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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' | HISTORY: ,The patient is a 5-1/2-year-old with Down syndrome, complex heart disease consisting of atrioventricular septal defect and tetralogy of Fallot with pulmonary atresia, discontinuous pulmonary arteries and bilateral superior vena cava with a left cava draining to the coronary sinus and a right aortic arch. As an infant, he was initially palliated with the right and modified Blalock-Taussig shunt in October of 2002 and underwent atrioventricular septal defect and repair of pulmonary artery unifocalization and homograft placement between the right ventricle and unifocalized pulmonary arteries. He developed a significant branch of pulmonary artery stenosis for which on 07/20/2004, he underwent a bilateral balloon pulmonary arterioplasty and stent implantation at the San Diego at Children's Hospital. This was followed on 09/13/2007 with replacement of pulmonary valve utilizing a 16-mm Contegra valve. A recent echocardiogram demonstrated a significant branch of pulmonary artery stenosis with the predicted gradient of 41 to 55 mmHg and a well-functioning Contegra valve. The lung perfusion scan from 11/14/2007 demonstrated 47% flow to the left lung and 53% flow to the right lung. The patient underwent a repeat catheterization in consideration for further balloon angioplasty of the branch pulmonary arteries.,PROCEDURE: , After sedation, the patient was placed under general endotracheal anesthesia breathing 50% oxygen throughout the case. The patient was prepped and draped. 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, 6-French wedge catheter was inserted into the right femoral vein and advanced through the right heart structures out to the branch pulmonary arteries. This catheter was exchanged over wire. A 5-French marker pigtail catheter was directed into the main pulmonary artery. A second site of venous access was achieved in and the left femoral vein with the placement of 5-French sheath.,Using a 4-French sheath, a 4-French pigtail catheter was inserted in the right femoral artery and advanced retrograde to the descending aorta, ascending aorta and left ventricle. Angiogram with injection in the main pulmonary artery demonstrated stable stent configuration of the proximal branch pulmonary arteries with intimal ingrowth in the region of the proximal stents. The distal right pulmonary measured approximately 10 mm in diameter with a mid stent section measuring 9.4 mm and the proximal stent near the origin of the right pulmonary artery of 5.80 mm. The distal left pulmonary measured approximately 10 mm in diameter with a mid stent measuring 10.3 mm and the proximal stent near the origin of the left pulmonary artery is 6.8 mm diameter. The left femoral venous sheath was exchanged over wire for a 7-French sheath. Guidewires were then advanced through the respective venous sheath into the branch pulmonary arteries and simultaneous balloon pulmonary arterioplasty was performed using the two Z-Med 12 x 4 cm balloon catheter was advanced into the branch of pulmonary arteries and inflated maximally to 9 hemispheres of pressure on 5 occasions near complete disappearance of proximal waist. The balloon catheter was then exchanged for a 5-French Mistique catheter for pressure pull-back and measurement in the angiogram. The catheter's wires were then removed and final hemodynamic assessment was made with the wedge catheter.,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 angiograph injection in the main pulmonary 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 in normal. Mixed venous saturation that was not normal with no evidence of intracardiac shunt. Left side of the heart was mildly desaturated following a part to parenchymal lung disease with the partial pressure of oxygen of only 82 mmHg. Aphasic right atrial pressures were normal with an A-wave similar to the normal right ventricular end-diastolic pressure. Left ventricular systolic pressure was moderately elevated at 70% of systemic level and there was no obstruction into the proximal main pulmonary artery. There was a 20 mmHg of peak systolic gradient across the branch pulmonary artery stents to the distal artery. Right and left pulmonary artery capillary wedge pressures were normal with an A-wave similar to the mildly elevated left ventricular end-diastolic pressure of 13 mmHg. Left ventricular systolic pressure was systemic. No outflow constriction 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 injection in the main pulmonary artery showed catheter induced pulmonary insufficiency, well functioning Contegra valve with no appreciable calcification. The proximal narrowing of the distal main pulmonary artery was appreciated. Neointimal ingrowth within the proximal stents were appreciated. There is good distal growth of the pulmonary arteries. Arborization appeared normal. Levophase contrast returned to the heart appeared normal with a well-functioning left ventricle and the right aortic arch. Following the branch pulmonary artery angioplasty that was increased in the mixed venous saturation, as well as an increase in the systemic arterial saturation. Right ventricular systolic pressure felt slightly to 40 mmHg with an increase in systemic arterial pressure with a systolic pressure ratio of 54%. The main pulmonary pressures remained similar. There was 10 mmHg systolic gradient into the branch of pulmonary arteries. There is an increase in distal branch of pulmonary arteries with the mean pressure increased from 16 mmHg to 21 mmHg. Final angiogram with injection in the main pulmonary artery showed a competent Contegra valve. A brisk flow through the proximal branch stents with the improved caliber of the branch pulmonary artery lumens. There was no evidence of intimal disruption.,DIAGNOSES: ,1. Atrioventricular septal defect.,2. Tetralogy of Fallot with the pulmonary atresia.,3. Bilateral superior vena cava. The left cava draining to the coronary sinus.,4. The right aortic arch.,5. Discontinuous pulmonary arteries.,6. Down syndrome.,PRIOR SURGERIES AND INTERVENTIONS: ,1. Right modified Blalock-Taussig shunt.,2. Repair of tetralogy of Fallot with external conduit.,3. The atrioventricular septal defect repair.,4. Unifocalization of branch pulmonary arteries.,5. Bilateral balloon pulmonary angioplasty and stent implantation.,6. Pulmonary valve replacement with 16-mm Contegra valve.,CURRENT DIAGNOSES: ,1. Mild-to-moderate proximal branch pulmonary stenosis.,2. Well-functioning Contegra valve and current intervention. A balloon dilation of the right pulmonary artery.,3. Balloon dilation of left pulmonary artery.,MANAGEMENT: , The case will be discussed at Combined Cardiology and Cardiothoracic Surgery Case Conference and conservative outpatient management will be pursued. Further cardiologic care be directed by 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' | REASON FOR REFERRAL: ,The patient was referred to me by Dr. X of Children's Hospital after he was hospitalized for what eventually was diagnosed as a conversion disorder. I had met the patient and his mother in the hospital and had begun getting information regarding his symptoms and background at that time. After his discharge, the patient was scheduled to see me for followup services. This was a 90-minute intake that was completed on 10/10/2007 with the patient's mother. I reviewed with her the treatment consent form as well as the boundaries of confidentiality, and she stated that she understood these concepts.,PRESENTING PROBLEMS:, Please see the inpatient hospital progress note contained in his chart for additional background information. The patient's mother reported that he continues with his conversion episodes. She noted that they are occurring approximately 6 times a day. They consist primarily of tremors, arching his back, and, by her report, doing some gang signs during the episode. She reported that the conversion reactions had decreased after his hospitalization, and he had none for 3 days, but then, they began picking up again. From information gathered from mother, it would suggest that she frequently does "status checks," where she asks him how he is doing, and that after she began checking on him more that he began having more conversion reactions. In terms of what she does when he has a conversion reaction, she reported that primarily that she tries to keep him safe. She puts a sheath under him because the carpeting is dirty. She removes any furniture, she wraps his legs together so they do not knock together, she sits with him and she gives him attention and says "calm down, breathe" and after it is over, she continues to tell him to be calm and to breathe. She denied that she gives them any more attention. I strongly encouraged her to stop doing status checks, as this likely is reinforcing the behavior. I also noted that while he certainly needs to be kept safe, that she does not want to give a lot of attention to this behavior, and that over time we will teach him ways of coping with this independently. In regards to his mood, she reported that his mood is quite good. She denied any sadness or irritability. She denied anhedonia. She reports that he is a little bit hard to get up in the morning. He is going to bed at about 11, getting up at 8 or 9. No changes in weight or eating were noted. No changes in concentration, suicidal ideation, and any suicidal history was denied. She denied symptoms of anxiety, although she did note that she thought he worried a little about going to school and some financial stress. Other symptoms of psychopathology were denied.,DEVELOPMENTAL HISTORY: , The patient was reportedly a 7 pounds 12 ounces product of an unplanned and uncomplicated pregnancy and planned cesarean delivery. Mother reported that she did receive prenatal care. The use of alcohol, drugs, or tobacco during the pregnancy were denied. She denied that he had any feeding or sleeping problems in the perinatal period. She described him as a fussy and active baby, but he was described as a cuddly baby. She noted that the pediatricians never expressed any concerns regarding his developmental milestones. SHE REPORTED THAT HE IS ALLERGIC TO PENICILLIN. Serious injures or toileting problems were denied as were a history of seizures.,FAMILY BACKGROUND: , The patient currently lives with his mother who is age 57 and with her partner who is age 40. They have been together since 1994, and he is the only father figure that the patient has even known. The father was previously in a relationship that resulted in an 11-year-old daughter who visits the patient's home every other weekend. The patient's father's whereabouts are unknown. There is no information on his family. Mother stated that he discontinued his involvement in her life when she was about 3 months pregnant with the patient, and the patient has never met him. As noted, there is no information on the paternal side of the family. In terms of the mother's side of family, the maternal grandfather died in his 60s due to what mother described as "hardening of the arteries," and the maternal grandmother died in 2003 due to stroke. There were 4 maternal aunts, one of them died at age 9 months from pneumonia, one of them died at 19 years old from what was described as a brain tumor, and there are 3 maternal uncles. In terms of family relationships, it was reported that overall the patient tends to get along fairly well with his parents, who reported that the patient and her partner tend to compete for mother's attention, and she noted this is difficult at times. She reported that the patient and her partner do not really do anything together. Mother reported that there is no domestic violence in the home, but there is some marital conflict, and this is may be difficult for The patient, as it is carried on in Spanish, and he does not speak Spanish. There also is some stress in the home due to the stepdaughter, as there are some concerns that her mother may be involved in drugs. The mother reported that she attended high school, did not attend any college. She denied learning problems. She denied psychological problems or any drug/alcohol history. In terms of the biological father, she reported he did not graduate from high school. She did not know of learning problems, psychological problems. She denied that he had a drug/alcohol history. There is a family history of alcoholism in one of the maternal uncles as well as in the maternal grandfather. It should be noted that the patient and his family live in a small 4-bedroom apartment, where privacy is very difficult.,SOCIAL BACKGROUND:, She reported that the patient is able to make and keep friends, but he enjoys lifting weights, skateboarding, and that he recently had an opportunity to do rock climbing, he really enjoyed that. I encouraged her to have him involved in physical activity, as this is good for discharge the stress, to encourage the weightlifting, as well as the skateboarding. Mother is going to check further information regarding the rock climbing that the patient had been involved in, which was at it sounds like by her description as some sort of boys' and girls' type of club. Abuse of drugs or alcohol were denied. The patient was not described as being sexually active.,ACADEMIC BACKGROUND: , The patient is currently in the 10th grade. At present, he is on independent studies, which began after his hospitalization. The mother reported that the teacher, who had come to school saw one of his episodes, and stated that, they would not want him to be attending school. I spoke with her very clearly and directly regarding the fact that it was probably not best for the patient to be on independent studies, that he needed to be returned to his normal school environment. He has never had an episode at school, and he needs to be back with his peers, back in a regular environment, where he is under normal expectations. I spoke with her regarding my concerns, regarding the fact that he is unsupervised during the day, and we do not want this turning into one big long vacation, where he is not getting his work done, and he gets himself in trouble. Normally, he would be attending at High School. The mother stated that she would contact them as well as check into possibly a 504-Plan. She reported that he really does not to go back to High School. He says, the "kids are bad;" however, she denied that he has any history of fighting. She noted that he is stressed by the school, there have been some peer problems, possibly some bullying. I noted these need to be addressed with the school, as she had not done so. She stated that she would speak with a counselor. She noted, however, that he has a history of not liking school and avoiding going to school. She noted that he is somewhat behind in his work due to the hospitalization. His grades traditionally are C's. She denied any Special Education Services.,PREVIOUS COUNSELING: , Denied.,DIAGNOSTIC SUMMARY AND IMPRESSION: , Similar to my impression at the hospital, it would appear that the patient clearly qualifies for a diagnosis of conversion disorder. It appears that there are multiple stressors in the family, and that the mother is reinforcing his conversion reaction. I am also very concerned regarding the fact that he is not attending school and want him back in the normal school environment as quickly as possible. My plan is to meet the patient at the next session to update the information regarding his functioning and to begin to teach him skills for reducing his stress and relaxing.,DSM-IV DIAGNOSES: ,AXIS I: Conversion disorder (300.11).,AXIS II: No diagnosis (V71.09).,AXIS III: No diagnosis.,AXIS IV: Problems with primary support group, educational problems, and peer problems.,AXIS V: Global Assessment of Functioning equals 60. | Psychiatry / Psychology |
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 states that she feels better. She is on IV amiodarone, the dosage pattern is appropriate for ventricular tachycardia. Researching the available records, I find only an EMS verbal statement that tachycardia of wide complex was seen. There is no strip for me to review all available EKG tracings show a narrow complex atrial fibrillation pattern that is now converted to sinus rhythm.,The patient states that for a week, she has been home postoperative from aortic valve replacement on 12/01/08 at ABC Medical Center. The aortic stenosis was secondary to a congenital bicuspid valve, by her description. She states that her shortness of breath with exertion has been stable, but has yet to improve from its preoperative condition. She has not had any decline in her postoperative period of her tolerance to exertion.,The patient had noted intermittent bursts of fast heart rate at home that had been increasing over the last several days. Last night, she had a prolonged episode for which she contacted EMS. Her medications at home had been uninterrupted and without change from those listed, being Toprol-XL 100 mg q.a.m., Dyazide 25/37.5 mg, Nexium 40 mg, all taken once a day. She has been maintaining her Crestor and Zetia at 20 and 10 mg respectively. She states that she has been taking her aspirin at 325 mg q.a.m. She remains on Zyrtec 10 mg q.a.m. Her only allergy is listed to latex.,OBJECTIVE:,VITAL SIGNS: Temperature 36.1, heart rate 60, respirations 14, room air saturation 98%, and blood pressure 108/60. The patient shows a normal sinus rhythm on the telemetry monitor with an occasional PAC.,GENERAL: She is alert and in no apparent distress.,HEENT: Eyes: EOMI. PERRLA. Sclerae nonicteric. No lesions of lids, lashes, brows, or conjunctivae noted. Funduscopic examination unremarkable. Ears: Normal set, shape, TMs, canals and hearing. Nose and Sinuses: Negative. Mouth, Tongue, Teeth, and Throat: Negative except for dental work.,NECK: Supple and pain free without bruit, JVD, adenopathy or thyroid abnormality.,CHEST: Lungs are clear bilaterally to auscultation. The incision is well healed and without evidence of significant cellulitis.,HEART: Shows a regular rate and rhythm without murmur, gallop, heave, click, thrill or rub. There is an occasional extra beat noted, which corresponds to a premature atrial contraction on the monitor.,ABDOMEN: Soft and benign without hepatosplenomegaly, rebound, rigidity or guarding.,EXTREMITIES: Show no evidence of DVT, acute arthritis, cellulitis or pedal edema.,NEUROLOGIC: Nonfocal without lateralizing findings for cranial or peripheral nervous systems, strength, sensation, and cerebellar function. Gait and station were not tested.,MENTAL STATUS: Shows the patient to be alert, coherent with full capacity for decision making.,BACK: Negative to inspection or percussion.,LABORATORY DATA: , Shows from 12/15/08 2100, hemoglobin 11.6, white count 12.9, and platelets 126,000. INR 1.0. Electrolytes are normal with exception potassium 3.3. GFR is decreased at 50 with creatinine of 1.1. Glucose was 119. Magnesium was 2.3. Phosphorus 3.8. Calcium was slightly low at 7.8. The patient has had ionized calcium checked at Munson that was normal at 4.5 prior to her discharge. Troponin is negative x2 from 2100 and repeat at 07:32. This morning, her BNP was 163 at admission. Her admission chest x-ray was unremarkable and did not show evidence of cardiomegaly to suggest pericardial effusion. Her current EKG tracing from 05:42 shows a sinus bradycardia with Wolff-Parkinson White Pattern, a rate of 58 beats per minute, and a corrected QT interval of 557 milliseconds. Her PR interval was 0.12.,We received a call from Munson Medical Center that a bed had been arranged for the patient. I contacted Dr. Varner and we reviewed the patient's managed to this point. All combined impression is that the patient was likely to not have had actual ventricular tachycardia. This is based on her EP study from October showing her to be non-inducible. In addition, she had a cardiac catheterization that showed no evidence of coronary artery disease. What is most likely that the patient has postoperative atrial fibrillation. Her WPW may have degenerated into a ventricular tachycardia, but this is unlikely. At this point, we will convert the patient from IV amiodarone to oral amiodarone and obtain an echocardiogram to verify that she does not have evidence of pericardial effusion in the postoperative period. I will recheck her potassium, magnesium, calcium, and phosphorus at this point and make adjustments if indicated. Dr. Varner will be making arrangements for an outpatient Holter monitor and further followup post-discharge.,IMPRESSION:,1. Atrial fibrillation with rapid ventricular response.,2. Wolff-Parkinson White Syndrome.,3. Recent aortic valve replacement with bioprosthetic Medtronic valve.,4. Hyperlipidemia. | 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: , Syncopal episodes with injury. See electrophysiology consultation.,POSTOPERATIVE DIAGNOSES:,1. Normal electrophysiologic studies.,2. No inducible arrhythmia.,3. Procainamide infusion negative for Brugada syndrome.,PROCEDURES:,1. Comprehensive electrophysiology studies with attempted arrhythmia induction.,2. IV Procainamide infusion for Brugada syndrome.,DESCRIPTION OF PROCEDURE:, The patient gave informed consent for comprehensive electrophysiologic studies. She received small amounts of intravenous fentanyl and Versed for conscious sedation. Then 1% lidocaine local anesthesia was used. Three catheters were placed via the right femoral vein; 5-French catheters to the right ventricular apex and right atrial appendage; and a 6-French catheter to the His bundle. Later in the procedure, the RV apical catheter was moved to RV outflow tract.,ELECTROPHYSIOLOGICAL FINDINGS:, Conduction intervals in sinus rhythm were normal. Sinus cycle length 768 ms, PA interval 24 ms, AH interval 150 ms, HV interval 46 ms. Sinus node recovery times were also normal at 1114 ms. Corrected sinus node recovery time was normal at 330 ms. One-to-one AV conduction was present to cycle length 480 ms, AH interval 240 ms, HV interval 54 ms. AV nodal effective refractory period was normal, 440 ms at drive cycle length 600 ms. RA-ERP was 250 ms. With ventricular pacing, there was VA disassociation present.,Since there was no evidence for dual AV nodal pathways, and poor retrograde conduction, isoproterenol infusion was not performed to look for SVT.,Programmed ventricular stimulation was performed at both right ventricular apex and right ventricular outflow tracts. Drive cycle length 600, 500, and 400 ms was used with triple extrastimuli down to troubling intervals of 180 ms, or refractoriness. There was no inducible VT. Longest run was 5 beats of polymorphic VT, which is a nonspecific finding. From the apex 400-600 with 2 extrastimuli were delivered, again with no inducible VT.,Procainamide was then infused, 20 mg/kg over 10 minutes. There were no ST segment changes. HV interval after IV Procainamide remained normal at 50 ms.,ASSESSMENT: , Normal electrophysiologic studies. No evidence for sinus node dysfunction or atrioventricular block. No inducible supraventricular tachycardia or ventricular tachycardia, and no evidence for Brugada syndrome.,PLAN: , The patient will follow up with Dr. X. She recently had an ambulatory EEG. I will plan to see her again on a p.r.n. basis should she develop a recurrent syncopal episodes. Reveal event monitor was considered, but not placed since she has only had one single episode. | 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' | SUBJECTIVE:, The patient returns to the Pulmonary Medicine Clinic for followup evaluation of interstitial disease secondary to lupus pneumonitis. She was last seen in the Pulmonary Medicine Clinic in January 2004. Since that time, her respiratory status has been quite good. She has had no major respiratory difficulties; however, starting yesterday she began with increasing back and joint pain and as a result a deep breath has caused some back discomfort. She denies any problems with cough or sputum production. No fevers or chills. Recently, she has had a bit more problems with fatigue. For the most part, she has had no pulmonary limitations to her activity.,CURRENT MEDICATIONS:, Synthroid 0.112 mg daily; Prilosec 20 mg daily; prednisone, she was 2.5 mg daily, but discontinued this on 06/16/2004; Plaquenil 200 mg b.i.d.; Imuran 100 mg daily; Advair one puff b.i.d.; Premarin 0.3 mg daily; Lipitor 10 mg Monday through Friday; Actonel 35 mg weekly; and aspirin 81 mg daily. She is also on calcium, vitamin D, vitamin E, vitamin C and a multivitamin.,ALLERGIES:, Penicillin and also intolerance to shellfish.,REVIEW OF SYSTEMS:, Noncontributory except as outlined above.,EXAMINATION:,General: The patient was in no acute distress.,Vital signs: Blood pressure 122/60, pulse 72 and respiratory rate 16.,HEENT: Nasal mucosa was mild-to-moderately erythematous and edematous. Oropharynx was clear.,Neck: Supple without palpable lymphadenopathy.,Chest: Chest demonstrates decreased breath sounds, but clear.,Cardiovascular: Regular rate and rhythm.,Abdomen: Soft and nontender.,Extremities: Without edema. No skin lesions.,O2 saturation was checked at rest. On room air it was 96% and on ambulation it varied between 94% and 96%. Chest x-ray obtained today showed mild increased interstitial markings consistent with a history of lupus pneumonitis. She has not had the previous chest x-ray with which to compare; however, I did compare the markings was less prominent when compared with previous CT scan.,ASSESSMENT:,1. Lupus with mild pneumonitis.,2. Respiratory status is stable.,3. Increasing back and joint pain, possibly related to patient’s lupus, however, in fact may be related to recent discontinuation of prednisone.,PLAN:, At this time, I have recommended to continue her current medications. We would like to see her back in approximately four to five months, at which time I would like to recheck her pulmonary function test as well as check CAT scan. At that point, it may be reasonable to consider weaning her Imuran if her pulmonary status is stable and the lupus appears to be under control. | 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 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. | 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: , Right hemothorax.,POSTOPERATIVE DIAGNOSIS: , Right hemothorax.,PROCEDURE PERFORMED: , Insertion of a #32 French chest tube on the right hemithorax.,ANESTHESIA: , 1% Lidocaine and sedation.,INDICATIONS FOR PROCEDURE:, This is a 54-year-old female with a newly diagnosed carcinoma of the cervix. The patient is to have an Infuse-A-Port insertion today. Postoperatively from that, she started having a blood tinged pink frothy sputum. Chest x-ray was obtained and showed evidence of a hemothorax on the right hand side, opposite side of the Infuse-A-Port and a wider mediastinum. The decision was made to place a chest tube in the right hemithorax to allow for the patient to be stable for transfer out of the operating room.,DESCRIPTION OF PROCEDURE: , The area was prepped and draped in the sterile fashion. The area was anesthetized with 1% Lidocaine solution. The patient was given sedation. A #10 blade scalpel was used to make an incision approximately 1.5 cm long. Then a curved scissor was used to dissect down to the level of the rib. A blunt peon was then used to again enter into the right hemithorax. Immediately a blood tinged effusion was released. The chest tube was placed and directed in a posterior and superior direction. The chest tube was hooked up to the Pleur-evac device which was ________ tip suction. The chest tube was tied in with a #0 silk suture in a U-stitch fashion. It was sutured in place with sterile dressing and silk tape. The patient tolerated this procedure well. We will obtain a chest x-ray in postop to ensure proper placement and continue to follow the patient very closely. | 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:, Neck pain, thoracalgia, low back pain, bilateral lower extremity pain.,HISTORY OF PRESENT ILLNESS:, Ms. XYZ is a fairly healthy 69-year-old Richman, Roseburg resident who carries a history of chronic migraine, osteoarthritis, hypothyroidism, hyperlipidemia, and mitral valve prolapse. She has previously been under the care of Dr. Ninan Matthew in the 1990s and takes Maxalt on a weekly basis and nadolol, omeprazole and amitriptyline for treatment of her migraines, which occur about once a week. She is under the care of Dr. Bonaparte for hyperlipidemia and hypothyroidism. She has a long history of back and neck pain with multiple injuries in the 1960s, 1970s, 1980s and 1990s. In 2000, she developed "sciatica" mostly in her right lower extremity.,She is seen today with no outside imaging, except with MRI of her cervical spine and lumbar spine dated February of 2004. Her cervical MRI reveals an 8 mm central spinal canal at C6-7, multilevel foraminal stenosis, though her report is not complete as we do not have all the pages. Her lumbar MRI reveals lumbar spinal stenosis at L4-5 with multilevel facet arthropathy and spondylitic changes.,The patient has essentially three major pain complaints.,Her first pain complaint is one of a long history of axial neck pain without particular radicular symptoms. She complains of popping, clicking, grinding and occasional stiffness in her neck, as well as occasional periscapular pain and upper trapezius myofascial pain and spasms with occasional cervicalgic headaches. She has been told by Dr. Megahed in the past that she is not considered a surgical candidate. She has done physical therapy twice as recently as three years ago for treatment of her symptoms. She complains of occasional pain and stiffness in both hands, but no particular numbness or tingling.,Her next painful complaint is one of midthoracic pain and thoracalgia features with some right-sided rib pain in a non-dermatomal distribution. Her rib pain was not preceded by any type of vesicular rash and is reproducible, though is not made worse with coughing. There is no associated shortness of breath. She denies inciting trauma and also complains of pain along the costochondral and sternochondral junctions anteriorly. She denies associated positive or negative sensory findings, chest pain or palpitations, dyspnea, hemoptysis, cough, or sputum production. Her weight has been stable without any type of constitutional symptoms.,Her next painful complaint is one of axial low back pain with early morning pain and stiffness, which improves somewhat later in the day. She complains of occasional subjective weakness to the right lower extremity. Her pain is worse with sitting, standing and is essentially worse in the supine position. Five years ago, she developed symptoms radiating in an L5-S1 distribution and within the last couple of years, began to develop numbness in the same distribution. She has noted some subjective atrophy as well of the right calf. She denies associated bowel or bladder dysfunction, saddle area hypoesthesia, or falls. She has treated her back symptoms with physical therapy as well.,She is intolerant to any type of antiinflammatory medications as well and has a number of allergies to multiple medications. She participates in home physical therapy, stretching, hand weights, and stationary bicycling on a daily basis. Her pain is described as constant, shooting, aching and sharp in nature and is rated as a 4-5/10 for her average and current levels of pain, 6/10 for her worst pain, and 3/10 for her least pain. Exacerbating factors include recumbency, walking, sleeping, pushing, pulling, bending, stooping, and carrying. Alleviating factors including sitting, applying heat and ice.,PAST MEDICAL HISTORY:, As per above and includes hyperlipidemia, hypothyroidism, history of migraines, acid reflux symptoms, mitral valve prolapse for which she takes antibiotic prophylaxis.,PAST SURGICAL HISTORY:, Cholecystectomy, eye surgery, D&C.,MEDICATIONS:, Vytorin, Synthroid, Maxalt, nadolol, omeprazole, amitriptyline and 81 mg aspirin.,ALLERGIES:, Multiple. All over-the-counter medications. Toradol, Robaxin, Midrin, Darvocet, Naprosyn, Benadryl, Soma, and erythromycin.,FAMILY HISTORY:, Family history is remarkable for a remote history of cancer. Family history of heart disease and osteoarthritis.,SOCIAL HISTORY:, The patient is retired. She is married with three grown children. Has a high school level education. Does not smoke, drink, or utilize any illicit substances.,OSWESTRY PAIN INVENTORY:, Significant impact on every aspect of her quality of life. She would like to become more functional.,REVIEW OF SYSTEMS:, A thirteen-point review of systems was surveyed including constitutional, HEENT, cardiac, pulmonary, GI, GU, endocrine, integument, hematological, immunological, neurological, musculoskeletal, psychological and rheumatological. Cardiac, swelling in the extremities, hyperlipidemia, history of palpitation, varicose veins. Pulmonary review of systems negative. GI review of systems is positive for irritable bowel and acid reflux symptoms. Genitourinary, occasional stress urinary incontinence and history of remote hematuria. She is postmenopausal and on hormone replacement. Endocrine is positive for a low libido and thyroid disorder. Integument: Dry skin, itching and occasional rashes. Immunologic is essentially negative. Musculoskeletal: As per HPI. HEENT: Jaw pain, popping, clicking, occasional hoarseness, dysphagia, dry mouth, and prior history of toothache. Neurological: As per history of present illness. Constitutional: As history of present illness.,PHYSICAL EXAMINATION:, Weight 180 pounds, temp 97.6, pulse 56, BP 136/72. The patient walks with a normal gait pattern. There is no antalgia, spasticity, or ataxia. She can alternately leg stand without difficulty, as well as tandem walk, stand on the heels and toes without difficulty. She can flex her lumbar spine and touch the floor with her fingertips. Lumbar extension and ipsilateral bending provoke her axial back pain. There is tenderness over the PSIS on the right and no particular pelvic asymmetry.,Head is normocephalic and atraumatic. Cranial nerves II through XII are grossly intact. Cervical range of motion is slightly limited in extension, but is otherwise intact to flexion and lateral rotation. The neck is supple. The trachea is midline. The thyroid is not particularly enlarged. Lungs are clear to auscultation. Heart has regular rate and rhythm with normal S1, S2. No murmurs, rubs, or gallops. The abdomen is nontender, nondistended, without palpable organomegaly, guarding, rebound, or pulsatile masses. Skin is warm and dry to the touch with no discernible cyanosis, clubbing or edema. I can radial, dorsalis pedis and posterior tibial pulses. The nailbeds on her feet have trophic changes. Brisk capillary refill is evident over both upper extremities.,Musculoskeletal examination reveals medial joint line tenderness of both knees with some varus laxity of the right lower extremity. She has chronic osteoarthritic changes evident over both hands. There is mild restriction of range of motion of the right shoulder, but no active impingement signs.,Inspection of the axial skeleton reveals a cervicothoracic head-forward posture with slight internal rotation of the upper shoulders. Palpation of the axial skeleton reveals mild midline tenderness at the lower lumbar levels one fingerbreadth lateral to the midline. There is no midline spinous process tenderness over the cervicothoracic regions. Palpation of the articular pillars is met with mild provocation of pain. Palpation of the right posterior, posterolateral and lateral borders of the lower ribs is met with mild provocable tenderness. There is also tenderness at the sternochondral and costochondral junctions of the right, as well as the left bilaterally. The xiphoid process is not particularly tender. There is no dermatomal sensory abnormality in the thoracic spine appreciated. Mild facetal features are evident over the sacral spine with extension and lateral bending at the level of the sacral ala.,Neurological examination of the upper and lower extremities reveals 3/5 reflexes of the biceps, triceps, brachioradialis, and patellar bilaterally. I cannot elicit S1 reflexes. There are no long tract signs. Negative Hoffman's, negative Spurling's, no clonus, and negative Babinski. Motor examination of the upper, as well as lower extremities appears to be intact throughout. I may be able to detect a slight hand of atrophy of the right calf muscles, but this is truly unclear and no measurement was made.,SUMMARY OF DIAGNOSTIC IMAGING:, As per above.,IMPRESSION:,1. Osteoarthritis.,2. Cervical spinal stenosis.,3. Lumbar spinal stenosis.,4. Lumbar radiculopathy, mostly likely at the right L5-S1 levels.,5. History of mild spondylolisthesis of the lumbosacral spine at L4-L5 and right sacroiliac joint dysfunction.,6. Chronic pain syndrome with myofascial pain and spasms of the trapezius and greater complexes.,PLAN: ,The natural history and course of the disease was discussed in detail with Mr. XYZ. Greater than 80 minutes were spent facet-to-face at this visit. I have offered to re-image her cervical and lumbar spine and have included a thoracic MR imaging and rib series, as well as cervicolumbar flexion and extension views to evaluate for mobile segment and/or thoracic fractures. I do not suspect any sort of intrathoracic comorbidity such as a neoplasm or mass, though this was discussed. Pending the results of her preliminary studies, this should be ruled out. I will see her in followup in about two weeks with the results of her scans. | 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' | HISTORY OF PRESENT ILLNESS: This is a 91-year-old female who was brought in by family. Apparently, she was complaining that she felt she might have been poisoned at her care facility. The daughter who accompanied the patient states that she does not think anything is actually wrong, but she became extremely agitated and she thinks that is the biggest problem with the patient right now. The patient apparently had a little bit of dry heaves, but no actual vomiting. She had just finished eating dinner. No one else in the facility has been ill.,PAST MEDICAL HISTORY: Remarkable for previous abdominal surgeries. She has a pacemaker. She has a history of recent collarbone fracture.,REVIEW OF SYSTEMS: Very difficult to get from the patient herself. She seems to deny any significant pain or discomfort, but really seems not particularly intent on letting me know what is bothering her. She initially stated that everything was wrong, but could not specify any specific complaints. Denies chest pain, back pain, or abdominal pain. Denies any extremity symptoms or complaints.,SOCIAL HISTORY: The patient is a nonsmoker. She