a significantly fungating mass involving the distal part of the urethra almost possibility to have including the fungating wart or fungating squamous cell carcinoma. Again biopsies were sent for pathology analysis. Prior to urine irrigation anaerobic aerobic cultures were sent, irrigation with over 2 L of fluid was performed. After irrigation, packing was done with Kerlix. The patient was brought to recovery in a stable condition. Please note that 18-French Foley was kept in place. Electrocautery was used at the end of the procedure to obtain hemostasis as much as possible, but there was fungating mass with slight bleeding packing was done and tight scrotal Kling was applied. The patient was brought to Recovery in a stable condition after applying 0.5% Marcaine about 20 mL were injected around for local anesthesia. | Urology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | HISTORY OF PRESENT ILLNESS: , The patient is a 53-year-old right-handed gentleman who presents to the clinic for further evaluation of diplopia. He states that he was in his usual state of health when he awoke one morning in January 2009. He had double vision. He states when he closed each eye, the double vision dissipated. The double vision entirely dissipated within one hour. He was able to drive. However, the next day he woke up and he had double vision again. Over the next week, the double vision worsened in intensity and frequency and by the second week, it was severe. He states that he called Sinai Hospital and spoke to a physician who recommended that he come in for evaluation. He was seen by a primary care physician who sent him for an ophthalmologic evaluation. He was seen and referred to the emergency department for an urgent MRI to evaluate for possible aneurysm. The patient states that he had a normal MRI and was discharged to home.,For the next month, the double vision improved, although he currently still experiences constant diplopia. Whereas in the past, when he would see two objects, they were very far apart in a horizontal plane; now they are much closer together. He still does not drive. He also is not working due to the double vision. There is no temporal fluctuation to the double vision. More recently, over the past month, he has developed right supraorbital pain. It actually feels like there is pain under his right lid. He denies any dysphagia, dysarthria, weakness, numbness, tingling, or any other neurological symptoms.,There is a neurology consultation in the computer system. Dr. X saw the patient on February 2, 2009, when he was in the emergency department. He underwent an MRI that showed a questionable 3 mm aneurysm of the medial left supraclinoid internal carotid artery, but there were no abnormalities on the right side. MRV was negative and MRI of the brain with and without contrast was also negative. He also had an MRI of the orbit with and without contrast that was normal. His impression was that the patient should follow up for a possible evaluation of myasthenia gravis or other disorder.,At the time of the examination, it was documented that he had right lid ptosis. He had left gaze diplopia. The pupils were equal, round, and reactive to light. His neurological examination was otherwise entirely normal. According to Dr. X's note, the ophthalmologist who saw him thought that there was ptosis of the right eye as well as an abnormal pupil. There was also right medial rectus as well as possibly other extraocular abnormalities. I do not have the official ophthalmologic consultation available to me today.,PAST MEDICAL HISTORY: , The patient denies any previous past medical history. He currently does not have a primary care physician as he is uninsured.,MEDICATIONS:, He does not take any medications.,ALLERGIES: , He has no known drug allergies.,SOCIAL HISTORY: , The patient lives with his wife. He was an IT software developer, but he has been out of work for several months. He smokes less than a pack of cigarettes daily. He denies alcohol or illicit drug use.,FAMILY HISTORY: , His mother died of a stroke in her 90s. His father had colon cancer. He is unaware of any family members with neurological disorders.,REVIEW OF SYSTEMS: , A complete review of systems was obtained and was negative except for as mentioned above. This is documented in the handwritten notes from today's visit.,PHYSICAL EXAMINATION:,Vital Signs: BP 124/76 | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | ADMITTING DIAGNOSIS:, Intrauterine pregnancy at term with previous cesarean.,SECONDARY DIAGNOSIS: , Desired sterilization.,DISCHARGE DIAGNOSES,1. Intrauterine pregnancy at term with previous cesarean.,2. Desired sterilization.,3. Status post repeat low transverse cesarean and bilateral tubal ligation.,HISTORY: , The patient is a 35-year-old gravida 2, para 1-0-0-1 with intrauterine pregnancy on 08/30/09. Pregnancy was uncomplicated. She opted for a scheduled elective C-section and sterilization without any trial of labor. All routine screening labs were normal and she underwent a high-resolution ultrasound during pregnancy.,PAST MEDICAL HISTORY: , Significant for postpartum depression after her last baby as well as a cesarean.,ALLERGIES:, SHE HAS SEASONAL ALLERGIES.,MEDICATIONS:, She is taking vitamins and iron.,PHYSICAL EXAMINATION,GENERAL: An alert gravid woman in no distress.,ABDOMEN: Gravid, nontender, non-irritable, with an infant in the vertex presentation. Estimated fetal weight was greater than 10 pounds.,HOSPITAL COURSE: ,On the first hospital day, the patient went to the operating room where repeat low transverse cesarean and tubal ligation were performed under spinal anesthesia with delivery of a viable female infant weighing 7 pounds 10 ounces and Apgars of 9 and 9. There was normal placenta, normal pelvic anatomy. There was 600 cc estimated blood loss. Patient recovered uneventfully from her anesthesia and surgery. She was able to ambulate and void. She tolerated regular diet. She passed flatus. She was breast-feeding. Postoperative hematocrit was 31. On the second postoperative day, the patient was discharged home in satisfactory condition.,DISCHARGE MEDICATIONS: , Motrin and Percocet for pain. Paxil for postpartum depression. She was instructed to do no lifting, straining, or driving, to put nothing in the vagina and to see me in two weeks or with signs of severe pain, heavy bleeding, fever, or other problems. | Obstetrics / Gynecology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSES:,1. Ventilator-dependent respiratory failure.,2. Laryngeal edema.,POSTOPERATIVE DIAGNOSES:,1. Ventilator-dependent respiratory failure.,2. Laryngeal edema.,PROCEDURE PERFORMED: , Tracheostomy change. A #6 Shiley with proximal extension was changed to a #6 Shiley with proximal extension.,INDICATIONS: , The patient is a 60-year-old Caucasian female who presented to ABCD General Hospital with exacerbation of COPD and CHF. The patient had subsequently been taken to the operating room by Department of Otolaryngology and a direct laryngoscope was performed. The patient was noted at that time to have transglottic edema. Biopsies were taken. At the time of surgery, it was decided that the patient required a tracheostomy for maintenance of continued ventilation and airway protection. The patient is currently postop day #6 and appears to be unable to be weaned from ventilator at this time and may require prolonged ventricular support. A decision was made to perform tracheostomy change.,DESCRIPTION OF PROCEDURE: , The patient was seen