is accompanied here with daughter who brought her over here. They were visiting the patient when this episode occurred.,MEDICATIONS: Please see list.,ALLERGIES: NONE.,PHYSICAL EXAMINATION: VITAL SIGNS: The patient is afebrile, actually has a very normal vital signs including normal pulse oximetry at 99% on room air. GENERAL: The patient is an elderly frail looking little lady lying on the gurney. She is awake, alert, and not really wanted to answer most of the questions I asked her. She does have a tremor with her mouth, which the daughter states has been there for "many years". HEENT: Eye exam is unremarkable. Oral mucosa is still moist and well hydrated. Posterior pharynx is clear. NECK: Supple. LUNGS: Actually clear with good breath sounds. There are no wheezes, no rales, or rhonchi. Good air movement. CARDIAC: Without murmur. ABDOMEN: Soft. I do not elicit any tenderness. There is no abdominal distention. Bowel sounds are present in all quadrants. SKIN: Skin is without rash or petechiae. There is no cyanosis. EXTREMITIES: No evidence of any trauma to the extremities.,EMERGENCY DEPARTMENT COURSE: I had a long discussion with the family and they would like the patient receive something for agitation, so she was given 0.5 mg of Ativan intramuscularly. After about half an hour, I came back to talk to the patient and the family, the patient states that she feels better. Family states she seems more calm. They do not want to pursue any further workup at this time.,IMPRESSION: ACUTE EPISODE OF AGITATION.,PLAN: At this time, I had reviewed the patient's records and it is not particularly enlightening as to what could have triggered off this episode. The patient herself has good vital signs. She does not seem to have any specific acute process going on and seemed to feel comfortable after the Ativan was given, a small quantity was given to the patient. Family and daughter specifically did not want to pursue any workup at this point, which at this point I think is reasonable and we will have her follow up with ABC. She is discharged in stable condition. | 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' | PROCEDURE PERFORMED:, Insertion of a VVIR permanent pacemaker.,COMPLICATIONS:, None.,ESTIMATED BLOOD LOSS: , Minimal.,SITE:, Left subclavian vein access.,INDICATION: , This is an 87-year-old Caucasian female with critical aortic stenosis with an aortic valve area of 0.5 cm square and recurrent congestive heart failure symptoms mostly refractory to tachybrady arrhythmias and therefore, this is indicated so that we can give better control of heart rate and to maintain beta-blocker therapy in the order of treatment. It is overall a Class-II indication for permanent pacemaker insertion.,PROCEDURE:, The risks, benefits, and alternative of the procedure were all discussed with the patient and the patient's family in detail at great length. Overall options and precautions of the pacemaker and indications were all discussed. They agreed to the pacemaker. The consent was signed and placed in the chart. The patient was taken to the Cardiac Catheterization Lab, where she was monitored throughout the whole procedure. The patient was sterilely prepped and draped in the usual manner for permanent pacemaker insertion. Myself and Dr. Wildes spoke for approximately 8 minutes before insertion for the procedure. Using a lidocaine with epinephrine, the area of the left subclavian vein and left pectodeltoid region was anesthetized locally.,IV sedation, increments, and analgesics were given. Using a #18 gauge needle, the left subclavian vein access was cannulated without difficulty. A guidewire was then passed through the Cook needle and the Cook needle was then removed. The wire was secured in place with the hemostat. Using a #10 and #15 scalpel blade, a 5 cm horizontal incision was made in the left pectoral deltoid region where the skin was dissected and blunted down into the pectoris major muscle fascia. The skin was then undermined used to make a pocket for the pacemaker. The guidewire was then tunneled through the pacer pocket. Cordis sheath was then inserted through the guidewire. The guidewire and dilator were removed. ___ cordis sheath was in placed within. This was used for insertion of the ventricular screw and steroid diluted leads where under fluoroscopy. It was placed into the apex. Cordis sheath was then split apart and removed and after the ventricular lead was placed in its appropriate position and good thresholds were obtained, the lead was then sutured in place with #1-0 silk suture to the pectoris major muscle. The lead was then connected on pulse generator. The pocket was then irrigated and cleansed. Pulse generator and the wire was then inserted into the ____ pocket. The skin was then closed with gut suture. The skin was then closed with #4-0 Poly___ sutures using a subcuticular uninterrupted technique. The area was then cleansed and dried. Steri-Strips and pressure dressing was then applied. The patient tolerated the procedure well. there was no complications.,These are the settings on the pacemaker:,IMPLANT DEVICE: , Pulse Generator Model Name: Sigma, model #: 12345, serial #: 123456.,VENTRICLE LEAD:, Model #: 12345, the ventricular lead serial #: 123456.,Ventricle lead was a screw and steroid diluted lead placed into the right ventricle apex.,BRADY PARAMETER SETTINGS ARE AS FOLLOWS:, Amplitude was set at 3.5 volts with a pulse of 0.4, sensitivity of 2.8. The pacing mode was set at VVIR, lower rate of 60 and upper rate of 120.,STIMULATION THRESHOLDS: ,The right ventricular lead and bipolar, threshold voltage is 0.6 volts, 1 milliapms current, 600 Ohms resistance, R-wave sensing 11 millivolts.,The patient tolerated the procedure well. There was no complications. The patient went to recovery in stable condition. Chest x-ray will be ordered. She will be placed on IV antibiotics and continue therapy for congestive heart failure and tachybrady arrhythmia.,Thank you for allowing me to participate in her care. If you have any questions or concerns, please feel free to contact. | 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' | INTERPRETATION:,1. Predominant rhythm is normal sinus rhythm.,2. No supraventricular arrhythmia.,3. Frequent premature ventricular contractions.,4. Trigemini and couplets.,5. No high-grade atrial ventricular block was noted.,6. Diary was not kept.,IMPRESSION:, Frequent premature atrial contractions, couplets, and trigemini., | 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' | IMPRESSION: ,EEG during wakefulness, drowsiness, and sleep with synchronous video monitoring demonstrated no evidence of focal or epileptogenic activity. | Sleep 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:, Well-child check sports physical.,HISTORY OF PRESENT ILLNESS:, This is a 14-1/2-year-old white male known to have asthma and allergic rhinitis. He is here with his mother for a well-child check. Mother states he has been doing well with regard to his asthma and allergies. He is currently on immunotherapy and also takes Advair 500/50 mg, Flonase, Claritin and albuterol inhaler as needed. His last exacerbation was 04/04. He has been very competitive in his sports this spring and summer and has had no issues since that time. He eats well from all food groups. He has very good calcium intake. He will be attending Maize High School in the ninth grade. He has same-sex and opposite-sex friends. He has had a girlfriend in the past. He denies any sexual activity. No use of alcohol, cigarettes or other drugs. His bowel movements are without problems. His immunizations are up to date. His last tetanus booster was in 07/03.,CURRENT MEDICATIONS:, As above.,ALLERGIES: , He has no known medication allergies.,REVIEW OF SYSTEMS:,Constitutional: He has had no fever.,HEENT: No vision problems. No eye redness, itching or drainage. No earache. No sore throat or congestion.,Cardiovascular: No chest pain.,Respiratory: No cough, shortness of breath or wheezing.,GI: No stomachache, vomiting or diarrhea.,GU: No dysuria, urgency or frequency.,Hematological: No excessive bruising or bleeding. He did have a minor concussion in 06/04 while playing baseball.,PHYSICAL EXAMINATION:,General: He is alert and in no distress.,Vital signs: He is afebrile. His weight is at the 75th percentile. His height is about the 80th percentile.,HEENT: Normocephalic. Atraumatic. Pupils are equal, round and reactive to light. TMs are clear bilaterally. Nares patent. Nasal mucosa is mildly edematous and pink. No secretions. Oropharynx is clear.,Neck: Supple.,Lungs: Good air exchange bilaterally.,Heart: Regular. No murmur.,Abdomen: Soft. Positive bowel sounds. No masses. No hepatosplenomegaly.,GU: Male. Testes descended bilaterally. Tanner IV. No hernia appreciated.,Extremities: Symmetrical. Femoral pulses 2+ bilaterally. Full range of motion of all extremities.,Back: No scoliosis.,Neurological: Grossly intact.,Skin: Normal turgor. Minor sunburn on upper back.,Neurological: Grossly intact.,ASSESSMENT:,1. Well child.,2. Asthma with good control.,3. Allergic rhinitis, stable.,PLAN:, Hearing and vision assessment today are both within normal limits. Will check an H&H today. Continue all medications as directed. Prescription written for albuterol inhaler, #2, one for home and one for school to be used for rescue. Anticipatory guidance for age. He is to return to the office in one year or sooner if needed. | 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' | ALLOWED CONDITIONS:, Left knee strain, meniscus tear left knee.,CONTESTED CONDITION:, Osteoarthritis of the left knee.,EMPLOYER:, ABCD.,I examined Xxxxx today September 14, 2007, for the above allowed conditions and also the contested condition of osteoarthritis of his left knee. He is a 57-year-old assembly worker who was injured on June 13, 2007, which according to his FROI was due to "repairing cars, down on knees to work on concrete floors." In addition, he slipped on an air hose on the floor at work on March 7, 2007, re-injuring his left knee. He developed pain and swelling in his left knee. He denies having any difficulties with his left knee prior to the injury of June 13, 2002.,DIAGNOSTIC STUDIES: , August 2, 2002, MRI of the left knee showed low-grade chondromalacia of the left patellofemoral joint space and a posterior horn tear of the medial meniscus, likely degenerative in nature, and also grade II to III chondromalacia of the medial joint space. On June 26, 2007, MRI of his left knee was referred to in the injury management report of June 19, 2007, as showing osteoarthritis of the medial compartment has advanced. He brought with him copies of x-rays taken July 16, 2007, of his left knee, which I reviewed and which showed marked narrowing of the medial compartment of his left knee with spurs on the margins of the joint medially and also spurs on the patella. There was subluxation of the tibia on the femur with standing.,After his injury, he received treatment from Dr. X for patellofemoral syndrome with knee sleeve. He also received treatment from Dr. Y also for left knee sprain and patellar pain. He also did exercise, does use a knee sleeve and Aleve. On December 5, 2002, he underwent arthroscopy of the left knee by Dr. Z who did a partial resection of a torn medial meniscus. He also noticed grade III chondromalacia of the patella as well as the torn medial meniscus. He states that he was asymptomatic until he slipped on an air hose while at work on March 7, 2007, and again developed pain and swelling in his left knee. Standing aggravates his pain. He has had one injection of cortisone by Dr. Z about a month ago, which has helped his pain. He takes one hydrocodone 7.5/750 mg daily.,Examination of his left knee revealed there was bilateral varus deformity, healed arthroscopy incisional scars, there was a 1/2 atrophy of the left calf. There was patellar crepitus with knee motion. There was no motor weakness or reflex changes. He walked without a limp and could stand on his heels and toes equally well. There was no instability of the knee and no effusion. Range of motion was 0 to 120 degrees.,QUESTION: , Xxxxx has recently filed to reactivate this claim. Please give me your opinion as to whether Xxxxx's current clinical presentation is related to the industrial injury stated above.,ANSWER:, Yes. His original MRI of August 2, 2002, did show low-grade chondromalacia of the patellofemoral joint and also grade II to III chondromalacia of the medial joint space, which was the beginning of osteoarthritis. Also, it is well known that torn medial meniscus can result in osteoarthritis of the knee; therefore, the osteoarthritis is related to his original injury of June 13, 2007, specifically to the torn medial meniscus.,QUESTION: ,Do I believe that claim #123 should be reactivated to allow for treatment of the allowed conditions as stated?,ANSWER:, Yes, I believe it should be reactivated to allow treatment of the contested condition of osteoarthritis of his left knee.,QUESTION:, Xxxxx has filed an application for additional allowance of osteoarthritis of the left knee. Based on the current objective findings, mechanism of injury, medical records, and diagnostic studies, does the medical evidence support the existence of the requested condition?,ANSWER: ,Yes. Please see the discussion in the answer to question no one. In addition, x-rays of July 16, 2007, do reveal medial compartment and patellofemoral compartment osteoarthritis of the left knee.,QUESTION: , If you find this condition exists, is it a direct and proximate result of the June 13, 2002, injury?,ANSWER:, Yes. See discussion in answer to question number one.,QUESTION: , Do you find that Xxxxx's injury or disability was caused by the natural deterioration of tissue, an organ or part of body?,ANSWER: ,No. I believe the osteoarthritis was the result of the torn medial meniscus as discussed under question number one.,QUESTION: , In addition, if you find the condition exists, are there non-occupational activities or intervening injuries, which could have contributed to Xxxxx's condition?,ANSWER:, No. He does not give any history of any intervening injuries.,If you opine the requested condition should be additionally recognized, please include the condition as an allowed condition in the discussion of the following questions.,QUESTION:, Based on the objective findings is the request for 10 sessions of physical therapy per C-9 dated July 27, 2007, medically necessary and appropriate for the allowed conditions of the claim of osteoarthritis of left knee?,ANSWER:, Yes., | IME-QME-Work Comp etc. |
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:, A 6-year-old boy who underwent tonsillectomy and adenoidectomy two weeks ago. Also, I cleaned out his maxillary sinuses. Symptoms included loud snoring at night, sinus infections, throat infections, not sleeping well, and fatigue. The surgery went well, and I had planned for him to stay overnight, but Mom reminds me that by about 8 p.m. the night nurse gotten him to take fluids well and we let him go home then that evening. He finished up his Augmentin, by a day or two later he was off the Lortab. Mom has not noticed any unusual voice change. No swallowing difficulty except he does not like the taste of acidic foods such as tomato sauce. He has not had any nasal discharge or ever had any bleeding. He seems to be breathing better.,OBJECTIVE:, Exam looks good. The pharynx is well healed. Tongue mobility is normal. Voice sounds clear. Nasal passages reveal no discharge or crusting.,RECOMMENDATION:, I told Mom it is okay to use some ibuprofen in case his mouth or jaws are still sensitive. He says it seems to hurt if he opens his mouth real wide such as when he brushes his teeth. It is okay to chew gum and it is okay to eat crunchy foods such as potato chips. The pathologist described the expected changes of chronic sinusitis and chronic hypertrophic tonsillitis and adenoiditis, and there were no atypical findings on the laboratories.,I am glad he has healed up well. There are no other restrictions or limitations. I told Mom, I had written to Dr. XYZ to let her know of the findings. The child will continue his regular followup visits with his family doctor, and I told Mom I would be happy to see him anytime if needed. He did very well after surgery and he seems to feel better and breathe a lot better after his throat and sinus procedure. | 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' | DISCHARGE DIAGNOSES:,1. Chest pain. The patient ruled out for myocardial infarction on serial troponins. Result of nuclear stress test is pending.,2. Elevated liver enzymes, etiology uncertain for an outpatient followup.,3. Acid reflux disease.,TEST DONE: , Nuclear stress test, results of which are pending.,HOSPITAL COURSE: , This 32-year-old with family history of premature coronary artery disease came in for evaluation of recurrent chest pain, O2 saturation at 94% with both atypical and typical features of ischemia. The patient ruled out for myocardial infarction with serial troponins. Nuclear stress test has been done, results of which are pending. The patient is stable to be discharged pending the results of nuclear stress test and cardiologist's recommendations. He will follow up with cardiologist, Dr. X, in two weeks and with his primary physician in two to four weeks. Discharge medications will depend on results of nuclear stress test. | 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 DIAGNOSES:,1.Stage IV endometriosis with severe pelvic pain.,2.Status post prior left salpingoophorectomy.,POSTOPERATIVE DIAGNOSES:,1.Stage IV endometriosis with severe pelvic pain.,2.Status post prior left salpingoophorectomy.,3.Severe adhesions.,TYPE OF ANESTHESIA: , General endotracheal tube.,TECHNICAL PROCEDURE: , Total abdominal hysterectomy, right salpingoophorectomy, and extensive adhesiolysis and enterolysis.,INDICATION FOR PROCEDURE: , The patient is a 42-year-old parous female who had a longstanding history of severe endometriosis unresponsive to hormonal medical therapy and pain medication. She had severe dyspareunia and chronic suprapelvic pain. The patient had had a prior left salpingoophorectomy laparoscopically in 2004 for same disease process. Now, she presented with a recurrent right ovarian endometrioma and severe pelvic pain. She desired surgical treatment. She accepted risk of a complete hysterectomy and salpingoophorectomy, risk of injury to underlying organs. The risks, benefits, and alternatives were clearly discussed with the patient as documented in the medical record.,DESCRIPTION OF FINDINGS: , Absent left adnexa. Right ovary about 6 cm with chocolate cyst and severely adherent to the right pelvic side wall, uterus, and colon. Careful dissection to free right ovary and remove it although it is likely that some ovarian tissue remains behind. Ureter visualized and palpated on right and appears normal. Indigo carmine given IV with no leaks intraperitoneally noted. Sigmoid colon dissected free from back of uterus and from cul-de-sac. Bowel free of lacerations or denudation. Upon inspection, right tube with hydrosalpinx, appendix absent. Omental adhesions to ensure abdominal wall was lysed.,TECHNICAL PROCEDURE: , After informed consent was obtained, the patient was taken to the operating room where she underwent smooth induction of general anesthesia. She was placed in a supine position with a transurethral Foley in place and compression stockings in place. The abdomen and vagina were thoroughly prepped and draped in the usual sterile fashion.,A Pfannenstiel skin incision was made with the scalpel and carried down sharply to the underlying layer of fascia and peritoneum. The peritoneum was bluntly entered and the incision extended caudally and cephaladly with good visualization of underlying organs. Next, exploration of the abdominal and pelvic organs revealed the above noted findings. The uterus was enlarged and probably contained adenomyosis. There were dense adhesions, and a large right endometrioma with a chocolate cyst-like material contained within. The sigmoid colon was densely adhered to the cul-de-sac into the posterior aspect of the uterus. A Bookwalter retractor was placed into the incision, and the bowel was packed away with moist laparotomy sponges. Next, a sharp and blunt dissection was used to free the extensive adhesions, and enterolysis was performed with very careful attention not to injure or denude the bowel. Next, the left round ligament and cornual region was divided, transected, and suture-ligated with 0 Polysorb. The anterior and posterior leafs of the broad ligament were dissected and opened anteriorly to the level of the bladder. The uterine arteries were skeletonized on the left, and these were suture-clamped and transected with 0 Polysorb with good hemostasis noted. Next, the bladder flap was developed anteriorly, and the bladder peritoneum was sharply and bluntly dissected off of the lower uterus.,On the right, a similar procedure was performed. The right round ligament was suture-ligated with 0 Polysorb. It was transected and divided with electrocautery. The anterior and posterior leafs of the broad ligament were dissected and developed anteriorly and posteriorly, and this area was relatively avascular. The left infundibulopelvic ligament was identified. It was cross-clamped and transected, suture-ligated with 0 Polysorb with good hemostasis noted. Next, the uterine arteries were skeletonized on the right. They were transected and suture-ligated with 0 Polysorb. The uterosacral ligaments were taken bilaterally and transected and suture-ligated with 0 Polysorb. The cardinal ligaments were taken near their insertion into the cervical and uterine tissue. Pedicles were sharply developed and suture-ligated with 0 Polysorb. Next, the electrocautery was used to dissect the cervix anteriorly from the underlying vagina. Once entry into the vagina was made, the cervix and uterus were amputated with Jorgensen scissors. The vaginal cuff angles were suture-ligated with 0 Polysorb and transfixed to the ipsilateral, cardinal, and uterosacral ligaments for vaginal support. The remainder of the vagina was closed with figure-of-eight sutures in an interrupted fashion with good hemostasis noted.,Next, the right ovarian tissue was densely adherent to the colon. It was sharply and bluntly dissected, and most of the right ovary and endometrioma was removed and dissected off completely; however, there is a quite possibility that small remnants of ovarian tissue were left behind. The right ureter was seen and palpated. It did not appear to be dilated and had good peristalsis noted. Next, the retractors were removed. The laparotomy sponges were removed from the abdomen. The rectus fascia was closed with 0 Polysorb in a continuous running fashion with 2 sutures meeting in the midline. The subcutaneous tissue was closed with 0 plain gut in an interrupted fashion. The skin was closed with 4-0 Polysorb in a subcuticular fashion. A thin layer of Dermabond was placed.,The patient tolerated the procedure well. Sponge, lap, and needle counts were correct x 2. Cefoxitin 2 g was given preoperatively.,INTRAOPERATIVE COMPLICATIONS:, None.,DESCRIPTION OF SPECIMEN: , Uterus and right adnexa.,ESTIMATED BLOOD LOSS: , 1000 mL.,POSTOPERATIVE CONDITION: , Stable., | 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' | PREOP DIAGNOSIS: , Basal Cell CA.,POSTOP DIAGNOSIS:, Basal Cell CA.,LOCATION: , Mid parietal scalp.,PREOP SIZE:, 1.5 x 2.9 cm,POSTOP SIZE:, 2.7 x 2.9 cm,INDICATION:, Poorly defined borders.,COMPLICATIONS:, None.,HEMOSTASIS:, Electrodessication.,PLANNED RECONSTRUCTION:, Simple Linear Closure.,DESCRIPTION OF PROCEDURE:, Prior to each surgical stage, the surgical site was tested for anesthesia and reanesthetized as needed, after which it was prepped and draped in a sterile fashion.,The clinically-apparent tumor was carefully defined and debulked prior to the first stage, determining the extent of the surgical excision. With each stage, a thin layer of tumor-laden tissue was excised with a narrow margin of normal appearing skin, using the Mohs fresh tissue technique. A map was prepared to correspond to the area of skin from which it was excised. The tissue was prepared for the cryostat and sectioned. Each section was coded, cut and stained for microscopic examination. The entire base and margins of the excised piece of tissue were examined by the surgeon. Areas noted to be positive on the previous stage (if applicable) were removed with the Mohs technique and processed for analysis.,No tumor was identified after the final stage of microscopically controlled surgery. The patient tolerated the procedure well without any complication. After discussion with the patient regarding the various options, the best closure option for each defect was selected for optimal functional and cosmetic results. | Dermatology |
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:,1. Seizure.,2. Hypoglycemia.,3. Anemia.,4. Hypotension.,5. Dyspnea.,6. Edema.,DISCHARGE DIAGNOSES:,1. Colon cancer, status post right hemicolectomy.,2. Anemia.,3. Hospital-acquired pneumonia.,4. Hypertension.,5. Congestive heart failure.,6. Seizure disorder.,PROCEDURES PERFORMED:,1. Colonoscopy.,2. Right hemicolectomy.,HOSPITAL COURSE: , The patient is a 59-year-old female with multiple medical problems including diabetes mellitus requiring insulin for 26 years, previous MI and coronary artery disease, history of seizure disorder, GERD, bipolar disorder, and anemia. She was admitted due to a seizure and myoclonic jerks as well as hypoglycemia and anemia. Regarding the seizure disorder, Neurology was consulted. Noncontrast CT of the head was negative. Neurology felt that the only necessary intervention at that time would be to increase her Lamictal to 150 mg in the morning and 100 mg in the evening with gradual increase of the dosage until she was on 200 mg b.i.d. Regarding the hypoglycemia, the patient has diabetic gastroparesis and was being fed on J-tube intermittent feedings throughout the night at the rate of 120 an hour. Her insulin pump had a basal rate of roughly three at night during the feedings. While in the hospital, the insulin pump rate was turned down to 1.5 and then subsequently decreased a few other times. She seemed to tolerate the insulin pump rate well throughout her hospital course. There were a few episodes of hypoglycemia as well as hyperglycemia, but the episode seem to be related to the patient's n.p.o. status and the changing rates of tube feedings throughout her hospital course.,At discharge, her endocrinologist was contacted. It was decided to change her insulin pump rate to 3 units per hour from midnight till 6 a.m., from 0.8 units per hour from 6 a.m. until 8 a.m., and then at 0.2 units per hour from 8 a.m. until 6 p.m. The insulin was to be NovoLog. Regarding the anemia, the gastroenterologists were consulted regarding her positive Hemoccult stools. A colonoscopy was performed, which found a mass at the right hepatic flexure. General Surgery was then consulted and a right hemicolectomy was performed on the patient. The patient tolerated the procedure well and tube feeds were slowly restarted following the procedure, and prior to discharge were back at her predischarge rates of 120 per hour. Regarding the cancer itself, it was found that 1 out of 53 nodes were positive for cancer. CT of the abdomen and pelvis revealed no metastasis, a CT of the chest revealed possible lung metastasis. Later in hospital course, the patient developed a septic-like picture likely secondary to hospital-acquired pneumonia. She was treated with Zosyn, Levaquin, and vancomycin, and tolerated the medications well. Her symptoms decreased and serial chest x-rays were followed, which showed some resolution of the illness. The patient was seen by the Infectious Disease specialist. The Infectious Disease specialist recommended vancomycin to cover MRSA bacteria, which was found at the J-tube site. At discharge, the patient was given three additional days of p.o. Levaquin 750 mg as well as three additional days of Bactrim DS every 12 hours. The Bactrim was used to cover the MRSA at the J-tube site. It was found that MRSA was sensitive to Bactrim. Throughout her hospital course, the patient continued to receive Coreg 12.5 mg daily and Lasix 40 mg twice a day for her congestive heart failure, which remains stable. She also received Lipitor for her high cholesterol. Her seizure disorder remained stable and she was discharged on a dose of 100 mg in the morning and 150 mg at night. The dosage increases can begin on an outpatient basis.,DISCHARGE INSTRUCTIONS/MEDICATIONS: , The patient was discharged to home. She was told to shy away from strenuous activity. Her discharge diet was to be her usual diet of isotonic fiber feeding through the J-tube at a rate of 120 per hour throughout the night. The discharge medications were as follows:,1. Coreg 12.5 mg p.o. b.i.d.,2. Lipitor 10 mg p.o. at bedtime.,3. Nitro-Dur patch 0.3 mg per hour one patch daily.,4. Phenergan syrup 6.25 mg p.o. q.4h. p.r.n.,5. Synthroid 0.175 mg p.o. daily.,6. Zyrtec 10 mg p.o. daily.,7. Lamictal 100 mg p.o. daily.,8. Lamictal 150 mg p.o. at bedtime.,9. Ferrous sulfate drops 325 mg, PEG tube b.i.d.,10. Nexium 40 mg p.o. at breakfast.,11. Neurontin 400 mg p.o. t.i.d.,12. Lasix 40 mg p.o. b.i.d.,13. Fentanyl 50 mcg patch transdermal q.72h.,14. Calcium and vitamin D combination, calcium carbonate 500 mg/vitamin D 200 units one tab p.o. t.i.d.,15. Bactrim DS 800mg/160 mg tablet one tablet q.12h. x3 days.,16. Levaquin 750 mg one tablet p.o. x3 days.,The medications listed above, one listed as p.o. are to be administered via the J-tube.,FOLLOWUP: ,The patient was instructed to see Dr. X in approximately five to seven days. She was given a lab sheet to have a CBC with diff as well as a CMP to be drawn prior to her appointment with Dr. X. She is instructed to follow up with Dr. Y if her condition changes regarding her colon cancer. She was instructed to follow up with Dr. Z, her oncologist, regarding the positive lymph nodes. We were unable to contact Dr. Z, but his telephone number was given to the patient and she was instructed to make a followup appointment. She was also instructed to follow up with her endocrinologist, Dr. A, regarding any insulin pump adjustments, which were necessary and she was also instructed to follow up with Dr. B, her gastroenterologist, regarding any issues with her J-tube.,CONDITION ON DISCHARGE: , Stable. | 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 DIAGNOSES: , Nonhealing decubitus ulcer, left ischial region? Osteomyelitis, paraplegia, and history of spina bifida.,POSTOPERATIVE DIAGNOSES: , Nonhealing decubitus ulcer, left ischial region? Osteomyelitis, paraplegia, and history of spina bifida.,PROCEDURE PERFORMED: ,Debridement left ischial ulcer.,ANESTHESIA: ,Local MAC.,INDICATIONS:, This is a 27-year-old white male patient, with a history of spina bifida who underwent spinal surgery about two years ago and subsequently he has been paraplegic. The patient has a nonhealing decubitus ulcer in the left ischial region, which is quite deep. It appears to be right down to the bone. MRI shows findings suggestive of osteomyelitis. The patient is being brought to operating room for debridement of this ulcer. Procedure, indication, and risks were explained to the patient. Consent obtained.,PROCEDURE IN DETAIL: ,The patient was put in right lateral position and left buttock and ischial region was prepped and draped. Examination at this time showed fair amount of chronic granulation tissue and scarred tissue circumferentially as well as the base of this decubitus ulcer. This was sharply excised until bleeding and healthy tissue was obtained circumferentially as well as the base. The ulcer does not appear to be going into the bone itself as there was a covering on the bone, which appears to be quite healthy, normal and bone itself appeared solid.,I did not rongeur the bone. The deeper portion of the excised tissue was also sent for tissue cultures. Hemostasis was achieved with cautery and the wound was irrigated with sterile saline solution and then packed with medicated Kerlix. Sterile dressing was applied. The patient transferred to 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' | 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:, | 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' | PROCEDURES PERFORMED:,1. Functional endoscopic sinus surgery.,2. Bilateral maxillary antrostomy.,3. Bilateral total ethmoidectomy.,4. Bilateral nasal polypectomy.,5. Right middle turbinate reduction.,ANESTHESIA:, General endotracheal tube.,BLOOD LOSS:, Approximately 50 cc.,INDICATION: , This is a 48-year-old female with a history of chronic sinusitis as well as nasal polyposis that have been refractory to outpatient medical management. She has underwent sinus surgery in the past approximately 12 years ago with the CT evaluation revealed evidence of chronic mucosal thickening within the maxillary and ethmoid sinuses as well as the presence of polyposis within the nasal cavities bilaterally.,PROCEDURE: ,After all risks, benefits, and alternatives have been discussed with the patient in detail, informed consent was obtained. The patient was brought to the operative suite where she was placed in supine position and general anesthesia was delivered by the Department of Anesthesia. The patient was rotated 90 degrees away where cotton pledgets saturated with 4 cc of 10% cocaine solution were inserted into the nasal cavity. The nasal septum, as well as the turbinates were then localized with a mixture of 1% lidocaine with 1:100,000 epinephrine solution. The patient was then prepped and draped in the usual fashion.,Attention was directed first to the left nasal cavity. A zero-degree sinus endoscope was inserted into the nasal cavity down to the level of the nasopharynx. The initial examination revealed a gross polypoid disease emanating from the sphenoid sinuses as well as off the supreme turbinate. There was also polypoid disease present within the left middle meatus. Nasopharynx was visualized with a patent eustachian tube. At this point, the XPS micro debrider was used to take down all the polyps emanating from the inferior surface of the left middle turbinate as well as from the supreme turbinate. The ostium to the sphenoid sinus was visualized and was not entered. At this point, the left middle turbinate was localized and then medialized with the use of a freer elevator. A ball-tip probe was then used to localize the openings for the natural maxillary ostium. Side-biting forceps were used to take down the uncinate process and was further taken down with the use of the microdebrider. The opening of the maxillary sinus was visualized. The posterior fontanelle was taken down with the use of straight line forceps. It should be mentioned that tissue was very thick and polypoid with chronic inflammatory changes evident. The maxillary sinus ostia was then suctioned with Olive-tip suction and maxillary wash was performed. The remainder of the anterior ethmoid was then cleaned again removing excess polypoid tissue. The basal lamella was visualized and the posterior ethmoid air cells were then entered with use of the microdebrider as the surgical assistant palpated the patient's eyes for any vibration. All polypoid tissue was collected in the microdebrider and sent as a surgical specimen. Once all polypoid tissue has been removed, the cocaine pledgets were reinserted into the ethmoid air cells for hemostatic purposes. Attention was then directed to the right nasal cavity. Again, a sinus endoscope was inserted. Inspection revealed a grossly hypertrophied turbinate. It was felt that this enlarged and polypoid turbinate was contributing the patient's symptoms. Therefore, the turbinate was localized and a hemostat was used to crush the mid portion of the turbinate, which was then resected with use of side-biting scissors as well the Takahashi forceps. Sinus endoscope was then inserted all the way down through the nasopharynx. Again, the eustachian tube was visualized without any obstructing lesions or masses. Upon retraction, there was again polypoid tissue noted within the ethmoid sinuses. The ball-tip probe was again used to locate the right maxillary ostium. The side-biting forceps was used further take down the uncinate process. The maxillary ostium was then widened with use of a XPS microdebrider. A maxillary sinus wash was then performed. Now, the attention was directed to the ethmoid air cells. It should be mentioned again that the tissue of the anterior ethmoid was very thickened and polypoid. This was again taken down with the use of XPS microdebrider while the surgical assistant carefully palpated the patient's eye.,Once all polypoid tissue have been removed, some bleeding that was encountered was controlled with the use of suction cautery in a very conservative manner. Once all bleeding has been controlled, all surgical instruments were removed and Merocel packing was placed in the bilateral nasal cavities with the intent to remove in the recovery room. At this point, the procedure was felt to be complete. The patient was awakened and taken to the recovery room without incident. | 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' | PROBLEM LIST:,1. Acquired hypothyroidism.,2. Papillary carcinoma of the thyroid gland, status post total thyroidectomy in 1992.,3. Diabetes mellitus.,4. Insomnia with sleep apnea.,HISTORY OF PRESENT ILLNESS: , This is a return visit to the endocrine clinic for the patient with history as noted above. She is 45 years old. Her last visit was about 6 months ago. Since that time, the patient states her health has remained unchanged. Currently, primary complaint is one of fatigue that she feels throughout the day. She states, however, she is doing well with CPAP and wakes up feeling refreshed but tends to tire out later in the day. In terms of her thyroid issues, the patient states that she is not having signs or symptoms of thyroid excess or hypothyroidism. She is not reporting temperature intolerance, palpitations, muscle weakness, tremors, nausea, vomiting, constipation, hyperdefecation or diarrhea. Her weight has been stable. She is not reporting proximal muscle weakness.,CURRENT MEDICATIONS:,1. Levothyroxine 125 micrograms p.o. once daily.,2. CPAP.,3. Glucotrol.,4. Avandamet.,5. Synthroid.,6. Byetta injected twice daily.,REVIEW OF SYSTEMS: , As stated in the HPI. She is not reporting polyuria, polydipsia or polyphagia. She is not reporting fevers, chills, sweats, visual acuity changes, nausea, vomiting, constipation or diarrhea. She is not having any lightheadedness, weakness, chest pain, shortness of breath, difficulty breathing, orthopnea or dyspnea on exertion.,PHYSICAL EXAMINATION:,GENERAL: She is an overweight, very pleasant woman, in no acute distress. VITAL SIGNS: Temperature 96.9, pulse 85, respirations not counted, blood pressure 135/65, and weight 85.7 kg. NECK: Reveals well healed surgical scar in the anteroinferior aspect of the neck. There is no palpable thyroid tissue noted on this examination today. There is no lymphadenopathy. THORAX: Reveals lungs that are clear, PA and lateral, without adventitious sounds. CARDIOVASCULAR: Demonstrated regular rate and rhythm. S1 and S2 without murmur. No S3, no S4 is auscultated. EXTREMITIES: Deep tendon reflexes 2+/4 without a delayed relaxation phase. No fine resting tremor of the outstretched upper extremity. SKIN, HAIR, AND NAILS: All are unremarkable.,LABORATORY DATABASE: , Lab data on 08/29/07 showed the following: Thyroglobulin quantitative less than 0.5 and thyroglobulin antibody less than 20, free T4 1.35, and TSH suppressed at 0.121.,ASSESSMENT AND PLAN:,This is a 45-year-old woman with history as noted above.,1. Acquired hypothyroidism, status post total thyroidectomy for papillary carcinoma in 1992.,2. Plan to continue following thyroglobulin levels.,3. Plan to obtain a free T4, TSH, and thyroglobulin levels today.,4. Have the patient call the clinic next week for followup and continued management of her hypothyroid state.,5. Plan today is to repeat her thyroid function studies. This case was discussed with Dr. X and the recommendation. We are giving the patient today is for us to taper her medication to get her TSH somewhere between 0.41 or less. Therefore, labs have been drawn. We plan to see the patient back in approximately 6 months or sooner. A repeat body scan will not been done, the one in 03/06 was negative. | Endocrinology |
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: ,1. Left carpal tunnel syndrome.,2. de Quervain's tenosynovitis.,POSTOPERATIVE DIAGNOSIS:, ,1. Left carpal tunnel syndrome.,2. de Quervain's tenosynovitis.,OPERATIONS PERFORMED: ,1. Endoscopic carpal tunnel release.,2. de Quervain's release.,ANESTHESIA:, I.V. sedation and local (1% Lidocaine).,ESTIMATED BLOOD LOSS:, Zero.,COMPLICATIONS:, None.,PROCEDURE IN DETAIL: ,ENDOSCOPIC CARPAL TUNNEL RELEASE:, With the patient under adequate anesthesia, the upper extremity was prepped and draped in a sterile manner. The arm was exsanguinated. The tourniquet was elevated at 290 mm/Hg. Construction lines were made on the left palm to identify the ring ray. A transverse incision was made in the wrist, between FCR and FCU, one fingerbreadth proximal to the interval between the glabrous skin of the palm and normal forearm skin. Blunt dissection exposed the antebrachial fascia. Hemostasis was obtained with bipolar cautery. A distal-based window in the antebrachial fascia was then fashioned. Care was taken to protect the underlying contents. A proximal forearm fasciotomy was performed under direct vision. A synovial elevator was used to palpate the undersurface of the transverse carpal ligament, and synovium was elevated off this undersurface. Hamate sounds were then used to palpate the hook of hamate. The endoscopic instrument was then inserted into the proximal incision. The transverse carpal ligament was easily visualized through the portal. Using palmar pressure, the transverse carpal ligament was held against the portal as the instrument was inserted down the transverse carpal ligament to the distal end.,The distal end of the transverse carpal ligament was then identified in the window. The blade was then elevated, and the endoscopic instrument was withdrawn, dividing the transverse carpal ligament under direct vision. After complete division o the transverse carpal ligament, the instrument was reinserted. Radial and ulnar edges of the transverse carpal ligament were identified, and complete release was confirmed.,The wound was then closed with running subcuticular stitch. Steri-Strips were applied, and sterile dressing was applied over the Steri-Strips. The tourniquet was deflated. The patient was awakened from anesthesia and returned to the Recovery Room in satisfactory condition, having tolerated the procedure well.,DE QUERVAIN'S RELEASE: , With the patient under adequate regional anesthesia applied by surgeon using 1% plain Xylocaine, the upper extremity was prepped and draped in a sterile manner. The arm was exsanguinated. The tourniquet was elevated to 290 mm/Hg. A transverse incision was then made over the radial aspect of the wrist overlying the first dorsal tunnel. Using blunt dissection, the radial sensory nerve branches were dissected and retracted out of the operative field. The first dorsal tunnel was then identified. The first dorsal tunnel was incised along the dorsal ulnar border, completely freeing the stenosing tenosynovitis (de Quervain's release). EPB and APL tendons were inspected and found to be completely free. The radial sensory nerve was inspected and found to be without damage.,The skin was closed with a running 3-0 Prolene subcuticular stitch and Steri-Strips were applied and, over the Steri-Strips, a sterile dressing, and, over the sterile dressing, a volar splint with the hand in safe position. The tourniquet was deflated. The patient was returned to the holding area in satisfactory condition, having tolerated the procedure well. | 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' | INDICATION FOR STUDY: , Elevated cardiac enzymes, fullness in chest, abnormal EKG, and risk factors.,MEDICATIONS:, Femara, verapamil, Dyazide, Hyzaar, glyburide, and metformin.,BASELINE EKG: , Sinus rhythm at 84 beats per minute, poor anteroseptal R-wave progression, mild lateral ST abnormalities.,EXERCISE RESULTS:,1. The patient exercised for 3 minutes stopping due to fatigue. No chest pain.,2. Heart rate increased from 84 to 138 or 93% of maximum predicted heart rate. Blood pressure rose from 150/88 to 210/100. There was a slight increase in her repolorization abnormalities in a non-specific pattern.,NUCLEAR PROTOCOL: ,Same day rest/stress protocol was utilized with 11 mCi for the rest dose and 33 mCi for the stress test.,NUCLEAR RESULTS:,1. Nuclear perfusion imaging, review of the raw projection data reveals adequate image acquisition. The resting images showed decreased uptake in the anterior wall. However the apex is spared of this defect. There is no significant change between rest and stress images. The sum score is 0.,2. The Gated SPECT shows moderate LVH with slightly low EF of 48%.,IMPRESSION:,1. No evidence of exercise induced ischemia at a high myocardial workload. This essentially excludes obstructive CAD as a cause of her elevated troponin.,2. Mild hypertensive cardiomyopathy with an EF of 48%.,3. Poor exercise capacity due to cardiovascular deconditioning.,4. Suboptimally controlled blood pressure on today's exam. | 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' | REASON FOR CONSULTATION:, Ventricular ectopy and coronary artery disease.,HISTORY OF PRESENT ILLNESS: ,I am seeing the patient upon the request of Dr. Y. The patient is a very well known to me. He is a 69-year-old gentleman with established history coronary artery disease and peripheral vascular disease with prior stent-supported angioplasty. The patient had presented to the hospital after having coughing episodes for about two weeks on and off, and seemed to have also given him some shortness of breath. The patient was admitted and being treated for pneumonia, according to him. The patient denies any chest pain, chest pressure, or heaviness. Denies any palpitations, fluttering, or awareness of heart activity. However, on monitor, he was noticed to have PVCs random. He had run off three beats consecutive one time at 12:46 p.m. today. The patient denied any awareness of that or syncope.,REVIEW OF SYSTEMS:,CONSTITUTIONAL: No fever or chills.,EYES: No visual disturbances.,ENT: No difficulty swallowing.,CARDIOVASCULAR: Prior history of chest discomfort in 08/2009 with negative stress study.,RESPIRATORY: Cough and shortness of breath.,MUSCULOSKELETAL: Positive for arthritis and neck pain.,GU: Unremarkable.,NEUROLOGIC: Otherwise unremarkable.,ENDOCRINE: Otherwise unremarkable.,HEMATOLOGIC: Otherwise unremarkable.,ALLERGIC: Otherwise unremarkable.,PAST MEDICAL HISTORY:,1. Positive for coronary artery disease since 2002.,2. History of peripheral vascular disease for over 10 years.,3. COPD.,4. Hypertension.,PAST SURGICAL HISTORY:, Right fem-popliteal bypass about eight years ago, neck fusion in the remote past, stent-supported angioplasty to unknown vessel in the heart.,MEDICATIONS AT HOME:,1. Aspirin 81 mg daily.,2. Clopidogrel 75 mg daily.,3. Allopurinol 100 mg daily.,4. Levothyroxine 100 mcg a day.,5. Lisinopril 10 mg a day.,6. Metoprolol 25 mg a day.,7. Atorvastatin 10 mg daily.,ALLERGIES: , THE PATIENT DOES HAVE ALLERGY TO MEDICATION. HE SAID HE CANNOT TAKE ASPIRIN BECAUSE OF INTOLERANCE FOR HIS STOMACH AND STOMACH UPSET, BUT NO TRUE ALLERGY TO ASPIRIN.,FAMILY HISTORY:, No history of premature coronary artery disease. One daughter has early onset diabetes and one child has asthma.,SOCIAL HISTORY: , He is married and retired. He has nine children, 25 grandchildren. He smokes one pack per day. He smoked 50 pack years and had no intention of quitting according to him.,PHYSICAL EXAMINATION:,VITAL SIGNS: Temperature of 97, heart rate of 90, blood pressure of 187/105.,HEENT: Normocephalic and atraumatic. No thyromegaly or lymphadenopathy.,NECK: Supple.,CARDIOVASCULAR: Upstroke is normal. Distal pulse symmetrical. Heart regular with a normal S1 with normally split S2. There is an S4 at the apex.,LUNGS: With decreased air entry. No wheezes.,ABDOMINAL: Benign. No masses.,EXTREMITIES: No edema, cyanosis, or clubbing.,NEUROLOGIC: Awake, alert, and oriented x3. No focal deficits.,IMAGING STUDIES: , Echocardiogram on 08/26/2009, showed mild biatrial enlargement, normal thickening of the left ventricle with mildly dilated ventricle, EF of 40%, mild mitral regurgitation, and diastolic dysfunction, grade 2. | 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 DIAGNOSES: , Vault prolapse and rectocele.,POSTOPERATIVE DIAGNOSES:, Vault prolapse and rectocele.,OPERATION: , Colpocleisis and rectocele repair.,ANESTHESIA: ,Spinal.,ESTIMATED BLOOD LOSS:, Minimal.,FLUIDS: , Crystalloid.,BRIEF HISTORY OF THE PATIENT: , This is an 85-year-old female who presented to us with a vaginal mass. On physical exam, the patient was found to have grade 3 rectocele and poor apical support, and history of hysterectomy. The patient had good anterior support at the bladder. Options were discussed such as watchful waiting, pessary, repair with and without mesh, and closing of the vagina (colpocleisis) were discussed. Risk of anesthesia, bleeding, infection, pain, MI, DVT, PE, morbidity, and mortality of the procedure were discussed., ,Risk of infection and abscess formation were discussed. The patient understood all the risks and benefits and wanted to proceed with the procedure. Risk of retention and incontinence were discussed. Consent was obtained through the family members.,DETAILS OF THE OR:, The patient was brought to the OR. Anesthesia was applied. The patient was placed in dorsal lithotomy position. The patient had a Foley catheter placed. The posterior side of the rectocele was visualized with grade 3 rectocele and poor apical support. A 1% lidocaine with epinephrine was applied for posterior hydrodissection, which was very difficult to do due to the significant scarring of the posterior part. Attempts were made to lift the vaginal mucosa off of the rectum, which was very, very difficult to do at this point due to the patient's overall poor medical condition in terms of poor mobility and significant scarring. Discussion was done with the family in the waiting area regarding simply closing the vagina and doing a colpocleisis since the patient is actually inactive. Family agreed that she is not active and they rather not have any major invasive procedure especially in light of scarring and go ahead and perform the colpocleisis. Oral consent was obtained from the family and her surgery was preceded. The vaginal mucosa was denuded off using electrocautery and Metzenbaum scissors. Using 0 Vicryl, 2 transverse longitudinal stitches were placed to bring the anterior and the posterior part of the vagina together and was started at the apex and was brought all the way out to the introitus. The vaginal mucosa was pretty much completely closed off all the way up to the introitus. Indigo carmine was given. Cystoscopy revealed there was a good efflux of urine from both of the ureteral openings. There was no injury to the bladder or kinking of the ureteral openings. The bladder was normal. Rectal exam was normal at the end of the colpocleisis repair. There was good hemostasis., ,At the end of the procedure, Foley was removed and the patient was brought to recovery in a 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' | REASON FOR CONSULTATION:, Hematuria and urinary retention.,BRIEF HISTORY: , The patient is an 82-year-old, who was admitted with the history of diabetes, hypertension, hyperlipidemia, coronary artery disease, presented with urinary retention and pneumonia. The patient had hematuria, and unable to void. The patient had a Foley catheter, which was not in the urethra, possibly inflated in the prostatic urethra, which was removed. Foley catheter was repositioned 18 Coude was used. About over a liter of fluids of urine was obtained with light pink urine, which was irrigated. The bladder and the suprapubic area returned to normal after the Foley placement. The patient had some evidence of clots upon irrigation. The patient has had a chest CT, which showed possible atelectasis versus pneumonia.,PAST MEDICAL HISTORY: ,Coronary artery disease, diabetes, hypertension, hyperlipidemia, Parkinson's, and CHF.,FAMILY HISTORY: ,Noncontributory.,SOCIAL HISTORY: , Married and lives with wife.,HABITS:, No smoking or drinking.,REVIEW OF SYSTEMS: , Denies any chest pain, denies any seizure disorder, denies any nausea, vomiting. Does have suprapubic tenderness and difficulty voiding. The patient denies any prior history of hematuria, dysuria, burning, or pain.,PHYSICAL EXAMINATION:,VITAL SIGNS: The patient is afebrile. Vitals are stable.,GENERAL: The patient is a thin gentleman,GENITOURINARY: Suprapubic area was distended and bladder was palpated very easily. Prostate was 1+. Testes are normal.,LABORATORY DATA: , The patient's white counts are 20,000. Creatinine is normal.,ASSESSMENT AND PLAN:,1. Pneumonia.,2. Dehydration.,3. Retention.,4. BPH.,5. Diabetes.,6. Hyperlipidemia.,7. Parkinson's.,8. Congestive heart failure.,About 30 minutes were spent during the procedure and the Foley catheter was placed, Foley was irrigated and significant amount of clots were obtained. Plan is for urine culture, antibiotics. Plan is for renal ultrasound to rule out any pathology. The patient will need cystoscopy and evaluation of the prostate. Apparently, the patient's PSA is 0.45, so the patient is at low to no risk of prostate cancer at this time. Continued Foley catheter at this point. We will think about starting the patient on alpha-blockers once the patient's over all medical condition is improved and stable. | 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:, Foreign body, right foot.,POSTOPERATIVE DIAGNOSIS: , Foreign body, right foot.,PROCEDURE PERFORMED:,1. Incision and drainage, right foot.,2. Removal of foreign body, right foot.,HISTORY: , This 7-year-old Caucasian male is an inpatient at ABCD General Hospital with a history of falling off his bike and having a root ________ angle inside of his foot. The patient has had previous I&D but continues to have to purulent drainage. The patient's parents agreed to performing a surgical procedure to further clean the wound.,PROCEDURE:, An IV was instituted by the Department of Anesthesia in the preoperative holding area. The patient was transported to the operating room and placed on the operating table in a supine position with a safety strap across his lap. General anesthesia was administered by the Department of Anesthesia. The foot was then prepped and draped in the usual sterile orthopedic fashion. The stockinette was reflected and the foot was cleansed with wet and dry sponge. There was noted to be some remaining periwound erythema. There was noted to be some mild crepitation about 2 cm proximal from the entry wound. The entry wound was noted to be over the third metatarsal head dorsally. Upon inspection of the wound, there was noted to be hard foreign filling substance deep within the wound. The entry site from the foreign body was extended proximally approximately about 0.5 cm. At this time, a large wooden foreign body was visualized and removed with a straight stat.,The area was carefully inspected for any remaining piece of foreign body. Several small pieces were noted and they were removed. The area was palpated and there was no more remaining foreign body noted. At this time, the wound was inspected thoroughly. There was noted to be an area along the third metatarsal head more distally that did probe to the bone. There was no purulent drainage expressed. Area was flushed with copious amounts of sterile saline. Pulse lavage was performed with 3 liters of plain sterile saline. Wound cultures were obtained, aerobic and aerobic. The wound was then again inspected for any remaining foreign body or purulent drainage. None was noticed. The wound was packed with sterile new gauze packing lately and dressings consisted of 4x4s, ABDs, Kling, and Kerlix.,The patient tolerated the above procedure and anesthesia well without complications. The patient was transported to the PACU with vital signs stable and vascular status intact. The patient is to be readministered to the pediatrics where daily dressing changes will be performed by podiatry. The patient had a postoperative pain prescription written for Tylenol, Elixir with codeine as needed. | 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:, Hammertoe deformity of the right second digit.,POSTOPERATIVE DIAGNOSIS: , Hammertoe deformity of the right second digit.,PROCEDURE PERFORMED: , Arthroplasty of the right second digit.,The patient is a 77-year-old Hispanic male who presents to ABCD Hospital for surgical correction of a painful second digit hammertoe. The patient has failed attempts at conservative treatment and is unable to wear shoes without pain to his second toe. The patient presents n.p.o. since mid night last night and consented to sign in the chart. H&P is complete.,PROCEDURE IN DETAIL:, After an IV was instituted by the Department of Anesthesia in the preoperative holding area, the patient was escorted to the operating room and placed on the table in the supine position. Using Webril, the distal leg and ankle was padded and a ankle pneumatic tourniquet was placed around the right ankle, but left deflated at this time. Restraining, a lap belt was then placed around the patient's abdomen while laying on the table. After adequate anesthesia was administered by the Department of Anesthesia, a local digital block using 5 cc of 0.5% Marcaine plain was used to provide local anesthesia. The foot was then prepped and draped in the normal sterile orthopedic manner. The foot was then elevated and Esmarch bandage was applied, after which time the tourniquet was inflated to 250 mmHg. The foot was then brought down to the level of the table and stockinet was cut and reflected after the Esmarch bandage was removed. A wet and dry sponge was then used to cleanse the operative site and using a skin skribe a dorsal incisional line was outlined extending from the proximal phalanx over the proximal interphalangeal joint on to the middle phalanx.,Then using a fresh #15 blade, a dorsolinear incision was made, partial thickness through the skin after testing anesthesia with one to two pickup. Then using a fresh #15 blade, incision was deepened and using medial to lateral pressure, the incision was opened into the subcutaneous tissue. Care was taken to reflect the subcutaneous tissue from the underlying deep fascia to mobilize the skin. This was performed with the combination of blunt and dull dissection. Care was taken to avoid proper digital arteries and neurovascular bundles as were identified. Attention was then directed to the proximal interphalangeal joint and after identifying the joint line, a transverse linear incision was made over the dorsal surface of the joint. The medial and lateral sides of the joint capsule were then also incised on the superior half in order to provide increased exposure. Following this, the proximal portion of the transected extensor digitorum longus tendon was identified using an Adson-Brown pickup. It was elevated with fresh #15 blade. The tendon and capsule was reflected along with the periosteum from the underlying bone dorsally. Following this, the distal portion of the tendon was identified in a like manner. The tendon and the capsule as well as the periosteal tissue was reflected from the dorsal surface of the bone. The proximal interphalangeal joint was then distracted and using careful technique, #15 blade was used to deepen the incision and while maintaining close proximity to the bone and condyles, the lateral and medial collateral ligaments were freed up from the side of the proximal phalanx head.,Following this, the head of the proximal phalanx was known to have adequate exposure and was freed from soft tissues. Then using a sagittal saw with a #139 blade, the head of he proximal phalanx was resected. Care was taken to avoid the deep flexor tendon. The head of the proximal phalanx was taken with the Adson-Brown and using a #15 blade, the plantar periosteal tissue was freed up and the head was removed and sent to pathology. The wound was then flushed using a sterile saline with gentamicin and the digit was noted to be in good alignment. The digit was also noted to be in rectus alignment. Proximal portion of the tendon was shortened to allow for removal of the redundant tendon after correction of the deformity. Then using a #3-0 Vicryl suture, three simple interrupted sutures were placed for closure of the tendon and capsular tissue. Then following this, #4-0 nylon was used in a combination of horizontal mattress and simple interrupted sutures to close the skin. The toe was noted to be in good alignment and then 1 cc of dexamethasone phosphate was injected into the incision site. Following this, the incision was dressed using a sterile Owen silk soaked in saline and gentamicin. The toe was bandaged using 4 x 4s, Kling, and Coban. The tourniquet was deflated and immediate hyperemia was noted to the digits I through V of the right foot.,The patient was then transferred to the cart and was escorted to the Postanesthesia Care Unit where the patient was given postoperative surgical shoe. Total tourniquet time for the case was 30 minutes. While in the recovery, the patient was given postoperative instructions to include, ice and elevation to his right foot. The patient was given pain medications of Tylenol #3, quantity 30 to be taken one to two tablets every six to eight hours as necessary for moderate to severe pain. The patient was also given prescription for cane to aid in ambulation. The patient will followup with Dr. X on Tuesday in his office for postoperative care. The patient was instructed to keep the dressings clean, dry, and intact and to not remove them before his initial office visit. The patient tolerated the procedure well and the anesthesia with no complications. | Podiatry |
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:, Bilateral lumbar sympathetic block.,ANESTHESIA: , Local sedation.,VITAL SIGNS:, See nurse's notes.,COMPLICATIONS:, None.,DETAILS OF PROCEDURE: , INT was placed. The patient was in the prone position and the back prepped with Betadine. The patient was given sedation and monitored. Xylocaine 1.5% for skin wheal 6 cm lateral and slightly inferior to the bilateral L2 transverse process was made. A 20-gauge, 15 cm LSB needle was then directed using AP and lateral fluoroscopic guidance until the tip of the needle was just inside the lateral aspect of the vertebral body and on the lateral projection, it was noted to be along the anterior vertebral body, at the junction of the upper two thirds, lower one third of the body. After negative aspiration 3 cc of Omnipaque dye was injected showing linear spread along the body. After negative aspiration 18 cc of 0.25% Marcaine was injected. Attention was then directed to the L3 level with the tip of the needle guided to the junction of the upper one third, lower two third of L3. At this point, after confirmation of the linear spread of dye along the anterior portion of the body, negative aspiration was performed and 18 cc of 0.25% Marcaine was injected. Neosporin and band-aids were applied over the sites. The patient was taken to the outpatient recovery room 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' | PREOPERATIVE DIAGNOSES:,1. Intrauterine pregnancy at term.,2. Arrest of dilation. ,POSTOPERATIVE DIAGNOSES:,1. Intrauterine pregnancy at term.,2. Arrest of dilation.,PROCEDURE PERFORMED:, Primary low-transverse cesarean section.,ANESTHESIA: , Epidural.,ESTIMATED BLOOD LOSS: , 1000 mL.,COMPLICATIONS: , None.,FINDINGS: ,Female infant in cephalic presentation, OP position, weight 9 pounds 8 ounces. Apgars were 9 at 1 minute and 9 at 5 minutes. Normal uterus, tubes, and ovaries were noted.,INDICATIONS: ,The patient is a 20-year-old gravida 1, para 0 female, who presented to labor and delivery in early active labor at 40 and 6/7 weeks gestation. The patient progressed to 8 cm, at which time, Pitocin was started. She subsequently progressed to 9 cm, but despite adequate contractions, arrested dilation at 9 cm. A decision was made to proceed with a primary low transverse cesarean section.,The procedure was described to the patient in detail including possible risks of bleeding, infection, injury to surrounding organs, and possible need for further surgery. Informed consent was obtained prior to proceeding with the procedure.,PROCEDURE NOTE: ,The patient was taken to the operating room where epidural anesthesia was found to be adequate. The patient was prepped and draped in the usual sterile fashion in the dorsal supine position with a left-ward tilt. A Pfannenstiel skin incision was made with the scalpel and carried through to the underlying layer of fascia using the Bovie. The fascia was incised in the midline and extended laterally using Mayo scissors. Kocher clamps were used to elevate the superior aspect of the fascial incision, which was elevated, and the underlying rectus muscles were dissected off bluntly and using Mayo scissors. Attention was then turned to the inferior aspect of the fascial incision, which in similar fashion was grasped with Kocher clamps, elevated, and the underlying rectus muscles were dissected off bluntly and using Mayo scissors. The rectus muscles were dissected in the midline.,The peritoneum was bluntly dissected, entered, and extended superiorly and inferiorly with good visualization of the bladder. The bladder blade was inserted. The vesicouterine peritoneum was identified with pickups and entered sharply using Metzenbaum scissors. This incision was extended laterally and the bladder flap was created digitally. The bladder blade was reinserted. The lower uterine segment was incised in a transverse fashion using the scalpel and extended using manual traction. Clear fluid was noted. The infant was subsequently delivered atraumatically. The nose and mouth were bulb suctioned. The cord was clamped and cut. The infant was subsequently handed to the awaiting nursery nurse. Next, cord blood was obtained per the patient's request for cord blood donation, which took several minutes to perform. Subsequent to the collection of this blood, the placenta was removed spontaneously intact with a 3-vessel cord noted. The uterus was exteriorized and cleared of all clots and debris. The uterine incision was repaired in 2 layers using 0 chromic suture. Hemostasis was visualized. The uterus was returned to the abdomen.,The pelvis was copiously irrigated. The uterine incision was reexamined and was noted to be hemostatic. The rectus muscles were reapproximated in the midline using 3-0 Vicryl. The fascia was closed with 0 Vicryl, the subcutaneous layer was closed with 3-0 plain gut, and the skin was closed with staples. Sponge, lap, and instrument counts were correct x2. The patient was stable at the completion of the procedure and was subsequently transferred 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' | CHIEF COMPLAINT:, Rule out obstructive sleep apnea syndrome.,Sample Patient is a pleasant, 61-year-old, obese, African-American male with a past medical history significant for hypertension, who presents to the Outpatient Clinic with complaints of loud snoring and witnessed apnea episodes by his wife for at least the past five years. He denies any gasping, choking, or coughing episodes while asleep at night. His bedtime is between 10 to 11 p.m., has no difficulty falling asleep, and is usually out of bed around 7 a.m. feeling refreshed. He has two to three episodes of nocturia per night. He denies any morning symptoms. He has mild excess daytime sleepiness manifested by dozing off during boring activities.,PAST MEDICAL HISTORY:, Hypertension, gastritis, and low back pain.,PAST SURGICAL HISTORY:, TURP.,MEDICATIONS:, Hytrin, Motrin, Lotensin, and Zantac.,ALLERGIES:, None.,FAMILY HISTORY:, Hypertension.,SOCIAL HISTORY:, Significant for about a 20-pack-year tobacco use, quit in 1991. No ethanol use or illicit drug use. He is married. He has one dog at home. He used to be employed at Budd Automotors as a die setter for about 37 to 40 years.,REVIEW OF SYSTEMS:, His weight has been steady over the years. Neck collar size is 17½". He denies any chest pain, cough, or shortness of breath. Last chest x-ray within the past year, per his report, was normal.,PHYSICAL EXAM:, A pleasant, obese, African-American male in no apparent respiratory distress. T: 98. P: 90. RR: 20. BP: 156/90. O2 saturation: 97% on room air. Ht: 5' 5". Wt: 198 lb. HEENT: A short thick neck, low-hanging palate, enlarged scalloped tongue, narrow foreshortened pharynx, clear nares, and no JVD. CARDIAC: Regular rate and rhythm without any adventitious sounds. CHEST: Clear lungs bilaterally. ABDOMEN: An obese abdomen with active bowel sounds. EXTREMITIES: No cyanosis, clubbing, or edema. NEUROLOGIC: Non-focal.,IMPRESSION:,1. Probable obstructive sleep apnea syndrome.,2. Hypertension.,3. Obesity.,4. History of tobacco use.,PLAN:,1. We will schedule an overnight sleep study to evaluate obstructive sleep apnea syndrome.,2. Encouraged weight loss.,3. Check TSH.,4. Asked not to drive and engage in any activity that could endanger himself or others while sleepy.,5. Asked to return to the clinic one week after sleep the study is done. | 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. protein-calorie malnutrition.,2. Intractable nausea, vomiting, and dysphagia.,POSTOPERATIVE DIAGNOSES:,1. Protein-calorie malnutrition.,2. Intractable nausea, vomiting, and dysphagia.,3. Enterogastritis.,PROCEDURE PERFORMED: , EGD with PEG tube placement using Russell technique.,ANESTHESIA: , IV sedation with 1% lidocaine for local.,ESTIMATED BLOOD LOSS: ,None.,COMPLICATIONS: ,None.,BRIEF HISTORY: , This is a 44-year-old African-American female who is well known to this service. She has been hospitalized multiple times for intractable nausea and vomiting and dehydration. She states that her decreased p.o. intake has been progressively worsening. She was admitted to the service of Dr. Lang and was evaluated by Dr. Wickless as well all of whom agreed that the best option for supplemental nutrition for this patient was placement of a PEG tube.,PROCEDURE: , After risks, complications, and benefits were explained to the patient and informed consent was obtained, the patient was taken to the operating room. She was placed in the supine position. The area was prepped and draped in the sterile fashion. After adequate IV sedation was obtained by anesthesia, esophagogastroduodenoscopy was performed. The esophagus, stomach, and duodenum were visualized without difficulty. There was no gross evidence of any malignancy. There was some enterogastritis which was noted upon exam. The appropriate location was noted on the anterior wall of the stomach. This area was localized externally with 1% lidocaine. Large gauge needle was used to enter the lumen of the stomach under visualization. A guide wire was then passed again under visualization and the needle was subsequently removed. A scalpel was used to make a small incision, next to the guidewire and ensuring that the underlying fascia was nicked as well. A dilator with break-away sheath was then inserted over the guidewire and under direct visualization was seen to enter the lumen of the stomach without difficulty. The guidewire and dilator were then removed again under visualization and the PEG tube was placed through the break-away sheath and visualized within the lumen of the stomach. The balloon was then insufflated and the break-away sheath was then pulled away. Proper placement of the tube was ensured through visualization with a scope. The tube was then sutured into place using nylon suture. Appropriate sterile dressing was applied.,DISPOSITION: ,The patient was transferred to the recovery in a stable condition. She was subsequently returned to her room on the General Medical Floor. Previous orders will be resumed. We will instruct the Nursing that the PEG tube can be used at 5 p.m. this evening for medications if necessary and bolus feedings. | 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: , Bladder tumor.,POSTOPERATIVE DIAGNOSIS: , Bladder tumor.,PROCEDURE PERFORMED: , Transurethral resection of a medium bladder tumor (TURBT), left lateral wall.,ANESTHESIA: , Spinal.,SPECIMEN TO PATHOLOGY: , Bladder tumor and specimen from base of bladder tumor.,DRAINS: , A 22-French 3-way Foley catheter, 30 mL balloon.,ESTIMATED BLOOD LOSS:, Minimal.,INDICATIONS FOR PROCEDURE: , This is a 74-year-old male who presented with microscopic and an episode of gross hematuria. He underwent an IVP, which demonstrated enlarged prostate and normal upper tracts. Cystoscopy in the office demonstrated a 2.5- to 3-cm left lateral wall bladder tumor. He is brought to the operating room for transurethral resection of that bladder tumor.,DESCRIPTION OF OPERATION: , After preoperative counseling of the patient and his wife, the patient was taken to the operating room and administered a spinal anesthetic. He was placed in lithotomy position and prepped and draped in the usual fashion. Using the visual obturator, the resectoscope was then inserted per urethra into the bladder. The bladder was inspected confirming previous cystoscopic findings of a 2.5- to 3-cm left lateral wall bladder tumor away from the ureteral orifice. Using the resectoscope loop, the tumor was then resected down to its base in a stepwise fashion. Following completion of resection down to the base, the bladder was _______ free of tumor specimen. The resectoscope was then reinserted and the base of the bladder tumor was then resected to get the base of the bladder tumor specimen, this was sent as a separate pathological specimen. Hemostasis was assured with electrocautery. The base of the tumor was then fulgurated again and into the periphery out in the normal mucosa surrounding the base of the bladder tumor. Following completion of the fulguration, there was good hemostasis. The remainder of the bladder was without evidence of significant abnormality. Both ureteral orifices were visualized and noted to drain freely of clear urine. The bladder was filled and the resectoscope was removed. A 22-French 3-way Foley catheter was inserted per urethra into the bladder. The balloon was inflated to 30 mL. The catheter with sterile continuous irrigation and was noted to drain clear irrigant. The patient was then removed from lithotomy position. He was 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' | PREOPERATIVE DIAGNOSES:,1. Hypermenorrhea.,2. Uterine fibroids.,3. Pelvic pain.,4. Left adnexal mass.,5. Pelvic adhesions.,POSTOPERATIVE DIAGNOSES:,1. Hypermenorrhea.,2. Uterine fibroids.,3. Pelvic pain.,4. Left adnexal mass.,5. Pelvic adhesions.,PROCEDURE PERFORMED:,1. Total abdominal hysterectomy (TAH).,2. Left salpingo-oophorectomy.,ANESTHESIA:, General endotracheal.,COMPLICATIONS:, None.,ESTIMATED BLOOD LOSS: , Less than 100 cc.,INDICATIONS: , The patient is a 47-year-old Caucasian female with complaints of hypermenorrhea and pelvic pain, noted to have a left ovarian mass 7 cm at the time of laparoscopy in July of 2003. The patient with continued symptoms of pelvic pain and hypermenorrhea and desired definitive surgical treatment.,FINDINGS AT THE TIME OF SURGERY: , Uterus is anteverted and boggy with a very narrow introitus with a palpable left adnexal mass.,On laparotomy, the uterus was noted to be slightly enlarged with fibroid change as well as a hemorrhagic appearing left adnexal mass. The bowel, omentum, and appendix had a normal appearance.,PROCEDURE: , The patient was taken to the operative suite where anesthesia was found to be adequate. She was then prepared and draped in normal sterile fashion. A Pfannenstiel skin incision was made with a scalpel and carried through the underlying layer of fascia with the second scalpel. The fascia was then incised in the midline. The fascial incision was then extended laterally with Mayo scissors. The superior aspect of the fascial incision was grasped with Kochers with the underlying rectus muscle dissected off bluntly and sharply with Mayo scissors. Attention was then turned to the inferior aspect of this incision, which in a similar fashion was tented up with the underlying rectus muscle and dissected off bluntly and sharply with Mayo scissors. The rectus muscle was then separated in the midline. The peritoneum was identified, tented up with hemostats and entered sharply with Metzenbaum scissors. The peritoneal incision was then extended superiorly and inferiorly with good visualization of the bladder. The uterus and left adnexa were then palpated and brought out into the surgical field. The fundus of the uterus was grasped with a Lahey clamp. The GYN/Balfour retractor was placed. The bladder blade was placed. The bowel was packed away with moist laparotomy sponges and the extension through GYN/Balfour retractor was placed. At this time, the patient's anatomy was surveyed and there was found to be a left hemorrhagic appearing adnexal mass. Attention was first turned