in the Intensive Care Unit. The patient was placed in a supine position. The neck was then extended. The sutures that were previously in place in the #6 Shiley with proximal extension were removed. The patient was preoxygenated to 100%. After several minutes, the patient was noted to have a pulse oximetry of 100%. The IV tubing that was supporting the patient's trache was then cut. The tracheostomy tube was then suctioned.,The inner cannula was then removed from the tracheostomy and a nasogastric tube was placed down the lumen of the tracheostomy tube as a guidewire. The tracheostomy tube was then removed over the nasogastric tube and the operative field was suctioned. With the guidewire in place and with adequate visualization, a new #6 Shiley with proximal extension was then passed over the nasogastric tube guidewire and carefully inserted into the trachea. The guidewire was then removed and the inner cannula was then placed into the tracheostomy. The patient was then reconnected to the ventilator and was noted to have normal tidal volumes. The patient had a tidal volume of 500 and was returning 500 cc to 510 cc. The patient continued to saturate well with saturations 99%. The patient appeared comfortable and her vital signs were stable. A soft trache collar was then connected to the trachesotomy. A drain sponge was then inserted underneath the new trache site. The patient was observed for several minutes and was found to be in no distress and continued to maintain adequate saturations and continued to return normal tidal volumes.,COMPLICATIONS: , None.,DISPOSITION: , The patient tolerated the procedure well. 0.25% acetic acid soaks were ordered to the drain sponge every shift. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSES:,1. Status post multiple trauma/motor vehicle accident.,2. Acute respiratory failure.,3. Acute respiratory distress/ventilator asynchrony.,4. Hypoxemia.,5. Complete atelectasis of left lung.,POSTOPERATIVE DIAGNOSES:,1. Status post multiple trauma/motor vehicle accident.,2. Acute respiratory failure.,3. Acute respiratory distress/ventilator asynchrony.,4. Hypoxemia.,5. Complete atelectasis of left lung.,6. Clots partially obstructing the endotracheal tube and completely obstructing the entire left main stem and entire left bronchial system.,PROCEDURE PERFORMED: ,Emergent fiberoptic plus bronchoscopy with lavage.,LOCATION OF PROCEDURE: ,ICU. Room #164.,ANESTHESIA/SEDATION:, Propofol drip, Brevital 75 mg, morphine 5 mg, and Versed 8 mg.,HISTORY,: The patient is a 44-year-old male who was admitted to ABCD Hospital on 09/04/03 status post MVA with multiple trauma and subsequently diagnosed with multiple spine fractures as well as bilateral pulmonary contusions, requiring ventilatory assistance. The patient was noted with acute respiratory distress on ventilator support with both ventilator asynchrony and progressive desaturation. Chest x-ray as noted above revealed complete atelectasis of the left lung. The patient was subsequently sedated and received one dose of paralytic as noted above followed by emergent fiberoptic flexible bronchoscopy.,PROCEDURE DETAIL,: A bronchoscope was inserted through the oroendotracheal tube, which was partially obstructed with blood clots. These were lavaged with several aliquots of normal saline until cleared. The bronchoscope required removal because the tissue/clots were obstructing the bronchoscope. The bronchoscope was reinserted on several occasions until cleared and advanced to the main carina. The endotracheal tube was noted to be in good position. The bronchoscope was advanced through the distal trachea. There was a white tissue completely obstructing the left main stem at the carina. The bronchoscope was advanced to this region and several aliquots of normal saline lavage were instilled and suctioned. Again this partially obstructed the bronchoscope requiring several times removing the bronchoscope to clear the lumen. The bronchoscope subsequently was advanced into the left mainstem and subsequently left upper and lower lobes. There was diffuse mucus impactions/tissue as well as intermittent clots. There was no evidence of any active bleeding noted. Bronchoscope was adjusted and the left lung lavaged until no evidence of any endobronchial obstruction is noted. Bronchoscope was then withdrawn to the main carina and advanced into the right bronchial system. There is no plugging or obstruction of the right bronchial system. The bronchoscope was then withdrawn to the main carina and slowly withdrawn as the position of endotracheal tube was verified, approximately 4 cm above the main carina. The bronchoscope was then completely withdrawn as the patient was maintained on ventilator support during and postprocedure. Throughout the procedure, pulse oximetry was greater than 95% throughout. There is no hemodynamic instability or variability noted during the procedure. Postprocedure chest x-ray is pending at this time. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHIEF COMPLAINT: , Right shoulder pain.,HISTORY: , The patient is a pleasant, 31-year-old, right-handed, white female who injured her shoulder while transferring a patient back on 01/01/02. She formerly worked for Veteran's Home as a CNA. She has had a long drawn out course of treatment for this shoulder. She tried physical therapy without benefit and ultimately came to a subacromion decompression in November 2002. She had ongoing pain and was evaluated by Dr. X who felt that she had a possible brachial plexopathy. He also felt she had a right superficial radial neuritis and blocked this with resolution of her symptoms. He then referred her to ABCD who did EMG testing, demonstrating a right suprascapular neuropathy although a C5 radiculopathy could not be ruled out. MRI testing on the cervical spine was then done which was negative for disk herniation and she underwent suprascapular nerve decompression of the scapular notch on 12/18/03. She finally went to an anterior axillary nerve block because of ongoing pain in the anterior shoulder again by Dr. X. She comes to me for impairment rating. She has no chronic health problems otherwise, fevers, chills, or general malaise. She is not working. She is right-hand dominant. She denies any prior history of injury to her shoulder.,PAST MEDICAL HISTORY:, Negative aside from above.,FAMILY HISTORY: , Noncontributory.,SOCIAL HISTORY: ,Please see above.,REVIEW OF SYSTEMS:, Negative aside from above.,PHYSICAL EXAMINATION: ,A pleasant, age appropriate woman, moderately overweight, in no apparent distress. Normal gait and station, normal posture, normal strength, tone, sensation and deep tendon reflexes with the exception of 4+/5 strength in the supraspinatus musculature on the right. She has decreased motion in the right shoulder as follows. She has 160 degrees of flexion, 155 degrees of abduction, 35 degrees of extension, 25 degrees of adduction, 45 degrees of internal rotation and 90 degrees of external rotation. She has a positive impingement sign on the right.,ASSESSMENT:, Right shoulder impingement syndrome, right suprascapular neuropathy.,DISCUSSION: , With a reasonable degree of medical certainty, she is at maximum medical improvement and she does have an impairment based on AMA Guide to the Evaluation of Permanent Impairment, Fifth Edition. The reason for this impairment is the incident of 01/01/02. For her suprascapular neuropathy, she is rated as a grade IV motor deficit which I rate as a 13% motor deficit. This is multiplied by