to the right round ligament, which was tented up with a Babcock and a small window was made beneath the round ligament with a hemostat. It was then suture ligated with #0 Vicryl suture, transected with the broad ligament being skeletonized on both sides. Next, the right ________ was isolated bluntly as the patient had a previous RSO. This was then suture ligated with #0 Vicryl suture, doubly clamped with Kocher clamps, transected, and suture ligated with #0 Vicryl suture with a Heaney stitch. Attention was then turned to the left round ligament, which was tented up with the Babcock. Small window was made beneath it and the broad ligament with hemostat was then suture ligated with #0 Vicryl suture, transected, and skeletonized with the aid of Metzenbaums. The left infundibulopelvic ligament was then bluntly isolated. It was then suture ligated with #0 Vicryl suture, doubly clamped with Kocher clamps, and transected and suture ligated with #0 Vicryl suture with a Heaney stitch. The bladder flap was then placed on tension with Allis clamps. It was then dissected off of the lower uterine segment with the aid of Metzenbaum scissors and Russians. It was then gently pushed off of lower uterine segment with the aid of a moist Ray-Tec. The uterine arteries were then skeletonized bilaterally.,They were then clamped with straight Kocher clamps, transected, and suture ligated with #0 Vicryl suture. The cardinal ligament and uterosacral complexes on both sides were then clamped with curved Kocher clamps. These were then transected and suture ligated with #0 Vicryl suture. The lower uterine segment was then grasped with Lahey clamps, at which time the cervix was already visible. It was then entered with the last transection. The cervix was grasped with a single-toothed tenaculum and the uterus, cervix, and left adnexa were amputated off the vagina with the aid of Jorgenson scissors. The angles of the vaginal cuff were then grasped with Kocher clamps. A Betadine-soaked Ray-Tec was then pushed into the vagina and the vaginal cuff was closed with #0 Vicryl suture in a running lock fashion with care taken to transect the ipsilateral cardinal ligament, at which time the suction tip was changed and copious suction irrigation was performed. Good hemostasis was appreciated. A figure-of-eight suture in the center of the vaginal cuff was placed with #0 Vicryl. This was tagged for later use. The uterosacrals on both sides were incorporated into the vaginal cuff with the aid of #0 Vicryl suture. The round ligaments were then pulled into the vaginal cuff using the figure-of-eight suture placed in the center of the vaginal cuff and these were tied in place. The pelvis was then again copiously suctioned irrigated and hemostasis was appreciated. The peritoneal surfaces were then reapproximated with the aid of #3-0 Vicryl suture in a running fashion. The GYN/Balfour retractor and bladder blade were then removed. The bowel was then packed. Again copious suction irrigation was performed with hemostasis appreciated. The peritoneum was then reapproximated with #2-0 Vicryl suture in a running fashion. The fascia was then reapproximated with #0 Vicryl suture in a running fashion. The Scarpa's fascia was then reapproximated with #3-0 plain gut in a running fashion and the skin was closed with #4-0 undyed Vicryl in a subcuticular fashion. Steri-Strips were placed. At the end of the procedure, the sponge that was pushed into the vagina previously was removed and hemostasis was appreciated vaginally. The patient tolerated the procedure well and was taken to Recovery in stable condition. Sponge, lap, and needle counts were correct x2. Specimens include uterus, cervix, left fallopian tube, and ovary. | 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: , Symptomatic pericardial effusion.,POSTOPERATIVE DIAGNOSIS: , Symptomatic pericardial effusion.,PROCEDURE PERFORMED:, Subxiphoid pericardiotomy.,ANESTHESIA:, General via ET tube.,ESTIMATED BLOOD LOSS: , 50 cc.,FINDINGS:, This is a 70-year-old black female who underwent a transhiatal esophagectomy in November of 2003. She subsequently had repeat chest x-rays and CT scans and was found to have a moderate pericardial effusion. She had the appropriate inflammatory workup for pericardial effusion, however, it was nondiagnostic. Also, during that time, she had become significantly more short of breath. A dobutamine stress echocardiogram was performed, which was negative with the exception of the pericardial effusions. She had no tamponade physiology.,INDICATION FOR THE PROCEDURE: , For therapeutic and diagnostic management of this symptomatic pericardial effusion. Risks, benefits, and alternative measures were discussed with the patient. Consent was obtained for the above procedure.,PROCEDURE: , The patient was prepped and draped in the usual sterile fashion. A 4 cm incision was created in the midline above the xiphoid. Dissection was carried down through the fascia and the xiphoid was resected. The sternum was retracted superiorly the pericardium was identified and pericardial fat was cleared off the pericardium. An #0 silk suture was then placed into the pericardium with care taken not to enter the underlying heart.,This suture was used to retract the pericardium and the pericardium was nicked with #15 blade under direct visualization. Serous fluid exited through the pericardium and was sent for culture, cytology, and cell count etc. A section of pericardium was taken approximately 2 cm x 2 cm x 2 cm and was removed. The heart was visualized and appeared to be contracting well with no evidence of injury to the heart. The pericardium was then palpated. There was no evidence of studding. A right angle chest tube was then placed in the pericardium along the diaphragmatic of the pericardium and then brought out though a small skin incision in the epigastrium. It was sewn into place with #0 silk suture. There was some air leak of the left pleural cavity, so a right angle chest tube was placed in the left pleural cavity and brought out through a skin nick in the epigastrium. It was sewn in the similar way to the other chest tube. Once again, the area was inspected and found to be hemostatic and then closed with #0 Vicryl suture for fascial stitch, then #3-0 Vicryl suture in the subcutaneous fat, and then #4-0 undyed Vicryl in a running subcuticular fashion. The patient tolerated the procedure well. Chest tubes were placed on 20 cm of water suction. The patient was taken to PACU in stable condition. | 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: , Right wrist pain with an x-ray showing a scapholunate arthritic collapse pattern arthritis with osteophytic spurring of the radial styloid and a volar radial wrist mass suspected of being a volar radial ganglion.,POSTOPERATIVE DIAGNOSIS: , Right wrist pain with an x-ray showing a scapholunate arthritic collapse pattern arthritis with osteophytic spurring of the radial styloid and a volar radial wrist mass suspected of being a volar radial ganglion; finding of volar radial wrist mass of bulging inflammatory tenosynovitis from the volar radial wrist joint rather than a true ganglion cyst; synovitis was debrided and removed.,PROCEDURE: , Excision of volar radial wrist mass (inflammatory synovitis) and radial styloidectomy, right wrist.,ANESTHESIA:, Axillary block plus IV sedation.,ESTIMATED BLOOD LOSS:, Zero.,SPECIMENS,1. Inflammatory synovitis from the volar radial wrist area.,2. Inflammatory synovitis from the dorsal wrist area.,DRAINS:, None.,PROCEDURE DETAIL: , Patient brought to the operating room. After induction of IV sedation a right upper extremity axillary block anesthetic was performed by anesthesia staff. Routine prep and drape was employed. Patient received 1 gm of IV Ancef preoperatively. Arm was exsanguinated by means of elevation of Esmarch elastic tourniquet. Tourniquet inflated to 250 mmHg pressure. Hand positioned palm up in a lead hand-holder. A longitudinal zigzag incision over the volar radial wrist mass was made. Skin was sharply incised. Careful blunt dissection was used in the subcutaneous tissue. Antebrachial fascia was bluntly dissected and incised to reveal the radial artery. Radial artery was mobilized preserving its dorsal and palmar branches. Small transverse concomitant vein branches were divided to facilitate mobilization of the radial artery. Wrist mass was exposed by blunt dissection. This appeared to be an inflammatory arthritic mass from the volar radial wrist capsule. This was debrided down to the wrist capsule with visualization of the joint through a small capsular window. After complete volar synovectomy the capsular window was closed with 4-0 Mersilene figure-of-eight suture. Subcutaneous tissue was closed with 4-0 PDS and the skin was closed with a running subcuticular 4-0 Prolene. Forearm was pronated and C-arm image intensifier was used to confirm localization of the radial styloid for marking of the skin incision. An oblique incision overlying the radial styloid centered on the second extensor compartment was made. Skin was sharply incised. Blunt dissection was used in the subcutaneous tissue. Care was taken to identify and protect the superficial radial nerve. Blunt dissection was carried out in the extensor retinaculum. This was incised longitudinally over the second extensor compartment. EPL tendon was identified, mobilized and released to facilitate retraction and prevent injury. The interval between the ECRL and the ECRB was developed down to bone. Dorsal capsulotomy was made and local synovitis was identified. This was debrided and sent as second pathologic specimen. Articular surface of the scaphoid was identified and seen to be completely devoid of articular cartilage with hard, eburnated subchondral bone consistent with a SLAC pattern arthritis. Radial styloid had extensive spurring and was exposed subperiosteally and osteotomized in a dorsal oblique fashion preserving the volar cortex as the attachment point of the deep volar carpal ligament layer. Dorsally the styloidectomy was beveled smooth and contoured with a rongeur. Final x-rays documenting the styloidectomy were obtained. Local synovitis beneath the joint capsule was debrided. Remnants of the scapholunate interosseous which was completely deteriorated were debrided. The joint capsule was closed anatomically with 4-0 PDS and extensor retinaculum was closed with 4-0 PDS. Subcutaneous tissues closed with 4-0 Vicryl. Skin was closed with running subcuticular 4-0 Prolene. Steri-Strips were applied to wound edge closure; 10 cc of 0.5% plain Marcaine was infiltrated into the areas of the surgical incisions and radial styloidectomy for postoperative analgesia. A bulky gently compressive wrist and forearm bandage incorporating an EBI cooling pad were applied. Tourniquet was deflated. Good vascular color and capillary refill were seen to return to the tips of all digits. Patient discharged to the ambulatory recovery area and from there discharged home.,DISCHARGE PRESCRIPTIONS:,1. Keflex 500 mg tablets, #20, one PO q.6h. x 5 days.,2. Vicodin, 40 tablets, one to two PO q.4h. p.r.n.,3. Percocet, #20 tablets, one to two PO q.3-4h. p.r.n. severe pain. | 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 is a previously healthy 45-year-old gentleman. For the past 3 years, he has had some intermittent episodes of severe nausea and abdominal pain. On the morning of this admission, he had the onset of severe pain with nausea and vomiting and was seen in the emergency department, where Dr. XYZ noted an incarcerated umbilical hernia. He was able to reduce this, with relief of pain. He is now being admitted for definitive repair.,PAST MEDICAL HISTORY: , Significant only for hemorrhoidectomy. He does have a history of depression and hypertension.,MEDICATIONS: , His only medications are Ziac and Remeron.,ALLERGIES:, No allergies.,FAMILY HISTORY: , Negative for cancer.,SOCIAL HISTORY:, He is single. He has 2 children. He drinks 4-8 beers per night and smokes half a pack per day for 30 years. He was born in Salt Lake City. He works in an electronic assembly for Harmony Music. He has no history of hepatitis or blood transfusions.,PHYSICAL EXAMINATION:,GENERAL: Examination shows a moderate to markedly obese gentleman in mild distress since his initial presentation to the emergency department.,HEENT: No scleral icterus.,NECK: No cervical, supraclavicular, or axillary adenopathy.,LUNGS: Clear.,HEART: Regular. No murmurs or gallops.,ABDOMEN: As noted, obese with mildly visible bulging in the umbilicus at the superior position. With gentle traction, we were able to feel both herniated contents, which when reduced, reveals an approximately 2-cm palpable defect in the umbilicus.,DIAGNOSTIC STUDIES: ,Normal sinus rhythm on EKG, prolonged QT. Chest x-ray was negative. The abdominal x-rays were read as being negative. His electrolytes were normal. Creatinine was 0.9. White count was 6.5, hematocrit was 48, and platelet count was 307.,ASSESSMENT AND PLAN:, Otherwise previously healthy gentleman, who presents with an incarcerated umbilical hernia, now for repair with mesh. | 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 REASON FOR CONSULTATION:, Evaluate recurrent episodes of uncomfortable feeling in the left upper arm at rest, as well as during exertion for the last one month.,HISTORY OF PRESENT ILLNESS:, This 57-year-old black female complains of having pain and discomfort in the left upper arm, especially when she walks and after heavy meals. This lasts anywhere from a few hours and is not associated with shortness of breath, palpitations, dizziness, or syncope. Patient does not get any chest pain or choking in the neck or pain in the back. Patient denies history of hypertension, diabetes mellitus, enlarged heart, heart murmur, history suggestive of previous myocardial infarction, or acute rheumatic polyarthritis during childhood. Her exercise tolerance is one to two blocks for shortness of breath and easy fatigability.,MEDICATIONS:, Patient does not take any specific medications.,PAST HISTORY:, The patient underwent hysterectomy in 1986.,FAMILY HISTORY:, The patient is married, has four children who are doing fine. Family history is positive for hypertension, congestive heart failure, obesity, cancer, and cerebrovascular accident.,SOCIAL HISTORY:, The patient smokes one pack of cigarettes per day and takes drinks on social occasions. | 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: , Need for intravenous access.,POSTOPERATIVE DIAGNOSIS: , Need for intravenous access.,PROCEDURE PERFORMED: ,Insertion of a right femoral triple lumen catheter.,ANESTHESIA: , Includes 4 cc of 1% lidocaine locally.,ESTIMATED BLOOD LOSS: , Minimum.,INDICATIONS:, The patient is an 86-year-old Caucasian female who presented to ABCD General Hospital secondary to drainage of an old percutaneous endoscopic gastrostomy site. The patient is also ventilator-dependent, respiratory failure with tracheostomy in place and dependent on parenteral nutrition secondary to dysphagia and also has history of protein-calorie malnutrition and the patient needs to receive total parenteral nutrition and therefore needs central venous access.,PROCEDURE:, The patient's legal guardian was talked to. All questions were answered and consent was obtained. The patient was sterilely prepped and draped. Approximately 4 cc of 1% lidocaine was injected into the inguinal site. A strong femoral artery pulse was felt and triple lumen catheter Angiocath was inserted at 30-degree angle cephalad and aspirated until a dark venous blood was aspirated. A guidewire was then placed through the needle. The needle was then removed. The skin was ________ at the base of the wire and a dilator was placed over the wire. The triple lumen catheters were then flushed with bacteriostatic saline. The dilator was then removed from the guidewire and a triple lumen catheter was then inserted over the guidewire with the guidewire held at all times.,The wire was then carefully removed. Each port of the lumen catheter was aspirated with 10 cc syringe with normal saline till dark red blood was expressed and then flushed with bacteriostatic normal saline and repeated on the remaining two ports. Each port was closed off and also kept off. Straight needle suture was then used to suture the triple lumen catheter down to the skin. Peristatic agent was then placed at the site of the lumen catheter insertion and a Tegaderm was then placed over the site. The surgical site was then sterilely cleaned. The patient tolerated the full procedure well. There were no complications. The nurse was then contacted to allow for access of the triple lumen catheter. | 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' | XYZ, D.C.,60 Evergreen Place,Suite 902,East Orange, NJ 07018,Re: | 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:, Dorsal ganglion, right wrist.,POSTOPERATIVE DIAGNOSIS:, Dorsal ganglion, right wrist.,OPERATIONS PERFORMED:, Excision dorsal ganglion, right wrist.,ANESTHESIA:, Monitored anesthesia care with regional anesthesia applied by surgeon.,TOURNIQUET TIME:, minutes.,DESCRIPTION OF PROCEDURE: , With the patient under adequate anesthesia, the upper extremity was prepped and draped in a sterile manner. The arm was exsanguinated and the tourniquet was elevated to 290 mm/Hg. A transverse incision was made over the dorsal ganglion. Using blunt dissection the dorsal ulnar sensory nerve branches and radial sensory nerve branches were dissected and retracted out of the operative field. The extensor retinaculum was then incised and the extensor tendon was dissected and retracted out of the operative field. The ganglion was then further dissected to its origin from the dorsal distal scapholunate interosseus ligament and excised in toto. Care was taken to protect ligament integrity. Reactive synovium was then removed using soft tissue rongeur technique. The wound was then infiltrated with 0.25% Marcaine. The tendons were allowed to resume their normal anatomical position. The skin was closed with 3-0 Prolene subcuticular stitch. Sterile dressings were applied. The tourniquet was deflated. The patient was awakened from anesthesia and returned to the recovery room in satisfactory condition having tolerated the procedure well. | 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' | CARDIOLITE TREADMILL EXERCISE STRESS TEST,CLINICAL DATA:, This is a 72-year-old female with history of diabetes mellitus, hypertension, and right bundle branch block.,PROCEDURE:, The patient was exercised on the treadmill to maximum tolerance achieving after 5 minutes a peak heart rate of 137 beats per minute with a workload of 2.3 METS. There was a normal blood pressure response. The patient did not complain of any symptoms during the test and other than the right bundle branch block that was present at rest, no other significant electrographic abnormalities were observed.,Myocardial perfusion imaging was performed at rest following the injection of 10 mCi Tc-99 Cardiolite. At peak pharmacological effect, the patient was injected with 30 mCi Tc-99 Cardiolite.,Gating poststress tomographic imaging was performed 30 minutes after the stress.,FINDINGS:,1. The overall quality of the study is fair.,2. The left ventricular cavity appears to be normal on the rest and stress studies.,3. SPECT images demonstrate fairly homogeneous tracer distribution throughout the myocardium with no overt evidences of fixed and/or reperfusion defect.,4. The left ventricular ejection fraction was normal and estimated to be 78%.,IMPRESSION: , Myocardial perfusion imaging is normal. Result of this test suggests low probability for significant coronary artery disease. | 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 DIAGNOSES:,1. Hallux abductovalgus deformity, right foot.,2. Tailor bunion deformity, right foot.,POSTOPERATIVE DIAGNOSES:,1. Hallux abductovalgus deformity, right foot.,2. Tailor bunion deformity, right foot.,PROCEDURES PERFORMED: ,Tailor bunionectomy, right foot, Weil-type with screw fixation.,ANESTHESIA: , Local with MAC, local consisting of 20 mL of 0.5% Marcaine plain.,HEMOSTASIS:, Pneumatic ankle tourniquet at 200 mmHg.,INJECTABLES:, A 10 mL of 0.5% Marcaine plain and 1 mL of dexamethasone phosphate.,MATERIAL: , A 2.4 x 14 mm, 2.4 x 16 mm, and 2.0 x 10 mm OsteoMed noncannulated screw. A 2-0 Vicryl, 3-0 Vicryl, 4-0 Vicryl, and 5-0 nylon.,COMPLICATIONS: , None.,SPECIMENS: , None.,ESTIMATED BLOOD LOSS:, Minimal.,PROCEDURE IN DETAIL: , The patient was brought to the operating room and placed on the operating table in the usual supine position. At this time, a pneumatic ankle tourniquet was placed on the patient's right ankle for the purpose of maintaining hemostasis. Number of the anesthesias was obtained and then induced mild sedation and local anesthetic as described above was infiltrated about the surgical site. The right foot was then scrubbed, prepped, and draped in the usual aseptic manner. An Esmarch bandage was then used to exsanguinate the patient's right foot, and the pneumatic ankle tourniquet inflated to 200 mmHg. Attention was then directed to dorsal aspect of the first metatarsophalangeal joint where a linear longitudinal incision measuring approximately a 3.5 cm in length was made. The incision was carried deep utilizing both sharp and blunt dissections. All major neurovascular structures were avoided. At this time, through the original skin incision, attention was directed to the first intermetatarsal space where utilizing both sharp and blunt dissection the deep transverse intermetatarsal ligament was identified. This was then incised fully exposing the tendon and the abductor hallucis muscle. This was then resected from his osseous attachments and a small tenotomy was performed. At this time, a small lateral capsulotomy was also performed. Lateral contractures were once again reevaluated and noted to be grossly reduced.,Attention was then directed to the dorsal aspect of the first metatarsal phalangeal joint where linear longitudinal and periosteal and capsular incisions were made following the first metatarsal joint and following the original shape of the skin incision. The periosteal capsular layers were then reflected both medially and laterally from the head of the first metatarsal and a utilizing an oscillating bone saw, the head of the first metatarsal and medial eminence was resected and passed from the operative field. A 0.045 inch K-wire was then driven across the first metatarsal head in order to act as an access dye. The patient was then placed in the frog-leg position, and two osteotomy cuts were made, one from the access guide to the plantar proximal position and one from the access guide to the dorsal proximal position. The dorsal arm was made longer than the plantar arm to accommodate for fixation. At this time, the capital fragment was resected and shifted laterally into a more corrected position. At this time, three portions of the 0.045-inch K-wire were placed across the osteotomy site in order to access temporary forms of fixation. Two of the three of these K-wires were removed in sequence and following the standard AO technique two 3.4 x 15 mm and one 2.4 x 14 mm OsteoMed noncannulated screws were placed across the osteotomy site. Compression was noted to be excellent. All guide wires and 0.045-inch K-wires were then removed. Utilizing an oscillating bone saw, the overhanging wedge of the bone on the medial side of the first metatarsal was resected and passed from the operating field. The wound was then once again flushed with copious amounts of sterile normal saline. At this time, utilizing both 2-0 and 3-0 Vicryl, the periosteal and capsular layers were then reapproximated. At this time, the skin was then closed in layers utilizing 4-0 Vicryl and 4-0 nylon. At this time, attention was directed to the dorsal aspect of the right fifth metatarsal where a linear longitudinal incision was made over the metatarsophalangeal joint just lateral to the extensor digitorum longus tension. Incision was carried deep utilizing both sharp and blunt dissections and all major neurovascular structures were avoided.,A periosteal and capsular incision was then made on the lateral aspect of the extensor digitorum longus tendon and periosteum and capsular layers were then reflected medially and laterally from the head of the fifth metatarsal. Utilizing an oscillating bone saw, the lateral eminence was resected and passed from the operative field. Utilizing the sagittal saw, a Weil-type osteotomy was made at the fifth metatarsal head. The head was then shifted medially into a more corrected position. A 0.045-inch K-wire was then used as a temporary fixation, and a 2.0 x 10 mm OsteoMed noncannulated screw was placed across the osteotomy site. This was noted to be in correct position and compression was noted to be excellent. Utilizing a small bone rongeur, the overhanging wedge of the bone on the dorsal aspect of the fifth metatarsal was resected and passed from the operative field. The wound was once again flushed with copious amounts of sterile normal saline. The periosteal and capsular layers were reapproximated utilizing 3-0 Vicryl, and the skin was then closed utilizing 4-0 Vicryl and 4-0 nylon. At this time, 10 mL of 0.5% Marcaine plain and 1 mL of dexamethasone phosphate were infiltrated about the surgical site. The right foot was then dressed with Xeroform gauze, fluffs, Kling, and Ace wrap, all applied in mild compressive fashion. The pneumatic ankle tourniquet was then deflated and a prompt hyperemic response was noted to all digits of the right foot. The patient was then transported from the operating room to the recovery room with vital sings stable and neurovascular status grossly intact to the right foot. After a brief period of postoperative monitoring, the patient was discharged to home with proper written and verbal discharge instructions, which included to keep dressing clean, dry, and intact and to follow up with Dr. A. The patient is to be nonweightbearing to the right foot. The patient was given a prescription for pain medications on nonsteroidal anti-inflammatory drugs and was educated on these. The patient tolerated the procedure and anesthesia well. Dr. A was present throughout the entire case. | 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' | DIAGNOSIS:, Status post brain tumor removal.,HISTORY:, The patient is a 64-year-old female referred to physical therapy following complications related to brain tumor removal. The patient reports that on 10/24/08 she had a brain tumor removed and had left-sided weakness. The patient was being seen in physical therapy from 11/05/08 to 11/14/08 then she began having complications. The patient reports that she was admitted to Hospital on 12/05/08. At that time, they found massive swelling on the brain and a second surgery was performed. The patient then remained in acute rehab until she was discharged to home on 01/05/09. The patient's husband, Al, is also present and he reports that during rehabilitation the patient did have a DVT in the left calf that has since been resolved.,PAST MEDICAL HISTORY: , Unremarkable.,MEDICATIONS: ,Coumadin, Keppra, Decadron, and Glucophage.,SUBJECTIVE: , The patient reports that the pain is not an issue at this time. The patient states that her primary concern is her left-sided weakness as related to her balance and her walking and her left arm weakness.,PATIENT GOAL: ,To increase strength in her left leg for better balance and walking.,OBJECTIVE:,RANGE OF MOTION: Bilateral lower extremities are within normal limits.,STRENGTH: Bilateral lower extremities are grossly 5/5 with one repetition, except left hip reflexion 4+/5.,BALANCE: The patient's balance was assessed with a Berg balance test. The patient has got 46/56 points, which places her at moderate risk for falls.,GAIT: The patient ambulates with contact guard assist. The patient ambulates with a reciprocal gait pattern with good bilateral foot clearance. However, the patient has been reports that with increased fatigue, left footdrop tends to occur. A 6-minute walk test will be performed at the next visit due to time constraints.,ASSESSMENT: , The patient is a 64-year-old female referred to Physical Therapy status post brain surgery. Examination indicates deficits in strength, balance, and ambulation. The patient will benefit from skilled physical therapy to address these impairments.,TREATMENT PLAN: , The patient will be seen three times per week for 4 weeks and then reduce it to two times per week for 4 additional weeks. Interventions include:,1. Therapeutic exercise.,2. Balance training.,3. Gait training.,4. Functional mobility training.,SHORT TERM GOAL TO BE COMPLETED IN 4 WEEKS:,1. The patient is to tolerate 30 repetitions of all lower extremity exercises.,2. The patient is to improve balance with a score of 50/56 points.,3. The patient is to ambulate 1000 feet in a 6-minute walk test with standby assist.,LONG TERM GOAL TO BE ACHIEVED IN 8 WEEKS:,1. The patient is to ambulate independently within her home and standby to general supervision within the community.,2. Berg balance test to be 52/56.,3. The patient is to ambulate a 6-minute walk test for 1500 feet independently including safe negotiation of corners and busy areas.,4. The patient is to demonstrate safely stepping over and around objects without loss of balance.,Prognosis for the above-stated goals is good. The above treatment plan has been discussed with the patient and her husband. They are in agreement. | Physical Medicine - Rehab |
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: , Chest pain and fever.,HISTORY OF PRESENT ILLNESS: , This 48-year-old white married female presents in the emergency room after two days of increasing fever with recent diagnosis of urinary tract infection on outpatient treatment with nitrofurantoin. The patient noted since she began to feel poorly earlier on the day of admission, had an episode of substernal chest discomfort that was associated with nausea, dizziness, and sweating. The patient does have a past medical history of diabetes and hypertension. In addition, the patient complained of some neck and head discomfort for which she underwent a lumbar puncture in the emergency room; this was normal, causes turned out to be normal as well. The patient denies nosebleed, visual changes, nausea, vomiting, diarrhea or changes in bowel habits. She has not had any musculoskeletal or neurological deficits. She denies any rashes or skin lesions.,PAST MEDICAL HISTORY: ,Hypertension, diabetes, hyperlipidemia, particularly elevated triglycerides with a slightly elevated LDL at 81 with an new standard LDL of 74, diabetics with a bad family history for cardiovascular disease such as this patient does have, and postmenopausal hot flashes.,PAST SURGICAL HISTORY: ,Cholecystectomy, appendectomy, oophorectomy.,FAMILY HISTORY: , Positive for coronary artery disease in her father and brother in their 40s.,SOCIAL HISTORY: , She is married and does not smoke or drink nor did she ever.,PHYSICAL EXAMINATION: , On admission, temperature 99.4 degrees F., blood pressure 137/60, pulse 90 and regular without ectopy, respiratory rate 20 without unusual respiratory effort. In general, she is well developed, well nourished, oriented, and alert and in no apparent distress. Head, ears, eyes, nose, and throat are unremarkable. Neck is supple. No neck vein distention is noted. No bruits are heard. Chest is clear to percussion and auscultation. Heart has a regular rhythm and rate without murmurs or rubs or gallops. Abdomen is soft, obese, and nontender. Musculoskeletal is intact without deformity. However, the patient did develop severe cramp behind her left knee during her treadmill testing. Neurologic: Cranial nerves are intact and she is nonfocal. Skin is warm and dry without rash or lesions noted.,LABORATORY FINDINGS: , Glucose 162, BUN 14, creatinine 1.0, sodium 137, potassium 3.6, chloride 103, bicarbonate 23, protein 4.2. Liver function panel is normal. CK was 82. MB fraction was 1.0. Troponin was less than 0.1 on three occasions. White count was 12,200 with a normal differential, hemoglobin was 12.1, platelet count 230,000. Urinalysis showed positive nitrites, positive leukocyte esterase, 5 to 10 white cells per high power field, and 1+ bacteria rods. Spinal fluid was clear with 11 red cells, glucose 75, protein 67, white count 0. EKG was normal.,DIAGNOSES ON ADMISSION:,1. Urinary tract infection.,2. Chest pain of unclear etiology, rule out myocardial infarction.,3. Neck and back pain of unclear etiology with a negative spinal tap.,4. Hypertension.,5. Diabetes type II, not treated with insulin.,6. Hyperlipidemia treated with TriCor but not statins.,7. Arthritis.,ADDITIONAL LABORATORY STUDIES:, B-natriuretic peptide was 26. Urine smear and culture negative on 24 and 48 hours. Chest x-ray was negative. Lipid panel - triglycerides 249, VLDL 49, HDL 33, LDL 81.,COURSE IN THE HOSPITAL: , The patient was placed on home medications. This will be listed at the end of the discharge summary. She was put on rule out acute myocardial infarction routine, and she did in fact rule out. She had a stress test completed on the day of discharge which was normal, and she was discharged with a diagnoses of chest pain, acute myocardial infarction ruled out, urinary tract infection, fever secondary to UTI, diabetes mellitus type 2 non-insulin treated, hyperlipidemia with elevated triglycerides and an LDL elevated to 81 with new normal being less than 70. She has a strong family history of early myocardial disease in the men in their 40s.,DISCHARGE MEDICATIONS:,1. Enteric-coated aspirin 81 mg one daily. This is new, as the patient was not taking aspirin at home.,2. TriCor 48 mg one daily.,3. Zantac 40 mg one daily.,4. Lisinopril 20 mg one daily.,5. Mobic 75 mg one daily for arthritis.,6. Metformin 500 mg one daily.,7. Macrodantin one two times a day for several more days.,8. Zocor 20 mg one daily, which is a new addition.,9. Effexor XR 37.5 mg one daily.,DIET: , ADA 1800-calorie diet.,ACTIVITY:, As tolerated. Continue water exercise five days a week.,DISPOSITION: , Recheck at Hospital with a regular physician there in 1 week. Consider Byetta as an adjunct to her diabetic treatment and efforts to weight control. | 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: , Right tympanic membrane perforation.,POSTOPERATIVE DIAGNOSIS: , Right tympanic membrane perforation along with chronic otitis media.,PROCEDURE: , Right ear examination under anesthesia.,INDICATIONS: , The patient is a 15-year-old child with history of a right tympanic membrane perforation following tube placement as well as right conductive hearing loss. Exam in the office revealed a posterior superior right marginal tympanic perforation. Risks and benefits of surgery including risk of bleeding, general anesthesia, hearing loss as well as recurrent perforation were discussed with the mother. The mother wished to proceed with surgery.,FINDINGS:, The patient was brought to the room, placed in supine position, given general endotracheal anesthesia. The postauricular crease was then injected with 1% Xylocaine with 1:200,000 epinephrine along with external meatus. An area of the scalp was shaved above the ear and then also 1% Xylocaine with 1:200,000 epinephrine injected, a total of 4 mL local anesthetic was used. The ear was then prepped and draped in the usual sterile fashion. The microscope was then brought into view and examining the marginal perforation, the patient was noted to have large granuloma under the tympanic membrane at the anterior border of the drum. The granulation tissue was debrided as much as possible. Decision was made to cancel the tympanoplasty after debriding the middle ear space as much as possible. The middle ear space was filled with Floxin drops. The patient woke up anesthesia, extubated, and brought to recovery room in stable condition. There were no intraoperative complications. Needle and sponge was correct. Estimated blood loss minimal. | 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' | MULTISYSTEM EXAM,CONSTITUTIONAL: ,The vital signs showed that the patient was afebrile; blood pressure and heart rate were within normal limits. The patient appeared alert.,EYES: ,The conjunctiva was clear. The pupil was equal and reactive. There was no ptosis. The irides appeared normal.,EARS, NOSE AND THROAT: ,The ears and the nose appeared normal in appearance. Hearing was grossly intact. The oropharynx showed that the mucosa was moist. There was no lesion that I could see in the palate, tongue. tonsil or posterior pharynx.,NECK: ,The neck was supple. The thyroid gland was not enlarged by palpation.,RESPIRATORY: ,The patient's respiratory effort was normal. Auscultation of the lung showed it to be clear with good air movement.,CARDIOVASCULAR: ,Auscultation of the heart revealed S1 and S2 with regular rate with no murmur noted. The extremities showed no edema.,GASTROINTESTINAL: , The abdomen was soft, nontender with no rebound, no guarding, no enlarged liver or spleen. Bowel sounds were present.,GU: , The scrotal elements were normal. The testes were without discrete mass. The penis showed no lesion, no discharge.,LYMPHATIC: ,There was no appreciated node that I could feel in the groin or neck area.,MUSCULOSKELETAL: ,The head and neck by inspection showed no obvious deformity. Again, the extremities showed no obvious deformity. Range of motion appeared to be normal for the upper and lower extremities.,SKIN: , Inspection of the skin and subcutaneous tissues appeared to be normal. The skin was pink, warm and dry to touch.,NEUROLOGIC: ,Deep tendon reflexes were symmetrical at the patellar area. Sensation was grossly intact by touch.,PSYCHIATRIC: , The patient was oriented to time, place and person. The patient's judgment and insight appeared to be normal. | 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' | OPERATION PERFORMED:, Phacoemulsification of cataract and posterior chamber lens implant, right eye., ,ANESTHESIA:, Retrobulbar nerve block, right eye, ,DESCRIPTION OF OPERATION: ,The patient was brought to the operating room where local anesthetic was administered to the right eye followed by a dilute drop of Betadine and a Honan balloon. Once anesthesia was achieved, the right eye was prepped with Betadine, rinsed with saline, and draped in a sterile fashion. A lid speculum was placed and 4-0 silk sutures passed under the superior and inferior rectus muscles stabilizing the globe. A fornix-based conjunctival flap was prepared superiorly from 10 to 12 o'clock and episcleral vessels were cauterized using a wet-field. A surgical groove was applied with a 69 Beaver blade 1 mm posterior to the limbus in a frown configuration in the 10 to 12 o'clock position. A lamellar dissection was carried anteriorly to clear cornea using a crescent knife. A stab incision was applied with a Superblade at the 2 o'clock position at the limbus. The chamber was also entered through the lamellar groove using a 3-mm keratome in a beveled fashion. Viscoat was injected into the chamber and an anterior capsulorrhexis performed. Hydrodissection was used to delineate the nucleus and the phacoemulsification tip was inserted into the chamber. A deep linear groove was dissected through the nucleus vertically and the nucleus was rotated 90 degrees with the assistance of a spatula through the side-port incision. A second groove was dissected perpendicular to the first and the nucleus was fractured into quadrants. Each quadrant was emulsified under burst power within the capsular bag. The epinuclear bowl was manipulated with vacuum, flipped into the iris plane, and emulsified under pulse power. I&A was used to aspirate cortex from the capsular bag. A scratcher was used to polish the capsule, and Viscoat was injected inflating the capsular bag and chamber. The wound was enlarged with a shortcut blade to 5.5 mm. The intraocular lens was examined, found to be adequate, irrigated with balanced salt, and inserted into the capsular bag. The lens centralized nicely and Viscoat was removed using the I&A. Balanced salt was injected through the side-port incision. The wound was tested, found to be secure, and a single 10-0 nylon suture was applied to the wound with the knot buried within the sclera. The conjunctiva was pulled over the suture, and Ancef 50 mg and Decadron 4 mg were injected sub-Tenon in the inferonasal and inferotemporal quadrants. Maxitrol ointment was applied topically followed by an eye pad and shield. The patient tolerated the procedure and was taken from the operating room in good condition. | 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' | GENERAL: ,XXX,VITAL SIGNS: , Blood pressure XXX, pulse XXX, temperature XXX, respirations XXX. Height XXX, weight XXX.,HEAD: , Normocephalic. Negative lesions, negative masses.,EYES: , PERLA, EOMI. Sclerae clear. Negative icterus, negative conjunctivitis.,ENT:, Negative nasal hemorrhages, negative nasal obstructions, negative nasal exudates. Negative ear obstructions, negative exudates. Negative inflammation in external auditory canals. Negative throat inflammation or masses.,SKIN: , Negative rashes, negative masses, negative ulcers. No tattoos.,NECK:, Negative palpable lymphadenopathy, negative palpable thyromegaly, negative bruits.,HEART:, Regular rate and rhythm. Negative rubs, negative gallops, negative murmurs.,LUNGS:, Clear to auscultation. Negative rales, negative rhonchi, negative wheezing.,ABDOMEN: , Soft, nontender, adequate bowel sounds. Negative palpable masses, negative hepatosplenomegaly, negative abdominal bruits.,EXTREMITIES: , Negative inflammation, negative tenderness, negative swelling, negative edema, negative cyanosis, negative clubbing. Pulses adequate bilaterally.,MUSCULOSKELETAL:, Negative muscle atrophy, negative masses. Strength adequate bilaterally. Negative movement restriction, negative joint crepitus, negative deformity.,NEUROLOGIC: , Cranial nerves I through XII intact. Negative gait disturbance. Balance and coordination intact. Negative Romberg, negative Babinski. DTRs equal bilaterally.,GENITOURINARY: ,Deferred., | 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:, A is here for a follow up appointment at our Pediatric Rheumatology Clinic as well as the CCS Clinic. A is a 17-year-old male with oligoarticular arthritis of his right knee. He had a joint injection back in 03/2007 and since then he has been doing relatively well. He is taking Indocin only as needed even though he said he has pain regularly, and he said that his knee has not changed since the beginning, but he said he only takes the medicine when he has pain, which is not every day, but almost every day. He denies any swelling more than what it was before, and he denies any other joints are affected at this moment. Denies any fevers or any rashes.,PHYSICAL EXAMINATION:, On physical examination, his temperature is 98.6, weight is 104.6 kg; which is 4.4 kg less than before, 108/70 is his blood pressure, weight is 91.0 kg, and his pulse is 80. He is alert, active, and oriented in no distress. He has no facial rashes, no lymphadenopathy, no alopecia. Funduscopic examination is within normal limit. He has no cataracts and symmetric pupils to light and accommodation. His chest is clear to auscultation. The heart has a regular rhythm with no murmur. The abdomen is soft and nontender with no : visceromegaly. Musculoskeletal examination showed good range of motion of all his upper extremities with no swelling or tenderness. Lower extremities: He still has some weakness of the knees, hip areas, and the calf muscles. He does have minus/plus swelling of the right knee with a very hypermobile patella. There is no limitation in his range of motion, and the swelling is very minimal with some mild tenderness.,In terms of his laboratories, they were not done today.,ASSESSMENT: , This is a 17-year-old male with oligoarticular arthritis. He is HLA-B27 negative.,PLAN:, In terms of the plan, I discussed with him what things he should be taking and the fact that since he has persistent symptoms, he should be on medication every day. I am going to switch him to Indocin 75 mg SR just to give more sustained effect to his joints, and if he does not respond to this or continue with the symptoms, we may need to get an MRI. We will see him back in three months. He was evaluated by our physical therapist, who gave him some recommendations in terms of exercise for his lower extremities. Future plans for A may include physical therapy and more stronger medications as well as imaging studies with an MRI. Today he received his flu shot. Discussed this with A and his aunt and they had no further questions. | 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 gastric biopsies.,INDICATION:, Abdominal pain.,FINDINGS:, Antral erythema; 2 cm polypoid pyloric channel tissue, questionable inflammatory polyp which was biopsied; duodenal erythema and erosion.,MEDICATIONS: , Fentanyl 200 mcg and versed 6 mg.,SCOPE: , GIF-Q180.,PROCEDURE DETAIL: , Following the preprocedure patient assessment the procedure, goals, risks including bleeding, perforation and side effects of medications and alternatives were reviewed. Questions were answered. Pause preprocedure was performed.,Following titrated intravenous sedation the flexible video endoscope was introduced into the esophagus and advanced to the second portion of the duodenum without difficulty. The esophagus appeared to have normal motility and mucosa. Regular Z line was located at 44 cm from incisors. No erosion or ulceration. No esophagitis.,Upon entering the stomach gastric mucosa was examined in detail including retroflexed views of cardia and fundus. There was pyloric channel and antral erythema, but no visible erosion or ulceration. There was a 2 cm polypoid pyloric channel tissue which was suspicious for inflammatory polyp. This was biopsied and was placed separately in bottle #2. Random gastric biopsies from antrum, incisura and body were obtained and placed in separate jar, bottle #1. No active ulceration was found.,Upon entering the duodenal bulb there was extensive erythema and mild erosions, less than 3 mm in length, in first portion of duodenum, duodenal bulb and junction of first and second part of the duodenum. Postbulbar duodenum looked normal.,The patient was assessed upon completion of the procedure. Okay to discharge once criteria met.,Follow up with primary care physician.,I met with patient afterward and discussed with him avoiding any nonsteroidal anti-inflammatory medication. Await biopsy results. | 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:, Left hemibody numbness.,HX:, This 44y/o RHF awoke on 7/29/93 with left hemibody numbness without tingling, weakness, ataxia, visual or mental status change. She had no progression of her symptoms until 7/7/93 when she notices her right hand was stiff and clumsy. She coincidentally began listing to the right when walking. She denied any recent colds/flu-like illness or history of multiple sclerosis. She denied symptoms of Lhermitte's or Uhthoff's phenomena.,MEDS:, none.,PMH:, 1)Bronchitis twice in past year (last 2 months ago).,FHX:, Father with HTN and h/o strokes at ages 45 and 80; now 82 years old. Mother has DM and is age 80.,SHX:, Denies Tobacco/ETOH/illicit drug use.,EXAM:, BP112/76 HR52 RR16 36.8C,MS: unremarkable.,CN: unremarkable.,Motor: 5/5 strength throughout except for slowing of right hand fine motor movement. There was mildly increased muscle tone in the RUE and RLE.,Sensory: decreased PP below T2 level on left and some dysesthesias below L1 on the left.,Coord: positive rebound in RUE.,Station/Gait: unremarkable.,Reflexes: 3+/3 throughout all four extremities. Plantar responses were flexor, bilaterally.,Rectal exam not done.,Gen exam reportedly "normal.",COURSE:, GS, CBC, PT, PTT, ESR, Serum SSA/SSB/dsDNA, B12 were all normal. MRI C-spine, 7/145/93, showed an area of decreased T1 and increased T2 signal at the C4-6 levels within the right lateral spinal cord. The lesion appeared intramedullary and eccentric, and peripherally enhanced with gadolinium. Lumbar puncture, 7/16/93, revealed the following CSF analysis results: RBC 0, WBC 1 (lymphocyte), Protein 28mg/dl, Glucose 62mg/dl, CSF Albumin 16 (normal 14-20), Serum Albumin 4520 (normal 3150-4500), CSF IgG 4.1mg/dl (normal 0-6.2), CSF IgG, % total CSF protein 15% (normal 1-14%), CSF IgG index 1.1 (normal 0-0.7), Oligoclonal bands were present. She was discharged home.,The patient claimed her symptoms resolved within one month. She did not return for a scheduled follow-up MRI C-spine. | 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:, Left nasolabial fold scar deformity with effacement of alar crease.,POSTOPERATIVE DIAGNOSIS:, Left nasolabial fold scar deformity with effacement of alar crease.,PROCEDURES PERFORMED:,1. Left midface elevation with nasolabial fold elevation.,2. Left nasolabial fold z-plasty and right symmetrization midface elevation.,ANESTHESIA: , General endotracheal intubation.,ESTIMATED BLOOD LOSS: , Less than 25 mL.,FLUIDS: , Crystalloid,CULTURES TAKEN: , None.,PATIENT'S CONDITION: , Stable.,IMPLANTS: , Coapt Endotine Midface B 4.5 bioabsorbable implants, reference #CFD0200197, lot #01447 used on the right and used on the left side.,IDENTIFICATION: , This patient is well known to the Stanford Plastic Surgery Service. The patient is status post resection of the dorsal nasal sidewall skin cancer with nasolabial flap reconstruction with subsequent deformity. In particular, the patient has had effacement of his alar crease with deepening of his nasolabial fold and notable asymmetry. The patient was seen in consultation and felt to be a surgical candidate for improvement. Risks and benefits of the operation were described to the patient in detail including, but not limited to bleeding, infection, scarring, possible damage to surrounding structures including neurovascular structures, need for revision of surgery, continued asymmetry, and anesthetic complication. The patient understood these risks and benefits and consented to the operation.,PROCEDURE IN DETAIL: , The patient was taken to OR and placed supine on the operating table. Dose of antibiotics was given to the patient. Compression devices were placed on the lower extremities to prevent the knee embolic events. The patient was turned to 180 degrees. The ETT tube was secured and the area was then prepped and draped in usual sterile fashion. A head wrap was then placed on the position and we then began our local. Of note, the patient had previous incisions just lateral to his lateral canthus bilaterally and that were used for access. Local consisting a 50:50 mix of 0.25% Marcaine with epinephrine and 1% lidocaine with epinephrine was then injected into the subperiosteal plane taking care to prevent injury to the infraorbital nerves. This was done bilaterally. We then marked the nasolabial fold and began with the elevation of the left midface.,We began with a lateral canthal-type incision extending out over his previous incision down to subcutaneous tissue. We continued down to the lateral orbital rim until we identified periosteum. We then pulled in a periosteal elevator and elevated the midface down over the zygoma elevating some lateral mesenteric attachments down over the buccal region until we felt we had reached pass the nasolabial folds medially. Care was taken to preserve the infraorbital nerve and that was visualized after elevation. We then released the periosteum distally and retracted up on the periosteum and noted improved contour of the nasolabial fold with increased bulk over the midface region over the zygoma.,We then used our Endotine Coapt device to engage the periosteum at the desired location and then elevated the midface and secured into position using the Coapt bioabsorbable screw. After this was then carried out, we then clipped and cut as well as the end of the screw. Satisfied with this, we then elevated the periosteum and secured it to reinforce our midface elevation to the lateral orbital rim and this was done using 3-0 Monocryl. Several sutures were then used to anchor the orbicularis and deeper tissue to create additional symmetry. Excess skin along the incision was then removed as well the skin from just lateral to the canthus. Care was taken to leave the orbicularis muscle down. We then continued closing our incision using absorbable plain gut 5-0 sutures for the subciliary-type incision and then continuing with interrupted 6-0 Prolenes lateral to the canthus.,We then turned our attention to performing the z-plasty portion of the case. A z-plasty was designed along the previous scar where it was padding to the notable scar deformity and effacement of crease and the z-plasty was then designed to lengthen along the scar to improve the contour. This was carried out using a 15 blade down to subcutaneous tissue. The flaps were debulked slightly to reduce the amount of fullness and then transposed and sutured into place using chromic suture. At this point, we then noted that he had improvement of the nasal fold but continued asymmetry with regards to improved bulk on the left side and less bulk on the right and it was felt that a symmetrization procedure was required to make more symmetry with the midface bilaterally and nasolabial folds bilaterally. As such, we then carried out the dissection after injecting local as noted and we used a 15 blade scalpel to create our incision along the lateral canthus along its preexisting incision. We carried this down to the lateral orbital rim again elevating the periosteum taking care to preserve infraorbital nerve.,At this point, we then released the periosteum distally just at the level of the nasolabial fold and placed our Endotine midface implant into the desired area and then elevated slightly just for symmetry only. This was then secured in place using the bioabsorbable screw and then resected a very marginal amount of tissue just for removal of the dog ear deformity and closed the deeper layers of tissue using 3-0 PDS and then closing the extension to the subciliary area using 5-0 plain gut and then 6-0 Prolene lateral to the canthus.,At this point, we felt that we had achieved improved contour, improved symmetry, and decreased effacement of the nasolabial fold and alar crease. Satisfied with our procedures, we then placed cool compresses on to the eyes.,The patient was then extubated and brought to the PACU in stable condition.,Dr. X was present and scrubbed for the entire case and actively participated during all key elements. Dr. Y was available and participated in the portions of the case as well. | Cosmetic / Plastic 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. Torn lateral meniscus, right knee.,2. Chondromalacia of the patella, right knee.,POSTOPERATIVE DIAGNOSES:,1. Torn lateral meniscus, right knee.,2. Chondromalacia of the patella, right knee.,PROCEDURE PERFORMED:,1. Arthroscopic lateral meniscoplasty.,2. Patellar shaving of the right knee.,ANESTHESIA: ,General.,COMPLICATIONS: , None.,ESTIMATED BLOOD LOSS: , Minimal.,TOTAL TOURNIQUET TIME:, Zero.,GROSS FINDINGS: , A complex tear involving the lateral and posterior horns of the lateral meniscus and grade-II chondromalacia of the patella.,HISTORY OF PRESENT ILLNESS: , The patient is a 45-year-old Caucasian male presented to the office complaining of right knee pain. He complained of pain on the medial aspect of his right knee after an injury at work, which he twisted his right knee.,PROCEDURE: ,After all potential complications, risks, as well as anticipated benefits of the above-named procedures were discussed at length with the patient, informed consent was obtained. The operative extremity was then confirmed with the operative surgeon, the patient, the Department of Anesthesia and the nursing staff.,The patient was then transferred to preoperative area to Operative Suite #2, placed on the operating table in supine position. Department of Anesthesia administered general anesthetic to the patient. All bony prominences were well padded at this time. The right lower extremity was then properly positioned in a Johnson knee holder. At this time, 1% lidocaine with epinephrine 20 cc was administered to the right knee intra-articularly under sterile conditions. The right lower extremity was then sterilely prepped and draped in usual sterile fashion. Next, after all bony soft tissue landmarks were identified, an inferolateral working portal was established by making a 1-cm transverse incision at the level of the joint line lateral to the patellar tendon. The cannula and trocar were then inserted through this, putting the patellofemoral joint. An arthroscopic camera was then inserted and the knee was sequentially examined including the patellofemoral joint, the medial and lateral gutters, medial lateral joints, and the femoral notch. Upon viewing of the patellofemoral joint, there was noted to be grade-II chondromalacia changes of the patella. There were no loose bodies noted in the either gutter. Upon viewing of the medial compartment, there was no chondromalacia or meniscal tear was noted. While in this area, attention was directed to establish the inferomedial instrument portal. This was first done using a spinal needle for localization followed by 1-cm transverse incision at the joint line. A probe was then inserted through this portal and the meniscus was further probed. Again, there was noted to be no meniscal tear. The knee was taken through range of motion and there was no chondromalacia. Upon viewing of the femoral notch, there was noted to be intact ACL with negative drawer sign. PCL was also noted to be intact. Upon viewing of the lateral compartment, there was noted to be a large bucket-handle tear involving the lateral and posterior horns. It was reduced from the place, however, involved the white and red white area was elected to excise the bucket-handle. An arthroscopic scissor was then inserted and the two remaining attachments the posterior and lateral attachments were then clipped and a Schlesinger grasper was then used to remove the resected meniscus. It was noted that the meniscus was followed out to the whole and the entire piece was taken out of the knee. Pictures were taken both pre-meniscal resection and post-meniscal resection. The arthroscopic shaver was then inserted into the medial portal and the remaining meniscus was contoured. The lateral gutter was then examined and was noted to be no loose bodies and ______ was intact. Next, attention was directed to the inner surface of the patella. This was debrided using the 2.5 arthroscopic shaver. It was noted to be quite smooth and postprocedure the patient was taken ________ well. The knee was then copiously irrigated and suctioned dry and all instrumentation was removed. 20 cc of 0.25% Marcaine was then administered to each portal as well as intra-articularly.,Sterile dressing was then applied consisting of Adaptic, 4x4s, ABDs, and sterile Webril and a stockinette to the right lower extremity. At this time, Department of Anesthesia reversed the anesthetic. The patient was transferred back to the hospital gurney to the Postanesthesia Care Unit. The patient tolerated the procedure 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' | TITLE OF PROCEDURE: ,Coronary artery bypass grafting times three utilizing the left internal mammary artery, left anterior descending and reversed autogenous saphenous vein graft to the posterior descending branch of the right coronary artery and obtuse marginal coronary artery, total cardiopulmonary bypass, cold blood potassium cardioplegia, antegrade and retrograde, for myocardial protection.,DESCRIPTION OF PROCEDURE: ,The patient was brought to the operating room and placed in the supine position. Adequate general endotracheal anesthesia was induced. Appropriate monitoring devices were placed. The chest, abdomen and legs were prepped and draped in the sterile fashion. The right greater saphenous vein was harvested and prepared by ligating all branches with 4-0 Surgilon and flushed with heparinized blood. Hemostasis was achieved in the legs and closed with running 2-0 Dexon in the subcutaneous tissue and running 3-0 Dexon subcuticular in the skin. Median sternotomy incision was made and the left mammary artery was dissected free from its takeoff of the subclavian to its bifurcation at the diaphragm and surrounded with papaverine-soaked gauze. The pericardium was opened. The pericardial cradle was created. The patient was fully heparinized and cannulated with a single aortic and single venous cannula and bypass was instituted. A retrograde cardioplegic cannula was placed with a pursestring suture of 4-0 Prolene suture in the right atrial wall into the coronary sinus and tied to a Rumel tourniquet. An antegrade cardioplegic needle sump combination was placed in the ascending aorta and tied in place with 4-0 Prolene. The ascending aorta was crossclamped. Cold blood potassium cardioplegia was given to the ascending aorta followed by sumping through the ascending aorta followed by cold retrograde potassium cardioplegia. The obtuse marginal coronary artery was identified and opened and end-to-side anastomosis was performed to the reversed autogenous saphenous vein with running 7-0 Prolene suture and the vein was cut to length. Cold antegrade and retrograde cardioplegia were given and the posterior descending branch of the right coronary artery was identified and opened. End-to-side anastomosis was performed with a running 7-0 Prolene suture and the vein was cut to length. Cold antegrade and retrograde potassium cardioplegia were given. The mammary artery was clipped distally, divided and spatulated for anastomosis. The anterior descending was identified and opened. End-to-side anastomosis was performed through the left internal mammary artery with running 8-0 Prolene suture. The mammary pedicle was sutured to the heart with interrupted 5-0 Prolene suture. A warm antegrade and retrograde cardioplegia were given. The aortic crossclamp was removed. The partial occlusion clamp was placed. Aortotomies were made. The veins were cut to fit these and sutured in place with running 5-0 Prolene suture. A partial occlusion clamp was removed. All anastomoses were inspected and noted to be patent and dry. Ventricular and atrial pacing wires were placed. The patient was fully warmed and weaned from cardiopulmonary bypass. The patient was decannulated in the routine fashion and Protamine was given. Good hemostasis was noted. A single mediastinal and left pleural chest tube were placed. The sternum was closed with interrupted wire, linea alba with running 0 Prolene, the sternal fascia was closed with running 0 Prolene, the subcutaneous tissue with running 2-0 Dexon and the skin with running 3-0 Dexon subcuticular stitch. The patient tolerated the procedure well. | 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' | Initially a small incision was made in the right superior hemiscrotum and the incision was carried down to the vas deferens. This incision was carried down to the area of the previous vasectomy. A towel clip was placed around this. Next the scarred area was dissected free back to normal vas proximally and distally. Approximately 4 cm of vas was freed up. Next the vas was amputated above and below the scar tissue. Fine hemostats were used to grasp the adventitial tissue on each side of the vas, both the proximal and distal ends. Both ends were then dilated very carefully with lacrimal duct probes up to a #2 successfully. After accomplishing this, fluid could be milked from the proximal vas which was encouraging.,Next the reanastomosis was performed. Three 7-0 Prolene were used and full thickness bites were taken through the muscle layer of the vas deferens and into the lumen. This was all done with 3.5 loupe magnification. Next the vas ends were pulled together by tying the sutures. A good reapproximation was noted. Next in between each of these sutures two to three of the 7-0 Prolenes were used to reapproximate the muscularis layer further in an attempt to make this fluid-tight.,There was no tension on the anastomosis and the vas was delivered back into the right hemiscrotum. The subcuticular layers were closed with a running 3-0 chromic and the skin was closed with three interrupted 3-0 chromic sutures.,Next an identical procedure was done on the left side.,The patient tolerated the procedure well and was awakened and returned to the recovery room in stable condition. Antibiotic ointment, fluffs, and a scrotal support were placed. | 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' | SUBJECTIVE:, The patient is a 33-year-old black male who comes in to the office today main complaint of sexual dysfunction. Patient reports that he would like to try Cialis to see if it will improve his erectile performance. Patient states that he did a quiz on-line at the Cialis web site and did not score in the normal range, so he thought he should come in. Patient states that perhaps his desire has been slightly decreased, but that has not been the primary problem. In discussing with me directly, patient primarily expresses that he would like to have his erections last longer. However, looking at the quiz as he filled it out, he reported that much less than half the time was he able to get erections during sexual activity and only about half of the time he was able to maintain his erection after penetration. However, he only reports that it is slightly difficult to maintain the erection until completion of intercourse. Patient has no significant past medical history. He has never had any previous testicular infections. He denies any history of injuries to the groin and he has never been told that he has a hernia.,CURRENT MEDICATIONS:, None.,ALLERGIES: , No drug allergies.,SOCIAL: , Only occasionally drinks alcohol and he is a nonsmoker. He currently is working as a nurse aid, second shift, at a nursing home. He states that he did not enroll in Wichita State this semester. Stating he just was tired and wanted to take some time off. He states he is in a relationship with one partner and denies any specific stress in the relationship.,OBJECTIVE:,General: He appears in no distress.,Vital Signs: Blood pressure: With large cuff is 120/90.,Lungs: Clear to auscultation.,Cardiovascular: Normal S1-S2 without murmur.,Abdomen: Soft, nontender. Femoral pulses are 2+.,GU: Testicles descended bilaterally. No evidence of masses. No evidence of inguinal hernias.,ASSESSMENT:, Sexual dysfunction.,PLAN:, We will check a free and total testosterone level as he does note some diminished desire. He was given a sample of Cialis 10 mg with instructions on usage and a prescription for that if that is successful. He will follow up here p.r.n. Lastly, I did give him a blood pressure recording card, as his blood pressure is borderline today. He will have that checked weekly at his workplace and follow up if they remain elevated. | 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' | PREOPERATIVE DIAGNOSES:,1. Blepharochalasia.,2. Lower lid large primary and secondary bagging.,POSTOPERATIVE DIAGNOSES:,1. Blepharochalasia.,2. Lower lid large primary and secondary bagging.,PROCEDURE: , Quad blepharoplasty.,ANESTHESIA: , General.,ESTIMATED BLOOD LOSS: , Minimal.,CONDITION: , The patient did well.,PROCEDURE: ,The patient had marks and measurements prior to surgery. Additional marks and measurements were made at the time of surgery; these were again checked. At this point, the area was injected with 0.5% lidocaine with 1:200,000 epinephrine. Appropriate time waited for the anesthetic and epinephrine effect.,Beginning on the left upper lid, the skin excision was completed. The muscle was opened, herniated, adipose tissue pad in the middle and medial aspect was brought forward, cross-clamped, excised, cauterized, and allowed to retract. The eyes were kept irrigated and protected throughout the procedure. Attention was turned to the opposite side. Procedure was carried out in the similar manner.,At the completion, the wounds were then closed with a running 6-0 Prolene, skin adhesives, and Steri-Strips. Attention was turned to the right lower lid. A lash line incision was made. A skin flap was elevated and the muscle was opened. Large herniated adipose tissue pads were present in each of the three compartments. They were individually elevated, cross-clamped, excised, cauterized, and allowed to retract.,At the completion, a gentle tension was placed on the facial skin and several millimeters of the skin excised. Attention was turned to he opposite side. The procedure was carried out as just described. The contralateral side was reexamined and irrigated. Hemostasis was good and it was closed with a running 6-0 Prolene. The opposite side was closed in a similar manner.,Skin adhesives and Steri-Strips were applied. The eyes were again irrigated and cool Swiss Eye compresses applied. At the completion of the case, the patient was extubated in the operating room, breathing on her own, doing well, and transferred in good condition from operating room to recovering room. | 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 OF PRESENT ILLNESS: ,This is a 53-year-old man, who presented to emergency room with multiple complaints including pain from his hernia, some question of blood in his stool, nausea, and vomiting, and also left lower extremity pain. At the time of my exam, he states that his left lower extremity pain has improved considerably. He apparently had more significant paresthesias in the past and now he feels that the paresthesias have improved considerably. He does have a history of multiple medical problems including atrial fibrillation, he is on Coumadin, which is currently subtherapeutic, multiple CVAs in the past, peripheral vascular disease, and congestive heart failure. He has multiple chronic history of previous ischemia of his large bowel in the past.,PHYSICAL EXAM,VITAL SIGNS: Currently his temperature is 98.2, pulse is 95, and blood pressure is 138/98.,HEENT: Unremarkable.,LUNGS: Clear.,CARDIOVASCULAR: An irregular rhythm.,ABDOMEN: Soft.,EXTREMITIES: His upper extremities are well perfused. He has palpable radial and femoral pulses. He does not have any palpable pedal pulses in either right or left lower extremity. He does have reasonable capillary refill in both feet. He has about one second capillary refill on both the right hand and left lower extremities and his left foot is perhaps little cool, but it is relatively warm. Apparently, this was lot worst few hours ago. He describes significant pain and pallor, which he feels has improved and certainly clinically at this point does not appear to be as significant.,IMPRESSION AND PLAN: , This gentleman with a history of multiple comorbidities as detailed above had what sounds clinically like acute exacerbation of chronic peripheral vascular disease, essentially related to spasm versus a small clot, which may have been lysed to some extent. He currently has a viable extremity and viable foot, but certainly has significant making compromised flow. It is unclear to me whether this is chronic or acute, and whether he is a candidate for any type of intervention. He certainly would benefit from an angiogram to better to define his anatomy and anticoagulation in the meantime. Given his potential history of recent lower GI bleeding, he has been evaluated by GI to see whether or not he is a candidate for heparinization. We will order an angiogram for the next few hours and followup on those results to better define his anatomy and to determine whether or not if any interventions are appropriate. Again, at this point, he has no pain, relatively rapid capillary refill, and relatively normal motor function suggesting a viable extremity. We will follow him along closely. | 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' | PRINCIPAL DIAGNOSIS: , Mullerian adenosarcoma. ,HISTORY OF PRESENT ILLNESS: , The patient is a 56-year-old presenting with a large mass aborted through the cervix.,PHYSICAL EXAM:,CHEST: Clear. There is no heart murmur.,ABDOMEN: Nontender.,PELVIC: There is a large mass in the vagina. ,HOSPITAL COURSE: , The patient went to surgery on the day of admission. The postoperative course was marked by fever and ileus. The patient regained bowel function. She was discharged on the morning of the seventh postoperative day.,OPERATIONS: , July 25, 2006: Total abdominal hysterectomy, bilateral salpingo-oophorectomy.,DISCHARGE CONDITION: , Stable., ,PLAN: , The patient will remain at rest initially with progressive ambulation thereafter. She will avoid lifting, driving, stairs, or intercourse. She will call me for fevers, drainage, bleeding, or pain. Family history, social history, and psychosocial needs per the social worker. The patient will follow up in my office in one week.,PATHOLOGY:, Mullerian adenosarcoma.,MEDICATIONS:, Percocet 5, #40, one q.3 h. p.r.n. pain. | 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' | 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. | 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:, CT cervical spine (C-spine) for trauma.,FINDINGS:, CT examination of the cervical spine was performed without contrast. Coronal and sagittal reformats were obtained for better anatomical localization. Cervical vertebral body height, alignment and interspacing are maintained. There is no evidence of fractures or destructive osseous lesions. There are no significant degenerative endplate or facet changes. No significant osseous central canal or foraminal narrowing is present.,IMPRESSION: , Negative cervical spine. | 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 DIAGNOSES,1. Cervical radiculopathy, C5-C6 and C6-C7.,2. Symptomatic cervical spondylosis, C5-C6 and C6-C7.,3. Symptomatic cervical stenosis, C5-C6 and C6-C7.,4. Symptomatic cervical disc herniations, C5-C6 and C6-C7.,POSTOPERATIVE DIAGNOSES,1. Cervical radiculopathy, C5-C6 and C6-C7.,2. Symptomatic cervical spondylosis, C5-C6 and C6-C7.,3. Symptomatic cervical stenosis, C5-C6 and C6-C7.,4. Symptomatic cervical disc herniations, C5-C6 and C6-C7.,OPERATIVE PROCEDURE,1. CPT code 63075: Anterior cervical discectomy and osteophytectomy, C5-C6.,2. CPT code 63076: Anterior cervical discectomy and osteophytectomy, C6-C7, additional level.,3. CPT code 22851: Application of prosthetic interbody fusion device, C5-C6.,4. CPT code 22851-59: Application of prosthetic interbody fusion device, C6-C7, additional level.,5. CPT code 22554-51: Anterior cervical interbody arthrodesis, C5-C6.,6. CPT code 22585: Anterior cervical interbody arthrodesis, C6-C7, additional level.,7. CPT code 22845: Anterior cervical instrumentation, C5-C7.,ANESTHESIA:, General endotracheal.,ESTIMATED BLOOD LOSS: ,Negligible.,DRAINS: , Small suction drain in the cervical wound.,COMPLICATIONS:, None.,PROCEDURE IN DETAIL:, The patient was given intravenous antibiotic prophylaxis and thigh-high TED hoses were placed on the lower extremities while in the preanesthesia holding area. The patient was transported to the operative suite and on to the operative table in the supine position. General endotracheal anesthesia was induced. The head was placed on a well-padded head holder. The eyes and face were protected from pressure. A well-padded roll was placed beneath the neck and shoulders to help preserve the cervical lordosis. The arms were tucked and draped to the sides. All bony prominences were well padded. An x-ray was taken to confirm the correct level of the skin incision. The anterior neck was then prepped and draped in the usual sterile fashion.,A straight transverse skin incision over the left side of the anterior neck was made and carried down sharply through the skin and subcutaneous tissues to the level of the platysma muscle, which was divided transversely using the electrocautery. The superficial and deep layers of the deep cervical fascia were divided. The midline structures were reflected to the right side. Care was taken during the dissection to avoid injury to the recurrent laryngeal nerve and the usual anatomical location of that nerve was protected. The carotid sheath was palpated and protected laterally. An x-ray was taken to confirm the level of C5-C6 and C6-C7.,The longus colli muscle was dissected free bilaterally from C5 to C7 using blunt dissection. Hemostasis was obtained using the electrocautery. The blades of the cervical retractor were placed deep to the longus colli muscles bilaterally. At C5-C6, the anterior longitudinal ligament was divided transversely. Straight pituitary rongeurs and a curette were used to remove the contents of the disc space. All cartilages were scraped off the inferior endplate of C5 and from the superior endplate of C6. The disc resection was carried posteriorly to the posterior longitudinal ligament and laterally to the uncovertebral joints. The posterior longitudinal ligament was resected using a 1 mm Kerrison rongeur. Beginning in the midline and extending into both neural foramen, posterior osteophytes were removed using a 1 m and a 2 mm Kerrison rongeurs. The patient was noted to have significant bony spondylosis causing canal and foraminal stenosis as well as a degenerative and protruding disc in agreement with preoperative diagnostic imaging studies. Following completion of the discectomy and osteophytectomy, a blunt nerve hook was passed into the canal superiorly and inferiorly as well as in the both neural foramen to make sure that there were no extruded disc fragments and to make sure