a maximum upper extremity impairment for involvement of the suprascapular nerve of 16% which produces a 2% impairment of the upper extremity when the two values are multiplied together, 2% impairment of the upper extremity. For her lack of motion in the shoulder she also has additional impairment on the right. She has a 1% impairment of the upper extremity due to lack of shoulder flexion. She has a 1% impairment of the upper extremity due to lack of shoulder abduction. She has a 1% impairment of the upper extremity due to lack of shoulder adduction. She has a 1% impairment of the upper extremity due to lack of shoulder extension. There is no impairment for findings in shoulder external rotation. She has a 3% impairment of the upper extremity due to lack of shoulder internal rotation. Thus the impairment due to lack of motion in her shoulder is a 6% impairment of the upper extremity. This combines with the 2% impairment of the upper extremity due to weakness in the suprascapular nerve root distribution to produce an 8% impairment of the upper extremity which in turn is a 5% impairment of the whole person based on the AMA Guide to the Evaluation of Permanent Impairment, Fifth Edition, stated with a reasonable degree of medical certainty. | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSES:,1. Right shoulder rotator cuff tear.,2. Glenohumeral rotator cuff arthroscopy.,3. Degenerative joint disease.,POSTOPERATIVE DIAGNOSES:,1. Right shoulder rotator cuff tear.,2. Glenohumeral rotator cuff arthroscopy.,3. Degenerative joint disease.,PROCEDURE PERFORMED: ,Right shoulder hemiarthroplasty.,ANESTHESIA: , General.,ESTIMATED BLOOD LOSS: , Approximately 125 cc.,COMPLICATIONS:, None.,COMPONENTS: , A DePuy 10 mm global shoulder system stem was used cemented and a DePuy 44 x 21 mm articulating head was used.,BRIEF HISTORY: ,The patient is an 82-year-old right-hand dominant female who presents for shoulder pain for many years now and affecting her daily living and function and pain is becoming unbearable failing conservative treatment.,PROCEDURE: , The patient was taken to the operative suite, placed on the operative field. Department of Anesthesia administered general anesthetic. Once adequately sedated, the patient was placed in the beach chair position. Care was ensured that she was well positioned, adequately secured and padded. At this point, the right upper extremity was then prepped and draped in the usual sterile fashion. A deltopectoral approach was used and taken down to the skin with a #15 blade scalpel.,At this point, blunt dissection with Mayo scissors was used to come to the overlying subscapular tendon and bursal tissue. Any perforating bleeders were cauterized with Bovie to obtain hemostasis. Once the bursa was seen, it was removed with a Rongeur and subscapular tendon could be easily visualized. At this point, the rotator cuff in the subacromial region was evaluated. There was noted to be a large rotator cuff, which was irreparable. There was eburnated bone on the greater tuberosity noted. The articular surface could be visualized. The biceps tendon was intact. There was noted to be diffuse discolored synovium around this as well as some fraying of the tendon in the intraarticular surface. The under surface of the acromion, it was felt there was mild ware on this as well. At this point, the subscapular tendon was then taken off using Bovie cautery and Metzenbaum scissors that was tied with Metzenbaum suture. It was separated from the capsule to have a two layered repair at closure. The capsule was also reflected posterior. At this point, the glenoid surface could be easily visualized. It was evaluated and had good cartilage contact and appeared to be intact. The humeral head was evaluated. There was noted to be ware of the cartilage and eburnated bone particularly in the central portion of the humeral head. At this point, decision was made to proceed with the arthroplasty, since the rotator cuff tear was irreparable and there was significant ware of the humoral head. The arm was adequately positioned. An oscillating saw was used to make the head articular cut. This was done at the margin of the articular surface with the anatomic neck. This was taken down to appropriate level until this articular surface was adequately removed. At this point, the intramedullary canal and cancellous bone could be easily visualized. The opening hand reamers were then used and this was advanced to a size #10. Under direct visualization, this was performed easily. At this point, the 10 x 10 proximal flange cutter was then inserted and impacted into place to cut grooves for the fins. This was then removed. A trial component was then impacted into place, which did fit well and trial heads were then sampled and it was felt that a size 44 x 21 mm head gave us the best fit and appeared adequately secured. It did not appear overstuffed with evidence of excellent range of motion and no impingement. At this point, the trial component was removed. Wound was copiously irrigated and suctioned dry. Cement was then placed with a cement gun into the canal and taken up to the level of the cut. The prosthesis was then inserted into place and held under direct visualization. All excess cement was removed and care was ensured that no cement was left in the posterior aspect of the joint itself. This _______ cement was adequately hard at this point. The final component of the head was impacted into place, secured on the Morris taper and checked, and this was reduced.,The final component was then taken through range of motion and found to have excellent stability and was satisfied with its position. The wound was again copiously irrigated and suctioned dry. At this point, the capsule was then reattached to its insertion site in the anterior portion. Once adequately sutured with #1-Vicryl, attention was directed to the subscapular. The subscapular was advanced superiorly and anchored not only to the biceps tendon region, but also to the top anterior portion of the greater tuberosity. This was opened to allow some type of coverage points of the massive rotator cuff tear. This was secured to the tissue and interosseous sutures with size #2 fiber wire. After this was adequately secured, the wound was again copiously irrigated and suctioned dry. The deltoid fascial split was then repaired using interrupted #2-0 Vicryl, subcutaneous tissue was then approximated using interrupted #24-0 Vicryl, skin was approximated using a running #4-0 Vicryl. Steri-Strips and Adaptic, 4 x 4s, and ABDs were then applied. The patient was then placed in a sling and transferred back to the gurney, reversed by Department of Anesthesia.,DISPOSITION: , The patient tolerated well and transferred to Postanesthesia Care Unit in satisfactory condition. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHIEF COMPLAINT: , Increased work of breathing.,HISTORY OF PRESENT ILLNESS: , The patient is a 2-month-old female with a 9-day history of illness. Per mom's report, the illness started 9 days ago with a dry cough. The patient was eating normal up until approximately three days ago. Mom was using a vaporizer at night, which she feels to have helped. The patient's cough gradually worsened and three days ago, the patient had a significant increasing cough. At that time, the patient also had significant increasing congestion. Two days ago the patient was taken to the primary care physician's office and the patient was given Xopenex 2 puffs every 4 to 6 hours for home regimen, but this per mom's report, did not help the patient's symptoms. On Wednesday evening, the patient's congestion and work of breathing increased and the patient was gagging after feedings. The patient was brought to Children's Hospital Emergency Room at which time the patient was evaluated. A chest x-ray was obtained and was noted to be normal. The patient's saturations were noted to be normal and the patient was discharged home. Last night, the patient was having multiple episodes of emesis after feedings with coughing and today was noted to have decreasing activity. The patient had a 101 temperature on Wednesday evening, but has had no true fevers. The patient has had a mild decrease in urine output today and secondary to the persistent increased work of breathing, coughing, and posttussive emesis, the patient was brought to Children's Hospital for reevaluation.,REVIEW OF SYSTEMS: , The remainder of the review of system is otherwise negative, all systems being reviewed, outside of pertinent positives as stated above.,ALLERGIES:, NO KNOWN DRUG ALLERGIES.,MEDICATIONS: ,As above.,IMMUNIZATIONS:, None.,PAST MEDICAL HISTORY: ,No hospitalizations. No surgeries.,BIRTH HISTORY: , The patient was born to a G8, P2, A6 mom via normal spontaneous vaginal delivery. Birth weight 6 pounds 12 ounces. Mom stated she had a uterine infection during her pregnancy and at the time of delivery, but the patient was only in the hospital for 24 hours with mom after delivery. The patient was full term and mom was noted to have gestational diabetes controlled with diet during her pregnancy.,FAMILY HISTORY: , Brother, mother, and father all have asthma. Mom was noted to have gestational diabetes.,SOCIAL HISTORY: , The patient lives with mother, father, and a brother. There is one bird. There are smokers in the household. There are sick contacts.,PHYSICAL EXAMINATION:,VITAL SIGNS: Temperature is 97.7 and pulse is 181, but the patient is fussy. Respiratory rate ranged between 36 and 44. The patient is saturating 100% on one-half liter and 89% on room air.,GENERAL APPEARANCE: Nontoxic child, but with increased work of breathing. No respiratory distress.,HEENT: Head is normocephalic and atraumatic. Anterior fontanelle flat. Pupils are equal, round, and reactive to light bilaterally. Tympanic membranes are clear bilaterally. Nares are congested. Mucous membranes are moist without erythema.,NECK: Supple. No lymphadenopathy.,CHEST: Exhibits symmetric expansion and retractions.,LUNGS: The patient has diffuse crackles bilaterally, but no wheezes, rales, or rhonchi.,CARDIOVASCULAR: Heart has a 2/6 vibratory systolic ejection murmur, best heard over the left sternal boarder.,ABDOMEN: Soft, nondistended, and nondistended. Good bowel sounds noted in all 4 quadrants.,GU: Normal female. No discharge or erythema.,BACK: Normal with a normal curvature.,EXTREMITIES: A 2+ pulses in the bilateral upper lower extremities. No evidence of clubbing, cyanosis, or edema. Capillary refill less than 3 seconds.,LABORATORY DATA: , Labs in the emergency room include a CBC, which showed a white blood cell count of 20.8 with a hemoglobin of 10.7, hematocrit of 31.3 with platelet count of 715,000 with 40% neutrophils, 2 bands, and 70% monocytes. A urinalysis obtained in the emergency room was noted to be negative. CRP was noted to be 2.0. The chest x-ray, reviewed by myself in the emergency room, showed no significant change from previous x-ray, but the patient does has some bronchial wall thickening.,ASSESSMENT AND PLAN: , This is a 2-month-old female who presents to Children's Hospital with examination consistent with bronchiolitis. At this time, the patient will be placed on the bronchiolitis pathway providing this patient with aggressive suctioning and supplemental oxygen as needed. Currently, at this time, I feel no respiratory treatments are indicated in this patient. I hear no evidence of wheezing or reactive airway disease. We will continue to monitor and reassess this patient closely for this as there is a strong family history of reactive airway disease; however, at this time, the patient will be monitored without any medications and the remainder of the clinical course will be determined by her presentation during the course of this illness. | Cardiovascular / Pulmonary |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | INDICATIONS FOR PROCEDURE:, Persistent cough productive of sputum requiring repeated courses of oral antibiotics over the last six weeks in a patient who is a recipient of a bone marrow transplant with end-stage chemotherapy and radiation-induced pulmonary fibrosis.,PREMEDICATION:,1. Demerol 50 mg.,2. Phenergan 25 mg.,3. Atropine 0.6 mg IM.,4. Nebulized 4% lidocaine followed by nasal insufflation of lidocaine through the right naris and topical 4% lidocaine gel through the right naris, 4 mg of Versed was given at the start of the procedure and another 1 mg shortly after traversing the cords.,PROCEDURE DETAILS:, With the patient breathing oxygen by nasal cannula, being monitored by noninvasive blood pressure cuff and continuous pulse oximetry, the Olympus bronchoscope was introduced through the right naris to the level of the cords. The cords move normally with phonation and ventilation. Two times 2 mL of 1% lidocaine were instilled on the cords and the cords were traversed. Further 2 mL of 1% lidocaine was instilled in the trachea just distal to the cords, at mid trachea above the carina, and on the right, and on the left mainstem bronchus. Scope was then introduced on to the left where immediately some hyperemia of the mucosa was noted. Upper lobe and lingula were unremarkable. There appeared to be some narrowing or tenting of the left lower lobe bronchus such that after inspection of the superior segment, one almost had to pop the bronchoscope around to go down the left mainstem. This had been a change from the prior bronchoscopy of unclear significance. Distal to this, there was no hyperemia or inspissated mucus or mucoid secretions or signs of infection. The scope was wedged in the left lower lobe posterior basal segment and a BAL was done with good returns, which were faintly hemorrhagic. The scope was then removed, re-introduced up to the right upper lobe, middle lobe, superior segment, right lower, anterior lateral, and posterior basal subsegments were all evaluated and unremarkable. The scope was withdrawn. The patient's saturation remained 93%-95% throughout the procedure. Blood pressure was 103/62. Heart rate at the end of the procedure was about 100. The patient tolerated the procedure well. Samples were sent as follows. Washings for AFB, Gram-stain Nocardia, Aspergillus, and routine culture. Lavage for AFB, Gram-stain Nocardia, Aspergillus, cell count with differential, cytology, viral mycoplasma, and Chlamydia culture, GMS staining, RSV by antigen, and Legionella and Chlamydia culture. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | REASON FOR CONSULTATION: , Possible free air under the diaphragm.,HISTORY OF PRESENT ILLNESS: , The patient is a 77-year-old female who is unable to give any information. She has been sedated with Ativan and came into the emergency room obtunded and unable to give any history. On a chest x-ray for what appeared to be shortness of breath she was found to have what was thought to be free air under the right diaphragm.,PAST MEDICAL HISTORY: , Significant for alcohol abuse. Unable to really gather any other information because she is so obtunded.,PAST SURGICAL HISTORY: ,Looking at the medical chart, she had an appendectomy, right hip fracture from a fall in 2005, and TAH/BSO.,MEDICATIONS:, Unable to evaluate.,ALLERGIES: , UNABLE TO EVALUATE.,SOCIAL HISTORY: ,Significant history of alcohol abuse, according to the emergency room physician, who sees her on a regular basis.,REVIEW OF SYSTEMS: , Unable to obtain.,PHYSICAL EXAM,VITAL SIGNS: Temp 98.3, heart rate 82, respiratory rate 24, and blood pressure 141/70.,GENERAL: She is a very obtunded female who upon arousal is not able to provide any information of any use.,HEENT: Atraumatic.,NECK: Soft and supple.,LUNGS: Bilaterally diminished.,HEART: Regular.,ABDOMEN: Soft, and with deep palpation I am unable to arouse the patient, unable to elicit any tenderness.,LABORATORY STUDIES: , Show a normal white blood cell count with no shift. Elevated AST at 138, with a normal ALT at 38. Alkaline phosphatase of 96, bilirubin 0.8. Sodium is 107, with 68 chloride and potassium of 2.8.,X-ray of the chest shows the possibility of free air; therefore, a CT scan was obtained because of the patient's physical examination, which shows no evidence of intra-abdominal pathology. The etiology of the air under the diaphragm is actually a colonic air that is anterior superior to the dome of the diaphragm, near the dome of the liver.,ASSESSMENT: , No intra-abdominal pathology.,PLAN:, Have her admitted to the medical service for treatment of her hyponatremia. | Gastroenterology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: , Left adrenal mass, 5.5 cm.,POSTOPERATIVE DIAGNOSES:,1. Left adrenal mass, 5.5 cm.,2. Intraabdominal adhesions.,PROCEDURE PERFORMED:,1. Laparoscopic lysis of adhesions.,2. Laparoscopic left adrenalectomy.,ANESTHESIA: , General.,ESTIMATED BLOOD LOSS:, Less than 100 cc.,FLUIDS: , 3500 cc crystalloids.,DRAINS:, None.,DISPOSITION:, The patient was taken to recovery room in stable condition. Sponge, needle, and instrument counts were correct per OR staff.,HISTORY:, This is a 57-year-old female who was found to have a large left adrenal mass, approximately 5.5 cm in size. She had undergone workup previously with my associate, Dr. X as well as by Endocrinology, and showed this to be a nonfunctioning mass. Due to the size, the patient was advised to undergo an adrenalectomy and she chose the laparoscopic approach due to her multiple pulmonary comorbidities.,INTRAOPERATIVE FINDINGS: , Showed multiple intraabdominal adhesions in the anterior abdominal wall. The spleen and liver were unremarkable. The gallbladder was surgically absent.,There was large amount of omentum and bowel in the pelvis, therefore the gynecological organs were not visualized. There was no evidence of peritoneal studding or masses. The stomach was well decompressed as well as the bladder.,PROCEDURE DETAILS: , After informed consent was obtained from the patient, she was taken to the operating room and given general anesthesia. She was placed on a bean bag and secured to the table. The table was rotated to the right to allow gravity to aid in our retraction of the bowel.,Prep was performed. Sterile drapes were applied. Using the Hassan technique, we placed a primary laparoscopy port approximately 3 cm lateral to the umbilicus on the left. Laparoscopy was performed with ___________. At this point, we had a second trocar, which was 10 mm to 11 mm port. Using the non-cutting trocar in the anterior axillary line and using Harmonic scalpel, we did massive lysis of adhesions from the anterior abdominal wall from the length of the prior abdominal incision, the entire length of the abdominal incision from the xiphoid process to the umbilicus. The adhesions were taken down off the entire anterior abdominal wall.,At this point, secondary and tertiary ports were placed. We had one near the midline in the subcostal region and to the left midline and one at the midclavicular line, which were also 10 and 11 ports using a non-cutting blade.,At this point, using the Harmonic scalpel, we opened the white line of Toldt on the left and reflected the colon medially, off the anterior aspect of the Gerota's fascia. Blunt and sharp dissection was used to isolate the upper pole of the kidney, taking down some adhesions from the spleen. The colon was further mobilized medially again using gravity to aid in our retraction. After isolating the upper pole of the kidney using blunt and sharp dissection as well as the Harmonic scalpel, we were able to dissect the plane between the upper pole of the kidney and lower aspect of the adrenal gland. We were able to isolate the adrenal vein, dumping into the renal vein, this was doubly clipped and transected. There was also noted to be vascular structure of the upper pole, which was also doubly clipped and transected. Using the Harmonic scalpel, we were able to continue free the remainder of the adrenal glands from its attachments medially, posteriorly, cephalad, and laterally.,At this point, using the EndoCatch bag, we removed the adrenal gland through the primary port in the periumbilical region and sent the flap for analysis. Repeat laparoscopy showed no additional findings. The bowel was unremarkable, no evidence of bowel injury, no evidence of any bleeding from the operative site.,The operative site was irrigated copiously with saline and reinspected and again there was no evidence of bleeding. The abdominal cavity was desufflated and was reinspected. There was no evidence of bleeding.,At this point, the camera was switched to one of the subcostal ports and the primary port in the periumbilical region was closed under direct vision using #0 Vicryl suture. At this point, each of the other ports were removed and then with palpation of each of these ports, this indicated that the non-cutting ports did close and there was no evidence of fascial defects.,At this point, the procedure was terminated. The abdominal cavity was desufflated as stated. The patient was sent to Recovery in stable condition. Postoperative orders were written. The procedure was discussed with the patient's family at length. | Cardiovascular / Pulmonary |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: , Persistent pneumonia, right upper lobe of the lung, possible mass.,POSTOPERATIVE DIAGNOSIS: , Persistent pneumonia, right upper lobe of the lung, possible mass.,PROCEDURE:, Bronchoscopy with brush biopsies.,DESCRIPTION OF PROCEDURE: , After obtaining an informed consent, the patient was taken to the operating room where he underwent a general endotracheal anesthesia. A time-out process had been followed and then the flexible bronchoscope was inserted through the endotracheal tube after 2 cc of 4% lidocaine had been infused into the endotracheal tube. First the trachea and the carina had normal appearance. The scope was passed into the left side and the bronchial system was found to be normal. There were scars and mucoid secretions. Then the scope was passed into the right side where brown secretions were obtained and collected in a trap to be sent for culture and sensitivity of aerobic and anaerobic fungi and TB. First, the basal lobes were explored and found to be normal. Then, the right upper lobe was selectively cannulated and no abnormalities were found except some secretions were aspirated. Then, the bronchi going to the three segments were visualized and no abnormalities or mass were found. Brush biopsy was obtained from one of the segments and sent to Pathology.,The procedure had to be interrupted several times because of the patient's desaturation, but after a few