the bony decompression was complete. A portion of the uncovertebral joint was resected bilaterally for additional nerve root decompression. Both nerve roots were visualized and noted to be free of encroachment. The same procedure was then carried out at C6-C7 with similar findings. The only difference in the findings was that at C6-C7 on the left side, the patient was found to have an extruded disc fragment in the canal and extending into the left side neural foramen causing significant cord and nerve root encroachment.,In preparation for the arthrodesis, the endplates of C5, C6, and C7 were burred in a parallel fashion down to the level of bleeding bone using a high-speed cutting bur with irrigant solution for cooling. The disc spaces were then measured to the nearest millimeter. Attention was then turned toward preparation of the structural allograft, which consisted of two pieces of pre-machined corticocancellous bone. The grafts were further shaped to fit the disc spaces exactly in a press-fit manner with approximately 1.5 mm of distraction at each disc space. The grafts were shaped to be slightly lordotic to help preserve the cervical lordosis. The grafts were impacted into the disc spaces. There was complete bony apposition between the ends of the bone grafts and the vertebral bodies of C5, C6, and C7. A blunt nerve hook was passed posterior to each bone graft to make sure that the bone grafts were in good position. Anterior osteophytes were removed using a high-speed cutting bur with irrigant solution for cooling. An appropriate length Synthes cervical plate was selected and bent slightly to conform to the patient's cervical lordosis. The plate was held in the midline with provided instrumentation while a temporary fixation screw was applied at C6. Screw holes were then drilled using the provided drill and drill guide taking care to avoid injury to neurovascular structures. The plate was then rigidly fixed to the anterior spine using 14-mm cancellous screws followed by locking setscrews added to the head of each screw to prevent postoperative loosening of the plate and/or screws.,An x-ray was taken, which confirmed satisfactory postioning of the plate, screws, and bone grafts.,Blood loss was minimal. The wound was irrigated with irrigant solution containing antibiotics. The wound was inspected and judged to be dry. The wound was closed over a suction drain placed in the deepest portion of the wound by reapproximating the platysma muscle with #4-0 Vicryl running suture, the subdermal and subcuticular layers with #4-0 Monocryl interrupted sutures, and the skin with Steri-Strips. The sponge and needle count were correct. A sterile dressing was applied to the wound. The neck was placed in a cervical orthosis. The patient tolerated the procedure and was transferred to the 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' | CHIEF COMPLAINT: , Marginal zone lymphoma.,HISTORY OF PRESENT ILLNESS: , This is a very pleasant 46-year-old woman, who I am asked to see in consultation for a newly diagnosed marginal zone lymphoma (MALT-type lymphoma). A mass was found in her right breast on physical examination. On 07/19/10, she had a mammogram and ultrasound, which confirmed the right breast mass. On 07/30/10, she underwent a biopsy, which showed a marginal zone lymphoma (MALT-type lymphoma).,Overall, she is doing well. She has a good energy level and her ECOG performance status is 0. She denies any fevers, chills, or night sweats. No lymphadenopathy. No nausea or vomiting. She has normal bowel and bladder habits. No melena or hematochezia.,CURRENT MEDICATIONS: ,Macrobid 100 mg q.d.,ALLERGIES: ,Sulfa, causes nausea and vomiting.,REVIEW OF SYSTEMS: , As per the HPI, otherwise negative.,PAST MEDICAL HISTORY:,1. She is status post a left partial nephrectomy as a new born.,2. In 2008 she had a right ankle fracture.,SOCIAL HISTORY: , She has a 20-pack year history of tobacco use. She has rare alcohol use. She has no illicit drug use. She is in the process of getting divorced. She has a 24-year-old son in the area and 22-year-old daughter.,FAMILY HISTORY: ,Her mother had uterine cancer. Her father had liver cancer.,PHYSICAL EXAM:,VIT: | 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' | EXAM: , Ultrasound Abdomen., ,REASON FOR EXAM: , Elevated liver function tests., ,INTERPRETATION: , The liver demonstrates heterogeneously increased echotexture with significant fatty infiltration. The gallbladder is surgically absent. There is no fluid collection in the cholecystectomy bed. There is dilatation of the common bile duct up to 1 cm. There is also dilatation of the pancreatic duct that measures up to 3 mm. There is caliectasis in the right kidney. The bladder is significantly distended measuring 937 cc in volume. The caliectasis in the right kidney may be secondary to back pressure from the distended bladder. The aorta is normal in caliber., ,IMPRESSION:,1. Dilated common duct as well as pancreatic duct as described. Given the dilatation of these two ducts, ERCP versus MRCP is recommended to exclude obstructing mass. The findings could reflect changes of cholecystectomy. ,2. Significantly distended bladder with probably resultant caliectasis in the right kidney. Clinical correlation recommended. | 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: , Bunion, left foot.,POSTOPERATIVE DIAGNOSIS: ,Bunion, left foot.,PROCEDURE PERFORMED:,1. Bunionectomy with first metatarsal osteotomy base wedge type with internal screw fixation.,2. Akin osteotomy with internal wire fixation of left foot.,HISTORY: , This 19-year-old Caucasian female presents to ABCD General Hospital with the above chief complaint. The patient states she has had worsening bunion deformity for as long as she could not remember. She does have a history of Charcot-Marie tooth disease and desires surgical treatment at this time.,PROCEDURE: , An IV was instituted by the Department of Anesthesia in the preoperative holding area. The patient was transported to the operating room and placed on operating table in the supine position with a safety belt across her lap. Copious amounts of Webril were placed on the left ankle followed by a blood pressure cuff. After adequate sedation by the Department of Anesthesia, a total of 15 cc of 1:1 mixture of 1% lidocaine plain and 0.5% Marcaine plain were injected in a Mayo block type fashion surrounding the lower left first metatarsal. The foot was then prepped and draped in the usual sterile orthopedic fashion. The foot was elevated from the operating table and exsanguinated with an Esmarch bandage. The pneumatic ankle tourniquet was inflated to 250 mmHg and the foot was lowered to the operating field. The stockinette was reflected, the foot was cleansed with a wet and dry sponge. Approximately 5 cm incision was made dorsomedially over the first metatarsal.,The incision was then deepened with #15 blade. All vessels encountered were ligated for hemostasis. Care was taken to preserve the extensor digitorum longus tendon. The capsule over the first metatarsal phalangeal then was identified where a dorsal capsular incision was then created down to the level of bone. Capsule and periosteum was reflected off the first metatarsal head. At this time, the cartilage was inspected and noted to be white, shiny, and healthy cartilage. There was noted to be a prominent medial eminence. Attention was then directed to first interspace where a combination of blunt and sharp dissection was done to perform a standard lateral release. The abductor tendon attachments were identified and transected. The lateral capsulotomy was performed. The extensor digitorum brevis tendon was identified and transected. Attention was then directed to the prominent medial eminence, which was resected with a sagittal saw. Intraoperative assessment of pes was performed and pes was noted to be normal.,At this time, a regional incision was carried more approximately about 1.5 cm. The capsular incision was then extended and the proximal capsule and periosteum were reflected off the first metatarsal. The first metatarsal cuneiform joint was identified. A 0.45 K-wire was then inserted into the base of the first metatarsal approximately 1 cm from the first cuneiform joint perpendicular to the weightbearing surface. This K-wire was used as an access guide for a Juvaro type oblique base wedge osteotomy. The sagittal saw was then used to creat a closing base wedge osteotomy with the apex being proximal medial. The osteotomy site was then feathered and tilted with tight estimation of the bony edges. The cortical hinge was maintained. A 0.27 x 24 mm screw was then inserted in a standard AO fashion. At this time, there was noted to be tight compression of the osteotomy site. A second 2.7 x 16 mm screw was then inserted more distally in the standard AO fashion with compression noted. The ________ angle was noted to be significantly released. Reciprocating rasp was then used to smoothen any remaining sharp edges. The 0.45 k-wire was removed. The foot was loaded and was noted to fill the remaining abduction of the hallux. At this time, it was incised to perform an Akin osteotomy.,Original incision was then extended distally approximately 1 cm. The incision was then deepened down to the level of capsule over the base of the proximal phalanx. Again care was taken to preserve the extensor digitorum longus tendon. The capsule was reflected off of the base of the proximal phalanx. An Akin osteotomy was performed with the apex being lateral and the base being medial. After where the bone was resected, it was feathered until tight compression was noted without tension at the osteotomy site. Care was taken to preserve the lateral hinge. At 1.5 wire passed and a drill was then used to create drill hole proximal and distally to the osteotomy site in order for passage of 28 gauge monofilament wire. The #28 gauge monofilament wire was passed through the drill hole and tightened down until compression and tight ________ osteotomy site was noted. The remaining edge of the wire was then buried in the medial most distal drill hole. The area was then inspected and the foot was noted with significant reduction of the bunion deformity. The area was then flushed with copious amounts of sterile saline. Capsule was closed with #3-0 Vicryl followed by subcutaneous closure with #4-0 Vicryl in order to decrease tension of the incision site. A running #5-0 subcuticular stitch was then performed. Steri-Strips were applied. Total of 1 cc dexamethasone phosphate was then injected into the surgical site. Dressings consisted of Owen silk, 4x4s, Kling, Kerlix. The pneumatic ankle tourniquet was released and immediate hyperemic flush was noted to all five digits of the left foot. Posterior splint was then placed on the patient in the operating room.,The patient tolerated the above procedure and anesthesia well without complications. The patient was transferred back to the PACU with vital signs stable and vascular status intact to the left foot. The patient was given postoperative instructions to be strictly nonweightbearing on the left foot. The patient was given postop pain prescriptions for Vicodin and instructed to take one q.4-6h. p.r.n. for pain as well as Naprosyn 500 mg p.o. q. b.i.d. The patient is to follow-up with Dr. X in his office in four to five days as directed. | 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' | Please accept this letter of follow up on patient xxx xxx. He is now three months out from a left carotid angioplasty and stent placement. He was a part of a CapSure trial. He has done quite well, with no neurologic or cardiac event in the three months of follow up. He had a follow-up ultrasound performed today that shows the stent to be patent, with no evidence of significant recurrence.,Sincerely,,XYZ, MD, | 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' | CHIEF COMPLAINT:, Newly diagnosed mantle cell lymphoma.,HISTORY OF PRESENT ILLNESS: , The patient is a 47-year-old woman who presented with abdominal pain in September 2006. On chest x-ray, she had a possible infiltrate and it was thought she might have pneumonia and she was treated with antibiotics and prednisone. Symptoms improved temporarily, but did not completely resolve. By the end of September, her pain had worsened and she was seen in the emergency room at ABC. Chest x-ray was compatible with pleurisy and she was treated with Percocet. Few days later, she was seen and given a prescription for Ultram because Percocet was causing nausea. Eventually, she was seen by Dr. X and noted to have splenomegaly. Repeat ultrasound was done and showed the spleen enlarged at 19 cm. In retrospect, this was not changed in comparison to an ultrasound that was done in September. She underwent positron emission tomography (PET) scanning, which showed diffuse hypermetabolic lymph nodes measuring 1 to 2 cm in diameter, as well as a hypermetabolic spleen that was enlarged.,The patient underwent lymph node biopsy on the right neck on 10/27/2006. Pathology is consistent with mantle cell lymphoma.,On 10/31/2006, she had a bone marrow biopsy. This does show involvement of bone marrow with lymphoma.,She was noted to have circulating lymphoma cells on peripheral smear as well.,Although CBC was normal, MCV was low and the ferritin was assessed and was low at 8, consistent with iron deficiency.,ALLERGIES:, NONE.,MEDICATIONS: ,1. Estradiol/Prometrium. ,2. Ultram p.r.n. ,3. Baby aspirin. ,4. Lunesta for sleep. ,5. She has been started on iron supplements.,PAST MEDICAL HISTORY: ,1. Tubal ligation in 1986.,2. Possible cyst removed from the left neck in 1991.,3. Tonsillectomy.,4. Migraines, which are rare.,SOCIAL HISTORY: , She does not smoke cigarettes and drinks alcohol only occasionally. She is married and has two children, ages 24 and 20. She works as a project administrator.,FAMILY HISTORY: ,Father is deceased. He had emphysema and colon cancer at age 68. Mother has arrhythmia and hypertension. Her sister has hypertension and her brother is healthy.,PHYSICAL EXAMINATION: ,GENERAL: She is in no acute distress.,VITAL SIGNS: Her weight is 168 pounds, and she is afebrile with a normal blood pressure and pulse.,HEENT: The oropharynx is benign.,SKIN: The skin is warm and dry and shows no jaundice.,NECK: There is shotty adenopathy in the neck.,CARDIAC: Regular rate without murmur.,LUNGS: Clear to auscultation bilaterally.,ABDOMEN: Soft and nontender and shows the spleen palpable about 10 cm below the right costal margin.,EXTREMITIES: No peripheral edema is noted.,LABORATORY DATA: , CBC and chemistry panel are pending. CBC was normal last week. PT/INR was normal as well.,IMPRESSION:, Newly diagnosed mantle cell lymphoma, admitted now to start chemotherapy. She will start treatment with hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone. Toxicities have already been discussed with her including myelosuppression, mucositis, diarrhea, nausea, alopecia, the low risk for cardiac toxicity, bladder toxicity, neuropathy, constipation, etc. Written materials were provided to her last week.,PLAN: , Plan will be to add Rituxan a little later in her course because she has circulating lymphoma cells. She will be started on allopurinol today as well as hydration further to avoid the possibility of tumor lysis syndrome.,Plan will be to have her evaluated for bone marrow transplant in first remission. I will have Dr. Y see her while she is in the hospital.,The patient is anxious, and will be given Ativan as needed. We will discontinue aspirin for now, but continue estradiol/Prometrium.,Iron deficiency will be treated with oral iron supplements and we will follow her counts. She may well have gastrointestinal (GI) involvement, which is not uncommon with mantle cell lymphoma. After she undergoes remission, we will consider colonoscopy for biopsies prior to proceeding to transplant. | 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' | IMPRESSION: ,EEG during wakefulness, drowsiness, and sleep with synchronous video monitoring demonstrated no evidence of focal or epileptogenic activity. | 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' | CC: ,Progressive left visual field loss.,HX:, This 46y/o RHF with polymyositis since 1988, presented with complaint of visual field loss since 12/94. The visual field loss was of gradual onset and within a month of onset became a left homonymous hemianopsia. She began experiencing stiffness, numbness, tingling and incoordination of her left hand, 6 weeks prior to this admission,. These symptoms were initially attributed to carpal tunnel syndrome. MRI scan of the brain (done locally) on 6/23/95 revealed increased periventricular white matter signal on T2 images, particularly in the left temporo-occipital and right parietal lobes. There was ring enhancement of a lesion in the left occipital lobe on T1 gadolinium contrast enhanced images. There was gyral enhancement near the right Sylvian fissure. Cerebral angiogram on 7/19/95 (done locally) was unremarkable. Lumbar puncture on 7/19/95 was unremarkable. She complained of frequent holocranial throbbing headaches for the past 6 months; the HA's are associated with photophobia, phonophobia and nausea, but no vomiting. She has also been experiencing chills and night sweats for the past 2-3 weeks. She denies weight loss, but acknowledged decreased appetite and increased generalized fatigue for the past 3-4 months.,She was diagnosed with polymyositis in 1988 with slowly progressive bilateral lower extremity weakness. She has been on immunosuppressive drugs since 1988, including Prednisone, Prednisone and methotrexate, Cyclosporin, Imuran, Cytoxan, and Plaquenil. At present she in ambulatory with use of walker. Her last CK=3,125 and ESR=16, on 6/28/95.,MEDS:, Prednisone 20mg qd, Cytoxan 75mg qd, Zantac 150mg bid, Vasotec 10mg bid, Premarin 0.625 qd, Provera 2.5mg qd, CaCO3 500mg bid, Vit D 50,000units qweek, Vit E qd, MVI 1 tab qd.,PMH:, 1)polymyositis diagnosed in 1988 by muscle biopsy. 2)hypertension. 3)lichen planus. 4)Lower extremity deep venous thrombosis one year ago--placed on Coumadin and this resulted in postmenopausal bleeding.,FHX:, Mother is alive and has a h/o HTN and stroke. Father died in motor vehicle accident at age 40 years.,SHX:, Married, 3 children who are healthy. She denied any Tobacco/ETOH/Illicit drug use.,EXAM:, BP160/74 HR95 RR12 35.8C Wt. 86.4kg Ht. 5'6",MS: A&O to person, place and time. Speech was normal. Mood euthymic with appropriate affect.,CN: Pupils 4/4 decreasing to 2/2 on exposure to light. No RAPD noted. Optic Disk were flat. EOM testing unremarkable. Confrontational visual field testing revealed a left homonymous hemianopsia. The rest of the CN exam was unremarkable.,MOTOR: Upper extremities: 5/5 proximally, 5/4 @ elbow/wrist/hand. Lower extremities: 4/4 proximally and 5/5 @ and below knees.,SENSORY: unremarkable.,COORD: Dyssynergia of LUE FNF movement. Slowed finger tapping on left. HNS movements were normal, bilaterally.,Station: LUE drift and fix on arm roll. No Romberg sign elicited.,Gait: Waddling gait, but could TT and stand on both heels. She had difficulty with tandem walking, but did not fall to any particular side.,Reflexes: 2/2 brachioradialis and biceps. 2/2+ triceps, 1+/1+ patellae, 1/1 Achilles. Plantar responses were flexor on the right and withdrawal response on the left.,GEN EXAM: No rashes. II/VI systolic ejection murmur at the left sternal border.,COURSE:, Electrolytes, PT/PTT, Urinalysis and CXR were normal. ESR=38 (normal<20), CRP1.4 (normal<0.4). CK 2,917, LDH 356, AST 67. MRI Brain, 8/8/95, revealed slight improvement of the abnormal white matter changes seen on previous outside MRI. In addition new sphenoid sinus disease suggestive of sinusitis was seen. She underwent stereotactic biopsy of the right parietal region on 8/10/95 which on H&E and LFB stained sections revealed multiple discrete areas of demyelination, containing dense infiltrates of foamy macrophages in association with scattered large oligodendroglia with deeply basophilic, ground-glass nuclei, enlarged astrocytes, and sparse perivascular lymphocytic infiltrates. In situ hybridization performed on block A2 (at the university of Pittsburgh) is positive for JC virus. The ultrastructural studies demonstrated no viral particles.,She was tapered off all immunosuppressive medications and her polymyositis remained clinically stable. She had a seizure in 12/95 and was placed on Dilantin. Her neurologic deficits worsened slightly, but reached a plateau by 10/96, as indicated by a 4/14/97 Neurology clinic visit note.,1/22/96, MRI Brain demonstrated widespread hyperintense signal on T2 and Proton Density weighted images throughout the deep white matter in both hemispheres, worse on the right side. There was interval progression of previously noted abnormalities and extension into the right frontal and left parieto-occipital regions. There was progression of abnormal signal in the Basal Ganglia, worse on the right, and new involvement of the brainstem. | 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: ,The patient is a 58-year-old right-handed gentleman who presents for further evaluation of right arm pain. He states that a little less than a year ago he developed pain in his right arm. It is intermittent, but has persisted since that time. He describes that he experiences a dull pain in his upper outer arm. It occurs on a daily basis. He also experiences an achy sensation in his right hand radiating to the fingers. There is no numbness or paresthesias in the hand or arm.,He has had a 30-year history of neck pain. He sought medical attention for this problem in 2006, when he developed ear pain. This eventually led to him undergoing an MRI of the cervical spine, which showed some degenerative changes. He was then referred to Dr. X for treatment of neck pain. He has been receiving epidural injections under the care of Dr. X since 2007. When I asked him what symptom he is receiving the injections for, he states that it is for neck pain and now the more recent onset of arm pain. He also has taken several Medrol dose packs, which has caused his blood sugars to increase. He is taking multiple other pain medications. The pain does not interfere significantly with his quality of life, although he has a constant nagging pain.,PAST MEDICAL HISTORY: , He has had diabetes since 2003. He also has asthma, hypertension, and hypercholesterolemia.,CURRENT MEDICATIONS: , He takes ACTOplus, albuterol, AndroGel, Astelin, Diovan, Dolgic Plus, aspirin 81 mg, fish oil, Lipitor, Lorazepam, multivitamins, Nasacort, Pulmicort, ranitidine, Singulair, Viagra, Zetia, Zyrtec, and Uroxatral. He also uses Lidoderm patches and multiple eye drops and creams.,ALLERGIES:, He states that Dyazide, Zithromax, and amoxicillin cause him to feel warm and itchy.,FAMILY HISTORY:, His father died from breast cancer. He also had diabetes. He has a strong family history of diabetes. His mother is 89. He has a sister with diabetes. He is unaware of any family members with neurological disorders.,SOCIAL HISTORY:, He lives alone. He works full time in Human Resources for the State of Maryland. He previously was an alcoholic, but quit in 1984. He also quit smoking cigarettes in 1984, after 16 years of smoking. He has a history of illicit drug use, but denies IV drug use. He denies any HIV risk factors and states that his last HIV test was over two years ago.,REVIEW OF SYSTEMS: , He has intermittent chest discomfort. He has chronic tinnitus. He has urinary dribbling. Otherwise, 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: HR 72. RR 16.,General Appearance: Patient is well appearing, in no acute distress.,Cardiovascular: There is a regular rhythm without murmurs, gallops, or rubs. There are no carotid bruits.,Chest: The lungs are clear to auscultation bilaterally.,Skin: There are no rashes or lesions.,NEUROLOGICAL EXAMINATION:,Mental Status: Speech is fluent without dysarthria or aphasia. The patient is alert and oriented to name, place, and date. Attention, concentration, registration, recall, and fund of knowledge are all intact.,Cranial Nerves: Pupils are equal, round, and reactive to light and accommodation. Optic discs are normal. Visual fields are full. Extraocular movements are intact without nystagmus. Facial sensation is normal. There is no facial, jaw, palate, or tongue weakness. Hearing is grossly intact. Shoulder shrug is full.,Motor: There is normal muscle bulk and tone. There is no atrophy or fasciculations. There is no action or percussion myotonia or paramyotonia. Manual muscle testing reveals MRC grade 5/5 strength in all proximal and distal muscles of the upper and lower extremities.,Sensory: Sensation is intact to light touch, pinprick, temperature, vibratory sensation, and joint position sense. Romberg is absent.,Coordination: There is no dysmetria or ataxia on finger-nose-finger or heel-to-shin testing.,Deep Tendon Reflexes: Deep tendon reflexes are 2+ at the biceps, triceps, brachioradialis, patellas and ankles. Plantar reflexes are flexor. There are no finger flexors, Hoffman's sign, or jaw jerk.,Gait and Stance: Casual gait is normal. Heel, toe, and tandem walking are all normal.,RADIOLOGIC DATA:, MRI of the cervical spine, 05/19/08: I personally reviewed this film, which showed narrowing of the foramen on the right at C4-C5 and other degenerative changes without central stenosis.,IMPRESSION: ,The patient is a 58-year-old gentleman with one-year history of right arm pain. He also has a longstanding history of neck pain. His neurological examination is normal. He has an MRI that shows some degenerative changes. I do believe that his symptoms are probably referable to his neck. However, I do not think that they are severe enough for him to undergo surgery at this point in time. Perhaps another course of physical therapy may be helpful for him. I probably would not recommend anymore invasive procedure, such as a spinal stimulator, as this pain really is minimal. We could still try to treat him with neuropathic pain medications.,RECOMMENDATIONS:,1. I scheduled him to return for an EMG and nerve conduction studies to determine whether there is any evidence of nerve damage, although I think the likelihood is low.,2. I gave him a prescription for Neurontin. I discussed the side effects of the medication with him.,3. We can discuss his case tomorrow at Spine Conference to see if there are any further recommendations. | 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' | PROCEDURE:, Left heart catheterization, left ventriculography, coronary angiography, and successful stenting of tight lesion in the distal circumflex and moderately tight lesion in the mid right coronary artery. This gentleman has had a non-Q-wave, troponin-positive myocardial infarction, complicated by ventricular fibrillation.,PROCEDURE DETAILS:, The patient was brought to the catheterization lab, the chart was reviewed, and informed consent was obtained. Right groin was prepped and draped sterilely and infiltrated 2% Xylocaine. Using the Seldinger technique, a #6-French sheath was placed in the right femoral artery. ACT was checked and was low. Additional heparin was given. A #6-French pigtail catheter was passed. Left ventriculography was performed. The catheter was exchanged for a #6-French JL4 catheter. Nitroglycerin was given in the left main. Left coronary angiography was performed. The catheter was exchanged for a #6-French __________ coronary catheter. Nitroglycerin was given in the right main, and right coronary angiography was performed. Films were closely reviewed, and it was felt that he had a significant lesion in the RCA and the distal left circumflex is basically an OM. Considering his age and his course, it was elected to stent both these lesions. ReoPro was started, and the catheter was exchanged for a #6-French JR4 guide. ReoPro was given in the RCA to prevent no reflow. A 0.014 Universal wire was passed. The lesion was measured. A 4.5 x 18-mm stent was passed and deployed to moderate pressures with an excellent result. The catheter was removed and exchanged for a #6-French JL4 guide. The same wire was passed down the circumflex and the lesion measured. A 2.75 x 15-mm stent was deployed to a moderate pressure with an excellent result. Plavix was given. The catheter was removed and sheath was in place. The results were explained to the patient and his wife.,FINDINGS,1. Hemodynamics. Please see attached sheet for details. ED was 20. There is no gradient across the aortic valve.,2. Left ventriculography revealed septum upper limits of normal size with borderline normal LV systolic function with borderline normal wall motion, in which there is a question of diffuse, very minimal global hypokinesis. There is mild MR noted.,3. Coronary angiography.,a. Left main normal.,b. LAD. Some very minimal luminal irregularities. There is a 1st diagonal which has a branch that is 1.5 mm with a proximal 50% narrowing.,c. Left circumflex is basically a marginal branch, in which distally there was a long 98% lesion.,d. The RCA is large dominant and has a mid somewhat long 70% lesion.,4. Stenting.,a. The RCA revealed a lesion that went from 70% to a -5%.,B. The circumflex went from 95% to -5%.,CONCLUSION,1. Decreased left ventricular compliance.,2. Borderline normal overall ejection fraction with mild mitral regurgitation.,3. Triple-vessel coronary artery disease with a borderline lesion in a very small branch of the 1st diagonal and significant lesions in the mid dominant right coronary artery and the distal circumflex, which is basically old.,4. Successful stenting of the right coronary artery and the circumflex.,RECOMMENDATION: , ReoPro/stent protocol, Plavix for at least 9 months, aggressive control of risk factors. I have ordered Zocor and a fasting lipid panel.,AICD will be considered, realizing when this gentleman becomes ischemic he is at high risk for fibrillating. | 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:, Bilateral ear laceration deformities.,POSTOPERATIVE DIAGNOSIS:, Bilateral ear laceration deformities.,PROCEDURE:,1. Repair of left ear laceration deformity Y-V plasty 2 cm.,2. Repair of right ear laceration deformity, complex repair 2 cm.,ANESTHESIA: , 1% Xylocaine, 1:100,000 epinephrine local.,BRIEF CLINICAL NOTE: , This patient was brought to the operating room today for the above procedure.,OPERATIVE NOTE: , The patient was laid in supine position, adequately anesthetized with the above anesthesia, sterilely prepped and draped. The left ear laceration deformity was very close to the bottom of her ear and therefore it was transected through the centrifugal edge of the ear lobe and pared. The marsupialized epithelialized tracts were pared to raw tissue. They were pared in a fashion to create a Y-V plasty with de-epithelialization of the distal V and overlap of the undermined from the proximal cephalad edge. The 5-0 chromic sutures were used to approximate anteriorly, posteriorly, and anterior centrifugal edge in the Y-V plasty fashion to decrease the risk of notching. Bacitracin, Band-Aid was placed. Next, attention was turned to the contralateral ear where an elongated laceration deformity was pared of the marsupialized epithelialized edges anteriorly, posteriorly to create raw edges. This was not taken through the edge of the lobe to decrease the risk of notch deformity. The laceration was repaired anteriorly and posteriorly in a pleated fashion to decrease length of the incision and to decrease any deformity toward the edge or any dog-ear deformity toward the edge. The 5-0 chromic sutures were used in interrupted fashion for this. The patient tolerated the procedure well. Band-Aid and bacitracin were placed. She left the operating 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' | IDENTIFYING DATA: ,Mr. T is a 45-year-old white male.,CHIEF COMPLAINT: , Mr. T presented with significant muscle tremor, constant headaches, excessive nervousness, poor concentration, and poor ability to focus. His confidence and self-esteem are significantly low. He stated he has excessive somnolence, his energy level is extremely low, motivation is low, and he has a lack for personal interests. He has had suicidal ideation, but this is currently in remission. Furthermore, he continues to have hopeless thoughts and crying spells. Mr. T stated these symptoms appeared approximately two months ago.,HISTORY OF PRESENT ILLNESS: , On March 25, 2003, Mr. T was fired from his job secondary, to an event at which he stated he was first being harassed by another employee." This other, employee had confronted Mr. T with a very aggressive, verbal style, where this employee had placed his face directly in front of Mr. T was spitting on him, and called him "bitch." Mr. T then retaliated, and went to hit the other employee. Due to this event, Mr. T was fired. It should be noted that Mr. T stated he had been harassed by this individual for over a year and had reported the harassment to his boss and was told to "deal with it.",There are no other apparent stressors in Mr. T's life at this time or in recent months. Mr. T stated that work was his entire life and he based his entire identity on his work ethic. It should be noted that Mr. T was a process engineer for Plum Industries for the past 14 years.,PAST PSYCHIATRIC HISTORY:, There is no evidence of any psychiatric hospitalizations or psychiatric interventions other than a recent visit to Mr. T's family physician, Dr. B at which point Mr. T was placed on Lexapro with an unknown dose at this time. Mr. T is currently seeing Dr. J for psychotherapy where he has been in treatment since April, 2003.,PAST PSYCHIATRIC REVIEW OF SYSTEMS:, Mr. T denied any history throughout his childhood, adolescence, and early adulthood for depressive, anxiety, or psychotic disorders. He denied any suicide attempts, or profound suicidal or homicidal ideation. Mr. T furthermore stated that his family psychiatric history is unremarkable.,SUBSTANCE ABUSE HISTORY:, Mr. T stated he used alcohol following his divorce in 1993, but has not used it for the last two years. No other substance abuse was noted.,LEGAL HISTORY: , Currently, charges are pending over the above described incident.,MEDICAL HISTORY: , Mr. T denied any hospitalizations, surgeries, or current medications use for any heart disease, lung disease, liver disease, kidney disease, gastrointestinal disease, neurological disease, closed head injury, endocrine disease, infectious, blood or muscles disease other than stating he has a hiatal hernia and hypercholesterolemia.,PERSONAL AND SOCIAL HISTORY: , Mr. T was born in Dwyne, Missouri, with no complications associated with his birth. Originally, he was raised by both parents, but they separated at an early age. When he was about seven years old, he was raised by his mother and stepfather. He did not sustain a relationship with his biological father from that time on. He stated his parents moved a lot, and because this many times he was picked on in his new environments, Mr. T stated he was, at times, a rebellious teenager, but he denied any significant inability to socialize, and denied any learning disabilities or the need for special education.,Mr. T stated his stepfather was somewhat verbally abusive, and that he committed suicide when Mr. T was 18 years old. He graduated from high school and began work at Dana Corporation for two to three years, after which he worked as an energy, auditor for a gas company. He then became a homemaker while his wife worked for Chrysler for approximately two years. Mr. T was married for eleven years, and divorced in 1993. He has a son who is currently 20 years old. After being a home maker, Mr. T worked for his mother in a restaurant, and moved on from there to work for Borg-Warner corporation for one to two years before beginning at Plum Industries, where he worked for 14 years and worked his way up to lead engineer.,Mental Status Exam: Mr. T presented with a hyper vigilant appearance, his eye contact was appropriate to the interview, and his motor behavior was tense. At times he showed some involuntary movements that would be more akin to a resting tremor. There was no psychomotor retardation, but there was some mild psychomotor excitement. His speech was clear, concise, but pressured. His attitude was overly negative and his mood was significant for moderate depression, anxiety, anhedonia and loneliness, and mild evidence of anger. There was no evidence of euphoria or diurnal mood variation. His affective expression was restricted range, but there was no evidence of lability. At times, his affective tone and facial expressions were inappropriate to the interview. There was no evidence of auditory, visual, olfactory, gustatory, tactile or visceral hallucinations. There was no evidence of illusions, depersonalizations, or derealizations. Mr. T presented with a sequential and goal directed stream of thought. There was no evidence of incoherence, irrelevance, evasiveness, circumstantiality, loose associations, or concrete thinking. There was no evidence of delusions; however, there was some ambivalence, guilt, and self-derogatory thoughts. There was evidence of concreteness for similarities and proverbs. His intelligence was average. His concentration was mildly impaired, and there was no evidence of distractibility. He was oriented to time, place, person and situation. There was no evidence of clouded consciousness or dissociation. His memory was intact for immediate, recent, and remote events.,He presented with poor appetite, easily fatigued, and decreased libidinal drive, as well as excessive somnolence. There was a moderate preoccupation with his physical health pertaining to his headaches. His judgment was poor for finances, family relations, social relations, employment, and, at this time, he had no future plans. Mr. T's insight is somewhat moderate as he is aware of his contribution to the problem. His motivation for getting well is good as he accepts offered treatment, complies with recommended treatment, and seeks effective treatments. He has a well-developed empathy for others and capacity for affection.,There was no evidence of entitlement, egocentricity, controllingness, intimidation, or manipulation. His credibility seemed good. There was no evidence for potential self-injury, suicide, or violence. The reliability and completeness of information was very good, and there were no barriers to communication. The information gathered was based on the patient's self-report and objective testing and observation. His attitude toward the examiner was neutral and his attitude toward the examination process was neutral. There was no evidence for indices of malingering as there was no marked discrepancy between claimed impairment and objective findings, and there was no lack of cooperation with the evaluation or poor compliance with treatment, and no evidence of antisocial personality disorder.,IMPRESSIONS: , Major Depressive Disorder, single episode,RECOMMENDATIONS AND PLAN: , I recommend Mr. T continue with psychopharmacologic care as well as psychotherapy. At this time, the excessive amount of psychiatric symptoms would impede Mr. T from seeking employment. Furthermore, it appears that the primary precipitating event had occurred on March 25, 2003, when Mr. T was fired from his job after being harassed for over a year. As Mr. T placed his entire identity and sense of survival on his work, this was a deafening blow to his psychological functioning. Furthermore, it only appears logical that this would precipitate a major depressive episode. | IME-QME-Work Comp etc. |