minutes of Ambu bagging, he recovered satisfactorily.,At the end, the patient tolerated the procedure well and was sent to the recovery room in satisfactory condition., | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHIEF COMPLAINT: ,This 18 year old male presents today with shoulder pain right. Location: He indicates the problem location is the right shoulder diffusely. Quality: Quality of the pain is described by the patient as aching, throbbing and tolerable. Patient relates pain on a scale from 0 to 10 as 5/10. Severity: The severity has worsened over the past 3 months. Timing (onset/frequency): Onset was gradual and after pitching a baseball game. Modifying Factors: Patient's condition is aggravated by throwing. He participates with difficulty in basketball. Past conservative treatments include NSAID and muscle relaxant medications.,ALLERGIES: , No known medical allergies.,MEDICATION HISTORY:, None.,PAST MEDICAL HISTORY: ,Childhood Illnesses: (+) strep throat (+) mumps (+) chickenpox,PAST SURGICAL HISTORY:, No previous surgeries.,FAMILY HISTORY:, Patient admits a family history of arthritis associated with mother.,SOCIAL HISTORY: , Patient denies smoking, alcohol abuse, illicit drug use and STDs.,REVIEW OF SYSTEMS:,Musculoskeletal: (+) joint or musculoskeletal symptoms (+) stiffness in AM.,Psychiatric: (-) psychiatric or emotional difficulties.,Eyes: (-) visual disturbance or change.,Neurological: (-) neurological symptoms or problems Endocrine: (-) endocrine-related symptoms.,Allergic / Immunologic: (-) allergic or immunologic symptoms.,Ears, Nose, Mouth, Throat: (-) symptoms involving ear, nose, mouth, or throat.,Gastrointestinal: (-) GI symptoms.,Genitourinary: (-) GU symptoms.,Constitutional Symptoms: (-) constitutional symptoms such as fever, headache, nausea, dizziness.,Cardiovascular: (-) cardiovascular problems or chest symptoms.,Respiratory: (-)breathing difficulties, respiratory symptoms.,Physical Exam: BP Standing: 116/68 Resp: 16 HR: 68 Temp: 98.1 Height: 5 ft. 11 in. Weight: 165 lbs. Patient is a 18 year old male who appears pleasant, in no apparent distress, his given age, well developed, well nourished and with good attention to hygiene and body habitus. Oriented to person, place and time. Right shoulder shows evidence of swelling and tenderness. Radial pulses are 2 /4, bilateral. Brachial pulses are 2 /4, bilateral.,Appearance: Normal.,Tenderness: Anterior - moderate, Biceps - none, Posterior - moderate and Subacromial - moderate right.,Range of Motion: Right shoulder ROM shows decreased flexion, decreased extension, decreased adduction, decreased abduction, decreased internal rotation, decreased external rotation. L shoulder normal.,Strength: External rotation - fair. Internal rotation - poor right.,AC Joint: Pain with ABD and cross-chest - mild right.,Rotator Cuff: Impingement - moderate. Painful arc - moderate right.,Instability: None.,TEST & X-RAY RESULTS:, X-rays of the shoulder were performed. X-ray of right shoulder reveals cuff arthropathy present.,IMPRESSION: , Rotator cuff syndrome, right.,PLAN: , Diagnosis of a rotator cuff tendinitis and shoulder impingement were discussed. I noted that this is a very common condition resulting in significant difficulties with use of the arm. Several treatment options and their potential benefits were described. Nonsteroidal anti-inflammatories can be helpful but typically are slow acting. Cortisone shots can be very effective and are quite safe. Often more than one injection may be required. Physical therapy can also be helpful, particularly if there is any loss of shoulder mobility or strength. If these treatments fail to resolve symptoms, an MRI or shoulder arthrogram may be required to rule out a rotator cuff tear. Injected shoulder joint and with Celestone Soluspan 1.0 cc . Ordered x-rays of shoulder right.,PRESCRIPTIONS:, Vioxx Dosage: 25 mg tablet Sig: TID Dispense: 60 Refills: 0 Allow Generic: Yes,PATIENT INSTRUCTIONS:, Patient was instructed to restrict activity. Patient was given instructions on RICE therapy. | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHIEF COMPLAINT:, Worker’s compensation injury.,HISTORY OF PRESENT ILLNESS:, The patient is a 21-year-old Hispanic female. She comes in today with her boyfriend. The patient speaks English fairly well, but her primary language is Spanish. Her boyfriend does help to make sure that she understands what we are talking about. The patient seems to understand our conversation fairly well. She works at Norcraft and injured her right thumb on 09/10/2004 at 12:15 a.m. She was pushing a cart and mashed her thumb between the cart and the wall. This was at the finishing room in Norcraft. She went ahead and went to work yesterday, which was the 14th, but was not able to work on the 13th. She has swelling in her thumb. It hurt only if it is pushed on. It was the distal end of her thumb that was mashed. She has not noticed any numbness or tingling or weakness. She has not sought any treatment for this, is not taking any pain medications. She did try soaking it in warm salt water and did not notice any improvement.,MEDICATIONS: , None.,ALLERGIES: , None.,PAST MEDICAL HISTORY:, Possible history of chicken pox, otherwise no other medical illnesses. She has never had any surgery.,FAMILY HISTORY: , Parents and two siblings are healthy. She has had no children.,SOCIAL HISTORY:, The patient is single. She lives with her boyfriend and his father. She works at Norcraft. She wears seatbelt 30% of the time. I encouraged her to use them all of the time. She is a nonsmoker, nondrinker.,VACCINATIONS: , She thinks she got a tetanus vaccine in childhood, but does not know for sure. She does not think she has had a tetanus booster recently.,REVIEW OF SYSTEMS:,Constitutional: No fevers, chills, or sweats.,Neurologic: She has had no numbness, tingling, or weakness.,Musculoskeletal: As above in HPI. No other difficulties.,PHYSICAL EXAMINATION:,General: This is a well-developed, well-nourished, very pleasant Hispanic female, in no acute distress.,Vital Signs: Weight: 121.4. Blood pressure: 106/78. Pulse: 64. Respirations: 20. Temperature: 96.,Extremities: Examination of the right hand reveals the distal end of the thumb to be swollen especially just proximal to the nail bed. The nail bed is pushed up. I can see hematoma below the nail bed, although it does appear to be intact. She has some blue fingernail polish on her nail also, but that is starting to come off. She is able to bend her thumb normally at the DIP joint. She has no discomfort doing that. Sensation is intact over the entire thumb. She has normal capillary refill. There is some erythema and swelling noted especially over the posterior thumb just proximal to the nail bed. I am not feeling any fluctuance. I do not think it is a collection of pus. There is no drainage. She does have some small fissures in the skin where I think she did injure it with this smashing injury, but no deep lacerations at all. It looks like there may be some mild cellulitis at the site of her injury.,LABORATORY:, X-ray of the thumb was obtained and I do not see any sign of fracture or foreign body.,ASSESSMENT:, Blunt trauma to the distal right thumb without fracture. I think there is some mild cellulitis developing there.,PLAN:,1. We will give a tetanus diphtheria booster.,2. We will start Keflex 500 mg one p.o. q.i.d. x 7 days. I would recommend that she can return to work, but she is not to do any work that requires the use of her right thumb. I would like