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 cholecystitis without cholelithiasis.,POSTOPERATIVE DIAGNOSIS: ,Chronic cholecystitis without cholelithiasis.,PROCEDURE: , Laparoscopic cholecystectomy.,BRIEF DESCRIPTION: , The patient was brought to the operating room and anesthesia was induced. The abdomen was prepped and draped and ports were placed. The gallbladder was grasped and retracted. The cystic duct and cystic artery were circumferentially dissected and a critical view was obtained. The cystic duct and cystic artery were then doubly clipped and divided and the gallbladder was dissected off the liver bed with electrocautery and placed in an endo catch bag. The gallbladder fossa and clips were examined and looked good with no evidence of bleeding or bile leak. The ports were removed under direct vision with good hemostasis. The Hasson was removed. The abdomen was desufflated. The gallbladder in its endo catch bag was removed. The ports were closed. The patient tolerated the procedure well. Please see full hospital dictation. | 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: ,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:, I had the pleasure of meeting and evaluating the patient referred today for evaluation and treatment of chronic sinusitis. As you are well aware, she is a pleasant 50-year-old female who states she started having severe sinusitis about two to three months ago with facial discomfort, nasal congestion, eye pain, and postnasal drip symptoms. She states she really has sinus problems, but this infection has been rather severe and she notes she has not had much improvement with antibiotics. She had a CT of her paranasal sinuses identifying mild mucosal thickening of right paranasal sinuses with occlusion of the ostiomeatal complex on the right and turbinate hypertrophy was also noted when I reviewed the films and there is some minimal nasal septum deviation to the left. She currently is not taking any medication for her sinuses. She also has noted that she is having some problems with her balance and possible hearing loss or at least ear popping and fullness. Her audiogram today demonstrated mild high frequency sensorineural hearing loss, normal tympanometry, and normal speech discrimination. She has tried topical nasal corticosteroid therapy without much improvement. She tried Allegra without much improvement and she believes the Allegra may have caused problems with balance to worsen. She notes her dizziness to be much worse if she does quick positional changes such as head turning or sudden movements, no ear fullness, pressure, humming, buzzing or roaring noted in her ears. She denies any previous history of sinus surgery or nasal injury. She believes she has some degree of allergy symptoms.,PAST MEDICAL HISTORY: ,Seasonal allergies, possible food allergies, chronic sinusitis, hypertension and history of weight change. She is currently 180 pounds.,PAST SURGICAL HISTORY:, Lower extremity vein stripping, tonsillectomy and adenoidectomy.,FAMILY HISTORY: , Strong for heart disease and alcoholism.,CURRENT MEDICATIONS: , DynaCirc.,ALLERGIES: , Egg-based products cause hives.,SOCIAL HISTORY: ,The patient used to smoke cigarettes for about 20 years, one-half pack a day. She currently does not, which was encouraged to continue. She rarely drinks any alcohol-containing beverages.,PHYSICAL EXAMINATION: ,VITAL SIGNS: Age 50, blood pressure is 136/74, pulse 84, temperature is 98.4, weight is 180 pounds, and height is 5 feet 3 inches.,GENERAL: The patient is healthy appearing; alert and oriented to person, place and time; responds appropriately; 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. No nystagmus.,EARS: During Hallpike examination, the patient did not become dizzy until she would be placed back into sitting in the upright position. No nystagmus was appreciated; however, the patient did subjectively report dizziness, which was repeated twice. No evidence of any orthostatic hypotension was noted during the exam. Tympanic membranes were noted to be intact. No signs of middle ear effusion or ear canal inflammation.,NOSE: The patient appears congested. Turbinate hypertrophy is noted. There are no signs of any acute sinusitis. Septum is midline, slightly deviated to the left.,THROAT: There is clear postnasal drip. Oral hygiene is good. No masses or lesions noted. Both vocal cords move well to midline.,NECK: The neck is supple with no adenopathy or masses palpated. The trachea is midline. The thyroid gland is of normal size with no nodules.,LUNGS: Clear to auscultation bilaterally. No wheeze noted.,HEART: Regular rate and rhythm. No murmur noted.,NEUROLOGIC: Facial nerve is intact bilaterally. The remaining cranial nerves are intact without focal deficit.,PROCEDURE: , Fiberoptic nasopharyngoscopy identifying turbinate hypertrophy and nasal septum deviation to the left, more significant posteriorly.,IMPRESSION: ,1. Probable increasing problems with allergic rhinitis and chronic sinusitis, both contributing to the patient's symptoms.,2. Subjective dizziness, etiology uncertain; however, consider positional vertigo versus vestibular neuronitis as possible ear causes of dizziness, cannot rule out systemic, central or medication or causes at this time.,3. Inferior turbinate hypertrophy.,4. Nasal septum deformity.,RECOMMENDATIONS:, An ENG was ordered to evaluate vestibular function. She was placed on Veramyst nasal spray two sprays each nostril daily and even twice daily if symptoms are worsening. A Medrol Dosepak was prescribed as directed. The patient was given instruction on use of nasal saline irrigation to be used twice daily and Clarinex 5 mg daily was recommended. After the patients' ENG examination, we will see the patient back for further evaluation and treatment recommendations. In light of the patient's atypical dizziness symptoms, I cannot rule out other pathology at this time, and I informed her if there are any acute changes or problems with regards to her balance or any other acute changes, which she attributes associated with her dizziness, she most likely should pursue an emergent visit to the emergency room.,Thank you for allowing me to participate with the care of your patient. | 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: , Shunt malfunction.,POSTOPERATIVE DIAGNOSIS: , Partial proximal obstruction, patent distal system.,TITLE OF OPERATION: , Endoscopic proximal and distal shunt revision with removal of old valve and insertion of new.,SPECIMENS: ,None.,COMPLICATIONS:, None.,ANESTHESIA:, General.,SKIN PREPARATION: ,Chloraprep.,INDICATIONS FOR OPERATION: , Headaches, irritability, slight increase in ventricle size. Preoperatively patient improved with Diamox.,BRIEF NARRATIVE OF OPERATIVE PROCEDURE: , After satisfactory general endotracheal tube anesthesia was administered, the patient was positioned on the operating table in the supine position with the head rotated towards the left. The right frontal area and right retroauricular area was shaved and then the head, neck, chest and abdomen were prepped and draped out in the routine manner. The old scalp incision was opened with a Colorado needle tip and the old catheter was identified as we took the Colorado needle tip over the existing ventricular catheter, right over the sleeve on top of it and when that was entered, the CSF poured out around the ventricular catheter. The ventricular catheter was then disconnected from the reservoir and endoscopically explored. We saw it was blocked up proximally. The catheter was a little adherent and required some freeing up with coagulation and on twisting of the ventricular catheter, I was able to free up the ventricular catheter, and endoscopically inserted a new Bactiseal ventricular catheter. The catheter went down to the septum and I could see both the right and left lateral ventricles and elected to pass it into the right lateral ventricle. It irrigated out well. There was minimal amount of bleeding, but not significant. The distal catheter system was tested. There was good distal run off. Therefore, a linear skin incision was made in the retroauricular area. Tunneling was performed between the two incisions and a ProGAV valve set to an opening pressure of 10 with a 1-5 shunt assist was brought through the subgaleal tissue, connected to the distal catheter and a flushing reservoir was interposed between the burr hole site ventricular catheter and the ProGAV valve. All connections were secured with 2-0 Ethibond sutures. Careful attention was made to make sure that the ProGAV was in the right orientation. The wounds were irrigated out with Bacitracin, closed in a routine manner using Vicryl for the deep layers and Monocryl for the skin, followed by Mastisol and Steri-Strips. The patient tolerated the procedure well. He was awakened, extubated and taken to 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' | CC: ,Headache.,HX:, This 51 y/o RHM was moving furniture several days prior to presentation when he struck his head (vertex) against a door panel. He then stepped back and struck his back on a trailer hitch. There was no associated LOC but he felt "dazed." He complained a HA since the accident. The following day he began experiencing episodic vertigo lasting several minutes with associated nausea and vomiting. He has been lying in bed most of the time since the accident. He also complained of transient left lower extremity weakness. The night before admission he went to his bedroom and his girlfriend heard a loud noise. She found him on the floor unable to speak or move his left side well. He was taken to a local ER. In the ER experienced a spell in which he stared to the right for approximately one minute. During this time he was unable to speak and did not seem to comprehend verbal questions. This resolved. ER staff noted decreased left sided movement and a left Babinski sign.,He was given valium 5 mg, and DPH 1.0g. A HCT was performed and he was transferred to UIHC.,PMH:, DM, Coronary Artery Disease, Left femoral neuropathy of unknown etiology. Multiple head trauma in past (?falls/fights).,MEDS:, unknown oral med for DM.,SHX:, 10+pack-year h/o Tobacco use; quit 2 years ago. 6-pack beer/week. No h/o illicit drug use.,FHX:, unknown.,EXAM: ,70BPM, BP144/83, 16RPM, 36.0C,MS: Alert and oriented to person, place, time. Fluent speech.,CN: left lower facial weakness with right gaze preference. Pupils 3/3 decreasing to 2/2 on exposure to light. Optic disks flat.,MOTOR: decreased spontaneous movement of left-sided extremities. 5/4 strength in both upper and lower extremities. Normal muscle tone and bulk.,SENSORY: withdrew equally to noxious stimulation in all four extremities. GAIT/STATION/COORDINATION: not tested.,The general physical exam was unremarkable.,During the exam the patient experienced a spell during which his head turned and eyes deviated to the leftward, and his right hand twitched. The entire spell lasted one minute.,During the episode he was verbally unresponsive. He appeared groggy and lethargic after the event.,HCT without contrast: 11/18/92: right frontal skull fracture with associated minimal epidural hematoma and small subdural hematoma, as well as some adjacent subarachnoid blood and brain contusion.,LABS:, CBC, GS, PT/PTT were all WNL.,COURSE:, The patient was diagnosed with a right frontal SAH/contusion and post traumatic seizures. DPH was continued and he was given a Librium taper for possible alcoholic withdrawal. A neurosurgical consult was obtained. He did not receive surgical intervention and was discharged 12/1/92. Neuropsychological testing on 11/25/92 revealed: poor orientation to time or place and poor attention. Anterograde verbal and visual memory was severely impaired. Speech became mildly dysarthric when fatigued. Defective word finding. Difficulty copying 2 of 3 three dimensional figures. Recent head injury as well as a history of ETOH abuse and multiple prior head injuries probably contribute to his deficits. | 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' | TYPE OF PROCEDURE: , Esophagogastroduodenoscopy with biopsy.,PREOPERATIVE DIAGNOSIS:, Abdominal pain.,POSTOPERATIVE DIAGNOSIS:, Normal endoscopy.,PREMEDICATION: , Fentanyl 125 mcg IV, Versed 8 mg IV.,INDICATIONS: ,This healthy 28-year-old woman has had biliary colic-type symptoms for the past 3-1/2 weeks, characterized by severe pain, and brought on by eating greasy foods. She has had similar episodes couple of years ago and was told, at one point, that she had gallstones, but after her pregnancy, a repeat ultrasound was done, and apparently was normal, and nothing was done at that time. She was evaluated in the emergency department recently, when she developed this recurrent pain, and laboratory studies were unrevealing. Ultrasound was normal and a HIDA scan was done, which showed a low normal ejection fraction of 40%, and moderate reproduction of her pain. Endoscopy was requested to make sure there is not upper GI source of her pain before considering cholecystectomy.,PROCEDURE: , The patient was premedicated and the Olympus GIF 160 video endoscope advanced to the distal duodenum. Gastric biopsies were taken to rule out Helicobacter and the procedure was completed without complication.,IMPRESSION: ,Normal endoscopy.,PLAN: , Refer to a general surgeon for consideration of cholecystectomy. | 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 DIAGNOSES,1. Empyema thoracis.,2. Need for intravenous antibiotics.,POSTOPERATIVE DIAGNOSES,1. Empyema thoracis.,2. Need for intravenous antibiotics.,PROCEDURE:, Central line insertion.,DESCRIPTION OF PROCEDURE: , With the patient in his room, after obtaining the informed consent, his left deltopectoral area was prepped and draped in the usual fashion. Xylocaine 1% was infiltrated and with the patient in the Trendelenburg position, the left subclavian vein was subcutaneously cannulated without any difficulty. The triple-lumen catheter was inserted and all ports were flushed out and were irrigated with normal saline. The catheter was fixed to the skin with sutures. The dressing was applied and then the chest x-ray was obtained which showed no complications of the procedure and good position of the catheter. | 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' | INDICATION:, Coronary artery disease, severe aortic stenosis by echo.,PROCEDURE PERFORMED:,1. Left heart catheterization.,2. Right heart catheterization.,3. Selective coronary angiography.,PROCEDURE: , The patient was explained about all the risks, benefits and alternatives to the procedure. The patient agreed to proceed and informed consent was signed.,Both groins were prepped and draped in usual sterile fashion. After local anesthesia with 2% lidocaine, 6-French sheath was inserted in the right femoral artery and 7-French sheath was inserted in the right femoral vein. Then right heart cath was performed using 7-French Swan-Ganz catheter. Catheter was placed in the pulmonary capillary wedge position. Pulmonary capillary wedge pressure, PA pressure was obtained, cardiac output was obtained, then RV, RA pressures were obtained. The right heart catheter _______ pulled out. Then selective coronary angiography was performed using 6-French JL4 and 6-French 3DRC catheter. Then attempt was made to cross the aortic valve with 6-French pigtail catheter, but it was unsuccessful. After the procedure, catheters were pulled out, sheath was pulled out and hemostasis was obtained by manual pressure. The patient tolerated the procedure well. There were no complications.,HEMODYNAMICS:,1. Cardiac output was 4.9 per liter per minute. Pulmonary capillary wedge pressure, mean was 7, PA pressure was 20/14, RV 26/5, RA mean pressure was 5.,2. Coronary angiography, left main is calcified _______ dense complex.,3. LAD proximal 70% calcified stenosis present and patent stent to the mid LAD and diagonal 1 is a moderate-size vessel, has 70% stenosis. Left circumflex has diffuse luminal irregularities. OM1 has 70% stenosis, is a moderate-size vessel. Right coronary is dominant and has minimal luminal irregularities.,SUMMARY: , Three-vessel coronary artery disease with aortic stenosis by echo with normal pulmonary artery systolic pressure.,RECOMMENDATION: , Aortic valve replacement with coronary artery bypass surgery. | 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' | CC:, Headache and diplopia.,HX:, This 39 y/o African American female began experiencing severe constant pressure pain type headaches beginning the last week of 8/95. The pain localized to bifronto-temporal regions of the head and did not radiate. There was no associated nausea, vomiting, photophobia or phonophobia. The HA's occurred daily; and throughout daylight hours. They diminished at bedtime, but occasionally awakened her in the morning.,Several days following the onset of her HA's, she began experiencing numbness and tingling about the right side of her face. These symptoms improved, but did not completely resolved.,Several days after the onset of facial paresthesias, she began to experience binocular horizontal diplopia. The diplopia resolved when covering either eye, and worsened upon looking toward the right. Coincidentally, she began veering toward the right when walking. She denied any weakness. She had had chronic unsteadiness for many years since developing juvenile rheumatoid arthritis. She was unsure whether her unsteadiness was due to poor depth perception in light of her diplopia.,The patient was admitted locally 9/2/95. HCT, 9/2/95 and Brain MRI with gadolinium, 9/3/95, were "unremarkable." Lumbar puncture (done locally),9/3/95: Opening pressure 27cm H20, CSF analysis ( protein 14.0, glucose 66, O WBC, 3 RBC, VDRL non-reactive, Lyme titer unremarkable, Myelin basic protein 1.0 (normal <4.0), and there was no evidence of oligoclonal bands. ESR=76. On 9/11/95 ESR=110. Acetylcholine receptor binding and blocking antibodies were negative. 9/4/95, ANA and RF were negative. 7/94, ANA and RF were negative, and ESR=60.,MEDS: ,Tylenol 500mg q5-6hrs. No known Allergies.,PMH:, 1)Juvenile Rheumatoid Arthritis diagnosed at age 10 years; now in remission. 2)Right #5 finger reattachment as child due to traumatic amputation.,FHX: ,Mother died age 42 of unknown type cancer. Father died age 62 of unknown type cancer. 4 sisters, one brother and 2 half-brothers. One of the half-brothers has asthma.,SHX: ,Single, lives with sister, and denies Tobacco/ETOH/illicit drug use.,EXAM:, BP141/84, HR99, RR14, 36.8C, Wt. 82kg Ht. 152.,MS: A&O to person, place, time. Speech fluent; without dysarthria. Mood euthymic with appropriate affect.,CN: Decreased abduction, OD. In neutral gaze, the right eye deviated slightly lateral of midline. In addition, she had mild proptosis, OD. The right eye was nontender to palpation during extraocular movement. Visual fields were full to confrontation. Optic disks appeared flat. Face was symmetric with full movement and sensation. Gag, shoulder shrug and corneal responses were intact, bilaterally. Tongue was midline with full ROM.,MOTOR: 5/5 strength throughout with normal muscle bulk and tone.,SENSORY: Unremarkable.,COORD: Unremarkable FNF/HKS/RAM.,STATION: Unremarkable. NO Romberg's sign or drift.,GAIT: Narrow based gait. Able to TT and HW without difficulty. Mild difficulty with TW.,REFLEXES: 2+/2+ Throughout all 4 extremities. Flexor plantar responses, bilaterally.,Musculoskeletal: Swan neck deformities of the #2 and #3 digits of both hands.,GEN EXAM: unremarkable, except for obvious sign of right finger reattachment (mentioned above).,COURSE: ,Repeat lumbar puncture yielded: Opening pressure 20.25cm H20, protein 22, glucose 62, 2RBC, 1WBC. CSF cytology, ACE, cultures (bacterial, fungal, AFB), gram stain, cryptococcal antigen, and VDRL were negative. Serum ACE, TSH, FT4 were unremarkable.,Neuroophthalmology confirmed her right CN6 palsy and proptosis (OD); and noted her complaint of paresthesias in the V1 and V2 distribution. They saw no evidence of papilledema. Visual field testing was unremarkable. MRI Brain/orbit/neck with gadolinium, 10/20/95, revealed abnormal enhancing signal in the right cavernous sinus and sinus mucosal thickening in both maxillary sinuses/ethmoid sinuses/frontal sinuses. CXR, 10/20/95, showed a lobulated mass arising from the right hilum. The mass appeared to obstruct the right middle lobe, causing partial collapse of this lobe. Chest CT with contrast, 10/23/95, revealed a 3.2x4.5x4.0cm mass in the right hilar region with impingement on the right lower bronchus. There appeared to be calcification as well as low attenuation regions within the mass. No lymphadenopathy was noted. She underwent bronchoscopy with bronchial brushing and transbronchial aspirate of the right lung on 10/24/95: no tumor cells were identified, GMS stains were negative and there was no evidence of viral changes, fungus or PCP by culture or molecular assay. She underwent right maxillary sinus biopsy and right middle lobe wedge resection and lymph node biopsy on 11/2/95: Caseating granulomatous inflammation with associated inflammatory pseudotumor was found in both sinus and lung biopsy specimens. No sign of cancer was found. Tissue cultures (bacterial, fungal, AFB) were negative times 3. The patients case was discussed at Head and Neck Oncology Tumor Board and a differential diagnosis of Sarcoidosis, Histoplasmosis, Wegener's Granulomatosis, were considered. Urine Histoplasmosis Antigen testing on 11/8/95 was 0.9units (normal<1.0): repeat testing on 12/13/95 was 0.8units. ANCA serum titers on 11/8/95 were <1:40 (normal). PPD testing was negative 11/95 (with positive candida and mumps controls).,The etiology of this patient's illness was not discovered. She was last seen 4/96 and her diplopia and right CN6 palsy had moderately improved. | 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. Cervical spondylosis with myelopathy.,2. Herniated cervical disk, C4-C5.,POSTOPERATIVE DIAGNOSES,1. Cervical spondylosis with myelopathy.,2. Herniated cervical disk, C4-C5.,OPERATIONS PERFORMED,1. Anterior cervical discectomy and removal of herniated disk and osteophytes and decompression of spinal cord at C5-C6.,2. Bilateral C6 nerve root decompression.,3. Anterior cervical discectomy at C4-C5 with removal of herniated disk and osteophytes and decompression of spinal cord.,4. Bilateral C5 nerve root decompression.,5. Anterior cervical discectomy at C3-C4 with removal of herniated disk and osteophytes, and decompression of spinal cord.,6. Bilateral C4 nerve root decompression.,7. Harvesting of autologous bone from the vertebral bodies.,8. Grafting of allograft bone for creation of arthrodesis.,9. Creation of arthrodesis with allograft bone and autologous bone from the vertebral bodies and bone morphogenetic protein at C5-C6.,10. Creation of additional arthrodesis using allograft bone and autologous bone from the vertebral bodies and bone morphogenetic protein at C4-C5.,11. Creation of additional arthrodesis using allograft bone and autologous bone from the vertebral bodies and bone morphogenetic protein at C3-C4.,12. Placement of anterior spinal instrumentation from C3 to C6 using a Synthes Small Stature Plate, using the operating microscope and microdissection technique.,INDICATIONS FOR PROCEDURE: , This 62-year-old man has severe cervical spondylosis with myelopathy and cord compression at C5-C6. There was a herniated disk with cord compression and radiculopathy at C4-C5. C3-C4 was the source of neck pain as documented by facet injections.,A detailed discussion ensued with the patient as to the pros and cons of the surgery by two levels versus three levels. Because of the severe component of the neck pain that has been relieved with facet injections, we elected to proceed ahead with anterior cervical discectomy and fusion at C3-C4, C4-C5, and C5-C6.,I explained the nature of this procedure in great detail including all risks and alternatives. He clearly understands and has no further questions and requests that I proceed.,PROCEDURE: ,The patient was placed on the operating room table and was intubated taking great care to keep the neck in a neutral position. The methylprednisolone spinal cord protocol was instituted with bolus and continuous infusion dosages.,The left side of the neck was carefully prepped and draped in the usual sterile manner.,A transverse incision was made in the neck crease. Dissection was carried down through the platysma musculature and the anterior spine was exposed. The medial borders of the longus colli muscle were dissected free from their attachments to the spine. Caspar self-retaining pins were placed into the bodies of C3, C4, C5, and C6 and x-ray localization was obtained. A needle was placed in what was revealed to be the disk space at C4-C5 and an x-ray confirmed proper localization.,Self-retaining retractors were then placed in the wound, taking great care to keep the blades of the retractors underneath the longus colli muscles.,First I removed the large amount of anterior overhanging osteophytes at C5-C6 and distracted the space. The high-speed cutting bur was used to drill back the osteophytes towards the posterior lips of the vertebral bodies.,An incision was then made at C4-C5 and the annulus was incised and a discectomy was performed back to the posterior lips of the vertebral bodies.,The retractors were then adjusted and again discectomy was performed at C3-C4 back to the posterior lips of the vertebral bodies. The operating microscope was then utilized.,Working under magnification, I started at C3-C4 and began to work my way down to the posterior longitudinal ligament. The ligament was incised and the underlying dura was exposed. I worked out laterally towards the takeoff of the C4 nerve root and widely decompressed the nerve root edge of the foramen. There were a large number of veins overlying the nerve root which were oozing and rather than remove these and produce tremendous amount of bleeding, I left them intact. However, I could to palpate the nerve root along the pedicle into the foramen and widely decompressed it on the right. The microscope was angled to the left side where similar decompression was achieved.,The retractors were readjusted and attention was turned to C4-C5. I worked down through bony osteophytes and identified the posterior longitudinal ligament. The ligament was incised; and as I worked to the right of the midline, I encountered herniated disk material which was removed in a number of large pieces. The C5 root was exposed and then widely decompressed until I was flush with the pedicle and into the foramen. The root had a somewhat high takeoff but I worked to expose the axilla and widely decompressed it. Again the microscope was angled to the left side where similar decompression was achieved. Central decompression was achieved here where there was a moderate amount of spinal cord compression. This was removed by undercutting with 1 and 2-mm Cloward punches.,Attention was then turned to the C5-C6 space. Here there were large osteophytes projecting posteriorly against the cord. I slowly and carefully used the high-speed cutting diamond bur to drill these and then used 1 to 2-mm Cloward punches to widely decompress the spinal cord. This necessitated undercutting the bodies of both C5 and C6 extensively, but I was then able to achieve a good decompression of the cord. I exposed the C6 root and widely decompressed it until I was flush with the pedicle and into the foramen on the right. The microscope was angled to the left side where a similar decompression was achieved.,Attention was then turned to creation of the arthrodesis. A high-speed Cornerstone bur was used to decorticate the bodies of C5-C6, C4-C5 and C3-C4 to create a posterior shelf to prevent backwards graft migration. Bone dust during the drilling was harvested for later use.,Attention was turned to creation of the arthrodesis. Using the various Synthes sizers, I selected a 7-mm lordotic graft at C5-C6 and an 8-mm lordotic graft at C4-C5 and a 9-mm lordotic graft at C3-C4. Each graft was filled with autologous bone from the vertebral bodies and bone morphogenetic protein soaked sponge. I decided to use BMP in this case because there were three levels of fusion and because this patient has a very heavy history of smoking and having just recently discontinued for two weeks. The BMP sponge and the ____________ bone were then packed in the center of the allograft.,Under distraction, the graft was placed at C3-C4, C4-C5, and C5-C6 as described. An x-ray was obtained which showed good graft placement with preservation of the cervical lordosis.,Attention was turned to the placement of anterior spinal instrumentation. Various sizes of Synthes plates were selected until I decided that a 54-mm plate was appropriate. The plate had to be somewhat contoured and bent inferiorly and the vertebral bodies had to be drilled so that the plates would sit flush. The holes were drilled and the screws were placed. Eight screws were placed with two screws at C3, two screws at C4, two screws at C5, and two screws at C6. All eight screws had good purchase. The locking screws were tightly applied. An x-ray was obtained which showed good placement of the graft, plate, and screws.,Attention was turned to closure. The wound was copiously irrigated with Bacitracin solution and meticulous hemostasis was obtained. A medium Hemovac drain was placed in the anterior vertebral body space and brought out through a separate stab incision in the skin. The wound was then carefully closed in layers. Sterile dressings were applied, and the operation was terminated.,The patient tolerated the procedure well and left for the recovery room in excellent condition. The sponge and needle counts were reported as correct. There were no intraoperative complications.,Specimens were sent to Pathology consisting of disk material and bone and soft tissue. | 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: , Left canal cholesteatoma.,POSTOPERATIVE DIAGNOSIS: , Left canal cholesteatoma.,OPERATIVE PROCEDURE:,1. Left canal wall down tympanomastoidectomy with ossicular chain reconstruction.,2. Microdissection.,3. NIM facial nerve monitoring for three hours.,COMPLICATIONS: ,None.,FINDINGS:, There is an extremely large canal cholesteatoma, which eroded most of the posterior and superior canal wall. There was a significant amount of myringosclerosis and tympanosclerosis. There is some mild erosion of the lenticular process of the incus. The facial nerve was normal. We removed the incus, removed the head of the malleus, and placed a titanium-PORP from the stapes capitulum to a cartilage graft.,PROCEDURE: , The patient was taken to the operating room, placed under general anesthetic and intubated without difficulty. The NIM facial nerve monitoring electrodes were positioned and monitoring was performed throughout the procedure. There was no abnormal activity during this case. We inspected the ear canal, identified the huge defect, which was completely filled with cerumen. Through the ear canal, we removed as much as we could and then infiltrated the canal and postauricular area with 1:100,000 of epinephrine.,We prepped and draped the ear in a sterile fashion. We reopened the previously used postauricular incision and dissected down the mastoid cortex. We reflected the soft tissues anteriorly to the level of the ear canal and identified where the ear canal skin entered the defect in the mastoid bone. A #6 cutting bur was used to drill down the mastoid cortex and identified this cholesteatoma which was then carefully dissected out. We went all the way to the mastoid antrum. We finished a complete mastoidectomy with identification of the tegmen, sigmoid sinus. We removed the lateral aspect of the mastoid tip. We lowered the facial ridge. The incudostapedial joint was already membranous in nature, we went ahead and used the joint knife and removed the incus. We separated the incus from the stapes and then removed it. We used a malleus head nipper to remove the head of the malleus and then we continued to saucerize the entire mastoid cavity.,There was no cholesteatoma within the middle ear space, but there was roughly 40% surface area perforation. The remaining portion of the tympanic membrane was extremely calcified and myringosclerotic; this was removed. There was also a large focus of tympanosclerosis between the stapes crura, which was impinging the ability of the stapes to move. We carefully dissected this out. This did seem to improve the mobility of the stapes somewhat. At this point, there was a near total perforation. There was only a minimal amount of anterior remnant of the drum left. We tried to go ahead and harvest the temporalis fascia, but there was really only wisps of this fascia in place. He had already had a previous tympanoplasty, but even outside the areas where the graft was taken, the temporalis muscle was quite atrophied and lumpy, and I suspect this was due to his chronic disease and long history of corticosteroid usage. We harvested a few pieces as best as we could. We went ahead and did a meatoplasty by making a canal incision in the 6 o'clock and 12 o'clock positions. We excised cartilage posteriorly and inferiorly to enlarge the meatus. This cartilage was thin and used for cartilage tympanoplasty. We placed some Gelfoam in the middle ear space and placed the cartilage on the top of it. We did cut a titanium-PORP of the proper side and placed on top of the stapes capitulum to interface with the cartilage cap. A few other small pieces of temporalis fascia were used to bulge through the surrounding edges of the cartilage and make sure that it was medial to any remnant of ear canal and tympanic membrane remnants. We placed a layer of Gelfoam lateral to the graft, closed the postauricular incision in layers and put 2 Merocel packs in the ear. Glasscock dressing was applied. The patient was awakened from anesthesia and taken to the recovery room in stable condition. He will be given antibiotics and pain medicines and he will be given instructions to follow up with me in one week. | 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' | IDENTIFYING DATA:, Psychosis.,HISTORY OF PRESENT ILLNESS: , The patient is a 28-year-old Samoan female who was her grandmother's caretaker. Her grandmother unfortunately had passed away recently and then the patient had developed erratic behavior. She had lived with her parents and son, but parents removed son from the home, secondary to the patient's erratic behavior. Recently, she was picked up by Kent Police Department "leaping on Highway 99.",PAST MEDICAL HISTORY: , PTSD, depression, and substance abuse.,PAST SURGICAL HISTORY: ,Unknown.,ALLERGIES:, Unknown.,MEDICATIONS: , Unknown.,REVIEW OF SYSTEMS: , Unable to obtain secondary to the patient being in seclusion.,OBJECTIVE:, Vital signs that were previously taken revealed a blood pressure of 152/86, pulse of 106, respirations of 18, and temperature is 97.6 degrees Fahrenheit. General appearance, HEENT, and history and physical examination was unable to be obtained today, as patient was put into seclusion.,LABORATORY DATA: , Laboratory reviewed reveals a BMP, slightly elevated glucose at 100.2. Previous urine tox was positive for THC. Urinalysis was negative, but did note positive UA wbc's. CBC, slightly elevated leukocytosis at 12.0, normal range is 4 to 11.,ASSESSMENT AND PLAN:,AXIS I: Psychosis. Inpatient Psychiatric Team to follow.,AXIS II: Deferred.,AXIS III: We were unable to perform physical examination on the patient today secondary to her being in seclusion. Laboratory was reviewed revealing leukocytosis, possibly secondary to a UTI. We will wait until the patient is out of seclusion to perform examination. Should she have some complaints of dysuria or any suprapubic pain, then we will begin on appropriate antimicrobial therapy. We will followup with the patient should any new medical issues arise. | Psychiatry / Psychology |
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: , Post infarct angina.,TYPE OF PROCEDURE: , Left cardiac catheterization with selective right and left coronary angiography.,PROCEDURE: , After informed consent was obtained, the patient was brought to the Cardiac Catheterization Laboratory, and the groin was prepped in the usual fashion. Using 1% lidocaine, the right groin was infiltrated, and using the Seldinger technique, the right femoral artery was cannulated. Through this, a moveable guidewire was then advance to the level of the diaphragm, and through it, a 6 French pigtail catheter was advanced under hemodynamic monitoring to the ascending aorta and inserted into the left ventricle. Pressure measurements were obtained and cineangiograms in the RAO and LAO positions were then obtained. Catheter was then withdrawn and a #6 French non-bleed-back sidearm sheath was then introduced, and through this, a 6 French Judkins left coronary catheter was then advanced under hemodynamic monitoring to the left coronary ostium, engaged. Cineangiograms were obtained of the left coronary system. This catheter was then exchanged for a Judkins right 4 coronary catheter of similar dimension and under hemodynamic monitoring again was advanced to the right coronary ostium, engaged. Cineangiograms were obtained, and the catheter and sheath were then withdrawn. The patient tolerated the procedure well and left the Cardiac Catheterization Laboratory in stable condition. No evidence of hematoma formation or active bleeding. ,COMPLICATIONS: , None. ,TOTAL CONTRAST: , 110 cc of Hexabrix. ,TOTAL FLUOROSCOPY TIME: ,1.8 minutes. ,MEDICATIONS: , Reglan 10 mg p.o., 5 mg p.o. Valium, Benadryl 50 mg p.o. and heparin 3,000 units IV push. | 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: , Left distal ureteral stone.,POSTOPERATIVE DIAGNOSIS: , Left distal ureteral stone.,PROCEDURE PERFORMED: , Cystopyelogram, left ureteroscopy, laser lithotripsy, stone basket extraction, stent exchange with a string attached.,ANESTHESIA:, LMA.,EBL: , Minimal.,FLUIDS: , Crystalloid. The patient was given antibiotics, 1 g of Ancef and the patient was on oral antibiotics at home.,BRIEF HISTORY: , The patient is a 61-year-old female with history of recurrent uroseptic stones. The patient had stones x2, 1 was already removed, second one came down, had recurrent episode of sepsis, stent was placed. Options were given such as watchful waiting, laser lithotripsy, shockwave lithotripsy etc. Risks of anesthesia, bleeding, infection, pain, need for stent, and removal of the stent were discussed. The patient understood and wanted to proceed with the procedure.,DETAILS OF THE PROCEDURE: , The patient was brought to the OR. Anesthesia was applied. The patient was placed in dorsal lithotomy position. The patient was prepped and draped in usual sterile fashion. A 0.035 glidewire was placed in the left system. Using graspers, left-sided stent was removed. A semirigid ureteroscopy was done. A stone was visualized in the mid to upper ureter. Using laser, the stone was broken into 5 to 6 small pieces. Using basket extraction, all the pieces were removed. Ureteroscopy all the way up to the UPJ was done, which was negative. There were no further stones. Using pyelograms, the rest of the system appeared normal. The entire ureter on the left side was open and patent. There were no further stones. Due to the edema and the surgery, plan was to leave the stent attached to the string and the patient was to pull the string in about 24 hours. Over the 0.035 glidewire, a 26 double-J stent was placed. There was a nice curl in the kidney and one in the bladder. The patient tolerated the procedure well. Please note that the string was kept in place and the patient was to remove the stent the next day. The patient's family was instructed how to do so. The patient had antibiotics and pain medications at home. The patient was brought to recovery room in a 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' | CC:, Weakness.,HX:, This 30 y/o RHM was in good health until 7/93, when he began experiencing RUE weakness and neck pain. He was initially treated by a chiropractor and, after an unspecified length of time, developed atrophy and contractures of his right hand. He then went to a local neurosurgeon and a cervical spine CT scan, 9/25/92, revealed an intramedullary lesion at C2-3 and an extramedullary lesion at C6-7. He underwent a C6-T1 laminectomy with exploration and decompression of the spinal cord. His clinical condition improved over a 3 month post-operative period, and then progressively worsened. He developed left sided paresthesia and upper extremity weakness (right worse than left). He then developed ataxia, nausea, vomiting, and hyperreflexia. On 8/31/93, MRI C-spine showed diffuse enlargement of the cervical and thoracic spine and multiple enhancing nodules in the posterior fossa. On 9/1/93, he underwent suboccipital craniotomy with tumor excision, decompression, and biopsy which was consistent with hemangioblastoma. His symptoms stabilized and he underwent 5040 cGy in 28 fractions to his brain and 3600 cGy in 20 fractions to his cervical and thoracic spinal cord from 9/93 through 1/19/94.,He was evaluated in the NeuroOncology clinic on 10/26/95 for consideration of chemotherapy. He complained of progressive proximal weakness of all four extremities and dysphagia. He had difficulty putting on his shirt and raising his arms, and he had been having increasing difficulty with manual dexterity (e.g. unable to feed himself with utensils). He had difficulty going down stairs, but could climb stairs. He had no bowel or bladder incontinence or retention.,MEDS:, none.,PMH:, see above.,FHX:, Father with Von Hippel-Lindau Disease.,SHX:, retired truck driver. smokes 1-3 packs of cigarettes per day, but denied alcohol use. He is divorced and has two sons who are healthy. He lives with his mother.,ROS:, noncontributory.,EXAM:, Vital signs were unremarkable.,MS: A&O to person, place and time. Speech fluent and without dysarthria. Thought process lucid and appropriate.,CN: unremarkable exept for 4+/4+ strength of the trapezeii. No retinal hemangioblastoma were seen.,MOTOR: 4-/4- strength in proximal and distal upper extremities. There is diffuse atrophy and claw-hands, bilaterally. He is unable to manipulate hads to any great extent. 4+/4+ strength throughout BLE. There is also diffuse atrophy throughout the lower extremities though not as pronounced as in the upper extremities.,SENSORY: There was a right T3 and left T8 cord levels to PP on the posterior thorax. Decreased LT in throughout the 4 extremities.,COORD: difficult to assess due to weakness.,Station: BUE pronator drift.,Gait: stands without assistance, but can only manage to walk a few steps. Spastic gait.,Reflexes: Hyperreflexic on left (3+) and Hyporeflexic on right (1). Babinski signs were present bilaterally.,Gen exam: unremarkable.,COURSE: ,9/8/95, GS normal. By 11/14/95, he required NGT feeding due to dysphagia and aspiration risk confirmed on cookie swallow studies.MRI Brain, 2/19/96, revealed several lesions (hemangioblastoma) in the cerebellum and brain stem. There were postoperative changes and a cyst in the medulla.,On 10/25/96, he presented with a 1.5 week h/o numbness in BLE from the mid- thighs to his toes, and worsening BLE weakness. He developed decubitus ulcers on his buttocks. He also had had intermittent urinary retention for month, chronic SOB and dysphagia. He had been sitting all day long as he could not move well and had no daytime assistance. His exam findings were consistent with his complaints. He had had no episodes of diaphoresis, headache, or elevated blood pressures. An MRI of the C-T spine, 10/26/96, revealed a prominent cervicothoracic syrinx extending down to T10. There was evidence of prior cervical laminectomy of C6-T1 with expansion of the cord in the thecalsac at that region. Multiple intradural extra spinal nodular lesions (hyperintense on T2, isointense on T1, enhanced gadolinium) were seen in the cervical spine and cisterna magna. The largest of which measures 1.1 x 1.0 x 2.0cm. There are also several large ring enhancing lesions in cerebellum. The lesions were felt to be consistent with hemangioblastoma. No surgical or medical intervention was initiated. Visiting nursing was provided. He has since been followed by his local physician | 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:,1. Pelvic pain.,2. Ectopic pregnancy.,POSTOPERATIVE DIAGNOSES:,1. Pelvic pain.,2. Ectopic pregnancy.,3. Hemoperitoneum.,PROCEDURES PERFORMED:,1. Dilation and curettage (D&C).,2. Laparoscopy.,3. Right salpingectomy.,4. Lysis of adhesions.,5. Evacuation of hemoperitoneum.,ANESTHESIA: , General endotracheal.,ESTIMATED BLOOD LOSS: , Scant from the operation, however, there was approximately 2 liters of clotted and old blood in the abdomen.,SPECIMENS:, Endometrial curettings and right fallopian tube.,COMPLICATIONS: , None.,FINDINGS: , On bimanual exam, the patient has a small anteverted uterus, it is freely mobile. No adnexal masses, however, were appreciated on the bimanual exam. Laparoscopically, the patient had numerous omental adhesions to the vesicouterine peritoneum in the fundus of the uterus. There were also adhesions to the left fallopian tube and the right fallopian tube. There was a copious amount of blood in the abdomen approximately 2 liters of clotted and unclotted blood. There was some questionable gestational tissue ________ on the left sacrospinous ligament. There was an apparent rupture and bleeding ectopic pregnancy in the isthmus portion of the right fallopian tube.,PROCEDURE:, After an informed consent was obtained, the patient was taken to the operating room and the general anesthetic was administered. She was then positioned in the dorsal lithotomy position and prepped and draped in the normal sterile fashion. Once the anesthetic was found to be adequate, a bimanual exam was performed under anesthetic. A weighted speculum was then placed in the vagina. The interior wall of vagina elevated with the uterine sound and the anterior lip of the cervix was grasped with the vulsellum tenaculum. The cervix was then serially dilated with Hank dilators to a size #20 Hank and then a sharp curettage was performed obtaining a moderate amount of decidual appearing tissue and the tissue was then sent to pathology. At this point, the uterine manipulator was placed in the cervix and attached to the anterior cervix and vulsellum tenaculum and weighted speculum were removed. Next, attention was then turned to the abdomen. The surgeons all are removed the dirty gloves in the previous portion of the case. Next, a 2 cm incision was made immediately inferior to umbilicus. The superior aspect of the umbilicus was grasped with a towel clamp and a Veress needle was inserted through this incision. Next, a syringe was used to inject normal saline into the Veress needle. The normal saline was seen to drop freely, so a Veress needle was connected to the CO2 gas which was started at its lowest setting. The gas was seen to flow freely with normal resistance, so the CO2 gas was advanced to a higher setting. The abdomen was insufflated to an adequate distension. Once an adequate distention was reached, the CO2 gas was disconnected. The Veress needle was removed and a size #11 step trocar was placed. The introducer was removed and the trocar was connected to the CO2 gas and a camera was inserted. Next, a 1 cm incision was made in the midline approximately two fingerbreadths below the pubic symphysis after transilluminating with the camera. A Veress needle and a step sheath were inserted through this incision. Next, the Veress needle was removed and a size #5 trocar was inserted under direct visualization. Next a size #5 port was placed approximately five fingerbreadths to the left of the umbilicus in a similar fashion. A size #12 port was placed in a similar fashion approximately six fingerbreadths to the right of the umbilicus and also under direct visualization. The laparoscopic dissector was inserted through the suprapubic port and this was used to dissect the omental adhesions bluntly from the vesicouterine peritoneum and the bilateral fallopian tubes. Next, the Dorsey suction irrigator was used to copiously irrigate the abdomen. Approximate total of 3 liters of irrigation was used and the majority of all blood clots and free blood was removed from the abdomen.,Once the majority of blood was cleaned from the abdomen, the ectopic pregnancy was easily identified and the end of the fallopian tube was grasped with the grasper from the left upper quadrant and the LigaSure device was then inserted through the right upper quadrant with # 12 port. Three bites with the LigaSure device were used to transect the mesosalpinx inferior to the fallopian tube and then transect the fallopian tube proximal to the ectopic pregnancy. An EndoCatch bag was then placed to the size #12 port and this was used to remove the right fallopian tube and ectopic pregnancy. This was then sent to the pathology. Next, the right mesosalpinx and remains of the fallopian tube were examined again and they were seemed to be hemostatic. The abdomen was further irrigated. The liver was examined and appeared to be within normal limits. At this point, the two size #5 ports and a size #12 port were removed under direct visualization. The camera was then removed. The CO2 gas was disconnected and the abdomen was desufflated. The introducer was then replaced in a size #11 port and the whole port and introducer was removed as a single unit. All laparoscopic incisions were closed with a #4-0 undyed Vicryl in a subcuticular interrupted fashion. They were then steri-stripped and bandaged appropriately. At the end of the procedure, the uterine manipulator was removed from the cervix and the patient was taken to Recovery in stable condition. The patient tolerated the procedure well. Sponge, lap, and needle counts were correct x2. She was discharged home with a postoperative hemoglobin of 8.9. She was given iron 325 mg to be taken twice a day for five months and Darvocet-N 100 mg to be taken every four to six hours for pain. She will follow up within a week in the OB resident clinic. | 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' | PRESENTATION: , A 16-year-old male presents to the emergency department (ED) with rectal bleeding and pain on defecation.,HISTORY:, A 16-year-old African American male presents to the ED with a chief complaint of rectal bleeding and pain on defecation. The patient states that he was well until about three days prior to presentation when he first started to experience some pain when defecating. The following day he noted increasing pain and first noted blood on the surface of his stool. The pain worsened on the subsequent day with increasing bleeding as well as some mucopurulent anal discharge. The patient denies any previous history of rectal bleeding or pain. He also denies any previous sexually transmitted diseases (STDs) and states that he was screened for HIV infection eight months ago and was negative. The patient does state that he has not felt well for the past week. He states that he had felt "feverish" on several occasions but has not taken his temperature. He has also complained of some abdominal discomfort with nausea and diarrhea as well as generalized myalgias and fatigue. He thinks he has lost a few pounds but has not been weighing himself to determine the exact amount of weight loss.,The patient states that he has been sexually active since age 13. He admits to eight previous partners and states that he "usually" uses a condom. On further questioning, the patient states that of his eight partners, three were female and five were male. His most recent sexual partner was a 38-year-old man whom he has been with for the past six months. He states that he has been tested for STDs in the past but states that he only gave urine and blood for the testing. He is unaware of the HIV status of his partner but assumes that the partner is uninfected because he looks healthy. The patient also admits to one episode of sexual abuse at the age of 8 by a friend of the family. As the man was a member of the family's church, the patient never felt comfortable disclosing this to any of the adults in his life. He is very concerned about disclosure of his sexual behavior to his family, as they have expressed very negative comments concerning men who have sex with men. He is accessing care in the ED unaccompanied by an adult.,PHYSICAL EXAM: , Thin but non-toxic young man with clear discomfort.,Pulse = 105,RR = 23,BP = 120/62,HEENT: Several areas of white plaque-like material on the buccal mucosa.,Neck: Multiple anterior/posterior cervical nodes in both anterior and posterior chains- 1-2 cm in diameter.,Lungs: Clear to auscultation.,Cardiac: Quiet precordium.,Nl S1/S2 with a II/VI systolic murmur. ,Abdomen: Soft without hepatosplenomegaly.,GU: Tanner V male with no external penile lesions.,Lymph: 2-3 cm axillary nodes bilaterally.,1-2 cm epitrochlear nodes.,Multiple 1-2 cm inguinal nodes.,Rectal: Extremely painful digital exam.,+ gross blood and mucous.,LABORATORY EVALUATION:,Hbg = 12. 5 gm/dL,Hct = 32%,WBC = 3.9 thou/µL,Platelets = 120,000 thou/µL,76% neutrophils,19% lymphocytes,1% eosinophils,4% monocytes,ALT = 82 U/L,AST= 90 U/L,Erythrocyte sedimentation rate = 90,Electrolytes = normal,Gram stain of anal swab: numerous WBCs,DIFFERENTIAL DIAGNOSIS: , This patient is presenting with acute rectal pain with bleeding and anal discharge. The patient also presents with some constitutional symptoms including fever, fatigue, abdominal discomfort, and adenopathy on physical examination. The following are in the differential diagnosis: Acute Proctitis and Proctocolitis.,ACUTE HIV SEROCONVERSION: , This subject is sexually active and reports inconsistent condom use. Gastrointestinal symptoms have recently been reported commonly in patients with a history of HIV seroconversion. The rectal symptoms of bleeding and pain are not common with HIV, and an alternative diagnosis would be required.,PERIRECTAL ABSCESS: , A patient with a history of receptive anal intercourse is at risk for developing a perirectal abscess either from trauma or a concurrent STD. The patient could experience more systemic symptoms with fever and malaise, as found with this patient. However, the physical examination did not reveal the typical localized area of pain and edema.,DIAGNOSIS: ,The subject had rectal cultures obtained, which were positive for Neisseria gonorrhoeae. An HIV ELISA was positive, as was the RNA PCR.,DISCUSSION: , This patient demonstrates a number of key issues to consider when caring for an adolescent or young adult. First, the patient utilized the emergency department for care as opposed to identifying a primary care provider. Although not ideal in many circumstances, testing for HIV infection is crucial when there is suspicion, since many newly diagnosed patients identify earlier contacts with health care providers when HIV counseling and testing were not performed. Second, this young man has had both male and female sexual partners. As young people explore their sexuality, asking about partners in an open, nonjudgmental manner without applying labels is integral to helping the young person discuss their sexual behaviors. Assuming heterosexuality is a major barrier to disclosure for many young people who have same-sex attractions. Third, screening for STDs must take into account sexual behaviors. Although urine-based screening has expanded testing of young people, it misses anal and pharyngeal infections. If a young person is only having receptive oral or anal intercourse, urine screening is insufficient to rule out STDs. Fourth, this young man had both localized and systemic symptoms. As his anal symptoms were most suggestive of a current STD, performing an HIV test should be part of the standard evaluation. In addition, as acute infection is on the differential diagnosis, PCR testing should also be considered. The care provided to this young man included the following. He was treated presumptively for proctitis with both IM ceftriaxone as well as oral doxycycline to treat N gonorrhoeae and C trachomatis. Ceftriaxone was chosen due to the recent reports of resistant N gonorrhoeae. At the time of the diagnosis, the young man was given the opportunity to meet with the case manager from the adolescent-specific HIV program. The case manager linked this young man directly to care after providing brief counseling and support. The case manager maintained contact with the young man until his first clinical visit four days later. Over the subsequent three months, the young man had two sets of laboratory testing to stage his HIV infection.,Set #1 CD4 T-lymphocyte count = 225 cells/mm3, 15% ,Quantitative RNA PCR = 75,000 copies/mL | 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' | SUBJECTIVE:, This is a 38-year-old female who comes for dietary consultation for gestational diabetes. Patient reports that she is scared to eat because of its impact on her blood sugars. She is actually trying not to eat while she is working third shift at Wal-Mart. Historically however, she likes to eat out with a high frequency. She enjoys eating rice as part of her meals. She is complaining of feeling fatigued and tired all the time because she works from 10 p.m. to 7 a.m. at Wal-Mart and has young children at home. She sleeps two to four hours at a time throughout the day. She has been testing for ketones first thing in the morning when she gets home from work.,OBJECTIVE:, Today's weight: 155.5 pounds. Weight from 10/07/04 was 156.7 pounds. A diet history was obtained. Blood sugar records for the last three days reveal the following: fasting blood sugars 83, 84, 87, 77; two-hour postprandial breakfast 116, 107, 97; pre-lunch 85, 108, 77; two-hour postprandial lunch 86, 131, 100; pre-supper 78, 91, 100; two-hour postprandial supper 125, 121, 161; bedtime 104, 90 and 88. I instructed the patient on dietary guidelines for gestational diabetes. The Lily Guide for Meal Planning was provided and reviewed. Additional information on gestational diabetes was applied. A sample 2000-calorie meal plan was provided with a carbohydrate budget established.,ASSESSMENT:, Patient's basal energy expenditure adjusted for obesity is estimated at 1336 calories a day. Her total calorie requirements, including a physical activity factor as well as additional calories for pregnancy, totals to 2036 calories per day. Her diet history reveals that she has somewhat irregular eating patterns. In the last 24 hours when she was working at Wal-Mart, she ate at 5 a.m. but did not eat anything prior to that since starting work at 10 p.m. We discussed the need for small frequent eating. We identified carbohydrate as the food source that contributes to the blood glucose response. We identified carbohydrate sources in the food supply, recognizing that they are all good for her. The only carbohydrates she was asked to entirely avoid would be the concentrated forms of refined sugars. In regard to use of her traditional foods of rice, I pulled out a one-third cup measuring cup to identify a 15-gram equivalent of rice. We discussed the need for moderating the portion of carbohydrates consumed at one given time. Emphasis was placed at eating with a high frequency with a goal of eating every two to four hours over the course of the day when she is awake. Her weight loss was discouraged. Patient was encouraged to eat more generously but with attention to the amount of carbohydrates consumed at a time.,PLAN:, The meal plan provided has a carbohydrate content that represents 40 percent of a 2000-calorie meal plan. The meal plan was devised to distribute her carbohydrates more evenly throughout the day. The meal plan was meant to reflect an example for her eating, while the patient was encouraged to eat according to appetite and not to go without eating for long periods of time. The meal plan is as follows: breakfast 2 carbohydrate servings, snack 1 carbohydrate serving, lunch 2-3 carbohydrate servings, snack 1 carbohydrate serving, dinner 2-3 carbohydrate servings, bedtime snack 1-2 carbohydrate servings. Recommend patient include a solid protein with each of her meals as well as with her snack that occurs before going to sleep. Encouraged adequate rest. Also recommend adequate calories to sustain weight gain of one-half to one pound per week. If the meal plan reflected does not support slow gradual weight gain, then we will need to add more foods accordingly. This was a one-hour consultation. I 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' | PREOPERATIVE DIAGNOSIS:,1. Severe chronic obstructive coronary disease.,2. Respiratory failure.,POSTOPERATIVE DIAGNOSIS:,1. Severe chronic obstructive coronary disease.,2. Respiratory failure.,OPERATION:, Right subclavian triple lumen central line placement.,ANESTHESIA: , Local Xylocaine.,INDICATIONS FOR OPERATION: ,This 50-year-old gentleman with severe respiratory failure is mechanically ventilated. He is currently requiring multiple intravenous drips, and Dr. X has kindly requested central line placement.,INFORMED CONSENT: ,The patient was unable to provide his own consent, secondary to mechanical ventilation and sedation. No available family to provide conservator ship was located either.,PROCEDURE: ,With the patient in his Intensive Care Unit bed, mechanically ventilated in the Trendelenburg position. The right neck was prepped and draped with Betadine in a sterile fashion. Single needle stick aspiration of the right subclavian vein was accomplished without difficulty, and the guide wire was advanced. The dilator was advanced over the wire. The triple lumen catheter was cannulated over the wire, and the wire then removed. No PVCs were encountered during the procedure. All three ports to the catheter aspirated and flushed blood easily, and they were all flushed with normal saline. The catheter was anchored to the chest wall with butterfly phalange using 3-0 silk suture. Betadine ointment and a sterile Op-Site dressing were applied. Stat upright chest x-ray was obtained at the completion of the procedure, and final results are pending.,FINDINGS/SPECIMENS REMOVED:, None,COMPLICATIONS:, None.,ESTIMATED BLOOD LOSS:, Nil. | 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 CONSULTATION: , Left hip fracture.,HISTORY OF PRESENT ILLNESS: , The patient is a pleasant 53-year-old female with a known history of sciatica, apparently presented to the emergency room due to severe pain in the left lower extremity and unable to bear weight. History was obtained from the patient. As per the history, she reported that she has been having back pain with left leg pain since past 4 weeks. She has been using a walker for ambulation due to disabling pain in her left thigh and lower back. She was seen by her primary care physician and was scheduled to go for MRI yesterday. However, she was walking and her right foot got caught on some type of rug leading to place excessive weight on her left lower extremity to prevent her fall. Since then, she was unable to ambulate. The patient called paramedics and was brought to the emergency room. She denied any history of fall. She reported that she stepped the wrong way causing the pain to become worse. She is complaining of severe pain in her lower extremity and back pain. Denies any tingling or numbness. Denies any neurological symptoms. Denies any bowel or bladder incontinence.,X-rays were obtained which were remarkable for left hip fracture. Orthopedic consultation was called for further evaluation and management. On further interview with the patient, it is noted that she has a history of malignant melanoma, which was diagnosed approximately 4 to 5 years ago. She underwent surgery at that time and subsequently, she was noted to have a spread to the lymphatic system and lymph nodes for which she underwent surgery in 3/2008.,PAST MEDICAL HISTORY: , Sciatica and melanoma.,PAST SURGICAL HISTORY: ,As discussed above, surgery for melanoma and hysterectomy.,ALLERGIES: , NONE.,SOCIAL HISTORY: , Denies any tobacco or alcohol use. She is divorced with 2 children. She lives with her son.,PHYSICAL EXAMINATION:,GENERAL: The patient is well developed, well nourished in mild distress secondary to left lower extremity and back pain.,MUSCULOSKELETAL: Examination of the left lower extremity, there is presence of apparent shortening and external rotation deformity. Tenderness to palpation is present. Leg rolling is positive for severe pain in the left proximal hip. Further examination of the spine is incomplete secondary to severe leg pain. She is unable to perform a straight leg raising. EHL/EDL 5/5. 2+ pulses are present distally. Calf is soft and nontender. Homans sign is negative. Sensation to light touch is intact.,IMAGING:, AP view of the hip is reviewed. Only 1 limited view is obtained. This is a poor quality x-ray with a lot of soft tissue shadow. This x-ray is significant for basicervical-type femoral neck fracture. Lesser trochanter is intact. This is a high intertrochanteric fracture/basicervical. There is presence of lytic lesion around the femoral neck, which is not well delineated on this particular x-ray. We need to order repeat x-rays including AP pelvis, femur, and knee.,LABS:, Have been reviewed.,ASSESSMENT: , The patient is a 53-year-old female with probable pathological fracture of the left proximal femur.,DISCUSSION AND PLAN: , Nature and course of the diagnosis has been discussed with the patient. Based on her presentation without any history of obvious fall or trauma and past history of malignant melanoma, this appears to be a pathological fracture of the left proximal hip. At the present time, I would recommend obtaining a bone scan and repeat x-rays, which will include AP pelvis, femur, hip including knee. She denies any pain elsewhere. She does have a past history of back pain and sciatica, but at the present time, this appears to be a metastatic bone lesion with pathological fracture. I have discussed the case with Dr. X and recommended oncology consultation.,With the above fracture and presentation, she needs a left hip hemiarthroplasty versus calcar hemiarthroplasty, cemented type. Indication, risk, and benefits of left hip hemiarthroplasty has been discussed with the patient, which includes, but not limited to bleeding, infection, nerve injury, blood vessel injury, dislocation early and late, persistent pain, leg length discrepancy, myositis ossificans, intraoperative fracture, prosthetic fracture, need for conversion to total hip replacement surgery, revision surgery, DVT, pulmonary embolism, risk of anesthesia, need for blood transfusion, and cardiac arrest. She understands above and is willing to undergo further procedure. The goal and the functional outcome have been explained. Further plan will be discussed with her once we obtain the bone scan and the radiographic studies. We will also await for the oncology feedback and clearance.,Thank you very much for allowing me to participate in the care of this patient. I will continue to follow up. | 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' | RIGHT LOWER EXTREMITY:, The arterial system was visualized showing triphasic waveform from the common femoral to popliteal and biphasic waveform at the posterior tibial artery with ankle brachial index of 0/8.,LEFT LOWER EXTREMITY:, The arterial system was visualized with triphasic waveform from the common femoral to the popliteal artery, with biphasic waveform at the posterior tibial artery. Ankle brachial index of 0.9.,IMPRESSION: , Mild bilateral lower extremity arterial obstructive disease., | 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 41-year-old white male with a history of HIV disease. His last CD4 count was 425, viral load was less than 50 in 08/07. He was recently hospitalized for left gluteal abscess, for which he underwent I&D and he has newly diagnosed diabetes mellitus. He also has a history of hypertension and hypertriglyceridemia. He had been having increased urination and thirst. He was seen in the hospital by the endocrinology staff and treated with insulin while hospitalized and getting treatment for his perirectal abscess. The endocrine team apparently felt that insulin might be best for this patient, but because of financial issues, elected to place him on Glucophage and glyburide. The patient reports that he has been taking the medication. He is in general feeling better. He says that his gluteal abscess is improving and he will be following up with Surgery today.,CURRENT MEDICATIONS:,1. Gabapentin 600 mg at night.,2. Metformin 1000 mg twice a day.,3. Glipizide 5 mg a day.,4. Flagyl 500 mg four times a day.,5. Flexeril 10 mg twice a day.,6. Paroxetine 20 mg a day.,7. Atripla one at night.,8. Clonazepam 1 mg twice a day.,9. Blood pressure medicine, name unknown.,REVIEW OF SYSTEMS:, He otherwise has a negative review of systems.,PHYSICAL EXAMINATION:,VITAL SIGNS: Temperature 36.6, blood pressure 145/90, pulse 123, respirations 20, and weight is 89.9 kg (198 pounds.) HEENT: Unremarkable except for some submandibular lymph nodes. His fundi are benign. NECK: Supple. LUNGS: Clear to auscultation and percussion. CARDIAC: Reveals regular rate and rhythm without murmur, rub or gallop. ABDOMEN: Soft and nontender without organomegaly or mass. EXTREMITIES: Show no cyanosis, clubbing or edema. GU: Examination of the perineum revealed an open left gluteal wound that appears clear with no secretions.,IMPRESSION:,1. Human immunodeficiency virus disease with stable control on Atripla.,2. Resolving left gluteal abscess, completing Flagyl.,3. Diabetes mellitus, currently on oral therapy.,4. Hypertension.,5. Depression.,6. Chronic musculoskeletal pain of unclear etiology.,PLAN: , The patient will continue his current medications. He will have laboratory studies done in 3 to 4 weeks, and we will see him a few weeks thereafter. He has been encouraged to keep his appointment with his psychologist. | 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' | CC:, Fall with questionable associated loss of consciousness.,HX: ,This 81 y/o RHM fell down 20 steps on the evening of admission, 1/10/93, while attempting to put his boots on at the top of the staircase. He was evaluated locally and was amnestic to the event at the time of examination. A HCT scan was obtained and he was transferred to UIHC, Neurosurgery.,MEDS:, Lasix 40mg qd, Zantac 150mg qd, Lanoxin 0.125mg qd, Capoten 2.5mg bid, Salsalate 750mg tid, ASA 325mg qd, "Ginsana" (Ginseng) 100mg bid.,PMH: ,1)Atrial fibrillation, 2)Right hemisphere stroke, 11/22/88, with associated left hemiparesis and amaurosis fugax. This was followed by a RCEA, 12/1/88 for 98% stenosis. The stroke symptoms/signs resolved. 3)DJD, 4)Right TKR 2-3 years ago, 5)venous stasis; with no h/o DVT, 6)former participant in NASCET, 7)TURP for BPH. No known allergies.,FHX:, Father died of an MI at unknown age, Mother died of complications of a dental procedure. He has one daughter who is healthy.,SHX:, Married. Part-time farmer. Denied tobacco/ETOH/illicit drug use.,EXAM: ,BP157/86, HR100 and irregular, RR20, 36.7C, 100%SaO2,MS: A&O to person, place, time. Speech fluent and without dysarthria.,CN: Pupils 3/3 decreasing to 2/2 on exposure to light. EOM intact. VFFTC. Optic disks were flat. Face was symmetric with symmetric movement. The remainder of the CN exam was unremarkable.,Motor: 5/5 strength throughout with normal muscle tone and bulk.,Sensory: unremarkable.,Coord: unremarkable.,Station/Gait: not mentioned in chart.,Reflexes: symmetric. Plantar responses were flexor, bilaterally.,Gen Exam: CV:IRRR without murmur. Lungs: CTA. Abdomen: NT, ND, NBS.,HEENT: abrasion over the right forehead.,Extremity: distal right leg edema/erythema (just above the ankle). tender to touch.,COURSE:, 1/10/93, (outside)HCT was reviewed, It revealed a left parietal epidural hematoma. GS, PT/PTT, UA, and CBC were unremarkable. RLE XR revealed a fracture of the right lateral malleolus for which he was casted. Repeat HCTs showed no change in the epidural hematoma and he was discharged home on DPH. | 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' | Dear Sample Doctor:,Thank you for referring Mr. Sample Patient for cardiac evaluation. This is a 67-year-old, obese male who has a history of therapy-controlled hypertension, borderline diabetes, and obesity. He has a family history of coronary heart disease but denies any symptoms of angina pectoris or effort intolerance. Specifically, no chest discomfort of any kind, no dyspnea on exertion unless extreme exertion is performed, no orthopnea or PND. He is known to have a mother with coronary heart disease. He has never been a smoker. He has never had a syncopal episode, MI, or CVA. He had his gallbladder removed. No bleeding tendencies. No history of DVT or pulmonary embolism. The patient is retired, rarely consumes alcohol and consumes coffee moderately. He apparently has a sleep disorder, according to his wife (not in the office), the patient snores and stops breathing during sleep. He is allergic to codeine and aspirin (angioedema).,Physical exam revealed a middle-aged man weighing 283 pounds for a height of 5 feet 11 inches. His heart rate was 98 beats per minute and regular. His blood pressure was 140/80 mmHg in the right arm in a sitting position and 150/80 mmHg in a standing position. He is in no distress. Venous pressure is normal. Carotid pulsations are normal without bruits. The lungs are clear. Cardiac exam was normal. The abdomen was obese and organomegaly was not palpated. There were no pulsatile masses or bruits. The femoral pulses were 3+ in character with a symmetrical distribution and dorsalis pedis and posterior tibiales were 3+ in character. There was no peripheral edema. ,He had a chemistry profile, which suggests diabetes mellitus with a fasting blood sugar of 136 mg/dl. Renal function was normal. His lipid profile showed a slight increase in triglycerides with normal total cholesterol and HDL and an acceptable range of LDL. His sodium was a little bit increased. His A1c hemoglobin was increased. He had a spirometry, which was reported as normal. ,He had a resting electrocardiogram on December 20, 2002, which was also normal. He had a treadmill Cardiolite, which was performed only to stage 2 and was terminated by the supervising physician when the patient achieved 90% of the predicted maximum heart rate. There were no symptoms or ischemia by EKG. There was some suggestion of inferior wall ischemia with normal wall motion by Cardiolite imaging.,In summary, we have a 67-year-old gentleman with risk factors for coronary heart disease. I am concerned with possible diabetes and a likely metabolic syndrome of this gentleman with truncal obesity, hypertension, possible insulin resistance, and some degree of fasting hyperglycemia, as well as slight triglyceride elevation. He denies any symptoms of coronary heart disease, but he probably has some degree of coronary atherosclerosis, possibly affecting the inferior wall by functional testings. ,In view of the absence of symptoms, medical therapy is indicated at the present time, with very aggressive risk factor modification. I explained and discussed extensively with the patient, the benefits of regular exercise and a walking program was given to the patient. He also should start aggressively losing weight. I have requested additional testing today, which will include an apolipoprotein B, LPa lipoprotein, as well as homocystine, and cardio CRP to further assess his risk of atherosclerosis. ,In terms of medication, I have changed his verapamil for a long acting beta-blocker, he should continue on an ACE inhibitor and his Plavix. The patient is allergic to aspirin. I also will probably start him on a statin, if any of the studies that I have recommended come back abnormal and furthermore, if he is confirmed to have diabetes. Along this line, perhaps, we should consider obtaining the advice of an endocrinologist to decide whether this gentleman needs treatment for diabetes, which I believe he should. This, however, I will leave entirely up to you to decide. If indeed, he is considered to be a diabetic, a much more aggressive program should be entertained for reducing the risks of atherosclerosis in general, and coronary artery disease in particular.,I do not find an indication at this point in time to proceed with any further testing, such as coronary angiography, in the absence of symptoms.,If you have any further questions, please do not hesitate to let me know.,Thank you once again for this kind referral.,Sincerely,,Sample Doctor, M.D. | Letters |
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