to see her back on Monday, the 20th in the morning and we can see how her thumb is doing at that time. If she is noticing any difficulties with increased redness, increased warmth, increased pain, pus-like drainage, or any other difficulties, she is to go ahead and give us a call. Otherwise I will be seeing her back on Monday. | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | REASON FOR ADMISSION:, Penile injury and continuous bleeding from a penile laceration.,HISTORY OF PRESENT ILLNESS:, The patient is an 18-year-old detainee who was brought by police officers because of a penile injury and bleeding. He is otherwise healthy. He tried to insert a marble in his penis four days ago. He told me that he grabbed the skin on the top of the penis and moved it away from the penis shaft and then using a toothbrush that he made in to a knife object he pierced the skin through from both sides and then kept moving the toothbrush to dilate and make a way for the marble. Then he inserted a heart-shaped marble in one of the puncture wounds and inserted it under the skin and kept it there. He was not significantly bleeding and essentially the bleeding stopped from both puncture wounds that he has. Then today four days after that procedure, he was taking a bath today and he thinks because of the weight he felt a gush in his pants and he looked and he saw the bleeding come out. He was bleeding so much that he started dripping to the sides of his legs. So, he was brought to the hospital. Actually after being seen by two nurses at the facility where he was at the detention center where he was at and they actually did the dressing twice and it was twice soaked with blood. He came here and was continuously bleeding from that area that we had to change the dressing twice and he is actually still bleeding especially from one of the laceration, the one on the right side of the penis. The marble also still can be felt underneath the skin. There is no urethral bleeding. He did urinate today without difficulty, without hematuria or dysuria. There is pain in the lacerations. No erythema in the skin or swelling in the penis and no other injuries. He did this procedure for sexual pleasure as he said.,PAST MEDICAL HISTORY: , Unremarkable.,PAST SURGICAL HISTORY: ,Tonsillectomy.,MEDICATION: , He took only ibuprofen. No regular medication.,ALLERGIES: , None.,SOCIAL HISTORY: ,He has been in detention for two months for immigration problems. No drugs. No alcohol. No smoking. He used to work in fast food chain.,FAMILY HISTORY: , Noncontributory to this illness.,REVIEW OF SYSTEMS: , Aside from the pain in the penis and continuous bleeding, he is basically asymptomatic and review of systems is unremarkable.,PHYSICAL EXAMINATION:,GENERAL: The patient is a young Hispanic male, lying in bed, appear comfortable in no apparent distress.,VITAL SIGNS: Temperature 97.8, heart rate 99, respiratory rate 20, blood pressure 142/100, and saturation is 98% on room air.,ENT: Sclerae nonicteric. Pupils reactive to light. Nostrils are normal. Oral cavity is clear.,NECK: Supple. Trachea midline. No JVD.,LUNGS: Clear to auscultation bilaterally.,HEART: Normal S1 and S2. No murmurs or gallops.,ABDOMEN: Soft, nontender, and nondistended. Positive bowel sounds.,EXTREMITIES: Pulses strong bilaterally. No edema.,GENITAL: Testicles appear normal. The penis shaft has two lacerations on both sides, one of them is bleeding. They measure about 5 to 6 mm on the right side, about 3 or 4 mm on the left side. The one on the right side is bleeding much more than the other one. There is a marble that can be felt and it is freely mobile underneath the skin of the dorsum of the penis. There is no bleeding from the meatus or discharge and no other injuries were seen by inspection.,LABORATORY DATA:, White count 11.1, hemoglobin 14.5, hematocrit 43.5, and platelets 303,000. Coags unremarkable. Glucose 106, creatinine 0.8, sodium 141, potassium 4, and calcium 9.7. Urinalysis unremarkable.,IMPRESSION: , The patient with a penile laceration that is continuously bleeding from inserting a marble four days ago, which is still underneath the skin of the shaft of the penis. No other injuries that can be seen and no other evidence of secondary bacterial infection at this time. The patient is currently refusing removal of the marble and insisting on just repairing the laceration and he is having discussion with Dr. X.,PLAN:,1. The patient will be admitted to the hospital and will follow Dr. X's recommendation.,2. The patient was offered a repair of those lacerations, to stop the bleeding as well as the removal of the marble and he is currently considering that and discussing that with Dr. X.,3. Prophylactic antibiotics to prevent infection.,4. He has mild hypertension, which is likely due to stress and pain and also the leukocytosis probably can be explained by that. This will be monitored.,5. Monitor H&H to determine if he needs any transfusion at this time. He does not need that.,6. IV fluid for hydration and volume resuscitation at this time.,7. Pain management.,8. Topical care for the wound VAC after repair.,Time spent in evaluation and management of this patient including discussions about this procedure and the harm that can happen if he chooses to keep the penis including permanent damage and infection to the penis was 65 minutes.,I had clearly explained to the patient in detail about the possibility of permanent penile damage that could affect erection and future sexual functioning as well as significant infection if a foreign object was retained in the penis under the skin and he verbalized understanding of this. | Urology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHIEF REASON FOR CONSULTATION:, Evaluate exercise-induced chest pain, palpitations, dizzy spells, shortness of breath, and abnormal EKG.,HISTORY OF PRESENT ILLNESS:, This 72-year-old female had a spell of palpitations that lasted for about five to ten minutes. During this time, patient felt extremely short of breath and dizzy. Palpitations lasted for about five to ten minutes without any recurrence. Patient also gives history of having tightness in the chest after she walks briskly up to a block. Chest tightness starts in the retrosternal area with radiation across the chest. Chest tightness does not radiate to the root of the neck or to the shoulder, lasts anywhere from five to ten minutes, and is relieved with rest. Patient gives history of having hypertension for the last two months. Patient denies having diabetes mellitus, history suggestive of previous myocardial infarction, or cerebrovascular accident.,MEDICATIONS: , ,1. Astelin nasal spray.,2. Evista 60 mg daily.,3. Lopressor 25 mg daily.,4. Patient was given a sample of Diovan 80 mg daily for the control of hypertension from my office.,PAST HISTORY:, The patient underwent right foot surgery and C-section.,FAMILY HISTORY:, The patient is married, has six children who are doing fine. Father died of a stroke many years ago. Mother had arthritis.,SOCIAL HISTORY:, The patient does not smoke or take any drinks. ,ALLERGIES:, THE PATIENT IS NOT ALLERGIC TO ANY MEDICATIONS.,REVIEW OF SYSTEMS:, Otherwise negative. ,PHYSICAL EXAMINATION: , ,GENERAL: Well-built, well-nourished white female in no acute distress. ,VITAL SIGNS: Blood pressure is 160/80. Respirations 18 per minute. Heart rate 70 beats per minute. Patient weighs 133 pounds, height 64 inches. BMI is 22.,HEENT: Head normocephalic. Eyes, no evidence of anemia or jaundice. Oral hygiene is good.,NECK: Supple. No cervical lymphadenopathy. Carotid upstroke is good. No bruit heard over the carotid or subclavian arteries. Trachea in midline. Thyroid not enlarged. JVP flat at 45°.,CHEST: Chest is symmetrical on both sides, moves well with respirations. Vesicular breath sounds heard over the lung fields. No wheezing, crepitation, or pleural friction rub heard. ,CARDIOVASCULAR SYSTEM: PMI felt in fifth left intercostal space within midclavicular line. First and second heart sounds are normal in character. There is a II/VI systolic murmur best heard at the apex. There is no diastolic murmur or gallop heard.,ABDOMEN: Soft. There is no hepatosplenomegaly or ascites. No bruit heard over the aorta or renal vessels.,EXTREMITIES: No pedal edema. Femoral arterial pulsations are 3+, popliteal 2+. Dorsalis pedis and posterior tibialis are 1+ on both sides.,NEURO: Normal.,EKG from Dr. Xyz's office shows normal sinus rhythm, ST and T wave changes. Lipid profile, random blood sugar, BUN, creatinine, CBC, and LFTs are normal.,IMPRESSION:, | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: , Recurrent degenerative spondylolisthesis and stenosis at L4-5 and L5-S1 with L3 compression fracture adjacent to an instrumented fusion from T11 through L2 with hardware malfunction distal at the L2 end of the hardware fixation.,POSTOPERATIVE DIAGNOSIS: , Recurrent degenerative spondylolisthesis and stenosis at L4-5 and L5-S1 with L3 compression fracture adjacent to an instrumented fusion from T11 through L2 with hardware malfunction distal at the L2 end of the hardware fixation.,PROCEDURE: , Lumbar re-exploration for removal of fractured internal fixation plate from T11 through L2 followed by a repositioning of the L2 pedicle screws and evaluation of the fusion from T11 through L2 followed by a bilateral hemilaminectomy and diskectomy for decompression at L4-5 and L5-S1 with posterior lumbar interbody fusion using morselized autograft bone and the synthetic spacers from the Capstone system at L4-5 and L5-S1 followed by placement of the pedicle screw fixation devices at L3, L4, L5, and S1 and insertion of a 20 cm fixation plate that range from the T11 through S1 levels and then subsequent onlay fusion using morselized autograft bone and bone morphogenetic soaked sponge at L1-2 and then at L3-L4, L4-L5, and L5-S1 bilaterally.,DESCRIPTION OF PROCEDURE: ,This is a 68-year-old lady who presents with a history of osteomyelitis associated with the percutaneous vertebroplasty that was actually treated several months ago with removal of the infected vertebral augmentation and placement of a posterior pedicle screw plate fixation device from T11 through L2. She subsequently actually done reasonably well until about a month ago when she developed progressive severe intractable pain. Imaging study showed that the distal hardware at the plate itself had fractured consistent with incomplete fusion across her osteomyelitis area. There was no evidence of infection on the imaging or with her laboratory studies. In addition, she developed a pretty profound stenosis at L4-L5 and L5-S1 that appeared to be recurrent as well. She now presents for revision of her hardware, extension of fusion, and decompression.,The patient was brought to the operating room, placed under satisfactory general endotracheal anesthesia. She was placed on the operative table in the prone position. Back was prepared with Betadine, iodine, and alcohol. We elliptically excised her old incision and extended this caudally so that we had access from the existing hardware fixation all the way down to her sacrum. The locking nuts were removed from the screw post and both plates refractured or significantly weakened and had a crease in it. After these were removed, it was obvious that the bottom screws were somewhat loosened in the pedicle zone so we actually tightened one up and that fit good snugly into the nail when we redirected so that it actually reamed up into the upper aspect of the vertebral body in much more secure purchase. We then dressed the L4-L5 and L5-S1 levels which were profoundly stenotic. This was a combination of scar and overgrown bone. She had previously undergone bilateral hemilaminectomies at L4-5 so we removed scar bone and actually cleaned and significantly decompressed the dura at both of these levels. After completing this, we inserted the Capstone interbody spacer filled with morselized autograft bone and some BMP sponge into the disk space at both levels. We used 10 x 32 mm spacers at both L4-L5 and L5-S1. This corrected the deformity and helped to preserve the correction of the stenosis and then after we cannulated the pedicles of L4, L5 and S1 tightened the pedicle screws in L3. This allowed us to actually seat a 20 cm plate contoured to the lumbar lordosis onto the pedicle screws all the way from S1 up to the T11 level. Once we placed the plate onto the screws and locked them in position, we then packed the remaining BMP sponge and morselized autograft bone through the plate around the incomplete fracture healing at the L1 level and then dorsolaterally at L4-L5 and L5-S1 and L3-L4, again the goal being to create a dorsal fusion and enhance the interbody fusion as well. The wound was then irrigated copiously with bacitracin solution and then we closed in layers using #1 Vicryl in muscle and fascia, 3-0 in subcutaneous tissue and approximated staples in the skin. Prior to closing the skin, we confirmed correct sponge and needle count. We placed a drain in the extrafascial space and then confirmed that there were no other foreign bodies. The Cell Saver blood was recycled and she was given two units of packed red blood cells as well. I was present for and performed the entire procedure myself or supervised. | Neurosurgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PROCEDURE: , Radiofrequency thermocoagulation of bilateral lumbar sympathetic chain.,ANESTHESIA: , Local sedation.,VITAL SIGNS: , See nurse's notes.,COMPLICATIONS: , None.,DETAILS OF PROCEDURE: ,INT was placed. The patient was in the operating room in the prone position with the back prepped and draped in a sterile fashion. The patient was given sedation and monitored. Lidocaine 1.5% for skin wheal was made 10 cm from the midline to the bilateral L2 distal vertebral body. A 20-gauge, 15 cm SMK needle was then directed using AP and fluoroscopic guidance so that the tip of the needle was noted to be along the distal one-third and anterior border on the lateral view and on the AP view the tip of the needle was inside the lateral third of the border of the vertebral body. At this time a negative motor stimulation was obtained. Injection of 10 cc of 0.5% Marcaine plus 10 mg of Depo-Medrol was performed. Coagulation was then carried out for 90oC for 90 seconds. At the conclusion of this, the needle under fluoroscopic guidance was withdrawn approximately 5 mm where again a negative motor stimulation was obtained and the sequence of injection and coagulation was repeated. This was repeated one more time with a 5 mm withdrawal and coagulation.,At that time, attention was directed to the L3 body where the needle was placed to the upper one-third/distal two-thirds junction and the sequence of injection, coagulation, and negative motor stimulation with needle withdrawal one time of a 5 mm distance was repeated. There were no compilations from this. The patient was discharged to operating room recovery in stable condition. | Surgery |
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